PRE 2010 DOCSCity of Fridley
susJEcr
P NO.11�
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
i.
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
L
NUMBER
REV,
DATE
PAGE O
APPROVED BY
612-560-3450
910-F15
6/1/77
JOB ADDRESS 5530 Matterhorn Drive N.E.
1 LEGAL
LOT NO.
11
BLOCK
4
TRACT OR ADDITION SEE ATTACHED
Innsbruck North
DESCR.
SHEET
2 PROPERTYOWNER MAIL ADRESS ZIP PHONE
Wayne T. German 1506 Bonhof Junction, Fridley
3 CONTRACTOR MAIL ADDRESS ZIP H E
Registry Homes Inc. 7400 Candlewood Drive, Mpls. 55445 42911S3,40MT' '
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
iC NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Construct a 42' x 4414" Dwelling and a 32' x 2214" Garage ON,
SST P #i ITS, REQUIRED.,. RM WONG, T ikoNE .&CM •GAS E
9 CHANGE OF U .TO REQUIRED u c V[
STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side
yards. Provide a verifying survey before capping. Provide City with copy of
truss design. Cross bracing every 25' on center with let in or submit design
for approved bracing.
SEWER LOCATION: (approx. 10' deep) 87' South of Manhole (inv. 976.93)
WYE ELEV: 978.72 TOP OF FOOTING: 981.97 Minimum
WATER LOCATION: 71' S.W. of.Catch.Basin, 39.5' South of Catch Basin, Approx. 10'
South of Sewer Service
DRIVEWAY DEPRESSION COST: N/a Existing Surmountable Curbing
10 a MY. or� "MIX, Dais NOT WAer NKi SNI
. oAU is: fts wowu► w PuDxs &av— .Kx.
+... q. Nt
t►lriow
//��N
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
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
R-1
1428 -F 704
34,000 Tota
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
j
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.
$45,625
$22.81
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORIIX,4VVIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE AL LAW REGULATING CON-
$7.36.00
$375.00
STRUCTION OR THE FORMA CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$ 34.00
$567.81
O OR ORAUTHORIZEOAGENT I ATEI
P OPERLY VALIDATED THIS IS YOUR PERMIT
C
WWHEN
l^
BLDG INSP DATE
SIGNATURE OF OWNER 0F OWNER BUILDERI (DATE)
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER: A�' BUILDER:
Address: /�`D6t/< `I� Address:
Tel. No.
No.: . U street:.40
LOT:
LOT: �� BLOCK: �_ ADDITION:
CORNER LOT: INSIDE LOT: _r SETBACK: SIDEYARDS:S-? / /2/ /X6
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: A/.? !a
Front: Depth: Height:'
Square Feet: L' z� Cubic Feet: / Z
lo�}/� Front: �02 Depth: / !� Height:
Square Feet: Cubic Feet: �(�7
Type of Construction: QQQr Estimated Cost:
-Th Be Completed: s� 00-7, � , Ir, % � Alt. A
�J Alt.
Proposed Driveway Width If New Opening Is Desired $ 2� $
(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 informat' n.
,410 /Z1DATE: S SIGNATURE:
Stipulations:
Q � !
_ f�
,533 > /yi,5��l13
/zh z = 02 yCy
470
— Aa
-P-Z, G® _ &z .272 , oo
�
3, 6"3 z
3� 0o U
$: I-QtAt iV1,; -76442J,
CITY OF BUILDING DEPA RTMENT
• EXTERIOR KNVLIDPE rMUGE "U" COMPUTATION
(To be submitted with building permit applicationn)/)••
One or two family dwelling Owner l k� 414C
All ocher
Site address -
Contractor _=4NL Date -1-i4-7C Phone - 33
LINEAL
EXPOSED
FT. OF
WALL
ft.
above
grade
� S2.•ba
f
'
TOTAL
EXPOSED WA
-
OPAQUE
WALL CONSTRUCTION: "U" value x
t` �_ a�
fi4,", 1'-, NY:'1L rS�i. i•e 'iGi "U"
area
., i
r/
.
sq.
ft •
q end
-t�-,��.=
j '" C
i�e1,J
U A j
(U) ( )
" "
�__
x
s .
ft.
1�1` c3
i G
(U)(A)
A
O"x
L�:Jc, F1 "U" s t�
sq.
sq.
ft.
ft.
- Hq
(U)(A�
a/. 00
Detail
reference
r
"U"
x
s Q
f r..
