AF - 47892sus�ecr PERMIT NO.
City of Fridley 1410
AT THE TOP OF THE 7WINS g U I L D I N G P E R •
r
; � RECEIPT NO.
� ' L ___��_ COMMUNITY DEVEIOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
i �
�4 � /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
""'�' ,�� 612-560-3450
910-F15 5/25/77 � �
JOB ADDRESS 6170 Kerry I�ane N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDiTION SEE ATTACHED
DESCR. I.O 1 Heather Hills ZriC� ACICIl'tlOri SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Ron Cadwell
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Commercial Erectors 5298 Fillmore Street N.E., Fridley 571-8865
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION � REPAiR ❑ MOVE � REMOVE
8 DESCRIBE WORK
Construct a 58' x 44' Dwel.ling and a 22' x 22' Garage
SEP�itATE PERMlTS� REQVIREO T�R IRIRtNG,
9 CHANGE Qf USE FROM y TI. UNfBlNG ��� S�11S�
STIPULATIONS provide a hard surface driveway. Provide sod in the front an�d side
yards. Provide a verifying survey before capping. Provide City with copy of truss
design.
SEWER LOCATION: 31.5' South of Hydrant, Elev. at Property Line: 929.59
TOP OF FOOTING: 932.00 Minimum ���
WATER LOCATION: 17' South of Hydrant
DRIVEWAY DEPRESSION: N/A Existing Surtttountable c�rbing gefore digging c�N Iocai utitfies
TELEPHONE - ELFCIRIC - CAS Etc.
"� °n °i '`�D� D0� "10� °YA� � REQUIRED BY LAW
AtCt�RACY OE UtICRY LOG11ChIS /IMr I�IVAtlONS�
T�+15 DAiA !S 1'�OR INfOkMA'i10N PUR►O�� Q�i-�/1Nij
r:.��ons uwsc rt sHOUa vea�r ns �o�iioN
or� retE s�t�.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WpOC� Fr3I4@
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 ABANDONED FOR A PERIOD OF 120 DAYS AT R�1 1684+484 38,520 Total
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
WI H WHETHER SPECOIF EDN EREINIOR NOTOTHE GFANTING OF AOPERMIDT S5�-� 4O5 $ZS.%O
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE O LOCAL LAW REGULATING CON-
STRU I N O THE PERF�IMANCE O CONSTRUCTION. � $ZS4.OH $375.00
� PLAN CHECKFEE TOTALFEE
� �Z� $ 38.52 $593.30
SIGNATUREOFC N'RACTOR RAUTHORIZEDAGENT IDnT 1 � WHEN PROPERLY VAUDATEO THIS IS�YOUR PERMIT �
� "f-./
SiGNATUREOFOWNERIIFOWNERBUILDERI IDATEI BLDG INSP �ATE
1
.� � � . . . . _. _ . : . . . . . . . . . . . . . . .. _ . _.
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:
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OWf1ER:
Address
CITY OF FRIDLEY
AP?LICATIO�J FOR RESIDENTIAL BUILDING PERt�ITS
iNEW, ALTERATIOIVS, ADDITIONS, OR REPAIRS)
No. �� ,�a
LOT: �Q
CORNER LOT:
Street:
1ILDER: �
ldress : �a-� V �
�l. No. � �% �� � ,
_ ,--------
BIACK: � ADDI�ON: �i�Z'�,�� �''"�
--�
IN5IDE I+OT: `� SLTBACK: � i SIDEYARDS: �Ziv
�
Applicant attach.to this form �ao Certificates of Survey of Lot and propos.ed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
� ° � t
Front: � Depth:�� � � Height: v
5quare Feet: 16 8 y Cubic Feet: ��� �8d
Front: 2- Z' Depth: 2-- �- Height: � v
Square Feet: �� � Cubic Feet: �� � d
Type of Construction: Z.e�� Estimated Cost: $ '-
To Be Completed: � �� Alt. A JAItO ���
i
Proposed Driveway Width If New Opening Is Desired l� �$
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing �o do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse s' r ditional info ation.
