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Land Planning
land Surveying
Soils Teating
Civil Engineering
Municipal Engineering
Su�u�c��a►n � . .
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Engineers & Surveyors ,
Mortgage Loan Survey
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6875 Nighway No.6S N.E,
Minneapolis �
Minn. 54032
Telephone 784-6006
Area Code 612
for Ro�T�`��� �oi�����
q„
LOT 5� PLOcK 2.,
�DURDE�UX'S �P'�ING� �R�Q� A'DDITION
ANOKp couN°rY
,-
�
_Sc�le : i.`�� 30'+��
This js a true and correct representation of a survey of the boundaries of rhe land obove described aM! of �he
location of all buildings� if any� the►eon� and all visible encroochmeets� if any� froro or on said land. This survey is
made only in connecfion with a mortgoge loan now being placed on the propartr and no liubilitr is assumed �
except to the holder oi such mortgage or a�y other interest acquired by the reason of such mortgoge. It is
understood and agreed � monume is have been 1 ced for the purpose of estoblishing lot lines or boundory
corners. Oafed fhis�day of�A. D. 19�
SUBURBAN ENGINEERING, INC.
L3�+� Q Enb� �rs�� i�i'F��� �,l.y u�fJ y^� s
�C�� (` p
��ZyS
/ , /�
./
Number Fixtures �� x $2 . 00 � • � u �
Future Fixtures� 3 x $1.50 .�
New Fixture-Old Open. x $1.50
Catch Bastn x $3.25
Water Heater-99,000 BTLT �_ x $3.00 �,ud
Ground Run Old Bldg. x$3.25
Elec. Watex Heater x $2:00
Gas Fitting Fe�s:
]�st 3 Fixtures
/Y � x $2.00
Additional Fixtures x $ .75
Gas Range-199,000 BT[1 x $5.00
Repairs &-Alterationa
See
Description; Code 3 3.�J
State Surchar�e .50
TOTAL FEE $ �, o��
The undersigned hereby makea appl�ication for a permit
for the work herein specified, agreeing to do all work
in strict accordance w ith the City Ordinancea and rulin
of the Department of Buildings, and hereby declare that
all�the)fact� �d representations atated in this
n.,.,�in�f��.,,, �,. �-,...e �.,a ....«......�
�
sue�ecr PERMI
City of Fridley � 12460
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
� � R .
� • COMMUNITY DEVELOPMENT DIV.
� Ly �������
r � � PROTECTIVE INSPECTION SEC. ��J�C,��
1 = �
�� /'�'1 � CITY HALL FRIDLE� � 55432 NUMBER REV. DATE PAGE OF APPROVED BY
----�' �•' s,2-�so-aaso 910-F15 3/15/74 / /
JOB ADDRESS g121 Fairmont Circle N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. S 2 Bourdeaux's Spring Bxook Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Ralph Barris
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
The Rottluad Company, Inc. 4220 Central Avenue N.E.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDflESS ZIP PHONE LICENSENO.
6 USEOFBUILDING Residential
7 CLASS OF WORK � N� ❑ ADDITIOId ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK C0118'�1"ltCt $ X 8 SII S X 8.T3ge
9 CHANGE QF USE FROM T�
STIPULATIONS provide a hard surface driveway. Provide a verifying survey � before
cappizig.
SEWER L�ATION: 5' South of Manhole (Inv. 847,54)
Wye E1ev. 847.56
Top of Footing : 850.75 Miniun�m
WATER iOCATION: 11.3' South of Sewer Service
�'�'��ERATE PERMITS REQUIRFD FOR ��I�IN�p
�-t�ATING, PLUMBiNG AND SIC;NS�
TYPE OF CONST._ OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCZ FiB�le
THIS PERMIT BECOMES NUIL 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 ABANDONEO FOR A PERIOD OF 120 DAYS AT R�1 1146 + 636
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 yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT Z�F .509 �.2 oZS
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �`)r1.00 300.00
STRUCTI O PERFf�RMANC OF CONSTRUCTION.
