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PRE 2010 DOCS• E U City of Fridley, -Minn.. BUILDING P WHIT A Owner: -ice a1 Address No. Street Lot__ Block Corner Lot _ Inside Lot Sewer Elevation "/ r IN_ OF ation or Sub -Division Setback Sideyard Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth ---f Height p® Sq. Ft. Cu. Ft. �® Front Depth -9 -1 -.-/,Height 110 Sq. Ft.4K�/JO Cu. Ft. of Construction Est. Cost _ 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�grtand i� compliance with all provisions of ordinances of the city of Fridley. r !/h „ li ,. 1 In consideration of the payment of a fee of $ , permit is by granted to the to construct the building or addition as described above. This permit is granted upon 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 w� city limits and this permit may be revoked at aay t e upon vioJatien of any of the provisions of said Building Inspector NOTICE: M permit does not cover the eonstreadon, IaatallMon for WMO9r plumblg. gas hosing, swer or wtlor. Be wre to see the Building h>speetor for separde permits for these hams. , • , - r - - - V APPLICATION FOR BUILDIN4 PERMIT CITY,OF FRIDLEY, MIN-07SOTA OWNS- R' S NM4F_ � . v L � BUILDER • ' t o ADDRESS ADDRESS r.: LOCATION OF gUlLDING -._ A No. Street k Papt of Lot Lot Block Addition or bdi,ft 46M , Corner'Lot ✓ Inside Lot ,_Setback Side Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. To be used as: Type of Construction To be Completed DESCRIPTION OF BUILDING Front_/3 7 03 Depth A -®/ Height S q. Ft. _ 4_Cu . Ft,. Front Depth Height, Sq. Ft. Cu. Ft. Estimated Cost,&_ go 0 1� 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 A2�/ f� � _SICNATITRE (Schedule of Fee Costs can be found on tbe,Rewerse Side). II I f APPLICATION FOR BUILDIN4 PERMIT CITY,OF FRIDLEY, MIN-07SOTA OWNS- R' S NM4F_ � . v L � BUILDER • ' t o ADDRESS ADDRESS r.: LOCATION OF gUlLDING -._ A No. Street k Papt of Lot Lot Block Addition or bdi,ft 46M , Corner'Lot ✓ Inside Lot ,_Setback Side Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed build- ing location drawn on these Certificates. To be used as: Type of Construction To be Completed DESCRIPTION OF BUILDING Front_/3 7 03 Depth A -®/ Height S q. Ft. _ 4_Cu . Ft,. Front Depth Height, Sq. Ft. Cu. Ft. Estimated Cost,&_ go 0 1� 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 A2�/ f� � _SICNATITRE (Schedule of Fee Costs can be found on tbe,Rewerse Side). Application for Power Plants and Healing. 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 & Alterationk each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines=oto' 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line -34o 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 $ l � 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 Locatio & `�4r %S AVE /y City of Fridley: « 0 i' w 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-� ® 1963 Owner , C—/% / 1'� Kind of Building Used as To be completed about Estimated Cost, $ J Olduilding Permit No. Permit No. r�Z� DESCRIPTION OF WORK BEATING or POWER PLANTS—,Steam, Hot Wa Warm —No 'D /vr Trade Name 1: c -o Size No A r -/0 0 -,2 / a 0-0 C, Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load s� ®� Kind of Fuer' BURNER — Trade Name—_ Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Signed' ' � � 6217 J 2M Business Phone No- v+it ae HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOUS. MINN. E H S. .. , Weatherstrips A.Construction No. . _Insulation Guide din: dgws I ,Doors Reference Out. Wall Int :Wall Geilmg Roof Floor Ild M Ho Appked t`Yes—No Ye N 19— Fl. U) i " Roomi Length 77 Width ' Height;! 'c' Room I Length ' Width Height Windows and °Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of pjLne of age lights of crack sq. ft. Width Height No. of Lineal f . Area ., ofpaine oL, p lights of crac eq. ft. - rr Coo.- Coe#. Btu ..- InSltration Infiltratioa , Glass A& Glass Exp. wall Exp. wall Net exp. wall Net exp. wall. 4, - Int. wall Iot. wall. ... Ceiling Floor . Ceiling'' I - "; Floor ,y it rs' - ; Windows and Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of pjLne of age lights of crack sq. ft. Width. Helgh , No. of Lineal ft. Area No of p of, -I,, lights of crqsk f Coo.- Coe#. Btu ..- InSltration 7 � , Glass A& Exp. wall Net exp. wall 4, - Int. wall ... Ceiling Floor . s I - "; Total Btu.K LtTptal Btu, 1 y Requi qd s ft.-E,D.R. or sq. ins. W.A. Leader area Requlred.sq. ft, _E.D.R. or sq. ins. W.A. Leader area,. •ir oofq (Length .- Width �: Height. Fl I `' `_�"� oom (Length Width ;; Height Windows and Doors—Crackage and Area Windows and Doors='Crackage and Area Width Height No. of Lineal ft. Area Width Height No. of Lineal ft. Areaq N, o , ,ne of pa a lig ts. of crack 6q ft; N ' of-pshie of plane lights I otcplack sq, ft- Infiltration t Infiltration Glass Exp. wall ! Net exp. wall x _ Int. wajl Ceilingy Floor Total' -Btu. Required sq. ft. E.P.R. or sq. ins. W.A. Leader area FLS a.'r 7. -�oom ILenath 7 Width Heiaht I I _ Coef ,Btu _ Infiltration �'' _ Glass%\ Eap. wall _ Net exp. wall _ Int. wall I Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA, Ti-eader area_,' if F1.1 it " Room 1 Lengt width r Height dl Windows and Doors—Crackage ind Area Width. Helgh , No. of Lineal ft. Area No of p of, -I,, lights of crqsk f Coo.- Btu Infiltration j Glass 7 � Exp. wall Ise X ;11`1 Net exp. wall Int. wall Ceiling71t'!"117 4, - Floor ... Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and`Doors—Crackage and Area Width Hels No. of Lineal ft. Area NO" oivfve ofq 11 ht e of ,cra eq -ft. "A lop _ . _ Btu Infiltration a Glass Exp. wall ; Net exp. wall - Int. wa Ceiling 1. r Floor ToM Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ? 4-M HEAT LOSS CALCULATIONS DEPARTMENT & BUILDINGS MINNEAPOLIS. MINN. Weatherstrips A.S.M.E, Construction I No. Insulation Guide yiifws ft!s * Reference Out. Wall MInt.Walla(Cefling I Roof L"?,floor Kind How. Applied Ye4.;: No _11#Y1CsiAxo 19— 64 I FUT.1,0541ARbom I Lenjzth7V, Width /0 Heialit A 11 1 RLV,)1hAA"A4 m I Length 11 Width Height/7'� Wildows, and Doors—Crackage and Area 7 A A Width HeightNo. of Lineal ft. Area No. Xofpaqg� of 14lights of Brack sq. fC f7l" 1 Lineal ft. Area of crack sq. ft., Glassti 4,ftW BAu Infiltration j Exp. wall Glass ,0 Glass Exp- wall 4YX Net exp. wall Net exp. wall Net exp. wall Int. wall Int. w4 Ceiling Ceiling Floor CeilingA, P I otafbtu. R.,Or aq. ins. W.A. Leader area , Length WidthI and DooriL-Crackaae"Ialid Area I and Area L Area sq, fv-,; Infiltration 7 A A Width Height No of Lineal ft. Area No. of pane of pane llg6ts of crack sq. ft. Lineal ft. Area of crack sq. ft., Glassti 4,ftW " Exp. wall Glass Net exp. wall Coef. Btu Net exp. wall A Int. w4 Ceiling 160 140 CeilingA, - 0 0# 404" Floor*K.z Net exp. wall TotJ,8-tu. pquir4A:., ft. E. or sq. ins. W.A. Leader area 'Height in I Length j;',,'Vidth Height,, 7_ __,D6&-C—Cracka Win ge and Area Width Helgh� No. of Lineal ft. Area of paa No f pan A jig r h&# ,* _5 V,, 7 17 of c e ft _,0 ICoe wu ahon 71, -IF InUtrat n Glass Glass Exp. wall " en', s, Exp. wall Net exp. wall L7Net exp. wall Int. wall Int. wall Ceiling Ceiling iO 1! Z Floor 4�, Floor Total Btu.'' W Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq,. ft. E.D.R Room I Length Width Height. , ' - :,, Width F1.1 Room I Length Height � 0 Windows and Doors—Crackage and Area Width Height No of Lineal ft. Area No. of pane of pane llg6ts of crack sq. ft. Lineal ft. Area of crack sq. ft., -Coef.1 Btu Infiltration Glass