AF - 40722�s����.�e�Q.
North East Real
_ �
HARSTAD -TODD CONSTRUCTION CO.
2200 SILVER LAKE RD. � NEW BRIGMTON, MINNESOTA 55112 � PHON6 636-3751
City of Fridley
6431 University Ave. Id.E.
Fridley, Minnesota 55421
Attention: Mr. Ron Holden, Building Inspector
Dear Sir:
x�
l
October 7, 197�
t
��
�
Submitted herewith is a soil report for a house foundation on
Lot 1, Block 1, Innsbruck North, 2nd Addition. Soil borings were
made by Willard Blake and myself. The borings were staked by myself
as shown on the attached map together with elevations.
These borings were made at 12:00 noon on the 6th of October,
1976 and at the time of our arrival fill and peaty material had been
removed for a distance of 8 feet below street grade as measured at
street grade from the center of the lot. The northerly boring had
been excavated to a depth of about the same distance and since that
time another 2 feet have been removed.
We propose to compact 3 feet of fill and construct normal
footings with rebar at that level.
KTIi/em
Enclosures
1 " �i'
1. .
% ��� � ,�';
� �,
1 :� �
'� . ,.
� ,,
�� �
� :,. �. '�
1` ,
' .�� �
�! ��� ,
`� � �
� i � ` �
�������
Yours truly,
���� xa�
Keith T. Iiars�ad
.�
i
�
1 � ;
�
H� �+
> `!
,,. , .
.y
Depth (ft) Boring No. 1
0 Previously excavated
0
9
17
Brown clay and sand
(fill and peat and loam)
Gray clay with sand--medium dense
Gray clay with sand--stiff
�J %� a ? C. �.
�
� . _ •
Depth (ft) Boring No. 2
9%
17
Previously excavated
Dark gray clay-soft to medium
Dark gray clay with sand-medium dense
Gray clay with sand-stiff
i�"� :p ,� k'" $ z�s" i t.s� '�e . a a�K«r�. . ��.iC' . � r�,i�a�%C.ya.,�- r.a6'rw�`�
.4 " �, {� ,:� k�, �°.. 4�..
.7� S' 'T'::
1 � , - . . . <.��� , . � � .. .
� �.'"5� �r r . . . . .
�_p` 3 ,"'% . . . .. . . .
�.`:.:. � � � �� . Y , . . . . �ti�� �.
y. . � � . .. � . .. e
� . . . " . . , � . . � . . .. . s .�
�: :s� '?- . . � - . . � � . . . . . . . .
q t . . . � � � . � . . ... . . . � ��.
,x s t
�A� � 5� a� ��- . . . . . . . _ ' S � :_�
5�.�%" N.,� � . . aff . . . -. . . �+ ,�'.
. . . . . _ . . . �
aA,� �� _ s�.
�c - ,
� �� ,
��� `^. . � �
e ' � ` < `�`
,�' ��� '�' � � � �d
� � �..
. .: ;` `` '` � .
.
. , . .. . .
��, �
r�w., w�,g��� � _ �, � . . -..������;r
,. :
T �r F . ' ' _ . .
� �
�,,, t .. _ � , .. . . '.
� t+ � '� � � - � i �.. S �c"xi,.
..�, a». ..� v�;"i .s�':.�'.;,y�T.��a.� f 't.:_ z�i•'_• -t*,�:i"�'..'�.,�Fyi' �'y �.��� �'�' �.
«N, ,.. . . . . _ r `y �,,
� � 4, . ��
I �� > `�
�
����� ti:
, .,
,} i �
�� J� �t� � � � � S � �,t
��: t
%rs� ,�,' ' ���
> � �� �* .t�; � � -i � �'
r - e � � sr
� `���.g� - . . . . . . . . . . � �'4 e
}��,'�"� � �`?;'?- ; `�c�
� � ��'� �� r'�a
4e r �
*�'; ,�
,
. , , .;
�k W'..�r :` t� .- :-. .-, . . . . � . . . >.. -
..
; ,
� . �
::
',�ci� r,' . . � ' ,' . . . � . ' . . � . . . . . •
9.:' 3
t";' "� �.��" . . � . � . ,�o-,.
2q'p k ;, �. . � . � . , , je � ~ .�' •-_'
a ,
S?. - .. . ..�
� .s, .�, ... . . . .. .. ���5
�
. .
,,,� ' ':. _ � . ., � � . . . ,� 1F
a
� '
, . � �' � ' �� .
.. �+�
. ..
.
y W . �µ'
s ;J z.. � ., . _ .: f ; �, �... . . , : � ', � - . � '*c
f� � � � n . . . �. , • �4 vyt �� k
� �l � � . .. . .. . �- , . �'
;;$' . . � . � . . -� f �.¢ ��'
P „� ��,� � : �` �._'
�,� `Y ¢ ; a , , . ��� . . � �.k � .
`�,:�k� «a ,y- �"a� i� ,�S .�4.0 � ' � . �y� �
�i,M''-�'�f`v+9,4irt",_ f �. �,��3�- .�:- � } � 1` ..j.� ""'=W �
x _ m..r.� .4 _ `�a..�.._,> � �a�6p.: rx3 ""� eb ^��
�"Z� � � . . . _ " u` �: �• _ „y '%F s . �^ �.. ;�*.
i'�w* .,�� , _ """ �^ �0�'.� �" x ��f
,
_ , ;
� �e :. �.�., . � � �� .. , ° . . . . � � . .. �.,� , . . �'r-'- .
. . ...., , .. . , , .
. . . . . . y"` . . c:°,
t � . . . � . � ��. � .
� � a . . . . - 'at�� . . ' . .
� . . � . . . � 4 . . .. . �, � '
� a;, , . _ - . . � � � _ A ..
� f 5 . . . .. �ry'
R. 'P ti.; ,1, .y,�' . � � `r: . �'V c��
{ n ; �� ' . . . . � .' . . . . ' i '�
� �
.. . . . : �. ... - „
.. , . . .. . _ . . �: � ...
.. . . . ., ,-� � ` ..
, . r;
y :� ;� . . . . . ., � .- . ..�'e .�.J�'+:
A
� ��� �f - . ' , . � � 4'n". . . �4 �
t' i�
, ,• x
� . :
� . • : -
, - .,,- . � , __
� , .
k�
,
... ��. . � .,
t ' �. :�.. . " . . . � . . . �. . � . ` . . . . ,. . � .
-,.v .., . . , .. . `'_ � '�.
�'!' � '� i°• • � � .. . . . .. . . . - _ i x� �.�, .
" , . . .. . �. � r .. .. R � �. �/ ��
� , � . .. . � !4.'��� i�
��5 s
� �' �
1. :X� '"�'�' - , " f�� '
� ��
`� ��,� ' . . � � � W c.u�
L d- � �'���,,.�
'�` i r�. L - . �G-fil�-��. p- A
4 kYrc "� � y� . . .. , t i'a �. ��y .4' '' M} �
y � �Nis�~ � .. L �. � ��i. A � 1 M { l�_�� 4.
y� .�+�`r� ��9'� A ::'�'ro `� ,�,\ y�, .�,. . . �e�
��. . - � � - - �
SUBJECT P NO.
City of Fridley � 13816
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
� � C .
� ; y �_�� COMMUNITY DEVELOPMENT DIV.
f � � PROTECTIVE INSPECTION SEC. �� � �'��
1 ; �
�l � /'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
L•"'� � �•� 612-560-3450
910-F15 e/7/76 � �
JOB ADDRESS 5587 �a�t Danu6e Road
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. � 1 Inns6ruck North 2nd Addition SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
�ohn Effland
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Harstad-Todd Gonstruction 2200 �ilver Lake Road 636-3751
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE , LICENSE NO.
SA E
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
es" e tial
7 CLASS OF WORK
�I NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
X
8 OESCRIBE WORK
constrqct 54' x 36' Fiause wi�th 22 ft x 21'9" garage
�MP�RTAf�T-� :°'
9 CHANGE OF USE FROM FY THE FRIDIEY ENGR,� TO , '
DI'Ir1�lON REGA D �����E • a.�C� • � �•
sTiPU�ATioNS qT DRIVEWA YOPENCNMEN� ����RED �►Y LA1Al
1. Provide So%1 6arings and com���tion te�ts �
2. Pravi�de truss des�°gn prior to capping n
3. Ptravi Qe vapor Garri er i°n cei 1 i ng
4. P�^ovi de a ver�`f i cati�on survey bg.f�r a IRED -°. F� �
5. Ptrovi� de a har d su r face d r i v� E P C. K A�€ ����jS R�� �N��
6. S a d t h e f n o n t a n d s i d e y a r d���� N�� p L U M 8 1 1� 6. A t� D S,
Sewer: � ` � � �a
l�ye 221 South of Manho1e on North Innsbruck Drive �y� ���►� �
i�[y� E1 evati on = 946. 65 �pt �9 pr� �.RO�'
Top of footing Minimwm elevation 949.65 D�S g �5�5 p�
B.M. Tnv. Elevat�on of Manhole 24°30. = 946.74 `Et �p ��Q��.��a��
f�ater: Stop Box Approximately 10' South ofp�e +� �. v��F►
SEPARATE PEflMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING. HEATING, �P N GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. `� �° � �
THIS PERMIT BECOMES NULL AND VOID IF WORK Ofl CONSTRUCTION N� v SO. FT. CU. FT.
OFl WORKES SUSP NDED ORNABA DONED FORAA PER OD OF N20 DAYS AT �.`��� �j� 3� ,368
ANY TIME AFTER WORK IS COMMENCED. N; �. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION � STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. � 53,339�ZO 2�.�
WITH WHETHER SPECIFIED HEREfN OR NOT. THE (iRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMiT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR L AL LAW REGULATING CON-
STRUCTIO THE PERFORMA E OF STRUCTION. ' 25,'Q'' 3�JO.00
PLAN CHECK FEE TOTAL FEE
G� �,( ��3/„3� 553.51 �
-- IGNAT REO C NT AC ROR THORI2EDAGENT IOATEI HE R V U� TED HIS IS PE aIT
2 � / �
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI LDG i �P DATE
CI�(Y UF FRIDLEY
APPLICATION F�R� RESIDENTI�L BUILDTNG PEF�1IT5
�NEW, ALTERlaTIONS, ADDITIONS, OR REPAIRS)
OWNER' S NAME : tJ0 �� ��'T I 2`� � ]3U ILDER :� R fZ 5�' A�— l o O D C� dJ S'�
ADDRESS : ADllIt�SS : �,�o O • �. �vP� �. �_ � �-�,
T�L. IdO. : C� .� l0 3% �
No:. ���`� s�rrx: �T �i�1�cc�3� � �
LOT : �_BLOCK: � ADD:LTZON : 1 h � s ��-u- � � %�. � N �y, � � � ,
. _ r , /
CORNER LOT: IP]SIDE LOT: X SETBAGY.: 3 S SIDEYA.RD: % F�l 'F' ��
Applicant attach to this €orm �tao Cextificates of Survey of Lot and proposed
building location dra.wn on these Certificates.
..�-
�� ������ �
� -_
IiL-'SCRIPTION OF BUILDI�V'G
To Be Used As:
r �
��� � � '°ti` � � Fxoiit : �y Depth ; 3� Height : � C�
Square Feet; Cubic Feet:
r
p
�r ��- Front: ��- Depth: �-r ' 9 Height• l�
Squaxe Feet; Cubic I�'eet:
Type of Construction: c� �t9 ����w.� Estimated Cost• $
. �To Be Completed; �� ]��. / �f'% �
The undexsigned hexeby makes applicativn for a permit ior the G�ork herein
specified, agreeing to do all t•�oxlc in strict accordance �oith the City of
Fxidley Ordinances and rulings of the Department of Huildings, and hereby
declaxes that all the facts and representations stated in this application
axe txue and correct.
DATE: / ��'� �� • � STGNATU • � �
���9��
(See Reverse Side For Additional Tnformation.)
s
�
�'�� ��l ✓�. �j/� � ��. � eJ. �g f�ee. a�$�r a� � :s
�� � �/ 3�, � a ����-,`�� � �. �
,, � • ' ' ,�,►�,f ' �1
��. ���,� � c. 6 7 � �
�s�� �33�a . �
�
�3�: s/ ��� � �
`� . '�"� � �
'�) !� � e�e�'..�
3 � �� � � �'����,� � Q �...�.
, ,..s.
� ,� � � s � _ . ..v- � � �
BUILllING PERMIT FL� SCIiEUULE
SECTION 2. The Inspector of Buildings shall, b�fore 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 repairs to any existing
building or stru.cture, 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:
NEW CONSTRUC�ION: Si.nig].e Family Fiomes and Garages: $4.00/1000 cubic feet
PLAN CHECK: 25 percent of building permit fee.
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 below the floor line �f the basement
or the cellar to 'the average heights of the upper surface or �o the average.*
�height of the roof surface of the ma.in 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 work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $7.50.
VERIFICATION OF FOUNDATION
NOTE: Permits for eonstruction will be issued a minimum of 24 hours from the
time of application, to allo�a for proper review of the proposed structure and
of the construction site.
A Cextified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shal,l be ma.de ten (10) days prior
to the use or occupancy of any structure for �ahich a building permit has been
issued; and said structure siiall not be used or occupied until a Certificate
of Occupancy has been issued.
land Plo�ning ��,(���t���� 6875 Higi►way No.bS N.E.
Land Surveying �� • � � Minnsapolisi
so�i� Testinp (' �1 ��1PPttj1 , �('y2('. n�;��. ssa�z
Civii Engineering � � teleghone 7$4-6066
Munitipal Engineering Engineere & Surveyors A�eo tod� bi�
Certificate of Survey for I�OI�i�-i�� 1 G/��% Y
30
�
d
� � s3s' =
�r,a
'�c
� �� � �
�� � �
.`�
� ��.
� '�
.
� o � � /�f��
/ �� � � 4' \ � �
0 � �
� � % \ ��
Q 1��� �ch 7ia
�, � . . /
r �� � � �
30 � / �
\ � �J;- � � �
/3��0 � � \ 1 �
c�` �� J�°
��
� �e
�
THE QiY OP 11�DLEY DOES NOT GVA�N1� ?�
ACCURACY OF tlN;PIY LOCATtONS AND Hi1/A�ONS
T:iIS DATA IS FOR WFOt?!ti^.A�ION PUE:POSES ONlY AND
��RSONS U9NG ft SFIO� dc v���Flr THE MFORMA1tON
�N 1HE Sf!'E
�OT 1 B1�OGK 1
� WAR�I�G -
��fore digging catllacal ufilities
YEIfPNONE •EtEC1RIC-GAS Eb�.
REQUIRED 8Y t,�4�W
—lMPORTANT--
�� �}'Y 'r}{E FRtDLEY E�
DIYISION REC,ARDING Ct
� p AT�DR YEWAY OP� CN�
.
