AF - 44219sue�ecr PERM
City of Fridley 137
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� �� R CEIPT NO.
� `L __�__ COMMUNITY DEVELOPMENT OIV. � �
r � � PROTECTIVE INSPECTION SEC. 3�
�
1 ; �
i---- A �r"�,'� CITY HALL FRIDLEY 55432 NUMBER FEV. DATE PAGE OF APPROVED BV
L �� si2-5sa3a5o 910-F15 9/22/76 � �
JOB ADDRESS 6441 Arthur Stxeet N.E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2O 4 HdL7'].S Lake Estates SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Mr. Ri.ebel
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
Erco, Inc. 3231 Central Avenue N.E., Mpls. Mn. 55418 789-8878
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE Of BUILDINO
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK �����G
'Constr.uct a 36' x 24' Dwelling and a 24' x 22' Garage
' �iNlITS REC�U1REp �'C�R ��RNG, �efore digging cali local utilities
r
9 CHANGE OF US � , '
� � � • � - ' ' RE �1�
STIPULATIONS provide a hard surface driveway. Provide sod in the front and side
yarc7s. Provide a verifying survey before capping. Provide City with copy ,
of the truss design. Soil borings and/or compaction tests may be required
prior to approval to pour footings. Call for all inspections.
SEWER LOCATION: (Approx. 11' Deep) 29' North of Manhole (Inv. 878.40)
WYE ELEV: 878.66
TOP OF FOOTING: 881.66 Minimum
WATER LOCATION: 11' North of Sewer service, 56' N.E. of Manhole
� anr of �r oo�s Not �u� �e ---IMPORTAIVT—
�Cti,1R/eCY pp 1�TIli?Y lOG4nONS AI� EIkVAtIG+ �� N0�'IFY ThtE FRIDLEY ENGR.
T.�3S DAiA� IS fOR INfOt'�MA'1'tON PltF'.FOS�S ON►Y ANa DIVISION REGARDlNG CUR�
PERSONS U51NG R SHOVID VEAIFY TH� MFOkA'Nb�GN REMOVAL AND REPLACEMENT
ON i1� SITE, AT DRIVEWAY OPENINGS�
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATIN(i, TMPE OF CONST. OCGUPANCY GROUP OCCUPANCY �OAD
VENTILATING OR AIR CONDITIONING. WOO� Fi�e
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WOHK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R�. 984 +SZS �.5� %ZO-F'r'JZSO
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
WITH WHETHER SPECIF EDNHEREINIOR NOT.OTHE GRANTING OF AOPERMIT $31� 16O �`�.5. S8
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � S9G.00 �/ f���j(� $350.00
,� ,.� PLAN CHECK FEE TOTAL FEE
- ���='���� $24.00� $485.58
- SIGNATUREOFCONTRACTORORAUTHORIZEDAGEN7 �DATEI WHEN PHOPERLY VALIDATED THIS IS YOUR PERMIT
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CITY OF FRIDLEY
APPLICATIpN FOR RESIDENTIAL AL7ERATIGN,
ADDITION, OR REPAIR QUILDING PERMIT
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OWNER'S NAME: A� �� BUILDER• � /� ��
ADDRES S s ��� z.c�vc/ ADDRES S: ��� ,/ n�
y���, . �1� - <��/� �%��� -�����
NO • . G �l"'*" � STRE�T • ��e°l�i>�rst�
LOT: �� BLOCK: • � ADDITION: �+� —
CORN�R LOT: INSIDE �OT:�_SETBACK: � � SIDEYEIRD: �G � ��
Applicant attach to this form �ao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
�ESCRIPTION OF BUILDING
To Be . TJsed As : �
. �� �
Front: �� Depth: � � Height:
Square Feet: 0� Cubic Feet: /�, /��
Front•: °� � Depth : � � �– Height : �° «�
Square et ; � '� � Cubic Feet : � � � �
2`ype of Construction: Estimated Cost: $ �/,/ � 6�
To Be Completed: / �
The undersigned hereby ma.kes applicativn for a permit for the work herein
specified, agreeing to do all work in st"rict accordance with the Gity of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all L-he facts and representations st,a�ed in this application
are �rue and correct. �
TE: � 7�fO SIGNATURE
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(See Reverse Side F�r Additional Information.� �Io� L�%T �� � i
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BUII.DIN� PL'IL�IIT I;L'E SClllilllll.L'
SECTION 2. The Inspector of Buildings sha11, before issuing permits for �he
erection of any building or structure, or for any addition to any existing
building or structuxe, or for any alteration or repairs to any existing
building or structure, upon application therefore, xequire the payment by the
applicant for such pei-mit of Lees to the amount herein below set forth and in
the manner herein provided to-;ait:
NEW CONSTRUC�IOI�: Si.�ag],e Family Homes and Garages: $�l.00/1000 cubic feet
PLAN CHECK: 25 percent of building permit fee.
ADDITIONAL INFOR�IATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered �rom a point six (6) inches below th.e floor line of the basement
ox the cellar to the average heights of the upper surface or to the average.�
height o� �.he roof surface of the ma,in gable of a pitched roof.
For repaixs ox altexations to an ezcisting struc�ure, trie fee shall be at the
rate of $3.00 pe-r each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $i.50. °
VERIFICATION OF FOU�IDATI01�
, NOTE; Pexmits for eonstruction will be issued a minimum of 24 houxs from the
time of application, to allow for proper revietv of the proposed structure and
of the construction site.
A Cer�ified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be ma.de ten (1G) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued. �
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ExTERIOR ENVELOP� A`7ERAGE "U" COMPUTATION
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OWN�R; IG � �'
S`-iTE ADDRESS : �-
CONTRACTOR:.
Page 1 of 4
DATE �� � �� �
PHONE : � �� - �� �
Determine working square footage of each
1. Total e.�cposed wall area...... ��S _ sq. ft. x .17 =
2. Toal roof/ceiling area ...... � sq. ft. x .05 =
Total exposed wa�.l area above floor =
a. Total wall window area ...............................o. ��<�
b. Total door area .... .................................. 3
r
c. Total sliding glass door area .........................
d. Total fireplace wall area ........o..........o.........
e. Total wall framing area (average.l0o) .................. D
f. 0 1 rim joist area .............................o.... �
g. � wall area above floor ..........................
h.� wall area above floor ..........................
i. wall area above floor ..........................
j. wall area a.bove floor ..........................
Total exposed foundation area = aY� �
k. Total foundation windaw area..............o............ �
l. Total net foundation area above grade ................. ,
a.
b.
c.
Determine "U" value of each wall segment
(e.g. window, door, each separate wall section)
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d. X "U"
e. ���, T � X "U"
f . " i� X "U"
g. �.� �1 �� X „U.,
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j. X"U" = If item #3 is the sama as,
or less thar. item #1, you
k. X"U" = have met the intent oP
--- • — ---�-- - SBC 6006 (c) 2.
