PRE 2010 DOCSDate:
Owner
Address
City of Fridley, Minn.
BUILDING PERMIT
0 -
N°068
Builder —
657
Address
?CA�J,O OF BUILDING
+��°°''
No. -Street -'' ;—,,4 Part o Lot
Lot _ Block —, Addition or Scub-TD)Ivislon
Corner Lot _'�' "~ Inside Lot . r Setback_�? �L _� Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To Used
,Front
.2 Depth �`� Height Sq. Ft. ` Cu. Ft.
Frront —.. DepthHeight Sq. Ft. Cu. Ft.
Type of Construction' ��" '.`Coit ,'o 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
ordinaaces of the city of Fridley.
In consideration of the payment of a fee of $ Gty "� , 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 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 la ' any of the provisions of said
ordinances. A /I /
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
du r;uildlna jW* for for separate pera is for thus hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY., MINNESOTA
Owners Name Ino 322 — nth gNE
AddressA _
Address
_. •AbO�"
.LOCATION OF BUILDING
54® . .
No, � Street4th StreetNE
,- Part of Lot
Lot 16 & 1731ock Addition or Sub'. Div, �ilton'a Addition 1'0 1eha10evill®
Corner Lot z. Inside Lot _ Set Back .35'
Applicant attach to this form Certificate of Survey of Lot and proposed
building location.
JESCRIPTION•OF BUILDING
To be used as
Knitiple Front_ Depth 46 Height 12
Sq. Ft. 1'54 Cu. FtL_18*528
Front —Depth Height
Sq. Ft. Cu. Fte _ ..
Coct
To be completed 2-1-61
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,
Date Signature
(A_ Schedule of Fee Costs : can 'be found --6h the :Reverse Side
Ap= � ' '�g Inspector
in
EGAN, FIELD & NOWAK
SURVE �
--�
f oRs
I" WEST LAKE STREET tr ' 1 F �L�°' MINNEAPOLIS B, MINN.
CERTIFICATE OF SURVEY ��
For B. & M. I NC. /�
13 0.6 2
14
300
(10
101
130.75-
54-7-H A Ve. AZLE-
DESCRIPTION:
LOTe 16, AND 17, BLOCK 11, HAMILTON'S ADDITION TO MECHANICSVIL.LE.
SCALE: In — 301
We hereby certify that this is a true and correct representation of a survey of
the boundaries of the land above described and of the location of all building4
if any, thereon, and all visible encroachments, if any, from or on said land.
Dated this28TH day of OCTOEiER 1960 EGAN, FIELD & NOWAK
Surveyors
F i le N o 5298- ego k N o t 534 - 33 b y'
V
Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULEDept. of Bldgs. Phone SV 4-7470
J
GRAVITY WARM AIR: RATE TOTAL,
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
each add. 60,000 BTU ...... ................. .
Replacement of Furnace .............................
Repairs & Alterations—up to $500.00 .... ............
Repairs & Alterations each add. $500.00 .............. .
Locafion �® ® .0/- '24 , 3�r
City of Fridley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and -hereby declares that all the facts
and representations stated in this application are true and correct.
8.00 $
2.00 $ _ Owner
0.00 $ Kind of
5.00 $
Used a:
2.50 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. IDR Steam_ ...... 8.00 $
oaa�
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 $ j
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 FPE $� • `�
ROUGH—
OUGH
FINAL—
FINAL
To
To be completed about
Estimated Cost, $ CPO
Old New Building Permit No. vt—b Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, EE'
Warm Air—No 0
Trade Name �/f _', - Size No
Capacity, 414 Sq. Ft. EM.R f_ _ 10-0 BTU H.P.
Total Connected Load —!35—, 0O Bind of Fuel IvIPr
BURNER — Trade Name -�-� Size No -
Capacity
(REMARKS—OVER)
a z ZM 7-59
Sq. Ft. E.D.R BTU H.P.
ETHIER - ST®LPE - PAAR, INC.
.�aaEut� sPecia�ieEa
Signe
By.
Business Phone No—[ L _ ,%�
Ddb az
HEAT LOSS
i
CALCULATIONS
DEPARTMENT OF BUILDINGS
1
FRIDLEY, MINNe
Weatherstrips
A.S.uidH. e .E.
G
Reference
19_
Coef. Btu
Construction No.
