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City of Fridley SUBJECT � .
AT THE TOP OF THE TWINS g U I L D I N G P E R M I • ��0�� \
i �
� � RECEIPT NO.
� ; L ___��_ COMMUNITY DEVELOPMENT DIV. ;
r � PROTECTIVE INSPECTION SEC.
i �
� ` �
�' /"'1 � CITY HALI FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
•"•� � ,'� 612-580-3450
910-F15 LF�2�73 � �
JOB ADDRESS
8112 aixmont Cixcle N
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 1 Bourdeaux's Spring Brook Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Castle Homes Incoroporated 7613 Central Avenue N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Dwelling
7 CLASS OF WORK
� NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBEWORK New 24' x 40' Dwelling & 22' x 24' Garage
8 CHANGE OF USE FROM TO
STIPULATIONS provide a hard surface dr.ivewaq. Provide a verifying aurvey before
capping. Correcir bath option and linen cloaet on either plan.
SEWER LOCATION: 123' E. of Manhole WATER I,OCATION: 11' W. of Sewer
Wye Ele�ation: 846.76 Top of Footing: 850.50 Minimum
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, �OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-�. �.O�FO Z�S��FOS TOtB�.
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�.9�9OS $ 9.95
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHE TATE OR LOC _L LAW REGULATING CON-
ST ION THE PERF ANCE OF C RUCTIO . � $�FS.00 $�L]S.00
PLAN CHECK FEE TOTAL FEE
�C1 � �--�� 332.95 �
� SIG , UREOF NTRACTOR(�RAUTHORIZEOAGENt IDATEI V�jHEN.PROPERLY VALIDA�TED THIS YO�R PERMIT.•
1
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI BLDG INSP pqTE s
•
�a� � � ;, �
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�
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AP.FI�IG�TIPJ�1 �Q� FtE�IDE�t�'��.�,� ��'T�R,A►'��QI�,
�k� �1AA�T�0�1 ��1ILDT�t� ��1$NdTT
�.r�T� 4� �+����.r�Y s M�1V1�iF�C1TA�
�� � �r� :�. ��� � - � ��' . • u - .
o� o
ADD�tESS: ,A�r�s3: 7613 Old Central Ave Fridley
�i�b�, � A � � :��'�'$� ��`t�. �`�-, � �� �_�S �, � � ,�... �,��
- a n �•w�s � �n1 � • � ! i e
�z 2 BLOCN� 1 d���IOPT�Bourdeaux's Sprin� Brook Add
i � � �+ 2 �. �
sG�R LOT: �� ZOT:� x , SETBACRg �� SIDEY�l,ItD�
.���,� �fi�r.+� #�, ��+�i�i,a Certificates of SuxveY of Lqt a�d prop��ed
�ui.��� �+�cati,o�t� dr� c� #�se Certificates,
�
A��C�IPT�ON OF BUIL�ING
�aa � [ie� Aa : S ingle Family
House �
�� �__,_c�! �#� = 4� ��t = , � ,�
��Y°" �X � ° � �' � : - �' �`
S��a�c� k'�e�� Cu�i� �'��� �t; '` =� q
� � , -�.
Gara,,,ge �,� Fraut: 22 Depth: 24 Heights , `;`,�
�qua��a �get ; ,� - '° Cubic Feet ; '� �` ' � ' : - -, �
�� oi Coa�truc�Gi.ou; Conventional Eati.m,a�ed Costt: S 31,000:�0
. �,.��,. ,.
�pp q�A� 8 1/ 1 7 � ��� �� ' �f ��.
pbM� � � �r � . w.11ll�l � �.i / f i� � s s � t: �. � �� ' �
/
� ttsR��rz�i.�a�d hereby �ea a�l�cativrt for, a pe�it fa� th� wo�ck he�reiu
����i� a8teei.n$ to do a�� ���rk � att�.at accordance witt� the �i,ty' p�'
$�.d�.�i' ��'+d�s�es �d �l�a� A� fi�e Degarl�iea� Af BuiL�d�.r�e, �ti i�exeby
dl��.a.�et� � al�. �:he� �Eacts � ��re�etitati.a�s �tated � �is ��►l�,catia�t
��+ � aa�d apxrectt .
�,�; � eT�+w�I1 q���+ .
v� �. � � �,., � s ...�sn�e �DiTalrr►.�.vfAs+ •
Davi . Rotter �
�R�e �t�tv�� B#ds Fos At1d�(t�oaal Ia�ost�atie►�..j ' �-r 1,, ��.�� �� k
� � �� ��% �� �� ��� � � - � a � -
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- _�. .' i^ ,�� � - - . ..
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BUT�A�NG P�RMIT F�� �CH�DULE
' ������ �. The IAepecto� pf �u�ldings s�al�, befoxe �esuiag pes�nit� fo� the
������OA o� a�y bu�lding �� e�ructure, o� for any addition to any p�ist�xig
��i�d?�i� ox struC�ure, or fo� any alteration or xe�airs to any ex���i�g
��������� ox st�c�uxe, upo�n �pp�i�ation thexef�se, require the paymeat by �hs
����i��t €p� such p�r�nit o� �ees t:o the a�taunt heaein below sat �ar�h �d ��
��� ��x h�x�in p�c�v#.ded �Q�wi� �
UN��'pRM �U�LIITNG CODEs Type 1�, 2� 4-$2,15 for eaeh a�e thous�d cubic
�e��' p� fr�actipn th�7cea�, f.a st�c� cubical cos��nts. �pe 3& 5-$1,85 �oar
� '(� Oi'1,8{ �01188IIt� ���-C �@�� w , .
