AF - 46918,,
* �
.� m
� 0 N
.-" .�
�
m
.� � �
s o
�� Z
� n e �
o � m
3' �
m o �
o � o
3 'a =
m c�'i -,
-o �.
O �
� � /
� � _
��
�
� �'
a
��
3
O
� �
�
�
m „
�.--�F
c�i ° �
. � m -i -a
� �D �
�" � � Q
c �' �
� �
� v y�
� '�' I�
�
��
�
� (
7C C
� �
�
� �
-n �
n o
� �
O
z
0
z
� _n
.. �
v
¢+
�
^' 3
b� �
��
�3
O• �
��
�
n
�
0
0
�
o �'
� N
� c
m �
cQ
m
��
� �
y �
<
c �
o�
� m
$ �
��
�' D
� mn �
� m
�
0 0
�`2 w
o...
�N
�
Z
D
n
3
N �r ,
i� D
�O O ,
Z � �
° � .
G
- G � �
,m m � cD � � � o
� D c 3 � � n.
�a -a � — m=.a..
a . ,. . .
� � �� �� �
� � ���
� 3 6 3
� m � �
a� � �
�
0
�
�
��� _ . O � C A
� �
e!� z o 0
-i�,m . � . � . ..
'�� �. N w 1 �
Q ��
��zm o �r � 3
im m- �oo =
� �o v �' -� o
.r �
3�r
� � m
. � �
�
3
D
�
n
Q.
0
�
�
m
�
N
m
�
� �
� �
�
m �
�
� � �
N _i ..�
tTf O O
O O O
� � �
� m :�_ ��,
� C
•• � D � .
� z
m
�
v c
� .� . -
0
� � 1`�
�
`�,'
V� '
v1
-c
�
m
�
�
_�
z
0
t
��
,.
�:
m � � �
o � �
.�
� � � � �
< � —
z• —
'" :� •
Q ( .r Q.
Q�!�np _
� �� ' e� _
.� O ..
� � � � .
g � 7e'
�' -- i:
5, �° =:�
3 . `
�
�.+ N � ' �~
� � •
� w
O O ;,• ,�
O O'�
0 0 •. �
f!! tf� y ��
W �
o �
.a
�� ���� 3
� $m�c
n� Nr���
a . � o.� � �
����
o �c°m
� W� �
�;_. � 4
j �?�:cQ
� am ° �
Q.
\, 3 ° 0 `G
\ � � � ID
� O
j�% a► ? o m
b a �'��
� Q s -o
�. �m ��.
� � '� �
����
G � o 0
m m m
����m
m �
�,- a ? 3
�� �fl'� 3'�
�y'y�� �:d :o
""J � . 1
. ��� ���
a;s " ? t
� (i
� � o
� (7 x
:.. ry Q� 3
� a � �
� �
�
� Q.
w
"-e
n:ti
N Q �
� � �� � �
� � � � .
z� � m
�� v
N � �
. `_Z.Z
tn =1�'
m ,.
A
�
O �
� :� v
� S �;{ < .
� � � .
. � ci
�� �
.� �
D
Z o
Z �
Q �
D O.�
�. ��.. . _
T • O �
� �v -� ,
� �Z R.
Z�
z
L �,:. :ra �Z . :,,, _ -�
p . �� o _. .,.
� �n =
a m
� �a � f.
rn �
�
v,' � � ; = �
(�, < �
`1 m Z .
� N <
m
2
�
�� �
A p
\ � ?
� m
� _ �
. .� �, . . .
,. . �; ��
��� .` :° .
� �� -� �« _� i�
1. C
('(� , �. - �
I ��
'�
� ��� . .
---__._ �_ - �
e
s
i
RIGHT-J LOAD AND EQUIPMENT SUMMARY
Filename: default
For: Johnson
1310 Eleanor
St. Paul MN 55116
By: Home Energy Center
15200 25th Ave. N.
