PRE 2010 DOCS1
City of ]Fridley, Minn. N.9 9943
BUILDING PERMIT
Date: Sept. 19, 1968
owner: Richard Edin Builder Rodney Billman Inc.
Address Address T 151 Silver Lake Road
LOCATION OF BUILDING
No. 5699Street _ Regis Trail --- part of Lot
Lot 12 _ _ Block 2 Addition or Sub -Division . Parkview Oaks $ s t Addn .
Corner Lot Inside Lot _ X Setback 351 —_ Sideyard --
Sewer Elevation — 965 .D1 968.01
Top ofd Footing
DESCRIPTION OF BUILDING
To be Used as:
DwIling_ Front 26' Depth 60' Height 20' Sq. Ft. 1560 Cu. Ft. 3$x31,200
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Fr=g_Est. Cost _ ._$2.8,. QQO To be Completed 1211168
SEWER LOCATION- Manhole
WATER LOUTION - 11.6' from Sewerx2lz= Stub
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 forth and in compliance with ;h provisions of
l -
ordinances of the city of Fridley. / 'I,—
In consideration of the payment of a fee of $__47 00 , permit is hereby granted to Rodney Billman Inc.
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 the provisions of said
ordinances.
Clarence Belisle
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas hoatbm sewer or wafer. Be ars to as
the Building Impactor for separate permits for then herr.
1XXTHT-5
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEYE MINNESOTA
ADDRESS ADDRESS .45-1
LOCATION OF BUILDING
�
not, STREET PART OF LOT
LOT BLOCK ADDITION OR SUBDIVISIONO_ _ i!et_ , l
CORNER LOT INSIDE LOT �SETBACK �!SIDE-YARD
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used Ad:
DESCRIPT10k'OF BUILDING
--1j---Frost Depth Piieight 20
Sq. Ft. Cu. Ft.
Front Depth Height
Type of Construction
To Be Completed_,
Sq. Ft./ Cu. Ft.
ell
Estimated Cost �444-e-OY2
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-Depattment of Buildings, and hereby declares that all the facts
and representations stated in this application 46, true and correct.
DATE 'ZZ ' d SIGNATURE
(Schedule of Fee Costs can be found on the Reversb S
:f 4
Application for power plants and bleating. Cooling. Ventilation, refrigeration and J
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3450
.12 '-.2 . --/ 12
GRAVITY WARM AIR: RATE TOTAL
ace Shell & Duct Work ..........................$10.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 .................. 6.00 $
Repairs & Alterations each add. $500.00 ............... 3.00 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ ®i
each add. 60,000 BTU ....................... 3.00 $
Replacement of Furnace ............................. 6.00 $
Repairs & Alterations—up to $500.00 ................. 6.00 $
Repairs & Alterations each add. $500.00 .............. 3.00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam ......
$10.00
$
Par—No
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water
... 10.00
$
BTU H.P.
Each add. 200 sq. ft. EDR Steam ...................
. .. 3.00
$
Capacity Sq. Ft. E.D.R
Each add. 320 sq. ft. EDR Hot Water ........ .........
3.00
$
OIL BURNER—to 3 gal. per hour ........................
6.00
$
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 199,000 BTU) .......................
5.00
$�
over 199,000 BTU See Fee Schedule
GAS FITTING FEES:
NO RATE
TOTAL
1st 3 Fixtures ......................—IZ
x$ 2.00
Additional Fixtures .................
x .75
$
Gas Range to 199,000 ...........
x$ 5.00
$
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
$
TOTAL FEE $ 0
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
Kind of
Used as
To be completed about
Estimated Cast, $ �
Old—New. Building Permit No. 9 zj_:3 Permit No.
DESCRIPTION OF WORK
(REMARKS—OVER)
By.
Business Phone
HEATING or POWER PLANTS—Steam, Hot Water,
Par—No
Trade Name
Size No
Capacity Sq. . E.D.R
BTU H.P.
0
Total Connected Load. Kind of Fuel
BURNER — Trade Name
Size No
Capacity Sq. Ft. E.D.R
BTU
(REMARKS—OVER)
By.
Business Phone
Permit Fee $............................
APPLICATION FOR MECHANICAL WARM AIR HEATING PERMIT
No. P...........
