AF - 46418BUILDING PERMIT
Village of Fridley, Minn. N� 2 5� 2
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Date:".�..�:��:.... .......................
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Owner �',� �!��� y� �+t� r►�;��,r,G: �'. �:� .
Builder ..,...!°':��'.-�t�_..*_ ..........................
Address .r,�'.�.� � . . .,�':L=�-�=;�':�?: . .� ��:�,� Address . . . . . . c�:�:":" . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCATION OF BUILDING
No. ��
� �`3 �'. . . . . . . Street . .� :� �� ;�� :�fi . . . . . . . . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
Y! D.,� � l/'�'� f
Lot ......,�',If........ Block ... .�......... Addition or Sub-Division�:f�:��:'?a�:,�'�:�'"�' �. '�"1`
� ..
Corner Lot .. . .. .. .. . .. Inside Lot . . �. . .. .. . Setback �� Side ard
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To be Used as:
��!'���.1.�� . . . . . .
DES�CR[PTION OF BUILDING
Front ,�'�,,, . . Depth . ,�:+5,�. . Height �l�y�.. .. Sq. Ft. �': �xQ: . Cu. Ft. . .. . . . . .
... .. .. .... .. .. . . .. . Front . .. . . .. . Depth . .. . . . . . Heiglit . .. .. . . .. Sq. Ft. . . . .. . . . Cu. Ft. . . .. . . . .
� �
Type of Construction ,�',�,�t&��. . Est. Co�,l�.�; !�i�.'� . . . . . . . . . . . . . . . To be Completed �% . .'�/'.�* t�^��.%: .
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In consideratian of the issuance to me of a permit 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.
...................................................
�'�S!:.., permit is hereby granted to �.-.�:� +��:�"........
Tn consideration of the payment of a fee of $. . .. .
��",�r,,:��.�s�. ...�,�t-,�o. construct the building or ad ditiion as described above. This permrt is granted upon
the express con�tion that the person to whom it is granted and his agents, employees and worl�nen, in all work
done in, around and upon said building, or any part thereof, sha11 conform in all respects to the ordinances of
F'ridley, Mixuiesota regarding loca,tion, construction, alteration, ma.intenance, repair and moving of buildings with-
in the village limit's and this permit may be revoked at any time upon violation of any of the provisions of said
ordiaances. .;� � �,
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....... Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspeatoefo� separate permits for these items.
.�.
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Date:
Owner:
Addres:
Caty of Fridley, Minn..
BUILDING PERMIT
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N° ; 4915�
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Buildbr �.�.. ...._ .. ..._..---.:_.._.. .....r..._.. .._.�.-- -..�..�' a_::�y ��
Address..._...------......._.._..._....__....._..__....__._._.._.......__..._....._.._._.._.._.__
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L CATI N OF BUILDING
No.�_�!�-�...... Street - -- � •-- -- - �•�'"-�'�-�-----...._ .............. Part Lot ..........---- --
-- • - . . .. ._._.----�--••--- ---••-----
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.. .... .
._.
Lot .... - �/r.........._....... Block .--�--...--......_.... P .� Addition or Sub-� ' n .. �---- --� � •-- ---�-���'''�
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Corner Lot ....._ ............................. Inside Lot ._.......--� - ._...................�back ..�...: .._ -- -�--.... Sideyard ....�...._......._...._............--�-�-- --...---------�-
SewerIIevation ---••-•---.....--�--��----•-------__..__...---•-�--•-----�-------••---•-�---...._.._..... Fo clation Elevation _....._.--�----�---••---�•----�•--•-•-�----••-�------------�---
DESCRIPTION OF BUILDING
TobeUed : �
.
,�.
-.�. ----..., . R�.�....�.... Front .-----.a�� Depth .. � ....._.. Height ...� � - - Sq. Ft. �.�� Cu. F� .. �_.�....���
...................._............_......._...:... -- . Front ........................ Depth ._..._............. H 'gh .......... . Sq. Ft. `....._.........._...... Cu. F't. ------............._..
�
Type of Construction ..: �_:. .._.:: ,�...... Est. Cos���, ..._�..._�....... To be Completed ....._...........___. _.
