AF - 45147�
City of Fridley, Minn.
BUII.DING PER.�VIIT
nat�: . . .`.�.r. . . .-. . . � . � ~� .-.�. . . . . . . . .
C�+aei' .......................................
Addre�rs ......................................
�
N° 3�72
Builder � . . . . .4��`� . . .
A�s . .3�:Y. o ... ... .�,�.?��:'.
LOCATIO�N OF BUILD[NG
No. �� f� � street . �.`.�/Ci��Ti1���.�e,��� of t . . . . . . . . . . . . . . . . . . . . . . .
Lot . . �,,.� . . . . B2ock . . . . . y7. . . . . . . . . . . Addition or Sub-Dfvisi � 4. . �C��/.!�:a . . . . . . . .
Corner I.�t ............ Inside Lot .. %'�....... 5etback �.�..... Sidey ........�'� � .............
DESCRIPTION OF BU[LD[NG
Used : ,
. `/ ,�c 7
... �ont .�5�.'7'� �pth �:�1...��. 'Height /..�. � sq. Ft/./.� ,�! Cu. Ftt�l9./. �
.............. ..... Front ........ Depth ...... H t � Sq. F't. ........ C`u. Ft. ........
1�pe of Construction . . . . . . . . . . . . . . . . . . . Est. Coet. . ..1. ,��1�!.,y. :_..'% be Completed . . . . . . . . . . . . . . . . . . .
In oonsideration o! t�e issuance to me of a permit to construct the building desribed ve, I agree to do
ttie propased work in accordanc� with the description above set forth in camplian th all provisions of
an3inances of the dty of Fridley.
.� ...... ... ......................................
''7� Q'a
In consideration of the payment of a fee of �P�.4Y. . . . . . , permit is hereby granted to . . . . . . . . . . . . . . . . . . .
......................... to construct the building or additian as described above. This permit is granted upon
the express conditian that the person to who� it is gi�anted and his agents, employees and worlunen, in all work
done in, around and upon said building, or any part thereof, shaA conform in all respects to the ordinancx�s of
Fridiey, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
fn the city limits and this permit may be revoked at any time upon violation of any of the provusions of said
ordinances. �
"'1�%/%�`�..!r/..../Buildin� Inapector
MOTiCE:
This permit does not cover the construction, installa#ion or alt�� Yor wi�in{}, plumbing, gas heatlnp,
se�nrer �#* wat�r. ,Be s�e #o ses the Bui1dM� Inspeator for separate permits for these items.
,�..�
�i
� APYLIEATiON �OR BUILDIP3G PERMIT
� • � � . CITY OF FRIDL'EY� M�NNESOTA
� ,. . . . . . . .. . .
� .
' Owners Name Jo� &t�rer.i� Builder Edw�rd �hi�s �
Addresa _�..._.. Address _ 3l�1U dohaesx St. 1�.�.
� . LOCATION OF BUILAING � �
. . y.
, .. . .
. ,; � •
No. _ ---- . Street" ���='al...$�f'r.�$aP..�- P�x't of Lot _ __ .,..___..�.
Lot 1? Block .�' Addition ar Sub. Div. �xis�s ltei�hts
Co�`ti�ej� �Lat', Inaide Lot � Set Back �
: '
Applicant� tttta.ch to thia, form Certific�,te of Survey of Lot and proposed
buildirig location.
DFSGRIP'PION OF BUILDING
To iie `used as • . ,,' ,
�sr►ellini F�ont � Depth 2� Height
Sq � Ft. , . Gtii. Ft.
' Frqr�t .,,.:.._..�. nepth ..�.�Npight
Sq. F`t. . Cu. Ft. �_ `
Type �of Construction a�'� . Estimated Cost -.�1�a.4S�.
To be completed � ' . 15. ,��
The unders�.gned�hereby makes application for a permi.t for the work
herein specified,�agreeing to do a11 work in strict accordance w3th the.
City Ordinances and ru7.ing of the DepartMent.of Buildings,.and hereby
declaxes that�a].„1 the facta and representations stated in this application �
axe true and correct.
3�' �'��`" �`S Si ature ����� ' .
D�te �
(A Schedule of Fee Costs can be found on the Reverse Side)
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�wr�o surevc�roR
R[GIiT[RED UNDtR 4AWS OR iTATE OF MINNR�OTA
LICLNf�D fY ONDINAHCt OR CIT1f OF MINNLAPOLfS
3a1d EAST SSTli S'TREET PA. 4-4681
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r HEAT LOSS C�LCULATIONS DEPARTaV1ENT
Weatherstrips A.S.H.V. . Conatruction N
Guide
Windowa Doora Reference Out. Wall Int. Wall Ceiling
No I No 19— u� =— C
U Fl.� oom Length Width // Heisht
Windows and Doors—Crackage and Area
�Yldth Height No. ot Ltneal ft. Ares
No. ot pane ot Dane lights ot crack sp. ft.
.32 /�'i �cS—
! ! L
Coef. Btu
In6ltration � p p
{',lasa p
•Exp. wal!
Net exp. wall /
Int. wall
Ceiling /p
Floor
Total Btu.
Required aq. ft. E.D.R. or aq. ins. W.A. L.eader area
U�F7.� Room L.ength // Width / Height
; Windowa and Doora--Crackage and Area
Wld h Hof`ht No. o[ Llneal ft. Area
�io. ot Dane ot Dane llshts o[ crack W tt.
2
Coef. Btu
jn6ltration
�a�+ O
Exp. wall
�let esp. wall
Int. wall
Ceilin8 '1 /D
Floor � DV�'Q � �46 / / /2
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
U FI. ,C oom � Length Width Height
Windowa and Doora—Crackage and Area
Width Helght No. ot Llneal tt. Ares
3rto. ot pane ot pans Ilsht� ot crack p. it.
3 2 /b' /O
Coef.t Btu
Glau p �
Exp. wall
Net exp. wall
lnt. wall
Ceiling /Q �
Floor
Tbtal Btu.
�equired sq. ft. E.D.R. or aq. ins. W.A. Leader area
DF BUILDINGS FRIDLEY, MINN.
�. 3.� t •
Roof Floor Kind How Applied
_ s� , �
FI.) Room Length Width Height
Windowa and Doora--Crackage and Area
Wldth Hefght No. o[ Lfnoal tt. Aroa
No. o[ pana ot Dane IfBbts of crack sq. tt.
� ¢ O �'�+`.
Coef. Btu
Infiltration �,j 6� Q �
C,lass
E�cp. wall
Net ezp. wall /l%
tnt. wau
Ceilin8 � Q
Floor
Total Btu.
Required aq. ft. E.D.R. or aq. ina. W.A. Leader area
� F1.� ' Room ( Length 2 Width Height
Windows and Doors—Crackage and Ana
Wldth Hef[bt No. o! L1nea1 tt. Area
No. o[ yans ot pane ll�ht� o[ crack eq. [t.
/-pao 32 ,b 6 i
� _ _ ��. _ ;-
f. tu
In6ltration Z
Glaaa '" p
Exp. wall
Net ezp. wall
Int. wall
Ceiling Q �j9
Floor
Total Btu. /
Required eq. ft. E.D.R. or aq. ina. W.A. Leader area
�•I L�' N Room I L.ength Width / Height •
Windowa and Doon—Crackage and Area '
Wtdth Hs1�At Na of L1nea1 tt. A�e�
No. ot y�n� o[ pans Il�ht� ot crack W. it.
/�n ?/_ �A n..w� /Q � /'�
T
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� Gla�a
! Exp. wall
I Nec ezp. wall
Int. wall
Ceiling
Floor
Total Btu. z ='"
�! Required sq. k. E.D.R. or aq. ins. WA. l.eader area
Btu �
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HEAT i.OSS CALCULATIONS DEPARTN�NT OF BUiLDINGS 1VIINNEAP01.iS► MINN•
Weathcr�trips A G�� Constructioa No. Inaulation
'Wfndowa Doora Reference Out. Wall Int. Wall Ceiling Roaf Fl�r Kind How Applied
o , Y� 19_
• Fl Room Length Width Height Fl.j Room. Length Width Height
Windows and rs--Crackage and Area Windowa and Doora--Crackage and Area
Wldtd efght No. of Llnmal ft. Area Wldth Helght No. of Ltneal Lt Area
No. of psne ot Daqe lights ot crack ea. Lt. No. of Dane o[ Da e lighte ot crack eQ: ft.
Coe£ Btu Coef. Btu
Infiltration
Glasa
�� �� � Ezp. wai�
Net exp. wall
Ibt. wall � G q.�( ��
C�i�►or 800r �p�=/p �
� Total Btu.
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Windowa and Doors--Crackage and Area
WldLh eigAt Hio. 01 Ltneal ft. Ares
�VO. ot psne of pane ll�hts oL crack sq. ft.
Z � �
Coef. Btu
In6ltration . � p�,/ �
Glasa
E�cp. waU
Ne� exg .v�r+di c c �w�
Int. wall � 4„�,�
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C,eil. or fioot -- ..�
Total Btu.
Required aq. ft. E.D.R. or aq. ina. WA. Ltader area d
Fl. Room � Length Width Height
Windows and �oora—Crackage aad Area
Wiflth Hblr t No. ot Ltneal ft. Area
No. of ytne of'ytns HBbt� ot crack aq. ft.
Coef. Btu
Ia6ltration
Gla:a
Eup. wail
Net exp. wall
Int. wall
Ceil. or 8oar
Tota1 Btu.
Required sq. ft. E.D.R. or aq. ina. W.A. Leader area
o-se �eso
In6ltratioa
Glaaa
Eap. wall
Net e:p. wall
Iat. wall
Ceil. or 800r
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.I Room �.Length Width
Windows and Doors—Crackage and Area
No. o atns ofBDane ltBhta oiLcra k qrft.
Infiltration .
Giaas
Exp. waH
Net exp. waii
Int. wall
Ceil. or $oor
Total Btu.
Required sq. k. E.D.R. or aq. ins. VtI.A. I.eader area
F1.� Room I Length Width
Windowa and Doora—Crackage and Area
Width Iieleht No. oi Ltneel tt. Ares
No. of Dane ot,pane Ifght� of crack eQ. it.
�
Infiltration
Glass
Exp. wall
Net e:p. wall
InG wall
Ceil. or 9oor
Total Btu.
Required aq.-##.'E.D.R:;or aq: ma. W.A. Leader area
j
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sue�etr P t NO.
C�ty of Frid�ey 0 8 21
AT THE TOP Of THE TWINS 6 u I L D 1 N� P E R M I T
� ` RECEIPT NO.
COMMUNITY DEVELOPMENT OIV. �/� , %
y _ • '7
i ♦ �.�
r � � PROTECTIVE INSPECTION SEC.
1 �
� s �"'1 : CI?Y HALG FRIOLE� SS132 NUMBER nEV O�tE P�GE Or �OvnOVED er
�'"'"�� ,�� 612-571-3450 91Q-F15 4/12/00 � �
lOB ADDRESS 5261 Fillmore Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
oesca. 13 4 Horizon Heights SHEET
2 PRQPERTY OWNEp MAIL AOOfiESS 21P PHONE
Joe Bungert 5261 Fillmore Street NE 571-5366
3 COIVTRACTOfl MAIL ADORESS 21P PHONE LICENSE NO
Seal Guard Systems 3770 Dunlap Ave N, Arden Hills, MN 55112 (763) 7ll-0700
a ARCNITECT OR DESIGNER MAIi. AODRESS ZIP PMpNE UCENSE NO.
S ENGINEER MAIL AODRESS 21P PHONE LICENSE NO
6 USE OF BUIIDING
Residential
7 CIASS OF WORK
❑ NEW O ADDITION O ALTERATION C� REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Partial reroof of house (7 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must compZy with the State Building Code.
7YPEOFCONST. OCCUOANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICA�, P�UMBING, MEATING,
VENTI�ATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTNUCTION 20NING SO. FT CU fT.
AUTHOR12E0 IS NOT COMMENCED N/ITHIN 60 �AYS, OR If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO POR A PERIOO OF 120 OAVS AT
ANY TIME AfTER WORK IS COMMENCED. NO DWLG. UNITS OfFSTREET PARKING
I MEREBY CERTIFV TMAT I HAVE READ AND EXAM�NEO TNIS APPLICATION 1 STA�LS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECi. ALL PROVISIONS OF LAWS VA�UATION SURTA%
AND ORDINANCES GOVERNING THI$ TYPE OF WORK WILI BE COMP�IED �61Z �. SO
WITM WHETHER SPECIFIEO HEREIN OFi NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMONI7V TO VIOI.ATE OR CANCEI THE pEqMIT f EE SAC CNARGE
PROVISIONS OF ANY OTHER STATE Oii LOCAL LAW REGULATING CON- $29 � 6O Fire SG �. E71
FiU TION TME PERF MANCE OF CONSTRUCTION
PGAN GMECK FEE TOTA� FEE
License SC $5.00 $35.71
S�GN t pE CON"AA(;T0�70QAUTH iZED4GENi IDATEi WMEN PROPERLV VAUOATED THIS IS VOUR PERMIT
�GNATUpEO�OWNEQ���OWNEABUILDEAi iDATE� �OG �NSD' f�p�E
NEW L] �
ADDN []
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/2000
(763) 572-3604 Bldg Insp
B�at
ConstructionAddress�(9 � �i��('�( (' � . 1 -
Legal Description:
Owner Name & Address: �� F���U `�eQ.,�'-T' Tel. #� /� � 5 � � ' `J3% (o
Contractor: � Cc I� Y�(Y I�1,� ��'Q lYi MN LtCENSE # o� �j(o ��
Address���� �, ;� �n la� Av�� lv �(''r �(��� Tel. #�D f� �� ( 7 d� 6�
`S� 11 �-
LIVING AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION O�F IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
DECK AREA: Length
OTHER:
Width HgUGround Sq. Ft.
Construction Type: t�C- ('(��� 1 1`Fcif - O�F Estimated Cost: $_ ` �• l� ��-��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: `� ` � I\(�U APPLICANT: Tel. # rn I�'� (1 � U7O U
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Call (763) 572-3604 for Permit Fees if mailing in application
$ 0�9 �� Fee Schedule on Reverse Side
$ �o/ .001 of Permit Valuation (1/10th%)
$ �� $.50/$1,000 Valuation
$ $1100 per SAC Unit
$ S -C)D $5.00 (State Licgnsed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
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COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERlFICATION
When realacinq an existinq furance, the undersigned hereby verifies that the
venting has been examined and is f�ee from rust, deterioration, obstructions,
and is securely supported and fi�estopped 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. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and rnanufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the cur�ent codes
and manufacturer's specifications.
When required to instalf a new combustion� air it will be sized aflct it�stalled
To meet the current codes and manufacture�'s specifications.
When irrstalling a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category ! Central Furnace
Venting 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
separately as per current codes.
Yes� No ( )
�-
Yes ( ' ) No { )
Yes (�, No ( ) -� __
r
Yes (� No ( )
/`
Yes (�No ( ) e
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU lnput 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
Ap�liance #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 Diamefer in Type
ALTERATIONS: 1Descr`ibel
� I0�--
�C�N lQ A� �_
HEATING CO:
Signed By;
K cJ
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Date :
a+
JUt�-28-2@01 13�45 SALES ADM 612 3�1 522� P.05ipS
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DONDY RE9 dOb# Zonc: Entire Hq°1se
MANUAL):7thEd RrGF�T•J; 3.o.la...- 5mfi?o�e
�� � � �� � -.Y
1 Nameof Rnom enCt:a House whole houre
2 liunni�g Ft. E7tposed Well 1�q.0 Ft. 340.0 �. r[. Ft,
3 Roora Dimonsions. Ft 0.0 �• 24. 0 x 46.0 Ft, z Ft. x Ft.
4 Cciings, F[ Condit, Opdon B, o a e. o neas/cool
Ttit'1'£ OF ii'C'M Area Btuli Aroa &uh Arca Bwh Amu etuh
EXPQSURIS A3Q. Htg C!g Lehgd� }it� Clg l.�ngth Htg Cl� LenYth Htg Clg Lenath Htg Clg
5 G[oss A 12C 8.1 2.1 1120 •0t• rrrr _1Z0 wro�M ♦rs• a��s •�.r r�•7 �*�♦
EXposed b:4B I3.0 2.3 136 ���� w"r• I 136 •i��` ��'•s �rr• •�.� •��• .�..
W�il9 pnd C 15E 7, 8 0. 0 552 •�"�� •�s• SSi ���� �"+ ♦��• ���• w►►• sa�•
P'al'litidns d 158� 6.? 0.0 372 t�rv ■s+s 3y2 w�a� •s�s a.s• ►w�• r+sa •r�•
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5 Window� �td 8 3a Q9.6 �� 1Ad 7141 ���� 144 7111 •"�w ���� •��•
C�IesrD00rs 6 49.6 °'� 56 2777 '�"s S 2777 r��• t��w ���•
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7 WifldOW3 tmd Nortll �3.0 16 •�0� 368 :6 "*'�• 368 '���• '�'''"'
GIa1SS L10005 NH/IdW 0.0 p sss• � p W��r. p •�•• •��.
Codin� E"IU�' �2.Q 102 "'s�• 7344 lOL tt�s 7344 +s.♦ t*�s
SE/SW 0.0 0♦�+• 0 p•�t• O •iY� •�av
�5oudt 39.4 82 s��r 3116 82 •'��" 3116 •t�• •�s�
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8 Ofherdoo�s s IOe 28.8 7.6 e2 1210 3i7 42 121U 31�
6 0.0 0,0 0 0 t+ G o I
9 Nct s 32C 8.1 2.1 878 7:12 1£65 87� 7:12 1665
ExpOxA b 146 17.D 2.3 l36 1763 319 d36 2763 319
W2119 �nd C� 18E 7. 9 0.0 552 4322 d 552 4322{{ 0
PaKitions d 158 6.7 0.0 3%2 2Q79 0 372 2+179� 0
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10 Cnilings s 16c 3.0 1.5 2060 3196 iS34 I060 32a8 �539 I
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12 lnfiiVaUion a 34.8 3.9 292 8413 935 242 8413 935
l3 SubRt+tBtuhLnss=6+$.+jjt12 rer�r 41974 �'�+• �'st• 4197< "st• •rWw v�y► s�sa •��♦
�4 DUC[BIUh LOSS 5° 2099 tst• 5 20ffi9 +'�r" o •s�• o ww�•
15 To�al Btun Lou� 13+�4 •*�• ad073 •��• �w*• 49073 �'t"� •t�� rs�W w��r ♦r�•
16 Int. GtlRp_ P20plt tt 300 a •�'t 120 �+�•• 2200 •��• wyr•
AppL t� 1200 1•��• 1200 1•��'� 12G0 '��• �'*'�•
17 SubWtRSHC30in=9+8..t12+16 r•'• ��•v 18631 •��� ���• 19631 •�ss ♦�«r rrr. •��•
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19 TotaIRSHG�in={i'It�g)+PLF 1.00 �'��� 195021 1.00 •��� 19562 w�st *�rt•
20 CFMAirRoqnired +"'�•• 1046 10461 •�•' 104 1C46 •�r� •��• I
Pttintout certified by ACCA to mcct all requirements of Ivlartual J Farm
TOTAL P.�S
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