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PRE 2010 DOCSCity of Fridley SUBJECT T NO. rE AT THE TOP OF THE TWINS PERMIT, .13839 r BUILDING ECEIPT NO. • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. S_39® (19 1 = i NUMBER REV. DATE PAGE OF APPROVED BY "--'1 CITY HALL FRIDLEY 55432 612-560-3450 910-F 15 10/22/76 JOB ADDRESS 5840 Matterhorn Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 2 Grace High School Addn. SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Gary M. Gorham Const. 9050 Collins Drive N.W., Anoka, Mn. 421-0998 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 IR NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 57' x 48' Dwelling and a 24' x 24" Garage n W WARNING ate digging Call 10,'.r,1 utilities TELEPHONE 1 - UA 9 CHANGEOFOVAyfi,,?, PLUMBING AND SIGNS, REQUIRED .BY STIPULATIONS Provide a hard surface driveway. Provide sod in the $NX front and side yards. Provide a verifying survey before capping. Fireplace rough -in should be inspected before setting in damper. SEWER LOCATION: (Approx. 11" Deep) 68" North of Manhole (Inv. 927.14) WYE ELEV: 926.48 TOP OF FOOTING: 929.68 Minimum WATER LOCATION: MUST BE TAPPED 6" CIP watermain 5' East of West Line of Matterhorn Drive. TME CO OF f Diff DOES- NOT GUARAMM TME ACCURACY .OF UnIM .LOCAMONS AND tWATiC •a. —IMPORTANT. - TO DATA IS FOR INFORMATION PUMMS ONLY r.MJ NOTIFY THE FRIDLEY ENGR POSONS UStNO IT SHOULD VERIFY THE MP amAllOhf DIVISION REGARDING CURB ON INE SITF. REMOVAL AND REPLArgAAFb1;1 SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. AT 1VP6 R -NI U NCY LOAD VEL (AC V,7�10 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 1325 + 53 32,206 Tota ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. $41, 865 $20.93 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- $128.82 $350.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 32.20 $531.95 SIGNATUREO ONTRACTORORAUTHORIZEDAGENT (DATE) ( HEN PRO ERLY VALIDAT D THIS IS YOUR PER MIT rte/ ,ll DAT - SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) BLDG. INSP CITY OF FRIDLEY APPLICATION FOR. RESIDENTIAL BUILDI IG PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER'S NAME: BUILDER: cA r� M (FO ADDRESS: ADDRESS: `�oSc� G®/,�j:,r s '0'; AIIA) 684t® TEL. NO.: N0: STREET: I% f --. r) e LOT: y BLOCK: ADDITION: Gra rlc 14"24 ls-,Xod,% AaQ, CORNER LOT: INSIDE LOT:^,Y� SET19ACK:� a SIDEXARD: �J Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. -9 DESCRIPTION OF BUILDING To Bq Used As: Front: 6- -7 Depth: Height : lj%p` i3zs� .�5"` to�� Square Feet: Cubic Feet: Front: 2 J1 Depth: -Height: e Square Feet; 46'�Cubic Feet:6 S- 3O Type of Construction: r'c,, Al C Cklcooj) Estimated Cost: $ j�77 J To Be Completed: ncx., �� , -� 7� � GJ"r 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: J4 - IS - 74 SIGNATURE: (See Reverse Side For Additional Information.) Ads00&'r0'0N BE�004 E X497"OI9 too L14�wdpcl< 741SWAVZATA MIL 2 F 'MINNiAPOUS. MINKLUTA Este. II It N CELITIFICATE OF SUMVET Foe i QC _-1---- 143.52 va NA WARKIN More digging call local utilities TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BY LAW DESCRIPTION: Lot 4, Block 2, GRACE HIGH SCHOOL ADDITION. 0 QC 94 1 Q 9 awslON REGARD �N'Gik *EMOVAL AND REP CUR® AT DRIVEWAy OP igkl.NT SCALE: 1" = 301 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 all buildin94 if any, thereon, and all visible encroachments, if any, from or on said land, )a ted this 18th July 1975 �_,dey of Y , EGAN, FIELD NOWAKg INC urveyor f� 1 *fle N6.1_5299 _ Book No.1 by a. P o ^F S 6 � urn 811010, 49 r4 8A .9r46 �'OOF vg44/---o/o,/ CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING:FIXTURE RATES: NO. RATE TOTAL yri � x $3.00 $--��-- o x y New Fixture, Old Opening Water r. $2.00 - $ Catch Basin m x $5.00 $ sm+ c A W o 100,600 BTU to 199,000 BTU a w c Heater $ New Ground P..:.: Old Building x $5.00 Electric Water Heater E x $5.00 u $4 / ai , ? V lst 3 fixtures ( .oi J Additional Fixtures x $1.00 C 3 0 a y U d x 4, m N U N N C NG q 0 0 w Er C. U a �? � y U o ,as ilec r lst 2nd 3rd t.