AF - 47903SUBJECT
City of Fridley ° 14311
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � CEIP .
� • COMMUNITY DEVELOPMENT DIV. � �
� ; V � ,/
r � � PROTECTIVE INSPECTION SEC. � T^
�1 � /"��1 � CITY HA�L FRIDLEY SS432 NUMBER REV. DATE PAGE OF APPflOVED BY
""� � ,'� 612-560-3450
910-F15 8/22/77 � �
JOB ADDRESS 6181 Kerry Lane N. E.
LOT NO. BIOCK TRACT OF ADDITION
1 LEGAL SEE ATTACHED
DESCR. 2 2 Heather I�].�.ZS 2nd P,ddition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Donald H. Bratt 6701 Overton Drive N.E. 571-6591
3 CONTRACTOR MAIL ADORESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOFK i
Construct a 44' x 29'6" Dwelling and a 24' x 38' Garage •.�QS
TELEPHONE • ELECTRIC - GAS tc.
9 CHANGEQFUSEFRO��AT�N�' PLUMBING AND t ' REQUIRED BY LA
STIPULATIONS provide City with copy of truss design before capping. Provide
furnace room with louvered door, "combustion air", or an openable window. Provide
treated or redwood floor plates. Provide sod in the front and.side yards. Provide
a hard surface driveway. Provide a verifying survey before capping. Owner understa.n
that area to rear of garage cannot be converted to living space due to'�.nadequate se ack
SEWER LOCATION: (Approx. 18' Deep In 5treet) 86' South of Manhole (S. Inv. 928.40)
WYE ELEV: 928.74 TOP OF FOOTING: 932.24 Miniminn
WATER LOCATION: 12.5' South of Sewer Service
DRIVEWAY DEPRESSION COST: N/A Existing surmountable curbing.
THH C1TY OF FR1DlEY DOES NOT GUARAME� ?HE
ACCURACY OF UTiIITY IOCATiONS AND ELEVATIG+�:S,
7MI5 �ATA IS fOR INFORAAATION PU�POSES ONLY kNJ
PERSONS U�lNG �'1' SHOU�p yEWF�f Tp{E INPpRMATiON ..
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOC� FY'dICl2
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 R-1 1346+912 36, 040 Total
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 �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALIfATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 44, 975 $22.49
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S�-'44.16 $375.00
���c�_�% '/ � y J_ PIAN CHECK FEE TOTAL FEE
�r • � . �� ��.�� •��
(/1'�/�-''�. � � 1_ ',t/-1 -2.�- 36.04 ` $577.69
SIGNATUREOFCONiRACTORORAUTHORI2EDAGENT IDn7E� WHEN PR PERLY VALIDATED THIS IS YOUR PERMIT �
' � _� �
SiGNATURE OF OWNER UF OWNER BUILDERI IDATEI � BLDG INSP DATE �
. • . t
0
CITY OF FRIllLEY
APPL.IC/1TION FOR RESIDENTIAL BUILDING RERI�IITS
(NEW, AL1'ERATIONS, ADDITIONS,,OR REPAIRS)
. ' ' �cr� �'S�/"�
04JP7�F2. ''�:.��Y`- �UILD�R:
Address : G7� I C�i� p�. I�. �Address : 6 7�/ ��=�'�"�^.. ,��-. `U.F .
Te1. No . �7 (- � � g (
No. 6� �� � 5treet:
LOT: � BLOCY.: �-
ADDITION: • ��"a'-"" �� °��
CORNER LOT: INSIDE IAT: i� S,?TBACK: SIDEYARAS:
Applicant attach �to this form �ao Certificates of Survey of Lot and proposed
building location drawn on these Certificates. �
DESCRIPTION OF BUILDING .
To Be Used As:
J� D
\E'�-r-e- Front: �� Depth : � R� 6 Height : �
• Square Feet: Cubic Feet:
Front: �� Depth: 3 � � Height: / �
. � Square Feet: G�bic Feet:
Type of Construction: w�`'�- ��� Estimated Cost: $ ��"
Zb Be Completed: Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired �� $�_ $
(SEE REVERSE SIDE OF SHEET)
The undersigned herek�y makes application for a permit for the work herein
specified, agreeing to do all work in strict acc�rdance with the City of •
Fridley Ordinances and rulings of the Department oi Buildings, and hereby
�/declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional infozmation.
DATE : � S I GNATU RE : o� ;� � �'�-�/` /`l� • ��
. — � Ow,�.i� „L+�.LN.a�r� �.�' °t��. �
Stipulations: �� V�,�y�,�' �t fi�w�X�.•!
