AF - 45652�
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City of Fridley, Minn.
BUILDING PERNIIT
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Na ���.�l...—.... Street ..�!C��
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corner Lot
Sewer IIevation
Inslde Int
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N° 7008
Foundatia� IIevatlon
DESCRIPTION OF BUILDING
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_s.i.._......l�.%.....—_..—.
u� ' �/� �v �? /�..�.,f� ,� _�O
, _ .._ �t _...w�_�/�. nentn .....__�.....l.._ xe��t . _ ....._.. sa. F'c. _ ... . cu.
_ -! _..t_.!!__ Depth ..�,`�',y� HeiSht .��� .39. Ft��- Cu. Ft �..�.a�
Type of eti ... ._ Es4 Cosf –�� ..so be Completed .._.._.._._..�....__.-.--
Ea conaiderat[oa of the isauanoe to me of a permit to 0
Uu propoaed work in accordance with the description above
ordlnancea of the city of FMd1eY.
Ea camdderatl� a� the paymeat of a fee oP
permit is hei'ebY �nted
to do
ns of
to c�struct the building or addition as described above. Thia permit is granted up�
the express c�dition ffiat the peraon to whom it ia Branted and 6is agents, emPloyees and worlanen, � all wm'k.
done in,� around ead upan said buiidinB. oT �Y Part thereof, shall conPorm in all reaP�tB to the ordinances af
Frid1eY� Minnesota reBarding location. construction. alteration, maintenance, repair and mu`rin8 of buildings
ad�� city ]imiffi and this permit may be revoked at aqy� uyaQ� y1aYiCn of any of the proviaions of seid
//�v' 1
Buildln8 Inspector
NOTICE:
1Ns P�ni� dea �m cswr Nr �aNhueNee, hanlMNen Mr wGi�O, P�tiW 6�s M�1iny, aw�r x w�Nr. N wn ro w
/M MlWiey ImpK7ee for »p�nh p�rNh fer IMN N�ns. � .
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City of Fridley, Minn.
: � �I 1�1\�!�
.: ...
I��'►�I
pµ.�r; � llona.l rl T� . Wr ' rr lt ,., $vi]det
p,� . 13�.._Glen Creek Road
..---._._..._.._..--- Addresa
��-a � �
N° 10343
LOCATION OF BUILDING
Na -��_ Sh�eet Glen Creek Road __. _............_.... Part of Lot ---.---.--._.._.._..—.----
Lot —_..'L._.__ Block —.._� ...._...—.._....—._. Addition or Sub-Divisi� ...._Oak_Creek Addition ________
Corner Lot ---._..._..__ Inside Lot
Sewer IIevati�
To be Uted as:
$.a�odal -- Front
---------- F�oat
Type of Conetruction
Setback .__..__...._..._........_ Sideyard
_._._ Foimdation IIevatioa �_—
DESCRIPTION OF BUILDING
DePth -- Height ..—.___ Sq. Ft __..—_ Cu. Ft
DePth ----- Height _._.— Sq. Ft. ----- Gtit. Ft _..._�_
-.-- Esk Cost —��0. _00...._....__..... To be CamPleted _.. Au�?st.� ��
In cwnaideration of the issuance W me of a permit to c�st
the proposed work in accordance with the description above aet
�dinances ot the dty of Fridley.
I above, I a�ee to do
with ell Piwlstans oP
In caos[derati� of the payment of a fee oE;-- �_ nn -.._., permit is hereby grented to__3i0,ri�.l.d�..Idr'�
to rnnatruct the building or addition as descrlbed above. Thia permit is granted upon
the expresa conditi� that thepe reon to whom it ia granted and his agents, employees and worlanen, in all work
done io, around and uP� eaid building, or any part thereof, shall conPorm in all respecta to the ordinencea of
PY'idleY. Minneeota regarding locatlon, conatructia�, alteratt�, maintenance, rnPeh' and movin8 of buildu'�gs
wio '�� dty limits and this permrt mqy be revoked at arU' tme upaa� violation of aqy of the BTOVisions oP esid
Buildin6 Inspectm'
NOTICE
7hb pu�nY dws eN eowr 1M cer�ncHey IsqdhNan Ier r'YiM. P���W Y�s lu�floy, w�r�r er �v�Mr. M wn ro w
ffi� Wildiey Impuror fer aprx� p�raks fer IMw kwro. � .
