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AF - 45845� City of Fridley, Minn. BUILDING PERMIT .���" .�.� �� � Date: .. .... .......... C�i.� � - Addre� ...................................... � N° 3fi1�. � „�� • Builder . :: . ����o�� .. �" .. :�.. . . . . . . . ... Address ............................................. LO�CATIQ�1[ OF BUILDING �j . No. . /. � � �. . . Street . . �� %0 � . . . . . . . . . . � . ���!`.�. . . . . . Part of Lot . . . . . . . . . . . . � �„ .,�� . ... - � , �� �� I.ot . . . . . . . . . . . . Btock . . . . . . . . . . . . . . . . . . Addit4on or Sub-Dfv3sion . . . . . . . . . . . . . . . �. . . . . ...... Corner Lot . . . . . . . . . .. . Inside Lot �i. .. .. . . .. . Setback �: . � �. . Sideyard .��.'. .�'.°,..� . .. . . . . .. .. .. . . DESCRIPTION O�' BUILDING To Used as: �/ 0 �/ � /p � I °y �9�j ...... ... Fro� �� �! DePth .�.�. �7 Height / 1.'0 � Sq. Fk d� �p.�. Cu. Fk ��4G.�/. /' a�c?�e �,�: . . r�om �.�: :� �' nentn .� �. : :� H��r,t !9. : .�w' sQ. Ft. �'� �. ct�. �. �� � �. °° ��. ��s�sn .g�.0 . Pt �- Zj�pe of Co ct[on ................... �st. Cast..................... To be Coaipleted ..............:.... ���. �� � � � , ", , , , � - ,� = �� � : _ _ __ r �_ _ - -- � In consideration of 1�e fs�ance to me .oE a permit to construct the bwllding desribed above� I agree to do the proposed work in accmrdanc�e with the descriptlon above aet forth and in com�liance with all prov�tsions of ordinances of the dty of Fridley. � �/°�%�/c�� x. ... . .................... ...... � . In consideration of the payment of a fee oP $. � . . . . . . . ., permit is hereby granted to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . to construct the buildiug or addition as described above. This permit 9a granted upon the express condition that the person to whom ft is �aanted and lnia agents� employees and worl�nen, in all work dane in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances oP Fridley, B�Iinnesota. regarding location, conslruction. alteration, ma3ntenance, repair and moving of iruildings with- in the city limits and this permit may be revoked at any time ugon violation of any of the provisfona of said ordinances. �. � NOTICE: This pe�mlt doea not cover tha construction, Instailatlon or alteration To� wl eewe� or water. Be sure to see the Bulldlna Inepeator fo� separate pa�mN� for _ - .� '_' � Z ' �%�. . . ..�,...,....� c. ,.� c �: �L gas heating, iNOUSneu� wo�KCSs GTY LOTs TOIOORArHIC MAPPINO �,,�V � � ,� � � �` V \ � � � 1* _ 8� ac� -�'. Osr,�Q iv's T��ka Aoo �T�o�v C. E. COU LTER LAND SURVEYOR REGISTERED UNDER LAWB OF STATE OF MINNESp7A L[GCNSED !Y ONDINANO[ OP CtTY OP MINNlAPOL16 ' 3300 LYNDALE AVE. 50. ' MINNEAPOLIS 8. NIINN. TAYLOR 4-0370 S URI' LL/ FQ/� �T T� L/ .7 �r��Ji�i� �ttrnrqar's (IIn�t�r�rtr N�urr�No FAPM SYRVEY6 LAKpMOR[ JYDICIAL ScA«-� /'= 30" I � -`Z � � � � �.,� i� � � � � \_ � . � 'J '�^J �'� I hereby certify that the above is a true and correct plat of a survey of� Lot Eleven (11), Block Une (1), OSTf�`,�N'S THI�.D ADDITIUPI� anoka Coun�ty, ti'iinnesota. As surveyed by me this 19th day of November 195a A.D. Signed � <�. �c ��+°,.��-�. h�innesota �.egistr�tion No. 258�? �� � r 5449 ��"�%6 � .�,'''` � . 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R.� e`� � �� �, �> b � �� � � ; � ;a °� dc�a � ��o�. ���� O y C � p� � ��C �� ���Q'1 � iYi ���� ���-� O y .-�' � � p���e �ra.�°a �� �p7'° P y �� �� � a• � �. o �'��* � ��y �w� ��O ���i' � � t� �' � � 0 O D � r � � m y _ m C r m d � �, � � a � a i► A O �' � o � � � � �, � � 4 � ao �' � °�• d �_ ���� �y� H � 0.� �� �• �. � � � � � �� � �. � 0. �r� � �� � ' � J 1��1 GaTT/ � ��'Y/G�� `�ic��Q�� ��l'j �?- �i� �"����i��,�2 . � ' . Di6 z. .�e .a HEAT LOSS CALCULATIONS DEPART�IVIENT OP BUILDINGS fRIDLEY, MINN. 4 Weatherstrips A.S.H.V.E, Conshvction No. Insulation Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof F7oor Kind How Applied Yea—No Yes—No 19— F1.� Room � Lengch � 2� W;dth /� Height �• / FI.��.�� Room Leagth � o Width �'�/ Height�: Windows and Doors—Crackage and Area Windows and Doora—Crackage and Area �Vldth Helgdt No. oL Llneal f. Area Wldth Helght No. ot Llneal tt Area No. ot pane ot Dane lighte ot crack eq. tt. No. ot pane of De.ne lighte of crack ea. it Coef. Btu IaSltration /_�, 3 K '�Sjl� Glass 19P � � Fap. wall / 7� Net exp- _wall - - !S Int. wall Ceiling ,� �.� , Floor , Total Btu. Required sq. ft. E.D.R. or aq. ias. W.A. Leader area / Fl•I ��� . R�m ( �p� / � Widch Windows and Doors—Crackage and Area Widlh Height No. of Lfneal 1t Area No. ot pane ot pane IlBbts ot crack eQ. it, / -�t �� � l��i /7, % l2,r►' v V 2 /i Coef. Btu In6ltration � 7 �� �� Glaaa /� H/ �� Eup. wall .Z X' X X Net ezp. wall S,y �� i� Int. wall 'V Y �t 1l Geiling - r� /� - /- O� Floor � f s/�' Total Btu. d Required sq. ft. E.D.R. or aq. ina. W.A. Leader ana Ft, � oom'� Length /� Width / z- Height �= Windowa aad Doors—Crackage and Area Width Heig6t No. ot Llneal tt Area No. of Dene ot Dane Ilghts ot crack W. tt � � �,a 3.� � � 2 0 �l//i� 1 . /2,�' � 2� G� 1�' at.Y- Zv, � �, % Coef. Btu In6ltration '� � ' D �, � y/ _ii v Gtaas �p. Wau Net ezp. waU Int. wall Ceiling Floor Tbtal Btu. Required aq. ��Sf �/ / � � � X �Sf /Z � //D ft. E.D.R. or aq. ins. W.A. I.eader area / �/yf �G � T,J Zrs. ° y � /L � �-�/ � Pr s . � 3, y 3 `= 6 � �vy, a..