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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT o NO =4703" Date:...... f ' Owner:. , .. _. _ uilder.................... .... ..... _..._ AAddress --._.......... .. _ _: _. A dress ....................... ...;................. ...._....... ti No. /Jys treat _..._.. Lot ....._..... -- Block ............ Corner Lot .................................... Inside Lot Sewer Elevation ...... ............. .............. _.............. TION OF K..... ': rh'A..e—......--.. Part Of Lot ....................... ........ _ ition or Sub -Division - Setback...... ................. ..... Sideyard............::..._............._............................_........... ......... Foundation Elevation ...... . .......... ..................... .............. ........................... _...r....... DESCRIPTION OF BUILDING To bA Used as: 01 ,,pp ,,pp�� q af Front _._.. Depth .....:..._t Height ... .:... - - Sq. Ft. d..:.G! Cu. Fts .... _..--------- ..................... ........... Fr t _... ..... Depth ......... ... H 'ght Sq. Ft......_....------..._.. Cu. F't......................... Type of Construction _...... . ........ 1 .... Est. Co .. .............. To be Completed ...... ............. _.............. ................. In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. a ......................... In consideration of the payment of a fee of $ _.:................., 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 pon olatio7 any of the provisions of said ordinances. i 1 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. uQW4 Owners Address No. Lot7 -AC4 APPLICATION FOR BUILDING PERMIT nlrmrr nus "M"MT L+v Mllkwrenrrk ss LOCATION OF BUILDING of Lot r"f, Corner Lot Inside Lot--Y—Set Back A o Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: 9 Front tf(® Depth�Height . Sq. Fti ZI Ga. Ft• Front Depth. Height Sq. Ft. Cu. Fte Type of Construction , --� Estimated Cost CQ To be 0 The undersigned hereby makes application fox, s permit for the work herein specified$ agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares t,4at all the facts and representa- tions stated in this application are true ani q;®. Schedule of Fee costs can be found on the Reverse Side.) OIL BU) LNER- to 3' gal. per hour each add. 3 gal. per hour $10.00 $ i0.00 $ GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: ist 3 Fixtures x" $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONDITIONING $/ FAN HEATING SYSTEMS r$ See Fee Schedule VENTILATING SYSTEMS $ ALTERATIONS & REPAIRS_ S $ State Surcharge $ .50 TOTAL FEE $ ROUGH INSP. Date r^L\A:. INSP. Date APPROVAL FOR ?Er -*.=7.0 REINSPEC:IO1 FEE (.$10.00) . SSI``=wx FEE FOR A\*Y HEATING PER".IT IS $7.50 dl1 ESTIMATED COST / 740M - OLD- NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWE PLANTS, Steam, Hot Water, Warm Air- No. f(/ Ag„I_ 'rade Nam Size No. ^~ Capacity az Sq. Ft. EDR BTU H? _ Z Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company s ' • s e Signed By . Tel. No. 9 _ o CITY OF FRIDLEYlG�s-� APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY IiAR�I AIR: RATE- TOTAL Job Address F'ur-ace Shell & Duct Work $12.00 $ Reolace.:.ent of :":mace 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 NIECE-kNICAL WARM AIR: The undersigned hereby makes application for a permit for the work herein $12.00 $ specified agreeing to do all work in strict accordance with the City Codes Fsrnace Shell & Duct work to 100,000 BTL' 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the each add. 50,000 BTU 7.00 $ facts and representations stated in this application are true and correct. Replacement of Furnace Repairs & Alterations -up to $500.00 7.00 $ l9 4.00 $ Fridley, Minn. Re_airs & Alterations each add. $500.00 STE,;M OR FOT { aTi.R SYSiLM: OWNER Boiler & Linns up to 100,000 BTU $12.00 $ KIND OF BUILDING each ad,n. 53,000 BTU 4.00 7.00 $ $ USED AS Boiler only up to 100,000 BTU each addn. 50,030 BTL' 6.00 $ " TO BE COMPLETED ABOUT OIL BU) LNER- to 3' gal. per hour each add. 3 gal. per hour $10.00 $ i0.00 $ GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: ist 3 Fixtures x" $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONDITIONING $/ FAN HEATING SYSTEMS r$ See Fee Schedule VENTILATING SYSTEMS $ ALTERATIONS & REPAIRS_ S $ State Surcharge $ .50 TOTAL FEE $ ROUGH INSP. Date r^L\A:. INSP. Date APPROVAL FOR ?Er -*.