Dateof issuance................................................:...... 196...... Location.................................................................
Minneapolis, .Minn ................................................. 196....--
Inspector of Buildings '
The undersigned hereby makes application for a permit for the installation, alteration or repair of
a heating, air conditioning or ventilatins system, device or cgtdprncnt, as herein specified, agreeing to do
all such. work in strict accordance with the City Ordinances and rulings of the Depar-tribent of Inspections
and the specifications set forth in this application as approved and filed in the Department of Inspections.
Owner --- <r' ! . d t; :: % ......�� '�' .'`p % .....l ddre ss of Owner....
Kind of Buildin_s...G� .."•........:!=. �. ..........
�_ rflow occupied
ee
c�
Work to be started... .-----................ 196.•....;/
Work to be completed. ••...,.: lr`_
Estimated Cost 0..................................Old — Nece Building Permit Xo .............................................
DESCRIPTION of WORK
Notes Insert the word install, odd, alter, or repair, according to which is to be done. Under "Remarks," itemize removals, if any, and
alterations to equipment.
.................... ......'......-----Mechanical Warm Air Heating Plants—Furnaces._......--•-•---••-----••-.........................................
Make................�,�<-��. t,-�.:r..:........................... .................................Size ........... .....!� ....� � °�............................
az
Connected load ------------------ 0 ................................................Capacity ......... / ''®/.
Air Conditioning System: Summer — Winter — .411 Year;
.Lake .................................................... ..............._ .... ........Capacity.............----.......................Cfm........
Ventilating System: .Make ............................... ................................... Capacity ................................ Cfm.
•.-..•..- .... .............
Explanation ofwork to be done: ............................ Plans with permit (yes) (no)
®L�C/l� 1...�L-i'-�:,ftsC�2.� �-?•`.m'-?��y.�?°��e�,°.�� �m'.r�� ``��:%✓e! ��'��i''=--':'�
By..... -------------- 4ZI.......... .,„ �,..: -----------------•..
.4pproved............ ...•---•----•-•---.....................------......... 196------ .4ddress------- �%t'�.....p �% p��"—�......... '•.�
............ _-----------------•------------.......................------....------.'............... Telephone ....... °'-d.....+'............... ....................
Inspector.
....................................................................................
o-zo 6
Ir
HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTIONS MINNEAPOLIS, MINN.
Weatherstrips A.S.H.V.E, Construction No. Insulation
Guide
Windows Doors Reference Out. all,, Int. Wall Ceiling Roof -"Floor` Bind How Applied
Yes—No I Yes—No 19—
FI.I Room l Length /'` Width Height II / FLI Room i Length /--- Width /2—Hei;ht y
Windows a d Doors—Crackage
and Area
• .
Exp. wall
Width Height No. of
No. of pane of pane lights
Lineal ft.
of crack
Area
sq. ft.
3
="
"
9
Ceiling
1411L9
Floor
Btu
Infiltration
Total Btu.f
Coef.
Coef.
Btu
Infiltration
Glass
70
.7 �'
Glass
Glass
Exp. wall
...
Exp. wall
Exp. wall
Net exp. wall
Net exp. wall'
Net exp. wall"
Int. wall
Int. wall
Int. wall
Ceiling
s°
Ceilingi
Floor
Floor
1f
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/; Room l Length Width 12- 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 d S4 a
Glass
�` ✓�—c�/✓/J
• .
Exp. wall
/
Area
sq. ft.
Net exp. wall
Z
d
Int. wall
Ceiling
1411L9
Floor
Btu
Infiltration
Total Btu.f
Coef.
Btu
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Inspectors notes:
Windows and, Doors—Crackage and Area
• .
Width Height No. of
No. of pane of pane lights
Lineal ft.
of crack
Area
sq. ft.
I ' 1
Ahl
Coef.
Btu
Infiltration
Coef.
Btu
Infiltration
Glass
Glass
Exp. wall
sf'
Exp. wall
Net exp. wall
Net exp. wall'
Int. wall
Int. wall
Ceiling
Floor
Floor
Total Btu. 4
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.l Room (Length IZ, Width /. Height
Windows and Doors—Crackage and Area
• .
Width Height No. ofLineal ft.
No. of pane of pane lights of crack
Area
sq. ft.
Ahl
Coef.
Btu
Infiltration
Glass
Exp. wall
! .i
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTIONS MINNEAPOLIS, MINN.
Weatherstrips A.S.H.V.E, Construction No. Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No Yes—No 19—.x.
/ Fl.� / Room Length Width •' Height 11 Fl.� = '": r' Room Length Width Height/
Windows and Doors—Crackage and Area
Width Height
No. of pan4 of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
Area
eq, ft.
Coef.
Btu
Infiltration
Glass
d
.� ��"
._,
�' " i�
Coef.
Btu
Infiltration
Infiltration
Infiltration
Net exp. wall
✓'
Glass
�a
Glass
Int. wall
Exp. wall
a
Exp. wall
r
Net exp. wall
'
Net exp. wall
;✓
Int. wall
� 1
Net exp. wall
Ceiling
4/20
Ceiling
Floor.0
Floor
Total Btu.
7 -7
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ F J - ''' r° `Room I Lensith % Width % Height
Windows and Doors—Crackage and Area
Width
No. of pane
Height
of pane
No. of Lineal ft.
lights of crack
Area
eq, ft.
Coef.
Btu
Infiltration
Glass
d
.� ��"
._,
�' " i�
Exp. wall`
Coef.
Btu
Infiltration
Infiltration
Net exp. wall
✓'
i
�a
Glass
Int. wall
a
Exp. wall
r
Exp. wall
Net exp. wall
!`�
'_9
� 1
Net exp. wall
4/20
Ceiling
Int. wall
Ceiling
Floor
Floor
1
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Inspectors notes:
Windows and Doors—Crackage and Area
No.
Width
of pane
Height No. of
of Dane lights
Lineal ft. Area
of crack aq. ft.
Coef.
Btu
Infiltration
Glass
d
.� ��"
._,
�' " i�
Exp. wall`
Coef.
Btu
Infiltration
Net exp. wall
✓'
i
"° ��
Glass
Int. wall
a
Exp. wall
r
Ceiling
Net exp. wall
!`�
'_9
� 1
Int. wall
Ceiling
Floor
Total Btu. �'C?
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ Fl.l " Room I Lenszth Width �2 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
d
.� ��"
._,
�' " i�
Exp. wall`
;
Net exp. wall
Azo
Int. wall
Ceiling
l✓
!`�
%�r�
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTIONS MINNEAPOLIS. MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows Doors Reference Out.Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No I Yes—No 19—
<i FIJ Room l Length / Width /_,52 Height�� II / Fl.j
Windows and Doors—Crackage and Area f" Room Length Width '`,) Heights
Windows and Doors—Crackatze and Area
Width
No. of pane
Height No. of
of pane lights
Width Height
No. of pane of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
r J
36 z
Coef.
Btu
Infiltration
�r .
Coef.1
i
Coef.
Btu
Infiltratiotl
Exp. wall"''
= '
Glass
Net exp. wall
Glassp®�f
'lav
� i��
2�1J .,'�2
Exp. wall
Ceiling
4'
.:>
Net exp. wall
r/T
Ceiling
Total Btu.
Int. wall
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
? 41/)
/(J
Ceiling
Int. wall
Floor
a
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Width
No. of pane
Height No. of
of pane lights
Lineal ft.
of crack
Area
sq. ft.
c'
17,
Height No. of Lineal ft. Area
of pane llghts of crack sq. ft.
r J
36 z
Coef.
Btu
Infiltration
�r .
Coef.1
i
Glass
Infiltration
Exp. wall"''
= '
Glass
Net exp. wall
Exp. wall
Int. wall
Net exp. wall
Ceiling
4'
.:>
Floor
r/T
Ceiling
Total Btu.
= <r
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
? 41/)
"' F1.1 - Room I Length _ '-%' Width / °-' Height r Fl.� .' r•�i';i;" Room I Length Width /�� Height 7
Windows and Doors—Crackage and Area
No.
No.
Width
of pane
Height No. of Lineal ft. Area
of pane llghts of crack sq. ft.
r J
36 z
Coef.1
Btu
Infiltration
Infiltration
= '
Glass
GlaS3Ex
Exp. wall
Net exp. wall
wall
Int. wall
r/T
Ceiling
Net exp. wall
- ✓% , ��
Floor
? 41/)
/(J
3181
Int. wall
Ceiling
/1
Floor
Windows and Doors—Crackage and Area
No.
Width Height No. of
of pane of pane lights
Lineal ft.
of crack
Area
sq. ft.
r J
Coef. Btu,
Infiltration
= '
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
7 �110
- ✓% , ��
Floor
? 41/)
/(J
Total Btu. R Total Btu. ! S(a
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. ft. E.D.R. or sq. iris. W.A. Leader area
Inspectors notes:
C
City of Fridley
Dept. of Bldgs. Picone 360-3450
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PLUMBING FIXTURE RATES:
Number Fixtures
Future Fixture Opening
New Fixture Old Opening
Catch Basin ..
NO. RATE TOTAL
—� x $2.00 $
x $1.50 $
x $1.50 $
x $3.25 $
Water Heater (Up to 99,000 BTU) x $3.00 $ U d
New Ground Run Old Bldg. x $3.25 $
Electric Water heater = $200 $
GAS FITTING FEES: NO. RATE TOTAL
ist 3 Fixtures ..... .. .... x $2.00 $ 9 • ® b
Additional Fixtures ..... .............. x $ .75 $
Gas Range to 199,000 BTU .............. x $5.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description .................................. ....s........$
TOTAL FEE $ �
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- 1/0 - - 19
Owner
Kind of Building
Used as r '
To be completed about
Estimated Cost, $
Old—,q Building Permit No.-- _.._permit No. 07VO
Signed.
By_ _c�✓
Business Phone No �3
ROUGH
FINAL
WATER HTR.
�
Bax
F
p
f
X
1st
Z
2-
—
2nd
3rd
4th
_
° Future connection Openings Connectedwith
Now Fixture, Old I
❑
Cesspool ❑
PLUMBING FIXTURE RATES:
Number Fixtures
Future Fixture Opening
New Fixture Old Opening
Catch Basin ..
NO. RATE TOTAL
—� x $2.00 $
x $1.50 $
x $1.50 $
x $3.25 $
Water Heater (Up to 99,000 BTU) x $3.00 $ U d
New Ground Run Old Bldg. x $3.25 $
Electric Water heater = $200 $
GAS FITTING FEES: NO. RATE TOTAL
ist 3 Fixtures ..... .. .... x $2.00 $ 9 • ® b
Additional Fixtures ..... .............. x $ .75 $
Gas Range to 199,000 BTU .............. x $5.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description .................................. ....s........$
TOTAL FEE $ �
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- 1/0 - - 19
Owner
Kind of Building
Used as r '
To be completed about
Estimated Cost, $
Old—,q Building Permit No.-- _.._permit No. 07VO
Signed.
By_ _c�✓
Business Phone No �3
ROUGH
FINAL
.Y
SUBJECT
RMIT N
City of Fridley
31157
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
q
,���
r PROTECTIVE
°e'��
�
NUMBERREV
DATE
PAGE or
AOPROvEO BY
I
E "'1 CITY HALL FRIDLEY 55432
612-571-3450
910.F15
7/11/00
JOB ADDRESS 5699 Regis Trail
I LEGAL
LOT NO. BLOCK
TRACT OR ADDITION
SEE ATTACHED
OESCR.
12
I
1 Parkview Oaks 1st Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Scott Bardell/Barb Fealy 5699 Regis Trail
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Diversified Construction 7010 Hwy 7, St. Louis Park, MN 55426 952-929-7233 3641
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW CX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
14' x 161911 2 story addition
9 CHANGEOFUSEFROM
TO
STIPULATIONS
For stipulations, see attached plans.
WARNINGSEREQUI
�U �U�'S
Before digging call for
WIRING HEATING
all utility locations
PW MRII46 AND SIGNS
4540002
REQUIRED LAW
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING. HEATING.
TYPE OF C NST.
OCCUPANCY GROUP
OCCUPANCY LOAD
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
�
$17.29
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$34,582.00
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-
$492.25
Fire SC $34.58
STRUCTIO OR THE PERFOpRM NCE OF CONSTRUCTION
L_
PLAN CHECKJEC
TOT FEE
l -06
Lice e $5
549.12
If SIGNATURE O%CON 'RACTORORAUTHORIZED AGENT IDATEi
% �
H PROP VALID THIS IS-UR�MIT
.I .�
h
QKDG iNSP DATE
S-GNATURE OF OWNER, IF OWNERSUILOER) IDATEI
.Y
NEW I l Effective 1/1/2000
ADDN llaq CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2�
BUILDING PERMIT APPLICATION
Construction Address: 566 q C1 Q c,,� —TAI( -
'j ALC
Legal Description: L-Crt 1 Z. &ocle- Z ` lAgiL Ll 1 al C S R evT l P d -L --
Owner Name & Address: • -(T 8P9D E LL / f3 CIE� Tel. #
Contractor: DI V CER j) f ( � D 06 Aj Sn2uft
C®�I MN LICENSE # 75124 i
Address: ZCS (D N Ca 7 -2-'()�5 Tel. # 9y2 ^L77-1?^ 7,33 .a- ZS
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 l 6 C1 Height 1(/ Sq. Ft. `fit 2 7ZX7Z
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft 14-5✓�
OTHER:
vlSX Y 0 : �•
Construction Type: Acjd (ACL Estimated st: $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $,
DATE: lb�7dU
Tel.# qZ9- ZZ33 Z5
29�Z- 7701
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge $S''j�-� .001 of Permit Valuation (1/10th%)
State Surcharge $.50/$1,000 Valuation
SAC Charge $ „/� $1100 per SAC Unit
License Surcharge $_ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ . /7--
STIPULATIONS:
Y
STIPULATIONS:
LOT SURVEY CITT OF FRIMJY
LOT 12,.. BLOCK 2. PAMMEW OAKS FIRST ADDITION •
BUILM FOR BILLMAU CONTLkCTIBa Co.
2P� �w ....
a 1
si�� y ��'lc � �� i ;-. �� oma' f l •. .
r '
22GAL DISCRIPTION: Lot 12, Block 2, Parkview Oaks First Addition, City
of Fridley, Minnesota.
I hereby certify that this survey vas made under my direct supervision
and that I as a duly authorized Registered Land Surveyor under the laws
of the State of Minnesota.
William S. Loy*, A.L.S.
Mina. Rag. 06737
Data September 11, 1968
A 70
t-_ -
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INU
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 qh_.
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
Effective On January 1, 2000
JOB ADDRESS
OWNER5C k� f3C-- r �C-
Rate TOTAL
$ 30.00 $—
$10.00
$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
BUILDING USED
ESTIMATED COST 2 2®® .""W
PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units 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 correc .
y� rDAT Z 0, 6
HE INA'�G ('0 A1-2 W- - F,
Si
TEL #
*Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final [Ge
written permission from adjoining property owner.
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
Building
BUILDING
Permit No.: 5PO
Inspections
RESIDENTIAL APPLICATION
Received By: -
763-572-3604
CITY. OF FRIDLEY
Date Rec'd: l�
763-502-497 FAX
EFFECTIVE 1-1-2010
DATE
YOUR -MAIL ADDRESS
law
SITE ADDRESS
14 -
THIS APPLICANT IS:
❑ OWNER VGNTRACTOR
PROPERTY OWNER/
NAME: a 11 a¢if-r&LLA
TENANT
ADDRESS: CITY
�r
STATEIP I �D_
PHONE:
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # EXP DA%�eli
I
AND CERTIFICATE OF
ADDRESS: CITY
STATE ZI
INSURANCE
PHO c- FAX
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES_
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH[ OOF 13DRAIN TILE
❑ DECK ❑SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR MODELING
DESCRIBE WORK BEING DONE: ® d— re -7-00 (—
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING e p HOUSE ONLY
NUMBER OF SQUARES
13 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
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:
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
3.
Energy Calculations
IN EXISTING OPENINGS []Yes ❑No LOCATION OF WINDOWS
FOR WINDOWS
— PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE
SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED 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 VALUATION $ a9 Of 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)
$2100 per SAC Unit (Plans to MWCC for determination)
-ft +6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks Pavable to: Citv of Fridlev 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 *rmit dwork is not to start without a permit on site; that the work will be in accordance with the
approved plan in the cas o 1 orkui s rev' w and approval of plans.
SIGNATURE OF APPLICA PRINTNAMF,,un DATE
004