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AF - 43753SUBJECT PERMIT�NO. City of Fridley ° 13635 AT THE TOP OF THE TWINS B� I L D I N G P E R M I T • r � � ` RECEIPT NO. � ; y _��_�_ COMMUNITY DEVELOPMENT DIV. '��� �� r � � PROTECTIVE INSPECTION SEC. t , �4 , /'�'1 i CITY HALL FRIDLEV � 55432 NUMBER REV. DATE PAGE OF APPROVED BV ""'� � ,'� 612-560-3450 910-F15 7/7/76 � � JOB ADDRESS ].621 (,'dMelOt Lane N.E. 1 LEGA� LOT NO. BLOCK TRACT OR ADD�TION SEE ATTACHEO DESCR. �-9 2 Harris Lake Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Miller Homes 1600 Rice Creek Rpad N.E., Fridley 3 CONTRACTOR MAIL ADDRESS ZIP pHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER ,�,��M D ' ,r �W PHONE UCENSE NO. `�. `$� fRfOt�Y`µ p01� . N01' G�I,AI�a�i�; K�. , 5 ENGINEER D ' ' ••.' PHONE LICENSE NO. rr.l'.!M ��1-i �`OR � 1!#'O�MAi10li .J'UCI!O�S OMIi ANi� . 6 USE OF BUILDING ON tHE SttE Residential 7 CLASS OF WORK � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 40' x 26.4' Dwelling and a 19' x 22' Ga.rage fi�1.EPHONE-.ELECIRICa �� , 9 CHANGE QF USE FROM TO REC�U1�F�j 8Y LA STIPULATIONS provide a hard surface driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. Provide City with copy of tnuss design before capping. SEWER IACATION (Approx. 9' Deep� 65' East of Manhole (Inv. 878.00) WYE ELEV: 878.26 ToF> o�' �'OGTIi3G: �si. so rti.n�� ---tMP4RT�INT--� WATER LOCATION: 9' East of sewer Service NOTIFY THE FRIDLEY ENGR DIVISION REGARDlNG CURB ftEMOVAI AND RE�'l.ACEMEWT SEP�RATE' P�R�jTS I'�� �,jIR�D �,► AT phIVE�^�AY iiPER�1iVG$. N�ATING. PLUA�f$TN� q�p� Qi� �It1RI�G, StG1�S SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. OOC�L FY'3Me 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 SUSPENDEO aR ABANOONED FOR A PERIOD OF 120 DAYS AT R 1 1056 + 538 21� ZZO + 5380 ANY TIME AFTER WORK IS COMMENCED. N0. 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 IAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $33 � 97O $1'6. 99 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEFMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMA OF ONSTRUCTION. � $SO.02 $350.00 \��� /� PLAN CHECK FEE TOTAL FEE �1� 7- Z i- �� $417 . Ol SIGNATUfiEOFCONiRACTOR RAUTHORI2EDAGENT IDnTE� WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT _ • �� /!)! � Q _ .� LL.� 7 -a l-7�_ SiGNATURE OF OWNER UF OWNER BUILDEfiI IDATEI � B�DG INSP DATE �. l�PPLICI�'1'I:ON P01: ItliSIIII'.l�T1nL, ALTI;I:l1'.t'ION, 0 IZ /1 ll 1) I'1' I: 0 i� 13 U I i,1)1: N G I' E R?�'1 I'I' C1TY OI� FRTDLlY, r��1INN}-�SOTA OWNER' S i�F�� :!>.ICNr^��2i� L`t��:s:t� BUTLD�R; K�c_Ey�s;z:� P"�.ls:-�i_� �c�r;e: s_. ADDI�SS :�'� � �c�= [ �r ��c ��_ ADDRESS : �arit' NO: (���^ STRLET: CFir,�� � �-}�N�. __ LOT ._� ! Q BLQCI:.: Z ADDTTTOI�T : 1--Iga,z,� C�xs"t- ���r�-� - !d l.