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F�axL-.th�eoP, shatl �caa�%� fr� a11. reape� to:the �rrdi�ice�-�+u�° ; c1ie�, �iix�rzesota re�a.rc�ir�� ioca'E�, co�ns't�tt�etion, altera�to�c,-m�tenai�ce, r�p�3r and. t�v€ng of .buildi�a� wat�t �.: :he villag�, liimx#.� a�id '�iis P�r� may i'� s�evo�` �t a� time upon vialation lsf ariy of, �iie prtiui�tcfins_ of sa�td , Iia�t�ceS �` _ *' _ _ �� °� ° _ :�: : ..�..: ,, b �"� � . . �3uilc�ing 2��sp�etoic � .: � ti , - �- -°. <,� . E. � .m ��_ _ z• : _-. - . ,... - t�lQ'F��E, - - _ � - `'�''h3s p�'rmf� d'Qe� not caver e Cnrastr[[r��ion, in�itatla�don ,o� `at#era�ticn fn� � � ttsg, lr�u�€�ttng, 9as. he�ting, : sev+rer a�`vdater 'Be sure �e� s�e �ctil��ig ittspe4tor f�t� separ�te perr�i#s i�� iterns.: - _ �� ° � _ _ �. = ��.....,.„ �_ � - , . ;.� :; " : : ' <� City of Fridley SUBJECT AT THE TOP OF THE TbVINS g U I L D I N G P E R M I T r i � ; �L ______ COMMUIVITY DEVELOPMENT DIV. r j � PROTECTIVE INSPECTION SEC. 1 , , `.�__� ��""�� CITY HALL FRIDLEV 55432 NUMBER L 612-560-3450 910—F15 JOB ADDRESS 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. 6 3 S 2 PROPERTY OWNER � \AAII Ann�[�nn Lubanski 3 CONTRACTOR Richard Has 4 ARCHITECT OR DESIGNER 5 ENGINEER B USE OF BU 7 CLASS OF WORK 8 DESCRIBE WORK Reroof 8 CHANGE OF USE FROM STI PULATION S REV. DATE PAGE OF 6/14/74 � � �� 12592 RECEIPT N . /�� APPROVED BV SEE ATTACHED SHEET __NE 6201 Carol Drive NE. MAILADORESS :ZIP PHONE s Company 6331 Ri.verview Terrace MAIL ADDRESS ZIP PHONE MAILADDRESS ZIP PHONE LICENSE NO. LICENSE NO. LICENSE NO. � NEW ❑ ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE TO �,�Q�R;ATE PER(�ITS REQ.UIRED F�R �IVIRI[�G, �9��Ti�1�, Pt�NEB6�fi� ��D �I.�NS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. VENTILATING OR AIR CONDITIONING. Sr1111GJ�.@ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROV9SIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. $ 7? 5� WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- (.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ' �� e PLAN CHECK FEE � SIGNATURE OF CONTRACTOR OR AUT ; RIZED AGENT IDATEI �.-�.,�.. _.._. A � BUi OCCUPANCY GROUP OCCUPANCY LOAD S�. FT. CU. FT. OFFSTREET PARKING STALLS GARAGES SURTAX .50 SAC CHARGE TOTALFEE 6. 50 RLY VALIDATED TH S Y R�RMIT '" � � APPLICATION FOR RESIDENTIAL, ALTERATION, OR AllDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER' S NAME :_ L �t i� �11f/ S�i BUiLDER:_ L�� c�. p� t� H�S'� �`I�C �' C� > ADDRESS :� 2 ca / ��e 12 o L � i,� . ADDRES S: 6 33 r I�. �s �'2 ca d �+� �� Ae h� � NO :._ � o/ STREET : C A� o L � Z, LOT: � BLOCK: � ADDITION: S'� �!?� v� o r� /�-ciel; ��°�n� CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: BESCRIPTION OF BUILDING Fxont: Depth: Height: Square Feet; Cubic Fee�: Froni• Depth• Height: Squaxe Feet; Cuba.c Eeet: Type of Construction: l� � f�� != Esti.ma.ted Cost; $%�7'.�° To Be Completed: _ G �je �> � � The undersigned hereby makes applicatinn for a permit for the work herein specified, agreeing to do all work in stxict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and h.ereby declares that all the facts and repxesentations stated in this application are true and correct. DATE : �� ' � SIGNATURE t_ _ ^ �� (See Reverse Side �or Additional Information.) (�O '�`J �,� . �'� .��"".__`_�,� � �. �"� e e BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before issuing pernaits fox the erection of any building or structure, or for any addition to any existing building or stxucture, or for any alteration ox repairs to any existing build�ng or stxucture,.upon application therefore, xequire the payment by the applicant for such permit of fees to the amount hexein below set forth and in the manner herein provided to-wit: UNIFORM BUILDING CODE: Type 1, Z& 4-$2.15 for each one thousand cubic feet, ox fraction thexeof, in such cubical contents. Type 3& 5-$1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION Fox the purpose of computi�g fees fox building permits9 the cubical contents ot any building or addition, is determined by multiplying the ground axea covexed from a poin� six (6) inches Uelow the floox line of the basement or the cellar to the average heights of the upper'surface ox L'o the average.F height of the roof surface of the main gable of a pitched roof. Fox repaixs or alterations to an existing stxuctuxe, the fee shall be at �he rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. In no case sha11 the fee charged for any permit as set forth in Section 2 be l�ss than $5.00. VERIFICATIQN OF FOUNDATION NOTE: Permits for constl��ction will be issued a minimum of 24 hours from the t3.me of application, to allow for pxoper xeview of the pxoposed structuxe and of the construcCion site. • A Cextified Survey of the lot, showing the location of the foundation, once it has been constructed, wi11 be xequired before proceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a Cextificate of Occupancy shall be made ten (10) days pxior to the use or occupancy of any structure fcrx which a building permit has been i�sued; and said strucfiure shall not be used or occupied until a Certificate of Occupa�cy has been issu�d. � � a - . -� � � • � ' ' sue�eci � , PER c�ty of Fr�dl�y 2 8142 A7 THE TOP OF TME 71MINS" �� L D 1 N� P E R M I T r � ` NO. ; `y ___._ COMMUNITY QEVELOPWIENT OIV. r j ' PROTECTIVE INSPECTION SEC. /„ �/� � _ � liJ � �"'1 � CITY HALL FRIDLEY SS132 NUMBER REV O�TE nAGE Oc �PVROVEO 8r �----�: ,.� 612-571-3450 9t0-F15 10798 � � JOB ADDRESS 6201 Carol Drive NE ' 1 LEGAL �OT NO. BLpCK TRACT Oq ADDITION SEE ATTACMEO DESCR. 6 3 Shorewood SNEET 2 PROPERTY OWNEFi MAIL ADpR�S� zIP PNONE Cory & Nadine Tett 502 9599 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner a ARCHITECT Oii OESIGNEfi MAIL AOppESS � 21P PHONE LICENSE NO 5 ENGINEER MAILADDRESS ZIP PHONE UCENSENO 8 USE OF BUILOING � Residential 7 CLASS OF WORK 0 NEW O ADDITION 0 ALTERATIpN � REPAIR � MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage (17 Sq) Tear-off 9 CHANGE OF USE FqOM TO STiPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITSARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYp VENTILATING OR AIR CONDITIONING. THIS PEHMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 201 AUTHORIZEO IS NOT COMMENCEO V�1ITMIN fi0 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED Oii ABANQON�O FOR A RERIOD OF �2Q DAYS A7 " ANY TIME AFTER WORK IS COMMENCED ` NO. I HEfiEBY CEFTIFV THAT I HAVE READ ANp EXAMIN�O TNIS APP�ICATION AND KNOW THE SAME TO BE TRUE AND CORR�CT. A�L PROVISIQNS Of t,AW$ VAL ANO OROINANCES GOYERNING THIS TVPE OF WQFiK WILL �� CpMPLIEO WITH WME7HER SPECIFIED HEREIN OR NOT. 7HE GRANTING OF A PERMIT ], DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OF CANCEL THE pEq PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STqUCTION OR THE PERFORMANCE OF CONSTRUCT�ON (� P�A � Si N TUAE OF CON'RQCTOQ Op 4UTHOpIZ D e ENT IOATEi SiGNATUA O�OWNE� NEABUIL ER� �OAfE� . —�/� SQ. STA�LS OFF OCCUPANCVLOAD CU FT. ' PARKING GAFAGES TOTAI.FEE $50.69 OATED TMIS IS VOUR PERMIT � /�� O�rE . NEW ADDN ALTER [] L] L] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/98 `� � �$ �1 t� ConstructionAddress: !