'��P d�i'tGfo � G�O. .�"' � �f-��' `e-� _ PLAN CHECK FEE TOTAL FEE
� r-.6 —,�_ �a�x $363.ZS �
SIGNATUREO NTR CTOR RAUTHORIZED GENT (DATEI . WHE P,RO E LY I AT THIS IS YOUR PERMIT
� 1 J � � n
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI iNSP DA7E
�
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aPPi,TCATION FOR RLSIllENTII�L, ALTEIta1'Ii�;V,
OR �1i)U1"I'I01� �UII�DING PERMIT
CI'!'�" OF 1-1:1UL�:Y, 11J�tiNf�SO'T.A
���" ' YY/
%� /
awr��x � s r�rr� : � BUILDER: � ���c t�, u ' �� . ,��,,�
/AADRESS �-�-� � , . �, - -�,l/,,�'ADDRESS • yz 2 8 ��o�rj''�� � d�� .CI �
N� ; . C.� � �- � S TREET : �� � r �u o �* 7` � ! r �e / .�. ,�1 /. �
Lfl� : S� BLOCK : �- ADDITION : � �„� t.- ,^.� p„ ;v '� .S.,�i--1,�. � ,8 r a r/,�
CORN�R LOT : INS IpE 1.OT : �+ SETBACK: 3� � SIDEYARD: / s ��� '
Ag�l.ican� �ttach to this Lorm Ztao Certificates of Survey of Lot and proposed
bui.ld�.xig location drawn on these Certifi.cates.
�ESGRIPTI�N OF BUILDING
TO $� Used As: �i°r°v9'� j��M �lX �{Sv.�,o� � �
��r'� � , - -
a v � �e Front • � � Depth : G1 Heigh� • ��` �,�
Square Feet:��,Cubic Feet:�
,��,rp�e Fxont : � Depth : 2 � ' Height : �� '� �
I�, � °�^ j.'P, � ,b ,; (, J
Square Feet; _� Cubic Feet: J; '-, � ��
��
'I�►p� Of Constxuction; ��t�,A�s�- Estima.ted Cost: $ ;3o_ooc. �
� ,. �; � � , s � � !� ���?
�o Be C�mpl.e�ed: I �- 3/ — � � .�
The undexsigned hereby makes applicativn for a permit for the work herein
apeci.fied, agxeeing to do all work in sttic� accoxdance with �he City of
Fxidley Ordinances and rulings of thc� llepartment of Buildings, and hereby
declares that .ill the facts and representati in t is a lication
axe true and � urr��c t. .� O iy ��' ��o -��� Q
� ^f
DATE: �- /,�_ °� � S IGNATURE: 'Sy�.�
�' � � �
(Se� Reverse Side For Additional Tnforma,tion. ) � � �� ;� ,� � �-_ � j �/ ,� ' �' �,?'�
� ,�
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BUILDIN� k'�1L'�9l'I' I��E 5Cl-I�UUI_�:
S�GT�pN �. The Inspect��r uf BS►ildin�s shall, before issuing p�rmits for the
exection of any buiiding or stru��t�,re, ur fo� any addition to .iny existing
building oz structure, or jor ..uiy .� lterat i.on or r�pairs to an_y e?:isting
buil.din� or structure, upon applicati�n thereior�, r�q�,irc the payment by the
applicanl fox such permit of fec:s tc r.h�� :3mouut herein below se� forth and in
the manner herei.n provided to-���it:
TJN�FQRM BUILDING CODE: Type 1, 2& G-• $2.15 for each �nc: thousand cubic
feet, oz fraction there:of, in such cubical contents. T}�pe 3& S-$1.85 for
�aah one thousand cubic feet.
�1U1)ITIONAL [UFURh1ATI01V
Fox the purpose of computing fees f�r building permits, the cubical contents
of ar►y buildin� ox addition, is determined by multiplying �he gxound area
cov��:�d fxom a point six (6) inches below the floox l�tne of the basement
ox Ch�i Ce7.la� to tl��� average l�eiKlits ,>f the upper surface oX to the average �
h�+i�i�t �£ ths roof surface of tlie ma.in gahle of a pitched roo�.
Fox x�pai�ra ox al,texations to an existing structure, the fee shall be at the
7Cate o� $3.00 pex eacl� five hundred dollars ($500.00) or fraction thereof in
the �os� af all proposed work.
�rt x�a ��,s� shall the £ee charged for any permit as set forth in Secti.on 2 be
18a8 than $Ss00.
VERIFICATION OI' FOUNDATION
NQT�� Pexmit,s for construction will be issued a minimum of 24 hours from th�
t3�+2 of application, ta allow for proper zeview of the proposed structure a,nd
+a$ �he ao;nstruction site,
� Cartified Survey of the lot, showing the location of the foundation, once i�
ham been eonstxucted, will_be required before proceedin� with the framing.
+' GRT I F I CATE �F �JCCUPANCY
Applica�ion for a Cerkiiicate o� Occupancy shall be made ten (10) days prior
tA the uee or occupancy of any structure for which a building permit has been
$.a��t�d; and s;�id s�ructure sha11 not be used or occupied until a Certificate
oi Oceup�cy haa been issued.
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,�4l�(.RDk'A�l�e`�'S�::SP21/YG.._.:6'ii0'�K:.::�la������!� �
� " , , . supervisio�x and that I am a duly �e�istered
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. HEAT L�?SS CALCULATIONS � p� E�i1�01G 8� AIR �UNDITIOiVING CO. �►INNEAPOUS, ��AtN1€•J,
Weatherstrips A.S.H.V.E. Construction No. Insulation
Windows Doors Guide Out. Wall Int. Wall Ceiling Roof Floor Kind HowAnplia_d ^
Reference
Yes-No Yes-No �g
FI��`/��j/� Room Length Width � Height FI. Room Length � Width Fie�� !,
Windows and Doors-Crackage and Area V'dindows and Doors-Crackage and Area �
No. W�drh Height No. of Llneat ft. Area � No Width Height No. uf Uneal ft. Area
of oane of oane liohts of crack sq, ft. of pane of pane Iiahts of crack S4- �t.
Infiltration
Glass
Exp. wall ��
I
Net _exp. wa I I
Int. wall. �
Ceiling �
��
Floor'
Total Btu.
nequirea sq. rc. t.u.rc. or sq. ins. w.A. �eader area
�FI.�����G Room Length/� Width
Windows and Doors-Crackage and Area
Widrh Height No. of Lineal ft. Area
No. - ---- ..s ........ �:_�.,. ,.� .._....�. �., s.
I nf i Itrati on ��
G lass
Exp. wall ,
Net.exp. wall
InL wall
Ceiling
Floor
- - .
Total Btu.
B tU
Height
B tU
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI. '�'C � Room Length � Width Height
Windows and Doors-Crackage and Area
No. w�dth Heiqht No. of Lineal ft. Area
of pane of pane lights of crack sq. ft.
/� �� � �,� � �
Btu
Infiltration
Glass
Exp. wall �
Net exp. wall
Int. wall
Ceiiing ��
Floor
Total Btu. �
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
et exp. wa
Int. wall
Ge i I i ng
F loor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Infiltration � �
� lass
Exp. wall d�
Net exp. wall %
Int. wall
Ceiling � �
Floor
7otal Btu.
Required Sq. ft. E.D.R. or sq. ins. W.A. Leader area
%FI���� �� aoom � Length �� idth�
!
Windows and Doors-Crackage and Area
No. Width Height No. of Lineal ft. I,rea
of nane of nane tiahts of crack sq. ft.
Infiltration �° e
G lass .
Exp. wal l� Q C�
Net exp. wall
Int. wall
Ceiling /� L� �
Floor �
Total Btu. �
Required sq. ft. E.D.R. or sq, ins. W.A. Leader area
FI. ��� Room Length 7 Ylidth �
Windows and Doors-Crackage and Area
No. Widih Height No. of Lineal ft. A-�a
of �ane of oane liahts of crack `_a. `t. }
Infiltration I off ef + j(�i'
�
Glass � '.
Exp, wall � ; 2 �
Net exp. wal l _ �/L�i� %�j'
---«-f
Int, wall � j
Ceiling ��� �i ;/� ;/ �'
Floor �� �' f�J �
J i
Total Btu. �
Required sq. ft. E.D.R. or sq. ins. W.A. Lead�r area
Int. wall
Cei I ing !
F loor '
Total Btu.
Requiretl sq. ft. E.D.R. or sq. irs. :`�.A. Leader area
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HEAT L�'.�S G4LCl1LATI0NS HEATING � AIR �GNDITIONING CO. MINNEAPOLIS, Mfi�R�.
Weat�e�strips A.S.H.V.E. Construction No. Insulation
Windows Doors Guide Out. Wall Int. Wall �eiting Roof Floor Kind HowAppti_wi
Reference —
Yes—No Yes—No �g
�FI.��/ � Room Length fD Width Height FI. Room Ler�gth Width He��,t�_
VJindows nd Doors—Crackage and Area Windows and Doors—Crackage and Area
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Coef Btu Coef� �*.:�
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Net.exp. wall Q—Q Net exp. wall .
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Floar �� Floor
Total Btu. Total Btu.
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FI. Room Length Width eight FI. Roam Length . Width li�igE�t
Windows and Doors-Crackage and Area Windows and Doors-Crackage and Area
No. W�dth Heieht No. of Lineal ft. Area Na. Widrh Height . No. of Lineal ft. Area
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Btu
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Windows and Doors—Crackage and Area
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HOUSE HEATING TEST RECORD D-21063
ADDRESS 8121 Fairmont Circle APT. FLOOR CITY SUBURB �idley
OCCUPANT Henery R Baxisa Yes
OWNER
HEAT LOSS DATE HTG. INST. GAS C0. METER BADG�edgt�ic Htg.
SOLD BY INSTALLED BY
a n
Electrical Work By Gas Line By
TYPE OF HEAT GA FA x HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE WilliaIDSOn MAKE OF BURNER
M�e� 1117-10�5 Model
���a� 7412119 Max. BTU Rating
INPUT 100,000 Btu HI'. MAKE OF FURNACE
Model
CONTROLS
THERMOSTAT M g60 Heat PV�OOc
Va Ive •
Limit Rob9haw RFL 750u
Limit Safting 200 f
Fan Satting 90 f& 120 f
P�Ior Ty� Conple
Pilot Make
Vent Size
5" �
KiND OF LINER A1�• SIZE 8�� NONE
Draft Hood Vertical R�ulaiorMazitx'ol 325-3
Filters Size16�B25�� Number 1
Chiipney Loeation Inside Ye� Outside
Chimney Construetion M��1'1b�8t'�
Pilot Modal Smoke Bomb Wiring
Pilot Timing s� S�onde pra{t �g Test Tag Yea
L.W. Cut Off Door Pressure Lighting Inst. Ye$
Pressure 4,3"fflii�C� PereantCO 7��0 Date Tested 11�7�74
2
input CFH �-�0 Pereent OZ - $.a7��/ Company Testing C+
Staek Temp. ����f Pereent CO ��0��• Name of Tester
Form 235
560-3450
l �' � �8�dt �'
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ANOKA COUNTY
6431 UNIVERSITY AVEfUUE NE December 30, 1974 FRIDLEY, MINNESOTA 55432
Mr. Ralph Bariss
8121 Fairmont Circle N.E.
Fridley, Minnesota 55432
Re: Final Inspection of Your Hause
Dear Mr. Bariss:
We would like to set up a time, when it would be convenient for you, to
make a final building inspection of your house. This inspection is to make
suze the house was built according to the approved plans.
The inspection should only take about 20 minutes and can be done anytime
between 8:00 A.M. and 5:00 P.M.
We would appreciate your contacting us at 560-3450, ext. 41, to set up
an appointment to get this house finaled. Please contact us also, if there
are any questions or problems about this inspection.
Thank you,
CLARENCE J. BELISLE
Building Inspector
CJB/mh
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Building
Inspections
763-572-3604
763-502-4977 FAX
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-09 �
YOUR E-MAIL ADDRESS ��e�� �.� �/lG`S�O
-/�, Dh � C r J` /d/_ � .
❑ OWNER �ONTRACTOR
O -e�r
.�ss: �-1 � �r � � e� 1' �ITY �
E: �'vla -�9.��1 -�'ci�,'�
CONTRACTOR NqME:
SUBMTT A COPY OF STATE LICENSE #
YOUR STATE LICENSE
AND CERTIFICATE OF ADDRESS:�
INSURANCE pH01•rE ���} -
PROPERTY TYPE I�.SINGLE FAMILYMEW CONSTRUCTION
❑ TWO FAMILYiNEW CONSTRUCTION
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
❑ BASEMENT FINISH
❑ DECK
❑ NEW HOME CONSTRUCTION
❑ MAINTENANCE/REPAIR
.. .� ( �hl/1 f
ROOFIIVG
NUMBER OF SQUARES ��
GARAGES �,�1�
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDIIYG �
� VinY� �..,, l� U
� Aluminum `
❑ Other %ih
Permit No. • � ��'�
Received By
Dat��:�� � � LU��
id
EXP DATEQ� v%
CITY��1`! Cv �
%s�-�1-i0 � -
.A
�
STATE �iLZIP�
���
stzE C � - � `�
STORIES �7 P ' I
❑ GARAGE/SHED ❑ WINDOWS
�ROOF ❑ DRAIN TILE
�SiDING ❑ OTHER
❑ SWIMMING POOL
❑ ADDIT[ON �'n
�REMODELING � (�V l �
��A r � .�. 0/h� IrVI �tl I/� �I�
❑ HOUSE ONLY
,� HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
�1Soffit � f
fe�Trim _G� �
�( Fascia • � ' ��,(1`
,J•
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project
� 2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXIS1'ING OPENINGS �.Yes ONo QCA ON OF W�S I
OR FOR NEW OPENMGS-DESCRIBE SIZE OF �. ��ey��/�la I+h� ��Q 5�
OPENING CHANGES & /
TYPE OF,WWDOW TO BE INSTALLED NUMBER OF WINDOWS /�
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
SING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ��� � OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee �
Sewer Main Charge
Total Due
$ �� 3 a
$
$
$
$ � .,.
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the totai job valuation
.0005 x Permit Valuation Minimum $.Sd �
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMI'f-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the ' of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a r�is_nflt to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all i ' s review and approval of plan �� �
SIGNATURE OF APPLICANT �RINT NAME Q/�G� ��. DATE �/��
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for lg` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 181$25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,0�0 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
� fra.ction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Departrnent
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977