A�D�TIU�1A� INFI3�IAT�ON
Fp� �t� pu�ppee of �aanpuC� �ees for building penaits, the cubical contents
oi atty building or additioa, i� determined by mul��,ply�.n� the ground area
�oye�� $xpm a poi�tt s�x fC) ine�ies below the flaor line 4� the basement
�+ fi�.►e ���.1ar �o the average heights of the uppez surface or to the averag�A
�3,�� �� �e �001€ ��face of the ueain gab�e pf� a pi�ched xoof,
��i;rs o�c al��r�t�ou� � aa existin� s�t�a�reF �fie fee shall. be �� t�he
�x��,� o� $3.OU ,pe�r e�h f�,ve h�dsed dollar� ($300pf?8) � f���.an therso� �x�
i�� c�s� o� al� �a�c���ed wo�k.
I� � ca�se sh��l ��� �� for a�tg pea�it as se� fo� �a Sa��ion 2 be
� �l�A $3.t�i,
'
V�i���JATiQjai 0� �tS�INDATI�N
�Tp�s �'t�m�.ts �Qr �cr�s�u�tioa� wi�l be i$sued a�3�� oi� �4 hc�urs ��am the
l:� o� �a�+plicat�.on, �a ���aw �au prage� review of �ha pxopo�ad s�xu�tuxe atid
�� �e �st�uetion &ite.
' �, C���i�$ Sux��y o� � ls� �aq�ia$ i� �cscat3� v� thQ $oundati�t, Qmce �t
�t�aB �� ��s�t.+���, wiii #� sec,�uis�d bef�re aroceedin� w��h the fr�i�g.
.
C��tT'�F���1i'£ t�F l�£�PAN��f
�gap�i��ia�a ��� � G���.�3.�at.Q �1 Uccu�ancy sk�all be mad� Ce� (1Q) �ay�s pxior
�o �h� ��� Aac c���up�g oi ac►y �c�ure faz whicl� a bui.ld�.n� peznti� ha� besr►
issped; �►id s�3.$ s���u� �i�a2� �sot 6e used a� occup�ed matil a�m�t�.ficate
af O��upaz��y h� bes� �.san�d,
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V'��ea:7erstr��s A.S.H.V.E. Censtruction No. Insulation
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SUBJECT P 6t.
City of Fridley , 14361 �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
;,
COMMUNITY DEVELOPMENT DIV. ECEIPT NO.
� �
' � �. ----•-
r � � PROTECTIVE INSPECTION SEC.
1 = �
, /��'1 � CITY HALL FRIDLEV 5543Z NUMBER REV. DATE PAGE OF APPROVED BY
�""� � ,�� 612-560-3450
910-F15 9/14/77 � �
JOB ADDRESS g112 Faixmont Circle N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 1 Bourdeawc's Spring Brook SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Gary W. Velishek 8112 Fairmont Circle N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
R�sidential
7 CLASS OF WORK
❑ NEW ❑ ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct fireplace
9 CHANGE QF USE FROM TO
STI PU LATION S
Contractor to apply for license within 10 days.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATIN(3, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. MdSOT1iI7
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZEO IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-�-
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX .
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHEfi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S2�OOO �`�..00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � S�-2•OO
PLAN CHECK FEE TOTAL FEE
$13.00
SIGNATUREOFCONTRACTORORAUTHORI2EDA6ENT IDATEI WHEN PRO RLY VALIDATED THIS IS YOUR PERMIT
e� ' � � - f c%;�-�7 � � � _ -,�� ��'��2J �`�� -
SIGNATUREfi OWNERUFOWNERBUILDERI IDATtI BLDG WSP DATE
�
CITY OF FRIDLEY
' APPLICATIO�J FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWt7�SR: �i••� (�° . �l 2,L � S� m� BUILDER: �ov-
Address: �i�'d. �i91t�v`�i���l ('t�c-�t �ddress:
Te ]. . No .
No.: � � � � Street: a�,�Uw.� b�L
. I,pq+; BLOCY.: _�_ ADAITION : CSl2,D� U �S ��
CORNER LOT: INSIDE LOT: � S;sTB�CKs ' SIDEYARDS:
Applicant attach 'to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
��SpN ���/�L1�C,� Front: Depth: � � Height:
� S uare Feet: Cubic Feet:
q
Front: Depthe Height:
' Square Feet: Cubic Feet:
Type o€ Construction: �J� Estimated Cost: $�O�C9 �
7.b Be Completed: ��1CD • Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby ma.kes application for a permit for the work herein
specified, agreeing to do all work in strict acc�rdance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side far additional in£ormation.
DATE: � - � � - % 7 SIGNATURE: � 1.�7 . � �"�
Stipulations:
���.Ga
/�
��,��o-o
����lGS �J � d�`-.�
` �'��--
��r.� G ju; t
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� �� �
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Os�
BUILDIt�6 PER��IIT FEr SCiiFDULE
SECTION 2. The Inspector of Buildiiu,�s shall, before issuing permits for the erection
of any bui].ding or structure, or for any addition to any existing building or structure,
or for any alteration or repairs to any existing building or structure, u�on 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 pr.ovided to-wit:
NEW CONSTRUCTION: Single I'amily Homes anci Garages: $4.00/1,000 cubic feeti..
