AF - 45868�
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City of Fridley, Mi.nn.
BUILDING PERMIT
Date: Nov. 26, 1968
��: Ray Swenson g��, Same
Addre� 5615 Camden Ave. N. �,d�� g.�mp
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N° 10040
LOCATION OF BUILDING
No. 7076 Street - �ickory Drive part of Lot
Lot 3 _ Black z Addition or Sub-Division As t�a,�' s 3�e�--���� _
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Corner Lot � Ine�fde Lot � X Setback 40 � —_ Sideyard 16 S. 30
Sewer IIevation 85 2.30 ` 855 .3 -E
Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
Dwellin� �nt 24' Depth 38' Height .�' Sq. Ft _._9�� Gi. Ft 18.240
Ga.rage �nt 25�4�� Depth Z2� I�eight 10' �. � 550 �, �•t, 5500
Zj�pe of Construction Frame ��_ $20, 000 To be Completed
SEWER LOCATION -
WATER LOCATION -
135.5' West of Manhole
148' S. W. of Manhole
55' S. E, of Manhole
10' West of Sewer
Ea conaideratfon of the issuance to me of a permit to conatruct the building descrihed above, I agree to do
th� proposed work in accordance with the description above forth and in compliance with all provisfons of
ordtnances oP the dty of Fi3d1eY. � .
100.00 Sewer Con.n.�Eion Cha
Ea consideration of the payment of a fee of $ 36 . 00 � p�t fa flereby granted to Ra� Swenson
to construct the building or addition as descrii�d above. Thfs� t ia granted upon
the expresa condition that the person to whom 3t ia granted and his agents, employees anc� worlanen, in all work
done in, around and u�n said buildiing, or any part thereof, shall conform in all respects to the ordinance� oE
Fridley� l►Rinnesota regardlig location, construction, altera.tion, maiatenaace, repair and movin� of bufldings
within the dty limfts and this permft may be revoked at any time upon violation of aay of the provisiona of eafd
ordinancea �
".' -�-e�� ���'� B,�� �
Clarence Belisle �/���
ao�c�
7hb psemtt does aot eorsr t6s eera�eHon, tns�all�tioe to� �rMna plumbine, en 6aNng, ssw�� or waMe. B� wro ro a�
' th� Batldiq lesp�cta� [o� apsra» psrmhs for �has tt�na.
e
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APPLICATION FOR BIIILDING PII�MIT
CITY OF F'EIDLEY � PiINNESOTA
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LOCATION OF BtTILDI1dG
NO. % � 7 ` STREETI' U ���/l�
LOT �BLOCg '.� ADDITION OR SIIHDIVISION_Ck�i�� ,� ��
COR'� LOT INSIDE LOT !.� SETBAc;� ��` o" SIDEYARD /(� °`'1!O°� ,� �
SEGTII� ELEY9TION TOP OF FOCTING
Appliaant attach to thie form 'rtiao �ertificatee of Survey of Lot and
propoeed building location drs,wn on thc�e� Certificetese
DESCRIPTION OF B[TILDING
To Be IIsed Ae e ��� `
3L
y � ► �f " Front � Dapth �� �' � Height `��O �
�quare ieet �J/2, ����ic Feet '',� �, ��E` G
Front �a�"' �� `� Depth �i ,�...,� Height /n �
Square feet � � �, Cubic Feat � � � �
Type of Construction ���►,�� Estimated Coet_;�D. �a.� e�
To Be Completed °/�'/ �
The undersigned hereby makes application for a permit for the work
herein epecified, agreeing to do all work in atrict accordance with the
City of Fridley Ordinancae and rulinga of th� Department oi Buildinge,
and he�eby declares that all the facts and iw�,reeer.tations stated in
thie applicatioa� are true and correcto
DATE _ pl d!� � -- �v � SiGI�TATQRE
(Sahedule of Fee Coete can be fourid on the Reveree Sideo)
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BtTILDING P�tMIT FEE SC�ULE.
SECTION 2o The Inspector of Buildinge shall, before iasuing peraita
for the erection of any buildi_ng or structure, or for �.ny addition to any
exieting structure or buildingy or for any alteration or repaire to sny
existi.ng building or etructure9 upon application thereforFa require the
payment by the appliaant for such permit of feea to the amount heretn
below aet forth a.nd in the manner herein provided to-wit:
IIniform Buildi.ru� Code: Type 1, 2, 8� 4-=1 a75 for each one thoueaad
aubia feet, or fraction thereof, in �uch c�bical o�ntents. Type 3& 5-
�1050 fo� each one thoueand cubia feeta
For the puxpoee of computing fees for building permita, the cubical
oontente of any buildin� or addition to a uniform hei$ht throughout by
multiplyir,� the ground area covered from a point eix (6) inches below
the floor line of the basement or the cellar to the average height of
the upper eurface or to the avera.�e hei�ht of the rooi surface of the
main �gsble of a pitched roof .
For re�ai�s or alterations to an existix� structure, the fee ehall be
a� the ra�te of $3.00 per each iive hundred dollaxs (=500000) or
frac��on thereof in the cost of all �moposed worko
Ixi no case ehall the fee charged.for any permit as eet forth in Section
2 be le�� than $5000�
NS�SD Connection Charges based on location - Area 1 or 2.
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1Q130 HIGHYIIAY b5 NORTM�JtS7 -. MiNNEAPtiLIS,-M�i�tiVESflTA 5�43� Te�ephone
784-5480
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Certiiitate oi Survey. �� ki��fil i��F'E�I�Q��
t�i t e. �t� �r' � �t�� �
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- Lot 3, Block 2,
- Ostman's 3rd Addition�
Anoka County. Minnesot�
I HEREBY CERTtFY TMAT TH15 �S A TRUE AND CORRECT REPRESENTAT�DN OF A SURVEY OF THE BOUNDARI�S
OF TNE ABOVE DESCii1BE0 LAND, ANO THE LOCATION OF A�L BUlLDINGS, THER�ON, AND ALL VISIBLE'�N- ,
CROACHMENTS, IF ANY, FROM OR ON SAID LAND.
19th __ November 68 �
AS SURVEYED BY ME TWIS. ..DAY OF ............................................A.D. 19........... I
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N. C. HOiUM AND ASSOCI ATf 3, INC.�AND SU V YORS � ,
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HOUSE HEATING TEST RECORD
ADDRESS ��O � E �� APT. OOR CITY SUBURB
OCCUPANT OWNE
HEAT LOSS DATE HTG. INST. GAS C0. MET R BAD
SOLD BY INSTALLED BY
�
�
Eleetrical Work By Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
_�c�:� G�►�S� '° CONVERSION
MAKE A� ,��,��_MAKE OF BURNER
Model Model
Serial '���+ �?��" .� Max. BTU Rating
INPUT ,�(,Z��!� MAKE OF FURNACE
Model
CONTROLS y
THERMOSTAT eat Plug Vent Size �" �
Valve � KIND OF �INER IZ�NONE
Limit Draft Hood'_���""`y` Regularor
Limit Sefting ��"� Filters Size Numbar
Fan Setting ���''"`� r Chimney LoeaTion Inside � Outside
Pilot Typa Chimney Construetion
Pilot Maka /�
Pilot Model 2_ Smoke Bomb _ Wiring ��
Pilot Timing Draft Test Tag �
L.W. Cut Off D r Pressure— Lighting Inst.
