AF - 43720SUBJECT P {�('J;""""`�.,.
City of Fridley 13665
, ` AT THE TOP OF THE TWINS B U I L D I N G P E R M I RE T NO.
r
� �y �����_ COMMUNITY DEVELOPMENT DIV. ��/ �
r � � PROTECTIVE INSPECTION SEC. w
� �
`� A� /'�'1 � CITY HA�L FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
.��'.� \i �.J
612-5603450 g�0-F15 7/23/76 � �
JOB ADDRESS 1681 Camelot Lane N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCfi. ZS 2 Harris I,3�Le Estates SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ron Prasek
3 CONTRACTOR MAI� ADDRESS ZIP PHONE LICENSE NO.
Brickner Builders, Inc. 6245 Ben More Drive N.E., Fridley �rJ�` "�)�
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO.
6 USE OF BUIIDING
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE � REMOVE
-«
8 DESCRIBE WORK „r„ ` '
Construct a 51' x 24' Dwelling and a 26' x 22' Garage
R.
PERA"rE P�RNtiTS REQt1�RE� f4R �� � DtViSiON REGd4RDING CU B
9 CHANGE QF USE FROM P�Ma�NG �T
HEATII�Gi AT DRtVEWAY QPENIN .
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 truss design. Boring and/or compaction tests may be required.
SEWER IACATION: (Approx. 10' Deep) 9' West of Manhole (Inv. 880.00)
Sewer to property line may be straight north of mar�hole as it angles from
wye to property.
WYE ELEV: 879.97 ����'��
TOP OF FOOTING: 883.47 Minimum
WATER LOCATION: �o� East of Se�r e� s ic ��� di��inQ call locai utilities
1N� CI?T OF FRIqtEY DOES NOT GUA�it/tNfi� TI�E T�Lf!'NONE - ElECtR(C - GAS EtC.
A C C URA C Y Of tJ'iILITY tOCAfEONS AND �LEVATiGNS.
THIS DAiA IS FOR MFORMA7lON PU4:tQ5ES ONLY ANJ R�.QU�RGD �` LA �l�
rERSONS USING R SN4UlD VERIPY TMi iNFOQMAtlON
N TME SIT�.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCWPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOC� FY'aIl12
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 1374 + 572 27,480+5720
ANY TIME AFTER WORK IS COMMENCE0. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALIS 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 �'43 � 2SS �Z�.. G3
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE R LOCAL LAW REGULATING CON-
STRUCTION PERFORMANC CONS RUCTION. � 5�-32. HO� a� , $350. OO
PLAN CHECK FEE TOTAL FEE
� � � L � ' 7� $33 . 20 __� $537. 63
Si ATUREOfCON'RACTORORAUTHOFIZEDAGENT IDaTEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
��� 4 � �'A��U �-�� _�� }
� SIGNATUAEOFOWNERpFOWNERBUILDERI IDATEI BLOG.INSP` DATE �
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* EXTERIOR ENVELOPE AVERAGE "U° COMPUTATION
s
OWNER: ��'�yI%I�S �pN/ELA �"De�% SCI� DATE / � � O ' �"
SITE ADDRESS: /C� �� C���LD t l�/U'e PHONE: S%/� 7$7 J
corrrxACTOR: ��'� c 1� AJ�e�'C �3�'LQeks /N�.
• Detezinine working square footage of each
1. Total exposed wall area...... � 3�.5� sq. ft. x .17 =
2. Toal roof/ceilina area ...... �/ �� sa. ft. x .OS =
Total exposed wall area above floor = /� �J' 7b
a. Total wall window area.......... ...............�....� � 4�
b. Total door area ... ..................... .......... ,�"S�9
� c. Total sliding glass•door area ........................:� �
d. Total fireplace .all area ........................ .... C. ti
e. Total wall framing area (average 1Q�) ................ ��..
f. Total rim joist area ....................... ........�/ /�
g. wall area above floor........... ............ Y �/'1-
h. wall area above floor .........................
i. wall area above floor ..........................
j. wall area above floor ..........................
Total expased foundation area =
k. Total foundation window area ........................... /Vd/�"
1. Total net �oundation area above grade ................. /f�
Determine "U" value of each wall segment
(e.g. window, door, each separate wall section)
a. ��,5' X ,�U�� , 3�5 � � % � �. %.S�
- � �. . ` -� � _ �_ , � 3 ,✓
b. s- ya X„U„ , s �. ,
�. s'�. �� X „U„ � ,��-° _ �/,��p'
d. �C,. �1���.� .,U„ , L L = �' ,�,��.�.�.,,�.ti
e. � �� • � X� ��U�� . I � ! '�t 3 • 7�%��,,�
�,
a
; ,... /� �.. X „U„ � � � _ . 7 Y
g. ,� �� > 7 � X ��U�� � � _ _ �� . ��
i �
h. X ��U�� _
i. X ��U�� _ '
X"U" - ;2f item #3 is the same as,
�` �or less than item #1, you
k. X"U" _ �f have met the intent of
� � SBC 6006 (c) 2.
�. . � � . � � X ��UU r �� � ... � j... ��._....__.,,� � �
a
3 . .................. ........ Total _ 3 S�. 0.lSf _ �
... �-
__�__ _ . ,
._ ..� _,�,....��-
. .