Plymouth
WIl�T'I'ER DESIGN CONDTI'IONS
Outside db: -2 0 Deg F
Inside db: 7 0 Deg F
l�ign 1-p; 9 0 Deg F
HEATING SUMMARY
Bldg. Heat Loss 4 3 7 3 0 Btuh
Ventilation Air 0 CFM
Vent Air Loss 0 Btuh
Design Heat Load 4 3 7 3 0 Btuh
Il�iFII.TRAITON
Method Simplified
Construction Quality Average
Fireplaces �
HEATING COOLING
Area (sq.ft.) 960 0
Volume (cu.ft.) 7 6 8 0 0
Air Changes/Hour 1. 0 0. 5
Equivalent CFM 12 8 0
HEATING EQUIPMENT SUNIMARY
MN 55447
93-97
Job #
Wthr Minneapolis/St._Paul AP NIN
Zone Entire House
SUMIVIER DESIGN CONDITIONS
Outside db: 9 5 Deg F
Inside db: 7 5 Deg F
Design TD: � � �B �-
Daily Range M
Rel. Hum. : 5 0 %
Grains Water 33 gt'
SENSIBLE COOLIlVG EQUIP LOAD SIZING
5tructure 0 Btuh
Ventilation � B�
Design Temp. Swing 3. 0 Deg F
Use Mfg. Data n
Rate/Swing Mult. 1. 0 0
Tota1 Sens Equip Load 0 Btuh
LATENT COOLING EQUIP LOAD SIZIlVG
Intemal Gains 13 8 0 Btuh
Ventilation 0 Btuh
Infiltration 0 Btuh
Tot Latent Equip Load 13 6 0 Btuh
Total Equip Load 13 8 0 Btuh
COOLING EQUIPIVIENT SUMMARY
Make Make
Model Model
Type TY�
Eff ciency / HSPF 0. 0 0 COP/EER/SEER 0. 0 0
Heating Input 0 Btuh Sensible Cooling 0 Btuh
Heating Output 0 Btuh Latent Cooling 0 Btuh
Heating Temp Rise 0 Deg F Total Cooling 0 B�
Actual Heating Fan 0 CFM Actual Cooling Fan 0 CFM
Htg Air Flow Factor 0. 0 0 0 CFMBtuh Clg Air Flow Factor 0. 0 5 3 CFN1/Btuh
Space Thermostat Load Sens Heat Ratio 0
MANUpI, J: '7th Ed, RIGHT-J: V 1 3. 0. 0 5 S/N 110 8 9
Printout certified by ACCA to meet all requirements of Manual Form J
e
default Job# Zone: Entire House 93-97 a,
MANUAL J: 7th Ed. RIGHT-J: 3. 0. 0 5.- S/N 110 8 9
�
1 NameofRoom Entire House P7illson
2 RimningFk Ex�wsed Wap 128. 0 Ft 128. 0 Ft Ft F� �
3 RoamDimensirnis,Ft 0.0 C 40.0 x 24.0 FL x F� x Ft
4 Cei6tgg, Ft Condit Option 8. 0 d 8. 0 heat_only
TYPE OF CST HTM Area Btuh .4r� B� � B� '� B�'
�OSURE NO. Htg Clg Lc�th Htg Clg Length Htg Clg I.angth Htg Clg Length Htg Clg
5 �� a 12C 8.1 2.1 1029 "�"�"' ""'°' 1029 �'"""' ""'°" �' �' � �
Exposed b 0.0 0.0 0 '"'°P "°�"w p 'ws«° ww°e s�w eae •ws wree
Walls mtd c 0. 0 0. 0 0 �° w'Aee� p ew�s rae ss�ee ws� eeor ++�s
PeRitions d 0.0 0.0 0 '�"" �'° 0 '� °� �'� �* � �
e 0.0 0.0 0 °w' 'we'e p .'sew r°'q � arw eesv rware
f 0.0 0.0 p aoow w+s p *e�we e«a snres a+►e wwa ww
