AF - 43028�UIILDING PER1VdIT
�ilZ�.ge of Fridl.e�, 1llinn.
N° 2574
Date �� ./.'��,".'.": ;"?�.� . . . . . . . . . . . . . . . . . . . . . . . . .
(� . �
Owner .���:�t: t 6�! . .�''��r . . . . . Builder . ..r�^."�� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
••r�"": J?�'�• r"W:°1'�'. . .
Address . �! � "�+� . . . . . ."�'��'�ad�r+�.��. . � Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCATION OF BU6LDIIVG
No. ..��...... Street . .... ....�..��........ Part of Lot .......................
LOt . . . � �. . . . . . . . $loCk . . . . . . . . . . . . . . . . Addition or Sub-Division /.`.'"�". . .��"".�."�. . .r t�. .�_,!�'.� ,�� �, ,
+w.�` � #' ,
Corner Lot . . . . . . . . . . . . Inside Lot . '. „�.:^': . . . . . . Setback �, .�"«/', Sideyard ��. . . +�'"""" . . . . . . . . . . .
DESCRIPT(ON �JF Bl,JiLD{NG
To be Used as:
f a
• j i��� '��. .,�� �.�:��r.`: . . . Front r�;; :��. . . Depth .,�: �. . . I�eight �` �.�.�. . . . Sq. Ft. ����, . Cu. Ft. . . . . . . . .
.................... Frant ..:..... Depth ........ Heig2�t ......... Sq. Ft. ........ Cu. Ft. ........
�` �c,a
Type of Construction �1'�`,��w,�'... Esi. Cost���.�:��............ To be Completed ......'..........
Yn consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and i' compliance with all provisions of
" ordinances of the village of Fridley.
.�,,,""'"�"� � .
..���:�� . .. �..��..' ... �
, . . ..
m nsic�eration of the payment of a fee of $. �:'�: c; permit is hereby granted to . ..,.?�: ........
�. •.• •••.... to construct the building or addition as described above. This permit i�s granted upon
tlie express cnndition that ihe person to wham it is granted �nd his agents, employees and workmen, in all work
` done in, a'round arid upon said building, or any part thereof, shall conform in all respects to the ordinances of
x'ridley, Minnesota regarding location, construction, alteration, rnaintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time U n v' l�tio any of the provisions of said
ordinances.
�; �
• • �`• . . . . . - Buildmg Inspector
NOTICE: __ �
This permit does not cover the construction, installatian or attera#ion #or wiring, plumbing, gas heating,�
sewer or water, Be sure to see the Building Inspector for separate permits for these items.
- __ �
APPLICATTON FOR �UILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OwNEA' S NAME_ ,�v �c�,, e���� %�e f�{� `:,___ BUILDER�_ cS U S<S � I--- C c�
ADDRBSS__ �v � �c� ,O�el�avc'� � � � �DRESS /�Scz t-'er» a - � f �
LOCATION OF BUILDYNG
Na• Street Part of Lot
-�--
L�T K ADDITION OR SUBDIVISION
Corner Lot��Inside LOT Setback Side�Yard
SEWER ELEVATION FOUNDATIOR ELEVi4T�O1Q
�_
Applicant attach to this £orm Two Certificates of Survey vf Lot and proposed
_. build'ing location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
c�/� 7` d �� � � � .��, � /
�� Front � � peptt� � � geight ,{ G
Sq. Ft. �/ � Cu. Ft._ �i /� C-�
Frant Depth ��Height
Sq. Ft. Cu. Ft.
�ype of Caastruction _��-�t.,,.,,� EBtimaCed Cost f�%��
e,�
To be completed �o c�/ y s
�he undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances
and rulin�s of the Degartmen� of Buildings, and hereby declares that s21 the facts
and represerntations stated in this application are true and correct.
DA�-- 1't�`5� �� �l�O( S� SIGNATIIRE � r- `
(3chedule of Fee Costs can be found on the Reverse Side).
c�
� �
w '! . .
� . M • ~..�,,, ,
Sc.s4. - 2 3 82
LOT NAME � SIZE
Z.D'x Z2..-�Zarz.
�
UGE►.! .(�v�� E T 8x 2Z Po2.
� BLOCK ADDRESS � VALUE .. t � -
k �
6343 C�E�.�.�voou �2. ` 171oU =° �
� ADD'N. AREA TYPE �
�2�0��. F�zA.ME
��
�
�2'
�
�
�
m
0
�
Q
`'
,
/11usr $�'
AT G ��asr
N
�
_�
��
8
, � ,
20 8
. •
�ESH
(6� Uoa2
�� a P R o �►
(�c,�.rs
�urc.��2 c
AS PN AaT
{DQ, �., F w,� y
�7 EsH
�,oP� 1,>
s
Q
� N
� q$�_,
_,�
COaJDJ 1T �
3� � `�n
�� //
� I ? ��o.1s E
(" //% /
Usav�2.E ,vi,-H M4v5C � / //
2(� L��E S,oE. OF G�.2aU�
�
`�tTH S�oE �F S�rooP QS 7EIowU v�, Q
QSTAtZT F�2c� sJT" O F G A 2,8.C� E ltt �'
'�J� �c.c� QF (�cEP.2 �F Noc�sC-' 1"�5 �J' How�..)
� �H��,� eo�E V�2,, �A2E�c�l.<.�, # �
O RFMOVE 2- C�orH�s j�o�Es
�`J / �t E 5 i-1 £ �� �u
OutT
. � � r� n ! ` �
i�Ra �1T
_ ; .-�,.:.. . ..
sue�ECT PE .
City of Fridley � 16 0 51
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
f
; ` EIPT .
� • COMMUNITY DEVELOPMENT DIV.
r � y � PROTECTIVE INSPECTION SEC. a� r
i
1 � i
' � ����: � CITY HAL� FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�'""'� � ,�� 612-571-3450 910-F15 1/26/81 � /
JOB ADDRESS 6343 Dellwood Drive N.E.
LOT NO. BLOCK TRACT OR ADDITION
1 IEGAL SEE ATTACHED
�escR. 20 Moore Lake Highlands lst SHEET
2 PROPERTYOWNER MAIIADDRESS ZIP PHONE
Eugene Ouellette 6343 Dellwood Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO.
