AF - 47972City of Fridley
AT THE TOP OF THE TN11NS
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� 1 L_�__ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
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L-_•-� ��"" �,� CITY HALL FRIDLE� 55432
t 612-571-3450
J08 ADDRESS 1648 Kristin COZ1L"t 1V. E�
SuB�ECT
BU ILDING PERMIT
NUMBER REV. bATE PAGE Of
910-F15 11/2Cl/8� � �
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 7 �. ji@d,t�r Qa,j{g
2 PROPERTY OWNER MAIL ADDRESS
Tim/Alicia Slank
3 CONTRACTOR MAIL ADDRESS ZIP
Brickner Bui.lders Ihc. 624Q Highi,ta,y #65 N,E, ,#2Q.8� k'ridl
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
5 ENGINEER
MAIL ADDRESS
8 USE OF BUILDING �
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION 0 REPAIR
8 DESCRIBE WORK
Construct a 48' x 42� Dwelli�n.g and a 25t x 25t Ga,rage 0�I
9 CHANOE pF USE FROM
TO
° 20204
RECEIPT NO.
3 y���
APPROVED BV
SEE ATTACHED
SHEET
PHONE
PHONE LICENSE NO.
5 74-�8 71
PHONE LICENSE NO.
PHONE LICENSE NO.
`Q e �� REMOVE
;ging� call: for
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STIPULATIONS
P�ovi.de City witiz copy o� yeri�i�g s:uryey before ca�ping. Provide sod
in the �'ront and side yards. �?royide a hard sux�ace dxive�nzay� Pa,id $1500.00 Park Fe .
Paid $800.00 Storm Sewe� Charge. 1�ny addition i:� exces:s o� 100 square feet will
need a variance and any room addition to rear of house would encroach into the
required rear yard; maximum deck extension in rear yard in 10 feet.
SEWER LOCATION: 85` South of Manhole (S. Inv. 958.83) lnTYE ELEV: 959.17
TOP OF FOOTIIVG: 962�50 Minimum
WATER LOCATION: South of sewer service (probably in same trench.)
ClT1' flF �RdDLEY. DOES
1�'�ACY OF UTtLI�'Y LOC,� TIGNS �i �JA�ANiEE `; y�
�ATA IS FOR INFQRf1iATi0N� PU, p��;���TrO�JS SEP�IRATE PERlV�ITS RE�U!��p s pR
PERS01r►S i.IS1NG TH1S INFORIV1A7101y ^ O��LY, V�O��EiJG, I'6tr1 i�diVC�a, PLU�at�G Ai��� ����$�
Y !T ON T
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN BO 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 OFFSTREET PARKING
1
I HEREBY CERTIFY THAT I HAVE READ AIVD EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $103,050 ��C� $rj],,.53
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS O ANY OTHER ST E OR LOCAL LAW REGULATING coN• $653 . SO $575. �O
STRUCTI THE PERFORM C OF CONS UCTION.
PLAN CHECKFEE TOTALFEE
.� ,/ � l/ ` �Ci - $�..�ZS�s�3 �-P�'' & SS
SIGNATURE OF CON i R C R OR HOH ED AGENT IDATEI WHE PROP R L D THIS IS YOUH PERMIT
, � 1 r-a�
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SiGNATURE OF OWNER iIF OWNER BUILDERI IDATEI . -� � nr_ �.�eo _.__.
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� � � Effeckive 5/1/88
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Do�structian Addre�-,,s: �(�
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Iega1 pescriptian; � o i % �G /� / ��" �i T/� �� �� %�
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owr�er lvame & Address: _//�l � G r G e,4 ���9 /d11� Tel. #
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CbrYtractor: _ � � i �/� � � � L ��� Z►e1. � J � ` % ?�
Addres.s: _� 2 �� �G�„� � ,�-" � 1,� a�
LIVIIJG AREA:
t�R��GE ARE�IL
DDCK ARE�:
OTi�R:
Attach to thi.s applicatiaa�, a Qextificate of Stiuvey of the
lat, t�rith the pYCpo�ed coa�stivctiaa� drawn � it to scale.
�:'6�PTI�T �' II�'lmV8�T1'
Tpr� h Width Heic�t Sq. Ft.
�h Width Heic�t __ Sq. Ft.
_._
Width .__ Hgt��� Sq. Ft.
C�orner Lot [] Inside Iot �] Ft. Yd Setback �.f J Side Yard Setbacks �!� Z' �
�Yt� of Cbnstn�ction: F��An/1 � SWG ,G�7!'1 F�titmatgd Cbst: $�'J
�0
��X. ���.� ��: � � - � � � 6 � o�
Pttiposed Driveway Width If New Desired� Ft. $ $
W� + 6' See Back Page
n�: �/ �/3� � �c�rrr: �_ � S� _ �
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Pietmit Fee
State S�rdzarge
SAC Qzarqe
DriveHray Escr,a„i
park Fee
Se����
�rcruh► Sr�w��.
