AF - 36521City of Fridley, Min.n.. 119 2 0
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: _��mb�_r ?7a 1972
p��; _ Richard �iiller Homes� Builder Same
,Addr�s � 1600,.�tice reek_Road Address ...Same._._ .._ _
LOCATION OF BUILDING
Na 6160 Street -----Briardale.Court__N.E.._...-.-.--------------------------- Part of Lot _._....___..._._.________.
Lot 11 _ Biock .._...__ 3 �__._.._.__.__.__ Addition or Sub-Division ____Briardale Addition.__.__�_�_
Corner Lot .�..—._....�_ Inside Lot _.w_.._�._..__._.__ Setback ____.....3..��..-_-.------_ Sideyard .-----------Ei.'.._�.1Q_'__._._..__�__._.
h�6t'e�(e� Elevatian _.___..�.$_..71......_..._.__..�....._.___ .._.ha'oG,fi,�a(t�Idr�l�eE�,�l�,brl .__....912__._00__Minimum....._.__. _. _._.._
.,.�� Top of Footin�
DESCRIPTION OF BUILDING
To be Used as: 42' 26' 1052'
Dwelling � FSront 40' _�p� 24' Height ....20.�___ Sq. Ft. ..._9.60_!_ �, F�, .25,404 Total
Gax�a�e __._ Front 19. � 8�� Depth ?? � Height ..__1�.� ___.. Sq. Ft. ---.433_!__ �,. F� _4, 3a�'
Type of Canstxuction Wood__Frame_ _^ _ Es� Cost �32i263.;00_..._..,.. To be Completed _.._ June1____1973,._.__
Stipulations: Provide a hard surface driveway. Provide a verifying survey before
capping. Set elevation between 18" and 48" to provide drainage for rear dining room
windows. $322.62 Storm Sewer eacrow needed when water meter is takenyl out.
WATERLOCATION: 9.5' South of Sewer Service
SEWER LOCATION: 107' South Of Manhole (Inv. 908.05)�
In consideration of the issuance to me of a perniit to construct the building described above, I agree to do
'the proposed work in accordance with the desCription above set forth and in compliance with all provisions oE
Ordinances Of the city of Fridley. • ,
!��'�`� �l�
16 1'� St te SLrcharge ,
In consideration of the payment of a fee of $__4Z._QQ__..__.., permit is hereby granted to_._R]._�h��d Mi 1 1 Pr gomes
.___..._._�_..._.._._.._._.___......_.. to construct the building or addition as described above. This permit is granted upon
the eJCpress condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
pYithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
o7rdfnances.
/.✓1/f� ;�������-%_.r Building Inspector
DARREL CT ARK
NOTICE:
This permit doea not cover the construetion, installation for wiring, plumbing, gas heating, sewer or water. Be sun to sN
fhs Building Inspector for separate psrmits for these items.
a
AP���C�TIQN FQ� R�SIDE�T�A�. A�T�N,ATIQN,
q� ApAIT�O� ��ILDING P&RNjIT
��TY OF ��IA��Y, MINN�SOT�
OWN�R' S NAME : BUILDEI� ^��iC �-i/a 12 � M iU,� 2�Oht �
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ADDRESS : .ADp�tES3: Ilo(1C) ��c� �E�K �aQr� F�-tZtOLEY
._..._.___,--_^
�9�,. � i (�0 s��:�,���, �+__��„_c..t-.. C���T
�o�r; l` i $LOCZ�: 3 ����zoH: Br�����
�(�N�R LOT ; �Ni� �AE ZO'� . � k k . ,,,, S $TBACR t '� � � S I DEYARD : C�' (O ` +
��.i�a� ��ac� �� ��,# ���c? Certificatea of SuYVex of Lqt a�d proppeed
�i id,�g �aca t iar� dz�a v� t�ese � ert i f icates .
���CRIPTZON OF BUII,D�NG
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�u; e l � � n� �t= �O ' �,tt� : 24 ` xeight : Z� �
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Squaxe ��+a�;„ , 9l00' Cubi� F�et: I�f�LYJ. � � � � ; :y� L,
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G�-2ACQE �'rca�fi: $�-i Dep�h; 2Z' Height: �Q �
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F,qua��s �'eet; �- Cubic Feett �-
�� of �o�struc�io�� FR.�1 M� Estiaated Cost • $ ,,..��� ~ -; - �.�;- � L;
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�� � �g�.��e�� � �- I - 73
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�ct u�der��igxEed here}�y aiskes a�licativ�t for, a pe�i.t for th� wo�k 'h�rei�n
�pe�i£ied, a$xeein� to do a�l t�o� in stticC accordance with the Ci.ty o�
F�itii� Q�d�,aances aad �uli�� �f t�a Depar4nen� qf Bu��.dinga, �Rd T�e�reby
��.a�+e� � al�. �he+ �'�tcts �d, �e�resentations stated i� Xhis appli,cation
�9 ��11� $md CD�TEC�3 .
�tA,'�� � DAC , Z. � I SZGNATII�� : �-�-�c� /�-d1-Ct��' ,�i
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���8 R+a+�et�ve Bf.d� Fo= Add�t�.onal In�o�atian.)
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1�% �.� � `�' s , ._� �' � v �1v �,:. , . .