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. CIT? OF HUZLaII� DBPA R?MEN? �%,�/C,
�ZTLR20R��P �AGE "U" COIRPU?ATION
(?o b� subaitt�d rrlt►b builairt� p��it application)
On� �r tYO fa�il� d�wllie� __�__„ O�rt�r �.,^� f��f.�T' �
A 11 4.. .�r '
Sit• addr�ss
Contra�tor Dat• 8- �- 71 ne
LlltiAL !'T. OF �/
EYF09�0 MIAI.L �!� 1,�% ��f� T'i. f t. a bove �j"��D WA
�'OTAL EXP03 • • • •
OFAQUE wALL C.ONST,EiUCT20N: "U" value x ar�a
Sr-�.�� F�C � / - / � - "U^ 07a x
� M . �/ - � »U� .!� > �X
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z.�r,�,�..���� ....�
Detail r�fe�ence ������ ti` �,(,� "�" • X
f rom ;;��.�^�• �'it 3. "U" x
a�tacMed sheeLs "U" x
nU� x
�u� x
�Uw x
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wiNDOwS: "U"
Make k t�rpe
w
» w
N rl
N N
n n
fyC4R.g : "U"
Mt�[! t C�P�
� �
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value x arta
sq.
S (� .
sq.
SQ.
sq.
S�.
sq.
sq.
^U" X 3q.
"U* x sq.
x(j� �_X Sq.
7i�'� _ z/ 'S. _ "U" , X sq .
"U x sq.
»v* x sq.
valu� x arw
MUN �
"U" X
_ �� �r��._ . ���'s_"U , x
"U" x
T�'iAL ( U)( A) VALUES �o�. P? •
DIVID�D 8Y TOTAL MALL ARSA �� 74, 7�
ft. " �
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ft. - ��
fL. . • �U.
ft. .ov • �V
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. t. U,
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ft. � � � ��t� tA ) �
tt.
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sq. t't. • `VIC��
gq. rt. - tv�E�►1
sQ. ft. � tU)t��
�q. ft. � �U 1 �A 1
TOTALS �-�Sq. ft..��,` 'Zt U i(A i
.�GS � • �
A Vt�AtiE "U" . li or ltss for 1 k 2 faai ly d�121nis
.22 or l�sa for all other buildin�s
�Qi�/CBZLIN�3 :
TD'PAL A RBA :�,_,_ /.�u . Jf sq . f L.
D�tail r�i'e�nce "U" x
f roe "U
att�ch�d shs�ts. �r /G "U" x
D�scrib� openir�s "U" s
in root. "U" x
� � �'
s ft. • U) (A �
q. tt. • �U 1(A i
�q. ft. • iU � �A i
sq. fL. • (d)(A�
sq. ft. � (Ui(AI
T�J?A Ls_,��u , S�,i„�3 q. f �.��� ( tJ I I A 1
T4TAL ( U ) ( A ) YA LUf�S .�P. /� � • A 1R . �•Q••
DI VIDSD H? TOTA L i�DO!' / ���
/.�%• �J ...�"fi/ S �%i�%�'?' !vl�� f�.�'�i�''��:�
CEILI�IG A REA �
AVERAGE "U" .OS for vsntilat�d roof.s /�y. �����~J /N���TM��T GU
.10 for all otb�r construction ���T� ����N�` ���0�
. .�l7'd�� �
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-.x;* �� ., . . . . .
. WALL SECTION _ ?3,�� M +�rd�LL •?' �TK6ac�r
1VtYI'E s U�E 12'z QF OPAQUE WALL AREA FOR
FRAME CONSTRUCTION CAKSTRUCT; I�N
1
FIG. i�1 PLAN.1tIEW
FIG. �1 `3£CTIdN
FIG. #2 S�,CTI�N
FIG. �3 SECTiON
d
- z ^„r�—.sr�r:.;. ..�-. N:.r�*�.t�.-r,-:-;�.�- a
t �
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1. Irtt��ior' �i�' fi1�+ :G
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4 . ���",�,•' �'f'�..�c r�'t?'�!E ,. .
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6. Exteriar air fiis p,17
Ttrrn�, ( �;> . � �y�
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1
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4
5
6
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FIG. # 1 '�
CQMB . "U =( .12 X .,,_!, ' '�r► ,,,) i' ( . &8 X�,} "�,.�,:,M, E
' . . � �I��� Y .
I ��'
., p.
1. Interior air film � `
2.,�'/$"�,.0' /r'il.��� /NJ'�'. ,
3. �F" /� / _.�:��'�i' :
4 . P� S,� p � -� �M
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6. Tacterior air f iIm ���
{ �� ;
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2 . ; ..
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4 . �,t GM�Jc. ,D�LAC /,M�+„� ��.���/„� � �
5 fTi�c�c v ,
6. Exterior air film p.
TOTAL (R) � t0 �;
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2. Q.r �&b��G.�,��' ._........,�...,_ _��.....��,�• �- ,t�=
3. E�teriot air f �,lm ��~�� ,, �
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i �:' � d`��1� A
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A • � 7"�i4� td .,rf�'/�,PQ`� �/�/'�' iL%l�'� PA6$ � �f��"�� � �'.
