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PRE 2010 DOCS4' 346 <' City of Fridley, Minn. N° 8888 BUILDING PERMIT Date: JUNE 16 1966 Owner: RAY HARTUNG Builder CLEMRON INCORPORATED Address Address 701 Chlumb i a Blvd. Minneapolis, Minnesota 55421 LOCATION OF BUILDING No. 7381 Street MEMORY LANE Part of Lot Lot 8 _ Block 4 Addition or Sub -Division — MMY X&MR.- 3RD anDi= Corner Lot __ X Inside Lot _ Setback 35' __._ Sideyard 10 and 1716" Sewer ]Elevation _._ NONE AVAILABLE —MW& Elevation TOP OF FOOTING DESCRIPTION OF BUILDING To be Used as: DWELLING Front 26 Depth 42 Height 18 Sq. Ft. 1, 092 Cu. Ft.19, 656 ATT. GARAGE Front 26 Depth 21 Height 10 Sq. Ft. 546 Cn. Ft. 5,460 Type of Construction FRAME Est. Cost 24 j 5 00. 00 _ To be Completed SEWER LOCATION - 0.79 from Manhole WATER LOCATION - 0.85 from Manhole In consideration of the issuance to me of a permit to tract the wilding des "otnos do the proposed work in accordance with the description ab ov set fo in cam an _ of ordinances of the city of Fridley. / In consideration of the payment of a fee of $ 25.00 permit is hereby granted to CLEMRON, TXQQRPORATED. 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 nthe city limits and permit may be revoked at any time upon violation of any of the provisions of said WILLIAM H. SANDIN Building Lumator NOTICE foie psrmb don not carer the consBvafion, Gutalidlen for wbtng, Plumbing, on hush* ewer or wafer. Be am to ne the 8WWh* hapeftr for spm% pwmha for thea Bens. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME ADDRESS v `� ADDRESS LOCATION OF BUILDING N0. 15 , ` s / STREET, %!� � / PART OF LOT LOT_ BLOCK AD TION OR SUBDIVISION 2 CORNER LOT INSIDE LOT SETBACK 65 —C� SIDE -Y //{1 SEWER ELEVATION AU ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. BUILDING To be used as; Front i / DepthHeight Sr Sq. Ft. Cu. Ft .-S _ r l Front Depth/-�::p Height-!F�-�/ Sq. Cu. Ft. Qo 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 / Z SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). i a Application for Power Plants and Healing. 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 ............ each add. 60,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. Repairs & Alterations each add. $500.00 ....... . ..... . ITEAM or HOT WATER SYSTEM Dept. of Bldge. Phone 510-3450 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. 8.00 $ 2.00 $ Owner 5.00 $ Kind of 5.00 $ 2.50 $ Used a: Furnace Shell & Lines—to 400 sq. ft. IDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ co 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 $ 0�) GAS FITTING FEES: NO RATE //TO��TAAL�L 1st 3 Fixtures ...................... x $1.50 $_�� Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $--fl '0 15 FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE $ ® b ROUGH FINAL To be completed about v Estimated Cost, $_ Q Old—New. Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS --Ste Hot Water, Warm Air—No Trade Name LTJy c> �°1�� Size No Capacity Sq. Ft. E.D.R BTU A.P. Total Connected Load / Kind of Fuel if—'- BURNER — Trade Name ®� Size No U Capacity Sq. Ft. E.D.R r g p, Siga � (REMARKS -OVER) 42 Business Phone No HEAT LOSS CALCULATIONS DEPARTMENT .OF BUILDINGS MOINEAA011S. MRK Weatherstrips _ A Guide Construction No. Usulation Windows I Doors Reference Out. Wall llnt.Wall I Ceiling I Roof Floor Kind How Applied Ye—s--No Y— es— o 19— . I I I I F1.1 F4,- . ii Room I Length lei V" Width 13 le' Height 9 'D" 11 Fl.I r- Room I Length /.L' Width 13 ' Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. No. of pane of pane lights of crack Area sq. ft. t rq 3s �. iS o t 2.1 Coef. .. Btu width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Infiltration Glass Coef. Btu Infiltration Coef. Btu Infiltration Int. wall ZS &0,:D 4 �' Glass �yBtu 410 IT /s' 0 7Sa Exp. wall Z s'® Exp. wall Z (• (fl0 Net exp. wall Net exp. wall Net exp. wall Int. wall 1'eS0 Int. wall Ceiling Ceding 715 0 Floor ! S fo 15-46 Floor Total Btu. 4810 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area :2 a- /'( to F1.1 n 1r.7— Room 1 Length 12-' rY Width 13 ao" Height &, Windows and Doors--Crackage and Area t Width Height No. of Lineal ft. Area No. of pans of pane lights of crack sq. ft. 1 la s i is, ro L 23 3S I o S Coef. .. Btu width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Infiltration Glass Coef. Btu Infiltration Net exp. wall S Int. wall C4 &0,:D Glass Floor �yBtu 410 IT $ o 'a Up. wall Z s'® Exp. wall Lo 0 (fl0 Net exp. wall Net exp. wall lFj 1'eS0 Int. wall Ceding Ceiling G y I/* ! S fo 15-46 Floor Total Btu. 15.7 0 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area - Le h -11f " W'h ' 1, tj ' Fl. OT " Room ngt ld TOW BttL or sa. ins. W.A. Leader area I 'A i® `f Windows and Doors--Crackage and Area t $ (® eight O Windows and Doors—Crackage and Area Coef. .. Btu width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Infiltration Glass 1i;0 ISO Exp. wall �,? Net exp. wall Coef.1 Int. wall Infiltration 7. ,'S Floor �yBtu 410 Glass lb Floor So Z s'® Exp. wall (fl0 Net exp. wall Int. wall Ceding G y I/* O Floor TOW BttL or sa. ins. W.A. Leader area I 'A i® `f Windows and Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. AAS to aIL 3 Coef. .. Btu Infiltration % Infiltration Glass 1i;0 ISO Exp. wall �,? Net exp. wall 910 Int. wall p /S104 Ceiling Floor Ceiling Total Btu. 1 3 1 (i Required sq. ft. E.D.R. or sq. ins. W.A. Leader area X " FI -1 no u, ., c Room I Length / 11 Width a Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack Nt. ft. AAS to aIL 3 Coef. Btu, Infiltration -Lq Glass �,? 1 00 Exp. wall Net exp. wall $ p /S104 Int. wall )0 Ceiling /� 3 lb Floor 3 -L /0 Total Btu. 1 IS alp -- Required sq. ft. E.D.R. or sq. ins. WA. Leader area /� • • i F -IL , v t ni r Roam I Lenath 2 S f fe'' Width /� Heisht A Windows and Doors--Crackage and Area Width Height No. of Lineal ft. Ares No. of pane of pane lights of crack sq. ft. 1 51 1 Coef. ,. Infiltration Glass �,? 50 Exp. wall Net exp. wall )0 Int. wall ; Ceiling 3 -L /0 Floor Total Btu. ft. EA& or HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS Weatherstrips A-5Construction No. Guide Windows Doors Reference Out. Wall JInt.WalI Ceiling Roof Floor �Vo I es— 0 19— R-1 .icy Room I Lenath -1'^" Width (n 0" Height Windows and Doors—Craekage and Area Rooms I Length 4! 6, " IHeight No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. width Height No. of Lineal . Area No. of pane of pane lights of crack sq. ft. tt► ►i Width Height No. of Lineal ft. Area No. of pane of Dane tights of crack sq. It. Coef. Btu Infiltration -.J— J—Glass z . S S O Glass GIM 5 p Z Esp. wall 0 7 So Up. wall Glass Net exp. wall ZZ Exp. wall Net exp. wall Iet. wall L Zo 10 0 Ceiling Netexp. wall Int. wall 16 Floor Ceiling IoL wall Total Btu. Requbed sq. ft. E.D.R. or sq. ins. W.A. Leader area ' C? ro N R-1_ 0 2 Room Length / T / 9'iVllidth /a' 4 Height ® O Windows and Doors—Crackage and Area Rooms I Length 4! 6, " IHeight No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. )9 3S 1 Z q 35 JS 10 1 35 Width Height No. of Lineal ft. Area No. of pane of Dane tights of crack sq. It. la " Coef. to infiltration Btu z . S S O 'C GIM Infiltration O Glace 0 7 So Up. wall Glass CO ZZ Exp. wall Net exp. wall Exp. wall L Zo 10 0 Imo. wall Netexp. wall Int. wall 16 to Ceiling IoL wall Floor Floor Ceiling /U 960 Total Btu. 5Z40 Required sq. ft. E.D.R. or sq. ins. WA. Leader area i i F1 I & _ _ d Rnnm I [ enorth r n Width !1' 4 Heiaht 8 Windows and Doors—Crackage and Area TOW Btu. Rooms I Length 4! 6, " width Width Height No. of Lineal t. Area No. of pane of pane lights of crack sq. ft. I S' S b 1 35 Width Height No. of Lineal ft. Area No. of pane of Dane tights of crack sq. It. la " JCoef. Coef.1 Btu InWation S O z Z, f Btu Infiltration O Glace G4 Ift Glass CO 2401 Exp. wall L6,O Exp. wall L 47- ZNet / o Net exp. wall Netexp. wall Int. wall 16 to 14 in IoL wall Floor Ceiling 34 5 / �D Flaor /2,a 00 Ta or alt. ile. W.A. Leade„c-area 1 ' i° `' A�1POI.LS. NM Insulation Kind Iiuw Applied F1.1 (3� w Rooms I Length 4! 