°,�Q �� l � �(l �l C�-2�_J�-- I.egal Description: �� Owner Name & Address: I_I� � U'� �� r��l ��t�- Tel. #�-�GI�P Contractor: MN LICENSE # Address: 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 DESCRIPTION OF IMPROVEMENT W idth Height Width Height Width HgUG� � Tel. # Sq. Ft. Sq. Ft. Sa. Ft. , � Construction Type: Estimated Cost: $ � �� (o (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: (� � APPLICANT: ��Q (`�1� D � � �� Tel. # �jbZ-"1�� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ �' �j .� � Fee Schedule on Reverse Side $ /. .001 of Pemut 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 [ ] $ �a-� � BUII.DING PERMIT FEE SCHEDULE The Chief Building Official 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 structu're, 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 $SQ0,000 $500,001 to $1,OU0,000 $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 first $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, Q00 or fraction thereof DRIVEWAY DEPRESSIOI�F 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 tnne 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. PLUMBING RESIDENTIAL APPLICATION City of Fridley �s-�a� Pe umber e ` y�� D Rece' ed NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIPI THE PERMIT. DATE � �'�o�� SITE ADDRESS �� C - i'Ct THE APPLICANT IS: (CIRCLE ONE) PROPERTY OWNER/ TENANT NAME ADDRES: CITY ,� PHONE # __ YOUR E-MAIL ADDRESS 1 �r �;B OWNER CONTRACTO Ca r�r� °�e.�F �� , �M� ZIP, NAME @.i D DI�G�ABPI�Il� LICENSE# J�2��1 —��,�rrrr—� e�-ct� CONTRACTOR �DRESS �7Q C�DD �� cmr �C�B4RI. NIN 5512� STATE ziP PHONE # �651) 3�5 13�� Fa�c# �'� � 3�� l��'Z PERMIT TYPE TYPE OF WORK � p N�y FAMILY TWO FAMILY �2EPLACEMENT DETAILED DESCRIPTION OF WORK �`�T"� �"�� " "i �'�� FEES ARE BASED OPI $1Q.00 PER FIXTURE, EXCEPT WHERE NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINK/LAV FLOOR DRAINS BATHTUB GAS PIPING (Need CityLicense) CLOTHES WASHER KITCHEN SINK DISHWASHER LAUNDRY TRAY Permit Fee Plan Review Surcharge TOTAL DUE � ��- � � $ $ .50 $ ��7-� SHOWER SWIMMING POOL WATER CLOSET WATER HTR ($35) WATER METER TOWNHOUSE WATER PIPING WATER SOFTENER ($35) BACKFLOW PREY. ($15) FOR IRRtGAT10N OTHER MINIMUM: $15:00 or 5% of cost of the improvement whichever is greater on work less than $300 Make checks payable to: City of Fridley THIS iS AN APPLICATION FOR A PERMIT – NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; #hat the work will be in conformance with the ordinances and codes of the City of Fr(dley and with the Minnesota Constructlon Codes; that I understand this is not a permft 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 c�se of all work which requires review and app val of plans. NAME OF APPUCANT ` � � DATE I � – " �� Piease type �r�srha�t n � _ \ i' F —_/ SIGNATURE OF 6431 UNIVESIT1f,AVENUE NE, FRIDLEY, MN 55432 (763) 572-3604 Building Inspections 763-572-3604 DATE � .— � � � •� r SITE ADDP�ESS THIS APPLICANT IS: BUILDING RESIDENTIAL A.PPLICATION CITY OF FRIDLEY E-MAIL ADDRESS `...n O OWNER .1��N'TR.ACTOR PROPERTY OWNER/ I N�: L: TENANT nDDxESs CONTRACTOR STATE LICENSE #. SUBMIT A COPY OF /�ry�� YOUR STATE LICENSE �D�S: c.�'� WITH APPLICATION pHONE — � PROPERTY TYPE �G� F. 0 TWO FAN Y Y/NEW PERNIIT TYPE I �D111�N ❑ BASEMENT FINISH ❑ DECK ;�� r � c i � q �e r � EXP �A � �� ^ b�� F )NSTRUCTION S ;TRUCTION S ❑ GARAGFJSHED ❑ ROOF ❑ SIDING ❑ SWIMMING POOL TYPE OF WORK: � ��'�' � ❑ MAINTENANCE/REPAIR ❑ DESCRIBE WORK BEING DONE: ( T� I`�' �e SIZE OF IIvIPROVEMENT ROOFING NUMBER OF SQUARES � GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS OYes ONo ,� OR FOR NEW OPENINGS-DESCRIBE SIZE OPENING GI��„'�. TYPE OF Vi �LE AL �FE�� S ' T �I� Permit Fee Plan Review Fire Surchazge Surcharge License Surcharge SAC Charge Curb G�t Escrow Erosion Control Park Fee Sewer Main Charge Tntal Due F� �_ LENGTH ❑ HOUSE ONLY �'HOUSE & GAR.AGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia c- OF � _ � A � �s�� . ��ij� � 1� � - - -. : ; �. � i, , � . - ' - � ;' � �" / I' � �� - �. � i� � ' �'`"� ,. �� Ma�.�r.c� � � y-�`c'c CITY ' C � � � � � TORIES �— ❑ WINDOWS ❑ DRAIN TTLE ❑ OTI�R 1 R .�_ �� HEIGHT c�� A� "�Z� 55�� Ft gASEMENT REMODELING SiJBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structura] members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMTT: 1. Site Plan/Survey showing the existing structures and proposed project Z. Two sets of construction plans 3. Energy Calculations (G7� NUMBER OF WINDOWS i VALUATION, INCLUDING THE COST or� Lalsux alvli �v�a��K �H,,a. (USING THE 1997 U.B.0 FEE SCHEDLTLE) ��v � OCCUPANCY TYPE $ �j3 r'j �� See Back Page for Fee Schedule $ a a�, 0 65% of Building Permit Fee $ �� ,"' .001 times the total job valuation $ �� a j .0005 x Pemut Valuation Minimum $•50 $ .r�` p� $5.00 (Sta.te Licensed Residenfial Contractors) g $1550 per SAC Unit (Plans to MWCC for determination) $ $+6ft= ftx$20=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ ��j 1 Make checks payable to• City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; tbat 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 a wluch requires re 'ew a roval of plans. �� ^/— I SIGNATURE OF APPL PRINTNAME�� 3L1—! Ifv ", "-'ATE 1C7 �". -`��. � f�, x � � � , r. � � � � � � � ��t�, �� a' \.. _ ? " . �' . J . Compliance Certificate Project Title: Teff addition Report Date: o3/16t� Data fllename: C:IVVINDOifUStDESKTOP�TEFF.RCK Energy C�e: 2000 Minnesota Ernet'gy Cade L�atlon: Artoka County, Minnesota Construdion Type: Singit� Famliy Glazing Area Percentage: 16% Consttvction Site: 6201 Carol Drive Fridley, MN 55421 OwmerlAgen� Cory & Nadine Teff 6201 Carol Drive Fridley, MN 55421 7p-502-9599 Ceiling 1: Flffi Ceiling or Scissor Truss: VVall 1: Wood Frame, 16° o.c.: Wall 2: l�/ood Frame, 16° o.c.: Wall 3: {Al�d Frame, 16" o.c.: �ndwro 1: Abave-Grade:Vnyi Frarr�:Double Parte with L�v E: Windovd 2: Above-Grade:Vinyl Frame:Dauble Pane with L�E: �ndow 3: Above-Grade:Vinyl Frame:�utrle Pane with L�wE: �ndow 4: Above-Grade:Vinyl Frarr�:Double Pane adth L�+r-E: Window 5: Above-Grade:Vinyl Frame:Qouble Pane with Larosr-E: Floor 1: All-W�d .last/Truss:Over Outside Air. Fumace 1: Farced Hot Air. 78 AFUE Air Conditioner 1: Eiectric CenVal Air. 1.3 SEER Permit # Permit Date QesigneriContrador. David Hoffarth Blackridge Builders 5010 Edinburgh IAray Big Lake, MN 55309 692�50-7421 hoffarthhameimprovement@usfamily.net 270 38.0 0.0 8 152 19.fl � 0.0 9 112 19.0 0.0 7 112 19.0 0.0 3 11 0.300 3 11 0.300 3 11 0.300 3 13 0.3� 4 13 0.3� 4 266 39.0 0.0 7 Compliance Statemer►t: The pro�ed bui�ing design de�ibed here is c�nsistent a�th the building pians, speciflcations, and other calculatior�s submitt� wiU� the pertnit appllcation. The proposed building has been designed to rr�eet the 20� Minrtesota Energy Coda requiriemerrts in RESchsckVersian 3J.3 and to comply wi� tt►e mandatory requirements listed in Uee REScheck Inspection CheGkliSt. Builder/Designer Company Narr� Date Project Notes: Bladcridge Builders 14x22 addi�on to single family home Teff addition Page 1 of 1 u�Y� , ,„ ��r�;, �:� � :, � � � � � � � � ��:.��_�� Date; 03/14106 ,a.� r ,�, °+.r ; �s , ,, REScheck Inspection Checklist Plan Review and Inspection issues This list of items may be helpiul for Plan Reviewers and Building Inspectors to use as a guide far enfarang the Minnesota Ener�gy Code. The items apply to Group R, Divisian 3 Oca�panaes, one- and two-family residential darellings. The items marked with " apply only to detached one- and fiaro-family residential d�vellings. Plan Review Issues Foundatton Inspecttort: ❑ Foundation wall insulation R-5 minimum. ❑ Foundation insulation extends fram top of wall dawn to top of the foating. ❑ Exterior foundatian insulation is c�vered by a protective coating finish. Concrete Slab or Under-Slab Inspectlan: ❑ Slab on grade perimeter insulation R-5 minimum. ❑ Slab insulation extends fram top of slab to design irost line or top of footing. 0 Floors over unheated space R 30 minimum. 1Mlndows / Doars / Skyllghts: ❑ Average U-value is 0.37 maximum far windows and glass doors (excludes foundation windows). ❑ Window U-values consistent v� building plan and REScheck Certfficate. ❑ Window and doar areas oonsistent vvith building plan and REScheck Certificate. Mechanical Ve�rtllatlon Issues: ❑ Residential mechanical ventilabon system provides adequate ventilation per c�e requirerr�nts". ❑ Fumace efficiency is c�nsistent arith REScheck Certificate or building plan. ❑ Protection against excessive depressur¢ation is install� per c:ode r�uirements•. Envebpe Insuladon for Plan Review: ❑ Interior basement insulatian R-5 minimum ('rf no exterior insulation). ❑ Ceilings mrith attics R-38 minimum or c:onsistent with building plan and RESci►eck Certficate. 0 Watl framing and insulatlon level is cansistent �aith building design and REScheck Certificate. Inspec#ion Issues Concealed Insulation FramPng and Sh�thing: ❑ 1Mnd wash barrier installed at attic edge. ❑ Extsrior wail comers framed so that ir�sulation can be install� after exterior sheathing is installed. ❑ Irrtersections of interiar �rtition walls and exterior walls iramed so that insula�lon c�n be it�talled between the partition and exterior sheathing after exteriar sheathing is installed. ❑ Gaps between iraming tess than onefiatf inch are eliminated by securing framing together ar are insulated at the time af assembly ". ❑ All �netrations between conditioned and uncanditioned spaces made priar to iraming inspection are sealed'. IMerior Air Batrier. ❑ All fire stops are air sealed. Teff addition Page 2 of 3 ❑ Pipes, ducts, wrires, equipment and flues and chimneys through the interiar air barrier are sealed. 0 A sealed continuous interior air barrier is installed an the warm side of the building envelope at ceilings, walls, and floor rim joist areas *. ❑ Air barrier behind tub and shower is sealed and protect�. ❑ Recessed light fixtures are sealed. Emelope Insulatlon: ❑ Baserr�nt insulation R-5 minimum. ❑ Wind wash barrier ort wa!! separeting house and garage is sealed. ❑ Loose fill insulation is prevanted from entering the eaves. ❑ Insulation on skylight shafts and walls exposEd in attirs is supparted on the unconditioned side. Attic Insulat9on: ❑ Attic access panel i�ulated to R-38 for ceiling panel and R-19 for wall panel. 0 Attic card attached te framing rtear aa�ss opening. ❑ Notification of attic R-value and date aF installation post� near building pertnit inspedion card. This is a summary oNy. Other requirerr�nts may apply. S� the Minnesota Energy Code. Questians? Call the Department of Public Service Infortnation Center at 651 296-5175 or 1-800-657-3710. Teff addition Page 3 of 3 �� v , W �� - i � �� a� �1 .. ;� - , �_ �� _ - � � .._ i� � r 1 _ '.\�► , ' � .� . f _ �,� � � � � � , � za�� , r---------�--------� A � � ��m�mmg��=o��z — — �nto�a:x�NND'O� °'� I 1 � p � � � � � � o n c � m q .. � � � A � • � � � � ��$'°°��'��=o� � ��m��'�� 4 �� ' � �$ �� $ � � ��m,Q � �ta m �� o ro� 3 i i i �a �� 0 3� i ii i ��a�.m�� i 'C �' j N m A ---� ° __�.� `°� m � � � � m _ 1r I -� � � �� ° : � a�a� � � � � I � 3��. � � � � � � � � � m ^g 3 � � � �� a I � � _ � 2 � I A � ss= � w � I 3 3 � t P " I� d: �� `° �� S 3� O m I • r ^ � �' �. ' 3 �' V I � � � � m I _ 11" � f° a A I �' � � � � �� I � � � _ �- � � �� 3 � 3 � m � I � o � fi � � ° `� v , 1 " � h �� I� I m � I 9V_ � � � � �� ' � ^ A � A I I �O �D � n � I �� w Qp �: A I I o �V I N 2668 � I I � Z _w � I � I 0. I � � �y—` � � � � 67 / m v � °? � °' �° � V � � I � � � � � � � � O � Q I �, �, � � � � � � �.61 �. � � � � � � � � � � � D_ �� — — — — � — $— �- �— -1- — — — — ° � �— J A I � �� r � � � -�-� � � y � W � �— y IJ • � � � A f � � C/� �� t� � m �� g N � �� I � .. I .. �� m y �....... , . {� � � ° � � . �1 , ___ _ � N _ 2890 289D � _ _ — — �ro 47 2'8 7 2'8 4'6 2' 19' 3'1 aa�� z�o —� - , � 2 S�dea Trunk thru smalf window in �--- �� ,,�„a;� i�---=__ � basement, then framed and co1d air retums supply insulated .�' � 2ass � o i � � � Trunk line, under floor joists �� then boxed and insulated, � � or run across basemerrt , � ceiling then � , out rim joist �� - '� �� L_ o ,�_________________'� � � ; HEATING DIAGRAM , ,� � I L _ _- _ _ _ _ _ r � � L _ _ 2847 2847 C�rr; . 3 Root VeMs ICElH2O 3' bayond � wtth ter PeP� Designed by Blacl�idge Builders: David Ho�arth Not dra�vn by an architect or engin�r, not to scale Dtawing for. Corp & Nadine Teff 6201 Carol Drive Fridley, NIN 9 Ceder softtt & Fascte FF.'OM :WCE�:; FRIL:�LEl' FH;�'; hIQ. : �'h��71c�?E�i " f�l,�.r. 1� �t��5 �t4:1�F'I•1 F1 . .� � —� �� AR�L Dk'! �/'�C° `,, �, , �. ! �'l":►� �.s � .��' n � �� `,�' e � , ��'� , �^ ` �, „�.� � �.- : �r'� � � '��P �t" � � � � � a__ _ �C� �! �.� �a •. F � �'� �` _�� - -- � � .r. � � � � � � Form State of Minnesota !'� SP:C1 � License Applicant Information Under Minnesota law {M.S. 270.72), the agency issuing you this license is required to provide the Minnesota Commissioner of Revenue your Minnesota business tax identification number and the Social Security number of each license applicant. ' Under the Minnesota Government Data Practices Act and the Federal Privacy Act of 1974, we must advise '' you that: '• This information may be used to deny the issuance, renewal or transfer of your license if you owe the Mi�aaes�ta.Department of Revenue delinquent taxes, penalties, or interest; !• The Licensing agency will supply it only to the Minnesota Department of Revenue. However, under the Federal Exchange of Information Act, the Department of Revenue is allowed to supply the information to the Intemal Revenue Service; '• Failing to supply this information may jeopardize or delay the issuance of your license or processing your renewal applica.tion. ' Please fill in the following information and return this form along with your applicatioD to the agency '' issuing',the license. Do not return this form to the Department of �evenue. I' Personal information: �Proof of Workers Compensation Insurance Coverage Minnesota Statute Section 176.182 requires every state and local licensing agency to withhold the issuance or renewa� of a licsnse or permit to operate a business or engage in an activity in Minnesota until the applicant presents acceptable evidence of compliance with the workers' compensation insurance coverage requirement of MSS Chapter 176. The information required is: The name of the insurance company, the policy number, and dates of coverage or the permit to self-insure. This information will be collected by the licensing agenc� retained in their files. 'This information is required by law, and licenses and permits to operate a business may not be issued or renewed if it is not provided and/or is falsely reported. Furthermore, if this information is not provided and/or falsely reported, it may result in a$2,000 penalty assessed against the applicant by the Commissioner of the Department of La.bor and Industry. Pro'vide the information specified above in the spaced provided, or certify the precise reason your business is excluded from compliance with the insurance coverage requirement for workers' compensation. am not required to have workers' compensation liability coverage because: have no employees covered by the law. L� i am self insured (include permit to self-insure) ❑ I have no empioyees who aze covered by the workers' compensation law (these include: Spouse, Parents, Children and certain farm employees) � F�� name �t name Midaie r �� Ciry �_ � I y �� -�.�.��? � neme Date of birth � �� Stete Zip Code State �� Zip C�e CITY OF FRIDLEY INSPECTIONS DNISION 6431 University Avenue NE, Fridley, MN 55432 (763) 572-3604/ Fax 763-502-4977 CONTRACTOR LICENSE LICENSE TERM: May l; 2005 to April 30, 2006 APPLICATION FOR CITY LICENSE -$35 LICENSE FEE EACH ❑ Blacktopping ❑ Chimney Sweep O Excavating ❑ Gas Services ❑ Commercial or Spe�ialty ❑ Heating ❑ Masonry - ❑ Oil Services REGISTRATION FOR STATE LICENSED CONTRACTORS = NO FEE ❑ Electrical ❑ Mobile Home Installer �Residential Contra.ctor 0 Moving ❑ Plastering D Roofing D Sign Erector ❑ Wrecking � Flumbing � Well Driver TO THE HONORABLE CITY COUNCIL: � I herewith submit an application for license to perform construction within the City of Fridley in accordance with the City Code of said City regulating the same. I am over twenty-one years of age. Submitted herewith is a Certifica.te of Insurance evidencing the holding of Public Liability Insurance in the limits of $50,000 per person, $100,000 per accident for bodiiy injury and $25,000 for property damage, and Wonders Compensation as required by Minnesota Statute 176.182. ATTACHED ARE COPIES OF CERTIFICATES OF INSURANCE FOR LIABILITY AND WORKERS COMPENSATION �E'J�d� i C�-1� ��:v� i `�. Name of Liability Insurance Company �r ' � Liability nsurance Policy Number �—�1��5 %��%'–d(J' Policy Term t� Name of Workers Comp. Insurance Company �� WC Policy Number 0�� Policy Term �� * Minnesota License # � AT°fACH COPY OF STATE LICENSE For Office Use Onlv: � � �� Name of Compan o be Licensed/Registered s Name of Contract erson (First/Last Name) � � �-� ° � Address of Company �, �� .� � �3c� - c� sc �z�� + a. a�g�� c�—��2-t ��3 ~��i�� Business Telephone/Busi ess Fax FILL IN REVERSE SIDE OF FORM # License# Council Approval Date � Rene:v. Tnc.. 73 T�,ma I�rivc, I7arernauth, Nc�b�a. Sootia B:tiV3Yf� hone: �7?- —� ., , A 41�a�1T,�andtax;$7r-6S�-3G�l3Initi�t FkUP•9 : I:,:b:=Ei_ FF' I L.�LE'�' FH;�; NU. .; r=,.'�,�. _ _- -- —� � 1�._�.� h1,�1_. ].^ �'��F� ��: ].3F'frl F'1 �� ,, \ CA� L p �1 -� ~- Il5 ��' � � �� . � � _ � ` Y'~~f . , +�4 . _ � '4 _ y u 1 �� . ) _ �1`�� ' . 7� � �d��; �� b�,�-Fe � � �.�'d ��.-f- � w��. _ � -- . - --''�-� � �, �I � F��1 :Gity of Fridley FAh N0. :7635721�87 M3r, 23 � � 1�CI��.1��AIJ �e�� .: �uildua�, �,��ei��a r��: Yr�spectic�r�s 1tESI��1viTYAI1 �."PL�4CATI�.II�i p�� R�°�:� � �.� 763-572-36►Q4 �ITy �� r'I�TDY��.' . +.�47'E,�, / .,. YUL'Ii F�.-MAIL AL1DitG9S,. � �� . STl'F. AUI9�iF. °i , �, � � I �.Arg � � c �'V{ � r � �t'�. 'CIIIS flPk�LICAN[° i4; C] C)9dI3ER �Ct SN'fItAC7'tll3 IR{DPERi�' NAMf�:;_.. ��VL� (il !�1 � ��,�y �, ��,�, ��1 g�!`AT��GIP, UWNCYfJ p17uRCS3:_,.�...�L�l'-9c-�--�C-�--(:TTY .i�—• •= r��►�rs " ^ rraor,-� ��1 r � � _ .�=�1" �� . ss.��rr .� cogY or ypUR �'f'�TE J,TGI3NSE Wi'ril APYLCC'A'IIt:1t'�1 d'FRidIIT TYI�E TYPE �F yVORI{S Gc�tw�nNY nume:�� °s � u, �- CON.Pr�CT P�R!3C%N: ,�,. �G � r�_.. �� ...,_ S'I'A1i? LICFNSE �t „_ . k�XP UATL� _, . • - 5� crrY ��,�aip STA•rh.l'%(✓z�r� .5��3�3 �r��Rr+�.�: �7� ��s�.• • rr , — - PHt�NE?G �(c8�/ G13� , N'rtX,�� 3��L3�.. — Q �S1NCtLE PAMiLY ❑ 7W(} FAA2ILY �'1.. R1GVl' Cl RiI'i.AGEML•'�IT ❑ Tpq�AliiOt75L �'At.TLRATlUN/EZrMUDliI. ,�. . . I)B7'Ai1.F.� DBs�1dIPT10N U�' WOIiK _.�'Cy,�—� l� r� �`� .� �°—�� .._ PFR AAS 16I�.�65 thc; permi� �'ec ia a minimung �i Ci�.lfii ar �% of th� iotal s�t up to .�.OU, �uhicfi�vcr is greatr�, far the improvsm�nt, installatian c�r repla�emnnt of a resicientlal ii�ceuro, ex�ludiv}� the tixtus�s. Clius shauld reflect cmly tho eost c�f l�b4r ) Labor cast uncicx $300 =� I 5.0�3. Labor cost �ri+veen �3�t? io $SOD '� cost af labor _, x.d5 = ... __ P�R PtiA.1F.C7'S WI•tETti's I.�AI3tiit EXG�N;1''!.S �SAO, FL�LS AR1G DASL�I') t)N $I O.UU t'b;k FiXd'URk:, I�.XGtiPT Wk�CtTs NOTEP. ,�i7tTLJR�9; (!hl�TL"RTE T(Yl'AL NUM�ER Of EAC�H tiFLOW} �p�,�l,: ` SiZFslE�7't.l _.. Gqi�iP$1cntlnRtatlesi MNr: _ MODiL; _, 9fZI'i/8T1.T_. .. MI7G: _,,. SIZE/B't'1.)_.,.._ M�C: , _ I�IODktR.: ..,. -• - . �/C 525,00 _Fi[tEP!,A(:E (CiAS� $I i,i� _ tiA3 RANC,N,l+.)VC[� S10.04 ' A[T�'I'p NR B?iC:HANQI�ii 315 � FIYtTFLAC.'N {W�aD} $35.U�1 1VFLV GAS GRII.l. $10.40 rIIOII.ER S35.QU _FitftN �C.'C $�S 00 ,_t�A,S UNI'I' i�'fA $10.00 � CHIMhIE41 LINEIt $1A.bQ teA.S DRYB.F2 ,�10.a0 PC.KIL }1LILTEI2'�.9$.4Q 17DUCT Wt)Ki� �SO.aO _ GAS f'1PING S10.OU VE1�T11.�4TOR $15.1� PermiC E�ee S . � hTumber nf fixtures (r,� $10.0U x �lu.uu = � ,. _ Surch�t� �_..., °gv Number crf Ctxtures � � 15.00 _... ?t $15.00 = $._ TU'1"AL BaUE S,:..�.,.�_�� Nurret�r of ilaciuros ��25.OQ __ „_ x��S.UO =� Number of fixb�res � �r3�.U4 x �35•0�► ° � Staie �urcharge �° $__ . .50 ; Tatal - $ , � ~ TQI[S IS AN APPLICATIC�N Ft7�t A PiIcMIT-Ni)'�' VALI� UN7'11., NKOt•E9Sfi1� i hcroby ap�ly for a buildanr permit and I a.cknowledge that tho lt�faa�mamaxicm above is cpmp�et� �d accur�te; that ihe work will b� iri sonformancg with th� ordinances �nd cc� of the +Cit�� asfi Frldley �nd with [he Minne� �QU�� des; that T understand thi�, ;s not s� permit but only $n applicatic�n for a perrnit tm�i work iF ncre to �tart withaut a permit; that che wnrk wilf be ln accarci�ance wit� t,he a�rc7ved pl�r► i� thc case of a11 r 'eh rs�qnDres revi � w and appmval of pl�s. St{iNA'!'UltF t)F APPLIGAN'P . �� !!C,�. _ 1'EiIN'I' NAA/IG�,/��—"�'`.'n. a" T�A'i'� � i6 d 6 � ��y �f ��a�e� �e�ildin� j.n��cti��s D�par��ent 643�� Uav.versity Avenue NE, Fridl�y, hiN 5��32 7fi3-S72-��04 FA�: 7�3-502-4�77