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PRE 2010 DOCSCity of Fridley Appli n f r end 6--m Por0m Dept. of Bldgs. Phone M-3430 DESCRIPTION OF WORK Number, Kind and Location of Fixtures qp OGAS ■ �n WATER MTA. ELIC. Base. 1st 2nd 3rd 4th • Futuro Connection Openings + Now Fixture, Old Openings Connected with Bawer spool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................. _ _. �_ x $2.00 $ % N Future Fixture Opening ........... x $1.50 $-- New -New Fixture Old Opening.....:.... . x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater (Up to 99,000 BTU) .... x $3.00 $ 3 a New Ground Run Old Bldg........ x $3.25 $ Electric Water Heater .............. s $2.00 $ 3AS FITTING FEES: NO. RATE TOTAL' Ist3Fixtures ••••••••••..••• x$2.00 $ Additional Fixtures .................. x $ .75 $ a City of Fridley: The undersigned hereby makes application for a permit for the- work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and ' hereby declares that all the fact and representations stated in this application are true and correct Fridley, Minn._ Owner Kind of Building Used as To be completed about � '7 y Estimated Cost, $ Old—New. Building Permit No. Permit No. O D Signed By - Business Phone No f,-� - 0 'Y'7 L ROUGH ' FINAL—L- - j 7 S Gas Range to 199.000 BTU.. . x $5.00 REPAIRS A ALTERATIONS—Refer to Coda .50 State Surcharge Description..............................................3 TOTAL FEE 2, 0 0 5v 0 i suBJEcrERM City of Fridley `" 12697 AT THE TOP OF THE TWINS BUILDING PERMIT CEIPT NO. `- _ _ COMMUNITY DEVELOPMENT DIV. � PROTECTIVE INSPECTION SEC. IL CITY HALL FRIDLEY 55432 ,`J NUMBER REV. DATE PAGE OF APPROVED BY "'A 612-560-3450 910-F15 18/29/74 JOB ADDRESS 288 RK Liberty Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 51,52 6 Spring Brook Park Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Richard 0. Jacobson 205 Barry Avenue So., Wayzata 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Swanson Construction 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK Cj NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 34' x 24' Dwelling and a 22' x 24' Garage 9 CHANGE OF USE FROM TO STIPULATIONS _ Provide a verifying survey before capping structure. Provide a hard surface driveway. SEWER LOCATION: 101' East of Manhole (E. Inv. 845.50) Wye Elev: 846.01 Top of Footing: 849.01 Minimum WATER LOCATION: 10.2' East of Sewer Service SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 R-1 816 + 564 21,600 Total ANY TIME AFTER WORK IS COMMENCED. NO, DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $25,82.2 12.91 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE P?RO OF ANY OTHER STATE OR LOCAL LAW REGULATING CONS R THE PERFORMANCE OF CONSTRUCTION�la $40.00 $300.00 C PLAN CHECK FEE TOTAL FEE $352.91 SI NA RE OFCONTRACTOR ORAUTHORIZED AGENT (DATE) WH NPR PER DAT THIS IS YOUR PERMIT'' BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNERS NAME: RICHARD 0 JACOBSON BUILDER: SAME ADDRESS: 205 BARRY AVE SO WAYZATA ADDRESS: SAME NO:. 288 STREET: LIBERTY STREET N.E. FRIDLEY. MINN. LOT: 51 & 52 BLOCK: six (6) ADDITION: SPRING BROOK PARK CORNER LOT: INSIDE LOT: XXX SETBACK: SIDEYARD: Applicant attach to this. form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: RESIDENCE..... HOUSE Front: 34 Depth: 24 Height: Upper floor 816 Square Feet ........Family Room Lower Level 564 Square Feet Square Feet: Cubic Feet: Ac r ---a DT.. Garage — j Front: 22 Depth: 24 Height: 10 feet Square Feet; 528 Cubic Feet: Type of Construction: WOOD Estimated Cost: $ 27,500.00 To Be Completed: Approx. 