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PRE 2010 DOCSCity of r,Id$y Permit No. / eFr AT TH2 TOP TWI i PL_UM13ITN PERMIT APPLICATION b -------i COMMUNITY OEVELGm'-JEWT ®°V. �,.... CITY WALL. F€°!GL4V 0"R Itll 3CcD9 REV. DATE PAGE OF APPROVED 0Y .� j 04.1, 609-3900 _210 -F 1 A. 0 Z /15 73 1 1 800 Job Address - _ y/- ner e'td I as k if Ad dress Phone Contractor A res�$ Phone �. _ fM C� `�U G �, ( '' 6 ' Kind of Bukldii Use Completion Date TStl.mate .,ost r — q I s !y Plumbing Fixtu_re_pkates 6 NNO. RATE TOTAL �� � • � � ! j Number Fixtures /.3 x $2.00 $ a2(p •0 � � Future Fixtures x$1.50 BON tla� stl�� ( i j New Fixture -Old Open. x $1,50 •,ddtl� ! I I ® Catch Basin x $3.25 I 1 j Water Heater -999000 BTU / x $3.00 3-U® Ground Run Old Bldg. x $3.25 'MNltla� = Elec. Water Neater x $2.00 SNISVS M w HD1V�I � � I ! O _ I ^.0 Gas Fitting Fees c C a°°�j o. 1st 3 Fixtures / x $2.00 a-00 iz a Sa3MOH$I i—� I I t ' Addi, ioz.al Fi�:tures x $ .75 a a� 1Nnod 5+1.1:1.,a� I I iy! Gas Range -199,000 BTU x $5.00 r.HSVM siva I o o Re airs & Alterations .�._ ' 'Q Ei I I I Oa I See �NN�sI I I U Description: Code sNisve� I I i I � State Surcharge .50 TOTAL FEE $ H1V9 ! The undersigned hereby makes application for a permit for the woa-k herein specified, agreeing to do all work S13SC>,� g in strict accordance with the City Ordinances and ruling 631VPA, � � I � U of the Department of Buildings, and hereby declare that — — all the facts and representations stated in this 8Iapplication are true and correct. -Signa - re 6 Date i SUBJECT 'PERMIT.NO City of Fridley 12335 AT THE TOP OF THE TWINS BUILDING PERMIT RE IPT O. U. -_ COMMUNITY DEVELOPMENT DIV. /_ Q o r PROTECTIVE INSPECTION SEC. 02� ' {d CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ---- �`� 612-560-3450 910-F15 9/28/73 JOB ADDRESS 5590 Matterhorn Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 4 1 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Dennis Ulmer 607 South 20th, 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Ulmer Construction Inc. 103 East Golden Lake 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 X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 48' x 27' Dwelling and a 22' x 22' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide.a ,verifying survey before capping. SEWER LOCATION: $S 182' North zli of Sanitary Manhole WATER LOCATION: 192' North of Sanitary Manhole SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I STALLS I 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 $24,974 12.49 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- OF CONSTRUCTION. $70.00 $275.00 STRUCTION OR THE PERFORMANCE PLAN CHECK FEE TOT EE Z4 35 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI HE ROPERLY VALIDATED TH4 It R P MI J SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) BLDG -/NSP DATE APPLICATION FOR RLiSIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT C i TY OF 1-1:1 DLLY , MINNESOTA - � A," OWNER IS NAME:1 �4_ BUILDER: ADDRESS . G07 �v(/, o� ADDRESS: LOT: a BLOCK; L ADDITION: CORNER LOT: INSIDE LOT: SETBACK:SIDEYAFD: Applicant attach to this form Two Certificates of Survey of Lot and proposed buildirig location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: (, 9_a e— Front: Q Depth Height: Ct Square Feet: Cubic Feet: _ Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: $ To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that ;11 the facts and representations stated in this application are true and correct. DATE: / �O 3 SIC;NATURE: L,� (See Reverse Side For Additional Information.) .3 6875 Highway No. 65 N. E. �.Lnad Planning ���oi�"rf`�"1W)4o"Ifyinee"a617f �9 YLand Surveying (1 Minneapolls, %Z(+.. Minn. 55431 CIO,( inginooring Telephone 784-6064 Municipal Hnaiwteering Engineers & Surveyors Area Code 612 Certificate of Survey for ULM(-:R CONST NORTM 124,9 4 C� 10 � 10 17.67 1 S I _ ZT d N I® Y , of \ 4. N I �_- 00 ' - . 3.y � CY r N r I J 35 35.67 10 10Ir ' ' 124.34- } ,) _ :- _ - ` Denotes Dmino$e U hili}y Ea -,err -Q4 " F Ozarfhts, shown are alssurned 0 Deno+es iron monumeni (00 to Coni}rurfiotl 10i C(XYI 6 pal "I bit ni LOT 8 INNSSR ucu NOM ANoKA CouwTy I heroby certify thof this is a true and correct representation of a survey of the boundaries of the above dowiired land, and of the location of all buildings, thereon, and all visible encroochmonts, if any, from or on �sald iaAd: As surveyed by the this day of M A.D. 19L1• ' I a1� SUBURBAN BNGINE"ING, INC. /� /�!! Engineer Su v Ors • CQ Q rO% W - -z- _ bY4 +'OVANNO 4 Appftpm-ft? Power, � goa ° ®a 801'4 � Afr ae*ra Sync= md Devicm GRAVITY WARM SIR: RATZ, TOTAL Furnace Shell & Duct Work .. ..... .. $10.00 $ Replacement of Furnace 6.00 ��— Repairs & Alterations—up to $500.00 g O0 $ Repairs & AlteraUons each add. $300.00 3 00 $ 199A2L WARS Furnace Shell & Duct Work to 120,000 BTU each add. 60,000 BTU . ......... Replacement of Furnace Repairs & Alterations—up to $540.00 Repairs & Alterations each add. $300.00 STEAM or HOT WATER SYSTEM ..S10.00 $ 3.00 i 6.00 $ 6.00 $ 3.00 $ v Furnace Shell & Lines—to 400 sq. ft. F.DR Steam $10.00 $ 00 Furnace Shell & Line to 640 sq. ft. EDR Hot Water 10.00 $. Each add. 200 sq. ft. EDR Steam Each add. 320 sq. ft. EDR Hot Water 3.00 $ OIL BURNER—to 3 gaL per hour 6.00 $ over 3 gal. per hour—See Fee Schedule j/GAS BURNER (.up to 199jM B7.'U} &00 U ever 193,000 UM So* Fere Schedule GAS FITTING FEES. No RATE TOTAL 1st 3 Fixtures �— xS 20p S -- Additional Additional Fixtures x .78 $__ _ Gas Range to 199,0ft s3 &W g "sir d � Ihi sr: sk �S .ifart //-a®--26 State Surcharge .50 &W Fee schodMID TOT= s= Dept. of Bldgs. Phom CO - City of Fridley: The undersigned hereby makes application for a permit for the work here€r-. specified, agreeing to .do all work in strict accordance with the City Ordinancer- and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. �L Fridley. Minn Kind of Building Used as To be completed about, 6� - Estimated Cost, $ / Old—New. Building Permit No. _—_ Permit No. HEATING or POWER PLANTS --Steam, Ffot� Weer. Warm Air—No Trade Name Size No Capacity—__. _— Sq. Ft. &D.R BTU XJ11 Total Connected Lead _ 81vd of glint BURNER -- Trade Name_ Size Ale Capacity° Si. 1$'t. ZD -R B'1RT ffidla (WAAM95-6m) A/ / 1 9 W. audnan Z ZnL ��3_�� � Y '�_ �,s a _rvy �nxvy�.r..t �,.«y • e 1-.a•w,... � ..,-..,.....x . -. V; O MY OF htICAT10N FOR FOOD PLANTS ANO NEATING.�EMING. VENTILATION, QEFRIGERAT19N AMD• ,. AIR CONDITIONING SYSTEMS AND DEVICES WE . EA.R .1 FAL Job Address 5590 Matterhorn Drive SLS ISL �'— Furnace Shell and octet Mork. f 20.00 S__ Departaent s of building6471 university Are. M.E.. Fridley. W SS432 ep Burner Woo rlecs- t furnaw) city of Fridley Gas Piping S 10.00 $ Tel. 1%71-7450 f?1009.naedtl with saw in The -if rsigned hereby waked application for a peroit for the work heroin G" linagef 10.00 $�� v-aclares ltth um cit` Codes specifiedegreeinq to as all wort in strict accordance - : 10.00 f�� and rullwgs of the oapareaswt of buildings. and here" Gain OrTer facts and represewtatiee.e stated is this application am ten and eosceet. April 21 is 88 a Air Oditioning fall sisea) i 10.00 f 10.00 om Fridley. olnr+. - Nazfen & Kathy Swendsen Ail others/Aspairs and Alteration OWNERSteve It of Val" of Appliaaee or Mork S Frame RIND or BUILDIMG Residential . [0!ltDICIAL/IMDUSTRIAL USED AS 1f of Value of Appliance or Work S To BE COMPLETED Asan $4500.00 ESTIMATED COST State Surcharge PERMIT woo. BUILDING PEIMIT ID. S 10.50 OLD - NEW TOTAL !LE Rsisspection Fee (S1S.00) 9-- DfacuPrsa or yDR1ACL/WRRIt IMF0 **Installing one (1) Carrier suTlsc or POWER MAMe Mises. Not Wetsr, wee Air- w. Date 38ES030 21-2 ton air conditioner (ATTIC AIR) Final imp. "%�-'oP Trade name Miss M. /Til ate Capacity Sq. Fe, fDR �� �— Total Connected lead Rind of Frei Approval for Permit MININLNW FEE FOR ANY HEATING 1PEN41T IS $10.00 PWS $. SO STATE SURCHARGE