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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: La....:, .......... Owner .............I....... ............... Address ...... ..................... N® Builder ... Address.................. ...... ................. LOCATION OF BUILDING No. Street .... ...... Part of Lot ............. ............... Lot Block ..j ............ Addition or Sub -Division .. Comer Lot .......... Inside Lot ...X ....... Setback 3gnSideyard /0 ... ................b-' DESCRIPTION OF BUILDING To be Used as. Front ODepth .311eight :Kj Sq. Ft. Front /V..4> ­Depth j.7: Height "Sq. Ft Type of Construction ................... Fiat cost. 9..... To be Completed Ile In consideration I,iof the issuarip.ql,to me of a permit to construct the building desribed the proposed work in accordan VvIth the description above set forth and in compliance ordinances of the city of Fridle Cu. Ft. ./4; o74 / / 9ft Cm Ft. ja.;.o .................. , I agree to do all provisions of In consideration) of the payment of a fee of $..P. ., permit Is hereby granted to ....... .......... ................... ..... to construct the building or addition as described above. This p is granted upon the express condition! that the Person to whom it is granted and his agents, employees andW �rkmen, in an work , done in, around and upon said building, or any part thereof, shall conform in all respects t the ordinances of and mo of buildings with - Fridley, Minnesota regarding location, construction, alteration, maintenance, repair in the city limits and this permit may be revoked at any time upon violation of any of 41 provisions of said ordinances. ........ Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plu rr� bIng, gas heating, sewer or water. IlBe sure to see the Building Inspector for separate permits for thew Iterlis. City of Fridley, Mian.. X? 7599 BUILDING PEB:IVIIT Date: &' 27 z 1965 Owner: Cameron Legis Builder Metro Builders t, Inc. Address 67,40 Madison St. N. E. Address 2909 Nicollet Ave. So. LOCATION OF BUILDING No. Street 1 ulison St. N. Be Part of Lot Lot LBlock ,5� Addition or Sub.Division Rice Creek 'terrace, Plat 6 Corner Lot Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost $30000-0-0 To be Completed Storm Damage Repair In consideration of the issuance to me of a permit to construct theproposed work in accordance with the description above set for ordinanoss of the city of Fridley. , I above I agree to do with ail provisions of In consideration of the payment of a fee of $-10.M—, permit is hereby granted to Xet= Builders t nQ a to construct the building or addition as described above. This permit is granted upon' the express condition that the person to whom it is granted and his agents, employees and workmen, is all work done in, " aro�md and upon said building, or any part thereof. shall conform in all respects to the ordinanoPs of Fridley, Minnesota location, conatruct[on, alteration, maintenance, repair asci moving of buildings wiordiaan a city ]imits� permit may be revoked at any time upon violation of any of the Provisions of said NOTICE: 1W permb den not cover the conetruedon, huftfladon for whing, ppb& an hosting, ower or water. Be own to we the Building iffier for npmft perm6e /or thea Nems. AMLICATION FOR BUTLDIN+^ PEP.MIT CITY OF FRIDLEY, Mi -M-7- 10TA OWNER'S ���(���''� Street ���,•.�� ADDRESS 62 Part -ADDRESS LOCATION OF BUILDING , No. ���(���''� Street ���,•.�� Part of Lot Lot_ Block Addition or Subdivision lam, Corner Lot Inside Lot Setback -',dSide Yard L� SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. To be used as: DESCRIPTION OF 1BUILDI:?0 Front i;epth Height Sq. Ft. Cu. Ft. Front Depth Height, Sq. Ft. Cu. Ft. • rc Type of Construction Estimated Cost�Q� ©� To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct DATE_ ;�/ Z Z �(P 5 SIGNATURE ,(Schedule of Fee Costs can be found on the Reverse Side). //377 City of Fridley, Minn. N° 9863 BUILDING PERMIT August 5, 1968 Date: ameron G. L wi$ ? Peternfield Const Co. Owner: a�at= f2© en W • L•L.w c S Builder — —.