,
.
1. � c �-I' `.i X �� U �� , � � _ �-f� �
3 . ............................. Total = - I b � � a �° _
Exterior Envelope Average "U" Computation Page 2 of 4
s Total exrosed roofJceilin� area =
� ��
.
m. Total skylight area ............................
n. Total roof/ceiling framing area (average 10�)... �
o. Total net insulated roof/ceiling area...........
Determine "U" value for each roof/ceiling segment
Al. X °U�� °
n. �, � g ��U�� , o� � _
r '�/ { �/
O. C� X t1T711 � Q D—I � Y �
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4 ................. ........ Total � _
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If total of #4 is the same as, or less than #2, you have met the intent of
SBC 6006 (c) 1.
Alternate B�ilding Envelope Design
To utilize the total envelope system method, the valuns establishad by the sum o£
items #3 and #4 shall not be greater than fihe sum of items #1 and #2.
1.
�
+ 2, _
+ 4. _
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�- WALL SECTION5
NOTE: Use 10� of opaque wall area for
, frame 'construction
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Page 3 of 4
R-Value
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.
. � r p�
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- FIG. �iG� � --. . . . . ' .
: � _ • --� --- � J
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Page 4 of 4
Construction R-Value
1. Interior air film 0.61
2. �v ��
3. ► Y 7 - S
4. Exterior air film (still) 0.61
Total 2� � �
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Total - 2 j � � )�
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Note: Use addition�l sheets if more space is
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0
.
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TF�E CITY OF FRIDLEY DOES PIOT GUARAMT�E THF
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� usuRSAN
�� Na1NEERINai
1 NC.
� a Ciuil, Municipal & Enuironmental Engineering
❑ Land Surueying • Land Pldnrcing • Soil Testiag
Erco, Inc.
3231 Central Avenue NE
Minneapolis, Minnesota 55418
Attn: Mr. 011ie Erickson
Dear 011ie:
Main Office 5�1-6066
6875 Highway No. 65 N. E.
Minneapolis, Minnesota 55432
South Office 890-6510
1101 Cliff Road
Burnsville, � Minnesota 55337
October 8, 1976 �
l�
Re:'Lot 20 Block 4
Harris Lake Estates:
�t �t � � -
��
� >
�
On 14 September 1976 we drilled two hand auger holes on the
above captioned lot in the excavation area. The soils encounte'red
were visually identified by our Technician at the time of the
boring. The following is a log of the borings:
Test Hole #1
0-3.8 Wh�te sand
3.8-5.2' Black loamy sand
5.2-6.0' Brown medium loamy sand
No Water
�
��
�,,,�
�
Test Hole #2
0-3.5 White sand ,
3.5-4.3' Black loamy sand
4.3-5.0' Brown medium loamy sand
No Water
NOTE: Test holes originated from bottom of footing elevation
The overlying white sand seems to be well compacted. There
was no indication that any severly deleterious materials existed
below grade, however we did recorrenend to the footing contractor
that he place two #4 rebars in the footing to prevent differe,ntial
settlement of the footing if a crack occurs. � ,
If you have any questions,�please call at your earliest
convenience.
�
. _-RdM�/J P
cc: City of Fridley (Darrel Clark)
Dave Harris
R�,be•rr .M17inder. Reg. Eng. F.. A. Rath6un, Reg. Suru.
Wm E. Jenaen. fteg. Eng. Wm. K. Meyer, Reg. Eng.
�
Sincerely,
SUBURBAN ENGINEERING, INC.
� � �� �
Peter J. Molinaro
Project Engineer
Wm. E. Price, Reg. Eng. Gary N. Narris, Reg. Suru.
E�. w;rua»� Rogera. Reg. 3uru.
560•3450
c�f o ����e
.� �
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE December 17, 1976 FRIDLEY, MINNESOTA 55432
� Mr. 011ie Erickson
Erco, Incorporated
3231 Central Avenue
Minneapolis, Mn. 55418
0
Re: 6441 Arthur Street N.E.
Dear Mr. Erickson:
We made our final on the structural on the home located at 644I Arthur
Street on Friday, Dec�mber 17, 1976. The following is a list of items
to be completed;
l. Submit a verifying survey.
2. Provide a fire alarm (owner said they were installing their own).
3. Construct a deck or render the patio door inoperative.
4. Sod the front and side yards.
5. Provide a hard surfaced driveway.
Items 1, 2 and 3 should be satisfied by January 4, 1977 and items 4 and
5 should be"completed by June 15, 1977.
• If you have any questions on the above items, please feel free to
contact me at 571-3450.
S�.Ae�rely,
�, o
�,, � ;' ;
DARREL G. CLARK
Co�nunity Development Adm.
DGC/mh
P.S.� Please call for a final inspection on 1560 Mississippi Sti
�
sue�ecr PERMIT N. .`
City of Fridley � 14381�
AT THE TOP OF THE NVINS g U I L D I N G P E R M I T
; � R PT
� • COMMUNITY DEVELOPMENT DIV. <�/�`iJ Q1�
� j V �����'�
r � � PROTECTIVE INSPECTION SEC. `�f (O � 7
� _ � v
� /"�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�----� � �•� 812-580-3450 910-F15 9/21/77 / /
JOB AODRESS 6441 Arthur 5treet N.E.
1 LEGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 20 4 Harris Lake Estates SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
Roger A. Ri.cbel 6441 Arthnr Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
5ame
4 ARCHITECT OR DESItiNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDINa
ReS 1C1@Il'tld�.
7 CLASS OF WORK
� NEW �1 ADDITION ❑ ALTERATION ❑ REPAIR O MOVE � REMOVE
8 DESCRIBE WORK
Construct a 14' x 22' Deck
9 CHANOE OF U6E FROM TO
- STIPULATIONS
W�RNING
Sefo�t di�gi�g call local utiJitin�
� Y�iRiNG, �«��nE - �LECTRiC - GRS EFc.
SEPERAT� � PE��1TS REQUI�D fOR�" ��QUIRED �Y Ll�V�J
HEA11tVG, PlUli�911dt� aN0 SIGAi�.
TYPE OF CONST. OCCUPANCY OROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATINO, '
VENTILATING OR AIR CONDITIONIN(i.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. 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. DWL�. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES OOVERNINO THIS TYPE OF WORK WILL BE COMPLIED. $�jOO $.5O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE �HANTING OF A PERMIT
DOES NOT PRESUME TO (31VE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $,7, 5O
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
y48. 00
SIGN UREOFCONTRACTORORAUTHORIZEDA6ENT IDATEI HEN PRO RLY VALIDAT D THIS IS YOUR PERMIT
�
�/'�.�-c- � � 9-�i�
NATU OF OWNERIIF OWNER BUILDERI IDATEI BLOG INSP DATE
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- � CITY OF FFZIDLEY �'
' APP�ICATION FOR RESIDENTIAL BUILDING PER��IITS
� iNEW, ALTERATIONS, ADDITIONS, OR REPAIRS) �
• . . . � \
OWfd£R: ��'iP� li/� �/I � �UG � . .• BUILDER: d(-pCiG�� H ..'JC's•� � �
Address : ��/�i� . /7�v-��,(� � �� Address :
• Tel. No. �
No. b �v� S��t: `� �-11'�� � S - -
LOT: � � BLOCK� ' l ADDITION: _/y'i2J10J�i ���"•.� G�. _ _ '_ � �_--.
CORNER LOT: INSIDE LOT: SLTBACK: SIDEYARDS:
Applicant attach "to this fozm 7.tao Certificates of Survey of Lot and proposed
building location drawn on the�se Certificates. .
DESCRIPTION OF BUILDING :
To Be Used As: ' �
�.52.� Front: Depth: %'j/ Height: o? � -
Square Feet: Cubic Feet: �
Front: Depth: Height:
5quare Feet: Cubic Feet: �
Type of Construction: Estimated Cost: $�Q Q, O O
Zb Be Completed: � Alt. A Alt. B
Pro,posed Driveway �4idth If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein�
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
� , �
DATE: 9�/�-�% % SIGNATURE: � v
Stipulations:
_ 'N' 7 .�
✓
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BUILDING PERt�IIT FEt SCNEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the erecL-ion
of any building or structure, or for any addition to�any existing building or structure,
or for any alteration or repairs to any.existing,building or structure, upon application
therefore, require the payment by the appl.icant for such permit of fees to the amount
herein below set forth and in the manner herein�provided to-wit: �
NEW•CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$11.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3�foot wide approach with
. 6 inch depth; Driveway width plus 6 feet x$15.40
�11 � � � �' � �
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or the cellar to the
average heights of the upper surface or to the average height of the roof surface
of the nain gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 �ier each five hundred dollars ($500.00) or fraction thereof in the cost
of a11 proposed w-ork.
Tn no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a mini.m�mn of 24 hours from the time
of application to allow for pro,per review of the proposed structure and of the
construction si te.
A Certificate of Suxvey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
► : � � '' � -
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
_ �
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J'
SuBJECT PE
City of Fridley o 187�99
AT THE TOP OF THE TVFIINS g U I L D I N G P E R M I T�
r
� � RECEIPT NO.
� ; L ____� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 ` �
l--••� �r'��,,� CITY HALL FRIDLE� 58432 NUMBEP REV- OATE PAGE OF APPROVED BY
i 612-571-3450 910-F15 2/20/87 � /
JOB ADDRESS �r}41 Arthur Street N.E.
t LEGAL �OT NO. BLOCK TRACT OFi ADDITION SEE ATTACHED
DESCR. 2O � Haxris L3I{G' Esta.�es SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
David Buhman 6441 Arthux' Street N.E., Fridley, MN 55432 571-7581
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
AMRE 3700 Annapolis Lane, Plymouth, NIDT 55441 553-0020
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO.
8 USE OF BUILDING •
Residential
7 CLASS OF WORK
❑ NEW �1 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a 20` x 12� �� Deck
9 CHANGEOFUSEFROM TO
STI PU LATIONS
All wood a�ust he treated �or moisture resistance.
�Epq�qATE ������
�vrR�N�, ��ATrN � R�Qur�ED ���z ���
�� P�uMB�NG ��R �A !t ��ca► .::Ei';E'a
AND ����� �efore diggm� ca
TELEP�ONE � ELECTRiC - U��� ��.z
C����6��� �`� L��'e'�
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE 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 CERTIFV 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
WITH WHETHER SPECIFIED HEHEIN OR NOT. THE GRANTING OF A PERMIT $�-i 7SO $• 88
DOES NOT PRESUME TO GIVE AUTHOHITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $29. SO
0 � � � j+— ^ e�� PLAN CHECK FEE TOTAL FEE
C��'a $ 7.38 $37.76
SiGNATUREOFCON7R fCTQ ORAUTHORIZEDAGENT IDATEI WHEN PROPE ` ALIDAT THIS IS YOU PEFM
p �°� 1'J _ �Z� �
SiGNATUREOFOWNER�IFOWNERBUILDERI �DATEi BLDG �NSP �q7E
N� �'�] City of Fridley Effeetive 4/1/8b
ADDN. [ ] R-1 �AD R-2
pI,TEg. [ ] Building Permit Application
Construetion Address:����� ��'��-aa� �
Legal Description: �� �� ��� `��-. � '��S L-'�`� �.�`��S - -
� �l l Ce ���
Owner Name & Address : �d���"'� �"�`�"���� Tel. # � �,� � � � �
Contractor: � Tel' #'� � `3 �"�,
t� ,�,r e . . _ � �, ,-, . e ,
Address:
LIVING AREA:
GARAGE AREA:
DECR AREA:
OTflER:
Corner Lot L l
Attach to this application, a Certifiaate oP Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPRO�EMENT
Length Width Height
Length � � Width �-�_ Height � '� � �
Length Width _ Hgt/Ground
Sq. Ft.
Sq. Ft. `� 5 �
Sq. Ft. _ _
.��.�c . 3 � � �y �o� �
Inside Lot [] Ft. Yd. Setbaek Side Yard Setback J
Type of Construction: ��-�-� � Q��----s7 4°�
Approx. Completion Date: � � " � �
Estimated Cost: $
t� S�
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $ -
See Baek Page for Explanation
DATE: �— �� - �!
Permit Fee
Plan Cheek
State Sureharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
APPLICANT : ` � `�' Tel . � � � � �'�"
CITY IISE ONLY
$��•� Fee Schedule on Reverse Side
� � 25� of Building Permit Fee
$ $.50/$1,000 Valuation
$ � 525 per SAC Unit
� _ Fee Determined by Engineering
� Agreement Necessary L l Not Neeessary [ l
� � .7`
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BIIII.DING PERMIT FEE SCHEDULB
The Chief Building Official shall, before issuing permits for the ereetion of any
building or structure, or for any addition to any existing building or structure, or
for any alteration or repair to any existirtg building or strueture, upon applieation
therefore, require the payment by the appliQant for sueh permit of fees to the amount
herein below set forth and ia the manaer herein provided to-wit:
Total 9aluation
$1.00 to $500.00
$501.00 to $2,000.00
Fees
$10.00 (Minimum Fee is $15.00)
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraetion thereof, to and ineluding
� $2,000.
$2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraetion thereof, to and
including $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $�.50 for eaeh
additional $1,000 or fraetion thereof, to and
ineluding $50,000.
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for eaeh
additional $1,000 or fraction thereof� to and
including $100,000.
