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
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��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. ^
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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�
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�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 : � ° ��
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.
(Se� Aevers�=Side For Additioaal Information.) - ��
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/ , 5 �S �-lvu.0 � 9, �-3 �i . °.1� �.'�,c/ ,c�'��-�=�-�
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�-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 $5.00.
V�RIFICATION OF FOUNDATION
�TQT�; Permits for eonatruction will be isaued a ffiini�m of 24 hours facapt th�i
�ime of application, to aii� for proper review of the propoaed structuxe amd
o� the construction eite.
A Cextified Survey of the lot, ahowing the location of the fouadat�,p�� p�i4�� ��
1��i �ieen constzvcted, will be required befo�e proceeding with the f��n�,
CERTIFICATE OF OCCUPANCY
Ap�lication for a Certificate.of Occupaacy ehall be made ten (10) days ��C�,Ax
xc� the use ar occupancy of any structure for which a building pexmiC k�a+� b��R
issued; and said structure ahall not be used or occup�ed until a Certi�i�a��
o� Occupancy has been issued.
P � �
V
560-3450
�ito �Nid�Ce
� �
ANO�KA COUNTY
6431 UNIVERSITY AVENUE NE October 16, 1972 FRIDLEY, MINNESOTA 55421
I, Mel Ford, Vice President of Richard Miller Homes, Inc.,
have read the stipulations as stated on_ 'lding Permit ��11,717
and I understand and agree to the tergis t��ermit.
� �1�� � �'pRD, � Pres ident
�i'i,c�iard ill�r Homes, Inc .
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Th�� �s a rrue and co�.ect representa�ion o! o svrver o� �he bovndo.ies sl the laad above descnbed w�d 4f Me
lo�orion o/ olt bu�ldings, U aey� rhareon, and all vis�ble en:.oashments� ii onr, 4rcm or on �a:d land. Shif seroey h
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Fioor ' � — ' ' Floor � ,. : ... . . : ; ;, _ t- �
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Z'otat �tu. � .
Required sq. ft. E.D.R. ap s�: iacs. W.A. I.eader area
F°1.1 _�..� 3�am ��ecs�tit �'� W�;ach ,e�o 1
.�indows and DQOr�.�-��rac��e and A�rea '
Y
Wtdth Heie�t t3a oL 1.ineal ft. Ares
Na ot D$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 �.'� �,�-.
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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
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Legal De�-.�cription:
r� � r „ � - -
ow�r rr�ne & Aaa�ss:
Contractor: ��ti c C
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�aar�: � 2 � � -- ��
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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.
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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 [ ]
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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.
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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.
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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
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CTfY OF FRIDLEY
SINGLE FAMILY AND �DUPLEXES R-1 AND R-2
Building Peimit Applic�tbion
Effe�tive 5126193
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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
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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`�.��
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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)
$
$
$
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$� � ���
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.
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Cortss�ac�on Addrees:
CiTY �F FRIDLEY �ye �����
$�37 U�tive�sity Ave NE, Ftidley� MN 55+432 (T63� S7Z.16fi4 ��g MsP
�INGLE FANf�.V AA�? DUP�EXE� R-'1 AND R� l��, �7�
BUIl.i7!lVC3 PERMIT APPLfCPt'TtCN �,( �
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c.�� o�a��. ��.3-��� �-�9o�I
O4vne� Name 8 Aadress; �� �
Cona�+ctcr. �tN u�sE # .�/Lo�;i�-�
,�: on ow on�ep s o inneso a nco T,�. ��.��°�����/�%
Oile Aft�c4� ic � ap�ication, a Certifiqta oi Survey of the .
Suit� 114 �,� p�� �o�, � or� n to �.
Eagon, MI��5�
�escw� ap a��v�a�rrr
��emao ae�►: �o�r+� w�am _ r�nt�. �. �.
a�raa►c��: r.� ____— r�m.� w'�t_—.-�---- �. �t
pLGK AR,�A: Ler�qth �� HgtlGround Sq. �.
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Y,. ..: �
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Dfi►ewey Curb Gut V11�dth 1Veeded: � 6 Ft = Ft x$ _
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
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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