•rte L." ` -17 e a Address. (!'1 !40 NA A V t s o �% -S-T • VA. q Address SK � �� rr� �.y r7 6740 Madison St. N. E. 4995 Excelsior Blvd. LOCATION OF BUILDING No. 6740 Street Madison St. N. E. _ p of t ice�ree errace`ni Lot _ _ 5� M_ Block S �5_�_Addition or Sub -Division � C4!;_ gam= Y G' Corner Lot — Inside Lot Setback Sewer Elevation Sideyard Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front . _ Depth Height . _ Sq. Ft. _ Cu. Ft. Front Depth Height Sq. Ft. — Cu. Ft. Type of ConstructionJ?iUiah RM9n=t Fat. Cost To be Completed — In consideration of the issuance to me of a permit to constructAhe building described above I agree to do th ordinanc of work incity accordance f � y with the description above set fo and in compliance provisions of In consideration of the payment of a fee of $ 6.00 , permit is hereby grantedto Peter Dukinfield 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 said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair 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. Official BuildingXbopmkir Breher NOTICE. Thls permit does not cover the construction, Installation for wiring, Plumbing, gas heating, sawer or water. Be sore to no the Building Inspector for separate permits for them hems. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY,. IMMSOTA / V9 �� 6 7 BUILDER OWNER'S NAME �-v..���� r� va ADDRESS � �c C-. s i C' LOCATION OF BUILDING NO. STREET' ✓t '4 1' S 4 S LOT_ 0 BLOCK _ b ADDITION OR' SUBD'IViiiONtR/-- iLSiV- Q � OOMMIt LOT �INSZDEcL6•�. : '"SETBACKS �SIDEYARD _ SitTFRf. ELEVATION TOP Off' FOOTING Applicant attach to this form Two Certificates of"Suruey, of Lot and proposed building location drawn on.,theso Certificates.*-. ; DBS;CRIPTION OF BUILDING TO'.Be Used. AS: Front Dept �_. Height__ Square feat.-: Cubic Feet t� Front b -pth_ . HHeight Square feet Cubic F.et' Type of Construction'"-Estimated`to Cost' t O F -'o ,0 To Be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and represents ions stated in this application are true and correct. Col DATZ--C, 1 E(o _SIGNATURE _ (Schedule of Fee Costs can be found on the Reverse Side). f�- 7-7 7 01 SUBJECT P City of Fridley I� - 16717 AT THE TOP OF THE TWINS BUILDING PERMIT rp ECEIPT N • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 7/D 1 � � CITY HALL FRIDLEY 55432 1I,j NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 8/9/82 JOB ADDRESS 6740 Madison St. N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 5 1 Rice Creek Terrace Plat 6 SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Cameron Lewis 6740 Madison St. N.E. Fridley 55432 571-3048 3 CONTRACTOR MAIL.ADDRESS ZIP PHONE LICENSE NO. Milton L Johnson Co. 2513 Central Ave. N.E. Mp1s. 781-9548 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 $1 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage and ingi-all alumimun 11 -rim - 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be second but not third. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. S alt 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 �1 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 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 QTHER STATE OR LOCAL LAW REGULATING CON- S UCTION OR THE EIIIFORMANCE Qe CONSTRUCTION. PLAN CHECK FEE TOTAL FEE SIGNATU RE OF CO TRA OR OR AUTHORIZED AGENT IDATEI rn WHEN P O/PERLY// VALIDATED THIS IS YOOUUURr PERMIT V BLDG )NSP DATE SiGNATURE OF OWNER I IF OWNER BUILDER) (DATE) 01 CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDENTIAL BUILDING PER14ITS