Andreson-Lindstrcen Const. 9618 Utica Road, Bloomington 835-0309
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USEOF BUILDING
Residenti.al
7 C�ASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WORK
Install masonry fireplace
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REt�U1�ED FOR R�Vi�t��t;,
H�ATING, PLU�VlBlNG AND SIGNS,
�����
86fore QiB8in8 t�il bcaf utilities
TEIEPNONE - ELECTRtC - GAS Etc.
�EQIJtRE� BY L�AW
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICA�, PIUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
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
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $2�C�(�Q tiS`1.45
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �`].H.00
STRU TION OR THE PERFORMA CE OF CONSTRUCTION.
PLAN CHECK FEE TOTA�.E,E. 45
ly
-a�-
IGNATUREO ACTOFORAUTHORIZEDAGENT iDn7Ei � WHEN PROPEFLY VALIDATED THIS IS YO R PERMIT
*.
1 �Ip
SiGNATUREOFOWNERiIFOWNERBUILDERi IDATEI � BLDG iNSP D TE
CITY Of' f'ftIULCY •
APPLICn�rz�'d FOR (;ESI(�E:il7;f�1_ QUII.DI�iG E'E('v�I'fS
(tdc�•�, Al Ler��i;ivns, Pticlditions, or Rcpairs)
� � �/ � ,
A" r�L y � i. ���f I� .
�
1 , I , � �„ I
7et� ho:
�UI LD�R . -H �.,� D �t�o►.1 — L� ,u pS ,�,� om .
n�nRess: 9� rs� (���� A 2� �°`�'� t��
7CL td0: �� oc.,t� .. 5: S�3 �
� . 8 3s -c�� u�
Consi:ruction Location
. • � ,
� STItL•�T NO: 1��� STRE2:T: �
Lo��: c�� BLO�c: ' �wnz-rzo�: - � ' ��c�, �,t�-zc�;��
Corner Lot: � Inside Loi:: �—'""� SetbacY.:. Sideyards:
Ap�lica.nt attach to t3iis form tc,�o Certificates �f Survey of lot and
proposed building location dracan on certificatES to scale.
�Y���,v�� DESCRIPTIOi� 0!" CO�dSTRUCTIOPd •
i (L�}���C� � _ I'ront: llepth: Iieight:
S�,ua�e. Feet: C�ibic Feet: _ ..
. Front: Depth: Height:
� Squar.e� I'eet: Cubic I'eet:
%
Type of Co.�struction :``�
EstimaLed Cos�- �
. $ � ��1 •
�b Be Oor,,pleted: _�l - ��o '�l •
�
. . � Alt. A Alt. B
Praposed Drive��ray tvidth if New Opening Is Desired: $' $
. . SEL R�VERSF' SIDE OF SfIEET
�iie undexsianed heieby makes applic�-�ticn for a pernut fer the t•nrk� hezei.n specified,
agr.eei.ng ta do .all work iri stric� accardance ���ith tlte Ci4y of Fridley Ordiziances 2Ilt�
ruling� of t11e Dej��-�rtment. of 73uildings, and liereby declares that aIl the facts and
rcprescn t.it:i.cns stated ;i� this applic�tian are true: and correc�.
�
D.7TF: S7GPJ11'.CU ' � �—
�
Sti��ulations : %
- � � O .. �
�/, �S"
_�._ �� ��,
((/ //,�
V
ti
�
/ � ��� y
3S ,
/� �,
;
0
�. : • . . , _
�ut�r�rrtc�_t>►�r~t�t�r r-c.:�� :�r.�ir_r�ut_�.��, .
51.:t:'.C:[Ol� ?.. 7.'l�L 7:n�:��cct�or. of: Jiu�.lcli.iujr; t:liriJ..l, hcf.c�rc: i.r,r,uiruJ }�ennit:; !'or i:hc crcct:�.on
csf: ��>>y )�u�.l.cl.i.r,�� c,z :,�:::UGt:l11'C� vr !:c»_ c,na� �icicli.i:inn !.� an;� cr.a.�Li.�u1 I�uilclinc1 c�r :.tzucLvr.e,
cir. 1:a�' �,�;y ti.l.t�.cr�lt:lCill or. r.c�,��ir.s; t:o •any exS.r;t:in�� )nii.l.di.»+� or. ;;tr.uc:turc, uJwn �}�>pl.i.r.at.i.vn
ttir�J:�.f.'or.�c, r.cc�!t.i�-e 1Ji� pt�S�mcut: }�y U�c ar�p].i.c:ar�l: fc�i' :��ic1i j�cr.��i.L• of.� f�c.^, t� t)ic �rn�tant
11cr_cs.iti bcJ.c�ar sc:i: tor.Ui �incl �.0 t:hc riai�ric�: hc�:c�.n j�zovic]c:cl to-t•::iL•: •
l:l:h7 COI�`:�1'I'tUC'.CIUN: Si�2g�.c l.'ami).y ]lotr,cs and Garac{c,: ,`'.4.00/)_,000 cuLi.c tet:i:. •
PL7+:�2 CII;:C:t:: ?.5 i�cr.cent: oL l�ti;:7�cli.i�g }�e�-mit ice.
U1t1VI•;l•;l►Y llL•'1'P.c:SS:f.Ot•;: (Concretc, C�irb ;i:rcets Only) '
' 11).L'C:YIl.1i.0 A: ]tc:moval ai�d reF�lace;nent oi' concrete curb and
_ yutL-er o�tly; llriveway ��icltli plus 6 L•eeL• x�:�,�.75
111.ternatc I3; Rrymoval and replaccmcnt of concrete curb and
. gut�ter and i�istall a 3 fooL- r�ide anproaeh �,�iL-h '' �
' , 6�.neh clepth; llriveway �•�ic:th �plus G feet x$17.85
. .��I T I OPd/�L I n�'OR��1�iT I0� �
�'or the purl�se of co:npui:i.ng �ees for bua.lding perrnits,. L•lZe cu2�ica3_ co::tent-s of any
buil.d�.ng or. addition, i� deter.;niiied by rnultiplyir►g i:.tie ground area covered fro:n a
pvin4 six (6} inches below the' f].00r J_�ne of tlie basemeni: or th� cellar to 'the
averac�e 2icights oi thc �upper su�-face or t-o ihe average 2ieight of fhe rooF ,urf:a�e
of tlie r►azn gab].e of a pitched roof. �
For. zeFairs or a�terations to an existing structur_e, tne fee shall be at the xate
oi $3.00 �cr. each five hundred do].lars �� ($500.00) or frac�ion Uiereaf_ in tlle cost
oL all prqposc.d wor.k. . . '
In •no case J�1(�J.� the fee cIiarqed for any per.::;+� �_ set �:ozi::: :.n 5ectiun 2 b;, �:�ss �
t�l"*cIl $?. SO plus $.50 state swrcliarge. ' • �
� � V�RT F I C�TI0�1 �F F�ll'�D117I OId
NOTE: Permits ; or cons.t-�.-uct-ion ���ill be issued � mznimei.,z oi 24 hours fr.om t1�e t3me
�i apl�lication to ��.l.low fox proper re�riew of ihe proposed st-ructure and of ihe .
construction site.
A Certificate of Su�.vey of the lot, sho�+=ing the location of the foundat,ion once it �
has been cons�nicted ���ill be required be; ore pr.oceedinq wit�i the �raminq.
.�L�I r F r c ��F ���SLPnn►cti� . .
j►PPZi.cation �or a Certificate o� Occu��ancy shall be mad.� ten (lOj days prior t:o the
use or. occul�sncy o� any sti-uctu�:e �or �ahich a L�uilc3:i.ng pexz;iit has been issued; and
s�ii.d strtict=urc :liall i�ot l�e used or. occu��ied t:titi.l a Certi.fic�-��e of Occul�:tncy has
bceii xssued.
r �,
� �, �� . � :
. � 3�.UO � -
1�' � -
,
• � �/ .�� .
-. �
., .
� ,
\
sus�ecT P E
City of Fridley � 17 4 2 a
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � REC .
� • COMMUNITY DEVELOPMENT DIV.
� � L_�����_,
r � � PROTECTIVE INSPECTION SEG /a���
� �
� � r"'1 � CITY HALI FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPfiOVED BV
`'�«�.i �.J
612-571-3450 910-F15 3/28/84 � �
JOB ADDRESS 6343 Dellwood Drive N. E.
1 LEGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACHED
oESCa. 20 1 Nioore Lake Highlends �.S't SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Eugene Oulle�te 6343 Dellwood Drive N.E. 571-6353
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Milton L. J'Ohns:on Co, 2513 Central Avenue N. E. 781-9548 `
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof, �dd guttexs & bow window
9 CHANGE QF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PWMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO 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 ABANOONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATIOid SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT SS�OOO $2. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVIS�ONS Of ANY OTHER STATE OR LOCAL LAW REGULATING CON-
S7RUCTION OR THE PEF�FORMANCE OF CC�NSTRUCTION. ySSO. SO
� � // PLAN CHECK FEE TOTAL FEE
���-�.; % �, , , .-�!' $
53 . 00
SIGNATUREOFCONT ACT RORAUTHORIZEDAGENT IDATEI WHEN PROPERL VALIDATED THIS S YOUR PERMIT
�
SiGNATUREOFOWNER�IfOWNERBU1lDERi iDATEI BLDG WSP P7E
a. -- r
�
CITY QF f(tIDLCY
H�PLIC11TIa1 FOft RCS10Ci1TIP.� I3U1LQ1itG Pc('��I7S
(t�c�•i, Alterations, Additions, or Rc�airs)
OFiNER: � i,� �- , t� i i L
AD�P.ESS: C� � `E -3 � c L � 'W � � r� � �
TEL �l0: �7 1 — �,� S�
Effective Aug. 1, 1981
�t3UI LOER : �i L r � � . `�� �/ �s a ,�1 ( ;.a _
IIDDitCSS: � si.3 �� ti 7/� ,4 ���
TEL I10: `�g/ - �/-��/ �
Construction Location
ST7tI�T NO : tv .3 � 3 SZ`ItEF.T: �� L L w c� o,v ��
L07' :
BIACX : JIDAITIOiJ :
Corncr Lot: Inside Let: , SctbacY.: Sideyazds:
Ap�licant attach to tl�is form two Certificates of SUrvcy of lot and
pzoposed building locaCion drawn on certiii-cates to scale.
DESCR I PT 10�� OF CO�;STi:UCT 10t�
_ Front: Depth; Height:
Sguarc Feet: tvbic Feet:
Front : Depth : Heiglit:
Square Fe�t: Clibic Teet:
Q �
'.7�pe of Co:,struction: ��" t� �>1`�R�s ',�J��,; jil};n,.�c«: Estimated Cost: S���op
Zb Be mr.�pleted: � � Cfi -
Alt. A Alt. B
Propcs�d Drivc��ay iiidth If New Opening Is Desised: $ S
S�� P.EVF.R�E SIDi OF S}IEET
9he unc]ersioned hereby ma};e� a�plic�lticn for a perrzit fcr the �:vrk herein specified,
agreein� to do .all �ork ir� strict accordanre yith the CiLy of 1'ridley Ordi»ances t�id
zuli»�� of tlie DeZ�artmc��t of IIui:clings, and hereby decl�res at all tl�e facts and
rcprec��t,ltiens stated in this applic�tion are true and c r t.
n.��: 3 �. K g �f '
� sic�n�ru � : � h ,'�
Stii�ulations :
,�- � �, ��?� i
� � � ��
, ��� �i ���
"� � _; :- -
SUBJEC7 P
c�ty of Fridley I° 19485�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � ECEIPT N
COMMUNITY DEVEIOPMENT DIV. �7/ p
l � y � PROTECTIVE INSPECTION SEC. �Q C� u�
i �
� �
( � �'��: � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'----'�•� ,•� 612-571-3450 9�0-F15 5/23/88 / /
J08 ADDRESS 6343 Dellwood Drive N. E.
t LEGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ZO 1 Moore Lake Highlands lst SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Mr. & Mrs. Ouellette 6343 Dellwood Drive N.E,
3 CONTFACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Patio Village 7920 Powell Road, Hopkins, MN 55343 938-7989
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW C� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 14' x 12' Unh.eated Porch Addition
9 CHANGEpFUSEFROM TO
STIPULATIONS
See notations on plans
SEPARAT� pERMITS REQUIRED
, � V�'IRJN�, �EAT11V�, PLtIMB11�G
�� ���:��� F�R
$e#�re �ig�ing c�}i local u�±lities A1�{D S��1VS.
pHOi�E. - EI.FCTRIC - GAS Et+�.
;REQU1��� �Y �.��'����
.
TYPE OF CONS7. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC� FYdIRe
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION R�1
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEFEBY CERTIFY THAT I HAVE REAQ AND EXAMINEO THIS APPLICATION �' S7ALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX
ANO OfiDINANCES GOVERNtNG THIS 7YPE OF WORK WILL 8E COMPLIED $3,500 $1. %S
WITH WHETHER SPECIFIED HEREIN OFi NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR IOCAL LAW REGULATING coN- $63.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
�� PLAN CHECK FEE T 7AL FEE
v�—t� O� � �3 '� $64.75
�� S�GNATURE OF CO � RACTOR OR AUTHOR12E0 AGENT IDATEI
WHEN PROPERLY VlyC�ATED THIS IS YOUR PERMIT
r , r � �
SiGNATUFEOFOWNER�IfOWNERBUIlDEA1 IDATEI BLOG iNSP �ATE
I�7nt [ l City of Fridley EEfective 5/L88
AI�N [ ] R-1 AND R-2
ALZ�R [] Building Permit Appl ication
Construction Address
Legal Description:�
��
Owrer Na�cte & Address: �� • # � 1�5 �� �-1 � � ,�� - �i�.. Tel. �
' Goritractor : �1 ll� V 1�`�'� _ _ Te1. # - � I
��SS: _7� 2d �'�wEU� R�.D . �`►►� �I���� ���#�
Attach to this appl ication, a Certif icate of �rvey of the
lat, with the proposoed oonstruction clrawn on it to scale.
� �. :;a.
r:�: .;
�a.«e :;
�1y.i�;
� N
Length "'l�
Length
Length
L1ES(RIPP I�1 OF I1�ROVII�l�
wiar� 12� o" ��t,t ? �%�`� �. �. )lo�
Width Height St�. Ft.
Width Hgt /Groimd .�. 9q. Ft.
O�rr�er Lot [] Inside Lot 1'�] Ft. Yd Setback Side Yard Setbacks N��
JQ,
Type of Constructian: � Estimated Cost: S�
Approx. Completion Date: �� � � ��;�Z_ ��
Il�gx 20. �� 3y�,�.�� �t. A �t. B
Proposed Driv�aay Width If New Openinq Is Desired: S S
Width + 6' See Back Page
I�1TE : � l.� APPL IQ1Nr :
(3TY USE Cd�II,Y
Pem►it Fee
State Surcharge
SAC Clzarge
Driveway Escrow
Park F1ee
Sewer Main Charge
TOTAL
STIRJI�TIONS:
S �J� �
S � � '�
$
$
S
�
$ � �� 7J�
- � • � r�
,
Ftiee Schedule on Reverse Side
5.50/51,000 Valuation
5550 per SAC Unit
A].t. �A ° Oi A�.t. °B ° AE70V @
F�e Determined by Ehgir�eering
Agreenerit Neoessary [ ] Nat Neoessary [ ]
., .
��
2-f�Cd �- ��� �
a�
� 3, o0
��
��
v
��1 L� �1��.1��
�—
����i n�a���o�
for THE OUELLE�'E P�EgICENCE
�3q 3 DE�t.so00 DP�VE FI�i1DLEY
� a
12-0
n
a
�
0
O
�
0
,
�
�
a
�
�°
�
�
�
3
�
Z
�
w
v
�
_�
v
x
�
�:
0
_�
�
„o -,r = N�t : :rrvx
�����n���
wi� �a
�'0 „°JI a Q� x Z 431.V3'�L
4� 000r,�-� ya,� s�.v� �z�
Sl� � ��IV�1 �� b Q�L.V��1
„0 ; bl
�
�
�
�
�
�
�
�
�
�
�
�
�
�
�
�
�
Z
�
�
�z
�ITY OF FF. _EY INSPECTION DIV. Effective On January 1, 1991
� 6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AtR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS D�� 3 1.1� .�1-�-c,'Z� �,Q. ��
RATE SCHEDULE
Residential `� �-'� S `f`� 5 � ��
� -
� �} -�� ��
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
Rate TOTAL
$ 20.00 $ L � �--�
$ 10.00 $�=� �
The undersigned hereby makes application for a permit for the work
herein specified agreeing to do all work in strict accordance with the
city codes and ruling of the Building Division, and hereby declares
that atl the facts and representations stated in this application are
true and correct. �,�c� �— ,1991
OWNER � A� a ��S- d- �
$ 10.00 $ � (�
BUILDING USED AS �!� ��-' ��'-"`=0° � �
$ 10.00 $ � �7 /
ESTIMATED COST � PERMIT NO. / ���
$ 10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1% af Value of Appliance or Work
CommerciaUlndustrial
1% of Value of Appliance or Work
State Surcharge
TOTAL FEE
DESCRIPTION OF FURNACE AND OR BURNER
$ No. of Heating Units Circle One (Steam) (Hot Wate�) (Warm Air)
Trade Name � Size No.
BTU HP EDR
$ Fuel Total Connected Load
� .50_
$ 36,s�a
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS �15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
"Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY,�Q ��.-.� ���� ��!` °�"`�e l ��-"`-`-•�
,
Signed By���� s�.� � ��._:_�� Tel No. � .� � ' _ � S/
'i��� - te Final Date ` [
Approved B�r�� Rough !n Da
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
......
M A X I M I Z E Y 0 U R
IS IT WOOD OR IS IT CROSSFYRE?
a
The C��ossFyre... '
A Beautiful New Natural Look
And Remarkable Ef�ciency
For Mason��10�� Zero Clearance.
........................................
R 0 0 M' S P 0 T E N T I A L�
Once again Heat-\-Glo Fireplace Products leads the wa�� ���ith an
e�citing advance in gas-fireplace design. Now w�hen ��ou choose the
efficienc}� of gas for }�our existing fireplace, the CrossFt're gives you �
more natural look that ri��als wood.
A MORE NATIIR.ALLY BEAUTIFUL FLAME.
Heat-N-Glo`s CrossFrre flame-control design more closel}� resembles
the natural buming of wood...complete with glo���ing embers. The
patented burner design and pan burner creates a glowing bed of
embers for the most realistic look in an insert toda��.
EFFICIENCY NEVER LOOKED 'THIS GOOD!
The CrossFyre offers }�ou malimum heat output «�ith eaceptional
heating efficienc�• (up to ?>�b+ thermal efficienc�•'`). Tou get great fuel
efficienc�� too: 66.7% AFUE�"�.
One big reason is the air-tight combustion cha�nber. It draws
combustion air from outside }�our home...never steals the «•arm air
from inside, delivering the most effective heating design on the market.
Plus the C��ossF��re offers thermostat-control and lets you van� the
Flame height to contral BTU output.
INDOOR AIR QUALITY
Another benefit to the air tight combustion chamber is indoor air
qualiry, as there is no exchange of combustion air and room air. Also,
because this insert is airtight, it is not a contributor to negative air
pressure so common in today's tightly sealed homes and ensures that it
w�ill operate correctly even in a home where negative pressure exists.
' All efficiency rating based on testing at 28,5000 BTU/Hr.
" ANNUAL FUEL ITfIL1ZAT10N EFFICIENCY: Testing standards required for today's high efficienry fumaoes.
DIRECT VENT MODEL DVT INSERT (18,000/28,500 BTU)
SIDE VIEW FRONT VIEW SIDE VIEW TOP VIEW
2si��
�13��� 13'/."
� � 5'/." � � 3" DIA
2� 20% 'Ti 28/" I
19Y:" I 19'/."
� � � 5 � �
�-18'/.".� � �P7��
( � � I � PATENT PENDING.
S P E C 1 F 1 C A T I O N S
Heighc � Front Witlth Back Witlth Depth FroM Verrtirg
Motlel Actuat fremirg Aaual Fremirg Acluel Freming Actu21 Framing OD�ing System
DVUINSE � 20'/: NA 41y, NA 29Y. I NA 18'/. NA 26x15Y. DUAl3
HEAT-N-GlO reserves the right to update units periodically.
B-DVT-I 3/94
CROSSFYRE STANDARD FEATURES
• 28,500-18,000 BTU Input /Hr. I�G and LP
• Nigl� Them�al Efficienca (?5%+) : �' �D =
• AFUE Rating of 66.7%� at 28,500 BTU [nput \G � �
• AFUE Rating of 64.1% at 28,>00 BTli Input LP
• Sealed Combustion Chamber (Air Tight S�Stem)
• Includes Golden Embers (GE-93)
• Ceramic Glass
• Four Ceramic Fiber Logs (Installed)
• Large Viewing Area 24" x 13"
• On/Off Rocker Switch for Eas�� Start
• Variable Flame Height & BTU Outpvt
• New Pan/Ember Bumer for Enhauced Appearance
• 160 CFD4 Fan with Therrnal Sensor and Rheostat
• V✓arnock Heisey Approved for �lasonry and Zero
Clearance Fireplaces
OPTIONS
• Remote Control (RCH-09A)�
• RemoteThermostat (RC-STAT)fi ,M,,,,„U,,�,,,,,
• Wall Thermostat (WH-STA� W
• Black Arch Front (BKA-4DVT)
• Polished Brass Arch (PBA-4DVf)
• Air-Supreme Filter for GFK-160A(2) (FILTERS-2)
� Recei�er cannot be installed in firebox.
For those wanting tbe beaut�� of a u�ood frre with the
warmth, e�cienc�� and convenience ofgas.
Heat-N-Glo is the Smart Choice."
H �FAT-N-�
SYART
NOUSE
�O
FIREPLACE SUPPLIER
FOR SM4RT HOUSE
HEAT-N-GLO Fireplace Products Ine. 666� W. Hw�� 13, Savage,l4N 55378
� (612) s9o-s367 Fax (61z) s9o-3525
r e e • ♦ r
_ � .. . _:
1)L�T'IN3'F,Rl' � �
i
�'he �'rossF �e Inse�t. ���������""��� .
.Y _ ; . ,, _
VENTED
l�reat New Look for Gas. -�-
:,, , _ ,,.
--,,,..,..,,�
f • i ! • ! • i f • • • ! • i i • • • i • • •.! • • • • • • i t • • • • i • • • � • • • ! f f� • • • R
amed for Heat-N-Glo's exciting new flame-control technology, The CrossFyre
N dramaticall enhances the aesthetic a eal of the as fire lace. Now the uestion
Y PP g P q
becomes: Is it wood or is it CrossF��re?
1FY A HEAT-N-GLO
�tCIENCY FIREPLACE TO
} � -rRO �
, OME ENERGY NEEDS!
a remofe co�ttrol!
- — � —
' MINN:SOTA'S LARGEST
DISPLAY OF OPERATING
� � FtREPLpCES AND WOODSTOVES
IN HOMELIKE SERINGS
FIREPLACf SPfC1ACISTS
� ��� � SINCE 1957
HEAT-N-GLO Fin STATECONTRACTORLICENSElfo68 (612) 633-1042
�6 2700 N. fairview Ave. (at Co. Rd. 'C') • Roseville, MN 55113
SUBJECT PER
City of Fridley 7 30 7
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T
� ` RECEIPT NO.
� `L__.___ COMMUNITY DEVELOPMENT DIV. ���
r � � PROTECTIVE INSPECTION SEC.
� �
l-.--�,��'��;,� CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVED B�
i 612-571-3450 910-F15 $/19/98 � �
10B ADOPESS
6343 Dellwood Drive NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2O 1 Moore Lake Hi Il SNEE7
2 PROPERTV OWNER 011ellette MAI� AODRESS ZIP PHONE
Eu ene �$����$$s -
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Sidin Sales & Service -
4 AFCHl7EC7 OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ AD4ITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reside west side onl • Some utters
9 CHANGE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering.
7YPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIREO FOR EIECTRICAL, PLUMBING, HEATING,
VENTIIATING OR Alii CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTfiUCTION ZpNING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTHUCTION
OR WORK IS SUSPENDED OR ABANDONE� FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIFY THAT I'HAVE READ AND EXAMINED THIS APPLICATION STA�LS GAHAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVEFNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIfIE H REIN OR NO7. THE GRANTING Of A PERMIT �SOO .SO
DOES NOT PRESUME TO IV UTHORITV TO VIOIATE OF CANCEL THE PERMIT FEE SAC CMARGE
PROVI S F ANY OT R ST TE OR LOCAL LAW REGULATING CON-
STRU TION O THE PERF A CE OF CON TRUCTION 2]. . OO Fire SC . SO
PLAN CHECK FEE TOT L FEE
2%.0�
SiG UAE OF CO� " OR AUTHOA�ZED AGENT IOATEI N O VA�ID THIS IS V R PERMIT
. i
S�GNnTUREO%OW FluFOWNEAOUI�DEA� �DATEi � Bl iNSP � ���'TE
N�'W � '� [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �� ��
` ��
C nstruc i nA ress: �� Ll► �
o t o dd ��j � 3 �e I� '��
Legal Description:
—�
Owner Name & Addr ss:
Contractor: �' �
� 1
Address: � ��`j
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
e
-.�,s�
`ti` e 11 e, ) �-e Tei. # S 7�- (0 3� 3
S�c Y- MN LICENSE # a-a a% 5�� Z—
��r ' '� .
l�J C �.-S.� � � Tei. # '`z�e2o�� 8'.SQ
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
1
Width Height
Width Height
Wid/�th Hgt/Ground
,. -i� �-A., _ \ � �, �
Sq. Ft.
Sq. Ft.
Sq. Ft.
r
� dv
Construction Type: � ) � `��c�rom.eq �.�� Estimated Cost: $ �C
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �� J Q`-� g APPLICANT: � Tel. #�/�. Z���
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ ��/, c�'G'
$ S�
� ����
$
� 5�. ��
$
$
$
$
� �?` ;��
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.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 [ ]
STIPULATIONS: �
sue�ecr IT NO.
c�ty of Fridley 27614
' , AT THE TOP OF THE TWINS B U I L D I N G P E R M I T RECEI .
�
� �' COMMUNITV DEVELOPMENT DIV.
� t """', �.p
r � V � PROTECTIVE INSPECTION SEC. a'
� �
1 � �
� � /"'\ � CITY HALL FRIDIE� SS432 NUMBER REV DATE PAGE OF AVPROVED BY
�.---�: ,.' 612-571-3450 9�0-F�5 9/8/98 � �
JOB ADDRESS 6343 Dellwood Drive
1 LEGAL LOT NO. BLOCK TRACT OF ADDITION SEE ATTACHED
DESCR. ZO 1 Moore Lake Highlands lst SHEET
2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE
Eugene Ouellette 6343 Dellwood Drive 55432 571-6353
3 CONTRACTOR MAIL ADDRESS Z�P PMONE LICENSE NO.
New Haven Construction 4208 83rd Ave N Brooklyn Park 55443 566-5225 20077950
d ARCHITECT OR OESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CIASS OF WOfiK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Re r o o f ���x������;��� h
9 CHANGE Of USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
.�
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE HEOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR Alii CONOITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. 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
ANY T�ME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION STALLS GAiiAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UATION SURTAX
AND OROINANCES GOVERNING THIS TVPE Of WORK WILL BE COMPLIED $2�1FjS.00 $I.OH
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GFANTING OF A PERMIT
DOES NOT PFESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITfEE SACCNARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW EGULATING CON- ]/{.75 Fir SC �2.16
STRU I N OF THE PERFORMAN E OF CONSTR CT N �
� PLAN CHECK FEE TOT FEE
� ' � Licens $5.0 $82.99
SiGNATUAE O CON'AACTOA R AUTMOA4ED AGE T IDATE� HEN RO VA IDA lHIS IS R M�
/ -, i �
��
S�GNATURE OF OWNEAUF OWNEA BUILDERi IDATEI ip5p �iFTE
► 'r
Rug 26 98 06:52a
NEw � �
ADDN [ j
ALTER ( �
Kerri
566-7183
CTTY OF FRIDLEY
SINGLE FAMII,Y AND DUPLEXES R-1 AND g_Z
BUILDING .PERMIT APPI.ICATION
ConstructionAddress: ��7�
LegaI Descripdon:
e%/GvDa� �2 i 1�e�
p.3
Effective 1/1/98
�" ' �
�� �'�
� �
�wner Name & Address: ��/ �l1 / - � Tel- �7�- �j�.�3
Contractor: � �N �Q � �Uy�,s' _ - _ MTT LICENSE �,zOD 7 � 9� �
Address:� �..3r°� �f� /D�'�
,CIC Tel. f# .�G�� -.�Z �S'�
Attach to this application, a Certificate of Survey of the
loc, with the proposed construction drawn on it to scaIe. "'
LIVING AREA:
GARAGE �AREA:
DECK AREA:
OTHER•
DESCRIPTION OF IlVIPROVEMENT
�ng� Width Height ,____� Sq. Ft.
�n� __________ Width Height Sq. Ft.
�� Width Hgt/Ground Sq. Ft.
.-, .
Construction Type: ��Q'/� �' �� ���-d!/ „ Estimatcd Cost: $ e� / (�. °
T �
� (Fee Schedule o� Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = t x$ =$
DA1'E: c� L �APPLICANT: l% 'u���l c.JL_ Tel. #��o� -v�-� �
S.
Pccmit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STTPULATIONS:
�
� � ���
$ �. � �
� _ /. O �
$
$ w , �� (. �
�
$
$
$
� �`�-�- �
CITY USE QNLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/1Qth%) �
$.SQ/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Coatractors)
Alt. "A" or Alt. "B" Above �
$450.00 Conservation PIan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary ( ]
0
�r
From: 61 2 827 8129 Page: 1/1 Date: 12/27/2007 2:11:22 PM
. ,.��, �� ,,,� ,,, ..�,.,�,,, , ,,.,,,�, ,, ,.�. „
FROM :City o+'VFridley FAX N0. �76357112$7 Dec. 27 2007 02:39PM P2
� . � . , . . ' ,
, � , r
���a�.��
Inspections
'1�3-�72-3dt14
��,,T�1V���TG Permi� Na.:��
�S��N`�'IAL .A.��'I.�ICA.'TION �'V� �y�
CI'TY' UF` �`RTDi�E� ���� ���
DAi'E YO[1ti fi�M'Ail. ADDRFSS --r-.- '�
5]'C'� ADDRPSS .� ' _ ,. ... _ " ' �_,�..�
�s a�t�cau� zs; a awrr� . �arrrttacrcrn Lug�nelAnn Ouellctte . - - � --
6343 Dellwood i?�'ive l�ortheast
�t.OPE�'1'�C Nn��: Fiidlcy, MN 5��32 �
Qw��� "nD���---�—�-----_ 7635716353 �
T�1AN'� ��:
. , . �
svsM�r n cx��r a�
itoutt s'�aTe ,
.L�I�SE VVTTFi '
riERNEiT �TXx"E
sTn'1r� L1�isk
' + t [1�1'�t�f�ir
�SA�QLE FAMILY '
'�i YriE OF W�RK: � �a .
UETAII..ED DBS OAT Ot� W�RiC
p�7CP DA'IE
i�[I7Y�i _*��i
a r�va'�,�Y ' ' � �� TO�J��VSF
.�.�.�...�
�Q�uc�' -
0
x'�
• P�R MS 16$.6b5 tl�e 't fee is a m�#mum of �t5.40 or 5% ofthe tat�l sost up to S50b.O1►; whichever• is g�tet, €or the
�. improvernea�t, ins�s�ti o or replacement of a reside�ial fixtura, exFtuding the fixtures, ('i�4s.shouid refi�ect on]y the cost of labor )
l,abor cast �mdaC 5300 � 15.40. I..abor coSE betvvpe� $300 ta $500 = oost of labor x.05 =,�„_,_�,
�.' `•i�ORy$R03�.`1,8 VV1-�$RE ' 4:E���'7�5 Al��6 �45bA Oid $1��00 F�.'R FDC�'l '��EXCd���:�►i�s���'A'►'F. Z�-1'/�1.�
Nv�s� oF �x B� s�own.� wax�x �t�
_„ �u,r� sn�xn.a,v ^.,�� nw►a�s� — �nv� Pooz — wnz�t so� (s�s�
gA��g � TG,�S �a�rci n+�rn�rWC�1 .__.. '— ancrc.�.ow �Itev. �s1s�
� ci.�xt��s was� �rrct�t s� wA�R cws�r
bi9RWASFtER ' LAUNDRY TRAY �.WA7'P� E�AT21t IS3S� � FOR IItRt(iATEOFN
— "'- 9VA1ER M�'tI?R .,— ��
' S1�chi
^ TOTAL �
I hex�by epply for a C
cR�fbfm�a�c vvzth tbo
�t a prxr�,it lnu aniy
�PProved glan m tho c
SiCA�1A1'URE OP APPLLC,
Tltlm�be� Of £xtva�ss (� SX0.00,^�., x. 510;00 a�
'—"" .SQ ' NumLiex of fixt�es (r� S15,OQ x Sfi�':00 =''�
� N►tmber of fixaa'es ac �"3S.00State S�harge =�
. • • �. Tne9! � ,
iF�T5 lS AN ApPLJCA'I'ION POR A PF1tM1T NOrT VAWp UNP1L Z'ROC�S3m ' ,
;ding pcnz�it and � gcimowledge ti�t dte i�rmaticm above is compltte aad acc�; tbat � work wA�I bc in
du�o� �ct oodee of t�se City af ���ley and witb the Min�esotn Construatio�t Codes; dnat I undexstand t�is is
ap�,sx�ca4oR For a peamit and work is not to start wiihout a perrnit; that ti�e wark will be iu accordancn with rha
; oEall rk which requ�res rsvisw and approvel ofplans. �
r �P�N� �t ��.61�,�_ _ ���
' City af �`�rfid�ey � � .
Bt��lding �nspectio�as Dep�r�ment ,
&431'U�aivcrsity Av�nua N�, ��idley, �?N 55432
!Vr~� 1 fIV����
k'.9�7�: ��3-502-4977
Buil.ding � PLUMBING Permit No.: -
Inspections - R�SIDENTIAL APPLICATION Received By:
7'63-572-3604 CITY OF FRIDLEY ���� 2�7 . 07
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS Sdu.tL as D�.ar�e�
THIS APPLICANT IS: ❑ OWNER �ONTRACTOR Eugene/Ann Ouellette
PROPERTY 6343 Dellwood Drive Northeast
NAME:
OwNER/� Fridley, MN 55432
TENANT �D�ss' 7635716353 zip
� PHONE:
CONTRACTOR N�g:
SU$MIT A COPY OF STATE LICENSE #: C% EXP DATE
YOUR STATE ADDRESS• t� I CITY �' /S STATE�LIP S�S'r%O,�
LICENSE R�ITH . PHONE �� y+�� FAX —
APPLICATION -
PERMIT TYPE �SINGLE FAMILY O TWO FAMILY � TOWNJ-IOUSE
TYPE OF WORK: ❑ �W � ��PLACEMENT
DETAILED DESCRIPTION OF WORK
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the tntal cost up to $500.00; whichever is greater, for the
improvement, installation or replacement of a residenrial fixture, excluaing the fixtures. (This_shouldr�flect only.the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
>�OR:EROJEETS WHERE LP;BOR EXCEEAS�SSOO;�FEES ARE BASED ON $10.00 PER FIXTURE, EXCEI''i';W:fiEREN�"[Ei3: :RI�CPiIR£�:--•(II3DIGATE TQTAL
NUMBER OF EACH BELAVi�
BATH SWK/LAV FLOOR DRAINS SHOWEIt WATER PIPING
i BATHTUB GAS PIPWG R�� c«c�cE,vsE) � S WIMMING POOL WATER SOFINER ($35)
^ CLOTHES WASHER KITCHEN SINK WATER CLOSET � BACKFLOW PREV. ($15)
DISHWASHER =LAUNDRY TRAY ,LWATER I�ATER ($35) � FOR IRRIGATION
WA; ER METER OTHER
Permit Fee $ Number of fixtures @$10.00 x$10.00 =$
Surchar e .SU Number of fixtures @$15.00 x$15:00 =$
TOTAL DUE $ Number of fixtwes @$35.00 �_ x$35.00 =$ 3S.po
State Surcharge = $ .50
Tota1= $
THIS IS AN APPLICATION FOR A PERMIT-AIOT VALID UNTIL PROCFSSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
confoimanoe 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
appreved plan in the case of all work which requires review and approval of plans.
STGNATURE OF APPLIC + ���„�� � S "�� � �� � � �j�y�{y�'� �RINT NAME ��.'� JVO/QIDN�I DATE
��++�+�� -
Y�1��� k..
City of Frid�ey
Building Inspections Department
6431 University Av�nue NE, Fridley, MN 55432
763-572-3604
rAX: 763-502-49', 7
Complete vented combustion appliance information.
Furnace/Boiler:
❑ Draft Hood ❑ Fan Assisted irect Vent
(Not fan assisted) & Power Vent
Hood
fan
❑ Fan Assisted ❑ Direct Vent
& Power Vent
Input:
Inaut: y D
The CAS includes all spaces connected to one another by code compliant openings. CAS volw
Determine Air Changes per Hour (ACH)1
Default ACH values have been incorporated into Table E-1 for use with Method 4b (KAIR Method).
If the year of construction or ACH is not known, use method 4a (Standard Method).
Determine Required Volume for Combustion Air.
4a. Standard Method
To#al Ltu/hr in��t of �!! ��m��stie� ��p!iances (DO NOT Count �Erect �,'e�t Appl:ances; !n;,ut:� U
Room
�i;�,e2 v �k,_ � �2�.1` +
H x v+' 7� L.
7 . �f x�. S� Z�.
llo��
� l.�vw5 S(�acr�
O� � ft3 � �
Z�ti�
Use Standard Method column in Table E-1 to find Total Required Volume (TRV)
If CAS Volume (from Step 2) is greater than TRV then no outdoor openings are needed.
If CAS Volume (from Step 2) is /ess than TRV then go to STEP 5
4b. Known Air Infiltration Rate (KAIR) Method
Total Btu/hr input of all fan-assisted and power vent appliances
(DO NOT COUNT DIRECT VENT APPLIANCES)
Use Fan-Assisted Appliances column in Table E-1 to find
Required volume Fan Assisted (RVFA)
Total BuUhr input of all non-fan-assisted appliances
TRV:
Input: Btu/hr
RVFA: ft3
Input: I
Use Non-Fan-Assisted Appliances column in Table E-1 to find Required RVNFA: ft3
Volume Non-Fan-Assisted (RVNFA)
Total Required Volume (TRV) = RVFA + RVNFA RV = + _
If CAS Volume (from Step 2) is greater than TRV then no outdoor openings are needed.
If CAS Volume (from Step 21 is less than TRV then qo to STEP 5
Calculate the ratio of available interior volume to the total repuired volume.
Ratio = CAS Volume (from Step 2) divided by TRV (from
RF = 1 minus Ratio
4a or Step 4b) Ratio =
/ _
RF=1- _
'�' Calculate single outdoor opening as if all combustion air is from outside.
Total Btu/hr input of all Combustion Appliances in the same CAS (EXCEPT DIRECT VENT)
Input: Btu/hr
Combustion Air Opening Area (CAOA):
Total Btu/hr divided by 3000 Btu/hr per in2 CAOA = / 3000 Btu/hr per in2 = in2
Calculate Minimum CAOA.
Minimum CAOA = CAOA multiplied by RF Minimum CAOA = _ x - in2
CAOD = 1.13 multiplied by the square root of Minimum CAOA CAOD = 1.13 Minimum CAOA =
If desired, ACH can be determined using ASHRAE calculation or blower door test. Fol�ow procedures in Section G304.
. .' From: 612 827 8129 Page: 2/3 Date: 1/4/200812:07:14 PM
...,,, � ���„ �� „� ,�, ..�,�,�,,, , ,..�„�, „ _ �, ,��..�.,
s
❑ DrsR hlood
t fari �fied
..�
�
vent�t! Combustion
❑ Fan A�isbed
8e poW�r VeM
� Fan A�;isfied
& Pow�r Ve�t
appGanc6lr�iartnatian.
[� ver►t
p t�t venc
L��
t'he CAS indudes sll spac8s a�nr�ec�ed io a�e anottter bY code aompliarst openings. CAS vdume:��%f i
Determine Air Gf�.s Per Howr (ACHj1
Defauft ACH v�lues h�ve been irlc7orparat,ed ir►'to Table E-1 for use wdh Method 4b (KAIR Method�
If the year of �or� or ACH is not known. use meth� 4a (St�nd�rd Method).
Derternaine E�sa�red Vvlume for Cornbustbn Air.
�4a. Standard Mlelttt�d
fqtal Btulhr �uE o� 81l combustion applian�es (DO No7 Co�s�t Direct Vent Appliancesj �nput:,'',�t
Jse Stan�ard Nie{f�od calumn In Tsble E-1 to find Totsl Required Voiume (TRV) TlR�►'
f�3F�'�:���atr�w9�� TRV#I���" � �9:�t�de�•
If C�AS Vdu� (from $tep 2) is /ess ffian TRV then go �v STEP 5 �
4b. Known Air Infiltration Ftai� (KAtR) Method
%t2�i �r1hr input of atl fan-assisted and pow�r vern ap�s (nQur_ _ _ B�Ihr
(DO NOT COUNT DIR�CT VENT A#�PLWVCES)
use Far►,Assisted Appliances column ira Table E-1 �p find RVFA;,�ft3
Fiequired volume Fan Ass�ted (RVFA)
Total Butlhr input of �II non-fan�ssisted appliBhoeS Input BtW
Use Non-Fsn-Assisted Applianccs colurrn� ir� Tab(e E-1 t�o find Requir+ed RVNFA ft3
Vdume Non-Fan-Ass�sted (RVNFA)
Tot�l R�quired Volurr» {iR1� = RVFA + RVN�A . RV = �+ - 1
!f CAS Volums (froin Step 2) is gr�sater than TRV ttaan no outdoor openir�s ar�e need�d.
If CA.S Volume (trom Stiep 2) iS less tl�an TRY then go to STEP 5
Calc.ulate+ the �tin of ava�lable ir�erivr votume to the lotal � v�lutt►e.
R�tfo = CAS Volume (frc+m S�ep 2l aHvldied 6!� 7RV (from Step da or Sffip 4ts) Ratio = � _
RF =1 mJnus Ratio RF =1- =
Calcutate sif�gle oubdoor � 8S if all combustion art� is frvrn out5ide.
obl Btu/�tr�lnput flf aA Combustiors App1� in �e same CA�S IEXCEP'T DIRECT V�hJTj
In�
C.ombustion �tir Dpening Area (CAOA):
fofa4 �tulhr dlWded by 3D00 6tulhr per in2 CAaA = / 3000 Btulhr per in2 =_
CAOA = CAQA mrr�sd by RF Minimurn CAOA = _ x -
� * •
���� ��
;., �. ..� � �
7. s xFs. �7� �.�
����
lr�vu�y S��
��
�
CAOD = i_43 muttipiied by the squdr� t'oaQ oF Minimum CAOA CA�D = 5.13 Minimum GAOA =� in
If deslrsd, ACEI K'�n be deteRnined using ASHRAE cak�lation or blower dour tesi. FO�ow procedures In Section�G3D4.
��r�
• `( _
�, � ��