PRE 2010 DOCSCity of Fridley, Minn.
BUIIDING PERMIT N° 5155
Date: 14"
Owner: Builder
Address Address
� L CATI�I\I F BUILDING
No.
street
Part.. Lot
Lot _'. _ __ Block _ _ Addition or Sub -Divisions _
Corner Lot ___ Inside Lot Setback 120; * _ _ Sideyard
Sewer Elevation . _ _ Foundation Elevation
DESCRIPTION OF BUILDING
To Used as'
-400 1
Front Depth Height � _ Sq. Ft. ' Cu.' Ft.
. Im
Fro t _ DepthHeight Sq. F't. Cu, Ft.
Type Construction Est. oast ""moo be 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 forth and in compliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $- , permit is hereby granted to
to construct the building or addition as described above. This permit is, granted upon
the p ss 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�iola#9 6T'a1 y of the provisions of said
ordinances. ., / .,�'�
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sower or water. Be sure to we
the Building Inspector for separate ,permits for these hems.
Owners Name
Address
r
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
No. Part of Lot
LotBlock � Addition or Sub. Div.
.. r •:ter.. o.
Corner Lot side Lot Set Back Side -Yard
SETS ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
Front Depth^ Y Height
Sq,. Ft. Cu. Ft. ® g�
Front Depth height
Sq. Ft. Cu. Ft.
Type of Construction a-_ 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 Ordinances and ruling of
the Department of Bdildings, and hereby declares that all the facts and representa-
tions stated in this application are true and torr t. 1011 1
DATE l®� SIGNATURE
• (A Schedule of Fee costs can be found on the Reverse Side.)
{ 61 K
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII
DESCRIPTION OF WOKS ,,r �°
Number. Kind and Location of Fixtures Locatio
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $ 0 0
�
Future Fixture Opening ................— x 1.20 $� t
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: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description............................................I...$
TOTAL FEE s.
City of Fridley:
The undersigned hereby makes application for a permit for the work here!
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 facl
and representations stated in this application are true and correct.
19
Kind of Building
f
Used as
To be completed about
Estimated Cost, $
Old New. uTding Permit No Perm' No.
Signe
By
Business Phone No
ROUGH Z " 16� /
FINAL
4z 2M
ZN
N
F-
O
N
IJL D
V m
3
Ci Q
w
U� d'
Z
C� O
O
yR
WATER HTR.
GAS
ELEC.
Base
C'
J41
ist
2nd
3rd
4th
• Future Connection Openings
New Fixture, Old Openings
I
Connected with
Sewer E]
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $ 0 0
�
Future Fixture Opening ................— x 1.20 $� t
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: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description............................................I...$
TOTAL FEE s.
City of Fridley:
The undersigned hereby makes application for a permit for the work here!
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 facl
and representations stated in this application are true and correct.
19
Kind of Building
f
Used as
To be completed about
Estimated Cost, $
Old New. uTding Permit No Perm' No.
Signe
By
Business Phone No
ROUGH Z " 16� /
FINAL
4z 2M
Application for Power Pkmts and' . Heating, Cooling, VentiWon..Rehigeral'ioe tend
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 R.00 $
Repairs & Alterations up to $500.00 .... ............ 5.00 $
Repairs & Alterations each add. $500.00 2.50 $
STEAM or HOT WATER SYSTEM
Warm Air—No Z
r
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 ............
I ..... 2.50
$
BURNER
BURNER — Trade Name,
OIL BURNER—to 3 gal. per hour ........................
5.00
$
over 3 gal. per hour—See Fee Schedule
GEO. SE® ICK HTG. Afeo-CONN. CO
—11 �
1001 Xenia AV. S.
!
+O/
GAS BURNER (up to 400,000 BTU) .................
I ..... 5.00
$
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures ......................
x $1.50
$ d/
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 FFE
$ fV
1�
ROUGH
FINAL
-
Dept. of Bldgs. Phone SII_ 4-7470
,--2,
i
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 Building
Used as
To be completed about
Estimated Cost,
EL
_, 1 PY#W'i ME Wf&T,
nre
2c051
Permit No. �� `� Permit N
DESCRIPTION OF WORK
HEATING
Warm Air—No Z
Trade Names C-�/���
Size No ,v
Capacity
Sq. Ft. E.D.R BTU H.P.
Total Connected Load
uer
Kind of Fuel-
BURNER
BURNER — Trade Name,
Size No
Capacity
Sq. Ft. E.D/R H.P.
GEO. SE® ICK HTG. Afeo-CONN. CO
—11 �
1001 Xenia AV. S.
Minneapoil5 ora, Iri„ei.
