AF - 47897City of Fridlep, Minn..
6431 Univeraity Ave. N. E., Mmneapolis, Minn. 559
��� � � �� � � ����
��; __ July 22, 1971
p�; __ Dennis C. Otteson g�� Same
,Addr�s 430 Timberland Drive, Burnsvill�jd� _ Same
–
LOCATIOiV OF BUILDING
Ng _ 656 g�t Ki.mball Street N E. Part of Lot
IAt ��,�� Biock p Addition or Sub-Division -Bive�i� H��ghf� Ad�itiQa.
Cor�ter Lot Inside Lot X Setback 35' — Sideyard � 6! £v � �'
Sewer IIevatian Founda.tion IIevation
DESCRIPTION OF BUILDING
To be vsed as:
�? � ? �� Front ..._.�� �pth � Heighi ��_ Sq. Ft —1.Q5�L' Cu. Ft ..�.�4$.
�=a�" �� Froni � Depth .�� Height _..�0 � Sq. Ft. __� � Cu. F't �,.Q$0 �
Type uf Constructfon �djood Fr�tg� �, [��� 18. 7�1. pQ To be Completed Sept . 1971
Provide verifying survey. Provide hard surface drive. Sign agreement for Z sewer.
Set house grade 18 inches above centerline of street and provide � inch per foot
rise from ���iE front of house to garage �X1�� slab.
S��-v: � " . _
�/a,t.e� : �i " c.�cl � �° o , S � n�t,d�
-� n!✓. �►. r[ : g a�. %3 i a P d� �D o � �� : P�-9 u� C�,���s�.
In conaideration oP the issuance to me of a per,�nit to ct 'Ehe b ' g c sc 'b d above, I agre� to do
$�e proposed work 3n accordance with the d�erYption above' forth and '� with all provisions of
ol�nances oP the dty of Fridley. � <
9.37 State Surchart�e
In consideration of the payment of a fee of �$ �+5. 00 , permit is hereby graated to npnni a(]t j-aRnn
to construct the building or addition as described above. This permit is granted upa�,
'the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said buiiding, or any part thereof, shall conform in all respecis •to the ordinanc:es oi
Fiidley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildiiig6
�th�e dty ]imits and this permit may be revoked at any time upon viola.tion of any o� the provisiona oE said
CLARENCE BELISLE
NOTICE:
Thts permit do� eot eover the eonatweTion, 6ista1lallon fo� wiring, plumbing, eas heating, sewer or water. Be sun io ses
t6e Bnflding laspeeto� fo� aeparate permfts fo� these hena.
-_ `
.�.
�
�
APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME :��.�'N l5 �� � t' i�•� BUILDER: 4� � NN e S �; V?,7'� v�
ADDRESS : ��U T .0 r�R L� aa � �Yt � ADDRESS : �(3 � °�' �t. J? � L.eqs� rD �R
V�cB as s� t Lt_� /� w-� - h3�A � n�s � � a_.L.L,, avt �-t� �
NO : . �cS�� S TREET : l� ( /t�t l3 a4 �- � 5 T /U . G ,
LOT :��$� 3� BLOCK : a L.0 L IC �. ADDITION : �C ��7 `c r22� t C��.c7 �� i c.y ��'S
CORNER LOT: INSIDE LOT: "� SETBACK: �v � SIDEYARD•@�o( ��b�
�r---
AppliGant attach to this form Ztao Certificates�of Survey of Lot and proposed
building location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As: ��,��e..E F''°"^"��Y �c�s�""�":'`' , .
2 �-j-�j. :
� , � Front: � Depth: � Height: �_.� _ ' � ",
10� ¢�
Square Feet : � Cubic Feet : _� � -� �c �
�� � (-� F � ^ Front : ��` Depth : � � Z Height : � .-.� _ •
. ,
� Square Feet;_ '3 ��,' Cubic Feet: ��t��- �� ' �'`
—�_
Type of Constructioa: �ov0 �^q�,n L Estimated Cost: $��-,�'-v-
To Be Completed; _�rz pT , ( cl ~C/ � ,
�" i - " . .@ �. „� �"i ,%� � r�, �c>`� __ ,
� f ' � � �� t �, �, � � � -
The undersigned hereby makes application for a permit for the work herein;
specified, agreeing to do all work in sttict accordance with the City of
Fridley Qrdinances and ruliugs of the Department of Buildings, aud hereby
declares that all the facts aad represen ions stated in this application
are true aad correct.
� p( ) ` �.
DATE : f �c �l S IGNATURE • ��
(See Reverse Side For Additioaal Information.)
�- �
. � � ' �. �
a
/---
7°
rT � ,w >
�. ��'1 , -_
� � .
s.
�
BUILDING PERMIT FEE SCHEDULE
SECTION 2. Z'he Inspector of Buildings shall, before issuing pexmits for the
erection of any building or structure, or for any addition to any existing
buildi.ng or structure, or for any alteration or repairs to any exiating
building or structure, upon application therefore, require the paymeat by the
appli.cant for such peYmit of fees to the amount herein below set forth and in
the manner herein provided to-wit;
UNLFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building pex�its, the cubical contents
of any building or addition, is d�termined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to �the average heights of the upper surface or to the average�
height of the roof surface of the ma.in gable of a pitched roof.
For repair� or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work,
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours fram the
time of application, to allow for proper review of the proposed stnicture aad
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required befoxe Aroceedin� with the framing.
CERTIFICATE OF OCCUPANCY
� �}
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building pe�nit has been
issued; and said structure shall not be used or occupied until a Certificate
,� of Occupancy has been issued. •
` - --- --.._ _
, �. - -
I
`� �
__ _ �3 e � ..
; � ' f.� y r�
. �' ' '
, • • t
. , '
�
. . t�
�
. .,-�:
�, .
� :E. .
G ' �
. 9
i
' a
H��� �1�►� �d�
�€yaqtJq'�,!"�°�J�.sa°J ",�`',.4� '
� �. �1 �v � S ��
i
' / Dh.7E
� �
. ��„ ,�.,;�� �. � ' the owner of the
.
following des,cribed proper, y
_ � �` �� ��
,
� ���������
� %� � /`. L ,
. , . �' l ,.�� �
� Hereby agree fio pay in cash �
� � to the city o� Fridfey to cover my propor#ionate
, .
share�of fhe utility system, or in lieu fhereof agree
to have the City levy an assessment agcainst the
property described above. to � cover the cost of my
. �. proporfionafe � s�are of the vii(ify sys#e�n c�s pro-
� vided in" Sec�ion 2 of Ordinance I�o. 113, pcassed
' by the Council of the City �of Fridley on Decernber
. � � � 1 l, 195�. ,
OWNER'S SIGNATURE
.�
Tapping � er�i� V�9��
� �_ . ,, , .
�^ F .
=
�
'�
�
�
, �
�
�
�
�
� '�
� � y�
. ' �
=v
tt�z�
C 14 /73 S��Y FQBt Irflt. DBNNIS OTTESON
-� �IARRY S. J�HNSON LAND SURVEYORS, INC.
