AF - 46095City of Fridley, Minn.
BUILDING PER.MIT
��: ���--- ��..--
�
Owner: __ . _ Builder
Addresa --.�— _..__.. _ Address
N° 5440
� ��J��� �,/J�;pCATiON -7��NG
No. Street _. e�'5eS� Part o t— *�—�--
i u�J-�
Lot .,� Block _��— Additi� or Sub-Diviffioa _���� f
f
Corner I.ot _.__..—._.. Inside Lot —� Setback _�a,� r—_ Sideyard .{��
Sewer Elevation
T Used �
✓ -
Foundation IIevation
DESCRIPTION OF BUILDING
Front�� DePth �� Height �Ci ....... S4. F'k �.�/-.j-- Cu. Ftf_.4_t��t/
_.._.—..._._....._.__....---... t_..----- DePth —_---- Heig�h't�- �......�..._....... _. 5q. Fk _..._._..�_...
Type of Construction ._�� ._� .._: Est Cost ���/s!..(t—�':'.'°fo be Completed
G�. Ft
Ea conaderation oP ffie issuance to me of a pennit to constrvet the btrilding described abme, I agiee W do
the proposed work in accordance with the descriptioa above set forth and ia oompliance with all Provisions of
ordinancea of t6e cfty of Fridley. y �
4
In consideration of the payment of a fee of
_ to cronstruct the bui
the express conditian ihat the person to whom
done in, around and upon said building, or az
FridleY. Minnesota regesdmg location, constn
within the dry limiffi and tlus permit maS be
ordinances.
, P�t is hereby granted to—
or addition as described above. R'his permit is granted upon
gianted and hia agents, employees and worlanen, in all work
i thereof, shall �nform in all resPects to �the ordinances of
alteration, maintenance, mpair and moving of buil�nge
ed at aRY time upaa v_iolajiea-of'n�y oP the prov3�ons of said
F �:n,.:;y.r.T7
NOTICE
i6h p�rnk dws nef eever fM wn�efion, ��Moo Wr wiring, plumLiny, yas hsafing, sewer or wahr. B� wn b w
th� Build'm9 Iaq�eCOr for wpanN p�mits for f6w ihm�. .
�+
APPLICATION FO�t HUILDIHG P�UlIT
CITY �' FRIDIEY, HIHI�30TA
i► _ _
Ouaer's Neme Builder,
Addreea Addresa 'i�° o�Z �5Z"'�.
LOCATION OF BIIIIDING
No. /O / C/ Street /✓ �1I-�s«-�' Part oY Lot
Loty�4 d�'�.(�Block �. Addition ar 3ubdiviaio��-���
Corner Lot Inaide Lot X 3etback 3S � Side-Yard S^ 7�
3hWL[t TsLL�lATIOi� FOIINDATIOdi ELEYATION
1lpplicant attach to thia form Certificate of Surveq of Lot and proposed building
location.
DFSCRIPTI�i OF BIIIIaING
To ba used ea : Q�` ��-a�-+-��'7 "a`'"`"— "'"`7
✓
FYoat 3$ Depth � y Height
Sq. Ft. R/ L Gii. Ft.
l�ont Depth Height
Sq. Ft. Cu. Ft.
Type of Conetruction �/`�-�- + Estimsted Coat / Zi °"�
To be Completed ��/ f —/� 6 l.
The u�xlereignefl hereby makea application for a permit for the work herein apscified,
agreeing to do all vork in atrict accordance with the City Ordinances and ruling of
the Department of Huildinga, and hereby declarea that all the facte and representatione
etated i� thia application are true and correct. �n _
r
(A 3chedule of Fee Coate can ba foutd on the Renerae Side.)
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HEAT LOSS CALCULATIONS D ARE�BUILDINGS MINNFAPOLIS. @IINN.
A.S.H.V.
Weat6enttips Construction No. Insulatioo
Guide
Windowa Doora Referena Out. Wall Int. F/all Ceiling Roof F7oor Kind How Applied
Yea--No I Yea—No I 19—
Fl.� Room Length � 0 Width Height F7.� Room L.engt6 Width J/ Height
Windows and Doors-Crackage and Arca Windowa and Doora-Craekage and Area
WIdN Helght No. ot Llmal [0. Arw Wldth Heig�t No. a[ Llneal It Arec
No. o[ p�ne o[ ygne tlgh[e ot crack aY. t[. Na o[ yao� of D�ns tt6�[s ot enet aC. /L. .
�b 7� 20 � �Q �O '�- 32- a
.
!o .? !oe S �
Coef. Btu Coef. Btu
Infiltration Q 0 50 Q�� In6ltratio� �, S� / Cv 4�
Glaaa Q Q
F�cp. wall .
Net up. waU o0 /D � 473
- IaC wall ---
Ceilin8 0 /� OG �
Fioo� o (o ! tr p
row► Bm.
Required aq. k. E.D.R. or sq. ina. W.A. L.eader area �j O
/ FI.� J�t;� Room Length /(/ Width / z— Height
Win�wa and Doora—Craekage and Area ��J I
Wldt� Hal��t No. ot L1nee1 [t. � Aroa fl ��
No. ot Dane o[ psne Il��L ot craek eQ. tt. /� �'.
> ,� 8 � J 7 �
�D I
' Coef. Btu
In6ldation 5 p �jd
Glau . t- 0 / (P p
Exp. wall
Net exp. wall ... � b p p p I;
lnt. wall
Ceiling / Z /d / jy0
Floor i `J � (p // T�
- Total Bm. - - _ --
Required aq. h. E.D.R. or �q. im. W.A. L,eader area s J,
FL Room �l.engt6 � Width Height
' Windows and Doors--Crackaae and Arca
In6ltratioa
Glaas
Facp. waU (p •
Net exp. wa►1
lat. wall
Cei�ing
Floor
Total6tu.
Required aq. ft. E.D.R. or
Glaas
Fap. wall
Net esp. wall
Int. wall
Ceiling
' Total
Requ
�
Infilaation
Glasa
�R �
Net acp. wall
lot. wall
t.U.K...or nq. ma. W.A. Leader ares
Room I Length /�/ Wid O
I Doors—CrackagE and Area
Het60t No, o[ I.1nea1 [t. Aroa
o[ p�na 11{Sb ot creck p. tt.
� U i{ �3.`.� o� O
Coef. Btu �
b 00 Infittradon
� 0 D Glaas
Fap. wall
`3 �j 7d Net e:p. wal!
InL wall
� J O /�! 4j (� Ceiling
y �' (v F�oor
Total &a
der ana v� % Required sq.
����r� i ♦
�� i♦
h. E.D.R. or aq. ins. W.A. Leader area
� Room I Length !O Width i
�od Doora-Crackage and Area
/
/U
OD /a
/ Ob
or sq. ins. WA. Leader ana
L•�
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City of Fridley, Minn.
BUILDING PERMIT
��-�7�
N° _ 7158
Date: �. ""'r ._.�.��-�--
Owaer: ��. .__ _._.a _.. ^ Builder __ _..._.: —__._.
Ad&ess _ _.�._.._.__�._..._...,._.-----�..._._ Addrese -----....---.._............_._..----
/ LOCATIOM ���G//�
Na �l}L3��p�/_. Street t Part� Lot —.
�,?��-l_=7cQ81ock ._.�_ ------ Addition or Sub-IYlvlslon . � /Sd � "-��1�%�l—
i /
Corner Lot __..__.._ Inside I.ot ..—��.--- Setback _�:L -- 3ideyard —. .*l�
Sewer Elevatlon
w
Foundati� IIevatlon
DESCRIPTION OF BUILDING
�:
_�t r 1� nea+h ��c .L�_ sn. Fc:�`,� c�. m.�d
� ___.__.._ neyth _.._ xet�,c __� sn. Fc. ----- cu. r�t. _�—
7ype of Cmutruction Est C��� �._._ To be Caaipleted -.---
In cnosideration ot the issuence to me of a permit to consfruM the buil described above, I agree to do
the P�B� work in acooidance with the descriPtion above eet forth and in ' ce with ell prnvi�ons d
o�dinenoes of the dty oP F7i�ey.
�"
In camafderatlm oi the payment oP a fee of =J2_--, peimit is hereby gianted to
to conatruct the building or additim ae described above. Thia permit ia granted upam
the exPrnss condition that ihe Person to whom it is 8�'�ted and his agents, emPluYees and worlmien, in all worlc
�done in, around md uP� said buildinS. �' a4v Part theieof, shall aontam in all respects to the oidinancea o�
Fridlel'. blinnesota regardln� lacation. construotion. alteratim, maintenence, reP�' end mm'1nB^�, buildin�c
ordinanca. dty limits and tlus Permit may be revadced at aay Lme upam viol�tipn of any � the B�visions of aaid
/ J
Bu11d1ng Inspectaa'
NOTI�:
7hk pwk daa nae eewr tM caMxlMa iewlhlMe fw �YiY. ►I�b�a W wMM. awrw er wM�r. M aan » r
W� loiWey lep�aer far aWM� P�r�p fer 16n� h«u.
3uilding
[nspectians
763-572-3604
;rre nnDxass l�"
fH7S APPL[CANT [S�
TENANT
CONTRACTOR
BUILDING ��f I Permit
RESIDENTIAL A.PPL.ICA{TION
CITY OF FRIDL�Y
■ .u�• y••
Received
Date Rec'
SUBMIT A COPY OF STATE LICENSE A f3� DA7E
YOUR STATE LICENSE .nDDRESS: CtiY sinTe ZiP
WITH APPLICATION �n� py�
D BASFA�NT FMISH �'ROOF
O DECK ❑ SA71NG
❑ SWIMAi
DESCRIBE WORK BEING
GARAGES
PROPOSED STZB:
PROPOSED HEI6HT:
SIDING
p Vinyl
❑ Alvmimtm
❑ Othu
& GARAGE
❑ ATTACFIED GARAG£
❑ DETACE�D GARAGE
�Soffit
❑ T�m
O�Fauia
WINDOWS
IN EX(STING OPENAIGS DYea ONo (ACATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRISE SIZE OF
OPENIIJG CHANGES &
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Chazge
Curb Cut Escraw
Erosion Control
PazkFce
Sewer Main Charge
❑ DR41N TTIE
❑ OTf�R
ON VALUATION, INCLUDING TE� COST OF
(USING�.,� 1997 U.E.0 F'EE SCHEDULE)
�TION S ��� s . OCCUPANC
S
S
$
Ft
BASEt.�NT RFMOD£LMG SUBMiT:
l. Existing Floor Plen
2. Proposed floor pian
3. Liri of suucArcal membus to be used
:�
FOR NEW CONSIRUCIION INCLUDING DECKS,
DITION . ffi PORC - BMST:
i. Site P7aN5urvey showing fie existing swames
� PTOP�� P�J�
2. Tvro sets of amswction pians
3. Energy Calculaziora
See Back Page for Fee Schedule
65% af Building Perroit Fee
.001 t'¢nes the total job valvation
.OQOS x Permit Valuarion Minimum $.SQ
55.00 (State Licensed Residendal Conhactors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft� ftx$21=5
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
THIS iS AN APPUCA710N FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a build'mg permit and I ac}mowledge thaz 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 wderstand this is not a
peanit 6ut only an application for a pertnit and work is noi to start without a permit; th t the work will be in accordance with the approved
plan in the case of atl work jvhich r ui Fe�(lj'q('yr�7 a�nd a rov9tof plans. �/
SIGNATURE OF APPLICAN��� f111 I�XJ 4RiNT NAME � i Y�iJA7E �