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City of Fridley . 12650
, ` AT THE TOP OF THE TWINS g U I L D I N G P E R M i T CEIPT NO.
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r � � PROTECTIVE INSPECTION SEC. C�� ��
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�� /"'1 � CITY HALL FRIDLEV SS4$2 NUMBER REV. DATE PAGE OF APPROVED BY
""� � ,�� 612-560-3450
910-F15 7 25 ?4 � �
JOB ADDRESS y580 Dana Court N.E.
1 LEGA� LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9 2 Harris I�ake Estates SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Richard Miller Homes 1600 Ri.ce Creek Road N.E. 786-1600
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
$dIIl�
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE �ICENSE NO.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WOflK
�7 NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK Construct a 42' x 26' Dwel].ing and a 20' x 26 & 33' Garage
9 CHANGE QF USE FROM TO
STI PU LATION S
Nlaintain required side yards at right angles to lot lines. Provide
a hard surface driveway. Provide a verifying survey before capping.
SEWER LOCATION: 173' East of Manhole (E. Inv. 879.78)
Wye Elevation: 880.47
Top of Footing: 884.00 Mi.nimum
WATER LOCATION: 10' N.E. of Sewer Service
54' 5.E. of Manhole
� Location informa.tion received from Russ Johnson of Comstock & Davis
SEPERAT'E PE�tMITS REQU1Rf.t� FQR WlRtNG,
WEATIN�; PLUM�NG AND S�i.:GNS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOt� FiaIIl@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R I. �.092 27, 560 Tota.l
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNIT5 OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ], STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $`Z8�%S�. ].LJ�.3$
DOES NpT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION� THE PERFORM CE O ONSTRUCTION. � .,S` 'rJ�.• OO 300.00
PLAN CHECK FEE TOTAL FEE
�-��o - 7
$365.38
S,�NATUREOFCONTRACTORORAUTHORI2EDAGENT �DATEI i
', �- = WHEN PROPER LIDATED THIS IS YOUR PERMIT .
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APpLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : S PE L T Z BUILDER : R I G H'f} �� �l�t( I L L L�
ADDRESS: I.fBC� p/1-N� CovJ�.%" ADDRESS:��OC�O R�cc GR�EK ��D
NO :. 1 S� d S TREET : A/�/tl /� G Q�e l� T
LOT :_,��_BLOCK t � ADDTTION : I�i4-%L� I S L./4 K& �STi9�E iS'
CORNER .LQT: INSIDE LOT:�_SETBACK: � �, SIDEYAR.D:�d/$ /Q �
Applicant attach to this form Two Certificates of SurveY of Zot and proposed
building location drawn on these Certificates. r
HESCRIPTION OF BUILDING
To Be Used As:
,�WELL• 1 �V G Front : � Z� Depth : � (� � Height : � � �
Square Feet: �0 �%Z Cubic Feet; � J. � y'�
(��-�4I2/4G F F'ront : � 0'' � Depth : � �� ''� a� Height ; �� �
,_
Square �'eet; ��� Cubic Feet: � 71 ��U �� � �_:' �� -!
�pe of Construction: �R�/S((� Esti.ma.ted Cost: $ J�Q, OOO�
To Be Completed : � C % � !� � �E � `
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The undersigned hereby ma.kes applicativn for a permit for �he work herein
specified, agreeing to do all work in s::�ict accordance with the City of
Fridley Ordina.nces and rulings of the Department of Buildings, and hereby
declares that alI the facts and representations stated in this application
are true and correct.
DATE : 7' I oZ '�% � S IGNATURE : oCJ�-0�'v�G� �CL�t���
(See Reverse Side For Additional Informa.tion. ) "�' � `� ���<� ' `'
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BUILDING �PERMIT FEE SCHEDULE
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SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
buil.ding ox structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, requixe the payment by the
applicant fox such permit of fees to the amount hexein below.set forth and in
the manner he�ein provided to-wit:
. - ;
UNtFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical co�tents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches belo�a the floor line of the basement
or the cellar to the average heights of the upper surface or �o the averagef
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
- the cost of all proposed woxk.
Tn no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
t3ane of application, to allow for proper xeview•of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been cons�ructed,�wil1 be required before proceeding w ith the framing.
CERTIFICATE OP OCCUPANC'�
Application for a.Certi,fi.cate_of Occupancy shall be made ten�(10) days pxior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
.
, �.
., --
e
Main Office 784-6066
� UBURBAN 6875 Highway No. 65 N. E.
,----
1� �f���I NOINEERINGi Minneapolis, Minnesota 55432
.` 1=,_=' INC.
South Office 890-6510
� ;! �; Civid, �Municipal & Environmental Engineering 1101 Cliff Road
� Land Surveying � Land Planning • Soil Testing Burnsville, Minnesota 55337
�: ' '?;
�
i�__'i
City of Fridley
6431 University Avenue N.E.
Fridley, Minnesota 55432
Attention: Mr. Darrel Clark
Dear Darrel:
July 30, 1974
� ��. �z �� �'"� ,� �. �;�� � ;.:::_�'
Re: Harris Lake Estates
� �
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c���
�—, �, r-�,
We have observed the excavation and compaction of Lot 9, Block 2 of
the above subject p.roject. The deleterious materials were removed and
a compacted granular pad was constructed as per our letter April 26, 1974.
Density tests were taken and a result of 92% of modified proctor density was
obtained, 90� being minimum allowable.
If you have any questions, please feel free to call.
Sincerely,
SUBURBAN ENGINEERING, INC.
��� � s
v
Peter J. Molinaro
PJM/rp
Robert Minder, Reg. Ereg. E. A. Rathbun, Reg. 3raru. Charlea L. Lenthe. Reg. Erzg. John F. Dwyer, Reg. Swu. Jejfrey J. Roos, Reg. Eng.
Wm. E, densere, Reg, Erzg. Wm. K. Meyer, Reg. Eng. Wm. E. Price, Reg. Ereg. Donald E. W¢dleigh, Reg. Ert$.
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Fl�USE HEATING TEST RECOB2D �`" �,� r_.�.,
ADDR ESS �" � E< �� ,� �.r.-�:. ; ,� � .^ . �,;, � ,�
�, -� y *`' APT. FLOOR CIn SUBURB
OCCUPANT- `r� -�"� �'`�' OWNER
�4 � , . � `",r��
HF�!1T LOSS�—DATErHTG INST. GAS C0. METER BADGE R—,�. �—�=�
SOLD BY � - " `�'�'��'�"` *='" ` '� �-�� . INSTALLED BY y�'" �t_ ' '` = '' �` �' �,
� �� a� , �..
Eleetrical Work By Gas Line By �'�� °�,�' «'
TYPE OF HEAT GA FA � HW STEAM SPACE HTR. UNIT HTR. OTHER
�, GAS DESIGN CONVERSION
MAKE �^�`�+`°�'�'�``�'�"�' MAKE OF BURNER
Model � +� � � � "°' A'�' ,a'� Model -
Serial Mox. �Tll Retina
INPUT � � � �� MAKE OF FURNACE ''
Model
CONTROLS
THERMOS,,�T T���°� -" Heat Plug Vent Size � y{
Valva �'+ �� `"� ', KIND OF LINER � `& ���'� �`� SIZF '' �` NONE
Limit ��' �' ,� �°� �' �`� Draft Hood `-£��' f*"¢� , Regularor �� �~'`',`�
Limit Sel4ing � �''�� Filters Size �Smber
�+eo ` °° ° ;� �+ �
Fan Setting � �" Chimney Loeation (ns�de � Outside
Pilot Type ��' ` Chimney Construdion � �= �`='"J �'"` .
Pilot Make �'�'��>'�'�
�``;�
Pilot Model "°�` Smoke Bomb � Wiring "�' �"y_;
Pilot Timing �_';_�'`'�" Draft °�'� � Test Tae ?''���. +'
L.W. Cut Off Door Pressure Lighting Inst. `�'� `�
Prossure ��• �'� „ Percent CO2 � 3 � Date Tested �"� � '� �N � �
Input CFH� �+ x Percent 02 i+�j�* � Company Testing �' r�%'� ,`'� �" �'�
Stack Temp. � �'`�' �Percent CO �' - ��' Name of Taster �� ;s':�k' ., "
Form 235
� � . - ........ . . _ <__ . , . . . , _ ..,. . ._ f �, � . . � � � � � .
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H�AT I.�.9 CAI.CNA'f fONB �- �- A� .:.:� � .. _...,_.... . , _ . . .. _ r' ,' , e . ° � � : . ; � , .`^ �. .
Weatherstrips ' '' Coaat ction No. Insulation
Guide
Windowa Doara Referettce Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No I ` Ye—� 19_
<' Fl.� ,. Room L.ength �'' , r Width ,�' Height -�`` � r Fl.� Room Leagth .' Width . Height .
Windows and Doora—Crackage and Area Windows and Doors-�rackage and Area
� \Vldth He18At. No. ot Llneal !t. Are� Wtdth HelBht. No. ot Llneal tt. � A�e� .
' No. ot Dana ot Dene� Il�hte, � ot crack �q. tt. � � No. ot Dgns ot pane Ught■ ot crack �a. tt• �
-,(' � !.�- A� -°� G..ti ` � � � �e``.• ._.. .� / .� '�� .. .
. - f� .� o �E�:;• t . . . -
� � . . � . t„i' . .
Coef. Bcu � Coef. Btu
_ Inhltration � ?� _ � _ ,� - ; .�r'° Infiltration �;` .% � -� � ; � `�> ;
Glaas. „'� � �: �; � � . , � ' GI s s Y '" � i � - : '�
Exp. wall:.;, /
Nec eap. wal) m � • '"
lnt. wall
Ceiling --�° <�, �, � _, . �
Fl�or -
Total Btu. ,
Required sq. ft. E.D.R. or sq. ia�. W.A. Leader area
/ Fl.� ,�'', s-i• ;^ Room � L.ength ;�' �; Width,.i �' H
Vf/indows and Doort--Cracltage and Area
� � Width � Hel�ht � � No. ot � Llneat tt. Are�
No. o[ Dans ot D�n� � Iltht� of er►ck sa. tt.
`�% ' � ; 7 %� 4 .s'1 �dv
. . ,. �.
'.. Coef.
In6ltratioa ' ,� j�;,'
Glaa, . f-,� �
E:p. wall = : -, � st ,�
Net e:p. wall �`� " i
Int. wall
Ceiling -r" : %� ;� ''�..
Floor �
Total Btu.
Required sq. ft. E.D.R. or eq. ins. W.A. Leader aroa
.° Fl. • . E3QOm Length _: ' . ° Width "� �-
Windows and Doors—Crackage and Area
WIEth H�I�ht No. ot Llneal tt. Area.
No. o} ytne ot Dane 116bt� ot crack eq. tt.
: ,; � !✓�. " o' -� :1 / 3
1n61tration � r y •_
Glaas � t'° ,
Exp. wall '"" �
- �E! !1[p. Wa�� (�
Int. wall <: ;
Cetling `� �.
!� loor
. Total Btu.
Required aq. ft. E.D.R. or aq. in�. W.A. L.eader area
Fl. ,�!_ i - Room �l.ength ��, Width
fiVinc3ows and Doora—Craekage and Area
Wldth Hel6ht No. ot Li�osl tt. Arep
No. -etya+rs `of yana" i1tMr e[ enck �9. tt.
.s L� ��1 .l � . . � � d � 4� ... . .
:� t/' %
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ght ,�r -
Btu
as
Exp. wall _ `:�' -; "
Net eap. wall
Int. •rall
Ce„in g
Floor •
Tota! Btu.
�
r_ � � °!''' � SI !=. �"
Required sq. f.t. E.D.R. or sq. ins. W.A. Leader area f'
✓ FI.I �'' ,� i� . '=�-,,, , Roam I Length ' . Width . �', `' Height � ' � �
Windows and Doors—Cracltage and Area
Width Helght No. qt Llneal tt. Aren �
No. ot Dane of Dans 116ht� ot cracA eV. tt.
� °, a � �` �'
_ - � „ a;., .�
d :;r' �!_ : � �.v .a: - .. . _
f. m
1n61tration � � � ` � - -5
��--- .�... P .-
Exp. wall r, ° -
✓ r�
Net exp. wall
Int, wall
Ceiling
Flooi
Total Btu.
���
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�. ft. ED.R. OI 6Q. ins. QI.A. I,.eader area
� Fl.� _ Room I
Windows and Doors—C
Width Helaht N
No. ot pnne � ot pane 11
/ �:: �- <-
_ =- �:� �,.
<<
� � . ,-_ �
I I
Infiltration
GIBSS
Exp. wall � � � `•
P
Net exp. wall
,� � r
�,
i ' Widch . `� Height °
e and Area
Wnaa tt. Aro�
ot erack �O. tt. ° ... p.. �
� �, -� t �:
r � •� l r • � � . �,:� ,1�7 -�.
y �4'
Coef. Btu
< ." � �
� .J • / ,F,
��yf. ��.. ^': L �'X 1fl
in�. wau � � -�
Ceiling _. ._ ...:_:.-_ — _ ._
Floor .,,F,a " .
Total Btu.
. . / .� y�
Required sq. ft. E.D.R. or sq. ins. WA. L.eader area
j'� F7. r;,. _ Room I Length Width ^;/ �HeighRt ;`;� '
Windows and Doors--Cracicage and Area
_ R!ldth- #fatgilE- Nu of Ltneai ¢t. Ate�
No: oi dane ot D�oe 1l�bt� ot cr�ek' �Q: tt.
_�� '�� /: i,l / G7 �, '. ' .
�%
Coef. Btu
In6ltration � °.' � .� ;, F' �.- � . Infiltration '�' c � t- �� ,,
C�Iaea ,�1,. ,�°'� r� , Glaas 2 . .��
p� .`,^ r .w
G7[p. Wa�� ,''� � e ' �,� EXP. We�� � '�'; i . ,m�e"'.
Net esp. waU ,� � C;, `� . �. Net exp. wall �� f` s �r
int. wall Int. wall �a• f'�, -. ,' �..
.� .�
Ceilin8 r° �' -? t�' �' Ceiling
�loor E'loor ---0- °�'�-� �
Total Btu. ° ;1 p Tota) Btu. ��, ;`�
Required aq. ft. E.D.R or sq. ina. W.A. Leadsr aren Required sq. ft. E.D.R. or sq. ins. WA. Leader at+ta •
�o �
��y � � � .
H�AT LASS CALCUTAiiONS
Weatheret�ipi < A Guide � �d��ction No.
Windowa � Doare Refereate Out. Wall Int. Wall Ceiling Roof Floor Kind
Yes— o es-- 0 19,_.
�'1•f `-'!,, � , d �.-- .-� � Raom Length �° ,e Width �' j' , Height =' � -� ' Fl.� Room � 1
Windows and Doors—Crackage and Area Windows and Doora—Cr+
�� �Vldth HelgDt No. o[ Llneal ft. Arcs Wldth Halght No
No. ot pane - ot Dane Ilshte ot cnck �p. tt. No. ot Dane ot Dane Ilg
�� .n 6..
A , �. � P.o
� .
Coef. Btu
lnfiltrahon � r'a •;''._ "-'P� r`�' Infiltration
Glaas .�`'.�- � r �. fF, ;�� � Glaas .
Exp. wall �' ;�. ' �:`-:, . ._, .r' � ' Eap. wall
Net exp. wall �� � _ Net exp. wall
Int. wall
Ceiling
Fl��or
��0�
�_�_
Total Bcu.
Required sq. ft. E.D.R. or sq. ina. W.A. Leader area
'�, FI. ;;, ± f�: P Room � L.eegth e, Width ;
ii`
Windows and Doors--Crackage and Area
Wldth H�I�bt Ho. ot Lineal tt. Are�
No. ot DQ�e ot p�ns ll�ht� ot crack p. tt.
d • ',� � e_% �I,,s>...
• Coef. Btu
lnbltration' ,�� r_;' �ar,� J e.°:
Ad
�
%
Heighc r:�%
Glas.
Eap. wall 5' ' � ;�;.�,_ t.
Net e:p. wall '
Int. wal) �`,� �'a :
- Ceiling .
Floor -� � o__
Total Btu.
���
��_
����
Required sq. ft. E.D.R. or aq. ine. WA. Leadu area
j,s,a F1, '� ., ;;, " Room Length; Widthi�P-+
� ,;
Windows and Doors--Crackage aad Area
Width el6At No. ot Lfneal tt. Area -�
No. � ot D��e ot Dane II�At� - o4crack �p. 1t�.
.,� ° ' � "' Li" �,.
, .�,,
. ', .�q �.. .�'�, 1 - .�A.f ._. �i �
In6ltration J �
(�lan
E:p. wall ,�,f� ^ `
, ,�r
Net e:p. waU
Int. �aall �T„'y Fa
Ceiling
Floor
. Tots) Btu.
� ,_.
•':8
Required sq. ft. E.D.R. or eq. ins. W.A. Lesder area
F'I. ��; � ° Room � Length „2__ Width �
" Windows and Doors—Craekage and Area
Wldt� He1fAt No. ot Llno�l ft. Are4
No. � of psn• ot Dane Il��t� ot crack `�p. tt., �
�LL -� .,,, � «_ � �.,.° � ,_
7� '
�
1neulation
How Applied
Wideh
end Area
aeal tt. Area
cr�elt �a. tt.
—
Int. •rall
Ce��ing
Floor .
Total Btu.
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
FI.I Room I Length Width
Windows and Doors—Crac�age and Area
� R'Idth Hefght No. ot Llneal It. Area
No. ot Dane ot Dane 116ht� ot crac4 �V. tt.
Neighc
Btu
Infiltration
Glasa
Exp. wall � �
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required aq. ft. E.D.R. or nq. ina. W.A. Leader aree
FI.� Room I Length Width Height
Windows and Doora—Cracicage and Area .
Wldth Hel ht No ot Llnesl [t � Area
• r
u
�
No. of yane ot Dans U`ht� ot cr�ek p. tt. _,
Btu Coef. Btu
: ���'�_ In6ltration
. � � ; Glas� •
Exp. wall
/ � Net exp. wall ,f
� Int. wall
Ceiling
� z�' � Floor
�° Total Btu.
Required sq_ft. E.D.R. or sq. ins. WA. Leader arra
�t ;-'' Fl.� Room I Length Width . Height=
Windowa and Doors—Cracicage and Area
Wldth HeIQAt No. ot - Llneal ft. Aroa
No. ot pane ot Dans U�ht• ot eraek sQ. tt. . ,>r�
� Coef. Bcu Coef. Btu `�!'
In6ltration ` � *% �; ^'; �� � �,� Infiltration r'
„ 4 . _,
Glaaa � � �-, Glass
r�ap. WBII �� r2�o�.._r� . � T J C.i�%. W8II
Net eup. wall `' f' %� :e Net exp. waU ;�;�
,
Int. wall �s' _ �� � s"; ,r �� �' Int. wall
Ceiling Ceiling 'i,
Floor "?� �' �,�'' Floor '
, ��
Total Btu. / Total Btu. `
Required aq. ft. E.D.R. or sq. ina. QI.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Le�de� atra `�"
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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 OIV
' ��: _"'�',
r � � PROTECTIVE INSPECTION SEC
i �
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� � ��"1 � CITY HALL FRIDLE� 55a32 NUMBER aev onre PAGE oF
�----'�'• •'' 612-571-3450 910-F15 6/24/96 / /
JOB ADDRESS 1580 Dana Court NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 9 2 Harris Lake Estates
2 PROPERTV OWNER MAIL ADDRESS ZIP
Sally Young 1580 Dana Court NE
3 CONTRACTOR MAIL ADDRESS ZIP
Don's Weather-0ut 2808 W 72 St, Richfield, MN 55423
4 ARCHITECT OR DESIGNER MAIL ADORESS Z�P
5 ENGINEER
6 USE OF BUILDING
Reroof House & Gar
7 CLASS OF WOHK
O NEW
MAIL ADDRESS
ge (23 Sq) Tear-off
❑ ADDITION ❑ ALTERATION
ZIP
� REPAIR
B DESCRIBE WORK
Reroof House & Garage (23 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must meet the State Building Code.
��'�'30
� �� �
APPROVEO BY
SEE ATTACHED
SHEET
PHONE
571-7227
PHONE LICENSE NO.
869-3746 7155
PNONE LICENSE NO.
PHONE LICENSE NO.
❑ MOVE ❑ REMOVE
TYPE OFCONST. OCCUPANCV GROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, HEATING,
VENTILATING OF AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT CU. FT
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOH A PEHIOD OF 120 DAYS AT
ANV TIME AFTEFi WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOIiK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. TNE GRANTING OF A PERMIT � 1 s 897 �. 95
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- @
STRUCTION OR THE PERFORMANCE OF CONS CTION. �p.59..rJ0 IF $59. 50 Fire .SCi � 1. 9�
� � �� PLAN CHECK FEE TAL FEE
/`G'. Li s SC .00 ' $126.85
SiGNA UFE OF CON'RA TOA OA d.UTHOA�2ED AGENT 1DATEi pq LY V ATED THIS I�UR PERM�T
� '
S�GNnTUAE OF OWNEA uF OWNER BuILDEfii iDATE� _ _ �DG �p o qq7E
NEW
ADDN
ALTER
tl
��
�]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/96
ConstructionAddress: _ � �-' �;'o � ��,�. �" �
Legal Description: �,S �'G� °° � ��,r,a �' �°,
Owner Name & Address: �',,,_ �/.� Gs�, ,,�, / �°��► �,,�,,�� G' �'" Tel. # ,�` j- '� �
r---
Contractor: ��� ,� s �,r;pl�, �` _ �, � MN LICENSE # �/S �
Address: C�t✓ �io2 ��, ������� Tel. # ��' % -� % i�.�
���
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GAItAGE AREA:
DECB AREA:
OTHER:
DESCRIPTION OF IlVIPROVEMENT
�ng� Width Height
Length Width Height
Length Width HgtJGround
� �
Corner Lot [ ] Inside Lot [ ]
Type of Construction:
Approx. Completion Date:
� �'i /�Pc �lo� /'�-�-�;Z'_,.� �7 �t?
Sq. Ft.
Sq. Ft.
Sq. Ft.
,� `��-'�' e�?3��.
Ft. Yd Setback Side Yard Setbacks
Estimated Cost: $ ��> �' , .S-�
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ —$
DA�: l� - a y �(�� APPLICANT: _ �F �� ,% �� �- Tel. # � �i�-��� �> � ��.:.� i
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�� �g �
� ��.SU
�_ i�• �D
� �s'
$
$ .� � U
$
$
$
$
� /�� . ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1110th%)
$.so/$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 [ ]
BUII.DING PERNIIT 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 e�sting building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,Q01 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $5(�,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.(?0 for each additional$1,000
or fraction thereof, to and including $50,0(�
$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 $1�,Oi?0 plus $S.l� for each additional
$1,�000 or fraction thereof, to and including $500,�0
$2887.25 for the first $5�,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,0(� plus $2.75 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 $13.50.
Alte�nate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the l�ation of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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C� ' d �t1101
FILL IN COMPLETELX FOR REPLACEMEN7 FUEL BURNING APPLIANCE PERMITS
COMMON VENT VENT CONNECTOR AND COMBUSTIt�N AIR VERIFiCATION
When repiacin� an existinq fumace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructi�ns,
and is securely supported and firestopped where.required. Yes (� No ()
The venting system is plastic/PVC and meets al{ cu�rent codes and manufacturer
specifications induding sizing, length, number of elbaws and termination. Yes (�
The undersigned also ver�es that the replacement unit is a listed assembly
and meets the curreni codes and manufacturer's specificaiions. This do�s
include AGA-GAMA Category I Central Fumace Venting Tables fior fan
assistecl and natural draft applianc�s. Yes (�
. . ...a:,... ,.: . «. �� n .,1 • a+ +4.t,. ..� .
— Q.QFi7i�zrorr oair-�.-r .�Z£C�-�� If�&�x-cv n �� : .� �.. ..��fl�Flt &- ---- --
and manufacturers specifications. Yes (1�
When required to install a new combustion airLit will be sized and installed
to meet the current �des and manufa�ture�'s spec�cations. Yes �)
When installina a new venting svstem, the undersigned hereby verifi�:s fihat
it is a listed assembly and meets the current crodes and manufacturer's
specfications. This does include AGA-GAMA Category I Central Fumar,�
Venting Tables for fan assisted and natural draft appliancES. Yes (�
Is the common vent and vent connectors sized and inst�lled carrectly after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
No ( )
No ( )
No ( )
No ( )
Yes � ) No ( )
A liance T e and Size/Common V�nt and Vent Cunnector Information
Appliance #1 Type ��� B'R1 � nP� _E�..�� Fan Assisted or Nat -�.Y•
Appliance #2 Type BTU Input Fan �issisted or Nat
Appliance #3 Type BTU Input Fan flssisted or Nat
Total Appliances Tatal Btu Input _
Common Vent Type ��� � Vent Height � Diameter � inches
Appliance #1 Vent Connector Height 5� ft Length ,,,�e�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
ALTERATI�NS• Describe} -
� CENTERPOINT ENERGY
HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304
Signed By: ����� � � � A Date - �S
,,
�A/�R' �I SRJ,9I.SL Ol J,31Q 1�� �0 J.l 1� WO?J-I �� : i T b002-LZ-�IdEi.
�
Building
Inspections
763-572-3604
D.ATE `� "c.- �
SI'i t ADDRFSS �
THIS APPLICANT I5:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBNIIT A COPY OF
YOUR STATE
LICENSE WITH
.APPLICATION
PERMIT TYPE
TYPE OF VVORK:
� MECI-�A.NICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAJL ADDRESS
� r �
❑ OWNER �ONJ'RACTOR
� a
S: CITY
'1(_ � _r*�I _ '7�► l'1�
Permit No
Received By:
� . �� - .�
i1
�o��'Y N"',�: Anderson Heating and Air-Conditi�ning
CONTACT PER50N: �� J
STATE LICENSE � 4347 Central Ave N.E.
ADDRES$: �
PHONE ,� f�'� p��- ��s�� Col. Hts, Mn SS421 �
�INGLE FAMILY ❑ TWO FAMILY
p �.I�W �REPLACEMENT
n
GETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
p pLTERA7'ION/REMODEL
_STATE ZIP
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the totat cost up to 5500.00, whichever is greater, for the
i m provement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS �'I�RE LABOR EXGEEDS 5500, FEES ARE BASED ON $]0.00 PER FIXTURE, EXCEPT WH£RE NOTED. FiXTURES: (INDICATE TOTAL
NUNIBER OF EACH BELO� �"��' '4���= MODEL: SIZE/BTU o7 0, <�
Equipment Installed I''�G' MODEL: S��T�
��' SIZE/BTU
�G: MODEL:
�A/C 525.00 _FIREPLACE (GAS) 515.00 _GAS RANGF/OVEN $]0.00
P1R TO AIR EXCHANGEER S15 FIREPLACE (WOOD) $35.00 _NEW GAS GRII.L $10.00
BOILER $35.00 _FURNACE $35.00 _GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 _GAS DRyER 510.00 POOL HFATER $35.00
_GAS PIPING 510.00 _VENTII-ATOR $15.00
DUCT WORK $10.00 _ _ .._� .. .........:....e....,pr...n.a.m,:.�.���.�- .,,.�.�r,�.--�:�:- rc�::t*::cx,�,r_r:s��.nxhcriuccn
1,1.�2'��iL'�;i1CtJJGV1�Jr:L'iVd��.ti?.L�a✓ua4::�vrv.v. c�. �,•".•=n : � .,:,,.,.,� ...-.,- .. ... : .:... .. .„__ . _ _ .
Permit Fee $��• G� ' Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number af fixtures @ $15.00 x $15.00 = $
TOTAL DUE $��•� Number of fixtures @$25.00 x$25 UO =$
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Tota] _ $
� THIS 15 AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the inf�rmation above is complete and accwate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota �Construction Codes; that T 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 work which requires review and approval of plans.
S IGNA'rURE OF APPLICANT L`�� Sc(i''V • PRINT NAMEC � Gv�'I ��T e/J 4� iC � �j di/� DATE
e;ry of Fr;aley '
Suilding Inspections Depariment
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAx� 763-502-4977
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