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$
S �1 A�'�
$ _ ���� �
$ ���
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C1�R �E G[iII�Y
Fee Sci�edule an Reveise Side
S•so/Sl,oOO valuatian
$575 per SAC Unit
Alt. "A" Or Alt. �'B° Above
Fee Determined bY F��ginePSing
� �iOi�Y [ ] Not NeaessarY [ ]
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I: 11� � �lS �-".'v�Y _ Jr_ _•.I:n�_IJ }
Zhe Chief Buildir�g Official shall, before ;�Q,; *� pexmits for the erection of any
buildirg or stn�ture, or for any additioaz to any existir�q buildir�q or stsucture, or
for any alteratic� or rqaair to any e�d..,�ting building or �, �oai application
therefore, z�equir�e the paym�nt by tbe applicant for sudi �*�++; t of fees to the amo�uit
iyerein below set forth and in the manner l�erein prwided t�o-wit:
TO►7'1�iL VALIJE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
� a.
$15 (Minim�na Fee is $15 plus su�ti�ar9e)
$15 fa�r first $500 plus $2 for each additional $100 or
fraCtiaa'► thezeof, to and ir�cludir�g $2, 000
$45 for fitst $2,000 plus $9 for each additional $1,000
or fractiaai theraof, to ani including $25, 000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fractiaa� thereof, to ar�d including $50, 000
$414.50 for fi=st $50,000 plus $4.50 for eac3z additional
$1, 000 or fractioai th+eraof, to and ir►cluding $100, 000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction the.reof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1, 000 or' fractiCO'► thet�eof, t� and including $1, 000, 000
$1,000,001 ar�d up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
�tIV�Il�IY �SIC�T FSC[i0W
(Ooa�te 41rb Streets On1Y)
Alternate ��A�� ; Relocval and re�lao�oent of cu� and gutter only - Driveway width plus
6 feet time� $13.50.
Alteznate "B" : Removal arid replace�ent of c� at�d gutter ar�d install a 3 foot wide
approadi with 6 inii �� - Driveway width plus 6 feet tim�s $15.75.
.�- -. �� �.�� .:
Permits for �icai wi11 be 3ss�ed g+nini,Rn++ of 24 i�ut5 fY�u tiie time of
applicatian to allcw for prc�per review of the pra�posed stn�re arid of the
co�stn�ctica�► site.
A Oertificate of S1�rvey of the lot, st�owing the locatia� of the fauxiatiaa� aaxre it has
it has been oonstivcted urill be required before prooae,dir�g with the fzamirg.
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RONALD F. NIEYER
LAND SIIRPEYOR
LAND SUliVEYIN6 SVBDIVISION DE91GN
TELEPHONE 771-45H6
995 JE391E ST. $T. PAUL. MINN. B°5101
I hereby certify that this survey was prepared by me and that I am n duly
Registered Land Surveyor under thF: laws of the State of Minnesota.
/-- /
Req. No. 9051 Date: ( `'
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Scales i" = 40'
o Indicates iron monument
Is�t �. Block 1� HEATHER OAKS, Anoka County� Minnesota.
Contains 9000 aq.ft.. ZHE CITV OF:FRIDLEY DOES NOT GUAR�INTEE T�IE
��CURACY O� UTILCiY LOCR�fIONS,,�fVD ELEVATIOf�S.
�ES� DAT�4� IS FOFd.IRfFOP.NIATION PURPUSES 0@I.l,Y,
p� �ERSONS IJSI!NU THIS l�VFOi��MAT�,ON: �LOUL��
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, �architecturoJ �onsultv►nts inc.�
�.�_b008 _b� SL s. E. OSSEO� MN. bd368 Pii; ld�?1-4l4-9TTZ �
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iCOntrOCtO�J ��-' G rC. N� ��-A R� -
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�ite Address:
I)TOTAL EXPO�ED, WALL AREA r�'Z� sq. ft ��U�� '- � ''
, 2)TOTAL EXPOSED ROOF�CElLiNO AREA.. '� s'�� sq. ft. x'U���°�O '�
MIALL AREA CALCULATIONS� .
?OTAL WINDOW AREA
GLAZED
TOTAL DOOR AREA
70TAL GLASS DOOR AREA
__ = GLAZED
�OTAL fIREPLACE WALL -AREA
70TAL WALL FRAMING AREA
NET INSULATED WALL AREA __. ..
�OTAL RIM JOIST AREA
TOTAL FOUNDATI01� AREA (EXPOSED)
TOTAL FOUNQATION WINDOW AREA
' �jo°
sQ.ft.x�U�� `�= s �
.'�c� gq.ft.x�U�� • 01 - � � 7
��' sq.ftz�U���= ���
�-� sq.ft. x �U�� �� - �� p
� Zo �sq.ft.x�U"'_�= o ' �
0
_ � � sq.ff.x�U�� � G =�� -
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� sq.ft.x�U��' �4 = �
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_ ' � 3) TOTAL
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._ If item 3 is the same as,or less thanitem l, you have met ihe /ntent of
2 MCAR 1.16008 A an d D.
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ROOF/CElLINO CALCULATIONS�
_TOTAL SKYLIGHT AREA `° �q.tLx�U��'�Z- - 3' 9"
JOTAL ROOF��'iEIUNG FRAMINO AREA � SS .q,{�x'V" • ou}. �. b�
NET INSULATED ROOF CEILING AREA ��p° sq.f�x�.U����u` � '°
�- �.Z
- � -- --• ------- - . - - - _.. .- -:------- _ __ . . _ 4� TOTAL .
-__ If item 41s the some as,or less than ltem 2, you have met fhe intent of . ,
2 MCAR 1.16008 A ond 0. �.
ALTERNATE BUILDING ENVELOPE DESION � �
�• To utilize the totol envelope system method, the sum of ltems 1 and 2 shall �
: be �reater than the aum of ltems 3 and 4. . _. _ ._ .. :. � j.
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_ J hereby ce►�ify fhat the bulld/np here described meets or exceeds Stote of es a
Enerpy Conservotlon Act. � � ,
. . (slgned) .�4-�/
:�,1c � .�. I ��-. 2�-�-�
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CO�ISTRUCTION
FRAMIN(3 SECTION
� i�terlor alr film 0.68
2 � •� S/iL,P�� . �
� St lnches of sofi wood �,g1
4 ZS'I 9c 4�.���+¢++E' �L o i�
� SIO�r-1� � �s�
g exterior atr fllm p,17
. TOTAL R � � � °
- - ' U = 1/R ' °�
SECTION (INSULATED)
� lnterlor air film 0.6
2 ~��� �4S
3 S� '' A..�e.�+ �►-+'� �, c,
4�1 sz. e�� �e � L.o c.
5 's�w�.k •S 1
g exterior alr film p,�7
• TOTA L R Z.3 � �
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�IST SECTdON �
J interior air fllm 0.68
2 5 ��-� i+ 1..�. 19, o
3 �'d � �C�...�.o � 0°1
4 l3 (� �i�.F� t.�.c��
rj ��a�iJe_� � �Sl
� exterlor air film • p 17
- � TOTAL R � � �
U = I/R d o
ATION SECTION ,
� lnterlor aTr iPlm 0.66
2 �u�-r� �..��. o
3 � ��G+.� c�l� 1 „?�
a exterior Qir film
5 017
- - TOTAL R �'-S
- . U = 1 /R ' �.�
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, �CONSTRUCTION � � � � - . _
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VENTED
_ _�EtUNG�ECiJON ��INSULATED)._ .___.___ _. � .. _:_. . _. .' . :
_ __� ( � �iMerPor alr fllm 0.61 . __ _ � .
� � 2 � ��� ¢+NEETtz ac..k � 5� - -
---�-- r—• - ------ ---
, 3 'F�a,.��, �..��..� 44 ----.._...
�__��q exterlor afr film (still) 0.61 _.,.
_. – ; , ,
� ___ _:.� _:--._ : ---- _ _ __ -.---- TOTAL R ; 4�.7 S _ '
. ; . U = J��Z , DZZ
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�EILING FRAMING SECTION ._ _.� .____. �_ _.____ . _, _
,j�� lnterJor alr film ' - 0.61 �
_�Z�'B � Strer�ra.e�,c , Sto . . .
_ ( 3 �.LOw,.� I Msu�., 33 _ .
.�q inte►ior air film 0.61 --._._ _-,-
(5 ��iinches of �oft wood 4��5 _'__ _ __
� � . TOTAL R 3`�.13
. _!.i = I /R � _ .
�EILING SECTION i INSULATED).
__ _ � � lnterlor Qir tilm 0,6f
=---�2
13
_:__ ___ (q exterior air film (sttll) 0.61
� ___ ; _ _ ._ _ ._ TOTAL R
, i . U = 1 /R --
__�EILING FRAMING SECTION _ _ � �
: �;�.inferlor air film � 0.6J_
. --(e
—(3
4�q. interlo► afr film 0.61
_ _ (5 �nches of soff wood .
, TOTAL _ R � .
_il __ = . i /R
EXPOSED BEAM CEILING SECTION , �. � •
._ (� .lnterfor olr t!!m 0.61
(2 ' _ ...
. �3 ' -- .
(4 - -- -� -
(5 exterior air film 4•�7 . ..
------• --- --. _. _.. _ . . . .. TOTAL R - ----
��
� L = J/R ----
RONALD F. MEYER � �p �( �
LAND SURVEYOR
L4ND SURVEYING SUBDIVISION DE91GN
TELEPHONE 771-4586
985 J£S91E ST. ST. PAUL. MINN. 55101
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I hereby certify that this survey was prepared by me and that I am a duly
Registered Land Surveyor under the laws of the State of Minnesota.
/—^ 4` (� , I` � c�
Reg. No. 9051 Date:
/�o. Lo .Jec. 2 7, �989
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Scales 1" = 40'
o Indicates iron monument
Lot 7. Block 1� HEATFiER OAKS, Anoka Countye Minnesota.
Contains 9000 sq.ft..
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O
CHIMr�EY AN� STACK vERiFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (,)
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. Meets all current Code requirements for size and
total BTU connected
6. Has Total hea ting BTUts of
Al1 other BTU's
TOTAL
Rema rk s
No ( )
No ( )
No ( )
No ( )
. Yes ( ) No ( )
Company
Signed By
Da te
�:. 7��{ , R �-�
E�
� �:
L..�:,_'°',.
CIIYOF
FR(DLE�
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
April 26, 199.�.
Brickner B.uilders Inc.
6240 Highway #65, #208
Fridley, MN 55432
Re: Final Inspection at 1648 Kristin Court N.E., Fridley
Dear Sirs:
A final inspection was conducted on April 26, 1990 of the above address
and the following items were noted which.must lie completed before the
structure can he finaleds .
1. Provide sod in the front and side yards by June 15, 1990.
2. Provide a hard surface driveway by June 15, 1990.
We will e�ect the above items to be completed by the scheduled date
when a reinspection will be conducted to determine compliance. If you
have any questions�on thi5 matter, please feel free to contact me at
571�3450.
S i:rvicerely ,
DARREL G. CLARK
Chief Building Official
DGC/mh
Srickner
Builders
6240 Hwy. 65, Suite 2(l8, Fridley, MN 55432
574-9871
��n�, 2� . t99�
Date
I grant permission for the home at I(p �$ ��' ���i YL CT �
which is next to my home at �(p � �V-i S'�`iY! G'}'
to have their air conditioner installed on the side of their home.
��� %�o
Date
A�T°""ATI�
`� GARAGE DOOR
& FIREPLACES
,
�.
e
�
�:
:
�o � i 7-��
�
vr
220 - 77TH AYENUE N.E. / MINNEAPOLIS, MINNESOTA 55432 (612) 571-2525
� �
s � ��-� �
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a��-7-�rt�� ��� ti�
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�71� as�s �+ 1��
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'L�,� G����
sue�ecr RMIT N .
City of Fridley � �, � � 3
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � REC IPT NO.
� • COMMUNITY DEVELOPMENT OIV.
r � L � PROTECTIVE INSPECTION SEC. ���
i �
� 1 /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE vpGE OF APPROVED Bv
�""�' �'' 612-571-3450 910-F15 10/7/96 � �
JOB A�DRESS 1648 Kristen Court
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 7 1 Heather Oaks SHEET
2 PROPERTV OWNER MAIL ADDRESS 21P PHONE
Alisa Frank, 1648 Rristen Court, Fridley, MN 55432 571-7776
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Automatic Garage Door & Fireplace, 220 77th Ave, Mpls., MN 55432 571-2525 1990
d ARCHITECT OR DESIGNEFi MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASSOFWORK � NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑�REMOVE
8 DESCRIBE WORK
Set and vent of gasfireplace.
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCY LOAD
SEPAfiATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OFi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �2 � OOO. OO tate SC � 1. OO
WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- @62�25 ire SC �L.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �
PLAN CHECK FEE TOTAL FEE
� ��� �0�� —�` icense F $5.00 $70. 25
SIGNATU�7EOFCON�AACTOFIOAAUTHOA�2EDAGENT �DATE� pqpp R VALIDATE IS IS VOUR PERMIT
/6�7-��
S�GNATURE OF OWNEA i�F OWNER BULL�ERI IDATEI d DG iNSP �1aTE
�tr—iy—i��b
1�! �W �
` ADDN [ )
�.-T�t [ l
b�=4� L11Y Ur rK1llLtY olt Jrl LGOr r.�libG
� � �� � � S� Effective 3/1/96
CFT'Y OF FRIDL,EY y�, ��
SIlYGLE FAMII,Y AND D�i'i,E�S R-� ANb R-2 —"�
Buiiding Permit Applica�tion l� U, `:�
�����J°
conscructioaaaaress: 0 (p �g � r+�+tn �
Legal Description:
Own,er Name & Address: � {� �2 , � ��' ���, �r��Cr Tei. #
�7/ � 7?7('pp
ConuaciOr- _�N�Y�YYlra�cC, l��a✓r.�� ��� r�c �ve �I.C�Cl1> MN LICEi�iSE #_ / 9 qC' --
Address: ��Cj - 7 7T1� �� �1J � ��pl� �'Y �v b � �/�� Tei. # 57/ aSaS
LiVIN6 AREA:
G�A1t.A�,GE A,�tEA:
DECK AREA,:
4'THER:
A.ttach to this application, a Certificate of Survey of the
lot, with the proposed coas�uction drawn on it to scale.
DESCRIPTION QF �11rIPRfJ'YL'MENT
Lengt� Widrh • Heig� S�. Ft.
I.ength �Vidth Height Sq. Ft_
I.en�h Width �igtlGrround Sq. FL
' ��,�" Qvv1 c� U` CGYI� �', � �G� � J�e � CQ� ( �I Ce S � l n�S %� � �f�e.'1S �
Cotner Lot [� Inside Lot ( j Ft Yd Sex�acic � Side Yaxd Setbacics �
'I`yge of Coastivction: Escimat� Cost:. $ �' �� � � O
,A�pr�x- Camplenioa Date: � - - . . .
. . . . • {Cos�-�on Back) " . , .
Driveway C�r� Cut Width Needexi: Ft. + 6 Ft = Ft x� _$
DATE: j U��-�� APPI.ICANT: .;�_�✓u� Ct� Y"� Tei_ # 5 Z 1•�.5��-J-
�, , .
Permit Fee
Fire Stu�charge
Sta�e S�ge
SAC Charge
Licen.se Surc�arge
Dr�veway Escrow
Erosion Control
Park Fee
Sewer viai�n Charge
TOTAL
S'I'IPUI.AT'IONS :
.u:,�
CTTY US� ONLY •
$ lo,? �S � Fee Sc�eduie on Revetse Side
$ , d 6 .00I af Permit Valuatian (Xllthh%)
$ /, c�G $.50I$1,000 Valuanion
� �900 ger SAC 'Cimt
$ s a v �S.OQ (State Lice�d Residential Conrracto�s)
� Alt. "A" or Alt. "B" Ahove
$ $45o_00 Conservation Plan R,eview
� Fee Deiermined bY Engineering
$ Agr�menc Ne�essazy [ � Not Necessary [ ]
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CHIMNEY AND STACB VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2.
3.
4.
5.
6
Is free from rust or deterioration
Has no foreign objects lodged within
Is securely supported
Meets all current Code requirements for size
and total BTLT's connected
Has tota.l heating BTU's of
All other BTLT's
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks:
List ALTERATIONS Be'�ng Done•
HEATING CO:
Signed By:
Date:
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( � ) No ' )
�
Yes()1Vo()
sue�ecr P "1T NO �.
City of Fridley 30948
AT THE TOP OF TME TWINS g U I L D I N G P E R M i T
r
; � RECEIPT NO.
� `y _ COMMUNITY DEVELOPMENT DIV. � � �
r � � PROTECTIVE INSPECTION SEC.
� . .
� j �"'f � CITY MALL FRIOLE� SSIJ2 NUMBEp REV O�TE v�GE OF �vvt�OVEO Br
�""'�" �'' 612-571-3450 910-F15 5/18/00 / �
JOB ADORESS 1648 Kristin Court NE
t LEGAL �OT N0. BLOCK TpACT ON ADOITION SEE ATTACMED
oescR. 7 1 Heather Oaks SHEET
2 PROPERTY OWNER MAIL AOOFIES$ ZIP PHONE
Tim Blank 1648 Rristin Court NE 571-7776
3 CONTRACTOR MAIL ADORESS 21P PNONE LICENSE NO
Same
4 ARCMITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDi;ESS 21P PFIONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOfiK
� NEW O ADDITION � ALTERATION ❑ REPAIR p MOVE O REMOVE
B DESCRIBE WOIiK
Basement Finish
9 CHANdEOFUSEFROM TO
STIPULATIONS
See notations on plan.
�EPARATE �ERMIT�
RE�UIRE� ��R:
VUIRIhB�, ��A�P��,
�LUM�I�� ������ ����st3�
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAp
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL. PLUMBING. HEATING,
VENTILATING OR AIR CONDITIONING
THIS PEHMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED fOR A PERI00 OF 120 DAYS AT
ANY TIME AfTER WORK IS COMMENCED. NO. DWIG. UNITS OfFSTAEET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TNIS APPLICA7tON 1 STALLS GARAGES
AND KNOW TME SAME TO BE TiiUE AND CORRECT. AlL PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVEqNING TMIS TYPE Of WOFK WILL BE COMPLIED @
WITM WHETHEF SPECIFIED HEREIN Oii NOT. TME GRANTING OF A PERMIT W 13 s OOO �G . SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL TME pEqMIT fEE SAC CMARGE
PROVISIONS OF ANV OTNER STATE OR LOCAI LAW REGUTATING CON• �237 � 25 Fire SC �13 .00
STRUCTION OR 7ME PERfORMANCE OF CONSTRUCTION
PLAN CNECK FEE TOT FEE
56.75
S�GN/1T EOFCON' TOpOAAUTMONiZEDeGENT �OArE� I�EN PROP ALIO THIS IS VOUR PERMIT
� R� � �
S�GNATUAE O� OWNE WNEp B DEp� �DATE� Bl �NSp �7`TE
� �'1L%%°l� e
;r�
NEVV [ j
ADDN []
ALTER [ ]
Effective 1/1/2000
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
Construction Address: �[O � CV T� �, lS-�-i`v �— ,
Legal Description: �-��'-�%L..��v � C S , _ ,� 'f� �T��o c �C �
Owner Name & Address: � r�vt �� � Tel. #� I � �7 1 - � � � �
Contractor. fr t�� c�.-elJ . MN LICENSE #
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Tel. #
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
Width Hgt/Ground Sq. Ft
��a� �' �� $ /�'��
Construction Type: ��� ��1q�� Estimated Cost: $ l�,��4 ��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: J � "O APPLICANT: � � Tel. # C��Z �% ! --� 7% ��
��,���s �CC �
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $��7• o�., Fee Schedule on Reverse Side
Fire Surcharge $ /� � D� .001 of Permit Valuation (1/10th%)
State Surcharge $ ,�p � �� $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
$.
$1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
Sewer Main Charge $. Agreement Necessary [] Not Necessary []
TOTAL $_ �4�/ � �
STIPULATIONS:
BUII�DING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the er�rion of any building or structure, or for any
addition to any existing building or structure, or for any altera.tion 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 $2,000
$2,001 to $25,�0
$25,001 to $50,000
$50,001 to $1�,000
�
$100,001 to $500,000 `
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $5� 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 $50,000 �
$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 $1Q0,0(10 plus $5.60 for each additional
$1,000 or fracdon thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,0(}0 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Ci�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 wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issned a minimum of 24 hours from the time of application 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 will
be required before prQCeeding with the framing. New Houses Onlv
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sue�ecr IT NO.
C�ty of Fridley 31016
AT TFIE TOP OF THE TWINS g U I L D I N G P E R M I T
f
; ` RECEIPT NO.
� ; y ����� COMMUNITY DEVELOPMENT DIV.
r � � PiiOTECTIVE INSPECTION SEC. ���3
1 = �
� �'�'1 � CITY NALL FRIOLE� SSA$2 NUMBEF pEV DATE PAGE OF APPROVED BY
��°"� � �'' 612-571-3a50 s�aF�s 6/5/00 / /
lOB ADORESS 1648 Kristin Court NE
1 LEGAL LOT NO. BLOCK TNACT OR ADDITION SEE ATTACMED
oesca. 7 1 Heather Oaks SFIEET
2 PROPERTY OWNER MAIL AODRES$ ZIP PMONE
Tim Blanlc 1648 Rristin Court NE 571-7776
3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Rite Way Waterproofing 448 Lilac St, Lino Lakes, MN 55014 786-0550
4 AiiCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Interior Basement Drain Tile System
9 CHAN(3E Of USE FROM TO
STIPULATIONS
Electrical extension cords can not be used as part of the power source to the
power source to the pump. Drain tile can not be connected to the sanitary sewer
system.
�
�efore d�yAs�� �all foP
�II �tility loeation�
�E�UIRED °�
�Y LAW
riPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAO
SEPARATE PERMITS ARE REOUIRED FOF ELECTiiICAL, PIUMBING, MEATIN(i,
VENTILATING Op Alii CONOITIONING.
THIS PEfiM1T BECOMES NULL ANO VOIO IF WORK OR CONSTiiUCT10N LONING SO. fT CU FT.
AUTHORIZED IS NOT COMMENCED WITMIN 80 OAYS. Op IF CONSTqUCT10N
OH WORK IS SUSPENDEO OR A9ANDONED FOR A PERIOD Of 120 DAYS AT
ANV TIME AFTEii WORK IS COMMENCED. NO. DWLG. UNITS OfFSTREET PARKING
I NEREBY CERTIFY TNAT I HAVE READ ANO E%AMINEO TMIS APPIICATION 1 STALLS GARAGES
ANO KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PFOVISIONS OF LAWS ypLUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED @Z 886 �1.L}/�,
WITM WHETMER SPECIfIED HEREIN OR NOT. TME GRANTING OF A PERMIT �P �
OOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TNE pEqMIT FEE SAC CNAFGE
PqOVISIONS OF ANY OTMER STATE OR LOCAL lAW REGULA7ING CON- $83 � 25 Fire SC �Z .89
STRUCTION OR TME PERFORMANCE OF CONSTRUCTION
PLAN CNECK FEE TOTA� EE
city � � 58
S�GNATUAE OF CON"FACTOA Op aUTMOp12E0 OGENT IOATE� EN FOPE LIDAT D IS ]SOUR P�iMIT_ _
/ / Jl/\
/i�!/ �/ / J
C7 �TcJ V��
S�GNOTUAEO�O�NNEA��FOWNEABUqDEAi �D�tEi BLD � S� ����E
s
JUN-05-00 MON 11:14 AM
Prepaid Plan Check $
Esti.mat�d cost So"� ��(, . o 0
ttece�pt #
,����,��'ITY OF FRIDLEY
�, COIyIIrlERCIAL & INDVBTRIAL
BIITLDINO PERMIT APPLICAT�ON
Congtructioz� Address l��� ��(' � s� t^ �Jl�f '�"
P. 02
E£fective 1/2/2000
(612)572-3604
ol�°y�
�' ��
Zaning �
�eCal
O�er & Address T �� �j l(��k I(a 4 F k.�/: �}�i� C f: Tel# ((p1�) S%�" 7 i 7 C�+
CON�'R4CTOR & ADDRESS �� r �{,v�� ��Aya �y,� Tel# (�j,) �F_S'[_ � [15,,�,A
�.+� 4t L' I c�. �.��-,r�� �-- ,(_�e� (�s lr o� .�Q ) S�"�� �/
Architect Reg.# Er�qineer Reg.#
HU�LDINC: CONSTRIICTION
TY�FE OF WORK [] New [] Addi.tion `(�pAlteration -Deacribe
n�C. AR.EA: Length Width Height Sq. Ft.
W:ISE AREA: Lengtk� Width Height Sq. Ft.
oTt�ER AREA: Ler3gth ,�� W�,dth Height Sq. F�.
�
�.P��,zcarrr l Te� � L�/-7dr�-ai'�� Date ��_s_6rJ
VALVATION
S�d •�'� • x$ Cost/Sq. Ft. o valuatioa $ ) � 4� �,
5q •�'� • x 5 Cost/Sg. F't .- valuation S ) a$ � C-
Sq. kt, x$ Cost/Sq. F't. = Valuat�,on $ ) TOTAL VALUE
Building Use Construction Type V� Occupancy Group �s;�u ��
Ai � Conditioaing (] Yes (] No F'ire Protection Provided [� Yes [] No
Pezformance Boz�d Amount $ ' See Reverse for Schedule Received (�Yes [)No
Dermit �ee s 3. a S
p�.an Check $
Fire surcharge $_ �, g �
State Surcharge $, / , t{[�,
sAC Charge $
�ras�on Contxol $
�ark Fee $�Q `�,,��o � .��
5pec. Asaessments $
Driveway Escrow $
�oT�w S�. S�
-
�ERMIT FEES
See Fee Schedule on Reverse Side
In Excess of Prepaid AmounC - See Reverse Side
.001 x Fermit Valuati,o,n (1/lOth Rr)
$.50/$1,000 va�uation (See Sehed, for > $1 Million)
$1100 par 3AC IIriit (Plans to MWCC for determiz�,atlo�l)
$450.00 Conaervation 81an Review
Fee Determined By Engineering
A+greement Neceesary [1 Not Neeessary []
_ feet X $15.50/�OOt
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existina furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstnactions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all cuRent 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 current codes and manufacturer's specfications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specfications.
Yes ( ) No ( )
Yes( ) No( )
Yes ( ) No ( )
When installinca a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
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 current codes. Yes () No ()
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat -
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describel
HEATING CO:
Signed By: Date :
� _
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CiTYOF
FRtDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 57 t-1287
August 9, 2000
��i1:�FTiT7
1648 Kristin Ct. NE
Fridley, MN 55432
Re: Final Inspection at 1648 Kristin Ct. NE
Contractor: Owner and Fireside Corner
Dear Mr. Blank:
A mechanical permit was issued on May 23, 2000 for the property located at
1648 Kristin Ct. NE for additional ductwork in basement and gas fireplace.
According to Section 305(a) of the 1991 Uniform Mechanical Code a final
inspection shall be performed on the mechanical system. As of this date no
inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do
not hear from you, we will expire the permit and any inspections on this
installation will require a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
DAT/E,/�ENSEN
Buily�v(g Inspector
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COMMON VENT. VENT CONNECTOR AND CON :'lON AIR VERIFiCATION
When replacina an existing furance, the 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 ()
The venting system is plastic/PVC and meets ail cuRent 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 current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existinct combustion air is sized and installed to meet the current codes
and manufacturers specifications.
Yes { ) No ( )
Yes ( ) No ( )
�VF-ien reqwr o ms a nev�i ca�t�u�ti�n air; it wiil tre -sized and ir�siatler!- -- -- -- -
To meet the cuRent codes and manufacturers specfications. Yes () No ()
When installina a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed coRectly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No (�
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan As�i�..���;;�,�
Total Appliances Total Btu Input ����°" ;��
�� � R � � .
1� GD � :� ��,a
Common Vent Type Vent Height Diamet� '� ����ches
,���
Appliance #1 Vent Connector Height ft Length ft Diameter ���e
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS• (Describe)
HEATIN� C�:
Signed By: Date :
Building BUILDING Permit No.: - " ` �=� �
Inspections RESIDENTIAL APPLICATION Received By: �,�
763-572-3604 CITY OF FRIDLEY vat��(jt: �
763-502-4977 FAX �,.�,-,�s
DATE iJ 13 � YOUR � ADDRESS J ��'.N�fi'./� �/1.4J C��S f'�vc%ro n. �OS^-
�� r
srrE nnnx�ss � d
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY OWNERJ NpME; Sco � �/li�//ot�
TENANT ADDRESS: l b4� Kr. � s r�n �'� CITY rr�o(/e�i STATE�ZIP_ S�/3y
PHONE: �c�Z ' `7 �79 �`/S ° 3
NAME: v � -g o.�s ��t ��N /,d�
CONTRACTOR .�nD1tESS: 1�a �G � W�-� N� CrrY +�' �% STA'rE,�l.�ztr �s"yS'
SUBMIT A COPY OF PHONE l/y- 96 �9- 70� � FAX 7�3 ��6 7-'� z>
YOUR STATE LICENSE STATE LICENSE �i �� yU � Z SU EXP DATE
PROPERTY TYPE G mr�w coxs�xucr[ox srzE
TWO FAMII.Y/NEW CONSTRUCTION STORIES
PERMIT TYPE � O AnDrrtoN ❑ GARAGFJSHED ❑ WINDOWS
O BASEMENT FINISH �ItOOF ❑ DRAIN TILE
❑ DECK D�IDING ❑ OTHER
0 SWII�Il4IIIJG P�L
TYPE OF WORKI ❑ NEW HOME CONSTRUCITON ❑ ADDTfION
p MAINTENANCE/REPAIR MODELING
DESCRIBE WORK BEING DONE: 'r�1r i�' �� "�
SIZE OF IlVIPROVEMENT LENGTH WIDTH HEIGHT S Ff
� � 3 O�JAUSE ONLY BASEMENT REMODELAVG SUBMIT:
NUMBER OF SQUARES �HOUSE & GARAGE 1. Existing Floor Plan
GARAG ❑ ATTACEIED GARAGE 2. Proposed floor plan
PROPOSED SIZE: O DETACE�D GARAGE 3. List of stractucal members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING .ADDTfIONS. & PORCHES SUBMIT:
❑ Vi�l �Soffit
❑ plumiaam O Trim 1. Site Plav/Survey showiag the exisdng suucturres
0 Other ❑ Fascia �d P�Pos� P%l�
2. Two seta of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPININGS OYes DIVo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIlVDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALL
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
7 mo SING THE 997 UBC FEE SCAEDULE)
� ��a�. OCCIJPANCY
$��'d ,��, See Back Page for Fe,e Schedule
�
$ 65% of Building Pern7it Fee
$ ���' .001 times the total job valuarion
$ �% ej .0005 x Permit Valuation Minimum $.50
$ ��� $5.00 (State Licensed Residential Contractors)
$ $1825 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ a, e� Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building petmit and I aclmowledge that the information above is complete and accurate; that the work will be in coaformance with the ordinances and codes
of the Ciry of Fridley and with the Minnesota Construction Codes; that I undetstand this is aot a permit but only an application for a permit and work ia not to atart without a
permit on site; that the work will be ia accordance w't/h /the a pmved plan in the case of all work which requires review aad approval of plans.
SIGNATURE OF APPLICANT �/� �� PRINT NAME /l/,4T� v�."� N DATE �� d�
APPROVED BY DATE
=�5 l
Building BUILDINC,T Permit No.: — 0� ��
Inspe�tions RF SIDENTIAL APPLICATION xeceived By:
763-572-3604 CITy OF FRIDLEY vate xec'd: I-5 �-
763-502-4977 FAX EFFE�,.�,-,-os
DATE ' ^ � YOUR E-MAIL ADDRESS �� O�� AJr1 � h W CO 1'is }�LL G'�'1 D1(i • C(3:i�
SITE ADDRFSS �0 � 7 � I S'f l ii C- •
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY OWNER/ NpME; S C v}.r Ch j� Of.i� r
TEN`�T ADDRESS:�(1�Ig KY1S'I'�iil C�• CITY 1 R1 I'�.V STATE,�iZIP SS�132
PHONE: �IF� �0 � 2"_I � I— H 5 0 3
NAME: t
CONTRAC'roR nnnxESS:18 � 1��� t�VV�P . N E crr�r •�. STATE� SS i�2-
SUBNIIT A COPY OF pH01vE'� V 3- S 11— I� 3� FAX 1 L� 3�� l.0 -j - I2�-'�
YOUR STATE LICENSE STATE LICENSE # ZO�I ��S O EXP DATE ��� — O�
PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE 0�DTI'ION ❑ GARAGFJSHED ❑ WINDOWS
❑ BASEMENT FINISH � ❑ DRAIN TII,E
O DECK � SIDING O OTf�R
O SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCI'ION O ADDTI'ION
❑ MAINTENANCE/REPAIIt REMODELING
DESCRIBE WORK BEING DONE: �� ['�.t
SIZE OF IMPROVEMENT LENGTFI WIDTH HEIGHT S F7'
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBNIIT:
NUMBER OF SQUARES � HOUSE & GARAGE 1. Existing Floor Plan
GARAGES O ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACI�D GARAGE 3. List of strucdual members W be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ V�y� OSoffit ADDI1'IONS. & PORC[�S SUBIVIIT:
❑ pluminnm 0 Trim 1. Site Plan/Survey showing the existiag strucGues
�Other �J'��e ❑ Fascia and proposed pmject.
2. Two seta of construction plans
WINDOWS 3. Energy Celculations
IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS '
OR FOR NEW OPININGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING TI� COST OF LABOR AND MATERIALS:
TOTAL JOB VALU
Permit Fee
� Pla.n Review
Fire Surcharge
Surcharge
License Surcharge
.SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
THE 1997 UBC FEE SCHEDULE)
� �" 14[�-so�'
$
$
,
$ � c��
$ �,
$
$
$
$
OCCUPANCY '
See Back Page for Fee Schedule
65% of Building' Permit Fee
.001 times the total job valuation
.0005 x Pernut Valuation Minimum $.50
$5.00 (State Licensed Residenrial Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks navable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in conformance w+ith the ordinances and codes
of the City of Fridley and with the Minn�ota Construction Codes; that I understand this is not a permit but only an application for a permit aad work is not W atazt without a
permit on site; that wo wiU n accordance with the approved plan in the case of all work which requires review and approval of plaas.
SIGNATURE O APPL T ►�-- PRINT NAME rn��l f� DATE 11' g
APPROVED BY DATE 1 � �d
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERNIIT
RESIDENTIAL PERMIT APPLICATION HVAC
J NEW HOMES/ADDITIONS ,,�EXISTING HOME LJ MAKE-UP AIR
REOUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil Qr solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel trther than gas IMC Chapter S with MN Amendments
REOUIREII► �OR NEW �OMES
4. Heat lass & cooling load per room
a. RequYred on new construction IMC 1346.0312
5. Venrilation
a. Per MN Energy Code 7670 or 76�2
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Gui�eline�s software may be used for
combustion and make-ap air calcalatio�s.