DATE: �� , SIGNATURE:
!%�1 �Q�VL�. � 7'� MO �Zst� (l''"' �— �• L� �/ 9i�
Stipulations : �+xJ:' y�O � �
,� �o�,��
a�
cOPy 0� 7�C+�css AES� 4n� .
,
,
..�-,�
�
• OWtdER: �
SZTE ADDRESS:
COIITRACTORz
. �
EXT�RIOR ENVELOPE AVEF2AGE "U" COMI'iJT11TION
t C�C��lt'`����, DATE / l {f � � � �
� � '� �1 'G % �172� � PHONE : � �'J f�,�i �
Determine working squ�re footage of each
7
l. �� exposed wall area. ..... � 7� sq. ft. x .17
2. Toal roof/ceiling axea ...... ��o � � sq. ft. x .05
Zbtal exposed wall area above floor =
�� 1
: ���.
_ � �r��1 •
_ �9 �
a. Total wall window area ................................. �� ��
b. Total door area ............................ .......... �.. � a
. c. Total sliding glass door area ... �...... :...�r..: �f� � ,�t
d. Total fireplace wall area ........�... °�`�'�t
.• ,�
e. Total wall framing area (avera�e 10�) . . �-� . . . . . . . :•: . . / 33� C/ �3, i� - H �
: f . Total ri.m joist area . . . . .1:7.� . ,K / L: ��. . . . . . . . . . . . . . . . /�f-� ` � cF
g. wall area above floor .......................... �
h. wall area above floor .. .................... . �
i. wall area above floor ..........................
j. wall area above floor .............. ..........
�/ `
. To exposed foundation area = '
� � �� hr `
k. Total foun3ation'window area.�.� f.� ...................
1. Total net foundation area above grade ................. �(9
Determine "U" value of each wall segment
(e.g. window, door, each separate wall section)
a. � 6 � g ��U�� � j � _
b. �� � X „U�� - � g =
,
c. � X ��U�� � � 5 _
d. -f � g aUu , Gj !� _
e. � 2�X
U ��� X
g. l '� 3,� X
h. (� ��( X
.�U�� _
�.U�� c 6 � _
„v�� � � � 1 =
aUu � �r �i(p =
t
��� -
�_
�(�t�
� o �r
�
,��
15
i. �{�_ X ��U�� f � � _
j. X"U" a If item #3 is the same as,
or less than item #l, you
= have met the intent of
k. X"U" __ BC 6006 (c) 2.
l. � X „v�� _
._.____ �
3 . ..............�'.:........... Zbtal =� �
_ . . .�.�.�
/ /
, � Total exposed roof/ceiling area = / ����
m. Total skylight area ............................ "
n. Total roof/ceiling framing area (average 10�)...
o. Total net insulated raof/ceiling area...........
Determine "U" value for each roof/ceiling segment
m X "U" _
.
n X ��U�� _
.
o l �� x „U„ _
.
4 ........................... Total =
If total of #4 is the same as, or less than #2, you have met the intent of
SBC 6006 (c) l. , '
. Alternate Building Envelape 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.
.R
1. + 2. _
3. + 4. _
i
�
0
�.�
..� i� �.M� .
NOT�: Use lU� of opayue wall area for
• frame construction
FIG. #1
',_ _ . ___. . . . FR11Pl� [?ALL . .
• ` �« ` U
.� • �
4 � � �' _ � r
J � ,
F.SC. #3
r �
� � ,
`' ,
I (G
V
.J_, .�
.. '. . : .
.� � � f , , � ., .
o�
. • o - . ` u- •
, . • �• , ;
�., . .
, .r .• •!• • �
Construction R-Value
1. Interior air film 0.68
2 . �y � _�
3 . � � �"/
4 . t�-._�_�---�
5. i�1�_
6. Dcter�ar air f ilm 0.17
�+otai p g', J �
�r.
� ' �(O�
1. Interior air film 0.68
2 . . � ��
3. /�',p a
4 . �•' �Sn'�o Fc�qri� ��a �
5• � .�%�
6. EXterior air €ilm 0.17
���� �6, o�
. .- u� ;o�
l. Interior air f ilm 0.6$
2. ._....�/� �d
3 . 1. ��
4 . -7 i ��
—
5. . �.S
6. Exterior air film 0.17
Zbtal � _ �� y` j
� c,�=,a�
1. Interior air film 0.68
2. ,
s. , �� 2
4. _ (,L. ?�—
..�.�—
s. 3�0
6. Exterior air film 0.17
. tisr��o ..Total � , �
• , •' ! 6 . . r � � � �
: r� ' � <
. �� �'n_f� k . ' ; � ' '
� � � � � �.
