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PRE 2010 DOCSCity of Fridley, Mim. BUILDING PERMIT N?C5 3'7 4 Date: -- -- --- -- Owner: Builder Address _ _ __ _ _ Address ® TIO OF No. i_ Street _ Part of Lot ` _ ._ Block _ Addition or Sub -duds - •---- Comer Lot _ Inside Lot _ _ Setback's —_' Sideyard _— Sewer Elevation _ _ Foundation Elevation DESCRIPTION OF BUILDING' _� 40( Frond J4'Depth ? He1004 ight _ Sq. Ft. Cu.' Ft' o Depth Height Sq. Ft. Cu. Ft. t Type of nstruction ' ti Oo y --- To 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 $.""r , permit is hereby granted to.._._. to c0=4 the building or addition as described above. This permit is granted upon the express condition that the 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 violatro any of the provisions of said ordinances. +' T , , ding Inspector NOTICE: W This pomlt does not cover the construction, installation ico�rlringj plutebfng, eas'heatin®, sewer or water. Be sure to sea the Building Inspector for separate permits for these Items. Address APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY.. MINNESOTA LOCATION OF BUILDING No. Street 10 ¢ Fart of Lot Lot -4 Block / Addition or Subdivision_. Corner Lot Inside Lot V' Setback_ 0 67 Side -Yard, SEWER. ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To bused as - A Sq. Ft. / Cu. Ft.� n �� el ` Front Depth ­j Height��, Sq. Ft. l Gu. 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 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. DA � � SIGNATURE (A Schedule of Fee Costs can be found on the Reverse Side.) -.I V �,.A City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SII 4-1 DESCRIPTION OF WORK Number, Kind and Location of Fixtures q N eL tea{ Z yy1 Z _ N S} Y F. Z Z K Z pQ Z _ p W O j �U' Iu 0 (7 Z z �U' 6 WATER HTR. ELEG 3 ii �. m 3 o LL S Q 3 d -�U' 4n O R N -Ga5 m Base r j 1st 2nd _ 3rd — 4th ° Future Connection Openings Connected with Sewer � New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ b t% Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ...... x 3.25 $ Water Heater (Up to 200,000 BTL) ...... x 2.00 $�a'� New Ground Run Old Bldg. x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... \ x $1.50 $ t� 5 Additional Fixtures x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FETE 4 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, Owner Kind of Building Used as ✓� To be completed about Estimated Cost, $ mew. Building Permit No Permit No. zS ROUGH I I FINAL a z 2M 7-59 By L -e Business 19-6C la Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE- SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work .......................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. . Repairs & Alterations each add. $500.00 ............... 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 .............. STEAM or HOT WATER SYSTEM RATE TOTAL 8.00 $ 5.00 $ 5.00 $ 2.50 $ 8.00 $- 2.00 $ 5.00 $ 5.00 $ 2.50 $ 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 2.04 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $� REMARKS: Dept. of Bldgs. Phone IC City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to-do all work instrictaccordance 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, 19� Owner 195_ Kind of Buildix Used as To be completed abo 195— Estimated Cost, $ Old= ew uilding Permit No. DESCRIPTION OF WORK BEATING or PO R PLANTS team, Hot Water, —No Trade Nam Size No_ fK'2/ 6 Capacity Sq. Ft. E.D.R 4 BTU H.P. Total Connected Loa Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. 11 POST IM -12-58 AppRessfen !' Power Pkaft and H leg, �'e i1 ®e Re�ge Air Condoning Stem -and Devices GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ...........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—tap to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 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 .............. $.00 STEAM or HOT WATER SYSTEM Dept. of Bldae. Phone SW -3480 City of Fridley: The undersigned hereby makes application . for a permit for the work hereit: 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 facts and representations stated in this application are true and correct. Fridley, MJnn $ $ Owner rrl— t! $ Kind of Building $ Used as rj /yez ip $ To be completed about 171 Furnace Shell & Lines—to 400 sq. ft. EaDR Steam .... . $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 10.00 $ Each add. 200 sq. ft. EDR Steam 3.00 $ 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) ..... .................. over 199,000 BTU See Fee Schedule : GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 2.00 $ Additional Fixtures ............. x .78 $ Gas Range to 199,000+ ........... s$ &W $ 4- i y S' a r. i10, FAN DATING SYSTEM See Fee Schedaie VENTILATING SYSTEM / % / 34- 3 3 4 - ALTERATIONS ALTERATIONS & REPAIRS TOTAL FM $ a Estimated Cost, $ 5-00 - Od jil New. Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS—Stearn, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Bind of Fuel BURNER — Trade Name Size No Capadty _Sq. Ft E.D R BTU Hip (REMARKS -OYER' Z7 Signed By Business Phone CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTIUTION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer Rate TOTAL $ 20.00 $ x®10 e $ 10.00 $ $ 10.00 $ $ 10.00 $ *Air Conditioning - All Sizes $ 10.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ Commercial/Industrial 1 % of Value of Appliance or Work $ State Surcharge $ .50 TOTAL FEE $ .2®' S� MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. CSR -- 5 M ,1991 OWNE BUILDI ESTIMATED COST PERMIT NO. MOO DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units—L— Circle One (Steam) (Hot Water) arm Air) Trade Name Size No. BTU .57, ®D® HP_ t..3 EDR ll 9 Fuel ^ T al Connected Load 61 Burner Trade Name Size No. BTU HP. EDR HEATING COMPANY jf; nc Sons Elec., Inc. dh i..,..e .Ir .(i iP VVesi BF(I'dw✓ay Signed B `rysrz�, �� 55.1701 No. Approved By Rough -In Date Final Date' FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes �No ( ) 2. Is free from rust or deterioration Yes fro ( ) 3. Has no foreign objects lodged within Yes o ( ) 4. Is securely supported Yes ✓) No ( ) 5. Meets all current Code requirements for size and total BTU's connected 6. Has total heating BTU's c All other BTU's TOTAL BTU's Remarks List Alterations Being Done: Yes ( No ( ) Richmond & Sons ElElm,, Inc. HEATING COMPANY Golden Valley tltpr �.+r Cc'. dv,V,r Crys4sl, P,h{�l 55429 Signed By Date MAR - 5 R :' ® unum9AN NpINEE RINp .. rnoff,cr 571 GU66 fA75 Hhway No 65 NE I MmnrafxtLt, INC .-_.-____._.,___..—. !I M,nnru+te 55431 - �® r —I A Almm�7.d Tern r•ry tiyd 7* -1-, e l.e�d .Sr.rrn me � l and !`,noun -9906510 I( ir101 t,id1 ft' -f IO,n nh dlP, Rlpv,ex,te 55337 Certificate of Survey for OH,I MCCAULEY 75.00 g I I K, - I I I I I IO � . yaca�eZ;�M � i' 76 `b z -) - - e' y ilr Y f -i a I — - �- UrNIT y Easamenr to 75.00 ---'' Rickard Roo,& Scale I = 30 • Denotes iron monument folAnd o Denotes iron monument Se't' Lot 1 , Block Elwells Riverside Heights Plat 2 Anoka County Subject To easements jf any 1 hereby certify that this Is a true and correct representation of a survey of the boundaries of the above described land, and of the location of a,L buildinysl thereen, and all vlslo.1f, encroachments, if any, from or on sold land. As surveyed by me thisy of it f A.O. 19� I I g I I K, - I I I I I IO � . 75.00 ---'' Rickard Roo,& Scale I = 30 • Denotes iron monument folAnd o Denotes iron monument Se't' Lot 1 , Block Elwells Riverside Heights Plat 2 Anoka County Subject To easements jf any 1 hereby certify that this Is a true and correct representation of a survey of the boundaries of the above described land, and of the location of a,L buildinysl thereen, and all vlslo.1f, encroachments, if any, from or on sold land. As surveyed by me thisy of it f A.O. 19� Building Permit Fee BUILDING See Back Page for Fee Schedule Permit No.: ` �0 Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 763-502-4977 CITY OF FRIDLEY $ Date A �., A FAX $ Q U $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow EFFECTIVE 1-1-2010 ft + 6 ft = ft x $24 = $ Erosion Control DATE r a —w/o YOU E-MAIL ADDRESS Park Fee SITE ADDRESS I °C G� Sewer Main Charge THIS APPLICANT IS: ❑ OWNER I koNTR&CTOR Total Due PROPERTY OWNER/ NAME: 13ngi?. �Qr�n.sr TENANT ADDRESS:_ rzbd' CITY STATE_aZIP PHONE: CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # '2 0S VCS'% 7 �_ EXP DATE ` s AND CERTIFICATE OF ADDRESS: -8b 6< G r -H& CeCP/7 Cr CITY STATE ZIP /i INSURANCE PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONS TR CTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH DRAINTILE I,ROOF ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT U LENGTH WIDTH HEIGHT SQ FT ROOFING O 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 I. Site Plan/Survey showing the existing structures ❑ Other ❑ Feria !I and proposed project 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF DOWS 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 ER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: 2 L gg SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ; 1 U OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ TIC .001 times the total job valuation Surcharge $ t"1 .0005 x Permit Valuation Minimum $.50 License Surcharge $ Q U $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ ' Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks Davable to: Citv of Fridlev Attach Stioulations 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 ordinanc d es of City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicatio fo pe t d ork is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of w whi r res review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME. 0Du� -1(�AA71r;n DATE �� /� ��