ICoef.1
Insulation
Windows
e No
_
Doors
I
Out. Wall Int. Wall Ceiling Roof Floor
Kind
How Applied
es No
Ceiling IV
5F,90
Exp. wall
/ FI.I
Room I Length o s Width
i i Height r
II 1 F7_I ,R_ :0_ __Rnnm 1 Length
49G Width I -2y ' Height 8
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 pane lights of crack sq. ft.
-.v Yo • D �..®
Coef. Btu
Coef.
ICoef.1
Btu
Infiltration
S
Glass
! Net exp. wall
Int. wall
Glass
Exp. wall
Ceiling IV
5F,90
Exp. wall
i
'Z o SO
j Int. wall
Net exp. wall
Ceiling
/b
Int. wall
Floor
Ceiling
/�/
/p
/�� C
Floor
Total Btu. .� — /o x 6 ✓r0
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ F1.1 .A Room I Length 9 Width jL Height g
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 pane lights of crack sq. ft.
Coef. Btu
Coef.
Btu
Infiltration
.5s
Exp. wall
Glass
! Net exp. wall
Int. wall
`y
Exp. wall
Ceiling IV
5F,90
Net exp. wall
i
'Z o SO
j Int. wall
Ceiling
/b
Floor
Total Btu. .. ,m „ Z%
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ FI.I ogg&��... Room I Length /® Width 9 Height A?
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
36 A0 Z. / &
Coef. Btu
Infiltration
3
I Glass 3
53
Exp. wall
! Net exp. wall
Int. wall
`y
Int. wall
Ceiling IV
5F,90
Floor
p
Tbtal Btu. smfr
Reauired sa. ft. E.D.R. or so. ins. W.A. Leader area
Windows and Doors—Crackage and Area
Width Height No. of Lineal et. Area
No. of pane of pane lights of cracck sq. ft.
/S:1r
Coef. Btu
Coef. Btu
Infiltration
Glass
3 p
Glass
S3
Exp. wall
Int. wall
Net exp. wall
Int. wall
p
Ceiling
Floor
Total Btu. I -A7. I 5---97
r%equlrea sq. r . c..u.r%. or sq. ma. w.rt. a.caucr arca I
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 eq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft.-D.R. or sq. ins. W.A. Leader area
Fl.l Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height Na 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. WA. Leader area
I
CITY OF FRIDLEY
APPLICATION FOR PWMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
\
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
Number Fixtures
x
$3.00
$
Future Fixture Opening
x
tP
$
Water
of
w
m
A
x
$5.00
ro
$4
a+ c
a -+
m
W
A
$
u
rt k
ski
a
W
$
Water Softener
Heater
m
ai
`4
x
N
�
N
E
A M
l�
$
of
---
w
u
d M
C
C3
g
U
obi
+o
$4
to
ro
H o
x
ro
ro
ro
N
rtNm
+'SJ
v1
.°�
U
O
m
t�
W
3
G W
u1
w
U W
¢ 3
0
c7
O
as
lec
1st
2nd
3rd
4th
(R) - Future Connection Opening
Connected with Sewer
(*) - New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
\
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
Number Fixtures
x
$3.00
$
Future Fixture Opening
x
$2.00
$
New Fixture, Old Opening
x
$2.00
$
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU
x
$5.00.
$
100,000 BTU to 199,000 BTU
x
$10.00
$
Water Softener
x
$7.00
$
New Ground Run Old Building
x
$5.00
$
Electric Water Heater
x
$5.00
$
Job Address J % o/ ( t 4 S- 2�2 N
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. .�1 %� e G% 19�
OWNER �� lam/ S �� r Z? y "a
KIND OF BUILDING
USED AS
J e
TO BE COMPLETED ABOUT Cl N
ESTIMATED COSTj�
OLD - NEW BUILDING PERMIT NO. PEP14IT NO. 7V /
ROUGH INSP.
Date
Company ® �/ elpl- el�
Signed By
Tel. No.
d-&�'a'o�'F
14f75� -may -Sl .
F2�a
GAS FITTING FEES:
\
FINAL INSP.