,13
(U)(A)
from
attached sheets
x
.
sq.
ft.
_
(U
(U�
(A)
(A )
"U"
"U"
x
x
sq.
sq.
ft.
ft.
-
a
(U)
(A.)
"Un
"U"
x
sq.
ft._
--- ._._(U)(A)
(U) (A )
nun
x
sq.
ft.
WINDOWS: "U" value
Make & type
x area_Z�
55i ��^�� � �-� `� "U"
.:56�
�
sq.
ft.
ice. 8Z
_(U)(A)
"
n
TTU"
x
sq.
ft.
(U) (A)
n
n
"U"
x
sq.
ft.
i
(U)
(U)
JA)
A)
"
n
n
n
"
"U"
x
x
sq.
sq.
ft.
ft.(U)(A)
"U
n
n
nun
x
sq.
ft.
(U)(A)
DOORS:
Make &
"U" value
type
x area(U)
"U"
.S-�
✓ x
sq.
ft.
���. :o
Q-•°'
.. !. ,}
(A )
n
n
"U"
x
sq.
ft.
"
(U)(A)
(U)(A)
n
n
n
n
"U"
x
x
sq.
sq.
ft.
ft.
"
(U)(A)
"U"
TOTAL (U) (A) VALUES�'�
DIVIDED BY TOTAL WALL AREA
AVERAGE "U"
TOTALS 2 552, 2-2- S q.
• l � t A �JG .
.17 or less for 1 & 2 family dwellings
.22 or less for all other buildings
ROOF/CEILING :
TOTAL AREA : sq. ft.
Detail reference "U" x
from ; rr K u•_ {� "U"�Z�x
attached sheets. "U" x
Describe openings:' = �' cc, r:•t"U" .� t x
in roof.
"U" x
TOTA L (U ) (A ) VA LUES
DIVIDED BY TOTAL ROOF/
CEILING AREA
AVERAGE "U" .05 for
.10 for
ft.,YA6, 54(U)(A)
q. (U)(A)
sq.t.
sq. ft. .. �� r,;tac (U)(A)
sq. ft.=, �- L (U) (A)
TOTALS 114 = 7 Sq. ft.39�(U)(A)
'cf
-7
ventilated
',.�,,., •tea .� yc� �}��Kz- E�.':r: t'+�'� �� i -''+.J �,'b
ventilated roofs
ally" ,then construction
WALL SECTION - �a 'Y'� . Cr=O�l�
1/.l�iAye
PAGE
.NOTE: USE 121 OF OPAQUE WALL AREA FOR
FRA:*4E CONSTRUCTION
CONSTRUCTION
(R) VALUE
1, Interior air film
0.68
2
2. 11Z~Gyo
na
3.- j7uq
e
I
4 .-��/' •,CMZ
5.
5•Li. es -'s;
' &P
-4I'Z
6. Exterior air film
0.17
TOTAL (R)
G%, 41
FIG. #1 PLAN VIEW
"U"= 1/R= rpc�
1. Interior air film
0.68
2.
3
3. 5,/z G" �5/f az-•: •
. d v
- q
4,
4 . "/Z " 1-7e v 'aJ •
. G.�.
5. . 1. C/Ii?�?/2
/
6. Exterior air film
0.17
.'
TOTAL (R)
Z/, 73
FIG. #1 SECTION
"U"=I/R= ,C.q(
FIG. #1
Cori$. "U"=(.12 x .014 )+(.88
x ."46
1. Interior air film
0.68
_
F
2
2. 5 2-- F t g &L, i,a�'S,
11.00
3. zft R R- t M 7o tsr
i, 8
/.
4
4.
el -5
5. /Z.5. 460.41. S t o l e
"t
4-4
6. Exterior air film
0.17
TOTAL (R)
i
"U"= 1/R=
4
v J
1. Interior air film
0.68
Z'
2.
_ 3
3.
-,
q
4. is t0,VC, BLS
i_2$
s
S•
a 6,
6. Exterior air film
0.17
�!
TOTAL (R)
�, -3
FIG. #2 SECTION
"U"=1/R= ,Lf7
I.._
FIG. #3 SECTION
1. Interior air film 0.68
2.
3. Exterior air film 0.17
TOTAL (R)' d6
„Uri =1 %R= ,ley
• • WALL SECTION - yL PLY vj F 4(-E 6R) Lk
NOTE: USE 12% OF OPAQUE WALL AREA FOR
FRAME CONSTRUCTION CONSTRUCTION
FIG. #1 PLAN VIEW
FIG. # 1,4SECTION
a
a� J
4 A
7
FIG. #2 SECTION
_ P
r
d „
FIG. #3 SECTION
PAGE
(R) VALUE
1.