New, Alterations. Additions, or Repairs) OWNER: 0/4 rr ADDRESS: _� `� d _ MIVt'so TEL NO: S 7 - go V g BUILDER: C, 7 -o -/ o ADDRESS: S 3 TEL 110: -7 9/ s 4 Construction Location - STRIIST NO: 6, 7 V 0 STREET: ;a� D 1` S o nj S l /'j L LOT: BLOCK: ADDITION: U,� 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: Height: Squane Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: fL u Type of Construction: � �S� e- �'�� � �, Estimated Cost: $ �, ®--� 'Ib Be Oorapleted: 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 �aork' herein specified, agreeing to do -all work in strict accordance with the City of Fridley Ordinances and rulings of the Delwirtment of Buildings, and hereby declares that all the facts and representations stated in this application are true ano correct. i' DATE: ' Y -l� SIGd'IATvitE:�-�� Stipulations: Ltlective January 1, 2003 CITY dl= FRIDLEY INSPECTION DIViSION 6431 University Ave NE . Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 JOB ADDRESS 67410 R4121!�Q/!l S% kt RATE SCHEDULE OWNER C4MfXD1.I L6W 15 Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS 2E- C9' Also Replacement Furnace $ 30.00 (Side Vent - Fill Out Back) $ ® 1�O ESTIMATED COST PERMIT NO. � - 3 Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) ( arm Air Gas Dryer $ 10.00 $ Trade Name /CF - 19697.5 Size No. ao- BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel AMM- L'A- Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 an State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and TOTAL FEE 5D representations stated in this application are true and correct. $ '5o' DATE � d3 MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO #01n6 6✓6xc'y ee-V72:5Z REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed TEL # %I,& - `% -111,98 FAX # 7& 7Cv • l /�� REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 07/03/2003 16:44 FAX 7034761143 ROME ENERGY CENTER 2002 £0 • d-IH.LAl J NI\ W WVr/ .wr•rr . .rri ... . ., TO FRaM CITY OF PRIDI��C . �11yyHEN R�PLA IG FUEL M WPLWXM 0"M ApPL"MoNUa.i, BE theta' hey venTm that �'M and is &* from nit s °moons. Yes (A Not ) aneis�ac�ItQrc�sioQe��f'i� Vt cat(" &nd nwiufa@WW vtdudir SW . d im to um �epMMMOM Una is a wed The►vrtde Re codes aid filam fate's g °na'Ws does �[ MI$91 y Vi0M Tables furfz t Yes C*f NO () ' aq5 d nam drag vpearvcw _ ;s dZed SW instaved to Deet the cv Yes (Li NoW11 be sued and hatded Yed(-j Mt) t ) arm , � n�� ourref��des and tom" ��a�matluf+ec ' iAcisai d assembly and meets Ae4, AMA ! 1 Fames Yes 0 g6 t ) s��ptten w ,Id 1 dridt es �'�" Vig7abt�s fanaftersvo&abw as per CE- E'51 r f -j C > np or ToWApplarICISS - y� �`/,eM CCAM1W1*f MHy `7 - ^,x,_,117 S / rte-- ed in APP�� Vete �c�e�r Hetes _� YlW ��� � . s� TWVL P.03 TOTAL. P.03 £0f£0'd £vtiti9LVE9L 01 AFlaI2U -IQ Ai 10 woa� bZ:60 £00Z-CZ-Nnr For: Lewis 6740 Madison St. NE, Fridley, MN Notes: ign orm r�sh� es l.nf atlo:, �.. .�. Weather: Minneapolis -St. Paul, MN, US Winter Design Conditions Summer Design Conditions Outside db -22 OF Outside db 91 OF Inside db 70 OF Inside db 75 OF Design TD 92 OF Design TD 16 OF Heating Equipment Summary Daily range M Btuh Relative humidity 50 % Moisture difference 29 gr/Ib Heating Summary Building heat loss 50410 Btuh Ventilation air 0 cfm Ventilation air loss 0 Btuh Design heat load 50410 Btuh Infiltration Method Simplified Construction quality Average Fireplaces 0 Efficiency Heating Input Heating output Heating temp rise Actual heating fan Heating air flow factor Space thermostat 80.0 AFUE 0 Btuh 00 O Btuh 0 cfm 0.000 cfm/Btuh Sensible Cooling Equipment Load Sizing Structure Hea861 Cooling Area ft Ventilation 0 Volume ft') 12096 0 Air changes/hour 1.2 0.5 Equiv. AVF (cfm) 242 0 Heating Equipment Summary Total sens. equip. load Make Btuh Trade Efficiency Heating Input Heating output Heating temp rise Actual heating fan Heating air flow factor Space thermostat 80.0 AFUE 0 Btuh 00 O Btuh 0 cfm 0.000 cfm/Btuh Sensible Cooling Equipment Load Sizing Structure 0 Btuh Ventilation 0 Btuh Design temperature swing 3.0 OF Use mfg. data n Rate/swing multiplier 0.96 Total sens. equip. load 0 Btuh Latent Cooling Equipment Load Sizing Internal gains 0 Btuh Ventilation 0 Btuh Infiltration 0 Btuh Total latent equip. load 0 Btuh Total equipment load Make Trade 0 Btuh Cooling Equipment Summary Efficiency 0.0 EER Sensible cooling 0 Btuh Latent cooling 0 Btuh Total cooling 0 Btuh Actual cooling fan 0 cfm Cooling air flow factor 0.000 cfm/Btuh Load sensible heat ratio 0 % Printout certified by ACCA to meet all requirements of Manual J 7th Ed. 4- wnghtsoft Right-Sufte ResidentialTM 5.0.28 RSR20001 2003 -Jun -1014:35:07 CAWrightsoft 1­1VAM2001MABASICLOAD.rsr Page 1 RIGHT -J WORKSHEET Entire House Home Energy Center 15200 25th Avenue North, Plymouth, MN 55447 Phone: 763.476.1990 Fax: 763.476.1143 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. Awr�ghto sfC Right-Sufte ResidentialTM 5.0.28 RSR20001 2003 -Jun -10 14:35:07 K C:\Wrightsoft HVAC12001\AAABASICLOAD.rsr Page 1 J: 7th Ed. 71MANUAL Name of room Entire House Lewis 21 Length of exposed wall I 120.0 ft 120.0 ft I 3 Room dimensions 36.0 x 24.0 ft 4 Ceiings Condit. Option 14.0 ftj heat/cool d 14.0 ftj heat only TYPE OF CST HTM Area Load (Btuh) Area Load (Btuh) Area Area EXPOSURE NO. Htg IClg (ftj Htg I Clg (ftp Htg Clg Htg Clg Htg Clg 5 Grossa 12C 6.3 1.8 1680 **** **** 1680 **** Exposed b 0.0 0.0 0 **** **** 0 **** walls and c I 0.0 0.01 0I **** **** I 0I **** partitions d I o.o I o.o I o **** I ~~ o f **** 01 f 1 00:001 00:00 6 Windows anda 2A 43.7 ** 140 6118 '*** 140 6118 glass doors b 0.0 ^` 0 0 Heating e i i i 0 *'*" 0.0 ** 0 0 0 f 0.0 ** 0 0 **** 0 0 7 Windows and North 0.0 12 `**' 0 12 **'* 0 glass doors NE/NW 0.0 0 0 0 "** 0 ***' *`* E/W 0.0i 128� 0 128� 0 iCooling i 0 i 00:0 i 0 s� 0 Horz 1 0.01 0 '*" 01 0 "* 0 81 Other doors a 10F 29.41 6.31 42 1236 0 42 12361 0 Ib 0.01 0.0I 0 OI 0 0 0 0 I I c 0.01 0.0 0 0 0 0 0 0 9 Net a 12C 8.3 1.8 1498 12403 0 1498 12403 0 exposed b 0.01 0.0I 0 0 0 Owalls 0 0 I I I 1 and c 0.0 partitions I d 0.0 0.0 1I 0.0 0 0 0 0 0 0 le 0.01 0.0 0I I o 0 0 of 0I If 1 0.01 0.0 0 0 0 0 0 0 10 Ceilings a16D 4.9 2.1 864 4213 0 864 4213 0 0.01 0.01 0 01 OI 0 0 01 I I I 1 c� i 0.01 0.0 0 0 01 0 0 0 lb d 0.0 0.0 0 0 0 0 0 0 i e 0.01 0.01 0 0 01 0 0 0 I I If 0.0 0.01 0 0 01 0 0 0 11 Floors a 21A 2.2 0.0 864 1908 0 864 1908 0 (Note: room b 0.0I 0.0 0 0 0 0I 0 0 perimeter c 0.0 0.0 0 0 0 0 0 0 I is displ. dl 0.01 0.01 0 0 01 01 0 0 1 1 I I for slab a[ 0.01 0 0 I 0 0 0 0 0 I 0 1 1 I floors) f 1 0.01 0.0 0 0 0 0 0 0 12 Infiltration a 135 7.5 182 24531 0 182 24531 0 13 Subtotal loss=6+8 +11+12 **** 50410 **** **** 50410 I Less external heating **'* 0 **** I '*** I 0I Less transfer "*"' ( 0 **'* 0 I 14 Duct loss 0°/4 0 "** 0°/ 0 '*' °/a **** °/ 15 Total loss =13+14 "" 50410 *** '*** 50410 r16 Int gains: People @ 300 0- 0 0 **** 0 Appl. @ 1200 0 **** 0 0 * 0 17 =7+8.+12+16 _ Less external cooling i' i.... 0 i I » 0 i Less 0 18 Duct gain 0°/a "'*' 0 0°/ "'* 0 °/Q 19 Total RSH gain=(17+18)*PLF 1.00 *`* 0 1.00 "" 0 20 Air required (cfm) 0 0 **** 0 0 Printout certified by ACCA to meet all requirements of Manual J 7th Ed. Awr�ghto sfC Right-Sufte ResidentialTM 5.0.28 RSR20001 2003 -Jun -10 14:35:07 K C:\Wrightsoft HVAC12001\AAABASICLOAD.rsr Page 1 CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 May 18, 2004 Mr. Cameron Lewis 6740 Madison St NE Fridley, MN 55432 Re: Final Inspection at 6740 Madison St NE Contractor: Home Energy Center Dear Mr. Lewis: A mechanical permit was issued on July 2, 2003 to install a furnace 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 the inspection has not been requested. The permit 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 by homeowner after notification" and the permit will be expired. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. Sincerely, SUBJECT PI:R1�ii1T NO. City of Fridley 2 8 91 i AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. I VV COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. •�lJ r � � PROTECTIVE NUMBER REV DATE PAGE OF APPROVED BY � CITY HALL FRIDLEY 55432 l 612-571-3450 910-F15 2/16/99 JOB ADDRESS 6740 Madison Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 5 1 Rice Creek Terrace Plat 6 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Cameron Lewis 6740 Madison Street NE 571-3048 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Seal Guard Systems Inc 9199 Central Ave NE, Mpls., MN 55434 717-0700 2009368 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 B DESCRIBE WORK Replace window; Reroof; Reside; Fascia 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Call for building wrap inspection before covering. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 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 $6,785 @ $3.39 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $124.75 Fire S $6.78 PLAN CHECK FEETOTAL F Lice C 5. 9.92 SIGNATUREOF CON TRACTOR OR AUTHORIZED AGENT IDATEI NPR LI ATE YOUR PERMIT BL OG $P JIS (q TE S,GNATURE OF OWNERoF OWNER BUILOERt IDATEI :• *,'ss"..•n�-.-''.`fid- :, _.._c..,;, -�'+- [.-F.c''..3� i'"��' w.? .•.y .'^,-"='�e�. 10P ADDN [) z ze OF F1lTlLE j� ALTER [ ] SINGLE FAhMY AND DUPLEX R-1 AND R-2 BUILDING PERMIT APPLICATION ConstiuctionAddress : Legal Description: Owner Name & MN LICENSE # '-, q- - Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. 6 °1 �� lin 1t11) Construction Type: c�� (� Estimated Cost: $ B (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: I APPLICANT: Tel. # Lk2 - rl l I - (,l M Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY $ �0 ' Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $_ NA $.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 Necessary [ ] PLUMBING RESIDENTIAL APPLICATION City of Fridley Permit Number Received By Date Received NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE Z % e -5- YOUR E/ -MAIL ADDRESS SITE ADDRESS t! Y40 -' eel M c.1 5 �f- "' THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR NAME m T c wl PROPERTY OWNER/ _ ADDRESS TENANT CITY J' / ��/ �/ STATE %�% yl ZIP .6,6' PHONE # T NAME . �I i / %yl446JPL ICENSE # ADDRESS CONTRACTOR -9 CITY L' ('r it �' STATE -01 ZIP ) PHONE #_ FAX# PERMIT TYPESINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK ❑ NEW REPLACEMENT DETAILED DESC IPTION OF WORK ef, C �c 5 T'T C C'� j % e -.-A � G� FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINKILAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (Need City License) SWIMMING POOL WATER SOFTENER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREY. ($15) DISHWASHER LAUNDRY TRAY WATER HTR ($35) FOR IRRIGATION WATER METER OTHER 5 me a Permit Fee $ ®o MINIMUM: $15.00 or 5% of cost of the Improvement -whichever is Plan Review $ greater on work less than $300 Surcharge $ .50 TOTAL DUE $ /,5-, S D Make checks payable to: City of Fridley 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 accurate; that the work will be in conformance with the ordinances and odes 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 which requires review and approval of plans. 11 'A T NAME OF APPLICANTl_6o�•tr7' V • 1�lfDATE 61 Please type or print SIGNATURE OF APPLICANT �`� � ` � >iL�t` NOTE' SE�ARATE�'ERM�TS Al2E RE�t�IRED F`O`R BUILDri�G, Ei,.ECT121C�A`L, A111t).�WIEG�Fi�i4�i ItG,AL��1Q�1� ��'� x��' � CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT 6431 UNIVESITY AVENUE NE, FRIDLEY, MN 55432 (763) 572-3604