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AF - 44076/ , � City of Fridley, Minn. BUILDING PERMIT N° 6121 � . .: - . - ,� ,. "' i' � �'' . �� _ w' . .s. _,� «r ,�„_ _ ,IF � .. • .. �' -,; �� TION O f 1 �' � r: � ,�s No. � ..fr[.L[ Street . . , �` ''�_.�.r...�.__i � �'-< , � Lot _.. __ Block _._....._:,�.._..,.._.._..�, Additia� or Sub-Divie�iat . Corner Lot ______.._._..... Inside Lot ._._.�....�+l�'"r*_..... �back -�.�--t ~ Sid�yar�l� ' .. Sewer Elevatian _._..._....�.... __.._._ Fotindatlan IIevation `�. t �' . „ � . DESCRIPTtON OF BUILDINti"'�� '."�� . t . -. ,: - ,��.,,�. T v�a ; ,,��°"' " ,, . ; �` ` � � � � � �� , ', �. � � �t � H�t �: �. �. � , t � n�pth .�,'� -r e�t ._.,,��. sa. Ft. �ii� cx�. �t. . ,. f C7o�struction _. ;- Es�. Caf �..:.."'�'.:"`_"�o be Ca�d -- -- -- ` ,, , - _ + ; � } �� . 4 }� _ �y� .. . . , . L . �sF r . fi:�- �� y* �• _ ;; :�� In consideration of the issuance to me of a permit to construct the buildinB described abowe, I eSrM � E�o . th� proposed work in accordance with the d�scription above aet forth aad in compliance with all �rnvla�i�tle aE` ordinanoes o! the city oP Frfdley. , �} In ca�sideratiart of the payment of a fee of �i��*�*""� pe�mit is hereby granted tc► to car�struct the buiiding or addition as described above. This pe�rmit is gran#ed t� the express c�dition that the Persa� to whom it fs granted attd hfs agents, empioye� and w�, in aII w�k. dane in, around and uP� said buildin�g, or anyp� th�r f, shall c�nform in all resPects t� the ardi�1 0! Fridley, Minnesota re8ardin6 location, c�nstructfon, alt�rati maintenaace, s�pedr aad mavin8 a� within the dty limits and ttuis permft may be revol�ed at any� upon violativn of any a! the Frovlaior� ot ordinancea. �, � , : _ t � NOTICE: 7his p�ea� dou not Qewr th� eenNruefios, isq�NNiee fm rr1�i�l. 1�Y• ��0. s�ww �e �. M s�w 1�r w f6� 6viWfno Intp�clor fer t�p�raN pwndi� fer i6N� h�. ` �" .. «—� � � � ' � � �y , «„ `� � .�,:�+ "� '�, «*� �� r-> ry-.._ � �. ,� .� � � -� .� . ..�, � ''�< �.;� _''�`'�'� ; ,�.,� .��, � ��r�t �, <.,��;� ,� �,a a►�.+�►.,�' s. � �t ��' � \, <� sx`�,�: � "` t . � . i �,, ' �� .,.�.� �.�� .��;� � �'4{.• . ;� # t, e .. . ! '': � �� L:. � � � . . . . . � � . . � '+y� � � � , � � '� �, � "'^� � '�""�`�'`^�t 3, . 1' � ?tS t �",t �� l . .r . . M �!` e' "�'', � ..� ,�� _� t- �1 � � � �'�, ��,- 4.M1',� qy �+., # i'�°'� , � ! ��y �� -� � *-� . . «,� ;� � 4 � �� : : � �` � � �'q' '4s� �`+�� .,.A�4- � k � '�, .� � �� . �� ...._. . r � � v ., o :,� \ APPLTCATION FOR BUILDING` PLRMIT CITY OF FRiDLEY, MINNESOTA ��,�v�a s Co� s f e, Owner's Name ��.� ►.� � 1 S V Ih,�e, Y Builder �� 1f � + Address � � \ �L �„ c� � v � �qU� �� Address '1 g 0 � � � 'l � �1 �1 � , �e•� � � LOCATION OF BUILDING No. Street ��.��Gr,�c � Part of Lot Lot�_B1ock+�Addition or Subdivision �G� �' l 0 1`�, � � l, l� S ( t/ Corner Lot Inside Lot�_Setback �. js Side-Yard SEWI3R ELEVATION P'OiJNDATION EI,SVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: � Frant � (� Depth��Height Sq. Ft. Cu. Ft. Front Bepth Height Sq. Ft. Cu. Ft. Type of Construction �� Q Estimated Cost �,�`Z„ p � � To be Completed �� 1-- l Z'he 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. , DATfi�� _SIGNATURE (Schedule of Fee Coats can be found on the Reverse Sa.de). w � _.. � . "'- .. a . � � Application �or Power Plants and Heafing. Cooling, Yentilation. Refrigert*ion and Air Conditioning Systems ond Devices PARTIAL .RATE SCHEDULE �` GAAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work . . . . . . . . . . . . . . . . . . . . . . . . . . 8.00 � Replacement of Furnace ........................:.... 5.00 � Repairs & Alterations—up to $50Q.Q0 .................. 5.00 $ Repairs & Alterations each add. �50Q.00 . . . . . . . . . . . . . . . 2.50 $ MECx. wr►�� R Furnace Shell & Duct Work to iZl},000 BTI7 . . . . . . . . . . . . 8.Otl $ .T,D 0 each add. 60,Q00 $TU . . .. ...... .. . ... .. . . .. . 2.00 � Replacement of Furnace . . . .. . . . . . . .. . .. .. . . . .. . . . . . . 5.00 $ Repairs & Alt,erations—up to $500.00 . . . . . . . . . . . . . . . . . 5.00 $ Aepairs & Alteratioas each add. $500.00 . . .. . . . . . . .. . . 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. �DR Steam .... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Fiot Water _... 8.00 $ Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 2.50 $ Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50 $ OIL BURNER—to 3 gal, per hour . . . . . . . . . . . . . . . . . . . . . 5.00 $ over 3 gal. per hour—See Fee Schedule � ¢AS BURNER (up to 400,000 BTU) . . . . . . . . . . . . . . . . . . . . . . . 5.00 $ � GAS FITTING FEES: NO RATE TOTAL . lst 3 Fixtures ....................... x $1.50 $ Additional Fixtur�s . ............... x .50 $ Gas Range to 200,000 BTU . . . . . . . . . . . x 2.00 $ AIR CONDITIONING FAN HEATING SY3TEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL � $ee Fee Schedule $ TOTAL FEE $ �-�. Depi. of Bldgs. Phoae SU 4-7470 - � �wr��w�..�.. v�. City of Fridley: The t.�ndersigned 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 ail the facts and representations stated in this application are�rue and correct. �'idley, Owner Kind oP Building Used as To be completed about is G�--- aa Estimated Cost, $_ �D D �� Old—New. Building Permit No. �� ,� Permit No. o� �'S � DE$CRIPTION OF WORK HEATING or WER PI.AN team, Hot Water, Warm Air—No. � '� w Trade Name �,L/�"� Size No. /Oo,�ri ' Capacity Sq. Ft. E.D.R. BTL1 H.P. Total Connected Load �� ? q� Kind of Fue BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R. BTCT H.P. (REMARKS—OVER) l �,.�'�c a z 2M � ti:'� . /� .— ��1I ' �/ •�i ► �:: D�S6 � ..._ .,.oz ��G%O t� �•� /� � � � HEAT LOSS CALCULATI N 7I ��i��. �. ' N , O S DEPARTMIENT OF BUILDINGS �Itt�EY, MI N. Weatherstrips A.S.H.V. . Construction No. Inaalation Guide W.in�d�o Doors Refuence Out,'Wall Int. Wall Ceiling Roof Floor I4ind ' flow Appliod YE� No + Ype�No 19� /, . Fl.� v� Room Length Width Height � FI. Room Length �idth /J Heisht Windows and` oors—Crackage and Area Windowa and Doors—Cracicage and Area : �Ytdth HeEght No, ot Ltnea! tt. Area � Wldth Heljbt No. ot LInNI LL As�a �- No. ot oane o[ pane lishte ot crack eq. it. � � No. ot pane o[ pan� Il�hb ot etaet p. tt. �� z � . Coef. Btu Caef. Btn lnfiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Totat Btu. Required sq. ft. E.D.R. or aq. ina. W.A. Leader area F1.� Room � Length �dth /D Height Windows and Doora--CracJwge and Area Wldth Helght No. ot Ltnealdt, rea No. o[ Dane ot Dane lfaht� o[ crack . W. tt. � y► � „ Bca I In6ltration Glaaa � Exp. wall Nec exp. waU ' Int. wall Ceiling Floor . 7ota1 Btu. Require sq. ft. E.D.R. or aq. ins. W.A. Lea�r arca Fl. '' Room � Length Width � Windows a Doora—Crackage and Area Wldth Hefght No. ot Llneal tt. Area No. of Dsns o[ pane Ilshts ot enck eQ. [t. Btu I Infiltration � Glaaa Exp. waU Nec exp. wall Int. watl Ceiling Floor Tbtal Btu. Required aq. ft. E.D.R. or aq. ins. W.A. Leader ana Infiltration Glaaa Ezp. wall Net e:p. wall Int. wall � Ceiling Required sq. ft. E.D.R. or sq. ina. W.A. I.es�der. a '� F7.1 Room ( i.ength f/ Wi�h 1�indows and Doora—Crackage and Atea Wldth Hel�ht No. oL Llneal it. Ar�a I No. o[ nane of oan� 1ftAt� ot crack M. tt. Infiltration Glaas Exp. wall Net ezp. wa11 Int. waq Ceiling Floor Total Btu. �F— m d. Required aq. fi. ED.R. or sq. ms. W.A. Lea r uea �� Fl.� Roonn I Len�th ��/idch Hei�hc Windor� and Doon—Craeka�e and Area � Wtdth Hel�ht I�Ia of Lln�al tt. ArM No. o[ pan� ot.pane tfshb ot cract p. tt � � Coef &u jA�llti8h011 /9 .3 . ♦ Glasa Nec a�cp. wall Int. walt Ceiling Floor J Total &u. Required p. h. E.D.R. or sq. ias. �lA. Leader area ._--% . HEAT LOSS CALCUTATIONS S� " , �iN4p��T�iAENT OF BUILDINGS RO�BINSDALE, MINN. �i� A. S. H. V. E. Weatherstripa Guide Construction No. Insulation Windows I Doors Reference Out. Wall Int. Wall I Ceiling I Roof I Floor Kind How Applicd Yes--Na Yes—No 19_ Fl. � : Room ( Length / Width Height FL � Room � Length Width Windows and Doors--Crackage and Area Windows and Door�-Crackage and Area No. IWidth Hei ht No. of Lineal ft. Area Width Height No. of Lineal ft. Arca of pane I of pane I ligh'ta I of crack I sq. ft. I NO� I of pane I of pane I lights I_ of crack I aq, ft. Infi�ltration � �_ � Q� Infiltration Glass � Glass Exp. wall � Egp. wall Net exp. wall �_ � 52� Net eap, wall Int. wall Int. wall Ceiling �_ � � Ceiling Floor F1oor Total Btu. p Total Btu. Required aq. ft. E.D.R. or aq. ina. W.A. Leader area �' 'r Required aq. ft. E.D.R. o� Fl. � Room � Length Width Height Fl. � Raom Windows and. Doors--Crackage and Area I Windows and Doors— No IWidth I Height I No. ot I Lineal ft. I Area � No � Width I Height I of pana of vane li¢hta of crack sq. ft. I of vane of pnne � � .A. Leadez area w�a� and Area 'neal ft. i Area P crack I aa. fk � I I I Coef Btu I � I I �n&�ltration Infiltration Glass Glass Fxp. wall Esp. wall Net exp. wall Net eap. wall Int. watl Int. wall Ceiling. Ceiling F1oor Floor Total Btu. Total Btu. Required sq. ft. E.D.R. or sq, ins. W.A. Leader area Required aq. ft. E.D.R. or aq. ina. W.A. Leader a� Fl. � Room � Length Width Height Fl. � Room � Lengtl3 Width Windows and Doors—Crackage and Area I Windows and Doors—Crackage and Area No. IWidth Height I No. of Lineal ft. Area I Width I Height I No. of Ltaeel fL Aro of pane � of aane t lighYS I of crack I sa. Ft. NO• 1 of paneJ of pene J lighta I of cnek l sq.! I li Infiltration Glass Fxp. wall Net exp. wall Int. wall Ceiling F1oor Total Btu. ft E.D.R. oz aq, ins. W.A. Leader area Btu � � I � Infiltration GIass Exp. wall 1Vet exp. wall Int. wall Ceiling Floor Total Btu. Required aq. ft. E.D.R. or aq. ins. W.A. Leader asea 1 � ef Btu aefl Bta City of Fridley Application for P"lumbing dnd Gas Fitting Rermit Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK ��j� , _�- Number, Kind and Location of Fixtures Localion .��, �� a�� V1 �n � U' WATER HTR, •�, ~g� ��m �'� xy Z� 3 g3 uz Oux! J c� z • • K � O 2 �� ~ �`��'� Z� a F N GAS ELEC. � 3 C� � � �F � uZ-i 3 � o � �n � o l� � < 3 (9 '� (9 c5 C9 0 Base � i / lst 2nd 3rd 4th • Fuiure Conaectfon Openings * New Fi�cture, Old Openings PARTIAL RATE SCHEDULE 3ewer Cesspool City of Fridley: The undersigned hereby makes application for a pernnit for the work herei. specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn , 19_ _ Owner � �� —"'�+ — Kind of Building PLIIMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures . . . . . . . . . . . . . . . . . . . . . �r2� x $1.50 $ �, G � Future Fixture Opening . . . . . . . . . . . . . . . . x 120 $ New Fixture Old Opening . . . . . . . . . . . . . x 1.00 $ Catch Basin .... . .................. .. x 3.25 $ Water Heater (Up to 200,000 BTL7) . . . . . .,L x 2.00 $ •� < </ � New Ground Run Old Bldg. . . . . . . . . . . , . x 3.25 $ GA3 FITTING FEEB: NO. RATE TOTAL lst 3 Fixtures .......................... �/ x $1.50 $�_�� Additional Fixtures .................... x .50 $ Gas Range to 200,000 BT[J . .. ........ ... x 2.00 � I�pAIRS 8c ALTERATIONS—Refer to Code ' ........ , Description ........................................ TOTAL FEE $ � � � Used as l.J �� f� �°u Ta be completed about Estimated Cost, $ Old—New. Building Permit No. ��°'�'"'�" Pezmit No. � � , � �� ROUGH � � ` I � � � FINAL az 2M $y [ !T (e. Business Phvne N � � _ �.. �,,,,.._ .. �„ „ Bux�ding Inspect�o�s �63-s�z�3604 763-502-4977 FAX AA'I'£ I. �� S17�ADDRES5 Jss THIS APALICAPITZS; PROPE,xi'�'iC OWN�� T1EN.A�T7.' CONTRACTQR SUSMIT A, COFX 0�' YOUR S'�,A,'I'� �.zC�NS� p1tO�E�t�'X '�'X�'E PERlt�'� '�'X�� TPp�. U� �VQRK: DESCRIBE WO�C a£�NG A From: unknown Page: 2/2 Date: 10/8/2008 2:39:57 PM BUILDING RESIDEN'�XA,L .A�.PPLICATI�N CITY. U�' �'�DLEX EFF6CTTVE 1•1-08 XOLJR, Er-�,MAIL ADDRESS �� pwNER �SONTR4CTO�t l— �exmit No.��t�-r"i— Received By: � �,. ',� �AI PHONE �ISa :� 7'7 "�bD �'A7� r,�',��'' ' �''I �1 � r�Dqb 5TATE LIC�TSE #� Q�.�9 �p,� £X�' D�'�� b� � SINGLE FAMILYIJVEW CONSTRLfCZiO�t SIZE CJ �1�V0 kA,ZvT3I.Y/NEW CONSTRUCTION STORIES ❑ A,Ap�ON O Gt#�Gk/S�IBA �WINDOWS � 5.�4,S�lv�FN7 F1N1SH fJ ROOF ❑ DR4IN TI�.E 0 A$CIC O SIDiNG ❑ OTHER � NEW k#ON� CONSi1t1UCTI0N O MA[NTENANCE/REPAilt 1NU� QF SQUAR�S GARAGES P�tOPOSFJ� SfZE: PROPO5HD HEIGHT: SIDWG ❑ Virryl ❑ Aluminum ❑ pd�,er w IN F,7� 5'�iG Okk�iNGS �'es ❑No O�t �O�i N£W OP�NtNGS-DESCRIBE SIZE O�' OPENING CHANGES 1R D _. n_�� r0'�',A� JOB v,�i„i �ez�xt k'ee Plan Review �ure Surc�xarge Surch�go Licer�se Su�rck�a�rge SA,C Cha�ge Curb Cut Escrow Erosion Coz�tro� Fairk k'ee Stwer Main C:harge Total Due ❑ AAA�ON ❑ �OUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARA.Q£ ❑ DETAC�TaD GA,RAGE �N zz� � BAS�r?ENT REMODELING SUBMiT: 1. E�t1St1U$ F�00� P1gA 2. Pcoposed �loar plan 3. �.ist of suucnus] members to be used �'OR I+l�w CONS'RtUCTION IIVCLUDTNG DECI�S, DSofTt ADDITfONS. & PORCHES SUBMIT: ❑ 7rim 1. SiKe PIan�Survcy showing the existing sHtkttues O Fascia and proposed project, 2. Two sets of coastruction plaus 3. Energy Calculations �.00�#'!'f � OF W;NDOWS ��-,�,�; rdor�,L-r� .rn-•-� -- - - ---- ----- � I997 U�C k'� SC�AiJx.E) $'�f U z1.d � Scc Baek Pago �ox �'ee Schedu]e $ 65% o�f Buildxng Permit Fee $ l> .041 times the cotal job valuat�o� $ 6^„�' .00OS x �'ezzu,it Valuation Minimum $.50 $ ' �? $5.00 (State Liccnsed Reszdentia� Contxactors) $ � $1825 per SAC Unit (Plans to MWCC for determination) $ �-�6�t= fix$21-$ $ $450 Conservation Plan Review $ Fe� Determined by �ngiu�eeF►ng S Agreement �ecessary ( ) Non Nccessary ( ) $ c� Make chec�s,s pavab�e to: Citv of FridleY A,ttacbt THIS IS AN APPLICA'�ON �'OR P� Pk�I7-NOF VAL1D UNTIL PROCESS�A [ heteby apply for a buildiag per.mit aci,d ] ac e that infortnation above is complcte �;d accuran; thas d�e worlc will be in cont'ortnance wiAh �e ordiuAanas end codes of the City of Frid�ey and with tbe Mi Co cti C ; that 1 understand this is not a petaait but on�ly an; applicadon for a pem�it axd work is not to start without a �it an site; that the woric will be in daace len in the casc of aIl work which requir�iew a�� oval of plans. s��v,��u� o� a�P�t�i T ��t.ttv�r rr�� t� � 1 t f/�► n x- __ _�p.A.� b d .�'��OV�A BY JJ.A,T�' 3uilding BUILDING Perrriit rl . — �-� �:nspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY nate Rec'd: �(� )ATE �c �Q i/S� 3� , ada � YOUR E-MAIL ADDRESS S'�C �'"1�Q _'1/4 /i o a. Cc7� ;rrE,�DDxESS S,?00 B4chq�an 5'�NE,, �=�,c/%v MN SS�l� / i HIS APPLICANT IS: �COWNER �CONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR NAME: ��°Je ,�{�pSCMG�e�` avDxESS: 5�1� 8�ch4nu n�F- CITY� STATF�'W'LIPSS�s� / PHONE: � %� 3 � S%/ ^ /v? 6 % SUBMIT A COPY OF STATE LICENSE YOUR STATE LICENSE ADDRESS: WITH APPLICATION pHONE PROPERTY TYPE SINGLE FAMILY/NE TWO FAMILY/NEW PERMIT TYPE � �DITION - O GARAG ❑ BASEtv�NT FINISH �kOOF ❑ DECK ❑ SIDING ❑ SWIMId TYPE OF WORK: FAX AIIt ❑ REMODELING EXP DATE CITY STATE ZIP, ❑ DRAIN TILE ❑ OTHER DESCRIBE WORK BEING DONE: /�e�a�i it S SIZE OF IMPROVEMENT A� Sf?v4�t5 LENGTH WIDTH HEIGHT Sq. Ft. o7NS � ROOFING NUMBER OF SQUARES �,^ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SID1NG ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS ❑Yes CMo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENMG CHANGES & TYPE OF WINDOW TO BE INSTALLED _ �IiOUSE & GARAGE � ATTACI-IED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LACATION OF WINDOWS NUMBER OF BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDMG DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing strucdues and proposed project 2. Two sets of conswction plans 3. Energy Caiculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (LJSING THE ]9 7 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ci �%L1 � OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surchazge License Surcharge SAC Chazge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Tota! Due $ � . �� $ $ • ',�- $ ,� y� $ $ $ $ $ $ $ 7 • `1 See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valua.tion .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 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 Attach THiS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT(L PROCESSED lations I hereby apply for a building permit and I aclrnowledge 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 work which quires r iew and approval of plans. SIGNATURE OF APPLICANT s�� PRMT NAME ��ve S%4erKeY er _DATE /'�u4 3t� � OD {,