AF - 47936sue�ecr PER O.
City of Fridley ° 14195 ,
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECE T NO.
� ; L _ COMMUNITY DEVELOPMENT DIV.
{ � � PROTECTIVE INSPECTION SEC. �,;3
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�� � /'��1 � CI7Y HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPHOVED BY
----� � �'� 612-560-3450 910-F15 � �
7/5/77
JOB ADDRESS
6267 Kerr Lane
1 IEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. [F 3 Heather Hills SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Gar Anita Ob cki 571 Laf ette Street NE
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Richard W. Lennox 16120 Potowat�mi NW 784-9730
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
House and Gara e
7 CLASS OF WORK � NEW O ADDITION ❑ ALT��TI� � MOVE �❑ REMOVE
� �S.
8 OESCRtBE WORK (�'� 1OUT�')NS . � �,�yA�N�
Same �tYli DATA i� l�O� Mqrpy�
R �p � � �O�MA110N
�N � �fR �
9 CHANGE QF USE FROM
�`�'�11ItT5 RE��O i� WIRtNG,
STIPULATIO�a��, ►�;V1��NG aN 7 . �% D , NG•
�v, r�oun�o FOR Utt�
1. ver�fying survey .•��-�Ef irEAAQI/AL AND REPUCE ENi
�"` 2. provide sod in front and side yards � l�►T �:�H/1�1Y OPEN NGS.
3. provide a ha.rd surfaced driveway
• SEWER LOCATION (approximately 9.5' deep in street)
SS escrow $348.76 17' SE of Mnhl. (Inv. 923.70)
WYE Elev. - 923.17
��N� Top of footing - 926.50 (minimum)
8afore di�n6 c�N 10� ����ES WATER LOCATION 10' NW of Sewer Service.
'�� -.�IECIRiC • GAS Etc.
D/W Depression Cost: N/A Existing Surmountable Cur ing
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. Hpjne B].d .
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 1 894 32 980
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SUFiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT y$�FZ OUO.00 Zl. C)2
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ]„31.9L � 375.00
.�a=:
PLAN CHECK FEE TOTAL FEE
2
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI N�IH N PROPERLY V LID D TNIS IS Y UR PERM IT
Si NATURE FOWN IIFOWNER UILDERI IDA I P " BLDG INSP � �� ��
Surveyors ����ifac�t�
COi�1STOCK & DAViS, 1NC. Consulting Engineers andLand Surveyors
1446 County Road J, Mpls., b�inn. 55432, 784-9346
LOT SURVEY:
Lut 4, B�.ock 3,
Heather Hills,
Fridley, rlinnesota
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SUP.VEY FOR:
Gary Qbrycki
571 La£ayette Street N.E.
Fridley, Minnesota
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LEGAL DESCRIPTION:
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�y� G^_ V'o_' 6L. G'�
7 J
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---- rihr>'�rgrov�d Ufi/ f y eASe�e�f
:-
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TH� CtiY QF Fi�DLEY D4ES N0T GItARANfiEE TH�
ACCUti►CY �f t1T�LI1Y LOCA'114NS AND EtEYAT10N5.
�NIS DAiA 15 fOR tNFORAAATtQN �URrOSES ON�.Y ANi�
rERSONS USWG R SHOUtD V�tFY, i'HE Q�O�DM%fOti
oN n�e s►tee:
.
Lot 4, Block 3, HEATHER HILLS, Anoka County, Minnesota. ������
� Before diggin� caN lot;�l utilities
• �~ = so' TELEPHO�IE - ELECTRIC - GAS Ete.
de�ofes ��'an /rio�ume�� �ov�c� REQUIRED BY LA V�
de�ofes ��o� rr�onu�er�f se�
I hereby certify tliat this survey, plan or report was prepared by me or under my direct
supervision and that I am a duly Registered Land Surveyor under the laws of the State
of Minnesota. �
�_ /083,Z / /� �� .�7�.�
Reg. No. Date• Job No.
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APf'LIC/1TIOIJ FU12 RESIDEP�1'I1�L I�UILDING !'ERI��ITS, ��'� ,
�;
��'�EH', ALTERAfiIONS, AnDITIONS, OR IZEPAIRS)
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Street:
I3UILllER:
Address:
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Tel . No . . � �-- 3� '-
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BLOCK: � ADDITION: L ��,(��,GIliS � �����,0
,�J /O - �iv-� -a,�alo
COF�I.JER LOT: INSIllL' LOT: � SLTF3ACK: /� SID�YARDS: ,,,.:/
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Applicant attach to this form 7.tao Certificates of Survey of Lot and propo�ed
building location drawn on these Certificates.