Signed 14444 1
By �
_42 TM 7-59
Business Phone n--
(REMARKS—OVER)
r� r iif+w�++ sg ' n tta
HEAT LOSS CALCULATIONS
P x✓ E'opo { w
DEPARTMENT OF BUILDINGS
Weatherstrips
A.S.H.V.E,
Guide
Reference
19—
Construction. No...,
Urea,
Windowss
es No
I
ing Roof
Out. Wall Int. Wall CeilFloor
Kind
es—Door0
'.10
20
Room I LengthAr Y- Width /� Height
Glass
A)�
Windows and Doors—Crackage and Area
Width Height No. of Lineal f . 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.
Urea,
U R ed J11 6
<.
Coef
Coef. Btu
Infiltration
Btu
Infiltration
1S
Glass
Exp. wall
Glass
Exp. wall g
Net exp. wall
`'
Net exp. wall
9 111
,
Ceiling P
Int. wall
a
Floor
/67
Ceiling .1
Net exp. wall
Int. wall
Floor
'1A
je
Ceiling
Total Btu. 3 .
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I le
/ FIA 4,a A Room I Length Width Height ?!°
Windows and D06rs=Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane- of pane lights - of crack sq. ft.
Urea,
U R ed J11 6
<.
Coef
Btu
Infiltration '`
Btu
Infiltration
Glass
Exp. wall
Glass
Net exp. wall
`'
Int. wall
9 111
e
Ceiling P
a
Floor
/67
1 5;
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
J RA I , .— b,— Room I Length -2., / Width I i.1 Height
Windows and Doors—Crackage and Area
Width Height No: of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Urea,
U R ed J11 6
<.
l ,
Coef.
Btu
Infiltration
Infiltration
/0
Glass
""
`'
Exp. wall
9 111
e
Exp. wall
Net exp. wall
/67
1 5;
Net exp. wall
Int. wall
'1A
je
Ceiling
$
/
Floor
Ceiling '.,t i
Total Bfa. �+
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
MINNEAPOLIS. MILAN.
Insulation
How Applied
r Width � e Heiuht
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft.
No. of pane of pane lights of crack
Urea,
U R ed J11 6
<.
l ,
Coef.
Coef.
Btu
Infiltration
Glass".
Glass
`'
_
r
e
Exp. wall
Net exp. wall
/67
1 5;
Net exp. wall
Int. wall
Int. wall
$
Floor
Ceiling '.,t i
°61v"
Floor
Total 96. 4 AYY
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. Room I Length /Y' Width f ieF, Height
Windows and Doors---Crackage and Area
Width Height No. o! Lineal ft. Area
No. of pane of pane lights of crack efl• ft.
Infiltration ' _ Z io
Glass ?Z'
Exp. wall /k-
Net
k Net exp. wall,
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
FI -1 r''' 71 „a Ronin I Length ' P Width, i V Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. ft.
Coef.
Btu
Infiltration
Glass".
`'
Exp. wall
Net exp. wall
/67
1 5;
,
Int. wall
Ceilingp
$
Floor
Total Btu.
Required sq. ft. E.D.R.; or sq. ins. W.A. Leader area
M. [
CN2 9 4��s_
of Fridley,
BURDING PERAUT N? .7464
Date: 21s 1965
e • Robert Stayms Builder 0s He _ Q.°
Address IMI Ries Crack Merrace- Address 2923 Oaklimd AYS,-
LOCATION OF BUILDING
No. street Part of Lot
Lot _ ._ _ __ Block Addition or Sub -Division — Brookview Terrace
. Yi
Corner Lot Inside Lot _ _ Setback _ _ Sideyard
Sewer Elevation _ _____ _ Foundation Elevation
To be Used as:
Front
Front
Type of Construction
DESCRIPTION OF BUILDING
Depth Height Sq. Ft. Cu. Ft.
Depth Height Sq. Ft. Cu. Ft.
r.. Est. Cost — SILK _ _ To be Completed
Replace rmfp including any atractural damage
In consideration of the issuance to me of a permit to cons �In�cgozgPl
cribed above, I agree to do
the proposed work in accordance with the description ab a forthance with all provisions of
ordinances of the city of Fridley.
0
In consideration of the payment of a fee of $ 10•C , permit is hereby grant to
.F1WiMber.UO* to construct the building or addition as described above. This perrm� gfanted 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.
NOTICE:
Thb pormb dose not cover the construction, hm tdbdon for wiring, phnAing, gse headag, sewer or water. Be sure to sae
the BuMne hupamr for separate permho for these Boma.
.- 0
APPLICATION FOR B ING PERMIT
CITY OF FRIDLEYLNESOTA
OWNER'S NAME � �.� � BUILDER. �
ADDRESS _ fJ /•P a- /�h c� ��/�
l ; ADDRESS
LOCATION OF RING
No.
