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AF - 35382�� City of Fridley, Mirm.. 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT na�: October 10 1972 ��: Richard Miller Homes Bu,�� Same Aaaress 1600 Rice Creek Road N.E. Ad� ��me 633-7464 � ,�.3 7� ��71i� LOCATIOiV OF Bl11LDING No.�6161�S�t�Benjamin Street N.E. partofLot Lot 19 �._._..._ Block 3__.._.._._._ Addition or Sub-Divisian �. R"'�.aa.^a.�..e Ad.�� �� e�� Corner I.ot ___.___._� Inside Lot X Setback 3 5 1 Sideyard �� ��# Elevation ____�.(L7_....3.7 —./��jfd��g�q/7�1��i�n 910 . 37.__Mi,nimum T�„P To� of Footing - DESCRIPTIOM OP BUILbING To be vsed as: 2 0' 2 4' Dw e 11 i n g______ Front ? 2' Depth 2 6' �eight Z �� Sq. ]Et. � Cu. Ft � a.ge _.._..__._ Front 19.�" Depth � Hei�ht —.....}�Q..:� 84. Ft. � Cu. FY. �.�.8-e.s Type of Construction Wo o d F r�,�t�e Est, cost .._. �. � �,.6 q 7 To be Completed �.� �� �-. tlpu ations: Provi e a hard surface driveway. Provide a verifying survey before capping. Storm Sewer escrow of $Z70.1Z payable with water � sewer permit. Provide temporary drainage on Lots 15 thru 19 and Lots 13 thru 11, Block 3, 3riardale, If any drainage pxoblems occur on Lot 19, the City shall be held blameless. WATER LOCATION: 11 feet south of sewex service. 60,8 feet NNE of Manhole SEWER LOCATION: 65.6 feet north of manhole (Inv. 907.63) Temporary drainage to be provided by Noveu In consaderation of the issuance to me o# a permit to � proposed work in accordance with the descriptioa abo� orclinances of the city of Fridley. In consideration of the payment of a fee of ng descri'bed aimve I agree tp do compliance with a�l. provisions a� is hereby granted tv _�h r a M� i e r Home; to construct the building or addition as described above. This permit 3s granted upozt the express condition that the person to whom it is granted and his agents, employees and worl�nea, 3n. all WoYk done in, around and upon said building, or any part thereof, shall conform. ia all respects •to the ordin�nc�s oE I+'ridley, Minnesota. regarding location, construction, altera ' maintenance air and moving of buII ��� city limits and this permit may be revok • any tim upon via tio of th proviaiona oE Tnspeat� DARR L CLARK NOTICE: This �ermif do� aot eover fae eonsfruetion, instaRaHon for wirin�, plumbing, gas heating, �ta►er oe wm4eG Be wre M� r3he�'B�iildieg Inspecta� for aeparaTe permifs fo� theae itetds. ^ ': B• r I �: T � ��� s d� . AP.PLICATION FOR �tESIDENTIAI,, ALTERATIOIV, OR Allll�'TION BUILD�NG P��IT CITY OF FR�AI�EY, MINN�SOTA OWi�R,lS �vAMEs^, � C � BUILDER• �ceG ��i+2%%� /'�%dLo��� �%''�� � � .� � ADD�S& : ADDRESS : �� Op /`�L� �/E�� i2� � � � �.�� - �y�y �to:. � � s��r: ���� ,j �� � N ,,..._�., , L01' C� BLOCK °s J ADDITION Y��I ai�D � L�,_ ,.. ,� �. �, @.. ! / , CORNER LOT: INSIDE LOT:�SETB�ACR: SIDEXJ�RI?s, I@�AII e� Applicaat attach to this foam Ztao Certificatea of Survey of Lot a�d pxo�p��ad building location drawn an these Certificatea. HESCRIPTION OF BUILDING To �e IIsed Ae : �p , �4 ���/� Front: �� Depth: e�� Height: �� � � /b�'�`,.� �� ` _ - ��„ � � Square F�eet: - Cubic Feet: � �'��� � . Front ; Depth • �� Height ; �� �'���� � Square ��t; `�1���_Cubic Feet: O d � � 'lj►pe of Construction: �(�D /`'��"�°� Estimsted Coet: $ c��� ��'� +o�e i�e a mae �a �e Campleted: � �DM7�"� 3 �/ � � � �-�� , ��� ,� w �_` �' ;��� F;�,.,� „. ` The undersigned hereby malces applicativn for a peramit for tl�e .wQ7c1� ���� �pec�f�,ed� agreei�g to do all work in sttict accordaace witi� the C��► �� Fl��d�ey OZdinaacee and rulir�ge of tl�e Department of Buildings, aad '�e��b�' d�c���es that all the facte aad representationa stated in thie app�i�l���,� a7�e tzue aad correct. ��,'I�; ; �'� /� � 7 °� SIGNATIIRE : � ° �� . .^— � �� - . (Se� Aevers�=Side For Additioaal Information.) - �� ��" ,` , - � } , ;� � �� 4�� � -- t` l `' , . � � ,�u���.c9�--G�� __C)a>� ��..eJ�-�� �C� � o-�_ �� R �-P -e /- �J1�5-z,�,� �C-� �-�'v�� . / , 5 �S �-lvu.0 � 9, �-3 �i . °.1� �.'�,c/ ,c�'��-�=�-� � / , � 5 � ' o--c�� �y �Go--� � 9,, ,�G� �-e-� �(.�e_ ��.�.,�� � � �.,e�.,� . �UILDING PER�IIT FEE SCHEDULE $�C�ON 2. The Inspector of Buildings shall, before issui�g pexmit� fox �h� exection of any building or structure, or for any addition �o any existi,n� building or structure, or for any alteration or repairs ta any e�c�sti�ag building ox structure, upon application therefore, require the payme�� b� Gh� �pplicant for such permit o€ fees to the amount herein below set fa7ctia ,ax�d, �m �he manner herein pravided to-wit: TTNI�'ORM BUILDING CODE: 1�pe 1, 2& 4-$2.15 for each one thousand cub�,c fe�t, ox fracCion thereof, in such cubical coatents. �pe 3� 5-�1..