To Be Used As:
DESCRI PTION OF BUI LDI f�G
L/ �f l � ��
Front: � � 7 �� epth:3lj i' ��Height:
Square Feet: ��'7 Cubic E'eet: v��o �JD
� _ ,..,j 8
__ Front: '`% Depth: �C) Height: � �d
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Square Feet: �� v Cubic Feet: ���('
Type of Construction: ` Estimated Cost: $ '�I �jQ(�• Ov
---�-
To Be Completed: ��� �� l �7
�-- Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired ��Q $� $
� (SE�F.RSE SIDE OF SHEET)
The nndersigned hereby makes application for a permit for the work herein
specified, agreeing to do a11 work in strict accordance with the City of
F�cidley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and represeiitatioiis stated in t}Zis application
are true and correct. See reverse side for additional information. �
n�1TE: e�,� � %� 5IGNATUP.E:
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70P CM6SiD uvc g0 rsR LUMB6R SPHCIFICATIONS
oewo /� ►ar i Tor cMOao 2� f� a du G F 1 � i
. � 6UTTOM GliORD OEAD �Q P!R � SOTTOM CNORO _� X� .��..JOUGI F � �
. TOTAL DESIGN LOAD b Ci P3/ � W�.� - 2,�q �-a.bUG �► 2# 3
'� 7RU55 CENTERS Z'0 FT, j
' UNIT STR[SS LUMBER �J % I � .
:..__.._ --..
� INCR[ASE ruT6i S �
. . / °�i � rLAT6 fl111ES , 6A6S' 8 �
PANl1. POINT LOADS . AXUL FORCES �-
2�? �S Z G �
3
RATING
2ZU
4�' gRh
� 2v
60l
� 56v
S
1
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8��
4xQy2 �
2o3z2'19 �9'�"
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i LUMBERMATE COMPANY
�j-Z � SAINT LOUIf. MIfBOURi
r7 R T � TF113 OES16K SUGGESTI�l1 t3 INTENDED FOR USE BY tNE 6UtLD.
I( SO lO SO l2 �� pEg16NS.M� Np RAESPON B'ILITY IS ASSUM pTf�t TNE�ptECTI0t1,
��SO lOSO :Z.So 4 D�ESI6NSBl4SED ON CRBTERIAESTABLISHED BY E TRUSSE PLATE
vU Q7S `101j ! �N371TUTE AND "NDS" BY THE NATIOIW, FOREST PkODUCTS
� ASSOCIATION.
� CUT MEMBERS TO BEAR. LATERALLY St1PPORT CHORDS.
'LUMBERMATE TRUSS PLATES OF GALYJINIZED STEEI ARE INDi-
CATED BY 6AGE ANO SIZE. PRESS PIATES SECISitfLY ON HOTH
r; wrs�rt no, __ � SIDES OF 101NT3. CENTER PLATES ON JOINTS UNLESS NOTED.
C6R�tNUOUS LATERAL BRA�i
REQU�RED AS SH4WAi
No7E� T,�u55 HAS 3 F3EA2iNfi.S
i3'-o"
� Ec� A,o N r-c.5
/84x 4yz
�Q,��'�y C� �eFcti�'�.
�;' REGISTERED �:��
; PROfESS1�PdAt :
� ENGIidEER ;
v'� ;. PE. �S399 �� Q.
. • �c.
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CITY OF FRIDLEY
pPPLICQTION FOR PUJMBIN6 AND �AS �I�TING p�ti�12T
e� >. en � u x• m Water
a�r L .-�i � m H�� � � y qg y� �,Q', w � Heater
f�.r Q1 a�l q •.�i q .0 � C 3 � �.�i 6� � U � N ..
� .°� � ro y � ro��+ o.°e g ro ro y b ro y � �
v� u a w i� •vi 3 o w v� w c� m� 3 c� � c� o as lec
- f
�st � �' :
2nd
3rd
atn
(R) � F�ture Connection Opening Connected with Sewer
(") = New r^ixture, Old Opening Water
PARTIAL RATE SCHEDULE
PLUMBIl�G FIXTURE RATES
Number Fixtures
Puture Fixture Openinq
New Fixture, Old Openinq
Catch Sasin
Watez Heater - to 99,000 BTU
100,000 BTU to 199,000 BTU
Water Softener
New Groun3 1�n Old Buildinq
Electric Water Heater
GAS FITTING FEES:
lst 3 fixtures
Additional Fix tures
Gas Ranqe to 199,000 BTU
REPAIRS F� ALTERATIONS
Fizst $100.00
each add. $100.00 or fzaction
N0.