12/15/74 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: 8/23/74 SIGNATURE (See Reverse Side For Additional Inform v u+ _� �, </ 560-3450 Cit ANOKA COUNTY 6431 UNIVERSITY AVENUE NE FRIDLEY, MINNESOTA 55421 August 6, 1975 Swanson Construction 466-83rd-Avenue N.E. .Minneapolis, MN 55432 Re: Verifying Survey for 288 Liberty Gentlemen: Please be advised that of this date, we have not received a verifying survey for the above captioned house. We would appreciate it very much if you would get this survey_ into our office no later than September 1,.1975. Thank you for your cooperation in this matter. Yours very truly, DARREL CLARK - Community Development Administrator DC/cs SUBJECT P O. City of Fridley o 165.51 AT THE TOP OF THE TWINS BUILDING PERMIT _ i � ' COMMUNITY DEVELOPMENT DIV. `ti: ------ r i � PROTECTIVE INSPECTION SEC. y `•� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ----� ��'�-� j 612-571-3450 910-F15 4/30/82 JOB ADDRESS 288 Liberty Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 51-52 6 Spring Brook Park Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Marvin Dellwo 288 Liberty Street N.E. 780-1325 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK Ela NEW x ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 14' x 10' Deck 9 CHANGE OF USE FROM TO STIPULATIONS Changes are marked on plan. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED$700 $. 550 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $15.50 SIGNATURE OF CONTRACTOR OR AUT IZED AGENT (DATE) WHEN PROPERLY VALIDATED THISIS YOU PERMIT BLDG INSP t)A E SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) CITY OF FRIDLEY Effective Aug. 1, 1961 APPLICATIM FOR RESIDENTIAL BUILDING PEIU4ITS (New, Alterations, Additions, or Repairs) � G?, ADDRESS: zV- TEL N0: �2 ,fib / >5 a BUILDER ADDRESS: TEL NO: Construction Location - STRI3sT NO: =� �-k BEET: LOT:, 51— $2-. BLOCK: ADDITION: Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: /a Height: Square Feet: Cubic Feet: Front: Depth: Height: Square -Feet: Cubic Feet: n �Od. OTJ Type of Construction: e� Estimated Cost: $ �6 4o Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: SEE REVERSE SIDE OF SHEET . Mie undersigned hereby makes application for a permit for the mork' herein specified, agreeing to a3o ,all work iia strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. r DATE':: -�/— C��- k g SIGNATUFE: Stipulations: 0 -4? -Q- 0>0PL, �a� WILLIAM A. CARLSON, PRES. 2324 WEST 11Oth STREET 888-2084 55431 SURVEY FOR: RICHARD JACOBSON CERTIFICATE OF SURVEY a Aft" we. LAND SURVEYORS Licensed, Insured & Bonded S' ;' ; ,9 4 ,P 7-Y —57'i2E-4 T I I � I Jt.L7 • '* /✓x.2.78 ,y 'o \ \ tJ t , i ,- 30 30 LEGAL DESCRIPTION: LoiS51 AND 52, BLOCK 69 SPRING BROOK PARK. WE HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF ANY, THEREON, AND ALL VISIBLE ENCROACHMENTS9 IF ANY, FROM OR ON SAID LAND, AS SURVEYED BY US THIS 28TH DAY OF AUGUST, 1974. MINN. REGe No. 5648 SUBJECT PER City of Fridley 2 0 3 0 8 AT THE TOP OF THE TWINS BUILDING PERMIT _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. y 1 CITY HALL FRIDLEY 55432 IL""� 0 "'j NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/19/90 JOB ADDRESS 288 Liberty Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 51,52 6 Spring 13rook. Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Peterson 288 Liberty Street N.E. 784-9328 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remove Existing 101,x 10 Deck and Cons=truct a 141 x 10 RIKKK Addition 9 CHANGE OF USE FROM SEPARATE Prpawriff STIPULATIONSYVIKINGN6-1-1 F4R See notations on flan. 6-1-1 PLUMBING AND SIGNS. On all new roofs or fear -offs and replacement, roofs, State Cade requires that 2 layers of 15 I6. felt, mopped together, be installed to a point 24 inches Before"'g up from exterior wall line digging approved underlayment membrane use of other all utilit g cal! f41 locafiREQ ons �4Y U'Rt6 By LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $5 F 00.0 $4.95 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $117.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $121.95 S ATURE0 ONT ACT O TNORI2ED AGENT ,p(�DATE I JA WHEN PROPERLY VALID ED THIS IS YOUR P ,,IT^^ dT SIGNATURE OF OWNER (IF OVANER BUILDERi iDATEi BLDG iNSP LATE NEW ADC ADDN AMER [ J R-1 AND R-2 Building Permit Application i&rdL> Ste= 7-z . Effective 1/1/90 Legal Description:LG I a S ac �p r i �(00 I Owner Name & Address: i ar is i" 2 ger Tel. #_Vcf— q3 Contractor: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DEOF HT1' 'r f9�x LIVn4G AREA: Length N / Width (� Height a r/ Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Ieng Width Hgt/Ground Sq. Ft. Corner Lot [ ] Inside Int [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: -f-)C?O OTL Estimated Cost: $��9eO-00 Approx. Completion Date: Proposed Driveway Width If New opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: APPLICANT: Tel. '73 �� CITY USE CINLY Permit Fee $% Fee Schedule on Reverse Side State Surcharge $ ,9a $.50/$1,000 Valuation SAC Charge $ $600 per SAC Unit Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ J Not Necessary L l To►rAL\ $ STIPUTATIMS : WILLIAM A. CARLSON. PRES. 2324 WEST 110th STREET M-2084 55431 SURVEY FOR: R (CHARD JACOBSON CERTIFKATE OF SURVEY ANSM LAND SURVEYORS Licensed, Insured & Bonded ",6,6,v 7-y —5-7-1eez T Cox :1 to I pocr 3G, co LEGAL DESCRIPTION: Lois51 AND 529 BLOCK 6, SPRING BROOK PARK. ft HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE LAND ABOVE DESCRIBED AND Or THE -LOCATION OF ALL BUILDINGSt IF ANYV'THEREONV AND ALL VISIBLE ENCROACHMENTS9 IF ANY* FROM OR ON SAID LANDO AS SURVEYED BY US THrs 28TH DAY OF AUGUST 1974e 1�' U HEATING AIL=®USE HEATING TEST RECORD AIR CONDITIONING lwhiffl �AND ELECTRIC. INC. ADDRESS �c�j L i!J PA )�V S OCCUPANT�.Zh�- 4&1,M fQ HEAT LOSS DATE HTO. INST. SOLD BY / Electrical Work By lz " 9' TYPE OF HEAT GA FA _L, -HW STEAM® SPACEHTR.— GAS DESIGN MAKE NZr i Y_ THERMOSTAT Valve Umft Umit Setting Fan Setting _ Pilot Type _ Pilot Make Pilot Model CONVERSION MAKE OF RURHER Model Eche. STU Rating MAKE OF FURNACE PA,:021 Pilot Timing 5! 5 ' r . r . L. W. Cut Off Prassure Percent CO, Input CFH IeA Percent Oe z Stack Temp. 6�Lo Percent CO a Form 235 Smoke Bomb Wlrinp Draft Test Tag .err. &..x Door Pressuro Ughting Inst .", Lsu e�i✓o c Date Tested Ei — I F % Company Testing Name of Toster y, CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432. APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING -SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning — All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $(�� $10.00 $ $10.00 $ $10.00 $ $ 25.00 $ State Surcharge TOTAL FEE JOB 0 1, Effective On January 1, 1997 .V_ ti�5 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. ,�1y rl 1 � 1997 M i ke, lri m. 61) BUILDING USED AS -11a? ESTIMATED COST 1 4-7 I .C�D J PER 'I`f I /J&169) DESCRIPTION OF FURNACE AND�,OFOBURNER � R $ No, of Heating Units_ Circle One (Steam) (Hot Water) arm A Trade Name g i Q,n Size No, 3g5Lt� U �(��D BTU HP EDR $ Fuel nat"a, Total Connected Load 50 Burner Trade Name Size No. Zr). GO BTU HP EDR . MINIMUM FEE FOR ANY HEATING/COOUNGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining propgrty owner. Mr55304 Tel No. %57-4Qa O"O Approved By Rough—In Date FILL OUT BACK SIDE - R STACK VERIFICATION ON REPLACEMENT FURNACE Final Date Remarks: List ALTERATIONS Being Done: ca 0-4 06 16. HEATING CO: Signed By: Date: NAME HTii►. AIC ELECT., INC. I CEfipALAVE." M" WM CBMWgEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or suck: 1. Has been carefully examined Yes No ( ) 2. Is free from rust or deterioration Yes o No ( ) -3. Has no foreign objects lodged within Yes O No 4. Is securely supported Yes No (. ) 5. Meets all current Code requirements for size and total BTU's connected Yes (} No ( ) 6 Has total heating BTU's of /0-7 is rR All other BTU's TOTAL BTU's % 07 ®oo 7. Has a liner. been provided for water heater Yes {) Nof 8. Has combustion air been provided for water heater Yes No ( ) Remarks: List ALTERATIONS Being Done: ca 0-4 06 16. HEATING CO: Signed By: Date: NAME HTii►. AIC ELECT., INC. I CEfipALAVE." M" WM City of Fridley Building Inspections Dept. y 0757 Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 Mechanical Permit# Residential Application City of Fridley See Back Side For Required Information Site Address: Z 60 &,,` is: (cirice one) Owner Property Owner: _M CY-i / A I'm Address: 2813 L: bei St - City: F-A� l Phone:--7611— 7Cell: Contractor Information Company Name: Contact Person: Address: 67,YA LAIC tA4 Ale city:AA0j2it '# jvvx Phone: -70- gib Q&&7 Cell: Email: State: IWA� zip: S57,V3 Z Fax: Fax: MN Bond# & Exp Date Type of Work (circle one): New �ealacemeW Alteration/Remodel Detailed Description of work: Z J 1ti vIk rtk-j &'fjW0ic A/c (Als r - ®z N Equipment Installed: MFG: (d,*y%X Model: HS Z9-0 z-41 Slze/Bly: zyj oz MFG: Model: SizeBTU: MFG: Model: Size/BTU: Please check all that apply: _Fireplace (gas) $15.00 New Gas Grill $10.00 X( A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 to Air exchanger $15.00 _Fumace $35.00 _Pool Heater $35.00 _Air $35.00 _Gas Dryer $10.00 _Ventilator $15.00 _Boiler Liner $10.00 _Gas Piping $10.00 _Chimney Duct Work $10.00 _Gas Range/Oven $10.00 Permit Fee $ DCS Minimum fee $15 or 5% of cost of improvement Surcharge 1 0.50 whichever is greater + surcharge Total Due i_125 , �5d Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in case of all work which requires review and approval of plans. Signature of Appli Approval Inspecto Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMESIADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEWIEXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane MGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. ]MC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations Building $, �S BUILDING $ Permit No.;4 Inspections Surcharge RESIDENTIAL APPLICATION Received By: 66, 763-572-3604 SAC Charge CITY OF FRIDLEY c VJV 13 ff / l —l3 —0 7 PAU L� &' SCV10CA forJ5rP(JC770(J .GAM DATE YOUR E-MAIL ADDRESS SITEADDRESS Z8$ L(6&&r7 Sri¢ -6-C �i�-t PL, `l, tAN 5S,503 Z $ Sewer Main Charge $ THIS APPLICANT IS: ❑ OWNER *CONTRACTOR PROPERTY OWNER/ NAME: /✓1 /xc -f jt(-(- TENANT ADDRESS: Z,5 L6 15-6 AI `9 S IZ - CITY p , G /`—r Pt—G 4 STATE_ IP_5�4S Z PHONE: -7%) '7Sa-04)? CONTRACTOR NAME: Se ✓16LA STATE LICENSE # 0 7 S Z- EXP DATE 3 3 ��5 S� /J� CITN 66 ML STATF��ZIP SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION ADDRESS/"// /�G<��5��/�' PHONE7& 3 J( G Cf FAX G . 5 4,;44-117 O PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ■ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW 11 ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: AC,470W:VR6P 6r G .1' SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES gHOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITION& & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes []No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS 3 ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $, �S Plan Review $ Fire Surcharge $ -3,11 Surcharge $ 1.6e9 License Surcharge $ `51177 SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work wilich r �irrev' wand approval of plans./�e �]SIGNATURE OF APPLICANT PRINT NAME ! 0 / �v F51611/644 DATE/ �/J Building BUILDING Permit No. 4Co Inspections RESIDENTIAL APPLICATION Received 763-572-3?604 CITY OF FRIQDLEY Date Recd• D727DATE IZ s/J -D 7 f YOUR E-MAIL ADDRESS / �UG �/� EU�� s�2yG�0� • CSM SITE ADDRESS Z$ 51—lzee % THIS APPLICANT IS: ❑ OWNER WEONTRACTOR PROPERTY OWNER/ NAME://c fi f7 L L T W M II o ADDRESS:: ?-at Lld6-i«? STREET CITY fid(�LJ STATE) _5.45� Z TENANT �e $5.00 (State Licensed Residential Contractors) PHONE: 7&5 I So V/07 CONTRACTOR NAME: SEV/y" Gys`�1��/Lt�G?ars 4-_ 4. . /NG, Curb Cut Escrow STATE LICENNSSE # V 7gj Z_ EXP DATE 3 3l —rl��$ SUBMIT A COPY OF L 7T��jI'� G �!'�S�/� SE% NE CITYG. 06r&i. L- STATA� IP MOI' YOUR STATE LICENSE WITH APPLICATION ADDRESS:! 6 ?i-43 1 i� Wo ry 4 3- �'f- 17o Park Fee PHONE FAX ! PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE $ ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS �1 Make checks payable to: City of Fridley Attach Stipulations ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: 1,ArA 4-1— SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES 13 ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS IN EXISTING OPENINGS 41Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & a J TYPE OF WINDOW TO BE INSTALLED C/ NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATIONS OCCUYANUV 'l YYE Permit Fee $ of 5 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ 5-, �e $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ / `%fl. �1 Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work Mich r a-ew and approval of plans. // SIGNATURE OF APPLICANT � 7ZPRINT NAME / �U� ��v `�� DATE S [ V/J -0 7