L .. .
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accorda.nce with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley. ,
In consideration oP the payment oE a fee of $..;,�'�...�.�'_�._..., permit is hereby granted to....._ .............__......_. _.
..—�—_.__..___..____..�..__.__. 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 workmen, in all work
done in, arotmd and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at aay� n viola�on of any of the provisions of said
ordinances. ,,s° . %
Building Ins�etor
NOTICE:
This permh does nof eove� the construNion, installation for wiring, plumbing, �gas heafing, sewer or water. Be sure f��e
the Building Inspedor for separate permits fo� lhese itema �° ������ �
- 7F VIOLAT-
�•� q T��,.�..PERP:1?T D_t=;��di)I l:,�_! �i,� �-
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APPLIC�TION F�t BIIILDTNG PF�MIT
CITY OF FRIDLEY, �OT1
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IACATION OF BIIIT�ING
No. � � � 3treet � � !,� � � ��s - Part of Lot
. ,
Lot r 1 Block � Addition or Su�ivision �''� ��'�� '���
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Corner Lot rInside Lo� �� Setback Side-Yard �
SE'WER ELEVATION FOUND�TION ELEVATiON
�pplicant attach to thia form Certificate of Surveg of Lot and proposed building
loca.tion.
To be uaed as:
DESCRTPTION OF BUILDING
Front` pth He3ght
�. Ft. Cu. Ft.
Front epth Height
Sq. Ft. Cu. Ft.
._.�-�
Type of Conatruotion ,1`%"`���1 � - Estimated Cost
To be Completed
The vrsdersigned hereby makes 8pplication for a permit for the work herein spec3fied,
agree3ng to do all work in strict accordance with the City ardinances and ruli.ng of
the Department oi Bu31d3ngs, and hereby declares that all the. acts and:x�presentati
stated i.n thia ap 1,, `c�a.t3o�y� are true and correct. ��� �' � ,%, �/� J� ��
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u� �� ; � SIGNATTk�
DAT� �:��t? � �
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(A Sched.ule of Fee Costs can be found on the Reverse Si .}�
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�ection a. The Ine�ctar,.of_�t�,ldings "a1�3� -bePor�'t�T�3ng�`siqr peacm3t for Lhe
--ePes�an� -o�� a�+ ��3:�diag or struct�e, or Pos sny add3tion f,o e�+ existiag build-
ing or s�,icture, or fos any altaratione. ar. �epaire to e�► exi�t3�»g -building or
�truature, upon applice,t3on ��tieri�fbr, require the pe�rment by the spplicant por
such permit of feee to �he amdunt here3n belc�r set Porth �nd�� ia� � the me�ler her-ei� ��
provided to-vSta,, . • .. : . _ . ...._....__ . ..
�... . .:._..... .....�.. ___. ...._... _..__
2.7�. For en� such ge�mit for t}� erectioa of a�r��fl3'�p"raoi' building� o'�her 'th:ea.
._�a..:gara,ger;-��e�h'ouse, fsctory ar �+ra�3a eieeatAr� or for the, us,�tion .Q�. a�1y►.fi�e- '
proof �ddition;�,. for eim3l�r o��uPar�sy^,' ���'to� a�V' ex3stin� i�u9ldi.ng �e,l]. be at the
_.re�s� -v� �:� �for each one thous�ad eub�c..,�eei, or Pract3on thereof, ia.°sn�li `
cubica]. coatenta. . � .___...... _. ..... .. .... . �._...... _ .
2.2. For•.s�,p �i perm�.t for the erec�� of �ny fii�eprqof gsrege, ararehot�ei �`��'
factory�or grain elevator, or for the erect3ou of exi,y firepTaoS addition, Por
aim3].er occuP$,ncY, 'to any eod�ting builc'l�l.ng;.�I�.2 be at the rate of �7..25 for
each one thouaand �ubic feet� olassifi�d�ae� pfirep�aof" by Section �2 of the
��poi�s eu�.a�� coae.