�. � �c'.� I L�filtration � 3. s' Glaaa 7-� Fap. wall Net-eap. wall � Z Tn� wall Y Ceiling p Floor ,�c � Total Btu. Required sq. k. E.D.R. or aq. ins. WA. l.eader aree Ft.I T�Q T/,� Room ( l.ength � Width ; R/indows and D�rs--Crackage and Area Wldth Helght No. ot Llneal 1L Area No. ot Dane of pane I16b�e ot crack eQ. fG i z 5i /� �7rY. /3_ � 7. Y ef. Btu ' � a �� '/ 3 7D � �c X �t Y Y /2 � � (Pd /y '�,�3� H��hc � I Infiltration /3, 3 � ,S/O Glaas % L1/ c�a Eap. wall �'� 1� v Y Nec eap. wa11 8'0� /� .S3 � Int. wall V � � v - Ceilins .�i6 / a- %7 2 Floor �� � Total Btu. �- l� � Required aq. k. E.D.R. or aq. ins. WA. Leader aree / F7.� %� . Room I Length / Width �i Windowa and Doors—Crackage aad Area Width Hef6bt Na ot Llneal [G Ares No. o! pane ot.yane Ifghts ot arack sQ. tt �� /L � �,U 3 9,� � �� > G Z 71.s/ i� 9 d� o�c� ;i�ht � Coef. Btu 0 Infiltration %': 3 3�/ �8'C� • c�a� �y o �� �� Fsp. wall /'�'-� � �[ �C Y Net esp. wall / 1 � oD Iat wall �f �l x }� Ceiling /y3 /2 �s Floor t/ / � � � Total Btu. ' y � Required aq. k. E.D.R. or sq. ias. WA. l.eader area � � a " � o-� Z. .�6 , ,. , HEAT LOSS CALCULATIONS DEPART�INENT OP BUILDINGS FRIDLEY, MINN. � Weatherstrips A.S.H.V.E, Coastructioa No. Insulation Guide Windows ( Doors Reference Out. Wall Int. Wall Cxiling Roof F7oor Kind How Applied Yes—No Yes—No 19_ Fl•� ,�%., ,Room � Length (� Width � Height �'! Fl.� Room Lengt6 Width Hei Windows and Doors—Crackage aad Area Windows and Doora�rackage and Area �Vldth Helght No. o[ Llneal f. Area Wldth Halght No. ot Llneal !t Ares No. ot Dane ot Dane Iighte ot crack eq. tt. No. ot pane ot pane Ifghte o! crack eq. ft. Coef. Btu lnfiltration 9C y k Glass '�t v �r y Eap. wall �( y �r Y Net esp_ wal� -_ X _v X_ Int, wall Y 5� X Ceiling /� ! �– �� Floor / / .g �S Total Btu. � Required sq. k. E.D.R. or aq. ws. W.A. Leader ana Fl.� • Room � Length Vf/idth Height Windows and Doora—Crackage and Area wtatn Hetght No. o[ Llaeal ft Area No. ot nane oL oane IlRhte ot crack sa. !L � In6ltration Glaaa Eap. wall Net eap. wall Int. wall Ceiling Floor Total Btu. Required sq. k. E.D.R. or aq. ina. W.A. l.eader area Fl.� Room � Length Width Windows and Doora—Crackage and Area Wldth Helght No. oL Llneal tt Area No. of nane ot vaae Ifehts of crack sa. it. � , Infiltratioa Glaaa Eup. wall Net exp. wall Int, wall Ceiling Hloor Tbtal Btu. aq. ft. E.D.R. or aq. ias. W.A. Leader ana B�B Bi11 Btll Infiltration Glaas Eap. wall Net ezp. wall Tp�. Wau Ceiling Floor Total Btu. Required sq. ft. E.D.R. or aq. ins. WA. Leader area FI.� Room � Length Width Windows and D�ra—Crackage and Area �Wldth 8e16ht No. of Llneal tt. Area No. o[ nane of pane llBhts o! crack ep. tt Infiltration Glasa Eap. wall Net e�. wall Int. wall Ceiling Floor 1'otal Btu. Requued aq. k. E.D.R. or sq. ins. W.A. 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Z � � : � � O . � O p � � M Y a � en : Q � � : : bd ctDO : �' � : : »��: : � �� : � : : O � . . . � : . . . � � � . . . � . � . . • m f14 . . . . . . . . . : � : : : : : : : : : : r . : �� ' � N 0 ' � . �� Vt • � O N Q 0 aa �a �a " �a oa �e �e �a �a � � � � � � � � � � � � � �, � �� � � � g o � � � � � w �v .j y O O 'j "� E� C'b" � � , � � v � 0 a x � , i i � D "='+ r � m � n m C r m � � o I� � �' � a o b � � � �. � �6' �' w � Q � � � � . � * � � p. � ~ al a � y x ^� � �� �� � �� �� � � I � � ��e� $ ,��y ❑ ❑ 0 � � 0 C•7 � � � � b " � � � C � �� � a ` � � R : � � � WATER flOSETS URINALS e�rH �� BASIt�6 , SINKS WASH ra�vs DRINK. FOUNT. SH1MR5. FLOOR DRAINS GTCFI BASINS �u�ro WASF'�ER GAS APPL GAS RANGE GAS OPENINGS �. Z. � � � � �. �. � a b �� � ���� � ro�a � � ��.�. .. y � O � ��°� � � �� � ���� o� � b � �' � � ro a� �� p � � o � a a p ►�, H Na y � � n � �4 �D �y A a��� o��� ���y �� . ��� ��o �ava' � .� ro � 3� � a �' � x� � � W � A x & h°n p � M o �, pa � m W '0 � �i a � n � {� � � � ii. �- � � o � � �� �; x � 0 m � � � � � � � � F'd �J'l N Caity of Fridley, Minn.. 6431 University Ave. N. E., Mianeapolie, Minn. 55432 BUILDING PERMIT ��: Segtemb�r 7_a,�71 _11170 � Owaer: ThoTMSs I�ale�= Bwtlder Ex-teri�ox�lesi�A Services �� �H 7p19 Hickorv Drive N.E. Addres9 6391 Monroe Str.eet N.E. LOCATION OF BUILDII�G No. 7019 s�t Hickory Drive N.E. � _ p� of Lot Lot � � Slock Addition or Sub-Division Corner Lot Inside Lot X Setback Sideyard d3eWer IIeval3on Foundation IIevation DESCRIPTION OF BUILDING To ?� IIsed as: Re$iding H& G �'ront Depth Height Sq. Ft. G�. Ft Front Depth Hei�Y►t Sq. Ft Cu. Ft 'l�ie of Construction S,teel �.� �.� _ $2,600.00 To be Completed Oct. 1, 1971 In consideratioa of the issuance to me of a permit to construct 'the building described above, I agree to do �ig proposed work in accordance with the d�aription above set forth and ' compliance with all provisions of Orc7inances of the dty of Fridley. � � J , / / ��°-. � �i '" '� `�� In con�tderation of the payment of a fee of $.____1.�..Q�_, permit is hereby granted to x erig� D_. e_si�n Seiw. to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinances of FTYdley, 1123nnesota regarding location, consixuction, alteration, maintenance, repair and moving of buildfilg8 �� dty ]imit� and this permit may he revoked at any time upon violation of any of the provisions of 8aid � ,���_� ���e�� �`� Buiidin8 Inspector HANR � �iJ�iICH �. ' NOTICE: ffiis permit do� not eover the eoastruction, inatallaHon for wirins, plumbing, ges heatiag� sewer or water. Be soro to ses t6s Batlding Inspector for aeparate permih fo� these items. a AP.PLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITiON BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER�S N�AME' ���i �5 f7 �l� y BUILDER: �5l�e0`/af �srSno Seo�u�c�S . ' eT ' ADDR�S$ : oll�jliG/�o/' Y D!' �iDDRF.SS .� 3�%/ �pil/�D e. �%E �0:. STREET' 7�l � �t c.�r�r"'1 .�r. L0� ;��„ BLOCK; I ADDITION :� c� �%r �u, 3``d� c�e� Q� J. CORNER LOT: � INSIDE LOT:�_SETBACR: SIDEYARD: �i,ppllcaat attach to thie foan �io Certificates of Survep of Lot and proposed buildin$ locatior� dxawa on theee Certificates. H�SCRIPTION OF BUILDING To Be Used As: �es r �e.+/� F�oIIt : Depth : Height : ^ r �� �a�.� � � Squa�e Feet: Cubic Feet: %RI �� Fxont; Depth: HeighC: Squaxe Feet; Cubic Feet: �ipe of Conetruct�on: � f S,d�n�� Estimsted Ccet; �$ v?6Qo � s 7.°O B@{ COmplBted; �C% ��.�1 �% %� �., � � �' �;,� The uade�sigaed hereby makee applicatimn for a�ermi.t �or the work hereiu epeciiied, agreeing to dv all woxk in sttict accordaace w�.th tt`e C�ty �f $�ridley Osdin�aces and suliuge of the Departm��nt of Building�, and hersby dec].�tres that all the facto and repreeeatatiane stated in this applicatiou are tsue aad corsect. DiATE: ��! 7 SIGNATORE: ae�-� c"-�• (See Sav�sse Side For Additio�nal Imformation.� � _ . .. ,� .�- . _..,. / !-' .. ` P / �� � �-, � f� �� � � y w ' � l _� .._� ....`_Ya �. _ ls.: ' r - k�_o /�� • � ' =d� 7 , . E F� , � BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildiags shall, before issuing peYmits for tt►e erection of any building or atructure, or for any addition to any existing building or structure, or for aay alteration or repairs to any existing building or structure, upon application therefore, require the payment by the appl;tcant fur such pern�it of fees to the amount herein below set forth and in the auaaner herein provided to-w3ts UNIFORM BUILDING CODE: 1�ipe 1, 2� 4-$2.15 for each one thousaad cubic feet, ox fraction thereof, in such cubical conteata. Type 3� 5-$1.85 for each oae thousand cubic feetm ADDITIONAL INFORMATION Foz the purpose of camputing fees for building permits, the eubical contents of any building or addition, ia determined by multiplying the ground area covsred from a point six (6) inches below the floor line of the basement or �he cellar to the average heighte of �he upper surface or to the average� hei�ht cf the roof eurface of the main gable of a pitched roof. For xepair� or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. In ao case ehal� the fee charged for any permit as set forth ia Section Z be lesa thaa �5,5 � 00. V�RIFICI�ITION OF FOUNDATION NOTE: �etm�ts for Qonetrustion will be issued a minin�m of 24 hou�a from the ti.�e of applicatioa, to allaw.for proper review of the proposed structure �tnd of the conatsuction site. A Ce7cti�3ed Survey of the lot, ahawing the location of the foundation, ouce it has.been canstsucted, will be required before vraceedina with the framiag. CERTIFICATE OF OCCUPANCX Applicatiom for a Certificate of Occupaacq shall be made teq (10) daye prior to the uae or occupancy of any atructuse for which a building pexmit has been iasued; and eaid atructure shall not b� used or occug�ed until a Certiricate of Occupancy haa been issued. � '� ♦ �e � � � � � � � ��i � � � 88� � M C � � � � � ', � . g � ��� � , 2 � � �� � . � . �: � . . � � � • ¢ • • "$ t • • H (/� s e e � • • •'�j • e • � • r. •(A � � � e . 01 � • o • �-F � • : a • r sp� � e • �' � � . • •N • • e . � o o r �� r • • • � • t a � � • � + � • • • � �. r �' a • � • • • • � • � � • e(b r • • • • � � : . • • [/} • � ♦ a • � • � � � � • -• • � � • • • • • • � f � • � � � e •1-�j + • • f • � • � • � � �.J. •� • �--� • ' � • � � • N M M M M M i M M N 01 �; , ������������ � �« � � �r � .. � � oo� � � � � � • . � �' �, . 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N H t�-' ~'�d N Y• f�D � k � M � O � a� w a� ��� hi N W �'S W F�''. f�' f%S M N tq O N� ��w ¢' �� G� �y ° "{p w � tt O 'G N a � � N � K � rt � � � a"'xro � � � � ro � �sam w w r- rr rr � w p K w w w o ro�rt� �a a o o a n � � o�R'm � w k � �• � N N W M � a � � fD m � � � w m m a�Y� �rt�x ' �w�� � � ran �rt �" 5 � O b' W a Ft N N N � � \_ a y v 'D r � a � 0 z "T1 0 � -O 0 � m � T '"O � D Z c-'� -i o cn z a n � Z —1 rJ O S � D G`') .�r Z C/) G7 -G � N �--I f7 nl O 3 O N M Z C+� C7 � t� c C � n � m � � � 0 z � tn T � � I"I � a � O z a Z d T c-� �--1 -G O T 'll �TJ � r '-C , In I`� , L HOUSE HEATING TEST RECORD ADDRESS / � � � ��f �Lf dy' V �3"t �� �.. APT. FLOOR CITY SUBURB � OCCUPANT ��- ` �" � OWNER `� HEAT LOSS AT HTG. 1 T. � SOLD BY 7�� � ��� INSTALLED BY �� Eleetrical Work By Gas Line By �� TYPE OF HEAT GA FA e'' HW STEAM SPACE HTR. UNIT HTR. OTHER /i� GAS DESIGN CONVERSION MAKE L�(��� `�-�+-°- �. MAKE OF BURNER M�e� ° Modal Serial � `� � � �/� � Max. BTU Rating INPUT I��� °��, MAKE OF FURNACE Model �� CONTROLS �jd °/ THERMOSTAT �"� �` Heat Plug )�� Vent Size �`� Valva. �''�+�.- - KIND OF LIN R%�'�i'�`� SIZE ���� NONE Limit � � %� - Drak Hood � � �"— Regulator � � ~� Limit SeHing �-� � Filters Size,���� ��umber � Fan Setting / � � `� �/"� , Chimney Location Insid� ' �Outaide Pilot TYpe �.