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AF - 44143City of Fridley, Minn. BUILDING PERMIT �v� so3v Date: ...y�:� '�--�-- — � . Ovener: Builder �..�..�....... � ' Addreas ._..___...___ .. _ .�_._.....:.. Addr�.ws ....._ -- � � LO TION O G No =Stre�t. ,. ' . � : :�' P .:.�._ ° Lot _ ..._..__'�lock _.�......:�_._.. Additia� or. Sub-]�jiv�i�i . � ' Corner Lot .__....._.____ ?na�de Lot _ �__��.�. Setback a� ._.�.. ` Si .a.w��' ' ' . Sewer Elevation �_._. ...r...._. _ Foundation Elevation �-- � ',i„ ��._. DESCRlPTION OF BUILDI[alE'3 � � , . �'� f .:�r � ' � , t. �, � .,_ � �� , Fromt nepth $3eigat �a. Ft. ��,��,'�°t�. "� ' t �UePth' i�%ight �� l3q. P't. -��t�. � � c�iaa ` ' ]�e�. ,F ...._ T'o be �om�latad t = �, ; : , � � �. �! ' — . � ' e` , ` 'C. �-�<,:4 r�E;./ :�;�� .; ,� � � � e��' � � � , � �'!� : �,� � i - a��; � `+�'" � t. �'�nT � -05 ` {, � �. ,. � �' L !� .. � ,,.� ��e ._ � � ��. �� , �AR`' `� . ��,F r�."��f.. �^ •��d� �`, . x •. � - . . M� "�`•.� . . . . r , � y. � � , . �, ? s �. .' . � /y�. . ..- -' . - . , � . , y `� ` s! . .. , , . . . . . . ... _ . '- .. y t yl . . . �. . '� fi� ' . a .. . '� . . � i n . _ . .... . � - � . rt � . _ � :.r �,��y� n;F ,•i . � . � . . . . � . . . . 'p�". Z . . . In conaideration of the issuance to me of a permit to co�struct tbbe.`buiidiag de�crlbed 8bo�►� I �;�t +db " the proposed work in accordance with ,the d�scrlptioa abo�►e s�t fortii � in oo�npliaaee. wfth a�l �t ordinancea of the dty o! Fridley. � In cae�sideratfoai of the payment of a fee o! �.��....._.._._.., permit is hereb�► Sranted to ' - to caristruct the building or additi� `as descrlbed above. Thisperrn�t is �ranfid.°t�ou . the exPress conditioai that thepersox� to wham it is'gi'anted and his agents, emPloyees Auc� ww�y��t itl�`�1c. done in, around and upon safd buildin8� ��Y P� the � shall �ot�fo�m in all '"re�eets Lo tbe � oE - FridleY, Minnesota regardi:►g locati�, c�structioa�, altera�oa�, �aintena�ce� repair .aad na�S �' within tt►e city linnits and this pe�mit may be revoked at an�Y tia� iipan �tiplatt�oal o! any ai tt� p�o�s o[ ordinanc�. ^ �� 1�.�� 8� �`.� NOTICE: , .. . . , '1hk p�ndt dea not eewr fiN �ee�hoalioe, �Mion ter w4i��, �6wH�, sww� oe w�r. M w� N tw fM luildieo in�p�ebr [or ap� p�noils for f6� &�s. '� �_. ' • r -. ` � �� :��. -. . � r �,'ac.� ... ... . APPLICATION FOR BUILDIIdG PERr�iIT CITY OP FRIDLBY, MINNESOTA . , Owner's Name Builder � Address Address LOCATION OF BUILDING No. Street Part of Lot Lot Block Addition or Subdivision Corner Lot Inside Lot Setback Side-Yard �EWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed buiiding location drawn on these Certificates. To be used as: DESCftIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Bepth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost To be Completed 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 ated in this application are true and correct. e�e� DATE S IGNATURE i� �7 /% _ (Schedule of Fee Coats can be found on the Reverse Side). ` � � r , , ri r . .r City of Fridley App�icarhon for P'lumbing and Gas Fitting Pen�it - Dept, of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK S'� �� C�� ..5 i �� Number, Kind and Location of Fixtures Lxatio*► C% C N � � UI Y F' Ny � Z= Z W W Z �'' �� Z,�.m yZ z'�� 3 g� �y-� oxu! �a z �1 W < < < 5 ` < a � c a � �� O� 0� i n ' T F- �� N I�i O V a0 � 3 U < Ci � C� O Base Q � lst � � � 2nd _ 3rd _ 4th ' Futura Coanectiw�a Op�niags I Connacted wfth * I�ew Fixture, Old dpsaines 1 PARTIAL RATE SCHEDULE WATER HTR. � t f N GAS ELEC. Sewer � Cesspool j'� PLUMBING FI]CTURE RATE3: NO. RATE TOTAL Number E`ixtures .. .. .. . . ...... .... . . .. 