PRE 2010 DOCSCity of Fridley, Mime.
BUILDING PERMIT N°5 l s 3
Date:
a R� ,..T �; 'ter
Owner. i wilder -----
Address Address`
EATJON OF BUILDING
EfNo. ` Street � Pad.` o .Pt
>, ..—;—
Lot Bl —Addition or Sub -D v'on a--!
IF
Corner Lot �Inside Lot Setback °r" — Sideyard
Sewer Elevation _ Foundation Elevation
DESCRIPTION OF BUILDING
A
To, U e
Depth_ Height Sq. Ft. a cu.
Depth.-s'"��Iei t _�� Sq. Ft. Cu. Ft.
Type of Construction Est. Cos _ 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
ordinanoes of the city of Fridley.
�d
In consideration of the payment of a fee of $-.,J _" 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 of any of the provisions of said
ordinances .�'""p „
y} Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
4
y
APPLICATION FOR BUILDING PU MIT
CITY OF FRIDLEY, IOTA
Owner Is Name 9 o it Builder -L'�
Address
No. J Street d Part of Lot
Lot 1 , Block _�; Addition or Subdivision
Corner Lot -—Inside Lot SetbackSide-Yard_3 SS - S
SEafER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
To be used as:
DESCRIPTION OF BUILDING
0
Sq. Ft. / 3 .%% Cu. Ft. Zt 1. 5 10
'Z -;,, Heiaht - — - /
14 Sq. Ft. 4[ S ) Cu. Ft. q S / o
o�
Type of Construction Estimated Cost/ ®® o
To be Completed
z
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. \
DATE y� -j" 0 SIGXATM 6 -4-
(A Schedule of Fee Costs can be found on the Reverse Side.) % �,�
City of Fridley
Application for Plumbing and Cas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
.�}
Number Fixtures ......................
x $1.50
$/��U
Future Fixture Opening ................
s�
$
N
8�
~Qu!
$
Catch Basin ............................
w
2
•
.
N
WATER HTR.
GAS
ELEC.
$
GAS FITTING FEES:
1st 3 Fixtures ..........................
NO. RATE TOTAL
x $1.50
Additional Fixtures ....................
x .50
cuUo
Gas Range to 200,000 BTU ..............
x 2.00
$
Base
1st
2nd
_
3rd
—
4th
• Future Connection Openings
Connected withI Sewer �
New Fixture, Old Openings
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TgTAL
Number Fixtures ......................
x $1.50
$/��U
Future Fixture Opening ................
x 1.20
$
New Fixture Old Opening ..............
x 1.00
$
Catch Basin ............................
x 3.25
$
Water Heater (Up to 200,000 BTU) ......
1 x 2.00
$ CJ
New Ground Run Old Bldg. ............
x 3.25
$
GAS FITTING FEES:
1st 3 Fixtures ..........................
NO. RATE TOTAL
x $1.50
Additional Fixtures ....................
x .50
$
Gas Range to 200,000 BTU ..............
x 2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE .
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 trre and correct.
19'"
Owner C
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old—New. Building Permit
FINAL
4z 2M 7-39
Business Phone
Application for Power Plants and Heating. Cooling. Ventilation. AeMgeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU. 4-7470
GRAVITY WARM AIR: RATE TOTAL,
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 80,000 BTU .... . .................. 2.00 $ _
Replacement of Furnace ............................. §.00 $
Repairs & Alterations—up to $500.00 ............. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
STEAM or HOT WATER SYSTEM
c
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 BTU) .......................
5.00
$
t/
GAS FITTING FEES:
NO RATE
TOTAL
1st 3 Fixtures ......................
x $1.50
$
✓
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 F=
$
ROUGH
FINAL
Location " o)
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.
19 4_l
Owner
Kind of Building "r 4'�J
.A
Used as
To be completed about
Estimated Cost, $—.I
DESCRIPTION OF WORK
HEATING or WER PLAXTS-- Steam, Hot Wa4 EWjarmj:Air�-Wo
Trade Name _RA -�-P / Size No- 4^1-4 c)
Capacity Sq. Ft. E.D.R (0.4
g BTU H.P.