��+�� � Chimney Construetion '� Pilot Make �' `� ' Pilot Model Smoke Bomb PiloT Timing p "�'� ' Draft Wiring �'° .Test Tag �'" L.W. Cut Off Door Pressura Lighting Inst. �" � � � ,.s� Pressum � �' Pereent CO2 � Date Tested � � �'` � � Input CFH 6 B� Pereent OZ � Company Testing � Staek Temp. � Pereent CO U Name of Tester ` Form 235 sue�ecr PER City of Fridley ° 17 6 0 7, AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r ; � ECEIP � • COMMUNITY DEVELOPMENT DIV. I y/� n r � y � PRO7ECTIVE INSPECTION SEC. �� �� � _ � � /'�'1 � CITY HALL FRIDLE� BS432 NUMBER REV. DATE PAGE OF APPROVED BV 1""'"� � ,`� 612-571-3450 910-F15 7/11/84 � � JOB ADDRESS �019 Iiickory Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ].]. 1 Ostman's Third Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Robert Faulkner 7019 Hickory Drive N.E. 571-4597 3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO. Greco Constructi.on 41 - 70th Way N.E. 571-1914 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Residential 7 CIASS OF WORK ❑ NEW ❑ ADDITION [� ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Roo� can be the.2nd layer but not the 3rd. Install ridged galvanized valleys where necessary. � TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REDUIRED FOR ELECTRICAL, 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 WORK 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 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUfiTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �`],�600 S•8� WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $26. SO STR N OR THE PERFO M NCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE � � �'/ /��� $27 .30 °" Si ATUREO TRACTORORA�THORI2EDAGENT ��ionTE� d- WHEN PROPERLY LIDATED THIS IS VOUR P RMIT �� � � I � SIGNA7URE OF OWNER IIF OWNER BUILDERI IDATEI BLDG iNSP �ATE NEW L � City of Fridley Effeetive 4/1/84 ADDN. [ ] R-1 AND R-2 pLTER. � J Building Permit Application Construction Address: ��/ `� �'��°� � �� �� Legal Description: �7 /I +��- / ����'S �� ��N� Owner Name & Address: ������� ���/�� ' Tei. � ��1� ���r � Contraotor: �r� �r� �..��-� � � Tel. # �7� �� Address: �t � �0�� �t/� �'�� - LIVING AREA: GARAGE AREA: DECH AREA: OTHEa: Attach to this application, a Certificate of Survey of the lot, with the proposed eonstruetion drawn on it to scale. DESCRIPTION OF II�IPaOYEMENT Length _ Width Height Sq. Ft. _ Length _ Width _ Height Sq. Ft. Length width _ Hgt/Ground Sq. Ft. _ Corner Lot [] Inside Lot [] Ft. Yd. Setback __ Side Yard Setback � Type of Construction: � � Estimated Cost: $ ��� � Approx. Completion Date: �5��� � ��`� Alt. A Alt B proposed Driveway Width If New Opening Is Desired: $---- $ - See Back Page for Explanation � /G�� DATE: ��� APPLICANT: � Tel. #.�� � CITY IISE ONLY Permit Fee Plaa Check State Surcharge SAC Charge Park Fee SEwer Main Charge TOTAL STIPULATIONS: � ��-5� � $ -- U�O � $ � $ o`� �. �Li �� �a . � 0 Fee Schedule on Reverse Side 25� of Building Permit Fee �.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Neeessary [ ] ., a . . BIIII.DIAt's PERMIT FEE SCH$DIILE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or strueture, 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 Yaluatioa �1.00 to �500.00 �501.00 to $2,000.00 �2,001.00 to $25,000.00 �25,001.00 to $50,000.00 $50,001.00 to $100,000.00 $100,001.00 and up Fees i $10.00 (Minimum Fee is �15.00) $10.00 for the first $500 plus $1.50 for each additional �100 or fraction thereof, to and including �2,000. $32•50 for the first $2,000 plus $6.00 for eaeh additional �1,000 or fraetion thereof, to and including $25,000. �170.50 for the first $25,000 plus $4.50 for each additional �1,000 or fraction thereof, to and ineluding $50,000. $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and ineluding $100,000. $433.00 for the first $100,000 plus $2.50 for each additional $1�000 or Praction thereof. DRIYEi1AY DEPRBSSIOA ESCRW (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 replaeement of eurb and gutter and install a 3 foot wide approaeh With 6 iach depth - DriveWay width plus 6 feet times $15.75 VERIFICATION OF FOIINDATION Permits for construetion �ill be issued a minimum of 24 hours from the time of application to a11oW 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 onee it has been construeted will be required before proceeding With the Praming. � . .- �� � , � c� � � � ? 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O z � G N a � -� Z � r �� �O �Z m .,, �O � � O �- Z� a� v� a� � �� vz �v o= Zm a �Z �� � Q 0 Nr Z � v< v ''� Z � �n N O Z � °g `o , W ° � v Z � � � c �" � 0 0 � � � � m �� �'1 9 � � - � � 1V a � � n � � 1 � � � rh � N � rr cT \v 4 `� � w rt `C F-+ N 0 O W �'THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNiNG APPLIANCES OR THE APPLICATION WILL BE RETl1RNED r•► � � r•► • : ' ► � � �� : - - �Gmnrii:,:�� : _ !