PLAtJ Ci1�CY.: 25 percent of building peiznit fee. .
DRIVEWAY DEPI�SSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and ,
� gutter only; Driveway width plus 6 feet x$11.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
� 6 inch depth; Driveway width plus 6 feet Y$15.40
ADDITIONAL INFOR�IATION.
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 f�:om a
point six (6) inches below the floor line of the basement or th� cellar to the
average heights of the upper surface or to the average height af the roof surface
of the riain gable of a pitched roof.
For repairs or alterations to an existing structure, the iee 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 plus $.50 state surcharge.
_yERIFICATION OF FOUNDATI(1(J
NOTE: Permits �or construction will be issued a minimum of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construciion site. .
A Certificate of Survey of the lot, showing the location of the fo�andation once it
has be�n constructed will be required before proceedir.g with �he framing.
CtRTIFICATE OF �CCUPANCY
.,:j -
Application for a Certif3::cate of Occupancy shall be made ten (1G) days prior to the
use or occupancy of any structure for which a builclUng permit has been issued; and
said structure s}iall not be used or occupied until a Certificate of Occupancy has
been issued. '
� ��� ��
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` Septenber 14,1977
�
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8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
Custcan Pools Inc.
701 Excelsior Avenue East
Hoplcins, Mn. 55343
TELEPHONE ( 812)571-3450
Re: Swimming Fool Construction at 8112 Fairmont Circle N.E.
Dear S3rs:
This letter is to make cles.r this departments requirements for the swiuQning
pool construction at the above address.
1.
2.
3.
4.
5.
6.
7.
8.
As indicated, two (2) �skimmers approved by the 1�ational Sanitation
Foundation will be provided. .
As indicated, three (3) inlets of approved design for fresh and/or
repurified water will be provid�d. •
As indicated, a main drain of approved construction will be provided.
The filter and pump shall be approved by the N.S.F. and be of
sufficient capacity to provide a minimiun turnover of at least tw� (2)
times in 24 hours. This department recoumaends a turnover rate of
6-8 hours. �
A deck of at least three (3� feet wide, measured fr�n the pool water's
edge, shall be pro��ided which extends completely around all private
residential pools. Above ground private residential pools may be
provided with decking of a minimum size of 4 feet by 4 feet at pool
entry points and provided that such decking has the approval of tl:e
Gity. �
The diving area will be acceptable provided there is n,o overhead
obstructiono
Fencing or other effective means including but not limitea to walls
or buildings, acceptable to the.Ca..ty, shall be provided to positively
control all access to public and,private residential swimmi.ng pools.
Fencing shall meet the following-�riteria:
(a) The fencing shall nrevent �he entrance of children and be without
hand or foot holds that woulc� enable a person to climb over it.
(b) The fenci.ng sliall be at least 6 feet high and entrances shall be
equip�ed with self-closing and self-latching gates capable of
being lockEd.
(c) Self-closing and self-latching shall be placed at the top
• of the gate or otherwise inaccessible to small children.
(d) The opening between the bottom of the fence and the ground or
other surface shall be not more than four inci:es.
An automatic chlorinator should be pravided with a suitable test kit.
�
Custom Pools Inc.
September 14, 1977
Page 2
9. All electrical and pltunbing installations shall be inspected and
approved by the City Inspection,Department.
10. All electrical lines must be i0-20 feet or more.away from the pool
surf ace . •
11. The pool fill spout must be air gapped or protected by a vacuum
breaker.
12. Suitable safety equipment to include but not limited to a ring buoy
and rope that is 1� times the�pool diameter, and shepherds crook pole
must be provided and maintained with the pool at all times.
Furthermore, these and any other requirements must meet the provisions of
the Fridley City Code, 5ection 115, Swi.mming Pools. The building permit
is approved contingent on fina.l inspections and approval by the City.
If any questions or problems arise from this lette�, please feel free to
contact me at 571-3450, ext. 170.
Sincerely,
�
STEVEN J. OLSON
Environmental Officer
SJO/mh •
CCz Gary Velishek
8112 Fairmont Circle N.E,
9
6
24" CL�AtdANC� �
t".: u�VE FI�'��� `
°A' FILTER�,� �
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CAATALG� MODEL FILT/E�t3/t��kp�A �IJMnP
Isl�t�G�� �Vii1�ER �JVs 1-1�� �O��i"o
24�35-216 6�ft5Q-16 1.4 •1/2
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S�RUC�U�AI. FOAP�I SKID �- ,T
SELECTIQN CF�ART
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1980 71,Bc� 15,8�C0 19,80D �
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23d0 15, � ��� . 6,400
2fl2J 16a9�0 22,Sc�:O 28,20�
3720 22,320 2�,760 3i,2a0 � 24"� 41° a 1/2 I
GE(3ERAL NOTES:
Yhe Ptlter tanks end aump L unitrol valve a�� �FP*a�'ed
1. Flau� rates SHoam e►r �asod an 15 6nE l0 C.P.M. Dcr gq, tt. by the �lational Sanite4lon Focndat9on.
of Otiter aroa. Nowcvar� rateA mey vary from 1U to 2U G.P.c'.
per sq. ft. as desircd. These filters are covered by tne folla+tng paicnts:
Austrolia Pat. ho. 215.J46: Canada Pat. I�o. i�'_,"i:':
s m. r.9amm�so sa ua:x �e. • Great IiritLlln P;.t. tlo. )34,)97; rtexieo pat. ►��. )9�iJ7;
'eav�, r`••°z•� a�a°�n`ir�.�ir� m SOUth Afrlte Pat. i:0. 11UU/G5.
:.2::�i :m� e..'::.�sCa use mamavL
a.� ca �vs..++. w r.s a.r.
r..a �:r.�u�ra.
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SP-1082
FOR CONCRETE and
GUNITE POOLS
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PERFORATED
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SP-1084 ,;
FOR VINYL, F. G., STEEL, ��4` � ��
ALUMINUM and WOOD
POOLS �` ° .�"`f :
� �QIUSTABtE �
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I1.3is' � O�SNET � - �
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MWNiING . � �%E
FLANGE FOR � ��
WOOD PoOL _ . _ .
-r �_'J/!..
I�—o-yis. �--8'� F_<-1 �e-sne'--I . u-vs• '' •-.j Ti
y 2'STMAIGr1T CIVE THREAD I 2'STRL�CIR PiPE TtltEAO
� � brY�9 �'f���{'kr� �� }3 �� �� �j��' ��'}g'� ? aF �� �..� ��. '4 � '��i����.�' i��yv� � E� �� F ` �
$'7,'±�`,,��Ct�� ��`€,"���.�" ����:���`� �ir`�T^�� ` }��'��ir':3 r�! -�� y�i/.� ,�, ��7i��i�.��.t��-�w'`�� �
. � � �, ,4 � �,. `wT ' �z _
SP-1082 2" Cycolac Body, adjustable cover SP-1084 2" Same as SP-1082, but with 8
collar. Tamper-proof cover, basket, throat, Cycolac �ace rim (whi
SP-1082-1 �'/Z" weir, Flo-control slide plate. SP-1084-1 1'/z�� mount ng flange for wood pco�
�P-1082-iR �'/2" Same as SP-1082-1, but with 9�/e" ��� Same as SP-1084-1, but with 9
diameter ROUND cover (not illust.) SP-1084-1 R ��2 dfameter ROUlVD cover (not ili�
Standard screws are !or 3/ 16�� max. waU tr,ic
SP-1082-1, SP-1084-1 have 1%"pump outletand 2"equalizer/main drain outlet SP-1085 Wide Track Auto-Skim illustr�
�?�_rt� �- ������ �, separate page insert — No. 301A)-75.
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r:iJ��i ��:��9�JY �a��e.D`ht%� �i:`�� +1'03M$d�%i� %��6�ad5:o3�§f��l�% �� i _, °��.�,:�fss"]� .?fl _ �.;;�;3 '.3 ;Vr: t s 'i�`�.
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r � �i'�;'i ��GiY �i�z �'� �`.ttf.39los1t6.,c2Fiy' 3 e���t �. c�;,ilfJ.. 9a'!��`�i:��,.,n i.�'nkqd � � t ..u�t'!u9Sid+ •r �.a�.�i ..., ..�z �� �; � , � `-- >'.
4. � . . _ -
J� � � � ��..._ � � � �
... .. . . u.. .. ..� .. ...._.. . ... . .__ . ..._ . . _.
sue�ecr PERMIT
City of Fridley � 438'7 '
AT THE TOP OF THE NlINS g U I L D I N G P E R M i T
�
� � ECEIPT NO.
COMMUNITY DEVELOPMENT DIV. 1
r � v ; PROTECTIVE INSPECTION SEC. �
�` � ��"1 � CITY HALL FRIDLEY 55432 NUMBER REV. OATE PAGE OF APPROVED BY /
"•"'� � •�� 812-580-3450
910-F15 9/23/77 � �
JOB ADDRESS g112 Faira�nt Cixcle N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 1 Bourdeaux's 5pring Brook Addn. SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Gary V�lishek 8112 Faimnont Circle N.E.
3 CONTRAGTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Custam Pools Inc. 701 Excelsior Avenue South 933-2255
4 ARCHITECT OR DESIOPIER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENfiINEER MAIL ADDRESS 21P PHONE LICENSE NO.
8 USE OF BUILDINCi
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct inground swi.�ing pool
9 CHANOEOFUSEFROM TO •
STrPULATIONS See stipulations on letter dated September 14, 1977 from
Environmental Officer
yVARNl�G
SEPE�i1�TE R�111`� A'E�J�REt3 �'OR WI�ING, Betase4KEi�ElECTRIG!GAS`Etc.
HEATI(�G* PLUMBIN� A�1D �IGi�S. TE��N
REQUtRED `B� LAr►V
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBINO, HEATINQ, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OFi IF CONSTRUCTION
OR WORK IS SUSPENDED OH 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 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHEH SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S5� OOO $2. SO
DOES N PRESUME TO CiIVE AUTHO Y TO VIOLATE OF CANCEL THE pERMIT FEE SAC CHARGE
PROVI OF ANY OTHER TATE LOCAL LAW REGULATING CON-
STRU ION R THE PERFO NC O NSTRUCTION. � $30.00
PLAN CHECKFEE TOTALFEE
��'° $32.50
GNATUREOFCONTRACTORORAUTHORI2EDA6ENT IDnrEt WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
s
SI6NATUREOFOWNERUFOWNERBUILDERI IDATEI o BLDG.WSP � DATE
HOUSE HEATING TEST RECORD D204&8
ADDRE55 8112 Fairmont C3� APT. FLOOR CITY SUBURB Fridley
OCCUPANT �art Vel.ishek. ow�tER
HEAT LOSS DATE HTG. INST. GAS C0. METER BADGE
SOLD BY INSTALLED BY edgwick 23'L rig
Eleetrical Work By Gas Line By
TYPE OF HEAT GA FA X HW STEAM SPACE HTR.
GAS DESIGN
MAKE �ITiI li �mson MAKE OF BURNER _
Mcdel 1117-10 — 5 Modol
$�►�o� '731�81� Max. BTU Rating—
INPUT 100 � OOOBtu/hr. MAKE OF FURNACE
Model
CONTROLS
THERMOSTAX:Iri260 Heat Plug
Valve M.H. V�OOc
Limir Rnh�'haw RFT, 75(l
Limit Setting �n n� f'
Fa� Setting �n�F x l ��°f
Pilot Type �!A��nl [?
Pilot Make –
UNIT HTR. OTHER
CONVERSION
Vent Size 5 et
KIND OF LINER alum SIZE 641 NONE
Druh Hood vert i ca1 Regularor
Filters Size �-6X�_Mumber �-
Chimney Location Inside j�es Outside
Chimney Construetion me'�a_1- bestos
Pilot Model Smoke Bomb Wiring
Pilot Timing � n GF? �' - Draft Ok Test Tag �eS
L.W. Cut Off Door Prassure Lightirtg Inst. �ZeS
Pressure �- n��w�'- Percent C0 8- �� Date Tested 5�� 1-�%Z:
Input CFH Q �1 2
� Pereent OZ �.-�� Company Testing �
Stack Temp. � F n�'f' Percant CO , n- n n� Name of Tester
Fo�m 235
l
• �'. !s.
• �� CITY OF FRIDLEY .
' APPLICATIOIJ �OR RESIDENTIAL Bl1ILDING PERt�1ITS
iNEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNFR: ���,ati U� I� L�� t� BUILDER: L. i.- ���., ;,��� c-� L.S �,L`�C
Address: � � � �- .�y�,�,`2, �r�a3�.�, '��2 Address: `�� t � �C � �S i �-`� ��� S �
. . Tel . No . y°,' R3 � � � � ��
No.: � 1 1 r'�-- Street: ��t`�—����.:t. ��i��2 4
LOT: BLOCY.: ADDITION:
GORPJER LOT: INSID� LOT: • S; TBACK: � SIDEYARDS:
Applicant attach �to this form Ztuo Certificates of Survey of Lot and proposed
building location drawn �n these Certificates. .
DESCRIPTION OF BUILDING
To Be Used As:
/riJ � /�p,.�.�✓J/ .
�� t a� �-\��i ��ront: i Depth: �' � Height:
square Feet: .�y -�aiSi�F�et: �d l� � (a ��0�.55
Front: Depth: Height:
5quare I'eet: Cubic Feet: '
Type of Construction: �f ��( Estimated Cost: $�dc�p �=�
7.b Be Completed: �� c��"( �5 �7 Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE RE�TERSE SIDE OF SHEET) � `,�
. . � GJ
The 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 rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information. �
DATE: �� -� l % SIGNATURE.
Stipulations : �, � � � � v.. � J � v� � �p
!
�b �D �� .
�..�
q � ?� .
/ 6��•� ` •
Y G
.f.�
BUILDI(J6 PER��IIT FEE SCiiFDULE
0
SECTION 2. The Inspector oE Builclir�gs shall, before issuing permits for the erection
of any buildiny or struct-ure, or for any additian to any exisL-ing builQing or stnicturc,
or for any alteration or repairs to any existing building or structure, upon application
therefore, require the payment by the applicant for such perniit of fees to the amount
herein,below se� forth and in the manner herein provided to-wit:
NEW CONSTRUCTION: Single I'amily iiomes and Garages: 54.00/1,000 cubic feet..
�LAN CH�CK: 25 percent of building permit fee.
DRIVL•'WAY DEPRESSIOt�: (Concrete C�rb SLreets Only)
Alternate A: Removal and replacement of concrete curb and .
' � gutter only; Driveway width plus 6 feet x$11.75
Alternate B: Removal. and replacement of concrete curb and
gutter and install a 3 foot wide approach with
� 6 inch deptti; Driveway width plus 6 feet x$15.40
ADDI T IONAL I NFOR�1 Tf�ION _
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 (G) inches below the floor line of the basemeni or th� cellar to the
average heights of the upper surface or to the average height of the roof surface
of the main gable of a pitched roof.
For rePairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost
of all propos ed wo rk .
In no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
VERIFICATIO� OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the time
of anplication 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 been constructed will be required before proceeding with the framing.
CtRTIFICAT� OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any sti-ucture for which a builcli ng permit has been issued; ar.d
said structure s}iall not be used or occupied until a Certificate of Occupancy has
been issued. �
. ->
NEW
ADDN
ALTER
tl
Ll
��
ConslructionAddress: _
Legal Description:
Owaer Name & Address:
,,,�Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECg AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Pernut Application
�
i v / �^
�-�' 6 l� �t9 I f� 11Z `� t � j 1� l(.f "° %"�i+ e�
_ ��
Effective 8/ 1 /95
� �- d�l /1� —'
Tel-� ^��-����
MN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with die proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length _ ) - Width `� Hgt/Ground � � Sq. Ft. / .�j 5
Coraer Lot [] Inside Lot [] Ft Yd Setirack Side Yard Setbacks
�'ype of Construction: ' � �; $
Approx. Completion Date:
(Cost on Back)
�rriveway Curb Cut Width Ne,eded: Ft. + 6 Ft = Ft x$ _$
DATE: — � � �l � APPLICANT: � � l � C Tel. # 7 (� � �p � �S
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
Iacense Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$
$
$
$
$
$
$
$
$
$
CITY USE ONLY
Fee Schedule on Revease Side
.001 of Permit Valuation (1/lOth%)
$.SO/$1,000 Valuation
$850 per SAC Unit
$5.00 (Sta1;e Licensed Re.sidential Coatra.ctors)
Alt "A" or Al� "B" Above
$450.00 Conservation Plan Review
Fee De�nmiaed bY Engineering
Agreemem Nec�sary [ ] Not Nar�;ssary [ ]
BUILDING PERMIT FEE SCHEDULE
The Chief Build.ing Official sha11, before issuing permits for the erection of any building or structurE, or for
any addition to any existing building or struc�.ure, 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
$2,001 to $25,000
$25,�1 t,o $50,000
$50,001 to $100,Q00
$100,001 to $500,000
$500,001 to $1,�0,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $S00 plus $2.75 far each additional $100 or
fraction thereof, to and including $2,(l00
$62.25 for first $2,000 plus $12.50 for each additional $1,Q00
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additionat $1,000
or fraction th�eof, to aad including $50,000
$574.75 far first $SO,OQO plus $6.25 for each additional
$1,000 or fradion thereof, to and inclnding $lOQ,000
$8$7.25 for fnst $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,�
$2887.25 for the fn� $500,000 pfis $4.25 for �ch addi6onal
$1,000 or frac;tion th�reof, to and inclading $1,000,000
$5012.25 for die first $1,000,� plus $2.75 for each additionai
$1,Oa0 or fraction ther�f �
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
Alternate °A" : Removal and replaceme� of c�rb and gutxer only - Driveway width plus 6 fcet times $13.50.
Alteinate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Drivevvay width plus 6 feet times $15.75.
VE1tIFICATION OF FOUNDATION
Peimits for coastruction will be issued a minimam of ?� houus from the time of application to allow for proper
review of the proposed structure and of the consiruction site.
A Ceitificate of Survey of the lot, showing the la�tion of the foundation once it has it has been constcucted
will be required before proce�ding with the framing.
City of Fridley 313 5 6
' , AT THE TOP OF TME TWINS � � I L D I N G P E R M i T RE
r
� �` .��� COMMUNITY OEVELOPMENT O�V �/�/
� V � PROTECTIVE INSPECTION SEC. e
r , ,
, � ,
� /'�'1 � CITY NALL FRIGLE� SS132 NUM�EN REV DATE pAGE OF AVPROVEO BY
�---��' �'' 612-571-3450 910�-F15 8/30/00 / /
JOB ADDRESS g112 Fairmont Circle NE
LOT NO. BLOCK TRACT OR AODITION SEE ATTACFIEO
� DESCR. 2 1 Bourdeaux's Spring Brook Addition SMEET
2 PROPERTY OWNER MAIL AODRES$ 21P PMONE
Gary Velishek 8112 Fairmont Circle NE 763-786-6113
3 CONTRACTOR MAILADORESS 21P PMONE LICENSENO
J Benson Construction Corp 7020 Walker St, St Louis Park MN 55426 95�-920-0717
d AFiCNITECT Oii DESIGNER MAIL AOORESS 21P PNONE LICENSE NO.
4740
5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO
8 USE
7 CIASS OF WORK
p NE{N O ADDITION O ALTERATION � REPAIR
8 DESCRIBE WORK
Reroof House & Garage (26
9 CHAN(3E Of USE FROM
ff
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED V�1ITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOEO OR ABANDONEO fOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO OWIG.
I HEREBY CERTIFY TMAT I HAVE READ ANO EXAMINED THIS APPLICA710N 1
ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yp��AT10N
ANO ORDINANCES GOVERNING TNIS TVPE OF WOpK WILL BE COMPI,IED
WITH WMETMER SPECIFIEO MEREIN OR NOT. TME GRANTING OF A PERMIT �2 � 272
DOES NOT PfiE$UME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME pERMIT FEE
PROVISIONS OF ANY OTMER STATE Oii LOCAL LAW REGULATING CON-
TRUCTION OR THE PERFOiiMANCE OF CONSTRUCTION ��3.25
PIAN GNEC
�� L`i � 2 Lic
$iGNAT E OF ON7aACTOA OR A NOt+QED AGEN� IOA E�
� ID�TE�
M+
UNITS
SQ.
STALLS
C $5
❑ MOVE O REMOVE
NCY GROUP OCCUPANCV �OAD
CU FT.
OFFSTREET PARKING
GAFAGES
SURTA%
' $1.14
SAC CMARGE
Fire SC $2.27
TOTA FEE
91.66
LIDAT D MIS R �T
/ � �
noik
N� Il
ADDN []
ALTER j.�
Effective 1/1/2000
CIIY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DllPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: g� �'Z� �� �P...�Ot�T C��
Legal Description:
Owner Name & Address: C�tP�"'� ��-i�}�► EK- Tel. ��03> i�$to+ �� 1'�
Contractor: .� �S'�N C.e�, � �ct1� MN LICENSE# �'��D
Address: '� v'z� W tkV�L-r'�-- s�' `� �� � Q�-- Tel. #C� f Z� �Zn -�"1 ��I
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
�h HgUGround Sq. Ft.
� l� �� s, . � �� �U�
Construction Type: �•Q� �� �� Estimated Cost: $ • °?�'a
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
�t�.dC. (�t�O� �
DATE: � Z`Z �� APPLICAN " Ci� 5.�� Tel. �� Z 1 9� -�717
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ ��- ��r Fee Schedule on Reverse Side
Fire Surcharge $�•o�% a� .001 of Permit Valuation (1/10th%)
State Surcharge $ /• �`� $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ $1100 per SAC Unit
$ �• �� $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. ':B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
�
$ 9/-��
Agreement Necessary [ ] Not Necessary [ ]
<. � •
�
BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pemuts for the erection of any building or structure, or for any
addidon 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 herei� provided to=wit:, ,,,., .
TOTAL VALUE
$1 to $540, �
�$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1Q0,000
$100,001 to $SOO,OQO
$500,�1 to $1,Q00,000
$1,000,001 and up
FEES
;.. , , .
$23.50
, �
$23.50 for first $500 plus $3.05 for each additional $1� or
fraction thereof, to and including $2,Q00
$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 $1,000
or fraction thereof, to and including $50,0�
$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 $500,000
.''$3;233.'15'�for the firs� $5�,000 plus $4.75 for each additional
$1,0OO��or �raction 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.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Pemuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of S�rvey 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
� e e.
Building
Inspections
7. 63-572-3 �60 9 _ o �
N����C�
RE5�EN'JCYA� �PLICATION
CIT� (�F F�LEY
DATE (! F/o� �Q /o� I-�0�'! t� �E • YOUR E-MAIL ADDRESS
SI'I'E ADDRESS �' �R P O/� 6�'d'� �S �el. 6
THIS APPLICANT IS:
PROPERTY
OWNER�
TENANT
■ • �•
Permit No.:�?��7�/S�/
Receive
D����� 10 200'
,•u�+,y�: K
ADDRESS: �/ 1� �G� [ ae.• � et✓'tC^ � 1. CITY ,�/� l R�A STAT'E,�ZIPS`� � 3 J—
Pxor�: 7 63 -� 8 6� L I��
CONTRACTOR I co�atn Na,ME: /�� ��'
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
CONTACT PERSON: C�+ �e � G�.�
STATE LICENSE �
0
� �� r
EJ{P DATE
�aE CITY �iQ.e "� �•c STA1'E►��J ZIPS^� y�..'�
pxot•tE �b3- ���- � I 4 � FAX
�'SINGLE FAMILY ❑ TWO FAIvIILY � TOVVNHOIJSE
❑ NER► ❑ REPLACEMENT �ALTER?'110N/REMODfl.,
DETAII.ED DESCRIPTION OF VJORK �✓ts �'A �/ � rt I� t+R- �� g�-�
PER MS 16B.665 the permit fee is a minimnm of 515.00 or 5% of the total cost up to 5500.00, whicbever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. ('I'his should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between 5300 to $500 = cost of labor - x.OS =
FOR PROJECTS WHERE IABOR EXCE£DS $500, FEES ARE BASID ON S 10.00 PIIt FIXTURE, FXCEPT WfiERE NOTID. FD�I'URES: (II�IDICATE TOTAL
NiTNiBER OF EACH BELOV� _—
EquiPmentIastalled . MFG: .l S�'l �' MODEL: � ECb ol3� � SIZEBIV
MFG: MODEL:
MFG: MODEL: STLFJBTU
�LACE (GAS) $15.00 . GAS RANGE/OVEN $10.00
A/C $25.Q0 =FIREPLACE (WOOD) 535.00 IJEW GAS GRII,L $10.00
AIR TO AIFt EXCHANGEER $15 �gNACE $3i.00 GAS tJNIT HT'R $10.00
BOII.ER 535.00 pOOL HFATER $35.00
—CHIMNEy LINER $10.00 _GAS DRYER.$10.00 �pTOR $15.00
DUGT WORK $10.00 GAS PIPING $10.00 -' -:. _... �_ _ - -... .. " : .. , ��
_._.._._�_. .............»�.,.�u,��,�u�„�,;�.-rs�xa _ , v�,ii� ,
Surcharge
TOTAL DUE
�;7�r.►�€i94in._ ... -. . . .� a � . ..�a„-.,._;,._ __._.__.. ..._._._ .
$ _�, o � Number of fixttu'es @ $10.00 x $10.00 = _
$ .50 Number of fixtures @ $15.00 —� x $15.00 = $ � S� � �
$ �,� , s' o Number of fixtures @$25.00 x$25.00 =$
Number of fixttu'es @ $35.00 x $35.00 = $
State Surcharge = $ _50
Total = $ /s• � e
THIS IS AN APPLICATION FOR A PERM�T-NOT VALID UNTIL PROCESSED
I hereby appIy for a btiilding penmit and I aclaiowledge that the information above is complete and accurate; that i�e v✓ork will be in
conformance with the ordinances and codes of the City of Fridley and with tha Minnesota �Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans• �
�,�-s PRINf NAME �/'t ��� ao.►� DATE E� `�` O
SIGNA'NRE OF APPLICANT �i� �►.:�r�. �� ° " _ r�---_ _ _....._....,,��
�City of �ridley
�uilding gnspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
�A,�: 763-502-4977
REQUIRED lNFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMiT APPLICATfON HVAC �
❑ NEW HOMESI,ADDI�'IONS EXISTlI�G HOME ❑ MAKE-UP AiR
REQUIRED FflR NEW/EXISTING HOMES
1. Combustion Air (See note below) .
� Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Cras or Propan Cl��er�ffil�T Amenc�men .�s -- -,- --
2. Make-up Air (See note below) �
a. IMC Cha�ter 5 with MN Amendments .
3. .Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments .
b. Fuel other than gas TMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & c�oling load. per room
a. Required on new consl�uction IMC 1346.0312
5. Ventila#ion . �
_ __a. Per MN Energy Code 7670 or 7672
- -,— - ---
6. Duct Design Per IMC 134b:0603.2
a. ACCA Manual D
NO'Y'],E: Cen�erpoint Energg� Mechanical Code Guidelines software may be used for
comb.ustion an-d make up air calculahons
Building BUILDING P�t No.:� -
Inspections R�+ SmENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY D�'a��� �$ 2� �
n�� 08/12/09 Y��.�,�� estherd�probuiltam.com
srrEann�ss 8112 Fairmont Circle NE
THIS APPLICANT IS: � OWNER C]CONTRACTOR
PROPERTY OWNER/ N�: Garv Valeshek
�N� .�wnxESS: �ame as site crrsr sTA� z�
PHONE:
�ONTRACTOR �:proBuil .America
SUBINIIT A COPY OF STATE LICENSE # BC - 2 0 3 5 6 S 4 7 � Dp� � 3 1 �
YOUR STATE LICENSE nnnRESS: 2 211 11 t Ave E � North S� STATE z� 5 5].�► 9
W1TH APPLICATION pHONE 6 51- 77 0- 9315 p� 651- 77 0- 04 95
PROPERTY TYPE ❑ SINGLE FAMII.Y/NEW CONSTRUCTION SIZE
Q TWO FANIILY/NEW CONSTRiJCTION STORIES
PERMIT TYPE O anDiTCOr� 0 caRP.c�s�n ❑ wu�mows
❑ BASII4IIIVT FINISH ❑ ROOF ❑ BRAIN TII.E
� DECK � SIDING ❑ OTFIER
❑ SWIIVINN�VG POOL
TYPE OF WURK: � �'►' ❑ ADDTI'fON
❑ MAIIVTEATAAfCElREPA�t ❑ REMODELIIdG
DESCRIBE WORK BEING �NE: Replacing 8 window,
SIZE OF IIvv�ROVEMENT LENGTH WIDTH HEIGHT . Ft�
ROOEING ❑ HOUSE ONLY
NUMBER OF SQUARFS ❑ HOUSE & GARAGE BASFdVIENT RFdVIOD�I.ING SUBMIT:
GARAGES � ATTACI�D GARAGE 1. F�ieting Floor Plan
PROP�SID SIZE: ❑ DETACI�D (�ARAGE 2. Pro�sed floor pl�
PROPOSID HIIGHT: 3. List of struetwa( membere to be us�ed
�DING FOR NEW CONSTRUC110N INCLUBING DECKS,
0 Vbryl �Soffit ,ADDTfION3. & PORCHE$ S(]BMIT:
O Altm�inum ❑ Trim 1. Site Alan�Survey strm�ving dre exis�ng �pu�
O Offier O Fa�ia � proposed proje�t.
R'IIVDQR'S 2. Twa sets of �uchion plans
IN E3�[QSTING OPENINGS OYes ONo LOCATION OF WINDOWS 3' �� �����
OR FOR PISW OPIIVINGS-DESCRIBE SIZE OF
OPENIl3G CHANGES & 8
TYPE OF WIIVDOW TO BE INSTALLED NUMBER OF WIIVDOWS
ALL FEES ARE BASED OAi VALUATION. INCLUDING THE COST OF LABOR AND MATERIALS:
Permit Fee
Plaa� Review
Fire S�uchazge
Succhazge
License S�cherge
SAC Charge
Curb Cut Escrow
Frosion Cantrol
Park F�
Sevwer Main Charge
(USING THE 199"! U.B.0 FEE SCHEDULE)
JOB VALLTATION $ 4 9 8 7 �CUPANCY
$ � � 1'�; j Sce Back Page for F� Schedule
$ � 65% of Building Permit F�
$ .� 1 tim�s the total job valuation
$ � 0005 x Permit Valuaiion Minimum $.50
$ !�� $5.00 (State Licensed Residential Contractois)
$ $ I675 per SAC Unit (Plans to M�VCC for d�ermination)
$ $+6ft= ftx$21=$
$ $450 Conservation Plaa Review
$ Fee I�tecmin� bY Engin�ring
$ Agreemert necessa�y ( ) Non N�essar}+ ( )
P �; Make cheeks �vable to: Cit�v of FridleY Attat
TFIIS IS AN APPLICATION FOR A PERMff-NOT VALID UNflL PROCESSED
I hereby apply fvr a build'mg permit aad I aclmowledge that the inforrmation above is complete and accw�te; that the work will be in
conformance wit}► the ordinances and codes of ttte City of Fridley and witl� t}ie Minnesotaa Canstruction Codes; that I understand this is not a
permit but only an applic�tion for a�rmit aad work is not to stazt without a permi� that the work wlll be in accordance with th� approved
plan in the case of all work w}uch u�es review and approval of pl�s.
Esther Dahl 08/12/09
SIGNATURE OF APPLICANT 4� � PRINT NAME DATE