AF - 44127City of Fridley, Minn.
BUILDING PERIVIIT
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Addrees _......_.._.�... �.._......_.._. Addrese � . —....—..
;. �. CATION 1 � �
No .:�� Stree ¢. -`�/��FJ'�._+`.. P °t' _ -
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Lot _. _.,�.�::..__ Biock .__.:.._...�rr , ._.�... Addition or Sub-Divlaiqti .,
Corner Lot _.__.__._._._._ Inside Lot .. �_..- Setback ..�.��...._... Sidey�rd .:.�. r.
Sewer Ele�vatioaz ._._..._�.._. .�..._.. .._....._..w__ Foundatian Elevatiou
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, DESCRIPTION �OF BUILDINC��,��' : � � �:.� s=�
U ` .. �� . . �. � � �� a .r :
6 x.;•. � � " ��, ,. �t
x, „ :' . , "
' Frcuit s �Deptt► Height �:� Sq. Ft. Cu. Ft, ' �
:. J Depth _:. `.. eight . :�15q. F't. C�. 1�'t.
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L .Wi1D1.1{A{:1'i�i _ �1 ...�4�. . ��-!� ...-�..r. Q Yc' \IYfY� �........ .
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In co�nsideration of the issuance to me of a pexmit to construct the builaissg de�cribed above I agi�'tipr d�r '
th� ProPosed work in accordance with ti►e d�scription above set forth and in c�ompliance vei#h a�i pa�+o�vi� t�! ,
o�dinances of the city of Fridley.
�
In consideration oP the payment of a fee of ���""' �..�., permit is he�reby granted bo
to caa�struct the buiiding or addition as described above. Thisp� t is granbed t�t
the exPress condition that the Person to whom it is granted and hfs agents, employe�a and �, in all wo�lc
dane in, around and upan said building, or any �est thereof, shail conform in all respects to the ��
Fridley, 1Minnesota regarding location, construction, alterati maintenance, repair ana muti►lr3s o[
withiu the dty ]imits and this permft may be revoked at aqy� uPou v� of aRV o! the p�ovi�ti�ons ot d
ordinauces. ..� r ,.
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NOTICE: j�_.:,
1hk p�emit do�s not � 11u eoamueNos, iiutallMlon fer wMii� ��a �p, �av�n�K wMa. M�rn er �
th� duiWiea Infp�der for t�paral� p�nnits fer 1MN il«ns. �'� j
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APPLICATION FOR BUILDING PERMIT
CITY QF FRIDLEY, MINNESOTA
Owner's Name Builder '
Address Address
_�
LOCAT ON OF BUILDING
No. �� 7� Street �E' L�t Paxt of Lot
Lot Block Addition or Subdivision
Corner Lot inside Lot Setback Side-Yard
�EWER ELEVATION P'OUNDATION EI,EVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on �hese Certificates.
DESCRIPTZON OF BUILDING
To be used as; .
Front � Depth � � Height, � �
Sq. Ft. �Cu. Ft.
� Front �- � Depth � � Height � �
Sq. Ft .` Cu . Ft .
Type of Construction Estimated Cost
To be Completed
7,'he undersigned hereby makes application for a permit for the work herein
specified, agreeing to do ai1 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. J
�
DATE � �/��- SZGNATURE ;:� Gr%���'''�
�
(Schedule of Fee Coats can be found on the Iteverse Side).
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Application �or Power Plants and Heerting. Cooling. Yentilation� Refrigeration and
Air Condi#ioning Systems and Devices
PARTIAL RATE SCHEDULE
► GRAVITY WARM AIR: RATE TOT1lI.
F�xrnace Shell & Duct Work . . . . . . . . . . . . . . ... . . . . . . . . . . 8.00 �
Replacement of Furnace ............................. 5.00 �
Repairs & Alteratians—up to $500.00 . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . .. 2.50 �
�cx. w� �
Furnace Shell & Duct Work to 1T�0,000 BTU . . . . . . . . . . . .
each add 60,000 BTU .. ........ . . . ... .. .. .. .
Replacement of �raace . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Repairs & Alterations—up to $5W.00 . . . . . . . . . . . . . . . . .
