PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N° 3385
Date: ... ..... ..............
Owner ....................................... Builderr:1... ...::i.!o
Address...................................... Address .............................................
LOCATION OF BUILDING
No. o7V....
... Street . . !. ...` . �" .. . .. Part o Lot ........................... .. .
Lot .... Block .... .......... Addition or Sub -Division . . �� .. .
Corner Lot ............ Inside Lot ..X t S � �� Irg
Se back . A ........ Sideyard ...........................
DESCRIPTION OF BUILDING
Too be Used G //� t�
Front` f a.vP Height I1 :. Sq. Ft. /.SP:�ciT. Cu. F't.����
.. Front . 1 ®`Depth .%-.��nJHeight .: �. Sq. Ft. 547.. Cu. Ft. �.�' b
Type of Construction .............. •. •.... ]St, cost. , � 9, .. To be Completed ...................
In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
X.................................................
In consideration of the payment of a fee of $R........., permit is hereby granted to ...................
......................... to construct the building or addition as described above. This permit is granted upon
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 building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota' regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
.: ..... .... ;Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbin , heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
City of Fridley
Application for Pimnbing and Gas Fining Permit
DESCRIPTION OF WORK
Dept of Bldgs. Phone SII 4-7470 '
� 1 „
Number, Kind. and Location of Fixtures Location ;2� / �� '� l�y
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE BATES:
K
RATE
Z12S
Number Fixtures ......................
Y Z
$1.50
0-
Z=
Future Fixture Opening ................
2-
W
V'
?
S
-),40
WATER HTR.
x
1.00
$
Catch Basin ............................
x
3.25
c0
Water Heater (Up to 200,000 BTU) ......
$�
a3
��
��
�a
F
N
GAs
ELEC
$
GAS FITTING FEES:
NO.
RATE
TOTAL
1st 3 Fixtures ..........................
.-,
-�
x
$1.50
$
s 7�
Additional Fixtures ....................
x
Base
$
Gas Flange to 200,000 BTU ..............
x
2.00
$
1st
2nd
3rd
4th
• Future Connection Openings
Connected with
New Fixture, Old Openings
0
cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE BATES:
NO.
RATE
TOTAL
Number Fixtures ......................
x
$1.50
$
L --1r 5-0
Future Fixture Opening ................
2-
x
1.20
$
-),40
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$--
Water Heater (Up to 200,000 BTU) ......
x
2.00
$
New Ground Run Old Bldg . ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE
TOTAL
1st 3 Fixtures ..........................
.-,
-�
x
$1.50
$
s 7�
Additional Fixtures ....................
x
.50
$
Gas Flange to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS -Refer to Code
Description ............................................
TOTAL
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application re true and correct.
Fridle ,
Owner-d/"�� f ✓✓G"�_� ��_% `� a- 1�
Kind of Building
Used as
19_
To be completed about /-I o
Estimated Cost, --% r (',
New,'Building Permit No o
Sian
By
Business Phone No
Connection Permit No . .......................................................
Water
Sewer
11 1 M-8-sa
Meter Deposit
SUBJECT
City of Fridley
66 72
AT THE TOP OF THE TWINS
_ _
BUILDING PERMIT
r
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
I
"1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF APPROVED BY
612-571-3450
910-F15
5/12/81
JOB ADDRESS 281 _ 67th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
4
1 Rice Creek Plaza South Addition SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
Curtis Britz 281 - 67th Avenue N.E. 571-1439
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Gary Jansick 6480 Squire Drive N.E. 574-9679
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
❑ NEW] ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 16' x 16' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
WARNNG
Before digging call local utilities
TELEPHONE - ELECTRIC - GAS DO.
