AF - 47188/l
City of Fridley,�lVlin.n.
BUILDING PERMIT
N° 5662
Date: _�.��"'.:..�..':"'_SP._.l .__.__.._.._. _._..__.__..._.__
Y t����`�_ .
Owner: .. _. . ._._..�.___. ._.__._ Biulder . ._..----.....--•-_.......---------_..-•----..._..__......_..._.__
/'.
Address....._.._.._..........._....�.___.___.�.._.__...____....__.... .. ...----•-----_ Address ._.._.._._____..__.....__..._......_....._.-•-•...-•--�.._..___.._.._.__._._.__..__._
� . CATIO OF LDING
,
No. �% ._.�� - r�� . _ ... ...:....... .._... .....:_ �' Part o t ... --------•----.._..__.._._..-•----_._.–_
Street _ __ —
Lot ._. .. . . Block ....._..._.:,�.. _. . Addition or Sub-Division .._
..
-l-_-----•---. _. ... . ............�•-•-•-- •-- .. ... ___.
. ��.
i��t,,� �,�y
Corner Lot ._..._ ............._....._.. Inside Lot •----�".'...:.�..�..-.----- Setback �.�._5r._!.---•-...__._.._ Sideyard ----.f�!..._---_�_.._.._._._�_
Sewer Elevatian ....._.._._._._....---_..----....._.._.--••-_•-----...._--•----------------_ Foundation Elevation
DESCRIPTION OF BUILDIWG
T U -
.
._.. _ Front _��__.. Depth ���. Height ��.__ Sq. F't. a.!. ' � Cu. Ft
. Fro t.�._.. Depth .,�ar� eight .� ... Sq. Ft. � Cu. F� _ ��
-- • -�---
� �.y�
7.'ype of onstruction _ .�---- . _... : .�.......__ Est. Cost . :.._ .....L.�IG.i�--�o be Completed ...__........._.._._..___.__....�...
In consideration of the issuance to me of a permit to construct the building described abave, L agree to do
the proposed work in accordance with the description above set forth and in compliance with a11 provisions of
qrdinances af the city of Fridley.
.�L�..____._...._.__. _.Y.
In consideration of the payment of a fee of $.��.`.:..""".'�.._.., permit is hereby granted to..__.
.:.._.._......._.......__...____.._..__._......._ to construct the building or addition as described above. This permit is granted upon
�he express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding lceation, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this pernut may be revoked at any time upon violat��'on��of a�y of the provIsions,of said
ordinances. �,,. _
Building Inspeetor
NOTICE:
This p�rmM doa no� eovs� fhs eonstruetion, inst�ll�Non fo� wiring, piumbiny, gu heaHng, swwe or waMr. B� wn ro s»
fh� Building Insp�efor for separaM pa�mits for fh� if�ms.
��
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,� .> _ -
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owner � s
Addrees
APPLICATION FOR BIIII�ING P�IIT
CITY OF FRIDIEY, NIINNESOTg
l '�i;,,�. _ �.,►�� � � 1...�.�
,�
LOCATION OF BUILDING
No.
_��_(O � Street - � Part oi L�t
Lot� � Block ,,,,1 Addition or Subdivision ��-�- � ��
Corner Lot �Iriside Lot �( Setback _'� 5' Side-Yard � Z-
SEWER. ELEVATION ��i � . � �� , FOUNDATION ELEYATION ?� � S� . � � �
�lpplicant attach to this form Certificate of Survey of Lot and proposed building
loca.tion.
To be used as:
DFSCRIPTION OF BQILDING
Sq. Ft. _,_ I� C� C� Cu. Ft. l% lo ��
���
� Sq. Ft. _ �� Q Cu. Ft. ,� ��l v
Type of Conatruction�,,,=/il--r'�i.�-- Eatimated Cost 1�_ � v "-'!�
To be Completed
2�_
The undersign�l hereby makes application for a permit for the work herein speciPied,
agreeing to do all work in atxict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declaxes that a1I the facts and representationa
sta,ted in this application axe true and correct.
DA7Ts I a —� 1 —� I SIGNATURE -.
(A Schedule of Fee Costa can be found on the Reverse Side.)
.
�
� _ . . . . . ,
,'
' City of Fridley
�►ppl�cation for P'lumbing and Gas Fieting Pernrit
- Dept. of Bklgs. Phone SU 4-7470
DESCRIPTION OF WORK ��3
Number, Kind and Location of Fixtures Locatioa..
p � � N
w � F � Z
3� � o� �
� �
� S y Z z nn � Z V Z O S� y� Z � w
Z �� � �p = SSn ~<`� �� <u, ` a
In 3 F- O LL N LL O V GO < 7i U� U� 6� U O
Base � I �
ist
2nd
3rd
4th _
• Futuse Connectioa Opemings
* New Fixiuse, Old Opeaings
PARTIAL RATE SCHEDULE
WATER HTR.
• i
F N GAS ELEC.
City of Fridley:
�
� r
�
.
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Minn.
Owner
i
Kind of Building A .
3ewer [] Used as
Cesspool (�
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures . . . . . . . . . . . . . . . . . . . . . � x $1.50 $ • ��
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $
Catch Basin .... . ..................... x 3.25 $
Water Heater (Up to 200,000 BT� ........�-� x 2.00 $ 9,
New Ground Run Old Bldg . . . . . . . . . . . . . x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
lst 3 Fixtures .......................... t x$1.50 $ �'Sj%
Additional Fixtures .................... x .50 $
Gas Raage to 200,000 BTLT . . . .. . .. .. . . .. x 2.00 $
REPAIRS & ALTERATIONS—Refer io Code
Description................................................$
TOTAL F'EE $-L;7�
Ta be completed about
Estimated Cost,
�-
Old—New. Building Permit No. `�!� �2.� Pe�it N
— .✓I / � '�-
ROUGH � v� ' 0� �� b�
FINAL
4 z 4M 7-s9
By�
Business
1 ��
, Appfication for P�o�wer Pfants and He�oling, Cooling, Ven#ilatiot�. .Refriger�a�ion e�nd
Air Conditianing Systems and Device�s
PARTIAL RATE S�HEDULE
GRAVITY WARM AIR: RATE TOTAL ,
Furnace Shell & Duct Work . . . . . . . . . . . . . . . . . . . . . . . . . . 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.60 . . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alterations each add. �500.00 . . . . . . . . . . . . . . . 2.50 � ,
MECH. WARM AIR
Furnaee Shell & Duct Work to 1�(1,OOQ BTCT . . . . . . . . . . . .
reach add. 60,Q00 BTIT . . . . a . . . . . . . . . . . . . . . . . .
Replacement of Furnace . . . .. . . . . . . .. . .. ... . . .. .. . .. .
Repairs & Alterations—up to $500.00 . . .:. .. . . . .. . . .. .
Repairs & Alterations each add. $500.00 . . . . . . . : . . . . . .
STEAM os HOT WATER SYSTEM
, Furnace Shell & Lines—ta 400 sq. ft. EDR Steam. ......
Furnace Shell & I�inc�to 640 sq. ft. EDR Hot Water ...
,� Each add. 200 sq. ft. EDR Steam� . . . . . . . . . . . . . . . . . . . : .
�d Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . .
�
CiL BURIvER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . .. . . . .
over 3 gal. per hour—See Fee Schedule
8.00 $
2.00 � �.�__.
�.00 $
5.00 $
2.50 $
8.00 $
8.00 $ � �
2.50 $
2.50 $
5.00 $
GAS BURNER (up to 400,000 BZ"U) . . . . . . . . . .. . . . . . . . . . . . . 5.00 $ Sd�
GAS FITTING FEES: NO RATE TOTAL
lst 3 Fixtures ...................... x $1.5d $ � �
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU . . . . . . . . . . . x 2.00 $
AIR CONDITIONING ¢ .
FAN HEATING SY$TEM See Fee Schedule
VENTILATING SYSTEM � _ $
ALTERATIONS & REPAIRS TOTAL iE �_. %� _
� ,
ROUGH
FINAL
Dept. of Bldgs. Phoae SU. 4-7470
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City of Fridley:
The undersigned. hereby makes applica.tion for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, 1Vlinn. ,� -^ � � , 19 � �
Owner
�
Kind of BuiIding
Used as _
To be compieted about
Estimated Cost, $
Old—New. Building Permit No.
V�� � �--�-� Permit No.�L? d
��
DESCRIPTION OF WORK
HEATING or POWER PI.ANTS Steam, Hot Water, Warm Air—No.
�% �--
Trade Name_��f� � Size No , �- S'_'
Capacity ��� Sq. Ft. E.D.R. �-2 �1 BTLT ��O �«' Ii.P.
Total Connected Load1����� � S�oO����Kind of Fue1%b�.�/<a./
�—'--��
BURNER — Trade NamP ��,G �--� -�-�-� Siae No
. '
Capacity Sq. Ft. E.D.R BTIJ H.P.
(REMARKS-OVER)
Sign `�
By �..
�� 4 z 4M 7-59 Business hane No
- `/
�_. ., l�/ 9� 3 �5�'-�'����'�-C_
HEAT LOSS CALCULATIONS �� BURMAN COMPANY
OVeathersirips A.S.i-i.V.E, Constructian Na. Insulation
iaii.CjC
tr'indows ( Doors Reference ' Out. Wall Int. Wall Ceiling Roof F7oar Kind How ApF
Yes—No Ycs--�io 19_
F1•� j/ ,�/�'. Room � Length Width p Height
�inc�ows ar.d Boors—Crac�age and Area
tVidtli He[ght Na a: Llneal ft. Area
No. ot pano ot Pane IivUta ot crack aq, fG ��
/
a � 3� �
Cacf. Btu
Infiitration v � D
i,lass 5 c� D o
Exp. wal�
Net exp. wall �2
Int. wall
Floor
Ceil. 2 U ! o � Z o 0
� Total Btu. , - �
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
� FJ.� �` ,�_ � Room ( Length V✓idth j�, Height
Winrlows and Doors—�rackage and .Area
Width HeiBht No. ot Lineal ft. Area �/
No. oY Dane of pane ltghis ot crack eQ, tt. �
z � - �� �„
.} � �.,
Cotf. Btu
Infiltration � �
Glass �' �
Exp. wall
Net exp. wall � / ,? Z p
Int. wall
Floor
Ceil. �/
Total Btu.
Required sq. ft. E.D.f2. r q. ins. W.A. Leader area
Fl. aom ength Width / Height '
Windows an Doors—Crackage an Area
VJldth Aeight No. ot Lineal ft. Area .�
No. of pane of pane Ifghte ol crack sq, ft. +
t_/ i 1�1 �f c/ / an � d 9 1�
Coe£. Btu
Infiltration "
Glass
Exp. wall
Net exp. waD /Q ,2 � Q
Int. wall
Floor
ce,i. � ► n D
Total Bta. P% �
Required s:�. ft. �.D.R. �r sq. ins. V�/.A. Lead,.r area ~
Fl.� Room Length / Wi�lth /rJ Height �7
Windows and Doors--Crackage and Area
Wtdth Heigbt No. ot Ltaeal Lt. Area �
No. of pane ot pane liBhts ot crack eq: ft. Q
Q
2 z. I�� 7
�o
Coef. Btu
In5ltration 3 � .7-1J
Glass / ,7 0
Exp. wall
Ne# exp. waU l O O
Int. wall
Floor
Ceil. � D
Total Btu.
Required sq. �t, E.D.R. or sq. ins. W.A. L.eader area
F1.I 2 Room I 1�en8th Width Height
Windows and Doors—Crackagt and Area
Wtdth Hefght No. ot Llneal tt Area �
No. of cane ot Dane 1 hte ot crack e4._ tG_
Tnhltration
Giass
Exp. wall
Net exp. waU
Int. wall
Floor
Ceil.
Total Btu,
�ri
�OO
e���rr.�*� _
�
1^
'�
1
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
Ft., Room I Length j Width Heiglit
Windows and Doora--Crackage and Area
Width Helght Na ot Lineal [t Ares
Na ot pane ot,pane Iighte ot craok sQ. tt �
2 2 '7 �
Coef. Bcu
Inliltration _ _. ! c{ 'S!D .�`� D
IExp. wall
Net exp. Wall
� Iat. wa}!
IFloor
c�;t: I�y 1 �
Tc+tal Btu.
ReqLired sq. ft. E.D.R.,or sq. iaa. W.A. L.eader area
HEAT LOSS CA.LCULATIONS
Weatherssrips A.S.H.V.E. Construction Na.
Gaide
�;'indows Doors Reference ' Out. Q(all Int. Wall Ceilittg Roof Floor Kind
Yes—No Yes—No 19�
Fl.� �'yyl�r� Room � Length �� `�Jidth Z_HeiBht � Fl.� .�� Room � 1
Winci�ws ar. D��ors—Crac�age and Area Winclows and Doors--Cr,
�VSdtU Helght Nc. o: Lineal ft, f.rea � Wtdth Haight No
_ No. of pano ot pane 3ivhta ot crack sq. tt, ' � No. ot Dane of Dane 11B
� �
Cacf. Btu
�ags � � v �
�p. Watt
Net exp. wall
Int. wall
Fioor
Ceil. 60 /(1 /�(p
� Total Btu.
Required sq. ft. E.D.R. or sq. ins. W:A. Leader area
t$- Fl.� Room Length Width ! 7 Height
Windows and Doors—�rackage and Area
Width Helght No. of Ltneal ft. Area �
No. of pane of pane lights of crack eq, tt.
� L� x � � �� 2/ ��
coef. Bta
Infiltration p
Glass ,5 p �
Exp. wall
Net esp. wall G� /v 3(a �
Int. wall
Floor QQ �' S Qd
Ceil.
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Q
FI. i�aom ( Length — Width // HeiSht
Windows and Doors--Crackage and Area
Wldth height A[o. oY Lineal ft. Area
No. of pane of pane Iighta of crack ea• tt. �
� yz 3 v � 22 2/ I�
Infiltcation �
Glass O
Exp. wall
Net exp. wall / 0
Int. wall
Fioor
CeiL `
Total Btu.
Required s.�. f,t. E.D.R. �r sq. ans.11�1A. Leader area ~
BURMAN COMPANY
Insulation
How
Width
and Area
�eal LL Area
craek od: [t.
�'
Coef. Btu
Infiltration ! (�
Glass � � a 0�
.Exp. wall
Net exp. wall f�.� J ��'+
Int. wall
F�oo: I Z � � 60
CeiL
Total Btv. '�
Required sq. �t. E.D.R. or sq. ins. W.A. Leackr area
Fi.� �' Room ( L.ength Width Height
Windows and Doors--Crackagt and Area
Wldth Hetght No. of L1nea1 tt. Ares
No. o[ uane ot Dane ltghts ot crack eq`tt. �
d
�
Infelt*ation
l,lass --'--
Exp. wall
Net eacp. wall D 4 !d Q d e
Iat. wall
Floor ,j � S
�.ei�.
Total Btu, d �
Required sq. k. E.D.R. or aq. ins. W.A. Leader area '
Fl.� ,ty ,s' Room I Length Width HciSht
Windows and Doora—Crackage aad Area
Width He18bt Na of Ltneal tt Aroa �
li Na ot nane ot.Dane lishts ot crack sQ. !L.
Infiltration
Glass
Exp. wall
Net exp. wall
Iat. watl
Floor
CCII:
Total Btu.
ReqLired sq. ft. E,D.R.,or sq. ina. W.A. L.eader ana
rd
Btu
,� St D
SUBJECT
City of Fridley 19 4 2 3
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � REC O.
� i L_ COMMUNITY DEVEIOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEC. p�-�3�
� � ,
� � /"��1 � CITY HALI FRIDLEY SS4$2 NUMBER REV. DATE PAGE � Of APPROVED BY
�'"'"� � ��� 612-571-3450 910-F15 4/28/88 � �
JOB ADDRESS 6963 Hickory Circle N.E.
1 LEGAL �OT MO. BLOCK TRACT OR AODITION SEE ATTACHED
DESCR. '],'rdCt "A' Registered Land Survey #20 SHEET
2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE
Kyle Watkins 6963 Hickory Circle N.E. 572-2324
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS 21P PHONE LtCENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 OESCRIBE WORK
Construct a 10' x 20` Deck and a 6' x 20' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan
�`cll 1�`� Cl��l�i;�:��
SEPARATE PERMITS REQU)RED FOR
� • , _, ���3 S�� - �fH1�31? � ��`;�;i'1���l�.�
, ^ �,� .,� ,, � a ,•.
. . , _ . , i � � � n e r. � � r� t.s�t�t,:�7 d.�: r.
, . . . : :r �n ��� .-,p..,,,t�ti sai��,��r Z��oi il��� �"�
� ��N����:;� �,�
� ;.� � �
�:>..r<...�.
SEPARATE PERMITS ARE REQUIRED FOR EIECTRICAL, PIUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OC�UPANCV LOAD
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OFi CONSTRUCTION ZONING SQ. fT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OF IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PER�OD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCE0. , NO. DWIG. 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 WOAK WILL BE COMPUED $2�2�� $l.lO
WITH WHETNER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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. $38.50
! PLAN CHECK FEE TOTAL FEE
°`�` $ 9.63 $49.23
SiG UREOfCON'RACT RAUTHORIZEDAGENT ioa i +� yy'I�{EN PROPERIY V TED THIS IS YOUR P R IT
SiGNa UREOF WNER�iFOWNE�� ���AT� BLDG INSP � pT�
N� [] City of Fridley Effective 4/1/86
ADDN. [ ] �� R-1 AND R-2 �
AI,TER. �] Building Permit Application
Construetion Address:
.�C/Ca^c�'' C..�2(
Legal Description: ���r ��� �� �� � S � `�U
Owner Name & Address : '���- �'��` �!'u "� ' � �� �J Tel . # .�7a ',3d �
—�
Contraetor: (�(�f.�� Tel. #
Address•
Attaeh to this applieation, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width
GARAGE AREA: Length Width �
DECS AREA: Length � Width �
�' ,��"� 6 � �
� �`Z t 2 ��� �P� _
Height SQ • �'t •
Height Sq. Ft.
Hgt/Ground � Sq. Ft. ��
�/� ��-o
, ., � ' .
3'�� , �, � �
Corner Lot [] Inside Lot [�� -�. Xd. Setback �'��� Side Yard Setbaek �S
00
Type of Construction: L��'�-� a` �y Estimated Cost: $�
Approx. Completion Date: ��
/'�l,r ��� �
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Baek Page for Explanation
DATE: � °�� v
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAI.
STIPULATIONS:
.�e,(,(R,� � ,a G�,,J .
APPLICANT:
L��-�--� Tel . �`y�p'7 i Q � �
CITY IISE ONLY
$ C�, Fee Schedule on Reverse Side
$ g..� 25� of Building Permit Fee
$ ��.� � $.501�1,000 Valuation �
$ $ �,�Q per SAC Unit
$ Fee Determined by Engineering
� /�� Agreement Neeessary [ ] Not Necessary [ ]
$ "? ,1 �
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:e� o�
sue.,ecr PERMIT NO.
City of Fridley � � :� ��
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
f —
' ' RE
� �• COMMUNITY DEVELOPMENT DIV.
' �1.-""' ,
r � � PROTECTIVE INSPECTION SEC.
i �
i
� � /"�1 � CITY HAL� FRIOLE� SS432 NUMBER REV DATE PAGE OF APPROVED B
�'"'"��� ,�J 612-571-3450 910•F15 / /
J08 ADDRESS 6963 HICKORY CIRCLE
t LEGAL l0T NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 21 1 OSTMANS THIRD ADDITION SHEET
2 PROPERTV OWNER MAI� ADDRESS 21P PHONE
KYLE WATKINS 6963 HICKORY CIRCLE FRIDLEY MN 55432 572-2324
3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO.
D& D HOME IMPROVEMENTS 7G41 CENTRAL AVE 784-7543
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PNONE LICENSE NO.
5 ENGINEER MAII, ADDHESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
RESIDENTIAL
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOAK
REROOF TEAR—OFF (22Sq)
9 CHANGE OF USE FROM TO
STIPULATIONS �DERLAYMENT MUST COMPLY WITH THE STATE BUILDING CODE.
tYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING-
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERI00 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEFiEBY CERTIFY THAT I HAVE fiEAD AND EXAMINED THIS APPLICATION STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAl TIq�I SURT
AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILI BE COMPLIED �I. �/GO •��
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PEFMIT
PROVISIONS OF ANY OT EIRESTATE ORTLOCAL ' AWTF GULAT NG LCON� PER�I��E�S $9��A��iE 1. J6
!''1K (:
STRUCTIO THE PERFO ANCE OF CONSTRUCTION.
3 P�CENS�EKS�E5.00 T�Tb�FF3E9
GNATUAEOFGON�RACTOAORAUTHOflIZEDAGENT IDAT � WMEN PAOPEf:L ALIDATED THIS IS YOUp PERMIT �
�_�-�'�
S�GNATUREOFpWNERiiFOWNERBURDERi iDATEI BIOG NS ��FrE
, . .... . . .. • ��, .
N�W . iI
A�[�N Il
ALTER ( )
Construction Address:
CITY OF FRIDLEY
SINGLC FAM(LY AND DUPLEXES R-1 AND R-2
Building Permit Application
� . _ , 9^ � �� /
Gffective 8/1/95
�_�___
��`�s�
Legal Descripdon: --
Owner Name 8c Address: �
' Tel. # �7Z Z3Z ___-
Contractor: D& D Home Impravement, Inc _ MN LICENSE # 4840
Address: 7401 Central Ave NE Tel. # 784-7543
Attach to ttiis applicatioe, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESC:RIPTION OF IMPROVEMENT
LIYING AREA: � � Length , Width , -- Height Sq. Ft.
GARAGE AREA: Length � Width ' -- Height Sq. Ft.
DECK AREA: Length � Width ! Hgt/Ground Sq. Ft.
OTHER: ' -
;
Corner Lot [] Inside Lot j] Ft. Yd Setback ' Side Yard Setbacks
Type of Construction: B19-�-�' `�,GA�-c2ZT' Fstimated Cost: � � ,`'" —
Approx. Compledon Date: � - � .�O , /� ' �.� �K��e� k �'v ` °
; (Cost on Back)
Driveway Gtit Width Needed: ' Ft. + t= � Ft x$ _$
DATE: � � q� APPLICAN'1': Tel. #�5�7�; �
' �ITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�____1_�%!�_
� �r /1i '
� ��
S
$ 'i ��r� ;
$ ;
$
$ i
$ '
i
� �
$ ,3
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth�)
$.50/$1,000 Valuation
$850 per 5AC 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 [ )
CC_
s�e�ecT .- P AMIT NO.''�
City of Fridley 3 4 0 5 3,
AT THE TOP OF THE TWINS g � i L D i N G P E R M I T
r
� � RECEIPT NO.
� `� _ _�_ COMMUNITY OEVELOPMENT OIV. � � ��
f � r � PROTECTIVE INSPECTION SEC.
� � �"'1 � CITY MALL FRIOIE� SS�J2 NVMBER AEV O�TE n�GE Of �P►ROVEO Br
�""��� �'' 763-571-3450 910-F15 12/16/03 / /
J08 ADDRESS 6963 Hickory Circle NE
t LEGAL LOT NO. BLOCK TRACT Ofi ADDITION SEE ATTACMEO
oesca. 21 1 Ostman's Third Addition SNEET
2 PROPERTY OWNER MAIL ADORESS Z�? PHONE
Gina & K le Larson -
J CONTRACTOR MAIL ADDRESS Z�P PMONE IICENSE NO
B J Larson Remodelin Co $83 e 55443 763-503-1221
� ARCHITECT Op OESIGNER MAIL AD�iiESS ZIP PMONE LICENSE NO.
2529
5 ENGINEER MAIL ADOi;ESS 21P PHONE LICENSE NO
6 USE OF BUILDING ,
Residential
7 CLASS OF WOAK
❑ NEW [� ADDITION O ALTERATION O REPAIR ❑ MOVE D REMOVE
B DESCRIBE WORK
Construct a 40' x 26' Addition to Dwellin and a 6' x 22' Gara e Addit�on
9 CHANGEOfUSEFROM TO
STIPULATIONS
See notations on plan.
SE�'��ATE PERM�TS �A�� � MIC�
�` ��.UIRED FOR: Before digging call for
v'i� ��NG HEAT�NG all utility Iocations
p��,,,�,���� AND StG�IS 454-0002
�t����l��� �X �.�1A�
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCV�OAO
SEPARATE PERMITS ARE REOUIRED fOii EIECTRICAI, PLUMBING, HEATING,
VEN7ILATING OR AIF CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. fT CU fT
AUTHORI2ED IS NOT COMMENCEO WITHIN 80 DAYS. Op IF CONS7RUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PER100 OF /20 GAYS AT
ANY TIME AFTER WORK IS COMMENCEO. N0 DWLG. UNI7S OFFSTREET PARKING
I MEREBY CERTIfV THAT I MAVE REAO ANO EXAMINEO THIS APPL�CATION 1 STA�LS GARAGES
ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATION SURTAX
ANO OROtNANCES GOVERNING TMIS TVPE Of WORK WI�L BE COMP�IEO
WITM WMETMEfi SPECIFIEO HEiiE1N Ofi NOT. TME GF1ANTtNG Of A PERMIT �78,484 $39.Z�F
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEI 7ME pEqM1T FEE SAC CNARGE
PFOVISIONS OF ANY OTMER STATE OR IOCAL LAW REGUTATING CON-
STRUCTION OR THE PERfOfiMANCE OF CONSTRUCTION $846.75 Fire SC �%B.�FH
PLAN CNECK FEE TpiA� FEE
' ense SC $5.00 $969.47
SiGNATUpEOFCON'AACTOpOA1UT�+Op�IED�GENT �D�rE� � M N PROPERLY VALIOATED THiS IS VO Q PEp iT
� � �
S�GHntUAE O� OwNEQ ��� OWNEA 9URDEA� �DA1E� g�p � o qaiE
t
j . -. .
NEW
ADDN
ALTER
CITY OF FRIDLEY Effective 1/1/2003
(� 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Btdg Insp
[ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: � /� � ���`� � � � G' ��1� �• �' � � �
Legal Description:
Owner Name 8 Address: �%^' "g' `�'" �.V'�- Z ARSo�/ Tel. #�7� 3-SB�-c`�135
Contractor. • � • �'n� s°''� ��°�jc�.^' � • MN UCENSE # � sd�9
Address: o g �° (�•' � � %�oi � � . . Tel. # �G 3'�3-l�?/
LIVING 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 L� Width L Height � Sq
Length � Width � 2 Height �� Sq
Ft. ).���
Ft. � � Z
Length Width HgUGround Sq. Ft.
i� iv i� � ��
Construction Type: Estimated Cost: $ �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
. ��� �� �O � AP LICANT: � � i�`"v�- Tel. #�L��'"J`03"���
DATE. P
Call (763) 572-3604'for Permit Fees if mailing in application. Fax to 763�71-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
, . SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ �i � 7J Fee Schedule on Reverse Side
$ �1 , ti S .001 of Permit Valuation (1/10th%)
$ 3`i . au $.50/$1,000 Valuation
$ $1275 per SAC Unit
$ 5� C� $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ J Not Necessary []
TOTAL $ • Q �� . �7 STIPLILATIONS�
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ADDRESS
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�i-36U4 r�aa�:
: 6963 HICKORY CIR NE
PIN : 153024110026
LEGAL DESC : REG LAND SURVEY NO 020
: LOT BLOCK A
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
S"11-1LtS"!
PERMIT NO.: 2004-00173 i� �g�
DATE ISSUED: 02/06/2004
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
REPLACE AIR CONDITIONING
# A/C IJNITS
# FURNACES
# GAS RANGES
APPLICANT
HEATING & COOLING TWO INC
18550 CO RD 81
MAPLE GROVE, MN 55369-9231
(763) 428-3677
OWNER
LARSON KYLE R& GINA M
6963 HICKORY CIR NE
FRIDLEY, MN 55432
1 VALUE OF APPL OR WORK
0 # GAS DRYERS
0 ENTER VALUATION
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
will be �omplied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regul nstruction or the performance of constntction.
Applicant / Date
Bldg
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRSfALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 5248
0
0
5700
0.00
0.00
0.00
0.00
25.00
0.00
0.50
25.50
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTiLATION,
(763) 572-3604 REFRIGERATION AND AIR CONDlTIONING SYSTEMS AND DEVICES
FAX (763) 571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent • Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range .
Gas Dryer
*Air Conditioning • All Sizes
JOB ADDRES;
OWNER �
�tlective sarivary 1, "LUU3
Cs9 (�3 ��c,i�c�r� ���r�� �i
Rate TOTAL
BUILDING USED AS ��
$ 30.00
, $ 10.00
: $ �Q.00
.:;
$ 10.00
.��.�25.00
All Others/Repairs & Alterations (LIST ON �,�CK) �`
1% of Value of Appliance or Work �i �} �
Commercialllndustrial �
1.25 Jo of Value of Appliance or Work `�
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
�EFRIGERATION/AIR CONDITIONING PERMIT IS x25 00
PWS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
�
$
,�
� v �
ESTIMATED COS7 _� , / l�� � PERMIT N0. �'�' • ��,`���
DESCRIPTION OF FURNACE AND OR BURNER
$
No. of Heating Units _ Circle One (Steam) (Hot Water) (Warm Air)
$ Trade Name Size No.
BTU HP EDR
$ o� S uv Fuel _ Total Connected Load
��'
.
`��
�;l, ;� I
-i -=
$
.
$ � ,�
� � `�v
Burner Trade Name Size No.
BTU _ HP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do ali work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in tliis application are true and correct.
DATE ,..� " �' ` �' �I"
HEATING CO a��T�'.� b COOLIN ,'ryyp qdC
1�550 County Rd. 81
Signed �aP�s G�ara, MN 55369-�$$1#
FAX # �,3-4�-36��4�6��
Approved By Rough•In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNiNG APPLIANCES OR THE
APPLICATION WILL BE RETURNED
��„i•► I ► I ► •►► �: !►� •�i� •► ' : : L •►
�Jj�gn �ela i an _Yie in0 f�ran _e, the undersigned hereby verifies that the
venting has been examined and is free firom rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes (► No O
The venting system is plastidPVC and meets all current codes and manufactu�er
speciftcations including sizing, length, number of elbows and termination. Yes (► No ()
The undersigned al� "ve�ifies that the replacement unit is a listed assembly
and meets the currei�t codes and manufacturers specifications. This does
include AGA-GAMAi�ategory I Central Fumace Venting Tables for fan
assisted and naturai�iraft appliances.
The pY��b r_eme +`ben air is sized and installed to meet the current codes
and manufacturers specifications.
Wh6f1 neqult'ed to inetall a n_w cemh�c_�ien air it will be si�ed and installed
to meet the current codes and manufacturer's specfications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
WFten jpS�WpQ a npw� vpntinp,yystem, the undersigned hereby verifies that
it 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. Yes () No ()
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 O No O
! �� . � - �.- .�• - ���ii�� -� -�� -� •��-M. � •�u. .r
Appliance #'i 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 �
Tota! Rppliances _ 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 Diamete� in Type
Appli�nce #3 Vent Connector Height ft Length ft Diameter ins Type ` �
.� � o -
,
a� � � o v --
,
HF�4TING CO:
Signed By: _ Date :
,
CITY OF FRIDLEY PERMIT NO.: 2004-00202 /���
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 02/12/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 6963 HICKORY CIR NE r
� � €_.
PIN : 153024110026
LEGAL DESC : REG LAND SURVEY NO 024
: LOT BLOCK A
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
INSTALL FIRST FLOOR FIXTURES; 2 WATER CLOSETS, 2 BATHTUBS, 1 5HOWER, 3 SINKS
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# GAS WATER HEATERS 0 # GAS DRYERS 0
# GAS RANGES 0 # OF NEW FIXTURES 8
ENTER VALUATION 0 # WATER TRMT APPLIANCES 0
APPLICANT WATER TREATMENT APPLIANCE 0.00
NORTH ANOKA PLUMBING INC WATER HEATER - ELEC 0.00
22590 RUM RIVER BLVD WATER HEATER - GAS 0.00
ST FRANCIS, MN 55070 GAS RANGE FEE 0.00
(763) 753-3373 GAS DRYER FEE 0.00
PLBG REPAIR/ALTERATIONS 0.00
STATE SURCHARGE, PLBG FLAT 0.50
OWNER PLBG FIXTURES (NEW OPENINGS) 56.00
LARSON KYLE R& GINA M TOTAL 56.50
6963 HICKORY CIR NE PAID WITH CHECK # 10704
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performanc of construction.
Applicant Date
Bldg Ins G?� � Da
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
l;t � Y t1f� rt�ttl.it.� t s�v�rc�.. ��v�Y v�v.
g431 Ur►iversity Ave NE
Fridley, MN 55432
(763) 572-3604, �AX (763) 571-1287
Urinal
Sasement
Fioar 1
Fiaor 2
F'Ic�or 3
' Ffoar 4
pLUMBING �IXTURE RATES:
APPLiCAi`ION FC�R Pl.UMBING AND �AS �!T`i'!NG P�RMIi
MARK NUMBER OF FIXTURES 7C7 B� INSTA�LEC7 ON EACN FLqt�R
;i :: ' Wash t'�r�t�k- ':: :' Ftoc�r C�i�t� f4uta.
::,
,:
,: S�awer Sir�ii .! TraY �c�urt�� .. L7rain �&�Ct......; Washer
Gas
Nt'3. RATE 7C3TAL JOB AODRESS��„Q_3 C1 ��, Y�_��,.1�. �����
New Fixfures �_
Otd C)pening, New Fixture
Besr Dispenser
Blow 4ff Basin
Gatch Basin
Rain Water Leader
SurnplReceiving Tank
Waier Treatfng Appliance
Water Heater -Efectric
Water Heater - Gas°*
Gas Range"
Gas Dryer"
Back Ftow Preventer Requir�d ()Yes () Na
�YPe
� 7.00
$� 4.OQ
� 5.00
$ 7.00
� 7.Q4
$ 7.00
$ 7.0(l
��o.oa
� �.oa
$1t}.f�0
$10.00
$10.00
$15.00
Reinspection Fee �47:OOtHr
ALl �7HERS ANDIOR REPAtRS AND aLTERATl4hIS
1.5°l0 of Vatue of Fixture ar App[iance
State Surcharge
-�/L�1 t�b
Water t-ieater
G3S �I2C
G2�.r ihe undersigned hereby makes appfication for a permit for the work herein
specified agreeing ta da a41 wark in strict accordance with the city cades
and rutings af the Building Division, and h�reby declares that ap the facts
and representations stated in this app{ication are true �nd correct. ��.1,����'
,� 1
� .50
i 1 � �' :
_..��
� l� l.. (,�:. � ,�. . � ,. . �
Building Used As
Eslim3ted Cosi
���si - �,:sa._..::
PERM{T NO, `
� � ��� '� ��� � �
• : ��.I,I�.� 5.��..1 �.l ,iA �
Approved By �," Raugh-In Qate Final Date
iOTAL FEE $����1L5! PtUS THE S.SQ STATE SURCNARGE
COMBU5�'14N AIR SHALI 8E PROVIDED PER UMC SECT{C)N 544(A) RtJt3 TABLE 6-A. COMMON VENT t4�F0 ON B,hCK SfDE
//° i
CITY OF FRIDLEY PERMIT NO.: 2004-00203 . r� �
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 02/12/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 6963 HICKORY CIR NE '�t ��,
PIN : 153024110026 �°
LEGAL DESC : REG LAND SURVEY NO 020
: LOT BLOCK A
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
INSTALL BOILER, GAS FITTINGS; ADD BASEBOARD HEAT TO NEW ADDITION
VALUE OF APPL OR WORK 3000 # FURNACES 1
# GAS DRYERS 0 # GAS RANGES 0
APPLICANT HEATING PERMIT MINIMUM FEE 0.00
NORTH ANOKA PLUMBING INC FURNACE SHELL/DUCT WORK 30.00
22590 RUM RIVER BLVD GAS PIPING FEE 10.00
ST FRANCIS, MN 55070 GAS RANGE FEE 0.00
(763) 753-3373 GAS DRYER FEE 0.00
HEATING REPAIRS/ALTERATIONS 30.00
STATE SURCHARGE, MECH FLAT 0.50
OWNER TOTAL 70.50
LARSON KYLE R& GINA M PAID WITH CHECK # 10704
6963 HICKORY CIR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and lrnow the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or th perform ce of construction.
Applicant Date
Bldg Insp D� l%'
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
tY �JF FRlDLEY iNSP�CTION DIVi�lQ�V
� 31 Uniwersity Ave NE _ _
� dley, MN 55432 APPlIGATtON POR POWER PLAN�S AND HEATiNa, COOLlt�lGG, YE�lT#LATtON,
� 53} 572-3604 REFRiCERATit3N AND Ali� rONDiT[ONlNG SYSTEMS APtD DEVICES
¢�X (7G3) 572-1287 �
� � , Tj�1_ E_SCHED�E
m
m
� sidential
�� urnace Shei! and Duct Work� BUiA6i -
� !so Replacement Furnace — �o i ��r
(Side Vent • Pil1 O�,t Back}
�as Piping (PEeedeti with r�ew furnace,
but not replacernenty
�as Ran�e
�as Dryer
0
F �ir CondiUonir.g - All Sizes
Rate TOTA�
� 34.00
$ 14.40
� io.ao
; I4.00
$ 25.00
.!I Ot�►ers/Rspairs & Alterations {US7 ON BAGK)
1q, af Vai� of Appliance cr Work ._-- 3p p0`
�mmerciai!lndusirial
�.2�i� of Vatue �f Appliancs or Work
a
�
�
0
}
�
V
State Surcharge
TOTAL FEE
't •- � . ��_ .� , . 1,
. i � • , � - � �� � � � .. _; ; �l�
�
, � _ L ; �_ .:
� :1NSP�CTIQN F�E �47.00/Hr
r•i
�,
ir Conditior�ers c�� Rot he �laced in a side yard witf�out
�-itten permission irom adjoining praperty Qwner.
�
i
�
� �
'' �c
'� �
$ 3v
$— � Q _
$
Effectiva January,l, 2004
JOB ADDRESS_ _ � �I U � (, Yj�� ��� �,�
BUIt,DiNG USEO AS�
a �
ESTtMATED CO$T O O PERNiIT N0. �'i��I -' /-" -
QESCRIP7i0`I�,,,, Of F,�UR1�lACE AND OR BURtVER
No. �f Fleating U�its Circle One (Steam} (Hot Waier) (Warm Air}
$ Trade Name S�� �o.
BTU HP �DR -_�.
$ Fuel _.___ Total Cor�ne�cfed Load
� 3p
S
� .50
� _,1
8urner Tra�ie Name __ ,_ Size N�._ _
BiU HP EDR ��
�
'iE�e undersigr,ed hereby makes applic�iion for a�rermit ior ti�e woek herein
speci�[ed agreeing 4o cSo �1i work in strict accordance vriih #F�e i:ity Codes an
rul3�gs of the Buiiding Division, and he�eby �eciares tha! atl the facts and
representations stated in this applica4ion are iru� and correct. �� jo?��`�
N�nnrc co 1�V o �
Si - i�
FAX#— --
�`�TE ��� � d –
I�r��
iEL # �
�PP�'�d �Y..1.�� Rough•in Date� FinaE Date �
c.G� ' d `lk1!_L�1
��:�. i���.�%�% Mdia'�a i.�K �11.:rG6i IIM IYfIC'rIM O�LP{11v11'eV � vo..�. v�s�a�.��.�.... . do. .�•....... �... ...�
APPir1CATi0N WItJ. 6� R�TURNED
„�;a� l�� l ► �� � •: �#+ �u: E► _ � l. W ���
yy� , the wndecsigned hereby verifies that the
y�e�y�g h�g b08t� 9�if18d A�1d iS f!'� fi'oR� luSt, d8t�170fation, ob5tftlClioCis,
�d is sepNeiy suppotted aryd frestopped whet�e required. Yes ( i No {)
'i?ta ventir�$ systsm is plastirlPVC ar�d meets aq current codes and manufacturer
��tio�S includitt� sizir�g, iength, number of etbows anci termination. Yes ( 1 No ()
Ttwa��igned also v�ifies that the reptacement ur�it is a�sted �ssembly
a�nd meets the current �des �nd marsufacturer's spedfrcatians. T�is does
ir�de pGA.GqMA Category J Central Fumace Venting Tab�es for far►
asaisted and a��huai draR appliances.
� is six�d and instaA�d to meet the current cotles
and mat�ufacturcrs s��c�ficatia�.
VVl1�ic1 t�qt�ired to ' '' wiU be sf::ed and i�stait�.�c9
tca ttl�et the curtent �odes and manufacturer's specifications.
Yes ( ) Nc ( )
Yes(?No()
Yes ( ) No t )
yy� , the unders�i�ned hereby verifies t�at
� is a�isdad assem�ly and mieets tt� cum�t codes and rt�anufa�huers
specirycatirons, i'his does include AGA•GAMA Categary 1 Ceniral Fumace
Ver�ting Tables f�r fan assisted �nd natur�l �ratt appliances, Yes () No (}
Is the comrnon vent and vent connectors sized and instaNed correctly aRer
an e�t�tisnce has been removed from ttle common vent and vented
separafiel� z�s per c:utrent c�des. Yes (, ) No (: }
_ ♦ � � " � �S' ♦ ' . � ► 4- • If ll' � l '� 1 . • � ' 1 •�� �.' M ♦ / 1 /fl .l • /
A�iar�ce #1 Ty�pe BTU Input � Fan Assisted or Nat
App�at�ce #R2 Type BTU (nput ,,,_,.,� Fan Ass±sted or Nat ",- —
App�atice �i3 Type BTU Input � Fan Ass�sted or Nat �,�.
Totaf Appliances Tntai Btu tnput �
Common Vent Type Vent Height�,,,�„ Diam�t�r�„�, i�chQs
qpplia�s #�I i/ent Corut�tor Height ,_„rft Len9th ,�,n Diameter �in Type „�
App�Ce #2 Vant Conr�ector Height tt Len�th ft piartteter in Type �
Appi'�ance #3 Verat Conn�ector Height t� Length H Diameter ,,,_�,in Type a,
�- , � t • � �.� . :*�i
c • _ ,I�
r
_, - �!/%.`/
� T'l U
Dafe : %��,��,(�
c����'d 05�tiL��9L Ol J,3�iQI'�� .�0 1,1I� WOcI� Sb:£L b002-0Z-H3�
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-3604 FAX:
ADDRESS : 6963 HICKORY CIR NE
PIN : 153024110026
LEGAL DESC : REG LAND SURVEY NO 020
: LOT BLOCK A
571-1287
PERMIT NO.: 2004-00231 � �('��
DATE ISSUED: 02/18/2004
PERMTT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
' CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE.
REMODEL - ADDING 2ND FLOOR ON HOUSE
# INSPECTIONS
APPLICANT
T W HIPSAG ELECTRIC
17286 ULYSSES ST NW
ELK RIVER, MN 55330
OWNER
LARSON KYLE R& GINA M
6963 HICKORY CIR NE
FRIDLEY, MN 55432
2
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time a8er work is commenced.
I hereby certify that I have read and examined this
application and lrnow the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
STATE SURCHARGE, ELEC FLAT
ELEC PERMIT FEE - MIN (RESI)
TOTAL
PAID WITH CHECK # 25559
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
��� �%�l�
0.50
40.00
40.50
�
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�z-36u4 r�ax:
: 6963 HICKORY CIR NE
: 153024110026
: REG LAND SURVEY NO 020
: LOT BLOCK A
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
571-1"lIi7
PERMIT NO.: 2004-01774 ��r� 1
DATE ISSUED: 10/OS/2004
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114-
OWNER
LARSON KYLE R& GINA M
6963 HICKORY CIR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances goveming this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERMIT FEE - MIN (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 118132
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
20.00
0.50
20.50