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AF - 35166� � n City of Fridley, Minn. BUILDING PERMIT ��; Nov. 1, 1968 p�; Laxs G. Aaderson. g�� Same �d� 4024 Jeff�rson St. N. E. A� Same ����� N° 10007 LOCATION OF BUILDIWG N� 6696 �Cg�t Ashton Ave. N, E. p� op � �t 1 glock 3 Addition or Sub-Division Edgewater Gardens Cortter Lot � Ins3de Lot Setback �� Sideyard geW� ne��q� 836 .13 839.13 Top of Footing DESCRIPTION OF BUILDING To be vsed as: Dwellin� Frn�t 67 � 8�� Depth 29 � Height 28 � Sq. Ft c�. Ft 31, 752 Front Depth �Tei�t Sq. Fk Cu. Ft. Tj►pe of Conatructton Frame �, �_$20, 000 To be Completed Sffi�ICB ON 67th Way Sewer Location - 39' West of the Maahole Water Location - 10' Weat of Sewer (49' West of Manhole' In comsideration of the 9�uancae to me of a permit to constcuct the building described above I agree to Ho the p�oposed work ffi a�rdance with the descripf3on above set sad in c�mpliantae wlth af l provlaibne of or8iaanc�ea o4 the dty oE Fridley. � � �, �y e Ia camsdderation of the �yment of a fee oP $_ '�� .00 �.�t q$ ��, �� � Lars G. �aderson to cronslaniet the building or additfon as descxibed above. Thia� t is granted upoa the euPra� cauditfoa that thepe�a� to whom it is granted and his agents. emplo�y� en� worl�nea, ia all work fla�e in, araa�ad and upon said buiiding, or aqq�rt thereof, shall c�form in aII r�pects to the arr�insnc�s ofi FridleY. Minaesota la�tton, camstruction, alteration, maintenanc�. �aepair and movtng of b��� wl�� dLy limits��a�� permit ma�► be revoked at any tizne upoa vlolatia� oP any of the P�ovis�ams of ea�d t Clarence Belisle ��� � NOTIC& TW. p�ene aoe. eot �r t6s eo�dion, � h� �aa P�bre. ea k.at�s. .s�ra� ar �rats.. e. .un is ... Na Bu� I�ar h� +eW►ah Pe�b fo►11� i1�n, . �.PPI,IC.ATION FOR BITILDINC PF�ZMIT CITY OF FRIDI�Y9 NlINNESOTA ow� Ps N.� ���5. G, �Q�/,DE/'i'so� B�z�aoII� �•�i�lE-� aDnx.F�s ��� � .�'EF,FER s � � s�, w,E, ��xESS .� � �a t NO o �TRE�'I' I,OC9TIOlV OF BITILDI�TG �� � 6� LOT � BLOCK .� A�DITION OR �IIBDIVISIO�T �`db,FN✓AT,�rj b��QFI� S COR.'1'ER LOT �� I�TSIDE LOT SE°I'BA�K: SIDEY,4RD SE4dER ELEVATIOTi TOP OI' FOCTING Applicant attach to thi� iorm T�ro �ertificate� oi S�vey of Lot aza.d propo�ed build� lo�atior� dra�rn. on i;he�a Cestificateso DFSCR�IGI'_TON 0� BUILDING To Be TTs�d A�: �'iN6L F�WF� LI Nt�ont �� /��/ D�pth 2 9� Height ��' � �quare �°eet Cubic Feet � � � '� �- � F�ont Depth Height Squ�,re �eet Cubic Fe�-c Type of Construction L✓?'�i%9E Estima.ted Cost To Be Completed The underaig�.ed hereby make� application for a permit ior the work herei.n. epecif°ied9 a.g�eeira.g to do all work in strict aocordance with the City of Frid'ley Ord.inances and :eulings of the Departmexat oi Build�a.gs, and hereby decla.res tha.t all the facts a�a.d repreaentations stated in this appZication are true a.nd correcte /� DATE GS�'if 3/ —/9(� �' SiGNg'�TiTRE L����� . L%2���� dc—. (Schedule of Fee Co�sts can be fouxid on the Rever�e Sideo, � � � �� ��� �� � � � . � � � � r a i �� � �� � _ �„ � 1 � < � ' BIIII,DING PEftMIT �'EE SCHEDIILE SECTION 2, The Inspecto� of Buildin.�s sha,ll, �aefore issuirag pezciits for the e�ection of any building or �t�u.cture, or �or axxy addition to a,ny existix�.g �tr°ucture or buii�.ing, or for a.