$S �9r each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for building permita, the cubical coatents of aay buildi�g or addition, ie determined by multiplying the ground area covered from a point six (6) inches below the floor line of the baseaient or the cellar to the �vera�e heights of the upper surface or to the average� height of the roof surface of the msin gable of a pitched roof. �Qr xepaire or alterations to an existing structure, the fee shall be at tta.e rate of $3.00 per e�ch five hundred dollars ($500.00) or fractioa thereof in the cost of all proposed work. I�, ao ease shall the fee charged for an�.y permit as set forth ia Sect�,aa� 2�� less than $5.00. V�RIFICATION OF FOUNDATION �TQT�; Permits for eonatruction will be isaued a ffiini�m of 24 hours facapt th�i �ime of application, to aii� for proper review of the propoaed structuxe amd o� the construction eite. A Cextified Survey of the lot, ahowing the location of the fouadat�,p�� p�i4�� �� 1��i �ieen constzvcted, will be required befo�e proceeding with the f��n�, CERTIFICATE OF OCCUPANCY Ap�lication for a Certificate.of Occupaacy ehall be made ten (10) days ��C�,Ax xc� the use ar occupancy of any structure for which a building pexmiC k�a+� b��R issued; and said structure ahall not be used or occup�ed until a Certi�i�a�� o� Occupancy has been issued. P � � V 560-3450 �ito �Nid�Ce � � ANO�KA COUNTY 6431 UNIVERSITY AVENUE NE October 16, 1972 FRIDLEY, MINNESOTA 55421 I, Mel Ford, Vice President of Richard Miller Homes, Inc., have read the stipulations as stated on_ 'lding Permit ��11,717 and I understand and agree to the tergis t��ermit. � �1�� � �'pRD, � Pres ident �i'i,c�iard ill�r Homes, Inc . 0 �� a +.� � .'A 'z�,,t� , � .,.. X � ,.�°- � a�.'� �.«; . .. .. _ �,,.,--r- ��-"�`- -<. �"".''' xt ,x5. „h%� e +h � fs` r r t t � t � Z � >+ �i'� ar� q,�.�-. 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O�� _ ci�'° `�' ' ` ,� ui J^ �—� � __ ��� � c a�� oA�E ��i �g 6 0 � s R — — — � NokA C0�1N'TY ��no�� �r'o�nca�ie E ��� �i�'� Eayeni¢r�� Th�� �s a rrue and co�.ect representa�ion o! o svrver o� �he bovndo.ies sl the laad above descnbed w�d 4f Me lo�orion o/ olt bu�ldings, U aey� rhareon, and all vis�ble en:.oashments� ii onr, 4rcm or on �a:d land. Shif seroey h mode onl� in conneclion w��h o mo��gage loan now be�ng placed on the prppsrty and no �1ab�ll�y if asbumed e�cept to the holder o1 such mongoge o� unr other �Me►est acqu�rad by �he reoson o! �ucb martgage. 11 �� ueder►�ood and agroe�1M�monumr�+ Mo•e beea �Ip�ed for the purpose ol estoblishinq lot Hees o� boundorr �orne►s. 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O� G ssgs.� � �- � � � a �.� � ���� � ����. � o ��� � � d� �+i, �b � ��o� na�� ��� � M 0 m ��� � � ��m ���� m �a�� ��� �~ ���m a� ���� �� �y ��� � o � � � � � � � en � � � � 6 � � � � � ! � � r � � � .�. � �- � � � � � � �� s7 � � y � � � ��� m �� �. � � � a � � � � ro �ro ����iii�il����. i �-. � b � � li�'�,tF�, ',,�=�'� F µ �� {� r !� 1 � . �%G8�1�fS1Y1� �indo�va I D�rs es—rio � Yes--Pda R�oss� w�ao� a�a tiVtdth 1 Ne. ot oane � t -�--�-- , . �: , , _ - �. . . � r : ; �, ¢ ,� ` �'; ° � i„� :h / � . , .'.�.'� ,�sr!!v� �I` � ��"d''y1` �.t s.�l � 4. ��,� f ��;'. 4�, �� xl;tl �A? � • ,�� . . ��� �/6"� vrr— "'sd y . �1 �m t '�' �k�:,b'` � .� ' ��� • k - J t S �:,t. 5 'y° '�T� �'r ����.. . . •� _ , f 1 � r, . �°�"�' �II8$Y61CB10A �o. . , , . . > : �AS1614@60A ; � f ;4 A A igeld� Refer�etce �ut. �'!�U Iat. �lal! Ceilin� ` Raof .. ,�loar �iaad `; `$�i�r A��l��� ' f � � p i9� . , ; - ;. �� I�a�th ,r° � l�lidch `�-j' �-9ei�ht ��O✓' ':' F1• .�t� Ro�� I.�n�¢h . C1 :��'Ji�h' �� &�ea�e � � Ciractsage and Area . �iadows � Doors'--Crackage and �a ' � t � � , � Ivo. 01 E.fneal 1t. Area Wldth iielBht No. ot Lla�al 4t_`� .��� ' r c��j lightn ot craek np• t� No. oY Pana ol Dane lf6�te oY seac� . sA: YG : r,y i ,, � � � � J �'� � -�/1 ,� F- � � , � � ' � f . . � y �/ �'y _ � p- i f � C � �fs� r � r ` +' R !' . . ' �� f �..,�..: i t � • f ��, T -, •-, �' : Co�f. Bi�i 't Y'; �a��. �$�t w � �,;i _: � � ,..,'��' Infiltration -� f 4 l�' Infiltration �� �� �BSS . � ` . . � WiOSi , � ���•' ��_ ' ��� Y � � £sp. svall f . � � � �i � Eup. wall ,rt d ' � �'. - � `� :�� ; .� ldet eap. wall � -r'I. t� � �1et esp. wall _ " � ��� , . � `' ,- lnt. walt � Iat. •vall ' " �. � Ceilin� -� f 0 �- Ce�iit�� �'. rf C3 a l;• t . - Fioor ' � — ' ' Floor � ,. : ... . . : ; ;, _ t- � -� Z'otat �tu. � . Required sq. ft. E.D.R. ap s�: iacs. W.A. I.eader area F°1.1 _�..� 3�am ��ecs�tit �'� W�;ach ,e�o 1 .�indows and DQOr�.�-��rac��e and A�rea ' Y Wtdth Heie�t t3a oL 1.ineal ft. Ares Na ot D$ne c f�no ligbta o! erach �q. tG .� / '� � Coef.f �tu In6ltratioa � Gl�ss � Frxx�. wall � ' a Net eap, waD Z-- � I[lt. Wdu CCl�IR�$ . FI--- oo - T'atal Bt��. Requirec sq. k. E.D.R, t�= aq. ins. �lA. Leadee area F1• %' .;t�. -o �•� R�� t.et� i�lidth � �/indows and Daor.t-,�rackaqe and Area —'� R'ldth Hoi�ht ' fda of LSnsal Bt. Aren ,� No. � of Dine '"�f Dsns IlBbt• ot ecac& �p. ft �■ �� Coef. �tu " infiltrati �n '�,.,�-�: i ,�� � Cl�ss . E.ttp. wa 1 j . � Net eag� wali D � J� � Int.'