W,f�LL,j� SHC�ION - � a "
�(}�'Es tlSE 127 OF OPAQUE WALL AREA F(ift 2'�O�►! �' �IL T iTt�' � '° ,t"*'�r/. ,�: ' '�
FRAME CONSTItUCTION CONSTRIJGTION {�) �+��
r! _
=� � 1. Intexinr air f.tlm ._„_,�;,(�,�,_ , � �
. . .�....ir�� Y
� 2 . / 2" f'"i �flp: :t�,�i��i! .4
3 • " �' _._:.���.
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FIG. #1 PLAN VI�W
' �IG. �1 SECTIQN
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FIG. �2 SECTION
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<1 �
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,. ' • d ��l �-sy��
:.� � �'
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+ �G
PIG. �3 �ECTIQN
�� J
�
��U��s l!R= . //�
�
l. Interior air film ,,.,�6�%,�,
2 ,!� .. .�t yn �$`� �,.....z.� • �;
.
3 . �/ '� ! �"� l�� / !�y„�,�. ,_ ,
4 .1 ss « i # . ,
/ �i
S. "
6. ��i� air f lm / � ��►�
TOTAL f �) /:f ; 9��
��U���1/R= , 4�6.� _ :�:
FIG. fEl � � � �'��
GOMB. 'rU �(.12 X . t/� )+(.$B�R� '�)� -�. :
��.�.,���
. ��. � �� y �.��^ � `��;'
Y,
t� * K.
. .. �'.Y, A"� I '�
��
1. Intezior air film ���.4���'��
2.� N Fi�i!' /�. .�r�,�:,
3 . ,� `� ,C/,6' tM Tv�, f � �,,,
4 �ti/�1 " ��//L %'�t f/� r''`�# r -fr
s .�y.� rv�tra ` ` a � � ':
6.��iws a i r f i Ita /NT�rt � ,��.� $:
TOTAL (R) `` .�,'� � �
1/�11_ � lL�� • G/fI �..L� � '�"�A i.
Jr` ^
� k G fi -.`i�'� sg, }
1 • Interior air fflm � � �'��
2 . � ' ...�».�� �� �' �a �� �
3. :� t.t,��� 3
FrL[ � ��t'' ; t, �"; z
4 . �•►� �J6. tJ�LK . � k �..�;� �
• .1 �b`
5. �� � � � >
6. .sw�ie�r air film Iwslk,�iC� � ��` }��
TOT11I. (R} ��' � ���;,.��
� , �
��U��,�1 /R= �Dr L � x �,;�
. ` •.
" U1;f �'".f .�� � `' - ` �
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7 Y '
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.�� ; . � � ir�
1 Inte�iar afr film r >
2.�C Cl�G ��_ � ;�, u�Y z�;��
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3. Exteriar Iair €ilm � � a``:�
TQTAI. (R) ��
��U�� =1 �R� . C4 i .� .�n
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A
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r; .
n,4
$� �'�'
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WALL SECTION - P��
NOTE: USE 12X OF OPAQtJE WALL AREA FOR
FRAME C�NS'TRilCTION CONSTRUCI'ION (R) VALllE
Ar �-�--
�' � 1. Interior ai�' film O.�SB
2 2,
3.
� � , 4 • �_
5 S•
�y 6. Exterior air film 0.17
TOTAL (R}
FIG. !il FLA�I VIEW "U"= 1/R=
� 1. Interior air fi�m 0. 8
._,.V 2 .
3.
- q b.
-.� � 5 ,
5. Egterior air fi.lt� 0.17
TOTAL (R)
FIG. .#1 SFCTION "iJ"=1/R=
�� FIG. 1l1
COMB. " "=U (.12 X )+(.88 X }_
: : �
' SEC TiON
�
FIG. �3 SBCTIQ�i
1. Interior air film 0.6�
2. '
3.
4. �
5. -
6. Exterior air film � �.17
TOTAL (R)
��T1"= 1 /R=
�� f�i�' P'G,�J�'tF
1. Interior air film 0•�
2.
3. G[.��j=` �j.�'�' /. j.�
4. /�+�G"v��c. /$t��. . t.�
5.
6. �xterior air fflm �O�.�li_
TOTAL (R) � ��►
��U"=1/R$ � •
.��
�
1. Interior air fil.m q..bt8 ,
2.
