AF - 44522� � SUBJECT PER �
City of Fridley ° 141�"1
, ` AT THE TOP OF THE TWINS B U I L D I N G P E R M I T RECEIPT N.
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� • COMMUiJITY DEVELOPMENT DIV. g�3�
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r � � PROTECTIVE INSPECTION SEC. G�635
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�� � /�"1 � CITY HA�L FRIDLEY 55432 NUMBER REV. DATE � PAGE OF APPROVED BV
•---� • •'� si2-5so-sa5o 910-F15 6�Z��% � �
JOB ADDRESS 111 Alden C71^C12
1 IEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1 � Henri ckson' s Add i ti on s"EET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
John Beaulieu 129 Hartman Circle NE 55432 571-0559
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE N0.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO.
6 USE OF BUILDING
House & Gara e
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Same Construct a 25' x 30' Dwelling and a 22' x 32' Garage
9 CHANGE OP USE FROM TO
STIPULATIONS
1. Provide city with copy of truss design.
2. Provide pilaster course mid-wall of 50' foundation wall.
3. Hard surface driveway.
4. Provide sod in the front and side yards.
5. Provide a verifying survey before capping.
SEWER LOCATION: Approx. 8.5' Deep In Street, 53' East of Manhole(Inv. 849.87)
WYE EI,EV: 850.29 TOP OF FOOTING: 853.50 Minimum
WATER LOCATION: 56' Ea.st of Manhole
DRIVE�9AY DEPRESSION COST: N/A Existing Depression
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC� FYc1ICtG
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OFi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R 1 7920+704 36,168 Total
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT SS4 � 41S $27� 21
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $144.67 $375.OQ
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
5
nru o�NiAA ORORAUTHOR12 GENt IDATEI HEN P P LY V Lf ED THIS IS YOUR-PERMIT
a�� � (o- 2-�-�
SiGNATURE OF OWNERIIF OWNER BUILDERI IDATEI BLDG INSP I)ATE
��SUTq.�q` MINIVESOTA VALLEY
F ��� SURVEYORS 8t ENGINE�f25 CORF'.
N N
G � 12120 RIVENWO00 DR�VE . BCRMSVILLE, MINNESOTA 55337
��(. ��� . PM�e 890.I750
r�RS E�'
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Certificate of Survey for:_ ?�ief Henric
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___ TELEPHONE - Ef.EC?R!C - GAS E c.
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- � RfC,�UiRED BY tA
�a�t 1, �<?ock 1, Henr:icksen's addition, �.ccorc:ing to tht, plat
on �'=ilF: iri th�� ^PgistE;r �f d��eds, Anc�'r:� Couiit;��, i�ci+tnesota.
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,�,ie � OF PRIDLEY DOES NOi GNARAN� o S.
ACCURACY O P U T i I. i T Y L O G A7iONS �pOSES ON t Y A�
- T, :�S DATA IS FOR INFORNiA'�10N P� �p71 N.
PERSONS USING R SHGl1� V�� tHE �
- � � �r�e �Td -
I herebycerfify thai this is a true und correct repr�sentotion Mfaoeaota V���l�' .SUfYl�'Or4 dI
of a survey ol the boundories oi the above destribed land, Er��a�lfl. Co'rp, - , .
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and of fhe lo<atioe ol all bu�ldin s, therson, und all visible �..'� f�� �'� � .-'-"�
9 by --��—�=` � � __ '° . ��1.__ �_R L,S
encroachmen�s, il any, from or on said (und. �.
As surveyed by me th�e=Q day of .--��;� A.O. )9 � ���,� � �
�=----- Zfz !�i��sn: Re�. No. _
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CITY OF F�IDLEY
ApPLICATIOtd FOR RESIDENTIAL BUILDING �ERMITS
�NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
047�1ER: �G✓ �4 � '�_,I.` /��� l� � t-�- ]3UILDER- �a�Y>'�--�
Address : �� � �C,titX.t�..�.� �--�—°- Address : . �Q/Yv �-�
Tel . No. �^� � — � S .�
No. : /( � Street: /�--� G.�� C ���'L—� �
LOT: ` BLOCK: � ADDITION: ��,l� L��'�'��'� � f^�'�s / f w�/ `� !