Prossure �� � Pe a t 0 � � e Dat� ested ��"
Input CFH P ee ���`"' � pany Testing
Staek Temp. Percent CO A e�Q% Name of Tester
Form 235
ATTENTION OFs T -_,
�. _ __ -- __. _ ______ � _ _---_---- .___ . _ _ ___ ----__ _ _�
To �arac�e� Bn+ac�risr
_ _ . . __ __._... _._. _ _ . ._ _. __.� ...._ -- -. .__._ . ____ ...__ _.___. _ --
�--__
. . iF� � - >` -,a�
L_ _ _--_:�
___. _ _ _.--- __ _---.. _ _.__ .___J
SUBJECT � �f �';�a3�'° F�1"L�9.t F�
GITY OF FRIDLEY
6431 University N. E. ,- -
Minneapolis Minn. 55421
612-560-3450
� �
DATE �SY �r �TI
-- _ _ _P1� �$@ - I3 �--�,8 � Mtz_ .sQhT► _3�3tif�t-_ �#3g6_ $�tQ' �t�RTP�-$$3.'. s -- __ _ __
____. _ �� _. $�J�.19. _ `�i8 _�m� _ �d88 _ ,�`5 �-�-i4fi��r -S'��T� -!RUt� ��-.�3�-0� _t� _�g�t�t _f�d � _ . _ ___
_.. __..�t- He �tte keep�tg $��5t1 ��' _�p�.�R.._€�__�iB�,�l 8�t'�--�'=-ag`37`:69i___._-_---_
�
___ ____ _ _ °�::. __ _ _ _ ___----. _ _ __
'�is refu�s3 38 f'� _ Y�+n�laing �ifi #i�, � �s�e8 [�tatch 1$ �.__�9�6. _��__t� Aa!t_ _�ed.._--- _ _ , _
--_ _ __ _
__ _ _ ___-_ __— � �c�u� _
_ __ . --- ---_ _._— _ _—_
___.._ _..- ---..-- -
� .iy��.._._ ��.
__. ...___ ._ . ___._._ ....__._ .__. _ __ . _.�_. ._.._. _.�_._. .___ ��...__.__ ___
_—_
SIGNATURE �
REPLY: �
- -..�.,,,.�
�-
_ ____ __ _ _ ___ __ _ _. . ..___ ____ _--_.. . _ .__ _._.. . __.____ .__ ___� �;�___. _�___�--
_ .�
'a
�
DATE SIGNATURE
��Yi°aYiiWATOR — ��Yf�CFY ,Af�� �L�i�AYi�I •
SUBJECT
c�ty of Fr�aiey , �
AT THE TOP OF THE TWINS g U i L D I N G P E R M I T
;,
� �
� • COMMUNITY DEVELOPMENT DIV.
� VV �•�����
r � � PROTECTIVE INSPECTION SEC.
1 = �
�� �'-'1 � CITY HALL FRIDLEY 55432 NuMBER
.--.�' �•� s�2-5so-3aso 910-F15 1
108 ADDRESS 7076 Hickory Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 3 2 OS n's 3rd
2 PROPERTY OWNER MAIL ADDRESS
�X� John Honzl 7076 ickor
3 CONTRACTOR MAIL ADDRESS
Tom Bri kner 6245 Ben Mo e Dr
4 AHCHITECT OR DESI ER MAIL ADDRESS
5 ENGINEER MA L ADDRESS
8 USE OF BUILDING
residen 'a1
7 CLASSOFWORK � NEW � ADDITION ❑ ALTI
8 DESCRIBE WORK �dition to hou e approx ate
9 CHANGE OF USE
STIPULATIONS
SEPERATI
MEATING,
DATE
3/19/76
.tion
ZIP
.ve N.E
IP
E.
ZIP
�9�TION ❑ REPAIR
�.% gC 20
TO
,�`�
�
ER ! R QU
��t � A�a
r� i34i1
REC .
PAGE OF IAPPROVED BY
� �
SEE ATTACHED
SHEET
PHONE
ONE LICENSE NO.
P O E ICENSE NO.
RHO UCENSE N .
❑ MOVE � REMOVE
� �
�
F�R '�1{RIN��
� TYPE OF CONST.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATIN , W� frame
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRU , ION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRU/�TION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 l}�1YS AT
ANY TIME AFTER WORK IS COMMENCED. ✓ NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OP WORK WILL BE COMPLIED $`j,O�OOO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUM� TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 32.69
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
�
� SIGN TURE OF CONTRACTOR OR U ORIZED AG IDATEI EN PR(
. , b� 3l !v �
� cir_n�eru cnwNCauFOWNER8l11LD . IDATE) BLDG.INSP
�CCUPANCY GROUP OCCUPANCYLOAD
Sa. FT. CU. FT.
340 2912
OFFSTREET PARKING
STALLS GARAGES
SURTAX
5.00
�
TOTALFEE
37.69 `
D THIS IS YOt`1F� PERNJ
• � • •.°1"j'LJ.L/,IAVI�i 1•V1C ICL'JlLli�vllll�u.� n.va�..�.i .. .•� . .
� � OR AUllITTON. BUILDItiG P�RI�IIT , �
, . . �. . , , . �
. ,° � CITY OP PRIDLL•Y, htINNESOTA • � ;
• . • � . .. . , • , . .
, . . . .
' �' � � BUILU�R • �` p �-� � ,,% . , . �
. 047t3�R S NAt•1� : . • . �
• , � �`. ,ADDIt�S S : � 0�1'�.� ��'ic`a � �t� � � �.i� •. � �;
hDDIi�SS : t '�.. - . I
. � [��'�CJ� ��'� �
210 : . � � � � � STREET . �` � • .
b
�.OT: nL�JCl::�__-_____-ADDxTION : � � � ��
� . �
, . . �.
COrl�'ER LOT:, INSIDE LOT:�SETSACi�: __ SIDL'Y�1T.D:_________ .• ;
' — . � i
. . o
. . ' ' . • Y
. �ppl.icanti a.ttaci�. �o this far.r �•7o Certificates. �f Surve .of Lnt an�.pxoposed . '• '
buildir.A ?ocation di�sEan on these Certificates. • . � . . �
. . . . . �
• ' �. • � �. • - � •'� "i
, • . _ _ � . _ . . !
• . ' . ' '' ° ' . • �
� • �3ESCRIPTIOh' OF BUILD��1G . � ' � ;
. .
. . � . . . :
. � • • +
. . , a
, Ta Be Used As : . � � . . . . .
