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AF - 47486Caty of Fridley, Minn. BUILDING PEI�MIT .: - � �� �� � �� � . . . � - �. ..,.� � . ,r . � '� ��..i�ir/�..�'. , . - :'�'A' .� / ��. N° �5784 � � ATION O ILDIRIG No. �;,�,����,� Street ' s�� Part of t — — Lot �__ Blo Addii3on or Suli-Divlsio�p , �, Corner Lot � Inside Lot � Setback .�s��� ideyard -?'�� Sewer IIevation Founda.tion IIevation DESCRIPYION OP BUILDING T u� v�a � �,� � ,,� ,Ij� •' { /�,/�� t,Y��-� Height� Sq. Ft�f��/�� Cu, Ft�� Front ���.-" DeA _.._, nt �— Depth �H t..—� Sq. F� Cu. F� Type of Construction -��� Foa� Cost ������To be Completed In consideration of the isauance to me of a permit io construct the building- described above, I agree to do the proposed work ffi accordance with the description above set forth and in comAliance with all provisions of ordinanc� of the city of Fridley. ;� ' In consideration of the payment of a fee oP ��'� , permit fs hereby granted to to construct the bwticling or addition as described above. This Permit is granted upon �he exPress condition that the person to whom it is granted and his agenta, emPloyees and worlQnen, in all work q�one in, around and ugon said building, or any part thereof, shall conform in all respects to the ordinancea of �'ridley, Minnesota regarding location, construciaon, alteration, maintenance� rePair and moving of buildinga �vlthin the dty limita and this permit may be revoked at any time u n violation oE any of the provisiona oE said oralinance�. ,�°�.� .�a � �� NOTICE: 'i'his peredt does eot �:ovee the eoeatrodtoe. InalaQattoe ior wirie8. P���B. e� beaHng, sewer or weter. Be sure fo � the Bultdieg Inspeitor for separaTe permtts for theae Itema. � 4.;<„ ,'-'�, 4 /'� -� � _ ;. APPLICI3TIOiV �OA BUII,DING PERMIT Ci'1'X OF �RIDLEY, MZLQNESOTA Owne�' a Name ���'`��'� �� ��, �-��� BuiZder ��'�� �ddreas 1-�-��-� `'� � `���.To�k,-� �-V� ddress LOCATION OF HUgI�DIN(� No. � „��`Street ��_��°��� �� �� Part of Lot Lot � Slock _____! Addit�on or Subdivia�.on�%� Corne� Lot Tnside Lot�_,_Setback �� Side-Yard ���° � SEV�E�2 ELEVATION FOUNDATaON ELEVATiO1�T Applicant at�ach to this form Certi�icate of Survey of Lot and proposea building loca�ion. DE�CRIPTION Oi� BUILD?.1�TG i o 1oe used as o � ��,t�,l �°�-- � � ront �r__Q _ Depth �� � )C��� �Ieight � Sq . Ft . � �a,� Cu . Ft . � r,�_, � , - Front__�___��Dep•�h Height Sc�. F�t. Cua Ft. 7�ype o� Construction Est3mated Cos•t lo be Completed . The unaersigned hereby makes appiication �or a permit �or �the work here�.s� specif�,ed, agree�.ng to do all work in strict accordance with the C�.ty of Fridloy Ord�.nances and rul3.ng o� the Depar�nnent of Huilcl- ings, and hereby decla,�es that all the facts and represen�a�cions s�ated in this ap�licat3on are true and corr t DATE � � , b �,'° 2- SIGNATURE . (Schedule of I'ee Costs can be found on the Reverse Side). ` ' .✓i + ( 1 I I � d w ,z BUII,DTNG P]E�IT PEE SC�DULE Sec��on.2. The 3�spector o� Build�.r�rs ehall, before issuing any pe��n�.'c �or the erec•��,on o� any bu�.lding or s�cructure, or for any addition to any ox�.s��ng building or s��uc�cure, or for any a].tarations or repa�rs �o any exis�iag build�.ng or s�ructu�e, upon applieation �horefor, require �he pay.nent by �-he applicant �or such permit og fees �o �he amount herei.n below set fo�cth and �m the manne�c herein prov�.ded to-wito 2.1. For any such per�3t for the erection o� a,r�y fire-p�oo�` building, ofihe�c tha,a a garago, warehouse, factory o�c grain elevatar, or for �the erec��.on of any :��re-p�oo� add�.tion, �or similar occupaazcy, tp any existing b�aildi�g shall be at the ra�e o� $1.40 for each ono thousand cu�ic x�eet, or �raction thereo�E, in such cubical contents. 2��-. Fog anY Su� p�rm�� �o= the er�c�tion of any fire-proo� garage, warehouse, �ac�toYy or grain elevato�c, or for �che erection os any fire- proo� adoiit�on, �or s�snilaz occupancy, �to ariy ex�sting building shall �e at the ra�� oi $1.25 �or each one thousand cubic iEeet� ciassified a8 °��gaP�oo�" by Sec�ion 502 of the Minneapolis Building Code. HO� 2= For any such permit for the erec�ion oi ir�g other than a garage, warehouse, fac�ory or non-�ireprooF additiion, for s3milar occugancy, Permit $1.00 iEor each ona thousand culoic feet. �A_ any non-f3xeproo� build- grain eZevator, or any to any exis�ing build3ngn 2.a. �or any such permi�t �cor the erection os any non-fireproof garage, warehouse, �acto� or gra�.a elevafio�c, or for the erection of any non-fireproox.adci3�ion, ior simi3.a� occu�ancy, to any existing