� ����� ` w , � ' : � • �. . � �
(/! " ' . �
� • ' � Iil =
� _ � b . � ...
((( : : , . . . • , i /i/^ ,' 1
FIG. #4 "_ X � ' � � .� /�i
: /!t � . , � o �,
""' ` ` // f --
. .- .� • �
• � ��� � � X x + t��
• • /I ( :. lt r :. ��c �
NOTr'.:. Indicate tyne, "?�" 'v�lue, depth and
� � placeMent oi ins��lation.
��.-
,', �OOF/CEILING
.. ,
i „��_ �' r, ' .
�..,._ ,,�,�,, �, �-O �--�
�� � ;` � �' ?�►�1�� �
�-/� � I ,j �`��
��!�'�- �� --, � �
/, � l!i 1► �f 1�1 �
• v�rr � �� , �rl � _ !�� 11 -.�
. ;��\� � .--=-r--�-
� . %i� �� . • •
. : . .
. . .
��ented � . Heat flow .
up . . .
' , • .
.
� �'IG. �5 � . � � • .
.
.. - : • .. :. _ - - .
� �,.,�tt•..:u- :�.0,_+1;:�'� �*,.r.c�-f..��<c,r.aa..c�� .
_.._.�:.- -- - -
. ��� ��:.,� ��J ��J .
Near flo��s up � . � � ; •ven�ed
.' _ ,F3G. �k6 �. . .. . . � ' �' . • ,
. 3 r� . : 5 ;
. . � �i
�, ;. e� :,"�
ni L� i.:°�.'�...t, j a.S �.t '�l� _
' • .. . rttGui.�.ie.�=:'?„'�i�" _ .. _..
', rcU��-Yl:h'T'r:D • ' , . .
. ' .� • ' . • . :
.. � �. .., .
. � Hen� • • . � , •
. ; • •' flow up ~ .. • ' � .
. ..: . . . „ , .
i�xr,. �� � . , � , . �
Construction R-Value
1. Interior air fi Ln 0.61
z.
3.
4. Exterior air film (still) 0.61
Total
1. Interior air f il.m ` 0.61
2.
3.
4. bcterior air film (still) 0.61
7.bta1
u
l. Inside air film 0.61
3.
4.
5. Outside air film 0.17
7btal
Note: Use additional sheets if mare space is
needed for details and calculations
.
���
CI7Y 0� FRIDLEY .
APPLICA710N FOR PWMBING AND GAS FI�'TIN� PERMIt
y >, m a o x• w Water
� � � b a� q� � o, w q Heater
s�i m � y+ � ,�!( ,[ � � � oH .C�7 ..�i t5 .�C � o a yc��i
. p O � 11 N R N�� � p 17 tll �N N N N � 1�
ui U a aq `ai iri � n-�' w �n w U oa � 3 � � � O as lec
� �
lst
2nd �
3rd
4 th
(R) = Future Connection Opening Connected with Sewer
(*) = New Fixture, Old Opening Water
PARTIAL RATE SCNEDULE
PLUMBING FIXTURE RATES: N0. RATE
Number Fixtures � x 53.�0
Future Fixture Opening _� x $2.00
New Fixture, Old Opening x $2,00
Catch Basin x $5.00
Water Heater - to 99,000 BTU x $5.00
100,000 BTU to 199,000 BTU x$10.00
Water Softener x $7.00
New Ground lain Old Building x $5.00
Electric Water Heater x $S.QO
GAS FITTING FEES: .
lst 3 fixtures x '$3,00
Additional Fixtures x 51.00
Gas Range to 199,000 HTU x$�:0.00
REPAIRS � ALTERATIONS
First $100.00 $S.OQ
each add. $100.00 or fraction $2.00
State Surcharqe
TOTAL FEE
TOTAL
��
S �, O U
$
$
$ � C> U
$
$
$
$
$ �_d
S "
S
S
S
$ ,50
s �/_ sa
�� �\ REINSPECTION FEE `
/� �� ($10.00)
1 �t7v-�
,aob Address
nep��,�t of Bui2d.fng�
City of Fridley ,
Tel. #571-3450 �
The undersigned hereby makes�application for a pesmit for the work herein
specified agreeing to do all work in strict acccrdance with the City Codes
and rulings of the Deparffient of Buildings, and hereby declares that all
the facts.and representations stated in thia application are true and correct
Fridley, Mn. �� ! U , 19 7% I
OWNER
KIND OF BUILDING
USED AS �
TO BE COMPLETED ABOUT
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO. '/���
ComPanY U�
Signed By
Tel. No.
ROUGH INSP.
DEtte
FINAL 2NSP. q - / 5^" % �
� Date
APPRaVAL FOR RSRMIT _��1E:�L�
MINII�4UM FES FOR ANY PLUMBING PERMIT I3 $7.50 PLUS 5.50 8TAT8 SU�RGB
CITY OF FRIDLEY
aPPLICATION FOR POV�cR PLAN7S AND HEA7ING, COO�ING, VENTILA7TON, REFRIGERATION AND
AIR CO�DITIONING $YSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GR.�I'IT1 li:�R�l �IF: . RA'I'E
r,:r::ace S::ell & CLCt t,•orx $12•00
nc:. ��Cu:.Crt Of EL•YG3Ci: 7.00
na?aizs S :+lteraticns-up to $500.00 �'��
:epairs 6 a::erations each ad3. 5500.00 4•00
�i£CH.��ICaL ti�R�i :\IR: •'�6�' � p
.�cs�_CoSc �
F1tr.^.aca She11 & Duct �iork to 100,000 BTC 512.00
each afl.:. SJ.�JO STJ 4.00
Re�lace-e.^.t o:: :'urr.ace 7 • 00
C�rs?ss & �l�era:ior.s-up to 5500.00 �'��
: e: airs S�+lteratio :s each add. $500.00 4• 00
STc�.�: 0� }iJT i�:aTii.R S1'�?i:�f:
goiler d..iaes ;:� to 100, a�0 BTU
ea�.. ac.:.a. 5J, 0�0 ST�
Boiier c:ly Lp to 100,000 5TU
each ac:n, 50,0�0 &TU
OIL BUR\ER- .0 3' gal. per hour
eac:� a�3. 3 gal. per hour
G,�S SU�X::�- �rca 100,000 8�� to 199,999 STU
(oves Y�S,°.95 3::7 see Fee Schedule)
TOT�'lL
S
S
S
Job Address f� l / �
Departmer:t of IIuildings
City of P'ridley
Tel. ;i571-3450
The undersiqned hereby makes application for a permit :or tze worR herei.z
g��R? � specified agreeing ta do all wor�c in strict accazdar.ce with t�e City Cczes
S and rulings of the Depart:ncnt of Buildiags, ar.d hereby 8eclares that al: the
S facts and representations stated ia tY.is a�plication are true a:�d corrECt.
$ %.. //�
$ Fridley, Minn. �< 7 � 19Z �
�� ��
ow;vER _�'iH- -e ��. r,.� -z �-�
$12.00 $
4.00 $
7.00 S
6.00 $
510.00 $
10.00 $
$10.00 $ � p D
S
G>S FITTI\G FL-ES:
lst 3£ixtures x` S 3.00
A33ir.ional Fixtures x $ 1.00
Gas ::ar.ge to 199,000 BTU • x $10.00
�IR CO\DITIO\:\G ��
F�\ H:�Ti\G �1'�TL•�;S See Fea Schec�ule
�'E\TILaTI\G Sl'ST��!S _ \
aLTE3aTI0�S � REP�IRS �
State Surcharge
TOTAL FEE
5�
S
$
S
$
S
$ .50
S'L� J' -� �
yc.f—�—_
f'
R:Uwi Z\SF. REI:�SPECTZON FEE • g
Date CS10.00) .
c L�IAI. I�SP. e" 7
A3Le
e1P?:Z:.V�,:. FOR P.r.R`SZT ���'�� +
.�
� 'ti:.`Su':: FEE FOR ASZY HEATING PER':ZT IS $7.50 �
�._ \
� .
KTND OF BUILDING
USED AS
TO BE COMPLETED T,30UT
ESTIMATED COST �DO D �
OLD NEW UILDING PERidIT NO. PER'dIT NO. /�S �
DESCRIPTION OF FURVACE/SliR*lER .
H�7ITING oY POWER PLANTS, Steam, Hot Watez', r.ct Air- No.
�L �- �Q
K'rade Kame Size no. � G S` F l0 �
�QrGGO
Ca�acity Sq. Ft. EDR BTU jp,,�' oo O Y.2
Total Connected Loaa ��, • � L5 0 Kind of Fuel /I�-0� a�.ei.o '
BURNER - Trade Name Size 2:0. ���
Capacity �` Sq. Ft. EDR � STU Y.?
� .
.
Company
Siqned By �'�—>�� --�-V -�%'1-�,l/�,� _ •
-i
�• Tel. Ho. %� y J � Y�
�� '
� ,� � t
� ;;� ,z�
;-� �� , ,;:,�
�..o��� �� �������
�`� 6431 UNIYERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
'y
TELEPHONE ( 612)57t-345U
I)ec�aber 2, 1979
� _ .
Mr. Mike 0'Bannon
Commercial Erectors
814 - 9th Street South
� Minneapolis, Mn. 55421
Re: Final Inspection at 6].'70 Kerry Lane N.E.
Dear Mr. O'Bannon�
A final inspection was made on Decetnber 1, 1977 and the following items were
' noted whirh.must be completed before the structure can be finaled out;
1. Provide handrail to basement and lower level by December l5� 1977.
2. Complete insulation under windows in lower level by December Z5, I977.
� 3. Grade at east side of house may be a problem at windows - install
window weZls by May 30, 1978.
4. Reduce deck spanning to 9 inches maximum by May 3Q, 1978.
5. Instal2 joist hangers on deck by riay 30, I978.
FTe will. expect the above it�s to be completed by the scheduled dates when
reinspections will be made to determi.ne compliance. If you have any
guestions on these it�ns, please contact me at 571-3450.
5incerely.
�. r
RON HOLDEN
Building Inspector�
Rx/mh
CC: Mr. Ronald Q�dwell
6170 Kerry Lane N.E.
� , � �
`fi �
�� F }�f _,.,,_ ..... � . ,. ���
. ' � Lr F X
/.." K��
fE�.. .�.,.�
! ,� ��
�,�° �
t ����
` �
4
_.� .,
June 29, 1978
, ,,
- �,
c
� .
�- ' °�` '�-' `
6431 UNIYERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
TELEPHONE ( 612)571-3450
Mr. Mike O'Bannon
Commercial Erectors
5298 Fillmore Street N.E.
Fridley, MN 55421
Re: Final Inspecti.on at 6170 Kerry Lane N.E. (5econd Notice)
Dear Mr. O'Bannon:
A final reinspection was made on June 28, 1978 of the above address and
the following items were noted which must be completed before the structure
can be finaled out;
1.
2.
3.
4.
5.
6.
7.
8.
Pzovide handrai.l to bas�tent and lower level.
Submit a verifying survey of property.
Replace insulation under windows in lower level.
Grade at east side of house may be a problem at windows - install
window wells.
Reduce deck spacing to a maximtun of 9 inches.
Install joist hangers on deck.
Provide nuts on garage anchor bolts.
Provide protection for combustion air intalce on f ireplace from
impact .
We will expect the above items to be completed by July 21, 1978 when a
reinspection will be conducted to determine compliance. If you have any
questions on these items, please contact me at 571-3450.
Sincerely,
RON HOLDEN
Building Inspector
RH/mh
CC: Mr. RonaZd Cadwell
6170 Kerry Lane N.E.
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CITI� O� FRiDL�Y
- 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA b5432
17, 1978
Mr. Mike O'Bannon
Commercial Erectors Inc.
5298 Fillmore Street N.E.
Fridley, MI3. 55421
TELEPHONE ( 612)571-3450
Re: Final Inspections at 1411 Kerry Circle, 6170 Kerry Lane, and
1470 Rice Creek Drive N.E.
Dear Mr. O'Bannon:
.
Final reinspections were made on the above addresses on October 16, 1978
and the following it�ns were noted to be incomplete;
1411 Kerry Circle '
l. Provide handrails to lower level.
2. Provide a verifying survey.
.3. Install joist hangers on dec,k.
4. Adjust deck rail to 9 inch maximum spacing.
5. Plumbing work has not been finaled out.
,k� ' .
6170 Kerry Lane
1. Provide verifying survey.
2. Replace insulation under windows in lower level
3. Lower window wells at east side of house.
� 4. Reduce deck rail to 9 inch maximwn spacing.
5. Provide joist hangers on deck.
as they stiZl leak.
6. Protection needed for air cambustion intake on fireplace.
1470 Rice Creek Drive
1. Firerock garage header..
2. Provide vapor barrier in basement.
3. Call for plumbing final to get water meter sealed.
We will expect all of the above itc�ns to be completed by October 31, 1978
when reinspections will again be made to determine compliance. If you have
any questions on these it ans, please contact me at 571-3450.
Si re ,
RON HOLDEN
Building Inspector
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SuBJECT •
City of Fridley 25379
, , AT THE TOP OF THE TWINS g � I L D I N G P E R M I T RECEIPT .
r
� �
� ` ���� COMMUNITV DEVELOPMENT DIV. ��/
� v � PROTECTIVE INSPECTION SEC.
r � ,
� . ,
� � /'��1 � CITY HALL FRIDIE� 55e32 NUMBEp REV DATE PAGE Oi APPROVED B�
�---•� • •,' 612-571-3450 9t0-Ft5 8/18/97 � �
JOB ADURESS 6170 Kerry Lane NE
t IEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACHED
DESCR. lO 1 Heather Hills 2nd Addn sMeer
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ron Cadwell 6170 Kerry Lane NE 571-1832
3 CONTRACTOR MAIL ADDRESS ZIP PNONE LICENSE NO.
DeMars Construction 8401 166 Cir NW, Ramsey, MN 55303 441-7084 6614
d ARCNI7ECT OR DESIGNER MAIL ADDFESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION f� REPAIR ❑ MOVE O REMOVE
B DESCRIBE WOF;K
Reroof House & Garage (31 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must comply with $ie State Building Code.
TYPE OFCONST. OCCUPANCV GiiOUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOI� IF WORK OR CONSTRUCTION 20NING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANOONED FOR A PERI00 OF 120 OAYS AT •
ANY TIME AFTER WORK IS COMMENCED. NO. DWIG. UNITS OFfSTFEET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO ORDINANCES GOVERNING TNIS TVPE Of WOFiK' WILL BE COMPLIED $2 585 �1.29
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTtNG OF A PERMIT �
DOES NOT PRESUME TO GI AUTHORI?V TO VIOLATE OR CANCEL TNE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OT R ST TE O LAW REGULATING CON- ��[F.JS Fire SC �Z.S9
STRUCTI PE OFiM E TRUCTION.
PLAN CMECK FEE TO L FEE
License C $5 0 $83.63
S�GNAIUFlE F ON�RACTOAOAAUTHOAl2EDAGENT � IDATE� EN ROP� VAU D THIS IS UR PERMIT
� I I
S�GNATUREOFOWNEAi��OWNEABUILDEAi IDATEI B G�NSP � pt,TE
NEW
ADDN
ALTER
[�
tl
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ConstructionAddress:
Legal Description:
CITY,OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
QUILDING PERMIT APPLICATION
� ( 7� c � a,.�
Effective 1 / 1 /97
���3� �
a5
Owner Name & Address: � n �0.d � f � l % %.�y �,r Tel. # S % �- / �3 2
Contractor: � � cuCSt �� MN LICENSE #� 6 l c/
Address: �1 O 1-- �� 6�� C�� � i� C-J �% Tel- #_ �( �f ( 70� y
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length ; Width Height
GA,RAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER:
Sq. Ft.
Sq. Ft.
Sq. Ft.
