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P - 43332B��.ilding Inspections 763-572-3604 763-502-4977 FAX DATE �f�/ / SITE ADDRESS _ THIS APPL[CANT IS: BU�LDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-2010 YOUR E-MAIL ADDRESS ry� J� %� '�� ❑ OWNER �CONTRACTOR PROPERTY OWNER/ NAME: /��%� �E��'�% ,UEi��� TENANT ADDRESS: �� %lO '� /0 3�' ��� N� CITY PHONE: CONTRACTOR NAME: JA'V'� �'✓I��� ��d- f �'1 SUBMIT A COPY OF gTATE LICEN`S/E #�(�I ��b a' C AND CERTIFICATE OF ADDRESS:��r3'Z f%"� ��� �� INSURANCE pHONE ''� %S�� "I �3 PROPERTY TYPE �SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILYMEW CONSTRUCTION PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING SIZE OF IMPROVEMENT ❑ ADDITION ❑ GARAG ❑ BASEMENT FINISH ❑ ROOF ,�DECK ❑ SIDING ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR �C. / EXP DATE FAX f1631 /� SIZE ❑ ADDIT[ON �REMODELING O DRAIN TILE � OTHER Permit No.��Q -��.��� Received By: '%� ^� Date�C�c�: � � � � � 2 �1 � STAT&r` 3 3 � �0�.2._ � ��,QJ STA ' 3�.�� s3'Y��-- .1i00FING p HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE �. Existing Floor Plan GARAGES ❑ A7"fACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members w be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, p�V[ny�l ❑Soffit � � ADDITIONS_ & PORCHES SUBMIT: ❑ Aluminum ❑ Trim ,/�%,Q a'Q 1• Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia <(!/� rd and proposed project. 2. Two sets of consmfction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACNRE 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: TOTAL JOB VALUATION $ ��S�G�TI�E 1997 U.B.0 FEE SCHEDULE) �� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge 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) $ $2100 per SAC t�nit (Plans to MWCC for determination) $ ft+6ft= ftx$24=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ � O � Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D UNTIL PROCESSED I hereby apply for a buiiding 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 appmved plan in the case of all work which requ' es review and approval of plans. �J SIGNATURE OF APPLICANT ��/�� —^ PRINT NAMEi ��/�' `/���•O�»�"��� DA� � o�/U _ . __. _ ___ _ _____ _. __ _ __._. _�____ , ----._ „ _ _ __.. _ _ _ _ .. _ ___ __. � ,' i � N � � � � "� � �� � ��; � � � � �; � �` � � �� �.,� - r � � � ,,� � � � � � i� � � � �� � ; � i ; # .-�-�- � � ; �j g3 � � � � ' �' ; 1''S � � L�. � � , - i i � ! 3 � . � ; c { . ` � �, V ,��//,, : _. : � ; $ �7 � � � �� � �" . . . . . . . � � � , - 3 _ � p � § ? { # ! � � . ..� .... ... .. � ♦ .. . ' ' ` F i � f r � , l ` � j' s' � � � ¢�M��—M.� : � s . . : . _ . � . , � � - _� f � , : _ _ '� ' : •� ': a x � x t � , � � '� ` � ` � � Nf ,� � � � : � � � �- � # � � ��_ � � . � ; : - : � ; : . : : = r� , � . � — -- � 4 � �� � � � � � � .:� � � ` � �� �j r�_� � �� i � � � F �� � � ��► �°"-''"� ; � � ; , �, � < ; : � � � � � � '� �"' � � � •� � � = F� � � � � � � � � � �? f ,� �� � — � q, � - � , —�-- : , . � � t � � � v� �� ` _ . � ; �� `�; j i v �z �_ u�i �/►n � �s. � ---( : � � } ..'r ' � € + G � � - , � m �70 � : ' # t �; . �_. 3 i (C � �f � � �\/ � � o f ^ " �1 �� j N � - � ( S � �� � � � � 6Z� s . � � ` . . ::... � . .. .. . . . . i � �_ ;` �: [ � � ! � ! \ . . ; a b € ����� �� . . , _ r � � �� . , : . _ , .� : � __ ' , � - � . : ; � � � f � i ' � � � -�\ '`°4` +� . � ° ��y � � � ' � �-. . : ; � , .Q . .. _ . __ ._. `�s .�.