6, " width 'd" Herght 1V Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of Dane tights of crack sq. It. la " JCoef. Btu Infiltration Glass S O Coef. Btu Infiltration Net exp. wall G4 Ift Glass 2401 10 L6,O Exp. wall Floor Total Bin. 47- ZNet / o Netexp. wall Int. wall d Ceiling Floor 34 5 / �D Total Btu. �� d Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ' 3" F1 I A _ Room I Lenath 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. /9 T s"' 3 3„ B4 ► ao Coef. ' Bei JCoef. Btu Infiltration Glass S O 144 P42 -4C Glass Net exp. wall 170-0 Exp. wall 2401 Ceiling Net exp. wall Floor Total Bin. )ZYY / o Int. wall Ceiling Floor 5- 4ao Total Btu. Required sq. ft. E.D.R. or sq. iris. WA. leader area F1_I / ^ n Rnnm I Lenath Width Height Windows and Doors--Crackage and Area Width Height No. of Lineal It. Ana No. of pane of pane lights of crack sq. tt. T L Coef. ' Bei Infiltration 1 (, Glass S O Exp. wall 2 Net exp. wall Int. wall Ceiling Floor Total Bin. } f 0 Required sq. it. E.D.R. or sq _ � +A e"' O' Application for Power Plants and Healing, 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 $ AIR CONDITIONING FAN HEATING SYSTEM - See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FEE ROUGH FINAL Dept. of Bldgs. Phone 560-3450 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. Owner -Z� Kind of Building Used as To be completed about 18 " Estimated Cost, $ Old -,/New. Building Permit No. a Permit No.':�N"j 6� DESCRIPTION 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. (REMARKS -OVER) RAY N. WELTER HEATING CO. Signed .7 � �-,-QF-I I BA6 B �11/�. By MINNEAPOLIS 7. MINNESOTA 42 Business Phone No City of Fridley SUBJECT F_ r631 0 9 AT THE TOP OF THE TWINS BUI L D I N G P E R M I T R COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. i HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 7/30/81 10B ADDRESS 7381 Memory Lane NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 4 1 Melody Manor 3rd Add. SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Thomas Bloss 7381 Memory Lane N.E. Fridley 55432 786-6479 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Grant Home Remodelers 3835 Independence Av. No545-9023 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 ❑X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a t X -9-61 rnam addition - 9 CHANGE OF USE FROM TO STIPULATIONS WARNING Afore digging cell Iscol utilities Variance granted by Board of Appeals on 6/9/81. � � PH ON E - ELECTRIC - GAS Eft. [:;.:y:X11REp B' r ,CALL FOR ALG < 14W Final InsWctions of VIII fide$ required" rior to ecsupetlC .,et quildilne. SCF'ERATE PERMITS IRLQUIRED f'OR 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- 3. 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 $18,000.00 $9.00 DOES NOT P SuME TO GIVE AUP17 VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIO F NY THER STAL LAW REGULATING CON- 'RFORMAN STRUC OR HE UCTION. 108.00 PLAN CHECK FEE TOTAL FEE y -$IGNATI'iRE OF CONTRACT R AUTHORIZED AGENT (DATE) WHEN PRROOPERL- THIS IS YOUR PERMIT jVALIDATED f SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI a '{� BLDG INSP DATE CITY OF FitIDLEY APPLICATIM FOR RESIOUITM. BUILDIIIG PERMITS (New, Alterations, Additions„ or Repairs) 0WNER: &KIAd,Q3'_ P&!f Al -99 ADDRESS : 2�'/ TEL NO: STRMT NO: STREET: LOT: BLOQC: _ 3� y3 NO i � ADDRESS:_ ` Aly� TEL NO: Construction Location 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 • ®PFront: �ir Depth:�& ` height: Square.Feet: Cubic Feet: • �� Front: A IL. Depth: Height: Square. Feet: D3big Feet: _ �{t` X �O.IG� l�,7o�.SG .Ir �=13Zo � 1 �d�`.+� dr• AW '�� Type of Construction: �ly Estimated Cost: $9219 ll$, QOd 11b Be Oorapleted: F 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 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 by declares at 11 the facts and representations stated in this application a tru and co re t D.NTE /� l SIGNATURE: Stiff tilations 102.0 P . �7.o• AQ o o *4*154 ENERGY CONSERVATION SUPPLEMENT TO BUILDING PERMIT APPLICATION PLANNING AND INSPECTION DEPARTMENT CITY OF' F'RIDLEY, MINNESOTA This supplement is provided to assist the applicant in computing EXTERIOR ENVELOPE AVERAGE "U" FACTOR INFORMATION. This information is required so the BUILDING OFFICIAL can determine. that submitted plans comply with the ENERGY CONSERVATION DESIGN CRITERIA of the STATE BUILDING CODE (Section 6000). It is the APPLICANT'S responsibility to accurately compute the data; reflect the proper DESIGN CRITERIA in the plans; submit product specifications, if needed to support the "R" and "U" factors used; and to assure construction is per approved plans. JOB LOCATION: OWNER/CONTRACTOR: �� /� ADDRESS: it ., ir_ Irk 1../ • 0 ,'' A. Determine the Total Exposed Wall Area as follows: 1. Total wall window area 2. Total door area 3. Total sliding glass door area 4+. Total fireplace wall area 5. Total wall framing area (average .10%) 6. Total net wall area above floor(average 90%) 7. Total rim joist area Subtotal: "'::tal exposed wall area above floor 8. Total foundation window area 9. Total net foundation area above grade VA Subtotal: Total exposed foundation area GRAND TOTAL EXPOSED WALL AREA B. Multiply the GRAND TOTAL EXPOSED WALL AREA X .17 = Item I C. Determine the Total Exposed Roof/Ceiling Area as follows: 10. Total skylight area 11. Total roof/ceiling framing area (10%) VZI 12. Total net insulated roof/ceiling area L/ GRAND TOTAL EXPOSED ROOF/CEILING AREA D• D. Multiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X .05 = Item II 2 E. Determine the "U" value of each segment (1-9) and multiply by the area as follows: Item II, you have met the intent of State Building Code 6006 (c) 1. 1. x fluff + Item II 2. r x nu" = 1 3. If the sown of x ,lu„ II, you have met the 4. �� X "U" , = h 5. x „TT„ -- _ �, g 9 6. �°7'®� X flint 7. x fluff 8. g &lull 9. x „}7„ ADD 1-9 FOR TOTAL WALL SEGMENTS - ITEM III �►�� F. Determine the "U" value of each segment (10-12) and multiply by the area as follows: 10. 11. All, l2. X "U" / V6 X "U" Q X "U" , ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS ITEM IV / 0 7 G. If Item III is the same as, or less than Item I, you have met the intent of State Building Code 6006 (c).2. H. If Item IV is _ Item II, you have met the intent ITEM IV / 0 7 G. If Item III is the same as, or less than Item I, you have met the intent of State Building Code 6006 (c).2. H. If Item IV is the same as, or less than Item II, you have met the intent of State Building Code 6006 (c) 1. I. Add Item I + Item II J. Add Item III + Item IV = 1 K. If the sown of Items III and IV are less than Items I and II, you have met the intent of the Code for total envelope system. The undersigned, as applicant for a building permit, hereby affirms the above information has been prepared and submitted by himself or under his direction, hereby acknowledges the information to be correct and accurate; and hereby presents the information with required plans in support of the building permit applicatioryee-1 � '4 VIA CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On August 1, 1995 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BF INSTALLFn ON EACH FL COR Reinspection Fee $42.00/1-ir SIGNED BY �� TEL N0._ _MLl-..P 333 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fbcture or Appliance Approved By Rough—In Date Final Date State Surcharge ,50 MINIMUM FEE FO ANY PLUMBING/GAS PERMIT IS $0.00 TOTAL FEE $7,0 -so PLUS THE $.SQ STATE SURCHARGE "COMBUSTION AIR;SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. ;uH�, ' ^ ,R�,I Wash " Ftoor �� Auto, ��-f i Gas I,��% Water Heater Hr �!� Stories Urinal Sysower Tra Blow Off Basin Drain ;� �: Washer :rel'} Ran #. Gas Elec ,�y� I} iu�ryr .Rr lent r 'h Basement I ,1995 Sump/Receiving Tank $ 7.00 I , `��/ 3 �� Water Treating Appliance $10.00 Owner W A F_ RS O Y Floor 1 :.. !I. :'G;�!GI: u:h ! Water Heater — Gas** $1040 Building Used As Gas Range** , , Gas Dryer** $10.00 $10.00 (V Estimated Cost PERMIT NO. Back Flow Preventer Required.( )Yes { } No Floor 2 Type $15.00 PLUMBING COMPANY _ s "s': .. .::,t.; ! :BRre I� Floor 3 Ilia s l,/-� Floor 4 Reinspection Fee $42.00/1-ir SIGNED BY �� TEL N0._ _MLl-..P 333 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fbcture or Appliance Approved By Rough—In Date Final Date State Surcharge ,50 MINIMUM FEE FO ANY PLUMBING/GAS PERMIT IS $0.00 TOTAL FEE $7,0 -so PLUS THE $.SQ STATE SURCHARGE "COMBUSTION AIR;SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. 14 /A 4L PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS MErnOR LANE �R1D� IM fJ New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser '$5.00 and rulings of the Building Divislon, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 ,1995 Sump/Receiving Tank $ 7.00 I , `��/ 3 �� Water Treating Appliance $10.00 Owner W A F_ RS O Y Water Heater —Electric $ 7.00 Water Heater — Gas** $1040 Building Used As Gas Range** , , Gas Dryer** $10.00 $10.00 (V Estimated Cost PERMIT NO. Back Flow Preventer Required.( )Yes { } No Type $15.00 PLUMBING COMPANY Reinspection Fee $42.00/1-ir SIGNED BY �� TEL N0._ _MLl-..P 333 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fbcture or Appliance Approved By Rough—In Date Final Date State Surcharge ,50 MINIMUM FEE FO ANY PLUMBING/GAS PERMIT IS $0.00 TOTAL FEE $7,0 -so PLUS THE $.SQ STATE SURCHARGE "COMBUSTION AIR;SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. SUBJECT PERMIT NO. City of Fridley 1 5 7 1 8 AT THE TOP OF THE TWINS B U I L D I N G PERMIT Ir ` ECEIPT • COMMUNITY DEVELOPMENT DIV. __ v PROTECTIVE INSPECTION SEC. r 3 S 3 4d NUMBER REV PAGE OF AP CITY HALL FRIDLEY 55432 612-571-3450 910-F15 JDATE I JOB ADDRESS 7381 MEMORY LN LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED 1 LEGAL DESCR. 8 4 MELODY MANOR 3rd ADDITION SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE WAYNE BEVERS 7381 MEMORY IN FRIDLEY MN 55432 784-8333 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 ADDING KITCHEN WINDOWS 9 CHANGE OF USE FROM TO STIPULATIONS REPLACEMENT SLEEPING ROOM WINDOWS MUST MEET STATE EGRESS CODE 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 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 1500.00 .75 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- 48.50 FIRE SC 1.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 50.75 F^�� ONTRACTOR OR AUTHORIZED AGENT IDATEI PROPERLY N LrDATED THIS IS YOUR PERMIT (IGNjftPe0- "111/ (Z 1 �l �- g�W®HEN L� — Si NATURE OF OWN R IIF OWN 4 BUILDER) ID TEI BLD )NSP )ATE NEW' [ ] Effective 8/l/95 ADDN (] CITY OF FRIDLEY ALTER [ [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 73$1 Memoq LaNE - Legal Description: — Owner Name & Address: vets �3�1 Memo�N� Tel. # ��64-333 Contractor: S E LF _ MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING -AREA: Length Width . _ Height Sq. Ft.- GARAGE t.GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: AOn1yiG Klm W tiU)S _ Comer Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: _ Ft. Yd Setback Driveway Curb Cut Width Needed: DATE: APPLICANT: Side Yard Setbacks Estimated Cost: $ nn — (Cost on Back) Ft. + 6 Ft = Ft x $ Tel. # STIPULATIONS: CITY USE ONLY Permit Fee Fee Schedule on Reverse Side Fire Surcharge $ - .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.0 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ } Not Necessary [ ] TOTAL $ 5:6_7 STIPULATIONS: I an,1 !'da,mn►y I, / 07.S kA�i►�r y its # . 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