�-� � -� � �vo� �,—
Construction Type: � � Estimat�i Cost: $_ 3�'j � �.�OS,
�` S Q�`^�� (Fee Schedul e on Ba ck)
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft �x $ —$
DATE: � APPLICANT: Tel. #�y l��8 y
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULA"CIONS:
� ��
$ �, �g
� �. .� 9
$
$ � (11�
$
$
$
$
$_���.�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.SO/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ) Not Necessary [ ]
�- - '
From: City of Fridley To: 7637816681 Page: 2/4 Date: 5/27/2009 12:30:38 PM
Building MECHANICAL Permit No.: ?� �� �Z�j��
Inspections RESIDENTIAL APPLICATION Recei�e�� �y:� _�
763-572-3604 CITY OF FRIDLEY nat��'���-��(�-_�
763-502-4 � FAX Eh'h'�;C;TIVE2-19-09
u.� rt�_) �='�-
IITt AL)UIZtSS �
THIS APPLICANT I�:
PROPERTY
OW'NER'
TEVavT
CONTRACTOR
SI�BMIT A COPY OF
YOURSTATE
L(CE�SE N'!TH
.APPLICATION
PERti71T TYPE
TYPE OF �i'ORK:
❑ owNtx
NAM�:
AI�IJItt
PHONE:
COMPANY NAME:_
CnNTACT PEIZSON:
�TATE LIC;tN�S/�t'�
ADD1ZtSS: l!J �
PHONt �
YOU12 �-MAIL AllllR�SS
NTRACTOR
�INGLE FAMILY ❑ TWO NAMILY
❑ NtW �IZtPLACEMtNT
DE���� .^_ R�T.Lf'bw� 1� M
A IVIL�
� C:ITY���
� y- _
P llAT�
� C:iTY
��AX��,3- ��l ���,��
❑ TQWNHOUS�
❑ ALTERATIONiIttMODEL
� -�Cr�� A-.c��� 4
A
AT�IR.C) 7 -�C
FEES AR�. BASh:D OV �10.0(I PER FIX'I'URN; EXC �' '"f �VH�R� V07'ED. FIX'fURES: 1Vp1CA'1'E "f0'fAL VU�16�K OF N,ACH BELOW)
tqui�rtneni Installed Mh'G: MODEL: iY) d'y��� SILEiKTU ��
. Mf�G: MOUEL: �3�-��--�'�'N/� SlL6i8TU ���!y+�__
MFG: MODEL: �Ls�(�-�� SI'LEiBTU � —
�� F�� ��� FIREPLACE(GAS)$I5.00 GAS KANGEiOVtN $10.00
�IK TO AIR tXC:HANCttR $ IS N11Z�.PLACt (Va'OQU) $35.OQ NEN�' GAS GRILL $ IO.QU
O(LtR S3�.OU vM'UKNACE $35.00 �Z� _GAS UNIT HTR $IO.OQ
v C HIM�EY LINER. 10.00 ) GAS DIZYER$IO.QO PQOL HEATER$35A0
_DUCT WOKK � IO.GO _GAS PIPING $10.Q0 VrNTILATOK $I5.00
�ttfli�Gf O��Xt�Jf� �� � � i� �� T l .X:
h'urnl�er of t[xt�res �� $>15.0€7 : x:
i�umbcr ��f fix�iirc:� fa'? �25 tt� :::i x
t�urr�b�r off�xtar�s fa� S35Afl � x:
StaiL Siarchar�c �- � ,5�:
(i�itilliUl� FEE �35:>t}1 Total — $
THIS lS AN APPLICATION F'OIZ A PtRM17-NOT VALIU UNTIL PRO(:ESSEp
t hcrcby apply for a building permit and I acknowlcdgc that thc information abovc is complctc and accuratc; that thc work will br in
conformancc with thc ordinanccs and codcs of thc City of Fridlcy and with thc Minncsota Construction Codc:s; that I undcrstand this is
not a permit but only an p'cation for a permit and work is not to start without a permit; that thc work will bc in accordancc with thc.
approvc.d plan in thc. casr. of al rk which rcquires rcvicw and approva plans.
SIG\AT�RE OF APPLIC.4!v'T _ 1NT A ^ DAT 'F�� _.
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977