APPLICATION FOR BUILDING PERNIIT
CITY OF FB.IDLEY, MINNESOTA
owrr� �s rrar� �ou�.l 0 L.. �R��kf HJ�BUZ��
ADDRffiS /�S~ �e fEN ULEFK �e� ADDRESS
LOCATION OF BUILDING
N0. STREET � � v F
LOT 3 BLOCK / 6DDITION OR SUBDIVISION D`t ��@. QeLeL.c. �
COR.NER i0T INSIIlE LOT SEPBAGK SIDEYARD
SEWER ELEVATION TOP OF FOOTING
Applioant atteah to this form Two Certificates of Suxvey o£ Lot and
propoaed building location drswn on theee Certificatee.
DESCRIPTION OF BIIILDING
To Be IIaed Ae:
Front Depth Height
fiquare £eet Cubic Feet
F'ront Depth Height
Square feet Cubic Feet
Type o£ Conetruction T)o VC wl� �' Estimated Cost Sd C1 �
To Be Completed //l! rNl� HOrV%�7 -
The underaigned hereby makee applicatio.n for a permit for the work
herein specified, agreeing to do all work in atrict accordance with the
City of Fridley Ordina.nces and rulings o£ the Department of Buildings,
and hereby declarea that all the facta and represe.ntations stated in
thia application are true and correct, A _/ L�i"\ //i
� . �c �
(Schedule o£ Fee Costa can be found on the Reverae Side,
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� sue�ecr '- � � PERMIT�
'�City of Fridley . 12093
. ATTHETOPOFTHE.NJINS � BU�LD/�G PER�IT
� �� � � ECEIPT
� �� ; y CAMMUNITY �DEVELOPMENT DIV. � � � �� � �. �
f � . � � �� � PROTECTNE INSPEC710N SEC. �,��J�-��
� V ���
1� s�/'�'\ :� CITY HALL FqIOLEY ' S5032 HUMBEH REV. DRTE GnGE OF APFROVED BY � �
i--^�"' ''' s�z-sea3+so si0-Ft5 4/12/73 � �
� JOB ADDPESS 135 Glen Creek Road N.E.
1 LE6AL ��TNO. BLOCK. � TRACTORADOITION SEEATTACHED �
nescR. 3 1 Oak Creek Addition Plat 2 SHEE7
2 PROPERTYOWNER AAAILADDRESS 21P PHONE �
Dr. Wright 135 Geln Creek Road N.E.
� 3 CONTRACiOR � MAILADDRESS Z�P PHONE LICENSENO.
Milton SiQ1{.Tohnson Roofing 2513 Central Avetrue N.E.
d ARCHITECTOqOESIGNER MAILADDAESS ZIP PHONE � LICENSENO. �
5 ENGINEER MAILADDRESS � � ZIP PHONE UCENSENO.
e USE OF BUILDING � �
�F7ELL1Ilg .
1 CUSSOF WOHK . � NEW � O ADDITION HI ALTERATION ❑ REPAIR ❑ MOVE ❑� REMOVE
e oescaisewoAK
Re-roof Dwelling
9 CMANOEpFUSEiROM � �. 70 .
�STIPULATIONS� � � �
TVPEOFCONST. OCCUPANCVGROUP OCCUPANCYLOA�
SEPARATE PERMITS ARE REOUIRED FOR ELECTRIGAt„ PLUM@IMG, HEATING. � .
VENTILATING OR AIR CONDITIONING. �� � $h le8 .
. THIS.PERMIT BECOMES NUIL AND VO10 IF WOAN�OR OaNSTRUCTION ZONING� .� $p:FT. CU.FT.