� � ' � •` Txont : / / Depth • �-� Aeigh� : -
, . . . Se�uaxe 7Eeet: .� 7"v � Cubi.c.Feet: � �.,� 0+4 �i `
� . � �ront : � - - Deptfi . . . Height • � .
�.. _ � Squaxe Feet; Cubic Feet: ' '� '
. ` • �00� ' Estianated Cost • $ ��. QCJ(`�
� �.jrpe oi �Ganstruction: � ,
�`` . . . .
�o-lie Completed: � • ' '. . ' .. .
. . . . , �. .
� • T6te undexsigned hereby ma.kes applicati�n� for a permit for the work herein � �
spccii�ed, �breein� to do all warZc in st'xic� accoxdance t�ith the City of -
' Tzidlcy Ordinanccs 1nd ru��z��s of tlie D�paxtmcnt af Buildings, and her�by
declares �th�t ail tlic ta.cts and repr�sen�aLions stated in tliis aPplication
t�xe true and corrccC. � • . �
p��''� � • • . � . . . ' �� • .
Y'i'" '° ' ' ;, '
�+ AAT�: si�NEiTL�r.� a � � '
� �;� , . .
• Sce everse Si de For Addit3.on�1 �nioraaation. )' �' �
, t � . . • . • , .
0?9/2 eu��a� x, /.���av� � `�' .�'.�� • •' . _ .. • ,� _
�/��� �a`o;v��. � � `� :�. ��.�� 37.�9. R . � . .
• , . . . . ��,�� E- � �. . . . �� - .
a �'• y O 0 �K�s� ' • � •
� , e • .
,;g �'o,poX/DBOBS�3.A� � - � ', �
• ��%� � 9 `,� . . .
. • � • . •
, _ .. � ,�E' " �:� .
, � .� � � � • JSU1LlJ11Vlt L'.L'IU�IA 1 i'L'i: �7�.��a.uva.a. e . _
, . . • • ' (
. , . •
• • . . � • ,
' Sxcr.z0ia 2. 11ic In�pector of Builclin�s shall, before issuin� permits t�r the
buil.din or sLructurc or fox :lll addition to any c�:is�ir�g , �
czection oS any � , Y -
buildin� or stxuc�urc, or ioz any altcration or rcpairs to any exis�ing ;
building or sL-ructuxc, upon applicZtion Chcrciorc, requixc the payment.by the
� app�a.cant Lox such pcnniC of fces to thc amounC hcrein bclow set ioxCh and itt
, �I�e mannen c�rein provided to-wit: � . , • i
. , �
;
�. UP27I'OI'Si BUILDII�G COD�: Typc 1, 2& 4-$2.15 fox each onc thousand cubic
ieeC, or �raction Lhexeof, in such cubical �ontents. �pe 3& 5-$1,85 foX '" ' �
' each one thousand cubic feet. • •� '
i� , . � .. . � , • . ' • ' •
I. . .: • � .;
• . . ADDITTONAL INFORI�IATION . • ;
; . . . ,
' .F�x the purpose �f ;;omputing fees fox building permits, the cubical conten+:s �•
� �if any building ox addition, is detexmined by multiplying�the ground area
• covexed from a point si:c (6) inches below the flo�r line o� the basement • .
i.� ox the cellar to• the average heiohts of the upper surface or Co the avexaoe�
height of the•xaof surface of the main gable of a pitched roof. � '
' .. . . �
• Fox repairs •or alterations to•an existing structure, the fee shall be a� tlze
• rate �f $3000 per each five hundred�dollars ($500.00) or fraction thereof in .
.the cost of all pxoposed work. ' . _ •
�� � xn no case sha11 the fee chaxged for any permit as set forth i.n Section 2 be •
� less than $5.00. . '. � � e " ..
� ' VERIFICATION OF'rOUNDATION � �
' . . . • � �,� . f
1
I�OT�: Pexmits fox construction will be issued.a minimum of 24 hours from th.e �
ta.me of applicaCion, to allo�a for proper re�tiew of the pxoposed struc�uxe and, �
• pt the.GOnstxuction site. . • .. .
A Certif_ied Suxvey of .the lot, shoiaing the location of the ioundation, once it ;
has been cons�ructed, will be required before proceedinr with the framins. �
. �
, � CL-RTIrICATE OF� OCCIJPANCY • . :
Application for a Cextiti.clte of Oceupancy shall be made 4:en (IO) dn�s prior
� to L-lie use ox occupancy of zny structure £or wlii.ch a building permit tias been
issued; 1nd s�id strucL-ure shall not be used ox occupied until a Certific�te
�•• of Occupancy has bcen issucd., , , '' •
� •. • ;
� • . i
• , • • . ' : � ;
• , , . ,
.. . , , . , . � ,
. � � , ' • ' '
. . , . . . . �
. . • . .
. . . . • �i
, Page 1 af 4
,s
«-- =-s� .a
:�
�� �
EXTFRIOR ENVELOPE 2��7ERA�� "U" COMPUTATION
• ' V. ������ � � !� 1 � � �' �,1�� �, f
.. • I � �l� u(�I � • �'
CONTRACTOR: ��r
(��n C�t'►�n D�Z��CZC�'-4=�7��
Detennine v�mrking square footage of each
l. Total exposed wall area...... •�li�I",7 sq. ft. x .17
2. Toal roof/ceiling area ...... ���_ sq. ft. x .OS
Total exposed wall area above floor = ������
a. Total F�all window area .................................
b. 7'otal door area ....� ...................................
c. Total sliding gl.�s door area .........................
d. Total fireplace wall area ......... ..................
e. Total wall framing area (average 10�;) ..................
f. Tot:al rim joist area ..... .................. ........,.
g. wall area above floor............ ............
h. wall area above f�oor ..........................
i. walLr-area above floor .................. ......
j, wallg area,above floor ..........................
TotaJ exposed foundation area = �,�
;i�
_ �% . !�
�� �
1.
. 3 �
��. bfa.b
'L'2�7.2�
36�. �
�
�i1�,??
k. Total foundation window area .............o............. —
l. Total net foundation area above grade ................. I�I,Gj
Determine '°U" value.of each wall segment
(e.g. window, door, each separate wall section)
a. —�.�,`�' x ��U„ �fil� _ �D��� 3 •% �� �
b. ���� X „U„ ��� _ �� .��- �' h�r'�e��o���m���r.�Nn��,
�. l�il� � x „U„ ,�� _ ��
d. � � ��U�� ...._ _ .—
e. ��dl��� X
f. �.� x
g. 'U1�,2 x
n. �i�1� I x
�. ���r�b _._._ x
J • '��� � X
„U�. ,�� Y = �pj,�1
„U„ , D� '� = 4, I
„�„ ,o� � = f�IP,�
uUn �� v=
„u„ �� ✓
�
„U„ � � '�
s K� � X nUn -- _
• ���tT �` rL. +L. �\. �(i
�
,
i. 1lI��J X ,�v�� ,or� _
3 . ............................. To'�al =
2, m �, .�i� u u�Ue vurier�,� -� �� w�
��,D � �� �
� �`���������.�.