Interior air film
0.68
2.
yJ7�a 61P.
19,. 00
3.
yb+49-D
V' + F1,( S r9i Q
Is
4.
ny
2.
5.
F C Bkt{C,k
.38
.
Exterior air film
0.17__
TOTAL (R)
22.-13
"U"= 1/R= ,ID7
1.
Interior air film
0.68
2.
2 6 c-4kDyS
3.
- r! L (,v
q, oo
4.
_, . D�
5.
F AC E' QIdZ 144
6.
Exterior air film
0..17
.TOTAL (R)
21,'30
"U"=1/R= , cq 1
FIG. #1 44 wo
COMB. "=(.12 X , IC`1 )+(.88 X .Dc17 )_ •���
1.
Interior air film
0.68
2.
- P15, 4L. I :v5._ _
19,. 00
3.
2: " Flit R►M TOOT
Is
4.
F h tJ
b'2.
5.
F C Bkt{C,k
.38
6.
Exterior air film
0.17
TOTAL (R)
22.-13
"U'= 1/R= ,
1.
Interior air film
0.68
2.
3.
4 .
_, . D�
5.
F AC E' QIdZ 144
6.
Exterior air film
0.17
TOTAL (R)
7-34
"U"=1/R= 01
�-i7
5AME, P'S
2.� t v.-je,
(Ug,
1. Interior air film 0.68
2. Y' C��i�, #,tk, ,?/ .
3. Exterior air film 0.17
TOTAL (R) /. 4
"U" -1/R-,
.'a
FIG. #3 SECTION
1. Interior air film 0.68
3. Exterior air film 0.17
„ L' ll =i/R= TOTAL (R)
6�
k,4 i.' Det, ��•�r�LC
PAGE
e
. WALL SECTION - j 4v
NOTE: USE 12Z OF OPAQUE WALL AREA FOR
XZ" PLS � t Gy,� 8��
FRAME CONSTRUCTION
CONSTRUCTION
(R) VALUE
A
`--
1, Interior air film
0.68
Z
2 s �% a. 6A 4ey
3. 6" Fig S740
5
5. ' 631504A.D
6, Exterior air film
0.17
'
FIG.1$PLAN VIEW
TOTAL (R)
"U"=
1/R=
-!
1. Interior air film
0.68
2.
3. V� - Ft c,L$
j�l,00
_ , 4
4. Yz P611 "AJ62
5. 5IS' 611P. 0,4t -D
6. Exterior air film
0.17
'
TOTAL (R)
.2
FIG. #j1�SECTION
"U '=] /R=01/
FIG. #1
1
CO]4B. "U"=(.12 X'/07 )+(.88
X '(7q7
--
1. Interior 'air film
0.68
- _
?
2 Z
S pla !r(. wA '
►$.e0
3. f -I41 Tors-,
5
5. -13OAiep
.fib
-
---��
6. Exterior air film
0.17
TOTAL (R)
4 �
1. Interior air film
0.68
2.
2.
3
3.
a
.------ 3
5.
6. air film NTE74
6.
FIG. `i2 SECTION
"U" TOTAL (R)
Z,�r
-7=1/R=
.,
USE. .(41SA.'Ait *ST;2- tz" Lc'wc. CSLk,
FIG. #3 SECTION
1. Interior air film 0.68
3. Exterior air film 0.17
„ L' ll =i/R= TOTAL (R)
6�
41-
z.
2
-
-
� T �
`
,ra.` �, _' f�.�j
�y j�j /per �•
�L
ou
}ate 1� - ��
yv°! /V! L�'�✓ ��
--
.
�'� a, st �- •••�_. _
of
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_ f i
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09
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9.
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fx tg
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w
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-
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d
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. - r
•
au //������
WENT Sj• TOj i*%n
05
4 , f. '
rr4V.�Y. •a 7 115,
alij JIM +OTA"Ul .TICU
-
Pj
r- STT >.�1s `9
a�
✓'
�/ DCIV• ��"r;G'% ff WE
Fes: .•. _ .....'
