AF - 46177/�"�i
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City of Fridley, Mirin..
BUILDING PERMIT
N° 4145
_ o �
Date: ....._ .—___ / �._..... ��--.._.._._._____
Owner: .-•-----....._---•---�--------....._.._........._.-----....._._----•--•--......_....._...---�-- Builder ..............-�-�--•-•--.._...__.._...� .�. ��e�....._�fo�...e� Gi�'1...._�.� �
Address
- � ��
^� TIO O BUIl.DING
A � � �
No. .�.�.�-� Street -• - -- ...----•-- �7������_--•.. ..._�l�L�_. Part of Lot ....--�--•---._...._..... ..._.... ._..--- . ..._ . ._
Lot ............. y.............. Block -�--•--•----.'�.............._.............. Addition or Sub-Divlsion ....%!%:./..��._P.�.?�... ��... .......... a. _._..
` � c��a----....-•-- .............--_._..
Corner Lot ...._ ............._._._........ Inside Lot ....�....._..................... Setback .�:.�..:..:�.---........ Sideyard _..//.l�!...._...
Sewer Elevat'ion
To t�e usea as:
Type of Construction
Founda.tion Elevation
DESCRIPTION OF BUILDING
Front ----.I......�?� � bDepth ��� Height {....��.�. -..:. � Sq. Ft ��I._...._ .Y� Cu. F't. ?���� �
Front ....------...---�-�--. Depth ...................._.. Height .........�.. Scl. F� ....._............._.. Cu. F't.
........_....--� ..............--........._......... Est. Cost_ --�-f.• ._ ��/ ..._........ To be Completed �---�----......._.---...
..............
In consideration of the issuance to me of a permit to construct the ' ding described ve agree to
the proposed work in accordance with the description above set forth d m mplianc all ovlsiona
ordinances of tY►e dty of Frldley. 9 �/_ �� �
.
-
In consideration of the payment of a fee of $..��.....�...'�........, Permit is hereby granted to....._ ............._............._....-•---...._......._..
,..�.._____.--•----_..-------.._.._---...._----_. ta construct the building or addition as described above. This permit is granted upon
the express condit3on that the �rson to wliom 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
Frialey, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the dty limits and this Permit may be revoked at any time ugon violation of any of the provisions of said
ordinanc�. _ � e � 1 . �
Building Inspector
NOTICE:
This permM does no� cover the eoasfruetion, installallon for wiring, plumbing, gas heating, sewer or weter. Be wre to see
the Building Inspecfor for separafe permita for these hems.
4
nuTr+. No. HOUSE HEAT TESTING DEPARTMENT
� -, �,� FOLIO
nccouNr TEST RECORD �
�{.i?m. k. e,�:'•� +�q'"�.`"� ._ �,,, DATE
� -,. i �r `� � �.���.:_�..�, :�-° - �_ .,� 1
ADDRESS "'��°`y � , � �PT. TOWN �H-�"��"� YEAR BUILT
OCCUPANT PHONE OWNER' �� ��'�:c"` ��' `��� '� '� � �,�"`. PHONF
HEAT LO55 ESTIMATF MCF CF/DD METER SET DATE '
INSULATION: WALL� CEILING DATF WEATHERSTRIP: DOORS WINDOWS DATE
SOLD BY INSTA��ED BY E'�"���Y"'' �°� _`"�"� ��"'�" �x°� DATE IN3T
ELECTRICAL WORK BY C3AS LINE BY � RESET BY
TYPE OF H�AT ��r"�``�` G.D'`� cowV.—MAKF��:�°`���°�'-����' MODEL °�'�`�"'�°''�'�seRla� INPUT�j'�'�''*m'�
CONVERSION: MAKE OF PLANT MODFL�, SERIA� �{� FIREPOT COI�-
+w�+q�`�,� h" � .t� 't �� ..r!"i �LLf+' 'r` �
CoNTROLS: THERMOSTAT 4! ^#�-�HTG. PLUG VAWE `�'��' '�� LIMIT RELAY
M �' ' , ���.