`t.: (R) Fu urea Connection Opening Connected with Sewer (*) _ ::cw Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING:FIXTURE RATES: NO. RATE TOTAL \3:'.bE. Fixtures � x $3.00 $--��-- Future Fixture Cpening x $2.00 $ New Fixture, Old Opening r. $2.00 - $ Catch Basin x $5.00 $ Water Heater - to 99,600 BTU / / �I� x $5.00 $ 100,600 BTU to 199,000 BTU r. $10.00 $ Water Softener x $7.00 $ New Ground P..:.: Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: / , ? V lst 3 fixtures ( x $3.00 $ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ aLTEPATIONS First $1CO.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 '1 TOTAL FEE REINSPECTION: FEE ($30.00) Job Address ��� / //�®i �✓ b/�%� -)apartment 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 correal OWNER KIND C 7 Fridley, Mn. ` - , 19 USED AS vii � /� e, C TO BE COMPLETED ABOUT S ^ ® � Z ESTIMATED COST OLD UILDING PERMIT NO. PERMIT NO. Company Signed By Tel. No. ROUGH INSP. Date FINAL INSP. /-/?- Date APPROVAL FOR PER^.IT MINIMUM FEE FOR ANY PLUMBING PEruvIT IS $7.50 CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE J GRAVITY WARM AIR: RATE TOTAL Job Address Furnace Shen & Duct work 4t7-YiO $ � = Rcnlacame nt of Furnace 7.00 7.00 ;. $ Dcj�artmcint of Buildings F.epairs & :,iterations -up •to $500.00 4.00 $ City of Fridley Repairs & Alterations each add. $500.00 Tel. N571-3450 MECHANICAL WARM AIR: The undersigned hereby makes application for a permit for the work herein $12.00 $ 42 -CO specified agreeing to do all work in strict accordance with the City Codes Furnace Shell & Duct work to 100,000 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the each add. 53,670 BTU 7.00 $ facts and representations stated in this application are true and correct. Replacement of Furnace to $500.00 7.00 $ / '- �b Repairs & Alter.:tions-up 4.00 $ Fridley, Minn. 19 Re:airs S Alterations each add. $500.00 STEk'-: OR FLT Kk"LER SYSTEM: O41NER �� Boiler i roes up to 100, 060 BTU . $12.00 $ KIND OF BUILDING each adds. 50,060 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ USED AS each adan. 50,030 BTU 6.00 $ TO BE COMPLETED ABOUT OIL BURNEER- to 3 gal. per hour $10.00 10.00 $ $ ESTIMATED COST each add. 3 gal. per Your GAS BURNER- frc:a 100,000 3Tu to 199,999 BTU $10.00 $ OLD - NEW BUILDING PERMIT NO. PERdZT NO. _ • ' (over 199.999 BTU see Fee Schedule) $ GAS FITTING FEES: ist 3 Fixtures x' $ 3.00 $ DESCRIPTION OF FURNACE/BURNER Additional Futures x $ 1.00 $ Gas Rar.;e to 199,000 BTU x $10.00 $ HEATING or POWER PLANTS, Steam, Hot Water, Wawa Air- No. AIR CONDITIONING ! $ IDOUTrade Name /� Size No. %l FAN Ili -EATING SYSTEMSSee r^se schedule $ N VENTIL TING SYSTEMS $ Capacity Sq. Ft. EDR BTU H? ALTERATIONS & REPAIRS J S _ State Surcharge $ .50 Total Connected Load Kind of Fuel TOTAL FEE $ S .� BURNER -Trade Name Size No. Capacity Sq. Ft. EDR BTU HP F JG:i INSP. REINSPECTION FEE Date (.$10.00) �- Company i�. INS?. DateSigned By JZ�/a �l1 APP ZVAL FOR PEa%:IT % + •Tel. No. r FEE FOR ANY HEATI14C PER::IT IS $7.50 97-T-879001 bl 1 1 NI J JUAJ661 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Job Address 58ho. MATTERHORN DRIVE Department of Buildings City of Fridley Tel. @571-3450 The undersigned hereby makes application for ,a permit for the work here_! specified agreeing -to do all work in strict accordance with the City Code- and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and cor- Fridley, Mn. 4-4-77 , 19 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RAT w Nu -tuber Fixtures 4 $3.00 n Future Fixture Opening • jj o, $ Water x $2.00 $ A x $5.00 ro w ae .to m3 $5.00 $ ; x w $ Water Softener Heater $7.90 $ New Ground •Run Old Building x $5.00 $ Electric Water Heater - ya[� r $5.00 $ 4 gO C J O C N N .1 w as lec N % U o m y a U3 w 0 r E2-id 3rd 4th' (R) - Future Connection Opening Connected with Sewer (•) - New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RAT TOTAL Nu -tuber Fixtures x $3.00 $ Future Fixture Opening • 3i $2.00 $ Now Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ k Water Heater - to 99,000 BTU, x $5.00 $ 100;000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.90 $ New Ground •Run Old Building x $5.00 $ Electric Water Heater - x $5.00 $ GAS FITTING FEES: lst 3 fixtures x $3.00 S Additional Fixtures �- x $1.00 S __- .Gas Range to 199,000 BTO x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 S State Surcharge $ .50 TOTAL FEE $ 8.00 REINSPECTION FEE ($0.00 OWNER WM. GRAFFUNBER KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT -11-77 ' ESTIMATED COST 10.00 OLD - NEW BUILDING PERMIT NO. `08== PERMIT NO Q Company a W N E ASEGG Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT _ MINIMUM FEE FOR ANY PLUMBING PERMIT is $7.50 G!,Dss "A" Surcharge _90; 0 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 5840 Matterhorn Furnace Shell & Duct Work $12.00 $ Replacement 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 WARD1 AIR: The undersigned hereby makes application for a permit for the work herein Furnace Shell & Duct Work to 100,000 BTU $12.00 $ specified agreeing to do all work in strict accordance with the city Codes each add. 50,000 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the Replacement of Furnace 7.00 $ facts and representations stated in this application are true and correct. Repairs & Alterations -up to $500.00 7.00 $ November 15 19 77 Repairs & Alterations each add. $500.00 4.00 $ Fridley, Minn. , , STEAM OR HOT WATER SYSTEM: OWNER Garr Gorman Boiler & Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING Frame each addn. 50,000 BTU 4.00 $ DWellinE Boiler only up to 100,000 BTU 7.00 $ USED AS each addn. 50,000 BTU G.00 $ TO BE COMPLETED ABOUT OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ ESTIMATED COST GAS BURNER- from 100,000 BTU to 1990999 BTU $10.00 $ /0'0 OLD -(NDEW BUILDING PERMIT NO. PERMIT NO. (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: Gas Piping3 00 1st 3 Fixtures x $ 3.00 , $ DESCRIPTION OF FURNACE/BURNER Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00• $ HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. AIR CONDITIONING $ Trade Name size No. FAN HEATING SYSTEMS See Fee schedule $ VENTILATING SYSTEMS $ Capacity Sq. Ft. EDR BTU HP ALTERATIONS $ REPAIRS $ State Surcharge $ .50 Total Connected Load Kind of Fuel TOTAL FEE $_13-50 BURNER - Trade Name Size No. ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP Date ($10.00) FINAL INSP.-Y -6-- �2 Date /J APPROVAL FOR PERMIT ` ¢� MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE company OND. Signed By �f Tel. No. March 2, 1977 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 Gary M. Gorham Construction 9050 Collins Drive N.W. Anoka, Mn. 55303 Re: Final Inspection at 5840 Matterhorn Drive N.E. Dear Sirs: TELEPHONE ( 612)571-3450 A final inspection was made on March 2, 1977 of 5840 Matterhorn Drive N.E. and the following items were noted which must be completed before the structure can be finaled out; 1. Install permanent front steps -by May 25, 1977. 2. Provide sod in the front and side yards by May 25, 1977. 3. Provide a hard surface driveway by May 25, 1977. We will expect the above items to be completed by May 25, 1977 when a reinspection will be made to determine compliance. If you have any questions on the above items, please feel free to contact me at 571-3450. Ser y, RON HOLDEN Building Inspector RH/mh CI1W OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993 •6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Fumace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $ representations stated in this application are true and correct. ,1993 Gas Piping (Needed with new furnace) $10.00 $ OWNER������� 2 Gas Range $ 10.00 $ BUILDING USED AS Gas Dryer $ 10,00 $ ESTIMATED COST PERMIT NO. *Air Conditioning - Ali Sizes $10,00 $ .0y1, C j% `7`/,i , � P; erA 12ESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No, of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. Commercial/Industrial BTU HP EDR 1% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge X50 Burner Trade Name Size No. TOTAL FEE BTU HP EDR HEATING COMPANY MINIMUM FEE FOR ANY HEAT] NG/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed By el No, PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 Approved ByA Rough -in Date Final Datea-/7`9 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 4 CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( ) No ( ) 2. Is free from 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's connected Yes ( ) No ( ) 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Being Done: HEATING COMPANY Signed By Date New, oncea-day ,TABLEM oma uoraraalne) vW 'r Copyright 01992,wved S CR -15117204203 1112 Kenilworth, NJ dOn033, US � All rights reserved. �-I54n7204103 17/92 Printed in U.S.A Please see accompanying full Prescribing Information. Printed on Re® paper. C SUBJECT P V City of Fridley 30833 AT THE TOP OF THE TWINS BUILDING PERMIT r R NO. • COMMUNITY DEVELOPMENT DIV. LV _____ r � PROTECTIVE INSPECTION SEC. 1 . , CITY HALL FRIDLEY 55432 NUMBER REv DATE PAGE OF APPROVED By 612-571-3450 910-F15 4/17/00 JOB ADDRESS 5840 Matterhorn Drive NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 2 Grace High School Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kevin/Lisa Johanson 5840 Matterhorn Drive NE 763-586-0490 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO CRSI 1458 E Cliff Rd, Burnsville, MN 55337 952-808-3283 20219596 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 IR REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof House & Garage (31 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED 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 OFFSTREET PARKING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,709 $1.35 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• $83.25 Fi STR OR THE PERFORM NCE OF STRUCTI N _ a SC $2.71 PLAN CHECK FEET AL FEE Lice C $5. $92.31 SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT L. iD4TEi HE PRO VAL A D THIS IS YOU PERMIT 9 �� _� $.GN4TURE OFOW NEA iiF DINNER BUIIDERi 'DATES .. Bl Gr NSP T,AtE C NEW [ l Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: S �� Vl Dc'' /)v- �V �! le ® Legal Description: Owner Name & Address: 1 -e V1 w f I`sg Jv�g,l Somal ' Tel # 71, 1-7 P11- �c Contractor: /y S' 9 V V -V1,;" - MN LICENSE # -� ba / / �n7 G Tel.# %�'^� ` aCe- 3� 93 337 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 3 j Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER:��9 c/ �► t? �;c c/ Gr Tea r 0 Construction Type: �f cl 0,1 Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft =` Ft xp$ = $ DATE: 7 - a000 APPLICANT: S 1— U d s f �l ✓ I ? Tel. # q Sd, ^ g `� ®' 9> CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ (�33- .5� Fee Schedule on Reverse Side Fire Surcharge $ %/ .001 of Permit Valuation (1/10th%) State Surcharge $ /, •3 $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $ • 00 $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: 9 SUBJECTP OMIT NO. City of Fridley 31909 AT THE TOP OF THE TWINS BUILDING PERMIT r 16 RECEIPT NO. DIV. -__-- COMMUNITY DEVELOPMENINSPECTION INSPECTION SEC. r e ® i� 572-360 r I � PROTECTIVE �cSC NUMBER - REV DATE PAGE 0F APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 6/19/01 JOB ADDRESS 5840 Matterhorn Drive NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 2 1 Grace High School Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kevin Johanson - 5840 Matterhorn Drive NE 586-0490 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO RMT Exteriors 5725 Drew Ave N, Brooklyn Center, MN 55429 535-7566 20176909 a 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 0 ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Reside House 9 CHANGE OF USE FROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $7,500 @ $3.75 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 - $153.25 Fire SC $7.50 TRUCTION OR THE PERFO ANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL E License_.