AF - 45888City of Fridley
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Job Address
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Kind of Buil ing
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Permit No
PLUMdIidf, PER�IIT APPLICATI�Ji� �
�
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r__ d�,,.a �7s7�74�D,3�
f /� 3 .J �� '�-_
Plumbing Fixture Rates; �0. RATE TOTAL
Number Fi.xtures L x $2.00 �
Future Fixtures �_ x $1.50 {,�� " -
New Fixture-Old Open. x $1.50
Catch Basfn x $3.25
Water Heater-99,000 BTU 1 x$3.00 3 L0
__�
Ground Run Old Bldg. x$3.25
Elec. Water Heater x $2.00
Gas Fitting Fees:
lst 3 Fixtures
Additional Fixtures
Gas Range-199�000 BTU
Repsirs & Alterations
Description•
� x $2.00 �
_ x $ ,75
_ x $5.00
See
Code
State SurcharQe Sp
-
1 TOTAL FEE • $ a� D O
I
!The undersigned hereby makes application for a permit
'for the work herein specified� agreeing to do all work
in atrict accordance with the City Ordinances and ruling
of the Department of Buildinga, and hereby declare that
all�the facte and zepreeentationa atated in this
application are true and correct.
�%���=���' �-� /a .� �
5ignature � Date ,
�� -. -- .
I
� � � � . sue�ecr � � PERM.
City of Fridley- . �2���
` t�� ATTHETOP�JFTHETWINS � BUILDIN��� �PERMIT
�
'�� � �� COMMUNITY DEVELOPMENT pIV. � .. � p/�'
� r � � � PHOTECTNE INSPECTlON SEC.� � � � � � � � �D �O
I
�' '� /"�1 • CITV HALL FR{DLEV 55432 NUMBER REV. O�TE `-� PAGE OF qPPRO�EO BV
�...._At `•+ su�esa3aso sio-F�5 3-fi-74 � �
,oe nooRess 527 Glencoe St.
L'OT NO. eLOCK TRACT OR ADDITION
. 1 LE�AL L � SEEATiACMED
DESCR �.'] I2 & 1,14 H Riverview HB1CJ�1't$ � SHEET
- �2 PROPERTYOWNER MAILADORESS - Z�P PHONE .
Drake Designs, Inc. 7226 Riverdale Rd. Mgls. 55430 561-1958
�� CONTRACTON� MAILADORESS � � 2�P PHONE IICEN5EN0.
. � SA4A&� . . . .
�< ARCNITECTORDESIGNER MAILA�ORESS .. -� ZIP PNONE LICENSENO.
� 5 £NGMEER . � � MAILAQDRE65 T�P PHONE UCENSENO.
�� B USE OP BUILDINO � . - . .
IIwelling & 6arage
7 � CLASS Of WORK � -
� � � NEW ❑ ADDITION ❑ AITERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
e oesc�rvo�c 32' with 15, 360 cubic ft. ; 768 sq. ft.
Garage: 12' X 22` = 26�] sq.ft; 2fr40 cubic ft. Frame construction
� � �9 CHAN6E qP USE FROM . . � � � � TO� � -
� STIPULATtONS-� . � � � . .
Pr�vide verifying survey before capping basement & a hard surface
driveway
�� SEPARATE RERMIT$AflEAEQk11flE0 FOR ELECTR1CAi, PLWMBING, HEATING, rEa�eCONST,- . OCC{ZPAKCV GROUP OCCUPANCY LOAD
VENTIIATING OF AIR CONCIITIONWG. � � �. � ft 1
THI9 PERMIT BECQMES NULL AND VO�D IF WORK OR=fANSTFUCTION ZpNING � . S�iO32 I.HFODO
AUTHORIZED 1$ NOT��COMMENCED�WITHM 80 DAVS�. Ofi�fF�CONSTRUCTION � � � ' y �
OR� WOflK:i& SUSPSNDEQ OR A9ANDONED FOR A PERKlDAF 120 DAVS AT '� � � � �
ANV TIME AFTER WORK IS QOMMENCED. � � NO ��DW4G. UNITS�. OFFSTREET PARKING� ��
I HfREBV.CERTIFV TMAT 1 HAVE READ AND EXA#k1NED TMIS APPLICATION � � �STALLS � GARAGES
ANOKNOW<FHESAME70BETRUEANDCORHECT.ALLPROVISIONSOFLAWS y Lj1�j,j�Q ' SURTA% �
AND ORDINAqGES GOV£RNING THIS TYPE OP WORK WILL BE GOMPUED. � jO r�Z:L.,;�(O �H.�11
WIiH N!HETHEF SPECIFIED HEREIN OR NOT. THE �RANT�NG OF A PERMR �� �
� DOES k0 � ME��TO GIVE AUTHORITV T IOLATE OP CANCEL iHE pEqMITPEE .�' �� �� SACCHARGE � .
� PROVI � H9 fl ANY.OTHEH� E OB l � LAW fiEGULATING CON. � ��LI,.O�. ,300. ��
� BiFU {ON; TN� PEflFQ OF STi7UCT10F. �' -
� � � � PIANCH CKPEE � �. TOTALFEE
3-6-74 - - 342.11
SGNA?UREO COMRACTOROPAU. OPIZEOAGENT �.�16ATEI HE FOPEAL� VALIDATE . 51 YOUR PERMIT
�fll �NATV EOFOWNEAIIFOWNERBWLDERi IOATEI BLDG.�NSP � OPT
�'c.�-i�s�
APP1,ICpTION FOR RLSIllEN'T1AL, ALTERA'PIi?V,
OR !1llllJ'CION f3UII.DING PERMIT
CI7'Y OF FI:IULEl', ^dt��'NES�T:1
pWN$&�S NA1KE:�" � � �UILDER: `�Q
ADARESS :� j(i ��1tGr�9 �C Rd ADDRESS : c,_�H y�•�
NO:�_T STREET: O
LQTt� ��CK; N ADDITION:�
CORNER LOT: 1NSIDF. LOT:�TSETBACK: c3� SIDEYAfill;
Applicant attach to this Lorm Ttao Certificatea of Survev of Lot and proposed
buildirig location drawn on theae Certificates,
�ESGRIPTI�N OF BUILDING
To Be Used As:
��Ii f1� Front: �y Depth: 32- Height: �� /
Square Feet: �� Cubic Feet: / 5, 3(' O
�� Front: !� llepth: �=– Height: �� �
Square Feet; 2G y Cubic Feet: ��/'Y �
Type O£ Construction; 8 1 Eetimated Cost• $
1 C- a�. l. � �'
To Be Completed: �
�,�� 5��.,:�" �,��� (/r � � a,�c-� e���..�,�5"— 73
The iindersigned hereby makes application for a peYmit for the work herein
apecifled, agreeing to do all work in stiic� accoYdance with the City af
Fridley Ordinances and rulings of the llepartment oi Buildings, and hereby
declares ChaC ill th� facts and representation�.at�d in this application
are true and c.,lr�ct, / �
'� AATE: �( �� S[GNA7:�RE: r
—T �� (Sea Reverse Side For Additional Info�ation.) � �
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HEAT L� CALCULA7TONS —'�—DEPARTMENT OF INSPECTIOtv /!> s S � a�at�rt.
Weathentrips A' ' • Conuruetion No. -? Inaulation
Guide
Windows I Doon I Refvmce I) Out. Wall Int. Wall F.eJiug Roof Floor Kind How Applied
Ye�r do e�' s—�I o 19,
Fl.� m L.ength Width /O Height p' / FI.� Room Leneth Width /p Height
Windowi and Doon—Cracksar and Area Windows and Doors—Crackage snd Area
1n61tration
�aa
Exn. wall
7ota1 Btu.
Required eq. ft. E.D.R. or p. iab.
Fl.� ; Room Lengd
Windowa an ors--Crackae
w�eie- � x.i�ne xo. ot
Na ot Wna ot pan� .. l4hts �
aren
CoeE
In6ltntion
Gla�
Esp. wall �' y
Net e�: wall y LO
InG wa11
Ceiling O O /O �
Floor
Total Btu.
Required sq. fr. E.D.R. or p. in�. W.A. l.eader ana
Fl. Room �Length Width / Heigi
Win<bwe and Door�—Crackage aod cea
W Wth� N�1�nt . Na ot Lln�d t0. � Aro�
Np . et wm � ot wna � It[hts ot enek �a. ri - -
��
Infiltration
Int. wall p
C.GI�IGg O 2 � �y
Floor
Toal Btu.
Requircd �q. ft EA.R. or
Btu
No.
In6ltration �
Glasa
Fzp. wall SY�
Net ezp. walt
Int. wall
Ceiling S'� Lp
Floor
Total Btu.
Requircd �q. ft E.D.R. or aq. ina.
/ Fl.I G' Rocm I L�osd
Windows and Doors—Craekag
�Z
atea
Eip.wall iZ/y�i'�' �/
Net e:p. wall
Int. wall
Ceilin6 (J.���/ i.
Floor
Total &u.
Required �q. k. ED.R. or p. ina. WA. Leader arca
' F7.� Li i/ Room I Length Width},
Windows aad Doors--Cmckage aad Arca
Btu �
>3,G Infiltration
�_ Glasa
fsp. wall i
� Net exp. wall
��}' lat, well
�, p . CGI�II1g �
3�3�_ F�oa�
,� i-,\ Tota1 &a
�
� 1
7
.R. or sq. ins. WA. Leader a'ea
Btu
DM
i
HfAT LOSS �CALCUTATIONS
Westheratrips A•
Guide
Windowt I Daora I Reference I Out.
YerRo e�—�!o 19_
(� Fl. Room Length /� 1
Wiodowa and Doora—Crackaae aod Are
'ARTMENT OF INSPECTION
Con�ttuctioo No.
all Ceiling Roof Floor
-leight i II F7 �
Windowa and
wm�n
No. o[ otn�
Btu
Net
To41 Bm.
Required su. h. E.D.R. or w. im. W.A. Leader area
Coef.
Infiltwtioo
CJau
Fsp. wall
Ntt e:P: waQ
Inf. wal!
Ceiling
Floor `
Taal Beu:
Required sq. ft. E.D.R. or eq, in�. W.A. I.esder arca
FI.� Rwm �LenBth Width Heigl
�� Wintlowa and Doors—Crackage andsAcea��
_�
—_
f�3�1
Int. wdl
Ceiling
Floor
Totsl Btu.
Requind W h. E.D.R or p. im. W.A. Leader arca
Glaa
Eap. wall
Net e:p. wall
Int. wall
Room
lneuletion
How
Widt6
and Arca
h. E.D.R. or aq. im. W.A. Leader area
Room � Length Width
and Doore--Craekagt and Area
fsp. wall
Net e:p. wall
Int wall
Cei�ing
Floor
quired �q. ft. ED.R. or eq. ios. WA. Leader arca
•l.� Room I Length Width
Windowa snd Doort—Crackasr and Area
Claaa
Fap. wall
Net ezp. wall
lnt. wall
Ceiling
Floor
Total &u.
ReQuired sq. k. E.D.R. or aq. in:. WA. Leader ama
13L
Btu
zInspections
763-572-3604
SCCE ADDR£SS �
THIS APPLICANT I5:
BUILDING
RESIDENTIAL APPLICATION
❑ OWNER
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
Pernut
ReceivedBy:_�
Date Rec'd: /!i � 7
PROPERTY OWNER/ NnME: C)PrVC� iY1�J(L6�N
TENANT ppDRESS:'S2% PoCL<1"-�CG�E S�j. _ CITY F/ZZCI � STA
PHONE: '7�p � ^- 7 ��- �-�i f ZS
CONTRACTOR
SUBMIT A COPY OF STATE LiCENSE #
YOUR STATE LICENSE ADDRESS:�G
WITHAPPLICATION eHp� {of2
PROPERTY TYPE
P�RM1T TYPE I 0 �D1T10N
O BASEMENT FINISH
❑ DECK
TYPE OF WORK:
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
'. ROOFRVG O
NUMBER OF SQUARES �
o"^
' cnxncFS 9� 3) o C'
'� PROPOSED SIZE:
�'��. PROPOSED HEIGHT:
�j e�
inG`�O a �'l f � O
Y
Q Aluminum
Q Otha
WINDOWS
❑ HOUSE .2 GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
f� �t
m
Fescia
INEXISTINGOPENINGS OYes ONo LOCATIONOFWINDOWS
� OR FOR NEW OPENINGS-DESCRBE SIZE OF
� OPENING CHANGES &
E7fP DATE 3 -3 } - a �
� C[TYA A�
��i3-$b6-OG,o
s�
STORIES
❑ W�NDOWs
� ❑ DRARJ 7'[LE
❑ OTHER
)L
C Q lC<T11 � _ n1d�Y1 �'x!C
5543 2
BASEMENT REMODELING SUBMIT:
l. EzistlngFloorPlan
2. Proposed floor plan
3. List of sWCtural members W be used
FOR NEW CON57RUCTTON INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site P1ad5urvey showing the existing structures
and proposed project
2. Two sets of wnsWCtion plans
3. EnergyCalculazions
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST QF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee $ (��_�' See Back Page for Fee Schedule
Plan Review S 65% of Building Permit Fee
_EIiE �oh vah�atinn __ _
Surcl�srge $ .0005 x Permit Valuation Minimum 5.50
License Surcharge $ — $5.00 (State Licensed Kesidential Contractors)
SAC Chazge $ $1675 pet SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$
Erosion Control $ $450 Conservarion Plan Review
Park Fce $ Fee Determined by Engineering
Sewer Main Chazge $ Agreement necessary () Non Necessary ()
Total Due $ Make checks a able to: Ci of Fridle Attach Sti ulations
.THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D UNTIL PROCESSED
I hereby apply for a building permit and I acirnow]edge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the Ciry of Fridley and with the Minnesota Construction Codes; that I understand this is not a
petmit but only an applicadon for a permit and wodc is not to start without a pertnit; that the work will be in accordance with the approved
plan in the case of all work w`ct t req t s eview and approval of plans. C 'r�.
SIGNATURE OF APPUCANT ;�- PRINT NAME `���C :N ���`'Z DATE � O 2�—`� J
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,rF,� w�, ' .� State of Minnesota
tf��� �' �epartment of Labor and lndustry
C4�; � �r.. 443 Lafayette Road N.
`����� ��� St. Paui, MN 55155-43q4
LegaFName:
DBA�
Address:
Construction Codes and Licensing Division
Telephone: (651) 2845085
E-mail address: dli.contractor�state.mn.us
V1lebsite address: www.doli.state.mn.us
Residen#ia� Suifding �ontractor License
DAYTON EXT'ERtORS INC
14041 VINEWOOD LN
DAYTON, MN 55327
Licanse Identification Number. 20064871
License Expiration Date: 3/31I2D08
Business Structure:
CORPORATION
Qualifying Person: STEVEN JOHN HUNGER
Cantinuitig Education: 7 hours due by 3/31/2008