Attack stack verifiestion gots with replacement furnace remits •Air Conditioners can not bw plaeed in side yard wiUMUL written rr mission Iran adjoining 0019mor. Bulmit • Trade same Mi ss no. CApacity sq. Ft. an BTU co.yanr Dependable Heating and' A/C signed by Tel. no. 757-5040 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT w U 0 is ui � c -.ci o w 3m N �p' O w a�I al u r� +�paq+ ��1 aqi, 3 w c3 w il v S 0 Water Heater as lec let 2nd 3rd 4th (R) - Future Connection Opening (•) - New Fixture, Old Opening Connected with Sewer Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser S 4.00 S Blow Oft Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve S 5.00 $ Sump or Receiving Tank S 5.00 $ Water Treating Appliance $ 7.00 $ Hot Watqr Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ S.00 S ALL OTHMtS AND/OR REPAIRS AND ALTERATIONS 1t of Value of Fixture or Appliance $ Reinspection Pete $ State Surcharge & .50 ($15.00) TOTAL FEE $� Effective. Date May 1. 1988 Job Address 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 th lication are true and correct �Fridley, Mn .�/ , 19 919 OWNER KIND OF BUILDING USED AS TO BE COMPLETED i ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Glp e company 17 Clc Signed By �/ �f ` Tel. No. / O 00 ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT( N HINIHUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SUBJECT PERMIT NO. City of Fridley 2 2 4'9 2 AT THE TOP OF THE TWINS BUILDING PERMIT r COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. NUMBER REV. DATE 5/10/94 PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 �'--' "'' 612-571-3450 910-F15 JOB ADDRESS 5590 MATTERHORN DR NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 4 Innsbruck North Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Stephen Nazian 5590 Matterhorn Dr NE 572-1157 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. A-1 Handyman 13875 Ind. Park Blvd 4100, Plymouth, MN 553-9369 5876 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 C� REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (24 Squares) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,320 .66 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- Fire SC $1.32 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $33.00 PLAN CHECK FEE TOTALFEE License SC $5.00 39 8 WHEN P RLY VALIDATED THIS IS YOUR PERMIT SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) BLDG I DATE SIGNATURE OF OWNER 0F OWNER BUILDERI IDATEI NEW ADDN CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Shc v f�e��YVI �� /V �• l r L� 1 Effective 1/ 1/94 Legal Description: _ Owner Name & Address: r. [VkzzC& v\ Tel. # 5-7 1/ 5- 7 Contractor: A - I me . v-, MN LICENSE # SSs 7 6 Address: t 3S q �_ „ I;J- a.(k 6W . S"i �t 1a) PlY r%%h 7/`/ t Tel. #"; 5 3 -13 6 9 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: f -v D -r l�-� C� x(. 2 o La i,e Y� Corner Lot [ ] Insid� Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: -5}-„,%e S Estimated Cost: $ ` ! Z -C C -,O Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = t x $ = $ DATE: t APPLICANT: Tel. #� �� 3 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 3.3, co $ CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $800 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 [ ) land Plarni� 6875-M KS Al. Lax/SWVgilY Mimm"fi3 . SoilsTrsmy ENGINEERING, INC. "int° Civil bMre*001 mlimt4-60" i E % En yineers Surveyors — .Mortgage Loam Survey for UUAGQ CONc-T- 10 % a, +1 ! io 0 � r f0 �10 s x r N # �+ U 33 17.3 2,0 10 �o — X24 9¢ — v.►2o �s 7v4, r,u9e. � um. Lo-, 8 IB(-OcK INNc.BqUCK NOi:2 7H A1,10" This a a fru wd cared .eprrsmfafian aC'° sVrrey e`f1Ae bayndories ar('flie /mid above dtui rbed on�d q( !ot°fia� �01/6r�i/�inys. i,(�avy, fbrr�►in, and ail risible .mcrvn�ll�irnfs. �an, y, �ri ar an �lca7d. 7hnsutatJ a a►todo arr/y n urwnrci�ar� mtb a marfy� !an new ar the proprrfy�. and � lrahi/rfy n arsuned !b 11a o`wrfi mns�ye ar ollxr �haf ar�t�d y th ra�sar, g�' wrli maryt� f/s �d end aarcrd nnm+arnr�irnts /nr� imi �ee �cr � �rrpare �'a�lrs� /af tvxs aba�ay comas. pow this �. .' nor . SUBURBAN EN61NEEPING, INC. 6ymerrs and Sur 19 y SUBJECT P City of Fridley 29320 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO.p� COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. � v � !J L1 = �� " �'� CITY HALL FRIDLEY 55432 NUMBER REv GATE PAGE OF APPROVED BY •__-� l 612-571-3450 910-F15 4/28/99 JOB ADDRESS 5590 Matterhorn Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 4 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Steven Nazian/Kathy Swenson 5590 Matterhorn Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Trehus Builders 4937 28 Ave S, Mpls., MN 55417 729-2992 1474 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 Cj ADDITION O ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 26'2" x 14' Addition and a 20' x 12' Deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. WARMN6 Before digging tell for all utility ImZfo 454-W02 REQUIRED BY LAW SEPARATE PERMITS ARE REOUIRED 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 I HEREBY CERTIFY THAT 1 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $47,792 $23.90 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVJMNS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $556.75 Fire SC $47.79 S CT R T ERf A E Of NSTRUCTION PLAN CHECK FEE TOTAL F License SC $5.0 $6 .44 S�GN4 TUBE OF CON•RACTOR OR AUT ORi2E0 AGENT iDATEi HE PROP VALIDAT IS IS YOU PERMIT B OG iNSP DATt S.GNATURE OF OWNE R,6 OWNER BWLDERI iDATE. NEW I ] CITY OF FRIDLEY ADDN I J ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress : Legal Description: Tel. # Owner Name & Address: Contractor: �-� L-�-{-� � I � v � �� MN LICENSE Address: 2, �3 18 r -k Attach to this application, a Certificate of Survey o the lot, with the proposed construction drawn on it to scale. 7, DESCRIPTION OF IMPROVEMENT Ft. 2 � Length Width �� Height Sq•�� LIVING . GARAGE AREA: Length Width Height 5q. Ft. DECK AREA: Length �?� Width I Hgt/Ground /�'_' Sq. Ft: 5/)— 2 � OTHER: Estimated Cost: $ �� 000— . � Construction Type: 2 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: (o?- APPLICANT: Tel. # 72q^Z Permit Fee Fire Surcharge State Surcharge SAC Charge' License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge `TOTAL` STIPULATIONS: $ s3, CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 [ ] TREHUS BUILDERS 612 729 3982 P.01 MNcheck COMPLIANCE REPORT Minnesota Energy Code MNcheck Software Version 3.0 Permit # I Checked by/Date I COUNTY: Anoka STATE: Minnesota ZONE: 2 CONSTRUCTION TYPE: Single Family DATE: 4-20-1999 DATE OF PLANS: 4-15-99 TITLE: Addition PROJECT INFORMATION: Nazian / Swenson Residence 5590 Matterhom Drive N.E. Fridley MN COMPANY INFORMATION: TreHus Builders Inc. 4937 28TH Avenue So. COMPLIANCE: PASSES Post -its Fax Note COMPANY 7671oate¢•Z6-T ve¢�► To M %N From• coloopt. I� co. Phone 4 2� O Phona k 7z-?— vt-q FaxR 5`21 / L57 Fax# Z 13110z— 110Z Required UA = 108 Your Home = 83 22.9% Better Than Code Area or Cavity Cont. Glazing/Door Perimeter R Value R -Value U -Value UA - _ CEILINGS 364 44.0 0.0 10 WALLS: Wood Frame, 16" O.C. 624 19.0 4.0 32 WALLS: Concrete, Interior Insulation 208 11.0 0.0 20 GLAZING: Windows or Doors, Above Grade 43 0.360 15 DOORS 17 0.350 6 COMPLIANCE STATEMENT: The proposed building design described here is consistent with the building plans, specifications, and other calculations submitted with the permit application. The proposed building has been designed to meet the requirements of the innesota Energy Code. Builder/Designer�W_X�G Date 4--2 0— CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On May 10, 1999 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Stories :.:: ,:,,. �I�.:,. Urinal �:r:.. Shower Wash i��.;:.:.:<:: Tray 1.:�:#�C:<:::�:::::. :. :�?tit.:<,.:«.:.. r Drain �` ?��''.:. >:�i��<.. A <� Gas ...