AF - 45570-.
r,
� City of Fridley, Minn.
� BUILDING PERMIT N� --y �� . ��
� 40'72
. .� �._ _�,'
,�...c �,� � � �� �-----
Date: ....._.. � _._...�___.r...�___ �� . _..__�..
� � �'
Owner: ���"���'�' " z� �"' ��:.:!�'�.-'v�����_'� ..�i. . �`
._---........._.._._ _...._--- ..... . Builder .--Y--.:.;�.�..C'.�.�:�
----- - '` �..�.�.+ ._.._._. �
Address_.-----_______._.__.__�.�.._.._ .� Address ..._..._..____....---------------- ------ -- -
LOCATI�JM OF B{JILDING
� � �� ��-' �-
No. ...,�..�...� � �---. Street _..�:. ��` .__ _.......�.��----_.__...!.,,tt '•"•,`..._....--•----_ Part of I.ot ----._....---____..._....--------
�... ,- /, �
_ --...__........--•---_.___.._.._
Lot . ,'�:....-- �z �*
� -------�� Block ---��---•----�- --• --....-------� --� -- Addition or Sub-Divis4on �:_. �,��i�.".�'' ::��___� �--�--------..
Corner Lot
Sewer Elevation
To be Used as:
:. , j .
:�,� C �`,� .:-!'a'..39._......._.....
Type of Construction
Inside Lot .--.--�...._ ................. Setback ....----•-..---.----.-•-•-•----------... Sideyard
Founda.tion IIevation
DESCRIPTION OP BUILDING
� . i � � �, � / t •r
Front ._:!`_'�..��.!.'�.� Depth � �..._�.'�'�. Height ,�.�'`..--..:�! �q. Ft. ���.�°. �_�'..
Front ....--------...._.. Depth .._ - - ,�' �Ieight ............_....--... Sq. F� ....._.._........-�---
_ ................... --................__ -.... Es� Co�������+7ic'1 �.... To be Completed
l'"
cn. F� "�� i".+�,�
Cu. F� _..___..__..........
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the deacription above set forth and in compliance with all provisions of
ordinances of the dty of Fridley. �
,., .
In consideration of the a �' ``` '"*'
;.
P Yment of a fee oP $...,�..._...-•--•--.-•-•--.., permit is herebY granted to....._ ............._...........---..........----•---••--•
� _._. �__. __._._. �_.... to construct the building or addition as described above. This permit is granted upon
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 sa.id building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, ma3ntenance, repa.ir and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. � -
�""� _ � � _. ��''�"'�`�� ,'�
B11�Ifllllg IAB�CiOT
NOTICE:
Thls permh does not cover fhe wnafruetion, installallon for wiring, plum6ing, gaa heaKng, eewer or water. Be sure to see
fhe Building Inspeefor for separate permita for tl�ese hems.
�`—�:�
��
4 �
�a�-�-
�PPLICATION FOR BUiLDTNG PERMIT
CI3`Y OF FRIDLEY, MIlJNESOTA
• : �� _ � � j ; ; . � �" f� �-
�ClI'888
. � LOCATION QF BU�LDING .
..: . : .. •
No. �� a�. Stree� �r� ��' � A� �° ��Part of Lo�
'� i.i ;: i;'.; . . .
Lot _�� �' `� Block� � -�- � A,d.dition or Sub.Div,, � �Q �S'c��� d �
Corner Lot�Inside Lot.�Set Back �_�� Side-Yard
$EW�R ELEVATION _ _ _ �'OUNDATYQN 'FT �ATiON � .
., : �. ,
Appli�ant �attach. `to this forai • C�t3.fica.te of Survey. of �ot' arid proposed buui:i3.ding
. �:�:
location. . � ...
DESCRIPTION OF BUIT�DING
To be .v�s,eti,, ass. ._ . , .
-... c: . ; �: . , �
�� A� �i� � 1 crl. AT'47 • 'Fi'OTl'�i . _ J_� � IiDepthr„=� �T��H21g�i�.� � � l • r.
�
Sq. Ft. �� � Cu. Ft. _..
t,i...
� ont Depth Height
�. Ft: ^' .. . � Cu.. Ft. _ , ,
Type of Conatruction;���/ �l a sc1 Est3mated Gost ��„�� � 4�'a� ��
To be compleied � '
The undersigned hereby makes applica.tion for a permit for the wo�k herein specified�
agree3.��,,to.;do all work in strict accorda,nee with the City Ordinances and ruling of
the Department of Buildings,�'and hereby declaxes th�,� �.71 the facts and represen�a-
tions stated�3,n this application are true and correct.. . -�``�
.......__......
., �� ._� � /,,
(A Sch�dvle of Fee �osts can be found on the �tteverse aiae.l
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Y����1� i�l.,• 1r. ! .
� BIIILDING
. -�.�,
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PERMTT FEE SCHEDULE
..� �
Sectian 2. The Inspee�o�r'���a�-Bt�'rci°1.ngs� shall, before �issuing any'��ermit
for t,Y,�,...�rr�e�io�- of �any building or structure, or for any addition to
__.-°.-'--
,�,_.,_:.-.-----�- any existing building .r��'`�'tru�,-��are; ��or for any alterations or repairs tp.
a�.y_;�e�,,s.ting building or structure, upon applica.tion therefor� require .
,�,.._..------�"""��ie payment by �the appli��t�'t.. fo�' siich permit of fees � to the -amount �
here3.�. below set forth and in the manner herein provide�� _to.=�����-: °�-R-- -
_. . _
2.1 For an such er-r��--io "r" �li �-�:.. --�..- ^.
y p � e erection of ang fireproo€ `b`c�ii3ing�
_sLthe�---�han a garage, ,wareha�se;, ��.factor� or - g�rain elevator, or fp�' �h�t`�"i �=��
�°'"'��� � erection of any fir�p�oof addition, for .sim3.l�„r occuparic�r, • to ' any �.,
__,.�x�.sting�uild�ng sha11� be at the��rate' of �]..�,.0_..£or eacli ox��-L't1�o���t,nii�'`ti=�'
---°"�"�� cubic �eet, or fra.c�ion tlie"reof, 9:n such cubical conte�s:.'.. -
.. . rv.. �..'3 _ .. ... .. _ .... _ •• .li... .,�, ,�:,_.