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2.3. For ar�y such pe�.fi.t..FQr..the..eract3on''of-�pr-no�PiregroaP bui7.ding e�har
t�s-er -g�8`ge; �� wese`�ou�e, factory or grain ele�ator, : or. any� no�-fireprooP
add3t3.on, for s3m3].exL'occ�anc�Fe-� �Y..�'��"buil.ci3ag. Permi.t �7..00 for
ea-�-nne -tita�ad�� cubic fest. . --- �
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2.1F�-- -�or-��--��i��li perm3t for the ereat3on oF any aor�•firepro�f' �erage, ��ta,�e%uae, ���
factory or grain elevator:,���or for �the..erec�ion-flf�-eny��xo��isepreot` edd3tion, for .
s��r-�occup�anc�;��to 'any exiating bu�lding or for each suoh buildin� or.add3t3an.
Ninety Cents for ea.ch one thousand cubic f�et �o� � f'ra�ctian '�hei�eof; �in ihe cubieal
.. ..._
co��s� �ther�of � w3th a minimum of $4.00. .. • .. .. : . -. ; ; :.: � : . . . _ . _ .. . . • � �
,
For t�i�nP,.::ur�a� of .compu����fe��. for bu3lding'p�i�ifi,�.;.'t.he,..�cubi�ica't:;_4�s►nten�e `ef s�y r
build�ig .�a,�r. ai�dition to e. •un�Pt�rm he3�h�t threit��Iicju� �by' f.q�S.t�ply3ng. the �reund. �exee.
covered fram a��point s3x (6) inches below •the' t`loor �12ne of 'the basement or aellar
to the average height of the upper suriace or.to.�he everage height ef the raoF, .
eur�ace of the maia gable of a pitek�ed .roo�'. �,''::` .. .....---._� .
2.5. For repaira or alteratione. .i�o'��ext 'e�cistiri�� structure, the fee ahall be Bt tha
rate of �3.� for each Five I�uadred Dollars i�5�.00), or f�aotion thereof iti the
cost of all proposed work.
2.6. In no case �hell the fee cshaxged for any permit as set forth in Section 2 be
leas tha.n �L,.�00.
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City of Fridley, inn
BUILDING PERMIT
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N° '700�
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L CATION OF UILDING
No�_.�� Street �.l�..•__�C,�►l�–� P of t
Lot �__ Block � Addition or Sub-Di on ��til�/� � �
Coraer Lot ._ Inside Lot � 4�tback � Sideyard �� �
Sewer IIevatian — .� Fo dation IIevation
DESCRIPTION OF BUILDING
To Used
a t�. Depth �.._ Height � Sq. F't. � Cu. Ft ���:�
t Depth �Teight Sq. Ft Cu. Ft
Z�pe of Construction !, ����� F�� C�§t L._�._.. �' � To be Completed
Ea consideration of the fssusace to me of a permit to constru the building d�cribed above I agr�e to do
the proposed work in acc�rdance with the descript3on above / 6��� ��% //i" a//l a'11 provisions of
ordinaaces of the dty oY Fridley. ,
In cansideration of the payment of a fee oP $� , Permft 9s hereby granted to
to canatruct the buflding or addition as descrYbed above. TY�is �ermit fs granted u�n
the express condition that thepera�n to whom ft is granted and hfs agenta, employees and worl�en, in all work
done in, around and upoa safd building, or anypart thereof� ahall conform in all reapects to the ordinance� of
Fridley, Minnesota reg lacation, construction, alteration, maintenaace, repair and moving of buildings
within the dty limits aad� permft may be revoked at any t�e� vi�pn of sny of the provfsiona of said
ordfnancx�. / 9 / 1
Buildiag Inspector
NOTICEa
Thh � dws nt eoosr t6s we�rueHon, i�t�IHNoe ier vrMeg, plvmbine, �a hsaNeg, swe� or rrmr. B� sun to sa�
f6� Bnildieg le�cloe tor apuaM p�rm6a Por ��ms.
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� „ -: . . , ,. � . . APPLICATION FOR BUILDING. PERMIT : � •: , �.. ; , . :: _� . :
_ , . . ° . . . _�.' ., • : �
, . , CZ7.`Y (�F. FRIDL�Y, MINNL�OTA. ; � ,. .. ,; „ �
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OWNER' s NAI�:9��
Ann�ss �j� '`�
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��-.�f'� .: . .,. ADDR�'sS►,S, •��� �� , s'/ C�
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LOCATIOPT OF BUILDING- . ' . _ .