6 x $1.50 $ � G� Future Fixture Opening � x 1.20 $`�` 6� New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $ Catch Basin ..............:............. x 3.25 $ Water i%1�t f�JP ta 200,000 BTLT) ......� x 2.00 $ � 0� New Ground Run Old Bldg. . . . . . . . . . . . . x 3.25 $ GAS FITTING FEEB: NO. RATE TOTAL lst 3 Fixtures ..........................� x$1.50 $ �• 5� Additionai Fixtures . . . . . .. ... .. .. . . .. . . x .50 $ Gas RanBe to 200,000 BTLT . .. .. ..... ... . x 2.00 � REPAIRS 8c ALTER1i►TIONS—Refer to Code Description ............................... ...........$ . . . . TOTAL E'EE $� � ,/ 0 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stric t accor dance wi t h t he Ci ty O r d i n a n c e s and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this app2ication are true and correct. Fridley, Minn �� i�� Owner ��/��b/�% �� Y� - Kind of Building �� Used as ��'L�'�y6 To be completed about �a—�� Estimated Cost, $ �� ' � Old ew uilding Permit No. �� Permit No. °�- �� c:....oa �K/!/U / � �" 9 � %� _ — — I ROUC3H FINAL a z 2M 7-s4 Business Phoi% No. �� 3-�3� City of Fridley Application for P'lumbing and Gas Fitting Perntit Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK � � / Number, Kind and Location of Fixtures Locatio 1I� � U` WATER HTR. j1(� y� � W y� ` = y Z ui! y Y Z K �Q <Z V Z � iu� :� Z � � < 0.J � ~ 0° 1<I� Z <� y � = J ot ~<��< < aG, �Z �Z( 7 a F N GAS ELEC. ;(j ] �� m N ; F- O LL N LL O lJ m � 3 (� ` (� K Ci � 1_ I I' � 1 1 lst � 1 i 1 2nd 3rd 4th • Future Coaaectioa Openings Connected wiih I Sewer * New Fixture, Old Openings Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL � � Number Fixtures ...................... x $1.50 $�— Future Fixture Opening . _ . . . . . . . . . . . . . . y�— x 1.20 $ � - �' � New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $ Catch Basin .... .......... ... x 3.25 $ Water Heater (Up to 200,000 BTi7) . . . . . . ,f x 2.00 $ � C� � New Ground Run Old Bldg. . . . . . . . . . . . . x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL ist 3�Fixtures .......................... x $1.50 $ , • �� Additional Fixtures .................... x .50 $ ' � Gas Range to 200,000 BTiT . ..... ........ x 2.00 � REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ • TOTAL FEE $�' lc�t�� ,\ , City of Fridley: � The undersigned hereby makes application for a permit 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 ap ation are true and co,�rect. J � li J F'ridley, Minn. / G��L , 19 �% � _ .. _ �� Owner %' ��"''" ' � — � � Kind of Building ��"'�`y Used as To be completed about Estimated Cost, $ � Old Tew. uiiding Permit No. %' U��1 Permit No. U� 5igne � - By �� C K t � Business Phone No. 7��' S�� ROUGH FIN 42 'jM � Application for Power Plants and Heating. Cooling, Ventilation� Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work . . . . . . . . . . . . . . . . . . . . . . . . . . Replacement of Ftirnace .......:..................... Repairs & Alterations—up to $50Q.00 . . . . . . . . . . . . . . . . . . Repairs & Alterations each add. �500.00 . . . . . . . . . : . . . . . MECH. WARM AIR Furnace Shell & Duct Work to 120,Q00 BT[T . . . . . . . . . . . . each add. 60,000 BTU ....................... Replacement oP Furnace ............................. Repairs & Alterations—up to $500.U0 .. . . . . . . . . . . . . . . . Repairs & Alterations each add. �500.00 . ... . . .. . . . . . . RATE TOTAL 8.00 $ 5.00 � 5.00 $ 2.50 $ 8.00 $ �/ � � 2.00 � 5.00 $ 5.00 $ 2.50 $ STEAM at HOT WATER SYBTEM Fumace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $ ,� Each add. 200 sq. it. EDR Steam . . . . . . . . . . . . . . . . . . . . . 2.50 $ � Each add. 320 sq. ft. EDR Hot Water .. . . . . . . . . . . . . . . . . . 2.50 $ �L BURIvER—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 lst 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 8i REPAIRS TOTAL FEE �� ROUGH FINAL ne„� ..s nt,�„Q vw....e etT e_�a�n 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 e true and correct. , �idley, Minn. � , 1�� Owner Kind of Ruilr�ina Used as To be ca Estimated Cost, $_ � �� —� ' � �, �� Ol ew. uilding Permit No. �'% G� � PQlmit No. HEATING or POWER Trade DESCRIPTION OF WORK Hot Water. Warm Air—No. J � Capacity Sq. Ft. .D.R. B H,p, Total Connected Load %�_ n v/� Kind oi FueL_7�.� � BURNER — Trade Name Size No. Capacity Sq. Ft. E.D.R BT[T H,p, Sig By ,��<z sM Business Phone No.�� iJ —�� (REMARKS—OVER) c.�>. � � � _� �`�. a ��.+� - �� o-�s � . . CS .3 � HEAT LOSS CALCUL�4TIONS DEPARIMENT OF BiJ1LDINGS �11�1tNlVF.APOiJS. NMAV• Weatherstrips �� Guide � Cenatruction No. Intnlation ' w: I' ora Reference Out. Wall Int. Wall Geiling Roof Floor Kind How. e No e No 19� Fl.� /.i�c.�. Room Lengtk 2. Width / Height �' Fl.� Room Leagth Wit�li Height �'' '` Windowa and Doora—Crackage and Atea Windowa and Daors—Crackage,and Atta' �91dth Height No. of Ltneal f. Area Wldth HefghL No. oL Lfnstl !L �ra� No. �ot pane ot pane lights of crack � �p. tt. No. ot pans ot Dane� light� � Of e��ek ,:� � q.-tt» � � � y� G. " ' �'y � «� `7� � j G � ( �'�" 6 •�" /��P i 9 i� � Infiltration o ,,Z Glaas i � Exp. walt a 6 J� P o� Net exp. wall S' o" �, Int. wall Ceiling a �( / � !� � o t� Floor .Z � �L Total Btu. ,2 �"' Required sq. ft. E.D.R. or aq. ina. W.A. L.eader area Fl.1 Room Length Width /p Height � Windows and Doora--,Crackage and Axea Width Heteht No. ot Llnca! ft. Area No. • ot Dane ot pane Ifihts o[ crack �q• ft. d2 J 5F �/A / .? 7 .? / Coef. Bt�t In6ltration � 7 3 b � Glaaa � .Z '?� p h Exp. wall iY o2. Net exp. waU /n v Int. wall Ceiling /%�' /o 0 o Q o Floor X ! � v fj Total Btu. Required s. ft. E.D.R. or sq. ins. W.A. Leader area FI. � Room � Length �a? p Width ,� Height � Windowa and Doora—Crackage and Area W1dth HelBht No. ot Ltneal It. Area No. of pane ot pane Ifghts ot crack sq. tt. / .j ` G• �" �Jn° q7 a a o Coef. Btu lnfiltration 7 �% �3� � y Glaas L , f� 3 E�cp. wall � o X� o Net exp. wall /o 0 Int. wall Ceiling o�-O 3 !y o 0 0 Floor o?.0 2 p 'Total Btu. Required aq. ft. E.D.R. or aq. ins. W.A. Leader aree � Infiltration C�SEE � � :, ��±� � IL�� r _ Fap. wail �7 oi P Net e:p. wall o I Int. wall Ceiling �j / y ?v � m Ftoor � }� y o Total Btu. - t! Required aq. ft. E.D.R. or aq. in:. �.A. Iam�er ana Fl.l Room I I.ength i�'xhh "Hs�ht Windowa and Doors—Crackage and Ana Wldth , Hel�hL No. oL dn�al �. 11»t No. of ysna ot Dan� ll�bt� ot eraek �q. tA -� a � 36 / ,3 ' 1 � � Infiltration � Glaaa Exp. wall � 7 X 8 Net ezp. wall Int. wall Ceiling / K �,lr Floor �h� �C /�3 Total Btu. IRequued �. k. E.D.R. or sq. ins. � F1. _ Room I Lengcl Windows and Doors-Cracka� Wldth Hefiht Na o No. ot yaa� ot�pan� II�hN i �y .�� -� � I� In&Itration � Glass I F�cp. wall Net exp. wall Int. walt Ceiling f O ,1r Floor /p k �' Total Btu. � Required sq. ft. E.D.R. or sq. ins. W �� '� ro 0 ��^ ..� ..�_ 7 u ��' ._r... � ,; �1 - � �� ■�1 !� ■_ ;/li�� • li . �. �� - �� .�- ��-�� ! � . er area .. . f �-�-h�7" , ` ' " �,� , 9 � � HEAT LOSS CALCULATIONS DEPARTNIENT OF BUILDINCS 1NiNNEAFOL�LS. MiNN• Weatherstrips A� Guide � Construction No. Iasulation ' dowa oors RefeFence Out. Wall Int. Wall Geiling Roof F7oor Kind Ho�vr. Applie,d e o( e o 19T Fl.