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PRE 2010 DOCSCity of Fridley, Minn. BURDING PEPMT 6167 Builder 62409zlE17 -Address Address TION B ILD NG No. Street of Lot Lot _ _ __ Block .� Addition or Sub-Divisionn " � —4 Wo Corner Lot � Inside Lot Setback � :?.— —_ Sideyard Sewer Elevation — — Foundation Elevation DESCRIPTION OF BUILDING tv8ea o. A0 01010..& 10 Front &. Depth Height Sq. Ft. �� Cu. PAM Fm Depth--OeHeight Sq. Ft. Cu. Ft. Type of Construction Est. Cost Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set orth and in comp cq�� all provisions ordinances of the city of Fridley. e In consideration of the payment of a fee of $�v�Permit is hereby granted to the to construct the building or addition as described above. This permit is granted upon express condition that the person to whom it is granted and his agents, employees and workmen, in all work dare 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, re and moving of buildings within the city limits and this permit may be revoked at anyupon viola%any of the provisions of said ordinances. �l // NOTICE: 1bb permit does not emu the construction, halailafien for wWng, plumbing, gas hsa8ng, sewn or water. Be etre to as the BulUbM hopacter for separate permits for these hetes. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA T OWNER' S NAME 0zee / J BUILDER 100 ADDRESS ADDRESS Qo 41 .- LOCATION OF BUILDING No. 5 3 % X Street % ®/LtJ Part of Lot Lot Block Addition or Subdivision �"__ �i Corner Lot Inside Lot Setback 3,1571 Side Yard r® -14 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 BUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost 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 �� / SIGNATURE .GGI (Schedule of Fee Costs can be found on the Reverse Side). Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... 8.00 $ Replacement of Furnace 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour --See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x $1.50 $ Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ ti✓r I Pq ays ®n.) �,� P- IR CO ITIONING ,�� _ 63 / f)o O ®6 G,>w"/°l • _ �s� FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $-14 ROUGH FINAL Dept. of Bldgs. Phone SU 4-7470 a-# I I J13 S City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn1-2- 18 Owner R O D I3 /L.Lm QAj G, ® /US i C�o Kind of Building __ ' rQ /d fn Used as D W A L & i Al G To be completed about Estimated Cost, $. 4e", Old ew Building Permit No. Permit No.C.1 OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel BURNER —Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. GL0. SEDGWICK HTG. & AIR-COND. CO. 1001 Xenia AV. S. Signed Minneapolis 16, Minn. 'r U. 5-161P By (REMARKS -OVER) .49 42 2M Business Phone No Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-7470 GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ ✓ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ ✓ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ ✓ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ l �� ROOGH FINAL Location t3 %-7`ax E,9_ Kiln 6Z tJ '_ >kml t! b City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn 19 _ Owner O 7 I L,.L NIQ ti Kind of Building Used as - _bWf_L-L.tt2t) To be completed about Estimated Cost, i Old—New. Building Permit No. Permit No. ;A , 3 OF WORK HEATING ergNER pT AN= Staff etaNa Warm Air—No� 0 -Mc Trade Name U_� c "L-tQ;�.c-. %r, 1 Size No- 110— 10 Capacity Sq. Ft. E.D.R 1,411 ®oG BTU H.P. Total Connected Load I • SID 6!�-T Kind of Fuel -a BURNER— Trade Name 1 QA t L_L M Sa m Size No 11 t _1 —10 Capacity Sq. Ft. E.D.R BTU H.P. GEO. SEDGWICK HTG. & AIR-COND. CO 1001 Xenia Av. S. Minneapolis 16, Minn. Signed •• 54611 By 4E 2M Business hone No (REMARKS -OVER) " R -OD al i.Makzl E�1Zwi4 l-ltcs�.z Lo 14 1( 'a` 740 Width Height No. of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. —7* T7 j 1 1� �l / D..® I HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS 1 MINNEAPOLIS, MINN. Weatherstrips A.S.H.V.E. Guide Construction No. 1 Insulation Windows Doors I Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied Yes—No Yes—No 19- Int. wall Net exp. wall Net exp. wall 1 F1•I l .w 6 Al, f Room I Length 17 Width i;), Height 7 II 1 F1.14o Room I Length 1-7 Width i c N Height I Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. Width Height No. of Lineal f . Area No. of pane of pane ilghts of crack sq. ft. l IT D..® I `?� 4 11 1 1 1 1 Coef. Btu Infiltration Glass, 1 siI m Glass Glass al S® %600 Exp. wall ` o X 14o Int. wall Net exp. wall Net exp. wall Ceiling Net exp. wall 1311 Int. wall An2i1 1 Int. wall Ceiling 17 Y, 11 ® 16 (� Floor Ceiling D, 1 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 k t ;. t 7bl L) Room l Length tic) Width 9 Height $ Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. 06 l IT D..® I `?� 4 11 1 1 1 1 1 Coef. Btu Infiltration Glass, 1 vY -).