_
-'
�
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,
�
-
" �'
�� j yy
� Y •i'4 -C'` L -3l'Z
�� 4A4 �_ �� ,fes F
� "'*•a/yea;...e. L. ry. _
_ µ�"M-ry1. Y'n� �T'e'S.'ty �-bR°'J Y'n � ' .b�._.5 �' �Y
ExPe,�D. rl. �✓�10'' Tel/ 7T5
am: ust 14 ilw _slpe, FP ' Ir -L: AFM FMr
F RAX9 CflB?AUKTSC�f Ct IC."1'L0y
v•
i
;C?ou1
"v"• 1%`x.073
PAGN
(R) VAIM
o.61
r'
00.P
/3. GS
1. Thterior air i'iyls
2.
4. 1*
P. dz -
C t //";? Y ',Al.
6. Rxteri.or air ri.ls ,
____ .&.e
TOM
R
14.3`5`
FTG. #!
VdaC7lrG"•(.10 X . OdJ +(.90 Z
1. Mxterior air ii3m61
2.
=
-
6• x7[teriOZ' air ti]a'
I
V �1�
1. Interior air fi3a
2.
6. or air fila
,....e...,.,..:.
�.• ::_ .
Fm.
7,11r
CITY OF FRIDLEY
APPLICATION FOR
POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION 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
7.00
$
$
Department of Buildings
Repairs & Alterations -up to $500.00
4.00
$
City of Fridley
Repairs & Alterations each add. $500.00
Tel. #571-3450
MECHANICAL WARM AIR:
The undersigned hereby makes application for a permit for the work herein
Furnace Shell & Duct Work to 100,000 BTU
$12.00
$
specified agreeing to do all work in strict accordance with the City C6des
each add. 50,000 BTU
4.00
$�
and rulings of the Department of Buildings, and hereby declares that all the
Replacement of Furnace
7.00
$
facts and representations stated in this application are true and correct.
Repairs & Alterations -up to $500.00
7.00
$
) �y
Repairs & Alterations each add. $500.00
4.00
$Fridley,
Minn.
STEAM OR HOT WATER SYSTEM:
OWNER
Boiler & Lines up to 100,000 BTU
$12.00
$
KIND OF BUILDI
each addn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7.00
$
USED AS
' each addn. 50,000 BTU
6.00
$
TO BE COMPLETED ABOUT
OIL BURNER- to 3. gal. per hour
$10.00
$
,^C/�
each add. 3 gal. per hour 10.00
GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00
$
$ el
ESTIMATED COST ® �
OLDNEW BUILD NG ERMIT NO. PERMIT NO.
(over 199,999 BTU see Fee Schedule)
$
GAS FITTING FEES:
1st 3 Fixtures x $ 3.00 $ .
Additional Fixtures x $ 1.00 $
Gas Range to 199,000 BTU x $10.00• $
AIR CONDITIONING� C, $
FAN HEATING SYSTEMS Be. Fee Sc edule
a 7
VENTILATING SYSTEMS $
ALTERATIONS $ REPAIRS $
State Surcharge $ .50
TOTAL FEE
RQUGH INSP.
Date
FINAL INSP.
Date /� ,Q
APPROVAL FOR PERMIT
REINSPECTION FEE
010.00)
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PIANTS, Steam,_Hot Water, arm Ai No. /
Trade Name Size No. r L/ / l
Capacity Sq. Ft. EDR BTU OAP
r ,
Total Connected Load 6, Kind of Fuel
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR B HP
Co
G ".'
+tv'•3j',�i�15> �%7Sf'�iVeSC.1Fa `.�.)-°e.'2 .»
Company C%
� F
Signed By -
Tel. No.
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures
Future Fixture Opening
New Fixture, Old Opening
Catch Basin
Water Heater - to 99,000 BTU
100,000 BTU to 199,000 BTU
Water Softener
New Ground Run Old Building
Electric Water Heater
GAS FITTING FEES:
let 3 fixtures
Additional Fixtures
Gas Range to 199,000 BTU
REPAIRS $ ALTERATIONS
First $100.00
each add. $100.00 or fraction
NO.
RATE
Ix
$3.00
x
$2.00
x
$2.00
x
$5.00
_ x
$5.00
m�
$10.00
Water
m
x
$5.00
1
$5.00
�'
rd
Q
(d $4
004
w
Heater
14
0
.°1i
L,
..,�4
Fe}
m
14
.S
-P4
M
ro
M
rl
ro
H o
, 4
b b
1y
8
lec
m
U
0
w
ai
m
'�
Q w
to
w
U ca
µry 3
(79
o
as
lst
2nd
3rd
4th
(R) = Future Connection Opening
Connected with Sewer i
(°*) = New Fixture, Old Opening
Water
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures
Future Fixture Opening
New Fixture, Old Opening
Catch Basin
Water Heater - to 99,000 BTU
100,000 BTU to 199,000 BTU
Water Softener
New Ground Run Old Building
Electric Water Heater
GAS FITTING FEES:
let 3 fixtures
Additional Fixtures
Gas Range to 199,000 BTU
REPAIRS $ ALTERATIONS
First $100.00
each add. $100.00 or fraction
NO.