*q$5.0',% 9.50 Si AT REOF 0 TRACTOR OR AUTHORtZEO AGENT iDATE, EN P OPE ALIDATED HIS IS Y UR PERMIT S NAYUREOfOV.VNER,IFOVYNERSUILDERj iDATE. Bl0 NSR OAtE 9 NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: '�, V ` U � A. � Legal Description: dress: 00'6? Tel. # '/r �ic % MN LICENSE # Tel. # 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 Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length OTHER: Width Hgt/Ground Sq. Ft. Construction Type:_ _5 " :D,' -^D4c;> Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ �Z�'�� DATE: 4'/% '0 l APPLICANT:—:!:�—vg �G�/%�� Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ ���-��` Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ -. %�� $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $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 $ 6,9 SD STIPULATIONS: ITYIOF FRIDLEY INSPECTION DIV. 139 "Uruversiity Ave NE [� - ` idiey, MN 55432 13-572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On Jan 1, 2001 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR e : Stones urinal :. . :..::... i. - Shower Wash Tray i�ttFloor Drain : AuGas_:>{ Washer $ 7.00 E' Ran a eat........ W er Her at Gas Etec Basement :,.:.... $ 7.00 Ap/Receiving Tank $ 7.00 Aer Treating Appliance —T- $10.00 Owner /iCE✓",J ��r�.✓Sv.� Aer Heater -Electric iter Heater - Gas" �� 1 r F Oo 1 Noh� Building Used As it Range" $10.00 S 1S Dryer" $10.00 Estimated Cost y PERMIT NO. 6k Flow Preventer Required( )Yes ( ) No = Type $15.00 Floor 2 ........... Floor a>' Fl�r 4 .UMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS ,5 �"o �arr���vmz•� A/' avii Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein d Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes .ei• Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts riv Off Basin $ 7.00 and representations stated in this application are true and correct. it&h Basin $ 7.00 dh Water Leader $ 7.00 Ap/Receiving Tank $ 7.00 Aer Treating Appliance —T- $10.00 Owner /iCE✓",J ��r�.✓Sv.� Aer Heater -Electric $ 7.00 iter Heater - Gas" �� $10.00 la>y o Noh� Building Used As it Range" $10.00 S 1S Dryer" $10.00 Estimated Cost y PERMIT NO. 6k Flow Preventer Required( )Yes ( ) No Type $15.00 PLUMBING COMPANY Inspection Fee $47.00/Hr SIGNED BY TEL N0. L OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance 61e� Approved By Rough -In Date Final Date v i State Surcharge 50 TOTAL FEE $ �e 'SO PLUS THE 5.50 STATE SURCRIGE -)MBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE 1 G7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 November 9, 2001 Kevin Johanson 5840 Matterhorn Drive Fridley, MN 55432 Re: Final Inspection at 5840 Matterhorn Drive Contractor: Terry Overacker Plumbing Dear Mr. Johanson: A plumbing permit was issued on May 4, 2001, to install a water heater at your address. According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspections to make sure the work was completed according to the Plumbing Code. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will expire the permit and no further action will be taken. To set up the inspection, or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, DJ/mh sue.,Etr IT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT____ . COMMUNITY DEVELOPMENT DIV. L � w � ®� NO. f � � PROTECTIVE INSPECTION SEC. E � .3?3q REV DATE PAGE OF APPROVED BY _ ".-I CITY HALL FRIDLEY 55432NUMBER 612-571-34,50 910415 7/5/01 JOB ADDRESS 5840 Matterhorn Drive NE -_ I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 2 Grace High School Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kevin/Lissa Johanson 5840 Matterhorn Drive NE 763-586-0490 3 CONTRACTOR MAIL ADDRESS ZIP PHONE 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 ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 12' x 12' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. EL a WARNMING SEPARATE PERMITS Before digging call for REQUIRED FOR: all Utility locations 454-0002 �LVNtRING HEATIN UMBING� MI) SIG%S REQUIRE® BY LAW SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING, THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,584 $.79 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- $5,7.05 FA SC $1.58 STRUCTION OR THE PERFORM,40E OF CONSTRUCTION PLAN CHECK FEE T TA FEE z -113 59.42 S.GNATUREOFC N'R T RORAUTHORIZEDAGENT IDATEP HE PROP L/j ALIOA THIS IS YOUR PERMIT S.GNATURE OwNE -0wNER BuilOER� iDATE, BL G INS' GATE ok NEW [ ] Effective 1/1/2001 ADDN H CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 58y6 Av rnaaA) PQ- FA 10 01 AJ Legal Description: Owner Name & Address: K,!