Street
Part of Lot.
Lot
Block. _ Addit.iorr or Subdivision
Corner Lot Inside Lot _.;,.Set.W*tk Side -Yard, .
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to thit form, Two Certificates of.'survey of Lot and proposed•build-
ing 19cation drAvn on these Cettificates .
DESCRIPTION OF BUILDING
be b used as: 4
ont Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sri. Ft. Cu. Ft.
Type of Construction Estimated Costd-V-
.--Tb-.b--
The
_.TO-.be
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to iso all work iii 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.
Schedule of Fee Costs can be found on the Reverse Side).
SUBJECT
City of Fridley
4 7 9 4
AT THE TOP OF THE TWINS
BUILDING
PERMIT
Ir?
L
-
RECEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
tr -----
r ; PROTECTIVE INSPECTION SEC-
NUMBER
REV
DATE
PAGE OF
APPROVED BY
-'-1 CITY HALL FRIDLEY 55432
612-571-3450
910-F15
11/22/96
10B ADDRESS 1001 Rice Creek Terrace NE
1 LEGAL
LOT NO.
BLOCK
RACT OR ADDITION
TBrookview
SEE ATTACHED
DESCR.
5
1
Terrace 2nd
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Bill/Holly Wilken 1001 Rice Creek Terrace NE
571-2176
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Coronado Enterprises 8282 Arthur St NE, Spring Lake
Park MN 55432 7950
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
786-2341
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO,
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Install a Heat N Glo (EM41) wood burning stove
9 CHANGE OF USE FROM TO
STIPULATIONS
Install per testing agency's specifications.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
@
$•60
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,200
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISI S OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
Fire SC $1.20
STRUC OR THE PERF RMANCE OF CONSTRUCTION
$40.25
PLAN CHECK
FEE
W"ITOTAL
LicensFE SC
.00
$47.05
SIGNATURE OF CONTRA UTHORIZED AGENT (DATE)
1P
G IN
LY VA I ATED THIS IS YOUR PERMIT
)ATE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: / 6 0 j * i c e- ( �h_ e k
Legal Description:
Effective 3/1/96
Owner Name & Address:_B d, ,- A o L (Af ; K e ,& `v S
( abate Tel. #-17l 7
Contractor: ycj LICENSE #_2c,.,-,
S Ca
Address: 8 Z 8.2 Af Ith't ,e -T- nl �- �1't� �5 a-- Tel. # 7 tZ, 3
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
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER: & - 1) /-,/ .—, — I�C 01�7 4/1
Corner Lot [ ] Inside Lot [ I Ft. Yd Setback Side Yard Setbacks
Type of Construction: � s ` � ( � � � � "a'`C e
yp re ►� l� c e Estimated Cost: $
Approx. Completion Date: (o
(Cost on Back)
Sq. Ft.
Sq. Ft.
Sq. Ft.
(2-Go.oc-)
Driveway Curb Cut Width Needed: Ft. 6 Ft = F x $ _ $
DATE: I/ -,Z .2 ( APPLICANT: Tel. #_I
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.00i of Permit Valuation (1/10th%)
11`
$.50/$1,000 Valuation
6v,
$900 per SAC Unit V? O I
$5.00 (State Licensed Residential Contractors) � 1
1
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDEY INSPECTION DIV. Effective On Ma -h 1, 1996
5431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
'Air Conditioning — All Sizes
All Others/Repairs $ Atterations (LIST ON BACK)
1°0 of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate TOTAL
S30.00 S 30.00
S10.00 S
$10.00 S
S10.00 S
S25.00 $ CK'00
� J
JOB ADDRESS UGI/ - ,le � CC
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the -City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
OWNER
BUILDING USED AS Gtr
]ESTIMATED COST 3 �N- dv PERMIT NO.,�(��
DESCRIPTION OF FURNACE AND OR BURNER
$ No. of Heating Units Circle One (Steam) (Hot Water). arm Air
Trade Name Size No. a/C,O7DR 3C�
BTU %ULl>w HP `DRTT
S Fuel Total Connected Load
State Surcharge S .50
TOTAL FEE S
MINIMUM I•EE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE S42.00/Hr
'Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name
BTU
Size No.
HP =DR
SUBURBAN Alit
HEATING COMPANY 8419 CENTER DRIVE
MINNFAKNI I-,
Signed By�// , Tel No..
Approved By YA_ 21 Rcugh—In Date Final Oate
FILL OUT BACK SIDE FOR S T ACK VERIFICATION ON
REPLACEMENT FURNACE
SUBURBAN AIR
Pcal-it' brand
Fax Transmittal Memo 7672
To
U nra =
FU# 571- 12 8'7
Commends
r
6127644694 P.61
warPeges Tbft... f emse 31-97 sae `5Z�
L ,.,.,..,,. i'•Depl.Charge
_
'FMCS STa�ephoriea
(]oealrq ❑Fi=m ❑Ca forodw
Dbpoftw
/-- P-41117
1/31/97 SUBURBAN AIR WORK ORDER JOB #4053
8419 CENTER DR., SPRING LAKE PARK, MN 55432 PHONE - 784-6100
------------------------------------------------------------------------------..
Builder Name: System changeout Lock box:
Customer: Bill P*+ 571-2176
Job Address: 1001 Rice Creek Terrace Fridley 349-7750
Job Description=Znsaall new Amana A/C & Furnace
----------------------------- ----------------------------------------
JOB SPECIFICATIONS
SYSTEM 1 SYSTEM 2 Complete
---------------------------------------------------------
Furnace:
Air conditioner:
Coil:
Humidifier:
Thermostat:
Zone system desc:
Flues:
Supplies first:
Returns first:
Supplies second:
AMANA GUIC0$0A30 80%
AMANA RCC18AZB 1.5TON 12 SEER
CHA18TSC
MODEL 550 - (MOUNT HUMIDISTAT- ON RETURN AIR)
T8600 PROGRAMABLE OFF WHITE
VENTING - FURNACE &
NEW LOWER PLENUM
1 IN BASEMENT
2 IN BASEMENT
WATER HTR EXHAUST
Gas pipe: CONNECT FURNACE & DO ORSAT TEST
Electrical: CONNECT FURNACE & A/C
other: REMOVE OLD SYSTEM
***************** ORSAT TEST AND SERIAL NUMBER INFORMATION
** SEE EQUIPMENT MAKE AND MODELS ABOVE **
Furnace Serial Number: 17�fo?O/��
Air conditioner Serial Number:
ORSAT Information: CO2 7 02
CO Al-I'c4C F CFH INPUT 90
PRESS I& STAG,�TEMP
Gas valve + Ignition Make ,t — Ignition type
Filter size lb4w- Vent size P" Heat anticipator setting
Limit setting - fixed Fan on setting - timed �j
VERIFIED BY: _.,�'^�Lu+n/ DATE: `-�0+`r7
Building
BUILDING
Permit No.: —
Inspections
RESIDENTIAL
APPLICATION
Received By:
763-572-3604CITY
OF FRIDLEY
Date Recd:
DATE ��" _?dyJ
YOUR E-MAIL ADDRESS
SITE
THIS APPLICANT IS: O OWNER
NTRACTOR
PROPERTY OWNER/
NAME:
r
TENANT
ADDRESS:
CITY
STATE ZIP
PHONE:`
CONTRACTOR
NAME:
STATE LICENSE #
W DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: 3
d CITY
z/a
WITH APPLICATION
PHONE 2'
--� ® FAX
PROPERTY TYPE
o SINGLETAMILVINEW CONSTRUCTION SIZE
O TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
O ADDITIONO�ARAGE/SHED
O WINDOWS
O BASEMENT FINISH �O ROOF O DRAIN TILE
O DECK
O SIDING O OTHER
O SWIMMING POOL
TYPE OF WORK:
O NEW
O.ADDITION
O MAINTENANCE/REPAIR OREMODELNG
DESCRIBE WORK BEING DONE:
z/e ` m�
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
NUMBER OF SQUARES'; 2-'f!
O HOUSE ONLY
[OUSE & GARAGE
BASEMENT
REM_ODE1 ING SUBMIT:
1.
Existing Floor Plan
GARAGES
O ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
O DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SLDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
O Vinyl
OSofiit
ADDITIONS
& PORCHES SUBMIT:
O Aluminum
O Trim
1.
Site Plan/Survey showing the existing structures
O Other
O Fascia
and proposed project.
2.
Two sets of construction plans
NyINDOWS
3.
Epergy Calculations
IN EXISTING OPENINGS OYes ONO 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 THE COST OF LABOR AND MATERIALS:
(USING THE 199—Z U.B.0 FEE SCHEDULE)
cg=,
TOTAL JOB VALUATIONSe fo OCCUPANCY TYPE
Permit Fee $ �o- �� See Back Page for Fee Schedule
Plan Review $ rZ2= 65% of Building Permit Fee
Surcharge $ (.0005) times the total job valuation — Minimum $.50
Fire Surcharge $ .001 x Permit Valuation (1/10%)
License Surcharge 23 c $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $20 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due - $ Z�p ,-- Make checks savable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit yA work is not to start without a permit; that the work will be inaccordance with approved
plan in the case of all work wh' re iew and approval of plans. z c/o
SIGNATURE OF APPLICANT PRINT NAME Jc �`-� "/ DATE / z Z� U