%,1 Glass °� 471 50 �® Exp. wall Int. wall Net exp. wall 1 Ceiling Net exp. wall Int. wall in An2i1 1 Int. wall (0 ® 10Floor Ceiling D, 1 Ifm Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area t F1.1 Room ILength I: Width o � Height T Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 06 Coef. Btu Coef.1 Btu Infiltration 1u Glass, 1 4 .' Glass Exp. wall Glass °� Exp. wall �® 19 Exp. wall Int. wall Net exp. wall 1 Ceiling Int. wall in An2i1 7 Ceiling (0 ® 10Floor Ceiling1 a< 0 1 ® 7 otal Btu. ft. E.D.R. or sa. ins. W.A. Leader area Windows and Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 06 Coef. Btu Infiltrations Coef. Btu Infiltration Glass, 1 I Exp. wall Glass Q 1 1 �® 19 Exp. wall Int. wall 1 Ceiling Net exp. wall in An2i1 7 Int. wall Ceiling1 a< 0 1 ® II® Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 I Fl.l "':Ir -n Room I Length I � Width I �i Height 2 Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 06 Coef. Btu Infiltrations Coef. Btu 11,14-30 Glass, Exp. wall Glass Q 1 Net exp. wall s 19 Exp. wall Int. wall T9 Ceiling AIg in Floor Int. wall Total Btu. Required sq. ft. E.D.R. or sq. ifis. W.A. Leader area I F1.1'I*3 (3.�c- ,% Room I Length I t Width q Heistht x Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass 16 s + 00 Exp. wall T9 Net exp. wall Int. wall Ceiling 9 1 Floor 1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area >yss HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MMEAPOLIS. MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied Yes—No Yes—No 19- 1 F1.1 Room I Length lA Width -1 Heiaht II FLI Room I Length Width Heucht Windows aild Doors—Crackage and Area Width Height No. of pane of pane No. of Lineal f . Area lights of crack sq. ft. -in— Coef. Btu Infiltration Glass Exp. wall JCoef.j Btu Infiltration 1 1 Glass �® Exp. wall g Net exp. wall Int. wall Ceiling x Floor Total Btu. 1 IWO Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors --- Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area Nos of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l Room I Length Width Heiaht Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Reauired so. ft. E.D.R. or so. ins. W.A. Leader area I F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area City of Fridley Application for Plumbing and Gas i=itting Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location 07 I C RATE TOTAL Number Fixtures ..... x $1.50%-�� Y C Z Z C4 —Z ----L-1 w ? 0 0 • F • N WATER HTR. GAS EIEC Base 3.25 $ I Water Heater (Up to 200,000 BTU) ......— x ' $ New Ground Run Old Bldg. ............ x 3.25 $ 1st 2nd 3rd 4th • Future Connection Openings I * New Fixture, Old Openings 1 JJJ _ Connected with Sewer cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: O. RATE TOTAL Number Fixtures ..... x $1.50%-�� • Future Fixture Opening ................ —Z ----L-1 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ...... ..................... x 3.25 $ Water Heater (Up to 200,000 BTU) ......— x 2.00 $ New Ground Run Old Bldg. ............ x 3.25 $ GAS FITTING FEES: 1st 3 Fixtures ......................... Additional Fixtures ................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code NO. RATE TOTAL — x $1.50 — x .50 $ — x 2.00 $ City of Fridley: The undersigned hereby makes application for a t for the work herei specified, agreeing to do 411 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 colrrect. Fridley, Owner Kind of Building Used as To be completed about Estimated Cost, $ Old—ew. uilding Permit ROUGH FINAL Description ................................................$ TOTAL FEE $/� 0 48;0-2 2M CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1995 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS ori fi i IL - Residential Furnace Shellandd Duct Work, Burner — Also Aepiacement Furnaces (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) I% of Value of Appliance or Work Commercial/industrial 1 % of Value of Appliance or Work The undersigned hereby makes application for a permit for the work herein Rate TQTAL specified agreeing to do all work in strict accordance with the City Codes ar rulings of the Building Division, and hereby declares that all the facts and $ 20.00 representations stated in this application are true andcorrect. / / affll'�2 /� i� 199E $10.00 $ 1,1l/�-�-�i e OWNER $10.00 $ BUILDING USED AS ldvay�n 10.00 $6 ESTIMATED COST 6f2 PERMIT NO. $ 10.00 DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Steam) (Hot Water) arm Air Trade Name KI OX Size No. �® BTU HP Y42 EDR $ Fuel G( Total Connected Load -11 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 0 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name, BTU HEATING HP Size No. EDR Signed By UIR / (`Approve B JRough—In Date _ Tel No. Final Date i` FILL OUT BACK SIDE FOR STACK VERIFICATION ON �; REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. CHIMNEY AND STACK YERIFICATh The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yeses`) No ( ) 2. Is free from rust or deterioration Yes No ( ) 3. Has no foreign objects lodged within Yes(--) No ( ) 4. Is securely supported Yes (" ) No ( ) S. Meets all current Code requirements for size and total BTU's connected Yes.