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AF - 46993SUBJECT City of Fridley 18358 AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r � � � � � • COMMUNITY DEVELOPMENT DIV. QO ° r � ti: ----- � � � PROTECTIVE INSPECTION SEC. � � � � /'��1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE Of . APPROVED BV �""�" �� 612-571-3450 910-F15 / / JOB ADDRESS 6632 Arthur 5treet N. E. 1 LEGAL . ��T NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 2 Creekridge SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Jedinak 2795 - 21st Street N.W., New Bright�on, NIl�i 636-1098 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE UCENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residentia 1 7 CLASS OF WORK � NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK iAO�� p �� Construct a 28'x 36' Dwelling and a 34' x 24' Garage rr i� TELEPHOIV ging call local utilities 9 CHANGEQFUSEFROM TO [��Q�� * G, r� STIPULATIONS provide a hard surface driveway. Provide sod in the front and side yards. Provide City with copy of verifying survey before capping. SEWER LOCATICN: �Approx. 14' Deep In 5treet) 119' N. of M.H. at 66th Avenue INV. 879.14 WYE ELEVATION: 879.56 'InP OF FOOTING: 883.00 Minimum WATER LOCATION: North of and in same trench with sewer service Paid Park Fee of $1,500.00 THE CITY OF FRtDLEY DOES NOT GUAt�ANTEE THE � R NG TE P�R�� REQ�j(REp �QR A C C U R A C Y O F U T I L I T Y L G C A T f O N S AND ELEVATIONS. � H E A T l f� G� ��( j� g�� RND S((� S iHIS DATA IS FOR INFO t,�'AT(ON PURPOSES ON�f AND P�RSONS USING THIS INFO�MATION SHOULD VERIFY IT pf� TM� SIT�. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TVPE Of CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHOFIZED IS NOT COMMENCED WITHIN 60 DAYS, OF IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFAGES AND KNOW THE SAME TO BE TfiUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UATION SURTAX AND,ORDINANCES GOVERNING THIS TYPE OF WOFiK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $11'4� 7OO $S�%.3S DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �4%0.50 Credit from SC�'100�. LAN CHECK FEE TOTAL FEE $117.63 $645.48 + PF .�IGNA7UREOFCONTR ORORAU7MORIZED GENT �on7Ei WHEN PROPERLY V IDATED THIS IS YOUR PERMIT '��1 i �� t ' : '�-�� TUREOfp Ri OWNEABUILD RI DATEI BLDG INSP. pTE l, � �N��' L�sS c.�..c v l-�Tloi� �t N,� .�-bu� � �'I I��T �LUD(�- �f� : �x�S{o) t�O � �4) t C�Y14� — � I 2 o j� s��D �.�.- �� :�x�-i t �x14) t C�►� =- �0�4� � '�, p'��M�(�,, '�1Rv�' ��- � . 22t �C tt4+ �!-t � t� Z8 t �2tt2 g(��}-� � �� . V i4�..r'�� • � �. � { i� i � t � , { � r � 'A � ' +� Y�P��,t, /�� Y,� �.bR�� TD ��s) � l�i-x ta��25} -t�t3�O n 8� - 27�O�i� (�, R�M .�oiST ,��•p► : l��o � �'1 "� 7, �out�DRT1oN �Y� bf�c`� : ..'Z"? �C 1�4- �, ��ow ��,A. - �. �r� r.��►►�� C s� �o��r) � � �.. �,, ' , , � � Wq��T� �o . �Y U c� �� . 2�-x � ! 1, c.��it� ��.A l�' �..) �.�c.2Q� �2. �i�lt� ��A 2�f� :a �3. w�..� �, C�r -c�ss u�ss ��5, �> C��t-t33�}c�r�+5a�3 {4. w�L.�. �' C�t�n�r� - l�� N�T � zlr�i x. 