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BU��AIN� P�RMIT F�� S�H�DU�E
�����Q� 2, Th� Inepecto� pf $uildings s�a11, befoxe �asuing pennit� for the
e���t�on o� any building ox s�ructure, or for any addition to any e�cistin�
��ildi�,g oz stxucture, or fo� any alteration or repaixs to any ex���ing
���i���n� o� stxucture, upa� appl��ation therefore, require the paym��� by �hs
a��li�a,�it fp� such perm�t o� �ees to the amount herein below set �prth a�d �n
�;ne man�ex hexeir� prrnrided �o�-wi�;
iJNIFORM BUZLDING COAEt Type 1�, 2& 4- $2.I5 �or each ane thous,ar�c� cubic
,fe�t, t�� f�action thexea�, in such cubical con�ents, liype 3& 5-$�.85 �ox
t�ach ons thousand �ub3.c �ee�.
A�D � "I' IO�1AL � AiFi��MAT I0N
Fo� �ht� purpAre of �amputing �ees for building permits, the cubical contents
of any building or addition, is det�rmi�ed by mul�Ciply�.ng the �round area
�QV+a�� #9�om a poi�t� six (4) in�hes below the f loor line of the basement
t� t.�e ���lar �o the average heights of the upper surface or to the average�
��.�t c�� �e �oo� s►uface of the main gable of a piCched xoof,
��ir� ox alt$�a�ions t� aa existin� sCr�tu�e, the f�e shal� be aC the
��.�� o� $3.Ufl �e� e�,r�h five h�,Adxed dollax� ($�OO,Q4) �r fra�tion thex�of in
�� co�� a� all �►�c�pc�sed wo�'k*
�� cap�e sha�l ��e �ee ��d fo�c at�Y Pe�it as set io�r�li i.n Seat�,on 2 be
�� t3�an $5 . A4.
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V�R����ATiQN oF ��i1NUAi'ION
D1Q`�.i Ps7rmits for ���xu�t�.on will be �.$sued a t��n#.mu� oi' Z4 hours fxoea the
��Ae o# applicatia�, �o al�ow �ox prapez review of �1�e pxoposad s�ru�ture �d
�� �e �struGtion &i�e,
' 1� C�����i�� Sur�'ey of fiha lu�� �a�ting ti� �,ocatia�, of �h� �oundaticnt, o�c� ifi
�� i�� ��s���rd�, wiil b� �cequired be€ore proceedinp with �h� fr�ipg,
C�R'I'TF��A'�� QF Q��i�PANCY
A�p�i����.o� �or a Cex�i.�3.�a�e a� pccupancy shal� bs mads Gea (i4) days pxior
�o �h� �se ax ac�upa�y cs� any �t�ctare �ar whi�h a bui.l,d�.ng pexeai.� has been
issued; sutd said s�xu�kttxe �hal� �ot be used a� occup3ed until a�extificate
af O�GUpaz�cy ha� beet� �.sstsed,
�
lond Pinnn�ny C����((I/•'f jt •�7S NiQhway Ne.65N.:.
lor�d Syrv�rinQ � � � MinnROpolif �
So�iti Te►��no l' �t �J`������%%( ��r %1i�• M�nn. 33�31
C�vil ing�neer�ng
� � ?�I�phons 7�1-00�0
µun,c�pal Enq�nrr+ing Engineers 8t. SUiV8Y0I�� ��ru CpC�f 612
,f �,� �. �/ .
Certificate of Survey for�S"��,ti-�Kv �V!��-4 �^�' �`_'�`'��-°T _
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1 i��.�br c�.r+fr �ho� �1��► it e 1�u• owd co►r�af r�p���sn�ation •f o��rver Oi fh� bounder+�s ef t1�� o`e�•
d��cribed la�d� owd e} /Y�• loca�ie� •I ��� br�ldin �, rht.�qn, e�d oll vi�ibl� ♦�c�oackiw���1, i� �wy, ���rw w M
foid land �s turv���d by m• fki�_ day o1�/ �� •r. �! � A D. 10:'1. ' �
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SU�URtAN ENGINEERING, INC.
En�in���i S�►v�yort
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560-3450
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I'I 6431 UNIVERSITY AVENUE NE
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TO WHOM IT�MAY CONCERN:
ANQKA COUNTY
Decemberx`y, I972 FRIDLEY, MINNESOTA 55421
Whereas thg City qf Fridley has issued a building permit to construct a
�
structure at (�/��C 2��-�''C�l���� ��-t���-C=�._�:
Whereas the permit is dated prior to January 1, 1973 and tfie City or
Fridley did not collect or receive any "Service Availability Charge".
Therefore if for any reason the Metropolitan Council and or the rletropo?itan
Sewer Board assess or bill the City of Fridley a Servic� Avai'ability Charo2 for
this structure or sewer hook up, we the undersi�ned agree to and �oill pay the
City of Fridley for said charges.
���
Witness
T tle
0
' �
�ity of Fridley �
APP�icdion i�or Plwnbieq and Gas Fi�ii�r� ���t�it
TJapt. of Bldqs. P'hon� S�0•3490,
DE$CRIPTION OF WOR1C L����/�� %� d/� D� %�jt CG D,��
iiumber, Kind and Locatfon of Fixlures ���� ��r
N
W� z M y� � �
� Y F Z3( Y � li af
� !; j S� i N ;� O�
Base � � � %
lat
2nd
3rd
4th
• Fu�u� Conn�clioa Op�ninps
* N�w Fixtur�, Old Op�nin�s
� I�< I� Z I O � I 7 I�� I7 (�'� I . I N I G CTEN MTEC.
2
►t F? g
� ir O �y �< 3 U' l! C(J U
5....s o
��� n
PARTIAL RAT� SCHEDULE
PtQMBING FIXTURE RATE3: NO. RATE TOTAL
Number Fixtures . . . . . . . . . . . . . . . . `? x a2.00 a �C' �� �
F�ture Fixture Opening . . . . . . . . . . . x a1.50 �__.
New Fixture Old Opening . . . . . . . . . .
Catch Basin . . . . . . . . . . . . . . . . . . . .
Water Heater 'Up to 99,000 BTU). ...
New Ground Run Old Bldg. . . . . . . . .
Electric V{lat�r H�at�r . . . . . . . . . . . . . .
:.AS FITTING FEEB:
1st3Fixtures ••..•.••..••••••..
Additioaal Fi�ctures .. . . . . ... .. . . .
Gas Ran�e to 199.000 BTU . . .... . . . . ..
REPAIRS tr ALTERATION6—R�f�r to Cod�
_ X a1.5o a�_ _
x a3.25 a
� x 53.00 ; � . O ��
x 53.25 $
= az.00 s
NO. RATE TOTAL
� x 52.00 ; °7 L� �
x=.7b ;
x a5.0� i
Descriptlon ...................... . .. .............i
. TOTAL FEE ; °Z 3 S �
City o1 P�idley:
The undersigned hereby makes appllcation tor a permit for the asork herei
specified, agreeing to do all work in strict accordance with the Cit, Qtdinance
and ruling of the Department of Buildinga, and hereby declares that ali the tact
and representations stated ln this appllcation are true and correct
.
PYidley, Mian � �PRi �. s` _,,, 19 ��
Owner ����/��� � / f� � �;/1
Kind of Building �����
Used � �cte ,�
To be completed about �� /
Estimated Cost, � � �d0 � .
9�11l�—New. Bui:ding Permit No. Permit No. ���
Signed e��i �M�� Y ��
By � p�iAl`
Bwiness Phune No. �
ROUGH
�N�►�. 3 - /s -- � y
.
.
Application tor Power PtaM�s and HeaHng. Cooling, Yentilation� Rs��iqt�afion and
Air Cond[tioning S�st�ms and De�ric�s
PARTIAL RATE SCHEDULE
fa!lA11T'!'Y WARM AIR: !�►'�. TOTAI.
F1�mace ShelI dc Duct Work . . . . . . . . . . . . . . . .. . . . . . . . . . . $10.00 �
- Replacement oi F�rnaee ............................. 6.00 i
Repairs & Alterations—up to a500.00 . . . . . . . . . . . . . . 6.0p � ---
Repairs dc Alterations each add. �500.00 . . . . . . . . . . . . . . . 3.00 �
�cx. w�s nrn
F�rnace Shell da Duct Work to 190�000 BTU . . . . . . . . . . . . a10.00 ¢ 10 • 00
each add 80�000 BTU .................... ... 3.W i
Replacement oi �i�rnace ............................. 6.00 ;
Repairs & Alterations—vp to #500.00 . . . . . . . . . . . . . . . . . B.00 s
Repairs & Alterations each add. ;500.00 . . . . . . . . . . . . . . 3.00 ;
STE11M or HOT WJITER SYSTEM
Ftiarnace She�l & I.ines—to 400 sq., ft. EDR Steam .. $1Q.Q0 a
Flirnace Shell & Linc�to 640 sq. ft. EDR Hot Water 10.00 a
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . 3.0(1 �__
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . 3.00 E
� OIL SIIRNER—to 3 gal, per hour ... ... 6.0� �
`��i.� over 3 gal. per hour—See Fee Schedule
GAS BIIRNER (up to 199.000 BTL� . . . . . . . . . . . . . . . . . . . . . . . b.04 ; .'S 00
over 199,000 BTf) See Fe� Seh�dul�
GAS FI'PTING FEEB: PO RATE TOTAL
1st 3 FSxtures . . . . . . . . . . . . . . . . . . . � xi Z00 ; 2.00
Additioaal Fiatures ......... ........ z .76 ;
Gas Range to 199.00Q ........ z= 6.0� i
�un co�nrrzornta
F1►N HEATING SYSTElt
VENTILATIltG SYSTEIi[
ALTERATIOIQB � AEPAIRS
ROU(3H
i'INAL c� � �d � � 7`
Dept. of Bldys. Pkon� 5�0-3430
L�,�� 6160 Briardale
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City oi F�idley:
The undersigned hereby makes appllcation ior a permit for the work hereir.
specified, agreeing to do all work in strict accordance with the City Ordinance:
and ruling of the Department of BuiIdings, and hereby declares that aIl the facts
and representations stated in this application are true and correct.
P`ridley, Minn_ 4/6/73 , lg _
Owner Rie�.� Miller Homes
Kind �f Building frame
vsea as _ _ residential
To be completed about 4/30/73.
Estimated Cost, a 1� 020.00
Old—New. Building Permit No. Permit No. '� ���
DffiCRIP'i'ION OF WORg
HEATING or FOWER PI.ANT��Steam, iiot Water, Warm Air—No_ 1
Trade Ivame �STINGHOUSE Size No�UB'137
Capacity 110 � 000 gq, �, E,D,g gTU g,p.