-�" ��� ��� 2.2 For any , such permit for the erection of ��r- fi�eprt3of ` garage., �: war�' '
..._hous� �tory or grain eleva�or, o� for the erection of ang fireproof
�--""""����� addition :.:fo� .airailar occupancy, to any existing b�.ilding shea.11 be at the
,�,�Ef;�,��te`'of ��1.25 for each one thousan�.:,�CUbic feet, classified as "£3.x�epro��".;,�
by 5ection 502 of,�;he Minneapolis Building Code. - , .
HOUSES .. _. _ . . ' .
„ .. ...
2.3 For any such per�ii.t for the erection ��, a�i�'� non-fireproof buildin,g. ,,
other than a ara e warehouse facto �or ain �levator or_. °° �
g b > > y' �' � .. ��•� -._
non-fi�:�prdt>f �d�di'tion, for aini.l�.r occupancy, to any existing building.
�..- � ��----3�e"rm�.t �1.00 for each one thous��d-�°�Z6ic feet. _ ___...-� �� "
. . .. . • � : )r.
GA�GFS , ...._ _-- °::.. . .
2.�. Fo�� an� such permit���for the erection •f ang non-firep�'oof garage,. ...
_-��-----warefiouse, factory or grain el..�v�t�r; or for the erection o#':� arty non-
��-�fireproof addition, for si.milar,occupancy, to any-e�isting building or. �
for each such buildirig"�ar:•�:ddir�ion. Ninety'.,Cents ior.each one
thousand cubic feet or fraction thereof, in the .cut��cal�cbntents thereo�
_,_._ with a minimun of �4.00. -: : � ' .
,. . ,
_ .. ... . __. ._ . . . - .... . .
�- For the ��purpose of �omp�.ting fees for ,�ua.l.aing •pe�mits the cubica.� �y~'" �i , ' � -
. . . . . r-: ,:..:
���� :.: �,conten�s;. mf=, ariy building or addition' �to a uniforiri heigh�i � throughol�t � by `
�au,lt�.pl�r�;rrg:.tTie .ground area covered �from a point six (6) inEhes below �-^;�t�
'tT� �" � l,i ' . 11 � h h�3 h�°�- f th -•- -"
._�
e..�7:,�0� ° n8 of the bas�r�ent or ce ar to t e average g er - e•�
upper surface or '�o the •�,�rerage heigYit:�.o� :�i�� .roof surfa,�e �of the main.. ,,
gable. of a. pitchqd roof.: ; ._... . � ,,,: . '�':��:� � ,
_ _ .... ,t�: .
2.-5�-"�or" repairs or alter�.ta.on� to an existing structure, the fee shall
be at the rate of �3:00 for each Five Hundred Dolla�s (�5�:00), or "
fraction thereof in�the cost of a11 proposed work. -
2.6 In no case eh�:ll`the fee charged for any permit as set forth in
Section 2 be less than �4.00. �
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HEAT LOSS CAL�(��70NS� DEPARTMENI' OF INSPEC7'ION t-��p�� �,
Weatherslrips A• ° • Conetruction No. �
Guide Ianilation
Windowe Doon Reference Out. Wall Int. wau c.�a�g Roof Floor Kiad � How Applied ��
Yea— o I Ye�—No 19__._ —
1 F1•� Room Length ��.-� Width � Height FI,� Room Length Width Height
Windows and Doors—Crackage and Area Windowa and Doors--Crackage aad Area
WIEih Helg�c No. ot Llnsal ft. Area W11th Halgbt No. ot Llnea� tt. Ara;
NO. ot pane ot pane IIgAt� ot crack rq. ft. No. ot pane o[ pane Ilghte o! eraek �Q. [t.
� ;� ,a �� ,
� "'� /' y— b' G.�.<!'�
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: ��� 4 ' ia Ad� '° �` d,
�11��tf8�lOII D '�e �° ��• �B�U,� '. a `. f' y,i ° g P � � V° 1i' �f. Bhl
Clasa � � �- ,. ,�, ���, a .� Infiltration °�° ,�-t. � �; . � �, �
Ezp. wall p � �' � `a � Glasa � � �. �' �� �,�� 9 � � p `� �.'
Net exp. wall �" „ d�� � � Fap. wall -- �G+ „: ^-•*� ` '� / �
lnt. wall
� Net eap. wall � — °! .,t . ae a "°-= ��
Ceiling � ,� I dnt. wall �°
Floor 'e�, Ceiling
' =� � � Floor � �` �
Total Btu. � Total Btu.
Required sq. ft. E.D.R, or aq. ina. W.A. I,eader area � ° Required aq. ft. E.D.R. or aq. ins. WA. L,eader area
F7•� Room Lepgth Width Hei�ht F7,1 Room I Length Width Height
Windows and D�rs--Cr�tkage and Area Windows aad Doors—Crackage and Area
No. ot Oa e ote�ne light� ot ero k spr ft.
Wldth HelgAt No. ot Llnael !t. Area
No. ot ysne ot yane llghta ot craek aa. tt.
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Infiltration
CJaamm
E:p. wap
Net ezp. wall
Int. wall
Ceiling
Floor
Tocal Btu. �
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i�2��ui�r� sq. fc. E.D.R, or a�. we. W.A. Leader area
�. R�m 1 �4� �ra�
Windows and Doora—Cracka�e and Area
Wldtb Halset No. ot L1ne�1 tt, qrea
No. ot pane o[ pane IIg6t� oL crsct rp, tt,
�
�71�I��f8t1081
���
EXp. Wll��
Net exp. wall
lnt. well
Ceiling
Floor
Total �tu.
Required eq. k. E.D.R. or �q. ioe. WA. L.eadar aroa
—_ � —__._
Bht
B�II
In6ltration
Glass ' .
Fap. well
Idet tzp. wall
Int. wall
Ceiling
Floor
Tota) Btu.
Required aq. ft. E.D.R or sq. i8a. WA L,eadzr area
�►. �� i ��, w;a�
�Jiadflws and Doon--Crackage a� Area
�YIdtA He16ht No. ot L1nea1 ft. Area
Na e! pane ot pane Ilast� o! crack �a. tt
�855
E7I�1. WB�)
Net eap. well
Int. wa1V - �
Ceiling
Floor
T'otal Btu.
l3equired eq. h. E.D.R. or �q. in�. �HA. L�eader a�ea
B�tl
HOUSE HEATING TEST RECORD
ADDRESS = � / - �- � F �- APT
OCCUPAN � � � � � � _ OWN
HEAT LOS . . Z ) �
SOLD BY ��-�. � y-� 7�_ N
Electrical�or y Gas
TYPE OF HEAT GA
GAS DESIGN
. FLGOR CITY SUBURB���
ER � �
. B
ALLED BY � /
Li ne By
SPAC T. U T . OTH R
MAKE� (�,-� �t�`3� z� � MAKE OF BURNER
Mode � ,�, � � �- � �iode 1
Seri a •��.j �, � o ax. ati ng
INPUT � �, °° MAKE OF FURNACE
� Mode 1
CONTROLS
�H�RMOSTAT
Va 1 ve_�
Lti mi a� --4,
Limit Sett
Fan Settin
Pilot Type
Pilot Make
-v
Heat Plug y� Vent Size ���
� IND OF L r�
ft Hood
lt�rs Size�
imney Loca�tion
imney Construction
CONVERSION
�`�! egul ato� --�
���X/ Number
�nsiae � uts eT
��i��-
Pilot Mode Smoke Bomb Wiring �'
Pilot Timing � Draft est Tag �
L.W. Cut Off Door Pressure Lighting Inst. �
Pressure � ercent CO Date Tested ��
Input C IF'F-- ( ercent 02 �� Co�any Test ng
Stack Temp. �/� �° Percent CO � i� Name of Tester � �
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sue�ecr E T .
City of Fridley 16 9 4
' ` AT THE TOP OF THE TWINS gU I L D I N G P E R M I RECEIP O.
r
� `L ____�_ COMMUNITY DEVELOPMENT DIV. � � ��
r � � PROTECTIVE INSPECTION SEC.
1 S �
� /�"1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'"""� � ,�� 612-571-3450 910-F15 M21.y 4, lg 1/ /
JOB ADDRESS �371 Hayes �treet N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3S Aud. S'll�� #]�2� SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Allen Ford 7371 Hayes Street N.E. 784-0547
3 CONTRACTOR MAILADDRESS ZIP PHONE IICENSENO.
Dav-Ko H�ne Ilnprovement 1325 - 42nd Avenue N.E. 788-58
4 ARCHITECTORDESIGNER MAILADDRESS 21P PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
RP.S].CZPSl'tici�.
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOYE
x
8 DESCRIBE WORK
RPSOO� DfnTP.�.�.1
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd but not 3rd roo�. Install ri.dged galv�nized valleys.
S�PERATE �'ERIV�lTS RE'Q�11RED �OR 1�'I�f �d��
HEAT�NG, PLUMg11VG A�1D SIGi1�S.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTHICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WOiiK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVEFiNING THIS TYPE OF WORK WILL BE COMPLIED tiS`].� OQQ �S`. S�
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRES ME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIO S OF NY OTHER ST E OR L LAW REGULATING CON- .�'%e SC�
" STRU TI OR HE PERFORM C OF O TRUCTION.
PLAN CHECK FEE TOTAL FEE
� $ 8. 00
NAT FCONiRAC O RAUTHOR12EDAGENT ATEI sWHEN PROPERLY V LIDATED THIS IS YOUR PERMIT
�i
SIGNATUREOFOWNEAIIfOWNERBUILDERI IDATEI BLDG iNSP AT
CITY Of" FltIql_CY • �
A('PLICA'fIU:J F"Uft 1,l:SI[l[:i�1TI/1L [3UI�UI�1G ('CI�tlTTS
(IJe�•r, /ll L-erations, /tdditions, or Repairs)
� Ql•lIdER: � �
ADQRESS: ,S ,
TCL �d0: ��S � — Q S� � �
. sxz�c� , rio :
L07':
Corner Lot:
�UI LQ�R : � . � _ �+/ci -
�� �
nudncss:I3�� �.�—����,�,�.,
TEL ��d0: � �f � -- � �� C�
Consi;ruction Location '
sx��r T: .
$LOC�G : ADDITIOi1:
Insicte Loi: Se�tbacY.: Sid�yards s
Ap�licant attach to L-}iis form tw� Certificates o� Survey of lot and
proposed building .location drawn on certificates to scale. �
DESCRIPTIO�ti OF COtlSTP.UC1'IOPd - �
' ��� �$�I'ront: � D�pth: Height:
Squa�e.F�et: Cubic Feet:
� r'ront:
Square� I'cet:
/`— i r',�,�' a'=
Type of Construction
7b Be Oor,�pleted:
�
Propos�d Ariveriay �v
Depth: Height:
(xibic I'eet:
. �
EstimaL•ed Cost: $. �
� � A].t. A Alt. B
Yf New Opening Is Desired: $' $
. .. S�I:, R�VERSE SID� OF SHEET
2►ie undei: signed hereby ma};e� applic�tion for a permit for the t:vrfi� herei:n specified,
ac�reeing to c?o ,a].1 work iri str�ct accordance �•rith the City of I'ridley Ordinances �azd
rulings of the Departnte.��t of Buildii�gs, and hcz:eb declares that all tlie - cts and
zepresen tat�.ans statcd ;i� this �ippl.ication ar t e and correc .