�x
x
x
x
_L Y
x
x
x
x
f x
x
Y
State Surcharge
TOTAL FEE
RExNSPECTZON FEE
($10.00)
RATE
S3.Q0
$2.00
S2.00 �
55.00
$5.00
S10.00
$7.00
$5.00
$5.00
TOTAL
S_ ���(�
S
$
S
$ ��.L
S
S
S
S
'$3.00 $ �'�
$1.00 $ _
510.00 $
Ss.00 S
52.00 $
$ .50
S � �. V
Job Address � �p l � / / `Q�/ji/ .L���c✓
Department of Suildinqs
City of Fridley .
Tel. #571-3450
The undersigned hereby me�kes application Por a permit for the work herein
specified agreeinq to do all work in strict accosdance aith the City Codes
and rulings of the Department of Buildinqs, and hezeby declares that all
the facts and representations stated in this application are tzue and correct
Fridley, Mn. � ' � � , i9 T�
owc�x D +`
ICIND OF BUILDING J�""���- p
�
USED AS .�3/��- � �e=�1„r-�C-C�iC_
TO BE COMPLETED ABOUT "�—
ESTIMATED COST
OLD -�UILDING PERMIT NO. PERM=T NO. /� S /
�m�ny G2�.�+�--/
Signed Sy
Tel. No. �o� � � � � �l /
ROUGH INSP.
Date
FINAL INSP. � �- � ,z - % 7
� Ddte
APPR011AL FOR PERMIT ��%����-
MINIMUM Fffi FOR ANY PLVMSING lERM2T IS $7.50 gypg $�SO $TATS SU�E
.
,
� . i
K. E. ENGINEERS, INC.
CONSULTING ENGINEERS
11000 CENTRAL AVENUE N. E.( HIGHWAY 65)� MINNEAPOLIS, MINNESOTA 55434 � TEL. (612) 757 • 5830
KARIM EBMAILZADEX P. E. �
PRE8IDENT ---
October 24, 1977
Heat Loss Calculation for Gary Obrycki Residence:
U Wall = .17
U Ceiling = .05
U Window = .5f
U Perimeter = .p9-
U Door = .65
Net tiVall Area = 2324 Ft.2
Net Glass Area = 224 Ft.2
Net Building Underground Wa11 = 576 Ft.2
Net Roof = 216Q Ft.2
Net Door = 63 Ft.2
A t = 90°F
Q=UABT
Q Wall =.17 x 2324 x 90 = 3555.7
Q Glass =.56 x 224 x 9Q = 11289
Q Underground Niall =.U9 x 576 x 9� = 4665
Q Roof =, 0 5 x 2160 x�Q = 9 720
Q Door =.65 x 63 x 90 = 3685
Total Heat Loss = 64916 BTU/Hr.
�� � �
---_.__� ___-.__-----
Karim Esmai�zadeh, �. .
K.E. ENGINEERS, INC.
�
CiTY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATIN�, COO�ING, VENTILATION, REFRIGERATION AND
.AIR CONDITIONING $YSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL Job Address (/'�� �/�/�� L�/t✓�
Furnace Shell & Duct Work 512.00 S ,
Replacement of Flirnace 7.00 $
Repairs & Alterations-up to $500.00 7•OU S Department of Buildings
4.00 $ City of Fridley
Repairs & Alterations each add. $500.00 Tel. #571-3450
MECHANICAL WARM AIR:
Furnace Shell & Duct Work to 100,000 STU
each add. 50,000 BTU
Replacement of Furnace
Repairs & Alterations-up to $500.00
Repairs & Alterations each add. $500.00
STEAM OR HOT WATER SYSTEM:
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNER- to 3 gal. per hour
each add. 3 gal. per hour
GAS BURNE R- from 100,000 BTU to 199,999 BTU
(over 199,999 BTU see Fee Schedule)
$12.00
4.00
7.00
7.00
4.00
$12.00
4.00
7.00
6.00
S10.00
10.00
$10.00
GAS FITTING FEES:
lst 3 Fixtures x$ 3.00
Additional Fixtures x $ 1.00
Gas Range ko 199,000 BTU x$10.00
AIR CONDITIONING �
FAN HEATING SYSTEMS see Fee Schedule
VENTILATING SYSTEMS
ALTERATIONS $ REPAIRS
State Surcharge
R�UGH INSP.