�
t rior Envelo e Avera e°U" Com utation
Ex e P g P
Page 2 of 4
Total exposed roof/ceiling area = / �
m. Zbtal skylight area ............... ...........
n. Total roof/ceiling framing area (average 10�)...
o. Total net insulated roof/ceiling area........... /0
Determine "U" value for each roof/ceiling segment
� � _"'-�
m. X ��U�� -
n. X ��U�� �
o. ���� - X ��U�� . 0 � _ �t, � �
4 ........................... Total =
If total of #4 is the same as, or less t
SBC 6006 (c) 1. .
�� - � .-�'
you have met the intent of
Alternate Building Envelope Design
To utilize the total envelope system method, the values established by the sum of
items #3 and #4 shall not be greater than the sum of items #1 and #2.
l. + 2. _
3. + 4. _ .
' WALL SECTIONS
°NOTE: Use 10� of opaque wall area for
fXame construction
TOPV I ET�J OF
FR1�iE [7�1LL
�
•. . • ;, �
.� �.—�' • � . .,
c. • _ '
:FSG. #3
.� ,. �4 ` �
--_ � � .
- ,� - .
� �. . �
. .
� , , d
� . .� • �
,5� � �
�
,J .
: ._ . . .
Page 3 of 4
Construction R-Value
1. Interior air film 0.68
2. %ti'' 0 • S�
3. - �''�" �S�
ti
4, yf � ��,,,_� I, r�1
s . "rt��.� , -��,�L .. a- C 7
6. Exter�or air film 0.17
Total
7. i�
..-------
1, Interior air film 0.68
2 . � /i. �� .S�
3. , 3 '� �/'.
4. '�ci�i�,�,�c.. yL,. /. /
5 . �i%��.►,:�v �� " �' `%
6. Exterior air f ilm 0.17
Total ,�/ ��
. � 7�
l, Interior air film 0.68
2. _ 3 2„ /%
� . .,�,,.,, - � 'v'" L y %
4.'�j��?�-�.- t�1'' /- /y
5 . �;�r,�s-�+:�,�. - �ic '` a. t �
.��
6. Exterior air f i1m 0.17
Tota� � � S',S'
�--�-. .
1. Interior air film 0.68
2.
3 . / �- ' /. �!
4. .
5.
6. Exterior air film 0.17
Total 2 _ / 3
. . • . � t e , r- � � ` ` a
• � �' 1
._.�"� ��j��� k , � ,� � � `.� . . . ` - � ,
,
/!(.�— , , . ` .
%� v • , ' .
^ ' b ' � I!! _
�., , . � �
Y . — ��t
. ltl •- `; • ` .`. � /(/^ .
FIG.. #4 /!( ts t ` •. I p , = /�/
�. - ii r �
� ..—,
' �C( X ^ .� l �r .
. /� ( _ /! � r. �l� _
NOT1.: Indicate type, "Tt" �value, depth and
� n1flC.nmPht �nf ;nc.,1a4•;�n � . .� .
T
G ^
• �
Vented
ROOF/CEILING
�:/�11 .
�
Heat flow
, up
FIG. #i5 . . . .
-:,�,�r ,.. - a-� � -�.�, � �n �1 �.
. _.�= �-.-=-� ---_� �.: �
• .1 �� � Q-'
Heat flo��� up . , ; �vented
� _ _FIG. ��6 .. .. . � �. ` . .
. 3 � : . _ 5� :
y� ,,,t'
. n l� ��? ��e'S.' '!z.�j�i
- t�---�1'�'' L_S.,s� . ��� '`
- .
_ , , r R F w� . . . . .. . �=r ,•.�
. �. �
I�O.?�V�Iv'TF.� . ,'
' •� . .
• . � HBII� `• � ' .
, : • • ' f low up .• .. . ' . ;
. ,� . . . ,. •
}*xr. j�7 � . _ _ . . .
Page 4 of 4
Construction R-Value
1. In rior air film 0.61
a. ��L�, � 0,c��
3 . . a �� `�,Q�,,,,,�,...� L Y
4. Exterior air film (still) 0.61
Total L6, Gc�
�--- �
1. Interior air film 0.61
2.
3. '
4. Exterior air film (still) Q.61
Total
l. Inside air film � 0.61
2.
3.
4.
5. Outside air film 0.17
Total
Note: Use additional sheets if more space is
needed for details and calculations
�
0
CITY OF FRIDLEY
APPLICATIOI� FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
) � �,�s ►
OWNER' S I�AME :%) � I'✓ �G�.�SE�%1 BUILDER: ,�GG�C,(!/ll�{ li' G% ��� G .
ADARES S : �' I �� U C� ADDRES S : ���.� �t°/� %���1' -C %%. ' F���G -C (/�
l
N0 :�(� O STREET : � �
� / 1 �� � �f �
LOT : � BLOCK : t/ ADDITION ��il°j � - ��rES
/
CORNER lOT: INSIAE LOT: � SETBACK: ��� SIDEYARD: l G
Applicant attach to this form �tao Certificates of Survey of Lot and proposed
building location drawn on these Certificates. r
DESCRIPTION OF BUILDING
To B : ;3sed As : ,f �!'G , �j��l%+
. / /
�-Q Front : .� � Depth : -� `.� Height : �O
Square Feet: ���7 Cubic Feet: ���8 �
• Fxont: �� Depth: L�`- Height: l d
Square Feet; � / � Cubic Feet: � � � �
� �
Type of Construction: J',� yj�� Estimated Cos�: �,�,_T �� �
. ,
To Be Completed; �� ��/ � � �� �
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all wark in str`ict accordance with the City of
Fridley Ordinances and rulings of the Depaxtment of Buildings, and hereby
declares that all the facts and representations stated in �his application
�re true and correct.