No. ��� � .�� �e� Street - Part o£ Lot
, � •.. , - �� � ��.._: �
Lot . � ' ' B1ock : , � . Addition •or Subd?lvieion � -�� � - �-�`t.,� ��� �'��� ,��1-�i�s�Z�' � �
. _ � . - � ,o �' �
Coraer Lot Inside Lot �� Setback Side Yard:
SEWER II.EVATION FOUNDATION ELE9ATION
Applieant attach.to thia,.farm Two Certif3cates o� Survey of Lot aad.propused build-
ing location d�awa,,.on these_.Certifiaatee. '
, � . � � � ' ,� . . .. .
. ;: , ..
DESCRIPTION OF BOILDING '
To be used as; �
���� �ia��-� C?��� � �.- r:- y,, � � �
�c ; : -; � : � � , �� � _
�. °%� �1�� .��� �-e�:-� FronC_� , �� �;;Derpth��, � '�Height•� �
. Sq. Ft. � / �(�. �,� �� , Cu. Ft: � �, �� �e . �
. _...__
Fsont . Depth Ae3ght
. . � . :. _
� S.q. Ft . Cu . : Ft.: �
Type of, Construction ����^?-�-� EsLi:mated, Cost �'``� °'
. . � . � . . yr,� .
To be Completed � : � � �� � . _ , . . � . � � , ,
The undersigaed hereby makes application�:€or a.permit for the work hereia �,pecified,
agreeing to do all work in atrict accordaace with the City of Fridley Ordin�nces and
ruliags of the Department of Bu�ildiaga, and�herehy �eclar.ea that all ttre facts and
representatioas stated in this application are true'and�correct.
� `/,� � � � SIGNATUIiT ��'��� � `r l
�Schedule of Fee CosCs can be found on the Reverae Side).
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BUILDING PERMIT FEE SCHEDULE
� Sectioa 2. The Inepector of Buiidings shall, before is�uiag any perenit for
, the erection of any building or structure, or for any addition to any exiet-
ing building or aCructure, or for any alteraCioas or repaire to any existing
bu3ldiug or sCructure, upoa application therefor, require the payment by the
applicant for such 'permit of fees to the amou�t hereia below seC forth and
it� the mannes hereia provi.ded to-wiC;
2.1. For any such permit for the erection of any #ir�-prvof building, other
than a garage� warehouse, factory or graia-'elevator, or for the'e�ectioa of
anq fi�e-proof addit3on, for similar occuparuy, Co aay zxiating building
shali be at the rate of $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contenCs.
2�2. For any euch germit for ehe erection of any fire-praof garage, warehouse,.
factory or grain elevator, or for the erection of any fire-proof addit3on,
�for -similar occupaacq, to any exiating buildiag shall be at the rate of $1.25
for each oae thousand cubic feet, clasaified as /1fireproof" bq Sectiva 502 of
the Minneapolis Building Code. ,
HOUSES
2.3. For �y such permit for the eiection oE anq aon-fireproof bui.ldiag othe�
than a garage, warehouse, factory or grain elevator, or any boa-fireproof
_ addition, for s�tmilar occupancy, to aay existiag building - permit $1.00 for
each one thousand cubic feet.
GARAGES
2._____4., For any such permit for the er�ctioa of anq noa-fireproof garage,
warehouse, factorq or grain elevator, or for the erection of,any non-firaproof
additioa, �'or-similar occupancy, to anq existiag buildiag or for each such
_r_. -build3ag or addition - niaety cents ($0.90) ior each one Chou�and cubic feet
or fra¢t3on thereof, in the cubical contents thereo€ w3th a minimum of $4.00.-
For the purpose of computiag fees for building permits, the cubical contents
of any buildiag or addi.tioa Co a uniform height throughout by multiplying the
ground area,covered from a point six (6) iaches below the floor liae of the
b$sement or cellar to the average befgl�t of the upper surface cr to the
average heighC of the r�of surface of the main gable of a p�.tched roof.