�y alteration or repa.ir� to a�a.y existin.g buildin� or stxuctu:�e, upox� applicat3on therefo�e9 �equire the payment by the �,pplica,�t for �uch permit oi fees to the amount here�� below �et iorth and in the ma.�.ner hereira provided to�wit: Uniform Build�n� Codeo Type 1 9 2, & 4-$'i o75 for each one thou�ax�.d cubic feet, or fraction thereoie ua. such cubical c:ontentso Type 3& 5- $1050 for each one thouaand cubic feeta For the purpose oi computing iees for building permita, the cubical contents of any buildi.ng or �.ddition to a u:r�iform height throughout by multiplyi.ng the ground area covered from a point six (6) inches below the iloor line of the basement or the cellar to the avera,�e height of the upper suxface or to the avera.�e hei�ht of the rooi surface of th.e main �a.ble of a pitched roofo For repair� or alterations to an eacisting �tructu.�e, the fee sha,ll be at the rate oi $3e00 per each five hundred dollara ($500e00) or fraction thereof in the cost of all p�oposed worko In no ease sha.11 the �ee vharged for ax�.y permit as set ?orth i.n Section 2 b� less than $50000 NSSSD Cox�nectiox� Charges based o�. location - Area 1 or 2 0 � S � T � i � � a,qF 6 __� :ar �' t.-�`,�� .,+n �• � ,;,� `- ' . - �°s' - '�, �'e-:- - � . . 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FLOOR DRAINS CATCH BASINS nuro e/�s►�a GAS APPL GAS RANGE � OPENiNGS �. _. � � � �� �a� � �� � � � � �,�e � p+ � ���� � ���� ���� � ���� � �°�° � �� b��� � �� o- �� p �� o � � ��.�� ����' m `° ,� b � ���� ���; �m w� � � A � (Q O �� di" � ►w 3 `� � Y� �� � � a0 � � & �°n � 8 M � � � � -� � � � C) � m �, � � a � � :� � M. � � �x� � �m �� r� �_ . � $ � � �' � �. � � � � � � � � � 0 � h►� c� Q � � � t�'� � � ��� ��• ����,�. ��,s �' � � � � � y � � �. `t 0 � � � � ����� � t��l. 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IaAe � �. � APPL. � I�3A8 � � � RANOE :� � � I� 9 � H � �� I '" x � � �. � � � n p � O � � � � � � �, � � � � -o N I � �b � ` � •O � � , �� � � �', � � � �; � � o � � � t3+ 7 1 � � C � � r � :� P � � � � � � 0 a x .L� -!�"-�,:,�r r��� �r o � � � � � n � O ���� � � � p � "��� � � � � � g � �� y � M � � � � y � o W �g � �d ���� � � � ��p� p y tO o � � r ��: �� ��: �� . . � � � : : � : : : : � : : : : $�.� m � �„�o c� � � � � � � � � � 0 Or 00 I a � � 0 O AA7 � � � � � � � � � � � ° bd � � � a 8 �, 0 r o� e�/ �i °e � K I w �a W � � �� �� �� �! o � r, � : efDO � �: � � � � � • w � � � � ��p � I ►�! v � 0 � � � �� o � z 0 � � � °x M 0 � �� � 17 R+ G. o O � � � � �� o �r► �D ' ►! 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Job Name ��-� i/%��� /��� D-s6 Qe ��0 6zeelsto� Bonle�ard, Mineeapolls 16, Miee. / � �-+ NBAT LOSS CALCYLATIONB Job Address U�Lo r Weatherstrips A'S'H'V•E' Coastructivn No. I Insulation Guide Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor � Kind How Applied Yes—No I Yes—No 19_ I F1.� o° oom � Length � Width Height Fl.� �m Length � y Width !�° Height Windows aad Doors—Cracicage and Area Windows and D�m—�Crackage aad Area tVtdth Helght No. ot L1nea1 f. Area Wldth Height Na of Lineal LQ Ares No. ot Dane o[ pane Ilghte ot crack eQ. ft. No. oL pane ot pane ItghLe oL craak sC. f� �.fJ� Q D %� �.� �!� e 'S7 f�1 � � �- � � . �9� 09 � � � � �.� a� � 0 7.� `� coef. Btu 7�� Infiltration ' � Glass Q Eap. wall � X � � � �"-�- - - _-_ - �T"- - -_ - —� - -- — - Int. waU � Q Ceiling ` Floor (� ��j' � � Total Btu. Required sq. k. E.D.R. or sq. ias. W.A. l.eader area � F7.� Room ( L�ngth /,� Width /� Height � Windows ' d Doora--Crackage and Area Wtatq xeiahc xa ot Liaeal:t area Na ot pane ot pane llgnts ot crack sq. tt. % �� � '� /� » Coef. 8tu Infiltradon , /� � Glaaa _ Zt� ,� F.�cp. wall �� i� % Net esp. wall � "}+ (o � Int. wall Ceiliag _ ___ _o - - .. - _ -= - - - - - Flo`oi _ j�, p � ia O F1oor Total Btu. Total Btn. Required sq. ,ft. E.D.R. or sq. ins. W.A. Leader area �' Fl. j Room � Length / Width /� Height d Wiadows aad Doors—Crackage and Area Wldth Hetght No. oL Lfneal tQ Area No. ot pane ot pane Ilg6te of crack eq. tt � � , (�' (� � �� �i� Li6ltraticn C�laaa �� Nec eap: w In� wall Ceiliag Floor Total Btw rn��� � Requfred sq. fi. E.D.R. or aq. ias. W.A. Lsader area Z FI.I .d� Room Wiadows and Doon—I Wldts Helght 1 Na of Dane o! vane � In6ltratioa Glaas Eap. wall � �i �C Net esp. wall Int. wall 1n61tration � � Glass 1 Eap. wall � � Net ea�p. wall v � / Int. waQ Ceiling Floor ��/ Total Btu. ' Reqnired aq. k. E.D.R. or aq. ins. W.A. I.eader area /Z,_ Width and Area ! 2 � Required aq. k. E.D.R. or aq. ins. WA. l.eader area Btu `3 b 6-� ZFl.� �_ Room I Length // Width i.� He.i; Windowa and Doora—Crackage and Nrea Widts Helght Na of Lfneal [L Area Na of pane ot.pane Ilghts ot erack aQ. tt. 3 l� 3(� 3 fo I f� .z� _��- , �v � � B� I I 9 � p In6lhation � � Glaaa F�. w�11 .� x � Nec eap. wau Inw wall Ceiling � �,/ � Floor ��� � ��� . „ r. ���� ` � ,.: ,��� �7 ,►�71� / �_� ��%�'��ie _ � Total Btu. Reqnired aq. k. E.D.R. or sq. ins. WA 1.eader area ) .� .,��-,�-. �, .: �---« d�;ROAISTROMS HTG. & AIR COND.� INC. Job Nam D�56 '��O 6:celslor Boole�ard, Mieneapolis 16, Mtnn. �6 H6A'� LOSS CAL�7ILATIONB Job Addre A.S.H.V.E. Weatherstrips Conatruction No. � Insulaaon Guide Windowa I Doors Reference Out. Wall Int. Wall Ceiling Roof F7oor I Kind How Applied Yes—No Yes—No 19 �F7.� Room Leagth � Width Height F7.� Rcom Length Width Height Windows and D�rs—Crackage and Area Windows and Doora—Crackage and Area �Vldth Hetgbt No. ot Llneal f. Area Wldth Hetght No. oL Lineat IG Area No. ot pane oP pane Itghte o! crack eq. iG Na ot oaoe ot uane lltrhte ot crack e4. [t Coef. Btu Infiltration �f Q � B � Glass � Fap. wall � Z'C � � --- -. ----- ------ - -- Iat. wall Ceiling S" � 2,� Floor Total Btu. ' Required sq., ft. E.D.R. or sq. ins. W.A. Ixader area I �..�1.� Room � L,ength j.� Width / Z Heislit � Windows and Doors—Crackage and Area WIdi6', Hefght No. of Lineal fR Area No. ot pane ot pane lighte of crack aQ. tt. � �� � � � Coef. Btu Iafilaation i Z y�� Glaaa ✓�}( Eap. wall X g 2/ � Net eap. wall, /� � Int. wall Ceiling � /p -- - - - _ _ _ r'i -� -- -- - Required sq. k. E.D.R. or aq. ins. W.A. l.eader area Fl. Room � Length Width Windows and Doors—Crackage and Area Wldth Helg6t No. ot Liaeat tt Area Na o,! Osae o[ pane Ilg6ts ot orack eq. fL � Infiltration Glaaa Eup. wall Nec esp. wall ,; Int. waU Ceiling ' Floor Tbtal Btu. ' Required aq. f� E.D.R. or aq. ins. W.A. I.eader area Infiltra�ion Glaas _ Eap. wall �et_ e�. w InG wall Ceiling Floor Total Btu. i i f� E.D.R. or aq. ins. WA. Leader area I Windows and Wldth 7 Na of pane � � Infiltration � Glasa IEap. wall Net esp. wall In� wall Ceiling Floor I Total Btu. Room ( l.ength Width and Area aeal ft. / crack � Required aq. ft. E.D.R. or aq. ins. W.A. I.eader area Fl.