�I�.......... Washer �'. � Range �� Water :•.�<'':�.� t Heater � Gas EI ec aseme t Basement :. Floor 1 Floor 2 ;: Floor I Floor 4 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** NO. RATE TOTAL -3- 3 3 Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 Type $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $ 3,3.521 JOB ADDRESS 5-57_` -D 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. .1999 Owner Building Used As D, ' / C-0 [ 0 Estimated Cost 7 '�_p � PERMIT NO. /"?J C�';' PLUMBING COMPANY Z /rt rcls SIGNE TEL N0. 60'/ 7 7 3 S? Y o t Approved By // Rough -In Date Final **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. i _EY INSPECTION DIVISION ty Ave NE Effective On May 10, 1999 5432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES m JOB ADDRESS_ -5 p Mgt II`DYYI S/r'. �yic� �, ATE�SC_HiED_ ULE !11 xxII OWNS e'l /Y�ICn r `v�{ n efl��fa a�%2 Q Rate TOTAL �s l 1 and Duct Work, Burner - BUILDING USED AS R� 5ALY, l 4 a) ' nent Furnace $ 30.00 $ • OB mt • Fill Out Back ��,,@@ ��-- ' ESTIMATED COST�`�� PERMIT NO., ' seeded with new furnace, $ 10.00 $ � Y � til at not replacement) D SCRIPT-1—ON OF FURNACE AND OR BURNER $ 10.00 $ ; No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) o $ 10.00 $ Trade Name Size No. ~ Ing • AI! Sizes BTU HP EDR $ 25.00 $ Fuel Total Connected Load ; pairs & Alterations (LIST ON BACK ; ) Burner Trade Name Size No. , of Appliance or Work $ BTU HP EDR w idcrsirial ; J a ie o Appliance or Work$ 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 LL LL, Surcharge $ 50 rulings of the Building Division, and hereby declares that all the facts and; ; O representations stated in this application are TOTAL FEE -true and correct. $�� y FORA Y EATING/ LING/VENT HEATING CO S AI NDITIOAIR IT I 25.11.0s ATE SURCH RG Signed-&O/'o /tL, DATE qb4� FEE $47.00/Hr 's can no 2 be placed in a side yard without Approved ByRough•In Date Final Date ion from adjoining property owner. 4 FILL QUIAC E FO IC BIER IC TIQN ON R LAC; EM-EN1 FURNA 0 z i Z C M 0 3 M 0 c En D M P.®1 VO°d 10101 , CMMM AND STACK VERS CATION The undersigned hereby verifies that the existing chimney or stack: L Has been carefully examined Yes () No { ) 2. Is free from rust or deterioration Yes {) No { ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size aiad total BTU's connected Yes () No ( ) 6 Has total heating BTU's of 31 DOO. Cb'Z y HFqr`1?a rA -q°®v- ��' eY+-y All other BTU's TOTAL BTU's :1 7. Has a liner been provided for water heater Yes( No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks: 15 I 5 A -'tVCc9A-77111 :F\ WLn GF �' a C eco,e ire -+ yep I +-ky ?'f" List A.I,TTMLTIONS Being Done: HEATING CO: Signed By: Date: CITY OF FRIDLEY INSPECTION DIViSION 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, 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 $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 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. Effective On May 10, 1999 JOB ADDRESS57 ,�9t� M�WdW D/Ps OWNER I_slywk6wol TOTAL BUILDING USED AS��i9 ESTIMATED COST � �� PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Unitsj2&i Circle One (Steam) � (Warm Air) $ Trade Name Size No. BTU HP EDR $ Fuel Total Connected Load Burner Trade Name Size No. $_.:35_A90 BTU HP EDR $ 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 correct. HEATING CO ,. f -* Al¢©, Rough -In Date Final Date 6 Has total heating BTU's of All other BTU's P TOTAL BTU's 7. Has a liner been provided for water heater Yes (e) No ( ) S. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: L Has been carefully examined Yes No ( ) 2. Is free from rust or deterioration Yes No ( ) 3. Has no foreign objects lodged within Yes No ( ) 4. Is securely supported Yes (P) No ( ) S. Meets all current Code requirements for size and total BTU's connected Yes (0 No ( ) 6 Has total heating BTU's of All other BTU's P TOTAL BTU's 7. Has a liner been provided for water heater Yes (e) No ( ) S. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: SUBJEci PER City of Fridley 27 0 AT THE TOP OF THE TWINS BUILDING PERMIT ` COMMUNITY DEVELOPMENT DIV. RE N r PROTECTIVE INSPECTION SEC. NUMBER REV GATE 7/9/02 PAGE OF APPROVED BY l 1 �•"1 CITY HALL FRIDLEY 55432 �•� L.__.�% 612-571-3450 910-F15 % JOB ADDRESS 5590 Matterhorn Dr NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 8 4 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Steve Nazian/Kathy Swendsen, 5590 Matterhorn Dr, Fridley, MN 55432 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Trehus Builders, 3017 4th Ave S, Minneapolis, MN 55408 612-729-2992 1474 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO, 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO Residential 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW 0 ADDITION Ck ALTERATION ❑ REPAIR ❑ MOVE - ❑ REMOVE B DESCRIBE WORK Remodel existing kitchen. 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plans. SEPARATE PERMITS REQUIRED FOR: HEATING �MBING TYPE OFCONST. 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 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 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 $46 000.00 W $23.00 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 PR SOF ANY OTHE ATE OR LOCAL LAW REGULATING CON- $603.35 46.00 Fire SCS UC R PERF OF NSTRUCTION • 7-0 —� PLAN ;CHECK TOTAL FEE lise 5.00 $IW7.35 SIGNATURE OF CONTRACTOR OR AUTMOR4Ep AGENT iDATEi HE PR VALIDA 0 THIS IS YOUR PERMIT _ _e*_ S-GNATURE OF OWNER,1F OWNER BUILOERii0ATE �, OG iN5 - DATE NEW [ ] CITY OF FRIDLEY Effective 111/2002 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg�lnsp ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION U Construction Address: Legal Description: Owner Name & Address: ST�Ie &A Tel. # Contractor, s D.,. 90 a MN LICENSE # 13C, - ! 4.7 4 - Address: -3-0172 4--''* A-✓-kv- 5 o 71-?Edus ce'4o,-2s Aad - Tel. # p/dI5 6�ViO5 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: 9ja-k o k- to hw, -- t-, r S Q. F T6 _ Construction Type: ion Estimated Cost: $ O 0 0 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: Co -Z,1- 07- APPLICANT: Tel. # (� /Z 7 L? -L? 9 t Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY- NLY-Permit PermitFee $ Fee Schedule on Reverse Side Fire Surcharge $ p 00 .001 of Permit Valuation (1/10th%) State Surcharge $ ems: , (DO $.50/$1,000 Valuation SAC Charge $ $1200 per SAC Unit License Surcharge $ prod $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 $ 1212. 35 STIPULATIONS: Gil Y OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 (/rl/SG. -f-/X'f- PLUMBING FIXTURE RATES: APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Wash >>»= Floor ��:i�'c-*-' <"i?:Auto. Urinal s�< .........:.::.:Sowe ower —:1. Tray Drain �Washer Effective On Jan 1, 2002 �..nL �' �J%.►.�Slr Wit/1oS�, T NO. RATE TOTAL JOB ADDRESS_,- I 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" Gas Dryer** Back Flow Preventer Required ( )Yes () No Type Reinspection Fee $47.00/Hr Water Heater Gas 1EIec $ 7.00 4 , (/ O' The undersigned hereby makes application for a permit for the work herein $ 4.00 specified agreeing to do all work in strict accordance with the city codes $ 5.00 and rulings of the Building Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct. $ 7.00 $7.00 Z .2002- 2002- $7.00 $7.00 $10.00 OwnerGt Z / wy►/S..' C.a $ 7.00 $10.00 Building Used As $10.00 $10.00 _ Estimated Cost Z 00c') PERMIT NO. $15.00 PLUMBING COMPANY LD/ //7 / ✓'s ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance SIGNED FAX # TEL N0. GS/" 77,7 S7/J Approved ByRough-In Date Final Date State Surcharge $ .50 MINIMUM FEE OR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE gid • PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VENT, VENT ONN CTOR ANn COMM ISTION AIR VERIFICATION When rola _ino an exictinn f ramp, 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 (1 No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (I 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 px�st'np nnmhurttenn air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new rnmh ,ctien air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new ventinI3 syc Pm, 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 #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 r HEATING CO: Signed By: Date SUBJECT City of Fridley 33705 AT THE TOP OF THE TWINS BUILDING P E R M I T zRZ9FFWi 55' �ti: ----- _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. ry +�� f 1 ; V41 QT/ NUMBED REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910-F15 7/15/03 JOB ADDRESS 5590 Matterhorn Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 4 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Steve Nazian/Kathy Swendsen 5590 Matterhorn Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Trehus Builders 3017 4 Ave S Minneapolis. 612-729-2992 1474 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 Replace three windows within existing openings 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. Caulk and flash all exterior openings. 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 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 $2,400 @ $1 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .20 DOES OT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE P 11 OF ANY OTHER S TE OR LOCAL LAW REGULATING CON. $83.25 Fire SC $2.40 RU TME RFOR C CON RUCTION ®3 PLAN CHECK FEE TOTAL FEE Lice e SC $5.00 $91.85 IGN A TUAE OF CON "RACTOR OR AUTH941ZED AGENT iDATE, MEN PROPERLY VALIDATED THIS IS Y UR P RMIT SLOG �NSo n41E SIGNATURE OF OwNEA,1F OWNER SUiLOEAi iDATE, NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN (] 6431 University Ave NE, Fridley, MN 55432 (763) 572.3604 Bldg Insp ALTER. SINGLE FAMILY AND DUPLEXES R4 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: �^ �� /v6C�LR�✓� %� Legal Description: - Owner Name & Address: '57 r --W Y�-�`i ?.c Imo- -4 KA7X:j- S was el Tel. # Contractor. ��%� Y2> MN LICENSE # % 7� Address: 3 ®/ ;) 4 -It AZA in tAA r CLL o 'vs 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: 3 wis®yw c Construction Type: Estimated Cost: $- moo o Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ 0 DATE: 7—/f-2.3 APPLICANT: Tel. #66?-77-1?--Z?er 7 - Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-5714287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ 83 ..?s" $ 4C� TOTAL $ W.�� Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ] City of ]Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 PLUMBING Permit No ilding pections F76 RESIDENTIAL APPLICATION Received By ° 3-572-3604 CITY OF FRIDLEY Dat%ely- It 11 3 0 U 20 8 763-502-4977 FAX EFFECTIVE 1-1-08 DATE YOUR E-MAIL ADDRESS SITE ADDRESS ® %V �.�// THIS APPLICANT IS: O OWNER F�CONTRACTOR PROPERTY NAME: AJA ADDRESS: CJS- 6�ITY G� c` STAT IP4Z:Y_3 OWNER/ TENANT PHONE: �972_��� CONTRACTOR OF NAME: c SUBMIT A COPY STATE LICENSE # '10 EXP DATE Z C� YOUR STATE LICENSE, BOND AND STATE BOND EXP DATE MZO CERTIFICATE OF ADDRESS: t CITY STATE OBJ ZIP INSURANCE t� PHONE _r C9 — 3 r FAX '14 """LE FAMILY ❑ TWO FAMILY O TOWNHOUSE PERMIT TYPE TYPE OF WORK: O NEW PLACEMENT DETAILED DESCRIPTION OF WORK S to u, PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. BATH SINK/LAV DRAINS _ SHOWER W�ER PIPING _FLOOR —_ BATHTUB _ GAS PIPING (NEED CITY LIC) _ SWIMMING POOL a,JATER SOFTNER ($35) WASHER KITCHEN SINK _ WATER CLOSET _ BACKFLOW PREY. ($15) _CLOTHES _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER . Permit Fee $� Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ OR Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = $ .50 (MINIMUM $15.50) (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 work -which requires review and approval of plans. �� PRINTNAME �/ DATE SIGNATURE OF APPLICANT APPROVED BY DATE City of ]Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977