—� -- -• ► ► '- — When ' , the unde�signed hereby verifies that the ven�ng has been examined and is free from rust, deterioration, obstructions, Yes (X► No () and is securely supported and firestopped where required. The venting system is plasticlPVC and meets all current codes and manufacturer Yes XI No () specafications including s�zin9� �ength, number of elbows and termination. i The undersigned also verifies that the replacement unit is a listed assembly and meets the current codeS and n�l Fumace V nti gCTaUles fo' f noes i n c l u d e A G A- G A M A C a t e g o ry I C Y e s (� ) N o () assisted and natura� draft appliances. �e is sized and installed to r�e�t the c�+�rer�t codes Yes �) No O and manufacturers specifications. When required to �^�'"�� "��'� cemh�c_fien air_ it Will be Slzed and 'I�stalled Yes �) No () to meet the current codes and manufacturers specifications. When iostallia" ""°�•••°ntina c� _ct�m, the undersigned hereby verifies that it is a listed assembly oes i clude AGA-GAMA Cat gory I C ntral Fumace s p e c i fi c a U o n s. Th i s d Y e s �) N o () Venting Tables for fan assisted and natural draft appliances. Is the commo as been emoved from the commonv en alnd ented�y after an appliance h Yes (x) No () separately as per current codes. � • • . 1 / • ' . 1 � • 11 11 • 1 - � . � � - 1 • � 1 - H • � • �11 . 1 • � Appliance #1 Type ���� ��- BTU Input �o� �� Appliance #2 Type �✓° �°� �' � �� B-� Input �y � APPIi�� �'' Ty� - Total Btu Input �� Total Appli�nces _____.__- Fan Assisted or Nat t� Fan Assisted or Nat � �" Fan Assisted or Nat Vent Hei ht %8 / Diameter `% �� inches Common Vent Type �-�-�� 9 qp liance #1 Vent Connector Height 3� ft Length s Diameter '`� p• in Type c%.� p ' ft Length =ft Diameter �in Type �� Appliance #2 Vent Connector Height _L Appliance #3 Vent Connector Height = Length ft Diameter in Type .M . � ��.c���.,►,�..�-�-.- _ 13562 Central Ave NE, Anoka, MN 55304 EATING CO: CenterPoint Ener��1�liiane$�s�e , . ` :" i�t - ' . : . �� .. _ -:�r �_ - - .. �� ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCl'ION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 163) 572-3604 FAX: (763) 571-1287 : 7019 HICKORY DR NE : 103024440023 : OSTMANS 3RD ADD : LOT 11 BLOCK 1 : HEATING : RESIDENTIAL : ADDITION/ALTERATION PERMIT NO.: 2004-0�1240 e�� j DATE ISSUED: 02/20/2(�04 VALUATION . NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A REPLACE FURNACE (WARM AIR, CARRIER, 60,000 BTU'S) # A/C UNITS 1 VALUE OF APPL OR WORK #FURNACES # GAS RANGES APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304- (763)757-6202 OWNER FAULKNER ROBERT J & DEBORAH 7019 HICKORY DR NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this applicadon and know the same to be true and conect. All provisions of laws and ordinances governing this type of worN will be complied with whether specified herein or no� The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. App11C�13T�� Date . Bldg 1 # GAS DRYERS 0 ENTER VALUATION HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 5359 SEPARATE PERM(TS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 5900 0.00 30.00 0.00 0.00 25.00 0.00 0.50 55.50 = Ce�l%IPtll%:r� Enerr�qyy Minne asco ADDRESS �! �L t7� �� �� OCCUPANT L � HEAT LOSS Yes DATE HTP. INST. SOLD BY CenterPoint Enerav inn asco Electrical Work By � i / i TYPE OF HEAT FA a/ SPACE HTR. CiAS DESIGN MAKE. � r� �+ Model � f,�� Serial ` � NPUT ' c� � •� - -- CONTROLS THERM TA ��� ��f '1'� Heat Piu�_ Value iv�i�� �� Limit yl C•� Limft Settin Fan Settina �i'a7 e Pilot Ty� �/.S� .� PUot Meke �� �"� °'+ � PAot Model � /"1 PUot Tim(n��_,_,�� � Pressure o � � Percent COZ nput CFH �O � � � � Percent OZ Stack 7emp. � i Perc�nt CO�� u,.� ,,n �"_ ��us� ��`��tv� �'�s� ���o�� APT. �LOOR CITY � �� 01flINER _ INSTi4LLED BY CenterPoint Enereay Miy nneaacro Gas Line By � r �' ' UNIT HTR. OTHER COIdVER�ION Vent Siae ` � J �- KI�ID O� LINER � SIZE � �' - NONE Draft Hoad Regulator �v �YP,�e D' e FNters Size � ,� Number � Chimn�y Location Inside �./' Outside Chimney Construction _�� S S � Wirirsg � e Test Tag o/ LighUng inst. P/ Date Tested � d- O Company Testlng i� Name of Tester � � � s;. ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE i CITY OF FRIDLEY �a�� rnvrvFUCrrv evF�vr� x� FRIDLEY, MN 55432 572-3604 FAX: (7631571-1287 : 7019 HICKORY DR NE : 103024440023 : OST'MANS 3RD ADD : LOT 11 BLOCK 1 : ELECTRICAL : RESIDENTIAL : ADDIT'ION/ALTERATION PERMIT NO.: 2004-00241 DATE ISSUED: VALUATION . NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERNIIT ISSUE DATE. REPLACE FURNACE AND AIlZ CONDITIONER # INSPECTIONS APPLICANT CENTERPOINT ENERGYMIlNNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304- (763)757-6202 OWNER FAULKNER ROBERT J & DEBORAH 7019 HICKORY DR NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes nu11 and void if work or consttuction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and l�ow the same to be true and conect. All provisions of laws and ordinances governing this type of worl� will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date 1 STATE SURCHARGE, ELEC FLAT ELEC PERMIT FEE - NIIN (RESn TOTAL PAID WITH CHECK # 5359 SEPARATE PERNIITS REQUIltED FOR WORK OTI�R THAN DESCRIBED ABOVE. 0.50 20.00 20.50 OCT-17-2005 13�04 CITY OF FRIDLEY ��.ildiu�g r�spections 'G3-57�-3G04 a�� ITE ADDRESS r HIS •'•ppLIC.4N� IS: TEN,t�NT �TJ�I.DiNG R.�S�D►ENTI,�L AP�"LYCA'TIt�N C�Y ��' FRID��� XOLIR E-MAii. AAa7RESS _ �` u %�. ❑ O �CGNTRAGTOR NANIE; . �l—�/—P!� %�-- ADDR�SS� � p i' . �a�:, S l-� 3 5- �vl� � n�eu,rF• 1 /.�.h�nP�� �k%d�v!'� P.02iL4 Permit No.: � ' �L" �-' l �����a gy: - D�.te Rec'd: ��_ ' - _� ��i�' Z SUSMTI' A COPY OF STATE J�ICENSE � �' DATE �rovR s�ra� �cnvs� .Ew��: 2 7�� AJ � F�-� v�/� c.v _ crrx�� lZ �� /c.