INNSgRUGK NORTN 2� ADDITION ARD� c���) q°
1 herebr co.rifr �hot this is o truo artd cor�ect ►eprssentofion ol o survey of Ihw �aundorios o1 fhe above
ds�cribed Ivnd, ond of the locafion of oll buildings� lbereon� ond oll visibte encroochNfeel�, ii o�r� irom pr On
safd lond. As survered by me thi• dor o� 5���� A.O. 19�.
. Sca1e: I�� �� 5U8URBAN ENGINEERING, INC. �
6rtgina s Svrve rs„
, s��.s � ��)�3 �.� ,
,. o pEN8TE5 IaDrl M4NU�IENT by.L�. � V�- �'a � �. -�' �, , �
- - — O�xa�S �u��i,ra � ��rt.�_�,.;.. ... a„ ;�.;.
�
�-�: �� � `Tw �' 7 �o d �' B 7
, . . , . . _ . . . _. . �. �i,
EXTERIOR ENV�LOPE AVERAGE "U" COMPUTATIOP, �
dWNER ��o< � 1� � � E . � : 4 ��. ---�- -
SITE ADDRESS
, �.,_._,
CONTRACTOR I� �v� �' rr•- �. � Tara DATE a � ��'�./:� ?�; PHONE � �? Ca .� ��I
"�
� Deterinine working square footage of each.
1.. Tota1 exposed wall area ...... ��/[' sq. ft. x .17 a ,
2. Total roof/ceiling area ...... / L3 q fo sq. ft. x .05 = S'� , 8
�
. Total exposed wall area above floor =�2�ro� ;
a. Total wall window area...... ...............: .. �-j�O
b. Total door area ... .,.,. . ... ............ 5�
c. TDtal sliding glass�doar area�. ..............:. . 4 2 -
_ d. Total fireplace wall area........ ............ 4 g
e. Total wall framing area (average 10�).. ".... .. �.
f., 1'otal net wall area above floor .............. �
:g. 'total rim joist area e. ......... .......... . . . .
� Total expose� fo�ndation area =._ 3 5 '
h. Total foundation window area.. .. ...... ... ... �.! ���
i. Toal net foundation area above�grade .. ........ �
. Determine "U" value of each wall segment.
, ,� . , r �
� �
- a. . �. � ? x ����� , $ � = I I q,35
� 3��
h. 59 X „�,, , ► z a � °� ,S� .�
C►. y- �► X I�Ub / S�~ _.Z 3• � .
d. �8 X ,,U„ �� _ �,$`
,
. e. � .3 � X ����� , / 12 = � �• �� �
.. � ..���� �1• '��1�� X II�IL�..1 ��/� C .���•3f . � .,
h� 9- � � � X ,,�„ , �,�, � = I l . 0 `� ��
h. vZ I X,,�„ , y—,�' _ ( �,���
�. � �� X �,�„ ,y� � g3,�-g'
_ � � ;
3.;. ....... .. ..... .. . ..Total � �,I _ -,
i
If item #3`is �he same as, or less than item #1, yau have met the intent ,.
�� ° of SBC. 6006(c)2:.. - �
. . .!f.' �. . . ' - . � - . ' ff
X-'
, . . ... ��;R� � . . . . - ,. I
� ,�'�� �` "�p f � � ^�,,s' e � . " � -w� ., �.�. . . - •
� `� �' .: , .II
��� Y�� . , � �, � � . - .
��''rv£ ;� �� '�'�:F I
���;��.���: 7ota1 e�pc�s��-r�of/cei]ing area � � � � �
yV� � <
� . . �,;
a _
�- � . >
'f � � �.� . . � . . . . .
<� � Total graSS rao.f�c�iling area =
�, .
:t ` �:, Tatal s�t�y]ight area .. .... . .. ..
AY` k: Tota� radf/e�:3ling fr�ami'ng area' .� p ��
�, w�-��- ' . . . . . . , . . .
�� ;;�f 1.' .'�o�al n�t'' �nsu7atted t�oof/ceilir�g area.......
�x . _
4 . .. . � . . � . . . � � . . . . .
'�w,,., � A � �;, . . :. . . . .
���y� �� , �, , _ � :'�eterm�ne "U" value for each roof/��ei l i ng segm�nt. '
,. � _ �
,
. �
� �° � �
.,
, ..� <.
�� „u„
, t
.,
� ' � �a�'� � • � �'
� ,
� h
,� � �, � _.
� s �� � � : .
x � ra :� ,� � 3 �
�. �. • � x �t : �i �I � = .
k :� .i . . . � . . � ;L�,
�� `� �`� ?; �' � ���+r« X ouW �� :, a �` � �}. � ;� .tl
�� z
x v .�,r, � , , � . , . " , .
��''� �fi � `� � , :. . . � . . .. � x , � w ,�
r� � �,� . . . . . . . . . . . . . . . . . F.. : . . . . . . . ; . . . Tota'� - `� � � �
, �� . . �: �, ,�y,r'� d
�. ; � �. -� � . . � � ' . 1 ,�"��;Y,r��` � ��`
�y� ��` ��� �� � � � °�� t t.��,��, .i: �,
����f t�at�l o� �4 is'the s�aup�°��, .�Dr 1�ss t�ari #2, yau h�� met �he �nt�rrt qi? �'�' ,� '�
�
�
",, a ,�'�a � �•��� • '` E�� c ` �.;�
� ,�a � ,'
�. 5 4; � .
k �`�� _ �'a,:���1i��. the �ot�ii en�e�o s� st� t�th�d, t. , ; '_ , '
t� Y tFt� ualu��► ,�st.�%�i;s�d;;�� ��� .. �
� � r� , � �� ���,.��G�s ��.�.�t�d �!� �#�al l �ot be .great�r " t�t�t� ti�� s� of i�.�e� #��1� a� �
,�-�� c r? � �f � ���
� sa� � i � , / . . . . : ' . � .. . .+'v . . ys.� � ��
�
�3u��� ?���� , �; .., �
��� t% �+. � sa@'Y�`�i .. ' 1. 4�� �
;. } ±� A � ` j . � 2 . . _ ' F� `� � � �"
x �, x ' ,
� 4 �'re�-�u`z -er � .
�� � #} i.y �
_ . . . . '�r . s�fi k
. . . . . � . , _::p
s
. a..
. . . . . . . . . . . .
��
,
� . . . . . . . . .
X �}
��� . . . . . .. -
"t�� i ::?a X . � �� . �'t �
s. . `� - . . , . . .
.,+ : ' �i'. . . . �
3
_
- . . . 'E' . . .
. _
.� ��k, . .. .
. . .. . . �• ..
ti.+f . . " � . . � � . . ' � . . .
�a r � „
�.s�., r�4 .'� . .. . . . . ... � . � - - . , . .
,:� � . .. . . .
.
. . . . . , . . . . . .. . ,
�},.,., . . .. . . .. . . . . , . .. .
�. . . .. . . . . .. ..
,
fi
4' � �� � A S . . . . . ' t �r. - �: p�`.
s. ' �' . �� `� � �Y'
ti�2� �
��� � , . � .. ; 1: . �: �34
�T� � �� � _ . .. . � � �i� �..
� ���k �� g i� � � . . � . . . �. . . . �. . 5�.
�` � (s• �'$E ., � . � . . d1
�[f��'�v�iY! Tki��"� rw L� `y . . . ' -
g�+'�< k � JLt . � ' � ), '
� � � � � � ..
;�}rie ' +1�
3r's � . ""s. " . . . . � R F .*+� .
� f �
; 4 x �-.
�� � � . � �� � � �:
�. �r ,�,�'-� . . .. . .
�� �� ' r t� zN
��� � � , � �
,�1. , , - . , . . . .. ., . ... ,� „':
p � t:
�V�'� (' . � � . � � � .
�� t � ' � � . . � _ _ t . �
� `
�g� c'� � : . _ . ': . ,�� , '.:', . . (
6'.F ::s . . � - .. . �.'I
�
:i� i. ; ': .' �. . -.
� .-''„ - : - . , . . . , .. '. . . - . . �. ' . . ' . � . . � ' -�
¢� �,$ . .. f�.. � � . . . . . . .. � .
� . �n � , q. k ��kr .. ' i.
.r �� . . �. + '� < �.f � „ k;.
. � . ,r�r� �r�,��
�r. � . . . . - '"� .�'€��'_ � �,`
i �,' ''�!�v'.w'� .,� E3 . �� � 3` .
, . :
,
,.,, s' ., ..:, , -..� . � � � .
�'^� rT �,"' a� / �i ;
� �,.��� �' � ��:.� . � :f: ..
��'i � � �'$ �,'�� "a a .r ��i . «�
s � sM1 fili,; ..7f . . , ... _ .. . . . _ ..,._ . . .
�
CERTIFICATE OF �SURVEY
. �. � �
FOR: }{Qrs}c,� -Todd Co�nS�rUC�iOh
i
�-�
r
�
, /L
�
4�'�
� Oer�c
. -
�
Le�41 aescription -
INNsBRVCK NORTt►-ti
l.o� 1, BIoc.lrc 1�
2 ND ADDITION ,
Artioka. Coun-�y � M�nrleso�-o�.
,����1 � /� o � ��r� � �
� ��l�. ���I�;��.�
I hereby certify that this is a true and correct representation of a survey of
DEAAARS GABRIEL the boundaries of the above described land and of the location of all -buildings,
if any, thereon, and all visible encroachments, if any, from or on said land.
LAND SURVEYORS INC. � ,
• 3030 Harbo� �.ane • As surveyed by me this 9-�'t day of ' AIOV, , 197�5.
Pirmouth, 'MN 55441 �,/n
. �ir�.c�� -�'C�� J��
Minn. Reg. No. ��-
Job No.
Z35
Book — Page
li - 27
Scale I
1" = 30� .
�•
w � . �'��.., _ � •• � Y ���. r�7 � �;y�
, ` ` / ��*' � • f +,�.� � � , # }..:"J�r.-
�.,! .fy
3 t 1 i �, � Si y ,«t-
n'�C°15 t
Y. }lr� p� ':%" � ...� '1 s
�� r
-��'� .n ��! j.�. . .
A f �L �� � ,.� �'� � ?�„
� , .. � f, .� ' 'A'.. ' ?� . �{. . � c '
i� ` � ♦'�1..�.. . � • .. , � . . ' t � 'R�F Yi= �+�.
- �°.l�EI� � ' `
�
� ,= F �,-�� .� R,.�; _ `� �� ,� ��-
��� K �'�-} `�� ' �
,. �" �': 2'� �+4-`��
„ e`�r� :� t ..
�t ' � ,�
�+:- �` : � � � �; � ' , , 's���- �` ��
, `
� ` �� i;T �ce � : = , ��` 1��.
�, ,� , . � �
� �'F�k,'1 �i� ,.- , - !.: �.
e�. . � �- \� \ y\` ,., , f�o,.
� '' ,♦
� ';.�:�q�X`' . . :'�:� s
�. - ,�4dSa�+'`Q�:L _
,t: - . . . _ : �'.
� s 4y :' �. �. . . "er{+' � � d� �
�.i �
s �.� t,G . ' N.,E .
� / °���
�
�
�.
N
�'1
��.
T
���� �� • _ �� V' � Y / b��Li �_iy�0
c %✓U w
fl���'c�-X , g � 9 �
�'�u� .
� � ��
7� ��
� __ � �
� �
��� �
.d�'U+UIVtMOpNr`
'�S �
�..;�,:�
PROJECr:
REPORTED T :
�,,�,,�;
�:., .. �—
i
� ��� t� c��r t�n�
H���;:� . .z.a.. sl9d f�sC�y, �.
882 CROMWELL AVENUE
��-` T" ST. PAUL, MN 55114
�� PHONE 812/845-38p1
�ESIDE�N��ORT OF: �ENSITY TESTS OF COMPACTED FILL
��87 E��i DANU�E ROAD pATE: O�t�be� 29, 1976
FRIDLEY9 MYNNE��YA
Ha�t�d-Tod Con���u�ti�n Co coP�es °ro:
2200 Si l r�er Lake Road
New �r�°��ht�n, MN 55�.12
LABORATORY No. 11� 175�
'I'EST NUMBER:
DATE TAKEN:
UNIFIED SOYL CLASSIFICATION:
(Moieture-Denaity Sample
Number)
I,OCATION:
DEPTH �ELOW FINAL E�EVATYON:
DEPTH BELOW EXISTING GRADE:
1
��t�b�� 2�9 19%�
Cl�,yey sand9 �i��
t� med�um g��ined9
� �ittle gr°dvel,
b��1Nn ($�)�1
30°S �► �.0°E o� NW
���ne� o� e�ccavati �n
4�
6"
�
����b�� ��, i9i�
�
p� x
��
�
Silty ��t�d� mo�tl,y
i�i ne g�ai ned, some
g�avel, bworvn (SM)m2
20'S b 5'W of NE
�orn�r o� �x��v�ti��
�
FIELD DENSITY DETERMINATION:
Method Density in Place By ��f�dm�OP9� Method, AS'IIYI: D�,�����4 (-#4 Basis)
Dry Density (pcf) 1Q,6 0 5 115 a 5
Moisture Content (%) 9 0� 6 0 4
Plus #4 Material (%) ],o ],6
LABORATORY MOISTURE-DENSITY RELATION OF SOIL:
Method ASTM:D698m709 MethOd "A"' (�#4 ���1�)
Maximum Dry Density (pcf) 1� �. 0 4 �.24 0 9
Optimum Moisture (%) 110 � 10 0 3
COMPACTION TEST RESULTS:
Co�,PB�t�on (%) 91
Specified Compaction (%) 95
9205
95
R�MARKS: The aborre tes t 1�cati on� we� sel ected by Twi n Ci ty Tes ti ng and Er�gi neeri ng
Lab��°atory Inco C�mpaction is belov� �pe��ficatio�� in the ab�ve test areasa
AS A MUTUAL PROT6CTION TO CLIENT9,TNE PUBLIC AND OURSELVES.ALL REPORTB ARE 8UBMITTED A9 TNE CONFIDENTIAL PROPERTY OF CLIENTS. AND AUTMOR-
IZATION FOR PUBLIGTION OF STATHM6NT8. CONCWSIONH OR lXTRACTB FNOM OR RE6kRDIN6 OUR R6PORT8 �8 RHBERVQD PENDIN6 � OUR WRITTEN APPROVAL
Twin City Tes ng ond Engineering Labwotory, Ine.
� g "`�" � �B^—
Y
� _ �`; tu.nn a�"��st'nq
,:�:;::::: a� � �aeory, au.
662 CROMWELI AVENUE
,ov�D7D«c,y� �:a' T11� ST. PAUL, MN 55114
�y5>` �g PHONE 612/84&3601
�''���'� RESIDEiVCEo1ST�l�RE - DENSITY CUFZV� SAMPLE N0. 1
PROJECT: 5587 EAST DANUBE ROAD DATE: October° 29, 1976
FRID�EY, MINNESOTA
REPORTED TO: H��stad�TOCI COt��t1�UC't�011 CO COPI�S TO:
LABORATORY NO. 11—�.75� .
�
+�
1�
w
�
�
0
�
1.