�7 "► -/ ,- « s sA Ta H,Aa-5 oLV Tel. # 74 3 — -J SE. ^ O yl o Contractor: , ©y IV e72- MN LICENSE # Address: Tel. # 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 Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length 12, Width (2 ` Hgt/Ground Sq. Ft. OTHER: Construction Type: c6PAR- Estimated Cost: $ Driveway Curb Cut Width Needed: Ft.+ 6 Ft = F = $ DATE: G - 2'B*- a i APPLICANT: Tel. # 763-3A-0'00 CITY USE ONLY - - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $�% DS Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th% $.50/$1,000 Valuation $ $1150 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 [ ] $ S-9 GERALD T. COyNE LOT SURVEYS COMPANY 6911IDAHOAVE NH 300 BRUNSWICK AVE. S. GOLDEN VALLEY, MINN. LAND SURVEYORS BROOKLYN PARK, MINN.. BEGISTEBED VNDEB LAWS Or. STATE OF MINNESOTA LIomsmD BY oBDuTANoB or. CITY OF MINNEAPOLIS 533.9922 Minneapolis, Minnesota 55928 �06 INDUSTRIAL - JUDICIAi , INVOICE No. COMMERCIAL - TOPOGRAPHICAL Ourbeparg 'Certificate X64 -L2 CITY LOTS - PLATTING FIELD eoOx T (� lam, SCALE: 1" _3' t/ + GORHAM!, CONSTRUCTION COMPANY • 24.0 o �w zo ` ao 0 IFovno�4i�r� o 0/7 ti 4r A` l 142 Lot'4, Block 2, GRACE RIGH SCHOOL ADDITION We hereby certify that this is a true and correct representation of a survey of the boundaries of the above described property, and of the location of all buildings, if any, thereon, and all visible encroachments, if any, frorn or on' said land.. This survey is made only in connection with a mortgage loan now being placed on the property -and no Hability,`is as sumed except to the holder of such mortgage or any other interest acquired by reason of such morf9a . It is•,under- stood and, agreed no monuments have been placed for the purpose. of a lisping lot lines or dory n. � � ed r Surveyed by. us this !St day of &QV:_—, 191_. Sh TF,OSURVEYS COMPANY �-�• CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 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 Glias 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 Rate $ 30.00 $ 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. 'o Effective On January 1, 2000 $ 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 Signed TEL # Approved By Rough -In Date Final Date JOBADDRESS OWNER �� y,;i TOTAL / BUILDING USED AS /��-� '��-�• $ I t/ ESTIMATED COST X3crO . c:pv PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name, •zfz /-leu Size No. ��•� BTU 3�oo-o 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 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 Signed TEL # Approved By Rough -In Date Final Date COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : SUBJECT P O. City of Fridley 3'383-1" AT THE TOP OF THE TWINS BUILDING PERMIT f RECEIPT NO. ` COMMUNITY DEVELOPMENT DIV. y------ INSPECTION SEC. r � PROTECTIVE 1 NUMBER REV DATE PAGE Of APPROVED By i CITY HALL FRIOLEY 55132 763-571-3450 910-F15 8/27/03 JOB ADDRESS 5840 Matterhorn Drive NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 4 2 Grace High School Addn SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kevin & Lisa Johanson 5840 Matterhorn Drive NE 763-586-0490 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Gary Bongaarts Construction 11210 54 1/2 St NE, Albertville, MN 55301 20104143 / ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-497-3308 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION (j ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Kitchen Remodel 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. TYPE OF CONST OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 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 $26,510 $13.26 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• $411.45 Fire SC $26.51 ST UCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE V—d1-)zn ice a SC $5.00 1 $456.22 SIGNAr OFCON 