8001 BLOOMINGTON FRLPE�AY (9Ei�, AAtN10F�1P'OLis. 6{INNFiCTA Sli410 � PhCIiE N1•3311
Sa,rrveyv�'s Certi tcate �
� �
m �
� •� N
O
EE� ', -
� � �� R _�y
t
� � ��1 g � � �v
� K p. , �
� �
� �
l , �
II ;N . �• ; �
' • .. w•
, . , cr
. �
. . �
;. 1
• • ,1
� �
. � � . �
�—
� ���
N � ,.
;.'�� ° � . :��
� -�� 'o � .
; J ��. p o �
�a ,
� Z� o � 1�
y f,
f
� \
���
��\
� ��n _
�
. � � .� 1
� � �.
� •.
2� �
'� �4
� '
�.3
��
.�
�
�
� �—
��..% — �S .�
�- �
��w �
�} � �
, �3A 2Ai
��
�Q
0
��
�+ ,
s
,cl;.!�
�
NQT�$II
. Existing elevations ara shown
he rec*n.
. Propo�ed garage floot aldvatia
��
. Proposed fro�i hou�e entry
elevation 1Q��
. Proposed rear hvuse entry
el�vatfon 10�1_2
.�
I harebq certify that this is a true and �orrect regressntation of a surveq of tha br��ri�s o�
Lots 37 a�d 38, Black P. RIVERVIEW HEI(�iTS, accordin� to the recorded plat th�reof,
Anoka Cout�ty, Minnasota.
It does not purport to show improve�nts or en+croaciment�� if any. It slso shows ths l�ation
of a proposed house. As surveyed bq me this 7th dty of July, 1971.
REYIS�D JULY 16�1971 ��'r`'�"'�"'�'�' .��.,�
���.
Sd�ar I H. �unde �
Land 8usvnyor, ltinA. �te�. �bi2l
11023
�
C 14 /73 S��Y FOR: MR. DENNIS OTTESON
- HARRY S. JOHNSON LAND SURVEYORS, INC.
9001 BLOOMINGTON FREEWAY (3SMI�, MIPINEAPOL.IS, MINNES�TA 55420 • M�IOaIE �-3341
Surveyar's CertificatQ �
� �
� �
� •B N
O
� �' �EE'� y''
� l ` � /
N K 1�g A\r 0 , m
o gQ.4 � s
� 1
1
�� ;N .., m
� ',
� �
1
�
1� .�
� � '
-�' �
� '
N .,. , .
a.� � � �; .� ,��
s w N �
—�`a� �O . a
W�, O t- a
J �'�' •
� �
N ; ZgA��' `� ' , ' !
� D �.`
O� iL1 '',
; � •� i
4.2 ��r
� N � �a
�g � N �
� 7D�� N
\A
43
�
�� `
N P� N l
N C9 �
i,"� r- �
.�
4
'��
�—
� 9 •�
i
NOTES:
. Existing elevacions are shown
hereon.
. Proposed garage floor elevation
1Q0.0
. Proposed front house entry
elevation 1g1.2
. Prupos�d �ear house entry
elevatdon 101.2
t5.2 �
f, �
�
+,,
�. _
� �
�
�s 7 � � �
�� � �
a��
.,,
I hereby certify that this is a true and correct representation of a survey of the boundaries oE
Lots 37 and 38, Block P� RIVERVIEW HEIGHTS, dceording Co c�e recorded p2at chereof,
Anoka County, Minnesota.
It does not purport to show improvements or encroachments, if any. It also shows the locetion
of a proposed house. As surveyed by me this 7th day of July, 1971.
��-� '� � ,
k'.�<:, i�<w E.n J U LY I 6, I 97 I �;,__..�_
Edward H. Sunde
I,and Surveyor, Minn. Re�. #`$612
�
�
� �
� r
� �
. �
: �
�
. �
a
� o
. �
.
^fl,1 � •
C '
� �
n . .
1 � .
�'J
� � :
m �
�
I
v
� r
� �
� � � � � � d x � � x
�i w � � � � � � G1
� � �
� � � � � ] m � � � � �
S � °•° �' °' � • '� � � �
� ; �� : �� � �
n b '� O y y D
8 : .� a ° • � � � —�i
� ' . : � �$ . � � : D
. : . . °'° a . w . , r
: : : . � � : : : � A
: . . . . . . �
. . . . . . .
, . . . • • . . . \(� \ /
V =
T
� 0 r
�1 i{ 11 M �0 �1 k k i! �C m
� � � � � � � � � �
$ oy 8� 8 S� 8 8i ��$�
M M N tA M b� � M
n Q � � 0
�
V� � � �
/ v
�
� � Q � a �
� � x � �
� � �
� � � N
�� V
��� n �
� °�
tJ �=;; �
�
� x
�
�
�
A
.■��1
� ' ....'
I � � ..��,
� � ■■■�,
' ' ■��1��
" .■■■1
�����
�
a C �
�a��
� M ~
'C7 ��
f�p O�y.
� W
g l�
� �
��
. � \� �
'R
�
�
\
m
�
�
wnrTu
c.�os�rs
uau�t
Mrw
nua
��t
SINK4
www
rw►n
sou�rr.
sMw�.
�oo�
QMINS
GTtM
lilflNS
�0
WASiI�
G�S
APiL
G/�S
RA4iGE
GAS
OoENINGS
. •
i •
N �
i�+
D
r �
n
�
�
aa�, a
���� p�,
� M R
� � � �
� A �
����
$ o�
����
����
b��m
� �
$. �
�mo
�'
� s
� � M
� �
a
����
����
�m��
s �
� �
.. �
3��
�
�d
��
a0
��
� �
p
M �
�
�
�
�
�
• �
�
�
��
=
� �
��
� /
�
�
�
0
��
m
�
�
R
�
:+
�
�
�
r,
�
ro
p
�d
O
m
0
�
x
Z,
�
r
0!
�
3
a
�
i
��M�
y x � �
����
� M H M
x
� � � o
� � � z
'0 � � �
�
`��'
�
�
�
o �
� �
m
�
�
�.'
�
Z
m
�
�
z.
�
r
��
r.:
� �
M w
y y �
c� a �
� a � � x
�� �' � '��d
p � �g �
� ,�p,
� k
p � � �VMJ t0 O
�� y ���
�y: ��
. : : � �
. . m
: : : �:
. . . � .
. . . :�p% '
. . . W .
i i i m �
� � � x
�,��o
cn �
� � � �
����
��
o�
8
.�
��
�
0
r
�
�
�
z
C�l
°c �
� I
w
04 W
w pq
..�
'� �
.'7' y
O r�
� o
� �
M
�.
