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PRE 2010 DOCSCity of Fridley SUBJECT i®12933 PERMIT NO. AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NQ COMMUNITY DEVELOPMENT DIV.�� INSPECTION le t r PROTECTIVE SEC. ` 1 /---1 CITY HALL FRIDLEY 55432 J NUMBER REV. DATE PAGE OF APPROVED BY `---- 612-560-3450 910-F15 5/8/75 JOB ADDRESS 5666 Matterhorn Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 4 1 Innsbruck North SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Robert Sorenson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Robert Laugen 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONt 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 ' 1 x 251DwAling and a 22'Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before capping. SEWER LOCATION (Depth Approx. 9') 25' North of Manhole (Inv. 966.39) WAR10% Wye E1 ev : 965.55 Before Top of Footing: 968.55 Minimum digging call local utilities WATER LOCATION: 37.5' N.W. of Manhole TELEPHONE - ELECTRIC - GAS Etc. 67'' South of Catch Basin REQUIRED BY LAW SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGs, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 R-1 31,728 Total 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 $39000 19.50 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- $58.70 $325.00 STRUCTION OR THE PE ORMA OF CONSTRUCTION. _ PLAN CHECK FEE TOTAL FEE $403.20 SIGNATURE OF CONTRACTOR OR tORI DAGENT (DATE) W N PROP R I ATE THIS IS YOUR PERMIT _C` BLDje INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NA14-E S0 e4 BUILDER: a6c=,e ��4�c&E.V l7`��Gte �ilc ADDRESS: ADDRESS /-Mv'<F 4,oeo v S5 3.6 NO:. STREET: /46 i TC2hl®Lr=N 4TT1e11JC / LOT: BLOCK: f _ ADDITION: 2,-Vy fd'C't CORNER LOT: INSIDE LOT: ETBACK: 3,5. � SIDEYARD:zd7 Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: S1 �/4t E rARg. Jie;Cluo► &ont : Depth: 6'0 Height: A E7p Square Feet: Cubic Feet: %& UVg A l Fxont: Z- Z Depth: Height: Square Feet; SZ)r Cubic Feet: Type of Construction:A M.ey rle4,.we Estimated Cost: $ To Be Completed: A",.* / V / 5 7 S 3`le00u The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: C °- SIGNATU (See Reverse Side For Additional Information.) P�raw.:r, 31, '7 Z8 z185/00u = /�,�oJ�Q� �20J SDE. TAk 3�,00o X Sv, _ �cf.vo � aaiNCa, 7 7. Zo O V 3 c) ,-j;�r2® SjeFAOM 6te(VEUJ4y. GERALD T. COYNE LOT SURVEYS COMPANY 300 BRUNSWICK AVE. S. GOLDEN VALLEY, MINN. LAND SURVEYORS MINN. REG. NO. 4741 REGISTERED UNDER LAWS OF STATE OF MINNESOTA LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS 5747 W. Broadway Minneapolis, Minnesota 55428 533.9922 INDUSTRIAL —JUDICIAL Oumpyors (Inftf rata COMMERCIAL — TOPOGRAPHICAL �✓ aitl lX CITY LOTS — PLATTING ® �3t�t for excavation only r rA ev 3.'., a %t: uatum assumed 5464 Wt,wr TICr..WILA V WANING 66kre dIgging call local utilities TELEPHONE - ELECTRIC - GAS Etc. f REQUIRED BY LAW Lot � s 31ock 4, INNj3hUCK TdURTH WP nereby certify that this is a true and correct representation of a survey of the boundaries of the above d_scriGed land and the location of all builldings and visible encroachments, if any, from or on said land. Sur/eyed by us this 21St— day of April 19 75 41 I RAYMOND A. PRASCH 6917 IDAHO AVE. N. BROOKLYN PARK, MINN. MINN. REG. NO. 6743 INVOICE NO. 4719 F. B, NO. 11,, 9— 7 5 SCALE 1" — # ' O — DENOTES IRON i �s a X, Signed LOk SURVEYS COMPANY 1 WP nereby certify that this is a true and correct representation of a survey of the boundaries of the above d_scriGed land and the location of all builldings and visible encroachments, if any, from or on said land. Sur/eyed by us this 21St— day of April 19 75 41 I RAYMOND A. PRASCH 6917 IDAHO AVE. N. BROOKLYN PARK, MINN. MINN. REG. NO. 6743 INVOICE NO. 4719 F. B, NO. 11,, 9— 7 5 SCALE 1" — # ' O — DENOTES IRON i �s a X, Signed LOk SURVEYS COMPANY Afred ly - <it)� S ` Al, a � i✓l N, �WE G—f v 3 e5� �'� � � - 9�S 5s 1 � 2 or 00 0 On��-- i68� 55C/�,ti,�f��G �� S /g),q � s' 67 / 0 . , 1w /V" uj " & F /W, Y,, 'SO 0 F 6,,vTc H egslv ol Oily of Pridloy ApplicaTicii fir Plumbing c.d G. -m 17;H'IngI-a