AF - 45853City of Fridley, Mirm..
BUILDING PERMIT
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Owner: .... ._�.�..'.."._ �-::�_:,� ...._�'::¢..:«..::.����`s�'•:��--�`--- Builder
Address...____........._....._...�_.._.._..__.�..._.�___ ._........... Address
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, �.�_ _
N°;�'`! 4996^
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....._.....�._.,��:e�.�'-_ � .---�°��''-'��� ---
�� ,,�,� �ft,� 40�TION O �BUI4DING
No. �..l�}--���-. Street ....._�,� r.r..r .:-�;�__.: ..._ .. '. � .�..__........ Part oP„L�ot .--- .__---------_._----�� ---._.----
/' �'�'�-- - �-� _._...
� � .........._.. Bl�l{ ....._...._.... ._.. ' � r -,owe�� � _.
Lot ----�- �. t� �-- � - � - - ---- ,�„ .,.►� �::::.--o- --- - .�+�':..�raCr�:._�-'-"-��
tion or Sub-Drvision _... _:� �-�:� � _
Corner Lot .........................._...---.. Inside Lot .............._�.......... Setback ...__ ...�''�.:�!....--------�---.... Sideyard ..._�!.°.. �'_.'.�.%�'..rs�.�..�'�......... �.._...
Sewer IIevation
Foundation Elevation
DESCRIPTIAN OF BUILDING
To b�j Used as. �r
,� 7 j/ * � � q *f� �,, i-, / �,,.
.._ ��..%' �r..'�� Front i... �r...'_.. Depth . .�.�. ��g Height .�i.--..
- -�
,� ��{ �
-� -� ... �3�--°.,: �:/.......__ Front -..�-�...:.�1"_.. Depth �-�.�, .r....,,� - - Height -.� �-� ---
�e �
of Construction .......'��'=►��,t'-.��:�...... Est. Cost.....f��...f�'��-�!'�..�_.�.�'._�".'�-
/ . # � �
w�. �. !':_. .�.� �+_..��11. �.. .!'."a/...-��
Sq. F� .�' ,�� Cu. Ft .__�f?.._�'�'�
To be Completed
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley. �
�.�._---_....---._..._..___.._..._...___._._....._._..._._.....______�.�_.._..Y._._
In consideration of the payment of a fee of $..�::..�._.��...., permit is hereby granted to..._....._.....__.._..._.
_._..___.__.._.....___..._..._......._...._....... to construct the building or addition as described above. Tkus �rmit is granted upon
the 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 location, construction, alteration, maintenance, repair and moving of buildings
within the dty li�nits and this germit may be revoked at any time upon violation of any of the provisions of said
ordinances. ,�'�,.� � - `°'�
.._ _. �_� °+":` Buildin Ins ctor
••-•-�,�_`7E!�� g Pe
�
NOTICE:
This permit does not cover �he wnstrucHon, instaliation for wiring, piumbing, gas heating, sewer or water. Be sure to aee _
---- - - --
---- ----
-
--fhe Building Inspector �o► separa�e permita io� theae hema.
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C. E. COULTER ""�''"°
LA(VD SURVEYOR ��� ��r8
�sHOaa
RHC318TERHD UNDER LAWS OR ST)1TE OP MINNF.SOTA JYDIpwL .
LIClNBED CY ORDINANCi OP CITr OF YINNIW01.16 �
8300 LYNDALE AVE. SO. MlNNEAPOLIS 8. MINfd.�
TAYLOR 4-0970
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i hereby certify that the above is a true and correct plat of a survey of:
Lot 8, Block 1, OSTA9AN'S TE�IRD RDDITION, Anoka County, Mynnesota.
As s�rveyed by me this 19th day of January 1957 A.D. .
S�.�ned � �
Minnesota Registratd.on No. 2584
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�014°1 - C�iTC� -�'�'t°"MAL1j _ , � � �- �' ;
APPLICATION FOR BUl.�D�i1G PERI�[T
CITY OF FRTDLEY, N�N�SO�
�
�_Builder � ���
�rners Name �� �- � �
Atldress f c�� �' � �� '' .�' °�'���--- ��' .
.Addreas "�
_...._
• LOCATION OF BOILDING
. P ' �?
No. � � St,ree� ,� Y�-`+�'��''�- �. � �'�� � --� Part of Lot
� � .
Lot_ ` Hlock,,, � Addit3.on or S�b.Div. L�P
'-�,
Corner �t�7x�side I�ot_ �,�;_�� Back � � 3ide-Yard_�_,,,_,����,� o' ��'��-� �� ���� .
r� �r .��
3E`�i ELEt1ATI0N FOUNDATIDN ELEVATION . .._ ��
Applicant atfi�ach to this form Gertificate of Su�vey of Lo`t and propose,cl building
loca.tion.