�vksE CORNER LQT., �p ___ INSIDE LOT: `��. SET3AGIC: 3�� SIDF'Yti`.I:ll: s C-���t�+c� Appiicalzt attach to this form 7.�ao Certificates of_ Surve of Lot and proposed build.ing location draron on these Certificates. � llESCRIPTION OF I3UILDI;vG To c� Used As : , �Front : T � Depth , � G, � Iieight :���0 Square Feet : ,/�iL��� Cubic Feer : 'Q�j � Z O rront: �� � Depth: Z Z Hei�ht.� � d Square Feet; �_3 � Cubic Feet: �� O v Type of Construction: �•�/�� Estima.ted Cost:_$ ,�.3 �a To B� Compl�ted: � � fihe undersigned hereby makes application for a per.nir for the taork lzerein specified, agreeing to do all Gaor_lc ii� st'rict accordance wit11 the City of Fridley Ordi.nances and rulings oi the Depart�ent of 2iui7_dings, and herevy declares tliat all the facts and xePresentations stated in this application are true and correct. DATE :�� �.At=�t 1+ l C� l b S tGN�lIJI:� : e,e. �� (i (See Reverse Side For Additional In�ormation.) � p�,�i�,�,��.�,:�- ,�. � L ,o�,� /�� � � , L� /�"� e �,� � , D o ,_,.,.... 'f /% ; C� / � = . S��a,,c A T �'✓ S _ �,�d� ,v,� c ���-y "',�s<� C�6P. `` � J �,�' � ��I��E C,*-�oi �.- _- ,�� � ta��i ►ianhi�g �(( f r��/�1�, b81S Highwor No.iS N.E. lond Su�wsying • • ( Minnea�olis, a�►��� �.s��,.� � � '�J�l /Ilf'(�'Ifl1(� , •�����'. M�»�. sssas tivit En�lnee.�ng r� <" Telepho�te �a�-0060 Mvn(tapai E^g'errer�hy E��ineerb �C �UI'VPYQI'S Arco tod�s b{i .,_ , �� i-� R�1< L� l`► i�-�-- l."(2 T���.'S Certificate of Survey for � � 7HE CiTlf OP FRIDLEY DOES NOT GUARAN'f!'.E THE ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS. THIS DAU 1S FOR INFORN+A't10N PURPOSES ONLY AND PERSONS USING R SHOULD VEWFY THE fNFORMATION ON THE SITE n ��' O n � ���t�� utilities ��,�o�e di�g�ng �all local �AS Etc. ��G�FHONE - ELEC�f R1C - RE ��tRE� �Y �� tr �'` l.. U / I !� � ff� 5.3' lr�� �'`� � � = " F1 o usE 0 o ,o,o.. Gr�RAGE ? �4'- 30=0�� n .o 9 —IMPORTANT-- — ���p�( THE �'RIDLEY ENG� ,� � @IVISION REGARDWG CIiRB h ��MOVAL AND R�PLACEMEN�i i � �t DR1VEWaY. OPENINGS. � , R,-`--ZCS � � � � -- ---- ' > a ' 53.G5 C I��tt �o~r LAt�.tL Sr.aIL: i'�- �A�� � , l��T iy � aCK 2 _H�+S 1.�� E��a�S � A.�oka Cou�t�y 1 h�r�bY ce�tifY thot ih�s ie o true� ond conect ►eprvseqlation df a svrver ol tb• bou�da�iss o� �ha abav• d�fcr�bed ioad, and of �he locaf�on oI otl bu+ld�nq th��reqn, a�d olf risibl� encraochrnsnts� if a�r, lrorn or on lqid lartd. As surveyed by mr fh�s��day of ��•,.�'° ,--A R 1V�. 0 �NQTkS IRpN IulON11A�NT SU�URdAN ENC3INPERiNG, INC. En�ineers Surveyor3 � "-==== = �TES �i►tSAGr �, Uii►,:i i Y E�S�MtNT br; _ _ "�� __���`� ,' ,; , m�� � � ,��x, � '�� ��' � .�,� �_ ��' .... .�.��.��_ . � � ._..�.�- ��� �, or i��. 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L. _... . -_ ... _ _ .._�_ - . . ._. . } _.... ._�_ _ ; . ' 1 : t . ��� . , ` � i .. . . �. , � ��, �.w."". ... .. .. . .... ..