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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PER N® 4424 Date;.......... . ........ Owner: Builder ..... .......... ..........Q....._..-_......._._. Address Address --- – ------ --------- ------------------ LO TION RF BUILDING No. Street aiA of Lot ....._....----------•----•--------------•-. Ail Lot Block ............ ; ..... . ................................ Addition or Sub -Division Comer Lot ........................... ........ Inside Lot ............ Setback ...le ........... Sideyard . ..... Sewer Elevation ..... . ........................................... . ............................ ........................ Foundation Elevation ................... ........---------•--.....---._................._........._. ... DESCRIPTION OF BUILDING E T Used as: 1 1 . .. ... ..... ....... ................ ...... Front elf Depth Height 1.9 Sq. Ft. Cu. FJO YS5 I ........... Front Depth 14. Height Sq. Ft. Cu. Ft. ..f: . .. . stru f Used Type 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 and in compli provlslozvmzof—, ordinances of the city of Fridley. LSA In consideration of the payment of a fee of $.3�- 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 u rolatiorn kf any of the provisions of said ordinances. z'_� 7PI9 / I 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 these items. .41310.4 City of Fridley App ication for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SU 4.1 DESCRIPTION OF WORK �`✓ Number, Kind and Location of Fixtures Location - PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening x 1.20 $�'4--" New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ......--Z x 2.00 $ ' 0 0 New Ground Run Old Bldg. x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... � x $1.50 $ / h v Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FEE -0 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. Owner Kind of Used as Tobe c.,...r_ .. Estimated Cost, Old—New. Building Permit ROUGH FINAL 42 2M 7-59 PezmitN � ne , B Business Phone N ui '� Z O W -j W U' ? Z �O • F • N WATER NTR. GAS ELEC. YJ Bas 1st 2nd _ 3rd 4th • Future Connection Openings Connected withI Sewer New Fixture, Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $ Future Fixture Opening x 1.20 $�'4--" New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ......--Z x 2.00 $ ' 0 0 New Ground Run Old Bldg. x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... � x $1.50 $ / h v Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FEE -0 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. Owner Kind of Used as Tobe c.,...r_ .. Estimated Cost, Old—New. Building Permit ROUGH FINAL 42 2M 7-59 PezmitN � ne , B Business Phone Cify of Fridley App icalion for Ping and Ow Filing hnmir Dept. of Bldgs. Phone S®0-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening ........... x $1.50 $ _ New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater :Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg. ........ o 11 Electric Water Beater .............. V < GAS FITTING FEES: NO. RATE TOTAL :•N $ 2,00 Additional Fixtures .................. H.MELM' Base Gas Range to 199.000 BTU.. . x $5.00 $ ihstall (1) gaa grill & (1) lite 6,00 1st 2nd 3rd 4th_ ° Future Connection Opel+ * New Fixture. ON Openings Connected with Sewn ❑ Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening ........... x $1.50 $ _ New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater :Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water Beater .............. s $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ...... • • . • .... , 2 x $2,00 $ 2,00 Additional Fixtures .................. x $ .75 $ Gas Range to 199.000 BTU.. . x $5.00 $ ihstall (1) gaa grill & (1) lite 6,00 REPAIRS & ALTERATIONS—Rsf*r to Code Description ............................................. TOTAL FEE $ 8,00 I.acation5281 Matterhorn Drive City of Fridley: 52-84-915.51 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 Fridley, Minn Aug. 3. 