6 Windowemid a 2A 42.8 ""� 110 4703 *"'""' 110 4703 •'°'° "uBMi° °M"�
Gless Doors b 0. D '1'"' 0 0 '"**° 0 p **'°iY �'1`*` •�
Heetit�g c 0.0 r'� 0 0 *wa* p p '�w�'4 �are reee
d 0.0 �" 0 0 ��wr p p �rwr r►rw �rar
e 0.0 °r 0 0 'w"' 0 0 "R°' ew° rw*s
f 0.0 e' 0 0 "i°�' 0 0 *°p °'Miy` �
7 Windows mid North C. D 50 i°� 0 50 �" 0 '�°'* �"'
Gless Doors NEtNW 0. 0 0 **'a 0 0 '�"H°' � °°°"` �
Cooling E/Vy 0.0 24 'e'�'* 0 24 "'wo' 0 'as°a� eew'
SFJSW Q.0 0 °�"' 0 0'�"' 0 °'�8 ""�B°"
South 0.0 36 *�'* 0 36 *'°"' 0 '�°�"' �"
Horz 0.0 0 'ew"w p � wra' � � "�'
g ptjierdoors a l0E 28.8 7.6 92 1210 0 42 1210 0
b 0.0 0.0 0 0 0 0 0 0
9 Net a 12C 8.1 2.1 872 7063 0 872 7063 0
Exposed b 0. 0 G. 0 0 0 0 0 0 0
Walls end c 0. 0 0. 0 0 0 0 0 0 0
Partitions d o. 0 0. 0 0 0 0 0 0 0
e 0.0 0.0 0 0 0 0 0 0
f 0.0 0.0 0 0 0 0 0 0
10 Cailing� a 16D 4.8 2.3 960 4579 0 960 4579 0
b 0.0 0.0 0 0 0 0 0 0
c 0.0 0.0 0 0 0 0 0 0
il Floors e 19A 14.0 0.0 960 13478 0 960 13478 0
b 0.0 0.0 0 0 0 0 0 0
c 0.0 0.0 0 0 0 0 0 0
12 In6ltration a 83.5 1.0 152 12697 0 152 12697 0
13 SubtotBtuhI.oss=6+8.±1I+12 °°"� 43730 � ""'°� 93730 '� '�'"'" °"'°" °1°�` °�"�`°
14 Duct Btuh Loss 0"/ 0 � 0°/ 0 � o/ +�se o� a�e��
IS TotalBtuhLos9°13+14 '"""' 43730 � '�°' 43730 � a""'" �'°'�' °�°A' �
I 16 Int Gains: People @ 300 6 °*"" 0 6 °°°° 0 °f°° "`"°°
Appl. (rD 1200 1 "'"*'� 0 1 "°°" � `°'""' "�°°"
17 Subtot RSH Gain°7+8..+12+16 �"' °'""" p °�° °°°° p `��' ,� � �
18 Duct Btuh Gain �°� `""" � �'� �"� a �� � �� �
14 Total RSH Gain°(17+18)"PLF 1. 00 "**4 0 1. 00 "uY°' � '"°°'� �"
20 CFM Air Required e"'w+ p p ew*�' p p'r�"" w�e
Printout certified by ACCA to meet all requirements of Manual J Form
f � d z��3
� � HOUSE HEATING TEST RECORD
ADDRESS 5,�� /rP�'1 � `�/ � APT. FLOOR CITY ��''��`�` ,
OCCUPANT , �et � LS�?/� OWNER
HEAT LOSS DATE HTG. INST.
SOLD BY` HOME ENERGY CENTER INSTALLED BY HOME ENERGY CENTER
Electrical Work By HARRISON ELECTRIC Gas Line By
TYPE OF HEAT GA FA X HW STEAM SPACE HTR. UNIT HTR. OTHER
Model � � O'1 .S —
Serial
INPUT ��J �� -�
THERMOSTAT �''�) � Heat Plug _
Valve �—�
Limit � � �'
L1mit Setting �� �
Fan Setting � ° ! � s�
Pilot Type �� �' l �: �� �—
Pilot Make � �-
Pilot Model R�---_
Pilot Timing i z,x�
L.W. Cut Off - —
Pressure �• S— Percent CO2
Input CFH � c Percent 02_
Stack Temp. 3�a Percent CO .
