AF - 35166�
�
n
City of Fridley, Minn.
BUILDING PERMIT
��; Nov. 1, 1968
p�; Laxs G. Aaderson. g�� Same
�d� 4024 Jeff�rson St. N. E. A� Same
�����
N° 10007
LOCATION OF BUILDIWG
N� 6696 �Cg�t Ashton Ave. N, E. p� op �
�t 1 glock 3 Addition or Sub-Division Edgewater Gardens
Cortter Lot � Ins3de Lot Setback �� Sideyard
geW� ne��q� 836 .13 839.13
Top of Footing
DESCRIPTION OF BUILDING
To be vsed as:
Dwellin� Frn�t 67 � 8�� Depth 29 � Height 28 � Sq. Ft c�. Ft 31, 752
Front Depth �Tei�t Sq. Fk Cu. Ft.
Tj►pe of Conatructton Frame �, �_$20, 000 To be Completed
Sffi�ICB ON 67th Way
Sewer Location - 39' West of the Maahole
Water Location - 10' Weat of Sewer (49' West of Manhole'
In comsideration of the 9�uancae to me of a permit to constcuct the building described above I agree to Ho
the p�oposed work ffi a�rdance with the descripf3on above set sad in c�mpliantae wlth af l provlaibne of
or8iaanc�ea o4 the dty oE Fridley. � � �, �y
e
Ia camsdderation of the �yment of a fee oP $_ '�� .00 �.�t q$ ��, �� � Lars G.
�aderson to cronslaniet the building or additfon as descxibed above. Thia� t is granted upoa
the euPra� cauditfoa that thepe�a� to whom it is granted and his agents. emplo�y� en� worl�nea, ia all work
fla�e in, araa�ad and upon said buiiding, or aqq�rt thereof, shall c�form in aII r�pects to the arr�insnc�s ofi
FridleY. Minaesota la�tton, camstruction, alteration, maintenanc�. �aepair and movtng of b���
wl�� dLy limits��a�� permit ma�► be revoked at any tizne upoa vlolatia� oP any of the P�ovis�ams of ea�d
t
Clarence Belisle ��� �
NOTIC&
TW. p�ene aoe. eot �r t6s eo�dion, � h� �aa P�bre. ea k.at�s. .s�ra� ar �rats.. e. .un is ...
Na Bu� I�ar h� +eW►ah Pe�b fo►11� i1�n,
.
�.PPI,IC.ATION FOR BITILDINC PF�ZMIT
CITY OF FRIDI�Y9 NlINNESOTA
ow� Ps N.� ���5. G, �Q�/,DE/'i'so� B�z�aoII� �•�i�lE-�
aDnx.F�s ��� � .�'EF,FER s � � s�, w,E, ��xESS .� � �a t
NO o �TRE�'I'
I,OC9TIOlV OF BITILDI�TG
�� � 6�
LOT � BLOCK .� A�DITION OR �IIBDIVISIO�T �`db,FN✓AT,�rj b��QFI� S
COR.'1'ER LOT �� I�TSIDE LOT SE°I'BA�K: SIDEY,4RD
SE4dER ELEVATIOTi TOP OI' FOCTING
Applicant attach to thi� iorm T�ro �ertificate� oi S�vey of Lot aza.d
propo�ed build� lo�atior� dra�rn. on i;he�a Cestificateso
DFSCR�IGI'_TON 0� BUILDING
To Be TTs�d A�:
�'iN6L F�WF� LI Nt�ont �� /��/ D�pth 2 9� Height ��'
�
�quare �°eet Cubic Feet � � � '� �-
�
F�ont Depth Height
Squ�,re �eet Cubic Fe�-c
Type of Construction L✓?'�i%9E Estima.ted Cost
To Be Completed
The underaig�.ed hereby make� application for a permit ior the work
herei.n. epecif°ied9 a.g�eeira.g to do all work in strict aocordance with the
City of Frid'ley Ord.inances and :eulings of the Departmexat oi Build�a.gs,
and hereby decla.res tha.t all the facts a�a.d repreaentations stated in
this appZication are true a.nd correcte /�
DATE GS�'if 3/ —/9(� �' SiGNg'�TiTRE L����� . L%2���� dc—.
(Schedule of Fee Co�sts can be fouxid on the Rever�e Sideo,
�
� � �� ��� �� � � � . � �
�
�
r
a
i �� � ��
�
_ �„ �
1 � < � '
BIIII,DING PEftMIT �'EE SCHEDIILE
SECTION 2, The Inspecto� of Buildin.�s sha,ll, �aefore issuirag pezciits
for the e�ection of any building or �t�u.cture, or �or axxy addition to a,ny
existix�.g �tr°ucture or buii�.ing, or for a.�y alteration or repa.ir� to a�a.y
existin.g buildin� or stxuctu:�e, upox� applicat3on therefo�e9 �equire the
payment by the �,pplica,�t for �uch permit oi fees to the amount here��
below �et iorth and in the ma.�.ner hereira provided to�wit:
Uniform Build�n� Codeo Type 1 9 2, & 4-$'i o75 for each one thou�ax�.d
cubic feet, or fraction thereoie ua. such cubical c:ontentso Type 3& 5-
$1050 for each one thouaand cubic feeta
For the purpose oi computing iees for building permita, the cubical
contents of any buildi.ng or �.ddition to a u:r�iform height throughout by
multiplyi.ng the ground area covered from a point six (6) inches below
the iloor line of the basement or the cellar to the avera,�e height of
the upper suxface or to the avera.�e hei�ht of the rooi surface of th.e
main �a.ble of a pitched roofo
For repair� or alterations to an eacisting �tructu.�e, the fee sha,ll be
at the rate oi $3e00 per each five hundred dollara ($500e00) or
fraction thereof in the cost of all p�oposed worko
In no ease sha.11 the �ee vharged for ax�.y permit as set ?orth i.n Section
2 b� less than $50000
NSSSD Cox�nectiox� Charges based o�. location - Area 1 or 2 0
� S �
T � i
� � a,qF 6 __� :ar �' t.-�`,�� .,+n �• � ,;,� `- ' . - �°s' - '�, �'e-:- - �
. . ' � -. � . , . . `. . �`�
,
. ' - _
�. " ' ' _ ' = -< ` -
� �
. . _ .. . _ - ��
..�; � - � _ a .
,�-fiil �� - . - .
� � _ F _ �, ������� ���� C�,�'���������# ��# ��.A� �'�Y+O� ���
�_ � - - ��
J 1@�,�i' H���%1��.. �► �lQRT���" �:;1�1��1�L.��rr�i#�f�l�`T`t�-5�i�#� �`e��te I
, . �� ��
, ' �.�..:� � � ��� ��� ���� n� . � � �� : .:��_.._ :
_ _ �
.- - . - ��
' �#l47f1�7t �'w1 s�l/�+' . .. �; ' ., . . �- - a .
. - �� , ��/� Y ��� .