�e►al� � _ Ceiling-,e �°' ' Floor ; Tatal B u. � "`' I�$equire� mq. fG �.D.�. o�aq. ins. �/.A. I�ader_are8 ! � FI. � •P ,:' [dcom `� Lea�tth � � � Width - Eimight �t.G -i . - I'' 'gliac �ws aad l��--�Crack��e and Area . ' Jldth t efghi 1Va ot Llaeal ft. Aeea� �' ' No. c• yaae o. pano IIBIIt• of crack aQ. it �`� _ � � ¢ ,! -� . Coef. B Infiltrat on �''Z� c�ams .�. i � a; - Exp. w: ll , : „ ° 1Vee e� �. watl / '" �:�� Int. ws;l � � Ceiling , � •— ��; �loor , �. �a Total t3tu. ,�'' ��. Required aq. ft. E.D.R. oe sq. ia�. �.A. l�ader arra �k -- . _ __ . �. .,.. � - . . . _ . . , �- � , . .. �` Total �tu. _` „� ' � `� ,, Required sq. it E.D.R. or st�. ins: �.A."L�dee asea :� ` �' F1.1 1` ' R�ffi I L�;n ��-' .°.,�" �th �_:. �id�r I�e t ^; .; . . • Windo s and Doors�-'Cracka�: �ad �ea :: � a: � .'." : a W►dth 8ettht Na ot Ltneal Yt Ap6A F r' No. 04 Dane ot pnne ilghto ' oY crack " o¢. tt. t _ - �� � `�'� r�G� � , % ; � /�,�� ��. —"� - �ff. �a � Infileration . �� 9� - � � Glasa G'' ,�' r . F.�p. wall � °' ��o } x ' Net ezp, wall . � �' �• '': � . Int. WAIi 'r.'= , � CCI�1D$ , ;_ Floor , � - -� ° ,�'.". ?-� Total �tu. , - ''- Requued eq. ft. E.D.R. er sq. iais..�l.A; Le�d�s aYea ;:� �;� ';� �t�j I � Fl.� /.� • :: : : �m I I.et�e�i ' -� :. �idth: c�''� I��i�6t�' ,c �Jindows aad Doora—Crackage sm� �rea ` . 4j `';: r �; ��T Width HetehC Na of I.1naa1 YG Ares ��" No. ot yana o4 pun� Ii�hts of craak OQ: tt. - � t a' ;s. ' . O . n,': Y , 's � . � . . . . � _ - 'p�i , �'A¢¢. ' � ::`_��81 :, � � . Infiltration - ,;�.� �'�-- Glaas � . .,:. � �� ��.; Eap. wall s ; � � . � � : Net exp. waU : - �/� " .��` �: Int, �wall. . ;. . - : _,.._ Ceiling % �d ' " � Floor � f � i `: � 7 Total Btu. ' , , Required aq. ft. �.D.R. op'sq. ins> �I.E1. L�:a�r �s�r�;' r1:�� ,�,x, �„�:�� , l FIc� �!%d�%� Ra�� 1 Lsn� _,� -=�l idth f-"-�. Heighc � a �lindows sa Doors�racka� and �a' ; s �; Wtdth iiel�ht No. ot Lineal tG ` Arca No. o! psne o4 pane Il�hts ot RracM at. tt � ,� � �� -� ,�' o.�- � _�.-� ;r . �� �ry Q-�y , a � �� n �.:.. �' My`i �7�1P y r ✓' e . i �f. ��et ; � ,�. Infiltratioa ���. � ;�� Glass r . Exp. watl �. ` _ � � , Net exp. watl - : � . d Int. waDl • � o ��;, Ceiling . Floor �,� . �_ Total Btw ` � .� � Required sq fe. E D R, or sq iea W.� L.csaPa 8a+ra� ' �:�r .t��- � � .� �'� :J- '.�°! t 3Y�: i cr" - , t � t . - s , �c ��'.i .. . i . .. .. . " ... � .._. .. . •�, � 6 . '.� - '. «�.-_. -tY� �f'""' . '.Yr"� � 4:a�M - ( � Y'i.�N �4: 9' ) 7' H 4�� �'�KfJ •'�.� 1-! 'G. ��— � � �,.�� � 'Sry T� .F` 1 A. 1 AI � ��'N � � � . - ' � �.i .� `� � � ��� ' . . ' _ . ' , _ 4 �.�t _ s !r � ¢ � ��, �� ti' A.S.I . ���` Ia�atiQp. a`�;. � , �F � �Jeatherseri� . Gui� " ' Consttuceion No. ; , •. ; �, «,: �4 in �orrs I3oon Referense Out. �►all lnt. Wall C,eiling Roof ' ,� F7cor Kind , <t ,.-Hom+ A�plied . " :;' � `"; 'es--No I Y— es—�+ 0 19__._ -, . r � F1. - . j,.,., �com Y�en�ch �, ' �/idth ' Heisht ��--� Fl.� '. • . Room l.en�th� �`: ��dtDt` '; , I-i�i�ht . , Windows and Doors—Crackage and Area �indows and Door�--Crac�Ce�e and Pitrea "`- }� a; � �v dtd Helght No. af Llneal !t. Area � Wldth Hel�hi 2da ot • ,Lfaoat !t _ /►tms . � ,� ' �- ;� rm ! No: ot pane of pane tlghta ot crack aQ. it. No. ot pane ot Daa� Agbts o@ cssc2t `- BA• it.' _ .,. ,; � `f� 1 �� �/ ' . . . . � F �!i P� � . A F G � ��� -� � .! �� ��2. . , • , , <;� � v . � �. _ (:oet. Infiltration . ' � `� � Glass S ERp. watl � `� - ,L Net txp. waU' • Int. wall Cp1I1D� �. F�OOi Total Bcn. � Rcquired sq. f� E.D.R. or �. ii►s. �/.A. I.Eaiiea'arca ' �?l.� n} . Rc�m � l.tn�th -�►idth th � �Jindows and I3oo�sack��� and Area Width HetY { Ha oL Lfneat 1L Area Na ot pane ot papo Ilght� ot ernck sq. ft ..� �N 4�- �i' i .me• � .�-`-% Btu Hci�ht / Coef.I Btu [n6ltration �.Z.'? ;lass ,�, / :rp tvall � i � , _ J %t eap. wall n4. aa�� �eili,g �-��! .�8' � Floo ` /'� 7' Yotal Btu. Required sq. #G E.D.4$. ,�g aq. in�, �.A. Leadsr area F1: l � �,' R�s� l.en� _ea �lidth , � �i�/indows aad Doar�racka� aad Area NO. i ot % Btu Inhltaadon 1 ' CaDas: �rp. �11,�"'.�' ° � � S � . rlet esp. wall � / Int. �atl � ' Ceiling /' p Floor � r'� d � � Toea! �tu. ' � .,_Reqtaired mq. �t. E.D.�. o: aq. ia�. �/.A. Lea�er area . �:: -F1. - --- - -- — I��tn j l.�n�da _ --' �/idth - I�eight Windows aed I2o:.prs--Crackmge and Area Widtd Hslsht IVo. o! Lteeal tt. Aeea � No. ot �ane o[ Pane Ug9u ot crack sq. ft Infiltrati�a Glaas Eap. �vall N�e esp. waU Int. deraq Ceiling � loor `fotal Btu. Required sq. � � � � � � 1 1 1 1 �f. - f �� ~;, infiltration ' {� ' � _ � Glas' . . ` �� Eap. wall � �`� � :� Nec e:p. wall � Int. •�aU - : Ce,�ing . � J F16bi ' '' � } TOt81 Betl. �` Required aq. ft. E.D.�. or aq. ina.'�i.�►. L�der°�rea:_" °`` Fl.l laoom I Len�th. _.