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PRE 2010 DOCSCit of Fridl Citye y SUBJECT ®13864 AT THE TOP OF THE TWINS BUILDING PERMIT DEVELOPMENT DIV. GECOMMUNITY ®� Q I r PROTECTIVE INSPECTION SEC. p0 q d t ;LCITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ,'J 612-560-3450 910-F15 11/8/76 JOB ADDRESS 5880 Matterhorn Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Grace High School Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary M. Gorham Construction 9050 Collins Drive, Anoka 421-0998 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 CLX NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK — Construct a 26' x 40' Dwelling and a 24' x 24' Garage NOTIFY TH SG DIVISION REGARDIN -W Rt�� REMOVAL AND REPLACEME 9 CHANGE OF USE FR AT DRIVEWAY OPENINGS, EFAIING, AND SIGNS. STIPULATIONS Provide a hard surfaced driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. SEWER LOCATION: "Y" is 155' South of Manhole in Gardena WYE ELEV: 924.99 TOP OF FOOTING: 926.00 Minimum WATER LOCATION: Stop Box 76'-10" Northwest of hydrant/ 9'2" behind curb. THE CITY OF FROM DOES NOT GUARANTEE THE WARN ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS. Before digging call local uti!iti , T: IIS DATA IS FOR INFORMATION PURPOSES ONLY ANa `PERSONS TELPHONE . ELECTRIC - W E USMG IT SHOULD VERIFY THE WOMATIQN ON. "I SM REQUIRED BY W 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 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 1117+576 27,484 Total ANY TIME AFTER WORK IS COMMENCED. , NO. DWLG. UNITS OFFSTREET PARKING 1 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 $35, 540 $17.77 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $109.94 $350.00 7-76 PLAN CHECK FEE l A7.48 TOTALFEE $505.19 -AI-SIGNATURE O, ONTRACTORORAUTHORIZEDAGENT (DATE) HEN P5ePERLY VALIDATED THIS IS YOU PE IT BLDG NSP W� DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) VT CITY OF FRIDLEY APPLICATION FOR. RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) /'b��C✓a OWNERS NAME: BUILDER: Cc fl a..,.r, cc, tiIrl. �'T n. ADDRESS: 3 O �� Cep ��i �y c urs kldhol, ADDRESS : �O S"� �c�/%t.v, !%r' A r,4oW VO:. STREET: �y J TEL. NO.: /1 rot� I 11 c r^1 lei P P(dIc LOT: 2 BLOCK: ADDITION: C,.z C: /41:5-4 S c zn I Aad. CORNER LOT: INSIDE LOT: if SETBACK: -75- SIMARD: %.!r 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: relS74taee Front: Depth: ;"D` Height: /47 X618 Square Feet:�% Cubic Feet: (��nmc,L ront: o?�� Depth: -2V' Height: Square Feet; S-9 (0 Cubic Feet: % 0 Type of Construction: waoj Estimated Cost: $ y, .*To Be Completed: A 77 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: I/ - -L/- -76 -SIGNATURE: (See Reverse Side For Additional Information.) EGAN, FIELD & NO AK 1 --� SURVEYORS �: ;1_ 741S WAYZATA MCL is F MINNEAPOLIS, MINNESOTA ./ N , � 1 For i /43.52 143.52 h - DESCRIPTION: Lot 2, Block 2, GRACE HIGH SCHOOL ADDITION. • 0 -- - - -- � Q -j 1 Q< a � O y i 1 pp��q 1 Mpo , _T.— AF NO-IPY�f9�F LV* DIVISION RE 1N0 O REMOVAL AND PLACEM1PAT AT DRIVEWAY OPENIM& 100 o - - E arl v ®4� ®� �'nanf j-."' F,�, C'Ur', .A6y'�GE SCALE: 1" 30' ,,1A Fi FOR �t4�de9� ".E � ;� � � O� TION d�t�F�O n� EUVATiot �a t' 9 f is e ® cjQFr' .9 de i0ftsentetion of a survey of We hereby certify th the boundaries of the land above described an o %%location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. Dated-this_day of July , 1975. ELAN,J-,IELD 6 NOWA INC. ,/5urveyorr by 1 v, h W I � IO j C � ' a a c I •• r O I 1 � �• r Z• /43.52 143.52 h - DESCRIPTION: Lot 2, Block 2, GRACE HIGH SCHOOL ADDITION. • 0 -- - - -- � Q -j 1 Q< a � O y i 1 pp��q 1 Mpo , _T.— AF NO-IPY�f9�F LV* DIVISION RE 1N0 O REMOVAL AND PLACEM1PAT AT DRIVEWAY OPENIM& 100 o - - E arl v ®4� ®� �'nanf j-."' F,�, C'Ur', .A6y'�GE SCALE: 1" 30' ,,1A Fi FOR �t4�de9� ".E � ;� � � O� TION d�t�F�O n� EUVATiot �a t' 9 f is e ® cjQFr' .9 de i0ftsentetion of a survey of We hereby certify th the boundaries of the land above described an o %%location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. Dated-this_day of July , 1975. ELAN,J-,IELD 6 NOWA INC. ,/5urveyorr by ,, , 4e i I 4 op 91 ` Q15 ' T tlr t z z v 1 � ca -c C :Z N o c i I CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WAP -M AIR: Furnace Shell & Duct work Repiacece nt of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 MECHANICAL WARN, AIR: RATE TOTAL $12.00 $ 7.00 $ 7.00 $ 4.00 $ Furnace Shill! & Duct Work to 100,000 BTU $12.00 $ each add. 50,600 BTU 4.00 .$ Replace.:.ent of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ epairs & Alterations each add. $500.00 4.00 $ STEM CR I OT titi {Ti R SY i 01: Boiler & :.ines up to 100,000 BTU $12.00 $ each ad.in. 53,000 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 S each add. 3 gal. per hour 10.00 S CUS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ (over 199,999 BTU eea Fee Schedule) S GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas ,range to 199,000 BTU x $10.00 $ AIR CONDITIONING $ FAX HEATING SYSTEMS _ See Fee Schedule $ VENTIL :TING SYSTEMS ALTERATIOXS $ REPAIRS ) S State Surcharge $ .50 TOTAL FEE $�1, o ROUGH INSP. REINSPECTION FEE Date (.