R.epairs & Alterations each add. $500.00 . . . . . . . . . . . . . .
s.on � �
2.00 ;
5.00 $
5.00 $
2.50 $
STEAM ar HO? WATEii SYS?E!d
�rnace SheA & Lines—to 400 sq. ft. EDR. Steam .. .. 8.00 $
Etirnace Sheil & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $
Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . 2.50 $
Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50 $
OIL BURI�'ER—to 3 gal. per hour . ..... 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) . . . . . . . . . . . . . . . . . . . . . . 5.00 $ ✓
GAS FITTING FEES: NO RATE TOTAL
ist 3 Fixtures ...................... x $1.50 $�
Additional Fixtures . .......... .... x .50 $
Gas R,ange to 200,000 BTU . . . . . . . . . . . x 2.00 $
� AIR CONDITIONING =
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
� ALTERATIONS & REPAIRS TOTAL FEE ��__�__r' °' �
ROUGH
FINAL
Dept. of Bldgs. Phoae SU 4-7470
Locatiort� �v� �� /� 4!��yuP�iC� �/ �
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
�
Owner
Kind of Building
Used as
is _
To be completed about �,Ra,��1� ��
�.. �, o0
Estimated Cost, $
�
ew uilding Permit No. � Permit No. �� �,
DESCRIPTION OF WORK
HEATING �; �_'� �:: a Kr, Warm Air—No. � I
. �
Trade Name Size No/�✓3 7/d I
Capacity Sq. Ft. E.D.R.� °`"�� � BTU H.P.
Total Connected Loa� �O?' �`�°� ��i� Kind o! Fue �
BURNER — Trade Name ��- Size No. "
Capacity Sq. Ft. E.D.$�� �� BTIT H.P.
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(REMARKS—OVER)
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Application for Power Plants and Heating, Cooling, Ventilati on, Refrigeration and
Air Conditioning Systems and Devices
Partial Rate Schedule
ti GRAVITY WARM AIR: RATE
Furnace Shell & Duct W ork ..............................................._........... 5.00
R,eplacement of Furnace ..................................................................... b.00
Repairs & Alterations--up to �500.00 .................................... 5.00
Repairs & Alterations each add. $500.00 .............................. 2.50
MECH. WARM A1R
Furnace Shell & Duct Work to 120,000 BTU .................. 8.00
each add. 60,000 BTU ................................................... 2.00
Replacement of Furnace ..........................�--..........................-----......... 5.00
Repairs & Alterations—up to $500.00 ................................. 5.00
Repaixs & Alterations each add. $500.00 .............................. 2.50
STEAM or HOT WATER 5YSTEM
Furnace Shell & Lines--to 400 sq. ft. EDR Steam ...... 8.00
Furnace Sheil & Line—to 640 sq. ft. EUft Hot Water 8.00
Each add. 200 sq. ft. EDR Steam ....... ......................................... 2.00
Each add. 320 sq. ft. EDR Hot Water .................................... 2.00
OIL BURNE'R.—to 3 gal. per hour ........................................._..... b.00
over 3 gal, per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU) :......................................... b.00
GAS FITTING FEES: . NO RATE
lst 3 Fixtures ..... x $1.50
Additional Fixtures ................. x .50
Gas Range to 200,000 BTU ........................ x 2.00
VENTILATING SY5TEM5
Duct work etc. not to exceed 2,000 cfm .............................. 6.00
� Each additional 1,000 cfm ................._................................ 2.50
F ; AIR CONDlTIONING
FAN HEATING 3YSTEM
ALTERATION5 & REPAIRS
TOTAL
$ .................................
$ .................................
� .................................
$ .................................
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$ .................................
$......••-• .......................
$ .................................
$ .................................
$ ..............••••...............
$ .................................
$...... _ .........................
$ ...... _ .........................
� • • • • .............................
$ .................................
............. �......
$ ............... ..... _..........
TOT.�
$............ !�...........
$ .................................
$ .................................
$ .................................
$.....-� ..........................
$ . . . . . . _ . . . . . . . . . . . . _ . . . . . . . . . . .
See Fee Schedule $ .................................
$ . . . . . _ . . . . . . . . . . _ . . . . . . . . . . . . . .
-�:r,.,. . _
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TOTAL FEE s..l.... •..:. �............
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Location .��.�`:.�...�../�,�'�C�.l..:.r�.�:�..:��..�,�..�.......
