PRE 2010 DOCSCity of Fridley
SUBJECT
P
1322'7
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RE T NO
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE
LaS
1 INSPECTION SEC.
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
�4 /'•�1 CITY HALL FRIDLEY 55432
"•"' �'� 612-560-3450
910-F15
9/26/75
I �
JOB ADDRESS 6450. Squire Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
4
Harris Lake Estates SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Brickner Builders Inc. 6245 Ben More Driv a N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 - CLASS OF WORK
Cj NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 251. x 46' Dwelling and a 20' x 25'. Garage
9 CHANGE OF USE FROM TO
STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before
capping. Provide sod in the front and side yards. No floor elevation
below 866.0
SEWER LOCATION: (Approx. 8' Deep) 10' South of Manhole (Inv. 881.50)
Wye Elevation: 881.45
Top of Footing: 884.45 Minimum
WATER LOCATION: 25' North of Hydrant, 25' West of Manhol�LLQ
FoF/o
`�CrR/C,G Nil,
SEPERATE PERMITS REQUIRED FOR WIRING,
HEATING, PLUMBING AND SIGNS. �� 4S410
L
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOA
VENTILATING OR AIR CONDITIONING.
Wood Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
R-1
1465 + 500
17,580 + 5,0
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120,DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
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 COMPLIED.
$21. 00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$42.000
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-
$325.00
STRUCTION E PERFORMANC F CONSTRUCTION.
$5$.79
J^ � i�
PLAN CHECK FEE
TOTALFEE
,
1 $404.79
C-STGNATURE OF CONTRACTOR O UTHORIZED AGENT (DATE)
PROPERLY VALIDATED THIS IS YOUR PERMIT
e
yWHEN
u-,bLa C&,0Lk, / aG d a�
BLDG, INSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
APPLICATION FOR RESIDENTIAL, ALTERATION,
OWNER'S N&ME :
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
BUILDER: X ` ✓� I ��� ��Z S ��C
ADDRESS: ADDRESS : G/ t 4�'(— '('f-e'(s R%'e-r
NO:. STREET: QVI
�r
LOT: S BLOCK: ADDITION ; ��� ( /CS
CORNER LOT: INSIDE LOT:_ -,/—SETBACK: SIDEYARD:
Applicant attach to this .f-orm Two Certificates of Survey of Lot and propose
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front • 76'5—Depth: 4 Height:
Square Feet: 1 Cubic Feet: ®
Front: ` Depth Height ®02
Square Feet; Cubic Feet: SCO 40
Type of Construction; r q A Estimated Cost: $
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings„ and hereby
declares that all the facts and representations stated in this application
are true and correct.
s
DATE: Z- S �.T SIGNATURE:_X41t�
(See Reverse Side For Additional Information.) P5 e5p..M
PEA. 58.79 V6 A -04+t i'&,gym.
"V 11. ® v
'74C UAL
404.79
0
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings 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 repairs 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:
UNIFORM 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 permits, the cubical contents
of any building or addition, is determined 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 averagee
height of the roof surface of the main gable of a pitched roof.
For repairs 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 from the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location -of the foundation, once it
has been constructed, will be required before proceeding 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 permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
A-
10
C" S-
-quo c
roe
So
IA
3706
city of Fridley
Applicesian for Mumbling c-nd Gas G lfi' S it
Dept: of Bldgs. Phone 560.3450
DESCRIPTION OF WOi:r. �i r
Humber; KL -id and Locrllon of Fixtures Location
w
N
�
Z
I
Z
K
7
.
W
7 Z
Ag
NNU
2
7=
r
N
WATER N7R.
CAS
ure.
Barr
l
1st
2nd
3rd
4th
Futuzo- CannocZi:n Cwninpa
e Haw Flxturo. Old Oponings
PARTIAL RATE S%°HEDULE
So -war Q
Ccerpeol
City of Fridley..
The undersigned hereby makes application for a .permit for the work here!
specified, agreeing to do all work in strict accordance with the City Ordinarcv
and ruling of the Department of Buildings,- and hereby declares that all the fact
and representations stated in this application are true and correct'
Fridley, Minn
Owner N- (-
Kind of Building -
Used 'as -
To be completed about - -----_®----
Estimated Cost. S
Old --New. Building Permit No. Permit No.
LtNI RING FIXTURE RATES: NO. RATS. 'DOTAL
Number Fixtures • • • • • • • • • . • + . • . • X $2.00. $ I`0C) Signed °
Future Fixture Opening ........... x $1.50 $ . By
'New Fixture Old Opening....... • .. x 51.50 $_ _. Business Ph -n- Ho
Catch Basin • .... • • ............. x $3.25 $
Water Beater 'Up to 99.000 BTU). • • • x M.00 $ •UCS .
ROUOx
New Ground Run Old Bldg......... x $•3.25 S
l:loetrie Sflatar Haatmr.....:........ s $2.00 S iYP7AL
II' ZAS 77TTING FEES: NO. RATE TOTAL
IsL3Fixtures ••••••••••••••••••
_ x $2.00
Additional Fixtures ............... -- x i .75 $
Gas Range to 199.000 BTU......** x $5.00 G
113MPJl1RS & ALTERATIOH3••-Rafer to Codo .50 State Surcharge
. Dc;cription ................ i ...................... .
TO'T'AL rZE $� °
�', 9"'.rp��s :wia `"' S}+T� �iA�ti•.a�•rp 1�. •� ��� �a n�i yy,^.,+,n^. ^•'"'••�'^ �mrd"'f',� �< �ae''t G4'Rm�a�irs�a ,�'�,'� .�r�.�.�....n�.da. v�c4ti+1
aa. ;v �J Yo"�7 IIaafa wC6".v..t 6i yqq< mm zym. s�t9 G e.,. •...rz o�,gsap�!. wv oaC �!'��p
PARTIAL ATE SCKEDVI E
GiRAFITT WARM ArA: RAt 1L TOTAL
Fumve• Shell & Duct. Work $10.00 $
Replacernent of rurnare 6.00
P.epairc & Alterations— up to 5500.00 600 $
Repairs & Alterations each add. 4,500.00 3W $
Furnace Shell & Duct Wnr'R to 220,000 BTU ..$1000 $ /U
each add. 60,000 BTU S.w S -3= z
Re�Irce neat of Furnace 6.00 g
Repairs & Alt&ataans--up to 5500.00 6.00 S
Repairs & Alterations each add. $500.00 3.00 $
STEAM or HOT MATER SYSTEM
Pi race Shell & Lines --to 400 sq. ft F.DR Steam. $10.1 3
Furnace Shell & Line ----to 6-40 sq it. EDR )Tot Water 1000 $,
Each ;tdd 200 sq. ft Er)k Steam 8 tM $
Each add. 320 sq. ft EDR Hot Water 3.00 $
OIL BURN-ZE—to 3 gal. per :tour 6.00 S.
over 3 gal. per hour --See Fee Schedule
GAS BVRXI R (up fo 109,= BTU) 5.00 $ Ss 0
over IS`9.000 BTU 3oe Foe Schedule
GAZ FITTING FEES: NO RATE TOTAL
lit 3 Fixtures ✓ x$ Zoo 3-
Additional Fixtures _ x .75 $_—.
Gas Range to 199.000 x$ &00 3
AIR C0X s" TIOXIr.G°
FAX 2=7150 STBT=f
STS
ALi iATFG193 & TIZPAlRS
.I«opt. of Bidsm. Phorur SM -30M
City of Fridley:
The undersigned hereby makes application for a permit for the work %ere&.
specified agr- ing to de all work in strict accordance with the City Ordnance:
and ruling of the Depaitmentoof buildings, and hereby declares that all the fattt
and repr-!gentatiuns stated in this application are true and correct.
Fridley. Msnn
Owner _ Xie/ /I%e /.41e
Kind of. Building
Used as �__:s/✓�o�G
To be completed about 7C
Estimated Cost; $ /S
Old --New. Building Permit No. _.__ ,_ Permit No. S�`S
iiESCRLs'"iION OF WO"3X
HE.A77NG or POO ER Fa.A.N 'Sk-,Steam, Not 'Water, 16em No
Trade Name F2.�' 4 Lc/G Siwe Ido- C 9d6.Q /
Capacity S Zf; 'J/��5q. Ft. £.D.R BTU �p
Total Connected L 2d aU `d 9 Kind of t y�
BURNER — Trade Name_ Sl:z NO ,
State Surcharge .50 Cayaacity Sq. Ft. E.D R DW
so* F00 s1chadaloU ,
t • (, •
TOT'AL F= S� S
l /tel T�,�Fm� UFT • By ?"
(,02x0 -os sal
HOUSE HEATING TEST RECORD ,
ADDRESS�� �°�- " • APT.F OR CITY �` BURB
OCCUPANT OWNER �®°
HEAT LOSS DATEJiTG. II,9T. a00
SOLD BY INSTALLED BY
Electrical Work By Gas Line By
TYPE OF HEAT GA FA HW - STEAM SPACE HTR. UNIT HTR. OTHER OOF
E CONVERSION
MAKE MAKE OF BURNER
Model Model
Serial 7 3'7® Max. BTU Rating
INPUT jeu '®®® MAKE OF FURNACE
CONTROLS
THERMOSTAT �` Heat Plug
Volvo
Model
i' oe
Vent Size
KIND OF LINER SIZE NONE
Limit Draft Hood Regularor
Limit Setting e� Filters Size umber
Fan Setting � ` Chimney Location Inside a Outside
Pilot Type a Chimney Construction
Pilot Make
Pilot Model Smoke Bomb Wiring
Pilot Timing Draft Test Tag
L.W. Cut Off Door Pressure Lighting Inst. -
Pressure Percent CO2 Date Tested
Input CFH Percent 02 Company Testing,
Stack Temp. Percent CO Name of Tester
Form 235
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 VAX: (763)571-1287
ADDRESS
: 6450 SQUIRE DR NE
PIN
: 133024410059
LEGAL DESC
: HARRIS LAKE ESTATES
: LOT 5 BLOCK 4
PERMIT TYPE
: ELECTRICAL
PROPERTY TYPE
: RESIDENTIAL
CONSTRUCTION TYPE
: ADDITION/ALTERATION
PERMIT NO.: 2004-01752
DATE ISSUED: 10/06/2004
VALUATION
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A SAVERS SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAUL, MN 55114-
PEHOSKI PATRICIA A
6450 SQUIRE DR NE
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 wort
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 local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date.
ELEC PERMIT FEE - MIN (RESI) 20.00
STATE SURCHARGE, ELEC FLAT 0.50
TOTAL 20.50
PAID WITH CHECK # 118132
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.