�idth : I��a� t . . �/indows aad Doora-Crackag� and Mrea - ' - Width FIe ¢ht . No.ot Lfasel Yt. AreB '" �. No. ot Daae ot Dane HBbts o4 crack_ s4. [t ,-: ��', ,� : . �� ' _ _ •,N,• . . �, .. . .. ' ,� - _ �f. @�1 C�. In$ltracion ` :' � Glass _ . . ; _ .:; ,., F�cp. wall _ " € � Net eap. wall � � � �� _ _ � :� Int. wall ' ? � Ceiling � ' -�t � Floor `' � Total Btu. " Requaced aq. ft. E.D.R. or aq. icis. �/.A. L�der are�. '� 'I .�,. � R't1 : �-� . ' Fl.� Roacnll.ength �.:; �/'adti� �-iei�d�t ll�lindowa and D�r�raclta�e atad �rea ' r Wldth Holeht No. ot Lfaeal YG. Area � : cr � Na oY pane of Dmae il�hti ' oY cesek �q. tt ?., �h � ; J _ . _ .. . . 1 �w�,. 3 t Coef : �� ! In6ltration - � � C,laas - _ � . `� I Exp. wall - Net eap. wall �,�;° Int. wall - � _ -_ �x � .s� Cei ing ° , Floor - Total Btu: . � ; : �1 ft. E.D.R. o: aq. iaa. �/.A. l.eader area � � o-� z .,� _ Ih IRequired sq. ft. E.D.R.. or;nq. ie�s �/.A. Lead�� mr�a �_ _ �;. � � ;�.I _ .._.. Rc�m 1 L���- �. �i'�didth _...I�eig4,t �.;:, Windows mnd Doara--Cracka�e-and �4aea : Wtdth Hef�ht No. oi Lineal tt. ..Area �'' No. ot Dana ot Dnna ll�hts ot crack eQ. !G ' . . . � . � �.. '�1 .'� , ; COef. � .r: �ttl �. Infiltracioa Glass - E.�p. wall ` Net exp. wall Int. ee�all Cciling . - , Floor ` 4 'fotal Btu. ° ,'� ��, h3equieed �q. ft._E.O.Et. or sq. ins.. �IA.1��c are�;,• `;� ` k Ii' , _ ` r � 3 °9 i �.'� �,�-. 4�� , r__�;,_ -_ �... � _� � � �-=�.� , . r 00 �o � � a � ..�' p � � � x z ;� � � � � � G! � w 9C 8�. � g C, � .y 'O � p � � ,n ~ 7 �i t�p � wi o °°� � � ,� � � � � � � � ~ � � �e o � � � � °: 5 y � � . "' y ,� � � � �►p- , x . ; ':� �, � ' � 6p • � C . 7' o C! 'C �'e7 u�+ °� v � � � � � � � � o � o. � � � : • a : � � : • y • • 0� � • � . • � C ,0 ; ; � � , °q ' . �s o . • . . . � . . . . � � . . . . � . . . � . • • o � . . . . . . . . ' t . • • • • • • • • • �' � ` ,� o � o . . � : 11 �I DI M k % k k Dt �C � ; g a� 8 � $ '�'' �8 6i $ $ $ �' e1► M � M fn en &► tw �n M � p � � I I `'., F/.'�JI� � °, � `''� 4 "' � � � ��-1 �p �! °�' �� O�'° Q l OC" .. � I d �� � � � l � � � � C � � :� A � � a � A � a a �� � ro �. 0 , � 1 m � D � r � °"+ 1g7 � � m v r fl9 � �,. . i� �� i� � Ib� i � „a � 7 °� a � � �Seo:iea s�w�tu � � r1osErs unuu►�t - YILS wrM O � d �� � 4I S�NK4 �� w� rnwtrs DRINK. �OU►IT. SM1Y0.S. FLOO� DNAINS GTCN i7 d151N5 WASH6� � � � � GAS OPEN�MGS w • s • � � > � � � �❑ s � � r y o C � �. a � � � n � oM •y a � �n b o e»�e c, � A � o' � . ,� g. � � � �� � 1 • � � L1 .. � ��� acLa� ���� » ao � ~ a � ��x�.� .. � � � � � o Q 5��� � M � � rA � � � �� C b � $` �o �� � . ry `, ^J ^ ���~ �� m �� E� ���� ���� ��� ��� � �� M � 3 � �• , x � �� � A b a O � � �� p �i ao �� � � _.. � �\ �G �. � � � �.°b t� ' � � � � � � � � � HOUSE HEATING TEST RECORD ADDRESS ��_��,�.� ¢�.�,��,.,� APT. FLOOR � OCCUPANT �" C�TY SUBURB -�' + OWNER �� �'�,.���,� � � ° � " ' HEAT LOSS DATE HT . INST. GAS C0. METER BADG,E # SOLD BY ` INSTALLED BY -F�=:���a.� Elsetrical Work By � Gas Line By `� �+�' ��,_ TYPE OF HEAT GA FA �HW STEAM SPACE HTR. UNIT HTR. OTHER _ GAS DESIGN CONVERSION MAKE ��`�� �' MAKE OF BURNER Model �' +� � Model Serial Max. BTU Rating INPUT r�+� �'" MAKE OF FURNACE Model CONTROLS THERblOSTA� �� � Heat PIu9 Vent Size -`�� �r _ - - - Valve � � �r���.�.t� KIND OF� LINER � "°" �� �_ SIZE Limit _ !'�t�' + �^�, �►�,,� -�--NONE Drah Hood �`_.*_��.+�t �d�i ��: 9 Limit Setting ��� � Filters � Size � Re,ulato► 4M Fan Setting __ �+`� � �" � �t �' � �+umber Chimney Loeation Insld � Out ide Pilot Type Chimney Construetion �_m✓�.�" ^�`'d c��" Pilot Make ~ Pilot Model Smoke Bomb ,�* �� Pllot Timing �"�� �.a.%�.+t:+��t� W���^9 ' Draft �� � Test Tag � '�� L.W. Cut Off Door Pressuro ��, ,� �,r• .,,.P Lightirtg Inst. Pressuro- ,�s .:� Pereent CO2 Dote Tssted �'" �� '"" Input CFH ����_ pereent OZ �q Company Testing µ�' ' Staek,TemP• ��� �_.Peree�t CO -- �`![/ Name of Tester �. °!� � Form 235 HOUSE HEATING TEST RECORD ADDRESS � p' `� ��i°`�� ,��� �"�, � e � -- APT. FLOOR � _CITY SiJ�Rr6 OCCUPANT . ���z'x.�,� �..,�'� ��`,.���,� r OWNER ,�'--�`� � F HEAT LOSS �` DA�E HTG� INST. GAS C0. METER BADGE �°"`� °� SOLD BY �<��,, ,��:.p•� �' � �r�� � y r� � � �"' —� � �' y INSTALLED BY "� �'=: � �:,f � � �Y- ��`� Eleetrieal Work By �}'� p: Gas Line By �� �'� ,� ��3 TYPE OF HEAT GA FA :�HW STEAM SPACE HTR. UNIT HTR. OTHER �. ��, C�S QESIGAI � CONVERSION MAKE �• �.�° �` r p` �f� ''�' �i :�t�`'�- MAKE OF BURNER Model �e�' ��e� ��- �� ,,, �m�, �, �-,�,�� Model $e�ia� Max. BTLI Rafine ?�, INPUT �`e��$`� �'�� �`' MAKE OF FURNACE _' � Model ��, CONTROLS " THERMOSTAT ,�`;��'��� �� ,,� ,r Heat Plug Venf Size V4 �YQ �rp• d k,-�z.aNf,*i Limft p� � �"".,� Limit Sefting �'�°�'" s Fan Setting ` " Pilot Type "� '=�` Pilot Maka r"��� �°�"� KIND OF LINER �'� ����-��''`t�-�+� SIZE �'� NON�' Drah Hood ��-�� �� Regularor --"� °� z4'?