Fortn 235
'J �
MAKE OF BURNER
Model
Max. BTU Rating
MAKE OF FURNACE
Model
Vent Size �
KIND OF LIN�ER ��— SIZE�� NONE
Draft Hood �� �-�---- Regulator
Filters Size � 6 �'�"S'� SNumber
Chimney Location Inside Outside
Chimney Construc�on p�� � -
Smoke Bomb _ � Wi ' `�
Draft
Door Pressure_
Date Tested_
Company Testing
Name of Tester_
nng
Test Tag
UghUng Inst. °-��
� D
� �
� O
� �
a
� h
�' �
N �
y. -s
O N
� n
� �
o �
� �
0
� h
Q �
0
�•-�
_• �
Oq �
� Q'
� �.
��
� N
�G fl-
o CD
� �
m �
. �
S
O
C
�
D
a
a
<
c�
Q
W
�
�
0
c
�
3
�
�
C1
c�D
�
�
�
�'
i
�
rn
Z
C!1
�
m
n
�
�
Z
�
m
m
�
�A
v
0
�
�
2
�
D �
X �
�
� �
cz
_
m
�
Z
�
�
� a
��
� fD
-t
o �,
� �
CD C.
_
o �
� o;
v —
�
(7
m
0
�
O
�
o �
� �
r �
m �
m �
s
eu
ov
fD
� �
��
� �
0
_ �
D
� m
� � �
� � c
�% \ `�7
� � �
� G
�i 1
V
�
D
� _
� Q
-�i► �
< �
�
� N
(D (�p
�
O �
D ��
N
'D Qo
n�� D
m �
o .±
�C o
C �
O N
� r
�
-�
0
Z
a
c�
�
D
�
n
O
�
a
7
��
Oq
D
N
m
N
L7
d
N
�
�G
m
�
G� G� D '�1 �
� � N � N
.Tl � � .Z7 � �
_ �O. (n tD (np �
m � m � cn d
�- ^ C � fD
�m �� �
� � � �
a�
O � � .-r� a
,� Q. _ 'll �
—c
� � � � �
c �
�
..+
`3�W�o
m � � �
� '~` v
v -�a �
� �
C�D �
� � � � �
N � r-� r W
U1 O O O O �
n�
O O O O O �
� � t� � � �
-a
0
1 a
�
-, -. cn
'� �• N c�D � �
� � � � C �
� wN � � m
� o a � -�
n + n� y o�
o m �
� W �, m ` Z
y � = Q � ,,,
� . � W
d Q: e-i� C� fD
� � o �
�� � � \a
�•po�
� c fls
vi O � � C-
_
fl/ � � N � �U
'D C1 � i17
'D = _"�
c�' fl- N "O
� � � n
� � � �' �
� � � � �
� � O O � �.
� Q �, z
� d o� .o 0
? u � � m
a��3 ��
.� �o �-* � -i.
(�D � 'rt �
-�.�
�.�m �' �
m C� �
n � o
N Q � �
� Q S
� � � �
O„ N N
c, �- �
�
��
�W--�Z
� —I � O
�D c a
— � o
Z =
� �
d
m h
�
va
C
�
�
_
�� n
O _
fi �
01 n
(D
7 �
CD �
�- ^
N
�- v� m
d
o°� m � �
Qoz
� o �
_
0
ai
�
�
�
�
�
�
..�i
rn
�
-�
D
-�
rn
0
C7
O
'--�
�
(v
-D
rn
�
�
z
O
�
�1
�
W
C
�
�
Z
G�
C
Cn
m
�
D
Cn
�
S
�
�
V y
�
�
�
--i
rn
N
n
_
m
v
C
r
m
O
Z
m
�
�
�
V � � n
� Q W �
� cp �-' �
(It `_� C �
V �
N��'-n
W Z N �
� N �
� �' � m
W C -G
N � �
z�
m �
m
n
�
O
z
�
<
N
a �
.o z
�
r
��
��
L� Z
rn�
.� �
� �
O�
Z �
Z�
v .�
a�
�
c� -zi
vz
-i �
O =
O Z D
W Z -�
� ��
� � �
n m0
Nr
aZ
iii
� <
r_ o m
��+ � Z
^� � r
\ n
� �' o
1 , Z
IV
�
�
�
�
�
�
�
�
�
<
m
O
�
�
�
c
d
� �
N �
O �
0
N
�� : a�ea :�t8 pau6ig
I �O� JNilt/3H
�;
ui �a�aweia }� y�6ua� � �y6iaH ao}�auuo� �uan £# a�uei�ddy
ui �a�aweia � y�Bua� � �y6iaH �o�auuo� �uan Z# a�usi�ddy
ui �a�aweia �} y�6ua� }� }y6iaH �o}�auuo� �uan �# a�uei�ddy
�a}aweid ;y6iaH �uan ad�(1 �uan uowwo�
_ rlu � --- ---- - sa�uei d � o
-- -- -- ln f��l� Z- - .I I l 1
�o pa�sissy ue� �ndul f118 ad�l E# �uei�ddy
�o pa�sissy ue� �ndul f118 ad�l Z# �uei�ddy
�o pa�sissy ue� �ndul f118 ad�l �# a�uei�ddy
�sapo�;ua�n� �ad se ��a�e�edas
pa;uan pue �uan uowwo� ay� wo�� panowa� uaaq sey a�uei�dde ue
�a}�e �f�a.uo� pa��e�sw pue pazis s�o�auuo� �uan pue �uan uowwo� ay� s�
�sa�uei�dde }�e�p �e�n�eu pu� pa�sisse ue� �o� sa�qel 6uguan
a�ewn� �e.�ua� � tio6a�e� yWy�-y�y apn��ui saop siy,l �suo�}e��ads
s�a�n�e�nuew pue sapo� �ua�n� ay� s�aaw pue �(�qwasse pa�si� e si }i
�ey� sa�uan �(qa�ay pau6is�apun ay� ' , . , uayM
�suo���r�ads s,�a�n}�e�nuew pue sapo� 3ua�n� ay� �aaw o;
pa��e�sw pue pazis aq ��w► �, . , o; pa�mba� uayM
�suoge���ads s�a�n�e�nuew pue
sapo� �ua�n� ay� �aaw o� pa��e�sw pue pazis si , . ., ayl
�sa�uei�dde }�e�p ��n�eu pu� pa}sisse
ue} ao� sa�qel 6ui�uan a�ewn� �e�ua� � tio6a�e� ywy�-y�y apn�ui
saop sit�, •suo�e��i�ads s,�a�n�e�nuew pue sapo� �ua�rr� ay� s�aaw pue
�t�qwasse pa}si� e si �iun �uawa�e�da� a�.�} �ey} sa�}uan os�e pau6is�apun ayl
�uo�}euiuua} pue snnoq�a �o �aqwnu 'y�6ua� `6uizis 6uipn��ui suo�}e��i�ads
�aan�e�nuew pue sapo�;ua�n� ��e s�aaw pu� ����se�d si wa�s�(s.6u�}uan a41,
I •pa�mba� a�aynn paddo�sa�� pue pa}�oddns �(�a�n�as si pue
`suoi�ru�sqo `uog�oua�ap `�sru woa� aaa� si pu� pawwexa uaaq sey 6uguan
ay� �ey� sa�uan �(qa�ay pau6isaapun ay� ' ,. , uay/�/�
a3NZif1132i 39 ��IM N011d�l�ddd
JNINZIf1813f1� JNI�b'ld3�l N3HM NI a3��1� 391Sf1W MO139 3H1
�
Bbi.11dli]g
It�.spe�tions
7��-s�z-��aa
srrE ai,�ESS��
7�I15 AAPLI�AN'f 1S.
