PRE 2010 DOCSCity of Fridley, Mian.
BUILDING PERMIT N° (570 9
Dater .' +►"~ _
Owner: �'�' Builder
Address _ ____ Address
�
� a
OCATION , F BUILDING
No. -- += Street �! _Part of
� 4
Lot Block_ _ ____ dition or Sub �Divna�'o11.
Corner Lot _ Inside Lot — Setback tLvl __._ Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
TU'' Z ,.v
FrontDepth Height Sq. Cu. Ft.
Fro Depth ei t.. Sq. Ft. Cu. Ft. to
Type of nLiction Est. __ 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 is 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 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 limps and this permit may be revoked at any time upon vfolalaton of say of the provisions of said
ordinances. .�. . ,r� l
NOTICE:
This pen dt does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these Items.
Mr- ~
owner I
Addres
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
No. street Part of Lot
Lot /e% Block Addition or Sub sto
Corner Lot inside Lot Setback--5� Side -Yard_
SMMR ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and
proposed building location.
DESCRIPTION OF BUILDING
To be used as:
On 00.
Front �� l Dept1A4r'/a Height
Sq. Ft. /0 Cu. Ft.,�,,
Front Depth. _eight 13'7
Sq. Ft. _5Z Cu. Ft.�
Type of Construction Estimated Cosvl �
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 ruling of the Department of Build-
ings, 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 on the Reverse Side).
City of Fridley
Application for Plumbing and Gas Fittfiing Permit
Dept. of Bldgs. Phone SII 4-7470, ���
DESCRIPTION OF WORE Sof — /® j �
Number, Kind and Location of Fixtures I.ocafi°n ` [P�
qq
F
Ou�1
(9
�Z `z
I
`� a
•
F
•
N
WATER HTR.
GAS
ELEC.
�
IA
3F
DLL
LLD
S�
ii<
ci OC
iiO
Bas
1st
2nd
3rd
4th
• Future Connection Openings
Connected with
e New Fixture, Old Openings I
Sewer
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $
at
Future Fixture Opening ................ 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 $
GAS FITTING FEES: NO. RATE TOTAL f�
1st 3 Fixtures ..........................— x $1.50 $-16
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE
City of Fridley:
.11
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 feel
and representations stated in this applic on are true and correct. / g
Fridley, Minn, / „ 19
Owner / A4
Kind of Building o
Used as
To be completed about
Estimated Cost, $ Q 1
Old New uilding Permit No Permit Permit No.
Signe 'f
By
Business Phone No
ROUGH / — t o
FINAL
42 '2M
w
Application for Power Plants and Heating, Cooling, Ventilation, .Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL.
Furnace Shell & Duct Work ............ . ............. 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
each add. 60,000 BTU ....................... 2.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 ............. 5.00 $
Repairs & Alterations each add. $500.00 .............. 2.50 $
STEAM or HOT WATER SYSTEM
5.00
$
Furnace Shell & Lines—to 400 sq. ft. IDR Steam ......
8.00
$
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
8.00
$
Each add. 200 sq. ft. IDR 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 2.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
TOTAL FEE
$
ROUGH
FINAL
Dept. of Bldgs. Phone SU 4-7470
'e; '6'0 C
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 •ue and ccorrect.
Fridley, Mann_ ®� 19
Owner
Kind of Building
Used as
d
To be completed about3
Estimated Cost, $
Old ew uilding Permit No. ® Permit No. �.
DESCRIPTION OF WORE
HEATING or POWER PLANTS --Steam, Hot Water
Trade Name Size No—a&"&
Capacity Sq. Ft. E.D.R- BTU H.P.
Total Connected Load U Kind of Fuel
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
Q'04-�� ,
Signe
By
R 4 z 2M 7-59 Business Phone No
' Compliments of North Central Public Service Co.,
CITY
>HEEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS VILLAGE
Weatherstrips A.SILVX. Construction No. Insulation
Guide
Windows I Doors Reference Out. Wall( Int. Wall) Ceiling Roof I Floor Kind I How Applied
Yes -No Yes -Ko 19........
P7. I Room I Length a C Width /, Height FL I Room I Length .r Width 2 Height
Windows and Doors--Crackage and Area.
Doors-Crackage and Area
No.
Width Height
of pane of pane
No. of
lights
Lineal ft.
of crack
Area
sq. ft.
d-3
el
a"r ,° / .
l
v
I U/
y
lights
of crack
sq. ft.
Coef.
Btu
Infiltration G
J 7��-
4e d
3131
Glass
</'
h'
dye O
Coef.