�. . . .. ' . . . ' . ' .._._�..__ . ._' '_..._.. _ _.. _ .. .._ . . . .. _... _. .T�... ..._. ... ._. .. .. . . ...__-• _._.... � ...._ ,. .. :.. ._.... . _... ._. . � ,._ _�..._._. __ _"' __"_ _.'.�._....�_. 1 �-+ � , , . � , . . . �. . . � .s.`...__..._.... _ . .__... . ...., .. ...... ..... .... . .... . .. .... .. _ . ... .... ... �. . . . _ .�_ _ '_ _ . � � ` _. , . . . _ _.. _._ ,.._ _ . ._ ...._ __--r- - ,+-- I ` t--- ; ,---_.*_ ' � � , ; � , . .-__. _ . . . _ .._. _ _ . ___. __.__ ._ _. . _ ._ .. . ; _�:_- _.. _� ... . _ _ . -+- ____ a--- -�--__ �. � usuRSAN n❑ N�INEERINQ �j iNC. � a Civil, Municipal & Enuironmental Engineering ❑ Land Surveying • Land Planning • Soil Testing Mr. Dave Harris 6279 University Avenue NE Fridley, Minnesota 55432 Re: Lot 19 Block 2 Harris Lake Estates Dear Dave: Main Office 571-6066 6875 Highway No. 65 N. E. Minneapolis, Minnesota 55432 South Office 890-6510 1101 Cliff Road Burnsville, Minnesota 55337 June 23, 1976 � V ' � � a I V� �' CA . � At the request of the excavator, Jerry Belair, on 16 June 1976 we examined the excavation on the above captioned lot and found stable material below the excavation bottom. The Contractor then backfilled and compacted the excavation with a sandy gravel. On 22 June 1976, we ran a density test at footing grade and found 98.6� of modified Proctor density. Based on the above, it is our opinion that the foundation fill is satisfactory to support a typical single family framed dwelling. PJM/jp Sincerely, SUB AN ENGINEERING, INC. ����%� _ Peter J. Molinaro Project Engineer cc: Jerry Bel ai r City of Fridley (Darrel Clark) � L'uh�•�� Minder. Reg. Eng. N.'. A. ttnth6un, Reg. Suru. Wru h.'. -/rusen, lieg. F.ng. Wm. K. t�feper, fieg. Eng. Wm. E. Price, Reg. Eng. Gary R. Harris, Reg. Suru. H. WiUinm Rogera, Reg. Suru. __ _� _ _ • ` Page 1 of 4 a EY.TI;1?IOTt l.;�TJI�LOP'_: AVT'FtI�CE "U" ;:ONi?'UTATIUN '� _� .�-----------_�__._ ._ _____�.__._._ OW�I:"Ft; �r...�'-��Pf �.- ,�iaVC� � U�1TF _�%/%%,�G � � ir► e �o ?�.�l� ��'.�._`._._ PIiONli: __ �� '"�.� �' v --- SI'1'E A1�I')R�S �; : L _�� . coN���cTOx; � � . _r�.l — �� �-�_ lletennine working squa fooL-age of each .� ,�._�� n �^ 1. 'Total exposed wall area...... _�Q �F�_ sq. ft. x .17 = 3s/ ,3_�___, ' Z. Toal roof/cei:ling ar_ea . . . . . . �(� 5 � _ sq, ft. x _ .05 = .S v�. $' (� 'i'ot::1 ex�osed wa11 are�t abave floor = /'�63,v0 � a. Total wa].1 ��in�1o��� �are�i. . . . . . . . . . . . . . . . . . . . . . . . . . . . .. � , 7 h. To�al door �,r��a ....................................... 3.�,,�'i�� / c. Total ::li�:ing gl� ,s cloar s�ea ........ ............... /�.p,00 �,�f d. Tatxl firel�l<ice. tval.l are.a ................ ........... �"—" � e. To�kal wall fr�>•ni.r►y r_rea (average lOt? . . .. . . . . . . . .. . . . .. /Q6ti;a f. Tt�.i:al rim, jeis�: area . ... . ... . .. . .. ... ... ...... ...... /1.i�aQ � �~ -.--�►-- _ g. � wa11 azea above floor.... .................. .. �.3y3,s"'� �/� h. wall area a��ve i-loor ..... ......... ......... a. �aall area abave floor..... ....... ........ : , �. � wa1.l �re�� �bove floor .......................... , �'U�il�. (:X�)USt�r� 1UUTtC�Zltil01] iil:l''_�l = l9��00 k. 3'otal �ounclation window area............ ............. -- 1, TataZ net .found.ation area ubove grade ................. �f,o p �etc�rmine "u" value of ea�h �vall segmenL {e.g. window, door., each separate wa12 section) _ a• _.L�'`�.�7 r: ��U„ ,�-I = 8'/,y� � �. s3,3 5� ;� ��„�� /.3 - � , 43 � ' �� �� � c . / a a , � a ---- a �� u �� , S6 _ _ .:�.�2�2._ � �� �a � �' j Y d. X ��U�� _ , �' � � . --- - -- — �' S� �, ^�g� 30 X ,�L�� ./3__._ _ .� s/,a� � � �� ,; t. //3,va ;: °�.��� __ ,ob_ = _ G.7g' ��� , � „ ,,, �3 . _1,�?,_��_____ ': t , a _____.._ ° �.y, [7. r�. .._. a „t;,, � _ — i. . K �� U o � ..._ _. . �. -^ X ,,;T„ ,_°., ._ �y ._._,,, If i.tem u3 i.s the Sc1111(: �-�:� ,r..._�. _..__ �_.___ or less than item #1, yoti ,�. ._. X :.1��� ._._._ _ ---.. have met the intent ai' _.._..__.____ _._..,�. —•---�. .___.�_ SEiC G0�6 (c) 2. , , ; _�.. „ �, _ ` �, 0 C� ._....____ i: U ,.� �-----•-• ---- ��'�-�— - � � . .i . . . . . . .�. . . . . . . . . . . . . . . . . . . . . '1•c;4.., �. _ �_ l.Zc..�ia--__ �'3C1„(1t.i�:�t' 1•'uvrlu���� Avi•1 �i���� °ll" c'�mi��ul,�t lui� �'it/j1.1 j C)i� � Total exposed roof/ceiling area = ��� � F�Lf - 60 � d������'- ys � " m. Tatal skylight area ............................ --� n. ToLal r.aof/ccil.ing fr.aminy arca (averagc. 10�s) ... �,,��� � y��,aU o. Total net insulated roof/ceiling area... .. .... .. S�f 3,60 !�D �, g� __ Determine "U" value for each roof/ceiling segment m. X ��U�� _ � ^ — �. � .�-- x ------- n. �o� yv X ���,� ,��i = �,'/2. ys,aU � �d - '° - p. �.y�, 6Q X .,U., ,o,� _ �� � 3 � yvG, �� x , s �. ..�� 4 ........................... �otal = /3,I`f ' If �otal of #4 is the same as, or less than #2, you have met the intent of SBC b006 (c) l. Alternate Building Envelope Design To utilize the total envelope system method, the values establ�shed by the sum o� ` items #3 and #4 shall not be greater than the sum of items #1 and #2. �. 3 s�, 3 g + 2. �,� a = yo x� �___ `�_____ - � . d 4�, �'� + 4 . � 3:� � _ ,33,� o 0 6����. f��.� co �e�- � �� ��� � � .� , �: `''� � 0 . � wnr,r, :;i:c..i� i c,r�:; ..: U�e 10't, of r�j�ayuc wa7.1 al:ua for fr.ame const.ruct:i.c,n .r, . . _ � � � FASxC WALL , ��... �'►�� �Ser[. ,�ir 5�: al �,��i �� ► � „ '` �.' • � ��.: FIG. ��3 • �, . .� ` : • � . _ . ' .._.__ ----"`�J _._ _____._,. '�j� TOPVIEtJ O!