D.'�T�: `� � SIGNIITUF.r::
Sti��ulations : � �
� �. ��y
• P ��
� �_ ��
. '
�°
0
' • �
• 13U11_I)lI�lG ('f�ftl�1J"(' i'i.:�: >CflF:l)
_-- .__--. _'_.._ _._._.._ U l_ �. � � .
SI;C'!.':COI•� 2. � 7.'t�� 7n�.c���ct•c�r. of )�ui.lc?.in�1 ; t:hril.l , t�cf��:r. i.�s:.ua.r�cJ J�ennii::; for i:lic arecL•i.on
t>f .��iy l�t►:;.l.�l.i.u;j ax :st_:.�uct:tirc, c»: fc»: c�iiy aQcli.i:ir�n !.o �u,y r.r.a.;;L�.n�� 1�tiilcliaiy oL :>Lzuc�ur_c,
. i�Y. l:a�' ar,y tiJ.t.c�r..it:i�;ii c.>r. r.cl,��ir.:; t:o •any c;:3.::t:inr� hui.l.di.�i-J or. �;Li:ucturc, taJ�c,n ar�j��.a.c.at�.on
L'}1r.l:�:rp7�C� r.equ.i.i:c t�]i� l�a}�mc►►t: l�y Uic a7j7Z�]J.GiIII�: 1`C))" :;ucli ��cr.�hi.L• o!' fec.^, to L•I�c ��nount•
hrxc.i.►i bcJ.c��•1 scl forth �inQ a.>> tJlc �nanncr_ hczc�.n r,�:ovi.dc:cl t�-t:�:�t:; .
17F.1•1 CUIJS'!'];UC'L'IOI�: Si�lg].e l.'amil.y Ilorrc� ancl Ga�'�Zqes.�: ;�4.00/J.,000 CL1li�G £ec:t:. .
I?L7::7 Cil3:C1:: ?.5 I�erce�tt: af htt�.lcli_nc� }�c�-miL- ice.
U1tl:�TI;I•�111' llI:1'Rc:55201•:: (Concrctc, C.'�irb �i:rcet� Only) � '
' A1L-cin��i:e n: ltc�moval and r.ep].ac�nien� of concxe�e cur.b and
guLt-cr. only; l�riveway �:�iclth plus 6 feet• r. $13. �0
hlternate 13: Retno�al and re���.acem�•nt of concrete cuzb and
• guttcr and inst� 11 a 3 f:ooL �•�i.c�e approach �.►it.h ''
.� 6�nch depth; brivc;�ay �•�.i.dth �pl.us G feei: x$15.75
0
J�DDI i] Ot�/1L I t�F f�'�1/�I ON
7'or the purl�se ot ca�nputi_ng �ces f��_ building �ezcna.ts,. i:iie cubz_ca1_ contents of any
bui.l.d�.ng or a.ddition, i.s determi.ned by rnultiplyis�g the qround area covcrecl f-rom a
pa3.n� si�: (G) inches belo:•� the i•loor 7.a.ne oi tlie basemeni: or th� cellar io thc
av�r.aye heights af ihe �upper sw:face or L-o ihe aveiage height of the roof surf_ace
oi i:he r�aa.n gable of a p�.tched rooi. • '
Fox reFai.xs or a].i:�ratio:�s to an existing s�riicture, the f:ee shall be at the xate
..of $3.00 ricx eacli Five hundred dollars ��($500.00) or fracL-ion '�lier�af. in tiie cost
of all proposed wor.Y. -
Tn •no c.ase sha�.l the fee chargec. i'c�r_ any pennit as set 3orth i.n 5ectian 2 be less �
than $7.50 pl.us $.50 state surcharge. - '
' � . _ VCRTFICl�TIO�! OF FOUt�n�l'i0(d
NOTE: Pennits �or construction �•�ill be issued a minimt� af 24 hours �'rom tlie ti.me
oi applicatian to a]_low for proper review of the proposed structure and o� the
construction site. �
A Cert.ificate � of Sui-vey of the lot, shoc,*ing the 1oc�zt.i.on oi tiie founda�.ion once it
has been cons�nicted �.�a.11 be required L�e;ore pr.ocecding taith the �rami.ng.
.�:RTIFIGAL� QF ���UPA�vC1� ' '
��►PP�a-�atzc�n ior a Certific�zte oi Occ�ipancy shall k�e mad:� ten (lCt) days prioz to the
u: e or. occuFancy at an}� SLL�IC�U1"t? for !J�11CI1 a��uilcling permit has been issu�d7 iiI1C3.
s.iacl struci.uxc siia�]. Iiot l�e usec? ar. occu�,�ied t;riL-S.1 a Ce�:i:i.iicate or C�ccui�:inc}� h�s
bcen xssuea.
r.
� • �� +
t
�
PURCHASE ORDER °ATE
� /�
PURCHASED BY
THIS
GOOD FOR PURCHAS�CS
$1,000.00 ONLY
SUPPUER � I K(.,� � e d-J ��tiCi/ �/ �
_ aooa�ss � � C�
�� .� � � ��
C�TY OF
FRIDLEY PHONENO. /C�t1 +��/aJ
6431 UNIV. AVE: N.E.
FRIDLEY� MW 55432-4�4 CONTACT
612-571-3450
PR/NTED ON RfCYCLED PAPER.
� A(:cOUNT �TY. UNIT � PLEASE ENTER OUR ORUER FOR THE FOLL(
����"� ��
0
�
F 52��4
THIS NUMBER MUST APPEAR
ON ALl CORRESPONDENCE
SENT TO US
PAYMENT VQUCHER
BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE
PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEN
RECEIVED OR RENDERED AND ALL CITY GUIDELINES HAVE`
BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOW
STATED ITEMS.
PRICE
TOTAL � �d
THIS Ai3ENCY HAS A(3REED NOT TO DISCRIMINATE IN HIRING PRACTICES ON THE BASIS OF RACE, SEX, COLOR, CREED, MARITAL STATUS, RELIGION,
OR NATIONAL ORI(31N AND HAS AGREED TO TAKE AFFlRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGES
FlRMS AND OTHER A(3ENCIES WITH WHOM IT PURCHASES PRODUCTS OR SERVICES TO QO LIKEWISE.
WHITE, VENDOR — YELLOW, PURCHASING — PINK, ACCOUNTING — GOLDEN ROD, DEPT. HD.
s�e�ect PERMIT NO.
City of Fridley � e;� �� 4
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� �
� `y ___.__ COMMUNITV DEVELOPMENT DIV. '
r � � PROTECTIVE INSPECTION SEC. � ���
1 � �
1
' ����1 � CITY HALL FRIDLE� 55032 NUMBER REV DATE PAGE OF APPROVED BY
ti.__.11.' '•� 612-571-3450 9t0-Ft5 6/10/97 � /
JOB ADDHESS 7371 Hayes Street NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. .3.5 AUd. $llb. ��].29 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Mike 0'Brien 7371 Hayes Street NE 780-3113
3 CONTRACTOR MAIL ADDRESS tIP PMONE UCENSE NO
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION �7 ALTERATION O REPAIR O MOVE ❑ REMOVE
8 DESCFiIBE WOF;K
Change doorway opening from 2�" to 6'4" (Kitchen)
9 CHANGE OF USE FROM TO
STIPULATIONS
+ See notations on plan.
r
r
t
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIFi CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOFi A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND OROINANCES GOVERNING THIS TYPE OF WOpK WIIL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 4'3OO �.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON- @
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. y�21.O0 re SC �.30
PLAN CNECK FEE T L FEE
1.8�
Si FCON'RACIOAOAAUTHOAIZEDAGENT IDATEi E PfiO VALID TE HIS IS YOUfi PERMIT
p � � �/
aTUaE OF OWNER �iF OWNER BU4DERi �DA E� BL G�NSP �ia7E
NEW
ADDN
ALTER
��
��
�1
ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R 1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/97
Owner Name & Address: �Jjjrl/� �-�,�t �/ �� Tel. # �% ° 7�� .� j/�
�
Contractor: �� MN LICENSE �
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Consiruction Type:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Lengrth Width Height Sq. Ft.
�n$� . Width Height Sq. Ft.
�n� Width Hgt/Ground Sq. Ft.
�i 2.nr � ,,,..� ' ��.,, o a� w,B. �r�/ �'<
l
Driveway Curb Cut Width Needed:
liJ11111atGLL C�.St. � �Q�.�r'i
(Fee Schedule on Back)
Ft. + 6 F� Ft x$ _$
�
DATE: � � � _ APPLICANT• Tel. # o �3 //3
(� ° � ao�
��` °� � .g�i CITY U�E ONLY G`� a�lC - �aZ � ° �o�-II
� ���
Permit Fee $ e� Fee Schedule on Reverse Side ��
Yd% � ���
Fire Surcharge $ ,3. p0 :.�� .001 of Permit Valuation (1/lOth%) � � �
State Surcharge $ .50 $.50/$1,OQ0 Valua.tion i �LL �
SAC Charge $ $950 per SAC Unit C'" -
License 5urcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Controi $ �$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ j Not Necessary j]
TOTAL
STIPULATIONS:
$ a�
� I. G� �-"
�1
�L
�"i 1
� ��
�
f�UILD[NG I'ERM[T FEE SCH[sD�'Lt?
T'hc Chief Building Official shali, before issuing permits for the erectio» of any buiiding or structure, or f<�r
aay addition to any existing�buiiding or structure, or for any alteration or repa�r to any existing buildin� or
structure, upon application therefore, require the payanent by the appiicant for such permit of fees to the amounf
herein below set forth and in the manner herein provided �to-wit:
TOTAL VALUE
$1 to $S00
$SOI to $2,000
$?,001 to $25,000
$25,D01 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1, 000, 001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $S00 plus $2_75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for fust $2,000 plus $12_50 for each additional $1,000
or fraction thereof, to and including $25,(l�0 �
$349.75 for first $25,000 plus $9.00 for each additional $1,(}00
or fraction thereof, to and including $50,�
$574.75 for first $50,000 plus $6.25 for each a�dditionai
$1,000 or fraction thereof; to and including $1Qt);000
$887.25 for first $i00,000 plus $5.00 for each additionai
$1,OOO�or fraction thereof, _to and induding $5�,000
$2887.�5 for the first $500,000 plus $4.:25 for each additional
$1,OQ0 or fraction thereof; to and including $1,00O,OOU
$5012.25 for the first $1,000,(}00 plus $2_75 for each additional
$1,000 or fraction thereof
DRlYEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Drive��vay width plus 6 feet times $13.�t�_
=�lternate "B": Removal and replacement of curb and gutter�and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUI\TDATIOti
:.'ci-��its for construction will be issued a minimum of 24 hours from the time of application to allow for pro�er
��.:��iew of the proposed stn.icture and of the construction site_
\ Certif7cate of Survey of the lot, sl�owin� the location of the foundation ��nce ii has it has� be�n construc° _•.:
',�? h�_ rcyuircd t�i;forc ��rc�cccdirn� �vith the fran�in�.
sue�ecr E R
City of Fridley 2 6 2 0 0
AT THE TOP OF THE TWINS g � I l D I N G P E R M I T
r
; � RECEIPT NO.
� `v _ COMMUNITY DEVELOPMENT DIV. �� ��
r � � PROTECTIVE INSPECTION SEC.
� ` �
1 /"'1 � CITY HALL FRIDLE� SS432 NUMBER REV DATE PAGE OF AiPROVEO BY
�""'� � �'' 612-571-3460 g10-F15 6/10/98 / /
JOB ADDRESS 7371 Hayes Street NE
1 LEGA� �OT NO. 9LOCK TRACT OFi ADDITION SEE ATTACNED
oescR. 35 Auditor's Sub. 9�129 SNEET
2 PROPERTY OWNER MAIL ADDRES$ 21P PHONE
Tracy Brownson 7371 Ha es Street NE 717-1943
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Stephens Home Remodelin 22251 169 St Blaine MN 55309 262-0020 5743
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE UCENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑, NEW ❑ ADDITION O ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
B OESCRIBE WORK
Reroof House (West Side Only - STORM DAMAGE)
9 CHANQE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBIN(3, NEATINa, TYPE OF CONST. OCCUPANCY aROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTfiUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OH ABANDONEO FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWIG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PEF;MIT �SOO �.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CMARGE
PROVISIONS QF ANY OTHER STATE OR LOCAL LAW REGULATING CON- @
S�RUCTION OR THE PERFORMANCE OF CONSTRUCTION y�21 .00 Fire SC �. SO
PLAN CHECK FEE TOTAL FEE
�` B License SC $5.00 $27.00
siGNaru c CTO OR�ZEDAGENT IOATEI WHEN PROPERLY VALIDATED THIS �S VOUR PERMIT
S�GNATUAEOFOWNEAi�fOWNEABUI�DEA� IDATEI �Dfl �NSD f�pTE
l
NEw
ADDN
ai.�
[]
[l
[]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: ��% � ��f'�J� ��
Legal Description:
Effective 1/1/98
�o
(D� 1�
� � �'
Owner Name & Address: '�� �i2�l�JN-�'r��►i Tel. # � ( � �- /�J ��
Contractor: ,�%���� ��� ��ri�bE�r,✓ c� MN LICENSE #�% � 3
Address: e� �1s'/ �� � �T � � f�2►� �3 89 Tel. # �� � - �� �
Attach to this application, a Certificate of Survey of the
� -----.. s_.._._�_.
lot, with the proposed construction drawn on it to scale. �
LNING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
Construction Type:
DESCRIPTION OF IlVIPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
��� �f��J i
Sq. Ft. -
Sq. Ft.
Sq. Ft.
� �
�
�� Estimated Cost: $ �� �
(Fee Schedule on Back)
Driveway Curb G�t Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: APPLICANT• Tel. # ��- ��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �?� oa
$ S. C�
$ .�
$
$ .S ° v �
$
$
$
$
$ � ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 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 Nec�ssary [ ]
BUII�DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to auy existing building or structure, or for any alteration or repair 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 herein provided to-wit:
TOTAL VALUE
$1 to $5(�
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$SO,QO1 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000 �
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1, 000 or fraction thereof, to and including $500, 000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,�0
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 �r fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be �ssued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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A �
� COMM_ON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
� -
When replacina an existina furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and fire�t�pped v1h.e[e required. Yes O No (:)_ .
The venting system is plastiGPVC and meets all current codes and manufacturer : -
specifcations including sizing, length, number of elbows and termination. , -� Yes O� �No (. )
The undersigned also verifies'that the replacement unit is a listed assembly _
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances. Yes () No ()
The existina combustion air is sized and installed to meet the cuRent codes
and manufacturers specifications.
When required to install a new combustion alr. it wiil be sized and instalied
�a meet-tHe-curr�nt-codes an� manufaciurer's specificatiorr�.- - �
Yes ( )� No ( )
1�es ( ) No C-�
When installina a new ventina svstem, the undersigned hereby verifies that
it is a fisted assembly and meets the current codes and manufacturer's
specfications. This does include AGA-GAMA Category I Central Fumace �
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. � Yes O No O
_ Aapliance Tvae and Size/Common V�nt and Vent Cor�nector 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 iype Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appli�nce�#2 Ver� C�tnnector Height ---� Lengtf� - ft- Diameter- in' i'ype.
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
�
HEATING CO.
Signed By. _ � Date : � --
SEP-19-�0 TUE ii:19 AM DREYER.ROBERT T33498T P,05 a
k , ,
� ,
{ J'��%�t.,'V� C�7vl '
1000 sq Job# � 'Lone: Entire House Q9/15100 �
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� N����� Gntiro Ho•s?c ram�lcz atar.dartl
2 Rtm!!k� P;. $�rpoaed Wa11 176 . Q Bt 194 . C Fx Ft F�
3 Re»mpimm�ciatu�Ft D.0 t 25.0 x 36�C Ft x Fti x �
4 Ceiln�a Ft Capd(t Opdon 8, J fl 8. D heat/cool
TYPS OF CST H1A7 Area &uh Area Btuh Ar,,a Bwh Area Eqds
ID{i�OSURE NO. $t� C!S Len�11 Ht@ C16 Len�h Fk8 aB �+8� �8 C�B � �8 C�e
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17 9t:EtotRSHG¢in�1+8±i2+16 a�,� wM i200 1 �*a 1200 �r�� ��*
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� � �
,
HEATIIdC
AIR CONDITIONING
AND ELECTRIC, INC.
ADDRESS
OCCUPANT
HEAT LOSS DATE HTG. INST. I E� � IA ° C��
SOLD BY "
Elecorical Work By �' �
TYPE OF HEAT GA FA� HW TEAM SPACE NTR.
GA9 DESIGN
�►� R�
��
Serial �'��'p (���.�ii����J'��9�
INPUT � �LY�
CAN4ROLS
THERMOSTAT Heat Plug
Velue ��
Limi
Limit Seron
Fan Settlng li'1'p�_
Pilot Type� 1�
Pilot Make��
Pilot Model
PitotTiming �'�' -=
L.W. Cut Ott
Prsssure �� d�c� ° c Percent COz �
Input CFH Perosnt 02 � ��6
StackTemp. ��Q PeroentCO 0�
�
HOUSE hiEATIIVG TEST RECORD
APT. FLOOR CITY �I � SU9URB
OWNER
INSTALLED BY � ��-� M�l' _, N�hte .�e ,�F �
Gas Line By 9!
UNR HTR. OTHER
CONVERSION
y„
vent size
KIND OF LINER �-w� SIZE � NONE
Draft Hood Repularor �'� -eei�L�-ii��
Filters Size I�lK��l x I Number
Chimney Locadon Inside Outside
Chimney Construction
Smoke Bomb Wiring �
Drait Test Tag
Door Pressure Lighting Inst
Date Tested °' � ` �
Company Testing (1l. Yll'. � d°
Plame of Tester
Pressure Percent CO2
Input CFH Percent OZ
Stack Temp. Percent CO
s
�
u-r�roF
FR[DLEY
FRIDLEY MUMCIPAL CENTER • 6431 UMVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
February 1, 2002
Ms. Therese Brownson
7371 Hayes Street NE
Fridley, MN 55432
Re: Final Inspection at 7371 Hayes Street NE
Contractor: Blaine Heating AC & Electric Inc
Dear Ms. Brownson:
A mechanical permit was issued on December 11, 2000 to install a fi�mace at your
address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this permit. As of this date, no inspection has
been called for. -
The pernut fee that was paid covers the inspection to make sure the work was
completed according to the Codes. We will keep your permit open for another 30
days and if we do not hear from you within this time to set up the inspection, we will
mark the permit "no inspection called for" and no further acrion will be taken.
To set up the inspection or to have any quesrions answered, please contact the
Building Inspecrion Division at (763) 572-3604.
Sincerely,
DJ/mh
Building
Inspections
763-572-3604
DA� a, �
�
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
MECHANICAL
R�SIDENTIAL APPLICATION
CIT'�' OF FRIDLEY
COMPANY NAME
CONTACT PERSC
STATE LICENSE #1
> —'� 7�� '
410 WEST A �.
� �R $�}�, MN 55408
2- 24 �
FAX
`�SINGLE FAMILY ❑ TWO FAMILY
❑ IdEW [�EPLACEMENf
DETAILED DESCRIPTION OF WORK
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
Pernut No.:
Receiv By
� •�
R� v
Date'1�'e .
PER MS 16B.665 the permit fee is a minimnm of $15.00 or 5% of the total cost ap to $500.00, whichever is greatei', for the
improvement, installation or replacement of a residential fixture, excluding ti�e fnctures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of iabor � x.OS =_
FOR PROJECTS Wf�RE LABOR EXCEEDS $ , FEEES .4RE $ D ON $10.00 PER FIXTURE, EXCEPT Wi�RE NOTED• FIXTURFS: N`IDICATE TOTAL
NUMBER OF EACH BELOV� %�� � SIZEBTU �� wd
Equipment Installed MODEL: --,�-E-�– "
MODEL: ST�F9BTU
MFG: MODEL: SIZEIBTU
�,A/C $25.00 FIREPLACE (G,4S) �i15.� GAS RANGF/OVEN $10.00
AIR TO AIIt EXCHANGEER $15 FIREPI.ACE (V�VOOD) $35.Q0 —NGEAS UNiT HTR $ 0.00�
$OILER $35.00 _FURNACE $35.00
CHINWEY LINER $10.� GAS DRYER $10.00 POOL HEATER $35.00
�DUCT WORK $10.00 GAS PIPINQ $10.00 VENT�,ATOR 515.00
t,�- - .. _ .. ._.,
pemut Fee $ Number of fixtures @$10.00 x ._
Surcharge $ .50 Number of fixtures a� $15.Q0 x$15.Q0 =$
TOTAL DLJE $ Number of fixtures @$25.00 � x$25.00 =$�
Number of fixt�es @ $35.00 x $35.00 = $
State Surcharge = $ .50
Tota1= $ �C_�c
THIS IS AN APPLICATION FOR A PERNIIT NOT VALID UNTIL PROCESSID
I hereby apply for a building permit and I aclrnowledge that the infomnation above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the C' of Fridley and with the Nlinnesota �Conshuction Codes; that i understand this is
not a permit but only an application for a is n'�t to start without a permit; that the work will he in accor ce with the
approved plan in the case of wo � w'�' . revi and approval of�l.an� � �'1 r� /�
SIQNATURE OF
City of Fridley
Buildiag Inspections Department
6431 University Avenue NE, Fridley, MN 55432
. 763-572 3604
FAX: 763-502-4977
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDIT(ONS XISTIt�G HOME ❑ MAKE-UP AIR
R.EQUIRED F�R NEW/EXISTINC HQ�)IIES .:�::� .. . � � .
_. _ ,;::� . �'. ���i� �,
1. Combustion Air (See note belo`�v)`� ,� ;f ' .r � ,
_... .-,...
a.. Oil or solid fuel IMC Cha�ter 7 with MN Amendments
b. Nafural Gas or Propane/IFGC Chapter 3 wifh MN Amendm.ents
2, Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Ven.ting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel oth.er than gas IMC Chapter 8 with MN Amen.dments
REQUIRED FOR NEW HOMES
4. Heat loss & coolin.g load. per roam
a. Required on new construction IlVIC 1346.0312
5. Ventilation .
- — ��e,� �I F._ r � �'�P?fi70 �r 7672___-_
6. Duct Design Per IlVIC 1346.060�.2 �
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make up air calculations
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE
SITE ADDR _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LIC�TISE, BOND AND
CERTIFICATE OF
MSURANCE
PERMIT TYPE
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-04
❑ OWNER
Permit
Received By:
�.�; ��
YOUR E-MAIL ADDRESS �1�� � w ad�J,9 ,lj) �% r �
� ��_
ADDRESS: CITY
PHONE:
STATE LICENSE � S 93 5� Q
STATE BOND #
ADDRESS: . O - �� CITY
PHONE %b6�� � -e�a9a FAX
TYPE OF WORK: I� NEW
FAMILY 0 TWO FAMILY O TOWNHOUSE
�REPLACEMENT
DETAILED DESCRIPTION OF WORK Q,�,�„q��T_-�, �j
EXP DATE
EXP DATE
�
STATE ZIP,
STATE 1'��ZIP��
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (1NDICATE TOTAL NUMBER�OF EACH BELOW). MINIMUM FEE
$35.50.
O BATH SINK/LAV FLOOR DRAINS ' SHOWER
,� BATH7'UB _ GAS PIPING (NEED C1TY LIC) SWIMMING POOL
_ CLOTHES WASHER KITCHEN SINK WATER CLOSET
_ DISHWASHER _ LAUNDRY TRAY WATER HEAT£R ($35)
_ WATER METER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT(L PROCESSED
WATER PIPING
_ WATER SOhTNER ($
_BACKFLOW PREV. $1 )
FOR lRRIGATION
OTHER
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permi and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the c�e�6f all�rvork �ch requires review and approval of plans. .
SIGNATURE OF APPLiCANT
NAME�o (1 r� ��1 ��_DA
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
�� v r� I/� L V V/ J� L I����
� B►uilding
ITi$�C'C10YL5
763-572-36Q4
I 763-502-4977 FAX
STl`E An�1�.SS _,,,,�[ ; `,
TiII9 AFPLICANT IS:
�'�tOp'�'.RTl� O�V1�1EII/
T'�N'ANT
S�'� A GCUP'Y' O�
YOC]R S7'A't'� LIC�VSE
AND CSRT�!lCATE OF
IIJSZJItANCE
p�a�r��r� x^�a��
PEBMIT TYPE
From: unknown Page: 1/5 Date: 11/19/2009 3:15:49 PM
BLTILDIN�
R�SYD�NN�T� APPLYCATYOYII'
CITY OF FR.II�LEY
�� �� V L I J �� i
Pe�mit No.:
YOTJR&MAILADDRE83 (YZ i C4�F.1 � 1E''. s, �i1 f.i`.�'.-3 �'�s �� .(rs7t',�� �� . L, CtYYI
� OWNER �ON7RAGTOR
p�aN�: i�� t �Q.��i.a L�� c�CS _
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LE �AMIC.'YYN�9N CONS1RUCfYON' S�
1�AB�it/1�'W'CONS'fTtT�CrT4i� ' STOT2Yp9
O BASE[�.'+NT FINI9H O ROOF
❑ DECR � BIDIId(3
0 S'9VA9d
T'Yp� �T�'GV'O1tY{s � a r��w �ron� coxsrRUCrrox a Annrrw�
o a�a�tr�ra�c�a�a�a� �,tr�ron�c.
D�CRIBE wORK sBNG n0A1B: Y.P�vlr,� rt° �"'� i s� J r� :� � CPi �] I C:� ,fr. , ti
S1750F �YlO'VFMEN'C L.�NCr'f�i 'W'IC
ptOOY+�C O C�OTJ!S� ONY.'Y'
nrr��or sQun�� o xo�rs� �G.�aGB
�� ❑ ATTAGI�D (3ARAQE
PROPOSID SI�E: 0 DETACi�D f�ARAt�E
P1tOpOS�L1 Y�GHT:
■ � •s� � �
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0
�IGH1`
�,sr�r r.�n9ona�,nvo e� a�r,,
1. �acistingFl�rPlen
2. Pcupasedfloorpl�
3. Liat of shuchusl m�g W���
gID�� POR N�NW GON5TRUCfION 1NCiTJDTIJG DpCfCS,
❑ Ymyl O3offit A�DTITONS_ &. POIZCi�S SUHMCT•
� Al�awn ❑ rrim I. Site planlSwvey ehowiag the e�risring savc0ae�
❑ Othc , � Fascia Z, 7t�WD � tonsnl�etiCm p18�a
VI'YIVAOW3 ., t 3. F�ergy(`atn,dar:r,,,a
�T i?7�YS 1'YNQ OPF�IIQS �.�°1'es ONo LOCATtON OF'4YlNDOWS �'[ X`� 1' � i C) �°�C � l
OIi.�O�tN�aW QpII1YNt3S-DESCTt�B�s 3I2�'s O�
OP�ICi C'�1AN'�S �
TYPE OF WIlVDOW 1'O HE IIJSTALLID l NUMBER OF WIl+iDOW3
ALL FEES ARE BASED ON V UATION, INCY.�1riY1+TCx T� C057' O� iA�OiY AND 1�XA1'�YtYAY�:
�i (USYhiC T� 1997 �l'.B.0 ��E S�1�YJY.,�)
_OTAT.,_J'O$ V'AY.YTATYbN $ I "t �t��',Lc..'�`,� OCCIIPANCY TvpF
Permit Fee
Plan Re�riew
Fire Surcharge
Sarch�rge
Y,icense Su�rcbarge
SAC Cherge
�urb Cut �scrow
firosion Conlrol
park T�ee
Sower M�in Charge
$ ,o r See Back Page �or Fee Schedule
$ (p 654�0 oPBnilding Permit Fee
$ _� ,(Q _.00I times the tot�l job valnation
$ ' .0005 x Permit Valu�rion Minimum $.50
$ �5.00 (State iicensed ltesidential Contaa.ctors)
$ $2000 per SAC CJ'nit (1'lens io MWCC for detennination)
� ft+6ft° ftx$21=$
$ $4�0 Conservaiion pian Review
� �ee betermYned 6y �ngineering
� � Agreement necessary ( ) Non Necessary ( )
$ I,`� 1VI�ke checks pavable to: C�ls! of Frfdle� Att�ehh
TE�513 AN APPLICA'i701H FOR A PffitNBT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit aad 1 acirnqwledge #h�tt tb�e infv�ation above xs complete and acounflte; thflt the �work will be in
conformance witb tha ordinances and codes of �e City of firidle� and with the Minnesota Constiruaion Codes; that I understar,d t}uis is not a
pernut but only sn tpplication f�' fl permit �d ork is not to st2rt 'wi�haut � ptrmit on site; thst the work will be in $cCOrdauce with the
approved plan m the case af alk k q reariew and approval of plans.
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