Ddte
FINAL INSP.
Date
14PP1�OVAL FOR PERMIT /�
TOTAL FEE
RLiNSPECTION FEE
($10.00)
The undersigned hereby makes application for a pexmi.t for the work herein
$��•U d specified aqreeing to do all work in strict accordance with the City Codes •.
$�.vo and rulings of the Department of Buildings, and hereby declares that all the
$ facts and representations stated in this application are true and correct.
S
$ Fridley, Minn. �_/�'�_�� , 19 ��
�,�R �A,e r ���2y�i�,°
$ KIND OF BUILDING /,�/A�i� 0�1 r �'A� G�Pi�
S I % 9�
$ USED AS f ��/�'1; ` r /Jld�� �l; �'! �l — - - - — --
$ F�� a f ,uo Ue�, b� ��'»
TO BE COMPLETED ASO�IT �
$ p _
$ ESTIMATED COST �OOO. ��
$ iv.vo OLD �NEW �B LDING PERMIT NO. PERMIT NO. �� h-���
$ `�...�`'__
s �.Ud.
S
S
S
$
$ � .Q�
S
S ��.5�
MINIMUM FEE FOR ANY HEF�TING PERMTT IS $7.50 pLUS $.50 STATE SURCfiARGE
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name Di��/C��l �C�Yf%� Size No. �fLT/'i —/yQ /f
Capacity Sq. Ft. EDR BTU O dUO FIP �
Total �nnected Load Kind of Fuel �Jl�%y,�AC �TAS
BURNER - Trade Name � o�ef/,/%� �0 //q` Size No. �
Capacity Sq. Ft. EDR BTU HP
O
ComP+�Y
Siqned By � S� C��/r/�/�� (�O� ��
Tel. No. S/�' ��� /
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C��'Y Q� F��L:�LEY
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MtNNESOTA 55432
TELEPHONE ( 612)57i-3450
� �
f
September 22, 1977
� Mr. & Mrs. Gary Obrycki
571 Lafayette Street N.E.
Fridley. Mn. 55432
Re: 6267 Kerry Lane N.E.
Dear Mr. & Mrs. Qhrycki;
An inspection of the above house for framing was shown to be deficient in
the iollowing areas; .
1. Nail exterior built-rite sheathing 3 inches on center on the edqes.
2. Add one stud T1 feet from west end of north walkout wall.
3. Provide permanent approved support for west end of I-beam.
E 4.. Provide registerec� surveyor's drawing of �ahere house is located on
the lot (called "verifying survey").
5. Pravide truss design from truss supplier.
We will expect to be notified for a reinspection of the hause when
items 1 and 2 have been campleted. Items 3, 4 and 5 must be taken care
of by October 20, 1977. If yau have any questions, please contact me
at 571-3450.
Sincerely,
ROtd HOLDEN
Building Inspector
RH/mh
CC: Mr. Richard W. Lennox
16120 Potowatomi N.W.
Anoka, Mn. 55303
, � C�"T'Y C'�� IFF��C�l��Y
�1 8431 UNIVERSITY AVENUE N.E., FRtDLEY, MINNESOTA 55432
TELEPHQNE ( 612)571-3450
Dec�nbex I9. 1977
Mr. Gary Obrycki
6267 Kerry Lane N.E.
Fridtey, Mn. 55432
Re: Final Inspection at 6267 Kerry Lane N.E.
Dear Mr. Obrycki: :
A final inspection was made on December 16, 1977 af the above address a.r�d
the following items were noted which must be completed before the st�uctnre
can be f inaled out;
1. Provide sod in the front and side yards by June 9, 1978. ,
2. Provide house numbers by January 3, 1978.
3. Provide frost footings for deck by June 9, 1978. �
4. Prodide I-beam "permanent" support by January 3, 1978. .
5. Provide approval by Gas Company or replace wood-gas "Oneida" furnace . .
by January 3. 1978.
6. Lower stair handrail by January 3, 1978.
. 7. Handrail to den should be completed by January 3, 1978.:
We wiZl expect the above items to be completed by the scheduled dates when
reinspections will be conducted"ta determine campliance.
If you have any c�uestions on these items, please contact me at 571-3450.
Sincerely,
1
RON HOLDEN
Building Inspector
RH/mh
���
. `` ��' ,�
f , I ' �;�� �f
F�K �. N _. �_ � ��
,�t J � ���_.�. ..r,.��f�x
f �
; �r 1���, ,r' ,a
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,
, � ���, fr�Y�.