RATE
Ix
$3.00
x
$2.00
x
$2.00
x
$5.00
_ x
$5.00
x
$10.00
x
$7.00
x
$5.00
x
$5.00
x '$3.00
x $1.00
x $10.00
$5.00
$2.00
State Surcharge
TOTAL FEE
REINSPECTION FEE
($10.00) .
TOTAL
$ ;:5-/
S
$ .50
Job Address -:5-1 56) �'^� /1)`t,s
Department of Buildings
City of Fridley
Tel. #571-3450
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 Department of Buildings, and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn.
OWNER L
KIND OF BUILDING
USED AS
TO BE COMPLETED ABOUT[
ESTIMATED COST /
OLD - NEW BUILDING PERM�73{AIT NO. PERMIT NO. /
-%
Company !° � ✓yam C �z
Signed '
Tel. No.
ROUGH INSP.
Date
FINAL INSP. 3-16 6 ` 7e
Date
APPROVAL FOR PERMIT dt 196,9
197?
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUS $.50 STATE SURCHARGE
City of Fridley4
SUBJECT
9 9
AT THE TOP OF THE TWINS
BUILDING
PERMIT
—23 - �'
Ir
RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV
_
r � � PROTECTIVE INSPECTION SEC
30
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/29/95
JOB ADDRESS 5530 Matterhorn Drive NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
11
4
Innsbruck North
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Eugene Zgutowicz 5530 Matterhorn Drive NE
571-4990
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
B DESCRIBE WORK
Construct a 12' x 18' Deck in Rear Yard
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
WARNER
Before digging call for
all utility locations
454-0002
REQUIRE® BYLAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
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
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
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
$1,760
.88
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$41.00
Fire SC $1.76
PLAN CHECK FEE
TOTAL FEE
RE- NTRACTORo rjT �R DAGENT (DATEi
WHEN ROPE PALIDATED THIS IS YOUR PERMIT
".MNSP
/�Q�
r awy, Z7/
DATEf
URE CIFOWNE OF OW RB t R)
NEW []
ADDN (]
ALTER (]
Construction Address
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 1 / 1 /95
�s3c,
Owner Name & Address:,: 416,g-niE a, / C-scr "T.J-0c1c e-- Tel_ # S 71 � .3 g � U
Contractor: -� 4,1 ,41 EC MN LICENSE #
Address: Z5 ,-7'I C Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length
X
Hgt/Ground
Sq. Ft.
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback
Type of Construction: CF- 6A P- f/-rkcff rc
Approx. Completion Date: -
Side Yard Setbacks l (®
Estimated Cost: $
(Cost on Back)
Driveway Curb Cut Width Needed: Ft.+ _ Ft = Ft x $ _ $
ATE: APPLICANT: , �--- Tel. #__571- `l 95 b
CITY USE ONLY
Permit Fee $ 00
Fire Surcharge $ .
State Surcharge $ `6
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $ q�,, L
STIPULATIONS:
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,00 Valuation
$850 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ I Not Necessary [ l
Land Planning1J� 1 f {� j� 6575 Highway No. 65 N.E.
Land Sur,rey•ng Minneopolis,
5oi15. Testing (') f �'Jl fir �C r 1� y � r ��• Minn. 55432
�� Telephone
C. Engineering 7B4-6QbE:
M.n:cbpai inyirb er.ny En-ineers & Surveyors Area code 612
Cert ificate of Survey for W/\Y\JC— t . 6&i2/l�',�K
or MDW , Do2S Not GOAL A
W H Saar
�ti1'fi a cn'r tiou, Arra EI�vATro -
9efoce di�in�LECTRIC -
� Etc. Accu�� or un>.� s ®I��r AND
TM1S DATA 1S f0 R qO von pa Q ppMAi10�1_
JEEP uSING
RE�VIRED
+jl e i:l oc K fi 6)
-
! L
1
,} �s l
t?�vrin s _ Si'SOw:rr CGre- a
Ossumed O ueno613 .il\)re TY1C,rWrel:tnC-
LOT Irl BLON INNSGRUCk NORTH -
ANO, v4k
OUWT`e
1 hereby certify that th.s is a true and correct represrnsotion of a sur.key of ih'c bounddries aE_thc above
described load, and of ehr location of ull bu.ld#nnst rjtercon. and oll �`ible encroachments, tf any, from or on
soid land As surveyed by 'rne th.s__duy of--- -/ Y`_A.0. 14_
SUBURBAN ENGINEERING, INC.
