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PRE 2010 DOCSCity of Fridley, Mnn.. BUILDING PERMIT N? Date: Owner: Builder -' Address Address - LC F B I DING No. Street _ ep %or Part Lot _� _ _ _'Block Addition or Sub -Division . corner Lot _ _ . _ Inside Lot _ Setback ^�� "�'_ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING :TO Used W. Aft-- Depth i Height _ Sq. Ft. Fro t Depth H ght ._. Sq. Ft. Cu. Ft. -i Type of onstruction Est Cos ' To be completed In consideration of the issuance to me of a permit to construct the building described above, f 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 $.•�' , permit is hereby granted to_ to construct the building or addition as described above. This Permit is granted upo the express condi on that the person to whom it is granted and his agents, employees an workmen, in all wor done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. _ _ Building Inspector, NOTICE: This permit does not cover the construction, installation for whing, plumbing, gas, heating, sower or water. Be sure to we the Building Inspector for separate permits for these Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owner's Name. A! 11A 4-e- Builder Jo Address LOCATION OF BUILDING r, No. 6110 Street � Part of Lot Np Lot 1 &. Block Addition or Subdivision '?14-7-A � Corner Lot Inside Lot Setback -C I _3 Side -Yard /Do 4- 2 � * SD 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 &the-, As 144,.-1 4^,, fi: — .. q-` -41 P-lAt'4. ► � Depth ;)- 9' 9` Heisht _--- — Sq. Ft. Cu. Ft. FrontDepth__A -J.-- Height Sq. Ft. Cu. Ft. Type of Construction Vy 14-M . Estimated Cost 6 _ . 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 tha 1 the facts a=esentations stated in this application are true and correct. DATE SIGNATURE (A Schedule of Fee Costs can be found on the Revers de.) Application for Power Plants and'.Heating. Coding, Ventilation, .Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $--A,—f' .each add. 60,000 BTU ..... . .................. 2.00 $ Replacement of Furnace ............................. x.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. IDR Steam_ ...... 8.00 $ Furnace Shell & Line—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 $ 41� 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 See Fee Schedule VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL FF $ ROUGH FINAL Dept. of Bldgs. Phone 819 44-7470 Location q't ® 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. Owner Kind of Bt66ng a Used as To be completed about Estimated Cost, $ Permit No. V 4� e Permit No. Z 71_3 DESCRIPTION OF WORK HEATING or P WER PLANTS Steam, Hot Water, arijAlr Trade Name Size NoNo 8-d Capacity Sq. Ft. E..D.R_ (- Yf, BTU H.P. Total Connected Load /, d ® Xiind of Fuel A" BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Signe �- By -4637 CHICAGn nVE MINNEAPOLIS 7, MINNESOTA . <a 2M 7-59 Business Phone No 52-84-s915.51 City of Fridley AppUca#ion for PI= ing and G= Mug Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK 210 Al E 69th Place Number, Kind and Location of Fixtures Location y 3 1 �F x $1.50 $ S� Y o� c Z 8n ul �� < 0 w ? u� �p • R • N WATER HTR. GAS ELEG Base 1st 2nd 1/?J P 3rd 4th • Future Connection Openings +� New Fixture, Old Openings I Connected with Sewer E] Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ........................... Water Heater (Up to 99,000 BTU) ...... New Ground Run Old Bldg. ............ Electric Water Heater GAS FITTING FEES: NO. 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 199,000 BTU .............. 