Tota1 connected Loaa Kind oi lUe� Ga s
BURNER — Trade Name SAME AS A.BOVE �u No
Capadty Sq. !'k E.D.ii BTU H,p
� HEAT LOSS ATTACHED. SA7rESMA.Ns John Borry
SN � FN SelNdul�
� .5o suxCxGE /� ,;�
� � roru. Fae � 17. 50 si �C�,z- � � a �:��2 �
BYY
Business Phone���ie►�. ,- --
1IEATING b AIR CONDITION�NG
±$60 Got1w� Av�. ' 929•5757
(REMARKS—OYE�) � %oai� Pnk, Minoasuta 5543b
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��'C LOSS CALCUt.AT10NS �
� Weatherstrips A.S.H.V.E. Construction No. Insulation �
�_ Guide
`Xlindows I Doors Reference Out. Wall Int. Wall C,eiling Roof F7oor Kind How Applied
� es—No Y�s—No 19_
� FL��-'�._ -? � '; Room Length ; i' Width ,'� Height ; FI.� : - -�,r.., Room Length // Width /�� . Height ,
� Windows and Doors—Crackage and Area Windows a�d Doors—Crackage and Area
� �Vidth HetgAC ho. ot Llneal ft. Area Wldth He18ht No. ot Llneal [t. Are�
-1 `o, ot pane of Dgne lighta ot crack ap. ft. No. of pane ot Dane Ilgh[s of crack �Q. [t.
4j , _ f . -
� --- _
, - , _
Coef. Btu
Inhltration - - �
Glass - - ,
Exp. wall ' ,
" �--
Net exp, wall �� � ��! � ° ' '
Int. wall
Cei�ing / , , ,_._. ..,
Fl�or
To.al Btu. -
Re auired sq. ft. E.D.R. or sq. ins. W.A. L,ead�r area
? f l.; .:;..., ' Room � Length l� Width /_� Neight ;� -
� �indows and Doors—Crackage and Area
K'Idth He1QAt No. of Lfneal [t. wrea
No. o[ pane of pane I1ght• of crsck eq. 1t.
' . . . � -.. � . . .
! Coef.
InSltration � �
Gi �sa
E;�.�•�all"-'
N� c e: p. wall _j ,--
Int. wall
Ceiling _,� , - �
Floor
Total Btu.
Req+�ired sq. ft. E.D.R. or sq. ine. W.A. Lcader area
�FI. /,�;- -� Room �Length Width
V�'indows and Doors—Crackage and Area
F'tdth Helght No. ot Llneal ft. prea
No. of ptne ot Ddne Ilsht■ ot crack ep. tt.
COGf.
lnfiltration '
�08!
Exp. wall . ' �
Net exp. wall "
Int. wall
Cei�ing � ,; �"
Floor
Total Btu.
Required sq. fc. E.D.R. or aq. ins. W.A. L.eader areA
.' FI. Room { Length � W'idth
Windows and Doors—Cracicage and Area
F"Idth Helght No. ot Llneal [t. Area
No. of pane of Dane Ilght• ot crack sa. tt.
� - „ � . __ . � . .
COGf
In5ltration
Glass '
Eup. wall " ;
Net e:p. wall �
Int. wall
Ceiling _ .
F loor
Total Btu.
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
Btu
- . ,
.. �
..� -
eiszht
Bcu
'> :
�
E-icight
�
�
�
� Coef. Btu
Infiltration �
Glass
Exp. wall ;' . ' • ,'=� j
Net exp. wall % � �
Int. •rall
Ce,�ing
Floor _ -�"
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI.I -�; Room I Length �,� Width -'
Windows and Doors—Crackage and Area
R'fdth Helght No. oL Llneal tL Aree
I! h f 4 it
���
` ,• . .
No. o[ Dane of Dane g[s o crnc. �Q. .
" . . / _ - I � ', % '"��
�'�!` �.....
, `f �l:,
lnfiltration � �
Glass � �;
E�cp. wall - .' ;� '.
Net exp. wall ' i
Int. wall
Ceiling -r ,
Floor - -�
Total Btu.
Required aq. ft. E.D.R. or sq. iris. W.A. Leader area
/' F7.� /->. - Room I Length � � Width '�' '
Windows and Doors—Cracicage and Area �
W'(dth Hetght No. ot Llneal tt. Area
No. of pane o[ Done Ilghte ot crack �Q. tt.
'. � .. . � � . . .. % �r
Coef
' Infiltration
GIBSS ,f�� �
Exp. wall �
Net exp. wall � - �,;' ��
Int. wall
Cei�ing
Floor ^ � �J
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.,4. L,eader arra
Fl.� `' F�oom { Length ------ Widt6 ._'_
Windows and Doors—Crackage and Area
Wldth Helght No. o[ L1nea1 t4 Area
No. ot Dane ot pana Ilghts of crack �p. tt.
t' .
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.--
Net exp. wall �'�' ;�,
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Total Btu.
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A.S.H.V.E.
, Weatherstrips Conatruction No.
Guide
' rVindows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind
'r::r:
�, Yes—No I Yes—No 19_ _
�;= E'I.( .;•;' ., Room Length �Vidth
j Windows and Doors—Crackage and Area
\Pldth Helghc No. ot Llneal tt. Area
�� No. o[ pane o! D%�e ilghta of crack np. tt.