3. Exterior air fi2m _t�
To�ru, cx�
"u,� �i 1R=
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_� �577 G9 _ __ _ __
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING $YSTEMS AND DEVICES
PARTII�L RATE SCHEDULE '
�r
GRAVITY WARM AIR: RATE TOTAL Job Address �
Furnace Shell & Duct Work $12.00 $
Replacement of FUrnace
Repairs & Alterations-up to $500.00
Repairs & Alterations each add. $500.00
MECHANICAL WARM AIR:
EUrnace She11 & Duct Work to 100,000 STU
each add. 50,OQ0 BTU
Replacement of Furnace
Repairs & Alterations-up to $500.00
Repairs & Alterations each add. $500.00
STEAM OR HOT WATER SYSTDvI:
Hoiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTD
each addn. 50,000 BTU
OIL BURIVER- to 3 gal. per hour
each add. 3 gal. per hour
GAS BURNER- from 100,000 BTU to 199,999 BTU
(over 199,999 BTU see Fee Schedule)
7.00 $
7.00 $ Department of Buildings
4.00 $ City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
$12.00 $� specified agreeing to do all work in strict accordance with the City Codes
9.00 $ , and rulings of the Department of Buildings, and hereby declares that all the
7.00 $ facts and representations stated in this application are true and correct.
7.00 $ �
4.00 $ Fridley, Minn. _ /�%��/ � 19�
OWNER �/�-v.r ,�i%GN�
$12.00 S
4.00 $
7.00 $
6.00 $
S10.o0 $
10.00 $
$10.00 $ ,� � .
$
GAS FITTING FEES:
lst 3 Fixtures x$ 3.00
Additional Fixtures x $ 1..00
Gas Range to 199,000 BTU x$10.00
AIR CONDITIONING �� �" �/�
FAN HEATING SYSTEMS See Fee Sche ule
VENTILATING SYSTEMS
ALTERATIONS � REPAIRS
3tate Surcharge
TOTAL FEE
ROUGH INSP.
D9te
FINAL INSP. 1' � / ��
. Date
APPRpVAL FpR PERMIT -��
S_�_
$
$
$ //j �' �
$ ,,[_(L�
S
S
$ .50
s_3�, _S'D
KIND OF
USED AS
TO BE i."OMYI,�T�ll AtiVUT
ESTIMATED COST �, �
OLD 'NEW BUILDIN PERMIT NO. PERMZT NO. /�"i�
� . DESCRIPTION OF FURNACE/BURNER ,
HEATING or POWER PLANTS, Steam, Hot Water Warm AiY- o.
Trade Name Size No. � u- {� -���
Capacity Sq. Ft. EDR BTU �IlHP
����
Total Connected Load Kind of Fuel
BURNER - Trade Name� Size No.
REINSPEGTION FEE Capacity Sq. Ft. &DR BTU F1P
(.510. 00)
Company j_
, �
Signed By i ��
��iburt,ar� A►r Eor�lit.ioi�ing C.a, • Tel. rto. ��'y-� lo %� li
� 01� �Lnt�r Ur�vt.^ �5432
�;;�;;r,.�: �,:,�,lis, Pv;in�:.sota .
MINIMUM FEE FOR AN7l HEATING PERMIT IS $7.50 PLU� $.50 STATE SURCHAR6E
CITY OF FRIDLEY � .
APPLICaTION FOR PUIMBING AND GAS �I�'1'ING P�RMIT
a� �n v x• d Water
A y eh � ►�i �..[i my q� u p, w � Heater
�.�1 LN � �+ � ,M!� H ��C( u W 1oa .[S �� W iy Sd
p Q � 1J tll C. � N ••1 ;! O O � N J� N N N .�4"
vi c�i � w i� vi 3 c r� u"Gi w c.'tli w a 3 � � i� o as lec
r.,
' ' "' I i /
lst
2nd
3rd
4 th
(R) = Future Connection Openinq Connected with Sewer
(•) � New Fixture, Old Openinq Water
PARTIAL RATE SCHEDULE
PLUNBING FIXTURE RATES:
Number Fixtures
FUture Fixture Openinq
New F�.xture, Old Opening
Catch Sasin
Water Heater - to 99,000 81V
100,000 BTU to 199•000 BTU
Water Softenez
New Ground l3tn Old Huildirg
Slectric Water Heater
GAS FITTING FEES:
lst 3 iixtures
Additional Fixturea
Gas Rar►ge to 199, 000 BTtf
REPAIRS F, ALTERATIONS
First 5100.00
each add. $100.00 or iractiasi
N0.
�x
x
x
X
_� x
x
x
x
x
RATE
S3.p0
$2.00
$2.00 �
$5.00
55.00
S1U•00
$7.00
S5.00
$5.00
TOTAL
S ,.c:�;
$ 'c I
S
S
S 1 �'
$
$
$
S
x '53.00 $
x 51.00 $
x ST0.00 S
$5.0� $
52.00 $
8tate Surcharge $ .50
Taraw �E s 3�- S�
REINSPECTIpIQ ggE
(S10. 00)
,�--
Job Addresa
Department ot Buildinga
City of Fridley
Tel. #571-3450
�- � . . / .� �.` �
The undersiqned hereby m�kea application ior a permit !or the �+ork hereiu
speci�ied agreeing to do all aork in atrict accozdance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all
the facts an�epresentations stated in this applicati n are true and correct
i, < Fridley, Mn. __� , 19 � !
\ l
C. ���__-----
owrtEx �� ?`r2t / � A
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT
BSTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO. �
__�l /
Company l Y�-Ls--- --- ;� �
Signed Hy _.- � --� �
Tel. No. % � �'- `f 7� a��
R�S1G8 INSP.
Uate
' � —�1-7�i
F2NAL INSP. �/
' D3te
APPRO�VAL FOR PERMIT �������
MINIHUNI Pffi FOR ANY PLVM82NG PSRMI'P IS $y.SO pyvg �.SO STJITE SOR�lARGE
sue�ecT PERM NO
City of Fridley � 18914
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
f
; � REC .
� • COMMUNITY DEVELOPMENT D�V.
' � L _ c`
r � � PROTECTIVE INSPECTION SEC. � y�7 Z
1 , �
1
l---- �; '��,'� �CITY HALL FRIDLE� 55432 NUMBER . REV. DATE . PAGE OF APPROVED BY �
i J\ 6�2-571-3450 9t0-F15 4/30f87 / �
JOB ADDRESS 6181 Kerry Lane N. E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITtON SEE ATTACHED
DESCR. 2 2 Heather Hills 2nd T-,ddition SHEET
2 PROPERTV OWNER MAIL ADDRESS 21P PHONE
Donald Bxatt 6181 Kerry� Lane N.E. 571-6762
3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO.
5ame
4 ARCHITECT OR DESIGNER MAIL ADOF;ESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW � ADDITION O ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct an 18F x 15' Addition to Dwelling
9 CHANGE QF USE FROM TO
STIPULATIONS
5.ee notations: on plan�
��A����� ��� ,+� �:��:�:=
� -,� ,. :..
1(1Q, ��Li �4tia . .
�5 •` SEPAR�ITE P�'l��+I1TS REQUiRE� ��}1'�
a��g �.�
BefEPN�N� _ E.I.E��i 1�iG ° �.
��� . �,D $� 1��� 1NIRlN�, Hr /�rt1f�G, PLUMBING AN.D S1GN��
R��,11R
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZOtJING 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 OFFBTREET PARKING
I HEREBY CERTIFY THAT I HAVE REAO AND EXAMINEO THIS APPLICATION STA�LS GARAGES
AND KNOW THE SAME TO BE TFUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SUHTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S1 � 7SO $• 88
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OFi THE PERFORMANCE OF CONSTRUCTION. $Z9 . SO
PLAN CHECKFEE TOTALFEE
$30.38
� S�GNAT OF CON'RACTOR OFl AUTHOR12ED AGENT IDATEI WHEN PROPERLY LIDATED THIS IS YOUR P RMIT �
�<��i��/ / � � � � � F
r � A U
V
S�GNATUAE OF OWNERUF OWNER BUILDEA� IDATEI BLDG WSP Da7E
N� [] City of Fridley Effective 4/1/86
ADDN. [ � �R-1 AND R-2
pLTER. [ � Building Permit Application
Construction Address:��.,j �r '���-� �'A"N
Legal Deseription:
owner xame & Aadress: _ DaN � gRA � Tel. #��I- �Z�
Contraetor : D G nl A�(� � �2. /4 �"" Tel . # ,,.� �� `"�� 7 �
Address:_ � � �� �E•'p �' L� �
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
Attaeh to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to acale.
DESCRIPTION OF IMPROYEMEAIT
Length � Width _,�_ Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Corner Lot [] Inside Lot [}�' Ft. Yd. Setbaek Side Yard Setback�
Type of Construction: �vv � ��MF•- Estimated Cost: $ �'�
Approx. Completion Date: _ � .� t �.�'7
Alt. A Alt B
Proposed Driveway Width If Rew Opening Is Desired: $ � ,
See Back Page for Explanation
DATE: a0 Y7 APPLICANT: Tel .#`�'�— `7'��
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY IISE ONLY
$ • �v
$ ��
� ��
$
$
$
s `� 3g
Fee Schedule on Reverse Side
25� of Building Permit Fee
$.50/$1,000 Valuation
$ 525 Per SAC Unft
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�7 �
sb G � �n
._ .
4 I�1�•� ! l • �' �.--
�� ��
' '"'" ""'o"`_ � NC.�. a,[u+^�
CIiY QF FRIDLEY 1N5PECTlON DIV.
6431 University Ave NE
Fridiey, MN 55432 APP41CATiOf� FOR POWER PIJ�NTS AND HEATING, COOLING, VENTILATION,
572-3604 . REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
�ATE SCHEDULE
Residential
Furnace 5heil and Duct Work, Burner -
Aiso Repiacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace}
Gas Range
Gas Dryer
*Air Conditloning - All Sizes
AllOthers/Repairs & Alterations (L(ST ON BACI�
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
$ �0.00 $ p� av
$ 10.00 $ i0,, �v
$10.00 $
$10.00 $
$ 25.00 $
Effective On August 1, 1995
J08 ADDFlESS �o/Bi �,,,o�w�, �'o�iv,
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Divisian, and hereby declares that ali the facts and
representations stated in this application are true and correct.
� %Q .2� ,199�
OWNER �s�-� � v.,G�1�.e �.-�a� � 7/ � L 7 L Z
BUILDING USED AS ,C� /
ESTIMATED COST �33�7� o� PERMIT NO. �/�•���1
1? SCRIPTION OF FURNACE AND OR BURNER
$ No. of Heating Units � Circle One (Steam) (Hot Water) arm Air) „
Trade Name �.-�. Size No. ��
81'U �'O�pou HP EDR
$ Fuel^ 5�� � Total Connected Load
,
State Surcharge �.50 Burner 7rade Name Size No.
BTU HP EDR
TOTAL FEE �/0� STANDARD HEATING IIND AIR CONOITIONING Ctl.
4101NEST IAKE STREET
MINNEAPOUS, MN 55408-2998
HEATING COMPANY s�2-e2a-2sss
MiNIMUM FEE FOR ANY HEATING/COOLINGNENTILATION /j
REFRIGERATION/AtR CONDITIONING PERMIT IS $25 00 Signed By ��•-� � � Tet No.
PLUS THE $.50 STATE SUACHARGE , /�
REINSPECTION FEE $42.00/Hr
*Air Conditioners Can not be placed in a side yard without
written permission from adjoining property owner,
Approved By�� Rough-In Date Final Date
FILL OUT BACK SIDE F(�R STACK VERIFICA710N ON
REPLACEMENT FURNACE
410 W. LAKE ST. 1072 PAYNE AVE.
M I N N E APO L I S, M N 55408-2998 ST. PAU L, M N 55101-3892
612/824-2656 TING ANDAIRCONDITION1nGC 612/772-2449
Senin� TAe TwinCftier Siuce 1930'
ORSAT TEST RECORD
� � , ,
ADDRESS — � CITY �
OCGUPANT - , OWNER , - _
DAtE HTG, INST. /�—�,�y :�G INSTALLED BY�� ,/i��,��s ,z���
GAS` LINE BY
TYPE OF HEAT: GA FA HW STEAM SPACE HTR. UNIT NTR. OTHER
GAS DESIGN
MAKE � MAKE
MODEL .�. MODEL
S�RIAL��'����C�/�,�� MAX .
INPUT ��,��Y"`� ��(,r1s� MAKE
GONVERSION
OF BURNER
BTU RATING
OF FURNACE
CONTROI.S MODEL / _
ucnT n� �in �
THERMOSTAT � _ ��u ,._ � UENT SIZE ,-� �
VALVE KIND OF LINER SIZE N E�`
LI'MIT ' DRAFT HOOD RE�ULATOR �
LIMIT SETTING ����j� CHIMNEY CONSTRUCTION �//�' _
FAN SETTI NG ��� � DRAFT . �' ST TAG �,-,r��� _ �, `�
PILOT TYPE , S� LIG IN� rNST.
PILOT MAKE — _
:`PILOT MOO�L �
PILOT 7IMING �f�r�.�_L��;���: , l.r ��
PRESSURE�;����,.�- PERCE(�T CO2 � 1�. / DATE TESTED ��> ,� C�%
INPUT CFH C� PERCENT 02 /�
STACK TEMP. //7 PERCENT C0 �i NAME OF TESTEP.,, �� 2--�--�� �'.�'�-
__�•_Et-- �--� .
� % �.-
:;
. . . . ... . _. . .,: ..� .:.., ..�,;. .. �:. _.-:, ,. , - .. . , . � . . . . ...
sue�ecT PERMIT NO.
City of Fridley � ? �� � .��1 �`
AT THE TOP OF THE TWINS g U� L D I N G P E R M I T
r
; � RECEIPT NO.
� COMMUNITY DEVELOPMENT DIV.