�� �� If item #3 is the same as,
or less than'item #�, you
� have met the intent �f
-�-�-�--7� � SBC 6006' (c) 2.
� nol��, � �ji ��1 �G�IOYI�i Of,E�r-
P��� �a 1�2ac1�-v�Q �� �ii �,n� ►osr�t'-
�%7�•►,� .,� �nDl � tam r1rY�'i�t �a�/ri�►�als�'wnn�.6•
"��F.�terior Envelope Average "U" Computation Page 2 of 4
4-�
� Total exposed roof/ceiling area = ^ ��
m. �otal skylight area ............................ �
n. Total roof/ceiling framing area (average 10�)... �� �
o. Total net insulated roof/ceiling area........... �I�i��
Determine "U" value for each roof/ceiling segment
m. X "U" _
, �►a
n. �2�i�' X ��U�� � _.
o. �I I►21, �� x „U„ , n =
4 ........................... Total =
r� �r� �n �fr��F-��ra � �e� �'`���
I��� �►a��d�n�� �
� ,2
� � I ���
Sf tota.l of #4 is the same as, or ].ess than #2, you have met the intent of
SBC.6006 (c) 1.
Alternate Building Envelope Design
Zb utilize the total envelope system method, the values established by the sum of
items #3 and #4 shall not be greater than the sum of items #1 and #2-
i . .'1�°-��1• + a . b1�2 = �ll,�
3. ,��� + 4. 1`�r� _ ��oi�_ �F°
r
a
2{l'vl/V1�1� vWv����l �� k !'85��b00 � JI��
���(c��v � �°�� �-� �#
�!`
6y 3$ = � _ � �,� 9 /�z
�j �.. ;d � ��iu" � 0 6
',J. g ° �� °
._-�.:.�...
� �� �, � �
�
,
0
0
� ; '� LaALL S�CTIONS
NOTE:_4Use 1.0� of opaque wall area for
frame cons.truction
r
a` �, ` U
yt ''. �'�. ' � •'�
"�G, #�3
FRAi7E �2AT•T•
Pagc 3 of 4
common
Cunstruction R-Value 9�
�
l. Intexior air film. 0.68 y.
2 . ° .�?
3 . �/Z' �
�, 4. �r ,q � 2 U�
5 . - ° �61+ r1C'" �1 =�bdo = . �
6. Exter�or air film 0.1.7 .I�j
�r.Ota.J. �,�- q,D�j
, ,�
�� ��:
. � >/
��/i1. Jul
�►� [li � G I���i��' � •
' x t�� � �i�l��l ��1.'i��� {�����'/� ,��
� t I�1f I�I. (� ►f�, l� �.�, , �,.��� r
. a► - . � ,:
� �.
� 1, Interior air f ilm 0. 6�
' � II ,OD
a�.� ,
�3 . ����� � ?�
4. ' 2,01�
- 5. ���,�='��fi , ,� -,ob - ,
6. Exterior air film 0.17
Tota1 1 b���j
6 ' � ���n�
1. Interior air film 0.68 ,b�j
i �-
�' . ^ • ��
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Page 4 of 4
Construetion E�,���d1�"""""�� ^ R-Value .
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a . I�,� , 4�
� 3 . ��� • o
� 4. Exterior air film (still) 0.61
Tatal �p,�o� 'U og�'
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4. E�:terior air film (still) 0.61
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3.
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Total
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Note: Use additional sheets if more space is
� needed for details and calculations
�
Q
. -,,.�-��
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �` COMMUNITY DEVELOPMENT DIV.
� v � PROTECTIVE INSPECTION SEC.
r � ,
� ` �""1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE
�""'°� � �'� 612-571-3450 910-Ft 5 3/17/81
JOB ADDRESS g 7076 Hickory Drive N. '1''.�.
PAGE OF
/ /
�16067
RECEIPT NO.
�
APPROVED BV
1 LEGA� LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 2 �S'tffidI1�5' Th.ird Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
i�ialter Silesky 7076 Hicko�y Drive NeE. 571-5297
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Custom Pools 701 E. Escel�ior Avenue, Hopkins, N.�T 933-2255
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER
MAIL ADORESS
ZIP PHONE IICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK n_ NEW p ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 16' x 32' Iri-yround Ssir�� T�q Pool C8'Deep�
9 CHANGE OF USE FROM
TO
STIPULATIONS 5ee stipulations on letter da.ted March 17, 1981 by Environmental
Officer.
�,SEPERATE PER�]!T�� f;��lJl��� ���� `����pwC���'�
�A�'�nl+�, ��uMBiNG �rJ� ss��i��
TYPE OF GONS� .
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �-
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �`7 ��jOO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $45o OO
cTaur.nnN nar7HE PERFORMANCE OF CONSTRUCTION. � `' __
D
IDATEI �
� ' �@����
Before digging c�ll locai ut�9tties
TELEPNONE - ELECTRIC � GA5 ���
R��UIRE� �Y ���
P IOCCUPANCYLOAD
CU.FT.
OFFSTREET PARKING
STALLS GAiiAGES
SURTAX
$3 . 75
SAC CHARGE
TOTALFEE
$48. 75
=R�Y VALIDATED THIS IS YOUR PERMIT
CI7Y 0�' F(:If1LEY
�{r��.zcn'fIU;J FOR (?f;SI[)["i�ITIPt�_ [�UILf�ttlr PE�r�iTs
(tJet•r, A1 ter��ti�ns, /tdclitians, or Rcpairs)
� OL•�tJER: � � �� S � �Q
ADORESS:' � ��°7 C C ��-
TI:L h0: �7 f ' S�} � �
r
�UI LQL'R c v� o a' S .
�
11UDRCSS: �%�< < � .���c Si p/� v.�
TEL �t�JO: 9� � ' aa��
� Cons�ruction Location ' �
• STIt�ET NO : 7� % G� STREr T: �( C!� 62�/ ,��C
L07': � . SLOCK: � ADDITION : � /71Q�� � � r� . �i �CQa.- l.
Corner Lot: Inside Lot: Setback: Sideyards: .
Ap�licant attach to tliis form two Certificates ot Survey of lot and �
. proposed building �ocation drawn on certificates to �cale. �
DESCP,IPTIO;d OF COi�tSTRUCTIOPd � •
. �T �
j„� �.�� �. � l I�ront: � Depth c Height:
� Square. k'eet: Qtb�ia •Feet:
. Front: Depth: Height:
Square� I'eet: Glabic I'eet: •
7�'ype of Construction :�Ln o u�1 C S c v�✓✓�� �
„�,_. oO I Estimai:ed Cost: $ 7 SOO , O Cj
�b $e Oor.�pleted: � �3� /�( .