1 REPAIRS & ALTERATIONS—Refer to Code x $2.00 X $ x $1.50 $ x $1.50 $ x $3.25 $ x $3.00 $ x $3.25 $ $2.00 $ RATE TOTAL x $2.00 $— x $35 x$.75 $ / x $5.00 $(O City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn -68 Y 19_ Owner Don Falkum Kind of Building framA Used as To be completed about 3-20-68 Estimated Cost, $ IP -nn Old—New. Building Permit No Permit No. sign' -4F By Business Phone N ROUGH FINAL Description .............. $ TOTAL FEE $ -40-42 SUBJECT PER � City of Fridley ' 2239i7, AT THE TOP OF THE TWINS ? BUILDING PERMIT -- Ir RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. tr PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 JOB ADDRESS 210 69 Place NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 3 Rice Creek Plaza North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Donald/Gloria Falkum 210 69 Place NE 571-1082 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Superior Sash & Siding Inc 1784 E 7 St, St Paul MN 55121 739-9601 1312 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Aluminum soffit/fascia/gutters 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 80 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 ISTALLS 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 $2,568 $1.28 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $54.00 Fire SC $2.57 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE if A �, �� -j-- y .g y License SC $5.00 $62.85 V IDATED THIS. IS YOUR PERMIT SIGNATUR OF CONT RACTOR OR AUTHORIZED AGENT IDATEI JWONLY BLDG IN11 DATE SIGNATURE OFOWNER 0FOWNER BURDERI IDATEI NEW [ ] Effective 1/1/94. . ADDN [ J CITY OF FRIDLEY ALTER [ ]' SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building- Permit Application ConstructionAddress: Legal Description: Owner Name & Address: Tel. # 579 1-1 o8.2_ Contractor: ,Svoent-an- 5.,f54 AL -a MN LICENSE # 1 3 ! Address: srti< < z- Tel. # "J 3 9 -96o I Attach to this application, a Certificate of Survey of the lot, with- the proposed coiistruction 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: Corner Lot [) Inside Lot j ] Ft. Yd Setback Side Yard Setbacks 00 Type of Construction:g1a,.,, s�<�,r/��s4�/ Ger,�•1s Estimated Cost: $ aZ S6 Fs Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: y -y-y APPLICANT: Tel. # 9 3 9- 9 c a, TOTAL $ �'� <'�, -�7- STIPULATIONS: CITY USE ONLY Permit Fee $ 470 Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1 / 10th %) State Surcharge $ /. �20 $.50/$1,000 Valuation SAC Charge $ $800 per SAC Unit License Surcharge $ - 0 U $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ �'� <'�, -�7- STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1997 6431 Unlversity.AveNE Fridley, MN 5532 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, d 572_3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS_ RATE SCHEDULE � The undersigned hereby makes application for a permit for the work herein m Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and 0D Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and m Also Replacement furnace $ 30.00 $ representations stated in this application are true and correct. 'n (Side Vent - Fill Out Back) 1997 Gas Piping (!Needed with new furnace) $10.00 $ 0WNER. Gas Range $10.00 $ BUILDING USED AS �, Gas Dryer $10.00 N $ -n �` ESTIMATED COST ,� cam. � � PERMIT NO. Od *Air Conditioning - All Sizes $ 25.00 $ r DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (UST ON BACK) 1% of Value of Appliance or Work $ 6o-)- No. of Heating Unks Cirde One (Steam) (Hot Water) (Warm Air) d �b Z�; Trade Name /L) 66o Size -No. Commercfalllndustriat v BTU a-7vc� HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load o State Surcharge 5U Burner Trade Name Size No. BTU HP EDR TOTAL FEE $ _ MWFNM ;2911 HEATING COMPANY 2M N. Fater A MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION ORM ON 51110w REFIRIGERATIONIAIR CONDITIONING PERMIT IS $25.00 Signed By, (, rIm PLUS THE $.50 STATE SURCHARGE D, REINSPECTION FEE $42.00/Hr Approved By Rough -in Date Final Date i m r 'Air Conditioners can not be placed in side yard without FILL OUT BACKSIDE FOR STACK VERIFICATION ON �� N written permission from adjoining property owner. REPLACEMENT FURNACE su6IEcr PE City of Fridley 7 7 8 4 AT THE TOP OF THE TWINS r BUILDING PERMIT / ®�/ 1~ _ COMMUNITY DEVELOPMENT DIV. �; PROTECTIVE INSPECTION SEC. r F , i/�J NUMBERREV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 9/15/98 JOB ADDRESS 210 69th�N 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 2 1 Rice Creek Plaza North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE RxEmiti am D Faulkem 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Peak Roofing 11506 S Oakvale Minnetonka 5938-8150 20045301 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Cj REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage (25SQ) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $2,142.OU $1 .07 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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 ERFORMANC OF CONSTRUCTION. PLAN CHECK F TAL FEE L se SC $ 00 $82.96 SIGNATURE OF'EQN' ACTOI�OR AUTHORIZED AGENT IDATEI HE P 0 Y A EQ THIS R PE IT �__ ._--� SIGNATURE OFOWNEROFOWNER SUILDERI IDATEI OG INS DATE NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Q BUILDING PERMIT APPLICATION �I D O� ConstructionAddress: Legal Description: Owner Name & Address: S�,)- v\ 1, Z Tel. # Contractor:'-� `a� D:S�r ml MN LICENSE # �Zw IA/S3,o\ Address: '\\6o\4 Tel. # 3 d6 61 S o 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:----��,Py- - ®�a� Estimated Cost: $ ® o (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: �4' APPLICANT: - Tel. # Permit Fee $ Fire Surcharge $ •� State Surcharge $ SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ �•/ STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE or Fridley, MN 55432 572-3604 Effective On Jan 1, 2000 J -J -a APPLICATION FOR PLUMBING AND GAS FITTING PERMIT f MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR XJOBADDRESS i�11 �PLUMBING FIXTURE RATES: NO. RATE TOTAL V 1 '0New Fixtures $7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 �/ Rain Water Leader $ 7.00 S �i ' ®c) _ Sump/Receiving Tank $ 7.00 lu Water Treating Appliance $10.00 Owner �� Water Heater -Electric $ 7.00 Water Heater - Gas** $10.00 Building Used As Gas Range*" $10.00 Gas Dryer** $10.00 Estimated Cost PERMIT NO. Back Flow Preventer Required (?Yes () No Type re'$-5we4 OAC",- $15.00 x PLUMBING COMPANY Reinspection Fee $47.00/HrA SIGNED BY TEL NO.. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS / ` e I - 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ .50 MINIMUM FE UMBING/GAS PERMIT IS $20.00 TOTAL FEE $� SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 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 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 : CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 September 18, 2000 Donald Falkum 210 69 Place NE Fridley, MN 55432 Re: Final Inspection 210 69 Place NE Contractor: International Mechanical Dear Mr. Falkum: A plumbing permit was issued on June 6, 2000, for the above noted address, to install a back flow preventer for an irrigation system. According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (763) 572-3603. Sincerely, JAN. 5.2006 8:39AM SELA ROOFING SALES — --' '—NO.694— --P. i/2-A01�— NEW r j AQDN CITY OF FRIDLEY Effective 111 004 ALTER 1 6431 University Ave NE, Fridley, MN 55432 (763) 572.3604 Bldg Insp J SINGLE FAMILY AND DUPLM(ES R-1 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION Construction Address: C�(� iI� — A/ 0/p_ - Legal Description: Owner Name & Address: -Qofi 6k j (,-(j /j Contractor: Tel. MN LICENSE # 4100 EXCELSIOR BLVD. Tel. # G, -,-p3 d A F100FINC & REMOD ST AXI" � a Certificate of Survey of the 4100 EXCELSIOR BLV 17W*sed construction drawn on it to scale. ST. LOU18 PARK, MN %416 ID 000mos0 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. r OTHER: Construction Type: _ Estimated 01 Driveway Curb Cut Width Needed: Ft. + 6 Ft = —Ft x $ ` I 4 DATE: � �' � •.G _____." . PPLICANT• �t'. �, G' Tel. Call M) 572-W04 for Permit Fees if mailing in application, Fax to 763571,7287 if using credit card and we will call you for Gard number. Permit Fee $ ,�• Fire Surcharge State Surcharge $ /, SAC Charge License Surcharge $_ �. 11 0 Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge TOTAL CITY USE ONLY Fee Schedule on Reverse Side ,001 of Permit Valuation (1110th%) $.501$1,000 Valuation $1350 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt, "A" or Alt, "13" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ j Not Neces§ary j STIPULATI ,M. OCT -12-2085 16:19 CITY OF FRIDLEY P.02/03 Building MECHANICAL Permit No.: Inspections RESIDENTIAL APPLICATION Received $y: 763-572-3604 CITY OF FRIDLEY Date Recd: DATE YOUR EMAIL ADDRESS o SITE ADDRESS P THIS APPLICANT IS: D OWNER NTRACTOR PROPERTY I NAME: 0 ANT ADDRESS I1 Y � STATEM&&L5S CONTRACTOR COMPANYr►AME: O c SUBMIT A COPY OF eel CONTACT PERSON: P . C, YOUR STATE LICENSE VI/Ii'y STATE LICENSE 0 EXP DATE ADDRESS: 7 ®�, J APPLICATION � , r � � I �� ° �� CITY PHONE 651— 469 — 577® FAx 1 — 3 9 — TE sTA��P� -, ® PERMTf TYPE )(SINGLE FAMILY O TWO FAMILY O TOWNHOUSE TYPE OF WORK: O NEW )�REPLAC:EME M 12 ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK R r.01 Q LIQ.. .4',, A r. r o � . _ _0 A, - PER MS 16B.66S the permit fee is a minimum o(S1S.00 or S% of the total cost up to MO.00, whichever is improvement, installation or replacement of a residential fixture, excluding the fixaues. STS, for the Ci his should reflect only the cost of labor) Labor cost under 5300 = $15.00. Labor cost between $300 to $SOD -cost of labor _ X.05 = FOR PROJECTS WHERE LABOR EXCEEDS SS00. FEES ARE BASED ON $10.00 PER NUMBER OF EACH BELOW) FIXTURE EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL Equi; Installed F MFG: kVI0,A MODEL:takfiv4 SIZFJBTU 'I®s ®p MFG: „yt� MODEL: MFG: SIZEIBTU _A/CS23.00 MODEL: SIZEAM `AIR TO AIR EXCHANGEER $15 _FIREPL ACE (GAS) S 1 S.00 OAS RANGEIOVEN 510.00 _FIREPLACE (WOOD) $35.00 BOl{,ER 534.00 _,.,FURNACE S3S.00 NEW GAS GRILL 510.00 CMAMY LAYER 510.00 GAS DRYER $10.00 GAS UNIT t+TTR $10.00 _DUCT WORK $1000 &:AC w0wo%__ 02A ti —POOL HEATER 534.00 Surcharge $ :so Numoer Ortwures ® S10.00 _ x 510.00 - S TOTAL DUE o Number of fixtures (a� $ I5.00 x$15.00-$ $ Number of fixtures @ $25.00 x 525.00 m Number of fixtures ® $35.00 J_ x 535.00 = $ �� State surcharge m Total - S& D, So THIS IS AN APPLICATION FOR A PBRMIT NOT VALID UNTIL, PROCESSED permit I hereby apply for a building pit and I acknowledge that the information above is complete and accurate; that the work will be in c mfornmce with the ordinances and odes 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 stmt without a permit; that the work will be in accordance with the approved plan in the case of w k wb rev w and approval of plans SIGNATURE OF APPLICANT tINTNAME Zffi1—�- City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, UN 55432 763-572-3604 FAX: 763-502-4977 a Building $ I a S , a S' BUILDING $ Permit No.: 2 InspectionsRESIDENTIAL Surcharge APPLICATION License Surcharge Received By 763-572-3604 $ CITY OF FRIDLEY $ Da' 'di U N 0 2001 DATE a(4mauos YOUR E-MAIL ADDRESS t&J50,rdd @ !p enl;2 k9 c • Unnn SITE ADDRESS J PtCLW $ THIS APPLICANT IS: ❑ OWNER Y ONTRACTOR PROPERTY OWNER/ NAME: TENANT ADDRESS: ^ CITY STATE_ZIP PHONE: 2 NAME: Renewal By Andersen CONTRACTOR SUBMIT A COPY OF STATE LICENSE #_ 1920 County Road "C" West YOUR STATE LICENSE ADDRESS: Roseville, NfN 55113 t —STATE—ZIP— TATEZIPWITH WITHAPPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/NE` PROPERTY TYPE ❑ TWO FAMILY/NEW G 651-264-4777 — PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCEIREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: 4 C^ --;L c� / -"6 i SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S %. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING ❑ Vinyl ❑Soffit FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Aluminum ❑ Trim ADDITIONS. I. & PORCHES SUBMIT: Site Plan/Survey showing the existing structure ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 5, '14 -- 77�� OCCUPANCY TYPE Permit Fee $ I a S , a S' Plan Review $ Fire Surcharge $ Surcharge $ License Surcharge _ $ 5,60 SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due _ $ , See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks oavable to: Citv of Fridlev 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 i conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an applica1: for a and work is not to start without a permit; that the work will be in accordance with the approve plan in the case of all work ich requi view and approval of plans. }� SIGNATURE OF APPLICANT PRINT NAMEOI i r 1f, 7 DATE