� Room Len$th Width /..� Height �' Fl.� Room Length Wi�h Eki�}►t Windows and Doors--Crackage and Area Winc�wa and Doora---Cracica�e and'-�1tea Nidth Helgrt No. of Lfneal t. Ares � Wldth Het�Lt No. ot LtnNt L� 4rN� � � � . � No. ot Dane ot pane lighta o[ crack sq. tt. No. ot pane of Dans I/sbtt � of erack q. tt a?'� .�- � 3 � Coef. Btu �• � Infiltration �3 3 % Infiltration Gla:s (. S �� p. Waii a s� � G �p. Wan Net exp. wall Id a � Net ezp. waU Int. wall � ; Ceiling .2� jr � � /o / o Floor /,2. ?r � ?otal Btu. � Required aq. ft. E.D.R. or sq. ins. W.A. I.eader area Fl.� Room Length Width Height Windows and Doora---Crackage and Area Width Hetaht No. ot Lfneai tt. Area No. ot oane ot nane llrhb of crack w. tt. � In6ltration Glass . Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or aq. ina. W.A. Leader area Fl. Room � Length Width � Windows and Doora—Crachage and Area Wldth Hstsht No. ot Lin�al it. Are� No. of pane ot pane Ifghts ot crack sq. tt. � Inhltration Glaas Exp. wall Net exp. wall Int. wall Ceiling l� loor Total E ft. E.D.R. or aq. ins. W.A. Leader area Btu � .1 utU Int. wall Ceiling Floor Total Btu. Required aq. ft. E.D.R. or sq. in:. WA. I.eader araa F1.1 Room I I.ength Width Windows and Doors--Cracl�age and Area wlacn xefshe xo. os Ltneai tf. r.s i No. of pana ot yane li�ht� ot ctack , fi. � i In6ltration Glasa Exp. wall Net ezp. wall , Int. waU 'I Ceiling Floar T'otal Btu. Required sq. k. E.D.R. or aq. ins. WA: L�ea+de: a;ea Fl. Room I Length '�idth Windowa and Doors--Cracka�e aad Atea Width Hs[�dt Na ot Llpu� n. Area No. oi pan� ot.p�ae If�hts of craek p. ft. Infiltratioa Glaas E�cp. waU Net exp. wall Int. wall Ceiling Floor 'fotal Btu. . Required aq. k. E.D.R. or aq. ins.'WA. Lssdersres Btu Building BUILDING Permit No.:��;�X� Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: DATE "l �/ � SiTE ADDRESS `� TI-IIS APPLICANT IS: PROPERTY OWNER/ N,�: �O,(i TENANT qpDRESS: .� � G CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WIT'H APPLICATION PROPERTY TYPE YOUR E-MAIL ADDRESS N � �S%c" /�.� � _ OCONTRACTOR PHONE: �� 3��- �� C1 U Z STATE LICENSE # £XP DATE AT��t�S-�3�z� ADDRESS: CITY STATE ZIP, runrrF FAX _ SINGLE FAI� TWO FAMIL PERMIT TYPE � �DITION o G�t.,aG�s� ❑ BASEMENT FINISH '�200F ❑ DECK ❑ SIDING ❑ SWIMMING TYPE OF WORK: DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT ROOFING � i NLJMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum � Other _ WINDOWS IN EXISTtNG OPENINGS �Yes �No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & 'rvPF. (�F WiNbOW TO BE INSTALLED AIR ❑ REMC � -v�/� � TH ❑ HOUSE & GAR.AGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF ❑ DRAIN TILE ❑ OTf�R OOL J �af6i9�� a r�'r�5 WIDTH HEIGHT Ft. BASEMENT REMODELTNG SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structura! members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING E 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $��r19 OCCUPANCY TYPE Permit Fee Plan Review Surcharge Fire Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ ��3. �S' � - $ $ � �°,— $ $ $ $ $ $ ,� .- - See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times the total job valuation - Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( Make checks �avable to: Citv of Fridle_y THIS IS AN APPLICATION FOR A PER.MIT-NOT VALID UNTIL PROCESSED Attach I hereby apply for a building permit and I aclrnowledge that the information above is complete and accwate; 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 Slan in the case of all work ich re e revi and a roval of lans. IGNATURE OF APPLICAN7' � P�q�� PRINT NAMFY ��R 7`N i e_�G DA� ��/'�� S/