=7.0 REINSPEC:IO1 FEE (.$10.00) . SSI``=wx FEE FOR A\*Y HEATING PER".IT IS $7.50 dl1 ESTIMATED COST / 740M - OLD- NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWE PLANTS, Steam, Hot Water, Warm Air- No. f(/ Ag„I_ 'rade Nam Size No. ^~ Capacity az Sq. Ft. EDR BTU H? _ Z Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company s ' • s e Signed By . Tel. No. 9 _ o Effective May 1, 1990. CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures Future Fixtures Old Opening,,New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gag Range Gas Dryer Back Flow Preventer Required. . Type W RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 S 5.00 S 5.00 S 5.00 S 5.00 $ 7.00 S 5.00 $ 10.00 S 10.00 Yes ( ) No ( ) $ 5.00 TOTAL $15.00 R Job Address 1288 Skywood bane Department of Buildings City of Fridley Tel. 0571-3450 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 apli ation are true andppeorrect Fridley, Mn. 19 7b OWNER Grant Home Remodeling KIND OF BUILDING residential USED AS residential TO BE COMPLETED ABOUT July 1990 ESTIMATED COST $1,500-00 OLD - NEW BUILDING PERMIT NO. PERMIT 140. ROUGH INSP. Date Company Velter & Blaylock, I c. Signed By Tel. No. 881-3171 FINAL INSP. CJ r / 5 —_�V Date APPROVAL FOR PERMIT OUtl) ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ !1ININUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE S.50 STATE SURCHARGE State Surcharge S .50 Reinspection Fee $ ($15.00) TOTAL FEE $15-50 a m q u K wWater u7 N G a N ui O u O, ta, 1Ca. Heater M S4O 4/ O eq a �0 a �� 0l M .0 c u lec •� a i� C •.Oi o w O 8 w v m u n 4 ai m L O vsiu t� Wri as 1 1 1 1st 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (*) - New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures Future Fixtures Old Opening,,New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gag Range Gas Dryer Back Flow Preventer Required. . Type W RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 S 5.00 S 5.00 S 5.00 S 5.00 $ 7.00 S 5.00 $ 10.00 S 10.00 Yes ( ) No ( ) $ 5.00 TOTAL $15.00 R Job Address 1288 Skywood bane Department of Buildings City of Fridley Tel. 0571-3450 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 apli ation are true andppeorrect Fridley, Mn. 19 7b OWNER Grant Home Remodeling KIND OF BUILDING residential USED AS residential TO BE COMPLETED ABOUT July 1990 ESTIMATED COST $1,500-00 OLD - NEW BUILDING PERMIT NO. PERMIT 140. ROUGH INSP. Date Company Velter & Blaylock, I c. Signed By Tel. No. 881-3171 FINAL INSP. CJ r / 5 —_�V Date APPROVAL FOR PERMIT OUtl) ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ !1ININUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE S.50 STATE SURCHARGE State Surcharge S .50 Reinspection Fee $ ($15.00) TOTAL FEE $15-50 CITY OF FRI'DLEY APPLICATIONG AND AS ITTING * T RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 UO Beer Dispenser S, m $ Water $ 5.00 $ Catch Basin $ 5.00 $ CSC .m $ 5.00 4 all r.b $ Sump or Receiving Tank -y Heater 5.00 o Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 CCxW U -MI .� Gas Dryer 14C .- 10.00 $ Back Flow Preventer Required. . . yes ( ) No ( u Type $ 5.00 .$ ALL OTHAS AND/OR REPAIRS AND ALTERATIONS ci W 4j s-24,60 State Surcharge $ .50 Reinspection Fee $ Mo TOTAL FEE Inr.° u w 3 = o as lec 1st 2nd 3rd 4th (R) = ture Conneor on Opening Connected with Sewer (+►} New Fixture, Old Opening 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 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . yes ( ) No ( ) Type $ 5.00 .