P - 84228Building
I�lspections
763-572-3604
763-502-4977 FAX
DATE
SITE ADDRESS _
THIS APPLICANT IS:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑ OWNER OCONTRACTOR
PROPERTY OWNER/ I NAME: C�Ci�
TENANT ADDRESS:V C-
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
r�
\'� � '�
�
NAME: �Xe t ` ��1 �C�'t✓3
STATE LICENSE # U� Z.r ��g �i ��--- LEAD CERT NUMBEI
ADDRESS: � f� C7 �, � 5} s'�' iz Y�" CITY�
PHC� lJ� ��- 3��' ~�'«� N FAX
INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION ❑ GARAGEJSHED 0 WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ D IN TILE
❑ DECK ❑ SIDING �HER
O SWIMMING POOL
TYPE OF WORK: � NEW HOME CONSTRUCTION ❑ Aj��BrITION
❑ MAINTENANCF./REPAIR ��SMODELING
DESCRIBE WORK BEING DONE: 1� i� e� �'^ �'t �� i
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
❑ HOUSE ONLY
� HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GAR;AGE
HEIGHT
Permit No.i�l.� �
Received By:
Date Rec'd:
STATE�LZIP S�s y.3 L
(.Sd�1�6` xr: � 3 /�
i� STATEiM ZIP �S3S
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
SIDIlVG FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit SIDING/SOFFIT/FASCIA ADDITTONS_ & PORCHES SUBMIT:
❑ Aluminum ❑ Trim REMOVED? O YES 0 NO 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 DYes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
! OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
I OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USIlyG THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 3S. �z� , OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ � .`G ' See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ .001 times the total job valuation
$ .0005 x Permit Valuation Minimum or .50
$ $5.00 (State Licensed Residential Contractors)
$ $2365 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= 8x$25=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
� 1 ��'I: t Make checks �avable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTTL 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 p it and ork is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of ic req res review and approval of _n'_ `
SIGNATURE OF APPLICANT PRINT NAME � t�'� `V�J (i l��� DATE Z � Z
APPROVAL INSPECTOR SIGNANRE �1/1
.
EXTERIOR WALL
�
KITCHE ERN MODEL - ALL WALLS STAYING IN SAME LOCATION. CLOSING ONE DOORWAY TO PLACE FUTURE FRIDGE
REMOVING DRYWALL FROM WALLS, REMOVING SOFFIT VE CABINETS
REMOVE FLQORING FROM KITCHEN, IR5"T1RLT�1 M T�LE FLOOR IN ON S�ION AND WOOD FLOOR IN ANOTHER
SECTION
INSTALL NEW DRYWALL
PLUMBING AND ELECTRIC PERMITS WILL BE OBTAINED SEPARATELY
���� f ,(� � ���
�_ CJ'"'�'� � ( � � �-� SI�� P''
�
�,� �� � �`°'S � •
• ��- S-I� - _Z�� .�
- �a �.��, ��.- -
EXCEL BUILDERS, LLC
WW W.EXCELBUILDERSMN.COM
GAYLE CHNATERO
665 CHANNEL ROAD
FRIDELY, MN 55432
GAYLE CHIVATERv
6675 CHANNEL ROAD
FRIDLEY, MN 55432
Projed number Project Number
Date +ti�anz
Drawn by TRENT NEVWILLE
Checked by
A105
Scale 1/8" =1'-0"
3/20/2012 9:02:01 PM
0
c
�� \.��
EXTERIOR WALL'
� I II
AFTER 1/8" = 1'
23'-1"
9' - 7" V4' - 1 " �
3'-0"
�—� STAIRS LEADING TO THE
� —
`r I o
STOVE �
_R o
OPEN SHELVES, STAINLES$
-r�
-�� Wine Fridge
1' on the end
6'-0"
\ I I
EXTERIOR WALL
2'-6"
25'-7„
2' - � �,
��
co
�
0
m�
� �
in
�D
KITCHEN REMODEL - ALL WALLS STAYING IN SAME LOCATION. CLOSING ONE DOORWAY TO PLACE FUTURE FRIDGE
REMOVING DRYWALL FROM WALLS, REMOVING SOFFIT FROM ABOVE CABINETS
REMOVE FLOORING FROM KITCHEN, INSTALL NEW TILE FLOOR IN ONE SECTION AND WOOD FLOOR IN ANOTHER
SECTION
INSTALL NEW DRYWALL
PLUMBING AND ELECTRiCAL RERMITS WILL BE OBTAINED SEPARATELY
� ` � � ���� ,
... f'�'� ��
`�. — �L-
b
EXCEL BUILDERS, LLC
W W W.EXCELBUILDERSMN.COM
_ p���, •
,�,, �«,�I ,
-- �`'� �.c.�' �' S �, �, ��
t�c��- ��t�x �° GF w1 v � �
wu�-1�� -� a�l� - -
�
GAYLE CHIVATERO
665 CHANNEL ROAD
FRIDELY, MN 55432
GAYLE CHIVATERO
6675 CHANNEL ROAD
FRIDLEY, MN 55432
Project number Project Number
Date �y�4n2
Drawn by TRENT NEVWILLE
Checked bv
A105
Scale 1/8" = 1'-0"
3/20I2012 9:06:13 PM