AF - 37992�
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City of Fridley, Minn.
BUILDING PERMIT
Date: July 25 , 1968
p�; Homedale Blders.
g��, Same
Addreas 5217 Wayzata Blvd. �,g�� Same
�-s�.i � � a
N+� 9846
LOCATION OF BUILDING
No. 7412 Street Concerto Curve part of Lot
� 14 __ glock 2 — Addition or Sub-Division .� Melody Manor 3rd Addn.
Coraer Lot _ 7nside Lot —. x Setback 37 �� Sideyard 10' /5 �
Sewer IIevation _ 877 .5 0 _ 88Q .5 0
Top of � Footing
DESCRIPTION OF BUILDING
To be Used ea:
Awelling �t 46' �p� 24 28 g��t 20' �q, �, 1152 �� 23, 040
C�r� Front —LR � Depth ,2�� I�eight �1.� � Sq. Ft � Cu. F't 45 6 0
� op ����� _ Frame �yt, ��u�18, 900 _ To be Completed Oct . 1968
SE WER LOCATION 13' N. E. of Manhole
WATER LOCATION 23' N. E. of M�n.hole
In canatderatlon of the issuance to me of a permft to conatruct the bwllding described above I a�r¢e to do
the proposed work in acc;ordauce with the description above se, forth and compliance with provIsfons oP
orrlinanc:es oP the dty oP Fridley. �
0.0 0 Sewer Cd�nnection Charge �
Ea consfderation oP the payment of a Pee of $ 40. 00� p�rm�tt 3s hereby granted to Homedale Blders .
to construct the buflding or addition as de.scrlbed above. This �ermit is granted upon
the express candition that theperson to whom it fs granted end hia agente, employees and worl�en, ffi all work
done in, around and upon said building, or anypa� thereof, shall conform in all reapects to the ordinaaces of
Fridley� Minnesota regardin� location, conatruction, alteration, maintenance, repair aad moving of buildir�s
within the dty limits aad this permit may be revoked at ar�y time upon violation of aay of the provYs�iona eead
ordinancea
lm C uiiaiaBInspector
Clarence Be13�le
NOTIC�
71ds psrmh doa aot wrsr t6s eoe�ruetion, imhpatloa M� wiriae, plu�a6tne, ea heaNeg, mru er wat��. B� wn le a�
tlro BuiWleB lespsetoe Por aparat� pwmh� Poe t6as Ihm�.
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��zc�TtoN ��� �u�,n�c� r�ta
��7:Y 0� F'RS�Y, �SOTA
OWNES' S N�lE . BLTxLbER _
_...._.4,_....,—.— y --�---- —
. . • . . � �'
ADDRESS . _ . ,;,,: . . _ � _�'�DRESS � �I�,���� ,
_ �::._._.� _
�.. . , . . .. .. . . , �
� � LOCA.TTt�N� �}F � B�G�D�T� . - , . : . , ` . .. , ' . ...
� d : ., .� � . .. � • _ . :.�. � . ,�. , _ .. .
NO
..�a�l
LOT.+_��� .. BLOCR; _ r. . . ADDTTION OR SUBDZiRSiUN�c;�;����,�'�
•��- , ,.. . , ,. . •%" ! i; : y?i s [ „ ' ., . '
CORP3�R LOT`� �,INSIDE L(3��:�• : :�' �-SE�C�C :. .S�DEif�•D.:%,+,'. �'__.,_ ? �� .
SEWFR ET�EVA�ION
d �% -.J'!�Q TQP OF FQOTiNG .. . ���oo �1�:, . :..; ,`•,.;..
,
Ap, lican� a�ttach to this for�m �io Certificates of Snrvey of Lot aud propoeed
building .lo�atioA �drawa =`�n:��i��se� E��tifiEates�. . � � . •�• ;.. . , . , •
krZ�E�wt/ � T � . • , o�`.�''I V/'.�' i , G� �a'fAJ� . ;` , .� , . . .
� � � nESr�►.ar�ra�� �o� �.s�.aa�c���. � �: . . . . � >
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To sa Usea' •Aei s ` - � •, .. s . • . . • . , � . . - 7 . • . � ... .