i by'�'���',
r � � PROTECTIVE INSPECTION SEC. /�/ �
i �
� �
� � �"'1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF pPPROVED Bv
�'"""�"� ,'' 612-571-3450 910-F t 5 4/ 1/ 9 7 / /
JOB ADDRESS 6181 Kerry Lane NE
1 LEGAL LOT NQ. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 2 2 Heather Hills 2nd Addition SHEET
2 PROPERTV OWNER MAII ADDRESS ZIP PMONE
Donald Bratt 6181 Kerry Lane NE 571-6762
3 CONTRACTOR MAIL ADORESS Z�P PMONE UCENSE NO.
Richard Hastings Co 6331 Riverview Terrace NE, Fridle 55432 574-9966 4051
4 ARCHITECT OF DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW ❑ ADDITION p ALTERATION �1 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
�� Reroof House & Garage (28 Sq) 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS AFE REOUIRED FOR EIECTRICAL, PLUMBING, HEATINC�,
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTEF WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STAL�S GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1] ,87
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR GANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR L.00AL LAW REGUTATING CON-
S7RUCTION OR THE PERFORMANCE OF CONSTRUCTION �SG.75 Fire SC �L.7�F
� PLAN CHECK FEE TOTAL FEE
�� l L SC .00 b4.36
S�GNA�UAEOFCON'RACTOAO AUTHOA�ZEOAGENT IDATEI N ERLY V LIDATED THIS IS V R�EFl T
%
r �
SiGNATUFlE OF OWNEA��F OWNEA BU�LDEFlI 1DATE� � '' � �, 1 57 f�41E
NEW
ADDN
ALTER
��
Ll
[l
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 6 � �' / l<<= � iZ �y � �
Legal Description:
Effective 1 / 1/97
�i3/ �
Owner Name & Address: Jo�✓�C �3� � TT Tel. # S �� —� 7�Z
Contractor: %Z � c�, �,� � f�A S�' i M G S MN LICENSE #�o S%
Address: � ,� ,3 j iz ; � � p � � ; L � %',E R Tel. # ,S? �,/ — -�t 96.6
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
� :i �
Length
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width Height
Width Height
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
�,�1� C����z ��
Construction Type: �� Z a�, F Z. � Sy e Estimated Cost: $ 1.� �,
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � i� 7 APPLICANT: (���/-�R� ---- __ Tel. # 5� y- i�66
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� ��-��"
� 1- �
� .87
$
$ �. UD
$
$
$
$
$ �- . .��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1110th%)
$.50/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
� ��
✓
sue�ecr PERMIT NO.
City of Fridley 32300
AT TME TOP OF TME TWINS g �� L D! N G P E R M I T
r
� ` R�CEIPT NO.
� • COMMUNITY DEVELOPNiENT DIV. / � -,��
� � y � PFOTECTIVE INSPECTION SEC. ��
r � , 1!! �i
� . ,
� � �"'1 � CI7Y NAlL FRIOIE� SS�12 NuMBEP REV O�TE v�GE Oi •PanOVED Br
�'"""�" �'' 612-571--3450 9t0-Ft5 11/5/O1 / /
108 AODRESS 6181 Kerry Lane -
t LEGAL �OT N�. BLOCK 7RACT Oq ADDITION SEE ATTACMED
OESCR. 2 2 �ffa��ax Heather Hills 2nd Addition SHEET
2 PROPEFiTY OWNER MA�L ADpRES$ 21P PHONE
Linda Winn, 6181 Kerry Lane, Fridley, MN 55432 763-574-2588
3 CONTFACTOF MAIt ADDRESS ZIP VHONE UCENSE NO
Renewal by Andersen, 350 73rd Ave, Fridle , MN 55432 763-502-4777
a AaCHITECT OR DESIGNER MAIL AOORESS IIP PMONE UCENSE NO.
MN20130983
5 ENGINEER MAII AQOFiESS ZIP PkONF UCENSE NO
6 USE OF BUIIDING
Dwelling -
7 C�ASS OF WORK
� NEW ❑ ADDITION O ALTERATION O REPAIR ❑ MOVE • O REMOVE
8 DESCRIBE WONK
%��� Replace one patio door within existing opening.
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all Ievels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk
and flash all exterior openings
Permit �ns��C��on Cards
Will Be Mailed $t
To HomeOWner To Po
" TYP� OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIpEO fOF EIECTRICAL, PLUMBING, HEATING,
VENTI�ATING Oii AIR CONOITIONING. - � � ' � � �
THIS PERMIT BECOMES NULL ANp VOID IF WORK OR CONSTRUCTION ZpNING SO. FT CU iT.
