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PRE 2010 DOCSW � 7 e'-) . Application for Power Plants and. Heating. Cooling, Ventilation, .Refrigeraand i Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII, 4-7470 . S ULE , GRAVITY WARM AIR: RATE TOTAL, Locafion �� r `l S T A/ E, 1. Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ City of Fridley: Re airs &Alterations u to 500.00 The undersigned hereby makes application for a permit for the work herein P P $ .............. • ... 5.00 $ specified, agreeing to do all work in strict accordance with the City Ordinances Repairs & Alterations each add. $500.00 ............... 2.50 $ and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ 1 6. CLQ each add. 60,000 BTU ... . .................. 2.00 $ Replacement of Furnace . %.00 $ Repairs & Alterations—up to $500.00 .... ............ 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ STEAM or HOT WATER SYSTEM 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 $ 3-00 Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINALa $ See Fee Schedule $—�- TOTAL FEE $ Fridley, Minn_ 19 — Owner R 1 0 G t c J 0 y q 5 L. rD i� S Kind of Building Used as Q '..)- To be completed about Estimated Cost, $ / / C> CD Old New Building Permit No. ��% P�Permit DESCRIPTION OF WORK BEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No 7 s Trade Name Size Nc��a M S�• poo Capacity. G 5 O a Sq. Ft. E.D.R BTU H.P. A;? >-3 Total Connected Load 3z n/0 0 Kind of Fuel ---Q �9 4 BURNER — Trade Name------) � `11 c Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Sign u 7 By u HEATING AND AIR CONDITIONING INC. s 42 2M 7.59 Busin&gQP!�PNB BWD MINNEMUS 16, MINN. r CRONST16MS HTG.', & AIR GOND., INC. Job Name " D-56 4410 Excelsior Boulevard, Minneapolis 16, Minn. 26 NEAT LOSS OMMLATIONS Job Address Weatherstrips A.S.H. .E. Construction No. I Insulation Guide Windows I Doors Refer :a a Out. Wall Int. Wall Ceiling Roof Floor I Kind How Applied Yes—No Yes—No 19— F FQ N ,,,Room I Length �`3 Width ,� 6 Height Fry F1.1 s� � o , � Room Length Width 5 Height z Windows and Doors—Crackage and Area Width Coef.1 Btu Infiltration 20 1 32 2 0 - Windows and Doors—Crack a' a and Area Coef. ' Width Height No. of Lineal ft. Area Net exp. wall No. of pane of pane lights' of crack sq. ft. = Ceiling / :ay Net exp. wall t/ �.� Floor =" Int. wall Net exp. wall Total Btu. (5 y Ceiling c> Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Int. wall Windows and Doors—Crackage and Area Width Coef.1 Btu Infiltration 20 1 32 2 0 - Glass Glass Coef. ' Coef. Exp. wall - Infiltration Infiltration Glass Net exp. wall ye-) y 2 1 0 Int. wall i 5 of Exp. wall „ G = Ceiling / Exp. wall Net exp. wall t/ ; Floor =" Int. wall Net exp. wall Total Btu. (5 y Ceiling c> Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Int. wall I Fl.I P- �,. -t- Room I Length V Width 4 Height AA Windows and Doors—Crackage and Area Width Height e Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 1 3 e ' Width Height No. of 'Lineal ft. Area No. of pane of pane lights of crack sq. ft. 06 / Coef. Coef. Coef. Btu Infiltration Infiltration Glass `ocr ye-) -7 Glass ?� 4i i 5 of Exp. wall „ G = �� Exp. wall Net exp. wall t/ ; d e, =" Int. wall Net exp. wall Int. wall (5 y Ceiling c> I Int. wall Floor — Floor Ceiling �/ F F 0 Q Floor Total Btu."�sS' Required sq. ft. E.D.R. or sq. ins. WA. Leader area r F1. :5 t 0 Room I Length d `f Width Height e Windows and Doors—Crackage and Area 1 3 e ' Width Height No. of 'Lineal ft. Area No. of pane of pane lights of crack sq. ft. 06 / Coef. Coef. Btu Coef. ', Btu Infiltration Glass `ocr I y oC., Glass 'g ?