CORNER LOT: INSIDE 7AT: S:�,TBACK: SIDEYARDS:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be U ed As:
Front: �.S � Depth: �4� Height: ��
Square Feet: 79�0 Cubic Feet: �Z ��U
" � Front: � � Depth: _ � r Height• �� ��� ��
Square Feet: %D� Cubic Feet: 8��%� ��`��
Type of Construction: �� ),� /-'/�/-�/}� _ Estimated Cost: $ �`� /S
Zb Be Completed:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired /V $ $
(S E REVERSE SIDE OF SHEET)
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. See reverse side for additional information.
DATE: SIGNATURE:
� � 5tipulations : ��,y,-r'�j'' � � �i7. � �
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• Page 1 of 4
EXTERIOR ENVELOPE AVERAGE�"U" COMPUTATION �
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OWNER: <,� ..,'t11�.,J �,...7�� C.i L.. I �::.. �� �.�_ � � .- � � .,,_��,�
DATE _ .,,,,
SITE ADDRESS : I I I /-°t �-- �� �{�� �� '� _�
t � ...�. S
PHONE: �
CONTRACTOR: _. 4 _ ' , ,.•
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��:�G t- � � �� ' �l �. i � U
Determine working square footage of each
l. Total e�posed wall area...... ��j��� �� ,
-_.�:��1..Ls�._ S q- f t. x .17 = `� � C�
2. Toal roof/ceiling area e..... !;�j -: �,_� sq. ft. x OS S �
�.-, _
Total e �
xposed wall area above floor = �
a . Total wall window area. . e . . . . . . . . . . . . . . . f � S
b. Total door area oe...o .o..... •••�••.....`... �
c. Total sliding glass door.area ,,,, ""•°•.���.�......
d. Total fireplace wall area ... .e............�.....� ��``�
e. Total wa11 framing area (average•10$).•.�.������������� `�
f. Total rim joist area .......e ..............'°'•••.�.... �.
........ ��
g• wall area above floor.. �...
h• wall area above flooro.o,,,•� "••�...�...�..... ---�`'�
i• wall area above floor „ e„��.�..����......... ��--�
7• wall area above. f l o o ro.o.e.o...e......o...�.... �� i
Tota1. exposed foundation area = � ��; ^
k. Total foundation window area.e.e......e...
r.�
l. Total net foundation area ������������ °1
above grade .....a.a,......, �a^
. ,....,,
Determine "U" value of each wall segment
(e.g. window, door, each separate wall section)
a• / U l.� X njJ�a �� _ �� �,
— �,_.J._ ;;,�)�,_
b. � I � �
�- �:t_ X ,o �„ , 3 = 1 Co
�e � � a X ,vU„ , � _ �.�
de _ fr �._ X „U., �� _ ;�
.
e. �L� g o�U�� � � (� _ �;-�
�.,.a
f . (``, `? , � ;
X ��U�� � _. _ ,
�, `
g. �,,��� g ��U�� � , � _ ��
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h. T ""� •,t }{ nUn , _ -:�'
---, "�
-��..- ,.-1
1' •__ ��% J -`' X n U n �, - _ ���','j 4..J
.- � , a,�,,,,.
J � - t:...- c,; � X ��U�� � _
i _ ��� If item #3 is the same as,
. or less than item #1, you
k- X°U" /_ _ ;-- have met the intent of
-� .., _ _
SBC 6006 (c) 2.
1. `�
i ,� X ��U�� , _ , • _ �
3� . ............................. Total = _ '°� �
.
Exterior Envelope Average "U" Computation
Total exposed roof/ceiling area = ��������
m. Total skylight area ......
n. Total roof/cei2ing framing•area•(average•10'�)...
o. Total net insulated roof/ceiling area........... /��_'
�!�
Determine "U" value for each roof/ceiling segment
Page 2 of 4
m. g ��U�, _
11. % ��� `i �,,,.� X I�U�� r` �-� � . � . .. .
R , , ; .
