PRE 2010 DOCSCity of Fridley
SUBJECT
ERMIT� .
7111
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RE
u------- COMMUNITY DEVELOPMENT DIV.
��46 to
r PROTECTIVE INSPECTION SEC.
1
a
i � CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
8/20/76
JOB ADDRESS 5800 Matterhorn Drive N.E.
1 LEGAL
I LOT NO.
6
BLOCK
2
TRACT OR ADDITION SEE ATTACHED
Grace High School Addition
DESCR.
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James McShane
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Gary M. Gorham Const. 9050 Collins Drive N.W., Anoka, Mn.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSEI(O.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
C4A NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a 64' x 24' Dwelling and a 20' x 24' Garage WARNING
REQUIRED FOR WRING, Before Billing call localfi ides
crPPRATE PERMITS TELEPHONE- ELECIRIC -GAS
9 CHAN���TI� ` LlJh�B�J�lGi *� TO
�J
REQUIRED
STIPULATIONS provide a hard surface driveway. Provide a verifying survey before
capping. Provide sod in the front and side yards. Brace each rafter to
bearing wall or provide 2" x 8" rafters.
SEWER LOCATION: (.Approx. 11' Deep) 82' South of Manhole (Inv. 927.14 -
RE 938.12)
TOP OF FOOTING: 931.18 Minimum
WYE ELEV: 927.98
WATER LOCATION: must be tapped in boulevard. 6" CIP watermain 5' East of
west line of Matterhorn Drive.
—IMPORTANT--
THC CITY OF FP.IDLEY DOES NOT GUARANTEE
THE
ACCU'UCY OF UTILITY LOCATIONS AND ELEVATIOi,,S. 'NOY" THE FRIDLEY ENGR,
Ti1IS DATA IS FOR INFORMATION PURPOSES ONLY AND OMS16N REGARDING CUR®
PERSONS USING IT SHOULD VERIFY THE INFORMATION REMOVAL AND REPLP.►CEMENT
ON T14r-- SITE
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. ONAffA CY LOAD
VENTILATING OR AIR CONDITIONING. Wood Frame
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 R-1 1056+480 21,120+4800
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 VALUATJ5 SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 40
,
$ 16.77
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-
$103.68 $350.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. /oj (p®
^ „'�� PLAN CHECK FEE TOTAL FEE
Al��:7v/�^'�aL� 0-2-0'76 $25.92 $496.37
SIGNATU FCONTRACTORORAUTHORIZEDAGENT (DATE) H N RO/P/nERLY VALIDATED THIS IS YOUR PERMIT
v�V
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) BLDG )NSP - DATE
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
OWNER'S NAM: c� f Z C J �c. n/� BUILDER : �c. r �,/ M �c, r1 a �-
ADDRESS:�„hc*,A1 �; ADDRESS: Ivi4 co al pry N'�/�
N0:. .S` 00 STREET • m n .A � r
LOT:_ BLOCK: z ADDITION: Cfgcc- H1i 4 J VIC1 f Acid,
CORNER LOT: INSIDE LOT: SETBACK: 'V0 SIDEYARD: O �®
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be ,T, sed As:
sr�s�c %'rkM��y Front: 6y Depth: Height:
Square Feet: 10,S-6 Cubic Feet:
Front: e Depth: Height: f O
Square Feet; Cubic Feet:
Type of Construction: ?"' /In t. Estimated Cost: -9e
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
V'
ATE: cid - 1,T,- - 7 ✓'�' M
( SIGNATURE.
I
(See Reverse Side For Additional Information.)
4/03, 6$
5r, "04t 4-,# % ! a.� S '
02D , 9a
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-�1 E G,
7415 WAYZATA M06
MINNiAPOL16• MINNE=OTA
CERTIFICATE OF SURVEY
For
i
No.! 5299
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143.52 -------
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-IMPORTANT-� o
- ac
ti
CURB
.WARNING DIVISION fR[GARDING
a digging call local utilltlesREMOVA� AND REPLACEMENT
LEPNONE-ELECTRIC-GAS Etc. AT DRfyg1 y OPENING.
SQUIRED BY LAW
DESCRIPTION: Lot 6, Block 2, GRACE HIGH SCHOOL ADDITz NN --
G
i; jU GIIY OF FRIDLEY DOES NOT
OF UTILITY LO ONS AND E1iVATIOn
ACCURACY PURPOSES N
PHIS DATA ISSIFOR THE INFORMATIC
NSHO
LTION
PERSONS UVERIFY
NG R
ON PHE SITE. SCALE: 1" 30'
We hereby certify that this is a true and correct representation of a survey of
the boundaries of the land above described and of the location of ail building;
If any, thereon,,and all visible encroachments, if any, from
or on said land.
EO t NOWAK INC
Dated thisl�day of July 1975 0 FGAR# rr eyorV� !
No.! 5299
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560-3450
cittyOf rijleo
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE November 30, 1976 FRIDLEY, MINNESOTA 55432
Mr. Gary Gorham
Gorham Construction
9050 Collins Drive N.W.
Anoka, Mn. 55303
Re: Final Inspection at 5800 Matterhorn Drive N.E.
Dear Mr. Gorham:
A final inspection was made on November 30, 1976 of 5800 Matterhorn Drive N.E.
and the only item noted which was not completed was the installation of sod
in the front and side yards. We will expect this to be completed by June 15,
1977 when a reinspection will be conducted to determine compliance.
If you have any questions on this item, please feel free to contact me at
571-3450.
Sincerely,
RONALD E. HOLDEN
Building Inspection Officer
REH/mh
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
hu=ber 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
x
$3.00
x
$2.00
x
rn
x
ro
x
$5.00
x
w
x
$7.00
Water
$5.00
x
$5.00
rn
Heater
-A
$Aj 4 a
�r3
�
C
E
��[ Jai
00)
Q
4 C
E 0l
4
$+
07
14
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wro
C
m
.$4 0
A
14
rri 0�
ro
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-
ro
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lec
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U
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P7
rn
3
Q w
cn
w
U I=
Q 3
C7
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0
as
lst
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer
(*) = New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
hu=ber 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
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 $10.00
State Surcharge
TOTAL FEE
REINSPECTIQN FEE
$5.00
$2.00
TOTAL
$ X ,Do
$
Job Address Z-�y® ^ /,1"/jo
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. / _ 0 , 19 ?6
OWNER �� re y ® A'q/-'i
KIND OF BUILDINGb S j
USED AS Cv►� ( LiP C
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD NEWIBUILDING PERMIT NO. PERMIT NO.
�� Company
Signed By
Tel. No.
ROUGH INSP.
Date
FINAL INSP. ��— d - 76,
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY 1iAR\1 AIR: RATE TOTAL Job Address 2
Furnace* Shell & Duct Work $12.00 $
Replacer..ent of Furnace 7.00 $
Repairs & Alterations -up to $500.00 7.00 $ Department of Buildings
Repairs & Alterations each add. $500.00 4.00 $ City of Fridley
Tel. #571-3450
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 500,000 BTU
Replacement of Furnace
Repairs & Alterations -up to $500.00
Rerairs & Alterations each add. $500.00
STF-k\1 OR HOT KATER SY STLM :
Boiler & Lines up to 100,000 BTU
each adn. 50,060 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNER- to 3 gal. per hour
each add. 3 gal. per hour
GAS BURNER- frrm 100,000 BTU to 199,999 BTU
(over 199,999 BTU sue Fee Schedulu)
GAS FITTING FEES:
ist 3 Fixtures
Additional Fixtures
Gas Range to 199,000 BTU
AIR CONDIT1JNING
FAN Au iTIAu S2'STL�fS - See Fee Schedule
The undersigned hereby makes application for a permit for the work herein
$12.00 $ /x4,,00 specified agreeing to 'do all work in strict accordance with the City Codes
4.00 $ and rulings of the Department of Buildings, and 'hereby declares that all the
7.00 $ facts and representations stated in this application are true and correct.
7.00 $ /h 19Z
4.00 $ Fridley, Minn�
OWNER
$12.00
$
4.00
$
7.00
$
6.00
$
$10.00
$
10.00
$
$10.00
$
x $ 3.00 $
x $ 1.00 $
x $10.00 $
VENTILATING SYSTEMS
ALTERaTION'S $ REPAIRS -
State Surcharge
TOTAL FEE
ROUGH INSP.
Date
FINAL INSP. -�2i *%
Date
APPROVAL FOR PERMIT
REINSPECTION FEE
($10.00)
XINLNUM FEE FOR ANY HEATING PER+IIT IS $7.50
$ .50
$
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO.
PERMIT NO. ��O
DESCRIPTION OF FURNACE/BUPVER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name Size No.
Capacity Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel
BURNER - Trade Name
Size No.