� 4i i 5 of Exp. wall „ G = �� /0 Net exp. wall t/ / d e, =" Int. wall C Int. wall (5 y Ceiling 6v ;a ds 3 -7 6 Floor — Tbtal Btu. 7.Too- Required 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 eq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 1 3 e ' Coef. Coef. Btu Infiltration-,y� Glass 1� e-1 Glass Glass 'g ?� 4i i 5 of Exp. wall = �� /0 Net exp. wall =" Net exp. wall C Int. wall (5 y ® v �5 ' 4�-3 Int. wall Ceilin Floor Total Btu. F' Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / FLI -. Room I Length , --:P Width , e.) Height ;5;11 Windows and Doors—trackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Width Height No. of Lineal ft. Area No. of pane of.pane lights of crack eq. ft. Coef. Coef. Btu Infiltration Glass 1� e-1 = ? 01 Glass Exp. wall c ,,r r 1 -L" Net exp. wall Exp. wall /0 Int. wall Net exp. wall C (5 y ® v �5 ' 4�-3 Int. wall Ceiling 5,t? Ca Floor9 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 F1.1 A,& - , Rftem 1 Length 5' Width /-- Height _r? 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 m - Exp. wall c ,,r Net exp. wall y /0 Int. wall Ceiling CA ej u Floor Total Btu. Pf '9 0 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area CRONSTIOMS HTG.I' & AIR COND.,' INC. Job Nam - D -56 0410 Excelsior Boulevard, Minneapolis 16, Minn. 2 NEAT LOSS OALCIILATIONla Job Address_ H. � .E. Weatherstrips A.S.Construction No. I Insulation Guide WindowsIs—No Doors Reference Out. Wall Int. Wall Ceiling Roof Floor I Kind How Applied Yes—No Ye19— ,F1.1 g` 5,6 1--� Room I Length ,;,Width � ua; Height' 7 Windows and Doors—Crackage and Area Width Height No. of Lineal t . Area No. of pane of pane lights of crack sq. ft. Coef.1 Btu Infiltration;' Glass Glass Exp. wall Exp. wall v? ',Yp 84 ` ' Int. wall Net exp. wall 16, J,i 2i 5S Q5 6 Int. wall Ceiling J 4' Ts e'er a °� � .0 Floor Total Btu. ' °a I-V Required sq. ft. E.D.R. or sq. in;. W.A. Leader area •� � s 7 eQVdoom Length 13 Width cl H 14eight 7911 Windows and Doo rs--Cracka' a and Area Width Height No. of Lineal ft. Area No. of pan ofp�ane lights of crack sq. ft. Coef. Btu Infiltration Glass -2, 71 ,5 0 Exp. wall Q6 ;r Net exp. wall �157 s /5 3 -:' Int. wall Ceiling.' Floor E - - Total Btu. It') y s2 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Z4&,',, Room Len th j? :? 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. tl_ / Coef. Btu Infiltration aI ;X1 -?� Glass J-3 ",7 ---� d,�- Exp. wall �f Net exp. wall ' O 7 6 Int. wall Ceiling , err e/ - 'm Floor 4m Tbtal Btu. ;" &'° Required sq. ft. E.D.R. or sq. ins. W.A. Leader, area FIA Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane I 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 FU 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 Renm I Lenath 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 Stu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader arra Date: Owner: Address City of Fridley, Minn. BUILDING PERMIT Address L T F BUILDING No.Street f Part,p*ot Lot Block, Addition or Sub-DivisionOWE Corner Lot _ _____ Inside Lot _ _. Setback Sideyard INV Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING Top Used x Front Depth Height , Sq. Ft., Cu. Ft. From, Depthjf, Height _ Sq. Ft. Cu. Ft. Type of Construct ioIIEst Cost / Of To be Completed — Ae� 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 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 dart 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 .viol i'of any of the provisions of said ordinances. .rte, w 1 1 Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, Baa heating, :ower or water. Be son to sae the Building Inspector for separate permits for thea items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner'sWame u 11 d e r �' AM "MMM �' Address LOCATION OF BUILDING Mo.- J C� streets Part of Lot Lot _�" Block ,,_ Addition or Subdivi ion Corner Lot Inside Lot Setback3igE�_Side-Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used ass DESCRIPTION OF BUILDING Front =Depth �' Height -Z �� ..z_ Sq. Ft. Cu. Ft. Front____Depth height Sq. Ft. Cu. Ft. Type of Construction _ Estimated Cost /J� To be Comoleted d /� 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 ruling of the Department of Build- ings, 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 Rdri®rse Side). City of Fridley, Minn.. N° 8211 BUILDING PERMIT • Date: - Ju1Z 16, 1965 Owner: ROLL= SITCOM Builder DON PINME Address 5830-32 - 4th ST. N.E. Address 54.32 Altura Road Fridley, Minnes©t26 FridjaM Minncacota LOCATION OF BUILDING No. 583o-32 Street lith STREET N.E. Part of Lot Lot �_ Block 4 Addition or Sub -Division Bennett Palmer Addition Corner Lot _ Inside Lot _ __ Setback — Sideyard Sewer Elevation Foundation Mevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height _ Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost U P 000.00 _ To be Completed • REPAIRS DUE TO STORM DAMAGE • In consideration of the issuance to me of a permit to et the building described above I agree to do the proposed work in accordance with the description above rth aayt�' empliance with a'11 provisions of ordinances of the city of Fridley. (( In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to ROLL= WHITCQ to construct the building or addition as described above. Thisis granted the express condition that the person to whom it is granted and his agents, employees an 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 location, construction, alteration, maintenance, repair and moving of buil�n� within ordinances city limits a� permit may be revoked at any time upon violation of any of the provisions of said ALLEN G. JENSEN Building Inspector NOTICE: "b pumb don act eewr dw commeHoe, buftudion ler whiny, phnubinB► on hoallee, awu or watu. Be wn to no Na Butldtna lnap. r for sspa ponaib for thea Dom. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY* MINNESOTA I LA:66A ,ax.._ai..UILDERs - ADDRESS it 4(2*4.�&:&C__,ADDRESS LOCATION OF BUILDING NO. ® STREET PART OF LOT ou LOT_. —BLOCK ADDITION OR SUBDIVISION yLL 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 as: DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost nl-c� � YJ 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 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 l SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side. c� / G City of Fridley, Minn.. • BUILDING PERMIT 11 0 Date: NOVEMBER 30, 1965 •C1�7 ROLAND WRITCOMB & ROY MAGNUSON Builder SUSSEL COMPANY 4 3/� �g- N° 8618 Address 5a3O-32 - 4th st,, N.H. Address 1850 Ooma Aye„t�P Fridley, Minnesota 55421 St. Paul, Minnesota LOCATION OF BUILDING No. 5830-3?street 4th St. N. E. part of Lot Lot 5 _ Block 4 Addition or Sub -Division Re=tt Palmer Corner Lot , Inside Lot _ _ X Setback of house_ Sideyard 31 Sewer Elevation — Foundation Elevation To be Used as: DET. GARAGE DESCRIPTION OF BUILDING Front 22 Depth 24 Height 10 Sq. Ft. 528 Cu. Ft. 51280 Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Frame Est. Cost _ $1, 45 0 ___ ___„ _ 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 21 provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 5.00 permit is Eby granted SUSSEL COMPANY 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 any of the provisions of said ordinances. ALLEN G. JENSEN NOTICE Thu psm* don not aowr the aonstmatlon, hatelbd= for whing, phnnbino, on ha hm, awa or wrier. Be am to as the dolldhto Iespeator for apm% permlft for thea B=L APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA 0MR' S NAME 9 ®e BMLDER rlLr, ADDRESS—J--,F A, , ' 3,A •r,r. ADDRESS 8 fz ® _ /fie ' LOCATION OF BUILDING H� _ Street Part of Lot LOT ADDITION OR SUBDIVISIONr C 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. DESCRIPTION OF BUILDING To be used as: gel -141.1 4; d Front Oa- Depths X.), height / Sq. Ft._,��j Cu. Ft. .> _-L �--- Front Depth _Height, Sq. Ft. Cu. Ft. Type of Construction Fr�Estimated Cost J j" ®- 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 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 AD,y d 1 — ���SIGNATURE (�►- '�L (Schedule of Fee Costs can be found on the Reverse Side). LOT NAME - _- SIZE Z2'x 7.4 o a BLOCK ADDRESS VALUE _ 5650-52, 43" Sm U.t;-- cc (•4 So ADD'N. AREA TYPE f- Qt Seaue.W-E nWrr�4 H©usc O ISH McsH ��Ot9Pc� rT 16 1 Doo AV kpmoo �uTu2� R 53-84-879.01 City of Fridley pk &-*n hr MoMml md Gw R"Ift Pem* Dain. of Bidgm Phone 6980-3= W® 5830 N. E. Lith. Street i;1kM14, Cosmaegas t�,�-Mlnw AA%fto GM CF-"Minua cftT of Fr'ocv: �a r�-k-t Kind of Building Frame - .. saw" Used as Res. To be completed s 9 MARTIAL RATE SCHEDULE il'kiMS: NC% RATE 707" Numb x SX06 8— ruwn VzWm Q'pening — " Z,. - r - '' — x $1.50 $—.. New Fixtuve 0141 Owning ...... X $1.50 Catch Baskp � ........... ...... x i3 i6 S Water Heoter fup to 99'M BTU).. x $3.00 S Near Ground Run Old Bldg. . . . . * . x $3.25 S CLWL,qk Wet" Remer .............. —2 $2.00 8— GAS FITTING TEES: NO. RATE TOTAL 14 3 Fixtures ................ —23100 A"tional Fixtum . * ........ x S .75 Gas Rmp to 1W.000 BTU z $5.00 • State Surcharge REFAM & ALTERATIONS-4Ww So Cc& ... Re pl.ap e. j':pgp... . . . ......... S 3-00 TOTAL "M 0 3.50 Fatimated C(nF, � FATAL l - lo - 7 (-( SUBJECT City of Fridley 20529 ?17 AT THE TOP OF THE TWINS ? BUILDING PERMIT I NO. _ COMMUNITY DEVELOPMENT DIV. tr PROTECTIVE INSPECTION SEC. '7 —3 NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/16/90 JOB ADDRESS 5830-32 -- 4th Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 4 Bennett Palmer Addition SHEET 2 PROPERTY OWNER MAILADORESS ZIP PHONE Roland WHITCOMB. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Wayne Barkley Construction 67 - 13th. Avenue S.W., New Brighton, MN 55112 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Duplex 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Structure - Tear off (22 Squares:)_ 9 CHANGEOFUSEFROM TO STIPULATIONS if valleys need replacement, must be galvanized or equivalent. on all new roofs or tear-offs and replacement roofs, State Code requires that 2 layers of 15 Ib. felt, mopped together, be installed to a point 24 inches up from exterior wall line, or the use of other approved underlayment membrane. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 2 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1100 $.55 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $27.00 OR THE PERFORMANCE OF CONSTRUCTION. pLAN 6W6--GK-�-. Fire SC TOTAL FEE YT h- A: � 1.10 $28.65 siG TUREOFCONTRACTORORAUTHORIZEDA NT (DATE, WHEN PROPERLY LI DATED THIS IS YOUR PERMIT BLDG iNSP OAT SIGNATURE OF OWNEROF OWNER BUILDER) ,DATE) NEW [ ] Effective 8/16/90 ADEN [ ] R-1 AND R-2 ALTER [ ] Building Permit App/l%icCation Construction Address: Legal Description: �e'- / Owner Name & Address:�� ,l�i' I �� o ��r Z Tel. # Contractor: �/��lv l'54��/�� l "mss f Tel. #�33 - 9,J Address: e Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn an it to scale. LIVnrz AREA: Length Width Height Sq. Ft. QsiMM AREA: Length Width Height Sq. Ft. DEUR AREA: Length Width Hgt/Gr+ound Sq. Ft. Off: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: MO,- eal � e f�4- wsEstimated Cost: $ Approx. C cupletion Date: 0 Hod d Proposed Driveway Width If New opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: APPLICANT:&14d Tel. # Permit Fee $ r ()V Fire Surcharge $ S o 1 State Surcharge $ SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ S.B'y srIPUTATICNS: Fee Schedule on Reverse Side . 