bu3lding or �or each such building or addition, Ninoty Cen�ts for each ane �iousand cubic �eet or fractioa thereos, ia the eubical contents the�eof wi�h a minSmua-n o� $9,.00 a �or the purpose or computi.nq fees for build�.ng pexm�tts the cubical con- ten�s o� any building o�^ addition to a uniform height throughou� by multiplying the ground area covered arom a point six (6) 3nches below the flo�r line or the basement or cellar to the average height o� the upper �uriace o� �o 'che average heigh � of the roof surgace of the ma� gable of a 'pitched . rooL. 2,� 5. For repa�re or alterations to an exist3.ng structure, the �ee shall be at �the ra�e of $,3.00 per each Five Hundred Doliars ($500.00) or �raction��hereor in �he cost o� all proposed work. 2`6. �n no case:shall tho fee charg�d for any permft as s@t �orth ia Section 2 be legs t13.� $4.00. n �� o � _.4 � � �� $ �Z � �� � � � ' � ,�� ���� 1 � � � v f� � t �,y,.� , �° A '� �9 . �� t '�, 1'� � ' ,�, r ' . �'}y�„�ii�-t � `�. y �' -n� �p�t ���' � � �r:..� �'„�'� • .'� � � � ;� � ,� � :� � . x, a r � : �i� � - �� y ' S �'� . e k � ' : , . 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F : . , � �3� 9 5 _ � ; . �., � � , _ . �. ;� `� � � a � � x~ "L n T �, BL �C,� / ° �� � �, . - �� �� f L YIYDA,�,� Bl/iL ���P,� �' A�1�l�"/�� c _ l� - � �� �, � � � �� . : . . ._ • ' . . . . . � 4�: _ . . . . . . � 6A. , �„ . . � . . . . . .. S:� � . ... . ' . . .. .. �.° � a � . . . - . M1�`� � , . . .. . � � �. � � � � . + . � . . • . . . . . . . �� � � � . : ` . � . � , � . �� � . . . . . . . � .� . '� � ,y+-. $� � �S � O �'iAG 071� i� " "� _7 � �� +�"';� ?�r� � � 3 �� `w��y. � .►�da�. a�..�..�`�y.�'"'''�`'�'""� a�����--�'.�' � � � �� ' �`,,�'� �ra�t !%i �' , A.0 l�. , � � � � � ; ' �•----�--�---"�"_._ �'U� uR� ��� � ' � � T °�,�:" ` ° � '•� ; � �. � � w ��� �.; � � a -,:, ,�� ..� s $ x � �y ;; � �' `, � ' ��'�,� ,v��r���„ ��CAL�E _ �3 #� �� _ _ "' ,�, -�•• �j ' � ' .��` - - ,r� '� , , � . � . ��;`( , � � � � �: � � � �, � � � �� � , �, _ 'f 4 F`� � .. .' . . : .. . . �� � ;� �Y�._ '��y , � ? he .: s� s. ' . � � . s L+'��€ ., . , s � .-, � ;. 3� , � . . .,.�,. . .. ._, _ .. afi...,d__„ ._=,�ee5. .. ,. .. K..:� . � '4i91� asvY..,. - ,a...t.:tr.. � � m a a m � � � 0 � x 6� N � � � w a p m , �A� r��� � ��� H �S �.' � ►A W �M � � O � � � y. � y R+ ty�- M F� � � � O � ° � � � p ��`. FP "� � ►+7. � •- � � '� �� R*1 � o � �' N o � � � � � ° � � � - O rA O • �a� � � : : --•,-- . . . � � � : � : : : � � H � � m �a �e � o � � 0 0 4 � � ���� �� y ` r � b m � � S� � G �d Q b b7 � � I � � � co 0 � 0 0 � � `� o m �' 'd m � � � � M � � � _L=1 �� '� � � � � a °w bi � � � b � � ,..�� � . � � r � w w �� � � � ,`�° c�o c�o � S Q n�, � � � � � b � � '� w 'rs �� y � a a. � o " � � � �� � � � � � �C e� a o. tn m p R� R° '� �� �n � � R° � v� y m � w N�' Cr y p �' p�' oa ``' a�,mc R° R° y ��° �° � R° � ai a� �' R' � � Q0. � � � � "`�" �0 ,�� ��M��� � ° �Q� � p �� y A d V � � � � f� �D Q � �% � O � �n � � � � � � � O G p ''�„d f/1 0� � R' . 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'.:; �. � o N � � � � g � O � � � � ° \ \ p ., a � � m �� � ¢�.� � � �'p� o fp � M R+� Iaj m �, � a. po�o�a. � e+ � �M � �� r �� w � � �� � A+�p y A � CS��`� �� �y � � � � ��w � �� o���' p��o �����M¢7 �p �, � P� �� �ro a� �.� ���� �f�DM . ��� e�ti• p""{- l0 ��` 8 �� ��� � �. � � � 5' D � i � � m H 2 m C m i � G '~ � M � l` a � ro � 0 ���\\ ,� \� a 1 � � � , o '�\. e � � � � �� � � n� �. � � �,a _ �0• `�y . �� � � �. � � • �� � � � � �ti � O. � �� , ' :'� } � � �9'���TL/s Dd6 i� � 9 O �,,, r�_- . li HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDIN NIINNEAPOLIS, MIMei. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows Doors Reference Out. Wall Int. Wall Geiling Roof F7oor Kind How Applied Yes—No I Yes—No 19— 4" 1 Fl.� Living Room � Length2p� 3n Width 12• Height g� 1 Fl.� Bath EZoom Length 7' 6" Width8' Height8' Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area �Vldth Helght No. of Llneal f. Area Wldth HaiBbt No. oE Lineal ft. Area No. o[ pane of pane lighte ot crack eq. Yt. No. of pane ot pane lighte ot crack eq. ft 2 24 24 2L 32.0 21.0 16 2L 14.3 8 4 1 28 � 2L 15.7 10.2 1 5� 50 1L 8.2 2.6 1 3 7— Dr 20 •0 21 �0 Coef. Btu Coef. Btu Infiltration 3t3 3268 Iafiltration 14 38 532 Glass ?3 50 365� �ags 8 50 400 Esp. wal 3 258 Egp. wall 7• 6� 61 Net esp. wall 185 10 1850 Net esp. wall 53 l� 530 Int. wall Int. wa11= Ceiling 244 10 2440 Ceiling 61 10 610 Floor 174?8 if no heat in base Floor 7'otal Btu. e 11�208 Total Btu. 2s072 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sy. k. E.D.R. or sq. ins. W.A. Leader area 1�•I �inin Room � Length9• 9" Width 11' Height 8' 1 F1.�R.Bed Room ( Length 11* Width 11• Height g� Windows and Doors—Crackage and Area Windows and Doora—�rackag� and Area Width He1Bht No. o[ Llneal tt. Ares Wldth Hefght No. o! Llneal Yt. Area No. o[ pane ot pane ltghte of crack eq. ft. No. of pane of pane 116hta ot crack eq. ft 1 2a 20 2L 15.7 0.2 2 32 16 2L 30.6 19.0 1 32 20 2L 16.? 11.5 Coef. Btu Coef. Btu In6ltration 22 38 836 Infiltration 31 38 119$ Glass 22 50 1100 Glags I9 5� 950 Exp. wal! 20' 9� 167 Exp. wall 22' 176 Net exp. wall 145 10 1450 Net esp. wall 15? 10 1570 Int. wall Int. wall Ceiling 1�9 10 1090 Ceiling 2 10 21 Floor Floor 77 ? 539 ' Total Btu. �.476 Total Btu, 5 447 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1�• Dinette Room � Length 15' Width 11' Height 8* 1 Fl.� Pront Bed Room I Length 12' 9 W�dth12' Height 8• Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Wfdth Helght No. oL L1nea1 ft. Area Width Hefght No. ot Lfneal [t. Ares No. ot pane of pane lighte ot crack eq. tt. No. ot pane ot pane Ilghte ot crack eQ. tt. 1 2� 16 2L 14.3 8.4 2 32 16 2L 30.6 19.0 2L 16 7 lI 5 Coef. Btu Coef. Btu Infiltration 31 38 1178 Infiltration 31 38 1178 Glass 20 50 1000 Glass 19 50 950 Exp. wall 15' 120 Eap. wall 28 231 Net exp. wall 100 10 1�OU Net exp. wall ' 212 10 2 20 Int. wall Int. wall Ceiling 165 10 1650 Ceiling 206 10 2060 l�loor Floor 206 10 20$0 Total Btu. 4��� Z'otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ,�,�= •:__�j Required sq. ft. E.D.R. or�'sq. ins. W.A. Leader area �� � � . �,� - s � -• , _ --., HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS NIINNEAPOLIS. MINN• A.S.H.V.E. Weatherstrips Constructioa No. Insulation I Guide I Windows I Doors Reference Out.'Wall Int. Wall Geiling Roof Floor Kind How Applied Yes—No Yes—No 19— 1�,� F.C. 3ed Room � Length10 Width 12' 6QHeight a Fl.� Bed. �etc. Room Length 23' Width 10' Height 8' Windows and Doors—Crackage and Azea Windows and Doors—Crackage and Area I, Width Helght No. ot Llneal t. Area Wldth Helght No. ot Llneal 1t Area No. ot pane ot pane llBhta o[ crack - eq. ft. No. ot paoe of paae IfBhta � of crack eQ• tt. 2 32 16 2L 30.6 19.0 32 16 15.3 9.S I — 6/8 _.. Dr 1�.3 16.? � 1 28 14 1L 8.5 4.2 � Coef. Btu 1 �. r 18.7 17.$ Coef. Btu ' � Infiltration Infiltration 61 38 231$ I Glass Glass 48 50 2400 Eap. wall 14' Exp. wall 60• X 8' '�0 ' Net esp. wall Net eap. wall 432 10 4320 Int. wa1L _ Int. wall Ceiling Ceiling Floor Floor 352 5 1760 Total Btu. Total Btu. 10, 798 Required sq. ft. E.D.R. or aq. ins. W.A. l.eader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area l�,l Hall Room �[,e�gth 16• Width 4* Height g* ��ry,� Room ( I-ength Width Height Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Wtdth Helght No. ot Lfneal ft. Area Wldth Flefght No. ot Llneal tt. Area No. o[ pane ot psne Itghte ot crack eq. tt. No. of pane of pane llghte ot crack eq. ft. i In6ltration Glasa Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. 8�11 64 10 640 24 7 168 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area B�, usemet�t Room � Length 28' Width 2� Windows and Doors—Crackage and Area Wldth Helght No. oL L1nea1 tt. Area No. of pane ot pane llghte � ot crack eq. tt. 28 14 1L 34.0 16.8 I I I Infiltration 34 Cslaas Exp. wall 67 % 2 Net exp. waU Int. wall Ceiling l�loor Total Btu. Height Coef. Btu 38 1292 17 50 850 134 117 lA 1170 460 5 2300 • � aq. ft. E.D.R. or sq. ins. W.A. Leader area � �.....° `�- Infiltration Glass Eap. wall Net esp. wall Int. wall Ceiling Floor Total Btu. Required aq. k. E.D.R. or sq. ins. W.A. Leader area Fl.� Room I Length Width Windows and Doors—Crackage and Area Width Hetght No. ot Ltneal tt Aree No. of yane of pene Ifghte ot crack eq. tt. Infiltration Glass Ezp. wall Net exp. wall Iat. wall Ceiling Floor Total Btu. Required sq. ft. E.�.FZ. or s`q. ins. WA. Leader area Btu d R 0 p o-' . O • � : � ' �Vi V N U � na �� � ni r+ !� � � W � � p � � � � � ra o � o � o : o . o . . � : : O � � � LV F�+ � o q p � � � H H � � I `�. � � C�' � � m � w cZa � � 7• 8 � � 8 � � � � � � � � � ¢� �� � H � F� � � � y � �°�.° � '��•� � � . � . � o : � : � o . �y . . 0B o : . . : : � . . : : : � : : : : O �a oa 5d >: x ie W L� W ►+ F+ r � C�il p C�il O O O � {A {f� � ifl iA {fl 9j `� , y � � C�" � � 0 (,] x � � � � � �� � � � D � � � '� m � ♦ / _ m C r m O � R. � 8 R' 0 � � � I � � � p, a ~ W � R' � e 8 � WATER � � ci.osErs �� URINALS 0 r� BATtI o a n�s � � � ��� 4y � I � SINKS � � � W�►, T�,n DRINK. � FOUNT. . SHWRS. � FLOOR DRAINS CATCH BASINS �u'io wnsri�e GAS �� cns RANGE GAS OPENINGS � • 2 • � vDi D A m n p � � � o m � a �7 Q � O cr w a. p f) Vi pb M � � � y � ¢ ` � � �� g '� :. a. a � � � � � O ,a � �p � Mb ~ a � � p��� � �� � i ���� � tn � O � � ��o� � � � � � � � �a � �°�°�. � b � �-� � � ���w o� p � o �i �o � � ��,o F! ���w b � � <,� � \ ���� � :� ��� �� � m � � y iYi ~ � `� i m � n `p' � � r.• O�4 � '�� � � i C �' n �� � � � � � a $x � h°n n � �� � � � �p � -g � w�• 1 � � � � � �7 � � ti 4 �- b � � � M � �. o � �� � �� 9 +► �,• A � �o �<�� . � � �, � Date: Owner: Address � - ,�'• City of Fridley, Mi.n.n. BUILDING PERMIT r�.y 9, 1967 James Gagnon B��, Tom Silvis 5824 Jefferson St. � A�,� 6020 Wynnwood �� 922� 3 i9`%/ LOCATION OF BUILDING No. 5824., Street �.. Jefferson � � p� of Lot Lot � � _ Block 1� Addition or Sub-Div7sian _ LYndale Blders Addn. Coraer Lot — Inside Lot — � Sewer IIevation Setback —____ Sideyard Foundation IIevation DESCRIPTION OF BUILDING To be vsea as: Patio & Storage �nt _._. Depth Height .._._ Sq. F't. Cu. Ft Front Depth FTeight Sq. Ft. Cu. F't. �►pe of Conatruction Fr�e Es� Cost —+��50.00 �__ To be Completed August 1967 In consideration of the 3ssuance to me of a permit to construct th� building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisfons oP ordinances oP the dty oE FrYdley. �,,� ��l �` ' f` ��%�'r`/��--� �. �c�' _� ° � In consfderation of the payment of a fee oP $ 5. 00 ���t � hereby granted to Tom Silvis to construct the buflding or addition as described above. Thiape rmit is granted upon the express condition tt►at the person to whom it ia granted and his agents, employees and workmen, in all work done in, around and u�mn said building, or any �art thereof, shall conforai in all reapecta to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving oY buildiuga within the dty ]imita and thia permit may be revoked at any time upon violation of any of the provisiona of eaid ordinaaces. CT.ARFNCE BELISLE B��g �r NOTIC� 'I� pem�h does eot eaver ths eoos�rueHoe, Install�Hon fe� wtrtns, plumbine, gn hsaHae, sswe� e� wah�. B� sun io � tiro Buildiu8 i�apeetor for �eparat� panntfs hr thas It�mi. �✓ OWNER'S ADDRESS APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY; MINNESOTA � �' ` LOCATION OF BUILDING N0. �'�� � STREET � ' q�- PART OF LOT LOT � BLOCK ADDITION OR SUBDIVISION P��'�_ CORNER LOT INSIDE LOT � SETBACK SIDE-YARD SEWER ELEVATION TOP OF FOOTING Applicant attach to this form two certificates of survey of lot and proposed building loca�ion drawn on these two certificates. DESCIPTION OF BUILDING To be Used as: ����„�� � -- Front Depth • Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost ����. ���. To Be Completed �./�zr� " The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Qrdinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application ar true and correct. � a DATE � � ' SIGIVATURE � (Schedule of Fee Costs can be found on the Reverse Side). ,�, �� � �� �. � > � r fi . � ' n �"�°`° � . � � � / � .� -.BUILAING PERMIT FEE SCIiEDULE SECTION 2. The Inspector of Buildings �sha1�1, before issuing permits for the erection of any building of structure, or for any addition to any existing buil�ing.or structure, or for any alteration or repairs to any existing building or�st�ucture, upon application therefore, require the payment by the applicant €or such permit of fees to the amount herein below set forth and in,,tl�e manner .`► he�ei� provided to-wit: ' s � Uz!iform Building Code: Type 1,2, & 4- $1.75 for each one thousand cubic feet, or fraction thereof, in such cubical cont�ts. Type 3& 5-$1.50 for each one thousand cubic feet. � For the purpose of computing fees��for building permits, the cubical contents of any building or addition to a uniform height throughout by multipluing the ground area covered from a point six (6) inches below th� floor line of the basement or cellar to the average height of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. � For repai�s 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 �.,` in the cost of all proposed work. � In no case shall the fee charged for any permit as set forth in Section 2 be f� less than $5.00. �• :a �� - �t .�c NSSSD Connection`Charges based on location- Area 1 or 2. t ... . .. .., ; a � _� a ° . �...,��,,,,� � ^ - �._ , VF. � i►,.'�Mi - ��� `,]Mb � � � ��, �-- /�,,�: c.,�i4 ��',r ���s"lo�e� / t'r'��� _ . ��� � � J����� ��� h� � � �- ' .��- � � C � ,� �,�j:� w � � � � � i 0 � � ro � � a p fD 0 � O � x r��� y x x � ���� x x x � � � � O R N � � ���� � � � � o � �E m � �� . �Q w m `.0 � � � � N w y y � N a' �,. 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I 1 ' O y � ° 8 � � � 0 � � I� � � fi � � � � 1 � �P�IJJa[~ O O O O O 00000 fANNNN . , � � n � � broro� � t"' � H � W � Q� Q� fD tA � � ���� a � rtrro N H a aw��' �0 � x? oo�� � �N N Q rt H I N E n �b � r �o � ao m �o n O o S o �c ° m � � r A�1�1N y 0000 Ci7 0000 tn tn v► tn ►.� � r9- � a� � ��ro � G M �C �h O A � WfD d V MfpD an a a r�5 et m a K ww� H M f�D W O m M m m � �c � y � w R' � o � o � � w 0 fD M �. �• �+�~E�� W A O 6 m � °'"'x"�ro � � ►C,, � W � �µm �' .� � � � O • ro m � y 1�+ 0� Pr O � � � N H � fL �0 1 � � � � �K � � R � � � x M '•1 m � x� � w W m a=X+w� �K�x ' �w�x '�° �~�A � m • � 4 °v a � � m . � �� ' 1 � ,� � v -o v r c� b -i 0 z T O � 0 � m � a -v .� � n � O N t7 D -�1 C o s z mD �/% M '\ � i O y O d � m m < � n ►�+ m � N -� . 0 z � m � .'O � m .'O -Di 0 z a z ty c-� � QT •' � � �--. ty r-- � � ', � sue�ecr PER City of Fridley _ 16 9 8 � AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � „ ,� � � • COMMUNITY DEVELOPMENT DIV. ^ I � � r � L � PROTECTIVE INSPECTION SEC. � i � ' �"'1 � CITY HALI FRIDLEY SS432 NUMBER REV. DATE PAGE OF APPROVEO BV �'""� � �'� 612-571-3450 910-F15 4/21/83 � � JOB ADDRESS 58�4 Jefferson 5treet N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. % 1 Lynda.le Hll].�.C�.P.rS %'�1 SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Ken Greenlee 5824 Jefferson Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. James Rc�ofing and Siding 1105 - 50th Avenue N.E. 571-9569 4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW 0 ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE QF USE FROM TO STIPULATIONS R�f can be the second layer but not the third. Install ridged galvanized valleys. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED 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 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO 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 APPI.ICATION 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 $1�ZOO �`.(O WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $2O. SO S UCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE �,�� � � $ 21.10 q'��• SIGNATUREOFCONiRACTORORAUTHORIZEDAGENT IDATE� WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT � �� SIGNATURE OF OWNER �IF OWNER BUILOER� IDATEI BLDG iNSP �pTE CITY Of FRIDLCY Effective �ug. �, �9e� APPLICATIOF� FOfi RESIDCHTIIIL 6UILOli1G PCitN1ITS (N�►v. Alterations. Additions. or Repairs) owr�rt: �� �l ���- �- J� � � � , �— ADDA.ESS: ;�$�� �C-h-��S�c� bi TEL A0: ' . • STRI]�T NO: 6UILOER: �IQ.nn+� S �a���.�1`� °✓ ,��`�, ADORCSS: �1�� �t�� �19P fi�� �. TEL N0: S 7� ^ a! ��`�' Construction Location sTr�r: LOTs % HLOOCa � 11DA2TIONe ��d1 �,��� � 1��� �� `� • Corner I�ot: � Insic]e Lot: 6etback: Sideyazds: �lpplicar�t attach to tliis fozm two Certificates of S1�rvey of lot and proposed bufiding locatien dzawn on ceztificates to scale. DESCRIPT10i�! OF COFJSTP.UCT10t� ����_ Front: Depth: Hefqht: 6quare Feetr Oubic Feet: Fzont: Depth: Hefght: bquare Feet: Wbic �'eet: As � ��-� � . R�rpe of O�rstruction r ��p �'-C= Estimated Costa S L� � � 1b Se Nr.�plcted: � 7►lt. A Alt. 8 Proposed Dzivc��ay kiath If New Opeafng Is Des3sed: S� S � , . SEE RiVERSE SIDE OF SHEET . Ziie un8essigned hereby ma);es applicAtion for a penflit foz the »erk herein specffied, agreeing to do ,all verk i�, strict accordsnee with the City of Frialey Crdinances and rulings of the Delkiztmc�t of Duildinqs, nnd hereby declares thRt all tl�e fact� and represent�tiens stated in ti►is npplication are true and correct. Di.1TEa � SIGNATU�: Stipulatio� a � �r� ��`�0� ,��� � — � v 5 e� �/ � � i ,, BUILDII�IG PERMIT FEE SCHEDULE The Inspectoz oi buildinqs shall, befose issuing permats foz the •r�etion of any buildinq oz structure, oz for any a8dition to any �xiatiAg buildia� oz structnze, or tor any altezation or repaizs to any •sistinq buildinq or structuze, npon applicaticn therefoze, s�quiz� the payment Dy the applicant ioz ouch pezmit oi iees to the asouat b�sein below set iozth and in the �anner hereiA provided to-wit: !'OT11L Vl1I�UI►TION :1.00 ts► :500.00 5501 m :2,000 52,001 tc 525,000 525,001 to 550.000 SS0,001 to S100,000 5100,001 and np lEES �20.00 Minim� Fee 515.00 plus surcharqe 510.00 foz the first 5500 plus 51.50 for each additional 5100 os fzaction thereof, Lo and includirig 52,000 532.50 ioz the fir=t 5�.000 plus S6.0� for each additional S1.000 oz fraction th pseof, to and including 525,000 5170.S0 foz the first 525,000 plus 54.50 for each aciditional 51,000 oz fraction thPSeof, to and including 550,000 �283.OG toz the fizst 550, 000 plus 53. 00 for each addit3onal 51,000 oz fzaction therecf, to sr�d including $100, 000 5443.00 foz the first 5100, 000 plus S2. SO for each adc]itional S1,000 or fraction thereof pl.Ari C7�CK: 25 perce�t of building pe:mit fee DRIVE�WAY DEpRESSION E5f9tOW: Concrete Qirb Streets Cnly 111teznate "A"s Re�nov�al ana replacemes�t of curb arid gutter only Driveway vidth plus 6 feet z s13.50 � 111ternate •B": Renoval ar�d repleces�ent of cuzb arid gutter and install a 3 foot vide approach with 6 inch depth Driveway wi8th plus 6 feet x 515.75 VERIFICATION OF FOUNDATION Permit� for constsvctio:► viil be issued s minim�n of 24 hours fran the time of application to allow foz proper zeview of the proposed strvctuze ar�d of the construction site. A Cert3fica te of Snn+ey of the lot, st�oving the location of the foundation once it has been ocnstsvctecl vill be required before procee� dir�r wit1� trie frami.ng. `� � * 1 D �� 7 n 0 m a � o y m O y � � o � � 3 a� o m �. �a co � �a a � � �N � � � ; 1 Q � 0 c � � � D r 0 nc � Z n -� � � � �v z "' � O n � m � n � < m � n -i 0 z 0 Z � m Z � v m c� � Z � m m � w 0 0 0 D 'a � °< m fl. W � 0 c � � � � v ?; � � � v :+ (D ` ��V W`J � � c� a . m z 0 b � � 2 � z � n O � `v z ' _� �.w a ! O N � �'• � � r �n c m � � � � � � � L� o C � � m � a m Z � m 2 � � z 0 m' v � ...► ♦ / O O � � <� � � c � m � o �,-w a� �• � � m 0 � 0 � 1 D \ � o � <� w � m � O � D u� � Q° A� D � � � � 0 0 �� � �� � O Z � a � .3 � � c .W-� � o �D C a — � o w m� � � � � � � �c � � � `� _ o � n a� � c� `D o � � m m � �. � a v� � � m � � apo,� �� �� � �� � � d � � � D � v � _v, n 0 q 0 � � co v v� m � � N v m -. � � � w � � � � N _v, -o � co z m m a c� a � � � c 3 � � � � � � ..J j J 1 � � � � 0 0 � 0 tfl � � � v N n � � Z O � c � z n m z v � � c � Z m � N -� v -� m v n � -i � � � � m � � _� Z O .-9 � i \ 00 C r v z � c � m v � � C� � � � � � � � � D � y N � O (D � L�i. � �� � � � � m �' � � a c ° ty � c�u � 0 � W c 3 � i � o ap � °o m � � O 0 y ,D � � m � n _ v C m � ��•m � � �i `� � �D � � o � � �. r. � v, a o�- '� c� m, � p v,, �� m cp'i a m � � � c � a aco � � � ��-°•a � � � � N � o � � W o � � Q � y _ a� y� �� �_v,�� .. Q o y � �..�, '` o � � � N � A CD �'mo� c� � ` a �.: �i � � -� a�' a c� o �� � � � � � � � � y � � � � j � � �� `9 � � �9 � �4 � � rn n V =. 1� N Q. W � W O � � O .�a � < .n zy � �� v v' r N � '� z Z m� � m � z v m� < � � �a m � aZ O � Z � Z� � vp am �� � .� o� z v� -� N oD zZ �v 2 N � mZ � � zp vr vz C < nm �Z � � z `1 , ^V 1 / � � � m O � w � � � � cC (C j a��o Ag pa�bzg xr�a�o� �HZS��x :euoQ uteg suoi�B�a�t� �siz ( ) oH ( ) sa� si�.z�nzag o �O �� > S � II,LS Z�ISOS � 0 �� S � 11Lfi .zau�o TZK eop � �o s,�yg bu�r��au ZE�.o� s�g pa��aaczoa s� n,I,S TE�o� PuE azis .zo� s�tzauaa�-rnba� apo� �ua.z.zn� ZTE s�.aays W� .5 ( ) oH ( ) sa� pa��oddns �CTa.zn�as sI • � () oH () sa� uiu�.tM pabpot s�.aa Cqo ubtaao� ou sEg • E () oH () sax uoi�.Eaoi.za�ap �o �sn.z u�o.z3 aa�� s2 • z () oH () sa� pa�ztut2xa �ITjn3a.z2� uaaq s�H ' T :x���s .zo �iauatiu� bui�.sixa au�. ��u� sai�-�.zan �iqa�au paub�szapctn aqs Hois��=�ix�e x��rss ux�r a�nx� 5824 Jefferson Street NE May 31, 1991 To Whom it May Concern: Upon inspection of the furnace installed at 5824 Jefferson St. it was noted that the flue looked intact and clean. However, due to the inaccessibility of the flue we will not hold Sharp Heating and Air ConditiQning, or the City of Fridley liable for any flue problems that may occur in the future. Signed�j'Zz-» : �� �c%��••�-� Ken Greenley-homeowner Date � �y�Q� , � � 3 C � � N m �o � O Z n S N o ( C n W � m � �. � � ( c- � � �.. y � ? c � i o T � � -+ w � i � m � � T R1 � m � �e.J� � � 1� � O c cn � I � v � � -a � N � N � O � O O --�D ..� � � � � � �L c w wl � m � m --I c� m u► .• � � • -�I ' m a w m o a 1 N v T O 7D ���'� ��'I � p� �'1, � � � p � j @ � -�i � � w �: N N � t � � s �m � � � m � �'I w �D � m ;� '1p +F � N f�D � z� �i � I N y tG M '� � � m y �'n a I� � m i� .► pt N� w� I � � )N � *a �. I � i � � � � I � ; � �' � a I � ^ ' � i . .. ... � I � I I�I f I I I I) ( I I � � � � � � � � � ��� � � � � (11 O O O V O V V V V(11 A V °o 0 0 °o o °o °o o °o II °o °o o °o , tn -o m ao 0 L� C � � � la a m � -, � m 3 m � � . I,� �_ _ � . ? --1 Z 0 � �. � v m � � _� �� �.► � ���°' 0 � C � � Z � 'n � � m � � Z O � m O I� `o � :�} r�-,- - � �.:� ° � � 3 ;:i", �i. ? � � �. � ? � v � '� � �A '�; P�` s a Si �; � m � � �`9 � �, o � b n, w °' � A A N � �, N � p � � � � � ��.�� � w � W �l � O• � . Q N N ill N (p i 7 t0 I (O � i I ��-n�m� w 0 0 0 0 � °, A W N -+ � N � � m N a �i � ..� OWf '� j � � Z �� 11 A UI N, � � � � N � mv n O z v < ::::::: : ><: � �»::�� � � � 0 � c � '�n:;<::'»_> m � : r::::: •: • '�:i�:�'i:: �% � ?�;::::::`;::0 r <? T i� -n a -+ � � o � ��p 2 m �n � O -� � >�::::v;: � v o:::::�::> w r c>::�:���: m c :���:::X??� � � t`�i:t�:�::::: � � ?�. w�+ '� '. . �%i :':: � � D � � � � uw► p � Z ? O � � '0 'Ai::<:`�:; � '�.:::>:W:;: �. �o<:::>::a:::: �,:.,., + � w w 7 N N � � _ � � . � � O � � < W O � � � w � + t0 • � V sue�ecr IT NO. City of Fridley � 2 � 6 2 5 ' , AT THE TOP OF THE TWINS g U I L D i N G P E R M I T NO. I i t COMMUNITY DEVELOPMENT DIV. r � �' � PROTECTIVE INSPECTION SEC. � �� � � 1 = � � /'�'1 � CITY HALL FRIDLE� 55432 NUMBER REV OATE PAGE OF AGPROVED 8Y �----� • •,� 612-571-34b0 9t0-F15 9/9/98 � � 10B ADDRESS 5824 Jefferson St NE t LEGAL �OT NO. BLOCK TRACT OFi ADDITION SEE ATTACHED DESCR. 7 1 Lyndale Builders 7th Addition SNEET 2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE Ken Greenlee 5824 Jefferson St NE 55432 571-5417 3 CONTRACTOfi MAIL ADDRESS Z�P PHONE LICENSE NO. Premium Roofing 6680 Lucia Lane NE Fridley 55432 571-3973 20097688 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDIiESS ZIP PMONE LICENSE NO. 8 USE OF BUILDIN(3 Residential , 7 CLASS OF WORK O NEW � ADDITION ❑ ALTERATION �J REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house & garage (17 SQ) Tear-off 9 CHANOE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, �PE OF CONST. OCCUPANCY aROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT. CU. fT. AUTHOF;IZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OF; ABANDONEO FOR A PERIOD OF 120 OAYS AT ANY TIME AFTER WOAK IS COMMENCED. NO. OWLG. UNITS OFfSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALIS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of IAWS VALUATION SURTAX ANO OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMiT �1a456.O0 �.73 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �48. SO F SC � 1.�FC) �° PLAN CHECK FEE TOTAL � � � Lice S $5 0 5.69 SIGNATURE OF CONTFACTOF OR AUTHOR12ED AGENT IDATE� N P OP L OAT IS IS P IT � � S�GNATUiiEOFOWNEA�iiOWNERBUILOER� IDATEi BLD �NSp �IOTE � _ �� rrEw ADDN ALTER [] [l [l CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: .J $ a� c� ���7�'J 1d ST. �����[F�r Effective 1/1/98 LegalDescription: ��,q-�-��� i4.V� �,C-�� Owner Name & Address: /(E.v ��P�E�/G� SSa-Y �,7'E�'f��(°sa� Tel. #�7l Sy/ � Contractor: j°��� >�� j�or>,C1�v� MN LICENSE #�°�' 7,��8" Address: �� �a L vc,1e4 L. N��� Tel. �# S 7�;�`'77� Attach to this application, a Certificate of 5urvey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length DESCRIPTION OF IMPROVEMENT Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: l-7Sv � �s� (�oi9R� c-' �/`i l� °C��J_ Construction Type: Q�pp,�1N� Estimated Cost: $�t�� /�� �' �• � (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: �� � S� APPLICANT: L= �' l C. vN vEE''U _ Tel. #% y 1- ��6 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ �%�. SC $ %y� $ � _� $ $ $ $ $ $ � �� $ �. CITY USE ONLY Fee 5chedule on Reverse Side .001 of Permit Valuation (1 / l Oth %) $.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 [ J Not Necessary [] ,� _ ,� BUII.DING 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,OOO,Q01 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for fust $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25, 000 plus $9.00 for each additional $1, 000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet tunes $13.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15. 75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. � D �� � o � �° a �' � N � N. � o N � n � � O � � � 0 N '�' a� O �• � �• n� ov � m � a � �. a � fD y � �- o �D � 1 ���0�1� G � � �� � U �e � � � � �� �� � � ��n o � � Z D $ n � O �N a �o W m W �-�'i c � O N � Z � D m �� <� � rn � c �m � � � D z � -I O �z � z C � m z � � m r � � � \ C1 1 N f\ ..� (D � O (� � �, � \ � � m z N 'o rn c� -i O z � m m � �P V 0 O � _ � C � Z �'�3 C m 3 � -Di m opm � �y�° r�*rn�z C') .,� C Z 2 v ==�-Ai noz mz� G� n O �O m � Z 3� � \ < ym �, Z �� , �o Z � oq � m a 2 D -� z � � m � 1 � � 0 � D r � rn rn � � 1 � � � m � � � � � � m � 0 � � 0 �� � A o �, II1 d � fD Q� � rt D � � °' �' � � m 0 0 x- � O O S < fD � N c � m � a o �, D �' N � � a�' D c�i m � � o .�; '` o � � N � r � � � z W D^ l / � .. D � � v 0 o T' � �_ � � � aa a � N c� N d � n c N � a�i �°• ^ � c°�i � � �-°• N � �D = cQ4u � m w tn °' � ��<� m � � .3+ � fl1 O. � � � �. � Q-=�� —c .°— � � � �- � � h � � � � W � o � � � z- v � � W c m � � � � � � N � � � w � o 0 0 0 0 0 0 0 0� . � � � ��,���� ;V � 0 �, � �-��,-i � � m � � n � m� cu'� a � o n. � � � � � N o m � �� y W �, (D N � � � r-► 04 � Q- '+ CD CD � � � n- °° a � � p o � ,�<_a'3 � �n' � � ?. � N a � _ � �• a v N � � 1 �. j N .n-r =� ���� � � � ° � "-ac� � � d � � m � � N � � � �' � �. n p� rt O �'+ � 0 � � � � ,.n.f � fSD 3 (D Ci fD �� o N o � � �' N N � � Q. � tD _ �. W� C � m � � a m z � t�D _ � � m z 0 m' � .Z7 -*� ao -+ z � -I � o - C Q o m �, �z= a� c� � �' � p. (D , � � c ? rt N �y _ ` o � c �? � � a� � C) � �O > > � ° fD � �� m N �- � .� r N c°� mz� Q. p �o,� _ O d N � � � � D v m N _i D � m O c� � � � � b C; � m � � � z O �° � � � C r � z G� c � m v 0 Z � -� m N c� 2 m v C r m • �. �- . . .. �0 V 'T'1 Q1 n waw� � N� � O w��•� � z (p � � � �c m W � -� N m Z zN rn� m --i 0 Z � < � D O � z 'v r -m.� -�i � O rnZ � O �� o -� Z� �m. v� aD �Z O N vz �v o= zm Z� � Z N� �n rn� O 3r `� z Z � v< v "' rn Z <� �a � � O Z � m C� < m � � L fl1 � c � � r N O O r COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 sizing, 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 manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. The existing combustion air is sized and installed to meet the current codes and manufacturers 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 installinq 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 coRectly after an appliance has been removed from the common vent and vented separately as per cuRent codes. Yes () No () Appliance Tvae and Size/Corr�mon Vent and Vent Gonnector 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: (Describe) HEATING CO: Signed By: Date : �OM :Gity ai 1-ridle� �L�-- ►'{,lil.t� . � �s�tians f3�-57�-3604 �r� _ _ �� �5'i 14Pi�CAN�' I3: '�lQp�RTY Q�B! T�Twlv'r co�a�w�raa SUE�T A t�PY C�F YOUR S'fA'LE LI�SE W�Tfi AF'F:•ICAliQ?�l F1�QP'�TY'['Y�'E F8YtM1? TY�'E TYP� OF'WQR�C .W.t. • �u�r.�iaid...,"' - —J- i° ' _- �i���� P�t 1J�i.: �'�` � ?�° " ° � lt�l�IDE�'TIA.� Al'�'LiCATION R�'ea ��: , �IT�� O►F FI�LEY a� �•� � � I � �. .,.:� �� �:r,�j 11( :.�i�J� � r�e: srw�uce�� � � nw� -- — -- - - �: • cnv sTA7��P 7�E WbRK SEIIS4 �..z ,,�. _ �?; • ■"��,.y�► .:irs . �..,�.,yar �a ,� Y I 1 I' C • r"+r ■ ■1 • :,,� .�1�� �. .n � 7�aP. �'[ •�• � �t c:. ■ �i •�' `7,� 1 �I �vn -:�.V.r i`�" •iYlt • � ''.`"� t 'f [`�?: . Plsa Rev�aw �'�s S�s+� � �,iex»se S�ge SAC Cbarga t�nb Grt F.s�row 8r�sfa� Co�v1 Paie Fee Se�Me�at�ge pII�f; d S � r�r.�� LF ATl'ACi� t�AFAGB O DETA� W4RAl� ■. . ��, r R _ L'_L: ����� �/� +�7. {iQ�{V � �'1 �� e �C°� ..,- �, . . .�,� �l f- F�Flom'plain 2. P�e�e'd gooi' Pt� 3. L�f.af���+o6auoed � � � ��� � • i �.• r i ic �t:i�+'l. � �j�{Yi�J..i. i� �l.!= ;1 J% -!Y ���t: a :1 - ;' � I S�o Ba�kPa� fb�' Fee Sdx�•dula W'O!o o�f'anil�ng 1'ctnodt Fea �0l, ti�es d�e ta�al9ob val�ti� ADOS x Pern�it Yaiusmio� Ml11a5m� S.SQ �5.00 (S�to I.ixnsed Rcsfd�ti�a1 Ca�q�cmcs) sas� � snc v�tc (r�ns m�►+c:c €�r de�«��noa� $+68=,��.8x�21a� 5450 C.a�rvaaom � Raview . Fee Datesmi� bY �8 A,g�e��► ( ) NonNe�ess�► ( ) iHiS 18 AN A�'P'L�G•4TlQN FO�L A PBRf�[�10T vAL� t1NT1A. PRf�CFSSP.D ��y �Y $� a�d� Pqrm�t at�d � aakmowladge � tho �on abare is ao�Plete and a�e: th�t tha w�Ic WI11 � in ca�'oa�oe widt f�e aa�din�cas end eade� of @u (�ty of Fridl�r and w� t�te M'�eesois C'ams�ion Codes; tb�at I w�d rbis is nat a p�1t 6at e�ly an �li�ion f�s s p�xepac �d waric is ne►t to stmt �+iti� $ pesmi� tt�t d9e wark w911 be � accordance with 19�o e,ppa'oved pLon in the cz�c of al1 wark v�hi�i ��ew` a� �p�OVal af pls�fs. �./ nlr. �. o� � 1 ti,n�l�, Q_ 1�--��... s�ai►� cx� wa�►t�cAt�rr CI7YOF FRtDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763� 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, �'� l�/1v�V1�� ��r� , understand that the State of Minnesota requires that all residential building contraators, remodelers and roofers obtain a state license unless they qualify for a s ecific exe tion from the licensing requirements. As the owner of the property at �� (�i ����"9 � , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure 1 have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that 1 would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any conVactors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being perFormed on this property. � �1 �. 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