AF - 46341Caty of Fridley, Minn.
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BUILDING PERMIT N� 5199
Date: "" "' ,��► � ,,:,-*�, e
Owner. .�������"',r' . �`=,r"''��—ea�» Builder , � --
Address ,��� %�-��� ,_.�,�+�;� # Address °'� .�! --
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,,,, COCATIO OF BUILDIIo�G
.
No. .,.��� �Street '�'-�r� a ..t.�._.._..�_ Part of ----.._..�. �-•-. .
Lot ��..__ Block __..+_.� ._..... Addition or Sub� ' _ ..,� --� -. -�{�'
Corner Lot � Inside Lot —�"'�stback Sideyard �..� �� �—
Sewer IIevation � — Fo dation IIeval3on _
DESCRIPTION OP BUILDING
T . F'ront �� Depth i�'T- Height � Sq. Ft �.,,;f�' Ca. Ft �"'"
Front Depth _._.. Height � Sq. F� Cu. Ft _
� of Construction ..�� Est Cost _.: . � ix Completed �
� � ��M�
In consideration of the isauance to me of a permit to constrvet the buildiag described above, I agree to do
the proposed work 3n accordance with the description above set forth and in com�liance with all provisiona of
ordinances of the city of Fridley.
�
In consideration of �the payment of a fee of �---., permit is hereby granted to—
to construct the bwllding or addition as described above. This permit is granted upan
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
FrYdley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildinga
within the dty ]imSts and this permit may be revoked at any t3me upon viola.tion c�f any of the pmvisions of safd
ordinanc�s. h�
'"'� Building Inspector
��
NOTICE;
Thb peneif doei not eovsr the eeesfrueHon, installaHoe fo� wiring, plumbing, gas heaNeg, sewer o� watee. Be sure to sas
fhs Buildiee Intpsetor for ssparafe permRs for thete itanu.
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APPLICATION FOR BIIILDIlVG P�MIT
CITY OF FRIDI�Y, M�NNESa�g
owner �8 Name����GL �. �L v�3 5 s �y Bu3lder
�ddresa S � / � %��/e, � Z��' l�J � ° &ldress
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�. IACATTON BIISLDIlVG
No. `7�E `� 3treet �' Part of Lot
Lot � 81ock „� 14cldition or Subdiv3sion 5�;�;T �'������`�
Corner Lot _„_„_,_Inside Lot Setbaak S3de-Yard
SEtniER ELEVATTON FOUNDATION ELEVATT�N
�pplicant attach to tbis form Certific:a.te of Survey o� Lot a,nd propoaed building
loca.tion.
DESCRIPTION OF BIIIIAING
To be used es:
�L� � >c � �/ � �/�rz ��, -� Front � `/ � Depth�
Sq. Ft. 5%� Cu. Ft. �� � L� �
Front___ Depth Height
�q. gt. Cu. Ft.
Type of Conatruation �r�'�. ��l -� Eati�.ted Cos�„�� 5� �_
To be Comp�eted ��
The tandersigned hereby makes appl3cation for a permit far the work herein spec3fied,
agreeing �o do all work in strict accordance with the C3ty ardinances and ruling of
the Department of �i].din�s, and hereby declares that all the faot� aad representations
atated in hi.a applica.t3.on are true and correct. ��r�%
� SIGNA ���L
DATE °— �
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(A Sehedule of Fee Costs can be found on the Reverse Side.) �'�r
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BUILDIN� PERFRIT FEE SCHEDDIE
Section 2. 'Phe Inspector of Build3n�s ehe,]..1, before iasu3ng ar�,p permit for the
erection of ex� 'building cr structur�, or for any addition to any existing build-
ing or structure, or for any alterations or repairs to any ex3at3ng building or
etructu�e, upon applice.tion therefor, require the payment by the applicant for
such permit of fees to the amount herein below set forth and in the metiner herein
provided to-wit:
2.1. For any such permit for the erection of eay fire-proo� buildiag, other than
a garage, warehouse, factory or grai�n e].evator, or for the erection of ang fire-
proof addition, for aimi].ar occupanc�, to any e�i.sting building shal.l 'be at the
rate of $1.L�.0 for eacsh one thousand cubic feet, or fraction thereof, in auch
cubica7. contents.
2.2. For any such perm3t ior the erection of any fireproof garage, w�rehouae,
factory or gra3.r� elev�tor, or for the erection of �ny fireproof addition, for
similar occupancy, to ang existing buitding shall be at the rate of $]..25 for .
e�ch one thousand cubic feet, classified as ��fireproof" by Section �02 of the � ��
Minneapolis Build3ng Code. .
HOUSES
2.3. For ar�y such permit for the erection of any non-fireproof bu31d3ng other
than a garage, warehouse, factory or �ain elevator, or any nor�-fireproof
addition, for similar occupaneg, to any existing building. Permit �1.Q0 for
each one thousand cubic feet.
G�R.�
2.1�. For an� such permit for the erection of any nor�fireproof garage, warehouse,
factory or graiu elevator, or for the erection of ariy non-fireproof add3tion, for
simi7.ar occupancy, to an� existing buildin� or for each such building or addition.
Ninety Cents for each one thousand cubic feet or fraction thereof, in the cubical.
con�ents thereof with a minimum of ��1�.00.