$100,001.00 and up
$433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEfiAY DEPRESSION ESCROiI
(Concrete Curb Streets Only)
Alternate "A": Removal and replaeement of curb and gutter only - Driveway width plus
6 feet times $13•50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approaeh with 6 ineh depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Permits for construetion Will be issued a minimum of 24 hours from the time of
application to allow for proper review of the proposed structure and of the
construction site.
A CertiPicate of Survey of the lot, showing the loeation of the foundation onee it
has been eonstructed will be required before proceeding with the framing.
�
C��� /n /�[� DESIGNER,
��w„� �� DECKS
BY Q�i]G°�C DC�C�[� C�O[�pQ�l�
A Sears Authorized Contractor
Addendum to Contract
Customer Na
. �
Job Address: �-�y`�' �*� ��+ �� ''�"'E' '
Job Ph.• -'� � f Hls Work Ph.: �i?L7�� Ner Work Ph.:���-/��3
Deck S sclilcatlons: /J-
The deck Is to b eet long end is to project out�—feet. The deck ie to be aupported by�posts
and.� footero. The footera ere to be set 30 to 38 inches below grade surface. The deck's understructure ia to be
2x10 and 2x4 lamineted beama which will conalat of e houae plate, tront plate, glyder beama, side bands,and croas
Jolete. Each besm Is to heve gelvenized etress pletes presaed In et both ends end one centered. The underatructure
beame ere to be aet with the crown elde up. The house plate Is to be fastened to the houae using 3/9 inch by 4 Inch end
3/6 inch by 8 inch zinc plated leg boHa. The 4` lag ere to be apeced 24" on center and the 8" lags are to be spaced 48"
on center. The decking pettern ie to be tha''1��'-G��'� type. The 2x4 decking boerds ere to be speced with a 1/8
inch to 1/4 Inah dralnape gap between boerda. All lumber Is to be 100�6 preaesuretreated, number one grade, SEARS
BE3T WOOD which cerrles a forty yeer non-proreted warrenty againat demege by termltea, rot and decey.
Ralling SpecNleatlons:
� TRADITIONAL: Poets end post supporta ere to be 2x4, fitted and bolted with 3/8 inch leg bolte. Reiling cap fs to
be 3B Inches ebove the deck floor. Bottom rell Is to be 1 1/2 Inches from deck floor. Reiling pickete are to be 2x2
and ere epaced epprox. 4 1/2 Inches.
CR0388UCK: Poete and poet eupporte ere to be 2x4, fitted and bolted with 3/6 Inch lag bolts. Ralling cap is to
be 38 Inch� ebove the deck floor. Bottom rell Is to � 21 /2 Inches ebove the deck floor. The two middle refis ere
to be eentered between the top and bottom rells. Ralling crosa breces ere to be 1x4.
FULLVIEW: Poata and poat eupporta a�e to be 2z4, firied end bolted with 3/61nch leg bolts. Refling cap is to be 38
Inches ebove the deck floor. Bottom rell Is to be 21/2 inches above the deck floor. The two middle ralls are to be
centered between the top and bottom rells.
CONTEMPORARY: Poats and poet aupports ere to be 2x4, fitted end bolted with 3/B inch lag bolts. RaiHng cap Is
to be 36 Inches ebove the deck iloor. Relling pickete ere to be 2x2 mitered wtth e 45 degree cut on top and bottom
of each plcket and are epaced epprox. 41/2 Inchea. The bottom reil is to be 1 1/2 fnches ebove the deck floor.
LOWBOY: Posts and post eupporta are to be 2z4, fltted and trolted with 3/B Inch leg bolts. The ralling cep ia to be
22 Inches above the deck floor. The bottom rail is to be 1 1/2 inches ebove the deck iloor.
Lowboy Fullvlew Styls Is to have two 2z4 pletes.
Lowboy TredlUonal 3tyle la to here traditlonel syle picket spaced epprox. 4 1/2" apert.
Lowboy Contemporary Style la to have contemporery atyle picket apeced epprox. 4 1/2" apart.
DECORATIVE: Posta end poet supporte ere to be 2x4, fitted end bolted with 3/8 inch lag bolts. Railing cep fs 2x4
snd le 38 Inch� above the deck floor. Rail alate ere to be made 1 x8. The bottom rail plete ia to be e 2x4 end Is 1 1/2
Inch� above the deck floar.
Decoretive Type A: Hend cut decoretive designed tx6 alete.
O�oreUve Type B: Hend cut decoretive deelgned 1z8 slets. �. ..8... C.. �►
— pecoretive Tye C: Hand cut decoretive designed 1x8 sleta.
Decoretive Type D: Strelght cut alete 1x8 with 1/2 inch epace between. '
PRIVACY: Poate and post supports are to be 2x4, fitted and bolted with 3/B lnch leg bolta. Reiling cep is to be 6
f�t ebove the deck floar. Ho�izontel top, mfddle and bottom ledger stripa to be 2x4.
_ 1 z8 Traditlonal Prlvecy rail wlth strelght cut slets atteched to the top end bottom plates. Slats are to be speced
approx. 1/2 Inch epeA.
_ 2x2 Treditlonal Prlvacy rell with etrelght cut pickets etteched to the top end bottom pletea. Picketa are to be
apaced epprox. 2 Inchee epert.
_ tx8 Contemporery Prlvecy rall with strelght cut alata attached to the top reil plates and to the tace ot the
underot�ucture perlmeter. Slats are to be epeced epprox. 1/2 Inches apert.
_ 2x2 Contemporary Privecy rell with mitered cut picketa attached to the top rail platea and to the face of the
underotructure perlmeter. Picketa ere to be sDaced epprox. 2 inchea epart.
gtalrway L Ing And Walkway Saeciflcatlons;
E-Z aLIOE STAIRWAY: The stairway aupport atringers are to be 2xt0's. The rise per atep is to be B inches and
the tread Is to be 91/4 Inches wlds• Each tread is to be supported by e 2x2 mitered cheat.The railing is to consist
�o( 2x4 posts, two center relle, top rall end reil cap. Aa eppropriate, e steirwey pad 48 inchea (38 inches for 3 teet
wide stalro) by 18 1/2 Inchee wfll be aet et the base o1 the atelrs. Stefrways over 8 teet in elevetion are to be
eupported by 2 additlonel 2x4 auppo►t poste placed mld-way in the atelra along wlth 1/4 wind bracing.
TWO LEVEL STAIRCASE: 3tslrceae Is to consiet of lamineted plywood stringera 4 feet on center. There are to
_ ps treads (B 1/2" rlee wlth 141/2" tread) conelsting of 2x8 peMmeter epron and three recesaed 2x4 slets.