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Net exp. wall
Int, wall
Cei�ing
, Floor � �' �
Total Btu.
' Required sq. ft. E.D.R. or sq. ins. W.A. L.eader area
€<
Fl.� :�,,i�_1 Room � Lcngth , Width j
Windows and Doors—Crackage and Area
�' Wldth HetQht No. ot Lineal it. Area
'�+ No. of pane o( DBne light� ot crncK sp. Lt.
�'a .
� COOE.
Inbltration - "
Glasa
E�p. wali � . �
I�et exp. wali - ""�
jnt. wall
C eiling , .
F loor
T otal Btu.
� equired sq. ft. E.D.R. or aq. ins. W.A. Lead�r area
,: Fl.�.' : Room �Lengt:ti � Width ; =
T iL'indows and Doors�racl�aE;t and Arca
R'Idth He1Bht �No. of Llneal It. Area
• N �. of pane o( Dnne Ilghls ot crack sa. (t.
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'r �=
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C ling - � �
F ,or
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• T tal Btu.
F equired sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI. �(oom � �.ength -- Width
�' Windows and Dootr—Cracicage and Area
Wfdth Helght No. at Llneal [t. Area
?���� N o. o[ Dane of Dane Ilghts o[ crack sq. Lt.
? !. _
COtf
� Infiltration
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; A et exp. wall
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Btu
Insulation
How
Fl.� Room � l.ength Width
Windows and Doors—Crackage and Area
Wldth Hefght No. o! Lineal ft. Area
No. of Dane oC Dane � IlBhts ot r.rack ea. tt.
.
Coef.
1n61tration
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Net exp. wall
Int. • �all
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Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI.I Room I Length Width
Windows and Doors—Crackage and Area
�V4'ldth Hetght No. ot Lineal ft. Area
No. ot Dane ot Dane light• ot crack sa. [t.
Infiltration
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Exp. wall
Net exp. wall
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Cei�ing
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. iris. W.A. L.eader area
Fl.� Room I Length Width
Windows and Doors—Crackage and Area
Tvo. ot Dar e ot pnne Ilghte ot crack Qr tt.
Coef
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Net exp. wall .
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Total Btu.
Required sq. ft. E.D.R. or sq. ins. WA. L.eader ana
�.I rioom 1 t.enge� - -- --��:�i�
Windows and Doors—Crackage and Area
�Wldth Helght No. ot Ltneal ft. Area
No. of Dane ot pane Ilghte of crack �p. tt.
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Btu
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HOUSE HEATING TEST RECORD
ADDRESS L f'�" APT. FLOOR CITY �SUBURB
OCCUPANT OWNER �
HEAT LO55 DATE HTG. INST. GAS C0. METER BADGE #. ., �.
SOLD BY -� �' � INSTALLED BY r� ' �s'" ' ,� �
Electrical Work By Gas Line By �
TYPE OF HEAT GA FA %�`w HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE ��F'b'f�'=� � MAKE OF BURNER
Model �`" = �:. � Model
Ssrial Max. BTU Rating
INPUT �� -% f`f�`' . MAKE OF FURNACE
Model
CONTROLS
THERMOSTAT f'' �',� Heat Plug Vent Size
Valve �-;` ' KIND OF LINER $IZE y NONE
Limit '`' ' �' `'�-� " �' Drah Hood Regulator �-'�
Limit Setting Filters Size Number
Fan Setting '' ! Chimney Location Inside +�� Outside
Pilot Type �i�" Chimney Construction
Pilot Make �'�'�'''
Pilot Model - Smoke Bomb �f � Wiring
Pilot Timing ?�-'�r ` Draft Test Tag
L.W. Cut Off Door Prossure Lighting Inst.
Pressure Percent COZ Date Tested
Input CFH ' Percent OZ - Company Testing%
Stoek Temp. Percent CO �-'' Name of Tester
Form 235
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April 28, 1975
Mr. Richard Miller
Richa�^d Miller Homes
1600 Rice Creek Road
Fridley, MN 55432
Re: Drainage Problem at 6160 Briardale
Dear Mr. Miller:
Court C
Mr. and Mrs. John Kapotas, 6160 Briardale Court, notified our
Engineering Department of a drainage problem they are encountering
in their back yard. Upon investigation, it appears there is
an existing low point along their north property line where a
significant volume of water is ponding.
After reviewing the plat and drainage plan submitted to and
approved by the City, it indicates that the lots as situated
between Benjamin Street and Briardale Court have a rear yard
drainage pattern directing the flow of water to a common 10 foot
drainage easement along the rear lot lines. Any alteration of
the drainage flow as approved by the City is not acceptable wzth-
out prior reviewal and stated approval by the City.
Would you please inform us if an alternate drainage plan was
followed, or how the existing plan was altered to create this
problem? I urge that close supervision be maintained on the
remaining lots to be landscaped to ensure that the proper drainage
pattern is adhered to so that similar problems are not encountered
in the future.
If you have any questions, please contact me.
Yours very truly,
i�_
Thomas A. Colbert
Assistant City Engineer
TAC/ jm
CC: Mr. & Mrs. John Kapotas
6160 ariardale Court
Fridley, MN 55432
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June 13, I975
l-1r . P.ichard �Iiller
F.zchard Mi.11er Homes
1600 Rice Creek Road
Fridley, P�iinn, 55432
���°
-� � �� � ���
��n
��
P.E: Drainage Problem on West Side of Briardale Court
Dear Mr. Miller,
On April 28, 1975 a letter was sent to your attention
referring to a drainage problem being encountered at 6160
Briardale Court. I am of the understanding that a permanent
solution to the problem is currently being resolved. As
I mentioned in my previous letter, if any alteration to the
original drainage plan is being contemplated, the Engiueering
Department should be informed and the proposed alteration
submitted for our reviewal as additianal drainage easements
may be required for any possible future maintenance the
City may be required to perform.
Your cooperation with
this problem is requested
oreatly appreciated.
TAC/as
the City in the resolution to
and a prompt response would be
Sincerely,
� T
� �
THOMAS A. COLBERT
Assistant i,ity Engineer
f � �' _ . _.e,:. , .. . �; �xd
sua�ECr RMIT NO.
City of Fridley ° 14928
AT THE TOP OF THE TWINS g U I L D I N G P E R M T
r
� � ECEIPT NO
� �L __�__ COMMUNITY DEVELOPMENT DIV.
r � � PFOTECTIVE INSPECTION SEC. Q��,�
1 � ; <
, ' /'�-1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�•"'� � ,�� 612-560-3450
910-F15 9/19/78 � �
JOB ADDRESS 6160 Briardale Court N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1]_ 3 Briardale SHEET
2 PROPERTY OWNER MAII ADDRESS ZIP PHONE
John Kapotas 6160 Briardale Court N.E. 571-8362
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Re siden tial
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
%
8 DESCRIBE WORK
Install orch, patio & Deck
9 CHANGE QF USE FROM TO
STIPULATIONS
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYIOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTFUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4�000 y�2.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 24.00
PLAN CHECKFEE TOTALFEE
$26.00
SIGNATUREOFCONTRACTO ORAUTHORIZEDAGENT IDATEI WHEN PROPER VALIDATED THIS IS YOUR PERMIT
, � 9��1�� - , �-�9-��
iGNATURE OF OWN Uf O ER BUILDERi IDATEI BIDG iNSP DATE
0
CzTY oi� r-izz»�cY .
�rr�icnTror� f-OR (Zf�SII)f-t�TI/1L BUILDI(�!G nCR(�IITS
, (��LW, �LTLR�TIU(dS, �nllITIO(JS, OfZ REP/11fZS)
Oh'I2�R: r, ri-� �:Qn01 �.� 1�
�aar�s�: f���,� ��ardo�j,� �i
� �' ����
I3UILllr12: � yc►�f,�A.Y' �. � � 1�� r�
naar���a :
Tel. No.: __ '
g - � .
No. : , i 5treet: �)lC� )C�C� L-L. ���-��_?__� �_ � .
7.OT • i� -- --- BLOCY.: �_ I�DDITIOP] : r iQ �r d 0.� E'
COi21QL•'R L07': I2ISIDE IIJT: Sc.TJ311CY.: SID�YI�RDS:
Applicar�t. attach 'to i:his form Z�ao Certif-icates of Survey of- Lot and proposed
building location drawn on these Certificates. �
DESCRI PTIOhJ OF BUI LDI I�G
To 33e Used J�s:
Front: Depth: ' Height:
Sqt�are Feet: Cubic Feet:
I'ront: � Depth: Height:
� 5quare I'eet: �Zbic Feet: �
Type of Construction : � QrQ.LL ,,�Q lio$ � QQ- � Estiznated Cost: $���
7.b Be Complei:ed: Alt. A Alt. B
Proposed Driveway j9idt� If 11ew Opening Is Desired $ $
(S�r 12�17�RSE SIDE OF 5HEET)
The undersigned hereby makes application for a pe�mit for the work herein
speci�zed, agreeing to do all �.ork in strict accordance with the City of
Fxidley Ordinances and rulisigs of the Department oi fiuildinqs, at�d hereby
dec�ares Lhat all tlie facts a»d representations stated i�i i:}iis applicat:ian
are Lrue and correct. See revcrse side ior aQditional inforniation.
D11T�: SIGNATUP�E: �ZC.LO °
Stipulations:
�� � n�
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BUILDI�JG PER��11T FEt SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection
oi any building or structure, or for any addition to any existing building or structure,
or for any alteration or repairs to any existing building or structure, upon application
therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.OU/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$14.50
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway.width plus 6 feet x$17.20
�11 � : ► �' : •1
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or the cellar to the
average heights of the upper surface or to the average height of the roaf 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 cost
of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
VERIFICATIO� OF FOUNDATION
NOTE: Permits �or 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 ance it
has been constructed will be required before proceeding with the framing.
► ; � � ':l
Application for a Certificate of Occupancy shall be made ten .(10) days prior to the
use or occupancy of any structure for which a buildi.ng peYmit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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sue�ecr P-ER'MIT NO. � ��
c�ty of Fridley 27 �30
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T __ __.__..._
� � RECEIPT NO. '
� �
� • COMMUNITY DEVELOPMENT DIV. T
' j L- � F
r � � PROTECTIVE INSPECTION SEC. '� ��`
i �
�
i-__• A;�"';-� CITY HALL FRIDLE� 55432 NuMBER AEV O�7E v�GE OF nPVROVEO Br
1 '� 612-571-3450 9t0-Ft5 � �
9298
JOB ADDRESS
6160 Briardale Court NE
t LEGAL �OT NO. BIOCK TRACT OF AODITION SEE ATTACHED
DESCR. 11 3 Briardale Addition SNEET
2 PfiOPEfiTY OWNER MAIL ADORESS 21P PHONE
Mr. & Mrs. Ka otas 571-8362
3 CONTRACTOF MAIL ADDRESS Z�P PHONE UCENSE NO.
Heiderscheid Bros Const. 716 198th Ave E E —
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
5 ENGINEER MAIL ADDF;ESS ZIP PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ AODITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and ara e 25 S 2nd La er
9 CHANGEOFUSEFROM TO
STIPULATIONS
Roofing can be 2nd layer but not 3rd.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE FiEOUIRED FOR ELECTRICAL, PLUMB�NG, MEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU fT.
AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFfSTREET PARKING
I HEREBY CERTIFV THAT I HAVE FEAD AND EXAMINED THIS APPLICATION STALLS 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 1609 . HO
DOES NOT PFESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON•
STRU OR THE PERFOFiMANCE OF CONSTRUCTION S�F.00 Fire SC 1.60
PLAN CHECK FEE TOTAL FEE
�-- � Z^ � License SC 5.00 61.40
S�GNATUFlEO O�AAC70AOAAU�MOA�ZEDAGENT ionrEi . WHEN PROPERLV LIDATED THIS IS VOUR PERMIT
� � �
S�GNATUREOfOWNER�iFOWNERBUiLDERi iDATEi BlD �NSP ��FTE
NEW - [ .] Effective 1 / 1 /98
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ��
BUILDING PERMIT APPLICATION � � �%
,
�onstructionAddress: ��� %�/�i�j� ��/� ��/, �
Legal Description:
� Owner Name & Address: �1�� �/�,(�S �',,q-T%"� �' Tel. # �,?�._...���,.
Contractor: � C J,��� S'Clr'�/,� Cb� S7�j�UG,T �,,� MN LICENSE#�bZ��C�3,�'S�
� Tel. #o� %d —
Address: %/ rO / --�'r� � � G�-1J� C��Z���,r� �S�/l ,,�1. �
LIVING AREA:
GARAGE AREA:
DECK AREA:
�OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
W idth
W idth
Width
ovs�� t�f-G�t�� :
Height
Height
Hgt/Ground
�� �S
Sq. Ft. _
Sq. Ft. _
Sq. Ft. _
�ti,'
Construction Type:,�� � d� Estimated Cost: $, o�. ��
(Fee Schedule on Back) /�-� /
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
DATE: � 7�- ��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
��
APPLICANT: ' � c� Tel. # %��--%/ 6� /
� CITY USE ONLY
$ � � C��
$ /, lr�
$ � �'
c
$
$ S. L,C 1
$
$
$
$
$ �- i �/C,
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
. •
BUILDING PERMIT FEE SCHEDULE
The Chief Building Ofiicial 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 $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the �rst $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet 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.
� � �,� �7� c�-
CITY OF FR[DLEY BUILDING (NSPECTION
6431 UniversityAve NE
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
als� Replacement Furnace
Gas Piping (Nevi Furnace, Fireplace, InSert)
GasRange
Gas Dryer
�Air Conditioning-All Sizes
All OUier Repairs or Alterations (L�s[ on Bac1c)
14'0 of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cast of
Improvement �vhichever is greater
Effecti��e 4/1/2004
AP�LICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITfONfNG SYSTEMS AND DEV[CES
Fee
JOBADDRESS_ V��W�J gC 1C.�(—(�Q�e COU��-
Total ._...
Owner � � M e s �J � �i
$35_00 $ d� , O�� Building Used As �C.S:f'��Ue�"� � a
$10.00 $ ESTIMATEDCOST�`t�'�--� PERMfiNO_ �- 1r�=�����'� �_���.- `;��
$10.00 $ DESCRIPTION OF FURNACE AND BURNER
$10.00 $ N of Heating Units � Circle One (Steam) (Hot VVater) � Warm Air)
Trade Name �MP�t' � C4 n�r�.r.�� f'd g�Z� ��.
�25.00 $ BTU _ � �C'�0 NP EDR
Fuel }�(,�g Total Connected Load
Commercial/lndustriaVlnstitutio�al
1.25°� of 1�alue of Appliance or Work (List on Back)
Minimum Fee $35.�0 for Commercial/Industrial/Instit�rtional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
E�
Bumer Trade Narne rce�L��t �Cc.� �����l�ize Na.
STU _gC� � �� NP EDR
The undersigned hereby makes application for a permit f�r the work herein
spec9fied agreesng to do all wortc in strict accordance with the City Codes
$ and rulings of the Building Division, and hereby declares tilat al( the iacts
and representations stated in tt�is application are true and correcL
$ � 50 HEATING CO � ��v� ���^'��J� � �2l.1-��f't
� �' �� Sigrted����� Tel # �` a�$-�f o��
FAX # t�l 'a oZ�`S G�'� Date 9-0�' ��
*Air Conditioners can not be placed in side yard ►vithout written approval
(rum adjoining property o►vner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATlON ON REPLACEMENT FURNACE
Approved by Rough-in Date Fnal Date
09/21/2004 20:0B 6512289201 ST PAU� P�UMBiNG PAr,E 03 ` �
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT VENT CONNECTOR AND COMBUSTION A1R VERIFICA710N
When replacinq an existinq furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes � No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications, This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
The existinq combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes� No ( )
Yes � No ( )
Yes (� No ( )
Yes �l No ( )
When installing a new ventinq svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes �
No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes �Q No ()
Appliance Tvpe and Size/Common Vent and Vent Connector Info�mation
Appliance #1 Type ��.�'NC.c�- BTU Input 0 Fan Assisted or Nat� �' �
Appliance #2 Type IN�+rr �+o ✓ BTU Input Fan Assisted or Nat yV � i
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu lnput
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height �3 ft Length a0 ft Diameter 3�� in Type ✓
Appliance #2 Vent Connector Height �ft Length ^ fi Diameter " in Type 5S L�.�c,�
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO; � . ) �- �'
Signed By: � Date : � �
09/21/2004 26:08 6512289261
ST PAUL PLU�IBING
PAGE 01 � �.