— .. .. � s � a �/ a_ � . �i . . . z � � ,■, i,� ; . , ....,.v.z.b__.--.W. ��..�--.o...�....:. � � � j % � � �- y `� � E f 3 •. � = < � . � � t . . . � � � .. � . . . ..... � } �r�� - � � � � . -i `_ _: `.:: - a .. . = ���. 'rt �i .. _ . - _ ._E.. .� � � L . �. .�. Y i �'/ 'I i " ; � 2 r p�( � . � .. . ... . y .. . . . . . . . � . . . .. . .. '+✓r ` �/� � � � �- �..�,. � � � �1 . �' �' � N ib,` � _ a,. �, F _� � � ` _ � �.. _.. _..._ � � .- .,._ . � �.� �y.,_� �x� F._, ------� � = S � � � # � �C � � �` . �'a [ � ; � � � � � � � '' � � �� � m � =f � : g � � cg '�s' � _ ,� ' � �- � �.�` , � _ . , � __� _ _ .Y ,. ; U �e _ � _ � � � � � r : .�_. � � �. ._ - F � 4 : ..,. �r► t � - � `� � � � o �-• � � ' ^ ! '�` � , � � � ,_. � _ _ � � , � � � � ,,� _ µ rt/ � ..—. _ �-- �,-------� � � �� j �� � � �� � �� � � � � � _ � _ � ,�� � }�� �- _ � _ � u+ . .��� _ � _o� ._ :�' � � / ♦ HARVEY A. CARTWRiC;H'i � � �� � �� ANC�KA GOIINTY SL'RVEYS I-�ENNEPIN GAUN7Y SUR VEYS p:+ ]►T l3 t! �j Ll I;' Lq 4l fa YD L' n?1NtvEAPOLI5 SUkVEY5 d.,.r�1�3a i7 �l4 � Gl i1iAs7 6410 PALM STI'tE£T REG157'EF2El� UiJD�R LAVdS OF' STA7E OF MIAfNE50TA SUN9ET 8-0079 LICENSED BY ORDINANCE QF CITY OP MtNNEAAOLI9 CiWNEP 3d5 PLYMOUTi-i BU1LDlAIG FEOERAL 8-8721 iNDU5TRIAL - JUalC1AL B:1SlN£SS - TUPOGRAPHICAL � CIT'( LOTS - PLA�ii1NG �urbepor g ertifitatc '�"r,ora�..s � . Ui�v:is �/ 'ls%' �� / -'° � (.� � �� " ,� ; I � � lY; � � �� , ��: ��� - :� :-.-- , R `I * '7U� � I � � �� i�, ; ;�, . �,: � ::., G rl � � ��a — � � � ti x y �. � ,�_ COMSINING THE R6C9RO5 OF .i. �. t�ilLL, C�vi� ENG7NE�R ESTi�eLI5HE0 39a+8 C. F. SANDHOFF CIVIL. �NGiNEER ESTAHLISt1ED iG08 JAMES NELSON SURVEYOR E57ABL(SNEC 1922 METROPOLiTAfv LANA SURYEYORS� ESTABLISHEC 19St Invoic� -�'>>�= � �IJ�7� , �•i�7�,�-- � �:x, $ ,QF"c,� �� /��`� �c�'�A'oc�'� , - - -- - .. . � ,' � � � � . �-- �- � --• __._ ;, , � _ .__ �. � ._ _.._ .� _. _ _ y,, - ✓ _._ .� ;:r � ,. , , . . . � . ., . .. � , �:"1i:7.'_:3'. :".3Z't`,l' ;' L ' G t,it..'+.:.; 1_;; ,. t,'.'U..". .`21i: COT'T'F°C� '�.i.•:i; O 3 SI11"V°�J O J, J'L �' ) �--'�C: ;;�� ...:2_ � '.i �1_:; .. . :, V:l.OI; ',11U�'c .`Clll1i.. � :.1:1?•.oer ,��,� � �:(.?;; � v. ..., .. J c. =: a S LLT' V' i Q� r�e f;�iis �3t1-� ci:.,y o:: J��nu<-.r.r, . c>�� ... ,� . .• • SiGNED..,.__ �� � ,r�..:_-r--......__...__.----.._....__._.� .._ . _ CJIRTWFi1G�'iT aNO OL9bN � � � rHAP.V�Y A. CAf2TWRiGH'i �������� � � ����� AlVOKA COi.it�iTY SURWEYS yj /� D �:tEhdNEPIN COUN7Y S:JRVEYS ���%� S�%� �''El C/liS . M:NNEAPOLIS SURVEYS 8410 PALM STREET �g�{STERED UND�R lAW$ O�' SiA7E O�' MIIVPIESOTA SllNSer 8-0079 LICENSED BY 07iDliJANCE OF CITY OF MIIWNEAPOI.I$ GWNER 345 PLYMOU7N BUILDiNG PEDERAL 8-8727 fNDUSTRIAL — JUalCIAL HJSINESS — TVPOGRAPHIGAL �urbepor'� �ertiftcatc CIT'( LOTS - PLA'tTING Triomas � . �i�vis ��� (� .� r . �` l i+� F � t/�...rv�l e wr.... � � � ,�_.. _ _ _ r' r-. � ��+f . r��+r I GO�MBININi+ TH£ R6CORDS t?F J. E. H1LL, C�vsL EtvG��+E��z EST,a,eLtSY1ED 989+5 C. �. SANDHOFF CIYIL EN�1NE'ER ESTABLISMED 1608 � JAMSS NELSON SURVEYOR ESTABLISHEO 7fl22 METROPOL.ITAN LAND SURVEYORS� ESTAB415HEC 195i Inz�oice 19395 =oI7� � �t�{ $ p��`� ������� I�i�reb,y c�rti�`y th:�t t,`r�is is a tru�� ��=r�3 cor.rE�ct ;r�lat of a survey of Lo� 2, ��_ocl� �, Cl�.risiic� "�.:�:;? t_�.on, �:noka Count�, P;inr.esota, <�.s surv��yea b�r z�e this 3th da,y o�' J�nu��s�,=, i9`;`�`, t•r-°"f' .s. � ' r�- ��' B16NED -r= CARTW T AND QL90N -- __ __