$10.00) PnL% : I\sP. - 9 — 7 Date APP?ZVAL FOR PERNSIT _j4&d .MINL%:Ux FEE FOR JL%Y MTING PERMIT IS $7.50 Job Address ) 19 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 ar/e true and correct. Fridley, Minn. `— / , _'9'er OWNER KIND 0 USED A TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warn Air- No. Trade Name i Size No. Capacity Sq. Ft. EDR BTU HP (Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company 'l•�— Signed By ` �v �� • Tel. No. CITY OF FRIDLEY APPLICATION FOR PLIMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: ti_= ber =inures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,0:.0 BTU to 199,000 BTU Water Softener New Ground Fain Old Building Electric rater Heater GAS FITTING FEES: 1st 3 fixtures mditional Fixtures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each add. 5100.00 or fraction NO. RATE TOTAL rx $3.00 S2/- ®(J y y $0 X $5.00 p r. x N x Water $ x $7.00 $ r. $5.00 $ x $5.00 $ x $3.00 $ x $1.00 $ x $10.00 $ r G tr F i a W " C r ..uj Ll V Llp -+ G C U �i rt C1 p "� 14 `�' ro ro 3 .N o o u x v; � r. a a v 9Q4 a m 2: U . z U 4J 0. .as 'lec vyi zn 1st 2nd 4-L, 3rdi.- (R) a Future Connection Opening Connected with Sewer (*) = ::ew Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: ti_= ber =inures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,0:.0 BTU to 199,000 BTU Water Softener New Ground Fain Old Building Electric rater Heater GAS FITTING FEES: 1st 3 fixtures mditional Fixtures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each add. 5100.00 or fraction NO. RATE TOTAL rx $3.00 S2/- ®(J x $2.00 $0 X $5.00 $ r. $5.00 $® x $10.00 $ x $7.00 $ r. $5.00 $ x $5.00 $ x $3.00 $ x $1.00 $ x $10.00 $ $5.00 $ $2.00 $ State Surcharge $ nn .50 TOTAL FEE $ J ? .5-0 REINSPECTION FEE ($30.00) Job Address jepartment of Buildings City ,of, Fridley Tel, - '#_57,1=3450 The�undersigncd 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. OWNER KIND OF BUILDING USED AS z 7 TO BE COMPLETED ABOUT v% — 7 ESTIMATED COST OLDNEW BUILDING PERMIT NO. PERMIT NO. Company . Signed By �' GGA "- Tel. No. �� z? ROUGH INSP. Date FINAL INSP. j= Z. �6 - 2z Date APPROVAL FOR PErMIT //`Z -- MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND $12.00 .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE $ and rulings of the Department of Buildings, and hereby declares that all the ' GRAVITY WARM AIR: RATE TOTAL Job Address 5$$0 Matterhorn Furnace Shell & Duct Work $12.00 $ Fridley, Minn. , 19_ Replacement of Furnace Repairs & Alterations -up to $500.00 7.00 7.00 $ $ Department of Buildings Repairs & Alterations each add. $500.00 4.00 $ City of Fridley Tel. #571-3450 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to 199&999 BTU (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: Gas Piping 1st 3"Fixtures x Additional Fixtures x Gas Range to 199,000 BTU x AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS $ REPAIRS S State Surcharge TOTAL FEE S $ $ $ .50 s13.50 Trade Name Capacity Size No. Sq. Ft. EDR BTU Total Connected Load Kind of Fuel BURNER - Trade Name Size No. HP ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP Date [$10.00) CompanyADVANCED HEATING & AIR COMM Date Signed By )dr1 APPROVAL FOR PERMIT Tel. No. 571-1+$$1 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 $12.00 $ 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 $ November 1577 4.00 $ Fridley, Minn. , 19_ OWNER Gary Gorman $12.00 $ KIND OF BUILDING Frame 7.00 $ Dwelling USED AS 6.00 $ TO BE COMPLETED ABOUT $10.00 $ 10.00 $ ESTIMATED COST $10.00 $10-00 / OLD - NE BUILDING PERMIT NO. PERMIT NO. 23.00 $ 3.00 $ DESCRIPTION OF FURNACE/BURNER $ 1.00 $ $10.00 $ HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. State Surcharge TOTAL FEE S $ $ $ .50 s13.50 Trade Name Capacity Size No. Sq. Ft. EDR BTU Total Connected Load Kind of Fuel BURNER - Trade Name Size No. HP ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU HP Date [$10.00) CompanyADVANCED HEATING & AIR COMM Date Signed By )dr1 APPROVAL FOR PERMIT Tel. No. 571-1+$$1 MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE April 25, 1977 CITY OF FRIDLEY 6431 .UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 Gorham Construction 9050 Collins Drive N.W. Anoka, Mn. 55303 Re: Final Inspection at 5880 Matterhorn Drive N.E. Dear Mr. Gorham: A final inspection was made on April 25, 1977 of 5880 Matterhorn Drive N.E. and the following items were noted which must be completed before the structure can be finaled out; 1. Provide handrail to basement by May 3, 1977. 2. Provide a hard surface driveway by June 16, 1977. 3. Provide sod in the front and side yards by June 16, 1977. 4. Provide house numbers on structure by June 16, 1977. Reinspection will be conducted on or about the scheduled dates to determine compliance. If you have any questions on these items, please feel free to contact me at 571=3450. Sincerely, RON HOLDEN Building Inspector RH/mh CITY OF FRIDLEY 97-81,-879001 APPLICATION FOR PLUMBING AND GAS PITTING PiAMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL N=ber Fixtures x $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Fawn Old Building water $5.00 o Electric Water Heater x m $ H [+ m 4 1st 3 fixtures 'a., 5.1 .a 91, N5a Additional Fixtures x Heater $ Gas Flange to 199,000 BTU x $10.00 �q REPAIRS $ ALTERATIONS 1C�( a� First $100.00 Al e 6 $ each add. $100.00 or fraction $2.00 $ State Surcharge O O Qa 4 .�G �+ xm R 111 •M .f O p� O N L N N N L� W ' u a m v1 W a wo En w U W a 3 0 � rot9 (7 Q as lec 1st 2nd 3rd 4 t:1 LJ (R) - Future Connection Opening Connected with Sewer (*) - New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL N=ber Fixtures x $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Fawn Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x '$3.00 $ Additional Fixtures x $1.00 $ Gas Flange to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ 8.00 RF.T?V;!1f'.r-rTfill J'Iti: Job Address 5880 Matterhorn ' IIriae " 7 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 Godes 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. 6-12-78 , 19 OWNER Kundson . KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 6-19-78 ESTIMATED COST 90 . 00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company 1 R ' Signed By MINNEGASCO Tel. No. ROUGH INSP. Date FINALINSP. Date %�y APPROVAL FOR PERMIT ! \' MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.50 STATE SURQi}►RCE, SUBJECT fMMIT N - City of Fridley 16481 AT THE TOP OF THE TWINS BUILDING PERMIT r CEIPT NO. � •COMMUNITY DEVELOPMENT DIV. `U _____ r PROTECTIVE INSPECTION SEC. 1 1 i ! CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF AP RO ED BY I.J 612-571-3450 910-F15 I 1/27/82 I JOB ADDRESS 5880 Matterhorn Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Grace High School Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Darron & Kathy Knutson 5880 Matterhorn Drive N.E. 574-9712 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Harlan Berry (Not Licensed In Fridley) 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Finisli basement; two bedroons, bathroom family room 9 CHANGE OF USE FROM TO STIPULATIONS Provide products of combustion alarms near bedroom area. Use treated bottom plates. Provide escape windows in bedrooms. I':PERATE PERMITS REQUIRED, FOR WNW #&,, I i`ATIIVC, PLUMBING A11t1� Std TYPE OF CONST, OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 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 $8,Q�o $4 00 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- $68.50 NONE STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $17.13 $89.63 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT y I XS6TURZNNER(!F(WNER BLDG INSP DATE L_ BUILDERI IDATEI A, CITY OF FRIDLCY Effective Aug. 1, 1981 APPLICATI01 FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OW14ER: ��` ��° � 0 b�" BUILDER:ter- , ADDRESS: 5/�;�,�� ADDRESS: TEL NO: ,.5-- TEL NO: 4Zn Construction Location STREET NO :d STREET: ►� g CL V—j -- Dr. LOT: BLOCK: ---- ADDITION: G� -SC, /I p a 0 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. ,&�SCRIPTION OF CONSTRUCTION Front: Depth: Height: Squane.Feet: Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: Type of ConstructionEstimated Cost: 'fib Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ ' $ SEE REVERSE SIDE OF SHEET . Mie undersigned hereby makes application for a permit for the work herein specified, agreeing to cb .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. DATE: % 7-' SIGNATURE: Lavil Stipulations: ho GAJ]; ®P AlrjUsojlu,-� #6�09 .Prj,9 F 66-DfUA*A GERALD T. 40YNE 3W BRUNSWICK AVE. S. GOIAEV VALLEY, MINN. INDUSTRIAL - JUDICIAL COMMERCIAL - TOPOGRAPHICAL CITY LOTS - PLAITING 1. t ff LOT SURVEYS COMPANY 1DDAHO AYES 67 I . N LAND SURVEYORS BROOKLYN PARK, 1A1Nti SEO>[STEMM VIMER LAWS OF STATE OF LICENSED ET 021iffiAHOE OP OIiY OF ISIIISEA"La 6917 Idaho Ave- N. 533-9922 Minneapolis. Minnesota 5512E �4— Iwsb1U No. ourbepom Certificate FIS„ Booz � SCALE I" =1 tr � -- ]= Rf liPl �9\Djf. .moi; 11- l Lot. 2, Iil of -k :'r rii=ACE Iii°.;il S014 1-li r 1 We hereby --Cif that ibis is a true Bad correct representation of a survey of the boundaries of the above described property. and of the location of all buildings. R any, thereee. and all visible encroachments. if any, from or on said land This survey is made only in connection with is mortgage loan now being placed on the property -and no Nobility is as- sumed except to the holder of such mortgage or any other interest acquired by reason of such mortgage. It is under- stood and agreed no nsomrments have been placed for the purpose of estabCss6%'ng lot lines yr ry cornets.. Surveyed by us this tiffs_ day of rL::.. s_ _. _, 14y�._ f ]SOT SURVEYS COMPANY s 1 o u v . `'yo.7Z ° z4.3 a / g to==J o 2 i V JI•• 1 7 /j` /&. f N _ Lot. 2, Iil of -k :'r rii=ACE Iii°.;il S014 1-li r 1 We hereby --Cif that ibis is a true Bad correct representation of a survey of the boundaries of the above described property. and of the location of all buildings. R any, thereee. and all visible encroachments. if any, from or on said land This survey is made only in connection with is mortgage loan now being placed on the property -and no Nobility is as- sumed except to the holder of such mortgage or any other interest acquired by reason of such mortgage. It is under- stood and agreed no nsomrments have been placed for the purpose of estabCss6%'ng lot lines yr ry cornets.. Surveyed by us this tiffs_ day of rL::.. s_ _. _, 14y�._ f ]SOT SURVEYS COMPANY s SUBJECT P(,,703743 City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT NO. `L _ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. j � PROTECTIVE CITY HALL FRIDLEY 55432 NUMBER RE OATE PAGE OF APPROVED By L J` 612-571-3450 91aF15 10/4/99 JOB ADDRESS 5880 Matterhorn Drilre NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Grace Hig-h-School Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Brad GevinLr 572-0189 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO on Miller Constr. Inc - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION XM REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (22 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 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 80 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1923 $.96 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OT R TE OR LOCAL LAW REGULATING CON- S RUC N THE PE OF CONSTRUCTION $69.25 Fi SC $1.92 PLAN CHECK E TOT L EE Lice e C 0 7.13 $'G NATURE OFOA ORA'eVR4EO AGENT IDATEs WH P LY VALIDA THIS IS YAUR P MIT $�GN4 TUBE OF OW NEA,iF OWNER BUILDER, OE R, iDATE� alfbG -NSP fjAit NEW [ 1 Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2� BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address:C �/,'/ll� Tel. # Contractor: R. 114'1/1&- 0_cez _�¢ -7:714e MN LICENSE # Address: �` J 325 y/3 Z 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 Width Hgt/Ground Sq. Ft. OTHER: & iL' e b 6- ',- --- z A Construction Type: Estimated Cost: $ l Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: - APPLICANT: ZZ AnATel. # i- 21 3-3 /y TOTAL $ STIPULATIONS: CITY USE ONLY Permit Fee $ 4q, c�� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 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 $ STIPULATIONS: CITY OF FRIDLEY INSPECTION DIVISION Effective On May 10, 1999 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 5 2910 fho`tfahpvI3 iJr. RATE SGHEDULE OWNER rod G-eyinq Residential Rate TOTAL ;� Furnace Shell and Duct Work, Burner - BUILDING USED AS 4_��P-� Also Replacement Furnace $ 30.00 $ ro ' qQ D (Side Vent - Fill Out Back) ,_ ESTIMATED COST PERMIT N0. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Gas Dryer $ 10.00 $ Trade Name Size No. BTU HP EDR *Air Conditioning • All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $—,.&ZZV BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts* and representations stated in this application are'true and correct. TOTAL FEE T aleka41oa q- &as Z4-,.,s4r+ ftf bv3Z River City Sheet Metal, MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO jDC REFRIGERATION/AIR CONDITIONING PERMIT IS 525 00 RE t. N.W. CO®� Rapids, MN MWM— PLUS THE $.50 STATE SURCHARGE Signed 54-2189 Fax 612 ( ) 754-2908 FtElNSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved B Rough -in Date Final Date �2 v written permission from adjoining property owner. .► CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR DOWER PLANTS AND HEATING, C001.ING, VENTILATION, m ;763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES a J013 ADDRESSSg�O r' 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 z Gas Dryer w_ z N Mr N ae7 aM w O *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $10.00 $10.00 $ 26.00 A ;ammerciaUtndustrial 1.25% of Value of Appliance or Work d State Surcharge ci TOTAL FEE AINIMUM FEE FOR ANY HEATING COOLING/VENTILAT ON REFRIGERATION/AIR CONDITIONING PERMIT IS $26.0D FLUS THE $.SO STATE SURCHARGE v :EINSPECTION FEE $47.00/Hr .�, Air Conditioners can not be placed in a side yard without Britten permission from adjoining property owner. Effective On January 1, 2002 OWNER bra- - WA C CXR f L7 e-&- A a TOTAL BUILDING USED AS r�Q31 dC P_nr_-2 _ ESTIMATED COST xZ �99e, `'o PERMIT NO. DESCRIATION OF FURNACE AND OR BURNER No. of Heating Units I' Circle One (Steam) (Hot Water) (Warm Ai $ Trade Name X Size No. STU /[20. 00 HP r 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. � j DATE HEATI G 01- ®' �+ i t Signed TEL # 9 S�'9Yet �S4tX� FAX I, n q I Approved B Rough -in Date' Final Da 7TT BACK 31 -DE F 1 CATI C V Ln% 1 111 & 09/09/2002 MON 15:46 FAX 952 942 5791 THE MAINTENANCE TEAM INC ze • d _bMI TFC 6ELOW MUST BE FILLED W WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED venling has been e)wmined and Is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes VNo ( ) The venting system is plasticJPVC and meets all current codes and manufacturer spedfledons inducing sizing, length, number of elbows and termination. Yes No ( ) The,undersigned also verities that the replacement unit is a listed assembly WW meets the mmnt codes and manufacturer's specifications. This does Include AGA -GAM Category I Central Furnace Venft Tables for kin assisted and natural draft appliances. Yes)6 No ( ) The adsting cornhi mien air is sized and installed to meet the current codes and manufacturer's speons. Yesk No ( ) When requmed to;nsfall an= comhesfieoa'�rir will be sized and installed to meet the current codes and manufac tur+er's speacations.Y No( ) When•imsbUla the undersigned hereby verifies that It is a Lied assembly and meets the cL=nt codes and manufacturer's spedfications. This does Include AGA -G" Category 1 Central Furnace Venft Tables for fan assisted and natural draft appriances. Yes No ( ) !s the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented hely as per currant codes. Yesp No ( ) Appliance #1 Type LU�r�. g-ct BTU Input i2Z om Fan Assisted or Nat Appliance Q Type STU Input—_ Fan Assisted or Nal Applance #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 11—�ft Diameter n in Type AppCtance #2 Vent Connector Height ft -Length __ft Diameter in Type Appliance illi Vent Connector Height ft Length ft Diameter in Type 9003/003' S7.AZtr,,, �ytJ ��t -% ,12n�0��• Cc �K►�th f�— t� HEATING CQ: ze/m-d T64sev6m cu A-iai2w x0 Aiio Wmw sb:vt zooz--96-des �I CITY OF FR:IDLEY PERMIT NO(.20 0400467• 6431 UNIVERSITY AVENUE NE FRMLEY, MN 55432 DATE ISSUED: 04/08/2004 763) 572-3604 FAX: (763) 571-1287 ADDRESS : 5880 MATTERHORN DR NE PIN : 243024240004 LEGAL DESC : GRACE HIGH SCHOOL ADD : LOT 2 BLOCK 2 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 93,004.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651454-0002 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 40'X 16' ADDITION TO DWELLING STATE LICENSED CONTRACTOR APPLICANT LUCZAK CONSTRUCTION INC 487 LONESOME PINE TRL LINO LAKES, MN 55014 GEVING BRADLEY P & LESLIE J 5880 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 worl will be complied with whether specified herein or not. The granting of a permit does not presume t%eye authority to violate or cancel the visions ;;rance er state or local w regulating con ` i or of constrc �n. d Tlo*o Bldg Insp. 1 BUILDING PERMIT FEE 951.75 FIRE SURCHARGE 93.00 STATE SURCHARGE, VALUE 46.50 LICENSE SURCHARGE 5.00 TOTAL 1,096.25 PAID WITH CHECK # 2448 SEPARATE PERMITS REQUIRED'FOR WORK OTHER THAN DESCRIBED ABOVE. 30GEIIIALD T. 0 BRUNSWICK YNAVEE S. LOT SURVEYS COMPANY 6917 IDAHO AVE.SNH GOLDEN VALLEY, MINN. LAND SURVEYORS BROOKLYN PARK, MINfJ REGISTERED UNDER LAWS OF STATE OF MINNESOTA IdCENSED BY ORDINANCE OF CITY OF MINNEAPOLIS 6917 Idaho Ave. N. 533-9922 \linneapolis, .1linnesvte 55128 INDUSTRIAL - JUDICIAL INVOICE NO COMMERCIAL - TOPOGRAPHICAL &urbeporg Certificate FIELD BOOK' �T CITY LOTS - PLAITING SCALE: 1" 1, --- � )F'IIANi I,' ti, T!''"T; I[r );��"r',Ny o m, Lot, 2 , B t ock I-, :=-AC K H' I'�Ii ';C //H 0: i . A DD7 'I'll1: ; ' 8so na,,l (/f�cl.✓ .Pr We hereby certify that this is a true and correct representafion 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, from or on said land. This survey is made only in connection witha mortgage loan now being placed on the property and no liability is as- sumed except to the holder of such mortgage or any other interest acquired by reason of such mortgage. It is under- stood and agreed no monuments have been placed for the purpose of establish'ng lot lines or bouniiry corners. t i Signed _— -- —i -- - —r— — - - Surveyed by us this ti�1- day of �!!'.s_ _. 14�ti-. LOT SURVEYS COMPANY REScheck Compliance Certificate 2000 Minnesota Energy Code REScheckSoflware Version 3.5 Release le Data filename: C:\My Documents\Untitled.rck PROJECT TITLE: Brad Geving Addition COUNTY: Anoka STATE: Minnesota ZONE: 2 CONSTRUCTION TYPE: Single Family DATE: 03/22/04 DATE OF PLANS: 11-21-03 PROJECT DESCRIPTION: addition to back of house DESIGNER/CONTRACTOR: Luczak Construction, Inc. PROJECT NOTES: Remodel job adding 16'x40' addition to the back of the house. COMPLIANCE: Passes Maximum UA = 775 Your Home UA = 631 18.6% Better Than Code (UA) Permit Number Checked By/Date Gross Glazing Area or Cavity Cont. or Door Perimeter R Value R -Value U -Factor UA Ceiling 1: Raised or Energy Truss 609 38.0 0.0 15 Ceiling 2: Raised or Energy Truss 304 44.0 0.0 7 Wall 1: Wood Frame, 16" o.c. 1116 19.0 0.0 55 Window 1: Above-Grade:Metal Frame with Thermal Break:Double Pane with Low -E 129 0.320 41 Door 1: Solid 19 0.200 4 Door 2: Glass 42 0.320 13 Wall 2: Wood Frame, 24" o .c. 120 5.0 5.0 7 Door 3: Glass 42 0.320 13 Floor 1: Slab-On-Grade:Unheated 640 5.0 476 Insulation depth: 3.5' Furnace 1: Forced Hot Air, 98 AFUE Air Conditioner 1: Electric Central Air, 13 SEER Proposed and Maximum U -Factor Averages Proposed Maximum Average U -Factor Allq,t: Above -Grade Windows and Glass Doors 0.320 0.3'x; Includes Foundation Win4pws > 5.6 U COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the 2000 Minnesota Energy Code requirements in REScheckVersion 3.5 Release 1 e (formerly MECchec� and to comply with the mandatory requirements listed in tlw RESchecklnspection Chec�,,�,, Builder/Designer Date CITY OF FRMLEY PERMIT NO.- 004-00512# .�\ 6431 UNIVERSITY AVENUE NE --J" FRIDLEY, MN 55432 DATE ISSUED: 04/15/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 5880 MATTERHORN DR NE PIN : 243024240004 LEGAL DESC : GRACE HIGH SCHOOL ADD : LOT 2 BLOCK 2 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 AIR CONDITIONER, EXTEND DUCTWORK TO NEW ADDITION AND VENT FOR BATH FAN. # A/C UNITS 1 VALUE OF APPL OR WORK 2400 # FURNACES 0 # GAS DRYERS 0 # GAS RANGES 0 APPLICANT HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK 0.00 0.00 ST MARIE SHEET METAL INC 7940 SPRING LAKE PAR GAS RANGE FEE 0.00 SPRING LAKE PARK, MN 55432-2253 GAS DRYER FEE 0.00 (763) 784-5241 AIR CONDITIONING FEE 25.00 HEATING REPAIRS/ALTERATIONS 24.00 STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 43877 0.50 49.50 OWNER GEVING BRADLEY P & LESLIE J 5880 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 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 other state or local law regulating construction or the peance of construction. 7-/-Date Applicant Bldg SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Effective January 1, 2003 CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Q 44,0Oap Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 JOB ADDRESS 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 jo of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work 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. 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE 3 �� HEATING CO SignedTEL # 7F el— 5 ail FAX #7ra " 1/9 Approved By A Rough -In Date' Final Date D� FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE OWNER /YX CAK- CO -4 5771�'U,e—T/0, aJ Rate TOTAL BUILDING USED AS $30.00 $ ..// v ESTIMATED COS PERMIT PERMIT N0. LF $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name Size No. $ 25.00 $ () BTU HP EDR Fuel Total Connected Load Burner Trade Name Size No. $ �a BTU —HP EDR 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. 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE 3 �� HEATING CO SignedTEL # 7F el— 5 ail FAX #7ra " 1/9 Approved By A Rough -In Date' Final Date D� FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APRUCATION WILL BE RETURNED M6"MON VFNZ VENT r.QNNECTQR AND MMMISTIM AIR VERIFICATIM When raniaaing an everting 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 ev n i nmbivettinn airy is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to Install a new nnmhnsfinn air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes() No ( ) When jp,nfaj(jpa a new ventingyy a em, 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 O 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 #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 ALTERATIf NS- (nnscriW 6,v 1� �tJ� aP 0-� 1.�09X- ?-0 l J� HEATING CO: S' • !r[ signed By: Date: �1 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 FAX: (763) 571-1287 ADDRESS : 5880 MATTERHORN DR NE PIN : 243024240004 LEGAL DESC : GRACE HIGH SCHOOL ADD : LOT 2 BLOCK 2 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT �O.:20(044-0058 DATE ISSUED: 04/26/2004 VALUATION : $ 6,500.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL EIGHT FIXTURES AND A GAS HOT WATER HEATER # ELEC WATER HEATERS 0 # NEW FIXTURES (EXIST OPENINGS) # GAS WATER HEATERS # GAS RANGES # WATER TRMT APPLIANCES PIPEWORKS INC 680 VALHALLA DR CEDAR, MN 55011- (763)413-1883 APPLICANT OWNER GEVING BRADLEY P & LESLIE J 5880 MATTERHORN DR NE FRIDLEY, MN 55432 1 # GAS DRYERS 0 # OF NEW FIXTURES 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 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 provisioo of any 9&er state or local law regulating construction orthi perform ce of construction Applicant Date_ Bldg PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 2919 SEPARATE PERMITS AMQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 8 0.00 80.00 0.00 0.00 0.00 35.00 0.00 0.00 0.50 115.50 Ti CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 V_tA9D®0 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** NO. RATE TOTAL ® $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 _ $35.00 Gas Dryer** Back Flow Preventer Required ( )Yes () No Type, $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE JOB ADDRESS S ??O Y/i,oy, . AQr 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. DATE: �/� .20 e OWNER e<e r i u BUILDING USED AS ,,S 164 )-j C -e_ ESTIMATED COST 6$60 PERMITNO. C�c PLUMBING COMPANY �ih-c i�,l8 ✓/�� /�./� SIGNED BY TEL N0. Approved By Rough -In Date 9-,,26- 6 Final Date i MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $16.00 or 5% OF COST OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE 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-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 CITY OF FRIDLEY FERMINo.: 2oo4-oio24 �" 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 07/02/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 5880 MATTERHORN DR NE PIN : 243024240004 LEGAL DESC : GRACE HIGH SCHOOL ADD : LOT 2 BLOCK 2 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : FIREPLACE VALUATION NOTE: INSTALL GAS PIPING FOR FIREPLACE (HEAT N GLO, 40,000 BTUS) VALUE (FOR MINIMUM CALC) 2300 APPLICANT HEATING PERMIT MINIMUM FEE STATE SURCHARGE, MECH FLAT 25.00 0.50 FIRESIDE HEARTH & HOME 2700 N FAIRVIEW AVE TOTAL 25.50 ROSEVILLE, MN 55113 PAID WITH CHECK # 112013 OWNER GEVING BRADLEY P & LESLIE J 5880 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 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 com.1trAction or the performance of construction. Applicant Date Bldg In Date f�. SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 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 (Neededwith 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 Rate TOTAL $ 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. $ .50 $ JOB Al OWNE & 44� Effective On January 1, 2002 BUILDING USED AS_�iJ%G�2u ESTIMATED COST_ PERMIT NO. V DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Trade Name BTU HP Circle One (Steam) (Hot Water) (Warm Air) _ Size No. EDR Fuel Total Connected Load Burner Vade Name 6� Size No. BTU wiHP 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE 2ti Allied Flr�ide HEATING CO dIeF°H01Ae , 2700 N. Fahiew Ave. Signed ROS"11e,MN55113 R;,/Rgft.,;R, TEL # — FAX # Approved By _ Rough -In Date Final'Date 6 ®L� THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE 4 APPLICATION WILL BE RETURNED When re lacing an existingfUrance, 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 comhustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to,nstall a new cnmhustion 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 -LAMA 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 #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 HEATING CO: Signed By: Date: R --t i:- 185i % NEW [ ] CITY OF FRIDLEY Effective 1/1/2004 ADDN 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION �� ✓ l� Construction Address: ,5-880 r" /11 7-7';F9 #ORA/ Z) 4 , ti OW Legal Description: 40-t- ;2, Q G o C K 6 t1A( E f-/JG� Owner Name &Address: BRRD s� SSL /Z 4.:N, -A-)6 58 80 4n I # 76 3 -- T 7.2- d I $� Contractor: 0 c2 A k Z-Ox4f I-K(JC7�ld�v,� � C. • MN LICENSE # ,,? oa q o / / / Address: 416 % L 6X4fo `ft �E- /-) �u- `%6-6 `J//e# 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 / 6 Height / 6 Sq. Ft. 497 8 0 GARAGE AREA: DECK AREA: Length -- Width f- Height Length I- Width Hgt/Ground — Sq. Ft. .- Sq. Ft. OTHER: Construction Type:'4stimated Cost: $C�. Driveway Curb Cut Width Needed: --- Ft. + 6 Ft = "'-Ft x $ _ $ DATE: Z 2 O i APPLICANT: Tel. # 6S/- YX-,C 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 $��/a A- Fee Schedule on Reverse Side Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion C99trol Sewer Main Charge TOTAL $ q-3-60 •UO .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 rmined by Engineering nt Necessary [ ] Not Necessary [ ] �� ` 6JL CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 VAX: ( 763) 571-1287 ADDRESS : 5880 MATTERHORN DR NE PIN : 243024240004 LEGAL DESC : GRACE HIGH SCHOOL ADD : LOT 2 BLOCK 2 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-00556 DATE ISSUED: 04/21/2004 /�- VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # INSPECTIONS 3 APPLICANT THREE PHASE ELECTRIC INC 2705 FOX RIDGE NE BLAINE, MN 55449-5902 (763)786-9147 OWNER GEVING BRADLEY P & LESLIE J 5880 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 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 STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (RESI) 60.00 TOTAL 60.50 PAID WITH CHECK # 13974 SEPARATE PEKMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. REScheck Compliance Certificate 1995 MEC REScheckSoflware Version 3.5 Release le Data filename: C:\Program Files\Check\REScheck\Geving.rck PROJECT TITLE: Brad and Leslie Geving CITY: Fridley STATE: Minnesota HDD: 7391 CONSTRUCTION TYPE: Single Family DATE: 07/13/06 DATE OF PLANS: 03-20-06 PROJECT DESCRIPTION: foyer addition DESIGNER/CONTRACTOR: Luczak Construction, Inc. 487 Lonesome Pine Trail Lino Lakes, MN 55014 COMPLIANCE: Passes Maximum UA = 21 Your Home UA = 17 19.0% Better Than Code (UA) Ceiling 1: Raised or Energy Truss Wall 1: Wood Frame, 16" o.c. Window 1: Metal Frame:Double Pane with Low -E Crawl 1: Solid Concrete or Masonry Wall height: 3.5' Depth below grade: 3.0' Insulation depth: 3.5' Permit Number Checked By/Date Gross Glazing Area or Cavity Cont. or Door Perimeter R Value R Value U -Factor UA 45 38.0 0.0 1 152 19.0 0.0 9 10 0.330 3 67 0.0 8.0 4 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The�0�an� building has been designed to meet the 1995 MEC requirements in REScheckVersion Release le (formerly to comply with the mandatory requirements listed in the RES checkInspection C st. Builder/Designer Date �� p NEW [ ] CITY OF FRIDLEY ADDN 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-187 Fax BUILDING PERMIT APPLICATION % Construction Address: sego 1y,,&-fei L1,4n Aj Legal Description: 6�d e_i S c�®� �1 f� �� /OC Owner Name & Address:4 ✓'e� ev'I'LF LiOL hi � � Tel. #ZL Contractor: o eZ1`(�®� ��t�`�� I� C MN LICENSE Address: Z_ary�/ vk c e A.-'qA," Tel. # ��/ ��-ta 7% SS®' y Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to'scale. DESCRIPTION OF IMPROVEMENT r, _t�t LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: DECK AREA: OTHER: Length Width Height Sq. Ft. Length /v Width Hgt/Ground Sq. Ft 6. Construction Type: Deck Estimated Cost: $ �� VV 76 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ =$ DATE: APPLICANT: Tel. #�� Call (763) 572-3604 for Permit Fees If mail' in a lication. 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 TOTAL CITY USE ONLY - $ �P ,o�® Fee Schedule on Reverse Side $ 65% of Permit Fee $ 1h H .001 of Permit Valuation (1/10th%) $ a $.50/$1,000 Valuation $ $1450 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 [ ] $ A0 (.0 .CP STIPULATIONS: Building See Back Page for Fee Schedule BUILDINGPermit No.: i $ Sq .001 times the total job valuation a. .0005 x Permit Valuation Minimum $.50 Inspections $5.00 (State Licensed Residential Contractors) RESIDENTIAL APPLI T q Received By: 763-572-3604 ft+6ft= ftx$21=$ CITY OF FRIDLEY \� Date Rec'd®9- e �'o $ Fee Determined by Engineering DATE _ YOUR E-MAIL ADDRESS $ h , SITE ADDRESS c5890�— THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: ADDRESS: � S'8CCD '!�i"l2GN1 CITY /'/f lc- �!` STATBMi P TENANT PHONE: CONTRACTOR NAME: Z� e 2 /,d �c �vn6fff mC<c `t c STATE LICENSE # 21),_2VOI?l EXP DATE ZkJ J 1 V SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS:V�? 7 L0,17c�/c� � i � % re; CITY� STAT&gfP WITH APPLICATION PHONE J6 /- FAX/ - Y - C ti/l fi PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE -- Q a FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE AADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ADDITION ❑ MAINTENANCE/REPAIR 6XREMODELING DESCRIBE WORK BEING DONE: C' (/ Vl/' d SIZE OF IMPROVEMENT LENGTH WIDTH 1Y HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: i FOR NEW CONSTRUCTION INCLUDING DECKS, V ❑Soffit ADDITIONS, & PORCHES SUBMIT: num ❑ Trim I. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes BNo LOCATION OF YNDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF „!5� OPENING CHANGES & ®v //a— TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: �-- clo , 1v (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ da m O d O . OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ Cl 1. ;fes' See Back Page for Fee Schedule $ ( 65% of Building Permit Fee $ Sq .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ 6 .CX3 $5.00 (State Licensed Residential Contractors) $ $1550 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$21=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ h , Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -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 F 'dley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is t t without a permit; that the work will be in accordance with the approved plan in the case of all work whic10ires re ' a p al of plans. SIGNATURE OF APPLICANT PRINT NAME DATE_�2 Z�� U Building See Back Page for Fee Schedule BUILDING 65% of Building Permit Fee Permit No.: -6 Inspections $ RESIDENTIAL APPLICATION Received By: 763-572-3604 $ CITY OF FRIDLEY Date Rec'd: ':� DATE YOUR E-MAIL ADDRESS $450 Conservation Plan Review SITE ADDRESS Fee Determined by Engineering $ THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR Make checks payable to: City of Fridley Attach PROPERTY OWNER/ NAME; L P^0 TENANT ADDRESS: Y® / 7t,4t &X #a" CITY P"/ Swi!!i igIP .S-5 3 � s PHONE: 76.3 s S7Z -olr-% CONTRACTOR NAME:M-1, A 0 x) 74 U A) fie° y STATE LICENSE # --,�9' 7 EXP DATE .3 J ® (a ° / l %i� �U� Crry /- �I / STATE�'MP��#-9 SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS:Kno2 X I.fL -9T WITH APPLICATION PHONE G 3 - 7 �" /5V FAX - %SL - 6 PROPERTY TYPE X SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ SWIMMING POOL 14 OTHER CU C F— TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: ® L 10 1X, '—ItQ lNS A L L IVrkJ 1EE SeTC SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2• Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes [No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ See Back Page for Fee Schedule $ 65% of Building Permit Fee $ .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ $5.00 (State Licensed Residential Contractors) $ $1550 per SAC Unit (Plans to MWCC for determination) $ z&ft+6ft= _5�4/ ftx$21=$,7Lye6- $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -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 appli for a permit an w rk is not to start without a permit; that the work will be in accordance with the approved plan in the case of all wor 'ch r es r nd approval of plans. SIGNATURE OF APPLIC PRINT NAME /� A"DLrf� Ir�ki�ATE 7 Z