nit Dept. of Bldga. Phone SM -3450 DESCRIPTION OF WO11i Number. Kind and Loce2ion of FixturesL/O 60 I'OceB� City of Fridley: N Futuro CannecSea Opon ngs e Mew Flxturs. Old Openings The undersigned hereby makes application for a permit for the work herel specified, agreeing to do all work in strict accordance with the City Ord.rance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this apptica:ion are true snd correct Owner Kind of wu, Qv1;�Q wiza Saar Used as cc=pool n .5r - To be completed about �Ef PARTIAL. RATE SCHEDULE Estimates cast, $ O I< � � Q5 e Permit No. c4 S !. > � � g °� U Z_ I O Q 2.00 $ 2 Signed WATER MR. ,_�r. x ., $1.50 $_3 •� � F � .� _ J < � New Fixture Old Opening.......... x $1.50 $.__ � Catch Basin .................... I� $ Water Heater 'Up to 99.000 BTU)... • _L_ x $3.00 $ $ate ROUGH , New Ground Run Old Bldg......... x $3.25 $ ElectricWater Hoater. . ............. z $2.00 3 FINAL Ist NO. RATE TOTAL Ist3Fixtures •••••••••••••:::•• ---Lx$2.00 Additional Fixtures ................ x $ .75 $ Gas Range to 199.000 BTU ........... Zed 6 I P.EPAIRS & ALTERATIONS—Rofer to Code .50 State / Description ........................................ - 3rd 4th Futuro CannecSea Opon ngs e Mew Flxturs. Old Openings The undersigned hereby makes application for a permit for the work herel specified, agreeing to do all work in strict accordance with the City Ord.rance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this apptica:ion are true snd correct Owner Kind of wu, Qv1;�Q wiza Saar Used as cc=pool n .5r - To be completed about �Ef PARTIAL. RATE SCHEDULE Estimates cast, $ Old New. ilding Permit No. e Permit No. c4 PLUMBING FIXTURE RATES: NO. RATE TOTAL Q 2.00 $ Signed Number Fixtures ................ ,_�r. x ., $1.50 $_3 -" Future Fixture Opening ........... .— x By New Fixture Old Opening.......... x $1.50 $.__ Business W140 Catch Basin .................... x $3.25 $ Water Heater 'Up to 99.000 BTU)... • _L_ x $3.00 $ ROUGH , New Ground Run Old Bldg......... x $3.25 $ ElectricWater Hoater. . ............. z $2.00 3 FINAL ZAS FITTING FEES: NO. RATE TOTAL Ist3Fixtures •••••••••••••:::•• ---Lx$2.00 Additional Fixtures ................ x $ .75 $ Gas Range to 199.000 BTU ........... x $5.00 6 P.EPAIRS & ALTERATIONS—Rofer to Code .50 State Surcharge Description ........................................ T+YTAL FEE ANF.cafta Tw Fw Plana " it©��� Rt��;m and Air � 0mbn Synwn aM DG,4 PARTIAL RATE SCHEDULE GRAVITY WA&tM ,AM: >IItATZ TOTAL Furnace Shell & Duct Worcs .$10.00 � Replacement of Furnace 6.00 w Repairs & Alterations—up to $$00.00 6.00 6 Repairs & Alterations each add. $500.00 3 O KEEL WARll{ii am 3%unace Shell & Duct Work to 110,000 BTU each add. 60,000 BTU . Replacement of Furnace Repairs & Alterations --up to $300.00 Repairs & Alterations each add. $500.00 STEAM or RIOT WATER SYSTEM ..$10.00 $_1S 00 - 3.00 $ 3, cc) 6.00 $� 6.00 $ 3.00 $ Furnace Shell & Lines—to 400 sq. ft. 1r.DR Steam $10.00 $ Furnace Shell & Lineto640 sq. ft. EDR Hot Water 10.00 a. Each add 200 sq. ft. EDR Steam 3.00 $ Each add. 320 sq. ft. EDR Hot Water 3.00 $__ OIL BURNER—to 3 gaL per hour 6,000 $ over 3 gal. per hour—See Fee Schedule GAS BURTCER (up to 10,400 BTU) i3t� $ �•©Q over 199,000 9M Soe roe Schedule GAS FITTING FEES: ICAO RATE TOTAL Ist 3 Fixtures x$ 200 $ -0 Additional Fixtures A .76 $_— Gas Range W 149=0 X3 6.00m $ 0,111t S 'iAAN r .4. r 4 t �, g>i) AL #50-12 Don Bell State Surcharge .50 a" Fee schtdielo $JL ,00 TOTAL F=. Dept. Of Bldip. 1 wo-um 5666 Matterhorn Dr. City of rwdley: The undersigned hereby makes application for a permit for the work herein: specified. agreeing to do all work in strict accordance with the City Ordi=ncev and ruling of the Department of Buildings, and hereby declares that all the fart and representations stated in this application are true and correct. Fridley, Minn 5-7-75 1! towner . RobettlLaugen Hosea Kind of Building ille Used as residence To be completed about, 5-30-75 Estimated Cost; $ did—New. Building Fer•mit No. _ __ Permit No. CJ e3V`"�o F4 HEA77NG or POWER PLANTS—Steam, Rot Rater, Warm Air—No ' Lennoa L�11.