$ ALL OTHAS AND/OR REPAIRS AND ALTERATIONS 1% of value of Fixture or Appliance s-24,60 State Surcharge $ .50 Reinspection Fee $ ($15:00) TOTAL FEE $ a Effective Date May 1, 1988 Job Address A 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. 19 4 OWNER KIND OF BUILDING- 64. USED AS TO BE COMPLETED ABOUT, ESTIMATED COST c Z V -5e' , 0 ®- OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By, Tel. NO. ROUGH IN$P Date VqA 1 0 FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SUBJECT P City of Fridleyo 20268 AT THE TOP OF THE TWINS BUILDING PERMIT' RECEIPT NO Ir • COMMUNITY DEVELOPMENT DIV. ,.------, r I � PROTECTIVE INSPECTION SEC. 3 ss 1P 1 � i ---ti CITY HALL FRIDLEY 55432 It-'-- ,.J NUMBER REV. 0 DATE PAGE OF APPROVED BY 612-571-3450 910-F15 3/28/90 JOB ADDRESS 1288 Sk.Xwood Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Beverly Hills Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Mollers 1288 S'kywood Lane N,E, 574^0188 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Grant Home Remodelers 3835 Independence Avenue N,, New Hope, MN 55427 545-9023 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 Ek ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remodel. b4s:ement 9 CHANGE QF USE FROM TO STIPULATIONS See nota.tions- an 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 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 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 $lO 000 $S.00 WITH WHETHER SPE IED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRE E 0 GIVE AUTHORI TO IOLATE OR CANCEL THE PERMIT FEE SAC CHARGE ROVISIONS ANY O HER STATE O LAW REGULATING CON- $117,00 S RUCTIO OR• H FO CE F RUCTION. P FEE TO ALFEE n22 22.00 SIGNATURE OF CONTRAC OR AUTHORIZED AGENT IRATE) WHEN PROPERY aP V LIUDTIS YOUR PERMIT nATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI NEW [ ] CITY OF FRIDLEY Effective 1/1/90 ADEN [ ] R-1 AND R-2 ALTER [X] Building Permit Application Construction Address: 1288 Skywood Lane NE Legal Description: Owner Name & Address: Mr. and Mrs. David Mollers 1288 SkywoodTel. # 574-0188 Contractor: Grant Home Remodelers Tel.. # 5165-9023 Acidness: 3835 Independence Avenue North, New Hope, MN 55.27 Attach to this application, a Certificate of Survey of the lot, with the proposed cion drawn on it to scale. LTVIM AREA: Length Width Height Sq. Ft. GNRAGE AM: Length Width Height Sq. Ft. DECK AMM:- Length Width Hgt/Ground Sq. Ft. OTHER: Remodel existing finished basement 386 SF Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Wood framed Estimated Cost: $ 10, 000.00 Approx. Completion Date: May 15, 1990 Proposed Driveway Width If New ss ][)M. Ft. $ $ �(. Width + 6' See Back Page DATE: Mar. 26, 1990APPLSCANT: ale C. ant Tel. #JL5 -9023 Permit Fee $s 0 () Surcharge $ _. 6 SAC Charge $ _ Driveway Escrow $ Park Fee $ Sewer Main Charge $ STIPULATIONS: CITY USE CINLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] /�gc�rc San SUBJECT city of Fridley 7W5 2 AT THE TOP OF THE TWINS BUILDING PERMIT 1 , 5iEIPT NO. •____ COMMUNITY DEVELOPMENT DIV. _ 1 ~ r -- PROTECTIVE INSPECTION SEC. 3 -2- 3-3 1 � 1 CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/11%90 JOB ADDRESS 1288 S;kywood Lane N, E, 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESAL. 2 1 Reve.rly Hills Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Mollers 1288 Skywood Lane N.E, 574--0188 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Grant Home. Remodelera 3835 Independence Avenue North, New Hope, MN 55427 545-9023 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 C� ALTERATION ❑ REPAIR O MOVE ❑ REMOVE B DESCRIBE WORK Alteration to basement to add bathe furnace'room7 laundry room; bookcase cabinets 9 CHANGEOFUSEFROM TO STIPULATIONS Provide combustion air to existing furnace. Use treated bottom plates, See notations on plan, SEPARATE PERMITS REQUIRED FOR WIRING, HEATING, PU01;MING AND SIGNS, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 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 $6a 9L50 $3.48 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT P�ESUME TO GIVE AUT ITV 0 VIOLATE OR CANCEL THE REGULATING CON- PROVISIO.OWA OTHER STA CAL LAW STRU fgbN Off T PERFORMA 'C E. ONSTRUCTION. $ d/ $9DE 00 PLAN CHECK FEE TOT $ FEE 93 , 48 SIGNATURE OF CONT R OR AUTHORIZED AGENT IDATEI WH N PROP R IS YOUR PERMIT I=HIS S=/ t- lu WSp DATE SIGNATURE OF OWNER I)F OWNER BUILDER) (DATE)G NEW [ ] Effective 1/1/90 ADEN [ ] R-1 AND R-2 ALTER Building Permit Application Construction Address:' Legal Description: Owner Name & Address: Alp Ows, vilri? ff2r'( '2S` Tel. # V �d Contractor: jyr' Tel. Address: r &2,� Jl�'P- Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LrYM G AREA: Length Width Height Sq. Ft. GARAGE AREA: length Width Height Sq. Ft. //DF��3C}}R�p]AREA: (` 'aq Length Width p,✓a�Hgt/(lGround .+y � sq.��f/f F�t�.},p^�q ViiiM: 6,93 ' J/0 � .��lC�� Q� "�,� 0 ge'� ®� '�i., � W U Q Qr0 'l'9"��6b.� / IY FiT(/yb"G" C��V 1� �• ' 6'I ®"s �J. Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks of Construction: ® g'6 11�Pe Estimated Cost: $�� Approx. Completion Date: Proposed Driveway Width If New c7fIs Desired: Ft. $ $ + 6' See Back Page DATE:'5 `% APPLICANT• ! Tel. #.��% Permit Fee $ 90,06 State Surcharge $ a �� SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main (urge $ CITY USE CNLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL $ CA �.�� 95b y; ,p o 4-145 0 STIPULATIONS: �Un'�j *C -K- '5(3. Go paoo'�C' AX tw us or— Trt&&f P"Ors SUBJECT PERMIT NO. City of Fridley 07 3 —10 AT THE TOP OF THE TWINS BUILDING PERMIT `- _----- COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. �91� 1 � i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY ' 612-571-3450 910-F15 6/21/00 JOB ADDRESS 1288 SMOOD LANE NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 3= Beverly Hills Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Moller 1288 Skywood Lane NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Maple Leaf Homes 14230 Uranium St Ramsey, MN M94_*3 55303 763-576-3370 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 20220294 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION IN REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof House and Garage - Tear Off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the 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 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 1 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,932.00 $.96 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 $69.25 Fire SC $1.92 PLAN CHECK FEETOTAL7 F E A,/ Lic s SC 13 SIGNATURE OF ACTO OR AUTHORIZED AGENT IOATE� CO� EN ROPE ALIDATE T I$' IS�UR PFR_MI�� S-GNATURE OF OWNERJF OWNER BUILDER, IDATE� iNSp FJATE NEW I l Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp `ALTEK [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION J%f2 7P Construction Address Legal Description: Owner Name & Address: Da (/ 6 -� m "--b mo Io 1(''r - Tel. # ``II Contractor. 4L4 P L � L c ea L 4c) m L � MN LICENSE # (`Z� q`-�- Address: l 4� :3c� r e-4 rI.k J .�a � ift'y+5 1,- u 4J.L�_Tel. # - 33 7 (7 -5 s j--�S 3 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: Construction Type: J( C, a rr �� H"s L Estimated Cost: $ 5 c,�A Driveway Curb Cut Width Needed: Ft + 6 Ft= Ft x $ _ $ S DATE: - APPLICANT: �t(C c—\ k5q �� Tel. # 7 c � ^ J 7 ( -33 7 CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ a Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ (® $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $ 0 $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 [ ] $ f7 7, /e-57® STIPULATIONS: CITY OF FRIDLEY PERMIT NO.: 2004-00769 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/24/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 1288 SKYWOOD LN NE PIN : 243024330015 LEGAL DESC : BEVERLY HILLS : LOT 2 BLOCK 1 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 2,400.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CONSTRUCT A 6'6" X 11'6" FRONT ENTRY ROOF. STATE LICENSED CONTRACTOR 1 APPLICANT BUILDING PERMIT FEE PLAN CHECK FEE 83.25 54.11 GARY F J CONST INC (1959) 5741 164 AVE NW FIRE SURCHARGE 2.40 RAMSEY, MN 55303 STATE SURCHARGE, VALUE 1.20 LICENSE SURCHARGE 5.00 TOTAL 145.96 OWNER MOLLERS DAVID E & BARBARA A 1288 SKYWOOD LN NE FRIDLEY, MN 55421 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 work 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 construct, rformance of construction. ,NApplican Date D Bldg l IsD tit r VPARATE PERMITS REQ D FOUR W6kK OTHER THAN DESCRIBED ABOVE. 'jg NEW [ ] CITY OF FRIDLEY P-, K I 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 n 9/ �Do - vo fwi Construction Address: J J. �T* & - SXV Lne,&A N Legal Description: Owner Name & Address: D Ay C ILER Tel. # Contractor.' "f- MIJ LICENSE # S Address: `.? 1` Je V 01W A Af Z( W RA *�,*YH Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVINGAREA: Length Width Height Sq. Ft GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: Construction Type: a Estimated Cost: $ �` Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: 3- Y-0APPLICANT: Tel. #° Call (763) 572-3604 for Permit Fees If mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.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 [ ] STIPULATIONS: 15.0 !S•, i ` � 1- f.:.. I16. •�• Z r 0:.117.:1 II II r Lot 2, Block 1, BEVERLY HILLS, Anoka County, Minnesota I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE ABOVE DESCRIBED LAND, AND THE LOCATION OF ALL BUILDINGS, THEREON, AND ALL VISIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND. n AS SURVEYED BY ME THIS ....2.5.th DAY OF ......-MA•y......... A.D. 1S 6M... N. C. HOIUM AND ASSO TES C. — LAND SURVEYORS ..y s NB ce ##/us SURVEYS IN: INDUSTRIAL COMMERCIAL CITY LOTB if mclif rut Ace ANOKA, SANTI, TOPOGRAPHICAL ofm SHERBURNE LAKESHORE PLATTING LAND SURVEYORS COUNTIES COUNTIES 7101.13TH AVENUE SOUTH SHOPPING CENTER - WEST MAIN STREET MINNEAPOLIS 23, MINNESOTA ANOKA, MINNESOTA UNION 6-8208 1-6340 Sheldon ppHARRISON Mortenson 9 0 e� 294-112-63 w �/Z 1� N.E. t II I I ' ; X-3 I 711 f ` • '" J.; `O• KE•' BOE t�ZF' . '.�;� I � �; �' r`1 15.0 !S•, i ` � 1- f.:.. I16. •�• Z r 0:.117.:1 II II r Lot 2, Block 1, BEVERLY HILLS, Anoka County, Minnesota I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE ABOVE DESCRIBED LAND, AND THE LOCATION OF ALL BUILDINGS, THEREON, AND ALL VISIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND. n AS SURVEYED BY ME THIS ....2.5.th DAY OF ......-MA•y......... A.D. 1S 6M... N. C. HOIUM AND ASSO TES C. — LAND SURVEYORS ..y s CITY OF FRIDLEY PERMIT NO.: 2004-02293 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 12/17/2004 (763) 572-3604 FAX: (763) 571-1287 R 654 9 ADDRESS : 1288 SKYWOOD LN NE PIN : 243024330015 LEGAL DESC : BEVERLY HILLS : LOT 2 BLOCK 1 PERMIT TYPE . : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A PH:612-827-4033 # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 1 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 400 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) 0.00 0.00 NORBLOM PLUMBING CO 2905 GARFIELD AVE S PLBG FIXTURES (EXIST OPENINGS) 0.00 MINNEAPOLIS, MN 55408-2173 WATER TREATMENT APPLIANCE 0.00 (612) 8274033 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS 0.00 0.00 0.00 OWNER MOLLERS DAVID E & BARBARA A STATE SURCHARGE, PLBG FLAT 0.50 1288 SKYWOOD LN NE FRIDLEY, MN 55421 TOTAL 35.50 PAID WITH CHECK # 29683 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. a 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 work 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 ti . regulating construction or the performance of construcn A Date Bldg Insp Z' :)�"A SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ,ITY OF FRIDLEY INSPECTION DIV. Effective April 1, 2004 431 University Ave NE 'ridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTALLED ON FACH FLOOR d s�; •.• A.., 'LUMBING FIXTURE RATES: Jew Fixtures )Id Opening, New Fixture leer Dispenser Ilow Off Basin :atch Basin lain Water Leader )ump/Receiving Tank Vater Treating Appliance Vater. Heater -Electric Vater Heater - Gas** NO. RATE TOTAL JOB ADDRESS Sc n & , a -s o'W Alw- las Range** '36s Dryer** lack Flow Preventer Required ( )Yes () No Type $10.00 $10.00 $10.00 $1.0.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 leinspection Fee $50.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE 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 reprep--"'*--- •k'n ---I. *;^^ +^ie and correct MOLLERS, DAVE 1288 SKYWOOD LANE NORTHEAST 1j 6 20 FRIDLEY, MN 55421 (763) 574-0188 OWNER _ BUILDING USED AS GSI d e "C -It- ESTIMATED COST qo o 000 PERMIT NO. PLUMBING COMPANY NO C Ol ONS SIGNED BY. --c TEL NO.(%12) $2% ,h I Approved By Rough -In Date Final Date $-2SSD OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. 6. **PROVIDE COMMON VENT INFO ON BACK SIDE Irk M -Ins k 5� 'LUMBING FIXTURE RATES: Jew Fixtures )Id Opening, New Fixture leer Dispenser Ilow Off Basin :atch Basin lain Water Leader )ump/Receiving Tank Vater Treating Appliance Vater. Heater -Electric Vater Heater - Gas** NO. RATE TOTAL JOB ADDRESS Sc n & , a -s o'W Alw- las Range** '36s Dryer** lack Flow Preventer Required ( )Yes () No Type $10.00 $10.00 $10.00 $1.0.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 leinspection Fee $50.00/Hr kLL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE 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 reprep--"'*--- •k'n ---I. *;^^ +^ie and correct MOLLERS, DAVE 1288 SKYWOOD LANE NORTHEAST 1j 6 20 FRIDLEY, MN 55421 (763) 574-0188 OWNER _ BUILDING USED AS GSI d e "C -It- ESTIMATED COST qo o 000 PERMIT NO. PLUMBING COMPANY NO C Ol ONS SIGNED BY. --c TEL NO.(%12) $2% ,h I Approved By Rough -In Date Final Date $-2SSD OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. 6. **PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY -FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS. COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina an existing furnace, 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 () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () 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 existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When required to install a new combustion air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When Installina a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This, does include AGA GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan As 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 ALTERATIONS: (Describe) HEATING CO: Signed By: Date : De �M__ A Building MECHANICAL Permit Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: I DATE nYOUR E-MAIL ADDRESS SITE ADDRESS �! k THIS APPLICANT IS: ❑ OWNER 9e6NTRACTOR PROPERTY NAME: ADDRESS: CITY STATE ZIP OWNER/ TENANT PHONE: CONTRACTOR COMPANY NAME: CONTACT PERSON: Hearth & Homa Techrinlealm ' dba Fireside Hearth & HomBXP SUBMIT A COPY OF YOUR STATE STATE LICENSE # DATE LICENSE WITH ADDRESS: 2700 N. Fairview CITY STATE ZIP APPLICATION PHONE ;=SRI e, MN 55113 FAX /032651 PERMIT TYPE ff S&GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW ❑ REPLACEMENT k3'ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK PERMS 1613.665 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 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: MODEL: SIZEBTU MFG: ® MODEL: SIZE/BTU MFG: �— MODEL: SIZEBTU A/C $25.00 t-'� FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00 _AIR $35.00_FURNACE $35.00 _GAS UNIT HTR $10.00 _BOILER CHIMNEY LINER $10.00 S DRYER $10.00 _POOL HEATER $35.00 WORK $10.00 _GAS PIPING $10.00 VENTILATOR $15.00 _DUCT Fee Number of fixtures, @ $1() 00 y 10 fln -Rexaiit Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ ' 50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all wort which req ares review an pproval of plans. SIGNATURE OF APPLICANT PRMT NAME � r., -q 01 .