�
�
�.
�
W�
O
�
�
G
i
i
METHOD OF TES'i': A�TM: D698-70, M�th�d "A" ,(-#4 �asi �)
TYPE OF MATERIAL: �layey �and, fine to medium gwained, br�wn (SC)
MAXIMUM DENSITY: 121 m 4 lb. /C1i. f1G. OPTIMUM MOISTURE a 110 2 �
IV�OISTURE CON1'ENT %
a� ���
_ . ��� C�J11'7 CIG'� � �Cli"IQ
. 3
� � �� Q�+
882 CROMWELL AVENUE
,�r �+o�,� 'vz� T1° ST. PAUL, MN 55114
�y5>` � - PHONE 812/645-3601
°�,�,��� IVIOIST�I I�E DE�IJITY CC�U F�VE SAMPLE N0. Z
� RESIDEN�E
PROJECT: 55�7 �A�T DANU�E ROAD DATE: October 29, 1976
REPORTED ro: FRIDLE�°, MINNE�6TA �o�e�s ro:
Ha�sta - o �n�t�u�tion Co
LABORATORY No. 11-1758
�
�
125
w
�
c�
�
�
124
�
�
,..
�
Z
W 12�
�
�
�
�
122
�.21
METHOD O� TEST:
TYPE OF MATERIAL:
MAXINiUM DENSITY:
ASTM:D698mi0, Method "A", (m#4 Basis)
Silty �and, m��tly fine grained9 br°own (SM)
�24 a 9 lb. /Cll. f$. OPTIMUM MOISTURE = 10 a 3 %
� 9 10 11 12 13
IWOISTURE CONTENT %
�
_ � � �;� CWN'1 CIC� t�'itll'7Q
_'�;�-,,:,,..M ana �r�q �, n,c.
`f:" 882 CROMWELL AVENUE
��%z'S T.r.
ST. PAUL, MN 55114
PHONE 812/845-3�1
� REPORT OF: DENSITY T S OF COMPACTED FILL
"`�� RESIDENCE
PROJECTs 5587 EAST DANUBE ROAD
RIDLEY, MII�NESOiA _
REPORTED
22Q0 St 1 ver° Lake Rd
New Brtghton, MN 55112
LABORATORY No. 11-1758
TEST NUMBER:
DATE TAKEN:
UNIFIED SOIL CLASSIFICATION:
(Moisture-Density Sample
Number)
LOCATION:
DEPTH BELOW FiNAL ELEVATION:
DEPTH BELOW EXISTING GRADE:
, �, ',
l' ,
s
DATEs November 1, 1976
COPIE5 TO:
3
Oct 29, 1�76
C1 ayey sand, fi ne to
medium gwained, trace
of gravel, brown (SC)-1
20'S & 5'W of NE
corner° of excavat�on
(Retest of #2�
4'
.6"
r�
Oct 29, ]976
Silty sand, mostly
f�ne grained, a
lit�le gravel, brown
(SM)-2
30'S � 10'E of NW
corner of excavation
(Retest of #1)
:
�
FIELD DENSITY DETERMINATION•
Method Density in Place By Sand-C�11@ Method, ASTM: D1556-64 (-#4 Basis)
Dry Density (pcf) 121 123. 5
Moisture Content (%) $ 01 6 0 4
Plus #4 Material (%) 5 9
LABORATORY MOLSTURE-DENSITY RELATION OF SOIL:
Method ASTM:D698-70, MethOd "A" (-#4 Basis)
Maximum Dey Density (pcf) 124, 9 12`I m 4
Optimum Moiature (%) 10 m 3 11 . 2
COMPACTION TEST RESULTS:
Compaction (%) 97 102
Specified Compaction (%) 95 95
REMARKS: The above test locattons were selected by Twin City Testing and Engineering
Labo�atory I�►cm Compaction now meets specifications in the above test areaso
A8 A MUTUAL PROTECTION TO CLIENTB,THE PUBLIC AND OURBELVBB,ALL REPORTS AqE SUBMIiTED AS TNE CONFID6NTIAL PROPERTY OF CLIENTS, AND AUTMOR-
IZATtON FOR PUBLICATION OP STATEMENTS.CONCLU810N8 OR EXTRACTB FROM OR REGAROtN6 OUR REPORTB 18 REBERVfiO PENDING Cuet wo�
�AL
, Twin City T s ing cnd Enginaertng Laborato „jee,
B ��- G� ,
Y
r� ` �
: % • � � .��_' ' \ �
�( ���'�,,!
� '
, �
`
--.
REPORTED TO:
��� �
�� tWfl'7 Glt� C�SC111q
,., �;;�>r
. � � - _.>.
a;� �:.:.:,....,. ano � �a�tory, R,�.
682 CROMWELL AVENUE
�'' T'� ST. PAUL, MN 55114
PHONE 812/645-3601
REPORT OF: DENSITY TESTS OF COMPACTED FILL
RESIDENCE
5587 EAST DANUBE ROAD DATE: November° 1, 1976
FRIDLEY, MINNESOTA
Harstad-Tod Constr° Co COPIES TO:
2200 Si 1 r�er Lake Rd
New Brighton, MN 55112
LABORATORY No. 11-1758
TEST NUMBER:
DATE TAKEN:
UNIFIED SOIL CLASSIFICATION:
(Moiature-Density Sample
Number)
LOCATION:
DEPTH BELOW FINAL ELEVATION:
DEPTH BELOW EXISTIlVG GRADE:
5
October° 29, 1976
Clayey sand, fine
to medium grained,
a little gravel,
brown (SC)-1
5BW � 5'S of NE
co�ner of b�ilding
4'
C3{i
[:�
October 29, 1976
Silt,y sand, mostly
fine grained, a
little gravel,
brown (SM)-2
5'E & 5'S of NW
building
3.5'
�
FIELD DENSITY DETERMINATION:
Method Density in Place By $8�d—COn� Method, ASTM�1556-64 �-#4 Basis)
Dry Density (pcf) 115 0 5 119
Moisture Content (%) 7 0 5 8.4
Plus #4 Material (%) 13 7
LABORATORY MOISTURE-DENSITY RELATION OF SOIL:
Method ASTM:D698-709 Method "A"� (-#4 Basis)
Maximum Dry Deneity (pcf) ],2], m L} 12Q. , 9
Optimum Moisture (%) 11 m 2 10 0 3
COMPACTION TEST RESULTS:
Compaction (%) 95
Specified Compaction �%) 95
9505
95
R�MARKS: The above test locations were selected by Twin City Tesiing and Engineering
La6or°atory Inco Compact�on meets specifications in the aborre te�t areaso
AS A MUTUAL PROTECTION TO CLIENTS,TXE PUBLIC AND OURSBLVEB.ALL REPORTB ANE SUBMITTED AS TNE CONFIDENTIAL PNOP6RTY OF CLIENTS. AND AUTHOR-
IZATION FOR PUBLICATION OF STATBIdENT8.CONCLUBtONH OR EXTRACTB FROM OR R66AROING OYR REPORTB t8 p68ERVED PENDING OUR WRITTEN APPROVAL
Twin City Te g and Enginee�i�aboraL tory�, Inc.
�—� �
By
y� �a
i . - _ t
T ; . ��` .. , �
Y ,
, � �A.�� ...,
` � �':
, : �.
. ,
,. _Y,
_.
REPORTED TO:
� -- -
t�.
� � � �_
,�� �` ; CWlrl C1���-L`i�5t11'7C�
�:,; � � �� �
yr <
662 CROMWELL AVENUE
s ru. ST. PAUL, MN 55114
PHONE 612/8453807
REPORT OF: DEiV�i�Y fiE��S OF COMPACTED FILL
RESYDENGE
5587 EAST DA�IUBE ROAD
FRIDLEY, MINIYESOTA
arsta -Tod Constr Co
2200 Silver Lake Rd
IVew ��i gh�o�, M�t 551 i 2
LABORATORY No. ' 1 ° 1779
TEST NUMBER:
DATE TAKEN:
UNIFIED SOIL CLASSIFICATION:
(Moisture-Density Sample
Number)
LOC ATION :
DEPTH BELOW FIIVAL ELEVATION:
DEPTH BELOW EXISTTNG GRADE:
7
PJov 2 s 1976
r�~:
�vI �
4�
� . .
�
DATEs ���/�ber 39 1976
COPIES TO:
Sil�y �and, mos�ly
f�r�e gr°a�ned, �ome
gt��vel, brown (SM)-2
3°E8�3`SofNW
�orner of build�ng
6" -
�
:
�dov 2� 1976
Silty sand, mostly
fir�e gra�ned9 some
gr°avel, brown (SM)-2
3'N & 3'W of $E
co�ner o� build�ng
�
�
FIELD DENSITY DETERMINATION: p1556�64
Method Density in Place By S��d�°C011�' Method, ASTM: �-#4 B$318�
Dry Density �pcf ) 1� 4° 5 12�
�al 801
Moistuce Content �%� 23 20
Plus #4 Material �%%
LABORA'i'ORY MOISTURE-DENSITY RELATION OF AS� '�D69�-70,
Method
Maximum Dry Density �pcf) � 24 a 9
Optimum Moisture (%) � 0 a 3
CONIPACTION TEST RESULTS:
C ompaction �°�0�
Specified Compaction �%�
91m5
95
�1eth�d "A" (°#4 Ba��s��
124e9
1003
REMARKS: Th� ab�ve test 1 oc�t�o�s r�e�°e �e1 e�ted by Tw� n C� ty
Labor°ato�y Irac o Compacti on meet� �p�c� f i�at� ons i n
but i� be�orv �pec�f�cat�or�s tn the other test a�°eao
102e5
95
Test� ng arad Engi nee�°� ng
the area of test #89
p8 A MUTUAL PROTEGTION T� CLIENTS. TME PUBLIC AND OURSELVEB. ALL REPORT9 AR6 SUBMITTED AB THE CONF�DENTIAL PROPERTY OF CLIENTS. AND AUTHOR-
IZATION FOR PUBLICATION OF STATEMENTB CONCLUOION9 OR EXTRACTH FROM OR REGARDING OUR REPORTS IS REBERVED PENDING OUR WRITTEN APPROVAL
Twin City Tesfi and Engineering Laborafor , Ine.
By /�— G�
r � ^ � `
♦. �
t �- �Y' � �
� �
!
, ��.��I�;
. �
a
� ��
--•
REPORTED TO:
�` ~
e
/�
F:=j , tw�n c��� ��st�nq
� j - arb er�r,eer,r�q �aocraeon.I, �r,c.
¢"" ';�;�Y`���� ��� 662 CROMW ELL AVENUE
�-, T�,, ST. PAUL. MN 55174
PHONE 612/645-3601
�� �-
REPORT OF: DEKSIiY iESTS �F COP�PACTED FiLL
RES IDENCE
5587 EAST DANUBE ROAD DATE: November 3, 1976
FRIDLEY, MI�iNESOTA coP►ES ro:
Hars�ad-Todd Constr° Co
2200 Silver° Lake Rd
Nevv Br°ightor�, MN 55112
LABORATORY No. 11m177Q
9
TEST NUMBER:
DATE TAKEN:
UNIFIED SOIL CLASSIFICATION:
(Moisture-Density Sample
Number)
LOCATION:
DEPTH BELOW FII�AL ELEVATION:
DEPTH BELOW EXISTING GRADE:
Nov 2, 19i6
Siity sar►ds mostly fine
grained, a little gravel,
b���n cs��-2
3` E& 3' S of i�[W
corner �i building
(Retest of �7)
�
C:�i
FIELD DENSITY DETERMINATION:
Method Density in Place By $��dmCO�� Method, ASTM: D1556-64 �-#4 Basis)
Dry Denaity �pcf) 126 ° 5
(%) 7 a 5
Moistuce Content �
Plus #4 Material �%�
LABORATORY MOISTURE-DENSITY RELATION OFASTMaD698-70, iM�$hOd "A" (-#4 Basis,
Method
Maximum Dry Density �pcf) 124 ° g
Optimum Moisture i%) 10 0 3
COMPACTION TEST RESULTS:
C ompaction �%�
Specified Compaction �%�
REMARKS: Laborato�ytIracm
l�l05
95
� o�ati on wa� sel ected by fiw� n Ci ty Testi ng and Engi neea�i r�g
Compactlon r�o�t meets �p���ftcatjons in the abo�e test areao
pg A MUTUAL PROTECTION TO CLtENTB, THE P�uc us ONS ORS EL TRACTS FROMRORAREGARDI7NG OURBREPORTSNISDRE9ERVED PENDING OURi WR TTENDAPPROVAL
Twin City Tes4in ond Engineering Laborato y, Inc•
�
�y
�
f"'
�
a
�
z
F=
�
w �'
J N
Q Q
.--, (J
l.l_ A
Z
Q
L.L
O C7
z
H �
� 3
�
�
0
tL
z
0
H
Q
U
J
d
a
¢
r�-�-�r....� �
+�
."� � �
� U N U �I
ti
.k N � �
up�+'m � �
g U � N
N ,NG N �
� +� N �
ro v
u.�� N
p +� u ro
� 3'�d �
��c�i A �i �
u� ro s01i o '
aHx� c�
� �Urom \
o ro �
W � ��
� U N ,G l
�.�i H C�i � }y
1� +� •.i G
ro m ro •.+
� � � � �
w � +� :�
a, x
t° oom w
� ''� � a�Qi o
� �lf �
� o+ � �O p, �
� � a�"i +°-� � �+
� � �a a � a
� v •� �
4�d .-� tn � S�i O R7
q oro� H ro �n ro
w aw�+ vv � u�
ro �wu�i � �� u
� � O �k � -.i }.1 W
,p w � ,-i �i a° bp a,
h q U H � ro�
z
�
a
z
�
� �a a
� � �
�q
H W N H
� � u° ao
°� o �
G. U1 U
o a �q
� a"4 � � r� o
N
� ro �
3 x b
zaq�.0 N a�
abuc�i s2�
� 3
�x?3 'os?W � +
.4'
•Tdd� seg �
3
zaqsaM
oi�auio}n� ' �
�
suts2g ,, �
u��E� �
�
\ U
TE3Q SOOj3 (�
SXdMOLI$
suze�uno3 � �
but�t,zQ
� �
s�{azy qsaM �, g, �
S�=S � �a�+ o
SUiS2$ v `, N .
�p il
S�it4L $�E$ „_, U �
� •�
H G.
sTeurzp � 3
w� z
s�asoT� 4... `
aa e n n
,� ro ro � a v
saF.zo�S � <v rHi �
��
�
P
D
�
� � z
U t�A� H
a
z
H
0
a
� ��
� �
�
a
z
H
z
H
w
d � �
o =n
H
��� � ��� � �
�
H
�
a
0
w
0
a
�
�
� � �
0
�
n
�
�
( ; � 'S
� �
�� � �
W O O O O C O O O O O. O O C5 C
E, a o 0 0 0 0 0 0 0 0 0 0 0 0
a M N N �; �; o � �; �; �; �; o �; N
N t/} Ul� f/} V} ri N U} vI� N t/T i-F iA fq�
� N
iC k K k k k k k !C k k k �
A z � I � I I I I I I � I I � W
w �, �
x �
Cn �
rt H
W v�i H
�
H C
¢ • • °G °o •.�i u
�--� v�
p, o 0 2f a ro
¢ � � a � rn � H � p W
•.� ww ai .-� a1 v • o f�
� m o � o ro ro •• a�i o F �
� g' �u a°� � o a�c �.�r.� � rn � o°
� N N O 1� f-I F' �1 w N � rl W O
H � �1-� W q dl O Ul � fd C.7 � � 11 Q � t?
u' •� •� ��m m°o w a� z u.-i o
� w w x oo x o �°n o� E-' w o�r�' "`' +'-�is �
� a� � w.a s� .°-� N�� H �, �+�i i� a y`°
� �++ 3�.0 .�u 3 w u' +r � N Q N �
a w� z c� 3 3 z w ¢ � a c� W w w
w � Gt
W
w
0
� o
0
a °
� �
z :?
H[s]
Ci
;_.
��.,��
v
c
�
�
�
oe
C
.�
��
/ �
��
C
.E v
� �
�
.y
C
�C
�°
C�
O o
� V
�a
m
0
a.
�
o.
a
P <
�
�
�
�
a
b
�
0
a
a
W
�
�
W
U
H
W
�
J
�
�
a
■ti`
�� � �i
.�
.� �, �
� w
���
����
FGIy
w .�.'i N
��,� �
��bb `�
aU� � �
��x � � �
a�b�
°��
�M ��
ro � �� �
a
� � p�q � � °�
'� c a •� r; ��
�aY� �
,��,�a �
� �.� ►
0
�b��
� � � y
�'pA� �
��•���
d� �
� � � � �
� ��
F
O ty '�' � r�., y
� e�i b zs �
U y��w p
�
N
� � �
� c�, °o °o °o
�o���
�
: � � °
0
: ' o °r�
. � � �
� � �
� :� �
.�7
� � � �
���
�
�����
4°�o�d
� � � � �
3 � �.�.�
�W�
s � a � a
�
�
�
�
G9
O �
�
� �
y
b
O �
O �
�
.��,�,�
� ,;:� °o g o°
,�C��rtp cd cd ch
c�a : : : o
e�-° : : $ $
c� : : °o �
.. : � �
�� :� �
�� :
� p � �
�
�� ��
d � �, �
�°�� °� °
� � q � �
�� � � � �
� �
�� a���
V � Pi P'.
�
'�
.$
�
�
V
.c"
E�
�
�
z
a
z
�
a
� �
q •�
U �
a�i �
G7
� z
�
W O
� � � �
� o° $ $
o���
�
. � .
� � :
� x :
� � :
� � � Y
� g � �
�oo�o
�'��x
� o"i � F*7 W
�;����
'C °?3 aJ � m
3 �
O � � N M
x �, � ti �o
� � � � �
4 � � W W
�
0
�
0
O
a
�
A
�
$
� a
\ p�
rl
� � ��
z
� z � �
� � � °
�
�
�
p°C
a
.� W
�
�
���
� � �
a° � �
� � �
z z w �
z
N
�
b
�
W'
x
�
A
W
�
�
�
!� d 'u U � �
a
� H � �
PO U
:�
:�
�
. y
W
�,
�
��
O H
� �
0
�. .�
�, �
��
�
M
�
I �
�
w °
�
�
o�
a
0
�
\O
�
��,
�
�
�
F � �? �
E �� � �
� �
� � � � � �
�� N �
� �
z x �e x • a�
� �
H
oi
�m t
: '� : : w
� .�a� : :
: N : :
� w _ : :
�� : �
�� : :
�� � � g
.�
��..�k�
w�w � � °
a oC� �' ° q
� �
ra z M �
x F q b �
o�a w ~��
N N
� �
a�i �
�
�. �
� �
� �
���a
�
z
z � � �
o � � z
� � x 0
z '� 4 4
V � •`�. OG
� 4 Z a
4w�'�
x
]
a
�
a
�°
W
�
�
�v
a
�
�
`�
i
1
�
z
w
i
�
Y
Q
�
,, b,,
�� /�'
�9a��1�� a��.s �.s
�
� �,
i �
—
; �/
� ��� �
s
�� ��»�e4�� i��/� ��
�
�� �
s ������'
� �/
� �� ����
� ��� � °
� �
�p� ��//d���� ; �'`'. �
o� �/J'�3P%r��� . ��'���� �
N -
� i f ,*^' tr'" II
c��"� �.•�,�^!� " . e*.t' l3L' I�I
� �,,�a,.� ;—�._�a.� S�� ���� �
. � ��- �� , �
� � . ��� ,�� �
HEAT LOSS CALCUL.ATIONS .DEPARTMENT OF INSPECTION NIINNEAPOLtS. MR�V. '
Weatheretrips A.S.H. .. Coo,wcdon No. Inaulation I,
Guide �
Window� ( Dooro Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yea—No Yes—No 19_ i
/ Fl.� �. �,�'.�r Room Length Width ,�'� Height F7.� �' � Room Length Width Height '
Windows an 'Doora—Crackage aad Area Wiadowa and Doors—Craekage and Acea �,
Wldeh Helg�t No. ot Llaeal tt. Aroa Wldts Helght No. ot Llneal ib Aeaa i
No. o[ pane ot Dane IlBhts ot era¢k �a. tt. No. ot paee ot pane Il�ht� ot erack ro. fL
� Vd� `� . , ��` �" a`� yB � � °�. ,. 7 :��� �`4,�� A�D .,�'�:
Coe£ Btn
Infiltration � �' /� 3 �'�' ``
�� �r �z� � �
Glaes t � �`;� �.:� � e;�a
��'� �,: �
Exp. wall � p�'" ���
Net e:p. waU � � , ,�� ,'� �%`
lnt. wall
Ceiling �.,4 �� �,�y�,;, �
,�5 , � .
Floor '
� � � a�
��'�° , ���• �'
Tatal Btu. ° , � °-° ��.� �.�
Required aq. �ft. E.D.R. or sq. iaa. W.A. L.eader area
- Fl.�'�' �`��' :� Room Length �'j Wideh �' � Height
Windows and oors---Crackage and Area
Wldts Hel�ht No. ot Lfaaal tt. Area
No. o[ pane ot pane Il�nt� ot crack �. it.
B� '' �.��yi "v� l-'� ' � �
��• `'� � pf� e ✓`q�� ��,' �
Coef. Btu
In6ltration �� �,�`' ,,� � ,�; .�'
r , „q
�ai/ � ���,; �-� %�% �'�/
�cp. wall � �, �,..
Net e:p. wall �y'�' *?' � �.-?r�°
Int. wall
Ceiling �"d' � �
Floor �> > y' i� o ��
Total Btu. � �'�' '!���
Requieed aq. -ft.-E.D.R. or sq. ins. W.A. l.eader-area - -
Fl � � ��� -�a � _ �' Room � Length � Width � �Heig6t
Rlindowa and Doon—Crackat�e and Area
1n61tration � �� �''
Gla�a � � `'
�.
Exp. waU � � ^
Net e:p. waU � � '
�
Int. wal{
Ceiling
Floo� A ����}
Total Btut
Required aq. ft. E.D.R. or eq. ina. W.A. L.eader area
��I8�1011
Glass
�. Wau
Nec ezp. wall
Int. waA
Ceiling
IFloor
� � 1'otal Btu.
�uired eq. ft. E.D.R. or aq. ina. WA. Leader ana
F7.I ��'`�'�:; °%�.;:,+ Room I Length �� Width
Windows an 'Doora—Crac{cage and Area
Wldeh Hel�ht No. ot Llaeal Lt. Area
o[ D�ne ot pane It�kt� o! orack sC. lt.
, `� F —F'-' � � s� °t k:* �j .a;
%�l�if8t1011
Glasa
�p. Weu
Nec esp. wall
Int. wall
Ceiling
Floor
Total Btu.
Btu I
�'�,
a_�
� �:; �
�
—�
�'..� .� !
�
__ _
�,� � 3 �,� '
��,
������
� F7•� �. B;',' �,',' e;i,ROOni i LeO$tll °.� Width '��` t1e1$ht �
Windowe and!Doon--Crackage aad Area '
Wldtb Hel�dt No. o! Llnaal tt Are�
No. ot paee o! Oans II�hU ot cncic W. tt � !
v` ° J � r�'�t' �-� �" ?'� . � .�j� � Lme-P;i
B�
� ,� �� Infiltration
�---
'_?,�. �' � Gla�a
Esp. wall
°°s .-+' � -� Nec eap. wall
Int. wall
Ceiling
`��'s�� Floor
� "- "-'' Tocsl Btu.
.°'3 _�::, � i
, I "'� r G
IRequired w. ft. ED.R. or sQ. ins. WA. L.eadr� area
B�
�
c� �`� ��' I
, I
13L�-
r D�l��
HfAT LQSS CALCUlAT10NS .DEPARTMENT OF INSPECTION ��• �•
Weatheratrips A'S' ' Conttruetion No, ��e��
Guide
Windowe Doors Reference Out. Wal1 Int. Wall Ceiling Roof Floor Kind How Applied
Ye—� I Yea—No 19_
� F1.� �'�at�, ��{ ���-�;�ioom Length t� Width r� Height Fl.� �,�. �` �,�z��' Room L.ength � VNidth �%�� Height
Window 'and Doora—Crackage aad Area Windows and Doore—Craekage and Area
Wldth Helsht No. ot Llee�l tt. Are� Wldts He16tit No. ot Llnul it. Ara� �
No. of Dane o! D��e IIBht� ot crack aq. tt. No. ot pans ot pane Il�hu o[ cracr W. tt
�� - �,.%� a .,� � �,' �' �1 ,98 „`� ..;'� �j�:,,s.�;:. °O�e.:-,;,9' ,�':''
--.� �`' � �� �' E: �<� � ti �.� �-__. .
�� % I °,`a`' �� � `l�/ ,c�.�' 9"
Btu
lnfiltration � � � Na
�
Glaas � � r _;
Esp. wall p �
Net e:p. wall ; � �°
Int. wall
Ceiling
Floor � C� �
Total Btu.
Required aq. �ft. E.D.R. or aq. ina. W.A. Leader area
Fl �,�''�°;�` �'''` Room Leagth /�� VUidth �:.
Windows and Doors—Crackege and Area
Wldth Helsht No. ot L1naa1 tt. Are� �
Na. ot pane ot pane U�Ab ot eraok p. it. �4'
��',4] � � a/J .;'�' 4R� A r n
tN� '�i'.� C-- �f .. /A
8'
Coef. Btu
In6ltration � ;� ^,� sr^ � �'�
Glaa � ;=� �r� `� �; �
F�cp. wall � � G"��`+ ,:�'
IVet esp. wall ���� �' ` �;` � ��
lnt. wall
Ceilin8 ,�� 6`�` � � ¢�',
Floor
Total Btu. �°",�
Requieed aq. ft. E.D.R. or aq� ins. W.A Leader area -- ---
� Fl ��a�. k s'• r� Room � Length ;�` Width :"'�>" Height
Windowa and Doon--Crackage and Area
Wldth HN�ht No. oI Lln�al tt. Ana
No. o[ pan� ot pane Iltbt� ot crack �q. t�. �
e
C,.�.� �"�" � sa ��_' ,�f.�="� f��¢>
CoeE. Btu
r� f� _�
Infiltratioe / ; � B� �°� �'°�=�
�a19 ; 9 e'�s,d . � � L� t, :x u �
Eup. wall �`' �%, �=�
Net e:p. waU � .A a� '
Int. wall
G'� _ �:`'� ' " �
Ceiling � � ���' ^�-�
N loo'r'
Total Bt3. `�� `'' '=�'
-�
Required �q. ft. E.D.R. or aq. in:. W.A. Leader area
In6ltradon
Glaas
Eap. wall
Net e:p. waU
Iat. wall
Ceiling
Floor
� Totet Btu.
Coef. Btu
� . , ;- ,� ., . �} ,: r;�;�
iv^� �-�. �:y' �- -.
�, < <�� ,�, ,,� �.,i
�a � �j
Required aq. ft. E.D.R. or aq. ina. WA. l.eader ana
�o � I a -= � t. 'F�-,� c�m I �� �� w�ac� ,�
Windows aad Doors—Craekage and �►tea
Wtdeh Hel�ht No. ot Llnaal [t. Area �
qNo. ot pane of yans 11�6ta ot arack sp. tt.
' g ��/ ,i'!6 �� ,� �� I '�K� ��, �'�� �
c�¢f -J. . "ra
�
Infiltratioa
Glaes
�p. Weu � � �.
Net e:p. wall �
� Iat. wall �
Ceilin
Floor
,� a�:,
�:
"�
Keqnueasq r�. c.u.� arsq. �na. w.r�...eaa�r �..�a � -
��`� � � .s � �,� � ���►► �. W;dch /!�' He�hc
�+'- I �.. r _�:a:�
Windows and Doon---Crac�age and Ana
Wtdtd Iiel�ht No. ot Llnul tL Area /
No. of paae ot pans Il�hu ot cncic W �t ! •
6 ? ` ` �a
�; �y !"i °� v� '�°� � � � �
Coef. Btu
a � �i 9�
Infiitration ' � . ' ,� ��°
Glasa d�� � �' �� �s
Es wall � ` `.�
P• � � _�
Nec eap. wall `•� �'° ` � r��
Int. wall .
Ceiling �:w �< � �' �'�:�a
Floor
'fotal Btu. �'`�,�, :�,' r��"
Required �q. ft. ED.R. or sq. ins. 'WA. L.eader area
S60•3450
C�f o Y��l�
� �
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE February 7, 1977 FRIDLEY, MINNESOTA 55432
Haxsta.d-Todd Construction
2200 Silver Lake Road
New Brighton, Mn. 55112
Re: Final Inspection at 5587 F�.st Danube Road N.E.
�ar Sirs:
A final inspection was made on February 3, 1977 of the above address and the
following items were noted which must be completed i�efore the structure ca.n
be finaled out;
l. Provide sod in the front and side yards by July 3, 1977.
2. Provide a hard surfaced drivev�ra.y by July 3, 1977.
3. Post house numbers on structure by February 18, 1977.
4. Provide garage door closer by February 18, 1977.
5. Provide nuts on anchor bolts by February 18, 1977.
• 6. Provide 1 step in garage (from house to garage) by February 18, 1977.
We will expect the above items to be completed by the scheduled dates when
reinspections will be conducted to determine compliance. If you have any
questions on these items, please feel free to contact me at 571-3450.
Sincerely,
:�""'°.,.� ..
F� �OLDEN
Building Inspector
RH/mh
0
. 1--
. �
. a'
. C9
z
.�
�
� �
ra a
._.. c�
�
tL A
Z
ll� �
O C7
Z
��
E
C..) �
�
O
. t►,
z
� O
�"
�
' U
J
a
o.
¢
�
r�
0
�
N
�
1
�
I
N
�
a
�
n �
d
w vp .r � I
X U �0 �
M � b b .1
, guu u
� a�i `xi � m
H JC .i N
� p u u a �
• °d " s i a �
. O y ar >.•�i -�
- R'+ � C aAi � O
'� p� �pp d+Vi �
N JC .-1
�
.Q O V [ �
a1
a� � � �
p -•�i o� y �
' +i M C
� i� Y +i C
� - O W 'O +1
W.'�-t +�i y m .��i
p. ov �+ R1
� � 3 O �m k�.
� .
� '� .�a o 0
� b� s�i
e� Ab bu
� � o v aGi
m�o o�
.��! � O+ 01 M
� b��a
�� d
�. c a� H
W .-�i u�i ..�'i H O 't7
m ° ..�i � H � m m
�m EaF"n c d-.�i�
H O� m� N W
a w � .+ � v �o m
r° ciuH W ro�
�
H
M
a
�
N
m
�
�
1�
O
1'i
� O
� � z°
O
4-�I UI N 1-HI
N �
�
� a
O
-� �, � H
Cd L� E+ m H
' a � �i a
ov
o `� c°� �' �
�z W �w � �
�i a � v� o
M d
d � �
3 x �ro
�a�� v a�
3 +i
abue� s� � 3
�x'F3 'as� _
-Zdd� s� �
3
aaysetl
���emo�rn� y
su�srg �
��Q� �
. �a sooT3 �
SShchOti$
Su�r�uno3 0+
bvt�=a � [ ,e
�B� uSEM �, m
' S�F's o �
+� O
st+iSrH . a�i
� N
�RL �C3eS � a�
� �
sjrv�s�
�
c�asot� � z
� r
��, c w �.ri a :
cajao3S .� �v ,., , v
1 �.
� d1 �
a
o �' m
U v1 N
• � �
0
JJ
�
�
M
�
o�
[-a+ '
h
N N N- fl! f? N t? t? t71
t_
. '
ao °o °o °o °o °o °o °o °o
oG � N N Yf Yf O 1� Uf tt1
M N fQ f4 K '-t V! f/1 fA
y
x x �a x �a x x x x
�
m
� �
t
z'
H
z�
_ �
�
H
w
a
W
O
a
�
N N H
, °o °o o°
. M .-i o
tll N .�!
. y
�a x x
�
0
h
N
. �
a
0
�
n
N
H
i�-1
_ pa,l
�i
�
a
�
0
w
�
�
M
z
�
�
tl! N V1 y
°oo°
Ifl N
��
� °z
U
cn •
W ' '
J • �� �
iq O .�{ 'y�'
""' y b� O O y p b
¢ �a C K � � � y . � N M
a O4' � C� �.� �. � Op p„� • U
O
�] pm. C • e� O E+
O
_ � o � +� � O �C W � o� � o
a M O ��� q m w � ,.�j �+1 p
►� �� CI Q d O 0[I .� N C� y O�i � '� O•0-1
$ � � a � � O h
� � w� Op0 T O N 4 M �'n �.d a IA �
W O C, N �
�-�i � N W .0 N►i M (! a� ►r M sJ 0. a .+ °
e9 � u v ar u w .. m,e
a .. �� ci x x z w� a� ci a a n�
a . . � o�
0
b'
x
� �
y �
� �
�
� '
c
c
a `
y =
x
�
SUBJECT P
City of Fridley o 19660 �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� � ECEIPT NO
� `L _.___ COMMUNITY DEVELOPMENT DIV.
r j � PROTECTIVE INSPECTION SEC. 2� /� �
1 = i ✓
� /��'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPqOVEO BY
�.__.11.' �•� 612-571-3450 910-Ft 5 9/6/88
� �
JOB ADDRESS 55$7 East Danube Road N. E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1 1 Innsbruck North 2nd Addition SHEET
2 PROPERTYOWNER MAILADORESS 21P PHONE
Russ Duncan 5587 East Danube Road N.E. 574-1083
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Pacific Poqls 6922 - 55t1z Street North, Oakda.Ie, MN 55109 770-1313
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDINf3
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WOFiK
Construct a 2Q' x 40 Inground PooT
9 CHANGEqFUSEFROM TO
STIPULATIONS �e lettex dated 9/6/88 for stipulations.
WARN�H� �EP.q��l"� pERIO�dBTS RE�I_1BRED FOR
�efore diBB�g cat! 1gC�l �I�Iil�l�� '�1IIRIiV�, �HEAT�I��V�.; �PLlJ�I�-�il��'G �%� �����.
TELEPHONE . �.��r��c . a�� ���, .
�;EQUE��� �� ��'�
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY OROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHOFi12ED 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. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $lO OOO $S.00
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 O R STATE OR LOCAL LAW REGULATING CON-
T UC Ofi THE P FO MANCE OF CONSTRU6TION. �S`ZZ%.00
�'� � � `�- PLAN CHECK FEE TOTAL FEE
1 $1.22. Q�
fSIGNATUREOFCONiRACTORORAUTHO AGENT �DATEI �1�1HF,�N PROPEHLY V IDATED THIS IS YOU/R�PE MIT
SiGNATURE Of OWNER IIF OWNER BUILDERI IDATEI �� � X � D°^�i "
BLDG iNSP nATE
I�w [
�fi�N I ]
AL'1£�R [ ]
Qonstruction Address
j �1 Descriptian
1
S —
City of Fridley
R-1 AI�ID i�2
�,; t ding Peanit Appl ication
�
Effective 5/L88
Owrer N�ne & A�ress: ,�/�C S S' ��-� ,���. ✓ Te1. # -� � ���
�ritractor : ��i�� �r�c��S Tel. # �d " ���
�
��
��: ��o�� �� � s' � ������-�°` ���-� ��/G� � ,
Attach to th� appl icati�, a Certif icate o� S�uv�y of the
lat, with the proposoed construction draa��mm on it to scale.
��a� •• �. �� ., ,.. • :� i�
.
:LIViI� AREA: Length Width
r��c� ,� - • .
D�Qt ARFA: Length Width
. P
s�.. ��- ,� ;�?
Gbrner Lot [] Insicle Lat [ Ft. Yd Setba�ck _
�pe of Constrt�iasi: .�L�S����s�� �- l�itl� C
Approx. Comgletion Date : � —/S` ���
HP.i,ght
Height
�gt/Gro�a
` ���l��:�,�
St3. Ft.
�. I't.
9q. It.
,l'�� �-
� � �S' - 3d -�
_ siae Yara setbacacs -
F.gtimatea cost : s �� �c
Al� A Alt. B
Proposed Driva�vay Width If New Openi.ng Is Desirecl: � S
Width + 6' See Back Page
�� /�// �
DATE: ��� APPLICANr: L-�E' � Tel. # � ' ��
,
�t � �
State Surchatge $ � t� �1
SAC Cbarge , �
Drfveway Escrow �
Park I�ee S
Sewet Main Qzarge S
�-_ Y��
SPIPQI�I�:
� I�
�� � �; ov
�'' ,�,.. ,a,;� ;�,
4 1��e� ;-�\ ,
� < Y1
�Y 0� 770-1313
F� SC
5.50/�
5550 p
�`.s �
F�e De
��
..�.� _
'��S^ �,
„ �
� �_ ,. ,. ,. �
"`� ,
BILL DORNSEIF
PLANNINCi/LAYOUT
�� SALES CONSULTANT
� �
i � ���� ��.�.�� �° _
; , � �� � . �� �
.�` �o �
, � ,... ,�i� � ° '
�� . . . . . . . �
6922 55TH AVENUE NORTH
HIGHWAY 36 AND �4
NORTH ST. PAUL, MINN. 55109
� �; � - -
� ��, r�
�
.�:
� :�.,;
0
'��� ��'
����
--��
117��
�=-�� � �, ' �i�v�i� �� �M:I�i�,IJ
�e Chief Building Official shall, before issuing permits for the erection of any
building or structure, or for any additi� 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 applicarit for such permit of fees to the amount
herein belaw set forth and in the manner herein prwided to-wi.t:
TOTAL VALUE
�1 to 5500
$501 to 52,000
52,001 to 525,000
525,001 to 550,000
$50,001 to $100,000
5100,001 to 5500,000
0
S15 lNlinimtmi F�ee is S15 plus surcharge )
Sl5 for first 5500 pl�s �2 for �ch additional 5100 or f raction
thereof, to and inclucling S2, 000
S45 for f irst $2, 000 plus $9 for each additional S1, 000 or
fraction thereof, to and including 525,000
$252 for first 525,000 plus �6.50 for each adc]itianal $1,000 or
fraction thereof, to and including 550,000
5414.50 for first $50,000 plus $4.50 for each ac�itional $1,000
or fraction thereof, to anc] including $100,000
S 639. 50 for f irst 5100, 000 pl� 53.50 for each additional Sl, 000
or fracti� t,hereof, to and including 5500,000
$500,001 to �1,000,000 $2039.50 for the first $500,000 plus �3 for each additional
$1,000 or fraction thereof, to and including 81,000,000
51,000,001 and up 53539.50 for the first 51,000,000 plus S2 for each additional
51,000 or fraction thereof
�� ��+� �:`4 � � � ; • � ` �;,,�..
. - - . -- •
Alternate °A°: R�noval and replaoement a� curb and gutter o�ly - Driveway width plus 6
feet times $13.50. .
Atternate "B": Renaval and replaoement a� �rb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times �15.75.
��+� �i � �! • � . ° ;�.:�J� !-; M •��
Permits for constructia� will be issued a minimum of 24 hours f rom the time of
application to a].law for proper review of the prapo�ed structure and of the o�nstruction
site.
A Certificate of �rvey of the lat, �hawing:_the locatian of the fo�c7ation once it has
been aonstructed will be requirec7 bef�re�,prooeedi.ng with the fraaning.
. ra�:
J
... :` •:,��:
. �.(tl _
,
- �-_ ..�
� C�r 018as � .� ...- ,� : � , y � ,.�. :, w..,•..� �'
4S�.+s.
,V�7 . .. � '�� _
�/��� � ������',_���--�,
� �Yl• � - ���
- .� ��nn�s�o� P�� �pr�tiu�b �pmpa�►
�eronkim c.� Stors . _ - �to. _ sc Pa� � - : 8,+�, S�
1�l1 - 88lh Me. 1VQ. ' � - ' 6�12 - 85th � � �. , �Z� .y�; Co. I�. 4Z
�, Mn, 6S#218 ` Na._ �. Pau1, �In: =5�'►i� _ � Mn �
: (�0•9�'1��. . `- . . � .. .{{�•$�pQj .
� _ _
'�-..6�•��4�� �.. .
: :': _� ..�33"—,..-:.
��s� �! �,p�iY s T/fi
fl
`���fr �'�+�
� ��
7� Weyats 8hrd.
. � Mn. 683�13
(8+�1-l1�)
� � ' � .. . - ., . _.. '..._, _n' : ` . �' .. . . . .. ..G:_ � . � . . - _ -
���I��� � , . - . - �
���V"�`--�
� �=�t�-. cat
0 .� �� Tnu�t
3now �en�e � L� ` �irti-Loa�
.�nsp�tioris�
O Walls
O Plumbing
O Faatlng
a `Before Bacldlll
�fji^
0
'���.� rf ,
e1a�; ' e
:.._
►lr,,
��
, : . ;,
� , ,
.:,
�'l r l ��'� ��,r �'� �/�"� �°
�
l t: ,�' �? �' -L' � 1'��f. v.��i
,� >
�. �> f- � �:lC. �i.'�"` °�� `i�
`� ' ; � � y��%�
-� f X =� a
��
��
��
��
�� •
9-�-Ba
ou►� .
Diegram P�1 site fn rela�on to house, 9ara9e. property Iine� and wir�. (Allow 3"
� �
G�. V C �
�� `
J
I
�� ��� �� �a •
�
�.-- __..
��� �� —
_�
,,�`-:� ��a
M �� � � �� r
�
3�
i
�
0
— �� �
^�
�
�
�- � � : . � �.
Pxfic P�1 & Patifl wilJ make ��'i�a� �iDr �ri� pick-up !►oa�' ��rsntlrtg pool �ing permit f E�ctrical, 9as. brtce ar atfier
�Po�bility of 1he contrac�or doirtg ��t�'k�. . Pg�ifs afe the
'Ihe act�! casi � ik�e- �em�it is �t� ��bi7it�y of tt�e homecwrrnsr ar� P�cH�e �ool �:Pati� wfll expect to � reimbursed for this permit c�st �.
within � ���ia�9 tF►e Permi! fi�r ytw. -_ . :
� _
_ - o�� ��` r
_ �- -
�c tocaHoA otiilter andlar heat� b �
� Yi�'. .
� � � �l► � ° , i�r �dh9p�t1 pf di,��,,,.,
:� - � �
_ i �Custorr�r w�sh t� r+a�in Selyt�r ;Bil t�irt�[i�r1 �1.- , k P8� A�1 b i�BUo r�m�nds that e��omer fnsEall .
�v�or��1� ._
H
O
O
a
�
�
_
�
v�
C
�
�
�
�
�
3
L
�
��
�
�
C
C
V
�
�
�
0
V
F
�
O
T
a
a
O
N
i�
Z
Q
J �
W J
2 Q
Q O
aa
aw
� y
aW ~F J
OOJJO a
�ocdam� u�
ZZ f¢u�H�WI QO
C77 y��=�ys �j
QW �WCUJI=-W am
rV �$_�
;nN �¢W?WNO ;�
w2=tnOJO
=�Q j=ZZ
uWi�aigag
o�
Z?
¢Q
J �
OJ
maN
W
�60
>IS
Z�r
g�0
nzm
O
W
S�
Ou
na
of
NO
xu
i
a�
NC
% �
�y0
aQNa�o
3a._.oLL
W Q
VLLZ
m�o
U`;�
m�J
Y O �0
J
�62
Oy�
` V J
Omm
WUQ W
Q m �
y0;
� O
W
j m W •
LL Qd HK�
� �J i�f <
� Z Wo�
y� 2 2
d
V Q =W �S�
� �Z Wh pNm
? y0 (7� W JJ
m �� � O W W Y
_' ~ W W Z �Q<
Q
I g� m, Z<O
z ag ap °;o
�i g O� NJ ��a
> d= 2�J t=i�Zr-
2 = �Z �LLW �aO
o ° �� `>z3 �W=
F JIL �¢ �x�.dj, V`Gl7
t Na N� WQf m�Z
W
:
�p Y
WZ U n :
Ja�y��l¢- ;4' ° 2
UZaZO 'eCi�'
R
¢y(�Ym �r)�)
�WfA~W . Z .2
JfZQZ S( � f ,f,
QGLLQJ � -
\ � � � /
�
� 1 /.
>o
�tx�W �
�/ ' ;
LL � ` W
¢ b J
�`u�
£�wz
1y LL 6 W
Oy� W � Y
a�-W
�j�0
���
W
6
�WU
� 54 �
i j
LL
O �,�
1 U i
W `
Q ��� i
� �
Z W ►Qm �
iaa� �00
UWm �mUm �
Z�U
2F=-m
�
�,
O
a
�
0
�
.
�
x
O
N
78
._. _J� . - . ,
��_��--_--_.
_._� T
i �
�� fi1._ ..: —>!-H-- - •f' ---►;
_ I
1�
i _'j l
K �---Z; •. x ic
, .--- ---+ �r--�
;� �
, �
�_ :.._�� .��.-�
�
_-- -1
,—___.1 . � I
. '___�___ ' - . " Y.
. �. _ ._ - _� _'__.� ___'___ .�-.�_-� 1.1
�
. . - A -s a-a . ►;
ii II
_--1 i -
- - _ - __—�-�
----- - --- 1:
�
- ,--� ;!4- � -s-
i
- - --- --_ — _;�
--- ---;j II
_ . _ . I I .<
� • -----. � —�==��i ,
a -e -- r-=�
�1.- � �.;
w , � �
�
N
H
S
�= X X X X
Qa
F} x x
��
O
N �
�
� x
�X
� x
io x
�X
�x
x
�p x
�x
�p X
^� X
� = X �G X
wZ ���
V Q Q w X
¢��¢2
fn Q
Y � W Z �
U � ►- cn
Q J Z 0 J
m W W J W
wZUoZ
tnQF-_ Q
�aQcoa
� a�—�� a�
�������
X X X x X X
�
OLL V
¢�Wa
Wva�
V�oa
0���
x x. �c x x x
W
oop
0�0
NZa
x
x
x
x
X
x
J
0
. W
X�OQ
X°vza
x
X
X
X
x
�
Q
,J
J
�1
�
�
i
O
�
ac�
�����
7r:,_
SO4c�_ �
n4�;i,�
, r y _ -
a �- :�
0�..:w_
n
r �
�
�
�
d
�
�
�
-�-
e
1_. '
�
�
1�
!
1
I ^
� I i � �i
,. i � _ ���
� �,.
� '� -� i .
' . II
� � �
II
- Ii I (.
�— L+I . � I
� I i �. ( ,
_ 1� -� I�'
� � � ^ --� j -
_ � ,.
� '� � 4 v
i:-. � ` ' � I
�_� � _Y� �
�
�
,�
�
�
a
�
a
V
�
LL
�
�
�
a
�y
Z
mN
OW
��
�o
�Q
=0
Q
m�
�
QLL
Z
d �
W
W
H
�r�'�°�`�6�°5
��$�g������
C 6 � ��N
cmgN�m�pEou
�e m -
�°m``°m°"`'�
..W.►���my� `OU
C Y1�9DLD�..ym
mL m a.� 3'� o c°:
p���yOQp V �ip'D
� �'ApCi � v m �`G�°�
mQa�n-��°'yg
9 « O � � 9 a
� !.'O �� U V m940
s.W E mDp` 7�C� m
� r H
O��aii0my�cD
m3uEo�oc�oa.c
m�=a`�i����mE�
a;c�mmyEa °
����y��mom2
�_�m�
��o=��� ��o
m—y��o!no�p �
�c�c�c_�vc`o
�-m"E°��.�°8
aEWm� o
E 07� � nmDc
L�� O r O O E� O�
H N W U D U T m� U E
�
7
�
�
�
�
�� � x�. , * .� � ' .
��� �-
�1f � � � ST F� � � �• � ,&._... �' v
k ����� � .:���1.�� ?�•^C
��N^��a � ,�' � � ia
'� �' '� �` �'g� ' } iA �€ +"" � � �
��, x �`" ��-� .� - ` � �x � � t
��, �. •_,�$ q,�t �`� �i
�",. � iu� � � .�' •'`4'� ^1 �����
� � `� Y '', +., .._ , y �
� �4 �er rofc � > ° � .
� .£ t ' ++���., as
k� �- Sp� �zu?'r� �' �.. 'k� t j ��g•�, i� { a'" 1��
'�r'k> � i"� � � y,� e ^aa �! . ,qy��{ `1R�. �W
k. »T^ �,� " ' :' } 3. ( � .;?�
�-Xr �' .. ' 1�ar..? 3��c,, i� l�, y � �.-�t� '���
k - - �- �� � y �
�."� a� %�� � � +�' . ♦ ��` S
� ' � � ry
��� °.���i* �. �rt�� '�`� � � �'�' �� wa.�'`' *� �.{�`'�
i�,.
r'x
`�
� �
1 -�-.�- 'aomk�,'�. �3" _ � - ;: s +",..� �. .
��s � ��� �w* � � ����Y3a�*� � � +� . ,. .,n.g
u �_ r 4 i u's:@� 6 7 q�r«� .?i'b' .-" fi
� ��`�� �"'. � ra�� „'�,�y�" • �_ ,�
� � � �� ' II�` ' � _-Y��y �� _
a , � ° ''
�i m � 4����I �
.
� - — . �.�' "�� �..� ~�� � .r_.. _ .
.���
+� ,;� „�,,
� g � „ ���9 �`� w� m, '
, .•'- �� � �, � 17 81 '
q. ;
,� � � ,�_ � � u � �. �s�� ��� F � r �. �
" � � � -r� r �" � t .•�,� .
� l y � •. r`�:� 3 �ra � �.:..R6, .�.�( �'�e4'.*�'�-.3✓�� � .� 3i+W _
. _.. . �i+S'.s'��`" .-. .`"C _J��
�.Y�crn� x .`�- g ", �; '^c :.,,,nt�K., �� ,� ,,,� _�;. § .�,;, � -e.��.
-r �..r .. � t i-?, -_ 9 t-L �.��u �.
d �n � �{. W 3 �+Xe �
��' � W: � �A6 F � .'� .A �� '�%' <a'i �« a
". t � v'� � :�s �E� y � `m. ; � � :.,� � ' 7
.� b $ s "�.'i . r 7a"` �!' �at1�'� r �. .,� . r� `:
_L �'� _. B}�' � � ..T � °- I" �a �� [
��n .,. .. ' � �, � }..' � �,y� ��y
�'�..r- , a y �� c'h " r' \t
_�t� -. •.ti � � � z
� ✓ � +� z �o �' � - _ ' sA,�, r... ,,
� YLY '�,
r�'V�y�1e�€� iC
•-n�c-• •4 � .`: �
. �d � -8' _.. •. � � �
�.
��- ' _ ' ' - ..
-. ..a . _ . .,� ..
� >. � f�n4a-,ti �� �
� ?�9���. � ��.�'�'i, . h'" • . "'�::....., n..
. F- � � -
> ..�.. - �� v.�„�,s.�
��.�__ ,,, _ _ _ _ S .�.� _
fi '� • . . .. -' � . . � .
�
i
.. i�.
., . . � � • � • .. v" �. � �•
4
"q� �
�_E - . .c:+. ��� y� ..
'y°rs' =� 31, a Iy. � . _ i.
. . � �p J �' � � � i� �
�µ �� .aR �� �' �''E':. c - � . Y '� g � °'�M.
� _ `���,� �` `�= � R,�.��'"�,�I �; � ��� :,�;x
4 � �� �+,� '�' �• , � ^ { Z � , �
--� x 1f11�lARD.
�i'. . 1 n �,y- _
}�����,�� 4 y, �y� �"R! `� y.� �. � T"•�"C �� � '�.n.i� ,.�� �: � '-li ��. '
~� _ � h �ti.� T '�q �
, � �
+r +
�� �
. , ..'k... , � �� � .,y� �� �� ie .'& • � � .
.
� ���, � � �� ��
� y� � ` y� o
• �, ,.
� ..r. � � i� ; �_, ; , X -.i��r�:�'� ��� _ �e,`�,.. � 3 ..� ^�*,; �d_ ...
y
_ ` ,,. �. �'`
f . �6,,.a ' , '�+�� �°�,� �a;,�"� "�..,- ��-t - r
�° , .� ,�` 'r ,� � x �-„, 3 � �
,,,,�,_ �.
m`�:�' �'�k� "`�� ` "► �� � �
''f,1rs:_� � � ���� � � ��'�`• � ,�`k.� -?*.e� � ��ti '�; ." �. `��*"� � � . �
*� �.
_ b �, � .
,�� . �� , -� �� ���. � ,��� �
- �11 :�
� ,
�. ��� ..
� �`�� � � '��.'`� � � _��,
�,,, �. ,;�,� �,.�. �.. � � . �, : :� - _ ,
�� �:
��
�
�
�
' O
.n�
, . .--_ ;
�
_
; __
�,.,... .. :
�.
� . .
� r`, 3"iii,�' _ ;'�'�, lu*_. '�-��j�p
F r � � t , _,! )', �$C ,j r? r :S tCi;-t
3 F t^ • o- c•�.atih �t�M. �-� v� ���..
�_ . �
,�n� "t
,j�.� ��
` ;?�'`' `g.
�� , : ... *f�. � �� ` ..
� �/ ��� dX:
�� � �`�� � � •� , �
,�.`\ _�} �
w� _ .
� ° ,� ` -
�a�t' a:r.
�� - �
=- �;:,
.;:,.';,.� �'°"" :
ao
�
�
ro
S
O
0!
�
�
u
w
�-.
W
W
J
A
�
L.L
L.L
O
H
�
y
O
z
Q
Z
O
�
�
W
..�..
O.'
�
W
�
Z
O
H
5 `�
�+ U
2 >
W W
! A
. ca
Z Q
J y
O �
C..�) F-
N
� }
� N
Z
1--� Z
a -»
W Z
= O
p ..
Z ~
a a
z
� �
z
� �
a ¢
�
W
3
a°
�
� �
o �
I-- N
V �
J Q
a cc
�'aC
�
vl
m
�
v
�
O
r7
N
a
N
N
�
m
.i
�
W
W
2
m
�
�
-,�
�
s,
m
�
�
�
d'
�O
dJ
C
�
�
�mo
O � �
++ w �i
W �
.� O ae
aa �+' -i
� U E
� �
x�ro� °�
�
ipduy10�
3 U a+ �O
m m 0 �
� L M m
O ++ � �
+i 3y � 1�i
�UC EAl R '
t0 M O
a IMp .�C N
M U C +Ui
w° �° ��o,
O+Ui T� p
+� Y+ C 0 C
� F � � �
w "' o'o �°+ m
b M W '0 'O
m � ° a� "'
� b�� �
,gbao <
m ag� �
'O C t� m
�' ao m
M b m M �
'O '� C '0 `
� +� � �
m � � �q
Uy L�
� 01 � W
�
� v� ti► t� +�
a o 0 0
w o 0 0 0
H • • •
� N ei rl rl
fQ� f? f? f?
. m
'k � U
�� '�
{+ ,.� a+
Q � O
� �
�m a
� ,�
�
m°m $
a ai � ,� � om+ �
r� m w[ a �,
� �a aw� a
r°+ � � ro � � ro
W Pa OD C7 C7 C7
RS
��
I ��
z
� � �
� � W
a � tA w E
et
� � D p� Ey
y E W
� �
0
0
O
'i
N
x
co
�3
rt O
�
� .�I C.
ii N
•� � a
�ro�
m
b+ � o
C b
o a�
�a�+ m >
b a�i w
U O�
.�
4 �
.
�
.�
N
3
m
U
�
��
�
H a
a a
� O
0
� �
� >
� o
��
rl
U
Z
E
N
�
2
N
w
�
�
L�
PD
�
O
O
0
�
. l_
„�
� � �
d
b+
�
x
w �
N
m �
i�
�
y
O
0
�
�
�
m
w
0
a
�
m
LL
m
C
«-1
m
a
`
M
W �g o
D R Z
� 3 N
� � N
♦J
f� 3
� �
d�
�3
� N
O �
a
�
O �
xN
F b
� �
m
�
ro
O
a
�
a
M
�
b+
0
a
� a
'y.
.�1 �
� �
� O Z �
C N F
� N �
C
w
w �
� w
y
r7 fd
b x
m
m }i
O C�
� U � �
u ro � �
U E a�0 U
�
� .�
o �8
m
a
s�
Oa w
i-�i m
>
N N
a
w a
�
�
1
� �
� m z
� � �
N
0
0
�ei
M
�
H
H
�
a
��
� �
�N
��
w�
w�
� N
M (/J
Ha
�a
u
y
�
3
M
T
b�
.,�
m
e �
�
� �
ao
� �
.�
C �
q w
� o
� 'm
��
.�
0
" a
�9 �
u
u
4 3
.
N
V
�
C
i
�
�
�1
C
W
�
i0
d
aJ
i
c
O
C
O
i.�
t�
�
L
d
>
Y
U
�O
�
L
�
v
N
Y
U
�o
�
a�
�
�
CHIMtJEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or s tack;
1. Has been carefully examined Yes (�)
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. Meets all current Code requirements for size and
total BTU connected
6. Has To ta 1 hea ti ng BTU' s of
All other BTU's
TOTAL
Rema rk s
No ( }
No ( }
No ( )
No ( )
Ye s ( ) No ( )
Com pa ny
Signed By
Da te
�
�
��
r
� �L
,
� - �
� i�� 6 3 j .��'�. Y
� _ _ _
_ �� �
f���.�
�
�
-
��'� � ` �
p ..� �. ` • __�
�
__ .. . . . __ _. <-���_ �_�. 0� 1 /I
_�
�,{,n�2f.dlv- k- l � - - _- _ •F . . _
(;�q�_ - - _. .
���.�.��� C��-- � --- - ._ - - --
. � '�,,`
- -
- _ _ _ _ -- -
, �
G���-e-_ � . s�-� _ - --- - .- - - - - .
- - �-��I-� -- .
_ ��� -
63�-��z y
�
�
r
w
�
rn
Q
c
O
�
�
w
�d
g
Z
W
>
�
Z U
Ow
U0
�
� �
� W
= N
��
�
z
�o
z�
�o
az
0
W V
� �
O Q
A. p
�a
�O
� _
'"�
U �
� �
6 �
0
Z
O
U
� U.� .
zZ
m
� N
a
o ��
��z�
���
O > >+ ch
m
U � ti u�'i
�
�
�
W
�
�
Q
m
�
�
�
c
� � �
� � C
� � r
0
Y V �
m U a�
� � � �
.�"+°. �
s
� � L V
� U m =
�
����
�����
� � � R
i
� � � �
'Qms �
Q C � U
� Y � Q"
m a c �
� � o �
� � �9 £
�.pQ �
�
�
� ° c .m
����
c � m c
�
N � +s+ �
C � N �
!� y
� � � �
a
� ° 2 �
!
_.
�
.�
.
1�
�
1 I
wl
�
1�
�
¢
�
W
�
�
(9
� Z
Z �
Oao
� °
� D �
o °
F-
� � csi
�1
_ r
�
O
Z
F_,-
�
w
a
�
�
�
U
0
Q
�
�
w
L
Q
�
�
m
�
�
Z (]J �
�
^� �
ro N m
� �
� C
O U°
d �
� O
U = �'
�
�
c �
m �
= Z �
p m
O � l�=- 7
z f- an u-
�
�
11J
ci
z
N
�
a
S
m
� '
Z
"�O
�
d
L
m m
�
��
�
��i
��1
��I
��I'
�
� �
�
�f3 EA fA tf3
.�
� o 0 0 0 0
0 0 0 0 �n
M P r P- N
�{} y t�3 Ef} tf3
1 �
= s
m .�
Y
U
O d m C
� ���
� � O �
� tL IL �
� m � �
C
z
t �>~
� m
C c!) � � c
m���a
� 3 � �
�ti3 c7
m
m
�
�
a�
�
�
�
0
�
�
N
N
ac
�
�
�
c
0
�
-�
�
U
a
�
a
m
Z
O
�'"' Y
N Y O
� O �
� � O
.:, O V
� m
� c �
�. � �
� ya
Q�- � �
, o c �ro
d m C ?
� � .� >
0
s° E`
� O N
a U �
�
�1
�
s
U
7
�
::
f�
W
�
Q
O
�-
Z
a
O
U
('�
Z
Q
W
_
Z
m �
N
� �
m
�
'a
m
�
w
�a
�
�
z
O
Z
w. Q
� �
I �t
\ � Q
�
� W
O �
� z
Q
�
�` (n LL
A � Y Z
o m �.
� �, j U
a og
�a
��
O
O
�
Ef3
W
z
O
U
W
�
�
Z
w
�
�
�
0
s
3
� L
� m
A
� o
a, �
� m
= o
"G Q.
� �
a C
� �O
� �
o �
��
V �
0
o �'
o �
v�
� �
�
CI:LiMl1�Ey A1�D �TACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes O.: No (`)"�
_. _ { . _
2. Is .free from rus� or deterioraaon Yes O No O
3. Has no foreign objects lodged withia Yes () No ()
4. Is securely supported � Yes () No ()
5. Meets all current Code requirements for size
and total BTU's +conn� Yes () No ()
- � — -- - - —
—� Has totai heating BTU's of . -
7.
8.
All other BTU's
TOTAL BTU's
Has a liaer b�n provided for water heater
Has combustion air been provided for water heater
Remarks:
List ALTE ATIONS R�iqg Done•
HEATING CO:
Signed By;
Date:
Yes()No()
Yes()No()
. _ .... . , .. ffi hmc:: &sl+4a, iS.G�i-z:a5r a9N+�.:- .� :;r , . ,.. >v^. r. ,'l.,,ij�, .4''�-� :Y" �;rs4�6'�ra �ne. � . �. —'2— . . 4 . •,a• r,• �. . .. N,. . '�) .. -� ::�,rv
' � . s,w,.rc '-fl' ���„ N -:_a�t[at�?'!i'-"��•�? � F="� `�F`-__ ' .. .
410 W. LAKE ST.
MINNEAPOLIS, MN 55408-2998
612/824-2656
HEATING ANDAIRCONDITIONINGC
eServina The Tivio Clties Siate /930'
ORSAT TEST RECORD
1072 PAYNE AVE.
ST. PAU L, M N 55101-3892
`r, 612/772-2449
ADDRESS ' � ° - r'' �� �<
�".�`��' �� , d a f���... ��c�� L= C I TY � ' p� !� �.
OCCUPANT OWNER��i �a,t ,;�`-���. ��
DATE HTG. INST. �.�r �-`°v INSTALLED BY --� .� 1,, �__
�. -
GAS LINE BY � � r% �.
TYPE OF HEAT: � GA FA�HW STEAM SPACE HTR. UNIT HTR, f OTHER
,� GAS DESIGN CONVERSION
MAKE �?,�,� �;-` ,_�``` v MAKE OF BURNER
.-� , ` /�
MODEL -`;��`�1��6�i'���C�-��7C� ,1�����'� MODEL `�.°----_.� f�
SERIAL c.���,`�,!",� '7�,1��� MAX. BTU RATING
- - _ _ _ -- - -
INPUT ,��'j,�`"�°" �� ��T?��.� MAKE OF FURNACE �- =� -� -
—�,___..
f CONTROLS MODEL ,�--�'�� �
THERMOSTAT �� • F�T�� � �'.: VENT SIZE .p--� � �
, ,����. -�
VALVE Pr'���� � KINQ OF LINER SIZE NONE�
---,r�.;—
LIMIT °' � _� DRAFT HOOD ,--- RE�ULATOR �� `� �
���� "�"' � �o_: �--�
LIMIT SETTING ����Z� CHIMNEY CONSTRUCTION �y�j�`� .
FAN SETTING_ �,� r,y�� _ ; � _ DRAFT ��� ��,�' ;�.�<� ��TEST TAG ��-.� �._;�;� -�`/ �
PILOT TYPE 's-=.f' �. ~� LIGHTIN� rNSTr 4���P ,f� :a� .�:� � z��'s
. ` '°"` 7 -'°'�
PILOT MAKE �-'
.—�°_,..�' a� -
PILOT MODEL �-
PILOT TIMING �y�/ �, �,_ ,9',���e!
PRESSURE ; 4: ;��; -���. PERCENT CO2 ��, ;" DATE TESTED t��,�'� ,�`� -- Q t�
INPUT CFH_,.�''�� PERCENT 02 ��. �' '-
STACK TEMP. ���a PERCENT CO � NAME OF TESTEP, ��r"� f?�.- :%
�` , r,.`�' i.: '._� � r '�1 _L, �
. _, . _� _. . _ ._ . + _
sue�ecr P .
c�ty of Fridley � �- � _� �G
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T 5�� J� �
r
� �• COMMUiJITY DEVELOPMENT DIV REC O.
i LV � ��� �� ��
r � � PROTECTIVE INSPECTION SEC.
� . �
� � �-"1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE nnGE OF AvaROVEO Br
�----� • •�� 612-571-3450 910-F15 7/7/97 / /
JOB ADDRESS 5587 East Danube Rd NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 1 1 Innsbruck North 2nd Addition SHEET
2 PROPEtiTY OWNER MAIL ADDRESS ZIP PHONE
Russ Duncan 5587 East Danube Road NE 574-1083
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO
Midwest Siding & Roofing 18979 Gladstone Blvd, Maple Grove MN 55311
a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
416-7804 20010277
5 ENGINEER MAIL ADORESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION �J REPAIR p MOVE ❑ REMOVE
8 DESCRIBE WOHK
Reroof House & Garage (23 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TVPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
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 FOH A PERIOD OF 120 DAYS AT
ANY TIME AfTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTHEET PARKING
I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS APPLICATION 1+ STAILS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION� SURTAX
AND ORDINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED $1 918 �.96
WITH WHETHER SPECIFIED HEREIN OFi 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-
STRUCTION OR THE PER O MANCE OF NSTRUCTION. � �62.25 Fire .5�.' �1.92
PLAN CHECK FEE TOTAL FEE
(.� ��� � License SC $5.00 $70.13
S�GNATUAEOFCON'AAC70ROAAUTHOAIZEDAGENT �DATEi WHEN PqOPERLY IDATED THIS IS VOUR PERMIT
�/�/ a / / / 1
S�GNnTUREO%OWNEAUFOWNEABURDER� IDATEI BLDG NSP qpTE
NEW
ADDN
ALTER
[1
�]
��
ConstructionAddress: J
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AIiTD R-2
BUILDING PERMIT AppLICATIOIV
Effective 1/1/97
��� ��� ��
Owner Name & Address: ����_����� Tel. � S� �`' C ��3
Contractor: (°j MN LICENSE # a� L d a- j�
Address: �
G►'�i. # � � -- �
Attach to this application, a Certificate of Survey 'ot Chh� SS3 l i
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length . Width Height
DECK AREA: Length Width Hgt/Ground
OTHER:
Construction Type:
(Fee Schedule on Back)
Driveway C�rb C�xt Width Needed: Ft. + 6 Ft = Ft x$ _�
DATE: � l � ` � APPLICANT: I � Tel. # �'G � -
�t � �
Sq. Ft.
Sq. Ft.
.in Ft
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� . �� ���
$ .��
$ �
$
� , (,�Z�
$
$
$
$
$ �i�-��
CITY USE ONLY
Fee Schedule on Reverse Side
.�1 of Permit Valuation (1/lOth%)
$.50/$1,OOD Valuation
$950 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 [ )
(3UiLD[NG PEIZM[T f�EE SCHEUL'!,!:
`l'he Chief Building Officia( shall, before issuing permits for the erection of any buiiding or stcucture, or for
any addition to any existing truilding or struciure, or for any alteration or repair to any existing buitding or
structure, upon application therefore, rec�uire thepayment by the applicant for such permit of fee�s�to the amount
herein below set forth and in the manner�herein provided to-wit: �
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001. to $100,000
$100, 001 to $500, 000
$500,001 to $1,Q00,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $5(� plus $2.75 for each additional $1Q0 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,�
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $5.25 for each additionai
$1,0� or fraction thereof, to and including $1p0;000
$887.25 for first $100,0i}0 pYus $5_00 for ea.ch additio�al
$l,��or fraction thereof, _to and includ.ing $S�,OQO
$2887.25 for the first $5�,0� plus $4:23 for each additional
$1,� or fraction thereof, .to and including $1,000,000
$5012.25 for the fust $1,000,000 plus $2.75 for each additional
$l,� or fraction thereof
DRIVEWAY DEPRESSION ESCRO�V
(Concrete C�ub Streets Only)
Alternate "A": Removal and replacement of curb and gutter oniy - Driveway width plus 6 feet times $13.?0.
Alternate "B": Removal and replacement of curb and gutter and inst�ll a 3 foot wide •
approach with 6 inch depth - Driveway width pius 6 feet times $15.75.
VERIFICATION OF FOUI\TDATIOti
Permits for construction will be issued a minimum of 24 hours from the time of application to allow ior proper
eeview of the proposed structure and of the construction site_
,�� C;er�ificate of Survey of the lot, sh�u�ing the (ocation of dle f�undation �>nee it has it ha5 been construc-��.i
=.�i°1 h� ruquired h�ii�re ��r���cedin�� «�ith tl�e framin��.
,.. , _ _,
c�ty of Fridley
AT TME TOP OF TME TWINS
i �
� �
� `v _.��_ COMMUNITY DEVEIOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
� . ;
� _ �"'1 � CITY MALL FRIOLE� SS132
�'"'"� � �'� 612-571-34b0
�U II�DiNG PERMIT
NUMB@N pEV O�TE PAGE OR
9t0-F/5 2�20/O1 � �
JOB ADDRESS 5587 East Danube Road NE
t LEGAL I.OT N0. BLOCK TRACT OR ADDITION
oescA. 1 1 Innsbruck North 2nd Addition
2 PROPEiiTY OWNER MAII ADORES$ 21C
Mike Modahl 5587 East Danube Road NE
J CONTRACTOR MAIL ADDRESS ZIP
Norling Exteirors Inc 341 79 Way NE, Fridley, MN 55432
a ARCHITECT OR OESIGNER MAIL AODRESS 21P
5 ENGINEER
8 USE OF BUILOING
Residential
7 CLASS OF WORK
MAII ADOFiESS
❑ NEW O ADDITION ❑ ALTERATION
B DESCRIBE WOFiK
Reside House & Garage; Aluminum Trim
9 CHANOE OF USE FROM
TO
21P
�] REPAIR
3i651
RECEIPT NO.
/� �
►pvnOVEO Br
SEE ATTACMED
SMEET
763-571-5950
PHONE LICENSE NO
612-518-2399
PMONE LICENSE NO.
PHONE LICENSE NO
D MOVE O REMOVE
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requ3.res that a weather
resistive barrier be placed over exterior sheathing to pro�.ect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their application gu�Ldelines. Call for inspection of wrap
before covering.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, NEATIN(3, ' rrc air �,�na�
VENTI�ATING OR AIF CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK Oii CONSTRUCTION tONING
AUTHORIZED IS NOT COMMENCED Vt(ITHIN 80 DAYS, OFi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTEfi WORK IS COMMENCED. NO. DW4G. UNITS
1 MEREBY CERTIFY TMAT I MAVE READ AND EXAMINEO THIS APPLICA710N 1
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION
AND OROINANCES GOVERNING THIS TYPE Of WORK WILI BE COMPLIEO
WITM WHETHER SPECIFIEO MEREIN OR NOT. TME GRANTING OF A PERMIT �13 fOOO
DOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CANCEL THE pEpMl7 fEE
PROVISIONS OF ANV OTMER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR 7ME PERFORMANCE Of CONSTRUCTION �L23.ZS
\ / n �-, . s, .., ....�,.., «<
�� �is - V��f�
TUaE OF CON'aACTOA OR AUTMOpi2E0
Lice:
iOATEi �
�
io��E� r
FT
STA�LS
IUP OCCUPANCV�OAO
CU FT.
FSTREET PARKING
IGARAGES
IRTAX
$6.50
r�ire 5 '
TOTA� F
5.00 $2 .75
_RL IDATED T 5 IS VOl
$13.00
�&RMIT
ir.
N� � � Effective 1/1/2001
ADDN (] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Constn�ction Address: ��
Legal Description:
Owner Name & Address
Contractor. r � �
��
o�
fi �r/
P-��
� � 3�JmP �rs a�o�eTel. # �� ?�.$�/° S^�.�U
n � , MN LICENSE# �°O�%����
Te1. # �/og -S/� �� �9'
Attach to this application, a Certficate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type:��ia�� � ��u�-e� Y�-- �� � Estimated Cost: $ /�3, ° ° ° � ° `�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � �d � e / APPLICANT: ^ Tel. # 6�� —�/� °'� 94
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$��-3 �S� Fee Schedule on Reverse Side
$ 1�� Ov .001 of Permit Valuation (1/10th%)
$ ,.�'�b $.50/$1,000 Valuation
$ $1150 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 [ ]
� �`�`�, %�
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pernuts 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 $500
$501 to $2,000
$2,�1 to $25,000
$25,001 to $50,000
$50,001 to $1�,0�
$100,001 to $500,000
$500,�1 to $1,000,0�
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 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 $1,0(}0
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $1Q0,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $SQO,OQO
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,Q00,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Altemate "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
Pemuts for consiruction 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 location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
- ,._,
0
0
O
N
.-i
�
lC
�
c
c�
�
c
O
a�
>
U
�
W
Z
�
H y
�W
V
~ W
ZD
> C
� Z
Za
J N
�
OW
V N
Z y
C3
W Z
=O
C �
aZ
z�
�a
ao
W Z
�a
Z
a�
�Q
o�
W
Z C'i
O�
H �
Q W
V �
J
a
z a
O a
N
�
�
Z
O
H
U
wW
a' Z
N
Z Q M
} �
o y lL'i
� �Z
� .? � �
C
� _ ��
,..i � M
�M'DN
U�ti�f
t�
� � �
^� �
`V '
� r
�� � �
. �� y� W
N � �
� �
W
� �
Z
¢ w o
m Z
� O 00
W
J
�
�
W
_
C�
N
W
Q
�
�
�
O
z
I--
�'
W
�
�
O
U
�
w
Q
�
N
W
J
F�-
0
�
�
�
� °
0
M
�
i
Q
ZN
G
a�
m
0
v 0 �
� z W c�0
� � J
'�
v �''j
N �
C C
O Ua�
i �
U �
d F-
2
��
� �
� l�.
CO �c �
= Z 0
o �
O � F�=- �
ZI-mtL
�
�
W
O
Z
N
�
a
2
m
�
Z
a�
�
�a
�
�
a�
m m
�
I�
� � ��� �
0 0 0 0
O O O N
� � � �
� U
E �
7 i �
m � � C
�
� � � �
� a� m c �
� C � � �
� � � 3 a��i
'� ,F,,, t'' a� o
� N++ � �
� V � v.�
��coa�� an
�. a� a �°- •- c
C U � � .Q' c0
0� lC � `-� d Q'
.a ` N N N
��Q U' C7
N
N
Q
W �
C
� °
� �
C
� O
U
N `
C7 a
Y
U
Q
m
Z
�
H
N
v �
O
O �
�
+_� O
a� c°�i
� c
� a
L Q
� O
� �
� �
a� �
L p
O �
Q �
c �
•� N C
� � c0
� O tn
� V v
O �, c6
3 "'
y U �
� � � �
-� - a�
L �
� �
�= 3 s �
�a�+-c
U y
0. � � �
�
�
'� C� 'a i
����
'r'' �'j d CO
t�. � � � �
�a '� -� �
a .� c 'a
NY � Q
a� `o c �a
,�C ?� .O N
� N L
E �•>+�
�o�,c
� � ��
a�
� o c �
L �� y
� �d m N
c
� � a� o
. t1D t +,
i � �'' �
� � o �
� :� an �'
� � �C �
�.
I- N i i
o��
�
Efl 64
Y
O
�
O
N
U
C
co
+�+ ¢
y O
3
G 7
��
co
'` o
d o
� �
N
t� �
O�iO
�
�
'� W
� �
N Q
� �
f�
� o
'� �
� �
�U o
�
� � a�
� � �
I `� �
ry C
�C, �� LL
\
�
J
¢ � pJ F-
� �
N
�
co
� 0
c
�� QO
� '
0
� (�� �
\ �4 �
O �1I
� \y
�
z
� c
CD
S cn
i
2
�
�
O
n
�
�
W
W
LL
z
0
U
w
�
�
Z
w
�
m
v
a�
>
0
Q
Q.
Q
�l t1�
°�
� � �
„ � � �
� �
�� � ��
� a ��
O � �
a� � '��' �
� � �
>+ 3
� O
:O �
N
�a a
C �
� a
V �
� .0
Q C
O
� �
c° E
c �
U C
` .O
m �'
� N
o '�
`a a
C
U a�i
� �
d 3
: a�ea :�(g pau6ig
�O� JN11�3H
aqu�saa :SNOIlbRl31'ld
ad�(1 ui �a;aweia � y�6ua� }} �yBiaH �o��auuo� �uan E# a�uei�ddy
ad�(1 w �a�aweia }} y�6ua� �} �y6iaH �o��auuo� �uan Z# a�uei�ddy
ad�(1 ui �a�aweia �} y�6ua� �} �y6iaH �o}�auuo� }uan �# a�uei�ddy
say�ui �a;aweia �y6iaH �uan ad�(1 }uan uowwo�
3�d�1 n�8 le�ol sa�uei�ddy �e;ol
}eN �o pa�sissy ue� }ndu� �l8 ad�l £# �uei�ddy
�eN �o pa}sissy ue� �ndul f118 ad�l Z# �uei�ddy
�eN �o pa}sissy ue,� �ndul f118 ad�l �# a�uei�ddy
uo�euuo�u� �o;aauuo�;uan pue;uan uowwo�/azig pue a 1 a�uei� d
( ) oN ( ) sa� •sapo� �ua�n� �ad se ��a�e�edas
pa�uan pue �uan uowwo� ay� wo�} panowa� uaaq sey a�uei�dde ue
. �a}�e �f�}�a�o� pa��e�sw pue pazis s�o��auuo� }uan pue �uan uowwo� ay� s�
() oN () sa� •sa�uegdde }�e�p �em�eu pue pa�sisse ue� �o� sa�qe16ui�uan
a�ewn� �e��ua� � tio6a�e� yWy�-y�y apnpui saop siyl •suoi�e��i�ads
s,�am}�e�nuew pue sapo� �uaLn� ay� s}aaw pue /(�qwasse pa�si� e si }�
}ey} saguan �(qa�ay pau6is�apun a�.�} `wa;s s ui;uan nnau e ui���sui uayM
() oN () saA •suoi�e���ads s�a�n}�e�nuew pue sapo� �ua�n� ay� �aaw ol
Palle�sui pue paz�s aq ��inn }� ��e uoqsnqwo� nneu e ���sui o� pa�inba� ua�
( ) oN ( ) sa� •suoi�e���ads s,�am�e}nuew pue
sapo� �ua�n� ay� �aaw o� pa��e�sui pue paz�s si �ie uoi�snqwo� u�;sixa a�
() oN () sa� •sa�uei�dde }}e�p �e�n�eu pue pa�sisse
ue} �o� sa�qel 6w�uan a�ewn� �e��ua� � tio6a�e� ywy�-y�y apn��ui
saop siyl •suoi�e��}ioads s,�am}�e,�nuew pue sapo� �ua�n� ay} s�aaw pue
�(�qwasse pa�si� e si }�un �uawa�e�da� ay� �ey� sa�uan os�e pau6is�apun ayl
O oN O sa� •uoi�ewuua� pue sMOq�a �o �aqwnu `y�6ua� `6wz�s 6uipnpui suoi�e��}i�ads
�a�n�e�nuew pue sapo� �uaLn� ��e s;aaw pue �nd�i�se�d si wa�s�(s 6ui�uan ayl
() oN () sa� •pa�mba� a�aynn paddo�sa��} pue pa}�oddns �(�a�n�as si pue
'suoi}�ru�sqo 'uoi�e�oua�ap `�sru wo�} aa�} si pue pawwexa uaaq sey 6ui}uan
ay� }ey� sa�uan �(qa�ay pau6is�apun ay� `a�ue�n; ur�s�xa ue ui�e� a� uayM
NOIlV�I�Ia3A ald NOI1Sf18W0� aNb� a01�3NN0� 1N3A 1N3A NOWWO�
N
O
O
N
T
f0
�
c
ca
�
C
O
�
>
:�
U
�
W
Z
�
H N
Q W
J V
~ W
Z �
�o
�z
Z 4
N
J �
V N
C7 N
Z
Q ?
= 0
G �"'
Z p
Q Z
N O
Z �
Q.'
, �1
J Q
�> � �
� �a
z
<:y d o
��� � Q
� ��
. Z C3
� O �
. f. �
� W
ca.i �
J
a
z a
O a
�
�
�
z
�
F- .
U
ww
°- z
�
z j N
Qm
J � � p
� i � �
� � Z M
>
�.�g^
O � T�
� � .-.
�M'�1m0
U l�0 li v
�'
�
0
Q
m
�
'--�
W
J
�
C
W
x
v
N
W
Q
d'
I
��
�
�
�
�
z
�
�
�
W
n.
�
_��
,�
¢ �`F-
�
�w O
Cn U
� 0
C3 W
Z F"
� �
� �
m W
i
Q
'�
v
�
�
�
N
�
o �
0
�z°� oW
z
� N J y
� ln -p N
v � �
C)
� �
C G
O O
y U
U �
U " n"
. 4. F- 2
_
� �
C �
= Z
� � �
�
� � R
= Z ~
L
O � �
� � � i �
Zl�mti mm
J • �
Q o
� �
69 64 6F? d9� 69�
a�
a °o °o °o °o °o
� o 0 0 0 �ci
M � � � N
� � � � �
� U
i �
� i r.
m � v.�_ C
3 °'
Y � �
�N m C N
� � s R
C
� � � 3 a�Q'i
o � � � �
a�
� � ' � c
� +.+ N
� U � Z �
� � ca N � CO
Q� .
:. °' � tn �- cca
d cvC�"a. �
,� � � tn tn
�
� ti ¢ C7 C7
i,
�
N
�a
C7
�
N
N
N
�
¢
uo
C
C
O
�
c
0
U
Q
�
C C
_ ce
LN y � �
� �
YC,�jw `�
O >, � \
3 � '~
y U � ,
t a� .� �. � �
'� L = d
a„ r L
" Q t � O \
.►. = fC U �
� � � -� � �
� V � � �
a C L �
fQ '� �
i
� �U '� � .
c � � ca � I
� U � O p ,�
U � � 'a''
'o.y.�,� �
�a 'C c�a a .f
� O C cC
Y 3 p N
� _ N L
� R � C
>+ O 0 •—
� � mv �
�°c':
i �� y , �
c
c � m �
pp i � O
pp L :�:
i � a"I �
� a o c
C N y �
� � � N
N � ,C �
�..
►-- N i i
O
�' P
�
: �
� �
Y
U
m
Z
�
(/J Y
J �C O
� O '�i
p � O
N � U
� C C
�
Q � � o.
� 'a , a
a b ¢
`Q �'�
O
�- ° c �
� � \ R
N � � i.
� > �t� O
� O 0� �
O � � N
Q � V �
a�
�
�
'c W
� w
� �
� �
d Q
+. F-
� O
1
.�
,
���
i
� °� �
a �
� �
Z
¢ � �k
W p� X
= U� LL
_
�
O
O
n
�
�
w
w
�
z
�
H
U
W
�
�
Z
W
�
�
�
�
ca
�
�
C
L.L.
�
a
0
C
s
t]0
�
O
�
�
a�
>
O
Q
Q
Q
�
0
�
3
�
� �
�+ 3
� o
a �
N �-'
cv ��..
c �
:� a
N �
U C
cv .
Q .c
O
� 'L3
+� �
C �
c ..
ca �-
U C
y O
� N
C •N
O �
� �
c �-
o c
U 4?
� �
'�
¢ 3
�.
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED .
C:(�MMnN V NT�VFNT C(�NNFCTOR AND C`OMBl1STION AIR VFRIFICATI(�N
When � la .ine an _xic ine f�� ranr_P, the undersigned hereby veri�es that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The PYi� �ngsomh�,st�on a�r is sized and installed to meet the current codes
and manufacturers specifications.
Whe� �equl�ed to install a nPw remb�stien air�it will be sized and installed
to meet the cuRent codes and manufacturers specifications. •
Whe11 inctallin8 a npw venti ��v�, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers ,
specifications. This does inGude AGA-GAMA Category I Central Fumace
Ventirig Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separate�y as per current codes.
Yes( ) No( )
Yes ( ) No ( )
Yes() No()
Yes ( ) No ( )
Yes( ) No( )
Yes( )No( )
! • • . � ' � - . � • ' • 11 �� • � ' � . � • ' � • � / ' M • � • �11 . • �
Appliance #1 Type ` BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input � Fan Assisted or Nat
Total Appliances Total Btu Input �
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length • ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
� 1c ���
A � '
� �ri � � � � ,o/ � ,� � �/� , v
�1 ��� �
• - • /�1///./'.�!�L _�.� ` � >, � - " � J
�- �-
Building MECHANICAL Permit No.:� l��'L,►�,
Inspections RESIDENTIAL APPLICATION Received By;�,�
763-572-3604 eITY OF FRIDLEY n
°a����.�2��
763-502-4977 FAX �cTTVE i-1-os ��
DATE I �— l+-i — � �. YOUR E- ADDRESS �- b%i e c�.-1—i �l c� � r- c� �. Go ry1
srrE ann�ss S� g"T � c� S t a n� b�.� a cd.� '
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY N�: �', �h �` l e p�L cd.1•� �
TENANT annxESS: SS �'I �, s+ D c.�n �,, ti�� a cr�_� r' � d l e� STATEs�I N ZIP SS'� 3�2..
PHONE: � (� �i S'9 I S�i �O
CONTRACTOR co�,�rrYrr.�: EC��+ Z3�+-h�I H-ec_+-;.,q
NOTE:
SEPARATE CITY CONTACT PERSON: ��-'fi' �e C�► o c.� �i n c�r c�
LICENSES ARE STATE LICENSE # EXP DATE
REQUIRED FOR GAS ADDRESS: � dl 0�-I � D o!' w' o u d S 4- N W �I1
ANDHVAC. '� CITYU �-KG ro�� STA'1'E `� �Sb t �
SUBNIIT COPY OF BOND pHO�•r� �°° 3�{ 3�-1 1 l�1 +� F� i b 3 �-{ 3�} '{ Z e, S
AND INSiJRANCE
PERNIIT T'YPE � SINGLE FAMQ�Y � TWO FAMII,Y ❑ TOWNHOUSE
TYPE OF WORK: ��W ���'ACEMENT O ALTERA'PION/REMODEL
DETAILED DESCRIPTION OF WORK IZ� P L� e. -�-u r n e�L -�
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the tot�l cost up to $500.011, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
OR
Labor cost under $300 =$15.00. Labor cost betw�n $300 to $500 = cost of labor x.OS =
FOR P120JECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WI�RE NOTED. FIXT[JRES: (INDICATE TOTAL
NUMBER OF EACH BELOR� (` r
Equipment Installed MFG: �-O m t-� r-4-r..�.k e, r MODEL: C°� �� � O Z S�/ 2C SIZEJBTU ����
MFG: MODEL: SIZE/BTU
MFG: MODEL: g�g�
_A/C $25.00 FII2EPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
AIlt TO AIIt EXCHANGEER $IS FIItEPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 I FURNACE $35.00 GAS UNTf HTR $10.00
CHIIVINEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 _GAS PIPING $10.00 VENTII.ATOR $15.00
PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500
Permit Fee $ 3 � . — Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of iixtures @ $15.00 x $15.00 = $
TOTAL DLTE $ 3 S. Sb OR Number of fixtures @$25.00 x$25.00 =$
Number of fixtures (a� $35.00 x $35.OQ = $
State Surcharge = $ .50
A'IINIlVIUM $15.50 MINIMUM $15.50 Tota1= $
THIS IS AN APPLICAITON FOR A PERMIT-NOT VAI.ID UNTII, PROCESSED
I hereby apply for a mechanical peimit and I acl�owledge that the infotmatioa above is complete and accurate; that the work will be in conformance with the ordinances
and codes of the City of Fridley and with the Minnesota Coastruction Codes; that I undeistand this ie not a peimit but only an application for a peimit and work ie not to
start without a peimit; that the work will be in a rdance with the approved p�n m the of all work which requues review and approval of plana.
SIGNATURE OF APPLICANT � PRINT NAME P�Z'� �lGc, cu,�,��DATE/a -i 3-
APPROVED BY DATE
PLEASE NOTE: SEPARATE PERMITS ARE REQUIItID FOR BUILDING, ELECTRICAL AND MECI3pNIC,AI, WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977