TRANS:: MAKE FADDE� SEC. V. �.A - °ILCT TYFF�'' `�� M/4KF� �'� �f��"� ;" T�, rAODE�' `
+a ..Y. f�fP . � _ �
LINER: KINQ`''` �� - GIZ�_RISER: 51ZF LENGTH ELLS REG. �"' �.W. CUT OFF
,.:�; ,
VENT: SIZF ' LENGTHS __'�EL� iS � D.H. £'� FILTERS: C� - REP SIZF"�r y�r �` "�NUMBER +�
,dt.
GHIMNEY: LOC�TION CONSTRUCTION rWF FLUE SIZF CONDITION �y
PRESSURF �,', '�� SMOKE BOMB RESET FILTERS TEST TA�
.0" � .,� �wC'°� .
INPUT "� ' PILOT TIMING �''`` � WIRING LOW WATER CO INST. CARD
�- r+� ;t.*�,": `"'
ST/�K�EMP. 7� FF�N SETTING ���'� ♦�y'�`� uCONTROLS , FUSE SIZ GOV. SEaL
a d'.+� .� rwn .a� �, a�. >, i .
PE�CENT CO ��� �`LIMIT SET7ING �r''��Y � VENT � GALT CAP SEA� METER SIZF6 r�
.t�-<. .� t-0 �. �r,� ,,,.� �s. a.._ „r�'` � ,�Y
F3ERCENT Og � � �FT �` � ��i°°'°' �RAFT HOOD�METER SEA� DATF �' ��'� ;-'' -'�
�""�� , m�`A
PERCENT CO ��='� ^OOR PRESSURF LINER METER STATF
� ` '` ,�P" yT �. ��
WRITE ORSAT READING FOR OTHER SECTIONS ON OTHER SIDE. TESTED B�' "'Y t'�" f'�""�* '� 1`f °
i�..:�-.�.,��'' � «3<.:s
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FORM 29S
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sue�ecr PER
City of Fridley . 14826
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T
t
; � R CEIPT NO.
� `y __���_ COMMUiVITY DEVELOPMENT DIV. , �� �
r � � PROTECTIVE INSPECTION SEC.
1 .1 i
1` 1 /"'1 � CITY HALL FRIDLEY SS432 NUMBER HEV. DATE PAGE OF APPROVED BY
L����� / ,`� 612'560-3450
910-F15 8/1/78 � �
JOB ADDRESS 1353 Hillcrest Drive N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESER. L� 4 1�oore Lake Hills SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Peterson & Schmiesing 1353 Hillcrest Drive N.E. � 571-0690
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADDflESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
R@S �.d@11't111
7 CLASS OF WORK
❑ NEW ❑ ADDITION l� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof structure
9 CHANOE OF USE FROM TO
STIPULATIONS
Install ridged galvani.zed valley�. Roof can be second but not third.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. A3j�Yld�-'t
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTFUCTION 20NING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 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 OFFSTREET PARKING
I HEREBY CERTIFY THAT I 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 WILL BE COMPLIED $. SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S�QO
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- 7, 5O
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
PLAN CHECKFEE TOTALFEE
�`8.��
IGNATUREOFCONTRACTOPORAUTHORI2EDAGENT (DATEI yy N PRO ERLY VALIDATED THIS IS YOU PERMIT
�r `l �.� � . - / �. .`' �/ ��
S�� TUREO yVNERUFOWN RB I�DER IDATEI a'' - BLDG NSP OATE
CITY OF FRIULEY
' /1PPL.TC���IOP� rUfZ RESIll�P�TI/1L BUIi_DING f'ERf�1ITS .