For the purpoae of computing fees for building permits the cubicat content� of any
building or addit3oa to a un3form haight throughout by multip].yin� the ground area
covered from a point six (6) inches below the floor line of the basement or cellar
to the average height of the upper surface or to the average height of the roof
surface of the main gable of a pitched roof.
2.5. For repairs or alterations to an existing structure, the fee shall be at the
rate of �3.00 for each Five Hundred Dollars ($500.00), or iraction thereof in the
cost of all propoaed work.
2.6. In no case shall the fee charged for an� permit as set forth in 3ection 2 be
less than �4.00.
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Village of Fridley, Minn.
�� - �° 1774
BUILDING PERMIT
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Date: . . . V �.!'r. . .� . .�'�. . ��. . 6��v. . . . . . . . . . .
, , Builder �!�Y. °. . � .- :� �. . . . �d /! � B �9 . . . . . .
Owner.......................... ... ........
Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . �'4'. � d. . . . . ./. . .r e{ l!a � �. . . . . . . . . . . .
LOCATION OF BUILDING
No. . � � . �. � . Street . . !.!. .� Y . . �L .� !'i. . . !� � . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . . .
Lot . . . . l. .�. . . . . Block . . . . .�' . . . . . . . . Additionaor Sub-Division ��?.! :�. � .! ✓ . . . �� �•'• �• '• � •'• •
�
Corner Lot ........... Inside Lot ...�... Setback ..� �.... Sideyard ...f.� ......................
DESCRlPT10N OF BUILDIN6
To be Used as:
�. �!,ti �r �.��, q . . Front . .�Q. . Depth . �'.`� . Height 7.� s.'S . . Sq. Ft.�� � � Cu. Ft . .. .. . . .
v
. . . . . . . . . . . . . . . . . . . . Front . . . . . . . . Depth . . . . . . . . Height . � . . . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
Type of Construction .. �t: 4.!�t.f,%... Est. Cost ... �!?:.�s' .:.-� .... To be Completed ..................
Tn consideration of the issuance to me of a pernzit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
.....................................................
In consideration of the payment of a fee of $..�°?. �, permit is hereby granted to �r!!:.�..�`�.�°.���L!
. . . . . . . . . . . . . . . . . . . . . . . . . to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�en, in all work
done in, around and upon said building, or any � thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, constz�ction, alteration, maintenanc.e, repair and moving of buildings with-
in the village limits and this permit may revoked at any time upon violation of any of the provisions of said
ordinances.
� . . . �� . . . . . . . . . . . . . . .. . . . . . . B11�fIlIlg Ii18pCCtOP
NOTICE:
Thia permit does not cover the construction, instailation or altera4ion for wirtng, plumbing� gas heating,
sewer or waie�. Be sure to see the Building Inspector for separate permlts fo� these items.
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��OO LYNDAt.E AVC. �O. MIttIM1EAPOLIi t. MINN. .
LOGUfT 0370
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�� I hereby aea��it� that the s.ba�e ia e true aad correat plat oP a avr�ep► ol:: `` ��� 1:
L�►t 9s�e�teen (17). H1oCk '�i+o t2): CAHI.S�J'S SUl�4�IZT M!�'OR NORZii IID�'I'I�N. 1y�ka Coumti• 4,:�r
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�� Aa sur�eyed by �+e this 9th day d Jax�uaxy► 195b A• D• . ��` �,-
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SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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COMMUNITY DEVELOPMENT DIV.
L PROTECTIVE INSPECTION SEC.
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� �-�'1 � CITY HALL FRIDLEV 55432 NUMBER REV. j2a1�9��3
�-'�"�'� ,'� 812-580-3450 910-F15 a
JOB ADDRESS 5312 Aorizon Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT R AD[�ITIO
oesca. 17 2 Car�son a ummit Ma.nor
2 PROPERTYOWNER MAILADDRESS
Don Wa�tenhofer 5312 florizon Drive
3 CONTRACTOR MAILADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
6 USE OF BUILDING
7 CLASSOFWORK � NEW �] ADDITION �] ALTERATION
S DESCRIBE WORK
Adding fireplace and alterations
9 CHANGE OFUSEFROM TO
STI PU LATION S
ZIP
ZIP
PAGE OF
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2303
� 7��R
APPROVED BY
SEE ATTACHED
SHEET
PHONE
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
❑ REPAIR ❑ MOVE ❑ REMOVE
TYPE OF CONST. OCCUPA
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $SOO.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- ,$rj� OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. __
SIGNATURE OF CO T TOR OR AUTHORIZE� AGENT IDATEI � N PROPERLY
� .� ��� � � _ �� ���9-i3 � �'���
GROUP OCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
GARAGES
SURTAX
X�S $ . 50
SAC CHARGE
TOTALFEE
$5.50 �,
TE ��'IS YOUR �E�f�11�1��
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aPp1,ICpTION FOR RL5IllENTII�L, ALTERaTI�?U,
UR F1llU1'['IOI�` f3UII�AING PERMIT
C I'!'Y' OF 1-1:1 UL1�1', �ll NNESO'I'�1
AWNF� � 5 NAME :�D�v �+O�l?P�A�� ��T� BUILDER: r�'°� f�!=
,ApDItES S : � � � �- � !� � /�� /1� � �2 . ADDRES S :
NO;. STREET:
ZO�: I 7 TIiLOCK: �. ADDITION: ��l) R�,S�v1�� ��ILlI�9/7� �A��'%'Z
CORNEA LOT: INSIDE LOT: SETBACK: SIDEYARD;
Ag�].ican�k aCtach to this iorm Ztao Certificates of Survey of Lot and pxoposed
build�.tig 1oGation drawn on these Certificates.