_ - ��- /
DATE • `� - / � - r% � SIGNATURE • � � �'�'°�-�' C/' �'�' �'�,--_�
(See Reverse Side For Addi.tional Information.)
' � �`r��. ��
0?,3�� �t-�ic C�.,r 33 • a a
�S� a�.� a � , � 3
S�G c3�J �. O d
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5n��`c' ,�47; Q-'�' S
��,�6 J<<D� c�.� c� c. �� f �
CcSY� y b� � c.c. �i 5 ,� sr� ..�
„Z�i ��Ci�"r� °'"��p'� c.✓� . .
Z,G � ���1c..y G�.- .
� r�c� r
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Main Office 571-6066 1
� UBURBAN 6875 Highway No. 65 N. E.
�a NQINEERINa Minneapolis, Minnesota 55432
1 NC.
� South Office 890-6510
� Civil, Municipa! & Environmentat Engineering 1101 Cliff Road
� Land Surveying • Land Planning • Soil Testing Burnsville, Minnesota 55337
�
'� '�,( �t�
, F�' / .. .. ..
� �
Mr. Dave Harris
��L
6279 University Avenue NE
�=ri ci i ey, i�ii nnesoLa �5432
August 9, 1976
Re: Lot 25 Block 2 ��'n`l��
Harris Lake Estates /(�/ ��Z.�.�...���
Dear Dave:
At the request of Ron Holden, City of Fridley, on August 2,
1976 we ran a density test at footing grade and found 91.2�
modified Proctor density.
The footing elevation at the rear of the house was 3.0+
�eet below the front footing. The City, using a hand auger,
Mad determined the underlying soils were a natural sand as
Qxpected on this lot.
Based on the above, it is our opinion that the foundation
material is satisfactory to support the typical loading of a -
single family framed dwelling.
If you should have any questions, p1ease call at your
convenience.
PJM/jp
cc: City of Fridley (Darrel Clark)
S i iicere�y,
SUB BAN ENGINEERING, INC.
� �
Peter � olinaro .
Project. ngineer
0
�:ubrrl Alinder. lteg. F,ng. F.'. A. fta�h6un, Reg. Suru. 4S'nt. E. Price, Reg. Eng. Gary K. Harris, Reg. Suru.
Wm. h.'. -Jrnsen, tteg. Eng. Wm. K. Meyer, Xeg. Eng. ' H. Wiltiam Rogera, Reg. 3uru.
CITY QF FRIDLEY
APPLICATION FOR PLllMBING AND GAS FI'TTING PERMIT
N j, y '� � . oc v Water
-Q �°' � y Q '� o, w � Heater
jIJ .i �� N F •.i �C fa N �3 1� O. �
•.1 7.� c� ', c m x a! v 7-� .0 G F a: K
Sd U:� ..�i J�.1 4 � t�/l •.1 � 0 O 1UJ U� N UI N N .0
.�u ,-� ,-°� u ro m •�+ ro*+ o.c � ro m a ro ro •� � " as 'lec
cn t� � ta at m 3 o t�, �n t..� c� p �2 3 c� �.. C� o
� / � /
lst
2nd
3rd
4 Uz
(R) = Fliture Connection Opening Connected with Sewer
(*} = New Fir.ture, Old Opening Water
PARTIAL RATE SCHEDULE
PLUtiiBItiG FIXTURE RATES:
:.s.:�ez Fixtures
F�ture FiYture Ooening
New Fixture, Old Opening
Catch 3asin
Wate:: Heater. - ta 99,000 BTU
i.00,000 3'TU to 199,000 BTU
Wa*_er Sof tener
I�ew Groud Run Old Building
Electric Water Heater
GAS FITTI\'G FEES:
lst 3 fixtures
Additional Fixtures
Gas Rar.ge to 199,000 STU
REPAIRS $ ALTERATIONS
First $100.00
each add. $100.00 or fracti.on
N0.
�_ x
-�-- "
x
x
x
x
x
x
x
RATE
S3.Q0
SZ.00
$2.00
$5.00
$5.00
S10.o0
S7. o0
55.00
$5.00
TOTAL
�3� �l�
$ �co a
S
$
S C�G" _�
S
S
$
$
x $3.00 $ �Q�
x 51.00 $
x 510.00 $
State Surcharge
TOTAL FEE
55.00
$2.00
S
$
$ .50
$ �J.� ,S�i
:LVe+=
Job Address �/ '� i� E����'La-x a�
�
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work hezein
specified agreeing to do all work in strict accordance with the City Codes
arid rulings of tha Dcyartment of IIuildii�gs, aiid hereby doelares that all
the facts and representations stated in this application are tzue ar.d correct
Fridl�y. M:�. � / � e 19 /�
/� �
OWNER �,/j/ (o����,,,�
KIND OF BUILDING
JSED AS
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEW BUTLDING PERMIT NO. PERMIT NO. �(-'J '!�_
Company �
Signed By ~ u��
Tel, No. " �' p� r% `dc�i ��
ROUGH INSP.
