AF - 47852� SUBJECT PER , O.-�--,.:.,.., ,
City of Fridley . 13320 �
AT THE TOP OF THE TWINS g U i L D I N G P E R M I T
t
; � CEIPT NO.
� `L _.���_ COMMUNITY DEVELOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEG
1 . ,
� � �'�'1 � CITY HALL FRIDLE� 55432 NUMBEF REV. DATE PAGE OF APPROVED 8Y
�""� � ,'� 612-560-3450
910-F15 12 2/75 ! !
JOB ADDRESS 1400 Kerry Circle N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. S 1 Heather Hi11s 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Robert Donald's
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Commercial Erectors Inc. 5298 Filmore Street N.E.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAILADDRESS Z�P PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION O REPAIR O MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 38' x ' Dwellin and a 2' x ' G a
9 CHANGE QF USE FROM TO
STIPULATIONS provide a hard surface driveway. Provide a verifying survey before
cappinq. Provide sod in the front and side yards. $400.00 storm sewer escrow
paid.
WATER LOCATION: Stubbed to property line, 26' Southwest of Hydrant.
SEWER LOCATION: Stubbed to property line, 58.5' Southwest of Manhole, 35' South
of Hydrant. �����j���
Wye Elev: 929.71
Top of Footing: 934.21 Minimum �efore digging cail lacai utiiifies
Manhole znvert : 929 . 77 TELEPHONE -�LECTRiC - G�S Ete.
S�PERATE PERMaTS RE U1RED FOR �tRlf�G,�E�UIRE� �Y�,�i�RTANT--
Q NOTIFY THE FRiDLEY ENGR.
N�ATiNG, PLUMBIN� AND StGNS. DIViSION REGARDING CURB
TYPE OF CONST. OCCUP
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, AT DRtVE AY OPENI .
VENTILATING OR AIR CONDITIONING. WOOC�i FYdICl2
THIS PERM17 BECOMES NU�L AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-�. 1156+480 ZO� %ZO�'4HOO
ANY TIME AfTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. 34�200 1%.I.O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULAT�NG CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � $�i%.21 $325.00
PLAN CHECK FEE TOTAL FEE
$389.31
SIGNATUREOFCONTi1ACTORORAUTHORIZEDAGENT IDATEI . '`� WHEN PROPEfiLY VALIDATED THIS IS YOUR PERMIT
•, /]�.�h 11� �.Q��J /a?-1���IS
'r SIGidATUREOFOWNERIIFOWNERBUILDERI IDATEI BLDG.INSP DATE �
Surveyors Certific�zte
.....
COMSTOCK & DAVIS, INC. Consulting Engineers and Land Surveyors
1446 County Road J, Mpls., Minn. 55432, 7849346
�iOUSE LOCATION SURVEY FOR: MIKE O�BAtdNON ,
LOT 5, BLOCK 1 5298 FILLMURE ST. N.E.
HEATHER iiILLS 2ND ADD. MI:JNEAPOLIS, MIIdN. 55421.
FRIDLEY, MINNESO�A
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DESCP.IPTION: Lot 5, Block I, Heather Hi11s 2nd Addition, Anoka County, Mianea�ota
SCALE:I °S�� _
� ,D�iloYC S /ron /'7onu�+nei7t found - .
I hereby certify that this survey, plan or report was prepared by me or under my direct
supervision and that I am a duly Registered Land Surveyor under tlte laws of the State
of Minnesota.
� 10832 12-16-75 3592 _
: Reg. Na Date Job No. '
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A}'PLIC!�'1'IOIJ FOR RES1llEN'I'IAL, ��L7'I:I�ATlON,
OR AllUIT'ION }3UILDING PE'.�NIIT
CITY OF FRIDLEY, M:iNN�SOTA
jj``, �� �' c-�
OWN�R' S NAM� : ���� BUILDElt : ���%���^'�"� CC.��� �
ADD�SS • � �/� ADDRESS • � � ��
— � .. ,
NO • � / � S TR�ET • �-�-y �
, V
LOT: BLOCK:�, ADDITION:_
�i�� , ;
CORNER LOT: INSTDE LOT: '�/ SETBACK:_} SIDEYARD:
Applicant at�ach to this form Two Cer.i�ifi_cates of CurvPY of Lot and proposed
building location drawn on these Certificates.
