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PRE 2010 DOCSCity of Fridley SUBJECT P �,.�,._..... ®12395 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECE COMMUNITY DEVELOPMENT DIV. v r , PROTECTIVE INSPECTION SEC. I = , CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-580-3450 910-F15 1 111/19/73 JOB ADDRESS 5400 Matterhorn Drive N.E . 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 5 Innsbruck North SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Dr. Conrad Nauman 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. White '78Ai -6®11 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 [R NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a IM 54' x 311811 Duelling and a 28' x 24'811 Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before capping. Check floor elevation for sewer from data on permit. SEWER "Y": 43' North of Manhole "Y" ELEV: 992.78 Xffi� Minimum Top of Footing: 995.78 Inv. Elev. of Manhole: 993.90 WATER: 10' South of Sewer approximately. PERMITS REQUIRED FOR WIRINGI SEPERATE HEATING, PLUMBING AND SIGNS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame— THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION R-1 1544 20,880 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WLL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $36,220 18.11 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROV SIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- � STR NORTHE PERFO N F CONSTRUCTION. TI ]O.00 275.00 74 PLAN CHECK FEE TOTALFEE .11 SIGNATURE OF CONTRACTOR OR AUTHORIZE A NT (DATE) WH N PROPERLY VALID E-THjSO YOUR PERMIT s N. BLDG INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) 11 L0 P913 3 �893� APPLICATION FOR RLSIDENTIAL, ALTERATION, OR DD1T'ION BUILDING PERMIT CITY (1F 1-R I LILLY , \I1 NNESOTA /- ® 1/ OWNERS NAMEII- IaAh A44witd BUILDER: W kite., 0A &kjj C ADDRESS: USI ADDRESS • -W U Mat+ !�& NO'..SY60 STREET: M49�4-01- haw 174*,,ue LOT: BLOCK: LOCK: ADDITION: L 161. u e Ic Al®k f CORNER LOT: ` INSIDE LOT: SETBACK: S SIDEYARD: M;w. / % Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: aOW@/f w ront : F0nDepth: D Hei Square Feet:Cubic Feet:,_?i Front: I Depth: Height Square Feet;_ Cubic Feet: Estimated Cos Type of Construction: t $ �, o fE A t To Be Completed: _ c Th unders fined here y mz es al'ppicat on €br a permit for the work herein specified, agreeing to do all work in stiict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that ill the facts and representations stated in this application are true and corrt-ct. DATE : S [(;NATURE: 1 (See Reverse Side ForFpAdditional Information.) ` � ! �� a� ,. Vii . ~ '�. F .➢ t� � A' l ,� i•^ i,i !�� ,�� ,.. F p A!d �'.:.. � .:� t ./ . 1 J Cite of Fridley r % AT TME TOP OF THE TWINS ! L - a d L-- -- COUMVNITv DEVELOPMENT DIV, t i PROTECTIVE MV'VCTION DIPT. CITY MALL PRIDLCY 0042 Job Address ®i ane Cont acto V� Kind of ilding Completion Date SWjricr Permit No. HEATING PERMIT APPLICATION jw,lp REV. pATE PARE OP APPRCvEO :210- 17A 0 2/15/73 1 1 800 se SS SS GRAVITY WARM AIM RATE TOTAL Heating_/Pow2r Plants Furnace Shell & Duct Work :. .............. $f0.00 Steam Hot Water Warm Air Replacement of Furnace 6.00 � Repairs & Alterations --tap to $500.00 6.00 Trade Name Repairs & Alterations each add. $500.00Size 3.041 $— _ -- No. MCM WAM Ant Capacity Sq. Ft, Furnace Shell & Duct Work to 120,000 BTU ...... . ..$10.00 $— EDR BTU Ton. each add. 00,000 BTU .................... .... 