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
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
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$2,0Q0
$1.00.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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-
$12.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$13.00
? SIGNATURE OF CONTRACT OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
I
BLDG INSP 1A
SIGNATURE OF OWNER IIF OWNER BUILDERI tDATEI
CITY Of f=RIDLEY
APPLICATION FOR RESIDI"NTIAL BUILDING PERMITS
(New, Al ten tions, Additions, or Repairs)
OWNER: (_���0^7�is �1, Z' BUILDER:�Qru e�C,�19-sic �
nonREss. :-/ Cr ADDRESS: fir.
TEL NO: 677%' �%92 TEL I410:
Construction Location
STRI,T NO. STREET:
L07': BLOCK: y ADDITION: A 10
Corner Lot: Inside Lot: is Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location dra,an on certificates to scale,
DESCRIPTION Or CONSTRUCTION
Front: Depth: Height:
Squalls. Feet: Cubic Feet:
Front:
Square -Feet:
Depth: Height:
I
Cubic Feet:
Type of Construction:
r Estimated Cost: $ Q p Q
To Be Completed: U-"!3 .e. ( y f �
Alt. A Alt. B
Proposed Driveway `width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET .
The undersigned hereby makes application for a permit for the vork'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.
D,'=3: _S_ �`''/ simaUI.E:
Supinations:
Pali
1z'00 .
/3 0
i
;t
1
V1,
i
;t
1
J srj,
R� flWvC�i�
�J14C
a — aIX6 Devi
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XG
/G
DIEOk B41)as
RIG L ;-r
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e
`x 8xa .
SJaPQG�
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io Fmi-4
• _ axe so�.��o zx� rT��.us-..�
%QICiti6 is" 0.C.
GO.vCIfi. 7C
4�"AAOs7
NEW CONSTRUCTION
GARY JANSICK
6480 SQUIRE DR I
REMODELING
FRIDLEY. MN 55432
STAIR RAILINGS
574-9619
DECKS
J srj,
R� flWvC�i�
�J14C
a — aIX6 Devi
TiZP L l i 5
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XG
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DIEOk B41)as
RIG L ;-r
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`x 8xa .
SJaPQG�
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• _ axe so�.��o zx� rT��.us-..�
%QICiti6 is" 0.C.
GO.vCIfi. 7C
4�"AAOs7
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572=3604
RATE SCHEDULE
APPLICATION FOR POWER PLANTS AND HI=ATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 02k
Residential
Furna a Duct Work, Burner -
so acement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
Rate TOTAL
®v
$30.00--
$10.00. 30.00.•$10.00• $
$10.00 $
$10.00 $
$ 25,00.: $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $
Com mercial/Industrial
1.25% of Value of Appliance or Work $ 30
State Surcharge $5_0
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effective On August 1, 1995
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do ail work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
1-1-7 — 'f,% ,1995
BUILDING USED AS
ESTIMATED COST PERMIT NO.
No. of.Heating Units _ Circle One (Steam) (Hot Water)arm Air
Trad6Aame i'v _-�, �� � Size No. -7 �—
BTU • -75 , o eyy HP EDR
.Fuel . _r Total Connected Load
Burne[ Trade Name Size No.
BTU' ` HP EDR
HEATIN
Signed
Approved By Rough -In Date
FILL OUT BACK SIDE R STACK VERIFICATION ON
REPLACEMENT FURNACE
Final Date )-3647
6bf--,-
,6 Has total heating BTU's of
All other BTU's
TOTAL BTU's / S O
7. Has a liner been provided for water heater Yes No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
HEATING CO:
Signed By:
Date:
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes (� No
(
)
2.
Is free from rust or deterioration
Yes (r✓j No
(
)
3.
Has no foreign objects lodged within
Yes { ✓f No
(
)
4.
Is securely supported
Yes ('f No
(
)
5.
Meets all current Code requirements for size
and total BTU's connected
Yes No
(
)
,6 Has total heating BTU's of
All other BTU's
TOTAL BTU's / S O
7. Has a liner been provided for water heater Yes No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
HEATING CO:
Signed By:
Date:
SUBJECT
PER
City of Fridley
27859
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
COMMUNITY DEVELOPMENT DIV.
r 1 _E g SEC.