'RACT RORAUTHORIZEDAGENT (DATI!, WHEN PROPERLY VALIDATED THIS I BqUR PERMI B G INSP GATE S-GNATURE OF ONINER0F OWNER BUILDER. IOATEI NEW ICITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R4 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION ' Construction Address: ' t;O hnsitzcv- Legal Description: N/A Owner Name & Address: Aev 4 I Tel. # 76 90 Contractor: f -e . MN LICENSE # o e I o N/ 4 3 Address: II 210 # 4q to i a- ,,to 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 Length Width Height Sq. Ft. Length Width Height Sq. Ft. Ft. Construction Type: /,/ ,4 & k F_, Estimated Cost: $ ©� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: APPLICANT: Tel. # 6 f- J -1Z0 q q -(o,- 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 Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $�11 '-5- $ 51 $ .92 $ 00 $ TOTAL $ l Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ] CITY OF FRIDLEY BUILDING INSPECTION 6431 Unhwaity Ave NE Fridley, MPI 55432 763-5724604 FAX 763-57112ST RATE SCH Raskka l Furnace Shell and Duct Worst, Sumer & also Replacement Furnace Gas Plping(Now Furnace, Flreplace, Insert) Gas Ranps Gas Dryer *Air Conditbning - All Sizes All Other Repairs or Alterations (Litt on Bacot) IS of Value of Appliance or Work Minimum Fee $15.00 for Residential or 516 of cost of Improvement whichever Is greater Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEA ING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS fag I911d m $35.00 Budding Used AS $10.00 $ $10.00 $ $10.00 $ $25.00 Q ComrnemJaVIndustriaVInstltiftnal 1.25% of Value of Appliance or Work (List on Back) Minimum Fen $35.00 for Commercial/IndustriaVinsttitutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR ESTIMATED COST PERMIT NO # of Heating nits_, Circle one (Steam) (Hot Water) -� Trade a rn e_k., We Pio. 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 strlct 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. $ • �L� HEA.a?,Y-n -.+ P1Y *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FAX Tel # �-q FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by RougWn Date Final Date FILL IN COMPLETELY FOR REPLACEPAENT FUEL BURNINo APPLIANCE PERMITS. COMMON MINT, M914T COW CTO AN STIOWN 1 N the undersigned hereby verifies that the When MI)Iw Ino an 9"rrMAIMca► venting has been examined and is free from rust, deterioration, obstructions. Yes (°� No( ) and is securely supported and firestopped Where required• The venting system is plasticJPVC and meets all current cries and manufacturer of WIDOWS and terminOon. Yes ( No ( } specificaWns including sizing, length, number The undersigned also verifies that the repiacement unit _is a listed assembly specificati� and meeft to current codes and manufacturer's include AGA•GAMA Category I Central Furnace Venting W� for n Yes (� No( ) assisted and natural draft appliances. The ® CofpbUlrtian air is sized and installed to most the current codes yes (� No( ) and manufacturers specifications. When required to r *Arra ► combuatton air it wUl be sized and instaiked manufacturer's specifications. Yes ( No( ) to meet the current codes and #ntl aysteen, the undersigned hereby verifies that When Iimtaiiintt_a it is a listed assembly and meets the current codes and manufackmes ttions. This does indude AGA -LAMA Category I Central Furnace Yes { No ( ) Venting Tables for fan assisted and natural draft appliances• the commoninstalled ventcurl correctly mer Is the common vent and vent connectors No ( ) an appliance has been rem separately as per current codes. Yes (� - -- - v �- STU Input_ '.U__- Fan Assisted or Nat APPliancu #1 Type tii BTU Input Fan Assisted or Not - Applience 42 Type _ BTU Input Fan Assisted or Not Appliance #3 Typal Total Btu input _ Total Appliances , Common Vent Type Vent Height_ Diameter Inches ft Length ft piamWtWr ,,,,�..in Typal Appiiw= #1 Vent Connector Height eft �gth (, ft Diameter �In Typra .-- Appliance #2 Vent Connector Height f Length �� Diameter _ in Tye Appliance *3 Vent Connector Height„_____ A TE ONS: Des HEATING CO: Pse G � r � Date: Signed Sir