Date
FINAL INSP. l U-�. I' 7�
Date
APPROVAL POR P�RMIT �fG'
MINTMUM FEE FOR ANY PLUMBING PER'"1IT IS S7•SO
� REINSPECTSON FEE
. ($10.00)
�...,., _...__-�..�__._� ..._�._._
_-- ,-._ . . __....._ �_.... .__._,.._. -,.,.. __�..._ ._
_ .. . �__.
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTIL�TION, REFRIGERATION AND
AIR CONDiTTONIN6 SYSTEMS AND DEVICES
PA�TIAL RATE SCHEDULE
GR:aVITY WARhf AIR:
Furnace Shell S Duct Work
Replacement of r^urnace
Repaizs & Alterations-up to $500.00
Repairs & Alterations each add. $500.00
i�1ECHANICAL WAR�I AIR:
Furnace Shell & Duct Work to 100,000 BTU
each add. 50,000 BTU
Replacement of Furnace
Repairs & Alterations-up to $500.00
kepairs & Alterations each add. $500.00
STE�.'�1 OR HOT WATER SYST�'�I:
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTL'
Boilez only up to 100,000 BTtS
each addn. 50,000 BTU
QIL BURVER- to 3 gal. per hour
each add. 3 gal. per hour
RATE
Siz.Oo
7.00
7.00
4.00
Si2.00
4.00
7.00
7.00
4.00
$12.00
4.00
7.00
6.00
Sio.00
10.00
TOTAL
S
$
$
$
S �7. �'e'
S OD
$
$
$
$
$
$
$
S
$
GAS BURNE R- from 100,000 BTU to 199,999 BTU 510.00 $%�rOU
(over 199,999 BTU see Fee Schedule) $
GAS FITTING FEES:
lst 3 Fixtures � x$ 3.00 $.J��
Additional Fixtures x $ 1.00 $
Gas Range to 199,000 BTU _ x$10.00 $
AIR CONDITIONING � S
FAIQ HEATIIG SYSTEhtS ' See Fee Schedule $ '«C)
VE�?TILATII�G SYSTEb1S 1 $
ALTER4TI ONS $ REPAI RS _) S
State Surcharge $ .50
/ �/T `� / ,pA7i✓ l/�ir/i TOTAL FEE $-'���
ROUGH INSP.
Date
FINAL INSP. � ^ �- 3-�%/
Date
APPROVAL FOR PERMIT �%�,/�
REINSPECTION FEE
(.$10.00)
MINIMUM FEE FOR ANY HEA7'ING PERMIT IS $7.50
Job Address ���� ���f��� �
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work iierein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all the
facts and representiations stated in this application are true and correct.
Fridley, Minn. �' �/ , 19/ ;(O
OWNER �/�' I(�/C /U cy� �Gl /� L C�dC- cS �.•t:' L
KIND OF BUILDING �)�� /�/c.�7�
USED AS �ELC��1%
TO BE COMPLETED ABOUT '�� �� �C�
p,f s�
ESTIMATED COST �al/D'—
OLD NEW UILDING PERMIT NO. PERMIT NO. (p /J 1
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. �G% /,�,i C: �1�rv/'�
Trade Name (�F�f�PAG ��t"e'T.e/(� size No. �Gl ,�7�3 C?��i �
Capacity /�.��� Sq. Ft. EDR BTU HP
Total Connected Load
BURNER - Trade Name
Capacity Sq. Ft. EDR
Kind of Fuel /�/� T
Size No.
B� HP
�Company �n' v � L�
Signed By � �
Tel. No. � � -�`�-��
�l fy O 1"t GY Iey
U U
ANOKA COUNTY
560•3d50
6431 UNIVERSITY AVENUE NE October 29, 1976 FRIDLEY, MINNESOTA 55432
Brickner Builders, Inc.
6245 Ben More Drive N.E.
Fridley, Mn. 55432
Ree 1681 Camelot Lane N.E.
Dear Sirs:
A final inspection of the above address was made on October 2?, 1976. The
only item noted that was not complete was the installation of sod in the
front and side yards. We will expect the sod to be installed by Jurie 1,
1977 when a reinspection will be conducted to determine compliance.
If you have any questions on this item please feel free to contact me at
571-3450.
Sincerely,
RON HOLDEN
Building Inspection Officer
�/� .
sue�ecT PERMIT .
City of Fridley 18490
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
; � RECEIPT NO.
� • COMMUNITV DEVELOPMENT DIV.
' �ti:- /
r � � PROTECTIVE INSPECTION SEC. Q
i �
� -� ,�/'�';,� CITY HALL FRIOLEV SS432 NUMBER REV. DAT PAGE OF APPROVED BY
` ��� � � 612-571-3450 910-F15 ���' r�lO / /
10B ADDRESS 1
, g( C R✓�'� �z. �— U �F} 1J �
t IEGA� LOT NO. BIOCK TRACT OR ADDITION SEE ATTACHED
DESCR 2S 2 (�,� 1...,�� r' � SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
� � �o Ptz�-S � �.
3 CONTRACTOR MAIL ADDRESS Z�P PHONE IICENSE NO.
C� R2 '�' S��P � �
4 ARCHITECT OR DESI NER MAIL ADDRESS ZIP PHONE . UCENSE NO.
--�
5 ENGINEEfi MAIL AODRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
�--�(j c1��
7 CLASS OF WORK
❑ NEW � ADDITION L� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCFiIBE WORK
S 57`c� tt �}G �L i0 F3 Y c-� �,.� (k� c-..)