( No ( ) 6 r) Has total heating BTU's of Nr V All other BTU's /s TOTAL BTU's ��lJ 7. Has a liner been provided for water heater Yes ( ) No ( ) S. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: HEATING CO: Signed By: Date: Phone 535-20CU CITY OF FRIDLEY INSPECTION DIViSION 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, but not replacement) Gas Range Gas Dryer ) A -S /,)s *Air Conditionin - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25 Jo of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in•a side yard without written permissi n from adjoining property owner. �. Effective On January 1, 2000 JOB ADDRESS "3%' /1%7`"�Ln �r. 4 OWNER aa,,4-3 TOTAL BUILDING USED AS�s• d� ESTIMATED COST 6"5) PERMIT N0. Z DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units ,D— Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name Size No. BTU _ HP EDR $ Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR $ 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE HEATING CO /t/4,e-d % %r Signed .��!9E AZA TEL # Approved By L Rough -In Date Final D COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : G SUBJECT city of Fridley 7��; AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • ____ COMMUNITY DEVELOPMENT DIV. ♦V - PROTECTIVE INSPECTION SEC. �0 r � � 1 � � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910.F15 10/8/02 JOB ADDRESS 5375 Matterhorn Drive NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 1 1 Innsbruck 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Chuck Anderson 5375 Matterhorn Drive NE 763-571-8461 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Roof Design Partners 4026 7 Street NE, Columbia Heights MN 55421 763-789-6566 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20004817 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION n REPAIR O MOVE O REMOVE X B DESCRIBE WORK Reroof House & Garage (19 Sqs) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Permit Inspection Cards Will lva 'WO l To TO Post SEPARATE PERMITS ARE REQUIRED 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 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 $2,200 $1.10 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 $83.25 Fire SC $2.20 PLAN CHECK FEE T TAL FEE Lice SC 5 0 $91.55 SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT (DATE, H PR LY VA ED THIS IS YOUR PEEERR�MIT 4 S-GNATURE OF OWNER.IF OWNER BUILDER- IDATE, DG INS BATE G 10/08/2002 08:37 7898777 ROOF DESIGN PARTNERS PAGE 02 I ] CITY OF FRIDLEY Effective 1/1/2002 NEW NEW[ ] 6431 University Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Insp ADDNALTER.. [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: l'�N� I Owner Name 8 Address: 5 Tel. # ri o� - �'� Contractor. Ll MN LI °NSE # o1QQ� q � Address: fJ � ' Tel. # rl ILL 12- U 5 to to 5159a I 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/Gmund -_ Sq. Ft OTHER: �-�-� F �. (^ ��., / �L) 3A!ao-F��tConstruction Typek— Or T IDL9 Estimated Cost: S Driveway Curb Cut Width Needed: FL + 6 Ft = Ft x $ _ $ DATE: ICS- vl APPLICANT: CL Tel. # 2103- (q(o Call (763) 572.3604 for Permit Fees If mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge CRY USE ONLY - $ 83 - o� Fee Schedule on Reverse Side $ .�® .001 of Permit Valuation (1/10th%) $ L/0 $.50/$1,000 Valuation $ $1200 per SAC Unit $-- add® $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 [ ] TOTAL $ S �� STIPULATIONS; Building BUILDING Permit No.. d® Inspedions RESIDENTIAL APPLICATION Received By:, 763-572-3604 CITY OF FRIDLEY Dat d: 11 f 763-502-4977 FAX EFFECTIVE 1-1-08 DATE YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: E ADDRESS: 6:?L !'Jr llif_rr R1t DtCITY Yr P ^7 STATE✓ ZIP SSNZ1 TENANT PHONE: NAME: ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE WSINGLE 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 HOME CONSTRUCTION XADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: ID eg IC SIZE OF IMPROVEMENT LENGTH oZ r-' WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS. & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑Trim and proposed project. ❑ Other 11 Fascia 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 ALL FEES ARE BASED ON VALUATION, INCLUDING THIE COST OF LABOR AND MATERIALS: SING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ ,� � 15 "T OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge 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) $1825 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 uavable 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 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 CMr�� PRINT NAME d 941 FS ggI✓ 64FRJO,M1) DATE APPROVED BY DATE FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER 1' 2 Alk L E- 0 ACJ Eta --. ®understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at _ LLMo 9-n1 �R � ,Fridley, I am exempt from the state licensing requirement only if I am not building or improving this properly for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name Date 7 - 2,1 -0 S7