' �I'�C}�(, I�LTLR/1TION5, I�DDITIOtJS, OR REPAI(7S)
OWI7�R: � -a �C ' I3UILDL•'R: ' �A � �„ -' � •
Address : � �S`3 � � � � C�F,cT �r, n�dress :
T��. �o. �� 1- O��':C� .
No.: Street:
LOT: � BIACY.: � ADDITION: �j���� ��� y� � {.S
CORNER LOT: INSID� LOT: S;sTBACY.: SIDEYA12D5:
Applicai-�� attach 'to this form ZWo Certificates of Survey of Lot and proposed
building location drawn on these Certificates. .
DESCRIPTIOPd OF BUILDING
To Be Used As:
- � � � �?�� Front:
Depth: ' Height:
Square Feet: Cubic Feet:
Front:
Depth:
Height:
� Square Feet: Cubic Feet:
Type of Construction: ��-���tLT Estimated Cost: $ �o�
7.b �e Completed: Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(ST� R�VERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the c,�ork herein
specifi�d, agreeing to do �-i11 work in strict accord�zce witli the Cit}r of
Fridley Ordinances and rulings of the Depari.ment o� BuildincTs, and hereby
declares L-hat all the facts aiid representations stai:ed in this application
are true and correct. See reverse si for additional info�-mation.
DAT.i:i: �^ ` � / � SIGNATUP.E: t a
Stipulai:ions : ,
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BUILDI(dG PERt�IIT FEt SCNEDULE
SECTION 2. The Inspector of Buildings shall, before issuing pezmits for the erection
of any building or stxucture, or for any addition to any existing building or structure,
or for any alteration or repairs 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:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$14.50
Alternate B: Removal and replacement of concrete curb and
qutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x$7-7• 20
_ADDITIONAL INFOR�^1ATION
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or th� cellar to the
average heights of the upper surface or to the average height of the roof surface
of fihe main gable of a pitched roof.
For repa.i.rs or alterations to an existing structure, the fee shall be at the rate
of $3.00 ��ier each five hundred dollars ($500.00) or fraction thereof in 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 $7.50 plus $.50 state surcharge.
VERIFICATIOV OF FOUNDATION �
NOTE: Permits for construction will be issued a minimiun 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 Suxvey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
CtRTIFICATE OF �CCUPANCY
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 pe�it has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
. • �
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MAR-13-2002 12�33 FR�t CITY OF FRIDLEY TO
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CITY OF FRIDLEY
6431 iTNIVERSITY AVENUE NE
� FRIDLEY, MN 55432
ADDRESS
PIN
LEGAL DESC
572-36U4 r'AX:
: 1353 HII.,LCREST DR NE
: 243024120059
: LINAVAII.,ABLE
: LOT BLOCK
571-1257
PERMIT NO.: 2004-02180
DATE ISSUED: 11/29/2004
� � �
•
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
� VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRiTTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
VALUE OF APPL OR WORK 0 # FURNACES 0
# GAS DRYERS 0 # GAS RANGES �
VALUE (FOR 11�IINIMUM CALC) 100
APPLICANT
CENTERPOINT ENERGY/NIINNEGASCO
13562 CENTRAL AVE NE
, ANOKA, MN 55304-
OWNER
HOLLERICH DANIEL C & DEBORA
1353 HII.,LCREST DRNE
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 worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
reg�a '�construction or the performance of construction.
Annlicant . 1� Date i _
Bldg
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 1023514
15.00
0.00
0.00
0.00
0.00
0.50
15.50
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�P
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
.,
When realacina an existina furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer .
specifications including s'izing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes ()
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 cuRent codes.
No ( )
Yes ( ) No ( )
Appliance Tvae and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describel
HEATING CO:
Signed By: Date :
'�-�
Building MECHANICAL Pemut No.: `��'� 1 ,�
Inspections R�i SIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY nate Re�'d: �i' °�`�"�
DATE !� '" ��D �/ YOUR E-MAIL ADDRESS
srt�AnDt�ss 1353 / �L-�C2�S7'
THIS APPLICANT IS: ❑ OWNER NTRACTOR •
PROPERTY Np�: LL "e12/G '/
OWNER/ ADDRESS: (a � CI'Iy S'f�� ZI��"3 Z
TENANT PHONE: /�.� ° .� �%� �'�CO ��.3
CONTRACTOR COMP,�.NY N,�ME:
� � d,' � u.. f °
SUBMIT A COPY OF CONTACf PERSON:
.e � ��
YOUR STATE ST'A7'E 1-ICENSE �
LICENSE WI'I'H pDD�g; ' CITY STATE ZIP
APPLICATION PHONE (763) 754-2�� ��x (763) 754-29
- - — -- - z
PERNIIT TYPE �GLE FAMILY ❑ TWO FAMILY O TOWNHOUSE
TYPE OF WORK: ��W a�P�'CEMENT �'4L'TER�'TION/REMODEL
DETAILED DESCRIPTION OF VJORK �`' u- �(.4'�,-y�et�
PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of ihe total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fnttures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHER,E U�BOR IXCEEDS $500, FEES ARE BASID ON SI0.00 PER FIX'T[JRE, EXCEPT W1iERE NOTED. FDCPURES: (IIdDICATE TOTAL
NUNBER OF EACH BII.O�
Equipment Installed , MFG: MODEL: � SIZE/BTU
MFG: MODEL: SIZFJBTU
MFG: MODEL: SIZFJBTU
A/C $Z5.00 FIREPLACE (GAS) $15.00 . _GAS RANGFJOVEN $10.00
AIR TO AIIZ EXCHANGEER $15 FIREPLACE (W�D) $35.00 = � �r � $�10�.�
BOILER 535.00 e�FIJRNACE $35.00
�y �gR $�p,pp GAS DRYER $10.00 FOOL HEATER $35.00
_DUCT WORK $1000 GAS PIPING $1000 VEN'III.ATOR $15.00
.. �
i�x���������z. �`���..�� �:
,.� .. . . _. _ _ _
�.
�°������ .. : . . � . . . : � �t� �� . .� .. .M.:
Permit Fee $��� Number of fixtures @$10.00 x$10.00 $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
7"OTAL DLTE $��..� Number of fixtures @$25.00 x$25.00 =$
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge ° $ .50
Tota1= $
THIS ]5 AN APPLICATION FOR A PERMiT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
confolmance with the ordinances and codes of the City of Fridley and with the Minnesota-Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a pernvt; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT �.I PRIM NAME �DA7'E a" d
�����'�... '`�����Y7��_...«. Li,SCJd�J'/�•°...�"+;.�"��_Jd'`�����.LL�I�.7!"''P'.Ili��� �����.,li�yYi�i�+ti^F��S.x�.:
�'
�;�ty ot r riaiey
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FA.�: 763-502-4977
,.
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT A,PPLICATION HVAC
❑ NEW HOMES/ADDITIONS ❑ EXtSTING HOME ❑ MAKE-UP AlR
REQUIRED FOR NEWIEXISTING HOMES
1. Combustion Air (See note below) .
a. Oil or solid fuel TMC Cha�ter 7 with MN Amendments
b. Natw-al Gas or PropanelIFGC Cha�ter 3 with MN Amendments �
2. Make-up Air (See note below)
a. TMC Chapter 5 with MN Amendmen.ts
3. Ventin.g
a. Gas appliances IFGC Cha.pter S with MN Amendm.ents
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooli.ng load per room
a. Required on new constiiiction IMC 1346.0312
5. Ventilation .
� _ _�L r�n.r �„PT� trocie 7b�Q_oi' 767�_
6. Duct Design Per ]MC 1346:0603.2
a. ACCA Manual D
NOTE: Centerpoint Energ3T Mechanical Code Guidelines software may be u�ed for
comb.ustion and make up air calculations