1971 19_ Owner Russell Erlandson Kind of Building frame Used as residence To be completed about Aug. 6. 1971 Estimated Cost, $ 20.00 Old 51ew. Building Permit No. Permit No. i:20 ROUGH Mass 12W Surcharge .50V Signed Business*ne No SUBJECT City of Fridley 20509 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEI O COMMUNITY DEVELOPMENT DIV. v ____�_. PROTECTIVE INSPECTION SEC. r - i = CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 8/8/90 JOB ADDRESS 5281 Matterhorn Drive N,E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 1 Innsbruck 1st Addition SHEET 2 PROPERTY OWNER MAILADDRESyS ZIP PHONE Russell Erlandson 5281 Matterhorn Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Builders & Remodelers Inc. 3517 Hennepin Avenue, 827-5481 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION �J REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $7,600 $3.80 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. $99.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 102,80 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) r VHHPROPERL V IS YOUR PEPCVI (T a WDH Q1 SP riaTE SiGNATURE OF OWNER IIF OWNER BUILDER) IDATEI NEW [ ] Effective 1/1/90 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: s Legal Description: owner Name & Address: °� VSs �% �r /4 -2 YY /J 2P� �P� Tel. Contractor: i CP 1 'PrW)'4e lip r s i h Tel_ . Address: 1'1 Q n n2�� ► )p. P1 ✓1 0 5S- T Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. �* 1""* Oke'd �y171��4 LI71M AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DEM AREA: Length Width Hgt/Ground Sq. Ft. OTMM: r QS ;A i A p Corner Lot [ ] Inside Int [ ] Ft. Yd Setback Side Yana Setbacks Type of Construction: e S Estimated Cost: $ Approx. Cmpletion Date: -15WO - rC) Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Width + 6' See Back Page DATE: (0 '�} �, APPLSCAN'!': Tel. # 'R 2 "7s -S(4 R- Permit Fee $ . oo State Rnmharge $ 3 b SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ STIFULA ONS: CM USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ l $ ) se" %/ 0 6� r. i608 a000- qs,oc rFAtFIR El CIlYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 August 91 1990 Russell Erlandson 5281 Matterhorn Drive N.E. Fridley, MN 55432 RE: Property at 5281 Matterhorn Drive N.E. Dear Mr. Erlandson: On July 1, 1990, the City of Fridley began a new program called Systematic Code Enforcement. This program is designed to provide fair and equitable code enforcement, improve the City's appearance, and maintain property values by creating a more attractive suburban environment. Under this program, all properties in the City will be inspected approximately once each year to ensure that they are in compliance with the Fridley City Code. A recent inspection of your property revealed that not all Code requirements are presently being met. Listed below are item(s) which do not comply with the Code: 1. Observed unsecured solid waste container in front yard. Fridley City Code 113 requires that all solid waste must be kept in secured containers stored in the side yard, rear yard, or garage, except on the collection date. Your prompt attention in correcting this problem would help us in our effort to improve the City. A reinspection will be conducted on or about August 23, 1990, at which time compliance is anticipated. Please call me at 572-3595 if you have questions or wish to discuss this further. Thanks for your cooperation! Sincerely, Steven Barg Code Enforcement Officer SB:ls C-90-619 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 N'AX: (763) 571-1287 ADDRESS : 5281 MATTERHORN DR NE PIN : 253024120002 