3.Ov Total Connected Load Replacement of Furnace .. . .. ..... &00 g Repairs & Alterations --up to $500.00 600 Kind of Fuel Repairs & Alterations each add. $500.00 3.00 $ Burner STEAM at NOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. F.DR Steam Furnace Shell & Line --to 640 sq, ft. EDR Hot Water Each add. 200 sq. ft. EDR Steam Each add. 320 sq. ft. EDR Hot Water OIL BURNER—to 3 gal. per hour over 3 gal. per hour—See Fee Schedule Trade Name Q10.00 $ 20.00 $_— Size No. icn'7 3•00 $ - — Capacity Sq.Ft 3.00 $ EDR BTU Ton. 6.00 $ OAS BURNER (tip to 1£0,000 BTU) &00 $ over IOMM BTU See Fee Sehadule GAS FMING FEES: NO IRATE TOTAL 1st 3 fixtures x$ 200 Additional Fixtures Fixtures x .75 $ Gas Range to 199,E IS &CO $ AIR CM!.IDITI01.11150 FAN ITEATL G 3YOTET4 V ENTIL1iTUIG SYSTZ' ALTERATIONS & nEpAins ROUGH v� _ ` State Surcharge � f5_1 F�Schmdt!U S. - TOTAL Ff;E 9 lS C® Suburban Air Conditiot*V CO.'nature ' 8419 Center Drive g Minneapolis, Minnesota 654 i City ®f Fridley II�HdfiGT Permit No . f AT TME TOP OF THe TWIH6 Trade Name Furnace Shell & Lines—to 400 sq. ft. F.DR Steam HEATING PERMIT APPLICATION d'-U ------- i COM14VNITY DEVELOPMENT DIV. 10.00 � PROTECTIVQ W'_' cI IQN COPT. Each add. 200 sq. ft. EDR Steam I -CA C4TY HALL FRIOLCY ®OQ$ Capacity Sq.Ft Each add. 320 sq. ft. EDR Hot Water IM RQH. DATE PACE BY EDR BTU Ton. 910-F17A 0 2/15/73 =APPROVED 1 800 Job Address � Address Phone Contractor Address Phone Kind of 'lding Use Comp eti n Date EstedCost ®� � _� Z i cI&&Cta,z J%AA%; "WE; TOTAL Heating/Power Plants #r I Furnace Shell & Duct Work .... . ........... $10.00 $ Steam Hot Water Warm Air Replacement of Furnace . ..... .. 6,00 Trade Name Repairs & Alterations—up to $500.00 6.00 Repairs & Alterations each add. $500.00 3.00_____ Size No. CIS. W ArR Furnace Shell & Duct Work to 120,000 RTU ...... . each add. 60,000 BTU ............... Replacement of Furnace Repairs & Alterations --up to $500.00 Repairs & Alterations each add. $,500.00 CapacitySq, Ft 00 $10.00 $ ��" EDR BTU on. 3'00 Total Connected Loader 600 $ Kind of Fuel 3.00 $ Burner STEAM or HOT WATER SYSTE24 Trade Name Furnace Shell & Lines—to 400 sq. ft. F.DR Steam $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_ Size No. Each add. 200 sq. ft. EDR Steam I -CA Capacity Sq.Ft Each add. 320 sq. ft. EDR Hot Water 3.00 $ EDR BTU Ton. OIL BURNER—to 3 gal. per hour 6.0D $ —_ over 3 gal. per hour -See Fee Schedule j 0 e) GAS BURNER cup to 1f,1,C*0 BTU) 6.� $ l over 159,000 BTU See Fee Schadulo GAS FITTIPaG FEES: NO RATE TOTAL 1st 3 Fixtures x$ 200 $_S2 ®C� Additional Fixtures $ .76 = Gas Range to 199,000 Y$ &00 $ _ .50 State Surcharge AIR c®d:DI�cesardaG � FAN NE.t'a.TIPIG 3T3T'vM Servs Fea Sehadule VENTILATING SYST � ALTERATIONS & REPAIRS TOTAL FLS ROUGHSuburban Air Conditioning C0. $479 Center Drive FINAL J9 9ignature innewto 55432 --- 1 t n City of Fridley 56gd§CT Permit No. ' AT THE YAP AP THE TWINSj�'�- 'dPLUMEIiG PERMIT APPLICATION R.0 -------- COl MVNITY DEVELCIPUENT DIV, I i PROTECTIVQ MPUOYtCFM D$Fr, CITY HALL FRI®LFV Z@W �.q.. i .J CI�'6�1y^3C6d® P}Ip tit iSEV. ®A7C PJ3®£ A�BaH?13AVED BY 10• 1 0 2 15 73 1 • 1 800 Job Address 15- 40 v Owner Address Phone nn &F, 2 Cont -actor Address Phone Q Kind of Building Use Completion Date stimateCost Ta I Plumbing Fixture Rates; NO. RATE TOTAL =tJI I I I Number Fixtures x $2.00$ a 2.0 0 i Future Fixtures x $1,50 Q 39Nral to I j New Fixture -Old Open. x $1.50 U G Catch Basfin x $3.25 Water Heater -99,000 BTU x $3.00 J.a O •os,w •saQ� Ground Run Old Bldg. x $3.25 •MNiral I Elec. Water Heater x $2.00 k I SNisra 1 Ho:rol I I I � C .y Gas Fitting Fees: Oiz S aon� 00_1A $ Q � 1St 3 Fixtures x $2.00 �O •V 6N3MOHSI iz o.� 1 Additional Fixtures x $ .75 i �^ as %LNnOA '� xN1aQ I I I� i + Gas Range -199,000 BTU � x $5.00 U 'Cn jY SAral 1 .r HSVMI I I I I d Repairs & Alterations I See sHNI6 II-I4I U Description: Code State Surcharge .50 s®n1 k=' TOTAL FEE $ �.o 0 ! The undersigned hereby makes application for a permit S,rNian l I i for the work herein specified, agreeing to do a1.1 work GIMS013 II — i in Strict accordance with the City Ordinances and ruling H31VM of the Department of Buildings, and hereby declare that. all the facts and representations p ns stated in this application are true and