To: Inspections
640 Grand Avenue
St. Paul, MN 55105
Phone: 651-228-9200
Fax: 651-228-9201
From: Michelle
Fax: 763-571-1287 Date: 9/22/04
Phone: Pages: 3
Re:
CC:
� Urgent ❑ For Review ❑ Pl�ase Comment � Please Reply � Pl�ase Rerycle
• G0111f'11AMtS:
Please process the ,following permit w�th th� Visa nunnber b�low. If the tota] fee I have figured
is not correct, please char�ge it and run the card for the correct amouttt.
Visa
4251 2470 0073 5709 exp 06/OS
�
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
+Y/�QCS11L' � � �:F
: 6160 BRIARDALE CT NE
: 133024440037
: BRIARDALE
: LOT 11 BLOCK 3
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
571-11tS"/
.
PERMIT NO.: 2004-01648
DATE ISSUED: 09/22/2004
�
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.
INSTALL A FURNACE (WARM AIR, AMERICAN STANDARD, 80,000 BTUS)
# A/C UNITS 0 VALUE OF APPL OR WORK 0
# FURNACES 1 # GAS DRYERS 0
# GAS RANGES
APPLICANT
ST PAUL PLUMBING & HEATING
640 GRAND AVE
ST PAUL, MN 55105-
OWNER
KAPOTAS JOHN E& CAROL E
6160 BRIARDALE CT NE
FRIDLEY, MN 55432
0 VALUE (FOR MINIMUM CALC)
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant_ Q Date ;
Bldg Insp��""'�Q�,�\�/�— Date�r
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
3245
0.00
35.00
0.00
0.00
0.00
0.00
0.50
35.50
' rea-er-cnr.� .to��o I,IIT UF rKlUl�i
I' . lJG/ l?J
rv�w � � cirr oF �ttQt�r
ADDN ( j 643� Untverslty Ave N�', Rridl�y, MN 55432 (763) 5T2-3604 Bidg I�ep
ALTER [ J SINOLE FAMILY ANO DUPLEXES R-1 AND R-2 (763) 671-1 ZQ7 F�x
BUIL�ING PERMIT APPI,ICA'f1aN E_ ,� �� �j`� ���
l�
Construction Address' .._..... ���6 �j,���1L ��,� � � ------..
Lega( Descriptbn: _ ,.�.�.�_
Uwn�r Name� & Address� ��i�'� _� �C/-l/�- � ��?� _ T�i. # 763 S7T� �s� Z
Contractor; p%t C2 t SI a�r.- n rE �� �_,,,,,„„_„ MN LICENSE tt � l��/ t'��6
Addross: Z Z Z�F t//T �°�.._ �•B.c�S v� � c� Ta�. u__5S� ����`��v
�1V9NG AREA:
GARAGE AREA:
DECK AR�A;
O'T'HER:
Altach t� this applicatlon, a Certificate of Survey of the
lat, with the proposed cpn�truckion dr�w� on it to scala.
DESCRIPTION OF IMPROVEMENT
L�ngth __._ Width Height Sq. Ft
Lcngth _ Width HelpRt Sq. Ft. __
l..engih � W(dth WgVGround Sq. Ft.
Con�truction Yype�(.i��v� ` f�,PLAG,Er ¢�v� Estimated Cosf: S_ ��UV ...r
�
nriveway Curb Cut Width Nesdad: FG * 6 Ft = Ft x S =$ -
oar�: _E�;��_gL_ APPLICANT: �,_.,,,��ss TQi. 7y�- Z���
C�II (763) 57Z�36�4 for Pormit Fams if mailinp in applic�tion, Fax tfl 763-b71-1287 li usiny credit ci�rd 7111d v�w will call
�ou for card numDcr.
CITY U�E ONLY -
Permit Fee
Pian Rev(e�w
Fira SurcharAe
State Surcharge
SAC Charge
Vc:ense Surchar�e
Curb Cut Escrow
Erosion Control
Pa�lc Fee
Sewer Main Charge
TOTAL
$_ `�%„�� F�ee Schedule on Reverse S►de ..
$ � 65°!� of Permit Fee
$ _„_,_ 001 of P�rRlit ti/aluation (1/10th%)
$ ,, $.50/$1,000 Va{u�tian
$ $i450 per SAC Unit
$ � � � _ $5_00 (Stat� lfcsnse�d Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $�50.00 Conservation Plan Review
$ Fee Determined by Eng�neering
$ Agre�ment N�oesse�ry [ ] Not Necessary [ ]
$ � 7� ,�jjPULA7�ONS_
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