� sra� zrn -S'S/i 3 R'ITH APpY.ICATION p�o� -!� 9.� � v FAx 5/ - 2�°� -v/ y5 PROpERTX �'Y�E PERN�'1' T'YPE T"YpE QF �Vd�tK: O �uts O BASEIv�Ni' Fu�t[SH ❑ DECK �ESCRIBE QVO�ttC �EING ST�E OF II1�KOVE1b�fT_ JIIM'�ER OF SQUARES �.=Ai�AGE$ �ROFO5ED SIZE: �tOPOSID i�1GHT: — So��r f � O ROOF o SIDWG O SwWt�ID�TG POOL D AI�DITION � REMOD�G i; S�-e'� C�, l� HOUSE & GARAG� G ATPACFffA GARAG�E ❑ DETAC�D CrARAGE o nn�t zwE ��� 50�7 � �Cl.SL�G� C� �l f�lo,(" e �.S I�iGHT $�13�2QbEt�vcr susMrr: 1. �g F1oor Pl� Z. Pfopo^.�ed tloor plan 3. L�2 of strucleual r�nbers to be us�d 51riYNG FOR NEV+► CONSTRUClTON IltiCX.L1DING DECKS, � vimyl OSoffrt ADDIT[ONS_ &,RORCHES S[1BNIlT: � Alltelinua► 0 Ttim 1. Siec PianlSurvey showing the existit�g sd-t�res ❑ � D Fastia �d propased prc.ject 2. Two set� of wnstructiae plans Q.1� OP�7+1IN6S [3Yes �li�lo I.C)CATIaN dF a'IlJDC)WS 3. En�gy Caiculations pR FOR TiEW OPENINGS-DES�E SiT� OF _ _ a�r cxa�a� & TYP� OF WINDOW'PO BE MSTALLED NUMBIIt O�' WA�1pOW5 ALL k'E�S Alt� EASEb ON vAY.UATTUN, YNCLUAA�iG'Y'HE C4ST OF LA�Q�.t AN� MA�`E�tIALS: (U�iG T'AE 1997 U.B.0 FEE SC�riUL� 71'�'TAY. JOJ� �ALilA?AQN � �� U� _ �LE1PA1lfC� _ �°4'P� _ .— Permdt Fee Plan Review Swcharge Fire Swcharge �.1CCriS8 SSYG}i8l"�� SAC Cbarge Curb Cut Escrow Erosion Cantrol Park Fae Sewer Main Charge Total Due � }�' 3. a $ � � .�aa $ •� $ $ � _S $ $ °l/.SS -- See Back Page for Fee Scbcduie 65°h of Btulding Fennit Fee {.0005} times t'�e total jok► vai�ioA �- Mi.aimum �.59 .00 � x i�ermit Vatussion (1/l0%) $SAO (St3�te Licensed �t.esidearial Co�tractors} $1450 per SAC Unit (Plans t4 MWCC for detcrmiaariQn} �t+6ft= $x�20=$ $450 Conservation Plan �CView Fee Detern�iaasd by �agineering Ageement necessaiy ( ) Nom Ne�essary ( ) 7'�IIS IS AN APPLICATION FOR A PERN1Ff—N4T VALID UNTII. PRIX:L$$�D I hereby apply for a build3rn,� perrr�it and i ac�wl�ge tiaat the informatian above is carnple#e and ace�trate; that the wark wi�ll be in con�ormance with thd ordinances gnd codes di the City af �ridley and with t4�e Minnes�ta Construction Cades; that I understwd this is not a permit but o�y an application far a pern�it and work is not ta statt without a penmit; that the wprk wili be in accerdar�ce wit.� th� approved pian ia the case of all work which requires revier�v and a�proval of pians. SIGNATJiLEOFAPPLICANT./J%�C��� �dL11G����"��PR�iTNAME �LJ%.P,%ZfG�Ce IO�1�'Y�l��' �� 3/0 L OCT-17-2005 13�04 CITY OF FRIDLEY 3uilding CiSpectibnS '63-572-3G04 [TE ADDRESS __.L! HIS APPLICANT 1S: �� �U�LDING RES�DENTLAL APl"LYCATIC3N CYTY U� FRID��Y . � . . tx� p OyVNER, �G'NTRAG'tOR S 1- P.02iO4 Permit No. • �� � � % � �t����a �y: Date Rec'd: � -�' �? � � r ,� ��- corrrxac�-v� sv,v�: /�t��- �t(�� o�-s - - SUEMIT A COPY OF STATS 1.iCEDISE � f� DATE �rornt s�ra� �tcnvs�E �wn�ss: 27 8lr N• �"a � vrii c u> crrr� Fe u�!l e_srA� z� 5 S/ l3 WITH A�'Y.ICATION rHO� !� 5 �-[o G S- 3(� � c� . FAx !� S/- Z� 7-o i y.r PROPERTX TYPE T�ERN��' Ti�PE i"YpE QF VVO�tK: OBA5EN�Ni'FWISH �RaOF ❑ DECIC � SmIIVG Q S� �ESCRIBE �VORK BEING Dt7NE: i'� !�U t� � O.{ Lf �T�E OF sQu,v�s . � D - :�E� ?ROFOSEA S1ZE: ''ROPOSID i�TTGHT: - — eroYNG � vimyl � Alumim�m o mi►a � OPEf3IIdG�S C3�ies �No OR FOR NEVii OPENII3GS-DFSGRISE SIZE OF OPENYNCr CHANG$S & TYP� OF W�DOW TO BE �STALLED l7 HOUSE & GARAG� Q ATfACFIED GARACrE O LETAC�D CrAiielG� OSoffit 0 TEVn 0 Fascia Wca,3�aN OF wavnows ■ .• � � ■ • _�.r��• I�IGHT BASENID�T'i' RF1IV�ODELING SUBMiT: 1, �g Flaor Pl� 2� i�aposcd floor pfan 3. Lgt of str�cpua{ manbe�s to be us�d �'t FOR.NEW CONSIRUCITON INCL.UDING DFClC5. �1DIl'lONS_ & PORCHES SCiBl�RfL: 1. $iee Pian/5urvey shvaing �t existing spvcmre5 �d propo�d pro�ect �. Tvao set� of co�avc,�on pim►s 3. Encrgy Calcula�iots AL� l�'E�S AR� �AS�D ON YAY.UAT'�UN, nvcr,v�a�� � cosT a� L,vao� arm �vr.�►��ua�s: (USA�TG T�YE 1997 U.B.0 FEE SC�riITLE7 �►�ay, ,ro� ���A'��� � �l���A t����aavc� �� Permit Fee Plan R,eview Surcl�arge Fire Surcharge �.icense S�charge SAC Cb�arge Curb Cut Escrow Erosion Control Park Fee Sewer Mam Charge Total Dne $ �S3 a� See Back PagC for Fee Scbrdi�le $ 65% Of Builcimg PeTmit Fee $ (.�057 times the total,job vaivation � M�nimum 5.54 $ . �{ .QO1 x i�ermit Vatuation (1/10%) $ �,Q�j $SAO (State Licensed �Lesidential Cvr�tr�actors) $ $1450 per SAC U'nit (Plans to M'WCC for deterrn3nation) $ R+6ft= ftx�20=$ $ $450 Coffiervatian Plaa ZLeview $ Fee Detenr�i�oed by Enginee�ring $ Agreement necessary ( ) No�a Necsssuy ( ) S Make el�ecks payable to: City of F�idle� Attach TFIIS IS AN APPLICATION FOR A PERMff NQT VALiD C3Nl'IL PROC�SS�D I heTeby apply for a buflding permii �d i ac�wlet3ge tt�at Lhe informati�n above is cample#e and accurate; that the work will be in con�ormance with the ordmances and codes di the City of k'ridley and witt► the Mianesota Construction Codes; that I understand this is not a pzrmit but o�y ea application for a petn�it and work �s not so stact without a penaoit; that tbe work will be in accordance wit�a the approved plan ia the case of all work whioh requires revie d approval of pians. SIGNAJURE OF APPa.1CA3JT ;� _ Cl/7G���1�'�mrr rra�0 /e�'/e I��11I�iOd�DATE ���.� f D 6 �°o '� OCT-17-2005 13�04 CITY OF FRIDLEY 3uildiu�g tiSpectibn5 '63-57�-3f 04 rrE ,a►t�oxESS ,,,�C(, Eii5 APPLICA,IVT YS: _f�.►�li! �3U�LD�TG RES�ENTI,�.L A.P�'LYCA,.TICaN Cr'i'Y {Jk` FRID��Y �ovR. �-�r,vr.,�,p�ss _ Y� . ❑ avdxEx �ea:wrRa►c'rox P.02/04 Permit No.. �t���ea By: L7ate R.ec'd: ,� z���43� SUBMIT A COPY OF STATS L10Etd5E � E7� DATE �ovR s�rA� r�cnvs� ���: 27 Sf� �•�e'.� r v� �c� crrx� �/�1�, srA�7f1� S//3 WITH APp"y.ICATTON rxor� (�St -(�__95 -3l� �3� F.�x !� SI - a �� -O I �s '!"YPE �vLh rAtvut. zuvaw wr�a ixu�., i.vN . ❑ TWO FAIVIII.Y/1��'9V CONSTRUC7i0N '�� O �+,$£iTt3$�I O �A�,,4 O $ASEIvIDVT F�TISH O ROOF ❑ DECK �SfDIIVG G S'�VQvIIvJ QF �ESCRI�E oVOZLtC BEING Dt7NE: 3T�E OF II�1tOWE�`1' _ SQUAR$S ^, �_a�srPC, � �ROFO5ED SIZE:- — 'TtOPOSID i�11GHT: — 8t17ING � v;my1 � Alumirnm� ❑ Qthet � OPENINCvS C3Yes �No OR FOR NEW OPENB3GS-D�SC,RIDE SiZE OF �i'ENTiVCx GHAIVGES & TYPE OF WTI�t�0�1 TO BE Il4ISTALLEi7 ALL �'E�S AR� Permit k'� Plan R,eview Swci�arge Fire Surcbarge License S�cha�rge SAC Charge Curb Cut Escrow Erosir,n Control psrlc Fee Sewer Main Charge n l� HGIUSE & GARACsE G ATTACFIED GARACrE ❑ LETACHED GARAGE C]Soffit 0 T�t O fss�ia LACATTa�N OF w�mows OP ❑ DRAW TIL� O O'�IER T�EIGHT BA�7' RRMODE111VG_SiiBMt7': 1. �g Floor Pian 2_ I�oposed 9oor plse 3. Lgi of struct�ffi marnbc�s to be used FOR NEvJ C4NSTRUCTiON INCi.UDING DF.C�CS. ADDfl70NS_ & P(�RCHFS SLTBNIlT: 1. Si� PimUSuevry shoaing tht eatistirtg sprucmres �d proposed pra�ea. 2. 7wa sets of coaad'ac�bn plans 3. Enqgy Celculatietfs ON VAY.UAi`�4N, YNGZUA�N'G'Y'iiE COST OF LA�OR AN�t MA,�xtTALS: (U�i Z'FiE 1997 U.B.0 FEE SCSEriU3+� ►TIUN S � � � �__ O�CUPANC� _ T'i'p� $ �� � S° � See Sack Page for �'ee Sch�dule $ 65°/a Of 8uflding Per�nit Fee ,$ .?� {.0045) tinaes the total job valuatiam � M'vnimum �.SO $ s�� AO a x i�ermit Valuation (1/10%) $ l� $�.00 (State Licensed �tesidengal Gvutractors) $ $ I450 per SAC L?nst {Plans to M'OiiCC far deterrnination) � R+6ft= 8x$20=$ $ $450 Conserx+arioa Pian Zteview $ Fee Det�en�i�oed by Engmt�ring $ Ageement necess�y ( ) No�a Nets�sseuy ( ) � � S 7 1V1ake checks oavable to: C'rto of Fridfen Attac Tf�II3 I3 AN APPLICATION FQR A PERMCE NOT VALID i3N1`IL PROLES5FI5 I hereby apply for a build�g permit and I ac�wledge tha� the informatiq� above is cample#e and. accurate; that the work will be in con;formanc� with the ord'm�ances and codes af tlie City of �ridley and wiitb the Minrnesota Constnuction Cades; t�at I rmderstand this is not a permit but o�y sn application for a peru�it and work �s nat w start without a permit; that the w�►rk will be in accordance witb the approved p}.aa ir� the case of all work whiah requires revi�wv and a�proval of pia�s. s��ra�.n� oF ,��.tc�' �QA? i/�G� Na� !.C�.� iC /l � Va/1 �� �� 9 -l�� % �uilding �j,���� Permit No.: Inspections ����N��, �p�,ICA'I'I�1V Received By.°� 763-572-3604 ��►�� �g, ��� D��.'�'c� E P 2 2�Q 8 763-502-4977 FAX EFFECTIV� 1-1-08 DATE YOUR E-MAIL ADDRESS SITEADDRESS � . �. THIS APPLICANT IS: ❑ OWNER °�QNTRACTOR PROPERTY NAME: ��� ADDRESS: CITY STATE ZIP TENANT PHONE: � �] I ` S� �I CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE ��r um ng Q EXP DATE YOUR STATE LICENSE, BOND AND STATEBOND #�a90 ���� ��. N.�., # 38 EXP DATE CERTIFICATE OF ,�D�SS: �ridl�y, �� 5�jt "�2 CITY STA1'E ZIP INSURANCE PHONE ��) 7`�-2199 Fa�t (763) 754-'��� FqX PERNIIT .l�.,pE ❑ SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � N� ��PLACEMEtv'r DETAILED DESCRIPTION OF WORK - PER MS 16$.665 the permit fee is a mmimum of $15.00 or 5% of the total cost np to $500.00, 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 $500, FEES ARE BASED ON $l O.Ofl PER FIXT[JRE, EXCEPT WI�RE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVi�. NIINIMUM FEE $ I5.50. BATH SINK/LAV FLOORDRAINS SHOWER WATERPIPING BATHTUB GAS PIPING (NEED QTY LIC) SWIlVIMING POOL WATER SOFfNER ($35) CLOTi�S WASHER KTTCHEN SINK WATERCLOSET BACKFLOW PREV. ($I� _ DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($35) FOR IILRIGATION _ WATER MET'ER _ OTF�R .... _.. ., �.. _..._ _ , . w Y � � � ��... .i.- . � -: 1. i' } .�y?Y s� '}, 9 'ti ��' { ' f �4 �,� f �K ��Yes, z s. e.Fw . `33:" .7 �l .a� . �uz�' � = t�i��°�^; � . _ . , , . . ,. ' . ,. _„a. ..<.,,k �., . _ . r . ., u , f. . . , - ._:; r, Permit Fee $ Number of fixtures @$10.00 x$10.00 =$ Surchar e .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ OR Number of fixtures @$35.00 x$35.00 =$�_ (MINIMUM $15.50) State Surcharge = $ 50 (MINIMUM $15.50) Total = $ �— THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accutate; 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 case of a11 w�k which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME �,1� ��'��'D�DATE ( � / � �C APPROVED BY DATE . t c 3� � ,3�/ "�����' �� � b '��.r�.�"��.��. , �'�.�'" , . , , � s ,�� : <: � `y=�i�'�`� '�.' � ',�.�s° �� r���a City of F�idley �uilding Inspections Department 6431 University Avenue NE, Fridley, MN �5432 763-572-3604 FAX; 763-502-4977 Building T11S��@Ct10riS "1FG63-572-3604 763-502-4977 FAX DATE J V rw,,, SITE ADDRESS � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE PROPERTY TYPE � , uir r�� TYPE OF WORK: DESCRIBE WORK BEING SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: IDIN ❑ Vinyl ❑ Aluminum ❑ Other ❑ OWNER I � � 1 1� RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-08 'j'� YOUR E-MAIL ADD OrC �I �4. 11! +' . �� rj �� �/.. { � PHONE �LJ • 7�-7f�30 I� VL7.d .s3� � yy�� STATE LICENSE # �p �ZCf ^l EXP DATE �SINGLE FAbIILY/NEW CONSTRUCfION TWO FAMILY/iVEW CONSTRUCTION ❑ ADDITION ❑ GARAG ❑ BASEMENT FINISH ❑ ROOF ❑ DECK ❑ SIDING O NEW HOME CONSTRUCTION O ADDIITON 0 MAIIV1'ENANCE/REPAIR �REMODEI.1 �Lt%��'1�i ��ap�ir, i� ��Gifjlr ' I.EI�IGTEI g f WII ❑ HOUSE ONLY ❑ HOUSE 8c GARAGE O ATTACHID GARAGE ❑ DEI'ACHED GARAGE ❑Soffit � Trim ❑ Fascia SIZE STORIES / wnvnows IN EXIST'ING OPENINGS ❑Yes DIVo LOCA1'ION OF WINDOWS OR FOR NEW OPII�IINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WII�iDOW TO BE INSTALLED NUMBER OF WIIVDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF fOTAL JOB VALUATION ��i, s� ��G THE 1997 UBC FEE SCHED �) Permit F� Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Totat Dne ❑ DRAIN TII.E O OTI-IER @ Permit No. o� Received By:_ Date Rec'd:0 �z� f/� Z-. �SS�/3'L„ HASBMENT REMODELING SUBMIT: 1. Exi.�ting Floor Plan 2. Proposed floor plan 3. List of structuial members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, �DD1TiONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing d�e e�dsting structures � ProPo� P�J� 2. Twa sefs of constrnction plans 3. Energy Calculations lu�l Y �l� /:`iC� � S Sce Back Page for Fe� Schedule $ 65% of Building Pern►it Fee $ .001 tim� the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ $5.00 (State Licensed Residential Conlractors) $ $1825 per SAC Unit (Plans to MWCC for detetmination) $ ft+6ft= ftx$21=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Nece�aty ( ) $ __� l iViake checks payable to: Citv of Frldlev Attac THIS IS AN APPLICATION I hereby appty for a bu�ding permit and I ackno ledge that the of ifie City of Fridley and with die Minn�sota ishuction Co ish perniit on site; d�at tlie work w�71 be in accordan wi� the� SIGNATURE OF APPLICANT � _C , /, APPROVED BY A PERMIT NOT VALID UNTIL PROCESSED ve is complete a� accarate; that the work wi7l be in canformance with the ord'mances and codes t6is is not a permit but only an applic�tion for a permit �d work is nat w start without a the o which reqai�es review and approval o plaas. � ��e PRINT NAME��°�.$� • I�:� Z.. DATE e�4� 1 _ ,- DA � � * !I ; Y_......... . . ;� r � ` �9�¢ � / � _......... _... .. ._ .. 1_ .__ ( ..... ... ...._.. _.. _. .. .___.. _�_. .. . _ ... ; _.. . ... . . ... . ._._ . _. . .. . 2- .-_.... _ :. _: "'.. .. _ �� ( ' �\ �� � .'. l� I .... ._..- --. I ,���' ��,�'l .:�_ _ —..__ � . (i '� . �_ � � �`" ��,: °'�' . / j i �� i-��� � I C 4 4 ,r �V` �+- • La�, F: �` � r. � �?�' �!- � �.r � , � � . �,/'L[ (_ � y� .__ ��'�r�= ,,�,�'� o � L�1� �r � .� , � _ � " . �k�r ., i4, Ji`� f, ��� � X� �'�.;,�`'u'` %'' �/f (, �`` � y�' ��'' 1 ,_ . - � ----•-- i�.J� t i J" `�i L � � � �1_ L. r � � �..��r.� C ^' �� J �'U n(�' ; ��_�.,... y(_i� .. . �G u.t�i�. �,� r� kx � � �/ �� ��au� Ne� ��t�� '�C ��l�r �� �'�N.\� . > � �"�,b �?. ,�' I '�� VL ',�� �. �r � / /� �/ � �'� " �/ 1'/ V I �1/ v � . a t 7 �� � ; /� � ; ; t , � - --.__._ �_.____ __ . __.. __ _. _ � �:.�. �.,.-.. .....:.�....�..� � , �J ' `� � � ��; /� � � \ � /� \ . � �� � � ----.__._i.---__ . __-- , ��� �;�� ;_ ���� �..____.. _---_._...._..._. � / . . � ' `•.— ------ _ � �-- � � � �.. _.�-...�_-d--._.� ) � � � �� � , ■ 11 � , �I�:� � , J�/ I� � ,�,� ,;�'���. ..,� c- ��„ ,,���` � �� �_:- ----..._. __.._ --_ ------i.._.--__ __ _ Building PLUMBING Pernut No.: �;�°1 ��1 �� Inspections RESIDENTIAL APPLICATION Receivecl By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: f 763-502-4N%% FAX EFFECTIVE 1-1-09 DATE � YOUR E-MAIL ADDRESS SITE ADD SS 0 : 0'e'l THIS APPLICANT IS: ❑ OWN B�ONTRACTOR PROPERTY Nq�: �� ��, �/���,,, OWNER/ �DRESS:���/ CITY STATE ZIP TENANT PHONE: CONTRACTOR Np�: '—'� ' j SUBMTT A COPY OF STATE LICENS # �J��,� EXP DATE � YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF pDDRES % �.ri�-�c>o� �v� CITY �%y�� STATE y/ � ZIP D�3 INSURANCE PHONE iC�- ot�j�- 'S�tI�IP� FAX �<� � � �d°� 6 PERMIT TYPE ��GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � NEW 0 REPLACEMENT DETAILED DESCRIPTION OF WORK � � .`n/ �,�Jr�rv� PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, 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 $300 =$I5.00. Labor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge OR . FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV�. MINIMUM FEE $15.50. 1 BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (NEED CITY L1C) SWIMMING POOL WATER SOFI'NER ($35) CLOTHES WASHER KITCHEN SINK 1 WATER CLOSET BACKFLOW PREV. ($15) DISHWASHER ! LAUNDRY 7RAY WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER . �: �:������ i�; ��� : R � ���� � ���, �, � � � ��,. � ��F�>� � �.���� ',.���3� `��;� �,ib � ` �ci :; ,� . � . ...� �r��a . , � . . Permit Fee � $ Number of fixtures @$10.00 x$10.00 =$ Surcharge .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ d I.� Number of fixtures @$35.00 x$35.00 =$ c Sta.te Surcharge = $ .50 INIMUM $15.50 � J� (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMiT-NOT VAL1D LINTIL PRQCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in confortnance 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 case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT �,2�,�,,,��%O�,¢ �W PRINT NAME �� � �''Ll`Ltiy1/ DATE 0 �.�� �� ���✓X"7�. �-..� 4 ,...�, � i� ��� ��"�S ����i}.��.�������i`.�., ���'.��._. �" � ....� �5� t.. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977