The totel wldth of stalrcasee ere to be •
31NaLE 8TEPDOWN PAD3: The rise for tfle etepdown ped la to b.3 1/2" •5 1/2" •8" •other. . The
#length of the stepdown ped la to be�— . 3tepdown peda are t alst of pe�fineter epron with three
receeeed 2x4 elets. Total tread slze le to be 14 1/2".
��RNER STAIRCA3E: Steireaee is to set egelnet a corner wing on deck. 8teirceae is to consist of 2x10 atringers
_ with a 2xB klck boerd et the baee o1 each tread. The rlae perereand footeres). The undehstructuret decking end
LANDINO: Ths I�ndlnp Is to be eupported by..�P ( 1
�relling le to ba the aeme ae epecifled In the deck and relling sectlone.
WALKWAY: The welkwey size Is to be teet long end is to project out 4 feet. The walkway is to be
_ conneCted to the maln deck end le to be supported by.—footers. The understructure, decking, and reiling is
to be the same es apeclfied In the deck and relling aections. Ac�pres
Designer Deck Addendum Continued
Customer Name: ���� �� �4��� Date: r�-/o�� page:�
D�ck Aeaes�orin: (Chsck sa epproprlets end Indlcets el:e)
_Cantllsvsr peckapa _On Oround tree box (N.C.) —Beam Trellle
_Comer Wlnps _Relling Back Bench Wlndow Trellle
_�Ick�b on 8tdr nlli Opsn Beck Bench ._�Width_—Pro►.-1
a�b (8tyls: ) �Plcnlc Tebls _Opsn Weeve U S.
_Comsr Pl�nb► Box �LR�II Tebte � � —Lattics Underokirt
�soUnqul�► Pl�nbr Box _�un Trelll� _Closed Panel U S.
�ellmount Plenter Box _(Width:_�roJsction:_) —Post (iussete
Rns Shndlnq Dsek a�d or L�ndlnq; EIe�aUon:
a„t.. p�t (�) and Foot�r (�) Feet of Extra Flalling
Cu�tom Culting Work:
_Udllty Mst�r Notohlnq w/oo�nsr J�Aodulss to bs cwtom cut
_Utlllt�► Mstsr Notohlnp wo/covsr �odn�es cut eround tree
Custom 8lsinp (No. of Mod. out�.—) �ther.�
Cwtom FIII In (8q. Ft.:--)
Te�r Out �nd E:�w�tlon�Contnotor to Mwl �w�y: Ya • Npspalr Masonery/Concrots/Flesh
__ilemovs Fad�tirtp Wood Dsok
WIdtA�ro���lw
,��w Awnlnp�, Roof, or _Exc�vetlon (Houn: )
�emors Exl�tlnp Conc►�t� St�ps/L�ndlnq Othsr.
Wldth_Pro�._�Iw
•NOTE If �fter tM old �trueturo (I.s., old deck, eonarots stoop, eta.) Is teksn down end eny unforeeeen demage
�� d��pv�nd �uph u rottsn wood, encksd or ehlppsd muonsry/brlcks, end/or othsr truet worc�the�t ; uet
bs ropNred bsforo the nsw deak cen De Instelled� thero will bs edditlonel cherpes msd �M�,.�
'NOTE: If t e rel of utility Iinea, metere, etc. ia necesaery the cuatomer agrees to be reaponaible for the
edditlonel co�t$�.-�-1Customer Initial)
gQts�d �rtd►uetlom and Dl�Oram of D�elc (Inelude locetlon of houae, slze of deck, elevation, end location of all
acceesorl � n� � s3�+ct�ons)
Elevstlo^._,�.-- ,-�;
Horizontel 3teAing Point (HSP) ��
VeRlcel StaRlnp Polnt (V8P)
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Bulldln� P� t: Y„- - - - - -No- - - - - - - ICu�tom�r 1 N) Ju�i dictl
Wltn�u�s '��. ��"" Owmr.
Oatr. Own�r
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Dlrectlons to Job: (Olve Maln Cro�s S� t�)
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SUBJECT
c�ty of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i�
� �` _�_� COMMUNITY DEVELOPMENT DIV.
� v � PROTECTIVE INSPECTION SEC.
r , ,
, . ,
� = i�"� � CITY HALL FRIDLE� 55432 NUMBER pE�
�"-'� � ,'� 612-571-3450 910-F15
J08 ADDRESS 6441 Arthur Stxeet NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 2O 4 Harris Lake Estates
2 PROPERTYOWNER MAILADDRESS
Jim Earny 6441 AYthur Street NE
3 CONTRACTOR MAIL ADDRESS
Ricks Roofing & Sid.i.ng 77 ^ 2nd Street SE, New Br
4 ARCHITECT OR DESIGNER MAIL AODRESS
5 ENGINEER MAIL
OATE PAGE OF
6/4/92 / �
21373
'GEFP�-i�i'8�
" 7 "�' � �
APPROVEO B�
SEE ATTACHED
SHEET
571-�82 76
ZIP PHONE UCENSE NO.
ton 633-6395 3566
ZIP PHONE LICENSE NO.
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK � N� ❑ ADDITION O ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroo� House & Garage (24 Squa�ces) Tear^off
9 CHANGE OF USE FROM
STIPULATIONS
TO
UnderlaXment �gust comply �ai.th State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZOI
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, Ofi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yp
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
OOES NOT PRESUME TO GIVE AUTHORITV TO VI ATE OR CANCEL THE pE
PROVISIONS OF ANY OTH R STATE OR LOCA� AW REGULATING CON-
�S �RUCTI(�N�R �HE�ERF�RMANCE OF CONST CTIQN.
a :' PL
TURE
F
�
7 IDATEI
p
NG �u.ri.
DWLG. UNITS
1 STALLS
IATION
$1�272
dIT FEE
$31.00
V CHECK FEE
,icense SC $5.00
LOAD
CU. FT.