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S, 0 � 2" Got��, 1.2b ' r u w� �u�. ,�«- �.o� __►�i_� ��, � TbT� �_ '1 �13 ' .� U 3 �t� _ , 4 _� . : _ . . . _ _ __. �. _ . _ _ :_ _ _ :_ _ _ . .. . . : _ .__.. . : . � j . ., , ; , . . , . .r.�.,_�.�_ . . _ _ _ � _ _ ... � . �� . . ._n_ _� .._. _._ _ ._ _ ... . _ __�.« . , _ � �, � � ti', r,; r . � RECEIPT � � �it o �ri� e � � 6431 University Ave. N.E. Fridley, Minnesota 55432 • � Tel. 571-3450 t '�a RECEtVED OF ` w a �.�. � � ■�. � ADDRESS : ^' ~ ~� Q�� .-�-1 �3�a � � FOR��•O�i. FUND � � ��s' � � _ — , � �_ t�� • � �� _ - '.� � � ` • ��- �.- � � ' ��- --��`�-- _ � • - � r� i .r • � �- —�� '� � . • r3:/�� r.�:��riT�1�� _ � � � . RICHARD D. PRIBYL Treasurer �m_ � - ��,_,9�� No: �004� � . ��w»ww�r � /roow� wuNCSS �oww. �we..' «� . . . � � �� . _...�. . _. . , -� 0 CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTIN6 PEI:IIT • m a, w q u • x u Nater ,� ,� a � ►bi e a a � �+�+ a w � Neater r N .� w Hx.+ A � s� Ag w C4 M tll �.41 Ya .0 C C = M �.�d d.0 � U Y r�i! U � PO o� N i G u�. t�i1 � U to � 3 l7 � t7 O s 12c � � lst � r �. 2nd '� c� � 3rd 4 th ' (R) � Puture Connection Opaninq Connected with Sewez (') � Naw Pixture, Old Op�ning Nater RATE SCHEDULE PLUMBING FIXTU[tE RATES: N0. N�w iistus�r ruture listuras Old Op�niag, Nsv ii:tur• Beas Ditp�n�tr slov Of! dasln Catch Basin Rain Mater L�ador Nydraulic Valv• Suap or Rec�i'inq Tank Mat�r Treatinq Applianc• Hot Mater 8estez Gas Ranq� Gas Dryer �� _.� _._.� RATE $ 5. 00 g 3.50 S 1. 50 S 4.00 ; 5.00 S 5.00 $ 5.00 S 5.00 S 5.00 f 7.00 g 5.00 s 10.�� $ 10.00 11LL OTHERS ]1ND/OR REPIIIRS 11ND ALTERATIONS lt of Value of li:ture or ]►ppliance Rein• State Surchargs pection r« s (515.00) TOTAL PEE TOTAL S �� s lD s.° S S S S S S S S 5,�� S S S 5 . 50 S�,�oO Effective Aug. 1, lyal Jo6 Address � t!/ �� 12� u�. �� . // ` �° Departaent of Duildings City of Fridley Tel. �571-3450 Tfie undersiqned hereby �akes application for a psreit for the work her�ln specified agreeing to do all aork in strict accordance with the City Codes and rulings of the Departaent of Buildings, and hereby declaree that all the facts and representations atated in this application are tiue and correct FridleY. Mn• S lp1 a , 19 �� a�R .�t�- u i c� ��c�i.i��-k K2ND O! lUIT�ING s L�,J ��L.s� �£i✓L/kf' • [1SFF� AS ro sa eo�r.e�ren �sarr ;5��/ • ESTIWITED 006T OLD -( NEM DUILDING PEEipIT NO. PERNIT NO. ��0�� `_�' Cowpany / � � G`�J✓c /v /(Lh2 � /i'�- Signad ey � „+�+'`--� ��. �. T �) v2z7 - 36� � ROUQ! INSP. wte FINAL INSP. �� p O/'\ Date � % U 1P � l APPRWAL POR PERMIT �� % HINIMUM FEE FOR ANY PLUMBING PEtirlIT IS 510.00 PLUS THE $.50 ST4TE SURCHARGE ,,,r sue�ecr PERMIT City of Fridley o 184,�91 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T f ; � RECEIPT NO. � `v ___�_ COMMUNITY DEVELOPMENT DIV. A r � � PROTECTIVE INSPECTION SEC. �� C+ l � r. 1 � l.---�; ��1,'� CITY HALL FFIOLE� SS432 NUMBER REV. DATE PAGE OF APPqOVEO 9Y i 612-571-3450 9�0-Ft5 6/12/86 I � JOB ADDRESS 6632 Arthut^ Street N.E. t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. (3 Y 2 Creekr•l dge SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Jedinak 2795 - 21st Street NW New Brighton 636-0198 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDING residential 7 CLASS OF WORK � NEW C�( ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 14' hy 12' screen porch 9 CHANGE QF USE FROM TO STtPULATIONS 1. Raise �6�X� knee wall b.elor� screen openings ao that if ever glazed it would not have to be safety glass. 2. Footing must bean on virgin soil. SEPAiiATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING. THIS PEFMIT BECOMES NULL AND VOID IF WOFK 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 PRRKING I HEFEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GApAGES'. AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX AND ,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT ��L 2OO �1 .lO DOES NOT PRESUME TO GI�E AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHAFGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- S7RUCTION OR 7HE PERFORMAM E OF CONSTRUCTION. 3H .�JO , •- PLAN CHECK FEE TOTAL FEE 9.63 $49.23 - SIGNA OFCONTR RO AUTHOAIZEDAGENT ATEI WHEN PROP RLY V��IS YOUR ERMI � SiGNATURE OP OWNER iIF OWNER BUILDER� iDATE� ! BLDG 1NSP qq7E NEW [ ] ADDN . [X ] pLTER. [ ] City of Fridley � R-1 AI�iD R-2 ( Building Permit Application Construction Address: 6632 Arthur Street Legal Description• 'Lot 9, Blk 2, Creekridge Effective 4/1/84 Owner Name & Address: David Jedinak, 2795 - 21st St. NW, New Brighton Tel. # 636-0198 Contractor: same Tel. � Addt'ess • same LIVING AREA: GAAAGE AREA: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to seale. DESCRIPTION OF IMPROYEMENT Length Width Height Sq. Ft. Length Width DECS AREA: Length OTHER: screen vorch 14'- �� i� � j �_ �� 1� I� � Corner Lot [ ] Inside Lot [ ] Type of Construction: Wood frame Approx. Completion Date: August 1 Width -- , ., � ..�� Ft. Yd. Setback Height Hgt/Ground , � � _�� Sq. Ft. Sq. Ft. Side Yard Setback 11'-0" � Estimated Cost: a 1� - � ��J Alt. A� Alt B Proposed Driveway Width If New Opening Is Desired: � � See Back Page for Explanation � - . DATE: 6/09/86 APPLICANT: Tel. � b�6-0198 _ CITY DSE ONLY ��' N / �� Permit Fee $ � �+J�ee Schedule on Reverse Side Plan Check $ ��3 a,�j� 25� of Building Permit Fee State Surcharge $ � �� .50/�1,000 Valuation • SAC Charge � �' a425 per SAC Unit Park Fee $ `� ' Fee Determined by Engineering SeWer Main Charge $ (,�„ greement Necessary [ ] Not Necessary [ ] �OTAI. � STIPULATIONS• 1 �S � �L� l��lt.v� `� 1 �..�-� �''r`� :�. � C � - �- �R-� g-°� ��° . ,�- ,�� -� w C2,. 1 �CIT��V �uS) � �.rA-� C� • �1 �� 1 <.:. i' LOT SUR1/�YS COMPANY, INC. r.AND SURVEYORS REGISTERED UNDER LAWS OF STATE OF MINNESO'TA 7601- 73rd Avenue North 660-3093 DAVE JIDINAK „�-,��' IC'Z.8 � __- , �_ � �. � -` ----- � � c� — 1 — , __ _ ____.�- I � �5 � � 1 _ U'Cl LITY � r r��.uunv E � I Eetier►r�.�,-r � �OZ�b ,� � Minneapolia� Minnesota 55428 f�trae�ar� ��r�tif%�tt�t � t9° b644 ; , , --- . __ - - ---------'"1 ioz.. t� � �a �i O� ;.5 - - - I 13. 00 � - - �oz.� - _ _ _ , �0�,3 ' - --- o --- -- r; �_ - —3-�,0--- - -- \ �� I �o o� ; , ^,►oz.o i 34 U" ,r) .----- - �� ; � 0 r ._ � --- �- - -- '\-- — 1O' - I��,DO� Elevation datum gssumed a Denotes Wood Hub Set For Excavation Chly � Denotes Proposed Elevation -�-- Denotes Surface Drainage 000,o Denotes Bcisting Elevation Lot 9, Block 2, CREEKItIDGE Q J w� �� p w � � � � 0 rl` --- , �Qc�---- ---' __. -- .D�—�D29�1 . 1 S' 103.5 t�►4 bb� b The only easements shown are from plats of record or (nformation provided by client. We hereby certify that thia is a true and correct representation of a survey of the boundaries of the above described land and the location of all buildines and vis- ible encroachments, if any, from or on said Iand. Surveyed by us this 28th day of N3r�h 1g 86 Signed � i � I O � i i � � INVOICE N0. 17056 F. B. N0. 317-9 5CALE I" 20 � 0 -- DENOTES I RON �.;�.�,.� 1'02.0,� _ ._ � _ � 1 i I � � -�... �oo.00 W � :a�� J � : � �s w I a Z � � 140.'ici 'TL�.. Proposed Top of Blocic =�0� Z' Proposed Garage �loor =� 3 7 Proposed t.owest Floor = ��- Z A: Pra�ch, Minn. Reg. 8743 I 0 0 . . . _ _ �p/�y��/ F1ViJL.i.I CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 Septeraber 4, 1986 Mr. David Jedinak 6632 Arthur Street N.E. Fridley, luII�i 55432 Re: Final Inspection at 6632 P�rthur $treet N.SE. � Fri$le.y Dear Mr. Jedinak: A final inspection was conc�tcted on August 29, 1986 of the house construction at the above aci�dress and the following items were noted which nust be completed before the structure can be finaled; 1. Fill in guardrail, spacing to a 6 inch. maximwn �y Septembe,� 15� 1�9�86. 2. Provide house n�.er on structure by September 15, 1986, 3. Caaplete firewall in basement between the house and gr�ardge hy Septenber 15, 19F86. 4. Pravide sod in the front and side yards by October 6, 1986. We will expect the above items t�o be campleted by the scheduled dates when reinspec tions will be corbducted to detezmine campliance. If you have any c�,testions on these items, please feel free to contact me at 571-3450. Sincerely, DA . CLARK Chief Buildinq Official DGC/mh .:_ CITYOF FIZtDLEY C(VIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-34i0 Septesnber 17, 1986 Mr. David Jedinak 6632 Arthur Street N.E. Fridley, NIId 55432 Re : Final Reinspection at 6632 Arthur Street Pi. E. , Fridley Dear Mr. Jedinak: A reinspection was conducted on September 17, 1986 to determine compliance wi th our letter to you dated September 9, 1986. This inspection noted that all itesns have been oorrected and approved except for the following: Provide sod in the front and side yards by October 6, 1986. We will reinspect for compliance on the scheduled date. The structure is approved for occupancy. If you have any ques tions on this matter, please feel free to contact me at 571-3450. Si ncere ly , DA . CL�RK Chief Building Official DGC/mh sua�ecr P ) City of Fridley 2 9191 AT THE TOP OF TME TWINS g U I L D 1 N G P E R M i T r � . � � . • COMMUNITV OEVELOPMENT DIV. � ; � ----- . � l53 r � � PROTECTIVE INSPECTION SEC. � . i � � �"'1 � CITY HALL FRIOLE� 55132 NUMBEN REV O�TE v�GE OF �VVnOVED 8r �""'�" �'' 612-57t-3450 910-F15 4/13/99 / / �oe AooRess 6632 Arthur Street NE t LEGAL ��T NO. BIOCK tRACT OR ADOITION SEE ATTACMEO DESCR. 9 2 Creekridge SNEET 2 PROPERTY OWNER MAIL ADGRES$ 21P PHONE Mary/Dave Jedinak 6632 Arthur Street NE 3 CON7RACTOR MAIL ADORESS ZIP PHONE LICENSE NO To Gun Inc 5014 Parrish Ave NE, Ro ers, Mn 55374 428-4559 20155030 a ARCHITECT OR DESIGNER MAII ADDRESS ZIP PMONE LICENSE NO. 5 ENGINEER MAII ADORESS 21P PhIONE IICENSE NO 6 USE OF BUII�ING Residential 7 CLASS Of WORK ' ❑ NEW ❑ ADDITION 0 ALTEFiATION � REPAIR ❑ MOVE O REMOVE 8 DESCRI9E WORK Reroof House & Garage (35 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. Permtt inspection Cards Wili Be Matied To Nomeowner To Post TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO SEPARATE PERMITS ARE REOUIREO fOF EIECTRICAI. PIUMBING, MEATING. VENTI�ATING OR AIR CONOITIONING TMIS PERMIT BECOMES NULL AND VOID If WOiiK Op CONSTRUCTION 20NING SO. fT CU FT. AUTHORI2ED IS NOT COMMENCEO VyITHtN 60 OAYS. OR IF CONS7qUCTION OR WORK IS SUSPENDED OR ABANDONE� fOfi A PERIOD OF 120 OAYS A7 ANV 71ME AFTER WOFK IS COMMENCED. NO DWLG. UNITS OFFSTpEET PARKING 1 HEREBY CERTIFV THAT I HAVE REAO AND EXAMIN�D THIS APPLICA710N 1 STA�LS GARAGES ANO KNOW TME SAME TO BE TRUE ANO COiiRECT. ALL PqOVIS10NS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE Of WpRK WILL BE COMPUEO WITH WMETMER SPECIFIEO MEREIN OR NOT. TME GRANTING OF A PERMIT �2,999 $1.SO DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pEqMITFEE SACCHAFGE PROVISIONS Of ANV OTMEF STATE OR LOCAL lAW REGULATING CON• d�(�.75 Fire SC �3.00 STRUCTION OR TME PERFORMANCE OF CONSTRUCTION `Y P�AN CNECK FEE TOTA� FEE License SC 5.00 $84.25 SIGN�TUAE OF CON'�7A(;TOp OA �UTMOp�ZEO AGENT ipAiE� WMEN PROPERI� IOATED TH�S IS VOUR PEQMIT r/(/ ' r S�GNSTU�7E O� OWNEQ��F OWNEABU�LOEAi �OATE� � BLOG �h5� ' � ��TE ... . . s MAR-25-1999 16�14 FROM CITY OF FRIDLEY TO NEw � j AADN [ l CITY UF FRIDiEY �-T� [ l SINGLE FAMILX AND DIIP'LEXES R 1 AND R-2 BUILDLNG PERMIT APPLICATION 4288826 P.01i02 Effective 1/1/99 q� � � �� ConstructionAddress: (Q� (�,'F"�'�,l,t/� � i � � Legal Dcscription: � Owner Name & Address: f'1'l GUl(d q��- �Q(��,�V1Q12_`� N��-` .� Tet. � Contractar T� INC. MN LiCENSE � o? D�� 5 O 30 Address• Tel. �!Q/�) 5�Z8 - ��S J � LIVII�IG AREA: GARAGE AREA: DECB AREA: OTHER: Atta�h w this application, a Ca�rtif'icace of Survey of the lot, wi� the proposed construction draam on it W scale. DESCR�PTION OF II1�IPRO��A�NT L�ength Width �Ieight Sq. Ft. Let�gttt Width H�ight Sq. Ft. Length Width Hgt/Ground Sq. Ft. � C��j � . Construction TYpe; /�.0 - �/�(,�t `!�, Esiamatod Cost: S o� �% , D�"" -' lFee Schedu2e on Back1 Driveway Curb t,lit Width Needed: Ft. + c= Fc x S = S DATE: 'y�i��% APPLICAIV'1': Tel. � !2� �2S` � 9 P�rmit Fee Fire Surcharge State Surchargc sAC cn�&� Lictnse Surcharge Driveway Fscraw Erosion Coatrol Puk Fee Sewer Main Cbarge TOTAL STIPULATIONS: 7 � �1 1 S ��`� Fee Schcciule on Reverse Side S 3.� .002 of Pe�nmit V�luation (2ilOch96) s �s.soial,000 v��ttan S S1050 p�r SAC YJnit ' S �� SS.00 (5tate Lic�nscd Residanfsal Concractors) $ A1t. "A" or Alt. "B" Above $ S4S0.00 Co�rvatioa Plan Ravi�w $ Fa Detennined by EnS�mS S Agreement Necessary [] Not Nccessary [] s �y. �.�— �. � 'y �� _..• Building BUILDING -`� ` Pe�it No.c.��r��i �v�i Inspections ��j C�NI�� Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: 763-502-4977 FAX EFFECTIVE 1-1-08 DATE � 'S t' � YOUR E-MAIL ADDRESS /�'�^' e -sy"�"�O ^ S �`'� '� � S �"� � ""`° SiTE ADDRESS �v (0 3 Z �in-r��-,� ti s T TENANT NAME: ��"' ��^"'Q" �< SUITE NUMBER PROPERTY OWNER NAME: -v�"'�-- J��" r'' � ADDRESS: G� 3 Z G��- n+�K- ST . CITY �� `'� STATE"�"' ZIP 5 s`�3 z PHONE: � ARCHITECT NAM�: �� J� ADDRESS: CITY STATE ZIP CONTRACTOR NAME: $`trCf�1 � n r �.t,+� �� s� v t-�- � — * NOTE: CITY ADDRESS: `� S�3 C�t-0 n�.wc.-�.L ✓�x.� CITY S��,'�-STATE �"� ZIP �T� ��f LICENSE REQUIRED FOR COMMERCIAL, PHONE: 6T1- � y�r- �' � oO CELL: ��- FAX: 6r� � 6`f Y- v� °� INDUSTRIAL AND CITY LICENSE #: EXP: MULTI FAMILY PROPERTY TYPE ❑ TOWNHOUSE ❑ COMMERCIAL/iNDUSTRiAL ❑ INSTiTUTiONAL ❑ MULTI-FAMILY PERMIT TYPE ❑ ADDITION � NEW CONSTRUCTION OTHER ❑ REMODEL ❑ ROOF ❑ SWIMMING POOL PLEASE SUBMIT: 1: 4 SETS OF DRAWINGS 5. CONTRACTORS LICENSE OR 6. SPECIAL INSPECTION 2. SURVEY/SITE PLAN LICENSE APPLICATION SCHEDULE 3. LANDSCAPE PLANS 7. PERFORMANCE BOND 4. ENERGY CALCS AMOUNT $ BUILDING TO BE USED AS: OFFICE sF WHS sF OTHER sF TOTAL SIZE: STORIES FIRE PROTECTION (Y/N) AC(YM) DETAILED DESCRIPTION OF WORK �eht d v�f � � /k � i'Y*-� rv � � � c�,�� / � -c .( i �1, � ...,. .( ✓►� o ^ � i- Q� a b �ti s-►� c. IG • TTTT � T n. � ALL l�'L�'L�'S AKL+' �fAJr;L V1V VALUAl1Vlr� 11�Il.LULll�l� �nr. �.vai vr Ll117V1� Al\L 1�lAllY1�1[�i/v• (USING THE 1997 UBC FEE SCHEDULE) Sq. ft. x$ Cosdsq. ft. = Valuation $ Sq. ft. x$ CosUsq. ft. = Valuation $ Sq. ft. x$ Cost/sq. ft. = Valuation $ TOTAL JOB VALUATION: $ S�O USE OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge / S�-f�ge L � � • Erosion Control Park Fee Special Assessments Curb Cut Escrow Total Due $ .��-S'� See Back Page for Fee Schedule $ �-� 65% of Building Permit Fee $ . S� .001 times the total job valuation $ • Su► .0005 x Permit Valuation Minimum $.50 $ �:�s N $1825 per SAC Unit (Plans to MWCC for determination) $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ ft+6ft= ftx$21 =$ $ , j-�'j , S b Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPL[CATION FOR A PERMIT-NOT VALfD UNTIL PROCESSED [ hereby appiy for a building permit and I acknowledge that the informa[ion ove is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Frid(ey and with the Minnesota Construction Codes; that 1 derstand 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 e_._�ts�yed pla n the case of all work which requires review and approval of plans. f—! ____ ..__. _ . SIGNATURE OF APPLICAN ' PRINT NAME �i� �u`�iPl DATE �_�� U� APPROVED BY �ti�i/ __� DATE��d��J` G