DESCRIPTIUN OF BUILDING
To Be Used As:
� �T1����� � �
i� � ��s'2� �"���,� Front : Depth : Height :
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
7.'y�p� o� Construction: Estimated Cost: ��. C� �
�o Be Completed: /�PP��X !�� `�a `7 �
The undexsigaed hexeby makes applicativn for a permit fox the woxk herei.n
speeified, agreeing to do all work in st�ic� accoxdance with the City of
Fxidley Ordinances and rulings o� thc� llepartment of Buildings, and hereby
deelaxes that ��11 th� facts and representations stated in this application
axe true and ��rr��ct.
I3ATE: � ' � � ' �.3 S IC;�ATURE: � -
(Se� Revexse Side Fox Additiona.l Tnforma.tiot�.)
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BUILDING !'�11:�91'I' l�tif: SCl-I}:llUL�:
S�CTIpN 2. The Lnspect��r ��f I3,ii.ldings shall, befor� isstiing permits f.ox the
ex�etfon of any bui;ding or strurt��rc•, or for an.� addition to ;im� existing
buildfng oz structure, or for ._�ny .•1Cer�;ti.on or r�pairs to any c�:isting
lauilding or structuXe, t�pon appl ic:ation Ltiereluru, r�c��; irc ti�e payment by the
�.ppliaant for such permit of fees to r.h�� :3mount herein nelow set f�rth and in
the manner hexein provided to-���it:
IJNIFQRM BUILDING COAE: Type 1, 2& 4-� $2.15 for each onc: thousand cubic
fest, a]c �raction therc:of, in such cubical contents. T,}�pe 3& 5-$1.85 �or
eaah one �housand cubic feet.
�1ll1)ITIONAL IyPORD1ATI0N
For the purpose of computing fees for building permits, the cubica] contents
of ar�y building or .zddition, is determined by multiplying �he gxound area
a�v��ced fxrnm a point six (6) inches below the floox li.ne of the basement
o9r thE� CB11a� to tl��� average i�eiKlits ,�f the upper surface or to thc average •
h�iglxt a� the roof surface of tlie ma.in gahle of a pitched roo�.
Fo�e xBpair� ox a�texations to an existing structure, the fee shal]. be at the
xate o� $�.00 pex each five hundred dollars ($SOO.Op) or fraction therea� in
�he Cos� of all propoaed worlc.
Ta ma ease sha11 the fee charged for any permit as set forth in Section 2 be
leas than $5.00. '
VERIFICATTON OF FOUNDATION
ATQTF= Pexmits ior construction will be issued a minimum of 24 hours from Ch�
ti� o� applicati.on, to allow for proper review of the proposed structur� atid
ot t�he canstruction site.
A Certif�ed Survey of the lo�, showing the location of the foundation, once it
ha� been constru�ted, will be xequired before proceedin� with the framing.
i'liRTIFICATE UF OGCUPANCY
Applicatiun for a Certiiicate o: Uccupancy shall be made ten (10) days prior
t0 the u�e or occ�ipancy of any structure for which a building permit has been
�.sau�d; �nd s.iid structure sha11 not be used or occupied until a Certificate
of Aceupancy has been isaued.
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aPpI,I�ATION FOR Rli5IllENTIAL, ALTEItaTIi�N,
UR E1i)lll"['I01�` �UII�DING P�RMIT
C I'1'Y" QF 1�1:1 llLk.Y , ti11 NNESO'I'�
AWNF.� � 5 NAME : /�orv ��1TP�/�f� �C'Z BUILDER: �A �2=
�ADDRES S : � 3 / � �f� TL !� n� � Y2 . ADDRES S :
�10 ; . S TREET :
LO'� : I 7 B LOC K; aL ADDTTION ;�ii !2 G,S��eia �� f1�Ii°!N9/ ���/L��' �2,
CORN.�R LOT; INSIDE LOT: SETBACK: SIDEYA�D;
Applican� attach to this form �ao Certificates of Survey of Lot and pxoposed
bt�ildalxl� location drawn on these Certifi.cates.
�ESCRIPTIUN OF BUILDING
To Ba Used As:
j�/ fl� �� R'� E' �
� � ���f> �iOno',�. Front : Depth : Height :
Square Feet: Cubic Feet;
Front:
Depth: Height•
Square Feet; Cubic Feet:
'�`yp� o� Constxuction: Estimated Cost: ��a C� D
�a Be Completed: �1 PP1��X /�C� ��a 7 �
The undexsigned hezeby ma.kes applicativn for a perniit for the work herein
spe�ified, agxeeing to do all work in st�ict accoxdance with the City of
Fxidley Ordinances and rulings o� thc� Depaxtment of Buildings, and hereby
deelaxes that ,;11 the facts and xepresentations stated in this application
axe true and ��rxt•ct.
I�TE: � ' � / � �,� SIGNATURE: � �
(Se� Reverse Side For Additiona.l
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Tnformation.)
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13UI LDING t��:i�,T� �r ����: 5crl�uu�.�:
S��TIQN 2. T'he Lnspect��r :�f I3�ii.ld�n,�s shall, before issuing permits f.or the
e�ee��.on of sny 6uiiding or struc���rc-, ur �o� an�� addition to ;�n�� exi.sCing
buildfng oz structure�, or for ..iny ,� 1 t4rat i.on or r.:pairs to any c::isting
huilding or structure, tipon application Ltierelor�, r�quire ti�e payment by the
appliaant fox such permit of fec:s to rh�� amount herein h�low set forth and in
�hr� manner herein provided to-a�it:
IJ1vIFORM BUILDING CODE: Type 1, 2& 4-� $2.15 for each onc: thousand cubie
feet� o� fzaction therc:of, in such cubical conter►ts. T}�pc� 3& 5- $1.85 for
e�ch one �housand cubic feet.
:�UI)ITIONAL L�FORI�IATIUN
For t1�e purpose of computing fees f�; building permits, the cubical contents
of any buildint� or addition, is determined by multiplying �he gxound area
oC�V���:d fx'om a point six (6) inches below the floox line of the basement
o� thA �ellar to tl��� average heiglits ,�f the upper surface or to the average •
hai�ltt �� the xoof surface of tlie ma.in gahle of a pitched roof.
Fox zapairs� or altexations to an existing structure, the fee shal]. be at �he
x'ate o� $�.00 pex each five hundred dollars ($500.Op) ax fraction thereof in
the coa� of all proposed work.
Tu ma case shall the fee charged for any permit as set forth in Section Z be
�.Qt86 ��1r:�A $S s OQ •
VERIFICATION �F FOUNDATION
AiQT�; P�xmits L�r construction will be issued a minimum of 24 hours from the
ti�e of app�ication, to allow for proper 7review of the proposed structure and
oi the Coilstruction site.
A Certi�ied Survey of the lot, showin� the location of the faundation, once �.0
haa been constx'ucted, will be required before proceedin� with the fratning.
�'L'RTIFICATE Ui' OCCUPANCY
Appli.cation for a Certiiicate oi Uccupancy shall be ma.de ten (10) days prior
tp the use or occupancy of any structure for which a building permit has been
$.aeu�d; �nd sciid s�ructure shall not be used or occupied until a Certi�icate
o� Aceupancy has been isaued.
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City of Fridley 12615
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
� � CEIPT NO.
� ; L _.�� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. I��° ��
I i �
�� �'��; � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
----�• •� 8�2-56o-sa5o 910-F15 6/28/74 � � I
JOB ADDRESS 5312 I%rizon Drive N.E.
1 LEGAL LOT NO. BLOCK TflACT OR ADDITION SEE ATTACHED
DESCR. I.% i C3r�.SOri � S S17IIIID].t M3ri0I North SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Donald J. Wattenhofer 5312 Horizon Drive N.E.
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADURESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP pHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 18' x 26' Addition to Dwelling
9 CHANGE QF USE FROM TO
STIPULATIONS
Ventilate attic 1 square foot to 300 square feet
,P� � �� � �
��
����p FOR W1RiNG�
RATE pER{VtITS REND SIGNS,
SEpE P`��g�N� A
H�ATIN�•
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONOITIONING. WOOt3 FZ'tlIIle
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R�.
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �Zi%O4 1..35
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �.O.00
PLAN CHECKFEE TOTALFEE
� ' �.�.. 35 `
SIGNATUREdFCONTRACTOFORAUTHORIZEDAGENT IDATE) WHEN PROPERLY VALIDAT S S YO R PERMd7
.� �
%C- G�/ � �8-7y "�:
SIGNATURE OF OWN IIF OWNER BUILDERI IDATEI BLDG INSP �ATE
__�
AP.pLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME :� NAG?J .I �%1'/TF���UILDER: �5���
ADDRESS : 53/� �/,�iy��/ �/'� � ADDRESS : .SA �"JE
NO:. S'3/� STREET: %�af2iz�� ��2 � -
LOT : BLOCK : o�Z ADDITION : Ci7�� S�/V 5�� M/'7/ T/%^/ °� �o /z �.
COItNEx LOT: INSIDE LOT: � SETBACK: SIDEYARD:
s
Applicant attach to this form Ztao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Useii As : �
�ITI�� T h'�vl� Front: / � ! Depth: � �O � Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: /.�Jo dJ �1zA/7�E Estima.ted Cost: $ o�,� d�'
g � �
To Be Completed : J�/ •�/ E. / 9 7-S ? l' �` °
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in sticict accoxdance with the City of
- Fridley Ordinances and rulings of the Department of Buildings, and hereby
declaxes that all the facts and representations stated in this application
are true and correct.