� Room ( LeaSth Width Windowa a� Doora—Crackage and Area Wtdt6 HNght Na of Lineal f� Ares Na ot psne ot.pane tights o! erack sp. tt Btll Infiltration Glaaa FaP- wall Net eap. wall In� wall Ceiliag Floor — —� -- Total Btn. Requind sq. k. ED.R. or sq. ias. 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O :� � � � �� � � � �2��- � � � � �-�� o � Q a � �" �' � o � � cfl � �0°��. � �� � ���� m3s am Svo� �� _� �� o L ���� ����(�-, � �- � � 3�� �� ���� � m��'� � = n � O �� � � � � �� �� Q�� � ���� � � S � � O ' � �' � � � n � ��� � � m � w � a�m �� � � N Q � � j � � � � D z � w� v �� � . aZ rn� � � _Z v z � � rn � �° ma �O Z Z. �'1 : :� . � v � �� ao �. v �° �� Z y z�� � �v, v u� _ ... v � �. m �a � � y vd �g m� tn . � � � � � � a G� r � � Z m 0 T � 9 � �1 � � � �HIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimaey or stack: 1. Has been carefiilly examined Yes i''� o() 2. Is free from rust or deterior�ttion Yes ('�'�o () 3. Has no foreiga objects lodged wit6in yes (�No () 4. Is securely supported Yes (`'�No () 5. Meets all cuirent Code requireme�s for size and total BTU's conn� Yes �No () 6 Has total heating �BTU's of �. �� i�d� All other BTU's � � � � - � � � ' TOTAL BTU's 7. Has a liner bee�n provided for water heater 8. 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VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacinsa an exis�ng 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 plasticlPVC and meets all current codes and manufacturer specfications including sizing, length, number of elbows and termination. Yes () No () The undersigned also verifies that the replacement unit is a listed assembiy 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. The existins� combustion air is sized and installed to meet the current codes and manufacturer's specifications. � When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specfications. Yes( ) No( ) Yes ( ) No ( ) Yes ( ) No ( ) When installins� a new ventina system, the undersigned hereby verifies that it is a listed assembly and meets the cuRent codes and manufacturer's specfications. This does include AGA-GAMA Category i Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes (} No () Is the common vent and vent connectors sized and instalied correctly after an appliance has been removed from the common verrt and vented _,, �,, separately as per current codes. :�;� :°� • Yes O No O Apaliance Tvae and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assiste�i or Nat Appliance #2 Type BTU Input Fan Assis#ed or Nat Appiiance #3 Type BTU Input Fan Assisted or Nat Total Appliances Totai Btu Input . � Common Vent Type Vent Height Diam�ter �� 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 : Building Inspections 763-572-3604 SITE ADDRESS L'StCQ`'(L THLS APPLICANT IS: PROPERTY OWNER/ TENAI�TT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION ' PROPERTY TYPE PERMIT TYPE �r�rnE o� wo�x: � BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS ❑ OWNER �ONTRACTOR PHONE: S�l �-I - i c') � 3 STATE LICENSE # EXI' DATE O TWO FAIVIILYINEW CONSTRUCI'ION � ADDTfION O GARAG � BASEMENT FINISH -$ROOF 0 DECK 0 SIDING n DESCRIBE WORK BEING SIZE OF IIVIPROVEMENT sQu,vt�s �_ GARAGES PROPOSED S1ZE: PROPOSID HEIGHT: ❑ REMODAdNG 9'� /' P f !'°1 � O HOUSE & GARAGE ❑ A1'fACHED GARAGE 0 DETACI�D GARAGE 0 DRAIN TlLE ❑ OTHER Permit No.: Received By: Date Rec'd: HEIGHT ' s�-�.3-� A�Z�s�y 3 a BASEN�NT REMODELING SUBNIIT: 1. Existing Floar Plan Z. Proposed fl�r plan 3. List of structural memb�s w be �sed Ft� SIDING FOR NEW CONSTRUC7'lON 1NCLUDMG DECKS, O Viayl OSoffrt ADDITTONS. 8c PORCHES SUBNIlT: ❑ Aluminum ❑ Trim 1, Site Plan/Survey showing the existing sWchues ❑ Othet ❑ Fascia and ProP�� P%1� ��w$ 2. Two sets of constructi� plans IN E3QSTING OPENWGS �Yes ONo LOCATION OF WINDOWS 3. �� ����0� OR FOR NEW OPEMNGS-DESCRIBE SIZE OF OPENIIVG CHANGES 8c TYPE OF WATDOW TO BE IIJSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USINGT� 1997 U.B C FEE SCHEDULE) TOTAL JOB VALUATION $ '� 1 lQ _� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Fscrow Erosion Control Patk Fee Sewer Main Charge Total Dne _ _ $ $ 3. �2. $ L (� (� $ �.C� $ $ $ $ $ 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+68= 8x$21=$ $450 Conservarion Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Frtdley Attac6 THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in conformance with the ordiaances 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 of all work ch requ�res review and approval of plans. SIGNATURE OF APPLICANT �t�� PRINT NAME �—Lii''F UV� K� DATE �`�'I ' O�-F' Page 2- Building Residential Applica.tion BUII.DING PERMIT FEE SCHEDULE The Chief Building Official sha11, before issuing permits for the erection of any building or siructiu�e, or for any addition to any existing building or shucture, or for any altera.tion or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 � 763-572-3604 Fax: 763-502-4977 Bui�di�g Inspections 763-572�36U4 DATE � �V � Z✓ O SITE ADDRESS �n i'H1S APPLICANT IS: PROPERTY O�VNER/ � TENAI�TT CONTRACTOR SUBA�TT A COPY OF YOUR STA1E LICENSE oVITH APPLICATiON PROPERTY TYPE PERMIT TYPE •rYrE o� woRx: NAtv�: BUILDING RESIDENTIAL APPLICATI4N CIT� OF FRIDLEY � D O YOUR E-MAIL ADDRESS _ 1 aK �v. OW{VER OCONTRACTOR ,., G�cS —�ihy.4. A � ��r ►s: (� 6 t 6 A�s � e�.,. 14-t '7 I Z V _C '7t,1..- 7 G,lr.1 � STATE LICENSE EXP DATE � Permit No. •, R���� Date Rec'd: s'�' . �'4'�' � t S Y 3Z., ADDRESS: CT1Y � STATE ZIP PHONE FAX ❑ BAS�vm�' Fw1sH ❑ DECK o Man�,vac�rnrn DESCRIBE WORK BEING SIZE OF INII'ROVEMENT OFSQUARES GA�AGES PROPOSED SlZE: PROPOSED HEiGHT: SIDIIVG 0 Vinyl O Alumiwm ' 0 oa,� . wnvnows 1N EXISTWG OPFI�tWGS DYes ONo OR FOR NEW OPENIl�TQS-DESCRtBE SIZE OF OPENIIdG CHANGES 8c TYPE OF WINDOW TO BE INSTALLED 0 ROOF 0 SIDIN(3 �wn�m�� r�o� ❑ ADDTfION ❑ REMODELING bb� LENGTH �O � ❑ HOUSE �NLY ❑ HOUSE & GARAGE O ATTACHED GARAGE 0 DEfACHED GARAGE OSoffit O Trim ❑ Ffficia IACATTON OF W1AiDOWS ❑ DRAIIJ T[LE ❑ OTl�R u� G rek.K.d vV I? D Cs HEIGHT N S �� 1 �AS£MII�T REMODELWG SUBMIT: 1. Existing Floor Plan 2. Pro� 8�r plan 3. List of struct�ral �c►bers ta 1� uced F� FOR NEW CONSTRUC'RON IIVCLUDING DECKS, ADDI7'IONS. 8c PORCI�S•SUB2�4IT: 1. Site P1an/Survey showiag U�e �ing suucdues � P�� �J� Z. Twro sets of construrxion plans 3. EnExgy calcutations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COS� OF LABOR AND MATERIALS: ��'� TOTAL JOB VALUATION $� �� U.B.0 FEE OCCUPANCY TYPE Permit Fee � Plan Review Fire Surcharge S�rcharge License Surcharge SAC Charge G�rb Cut Escrow Erosion Control Park Fee Sewer Main Charge Toial Dne $ oi - � $ � o� c� $ $ � $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the wtal job valuation .0005 x Permit Valvation Minimum $.50 $S.QO (State Licensed Residential Contractors) $1675 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 payable to: City of Fridley Attac 1iiIS IS AN APPLICATION FOR A PERNlTf NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclmowledge thax the information above is complete and accurate; that t6e work will be in conformance wiRh the ordinances and codes of the City of Fritiley 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�i� that the work will be in accordance with the approved plan in the case of all work w}'ich requires revi w and pproval of plans. SIGNATURE OF APPLIGANT ���I.�L � R1M NAME �-�t K n, G- /�tn c� � fS a v+ DATE !��f (� 01 Page 2- Building Residential Applicatian �� � BUII..DING PEI2MIT FEE SCHEDULE . . � - . ��: ; 4 The Chief $uil,ding Officiai shall, before _i5suing permifs for the erectiou qf any building or , si�ucture, or for aaziy°�.dditidri fc� any'�xisting building or structwre, or for any�,alteration or repazr ' to any existing building or structure, upon application there�o're, require �the� payinent �y� the applicant for such p�rmit of fees to the amoun.t herein below set forth and in the manner herein pmvided to-wit: , � . ° � . _ , . . . , . , VERITICATION OF FOUNDATI4N Pe� for construction will be issued a minimum of 24 haurs from the time of application to allow for proper review of proposed structure and of the constYV.ction site. A Certificate of Survey of t�e lot, showing the location of the existing foundation will be required before proceedi.n.g with the fi�a.ming. New Houses Onlv City of Fridley Bualding Inspections Department 6431 Uruversity Avenue NE . Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 " � , � :-��l���oo� � CIlYOF FR[DL�Y FRIDLEY MIJNICIPAL CENTER • 6431 UNIVERSIT'Y AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a s,�ecific ex �on fro the licensing requirements. As the owner of the property at�,� y`���.(�. �e , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for cesale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forFeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perForm certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights fo reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and c'ity ordinances in connection with the work being pecFormed on this properiy. � _ �� � . .i�.�� � i_��-� Date � — � ( -- O � a s " h �G- � w C0<S d h �• � � � � � �ll�i � I . �� � W�� w►-� ��- o� e. -- i(� C� -� 3 r d l� �. �r-� d�-e. y 76 3 -s" 7!- 13�� �+-u�.c� �� l� e r -�l�.y w a. r�1 - Pe r-� ( e�- P+.�� 5 e, �^ 1 K- o.� C� u� ��, -� U. �r w a- r d Po w e r_� la �„ �. �J�LI� YG►rc� � �e.r..c�d l� '���1.A�K �: v�l� N � � � a � ��� ��� ��-G� ��t'�- v�G � F---�► � � � , a � � � � � h