Exp- wall Coef. Btu Net exp. wall Int. wall Ceiling 160 140 Floor 77 - Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of No. of pane of pane lights Lineal ft. Area of crack sq. ft., Coef. Btu Infiltration Glass 160 140 Exp. wall 17 / L2 e Net exp. wall Int. wall SS 0 3 Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area City of Fridley Application for Plumbing and Gas RMng Permit Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK � � Number, Kind and Location of Fixtures Locatio" q C) 'je�gq +� 3O uu�� s �F Number Fixtures ....... ....... ii �n ,Ssi 3� Y a Future Fixture Opening ................ Z �.o c�� w <3 �°d w �� z Z O • F • N WATER HTR. GAS ELEC Base ..../ Z' x 2.00 $ r O New Ground Run Old Bldg. ....... .... x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: O. RATE TOTAL Number Fixtures ....... ....... x $1.50 sz-,�_� 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) ..../ Z' x 2.00 $ r O New Ground Run Old Bldg. ....... .... x 3.25 $ 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 $ REPAIRS & ALTERATIONS—Refer to Code 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. a Fridley, W Owner Kind of Building Used as To be completed about Estimated Cost, $ Z ®� OldCew.,uilding Permit No. Permit No. ROUGH FINAL Description ..................................... . EE TOTAL FEE o ea Signe By Bus' ess Phone No ��e ' • CITY 01= FRIULEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTL=RATIns, ADDITIONS, OR REPAIRS) OWNER:* l BUILDER: %/// Address: Address : ��/'-� — ��` /�,{ . l �, . . Tel. No. No.: Street: LOT: BLOCB'.: ADDITION: COMER LOT: INSIDE LOT: SETBIACY: SIDEYARDS: Applicant attach to this form Tao. Certificates of Survey of Lot and proposed • buildinglocation drawn on these Certificates. j DESCRIPTION OF BUILDING , To Be Used As: Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height:• Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $ To Be Completed: �:` Alt. A Alt. B Prdposed Driveway Width If New Opening Is Desired—(( -o 0 Q $ (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: �G �;�Y SIGNATURE: Stipulations: 11 Building $ BUILDING Plan Review Permit No.: c Inspections Fire Surcharge RESIDENTIAL APPLICATION .001 times the total job valuation Received By: 763-572=3604 .0005 x Permit Valuation Minimum $.50 License Surcharge $ D a_4U 7 2007 SAC Charge $ CITY OF FRIDLEY Curb Cut Escrow $ DATE * Z �" % YOUR E-MAIL ADDRESS 0,0 SITE ADDRESS J�r %6*0 ;?V� A -,),e - Park Fee THIS APPLICANT IS: DOWNER OCONTRACTOR Sewer Main Charge PROPERTY OWNER/ NAME: .,% /'4E / 77zi-SAI 4E -,e Total Due TENANT ADDRESS: / (fir �, / CITY /'�/ /i �� L/ STATP4e__ PHONE:_ CONTRACTOR NAME: 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/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH AROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMNIDNIG POOL TYPE OF WORK: ❑ NEW ❑ ADDITION 'l LUAWTENANCE/REPAIR O REMODELING DESCRIBE WORK BEING DONE: dz. koy y SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES Z= ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Flow 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, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures 17 Other ❑ Fascia and proposed project WWDOWS 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: (USINGE,(1�97 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ O�r? D OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ . j) .001 times the total job valuation Surcharge $ .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 = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 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 which rewired 4reiew7d approval of plans. �,//SIGNATURE OF APPLICA�TG; J/ S / PRINT NAIb[E����f "/;7.t: �"�DATE (o ®Z ® /