^ J� �
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__r___ FroDC Depth �Height��_�
. .. ��. � . S. �^ feet •�v � G,ubic Feet• �_��, �
� s�� �_._._......,.-- ---
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�',�i �� � _ __ e � n...,�t, � � � Aai oht d �
Type of Conatruct
To Be Cample
. ° "; .. .: . � 1 : . . . ,.
Square feet�____,�� � . . : .Cub3c �eeC�,: �..r�. ,r � �
a ' ���r� timated, Cost• � �,.,:..��
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,� �, ;� �'
-- �" ft / SA � V
The undersigned hereby makes applicaCiou for a permit for the work l�ereia
specified, agreeing to do all work in strict accordance �ith the City of
Fridley Ordinaaces aad rulings of Che DepartmenC of Buildings, and here�q
declares thati all the facts and representatioas stated in this application
are true and correct.
DATE _ � �'� � SIGNATURE_��"�� - ----
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Schedule of Fee Costs caa be found on the Beverse Side�.
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� BUILDING PERMZT FEE S ,CHEDULE
SE�TION 2, The Inepector of Buil�tiags sha11, before•=issuirig pe�ibnits for
• the•erection df �ny building or atructure, or for anq �dditian �,� any
axisting atr�c�ure or building, or far any altera�ian or;repair§°to any
existiag building or etx'uctaire,�t upou' .�gpl�catian th�re�ore, require the
the payffient by the applicant for sueh permit of t�e5 to the amount herein
•below set fortb and in the mauner herin provided to-wit;
._ . _. --___�.. .. . .. ,
� . . • A••t ,.. . .
Uni_, form �tuildia� Ccde: Type��l, 2; '� 4-. �l..75��for each -oae thoiseand cubic
ieet, er irac,tioa thereof; in such cu�i�cal contenta. Type 3� 5• $1.50 for
each one theusand cubic £eet. � '° � �'
F�r ti�e �ur�oge ef c . � ' �7t' � ': . .
tmiputiag� fees for•. b�ild.ing perinite, the: cubical
conteats of any building or °additiioa t• a u�niform hei'ght t'hrou�hout by
multipi�ing the ground area coverec�: ,f��r, a point six (6) inches below the flor�:
line �# Che basement or the cellar Ce the average height of tbe ug�er surface
or to the average height of the roof surface of the main gab],e of a
p3tched roof. ' • �
..F�r regairs os alterations to ari e�is�3ng sCtucture, Lbe�-fee�ehall ba at the�
� rate.of`�$3.40'��p�r each five hundr�d:doliars ($500.�0) or fraction thereof
icti �the _cosC �f e].1 proposed �vork._. ' � �
In no c�se ahaxl th� fee :charged "i'air anq �peraiit�'as set forth ia Sectioa 2 be
less�th�n $S.AQ.,. .
NSSSD ��nneeti��n Char.g�e�:based aa locatiaa,- �,�ea 1 or �. ,
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HOUSE HEATING TEST RECORD
ADDRES�� �����`— �� - APT. F�OOR CI RB �
OCCUP�IT OWNER t -
HEAT i.OSS DATE HTG. INST. GAS C0. METER BAD
SOLD BY INSTALLED BY
Electrical Work By Gaa Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
GA ESI � CONVERSION
MAKE - MAKE OF BURNER
Model � �� Model
Serial � �--�° � Max. BTU Rating
INPUT /��-�-�� MAKE OF FURNACE
Modsl
C NTROLS �
THERMOSTAT ��� Heat Plug Vent Size
Valve KIND OF UNER SI� NONF
Limit �"� Droh Hood Regulator
Limit SeMing � � Filters Size Number
Fan Setting �-S��°��� Chtmney Loeation Inside � Outaide
Pilot Type Chtmney Construction
Pilot Muke � ��
Pilot Model Smoke Bomb Wiring
Pilot Timing ������ Draft � Test Tap �
L.W. Cut Off D or Presaure_ Lightirtg Inst. ��
Proasure �� � Per n�0 �� e � Da Tsated - °�" �' �
Input CFH�'� Pe��"P� mpany Testing -
Staek Temp. Percent CO , �t � Name of Tsater
Form 235
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SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� �
COMMUNITY DEVELOPMENT DIV.
� ��: ------�
r � � pROTECTIVE INSPECTION SEC.