�C DATE 11 -?Gl City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/E3USTING HOMES �� ibex 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duet Design Per 1MG 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations. Building Inspections 763-572-3604 763-502-4977 FAX DATE J I b I U'i SITE ADDRESS I Z THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 2-19-09 YOUR E-MAIL ADDRESS VJ®DGi La-" NF - 11 OWNER INCONTRACTOR Permit No.: Date Rec'd• v COMPANY NAME:] CONTACT PERSON: STATE LICENSE # " EXP DATE ll� ADDRESS:%SOee I/ %L CrrY :E6U'1ea- STATlB/�NZF`� 1 PHONE S Z• 6 3 S•% FAX 9S Z----74 rT— �0 1 0 PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW , rREPLACEMENT ❑ ALTERATION/REMODEL 1 ETAILED E gRIPTI0N OF WORK VA..r I Q Uc '�C Ay -t j 4 (, L `-, A C- rA'i� � ( 8pn� � a 1y2. 4 p Q FEES ARE BASED ON $10.00 PER FIXTUR XCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG. MODEL3154AVOW70 SIZEBTu-7%, 000 MFG: GU/t MODEL: 17,VZ� SIZEBTU MFG: MODEL: SIZE/BTU A/C $25.00 _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN $10.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 HEATER $35.00 _DUCT WORK $10.00 _POOL _GAS PIPING $10.00 VENTILATOR $15.00 state surcharge = $ .50 THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of work which requires review and approval of p1lans. SIGNATURE OF APPLICANT G,�// C �_ PRINT NAME VVC VII DATE 5A D City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building Permit Fee BUILDING See Back Page for Fee Schedule Permit No.: U Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 $ CITY OF FRIDLEY v AUN 1 201 763-502-4977 FAX $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow EFFECTIVE 1-1-2010 ft + 6 ft = ft x $24 = $ Erosion Control � DATE (9 ' 1-1 ' XO YOUR E-MAIL ADDRESS Z l7` )80 ® T 1>S & - SITE 1 ADDRESS 2 _ItR JKY 445 9 �Ag C P t_ $ THIS APPLICANT IS: ❑ OWNER ,$!CONTRACTOR $ PROPERTY OWNER/ NAME:_b/"\ V G !Mp C_L C -Z -S $ TENANT ADDRESS: CITY STATE ZIP PHONE: `Z b3 Is :::d: - CONTRACTOR NAME: i��L �� 1 I� iii M L SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # Z� Z Cis � ® EXP DATE '?? 2 AND CERTIFICATE OF ADDRESS:75,-z'A TL ) CITY STATV^P ZIP % LILIL) INSURANCE PHONE —? L:P ,3 - 2 �eS —T Ll j ( FAX "7 3 -- L4 41 ^ 9-7 PROPERTY TYPE I!jkSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING PkOTHER f -A75 C(A- ❑ SWIMMING POOL t ) TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION AINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: P_ PST/i L L Q E_::,3 T-0�t� t t 1 P Cx� F�A-s C) A - SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING;"S-EOHI-!' NUMBER OF SQUARES ❑SE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2.. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl offit ADDITIONS_ & PORCHES SUBMIT: ❑ Aluminum QTrim 1. Site Plan/Survey showing the existing structures ❑ Other J,Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL. JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ Ll (a 'I .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 200 #'13 Make checks pavable to: Citv of Fridlev 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 in conformance with the ordinances and code f the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a pe it d work is not to start without a permit on site; that the work will be in accordance with the approved plan in the cas of al oak w ich quires review and approval of plans. / DATE SIGNATURE OF APPLICAN PRINT NAME 2170 -t30 -t3 C®NN C��LI tJ ',1 16