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June 28, 1978
� � � ��:'
Y�
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a .
6431 UPIIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
Mr. Gary Obrycki
`` 6267 Kerry Lane N.E.
Fridley, MN 55432
Re: Final Inspection at 6267 Kerry Lane N.E.
Dear Mr. Obrycki:
TELEpHONE ( 612)571-3450
0
A final reinspection was made on June 9, 1978 of the above address and
the following items were noted which must he completed before the
structure can be finaled out;
1. Provide sod in the front and side yards by July 31, 1978.
2. Provide deck posts by July 31, 1978.
3. Provide approval by the Gas Company or replace wood-gas "Oneida"
furnace by July 31, 1978.
We will expect these items tA be completed by July 31, 1978 when a
reinspection will be made to determine compliance. If you have any
questions on these items, please contact me at 571-3450.
Sincerely,
RON HOLDEN
Building Inspector
RH/mh
SUBJECT PE �
City of Fridley _ 16 313
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r
; � EIPT NO.
� ' COMMUNITY DEVEIOPMENT DIV.
� �y_""'- � T�
r j � PROTECTIVE INSPECTION SEC.
� �
i
� � �"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF qPPROVEO BY �.
�'"""�� ,�' 612-571-3450 910-F15
7/31/81 � �
JOB ADDRESS 6267 Kerry Lane N.E.
1 LEGAL �OT NO. BLOCK TRACT OFi ADDITION SEE ATTACHED
DESCR. t� 3 Heather H1�.15 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ga.ry Obrycki 6267 Kerry Lane N.E. 574-9007
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LfCENSE NO.
Sd1R�
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO.
6 USE Of BUfLDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION p REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
Add bas�aent stora e area under ara e
9 CHANGEOFUSEFROM TO
STIPULATIONS
waR����
�eforo di�in� caN locai utilities
TELEPHONE • ELECTRIC • GAS Etc.
REQUiRED Bl' l�IV�I
SEPf RATE PER(�1TS REQUIRED FOR �ItiRING,
HEATI(V�, PL.U�IgING AND StGN�.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING 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 OFFS7REET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ], STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND COARECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI 8E COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT yi4�OOO $2.00
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. Z4.00
PLAN CHECK FEE TOTAL FEE
r-.
$26. 00
�NATUF7EOFCON'R O o.nutHO ZEDAGENT IDAT i WHEN PROPERLY VA IDATED THIS IS YOUR PERMIT
° � 3 / ��. C'�� � �� ,�/
SiGNATU OFOWN IIFOWN BUILOEAI IDATEI B�DG WS� DATE
CITY 0� FRIQLEY
Af PLIC/1TIt�:J FOft P,kSIDEi�TI/ti_ BUILDIi1G PEfZ`jTTS
(tde��r, Aller•�tions, Additions, or Repairs)
,4� v U �/%�-i�
01�J(dER: �[H✓� __v%�J(/� / �� [3UILDER: -
ADDRESS: ��� �c,°�'� G-�NC° �DDRESS:
TCL �v0: � 7 Yr- ,�'O �� '� TEL IdO:
Consi:ruction Location
� STItI�T NO : �� / STREET: / 1 �L� � _ L%f y�
L07': � BLOCK: -✓ ADDITION: ��f/-%1`k°r� 77`%�//-S
Corner Lot: Inside Lot: Setback: Sideyards:
Ap�licant attach to tliis form two Certificates af Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOtt OF COt•�STRUCTIOPd
I'ront: Depth : Height:
Square.Feets
Front:
Ciibic Feet:
Depth : Height:
Squar.e� Fee�: Cubic I'eet:
��� g�s� h, PA, �- sro,��� e - �
�d �'�► � /��P . ° "
Type of Construction : EstimaL-ed Cost: $ dd �.
�.b $e Oor,�pleted: �f/ �� �� �/
�
Alt. A Alt. B
Proposed Drive��ay Width If New Opening Is Aesired: $ $
. , SE� R�VERSE SIDE OF SHEET .
�'iie undexsigned hereby make� applicaticn for a permit fcr the t:�ork herein specified,
agreeing to e�o ,all work iz� strict accordance rrith the City of Pridley Ordivances znd
rulings of L-he Departrneizt of Buildings, and hereby declares that all the facts and
representations stated :n this application are true and correct.
DI:T� : �� S ZGNRTU i2E :
SLiF�ulati ns :
� a� Qd
a��
� D �
• • � w
a
sue�ecr PERMIT NO.
