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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT No 4061 Date: Owner- ....................................... -..................... ......... _.-_----_-------._ ----•------------- Builder �._.... _.... _.._ Address Address LOCATION OF BUILDING ....�No....�--,�.../..�........ Street .--•------1��!?�................................... Part of Lot .................... _............. ........ _.... ....... _-----_....._....._._. Lot........ ...Y ........ ...... Block .._._...� ............. -................. Addition or Sub -Division CornerLot .................................... Inside Lot ..... _................................ Setbac ...... ................ Sideyard ...... .....4..... ....... -............. ........ _ Sewer Elevation To be Used as: e Type of Construction Foundation Elevation DESCRIPTION OF BUILDING o f/ / Front ... Depth .rZ ._'..67 HeighV.,l�. _..._®..... Sq. Ft. /._ .19 4F Cu. Ft. ,�--- Front /�'..'..:.(.. Depth.2_.'.::.�. �� Height�:.�. Sq. Ft ...s�.�7 Cu. Ft. ?.7 ................................................. Est. Cos /e ��..�.F1 .°....®...0. To be Completed ..... -............. _ ...................... ......... In consideration of the issuance to me of a permit to construct9the building described above, I agree to do the proposed work in accordance with the description above set fo h and 'in compliance with all provisions of ordinances of the city of Fridley. _ G In consideration of the payment of a fee of $Zj.a....a-p-, permit is hereby granted to. ...._............._............._............._......._.. _............................................................. to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of a provisions of said ordinances. _ B Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. 4 Original PERMIT for Power Hants and Heating. Cool- ing. Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of 1 Heating plants li� CI'✓I.Y►'U to be installed Meted—repaired Make � A) -A U , Size __/I / `% -Q�, Oil fired—, Coal fired , Gas fired ; Gas Authorization No. Approved Final Inspection 19____ Inspector Permit N° - 4 6'7'7 Fee $ r U Office of the Inspector of Buildings City of Fridley City of Fridley, Minn., 1926- Cd sf! , 19-2Q Owner ��✓ MELUVE�J Location 061 64 4664 AA - Kind of Build* ) A How Occupied A W e- Z I IJ 6 Work to be Commenced—, 19 To be Completed iqffid, -z? ,19-ZQ �Estimated Cost, $ s37Y• 0 0 (Zew, Building Permit No. Permission is hereby granted to to install—erect—use the material and devices described in the above statement. This permit is granted upon the express0condition that the personIn'tioned hom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specifications setorth in the approved application for this permit on file in the office of the Inspector of Buildings. C 1 ) / .Q Qa& -C��! �, Inspector of Buildings 42 2M11 -UV SUBJECT City of Fridley "RECEIPTL___"__COMMUNITY AT THE TOP OF THE TWINS BUILDING PERM I T r DEVELOPMENT DIV.�� SEC. PROTECTIVE INSPECTION CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 7/9%80 JOB ADDRESSO1 Pandora Drive N.E. 1 LEGAL LOT NO.BLOCK TRACTOR ADDITION SEEATTACHED DESCR. 24 3 Brookview Terrace 2nd SHEECT 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ra mond L. Melgren, 901 Pandora DRive N.E. 571-3571 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK❑ NEW ❑ ADDITION ❑ ALTERATION X REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK - Rroof 9 CHANGEOFUSEFROM TO STIPULATIONS Roof can be second but not third OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,TYPE Re-roof 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 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 1,000.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT •50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 7.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 8.