� � � �„� . . . . �
O . I n �t
C�J $ U i �_'� _ "� �
4.....o .................e.. Zbtal = �.� �
If total of #4 is the same as, or less than #2, you ha�e met the intent of
SBC 6006 .(c) l.
Alternate Buildin Envelo e Desi n
To utilize the total envelope system method, the values established by the.sum of
items #3 and #4 shall not be greater than the sum of items #1 and #2.
le + 2.
30 + 4.
� WALL SECTIONS
NOTE: Use 10� of opaque wall area for
frame construction
V
Fzc. #�
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FRAP� Z9�T.r.
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Paqe 3 of 4
� Construction R-Value
I1. Interior air film 0.68
� 2 . I � �r c , ��_''�. `h� ? '
. � ('��
� 3' --� � � �� y� 35
' 4 . � :� '�' '�f� ��--�� � c.. �t.: �b , , "�
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s . _ �1�` �; � , �. , _ ; i � � � �
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6. Exter�rair film Q.��
. Total � � Gj.'�
U � , ► �{-
1. Tnterior a�t:r film Q.�,�
, ,, -
2. ,.�;�. ��:a:- �- ,�_ ,� � �
�' r ' � �
3 � ` � �' ' ` x �' �
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/ e �. r' �.-.-. ..,�
4 - " / �?: 6}; E � , ; .� �„P �', ( � � �-
5. �" � '-i'l� f 1 "T�� �."'�'t��ll�� :-.--
----�-�-r--�---------- =-�-�'_
6. Exterior air film 0.17
,�, `.
� :� � .�-- r �'�/'i�,�: � � ?� t ; �. / � � � �1 i � , '� �
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� --' � ��� �i ' ``�°�
1, Tnterior air £ilm 0.68
,�
2 . "� �� ' f�, - ' ? � � ► i�-
� 7
s . ��.. �, � -� ��
4 . '�__ �, •�' • _ ;:.�, i � �� • � C v
5. y}1�'; �"a,.�,.� � � ! .�- � �_
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6. Exterior air f ilm 0. i7
ti'otal
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1. Interior air fiZm 0.68
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2. � ' z�
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3, s=~ -
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4.
5.
6. Exterior air film 0.17
To�� ) c� , �r��%
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_ra e: i'�� • : � � L � �
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FIG.. #�4
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Indi^ate tyne� "R" vayue, depth and
placer�ent of insu? ��.;.Q;, _ . _
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• Yr�d�
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Vented
ROOF/CEILING
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FIGe �5 �
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Page 4 of 4
Construction R-Value
1. Interior air film 0.61
2 - �c� / ( � � c `�__� _--r . ��, �� 4 • `'PS
3 0 �-� �C t C� /1. �s
4. Exterior air film (still) 0.61
Total � �. � � c�-
r ,� i 0�
V
l. Interior air film 0.61
2 . � �� � C.. � `1 ' � �s.� �� .� `-�`�
3 . � Q�/ti �,.: �.� i � '` . � /`ti ,�, _� � ` ; i i.%
4. Exterior air film (still) 0.61
Total � (' � � �
v= ► ��
_ ,FIc;. #5 .. . . . . . 1. Inside air film 0.61
' � � �, � " 2�
� . i� 3 .
� � at ,.1�-'�-%,yo`i°..5; i�..��i^� � 4. � . . .
,� A�s.li:3'.y�:-=�•-�'"L0.-..•= .� A, 5. Outside air film 0.17
�/ . • •.. .�r ~i�,.si / � Total
r� . .
L-� �� . -
� Note: Use additional sheets if mor� space is
�, � - !, needed for details and calculations
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CITY OF FRIDLEY
APPLICATION FOR PI,UMBING AND GAS FI�'TING PEI�+IIT
m jv y � U • k N Water
� y� m � sbi c�.�+ N A � a w � Heater
iJ .�1 tn H .I rt N tn itl 1+ W
.N N N q � �.i q .0 � � 3 � � U � 0 .0 � U � N
+°+ ro.°a �►''i m ro � ro�s�+ o.°a g ro m� b ro .`�+ ro �
vi u a m w y 3 Q u+ �n w u oa �C 3,c� � c� o as lec
\ � �` \
lst � �
2nd t ,
3rd
4th
(R) = Future Connection Opening Connected with Sewer
(*) = New Fixture, Old Opening Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: N0. RATE
Number Fixtures 1� x 53.Q0
F'uture Fixture Opening x $2.00
New Fixture, Old Opening x $2.00
Catch Basin x $5'.00
Water Heater - to 99,000 PTU �_ x $5.00.
100,000 BTU to 199,000 BTU x$10.00
Water Softener �_ x $7.00
New Ground Run Old Building x $5.00
Electric Water Heater x $S.OQ
GAS FITTING FEES:
lst 3 fixtures �_ x $3,00
Additional Fixtures x 51.00
Gas Range to 199,000 BTU �_ x$10.00
REPAIRS � ALTERATIONS
First $100.00 $S.QQ
each add. $100.00 or fraction $2.00
;� fi State Surcharge
TOTAL FEE
REINSPECTION FEE
( $10. 00)
TOTAL
$ v�_
S
S
$
S �
$
$ � -
S
S
$ -�
S
S �_�_
$
$
$ .50
S ��
Job Address �j/ �� %'L � ��
Department of Buildings
City of Fridley
Tel. #571-3450 '
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 rulings of the Department of Buildinqs, and hereby declares that all '
the facts and representations stated in this application are true and correct
FridleY. Mn. ` Lc,.(_C , 19�
OWNER r ��/7 2� � ,J� L ( / / � L2
'v ,
KIND OF BUILDING —� j f�� \_/ ]��L-: �.: j! �_
USED AS ��� %L% ��
TO BE COMPLETED ABOUT � i' C_�. / � /� ��
ESTIMATED WST _, 1 � �� G
OLD NEW BUILDING P RMZT NO. � r� PERMIT NO. /c�J
� .
CompanY �C11.��- (�'T �Q-�-�-E.�C f'��
Signed By
Tel . No . �j�� �� S �� �
ROUGH INSP.
Date
FINAL INSP.
' Date
APPROVAL FOR PERMIT -��
MINIMUM FEE FOR ANY PLUMHING PERMIT IS $7.50 pLUS $.50 S'1'ATE SURCHARGE
CITY OF FRIDLEY
APPLICATION FOR PdWER PLANTS AND HEATING, COOLING, VENTILATION, REFRI6ERATION AND
.AIR CONDITIONIN6 $YSTEMS AND DEVICES
PARTI�L RATE SCHEDULE ' /
GRAVITY WARM AIR: RATE TOTAL Job Aaaress f
�/ f �� -���-�-" 3- �, l.,-� '"� �`..,� �._�
Furnace Shell & Duct Work $12.00 $ ,
Replacement of Eiirnace 7.00 S
7.00 $ Department of Huildings
Repairs & Alterations-up to $500.00 4.00 $ City.of Fzidley
Repairs & Alterations each add. $500.00 "
Tel. #571-3450
MECHANICAL WARM AIR:
Flirnace Shell & Duct Work to 100�000 BTU
each add. 50,000 BTU
Replacement of Furnace
Repairs & Alterations-up to $500.00
Repairs & Alterations� each add. $500.00
STFAM OR IiOT WATER SYSTEM :
Boiler & Lines up to 100,000 BTU
each addn. 50,000 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNER- to 3 gal. per hour
each add. 3 gal. per hour
GAS BURNE R- f.rom 100,000 sTU to 199,999 BTU
(over 199,999 BTO see Fee Schedule)
$12.00 $ %� �(��
4.00 $�
7.Q0 S
7.00 $
4.00 $
$12.00 $
4.00 $
7.00 $
6.00 $
$10.00
10.00
$10.00
GAS FITTING FEES:
lst 3 Fixtures x$ 3.00
Additional Fi.xtures x $ 1.00
Gas Range to 199,000 BTU x$10.00
AIR CONDITIONING
FAN HEATING SYSTEMS See Fee schedule
VENTILATING SYSTEbiS
ALTERATIONS $ REPAIRS
3tate Surcharge
RUUGH INSP.
Date
FINAL ZNSP. �^ % r
Date
14PPROVAL FOR PERMIT / W,�
Tor�. r�
REINSPECTION FEE
($10.00)
0
$
$
S ,c_✓`
-�
$.�_
$
S
�
S
S
S
$ .50
S :�5'. 5'�
MINIMUM FEE FOR ANY HEATING PERMSm IS $7.50 PLUS $.50 STATE SURCHARGE
The undersigned hereby makes application for a permit for the work hereiTi
specified agreeing to do all work in strict accordance with the City Codes •.
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this applicatiory.a�e true and correct.
1
s ���777
Fridley, Minn. �__r� ,� � 19�
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OWNER ` /O/ �✓✓C! �� , � -� f-� G1 �/ 'E' L � -
KIND OF BUILDIN� �" S l C/ ��Y �/C«"�� `I `CV
/ _
USED AS
TO BE COMPLETED AB�T �C � �
ESTIMATED COST /���
OLD -�W BUILDING ERMIT NO. �� PERMIT NO. C.�:s2
� DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Wate , Warm F(i'r- No.
xTrade Name j-� ./�/�/V �,� Size No. !— i t/
�c;apacity Sq. Ft. EDR ��_'7__ BT[f G?'�},�_ iiP
i
Total Connected Load Kind of Fuel
�BURNER - Trade Name ���// ,P � U IQ L� � Size No. �
Capacity Sq. Ft. EDR BTU iiP
Company � � � ��/
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HOUSE HEATING TEST RECORD
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ADDR E55 f,
11.�. AZC�E� G`1r'C1.6 N.E. APT. FLOOft CITY suauRB Fridlev
OCCUPANT John BeciU11GL1 OWNER �am�`
HEAT LOSS DATE H7G. INST. � n���7�
SOLD BY INSTALLED BY 0�►ner
Electrical Work By �WCIeY' Gas Line By Qt1'nE'•r'
TYPE OF HEAT GA FA �HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE Len�Ox. MAKE OF BURNER
Model Model
Serial � r� 3 Max. BTU Rating
INPUT �37� i,��7�'� ��y� MAKE OF FURNACE
Model
TH�%�TJ CONTROLS � /� ��
MUJ A�� Heat Plug �'" �" Vent Size � r�
Vatve � � � KIND OF LINER ���� ����SIZE� "� NONE .`
�, Draft Hood�v�L Y /N Regulator
Limit �
Limit SeNing � � Filters $izeL�d�''L' Number
Fan Settin `�� � �' /�� � Chimney Location ��� �nside �y Outside
9 � �� /VO/✓ L N✓ ��%�9' _ Chimney Construction %'� ��� �
Pilot Type
Pilot Make �� ,/ /(/�Q°�✓�/�� Wirin ���`
Pilot Model �r ¢ � Smoke Bom'bt�i 9
S G Draft � Test Tag �"��
Pilot Timi�g �-
L.W. Cut Off � Door Pressure � Lighting Inst.
� J
`�'� wG Percent CO � Date Tested �d �O � 7
�iessuro , G
Input CFH `'3 Pereent 02 Company Testing �f �
z .- ,. , 5��.9 FF�
Staek Temp. Percent CO � Name of Tester j
33.�J
Form 235
SuB�ECT
City of Fridley
AT THE TOP OF THE TW1NS g U I L D I N G P E R M I T
r
� �
� �
� • COMMUNITY OEVELOPMENT DIV.
� ; V ������,
r � � PROTECTIVE INSPECTION SEC.
� � �-"1 � CITY MALI fRIDLE� 55432 NuMeER pE�
�""�"� �'� 612-571-3450 910-F15
J08 ADDRESS
111 Alden Circle NE
t LEGAL LOT NO. BLOCK TRACT OR ADOITION
oesca. 1 1 Henrickson Addition
2 PROPERTY OWNER MAIL AODRESS
Carol Beaulieu Same
3 CONTqACTOR MAILADDRESS
Snook Co's 25 E Hayden Lk Rd Champlin
4 ARCHITECT OR DESIGNER MAIL ADOHESS
5 ENGINEER MAIL ADDRESS
OATE
9/10/98
55316
ZIP
ZIP
PAGE OF
� �
�'RMIT NO.
27676
APPIiOVEO 8V
SEE ATTACHED
SHEET
PMONE
571-7860
PHONE LICENSE NO.
323-1436 20134235
PHONE LICENSE NO.
PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ iJEW ❑ ADDiT10N ❑ ALTERATION L� REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reroof house & garage (29SQ) Tear-off
9 CHANGE OF USE fROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
TYPE OF CONST.
SEPARATE PERMITS ARE REOUIRED FOR ELECTR�CAL, PLUMBING. HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED fOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNI
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION
AND KNOW THE SAME TO BE TRUE ANO CORFiECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WOiiK 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 pEqM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
�r������ ��D � PlA � HECK FE
SiGNA1URE Of CONiRACTOA OR AUTMORIZED AGENT IDATEI _ � � i
ATUAE OF OWNE:7 UF OWNEA BU�lDER1 �DATEi
•• / �
Sa
� STAILS
$2,485.00
$74.75
. SC $5 0
Cv LOAD
CU. FT.
OFFSTREET PARKING
IGARAGES
SUFTAX
$1.24
SAC CHARGE
Fi SC $2.48
TO FEE
$83.47
THIS IS ����
!�
f)4TE
NEW
ADDN
ALTER
[�
[l
�)
ConstructionAddress: �/
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATTON
Owner Name & Address: _
Contractor: ,�t�.�a o�
�
�O%° ,►�..� G> C� C �
�.���� ��m C
� �l -j �'t� i.� �i P. U'
C� d : �
Address:_ _ �� � �A �.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Effective 1/1/98
���
��� ��
��
Tel. # .SJ �/ �' % ��D
MN LICENSE #�a/32J'o?35�
�.o-�el. # �,r?3— /y,��'
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
W idth
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
�,r► �.
2� �
Construction Type: ��°��'�� �' ��D a� Estimated Cost: $ _T ' � �5
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ =$
DATE: %�/G �� APPLICANT: �G'��,G�� Tel. #3,�,3 "� 1i%�,�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
r�•yr:�
STIPULATIONS:
$ % `i- �S�
$ . y�s
$ /• Z�
$
$ �-�. o0
$
$
$
$
$ �3. ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1000 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 [ ]
r. �
CITY OF FRIDLEY INSPECTION DIViSION . ! ��
6431 University Ave NE
Fridiey, MN 55432 � APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572•3604 REFRIGERATIOM AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCIiEDULE
Residential
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 Conditi�nin'g�`• All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1 jo of Value of Appliance or Work
Commercial/Industrial
1.25%0 of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
� , ,:
� , . , .,
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT fS $��.5.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard wiihout
written permission from adjoining property owner.
JOB ADDR
OWNE
1c��
Effective On May 10, 1999
TOTAL � n
BUILDING USED AS S �C%�7�c�X.
$ �� ��
ESTIMATED COST � CZ�� PERMIT N0. ` 1/
$
$
�
$
$
$
$ .50
� C�,�7�
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units� Circle One (Steam) (Hot Water) (Warm Air)
Trade Name ��r��o�c 6� �/v -�C� Size No.
BTU_ � HP EDR
Fuel f" �s' Total Connected Load
Burner Trade Name � ' Size Na
' 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.
RICCAR HEA;iIfVG & AIR
?387 CQMtv1ERGIAL B�LVD. NW
HEATING CO •�;', A�QOVER, MN 55304
„ -
Signed y1�'_� DATE �i
,
Approved By Ro�igh•In Date ,� Final Date �-3 oU
NEW
ADDN
ALTER
��o������
[ ] CITY OF FRIDLEY
[ J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Address:
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
U �
D !
o- �
� � �—t
��
� C�,
�_ Tel. # �� �r � � 7 -�
MN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width Height
Width Height
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
OTHER:
� �� i W*
Construction Type: S � � i''`�� �[ E' ated Cost: $ ��` C� d U
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x� _�
�C��
DATE�" / I� U S APPLICANT: ��b�(� 1 v, �}f,L! /�(,� Tel. #�� �= v 3 y�
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
Q � �r
.p
$
� O�
� r v c./
$
$
$
$
$
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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 $ �� STIPULATIONS: