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PRE 2010 DOCSCity of Fridley, Alun. t:. B MDING PERMIT N? 1 . Owaer: --j Builder Address LOCF I DING No. Street P Lot Block _ Addition or Sub -Divi. Corner Lot _ Inside Lot Setback Sideyard Sewer Elevation_ _ Foundation Elevation DESCRIPTION OF BUILDING To Used Front Depth height SQ. Ft .4 Cu. Ft ont �. Depth I�eiht Sq. Ft. Cu. Ft Type of coon Eat Cost bt 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 ail provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ry-1Wj -A un_ , permit is hereby granted to 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 pert 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 permit may be revoked at any time upon violation of any of the provisions of said ordinances. ,ems. 441 Z� NOTICE: 'this pom* does not cover the construction, hutalwan for V Wng► phmbing, on homing, sewer or water. Be su to see the Building hupector for soparate penalts for these Nems. Owner Ia Address APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OFBUILDING No. Streetc \I�2 Part of Lot Lot Blockddition or Subdivision 2ij�z4 Corner Lot Inside Lot Setback -31 'a Side -Yard SEWER ELEVATIO14 FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To be used as: Front DepthcKlg/ Height / Sq. Ft. Cu. Ft. z_ Frontg �I o Depth ;2-1 'Height Sq. Ft. Cu. Ft. Type of Constructions w i �� Estimated Cost / 7-r c')'- ' e To be Completed a 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 �� / � � SIGNNAATURE (Schedule of Fee Costs can be found on the Reverse Side). c BUILDING PERMIT FEE SCHEDULE Section 2. The Inspector of Buildings shall, before issuing any permit for the erection of any building or structure, or for any addition to any exist- ing building or structure, or for any alterations or repairs to any existing .building or structure, upon application therefor, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -vitt 2.1. For any such permit for the erection of any fire -proof building, other than agarages warehouse, factory or grain elevator, or for the erection of any fire -proof addition, for similar occupancy, to any existing building shall be at the rate of'$1.40 for each one thousand cubic feet, or fraction thereof, in such cubical contents. c 2.2. For any such permit for the erection of any fire -proof garage, warehouse, factory or grain elevator, or for the erection of any fire -proof addition, for similar occupancy, to any existing building shall beat the rate of $1.25 for each one thousand cubic feet, classified as "fireproof" by Section 502 of the Minneapolis Building Code. HOUSES 2.3. For any such permit for the erection of any non -fireproof building other than a garage, warehouse, factory or grain elevator, or any non -fireproof addition, for similar occupancy, to any existing building - permit $1.00 for each one thousand cubic feet. GAGES 2.4. For any such permit for the erection of any non -fireproof garage, warehouse, factory or grain elevator, or for the erection of any non -fireproof addition, for similar occupancy, to any existing building or for each such building or addition - ninety cents ($0.90) for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with a minimum or $4.00. For the purpose of computing fees for building permits, the cubical contents of any building or addition to a uniform height throughout by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or cellar to the average height of the upper surface or to the average.height of the roof surface of the main gable of a pitched roof. 2.5. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction thereof in the cost of all proposed work. 2.6. In no case shall the fee charged for any permit as set forth in Section 2 be less than $4.00. City of Fridley Application for Plumbing and Cv= Fitting Permit DESCRIPTION OF WORK Numbc-v, mind and Location of Fixtures V1 Gi in iGQCL�I yl12 Z F: c Cp V, 5Oi �U ZZ (�90 t F • N WATER HTR. GAS ELEC. Base 1st 2nd 3rd `1 4th � - — ° Future Connection Openings NewFixture, Old Openings Connected with Sewer Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE Number Fixtures ......................7 x $1.50 Future Fixture Opening ................ 2- - x 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 Dept. of Bldgs. Phone SU 4-7470 Location 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. N ! Sjr Fridley, Minn �® 19_ Owner 1-1-114 Kind of Building /- Used as `-P 4,v To be completed about Z 63 Estimated Cost, $ _ TOTAL Old—New. Building Permit No Permit No.c;;?-�'� � $ xa Signed LQ,N D: -e] -' '�:''. $i `i'Q By $ Business Phone No $ ROUGH FINAL 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 $ Q REPAIRS & ALTERATIONS—Refer to Code ( / Description TOTAL FEE $� �41114.42 2M1 U: Application for Power Plants and Healing, Cooling. Ventilation, Refrigeration and j Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 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 ............ each add. 80,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. Repairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. Each add. 200 sq. ft. EDR Steam ...................... Each add. 320 sq. ft. EDR Hot Water .................. 8.00 $ 2.00 $ 5.00 $ 5.00 $ 2.50 $ 8.00 $ 8.00 $ 2.50 $ 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) ................ I ...... 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 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 Off 9 5 1962 19 Owner Kind of Used as To be completed about v o� Estimated Cost, $ 6' s ew. uilding Permit No. & I? Permit No. DESCRIPTION OF WORK HEATINGer-P =Water Warm Air—No� 6 Trade Name 7_21 Size Nobe_ Capacity. Sq. Ft. E.D.R- n_=/Z BTU H.P. Total Connected Load �� Kind of Fuel BURNER — Trade Name 7,60 Size No Capacity Sq. Ft. E.D.R Tii 1�',:+OSEH,p G'Os SE®GWICK HTG. & AIR -COM: CC ®�� 5 1001 Xenia AV. S. Minneapolis 16, Minn. Si -ed. By 4z 2M Business Phone�o (REMARKS -OVER) Air Height �- Lineal ft. Area of crack - sq. ft$ >-56 a �1�� 36®�� alJ 3 0 �' c+ ZOLLIS. HEAT LOSS CALCULATIONS , DEPARTMENT OF BUILDINGS MINK. Weatherstrips A.S.H.V.E. Guide Construction No. Infiltration Glass Insulation Windows Doors Reference Out. Wall I Int. Wall Ceiling Roof Floor Kind How. Applied Yes—No I Ye^moo 19— I I Oa Net exp. wall Ceiling 241 II FV LI U o A ,/rjRoom 1 Length I(q Width l 10 Height II ( Y_ 10 1 1 Fl.l % 2GA Room I Lem ith 1 Width f Height 9 Windows and Doors—Crackage and Area Height Width Height No. of No. of of pane lights Lineal ft. Area of crack - sq. ft$ Bpane i So1 -;�4 3,7-- 1 �_ 1 Infiltration Coef. Btu Infiltration `� Glass jq Coef. Btu Infiltration Glass Net exp. wall / o d Glass Ceiling Net exp. wall Exp. wall Int. wall I I Oa Net exp. wall Ceiling 241 Int. wall ( Y_ 10 1 (� Ceiling Floor 16 of Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.1 1 00 Room I Length 1 j_%O Width Height Windows and Doors—Crackage and 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 panne lights of crack sq. ft. -;�4 3,7-- 1 1 Infiltration Coef. Btu Infiltration `� Glass jq _TDI 18f) Exp. wall Glass Net exp. wall / o d Int. wall Ceiling Net exp. wall Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area C 1.1—J, 16ED Koom I Length ) I v Width O v Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of panne lights of crack sq. ft. -;�4 3,7-- 1 1 Infiltration Coef. Btu Infiltration Coef. I Btu Infiltration 3 Glass Glass Int. wall / o d Exp. wall Floor $ Net exp. wall Net exp. wall Int. wall I I Oa Int. wall Ceiling Floor ( Y_ 10 1 (� Total Btu. ft. E.D.R. or sq. 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. t36 I r �r Coef. Btu Infiltration Coef. Btu Infiltration 31 .3 9, / Glass Int. wall 9-C 900 Exp. wall Floor $ ! ( a0 c) Net exp. wall Igg I I Oa Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area m i M A— s t n_ t r --_.l. 1 n lWlLUL @s & s re:..►.r a •1 "--- -----0-' ---- Windows and Doors—Crackage and Area ----�--- Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. t36 I r �r Coef. Btu Infiltration Glass Exp. wall yc Net exp. wall Int. wall Ceiling Floor $ ! ( a0 c) Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. ® 1 Q 8 A( 6in I Length 10 Width Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. !moi1 q® I i 1 '214 Height Btu Infiltration 1 13 138 274 Glass Exp. wall ze Net exp. wall ?' Int. wall Ceiling _ Floor (" (� Total Btu. Required sq.. ft. E.D.R. or sq. ins. W.A. Leader area D-36 14EAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS, MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How. Applied Yes—No Yes—ST 19_ F1.1 V t -W- Room I Length 1 `13 Width lin Height V II RLI Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal f . Area No. of pane of pane lights of crack sq. ft. c 4 Coef. Btu Infiltration 31 ijOG Glass 1 3so Exp. wall # Net exp. wall fro I V9 Int. wall Ceiling ' Floor 1® 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 Dane 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. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. 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 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 I Fl.l 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 Lfneal ft. Area No. of Wane of igne 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 I/ v 1 SUBJECT City of Fridley 17 016 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT • _____ COMMUNITY DEVELOPMENT DIV. a: — r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED- BY L J ` 612-571-3450 910-F15 6/22/83 JOB ADDRESS 7320 Tempo Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 11 3 MElody Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James 0. Bergerson 7320 Tempo Terrace N.E. 784-7611 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 120 square foot deck 9 CHANGE OF USE FROM TO STIPULATIONS 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 $700 $� rJQ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $15.50 N TUREOFCONTRACTOR OORAUTHORIZED AGENT (DATE) WHEN PROPERLY AL ATED THIS IS YOU PERMIT LDG INSP DATE NATURE OF OWNER OF OWNERB ERI (DfE) I/ v 1 CITY OF FRIDLEY APPLICATIO'1 FOR RESIDENTI& BUILDING PLRifITS (Herr, Alterations, Additions, or Repairs) OWNER: �° A&� r;.-® � � :�� a�� BUILDER: ADDRESS: 73 a D 1 0 T Ch' �� C 1'. ADDRESS: TEL N0: % 9 Y- % l® /Z TEL 110: Construction Location Effective Aug. 1, 1981 STRMT NO: �/ e l STREET: Tr -'M 'P IAT: BLOCK: ADDITION: !1'7 f 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. DESCRIPTIO► OF COWSTRUCTION oec'4& Front: Depth: Height: Square Feet:. Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction. ems, Tb Be Oompleted: ms�v Estimated Cost: Alt. A Alt. B Proposed Driveway Width if New Opening Is Desired: $ $ SEE PEVFRSE SIDE OF SHEET Tile undersigned hereby makes application for a permit for the work herein specified, agreeing to c3o,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 applicativ are true and correct. MTE: SIGNATUF.£ : N Stipulations: i ..o The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: Total Valuation $1.00 to $500.00 Fees #10.00 (Minimum $15.00) $501 to $2,000.00 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 and up $443.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof Plan Check: 25 percent of building permit fee. Driveway Depression Escrow: Concrete curb streets only. Alternate "A":Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75 Verification Of Foundation Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. Andersen WINDOWALLSP- - w9lipm Guo" mm so= DATE PACIFIC MUTUAL DOOR CO. 2655 FAIRVIEW AVE. NO. ST. PAUL, MINN. 55113 PHONE: 631-2211 JOB PERMA-SHIELD' WINDOWS GLIDING DOORS SHUTTERS PRIMED WOOD WINDOWS GLIDING DOORS I ! P c 0. aer - - -- -- - - - - - — - _ T - 3 -` T Lj I - - -- / -- -- -- j . - -� o I c30 _ ---- 'Falb-/( -- -}—; --- ----- --- - -� -- - — r c �S_-'-I 91 A/ I f - y "K6------------ I L- ------------- -4 - ' �— _ jh I R-i'c'--�--- --- --- --- -- -- -- �! -- - i* -- - - - 2-' x - - C� I 1 5 8 - ---i- - ---- T,� P G ti I -7- - - - � j I Yt ad 49v • A. - 1 ANDERSENSPERM SHIELDO UNITS FOR COMMERCIAL, INSTITUTIONAL F.