PROPEk'1''Y bwi�ER!
TENAIYT
CONTItACfQR
SU13MiT A C�PY OF
70UR STATE LICENSE
VJI'FH APPLICATION
FRU![�ERTY'fYP�
PER➢VIIT �'YPE
OP'
C d `� -
t�
�uILLIING
1�SIDENTIAL �►,1PPLI�ATIUN
CITY O►F FRI�LE"Y
r_ Yovrc �-MatL a,uuKH45 _ .
�►'or17� v���d� AV t... ...--
C] oWNER �[S.'(?IV'fItACI'OR
NAME'--... e.srC �.�
ADDRF.SS: ��I T_Y° �1°) I��
rnoxc: _`�_ (� 3 _ 7Ft�, '� —
NAI�E: 1 vl(.�-¢J ' C,-Fy,hL �
STATE LIC:l�T1S� � O
ADPRCSS: � LO�, � ���
P UNE �•i�— �� � �/ O�' FAX
SINGLE �F�M fiTE�VE'flAl�.i�'71c�.�G'f#)A1 -
� MILY/NHN� CC7N5'CFtUC"Tf(3N
� ADDTI7tiN p GAR.AGE'SIIED
❑ BASEMENf TWISId ❑ RCac'ir
CI DE�K L7 SlD1Nr,
O SWIINMMC7 Yi�(
Cl N�W O AD ()N
�XP DATE __ . .
o�-d.. �!��9c1�i�r �
��� f �7cy
�°' � � � �..,. _ `
� - . ...--
57'UkI�S
O WWL�(3W5
❑ DRAIN TII.F�
�;I !71'HF,R
,9�' �,�.�o °%3
Pesmit No.:i
Received .F3y:
1)�.te Rec'd:
, i a i r#�. .. I� �5���.
_tiTATE%� �P �S%a �
D MAINTGNAiVf;PJRF:PAIR 0 REMODELIIV(3
o�SCRrBF wORK BEWG DOATE: j �y�— �,r��,��� ,,,�� �-D� �zs�reun )&�!c_ �
- _..,.,,_,_. '
SIZE OF 1MPl�OY�MENT LLIJ{;'['H WIDTIi HEIGHT S. N'`t.
R FIN ❑ HOUSG ONLY
YUMBLT� Vr SQi1Ak�S _. ❑ HOl1SE & CiARACiE F�lp�$�'�TyT REMQDGLINCf 5UH(V,,,{�'I'•
G�� CJ ATfAi:HL�UGAttAGE
PRQPOSED ST�: ❑ DF.TqC,.I-J�I) fiAI�ACiE
E'kOl'05E1] HE1tiHT:
, ) P
❑ Yu9yl ❑�,�
0 �u�� C] Trim
G Othcr 0 Fagcia
WINfXfW!�
iPl EXI3IZYQ 0[�IVIId�S }�c; ONn WC Th7Af OF Wl tN�jU.y'
QR FQIt NF: W UI'ENllVGS-DESCRQ3E SIZE ()N oe �'ih � i� � a � e1�n.�
(}PENAIG �I�IAANNUES &
'FYFC C)B +.�lNl]f34�+TU RE 1Nb"fALL�D � I�JL'A7BEROi' WRVCw��VS
AI,L FEES ARE DA1�11 U!V
AL dOB V
LUDINC T1i � CQST OF
U.B.0 FF;E SCN�DtJLE)
1. �xistiag Floor Plan �
2. Pn�ased floor plen
3. List uf struc�urut m�ml�o�s Eo 6p �.sed
FOR NLW CONSTRUC.`T1tIN INGI.UDING DCCI{S,
AUIYI'1'I('1NS. & POj�CHFS_$�,►RA4I7':
1. Sit� Plan/Survey shnwing tho oxisting steucnu�es
nnd f+�l� 1�1cct.
2. Twi� eeUc of wastruotio�i uLgns
3. Eoor�y Galculatiu�
AND MATERIALS:
Permit 1'�ee „ See I3ack Pagc; for Fee Scl�ule
Plar� Rev�ew �. � 6S°/n �f Buildiu� Permir Fc�e
Fir� Surcharr�ee $ .001 times the m�al jub valus�nn
�'�'8e � . �.( .Q005 k l��rmit Valuution Nlinimum $.50
Lice�se Surcha�'ge � .() $3.00 (5tatc; LiCensed Residential Conir�ctors)
SAC Chsrge $ �155Q per SAt� Unit (Pl$ns to MWGC for determin�Cion)
Curb Cnt �Qerow $ il + 61� ° 8 x$2] =$
Erosion Contral $ $450 Conserva,tinn Plan Rvview
�ar6. Fee $ Fee Determin�� by �n�ineering
S�w�r Main Cbarge $ Agreement necessa�y () Non Nacess��ary ()
Total Duc $ ltilak,e checks �yable to: City of �ter� Attach 5tipalariqns. ,.
' ,.,
7'HfS iS AN APPLICATION rl�R A P�IiMrr-nrUT VALIn UNTFL PR�CGSS�u
T hereby apply for a bulldin� }x�rmit and I acknowledge that th� informatian above is cortiple,�te and accurate; that the worlc wiil be in
conform�nce with the ordlnance� and c;odes af the City of Fridley �d wieh tHe Mi�mesota Construction Codes; thal ! understand this ia not a
pennit but onty an application for g permit and work is not to start witliout a permit; th�t the work will be in accardanee with thn a�proved
p@an in the c;�s� of all work w� 6�s re ' w d a�ppruval c�fi plans.
SD�'NATU�IE UF :LN!'LICAN'C .,_ PRaNT NAtv1E d G ��DATf-: /� �
T
7d Wtic�:t� 9��� 9� °�anr� L82ZZL�9Z: 'ON XH� �a[P?a� .t� h�ta: Wp�
. _- _
.. _�. _...,_
.� u.ixuua�
:nspections
163-�72-3604
'�
i17'E ADDRF.SS ��' i �
"HIS APPLICANf IS;
PROPERTY OWNER!
T�NA1�Tr
SUBMTl' A CAPY OF
YOUR STA7E LICII�TSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
�r�r� oF woxx:
From: unknown Page: 2!5 Date: 7/6/20071:33:46 PM
D V iLLll�l l7r
RESIDE�T'I`IAL APPLICATION
CITY' UF FRIDLEY
E-MAIL ADDRFSS
L7 OWIIER
NA1vfE: DOX �
ADDRESS:�,�
rNn�• �'T l�r� �
5TA'i'E L10EhISE �i ipCZ� �- EXP DATE
—lla t'3 _
O BASEMENT Fll�iISH O ROOF
O DECK ❑ SII71NG
/ O SWA�AA
DESCRIBE 9�ORK BEING
NUNBER OF SQUARES
CAItAG�S
PROPOSED SQE:
PROPQSED F�iGHT:
}5�DYlVG
� Vinyl
❑ Aiumimm�
!3 Other
❑ HOUSE & GARAGE
D ATTACHED GARAGE
O DETACHED GARAGE
��
O Trim
CI Fascia
VvINDURrS / •
1N DQ517NG OPDdDdCiS OYes LS�l�lo IACA7'ION OF VUtNDOWS
OR FOR NEW OPETtINGS-DESCRIDE STZE OF �%%'� J�� � d� r/�
OPENWG CHANGES & _
a��.��� -� l�-�
r•�-
Received By:
_
�i I7t�V1 - STA'
�
❑ DRAIIJ '
D OTHBR
ALL FEES ARE BASED QN VALUATION, IN'CLUDING THE COST OF l
(USING TI3E 1997�.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �j . pC�p,a�Cy
32-
� . � �,� [ .� nt � � .t�' �
�
HEIGHT
