PRE 2010 DOCSCity` of Fridley, Minn..
BUILDING PERMIT 4 s 81
e
Date:
Owner:._.. r. ..` .:e '`'.. - !�, - guilder
Address ._..____.___ _ _ ___ . _ _ Address X
--AOCATION OF/)BUILDING
No... _. _ Street --k-41C 1; A ....... P f Lot
Lot ....._...... ....___........ Block .._._.. ._7 ......... _................ Addition or Sub -Division ... .:.....;nr
Corner Lot .................... _.... _....... Inside Lot .------ ............ Setback ....._.. ;, ....... Sideyard ....., .. _. ...-----__..._..
Sewer Elevation._.._.....__....__.....--------.._..--_-_-------..___._------_.. Foundation Elevation ........... ........................... ................
DESCRIPTION OF BUILDING
To be Used as: 1$ �
,I
-- .. �4. :..:.... Front _...� Depth .... �.. Height .. .. .. � Sq. Z''t,,�'.�--Cu. F���
. a• '` 4 ...... Front.. _.. Depth...... �, �� Height -Z-90 .x' Sq. Ft. 3 Cu. Ft. �j.. 40
Type of nstruction :. Est. Cost'.:, .. _ � To be Completed .....- ............._............._......._........
In consideration 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 city of Fridley.
In consideration of the payment of 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, around 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 any time upon violation ofg any of the provisions of said
ordinances. Z5 ,07 I
Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. pB,e sure to see
the Building Inspector for separate permits for these hems. CAUTION
ION OPW FRIvATE LAND GOVENANTS AN -0
BUILDING RESTRICTIONS. --
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Nsm' �� Builder �'�y
Address���� Address�„��=�-1���
LOCATION OF BUILDING
No: Streat Part of Lot
Lot _ Blocker Addition or Sub.Div.vi:
Corner Lot,
_,,;6'_jatlside Lot.L_Set Back Side -Yard_,/'.__._,
SEWER ZLEVATION FOONDAT10N ELEVATION
Applicant .attach to this form Certificate of:Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used ad:
�. Front 7Depth HeightE! ® .
Sq. Ft. Cu. Ft. ... :,
th Hai ht.
Front
_. .
Sq. Ft. Cu. Ft. ,. .. .
Type ot:Construction , ✓�---. Estimated Coat r g �
To be completed_.
The undersigned hereby makes application for a permit for the work herein specified,
aoreep.pg to do all work in strict accordance with the City Ordinances and ruling of
tk,p.DBpartment of Buildings, and hereby declares that all the facts and representa-
tioas'.siated in this application.are true and co ect.,'•
)ATE _ �7 / SIGNATUBE
(A'Sohedule of Fee costs can be found on the Reverse Side.)
GEORGE E. HOPKINS • Registered Land Surveyor and. C *il Engineer
Phone SO. 1-8856 10701 Nkiet Avenue South
Minneapolis' 20, Minn.
PLAT OF SURVEY
//// Seale 1 inch 40 feet
PROPERTY OF D/7�al9 Ga`J� J�'/�/�1�0� �`.�9 Geo%i»lv✓�%ri�,_�l���i Z.7
Deserlbed as L O T 6, BLOCK 5, INNS 5 R U C K 1 ST ADDITION
1 Z0.0
lZ0.o
"°' deno}e5 iron monument
This Survey was made and a cerlif ica6 prepared for
for the purpose of 5howin ' boundaries of }he Iof and Alily easerncnis.
There are no encroachments.
CERTIFICATE OF SURVEY
I hereby certify that on Nov. 19_2 I surveyed the property described above and that the above plat Is a -correct
representation of said survey.
Grlr
0
City of Fridley
Application faw Plumbing and Gas Fitting Permit
DepL of Bldgs. Phone SII 4.7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... '0/0 x $1.50 $ 'S
Future Fixture Opening ................— A -x 1.20 $<c
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x
Water Heater (Up to 200,000 BTU) ......—e x
New Ground Run Old Bldg. ............ x
3.25 $
2.00 $ g=R ^ ��
3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $1/1*1—
p
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description................................................$
TOTAL FEE
City of Fridley:
It
The undersigned hereby .makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true a9d correct.
Fridley, Mini
Owner /IZ�v _r
Kind of Building
e °
Used as
To be completed about
Estimated Cost, $ y
43
Old—New. Building Permit No G� Permit o. '�
Sign
0
By
Business Phone No.,
ROUGH ,® -../ 9 - 6 0
FINAL
42 2M.7 -S9
19 ` d-
i
y
OZ
�r3gz
5O�
-j1
0a
z
�0
•
F
r
N
WATER HTR.