- RESIDENTIAL USE SIEDGWICK HEATING & AIR CONDITIONING CO. HEATING JOB NO C� 8910 WENTWORTH AVENUE SOUTH - MINNEAPOLIS, MN 55420 - (612) 88`1-9000 TEST RECORD • SOLD BY MAKE r --o' e4,4 ai SERIAL NO. THERMOSTAT:--� o VALVE LIMIT 6;9 LIMIT SETTING>ko w FAN SETTING PILOT TYPE�f" .� IGNITION MODEL PILOT TIMING ZD -4 - PRESSURE �ecR- PERCENT CO2 INPUT CFH o PERCENT 02 CITY OWNER L INSTALLED BY MODEL INPUT VENT SIZE 0?1 TYPE OF LINER_lc LINER SIZE /f FILTERS: SIZE � NUMBER WIRING_^ TEST TAG LIGHTING INST. DATE TESTED 92 COMPANY STACK.TEMP.L"Z 49 PERCENT CO _-zw, _ NAME OF FORM 235 (REV. 1189) TESTING oop TESTER FORM DIST WHITE COPY - JOB FILE YELLOW COPY - CITY 0- ' 1-Z) Jw /-18,0 l - Je 2�6 a):"fad A ,fL 1%.tJ i E P/ A,): C'erre��cJ �7»e.� , CITY OF FRIDLEY INSPECTION DIViSION 2 - �� '� ` /tex"w Ariz Effective On January 1, 2000 643f University Ave NE s . 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 *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 4% of Value of Appliance or Work Commercial/Industrial J',.25% of Value of Appliance or Work Rate $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 e 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 permission from adjoining property owner. JOB ADDR OWNER TOTAL ' BUILDING USED AS ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Unit Circle One (Steam) (Hot ater) arm Air $ Trade Name ,�,'Vf_ Size No. BTU g��— HP EDR $ Fuels Total Connected Load Burner Tra 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 SbNT Approved By Rough -In Date Final Date �_�'✓� u 01 SUBJECT RM City of Fridley (- 3651 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. rr _ COMMUNITY DEVELOPMENT O � PROTECTIVE INSPECTION SEC.. t✓ � 1 NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 763-571-3450 910415 6/27/03 JOB ADDRESS 7320 Tempo Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 11 3 Melody Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Evelyn Bergeson 7320 Tempo Terrace NE 763-784-7611 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Bainville Exteriors Inc 2434 Hillview Rd, Mounds View MN 55112 763-783-3994 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20204603 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK a 0 NEW 0 ADDITION 0 ALTERATION X REPAIR 0 MOVE 0 REMOVE n 8 DESCRIBE WORK Soffit/Fascia 9 CHANGE OF USE FROM TO STIPULATIONS Install soffit ventilation to meet the State Building Code. 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,736 $.87 ME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE DOES NfNANY PERMIT FEE SAC CHARGE PROVI I OTHER STATE OR LOCAL LAW REGULATING CON-STR $63.15 Fire SC $1.74 IE PERFORM C OF CONSTRUCTION ® PLAN CHECK FEE TOTAL FEE Lacer_ a SC $5.00 $70.76 S ATU OF COQ RAUTHORQEDAGENT iDATE, WffEN PROPERLY VALIDATED THIS IS YOU PERMIT SIGNATURE OF OWNER, -F OWNER BUILDER. iDATE, OA TE u 01 NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER SINGLE FAMILY AND DUPLEXES R4 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: '�c) T "a Legal Description: Owner Name & Address: ''11 Tel. # Contractor. V-1 L' l e CC'S "C- MN LICENSE # c20 -a046023 Address: dcl/k2VUJVJS Tel. # 3 7_8,339 . S777 C3 -- 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/Ground Sq. Ft. OTHER: Vz . , I — ±- R. V Construction Type: $6� Estimated Cost: $ 0 ---L3(,0 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 6 ' ®� APPLICANT: � -CLaL ' �'� �� t1 Tel. # 7tO Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ e Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 per SAC Unit $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 [ ] BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for eaGh additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined rate. Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the. proposed structure and of the construction site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUIVIRFR OF FIXTI IRF. TO RF INRTAI I Fn rIM ;=A( -M 1=1 r-InO Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS Tempa _Teffacc� $7.00 7 V New Fixtures The undersigned hereby makes app I ton 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 theftuilding Division, 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 Sump/Receiving Tank $7.00 Water Treating Appliance $10.00 OwnerbTor6or?) ble (uyi Water Heater -Electric $7.00 j Water Heater - Gas** $10.00 Building Used As_&E6X_V�61 C.Z Gas Range" Gas Dryer** $10.00 $10.00 Estimated Cost PERMIT NO. Back Flow Preventer Required )Yes No Type, - $15.00 PLUMBING COMPANY .&/6&=M ELO A Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE SIGNED BY Approved By TEL N0.6LZIZ74(9�3 Rough-In Date Final COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE -41eelzv COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When reAlacina_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 ventingwsystem is. plastic/PVC and meets all current codes and manufacturer specifications :including sizing, length, number of elbows and termination. 1 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 existina 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.th_ a common vent and vented separately as;per_current codes. Yes(NoO 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 C0: i Signed By: Date Building $ 5 BUILDS" -;G Plan Review Permit No.: Inspections RESIDENTIAL APPLICATION $ Received By: 763-572-3604 $ CITY OF FRIDLEY License Surcharge REMeAUG �-2nu- DATE YOUR E-MAIL ADDRESS a •( -,J r J SITE ADDRESS 7300 : ,ma 'T.evv� $ THIS APPLICANT IS: ❑ OWN CONTRACTOR $ PROPERTY OWNER/ NAME: $ Fee Determined by Engineering Sewer Main Charge TENANT ADDRESS: Total Due STATE 3 t�- J%D, �, S Make checks payable to: City of Fridley Attach Stipulations PHONE: THIS IS APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building CONTRACTOR NAME: conformance with the ordinan d STATE LICENSE # permit but only an applicatio a SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY O U WITH APPLICATION p FAX —zip PROPERTY TYPE GLE FAMILY W CONSTRUCTION SIZE ❑ CONSTRUCTION STORIES PERAM TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH❑ OFW ' ❑ DRAIN TILE ❑ DECK ING ❑ OTHER ❑ SWIMNIING POOL TYPE OF WORK: Pw ❑ ADDITION ❑ MAINTENANCE/REPAIR '❑ REMODELING DESCRIBE WORK BEING DONE: IV SIZE OF IMPROVEMENT LE TH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, n; 17 ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum Wrrim 1. Site Plan/Survey showing the existing structures ❑ Other CO Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations 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 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ZS'/ 0ZM . M OCCUPANCY TYPE Permit Fee $ 5 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ (M .001 times the total job valuation Surcharge $ (Ttj .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = R x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ " J%D, �, S Make checks payable to: City of Fridley Attach Stipulations THIS IS APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building pe it I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinan d es of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicatio a work -is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work ch re ie and approval of plans. SIGNATURE OF APPLICANT /� /� Loot PRINT NAME &L-"'l—e f� Page 2 - Building Residential Application BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for I' $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 $2,001 to $25,000 $69.25 for 1' $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 ' $25,001 to $50,000 $39125 for 1' $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for l' $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for l- $100,000 plus $5.60 for each additional $1,000 or fraction to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the 1" $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the I' $1,000,000 plus $3.15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977