001 x Permit Valuation . (1/10th �) $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 64-2,- �� CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1993 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 512-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICE JOB ADDRESSy RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $ representations stated in this application are true and correct. / - �� Gas Piping (Needed with new furnace) $10.00 $ OWNER > > , Gas Range $10.00 $ BUILDING USED AS mOj Gas Dryer $10.00 $ ESTIMATED COST PERMIT NO. •J�� � n *Air Conditioning -All Sizes '� $10A0 DESCRIPTION OF FURNACE 6140 OR BURNER All Others/Repalm & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ No. of Heatin s Circle One (Steam) (Hot Water Air Trade Name Size No. Commercial/Industrial BTU HP EDR 1% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge .58- Burner Trade Name Size No. BTU HP EDR TOT FEE �lMEATING COMPANY_ �. L( MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATLO-N------ REFRIGERATIONIAIR CONDITIONING PERMIT-T-t� �15.Q0 % G� �) Signed By i No. - PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 Approved By G f �" _ Rough -in Date Final Date *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. 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 ( ) No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes ( ) No ( ) 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Being Done: HEATING COMPANY Signed By Date Building $ BUILDING Permit No.: Inspections $ RESIDENTIAL APPLICATION Received By: 763-5'72-3604 $ CITY OF FRIDLEY Date Rec'd: I ®' '0 DATE % .0 YOUR E-MAIL ADDRESS Pd Z Nd L° 61 N- j1- SITE ADDRESS s_�O -,:5&0.2 ��4 $ $5.00 (State Licensed Residential Contractors) SAC Charge THIS APPLICANT IS: AOWNER ❑CONTRACTOR $1550 per SAC Unit (Plans to MWCC for determination) PROPERTY OWNER/ NAME: TENANT ADDRESS: 65rQ ��! /G CITY STATV sQ PHONE: _6&7155 �oC 9U Park Fee CONTRACTOR NAME: Fee Determined by Engineering STATE LICENSE # EXP DATE $ SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE TWO FAMILY STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED 5' WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION MAINTENANCEMEPAIR ❑ REMODELING Q DESCRIBE WORK BEING DONE: /�Q�l� �ii /4 Lr % `II �J l j W d 0 j&_& QI & C,Rr 1 Tl, V/4441 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 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 ❑ Fascia and proposed project 2. Two sets of construction plans WINDOWS IN EXISTING OPENINGS XYes ❑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 $ d U®®® — OCCUPANCY TYPE Permit Fee $ !� 37, a`� _ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ -, (YC) .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21= $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ `S R- Make checks payable 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 and 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 equires re iew and approval of plans. / SIGNATURE OF APPLICANT L ACL // PRINT NAME / 9` V" C.(/�r&7�7 b DATE 271-1Y11261, FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER , RD �4,1� 0" a% "i , understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name Date/�����