vESCRIPTION OF BUILDING
To Be Used As:
� �
�'���'Ci«l Front : Depth : Iiei�ht : S �
__ ��
Square Feet: `� Cubic Feet: Z d �' Q
Front :_�_Depth :� Iiei.ght :��
Square Feet; Cubic Feet: �,d
-------• J _
Type of Construction: -�����%y l.�_ Estimated Cost:�
C� ` To Be Completed: �.�`' �3��r� • �
Thc undersigned hereby makes applicati�n for a permit for the work herein
specified, agreeing to do all work in stxict accordance with the City of
Fxidley Ordinances and rulings of the Department of Buildi.n.�s, 2nd hereby
declare� tliat ail �ne f�cts and representations stated in this application
are true ancl correct.
` )
DATE : � � 7,�.-___ SIGNATURE : ✓ ��� E"�°%�ltis�j-r/'
(See verse Side For Additional InformaLion.)
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P��Tt�L RAT� �C���3��£
GR11YiT7 WARAt 2tSR: 1�3.� �: TO'TP.L
itin:cr S.'s!TI dc Duct iYork .. $I0.00 $
Rr'acr�ser.t of FLrna^e fi.t� �
F,�pa:-s fr ,Ait�re;.�,r.s-_ up to S5Q4.Q0 6� S
Rc�strs & s.::crac:ons each add. 5500.W . 3 W o
ZiLCIi. W 11.AM 11ISt
�:r�� s�:cn ��uee wo� io iso,or.o s'rt7 �.S�o 00
tx.� add. FiJ,0a0 B'3'tT ..
�^vLc�'r�mt of fl�7-sacc
R�airs & A'tP*ations--trD to S5a0.Od
Reyain & At;natioas each add. SSOQ.00
STEA?•t o: HOT WJITER £YST£Bt
i�szr.acr She:i Sc L:nes- :4 4C0 zQ. t; F.DR Sieesn
F�:rnace Sh�i �tc L�ne---to 640 sq ft. EDR Fiot Water
1
Each Add :0+1 sq. !t. EI�R S'eam
�cti .ad. szo �. :� eDR xoc wa�
OIL BIIP.h"EP.-to 3 ga1 Der hour '
over 3 ga3. per hour�ee iee Schedv3e
3.UrJ
s:�
6.U0
3.00
S: 0.?^
20 00
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GAS avxxER CuD to 199.oC0 BTt3> �'` b.00 ; p o 0
� cr�r ??�.00� B'I'iT S.� Fe� SchoduJ•
GA5 FITTItiC P£E3: MO RATE TOTAL
lst 3 f�xtures xE 200 S_a .
AddiUo�ai Flz2ures z ,76 t_._. _.._
Gas Ra:�e to L'#9.C�C0 :a b.tm ;_ —
� ���Q��a ��� �State Surcharge � r o.0 0
T�Pf F�".:..*t1iI:G fr'?�'f��.�Q g�s Fes $e3..��
ii�"tiL�YY�C SYe3T�t . �i
u.rr�Tr��s a�.--pu�a �rozr�z. �� Y a s'°
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Cfiy o? Fri6;cy:
The �:ndersi,nc�i here�y ma;ces app.ic�tion !or a pr-rr.:it for L'�e a•a:i ��rci
spec�;ie•d agrc.�c:r.g to dc ai? x•erk �n ctrici acco�danet K�:ih L°�e Citp Crd'n�^.te
and r:i��r,� of thc Deya; tm�r.i ot E3;:�Idi^:�c. �.� he: °by dcclar� Lhat a77 :ue fnci
and reUres?ntatiuns s!xt�tii ;n this a�pucation are tn:e aad corrrct.
F�:dley, 1t,yan � ^ � r / � p ^
C.lwner
. l�!�%� ( J
Kir.d �i Buiid4ng . / `-`L°��''�--'�
Use� as
Tc+ 1?e compie;e�i about
�: � d 6 a e
Estima?tw3 Cas� S � `�
Old 'ew. Huiiding Pe*�rrut No. Pormit No. �D(C`7 �C
�.?.°�.^i3;�.�- i if32f Oi S�?p3�
iiEATTNG or POi�ER PI.A*7'I�-.&Sresm, fiot Water, S�; srm Air-I4o
Trade Name _ Slze 2do- r��=� .