� _ �"'1 � CITY HALL FRIDLEV 55432 NunnBER pEV oaTE
�""'� � ,'� 612-571-34b0 910-F15 7/2g
JOB ADDRESS 7412 Concerto Curve NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
oesca. 14 2 Melody Manor 3rd Addition
2 PROPERTY OWNER MAILADDRESS
illiam Heid 7412 Concerto Curve NE
3 CONTRACTOR MAIL ADDRESS
Same
� 4 ARCHITECT OR DESIGNER MAIL AODRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
ZIP
ZIP
PAGE OF
� �
� I�
APPROVED BV
7
SEE ATTACHED
SHEET
PHONE
78 3--05 89
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
7 CLASSOFWORK � NEW ❑ ADDITION O ALTERATION �] REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroo� House & Garage (23 Squares) Tear-o��
9 CHANGEOFUSEFROM
ro
STIPULATIONS Undexlayment must comply with the State Building Code. Propide adequate
attic ventilatian, �rov�-.de smoke detectors as per TJBC 121Q adjacent to all sleeping
areas and in basement.
TYPE OF CO�
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTtON
OR WORK IS SUSPENDED Oii ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG.
I HEfiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $l�Z/�2
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEf;M1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- $3]_aQO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
TUR F CONTRACTOR R" Opl2 AGENT IOATEI
� � �-z� �
'UREOFOWN R��fOWNERBU�LDEIii IDATEI
OCCUPANCY GROUP OCCUPANCYLOAD
SO. FT. CU. FT.
OFFSTREET PARKING
STALLS IGARAGES
VALIDA
$.62
AC CHARGE
Fire SC $1.24
OTAI.FEE
$32,86
� THIS IS YOUR PERMIT
�� � ��
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ADDN
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[]
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Construction Address:
Lega1 Description:
Owner Name & Address:
Coatractor:
Address:
Effective 5/26/93
CITY OF FRiDLEY
SINGI.E FAMII.Y AND DUPLEXES R-1 AND R-2
Building Permit Application
LMNG AREA: I.eugth
GARAGE AR�A: Length
DECK AREA: Length
� :�
Tel. # ��50�89
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the propos� construction drawu on it to scale.
DESCRIPTIUN OF IIUIPROVEMENT
Rlic�h
Hgticnound
Tel. #�
Sq. F�
�. Ft.
�. F�
Corner Lot [ j Inside Lot {] Ft_ Yd Se�back
�Type of Constcuction:
Approx. Completion l�ate:
Side Yard Setbacks
Estimated Cost: � `'�''�� �
(Cast � Back)
Driveway Curb C.'ut Width Needal: Ft. + 6 Ft = Ft x$ _$
� � ` � �
DATE: l��l %� APPLICANT: ��� Tel. # �c��OS�'
Permit Fea
Fire Surcharge
State Suurcharge
5AC Charge
License Surcharge
Drivevvay F.scrow
Erosion Control
Park Fee
Sewer Main Charge
� �1 C�
$ /. �
$ �v�-
$
$
$
$
$
$
+1. M. ' � .�I_
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/li�th%)
$.so��i,aoo v��aoo
$750 pe.r SAC Unit
$5.00 {State Lic�sed Residetrtial Contiractors)
Ait. "A" or Alt. "B" Above
Cons�vation Plan Review $45U.(K)
Fee D�ermined by Engineering
Agreement Necessary j] Not N�sary []
TOTAL $ ��' � �' STIPULATIONS:
BUII,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the ere�tion of any building or structure,
or for any addition to any existing bnilding or strucdire, or for any alteration or repair to any existing
building or structure, upon application therefore, require the pay�nent by the applicant for such permit
of fee.s to the amount herein l�low set forth and in the manner herein provided to-wit
TOTAL VALUE
$1 to $S00
$SOl to �$2,�
$2,001 to $25,0�
$75;001 to $50,000 • .
$50,001 to $1(�,000
$lIX?,001 to $500,0�
$500,001 to $1,000,� .