correct. i 0 0 U C W I ��9i G7 I 'Signature Date i CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1991 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas Gas Range NO. RATE TOTAL 111111111101• $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 Gas Dryer $10.00 Back Flow Preventer Required ( )Yes ( ) No Type $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .50 JOB ADDRESS -1-4 -e-t- k r Lc 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. - C? ,1991 Owner Building Used As Ec a n,L `C- - S A -C_ . Estimated Cost n0 PERM PLUMBING COMPANY' Minnegasco #342-5326 MINNEGAs10 SIGNED BY 700 W. Linden AvenucTEL N0. P. 0. Box 1165 Minneapolis, MN 55440-1165 Approved By CePZ 9_ Rough -In Date Final Date - 2-® CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 1998 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) 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 $ 30.00 $ Oe,oD $10.00 $ $10.00 $ $10.00 $ $ 25.00 $ State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOUNGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDRESS 5Y®C) M'ITt eV Aa 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. q-.23 ,1998 OWNER, /V Irv' J4,4/ !Q � lie L k14Y 1,,,1 BUILDING USED AS_ ct C .P. ESTIMATED COST Z19 c) 0 PERMIT NO. o 3 r DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU- HP EDR Fuel Total Connected Load Burner Trade Name BTU HP Size No. EDR n HEATING COMPANY f 61 Signed Tel No. Approvf FILL OUT BAI REPLACEME Rough -In Date HT G� C Final Date All other BTU's TOTAL BTU's L/ Has a liner been provided for water heater Yes (v) No ( ) 7. 8. Has combustion air been provided for water heater Yes (P) No ( ) Remarks: . List ALTERATIONS Beim one: HEATING CO: Signed By: Date: CHIl4NEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes (No ( ) 2. Is free from rust or deterioration Yes 3. Has no foreign objects lodged within Yes () No Yes allo ( ) 4. Is securely supported . 5. Meets all current Code requirements for size and total BTU's connected Yes ( No ( ) 6 J 4odo Has total heating BTU's of t ! All other BTU's TOTAL BTU's L/ Has a liner been provided for water heater Yes (v) No ( ) 7. 8. Has combustion air been provided for water heater Yes (P) No ( ) Remarks: . List ALTERATIONS Beim one: HEATING CO: Signed By: Date: III SUBjEGT City of Fridley 30622- AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. f PROTECTIVE /® 1 . � ` A CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED Br ____ f��"',•� L J` 612-571-3450 910415 1/7/00 JOB ADDRESS 5400 Matterhorn Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 5 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Anwar Abdel Karim 5400 Matterhorn Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO YK Contracting 879 Westwind Dr, St Paul, MN 55019 (651) 644-4139 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 B DESCRIBE WORK Reroof House & Garage (32 Sq) Tear -off; replace damaged decking and fascia 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 ISTALLS 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 $2.40 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4,797 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- $111.25 Fire SC $4.80 STRU TION V THE PERFORMANCE OF CONSTRUCTION $111.25 ,IF PLAN CHECK FEE TOT FEE Ci ce 229.70 S-GN4fuRE OFC OR OA'� OR4ED AGENT iDATE. HWN;L�IOATE THIS IS VQU�R P�iMI� OG IN FIATS S-GNATURE OF OWNER,iF OWNER SUROERi DATE, III NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: . �l� �p j,2 %� AV Legal Description: .\Owner Name & Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type:_ Tel. # LICENSE # A j tw) 7,41 Attach to this application, a Certificate of Survey of the v J lot, with the proposed construction drawn on it to scale. Length Length DESCRIPTION OF EMPROVEMENT Width Height Sq. Ft. Width Height Sq. Ft. ,C Hgt/Ground Sq. Ft. I Driveway Curb Cut Width Needed: DATE: 11'21,2C Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge Estimated Cost: $ Ft. + 6 Ft = Ft x $ _ $ Tel. # Co y113 g CITY USE ONLY � ��06 ///•� �� 020 _ $_ �l% eZ Fee Schedule on Reverse Side \ $ .001 of Permit Valuation (1/10th o) �� $ c .'� b A. 0 $1,000 Valuation $ _ per SAC Unit $ 0 $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above I TOTAL $ J' - %D STIPULATIONS: $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] Tr a SUBJECT P IT NO. City of Fridley0909 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ZN NUMBERDATE f7l PAGE OF APPROVED BY -1 CITY HALL FRIDLEY 55432 '-'j 612-571-3450 910-F15 5/8/00 JOB ADDRESS 5400 Matterhorn Drive NE T LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 5 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Anwar Abdel Karim 5400 Matterhorn Drive NE 839-2810 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 52 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace two windows 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 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 1 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 $1,350 $.67 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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- $50.95 Fire$1.35 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION ,8C PLAN CHECK FE TOTAL E $ 2.97 .IGNAT UAE OF CON' PAC TOA OR AUTHORIZED AGENT IDATEI ROPER EN LIDATfrDjHIS IS Y EaWT S.GNATURE OF OWNER. -F OWNER BUILDER. IDATEI lofs BlD .NSP r)ATE Tr a NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 '"\ BUILDING PERMIT APPLICATION Construction Address: `� 7oo Ha -61,4)14 D r Legal Description: Owner Name & Address: 141V 6AW Tel. # -335-2-9/0 Contractor: 0GeW/1 6,41' MN LICENSE # Address: 5,1,414 e- Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt(Ground Sq. Ft OTHER: Construction Type: k - 16�c r A1111Z V5 Estimated Cost: $ /-35-0- C'5�- Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ J DATE: APPLICANT: AW&),ar Tel. # CITY USE ONLY - Call (7 .57 -360 4�ff Permit Fees if mailing In application Permit Fee $ 6®•9&" Fee Schedule on Reverse Side Fire Surcharge $ -S� .001 of Permit Valuation (1/10th%) State Surcharge $.50/$1,000 Valuation SAC Charge $_$1 100 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. 'W or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] Building Permit Fee BUILDING Permit No. Pg6 Z I " Inspections $ RESIDENTIAL APPLICATION Received By: k 763-572-3604 .001 times the total job valuation Surcharge $ 763-502-4977 FAX CITY OF FRIDLEY Dalft $5.00 (State Licensed Residential Contractors) SAC Charge EFFECTIVE 1-1-2010 $2100 per SAC Unit (Plans to MWCC for determination) DATE J —a 0 `/ 0 (j TO5C-C 4 U Z I/ #or/VO/ m CD �� YOUR E-MAIL ADDRESSffg;:�:Al SITE ADDRESS - _540 b 1 "L a rGr �7 A) e 4 al 4 - 3a - THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: e/A ar U Z TENANT ADDRESS:,�j®i(/[G. DY %��CITY -Py/ CLI STATE µNLIP-, $ PHONEt'?M� 593 93 69 CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH [3 ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING e NUMBER OF SQUARES 6 ❑ HOUSE ONLY ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: I . Existing Floor Plan GARAGES ❑ ATTACHED 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, ❑ Viny] ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim l . 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) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ (Q See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ U .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ _ Agreement necessary ( ) Non Necessary ( ) Total Due $ "'%i Make checks payable to: City of Fridley Attach Stiuulations 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 v�,6rkPlt' h reAires review and approval of plans. SIGNATURE OF APPLICANT _ PRINT NAME QIS C A l/r Ul� DATE