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AF - 45683�� Cl� Of FPI�e�� MIII.II. BUII.DING PERNIIT �t�: ..�. -..��.-.. ��:........... � N° 3940 owner . . . .. . . . . .. .. . . .. .. .. .. . . . . . .. .. .. .. ... Bu�a� . �i�� .. . ��?�� . . .. .. Addre�ss ...................................... Addregs ............................................. , LO�CATIO�V OF BUILDING No. �9 6i .l./ . . . . Street . . . . . . . . . . . . . . .. . .. �� . . Part o . . . . . . .. . . . . . . . . . . . Lot . . �eJ. . . . . . Btock . . . . . .��. . . . . . .G� . . . . Addition or Sut�Dfvision . .. � . .�� ... + . � � / � Coraer I.ot ........... . Inside Lot .......... Setback ��.. 5ideyard C.�...� ............. ...... DESCRIPTION OF' BUILDING To be Us as: � �. . . . . . F'ro� ��; !d yDepth °J.�. .'� P%' � Height `1.': .`�.~ Sq. Ft. /�/. ! . Cu. � . . !. � P..... .. � . �' . Front ��. . :? DeAth ��.� Height �Q � �: Sq. Fk 7! ��. . Gti. Ft, �,�o? Type of Constr�iction .............. . ,c°� • . . . . . Fs�. � !.� . �°a.� . . �I�'I o be Completed . . . . . . . . . . . . . . . . . . . In consideration of Yhe issuance to me of a permit to construct the building desribed above, I agree to do the prop�ed work in accordance with the descrIption above set forth and in compliance with all pro ons of ordinances of the dty oP Fridley. . �. . . . .��:� . .. . �. . . .� . . . . . . . . . . ,.J� � In cons�ideration of the payment of a fee oP $. �". ,�. . . . . . . � permit is hereby granted to . . . . . . . . . . . . . . . . . . . . .. .. .. .. .. .. .. . . . .. .. . to construct the bwilding or addition as described above. This Permit fs graz►ted upoa the express condition that the pereon to whom it fs �an� and hfa agents� employees and worlQnen, in all work done in, around and upon said building, or any part thereop, shall c�nporm in a]1 respects to the ordinanc�s of FridleY, Minnesota. regarding location, construcl3on, alteration, maintenance, repair and moving of buildings with- in the dty limits and this permit may be revoked at a�y time upon violation of any of the previsfons oF said ordinances. NOTICE: Thla pe�mit does not cover the construotlon, InsEallatlon o� alterat(on io� wl�ing, '� sawer o� water. Be sure to see the Building Inspecto� for separate permlt� fo� these _-.� � ,� �.� gas heating, r •� Bsf o�.�r�' 4', Os T.��A:� y' �� Ti�1r�o .�1 �� b� r; i%� �v� INDU87RIAL C • E . �C O U L T E R ". :.. � � � � ��P��'�N� - . - eusiaess CITY LOTS - � - LAND SURVEYQR � � FARM BURVEYB - . � . -UlKEBMORE 70Ewm�U►PHtc MwpplNO` . � REGISTERED UPIDER LAWS OF STATE OF MINNESOTA �untC�n� -, �' . - LICENBED BY ORDINANCE OF CITY OF BlINNEAPOL�B 330� LYNDALE AVE. SO. MINIVEAPOLIS 8. MINN. TAYLOR 4-037Q S u,� vE Y Fo�� /�'%�r� C�L f� .�� g,�•� �� :io� = � / ��'<<- / = 30 �r�-' �' °, (� ��f d � . � f� � 0 � ., � , ,.:, � �, ti., �'�a �,, _ � � �. . . / / .�_ o�b �. �' D°Ib �h��b "�' � �� l C�j � L 1p6�� i �/ � � �! / 5 � � - , �eu � � d �� hereby certi fy tl�t tfie abov� i s a true and correct pl at of a survey of : LQt �''ifteen (1�}. �lock Four (J�)s 0.SZT�',.ATJ'S THIRD ADDITItnJ ,�noka, Gcunt;, l��inne�oter ��urvey�d by me this lOth day c�f D:py 1q58 .�:lj. �� _� � � �� d .�- �5/�10; �S�'d�'�G' �. �, ri'•i � '� - � . �, . � �te Ree�i� Id�. aK6� , e, i o ' � � � • � N U � L'J � � � � � p � : x :� . „ • O . � � ry� F+ H � � w � � �, � � �. � � N � . o . o � . o � ��] : : Cy . . 0 � � � p� � � O O O � $� Efl � � N � � � m @ � � x 8 � � � � � � � �� y ��: � � � � . o � � � � : a � � � � �� a ° : �. : N . � C . � . �0 ; � . . p . . : � • . . . � � � � � � � W N CA I-+ ►+ t�+ �J � Q � C O O � &9 ty .� � (� H � �� n c � � I--r p F-+ � � � U7 � ro �� a �� I I D '="' r � --� m N 2 ni C r m �. � � I� p � � Z � R' `* � .StOT�83 � � WATER M � � CLOSETS �e � � URINALS m � �� o �'� �p �� SINKS WASH �l0 � TRAYS (d DRINK. FOUNT. SHWRS. �FLOOR DRAINS �CATCH �y BASINS tf AUTO � WASHER GAS � APPL GAS RANGE GAS OPENINGS '�1 8P 2 � � � � N r�r 8 p �� o � � � �� O M z � �, a � � � �p N � � � � � � ro g � � � : � � �! • '� e�p �a(yp. : 0 ch �'! y : \ � . ; � � ew� a R�+ � `9 y � O �. � � � t6 ��7�� . �� y � � a �' � � �c � �°°�.� m � � ��'m � �� =' `�' w p � w o � � � � fD p' "y, o �� f1+� �� 1 � � �'* �*- 0 �-e� � � � y s�� 0 �� pr � � �� 4J�� '° � ,„ � � � � � b a� rpz Ap p � �h Q M� � •a � � � 0, � � '� (7 � � �- � o � � � T �Cj Q„ a t%' V• � � � � M W � �. � �. � � �, �� \ q A ` � �• , o v � � , .�__ � � _ r f+ 0 $ � � � � � � � � t�" � � � �a � � o r� � � � � � � o � � � � � � � � � � `ry�i � �n � Hy � t' � � V � � x � � �� e, 5,. � �� . � O r � � � Od � � J o ��, � � W N ; r� �'' o °o � w � g �° � � � o � � � � � o � q 0 0 � � � � J� � � � � . 7O , `h ` s . c� . � : � . i/1 . . . � : �„ : : : � : �' : : : , �� 00 � 0 � � o w � � a � � � � R+ cD � � � ;C � � � " � � � � � � � ►4b �i1 o � � � n � � � � � � m � � � � � � � � � � �� ' �� •�'�� ,�o �'�� y � �� '�� G� � ��' � � a � � R' � � o o � � a � � � o �� g � �,� � 8 � �� . � � �.,. : � a � ' � �' a. �, : � � tn : r� P' en . : � o : . � t» ,°o : �y� O Cj . : O O p. . V � . . . � o . . . � o : � : � o : : : � : : : ' : : : : : �, �� 0 0000 i�i � � ti � � �A � � � o �q x � � � � � � � � 0 O � � � � � O � � o � � � O �tp S�' R, �g �. � �� og000 R a� � 'p. � � � � � � �� 7 o � � �� t � �� ° a _ m I ►+ �+ I � C � � � � � �000 G O O O � 0 � �� ° �� H � O � �•� � d� �'�°� ��¢� O y C py� � R� � ^`d ��O.yO � i%'i � � �� p� �� w �ip.�p �� ! �� A ��.�� y �A� w�-� � ��o � � t� p. � � �� D � � � m H _ m C m d � �. o� T b% � a ra A O ' .. � `"- a �� . � � �� . � � O � ao �� 'w � W ; �y� �H ^ •• � � �. '0 � � e� .3i � � � �o � � �'. � :!. �,��-��.> e O � � Form BD5' ��ZF�7''�G%�y G!,�!'C�k—t►'�'t — �,.f��'��'s� .'�� °� �1�11 OSS CALCOLATIONS BUIl.DING DEPARTMENT - �.�� We�hers��ips A.S.H.V.E. Construction No. Guide Windows Doors Reference Out. Wali Int. Wall Ceiling Roofi Floor Kind Yes—No Yes—No 19 j.� FI. ��,�,ur,C�' Room � Length �.� Width Windows nd Doors—Cracka e and Area WidTh Haight No. of Lineal ft. Area No. of pane of aana liahts of crack sa. ft. Infiltration � Glass Exp. wall �� f � Net exp. wall �; �: wall �s Flaor � 6�. Ceil. Total 6tu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / FI. �,�'-� ,� � p Room � Length �, � Width indows nd Doors—Cracka e and Area Width Height No. of Lineal ft. Area No. of pane of pana lights of crack sq.ft. �� - �� s/vi � ��ii a,� Heignt 7 ' Coef.l �tu X sC � 0 7 T� Neight ,� Coef. � Btu Infiltration � �� Glass � a� � Exp. wall � ^ Net exp. wall � j Int. wall Floor � � Ceil. X � Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / FI. Room � Length " Width � �VU'indo 's and Doors—Cracka�e and Area of pana of �� s � � Y k �e � el i o�* Height �` I -- _r_ __ _ Coef. Biv Infiltration p �/ �p Glass � � Exp. wall �, �r �e � Net exp. wall ,� �� , Int. wall � � � � Floor � Ceil. � � � � Total Btu. �� Required sq. ft. E.D.R. or sq. ins. W.A. Leader area � FI. No. Insulation How Room � Length �'Lf Width iors—Crackage and Area �ht No. of Lineal ft. Area ine lights of crack sq. ft. �ALLEY, MfNN. Height � I I � Coef. Btu Infiltration � , � � Glass �� Exp. wall ,� � Net exp. wall �� o� Int. wall � � �; Floor � �.—� Ceil. ,� Total Btu. � Required sq. ft. E.D.R. ar sq, ins. W.A. Leader area / FI. ��F Room � Length Width � Height � Windows and Doors—Crackage and Area Width Height No, of Lineal ft. Area No, of pane of pane lights of crack sq. ft. i �� fti �.�/ �'.r./ � 7 s' Coef. � Btu Infiltration I / , � • � Glass �� Eup. wall � � � � Net exp. wall � �� Int. wall � � � Floor � � Ceil. � � �. � ! Tetal Btu. � � f� Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 9'� � ,� FI. �� Room � Length �%p Width �� Height � of pane of pane �� Coef.I Btu Infiltration ��,,� � � � Glass � - � Exp. wall � x � � � Net exp. wall �� Int. wall � y u � ', Floor � X � � Ceil. � Z ��, Total Btu. � �� Repuired sq. ft. E.D.R. or sq. ins. W.A. Leader area Form BDi� _ t+��l'f'COSS CALCULATIONS BUILDING DEPARTMENT 60LDEN YALLEY, MIEIN. r�-' � We�$herst�ps A.S.H.V.E. Constructian No. Insulation Guide Windows ' Uoors Reference Out. WaIC Int. Wall Ceiling Roof Floor Kind How Applied Yes—No Yes—No 19 � FL �� Room � Length %� Width �� Height �, FI. ��, Room � Length �'/ Widfh % Height ,s! Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Height No, of Lineal fF. Area Width Height No. af Lineal ff. Area No. of pane of pane lights of creck sq. ft. No. of pane of pana lights of crack sq. ft. �i � �So� �°o �O / ;�� % � �i D: G /� � �=.� . � , � �� f� � Coef. - Btu Coef. Btu Infil�ration ��o � ��D Infiltration �6.� � �� Glass �G // 7�• Glass � �� Exp. wall � � ;� � X Exp. wall � � �. Net exp, wall �/ �. Net exp. wall � �� Int. wall �t x� Int. wall � y. ,� �, Fioor y� Floor �- �e � Ceil. j� � l� �.pe Ceil. � /� � Total Btu. � �. Total Btu. �� Required sq. ft. E.D.R. or sq. ins. W.A. Leader area � Required sq. ft. E.D.R. ar sq. ins. W.A. Leader area � FI. �� Room � Length � Width /� Height �. L F� I. �� Room � Length �� Width /� Height , Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Haight No. of Lineal ft. Area Width Height No. of Lineal ft. Area No. of pane of pane - lights of crack sq. ft. No. of pane of pane lights of crack sq. ft. "�i / - %� . � /'�a !