2.5. For repairs or alteratioas to aa exiating structuxe, the fee �ha11 be
at Che rate of $3.00 per each Five Huadred Dollars ($500.00) or fraction
thereof in the cost of all progoaed work. �
, �
2.6. In no rase shall the fee__char�ed .for..a.np permit as ��set forth ia
Section 2 be less. thaa $4.D0. .
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sus�ecr P N O.
City of Fridley 19257
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � R EIPT NO.
COMMUNITY DEVELOPMENT DIV. ����
r i L � PROTECTIVE INSPECTION SEC.
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l--_.� ��"��,.� CITY HALL FRIDLEv SS432 NUMBER REV. DATE PAGE OF APPqOVED BY
i 612-571-3450 910-F15
103087 � �
JOB ADDRESS 510g Hughes Avenue N. E.
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 11 6 Carlson's Summit Manor South Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Maurice Bla.nch 5109 Hughes Avenue N.E, 572-8231
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
American �emodeling 3700 Annapolis Lane, �lymouth, NIl�T 55441 553-0020
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION D� REPAIR ❑ MOVE O REMOVE
B DESCRIBE WOHK
Reside Dwelling
9 CHANOEOFUSEFROM TO
STI PU LATION S
SEPARATE PERMITS ARE REQUIiiED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING S0. 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
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT $4, 500 $2 • 25
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISION ANY OTHER STATE OR LOCAL LAW REGULATING CON-
RU T OR H ERF MANCE OF CO ST CTION. $SO. SO
PLAN CHECKFEE TOTALFEE
' �,�'%� $52.75
Grvar R OFCON7RACT RAUTHOR12EDAGENT IDATEI WHEN PROPEFLY IDATED T IS IS YOUR PERMIT
SiGNATURE OF OWNER iIF OWNER BUILDERi �DATE� BLDG INSP �� �a E�
N� [] City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
pLTER. [ ] Building Permit Applicatioa
Construction Address: -���� �`y��`� ��� • �� . -
Legal Description:
Owner Name & Address : ������� � °��� Tel . � -��°'� �� -�/
��i����� ���i� d� �� Tel . # SS��ca.zo
Contractor: _ _ _
Address
LIVING AREA:
GARAGE AREA:
DECR AREA:
OTHER:
�s �ii/�
�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTIOH OF IMPROYEMENT
�
Length Width Height Sq. Ft.
Length Width Height Sq. Ft. ________—
Length Width Hgt/Ground Sq. Ft. _
Corner Lot [] Inside Lot [], Ft. Yd. Setback Side Yard Setback �
Type of Construction: �s'' u' �� Estimated Cost: $����
Approx. Completion Date: �..� ° ����
Alt. A Alt B
Proposed Driveway Width If NeW Opening Is Desired: _ � �
See Baek Page for Explanation
DATE: �� �� ��
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
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APPLICANT -
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� �� � Fee Sehedule on Reverse Side
$ 25� of Building Permit Fee
� � �` $.50!$1,000 Valuation
$ _ $ 525 per SAC Unit
� Fee Determined by Engineer3ng
$ �,S"° Agreement Necessary [ ] Not Necessary [ ]
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existina furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions, �
and is securely supported and firestopped where required. Yes (�o ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (�No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air. it will be sized and installed
To meet the current codes and manufacturer's specifications.
Yes ( � o ( )
Yes ( ) No ( )
Yes ( �No ( )
When installinq a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes (� o()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from .the common vent and vented
separately as per current codes. Yes (�No ()
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type �il���� BTU Input O gta Fan Assisted or Nat 1Poc.��
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input •
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe) 5'l a� V u�-`�� � iJ �. �c� ��A-�z� -�- � �� ,�
�!� � � r�t H,c���v,✓ �o �2 t a�/�
a�'d"����'iA'!�� �M�„'n��T�/4if'h:..n�.*; p�, �.
61t1 .�?`��1�9 d�a^�ao.!^ s'��.
HEATING CO: �rys��,?, 6�'�r� �;-o�:.�
Signed By: �� Date : °� ���(
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CITYOF
FRiDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UMVERSTI'Y AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
March 8, 2002
Laura Lee
5109 Hughes Ave NE
Fridley, MN 55421
Re: Final Inspection at 5109 Hughes Ave NE
Contractor : Superior Contractors, Inc.