Date C Lv
1st 3 fixtures x
$3.00
$ -3.00
Additional Fixtures x
$1.00
$
Gas Range to 199,000 BTU x
0:0.00
$
APPROVAL FOR PERMIT
REPAIRS & ALTERATIONS
First $100.00
$5.OQ
$
each add. $100.00 or fraction
$2.00
$
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
State Surcharge
$ .50
TOTAL FEE
$
REINSPECTION FEE
($10.00)
---
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OWNER:��,I�, t� �� l� t � j4-
ADDRESS:
_ADDRESS: 1�oe'
TEL NO:
STF.EET NO:
LOT:
BUILDER:
ADDRESS:TEL NO: C'
Construction Location
STREET: '_// %h
BLOCK: ADDITION:
Corner Lot: Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
Front: Depth: �C Height: `2-
Square Feet: ,7_(�5 Cubic Feet:
Front: Depth:
Square - Feet: Cubic Feet:
Height:
Type of Construction: 0-931V_ Z C4 9E Estimated Cost: $
To Be Completed:
Alt. A Alt. B
Proposed Driveway Width if New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
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 ark true andrrect.
DATE: //- ? - -7 (? SIGNATURE:
Stipulations:
MUb r 3Zf Fes► PWA kt*A VC
evotb
rIM: $35.00
City of Fridley
AT THE Tol` Of 1110 Ttims
; .., COMMU11ITY DEVELOPMENT CIV.
1 i PROTCCTIVV INSPECTION 02M
CITY HALL FRIDLEY 50432
EY.P11MIE:011 VATS: Aprj,.L sv, .LVUU_
SUDJECT
LICENSE APPLICATION
Application For License
/I-- 2 , 1975
Date
TO THE HONORABLE CITY COUNCIL:
New
herewith submit Renewal application
V
for license to perform within the City
of Fridley, in accordance with the ordinances of aid City regulating
the same. I am • over twenty-one years of. age.
Submitted herewith is.a. Certificate of Insurance evidencing the holding
-of Public Liability Insurance in the limits of $50,000 per person,
$100,000 per.accident for bodily injury, and $25,000for property damage,
and a Certificate of. Insurance evidencing the holding of Workman's
Compensation as required by law. .
Certificate of Insurance N IS
of Con truction Company
Workmen's Comp.
Expires Name oflindividual to Co tact
Public Liab. _
Expires k)
Bond Address of Company
Expires s
City Zip Code
. SGC 7 0 9 J .
Telephona No. of ]business
SLnta Haster er Li.cense
No.__ w (Mien AI)plicable) '
Cities of: 1'ill.lg S W110-3:0
Crntnp;lny 1>>:c:selitly Licensed:
Receipt No.
__ --- License Na.
w.y.ww...w.rww..w._.w...0 �......n.►....♦.+..Y..w...M..w...w.._-.r........+...-a..ww�... r.wrwn..rr+..._..O.r.s..w..M..ww�.r'."....y°.'�...rr rw•-...+....w.w.+.w....w... w
Building
BUILDING
Permit No. O
Inspections
RESIDENTIAL APPLICATION
Received B Wf
763-572-3604
CITY OF FRIDLEY
va c�o
763-502-4977 FAX
EFFECTIVE 1-1-08
DATE
YOUR E -MATT. ADDRESS
SITE ADDRESS
5
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: �O
TENANT
ADDRESS:/S S 4 CITY
`
STATE �/AIP
PHONE:
NAME:
CONTRACTOR
ADDRESS: 9lJIO Ji'_I AVT C
CITY
STATE ZIP
SUBMIT A COPY OF
FAX
YOUR STATE LICENSE
-
3131
STATE LICENSE # EXP DATE
PROPERTY TYPE
b9fSWLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION GE/SHED El WINDOWS
❑ BASEMENT FINISH ❑ DRAIN TLE
CIG
13 DECK ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCEIREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: eem® 9l a 6
SIZE OF IMPROVEMIIVT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING❑ HOUSE ONLY
25—
BASEMENT
REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
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
l7 Trim
tures
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and Propos Protect'
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE 13ASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
'OTAL JOB VALUATION
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dae
SCHEDULE)
OCCUPANCY
See Back Page for Fee Schedule
65% of Building Permit Fee j
.001 tines the total job valuation !.
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks navable to: City 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 permit and work is not to start without a
permit on site; that the work will be in actor nce 'tir the appro d an ' the case of all work which requires review and approval o plans.`
SIGNATURE OF APPLICANT PRINT NAME JJ i e, J ,ed dei DATE
APPROVED BY
DATE
i1060"d
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