The URL can be used to link to this page

PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT N° 5 z:7:1) Date: Owner: t Q r -rte. l Builder K� Address _ tj Address -- — _L TI OF BUI IRIG No. � +.a, a Street �., ,�. may- •+1...:�' a r P f Lot ,l' Lot Block Addition or Sub -Division" _;d"� +'�" �` 7f Corner Lot T—ke—f" Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING Tom U :e r '' Vit'_ � � � .,�f✓ Front f Depth - l� Height S4• Ft. ` ..Lu. Ft.,.c�r�.=� Fro Depth R Height Sq. Ft. Cu. Ft. Type of Construction Est. Costa ��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. P_ 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 of any of the provisions of said. ordinances a4 f rr� -t.• : `� ; ,, ' "ter � uilding Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to no the Building Impactor for separate permits for these hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDIEY, KWMSOTA Owner's Name..4 Address Address 3"0- 36 r LOCATION OF BUILDING No.�J_Street Part of Lo,,L Lot / BlBlock % Addition or Subdivision Corner Lot _,Inside Lot Setback Side -Yard SEWER. ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as,; DESCRIPTION OF BUILDING Sq. Ft.� Cu. Ft.��," Fronts epth Height Sq. Ft. Cu. Ft. p�'� o e' Type of Construction Estimated Cost .J/%gP� To be Completed 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 facts and representations stated in this application are true and correct. -&:::p SIGNATURE/ icy ek.,* (A Schedule of Fee Costs can be found on the Reverse Side.) IJ City of Fridley Application for Plumbing and Gas Fining Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures G7 U, C a Z x -y YZ � pz tT}z O� J C9 1 Z U' O • F • N WATER HTR. GAS ELEG Base / 1st 1 I 1 2nd 3rd 4th • Future Connection Openings New .Fixture, Old Openings I Connected with Sewer E] Cesspool E] PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO, RATE OTAL Number Fixtures x $1.50 $� Future Fixture Opening ................ / x 1.20 $ a New Fixture Old Opening .............. x 1.00 $ Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ GAS FITTING FEES: 1st 3 Fixtures ......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code x 3.25 $ NO. RATE TAI. L —x$1.50 $ ' J x .50 $ x 2.00 $ Dept, of Bldgs. Phone SII 4-1 T �.� 1� City of Fridley: The undersigned hereby .makes application for a permit for the work hereii specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the facl and representations stated in this application are true and correct. Fridley, Alin. Owner Kind of Building Used as AV To be completed about G� Estimated Cost, $ Old—New. Building Permit No Permit No. SignedLi/e4fz 10.9 i% - B Business Phone No - ROUGH, -..!7 - o- ROUGH!7' I t� I FINAL Description ................................................$ TOTAL FEE $ -989042 2M f CITY OF FRIDLEY Effective Date January 1, 1991 .APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL RATE TOTAL Job Address -1: Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 Building Inspection Div. 6431 University Ave NE Fridley MN 55432 Tel. No. 572-3604 Gas Piping $ 10.00 $ (piping needed with now furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. • Air Conditioning (all sizes) $ 10.00 $ All Others/Repairs and Alterations OWNER It of Value of Appliance or Work $�.� D KIND OF BUILDING COMMERCIAL/INDUSTRIAL �T USED AS nly.G F1 , 1% of Value of Appliance or Work $ TO BE COMPLETED ABOUT _ 40 ESTIMATED COST oIV D . State Surcharge $ .50 OLD NEW BUILDING PERMIT NO. PERMIT NO. V� �• TOTAL M $ REINSPECTION FEE $30.00: $_� DESCRIPTION OF FURNACE/BURNER Rough Inap. Date 1� Hot Water, Warm Air No. HEATING or Po R P%NTS, Steam, �� G'O.�j`'' o Trade Name) Y c.., E Size No. 69014®4f0//d �/, Final Inap. Date jL Capacity Sq. Ft. EDA BTU Y HP // Approval for Permit l�i-- Total Connected Kind of Fuel "0;' BURNER - Trade, - Size No. a CapacityRw :.Sq. Ft. EDR BTU HP —i=:- MINIMUM FEE FOR ANY HEATING/COOLING/VENTING PERMITP�LJ¢CE•NEd� y� 77l�L'd�dfs ' IS $15.00 PLUS THE $.50 STATE SURCHARGE Company OWL c�SO °—G Signed By 2 .. Tel. No. 13- is *Air Conditioners can not be placed in side yard without written permission frau adjoining neighbor. Fill out back side for stack verification on replacement furnaces CHIM14EY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes ( No ( ) from 2. Is free rust or deterioration Yes (✓� No ( ) 3. Has no foreign objects lodged within Yes (.