City of Fridley 2 0 6 0�
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T --`�
� � RECEIPT NO.
� � COMMUNITY DEVELOPMENT DIV.
; �,;---- 37y�7
r � � PROTECTIVE INSPECTION SEC.
� � /"'1 � CITY HALL FRIDLEV 55432 NUMBEF REV. OATE �AGE Oi APPROVEO BV
�""'~'� �'' 612-571-3450 9�0-Ft5 9/27/9Q � �
JOB ADDRESS 6267 Kexry Lane N.E.
1 LEGAL LOT NO. BLOCK TRACT OR AQDITION SEE ATTACHED
DESCR. 4 3 Heather Hills SHEET
2 PROPERTV OWNER
MAIL AODRESS ZIP PHONE
Gary Obrycki 6267 Kerry Lane N,E. 574-�007
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW C� ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 16� x 14� �oxch_a,nd a 16� x l0� De_ck Additi4n
9 CHANGEOFUSEFROM TO
STtPULATIONS
See notations on plan. Variance on arear yaxd appx'oyed to 20 �eet on
September 25, 199.0,
V�ARNIHG
Before digging call for
all utility locations
SEP�kATE PERMITS REQt�IRED FQR 4g�-0002
WIR(NG, HEATING, PLUMBING AND SIGNS. REQUIRED BY LAW
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OA CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERT�FV THAT i MAVE READ AND EXAMINED THIS APPLICATION �- STALLS GAFiAGES
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 $6r450 $3e2,�.
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 OP ANY OTHER STATE OR LOCA� LAW REGULATING CON- $90.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
Fire SC $6.45 $�9.F8
S�GNAT E OF CONTRACT R O AUTHOAIZED GENT IDATEI /WH PROPERL HIS �IS YOUR PEP IT
� C,� p �=�� ; �
i NATUREOF NERUFOWNERBUILDER� iDATEI LDG �NSP � �aTE
� Ll
�nrr �
AI�TER � ]
R-1 AND R-2
Buildir�g Permit Applicatioai
Effective 8/16/90
Construction Address : �j � '�j � �� �j�' ��y�
� n�iPti�: � c�T /, ,��oc% 3, IYe�Th`eiP f��LGs
� � & �: ��,eY ���Y���' �. # S7f' P�7
Qontractor: C�/�iPY (��i�YC /�i � Te1. # S7f' i'c� �
�a�: �'��� �e,e�Y ��,�
Attach to this application, a Certificate of Suivey of the
lot, with tt�e prq�osed vo�ctiaa� drawn oaz it to scale.
D�'SCItiPTI�1 OF Il�O�VII�TP
LIVIIJG AREA: Lesigth �-b � Width �� Height �_ Sq. Ft. .�._
GAT�GE AREA: TpT�h Width Heic�it Sq. Ft. n'�
D�7CR AREA: � Lerigth � Width _/D , Hgt/Grau�d _� Sq. Ft. �O ���'+ L 21(
o�: 3 — se.�so � �o�� h�
�zy� z►,�� L��, �� a-�'Zi i X�,�� t i s3�.� �� �'-b?6.�
Corner Ipt [) Inside L�t [v]' Ft. Yd Setbac,Jc Side Yarci Setbac.xs
Type of Construction: Res;a�e.vT%�� i��a i�T v�timated Oost: $ 6 SOo, o`�
Approx. �g�letion Date: .p eC /� / 9 9v (p , 0
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
' ',�T� "
� � r
P�ermit Fee $ �D, E�O
Fire Suml�arge $ (o , 5
state svrcharge $ 3 �013
SAC Charge $
Driveway Escrow $
Park Fee $
sewer Main Charge $
. v�
SPIPtTlATIONS :
$ �•
Width + 6' See Back Page
' �el. # S7y —900 7
crl�t � a�Y �
Fee sc3�eaule o� Reverse siae
.001 x P+ermit Valuatio� (1/lOth �)
S.5o/S1,000 valuatio�
$600 per' SAC Unit
Alt. "A" or Alt. "B" AUave
Fee Deteratined by �gineerir�g
Agra�e,nt NeoessarY [ � rTdt NeoessaYY [ ]
1 . G'
.
R�'i'�'�'` Qoo�M �l'�' �h �.� G�9Tl�
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CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2001
6431 University Ave NE `
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763-572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
�` JOB ADDRESS �v a � `7 %����7 �.��
RATE SCHEDULE
Residential
Furnace Shell and Duct Vllork, Burner -
Also Replacement Furnace
(Side Vent • Fifl Out` Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer �
Rate
$ 30.00
$ 10.00
OWNER �Ni %�2/�l��¢-
TOTAL
BUILDING USED AS ���
$ � ! , �,
= ESTIMATED COST PERMIT N0.
$ _
DESCRIPTION OF FURNACE AND OR BURNER
$ 10.00 $ �
$ 10.00
*Air Conditioning - All Sizes $ 25.00
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial:
1.25aJo of Vaiue of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY: HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
$ Trade Name �}f�4-r N�Lca.J Size No. �' ac
BTU HP EDR
$ Fuel Total Connected Load
Burner firade Name Size No.
$ BTU HP EDR
�A5 �d��P�az� �;vs�'�i ��
$ 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 an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
$��.�b representations stated in this application are true and correct.
DATE ��� 3 ( P!
H�ATING CO
.�
�
• TEL # �'�i` ���1- ��- � �
- �_ �,
Approved By� Rough•In Date Finai Date � � �S (:(
CK SIDE MUST BE FILLED IN ON V
D COMBUSTION AIR VERIFICATION
SuB�ECT
City of Fridley 33822
AT THE TOP OF THE TWINS g � I L D I N G P E R M I
� , q p,
� �
� • COMMUNITY DEVELOPMENT DIV. � � �
� j V'��.��'
� � � PROTECTIVE INSPECTION SEC
� ' �'�'1 � CITY MAL� FRIOLE� SS�JZ NUMBER NEV DATE PAGE OF AVVRO�EO 8Y
�""��� �'' 763-571-3450 910-F15 8/22/03 / /
JOB ADDRESS 6267 I�erry Lane NE
t I,EGAL LOT NO. BLOCK TRACT OR ADDtT10N SEE ATTACMED
oesca. 4 3 Heather Hills SMEET
2 PROPERTY OWNEF MAII ADDRESS ZIP PMONE
James Brinda 6267 Kerry Lane NE 763-571-1612
J CON7RACTOR MAII A�ORESS ZIP PMONE LICENSE NO
Renewal By Andersen 1920 Co Rd C W, Roseville, MN 55113 651-264-4777
l AHCHI7ECT OR DES�GNER MAIL ADORESS ZIP PMONE LICENSE NO.
20130983
5 ENGINEER MAII ADDFESS IIP PNONE IICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION � REPAIR � MOYE O REMOVE
a oescaiee woaK
Replace one patio door within existing opening
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on a11 levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all
exterior openings.
Permit Inspection Cards
Wiii B� Mai►ed
To HomeownerTo Post
TVPE OF CONST. OCCUPANCV GROUP OCCUPANCV �OAD
SEPARA7E PERMITS ARE REOU�RED FOF ELECTRICAL, PLUMBING. MEATING,
VENTiLATING OA AIR CONDITIONING
THIS PERMIT 9ECOMES NULL ANO VOIO IF WOpK OR CONSTiiUCT10N 20NING SQ. FT CU iT.
AUTHOR12ED IS NOT COMMENCED WITMIN 60 OAYS, OR IF CONSTRUCTION
ON WORK IS SUSPENDED OR ABANDONED fOp A PER100 Of 120 DAYS AT
ANV TIME AfTER WORK IS COMMENCED. NO DWIG. UNITS OfFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ ANO EXAMINED 7HIS APP�ICATION 1 STAl,LS GARAGES
AND KNOW TME SAME Tp BE TRUE AND COFiRECT. ALL PiiOVIS10NS Of LAWS VA�UATION SUiiTAX
AND ORDINANCES GOVERNING THIS TVPE Of WORK WILL BE COMPLIEO @
WITM WMETHER SPECIFtEO MEREIN OA NOT. 7NE GRANTING Of A PERMIT �yZ � ZH�F � 1. L�k
DOES NOT PRESUME TO GWE AUTMORITY TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CMAfiGE
PROVIS�ONS OF ANY OTNEii STATE QR IOCAL LAW REGULAIING CON- @
STRUCTION OR TNE PERfORMANCE OF CONSTRUCTION �E�3.ZS F1T.' C�p2.ZH
PLAN CNECK F TOT EE
Lice $ . 1.67
S�GN4fUAE O� CONCFACTpF OA �UTHOp�ZEO �GENT �O�iEi RO �� VALIO THIS IS V Uii AMIT
S�GtisiuAE O� OwtiEa��c OwN£Q BuuOEA, �D�iE� : B� G�tiSo ��<<
�w [ �
ADDN [ ]
ALTER [ ]
�onstruction Address: `
Legal Deseription: �
OWIICT NaIIle & Ad(1TeSS'
Effective 5/10/99
CITY OF F'RIDLEY
SINGLE FAMII.Y AND DUPLEXES R-i AlVD R-2
BLTiLDING PERMTT APPLICATION
l.�-1 �",-en�/'�,� 1.:� _ N��
e
Tel. #�t9� �� � —� � �
Contractor:;��\ �j u Ac�1�xS�,t�� MN LICENSE # oi013098� �
�-
Address:_j9 2l� CAv.r�}� 1'�oo.d C. W+�.�}: �.c�'yc..��l1t� C�n 1 SIS I1� Tel. #(�l � ello4 ��i�-�
,
- y.