GAS
ELEC.
Base
1st
2nd
_
3rd
_
4th
• Future Connection Openings
I
Connected with
sewer
New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... '0/0 x $1.50 $ 'S
Future Fixture Opening ................— A -x 1.20 $<c
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x
Water Heater (Up to 200,000 BTU) ......—e x
New Ground Run Old Bldg. ............ x
3.25 $
2.00 $ g=R ^ ��
3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $1/1*1—
p
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description................................................$
TOTAL FEE
City of Fridley:
It
The undersigned hereby .makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true a9d correct.
Fridley, Mini
Owner /IZ�v _r
Kind of Building
e °
Used as
To be completed about
Estimated Cost, $ y
43
Old—New. Building Permit No G� Permit o. '�
Sign
0
By
Business Phone No.,
ROUGH ,® -../ 9 - 6 0
FINAL
42 2M.7 -S9
19 ` d-
to
s
Application for Power Plants and Heating. Cooling, Ventilation, Refrigeration and
Air Conditioning System and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Furnace Shell & Duct Work ..........................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 ..................
Repairs & Alterations each add. $500.00 ...............
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU .......................
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .................
Repairs & Alterations each add. $500.00 ..............
STEAM or HOT WATER SYSTEM
RATE TOTAL
8.00 $
5.00 $
5.00 $
2.50 $
8.00 $ y
2.00
$
5.00
$
5.00
$
2.50
$
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $
Each add. 200 sq. ft. EDR Steam ...................... 2.50 $
Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $
OIL BURNER—to 3 gal. per hour ........................
5.00
$
over 3 gal. per hour --See Fee Schedule
GAS BURNER
(up to 400,000 BTI) .......................
5.00
$
GAS FITTING FEES:
NO RATE TOT/AL
1st 3 Fixtures ......................
x $1.50
$ f✓
Additional Fixtures .................
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM
,ALTERATIONS & REPAIRS
TOTAL FEE
REMARKS:
Dept. of Bldgs. Phone SU 4-7470
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
OCT 2 0 1960
Fridley, Minn ,r 195—
Owner
Kind of Building
Used as
To be completed about t u 4 U I=
eel
Estimated Cost, $_— %®®
w. ding Permit No. -�O�f/
DESCRIPTION OF WORK
HEATING �. a+,Qr, Warm Air—No.
Trade Nam / Size No ./.�� i�
Capacity Sq. Ft. E.D.R Z�' BTU H.P.
Total Connected Loa ^ Kind of Fue®
BURNER — Trade Nam � � ` f Size No-�/®
Capacity Sq. Ft. E.D. 2 • rrarA'9 BTU. H.P.
rA GEO. SECS WICK HTG. & AIR-COND. CO
®� 1001 Xenia Av. S.
Minneapolis 16, Minn.
11 5 Mill
Signe�
A90-11 posr 1M-12-58 Business Phone No
195-
195—
HEAT LOSS CdCULAnom DEPARTN EM OF BUILDINGS
Weatherstrips Guide Construction No.
lowsDoors Reference Out. Wall Int. Wall Ceiling Roof Floor
:NoI 'mea— 0 19_
L Room I Length la Width Height j Fl.( 4
Windows a Doors—Cracltage Area WM&W d
Width Height No. of LI 1 t Area 1 Width 1
of pane of pane Ilghts o oraek aa. [t. �'A► No. of pans a
..: pa
i i j Coef. Btu
Infiltration 412 1� j-1 -Mr
Glass
Ev.wall _'IAI
Net exp. wall -
r' 'e
AFw
Width Hslght No. of Llsaal ft. Area
Nos of pane of pane lights of crack sq. ft.
•i' j
Ceiling
Floor s
Cftf.1 Btu
Total Btu.
"
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Room I LengtheWidth
Height
Windows and Doors—Crackage and Area
Ceiling
Width Height No. of Lineal ft. Area
No. ' of pane of pane lights of crack sq. tL
"0"
hy
coef.1 Btu
Infiltration`
_ foI k
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor '
Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. Leader area
I FL17= F:g `a+' Room I lenath �o an Width . z, 146ht
Windows and Doors--Crackage and Area
r' 'e
AFw
Width Hslght No. of Llsaal ft. Area
Nos of pane of pane lights of crack sq. ft.