$ASEMEN!'1Z.�=MOD�t TNt� c�tat.nt�
1. F,xisting Floor Plaa
2. Propos�d floor plan
3. List of snvctural members to be used
Ft
FOR NEW CDI3S'fRUCT[ON INCLUDINO DECKS,
.A.DDIi70NS & PURCHES SUB�;
1. Site Plm�lSurvey showing tlu mtisting structttrec
ac�d propctsed pmjtct,
2. Twa sets of wnsvuction pfans
3. Encrgy Calculations
���I �l�'�I:�
p�m�t Fee ��'c� 0(} 3ee Back Page for Fee Schedule
Plan Review $ 65°/a of Bvilding Permit Fee
Fire Sur�harge $-/- �:.�� .001 times the totai job valuation
Surcharge $ .?/ .0005 x Permit Valuation Minimum $.50
Li�e Surcharge $,T; (�`j� $5.00 (State Licensed Residential Co�actors)
SAC Charge $ $I550 per SAC Unis (Flans to NlWCC for detenmination)
Curb Cut Fscraw $ fi + 6 ft ° ft x$21= $
Erosion Control $ $450 Conservation Plan Review
p� F� $ Fee Determined by Enginesring
Sewer Main Ch�ge $ _ Agseement necessary () Noa Necessary () •
Totat Dae r�,� ,/� Make checks payable to: Ciiy of Fridley Attach Stipulations
THIS IS AN APPi,ICATION FOR A PERMIT NOT VALJD CRdT(L PROCESSED
I hereby apply for a bcrild'uig pemrit and I acknowledge that the information above is complete and accurate; that the work will be ir.
confarmance with the ordinanrces and codes of the City of Pridley and with the Minnesota Cons�ction Codes; that I understand this is not �
perrnit but only an application for a pertnit and work is not to stert withont a permit; that the work will be in accordance with the approved
plau in the case of all work h' requ'sres eview and approval of pians,
SIGNATiJRE �F APPL[CANT PR11JT NAME_ ��.! �-,R�%/� '�JL IfJLLI �I %� DATE / ''" �p "'C3 �"
� �
....: ..� .., _�. _..,_
m
From: unknown Page: 3/5 Date: 7/6/20071:33:47 PM
�1V.:I ♦ 1
ALTER UFENIlVG (W/HEADER CHA.NGE)
JUB# 1417a, HITDEK
Location in home:� t�� ��-�..- •
Removing: � u�v� ��2 �, o� � l�v✓���v✓ •
Size of new Patio Door: (,� ` x��'`
Header size: �
Dia�ram (Please do a dra.wing of plans for new ��+��
installation.}
.
� C�'> �� h�
_.._�,_:_..._._._______�..__._._..__.--_-- . .............._........_.
_._.._
, .,.........__......_._ ... . ... . .. ... . ..
. �p rl
� - �h r o ��-- �-� �,,)
�_� � � �GZ �/
� �`"�"7. � -r� 01
r-�
��`%�r�c`.,r�
" � From: unknown Page: 4/5 Date: 7/6/20071:33:47 PM
...._ ..� ... _�. _..,_
�9
�..
�
�
�
-.._
�
�
�
�,-ia
�
.�
�
�
_.,
�^�
�
�
M
1
—..,
-,
Do
�
.�:
40
�
�
�
�
�J
0'�
_.�... ..::.,.... :_�.:,.,-�i-.., z.:-�-__-.,.-�.-� -y,--..
a+:�•'�.it."i�+°t.,^�,. .�.:i'-'fr:a: t' I_. .. --. ...,
^
.�,
'
�
�
�
�
�
�
�l
�
"`�`
r- �
. . ..
. .. �p.. � . �..:..� . � -:.:. .