Btu
Infiltration
/0 6
Net exp. wall
y®
v
Glass
Int. wall
Doors-Crackage and Area
Net exp. wall
Exp. wall
Ceiling
(� �®
Int. wall
Net exp. wall
Floor
/a
U V
Int. wall
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
W77 0
Floor
Ceiling
0
69 OR
Floor
6 v
/ '1'
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leder are
r / Fl. I Room I Length // Width /') Height V
Windows and Doors- Crackage and Area
Doors-Crackage and Area
No.
Width Height No. of Lineal ft.
of pane oY pane lights of crack
Area
sq. ft.
o. of
lights
Nx
33
d-3
Lineal ft.
a"r ,° / .
/6he
7 0
I U/
y
lights
of crack
sq. ft.
Coef.
Btu
Infiltration G
Net exp. wall
4e d
9G y0
Glass
</'
h'
dye O
Exp. wall Ole
'-
Glass
v
Net exp. wall
/ %
/v
z
Int. wall
Doors-Crackage and Area
Net exp. wall
No.
Ceiling
(� �®
Int. wall
Area
sq. ft.
Floor
Ceiling
13y
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
W77 0
Fl. I (1 P..n Room I Length 6 Width /a Height P
Windows and
Doors-Crackage and Area
No.
jWpldg
e
N�o. 13
Lineal ft.
of crack
o. of
lights
Nx
I Lineal ft.
I of crack
I Area
I sq. ft.
Lineal ft.
a—
/6he
7 0
I U/
y
lights
Windows and Doors-Crackage and Area
Room I Length -A ,r Width ' ; Height 8'
No.
Width height No. oY
of pane of pane lights
Lineal ft.
of crack
Area
sq. ft.
Height
n
Lineal ft.
�.
,0
7 0
IWidth
of pane
of pane
lights
of crack
sq. ft.
1-
X-
Net exp. wall
o
CoeL
Btu
' Infiltration
h'
'7 l
Total Btu.
'-
Glass
v
/ ?' Cs 0
O
Exp. wall 7
/FL I Room I Length _i- Width Cl Height jP
Windows and
Doors-Crackage and Area
Net exp. wall
No.
0
(� �®
Int. wall
Area
sq. ft.
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leder area
J I J Coef. Btu
Infiltration 1 D
Glass j� f
Exp. wall •? /��
Net exp. wall
Int. wall
Ceiling / 1 / 6D
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Ij
Fl. I F&,4
Room I Length -A ,r Width ' ; Height 8'
Windows and Doors-Crackage and Area
I
No.
Coef.
Height
No. of
Lineal ft.
Area
,0
7 0
IWidth
of pane
of pane
lights
of crack
sq. ft.
1-
X-
Net exp. wall
o
3.3
'®
Int. wall
-i
I I
I
Coef.
Btu
Infiltration�/
G a
Glass
,0
7 0
Glass
a
3
o S-0
Exp. wall
1-
Int. wall
Net exp. wall
o
10
/75-0
Int. wall
h'
'7 l
Total Btu.
Ceiling
/
/ ?' Cs 0
Floor ®
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
0 `I%
/FL I Room I Length _i- Width Cl Height jP
Windows and
Doors-Crackage and Area
No.
Width
of pane
I Height
of pane
No, of Lineal t.
I lights of crack
Area
sq. ft.
-i
I
I
Coef. Btu
Infiltration
G a
Glass
a
DL
Exp. wall
Net exp. wall
-a-
fo� a C7
Int. wall
Ceiling
Floor
h'
'7 l
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
City of Fridley
sue�Ecr
P E
® 141'74
AT THE TOP OF THE TWINS
P E R M I T
r
Z
BUILDING
RE EIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
612-560-3450
910-F15
6/21/77
JOB ADDRESS 90 - 66th Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
lO
5
Edgewater Gardens
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Roger Nawrocki 90 - 66th Way N.E.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Sawhorse 2001 Laramie Trail, Brooklyn Park
561-8007
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 24' x 20' addition to back of dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS variance for side yard setback of 10.13 feet approved on 6/14/77.
SEPERATE PERMITS REQUIRED FOR WIRING,
WAWNG
HEATIM :PLUMBING AND SIGNS:
low utttities
�eforo dt n �g
TELMME• aECjMC W Etc.
1iY
REQUIRED BY 1A
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Wood Frame
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
$7,800
$3.90
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
PROSTRVITIONS RFTANY OTHER LOCAL LAW EGULATING CON-
$48.00
NONE
FORMANCE OFRCONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
NONE
$51.90
SIG T RE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN P OPERRL�YVA,LID�ATED THIS IS PERMIT
BLDG INSP
YOUR
DATE
SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
1
HARVEY A. CARTWRIGHT
ANOKA COUNTY SURVEYS
HENNEPIN COUNTY SURVEYS
MINNEAPOLIS SURVEYS
8410 PALM STREET N W.
SUNSET 4.7655
OWNER
INDUSTRIAL - JUDICIAL
BUSINESS - TOPOGRAPHICAL
CITY LOTS - PLATTING
' n.ji Huhn
Cm T N
LAND SURVEYORS
REGISTERICO UNDER LAWS OF STATE OF MINNESOTA
LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS
326 PLYMOUTH BUILDING FEDERAL 8.8721
HENNEPIN AT SIXTH • MINNEAPOLIS 3. MINNESOTA
�arbepor'g certificate
t
or
A � �a
Y,
- 1
10,x.
COMBINING THE RECORDS OF
J. E. HILL. CIVIL ENGINEER
ESTABLIBHEO I8
96
C. F. SANDHOFF
CIVIL ENGINEER
ESTABLISHED 1908
JAMES NELSON
SURVEYOR
ESTABLISHED 1922
METROPOLITAN LAND
SURVEYORS, ESTABLISHED IPS?
Invoice 22275
^ 7i
` L � 7'' _ �_ � int.•:
:?: :;1 c::� tl `J L:.7 � I -hi s i s .-. t" ue _,n.., CG'rr-7-'C u r __ a5o� } 1Yt F{ D rLEY r
BOARD OF APEA"
Lot 10, Block 5, Edgewater Gard?as EXHIBIT No
r:. ;r- �his ?7Uh. ti o 'cto�cr,°1?';l.qh
MEETING DATE .l
UT r14209 408 sE 4Tui29cl Aug Z03 p9522tP aa; Oq4 TTVgS as•eO Ou u1 ° 9 • Z
°staon+, pasOdOad TTP 30 4SOO esr. UT 309aau4 uOTI-OvaZ aO
IAA�AAw.L� ��r...a..w�+ rw�r.►�1 waT e •fwM� Trv..T AAS wJ. .w w.nrT w�.n wM �r TTr�lM
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: Yo LI2. �AW IC iiC lel BUILDER: Saw 0s'e
Address: l V �.W w�� Address: d<f�' d q Am_ it
Tel. No. Sw
No.: Street: "C 344
LOT: BLOCK: S ADDITION: W Q `Q �Ab ty l , PR4QY,s
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS:
Applicant attach 'to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
4
&00(--l0Y�-
DESCRIPTION OF BUILDING
Front: Depth: Z Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: FY0,Ud\-9,_ . Estimated Cost: $ O
To Be Completed: 4 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
are true and correct. See reverse side for additional information.
DATE: c� `i "- SIGNATURE:
Stipulations:—'
p ouj
Uajua
cJ��� L�ti
I* /_/ 8 • L. v
CITY OF FRIDLEY INSPECTION DIV.
6431 Univemity.AveNE
Fridley, MN 5532
572-3604
RATE SCHEDULE
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace $ 30.00 $
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace) $10.00 $
Gas Range $10.00
Gas Dryer $10.00 $
`Air Conditioning - All Sizes $ 25.00 $
Ali OtherslRepairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Cornmerclal!! ndustrial
1.25% of Value of Appliance or Work
Effective On January 1, 1997
JOB ADDRESS Ch) t C_ 66,0 GJ,
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
,1997
OWNER
BUILDINGUSED AS ..a
ESTIMATED COST I I fes. PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER IaL,C� CL
$ No. of Heating Units I Circle One (Steam) (Hot Water) (Warm Airy
Trade Namek-a-fi 0 to LL, Size No, l-ccc%
BTU a 1 C` D HP EDR
$ Fuel_ &e_z Total Connected toad
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATINGICOOLINGIVENTILATION
REFRIGERATIONIAIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00ft
'Air Conditioners can riot be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY,l/Lcct"cs-
Signed By Tel No. 3 3 -
Approved By Rough -in Date Final Date �v
FILL OUT BACK SIDE FO STACK VERIFICATION ON
REPLACEMENT FURNACE
M
C)
n
w
m
W
0
d
0
m
w
U
03
03
A
m
m
IQ
E
SUBJECT
PERM
City of Fridley
27963
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RE
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
�3
r
5-6
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i "'t;'� CITY HALL FRIDLEY 55432
---- JAI.
L 612-571-3450
910415
9 24/98
JOB ADDRESS
90 66th ay NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
10
5
lEdgewater Gardens
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Bill & Paula DuPa
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Murphy Bros. Building 1613 93rd Ln Blaine MN 55449 780-326216
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW X1 ADDITION x® ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Adding gas fireplace to living room (Heat & Glow 6000 direct vent);
Change out 10 windows ("Existing size inserts")
9 CHANGEOFUSEFROM TO
STIPULATIONS A e\,� T����
Separate gas permit required for gas Piping.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST,
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$10,500
$5.25
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-
TRUCTION T E PER RM NC F CONSTRUCTION
$174.75
Fire SC 10.50
PLAN CHECK FEE
TOTALFEE
License 5 0
195.50
NA RE F'ON'/R O AUTHOR,ZEOAGENT iOATE,
EN R VALI
D THIS I$
T_
BLOt ,NSP
�RkR
gAfE
S,GNATURE OF OWNER dF OWNER BUILDER, ,DATE,
E
NEW" 't ] Effective 1/1/98
ADDN CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:9 () 0 �.i
Legal Description:
Owner Name & Address:
Tel. #
a
Contractor: MN LICENSE # �T
Address: 16 o -,i.: 'r:::; ,0 ;C Tel. # 780'
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF MIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: AM i of� L%O t o3L, .
Construction Type: 4X):50 6E� Estimated Cost: $
(Fee Schedule on Bac ) i
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
II • s r. �,
APPLICANT: Tel. # 7go—s kz
Permit Fee
$
9V %s
Fire Surcharge
$
State Surcharge
$
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ / I�' SO
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
f& W
.jA
�ll A1
I
$.50/$1,000 Valuation PT -,P• (
$1000 per SAC Unit I PSS
$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 \5q BUILDING Permit No.:
Inspections C� RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Recd:
DATE 5- - ( (Q - 0 ,,CD
L
SITE ADDRESS CTO U[CS
THIS APPLICANT IS:
YOUR E-MAIL ADDRESS
❑ OWNER M ONTRACTOR
PROPERTY OWNER/
NAME:
/--) t"
ADDRESS:q c�
U
CITY � f `e. A STAT>i�ZIP�� 3 �
TENANT
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # 6c ,9n
N � 3a s D EXP DATE 3"0 i
SUBMIT A COPY OF
STATTt, �VZII'�S 3,:;1WITH
YOUR STATE LICENSE
ADDRESS: /5S- (204--
�!
tt2
-CITY-
APPLICATION
PHOS -6 (Q Q
FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION
SIZE
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION
❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH
VkROOF
❑ DRAIN TILE
❑ DECK
❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW
❑ ADDITION
❑ MAINTENANCE/REPAIR
❑ REMODELING
DESCRIBE WORK BEING DONE: 1/ /'0 O -C—
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ,? n Lf 9, 6-6 OCCUPANCY TYPE
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
HEIGHT
Ft.
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
R+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
S C _1../-i Make checks payable to: City of Fridley 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; that the work will be in accordance with the approved
plan in the case of all workAvhich requires review and approval of plans.
Cn_cOR4 3 -tel
-Buihding
$
BUILDING
See Back Page for Fee Schedule
Permit No.: —06913
Inspections
CXO , (P k
RESIDENTIAL APPLICATION
Fire Surcharge
Received By: �--
763-572-3604
—.00 1 times the total job valuation
Surcharge
$
3 ,-1Z(
.0005 x Permit Valuation Minimum $.50
License Surcharge
CITY OF FRIDLEY
S. OD
Date Rec'd:3-9— a"I
763-5022-4977 FAX
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
EFFECTIVE 1-1-09
ft + 6 ft = ft x $21 =$
Erosion Control
$
$450 Conservation Plan Review
DATE 3 D !
YOUR E-MAIL ADDRESS
SITE ADDRESS
$
THIS APPLICANT IS:
❑ OWNER J(CONTRACTOR
Total Due
PROPERTY OWNER/
NAME: &a
Make checks Davable to: Citv of Fridlev Attach Stiaulations
TENANT
ADDRESS: 9,'0 7�t' 4.4;Se CITY
STATE/ -VW
PHONE: 7kf - 5-71- 12Lri= ,
CONTRACTOR
NAME:I'A-c- , -e 9 e r.z%v e
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # ��VPtS—��c01 EXPDATE
J-31-69
AND CERTIFICATE OF
��ss
ADDRESS:�S �-4"C'/V CITY!//��
W ele STATER &,ZIP.,i J_3V5-7�'
INSURANCE
PHONE -671) ` 2 70 Z. FAX
PROPERTY TYPE
❑ SINGLE FAMILYNEW CONSTRUCTION SIZE
❑ TWO FAMILYNEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ,»'OTHER
❑ SWIMMING POOL�s
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR '0 REMODELING
DESCRIBE WORK BEING DONE: 7G'Az'A 4,/- �Fr/,�p �Rs� �L�/ 7- f!'TiY
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
NUMBER OF SQUARES
❑ HOUSE ONLY
❑ 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
1.
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
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 BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 7el -70. OCCUPANCY TYPE
Permit Fee
$
15 "
See Back Page for Fee Schedule
Plan Review
$
CXO , (P k
65% of Building Permit Fee
Fire Surcharge
$
:I ,A,
—.00 1 times the total job valuation
Surcharge
$
3 ,-1Z(
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
S. OD
$5.00 (State Licensed Residential Contractors)
SAC Charge ,
$
$2000 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
$Qtnq.
()-7
Make checks Davable to: Citv of Fridlev Attach Stiaulations
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 accordance with the
approved plan in the case of all work
which requires review and approval of plans. '/
SIGNATURE OF APPLICANT '�✓L `fir PRINT NAME ��/�I��iIWIJ-�T DATE
AY
XL
® O M L � �_ Z.
Al
l3r
ru.
Al
Building
PLUMBING
Permit No.:' gj, v0a�
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
763-502-492277 FAX
EFFECTIVE 2-19-09
DATE �' � X ,09 YOUR E-MAIL ADDRESS COP S 1 klAk I ✓1
SITE ADDRESS 9 U — A� 1\4(,,
THIS APPLICANT IS: ❑ OWNER #CONTRACTOR
PROPERTY
NAME:9.,
OWNER/
TENANT
ADDRESS: CITY STATE ZIP
PHONE:
CONTRACTOR
NAME: ('rirVets6 '-_91tiM%0\nCk, JAC
SUBMIT A COPY OF
jj
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE, BOND AND
STATE BOND # EXP DATE
CERTIFICATE OF
r
ADDRES/S:- �r� CITY E�Ij�ZIP'7
aL5� Q�W-0
INSURANCE
��,
PHONE (65k- 1—� FAX 16lbf- lOS.T
PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK !, 4. St r—P i^_
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
.50.
T$3
BATH SINK/LAV FLOOR DRAINS SHOWER _ WATER PIPING
—BATHTUB _ GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($35)
_ _
—CLOTHES WASHER —KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15)
—DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
Number of fixtures @ $10.00 x $1.0.00 = $ Car C U3
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge $_q.0 .50
$35.50 Total = $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 accordance
with the approved plan in the case of_ work-wires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME DATE
o* C /�/� l �Cf+ DATE
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55
763-572-3604
FAX: 763-502-4977
Building
MECHANICAL
Permit No.:�6
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: I b763-502-4977
FAX
EFFECTIVE 2-19-09
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS 9 Q LQ (V
THIS APPLICANT IS: ❑ OWNER ,IOCONTRACTOR
PROPERTY
NAME:
OWNER/
ADDRESS: CITY STATE ZIP
TENANT
PHONE:
CONTRACTOR
COMPANY NAME: P.T_ MaC•k a n iffy f
SUBMIT A COPY OF
CONTACT PERSON: 'PC. J c`i CK
YOUR STATE
STATE LICENSE # EXP DATE
LICENSE WITH
n�� j
ADDRESS: �J` -7 t�k\ �I� �� CITY Si), S`) i STATE 1 6N Zip--5-50-75-
IP-55075APPLICATION
APPLICATION
PHONE (051 — 7 5— D QLq 3 FAX
PERMIT TYPE
K3 SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW ❑ REPLACEMENT VALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK I l I S u p �1 (c�X�q uS-t Fwn
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
OILER $35.00 $35.00 _G UNIT HTR $10.00
_FURNACE
CHIMNEY LINER $10.00 _GAS DRYER $10.00 L HEATER $35.00
e DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
•' K 4:i N" "', l- �� fin.' � `t�.. }`' �� � b b�^.':� y'k� IF' Z �g,f : � A H.rh� }� �`>< � f � ck �,m„ � ��� ���� -
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Y ho
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 o the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an ap ion for a pe it and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case f l w k whic r quires review and approval of plans.
SIGNATURE OF APPLICA A l%til n PRINT NAME DATE r �
i
City of Fridley
Bu ding Inspections Department
6431 versity Avenue NE Fridley MN 55432
763-572-3604 FAX: 763-502-4977
City of Fridley Residential Mechanical Application Page 2
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
0 NEW HOMES/ADDITIONS 0 EXISTING HOME 0 MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Required on new construction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for
combustion and make-up air calculations.