DATE : �o -- � � — 7 `i S IGNATURE : �
` _ �' i, ° %�. '� i-� '/rr / ' '�,r--
_ (5ee Reverse Side For l�dditional Information.) �/
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BUILDING PERMIT!FEE SGHEDULE
SECTION 2. The Inspector of Euildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building ox structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, xequire the payment by the
applicant for such permit o� fees to the amount herein below-set forth and in
�he manner herein provided to-wit:
ITIVIFORI�2 BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.� �
�
_��
L
�
. ADDITIONAL INFORMATION �
b
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point si.x (6) inches below the floor line of the basement
Dx the cellar to the average heights of the upper surface or �o the averager
height of the roof surface of the main gable of a pitched roof.
For repairs o-r alterations to an existing structure, the fee sha11 be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all propos.ed work.
In no case sha11 the fee chaxged for any permit as set forth in Section 2 be
less than $5.00. �
VERIFICATION OF FOUNDATION
NOTE: Permits for construc�ion will be issued a minimum of 24 hours from the
time of application, to allow for proper review o� the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once i.t
has been constructed, will be xequired before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy sha11 be made ten (10) days pr3or
to the use ox occupancy of any structure for which a Uuilding permit has been
issued; and said si�ructure shall not be used ar occupied until a Certificate
of�Occupancy has been issued.
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CHIIVII�TEY AND STACK VERIFICATION
The undersigaed hereby verifies that the existing chimney or stack:
L Has been carefully examined • Yes (�) No i)
2.
�3.
4.
5.
6
Is free from rust or deterioration
Has no foreign objects lodged within
Is securely supported
Meets all �urrent Code requirements for size
and total BTU's connected
Has total heating BTU's of
All other BTU's
Yes ( ) No ( )
Yes ( ) No ( )
Yes()No()
Yes ( ) No ( )
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ()
8. Has combustion air been provided for water heater Yes () No ()
Remarks: .
List ALT'ERATIONS Being �one:
HEATING CO:
Signed By:
Date:
SuBJEC�
City of Fridley
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
i �
� �
� ' COMMUNITY DEVELOPMENT DIV.
� j L �•���'�
� � PROTECTIVE INSPECTION SEC.
i--_-� ��"' �,� CITY HALL FHIDLEV 55432 NuMBER
l 612-57 �-3a50 - s� aF� s
JOB ADDRESS
5312 Horizon Dr
t IEGAL �OT NO. BLOCK TRACT OR AODITION
DESCR. 1� 2 Carlson'
2 PROPERTY OWNER MAII ADDRESS
Don Wattenhofer 5312 Horizon Dr
3 CONTRACTOR MAII ADDRESS
Owner
4 ARCHITECT OR DESIGNEF MAIL ADORESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
7 CIASS OF WOHK
REV DATE PAGE Of
8/7/98 / /
ZIP
ZIP
P MIT NO.
7062
RE .
����
APPROVED BY
SEE ATTACNEO
SNEET
PHONE
572-1045
PHONE LICENSE NO
PNONE LICENSE NO.
PHONE IICENSE NO.
❑ NEW C� ADDITION ❑ ALTERATION O REPAIR O MOVE ❑ REMOVE
B DESCRIBE WORK
construct garase (12'x18') 216 s.f.: daka model 3_11 wood_furnace
9 CHAN(iE OF USE FROM
TO
STIPULATIONS
Install a hard surface driveway. Wood furnace to be installed
in accordance with testing agency's specifications.
�
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK Ofi CONSTRUCTION ZONtNG
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTpUCTION
OR WOF;K IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I NEREBY CERTIiV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL PROVISIONS Of LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN ON NOT. THE GRANTING OF A PERMIT 3993.8�F
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE Of CONSTRUCTION. $S%.ZS
SQ.
STALLS
GROUP OCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
IGAFAGES
MARGE
.re S
.FEE
OFCONTRACTOAOAAUTMOAIZ AGENT IDATEI N O VALI ,T THIS I�UR �ERM
� i/� �
)FOWNERiiFOWNERBU1lDERi IDATEI .. -- n iaeo ncic
r�w
ADDN
ALTER
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CI1'Y OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERNIIT APPLICATION
ConstructionAddress: S3 / �2 �4 JZ / ? c��l% �/� .
Legal Description:
Effective 1/1/98
��� �
��� �
Owner Name & Address: �p^/ �i477�N/�OFl�7Z Sf �� Tel. #� �%;Z /O `�-S
Contractor: O(� /1/E R MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length � Width /�` Height Sq. Ft. �% �, ��
DECK AREA: Length Width Hgt/Ground Sq. Ft. _ �> (��
OTHER: � A.if A MD fJ �L, 3// GcJ o o� � v x�/ � G�
Construction Type: Estimated Cost: $
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$•
DATE: � - 7 - `9� APPLICANT: ,�(� Tel. # v�7o� °�d' /S
Permit Fee
Fire Surcharge
State Surchazge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� �ZS
$ <
� e�
$
$
$
$
$
$
$ 3>�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuadon (1/lOth%) .
$.50/$1,000 Valuation
$1� per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require Yhe payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,0�
$25,001 to $50,000
$50,001 to $1(}0,000
$100,001 to $SOO,Q00
$504,001 to $1,000,000
$1,000,001 and up
� � FEES • � .
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional$1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,0(� plus $6.25 for`each additional
$1,000 or fraction thereof, to aad including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 fox the first $500,000 plus $4.25 for each additional .
$1, Ot� or fraction thereof, to and including $1, 000, 000
$5012.25 for the first $1,000,000 plus $2.75 for each additiona.l
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.�.
Altemate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
SuB�EtT
City of Fridley 3079
AT THE TOP OF TME TW�NS g � � L D 1 N G P E R M i T
�
; � ECEIPT NO.
� • COMMUNITY DEVELOPMENT OIV. � A��
f � v � PROTECTIVE INSPECTION SEC. �
� _ �
( �"'1 � CITY NALL FRIDLEY SS132 NU119EA NEV OATE PAGE Oi AdPROVEO BY
�""'�' �'' 612-571-3450 910-Ft5 4/6/00 / /
!OB AODRESS 5312 Horizon Drive NE
t IEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 17 2 Carlson's Summit Manor North Addition SHEET
2 PROPERTY OWNER MAIL ADDRES$ IIP PNONE
Don Wattenhoffer 5312 Horizon Drive NE 572-1045
3 CONTRACTOR MAII ADDRESS Z�P PNONE LICENSE NO
Coty Construction 1001 6th St S, Hopkins, MN 55343 933-3536 9356
4 ARCNITECT OR DESIGNEF MAIL AODRESS IIP PHONE LICENSE NO.
5 ENGINEER MAIL AODRESS 2�P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION [� REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Reroof House (18 Sq) Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlaym.ent must comply with the State Building Code.
SEPARATE PERMI7S ARE REOUIRED FOR ELECTfiICAL, PIUMBING. HEATING, TVPE Of C NST OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
TMIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION IONING SC. fT CU FT
AUTMORIZE� IS NOT COMMENCED VjIITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANV TIME AF7ER WORK IS COMMENCED. NO OWIG. UNITS OFFSTREET PARKING
1 MEREBV CERTIFV TMAT I HAVE READ AND EXAMINED THIS APPLICATION 1 S7A�LS GARAGES
AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS yA�UATION SUR7AX
AND OROINANCES GOVERNING THIS TYPE OF WOiiK WILL 8E COMP�IED @
WITM WHETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT W1sS73 �.79
OOES N07 PRESUME TO GIVE AUTMORITV TO VIOLATE Oii CANCEI THE pEqMIT FEE SAC CMARGE
PROVISIONS OF ANY OTNER STATE OR LOCAL lAW REGULATING CON-
TRUCTION OR TNE P FOfiMANCE OF CONSTRUCTION �5%.�.5 Fire SC, �1..'r�%
� � � �� PLAN CMECKFEE TOTALFEE
in� � License SC $5.00 $64.41
S�GN4TUAE0� ON•AACTOpOA4UTMOA�ZEDAGENT iO�iE� ME ROPERIV VALIOATED TMIS IS VOUp PEAMITw'
�—� —W
S�GNOTUAEO�OWNEA���OWNEABU40ENi �OAfE� OG �NSP �1�TE
NEW []
ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING,PERMIT APPLICATION
Construction Address: �� � ��
i
�
Effective 1/1/2000
(763) 572-3604 Bldg In�p �
'��a�
�O �
Legal Description:
Owner Name & Address �� � �/ Y�°�l ,P� Tel. # l�/�—.S�,a � �C�Xf�
Contractor: � � MN LICENSE # ��e
Address: � � ` j S� � � ii ' , S.S�y3 Tel. # �.33 ��-3�
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Vlfidth Height Sq. Ft
Length��_ Width Hgt/Ground Sq. Ft
���- �r ��c� � - � /� �'�� . / � �l ��� - <� ��
, � � �
Construction Type: ���F'—' Estimated Cost: $ � ����
Driveway Curb Cut Width Needed: Ft. + 6 Ft =� Ft x$ _$
DATE: `�I � —C'�O APPLICANT:� ���r1� Tel. # l�� ��'��"`� ,
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ ? D� ' Fee Schedule on Reverse Side
Fire Surcharge $ �� ��`� .001 of Permit Valuation (1/10th%)
State Surcharge $ %i? $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ � - �' (j $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee
Sewer Main Charge
r���r�l
STIPULATIONS:
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ �,, % �
BUII,DING PERMIT. FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,0(}0
$50,001 to $100,0t}0
$100,(�1 to $500,000
$500,001 to $1,QOO,OQO
$1,000,001 and up
FEES
$23.50
$23 .50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,Q00
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,Oi� plus $10.10 for each additional$1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1, 000 or fraction thereof, to and including $100, 000
$993.75 for first $100,000 plus $5.60 for each additional
$1,Q00 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of S�rvey of the lot, showing the location of the foundation once it has it has been consiructed will
be required before proceeding with the framing. New Houses Onlv
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CHIMNEY AND STACS VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioration Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4. Is securely supported Yes () No ()
5. Meets all current Code requirements for size
and total BTU's cennected Xes () No ()
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ()
8. Has combustion air been provided for water heater Yes () No ()
Remarks:
List ALTERATII�NS Bein Done•
HEATING CO:
Signed By:
Date:
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CIIYOF
FRIDLEY
1
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
March 16, 2001
Don Wattenhofer
5312 Horizon Drive NE
Fridley, MN 55421
Re: Final Inspection at 5312 Horizon Drive NE
Contractor: American Heating & Air Supply Inc.