Total Connected Load f% /' e jl r'I Bind of Fuel
BURNER — Trade Name Size No
Capacity.
(REMARKS—OVER)
Sq. Ft. E.D.R BTU H.P.
SigneRAYTt w W C I T f= R H EAT I N G f'. Q,
By 4637 CHICAGO AVE.
MINNEAPOLIS 71 MINNESGTA
snn 7-59 Business Phone No-
A
r
Ddb OQW7P
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS"f
Weatherstrips o A.S.H.V.E. Construction No.
Gaide
ndows I Doors Reference Out. Wall Int.Ceiling Roof Floor Kind
T,'—No— � � e�Y s No 19_ .
F1.11W t _„o' Room Length ./ - Width of/ � Height II Fl.l . _ ° A :Room I Lenath
Windows and Doors—Crackage and Area
JCoef.j
Btu
Width Height No. of Lineal f . Area
No. of pane of pane lights of crack sq. ft.
91 dr �•�
/ 7 y
Glass
'
Coef.
Coef.1
Btu
Infiltration
Coef.
Ov V,6-2
M 1
42- 9 2.
Glass
Ceiling
Floor
Exp. wall . �,
e
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Exp. wall :7 7 j g
Net exp. wall
�
Height S.
'
Net exp. wall
Net exp. wall
Ceiling 0 x
Int. wall
Ceiling,.'
co
Floor
Floor
Ceiling" .°
-
At
r
Floor
A
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ' '
F1.1 MAI V Room I Lenath 91' Width "` Height
Windows and Doors—Crackage and Area
JCoef.j
Btu
WidthHeight No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
91 dr �•�
/ 7 y
Glass
'
Coef.
Btu
Infiltration
Coef.
Ov V,6-2
Glass
�
Glass'
Ceiling
Floor
Exp. wall . �,
s e
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Exp. wall '►
Net exp. wall
Room I Length ,V- Width
Height S.
'
Int. wall
Net exp. wall
Ceiling 0 x
-
+ 5—
Ceiling,.'
co
Floor
Floor
Floor
-
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area��y�
r1. I i R....... It —5. iilrt�9 �iirtrt. `s Neieiff dM
Windows -and Doors—Crackage and Area
JCoef.j
Btu
Width Height No. of Lineal ft. Area
No. ofpane of pane lights of crack sq. ft.
91 dr �•�
/ 7 y
Glass
'
Exp. wall
Coef.1
Btq
Infiltration
Coef.
Ov V,6-2
Int. wall
�
Glass'
Ceiling
Floor
74"
1'-
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Exp. wall '►
1 FI_I`a'a-Vt,
Room I Length ,V- Width
Height S.
Net exp. wall
Net exp. wall
Int. wall
Ceiling,.'
.
Int. wall
Floor
Floor
Ceiling'
Total Btu.
sq. ft. E.D.R. or sq. ins. W.A.
ser area }
,MDMMUQW. MINN.
Insulation
How. Aoalied
Win2ows and Doors—Crackage and Area
Width Height No. of Lineal ft. Araa
No. of pane of pane lights of crack eq. ft.
Windows and Doors—Crackage and Area
JCoef.j
Btu
Infiltration
,
/ 7 y
Glass
'
Exp. wall
Coef.
Btu
Net exp. wall
Coef.
Ov V,6-2
Int. wall
�
Glass`r+'
Ceiling
Floor
74"
1'-
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Exp. wall
1 FI_I`a'a-Vt,
Room I Length ,V- Width
Height S.
Windows and Doors—Crackage and Area
A%LMM 1 L'GA%ui ----
.V .-- ....p... 1 ...
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Width Height No: of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
s
Coef.
Btu
Infiltration
Coef.
Btu
Infiltration
�
Glass`r+'
13
74"
Glass
z
Exp. wall
S#'
" c
Exp. wall
Net exp. wall
Int. wall
Net exp. wall
Ceiling
e r
'"
Int. wall
Floor
Ceiling'
Total Btu. 44 1" co
Required sq. ft. E.D.R. or sq., ins. W.A. Leader area
A%LMM 1 L'GA%ui ----
.V .-- ....p... 1 ...
Windows and rs-Crackage and Area
Width Height No: of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
s
Coef.
Btu
Infiltration
�
13
74"
Glass
115,140
Exp. wall
Net exp. wall
.•-
'"
Int. wall
Ceiling'
Floor
Total Btu. 44 1" co
Required sq. ft. E.D.R. or sq., ins. W.A. Leader area
M:
SUBJECT
PE
City of Fridley
® r13264
AT THE TOP OF THE TWINS
P,
BUILDING PERMIT
REC T NO.
Ir
1y �_____ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r
1 �
� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
J 612-560-3450
910-F15
I
10-15-75
I
JOB ADDRESS
5251 Matterhorn Drive
1 LEGAL
LOT NO.
BLOCI-rRACT
OR ADDITION SEE ATTACHED
DESCR.
11
1
Innsbruck lst Addition SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
Dorothy Downey 5251 Matterhorn Drive
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
lton L. Johnson Company 2513 CentralAvenue N.E.
4 ARCHITECT OR DESIGNER MAILADDRESS 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
insulate and sheet rock for family room
9 CHANGE OF USE FROM TO
STIPULATIONS
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 1 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.
800.00
. 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
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
6.00
STRUCTION OR THE FORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE.
ij
.50
SIGNATURE OFC NT➢ACTOR OR AUTHORIZED AGENT (DATE)
HEN PROPERLY V ED THIS IS YOUR PER IT/
/
6), 71
BLDG. )NSP ATE n
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OW;`TER'S NAME: �L7 0 N'
e' WILDER:�I
-�✓�S� - ��%%13 Q��frlF. nl1
ADDRESS: � � ��ESS•
NO:. J72 S t 1 STREET:
LOT: �/ BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
AnDlicant attach to this form Tc,?o Certificates of Survey of Lot and proposed
�catioz� drawn on these Certificates.
'F]'Bp
.9
Total
BtU. ,:
Required
sq• ft• F A n
SUBJECT
P
City of Fridley
o
AT THE TOP OF THE TWINS
BUILDING P E R M I T
.16560
i
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
� CITY HALL FRIDLEY 55432
X0.-1
L 612-571-3450
910-F15
5/6/82
10B ADDRESS 5251 Matterhorn Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
11
1
Innsbruck lst Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Dorothy. Dawning 5251 Matterhorn Drive N.E. 571-3956
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Southwestern Construction 5117 West 98th Street, Bloomington 835-6388
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Kitchen Remodel and 4' Addition; 12x12 Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRINU,
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
SO. 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
1
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
$11,150
$5.75
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 CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$86.50
STRUCTION OR THE PERF MANCE OF CONSTRUCTION.
CHECK FEE
TOTALFEE
ePLAN
j_= (I—
$92.25
SIGNATURE OF CONTRACTOR OR AUTHORIZED AG JT MATE)
WHEN PROPE LY VALIDATED THIS IS YOUR PERMIT
&/
BLDG INSP E
SIGNATURE OF OWNER 0F OWNER BUILDER) IDATEI
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATIM FOR RESIDENTIAL BUILDING PEIU4ITS
(Nero, Alterations, Additions, or Repairs)
c ' f
OWNER:
ADDRESS:
TEL NO:
QUILDER.
ADDRESS: Vatd , 9j
TEL 140:
3-'/'30
Construction Location
STRICT NO: STREET:/1� 19 Coe 4106P)V 01—r
LOT: BLOCK :
ADDITION: TrU/US /�/� / L A6�9l n
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
Ldp Front: Depth: Height:
Square Feet: Cubic Feet:
2 IZ Front:
Depth: Height:
Square -Feet: Cubic Feet:
®G
Type of Construction:I Estimated Cost: $
Rb Be Qir.�pleted: --,5
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired:
SEE REVERSE SIDE OF SHEET
Mie undersigned hereby mazes application for a permit for the work herein specified,
agreeing to do,all work in strict accordance with the City of Fridl dinances Paid
rulings of the Department of Buildings, and h eby declares th al ie facts and
representatio s stated in this application a ue and co_ t.