Capacity_.. __ Sq. �'t. E•D.R STt1 g�
y/ �°`�
Tota? Connected T.�a,.�d� �� Klnd of I�'tie -
%
BURNER - TY�e 2iam C2� Sisr I�to
C�pacity 3q. F!. E.D.R BT'iJ I�;:s
c�ee��ax�.ovg:�
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p,� 9t,c�c�^ '
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. • ' • �.l,�°-x. ��' r °'"°� •,» •ti •
. • L��°i�'�36!5i1tIi7 �Oa ��fl�.c,:.:ir� t�.a,.�t �ia,r ti'1't�;ari� ��"e:'.'•is
' - �. ,_.-.--.---- Dopt. of B;dps. Phone &�`J•3450
I D�3C�IPTI02i G: VIOI�� �a���_ �� yoo -� �,�
2iu�s`�.�-. Y.i:..3 n..zd Lecr_icn o! F!x!'�'e� ,
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� I I u w�rca Hrk. City of FYidlcy:.
- '�C R� � z � iI ��i�I7�gZjFZ °� � il z e e .
��i; �� S� � = i� ? �� I� ; a(� �<; �� u a�u $ � N."s E�cc. 1"he undersig-ned hereby rr.akes aDp��cation tor a permit for thr w�o-Y he:�i
� ! specified, a� eeing to do all �ti•o:k in strict acco:'�ar.ce w!th the Cib O�'�-:^'�
°" ar.d ruling of the Depurtment of Buil.a.:a�s; ar.d hereby declizes �'�at a:I �'^e ::c1
E3sr � �� �, and rapresc-ritatlons s:ated in th:s app:icatioa are true ar.d cozeri .
I� � i . _ � r.1�.. , l m.�
`r�idley, biinn s
2•i� � � - � �� � _
- Owr,er �� ..—,i.�t e� "'-� -
3:d .
S:� I Kind oi Buitding
:• -- �'iG^. :Lt::�. Cr7:`1`�
FU:"r'6 CiGr.:G:'.i..".� �:S�.f�� . stl'Si't�Z -
❑ Used as
s?{av Fr�s:v. Old a-,•sr: z:�s Cc:spcol [� • •
- - � Ta Ue co:r�pleted about — -J
.� PAP,iIAL RA7E S�H�DULE
; L�iBI?rC F1:cTJ:?E RATES: HO. RATE TOTAL
�':iTt,beC F:xtUf�S . . . . ... . . . ... . . . ��. X ��.Q7. g �di
FLtu�e F:xture O,,cning . . . . . . . . . . . . � x Sl.� S , -
1ew Fixture 01d Oyening...••:•••• x$1.50 y_..--•
C�tch II:�sin • • • . . • • • • • • • • � • • • • a • X �•2`5 a -
W:,tet fieater 'Up to 99,OOd BTU� •••• x 33.00 5��
`:e�+ C: ound Run Old B:dg. . . . .•. . •. . _._.-----.- x :3.25 S- --
E:ectric V7a:sr Hwslar. . . . . : . . . . . . . . = 52•� s _
s1.S FITTI:iG FEE3: ' Y'�O. Fi%�'I� TOTAL
• lst3 Fixtures ••.••������• •• •• •• X 52•� i�
AddiUcaal Flxtuses .. . . . . .... . .... .------ x S .75 S - �
Gu R.=..^.fe to 199.OG0 BTU ..... .....• ---,--- x 55.C8 L --
Estimated Cost, S
OId e F3ui:dir.g Permit tso._� �.� �� p•="'t'�'.-�-"""""-'-'—'"
� •
• Signed __
. $y
Buain��..s Ph�ne No
ROUGH,
FINA� � - 2 3 - % % � .
°.:"?i:R3 ic ALTE°J1T2�?d3-P.�:�s ;o Coda • . .50 State Surchaxqe
''y .�C:CTiy:.iOA . � � • . � . . . � . • . • • : ....•.. • • . s.• • . . • •. . . . .y�-�^--- .
y
s. . TOTAL F��
I_ �� L � : • � , .
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• .
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sue�ecT PERMIT N
City of Fridley 15 3 7 4
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
i •
, � ECEIPT NO.
� ' COMMUNITY DEVELOPMENT DIV.
, ;�______, 9 y�
r � � PROTECTIVE INSPECTION SEC.
1 �
i
1 � �'��1 � CITY HALL FRIDIEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV �
� ----� • •�' 612-571-3450 910-F15 / /
8/6/79
JOB ADDRESS ]_t�OO KP.rY'�% C1Y'C�.E N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �j 1 Heather Hills 2nd Addn. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
l�bert Donalds 1400 Kerry Circle N.E.
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
Vossen Bros. Inc. Route #1, Box 171B Prior La.ke 447-5893
4 ARCHITECT OR DESIGNER MAI� ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE UCENSE NO.
6 USE OF BUILDING
Residential'
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION 0 REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Install a 15' x 43' Swi in P
9 CHANGE OF USE FROM TO
STIPULATIONS
Stipulations as per letter from Envirorianental �fficer dated 8/6/79
to be mailed out.
SEPE'RAS'E fl'ER'�ttTS REQUtRED �R iNIRf1��, ����G
HEAT�NG, ,P�t���tNG AwD S�GNS�� . teton a� aa �c,r.�r�
TELE►ttONF • EIECTRIC• Q11S �ic.
REQUIREt� BY LAW
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
7HIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WlTHIN 60 DAYS, OR If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS A7
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFS7FEE7 PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]_ STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT ]_]. SOO rJ. %S
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
i� `,�. /�1. (��.a.�--Y-, ���--7�
S�GNATUREOFCONTRACTORORAUTHOfiIZEDAGENT IDATEI WHEN PROPERLY VALIDATED THtS IS YOUR PERMIT�
� �V �
SiGNATUREOFOWNERIIFOWNERBUIlDER1 IDATEI � � BLDG iNSP D E�
A
CITY OF FRIDLCY •
� ARPLICI1TIOfd FOR RESIDEN7IAL QUILDIPdG PERMITS
' (New, Alterations, Additions, or Repairs)-.
� � OWNER: �nb'�" � �-0�5 �vnC�Ic�� BUILQER: �JO�..S��r'� V-��S• Snc.
ADDRESS: � �O ��`r C� �'L-�-� �- ADDRESS: �r l �� � � � � �r►a� l^AKe
TEL N0: TEL N0: �I �`1- S� Q�
� Construction Location '
. � � � ,
STRE�T NO: �C� , STREET: �Y� i` � (� C• ''t ,
LOT: � BLOQC: �� ADDITION: I1 �A-`�1''�'�Y'` (LLS �n� �I��•
Corner Lot: Inside Lot: �^ Setback: 5ideyards:
�—
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOtd OF CONSTRUCTION � �
� � � iI
� rj(�.) /r-1 1�1 t f�G o� Front: /� �( �/3 � Depth: ��10 �r �-p � iD Height:
�.0 �'\ C, r�-e..T � Squ�ne Feet : Cubic F eet: '
Frant: Depth: --- Height:
Square� Feet: Cubic Feet:
Type of Construction :� YIC.. f�t'e bl� 1 M M � I�G ��L Estimated Cost: $ � �� SU� •
Zb Be Cbmpleted: ���� . � s � �'1� �___�___/ � rG� •
Alt. A Alt• B
Proposed Driveway Width If New Opening Is Desired: _ $ $
SEE REVERSE SIDE OF SHEET ,
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 Ordinances and
rulings of the Department of �uildings, and hex'ek�y declares that all the facts and
representations stated in this application are true and cnrrect.
DATE : R" ID -� q S IGNATU RE :
Stipulations:
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CITY OiF FRIDLEY
8431 UNiVERSITY AVENUE N.E., FRIDLEY, MINNESOTA b5432
TELEPHONE ( 612)571-3450
August 6, 1979
�
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�
Vossen Bros. Inc.
Imute #1, Box 171B
Prior Lake, MN 55372
Re: Swimmi.ng Pool Construction at 1400 Kerry Circle N.E.
Deax Sirs:
This letter is to make clear this departrnents requirements for the swimming
pool construction at the above address.
1. As indicated, two (2} skimmers approved by the National Sanitation
Foundation will be provided.
2. As indicated, four (4) inlets of approved design for fresh and/or
repurified water will be provided.
3. As indicated, a main drain of approved construction will be provided.
4. The filter and pump shall be approved by the N.S.F. and be of
sufficient capacity to provide a minimiun turnover of at least two (2)
times in 24 hours. This department recomanends 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 minimum size of 4 feet by 4 feet at pool
entry points and provided that such decking has the approval of the
City.
6. The diving area will be acceptable provided there is no overhea.d
obstruction.
7. Fencing or other effective means including but not limited to walls
or buildings, acceptable to the City, shall be provided to positively
control all access to pub].ic and private residential sw.imming pools.
Fencing.shall meet the following criteria:
(a) The fencing shall prevent the entrance of children and be without
hand or foot holds that would enable a person t4 climb over it.
(b) The fencing shall be at least 6 feet high and entrances shall be
equipped with self-closing and self-latching gates capable of
being locked.
(c) Self-closing and se-lf-latching devices shall b e placed at the top
of the gate or otherwise inaccessible to small children.
(d) The opening between the bottom of the fence and the ground or
other surface shall be not more than four inches.
8. An automatic chlorinator should be provided with a suitable test kit.
9. All electrical and plumbing ins�allations shall b e inspected and
approved by the City Inspection Deparl�nent.
, . �
Vossen Bros. Inc.
August 6, 1979
Re: 1400 Kerry Circle N.E.
Page 2
10. All electrical lines must be greater than 15 feet away from the pool
surface. An alternative is to bury said lines. .
11. The pool fill spout must be air gapped or protected by a vacuum breaker.
12. Suitable safety equipment to include but no t limited to a ring buoy
' and rope that is 1� times the pool diameter, and shepherds crook pole
must be provided and maintained with the pool at all times.
Furthermore, these and any other requirements must meet the provisions of �
#he Fridley City Code, Section 115, Swimming Pools. The building permit
is approved contingent on final inspections and approval by the City.
, If any questions or problems arise from this letter, please feel free to
' contact me at 571-3450.
Sincerely,
S J. 0 N
Environmental Of f ice r
SJO/mh '
CC: Mr. Rc�bert Donalds
1400 Kerry Circle N.E.
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sue�ect r �v----,
City of Fridley 3 i 7� 6
AT THE TOP Of THE TWINS � U� L D I N G P E R 1. 1 I T
r
; � RE NO.
� ; y__���� COMMUMITY OEVELOP�EN7 OIV. ��+ ��O a ��/�
r � � Pq07ECTIVE INSPECTION SEC. 2� 4
� �
� � �"'1 %
l--_-�,� �-I CITY NALL f RIOLE� SS��� NUMBEP REV O�TE PAGE Of AVPqOVEO 9Y
L 612-57�--3450 s�aF�S 5/2/01 / /
10B ADDRESS 1400 Kerry Circle NE -
t LEGAL �07 N0. BLOCK TRACT OR ADDITION SEE ATTACMEO
oescR. 5 1 Heather Hills 2nd Addition SNEET
2 PROPEiiTY OWNER MAIL ADORES$ ZIP PHONE
Paul Hilburn 1400 Kerry Circle NE
3 CONTRACTOR MAIL ADORESS ZIP PHONE UCENSE NO
Twin City Concrete Equipment 11501 Excelsior B1vd, Hopkins, MN 952-935-8877
4 ApCHITECT OR OESIGNER MAIL ADDRESS 21P PHONE UCENSE NO
5 ENGINEER MAIL AODi;ESS 21P PNONE LICENSE NO
6 USE OF BUIIOING
Residential ,
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION p REPAIR O MOVE � REMOVE
8 �ESCRIBE WORK
Wreck and remove in-ground swimming pool
9 CHANGE OF USE FqOM TO
STIPULATIONS
Remove all demolitnn debris from property. Fill and level property where pool
was located.
TYPH OF GONST. OCCUPANCV GROUP OCCUPANCV �OAO
SEPARATE PERMITS ARE REOU�RED FOR ELECTRICAL, PLUMBING, HEATING.
VENTIIATING OF AIR CONOITIONING
THIS PERM17 BECOMES NULL AND VOIO IF WORK OR CONS7RUCTION ZONING SO. fT CU fT.
AUTHOR12E0 IS NOT COMMENCE� N/ITHIN 60 DAYS, OR IF CONSiRUCTION �
OR WORK IS SUSPENOED OR ABANQONEO FOR A PERIQD OF 12Q OAYS A7
ANY TIME AFTER WORK I$ COMMENCED. '' NO DWIG. UNITS O�FSTREET PARKING
1 HEREBV CEfiTIFV THAT 1 MAVE READ ANO ExAMIN�D TNIS APP�,ICATION 1 S7Al,l5 GAFIAGES
AND KNOW THE SAME TO BE TiaUE AND CORRECt. A�L PROVISIONS Of �AWS VALUATION SURTAX
ANO OpDINANCES GOVERNING TNIS TVPE OF WORK WILL Q� CpMP�lEO @ @
WITN WHETMER SPECIFIEO MEREIN OR NOT. 7ME GRANTING OF A PERMIT y�SOO� y�.SO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pEqMIT f EE SAC CHAfiGE
PROVISIONS OF ANY OTHER STATE OQ LOCAI LAW REGULATING CON- $23.50 Fire SC �SO
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION
Pt,AN CMECK fEE TOiA EE
Lice e C $5 9.50
$�GN1iUAE0FCON'AAC.TOpOpAUTNOA�2ED�GENi iO�iE� MEN PROP ALIO T TMIS IS YOUp PERMIT
� � r y �V �
S�GN4IUAEO�OWNEp��FOWNEABU�LOEpi � iDATE� . ' ��� p� .�'�n,SO � � - r��tE
�!/
NEW I I
ADDN [ j
ALTER [ j
'� Construction Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
/ �fDC; K C /�/�/ C � ('c I � / ;/'r cA �-Pi %
Legal Description:
� Owner Name & Address: PQ�� "
Tel. #
Effective 1/1/2001
(763) 572-3604 Bldg Insp
�( Contractor: w o y MN LICENSE #
� Address: // I �' c � C cd /� i3% , Tel. # y5"et � 93S � �7 �
� y3 ����
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft
GARAGE AREA:
DECK AREA:
� OTHER:
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
G.�/'cC, c -i- �c,�o..,� d� 6`�c.r�,�.
Construction Type: Estimated Cost: $ ��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: APPLICANT: Tel. #
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ ��. S� Fee Schedule on Reverse Side
$ .�?� .001 of Permit Valuation (1/10th%)
$ Sv $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ �OD $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [] Not Necessary [ J
$ �/�.��
CITI( QF FRIDLEY Bt1fLD1NG INSPECTION
�31 Unh+ers�ly Ave NE
Ftidley, MN 55432
763-l572.3�t14 FA�( 7$3-57132'$7
R!TE �HEDLu �
Furn�oe SheU nnd Dud Work. Bum� d�
�Iso Replac�ement Fumace
Gas Pipng (New Fumace. FirePiace. Ir►s�e�tj
c�� •. ,�:
C�as Dryer
*Air Conditi�oning - AI{ Sizes
a� ou� �tepatB or a�er�ons cii�c o�, eo�cf
196 aF Value of Appliarnce or Worlc
Minimum Fee SiS.00 far ib�fder�tial or 59b of coet of
lmprovemerrt whichever ts jpr�
�do� -�a���
�e��ve ajy2aQa
APPLIC�4TiQN FOR POWER Pi,ANTS AND HEATING, COQLiNG. VENTlLAT10N
REFRIGERATIQN AND AIR CQND�TIONfNG SYSTEMS AND DEV'��ES
F.� YS�!
�i.00 �,�� ��
510.00 S
�10.04 �
�1Q00
�25.00
1.2596 of Y81ue of Appliance bt Work (t.Ist on 8acit)
Minimum Fee $35.00 tar Cornmerda!/Iruiwtrlal/Ins�tutional
St�te Surchar�e
'TOtAI FE£
REIt�SPEC?tOM �EE �SO.Ob/HOt3R
, .
