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PRE 2010 DOCSNEW [� ADDN [] ALTER [ ] Construction Addre Legal Description: CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Owner Name & Address:'eF4- tfLAZ.. Tel. # Contractor: M eco A OW U; e w 401hes MN LICENSE # Address: I gG21 Nloeraeem } - q q-� V. L & M Tel. # -707V- 73ZO LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to'scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft Construction Type: /V %ji Estimated Cost: 69 -:�f/o Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ DATE:S5® 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. CITY USE ONLY - Permit Fee $ CI L15.7 5- Fee Schedule on Reverse Side Plan Review $ ( &&4 .-ILI 65% of Permit Fee Fire Surcharge $ 0C49 .-3�,1 .001 of Permit Valuation (1/10th%) State Surcharge $ 134, ( $.50/$1,000 Valuation SAC Charge $ L+f- Q,00 $1450 per SAC Unit License Surcharge $ S , Q $5.00 (State Licensed Residential Contractors) Curb Cut Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Ag^yr.�e�e eent N®e{`�^TwwggssGary ] Not Necessary[ ] !S78 ' Ze `Y o `�1� C 1'-`HI���M�N4- TOTAL $ I (a 03 STIPULATIONS: City of Fridley 6431 University Ave. NE Fridley, MN 55432-4383 763-571-3450 10 -May -05 Special Assessment Search And Statement of Charges TO: On all that tract or parcel of land lying and being in Anoka County, Minnesota described as follows to wit: Parcel No: 13-30-24-44-0117 1561 WOODSIDE CT Lot: 3, Block: 1, TBEILMANN EST LEVIED SPECIAL ASSESSMENTS This is to certify that I have examined the records in the office of the Clerk, City of Fridley, Anoka County, Minnesota, and for such search, certify that the following special assessments appear unpaid with respect to the above described tract or parcel of land: Term Certified Initial Interest Remaining Current Current Project Number Project Description Type (Yrs) Date Amount Rate Balance Principal Interest NONE PENDING SPECIAL ASSESSMENTS For the purposes of this document, the City of Fridley has determined that an assessment is considered pending after the City Council passes a resolution ordering the improvement, the approval of plans and the advertising for bids. This is prior to the City Council adopting the final assessment roll. If you seek further information, you should do so upon your own independent inquiry. Any amount given as to pending assessments is informational only and may or may not be the amount ultimately assessed. Term Initial Interest Estimated Project Number Proiect Description (Yrs) Year Rate Pending Amt. 5000-2004-01 00 Theilmann Estates Improvements 0 2004 0.000% $14,936.58 $14,936.58 MISCELLANEOUS FEES Description Status Date Fee Amt. Park Fees Unpaid 3/24/2003 $1,500.00 UTILITY CHARGES You shall be responsible to verify the status of any outstanding utility charges. To check utility charges ( water and sewer) contact Fridley Utility Billing Department at 763-572-3529. The records referred to above are public and may be inspected by anyone during regular business hours. The search of these records was made by the undersigned as a public service on request. The undersigned certifies that the above indicated searches were made and are believed to be accurate, however, the undersigned or the City of Fridley does not insure the accuracy of the above statements and does not assume liability for errors and/or omissions. The above figures are good through November 15, 20 Date Prepared: Tuesday, May 10, 2005 By Page 1 of 1 City of Fridley 6431 University Ave NE Fridley MN 55432 (763) 572-3602 or Fax (763) 502-4977 Water and Sewer Permit Application New Connection ❑Utility Line Repair/Relocation ❑ Existing OWater and Sewer Connection Date: J �, p Job Address:, (40 V0 Name of Applicant (Plumber):.. , C-0 P P Name of Property Owner: EAAou) 9%ler.j Er Existing Structure Permit # Permit Typel�-�" : Sewer Fee: p eu-s Water Fee: Meter Fee: Repair Fee: Relocation: State Surcharge:-�� SAC Charge: Special Assessment Fee: Total: $ 1016" N Applicant Signature: Inspector approval: Water Meter Repair — Weekend & Holidays $125/hour Water Connections Permit $50 Sewer Ca ections Permit $50 Inspection' Fee for Water/Sewer Line Repair $40 Special Assessments See En ' eerie Cost of Water Meter See Utility Billie SAC Charge $1450 State Surcharge $ .50 Water Ta See Engineering 04/04/05 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 KAAPV NI 1URFR nF FIXTI IRFS TO RF INSTALLED ON EACH FLOOR Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Stories >����I Urinal '�•:"•[i Shower •.�.,�#. 't Wash Tray If`E:::::>::: Floor Drain �><<: Auto. 1 Gas <.....:::. `':�� Range I.�M< Water Heater �� l~```• ���'...... Gas jElec Bas ement Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** Floor or 1 Back Flow Preventer Required ( )Yes () No Type Floor 2 -" / Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS /SW/ $10.00 f �01 OV The undersigned hereby makes application for a permit for the work herein $10.00 specified agreeing to do all work in strict accordance with the city codes $10.00 and rulings of the Building Division, and hereby declares that all the facts $10.00 and representations stated in this application are true and correct. $10.00 $10.00 DATE: 3 _120 $10.00 $35.00 OWNER $35.00 �� $35.00 3 v BUILDING USED AS /r e4 " $10.00 $10.00 ESTIMATED COST �'? aOc� _ PERMIT NO. $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE PLUMBING COMPANY. SIGNED BY gcJ-� Approved By J 4 (Sz- I^( 61je6rh 41;1 1z �� TEL N0.�6�-7s3- r/ 3 4 Rough -In Date Final Date $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST $ OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE l 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 $10.00 f �01 OV The undersigned hereby makes application for a permit for the work herein $10.00 specified agreeing to do all work in strict accordance with the city codes $10.00 and rulings of the Building Division, and hereby declares that all the facts $10.00 and representations stated in this application are true and correct. $10.00 $10.00 DATE: 3 _120 $10.00 $35.00 OWNER $35.00 �� $35.00 3 v BUILDING USED AS /r e4 " $10.00 $10.00 ESTIMATED COST �'? aOc� _ PERMIT NO. $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE PLUMBING COMPANY. SIGNED BY gcJ-� Approved By J 4 (Sz- I^( 61je6rh 41;1 1z �� TEL N0.�6�-7s3- r/ 3 4 Rough -In Date Final Date $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST $ OF THE IMPROVEMENT WHICHEVER IS GREATER ON WORK LESS THAN $300 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE t FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT; VENT CONNECTOR AND COMBUSTION AIR VERIFICATION Men replacing 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 terminatidn. 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 ( ) This 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 installing 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 Fumace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Id 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 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 ALTERATIONS: (Describe) HEATING CO: Signed By: Date : CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Effective 4/1/2004 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, __COOLING, VENTILATION 763-572-3604 FAX 763-571-1287 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE Fee Total j Residential Owner � 1� � f-ai Fumace Shell and Duct Work, Butner & ��.� &_ �� also Replacement Furnace $35.00 $ Building Used AsTLadefif Gas Piping (New Furnace, Fireplace, Insert) $10.00 $ %®. ESTIMATED COST /®FCD PERMIT NO Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ # of Heating U ts�_ Circle One (Steam) (Hot Wa r) (Warm Air) Trade Name fC!y Size No. *Air Conditioning - AllSizes $25.00 J, BTU 1,40. �Q HP EDR Fuel Alrr C= -_S, Total Connected Load All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ 719O® Burner Trade Name Size No. Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Improvement whichever is greater The undersigned hereby makes application for a permit for the work herein Commercial/industrial/Institutional specified agreeing to do all work in strict accordance with the City Codes 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building Division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/Industrial/Institutional and representations stated in this application are true and correct. State Surcharge $5 HEATING CO��� TOTAL FEE $_-ZLW= Signe Tel #.74-43 -7A,:* S3 REINSPECTION FEE $50.00/HOUR FAX # o Date *Air Conditioners can not be placed in side yard without written approval from, adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT.. VENT CONNECTOR- AND COMBUSTION AIR VERIFICATION When replacing 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 oto 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 installing a new venting system, the undersigned hereby verifies that it is alis ted 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 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 ALTERATIONS: (Describe) HEATING CO: Signed By: Date : Date: 5/9/2005 Revision Date: 5/9/2005 Site Information Address 1: 1561 Woodside Court Address 2: City: Fridley County: Application Information Business Name: Air Mechanical Inc. Contact Person: Brian Ebert New Construction Project #: Lot: Block: Subdivision: MN Contractor License #: Office Ph: 763-746-3753 Fax: 763-434-1699 Cell Ph: Address 1: 16411 Aberdeen St. N.E. City: Ham Lake State: Mn. Zip Code: 55304 House Details Square Feet: 4420 sq. ft. Avg. Ceiling Ht: 9 ft. Number of Bedrooms: 4 Ventilation : Balanced Total Ventilation Capacity: 174 cfm. Minimum Continuous Ventilation :75cfm. Intermittent Ventilation: 99 cfm. Combustion Appliance Water Heater: Power Vent Input BTUs: 50,000 Independently Vented Furnace/Boiler: Direct Vent/Sealed Combustion Input BTUs: 120,000 Independently Vented Other Combustion Appliances Gas Fired Direct Vent Fireplace(s): Yes Gas Fired Power Vent Fireplace(s): No Gas Fired Natural Draft Fireplace(s): No Solid Fuel Appliance(s): No Exhaust Equipment Continuous Exhaust Ventilation Capacity (cfm): NA Clothes Dryer (cfm): 135 Exhaust Fan Rating (cfm): 70 Make -Up Air No Make -Up Air Required by Code Combustion Air Round Rigid Required: 5 inches or Insulated Flex: 6 inches Applicant Name (print): SignaturelDate: - Code Official (print): Signature/Date: © 2004 CenterPoint Energy Minnegasco. 2004 Mechanical Code Guidelines. Page 1 O CITYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 November 17, 2005 Meadow View Homes 14621 Aberdeen St NE Ham Lake, MN 55304 Re: Final Inspection at 1561 Woodside Court NE, Fridley, MN Dear Sirs: A final inspection was conducted on November 8, 2005 of the above address and it was noted that the construction is completed and approved. The sod in the front and side yards will be completed by June 1, 2006. Occupancy is approved for this structure. If you have any questions on this matter, please feel free to contact me at 763-572-3602. Sincerely, .'�& - RON JULKOW KI Chief Building Official RJ/mh 04/11/2006 10:30 FRAM :City of Fridley MIding n speetiorls 763-572-3604 [ITB A,DDRSSS ,_..! CIM APFLICAW I:S: TFINAgr SUAMU A COPY OF YOUR. STA` 11 LIt"TME WITii APPLICATION 7634284463 PRECISION TECH INC \ ��� FAX NO, :7635711287 fpr. 05 2001; 10, RESIDENTIAL ,�iYFLICATION I,e eRe zef BY: CX'-', Or v LES' PIIAGE 02/0)5 YOUR T.;, -MAR, ADDRFA9 ^� ea rte. 1=14w1�iF.It )CONTRACT©R NAME. CITY-21 STA,'fk'a IMSE Q% AIsplts"M5! P C1l+TI3 r Z ��' 2-�C1' FAX S1E KNGLE FAMILYJNEW ONSTRUC17C1N — D TWO FAMII..YMM CONSTRUCTIOK 9T0EJ g WS Ij &DDMON ❑ t3AliA©WXPM p DRASN TD L E3 i3ASWMiBN'i' FINISH [2 RWF O OTHM DIILiC M StTOINO 13 SW2, MMPOOL TYM OF WORK.+ , I)MCR.T.BE'trirORK BMNG NUMBER OP SQUARES go G PROPOSM SL' 1-- pnopoawD rmr01IT: SMS C3 vinyl Ahayanwr Cl Cita, - I►+T�t} MMMOS Dyna M40 ok FOR t t:tPURNOS-ul RTRE RIM Or OF>;14MG CHA,l`ltr'M & Mo C I)USE •It (aARAGE 11 ATTAcM GARAGE 0))UTACM OARAGS OW'd p Trim 10 yNcia L0C.A'r10N OFF ` M0 WS g • O i. Ext�I: Pinar Flet► 2. proposed door Pian 3• List oft mcmni membm. to bo m14 Ft?RNEW CDN'STRIJCTIcaN INCLUDING DECKS, AD 'CO R 1. She g1M+Survey shavAng the vxMD9 *U0t1M CA t11'aPoed project 2. Two SM of Weaxlaft plana 3, BMW caled ROMS W�1S1pRt TG J3I IIdSTALd .vn �,..r.., . ALL FM ARE BAS'S ONVWTATION NC��3 )TWI x COST OF LABOR A" nTCTNr:: TTM 1997 V.B.0 FFE SCMDULE) - — %Y•i� Set Back Page far Fee u e e Pb0l7it Pte plan Review 1�4 — �—,. —5a/a o£I�urildutg 3xmcmit Fee o01 ernes d1.o tatal jab valuation Fire SU=Farge x Posen VaWjon. Minimum $.54 Slarchart�e .(1005 $5.00 (Stmt Liecnaed Residential Contractors) SU sc 5urcbarge I.iGense S 1550 per SAO Unit (flans to M4VCC far detttmin ltaorr) Lice c S 5— CWb tett Escrow . $450 Canservatio 1'latl Rcv�iew Erasion Control Fee Det ed by Disineering Park Fee , $ $ Agreement neM Y ( i Non Nece"WY ( ) se SGwcT Mata Chsrgc ^ Make ah1 bd 8 able io: Gfi of Fridl Alta+ 0 THIS IS AN APPI.dL`A.TPN FORA Fi6RMIT-N0TWAWD UKMPRMr9MND iltfcirW4.00a above is complete and acuate; that the work wilJ int Wi 1lareby apply for a bualft permit and I acleaawltc{Se that the conftsrr, ance'witb the ordinran+ce.5 t id4odes of U City of l;ridlay and with the WTITIB ata t'.cmattractiari Codes: that I uDderatand this 1s Dbt a peTxtait but only an applicatuot rmNVIF &0* oiplaathotn a perm that the vuoric will be in aardanct with a agpraved ` plan in the case of all work sI(INATt)U 6P Arr1.It:;ANT 76Y`Y 44 �°d I obi w0aD5��>✓ g I o Ls. 'I �12-- e oq- slod THIS JOB COPY SHALL BE AVAILABLE ON THE JOB SITE FOR THE FRAMING i AND FINAL INSPECTIONS I L; F-c©iz {tns Q.[� 6a.� haw m kxq sus mwe Z2cz X45 C.s. r THIS JOB COPY SHALL B� AVAILABLE ON THE J0B SITE FOR THE FRAMING AND FINAL INSPECTIONS 14rnj N CD cn THIS JOB COPY SHALL B� AVAILABLE ON THE J0B SITE FOR THE FRAMING AND FINAL INSPECTIONS H r W l N -font ih5 As = - -rh5r6-A� -r!) i 14 3> OAK R Co m 14rnj H H Z 1 H r W l N -font ih5 As = - -rh5r6-A� -r!) i 14 3> OAK R Co m 04/11/2006 10:30 7634284463 PRECISION TECH INC PAGE 03/05 PIONEt.K. lyiend90 Of{Ir e Avetnte N:9V, is M i� 5 .T, O M—Al .S 1 Agib �1mm-1T t 9t'NOSCh i A.4ZCta4i Lir:! S Zd7it [A11vts Mfiat 193.IR83 t i .1910 MWAMI1A �>usot;t 5 120 �oo� Rapids �C�t Certificate of Survey for: M' House Addr-es$: -1 M-LYA241ift.-Ourt House Model: ..,A QP. 99114 411p.d w M915.1 to b l3! 4 a vac.,an %mi .00 �f J X $1 �,,Q, �w 019.17 918.6 r f IWWOW MOUtSE 1.5 F' FMW IN t:tsYATIOTti�', SHORN QM ttACti+IG an,a 991.13 SfiRVE'I?NG A5 f3A .CTM BY JON HAMMS 7W MMC ROW ) tiAF�CFt7R „o' POCK= W= f N a2on WWI I wnuu�err G�,tGfi r � I ! 9tZo Dec IL - W Be Lid L1j 71N a 20.9:4 Ar 17 9if, B .ti *j Et .. 9116:713 &4S ter", Cos SOMM LOWEV M MVEWAT V-1 ��� 1710 o;►� Q pim ray posm-B L �r 5&.r lruric*j= t;rnergetley ovemow x om Dwates Fxbttng Elevation xcM Denotes Proposed. Elevotton .—� Dmota Urofnoge Aow ffirer tion �- 0motes orolnoge & utlity leamm nt (per r+eeorded Piet) .•+�•. Venotee O0sets Iron g� Bea�ri+�n�re aestrrn $ shown am T It !' T . I F7 T^1�.r K 1 a Top of frourowba Devow m *MR . Nm V V'*" oww*A by (" city oftwftmo ,rRn the 6 least wVy 191 44rneneloes & ddMMy a MWL 11077: ere +Here ra Qrwhbrtwen fi+al d Brad :ew11e+► 1e� ee�a�fetemlEl+�e7tl iry oontaeotot, INI�M :t $ `A TES Building $ a BUILDING Plan Review Permit No.: Inspections Fire Surcharge RESIDENTIAL APPLICATION Received By: 763-572-3604 $ S CITY OF FRIDLEY Dat . dAY -QQ� 763-502-4977 FAX EFFECTIVE 1-1-08 SAC Charge $ 1 YOUR E-MAIL ADDRESS K 9 L. U T F E I DT F— R P R 1 S F—S DATE `- $ ft + 6 ft = ft x $21 =$ SITE ADDRESS 15- 1 W C�'s S% A �-- G v P ! $450 Conservation Plan Review THIS APPLICANT IS: ❑ OWNER /CONTRACTOR $ PROPERTY OWNER/ NAME: J- E F F Lz� P'. A F\ A N S v A% $ TENANT ADDRESS: 1 ®® S/ 0L C-1 CITY C P- 1 13 L Y STATEN �4 ZIP �J Make checks payable to: City of Fridley Attach Stipulations PHONE: 17 IR— NAME: C-oW N CONTRACTOR ADDRESS: I l�s� M IS.51 SS l PP) D F� I V L � CITY C K A -M FL / PA STATE 9l/ tAP 4 -:?/-C SUBMIT A COPY OF PHONE C J ®- :?a 3 FAX YOUR STATE LICENSE STATE LICENSE # '14 - I Z EXP DATE PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DECK >gmiDING ❑ DRAIN TILE ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: di t> 9sQa `.- . 'A' �^ SIZE OF IMPROVEMENT _. LENGTH �` WIDTH HEIGHT I SQ FT . S ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 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: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum❑ Other 1 �` i_ Trim -� ❑ 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 MA-FEkUALN: J(USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ ®�I 13w _ OCCUPANCY TYPE Permit Fee $ a See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ S .0005 x Permit Valuation Minimum $.50 License Surcharge $ '5-'CJ0 $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 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; tht 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 accordanwi the approved 1 in the case of all work which requires review and approval of plans. SIGNATURE OF APPLIC_ ,� SPRINT NAME pP to 10O' L O U 4. / wry DATE �� 9 From: 7637463777 Page: 2/2� 1 1 Date: 9121/201012:47:31 PMS IJ I V JL_I Li LViV iL•VV 1 1 VIII.1111♦ I ILA+1111111 VI IL 1 Building 0\A.0 -1(71q MECHANDPAL Inspections RESIDENTIAL APPLICATION 1-eeeiva4 By..Wk 763-572-'3604 CITY OF FRIDLEY 763-502-4977 FAX BFl�CT1vIr�.1e-o1+ DATE 1 `I w t YOUR E-MAIL ADDRESS Y h/ . orn l wry^ 0,r 5 I GL SITE ADDRESS _,•,,,,i„•.-, LSLPI (,�(•, _ff AQ THIS APPLICANT IS: 17 OWNER WCONTRACTOR PROPERTY NAME: OWNER/ TENANTCITY ADDRESS;VW STATI!_ZiP_ PHONE,-- CONTRACTOR COMPANY NAM SUBMIT A COPY OF CONTACT PERSON: YOUR STATE STATE LICENSE # "PDATE LICENSE WITH ADDRESS! 1LOLM AM T&J„ ' STAT lP. `7 APPLICATION „ PHONF -7 FAX VA3—" 7 �t U �� I7 I PEMKIT TYPE SINGLE FAMILY O TWO FAMILY D TOWNHOUSE TYpE QF WQR&. 0 NEW 13 REPLACEMENT WALTERATION/MMODEL DETAILED DESCRIPTION OF WORKadd ORES ARE BASED ON 1110.00 PER RIXTUNE, r CEPT WHERE NOTED. FIXTUR -. (INDICATE TOTAL. NUMBER OF F.ACII OELOW) BquipmMt Im"a w MPO: MODEL- - SIZFJ13TU MPO: wll .11 MODEL: SIZEIBTU,a-� MAO: - MODEL: r SIZERITU A/C 1185.00 FIREPLACE (OAS) S 15.00 GAS RANGPJOVEN 510.00 „FAIR TO AIR EXCHANOEE FIREPLACE (WOOD) $35 00 NEW OAS ORILL S10,00 _GOMR $39.00 _FURNACE 535.00 GAS UNIT HTR $10.00 MM LINER $10. / j _OAS DRYER $10,00 :::POOL HEATER 1133.00 DUCT WORK SIo.00 I / P OAS PIPING 510.00 VENTILATORS1.5.00 t i �.� n . f! i" 5ru=':• +iJ�q• t 1 � t�•. fP"wf. I 1.,1..1 .1'�.F!"4�• „ +� ;Q�;:tl�� :':i.',°�• �rkr��:..i1,�R� .�;;�.,, ,�;��••.r;:�-`'.+•xr�'3 . ..,:,.J; Jt•1?�' 'r'�`�s•.,,.£'-' ,'P`� '� •:wr. ?"?.1L�yl ��•a �•r.s�I�r��r.7�}'�, 1 j1JLt.•i. .•i ,i. �•!:' ;a�"i ,:;N;''•. ,F yf,y 'y,L :'r:•'":SY''••6J:� .. 1', ,r.' •f ,0: r.'•i• (f:p i "T' +.1 .t �, .1" r'i �,,Yx1i• .i6T•T .I .l.'."Y.c ..'�-'�• •t •gyp. e��'':y�`Y`, .:i :�api�, {;.bi.��'_{•�+e�''1r�rtYlgi,, :L.r." �•i 'ih.•.=tr• t `'!:;' elm: 'j • I ri �,' :. ' l.i r'. �.r'g ..�" , l l Y, 1 t.y��� t,• :. r, 1 ,�, i x. �,} �t �,Cp. `(r• • 'r l,•� gr.� ;,1 .!'• �'�` �� 1':"d ?k ' i '' l: �`� ]P?�TH�' •�.� Via, &. M�WJ:'�?' ,,ri, ^:t.} +N tt'!tPt `'.';.•:i,,�'`�'4'�IJ 7�Ca� `1K` �.��''G � ':'i., �1 ;9 ,•,c" j•:Ir. f5 :. - ': r'.,^; •;. n ,d.M i`• k N]�' ,*,• .t.M1Z• . �� J•L ,t". �.r;:�'_• .,� •.P.�,• a. s •.�'�• ` • '''J.+ Iii :.'� �.°(jt; _,,. �:.. ;i.. *'` �''w° x ' 4a �'"�"" , •',.:�. . r t •,' ,.:.a'i. , :,� : ,� < �, P� r:ry' _ • . � . I'� y.:�•�{' ; �' .' �'' ,.i• 1 �!a t •.�c. 'h,•,• rY : •��• �,v1�jJ�,Yi�� ;�1..•,, °�,. ,+,'i:..a.'.n'ro•.M vj''� ''',,,•,c r .'r'x•,l'1::!'':`�:}#9••r' �r •t ';:`'�1:15:�'�:'.r'ro�i tl�k,:4' 'K.1 THIS 15 AN APPLIGA'r10N 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 confbrimce with the ordinances and codas of the City of Fridley and with the Minnesota Construction Codes; that I understand dtis is not a permit but only an application for a permit and work is not to start without 0 permit; that the work will be in accordance with the approved plait in the case of ap work Which requires review and approval of pians. SIGNATURE OF APPLICANT 1. � ,l Dpi. PRINT NAME DATE lei t Lo M 1 O • ! l ! ; M City of Fridley Building Inspections Department 6431 (Wversity Avenue NE, Fridley, MN $5432 763472-3604 FAX: 763-502-4977