� '�' �° Fi Iters Size ° Number Chimney Loeation Inside F� .;t0utside '��`� � „�'`,:' ,'�"�=' Chimney ConstrueTion � -� Pilot Model °'�"` Smoke Bomb t' Wiring ��r PiloT Timin9 ,�=; i`'-� �°`' ' ,�c;r� g„ Draft u�' �� Test Tag � . L.W. Cut Off Door Pressure Lightirtg Inst. i'`"�'�� ' Pressure � � -�� Percent CO �� � Date Tested d �`� ` � � � � 2 �, �„ . �; Input CFH -� �'` �' Pereent 02 � �-� Company Testing .'��'"` ' >``�� � °u 's" �"� `� Q§ Staek Tamp. � P��r' Pereent CO �� "-}' Namo of Tester — �»`�» •� "-d z Form 235 ' SuBJECT P City of Fridley 2 0 4 3 0 AT THE TOP OF THE TWINS g U I L D I N G P E R M i T r � � RE EIPT NO. � `y ______ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. ��, � Q� � � _ � � /"'1 � CITY HALL fRIDLEY 55432 NUMBER i1EV. OATE PAGE OP APPROVED BV �'""� � ��� 612-571-3450 9t0-F15 6/18/90 / / J08 ADDRESS 6161 BQn]dtttlri Street N.E. t LEGAL �OT NO. BLOCK TRACt OR ADDITION SEE ATTACHED DESCR. ,1,9 3 Briardale Addition SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Ron Bohm 6161 Benjaulin Street N.E. 572-0909 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Day�s Cb,�struction & Remodeling 3242 Sandeen Road, Arden Hi:lls 55112 631-8333 4 ARGHITECTORDESIGNER MAILADORESS ZIP PHONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Interiar Alterations : Add TnTall in ba,sement r enlarge archsaay to dining room 9 CHANGE OF USE FROM TO STIPULATIONS �royide comhustion air to e�:sti.ng.�urnace. Provide smoke alarms on both_leyels. o£ structure. S:ee notations on plan. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION 1 STALLS GAFAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIEO .,S2.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4 QQ.Q 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- STRUCTIO OR THE P ORMANCE OF CONSTRUCTION. $63,QO PLAN CHECK FEE TOTAL FEE $65,00 SIGN EOFCONTRACTORO AUTNORIZEDAGENT IDATE� WHE PROPE LY V A E � IS IS YOUR PERMIT F' -° � . ��lu�/V SiGNATURE OF OWNER�IF OWNER BUILDERi IDATEI BLOG �NSP �ATE � [] ADDN [ ] . AI�TIIt � Construction Addres.s: R-1 AND R-2 Building Permit Application °- � �h ( �Vi1� �� , �� ' Legal De�-.�cription: r� � r „ � - - ow�r rr�ne & Aaa�ss: Contractor: ��ti c C — �-- �aar�: � 2 � � -- �� � Effective 1/1/90 �el. # �"'�� �o F c�� Attach ta this application, a Cextificate of Suzvey of the lot, with the praposed construction drawn on it to scal.e. E� `«C M�M •l+ • I�IJ:•�1•/�+vlJi.�l �1 � � " ' •J�' ' • • - •I .• �7' � ' H ' �J}I• - • • � •I • �i?�I� • 'JJ�• ' • • • • Cy • 1 . • • ' I yl • � -� I� �� ' � l � ti�.] � � 1i �i� 7 � �� 'I>1 J �� - � _ � a �' - .���� _ � �_ �i��'� �� �!' ��r� � �r�ss ���ra'ir��._ � �• .�•����'.r�' ',,�/,`�f►�yr'.'%s!:/;til:',�'4 % .� r. � ' . . _ , r. �> _ � � ..i _, F - - �<. � _ - .� - . - . 3 �_ .. _ - • •. •- • •_ • - • • t � _• • � +r.a� r. �-,, ' � `��. ����'l��l�� � � � • • •; i• - • �: - Proposed Driveway Width If New Openirig Is Desired: Ft. $ $ Width + 6' See Bacac Page �: ��-c� -�� �c�r: �. # � �31 � 3 3� CITY IISE �Y P2rmi.t Fee " $ ,�i w State Surchaz9e $ (� SAC C�arge $ Driveway Fscrow $ Park Fee $ Sewer Main Charge $ Fee Schedul,e on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Abave Fee Determined bY ���1 AgreFment N�ary [ ] Not Nec,essazy [ ] •v. , •/ ` . . � I' / ♦ I �� 1, I �s_ , �i �� . � C�j � . � i � • � � ��� .� .� ��� t �� � G�� :+��• � �1. i�>>Y�4 �i�+- _,�;��i .i i�+a� The Chief Building Official shall, before issuirig permits for the erec�tion of any �,; � ding or stnicture, or for ariy ackiition to ar►y existirig building or structure, or for arYy alteration or repair to any existing buildiag or structure, upon application therefore, require the payment by the ap�licant for such ��++;t of fees to the amount herein belaw set forth and in the manner herein provided to-wit: TOr!'AL VAIiJE $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 �a. $15 (Minitmun Fee is $15 plus surchaYge) $15 for first $500 plus $2 for each a�litional $100 or fraction thereof, to and including $2,000 $45 for first $2,000 plus $9 for each additiorial $1,000 or fraction thereof, to arid including $25,000 $252 for first $25,000 plus $6.50 for each additional $1,000 or fraction thereof, to and including $50,000 $414.50 for first $50,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $100,000 $639.50 for first $100,000 plus $3.50 for each additional $1,000 or fraction thereof, to arid including $500,000 $500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional $1,000 or fraction thereof, to and includirig $1,000,000 $1,000,001 ar�d up $3539.50 for the first $1,000,000 plus $2 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSI�TT ESC[mfi� (Concrete Curb Stxeets On1Y) Alternate "A": Removal and replacement of curb and gutter only - Driv�way width plus 6 feet times $13.50. Alternate "B": Remdval and replacemes�t of curb arid gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. ►'/�� ■� �+: `/ ��, • " �� II u • �) P�ermits for con.struction will be issued a minitmnn of 24 houzs frcnt the time of application to allvw for proper review of the proposed structure ar�d of the construction site. A Cestificate of SuYVey of the lot, shdwirig the location of the foundation or�e it has it has been construct.ed will be required before proceading with the framing. � . � � ��C � `���, �„o°J�' / � � � �� �.��o�� � �. C� .�— S�'�� ��. f �1 e c�, ( !-d �- t � � xc{ r—(�,,� �� � S���f� G �-�� � �� , , , � ( � ( — ' �'-M, { � �J�'� w.j`� ta�l � v ���.�U_�-�,. � r— (�� j�� ����� ��.5� � �' �. _...._ ��06�, � G � ���../ . ,� �.���l� d� �� �� .� � , � sue�ecT 'PERMI City of Fridley 2 2 0 3� AT THE TOP OF THE TWINS g U I L D i N G P E R M I T f � � CEIPT . � �,L ___��_ COMMUNITY DEVELOPMENT DIV. �—I�� r � � PROTECTIVE INSPECTION SEC. �� i = � � r�"1 � CITY HALL FRIDLE� $5432 NUMBER REV. DATE PAGE OF APPROVED BY �----� • •', 612-571-3450 s�aF�5 8/17/93 / / JOB ADDRESS 6161 Ben j amin Street NE t LEGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHED DESCR. 1� 3 Hriaxdale Addi,tion SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ronald Bohm 6161 Henjanlin Street NE 3 CONTRACTOR MAILADDRESS ZIP PHONE UCENSENO. Rich.ard Hastings C�tr, 6331 Ri,verview Terr NE, Fa^idley 55432 574-9966 4051 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Res idential 7 CLASS OF WORK ❑ NEW � ADDITION O ALTERATION �] REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (;23 �quares) 2nd Laye.r 9 CHANGE QF USE FROM TO STIPULATIONS Roc��i�g ca,n be the 2nd la�er but not the 3xd, �nst�.11 adequate ventilatio . Px'ovide �moke detectoxs �,s �e,r UHC 121Q a,djacent ta all �leeping areas and in basem t. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OH 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 HEREIN OR NOT. THE GRANTING OF A PERMIT $�'(70Q $'8� DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEHMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �39.e Q� Fj.� SC y�`�., %O /� -�- PLAN CHECK FEE TOTAL FEE .5�����„�...-� s�h��-e��- _ 3' / i i Li cens e S C$ 5. O Q $ 46 a 55 SIGNATUREOFCONTFACTORORAUT RIZEDAGENT ID TEI WHE ERLY VALIDATED THIS IS YOUR PE-RMIT a- _ � / < SiGNATURE OF OWNERiIF OWNER BUILDER� IDATE� BLOG ��i aTE NEW ADDN ALT'ER Il �� �l CTfY OF FRIDLEY SINGLE FAMILY AND �DUPLEXES R-1 AND R-2 Building Peimit Applic�tbion Effe�tive 5126193 -���/� Conslrttcrion A�: �, / � � ��'�v°7",� �u � �V Legal Description: 4wner Name & Address: _����L p � � �, ,� Tel. # Co�ractor: �� e� � Q D ���«/ �' S' MN LICENSE #;��5/ Address: __G33 t � � c�F,� v �� � � ��tZ Tel. # S? �F - 9�C� Attach to this application, a Ce�tificate of Swvey of the 1�, with the proposed construct�on drawa on it to scale. DESCRIPI`ION OF IIVII�'RO�i� LIVING AREA: Lea�gth Width Heighi GARAGE AREA: Length Width Heaght DECK AREA: � •t � , Width �� ' Sq. F� Sq. Ft. Sq. Ft. Carner Lot [ j Inside Lot �] F� Yd Seiback Side Yard Se�backs Type of Consbruction: (`� ��2 o a� Estimaced eost: � 1°7 ¢7 a ------� Approx. Completion Date: � / .S �� . , {Ca�t on Back) Driveway Curb Cut �Vidt6 N�ded: F�. + b Ft = Ft x$ _$ DATE: �! 7 APPLICANT: � r���.�.Lr� Tel. � S� eC ` 9' I`�.�� �. _M. ' 1 _�L Permit Fee S �� C? C? Fee Schedule on Reverse Side Fire Surcharge $ /� �D .001 of P�mit Valuatiion (1J1�`�) State Surcharge $ . �S $.50/$i3O� Vaivation SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge T4TAL $ $750 psr SAC Unit $ ,�, C G� $5.00 (State Licensed Residential Contractors) $ $ $ � $� � ��� Alt. "A" or Alt. "B" Above Conservation Plan Review $450.QU Fee I�termiaed by Engineering Agreement Necessary [ J Not Ne�essary [] STIPULAT'IONS: � �.� _. BUII,DING PERMIT FE� SCHEDULE The Cluef Building Official shall, before issuing permits for the erection of any building or struchu'e, or for a�► addition to any existing bnilding or structure, or for any alteration or repair to any existing buiiding or st�v�u'e, upon application th�efore, require ttie pay�ent by the applicant for such permit of fees to the amount herein below set forth aad in the manaer herein provided to-wit TOTAL VALUE $1 to $500 � $501 to �$Z,000 $2,001 to $25,000 $25;001 to $50,000 ' $SO,QOl to $100,000 � $10(},001 to $500,000 $SOO,OOi to $1,000,000 $I,OOU,001 and up FEFS $15 (Minimum Fee is $15 plus surchaz'ge) $15 for first $500 plus $2 for each additional $100 or fra:ction thereof, to and including $2,OOU � $45 for first $2,000 plus $9 for �each additional $1;000 or fraction thereof, to and including $25,000 $252 �for first $25,(l00 ples $6.50 for each additional $1;OOQ or fraction thereof, to. aad including $50,000 - $414:50 for first $50,OOU plus $4.50 for �ch additional $1,000 or fiac�ion theareof, tQ .and including $100,000 $639.50 for first $i00,00Q plus $3.50 for each additi.onal $1,(I00 or fiacxion t�eof, to and including �$500,000 $203g.50 for the first $500,0(l0 pins $3 for each additional $1,Q� or fraction thereof, to and iacluding $1,(�0,000 $3539.50 for the fnst $1,OOQ,000 plus $2 for each additional $1,000 or fraction �thereof - DRIVEWAY DEPRESSION ESCROW (Concrete (;�ufi Stre�s Only) Alternate "A" : 8emoval and replacemem of curb and gutter only - Driveway width plus 6 fcet times $13.50. . Alterc►ate "B": Removal and replacement of curb aad gutter and install a 3 foot wide. approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the coastrudion site. A Certificate of Survey of the lot, showing the iocation of the foundation once it has it has been constructed will be required l�fore proceeding with the framing. � � � �g, � � � � �. � a; 0 �. � = m n o � � Q . g " . �; � to n 'Q C.. O � "C7 � � � i�. � `� •c � �' n. � � � rn � n � � m � N 8 -. m � � O a m � � � � ` � � � �- C � � � O m �� m � X � m � � � � � c� �7 ? � z G � � � 0 � � ` N � . �� � �r rn C � f,l: rts m t� � Q � � �� m� � c� � � � �� m �ir � m � � -�1 [A ts tNlt b 0 `� � {l. � � � � � -�C � (� 0 � � g� �� �m �� •�� �� � � �� � a r m m !� c� � .�-� � � A d � � � 0 �W � ; w m Z w 3 �o �. 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O. `$. �, � v c � � � � A m ��o �i � G � tx1 �i � � � m. � � � � � �n es+ 0 0 � � g � � � 0 a r � c � � ^��i N � � �°—�.� . s � � � � � m � � �, �• � o. m a� � o' �• � `� n �'-,��-�•c ��, �3 � o w � o � a��"' �. 3 a m �. � v ��s� m K n 3 � � � Qt ? m � � a ;� n+ " o � � � ��,.•o � � 1 � � � . � � O � O � � Q � a w A 3�. � � � � v c r W a 0 m � � 0 � y � � � N (a, � Crt � � Q $ z A .," � � v c,�D� N '� �D Z z tn m -� n � z � < � � m � � --t O Z � � . _) Z :J >� � a� o� �� O � � �� �� �� 9 0 � m� �r-. r rn z CA � < g � Z � � � 0 � C � � � �� �aoN a�TER .� " tl �� II Cortss�ac�on Addrees: CiTY �F FRIDLEY �ye ����� $�37 U�tive�sity Ave NE, Ftidley� MN 55+432 (T63� S7Z.16fi4 ��g MsP �INGLE FANf�.V AA�? DUP�EXE� R-'1 AND R� l��, �7� BUIl.i7!lVC3 PERMIT APPLfCPt'TtCN �,( � � � e � %� � �/ 1n I f�1.. /°l�l / r,� ' � ! c.�� o�a��. ��.3-��� �-�9o�I O4vne� Name 8 Aadress; �� � Cona�+ctcr. �tN u�sE # .�/Lo�;i�-� ,�: on ow on�ep s o inneso a nco T,�. ��.��°�����/�% Oile Aft�c4� ic � ap�ication, a Certifiqta oi Survey of the . Suit� 114 �,� p�� �o�, � or� n to �. Eagon, MI��5� �escw� ap a��v�a�rrr ��emao ae�►: �o�r+� w�am _ r�nt�. �. �. a�raa►c��: r.� ____— r�m.� w'�t_—.-�---- �. �t pLGK AR,�A: Ler�qth �� HgtlGround Sq. �. . .; -. i6 r � � � �. 1/� /�� ; Y,. ..: � _.� .M� • 1 � � - Dfi►ewey Curb Gut V11�dth 1Veeded: � 6 Ft = Ft x$ _ pp'�,; � APRLICAMT: �Cai� (763) ��504 for P�rmit F� if tmmaiting bt �Pi��� +or Fax to 7�i-57 -: 4ali � f�r r.u�d �u�nb�r. C17'Y t,l�E ONLY - � �� �J' •� : � using ared(t cand and we wiil ,�`� •�s Fee 5chedule on Rever�e Scde Permit Fee � �.001 oi Pom�t V�lua�on (11i0th°lo} F'me� surcharge � � l , S�te Surch�rge $ �.50tS�t,000 Valuatran SAC Charge $ ',� $t2� per S�1C Unit Licer�e Surc��e ��� [��_ �5.00 (Sta�e Lir.ensed Res�ier�iial Cor�tractors� DriVeWajf �'�roW � A�(L "r4fl OC �1it °�" �b�sVB Eroaion Conb'ol $ $450.00 Consetv�tian Pl�n Revie�n+ P�rk Fee S. �ee Detgrmin�cl by �Engir�ering Sewer Main Ch�rg� $ �19reement N�s�ary [� Not Me�ce�tY I l '� "fOYAL � ` � s��v�'�ar�s: n, Building PLUMBING Permit No.: �. �� �� � T Inspections RESIDENTIAL APPLICATIUN Re ��� By: 763-572-3604 CITY OF FRIDLEY va���'�A� � 763-502-4977 FAX EFFECTIVE 2-19-09 DATE ��� � f e; YOUR E-MAIL ADDRESS SI7'E ADDRESS �. '� �— THIS APPLICANT IS: OWNER I�ONTRACTOR PROPERTY NAME: V ��2. �� ; � �� OWNER/ fwnxESS: � � G � ��.�a�,��.`� °� - - c�TY ��i.-����.� sTATF�_�ZIP .� �" �� � � TENANT PHONE: `°I o 3."5 i� _�o �'� n Cl CONTRACTOR NAME: SUBMIT A COPY OF Terry Overacker Plumbing Inc YOUR STATE STATE LICENSE 502 E Ma,in St EXP DATE LICENSE, BOND AND STATE BOND #_ �Ok MN SS3O3 —�P DATE CERTIFICATE OF pDDRESS: a' STATE ZIP INSURANCE pHONE (763)572-8880 PERMIT TYPE � SINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: � NEW �REPLACEMENT DETAILED DESCRIPTION OF WORK _ � ��''���-�.' �-��-�-� FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELO�. MRVIMUM FEE $35.50. BATH SINKILAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (NEED CITY L1C) SWIMMING POOL WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($IS) DISHWASHER LAUNDRY TRAY _[_WATER HEATER ($35) FOR IRRIGATION — WATER METER OTHER : y tw`-'�s r� tie 49 1�,� A ,. i4 tw �r �, S al V i'. ���' �� � r,.:. t h r:., � u i'� �; xxli�i} �,�e4i�:. � rN �� , S'd�� ! �4�y t�'�r �: ��' � uy �.! �,x!. r,'� ry a} � 5� �. A '� � r � 'F i fi i r } � t . e 7{ i: f�+- - S/ ��, Y/i .��3�`i� i• t � ,� .�.,..�, i �1 m"^' � ��� yr q� i� �-� � . II � _� �. l £� k 1 y . { 1�, t f � �4 t � '� { � t � � � � fN�i�� �� i v ':.,� � �� i � r - �Myf ,� 5 7 I „ �W�' �: �TG `�, � us P`� D r� - i "r ; �Y y�w I,.1 I �—"'.�,"„rl ;. M1 i� � .��' ' i r � 1 �! �. �� { I a' Y hl . 