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELEC7RICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY IOAD
VENTILATING OR AIR CONDITIONING. �Q��M ` �-' �
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 �_ 1 �_`
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT U
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STAL�S 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. 7HE GFANTING OF A PERMIT V�, U U �J
DOES NOT PRESUME TO GIVE AUTHOFITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � U
� P�AN CHECKFEE TOTA4FEE
. SIGNA UR F CONiRACTOR OR AUTHOqIZEO AGENT �- /IDATE� �� �- � /� U
HEN PROP LI TED THIS IS YOUR PERMIT
_ . ��� —K�
SIGNATURE OF OWNER IIF OWNER BUILOERi IDATEI BLOG WSP qATE
�_ __._ _ �_ . . '
4
�
/CG� � l.�,nL�sl� �� ,
�•�d no����y �/////I//>%/ 6�)S N�..er No.st N.E.
lond S�►v�y��y
� M�I111t6POIi1,
s.�i, T�s1�n� � ii��//I'f'IlJIl�� •!l!'. M���. ss�ai
Civ�l Ee��e��.�e9 `, T�leplqn� �i�-OOOA
Mve��ipol teg�ne�.ino Engineers k Surveyors Aree Cede A1i
Mortgage Loan Survey torBR�CKNER CONSTRuCTION CO.
�
11�
r-
Cr
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�
lo r
i
i"
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( 6
y��
��t 1.a a'i t� R�� I� S I�.�
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h �qR -o '2��� .i�% �
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(�- � 2-86
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C.� �
LoT BLOC K�
� MAaars LAxE Es,-AT�s
Anako �'ounfy
TAiti is a♦►u• and co•r�tt r�pr�ftw�af.M 01 e►u.v�r •� Me b�w�dor��ti o{ the land alow d�se.�Y�ed ond d 1h•
I�cati�e of eN rv�{d1ny�, �f awy, tb�r�on, ond oll v��ible enarO��brh�nH� N ony, h�m sr on ►o�d lond Thi• sur�y i�
wwde ��ty in �onn�c�ioe w.�h o nwrt���r l�ew n�«r b��nq ploced on �b� proper�y and no I�ob�l��y n o�sv�w�d
eac�pt » tl�• hold�� o! wcA rr�or�oe�e �r �y o�he. iwts�es� ocqu.��d by �h� •�es�n o/ �vcb w�o.�yoqe n�s
v��s��ed �nd wq.��� .w�,w,we rs Aove i���.wloi�d 10. Me p�rp�fr oi rsro�li�bmy 1�� hnes er b��wdery
c��n��a. Dal�d rl.is ror ef�,� 0. IV�{O
SU�UR�AN tNGlNEERING, INC. N �
-- 0�►�s �C � u��G�y caxmc�s ���:..�- � v� <s�� Scn 1=40
►r L,. �
�---�e
L�lt. �y
--- - ..�_._.,;
�
ADDN.
AI,T ER .
� �
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[l
City of Fridley
I R-1 AND R-2
Building Permit Application
Effeetive �/1/86
\
Construction Address : / (O d � �4 ri'I � �� / � a `I �.
Legal Descript3on• �0'`Z..s �L�L-�L Z+ �-��CL�.1S i�fTl��, �'��f��
Owner Name & Address : / � � � �d ��Q S � �C T�1. �
Contractor: Ctru �Q�IS��C,� Tel. � ' �%%
Address• �-<'7` �0 s ul`�� �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to seale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECR AREA: Length Width Hgt/Ground Sq.�Ft.
OTHER : �-�-a-rti2 c �e � �I e + �au �1.� ► n� 6 w � x /S � �
Corner Lot [] Inside Lot [�] Ft. Yd. Setback Side Yard Setback
Type of Construction• �1 �'� �rGtvyl � Estimated Cost: $
Approx. Completion Date: u 1 �� �� y v
Alt. A Alt B
Proposed Driveway Width If Ne�r Opening Is Desired: $ $
See Back Page for Explanation
DATE: �-��- ��
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
APPLICANT: !/�- Tel. ��5��5�-9�79
CITY IISE ONLY
$ � J��� Fee Sehedule on Reverse Side
� `�.
� ,S�
�
$
$
$ �5,5 �
25� of Building Permit Fee
$.50/$1,000 Valuation
$475 per SAC Unit
Fee Determined by Engineering
Agreement Idecessar3r I] Not Necessary []
,,. . , �
sue�ecr P E . ,
City of Fridley 210 7 0
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
i � RECEIPT NO
� �
� • COMMUNITY DEVEIOPMENT DIV. `' /_
' � V O (C/
r � � PROTECTIVE INSPECTION SEC. , �
�.--_�; ����;'� CITY HALL FFiIOLE� 55432 NUMBER REV. OATE PAGE Of APPROVED BY
612-571-3450 910-F15 9/19/91 � �
JOB ADDRESS 1681 Camelot Lane NE
1 LEGAL LOT NO. BLOCK TpACT OR ADDITION SEE AT?ACHED
DESCF. 25 2 Harris Lake Estates SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ron/Jennifer Prasek 1681 Camelot Lane NE 571-6291
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Jansick 6480 Squire Driye NE, Fridley ��S�B 55432 574-9679
4 ARCHITECT OR DESIGNEF MAIL ADOflESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDFlESS ZIP PHONE LICENSE NO.
6 USE OF BUIIDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Constxuct a 14' x 19' Addition
9 CHANGE QF USE FROM TO
STIPULATIONS
Variance a�proyed Septemb.er 9� 1991. No construction can be located
withizz ths 15 foot drainage eas-ement,
��"� f°' ��;�� � ' �.