• �i X �
. : L .I� / '
8uilt�lrtg IJ.�ed As
ES'i11NATED CO.ST PERMff NO
�,?=,h: :11 • � �. :_I�..i .,_... . ► � :l ; � aC
S � o�T H�ting nits � Clrcle Qne (Steam} (Hot Water) Air
7rade Meme ��e �„
�� 8'T!J HP � EDR
�'uel 7a�a1 Canneded Load
S
$�
�,��
��V
*Air Con�df�onara can nat be plaaQd in slda yard wlkhout yvrnten �pproval
irom �d,jofning property awner - c�op�r to City
FILL OUT BACK SIDE FOR StACK YERIACATION ON REPLACEMEM FURNACE
Bumer Trade Name Size No.
87ti HP EDft
The urxtersigned hereby makes �ppllc�tion far a permit ftar the worlc henein
sP�ed agr�ng �o do �Il work in stric� �dar�ce with the C�ty Codes
and rulln�5 of the Buiiding DIWS�On. �rt� Aer�by d�cl�res thet atl the facts
and representations stated �n this appfi�a�on �re bve and correck.
HFA7ING
�� Tel # - -- l(..J �
Fax � - - r�te � �`� -1 �� d��-
uJ �
App�oved b�+-- ---- Ro�3n Date FlnaE Date
COMPLET6LY FOR REPLACEM�AiT FUEL BURNiNG APP�IANCE PERMIT&
COMMt7N VENT.IL�NT GCiNMECTQR A D CO� TiON A1R VERIFI�ALiaN
When reo�aclns� an e�ci nn turnace, tha �d�signed hereby �eri�es tha# tt�e
verrting hss baen examined and is free from rust, deteriara�tian, obstrudions, Yes {� No �}
and is secur�ty suppnrted and firest�pped u�ere required.
The verrtmg system is plasticlFxtl'C antl meete aN curre�t codss and rnanufs�r Y� � No ()
speafit�tions istt�uding sizing, i�rtgth, �mber oi el�rn+s and termination-
The uru�er�igned a�o veri�es #�at the repiacem�t ur�t �� listect asaemblY
and me�ts the a�rrent aadas �� �� V� Tab�a for fen
irrctude AG�G�+11AA Cate�orY y� E� Na (}
ass�ted ar�d naturat draft appiianc�s. -
,r}� d, �•ra �omb� r is sr�ed �d ir�staNea to rr� the curre�t c�de�s Y� (� No (}
and m��rfactur�r's s�ic�s.
When required to Ir�ts i a � com�on air�� a�it be sl�! �d i� Y� ��/ No {)
to mee# the curr�t cxxles and manufactur�s ep�c�Nc�tions•
Whgn ti a , ti� ur�tersiAr�ed t�►Y �ies tl'�t
it � a i'�ted �b�Y �t� meets tt�e aure�t c�ee a� �� umace
s��ci�c�ia�ns. This d�s indude ACA-GAtoAA Ga�go�Y Yes (�' � f i
Ver�ir�g Tai� for fan assist�d ar�d �tur� draft �.
la the cocnm�+ vent �+d v�ent cattnectrnrs sized at'td ��Y �
an �piianoe i�as beert removed from the aa�mm� v�ent ar� v�a� Y,� �� No t)
�p�t�1y � pr�r currorit c�des.
--�.'��e Tvos and S�lC��n Vent an��,f� !�n
� , ,,� BTU i� � �an A�seisted w' [Vat_ _��_: ��'`--
A`ppliance #1 Type �,..- BTU Ir�t � Fen Assts�d a' Nat ,�r..
qp�liance � Type BTU 3rp� _.__._.._� F�r+ Aes�t� oG t�t ____.__.._
App!'iatu+e �Ki Type _ Tats� 8tu Ir�t ,....�--
Ttrta4 A�11anc:ea
� ����
Common VeM fiype �� �� (�
He� ht . R t�th � R D�u�e� in Typs "�
qp�at►ae #1 Ve�t Cau�ar g� �eker [n TY� �
q�� � Ve�t Co�rtect� Height �ft L�th ��er �, Type .__._�-
A�iiance #3 Vent Connedor Hei�ht _____ � �� .___.-
A R
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