$1,000,001 and up
FEF.S
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$45 for first $2,000 plus $9 for each additional $1;000
or fraction th�eof, to and including $25,000
$2.52 for first- $25,OD0 pl�s $6.Sa for each additional $1,OOQ
or fraction thereof, to and including $50,000 -
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or frac�ion thereof, to _ aad including $100,0�
$639.50 for first $1�,OUQ plus $3.50 for each additional
$1,�0 or fradion th�eof, to and including $500,(m0
$2039.50 for the first $500,000 plus $3 for each addifronal
$1,000 or fraction thereof, to and iacluding $1,(m0,�
$3539.50 for i�Ce first $1,0�,000 plus $Z for �ch additional
$1,000 or fraction �thereof �
DRIVEWAY DEPRESSION ESCROW
(Concrete (;�ufi Sixe�ls 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 const�ucbioa will 1� issued a minimum of 24 hours from the time of application to allow
for proper review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the locdtion of the foundation once it has it has been
constructed will be required before proce�ding with the framing.
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10/15/1999 15:50
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6128616361
TO: Ron Julkowski
/ �
Re: 7492 Concerto Cv
Frid/ey, MN
Phone
F�x Phone 6�2,579-9287
I CC:
BLANCHARD
PAGE 01
Date 10/15/99
' Number of pages including cover sheet 4
FROM: 8/ancharol Engineering
6936 Washbum Ave. S.
Rich�eld, MN 55423
(m) 961-0770j
Phone 861-6361
Fax Phone 869-6361
10/15/1999 15:50
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6128616361
7 �/ �
BLANCHARD
c.r� c.v�r.,v,�
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1 here8y Ce�Wy that this ptan was prepered by
m6 or u[bet my �rod su,�ctvision and that I am
a t�uly Regi�ered Protvsgbnai Er�ineer under
tt1-r l�wS o� Ih8 Sti�9 OF Mk1119Sptt3.
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City of Fridley
AT THE TOP OF TNE TWINS � � I L D I N� P E R M I T
r
� �
; `y _ COMMUNITY DEVELOPMENT DIV.
f � � PR07ECTIVE INSPECTION SEC.
� _ �'�'1 � CITY NALL FRIDLE� SS132 NUAIBEP
�----�: ,.� 612-571-3460
s�aFis
JOB ADORESS `��� � /'n��• ��`�e �
�&
t LEGAL �OT NO. BLOCK TRACT OR AODITION
DESCR. j(} 2 Melody
2�, P`iiOPERTY OWNEii MAIL AODRES�
GTA�'��ia✓!r J �� ��lZ �r2t.�� �vrs
3 CONTRACTOR MAIL ADORESS
�l�C/l ��C ��lS��e� Owner
a ARCHITECT OR OESIGNER MAIL AODRESS
5 ENGINEE MAIL ADORESS
�s �/ �����
8 USE OF BUILDING
Residential
7 CLASS OF WORK
NEV DATE VAGE O:
12/3/99 / /
Manor 3rd Addition
21P
��
0565 �
RECEIPT NO. �
er
/����
SEE ATTACMEO
SMEET
PHONE
� �/Z ��o�°
PHONE LICENSE NO
PMONE IICENSE NO.
Ph10NE LICENSE NO
O NEW � AODITION � ALTERATION p REPAIii p MOVE O REMOVE
B DESCRIB� WOFK .
�� a �� •��. ; g��� , ��l � ��,:�� �
9 CHANGE OF SE FROM ' �� r TO
STIPULATIONS �
See notations on plan. Call for building rarap inspection before covering.
Underlaym.ent must comply with the State Building Code. Install smoke detectors
to meet the State Building Code; in each sleepinbg room and on each level of the
house. �``t
` �������
Before ci�ggir�; v;�4f f�s
a11 uti�ity !ocations
454-O�OZ
p'����`� ����t�TS ����RED BY LA�
����'�„ HCATIf��, F'L�g U� E� �C1R .
� Ai�� SI�S.
SEPARATE PERMI7S ARE REOUIRED FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING.
THIS PEiiM1T BECOMES NULL AND VOID IF WORK OR CONSTRUCTtON 20NIN(3
AUTHORIZED IS NOT COMMENCED V111THIN 80 DAYB, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONEO FOR A PERIOO OF 120 DAYS AT
ANV TIME AfTER WORK IS COMMENCED NO DWIG. UNITS
1 HEiiEBV CERTIFV THAT I HAVE READ ANO EXAMINED THIS APPLICATION 1
ANO KNOW TME SAME TO BE TRUE ANO CORREC7. ALL PROVISIONS pF LAWS yqLUATION
ANO ORDINANCES GOVERNING THIS TVPE OF WQqK WILL BE COMPLIED
WITH WHE7HER SPECIF�ED HEREIN OR NOT. TME GRANTING Of A PERMIT �9S �OOO
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL THE pERMIT FEE
PpOVISIONS OF ANV OTNER STATE OR IOCAI LAW REGUTATING CON-
STRUC710N OR TH ERfORMA C OF RUCTION $958 ,�S
/ PI,AN CMECK FEE
�� �
4TUNE 0� C • OA OA oU�M0�7i2ED OGENt 1DAfE� EN P OPI
S�GN4TUFE O� OWNEA��� OWNEABWIDEAi IOAi�i Bl �NSP �
� � � a
r-- � �
SO.
S7ALlS
CU FT.
iffSTREET PARKING
IGARAGES
IURTAX
$47.50
AC CMARGE
Fire SC $95.00
OTAL F E
$ 1.25
iS iS rOUp PEpMir
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Q`TE
LOAO
r�w � �
ADDN
ALTER
Effective 5110/99
I l CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 ,,,p ,&;
BUII..DING PERMIT APPLICATION �� a-�`�
s
Construction Address: %��j Z ��� �-�a �r� ,�/'�
Legal Description:
�wner Nau
Contractor:
Address:
Tel. # �� ��S 4u'9
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRII'TION OF IlV�ROVEMENT
�� ; �cr'�
LIVING AREA: Length � Width 2�� Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AI�.EA: Length Width Hgt/Ground Sq. Ft.
�T,��: G � �uP Z.
����� �Y'�ID t?�� �' ��SS� �%�R� EtJ•'�aerJS S' G 1�-�-G-� b��
Construction Type: �' �,-.�.� Estimated Cost: $� v� , pqp
—�
Driveway G�rb Cut Width Needed: Ft. + 6 Ft = Ft x$
_$ .
DATE: � Rl - APPLICANT: �G� �� �,� ,��}� P� Tel. #� - � � �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ ��,�� Fee Schedule on Reverse Side
$ � � .001 of Permit Valuation (1/lOth%)
$ � � $.50/$1,� Valuation
$ $1050 per SAC Unit
$ �`� $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.� Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ � �� � ��
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 structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit: �
TOTAL VALUE
$1 to $5(�
$501 to $2,Q00
$2,001 to $25,�0
$25,001 to $50,(�0
$50,(}O1 to $100,000
$100,001 to $500,000
$500,001 to $1,�O,Q00
$1,000,001 and up
FEES
$23.50
$23 .50 for first $500 plus $3 .OS for each additional $100 or
fraction thereof, to and includi.ng $2,000
$69.25 for first $2,0� plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,Q00 or fraction thereof, to and including $100,0(}0
$993.75 for first $100,000 plus $5.60 for each additional
$1,(�0 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,�0,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
�
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construcrion site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the frami.ng.
19i94/1999 a7:28 6128616361 BLAMCHARD PAGE 01
MNCheCk COMPLZANCE REPORT
Minnesota �nergy Code
MNcheck Saftware Jersion 2.p
Min�esota Department a� Public ServiCe
1-�12,296-5175 1-800-657-3710
COL�J'TY: Hennepin
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE:
DATE: 10-$-1999
�ATE OF' PLANS :
TTTL,E :
GOMPLYANCE: PA5$�S
Requir�d UA = 482
YQUr Home = 365
Single Family
Ferm3t #
Checked y Dat�
�r�a or Insul Sh�ath Glazing/Door
___,______�______,_ ___w_____^ Perimeter R-Value R�value U-Value U,�,
------------------------------
CFTLINGS: Raised Truss 1156 38,0 0.0 + ^�Zg
wALLS: W�od Frame, 16" O.C. 2664 19.0 2,4 I3�
GLAZING� WindqFts or poors 321 0.350 112
DOVRS 42 0.350 15
B5MT: 8.0� k�t/7.0� bg/8.p' insul. 1184 1Q.0 72
HVAC EFFIGIENCY: Furnace, 95,0 AFi7E
COMp�,�ANCE STATEMENT: The propos�ed building design represent�d in these
dGCUment� is consistent wi�h the btzilding plana, sp�cif�.�atione, and othex'
calculations submitt�d with the permit applicatian. The propo$ed buildin,g
has been designed to m��t th� xequirements of �h� Minr�e�ata Energy Cocl�.
Buiider/Designer ../ .� �,[� � . Date����T_
10,+'a4r'1999 07:28 6128616361
�'
{ CATEt;nRY^ 2 }
BLANCHARD
PAGE 02
.� �
NEW HOME Fzk:�,z7 IN$pECTION
ENERGX CH�CKLI�T
�c�uv�a�r zc�rr :
[ ] Exterior foundat�o� w�ll
insu].atzoz� installed:
kt -
[ J Slab-on-grade insulatit��.
ir,st�lled: R-
� i L�ucts i.n slabs have R-5
insulatiQn bottcrn and si�es
P�NE�'F.ATIt�NS :
[ l Win�ow and d�ar fzames sealed
� l�'zame� wali �pzr�ings into attic
sealed
[; Other joXn.ts in wall sealed
[ i D•r�ppPd ceilin� aa�r-blocked
[ ] �'1umk�ing penetratipr�s se���ci
[ ] Extexior w«lls behind tub
a�� 3hower sealed
[ ] PJ.umbing vent stack seale�
L ] Chimr_�y flues sealed at cei].ing
i 1 Pexi�,eters of all grills azxd
xeg�sters sealed to vapoz
b�rrier
[ ; ��e�trical service sealed
E 3 Rec�ssed ligY:t fixruxes s�aJ.cd
[ ] w�re pez�etra�ion5 into attic
sealea
� ] �'elp�hone, cable T'J
p�n.eC�r�t i.oz�� sealed
� � F'an� sea�.ed w�.er� v�pc�� barrizr
p�n�trated
OPTIOAAL
(CATEGORY 1}
. } k'ouz�dation rim joist s�alec�
3iY'�l�rxt
[ ) Upper s Cory k��r�d j ox st s
seal�d ai�x��.gk��
_ ] Geili:�g poly sealed t� tc�p
af a.�teri�r partition walls
[ J E�e��xi.cal bc�xes se«led to
va�or barrier
: ] �'ax.: k�ousings air sealed
10f04f1999 07:2b 6128616361
BLANCHARD PAGE 03
NEW HOM� FIELD INSPECTiON
ENERGY CHECKLTST
PA3E 2
{ �ATEGORY 2 )
I NSUZ,ATI p1V :
[ ] Vapar barrier installed
[ j Interior foundatioz� wall:
( ) tlapor baxrier installed
! ) InSUZa�ion installed: R-
( ) Moisture k,arrier iriSta�lAd
[ ] Attic insulation ins�alled:
P. -
[) At'Cic card posted with proof of
bags inata?led
[ ] F�oax ineulation inetalled:
R-
i ] Wall insulation ir�stalled:
( } R-19 ( ) R-21 ( ) R-
WIND WASH BARRI�RS:
[: Wind waah barriez installed a�
atti� edge
( � averhangs (cantilevered fLoors
and baX windows)have wind wash
�arriers
MEGHANICAL•
[ ] Ducts running outeic�e conditioned
space sealed and insulat�d
w�th minimum of R-8
( J Returns in same space as furnace
aealed
[ J �iucta ir� unheated spaces
I] Water heater has pipe insulation
ar h�at tra�s installed
[ l Furnace AFUE:
[ � Cen�ral Air S�ER:
�pT IOATAL
i CATE�',pRY 1 j
[ l A�1 exterior joints in
building enveJ.�pe epaled
[ ] Residential mechanical
ventilation sy�tem
installect (Mandatory if one
or more item in �hia column
is checked?