Es � 1 it iitE` �
� E�qRA�. 8efiore d;gging r� ftX
�RI11�(�;� �� EI�M/]'S � a11 u454-fl�OU��
T�N+�. P�vMB��R�o fio R�QU�RED Bl� �#'�!
l/y� ANo S .
��:
TYPE OF CONST. OCCUPANCY GRQUP OCCUPANCY LOAO
SEPARATE PEfiMITS AFE REQUIRED FOR ELECTqICAL, PLUMBING, HEATING,
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULI AND VOID IF WORK OH CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHOR12ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIO� OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THA7 I HAVE READ ANO EXAMINED THIS APPLICATION 1 STALI.S GARAGES
AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVfS10NS OF LAWS VALUATION $URTAX
AND ORDINANCES GOVEFiNING THIS TYPE OF WORK WIIL BE COMPLIED $lO � S�JO SS.43
WITH WHETHER SPECIFIED HEREIN OP NOT. THE GRANTING OF A PERMIT
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHAFGE
PROVISIOIJS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $�-ZC.00 Fire SC $I.O. SS
PLAN CHECK FEE TOTAL FEE:
• ,L /� � _ - c $142. 28
SIGNATURE ON'RACTOpORAU7HORIZEDAGENT IDATEI WHE PROP � I ED THIS IS YOUR PE//RM��IT
iSiGNATUREOFOWNEPi�FOWNERBUILDEFi �OATEI� 9L �NSP "FT�
.����
1�i�J � �
�� [ l
l�l At�ID R-2
Buildin� Pezmit �lpplicatian
Oonst�nx.tion AddL�ess: �� �� c.,-fiflc"L�1T ��(..3 i(/'�
Effectiv�e l,/1/91
Legal DesaiPtian:
Owr�er Na�e i� Ac3dr+�ss: ff 6.tJ 7` �E��t!/�C�� ��5�'K 'I�el. �� 7i — lv�/
oor,tracto�: _� sic,� Te1. # S7�/— 9GT �
Adciress: � �/�f> �S C� C���P ,�� . �/C'/„c► L�S—
1,ttach to this applicatian, a Oeztificate of �v+�y of the
lot, urith the p��oposc�d �icn drawn an it to acale.
!� r_�.; �VM •, •r �.�i���1-'���"�t
z.ivn�c �►�,: �nytn /y wiath � Ke.i.�t 8' sq. Ft. Z�a. ao
t�iR� ARF�,: Iength i�li,dth Heic�t sq. Ft.
�C'iC aRFA: Le�c3th Wi,cit�h i�gt/�otu�d Sq. Ft. 1s�s/
0►�t: �e,Pe� �STdP.�a�E ,�d�' �? y0 S�G'► �'T
Cbrner ldt [] Inside Lot [� Ft. Yd Set�aack Side Yazd SethacJcs
�Ype of �ion: a e s' P�,�-tamated Cbst: $.•?!��
. �
Approx. o�letian Date: /(�, ��1
��q.�osea nriveway wia�nn if rrew openir�q is n�' . Ft. S S
Width + 6' See Back Page
DAT� : 9 /Z y APP'LIC�tJr: � Z�el . # .S',7S/ - 9� �
Io�` •Uv �rrsr �s aa�Y
�t F� s �.'
Fire S�rd�atge $
State Surd�rge s .
sAC C�aYge $
D�iveway Escrow $
park Fee $
Sewer Main �ge $
�, $ ��ra.�
P�ee Sci�le an AeveYSe Side
.001 x Pexmit Valuatian (1/lOth $)
$•50/S1,000 Valuaticn � :
$650 per SAiC ifiit
�ilt. "A" C� Alt. NB" Abvve
Fae Deteim? .*� b!' H�4ineerin'1
� �tY I ] �t N�e�a�' I ]
���:
u,��,. ��R. ��" 9, I 9� I ,
ST�� � N4 Co�S',n u�'���, C�� ��
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�C��l L.��,�1'��v ��,
lnnd Ptann�ng � � 6875 N1 wa No.65 N.E.
land Surveying �*�,,,�'��, � • . � Y
g /' �,��„���'�,� �� ���n• Minn�apofis,
Soe1i Tesfin �` � I� � Mi nn . SSi�i
Civil f�gincering Telepiqne 784-6066
Municipal Engineer�ng Engineers & Surveyors A��a Code 614
Mortgage Loan Survey forBRICKNER CONSTR�CTtON C(?.
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AR/ZI S LfiKE ,ESTi4TE5
�Inc�so �'our�ty
This is a t�ue aod cor•ect reprefeo�af�on of o�ur.ey o� thc boundar�rs of the land above descr�bed ond o� th�
locotioa o4 all buildinys� if uny� thtreo�+� a�d a�l v�eible er+trouthmenfs� if uny� (rom oi on taid lond. This �urvey if
mode oely in connucfion wilh a mortypy� lona now ba�ny ploced oh the propr��y ond no Iiobil�tr �ti o�sumed
e:cepe to /he holder of s�ch mortyoge m o�y otha. iMerest acqu�red 6y the reatio� o} suth mo•�goge. It u
undersfood ond c�greT� .�onumer�ts have bee.+..pJa�ed /o. rhe purpoee ol rsrob��+h{ny let I�ne} or boundory
corner�s. Doted tFr�s doy oi ��'_!t�q__ A. 0. 19«p
� ' SUBURBAN ENGINEERING, iNC. C�� �1 �� /�� �
(�� t � 1• / / En9irvea�.c� .. . .SI,�L Q�. JW'Y�� I �'7�
—'"'" l/1C/IUTQ�"i �YOl�10f02 1 Ur1�ITU QUSEII'71e17i$ • by�y_ ." �._..__. il_�_�`:�i E-' -. �
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SVBJECT RMIT NO.
c�ty of Fridley � t�. �� 9
AT THE TOP OF THE TWIPIS g � I L D I N G P E R M I T
f
; � RECEIPT NO.
� ; y___�__ COMMUNITY DEVELOPMENT DIV. ��
r i � PROTECTIVE INSPECTION SEC.
� �
� � /'��1 � CITY HALI FRIDLE�' S5432 NUMBER REV DATE PAGE OF APP OvED BV
�""'�"� �'� b12-571-3450 910-F15 10/4/95 � �
J08 ADDRESS 1681 Camelot Lane NE
t LEGAL LOT NO. BLOCK TRACT OF ADDITION SEE ATTACMED
DESCR. 25 2 Harris Lake Estates SHEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE
Ron Prasek, 1681 Camelot Lane NE, Fridley, MN 55432 571-6291
3 CONTRACTOR MAI� ADDRESS ZIP PHONE UCENSE NO
D& D Home Improvement, 7401 Central Ave., Fridley 55432 784-7543 4840
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAtL ADDRESS ZIP PHONE IICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION �J REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WOFiK
Tear-off and Re-roof
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEAT�NG,
VENTILATING OR AIR CONDITIONING.
TNIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. fT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OF IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UN17S OFfSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALIS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFiK WILI BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1.6SO State SC .H2.
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVI S Of ANY OTHER STATE OR LOCAL LAW REGUTATING CON-
STR TIO �OR THE PERFO A CE OF C�NSTRUC�IQN SL}.QQ Fire SC 1.65
PLAN CHECK FEE TOTAL F
�� Lic 7
51GNA�URE OF CO�t'RACTO�:OR AUTMOAIZED AGENT I TE �I1/ N OPEfi Y• DATED IS VOUR PERM T
, C 4�
SiGNATUREOF OWNER�iF OWNERBU�LDER� IDATEI INSP 1aTE
NEw
ADDN
ALTER
C]
�)
[l
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: ,��0 S� �/,7;�6��� J /��
Legal Description:
Owner Name & Address:
Effective 3/1/96
���( �-
Tel.# �7/-loZ�'f
Contractor: D& D Home Improvement , I nc MN LICENSE # a� q n
Address: 7401 Central Ave NE Fridley, MN 55432 Tel. # 784=7543
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IlVIPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks �
Type of Construction: /QD� ��A7,� ,��� o- Estimated Cost: $�, t/ S
Approx. Completion Date: �p�3� Q'� T���� o�� �S�u��GS
-r—.-
.(Cost on Back)
Driveway Curb t Width Needed: Ft. Ft = Ft x$ _$
DATE: APPLICANT: Tel. # �'���5��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ .�" ���
$ �, �
$ � �c�.
$
$ .5n�
$
$
$
$
$ C� � • ��
CiTY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$900 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 [ ]
. �
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572•3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEYICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
A1so Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1 Jo of Value of Appliance or Work
Commercial/Industrial
' 1.25% of Value of Appliance or Work
�
Rate TOTAL
$ 30.00 $
$ 10.00 $
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAI.FEE
MINIMUM FEE FOR ANY HEATING/CO�LING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effective On January 1, 2000
JOB ADDRESS i�� I �(� VY�Q_ � C�� �/ V�
.n
OWNE
BUILD
ESTIMATED COST ��� f�C� PERMIT NO.�'tiiF�Y
DESCRIPTlON OF FURNACE AND OR BURNER
$
No. of Heating Units_, Circle One (Steam) (Hot Water) (Warm Air)
$ Trade Name Size No.
BTU HP EDR
$ 25� � Fuel ,_ Total Connected Load
$
$
$ .50
$�.5-�
Burner Trade Name Size No.
BTU .^ HP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do a11 work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
' DATE !%�.� �C / ( ��
HEATING
Signed
Approved By
�vc �trvrRF�L A . N,E.
��a��, �.�R, s. � E� # ���- �aba
�
f�ough-In Date Final Date c� �
�7
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacina an existina furance, 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 cuRent codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (�, No ()
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 Fumace Venting Tables for fan
assisted and natural draft appliances.
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to instali a new combustion air. it will be sized and installed
To meet the current codes and manufacturers specifications.
When installina a new ventingsystem, 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 Furnace
Venting Tables for fan assisted and natural draft appliances.
Yes �J No ( )
Yes (� No ( )
Yes (�T No ( )
.r�
Yes (� No ( )
Is the common vent and vent connectors sized and instalied correctiy after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes'(�, No ()
r
Appliance Tvpe and Size/Common Vent and Vent Connector Information
55�.���o3a
Appliance #1 Type B�ti-inpdt ��� � �� Fan Assisted or Nat _ G���
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Tota! Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
r
� �
-
_
CIlY OF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRiDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
August 9, 2000
Ron Prasek
1681 Camelot Lane NE
Fridley, MN 55432
Re: Final Inspection at 1681 Camelot Lane NE
Contractor: Blaine Htg. A/C Elect., Inc.
Dear Mr. Prasek:
A mechanical permit was issued on June 19, 2000 for the property located at
1681 Camelot Lane NE for an air conditioning unit. According to Section 305(a}
of the 1991 Uniform Mechanical Code a final inspection shall be performed on
the mechanical system. As of this date no inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do
not hear from you, we wilf expire the permit and any inspections on this
instaflation will require a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
� �. �/� �� 1
��
: • lr •- •
Building MECHANICAL
Inspections RESIDENTIAL APPLICATION
�63-s�2-3604 CITY OF FRIDLEY
763-5�2-4977 FAX EFFECTIVE 2-19-09
DATE � "-
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
L ADDRESS
Permit No.:
Received Byi� �
Date�'�: a � � n g
ADDRESS: C1TY STATE ZIP
PHONE: � L �.
COMPANY NAME:
CONTACTPERSON:
STATE LICENSE # XP DATE
ADDRES : CITY ,iDDYI �-L7/D STATE�LIP
PHONE ��o� ��"I '-r �v � FAX _ __
C�SINGLE FAM[LY ❑ TWO FAMILY
v -
❑ NEW �REPLACEMENT
��1.fi :�.�
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
0
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (CNDICATE TOTAL NUMBER OF EACH BELOW)
Equipment tnstalled MFG: MODEL: SIZE/BTU
MFG: MODEL: S1ZE/BTU
MFG: MODEL: SIZElBTU
A/C $25.00 FIREPLACE (GAS) $I5.00 GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 ____NEW GAS GRILL $10.00
BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00
_CHIMNEY LI1�3ER $10.00 �GAS DRYER $10.00 lPOOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING 510.00 _VENTILATOR $I5.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VAUD UNTIL PROCESSED
I hereby apply for a building permit 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 this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all ork which requir review and approval of plans. .
SIGNATURE OF APPLICANT ��� �`+`�sC ��"'i `�r I PRINT NAMEJ ` n I�Ci �� DATE �,��,L� J� �F�---
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
�
Building MECHANICAL Permit No.: �
Inspections RESIDENTIAL APPLICATION Received B-
763-572-3604 CITY OF FRIDLEY Dat��`�' ``' �
763-502-4977 FAX EFFECTIVE 2-19-09
DATE I aI (( YOUR E-MAIL ADDRESS
SITE ADDRESS I L4 fi ( ��u !"+ �� o� � � N. C.
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY N�: Ron Prase {c
OvVNER/ ,a,DDx�ss: f Co K l C a,.,-.410 � L� ct�r �r) �t � �-� STATE/11 /l ZIP SSy��
TENANT PHONE: 'I Cf 3' S% l^ LI `.� �I � -T
CONTRACTOR COMPANY NAME: Tachnnloaie3. Ir1C.
I fearth � Home
SUBMIT A COPY OF COrrI'ACT PEitSON: dba Fireside Hearth & Home
icense
YOUR STAT'E STATE LICENSE # EXP DATE �nn N_ Fairview Ave.
LICENSE WITH ADDRESS: CITY Roseville, ��AN 55113 STATE ZIP
APPLICATION
PHONE FAX '
PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: J��W ��PLACEMENT 0 ALTERATION/REMODEL
DETAILED DESCRIP'fION OF WORK ` n � 1� a ; c la c e ti. � n
FEES ARE BASED ON $10.0(i PER FIXTURE, EXCEPT WHERE NOTED. FLYTURES: (INDICATE TOTAL NUMBER OF EACH BELOR�
EquipmentInstalled MFG: N�a� n C.Id MODII.: �n f � X� SIZEBTU '��lJ'tT0
NtFG: Q�lw�.rc. F'; � e Mon�,: C olwr•b: A Q a-� siz�B� 3�
MFG: MODEL: SIZE/BTU
A/C $25.00 �FIltEPLACE (GAS) $15.00 GAS RANGEOVEN 510.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL S 10.00
BOILER $35.00 FURNACE $35.00 GAS UNIT HTR SI0.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATETt $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VEN'1'ILA'I'OR $15.00
Number of fixtures �$ i 0.00 � x� I0.Q0 =$ o� d. �
Number of fixtures @$IS.OQ o� x$15.OE! _$ 3 D. U'U
Number of fixtures @ 525.00 x$25.Oi? �� ;.
,;,�
�.
Number of fi�ctates Q 535.O0 x$35.� =�
Sta�te Surcharge = $ .50
FEE S35.S0 TotaJ = � �C�. �Q
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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 this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved pian in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT� �....--�- i�i✓1-� PRINT NAME 1C �VI /1 r'/'i � b 1 G DATE � / ��
-� -a
PLEASE NOTE: SEPARATE PERMTTS ARE RE UIRED FOR BUILDING, ELF.CTRICAL ANI� ML�iCHAMCAI: �E)RK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977