1 7q 4C ��h G b �` ?iM 1. � �. iS i h r� 5 7 i d l 1 x'� S ��� 5 y ` t + n�., 4.�. 1 1 Gd t 4� � �Fl7} 4 I �: � ;`' �'^,1�x�" � � ,.» y.¢ ��.; � � H I � x x > e `r ' r �' L'� �� 'n t ��" S e t �1 27,� �. �°„�i r % _ Cy<e �.. z yi �'��. P it �. : �{� i� f I � S _ i 1 . rv � p '. � r✓ E ?� X �, a �r ; � � 7�� ���45s'���� '� '�R hP�`i� '�'"�'' �' � 8 a� I K r ,1 � C f� 3: ,� � ' �a 1 ty, . ` { 4 ^Ak �. x � � �� { z� k��}F �, Yr4j� att � � � � �, L � r : ,w� y�`c,_ st r F x A a i. 1""^'.�^a,,, L y :.y `,h ,��' n 1 j ���.V E,� �t,k � <� �d , 31 t h 4^' e� �"�Fr G�iri i'" �?rf��l �"�'�_ 71 x r�{ .� �'� "(*x �'S's'7`��* r; a �'z yi7,:��.'*�kQ r 4 �`.r b :: ���L"� t �� �� v+� ) � N � ,+ 1 .�. f ,. '' �i a ;��� 7 4y�r r lY .fiy �: �, ldd� t+ � �(c .�t oi� .F + � ;��y+ + �r `eio? �� : tvt �' �v' d � / i. �� � ��'� *�" 'FS+�f�.� x z� �� c ,7 s Y �, k . � a y 7 t r u 1 ! ii . N 1 n. ,t S !� aF� � '�,h �� d � � r �. I(� ?�' r. N i^� , G ���. iay a ry7.,. Pt i� i 9�ty {?,fi ���r�1�'t, vy, ��WI ry,��i�`� �ni �is� ��hl����, .�.-,� ,� � i f ;7 u � ., � .��. � � �_ � � .�. � e � �. i � i r - � v jl [ .,� p �� ��S '� �a e+, � � F u . .�P h - t I� �.- l„ �� � i�,'i d w ;� r y ,, a r �;�.. iw�y i't , y �s'..��-�'} ta� � 4� �6 y�ix'� �.a11 y i iG'-i ::��t} F na,u 1" k �isF, r I, @ � �s �rc 7 rx ? � � f x �'�,i'��� �Y' � �:tfr � t �R�++�'���.�. 4r � � ��� '�a���iW�y �����_ °l �4�x�.1�G��`'�.s�`4�j�sv rj� �r'� ���+�It���rV;�;�{�.�ri `�r'Ua��a��� �' �+ � ,� �t�. .�''k �,�,._.;4 i _- . ��3�'� ��ry "e�Y�: i 'Je `1� ri � sf �gk tkn �.`�•} i f ir ''��,�'k �"�ti �n�'�,��.,,�.�r�^l�r.� k. 5� t i '�'P „ +,v,_ , s- �! ,� sr Y� THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PRQCESSED I hereby apply for a plumbing pernut 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 ttris is not a perrnit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. �` � d SIGNATURE OF APPLICANT Lt-� �'�Q— PRINT NAME �-1 �if L° IC. P� 9\,. �� b+� � DATE Z��� P ' .�'.��� �":: t ��;� r+�"4 � � 4' ;_ ��... .;;� :.k'� l r City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building BUILDING Permit Ivo.: ���.� '� � Inspections RESIDENTIAL APPLICATION xeceived By: �' 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX �e� EFFECTIVE 7-1-2010 DATE �— � YO E-MAIL ADDRESS L�Sp��� p'�/},bp v�al ��S�1�Yi STTE ADDRESS ��! �/i11,! c7T � TE-IIS APPLICANT IS: ❑ OWNER �ONTRACTOR PROPERTY OWNER/ NA1�: J�o,ri/J-� �(�-/rJ TENANr ADDRESS: ,� /��� CITY STATE ZIP PHONE: '%(,� �ja� —O �'!' lJ � CONTRACTOR NpME:� �dJ G��T/� 'T�',���'i � oZ�C SUBIVIIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE LICENSE /� AND CERTIFTCATE OF ADDRESS: �D�O�ff L�/i/�y �J% �/%>g CITY�Of,�_Zy�STA ZIP��� INSURANCE PHONE - �'' 3 FAX ` -�ia� PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCI'ION SIZE C] TWO FAMILY/NEW CONSTRUCTION STORIES PERNIIT TYPE � �DITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN Tll.,E ❑ DECK �SfDING CI OTHIIt ❑ SWIMivIING POOL TYPE OF WORK: � NEW HOME CONSTRUCTION • ❑ ADDTI'ION ANCFJREPAIR � REMODELING DESCRIBE WORK BEING DONE:�S/� �ITi�c.��/1j1/�55 c j�� SIZE OF IMPROVEMENT LENGTH WIDTH HEIGH'I' S FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBNIIT: NUNIDER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROFOSED SIZE: ❑ DETACHED GARAGE 3. List of structival members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, � V�y� �� ADDITIONS. 8c PORCHES SUBMTT: ❑ Aluminum Tnm 1. Site Plan/Sutvey showing the eacisting structures � Other�� �. �ascia and pmposed pro�ec� 2. Two sets of consiruction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS DYes �No LOCATIpN OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPBNINGS-DESCRIBE SIZE OF MANUFACTURE STfCKER ON WINDaW. OPENING CHANGES & TYPE OF WINDOW TO BE IATSTALLED NUMBER OF WINDOWS ALL N'1�'.L�'� AKL+' BASL�'D UN VALUA"1'lUIV, llV(;LUllllV(i "1'HL C:U�'1' Vl+' LABVK A1V U MA"1'L�'liIALJ: JOB VALUATION $ ���� ��-���7 U.B�G FEE SCH�� ��CY TYPE Permit Fee Plan Review Fire Sur�;harge Surcharge License Surcharge SAC Charge Curb Cut Fscrow Erosion Control Park Fee Sewer Main Charge Total Due � S, DD $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valua.tion Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks navable to: Citv of Fridlev Attac THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PRQCESSED I hereby apply for a building permit and I acknowlec}ge that the informarion 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 application for a er 't and wo • is no start without a permit on site; that the work will he in accordance with the approved plan in the case o, wo�l' J,e �+ d approval of plans. SIGNPtTi3RE O� APPLICANT 7 I �i' � PRINf NAME �Q12�%�-Sl�ilil�SG�j DATE JO 'r� /Ii APPROVAL INSPECTOR SIG A"FURE PLEASE NOTE: SEPARA ERMITS ARE REOUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK