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-04o, City of Fridley, Minn. BU ILDING PERMIT N?, (" 51 31 Date: Owner: Builder Address Address LOCATION OF UILDING � No. '4� ir Street— P f Lot Lot Block Addition or Sub -Division Corner Lot Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To Used Used aps Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft Type of Est. cost 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 ordinancesthe city of Fridley. In consideration of the payment of a fee of permit Is hereby granted to._._. toconstruct 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 dine 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,,of the provisions of said ordinances. 7 `Building Inspector NOTICE: This permit don not cover the construction, Installation for wiring, 'plumbing, gas heating, sewer or water. Be sure to sea the Building Inspector for separate permits for then items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name C��=� ------ Builder Address' Address .5z®a- 3 & A AOV_.�._..P LOCATION OF BUILDING Ne.,z4zZ Street— 0r1V462t �c� &ge6�Part of Lot Lot . Block Addition or Sub.Div. �, 0 01 Corner Lot Inside Lot_____ Set Back Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft, 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 strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representa- tions stated in this application are true and a ect. e. DATE �2 �2./_ — / SIGNATURE �;� (A Schedule of Fee costs can be found on the Reverse Side.) 1 Application for Power Plants and - Hea ing, Cooling, Ventilation..Refriger%KIion and ,r Air Conditioning Systams and Devices PARTIAL RATE SCHEDULE i_ GRAVITY WARM AIR: Furnace Shell & Duct Work .......................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 .................. Repairs & Alterations each add. $500.00 ............... RATE TOTAL, 8.00 $ 5.00 $ 5.00 $ 2.50 $ MECH. WARM AIR `�, Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 80,000 BTU ........................ 2.00 $ Replacement of Furnace %.00 $ Repairs & Alterations—up to $500.00 .... ............ 5.00 $ Repairs & Alterations each add. $500.00 ....... :..... . 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam..... . 8.00 $ Furnace Shell & Lane—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $� GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS I ROUGH— OUGH FINAL— FINAL See See Fee Schedule TOTAL FEE $ Dept. of Bldgs. Phone SII. City of Fridley: The undersigned hereby makes application for a 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 that all the facts and representations stated in this application are true and correct. /I Edey,_ Minn A P R 5 18 — Owner Kind o. Used a: To be completed about Estimated Cost, $ L Ap4ew. uilding Permit No.Z Permit No._�� - DESCRIPTION OF WORK HEATING w Warm Aar—No P'ir Size Na��� 2 Trade Nam Capacity Sq. Ft. E.D.R`0 BTU H.P. Total Connected Loa' d ` Kind of Fuel BURNER — Trade Name% Size No6227— -,-e) Capacity-� Sq. Ft. E D.Rr���'�' BTU H.P. GEO. SE®G ICI' HTG. & AIR-COND. CO 1001 Xenia Av. S. Minneapolis 16, Minn. Signe By 42 iM 7-59 Business Phan o. (REMARKS -OVER) D•56 � v HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS® ® MINNEAPOLIS- MINN Weatherstrips A.S.H.V.E, Construction No. Insulation Guide WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No Yes—No 19— I`— Room Length -2--, ° Width t ► Height II I Fl. I 1 Room l Length 12- Width 11 Height 'Z Windows and oors—Crackage and Area Width I q Width Height No. of Lineal f . Area No. of pane of pane lights of crack sq. ft. Windows and Doors—Crackage and Area No. Width Height No. of Lineal ft. Area of pane of pane lights of crack sq. ft. Coef. Coef. Btu Infiltration aL 7-7 to Sp Glass �, Net exp. wall Int. wall Infiltration Exp. wall `L X1 ® ®® a IN WN Net exp. wall Exp. wall 2,9 ef Floor Int. wall 4 Ceiling i IY t® Ceiling Floor 3 a Floor : Total Btu. 1 10 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I Fl.l a te , Room I Length t in Width % cN Height Windows andboors—Crackage and Area Width I q Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Windows and Doors—Crackage and Area No. Width Height No. of Lineal ft. Area of pane of pane lights of crack sq. ft. Coef. Btu Infiltration aL 7-7 to Exp. wall 2Q ® �, Net exp. wall Int. wall Infiltration v Ceiling 16 X1 ® ®® a IN WN Floor Exp. wall A6� Ceiling Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1. Room I Length I I Width I °o Height 'K Windows and Doors—Crackage and Area No. Width Height No. of Lineal ft. Area of pane of pane lights of crack sq. ft. Coef. tSY Infiltration .3 a qS0 Glass (m S® Coef. Btu Infiltration I? 1 eke® Glass a IN WN 1500 Exp. wall A6� Ceiling Floor Net exp. wall Int, wall 4 Ceiling i IY t® ® 3 a Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. oP pane of pane lights of crack sq. ft. b Coef. Coef. Btu Infiltration .3 a qS0 Glass (m S® 9,00 Exp. wall 9 Net exp. wall Net exp. wall Int. wall t r Ceiling Ceiling Floor Total Btu. I S3 7 1 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I Fl. ! -& Room I Length 14 Width 10 Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane ofp�ane lights of crack a.. ft. Coef. Coef. Btu Infiltration b Y g S; Glass —0 `� O Exp. wall Z. 2 Exp. wall Z Y t 2. Net exp. wall Net exp. wall Int. wall Int. wall Ceiling Ceiling Floor )C t Z Floor 1 Total Btu. I Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 FI. t� saw 2L Rnnm I Lenath t C Width 12. Height ' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration 14 � Glass —0 `� O Exp. wall Z. 2 z, Net exp. wall Int. wall Ceiling Floor )C t Z 1 Total Btu. sq. ft. E.D.R. or sq. ins. W.A. Leader area Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room ( Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lighta of crack sq. ft. ft. D•56 OffW v s Coef. Btu HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MINNEAPOLIS. MIM. Weatherstrips A.S.H.V.E. Construction No. Insulation Int. wall Guide Reference ��- Exp. wall Floor WindowsI Doors Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No Yes—No 19— Int. wall Fl.� Room I Length Width cl Height 06 FI.1 Room I Length Width Height Windows and Doors—Crackage and Area �3 Windows and Doors—Crackage and Area Width Hefght No. of Lineal ft. Area No. of Wane of pane lights of crack aq. Pt. Width Height No. of Lineal f . Area No. oP pane of pane lights of crack sq. Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room ( Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lighta of crack sq. ft. ft. Coef. Btu Infiltration Coef. Btu Infiltration ( Cn Glass Int. wall ��- Exp. wall Floor Net exp. wall 6 (n 1 C4` Int. wall Ceiling �3 a Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room ( Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lighta of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Floor Total Btu. Required sq. ft, E.D.R. or sq. ins. WA. Leader area I F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. JCoef.j Btu Infiltration Glass _Exp. wall_ Net exp. wall Int. wall Ceiling Floor Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1I Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef.1 Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. his. W.A. Leader area F7:1 Room I Length "' Width Height Windows,,and, Doors—Crackage and Area Width height No. of Lineal ft. 'Area No. of pane of`pane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Effective On January 1, 1991 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 - Aiso Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes Rate TOTAL $ 20.00 $ ` $10.00 $ $10.00 $ $ 10.00 $ $10.00 All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/industrial 1 % of Value of Appliance or Work State Surcharge TOTAL FEE x tj0 �E MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 JOB ADDRESS /qc-;6 W ind o- m ere- Dr n i 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 60 - Z-9 ,1991 OWNER 3"P— Ptir7' o U` I k BUILDING USED AS ESTIMATED COST /0-0() (9 O PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) arm Ai Trade Name Briom- - Size No. 395 C AV® " c� BTU 't fog HP EDR Fuel,,M Total Connected Load er,00 0 Burner Trade Name Size No. ° BTU HP EDR HEATING COMPANY. Signed Approved ByGEF Rough -In Date KM, A/C & ELECT. INC ! CENTRAL AVE. N.E. Tel No. -75'7_6--Lo-0 Final Date ` Z'�fi� *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CII Y OF I-RIULLI IIVJI-LU 1 ION LAV 6431 University Ave NE Fridley, MN 55432 (763)572-3604 PLUMBING FIXTURE RATES New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () Nc Type Reinspection Fee $47.00/Hr L-ttective un Jan 1, 2002 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Bath_ Wash Drink. .. Floor Catch Auto. Gas GasMlsc Water Heater Tub Shower Sink, Tray Fount. Drain Basin . Washer Appl, Range Ft�c#,. ..> Gas Elec NO. RATE TOTAL JOB ADDRESS �1 p�Cj 1 `(g (�1 Q�PJ Dr, �k $ 7.00 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 odes $ 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�- 20y $ 7.00 $10.00 Owner $ 7.00 $10.00 Building Used As $10.00 $10.00 Estimated Cost — PERMIT NO. $15.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE 50 $060 - PLUMBING 60 PLUMBING COMPANY SIGNED BY __L c TEL NO��� FAX # - - Approved By Rough -In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. 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 V NT rf)KjN CTQR AND CQMR1 IRTION AIR VPRIFIreTION When replacing an exictino furanre 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 manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing rn - J.- Linn air is sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When required to install a n -w comhustion air. it will be sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When instam yentinaqyqttam, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers 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. Appliance Type and Rize/ ommon Vent Yes( )No( ) and Ven t Canintactor Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Appliance #3 Type BTU Input Fan Assisted or Nat 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 HEATING CO: Signed By: Date : CITY OF FRIDLEY PERMIT NO.: 2004-00444 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 572-3604 FAX: (763) 571-1287 ADDRESS : 1429 WINDEMERE DR NE PIN : 253024120027 LEGAL DESC : INNSBRUCK 2ND ADD : LOT 4 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITIONIALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. KITCHEN & BATHROOM ALTERATION # INSPECTIONS APPLICANT SETHI SANJAY K & NEETI 1429 WINDEMERE DR NE FRIDLEY, MN 55421 OWNER SETHI SANJAY K & NEETI 1429 WINDEMERE DR NE FRIDLEY, MN 55421 1 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date STATE SURCHARGE, ELEC FLAT 0.50 ELEC PERMIT FEE - MIN (RESI) 20.00 TOTAL 20.50 PAID WITH CHECK # 2377 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ul/ CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 YAX: (763) 571-1287 PERMIT NG.,-, 2004-00443 DATE ISSUED: 04/05/2004 ADDRESS : 1429 WINDEMERE DR NE PIN : 253024120027 LEGAL DESC : INNSBRUCK 2ND ADD : LOT 4 BLOCK 1 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 500.00 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. MOVE KITCHEN WALL APPLICANT SETHI SANJAY K & NEETI 1429 WINDEMERE DR NE FRIDLEY, MN 55421 XIA0 01.7 SETHI SANJAY K & NEETI 1429 WINDEMERE DR 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 worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or c 1 pr vi§ions of any other state or local law regulating o the performance of constructi n. Applican Date Bldg Insp Date BUILDING PERMIT FEE 23.50 FIRE SURCHARGE 0.50 STATE SURCHARGE, VALUE 0.50 TOTAL 24.50 PAID WITH CHECK # 2377 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 11 NEW [ ] CITY OF FRIDLEY , Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: 14)-01 W �i/ i cQ (Y► G �, Legal Description: Owner Name & Address: SCAL� SA16 Tel. # Contractor. �� 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 IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. " OTHER: )'Ylo,� i.� _ `--,VP-Out" c inn gSjy t.� 4-e r Construction Type: WC564� Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: S 200 APPLICANT: 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. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - 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 [ ] TOTAL $ 1 S STIPULATIONS: t"41 �- S. �.ia:7C - . !J!a' 1. 5.`i�. I'9J L -"'D- d J"� ID N F W t 1 0`11-Y OF FRIDLEY Errective 11912004 �0bld J 5431 University Ave NE, Fridley, MN 55432 (763) 572-36©p8jljVpp Al TER (J SINGLE FAMILY ANLL DUPLEXES R-1 AND R-2 (763) 571=128BUILGIIdG PERMIT APPLICATION It'-wr D,^ - vl`l�if Ui� rij� � � e - c / C.- Uwner Name 6 Address: Tel. '--Ui ILS d%.,Iu° . MN LICENSE # Mjrli ess: azLA f1i)(JAw &EfY1WELIL InI, Tel. # 6/2- - 4 WO EXCELSIOR BLVD, STAfti iZU-t#WaPPlicWMS a Certificate of Survey of the SETA 1`10017-ING & REMODELU�4+ 41UU EXCELSIOR BLV6rNVt96'J0?8P8sed construction drawn on it to scale. T ROUIS PARK, M1 55196 i?lD 4000 1050 DESCRIPTION OF IMPROVEMENT 1 -WING AREA: Length Width Height Sq. Ft. GARA(F ATEA: Length 1Nldth Height Sq. Ft P1=x-11. AREA, Lei,ytti Math i Hgt/Ground Sq. Ft. 1 VTI IER: �i I li uGii l i Tyis ci _'` tea a v Estimated Cost; $ r Ft =$ NT:� /` �� l''�.�� Tel. # _ W / �% 6411 (lu;s) 511-3601 fet' Puitiiit Fee, if mailing in application. Fax to 763.571-12$7 if using credit card and we will call Cu fur Call nurlal,er. Permit Fee Fite Surcharge Stale Suicl-iafge j% 0 CI jarge Licnse Surcharge rurh Gmt Escrow krusi��ti t.=��rltic+l v� �v4r Mall, GlIal-gi✓ CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/1 Ott-,%) $.5041,000 Valuation 1350 Pei SAC Unit $>.00a (State Licensed Residential Contracturs) Alt. "A" or Alt.. "B" Above -$,150.00 Conservation Plan Review Fee Determined by Engineering i�v,11eement Necessary [ ] Not Neces§ary [ ) STIPl1l KOONS: From: City of Fridley To: 651-203-0554 Page: 4/5 Date: 7/26/200612:02:13 PM S kl;Fs .14:=� Building. Permit Fee BUILDING �, See Back Page for Fee Schedule Plan Review Permit No.: Inspections Fire Surcharge RESIDENTIAL APPLICATION .001 times the total job valuation Received Byb 763-572-3604 .0005 x Permit Valuation Minimum $.50 CITY OF FRIDLEY $ TQO $5.00 (State Licensed Residential Contractors) Date S P DATE�YOURE-MAIL ADDRESS $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow SITE ADDRESS vy,nden( enc 3�'I ,f�z-k Erosion Control $ THIS APPLICANT IS: ❑ OWNER XONTRACTOR $ Fee Determined by Engineering PROPERTY OWNER/ NAME: Agreement necessary ( ) Non Necessary ( ) Total Due TENANT ADDRESS: GCAV y,$1 CITY STATE ZIP PHONE: CONTRACTOR NAME: i�hzA x ar SIX nr)aA IC 0� STATE LICENSE # 7-02— EXP DATE SUBMIT A COPY OF LC , 1P CITygk0L.r!',r��4y, ' STATMIP YOUR STATE LICENSE ADDRESS: WITH APPLICATION PHONE L-kCt FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHEDINDOWS ❑ BASEMENT FINISH 0 ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW `"❑ ADDITION ❑ MAINTENANCVREPAIR MEMS Let2kaL-P DESCRIBE WORK BEING DONE:,fie SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES [3 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 ❑SOfftt ADDITIONS, & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS Wfes ONo LOCATION OFINDOWS j OR FOR NEW OPENINGS -DESCRIBE SIZE OF PA., P_ G(e OPENING CHANGES & 1,51ckS TYPE OF WINDOW TO BE INSTALLEDC4, NUMBER OF WINDOWS N ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OY LAIWX A4.0 NIA I c a •,: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 9::�d l00 - ( OCCUPANCY TYPE Permit Fee $y �, See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ TQO $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 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 work which r uire revie nd approval of plans. SIGNATURE OF APPLICANT PRINT NAME d DATE��c ��'