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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
�
constivctionAddress: ��.5% /�/-����� �,�
Legal Descrip6on:
Owner Name & Address: /W ,,,r CiT� / w,v i,,lo�,�1 Tel. #
A
�Odh'8Ci0I'
Aadress: �"z a s-- `1'i.
MN LICENSE #
�6�y�
Attach to this application, a Certificate of Survey of t�e
lot, with the� proposed construction drawn on it to sscaale.
DESCRIPTION OF IMPROVEMENT
Cff-ective 8/ 1 /95
-���a
Tel. # SS'I'- S�Dl�
�
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length �dth Hgt/Ground Sq. Ft.
OTHER: /1�F� G���_'� ,�l "�-�'L.4G�" _
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard S�a.cks
'Type of Coastniction: E�imat,ed Cest: $ /�C� � _
,l�pprox. Completion Date:
(Cost on Back)
�riveway Curb G�t Width Needed: Ft. + Ft = Ft x$ _$
DATE: _ APPLICANT: �- i� 1� � Lc,U1� �-�..� Tel. #_� s q_ S�
d
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
flriveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATI4NS:
$ � 75
$ /. a v
$ •Sa
$
$ �; a v
$
$
$
$
$ /� �
CITY USE ONLY'
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/i(�h%)
$.SO/51,000 Valuation
$850 per SAC Unit
$5.00 (State Licensed Re.sidential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Nece,csary [ ] Not Necessary [ )
�, _ _ �.
sue�ecT P •
City of Fridley � � � �
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T
r
� �
, � RECE�PT NO.
� • COMMUNITY DEVELOPMENT DIV. �
� LV_�����',
r � � PROTECTtVE INSPECTION SEC.
, � �'��1 � CITY HALL FRIDLEv 55432 � NUMBER AEV OATE PAGE OF APPROVED B�
�""'�'� �'' 612-57 t-3450 910-F15 1/ 16/96 / /
JOB ADDRESS
1057 Fillmore Circle NE
t LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1 1 Hillwind Townhouses SHEET
2 PROPERTY OWNER MAIL ADDRESS IIP PHONE
Twin Cit Townhomes
3 CONTRACTOR MAIL ADDRESS Z�F PHONE LICENSE NO
Midwest Fire lace 2 H 6 P1 h 4 2 559-5900 2359
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDHESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Resid ntial
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WOFK
Install wood burnin fire lace
9 CHANGE OF USE FROM TO
STIPULATIONS
Install per testing agency's specifications.
TVPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONOITIONING.
THI5 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
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA��S GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. A�L PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �ifOOO W.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- �34. %S Fire SC � 1.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK fEE TOTAL FEE
License SC $5.00 $41.25
S�GNATUFlEOFCON�RACTOROAAUTH0�7�ZEDAGENT IDATE� WHEN PfiOPER VALIDATEO THIS IS VOUR PERMIT
_ � (,.(/v � � ( � -/ �
SiGNaTURE OF OWNER�iF OWNER OUiLDERi IDAiEi .�♦ BL G�NSP � q41E
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Construction Addrecs: �
Legal Description:
Owner Name & Address:
Contractor: '
Address: la�.{ 1�-Lt
CiTY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-Z
Buitding Permit Applica6on
� ��
Effective 1/i/94
�a5 �
20--�1�4 Tel. � `�'�
MN LICENSE # �('��ol ��J
�� �`il � Tel. # �.��% �?-f4�
Atzach to this a�fplicat�on, a Certificate of Survey of the
lot, with the proposed constructicm drawn on it to scale. Q� �
DESCRIPTION OF IMPROVEMENT �IC �`� � �
LIVING AREA: Length
GARAGE AREA: Length
DEGK AREA: Length
OTI�ER:
Width
Width
w�a�n
Height Sq. �`t.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
Corner Lot [) Inside Lot [] Ft. Yd Setback Side Yard SetbaCks ,�„
Type of ConsEruction: Estimated Cost: $ ���D�
Approa. Completion Da : —/s ''
(Cost on Back)
Driveway Curb G�t Width Needed: Ft. + 6 Ft — Ft a$� —$
DATE: -� � APPLICANT: /%% Tel. #�C� %�%�l1
,
CITY USE ONLY. ,
`. Permit Fe� '., , $_���1�,,,�`'�' ._ Fee Schedule `on Reverse Side
F'u�e Su�charge $ �: �� ..001 of Permit Valuation (1/lt�th%)
State��ureharge : S , S,� S.SO1�1,U((ff) Valuatioa
SAC Charge _ $ , $800 per SAC Unit .'
License Surcharge $ J`� . D C� $5.00 {Stat� Licensed Resideatial Contcactors)
Driveway Escrow $ Alt. "A" or Al�. "B" Above
Erosion Control $ $450.00 Cons�rvation Ptan Review _
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Ne+cessary [] Not Necessary (]
TOTAL $� �
STIPULATIONS:
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Jan-26-96 02:42P AIR MECHANICAL INC
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FRIDLEY
FRIDLEY MUNIC(PAL CENTER • 6431 UN►VERSITY AVE. ti.E. FRIDLEY', titN �S�i32 •(612) 571-3450 • FAX i61 �� 571-12K7
June 24, 1996
Twin City Townhomes Inc
1250 E Moore Lake Dr NE
Fridley, MN 55432
Re: Final Inspection at 1057 Fillmore Circle NE, Fridley, MN
Dear Sirs:
A final inspection was conducted on June 24, 1996 of the above noted address. We found that
the construction of the building unit complies to the best of our knowledge and belief, with all
the requirements of the building codes of the City and the State of Minnesota relating thereto,
and permission is hereby given for the occupancy of said units.
If you have any questions on this matter, please feel free to contact me at 572-3602.
Sincerely,
RO ULKOWSKI
Chie Building Official
RJ/mh
. �
sue�ctr P
City of Fridley
AT TME TOP Of TME T1N�NS B � ��� ������� � T 2 8 V O 9
r
� ` RECE PT
� ; y ����� COMMU!'!►TY DEVEIQPMENT DIV.
j � �� PRpTEC7iVE INSPECTION SEC.
� _ .
� �"'1 � CIFY MALL fR10LE� SSI$2 NUMBfN pEV O�TE PAGE Oi A► pOVEO Sr
�----�� �•' 612-571-3450 9t0-F15 I2/31/98 � /
�oe no�Aess 1057 Fillmore Circle NE
1 IEGAL �OT NO. 9LOCK TRACT Oii AOOITION SEE ATTACHED
oescR. 1 1 Hl�.IW1.AC3 TOWriYlOII12S SHEET
2 PiiOPERTY OWNER MAIL A,OOR�S$ ZIP PHONE
3 CON7RACTOR MAIL AODRQSS 21P PHONE UCENSE NO
_ Top Gun Inc. 5014 PARRISH Ave -
4 ARCHITECT OR OESIGNER MAIL AOORESS ZiP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO
6 USE OF BUI 1 G
Reside ial
7 CLASS OP WORK �
O NEW Q ADDITION O ALTERATION X$ REPAiR O MOVE O REMOVE
8 DESCRIBE WORK
9 CHANGE OF USE FROM TO
STIPUTATIONS
Call for building wrap inspection before covering.
TYP OFCONST. pCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS AqE REOUIREO fOR EIECTRICAL, PIUMBING, MEATING.
VENTILATING OR AIR CONOITIONING
THiS PEFMIT BECOMES NULI ANO VOID If WORK Ofl CONSTRUGTION 20NING SQ. fT CU fT.
AUTNORIZED IS NOT COMMENCED N/ITMIN 60 DAYS. OR IF CONS7RUCTtON
OR WORK IS SUSPENDEO OR ABANOONEO POii A PER100 OF 120 OAVS A7 �
ANV TIME AFTER WORK IS COMMENCED. NO OWLG. UN�7S OfFSTqEET PARKING
I HEREBY CERTIFV THAT 1 HAYE R�AQ AND EXAMINEO THIS APPlICA710N STA��S GAFAGES
ANO KNOW TME SAME TO BE T9UE AN0 CORRECT. ALL PROVISIONS OF LAWS VAIUATION SUHTA%
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL 9E COMPUED
WITM WHETMER SPEGf1E0 MEREIN OR NOT. THE GRANTING Of A PERMIT �SOO $.SO
DOES NOT PiiESUME TO GIVE AUTMORITV TO VIOLATE OFi CANCEL THE PERMIT fEE SAC CNARGE
PROVISIONS OF ANY� OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION OR TME PERFOfiMANCE Of CONSTRUCTION �ZL.00 Fire S $.SO
PLAN CHECK f EE TOTA� F E
Licen $5.00 $27
S�GNATUpE OF CON"�7AC.TOQ OA AU�HOQ�ZEO �GENT iO�TE� N P OPE �� ALIOATE T S IS VOUR PEQ T
> /
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$�GNStUAE O� OWNEa�i� OwNEpBw�DEA� � �O�iEi � � B�0 �NS� - � ���Tf
NEW ` ' � ]
ADDN [ ]
ALTER [ ]
ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Legal Description:
Owner Name & Address: � Tel. #
Contractor:
Address:
MN LICENSE #
Ati�ach to this'application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
� �. � DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AItEA: Length Width HgtlGround
OTI3ER:
Effective 1/1l98
/
i ���
Tel. # � �--:�5�'S ,S� `i
Sq. Ft.