�' FRT�'lE 11ALL T,� � zin �n� Con:;t.r.ucti_on Page 3 of 4 R-Value 1. Interior air film 0.68� %. �sl �� Y�/�COSSl/^'L � ��-�r. 3. �%� 5iz� 7�w_s_.a c4'" �/,y? S 4 . � // � 5. '� °� 70.. 6. Ex�.erior air film 0.17 Total �� . U ,�..��%3 •,���J l. Intc>.ri�or air film 0.68 ` • • /IiSv�c7�/U' 2� ���SUM i y.$� � . _. � :.�j 3 . � / /� � 1rs� I �� 4 O ____–{� 4. _ l/c��C;6.. s�l<<�,n4 ,,,3� ._..��,.�.-.� � . %/�i �/7z i 6sr . c� � % w��� .�" 6. F,xterior air film 0.17 ,........_._. .:._. _.� , y � To tal 5' � � � � v3,a�, ---r-^'--`—'U ' R1„� 1, Interior aiz film 0.68 ..�.......— ---{�� �'vrs�' a. 3 // ��F,6�.�/r.�.s /l� a v - Q `� 3 • ���nz'��.�D / , g� ' --1 4. � // /'r�e� ,�%le��/�.�r4 %•.��- '.�....�.._.......�i - 5. %�.� P•�'6�:r�—� ,� 6? .• � 6. Exteriar air film 0.17 t � Total s. �� _..:._.�—. �� ���, . tJ� , r� 6 1 �`��\� r � ��.�,��J 1°�n��`� 1. Irfterior air film � �� '�',. �l • ... ..2 , .., '��il Ys' � ,�ios�r,� , - ,��'- `�+ � �� , � � 3 . 1 '� % i �S r �s /r ss ___� o a_. ._ 4. 5. 7// i�7 q.- l� !�/'_ r%� ,r � 6. Exterior air film 0.17 ° Zb t�a 1 .� � � '"--_�-li .,r� . iri ` �,�� - /r� ��� � � .c� , . ` t' L . a ,� , � ` �.� • ., ` � • � ' � , , • }; . � � ° • � � � � r �,�' , i ._�'.�`r� j�t=�l � • , '� ..,�'.�- � /��.... , �� , `�6 . • ....-- , ir � >� � • , � , �� , ' 6 • ' �11 – ^ _ , r- . ��� : - , • - . i .� � � � � ^' ' � /!! � . rzc;. it4 –" � ' � ' ` :=' /�( �. ICt � � •. o -- ' (l( � X ^ � . �r � �!( . — � • /l � !! f =. �it =. ` NO'1'r'.: Indicate tyc�e, "?:" v�zlue, ciept:h Zn�l placer�ent of 2I1f:11.LaLion. 2'agc: 4 of 4 ROOF/CEILING . �'��� �;�.�„�g �L� � Constr.uction R-Value �V� ' �-�'`�J�f�'� ,f, 1. Interiar air film 0.61 ��,.!'' �:; ,,��' �`� `G ' (. �s,+.n�f � s` ' �""./.-"^'��� ' J � fi � . % �� ��fa/t�S( � �..,. :�� j e-� �) _,-i . M --�- . 3 ►_ ��%;� I��.► n-����i�����'� , 3. c��� �;s�.s rss �g,� o �/, I 1 ��� `� �I_ �',- � j ^ �; � � 9. Exterior air film (still) 0.61 . v�� , .��, 1_.��.�r���� � �,�_at.���i- .:� � ` .� "" _ ;�.r.:..�. Total � j � L S ������ }. �� -� ' f� U: ,vy . �,�. --� --� �vL� � • , . • l��• f�rr � M �'� � � . ��, r�GyPs�M , s� t�ented � . �leat Llow ?��yS�°i`woo� G.a� � t uP . . �'xf �„ �/.n , 6 / �-------- . � � 10,8� �'IG. ;i5 v` , v9 . • ��7rd (/�S✓�r�0'� w . � . . . 1. Interior air film 0.61 "�A�tj�.�4t/ .�^,��=�"_;``�T'�'t'!'r'��sps^t"Li=� ��i&T 2. �/`6/� V6�Jri/r� t i D .. _ �._______._._� ���..-_.---�• 3• 1� ��%Cif t_.C,_.�s� L. c 3�• 0 2' 1 ' /'� 9. Ext�rior. air film (still) 0.61 '. � � Total �� 31, S' U s'' �� �11C� �t��:;% t]_ , 03 � � ��,. �►�r � ,, . a � ,1�, t � �. . _� _�_�_._._...__._ _� _.._...._,, / � ,_...� -- �' �'�' (�Z�/�' /✓�i ai� t`�M � G/ � � f: �� ����� G� �5��'h , .J� : .i t`� � !' . /,' - � / �r S,S /�j', U O 6 i�6 s }'cai: floc� up . , ;•venCeci �;Xff�i���M � ' ' .,' ...' . �o,�U ,�S , ,kIr,. 