Scal e : .I -nch. 40 � eta . Ent�inrrrs _ Su;vsyor:
CI
-9
I�
Ujq.� S r d,4
CL
,H
t1 -
• 1
1I ►1 1
zx �'
_ 11
(l6•1 duh Cd
1 "em I
lZ46Z%.
1% lJ
SUBJECT
PERMIT NO.
City of Fridley
63
AT THE TOP OF THE TWINS
BUILDING
P E R M I T
r
COMMUNITY DEVELOPMENT DIV.
r V PROTECTIVE INSPECTION SEC.
sI®Z_
NUMBER
REV
DATEPAGE
OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
8/16/95
JOB ADDRESS 5530 Matterhorn Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
11
4
Innsbruck North
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Eugene Zgutowicz 5530 Matterhorn Drive NE
571-4990
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 Ek ADDITION p ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 12' x 10' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
Side yard variance approved 8/15/95. See notations on plan.
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
SQ. 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
] I
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
$978
$.50
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$25.00
Fire SC $.50
PLAN CHECK FEE
TOTALFEE
$26.00
oF NTRACT TH IZEDAGENT DATEIHEN
PFIOPERLYYALIDATED THIS IS YO R PERMIT
$,GT F OWI WNE BUILDER 1 AT ,1
BLD99 INSP
f)!TE
1% lJ
C2 . -,i, Mn i;s;�ic Z!�.1i. �. r.........n'i �"!c:.;::i:iC::i:K �w .www•. .r: w'.:tinw .:...... �. �....... .................
NEW [) Effective 8/1/95
ADDN [) CITY OF FRIDLEY 31 d
ALTER SINGLE FAMILY AND DUPLEXES R -I AND R-2
Building Permit Application
Construction Address: S S 3n - /y1 A z ri }a tfo RAJ Nem. iy. C - ER IEV,SsY 3 Z _
Legal Description: L. o r t l 8 In, k q Sn4.vsS& u ck AL0P- r H —
Owner Name & Address: E u c£,., c J . Z C� u ro CZrC_z - S141 -AA Tel. #_
Contractor: Ss t F _ MN LICENSE #.
Address:
Attach to this application-, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
s71-4940
LIVING AREA". Length Width .Height Sq: 'Ft:
A
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length 1 Z Width t o Hgt/Ground 3o,N Sq. Ft. I7 -a
OTHER: -
Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: C em K Estimated Cost: $ /2
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x = $
DATE: APPLICANT: Tel. # S 71- y 9 9 p
CITY USE ONLY
Permit Fee $ r �Fj `'t) Fee Schedule on Reverse Side
Fire Surcharge $ , j7J .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $850 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.0 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS:
4 ortn 1. A,
�i
mk - Pix ix
C..A Pry
r �l
'WN A - 3
1✓�9aComr j
N,wJ-4
CIN OF FRIDLEY INSPECTION DIV. Effective On March 1, 1996
6431 University Ave NE �r
Fridley, MN 554432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VERTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES .
JOB ADDRESS 5530 —p'-7
.RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential, Rate TOTAL specified agreeing to do all work in strict accordance witli the City Codes and
Furnace Shell and Duct Work; Burner — rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00 $ o'.o representations stated in this application are true and correct, _
(Side Vent — Fill Out Back) ,
Gas. Piping' (Needed with new furnace) $ 10.00 $ l o'to o 1996
OWNER
Gas Range $ 10.00 $ v0
BUILDING USED AS
Gas Dryer $10.00 $
*Air Conditioning —All Sizes $ 25.00 $ ESTIMATED COST Say r-, oo PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work $ No, of Heating Units— Circle One (Steam) (Hot Water) arm AI
Trade Name,,,,,d-- Size No. 35,=Commercial/Industrial BTU ®o®o HP EDR
1.25% of Value of Appliance or Work $ Fuel'_Total Connected Load
State Surcharge ,50 Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE L10, 5b
6-rNom KAM ASD MR cowmn c— ct.
41oruaaTR
HEATING COMPANY 1ffZ6JUW9, MN as
MINIwY .
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed ByTel No.
PLUS THE $:50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved ByRough—In Date Final Date
"Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FO. STACK VERIFICATION ON
written permission from adjoining property owner. REPLACEMENT URNA E
w �N
M
Remarks:
List ALTERATIONS Being Done:
HEATING. CO:
Signed By:
Date:
CHMINEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or
stack:
1.
Has been carefully examined
Yes (_)
No ( )
2.
Is free I from rust or deterioration
Yes*
O No ( )
3.
Has no foreign objects lodged within
Yes ()
No ( )
A.
Is securely supported
Yes
O No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes
O No ( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes ()
No ( )
8.
Has combustion air been provided for water heater
Yes ()
No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING. CO:
Signed By:
Date:
CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1997
6431 University Ave NE
Fridley, MN 55432 `,, " APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
572-3604 1
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES: NO. RATE TOTAL
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance
$10.00
Water Heater -Electric
$ 7.00
Water Heater - Gas** ^�
$10.00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
Type
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ rye .50
TOTAL FEE $ 40- d
JOB ADDRESS 45-25-.3 D
—I--r—
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.
OwnerC��� o�/Z`� ��f�1 �� f.�J� �' !3
Building Used As
Estimated Costl.) F] PERMIT NO. !/c�
PLUMBIN� COMPANY /5_Q/ �d
1
SIGNED B c TEL N0.
Approve By Rough -In Date Final Date;5
llMINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00
PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SO INCHES.
SU9jEtT
PE
City of Fridley
3 0312
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
NO.
16
• COMMUNITY DEVELOPMENT DIV.
SEC.
r PROTECTIVE INSPECTION
F 1
REV
DATE
PAGE OF
APPROVED BY
01r"''*: CITY HALL FRIDLEY 55431
L 612-571-3450
[NUMBER
910415
9/29/99
JOB ADDRESS 5530 Matterhorn Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
4
Innsbruck North
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Gene Zgutowicz
571-4990
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Christians Inc. 1480 Park Rd. Chanhassen 55317
470-2001 3712
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 Ex REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (29 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 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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
$1.27
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
2535
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.
$$3.25
Fre SC $2.54
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
T,OT/AL FEE
Llcens $5.
92.06
SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT IDATEI
EN PR
VA D THIS I U PR,6PS IT
r
S,GNATURE OF OWNER,IF OWNER BUILDERI [DATE,
--TLTG 'N00'MATE
NEW [ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
1
Construction Address: SS 30 Mft7[-�-7-F ftoAv %fig I UJS� A/E
Legal Description: AV
''ll
Owner Name & Address: �9utor�ie—z 5s60 1`�V' Tel. # (6fy 57/- "170
Contractor: L'.�i�77i/lis / /V' MN LICENSE # 3-7IL-2"
Address: 1 VOO P/W, AD 'Z;5 -3./ 7Tel. # (wd - -V -v -R6151/
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:
wry )% G ( s
Construction Type: /" Estnnatf
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE:q 14 q1 APPLICANT:
Permit Fee
$ _ 2-5-
Fee Schedule on Reverse
Fire Surcharge
$ a- -S
.001 of Permit Valuatio
State Surcharge
$ %
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$ -5-,00
$5.00 (State Licensed Re
Driveway Escrow
$
Alt. "A" or Alt. "B" Abo
Erosion Control
$
$450.00 Conservation Pla
Park Fee
$
Fee Determined by Engin
Sewer Main Charge
$
Agreement Necessary [ ]
TOTAL $ 7J,06
STIPULATIONS:
Cost: $
Tel. #
(1/10th%)
Contractors)
Review
Not Necessary [ ]
CITY OF FRIDLEY PERMIT NO( 2004-01096
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 07/13/2004
572-3604 FAX: (763)571-1287
ADDRESS : 5530 MATTERHORN DR NE
PIN : 243024420049
LEGAL DESC : INNSBRUCK NORTH
: LOT 11 BLOCK 4
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : WINDOW/DOOR REPL
VALUATION : $ 13,994.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317
OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS.
REPLACE 8 WINDOWS WITHIN EXISTING OPENINGS.
STATE LICENSED CONTRACTOR 1
APPLICANT
RENEWAL BY ANDERSEN (20130983)
1920 W CO RD C
ROSEVILLE, MN 55113-
(763)502-4777
OWNER
ZGUTOWICZ EUGENE & MAUREEN
5530 MATTERHORN DR NE
FRIDLEY, MN 55432
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 worl
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 coipstruction or the performance of construction.
Bldg Insp �•_j DatePL
BUILDING PERMIT FEE 237.25
FIRE SURCHARGE 13.99
STATE SURCHARGE, VALUE 7.00
LICENSE SURCHARGE 5.00
TOTAL 263.24
PAID WITH CHECK # 36158
MA
eo�ie a�iad or
Jr rtlr.ZA I ri r-r'fuV111 J ' r-yU 1Wj ' 1J r uw W ur-m v 1 rlrill 1 i1t11V LL1Jl.111D1_.L t1D V Y Ll.
04/02/2004 FRI 13:21 FAX ELDER JONES 2-*.+ 3W 10 X1001/001
COL
NEW [ ] CITY OF FRIDLEY Effective 4/1/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
(763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: 553
Legal Description:
Owner Name & Address: Tel. # -3" 57 r-4996
Contractor. MN LICENSE# 201W933
Address: RENEWAL BY ANDERSEN Tel. # (ns -
1920 COUNTY ROAD C WEST
ROSEVILLE, MN 55113 !cats of survey of the
i 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 HgUGmund Sq. Ft.
OTHER: U i l 1^CIO r
Construction Type: Estimated Cost S
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x
DATE: UA APPLICANT.- r� � � Tel. # � �'3�`k��'
Call (763) 672-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 N using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CrrY USE ONLY -
$ '• �� Fee Schedule on Reverse Side
65% of Permit Fee
$_ 1•� .001 of Permit Valuation (1110th0/6)
$ '$.50/$1,000 Valuation
$ $1350 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ ' Q I STIPULATIONS-
. .. V
Building
$ 139 . a t
BUILDING
Plan Review
Permit No.:
Inspections
Fire Surcharge
RESIDENTIAL APPLICATION
.001 times the total job valuation
���,I
Received By:
763-572-3604
.0005 x Permit Valuation Minimum $.50
CITY OF FRIDLEY
_$ S. 00
DatR*D
DATE 19 R U� O 9)
YOUR E-MAIL ADDRESS 1X.*J5QV\CLa6) epi
D Cnw�
SITE ADDRESS 5553a
TY\Gi.}}-el(r\o C b (io-e..
ft + 6 ft = ft x $21 =$
THIS APPLICANT IS:
❑ OWNER ,CONTRACTOR
$450 Conservation Plan Review
PROPERTY OWNER/
NAME: (Y\OI.0 r4- -C. _& q LA -ow i G -a
Fee Determined by Engineering
TENANT
ADDRESS: -111, u CITY
STATE ZIP
Total Due
PHONE: -R0 ,3 1 — Logo
NAME:
Renewal By Andersen
Make checks payable to: City of Fridley_ _ Attach Stipulations
CONTRACTOR
SUBMIT A COPY OF
STATE LICENSE #_ 1920 County Road "C" West
YOUR STATE LICENSE
ADDRESS: Roseville, NIN 55113 r
STATE ZIP
WITH APPLICATION
PHONE License #20130983
❑ SINGLE FAMILY/N0
PROPERTY TYPE
❑ TWO FAMILY/NEW C 651-264-4.7.77
❑ ADDITION ❑ GARAGE/SHED -B WINDOWS
PERMIT TYPE
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
INTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: R-e.D LQ G -C ti W i to cA o S w 1; el _t,%,;
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE BASEMENT
REMODELING SiRMIT
GARAGES
❑ ATTACHED GARAGE I.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE 2•
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
❑ Vinyl
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑Soffit
13 Aluminum
❑ Other
13 Trim A_DDiTInNc
1.
&PORCHES Ci TRI1APr•
Site Plan/Survey showing the existing structure
❑ 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
MUJU r zr a MUM aAar.L Ulr VALUAI'IUN, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1907 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S (s, o') $) 090rCI IPANVV TV IV
Permit Fee
$ 139 . a t
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ G''39
.001 times the total job valuation
Surcharge
$ �; , 1 q
.0005 x Permit Valuation Minimum $.50
License Surcharge
_$ S. 00
$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
$ 5
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 i
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 application for 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 w1#h requir=eviewdapproval of plans. Aux -408 c�
SIGNATURE OF APPLICANT �D PRINT NAME __ ��cAnSgr r ' DATE / �O U
A