Sq. Ft.
Sq. Ft.
�
Construction Type: � Estimated Cost: $
• � • � (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �- —� � APPI:ICANT: Tel. # �-) `� �rs � �
- CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Chaxge � �
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer'Main Charge
TOTAL �
. STIPULATIONS:
�
$
$ � Sa
$ � Sd
$�
$ �
$
$
$
$
�
$ '�'
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (5tate Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
>
CITY OF FRIDLEY
= 6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
572-36U4 N'AX:
: 1057 FILLMORE CIR NE
: 243024320130
: UNAVAILABLE
: LOT BLOCK
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
571-1Zti7
PERMIT NO.: 2004-02191
DATE ISSUED: 11/29/2004
�gg���
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
# A/C UNITS 0 VALUE OF APPL OR WORK 0
# FURNACES 1 # GAS DRYERS 0
# GAS RANGES 0 VALUE (FOR MINIMUM CALC) 2369
APPLICANT
AIR MECHANICAL INC
16411 ABERDEEN ST NE
HAM LAKE, MN 55304
OWNER
HARSTAD FORREST K
1057 FILLMORE CIR
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at ariy time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. 'The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
App� !� Date i �
Bldg Insp
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 028928
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0.00
35.00
0.00
0.00
0.00
0.00
0.50
35.50
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OCT-0'7--2�a4 � 16' 22 C? 7�Y OF FF? I GLE`.�'
P . C��.'0�
FtLL fN CQMPL�TEi.Y FOR R�PIACEMENT FUEL �URNING A�'PLIANCE PERMITS
COMMON VENT. il�Ni C�NNECTpR AND CONi�U�TlOIV AIR VERIFl�ATiON
'Whert rep�ac„�1� �n existin� furn��, ti� unde�igned hereby var�iies that th�
v�nting haa been escamined and is f�e from rust, deterior�tion, obstructions,
and is seCUtely supportad ar�d fi���top�d where r�quired_ Yes� � No ()
Ttte ve�ing system is pla�t+cdPVC �nd meets ali c.urrent codes and manufiacturer
specifir.atbns induding sizing, len�th, number af eibows �nd term+nation. Yes () No �)
Ttye ur�dersi�ned also verifiES that the rcplacement unit is a listrd a�$embly
and meeta the wrrent a�des �n� manufactu�ar's sp�cifications. This does
inClude AGA-GAN1A Ca#egory I Central Fumace Venting Table� for fan
assisted and natural dra�t applianaes.
/
Yes �1� i, ;
The exiatin,� combustiot� air is si�d �nd insta€led to meet the +cu�rent co��s
. . . _ _�_�-?
- - — - - --- - - -- �--� -- - _
When required to insta!! a nsvy combu�tiQn air, it will be si��d and installed
to meet the curr�nt cod�s and manufa�turer's specifications. Yes �j
Wf�en l�staltins� a nsvsr veotina svs�em, the undersigned hereby verifi�s that
it is a tisted assembly and me�t� th�a current codes and ma�u€acturer's
speafications. This does indud� AGA-GAMA Cat�gory ! Cer�ral Fu�nac� \�
Venting Tables for fa� ass�steti and nakural draft appfiances. Y�s�) ,
ido ( )
No ( �
!s the common vent and vent cannectars sized and instalted correcfly aft�r
an �ppli�nr.e has been remov�d frorn the c�mmnn v�nt ar►d ;rented
separately as pe� current codes. Yes (� h10 (}
��
Appliance TYpe and SizrlComn�oar Veni and Yent Cannector Ireformat�on
ApplianCe #1 Type S�C`fAO�n.�j�,,, BTU Inp�t ��O,UDC� F"�n Ass+stet! nr Nat „C�,_,,,
Appliance #2 iype BTU inpUt __ � Fan Assisted nr Nat __�._
Appliance #3 Type BTU Input Fan Assist�� ar Nat �
Tcta! Appliances r_,�____ 'T'ttal Btu Input m�► ,,,��--
Cammon Ven! Type
Vent H�ight �, Diamet�r inciies
Appli�nce #1 Vent Connector He3ght �ft l_eng;h �it Diarneter "�in Type ��
Appli�nce #2 Vent C:onnectvr Height ft l.ength ft C3i�mete; in T}r�e �
Appliance #3 Vent Corn�er,�ar Height ft Len�th ft Diarn�t�r �in Type ,�
ALTERr�TfONB: ri
HIEATING CO� � ('����,����.� _- -
Signed By; " % „� �at8 : _ l f� % �� �
?U iF7L F. �� �
� ' .
.`