� No ( ) 4. Is securely supported Yes (^� No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes No ( ) 6. Has Total heating BTU's of /.2® All other BTU's TOTAL i i- o -1-/ Rema rk s 34M 2184en a North SWte 222 Con pa ny Putti, NN "441 Signed By Date CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 VAN: 17631571-.[Lbl ADDRESS : 5365 MATTERHORN DR NE PIN : 243024430002 LEGAL DESC : UNAVAILABLE TOTAL : LOT BLOCK PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-00606 DATE ISSUED: 04/28/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # 0-100 AMP CIRCUITS 5 APPLICANT LIGHTER ELECTRIC 630 PINEWOOD DR SHOREVIEW, MN 55126 OWNER CLEARY PAUL E & MICHELS J A 5365 MATTERHORN DR NE FRIDLEY, MN 55421 STATE SURCHARGE, ELEC FLAT 0.50 ELEC AMP SERVICE FEE 30.00 ELEC CIRCUIT FEE (0-100 AMPS) 30.00 TOTAL 60.50 PAID WITH CHECK # 6827 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 any 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 wort 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. Applicant Date Bldg Insp. Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 E.1►r�c�7�L� ADDRESS 5365 MATTERHORN DR NE PIN 243024430002 LEGAL DESC UNAVAILABLE LOT BLOCK PERMIT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PE NO.:2004-00944 DATE ISSUED: 004 VALUATION : $ 25,576.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CONSTRUCT A 22'X 16' ADDITION TO DWELLING. STATE LICENSED CONTRACTOR 1 APPLICANT WIGER DAVE CONSTRUCTION (8392) 901 RICE CREEK TER NE FRIDLEY, MN 55432 OWNER CLEARY PAUL E & MICHELS J A 5365 MATTERHORN DR NE FRIDLEY, MN 55421 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 any 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 work will be complied with whether specified herein or not. The granting of a permit does not presur4e to give authority to violate or can el the prov. ions of any other state or local law re atin c ction h e rmance of construction. Applicant Date i BUILDING PERMIT FEE 401.35 PLAN CHECK FEE 260.88 FIRE SURCHARGE 25.58 STATE SURCHARGE, VALUE 12.79 LICENSE SURCHARGE 5.00 TOTAL 705.60 SEPARATE PERMITS REQbIRED FOR WORK OT --EER THAN DESCRIBED ABOVE. EY NEW [ j CITY OFNE I� Fridley, MN 55432 (763) 572-3604 Bldg Insp C ADDN [ j 6431 University Ave y, ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: S3 6S- mAaM ��RAJ AM Legal Description: ka1< / J344e' l tHA)St3 UcL 10 AT'T"o Owner Name & Address: PAct4 Cl E1fi�Y�1-go-IF 1411-A945 _ Tel. # 743 &-Zg e32E Contractor. -0#40119 w tC*0'j' / MN LICENSE # 8,39 g2 Address: 90 / 91 er Ct?ffr 7-16R', t/f).21-A " AM e Tel. # 76, 3^ -"43 Attach 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 v�o Width �� Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width HgttGround Sq. Ft QTHER: Construction Type: F9#RF9 FAALY& Estimated Cost: $ 36 _f 00(3 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $, DATE: 7 Tel. APPLICANT: � Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review $ l� Fire Surcharge State Surcharge $ l • -7 SAC Charge $ License Surcharge Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ –�o 5-° 60 Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] STIPULATIONS: CERTIFICATE OF SURVEY FOR PAUL CLEARY WEASUREMENTS SHOVN IN FEET AND DECIMALS OF A FOOT) DATE 2-I I-04 I HEREBY CERTIFY THAT THIS SURVEY. PLAN OR REPORT KURTH SURVEYING, INC. 0 • IRON MONUMENT WAS PREPARED BY WE OR DER UV nIRECT SUPERVISION 4002 JEFFERSON ST. N.E. 0 20 AND 1 AY A ULY CCENSED L ND SURVEYOR UNDER COLLWA FMTS, A84 55421 T LAWS F THE TATF U . A. P}KME (7631 788-9789 FAX (7631 788-7602 E -MAIC: KURTHSURVEY9A L. CON SCALE IN FEET Ran L. Kur h,Y.L.S. No. 20270 Russell J. Kurth. L.L.S. No. t8IIS 694 i NORTy L /N Op L OT �_ CK BLO I I I MATTERHORN CIRCLE 160' RIW3 LEGAL DESCRIPTION THE SOUTH 88 FEET OF LOT 1, BLOCK 1 INNSBRUCK IST ADDITION, ANOKA COUNTY, MINNESOTA kL o�J av 1.7 p!e_UD I I I I W I 2� z 2 I �LU yO— Qc 6�� WOOLU FENOCANCH ERCORNER q 2 3OVER L 1 NE 3 � � J J .�� e e x5353 to 6.4 caw Z Z 21. T 5 'b ROPO < LY P �0 w LIJ 16.4 O w a QLwLL op �7� s a0 w z G 2 Z 20.8 ?z 11 < ti �- --103.02-- -' MATTERHORN CIRCLE 160' RIW3 LEGAL DESCRIPTION THE SOUTH 88 FEET OF LOT 1, BLOCK 1 INNSBRUCK IST ADDITION, ANOKA COUNTY, MINNESOTA kL o�J av 1.7 p!e_UD CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 kAX: (763) 571-1287 ADDRESS : 5365 MATTERHORN DR NE PIN : 243024430002 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-01570 q0 DATE ISSUED: 09/09/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # 0-100 AMP CIRCUITS 8 APPLICANT LIGHTER ELECTRIC 630 PINEWOOD DR SHOREVIEW, MN 55126 OWNER CLEARY PAUL E & MICHELS J A 5365 MATTERHORN DR NE FRIDLEY, MN 55421 ELEC CIRCUIT FEE (0-100 AMPS) 48.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 48.50 PAID WITH CHECK # 6936 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 any 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 work 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. Applicant Date Bldg Insp. Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 �.yr_�i1�Ls a►�;� ADDRESS : 5365 MATTERHORN DR NE PIN : 243024430002 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : FEE SHORTAGE VALUATION ENTER FEE AMOUNT 24 APPLICANT LIGHTER ELECTRIC 630 PINEWOOD DR SHOREVIEW, MN 55126 OWNER CLEARY PAUL E & MICHELS J A 5365 MATTERHORN DR NE FRIDLEY, MN 55421 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 any 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 worl 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. Applicant Date Bldg Insp, Date PERMIT NO.: 2004-01707 S � DATE ISSUED: 10/05/2004 FEE SHORTAGE AMOUNT TOTAL PAID WITH CHECK # 6965 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 24.00 24.00 CITY OF FRIDLEY PERMIT NO. 2004-016* 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 09/20/2004 F63) 572-3604 FAX: (763) 571-1287 ADDRESS : 5365 MATTERHORN DR NE PIN : 243024430002 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION 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. INSTALL GAS PIPING FOR FIREPLACE (NAPOLEON, GD 36 NTR) # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES # GAS RANGES APPLICANT CLEARY PAUL E & MICHELS J A 5365 MATTERHORN DR NE FRIDLEY, MN 55421 OWNER CLEARY PAUL E & MICHELS J A 5365 MATTERHORN DR NE FRIDLEY, MN 55421 0 # GAS DRYERS 0 0 VALUE (FOR MINIMUM CALC) 0 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 any 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 worl 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 constructign or the performance of construction. Bldg Insp _ DatQb f HEATING PERMIT MINIMUM FEE 15.00 FURNACE SHELL/DUCT WORK 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 15.50 PAID WITH CHECK # 13578 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITYOF FRIDLEY BUILDING INSPECTION `6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, F'repla e, Insert) -�r �irePlae� Gas Range Gas Dryer Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS�� RR ©rn br. A �Vw) Fee Total Owner P I/t F, Ue4r\ $35.00 $ Building Used As Pes4eAeyl $10.00 $ ESTIMATED COST PERMIT NO 0C, p �� $10.00 $ $10.00 $ *Air Conditioning - All Sizes $25.00 $ All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater on work less than $500.00 Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR ° DESCRIPTION OF FURNACE AND BURNER # of Heating Units t Circle One (Steam), (Hot Water (Warm Air) Trade Name Size No. BTU HP EDR FuelTo aI Co a ted Load vinsr(e ® �►®s�e Burner Trade Name Size No. BTU HP EDR 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. $ .50 HEATING $ !0 *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Tel #'J 6�_ / l 0 FAX # \A Date Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina an existina furnace, 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 existina 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 installina 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 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 ADDRESS 5365 MATTERHORN DR NE PIN 243024430002 LEGAL DESC UNAVAILABLE LOT BLOCK PERMIT TYPE HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT O.: 2004-0117 DATE ISSUED: 06/30/20004 , 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. INSTALL AN AIR CONDITIONER. # A/C UNITS I VALUE OF APPL OR WORK 0 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES APPLICANT DAVES HEATING & AIR INC 160137 AVE NE COLUMBIA HEIGHTS, MN 55421 (763) 781-6901 OWNER CLEARY PAUL E & MICHELS J A 5365 MATTERHORN DR NE FRIDLEY, MN 55421 0 HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 25.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 25.50 PAID WITH CHECK # 34670 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 any 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 worl 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 c9pstruction or the performance of construction. 104 1711 a, SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. .,.CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-5711287 RATE SCHEDULE Residential, Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *Air Conditioning - All Sizes Ail Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 51/6 of cost of improvement whichever is greater Commercial/Industrial/Institution e, ��69 )- Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fie Total $35.00 $ $10.00 $ JOB ADDRESS � 14 H n �[ n ' L Building Used As ESTIMATED COST PERMIT NO -� 0cd1 o/ c $10,00 $ QESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. $25.00 BTU HP EDR Fuel Total Connected Load $ 1.25% of Value of Appliance or Work (List on Back) $ Minimum Fee $35.00 for Commercial/industriaVinstitutional State Surcharge $�L TOTAL FEE REINSPECTION FEE $50.00/HOUR *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City Burner Trade Name BTU Size No. HP EDR 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 FAX # 1:FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, 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 -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes O No ( ) The existing combustion al r is sized and installed to meet the current codes No ( ) and manufacturer's specifications. Yes (} 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 Yes ( ) No { } Venting Tables for fan assisted and natural draft appliances. Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented Yes {) No( } separately as per current codes. Appliance Type and size/Common Vent and Vent Connector information Appliance #1 Type BTU Input Fan Assisted or Nat BTU Input Fan Assisted or Nat Appliance #2 Type 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 in Type Appliance #2 Vent Connector Height ft Length __ _ ft Diameter Appliance #3 Vent Connector Height ft Length _ ft Diametpr in Type ALTERATIONS: Describe A n Building, PLUMBING Permit No.• Inspections RESIDENTIAL APPLICATION Reeeived By: 763-572-3604 CITY OF FRIDLEY Da' `l DATE V� YOUR E-MAIL ADDRESS SrMADDR6s C�� paul Cleary THIS APPLICANT IS: ❑ OWNEI 5365 Matterhorn Drive Ne PROPERTY NAh1E: Fridley, MN 55421 OWNER/ ADDRESS: 7635720498 STATE ZIP TENANT PHONE: CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # C> EXP DATE YOUR STATE ADDRESS fi / CITY�0,;roe a /S STATE S�SyO0 LICENSE WITH , PHONE gal— x/033 FAX 4,1217 7 7_112 q APPLICATION - PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW XREPLACEMENT DETAILED DESCRIPTION OF WORK Lglagto PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00; whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. CMis.should_reflect only.the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = '•FORXROIECTS WHERE LABOR EXCE®SS-500,7EES ARE BASED ON $10.00 PER FIXTURE,•EXCEPT•;W;fIEiLB"NNGMB-,FIXTUM:•.,(INDICATE T.OTAi NUMBER OF EACH BELOW) BATH SINK/LAV FLOOR DRAINS _ SHOWER _ WATER PIPING - _ _ BATHTUB —GAS PIPING (xEm cnruca m) _ SWIMMING POOL _ WATER SOFTNER ($35) _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15) DISHWASHER _ LAUNDRY TRAY TWATER HEATER ($35) FOR IRRIGATION WATER METER OTHER I Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surchar a .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 _� x $35.00 = $ 36'.00 W TOTAL DUE $ State Surcharge = $ .50 Total — THIS IS AN APPLICATION FOR A PERMrr 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 app ' on for a permit nd work is not to start without a permit; that the work will be in accordance with the approved plan in the case of c en nam d approval of plans. [ / J NAME e-T .1610/D/Oiyi DATE SIGNATURE OF APPLICANT PRINT j A City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977