AF - 44334sue�ecT PE O.
c�ty of Fridley 18809
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � REC T NO.
COMMUNITY DEVELOPMENT DIV.
r � L � PROTEC7IVE INSPECTION SEC. ���, ��
1 i
l1 = i
.-__� /"'1'� CITY HALL FRIDLEY 55432 NUMBER REV. OATE PAGE OF APPqOVED BY
i ' � 612-571-3450 910-F15 3/4/87 / /
JOB ADDRESS 6691 Arthur Street N.E.
LOT NO. BLOCK TRACT OR ADDITION
1 LEGAL SEE ATTACHED
DESCFi. 9 1 R1Ce Creek School Addition SHEET
2 PROPERTYOWNEA MAILADDRESS ZIP PHONE
Don Bloomberg 6691 ArtMur 3treet N.E. 572-�542
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Fireside Corner, Inc. 883 Front Avenue, 5t. Paul, N.�T 55103 488-6611
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 EN(iINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Wood Burning Stpve (Vermont Ca,sting Tnc. - Resolute) TGBO #3793
7 CLASS OF WORK
❑ NEW ❑ ADDITION 6� ALTERATION p REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
�XI�T� See Above
8 CHANCiE OF USE FROM TO
STIPULATIONS
Install per ma,nufacturea;'s specifications. Provide comhustion ai.r.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTHUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAY$, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OH ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME APTER WORK IS COMMENCED. • NO. DWLG. 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 ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT Sl18OO �. 9O
DOES NOT PRESUME TO GIVE AUTHORITY 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
PLAN C� ECK FEE TOTAL FEE
$30.40
SIGNATUREOFCONiRACTORORAUTHORIZEDAGENT IDATEI WHEN PFOPERLY VALIDATED THIS IS YOUF PERMIT
, � �
SiGNATURE OF OWNER�iF OWNER BUILDERi IDATEi BLOG INSP � E
p� ., f.� City of Fr3.dley Effective 4/1/86
ADDN. L J R-1 AND R-2
11L,TER. [ ] Buildin� Permit Application
Construetion Address:
6691 Arthur ��. E.
Legal Description:
Owner Name & Address: Don Bloomberq Construction Address Tel. � 579-15a9
Contraetor: Fireside Corner, Inc. Tel. # 488-6611
Address• 883 Front Ave., St. Paul, MN 55103
Attach to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to seale.
DESCRIPTION OF IMPROVEMENT
-- - -- --__
- -
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECB AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: �:s% %����l��
Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setback
Type of Construction: Existing Estimated Cost: $ 1800.00
Approx. Completion Date: " � ��, ���� ���
�I;,,�u 6 � c'' .�,�
�Q��-1,�` ' _ �� � C �" t. A Alt �
Proposed Driveway Width If New Opening Is Desired: $ $
See Baek Page for Explanation
DATE: z�27�87 APPLICANT: Fireside Corner Tel. # ti12 aRR_titiii_
CITY IISE ONLY
Permit Fee $ ��� Fee Schedule on Reverse Side
Plan Check $ ��� 25� of Building Permit Fee
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $ 525 per SAC Unit
Park Fee $ Fee Determined by Engineeriag
Sewer Maia Charge $ -
2�'�� Agreement Necessary [] Not Necessarq []
TOTAL $ °���'
STIPULATIONS:
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BUII.DING PERMIT FEE SCHEDIILE
The Chief Buildin� Offieial 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 strueture, ugon applieation
therefore, require the payment by the applicant for sueh permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
Total 9aluatioa
$1.00 to �500.00
Fees
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and ineluding
$2,000.
$2�001.00 to $25,000.00
$25,001.00 to $50,000.00
�32•50 for the first $2,000 plus $6.00 for eaeh
____additional $1 , 000_ or fraeti_o_n thereof, to and
including $25,000.
$170.50 for the first $25,000 plus $4.50 for eaeh
additional $1,000 or fraction thereof, to and
including $50,000.
�50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraetion thereof, to and
ineluding $100,000.
$100,001.00 and up
��+33•00 for the first $100,000 plus $2.50 for eaeh
additional $1�000 or fraction thereof.
DRIIIEWAY DEPRESSION ESCRON
(Conerete 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 replaeement of curb and gutter and install a 3 foot wide
approaeh with 6 inch depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOIINDATION
Permits for construction will be issued a minimum of 24 hours from the time of
application to allow for proper revieW of the proposed strueture and of the
construetion site.
6 Certificate of Survey of the lot, showiug the location of the foundation onee it
has been eottstructed will be required before proeeeding with the framing.
—�..
sue�ecr PE .
City of Fridley 15 4 3 6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
i � R�C
COMMUNITY DEVELOPMENT DIV.
r� � L � PROTECTIVE INSPECTION SEC. p� ��� �/
't ; �� �
, /'�'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�""'"� � ��� 612-571-3450 91 o-Ft 5
9/7/79 / /
JOB ADDRESS 6691 Arthur Sfixeet Ne E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 9 1 Riee C�rek School Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Alan Clai.r 6701 Ashton Avenue N.E. 574-7549
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
5ame
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ������r �7��� f�MQM�t1 �
S � 1' L�
8 USE OF BUILDING P��.���N� �t�D
R • KEATtiNG,
7 CLASS OF WORK
� NEW ❑ ADDITION ' ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
I t 1 �
9 CHANQE QF USE FROM TO
STIPULATIONS provide a h�xd surface drivway. Provide sod in the front and side yardse
Provide City with copy of Verifying Survey before cappirig.
Services angled off ma.ins. Contract City Public Works Division for locationa
Utilities have been extended to pro�rty linem
DRIVEWAY DEPRESSION COST: 18' + 6' x$15e75 =$378,00 � ������
$200.00 Storm Sewer Excrow paid �e� �t�(111$ �� � ���Eg
TEIEP�itlMf • ElECt1�C • �S Et�.
Tr�e an. ot, r�cu��r oo�s,:NO�r cu� r�� RfC�U1RE� 6Y 1.�►W
ACGtJRACT O!� • Vi�,R16 LOCJ►TN7►IS APD lL�I►Ai�Q!;..
1?tt5 DATA ,� tO1t �M�i�ORNAnCN PURPOSlf pN�lt �
P�OMi Y5{� R SMOb�D VEItiFY iHE tNF4tMAtfptY
ON tN� $lifc
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
SEPARATE PERMITS ARE HE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. Wpp(�
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO 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
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STAILS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $35,150 �1%. S8
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR IOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S78o 22 $425.00
-� PLAN CHECK FEE TOTAL FEE
�' �.�-c,�„� `"C..- �,a�•. `�'�'�� �� $19056 $540e36
SIGNATUREOFCONTRACTORORAUTNORIZEDAGENT IDnTE� - WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
/, �
SIGNATURE OF OWNER �IF OWNER BUILDE(al IDATEI BLDG INSP ATE
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CITY Of FRIll�EY .
' APPLICliTIOP� FOR RCSIllCNTIl1L BUII..DING PERf�1ITS
' (1VEW, �ILTCR/1TIONS, ADDITIONS, OR REPAIRS)
,
GWH�R: �;� � �= - `;���, � BUILD�R: � ����a . �, -'' �.
Address : (o� 01 i�'.,� ��g. Ac3dress : (�a� 91 '��� ��r-�= �
Tel. Nio. 5�°'�� �S�a� •
No.: ����,��, Street: (�,a„�,
LOT: E BLOCY.: _�_ ADDITION: �st, ��JAA��,�,l��,,� 1�,1�!��a •
COitI�IER LOT: INSIDE LOT: S^TB�4Q:: �' �' SIDEYARGS : ���
Applica'r�t attach 'to this foxm �tuo Certiiicates of Survey of Lot and propose3
building location drawn on these Certificates. .
DESCRIPTYOPd OF BUILDI.NG
To Se Used As:
3
� "��wus" Front: � � o Depth: � � � � Height: . � � '
Square F�et: � � (� G�ibic Feet: i � ' ' �
��f�z �'ront: ��� � Depth: �- � � Height: �
� Square Feet: ' Cubic Feet: �
Type of Construction: �, Estimated Cost: $ fo5 ���,
Zb Be Campleted: �� U, 0�,� �, Alt. A Alt. B
��
Proposed Drivecvay Width If New Opening Is Desired� �_ $� $
. �� RSE S � O SHEET) .
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all cvork in strict accardance with the City of
Fridl�y Ordinances a�id rulings af the Department of Buildings, and hereby
declares that°all thc facts �nd representations stated in this application
are tue and correct. See reverse side far additional information. .
� ,, ..
DATE: � a °�� SIGNATUI2E: � � • �'�°
Stipulations : � ""'°"'"'' � �` ,
Su�3n��T, �e�+FcnlF�r C�c. C.t��..�T7��u
�VItM � T �g��Z
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. BUILDING RER��IIT FEE SCHEDULE _ kr,
��CTION 2. 2he Inspector of }3uildi.ngs shall, before' issu,ing permits for the erection
�f any bvilding or structure, or for any addition to any exi.sting building or structure,
.<or for any alteration or repairs to any existing building or structure, upon application
therefore, require the payment by the applicant for such pera►it of fees to the amount
�erein below set forth and in the manner herein_provided to-wit:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
�LAN CHECK: 25 percent of building permit fee. ,
,DRIVE4JAY DEPRESSION: (Concrete G�rb Streets Only)
• Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$�So75
=:�1lternate B: Removal and replacement of concrete curb and
. gutter and install a 3 foot wide approach with
" 5 inch depth; Driveway width plus 6 feet x$17.85
' 11 i � ► �i ' •1
For the purpose of computing fees for building permits, the cubical contents of any
sbuilding or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or th� cellar to the
.average heights of the upper surface or to the average height of the roof surface
-of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
-of $3.00 per each five hundred dollars-($500.00) or fraction thereof in the co'st
of all proposed work.
Zn -no case shall the fee charged for -any pe.nnit as set forth in 5ection 2 be less
�han $7.50 plus $.50 state surcharge. '
i f • � � I s •
iQOTE: Periaits for construction w311 be issued a m%nimian of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
�onstruction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
iias been constructed will be required before proceeding with the framing.
: ' • ''►
Application far a Certificate of Occupancy shall be made ten (10) days prior to the
�se or occupancy of any structure for which a building gerntit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
�
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_ - LATIONS
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---�� �`'� Guide
C�lindow� �I Daors Referwce ' Out. Wall Iat Ws� Cet1mg Roof Floor Kind
Ye Yes—�io 19
Fl.� Room � t.engcl, L. Widrb l�Eiei�ht � Fl.� Room 1
Wiadows and Daors—Cracl:age and Area
wsach ae�gbc No. or �o�i rc ti� ����� Windows an Doors—Cra
No. of Da,no ot ne Ughta o c k eq, f�, Wldth Helght ,No.
(�'� � - No, oL pane of ane ligt
�= ' � �2� � � �� �
L�.� �
� Infiltration s
Glasa
� F.�p. waq �
� � Net esp, vvalj
I Int. w.aU � -
� � r ��
� ' �
I Total Btu.
Required sq. ft. E.D.R. or sq. ins. W:A. Leader area
i
� �•� Room Len
� I � � �Jidch
I� Win ows and Doors--�rackage and qTea
No. oP � ane Helght No. of Llneal it. p�, �
p oP Aane Ilghta oY craok eq, n,
�- ��,� ��- �� v
� �� � �� ��� �d� ��o
�
I In6ltraqoa °
Giass ��°.�
Esp. wajl m
� Net esp. wall �,
' InG wa11 `�`
I Floo:
� (:eil. �
Total Btu. '''
I
i Required sq. fG E.D.Y�. or aq. ins. W.A. l.eader area
� Fl. Room � Len$th ZsWidth !
' Windows and Doors—.Crackage and Area
w
�
����
No. of Rane felane No. oP L1aea1 ft, �
p Ughts oP etack Area )
f� �I
i �
%.
�� �
I
Infiitration �O�f _ B�u
I Glass
�
! Exg�. wall
I Net ezp, h,a]j �
i Int. wall
Flooe
Ceil. � �
Total Btu. � � -
Ftequire� s:�. fi. E.d?.R GP &Cj. �ns.1ylA. I.ead,.r area
��
��
{� Infiltration
� Class
� .�
. wall
� Net eap, wall
� �►°°�
�.._. Cei7.
BURMAN COMPANY
Insnlation
How
h `alYidth �,�I-deiaht-
;e aad Area _.
Llnaal tL Area �
ot craok eQ: fG ��
e3�� ' �, �
��J +✓"
/�
Coe£ Btu
Tat�il Btn. — � `�
Required sq. �t. E,p.R or sq. ins. W.A. Leader area
Fl.I Room ( I.�n�ch /� Wi�h f' � He;ght �'
th
W"ldows and Doors--�Crackage and A,rea
Wldth Hefg6t No, ot Llneal tG Area
va ot pane ot pe,�e llghts o! crack eq, tt �j
� � � 2�- /� �� � . /-� ��
c� � '�.�'`' o � .:�2 _ f �a � _. �
�
Infil�aatioa
Glass —
E.xp. wall .
Net eup. Hrap
Int. �Vall
F1oor
Ceil.
T'ota'1 Btu,
.r�■
►i��
�
Kequued sq. ft. E.D.R or sq. ins. W.A. I,eader area �� �
,�•� � � Room I Le,�th � Width `a Hei$ht
9V'mdows and Doors—Crackage and Area
Wl�eh Helght Na ot Llaea! tL prea
Na of yane of,pane Ng te �-
� � of crack eQ. YG � �
' �7m � �r.
. ���
Inhltration Coef. ��
Glass �° � � � ��
�
�cp. wall `°�� 5 /� �
Net esp. �yap
In� wa11 P � � / %
Floor
�� _
t:e;�: �
Totnl �t�. �
Requirecl sq. ft. E.D.R., or �p) —
sq. IiIS. „Y,A, �'A�PA ��,a.,
_ `
HEA'i ,�SSS CALCULATIOIVS BUIiMAN COMPANY
%'��ath��rstrips G� C�trne�on IVO, tasnlation
C�lindowa Doors Reference ' Out. Wall Int WaY Ceilmg Ruof Fkor I�.ind How �tsplied
eY s—No Y�o 19_
Fl.� e �� Room � Len�th Width �� Height � F1.� l�ooffi Length `aX/idth Heia6�
Vd;ndowa aad Doors—Cracba$e and Area Windows and Doors--Crackage and Atea -.
Widtd Helght IQo. 04 Llneal PL 6sea �'� � Wldth Iielght i�io. ot Llneal fL Arau
No. oY pano of pane Iivhte o[ craek sq, fL �v�� No. of pane of pane 11Bhts ot craok sQ: Y4
0 � f� � � 3P � `�
�z.� � �.� � � a-� i,l �� ,�
f. Bta Coef. Btu
Infiltration o � " � � � InGitration
Gl�ss � � 1 � � Glass
�• �"'� �- - F�p. wal!
Net eap. wall � 3� � � Net esp. wall
dnt. wall ��, W�
Floor �� F�oor
Ceii. � - �' �, '
�Total Btu. �� �� Total &u.
Reyvired sq. k. E.D.I�. oa sq. ins. W:A. Leader area Reqvired sq. #t. E.D.R. or sq. ins. W.A. L�ader area
1F7.� lZoom ( Length P�/idth He�ht �,� Room ( Length Width Heighk
Windows and Doors--�rackage and Arsa Windows and Doors—Crackage and Area
Width Height No. ot Llneal !t. Area �4Wth Hefght No. o! Llaeal f4 Area
No. oY pane of pane Itghte oY crack eq. tt No. o! pane ot pane llghte ot crack sq. tt
�.08¢, Btl1 �Cf. Bfll
Wiltration In6ltaation
Glass Glass
Esp. wa11 Esp. wall ' �
Net esp. wall Net esp. wall ;��
IaG wall • Int. svall ' ,
Floo: Floor ,
Ceil. Ceil.
Total Btu. Total �tu.
Required sq. ft. E.D.1'�. or sq. ins. W.A. Leader area Requued sq. fw E.D.�i. or sq. ins. W.A. I.eader area j
Fl. Room � Length Width He'sght �ry.� Room I Length Width [-iei$ht ~,
Windows and Doors—Crackage and Area �N'mdows aml Doars—Crackage and ?►rea
Wl�lth Helqht No. oP Ltneal fL Area Wtdth He16ht Na ot Ltneal tQ Area �1
No. of pane oY paae lighta of crack sQ. ft Nd oE pane ot,Dane I16bte of crack s4. ft �i
�
Coe$. Btn Coef. I3tu
Infiltration Infiltration ',
Glass Glass `
Exp. wall Eap. wall
Net exp. wall Net esp. waD
InG waU In� wall
Floor Floor
�eil. Ceil:
ToEal B:n. Tota,l Btu.
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6431 UNIVERSITY AVENUE PI.E., FEiIDLEY� MINNESOTA 55432
TELEPHONE ( 612)5T1-3450
Febxuary 15, 1980 •
Mr. Alan Clair
6701 AshtAn Avenue N.E.
Fridley, NIN 55432
Re: Final Inspection at 6691 Arthur Street IJ.E.
Dear Mr. Clair:
A final inspection was made on February 14, 1980 of the above address
and the following items were noted which must be completed before the
structure ca.n be finaled out; "
l. Post address on structure before occupancy.
2. Provide verifying survey to City before occupancy.
3. Provide closer on door between garage and basement before occupancy.
4. Install handrail on stairs to basement before occupancy.
5. Rsnder patio door inoperative until deck i s constructed.
6. Provide a hard surface driveway by June 15, 1980.
7. Pmvide sod in the front and side yards by June 15, 1980.
We wi].1 expect the above items to be completed and a reinspection
called for. If you have any questions on these items, please contact
me at 571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
DG C/mh
�
�
.
6230 HWY.65 SUITE 104
FRIDLEY, MN. 55432
City of FMdley
Mr. John Flora
6431 University Ave. N.E.
F'r].dley� Mn• 55�+3�
Dear John Flora.
8ea Detsntion Pond �O91Arthur St.
����
���
��
_ �
Decsmber 12� 1988
Brickrier Builders'� agrees to replace the ski�ming weir that was
destr�yed by the Cities hired contractor and also sod the pQnd.
Both these itsms are not our obli�ation, but we will take care of
both by June 15. 1989•
Our reason for doiag this is to satisfy all interested parties xith
the hopes of bring this project to completion.
Ttte homeoxner ha� stated from the start that he did not want sod�
because of the maintenance, but I assume aft,er the sod is laid the
maintenaace question wi13 be handled directly bet�een the homeoxner
and the city.
Sincerely�
s�. J�
�.= �. .. "�� � ��c��-:� -�'r`i�✓L---
�- v
Brickner Builders'� Inc.
sue�ecT �f"` MIT NO.
City of Fridley `� 2 7 58 4
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
� ; V «'��'' ��� /
� � PROTECTIVE INSPECTION SEC.
' i '
� �'�'1 � CITY HALL FRIDLE� SSA3Z NUMBER REV DATE PAGE OF APPROYEO 8Y
�"'"� � ,�� 612-571-3460 910-F15
9/4/98 / /
JOB ADDRESS
6 A
1 LEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACMEO
DESCR. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
3 CONTRACTOR MAIL ADDRESS Z�P PMONE LICENSE NO.
Westurn Cedar Su 1 7 N H -
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WOHK
O NEW � ADDITION ❑ ALTEFiATION � REPAIR ❑ MOVE ❑ FiEMOVE
8 DESCRIBE WORK
Reroof house and arage (26 S) Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIqED FOF ELECTRICAL, PLUMBIN(i, FIEATINa, TVPE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SC. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 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
1 HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORREC7. ALL PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 222$ ], . 1],
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PR VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATIN(3 CON-
T TIO OR THE PERFO ANCE OF CONSTRUCTION. ]LF. ]rj Fire SC 2.23
� PLAN CHECK FEE TOTAL FEE
, ���- C��4 � 9-y
License SC 5.00 83.09
SIGNATUfiEOFCON7RACT RORAUTNORIZEOAGENT �DATE� . WNEN�PERLY LIOATED THIS IS�UR PEFM17
� � /�
SiGNATURE OF pWNER i�i OWNER BUIIDER� �DATE� BLO iNSP � f�qTE �
NEw
ADDN
ALTER
[]
[l
[l
CITY 4F FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ��� % � ����U� 6�
�
Legal Description: ��,�p�—� � • ,r%
Owner Name & Address:
Contractor:
Address: °�� � /U, �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Effective 1 / 1 /98
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MN LICENSE # Z��� �7id �
Tel. # �yl- � ��
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
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Construction Type�,y�-%�(j�� ��,�d� Estimated Cost: �_�j •! ����
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: , APPLICANT:�s � � � � . f �j �' O�D �%
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
CITY USE ONLY
$ �`' .`� ,�� Fee Schedule on Reverse Side
$ ,� .001 of Permit Valuation (1/lOth%)
$ d , / l $.50/$1,000 Valuation
$ $1000 per SAC Unit '
$ � •�� G� $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 [ ]
$ � �� �
. �.
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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 $500;000
$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 $1(?0 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,Ot?0 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
$1,0(� 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 DEPRES5ION 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 times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction 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 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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THE BEIOW MUST 8E FlLLED IN WHEN REPLACING FUEL BURNiNG APPLWNCES OR THE
APPLlCATION 1MLL BE RETIJRNED
• �, �, • , I � r I _. ; . . . ; , , ._ _ ._, �.0 1 • ► _ � � ' • �
jjV}�@n � IgP,�� an aYietinQ � nce. the undersigned hereby verifies #hat the
ven�ng has been examined and is fres from rust, dete�ioratian, obstructians,
and is securely supported and firestopped wher.e required. Yes {�� No {)
The venting system is plas#icJPVC and meets aif current codes and manufacturer
s�ca�ans including sizing, length, number of elbaws and termination. Yes (� No {)
The undersigned aiso veri#ies that the repiacement unit is a listed assembly
and me�ts the current ccdes and manufadure�`s speafications. This does
indude AGA GAMA Category I Cen�rai Fumace Venting Tables far fan
assisted and natural draft appliances.
�he AYL�^,� �-�rr�h�c�en A�r is sized 8r1d illstalled to rlrleet the Curient Codes
and manufacturer's speafications.
When �quired to o�+�� g ��y � e���^ 9it� �# w�II be s'rzed and installed
to meet the current codes and manufacture�s specfications.
�� �� a r,ew v�r�n: �y ty ��, the undersigned hereby verif�es that
it is�a I�ssted assemb�y and meets the current codes and manufadurer's
specittcations. This does indude AGA�ANW Categary I Central Fumace
Venting Tables for fan assisted and natura! draft appliances.
Is the common vent and veM connectors sized and instailed carrectly after
an appliance has been removed from the common vent and vented
separately as per aarrent codes.
Yes � No ( )
Yes i� No ( )
Yes ( ) No {�
,
- �,'t •-��y�,
Yes �� No { )
�.. ..«� ,.�,�. �<< .����.. -.� :�� �� •���.,. � ..�,:�.�
App�ance#1 T�e ���2���L�- BTU Input �c� ,��� Fan Assisted ar Nat �'�'�
Appl�ance #2 Type ��sc- i�-� r�- BTU Input � �`� ,��� � Fan Assisted or Nat ���
App�ance #3 Type 8TU Input _ Fan Assisted or Nat
Total Appli�nces _�_. Tot�l B#u Input ,��, n�,
, � � � � / inches
Common Vent Type � CNiM L��r� Vent Height l� Diameter
AppGance #1 Vent Connector Heighf,�ft Length d`' ft Diameter � in Type �� �'
Appliance #2 Verrt Connector Height _�ft Length �ft Diameter �in Type �
Appliance #3 Vent Con�ector Height ft Length ft Diameter in Type �
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HEATING CO:
Slgned By:
Date : � � � � � �",�
i
ADDRESS
PIN
LEGAL DESC
PERMTT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57Z-36U4 FAX:
: 6691 ARTHiJR ST NE
: 133024140123
: RICE CREEK SCHOOL ADD
: LOT 9 BLOCK 1
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
571-1287
PERMIT NO.: 2004-00037
DATE ISSUED: Ol/14/2004
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
REPLACE FURNACE (WARM AIR, LENNOX, 70,000)
# A/C UNITS 0 VALUE OF APPL OR WORK
# FURNACES 1 # GAS DRYERS
# GAS RANGES p
APPLICANT
DAVES APPLIANCE HEATING & AIR INC
1601 37 AVE NE
COLUMBIA HEIGHTS, MN 55421
(763)781-6901
OWNER
WESTBY DAVID L
6691 ARTHUR ST NE
FRIDLEY,IVIN 55432
HEATING PERMIT MII�TIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 33673
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construcrion
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 goveming 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
regfitat�rgsc�nstn,}�tion or the performance of construction.
Bldg
�
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
0.00
30.00
0.00
0.00
0.00
0.00
0.50
30.50