Dear Mr. Wattenhofer:
A mechanical permit was issued on October 15, 1999 for the installation of a furnace at
your address. According to Section 305(a) of the 1991 Uniform Mechanical Code, a
final inspection shall be performed on the mechanical permit. As of this date no
inspection has been called for.
The permit fee that was paid covers the inspector's time to check to make sure the
appliance was installed correctly. We also need to check for the installation of
combustion air, vent and connector sizing.
If you would like the installation inspected, please contact us within 30 days to arrange
the inspection. If we do not hear from you we will expire the permit and note that no
inspection were called for.
Any questions can be addressed to myself at (763) 572-3603.
DJ/mh
3uilding
�gpeCt10I1S
763-572-3604
BUILDING TION
RESIDENTIAL APpLICA
C�Y OF FRIDLEY
ypUR E MAIL ADDRESS
�n� v K�i 2 H��'� dr�
>ITE ADDRESS ❑ OWNER
; HI.S APPLICANT IS:
PROPERTY OWNER/ NAME: �,� s.� I.��ri7�Ov� L7�+ CITY
TENANT nnDxESS:
PHONE: '"
CO CTOR
S�� p COPY OF
YOUR STATE LICENSE
VJITH APPLICA'1'ION
. nonpF.RTY TYPE
PE TTYPE
STA'I� LICENSE #_
ADDRESS:�(�
nvllAlF � 1 �+
� T'edv r��� � ��.,...
❑ pDDIT10N �ISH
o B�+sE�T
❑ DFCK
TYPE OF W0� I �Mp�iT
DESCRIBE VJORK BEING DONE:
SIZE OF 1MPROVEMENT
OF SQUARF•S
G,ARAGES
PROPOSID S��—�
PROPOSID HEIGHT: _�
SmING
0 VinY�
❑ Atuminum
❑ Other ��
0 ROOF
❑ SIDING
p SWIMM
❑ HOUSE & GARP•GE
O ATTACHED GA1tAGE
❑ DETACF�D GARAGE
OSoff1t
❑ Trim
❑ pascia
pKrg ],p�pT10N OF WINDO�'''S
IN �'�G OPENINGS I]Yes �E SIZE OF
ENII�IGS-DESCRIB
Permit No.: �
Received By: �
DateRec'd: �'_ i�'
EXP DATE C� �y1'�t�Pn�li� _STAI'�='Z�-�--%
�DRAIN 7'ILE
] OTHER
HEIGHT
�
Ft»
BASEMEI�T RENI0DELING SUBNIIT:
1. Exist►ng fl� P��
2. �P�d members to be ►�ed
3, List of stcuctural
FOR NEW C�NSTRU�cCTIiFC�cl rBMIT: �G DECKS,
� DITIGrvS a ��•• �e existing st�uc�res
1. Site Plan/SurveY s�o`"'ns
and proPosed Pro]�.
2. Two sets of consuucbon Plans
3. En�gy Calcuiations
ORFOR1�tEW OP .���;
OPENWG CHA��'� � NUMBER OF W�O� COST OF LABOR AND Mp`
T'I'PE OF W W�W TO BE INSTALLID INCLUDING TTI�
AI.L FEES ARE BASED ON VALUATION, DULE) —
rttcnvG THE 1997 U.B.0 FEE SCHEro A,Urv TYPE
►7
Permit Fee
Plan Review
Fire Surcliarge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
�in Charge
JA'11t�t� a� - S� gack Page for Fee 3cheawe
$ �� �� 65% of Building Pemnit Fee
� .001 tunes the total job valuation
$ � 7� .0005 x Permit Valuation Minimum $.50
$ � �9
$ $5.00 (State Licensed Res�id��nt��CC�tdetermination)
$ $1550perSACUnit(P ftX�l_$ _
g+6ft=__ ,
$ $45p oC nservation Plan Review
$ Fee Detertnined by Engineenng
$ pgreement necessary () Non NecessarY ��� A�ch
$ .._.__ ..�.a..tic navable to: C:'�' ^f Fridley
Sewer $ �._y : � o -�----
Total Due
TEIIS IS AN APP1-ICATION FOR A PERMIT NOT VALID 1JNTIL pROCESSE �at �e �,ork will be in
lete and accurate, d�is is not a
nnit and I aclmowledge that the information above is comp �at I understan �ved
I hereby apply for a building pe of Fridley and �+'itt► the Minnesota Construction Codes;
��o��� �� �e o�ances and codrt and work is not to start without a permit; that the work will be in accordance with the app
permit but only an apPlication for a percr► P�V� of plans. �
pl� � the case of all work which requires review and a p P�T N� ���- -�hy��d� DATE
� �% 1�a
OF APPLICANT � ��A """���
SIGNA'NRE —� � �
Page 2- Building Residential Application
BUII.DING PERNIIT F�E SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of propos�. structure and of the construction site.
A Certificate of Survey of the lot, showuig the location of the existi.ng foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
Building PLUMBING PermitNo.: GC'7�G�
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY vate x'�
OOi
DATE YC�UR E-MAIL ADDRESS ,(/1"4' �� x�" a�• �
SITE ADDRES � 12o+ti. ��' N � � .F �� Y�'Jl�( . � �
THIS APPLICANT IS: �OWNER ❑CONTRACTOR
PROPERTY Np�: ,`+N QV� Q r�/r'�
OWNER/ �DRESS: �� �- CITY STATE ZII'
TENANT PHONE:�Q � Z"�� '�' —�� � O
CONTRACTOR Np�;
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE ADDRESS: CITY STATE ZIP
LICENSE WITH pHONE FAX
APPLICATION
PERMTT TYPE �S�GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � �W �.�P�CEMENT
DETAILED DESCRIPTION OF WORK e Y1!� �t �� �Q ���
PER MS 16B.665 the pemut fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fi�cture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (iv� crr�'t�c�✓sE) SWIMMING POOL _ WATER SOFI'NER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER _ OTHER
' �.�, s ;�, � 2 ����'�� `� ��,� � ��; ���` 5 _ �<. ��?
�
Permit Fee $ Number of fixtures @$10.00 x$10.00 =$
Surchaz e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ Number of fixtures @$35.OU x$35.00 =$
State Surcharge = $ .50
Tota1= $
THIS IS AN APPLiCATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that 1 understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all rk which requires review and approval of plans.
�) �
SIGNATURE OF APPLICANT �1 RINT NAME �"e�l��C1°`� �� ���DA'I'E �� d�
� , ,
-� � � 1�� ��
: '
..._.��.F�;��,. .. h ::,.� ._.� .;:.,. ��:�_ �, ,,. ._. _� _,� _�..'`... �� ,r�"� __�� .���+.
,� E� ��,! �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building �� MECHANICAL Pernut Nc.t � �� ��f,�f
Inspections �w� �SIDENTIAL APPLICATION Received By•
763-572-3604 CITY OF FRIDLEY �e��
DATE �U�.Y� �G 3� 1 a�0 g YOUR &MAIL ADDRESS
srrEAnnxFSS 53 �°� Nar'• zov� �r:v -e N�
THIS APPLICANT IS: ❑ OWNER �]CONTRACTOR
PROPERTY NAME: %� e r sn a.. v�, �or �e r �.
OWNER/ ADDRESS: rJ3� 7— c�r��c.oy� !� R�i�CTI'Y _ �r � d �-e-.n STATEV�1 N ZIP S Su'o? I
TENANT PHONE: CO�°a - 3H� —7 °' i 6 1 b
CONTRAGTOR �o�� N�: CENTERPOINT ENERGY
SUBMIT A COPY OF
CONTACT PERSON: '7OANN 'Ic INKEN
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH �D�S: 93�0 EVERGREEN BLVD STE HrrY "CU�311i' °R1�P.IDS sTA�Na1T z�r55433
APPLICATION PHO� 763 — 757 -- 6202 F,� 763�757--6701
PERMIT TYPE ,� SINGLE FAMILY ❑ TWO FAMII.Y ❑ TOWNHOUSE
TYPE OF WORK: o rTEw ��riaC� ' ai.�xnTto�on�.
DETAILED DESCRIPTION OF WORK iv.5� w� � �(Le �l �� IA � � C��n� �� �or1 � r
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixbures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. La.bor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WI�RE LABOR EXCEEDS $500, FEES ARE BASID ON $10.00 PER FIXT[JRE, EXCEPT WHERE NOTID. FD{TURES: (INDICATE TOTAL
NUMBER OF EACH BELOVi� �
Equipmetrt Installed MFG: �°-'�� MODEL: � Y� N�.-' b3 O g�g/g� � 2-�p p-�
MFG: MODEL: ' SIZFIBTU
MFG: MODII.: SIZF/BTU
1A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGFJOVEN $10.00
AIR TO AIIt EXCHANGEEIt $15 _FIREPLACE (WOOD) $35.00 iVEW GAS GRILI. $10.00
_BOIL.ER $35.00 _FURNACE $35.00 _GAS LINIT H1R $10.0U
_CI-IIIv11VEY LINER $10.00 _GAS DRYER $10.00 P�L HEA1'ER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTII,ATOR $15.00
, � ;�,':-.._ " � �t � d '' @ �ir� �. ? ` �� r ,� °q�a� vY, ;� -..t , � �� ,� � ., -,; ' �, " ,-.
:.:, . ,_ ,. ,.. ,. . .:.... :. . -.. , . . ,._,'�.. ,_. �. ... ..._ . .v . :.� . ... ,y.
�ermit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DiIE $ Number of fixtures @$25.00 l x$25.00 =$�,� �
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Tota1= $ ,�s s v
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTII. PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete an� accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Conslruction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNAT(lRE OF APPLICANT �• `� ' � N,�1� ROGER ftOFFHEIN DATE ��O/O�
, „, , . .:. . � ., . �.,�„ .. , ., A � � . y..t... ,. , v; ... . - ��. ;� Y
�N. . ,. ._. _ �
. .� � ..m .:,..
_
� - a .,- ,� .n_�. . ;�,_ c - ...?'�'.'i• '��' :I
. �... ,. .. ,� :..
�� ,
.r -
City of Fridley
Building Inspections�Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
.��
City of Fridley Residential Mechanical Application Page 2
�
REQUIRED INFORMATION NEEDED TO PROCESS PERNIIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS �XISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/1FGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REOUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
-- - -- - ��. —�s�-Desig� P-� Il� ��4b.06g3.2 -
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.
0