AUTMORIZEO IS NOT GOMMENCED WI7H�N 60 DAYS. OR IF CONSTRUCTION �
OR WORK t5 SUSPENDED OR ABANQONEO fpii A PERIOD Of 120 OAVS A7
ANV TIME AFTER WORK IS COMMENCED. ` NO DWLG. UNITS OFFSTREET PARKING
� HEAEBY CERTIFY 7HAT I MAVE READ AND EXAMINED TMIS APPLICA710N STA��S GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. All PROVISIONS Of LAWS VAWATION SURTAX
ANO ORDINANCES GOVERNING THIS TVPE OF WORK WI�L BE C(JMP�IED $2 8�3.00 �1.44
WITM WNETHER SPECIFIEO MEREIN OA NOT. TME GRANTtNG Of A PEAM17 �
DOES NOT PRESUME TO GIVE AUTMORITY TO VtOIATE Oii CANCEL THE pEqMIT FEE SAC CNApGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW qEGULATING CON-
S7RUCTION OR TME VERFOFtMANCE OF CONSTiiUC710N �83.25 Fire SC �2.$%
PLAN CMECK FEE TOTA� f EE
L c se . 00 $I�BX8�5 $92 . 56
S�cN�tuQE o� CONCFA(;iQii OR AUTwQq�ZED AGEN1 IOATE� M ROPERL� VAUOATED TMIS IS VOUp PER IT
� � O
S�GHaiUAEO�OWtiEQ�iFOWNENeU�LDEA� ��ATEi � ' BL �N50 � - �6lE
NE� [ l
ADDN
ALT�R
Effective SI10/99
[ l �� oF ���
[ 3 S�G� FAid�,3� � iJUPi.E�E,S R-� AlaiID �-2
BUILDING PERNIIT APPLICA�TON
: onstiuction Address:
V
Legal Description: '
Owner Name & Address : ' ' � �' Tel. #� � • � �
Contractor: . Renewal By Andersen �j j;j��jSE #
350-73rd Ave. NE
Address: Fridley, MN 55432 Tel. #
763-502-4777
� #MN20130983 ►urvey of the �
lc_, .. _� �_ r...�.,,�.,,. „��,,�u���,r uaawu JII lt t0 SCa1C.
DESC�I.flN OF ��iU�EMENT . � �
LNING AREA: Length
GARAGE AREA: Length
DECK AREA: Length
� .� .
Construction Type:
Width Height Sq. Ft.
Width Height Sq. Ft.
Vi�idtli � Hgt/Ground Sq. Ft.
Driveway C�rb C�t W idtli Needed:
��� �� . _r-:.��.z��. � �fi�i7
Ft. + b Ft =_ Ft x$,
_$ -
' � �. � ' ' /I� 1. ��. � � �► � �i�• A►� � �
.
Permit Fee
Fire Surcl�arge
State Surcharge
SAC Charge
Licsnse Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Chazge
TOTAL
STTPULATIONS:
$ �3.aS
$ a.
$ • �i�i
$
$ S+ ��
$
$
$
$
� q � ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Psrmit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State L�censed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.� Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
..
CITY OF FRIDLEY INSPECTION DIViSION � �
6431 University Ave NE �
Fridley� MN 55432 APPLICAT{ON FOR POWER PLANTS AND HEATING, COOLING, VENTILATION�
572-3604 REFRIGERATION AND AIR COND1710NING SYSTEMS AND DEViCES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner •
Also Replacement Furnace
(Side Vent • Fill Out Back)
Gas Piping (Needed with new furnace�
but not replacement)
Gas Range �
Gas Dryer� �
Rate TOTAL
$ 30.00 $
$ 10.00 $
$ 10.00
�, I 1�1
` �Air Conditioning - All Sizes $ 25.00
All Others/Repai'rs & Aiteraiions (IIST ON BACK)
l°Jo of Value of Appliance or Work
Commercial/Industrial
� 1.25�, of Value of Appliance or W�rk
� �_ � State Surcharge
.. =� � � TOTAL FEE
. �-.,; ,
.., =s , . .•:�: . .
MINIMUM FEE FOR ANY�HEATING/CQOLING/VENTILATION
REFRIGERATION/AIR CONDFTIONING PERMIT IS $25.00
PLUS THE 5.50 STATE SURCHARGE
REINSPECTfON FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effective On May 10, 1999
JOB ADORESS ��� ��������
OWNER /�v� 1.U� w�
BUILDING USED AS..�J�l��� - - o -
ESTIMATED COST � Sd8 �— _- _- _ PERMIT N0. �" �' � �
DESCRIPTION OF FURNACE AND OR BURNER
$ �
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
$ Trade Name Size No.
; BTU HP EDR
$� Fuel Total Connected Load
$
$
�
$�
Burner Trade Name Size No.
BTU HP EDR
The undersigned hereby makes application for a permit for the work herein
speci�ed agreeing to do atl work in strict accordance with the City Codes an
rulings of the Building Division. and hereby declares that all the facts and
representations stated in this application are�true and correct.
HEATING CO '�'�. � ��
.�
Signed DATE
Approved By Rough-In Date Final Date �' �� �
f
CHIlI�INEY AND..ST�►CK VERg'ICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined � Yes () No ()
2. Is free. from rust or deterioration . '. Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4. Is securely supported � � �
5.
�
Meets all current Code requirements for size
and total BTU's connected
Has total heating BTU's of
All other BTU's
TOTAL BTU's
Yes().No()
Yes ( ) No ( )
7. Has a liner been provided for water heater Yes () No ()
8. Has combustion air been provided for water heater . Yes O No O
Remarks: �
_ O . --�--/' .�%1�,. _�
List ALTERATIONS BeinQ Done•
HEATING CO:
Signed By:
Date:
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