N
DATE: SIGNATURE:
Stipulati ns:� f
S
GEORGE E. HOPKINS a Registered Land Surveyor and Civil Engineer
Phone SO. 1-8856 10701 Nicollet Avenue South
Minneapolis 20, Minn.
PLAT OF SURVEY
Beale 1 inch 40 feet
PROPERTY OF AP/'fT70H a' baa o� lC.P9 Cs/v�,rl�� wi Ar/.,. 24?
i rima as LOT 11, BLOCK 1, INN55RUCK 15T ADDITION -
I 30
io}es iron monumcn+
o�
Rs 301, o�
This survey was made and a cerli f i cane prepared for
for the purpo5e of showinj boundaries of {he 14 and Alily
ea5emenls. There are no encroachtnen4s.
f�
N
CERTIFICATE OF SURVEY /1
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.
atceotive Aug. It i9bi
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
s! /
Job Address
O
m
O
c'i
D
o�
�l
o�
to
a
3�
"'
i w
F
al
,�j
w
qA
u P1
u
ue M
1.
3
w
�'
w
�Uq
a
t�
dl
Water
Heater
leC
lot
I
2nd
3rd
4th
(R) b Future Connection Opening
(*) - New Fixture, Old Opening
Connected with Sewer
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures .; $ 5.00 $ /' !
Future Fixtures $ 3.50 $
Old Opening, New Fixture $ 1.50 $
Beer Dispenser $ 4.00 $
Blow Off Basin $ 5.00 $
Catch Basin $ 5.00 $
Rain Water Leader $ 5.00 $
Hydraulic Valve $ 5.00 $
Sump or Receiving Tank $ 5.00 $
Water Treating Appliance $ 7.00 $
Hot water Heater $ 5.00 $_
Gas Range �_ $ 10.00 $ / <;
Gas Dryer $ 10.00 $
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
ReinsPection Fee $ State Surcharge $ .50
($15.00) TOTAL FEE $
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 correct
Fridley, Mn. � , 19�
OWNER p & 7 ® - 3c), Al�-�
KIND OF BUILDING Fe Aj-, -
USED AS��
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO. �r
Company
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP. G ` 2- 4/
Date
APPROVAL FOR PERMIT
1
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
0
SuB,,ECT-PERMIT
NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
29242
`
RECEIPT
b ______ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r
1 . �
NUMBER
REV
DATE
PAGE
OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
4/19/99
JOB ADDRESS 5251 Matterhorn Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
11
1
Innsbruck 1st Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP P ONE
Gerald Johnson 5251 Matterhorn Drive NE
5 1-2507
3 CONTRACTOR MAIL ADORESS
ZIP P ONE LICENSE NO
Same
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 D REPAIR ❑ M
X
VE ❑ REMOVE
B DESCRIBE WORK
Reroof House & Garage (30 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; :00 am to
9:00 pm on Saturday; No work on Sunday.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. 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
OFFST EET PARKING
I HEREBY CERTIFY THAT 1 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,571
$1.29
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACC A E
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK F
TOT FEE
$ .61
ATURE Of TOR A AUTHORIZED AGENT IDATE,
HE PR
I IS I$ PE41PIT
s
AIN
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NEW I ] CITY OF FRIDLEY
ADDN [ l
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: .S S/ _6-1 T % //f 0AJ
Effective 1/1/99
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Legal Description: .
ia- C �� �- � D � ®� � S 04) Tel. # _5- 71 � .S'O
Owner Name &Address:
�� �'L � MN LICENSE #
Contractor:
Tel. #
Address:
LIVING 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
Lenges Width Height Sq. Ft.
Lenges Width Height Sq. Ft.
Lenge _ Width /+ Hgt//7Grroun�i Sq. Ft.
AV A
Construction Type:
Estimated Cost: $ 02—S
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #_f Z
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
I
$ 116.6/
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ]