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PRE 2010 DOCSi City oFridley, Fridl, Minn. 0 BUILDING PERMIT x® Date:....._.. P909W.10s....9...9...... ..................................... --- Owner: Address Builder --.......Thomas S. Silvia Address RIQQ.._Indiana... AVenue... NOrt-I......_.....__........ Minneapolis, Minnesota LOCATION OF BUILDING No....._ r�l:�,............ Street ..----........ri th... S�re®t... N. 1C. .................... .............. ..................... Part of Lot ................................... _............. - ............. .............. _._. Addition or Sub -Division ..................p... BIId-,----- �d.C1j.t 0II...._......._...� Lot 20- ............ ... Block .....-.....................2. V .l CornerLot .................................... Inside Lot ....................................... Setback ............................................ Sideyard.................... _............. _............................ _........... Sewer Elevation .................. $,'o..........._......---...........................-............... Foundation Elevation................................................................................_............._-- DESCRIPTION OF BUILDING To be Used as: ..DW .................. _..... Front 400 Depth ...-.24V" Height ......._..1--9 "Sq. Ft. _90...-..-_.. Cu. Ft. 100. ..._ .............._................._................... Front ........................ Depth ................ _.. Height ............... Sq. Ft......................... Cu. Ft......................... Type of Construction ............ Fr me ........................... 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 ordinances of the city of Fridley. In consideration of theyment of a fee of $ __48 p a ............. permit is hereby granted to ....._............._......... _...._—...__.........._......._.......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any oft provisions of said ordinances. .e Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name Buil der Address LOCATION OF BUILDING :L/0 e No. Street �i�'�%-. Part of Lot. Lot ; Or Block Addition or Sub.Div. Corner Lot_)( _Inside Lot, Set Back Side -Yard SEWER ELEVATION�P FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building loc! ._ on. DESCRIPTION OF BUILDING To be used as: e4- Front Depth % o , Height Sq : ':.Ft: ��® Cu. Ft. Front Depth Height Sq. -Ft. Cu. Ft." Type of Construction Estimated Cost:` /Z red Td'+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 correct. DATE_Z 2/6 7 SIGNATURE (A -Schedule of Fee costs can be found o t�veide.) City of Fridley 4 Application for PIUMVIng and Cas F&Nng Pem* Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location- PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $-91 ca ZSQ Vl y yp K �Kp Z_ O� $ ,T�� �°q' �QZ n 1U� R N WATER HTR. GAS ELEC. 3 NO. RATE TOTAL al x $1.50 YI 3 !- C LL Yl LL O U`1 U 0 3 Ii Q Ci 6 O Base 1st 2nd 3rd 4th • Future Connection Openings Connected with New Fixture, Old Openings I Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 $-91 ca Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... Z x 2.00 $ o New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ / L Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................$ TOTAL FEE $ 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. Fridley, Minn � � 19 /' ej, Owner 19— Kind of Building �!/�- p , 19— Used as To be completed about y Estimated Cost, $ �� O Old—New. Building Permit No�C O Sign �� L 7 — �='y By z� v~ Business Phone No FEB 3 1960��_°� 11 POST 1M-12-58 City of Fridley, Nunn. BUILDING PERMIT N? 5 4 2 Date: -'r— 'V V... Owner:er Address Address -�N OF BUILDING No. ka Street _. — Part of Lot Lot 0__ Bqqck 221Addition or Sub i on Corner Lot — 1 Inside Lot ,FWtback deyard Sewer Elevation F6undation Elevation DESCRIPTION OF BUILDING be. as: Front VIJ Depth Height Sq. Ft cu' Fro Depth H ht I Sq. Ft Cu. Ft Type of Constractio .....� 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 ordinances of the city of Fridley. In consideration of the payment of a fee of 12 -4 , permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the meson to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon v�gton of any of the provisions of said em Building Inspector NOTICE This permit does not cover the construction, installation for wiring, plumbing, Bae heating, sewer or water. Be sure to we the Bu[Wing Inspector for separate permits for thea items. Owner's Address No. APPLICATION FOR BUILDING PERMIT CITY OF FRIDIEY, MINNESOTA LOCATION OF BUILDING Abq of Lot Lot Block Addition or SubdivisionL Corner Lot Inside Lot Setback Z 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 vZ �- Height /0 Front Depth Height Sq. Ft. Cu. Ft. Type of Construction,Estimated Cost ® C" 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 representations stated in this application are true and correct. A 3 j (A S& dole oP Fee Costs can be found on the Rever Side.) 0 0 • • 11 X900 City of Fridley, Minn. N° 7820 BUILDING PERMIT MOV-711MVP _ . . Owner: F. ©anderstoep Bider Inter City Garage Builders' Address 6101 5th Street N. E. Address 35 H• 10 1i 1s.l NIM- 33 LOCATION OF BUILDING No. 6101 Street 5th Street N. E. part of Lot Lot - 20 _ Block 2 Addition or Sub-DivisionU�anas 0 2nd Addition Corner Lot _ Inside Lot Setback — Sideyard Sewer Elevation To be Used as: Foundation Elevation DESCRIPTION OF BUILDING Front Depth Height Sq. Ft Cu. Ft Front Depth Height Sq. Ft Cu. Ft Type of Construction Est Cost P.P400.00 To be Completed Storm damage repair In consideration of the Issuance to me of a permit to construct the buildindindescribed above I agree to do the proposed work in accordance with the description above set forth and in ]lance with a'll provisions of ordinances of the city of Fridley. /► / In consideration of the payment of a fee of $_10.00 _permit is hereby granted to Inter City Gar. Builders t to construct the building or addition as described above. This permitis granted upon the express condition that the Peron to whom it is granted and his agents, employees an 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 location, construction, alteration, maintenance, repair and moving of buildings within the city limits s permit may be revoked at any time upon violation of any of the provisions of said ordinances. Allen Jensen Building Inspector NOTICES 7hfs peemft don not emu the eondmd lee, fns &Won for wbht , pinmblag, gas hash& www or wdw. Be sun to no rho S Udiog r for apuato pormhs for OWN Moms. a APPLICATION FOR BUILDING PERMIT LOCATION OF BBUILDING No. �j ¢� Street. • Jell l/•, Part of Lots LOT BLOCK ADDITION OR SUBDIVISION I[ Corner Lot Inside LOT Setback Side -Yard SEWER' ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two,.Certificates of Survey of Lot and proposed building.locatign drawn on these Certificates. DESCRIPTION OF BUILDING To be used as; dW" Front Depth _� Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft.. Type of Construction ,Q Estimated Cost To be completed /4 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE (Schedule of Fee Costs can be found on he Reverse Side). CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE $12.00 $ ' GRAVITY WARM AIR: RATE TOTAL Job Address�� / ��g� / / eg- Furriace Shell & Duct Work $12.00 $ $ Replacement of Furnace 7.00 7.00 $ $ Department of Buildings Repairs & Alterations -up to $500.00 4.00 $ City of Fridley Repairs & Alterations each add. $500.00 (over 199,999 BTU see Fee Schedule) Tel. #571-3450 MECHANICAL WARM AI•R: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STEAM OR HOT WATER SYSTEM: 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 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the 7.00 facts and representations stated in this application are true and correct. 7.00 S 4.00 $ Fridley, Minn. / , 197,? OWNER Boiler & Lines up to 100,000 BTU $12.00 $ each addn. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ each addn. 50,000 BTU 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ GAS BURNER- from 100,000 BTU to 1990999 BTU $10.00 $ 10.0c) (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ Joc) , Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00• $ AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule $ VENTILATING SYSTEMS $ ALTERATIONS $ REPAIRS $ State Surcharge $35050 TOTAL FEE $ •al_b ROUG'S INSP. REINSPECTION FEE Date ($10.00) PINAL INSP. Date APPI VAL FOR PEIMIT hZ362 MINIMUM FEE FOR ANr HEATING PERMIT IS $7.50 PLUS $.SO STATE SURCHARGE KIND OF BUILDING USED AS TO BE CO ESTIMATED COST OLD - BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Wate , Wazm Ai No. Trade Name Size No. or) 0 Capacity Sq. Ft. EDR BTU HP Total Connected Load Kine] of Fuel BURNER - Trade Named Size No. Capacity Sq. Ft. EDR BTU HP Company 1VO 1 ii Cid( Signed By Tel. No. SUBJECT City of Fridley® 14696 AT THE TOP OF THE TWINS PER I T BUILDING ECEIPT NO. `L - COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ��� O 1 � ; 1 / "1 CITY HALL FRIDLEY 55432 't---- NUMBER REV. DATE PAGE OF APPROVED BY \.J 612-560-3450 910-F15 5/12/78 JOB ADDRESS 6101 Sth Street N.E. 1 LEGAL TRACT OR ADDITION SEE ATTACHED ILOTNO. DESCR. 20 2 Upland 2nd Add. SHEET 7 -PROPERTY OWNER MAIL ADDRESS ZIP PHONE Donald W. Perish bbl 5th St. N.E. 55432 574-0908 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Dwelling 7 CLASS OF WORK ❑ NEW ❑ ADDITION CX ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remove interior walls and install open stairway 9 CHANGE OF USE FROM TO STIPULATIONS Block existing sliding glass door until step or deck is provided . Call for rough -in inspection before covering TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $ 500.00 $ .50 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- $ 7.50 STRUCIION OR THE PERF,4RMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $ 8.00 SI NATURE OF*CONT.TOR OR AUTHORIZED AGENT IDATEI \SIGNATURE W N P OP RLY V ID BLDG INSP E T IS IS YQUR ER IT 17ATE OF OWNER BUILDERI 10 EI CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PEIMITS (NEW, ALTERATIONS, ADDITIONS-, OR REPAIRS) 011I1ER: 12 a W ��� BUILDER: Address: �, d �� Address: Tel. No.: ©_ 9d, No.: Street: LOT: CJ BLOCK.: �_ ADDITION: L A Ij d CORNER LOT: I14SIDE UtiT: SETBACK.: SIDEYARDS: Applicant attach to this form lvo Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Sf A Ilk w �-AA L±EA, Depth: Height Square Feet: Cubic Feet: Front: Square Feet: Depth: Height: Cubic Feet: Type of Construction: Estimated Cost: $ 2�jrC`/C7 To Bp Completed: > /Lfp�1 �� Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired ! $ $ (SEE PX -VERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict .-accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. See reverse side f additional information. DATE: 7 SIGNATURE: Stipulations: PR dv This is wAyt-6 NA k-:RH- - Building MECHANICAL Permit No.: -9I0W _"41 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 U19300- CITY OF FRIDLEY 763-502-4977 FAX EFFECTIVE 2-19-09 DATE OV • e YOUR E-MAIL ADDRESS SITE ADDRESS O I �� S E THIS APPLICANT IS: ❑ OWNER NCONTRACTOR PROPERTY NAME: ®.1!`mer` ADDRESS: tok o t Sk y0e CITY STATEI ZIPsS143� OWNER/ TENANT PHONE: —1 t03 - 5"11. 3 ® (V L4 CONTRACTOR COMPANY NAME: CENTERPOINT ENERGY SUBMIT A COPY OF CONTACT PERSON: JOANN ZINKEN YOUR STATE STATE LICENSE!! BOND 22013346 EXP DATE 08/19/2009 - LICENSE WITH ADDRESS:9320 EVERGREEN BLVD NW SUITE B CITYCOON RAPIDS STATE MN ZIP 55433 APPLICATION PHONE 763-757-6202 FAX 763-757-6701 PERMT TYPE I�SINGLE FAMILY Cl TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 11 NEW IV&PLACFMENT 0 ALTERATION/REMODEL DETAILED DESCRIP``Tj N OF WORK �y- Q X1-1 r - Ond t one FEES ARE BASED ON $10.00 PER FIXTURE,j' COPT WHERE NOTED. FIXTURES: INDICA E TOT L NUMBER OF EACH B L W Equipment Installed MFG: �Q MODEL: C6 SIZE/BTU go 1_&�o MFG: MODEL:y��.� SIZEBTU oZ.'1vt�I SS 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 $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00 _BOILER CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 y dSKi ` . � 2'if� g.1� '�, yryi_2, h ,� � VEL \ �;�-r�K � ����L �"� t a��*3{i�+`. �n � �'?��Y�,V` �yi•� t s'•"�ti¢� _v'�i�'n•1 a �v3f';'u3' ♦ � -t :x ��' c, t (- �.��,4 � ��k t k�`�Sa ae ,�«' E ,'a�5�*�,�'�_: ���i yr r;,x ��, < a i�„�.�'� n"s�ef9,�,'S" W J a ��� � XiT M1'�� �''� .5. _ 'v ti � R✓��2"•� ;` d•C1, n.'':,e S'" „k ���,y,.V". c`�f V �""�4.`'�S' ��@' i'4`Lk. k � £�� �S���vST 'at�F� '4 ' t' .' 1, �y _ � '`7' �- x.'4:� �„p � �++�i s 't" J.� �R�� £`fir+ /E2� +��, RS b"P� � Ai:. .�3�`•i�2 .�tS' .J ��i� +f" _ x��"�.sL�:' fA '�4 C� ��� � �'S�'.v' �. �g �.. �;`��1: S "4 �.�Pxx��,�'„k`� pS ��e'%. £. �i �,�, ,. ,i § °'4S£.. i����k�Cn.} f'''�" fi. «+: i�r•% 4 . f��'1�3�s����v`a�?' �`.�4-�TeE7+•VN 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 all work whi h uire eview and approval of plans. • � ~`'pPRINT ROGER HOFFHEIN SIGNATURE OF APPLIC ��' NAME DATE 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 0 NEW HOMES/ADDITIONS ZEXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 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. Duct Design Per IMC 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 $ BUILDING ! ' Permit No.: Inspections Fire Surcharge RESIDENTIAL APPLICATION J P .001 times the total job valuation Received By: 763-572-3604 5cR8 .0005 x Permit Valuation Minimum $5.00 CITY OF FRIDLEY $ Da 'tjoV 1 �® 763-502-4977 FAX I $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ EFFECTIVE 7-1-2010 $ $450 Conservation Plan Review DATE 17 I Vcc YOUR E-MAIL ADDRESS O Fee Determined by Engineering SITE ADDRESS Vii-? 7�L1 S7 r. Agreement necessary ( ) Non Necessary ( ) THIS APPLICANT IS: ❑ OWNER ONTRACTOR Make checks payable to: City of Fridley Attach Stipulations PROPERTY OWNER/ NAME: `a TENANT ADDRESS: !IrA CITY 9YLA tV L4 STATE_Md ZIP �5 2 PHONE: ""%!IDI CONTRACTOR NAME: I n do Remodeling SUBMIT A COPY OF YOUR STATE LICENSE 1 82b Point Douglas ® a STATE LICENSE # J'7 N eM�1 EXP DATE J / MN AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE p '�` PHONE (QS $ " C) "t "'f FAX SL� - I Sulo PROPERTY TYPE SINGLE F Y/NEW CONSTRUCTION SIZE ❑ TWO FANIILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED AWINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR AREMODELING DESCRIBE WORK BEING DONE: fJ4=S SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & 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 ❑Soffit 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 es ❑No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND OR FOR NEW OPENINGSZDESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & 17if TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: �// SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ D `f ob OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ J P .001 times the total job valuation Surcharge $ 5cR8 .0005 x Permit Valuation Minimum $5.00 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 $ Make checks payable to: City of Fridley Attach Stipulations THIS ISAN 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 on site; that the work will be in accordance with the approved plan in the case of a rl equtres review and approval of planCt SIGNATURE OF APPLICANT �� PRINT NAMED�V� (l%1 tO��S DATE ELECTRICAL AND MECHANICAL WORK 7 V1 Building BUILDING Permit No.:6VV106d3&,67 Inspections 763-572-3604F RESIDENTIAL APPLICATION Recei : - CITy O FRIDLEY nate 763-502-4977 FAX EFFECTIVE 7-1-2010 DATE IZ13 lin YOUR E-MAIL ADDRESS CI 1.4 Q P14e e4 ll bOl� i�f1 �i Vt k— . n i' SITE ADDRESS -e- THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: ADDRESS: (it 1 O1 ..i h 5+ CITY ` STATEVWZIP—S C L TENANT PHONE:�76 "i -5'T I" 30(¢ CONTRACTOR NAME: L o e. a STATE LICENSE #ti S EXP DATE 3 (3 I —►— SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: �Z vt t 4 CITY �%STATEJ§,&JZIPSJQ53_ INSURANCE PHONE Z — 1-7 ne FAX (a PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE DDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TELE ❑ SIDING ❑ OTHER ,VbECK ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: • tt t SIZE OF IMPROVEMENT LENGTH WIDTH LL HEIGHT ZOSQ Fl �.. ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES PROPOSED SIZE: ❑ ATTACHED GARAGE �- bt?.� V N ❑DETACHED GARAGE_ ' + � 2. Proposed floor plan 3. List of structural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDIN_ 4� ADDITIONS & PORCHES SUBMIT: ❑Vinyl ❑Soffit `� 1. Site Plan/Survey showing the existing structures ❑ amino "Trim�i3 � 14 SPD : and proposed project. ❑ Fascia 3 2. Two sets of construction plans VANDOWS j ,, 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS��'� FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF `j' 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 IT4Fy1997 . J,.B.0 FEE SCHEDULE) TOTAL JOB VALUA' Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $-421 0'. C) $ 3(Pr0q- $ 5.eo _ M. 1114 I See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $5.00 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks savable to: City of Fridley Attac 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 on site; that the work will be in accordance with the approved plan in the case o Il work which uir eview and approval of plans. n 1 - Q / SIGNATURE OF APPLICANT �� (A t�� PRINT NAME L R h P Oi I� t 1�1 S DATE �j ( v APPROVAL INSPECTOR SIGNATURE PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK Nil m L7 .Qom/p-ec�— 0 V e-� 107 :�.40 I �LG"l JL 1