•i' j
Cftf.1 Btu
Infiltration
Glass
"
Exp. wan
,
Net am. wall
Int. wall
Ceiling
Floor
f otal I"
Required sq. & EDJL or sq. ins. WA. Leader area
LD. 218
i
Infiltration
Village of B19omington
Insulation
How
r Height
fly
mM Btu
Glaa� —111.C22
&P. wall p
Net exp. wall
Int. wall
Ceiling
Floor 6
Total Bat.
.2Required sq. ft. Ep,.D.R. or sq. ma. W.A. Leader area q
s � t .�., v a �... _..�; � _t�Mf.. t t ,nit. a .b' '�. ® �l/��t• a L� Jl ���s�� B�
Windows, and Door—Gaokage and Area
.r 1.1
Width Height o. of Uneai ft. Ana
No. off "no of pam lights of crack ep. tt.
•i' j
Btu
Infiltration',
Glan T
Exp wall '
"
Net exp. wall
Int. wall
,
Ceiling
Floor
Total JIM w
Required sq. ft. E.D.R. or sq. inL WA. Leader area
FL , ,, Room I Length Width Height
Windows and Doors--Cracimip and Area
Width Height no. of Lia tt. Ana
No. of psna of O Ilghts of crack eq. eL.-
,e
---t- -
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp.. w
Int. wan
h. E.D.R. or sq. ins. W.A. Leader area
Village of Bloomington
HEAT LOSS CACcOu TONS DEPARTMENT OF BUILDINGS
Weatherstrips Construction No. Insulation
W, I D n Reference Out. Wall Int. Wall Cel7iag Roof Floor ICinEd How Applied
19
Room I L.ensith A Width f M Hekht II F1.1 Room I Lith Width Height
Windows and Doors—Craekage and Area
A�
Width Height No. of Lineal ft. Area
or pane of tune llahte of crack sq. ft.
Cftf.1 Btu
Infiltration
Glace
_ Fzp. wall
Net exp. wall
Int. waU
Ceiling Oe
Floor ,%► G' 5WTI717
Windows and Doom--Crackage and Area
WidthHeight No. of Lineal tL Area
No. of pane of pane lights of crack eq. tL
C ief. Bin
Infiltration
Glace
Exp. wall
Net exp. wall
Int. wall
Ceding
Floor
Required sq. & EDJL or sq. ins. W.A. Leader area
FM Room I Lendh Width Heisht
Windows and Doors—Craekage and Area
Width Height No. of ",Area
No. of Haas of pane lights of amok tq. tL
ONE BW
Infiltration
Glace
Exp. wan
Net ow. wall
Int. wall
Ceiling
Floor
City of Fridley
Applicafioe for Phwddng and Gas NOW hnmk
Dept. of Ridge. Phone 9®0-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
10
U)
z
Z
•
I
•
N
WATER KM.
GAS
ELEC.
Base
1st
2nd
3rd
4th
• Futuro Connection Openings
* New Fixture, Old Openings
Connected with
Sewn ❑
Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ x $2.00 $
Future Fixture Opening ........... x $1.50 $
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater ;Up to 99,000 BTU) .... x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Electric Wager Heater ............. x $2,00 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures ................ 1 x $2.00 ; 2.00
Additional Fixtures ..............-x$.75 $
Gas Range to 199.000 BTU .............. x $5.00 $
install (1) gas grill 3.00
REPAIRS & ALTERATIONS—Refer to Code
Description .................... ....... . • .... . ...... ..... i
TOTAL FEE $ 5.00
53-84-5915.51
Location 018 Matterhorn Drive NE
City of Fridley:
The .undersigned hereby snakes application for a permit for the- work herei
specified, agreeing to do all work in strict accordance with the Cita Ordinance
and ruling of the Department of Buildings, and hereby declares that aA the fact
and representations stated in this application are true and correct.
Fridley, Minn May 10. 1972 „ 19,
Kind of Building frame
Used as residence
To be completed about May 151 1972
Estimated Cost, $10 Q
OldX-New. Building Permit No. Permit No.
Signed
By
Business Phone No
ROUGH
FAUAL o
CWs "N' Surcharge .50,y
SUBJECT
P
City of Fridley
�52.
AT THE TOP OF THE TWINS
B U I L D I N G P E R M I T
r�
r
RECEIPT NO.
�y ______ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
5/31/79
JOB ADDRESS 5218 Matterhorn Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR,
6
5
Innsbruck lst Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Robert McKay 5218 Matterhorn Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Leonard Good)6road 7906 Terrace Road N.E. 784-3816
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Construct a 12' x 6' Addition to House
9 CHANGE OF USE FROM TO
STIPULATIONS
SEP ERATE PERMITS REQUIRED FOR WIRING,
NG PLUMBING .
HEATt AND SIGNSdtgg►ng ce►I joed
TELEPHONE Utilities
- ELECTRIC - GAS Etc.
REQUIRED Sy ;CAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
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
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
ISTALLS 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
$3,000
$1.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$3.8.00
TRU TION OR TWPEORMAN OF ONSTRUCTION._
N%
PLAN CHECK FEE
TOTAL FEE
('6r
$ 4.50
$24.00
'46IGNATURE OF CONTRACTOR OR AUTHORIZE D AGENT"(DATE)
WHEN PROPERLIS YOUR ERMI
BLDG WSP DAT
SIGNATURE OF OWNER I IF OWN ER BUILDER) (DATEI
CITY OF FRIDLEY
APPLICATION FOR m7sI f:uiTIAL LUJLDING Pr:AmITS
(NEW, ALTL"RATIONS, ADDITIONS, OR REPAIRS)
J
OW ER: �/
�J'
// BUILDER:
v
Address: Vii. r" �� Address:
. I
Tel. No.:
No. Street:
LOT: BLOCK: ADDITION:
���
CORNER LOT: INSIDE LOT: r"° " _ SETBACK: SIDEYARDS:
Applicant attach to this form A.io Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
4 2' � Front: �,� � Depth: �,rl Height: � .
Square Feet: Cubic Feet:
'Front: Depth: Height:
Square Feet:4 Cubic Feet: '
Type of Construction:
.�✓� Estimated Cost: $ d
To Be Completed:Alt. A Alt. B
Proposed Driveway tti'idt'h If New Opening Is Desired $ $
(SEE 12EVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all cork in strict accordance with the City of
Fridley Ordinances and rulings of the Dcpartment of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional info.. 'tion.
(j �' � �/� SIGNATURE': �!
DATE: _ ___" -
Stipulations: -
ad
3 0
Building and
— BY —
Remodeling Leonard Goodroad
m
004hone _
I
Painting and
Paperhanging
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUNIBING FIXTURE RATES:
Number Fixtures
Future Fixture Opening
New Fixture, Old Opening
Catch Basin
Water Heater - to 99,000 BTU
100,000 BTU to 199,000 BTU
Water Softener
New Ground Run Old Building
Electric Water Heater
GAS FITTING FEES:
1st 3 fixtures
Additional Fixtures
Gas Range to 199,000 BTU
REPAIRS & ALTERATIONS
First $100.00
each add. $100.00 or fraction
NO.
RATE
TOTAL
x
$3.00
x
$2.00
$
x
$2.00
$
x
X
0
x
Water
of
m
m
Q
x
$7.00
►bi
a -c+
e
q
x
4J
pa
w
$3.00
$
Heater
$1.00
$
$
c
m
°1
�
ro
'o
x
$
m ro
ro
4
M0
-4
U
k
0
w
c�
0
S
o w
W
w
U w
a S
U9
U�
0
as
kec
1st
2nd
f
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUNIBING FIXTURE RATES:
Number Fixtures
Future Fixture Opening
New Fixture, Old Opening
Catch Basin
Water Heater - to 99,000 BTU
100,000 BTU to 199,000 BTU
Water Softener
New Ground Run Old Building
Electric Water Heater
GAS FITTING FEES:
1st 3 fixtures
Additional Fixtures
Gas Range to 199,000 BTU
REPAIRS & ALTERATIONS
First $100.00
each add. $100.00 or fraction
NO.
RATE
TOTAL
x
$3.00
x
$2.00
$
x
$2.00
$
x
$5.00
$
x
$5.00
$
X
$10.00
$
x
$7.00
$
x
$5.00
$
x
$5.00
$
.x
$3.00
$
x
$1.00
$
X $3:0.00 $
$5.00 $
$2.00 $
State Surcharge $ .50
TOTAL FEE $ -d
REINSPECTION FEE
( $10.00)
Job Address ��(� ._is'f l �`•�r�i /
Department of Buildings '
City of Fridley
Tela #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and roprosontations stated in this application are true and correct .
OWNER
USED A
Fridley, Mn. (% / 19-?
3 -
TO BE COMPLETED ABOUT / ' "oor- 7Cy'
ESTIMATED COST �® C9 ..
OLD NEW B ING PERMIT NO. �� �� � PERMIT NO.
company
Signed By
Tel. No. 0
ROUGH INSP.
Date LFINAL IRSP. a - �L l ^ 7
Date
APPROVAL FOR PERMIT ^W
MINIZZ MM FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
FAI
07
SUBJECT
PER
of Fridley
F'3
AT THE TOP OF THE TWINS
BUILDING PERMIT
rpCity
�
RECEIPT
COMMUNITY DEVELOPMENT DIV.
SEC.
/I
r PROTECTIVE INSPECTION
1 CITY HALL FRIDLEY 55432
".j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/2/79
JOB ADDRESS 5218 Matterhorn Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
5
Innsbruck 1st Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
RDbert McKay 5218 Matterhorn Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Leonard Goodraod 7906 Terrace Road 784-3816
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION El ALTERATION El REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 23' x 25.35' Addition to House
9 CHANGE OF USE FROM TO
STIPULATIONS
WARMS
Before digging can total utalpa
TELEPH®NE • ELECtMC • 041te,
SE`P:ERATE PERMITS REQUIRED FpR WjRlW RMU11tED BY LAW
HEATING, PLUMBING AND SIGNS.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
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
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
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$13,450
$6.73
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL CON-
fREGULATING
TRUCTION OR THE PERFORMANC OF C NSTRUN.
$81.00
NONE
PLAN CHECK FEE
TOTAL FEE
$?0.25
107.98
IG
SNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) �,�WHENERLY
ALI DATED THIS IS YOUR PERMIT
d
BLDG )NSP E
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
FAI
07
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterati'ons, Additions, or Repairs)
OWNER: �)V �
ADDRESS: < f'�/'� L•
TEL NO:
BUILDER:
ADDRESS: c�
TEL NO: ' �" ?
Construction Location
STREET NO: STREET:--
.!
LOT: BLOCK: S ADDITION: ��! 42 f
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
�
a �
Front: .J
Depth:
2
��� Height:
Square. Feet: e /
Cubic Feet: #)I
Front:
Depth:
Height: 'J`
Square Feet:
Cubic Feet:
�.2
Estimated Cost: $
Type of Construction:
1�
lb Be completed:
Alt. A Alt. B
Proposed Driveway
Width If New Opening Is
Desired:
$ $
SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated ]11 this applica},^^ +r„n a^A rnrrcaCt_
DATE: SIGNATURE:
Stipulations:
PA- Ills)( v ,00 Pence.
do ep
63-8C�-l�i6o�1
10 CITY OF FRIDLEY
• APPLICATION FOR PLUMBING AND GAS FITTING PER44IT
PARTIAL RATE SCHEDULE
ESTIMATED COST 50.00
PLUMBING FIXTURE RATES: NO.
OLD - NEW BUILDING PERMIT NO.
RATE
Fixtures
x
$3.00
Fat•re Fixture Opening
x
w
New Fracture, Old Opening
M
tp
Catch Basin
water
$5.00
m
A
$5.00
1 0,000 B.J to 199,000 BTU
x
ro
u
a a
C• 4
m
e
New Ground run Old Building
++
:�
w
x
$5.00
Heater
++
C
Q
x
C
Additional Fixtures
E+
„a ro
x J
$4
U
Hp
F C
E v
APPROVAL FOR PERMIT
First $100.00
fa
$5.00
1U
0
c7
c
—4
State Surcharge
•"a
xm
. G
y
..Ly 7
O
O
m
N
N
m
Cl
ai
'A v
c
ci
ai
3
0°
bCi
w
U m
a r
chi
o
as
lec
Ist
S
ace
he
to
Zaa
qrm
Mcrn,6
Tma20
y_y
= Future Connection Opening
Connected with Sewer
E(R)
= Now Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
ESTIMATED COST 50.00
PLUMBING FIXTURE RATES: NO.
OLD - NEW BUILDING PERMIT NO.
RATE
Fixtures
x
$3.00
Fat•re Fixture Opening
x
$2.00
New Fracture, Old Opening
x
$2.00
Catch Basin
x
$5.00
:cater Heater - to 99,000 BTU
x
$5.00
1 0,000 B.J to 199,000 BTU
x
$10.00
Stater Softener
x
$7.00
New Ground run Old Building
x
$5.00
Electric Water Heater
x
$5.00
GAS FITTING FEES:
Date
lst 3 fixtures
x
$3.00
Additional Fixtures
x
$1.00
Gas Fa.-ge to 199,000 BTU
x
$10.00
REPAIRS & ALTERATIONS
APPROVAL FOR PERMIT
First $100.00
$5.00
each add. $100.00 or fraction
$2.00
State Surcharge
TOTAL FSE
REINSPECTION FEE
($1.0.00)
Job Address 5218 Matterhorn Drive
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and ccrrect
Fridley, Mn. 1-16-81 , 19
OWNER Mikay .
KIND OF BUILDING frame
USED AS res.
TO BE COMPLETED ABOUT
1-23-81.
$ MINIMUM FEE FOR ANY PLUMBING PEm= IS $7.50 PLUS, $.SO STATE SURMIARGE
S .50
ESTIMATED COST 50.00
TOTAL
OLD - NEW BUILDING PERMIT NO.
PERMIT NO.
$
company
ae._
$
MINNEGIASO®
Signed By
S
$
Tel. No.
$
ROUGH INSP.
$
Date
FINAL INSP.
$
Date
$
APPROVAL FOR PERMIT
$ MINIMUM FEE FOR ANY PLUMBING PEm= IS $7.50 PLUS, $.SO STATE SURMIARGE
S .50
f
suaJEcr
PE
City of Fridley
199 8 7
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
RECEIP
`-------- COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
3 �5�
t i
=
l ,,� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
7/10/89
JOB ADDRESS 5218 Matterhorn Drive N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
5
Innsbruck 1st Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Robert McKay 5218 Matterhorn Drive N.E. 574-1157
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
X21KXM Twin City Design 1809 Lake Street E., Mpls. 55407 722-1433
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION? ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Remodel Basement; new sheetrock, tape, texture & trim
9 CHANGE OF USE FROM TO
STIPULATIONS
Install smoke detectors on both levels of dwelling
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
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
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS IG ARAGES
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
$5. �QQ $72.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$2.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTALFEE
$74.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY V IDATED THIS IS YOUR PERMIT
D
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
BLDG NSP ATE
f
NEW [ ] Effective 5/1/88
ADDN [ J R-1 AMID R-2
ALTER [xj Building Permit Application
Contractor: `:a#.J C7 -Y Df.5 t 4^3 Tel. # 7.2-7 - 143s
Address: 16o9 F, LA)cF- 5-17 M PLS
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVnC AREA: length Width Height Sq. Ft.
GARAGE AREA: length Width height Sq. Ft.
DECK AREA: length Width Hgt/Groiudd Sq. Ft.
7—A PE -- ruje5-: i ►M
Corner lot [ ] Inside lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $ .CT®oO
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired: Ft. $ $.
Width + 6' See Back Page
DATE: �-�� 9 APPLICAtdr: /GG� Tel. # 722 I r4�3
Permit Fee $
State SurchargeS-
SAC Charge . $
Driveway Escrow $
Park Fee ' $
Sewer Main Charge $
CITY USE MW
Fee Schedule on Reverse Side
$.50/$1,000 valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by rte; r�ri m
Age Necessary [ ] Not Necessary [ ]
qa00
7
6`3/ . w ave- 'v`
O /Ie _ f . •A �f -.- -/
;7? rnO�-lU" 4� �
J- .4 _ % o .
,
„ �11- /i% Com.. 4'-I•(/- 114-7
. • -
SUBJECT
City of Fridley
20933,
AT THE TOP OF THE TWINS
BUILDING PERMIT
i �
ECEIPT
_ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
1
CITY HALL FRIDLEY 55432
NUMBER
1
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/10/91
JOB ADDRESS 5218 Matterhorn Drive NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
6
5
Innsbruck 1st Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Bob/Nancy McKay 5218 Matterhorn Drive NE 574-1157
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Twin City Design Inc. 1809 East Lake St. M is 722-1433
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 141611 x 23E Garage Addition
9 CHANGEOFUSEFROM TO
STIPULATIONS
13 Variance to 29.5 front yard setback approved by Council on 6/3/91.
Pxovide a firewall between garage and house ceiling. Door between house/garage
must be firerated and self-closing. See notations on plan. Provide a hardsurface
driveway.
WARNMG
Before digging call fw SEPARATE PERMITS REQUIRED FOR
alt utility locations WIRING, HEATING, PLUMBING AND SIGNS,
b54-0002
REQUIRED BY LADY
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$5,150
$2.58
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OT R STATE OR LOCAL LAW REGULATING CON-
$81.00
Fire SC $5.15
STR CTION JR THE PER RMANCE OF CONSTRUCTION.
LAN CHECK FEE
TOTAL FEE
IlIV '7-10-11
$88.73
SIGNATURE OF CONTITACTOR OR AUTHORIZED AGENT IDATEI
HEN PROPERLY VA A ED THIS IS YOUR PERMIT
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
DG )NSP f)AT
NEW [ J Effective 1/1/91
ADTN 1-1 AMID R-2
ALTER [ J Building Permit Application
aowtructicn Address: �`� / �A ��� MI'l/E
legal Description:
owner name & Address: Owe, � ` �� Tel.
Contractor: -7w) j4 Cl iY P<1516
Address: 1609 i St ' 1 d'a'lO S
Attach to this application, a Certificate of Survey of the
lot, with the proposed oorwtruction drawn cn it to scale.
DESCRIPI'I��T CF 1001 MIMCM
LIQ M AREA: length Width ---- Height Sq. Ft.
GRRAGE AREA: Length 14 --(Pu Width 2S= 0 cr Height /J.T• f Sq. Ft.
UM AREA: Length Width Hgt/Ground ^ Sq. Ft.
S`3`:3 )o I" `{g 'z-SlS7f e Y
Cbrner Lot [ ] Inside Lot [ ] Ft Yd Setback Side Yard Setbacks
Type of Construction: LO® R� Estimated Cost: $
Approx. C®pleticn Date: A4uC- J 19 Ah
Proposed Driveway Width If New opening Is Desired: E%CMi d/ -F t. $. $.
Width + 6' See Back Page
DATE: '' APPUCARr: Tel. #= -J(133
r j ,rI
QTY USE MLY
Permit Fee $ 5 " :.'-: -Fee Sc heIde an Reverse Side ® q3,00
Fire Rrch<zrge $ 'rte :� .001 x Permit Valuation (1/10th $) 4/vi
..,;
State Surd= ge $ o $.50/$1,000 Valuation
SAC Marge $650 per SAC Unit �'. Od
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Park Fee $ Fee Determined by Engineering
i *gig
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
70TAL $
srIPULATIMS:
(3) on, w r s� 6 use �- l�i� S�e� a44r`4
` Scale 1 Inch ` 40 to
OF
LOT G, ROCK 5, INN53RUCK 1 sT ADDITION
• (4aw pe w To
w,fj-T• ovUsnN�
30 G '
i
""`' Jeno}e5 • Iron monumen}
This Survey was made and a cerbficAc, preaacec for
for 4he purpose of showin boundaries of }ne io and c.i;ity eascmcnts.
There are no encroachment5-
ERTIFICATE OF SURVEY
SITE PLANM
IZo.o �•
I '
a� �`�
X MW
16,
• j r
Z'1 '-
� f�
WN
o-
30 G '
i
""`' Jeno}e5 • Iron monumen}
This Survey was made and a cerbficAc, preaacec for
for 4he purpose of showin boundaries of }ne io and c.i;ity eascmcnts.
There are no encroachment5-
ERTIFICATE OF SURVEY
SITE PLANM
SUBJECT
P
City of Fridley
.
3
AT THE TOP OF THE TWINS
?
BUILDING
PERMIT
-RECttPT-?46
Ir
I 16
COMMUNITY DEVELOPMENT DIV.
r I I PROTECTIVE INSPECTION SEC
I
�
� . I
NUMBER
REV
DATE
PAGE OF
APPROVED BY
S CITY HALL FRIDLEY 55432
"'j 612-571-3450
910-F15
8/23/94
JOB ADDRESS 5218 Matterhorn Dr NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
5
Innsbruck lst Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Bob McKay 5218 Matterhorn Drive NE
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO.
Al -Ko Home Improvements 8090 4 Ave Lino Lakes 55014
788-5850 2097
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION X REPAIR
❑ MOVE ElREMOVE
8 DESCRIBE WORK
Reroof House (17 S) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building
Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
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
ANY TIME AFTER WORK IS COMMENCED
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
I 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
$1 275
$.64
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC 9HARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$31.00
Fire SIC $1.28
TRUCTION O T F CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
.PERFORM�AN
License SC $5.00
$37.92
SIGNATURE OF .RACTORO THORI2ED AGENT IDATEI
ERLY DATED THIS IS YOUR PERMIT
BLDG INS
AT
SIGNATURE OF OWNEP11F OWNER BUILDERI IDATEI A -
ITI:l
ADDN [ J CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: 7,� �� % t '
Legal Description:
Owner Name &
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Effective 1/1/94
Tel. #
v
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft — Ft x — $
DATE: -- APPLICANT:
_ Tel. # r
Clix USE ONLY
Permit Fee
$ .3/. Och
Fee Schedule on Reverse Side
Fire Surcharge
$ %
..001 of Permit Valuation (1/10th%)
State Surcharge
$ �
$.50/$1,000 Valuation
SAC Charge
$
$800 per SAC Unit
License Surcharge
$ U
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation .Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$ �%
STIPULATIONS:
CITY OF FRIDLEY INSPECTION DIV
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOnR
Effective On May 10, 1999
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
NO. RATE
Gas Range** _
Gas Dryer** _
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
TOTAL JOB ADDRESS I I C)
y
State Surcharge $ .50
TOTAL FEE $ 0
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
'1999
Owner
Building Used As
� c
Estimated Cos �� - — PERMIT NO. /0? 6 n
MR. ROOTER OF AN
PLUMBING COMPANY 6250 Industry Ave. N. #114
Ramsey, MN 5153 l A
SIGNED BY TEL N0.
421 -6198 -FAX a :�
Approved ByZL�'4 Rough -In Date Final Date -- cd
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
CRYOE
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
March 16, 2001
Nancy McKay
5218 Matterhorn Drive NE
Fridley, MN 55421
Re: Final Inspection at 5218 Matterhorn Drive NE
Contractor: Mr. Rooter of Anoka County
Dear Ms. McKay:
A plumbing permit was issued on September 20, 1999 to install a water heater at your address.
According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted
on the plumbing authorized by this permit. As of this date, no inspection has been called for.
The permit fee paid covers the inspector's time to make sure the appliance was installed
correctly. We also check to make sure combustion air has been installed and that the vent and
vent connectors have been sized properly.
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 inspections
were called for.
Any questions can be addressed to me at (763) 572-3603.
Sincerely,
DA E SEN
Build' Inspector
3TY OF FRIDLEY INSPEC'11t7N DIV.
43i University:Ave NE
'ridley, MN 55432
163-572-3604
C APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
UAcsv w" M=0 nc C!Yn 10=Q Tn CM INCTAI 1 1=11 nM FACI•I FI 0OR
Effective On Jan 1, 2001
`�'�
$ 7.00
$'• >:.; •�
''\:v;'. �••
$ 4.00
.;>:.; .
Wash
r>v:'
�` .Floor
!•2i8,rir}.:}.•}�•:.}:••::
'- Auto.
�:.
.a.i�:Y1:i�:#'?:::'i,r'r<`:,♦•:.
.: Gas
:mss:::<:>.:.-.: 5��
::--,]C�!tiF:{'•:•::;•i:-^:4L::'•'i:ji�»:
Water Heater
h:,.
::lh
ViShower
$ 7.00
Water Treating Appliance
Tray
Water Heater -Electric
Drain Washer
Range
Gas Elec
Stories
Urinal
Gas Dryer"
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
^•'••7.;;:°ai�i::;v:+Y4•::
fi r.,{...
•.•.•.J}:•G'.:Cr-.
:n•:c:$}•
'•j""
A
t-:::�i
sr:;.
y?S•fi•`::!'s1:'::::::::
:{::ih.•J::•:i:::rtivi}i
ilii:;'.;:::::•• :
''r::j.::::: ..Yic:: ::;`.:��,: ;.
Basement
jnii�
Floor 1 :.: s:.:....::.:.
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PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas"
$10.00
Gas Range"
$10.00
Gas Dryer"
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Buildin
"av`� -.200(
Estimated Cost wf—PERMIT NO. 13
PLUMBING COMPANY 60
SIGNED BY
Approved By
TEL N0.
Rough -In Date. Final Dat _
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing 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 () No ( )
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 Furnace Venting Tables for fan
assisted and natural draft appliances. Yes ( ) No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No
When Installing a new venting system, 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 Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No
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 Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
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)
HEATING CO:
Signed By: Date:
rAW
CCIYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
November 9, 2001
Nancy McKay
5218 Matterhorn Drive NE
Fridley, MN 55421
Re: Final Inspection at 5218 Matterhorn Drive NE
Contractor: Shiloah Water Co.
Dear Ms. McKay:
A plumbing permit was issued on August 29, 2001, to install a water softener at your address.
According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted
on the plumbing authorized by this permit. As of this date, no inspection has been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the Plumbing 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 expire the permit and no
further action will be taken.
To set up the inspection, or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Rincerely.
DJ/mh