PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn. N? 2329
Date`,,�! ... ....................
Owner • •ri... Builder ............................
Address......................................... Address .........................................
LOCATION OF BUILDING
No. .4'5.1 ... Street . e ?"�. 1�` .! e .............. Part of Lot ...................... .
Lot ........ ;r...... Block .7 ............. Addition or Sub -Division �.. �.............
Corner Lot ....... .. Inside Lot ............ Setback4jrt.. Sideyard @.�. " ..........
DESCRIPTION OF BUILDING
To be Used as:
s
.. Front .44Y.. Depth ., ... Height ......... Sq. Ft. ,Z,44.. Cu. Ft. ........
......... Front ... Depth 02.... Height ......... Sq. Ft......... Cu. Ft. ........
Type of Constructio n * s;Jf ... Est. Cost dQ 0 ....... To be Completed Ir-*-f6"O. "tbfaCl.... .
i
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work h accordance with the description above set forth and in compliance with all provisions of
ordinances of the vil age of Fridley.
...................................................
,I
�in consider on f the payment of a fee of $.,��' .:'.'� permit is hereby granted to I:: .....
.. to construct the building or ad dation as described above. This permit is/granted• upon
the expresso that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and pon said building, or any part thereof, shall conform in all respects to the: ordinances of
Fridley, Minnesota r garding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits this permit may be revoked at any time upon violatI.Qn of any of the provisions of said
ordinances. r Of /I �
j f4&{f*V7Ze ... Building Inspector
V
NOTICE:
This permit d pes not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to seethe Building Inspector for separate permits for these Items.
City of Fridley, Minn. N° 7621
BUILDING PERMIT
•
Date: Jame 1, 1965
•
L�
�.• .� • ;, P 11 r.r-73= 111 — { , i• ! =6d
{
lvo. 532
Int 7
Corner Lot
Street
. Block
LOCATIION OF BUILDING
67th. Ave. N. . Part of Lot
7 Addition or sub-DivisioAISG Creek Terrace
Inside Lot Setback
Sideyard
Sewer Elevation _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft. Cu. Ft
Front Depth Height Sq. Ft Cu. Ft.
Type of Constriction f'r'ame Est. Cost .532-00 To be Completed
Storm Damage Repair
In consideration of the issuance to me of a permit to construct the buil g cribed above I agree to do
the proposed work in accordance with the description above set f and p ce with a'll ons of
ordinances of the city of Fridley. v %per
In consideration of the payment of a fee of $ 10.00 , permit is hereby granted toSM=3j n Const,
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, Minnesotag location, construction, alteration, maintenance, repair and moving of buildings
within the city limits andtthis permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Luen Jman Building Inspector
NOTICE:
Sh pwmh des no cffw thm coestroc8oe, t ahNatioe for wbhsg, phmbieg, gat hmatleg, ower or water. Be sore to smm
the BoHAV pupa br for sopmft pwm8s Por them hems.
APPLICATIOIQ FOR B ' ING .PERMIT
CITY OF FRIDLEYy NNESOTA
OWNER'S NAMED®nald 13r_2teA BUILDER T._ �. 2 elac�m :erre :r�Qti ng
ADDRESS , -532 67th Ave N. E. ADDAkSS River Roe.d
e
784-7980
LOCATION OF BING
No. 532 Street 67th Ave. No. Part of.Lot_
Lot ( Block Addit.iotr or Subdivi9ion
Corner Lot Inside Lot .getbmk Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to thio form, Two Certificates of• Survey of Lot and proposed build-
ing ]:vocation. dtivn of these Wtificates.
DESCRIPTION OF BUILDING
To be used As: Rest ucco exterior
• d .j
_HOW 1 d GI'M MA Front 3.¢ Depth 22 Height
Sq. Ft. Cu. Ft.
-Glass Repair and sash Front Depth Height
Std. Ft. Cu. Ft .
Type of Construction Fpuae Estimated. Cost_ J40532_00
_-qty--be �omPLeted _gs �oA� Ae Possible
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work iii 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.
DATE_- ZaT24, 1965 SIGNATURE
iSchedule of Fee Costs can be found on the Reverse Side).
SUBJECT
PERMIT NO.
City of Fridley
16 2 7
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
r 1 PROTECTIVE INSPECTION SEC.
1 �
i CITY HALL FRIDLEY 55432
NUMBER
REV
DATEF7;
GE OF
APPROVED BY
L 612-571-3450
910-F15
7/9/81
/
JOB ADDRESS 532 - 67th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
7
Rice Creek. Terrace Plat 4 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
1qE Ray Kostelecky 532 - 67th.Avenue N.E. 571-4417
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Miles Garage 4500 Lyndale Avenue North 588-9403
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑
❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 191611 x 30' Garage Addition to Back of Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway
WARKIIIIN
NING
Before digging call local utilities
SEPERATE PERMITS REQUIRED FOR WRING, TELEPHONE-ELECTRIC-GAS Etc.
HEATIK PLUMBING AND SIGNS. REQUIRED BY L4,W
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Wood Frame
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
585
5850
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
Z
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
$5,500
$2.75
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 O HER STATE OR LOCAL LA REGULATING CON-
$36.00
HEP�FORMANCE ONSTR�IN.
PLAN CHECK FEE
TOTAL FEE
�TRU�CTION
$38.75
SIGNA URE OONTRACTORORAUTHORIZED AGENT (DATE)
WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT
%
`�-t1
BLDG INSP pelp
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
•
0I111ER: /`I�� �' , l'i c+.5f vK BUILDER: cz E
ADDRESS: �� � .- 6 7 atk. )U /,�. ADDRESS: A y ov tj c,,- R16
TEL NO: 7 TEL NO: 9 9 y 6N
Construction Location
^
STREET NO: STREET: ®%lQ, A'
LOT: - BLOCK: ADDITION:
Corner Lot: Inside Lot: � Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
• proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front:
Squane. Feet:
Front:
Depth: Height:
Cubic Feet:
Depth: Height:
Square- Feet:Cubic Feet:
Type of Construction Lz�
To Be Completed:
Proposed Driveway Width If New Opening Is Desired:
Estimated Cost: $ e?
Alt. A Alt. B
SEE REVERSE SIDE OF SHEET
Mie 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 correc .
Di%TE: 7 SIGNATURE:
Stipulations:
�a
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caa - (rv,,,.. J.E K •i�,3i: � }'
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00't
t°;-A
>• tar `.�.T'RF' •:` .t. 4 -'*3' _' $ °"' r eai - i '� 'v 4'" :i P
F.. t t '.�. i. ..�^ .i.'A' 1 �+ ��b,y� F, ,� +. t L S .f '•I+ii .. _ 3�d P ..i�.ty. d.: ;.
� tYt s�� s�.•u �+-i d �*�a"PI' +�.}�e^AYe xi�ia� � �''� �^" ' H, R'� �a '�� 'u "i• `t '%�'+' S'�` �'y�[a$ y�, '$r.� o `^,. 9�^,jc,tp`$r
571 4417 MILES' GAP
332 2561
4500 Lyndale A
Minneapolis, Minna
Invoice oa Can
Size of Garage 19 `6"x30 • Attached Apron 2 t
Name Raymond V. Kostelecky S
Address 532 — 67th Ave. N. E. S
City or Building Area Fridley, MN S
4" Garage Slab and apron, Sq: Ft. Area ..........................................
4" Breezeway Slab, Sq, Ft. Area ......................................................
4" Driveway, Sq. Ft. Area.................................................................
4" Sidewalk, Sq. Ft. Area t
6 x 6 10 -gauge Mesh Reinforcement, Sq. Ft. Area ..........................
Numberof yards extra Concrete used ................................................
Number of yards Fill DirtSand..................................
42" x 9" Footings, Lineal Footage ..................................................
12" x 12" Footings, Lineal Footage ................................................
Number of 8 x 8 x 16 Cement Blocks used ......................................
Number of Steps installed (Give Width of Step) ..............................
Costof Building Permit .........................................................
�i���ou Obtained]
Was Pipe Installed? Yes No .........................
% course Tbloc'ks on top of spot gs
I11bTEie*ePQ rr sia8 after garage �si!
17ea�PPIT ;lit aoCtay.3._ eementf'
y"Will
TOTAL S
Signature of Cement Man
State somber of yards esed for entire job bore
NOTE: Concrete Slips, Fill Slips, Building Permit and Work Order must be attached. GA910-0980
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Effective On January 1, 1991
Fridley, MN 55432 APPLICATION F•3R POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATIOA AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
Gas Piping (Ngeded with new furnace)
Gas Range
Gas Dryer
Rade TOTAL
$20.)0 $
$10.00 $—
$10.00
$10.00 $
$10.00 $-
a Air
'Air Conditioning - All Sizes $ 10.00 $
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work $ C�
Commerc iaUlndustrial
1 % of Value of Appliance or Work $
State Surcharge $ .50—
TOTAL FEE $��
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00
"Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
JOB ADDRESS 's -�> .Z- — ('C' --) Ay Nz'�
The undersigned hereby makes application for a permit for the work
herein specified agreeing to do all work in strict accordance with the
city codes and ruling of the Building Division, and hereby declares
that all the facts and representations stated in this application are
true and correct. t — 11991
OWN
0 L -L. o -
BUILDING USED AS �� L �-e_ r"—Q .� V L// 7
ESTIMATED COST (9-9 PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel Total Connected Load
—
Burner Trade Name Size No.
BTU HP EDR
AO"i Jgd
HEATING COMPANY Minn~yas^'n el e�AIS
700 W. Linden Avenue
Signed By P_ n_ Rex 11 hTo1 No.
Minneapolis, MN 55440-1165
Approved By C-t✓� J Rough -In Date Final Date
-��-j2-
FILL OUT BAC IDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CRIMNEY 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
( )
No ( )
3.
Has no foreign objects lodged within
Yes
( )
No ( )
4.
Is securely supported
Yes
( )
No ( )
5. Meats 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
Remarks
List Alterations Being Drone:
HEATING COMPANY R A. Attno .Jud
Signed By
900 W Linden A enu6
ox 1165
Date Minneapolis, MN 554 � '�-? 1 ti5
A INNEGASCO
SUBJECT
PER
City of Fridley
2 0 9 3 2
AT THE TOP OF THE TWINS
BUILDING PERMIT
i
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
t "'j 612-571-3450
910415
7/10/91
JOB ADDRESS 532 - 67th Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
7
Rice Creek Terrace 4th Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ray Kostelecky 532 - 67th.Avenue NE 571-4417
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Showplace Exteriors 3862 Crestwood Place, White Bear Lake 55110 429-1317
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
❑ NEW ❑ ADDITION jP ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Aluminum soffit/fascia
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED$2,700
$1.35
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STAT O LOCAL LAW REGULATING CON-
$54.00
Fire SC $2.70
,yTRyJCT10 R THE PERFORMAN E O CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$58.05
/\J�f/
9
4RTO
SIGNATURE OFC O A THORIZED AGENT (DATE)
WHEN PROPERLY VA ATED THI IS YOUR PERMIT
.BLDG INSP f)ATE
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
NEW [ ] Effective 1,/1/91
ADDN [ ] R-1 AND R-2
ALTER [ ] Building Permit Application
7 LY-
Legal Description: �
�—c-4%
Owner Name & Address: ���� ��� Teel. # S7/ — ewy
Contractor: �6zcro lle°c°� C X-I-e�►U{ S Tel.
Attach to this application, a Certificate of Survey of the
lot, with the proposed oonstxuctian drawn on it to scale.
CRE "IIPPIM CW MCM
LTVM AREA: Length Width Height sq. Ft.
GUM= AREA: Length Width Height sq. Ft.
EEM AREA: length Width HOt/Growid sq. Ft.
Corner Lot [ ] Inside Int [ ] Ft. Yd Setback Side Yard Setbacks
Type of tion: Estimated Cost: $ 7JU s,01)
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired: Ft. $. $.
Width + 6' See Back Page
HATE: - fl' AP�rircarrr: �� s/� i Tel. # �a 9- /3 / ^7
Permit Fee oo Fee Schedule an Reverse Side
Fire Surcharge '2C .001 x Permit Valuation (1/10th �)
State Surcharge $ % , 3 S $.50/$1,000 Valuation
SAC Charge $ $650 per SAC Unit
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Park Fee $ Fee Determined by
Sewer Main Qkarge $ Agri*+* Necessary [ ] Not Necessary [ 7
Tam
srlP[ MATICNS:
City of Fridley
SUBJECT
1184
AT THE TOP OF THE TWINS
BUILDING PERMIT(
r
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
763-571-3450
i"
12/4/02
JOB ADDRESS 532 67 Avenue NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
7
Rice Creek Terrace 4th SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ray Kostelecky 532 67 Avenue NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Raj Meister Development 3778 30 St SE, Delano, MN 55328 703-972-9408
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20243944
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
T CLASS OF WORK
O NEW ADDITION O ALTERATION O REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Construct an 18' x 18' Addition to Dwelling
9 CHANGE OF USE FROM
TO
STIPULATIONS See notations on plan.
SEPARATE PERMITS
REQUIRED
WARNINGMIRING
AND
®fore dieein
PWMBINd SIGNS
all ubhty 1® 9 cell for
cations
454-0002
'"QUIRED By
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
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 I HAVE READ AND EXAMINED THIS APPLICATION
1
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
$31,500
$15.75
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 -
$461.95
Fire SC $31.50
STRUCTIO E P F RMANCE OF N TRUCTION
PLAN CHECK FEE
TOT LFEE
Licens $5.0
514.20
ATu EOFCON•RACTORORAUTHORi2EDAGENT iDATEi
MEN PROP VALIDATE THIS IS YOUR P MIT
_
S.GNATURE OF OVVNER,IF OWNER BUILDER- JDATE,
E
NEW [ ] CITY OF FRIDLEY Effective 1/1/2002
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: Z u -7 Z 11 //- F -e -
Legal Description:
Owner Name & Address:
Contractor.
Tel. #
_MN LICENSE # C—'�Zq39
�(�
`� Tel.# 7�� .`%�� b
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: X " % ' _ / ✓ z'z
n F 5� fid' C.T,J CZ5XIIrrmD e;" 1-y "Q
Y� T
Construction Type: Cts' ��� Estimated Cost: $ 3 � S0 3
Driveway Curb Cut Width Needed: Ft + 66 Ft = F;t x $ _ $
DATE: APPLICANT. V /' �` Tel. #
Call (763) 572-3604 for Permit Fees if mailln n application or Fax to 763-571-1287 if using credit card/and e will
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
$- /-/&/. 96"
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ .5/ r -c;�® STIPULATIONS:
:.H!' .t a ,• a"�� ... .'� ... 1�1. ��}.. 3k 4 • �.
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;T
Y�
op
Ob
L°X
-t SLP � `�t •� � .. ' . 1 • _ �� 3 �."M +Y W r��� .
71- �.::i!''�.a�gT.d,� s--.. $� b , i - ., ..... .any....•.:. �.• � -.6 ,�,��'� - '.
' � •yam .
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{Jif
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fi4 °�� ' * ' yi'�� .. � ',� � �' .z G ' '� t 4' f ;{ -t9'.t u l Y �';y:�+E 3•=,j ••
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{ -4%+ �� �X; - <'�. ^S t', !it' 9 r t T�'..,Ca • 7 v �` '4r4 -Q•+. �_'q*.
,�,�' � .ny*' x�g,2 .r•,..,.: n %�.. r - _ .. y + [SSC � �g
v� ry
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, , Y �y�.a, � '°+� T `r • '� � !' ' �'� .. ... 3��...,�, .�'xvTr {�° alp` � . t
^� W m A.3# w. s �'�': W �.•�, f a p.... �_+i M'd 4 , � z' � -f r
�' 4{ �Di. Y •�}'S.�Lr�'t' ��'F � �3 "� � .' ::;A a - ,�I•_ i. ;aA:
.fa.;
•A
�' 01
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OWNER i!�aSI* P1P 1�1C�PLAN NO. Ole
sin ADDRESS S���'7`�' Vs MVL�AA , DATE OkI._2 4 UV Z
CONTRACTOR PHONE
Detarains wa dni square fboftr of a wk
1. Total exposed wall area. .......
2. Total rooVwding um..........
3. Tota], SooNaatt. am .......... sq. & x
Total a omd wall arae above Door .- 4rv*J • 4
L Tonal 'WAU window wm ..............................S�"• +'�
b. ToW door mea .......................................
c. Total sliding Mass door ares ........................
d. Told lirepM vnatl eros..... •-
e. TOW waft t=rot ma (10'Y. )...................
f Taal eat wadi sres abm ltor......................
S. ToW rim joist va ...........................
Total ogmod fov+ Wmdon area
h. Total fouavdstiom window ares
i. Total east Mwas as aba+vo ®rade ......... '. •o
"'U" valeta of emb wall sa®uant:
a. 5(e.o xmr
b.
b. x `1J" o •
L x "U"
4 . ......................................................Total = �O• o4i
18saia+ r4 i. ebr ,rare .., cv � than !f l , ei�m infant of 60tlfi (a Yt ltsa Man aaat.
TRIM STUD W/
lnWor Air
.68
THRU INSUL. WAIL
it"lor Air
0
S.R. t SIDING
'A" SJR.
45
W/ S.R. R. SIDING
%" S.R.
.45
Studd
(i." 5
iQ - baud.
to], i0
2932" Bildrite 2.06
2Y32" 8ildrift 2.06
)V7
Siding.�7
Exwkir Air
.17
Exterior Air
.17
fatal %R"
10
Tow "R" -
1111 - "U" _ .OqZ•
uR � "U" � d�3
THRU RIM JOIST
latmrim Air
69t
THRU CONC. BLOCK
bdwior Air
6i
(O" b"L
11.0
GB. (1v)
1.1b,
Opt. Styrofoam
o
opt. Maui.�j,p
1 %10 Woad
1.149
Edwiar Air
.17
---------
25W Bildern 2.06
';
Opt.
Sidinll
' G?
•
opt Siwkg
1
Extmtlor Air
.17
opt. Brick
n .. !
TOW "R" "
`7i (t3
Total mr
T*+7
i
•
l «U.
. , p.
,fes
THRU CEILING
itttrior Air
.61
THRU CEILING
bumrior Air
.61
M EMER
(�.►,`tt�MM")
��(,
INSULATION
$-itA
Sb
/S�..K
veil. l�llli.:�%'
.'�. ( 4)
41rp.o
baud.
Still Air
.61
6m
Still Air
-o----
Tow -w
.61
Tow "IR." -
S1.1.5
UR - °'U"
ir.I
�.e....
VR • "Vr.
• f3
,O
Tmu mEmm ®
buwior Air
.92
TRU MUL.
Inswior Air
.92
TUCKUNDEW
cwpd pwd
TUCK-UNDEW
Cwrpot/f W
CANTILEVER
Vinyl
CANTILEVER
Vho
5/S" Under.
.92
S/r Under.
.82
%- plyjl ow
.62
'/a" 1'i j/1 oW
.62
joist D"m
~ laval.
..
Sltl" S.R.
.36
54r S.R.
.36
Stili Air
.92
Still Air
.92
Total' r -
Tow V'R"
Total exposed "Croeiling veva
j. Total skylight was .....................................................—
k. Total roo0oeiling @sting area (av=gp) (.10@ 16" OO.......
(.o62s� �a„ dc).
I. Total osteo 'vtsotlatod root%eiiing area .................................
Odarmine "U" value for each roofloeiling segment;
x` r
k. :w— X"U" -G
1. �• X"U" _ . ....
5....................................................................................... Total
If total of #S is the suae as. or loins than 02, the intent of SOC 6006 (e )1 his bean tt>rt
Trial =pond floor/ate. was
on. Total floodcant. framing ares (average A0%) ................
n. Total net insulated floor/cant. area ........................... _
Detemdne "U" valuc for tach fluor/wnt. segment:
M. x "U"
a. x "U" '�
6. .................. ............................. ................... I ..... .............. Total = J
If total of #6 is the ssme as, or less than 03, the int+am of SOC 6006 (03 has bean rico.
ALTERNATE BUILDING ENVELOPE DESMON
To tatiliee the total envelope systan aaethvd, the: values Otttblished by the &M of kaw 04, #S and #6 shall
11g be gresw then the sum of items #1, #2, and M3.'
1. too.5t7 2. Qy. So 3. _ &01, o�
4.
NoTr,: k, tome„ Paf-wYS NFVJ APOIT'lot,-i 0141-y-
MU heck COMPLIANCE REPORT
Minnesota Energy Code
MNcheck Software Version 3.0
COUNTY: Anoka
STATE: Minnesota
ZONE: 2
CONSTRUCTION TYPE: Single Family
DATE: 10-21-2002
COMPLIANCE: PASSES
Required UA = 77
Your Home - 75
2.7% Better Than Code
y Permit
1 1
1 Checked by ate 1
! !
Area or
Cavity Cont.
Glazing/Door
Perimeter
R -value R -Value
`J -Value
UA
--------------------------------------------------------------------------------
CEILINGS 328
45.0 2.0
9
WALLS: Wood Frame, 16" 0.C. 550
19.0 2.0
31
GLAZING: Windows or Doors, Above Grade 56
0.250
14
DOORS 40
0.310
12
CRAWT.: Concrete 42" ht/ 36' bgr/ 24" insul.
55
5.0
9
-------------------------------------------------------------------------------
COMPLIANCE STATEMENT: The proposed building
design described
here is
consistent with the building plans, specifications.
and other
calculations
suboutted with the permit application. The
proposed building
has been
designed to meet the requirements of the Minnesota
Energy Coae.
Date
i
OTY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Ridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
763.572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential �U, ruJoi
Furnace Shell and Duct Work, Burner
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
`.Air Conditioning - All Sizes
Effective On January 1, 2001
JOB ADDRESS�� ! �IZ� � L,
A4bd OWN
Rate TOTAL
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
$ 30.00 $ 361
$ 10.00
$
$ 10.00
$
$ 10.00
$
$ 25.00
$
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
$ .50
$ ;0.50
BUILDING USED AS /
ESTIMATED COSASOUr ,00 PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU HP EDR
Fuel _ Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
HEATING CO
Signed
Approved Byz� Rough -In Date
DATE
TEL
N
Final Date
BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS
AND COMBUSTION AIR VERIFICATION
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing 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 manufacturers 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 manufacturers specifications. Yes () No 00
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturers specifications. Yes 00 No ( )
When installing a new venting system, 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 Furnace
Venting Tables for fan assisted and natural draft appliances. Yes (7) 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 ft Diameter
in Type
Appliance #3
Vent Connector Height
ft Length ft Diameter
in Type
ALTERATIONS: (Describe)
a1
HEATING CO: V PIC,
Signed By: ; Date : (-DO-03
,Y'