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PRE 2010 DOCSCity of Fridley, Y[inn.. BUILDING PERMIT N° 5210 Date: —13 Owner: �' t-' :;� Builder -- Address __ + Address _C ICON OP.;r PUILDING —ORNo. j3- Street _ 7r' * Papt 3f Lot Lot .. _.__ Block______ ___, ddition or Sub-Divisio Corner Lot Inside Lot — Setback. 4q�_,-- Sideyard _- Sewer Elevation Foundation Elevation D6CRIPTI®N OF 13UILDING To�e Used �!� Front 7.4 Depth Height Sq. Ft Cu. Ft921jyG' Front Depth Height _ _ Sq. Ft ___ Cu. Ft Type of Construction!"' =' Est. Cost i _ 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 all provisions of ordinances of the city of Fridley. 4-j.�4 In consideration of the payment of 4 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 limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. 117`y Building Inspector NOTICE: This permit 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 theca Items. 4 I � .' — LO, - n APPLICATION FOR BU31DING PERU= CITY OF FRIDLEY, MINNESOTA Owner's Name Builder Address LOCATION OF BUILDING - :::�. 6. yuc No. �r treet_ /� �/E�'�/�rJ r _Part of Lot n Lot Block Addition or Subdivision Corner Lot Inside Lot ` Setback Sides -Yard /~a SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPT ON OF BUILDING ell To used as• % Sq. Ft. Cu. Ft. FrontDepth Height Sq. Ft. CU.. Type of Construction Estimated Cost�,� To be Completed The undersigned hereby makes application for a permit for the work herein specified, .7-1 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. DATE �°-- — SIGNATURE e (A Schedule of Fee Costs can be found on the Reverse Side.) Application for Power Plants and Heaping, Coding, Ventilation, -Reh igeral'ion 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 §.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 $ 1 Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ ti 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: 1st 3 Fixtures ...................... Additional Fixtures ................. Gas Range to 200,000 BTU ........... AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL NO RATE TOTAL _ x $1.50 $ ^� _ x .50 $ -x 2.00 $ See Fee Schedule TOTAL FEE $� Dept. of Bldgs. Phone 4-7470 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 true and correct. Flrirllpv, Minn /,f7 19 ow ner°' Kind of Building y zz Used as To be completed about 6/ Estimated Cost, $sa�n� v �� Old New. ' ding Permit No. s d Permit No. DESCRIPTION OF WORK HEATING or P9WER PLANTS --Steam, Hot Wa �WarmAiro Trade Name ASize No. /22/&-d Capacity Sq. Ft. E.D.R � �° BTU H.P. Total Connected Load— Kind of Fue BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Signed RAY N. WELTER H EAT I N r 01 4637 CHICApp AVE. By MINNESOTA �� 42 ZM 7.89 Business Phone No-- / HEAT LOSS CALCULATIS ` 1 ei DEPARTMENT OF BUILDINGS Weatherstrips A.S.H.V.E. Construction No. Guide Windows ( Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Yes—NO Yes --No 19 F1.1 Room Length 3 ® Width 0 Height s / F1.I Windows ar width of pane Windows and Doors—Crackage and Area Width Height No. of Lineal it. Area No. of pane oP Pa�nfe lights of crack sq. ft. No. Total Btu. r1.1 LLIS ® W &a "& Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. EQ No. of pane of pane lights of crack Width He No. of Lineal ft.;Goef.1 ® CoeE Coef. Btu Infiltration Btu Infiltration Glass /,9,c 0 Glass Exp. wall Net exp. wall . 3 (0 / Int. wall p Net exp. wall Int. wall / � J` or floo o -M. or 44r Total Btu. r1.1 LLIS ® W &a "& Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Windows and Doors—Crackage .and Area EQ No. of pane of pane lights of crack Width He No. of Lineal ft.;Goef.1 ® CoeE Btu Infiltration o /7,f& Btu Infiltration 67f /,9,c 0 Glass Net exp. will 0 Exp. wall ,( p Net exp. wall Int. wall / � J` / -M. or 44r /0 1 %? 0 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ) m I J1- a 'dna 1 , ®l I Width Height PO Windows and Doors—Crackage and Area Height A7 Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. 6s /' a EQ fa s Coef. CoeE Btu Infiltration o /7,f& 0 Glass 67f /,9,c 0 Exp. wall Net exp. will 0 Net exp.- wall ® -� p Int. wall / � J` Gait or floo . orf$oo d /® Total Btu. Sr* Required sq. ft. E.D.R. or sq. ins. WA, Leader area Insulation How Applied r ® Width Height e and Area Lineal ft. Area of crack eq: ft Coef. Btu Infiltration �� ' .-;2, Glass Exp. wall )C / Net exp. wall Int. wall C-0 or !oti Total Btu. F1.I Room I Length ®Width Height A7 Windows an Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of pans of p ne lights of crack sq. ft. 7' , ° Exp. wall �?l EQ Coef. Btu Infiltration Int. wall /7,f& Glass e cJ a Exp. wall G .orff Net exp. will 0 Total Btu. -� Int. wall Required sq. ft. E.D.R., or sq. ins. W.A. Leader area Gait or floo Total Btu. :Required sq. ft. E.D.R. or sq. ins. W.A: Leader area / Fl.