----1�TCTES Tp FIET,D (Building Department Use Only) -----..______________..____
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Buildi.n;g I�LUMBING P�rn��.rro.: �DZ
Ix�p�ctions ItESIDENT�.AY. APP`LICATIUN �v�ct �y:
76�-572-3604 �Y'a"'Y' OF FItI])LEY n 0�
763-50�-4977 FAX EFFEGTNE 1-1-08
�ATE 1/I� G „y, �.�a�9' YOUR &-MAIL A17DTi�3S �+C.l�"G r. ' � t��/'YI iC / � � /%7
311E ADUR�SB �la/ %�—L��'' n �+��t+ r �s+ � �r. � � �/ �.S"�✓ ��
THIS Al�FLICANT I9; � OV�R�F�k OGONTRAGI'�R
PROFERTY xa�: . ' �ix � ,
�� ADDRESS: 7�I � ` sM f1�n � �.�-� J�'CITY � � ' -�J� STATE ���
��
�xo�: '7�' 3 c^.s"�'S'
CQNTRACPOR rran�:
ST�IVIlT A COF1r OF g,1,A'1'E I.ICEN3E N 67� DAT'E
YOI1Ct STA1E - -
Y�CENSTi. FtONb AI+1D STA'fE BQIVD � B� CiATE
CEkiffiCATE OF ariri]�ESS: C!7 Y S'rn�rE ZIP
INSUltANC� rttbN'� �n�c
� ��, �p� �I( SiNGLE �'A1rIILY O'1°WO FAMII.Y O T+DWNHOCISE
TYPE OF'W�RK: � T'�W �3'R�PT�0.CEMENT
dETAII.Eb XIESCR1PT101�T OF V6rORK a r" �
PER MS 16B.6�i5 ti�e permit fee is a mi�i�om oi 515.00 ar 5"/0 oP the tutat caat np to 5500.00, wi�ichev� is greater, for the�
intprav�, in.�atlation or replac�n��t of a residcd►tial fixture, excluding the fixpu�s_ (This ghould reflect otily d�e oost of lmbot )
Labor c� w�r �Q4 = 515.00, Labor aost bet�ween �.300 to $500 ° c.ost of' lsbor x.�5 = plus .50 sutcharge
UR
FQI� pRQj$C75 W�RE LABQR PJCCF�DR 5500, FE�S ARE �AA9F.D ON f10,00 PER PlX1i1RE, E7CCSPT WFiERE NQTBb. �'DL1Vlt�s: (Q+IriTCA7'E TCYI'AL
NUMBffit oF �nCH HE[.ow�. N�NUM F�¢ 515.50.
BATH S�lL.AV Ff.00►li riRAIN9 $}iOW�Et _ WATER P7PWG
BA7i�'[U� GIRS PT�NWQ (N�D CI'CY 1JC) _ SVYIIaA�ANG POOL WA7'E12. 30F'19J� {$35)
—�,p�,q �rpg�t KlTCt�N S11VK WA1ER C[ASET � BACKCLOW PRBV. (S15}
bLSHOVASt�R LAIYNb�t'Y TRAY ,� V�IATER HEA7'�R (S33) FtfRlRlt�0AT10N
_'WATER MErE� _ 07�R
. . ,o. L. .. . • ;. e•,.,
�;: .
p�n�t F�e a�,- c� N� of Fuch�ro� (t�, S1p.00 x�YO.� _$
e .50 Num6� of $xqu+es (a3 �15.00 x SiS.dU °�
TOTpY, DUE $�. '�4 OR N�rtnber of Sxt�es (e� �33.00 x 535.00 =$
Stete Surcharge � $ .50
�[1'hd $15.50 $15.5� Tofal � $
'TH1S TS AN APPLiCA"C10N FOR A PfiRA+�T NUT vAL(p tINTIL PR��44SED
I heneby apply for a p}umbu�� per�nit and I aclanowl�tige that the inform�ian above is complete and scctvate; that the work will be in
c�formar►ce wit� die o�s aad oodes of the �ity of Fridley �d witb dte Mlnnesom Cor�struction C�od�s; d� i understand ibis is
n�, a pennit but only an sppli�tion for a permit and wark is not to start without a permit an site; d�t the wosk will be in accardanae
with the approved plan � the c�ci of al work � ' r�wiaw and approvai af plans.
SIGNATURtE OF APPi.[�nNy' /� PR�TT NAt� �i Il�a.�'f ��G� riATE I�� I� 0�3
APPROVLri BY DATE
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�'ity of F�°lrlley 41l'Y7 �g'�o g9d� �s�`l
H�eilding In�p�ctione Depart�tent Q9/1v
�31 V�i1l►eiTS�� I'lV�llB �� FTI�$�1, MN 55432
763-572-3604
FAX: 763-502-A977
W�6£�OL�6800Z/6/Zl �a3�a 1./6:a6�d 89ZZ08LZ69:wa� . .