. � . . � Alt. A ��''I�.t. B
Proposed Drive��a�� tiaidth rf New Opening Is Des3.red: $' $
. .. SE� Rc^�VERSE SIDE OF SiIEET
�.ixe u.n�exsigned hereby ma};es appl3.cZtion for a perm3.t fcr the �,vrk' herein specified,
agre�ing to w,all work in s'trict accordance �•�ith tlie City of I'ridle�t Ordi��ances and �
ruliiig� of L-lle DG'2�1I:1.[I1CIlt of Buil.dings, and ]iereby declares that all tlie iact� and
rcpresen t; ti.ons statecl an this a�plicatian are true and correct.
�
D.'�TE : � ! G� �f � S ICNATU F.k: : � � ��.t� n
// ' ..
Stii�ulations :
� y� ��
3. �S
' � ��•'75�
� .���!`w" ,,,� ,
% _ �� ^ �-'�-2 —
l _ ,,�._.�._ �
-�^- �..
. ,=
�
_ ' • • ��
. �u��n�ric I'f_f�1�1"f f"L:�� :>r.��r:nut_�� �, .
Sl.:�"rI01•� 2. 7'1�Z 7►r.o��ecL•or. of I3ui.lc?itui :::lui].�., bcfa�:c: �;r.�ai.iuJ pennits f�r l:he crccL•i.on
af ��ny )�u�.1.�].i.�,�� c�r :,t:::uct:urc, �r. tax uny adQi.l:i��n L•r� t�uy er,i�4�.n�� l�uildi:ng o� :;tYUC:tur.e,
. cir. f:��• �,iiy t,J.i:c�aL•ic-,n nr. rc�,��ir.:; l:o •any c;:i.:t:in�� )nii.t_c�i.�u.� or sL-r.ucturc, u��c,n ar���li.c:ati.on
=ther..:i'or.c, r.equ.i.�:c tl�� n�,ymc��L• }�y tlic ar,p].i.c:an!: fo�- :;uch per.mi.t o!: fec:, to thc a�nount
hcr.uiri bcl.c��•� scL• for.th �u�Q i.�i t:lic �iianticr. hcrc�.n �»:ovidc:cl to-�•::iL-; •
1d3:19 CUId�-:�17tUC'1'ION: �ingJ.c 1'amil.y llomes and Gai��zcres; ;:�1.00/).,0�0 cul�xa �cat.. .
1�1,1:F� Cit1:CJ:: 25 i�cr.cc»t: oi buz.lcli_ng }�c�-miL fee. � �
V2Z]:VI;t:11Y llL•'L'P.e:SSI01•:: (CvncreLq G`�ix}� �Lreet� Only) �'
' A).t-ein�lt:e A: lte�noval anc3 repl�zcctr�ent of concre�e curb and
quL-L-er only; l�riveway widtli plus 6 ieet x�:�,�.75
1U.tcrnai:e II: Removal and rep�.acemcnt of concrete curb and
• ' gui:ter and inst�ll a 3�fooL- wide aPproach caith �'
' ,� 6 a.neh cic:pth; Driveway �•�ic:th �plus G ieet x$17.85 �
• . —ADDIiION/�L Itdi=0R��1/1TI0�
�'or the pur��se of co:nPuti.ng �'ees for bui.lding pexmits, L-he cubica3. contents of any
buildi.ng or addition, is determi_ned by rnultip.lying the ground area covered L-rorn a
p�int �is: (G) inches belo;� ihc iloor ).,ine of tlie bas�meni. or th� cellar to 'thc
averag� iieights of the •upper su�.face or i:o the average height o£ the roof sui:face
of the raai.n gable of a pa.tched roof. �
Fox re�ai_rs or �7.t�rations to an existing stZ-�icture, the fee shall� be at the xate
. of �3.00 �ier each £ive 't�undred dollars °($500.00) or fracL-ion �1@1"l•:O� Sn the cost
of all proposed wor.k. . . •
xn •no case sha�.l �-he ��_e cliarge� �c�r any ppxmit �� set iorth i.n Sectiun 2 be l�ss �-
than $7.50 plus $.50 stat-e surcliarge. � • '
� VERTFIC.�TIO� �F r-our�nn -ior
NOTE: Permits �or construct•ion �vill be isstied a minimiun oi 24 hours from the time
oi application to a].low for �roper revie�v of ihe proposed stzucturc and oi the
construction site. �
..
?� Certificatc � of Survey of the lot, sho�.►ing the location of tiie foundation once it
has been cons�nicted �aill be required bef_ore pr.ocecding �•rith the iraming. �
.�RT I F I G1�TE QF ���UPA(��CY � '
I►PP].ication �or a Certificate oi Occupancy shall k�e madt� ten (lCt) days prior �o the
u� e oz accurancy oi any stz-ucture for ��hicli a Liuil3ing permit Las been issued; and
saac3 structure shall. iiot 1.�e used or. occu�,�ied Luiti.l a Ceri:�.iicate of OccuPancy has
becn xssued.
0
0
� ' .
...�, 4-�. '� .
F • �
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� ��������,���`�� *1
s� ��"����.�,�4.t�
r�� g v TM �
t
't _.�� f�::i� 1,'F. � �'��;f* �w! i
� '�"'�
t �S� ti� t -��' � .
� � hn ft��s
fa.`�.:: �' ���� ''
'� .
8 w � � �y: +�-� y �r : $�� � T� '' �. a.
. F g`. R` g _ y �a
6431 UNIVERSITY AVENUE N.E., FRlDLEY, MINNESOTA 55432
TELEPHONE ( 612j571-3450
March 17, 1�81
Cu�tom Pools
701 E. Excelsior Avenue
Hopkins, NIl�T 55343
Re: Swimm►ing Pool Construction at 7076 Hickory Drive N.E.
Dear Sirs:
This letter is to make clear this department's requirements for the sw�+�+�rig
pool construction at the above address..
1. As indicated, an.e (1). skimmer approved by the National Sanitation
Foundation will be provided.
2. As indicated, four (.4). inlets oi approved design for fresh and/or
_ _:zepurified : w���r �l- be provided: _�:�.
3. As indicated, a main drai.n of approved construction wil.l be provided.
4. The filter and piunp shall be approved by the t1.S:F. and be of
sufficient capacity ta provide a minimtun turnover of at least two (2)
�Fimes in 24 hours. This departmeht recommends a turnover rate of
6 - 8 hours.
5. A deck of at least three (3) feet wide, measured from the pool waters
edge, shall be provided which extends completely around all private
� residential pools. Above ground private residential pools may be
provided with decking of a minimtun size of 4 feet by 4 feet at pool
entry po3.nts and provided that such decking has trie approval of the City.
6. The diving area will be acceptable provided there is no overhead
obstruction. �
7. Fenci.ng or other �ffective means inc].uding but not limited �o walls
or buildings, acceptable to �khe City, shall be provided to positively�
con�Crol all access to public and private residential swimming pools.
Fencing shall meet the tollowing ariteria: .
(a). The fencing shall prevent the entrance of chi.ldren and be without
hand or foot holds that would enable a person to climb over it.