-1�V Trade Name Size No Capacity input Sq. Ft E.D.R BTU H P Total Connected Lwd 66.096 Kind of )fit Baa BURNER — Trmb Names acme as above Size lYa� Capacitlr. 114. fru D BTU Neat. OP036 3 ton 3.200 CFX 369000 BTU's FRED VOGT & CO. g1r> HEATING & AIR CONDITIONING , D260 Garfiam AM. • 929.6767, Irk Loud Eld4 MIPROW11 05426 %� I' SUBJECT P MI O. City of Fridley 15 6 9 2 AT THE TOP OF THE TWINS BUILDING PERMIT f ECEIPT NO. r.v _ _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 4/30/80 JOB ADDRESS 5666 Matterhorn 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 4 Innsbruck North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bob Sorenson 5666 Matterhorn Fridley 55432 571-1887 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Patio Village 3918 West 49:� St. Edina 55424 926-2771 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 Acid on a 20' X 14' deck. 9 CHANGE OF USE FROM TO STIPULATIONS 1. Provide railing pp more than 30" from the ground. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,800.00 $.90 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- STRUCTION OR THE P RFORM NCE OF.,CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $ $15.90 S NATURt 0., CONTRACT RORAUTNORIZEDAGENT (DATE) WH PROPS LY WD THIS IS V PURR PERMIT 0 LDG INSP DATE SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE) CITY OF FRIDLEY 1. APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: &8 'snG 5tj�� BUILDER: ADDRESS: S6C(6 r:aeiRt� ADDRESS: �%�/_U'! 57 TEL NO: /607 TEL NO: %2 L 2 zz Construction Location STIMT NO: STREET: KA Y=/40�� LOT: BLOCK.: <— ADDITION: �j luS� — k)Q P 77� 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. b�� DESCRIPTIO14 OF CONSTRUCTION Front: �Depth: Square Feet: 29O p4b(Cabic Feet: Front: Depth: Square -Feet: Height: OFF C ecrLt-AJJ6 Height: Cubic Feet: Type of Construction: �riJ bb'dl4 Estimated Cost: $ To Be Cbnlpleted: Alt. A Alt. B Prof�osed 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 in this applica DATE: � / 0 SIGNATUrJ,: Stipulations: 4poo."W , 2.;00 Re 3.oa ,g a -iso G� GERALD T. COYNE LOT SURVEYS COMPANY RAYMOND A. PRASCH 300 BRUNSWICK AVE. S. 6917 IDAHO AVE. N. GOLDEN VALLEY, MINN. LAND SURVEYORS BROOKLYN PARK, MINN. MINN. REG. NO. 4741 MINN. REG. NO. 6743 REGISTERED UNDER LAWS OF STATE OF MINNESOTA LICENSED BY ORDINANCE OF CITY OF MIIQNEAPOLIS INVOICE NO.4719 5747 W. Broadway Minneapolis, Minnesota 55428 533-9922F. 14— 7 INDUSTRIAL — JUDICIAL 't �j�f }� Sir i @. NO. COMMERCIAL — TOPOGRAPHICALurv�uxs QtiPI'�ifLCMtP SCALE 1" = 3 CITY LOTS — PLATTING O — DENOTES IRON ROBERT Ld',UO „N HOMES INC. DOenotes hub set for exeavati n only, v� Elevation datum assumed �•) �o _ _ X02 -,��� �o - �,;� � - - �,► + 19� ,, 4 24.33 42 4.33 '0 _ N'41 0\1 0 6�A t; /n A Lot 2,.-Block 4, INNSBRUCK NORTH Revised to show foundation May 23, 1975 w� We hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land and the location of all builldings and visible encroachments, if any, from or on said land. Signed Surveyed by us this 21st - day of April 19 75 Lotr COMPANY SUBJECT City of Fridley 2 4 4 068. AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. _ -'---COMMUNITY DEVELOPMENT DIV. L r PROTECTIVE INSPECTION SEC. ; NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/1/96 JOB ADDRESS 5666 Matterhorn Drive NE I LEGAL LOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 4 Innsbruck North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bob Nees sen, 5666 Matterhorn Dr., Fridley 55432 628-6911 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Allstar Construction, 3315 N Highway 100, Minneapolis 55422 593-5326 3247 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 RE-ROOF - tear off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with 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 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 $19980.00 $ .99 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- $60.25 Fire SC $1.98 STRUCTION ORT ERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE $5.00 TOTAL FEE $68.22 (GNA URE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPE Y VA DATED THIS IS YOUR PERM T EVOG INSP GATE SIGNATURE OF OWNER OF OWNER BUILDER) (DATI NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: 5&&h IM Ar E-9- M QA 0 - Legal Description: Owner Name & Address: CR5's' er� Tel. # to2-e Contractor: Aw%A-g- ctc jy72" uc�rw-rj MN LICENSE # Address: 33 cS 55 2Z- Tel. # Atta6h 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 Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: -Cpl2 OFF OF R* --i- Ko Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: 04:;,o V-: (Tem p-ool Estimated Cost: $ O Approx. Completion Date: (.r, o��c�- • / -� �' � (} . m (Cost on Back) Driveway Curb Cut Width Needed: DATE: APPLICANT: Ft. + 6 Ft = Ft x $ =S Tel. # TOTAL $ STIPULATIONS: CITY USE ONLY Permit Fee $ L6, c� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State. Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ �', f� $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 BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 7&"72-3604 FAX 763-5711287 1i . Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Cas Range Gas Dryer *Air Conditioning - All Sizes Alt 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 - viz -y Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES $35.00 $10.00 $30.00 $10.00 $25.00 CA fYle d t L25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/IndusirlaVinsUtutional State Surcharge TOTAL. FEE REINSPECTION FEE $50.O0/H0UR *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 # -2LL:- &a 0l 0 l FAX* 7 9GI - 9& S Approved by Rough -in Date Rnal Date JOB ADDRESS 1 Y i I Owner V b D UWJ V $ Building used As ESTIMATED COST PERMIT NO $ DESCRIPTION OF FURNACE AND BURNER $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. $� BTU HP EDR Fuel Total Connected Load $ 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 Coles $ and rulings of the Building Division, and hereby declares that an the facts and representations stated In this application are true and correct *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 # -2LL:- &a 0l 0 l FAX* 7 9GI - 9& S Approved by Rough -in Date Rnal Date Building MECHANICAL Permit No.: �Up1- 0 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY n QV 15 200 DATE l YOUR E-MAIL EDRESS SITE ADDRESS e r T THIS APPLICANT IS: D OWNFR CONTRACTOR PROPERTY NAME; r'6 O\ OWNER/ADDRESS: SG i t T� ZI TENANT PHONE: CONTRACTOR COMPANY NAME;1111J1111 _11111111 CONTACT PERS(; (.,,. 410 WE ? SUBMIT A COPY OF } , MN 55408 YOUR STATE STATE LICENSE #2-24- STATE ZIP LICENSE WITH ADDRESS; APPLICATION PHONE FAX PERNIIT TYPE ,SINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE WORK: 0 NEW PLACEMENT ❑ ALTERATION/REMODEL TYPE OF DETAILED DESCRIPTION OF WORK R Ce 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. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X-05= FOR PROJECTS WHERE LABOR EXCEEDS $500 ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (DIDICATE TOTAL NUMBER OF EACH BELOW) MFG: MODEL:_ SIZE/BTU Equipment Installed MFG: MODEL: SIZF9BTU MFG: MODEL: SIZE/BTU A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 NEW GAS GRILL $10.00 _AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 BOILER $35.00 3eFURNACE $35.00 GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 VENTILATOR $15.00 DUCT WORK $10.00 GAS PIPING $10.00 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @$15.00 x $15.00= $ TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 :Z x $35.00 = $ O State Surcharge = $ 50 Total = $ • THIS IS AN APPLICATION FOR A PERMITNOT 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 dley and with the Minnesota Construction Codes; that 1 understand this is conformance with the ordinances and a CL7k nota permit but o cAitio for annot to start without a permit; that the work will be in accordance with eapproved plan ' e work 'ch r ' esd approval of s. 1 PRINTril ATB V / SIGNATURE P City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977