� PARKING
GARAGES
$ . 64
iAC CHARGE
Fire 5C $1,27
fOTAI FEE
$37.91
) TNIS IS VOUR PERMIT
a � .�( _ �7i
natE
�W � � Effective 3/ 1192
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Conctruction Address:
Lega1 Description:
Owner r
contract+
Address:
�('��V
LIYING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
r
Tel. � -- � �j
�v �c�vsE #C��O �S'C �
�_Tel. � C �,�� 6� °� �
_ _--- - _ _ . ey of the
lot, with the proposed conslruction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Lengfih 1�Vidth Height
Length Wi�h Height
I:en Width/ Hgt/�Groimd
�P�.n �,n � �� l'� ( .�� S ��c ) / r�1-/z-fJ�F
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot Ft. Yd Setback Side Yard S�backs
Type of Construction: � a�/L-C�f�S_S Estimated Cost: $ A� %�
Approx. Completion Date:
(Cost on Back)
Driyeway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
� /�
DATE:�j ' APPLICANT: TeI. # ` � J
('ITY USE OI�II.Y
Permit F� $ �/ � �
Fire Surcharge $ /• � %
State Surcharge � • lo �`
SAC Charge $
License Surcharge $ � � o O
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL $ '� � ' 9 �
STIPULATIONS:
Fe� Schedule on Reverse Side
.�1 of Permit Valaation (1/lOth%)
$.SO/$1,0� Valuation
$7W per SAC Unit
$5.00 (State Licensed Residential Contra.ctors}
Alt. "A" or Alt. "B" Above
Fee Detemained by Engineering
Agreement N�essai}► ( j Not Neceesssary []
_ r j�
` ���
��
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the er�tion of any building or strucb�re,
or for any addition to any existing building or structare, or for any alteration or repair to any existing
building or structure, upon application therefore, require the payment by the applicant for such permit
of fees to the amount herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,0�
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1�,000
$10(},�1 to $5�,0�
$5�,001 to $1,000,0�
$1,(�00,001 and up
FEES
$15 (Minimum F� is $15 plus surcharge)
$15 for first $500 plus $2 for each additioaal $100 or
fraction thereof, to and including $2,000
$45 for first $2,000 plus $9 for each additional $1,000
or � fraction thereof, to and including $25,0�
$252 for first $25,000 plus $6.50 for each additional $1,000
or fraction ther�f, to and including $50,0�
$414.50 for first $50,0� plus $4.50 for each additional
$1,(�0 or fraction thereof, to and including $100,000
$639.50 for first $100,�0 plus $3.50 for each additional
$1,�0 or fraction thereof, to and including $500,000
$2039.50 for the first $500,000 plus $3 for each ad.ditional
$1,000 or fracNon ther�f, to and including $1,IX10,0(30
$3539.SU for the first $1,�,� plus $2 for each additional
$1,000 or fraction ther�f
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times
$13.50.
Alternate "B": Removal and replacement of curb and gutxer and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for consbniction will be issued a minimum of 24 hours from the time of application to allow
for proper review of the proposed structure and of the constivction site.
A Certifica.te of Survey of the lot, showing the location of the foundation once it has it has been
constructed will be r�uired before proceeding with ifie framing.
�
_'- � -
SuBJECT - .�_
City of Fridley � �� � � � �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� • _���_ COMMUNITY DEVELOPMENT DIV. ���q
' t L' �
� � PROTECTIVE INSPECTION SEC. �7
� � /
i � �
� � /"'� � CITY HALI FRIDLE� 55432 NUMBER REV DATE VAGE OF APPROVED Bv
�"""'�' ''' 612-571-3450 910-F15 10/23/95 � �
JOB ADDRESS 6441 Arthur Street NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2Q 4 Harris Lake Estates SNEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jim/Dee Carney 6441 Arthur St NE 571-8276
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Custom Remodelers 8729 Central Ave NE 784-2646 174
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASSOFWORK � NEW ❑ ADDITION ❑ ALTERATION W REPAIR ❑ MOVE � REMOVE
8 DESCRIBE WORK
Reside Dwelling; Soffit & Fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OF AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OROINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED 13,538 �6.75
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTtNG 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- �212�25 Fire SC $13.S�F
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION
PLAN CHECK FEE TOTAI FEE
a��-�c�+.►�+°���9:L �� �'3 � License SC $5.00 $237.54
..�+
—�SiGNATUAEOFCON'fiACTOROAAUTMOAIZEDAG NT IDATEi WNEN PAOPE VALIDATED THIS IS VOUR PERMIT
��. I'�c.�r/'i /��-2t�i
SiGNnTURE OF OWNER iiF OWNER BU�LDERi iDATEi B G�NSP ��FTE
NEW
ADDN
ALTER
[1
�l
��
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 8/ l /95
��/ /
ConsbructionAddre�s: ���1 I Q�'i'-fl� �^ �-� _
Lega.l Description:
Owner Name & Address: aiw� � ��� � ��.�,r`� �' Tel. # '� �1 - � �
Contractor: C�.��°��,�� �-� e•v°� o�c,�.��.r� .� � MN LICENSE # r��
Address:�� �� C' .� � l��, � � ��1 ve 1� � Tel. #�g�-j ° Z G� �'�
At�ach to this application, a Certificate vf Survey of the
lot, with the propossd construction dra.wn on it to scale.
DESCRIPTION OF IMPROVEMENT
�I�II�iG AREp: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. FL
DECg AREA: Length Widt6 Hgt/Ground Sq. Ft.
OTHER: -
Coraer I.at [] Inside Lot [] F� 3�d Setback Side Yard Setbacks
Type of Canstiuction: ���Q� / `70 -�-f � � ' � CaS�: $ i � . `7 � � - c'
*-t � - L'C� � ��
Approx. Completion Date:
(Cost on Back)
i)riveway Curb G'�ut Width Naded: F� + 6 Ft = Ft x$ _$
DATE: r � %z 3 / �� � APPLICANT: ���,.4� i�.�� � � ` �� ���- Tel. # %�'L/-� � �� ` O�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Maia Charge
TOTAL
�ITY USE ONLY`
$�/� • a S Fee Schedule on Reverse Side
$ / 3. s� .0p1 of Permit Valuation (1/lOth%)
$ � . �S $.50/$1,000 Valuation
$ $850 per SAC Unit
$ �, o � $S.� (State Licensed Residential Contractors)
$ Alt "A" or Al� "B" Above
$
$
$
$ ��7.5
$450.00 Conser�►ation Plan Review
Fee Determined by Eagineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: � ' � �
�UILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, t�fore issuing permits for the erection of any building or structure, or for
any addition to any existing building or siructure, or for any alteration or repair to any existing building or
siructure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit: '
TOTAL VALUE
$1 to $500
$SOl to $2,00p
$2,�1 to �"15,000
$25,001 to $50,000
$50,001 to $100,OQ0
$100,0p1 to $500,000
$500,001 to $1,000,000
$1,0�,(?Ol and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for fust $SOp plus $2.75 for each additional $1W or
fra.ction thereaf, to and including $2,(100
$62.25 for first $2,000 pins $12.50 for each additional $1,000
or fractioa thereof, to and including $25,000
$349.75 for first $25,OOp plus $9.00 for each additionat $1,000
or fraction th�eof, to and including $50,000 .
$574.75 for first $Sp,Upp plvs $6_25 for each additional
$1,000 or fiacti� thereof, to and inclnding $100,000
$887.25 for first $100,000 plas $5.00 for each additional
$1,000 or frac.�ion th�eof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for e�ach additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,0{� plas $2.75 for each additional
$1,000 or fraction ther�f -
DRIVEWAY DEPRESSION ESCROW
(Concrete eurb Stteets Only)
Alterna.te "A": Removal and repiacement of curb and gutter oniy - Driveway width plus 6 fcet times $13.50.
Alteraate "B": Removal and replaceme�nt of curb and gattsr and install a 3 faot wide
approach with 6 inch depth - Drivevv�ay width plus 6 feet time.s $15.75.
VERIFICATION OF FOUNDATION
Pe�ts f°r �°n�uc1�°n will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the coaslruction site_
t1 C� tificate of Survey of the lot, showiag the l�ation of �e foundation once it has it has been coas�ructal
vvill be required before pr�eeding with the fiaming.
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CHIlVINEY AND STACg VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
L Has been carefiilly examined Yes O No O
2. Is fi�e from rust or deterioration
3. Has no foreign obje�ts la�ged within
4. Is secutelY �PPa�
5. Meets all current Code requirements for size
and total BTU's conne�ted
6 Has total heating B1'U's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heaxer
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
YesONoO
YesONoO
Yes()No()
Yes()No()
Yes()No()
Yes ( ) No ( )
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� ; V ����� �
COMMUNITY DEVELOPMENT DIV.
f � � PROTECTIVE INSPECTION SEC.
� : �"'� � CITY HALL FRIDLEV S5C32 NUMBER aev
�""� � �`� 612-571-3450 9t0-F15
108 ADDRESS 6441 ARTHUR ST NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 2O 4 Harris Lake Estates
2 PROPERTY OWNER MAIL ADDRES$
Jim Carney 6441 Arthur Street NE
3 CONTRACTOR MAILADDRESS
Same
a AfiCNITECT OR DESIGNER MAIL ADDRESS
DATE PAGE OF
12/23/97 / /
"PERMIT NO.
25742
RECEIPT NO.
��73
APPROVED BY
SEE ATTACHED
SHEET
PHONE
571-8276
PHONE LICENSE NO
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PMONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WOiiK
0 NEW ❑ ADDITION C� ALTERATION 0 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct fireplace enclosure
8 CHANOE OF USE FROM
STIPUTATIONS
TO
S�EpARATE PER�ItTS REQUtR�£D FOR
WIRI(VG� HEAi'IiVG, PLU�iBi1�G �4ND SIGIVS.
TYPE OF CONST
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, NEATING,
VENTILATING OR AIFi CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UN
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITFI WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PEFMIT WlOO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pEFMIT FEE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFOR CE OF CONSTRUCTION. �LL.00
� PLAN CHECK FI
� � �� �-3-�7
�$IGNATURE Of ONi AC OR OR AUTNORI ENT IDATEi NEN
� �
�OATE�
OCCUPANCY GROUP
S0. FT.
OFFSTFiI
STALLS
SURTAX
$.50
OCCUPANCVLOAO
CU. fT.
� PARKING
GARAGES
Fire SC $.50
rOTAI FEE
�ZZ.00
i THIS IS YOUR PERI
• / �1 s
NEW
ADDN
ALTER
[l
Il
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CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress. � ' (�� �[ / / � � / � J �' "' a \ / /r , ✓ ✓ � � •
Legal Description:
/�
Effective 1/�/97
� � l� �7
,��_(�
�'� �
� G
Owner Name & Address: �" y �/ � % �(' ,��7� �����`��1 �� Tel. # S �/ S �� G
Contractor: G� t,v � G"l� �s � C�/t'��� MN LICEN5E #
Address: S� ��2 � Tel. # s�''-� E'
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
Attach to ttus application, a Certificate of Survey of the
lot, with the .proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
$q. Ft.
��' -
Construction Type: �� 1i1i G',� s �'=�l��PG,qcE Estimated Cost: $%��O
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �� ' � � - i7 APPLICANT: � ` Tel. # �`'7 t - ��-? 6
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ��
�D a J "
W o �/ —
$
$
$
$
$
$ -
$ � �
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$950 per SAC Unit
$S.QO (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $SOO,OQO
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100, 000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet tunes $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the tune of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
*
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacina an existin4 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 plasticlPVC and meets all cuRent 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 manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the cuRent codes
and manufacturers specifications.
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()
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventina system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed coRectly after
an appliance has been removed from the common vent and vented
separately as per cuRent codes. Yes () No ()
Apaliance Tvae 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: (Describel � ��/'� j'�� �� /�(,l f� � �,� �' Q (�
��"7(� ��d�� � �'� �Gi ��,�-�' ('1 � c'�G� 1�71�� -
HEATING CO:
Signed By: Date :
_
_
CI"IYOF
FR[DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UMVERSTTY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
March 8, 2002
Westem Construction
6441 Arthur Street NE
Fridley, MN 55432
Re: Final Inspection at 6441 Arthur Street NE
Contractors: Maple Grove Heating & Air Conditioning, Inc.
Dear Property Owner:
A mechanical pemut was issued on January 25, 2001, to disconnect a heat run under the old
patio door and extend it into the addition at your address. According to the 1991 Uniform
Mechanical Code, a final inspection shall be conducted on the work authorized by this pernut.
As of this date, no inspection has been called for.
The permit fee that was paid covers the inspection to make sure the work was eompleted
according to the 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 mark the permit "no inspection called
for" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
sue�ecT IT NO.a�
c�ty of Fr�a�ey , �
AT TNE TOP OF TNE TWINS g U I L D I N G P E R M I T 3 i 5� 2
r
� � RECEIPT NO.
� `v _�_�� COMMUNITY DEVELOPMENT DIV. /S��
r � � PROTECTIVE INSPECTION SEC. ��
1 . ,
� t �"�� � CITY HALL FRIOLE� SS132 NUMBER NEV OATE PAGE Of APPqOVE �
�""'� � �'' 612-571-3450 et0-Ft5 10/31/00 / /
JOB AODRESS 6441 Arthur Street NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
oesca. 20 4 Harris Lake Estates SNEET
2 PROPERTY OWNEFi MAIL ADDRES$ 21P PHONE
Ji.m/Dee Carney 6441 Arthur Street NE 639-0424
3 CONTiiACTOR MAIL ADORESS Z�P PMONE LICENSE NO
Western Const�ruction Co 4301 Hwy 7, STE 115, Minneapoiis, MN 55416 4238
A AfiCHITECT OR DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
952-920-8888
S ENGINEER MAII ADORESS 21P PHONE LICENSE NO
8 USE Of BUILDINO
Residential
7 CLASS OF WOFiK
❑ NEW C� ADDITION O ALTERATION O REPAIR O MOVE O REMOVE
8 DESCRIBE WOfiK Fi'OUr
Construct a l0a x 12' �ee Season Porch Addition and a lZo x 14' Deck
9 CMANOEOFUSEFROM TO
STIPULATIONS
See notations on plan.
Additional amounts for 4 season porch paid on 11/8/00.
SEPARQTE PER�AITS ��R I %I �
REQUIR�D FOR: �efore digging call fo�
WIRING,� HEATING aI1 utility locatiort�
PUIMBING AND SIG(NS �540002
REQUIRED �� L�AVI/
nPE OF CONST. OCCUPANCY GROUP OCCUPANCr LOAO
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, MEATINd.
VENTILATING OR Alq CONDITIONING
TMIS PEFMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION 20NING SC. fT CU FT.
AUTHOR12E0 IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOF A PERIOD OF 1T0 DAYS AT
ANY TIME AFTER WORK IS COMMENCED NO DWIG. UNITS OFFSTREET PAFKING
1 MEREBY CERTIfV THAT I MAVE REAO ANO E%AMINED THIS APPLICATION 1 STA�LS GARAGES
AND KNOW TNE SAME TO BE TRUE ANO CORREC7. ALl PROVISIONS Of LAWS yq�UATION SURTAX
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMP�IED � G�� @
WITM WMETMER SPECIfIEO MEREIN Ofi NOT. TNE GRANTING OF A PERMIT �-�'�*'' `V11 � 2OO � �S . C)O
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TME pEqMl7 fEE SAC CNAFGE
PROVISIONS OF ANY OTMEfi STATE Ofi LOCAL LAW REGULATING CON- @ @
STRUC TNE PERFO OF CONSTRUCTION ����5' y�2O9.2S Fire SC yrS� $1]..Z,O
PLAN CNECK FEE TOTA FEE
Licen C $5. 3&� $ 31,.0
S�GNA uAE � CO •p t0 OA AU MOA�ZED AGEti �D�iEi E pp p . VALIDAT TMIS IS VOUp RMIT
a� D 3 � �
S�GN4TUAE O� OWNEp��� OWNEp BULLOEp� iD�iEi BL G �NS� q6T
�,� rs=+ ',ri.
Oct 19 00 11:15a Western Construction 612-920-117Z p.2
rr�w [ ]
ADDN [�
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effect►ve 1/1/9�
ConstructionAddress: � � � � � v ��''10 +� �� • 1v -
Legal Description: �--�'�' a O,�jl o C. jC ��GZ. �''r� S/a /�2.� Es��-i�2 5�rJo�i Cn�wt�,
Owner riame & Address: �,�_I.ie � - �.Ou�' Cl�.�(, Tel. # %��- �3 —Q�a.�
Contractor: i��k�'r'1 �.��f1S-�'t'`1C,��� ��1�0. MN LICENSE #
Address: �-i 3A ! hlur�a� ��� ' I� S il(li nD ST 1;.� �ar'a,�-Il I(o Tel. #�I%a.��,� q d�- .��d�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
� ��k1-�SOb�
J�/�-� �� ���
:
GARAGE AREA:
DECK AREA:
DESCRIPTION OF DVIPROVEMENT
Length 1� Width 1�Z Height � Sq. Ft. ( a O
�ng��: Width Height Sq. Ft.
Length 12. Width 1'f - HgVGmund � Sq. Ft. �'� �c���
OTHER:
C�'��n S`C��'Co � �/C�
Construction Type: Nr I.J Estimated Cost: $�a 00�0
, (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = $ _�
DATE:10 ) , APPLICANT: Tele # (ol�-��,�
CITY USE ONLY
Permit Fee $.� ao�� Fee Schedule on Reverse Side �
Fire Surchazge $ �9 `� .d01 of Pernut Valuauon (1/10t�%)
State Surcharge $ � $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee•
Sewer Main Chazge
TOTAL
STIPULATIONS:
$ $1000 per SAC Unit
$ �J
$
$
$
$
� �.
, ���
$5.00 (State Licensed Residential Contractors)
Alt. "A° or Alt, "B" Above
$450.00 Conservation Plan Review
Fee Determaned by Engineering �
Agreement Necessary [] Not Necessary [ J
�
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Oct 19 00 i1:i5a . Western Construction 612-920-1172 p.l
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FAX #:
FROM:
DATE:
# OF PAGES:
�:
WESTERN CONSTRUCTION CONIPANY
4301 Highway Sev�n, Suite 115
Saint Louis Park, Minnesota 5541fi-5.807
932-920-8888 Oflice '` 952 9Z0-1172 Fau
� FAX COVER SHEET
MEMO❑
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PIN
LEGAL DESC
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�63) 572-3604 FAX: (763) 571-1287
: 6441 ARTHLJR ST NE
: 133024410074
: HARRIS LAKE ESTATES
: LOT 20 BLOCK 4
PERMTT TYPE .
PROPERTY TYPE .
CONSTRUCTION TYPE .
HEATING
RESIDENTIAL
ADDITION/ALTERATION
PERMIT .:2004-012
DATE ISSiTED: 08/03/2004
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERNIISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL A FURNACE (WARM AIlZ, CARRIER, 60,000 BTUS) AND AN AIIZ CONDITIONER.
# A/C UNITS 1 # FURNACES 1
# GAS DRYERS
VALUE (FOR NIINIMUM CALC)
APPLICANT
SUPERIOR HEATING AC & ELECTRIC
2132 2 AVE N
ANOKA, MN 55303
(763)422-1721
OWNER
CARNEY JAMES C& DE ARLYN
6441 ARTHLJR ST NE
FRIDLEY, MN 55432
0 # GAS RANGES
6075
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 lmow the same to be true and correct. All
provisions of laws and ordinances goveming this type of wor�
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 cons ction or the performance of cons ction.
Appl e1II I� Date � i
Bldg
HEATING PERMIT NIINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 1161
SEPARATE PERMITS REQUIItED FOR WORK OTI�R THAN DESCRIBED ABOVE.
0
0.00
35.00
0.00
0.00
25.00
0.50
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FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT COIdNECTOR AND COMBUSTION AIR VERIFICATION
When realacina an existinq furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and flrestopped where required. Yes (� No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
spec�cations including s'izing, length, number of elbows and termination. Yes (�j No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specific�tions. This does
include AGA-GAMA Category I Centrat Fumace Venting Tables for fan
assisted and natural draft appliances.
The ezistina combustion air is sized and instalted to rr�t t�ie eurrent codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturers specifications.
Yes �j No ( )
Yes (� No ( )
Yes �) No ( )
When installinu a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and rr�anufacturer's
specifir.ations. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes (�
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.
No ( )
Yes � No ( )
Appliance Tvae and SizelCommon Vent and Vent Connector Information
Appliance #1 Type L(la�.�-Gt� .eee'�'��BTU Input ���� �° Fan Assisted o�
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assist�! or Nat
Total Appliances Tatal Btu Input ��
- — -- - q � c
Common Vent Type 1,� 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) �e rJ%�e � �e��� �-� � � ��C �
�, ���`'� L< ?�� �' `° L � � �� � iJ �'� 1! ��.� �'�.- �e �. � r=����� �.
w �
HEATING CO: ��°F H ��n ���� �j"1 �
Signed By: � Date : � �