� .
f�D �
eD -
� •
i. :
�:
c�
�
�
'd � �f� � m
� �'.r p7 � �
� � � � c�i
� „ o
� �r Q
co' b
� � ,
;� ;�
� �
� �� : �� � � �
� g�
� `� e� � � �i
�"� � x°
�° �
Q�z1 � '�� � M
�� �°� � �
� � � � �
� a � �
y � ° Od �'
Q o � � o
�
0
�� �
�' � �
� �� �
b �v
�
� � �
�� �
� �
W p1 � n M
aa `D fD x
w N � x y
oo���
� � R° R° '�
� � � � �
���
��
� � o o �
�' o
��:��
M ' 'Y s,�
. . � �
� � x �
. . a �
. . �
: � � �
: : � :
ca ea o 0
8 � S $
�, � .�
a �
� �
Cv �
R
� �
�
�
o � ^
� ,�
0
�
O
�
�.
g
�
m
�
0
1
I
�
� ,� � � �
���' �
� � � � � �
�.�� �
�� �
� � 1,ro�.r � �
�O �y � �
�;
� � � o e
R'' . � p'i
w � ' �
p, � : G ..
�o: : �
O O . . 0
O � . . �
w o� o� ea o
$ � � $ o
� �
�
� �
1
�
�
a`°. �
� �,
m
P
OG
���
(�
`�i`�
E
�f
m
I�
�
b�b �a
� � �
���� �
� �
�a"'��
� � ° �
O O �
����
� b � °
a. � � �
�, .� . .
�„ . .
�•°::
Oq � . .
C : : :
. . . .�„ �ro
w o� a� o
Soo$ r�
�
0
�
a�b �
a..a�
� ��� ro
M
y �
� �� � �
o�p� !4
y d°� �
� �,
�b �
��o �
m�
ppG�
��
0
�rory
�i
����
y b
w '�'�
p-��' � m
��
�°'op
��.o
�' y ro
����
�
�� �.�
a ���.
����
��
���
��o
��
� �.
��
���
�
D
�
i
�
�
�
y
S
m
C
m
d
�+
M
�
�
x
�
m
�
�
�
i�
�
�
�
'
�
O
�
-�
�o
o�
�o
o. �
0
;. _
�
�'
� ��
� �
0.�
A A
�� �
� ��
�i
O
D
�
�
�
�
�
�
�-
' p �',M .:��. .� . � . ��yJj .... 4 � r .. -� ..� ', �,_,
� 7 ° .,i � f C""' "a' . . .�.°i '"'"' ,�."' "` "_ _. _. ._. �� ' _ . -. - . v^ . ]: z T � " .� i--•yr' `^,�`.^.
^R.,f+.�pi, ;4����» .,.1 ✓� �_ _ - .
, .�'�"�,I:CP�S� �i.CCJ[.�'!`IO1�.S ; DEP� � �D�' �L11LI)II��S ' T `� ���-^� � ��
�;`f��,t�a���e.�tbers�s4�' ' A.S.H. (;oa��cteo� Ido. � . Y�aplad�� . � ` ''�4;� .
�, — ; --=�---- _.,— Guide ' � . '
"�NMdpv�ta ��;' iAooca' RefeReeaxe Out, �{faU Int. Wall C.eilin� Itoo� F7oor �d � E$o� App�aed y.
t ,,
, r�-�- � ��=�-�-No . 19_`� ,
�:'iEl. t/ j� '''"Raam Len�th Width � 1-leight — �' Fi.� Raono Lera�th i�lidch' �'.' k�leight
F�,, j ; �,?lsa�doww�'and' D�rs�-Cracdca�e and Area' ' ' �indows and Door�--Cracl�a�� ae�d �ee�i � .` � ,' ' ': F''
Ay/dth Helght No. o! Llneal 1t. : Area.. � Wldth Helght No. o[ LIne�112. AreA
!�, No. �'�' �.of yane ,..o[ Dane LI�Wts ot crack . e0. IL � . � � • ' Na o4 Dane ol D�na - IlBhto oQ cracg 9�. [L ' �
� 1 ''� . ,. ��� �W � - ( � � � �. '��� 11� � , .
p � �� ��' � J . � I I I� . - , . . I �"� ��I'.
� t
f �I
f .. �.�� �� � �. ' .
su � ��.'°.� '�Si` �� " .�'7� Gef. �tu' �lf. , �au
,'; infalteation ''. :,� ; : � - � ,.3
� o �' �
����� G,iass k`'� � �� '� �� �
, ;'F.�ip: wa1C ' ` _ � .
-- , ' S.
°c� .�1et t�tp. we� '-' , a� s s
;��Ifrt..lV��i � � 4; ',t' � �� , � p�. �
'Fr�;CeiDang ^, � : Y l� 1.�,
'���loor �:',�, ,,� �' � � � � -
:1'otal �tu. ' � �
, � .
;�'Requere' sq,'ft. E.Q.�. or.a�. ins: �.A. �ader area ',
�l.� '' ,, �` Raom � Len�th � �Jidth � Hei�ht
<�r; ��liadoeaa and Dvora�rackage and �rea f �
yi �;: Width Ha ght No. ot Llneal ft. Are9
S,'. No. '" ' ot yane o[ Dane ' IlBh40 ot craclt ep. !� �", ,
i / �� �� ' 6 1%—
�5 �� � � �, �
,, ,
� . � �asf. �eu
'.Iti�lt�ation` ' �; � p
'°C�H�qa ' ' � U
� F..�p: �aBl � �.
r; 'TI¢t exp. �raU � 2e9 .��
`�; �Int. ��*✓all � � � �
�' ��ilfng , � . � � �
�'
;F�oor '' : , � �.
, Yotal �tu ,�� �
;R�qeaired sq. f�: E.D.Ed. or sq. ins. �/.A. Lemd�se area I
'F'1. p, ' Roaan � Lee��tie �iaD4� � i�i�4
,t
':,�/iadows and D�rs—Craekage �nd Aeea
+ `R/idth Iiel�ht No. oC L1nea1 tt. Areo
Ne ': � ot paAe . ot Dene H�hte o2 craak ep. !t
r
�� � '
�, � � �r, ,
4 �
Coef. �tu
'`�Iaa�lta�tio�t,;:� ` ,� �
.: ;�l�se , ' '' S �
�� �E�¢s,;wel! . ,,. � ,,,._.,�
� =ld�t Rxp. ��1! � � 0 �
'I�e. w�ll �
�'; Ceilicsg " + `$ `� �
, .,. ,
�.�loon
�',:,Tpeai �tu:, �
"'�ec�ir� �a1. %�.D.�t. or aq. iaa. �.A. Leader erea
� � ��' �r
���E��ct '�1� � ' ',; �'/�,1��' � � �"' ,� �S �- �T' � ��'J�
: I�fileaaBion
�l�s
F��. m��ld . ,
� �`l�t eap. wall � — ----
. yPii. bY� ' .
Ceilin� .. .
Floor '
'Tocal �tu.
,
�1 � ,
'i i' �i .,. „.
Fdeauired se�. h. E.D.R. or ac. ias. i�/.A. I.e�der are� :
' / �I.I ,D ��
�u�dodva �nd Dmase�—a
.I � .0 �
In6ltratio�
Clas�
�p. aaall
Wet eap. wrall
I�t. wall'
Ceiling ,
�looe
Toeal �eu.
rr��
� Q � ' �l ie�th CJ' : , �-d�n�ht
� arad ��a , , �,�, , ��,. .,
LIne81 [6. Arbn ' ' �
ot cracB sq. [t P
"
,�`� / i, .
' ,;;.
