AF - 41572�
n
City of Fri.dley, inn
BUILDING PERMIT
Date: —�.� ,� ��
Owner: -- �� � -°� f Bu3lder '
Adaress Address
�����7
N° 697'5
LO ON OF UILDING
� �
No. ��.� S'treet ___._. Part of Lot
Lot - ��� Block Addition or Sub-Divisioa . � ,� ,� �
Coraer Lot � Ins�ide Lot _.._ � Setback _ r�� -`�' � Sideyard � � � ,
Sewer IIevatian �� � � I _ IIevation _ � �l 7 a .a /
Te� ar Foo-r rn��
,�,�;�
��./�!. � �� i/ ` y.� :
DESCRIPTION OP BUILDING
.� ,, �-. � - —�' �� �' ♦ /y�f/'
•� .
Front Depth � I�eight Sq. F`k Cn. F't.
Type of Construction�/����.�..���...._ Est. Cost ������._'�'"�` T be Completed
In consideration of the issuance to me of a permit to construct the building described a�ve, I gree to do
th� proposed work ffi accordance with the description above set fo��j� `�� with al]%�rovistons of
ordtnances of the city of FrYdley. �/
_ t�
In coIDSfderation of the payment of a fee oP $��permit is hereby granted to
to construct the buflding or addition as described above. Thia permit is granted upon
the express condition that theperson to whom it is granted aad his agents. employees and worl�en, in all work
doae in, around and upon said building, or anypart thereof, sl�all oonform itt all reapects to the ordinance�a of
FridleY, A�Iinnesota regardfng location, constructt�ffon, alteration, maintenance, repair and moving of buildinga
w�ithin 'the dtY ]imits and 'this permit may be revoked at any time upon violation of any of the provisiona of said
ordinancea
Buildin8 Inspector
NOTIC�
'hds pqrmi! doa not corer �6s conslrueNon, 6uta11aHon te� vrGtao, plumbie�, ea 6�Nlne, tsw�� or water. B� sun to ss�
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APPLICA.TION FOR BUTLDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME�d ,�� % � O 0� S�a /V BUILDER �(� r �-�/��� ,s'
ADDRESS�� � �—,�L y � � ��" ADDRESS �—
LOCATION OF BUILDING
N0. �% � STREET �� �-` PART OF LOT �
LOT � o�- s� BLOCK ADDITION OR SUBDIVISION�S�%� ��(r %��Ga/� •/�e,, q�
CORNER LOT INSIDE LOT � SETBACK SIDE-YARD
SEWER ELEVATION
TOP OF FOOTING
Applicant attach to this form two certificates of survey of lot and proposed
building location drawn on these two Gertificates.
DESCIPTION OF BUILDING
To be Used as:
� �, /� ,� (�- � - Front_____�� � Depth �o� � Height a ��
^� I � ,�, �
S q . F t . ,. )_��_Cu . F t . � � r" �'
Front � Depth Height
' Sq. Ft. Cu. Ft.
� � �S-,�" o � �
Type of Construction v'�,�� �(%� �/���. Estimated Cost
,
To Be Completed � � �' � — � � �o �
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 ruling of the Department of Buildings, and hereby declares that all the facts
and regresentations stated in this application are true and correct.
_�
DATE ,� � '7 SIGNATURE �� �o c
(Schedule of Fee Costs can be found on the Reverse Side).
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building of structure, or for any addition to any existing
building:or structure, or for any alteration or repairs 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
hereir_ provided to-wit:
Ur..iform Building Code: Type 1,2, & 4- $1.75 for each one thousand cubic feet, or
fraction thereof, in such cubical contents. Type 3& 5-$1.50 for each
one thousand cubic feet.
For the purpose of. computing fees-�for building permits,.the cubical contents of
any building or addition to a uniform height throughout by multipluing the ground
area covered from a point six (6) inches below tha floor line of the basement or
cellar to the average height of the upper surface�or to the average height of the
roof surface of the m�.in gable of a pitched roof.
For repairs or alterations to an existing structure, the fee sha7.1 be at the
rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction thereof
in the cost of all proposed work.
In no case shall�the fee charged for any permit as set forth in Section 2 be
less than $5.00.
NSSSD Connection Charges based on location- Area 1 or 2.
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Bu�lding
In�pections
763-572-3604
763-502-4977 FAX
STfE ADDRESS 't �
THIS APPLICANT IS: p�
PROPERTY OWNER/ N�:
TENANT anD�ss:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BIING
SIZE OF A4PROVEMENT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O Vinyl
❑ Aluminum
❑ Other
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-1-09
Permit No.:�
Received By: �
Dat�R�d:� � � �'
YOUR E-MAIL ADDRESS g�pr o�Q ��� Gl�y,+H ���j'� (�j�
❑CONTRACTOR
c..2
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—3�� �-� 3Li f
STATE LICENSE #
crrr
E}�' DATE
� 3.��3 �.
ADDRESS: CITY STATE ZIP
�vN� FAX
,SINGLE FAMII.Y/NEW CONSTRUCTION SIZE
TWO FAMILY/NEW CONSIRUCTION STORI]
u rwi.niiviv LJ IiAKACit�JSH�ll �WINDOWS
❑ BASEMENT FIIVISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING p p'['�R
❑ SWIlVIIvIIlVG POOL
NEW HOME CONSTRUCTION ❑ ADDTITON
MAINTENANCE/REPAIR ❑ REMODELING
��Ld �'L �C15�'�e'"+1 �> ���&s/�, �re9% ���° i
LENGTH WID'Tfi
❑ HOUSE ONLY
_ ❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
�t�YSS �-ZxG"fa►r
SQ FT ��'�^d e+�
BASEMENT REMODELING SUBMIT
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FORNEW CONSTRUCTION INCLUDING DECKS,
❑Soffit ADDITIONS. & PORCHES SUBMIT•
❑ T� 1. Site Plan/Survey showing the eacisting structwes
❑ Fascia and proposed project.
2 Two sets of constructio 1
n p anc
WINDOWS 3. Energy Calculations
IN EXISTING OPININGS es ❑No LOC TION OF W,�
OR FOR NEW OPENINGS- ESCRIBE SIZE OF P.-r g� �, � Fq �°¢�f �
OPENING CIiANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINBOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
�+ SING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $/� OCCUPANCY � TYPF,
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
$ �
$ I c�c�
$ �
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuarion
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residenrial Coniractors)
$2000 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 UN1'IL PROCESSED
I hereby apply for a building permit and I acl�owledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the ' ridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for it an ork is ot to start without a permit on site; that the work will be in accordance with the
approved plan in the case of a11 w 'ch re ires re 'ew and approval of pl
SIGNATURE OF APPLICANT � PRINT NAME VC 1'�' -1 �� � DATE � Z� I
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Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any e�sting 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 - /�1�.v
Building Inspections Department �
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
� Building
,� Inspections
763-572-3604
763-502-4977 FAX
DATE �` /
SI7'E ADDRESS _
THIS APPLICANT IS:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
Permit No.:
Received By:
YOURE-MAILADDRESS OPit�+uattit�eltq�vi � SYSF'EstS@ �tqrc.
41 �
❑ OWNER �ONTRACTOR
PROPERTY Nq�: ��-..�Z� Y � t C�
ENNAN�T ADDRESS: Y% 1 L L Y Sr sv � CITY � t� L£ e/ STATE Mn/ZIP,rSY3 a-
PHONE: l9 S I- 3�lo -� 3 p 1
CONTRACTOR co�P,�rr� Nn�: __/� P; �,,,� c�,�,� ,k C C-F�4�� a� S�rsr,€.�-� S
SUBMIT A COPY OF CONTACT PERSON: ��� � �Q e,vt� � Kt-+J
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WIT'H ,r�DRESS: �p�,a L' �� � 2,J ��.� CITY L t 1-Tzf. C/}�i}p�- STATE Ha�ZIPs�/ t i
APPLICATION PHONE lo� f-Ya g-� 3 e-�- FAX ��( - Y a- °� - 9�S'O !o
PERMIT TYPE � SINGLE FAMILY ❑ TWO FAMILY
TYPE OF WORK: � ��' J��p�+CEMEN'['
DETAILED DESCRIPTION OF WORK K�Z
❑ TOWI�[HOUSE
❑ ALTERATIONJREMODEL
zt2.v�-e � � �- �
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDIC TE TOTAL NUMBER OF EACH BELOVI�
FquipmentInstalled MFG: C'pD1�MA-N MODEL: (�gyhH�SO?03 � X SIZEBTU %D K 4��"fp
MFG: �()D MR� MODEL: SLp ��O�t�t SIZE/BTU ��I a 9'-�,v
MFG: MODEL: SIZE/BTU
I �C $25.(Ml _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00
_AIR TO AIIt EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
_BOILER $35.00 LFURNACE $35.00 GAS UNIT HTR $10.00
_CHININEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
_DUCT WORK $10.00 GAS PIPING $]0.00 _VENTILATOR $I5.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL 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 pernut but only an appli on r ermit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of a�l�or .w���e uires reyoiew and approval of plans.
SIGNATURE OF APPLICANT
NAME �t2r�{�4�' �,u,t:�yy�.S DATE l� I b�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
e
�
� HEAT TRANSFER CALCULATIONS
Name 1 Q'C � e��-�- Address '�'1 I � �K gT /��
��
Heating TD = 90 F(-20 F Outdoor, 70 F Indaor) Cooling TD = 20 F(95 F Outdoor, 75 F Indoo�
HEAT LOSS HEAT GAIN
SQ FT COEF� BTUH SQ FT COEFF BTUH
��� ' � _ :
�_ � � � w ; �� � �� -
s �s=�" .. � .�
�� „ :
-- - �-__ _� ,� _
_._ � _�_�zt _ _�^ ._ ._ _ _T
Single 116 North o 3 33 / 24 � � Z
Double p Q� 82 1�, �� East-West (0 90 / 74 ��
Lovu E 40 South �S 48 / 39 2� ��
Other
�� � � == #�_ 4000 �!� � # 2� 300 (� no
�
� ���� 'S. i^^'� r 4 _ { � �? £ ��i������ �T �� c'� 'F . ��-�i` S _
� _ +-�, ' '_+._�P
20°.���= _ - - = � - � 20° 1
16" 2 16" 1
12° 1'sv 3 2��D 12" � 0 1 `� `So
g� 4 � 9" 2
6" 5 6" 3
3fl 8 3" 4
���� �€� .� r -� � ` _ ����e�> � �` _ � � � � � - -
1.5" � � _ .� 1U . �:_ 1.5" . r _ ,..4 a.
3.5" `� 3 7 .Smo'1 3.5" � 3 3 Z�' 1
5.5" 4 5.5" 2
�#� ��a��'� _. � ,�, �_ � _ . ___ � # 600 2�t,�
0° �i(Q 6 ��
1" 3.5
�; � �� � f -
��" _ _ _ � _ `3'—� _ a
_._ -.� _... _ : �_ , . _..� _ �. __ � _ �, .
Blw Grd 1.5 ALL - 2500 2��
Slab Grd lin ' 30/lin '
SUBTOTAL �j� �'� SUBTOTAL ,� �� g�
IAtFILTRATION: Infiltration CFM = 0.50 X cubic feet of house / 60
4.50 * L mo * W 2� * H `� / 60 = t2� InfilUation CFM
*Add"►tional heating infi�tration load should only be calculated if house is loosely constructed*
Infiltration Infilt CFM Coeff BTUH Inflitration Infilt CFM Coeff BTUH
Sensibie 99 Sensible Z 22 2�t � 2
Latent � 24 � u 2
Attic/Crawi Space Add 10% Attic or craavl space 10%
�, , , � ,. . . 22 ��
80% Efficiency /.70 1 Stage / 12,000
92% Efficiency I .80 � � , dov � ��t� � 2 Stage / 12,000 Z �_ �-� ,f�S