DF�CRTPfiION OF BUILDIl�TG
To be used ass
�'i
���� � ..��.� �'ro�t � (� De th F�'` 7 He3 t �'
.���--.-�- ��_...�._ P .��� �._, �._.. �
sq. �t. ,.,� G,l� %' 9 r` c�. r't. ��� N 3�
�o�t :� �l�— Depth � � � ��.�nt I e> �
r�.i� '�'-�l'•-�%i�� �� .
�. �. �, , cu. Ft. L� �" ��
,
Tgpe of Construet3on �����-� Estimated Gast �;� �„�_�"�_
To be
The undersigned hereby makes application for e perinit £or the work herein epecified,
agreein� to do al�. vork in etriet accordance with the City Ordir�a,nces aud ru].ing of
the Depari�►ent of BuiZclinga, and hereby declares that all the facts and represents-
tions �tat�ed, 3n this applicat3on are t�rue arsd correct. ,
a �
D�TE ��� `� � SIGNATtJRE r�" `Z'� �
(A Schedule of Fee costs ca.n 1� fouad on the Reverse Side.)
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BIIIZDING PERMIT 1�EE SCi�DULE
Section 2.� The Inspector cf Bu3.].dir�s sh�.l.11, before issu3ng any per�cit
for the ereation of aay bui.lding or structure, or for e.r�y addition to
any ex3.sting buildin� or structure, or fbr �,ny alterationa or repairs
�o any e�dsting building or structure, upon applica.tion therefor, requ3re
the payment by the applicant fcr suck� permit of feea to the amount hersin
beiow set forth and in the manner herein provided to-wit:
2.1. For any such permit for the erection of a.n�r f3re-proof bu3Zdin��:other�•
than a gara�e, warehouse, factor�' or grain elevatar, or £or the erection oP
any fireprooP addition, for similar occupancg, to any exiating bui].ding
ahall be at the rate oP .�1.40 for each one thousand cubic feet, or fraction
thereof, 3.n such cubice,l contents.
a.2. For an�r �uch permit for the erection of ar�r fireproof gere,ge, ware-
haus�� factory ar grain elevator; o� for the erection of any f'�reproof.
addit3on, for similar occupency, to ang existing building sha11 be at the
rste of �7..2� for each one thousand cubic feet, classified aa "fireproof" .
by 3ectioa 502 of the Minneapolis Buil.d�aig Code.
�OUSE3
2�3. For a.ng such permit fcr the erect3on of. any, non-f3reproof buia.ding
other then a gara.�e, warehouse, factory or grain elevator� or any non-
fireproof addition, for simi].ar oceupaney, to any existing bu3lding. �
Perm3.t �.1.00 for each one thousand cubic feet.
GARAGES
2.4. For any such per'nmi.t £or the erect3on of any non-fireproof �arage,
werehouse, factorg or grain eleva.tar, or for the ere�tion of any non-
f3seproof addition, for s3.m3.lar occupaanc�, to ar�y exist3ng buildin� �r
for each such building or addition. Ninet�r Cents for each one thousand
cubic feet or fraction thereof, in the c;ubical contents thereof with s
m�nin��m of �.00. - :
For the purpose of computing fees for building permits the cubical conteata
of any bui.].ding or addit3on to a uniform height throughout b�►�aultiplying
the ground area covered from a point six.(6) 3.nches below the floor line of
the basement or cellar to the average height of the upper surface or to the
average height of the roof aurface vf the main gable of a pitched roof,
►
2.5. For repairs or altera.tions to an exiating structure, the fee shall be
at the rate of �3.00 for each Five Hundred Dollar� (�50�.00), or f`raction
thereof 3n the coat of all proposed work.
2.6. In no-case shall the fee
Sect3�:-2" be less than �4.�.
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charged far an� perm3t es set forth in
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�� ,�?'�'�'`i ,� � �`���►�,�r AN.�g� �ATi1�fiG & AIR CONDITIONING '
HEAT LOSS CALCULATIONS ,�/� '°a 327 VAN BUREN, ANOgA, MINNESOTA
� ~% d9'7.:�'„�:� �+- /�I�ea�ti `Ga"*y fa1�'!° - --- . .
, Weatherstrips A.S.H.V.E. ''` �'y�Construttion No. Insulation w�
Guide
' Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
� Yes—No I Yes— 0 19—
Fl.� �� Room � Length �' Width f,�.'' Height �� FI.� Room Length ,p Width %„3 Height ,
Windows and Doors—Crackage and Area Windows a Doors-�rackage and Area
! �Yldth Helght No. o[ Lineal tt. Ares Wldth Helght No. oL Llneal [t. Aeea
No. ot pane of Dane I�Bhte ot crack eq. [t. No. ot Dane ot Dane lighte of crack ep. It.
I, _ �t� ;;� � �� �' .��.,� �� ��' ,�%1� /,% % %/..�
! / �� �G r�''/� /�.�'� 7 �e.,� ,�. ,1'c� �,�if 30.� /gE+
j �fa �: ,� �. � �r,�
� Coef. Btu / 3.°�- �t: � �� � � = v � Coef. Btu
i In6ltration /�. ] /p
Glass ;r.�.� �� ��0
r Exp. wall ° .9! ,�l l� �1
' Net exp. wall ��.¢ �J t�.
Int. wall _ j( *�t Y �' �!' •
Ceiling g'"�• ,� � 'p
Floor . �t ' Y �t ,k Y .
'�, Total Btu. ,$° C►p
�I Required sq. ft. E.D.R. or aq. ins. W.A. Leader area .
� F7.� $ , Room � Length ,i,�. P Width � �5.' Height . �" �' , '
Windows and Doors--Crackage and Area � �,;
Wldth Helght No. o[ Lfneal it. Area .
Na of pane ot Dane Ilahta of crack �Q. tt.
�- � Q ��.� ` � �J� .
} .
� ..
1n61tration „/'6. % . �
Glass /l ,3'� ��% d�
Eap. wall . : p.p°. ' ,1� 1� �G' .'�. : .:
Net ezp. wall ' ' . �i3` /�/ 3�a
Int. wall . i� lt it �
Ceiling %,� � ��- '°
Floor : . �' � �r ,tt.:
Total Btu. . �� :
Required sq. �t. E.D.R. oi sq. ins. W.A. L,eader area . .
F1. /� T"t� �J,ly, Roonn � Length /��"� .Width '�?' �:�' .. Height
Windowa and Doora-Crackage and Ar.ea . . .,
Wldth Helght .. No. ot Llneal It. Area '
No. ot pans o[ pane Ilgdts ot orack eq. tt. �
�ji �- ��7 f�'T� -�I�i�/ -b� � . . �..
� G � o P!!►: % � i /�.
J � 3� �'� ��v Z� � �� � . � .
. Coef. � Bti� �
lnfiltration �C�eQ► �{. _
Glaas '�'./ �% G.�
F�xp. �rall � �.,4. . �.: � �+ �d ',�
Nec ��p. W�li � C.9 i �.3 d►
Ine. wall . �i !1' �}`' +�Q lt
Ceiling /", t:�i!,p
Floor - . ��► _� .
Tbtal Bta. - _ � - - - _ �`'� �, p� . .
Etequired sq. ft. E.D.R: or aq. ina. W.A. l.eader'area
Infiltration �. ° �
Claas [�: � / f3�
Eap. wall � _ �' � � . .
Nec e�p. wall ' �l �./ G
Int. wall X ,JZ �li' � !�
Ceiling 26'� /?.s ..?i%�G
Floor . . � Y � �
' Total Btu. �e/d v
Required sq. ft. E.D.R: or aq. ins. W:A. l.eader area
�1 F7.1 ��'e �/9 Room I LenF
Windows and Doors—Crac�C+
Wldth . AePght '�T o. of
" No. ot pans oL Dane Ilghb
a-</ � � �'�+i�
f�, Wi�th '� Height�;
and Area "
neal tt. Ares
'crack � eQ:ft.�
� � v �
�i
wo�� . o • i . � �+
Esp. w�all , , ,.n� ° �• 1f �t !/
Net.ezp. wall � h► . / // � : ,�
Int: wall 1� �t �t '� Y
Ceiling • ' / � jt? �
. Floor.•'. : . . . � `� lt i�' }�►
Total Btu.. � i> -- � � � ,� . ,� �`tl
Requued sq. k. E.D.R. os �q. uis. W.A: Leader ares
F7.� ,� ,� Room I L.ength / w�a� 3 Height �`
�indows and Doora--Crackage and Area . �
W,Jdtb Helght No. ot Lineal [t. Ares
�� No. of paae ot Dnee I/ghts ot crack eQ. tt.
- � � �' �:) !�� , t'.�`. �? /`d+. 3�
� .. ,� a. F�+ .� � �► h p �' �, :�
. . Infiltr
Glaaa
Esp. evall
�Net eap. wall
Int. wall
. Ceilin
Floor
0 �� e�
Btu
� % Y SF t� �
,G �i/ �c,f,�b
�t � +� ' t! iR �
/lrq'� /!. � � 3a .
Total Btu: . ' .
Required �q. k. E.D.R. or sq.: ins: W.A. Leader area
! ��
� ANOgA HEATING & ,AIR CONDITIONING
= HE�►T LOSS CALCULATIONS ��, � �� 327 VAN BUREN, ANOBA, MINNE�OTA "
,� _ � � . .
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows I Doors Reference Out. Wall Iat. Wall Ceiling Roof F7oor Kiad How Applied
Yes—No Yes—No 19_
j3 Fl.� �" ` Room � Length � Width �'. Height �'�'�'' Fl.� Room l:eagth Width Height
Windows and Cloors—Crackage and Area Windows and Doors---Crackage and Area
\Yldth Helght No. ot Llneal tt. Area Wldth Height No. ot Llneal It. Area
No. of pane o[ pane Ilghta of crack eq. !t. Na. at pa�e ot pane Ilghte ot crack eQ. ft.
.� /� /�% .
� ?.� E°' 0.6 . :
� � '�a �' , .6
Coef. Btu Coef. Btu
InfilEration �, e9. �. !� Infiltration
Glas� . - / �� Glass �
Exp: wall ; � �° . „r. c �( � Eap: wall
Nee exp. wall ; t� , E ♦ . ,t- ��" -. �, � Net eap. wall _ __.
- -- -- - - - --
i�t. wa1l��-- ,,� .. � _- r� ;�` �C•+?} Int. wall
Ceilin�; }f 1�► �► 1� '�f � Ceiling
Floor �� ✓t�� � . Floor.
Total Btu: : �. Tatal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. L.tader area, - Required sq. ft. E.D.R. or sq. ins. W.A. Ixadee are�
. F7,� , Room ( Length Width . Height �.� Room I 1..ength Width HeiBht �
Windows and Doors—Crackage and Area ., Windows and Door�—Crackage 'arid Acea
Wld'th Helght No. o[ Lfneal it. Area . Wldth HefHbt DTo. of Llneul tt. Area
No. ot pane ot Dane llQhte o[ crack ati: tb ` No. ot pane ot pana �Ighte o[ crack ep. tt.
" I
� ' . �.� � -. .. . . . i
Infiltration �
Glaas :
Eap. wall
Net exp: wall
Int. wall
Ceiliqg `
Floor
Total$tu
��
o�
�
Required sq. ft. E.D.R. or aq. ins. �l.A. teader are$ �
F7. Room � Length Width
Windows and Doors—Crac{cage and Area
Wldth Helght No. ot Lineal tt: Area
No. ot Dene ot Dane IlBhts ot crack ep. tt.
rnni�ra�ron
Glas�
Fxp. walt
Net exp.� wall
Int. wall
Ceiling
Floor
Tatal-Btu.
Required sq. Et. E.D.K. or sq. ►ns. W.A. Leader area °
Btu
Height
Btu
Coef. B
In6ltration
Calaas
Fzp. wall .
Net eip. wail-
Int. wall
Ceiling
- �loor
ToEal BW: �
Requ�red-sq: ft. ��.R.-og sq i�s.-�F.��ad_er ac�a_ __
F1.� Room I L�ength Width Height
Windows' and Doors—Crackage and Area
Wldth Helght No. oL L1nea1 tt. Area
No. . ot Dsne ot pane ItBht• of crack eQ. tt.
Btu
Net eap: wall �
Int. wall I
Ceiling '
I
Floor ;
Total Btu. �
�. Required :q. k. E.D.R. oi sq. ins. WA. L.eader area '
�___.�.- _ �_
SUBJECT PE O.
City of Fridley 134'79
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
f
� � COMMUNITY DEVELOPMENT DIV. RECEIPT NO.
� �v _._��-�
r � � PROTECTIVE INSPECTION SEC.
' i '
� /�'�1 � CITY HALL FRIDLEY 55432 NUMBER REV. PAGE OF APPROVED BY
�----� � �'� si2-5sasaso 910-F15 �%���&� � �
108 ADDRESS 7043 Hicko�^ Drive N.E. �
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. $ � Ostman's 3rd Addi ti on s"EET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
o Genos 7043 Hickor Drive N.E.
3 GONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
ree N.E. 788-4071
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
residential
7 CLASS OF WORK
❑ NEW �7 ADDITION ❑ ALTERATION ❑ REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WORK
pat'io deck 2` off ground and adding sliding glass door
9 CHANGE OF USE FROM TO
STIPULATIONS
���,����� g�Eg���I�T�, RFQUIREQ FOR VV6RIi�G�
HEATi�B�. PL���19VG Af�D Si�►�S.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. Frame-fi r
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 CONSTHUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �� �2CJO .62
WITH WHETHEA SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVIS S OF ANY OTHER STATE OR LOCAL LAW iiEGULATING CON- 9� OO
STR N OR6THE PE ORMANC OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
. � , �}. �, $9.62
SIGNATUREOFCONTRACTORORAUTHO DAGENT IDA E) EN PRO L VALIDATED TH�IS IS YOUR PERMIT
d �
Z ,T� ``- � � �
SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI BL iNSP DATE
� c
�
AP.PLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING PERMIT
CITY OF FRIDLEY, NIINNESOTA
owNEx � s ru� : �v�� �'��9�S�k �! $UILDER:_ �/�A� Z� �� ��� i . �
AnnxESS : C� 3 s�- � rC annxESS :�a�'l� - RS'� � i o� -� �
r7� S ��fu���
NO : . � (� �I� STREET :
LOT : C� BLOCK: � ADDITION : D.S i i a1 �N =s �� /� ��ib(/
CORNER LOT: INSIDE LOT: t� SETBACK: SIDEYARD:
Applicant attach to this for�a Ztao Certifica*_..s of .Surve� of Lot and. progosed
building location drawn on these Certificates.
BESCRIPTION OF BUILDIIVG
To Be Used As;
7�'� 1•�O ���`� Front: ��' Depth: /,� � Height:
� � c��I� �oF�prz�Ll(�
Square Feet: Cubic Feet:
A��I cA� � S �� �� aJ � Front • Depth • Hei ht •
�
�'L�ss bo o� .
Square Feet; Cubic Feet:
Zjrpe of Construction: ��Aj1'l�, —�� Estimated Cost: $%?� --'
To Be Completed: � � �S.
The undersigned hereby ma.kes applicativn for a permit for the work herein �
specified, agreeing to do all work in stiict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declaxes that all the facts and repxesentations stated in this application
are true and correct.
� DATE : _ °�' o� °'i �o SIGNAT[TRE : .
(See Reverse Side For Additional Infarmation.)
,
�'� / .� 5 8 .r6 = , �.,��
S� � �r � Z �
� ��
�
�—
BUILDING PERMIT FEE SCHEUULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or stru.cture, or for any addition to any existing
building or structuxe, or for any alteration or repairs to any exiseing
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 i.n
the manner herein provided to-wit:
UNtFORM BUILDING CODE: �pe 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. �pe 3& 5-$1.85 tor
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical conCents
of any building or addition, is determined by multiplying the ground area
covered from a point si.x (6) inches ioelow the floor line of the basement
ox the cellar to the average heights of the upper surface or to the average`
�height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof i.n
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for eonstruction will be issued a minimuxn of 24 hours from the
time of application, to allow for proper revi.ew of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be xequired before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall.not be used or occupied until a Certificate
of Occupancy has been issued.
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F STATE OF MINNE8�7A
L►�NHgD pY ORDINANCE OP C��IN�EAPOLIS .B. MINN.
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,. a true and correct plat of a surveY °�'
;; hereby certify �hat tre abovt �-s
. � S TElIR� n1�llITIQN, Anoka County, M�nnesota .
i,ot 8, Block 1, O S T P 9 P. N
me t hi s 1 9�- h d� y °f �arivary 1957 A.D.
As surveyed vY ,�-
' � D�.�� 84
; �e�ned 25
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City of Fridley 214 9 5�
' , AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RECEIPT N.
r
� � COMMUNITY DEVELOPMENT DIV. 9
, • e�`��
� Ly � ��'
r � � PROTECTIVE INSPECTION SEC.
� . �
� _ /'�'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�----� • •'� 612-571-3450 910-F15 8/17/92 / /
J08 ADDRESS �043 H%ckory Drive NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 8 �. OStS43ri � S Third Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Tom Genosky 7043 Hickory Dx�iye NE 571-2972
3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO.
Twin City Storm Sash Co Inc. 10825 Greenbxier Rd, Mtka 55343 546-8160 3090
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS Z�P PHONE LICENSENO.
8 USE OF BUILDING
� S 1 C12T1't7.3�.
7 CLASS OF WOFK
O NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Replace windows
9 CHANGE OF USE FROM TO
STI PU LATIONS
TYPE OF CONST. OCCUPANCY OROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATIN(i,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION '1' STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED $1 � 483 $. 74
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO, GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEFiMiT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW FEGUTATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 3S.OQ F� re C 1 48
PLAN GHECK FEE TOTAL FEE
License SC $5.00 $42.22
SIGNATUREOFCONiRACTORORAUTHORIZEDAGENT IDATEi HEN R fiLY V ID ED THIS IS /�YO'UR PE�RMIT
' L�/ I ! �
SiGNATUREOFpWNER�IFOWNER8U1lDElii �DATE� BLDG �NSP �iATE
� 2 ? :A
�.::....•;•::;;tl . . . . . � . , ,.,.. . . . . . .< . . ... . .. . . . . . . . . . . . . . ... . . . . . . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ... .. . , . . . . . . . —? _ . � --,;_ �
Effective 3li192
NEW [ l
ADDN I l
ALTER [ �v� �, �
,�t�t%
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
Building Permit Application
Constiuction Address: '`;� r � °� � ` � � ,� �
» �_
Legai Description: .
Owner Name & Address: � � �' � _ -� _ �=� � � Tel. � " �� � � � ' ' -�,'
'@'!lIiIN CIiY STORM SI��H CO,, 9N!�. � MN LICENSE �=`l��`�-��`�� � �" ��',�
Contractor: 1AR�R f°R��,�oF����,�,.�,�
Address: �
t��+UV�'TON�, i��NNESOT'�► ��34� � Tet. �f �_ "�� ; � -�
Attach to this application, a C.ertificate of Sunrey of the
lot, with the proposed consbruction drawn on it to sc�le.
DESCRIPTION OF IIVIPROVEMENT
LIVING AREA: Length Width Height Sq. F�
GARAGE AREA: Length Wi�h Height Sq. Ft.
DECK AREA: _ LBngth _ ---Widdi _ --Hgt/Ground Sq. Ft.
. � _ ,,a � � �-_ � , �
OTHLR. � n �- y � � � ` , `
_� ` _ _ t — + 'r— � - a — ,— — -
Corne� Lot [] insi�le Lot [ J Ft Yd Sdback Side Yard Setbacks
Type of Construction: � F.stimated Co�: S " . _ , -- , -, -`- - -`�
-�_-
Approx. Completion Date:
(Cost on Back)
Driveway. Curb Cut Width Needed: F� + 6 Ft = Ft x$ _$
d
e �� , p ,
DATE: v - � _� _ ApPLICAN'�� -� ` - ' _ , �-_, _ , � ���-_�- Tel. 1� � � � � _ �- � �
Permit Fee $ ,_�-� , (�t�
Fire Surcharge $ �/ - � ��
State Surcharge S ,_�`
SAC Charge $
License Surcharge $ -� � ��`
Driveway Escrow $
Park Fee $
Sew� Main Charge $
TOTAL
STIPULATIONS:
$ ��. ��z
(,ITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth l )
$.50/$1,�0 Valuation
$700 per SAC Unit
$5.00. (State Licensed Residetttial Contractors�
Alt. "A" or Alt "B" Above
Fee Detercnined by Engineering
Agreement Necessaiy [ ] Not Necsssaty ( )
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CHIMNEY AND STACK VSRIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes ( j No ( j
Z�. Is free from rust or deterioration _ Yes ( j No (�
3. Has no foreign objects lodged withi.n Yes () No ( j
4. Is securely supported Yes (�) No ()
5. Meets all current Code requirements for
size and total BTIJ's connected Yes () No ()
6. Has total heating BTU's of
All other BTII's � � `
TOTAL BTU's �
Remarks
List Alterations Beinc� Done:
� - ;„
e
. - �
- ,�.
HEATING COMPANY � � � �' �
�,. ..
r, �3
S igned By _ �r4 ; � �
�
�' t ��``.�
Date ' � � "�
�
Purchaser �.�.��,t��� -
� � �, � Salcs Rcp �'-�.�N� Datc � �-93
R�SIDENTIAL LOAD CALCULATION
Running wall bclow gradc�2� �t � rt wall hci�ht -7 Sq Ct gross wall bclow gradc
Running wail above �;radc 12� rt �� �t w:�ll hcibhc �� Sq rt brass wall ahovc gradc
Windows & Doors � � k, Sq Pt
infilcration (W&D x 1.3) � Sq rt
Nct wall bclow gradc � Sq rt
Nct wall abovc gradc �� Sq rt
Cxposed Cciling ��� Sq T't
Exposcd Floor Q�� Sq rt
RUNNING WALLS
3�
2�
3S
��
�
.�
1 Z�f
�,. ., r
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� S FITM
S HTM
11 F{TM
�� FITM
�� 1-�TM
� �Ja a7vtt
�-�7 S (3TUH
s .. BTUH
� 2 . • BTU li
a BTUH
-7� IITUH
�-�_ 13TUH Total
WINDOWS �Sc DOORS
S 3�
S' ��
� 5
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5'� � l �
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CCILINGS & rLOORS
��2�= '��
O 1992 S�andud I latins url Air Condition'vv Co.
�.
b
410 W. LAKE ST. 1072 PAYN E AV E.
MINNEAPOLIS, MN 55408-2998 ST. PAUL, MN 55101-3892
612/824-2656 HEATING AND AIR CaNDIT10NING CO 612/772-2449
escrvinq T6e Twia Cltita Siace 1930'
ORSAT TEST RECORD
ADDRESS rJ�,�-- �,��'�,1.� s CITY �
.,�� �` .� � � �/ 'd`.s'� �?s
OCCUPANT � E�—�/p � �� OWNER
DATE HTG. INST. � INSTALLED BY
GAS LINE BY
TYPE OF HEAT: GA FA�HW STEAM SPACE HTR.
GAS DESIGN
MAKE �� %��G�C� MAKE
MODEL� � ,� -� /� MODEL
SERIAL � ` �c� �.rv �. MAX.
I NPUT � �,��� MAKE
CONTROLS MODEL
THERMOSTAT �� HEAT PLUG VENT
VALVE � KIN�
UNIT HTR. OTHER
CONVERSION
OF BURNER
BTU
OF FURNACE
SIZE ,� `� _�-
OF LINER SIZEC� � _NONE
LIMIT DRAFT HOOD RE�ULATOR
LIMIT SETTING �,s'r� �� CHIMNEY
FAN SETTING �'��"'� DRAFT
PILOT TYPE � -�i"'.��LICHTIN�
' �
PILOT MAKE � r, �
PILOT MODEL �--°--'
PILOT TIMING ,��,� �/��✓�'
PRESSURE � � �P PERCENT CO2 DATE
INPUT CFH � PERCENT 02_�;�
STACK TEMP.�-� PERCENT CO 6���� NAME
CONSTRUCTION ����'j �
T E S T TA(; �-�-°-��
TNST.
TESTED �,-' � ���
d �
OP TESTER �� '°`'�� �"° �____-�_
�� ��°'"
.e '
SuBJECT .
c�ty of Fridley 2 6� 5 2
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
; � E NO.
� `v _����_ COMMUNITY DEVELOPMENT DIV. , O
r �
PROTECTIVE INSPECTION SEC. �� �
� ;
� .1 ,
( 1 /"'1 � CITY HALL FRIDLEv 5SG32 NUAABER REV DATE PAGE Of APPROVED BV
�.__.11.' '•� 612-571-3450 910-F15 7/28/98 � �
JOB ADORESS 7043 Hickor Dr
1 LEGAL �OT NO. BLOCK TRACT OFi ADDITION SEE ATTACFIED
oesca. g 1 Ostman's Third Addition SNEET
2 PROPEFiTV OWNER MAIL ADDRES$ IIP PHONE
Tom Genosk
3 CONTpACTOfi MAIL ADDRESS ZIP PHONE LICENSE NO.
Solomon & Sons 12211 O1 4-5 2
a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUIIDING
Residential
7 CLASS OF WORK ¢7� REPAIR O MOVE O REMOVE
� NEW ❑ ADDITION O ALTERATIORI
8 DESCRIBE WOFK
Reroof house and garage (22S ) Tear-off
9 CHANaE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REQUIREO FOR ELECTRICAL, PLUMBINCi, HEATINO, �PE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIH CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OF CONSTRUCTION 20NINd SO. FT. CU. FF.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEU FOR A PERI00 OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBV CERTIfV THAT I HAVE READ AND EXAMINED THIS APPIICATION 1 STALLS GANAGES
AND KNOW THE SAME TO BE TRUE AND CORpEC7. ALL PROVISIONS OF LAW$ VALUATION SURTAX
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITFI WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1834 .9Z
DOES NOT PRESUME TO GIVE AUTHOfi1TY TO VIOLATE OR CANCEL TNE pERMIT FEE SAC CHARGE
PROVI ONS OF ANY OTHER STATE Ofi LOCAL LAW REGULATIN(3 CON-
CT N OR TNE PERFOfiMANCE Of CONSTRUCTION. �59.50 ire �'. �1.83
�� +„�a-ep� PIAN CHECK FEE TOT FEE
d� � Licens
$5.00 .25
SIGNATUpEOFCONTRACTORORAUTNOfiIZEDAGENT IOATEI N FOP l ALID THIS IS OU�ERMIT
� �
S�GNATUREOFOWNEAUiOWNEABU�IDEp� IDATEI BL �NSP qpTE
NEW
ADDN
ALTER
[l
[l
[l
ConstrucrionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-Z
BUII.DING PERMIT APPLICATION
� �.� �/��'!��'t�"�j �/�-�
Effective 1/1/98
/�'
A
�
.
Owner Name & Address: �a/�� Tel. #
Contractor: ����� �A/ _ �j�� NINLICENSE## �����6�
Address: /}'�l% ��'� �• /is� Tel. # ���°-���
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. ��
DESCRIPTION OF Il1�IPROYEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE �AREA: - Length Width Height Sq. Ft.
DECB AREA: Length Width Hgt/Ground Sq. Ft.
o��t: �1va� _ ����•r-�-�-�,
�—� � �'� � ����c.� � .
Construction Type: � @ �� � � Estimated Cost: $ ����
—I a
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �������
Pemut Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
r
.., .`
$ � ��
$ 1, �
$ �
$
$ � UC�
$
$
$
$
�
$ 7 ��-
CITY USE ONLY
Tel. # �� ��?�
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
,
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i
SuBJECT ,
City of Fridley 31172
�
AT THE TOP OF TME TW�NS � � ��. D I N G P E R M I T
; : REC .
� `v __��� GOMMUNITY D�VELOPMENT DIY.
r � � PqOTECTIVE INSPECTION SEC. �� C�
' d
� . ,
' � r"'1 � CIiY NALL FRIDLE� SS�32 NUMBER pEV OATE CAGE OF AVPROVEO 8Y
ti.__.11.' '•� 612-571-3450 910-F15 7/13/00 � �
�oe aopRess �043 Hickory Drive NE
t LEGAL �07 NO. BLOCK TRACT Oii ADDITION SEE ATTACMED
oesca. g 1 Ostman's Third Addition SNEET
2 PiiOPERTY OWNER MAIL ApDR@S$ 21P PMONE
Thomas Genosky 7043 Hickory Drive NE 763-571-2972
3 CONTRACTOR MAIL ADORESS ZIP PNONE IICENSE NO
Bui.lders F� Remodelers 3517 Henne in Ave. So., ls. 1�1 55408 612-827-5481 1104
4 ARCHITECT OR OESIGNER MAIL ADONE33 ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION C�C REPAIR ❑ MOVE O REMOVE
B DESCRIBE WOFiK
Reside House and Garage
9 CHANOE OF USE FqOM TO
STIPULATIONS �
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatl�erproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Call for inspection of wrap
before covering.
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, MEATIN(i, TYPE OF G NST. OCCUPANCY GROUP OCCUPANCV �OAD
VENTILATING OR AIF CONDITIONING,
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONS7RUCTION 20NING SQ. F7 CU FT.
AUTHORIZED IS NOT COMMENCED VR!ITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY 71ME AFTER WORK IS COMMENCED. NO DW�G. UNITS OfFSTREET PAHKING
I HEiiEBY CERTIFV THAT I MAVE READ AND �XAMINEO THIS APPLICA710N 1 STALLS GARAGES
AND KNOW TME SAME TO BE TNUE ANO CORRECT. ALl PROVISIONS OF �AW$ VALUATION SUR7AX
AND ORDINANCES GOVERNING TNIS TVPE OF WORK WI�L BE COMPLIED
WITM WMETHER SPECIFIE EREIN OA NOT. TME GRANTING OF A PERMIT �6sOOO.00 ` .�3.00
DOES N07 PRESUME GI AUTMORITY TO V�OIATE OR CANCEL THE pEqMIT FEE SAC CHARGE
PROVISIONS OF ANY TMEq STA7E OR LOCAL LAW REGULATING CON-
TqUCTION R TME E FOFMANCE Of CONSTRUCTION ��-25.25 Fire .SC �6.��
PLAN CNECK FEE TOTA FEE
�%j'�� Licens $S.0 139.25
S�GNATUAEO�CON'AA OpOpAUTMOp�ZEDAGENT iD�fE� N P OPEFiI IDAT D N�S 1 OUR PERMIT
- �`-l3 -�
S�GN4TUAEO�OWNEQi��OWNEpBURD@Ai �D�TH� � Bl q6ft
. . e�
N� � � Effecctive 1/12000
ADDN [] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ��y, n
BUILDING PERMIT APPLICATION \ 0 rA \
�`�L
�/ iJ
Construction Address: � � 7 � � 1 � K ��-y � 12 ° � �
Legal Description: - �
Owner Name & Address: �01M � �S � Tel. # 7�.3— s%/� 2 9%Z
Contra�tor: .� �q �°� v� �P�o P�12S MN LICENSE# �/��
Address:��l� tT�'N��i�i � %�e � . ���a�j Tel. # �l � - ���- •� �� I
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
" � ��Ls
Attach to this applicatio , a Certificate of Survey of the
lot, with the proposed constnaction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length
LengtFi
U
Width Height Sq. Ft
Width H�UGro d Sq. Ft
t�Cs � � �� � �
�
e 0p
Construction Type: Estimated Cost: $ . (0����
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE. � %� 2'�� APPLICANT: �T� �C� Tel. #
�- -
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $��.� �S� Fee Schedule on Reverse Side
Fire Surcharge $ �- b d .001 of Permit Valuation (1 /10th%)
State Surcharge $ � UU $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$ $1100 per SAC Unit
� �- D b $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ J Not Necessary []
TOTAL
STIPULATIONS:
$ .�Gf.� o��-
BUII.DING PERMIT FEE SCHEDULE
The Cluef 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,OU0
$25,001 to $50,000
$50,001 to $100,000
$100,(�1 to $500,000
$500,001 to $1,000,000
$1,000,�1 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,Q00
or fraction thereof, t� and including $25,OQ0
$391.25 for first $25,000 plus $10.10 for each additional $1,0�
or fraction thereof, t� and including $50,000
$643.75 for first $50,� plus $7.Ob for each additional
$1,000 or fraction thereof, to and including $100,(J�0
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,O�,Q00
$5,608.?S for the firs� $1,OQ0,000 plus $3.15 for ea.ch additional
$1,�0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Sireets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 faot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
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 foundadon once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
�,..� _. �