Dear Ms. Lee:
A mechanical permit was issued on February 23, 2001, to install a furnace at your address.
According to the 1991 Uniform Mechanical Code, a final inspection shall be conducted on the
work authorized by this permit. As of this date, no inspection has been called for.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Code. We will keep your permit open for another 30 days and if we do not hear
from you within this time to set up the inspection, we will mark the permit "no inspection called
for" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerel
DAV� JENSEN
Buil �Yng Inspector
DJ/ls
.e
a
BU11C�lrig; $U�..D�(i Permit No.: � i���' l°1C�
Itlspe�tions RESIDENTIAL APPLICATION �teceived sy: �' ~—
763-572-3604 CITY OF FRIDLEY vat� `' J�11V � ���
763-502-4977 FAX EFFECfIVE 1-1-2010
nA� � o"� I 1� YpUR E-MAIL ADDRESS � Y I S C� Y1 f� r I C� ('1 Glr�i {1 V���t�P°IC��'�,
SITE ADDRESS � n �'r i I�,�,�
THIS APPLICANT IS: ❑ O ONTRACTOR
PROPERTY OWNER/ Np�: �
TENANT annttESS: 5 l O� G�� �.P�'rx �I��
� �ci l� � sTA� z�� � 1
PHONE: % �ss 3 , S �% f - � C' '� �
CONTRACTOR Np�:_�-��� C�_� i�SfiY'tA G� C� e I�i C' ._
SUBMIT A COPY OF STATE LICENSE # EXP DATE � I J o�
YOUR STATE LICENSE 3 I I
AND CERTIFICATE OF ADDRESS: I� CITY_}� STAT�ZIP�
INSURANCE PHONE I— -- FAX �— �r�
PROPERTY TYPE GLE FAMILY/NEW COIdSTRUCI'ION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERNIIT TYPE ��DI1'ION O GARA�SHED 0 WINDOWS
❑ BASEMENI' FIIVISH �800 p�,e- r� of ) O DRA1N TILE
❑ DECK ❑ 5IDIN ❑ OTHER
❑ SWIMNIING FOOL
TYPE OF WORK: O NEW HOME CONSTRUCTION ❑ ADDITION
�.pQAINTENANCE/REPAIR ❑ REMODEL[NG
DESCRIBE WORK BEING DONE: -t- j -}-'Y� �
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S F1'
RQOFING S � (�rf� ❑ HOUSE ONLY
NUMBER OF S UARES � BASEMENT REMODELING SUBM�TT;
M
Q � I� �OUSE & GARAGE 1. Existing Floor Plan
GARAGES a ❑ ATTACI�D GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACF�D GARAGE 3. List of sfi�ctural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. 8c POIiCHES SUBMIT:
❑ Vinyl ❑��t i. Site Plen/Survey showing the existing stcuctures
❑ Aluminum ❑ Trim and ProPo� ProJect.
❑ Other ❑ Fascia 2, Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ONo LOCA1'ION OF WINDOWS FOR WINDOWS - PROVIDE U-dALUE AND
OR FOR NEW OPEMNGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WIlVDOW TO BE INSTALLED \ NUMBER OF WINDOWS
ALL FEES ARE BASED ON ALUATION. INCLUDING THE COST OF LAB�R AND MATERiALS:
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Doe
(USING THE �999a U.B.0 FEE SCHEDULE)
� C� � � — t�cCirn.
$ �1 "4 ,:'� � See Back Page for Fee Schedule
$ 65% of Building Permit Fe�e
$ r .001 times the total job valuation
$ ( $� .0005 x Permit Valuation Minimum $.50
� L� $5.00 (State Licens�i Residential Contractors)
$ $2100 per SAC Unit (Plans to MWCC for determination)
$ $+6ft= ftx$24=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$__ ___ V � Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERNIIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge 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 I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all work which requires review and a p val of plans.
SIGNATURE OF APPLICA,N� �'1. NAME�ST�AG M. IN ��A1'E �� a I � I�i
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