Capacity . Ft. EDR BTU HP
1
Company
Signed By
Tel. No.
v .
CITY OF FRIDLEY
APPLICATION FOR
POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
.AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
RATE
TOTAL
Job Address 5800 Matterhorn
Furnace Shell & Duct Work
$12.00
$
Replacement of Furnace
Repairs & Alterations -up to $500.00
7.00
7.00
$
$
Department of Buildings
Repairs & Alterations each add. $500.00
4.00
$
City of Fridley
Tel. #571-3450
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 BTU $12.00
each add. 50,000 BTU 4.00
Replacement of Furnace 7.00
Repairs & Alterations -up to $500.00 7.00
Repairs & Alterations each add. $500.00 4.00
STEAM OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU $12.00
each addn. 50,000 BTU 4.00
Boiler only up to 100,000 BTU 7.00
each addn. 50,000 BTU 6.00
OIL BURNER- to 3 gal. per hour $10.00
each add. 3 gal. per hour 10.00
GAS BURNER- from 100,000 BTU to 199#999 BTU $10.00
(over 199,999 BTU see Fee Schedule)
GAS FITTING FEES: Gas Piping
1st 3 Fixtures x $ 3.00
Additional Fixtures x $ 1.00
Gas Range to 199,000 BTU x $10.00
AIR CONDITIONING
FAN HEATING SYSTEMS see Fee Schedule
VENTILATING SYSTEMS
ALTERATIONS & REPAIRS
State Surcharge
TOTAL FEE
ROUGH INSP. REINSPECTION FEE
Date ($10.00)
FINAL INSP. 7i l Z - ?/7
Date
APPROVAL FOR PERMIT
7
S
S
S
S
.50
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
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, Minn. November 15, -- , 1977
OWNER Gary Gorman
KIND OF BUILDING Frame
USED AS Dwelling
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD -®BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name
Capacity
Size No.
Sq. Ft. EDR BTU HP
Total Connected Load Kind of Fuel
BURNER - Trade Name' Size No.
Capacity Sq. Ft. EDR BTU HP
conpatyADVANCED H TING & AIR COND.INC
Signed By
Tel. No. 571-4$$1
Or
.
eyr
CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
August 9, 1990
James McShane, Jr.
5800 Matterhorn Drive N.E.
Fridley, MN 55432
RE: Property at 5800 Matterhorn Drive N.E.
Dear Mr. McShane:
On July 1, 1990, the City of Fridley began a new program called
Systematic Code Enforcement. This program is designed to provide
fair and equitable code enforcement, improve the City's appearance,
and maintain property values by creating a more attractive suburban
environment. Under this program, all properties in the City will
be inspected approximately once each year to ensure that they are
in compliance with the Fridley City Code.
A recent inspection of your property revealed that not all Code
requirements are presently being met. Listed below are item(s)
which do not comply with the Code:
1. Discontinue outside storage of stacked firewood along driveway
in front yard. (Fridley Zoning Code does permit storage of
stacked firewood in the side or rear yard.)
Your prompt attention in correcting this problem would help us in
our effort to improve the City. A reinspection will be conducted
on or about August 23, 1990, at which time compliance is
anticipated. Please call me at 572-3595 if you have questions or
wish to discuss this further. Thanks for your cooperation!
Sincerely,
Steven Barg
Code Enforcement Officer
SB:ls
C-90-564
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
TOTAL
��
Job Address .5-800 'Wa Dn'4� 2za.
Furnace Shell and Duct Work,
Burner (Also replacbSOnt furnace) $ 20.00
$ rf9 U
Building Inspection Div. 6431 University Ave NE Friedl MN 55432
9 P Y Fridley
Tel. No. 572-3604
Gas Piping $ 10.00
$ 4,6,c 0
(piping needed with now furnace)
$ 10.00
$
The undersigned hereby makes application for a permit for the work herein
Ga/ Range
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.
� 1
a� ' 9�
• Air Conditioning (all sizes) $ 10.00
$/D, 0-D
All Others/Repairs and Alterations
OWNER Int -
it of Value of Appliance or Work
$
KIND OF BUILDINGD�
COMMERCIAL/INDUSTRIAL
USED ASI..— C
It of Value of Appliance or Work
$
Ta BE COMPLETED ABOUT -
ESTIMATED COST 7--9-3 y
State Surcharge
S .50Z)f7�v
_
OLD - NEW BUILDING PERMIT NO. PERMIT NO. /(J
TOTAL !'EE
622/ O o
REINSPECTION FEE $30.00.
$
DESCRIPTION or FURNACE/BURNER
Rough Insp.
HEATING or POWER PLANTS, Steam, Not Water, Warm Air- No.
Date
S� '
Trade Name �� Size No.
Final In/p.
Date
Capacity Sq. Ft. EDR BTU 4Lyhp e9 HP
Approval for Permit
Total Connected Load Kind of Fuel
BURNER - Trade Name Rize No.
Capacity Sq. Ft. EDR BTU HP
STANDARD HEATING AND AIR CONDITIONING
MINIMUM FEE FOR ANY HEATING/COOLING/VENTING PERMIT
Company411
IS $15.00 PLUS THE $.50 STATE SURCHARGE
�T FTEEI
Signed By MINNEAPOLIS, MN 55408
k.-rrlkaimr- -b24-2656 A
Tel. No.
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
Fill out back side for stack verification On replacement furnaces
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (,)
2. Is free from rust or deterioration Yes ( )
3. Has no foreign objects lodged within Yes ( )
4. Is securely supported Yes ( )
5. Meets all current Code requirements for size and
total BTU connected Ye, ( )
6. Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
Company
Signed By
Da to
No ( )
No ( )
No ( )
No ( )
No ( )
STANDARD HEATING & AIR CONDITIONING CO.
SERVING THE TWIN CITIES SINCE 1930
HEAT LOSS CALCULATION FOR qCSHANE-5800MATTERHORN DR
MAIN LENGTH 25 WIDTH 44 HEIGHT 8
WINDOWS & DOORS - CRACKA@E AND AREA
WIDTH HEIGHT NO. LIN FT AREA
NO. \ PANE PANE CRACK SO R
' 8 ` 21 3\ 1 '` 81.3 50
15 31 / 1 9.2 4.7
!
16 30 1 18.3 9.7
21 53 | 1 �41.5 30.2
36 96 [D' 36 48
�
32 80 / U '18 7 17.8
36 8* \ D / 19.3 20
\/ COEFF B0
INFILTRATION ................. 224.3 20 4486 Q -_j
GLASS ...^.......................... 180.4 50 9020
EXP WALL .......................,,. 138
NET EXP WALL.........~........... 923.6 13 C006.8
BELOW GRADE ..... O ............... 0 5 O
CEILING ............................. 1100 15 16500
FLOOR ............................. A O O
VENTILATION ..... O ............... O O 0
TOTALBTU................................................ 42012.8
BASEIIENT LENGTH2-151 WIDTH
44
HEIGHT
WINDOWS & DOORS - CRACKgGE AND
AREA
WIDTH HEIGHT NO. LIN R
AREA
N1 PANE PANE LIGHTS CRACK
SQ R
9 21 31 1 91.5
56,2
3 22 30 1 30.5
19
1 15 31 1 9.2
4.7
OEFF
B0 1718 R.R
INFILTRATION ............. .... 131.2
20
2624
GLASS .........,...........~......
79,9
50
3995
EXP WALL .....,....................
138
NET EXP WALL .....,................,
472.1
13
6137�3
BELOW GRADE...... 4 ......~........
552
5
2760
CEILING .................. ...........
O
O
O
FLOOR ...............,............
1100
5
5500
VENTILATION ...... V ................
V
O
O
TOTALBTU ....,...,......,...~.......".................
2016.3
^
'o -YV -? 11 "
RiAt
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763-572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer /
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Effective On January 1, 2001
JOB ADDRESS 5y�0-r__ /n11
OWNER 3��,.�
Rate TOTAL J�
BUILDING USED AS
$ 30.00 $
ESTIMATED COST
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.�.:�
PERMIT N0. 1 �; 3
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Cir le One (Steam) (Hot Water) (Warm Air)
$ Trade Name d� _?� u.i /`?i/�J�'%J Size No.
BTUHP 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 Codes an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
_ representations stated in this application are true and correct.
DATE - / "`' /
HEATING CO A/4
Signed
Approved By?� Rough -In Date
TEL # v?g 4
l�
Final Date
BACK SIDE MUSE BE FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTION AIR VERIFICATION
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verges 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 manufacturers
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 _
Appliance #2 Type _
Appliance #3 Type _
Total Appliances
Common Vent Type
_ BTU Input
_ BTU Input
_ BTU Input
Total Btu Input
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
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 :
V% CITY OF FRIDLEY PERMIT NO.: 2004-02259
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 12/09/2004
572-36U4 1"AX: (763) 5714114"/
ADDRESS
5800 MATTERHORN DR NE
PIN
243024240008
LEGAL DESC
GRACE HIGH SCHOOL ADD
LOT 6 BLOCK 2
PERMIT TYPE
BUILDING
PROPERTY TYPE
: RESIDENTIAL
CONSTRUCTION TYPE
: WINDOW/DOOR REPL
VALUATION
: $ 14,253.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317
OF THE 2000 INTERNATIONAL RESIDENTIAL CODE.
I CAULK AND FLASH ALL EXTERIOR OPENINGS.
APPLICANT
RUM RIVER
10141 WOODCREST DR
COON RAPIDS, MN 55433
(763) 862-7320
OWNER
MCSHANE JAMES T JR
5800 MATTERHORN DR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at 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
mguhwkg construction or the performance of construction.
Annlicant ,I Date i
Bldg InIDate
BUILDING PERMIT FEE 251.25
FIRE SURCHARGE 14.25
STATE SURCHARGE, VALUE 7.13
TOTAL 272.63
PAID WITH CHECK # 20322
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
.--zL4915
NEW [ ] CITY OF-rRIDL�EY
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432
ALTER% SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Effective 4/1/2004
(763) 5724604 B -l -d9 IInsp
(763) 57fi=fi287 Fax )
Legal Description:
Owner Name & Address: eSe�fA�Tel. #
Contractor. W-� ,4W i'%!— MN LICENSE # 490 3,4 A '
Address: /�'i�/ A�"�� ST 012-. 4� ffi'/ Tel. # 'ZO -- f .0 —'73
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. RIq Z 5-3 7y
I
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:
Construction Type:Estimated Cost: $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$
DATE: f -G APPLICANT:' �'��Tel. #
G'�
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.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
$ ' /- Z
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 [ ]
TOTAL $ `1 STIPULATIONS:
Building
Inspections
763-572-3604
DATE w_
SITE ADDRESS _,
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Vw •, • i
•_N
COMPANY NAME; 0 1 ANUA41B
CONTACT PERSC .
STATE LICENSE Ij
PHONE
PERMIT TYPE Xs"GLE FAMRY ❑ TWO FAMILY
TYPE OF WORK: [I NEW /NEPLACEMENT
DETAILED DESCRIPTION OF WORK li
FAX
MN 55408
24 —
❑ TOWNHOUSE
Q ALTERATIONMEMODEL
Permit No.:
Received By;
PER MS 16B.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
'should reflect only the cost of labor )
improvement, installation or replacement of a residential fixture, excluding them'es
. d..: (This . .
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost -of labor x .OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE HAS ON $10.00 PER F1XfI7RL, EXCEPT WHERE NOTED. FMTURES,: (INDICATE TOTAL
NUMBER OF EACH BELOW) MODEL: ' SIZEMTU
Equipment Instatied MODEL: " SDWBTU —
MFG: MODEL: SIZE/BTU
FIREPLACE (GAS) $15.00 GAS RANGEIOVEN $10.00
A/C $25.00 NEW GAS GRILL S10.00
AIR TO AIR EXCHANGEER $15 FURNACE (WOOD)
D) $35.00 GAS UNIT HTR $10.00
BOILER $35.00 POOL HEATER 535.00
CHINIIQEY LINER $10.00 OAS DRYER S10.00 TOR;15.00
DUCT WORK $10.00 GAS PIPING $10.00
Permit Fee $ Number of fixtures @ $10.00 x $lu.uu =41—
Surcharge .SQ Number of fixtures @ $15.00 x $15M $
TOTAL DUE $ Number of fixtures @ $25.00 � x $25.00
Number of fixtures @ $35.00 x $35.00 = $
State SurchargeIM&
Total
THIS IS AN APPLICATION FOR APERMIT-NOT VALID UNTIL PROCESSED
wledge that the inforrmalion above is complete and accurate, that the work will be in
.e City of Fridley and with the M'mnesotaConstruction Codes; dw1 understand this is
and work is not to start without a permit; that the work will be in aecoee j
tht
res review and approval ofppos; `1 nr
I hereby apply for a building permit and I
conformance with the ordinances and
not a permit bu;r=—
onf." approved plan ork
SIGNATURE OF
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley,MN 55432
763-672-3604
FAX: 763-502-4977