City of Columbia Heights:
The undersigned hereby makes applieation for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
/�olumbia Heights, Minn.,... �OV...� — _I�L ....................... 19-----.............
.........
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Owner
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Kindof Buildin ............ ...�..��..........................................................................................................-----.......
Used as ........................................ .�.y . ........ �........ ...........
.�;��rHN a - �fg6'3 ..................................................................
Tobe compeletd about ....................................................................................................................................
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EstimatedCost, $...stf�,�s�...' ............................................................................................................................
� New. Building Permit No ........................................... Permit No........................................
DESCRIPTION OF WORK
HEATING _ , Warm Air—No.........l ..............
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Trade Name.. .. .. . . . ....�-�?-�t.-�1✓ ................................ Size No..,ls,�.�� .%...:",ll...�..
Capacity ....................................... Sq. F't. E D R...��...�, ....�.?....:. BTU..............:..................... H. P.
Total Connected Load..........1�....1..�..��—�..�......������l. ./.._� Kind of Fuel......��'�� .
.............. ........
BURNERr—Trade Name............G2 � ...�.�Ct.X�� .......:................... Size No......._�22�?:��i............
Capacity ....................................... Sq. Ft. E D�,�.:....71/.f_.:. ... ...... TU................................. H. P.
GEO. S GWICK HTG. & AIR-COND. CO
������`-� 1001 Xenia Av. S.
Signed ...................................... ...... .Minneapolis... � 6....Minn.
.... .................
LI. 5-1611
By.. ...� ... ..........:... .::. .. ...... ...................... ..........................
BusinessFhone o..... .........................._...................................
( remarks—over)
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�� � 9 � ` �_ . �RoSS- �2�y �3 ��`T- 37,37�
HEAT LOSS CALCULATIONS DEPAI2T'MENT OF BUILDINGS
Weatherstrips A.S. .V. , Conatruction No.
Guide
Windows ( Doors Reference Out.'Wall Int. Wall Ceiling Roof F1oor Kind
Yes—No Yes— o l9_
Fl.� �/ Room Length Width Height Fl.) ��E Room 1
Windowa and Doors—Crackage and Area � Windowa and Doors—Cr
Width HefgAt No. ot Llneat f. Ares W►dth Helght No.
No. ot pa.ne ot pane lighta ot crack � aa.1t. � No. ot pane �ot pane tl8
D 12 l q 2A0 3$ ` :
2 �. a• �.
t S6 So
Coef. Btu
lnfiltration � � Infiltration
Glaas 3 10 O Glaaa
Exp. wall 2� Eup. wall '� t� f�
Net exp, wall '2. Net eap. waU
Int. wall Int. wall
Ceiling Ceili�ng�_
Floor �,1 � fl.Z- Floor / � AtiC�1
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. ins. W.A.'
� Fl.� �- N Room � Length �� Width 2„ Height �,� �, g� �� �(,�pg�, � 7,;,
Windows and Doors—Crackage and Area Windows and Doorr--Crackage and
Wtdth Height No. oL Lineal tt. Area Wtdth Hatght No.nt Llneal t
. 230. of pana oi pane� lights ot crsek W tt.
No. o[ psne of Dsn� ll�ht� of ¢racl
a.-= $ CfZ t°I 3 �- S Z„ �?
t 2.
32 zo 3 3 2
Coef. Btu
Infiltration �j g' � Infiltration -
Glasa �--�( ji Glasa
E�cp. wall 7j33 �t Exp. wall ,�3 `�c �
_- ---
Net exp. wall � Net exp. wall
Int. wal! Int. wall
Ceiling Ceiling
Floor 3�G Z,. 'j$'�' (� g� �loor �Z,X�\
Total Btu. Total Btu.
. � ' � � a . . � ,
'�MtNNEAPtK.i.S, A�i.
i_'i,� Wi�h Heieht �;
and
n..� �c� wre.
� craat' p. tt. '
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Required sq. ft. E.D.R. or aq. ina. W.A. Leader area Required aq. ft. E.D.R. oc sq. ins. W.A: r�res. '
FI. �'[' Room � Length �v Width g Height - Fl. � 3 k3ED �� I L.ength � Wit� HeiSht
Windows and Doors—Crackage and Area Windowa and Doors—Crackage and
Width Aelght No. ot Llneal ft. Area Width Heiiht Nd ot Llnsai lt., ArN►
Nu, ot Dane ut pane lights ot crack sq. it. r
Btu
In6ltration � �
Glaaa ,
Exp. wall X
Net exp. wall
Int. wall
• Ceiling
Floor y� 7 �
Total Btu.
Required aq. ft. E.D.R. or aq. ins. W.A. Leader area
������
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-___��
-_�_���
Gleas
Exp. wall q 1G
Net exp. waU �
Int. wall
Ceiling
Floor � �. _ 7 .i,,
'fotal Btu.
Required sq. ft. E.D.R. or sq, ins. WA, t soea
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City of Fridley
AT TME TOP OF TME TWINS
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� ; L____�_ COMMUNITY OEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
1 �
� � �"'1 � CITV MA�L FRIDLE� SS�32
�""�" �'' 612-571-3450
JOB ADDRESS 5241 Buchanan Street NE
6UILDING PERMIT �
�72-360�
IBER NEV OATE PAGE Oi
91Q-F15 10/2/Ol � �
�2210
vE P iVO.
s���
iOvED Br
t LEGA� ��T NO. BLOCK TRACT OR ADDITION SEE ATTACMEO
oesca. 13 2 Marian Hills Addition SHEET
2 PROPERTY OWNER MAIL AODRES$ ZIP PNONE
Don Zbikowski 5241 Buchanan Street NE 763-571-8948
3 CONTRACTOR MAIL ADORESS IIP PNONE LICENSE NO
American Building Contractors (ABC) 12247 Nicollet Ave S, Burnsvalle, MN 55337
� ARCHITECT OR pESIGNER MAIL AODRESS ZIP PMONE UCENSE NO
952-707-6959 20169383
5 ENGINEER MAII A�DRESS ZIP PHONE LICENSE NO
6 USE Of BUILDING
Residential
7 CIASS OF WORK
❑ NEW O ADOITION O ALTERATION C� REPAIR p MOVE O iiEMOVE
8 DESCRIBE WORK
Reroof House & Garage (2� Sq) Tear-of�
9 CHANGE OF USE FROM
STIPULATIONS
TO
Ur.derlaymer:t must compiy wzth the S�ate Bui3ding Code.
TYPE OF CONST.
SEPARATE PEiiMITS AqE FEOUIRED FOR ELECTfiICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTpUCT10N 20NING
AUTHORIZED IS NOT COMMENCED W�THIN 60 OAYS. OR IF CONS7FUCTION
OR WOiiK IS SUSPENOED OR ABANDONEO fOFi A PERIOD OF 120 DAVS AT
ANV TIME AFTER WOiiK IS COMMENCED. NO DWLG. UNITS
I MEFiEBV CERTIFY THAT I HAVE REAO AND EXAMINEO THIS APPLICA710N 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION
ANO ORDINANCES GOVERNING THIS TVPE Of WORK WILL BE COMP�IEO
WITH WMETMER SPECIFIED HEREIN Oii NOT. TFiE GRANTING OF A PERMIT �3sOO1
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEI THE pEqMIT FEE
PiiOVISIONS Of ANV OTHEFi STATE OR LOCAL LAW REGUTATING CON- A9.7 � 25
STRUCTION OA �ME �ERFOFMANCE Of CONSTRUCT�ON `V
PLAN CNEGK FEE
License
S�GN4TUAE OF �ON'aACTOQ OA vUT�OR�ZEO eGENT ID�TE� Cu �
OCCUPANCY
SO.FT
STA�L$
$5.00
�PE LIDA
OCCUPaNCrLOqp
CU
FFSTREET PARKING
IGARAGES
�URTA%
$I.50
AC GHARGE
Fire C $3.00
Ora� F E
$ 6.75
� T �S IS �OUR �ERM;
OwNEQ���OWNEQBU0.Df�1� �D4TE� � I a�n �aco � � cr
NEW [ ] `�GJ�3
ADDN [ ]
ALTER [ )
��� �' � � � � Effective 5/10/99
�; � C�'Y OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUII..DING PERNIIT APPLICATION
Construction Address: � � �'� � � �, � � � n G �
Legal Description: '
Owner Name & Address:
Con�actor:
Address:
LIVING AR�A:
GARAGE AREA:
DECK AREA:
OTHER:
,,•, u� Tel. # 76 3 �7/ �f�s/�
MN LICENSE # � <S/69 � 8 �
?�S 3 3 Tel. #�'Snl x i G`9S�'i
Attach to this application, a Gertificate of Survey of the
lot, with the proposed=construction drawn on it to scale.. .
iJESCRIP'rION OF Il��IPROV�I4�EN'd'
Length Width Height
Length V�Iidth Height
Length Width Hgt/Ground
. J._
x�.� t- � �-�i�' -_�;�s'—' , f.
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: �� � (���� Estimated Cc�st: $ ���� � ��� � _
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ =$ �
, I i ' � - U
DATE. �! 2.� 10� A.PPLICANT: ;,; Tel. # QS�� 7�'� S
CITY USE ONLY / _
Permit Fee
Fire Surcharge
S+.��� Su�cr,arge
SAC Charge
License Surchar�e
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �'� =�sy
$ �s O c�
$ /, S�
$
� � : C?�)
$
$
$
$
� /IJL.-� . >.t �
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50i�1,wv vaI-uaiioii
$1050 per SAC Unit
$5.00 (State Licensed Residen.tial Co�
Alt. "A" or Alt. "B" Ab�ve
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [] Not Necessary [ J
Building
Inspections
763-572-3604
DATE�J ( if
SITE ADDRESS _
THIS APPLICANT IS
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PER.MIT TYPE
TYPE OF WORK:
:.r'
MECHANICAL
RESIDENTIAL APPLICATION
CIT'�' OF FRIDI.�EY
. � �..�
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• � Z�f��i►��C�
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Permit No.:
Received B
Date
A
coNTacT rERSC ,��U� L,� 410 WESt lA
sTA�Lic�sE� ��}�� MN 55408
2-82, �(} STATE ZIP
ADDRESS:
FHONE
Fq�,y ❑ TWO FAMILY
❑ t�rEw �rLacEt�rrr
DETAILED DESCRIPTION OF WORK
F�
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
PER MS 16B.665 the permit fee is a mi�imum of $15.00 or 5% of the total cost up to 5500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures_ ('This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS -
FOR PRQJECTS WfIERE LABOR EXCEEDS S , FEES ARE BA ED ON $10.00 PER FIX'I'URE, EXCEPT WHERE NOTED. FDCTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV� STZE/BTU
Equipment Installed MODEL: –�� SiZFJBTU
MFG: MODEL:
MFG: MODEL: SIZE/BTU
FIREPLACE (G/tS) $.15.00 GAS RANGE/OVEN 510.00
A/C $25.00 NEW GAS GRII,L S10.00
_AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 G� �T HTR 510.00
BOII,ER $35.00 _FURNACE $35.00
CHIMNEY L1NER $] 0.00 _GAS DRYER $10.00 POOL HEATER 535.00
DUCT WORK S10.00 GAS PIPING $10.00 _ VENTILATOR 515.00
— � �r—
Permit Fee $ Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @ $I5.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @$25.00 � x$25.00 =$�C�
Number of fixtures @ 535.00 x$35.00 =$
State Surcharge = $ .50
Tota1= $ �-<_S<
THIS IS AN APPLICATION FOR A PERMIT NOT VAL1D UNTIL PROCESSED
I hereby apply for a building permit and I
conformance with the ordinances and cod
not a permit but only li�' or a�
approved plan in th e o���fl,�^vhic�
SIGNATURE OF
:dge that the infornnation above is complete and accurate; that the work will be in
ity of Fridley and with the Minnesota �Constxuction Codes; that i understand this is
l wark is not to start without a pemut; that the work will be in accordance w' the
review and approval of�}ans,.
�..___ r,��,...1-Id��e�, �/YlQ/�ATE S(
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley,. MN 55432
763-572-3604
FAX: 763-502-4977
REQUIRED INFORMATiON NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS EXiST{NG HOME ❑ MAKE-UP A!R
REQUIRED FOR NEW/EXISTIN� HD�IIES ,.. , _
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1. Combustion Aix (See note belovv)
a. Oil or solid fuel IMC Cbapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venti.ng
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other tUan gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a.. Per MN Energy Code 7670 or 7672
6. Duct Design Per lMC 1346.0603.2 �
a. ACCA Mauual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations