AF - 46789City of Fridley, Minn.
BUILDING PERMIT
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i�T° 4783 �
Date: ....d•••:•."`."..w.`....�'.:"...�_'�-.....4r!. �_.✓._--...----•-••---•--•------..._......---- /
�� --------�----...._..._...... Builder ..
_ : .._..._._...._4E .-- ._�-�����,
Owner: � ..... ....... . .�---- � . ,,' /
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A�ddress �-' ..�-L�---•----�--'-'-�'�...`c-?.S.e�._..�.�-r.l..L�!f.�t Address .. �-�-'*�---- - �----_. .. . ..._ .. .. .. ........
,,,� 40CAT1 N r OF BUfLDiNG
f -----.. ...
. Part of t ... .......... ..... .........---_.._-----... --._....
No. �xl"✓::.�.-------- Street �/��.I�:��_ .. --- •• ._�.- ---- --.....-----
� . . . - -�- •- ------��f
Lot .....�.:� .... ......:... Block .:._.............�...................::.:..._. Addition or Sub-Di '' n �/�
.._
f f: /
Corner Lot ...__.---_....-----.--..._... 7nside Lot ......_. �""� ............. Setback ..._;,'...�!_-� ---___... Sideyard ....I::.--._...__�.:_.�....-----�------- �---....__..
SewerElevation _..... -...._......_ .:......................._. _...._...._......... - � ... Foundation Elevation ...................._..........._.....--�-• ...--•---- ..._. -........_..--._..-•--
DESCRfPTlON OF BUILDING
To �e Used as��, � �
�a .. . � . � � ��f .. ; •�. , ., � ,Y, _"` � ; f.�� ' �
�. �.. � � � � .�.� , h;,E Front � !`_;.�._ Depth _` [._ Height �_i.r�._ Sq. Ft �f -...r ., �� Cu. Ft f � �
� ��" '' ` � � .�: '� �- '�"' �: . �� ,' ti � '''
, �-�,;� � ''�,� �'`. Front � � . �` Depth �-� ,r-_� Height _ �-• .._ Sq. Ft. .. �:. 4 -; . Cu. Ft. � -'- f ..
C_,,.... ..{ . _.. _f�.r,,., �N:- 1 ,
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Type of �onstruction �__ :-__ d- `-:::: Est. Cosi '-- ', _ . �. .- f - �-`'::. To be Completed ...
, . ...__.. ..._ ___ .__. __ ..
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In consideration of the issuance to me of`a permit to construct the building described abave, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
� �
In consideration of the payment of a fee of $;�.�°....__._..._.........., permit is hereby granted to ...................................-....-...-....-....----..
••..._.._..........._.....---..._.._.---.----_----------...._. to construct the building or addition as described above. This permit is granted upan
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all x�esPects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city ]imits and this permit may be revoked at any time upon violation any of the provisians of said
ordinanoes. ��
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J': � �. � � �
- -- _ ��[d__...._..�Y`..:r.�'"`-.�!1�$uilding Inspector
NOTfCE:
This permit does nof eover fhe tonatwdion, installation for wiring, plum6ing, gas heating, sawer or water. de we� !o se�
fhe Building Inspecfor for separsts permifs fo� th�se ifems.
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APP'LICATION FOR BIIII,DING PT;RHIIT
CITY OF FRIDLEY, M�iNE30TA
Owners Name ! 0,�� _ Bui.lder__,_ Uf��'!�- _�l.4� �-os�sT. �C,
` � ,3 � � 1���
Addr:ss •�3�/ `�vLr �v2 • ABdress „_,
IAGATION OF BIIILDINC�
No.�_, Stree-� ,�„ � �Part of Lot ���'�..�
..__�c9',� ,�/ r
Lot /� B1ock . �Z Atidition or S�b.Div. �/� v/' ��"� /� h
�� I �il ■ " �
Corner Lot�Inside Lot � Set Back S%G� � Side-Yard /D � 9� �30 � \�
SEf�R ELEVATION FOUNDATION ELEVATION
Applicant atta.ch to this form Certificate of Survey of Lot and groposed building
Iooation.
DESQtIPTI016 OF BUILDING
To be used ass
� F�ont 38 ' Dept.h .� G� He
��..r.,_.... x G�3s- 9�-.�9� Z�. X Z Z �- �c t d.
Sq. Ft. !?�,i .�_______.__ �• Ft.
Front Depth Height
Sq. 1�. Gu. 1�`tt
R�rpe of" Con�t�x�uction__i�� 0�2� ��� Fastimated Cost
To be completed , _.. . .
The undersigned hereby makes application for a perrmit for the work herein specified,
agree� to do alI work in striet accordance with the Gity Ordinances and ru].ing of
the �'iepsrtment of Suildings, and hsreby declares that all the facts and representa- _
tioris steted 3.n this app].ieation are true and correct. .�'��-
. ` t.,�-'Q-h �,
DATE � �L_..;.,. SIGI�iATURE
(A 5chedule of Fee costs <�an be found on the Rev se e.
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HEAT LOSS CALCULATIONS �,- . J
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A. S. H. V. E.
Weathesatrips Guide Construation No. Insulation
Windows � Doors Reference Out. Wall Int. Wall Ceiling Roof Floos Kintl k'Ipw Appliet�
Yes--No Yes—No 19� � I � �
Fl. oom � Length � Width �-Ieight � F1 oom � Leng#h / Widtti �2�E3eight --
Windows an oora—Csackage and Area a,�r Windows and Door�--Crackage and Area `
Qlidth eight No. of Lineal fL. Area /�� ���'` WidtL Hei�ht No. of Lineal ft. Area �
NO' of pnne of pane lighte of craek sq. ft NO• of pane of pane Ughts of erack aq. ft. f-- ��1 x� �,�
--� � -�'� --�-.� � �.9 � ---/�__� a ` !�
,
,
Coef Btu Coef Btu
Infi�ltration s�/� i/ Infidtration /�
ct� � — -v ci� �� d �.54
Eap. wall — Ezp. wall
Net exp. wall rQ q? „� /(j Net ezp. wall �S/ ,2 )( �_ U/ 4
Int. wall Int. wall
Ceiling j� a? _X /� 2 �O � ' Ceiling j 2 �Q ��,/ Qo�
Floor i,,.- i,�- ,�j "'� F1oor ��
Total Btu. Total Btu.
Re uired s. ft. E.D.R. or s. ins. W.A. Leader area � Re uired s. ft E.D.R. ot s. ina. W.A, eader area
F7. � Room j Length Width ,�'„�,��eight � % FI '" oom � Lengt Width Height
Windows and Doora---Crackag and Area Windows and or�--Crackage and Area `,,
WMth Height No, of Liaesl h. Area �-' �Q 'r�i "� Width eight No. of Lineal ft. Area /,� �' `ji -- S
No. of pane ot pane llghis of crack aq. ft. KO• of pane of paae llghts of crack eq. ft
—�— � °1 .�_ '— – /�X �'
� .2- � !� � �' _,
- �-� ���2
Coef Btu Coef Btu
Infrltration �� j Infi�ltration � ��
Glasa Glass �,'� � � 3i�sa
Fap. wall � X�' � Eap. wall �
Net eap. wall � �� Net egp. wall /D �i ��_
Int. wall � Int. wall
Ceiling '� � f � ;,'�,, `p Ceiling �.? �' / t a? S /d _���
F1ooY �,,.�. t.'' � '' Floor i� / 3�!�
Total Btu. Total Btu. T
�--
Required s. ft E.D.R. or aq. ina. W.A. Leader ar Re uized a. ft E.D.R. or a. ina. W.A. Leader area
F1. oom � Length Cj Widtl�/� „'�, Height � Fl. oom � Length ,�Width Height �
Windows an oors—Crackage and Area � r�� � � Wi r�--�Crackage and Area
Width eiQht No. of Liuenl fi. Area r ��'l Width Hei�ht No. of Lineal ft. Arqa�� �,� �G,r� � "�
A1°• of pene ot pane iigh�ts o� crnck aq. ft, NO• of pnne pf pnne ligh2s of crack aq, R, .5
___Q3_��. �4_.���. �Q � �' � � � .�'!� 1.�—� � //
s .,�3 �-- � %�
Coef Btu Coef Btu
Infi�tration j� � Infrltration 3'`i �/s� 9 0�,
��� � s � o �l� iao �
Ezp. wall / O a( � � Eap. wall /�,? X� 'S�''�
Net ezp. wall _�Q Net eap. wall �t� �^� �/Q
InL wall Int. wall
Ceiling U /3� Ceiling �i � f�_ /
F1oor ✓ F7oor ��- ✓
Total Btu. Total Btu.
..
Required aq. ft E.D.R. or sq. ina. W.A: Leader:area ��Q3 Required sq. ft E.D.R. or sq, ins. W.A. Leader area ��� �
y, ,
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HEAT LOSS CALCULATIONS "'' � ' E
A. S. H. V. E.
Weathexstrips ��de Conatruation No. Insulation
Windows Doors Reference. Out. Wall Int. Wall I Ceiling I Roof I F1oor Kind How Applied
Yee--No Yea—No 19_
Fl. oom � Length Widt�/3�2 Hei$htF Fl. � Room � Length Width Height
Windovirs and ooza—Crackage and Area Windows and Dooss—�rackage and Area
N� Width Height No. of Lineel ft. Ares �� a x� Width Height No. of Lineal ft. Area
of pane of pane llghta of creck sq. ft. �� NO• of pane of pane llgMs of erack sq. ft.
� a y a� �.2_ � �� � x �
—� ���. �1 y � l /� c A
—L.�� �_ �' 2_ 1�
� Coef Btu Coef' Btu
lnfrltration � ,� y Infi�ltration
Glass ln / p Gl�
Eap. wall � S � � Ezp. wall
Net eap. wall 3p 3/d p Net esp. wall
Int. wall Int. wall
�eiliag ,I/ � �t' / 3 �. f�_ / Ceiling
F7oor ��,,,. �,,� �' Floor
Total Btu. Total Btu.
Re uired a. ft- E.D.R. or s. ins. W.A. Leader azea Re uirrd a. ft E.D.R. or a. ins. W.A. Leader area
F1. � Room � Length Width Height Fl. � Room { Length Width Height
Windows and Door�—Crackage and Area � RJindows and Doors--Crackage and Area I
No. IWidth Height I No. o Liaesl ft. Area t Width Height No. of C.ineal ft. Ana
of vaae I of nene 1 li¢hts � of crack ( aa. ft. NO• I of pane� of pnne ' ltghts I of eraek I sq, ft.
In<ration
Glaas
Ezp. wall
Net eap. wall
Int. wall
Ceiling
Floor
Total Btu.
Required aq. ft E.D.R. or sq. ins. W.A. Leader area
Fl. � Room � Length Width
Windows:and Doors—Crackage and Area `
No. I Width I Height I No. of I Liaanl tt. � Area I
of nane of onae dtahts af creck sa. ft.
I
Infi�tration
Cflass
Ezp. wall
Net eap. w
Int. wall
Ceiling
F7oor
Total Btu.
ft E.D.R. or sq. ina. W.,dt. Leader area
Btu �_ � � � Coef Btu
Infi�ltration
Glass
Esp. wall
Net esp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required aq. ft E.D.R. or aq. ina. W.A. Leader area
t Fl. � Room � Length Width Height
Windows and Doora=Crackage and Area
No. width Hei�ht No. of Lineal ft. Area
I of sxael oE oane � lights I of crack I$9• �'C•
Btu � � � I
Infi�ltration
Gla�
Ezp. wall
Net eap. wall
lnt. wall
Ceiling
F1oor
Total Btu.
Required sq. ft ED.R. or sq. ins. W.A. Leader area
Btu
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FILL IN COMPLETELY FOR REPLACEMENT FUEL BUF�NING APPLIANCE PERMITS
COMMON VENT; VENT CONNECTOR AND COMBUS�fION AIR VERIFICATION
V1/hen replacina an existinq furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required.
The venting system is plastic/PVC and meets al! current codes and m�nufacturer
s�ecifications including sizing, length, number of elbows and terminatidn.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This dbes
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft app(iances.
The existinq combustion air is sized and installed to meet the current codes
arid manufacturer's specifications.
When required to install a new combustion air, it will be sized and in�talled
to meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( )
When installina a new venting svstem, the undersigned hereby verif�es that
it is a listed assembly and meets the current codes and manufacturer's�
specifications. This does include AGA-GAMA Category I Central Fum�ce
V�nting Tables for fan assisted and natura! draft appliances. : Yes ()
IS the common vent and vent connectors sized and installed correct(y after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
No ( )
Yes ( ) No ( )
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS• (Describe)
HEATING CO:
Signed By: Date :
APR-�-2005 11:40 FROM:RDULT MENTAL HEALTH 763 421 9343 T0�7635711287 P.2�3
Z��S ' c�`�`.� �'
NEW [ ] CITY OF FRiDLEY
ADDN [ j 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bidg insp
ALTER ➢Qj SINGL� FAMILY AND DUPLEXES R-1 AND R-2 (763� 571-1287 Fax
SUILDING PERMIT APP�ICAiION
Canstructian Address: %� �
�egal Description: � o t- I�- R t k �������s +- � add! , vC�.r o kt �,�
cTl9�Gi � n�C+ps � 7SD S-f'; n so r� /$ v
Owner Name 8� Address: c: �rr : r� aac�, c,o I� �r� k�� �sy,� Tel. # 7G3 ;� �7d -nrP � 6
Contractor: MN LICENSE #
Address: Tel. #
�
Attach to this application, a Certificate of Su ey of the
lot, with the proposed construction drawn on it to scale. — �� �.��s •'•�s ����^ -
nat �r�,�� f� 5����
LIVING AREA:
GARAGE AREA:
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
length Width Height Sq. Ft.
DECK AREA: Length
OTHER:
Width Mgt/Ground Sq. Ft.
....,. . _ � i 1 . . / . .... i ..
.
1+,�.�.Q�-.J
Construction Type: R��lar�n,�r►f-� 1.�;�o�..i Estimated Cost: ��p ,� �r
Driveway Cu�b Cut Width Needed: Ft. + 6 Ft = Ft x$ _�
�� /vs S7� -D�' 7,r'
DATE: APPLICANT; J��G«►�.c. �o�.�l,�<..� Tel. # 7 G 3�
Call (T63) 572-3604 for Permit Fees Yf mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
P{an Review
Fire Surcha�ge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
� ��-t � C�o
$
� � (03
$ ��
$
$
$
$
$
$
CITY USE ONLY -
Fee Schedule on Revers�e Si�e
65°l0 of Permit Fee
.001 of Permit Vafuation (1/10th%)
$.SQ/$1,OQ0 Valuation
$1450 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 [ ]
T07AL $ � � � ` � STIPULATIONS:
0
APR�1-2005 11:40 FROM:ADULT MENTAL HEALTH 763 421 9343
0
0
COVER
. ,-
�_____-.
SHEET �
To:
Fu #:
�'ro�n:
Snbjec�
Aate:
PRgas:
�
T0:�635711287 P.1�3
_�
COIVQVIEN'I'Se
Y'/ / v �
� � fo,cloid,ine this cover s68et. � .
� �
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_ , ,
.,_..�_..�.,
, tf 7 b 3— S �a D� �� �, -
Co�M.+�al1p►Non: lb {et�a� oaat�aeb i� tlis �ilmNe �w�e b ie�flp
prlrUq�pd.na ooa�aendd 'mfotantino iAw4oa m►y aor tl�c um at16e mdiridual er
eotip� aaoed aO�Ore. 2[ Wo �or�rna of �is me�0�o la Oot Ibo i�omdod noc�C �
ore bae�r ��ut �p► d�aeaale�tiao. ditd+hudaar ar co� of ILb S�itoib io
aM�► aahlbiood, llyou aae �ooat►e� m�ts b�lm;k in a�r. ptos�e imoaoole�dr
nolibr ut bY 41�pio��e �ad �a 1� orl�intJ neesyn m u� �t dio �bors �dd� ria
We U,S. PaW &nios. T1rNk Yau, .
�uilding
�nspections
'�63-572-3604
BTJILDIl�TG
R�SIDENTIAL APPLICATI�N
cIT� aF ����
Pernnit No.�
Received By:
Date Rec'd:
DATE O 1�\D�-C � YOUR E-MAII, ADDRESS �'Cq� 'C. IQ'�J� \ Ol�'C S�?YYl
SITE ADDRESS C �'( (. I� , �. .
i�IIS APPLICANT IS: ❑ OWNER �;OIJTRACTOR
PRET�ERTY OWNER/ NaME: Sp�nln ��Ynlf`(1—C.. ir1 .
TENANT .y�DltESS: �0--E-fi le� �
�-/ STATE ZIP
PHONE: T �?j � S� I "
CONTRACTOR
SUBMTT A COPY OF
YOUR STATE LTCENSE
WITH APPLIC:4TiON
PR�FERTY TYPE
PERMli' TYPE
z�E oF woxx:
N��— RENEW.AL BY ANDERSEN
STATE L; 1920 COUNTY RD. "C" W.
�D�� ROSEVILLE, MN 55113
Pxor� _ 651-264-4777
a sna�L
❑ rwo F. LICENSE #20130983
❑ BASEMENT FINIS3i ❑ ROOF
❑ DECK � SIDING
r,
)ESCRIBE WORK BE]NG
iZE OF
UMBER OF SQUARES
'ARAGES
20PC?SED SIZE:
�OPOSED HEIGHT:
�
LENGTH
D HOUSE 8c GARAGE
❑ ATTACI�D GARAGE
0 DEfACf�D GARAGE
�+ n
CTfY STATE ZIP.
❑ wnaDOws
❑ DRAIN TILE
❑ 01i�R
HEIGHT " S4. Ft
BASEMENT REMODELING SUBMTf•
1. Existing Floar Plan
2. Proposed $oor plan
3. List of stiuctural manbers to be used
��
��G FOR NEW CONSTRUCTTON 1NCLUDIN(� DECKS,
� �� DSO� A_pDTITONS. & PORCHES SUBMTT•
`��� 0 T� . 1. Site Plan/Survey showing thc ezisting structures
�a � ��015 snd proposed project
'INDOR'S 2. Two sets of conshvction plans
f EXISTING OPErRNGS �Yes ONo IACATION OF WBdDOWS 3• ��SY ��lations
2 FOR NEW OP�iINGS-DESCRIB$ SIZE OF
?ENING CHANGES & �
(PE OF WINDOW TO BE 1NSTALLED NUMBER OF WII�IDpWS
ALL FEES ARE BASED ON VALUATTON, INCLUDING THE COST OF LABOR AND MATERiAI,S:
(USIN�* THE 1 97 U.B.0 FEE SCHEDULE)
_ TOTAL JOB VALUATION $`7r S� —' OCCUPANCY TYPT�'
xmit Fee '
an Review
�rcharge
re S�u�charge
cense Surcharge
�C Charge
�rb C�t Escrow
�sioa Conirol
ck Fee
wer Main Charge
ta! Dne
$ 1� I : � --
$
$ 3
a . l0
$ S. �b
$
$
$
$
$
_$ o C�h.��i
See Back Page for Fee Schedule
65% of Buildmg Permit Fee •
(.000� #imies t�e total job valuation — Minimum $.50
.001 x Permit Valuation (1l10°loj
$5.00 (State Liccnsed Residentia.l Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks FaYable to: Citv of Fridlev Affarh
THIS IS AN APPLICAT70N FOR A PERMIT NOT VALID UNTII, PROCFSSED
araby apply for a building permit and I aclmowle�ge that the information above is complete and accurate; that the work will be in
lformance with the ordinances aud codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
mit but onIy an applicaiion f permit and k is not to start withont a permit; that the work will be in accordance with the approved
n in the case of all work which ires revi d approval o�plans. .
HATURE OF APPLICANT // A n�/1n�Y'�� ,��/1 fn � r� �/f n �._... � n'1 /1 r/� n
�nsp�tions
763-572-3604
763-502-4977 �AX
DATE I 11�lL
SITE ADDRESS _
THIS APPLICAl3T IS:
BUILDIN�
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTi.'E 1-1-08
YOUR E-MAIL ADDRESS
�,__ , _
❑ OWNER �`ONTRACTOR
PROPERTY OWNER/ I NAME: t
T�NANT ,r�DRESS:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING DC
S1ZE OF IMPROVEMENT
ROOFIN
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
D Aluminum
❑ Other - —
C1TY
Permit No.:
Received B
Date Rec'd:
A
ADDRESS: �,/,�_C�q 1 3��i�f%Z° N� �. CITY�� !'Cc�)(� � STAT��ZIP ✓.�7 2r
rxor�r� � — -155.� -r'� 3�r F,�x '
STATE LICENSE # o'Z� 1 g" ]?% 3 EXP DATE O
O SINGLE FAMILYMEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STOf
FINISH
❑ NEW HOME CONSTRUCTION
❑ MA[NTENANCEIREPAIR
WINDOWS
IN EXISTING OPENINGS OYes DNo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED _
ALL FEES ARE
TOTAL JOB VALUATION
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
❑ ROOF ❑ DRAIN TILE
❑ SIDING �OTHER
❑ SWIMMING POOL
❑ ADDITION
�tEMODELING L'
❑ HOUSE ONLY
❑ f{OUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
%� S
� S�P
HEIGHT
BASEMENT REMODELING SUBMIT:
I . Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
OSoffii ADDITIONS & PORCHES SUBMIT:
� Trim 1. Site PIaNSurvey showing the existing struciures
❑ Fascia � and proposed project.
2. Two sets of conswction plans
3. Energy Caiculations
LOCATION OF WMDOWS
NUIvIBER OF
�D ON VALUATION, INCLUDING TAE COST OF LABOR AND MATERIt�LS:
(US G THE 1997 UBC FEE SCHEDULE)
� �O OCCUPANCY TYPE
$ ,� See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ � 5•� .001 times the total job valuation
$ a 1� Jro .0005 x Permit Valuation Minimum $:50
$ �j v $5.00 (State Licensed Residential Contractors)
$ $1825 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21 =$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ I � rl . 4 Make checks pavable to: City of Fridley Attach
I hereby apply for a building permit and [
of the City of Fridley and with the Minni
permit on site; that the work will be in ac,�
SIGNATURE OF APPI�FC9(�' �
APPROVED BY
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTiL PROCESSED
lations
owledge that the information above is compiete and accurate; that the work will be in conformance with the ordinances and codes
Construction Co s; t t I understand this is not a permit but only an application for a permit and work is not to st wi out a
�ce with e appr ed an in c all work which requires review and approval of plans.
PRINT NAME YY� , C�� I� DATE � I 6
wn_ _ � � .
� 10/14/200$ 14:27 FAX 6�1_644 9520
,� \
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WEEKES FOREST PROOUCTS: f� 001/002 ��
1(� � `'
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/v we�lcea F'orest Products
�Po sox t a�sz�
r�� /� S� Pau1, MN S.S114-0329
e�l'� (651) 64d-9807 � (800) 328-2890
�-1�+ (651) 641-9i20 Fax
To: Leo Fax: 763-?84-2275
pate: l0l16f08
Re: S�ALED BEAM CALC Pdges: (Including cover) 2
urgern o For Review 0 Re�um Requ� o Pis�e Rep1y o You� Request
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Ke Beam� Calculations KeYmark Engineering, �nc.
y 6707 V�lnChester Circ{e
�aos�o6 eo��er, co soso,
Phone: 303�43-2068
11:08 AM EWP�obs�keyme�ic.com
4 of 4
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Membsr Data
Description; Member 7ype: Beam Applic�tion: Floor
Latasl eracing: Conti�uous Top
Standard Loed: Moisture Condition: Dry euilding Code: iBC ! IRC
Dead Load: 40 PLF Oefledion Criterla: U360 live, L/240 total
Live load� 120 PlF pedc Connedion: Nailed Member Welght: 4.1 PLF
Fileneme: KY82
Qthet Laads
Type TNd. Dead Other
(pescription) Begin End 1Mdth SteK End Start End Catagory
Point LBS �4' .00" 20 24p Live
,300 � 16a
m
14 6 0
Bearings and Reactions
Lotatfon Type Input Lsngtll Mln RequMd Gravlty RaCtfo� Gravlry Uplift
t a' 0.000'° Wall 3,500" 1.5oD" 1042A� -
2 12' 9� 75" W9ll 3.500" 1.500^ 180Git
Maximum Load Case Reactions
Woa ror invM�B v�,n uwi (or Nns w•e�l w erM�7 �mma.n
Deatl Livo
� 276k T67if
2 37dIt 1228s�
Desig� spans
12' 8.375' t' 6,OOa" (�Ight ca�tt)
P►oduc� 1,3l4 x 8-v4 MAX•1.AM LVL 2.OE t py
Compone�K Membor Daslgn has Passed Design Gwcks"
NOTE: Daslpn ssswnas member is rlppod to 8-00'' dpp
De9ign assuinp eontinuous fat�era� Dracing alonp tTw top cho.d.
Allowable Sttess Design
Aowe1 ANoNa010 Capuky locsdon Loading
Pos�tive MomeM 331 t.'tt 6�e85.�i . 519L 6,39' Odd Spans D+l
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Building
Inspections
763-572-3604
763-502-4977 FAX
DATI
S[TE
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
' / �1 /�% �/�C_L �
THIS APPLICANT 1S: ❑ OWNER I�ONTRACTOR
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERMIT TYPE
TYPE OF WORK:
DET.
ADDRESS:
PHONE:
NAME: G. � �
STATE LiCENSE #_
STATE BOND q _
ADDRESS:�
PHONE�=
�STNGLE FAMILY
❑ NEW
CITY
Permit No.:
Received By_ �
Date
STATE ZIP,
EXP DATE ( Z � �� � �
EXP DATE
ATE�(i ZIPS .30,
❑ TWO FAMILY
�REPLACEMENT
/ �
❑ TOWNHOUSE
PER MS 16B.665 the permit fee is a minimum of SiS.U� or 5% of the total cost up to 5500.00, 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 = plus .50 surcharge
OR
FOR PROJECTS WHERE LABOR EXCEEDS 5500, FEES ARE BASED ON S10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIX7'URES: (INDICATE TOTAL
NUMBER OF EACH BELOV�. MIN[1vtUM FEE $15.50.
BATH SINK/LAV FCAOR DRAINS SHOWER _ WATER PiPTNG
BATHTUB � GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOF7'NER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET _, BACKFLOW PREV. (SIS)
_ DISHWASHER � LAUNDRY TRAY _WATER HEATER (S35) FOR fRRIGATION
WATER METER _ OTHER
Permit Fee $ Number of fixtures @$] 0.00 x$10.00 =$
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ OR Number of fixtures @$35.00 x$35.00 =$
State Surcharge = $ .50
(MINIMUM $ I 5.50 (M1NiMUM $ I 5.50) Tota1= $
THIS 1S AN APPLiCAT10N FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 on site; that the work will be in accordance
with the approved plan in the c f 1 work w ich equires review and approval of plans.
SIGNATURE OF APPL � -C. PRINT NAME �ela�c� s �y` �' L' DATE f�' -' 0
APPROVED BY
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
DATE
Buildi.ng MECHAl�IICAL permit rTo.: ��
Inspections RESIDENTIAL APPLICATION xeceive y:
763-572-3604 FRIDLEY Date��: � 8
763-502-49�� FAx CITY OF
EFFECTIVE I-1-08
DATE ` � YOUR E-MAIL ADDRESS
SiTE ADDRESS
THIS A.PPLICANT IS: � OWNER I�ONTR4CTOR
PROPERTY NAME:
OWNER/ p,DDRESS: � CI'{'Y l� I'e �� STATF�IP
TENANT
PHONE:
CONTRACTOR COMPANY NAME: 0 `" � �
NOTE:
SEPARATE CITY CONTACf PERSON:
LiCENSES ARE STATE UCEN E# � U� �°� EXP DATE � r �
REQUIRED FOR GA3 C��-y v� � STAT�ZIR �� ��
AND HVAC. �DRESS:
SUBMIT COPY OF BOND pHp� �. ` FAX
AND MSURANCE
PERMIT TYPE -�SINGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW ❑ REPLACEMENT �LTERAT(ON/REMODEL
DETAILED DESCRIPTION OF WORK � �
PER MS 16B.665 the permit fe� is a minimum of $15.00 or 5% of the totaf cost up to 5500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
OR
Labor cost under $300 =$I5.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $5(10, FEES ARE BASED ON 510.00 PER FTXTURE, EXCEPT WHERE NOTED. F[XTUR£S: tMDfCATE TOTAL
NUMBER OF EACH BELOVi�
Equipment Instal{ed MFG: MODEL: SIZFJBTU
�'C,; MODEL: SIZEBTU
��,; MODEL: SIZE/BTU
A/C $25.00 _FIREPLACE (GAS) S I5.00 _GAS RANGFJOVEN S 10.00
AIR TO AIR EXCHANGEER SIS F[REPLACE (WOOD) S35.00 NEW GAS GRILL S10.00
BOILER 535.00 FURNACE 535.0(1 ,GAS UNIT H7R 510.00
�CHIMNEY LMER 510.00 GAS DRYER 510.00 POOL HEATER 535.00 .
Ai3CT WORK S10.00 GAS PIPING 510.00 ,_VENTiLATOR SI5.00
Permit Fee $ � Number of fixtures @$10.00 x$10.00 =$
Surcharge .5 Number of fixtures @$15.00 x$15.40 =$
TOTAL DUE � OR Number of fixtures @$25.00 x$25.00 =$
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
M MUM $15.50 MINIMUM $15.50 Tota1= $
THIS IS AN CATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I fiereby apply for a mechanical permit and T acknowledge that tfie information above is compiete and accurate; thai the work wil) be in conformance with the ordinances
and codes of the City of Fridley and with the Minnesota Construdion Codes; that 1 undastand this is not a permit but only an application for a permit and work is not to
start without a pertnit; that the work will be i accordance with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT �� PRINT NAME�',(,G�� ���� i'l DATE�j` 7''v
APPROVED BY DATE
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
RLQUIRED INF4RMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC _
� NEW HOMES/A,DDITIONS 0 EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel TMC 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 Mechan�cal Code Guidelines software may be used for
combustion and make-up air calculations.
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE�_O__- %�
SI'TE ADDRESS �
' ' � I�IECHANICAL
O RCIAL APPLICATION
' CITY OF FRIDLEY
EFFECTIVE 1-I-OS
YOUR E-MAIL ADDRESS
THIS APPLICANT IS: �CONTRACTOR
PROPERTY NAME:�
OWNER/ ,�D�ss: 1 �_5
TENANT
CONTRACTOR
NOTE:
SEPARATE CITY
LICENSES ARE
REQUIRED FOR GAS
AND HVAC.
AND INSURANCE
PERMIT TYPE
PHONE:��;
COMPANY NAME:
CONTACf PERSON:
STATE BOND # /l,
�
Permit No.: lii�W �'� C��'"T
Received B
Dat��d�. � s
c�1Y r� �� L�� STATE.
, CELL: FAX:
J = tii
EXP DATE: O D�Z �d
i.c � CIT � STATE�
�!L_�1.��_ CELL: FAX:
— - —_ — -- — ___—� —�
# rlLi JO CITY HVAC LICENSE # EXP:
❑ MULTI-FAMILY ❑ COMMERCIAL ❑ INSTINfIONAL ❑ CONDO ❑ INDUSTRIAL ❑ SWIMMING POOL
O OTHER
TYPE OF WORK: I� NEW ❑ REPLACEMENT
DETAILED DESCRIPTION OF WORK:
�ALTERATION/REMODEL
�.�
�17�-�
EQUIPPIENT INSTALLED , MFG: �11'l N[ i� MODEL: !S L��! 5() �JC C SIZEBTU�Z''( ���U
MFG: MODEL: SIZEBN
MFG: MODEL: SIZEBN
A/C DUCT WORK ROOF TOP UNIT (RTU)
BOILER FURNACE REFRIGERATION
CLASS 1 HOOD � GAS APPLIANCE STEAM/HOT WATER HEATER
CLASS II HOOD GAS PIPING SWIMMING POOL
CObIlvtERCIAL KITCHEN POOL HEATER OTE�R
ALL FEES ARE BASED ON VALUATION, INCLUDING TF� COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION: $ ;�00 .O U
PERMIT FEE $ .��},O 4 1.25% OF JOB VALUATION / MINIMUM FEE $35.00
SURCHARGE $ � VALUATION x.0005 / A�III�TIMUM .50
TOTAL DiJE $ , •�� MIMMUM $35.50 Make Checks Payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCFSSED
I hereby apply for a mechanical 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 applicati n for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case all work h require review and approval of p s.
SIGNATURE OF APPLICAN PRINT NA dZ L l✓� G DATE 1,3� "d
APPROVED BY � � � ,. _ DATF.%% ��l7�
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
DATE��
SiTE ADD[tESS
TH[S APPLICANT LS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
BUILDING
Permit
RESIDENTIAL APPLICATION Received By1�O
CITY OF FRIDLEY
Da� �� � E � 4
YOUR E-MAIL ADDRESS t�50.rdd@ � eool�r D C� CUi1r'1
-. --- - - n . _ _� _ .. �t
❑ OWNER '�CONTRACTOR
ADDRESS: � CITY
PHONE: ��03����^'
NAME:
STATE LICENSE tf`
ADDRESS:
SINGLE FAMILY/NE�
Renewal By Andersen
1920 County Road "C" West
Roseville, NiN 551 l3
License #20130983
ATE ZIP
ATE ZIP
PERMIT TYPE O ADDITION O GARAGE/SHED O WINDOWS
❑ BASEMENT FINISH O ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING 0 OTHER
❑ SWIMMING YOOL
TYPE OF WORK:
DESCRIBE WORK BEING
S[ZE OF IMPROVEMEr
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aiuminum
O Other
MAtNTENANCE/REPAIR O REMODELING
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
OSoffit
O Trim
❑ Fascia
WINDOWS
IN EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRiBE SIZE OF
OPENING CHAAiGES &
Ft.
BASEMEM RFMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
Ai�DITIONS_ 8c POR�S SUBMIT:
i. Site Plan/Survry showing the existing swcture
and proposed project.
2. Two seu of construdion plans
3. Energy Calculations
� WINDOW TO BE INSTALLED NUMBER OF WINDOWS I
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1�97 U.B.0 FEE SCHEDULE)
TOTAL
Permit Fee
Plan Review
Fire Swchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$
$
$
$ s .oc�
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
�1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftxS21=�
5450 Conservation Plan Review
Fee Determined by Engineering
Agreement rrecessary ( ) Non Necessa�y ( )
Make checks oavable to: Citv of Fridlev Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALtD UNTIL PROCE3SED
I hereby apply for a building permit and 1 acknowledge that the information above is comptete and accurate; that the work will be i�
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not ;
permit but only an application for a permit and work is not to start without a pe�mit; that the work will be in accordance with the approvec
plan in the case of all work w ch requires view and approval of plans.
SIGNATURE OF APPLICANT �� r -�^ �iY�'!�-�PRINT NAME�1 1Q([�,, �. 1I�Se 1f�� DATE /