� h �� Room I Length /,2 -�. Width ® Height ft"'. 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 7,—k a Glass / &--e— Exp. wall �?l EQ Net exp. wall Q ^ %® 6 d o Int. wall .orff Total Btu. Required sq. ft. E.D.R., or sq. ins. W.A. Leader area CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRI ERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Job Address — Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Department of Buildings 4.00 $ City of Fridley Repairs & Alterations each add. $500.00 Tel. #571-3450 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to 199,999 BTU (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: $12.00 4.00 7.00 7.00 4.00 $12.00 4.00 7.00 6.00 $10.00 10.00 $10.00 1st 3 Fixtures x $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU x $10.00 WAIR CONDITIONING FAN HEATING SYSTEMS see Fee schedule VENTILATING SYSTEMS ALTERATIONS $ REPAIRS State Surcharge TOTAL FEE ROUGH INSP. REINSPECTION FEE Date ($10.00) FINAL INSP. Date APPROVAL FOR PERMIT a The undersigned hereby mak s 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 Departmen of Buildings, and hereby declares that all the $ facts and representations st ted in this application are true and correct. $ ridley, Minn. — f I , 19 -1'F OWNER f''4j MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE KIND OF BUILDING i USED AS TO BE COMPLETED ABOUT ESTIMATED COST teLn 60 OLD - NEW BUILDING PERMIT NO. PERMIT NO. /�7 DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name Size No. Capacity Total Connected Load BURNER - Trade Name Capacity Sq. Ft. EDR BTU HP Kind of Fuel Size No. Sq. Ft. EDR BTU HP Company CI 1') l kok 1 ( n Signed By 1Q' ! ( /(1�Q eA' pzX Tel. No. e SUBJECT PER City of Fridley 23021 AT THE TOP OF THE TWINS BUILDING P E R M I T T NO. Ir • _ COMMUNITY DEVELOPMENT DIV. �� - ---- r � � PROTECTIVE INSPECTION SEC. y 1 � NUMBER REV DATE OF APPROVED BY S CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/21/94 r;GE / JOB ADDRESS 5204 Matterhorn Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 5 Innsbruck 1st Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kenneth Littler 5204 Matterhorn Drive NE 571-0567 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 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 Reroof House (16 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,200 $.60 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- $29.00 Fire SIC $1.20 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE $30.80 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WH E N ALID_ATED THIS IS YOURPERMIT �PPRRO4/PERLY I BLD INSP DATE SIGNATURE OF OW NERiiF OWNER BUIL DERI IDATEI NEW [ ) ADDN [ ] CITY OF FRIDLEY ALTER [) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstcuctionAddress: Legal Description: Owner Name & Address: Contractor: Address: Effective 1/1/94 Tel. # 5�/ �,pjS6 7 MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tei. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length idth Hgt/Ground Sq. Ft. OTHER: /6 p -4/ Corner Lot [ J Inside Lot [ J Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ D Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 — Ft x $ _ $ DATE: 0 -,2-o - APPLICANT: Tel. #.f-/ �T Permit Fee $ 0 Cy Fee Schedule on Reverse Side Fire Surcharge $ 1,,-2(-, ..001 of Permit Valuation (1/10th%) State Surcharge $ C' ..$.50/$1,000 Valuation SAC Charge $ $800 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [) Not Necessary [ ) TOTAL STIPULATIONS: C'oTY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2001 6431 University Ave NE Fridley, ISN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 763.572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE OWNER Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL v U BUILDING USED AS $ 30.00 $' ESTIMATED COST PERMIT.NO. $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units_ Circle One (Steam) (Hot Water) arm Air $ 10.00 $ Trade Name&/1f'1©/-e��'7�c O�S.35ize No. BTU s'wo HP EDR $ 25.00 $ g ` Fuel r a Total Connected Load Burner Trade Name Size No. $ BTU _ HP EDR 01,--7-9-V-1 2 ion A /G State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. 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 an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. DATE ? - �'- 6/ HEATING CO Adtl,�2/) Signed Approved By Rough -In Date TEL # Final Dat&ice Lk =-a -ttL BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes ( ) No ( ) The venting system is plasticlPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( ) No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( )No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date 1 CI7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 November 9, 2001 Gregory Theisen 5204 Matterhorn Drive NE Fridley, MN 55421 Re: Final Inspection at 5204 Matterhorn Drive NE Contractor: Advantage Air, Inc. Dear Mr. Theisen: A mechanical permit was issued on August 14, 2001, to install a furnace and air conditioner at your address. According to section 305 (a) of the 1991 Uniform Mechanical Code, a final inspection shall be conducted on the mechanical work authorized by this permit. As of this date, no inspection has been called for. The permit fee that was paid covers the inspection to make sure the work was completed according to the Mechanical Code. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will expire the permit and no further action will be taken. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DA Inspector DJ/mh Building $ BUILDING Plan Review Permit No. Inspections Fire Surcharge RESIDENTIAL APPLICATION �_O .001 times the total job valuation Received BW -'0!0 763-572-3604 % _ o 14 .0005 x Permit Valuation Minimum $.50 CITY OF FRIDLEY $`, Date Rec'd� DATE— YOUR E-MAIL ADDRESS $1550 per SAC Unit (Plans to MWCC for determination) SITE ADDRESS a G � !�!�/ ,e A y - ft + 6 ft = ft x $21 = $ THIS APPLICANT IS: ❑ OWNER J dCONTRACTOR $450 Conservation Plan Review PROPERTY OWNER/ NAME: Fee Determined by Engineering TENANT ADDRESS: 5;? O q CITY r ' STA�,/�r ZIP Total Due PHONE: / . Make checks payable to: City of Fridley Attach Stipulations CONTRACTOR NAME: � STATE LICENSE # O a EXP DATE D SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: 'ej STA�kZIP Q V y WITH APPLICATION PHONE Irc /-t FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISHROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCEIREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: n� ✓� ,r7�,�� SIZE OF 1MPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY S NUMBER OF SQUARES 17 ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor 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 ❑ Other ❑ Fascia and proposed project. WINDOWS 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: (USINVZ THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 6M89. — OCCUPANCY TYPE Permit Fee $ 3 25' See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ �_O .001 times the total job valuation Surcharge $ % _ o 14 .0005 x Permit Valuation Minimum $.50 License Surcharge $`, ®(o) $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 $ / . 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 requires review and approval of plans. SIGNATURE OF APPLICANT G' �� ��✓�/�i PRINT NAMEZJZ ' l ,q AA, -) DATED ^ 30 — 0 [o Building BUILDING Permit No. -0 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd:—a 0 763-502-4977 FAX 65% of Building Permit Fee Fire Surcharge EFFECTIVE 8-19-09 .001 times the total job valuation DATE k` �'D9 YOUR E-MAIL ADDRESS .0005 x Permit Valuation Minimum $.50 SITEADDRESS Qr-, $5.00 (State Licensed Residential Contractors) THIS APPLICANT IS: ❑ OWNER ZKONTRACTOR $2000 per SAC Unit (Plans to MWCC for determination) PROPERTY OWNER/ NAME: ft + 6 ft = ft x $22 = $ ADDRESS: —52- CITYSTATE +Mi'ZIP Lilt TENANT Park Fee PHONE: Fee Determined by Engineering CONTRACTOR NAME: QikS SUBMIT A COPY OF STATE LICENSE # i-0-3 1-1 Q (Q EXP DATE2 0 In YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: LI S (11 S"t3- S -E ` TA c CITY STATE I-rZIP .LYZ INSURANCE PHONE 7 �3 - 5 -� - �"I b i FAX r/ 63- - PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED W'GVINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ]a REMODELING DESCRIBE WORK BEING DONE: i C.4/ Sa S SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING NUMBER OF SQUARES ❑ HOUSE ONLY ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES 11ATTACHED 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 I. 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 FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. 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) IUTAl, JUD VALUAIIU1N N CAV -- Co- - UUUUYAINUY 1 YYE Permit Fee $ pZ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ i .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $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 $22 = $ 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 on site; that the work will be in accordance with the approved plan in the case of all workWhic requires review and approval of plans. SIGNATURE OF APPLICANT'= PRINT NAME 0ftA �U��� ^� bE R DATE1 t� Dq