AF - 43764�
Date:
Owner:
Addres�
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LJ
�
City of Fridley, Minn.
BUILDING PERMIT
N°
� � ��3.�"
'7050
�
_.. ...... ..�� _.....�:.....�_.._
L TIO O,F'BUIL ING
Na� __ __ . ...._ _......... Street . .L��'.�.J'.�1 Part of Lot ....._....__...___._�....___.___._.........._._...__._
,� '� �' ����...�� ._ .. ..._......._W_:..
Lot ._.._......._....__.._._...._ Slock ._.._._.._... ._ ............._........... Addition or Sub- on ....._..._.._.__.._._..__�_.r___._.__.
.7__._._.----
Corner Lot ...__�/�. Inside Lot .... ._. .__.••--.---...'�ltback .... _. ........_...... ._ Side3'ard _.....�...l..__ _._....._......_.
Sewer Elevation ._._.._.._.___..._....--•.__..._.._.._.._..__._._......._...._......_ F dation Elevation ....._..___..__.__._._.._._..:�__.�_...._.�
DESCRIPTION OF BUILDING
ol�v •
% . /�� , ,
...........__..._.._. ... .: Front _.1-•---.�. Depth _..�_� Height ..�..Gf_.. Sq. Ft��._�Cu. Ft,���
.....___..o f_�' _......__...., � _____..._.__ Depth _._--_..... eight ._.._ .. Sq. F� Cu. F'�
_.___._.._.�. _.._...�_�
�.�. �
Type tructio _..._ ._ �._... Es� C ... ..�a"�� To be Completed ._.._._._.._.._.._.__._...__.__
�. _._ .
In consideration of the issuance to me of a pernut to constru building cribed above, to do
th� proposed work in accordance with the description above d' ons of
ordinances of the city of Fridley. � �
In co�sfderation of the payment of a fee of �._ .._�..��. _.
•- •--- , rmi is hereby granted to.....�. �
....__,....._..__.._._._.._..._:___.___.._.._ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridiey, Minnesota regarding location, construction, alteration, maintenance, repa.ir and moving of buildings
within the city limits and this permit may be revoked a t ax�y time upon violatien� of any of the provisions of said
ordinances. �. ., � f I
BuiidinS �P��
NOTICE:
iMs p�emif doa not iovsr fhs consfrueNoe, installNlen fer wirin�. Phimbing. gas h�afin�, aw�� or wN�r. B� sun to sN
�h� BuiWiag In�p�or for s�p�nh p�nnin for th�a fbms.
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ALTER„ [ ]
City of FYidley
R-1 AND R-2
Building Permit Ap�al ication
EEfective 5/L88
Gbnst r uct ion Addr ess :— ��� �c�f�'� o�� '� -��✓t'/�D/.a�
Legal Description: �a�� /�� �/��� �i� �.` veir. ,✓.` �� ,��,�. ��n/e� Gv�
Owner Naane & Address:__ �.�9� �G ��� T�, �
Cbntractor:
Aaaress : _�� �'�1_� .,�/� S � �� ��;s ���2,�
a
Tel. # / s7s
Attac3� to this appl ication, a Certif i�cate of Shrvey of the
lat, with the proposoed constructi� drawn on it to scale.
�ESQtIPPI0�1 OF' IM�ROVFI�I�TP
� . Length Width Height � Ft.
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��y.l�; �, /�
Width Heic�t St�. Ft. �
Width I�gt /Gro�d 9�. Et.
c�h� . /.�o��/a�- SUS �ri9� l/ii/fi ood/�e/ � �c� ' /�X/� �
Gbrner Lot j�] Inside Lat [] Ft. Yd Setback �?/ , Side Yard Setbacks �? jc"��- a.� �¢s�
Type of Construction: �:Z"- ,9��r�'1,�ss%���lz-������/sJe�,.� Estimated Cost: S/ 0�0
Tyf'er'�O �2-
Approx. Comple�tion Date: ��� - � .
A1t. A Alt. B
Proposed Driveway Width If New Opening Is Desired: S S
Wiz3kh -� 6' See Back Page
ao �
I]ATE : � /� /�'.% APPL ICANr : � � Tel. # � � s - ���'` �;�•n
Permit Flee
State Surc�iarge
SAC �arge
Driveway Escrow
Park Fee
Sesver Hain Cl�arge
jV . .�.. .
�1�AV i
S
S
$
S
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CL'T`Y USE Q�LY
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PATIO ENCLOSURES, INC.
PANEL ENGINEERING DATA SUMMARY
WITHOUT ASPHALT ROOFING SHINGLES
Core Material:
Panel Dimensions:
Skin Thk.:
Edge Support:
Test Procedure:
,
1.5 PCF Foam
3" x 3' x(Clear Span + 1')
.024"
Alumax 4�3889-A
ASTM-E196
40 PSF DESIGN SNOW LOAD
SHEET 1 OF 1
I hereby certify the
information contained
on this sheet to be
true and correct.
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Clear S an, Ft. 10 11 12 -• . 3
Ultimate Roof
Load, PSF 151.3 125.1 I05.1
Allowable Roof
Load, ** PSF 60.5 50.0 42.0
Deflection @ 40 PSF
(Design Load)� In. .588 .799 1.027
** Ultimate roof load divided by a safety factor of 2.5
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M�11�' �5 'O� 1E��@0 216-4b7-4�9? PEI.
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P.3i3
, � Sheet 1 oE 1
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ENCiOSURfS� �NC� MANUFACTUReRS OF RATIO ANQ PORCri ENGtQSURGS
L DISCOUNTERS CiF FINE CASUAL FURNiT��E d ACCESSOR�ES
raTin gvr.t:n�rrRFC, T�tl'_ . . .
ROOF P�tiEL EvGI;IEERINC DaTa SiS:�1r1RY ,' '
' .� , !�
, � . t�� OP /\� r
Panel Dimensians: �' � 3' x (Clear Snan + 1' ) �R;: •'"~''••�'yj 'rr�
`�;= � dOS�PN �•;� �
Skia: . 024" '� & B ( 3105-H274 �iuminum) . . ' � : �ROl��BT : � '�
•��
� abo s..: HEiZ£L� ; w
Core : 1. 5 pC� (EPS Foam) ,��';� E•48.�J$a ��• 4� �
.
t',�,5` ;'wC� S ? �p4'• ���►��
Edge Suppor�: �-�3eams. Easco 0/6835--_ � � •••••••'• •
(6063-�'6 Aluminum) ���N �" �"?'� �
. '!'M►M.ii..i..•,Mt .
CERTIFICATION: Y hereby certi.fy Lhat the information contained herein is
prepared by me, and said information is true and corre�t. �
��{ � �gS4 $ •. ,
.
M� � 1 �o !g 5', 1Q�88
�
Sigriazure) (�umbar) bate)
.. .
T�e foilowing, chart shoras ulta.mate loading of panels based oA cert'ifi�ed tests,.
l ..
Clear Span, FC.
Ulti�aate Applied
Roof �.oad. PSF
�10 12 12 1�� 14 15 16 17: 18 19 .
I76.5 145.8 122.5 104.5 90.0 78.4 6$.9 6,1.4 ��54.4. 48.9
; , . ..,. ,,... ...:' �: .
- , , .� . :
740 EAST HtGHLAND RpAO, MAC£DONIA, OHiO aa05� •(2�6) a67-4267
,
SuBJECT •�'-\,
City of Fridley 2 � 6
AT TNE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� ` RECEIPT NO.
� `y _ COMMUNITY DEVELOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEC. �
� �
i_-_- A;�'�';,j CITY HALL fRIDLEV 55032 NUMBER REV DATE PAGE OP AVPROVED BV
Z '� 612-571-3450 9�0•F15 9/9/98 / /
10B ADORESS
581 Buffalo St NE
t LEGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. 1 2 X Riverview Hei hts SHEET
2 PROPERTV OWNER MAIL ADDRESS 21P PHONE
Renee McCo 581 Buffal -
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICEMSE NO.
Four Seasons R -
a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LIGENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PNONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW O ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE
x
8 DESCHIBE WORK
Reroof ���iS��x������t� house (16SQ) Tear-off
9 CHANGE OF USE FfiOM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE Of CONST. OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED fOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. fT.
AUTHORI2ED IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK �S COMMENCED. NO. DWLG. UNITS OffSTFEET PARKING
I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yq��ATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WpRK WILL BE COMPLIED $1�3]1.00 �.69
WITH WHETHER SPECIFIED HEREIN Ofi NOT. TNE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF THER STATE OR IOCAL LAW REGULATING CON- ��}S.7S Fire SC �1.37
R CT THE PEFi ORMANCE OF CONSTRUCTION.
^��Q� PLAN CHECK FEE TOTA� F
`L Lice SC $5. $52.81
S�GNA7URE OF CONTR r oa nurH HQEO AGENT iDATEi EN P OP LI ATE T � IS Y R PERMIT
-' •
S�GNATURE OF OWNEF Uf QWNER BUILDEiii IDAiEI NSP D�7E
_ w
. ; . �, ; [ � Effective 111/98
,' `, L] � w CITY �F FRIDLEY
-.' .={ [] SIIVGLE FAMILY �AND DUI'LEXES it-1 AND R-2 '��"�
BUILDING PERMIT APPLICATION ��(o�O
,.
x"ast� �.��� � , '��%!� `�,.
._.��.-�ictionAddress:..���L ��°�-��i � �- N � •
9
- '.: �1GSl;l�:fJliv[1. _ . .. : �'� 4'��:'�'t'�'.
_ .,.-:- �i'?Iilf; '• Address: �Q.Y14.`L'.. � ' �.C:.v �,,,_,��% �C� �Ic� ,Tel. # "� / ""�l���}��.
.. ..:cor: �vti_c 5� r�rt��r.ici���� 5����-� �}' ,� f, u, � LC.G MN LICENSE #_ ��,
._._ �s: '��.^� i� �f�✓ F�r� !-r Te1. # 79�-' 9�1d
-T---- —T----' 4-�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. ; `
'�,,�. ����, _�,.
, :� ..
::�
DESCRIPTION OF IMPROVEMENT
-.- .�i�'�� ��.1i:r�.: I.ength ' ' Width Height Sq. Ft.
�:.. .:�;;L �1���.: Length Width Height Sq. Ft.
�'���> �iI�L;A: Len�tii �' Width � F-igt/Ground Sq. Ft.
.. �'.�:;�z: f� �f u�i� � 1 c�.ce l(o ��.� -� 511 i r�,�' 1�es --
�
. � � � . , . r� / � . XF. .
... _!�:;;[t011 �.��j'��: � lCoo Estin�ated Cost: $ %� l
—r-.�' �
(Fee Schedule on Back).� �
., ., ::y C:�:-t� Cut Wicith Needed F 6 t= F $ _$
�;: _'� �. -� l� - APP'LICANTt 1 Tel. # "CI � I �
� _��N
� � ��; �
. ; �k
CITY USE ONLY R ����':...: � `
_.._::: l��ec $ 5. �f Fee Schedule on Reverse Side ` F�"'°"; '`
� �� �3
. .. . ._ _:rch:ir�� � � � � .001 of Permit Valuation (1/lOth%) : �
_
'" 1
{ • . i
.��• � - Surcharge $ . ;- � 3 $.50/$1,�00 Valuation , -
�: � �; Charge $ `$1000 per SAC Unit ;Y �
. . 4.; ��t�i �
?�.ic:;nse Surcharge $ �;- r � ,; $5:00 (State Licensed Residential Contraetors) ,; , K, ��,N
.;=-r����;a Escrovr $ ��"`Alt.':��A�� or�Alt. ��B�� Above �..,.�,:.,��� :r� �s�J=
Y
�:. ��i�n Control $ ;,$450.00 Coriservation Plan Review
- � $ ��"Fee Determined by Engineer'ing + �
. _.., s;��
;
_, _ .. :: :��1ain Cllarge � °; Agreement Necessary [ ] Not Necessary [ J � ��,s,
i:, *
�. � � �. �r� ��. �
J' °`-. . �j � `, , � � � �� � � ; �r
"1'O'I AL $ r } � � �, ��
�,� � ' �rr ;� ..�
. � �' j �� = 4y .
.. � � . . .. �� .. : .r K { :�'� � if : � �.-4'" 1�5 t��� 4� c s' �:."
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� :I�'ULATIONS: � :` ' � '������;, 4
. . - . . . - i+rpa . .
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.. . � .. � .." . . : .... �� ..
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- sue.,etT MIT NO.
City of Fridley J 2 8 9 01
AT TME TOP OF THE TWINS g �� L D I N G P E R M I T
r
; � RECEIPT NO.
� ; y__�_�__ COMMUNITY OEVELOPMENT pIV. ���
r � � PROTECTIVE INSPECTtON SEC.
i.__-�,��"' �'� CITY HALL f fiIOLE� 55�32 NVMBER pEV O�TE P�GE Oi •6vqpvEO Br
L 612-571-3450 9t0-F15 2/5/99 / /
JOB ADORESS 581 Buffalo Street NE
t LEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACHEO
DESCR. 1, 2 X Riverview Heights SHEET
2 PROPERTY OWNER MAIL A,DORES$ ZIP PMONE
Renee McCoy 581 Buffalo Street NE 7ll-5780
J CONTRACTOR MAIL ADORESS 21P PNONE LICENSE NO
Custom Remodelers 474 Apollo Dr, Lino Lakes, MN 55014 784-2646 1748
4 AqCHITECT OR DESIGNER MAI� ADORESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS IIP PHONE UCENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WOFK
O NEW O ADDITION ❑ ALTERATION �7 REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Replacement windows (no change in size)
9 CHANGE Of USE FiiOM TO
STIPULATIONS
Install smoke detectors to meet the State Building Code — in each
sleeping room and on each level of the dwelling.
_ : .... , w.:_,,,
� Contractor reported error on application - change value from $22,000 to $2,200 -
j; refunded over payment on purchase order F60462, 2/9/99.
�`�-.,.._.�� .. _ _ , -
TYPEOFCONST. pCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS AHE REQUIREO FQR ELECTRiCAI. PLUMBING. HEATING,
VENTII,ATING OR AIF CON�ITIONtNG
THIS PERMIT BECOMES NULI AND VOID IF WORK Ofi CONS7pUCTION 20NING SQ. FT CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAVS. Oii IF CONSTRUCTION
OR WORK IS SUSPENOEO �fi ABANOONEO FOR A PERIOD OF 120 OAYS A7
ANV TIME AFTER WOFK IS COMMENCEO. NO DW�G. UNITS OfFSTREET PARKING
I MEREBY CERTIFV TMAT 1 MAVE AEAO AND EXAMIN�D TNIS APPLICATION 1 STA��S GARAGES
ANO KNOW TME SAME Tp BE TRUE ANO CORRECT. ALL PqOVIS10NS OF LAWS yp�UATION SURTAX
ANO ORDINANCES GOVEFiNING THIS 7VPE OF WOAK WILL BE COMPUED
WIThi WMETMEA SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT ���-0O�" $2a2OO ���� �L.lO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEI THE pEpMIT fEE SAC CHARGE
PROVISIONS Of ANY pTHER STATE OR IOCAI lAW FEGUTATING GON- ��'�� $74.75 Fire SC �%�}O @
STRUCTION OR THE PERfORMANCE OF CONSTFUCTION W2 • 2
PLAN CNECK FEE TOTA FEE
License C $5.0 �50.-�5 $83.05
� S�GN- •TT �IREO�CON"iiACTOpOpAUTNOQ�ZED�GENT iO�iE� EN ROPE V ALIOA E TNIS IS VOUR PEFlMIi
-�-s99
S�GHStUAE OF OwaEQ i�F OWNEp BU4DEQ� iD�Tpi � Bt �NSo - � �is�E
NEW [ ] Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �� �
BUILDING PERMIT APPLICATION ��, y�
� ��
ConstructionAddress: Sg I �j' �,��� 1 � ��
LegalDescription: �2 ��Q��o�--��+ w r�p� S �l! d fl �-�r�"°r�-�� �l S
Owner Name & Address: R� n�°e iMC- c��: .S-�� �cr�'�'�el. # 7� 7�% g�
Contractor: � U S'{d �.. (��e v�.c� G��-1 �e� s MN LICENSE #%7 ��
Address: 7 `7 � � �o L Lc� � i L�h o L-�- � � S ��'✓ Tel. # � � y " 2 � �.�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
�� ,
Height Sq. Ft.
Height Sq. Ft.
HgdGround Sq. Ft.
�-
Construction T e: 2� � � � ��
yp ��. � J�c.,v��en�f u�,�`n.cto� S Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
G
DATE: � — S ' � I APPLICANT: Tel. # %f� �l " �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ����. a.�"
$ ��� �'U
$ l l , U C�
$
$ �1�C'��
$
$
$
$
$ �� �� . �s _
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
PURCHASE ORDER DATE DEPARTM T 6 0 4 6 2
�-q�q ; F
PURCHASED BY THIS NUMBER MUST APPEAR
ON AILCORRESPONDENCE
SENT TO US
THIS DOCUMENT GOOD FOR PURCHASES UNDER 51,000.00 ONLY
_ SUPPLIER
_ ADDRESS
!
C�TY OF
FRIDLEY PHONE N0. /r , / - �?� ��-� -
6431 UNN. AVE. N.E.
FRIDLEY. MN 55432-4384 CONTACT
6125713150
PRNVrED ON RECYCLED PAPER. �
ACCOUNT �TY. UNIT ^ PLEASE ENTER OUR ORDER FOR THE FOLLOWING
!0/ � 6b�D0-
lD/- GIdG�D-a
0
0
PAYMENT VOUCHER
BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE
PAYMENT AND THAT THE 600DS AND SERVICES HAVE BEEN
RECEIVED OR RENDERED AND ALL CITY GUIDELINES HAVE
BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOW
STATED ITEMS.
2'i 9r i'f / /% /
. D BY
UNIT PRICE AMOUNT
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1 • ��
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TOTAL I v� (o%o�Q
THIS AGENCY HAS AGREED NOT TO DISCRIMINATE IN HIRING PRACTICES ON THE BASIS OF RACE, SEX, COLOR, CREEO, MARITAL STATUS, RELIGIpN,
OR NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGES
FIRMS AND OTHER AGENCIES WITH WHOM IT PURCHASES PRODUCTS OR SERVICES TO DO LIKEWISE.
0
WHITE, VENDOR - YELIOW, PURCHASING - PINK, ACCOUNTING - GOLDEN ROD, DEPT. HD.
A
_
02-09-1999 08�56AM FROM TO 5711287 P.01
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SuBJEGT .
City of Fridley 3 008
AT TNE TOP Of TNE TWINS g � � L D I N G P E R M I T
f
; � RECEIPT NO.
� i L__���� COMMUNITY OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTtON SEG. �a63
i-_--����"' �'� CITY NALL FRIOLE� 55�32 NVMBEp nEV O�TE v�GE OF •pvROVEO Br
t 612-571-3450 910-F15 8/ 19/99 / /
�oe AooRess 581 Buffalo Street NE
1 LEGAL LOT NO. BLOCK TAACT OR ADDITION SEE ATTACNED
oesca. 1, 2 Riverview Heights SHEET
2 PHOPERTY OWNER MAII ADDRESS ZIP PHONE
Renee McCoy
3 CON7RACTOR MMl ADORESS Z�PSS 337 PMONE IICENSE NO
Four Seasons Roofing $ Rem. 2107 1/2 Burnsville Pkw Burnsville 890-1899 20138780
4 AFCNITEC� OR OESIGNER MAI� AOORESS 21P PMONE IICENSE NO.
5 ENGINEER MAIL ADDFESS 21P PHONE IICENSE NO
6 USE OF BUIIDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Soffits and fascia
9 CHANGE OF USE fROM TO
STIPULATIONS
Pxovide soffit ventilation to meet the State Building Code.
TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD
SEPARATE PERMITS Af;E REOUIREO fOR ELECTFICA�, PLUMBING. MEATING,
VENTI�ATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NUIL AND VOIO If WORK OR CONSTRUCTION 20NING SO. FT CU fT.
AUTHORIZEO IS NOT COMMENCEO WITH{tJ 60 OAYS. OR li CONSTRUCTION
OR WORK tS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 DAVS AT
ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFfSTREET PARKING
I HEREBY CERTIFV THAT I MAVE READ AND EXAMINEO TMIS APPLICATION STA�LS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECi. ALL PROVISIONS Of LAWS VALUATION $URTAX
ANO ORDINANCES GOVERNING THIS TVPE Of WOFK WILL BE COMPLIED �i 1900 �.95
WITH WHETHER SPEC�FIEO HEREIN OR NOT. 7NE GRANTING OF A pERMIT yr
DOES NOT PRESUME TO GIVE AU7HORITV TO VIOIATE OR CANCEL THE PEqMIT FEE SAC CHARGE
PROVISIONS OF ANV OTHER ST E OR LOCAI lAW REGULATING CON-
STRUCTION OR THE PERFORMA OF CONSTRUCTION �EG. ZO Fire SC �I. JO
Jq g PLAN CNECK fEE TOiAL FEE
�/ / �/ Licens $5, 0 °' 4.05
S�GN�ruAE FC TpACTOQOA�UTMOp�ZEOAGENl iOATE� EN ROP AUDA E HIS_I$�/Q�R R Ii�
.l�j(� `Q v
�
S�GNa�uAE O� OwtiEA �rt OwHEA BuiIDERi iD�iE� B�D �tiSo qarE
� r
NEW [ ]
ADDN [ ]
ALTER [ ]
Construction Address:
Legal Description:
Owner Name & Address:
Contractor: �cc►�
Address: v� / p r? !�
Effective 5/10/99
CITY OF FRIDLEY �
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION G� �,,�
� /�"
�� / �'���e �� A�,�'. �
C Tel. #
, c MN LICENSE � ,�U/ 3��
• �',�it9�/ ��,Pk.b vi /1 � /�l�f/� Tel. # �'�'� - jf<9�' _
Attach to this application, a Certificate of Survey of the _..
lot, with the proposed constcuction drawn on it to scale. _
DESCRIPT�ON OF IlVIPROVEM�NT -
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: ,�,�'t'.4- �- �� �S
Construction Type:
Driveway C�rb Cut Width Needed:
Estimated Cost: $ �, �Q�
Ft. + 6 Ft = Ft x$
_$ �
��� �� i / �
YL��:� � � n ��:�►� ����� �.�-- . - . - - ��i��i�v�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$___��.�
$��
$ .^
�
$
$_��CO
$
$
$
$
$^ � �I� S�"
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 {State Licensed Residential �ontrac�ors) � ..
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary ( ] Not Necessary [ ]
Building MECHANICAL permit rlo.: �(� �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY D���'�CT 1
DATE , U' l`` U� YpUR E-MAIL ADDRESS
SITE ADDRESS S�$ � Q V T�4 `d 5�. ,vE •
THIS APPLICANT IS: ❑ OWNER �JCONTRACTOR
PROPERTY NAME: CO
OWNER/ ,,�Dx�ss: S� 1 T�v..�a.,� o S�- � N ci� � STATE WiI�IP 55�3�
TENANT xE
PHONE: 'I �0 � - -► q � - �I � a �1
CONTRACTOR co�ANY NA�: CENTERPOINT ENERGY
SUBMIT A COPY OF
CONTACT PERSON: '7OANN Z INREN
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH pDDRESS: 9320 EVERGREEN BLVD STE HITY �COF311� 'RAPIDS STATEMN ZIP5543�
APPLICATION PxoNE 763 — 757 — 6202 FAX 763--757�-6701
PERMIT TYPE �SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW �REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �� (Z� �t�.rr�
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, 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 PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NO'I'ED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
Equipment Installed MFG: � �a.a... � MODEL: �Jl �o p(V — OS SIZEIBTU S��d 0�
MFG: MODEL: SIZEIBTU
MFG: MODEL: SIZE/BN
_A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGFIOVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER $35.00 �FURNACE $35.00 _GAS UNIT H1'R $10.00
CHIMNEY LINER $]0.00 GAS DRYER $10.00 POOL HEATER $35.00 -
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
Permit Fee $ ' Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DiIE $ Number of fixtures @$25.00 x$25.00 =$
Number of fixtures @$35.00 �_ x$35.00 =$ 3 S,�
State Surcharge = $ .50
Total = $ 35,5
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII.. PROCESSED
I hereby apply for a building permit and I acknowledge 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 requires review and approval of plans.
SIGNATURE OF APPLICANT e� �' � tva,ME ROGER HOFFHEIN DATE � �� /
�T
City of Fridley
Building Inspections�Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
0 NEW HOMES/ADDITIONS �EXISTING HOME ❑ MAI�E-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
l. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 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. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than 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 IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.