1 i
{ CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
612-571-3450
910-F15
9/18/98
JOB ADDRESS 281 67th Ave NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
4
1 Rice Creek Plaza South
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
maim
571-7999
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Brost Commercial 677 Hamline Ave N St Paul 55104
646-3500 20107295
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
0 NEW 0 ADDITION 0 ALTERATION G} REPAIR
O MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof house & garage (23SQ) Tear—off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 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 1 HAVE READ AND EXAMINED THIS APPLICATION
ISTALLS
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
$1,971.00
$.98
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISION OF ANY OTHER STATE OR LOCA LAW REGULATING CON.
$62.25
Fire SC $1.97
STRUCTION R THE PERFO MAN'(:!Of CONST CTION
PLAN CHECK FEE
TOTAUPIEE
Licepge SC$ .00
$70.20
SIGNATURE O CONCRACTO OR AUTNORi2E0 AGENT (DATE.
N OPROP VALIDA D HIS 1 UR PEBMI
S-GNATUREOF OWNEROF OWNERBU4DERi iDATE,
FOG 1NSP
gArE
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
Y9 186q
ConstructionAddress: oJi�
Le al Iles ' 1on• -
Owner Name & Address: 1P,, _ �. ,� J� t Tel. # 5-1
Contractor:'1 �a MN LICENSE #
Address: VI `j \,\nC>.rv. SS \ p `( Tel. # Zoe—[ l� ~ 3 S Q U
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length
Width
Height
Sq. Ft. _
GARAGE AREA: Length
Width
Height
Sq. Ft. _
DECK AREA: Length
Width
Hgt/Ground
Sq. Ft.
OTHER:
Q --k-
'23 sun , - 7-(-)
(;
Construction Type: �Iou-x Estimated Cost: $ ti -1 zc r o
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: CA \ 19) q % APPLICANT: Tel. # 3
TOTAL
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ /, 97
.001 of Permit Valuation (1/10th%)
State Surcharge
$ j
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ 66
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
3ITY OF FRIDLEY INSPECTION DIV.
3431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON FACH FI OOR
Effective On Jan 1, 2000
SIB
® �'R CR
•
JOB ADDRESS NNIF its 61401✓ I—
�
� c
Y•
• •
�
_`sem �
.y.
r�
'.RAF
•W�[�i�
Beer Dispenser
- - _ -
r
�®
$ 7.00
and representations stated in this application are true and correct.
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
SIDDIQUI, ASHRA 5.20J7
Sump/Receiving Tank
$ 7.00
281 67TH AVENUE NORTHEAST
Treating Appliance
$10.00
Owner— (763) 5 1 99 55432
FRIDWater
(763) 571-7999
Water Heater -Electric
$ 7.00
Water Heater - Gas** ^�
$10.00
Building Used As�`�i��Ry Cer,
Gas Range**
Gas Dryer**
$10.00
$10.00
ff
Estimated Cost PERMIT NO. /V
Back Flow Preventer Required ( )Yes O No
Type
$15.00
PLUMBING COMPANY4ik=M PLO A C, CA
PLUMBING FIXTURE RATES: NO.
RATE TOTAL
JOB ADDRESS NNIF its 61401✓ I—
New. Fixtures
$ 7.00
The undersigned hereby makes application for a permit for the work herein
Old Opening, New Fixture
$ 4.00
specified agreeing to do all work in strict accordance with the city codes
Beer Dispenser
$ 5.00
and rulings of the Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7.00
and representations stated in this application are true and correct.
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
SIDDIQUI, ASHRA 5.20J7
Sump/Receiving Tank
$ 7.00
281 67TH AVENUE NORTHEAST
Treating Appliance
$10.00
Owner— (763) 5 1 99 55432
FRIDWater
(763) 571-7999
Water Heater -Electric
$ 7.00
Water Heater - Gas** ^�
$10.00
Building Used As�`�i��Ry Cer,
Gas Range**
Gas Dryer**
$10.00
$10.00
ff
Estimated Cost PERMIT NO. /V
Back Flow Preventer Required ( )Yes O No
Type
$15.00
PLUMBING COMPANY4ik=M PLO A C, CA
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE $2LJ-50
SIGNED BY
Approved By
TEL N0.&Z- - 0 .
Final Date
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A COMMON VENT INFO ON BACK SIDE
COMMON VENT, VENT CONNECTOR AND COMBUSTION 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 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 current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes ( ) No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes ( ) No ( )
When installina a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category (.Central Furnace
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 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 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 It Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
Building
$
BUILDING
Plan Review
$
Permit No. -2L9519, I
Inspections
$ 1C J,) 0
RESIDENTIAL APPLICATION
Surcharge
$ Soo
ReceivedB :
763-572-3604
$ 5-o
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
gec ''
Curb Cut Escrow
$
CITY OF FRIDLEY
Erosion Control
$
>
763-502-4977 FAX
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
EFFECTIVE 1-1-09
Make checks payable to: City of Fridley Attach Stipulations
DATE :: — –
YOUR Ec-MAIL ADDRESS r S h 1
A/
Yf,� / o a Coh-1
SITE ADDRESS 1
7� // N C-
P
THIS APPLICANT IS:
OWNER *CONTRACTOR
PROPERTY OWNER/
NAME: /-f I 'MM f T DyY1 S
/UC ,
TENANT
ADDRESS: Soa S 16,44 1/0 S r CITY
R1A1 L
STATE &ZIP
PHONE: & 3 - 7
CONTRACTOR
NAME: :64 M
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # ? d O 6'
EXP DATE
AND CERTIFICATE OF
ADDRESS:
CITY
STATE ZIP
INSURANCE
PHON ZJ FAX
2&
– �L
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILYNEW CONSTRUCTION STORIE
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
WINDOWS
❑ BASEMENT FINISH ❑OOF ❑
DRAIN TILE
❑ DECK !=ING ❑
OTHER
13 SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ DITION
❑ MAINTENANCE/REPAIR >QREMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
13 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I .
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS>IYes
❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBES E OF
OPENING CHANGES &
, d
TYPE OF. WINDOW TO BE INSTALLED AQ O U NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ 1C J,) 0
.001 times the total job valuation
Surcharge
$ Soo
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ 5-o
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $22 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ U vl4�
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of or 'c2res review d approval of plans. �� �Kl
SIGNATURE OF APPLICANT + PRINT NAME l� o b f R -r ""; DATE
Building
PLUMBING
Permit NO.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
l'
CITY OF FRIDLEY
D��'a
763-502-4977 FAXq
EFFECTIVE 2-19-09
DATE ZOQ / YOUR E-MAIL ADDRESS
SITE ADDRE S �J 67
THIS APPLICANT IS: ❑ OWNER OCONTRACTOR
PROPERTY
NAME:
OWNER/
TENANT
ADDRESS: CITY STATE ZIP
PHONE:
CONTRACTOR
L
NAME:
SUBMIT A COPY OF
'
YOUR STATE
STATE LICENSE # 6 �6 EXP DATE Z 0
LICENSE, BOND AND
D
STATE BOND # j&_Z <,4, J -M3 EXP DATE 12-l-,,
CERTIFICATE OF
INSURANCE
ADDRESS:_/' 7Z WIL 211 1" A,e• ✓U, M -A CITY c4 C /C S ATE�ZII�.
PHONE �Z - 2>/ — � ? iV FAX
PERMIT TYPE
226INGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK 7A
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
2- BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING
-'2
_ _
:BATHTUB _ GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($
_
CLOTHES WASHER / KITCHEN SINK Z WATER CLOSET PREY. $1
_BACKFLOW
_DISHWASHER _LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
_ WATER METER —OTHER
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THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of al work which requires review and approval of plans.
/
SIGNATURE OF APPLICANT PRINT NAMATE 6 Z•t7
�~��d����. -��•°�s�° :��B�i�.��� ®��lo��t1�� �It1ll�C #(�[ �� ^fid �1 `�I a ��� ��
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-5024977
BuHdint
$
BUILDING
$
Permit No.: l 8
Inspections63-572360
Park Fee
RESIDENTIAL APPLICATION
Sewer Main Charge
Received By:
763-572-3604
$
._
CITY OF FRIDLEY
Date Rec'd:
763-502-49/77 FAX
'
EFFECTIVE 1-1-09
DATE__ �O�
i YOUR E-MAIL ADDRESS
SITE ADDRESS
7 L/ Z—
THIS APPLICANT IS:
X OWNER ONTRACTOR
PROPERTY OWNER/
NAME: SA hal A S e-cA) Tit /f -- 7"01
TENANT
ADDRESS: CITY
STATE ZIP
PHONE:
CONTRACTOR
NAME:
SUBMIT A COPY
YOUR STATE LICENSE
STATE LICENSE # dO ✓'� EXP DATE
AND CERTIFICATE OF
ADDRESS: p q OaS (S4 g,,zl 'V 5 CITY
STATE ZIP
INSURANCE
PHONE - S FAX (o 3 2 -
PROPERTY TYPE
PROPERTY
SINGLE FAMILY/NEW CONSTRU TION SIZE
❑ TWO FAMILYNEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
-v ,Q ti 3 S� F,9 S o N per
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
r
/'u Tp1 Sf/f Saw
❑ DECK ❑ SIDING 'POTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR I REMODELING
DESCRIBE WORK BEING DONE:._Sdti /-(fiQ Cff IIU 7-0
Oy F'4 SOV
SIZE OF IMPROVEMENT
LENGTH /02 WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
I.
.Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
I .
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF. WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION $ —//! 0 (USING HE l 997 U.B.0 FEE SCH
D ® OCCUPANCY TYPE
Permit Fee $
Plan Review $
Fire Surcharge $
Surcharge $
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
-ft +6 ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a p�ri
mit d work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of o ws a ires review approval of plans.
SIGNATURE OF APPLICANT PRINT NAME A-6 S�40,00Cl% *'ZDATE_ - 2
CERTIFICATE O. F SURVEY
for
SKYWAY QUALITY HOMES
/
<
n ,
V
/
Ile
.,
0.
VII
1281
�W Existing e,
� House
.
� o
Scale: 1 " = 30'
0 Denotes 1/2" iron pipe monument 3P. U) U) of °t'I� O°
found. 1c\
up.0 Denotes Utility Pole �m
-ou- Denotes Overhead Utility Line - de
9.
The orientation of this Bearing System /
is based upon the recorded plot of
RICE CREEK PLAZA SOUTH ADD1710N.
DESCRIPTION PER DOC. NO. 2006589.005
All that part of Lot 4, Block 4, Rice Creek Plaza
South Addition that lies northeasterly of a line
which is 75 feet southwesterly and parallel with
the northeasterly line of said Lot and as measured
along the southeasterly and the northeasterly lines /
thereof, Anoka County, Minnesota.
I hereby certify that this survey, plan or report was prepared by me or under my
direct supervision and that I am a duly Licensed Land Surveyor under the laws of
the State of Minnesota.
I I MIDWEST and
No certillcation whatsoever is extended to subsequent owners, mortgagees or title
Lend Surveyors & Civil Engineers, Inc. insurers, unless this survey has been redated for this purpose by the surveyor.
710 East River Rood. Dated this 27th day of ov 2009.
Anoka, MN. 55303 B r: • Registration No. 25343
Ph. 763-712-9099 Fox. 763-712-9055 y
es E. spier — Mi esoto Licensed Land Surveyor
Job No. 09-127 Book—Page DCF Acad FJIe 09-127 Asbuift Dated this day of 20
02009—Midwest Land Surveyors & Civ9 Engineers, Inc — All Rights Reserved
D/" 7LVf 'r q UffLI7 r vrYIt—';o f(
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a &Cf U(44�. WC6
i
am
THIS JOB C®PY S
4J IAlfbd�%t/ /
AYAlt AdLt ON IKE JOB
SITE FOR THE FRAMING X /n
AND FINAL INSPECTIONS 3 5919 5 ®n1
IY`C:S..JVI S ( V /�7tO Pooh
�d?Av�cl� tZE i � M zea - 29xw
�r aicc�lois 0
^
VIAs 61-7
k-,// S 9 -7-0 R /u -77/Y�E APPROVED PLANS\
/, 1 PER RC SEC R106.3.1
BLDG I SP CTO
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REScheck Software Version 4.2.1
Compliance Certificate
Project Title: REMODEL
Energy Code: 2000 Minnesota Energy Code
Location: Anoka County, Minnesota
Construction Type: Single Family
Glazing Area Percentage: 200%
Climate Zone: 2
Construction Site: Owner/Agent:
281 67TH AVE. ROB SCHMANSKI
FRIDLEY, MN 55432 SKYWAY QUALITY HOMES INC.
612-644-1442
Compliance: 3.4% Better Than Code )Maximum UA: 116 Your UA: 112
Mllff"Awss"IM"bly
Designer/Contractor:
RICHARD J. SCHWIETERS
SCHWIETERS HOME DESIGN
1628 COUNTY HIGHWAY 10 N.E.
SPRING LAKE PARK, MN 55432
763-785-2105
SCHHOMDSGNC&AOL.COM
Ceiling 1: Flat Ceiling or Scissor Truss
117 38.0 0.0
4
Wall 1: Wood Frame, 16' o.c.
294 20.0 0.0
14
Window 1: Above-Grade:Wood Frame:Double Pane
16 0.350
6
Door 1: Glass
42 0.330
14
Floor 1: Slab-On-Grade:Heated
117 30.0
74
Insulation depth: 4.0'
Furnace 1: Forced Hot Air 90 AFUE
Boiler 1: Click here to select Assembly 80 AFUE
Compliance Statement The proposed building design described here is consistent with the building pians, specifications, and other
calculations submitted with the permit application. The proposed building has been designed to meet the 2000 Minnesota Energy Code
requirements in REScheck Version 4.2.1 and to comply with the mandatory requirements list i e REScheck inspection Checklist
leit,10jO h 5&1-14ve oft
Name - Title ) lJ �? r�-- Si nature Date
S C Ile", s `�ri�7 i�r �4 <l
REScheck Software Version 4.2.1
REScheck Inspection Checklist
Plan Review and Inspection Issues
This list of items may be helpful for Plan Reviewers and Building Inspectors to use as a guide for enforcing the Minnesota Energy Code. The
items apply to Group R, Division 3 Occupancies, one- and two-family residential dwellings. The items marked with ' apply only to detached
one- and two-family residential dwellings.
Plan Review Issues
Foundation Inspection:
Foundation wall insulation R-5 minimum.
Foundation insulation extends from top of wall down to top of the footing.
Exterior foundation insulation is covered by a protective coating finish.
Concrete Slab or Under -Slab Inspection:
Slab on grade perimeter insulation R-5 minimum.
Ll Slab insulation extends from top of slab to design frost line or top of footing.
0 Floors over unheated space R-30 minimum.
Windows / Doors / Skylights:
Average U -value is 0.37 maximum for windows and glass doors (excludes foundation windows).
0 Window U -values consistent with building plan and REScheck Certificate.
Ll Window and door areas consistent with building plan and REScheck Certificate.
Mechanical ventilation Issues:
0 Residential mechanical ventilation system provides adequate ventilation per code requirements'.
L) Furnace efficiency is consistent with REScheck Certificate or building plan.
U Protection against excessive depressurization is installed per code requirements'.
Envelope Insulation for Plan Review:
E] Interior basement insulation R-5 minimum (if no exterior insulation).
0 Ceilings with attics R-38 minimum or consistent with building plan and REScheck Certificate.
i] Wall framing and insulation level is consistent with building design and REScheck Certificate.
Inspection Issues
Concealed Insulation
Framing and Sheathing:
L1 Wind wash barrier installed at attic edge.
U Exterior wall comers framed so that insulation can be installed after exterior sheathing is installed.
C3 Intersections of interior partition walls and exterior walls framed so that insulation can be installed between the partition and exterior
sheathing after exterior sheathing is installed.
L1 Gaps between framing less than one-half inch are eliminated by securing framing together or are insulated at the time of assembly'.
L] All penetrations between conditioned and unconditioned spaces made prior to framing inspection are sealed'.
Interior Air Barrier:
All fire stops are air sealed.
Pipes, ducts, wires, equipment and flues and chimneys through the interior air barrier are sealed.
LI A sealed continuous interior air barrier is installed on the warm side of the building envelope at ceilings, walls, and floor rim joist areas `.
O Air barrier behind tub and shower is sealed and protected.
Ll Recessed light fixtures are sealed.
Envelope Insulatiaip:
Basement insulation �i-5, minimum.
Wind wash barrier an wall `separating house and garage is sear.
U Loose fill insulation is prevented from entering the eaves.
Lj Insulation on skylight shafts and walls exposed in attics Is supported on the unconditioned side.
Attic Insulation:
Ll Attic access panel insulated to R-38 for ceiling panel and R-19 for wall panel.
Ll Attic card attached to framing near access opening.
D Notification of attic R -value and date of installation posted near building permit inspection card.
This is a summary only. Other requirements may apply. See the Minnesota Energy Code. Questions? Call the Department of Public Service
Information Center at 651-296-5175 or 1-800-657-3710.
Building
MECHANICAL
Permit 06q,00
RESIDENTIAL APPLICATION
ReceiveInspections WBy:
763-572-3604
Da
CITY OF FRIDLEY
763-502-4977 FAX
I
EFFECTIVE 2-19-09
DATE o YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER INCONTRACTOR
PROPERTY
NAME: L✓® m m
ADDRESS: 1e CITY STATE ZIP
OWNER/
TENANT
PHONE:
CONTRACTOR
COMPANY NAME: `7Q
CONTACT PERSON: 614 6 f
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
STATE LICENS # EXP DATE ��
ADDRESS: �� CITY ��� STATTi/O*ZIP�
APPLICATIONPHONE
%%,�� % YU FAX / k.� 2�` /�
PERMIT TYPE
E SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
❑ Qd'ALTERATION/REMODEL
TYPE OF WORK:
❑ NEW REPLACEMENT
DETAILED,DESCRIPTION OF W�1tISi f'a� d'� In � rt---e/W'V o� P
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
$25.00 (GAS) $15.00 _GAS RANGE/OVEN $10.00
_A/C _FIREPLACE
TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00
_AIR _FIREPLACE
$35.00 $35.00 _GAS UNIT HTR $10.00
_BOILER _FURNACE
CHIMNEY LINER $10.00 DRYER $10.00 POOL HEATER $35.00
_GAS
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
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§ P -Lwin y.E �.T .%
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all 9r1 hich re . es review d approval of plans. %
SIGNATURE OF APPLICANT PRINTNAME' �/` �S �QFATE
AiR fi 01
LEEDS 10 MIXA, � 011
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
0 NEW HOMES/ADDITIONS 0 EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
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 Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.