AUTHORIZEp IS NOT COMMENCE� WITHIN 60 DAY3,'OR IF CONSTpUCT10N �
OR WORK IS-$USPENDED OR ABANDONED FOR A-PER10D Of 120 �AVS AT jt,-J,-. . �
ANY TIME AFTER WORK IS COMMENCED. � ��. q0. DWLG. UNITS � OFFSTREET PARKING �
I HEHEBV CERTIFY THAT 1 HAVE READ AN� EXAMINED THIS APPLICATION � ��� -STALLS GARAGES
ANDKNOWTHESAMETOBETRUEANOCOHRECT�.ALLPROVISIONSOFLAWS yALUHTION � � � � SURTAX
AMO OROINANCES GOVEPNING THIS TYPE OF WORK WILL BE COMPUED � � �
WITH WHETHER SPEGfIED NEREIN OR NOT. TME�-GRANTING OF A PERMIT L�LHS�.00 � .9�F � �
DqES NOT PRESUME TO GIVE AUTHOPITY TO VlOLATE OR CANCEL THE pERMITFEf SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL�LAW REGULATING CON- p � �
STRUCTION OR THE PERFORMANGE OF GONSTRUCTION. y9.AO �� �
� /� ,Q PLANCHECKFEE� TOTALFEE ��
% �i6�:�-ta-ci�- y'�.�` i3 $9.94 ,
� NpT� EOF:GONTRACTOROPRUTHOPIZEDAGENT IOATEI WMEN�PROPER4 VAL ATED THIS f5 YOUR PERMIT
. ' _/ oi :''%�
SIGNA� � DFQWNERIIFOWNERBUILDEPo IDATEI � BLDG iNSG OnTE
AFP�ICATION PQk RE9IAENTIA�. ALT�R�ATIAN.
OR ADAITION BUILDING P&RMIT
G�TX OF FAIA�HY, MINN�SOTA
� ;�� � ,� � ,�/ •.� > s• �d �...�„ �
� u• .� i„ /,_ � . � �.� _ . / �
3�us�... �� �
�
-- ---- --- -
�,o�r: 3 sI.ocxx I nnASxlor�t C��,G �'�c�
C�TiER LOT• ILi8�1l: LQT: , SBTBAC&t sIDEYARD:,,,,_�,,,,,,_,_,,,.
�i�aant Atxacch ;o th�,y �pstR�„o Certificates of Suxvey of Lot ead proppeed
}niidiag dacatioa dTapia oA �e Certificates.
�
��BCRIPTI(JN OF BUILAING
9b � itsed Aa :
� I�UC�o F�5 4 P�a�7 �+t�: AeiBkt:
SquASe Fantt cubia l�eta
i+roat: Depth; Height•
Squaxe �'eet; Cubic Feett
1 l $%� B 5� �°
'�� oi Goastructi�l�� ���i(�JBati.a�Ced Coat: $
'�:D AO QOAjliqtidi ,_ / (�-�X./C� .
�lMt qn¢sspigned heraby skea apPlicativa For,e pes�ait for the waTk h�reia
��fS�!#�ed� agseeia$ ta do alI Noik 1n eti�.ct accordance with Che C,ity p£
ilC�ld�sy Ox'dLF��e Ai+d �+tli�t pf i.qe Aapaztmen� 4f Buiidi�s, e,�ed heteDy
#M+3.aret► C�It, all #he #acts aled repreaentatione stated i�s Chie applicatioa
au�e Gsue ated carsect, .
n��s y� �7 � sisr�+TOaE: �.�'��
{�p Rsvss�e BiAe Fos pddi(j,onal Infoaqatioa.}
_1'�C/ G� ���
<�
� 9. 9 �!
� sue�ec� . : PER .
City of Fridley /��. F ° 1366
r� ATTHETOPOFTMETWIN$ � . . BUILD�N\/ PLR� IT • �
,
. � . .. RECEIPT NO. �
� � • COMMUNITY DEVELOPMENT �IV. � � �
� . 1 y �����'�
r���. .� � � PROTECTWE:"{NSPEQ:IONSEC. � �
� .i. : .. . . . . .
�` �/'�'1 � GTY HALL FRIDIE����55432 NUMBER REV. OATE � PAGE OF nPCqOVED BY
L•••��'� `-� etz-5803a50 � , 910-F15 � � �
7 217
ioe aooRess 135 Glen Creek Road N.B.
1 LEGAL �OT NO. BLOCK �. TRACT OR ADDITION �. � SEE ATTACNED
DESCR.� 3 1 Oak Creek. Addition. Plat 2 sHeer � �
-2 PROPEPiVOWNER MAILADDRESS � � � I�P PHONE � � �
nr. Y�iY2 Donald Wright 135 Glen Creek i2oad N.E.
3�CONTRACTOR MA4�ADORESS � Z�P PHONE UCENSENO.
L. Gudmunsen Construction Co. 1054 93rd Avenue N.W. Coon Ra 'ds
�� 4 ARCHITECTORDES�GNER MAILAODRESS �� ZIP PHONE LICENSENO.
� 5' ENGINEER MAIL ADORESS . Z�P PHONE UCENSE NO.
8- USE OP BNLDING � � - .
Residential
7 CIASS OF WORK -
❑ NEW � X. ADDITION ❑ ALTERATION ❑ REPAIR .❑ MOVE ❑� REMOVE �
8. DESCRIBE WORK .
Construct a 20' x 9'3" Laun Room Addition d ' x 11' "
B GNAN6EOPUSEFROM . TO � ' �
�:STfPUlAT10NS � � - � . . . � ..
WARNtNG
SfPERATE PERMI7S REQUlREQ FOR iMtRtAtG, 8efwe dlaginQ calt local u,i"�tp�
HEATING, PLUMBING AND StGNS. TELEPHONE-ELECTRIC-GpJEtc.
REQUIRED 8Y LAb1�
� � - � TVPEOF:CONST.� OCCUPANCVGROUP � OCCUPANCVLOAD
� SEPARATE PERMITSARE REOUIRED FOR ELECTRICAL, PLUMBING. NEATING. . . �
VENTILpTiNG OR AIR CONOITIONING. � WOOFI.$'Y8818.
���.THIS PERMIT BECOMES NULL AND VO10 IF WORK OR AOkSTPUCTION ZONING�'�� ��SO.FT. CLL FT: � �
AUTHORIZED IS NOT COMMENCEO WITHIN 80 DAVS;�ORYF �CONSTRUCTION � � � .�� .
OR WORK4S SUSPENDEO OR ABANOONED FOR� A.PERIOD OF-120 DAYS AT $�� ��
ANV TIME��AFTER WOFK IS�COMMENGEO. � � � �. NO. �44�G. UNI7S � OFFSTREET PARKING �'.
1 HEREBY CBHTIFY THAT I NAVE REA� AND EXAMINED THIS APPLICATION j, � � STAI.�S �� GAFAGES
ANDKNOWTHESAMETOBETRUEANOCORqECT.ALL�PROVIS10NS0:LAWS yp�UATION � � ��� � �� SURTAX� �
AND ORpINANCES GOVERN�NG THIS TVPE OF WORK WILL BE COMPLIED �� � � �
WITH WHETHER SPECIFIED HEREIN OR NOT. 7HE pRANTING OF A PERMIT S1ZyOOQ. . � ��$S.SO �
OOES NOT PRESUME TO GIVE AUTHpRITV TO VIOLATE OP CANCEL THE pEHMITFEE .. � SACCHARGE
PROVISIO - F ANV OTH �.STATE OR lOCAL LAW REGULATING CON- � � �
THUCTI R THEPEPF ..ANCE OF CONSTRUCTION. � S43.OB � � �
" � PLANCHECKFEE TOTALFEE
% /2� 510.77 $59.35
SiGr+ATUR NrR �TOnonn�rHOn¢EDaGEr�r iflaT � WHEN PROPERIY�VALI�ATE THIS IS YOUR PERMIT� �
`�-�/-'��o
�.SIGNPTUPEOFOWNERIIFOWNEBBUILDERI � IMTEI � BLOG W5� 9AiE
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
OWNER�S NAME: DfZ. 1.)a.,.,o-�d �2�r.�{�� BUILDER: �� �vc+m �..�S�at��o�^'S��.o
AnnxESS:�,3s -�lemkJ �v�e � 12 � ADnRESS: las y- 93.-� /✓�t.-r�Cc1-C.�.
NO:. I 3 s
d
IAT: 3 BLOCK: I ADDITION: Op � .c �¢. K��ldl'�ibr.1 f�/.0�-& Z
CORNER LOT: INSIDE LOT:�SETBACK:�SIDEYARD: I{��o
Applicant attach to this form 1t_ro Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As;
I Q
.i.�, ,r QUnFront: 2 � � Depth: � ^ 3 �� Height: �� �
Square Feet: ��s � CuUic Feet:
i G
r Front: ZD � Depth: (1 g�� Height: O�
Square Feet; ,2.3s� Cubic Feet:
o�
Type of Construction: �r�.,v� -P Estimated Cost: $. )�000
To Be Completed: �� c� A y�
The--undersigned hereby makes application for a permit for the work herein
specified, agreeinp, to do all work in str`ict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declaxes that all the facts and representations stated in this application
aYe true and correct. �/�� �
DATE: �—/�� / �
(See Reverse Side For Addit
1
I gs x i z. �'L, tz-�
aasx �t= Z��
�d�i�� J�a�%�d X
�� c}5S �� 6� 1 I, X(o, o v
o7a�ati�n. ) ' � ���'A'. �3. �
/ /
�.C�. _ :JO,��
53�5
�l�nov 2a,�6 ^'��' . � � °`
6�lc . ��,�?$ �'��7� ;� '�
.�
� EXTERIpR ENVGLOP� nVER11GE "U" COMPUTATION
:
r
Page 1 of 4
? � OWNER: A�JG. If/:� _ W � r �jj �'�� DATE � ' � I " �� - -
SZTE ADDRESS: (]� l,;,J�,. J��j � p. �a PHONE: �
a
CONTRACTOR: ����AM«�I�---- .
Determine working square footage of each
1. Total exposed wall area� �!�.�'� sq. ft. x .17
2. Toal roof/ceiling area ...... �� � sq. ft. x .OS
Total exposed wall area above floor =
= 5�,�
_ °I,z�
a. Total wall window area ................................. �
b. Total door area .......................................
c. Total sliding glass door area ......................... —
d. Total fireplace wall area ............................. --
e. Total wall framing area (average 10�) .................. �-
f. Total rim joist area .... ............................ '
g, wall area above floor ..........................
h. wall area above floor ..........................
i. wall area above floor ..........................
j, wall area above floor ..........................
Total exposed foundation area =
k. Total £oundation window area ...........................
1. Total net foundation area above grade .................
Determine "U" value of each wall segment
(e.g. window, door, each separate wall section)
a.
b.
c.
d.
e.
f.
9•
h.
i.
X "U"
X "U"
X "U"
X "U"
X "U"
X "U"
X "U"
X "U"
X "U"
a
a
;� x uUn =
� Y.� ' %S uVn ° .
l. X nun �
3 ............................. Total =
t
If item 113 is the same as,
or less than item N1, you.
have met the intent of '
SBC 6006 (c) 2. .
a
Exterior Envelope Average "U" Computation
' , Total exposed roof/ceiling area =
m. Total skylight area ................ ..........
� n. Total roof/ceiling framing area (average 10$)...
o. Rbtal net insulated roof/ceiling area........... �
Determine "U" value for each roof/ceiling segment
m. X "U" _
n. X "U" _
o. X "U" _
Page 2 of 4
4 ........................... Total =
If totdl of #4 is the same as, or less than #k2, you have met the intent of
5BC 6006 (c) L
Alternate Building Envelope Design �
Rb utilize the total envelope system method, the values established by the sum of
items #3 and #4 shall not be greater than the sum of items #1 and #2•
L + 2. _
3. + 4. _
0
, ' WALL SL•'CTIONS �
NO'PE: Use lOW of opaque wall area for
frame construction
FIG. $1 TOPVIES9 or
. . FRRtSE (71+LL
� „ � U
�� • �,
� `' �,, ' '
F3G. #3
• ♦ �
IJ �
-- � :• •a � � �
. , , . �, �
' _ ' ,� .
_ _ ,_ . .
��
Page 3 of 4
Construction R-Value
1. Interior air film 0.68
2.
3.
4.
5.
6. Exteri�r air film 0.17
Total
1, Interior air film 0.68�
2.
3.
4.
5.
6. FSCterior air £ilm 0.17
Total
1_ Interior air film 0.68
2.
3.
4.
5.
6. Exterior air film 0.17
Total
J � •
1. Interior air film
: : • . .
2.
� 3.
4.
5.
6. Exterior air film
.i�:i �
0.17
Total
. ' . .' 1 - a . : . —
r ` . �
� �
-�.--r'r-- r-�;,'-FTrr x . . ; `a : - ' .
�!(�- , • •`� •
/�( � • , ' .
' b ' � Ill =
_ � � � _
. � — �� �
, ffl , •, .. /(1^ .
�zc. 1In �t� k �' •, p` � /�!
. . _ • 'f�� � .
. �~ �
i �
' ([!/!( � /[f � r�� ;: .�. ��
NOTr:: Indicato type, "R"'valuc, deptL and
�'
/
�
• V'LI�T
Ventcd
0
R0C7F/CEILING
t�
Z
��11�!) ..
\J `J
flcat flow
, uP
FIG. �iS ,
1 2:eat flosa up
. .FI,. I!6-.. ...
�, .�ventad
' M nUC� Vl:.l�i1C1J � _ '
. • • • •. .` • . �. '
. �Heat • . �
; , • •' flow up „ • •: �
fi XG. (!9 � . . . .
Page 4 of 4
Construction R-Value
1..Znterior air film 0.61
2.
3.
4. Exterior air film (still) 0.61
Total
1. Interior air film 0.61
2.
3.
4. Exterior air film (still) 0.61
Rbtal
1. Inside air film 0.61
2.
3.
4.
5. trstside air film 0.17
Total
Note: Use additional sheets if more space is
needed for details and calculations
City .of Fridley � '
ATTIiETOPOfTMETWINS gUILDING PERMIT
;,
� •
�
COMMUNITY DEVEIOPMENT DIV.
r � � .�� � PROTECTIVE WSPECTION SEC.
� �
� i �
� /"'1 • CITY HALL FRID�E� 55�J2 NUMBErr pEY D�TE o�GE O�
�""� � �'' 612-571-3450 910-Ft5 5/13/98 � �
lOB ADDPE55 135 Glen Creek Road NE
YERMIT NO.
26050
_.__.__—
RECEIPT NO.
��O /
RFVROVEO BY
1 LEGAL �OTNO. BLOCK TRACTORAODITION SEEATTACMED
DESCR. 3 1 Oak Creek Addition SHEET
2 PfiOPEPTYOWNER MAILADDRESS 21P PMONE
Gary Leske 135 Glen Creek Road NE 571-0917
3 CONTqACTOR MAIL ADORE55 ZIP PHONE
Dan Netko Exteriors 7118 Riverdale Rd, Mpls., MN 55430 566-3731
< ARGHITECTORDESIGNER �MRILAD�RESS 21P PMONE
MAIL
PMONE
r.r.�
8 USE OF BUILDING .
Residential
7 CLASS OF WORK
❑ NEW ❑ AODITION O ALTERATION �] REPAIR ❑ MOVE ❑ REMOVE
B oESCRIBE wOHK
Reroof House & Garage (29 Sq) Tear-off
9 CHANGEOiUSEFHOM
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PEAMITS ARE REQUIRED FOR ELECTPICAL, PLUMBING, MEATING.
VENTILqTING Ofl AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSiRUCTION
AU7HOR2ED IS NOT COMMENCED WITHIN 60 OAYS, OP �F CONSTRUCTION
OR WORK IS SUSPENOE� OR ABANOONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOAK IS COMMENCED. �
1 HEREBV CEflTIFY iHAT 1 MAVE READ AND E%AMINED TNIS AGVULATION
AND NNOW THE SAME TO BE TqUE AND COHRECi. ALL PFOVISIONS OF �AWS
AND ORDINANCES GOYERNING TMIS TVPE OF WORK WILL BE COMPLIED
WITN WMETHER SPECIfIEO MEREIN Oii NOT. TNE GRANTING OF A PENMIT
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME
PROVISIONS OF ANY OTMER STATE OF LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNAiUAE OF CON: PALTOP OP 1pTNON4ED 4GEN i
1
LUATION
$2,418
RMITfEE
$74.75
STAlLS
:L
GHOUP OCCUPANCVLOAO
CU. FT.
OFFSTREET PAPNING
�1.21
SACLHARGE
Fir SC $2.42
TOT EE
.38
NEW
ADDN
ALTER
��
I]
fl
ConswctionAddress:
L.egal Description: `
Owner Name & Ad
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY - . _
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Buiiding Permit Application
E
Effective 3/1/96
,..` � �
�
Te1. A' S ?l � `�% �
MN LICENSE+�
Te1.11 .5�� 37...�1
Attacli [o�'i�t is application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
I.engUi
Length
DESCRIPTION OF IMPROVEl1�NT
Width Height
Width Height
Width Hgt/Ground _
Corner Lot [] Inside Lot [] Ft. Yd Setback
Type of Construction: . �� �
Approx. Completion Date: � ni 0�
(Cost on
Sq. Ft.
Sq. Ft.
Sq. Ft.
_ Side Yard Setbacks
Estimated Cost: $ �
a�lo°
Back)
Driveway Curb Cut Width Needed: Ft. 6 Ft — F x$ _$
DATE: ��i g APPLICANT: �� �� Tel. N S64�i�
Permit Fee �%'� %� $
Fire Surcharge � ��-$
State Surcharge �,02� $ 1�
SAC Charge $
License Surcha���
Driveway Fscrow $
Erosion Control $
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (i/lOth%)
$.50/$1,000 Valuation
$900 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ ��� Agreement Necessary [ J Not Necessary []
TOTAL
STIPULAT]
����
/
.,� - ,
� __ —.- _ _ _ __ __ _— _ -- —
Building PLUMBING Permit No.: -
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Re°'d:
DATE 9—°t�O ��'� � YOUR E-MAIL ADDRESS I eS /1 c_ �� OC ^✓ LL ✓Yi N- �°� G
SITEADDRESS I 5 . (�,� CwP�''.. ��
THISAPPI.ICANTIS: �OWNER �CONTRACTOR
PROPERTY NAME: Q I�es r� n
OWNER/ pDDRESS' 93S �ieq �Y�°�°�� "C� CITY htc c� STATE ZIPS��i3oZ
TENANT PHONe 7(0 3-- 57l— 09 /� �
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE IX EXP DATE
YOUR STA�I'E ADDRESS: CITY STATE_ZIP
LICENSE WI7H pHONE FAX
APPLICATION - �
PERMIT TYPE �S�NGLE FAMILY ❑ TWO FAMILV ❑ TOWNHOUSE
TYPE OF WORK: � NEW ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK �c�.c fC cn✓�+Teucca WaSit�°r °''` wq�"�" `'`✓= S�k �p �`f
— iJL'�Bra Is�c��'
PER MS 16B.665 the permit fee is a minimum of SI5.00 or 5% of the to[al cost up to $SOO.OQ 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 PROIECTS WHERE LABOR EXCEEDS $500. FEES ARE BASED ON SI0.00 PBR FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV FLOOR DRAINS SNOWER WATER PIPMG
BATHTUB GASPIPMGw��:ru��'m�urr:xs;) SWIMMMGPOOL WATERSOFP9J5R($35)
CLOTHES WASHER KITCHEN SW K WATER CLASET BACKFLOW PREV. (SIS)
DISHWASHER _ LAUNDRY TRAY WATER HEATER (535) FOR IRRIGATION
WATER METER OTHER
�r'
Permit Fee $ Number of fixtures @$10.00 _ x$10.00 =$
Surchar e .50 Number of fixtures @ $15.00 / x $15.00 = $ �,�C.,'�
"COTAL DUE $ Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 50
Total = $ S• 5
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
[ hereby apply for a building peanit 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 1 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 a w rk which equires review and approval of plans.
S[GNATUREOFAPPLICANT � PRMTNAME �aN1 �sV"e DATE � �� ��
�
City of Fridley
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
SITf APDRESS _
IHIS APPLICANT IS:
OWNER/
TENANT
SUBMIT A COPY OF
YOL!R STATE
LICENSE WILH
APPLICAIION
PERI�TIT TYPE
TI'PE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
ADDRESS
❑ UWNER
COIIP.WYNA�fE: •,nit. ,.vua.i..y u a�.a..
coxr.acraeasox:Floyd Joswick
S7AiE LIL'ENSE k
EXP DA] E
No.:
Received By:�
Date ���: �� U
�wDxES9221 University Ave. N E cirYFridley s147EMN z855432
PHONE 763-572-0459 Fax763-572-0164
�LSINGLE F.•LVIILY ❑ Tl�%O FA\1ILY
❑ NE\b' 'E�REPLACEh1EN7
DETAILED DESCRIPTION OF WORK
❑ 701A'NHOUSE
❑ .1LTER41'ION�RE\fODEL
FEEp ARE BASPD ON 310,00 PER FItiiURE, %fEPT �VHERE NOTED. FIXil1RES: (IN IC � QTAL .�'i'\IBER OF EAfH B 0ti4)
Eiui mentLutelled ;�(FG: \1UDEL: 0 SIZE:B7L.
�iFG: ���QQ �SODEG �73 SIZE�BTU r �
D7FG: b90DEG
_ a� C 525.00 FIREPLACE (GAS) S I SAO
_AIR TO AIR EXCHANGEER Sl5 FIREPLACE (�4'OOD) 535.00
_BOILER 535.00 �FURN.9CE 535.00
�CHIMNEY' LINER S I0.00 GAS DRYER 510.00
Di1CT WORK 510.00 " GAS PIPING SI0.00
Number of fixtures (a S 10.00 _ x�,10,00 = S
Number of fixtures (2 $15.00 _ x 515.00 = 5
q� t0
Numbez of fixnues (a? $25.00 � x�25.00 = S' N•
�[� c0
Number of fixmres (a� �35.00 � x$35.00 = b Y. ""
State Surcl�azge = � 50
-� ��_s
SIZE'BTU
GAS RANGE�OVEN SIO. W
_NEW GAS GRILL Sl0.00
GAS UNSI' H7R SLO.OD
JPOOL HEA7ER 535.00
VENIILATOR 513.00
THIS IS AIJ APPLICAIION FpR A PERMIT-NOT VALID LJNTII. PRUCESSED
I I�ereby apply for a buildiug penuit and I ackuowledge tl�at the infonuation above is complete and accurate; tliat the work will be in
covfonnauce with the ordinances and codes of tl�e Ciry of Fridley and �y�ith the Mumesota Consm�ction Codes; chat I understand this is
not a pemut but oiily an ap lication foi a permit and work is not to start without a pemtit; that the work will be in accordance witl� the
approved plan in die case o all ���ork �� h iires revie«� and approval of pla �s. J
SIGNATL'RE OF APPLICANT �. �/j_. _ pRINT NA�fE .��f 1 }%(Z narE (! l� - ��
T_ —
" City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridfey Residential Mechaziical Application Page 2
REQUIRED INFORMATIOIV NEEDED TO PROCE5S PERMIT
- — � __ ------ - -- -- _._ _ _ _
RESIDENTIAL PERMIT APPLICATION HVAC
= NEW HOMES/ADDITIONS - EXISTING HOME - MAKE-UP AIR
REOUIRED. FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or, solid fuel IMC Cl�apter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-iip Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chaptec 5 with MN Amendments
b. Fuel other tlian gas IMC Chapter 8 with MN Amendments
REOUIRED FOR NEW HOMES
4. Heat loss & cooliug load per room
a. Required on new consuuction IMC 1346.0312
5. Veutil�tion
a. Per MN Energy Code 7670 or 7672
6. Ihict Design Per IMC 1346.0603.2
a. ACCA Manual D
. _. ��T. !�_�� • • � I
- �•-c�rzcerp icsl eatt�Gui�e-lines soti`wa-re may-tie usea �r
combustion and make-up air calcnlations.