4t6� . . . ` . ]„ In�ide air film 0.61 • Y� ------- -- �r -- --�._._�_r... 2. � ' ti 3 . �� ,��•• �,�5''.t..��t•'��� �3. - - -- _ � , � ; _� , . .: , � �_____._._____.__..._.._._ _____._....�..____� _ • . , � .�.!.:�^-,��.:.�:.�:: :' . ..: -�� 5. Out<_;.idc �i.r film 0.17 , ,,,��, c,:: .� . . ... .. .. . :::� �.:� =�:-. . j � , � j•, ` �y.-.._---,� � /� . �'._:;� ��- � : t :' �: :•' ' ��'..: -::-=-= f f/ /.�---c,�. �""'� . Total .:►----- � J � t=-���� �� �i.�:�..� f , '", '�`' �J . •�'..� .r ' ' � / 1,..-1,.��� / � � Note: Use additional sheets if more space is ,/� �� 1)_ z � �`� /� needed for deL•ails and calculations ../�/f, � . -r- /% � . � . . � . . . � 2� 0:?-VP,2dTF.D , . ' • • . •. •� • . Ncn� . , , , � f low u� � .. ' � � , r.r.�. �: � . . ' . - � � . ,�,,,,,.�, . ��,�, ,..�� .. �.�.s-.. eascf�:;r� DATE 7 G SUBJECT �As.�[=,%� Cz�e.�Q� . ; ♦ ♦ � . DATE SUBJECT CITY OF FRIDLEY APPLICATION FO R PUIMBING AND GAS FITTING PERMIT N �N,, �, '� � • X v Water � N y � y�,� �.,�.� y q . i l p, G�., � Heater v � ,-i m E�.� �S S-i N ro N W � •�-I .Sa N �d C N X+� U� f-I .0 C�� N I � • fy �J ul G .0 •� ?C .0 C C 3 0 U•.i O.0 U 41 •.�I l� m� C N •.�I � O O +� fA +1 fn UI N N � � m ° �+ ro ro •-� �a �+ o .� � ro ro � ro. ro � � " as lec m U � rA W v� 3 Q k, tn t� U al �L 3- C7 � c7 O / ( lst � � / 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water 1 PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: N0. RATE Number Fixtures /oZ x S3.Q0 Future Fixture Opening x $2.00 New Fixture, Old Opening x $2.00 Catch Basin x $5.00 Water Heater - to 99,000 BTU � x $5.00 100,000 BTU to 199,000 BTU x$10.00 Water Softener x $7.00 New Ground Run Old Buildi-ng x $5.00 Electric Water Heater x $5.00 GAS FITTING FEES: lst 3 fixtures � x $3,00 Additional Fix tures x $1.00 Gas Range to 199,000 BTU x$7:0.00 REPAIRS �, ALTERATIONS First $100.00 $S.OQ each add. $100.00 or fraction $2.00 State Surcharge TOTAL FEE REINSPECTION FEE � ($10.00) TOTAL $ ���0� $ $ $ $ S� Dd S S $ $ $ �-00 $ S S S $ ,50 S N�)�SU Job Address � ���L' L0� Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herei.n specified agreeing to da ali work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all tne facts and representations stated in this application are true and correct Fridley, Mn. �� ` rl � , 19 �� OWNER �I C ( ( � �%�C: � KIND OF BUILDING /���� USED AS �� �s � �alY ',f TO BE COMPLETED ABOUT ����� ESTIMATED COST �d��^ � �� 9�r- NEW BIIILDING PERMIT N0. PERMIT N0. �S� 1 Company / r �[..` ��� ���1"� G,G�. I Signed By .� -. / . GS?�^•J�. , Tel. No. � T/ y/ J�/ ROUGH INSP. Date FINAL INSP. -,.�� �/ - / � Date APPROVAL FOR PERMIT � MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 HOUS HEATING EST RECORD ��� �r:� .����` . . ,' � ADDRESS `A . fL00R CtTY St)8UR , , OCCUPANT OWNER ;; HEAT L055 �1��!��.�,I�/}T�.�.�N.� SOLD BY - � r' INSTAI.�ED BY Elsehical Work By Gaa Line By TYPE Of HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER :AS RESI CONYERSION - MAKE MAKE OF BURNER Mod•) • � Model Se�iol Max. 67U Rating � tNPUT MAKE OF FURNACE Model - CONTROLS � . _ , . . THERMOSTAT ' Heot Plug Vent Size Valve KIND OF LI R S1ZE t�IQNE.,.'^�_ Limit Droh Wood ''�'�''""' R�gvlaws Limit Sstting � Filters Size urnk�r Fan Sstting �r "` � G►tmney Location 4nsi Outs Piloi Type _� � Chimney Construetion �*��--'w!�'�!?�' s Pitot Make ' Pilot Model Smoke Bomb Wiring ���` Pilot Timing � Draft � �"�` T�tf �%p L.W. Cut Off Door Pressure Liyhtin� lnsf. Pressure � • � Percent CO2 --�-�,---=.-- �ate Tested ' { � (nput CFH Percent OZ Compony Testing Stack 7emp. � Parcent CO .--. Name of Tester " Fwm 235 , CITY OF FRIDLEY INSPECTION DIV, 6431 University Ave NE Fridley, MN 55432 572-3604 , RAT,� SCHE�ULE Residentiai i4PPLICATlO�' F�JFt PaWER PLANTS AND HEATIh1G, CbOLIh1G, VENTILAZ ION, REFRIGERATION AND AIR CUNDITIONING SYSTEMS A'ND DEVICES Furnace Shell and Duct Work, 6urner - Aiso Replacement Furnace (Side Vent - Fii{ Out Sack) Gas Piping (Need�d with new furnace) Gas Range Gas Dryer *Air Canditioning - Ali Sizes All Others/Repairs & Alterations (LIST 01� BACK) 1% of Value of Appliance or Work Commorcial/Industrial 1.25% of Value of Appliance or Work Rate Effective On March 1, 1996 JOB �4QDFIES� � `P � I �Q �� \" l `�� The undersign�d hereby makes application for a pErmit for the work herein T07AL sp�cified agraoin� tu do all work in strict dccordance with the City Codes and rulings of the Building Division, and h�reby cleciares that ail the facts and $ 30,00 $ representations s�tated in this application are true and correct, ----- - _ � 0 — � v ,1996 $ 10,00 $ � o,00 $ 10,00 $ 25,00 State Surcharg� TOTAL FEE � �r� LA �-i�,�� S � � - � 5'39 owN�r� � $ �F3UILDING U�ED AS W-p,�I �� $ ESTIMATED C�ST � S �'OC� PERMIT N0. �� $ I�SCRIFTION �OF FURNA�:E ANC> �UR BURNER $ No. of F-leating Units Circle One (Steam) (Hot Water) (Warm Air) Trad�► Name Size No. ��"' ' E�TU HP EDR $ Fuel Total Connected Load ,50 urnQr 7rade Name Sfze Na--... ... ,. ._ BT�! . _ _. HP _ . EDR � a � � 5 . 5 C --_ _ - — C� 1� -�-� �� (ce.cs� 1 ✓�S . MiNiMUM FEE FOR ANY HE�ITINGCCQQLIWG�/EN7ILATIUN REFRIGERATION/AIR CONDITIONIIVG PERMIT IS 25.00 PLUS THE .50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr xAir Conditioners can not be placed in a side yard without written permissian from adjoining property owner. �^-e ''� _.- ... __._.- -----...._ .._....� ._ ....._ ��,.�_ ____- '/�n HEAI"ING CCIMPANY �� � r�-�� �° ��= °C� v v I � Signed By�� � a� Tel No. �g� � S�-�'� __ (��� Approved 8y Rough-In Date Final Date FILL OUT RACK SIDE N STACK VERIFICATION ON REPLACEMENT FURNACE sue�etr PER _� c;ty of Fridley 28605 AT TNE TOP OF THE TWINS g � I L D 1 N G P E R M I T ' �.572-3 �(�� NO. �1{ NITY DEYELOPMENT DIV. ��� ' j V -�-�� r � � PR07ECTIVE INSPECTION SEC. � � �"'1 � CITY NAII FRIDLE� SSIa2 NUMBEp REV O�TE PAGE Of AvvROVEO Br �""�"� �'' 612-571-3450 9t0-Ft5 11/17/98 / / 108 ADDRESS 1621 Camelot Lane NE t LEGAL lOT NO. BIOCK TRACT OR ADD1110N SEE ATTACMED DESCR. 19 2 Harris Lake Estates SHEET 2 PROPERTV OWNER MAIL ADpR�SS ZIP PHONE Sam Iaguinto 572-2539 3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO Northern Crest Inc. 8245 Polk St NE S rin Lk Pk 55432 792-9364 20098415 � ARCMITECT OR DESIGNER MAIL AOORESS 21P PHONE IICENSE NO. 5 ENGINEER MAIL AODRESS 21P PHONE IICENSE NO 6 USE OF BUILOING Residential T CLASS OF WORK O NEW O ADDITION O ALTERATIQN §� REPAIR O MOVE O REMOVE 8 DESCRIBE WOFiK Reroof house and garage (24 S) Tear-off 9 CHANGEOFUSEFROM TO STIPUTATIONS Underlayment must comply with the State Building Code. TYP� OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD SEPARA?E PERMITS ARE REOUIRED FOR EIECTR�CAL. PLUMBING. HEATING. VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AN� VOID IF WORK OF CONS7RUCTION ZONING SO. FT CU FT AUTMORIZED IS NOT COMMENCED WITHIN 60 OAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOEO OR ABANDONED fOR A PERIOD OF 120 DAYS AT � ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNI7S OffSTREET PARKING 1 HEREBY CERTIfV 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 TVPE OF WQAK WI�� 9E COMPUEO WITH WMETHEA SPECIFIED MEREIN Ofi NOT. TME GRANTING OF A pEqM1T 2056 1.O3 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqMIT fEE SAC CNANGE PROVISIONS OF ANV OTHER STATE OR LOCAI LAW REGUTATING CON• STRUCTION OR THE PERFORM CE Of CONSTRUCTION 7�F.75 Fire SC Z.O6 � PLAN CHECK FEE ?OTA� FEE icense C .00 82.84 $iGN4TUQEO�CON"A1�TOQOA1UTtiOA�ZEDpGENT �O�rEi WMEN PqOPEpI� V A�D HIS IS �OJJ PE MIT I � � I i / '-$�GN4TUqEO�OWNEQ���OWNERBU�IDEfi� �OATE� � BLOG N5�' f�ifE r � rrEw [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 1621 Camelot Lane I,egal Description: Owner Name & Address: Sam zaquinto Contractor:Northern Crest, Inc. Effective 1/1/98 � �T?����� Tel. # 572-2539 MN LICENSE # 2 0 0 9 8 41 5 Address: 8245 Polk St. NE Spring Lake Park, MN 55432 Tel. # 792-9364 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: tear off and re-shingle house and garage Construction Type: 24 square shingles Estimated Cost: $ ���Co (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: 1 1-17 - 9 8 AppLICANT: ��:�� Tel. # 7 9 2- 9 3 6 4 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ L°' .�.� Fee Schedule on Reverse Side $ �_ U(�� .001 of Permit Valuation (1/lOth%) $ , � �� $.50/$1,000 Valuation $ $1000 per SAC Unit $ �. C� L% $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 [ ] $� ��b�! C=