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT W PRQPERLY LI TED THIS IS YOUUR PERMIT d�(DATE) BLDG INS GATE OW IDATEI CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL_ BUILDING PERMITS (New, Alterations, Additions, or Repairs) 04JNER: A'4umojuj) L -El - C 2 CA) ADDRESS: R0I 89/yoor2ig. pie /uC TEL NO: 57/-3571 BUILDER:4 ADDRESS: TEL NO: . Construction Location STRE'GT NO: _ 0 L STREET: LOT: '' q BLOCK: ADDITION: / Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTIO14 OF CONSTRUCTION Front: Depth: Height: Squane.Feet: Cubic Feet: Front: Depth: _ Height: Square -Feet: Cubic Feet: Type of Construction • w Estimated Cost: $/006,0 O To Be Completed: 0 99 Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ 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 •e true and correct. DATE: lFeO SIGNATURE: Stip ations: - - - - =- �_ 5-0 . T a Sa CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE B / /� �® Job Address q4w ��N ��K� z%//G ielz RESIDENTIAL I RATE TOTAL Furnace Shell and Duct Work, m� Burner (Also replacement furnace) $ 20.00 $ G �� Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 ®p City of Fridley Gas Piping $ 10.00 $ Tel. #571-3450 (piping needed with neva furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. * Air Condit' oning (all sizes) $ 10.00 Z $ �� Fridley, Minn. % J 19ff 0000 All Others/Repairs and Alterations OWNER 1% of Value of Appliance or Work $ _ KIND OF BUILDINNG COMMERCIAL/INDUSTRIAL USED ASy 4.) 1% of Value of Appliance or Work $ TO BE COMPLETED ABOUT 2 ESTIMATED COST State Surcharge $ .50 TOTAL FEE p� $ D OLD - NEW BUILDING PERMIT NO. PERMIT NO. Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough Insp. HEATING or POWER PLANTS,// Steam, Hot Water, Warm Air- No. Date Final Insp. /' ,12 tl Trade NameA�/��1� Size No. Date Capacity 760 Sq. Ft. EDR BTU �� HP � Approval for Permit r�'// Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00, n Company PLUS $.50 STATE SURCHARGE ,, Signed By `7 C1�� Tel. No. *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Fill out back side for stack verification on replacement furnaces CHIM14EY 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 No ( ) 3. Has no foreign objects lodged within Yes ()e) No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes C No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL. l l Rema rk s -��/ Company Signed By Date F� sueJEcr �City of Fridley 0 72� AT THE TOP OF THE TWINS BUILDING PERMIT i RECE • COMMUNITY DEVELOPMENT DIV. �: ------ PROTECTIVE INSPECTION SEC. cc II� �Ogg��'Tq r � � 1 NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/17/93 JOB ADDRESS 901 Pandora Drive NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 3 Brookview Terrace 2nd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Raymond Melgren 901 Pandora Drive NE 571-3571 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 (R REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke dete.ctors as per UBC 1210 adjacent to all sleeping areas and in basement, 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 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 $1.p20A $,60. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SACCHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $29,00- Fire SC $1x20 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $30.80 IG ATUREOFCONTRACTORORAUTHORIZED AGENT IDATEI WHEN PER VALIDATED THIS IS YOURPERMIT BLD INSp DATE SiGNA RE OF OWNER IIF OWNER BUILD RI IDATEI F� NEW [ j Effective 5126/93 ADDN [ ] CITY OF FRIDLEY ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: �% 0% Al D o R A 2 A) f" P t b LE Mi,) Legal Description: Li 21 ) L • 3 SAM E Owner Name & Address: ,� o v.) l� G c� E A fl �3 0 Tel. # S7/ -3S7 l Contractor: S r MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EM PROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: V r AJ , -4 L Rc - S 1 a 1A) C; Corner Lot (] Inside Lot [ ] Ft. Yd Setback Type of Construction: Approx. Completion Date: 9 3 Driveway Curb Cut Width Needed: DATE: 9- 18' -9 3 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge Side Yard Setbacks Estimated Cost. $ / .2o o (Cost on Back) Ft. + 6 Ft = Ft x $ $ 00 Fee Schedule on Reverse Side $ /. X20 .001 of Permit Valuation (1/10th`) $ - ( Co $.50/$1,000 Valuation $ $750 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ Conservation Plan Review $450.00 $ Fee Determined by Engineering $ Agreement Necessary [ I Not Necessary ( ] TOTAL $ D C Ci STIPULATIONS: Tel.