(b) The fencing shall be at least 6 feet high and entrances sha11 $e
equipped with self-closing and self-latching gates capable of
being locked. � �
�(c) Self-closing and self-latching devices shall be placed at the top
Qt the gate or othexwise inaccessible to.small children.
(d� The o�ning between the bottom of the fence and the ground or
other surface shall be not more than four inches.
Cl1StOID POOlS
March 17, 1981
Re: 70.76 Hickory Drive N.E.
Page 2
8. An automatic chlori.nator should be p�ovided with a suitable test }cit.
9. Atl electrical and plwmbing installations shall be i,nspected and
approved by the City Inspection Departsnent. .
10. All overhead el�ctrical lines must be a minimi� of 10 feet horizontally
from the pool surface and,18 feet straight line d.istance from the
waters edge.
T1. The pool fill spout must be protected by a vacuum breaker or air-gapped.
12. Suitable safety equipment to include but not Iimited to a ring buo�r
and rope that is 1� times the pool diameter, and shepherds crook pole
must be provided and ma.i,ntained with the pool at, all times.
Furthermore� these and any other requirelnents must� meet the provisions of
the Fridley Cti..ty Code, Section 115, Swiffining Pools. The building permit is
approved contingent. on final inspections and approva.l by the City.
If any questions or problems arise from this letter, please feel free to
contact me at 571-3450.
Sincerely,
_�- ' �� _ ,- � ' �'���a �� .___._ - - - - _ - �-. - -
.�,�� -- s . _. •_ _ . _ .__ e _ ... : _._� .., _ . �_ . , .. _ .
. , . . - - - -
F�vironmental Officer
SJO/tnh
CC: Mr. Walter Silesky
7076 Hickory Drive N.E.
Fridley, 1+MT 55432
,
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24" CLEARANCE
. ABOVE FILTER
'A' FILTER
DIAP1ETER `S
,B,
/ \
27" MAX. WIDTH
DIALATROL VALVE �
��.
TO WASTE �
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15" `
I
.
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AIR RELIEF AfJD
PRESSURE GAUGE
'C' — 100� BAGS
OF Id°— 20
�SILICA SAND
� 34„
`�I
�� DRAI P�
"1 1/2" POOL RETURN
PUMP SUCTION
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STRUCTUP,AL FOAM SKIU
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INBf�TUT6
SELECTIOf! CHART
CATALOG MODEL FILTER AREA PUf�1P RATE Sn. FT. TURP�OUER CAPACITIES �
NUMBER NUMBER (SQ. FT.) H.P. 15 gpm 20 gpm HOUR 6 HRS. 8 HRS. 0 HRS. A B C
21 1260 7,560 10,030 12,600
24735-216 IIRSD-16 1.4 1/2 16" 33" 1 3/A
2S 1480 8,880 11,840 14,800
33 1980 11,E80 15,840 19,800
24740-2 HRSD 20 2.2 3/4 20�� 3��� 2
44 2640 15,840 21,120� 26,400
24741-224 1 47 2820 15,920 22,560 28,200
HRSD-24 3.1 24" 41" Z 1/2
24741-324 1 1/2 60 3600 21,600 23,800 36,000
GEt�ERAL NOTES:
Tne filter tanks ana nump a unitrol valve are approved
1. Flow rates siio�•m are oased on li, anC 1U f,.P.;i. per sq. ft. by the ;lational Sanitation Foundation.
of filter ar�a. iiov�evor, rates may vary froin 10 to 20 G.P.".
per sq. ft. as desired. Ti�ese filters are covered �y the following patents:
• Australia rat. roo. z�s,346. Canada Pat. fio. 722,01�;
TM„dr„�,,,rau,��e Great 5ritain Pat. �70. 934,7?7; �4exico Pat. �lo. 79,7J7;
•vuwu ro ua �r ntce w nnnmrwra�. South Afr1Cd Pat. ��0. 1100/65.
�q�yq� ptllp�y y�p p)�ERB IMYpWFD IN
WTRAIIq A10 APS[lVl11Y3 ilU8 WRFW.
�581111R IID YM�LITY POII rte 118L �
8M[8T i�TL[�
sWimQuip
3307 011men HoaE, EI Monte, Celli. B173Y
1121 Nufl RoaO. N.W. Allanls. OeorgI930918
P839 Welnul HIII Lene. Suile 128, �allee, Texes 75228
c� COWRI�HT 1B72, SWIMOUIP. �IVISION OF WEIL-MtLAIN COMPANY. INC.
VERTICAL H I-RATE (SKID UNIT)
HRSD SERIES W/DIALATRO� VALVE
�. ` ��� JUNE 1973
AII�IO IM Y.t �.
SPECIFICATIOtJS:
FILTER PLAt�T
The tiRSD filter plant specified under this section shall be of
the pressure sand, HI-R/ITE type manufactured by Swimquip,
Inc. The filter plant shall be a product of a company regularly
engaged in manufacture of �aater filtration equipment �•�ith a
minimum of ten years' experience in manufacturing filtration
equipment for public swimning pools.
The filter plant shall consist of a filter9ng un9t, face piping,
cast iron dialatrol v�lve, injection molded hydraulic dis-
tribution system and lower collection manifold, gauges, XL
Series, cast iron recirculati�g pump and pump strainer, all of
��hich shall be manufactured and assembled on a structural foam
skid by S�vimryuip, Inc.
The filter plant shall be designed and valved to pern�it reverse
flo:v backwashing with Sr�imquip's dialatrol valve.
(1) FILTER AREA
The filter plant shall have a total effective area of
square feet.
When operated at 15/2U GPh1 per square foot of filtering area,
this filter plant �+ill have a capacity af filtering
,gallons in hours and m nutes.
(�) FILTER TAflK
The filter tank shall be in diameter and shail be
constructed of type 304 stain ess stee r�ith a minimum s9de
shell and head thickness of l� gauge (16" and 20" diameter),
1G gauge (24" diar�ter). Tank to be reversed electropolished.
Al1 piping shall be through the side of the filter unit in order
that the lid may be freely removed ��ithout any piping disassembly.
The filter tank shall be supported by means of a structural
foam skid.
The filter tank shall be designed for a 200 pound minimum
bursting pressure and tested,at 75 psi 9n accordance �vith the
(;JSF) I�ational Sanitation Foundation requirer�nts.
(3) FILTEP, hSEDIA
The filter �dia shall be a hard, uniformly graded silica material,
coiranonly referred to as Crystal Grade filter sand. There should
be no limestone or clay present. Crystal Grade B20 fitter sand
must have an effective size of .45mm and a uniform9ty
s
- .
(4) FACE PIPI�JG
A1l piping required for the operation of the filter plant shall be
included. Pipinq shall consist of cast iron dialatrol valve
connected by 5.5. band clamps. The operation of the filter and
backv�ash cycle may be accompltshed by the s9mple manipulation
of the valve handle. The d9alatrol filter cantrol valve shall
be fully ported with positive sealing gasket and rotary plug.
The dialatrol valve shall be connected to the tank o�ith
band clamps for easy removal. The filter shall be con-
nected to the pump by rt�ans of a stainless steel connector.
(5) RECIRCULATING PUt4P At�U PU,•1P STRAI!dER
The pumping unit shall consist of a self-priming single suctian
centrifugal pump of the built-together type. The pump volute
and seal plate shall be manufactured of cast iron especially cast
to produce smooth surfaces for water passage.
A cast iron pump strainer shall be an integral part of the pump
asseribly. The strainer lid shall be cast iron and secured with
manganese bronze "T" head bolts. The seal between the cover
and the strainer pot shall be effected by means of an 0-Ring
gasket. The strainer baskets siiall be molded of hi-temperature,
hi-impact styrene viith integral lead ballast.
The pump impeller shall be an integral bronze casting of the
semi-enclosed type, attached to the motor shaft. A stainless
steel shaft seal of the mechanical type shall be provided with
ceramic seat and carbon v�ear ring.
A NEtih C faced motor �aith a drip proof enclosure shall be
bolted to the pump volute. The motor shall be of the capacitor
type with silver faced centrifugally operated disconnect switcq-
ing, and shall be fitted with a thermal overload-protection of
the self-resetting type and a stainless steel shaft.
The motor shall be single phase, 60 cycle horse-
power for service on 110 or 220 volt electricaTT suppT
The pump and motor unit shall be designed for self-locating
assembly, ease of maintenance, inspection and service without
the use of special tools and without the need to disturb piping.
The HRSD filter plant as outlined herein shall be Swimquip
f�o. .
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SuBJECT •
City of Fridley 2 0 3 5�
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� � .
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� • COMMUNITY DEVELOPMENT DIV. �� � ��
v PROTECTIVE INSPECTION SEC.
� —___—
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� _ ,
� /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'""'� � �'� 612-571-3450 910-F15 5/15/�Q / /
JOB ADDRESS 7076 Hick�oxy Driye N,E,
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
DESCR. 3 2 QS�I113ri tS Third Addi,tion SHEET
2 PROPEFiTY OWNER MAIL AODRESS ZIP PHONE
Th�ma,s/Sheryl Qruutt 707� t3ickory Drive NRE, 572-0046
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW C� ADDITION O ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Cqns:tx�uct a 12 ` x 13 t Deck
9 CHANOE OF USE FROM TO
STIPULATIONS See notat�:c2ns on plan
��p��'� �'
R�N� � A�R
F,qT�NG,rs R
�������1 ' pIV�QUj,��
6efore digging cap for e/N�i ,q ��R
alt utility locations �
454•0002 O `s��'°��
REQUIRED BY LAW ��''
TYPE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED Oli ABANDONED fOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �" STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SUFTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED yS`1 � 1S�O S e 5S
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEFiMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON- $2�, OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$29.58
NATURE OF C NT TOR OR AUT ZED AGENT IDA EI yy � N PR E, Y LI A ED THIS IS VOUR PERMIT
p 151 CC�• � ��1� �ia
SiGNATU E OF OWNER�iF OWNER BU1lDER� iDATE� BLDG �NS� ��qTE
� [ ] Effeetive 1/1/90
� [ ] R-1 AND R-2 �
�T� [ ] Huilding P+ermit Application ��
Con.struction Ac�dress: ��� � �j��d'�/ ��
Legal Description:
��&�:
9 �her�� i
�. #5�t2-oc���
���: � S�� �. #
�:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to sca].e.
.;:� «� .� . � � �� •,. � :� �:�
L1VII�iG AR�►: Length Width Height Sq. Ft.
(�R� AR�i: Length Width Height Sq. Ft.
D�GR AR�: Length Width Hgt/Gro�uxl Sq. Ft.
O'1'i�R: � � � X l � � � � � � � I e � � 1 �
Corner Lot [] Inside LAt [] Ft. Yd Setback Side Ya�i Se
Zj�pe of Construction:'��G�%U� Estimated Cost: $ /p
Approx. Ccanpletion Date: I' ��
Proposed Driveway Width If New Opening Is De.sired: Ft. $ $
fr�(� W' + 6' See BacJc Page
L1ATE; � l l� ! 1(� APPLICA�PI': l f I' �3'J'�� � Z�e]. ,#�� Z �C�� �
Permit Fee $
State Surcharge $ � �
SAC Charge $
Driveway Fscrow $
Park Fee $
Se�aer 1Kain Q�arge $
Z10►I'AL " � A e
$
CITY USE �Y
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by E�cJ��9
Agree�nent Necessary [ ] Not Ne�s.saty [ ]
i
S'I'IPtTLATION.S :
,
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I�������_ i�,y�4 �+:�- :_�.:i�� �1 _
The Ciuef Building Official shall, before ���»+� pera�its for the erection of any
building or stnictura, or for ar�y a�dition to ariy existing building or structure, or
for ariy alteration or repair to any existing building or structure, upon application
therefore, require the paymetzt by the ap�licant for such ��+i t of fees to the aa�uit
herein belvw set forth and in the manner herein provided to-wit:
Z+OrIAL 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
��
$15 (Minimtan Fee is $15 plus surrhaYge)
$15 for fiYSt $500 plais $2 for each additional $100 or
fraction thereof, to arid including $2,000
$45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to arid including $25,000
$252 for first $25,000 plus $6.50 for each acklitional $1,000
or fraction thereof, to and iricl� $50,000
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and includirig $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each aclditional
$1,000 or fraction thereof, to and incl� $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DRIVEF1piY DEPRF'�SI�.J E.SCROW
(C;AnCrete Curb StY'eets On1Y)
Alternate "A": Remaval arid replacement of curb arid gutter only - Driveway width plus
6 feet times $13.50.
Alternate "B": Remaval and replacement of curb and gutter arid install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIF'IC�TI�T OF F�Il11IDATI0�1
P+ermits for construction will be issued a miniimmm of 24 hours frcen the time of
a�lication to allaw for proper review of the proposed structure and of the
c�nstruction site.
A Certificate of Sutivey of the lot, showing the location of the four�dation once it has
it has be�n constructed will be required before pra�edirig with the fiaming.
.
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10130 HI�'�HWAY 65 NQ�7�Eea�T -�INNEAPOLIS, t�Ira�ESOi� 55�r33 ��.'r:=��h��.,9�
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Cer4ificate of Surr�y�� _ —
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An�ka l.aunty, t�irones�ta
I ME�EHY �ERT � `��aT TN�S IS A TRUE AND CORRECT REPRES�MFATIC>N �F A SU�lVE°�' G�F ih1EB0UWLARlES
�1F TkE ASOvE pE',:�� �•FD L.aND, AN� THE L�CATION OF At_L 6U!LDlNGS THERE�N AND ALL V1518LE C-YJ
CRUACHPAENTS IF hti � �-� �M ;l� ��N SAID LAND
AS SURVEYED 6� r��E '�� ��'r� DAY OF ��Q�'�mb�r �� �� fi�
N C HOIUh1 AND ASSOGIAT�S VNC .= LAPdD SU�v�Y0R5
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10130 HIGNWIAY 65 �dORTh�A�T - r�INPlEAP�LIS, M�t��1ESi3Tc� ������ ��p'�°������
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Ano6:a County. Minnesota
1 HEREBY CERTtFY 1�+qT TNi515 A TRUE AND C�RRECT REPRESEWTATIC?� f3�' A SRJ�kv'E�° 0� 761EB�UPdp�aRdES
OF TFdE A00VE DES�FtihED L�ND, aN0 THE LOCATION OF ALL BUILDINGS TFl�a�EP'j�i A9�0 ALL 4°ISIBLE E4�•
CR�ACFdMENTS, IF ANY F�;+_lM OR ON SAID LAND
AS SURvEYEO BY t�E Tr+��, ��Ch pAY OF . �iObeRl��B^ .. A D 19 ��
W C MOIUM AND ASSOCIAT�S iNC .-` LAN� SU� V�YORS �
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COMMON VENT. VENT CONNECTOR AND C091ABUSTION AIR VERIFICATION
When realacina an existing furance, the undersigned hereby verfies that the
venting has �en examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes ( No (
The venting system is plas�clPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No {� .
��
The undersigned also verifles that the replacement unit is a listed assembly
and meets the cuRent codes and rr�anufacturer's specific�tions. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fa�
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the cuRent codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
to meet the cuRent codes and manufacturers specifications.
Yes ) No ( )
Yes ) No ( )
Yes No ( )
When installing a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the cuRent codes and manufacturer's
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 ) No ()
Appliance Tvpe and Size/Common Vent and Vent Cennector Information
Apaliance #1 Type �v�^ �� BTU Input � o� Fan Assisted or Nat ��
A liance #2 T e(,u � �� BTU Input `/� a�o Fan Assisted or Nat N� .
PM YP —�—
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances �_ Total Btu Input ( O do
Common Vent T e r I� Vent Height �� � Diameter � inches
YP
• 3 � �� .S� ��e wa l�
�
Appliance #1 Vent Connector Height ft Length l ft Diameter � in Type �
Appliance #2 Vent Connector Height 'z' ft Length 2` ft Diameter 3�in Type s'in P����
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
AI TFRATIANS� (Describe) ��Ct�1G>� I C�/'`n � �'l° _ �� � ���
��'l JlOS 1'i �► rr��
HEATING CO: e�'�P .��r� Pr'G �/ Ci�l
Signed By: Date : ( _ � o �
�
; :;: _
Ct1YOF
FR[DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
February 7, 2003
Mr. Joel Anderson
7076 Hickory Dr NE
Fridley, MN 55432
Re: Final Inspection at 7076 Hickory Dr NE
Contractor: Pierce Refrigeration
Dea� Mr. Anderson:
A mechanical permit was issued on September 7, 2001 to install a furnace at your address.
According to the 1991 Uniform Mechanical Cale a final inspection shall be conducted on
the work authorized. by this permit. As of this da.te the inspection has not been requested.
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your permit open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the pernut "no
inspection called for by homeowner after notification" and take no further action.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
DJ/mh
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
►63) 572-3604 FAX: (763) 571-1287
: 7076 HICKORY DR NE
: 103024440041
: OSTMANS 3RD ADD
: LOT 3 BLOCK 2
: BUII.,DING
: RESIDENTIAL
: ROOFING
VALUATION : $ 2,315.00
NOTE: UNDERLAYMENT AS PER STATE BUII,DING CODE.
REROOF HOUSE & GARAGE (20 SQ) TEAR-OFF
APPLICANT
ANDERSON, JOEL
7076 HICKORY DR NE
FRIDLEY, MN 55432
OWNER
ANDERSON, JOEL
7076 HICKORY DR 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 governing 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
re� tructi n or the performance of construction.
Ap�?licantr� Date �
Bldg Insp.
�z_ .. __� . �P_ ���\
PERNIIT 1�0.: 2004-00350
�---_�-__---'.
DATE LSSUED: 03/17/2004
BUII.,DING PERNIIT FEE
FIRE SURCHARGE
STATESURCHARGE,VALUE
TOTAL
PAID WITH CHECK # 4933
�
SEPARATE PERNIITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
83.25
2.32
1.16
86.73
NEVI/ [ ]
ADDN []
ALTER [ j
Construction Address: 7�
Legal Description: Si `✓z
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
%_���r�r �r��L
p �,� S e
������
Effective 1/1/2004
(763) 572-3604 Bldg Insp
(763) 571-1287 Fa�c
/r -� �9 3 �
� ��`l `<�,
Owner Name & Address: �� � � i�v�� -� �So � 5'��� � y �+�'q'el. #�6� 3 -.� 7� - � / ?C�
Contractor: S� I`� MN LICENSE #
Address: Tel. #
LMNG AREA: Length
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Width Height
Length Width Height
Length Width Hgt/Ground
K e /C �'� �1 D tn. � �_ � � � ✓� �
Sq. Ft.
Sq. Ft.
Sq. Ft.
� 5� %�e�i n l`t'
�+ � � s'r`-' �
Construction Type: o o(� Estimated Cost: $ �`'`�- ,� �:`-
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _�
DATE: C� APPLICANT: Tel. # 7G `3 �S%� - 1� 7C�
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number. '
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
� � -- -
� E� f �,
��� � � �.
$ �' , .�
�, �.
$ i f' �
$
$
$
$
$
$
� �� � �
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
STIPULATIONS:
A
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$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
$23.50
$23.50 for first $S00 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,OQ0 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,OQ0 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or ftaction 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 $1,000,000
$5,608.75 for the first $1,000,0(?0 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate.
Pernuts 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.
VERIFICATI�N OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
City of Fridley
6431 University Ave NE
Fridley MN 55432
(763) 572-3604 or Fax (763) 502-4977
REC'D OrT 15 2001
°��� —��%l �
Water and Sewer Permit Application
❑ New Connection
�xisting
Date: �� OCT L 5 2007
�Utility Line Repair/Relocation
❑Water and Sewer Connection
Job Address: �O %( �fC f%3-P V
�i� i �V -�
Name of Applicant (Plumber): ''� �� J
Name of Property Owner:
Existing Structure Permit #
.S o e �
Permit Type: Sewer Fee: �
Water Fee:
Meter Fee•
Repair Fee: �_ ,��R,t��
Relocation:
State Surcharge:
SAC Charge:
Special Assessment Fee:
Total: $ � - �
Applicant Signature;
Inspector approval:
�e lSo v�
� ,
.i� il
Water Meter Re air — Weekend & Holida s $125/hour
Water Connections Permit $50
Sewer Connections Permit $50
Ins tion Fee for Water/Sewer Line Re air $40
S ial Assessments See Finance
Cost of Water Meter See Util' Billin
SAC Chaz e $1675
State Surchar e $ .50
Water Ta See En ' eerin