PRE 2010 DOCS•
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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 ® /