# 5-71r 3S 7( City of Fridley' AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PER _ 6 4 d r 1 i __ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. r �; CITY HALL FRIDLEY 55432 ,.j 612-571-3450 9793 NUMBER 910-F15 REV DATE /30/98 PAGE OF APPROVED BY JOB ADDRESS 901 Pandora Drive I LEGAL DESCR. LOT NO. 24 BLOCK 3 TRACT OR ADDITION Brookview Terrace 2nd SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS Raymond Melgren, 901 Pandora Drive, Fridley 55432 ZIP PHONE 571-3571 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Quality Contracting, 11412 W River Rd 427-7733 7035 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 ❑ XREPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof (tear -off) 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must meet State 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 AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SO. FT. CU. FT. 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 STALLS GARAGES 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 VALUATION $2,800.00 SURTAX Fire SC $1.75 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIO OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCT N ORPERFORMANg OF CONSTRUCTION. $56.75 $_.88 State SC PLAN CHECK FEEAL T FEE $5.00 $64.38 SIGNATURE drF CONTRACTOR ORAUTHORIZED AGENT (DATEI E PY VALI A THIS IS Y UR PERM11 BL G INSP FATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI FA NEW [ ] ADDN [ l ALTER [ l ConstructionAddress: Legal Description: CITY. OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION of 01 PtdoV01- Effective 1/1/98 Owner Name & dress: �� SZ VLA_a vL �l _5Tel. # Contractor:cc_� ," f e K-��-`n��' MN LICENSE Address: f l G%l�. G� lee �e�� osC Tel. # e -`Z 7, 7 7 -7 `3 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 IlAPROVEMENT Length Width Height Length Width Height Length Width Hg/t//Ground Construction Type: ( z,. -_y' a �'Jq c- V' e VbcA' Estimated Cost: $, Sq. Ft. Sq. Ft. Sq. Ft. (Fee Schedule. on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: v APPLICANT: # 6Z 7 — 7 7 STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ -75-'.001 of Permit Valuation (1/10th%) State Surcharge $ 8 Y $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ s�, 00 $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 $ 4q.1f, STIPULATIONS: CITY OF FRIDLEY PERMIT NO.: 2004-00091 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 01/22/2004 572-36U4 YAX: (763) 571-1287 ADDRESS : 901 PANDORA DR NE PIN : 133024220055 LEGAL DESC : BROOKVIEW TERRACE 2ND ADD : LOT 24 BLOCK 3 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL XCEL ENERGY SAVERS SWITCH # INSPECTIONS 1 APPLICANT HUNT ELECTRIC CORP 2300 TERRITORIAL RD ST PAUL, MN 55114-1614 (651) 646-2911 OWNER ZEMBAL, BRANDON J 901 PANDORA 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 wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 113375 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Building — OCCUPANCY TYPE BUILDING Permit No. �. Inspections Plan Review RESIDENTIAL APPLICATION Received By: 1 To 763-572-3604 $001 CITY OF FRIDLEY DatR d Q1 �U rJelvIf—IpC C.0 DATE YOUR E-MAIL ADDRESS �SQ Q� • yn SITE ADDRESS 1 o l 32'()'A0( -o'_ b IJI--Q $1550 per SAC Unit (Plans to MWCC for determination) THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR ft + 6 ft = ft x $21 =$ PROPERTY OWNER/ 1— ^ NAME: tO�Y�C�On -b'e rnLJc I $450 Conservation Plan Review ADDRESS: -111, CITY STATE ZIP TENANT Sewer Main Charge PHONE: T L l U " te-55 NAME: Renewal By Andersen Agreement necessary ( ) Non Necessary ( ) CONTRACTOR SUBMIT A COPY OF STATE LICENSE lt_ 1920 County Road "C" West YOUR STATE LICENSE ADDRESS: Roseville, MN 55113 r STATE ZIP WITH APPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/NEI 651-264-47.77 PROPERTY TYPE ❑ TWO FAMILY/NEW G. _ ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS PERMIT TYPE ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: �D lar -e q LTJ) r d CTS ";t\D —MC sdir\ikcn M (\40 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE I. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: 0 DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS & PORCHES SUBMIT• ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structure ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 19,7 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ — OCCUPANCY TYPE Permit Fee $ O?Lo S . 05- See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $001 times the total job valuation Surcharge $ 5 .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 $ 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 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 applicatiopffor a permll.,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 w1fich requiref..Oview and approval of plans. }� �� /D SIGNATURE OF APPLICANT PRINT NAME01 WCI,�1IXSA V�� DATE _