LEGAL DESC : INNSBRUCK 1 ST ADD : LOT 9 BLOCK 1 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT O.: 2004-0 0 DATE ISSUED: 04/21/2004 VALUATION : $ 5,875.00 NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL FURNACE (WARM AIR, BRYANT, 80,000 BTUS) AND AN AIR CONDITIONER # A/C UNITS 1 # FURNACES # GAS DRYERS APPLICANT STANDARD HEATING & AIR COND CO 410 WEST LAKE ST MINNEAPOLIS, MN 55408-2998 (612)824-2656 OWNER ERLANDSON RUSSELL A & J P 5281 MATTERHORN DR NE FRIDLEY, MN 55421 0 # GAS RANGES AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law re ons ction or the performance of construction. ADDlicant . Date Bldg HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 10015 CFPAR ATF. PF.RMTTC RF.OT ITRF.n FOR WORK OTAF.R THAN T)F.S('RTRF.T) AROVF 1 0 0.00 35.00 0.00 0.00 25.00 0.50 60.50 Effective January 1, 2003 CITYIOF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 JOB ADDRESS � i Olj1—rte RATE SCHEDULE 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 OWNER 7 Z> L( 1 Q✓ICXZ's o -r) Rate TOTAL n - BUILDING USED AS M� 1 denC� $ 30.00 $�O ESTIMATED COST —7S PERMIT NO. DQ�'�Os(dJ $ 10.00 $ DESCRIPTIO"F FURNACE AND OR BURNER $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) ( arm r) $ 10.00 $ Trade Name Size No.3 - �� BTU HP EDR $ 25.00 $ Fuel Total Connected Load Burner Trade Name Size No. $ BTU HP EDR 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 $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and corr ct. DATE � G H EATI CO STANDARD HEATING & AIR CONDITIONING CO. 410 WEST LAKE STREET MINNEAPOLIS,X408-299 # 612-824 ?656 Approved By Rough -In Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE TIE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When renl� acingan ayk inn . iran _%. 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.(�eNo The venting system is plastic/PVC and meets all current codes and manufacturer ,� specifications including sizing, length, number of elbows and termination. Yes (WNo ( ) 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 (Y ( ) The ®Y ding rnmhi ictinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a nnw cambustiloo W4 it will be sized and installed to meet the current codes and manufacturer's specifications, Yes ( eo ( ) When Installing a new ventng 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 (/o ( ) Appliance #1 Type FC11E BTU Input 6 D 00 D Fan Assisted or Nat Appliance #2 Type 1,4- BTU Input o Fan Assisted or Nat nJA-7- Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances. Total Btu Input, Common Vent Type �f A) 12 Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type 1` v C Appliance #2 Vent Connector Height ft Length ft Diameterin Type C - Vk-&''T Appliance #3 Vent Connector_ Height ft Length ft Diameter in Type __ HEATING CO: Signed By: M Date : �- 7Z - b CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 tAX: (763) 571-1287 G PERMIT NO.: 2004-00577 � DATE ISSUED: 04/23/2004 ADDRESS : 5281 MATTERHORN DR NE PIN : 253024120002 LEGAL DESC : INNSBRUCK 1 ST ADD : LOT 9 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. WIRE FURNACE AND AIR CONDITIONER # INSPECTIONS 1 APPLICANT SPARK ELECTRIC 2114 WASHINGTON ST NE MINNEAPOLIS, MN 55418 - OWNER ERLANDSON RUSSELL A & J P 5281 MATTERHORN DR NE FRIDLEY, MN 55421 ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 39649 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp, Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Building $ :a -3.,35 BUILDING Permit No.: I11S BCtiOriSReceived 65% of Building Permit Fee � ��i � � By: 763-572-3604 Surcharge CITY OF FRIDLEY ��'[�e��1! 3 0 007 DATEO7 YOUR E-MAIL ADDRE�SSS SITE ADDRESS U% /14" TENANT��/u/(,�(yJSuite No. PROPERTY OWNER NAME: $ 1 ADDRESS: fj/ he 4,d-G,i-,,CSS CITY STATE ZIP Special Assessments PHONE: 7&,92:571 67 791 ARCHITECT NAME:Al IA - ADDRESS: CITY STATE ZIP ft + 6 ft = ft x $21= $ CONTRACTOR NAME: AM; - r/ k,8 4wC � {�% o n , L%Z�• Make checks payable to: City of Fridley Attach Stipulations ADDRESS: xWs 1sMe211 *?�N-1 CITY 1' STATE ZIP SrO�is� PHONE: U6-)-'q&41"49Z' FAX *NOTE: CITY LICENSE REQUIRED FOR MULTI FAMILY/COMIVIERCIAL/INDUSTRIAL JOBS PROPERTY TYPE ❑ TOWNHOUSE ❑ COMMERCIALMMUSTRIAL ❑ INSTITUTIONAL ❑ MULTI -FAMILY 6 PERMIT TYPE ❑ ADDITION ONSTRUCTION ❑ OTHER ❑ REMODEL OOF S ❑ SWIMMING POOL PLEASE SUBMIT: 1.4 SETS OF DRA CTORS LICENSE OR 6. SPECIAL INSPECTION 2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE 3. LANDSCAPE PLANS 7. PERFORMANCE BOND 4. ENERGY CALCS AMOUNT $ BUILDING TO BE USED AS: OFFICE SF VMS sF OTHER SF TOTAL SIZE: STORIES FIRE PROTECTION (Y/N) AC(Y/N) DETAILED DESCRIPTION OF WORK 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 SIGNATURE OF APPLICANT }res r - w and a roval of plans. �j OkYp� c '�^ [%�% w is rTe PRINT NAME I I L Y�J 1JV (DATE _1[14t ALL FEES ARE BASED ON VALUATION Sq. ft. x $ Cost/sq. ft. = Valuation $_ Sq. ft. x $ Cost/sq. ft. = Valuation $ Sq. ft. x $ Cost/sq. ft. = Valuation $_ TOTAL JOB VALUATION: $ USE OCCUPANCY TYPE Permit Fee $ :a -3.,35 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 51 - o - .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 SAC Charge =� ` $1675 per SAC Unit (Plans to MWCC for determination) Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Special Assessments $ Agreement necessary ( ) Non Necessary ( ) Curb Cut Escrow $ ft + 6 ft = ft x $21= $ Total Dae $ Make checks payable to: City of Fridley Attach Stipulations Building BUILDING Permit No.• `r Inspections RESIDENTIAL APPLICATION Received By: �. Fire Surcharge $ APR ZOc 763-572-3604Date CITY OF FRIDLE�Y_1 1.61 .0005 x Permit Valuation Minimum $.50 \ DATE 1 1 YOUR E-MAIL ADDRESSSITE 5, D $5.00 (State Licensed Residential Contractors) ADDRESS ✓c �Q 11 $1 D�h b ( t $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ THIS APPLICANT IS: ❑ OWNER J TCONTRACTOR $450 Conservation Plan Review PROPERTY OWNER/ NAME::Se ana_-"On Fee Determined by Engineering TENANT ADDRESS: n CITY STATE ZIP Total Due PHONE: q(02) r SI'1__51:0 _/ NAME: Renewal By Andersen _ p Make checks payable to: City of Fridley Attach CONTRACTOR SUBMIT A COPY OF STATE LICENSE # 1920 County Road "C" West YOUR STATE LICENSE ADDRESS: Roseville, MN 55113 t STATE ZIP WITH APPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/NEI 651-20-4•%77 PROPERTY TYPE 13 TWO FAMILY/NEW C — ------��-- ❑ ADDITION ❑ GARAGE/SHED -WINDOWS PERMIT TYPE ❑ BASEMENT FINISH 13 ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK:1ARAINTENANCE/REPAIR EW 13ADDITION ❑ REMODELING DESCRIBE WORK BEING DONE. 1 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S . ROOFING ❑ HOUSE ONLY SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT 1. REMODELING Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 13 Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑ Aluminum ❑Soffit ❑ Trim ADDITIONS 1. & PORCHES SUBMIT: Site Plan/Survey showing the existing structure ❑ 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 COSTyr LAIfVK APIu XM i nRua+,.,a. (USING THE 1997 U.B.0 FEE SCHEDULE) VALUATION Permit Fee $ V3. P S See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ a• 1 _ .001 times the total job valuation Surcharge $ 1.61 .0005 x Permit Valuation Minimum $.50 License Surcharge $ 5, D $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 $ _ p 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 conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an applicatiopfor a permit and work is not to start without a permit; that the work will be in accordance with the approve plan in the case of all work w ch requires rev' and approval of plans. O 9 SIGNATURE OF APPLICANT NAMEDA J