Attach� to this app�cation, a'Certificate of Sti�vey: of--t�e �
lot, with the :proposed �constr�ction drawn �n-it to scale.
DF„SC�flN'OF �P-�!LI�EMF�IT . � '
LNING AREA:
GA,RAGE AREA:
DECK AREA:
OTHER:
I-ength Wisith Height Sq. Ft.
Length Width Height Sq. Ft:
Length Widtli Hgt/Ground Sq. Ft.
�-- � .(�c�,-v c�c��
Construction Type: ( Estimated Cost: $ ��Z--i ,—
Driveway C�rb Ciit Width Needed: Ft. + 6 Ft = Ft x$ .— � .
� . �����k.:.� , � . /\ . . _I���II ���i ' . •�
Permit Fee
Fire Surcfiarge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIl'ULATIONS:
$ $ aS
� a
$--J---
$
$ J.6D
$
$
$
$
$
`�! ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuadon (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State L�censed Residend.al Contractorc)
Alt. "A" or Alt. "B" Above
$450.OU Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
. . . •
3uilding
nspections
163-572-3604
)ATE S".�- C3h-
�ITE ADDRESS � LC7�
'HIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
�-i I h�rt 4 i^i C'.
❑ OWNER �CONTRACTOR
NAME:
t,
ADDRESS: 8 Z6 � � f t'-t ��+t �V � CIi'Y
PHONE: "I io � S� 4' � le 1 2
STATE LICENSE #�� 3 �! 3 EXP DATE 3- 3 r-�
ADDRESS: �S 2'� t1 l 45 ki t�. CITY,
PHONE � 6�� 23'Z- 23 � 6 FAX
❑ SII3GLE FAMiLY/NEW CONSTRi3CTI0I�t SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ ADDITION
❑ BASEMENT FINISH
O DECK
TYPE OF WORK: I � ��'�'
D MAII�
DESCRIBE WORK BEING
SIZE OF IlvIPROVEMENT_
ROOFING
NUMBER OF SQUARES ��
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
� Vinyl
❑ Aluminum
❑ Other
�2 �. r 0
0 ROOF
❑ SIDING
❑ SWIIvIMING
❑ ADDITION
AIR ❑ REMODELD
ha t,�.S C 1'
LENGTH
\O���OUSE ONLY
�J HOUSE 8c GARAGE
!J
❑ ATIACHED GARAGE
❑ DETACHED GARAGE
�Soffit
❑ Trim
❑ Fascia
�
Permit No.: •`��'�'1���� , l � �,.
Received By: �
Date Rec'd:�� � �G
❑ DRAIN TILE
❑ OTf�R
L
tFSQ
WIDTH HEIGHT
ATE ZIP
,,�n.,� ss3)3
Ft
BAS REMODELING SUBMTf•
1. Existu�g Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDTTIONS & PORCHES SUBMIT•
1. Site Plan/Survey showing the existing structures
and proposed project
2. Two sets of consUvction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS �Yes �No LACATION OF VJINDOWS
OR FOR NEW OPENINGS-DESCRIBE STZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE WSTALLED NUMBER OF WIIdDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING 'I'H� COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb C'tiat Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
$ �� ,� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ �j, �q .001 times the total job valuation
$ , gt.( .0005 x Permit Valuation Minimum $.50
$ -rJ-CR� $5.00 (State Licensed Residential Contractors)
$ $1550 per SAC Unit (Plans to MWCC for determination)
g ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ � p�j !t Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT V ALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
perinit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which re uues review and approval of plans. S
SIGNATURE OF APPLICANT � �" ` S�/"` PRINT NAME f' I�f I� ,SQ 4S h o� DATE ����