� � �.� . - , tz �
_ _ � �� : �- � �� ��� _ _
� �,��.., ...� �
��� � � �
� � t � � � - -
_'�" : _ � � � � - _ �.�
Y ' . r , ° : p . � . .�� �,� �. _.e .,�,w! - r # ' - , i a,x - �, h �'' } � ��
' _"°' }_ ' '_ .' ' ��-� ....,- f' ' , ... "_ .. .. ' , _ _ _ �A
� -��. � /� � . .: , , -2`;
"t. - . .. . : � __ _ C �F �)1
_ • E1
� � � � r , _ tia
,t� -� �--�
� . � '.
� �, � � _ ,
t �'�" � � � �-� c�► � 5��� : ��= �� =�i
.
-� -.� � ��` � � _ _ � - �� -� p�rv�'.�� ���� �
��. _ : � M `�` �' � - � � �� � t .: ����
�' �� � . �
: �� .�r �,y
' `_ '�: :
. �� � �� ,,,� '"' �
_ �: ^.._r '" � �: �►� s .
� ; 'r� ;
t'�, � � �$
x i «
�..�.
�'R� F7�� �� �� �+� D��fitC-1� �
� � t -
, . -
G _ '_ _ . _ - . .
- � �.- �: < < .
-',. . .- -�. .._ . - ��.�: .
!i!!'!!^r�': . . .. . _ , . .� . _,,•
y .... ,`� ... .._ � .. ��r��� , . �� � { .. . � . � . l . .. - .
�
,� �...'-m+ _' .P- . -.. � t�- �- ' ' ��:.: � �`�� �, � �..�_�CC'"�; _._R n_..��,._ -
� Ft���pa►-r�a� F� - � -
; �'D�`a ��:A.�' � � �s A►#�i�E ��� ' `W
_ k„�� � �, B�. 4' . . ; , �
` � _
� ��t��A ���,�i-r�� :�rr�r�..: - :
� - � .
k��" . . � � � � . � - x` -
. . . ; . .. . -. . � . . . . - . .
�.��_ t� : �-. .. . -._ . - �, � - � ...
� . . .._. . . .
.,,... ., .. . . .. . _ . _ ,
� . . . .;�.!. . " La:. . . .:. . . ., � .. , . . ..,=.
W � .
� � ,.. �� , _ � r����tr ±��'���� �r�ti�T T��s ts � �u� �►_cos��� ������r�►� a� ��_sut��gY�o�. °��������e���s
�" Ttil A��I� `C��S!CRIQ�#? L�r`:J�N�i��"TFf�'���A7'f�f dF ALt @[�t4:t31l+tGS. THE�EON, #M� 14L,i�. �'i�tB�,� �ti•
< �A�t1M��'S, !ir 111�t. �`�E1lYt t� tfiNt �ffi��.A�i�i:, '= "
�. `s A3 3UiFY�Y��`$� 11B T�ft3 �,�K� T�,.�A�l OP .. ..!.?„�.�, ��!"i ...y1►;D. tg:�.�i..,, K
_ `�1..!C�.itQii�{N, � �. ;_ � tES, 1N� .�'#.AND3UR��Y�i3 � - � = =
� � � �
* � _ �'; : � =,a,x � =
�+ - _ a r ' Y� fi'. ` � ��_ � �. �' ;
� , _ � . a� � * , ,��� ,. �, .... , #
� � �
.. ��.�..t.-�i�G"�. �'`<' r = - - s 7r;, .-:.� ,:._-e..,�-,--�.,,_,�`� ,•�`��_„ . ��.
• ,_
�
_ -
�
c . , �. : �."" .`.. .'. . .akc +;.r'�- . a�.. ��;
� -� �� ' , � . - -
._ , -..: . .. . � . .:. .i:�.. . . ':: - '
,
. ,:� , , -�e"s, . .. �, �: .,..,.
�_ -
+ Y
. �
, � . _..
_ . . .. .. � .. - . ...
,R , .-n. ». .. . . - . -. ." .. _ . � .. . . ... . ... _ - , . . . . ._.. ., ... . ,.-a,. .._ _ . , _..� . ... ..� .+... � :s _ ,.
�� c�1 c�-s o �r � 7� Z�s�
�
� � � � � �. � � 119/�
`� ,� � �E-�w� �-
w y �- �'� �-� ^ s3 �. �3
'% � O °'!" � 6 7"!/JG T � J /, � � �
i�
�,� ��- _
t-- �
?C1' �a. 5��� � � % � LJ • o' ,�,�/I//�
e
t= + .�
I I � _
' 1
e
- t }
.,j
•. .�'.• \- �' r - y t : � ' �.
.. r-,ti , . i : +�yy" .
a �� ' fir f y � -%` : '';
�������� _��� . .�
'r ( -tili�tal�['ai�i�c"liiqu�/
� � � ��" . ' �, ':. , - :
� r ,. # s i yr�' � ' f # a 7 'a.+
b, .y � 1�I�,� ] '�
4S t �''C��"� r � _ C ��� x _� �`�� �� � �;4��11 �� � ' } ` _ 4 1
� tj ����`Y��� � y Y� � . $�+_.
¢ t J����� � �` 4 � '� �
��� _ 1
y� � 4�F�F! � � � � f „C � � _ Z" �• x
�,. ' ��1� �y+� � e,; ` y ��
� ^ f !� � } � - ' � .. , � �y'.
��..& .(. _��'� .�:�, �� �� -, . .. . . _ _ �.3
� �� ' . _. . , � `� • � . ,� _ . .. . . • � � _ -� � S , �
�� nfi�"+'y - ` - �-_'' i'=- c-�ge t a".r�'� �� .� � \— �. `Y3�`+lf�i' _ _ -T °e*,e-' —�-4§. __ - ` �_' �
£ � '.. f' _ ' + � ,,g.` j
�.,�ye�,�� ��. �.P W�a r.
t _ i �"ht.�""��:�_. � � - _ � 5 �°" ;'�I
�: � , T `� - • - '
�' � •
� ' �l� �� � T , � _ . . - _
� ti - �� ` - � ''7 -
r �-�..�'i.�i�� a � �
��'��� ' � � � �� � .�� <.
r � ` -'��`"'°.
�� .�" - -,,tH ��,�.:; `��- � �}�et��`��*� ���+. J ,�
�� ,, �. � � ��"
�� � b '``� �_ �, - �'�, ��` '. .� ��-'��� �1
: - >Y. �,+ �.-��
- � .. �
.,: •. . ,_
": � - �
. . _
., y ,,� . - � �..
- � , : �,.:� �;�
1 �_ �, .- � - �3
� , � �� / j/' -
„ � � � I � �
� ',�` �, �� '.,,�+ �,"'�" �� � �} � �' ,,,�� �„ �% � -e�. �! � "� : i
4 �� �. T - � _ . _ .�,�
�� , . Q v�� 1 �� � � � �� � ' �
�,
� �F��1���'�� ���t��N+CE . .� - � F;I
_ _ � _ - _ ,� - �:
, �. . _
: _ _, , _.
_ ..
.-_ � , _ -
,. : - .
�
,;.�._.,.,...
. : _ � :a, . . _ , y
-•• ��,� _ / � � � , � '�_ '�
: _ � - _ �. � . _= = - - = - _ _ } .� --t, aa`'('� � ��. C� �k�< � �
�� � �
: Fvu��p�r}oN �x �4-. � _ R �� �
L.oY �3;:�t�� .� . _ � D ix � �f A 1` � R �r /\ Iafic �,_ -<�,
. _ � �101�C A � d t,� i� �"i',> � � � i� : ; ��7'�
- _—�- �� i
' ' � ,�
, _ : =. ;�1
. � - . .��
�:�- - rl
., _ ,
� I Mfil�B�! ��RTIfY TMAT Ttt1S i9 A-TRtlE At�Q �ORRBCT REPR�SEi�]TAT#DN OF d 5(J.RYEY QF '[tFE BQ{t�i1AR1E3 _ : ,`I
OF THE �B��'F DE3ttlIQED LA�D, AND THL !.{�EAT14fV OF J�lLC BIJIt;DING3, THER�ON, :AN� A6L ,�itl5l8LE EN-, >
CRO�tttl�tEM"�3, !F ANY, I�Rt?M Q�t aN SAIQ LAAiD. -' �'�I,
'�' � . , '
' `i '
. ;,
�r : y _;
�
, ;as wR���r�e e�Y a�� ��s....��.:�........�x�r af.,.._....... � �.. � .......:�.o ��.�:�... �
i�i. C. HOIWN AMD.AS50 TES, INC. -. �:�ti�tD SSlRVEYQI�S � -
_ _, i
... ..... . �.! � �� .. ..�. , .. �
' �.,. _ - _ _ �
_ _ ,�,�
, _ -. _ _ ,� _ _ _ _ <.. . - ;. . _ :�
�
�
�. �
� �
p
:�
: x°
:r
' M
: N
: o
• �
. 0
� .
� :
��
ro
� �
"� �
� � � ,� � � m eZa � Z G�]
�o W � L� � � 8 � � "�
d � � �4 � � � 6C
� � ���' � � � �
� : ���: �Q,���
� : : � � p ; � � : �
�: : ��: �: .
. . � � . . . .
: : : : � : : : :
� ` �
aa �a �a �" oa oa oa �a oa aa �
� � � � � � � � � �
������$���8�
� �
p •°� � °�
o� � �
� �
� �
�
�
'�
�
�
m
H
n
m
C
r
m
o��
8 �
� �
�
�
�
0
�
�
�
:
�
0
�
" ■i���
: ...'
� ; ��1
- � �■'�l0�
' ' ��l��
• .�.�
_____
��
o a � �
� � p� M
� �
b
� a
� ��
�
�
�
� �
m
\,
wnrren
�osets
u�uwv.s
�TM
TuBS
��
SINKS
WASH
�n
oaiNK.
FOUNT.
sHwRS.
FLOOR
DRAINS
CATCH
BASINS
nuro
e/�s►�a
GAS
APPL
GAS
RANGE
�
OPENiNGS
�.
_.
�
� �
��
�a� �
�� �
� � �
�,�e � p+ �
���� �
����
����
�
����
�
�°�° �
��
b���
�
��
o- ��
p �� o
� �
��.��
����'
m
`° ,� b
�
����
���;
�m w�
� � A
� (Q O
�� di"
�
►w
3 `�
�
Y�
��
� �
a0
� �
& �°n
� 8
M �
� �
� -�
�
�
�
C)
�
m
�,
� �
a
� �
:� �
M.
� �
�x�
�
�m
��
r�
�_
.
�
$
�
�
�'
�
�.
�
�
�
�
�
�
�
�
�
0
�
h►�
c�
Q
�
� � t�'� �
�
��� ��•
����,�.
��,s
�' �
� � � �
y � � �. `t
0 � � � �
�����
�
t��l.
Q � � �
� � �• �
�
�O � �.
� �
� � � �
� �
t�o' � �. �
����
�
� � �
a� S�' y M
� O VJ � 0
� �C O � � .
� ����
����,�
�' C �, s �,
Y
� ��o���
� �.a`r`!� Y� �y of.
�
� � � � � �
O
lti a. � b � �,
N.
� ��'�.��
�
������
�
�
�
�
b
�:
0
�
O
�'
�
�
11
�
i-r
�
P
W
O
M
�
r°�
� �. a �' � �
�
�
I I— I— I— I� os�a
I I I URINALB
I I I ITUBS �
II' f—' I IBA8IN8
``�' ' �' A. � �
� �
�, o � � �S�'
a
o �" �
�. �'
'89 R' ,�,
I � �_ �
�
�
.
a
�
�
ISINKS � ' z ,�
_ IWABH K G�J � �
TRAYB �iiA p � �
DRINK a � � y �
IFOUNT. � O
��
� z �' �' �°
ISHOwEws Q � � g �
W�
1 , FLOOR p � � �
N I M�
DRAINS �
CATCH � � � �
IBASINB m �" �
� �� W
RAINW. 1�yy �
LDRB. � p �
et
MISC. � �• �
IFIX.
IaAe � �. �
APPL. �
I�3A8 � � �
RANOE :� � �
I� 9 � H
� ��
I '" x
� � �. �
�
� n p
� O � �
� �
� �
�, � �
�
�
-o
N
I
� �b �
` � •O
�
�
, ��
� � �',
� �
� �;
� � o
� �
�
t3+
7
1
�
�
C
�
�
r
�
:�
P
�
�
�
�
�
�
0
a
x
.L� -!�"-�,:,�r
r���
�r o
� � � �
� n � O
����
� � � p
�
"���
�
�
�
�
� g
�
��
y �
M �
� � � y
� o W �g �
�d ����
� � � ��p�
p y tO o
� � r
��: ��
��: ��
. . � �
� : : � :
: : : � :
: : : $�.�
m �
�„�o
c� �
� � � �
� � � �
0
Or
00
I
a
�
�
0
O AA7
� �
� �
�
�
�
�
�
�
�
° bd
� �
�
a
8
�,
0
r
o�
e�/
�i
°e �
K I
w
�a W
� �
��
��
��
�! o
� r,
� :
efDO �
�:
� �
� �
� •
w
�
�
� �
��p �
I ►�!
v
�
0
�
�
� ��
o �
z
0
�
�
�
°x
M
0
�
��
� 17
R+ G.
o O
� �
� �
��
o �r►
�D '
►! '
�
� �
� M
� �
eo 'j
��
R° �'
6 �
r�
��
�
s�
�
t"o'
�
�
ea w o 0
� � � �
���,�
� �
em+
� �
i�
� �
� �
�
�
�
�
c
�
m
�
0
�
�
�
\
O
�
O
'�tl�
�
�
g
��� �
b � � � �
�����
� �, � �
��� �
" ro � � �
��
� � � �
� � � � 8
� . ��
f.L � � �
i�' e�i+ : , '''
�a o : : �
g $ ' , �
: : : : �
. . . . �
w a� c� w o
� � � � �
� ��
4
oc
Oc
q �
G�+ ¢,
� �,
�
�
�
S�
'!
m
�
�
���5
��� �
�����
� �
� � � � �
����°�
0 0 �
�� �
����
a � � �
a, �n . .
en . .
� o : :
c
o $ . .
P . . .
I
wo��o �
� � � � �
�
0
�
w
R. �+� ``�
���� °
m �� �
�p m � p
p ��.7. Fr'
� ��► � �
Of�D�
� b� �
�.� "� �
L��p y
�
p � ��
O $
�•,y �
'�+
���b
b
oy��
p�m0
�a��
��,o
���"
� m
�� �
a � a,�
'� � �«
���~
���
� o
� �
� �
�
� �i
D
�
�
�
m
H
_
T
C
m
�
►�i�
m
�
o�
:
�
�
0
�
�
�
�
�
O
�
��
��
��
o=
�.
�
��
���
'
��
� �
� �
� �
o'
�
�
�
�
�
. D
�
O.
� .
�-� �
� _�-�= � �' � $. �
�-RON�STROMS HTG. �& AIR COND.� INC. Job Name ��-� i/%��� /���
D-s6 Qe ��0 6zeelsto� Bonle�ard, Mineeapolls 16, Miee. / � �-+
NBAT LOSS CALCYLATIONB Job Address U�Lo r
Weatherstrips A'S'H'V•E' Coastructivn No. I Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor � Kind How Applied
Yes—No I Yes—No 19_ I
F1.� o° oom � Length � Width Height Fl.� �m Length � y Width !�° Height
Windows aad Doors—Cracicage and Area Windows and D�m—�Crackage aad Area
tVtdth Helght No. ot L1nea1 f. Area Wldth Height Na of Lineal LQ Ares
No. ot Dane o[ pane Ilghte ot crack eQ. ft. No. oL pane ot pane ItghLe oL craak sC. f�
�.fJ� Q D %� �.� �!� e 'S7 f�1
� � �- � � . �9� 09 �
� � � �.� a�
� 0 7.� `� coef. Btu
7��
Infiltration ' �
Glass Q
Eap. wall � X � �
� �"-�- - - _-_ - �T"- - -_ - —� - -- — -
Int. waU � Q
Ceiling `
Floor (� ��j' � �
Total Btu.
Required sq. k. E.D.R. or sq. ias. W.A. l.eader area �
F7.� Room ( L�ngth /,� Width /� Height �
Windows ' d Doora--Crackage and Area
Wtatq xeiahc xa ot Liaeal:t area
Na ot pane ot pane llgnts ot crack sq. tt.
% �� � '� /� »
Coef. 8tu
Infiltradon , /� �
Glaaa _ Zt� ,�
F.�cp. wall �� i� %
Net esp. wall � "}+ (o �
Int. wall
Ceiliag _ ___
_o
- - .. - _ -= - -
- - -
Flo`oi _ j�, p � ia O F1oor
Total Btu. Total Btn.
Required sq. ,ft. E.D.R. or sq. ins. W.A. Leader area �'
Fl. j Room � Length / Width /� Height d
Wiadows aad Doors—Crackage and Area
Wldth Hetght No. oL Lfneal tQ Area
No. ot pane ot pane Ilg6te of crack eq. tt
� � , (�' (� � �� �i�
Li6ltraticn
C�laaa
��
Nec eap: w
In� wall
Ceiliag
Floor
Total Btw
rn���
� Requfred sq. fi. E.D.R. or aq. ias. W.A. Lsader area
Z FI.I .d� Room
Wiadows and Doon—I
Wldts Helght 1
Na of Dane o! vane
�
In6ltratioa
Glaas
Eap. wall � �i �C
Net esp. wall
Int. wall
1n61tration � �
Glass 1
Eap. wall � �
Net ea�p. wall v � /
Int. waQ
Ceiling
Floor ��/
Total Btu. '
Reqnired aq. k. E.D.R. or aq. ins. W.A. I.eader area
/Z,_ Width
and Area
!
2
�
Required aq. k. E.D.R. or aq. ins. WA. l.eader area
Btu
`3 b 6-�
ZFl.� �_ Room I Length // Width i.� He.i;
Windowa and Doora—Crackage and Nrea
Widts Helght Na of Lfneal [L Area
Na of pane ot.pane Ilghts ot erack aQ. tt.
3 l� 3(� 3 fo I
f� .z� _��- , �v � �
B� I I
9 � p In6lhation �
� Glaaa
F�. w�11 .� x
� Nec eap. wau
Inw wall
Ceiling
� �,/ � Floor
��� �
��� . „ r.
���� ` �
,.: ,���
�7 ,►�71� /
�_�
��%�'��ie _ �
Total Btu.
Reqnired aq. k. E.D.R. or sq. ins. WA 1.eader area )
.� .,��-,�-.
�, .: �---«
d�;ROAISTROMS HTG. & AIR COND.� INC. Job Nam
D�56 '��O 6:celslor Boole�ard, Mieneapolis 16, Mtnn.
�6 H6A'� LOSS CAL�7ILATIONB Job Addre
A.S.H.V.E.
Weatherstrips Conatruction No. � Insulaaon
Guide
Windowa I Doors Reference Out. Wall Int. Wall Ceiling Roof F7oor I Kind How Applied
Yes—No Yes—No 19
�F7.� Room Leagth � Width Height F7.� Rcom Length Width Height
Windows and D�rs—Crackage and Area Windows and Doora—Crackage and Area
�Vldth Hetgbt No. ot Llneal f. Area Wldth Hetght No. oL Lineat IG Area
No. ot pane oP pane Itghte o! crack eq. iG Na ot oaoe ot uane lltrhte ot crack e4. [t
Coef. Btu
Infiltration �f Q � B �
Glass �
Fap. wall � Z'C �
� --- -. ----- ------ - --
Iat. wall
Ceiling S" � 2,�
Floor
Total Btu. '
Required sq., ft. E.D.R. or sq. ins. W.A. Ixader area I
�..�1.� Room � L,ength j.� Width / Z Heislit �
Windows and Doors—Crackage and Area
WIdi6', Hefght No. of Lineal fR Area
No. ot pane ot pane lighte of crack aQ. tt.
� �� � � �
Coef. Btu
Iafilaation i Z y��
Glaaa ✓�}(
Eap. wall X g 2/ �
Net eap. wall, /� �
Int. wall
Ceiling � /p
-- - - - _ _ _
r'i -� -- -- -
Required sq. k. E.D.R. or aq. ins. W.A. l.eader area
Fl. Room � Length Width
Windows and Doors—Crackage and Area
Wldth Helg6t No. ot Liaeat tt Area
Na o,! Osae o[ pane Ilg6ts ot orack eq. fL
�
Infiltration
Glaaa
Eup. wall
Nec esp. wall ,;
Int. waU
Ceiling '
Floor
Tbtal Btu. '
Required aq. f� E.D.R. or aq. ins. W.A. I.eader area
Infiltra�ion
Glaas
_ Eap. wall
�et_ e�. w
InG wall
Ceiling
Floor
Total Btu.
i i
f� E.D.R. or aq. ins. WA. Leader area
I Windows and
Wldth 7
Na of pane �
�
Infiltration
� Glasa
IEap. wall
Net esp. wall
In� wall
Ceiling
Floor
I Total Btu.
Room ( l.ength Width
and Area
aeal ft. /
crack �
Required aq. ft. E.D.R. or aq. ins. W.A. I.eader area
Fl.� Room ( LeaSth Width
Windowa a� Doora—Crackage and Area
Wtdt6 HNght Na of Lineal f� Ares
Na ot psne ot.pane tights o! erack sp. tt
Btll
Infiltration
Glaaa
FaP- wall
Net eap. wall
In� wall
Ceiliag
Floor — —� --
Total Btn.
Requind sq. k. ED.R. or sq. ias. WA l.eader
Btu
Bcn
� ���.
��;�C
A � � R N
� �����
�� �
� �o� .
�C ��.
�����,�.
��� �� �'
K � � � �
��,����
�
� � �� �
s �.� �. s
ti. � i� �
Q �
� ���
�b �,�
���
��o
� -°, �: �
���
�o' �"+
C Q
�•��
��•�
�. � � e
� �• �
� � �
�� � �
� � �:
� � ��
'�;�As
„� �,�.
. �,�A�'
�A���
�� ���.
y ,Q
�q
� � �
��'� �
�
�. �� �
-Q�,��
b���.
��o�, �
���'���
b���
� ��"�
s $��.�
� ����
� ��,��
� ��o�
� ��' � �'
� b �
� o �
� � �
n �a
�
� � Y
�
I
�
�'
ti
�
F'.C'.
�
r•
�.
�
V�
�
�
�
�
�
�
�
�
,
�
0
lp+
�..
�
�
Z
�
�
�
a� o� o� o �
� �: � � � �. � � � �
z � � � � o �
� � o � � � g -� m
� � b n �; � �
,.� �' � � A �
� �� � ��-
� � �. �
�, �
� �
� ��
o . � ,
o � � . � �'
� �
� � �
c�c o � �•
I.0 � �i �
�
�.
c, � -v
� =° �
�� 3
� ��
� Q �
� O �
y 3 O
-
•y�• 70 �A
3 � '
y � 0
� ': �'
� i 0
� � �
�• 3 �
� �
� �
� �
.
�
O
�
� ��
�
�i
0 �
, ;; �
�, w
N.�
C.Ji �
oOOO �
�
�
� �'
��
� �
� O
: �
: �
: �
: �
: �
� :
� :
�:
.
� �
� �
� �� � �� x��'�
"Q ' � �� ���
� �,
��' ��a�� �
,.. • �o : O �o �
� : � � b � � � �
�. : ��� ��: �
� ' ' W � : �' .
� : : �' g : :
O
: �_ : : � : : :
N
0 0
� � � M il al i! iC ie iQ
$08�8�8�$�8�
�� a�� �
w yH y
� • �
� O
� �
1
�
,
�
�-
�
�
�
�
�
0
�
I
�
�
1'D'
�
Pfl
�
i°i
m
v
rC-
m
....,
- ����
� �
: � ����,
. � ■�■,
� � �N��
�
O � o Q
z��a�
g � � � �
� A b
�
� � � �
� � g I
�
�
�
�
�
��
�TM
n�es
awaMs
��
www
rrt�Ys
WUNK.
SH1MR5.
OdlAItJ.S
urcM
ewsi�u
ww�
�
�
�
�
���
..
_.
�
��
p
n �
� �a� �
y � � �.
� � �
�� a �
�� �
� ����.
� � �.��
�
jo � ���v
� � ��°�
�
� ����
�
� �- ��
� $�,��
�° � �
�'
� � M
a' Rt
�
a �q � �
� � � y
'T � A �'+•
�
� O
� �
r+ 10 .�
� , 3Q �
�
�d
��
� O
�
�
0
P. �
�
�
�
, : .
�
-�i.
� �-
� �
;� �
s.
�
� �
� g
��
� ��
�
�
�
�
N
�
N
�i1
�
N
.
� � r
� � �
� � � � n � � m x � � �
w � •°= � � G G1
.o � � � � � � �$ �
� � � �� � � �
��� ���.�. �� �
' � N� S� ti ° 0 q�I
��� �o�:,��•�'
� . ' a ° . . �
: � ... . : , m � • 2. � •
.
� � p�p � . . . � $ . � . .
. � : . . . .
. g' . . . . . . .
, � . . . . � . . .
�! ►�q : . . . . : . . .
� � �• � � . . . . � .
• • •
• �i : • .. • .
L . . . .
i : . . . • . . . . .
.
0 0
c� �• � w w " x x� x a �e
� � : � p P� ;� � �[� � � �" � � ;y
� �� S qi H,.'�i M iii H��� H y
!�! « � L+l
m
�
W N y y
�' • 3 S � �
�
�
� �
�
, �,
D
�
r
70
—��1
�
�
2
T
v
�
m
....,
� : .■.■'
, � ����,
� _ ■■■■�
. • ����,
..■.,
�����
�
wtu
aoarrs
�
�
�
��
rw►�s
��.
Fou�R.
�
oNA1Ns
GTdI
kRiNS
�
w�
�
�vn.
�
�
c�
OVENfN3S
� •
s •
�
� �
��
° � � C � ��� �
� d � �' � � �
� � 'y � N �� �
� � � � w � p' �
�.���� � �� ..
� � � ��
�o�•�����,�
� g � � � � ����
�
, , � �
;
N
�� ���.�.
�
� "� �' m
o ��� � �'
��� $
.,
� � .� m
, N �a��
a� M
���
� �a
.. ,� �
� �
� A �.
1 3 L�
�
;• d
�
� �
�
� �
�
w
�
�
�
N
�
F�-+
�
�
�
� �
� �
�, �
� '
��
a��
��
�
� �
� n
�
���,..... ._ . . r�i�
�; �' ��� .. ......: �� .
, .,�r �� ,, _... .. �� �
� � t � �...:.� . ,�
� ��t( �
: � ' !
� ��`� /�
l;,. ; � .
�e��>'
�� r
��J
Jt
' j�%'!
� , ;�
.,
/�
a �g
_i_ A
,� �
�
/
� •
�
�
.
P / `_ r s}
✓�
� �' `� `� i��'r.�" ,s'
� -
\ ���
l.lLBF�"�� _�
� � �
�'r'� ` �������. `
,
, -,
�,�
H.�,�
����+: .,N .
;a � •,��
. ! F� �°
: `�,' a
� �i�%.�� c
9� �. `��
���6 rIH.
. �
�3, �y� ► � e � p� ".�r.m.,. � . �•±Q. �°'
a � �� � ��W.�„����. �
8431 UNIYERSIiY AYENUE N.E.� FRIDLEY� MINNESOTA 5543x
, TCLEPHONE � 612)571•'s4S0
0
OBSTRUCTION:
� ;���',��� �.� ��,. �: �r�'�-
' � �� . � ��
�� �t �.�,. >--,
�F.a, ,^f ; a ,,' k` ^:.'� ! {�� � i'�,.r� ('.�`��`_ "_i`_.,�' '�-Y
s
Lot Bl.ock
Addition
(�� e �_ ��� ���f
P�.roperty O��ner -:�ddres� �
���� ��
_� � a��� � �° ,FS�,,_
� ,� �-- � s� � �
REQORA OF C��1FJ:�IC�TIOti�:
�. -
�.�/� y� ' �
2. ,
3.
4.
S.
G.
7.
, .. . :�:�i`:....,..,;.,:`:�.`; `.�i,.�:�: :,(�.�:�i . :�C.,S 1
��2 4�. � . `.ti`� :�i i i�� �
,� ,>u...,..,.�.2..>.h:.,.!.... . .,.,, .:i..;.>,.,,.;..� . . . .... ... . .. ... . . . ...... . . . . . . . ... . . .�:v:;::�1,`�h':d.;�:,7,;:k?:22.:�t.!i>.'1�.3:.;.`}.... .,.i.w,'K73ti12::::1:; .,,.. , .,.,.�i.)t ... �.,.�.:Sf1t1:):�:2t±:i�i�i.2.f1t?.',. .a;i,>;>,. . �`f3�5:
7F ZJ
� m �
� O y' �
-o
�
m
� � � �
o �
3 � Z �
O � m �
3 � �
�� �' c
o m � �
t
3 �
� � . _1 �
� � �
� � �
�� n
�
.m
�' �
, �
. �
. . � � .
rnT
s�
m�.�
� z��
��
� �v
� m
��o
��
�
�
�
�--
�
�
�
�
<
�
m
�
a
� �-i
� N
C
rn s
�
. �
G
�� �
_
�.
z
�
O
-�a
�
'i�
� 3 ` �
a �
� � �
0
Z
Z �
o �
� �
v � �
�'
1
�
�. . �,9
��
m•
�
Z
m
m
s
�
N
�
z
d
rn�
v
�
iv 3
��
� �
� �
S
°a
°. c
� ��
�
m
�
�
�
�� �
� O
a
°, �
��
m�
�. �
��
�
m�
�.
0 �
fl!
o �.
xN
""�
aZO "
n
3
� �
.� °° �-� Z ��
—�a�
�.D � _ �
�� �
3
m
� c
�� �
v�
�
-� � a
� ? �
� o
� �
� �
�. !A �
�r �' 3
�oo =
ao -
��
b' �
�
3
�
� m � m �� �
� � � � � �
c� p 70 'v -� �p � m
� '� � zs a -�ua �
o� . � m � � m �
� Z � � m
cQ � " 3 �
� � � � �
� a '?� C o
�, �o� �.
� g � � �
��` v �
�l � m
� v �
� � �
� O, o
O C" - O
�r, �» �,
v�i c
A • Z
. �
v �
� m
v
� �
��,)
�
c
��
�
6g
'o C
�
�
z
0
�
�
��
r
� �
O �i �
O . O :�
�
�
�
��
�
�
� �2��-
�
� � � �-�� o � Q a
� �" �' �
o � � cfl
� �0°��.
� ��
� ����
m3s
am
Svo�
�� _�
�� o
L ����
����(�-, � �- �
� 3��
��
����
� m��'�
� = n � O
�� � �
� � ��
�� Q��
� ����
� � S
� � O
' � �' � �
� n
� ���
� � m �
w � a�m
��
�
�
N Q � �
j �
� � � D
z �
w� v
�� �
. aZ
rn�
�
�
_Z
v
z
� �
rn
� �°
ma
�O
Z
Z. �'1
: :� . � v �
��
ao
�.
v �°
��
Z y
z�� �
�v, v
u� _
... v � �.
m �a
� �
y vd
�g
m�
tn .
� �
�
� �
� a
G�
r
�
�
Z m
0
T �
9 �
�1 �
�
�
�HIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimaey or stack:
1. Has been carefiilly examined Yes i''� o()
2. Is free from rust or deterior�ttion Yes ('�'�o ()
3. Has no foreiga objects lodged wit6in yes (�No ()
4. Is securely supported Yes (`'�No ()
5. Meets all cuirent Code requireme�s for size
and total BTU's conn� Yes �No ()
6 Has total heating �BTU's of �. �� i�d�
All other BTU's � � � � - � � � '
TOTAL BTU's
7. Has a liner bee�n provided for water heater
8. Has combustion air been provided for water heater
�ematks:
.
_.Y _� __� J. ���i.� ����
HEATIATG CO:
Signed By;
Date:
Yes{)Not)
Yes ( ) No ( )
�� m
Z
� � �
� O �
Ot�-fi Z
�' � �
�
� � �
o � �
� -0 3
m c�i �
v a.
�
�
o �'
��
� �
�
O
�
m �'-'
�F
So
c� �
m
�
�� �
� �
� rn `�
� � .�
m
�
D
� o
C� �
D ?
� �
�
Z �
� m
z .
�
v
�
�
� ,
��
�
�
�
cn
�
�.
�
�
Z�.
01
I�
p� 1
0
W
�
�
O �
m
� �
� `
A
rn �
- �
�3 �� � �
C � < � a �
A! t� ._: -�,
� � � m �
O ' � � �
_ '' 7 �' � ;;'. �• ' ,�F�,.. :�!�ea `, ,�, ,
f3P.�°�",: �`:�° .��� .
m '�°' . 'o�' � ' :�.
o.=, ��,.o .. .
�o =,^.:
� � �
�
z
�
�
� �
�
� �
A �i
O � I
••
m�
<��
m =�
� ��
�Z
n
��
�
;
n
�
z
�3
_�
�
�
�
m
� � �
,�cii o 0
� S �
tfl c� tfl fs
�
4
� � o
a.
m o
��
��
c
�
�
� G
o � n �
� m �
O �
� � �
m Z
� � m
S � � v
� � � � �
� C
m
'�' m
�
� v!
� �
m
�
�
v
O
�
4
�
.
I
�
�
O
�.T�
�
c
6
�
c
m
v
�
�
�, -
�
�\
�
�
�
�
O
�
�,
0
�
�
� � �
'D � $ � �
'a � � �,
� � � � �
< n
� � � �
� � o.
� O � v
� �
s�
m �
0
� � �-
� v �
m �
... �
� �
o � �
g � �
ts� tfl
O
�
$2��
� �
� �
��
°' �. �
r. �,
=
m •
����
�Q. �
� o �
� �o�
sv�—,•p' 3
N � O �
� � � N
� a 7 �
�
� � � n
� �D :�. g±
����
���a
��
\�-�m�
gp s �
N � � �-"
0
� � s
. �-nm
�' � o
���
-, � � �
�i � '
�.
�.
�
n
_
m
v
C
�ii
W
g
�
m
�
�
Z
,
����
N p�, �
� j �
"' Z c � �
� � -G
N �
Z Z
rn�
n
�
z
v
S
�
m� �
�� z
�a
�
oZ
Z �
v �
� �
� �
O �
v�
��
z '�
z �'
��
v� v
� �
��
Z
v�
vg
� O
n�
z
� �
�
�
a
�
m
O
�
�
�
�
�
� �� �
���a
:�s �Is
� " - �o� �x��x
�$b'�g NW `��d ul�p1°°ag
y�i�N �11ue�b p�EB OZ Lti
°��� amn�,rH�x3 a�dNdna � .
a��n��an _
()oN()sa�
( ) oN ( ) Sa�
:sx.retuag
I�E2ij .I23L'M I03 p2pIA0.I(I II2aQ dIL IIOI�SiI(�IIIO� SE�-j
aa��a� sa��m io3 PaPtnoid uaaq iautl � s�g
S �l1.LS 'Id.LO.L
s�n,j,g ia�o II�'
3o S�fLLS ��� I�o� �H
�
'L
0
() o�i () Sa� pa��auao� scf1.LS I�n� P�
--- azrs io3 s�uauzannbai apo� �gaun� I� s�aa�y- --- '�
( ) oH ( ) sa� pa�odd�s ��ain�as sI •{,
( ) ol�I ( ) sa�i �1'1im pa8poj sl�afqi� �i$i�a� ou s�eH ' £
() ox () sa� uoq�oua�ap ��=�siu iC�oS� aa.r� sI •Z
,� .
.��
( ) ol�t ( ) Sa� pau�xa �`� �uaaq s�g • i
, �
:x��s ao �anunq� ��sixa aq� l� sa�uan �q�aq pau�isiaptm aq,I,
l�IOI.L�'�I3I�I�A �I��ZS Ql�i� �i�11iL1IIH�
� n �
m
1 z
� o �
� Q m
� .,; �
y' � �
�,, � z
N
� � rn
-« d m
�� �
o, v
0
� � O
� '� _
_ � �
� �
v Q-
� �
� �'
N
� �
� �
� r�-- -
. �
s
0
c
�«
n
-�
v
<
cD
a
�
�
0
c
�-
�
°
�
�
�
I�
_n : �
�
�
v
� �
1 �`1
�
� V�
�
�
� o
�3
��
�
o, �.
� �
�a
C
••�.w N
a �;
'� O�
�1
�
�
0
-�
0
�
�
O �
�
r �
m �
m �
�' -
al
�
m
� �
C�7 .
� O
�
� .r
� A � �• N l=D
� � � � �
� � � � a
�� ����N
G� ,q o c� � oa'
� Q : N � � �
y N c, � a
� .�+. = 0+4 �-
OAi p � � o �
� c � o. � n, �
wr � vo�
�'�� �<=_'�
�>• Ho��-
� � ' Ol � � N
��
i� �'Q'v�►�.°°—
� ��� �
D ����
�m �`�� �
�.��� ° �
c � � �
� �D��
� � � N � 3
� � �
� 3 �
o •°'* ? -,.
��,�o
—�.+
� .,�� ? cu �-
c� n �
� � O
N O �
�, a �
m �
Q. � �,
� �
�D�n
� Q � �
°� � ,o�
< � Q-
0� � �_r
�D t�D � �
v
°• �', �a�a
'�O � �D
.J
ni v — cn
A f�D Q�(V
� p> > N
o =«
�o
�
N
i- i
� �
O vG�
Z ��
� �
v ��
� N
�
0
0
G�
�
N
v
c�o
�
d � a= y
N
� ���A 3
� �°-• cn `° c� =
m �m�cnoi
p� ^ < � �
�� �� �
� Q ' 3 �
�a„•Tv
=c
'� .� O = n
a► 3- �' c� �
��oo�o
� � � �
� 'a v
v � W
� 3
� �
%A �A � t�
� � � w
0 0 0 0 �
°o °o °o � �*
m
� � � � � �
� o
a
� r
cW
�
cu
�
�
�
a
co
Z
a�
�
_
�
N
m
z
0
v
�
'� � -� Z
���°
_cQ•
m �
� �
3 �
m �
�
N
2
�� n
fl/ n
n �
o p
> >
� �
� N
a cn �
r ni °'
QmZ3
v
�o,.
.2
�
�
0
3
�
N
-s
3
v
�
N
t�
v
C
r
�
c�i, � g O
D v � o
Z
m � �
° � v
�
� y �C
�/ �
-�
� ,
�
�
�
rn
�
�
� L
Z
O
�
�
0
�
�
tn „ o� c� �
NQ.W���
�� � � _
o � � �
�P3� -n �
Z cc � �
�� m
� �
N � � i
z �' t a�
m � ��
� �
O r
S�z -."�
��
� �
� �
��
r
� n �
��� �
1� Z
R1 .n
�O
� � i
O� ��
a
z�
v�
>�
�z
�Z
�O
� _
Z
�z
-Nt -n
�O
�
3�r
yZ
L�
v<
�
�
a
�
m
�
m
0
�
�
�
�
c
Ot
�
r
N
O
O
O
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacinsa an exis�ng 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 plasticlPVC and meets all current codes and manufacturer
specfications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembiy
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existins� combustion air is sized and installed to meet the current codes
and manufacturer's specifications. �
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specfications.
Yes( ) No( )
Yes ( ) No ( )
Yes ( ) No ( )
When installins� a new ventina system, the undersigned hereby verifies that
it is a listed assembly and meets the cuRent codes and manufacturer's
specfications. This does include AGA-GAMA Category i Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes (} No ()
Is the common vent and vent connectors sized and instalied correctly after
an appliance has been removed from the common verrt and vented _,, �,,
separately as per current codes. :�;� :°� • Yes O No O
Apaliance Tvae and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assiste�i or Nat
Appliance #2 Type BTU Input Fan Assis#ed or Nat
Appiiance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Totai Btu Input . �
Common Vent Type Vent Height Diam�ter �� 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)
HEATING CO:
Signed By: Date :
Building
Inspections
763-572-3604
SITE ADDRESS L'StCQ`'(L
THLS APPLICANT IS:
PROPERTY OWNER/
TENAI�TT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
' PROPERTY TYPE
PERMIT TYPE
�r�rnE o� wo�x:
�
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑ OWNER �ONTRACTOR
PHONE: S�l �-I - i c') � 3
STATE LICENSE # EXI' DATE
O TWO FAIVIILYINEW CONSTRUCI'ION
� ADDTfION O GARAG
� BASEMENT FINISH -$ROOF
0 DECK 0 SIDING
n
DESCRIBE WORK BEING
SIZE OF IIVIPROVEMENT
sQu,vt�s �_
GARAGES
PROPOSED S1ZE:
PROPOSID HEIGHT:
❑ REMODAdNG
9'� /' P f !'°1 �
O HOUSE & GARAGE
❑ A1'fACHED GARAGE
0 DETACI�D GARAGE
0 DRAIN TlLE
❑ OTHER
Permit No.:
Received By:
Date Rec'd:
HEIGHT
' s�-�.3-�
A�Z�s�y 3 a
BASEN�NT REMODELING SUBNIIT:
1. Existing Floar Plan
Z. Proposed fl�r plan
3. List of structural memb�s w be �sed
Ft�
SIDING FOR NEW CONSTRUC7'lON 1NCLUDMG DECKS,
O Viayl OSoffrt ADDITTONS. 8c PORCHES SUBNIlT:
❑ Aluminum ❑ Trim 1, Site Plan/Survey showing the existing sWchues
❑ Othet ❑ Fascia and ProP�� P%1�
��w$ 2. Two sets of constructi� plans
IN E3QSTING OPENWGS �Yes ONo LOCATION OF WINDOWS 3. �� ����0�
OR FOR NEW OPEMNGS-DESCRIBE SIZE OF
OPENIIVG CHANGES 8c
TYPE OF WATDOW TO BE IIJSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USINGT� 1997 U.B C FEE SCHEDULE)
TOTAL JOB VALUATION $ '� 1 lQ _� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Fscrow
Erosion Control
Patk Fee
Sewer Main Charge
Total Dne _ _
$
$ 3. �2.
$ L (� (�
$ �.C�
$
$
$
$
$
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)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+68= 8x$21=$
$450 Conservarion Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Frtdley Attac6
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conformance with the ordiaances 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 work ch requ�res review and approval of plans.
SIGNATURE OF APPLICANT �t�� PRINT NAME �—Lii''F UV� K� DATE �`�'I ' O�-F'
Page 2- Building Residential Applica.tion
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erection of any building or
siructiu�e, or for any addition to any existing building or shucture, or for any altera.tion or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
� 763-572-3604
Fax: 763-502-4977
Bui�di�g
Inspections
763-572�36U4
DATE � �V � Z✓ O
SITE ADDRESS �n
i'H1S APPLICANT IS:
PROPERTY O�VNER/ �
TENAI�TT
CONTRACTOR
SUBA�TT A COPY OF
YOUR STA1E LICENSE
oVITH APPLICATiON
PROPERTY TYPE
PERMIT TYPE
•rYrE o� woRx:
NAtv�:
BUILDING
RESIDENTIAL APPLICATI4N
CIT� OF FRIDLEY
� D O YOUR E-MAIL ADDRESS _
1 aK �v.
OW{VER OCONTRACTOR
,., G�cS —�ihy.4. A � ��r
►s: (� 6 t 6 A�s � e�.,. 14-t
'7 I Z V _C '7t,1..- 7 G,lr.1 �
STATE LICENSE
EXP DATE
�
Permit No. •,
R����
Date Rec'd:
s'�' . �'4'�'
� t S Y 3Z.,
ADDRESS: CT1Y � STATE ZIP
PHONE FAX
❑ BAS�vm�' Fw1sH
❑ DECK
o Man�,vac�rnrn
DESCRIBE WORK BEING
SIZE OF INII'ROVEMENT
OFSQUARES
GA�AGES
PROPOSED SlZE:
PROPOSED HEiGHT:
SIDIIVG
0 Vinyl
O Alumiwm '
0 oa,� .
wnvnows
1N EXISTWG OPFI�tWGS DYes ONo
OR FOR NEW OPENIl�TQS-DESCRtBE SIZE OF
OPENIIdG CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED
0 ROOF
0 SIDIN(3
�wn�m�� r�o�
❑ ADDTfION
❑ REMODELING
bb�
LENGTH �O �
❑ HOUSE �NLY
❑ HOUSE & GARAGE
O ATTACHED GARAGE
0 DEfACHED GARAGE
OSoffit
O Trim
❑ Ffficia
IACATTON OF W1AiDOWS
❑ DRAIIJ T[LE
❑ OTl�R
u� G rek.K.d
vV I? D Cs
HEIGHT N S ��
1
�AS£MII�T REMODELWG SUBMIT:
1. Existing Floor Plan
2. Pro� 8�r plan
3. List of struct�ral �c►bers ta 1� uced
F�
FOR NEW CONSTRUC'RON IIVCLUDING DECKS,
ADDI7'IONS. 8c PORCI�S•SUB2�4IT:
1. Site P1an/Survey showiag U�e �ing suucdues
� P�� �J�
Z. Twro sets of construrxion plans
3. EnExgy calcutations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COS� OF LABOR AND MATERIALS:
��'� TOTAL JOB VALUATION $� �� U.B.0 FEE OCCUPANCY TYPE
Permit Fee �
Plan Review
Fire Surcharge
S�rcharge
License Surcharge
SAC Charge
G�rb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Toial Dne
$ oi - �
$ � o� c�
$
$ �
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the wtal job valuation
.0005 x Permit Valvation Minimum $.50
$S.QO (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attac
1iiIS IS AN APPLICATION FOR A PERNlTf NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge thax the information above is complete and accurate; that t6e work will be in
conformance wiRh the ordinances and codes of the City of Fritiley 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�i� that the work will be in accordance with the approved
plan in the case of all work w}'ich requires revi w and pproval of plans.
SIGNATURE OF APPLIGANT ���I.�L � R1M NAME �-�t K n, G- /�tn c� � fS a v+ DATE !��f (� 01
Page 2- Building Residential Applicatian
�� � BUII..DING PEI2MIT FEE SCHEDULE
. . � - . ��: ;
4
The Chief $uil,ding Officiai shall, before _i5suing permifs for the erectiou qf any building or ,
si�ucture, or for aaziy°�.dditidri fc� any'�xisting building or structwre, or for any�,alteration or repazr '
to any existing building or structure, upon application there�o're, require �the� payinent �y� the
applicant for such p�rmit of fees to the amoun.t herein below set forth and in the manner herein
pmvided to-wit: , � . ° � . _ , . . . , . ,
VERITICATION OF FOUNDATI4N
Pe� for construction will be issued a minimum of 24 haurs from the time of application to
allow for proper review of proposed structure and of the constYV.ction site.
A Certificate of Survey of t�e lot, showing the location of the existing foundation will be
required before proceedi.n.g with the fi�a.ming. New Houses Onlv
City of Fridley
Bualding Inspections Department
6431 Uruversity Avenue NE
. Fridley, MN 55432
763-572-3604
Fax: 763-502-4977 "
� , � :-��l���oo�
�
CIlYOF
FR[DL�Y
FRIDLEY MIJNICIPAL CENTER • 6431 UNIVERSIT'Y AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I, understand that the State of Minnesota
requires that all residential building contractors, remodelers and roofers obtain a state
license unless they qualify for a s,�ecific ex �on fro the licensing requirements. As
the owner of the property at�,� y`���.(�. �e , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for cesale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forFeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perForm
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forfeit my rights fo
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and c'ity ordinances in connection with the work being
pecFormed on this properiy. �
_ �� � .
.i�.�� � i_��-�
Date � — � ( -- O �
a
s "
h �G-
� w C0<S d h
�•
�
�
�
�
�
�ll�i
�
I
. ��
� W�� w►-� ��- o� e. -- i(� C� -� 3 r d l� �. �r-� d�-e. y
76 3 -s" 7!- 13�� �+-u�.c�
�� l� e r -�l�.y w a. r�1 - Pe r-� ( e�- P+.�� 5 e, �^ 1 K- o.�
C� u� ��, -� U. �r w a- r d Po w e r_� la �„ �.
�J�LI� YG►rc� � �e.r..c�d l� '���1.A�K �: v�l�
N
�
�
�
a �
���
���
��-G�
��t'�- v�G �
F---�►
�
�
�
,
a
�
�
�
�
�
h