� r
`
�f. � �-��`
��
�
� ��
.',. �
` ,;
� �
oo�. ' ..7-' ;'�dY �A.� ,�.
�r------�.;
quu� eq. f� E.D.4i. or sq. ims. �l.A. I.eadee arem
°l.l �ama I i.en�81a �Jidd►
�emm�aaJa end D�es—Cracka�c e�ed Area
•a
�94dbA l�elg�t No. ot Llneal Q& als�a
04 nm�e of oa�m II�A¢� ot crack oa. 4L
,
Glasa
��
��
�
�
;��� � ;� .
_i ;�,�
, ;,��
,`
,� , �� 'n.
Coef. �¢eb
Eap. ��ll G
Alet egp. �arall �� � , :� ?� '
,;
Ine. wmll �
Ceiling � � , �
Floor � . � ' ,
�otal �tu. , , �''�.I ;
�eec�eiired eq. k. �.D.R. oe sq. i�s. �blA. l.�sidae ee�ea ,,�
s.r.e�e
�� , �` � �
4 � °� p� �
�Y OF FRIDLEY � - � 394
Application for Ins1�Da,tion of Wats�, and Sewer Service
This form to be completed before a ta.p is made to any
or sewer line.
Lot .,�� �:3� Block ---..___..�......_ Additiory�t--l-.. ._!
Address fe��la -- --- ----�_�__��.....__..
water
Owner _... -• ----- -- -• - -.___ . _..__ ._._ ..
__.__.__ ____.
Plumber����� _ - ------- _.�..�� .__ .
(this portion of rm to be completed by n requestiag tap?
CHARG�S TO BE PAID BEFORE TAP IS �� E— WHERE
ASSESSNN�NNT HAS NOT BEIIV LEVIED AGA�TST �'ROPERTY
Sewer Conneci�ton fee
�'Street patch __..
Water Connection fee
Meter deposit
Materials used
�Street patch ......
�����s � _ �.
��9.�. ��
" Where applicable
The above applies for all regular residential size services
IF LATEftAL ASSFSSMENTS HAVE BEIIV ?�E�TIED AGAINST
7'FIE PROPERTY, '�'T�'•RF WILL BE NO CHARGES OTf�R. THAN
CONNEGTION PERNIITS AND N�°1`ER DEPOSIT
The City will furaish materials for water service and the pl�mber
will bill tY►e City for sewer, not to exceed $3.00 a foot or a ma�mum
of $60.00.
ASSFSSN�NTS TO BE LEVIED
I / "'�� �
I _�� ,
Clerk's signature -----�----!!.._y._.1
I hereby authox iae the above
1at copy—Public Works
Water Lateral $...�.__.�.-----
Credit for ma.terial ...._._._...______.__..
Tot81 asseccma.nt
$•---.___.._._...._._.._....
Sewer Lateral $--_. ._.�.
Credit for ma.terial 60.00
1 Totat asse�ment �.. r......_--- —
Director of Public Works �� �M
HOUSE HEATING TEST RECORD
ADDRESS ���'' '���� �`� APT. ��,�, -OOR �CI _ �— SUBUR��
OCCUPANT OWNER ,��%�-+��- - ��!" --�z��� `=�
HEAT LOSS DATE HTG. INST. GAS C0. METER BAD #
SOLD Blf INSTALLED BY � ����� � � � � � . -; - �
Eleetrical Work By Gas Line By �
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
� GAS DESIG o CONVERSION
MAKE �� -� �- �� -�� MAKE OF BURNER
Model f' � �%�'�� � Model
Serial ����� �°``� Max. BTU Rating
INPUT �� �!�� MAKE OF FURNACE
Model
(�� CONTROLS ,�
THERMOSTA „�i��=��� ot Plug Vent Size •�
I. T '.,., a . ,.�?� /._ ''�'
Valve a '�= � KIND OF LINER —'"°""`"'SIZE—��NONE
Limit �� �--� Drah Hood Regularor
Limit Setting � Filters Size Number
Fan Setting ��-� ��� Chimney Loeation Inside � Outside
Pilot Type �� Chimney Construdion
Pilot Make ���-,--G'���-e'-� � ���'-= ���-�-�.
Pilot Model Smoke Bomb Wiring ��
Pilot Timing �%���-�—�_ Draft �'` Test Tag �
L.W. Cut Off D or Pressure— Lighting Inst. �
� _���:.� �� ,�' � �
Prossure � `� Pere�t�0„_4 � Date Tested °`� � °� �
I�+put CFH ��'� Per� �� �����Company TestiRg r�a -
Staek Temp. �-'��� Percent CO �1''a � Name of Tester
Form 235
t .: �.
0
�� �7� �i�
. �� �� �► : � _
�� �x� �� �.�. "- - - -
___-
F��.d�+�� ' +�t� 5,� -
� �, ��&�
� � ��'� � �� � d� ua� � ra�� ���`� � v�r
�� � ���
������������� ������� �������
�t�� be�� +� � �,� +�.�� �� +� ��cm,
� li P
��3,��
�A� ; � +�;���� .�t�
e�.ir- .-��� . rS�:: �
sue�ecT p
City of Fridley _ 19190
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� � RE .
� `y ___� COMMUNITY DEVELOPMENT DIV. ��
r � � PROTECTIVE INSPECTION SEC.
l1 = �
--_.� ��"',,� CITY HALL FRIDLE� 55432 NUMBER REV. OATE - PAGE OF APPROVED BV
i 612-571-3450 910-F15 9/25/87 i /
J08 ADDRESS 656 Ki:mball Street N. E.
t LEGAI LOT NO. BLOCK TRACT OFi ADDITION
SEE ATTACHED
oescR. 37,38 F Ra.vervie�r Iiei.ghts Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Thomas Ma.ttson 656 Kixn'ba11 &treet N. E. 784-1052
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
B USE OF BUILDINO
R.esi:dential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling and Pa,rtial Reside
9 CHANOEQFUSEFROM TO
STIPULATIONS �� can be the 2nd layer but not the 3ard. Install xidged galvanized
v alleys .
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GHOUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WOFK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. • NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS yALUATION SURTAX
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�-�400 $. %O
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. 523. 'rJO
P AN CHECK FEE TOTAL FEE
$24. 20
� SIGNATUREOFCONiRACTOHORAUTH RI EDAGENT IDATEI ` HEN PROPERLY VALI ED THIS I YOUR PERMI
�1 //']j
T SIGNATUREOFOWNERiIFOWNERBUIL ERi IDATEI BIDG �NSP n E� �
N� [] City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
pLTER. [ 7 Building Permit Application
%�/ ti tn,
Construction Address: ��v 1� 1 1'1'����-� 5� 1 v' L � —
Legal Description:
owner Name & Address : � ��'��S � ���� � Tel . � ��7 — ��
Contractor • �� �� 9'� �� Tel . �
Address • ���� �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed constr.uction drawn on it to scale.
DESCRIPTIOH OF IMPROYEMENT
Length Width Height Sq. Ft.
Len�th Width Height Sq. Ft.
J� _�
th
Sq. Ft. \
� � S c d� �, /S �t�T'S �
Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setbaek
Type of Construction: DC�� L�l� Estitnated Cost: $ �i ''
Approx. Complet3on Date: 1 �� ��-
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
�c� � ��� -( oS Z
DATE: aS U APPLICANT: � Tel. �
CITY IISE ONLY
Permit Fee $ °��•S� Fee Schedule on Reverse Side
Plan Check $ 25� of Building Permit Fee
State Surcharge $ � $.50/$1,000 Valuation
SAC Charge $ $ 525 per SAC Unit
Park Fee $ Fee Determined by Engineering
SeWer Main Charge $
� � Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS:
. � _ �
BIIII.DING PERMIT FEE SCHEDULE
The Chief Building Offieial shall, before issuing permits for the erection of any
building or strueture, or for any addition to any existing building or structure, or
for any alieration or repair to any existing buildin� or structure, upon applicatio n
therefore, require the payment by the applieant for sueh permit of fees to the amount
herein below set forth and in the manner herein provided to-Wit:
Total 9aluation
$1.00 to $500.00
Fees
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraetion thereof, to and
ineluding $25�000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraction thereof, to and
ineluding $50�000.
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
ineluding $100,000.
$100,001.00 and up
$433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEWAY DEPRESSION ESCROii
(Conerete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13•50
Alternate "B": Removal and replaeement of curb and gutter ahd install a 3 foot wide
approaeh with 6 ineh depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of
application to allow for proper revie�a of the proposed structure and of the
construction site.
A CertiPicate of Survey of the lot, showing the location of the foundation onee it
has been eonstructed will be required before proceeding with the framing.
.a -F '�
�
4TE
T�7u1
1BJECT
PUBLIC WOR�S
MAINTENANCE
Paul Lawrence
0
Traffic Concern on Kimball Street
m Hill
Safety
�u� �� �
� °� :.� ,
IOAEMORANDUIIA
TO
of Public
x
ONI INFO
I received a call fro�a a Mrs. Kelly Matson, 656 Kimball Street, telephone rnmiber
784-1052, requesting 10 N�H signs and slvw children signs in the Kimball Street
area. I advised Mrs. Mattson that state law sets a m?n„m�►f+ speed at 30 N�H, ar�d
tliat slaw children signs are not very effective in achieving her desired goal
of protec,�tirig children frarn reckless drivexs.
I suggested that she work thtroug� the neic�iborhood crime watch, ar�d they co�ld
be effective in identifyirig violators and impravirig the current corxiitions. It
would be helpful if you could pass Mrs. Mattson�s oonoern.s along to the block
captain in her neigi�orhood.
_,.,.�,gr� - �
��� � � ��S
���� j��:e�c..Te..�
'rh� S%`2 '� `��'�
�� -� ,� �roh�.�xv�
� ,�- C.:,.�,-� ���-���
�+1(1 e.�e.. � � 1v � ° �
�� _ _
'- � .lVtl�el.r
City of Fridley
AT THE TOP OF TNE TWINS
i �
� �
� ; v _____ COMMUNITY DE�ELOPMENT DIV.
r � � PAOTECTIVE INSPECTION SEC.
�
ii S ,
-� �"'1,� CITY MALL FFIOLE� SS1J2 NuMBER
L % �
�U ILDING PERMIT
°� 612-5��-3ab0 s�aF�s
J08 ADDRESS 656 Kimball Street NE
t LEGA� �OT NO. BLOCK TRACT OR ADDITION
oescR. 37, 38 P Riverview HE
2 PROPERTY OWNER MAIL AOpR�S$
John � Tina Hinnenka.mp
J CONTRACTOR MAIL ADDRESS
Owner
4 ARCHITECT OR OESIGNER MAIL ADORESS
5 ENGINEER MAILADORESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
NEV OATE PI
7/27/99 /
ts Addition
ZIP
ZIP
ZIP
Oi
/
29945
tC..-ElY 1 NU.
� ���
�vpOVED Br
SEE ATTACHED
SHEET
PMONE
780-7221
PNONE LICENSE NO
PMONE LICENSE NO.
PMONE LICENSE NO
O NEW ❑ ADDITION O ALTERATIpN �c REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reside house
�
8 CHANOE �,jF USE FROM
,,.
STIPULATIONS
�
TO
Call for building wrap inspection before covering.
SEPARATE PERMITS ARE REOUIRED fOR ELECTfiICA�, PLUMBING, HEATING, TYPE OF CO
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK Ofi CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED V�IITMIN 80 DAYS. OR IF CONSTqUCTION
OR WORK IS SUSPENDED OR ABANOONEO FOR A PERIOD OF 120 DAYS A7
ANY TIME AF7ER WORK IS COMMENCED NO DWLG.
I NEFiEBY CERTIFY THAT I MAVE READ AND EXAM�N�O THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIQNS OF LAW8 VAlUAT10N
ANO OFDINANCES GOVEpNING TMIS TVPE Of WARK WI�L BE COMP�IED
WITH WHETMER SPECIFIED HEREIN OF NOT. TME GRANTING OF A PERMIT %OO
OOES N07 PFESUME TO GIVE AUTMORITY TO VIOlA7E OR CANCEL THE pEi�Ml7 FEE
PROVISIONS OF ANY OTMER STATE OR IOCAI LAW REGUTATING CON-
STqUCTION OR TME PERFORMANCE OF CONSTFiUC710N .P.2U _ h(1
SiGNa �O 'p TOA TNOpi2ED aGENr iDAfE�
4 UaEO wNE O� pBWIDER� iO�TE� �
SO. FT I CU f T.
OfFSTREET PARKIN(
STALLS GAiiAGES
SURTAX
.50
SAC CMAiiGE
Fire C .7
rora� e
LIDATE MIS � Y R
J `
r„ r
LOAO
_; .. �
�w [ l
ADDN
ALTER
Effective 5/10/99
[ l CITY OF FRIDLEY
[] SINGLE FAlV�.Y AND DUPLEXES R-1 AND R 2
BUII,DING PERMIT APPLICATION
Construction Address:
Legal Description:
��
�� ��
� ��
Owner Name & Address: .� j�(A �� �;,,� ', �� Tel. # Cp � 7�=��?�..���
Contractor: — o o� ��� MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Tel. #
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECB AREA: Length 1W/�'dth HgtJGround Sq. Ft.
OTI�R: �%�<'.I ' _�i'' �O`�a7 o c �
� v
Construction Type: (,✓� l Estimated Cost: $��:�
Driveway Curb Cut Width Needed:
DATE: � I
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �%��
$ ��
$ S�
$
$
$
$
$
$
$ �� - ���
Ft. + 6 Ft = Ft x
Fee Schedule on Reverse Side
_$
Tel. # '
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5. W (State Licensed Residential Conixactors)
Alt. "A" or Alt. "B" Above
$450.00 Conservarion Plan Review
Fee Determined by Engineering
Agreement Necessary [ J Not Necessary []
.� -� �
BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon applica.tion therefore, require the payment by the applica.nt for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,�1 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1, 000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,�
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,0� or fraction thereof, to and including $5(�,000
$3,233.75 for the first $5�,000 plus $4.75 for each addirionat
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alterna.te "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15 .50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applicat�on to allow for proper
review of the proposed structure and of the consirucrion site.
A Certificate of Survey of the lot, showing the location of the foundation once it rias it has be�n �o�tnac�d �vill
be required before proceeding with the framing.
SuB�ECi
c��y of Fridley
AT THE TOP OF TNE TWINS g U I L D I N G P E R M i T
r
� �
; ; v _���� COMMUNITY DEVELOPMENT DIV.
r � � PR07EC71VE INSPECTION SEC.
l.-_.� ��"' ��� CITY NALL FRIDLEV 53132 NUMBER nEV DATE
l 612-571-3450 9t0-Ft5 6/5/00
JOB ADDRESS 656 Kimball Street NE
t IEGAL L07 N0. BLOCK TRACT OR ADOITION
DESCR. 3],38 F Riverview Heights Addition
2 PFOPERTV OWNER MAIL AOORES$ 21P
John Hinnankamp 656 Kimball Street NE
3 CONTRACTOR MAIL ADDRESS 21P
Same
4 ARCNITECT OR OESIGNER MAIL AOORESS ZIP
5 ENGINEER MAIL ADDRESS 21P
8 USE OF BUILDIN(3
Residential
7 CLASS OF WORK
O NEW O ADDITION � ALTERATION f�7 REPAIR
8 DESCRIBE WORK
Reroof House & Garage (20 Sq) Tear-off
9 CHANOE OF USE FqOM
lZ•]
STIPULATIONS
Underlaym.ent must comply with the State Building Code.
TYPE OP CO�
SEPARATE PERMITS ARE fiE0U1qE0 FOR ELECTRICAL. PLUMBING. MEATING,
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED WITMIN 80 OAYS, Oii IF CONSTiiUCTIpN
OR WORK IS SUSPENOEO OR ABANDONED fOR A PERI00 OF 1� DAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. DWLG.
I HEREBY CEpTIFY TMAT I HAVE iiEAO AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE ANO CORflECT. ALL PROVISIONS OF LAW$ yp�UATION
AND OROINANCES GOVERNING TMIS TVPE Of WORK WILL BE COMPLIEO @ 1� 74H
WITN WHETMER SPECIFIED HEREIN OR NOT. TNE GRANTING Of A PERMIT �P
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEI TME pEqMIT FEE
PROVISIONS OF ANY OTHEFi STATE Oii LOCAL LAW REGULATING CON- @
STRUCTION OR TNE PERFONMANCE OF CONSTRUCTION �pC3.1S
OTUAE�CON7A4CTQ$QR4UfNOAREOOGENT 1QATE�
SQ.
J
ERMIT NO. �
31013
R T NO. '
3�3�
Oi APPROVEO BY
/
SEE ATTACNEO
SNEET
PMONE
790-7221
PMONE LICENSE NO
PNONE LICENSE NO
PHONE IICENSE NO
❑ MOVE O REMOVE
GROUP IOCCUPANCY
OFFSTflEET PARKING
STALLS GARAGES
SURTAX
�.8%
SAC CM RGE
Fi SC $1.75
TOT L FEE
.5.77
VALIOAAE ,TMIS IS VOJiF PERM
NEW ( ]
ADDN [ ]
ALTER [ ]
� ��
Construction Address: °-�
Legal Description:
Owner Name & Address: �
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
�►�flls/
Effective 1/1/2000
(763) 572�604 Bldg Insp
U���`�
�� ���
Tel. # �lL �� ' � �>
Contractor. — MN LICENSE # �
Address: �- — Tel. # �
LMNG AREA:
GARAGE AREA:
DECK ARE�4:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
OTHER:
���� �
Construction Type: �.r ��y�,� 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
$��� Fee Schedule on Reverse Side
$ �� %� .001 of Permit Valuation (1/10th%)
$ � 8% $.50/$1,000 Valuation
$ $1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$_ _ Alt. "A" or Alt. "B" Above
$
$.
$
/
i
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or stcucture, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,Q00
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
� �1
$100,001 t0 $500,000
$500,001 to $1,000,000
$1,OQ0,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,�0
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,Q00 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,0(m or fraction thereof, to and including $SOO,ODO
$3,233.75 for the first $SQ0,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,(}00 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW �
(Concrete C�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot �ide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for consiruction will be issued a minimum of 24 hours from the time of applica.tion to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed �vill
be required before proceeding with the framing. New Houses Onlv
�.
*
-� D
�: �
� O
-� �
c� �
3 0'
N' �
� �
O N
� �
� �
o �
3 �
0
� �
Q�
0
�•-v
�• a�
oa �
m
v Q"
o ��
� �'
"t y
� �
O �
1
m Q
. c
�
�
0
c
�
�
m
z
�
-�
m
�
O
Z
T
m
m
�
�
V
O
0
\
2
�
�
�
C)
� o
cNn �
��
o �
d
� �
rn a
c
O y
D rt
v °—'
�'
�
n
m
0
�
0
�
�
o h
a1
D u
r �
m �
m �.
m
aa
m
� �
O
� o
� � y �
.D � � S
m
� � � �
m� cp'�
�.
� O Q �
� ,.�. C) �
� � � �
v, �o m, cu
N � � Q
.� Op
?
N � 0 �
� °- °q �- o-
�•vo�
,.r <: °' 3 -
S tn p�
u� o' F �
� � O y
� � � �
C� Q- N. "�
� � � �.
y � fD .+ ='�
m � � � �
� � � �
=`—'aa�
� � �
�
m �
� N � �
a�� �
c, � . �
o -��-..
� -� �, o
� _ '� �
n' — S ,-�.
`i� � � � �
m C� �
a � �
0
v o �
� Q S
�D �
QN m
� _.
�
D
�-
� Q
°. s
< fD
-,
d N
�
m �
�
O �
D ��
� N
a Qo
�' n
� �
��
O .��+,
�O
�
�
��
�
�
�
Z
W
a
C)
�
D
C�i
0
a
0
�
OG
D
v_�
N
m
N
�
�
N
v
c`�o
�
�s t�
N �
tn o
°o °o
� G� D�e�D
N N N 't N
Cl � � '� A �
� �•�� �D =
m � m � � °—'
�
� z � � m
� � � � �
Q � �
O Q- � � �
—c
� � � � �
� S � � �
m = oo � o
� `�' n �
��v �
� _
� �
� �
m �
� � �
0 0 0 �
°o o° °o �*
m
� � � � � �
p �
� o
� r
� �
�
m
�
�
�
a
m
Z
�
N
_
'�
�
N.
(D
z
0
� � � z
� -i � O
— C � �
'J � m
_ � � �
m �
S� G oa
� �
�
,_
o � c?
rr �
� A
n �
0 ._ �
� � �,
� fp
.n.r ^
m �
Q- cn m
I-' N �
a"'z�
� o
� _
�o
a�i
.�r
v
�
D
v
m
�
�
D
�
m
�
C�
O
�
�
�
rn
�
�
�
z
O
�
��--�
9�
W
C
r=
�
Z
�
C
CA
m
�
a
�
m
N
n
_
m
v
C
r
m
0
O
Z
r" ,
V � � n
wQ-c"'�
�
� �� � 0
v �
N��'�1�
wz� �(�
� y � �
� v'� m —
WD '�
< �
N z � �
rn��
m
C7
�
�
0
<
�
a �
� z
�
r
� -��I '�
��
G� Z
m �,
a�
��
O�
a�
z�
v�
a�
�Z
Q N
za
v_z
�v
0
_
Z
W Z�
D � Z
� � �
�
n
� m0
3r
N Z
�
� v<
v '''
,� z
< 'i
i'i �
N �
0
Z
�
�
�
�
m
�
<
m
O
�
�
d
�
c
�
�
r
N
O
O
N
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
��ii7ii�i�► I ► I ► •►► •:. _►� •i�� •► � : l : � •►
YVI Iel�i �, �n acinA 9P1 _YIC 111� f�r� anr_p, �e undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes ) No (
Y
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes,� No (
The undersigned also verifies that the replacement unit is a listed assembly
and meets the cuRent codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The pYic+in8 cemb ,�t�en air is sized and installed to meet the current codes
and manufacturers specifications.
Whel1 1'EqUI�@d t0 inc_tall a n_w _emb �c+ion air�it wi11 be sized and installed
to meet the current codes and manufacturers spec�cations.
Whe� inc_tallin8 a new venting�ye_±em, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
speciflcations. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per cuRent codes.
Yes,,�`) No ( )
Yes (� No (
Yes (�No (
/
Yes� No (
Yes� No ( )
! � � . � ' • ' , � � ' � 11 11 � � ' � . � • ' � �• � � ' �1 • � • �11 . • �
Appliance #1 Type BTU Input o� Fan Assisted or Nat �,�
Appliance #2 Type l,c�, �'P� BTU Input '� �o Fan Assisted or Nat ,�
Appliance #3 Type BTU Input Fan Assisted or Nat
T�fal Appfi�nces _� -- iotal Btu Input 1�
Common Ven� Type Vent Height � 5 e Diameter � inches
Appliance #1 Vent.Connector Height �ft Length `'� ft Diameter yl �� in Type �
Appliance #2 Vent Connector Height �ft Length �ft Diameter P-1 �. in Type �`
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
�li� �•► �- ..-
� s
HEATING
Signed By:
-2
w�-t-°
• � D D�
n
�
�
C
-i
Z
�
�
2
D
r
r
o�
m
'�
�
O
v
m
v
�
m
�
C
�
�
�
m
�
z
�
0
.p
.-.
�
D
Z
v
D
�
r
m
rn
,D
n��i
m
�
�
o �
D �
r �
�
m
rn
� � m
�
�
\o�
2 c�
-�i� m �-F'
v��
7'I
� Z �
�, v �
-r1 O O
� � o
m m=
o � �
-, y
-� �
�� z
�v
D
�
rn
�
�
0
Z
�
� �
�� �
, � �
�
nWi v���� c n�i n�i o cWU a m
,� �- v, v, m m m�� � g� �
v T v � -, � -, � � �' � � � �
� �� 2 2--I � N W� v►
� fD �° ai n�i fD � m a, oo ���
� �"' �* N fD ='• � � � d � tp fD
� *� -,� <:� �.� w
� Z
< m � a � �
� � � -� -� � �
r► N � -0 � -�
� * �. _ � '71
� � c
c �
m
a
�
m
�
�
-o
r
c
�
�
Z
c�
�
�
c
�
rn
�
m
cn
I�IIIIIIIIIIII °
�
�
0
0
������������ �
� � w w w � �. � � �._ �_ � _
� o cs, tn cs, o 0 0 0 0 0 0 -�
0 0 0'0 0 0 0 0 0 0 0 o rn
0 0 0 0 0 0 0 0 0 0 0 0
v N � � C
v Z c -� r,
°< m W
v
W W � � �
,` -� n ° �
C�
� y v
D '� �
Z
�
�
� � � �c?
�
�
-n
�
N
v
�
m
�
m
r
z
o�
�
W
�
?
-�
m
�
�
�
z
O
�°
��
�
�
�
�
�
�
�
G
z
m
�
�
�
a �. N S
c� �
m 2 �; 3
�Qa
t�n y N y
'. °� m `°
�
� o � �• o„
��
�' � o �
� Q- °- �
,� � o �
Qc° °' �
�v��
< �
D �'s, tn; � �
-� rn o . p�
m _�i _ ? � -o
'p � N; 'a
v � _ �
. Q � rt
.-►. � N O�
j � � 7
� � � O
N Q d N
m d � rn
m �
d m �, r;
� m � 3 0
�S �, �
°: m s
� � � fCD
� rt � c
� O �
--�. p.
fD
. y N �
O �
C�
�
�
� � � n
w � � «�
cn � c O
N��.�
ia Z m
����
����
�,N�v
� Zm
i m�
w Z
� �
� m
� �
�' O
Z
_ <
a
�
r
D
�
O
Z
'n
�
'O
3 �
Z
Gi `
Z
v
n
N
`T1
�
^Z
Y+
m �
� � �
3 � �
� �
�� �
D
v
N
O
�'
�
�
�
s�
�
a�ea :�(g pau6ig
�O� JNIl�H
( ) oN
aqi��saQ :SNOI1bR1311V
adi(1 w �a�aweia �} y�Bua� }} �y6iaH �o��auuo� �uan E# a�uei�ddy
ad�l ui �a;aweia �} y}6ua� }} �y6iaH �o��auuo� }uan Z# a�uei�ddy
adi(1 ui aa�aweia � y�6ua� � }y6iaH �o}�auuo� �uan �# a�uei�ddy
sat�w - - .ia�aweiQ ;4Ei�H ;uan — ad�fl �� uo�uwo�
�ndul n�8 I��l sa�uei�ddy I��ol
}eN �o pa�sissy ue� �ndul f118 ad�l £# �uei�ddy
�eN �o pa�sissy ue� �ndu� �18 ad�l Z# �uei�ddy
�eN �o pa�sissy ue� �ndu� �18 ad�(1 �# a�uei�ddy
uoi;ew.io}u� �o��auuo� �uan pue �uan uowwo��azig pue a 1 a�uei� br
( ) sa� �sapo� �ua�n� �ad se �(�a�e�edas
pa�uan pue �uan uowwo� ay� wo�} panowa� uaaq sey a�uei�dde ue
�a}}e I(���a.uo� pa��e�sw pue pazis s�o��auuo� �uan pue �uan uowwo� ay� s�
�O oN O sa� �sa�uei�dde }}e�p �em�eu pue pa�sisse ue� �o� sa�qel 6ui�uan
a�ewn� �e��ua� � tio6a}e� yWy�-y�y apn��w saop siyl •suoi�e���ads
s,�am��e}nuew pue sapo� �ua.un� ay� s}aaw pue ��qwasse pa�si� e si �i
�ey� sa�uan �(qa�ay pau6is�apun ay� 'wa;s s ui;uan nnau e ui��e�sui uayM
( ) oN ( ) SaJI
( ) oN ��=sa�
( ) oN
( ) oN
�suoi�e��i�ads s,�a�n}�e�nuew pue sapo� �ua.un� ay� �aaw o}
pa��e�sui pue pazis aq ��w► �i �ie uo�;snqwo� nnau e ���sui o� pa.nnbaa uayM
— — - �sua�e��i�aas�,�a�rr�.�riuear�pve
sapo� �uaLn� ay} �aaw o� pa��e�sw pue pazis si ��e uoi;snqwo� ui;snca a�l
( ) sa� �sa�uegdde }}e�p �ean�eu pue pa�sisse
ue� ao� sa�qel 6ui�uan a�ewn� �e��ua� � tio6a}�� yWy�-y�y apn��ui
saop siyl �suoi���i�ads s,�am�e�nuew pue sapo� �ua.�n� ay� s�aaw pue
�(�qwasse pa}si� e si }iun �uawa�e�da� ay� �ey� sa�uan os�e pau6is�apun ayl
() sa� �uoi�euiuua� pue snnoq�a �o �aqwnu 'y}6ua� `6uizis 6uipn��ui suoi�e���ads
�am�e�nuew pue sapo� �uaLn� ��e s�aaw pue �nd/�i}se�d si wa}s�(s 6ui�uan ayl
O o� O sa� �pa�mba� aaaynn paddo�sa�� pue pa�oddns /��a�n�as si pue
'suoi��ru�sqo `uoi�e�oua�ap '�sru wa} aa�� si pue pawwexa uaaq sey 6w�uan
' ay� �ey� sa�}uan �(qa�ay pauBisaapun ay} `a�eu�n� u�;sixa ue ui�e� a� uayM
;� NOIld�I�1a3A bl�d NOIlSf18W0� ONd 2101�3NN0� 1N3A 1N3A NOWWO�
SlIWa3d 3�N�dllddt� JNIN21f18 �3f1� 1N3W3�d1d3212lO� J11313'1dW0� NI �'ll�
ADDRESS
PIN
LEGAL DESC
PERNIIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY PERMIT N• 2004-00650 �` a�.
6431 UNIVERSITY AVENiTE NE � .,
FRIDLEY, MN 55432 DATE ISSUED: 05/05/2004
�63) 572-3604 FAX: (7631571-1287
: 656 KIlVIBALL ST NE
: 033024230126
: UNAVAII.,ABLE
: LOT BLOCK
: PLUMBING
: RESIDENTIAL
: ADDITION/ALTERATION
VALUATION : $ 200.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER
HEATER
# ELEC WATER HEATERS 0 # NEW FIXTURES (EXIST OPENII�IGS) 0
# GAS WATER HEATERS
# GAS RANGES
# WATER TRMT APPLIANCES
APPLICANT
H P PIPEWORKS
3670 DODD RD STE 100
EAGAN, MN 55123-
(651) 365-1340
OWNER
656 KIlVIBALL ST NE ��� ���.J
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or locallaw
regul ' construc 'on or the perFormance of construction.
App ' ant Date
Bldg Date � �
1 # GAS DRYERS
0 # OF NEW FIXTURES
0
PLBG FIXTURES (NEW OPENR�TGS)
PLBG FIXTURES (EXIST OPENINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 8600
SEPARATE PERNIITS REQUIltED FOR WORK OTI�R THAN DESCRIBED ABOVE.
0
0
0.00
0.00
0.00
0.00
35.00
0.00
0.00
0.50
35.50
Building
Inspections
763-572-3604
MECHANICAL
RESIDENTIAL APPLICATI4N
CIT� OF FRIDI.dEY
DATE —
SI'I'E ADDRESS o
THIS APPLICANT IS: ❑
PROPERTY Npl,,¢:
OR'NER/ �vDxESS:
TENANT �
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
.�
Permit No.:
Received By:
�a.
COMPANY NAME; _
CONTACT PERSC ;��� ;(„� 410 WEST L
STATE LICENSE # Q�}�� MN 55408
2- 24- STATE ZIP
ADDRESS:
PHONE F� -- - — -- _
FAMILY ❑ TWO FAMILY
TYPE OF WORK: I � �w �L'a'�Et�'
DETAILED DESCRIPTTON OF VJORK
❑ TOWNi-IOUSE
❑ ALTERAI'ION/REMODEL
PER MS 16B.665 the permit fee is a miuimnm of $15.00 or S°/a of the total cost np to $500.00, whichever is greater, for the
unprovement, installation or replacement of a residential fixture, excluding the fixtw-es. ('Iiiis should refleet only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $5� = cost of labor � x.OS -
FOR PROJECTS WFIERE LABOR EXCEEDS $SQO, ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FD�fURB$: (IIZiD�ATE T A]
NUMBER OF EACH BELOW) l�
W %
E9uiPment Ic�ctalled . MFG: � MODEL: l/� STZE/BTU � �
MFG: MODEL: SIZE/BTU
MFG: MODEL: � SIZEBTU
$25.00 CE ( ,4S) $15.OU GAS RANGFJOVEN $1 .00
TO AIR EXCHANGEER $IS CE (WOOD) $35.00 NEW GAS GRII.L $10.00
BOILER $35.00 C�'��URNACE $35.00 GAS Ui�IlT HTR $10.00
CHIMNEY LWER $10.� AS DRYER $10.00 POOL HEATER $35.00
^DUC'f WORK $10.00 GAS PII'1Nii $10.� VEAITII�ATOR 515.�
Surcharge
TOTAL DUE
._ . _._ __
$ Numiser of fixtures @ $10.00 x $10.00 =
$ .50 Number of fixwres @ $15.00 x $15.00 = $
$ Number of fixtures @ $25.00 � x $25.00 = $
Number of fixtures @ $35.00� x $35.00 = $ -
S Surcharge = $ 4
Total ° ` � �
� ="�
�
TFIIS IS AN APPLICATION FOR A PF,RbIIT NOT VALID UNTfL PROCESS�
I hereby apply for a building permit and I acknowledge that the information above is complete and accwate; that the work will be in
confoimance with the ordinances and codes of the ity of Fridley and with the Nfinnesota -Construction Codes; that i understand this is
not a permit but only an a k is not to start without a permit; that the work will be in accorcjance with the
approved plan m the of all +�I�hich revi and approval of�ans� � �, / � ,
SIGNATURE OF
City of Fridle�
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
. 763-572-3604
FAX: 763-502-4977
�
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS EXISTtMG HOME ❑ MAKE-UP AIR
REQUIRED F�R NEW/EXISTIN..C� F�QMES .:_.:... . � .
fi� `t`
' ._. , - :;: . '2 .
1. Combustion Air (See note belo'vv-)� ;�,. �' - ' ' � .'r '
.. . . ' i:.. ' . ..
a.. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Ai.r (See note below)
a. IMC Chapter 5 wi.th MN Amendments
3. Venti.n.g
a. Ga.s appliances IFGC Chapter 5 with MN Amendments
b. Fuel other tbau gas IMC Chapter 8 with MN Amendments
REQUIRED F�R NEW HOMES
4. Heat loss & cooling load per room
a. Required on new consi�uction IlVIC 1346.0312
5. V�n�ilation __. -- - - - --
a, per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1:346.060�:2 � �-�
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make np air calculations