� °� (o F�// %h`. ` �— 0 � �%�' / �: /'' Coef. Btu Coef. �tu Infiltration ,� � �p� Infiltration �, � ° � O Glass �� / �j Glass a� Csc�� Exp. wall �� ,� �t .t� Exp. wall � s1 �f y Net exp. wall 0 �. Net exp. wall ,� /�, °� � Int. wall � � Int. vuall � k X� Floor 1( X�� Floor c� � y y CeiL / � Ceil. � � /� j�- Total Btu. f � Total Btu. � �Repuired sq. ft. ED.R. or sq. ins. W.A. Leader area � Required sq. ft. E.D.R, or sq, ins. W.A. Leader area FL �� Room � Length e� Width � Height �FI. ��'.B-�/ Room � Length �� Width �� Height� Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. fF. No. of pane of pane lights of crack sq. ft. i / d - �1/Lf, v f � l /� . �s� � , S -_ - � — - - - - — - --;' - ; � Coef. Btu � Coef. Btu Infiltration - � � f / Infiltration / s � Glass � �// Glass >� d � Exp. wall �C ��c Exp. wall � k� y Net exp. wall / Net exp. wall ..� �j Int. wall � u X� Int. wall X y� �- Floor x X�c Y Floor �� Ceil. /� � Ceil. 9 � �� Total Btu. � p Total Btu. ,� Required sq. ft E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. 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FLOOR DRAI NS CATCH A e�ws � Atrro WASHER � " 1.' GAS S sA APPL � GAS RANGE G0.S OPENINGS a • z + � �m � � A �❑ � � � � o � o � � o ��; �? � �° � I �' � � �. ¢�� A�p n � �' y � �" � � � � �' � � � aa �, � � o � � ��,q�� W 05• ��y. t�..er.� � y �Q F+• 1+ �' W o m�a� g I ��o�. �- ^� � �° a � 6I ,JN T ;-� � � �� r+ o � 1 � � �� F� � ��oy a � fD � � � � �a � � �°*° � � � � � � b � � ,� � � �� G �� w p ` p� w 0 ° �p,ots c�o a ° �7 ��w � � � �. m a� � � � cr ,� H y � y � �A� �� m � O 'O'! tpwf� � � . F'' fD �J� f ,' � •�'! s�'1 � 5' C �' d �� . � ��a Rx �� p � M � � � � �� • $ � ^ C �: �•� •w �1 r/ ' � � � Q � m 0 0 �� M � � � ro � o � � A �� I ,� V O � '� � � =a `�"p � �. � d . ' e �)� .�� r ��1 r _, sue�ECr PERMIT NO City of Fridley 18572 ' AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ;, ,� � ; L __�___ COMMUNITY DEVELOPMENT DIV. / �� r � � PROTECTIVE INSPECTION SEC. � f�(PI S � i � l•-__ A ��'��,,� CITV HALL FRIDLEY 55432 NUMBER REV. OATE PAGE OF APPROVED BV i �� 612-571-3450 910-F15 7/30/86 / / JOB ADDRESS 6g18 Hickory Drive N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. �.rJ 4 OS�II�S Third Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bert S�venson 6918 Hickory Drive N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO. Richard Hastings 6331 Ri.verview Terrace N.E. 574-9966 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDIN(3 Residentiai 7 CLASS OF WORK ❑ NEW ❑ ADDITION �l ALTERATION ❑ REPAIR � MOVE ❑ REMOVE 8 DESCRIBE WORK Reroo� Dwelling 9 CHANOE OF USE FROM TO STIPULATIONS Roo� can be the 2nd layer but not the 3rd. B� Install ridged galvanized valleys. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOfi A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. • N0. DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ], STALLS GAFiAGES AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES OOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S2rSOO �`I..ZS 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`3S.SO ' LAN CHECK FEE TOTAL FEE ��,..�°% % � � «�' $3 9 . 75 SIGNA7UREOFCON7RACTORORAUT aiZEDaGENT IDATE� WHEN PFOPERLY �C�IDATED THIS IS YOUR PERMIT � _ � � � t .� U SiGNATURE OF OWNEP iIF OWNER BUILDEFi IDATEI BLOG �NSP rjA N� �� City of Fridley Effective 4/1/86 ADDN. I l R-1 AIiD R-2 pLTER. [ 7 Building Permit Application Construction Address: �� / C�o��! 1��> /� �� Legal Description. L o "'� � S � L � � � � �5�r��•a �crs ''rf� � �2 � f� d . Owner Name & Address : '°� �= �� "�'� ^� S�' � Tel . # b Contractor: � f c G� A�� S 7'�� n/GS Tel. # S��`� "�� Address: 6�� f t� �� tZ �1' ��J �� i2 LIVING AREA: GARAGE AREA: DECB AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, With the proposed construction draWn on it to scale. DESCRIPTIOp OF IMPROVEMENT Length i�idth Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setback Type of Construction: ��A-� vFt- c� [Z � t�oc� Estimated Cost: $ � S� �� Approx. Completion Date: T � �� Alt. A Alt B Proposed DriveWay Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: � 3� � APPLICANT: �`�� `�''� Tel. 4 � � � � �1✓G�� CITY OSE ONLY Permit Fee � °� �? •� U Fee Schedule on Reverse Side Plan Check $ 25� of Building Permit Fee State Surcharge $ f°�� 5.50/$1,000 Valuation SAC Charge $ $475 per SAC Unit Park Fee $ Fee Determined by Engineering SeWer Main Charge � c � %� _ Agreement AJeeessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: _ � r BDII.DIAG PERMIT FEE SCHEDIILE 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-vit: Total Yaluation �1.00 to �500.00 5501.00 to �2,000.00 �2�001.00 to $25,000.00 �25�001.00 to �50,000.00 �50,001.00 to $100�000.00 �100�001.00 and up Fees �10.00 (Minimum Fee is �15.00) $10.00 for the first �500 plus $1.50 for eaeh additional �100 or fraction thereof, to and including �2,000. $32•50 for the first �2�000 plus $6.00 for each additional �1,000 or fraction thereof, to and including �25,000. $170.50 for the first �25,000 plus $4.50 for each additional �1,000 or fraction thereof, to and including �50�000. �283.00 for the first �50,000 plus �3.00 for each additional �1�000 or fraction thereof� to and including �100,000. �u33•00 for the first E100,000 plus $2.50 for each additional �1,000 or fraction thereof. DRIVEHAY DEPRESSION ESCRO�iiT (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - DriveWay width plus 6 feet times $13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach kith 6 inch depth - Driveway t�idth plus 6 feet times $15.75 VERIFICATION OF FOUNDATION Permits for construction `ill be issued a minimum of 24 hours from the time of application to allo�a for pr��ser �evieW 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. � n � rt" rr � � ro � � O �� o � n � K � rt a� Wro � � a w � � � � ti � c � a' � � rr i . � \ `. \ r N �� o h! �� x �� ' z � ro en � H W � i 0 0 � � � ,.� H !n Q r � ro o °' � t,�,o � � ro w o r C � . � o � n ro a � rt rt t c� � f 1� � 0 a W � M � � �u . 0 a rt m W C O � M � a � � w a � � � ~ w 2 G] ��„ W A �x °' � � ro a � � G z � � � / �� a . � N � I � � (��pt � 9 N r�r � z t� �r �i � a � M � w � w � t�u � m w z � c o � � •° � � � � r o � � � w � m � � n rt w � � m � in r ' � 0 0 o rt � a rt m � � � .7 W m iA i/1 t/! �..^ O o d O r �da M (] C � a � � � � 0 M y ro � ro r w � ID M 0 r1 x � d y � � N W p � � � � O O � H y � � � ro °r� � H o � � � � H � x o i � ao� W � � � � � N F�+. �r n � � O r°,, � a Cm rt �� o fD w �� n `� � °' a i° Q+ ~ "a F+ N� A 1t fD �n � ►�i rar O p Xw � � 0 0 0 tn +n a a w cc � m m�`o tn n n Cy k �ro � w . � �i � �C � � ro iu M ��w �x � � o r ,y r � �µ aa n � �o a M rt rt � �� w x :°. �. � � � � � r r n� � 0 0 0 0 . 0 0 o p � �v► v� tn tn � w � �o m w c� � aW � ~`�a z ��ry � W N p J M � a�aa r� M m a M w w� M MtkD W � �M � - � w � � � �a � w °' � � �ro�n � � � �S o � SP � � E mc��, � �� ~ � rF (D � � wr°nZ�W w �� wy w h \ � ��o � • �y fp � ,y ` m ra a o � � ao � zi � ��g�y ;, � P� 'G f�D F- H ` c�o aE'� a c� "' o m �e �� mx� � �mmW � (Q�'�w� u�i � M fT �C 7Mi' N K a � x � c�i r a n � �r m m � �' �a' H O � 0 tr a � m m 1 0 v � �' � r m c� ti � S O � z r O i�� O � m � D � � � O t�i� Z C7 � � Z --I G ? a � � z � � .� ► N m—I n 3 O y r d � m m < Z n � m � � � 0 z a m -n .:7 � m z D � 0 z D Z C CHIMtJEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or s tack; 1. Has been carefully examined Yes (9� 2. Is free from rust or deterioration Yes (�) 3. Has no foreign objects lodged within Yes (� 4. Is securely supported Yes �) 5. Meets all current Code requirements for size and total BTU connected 6. Has Total hea ti ng BTU' s of /�'j_ o-�--r� All other BTU's yD_ �-c� TOTAL f�� 4� Rema rk s No ( ) No ( ) No ( ) No ( ) Yes (� No ( ) Com pa ny � �% � Signed By _ Da te %/� ��`J' - - � 0 C l"� Q N n 7e" r. f�'D 0 � � � m n � < A 3 � � O � 0 � � � m A � �. � , � d � � N . c � w w �� O �� ' � 0 �� M � R �� w� � � �o ° m w h � � m � � c r► � M N3 N � O '�J , y �e� �� y n� x �� n � H N N M � 0 0 A W � r �ro � m � �C 1 � � � O �r � `' , W M N r, _ � a o .° �° K b � � rt K � m � 1 � 1� � 1 ,� C � � a � ►��. � ''' � � y � I `� �C � M � � W tD► O z a r�i � � a a � � � n � ,� � � � � . C g oz R �] � m � R �0 N M � � � m � ca � m a � � � � � °� � � G� 1 r � b � � w p � b � � � � m N �► � 0 0 � � � � rr m � y G n 'J' W m N � N v\ • �1 O C� G 1 � C M � � � H .� � � 0 � a (� � � � � y �: � r m M � W C+ !r � � M y b H �O �! w �. � � � N �' � � d � � � m C ri O Z � � � I � � �r � O f� O Mm a a� w r �o 0 �'�O 1�+� MM a y °D a �a ~ �w� m W m � m K� r O � i�C � � r 0 0 0 � � �± ai c� oo � � owo m$ m �t K O�q O�y '�U'� R7 �ry � �; �C p � �O M � H w �i m�w' �� o� N � � � ° �g � n � n rr �o � X � $. � � � � � � 0 0 0 0 � o °o 0 0 � � � � � y ^•. O � � � � 0� C7 h7 . ry� In+� fD on a tc r3 r r� �p m C M�• ac O W c� � a f �n� � m�0 Oi wW� A G, O M �'4 fp �C O O � '�i O p fp .7 �C tp �y � �� 1+ p �f W ? W O M � 5��'�' m N m � ~ � W �K � r � p~, �� C '7 �, `J M � � � m � � � � �) • wmn5 � � m � r w m o � n ca g '� z � R SM � Nl r` � � � �� r ��o m �m�� mmm � 0'��'S `" � O R K f�S � ►' � r m � � r�� O O' � 0 m � y 2 � � � r n a -i O z O 7G O � m � a� a z �� N 2 C ZD -1 C O S Z 9 GZ'f � 2 N � � � N �1 f'1 [T1 O 3 O N � d � m m C � f'f .r m � N "'� O z a m T 70 G9 m a a � O Z a z 0 CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the exis ting chimney or stack; 1. Has been carefully examined Yes (,) 2. Is free from rust or deterioration Yes �) 3. Has no foreign objects lodged within Yes () 4. Is securely supported Yes () 5. 6. Meets all current Code requirements for size and total BTU connected Has To ta 1 hea ti ng BTU' s of All other BTU's TOTAL Rema rk s No ( ) No ( ) No ( ) No ( ) Yes() No(j Company Signed By Da te 4� sue��er P NO.- City of Fridley 2 8 31 � � AT THE TOP OF TME TWINS g u I L D 1 N G P E R M I T ; � RECEIPT NO. � `L _�� COMMUNITY OEVELOPMENT DIV. � r � � PROTECTIVE INSPECTION SEC �D � 1 . . i-__-�� "' �•� CITY MALL FRIDLE� SS132 NuMB6R pEV D�TE nAGE Oi AvvqOVED Br t 612-57�-3a50 e�aF�S 10/20/98 � � lOB ADORESS 6918 Hickor Drive NE 1 LEGAL �OT NO. BLOCK TRACT Oq ADOITION SEE ATTACMED DESCfi. 1S 4 Ostman's Third Addition SNEET p PROPEfiTY OWNER MAIL ADORES$ ZIP PMONE Rich VanHeuveln 1-8562 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Cedar Pointe Construction Inc. 20 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO 5 ENGINEER MAIL ADDRE$S ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CIASS OF WOqK , O NEW O ADDITION O ALTERATION {� REPAIR p MOVE � O REMOVE 8 DESCRIBE WORK Reroof house and ara e(28 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS ' Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQU�RED FOH EIECTiiICA�, PLUMBtNG, MEATIN(i, T�P� OF CONST. OCCUPANCY GROUP OCCUPANCr LOAD VENTILA7ING OR AIR CONDITIONING 7HIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU FT. AUTHOR12E0 IS NOT COMMENCED V�1ITMIN 80 DAYS, OR IF CONS7RUCTION OR WOFK IS SUSPENDED OF ABANQONEO FOii A PER100 OF 120 DAYS AT ` ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNITS OFFSTpEET PARKING I HEREBV CERTIFY 7NAT I HAYE READ ANO EXAMIN�O TMIS APP�ICA710N STA�LS GAiiAGES AND KNOW TME SAME TO BE TAUE AND CO�iRECT. ALL PqOVIS10NS OF LAW$ yp�UATION SURTAX AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMP�IEO WITH WMETHEq SPECIFIED MEFEIN OR NOT. TME GRANTING OF A pERM1T 239 1 20 DOES N07 PFESUME TO GIVE AUTMORITV TO VIOLATE OR CAMCEL TFiE pEqMIT fEE SAC CMARGE PROVISIONS OF ANV OTMER STATE OR LOCAL LAW REGULA7ING CON- STqUCTION OR 7N PERFORMANCE OF CONSTqUC710N ]l{, F3re L�FO __ PLAN CMECK FEE TOTAI FE S�GNaTUa OFCON'AACTOpOAAUTMOp�ZEUeGENf iD�iEi N P PEii LIDATE T IS �OUR PERM17 b �Q- S�GNaTUFEO�OWNEp��FOWNEN8U40ERi �DATE� ' v BIDG NS� q�fE ._ , � rrEw i ] ADDN I l �.�R L l ConstructionAddress: Legal Description: _ CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R 1 AND R-2 BUILDING PERNIIT APPLICATION �� . , , . > , -, _ 0 Effective 1/1/98 �` 6 � �� .�o W7/jJ Owner Name & Address: �/`C�i Ua/�iQGt�/e�r! �9' /i%c�-vs-�r ,�7Y Tel. #��%/��,.5"�Z Contractor: C2a��/' /�diyJfC CO'/'lS�/'t�fC�'i'�r�. l�/G� MNLICENSE# 2��'��-�� Address:��G�J �/ 6��y S� , �.S'�a��fe %�/Z Tel. #�'8C% %��% Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT I.ength Width Height Length Width Height I.e idth Hgt/Ground � � �� ; Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: Estimated Cost: $ �� s�9 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: �0.�� APPLICANT. � � � � %�9 ° 79i% 6 Tel. � Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ S-, $ a- �a $ /��D $ $ ��D $ $ $ $ $ ��-3S CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1�0 per SAC Unit � $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary (] Not Necessary [ J �, . . .� BUII�DIlVG 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 $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 � $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 � $5012.25 for the first $1,000,000 plus $2.75 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 $13.50. 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 $15.75. VERIFICATION OF FOUNDATION Permits 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 Survey of the lot, showing the location of the foundation once it has it has heen constructed will be required before proceeding with the framing. Building Inspections 763-572-3604 763-502-4977 FAX. —� _ r'I C, _I"�[''.ti SiTE ADDftESS �Q THIS APPLICAIdT IS: OWN.ER/ TENANT From: unknown Page: 2/2 Date: 6/29/2009 4:37:47 PM 1VI�+ CHANICAL Pe�it No.:.� RESIDEN7.`IAL APPLICATION R�eived By: CITY �F FRIDLEY nat� _ I� OwNER YOUR &M�L ADDR6S5 � ,C CONTRACTUK COMPANYNAME: � ` ' -- SUBMIT A COPY OC ��'°�� PERSON: YOUR STA1� STATE LICBNS E# � fl�T� LICENSE WITH L%\ CI'i'Y STA��ztR� ADDRESS. APPLICA'�ION PHON� � F� PERMiT TYPE '� °"""' TxrE oF woax: O1�"' )ETAILBD DESCRIP(TION OF FAMiLY � TWO FAMILY ❑ TOWNi{OUSE O ALTGRAT[ON/RBMODBL � F1;E9 ARE BAS�D ON 91dA0 PER FIX'!'l1RE. ICXC�1�'1' WHERE NOTL�D. FIX'1'URES: ON�iG►TC TOTA4 NUMlBEAS �� BELOVI� 6wtpment Inatapeci MFd: MOD6L: �,� MFCi. MODEL: SIZF/B'l1J - MFG: MODBL: SIZFJR'fU ✓a� ��.ap ,FIREPI.AC6 (GAS) $1 S.QO _,GAS W1NOE/QVEN $10.00 AIR TO AIR EXCHANGfiER $IS FIREPLACE (VNOOP) �3S•00 NEW C}AS GR1LL 510.00 ✓FURNACE $35.00 QAS UNIT 11TR $IO.UO ,BUILER $35.00 �y� pRYER S 10.00 POOL WEATi:R $35.00 �CHIMNEY LiNBR $10.40 QAS PIPINCI $10.00 ~VEN7'1LATOR$15.00 DUCT WORK SIU.1l0 Number aP fixtures @$ i 0.�0 _.___, x$10.00 =$ Number of flxtures (� $15.00 „�, x$15.00 = S Number of £ixtqres @ �25.00 ` x $25.00 � $'�'S Nutr�ber afflxtures Q$35.�0 � x$35.00 R$� v State Surch�tge = $� .wAn►rriun r�,r �C�+ Caa en1 '�"r.ral m � � o �� TH1S 13 AN APPLICATiON FOR A PERM[T-NOT VAL1D UNTIL N1tOCP.SSED 1 heraby apply for a building permit and i acknowledge that the information above is complete and accurate; thet the work will be in c�nformance with the ordinances and codes of the City of Fridloy and w'sth the Minnesota Construction Codcs; tltat T understatfd this is not a permit but oaly an application for a permit and work is not to start ith�ut a permit• that the work will be in accordance with the approved plan in the case o all work w h requires review and approva plans. SIGNATUREOFAPPLICAN'f�� "`+�� PRINTN DATE�j,L�_. City of Fridley Building Inspections Department 6431 University Avenue NL, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977