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AF - 35674� * � D � � m n � o m n. 3 � 0 N� � o' �, � � O 7 3 0 � Q o � �� c� � -a i � �. � � �� `° � � m p' � Q � � O � � m Z � � rn n -� O z � m m � A. N 0 0 _ � m �' -� � 0 C D rn � � mD °< -z-� � �- � � � V' � C � Z � m rn c � � T �.�m 0 o rn � Z O y D �7 m � � (n 0 -t C Z 2m n � D �' z I L� mZ I r� � �' G7 p � sv rn lo � � � Z � � � � rn c=, � m � u, m � Z � GF! � N CJ1 f-' o � O � � cn � c� a W 2(T7 --D-I z � � �1 O � _' O � D D G) L) � D-n � vNi � o � va', csun `n � U' � ° � O S O � �7 -D -� �l � (�D � a < � a c�n � �• Q -�a �° � � m i" � ~ -' m cn �D n� � su i C � � .� � Z m m � �1 c° Q o p, �" m�� Q, D D� �nN� `� � i � Q m � �� s� D a?! „ o cn � ?� �i � = g = � � C) n; � � � •O� 2 n T � � rn m o� c�Dn m oo m o � o -, o � sv �. C � � � � � a� � v W rn r- ,�°c '� � m � � � �. O � z b C7 � !� � � V � 0 � � � � � ,� Z � � -1 � O m � — C � o � z � � �j 3 m � � � 7 Z � w 3 N ca l� 2 2 0 � I C� � � � � � `° o � o � � m � (D � � n � N � � � Q- N O W N � m m Z m � o 0 o � " o � � m � � � � � � f» � r� N CJ7 O O � O °o °o o° o° °o � ,� .� .� � � c o � r � � m Z � � � m c� m \ � O � � � � � � (, � O "y Z Q O � � � r � � I ry Z � n � Z � � � � � � Z � � � � � z n M n �.� � � � � � � io- --1 � D r � --. ln ---1 � (1 �, C � �, -~: � m � � O Q � �. S � N o m�c�- � �° ro. c�n ��•� n. m Q- � �- m � o � rz � � m � 0 0 .� �. vi n' � N� o u� � o c�p � �-Q�� n -a o' � ' �- c� � (D .-nr �,.1 � � � O. (D � N O O (D � � ¢1 -. � � C� (D 1 Q � � � O S�U • �` �` sv � o � � �- m s � n � � � � � o �N � � _ � °�, �- � � � co a cn c� � � �• V � Q V � ��i � N p, W � I � W `< C O o � -" A z � � � �� c�, D N � z Z m �' v rn C� � O z 0 < m � � � r � n m D D —i -� O O Z Z � Z Z77 � � D �p �C� � � Z � � � � Z � � z U, z D � o ..�� o o m � 3�] � �. D Z � Q L� � o O � � O ,� Z � � � Z � � � � � Z V � � m m � <� cD O � L A� � � � � � � �� C�IIlVINEY AND STACS VERI��CATION The undersigned hereby verifies that the�existing chimuey or stack: 1. . Has been carefiilly examined Yes O No O 2. Is free from n�st or deteriorarion �3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code reqairements for size -- -- -- - - - -- and total BT'U's connected 6 Has total heating BTU's of All other BTU's TOTAL BTLT's Yes()No() Yes()No() Yes()No() _ _ YesONo-O - 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Yes ( ) No ( ) Yes()No() ,� �� List ALTERATIONS Bein�Done: HEATING CO: Signed By: Date: . ��/X/ � / .�--- * * n O 'S �'^ VJ/ .�.1 O Z D � � 2 D r r � m � � O < v m 0 � m � c � n � m n -i O Z � 0 A D D z v � � r m � I D � Z � c � � N m � � O z n 2 m m O � � m m fA � � � ._J � m � c A � w cfl m � 0 D '� � < m a � � � 0 c co s I � � � m � v m m � � 1 � � �' o�° � 'pN --I O = n < - w � � m D � �z�, � � � „X,� � N c � � oT 0 y 1 D D v � v � - D � v � D r m � O z � d � C -► °�' a, r�'n �� c m w W� a m m w?: 3 3 ci °-, � a� v 7o m m m.� �� 0 O-n � o�� 2 2-� � p�, oo � v, m� g� co �� m �� y W v � c . ro r. r. Q: m m�� m �**�� z• r' 3 y y co u, c I 1�� m � c� Z � � m -° --� m � �o * � �. � -n � � � � .Q � 1 �' � � m a -C m .-. �� I I I� I I I I I I I � � � � � � � � � � � � � (71 "' O O O y O V V�I V Uf A�J 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 • � �, c � . �n �o m � C '• z 3 m W � v � � a : O y � � z � � �i \ � � -o m � � =i z � O �;C �� O�" � ��p� � � °�� .� ' � �' O � � � � a � � .� m tn s. C N � A � a y � � �� C> � � � � � � � � � � � � � � � �,(� � � t � W r � � co v � � a s n. o. cu w -. -. �. cp c _.,, c � � ' °- m N y Of � � o. � co � � � . �. � o co . � - a y W � S C 0 N m o: Q- v' � � O .0 a �° ?' 3 � � g �. 3 �: � y w o , a� w ? � v v � � v '6 � � n o a c,�,' w. � � m o m � m � �. � � o 0 a m Q j w c o � m m °i m 3 m m � a; n- ;� �� o � s .' ., � � � s � m � m � � " 3 � O � � x O � � � N � � v r C � � Z � � X � , m � � m � z 0 D -i m O � � O W D v � � � � � � � � � � 0 0 0 o m 0 0 0 0 � ° ,A W N � � t�/i � c � w :::>:: � �n:::>:... D � � � � z � C � �><::;>:<:;? m ?:<:::>`::<'>::: � <�':::>:::::::::::: 0 :'.;:' 'n � � w � `` �' m � -i :a:;;.�y;' O o:;::::;�;:: o0 c:::>::�:::; m :�:>::::.. ?c�::: �;::;:: : Z :>:: (n E.� ..::�:. � � ° r � ° m v ,W `i>i�` Z sn::»: :?' v��:;.:�::>�7 �;; D 7;;:;:;:. �'.? � � :>:.. _ �..... � D N o r � O � � � w tn N � 2 m � m m o � � @ SuBJECT City of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T i � � t � ; v __��_ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. � _ �"'ti � CITV HALL FRIOLEv 55432 NUMBEP nEv �"'"�� ,�� 612-571-3450 910-F15 10B ADDRESS 6216 Caro1 Circle NE t LEGAL LOT NO. BLOCK TRACT OR AODITION DESCR. 2 PROPERTY OWNER MAIL ADDRES$ Ra.lph D Olson 3 CONTRACTOR MAILADDRESS Owner 4 ARCHITECT OR DESIGNER MAIL ADORESS 5 ENGINEER MAIL AODRESS 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION 8 DESCRIBE WORK Reroof house & garage (24SQ) Tear-off 8 CHAN(iE OF USE FROM TO OATE 9/ 21P PAGE OF � � PHONE PHONE PHONE 27798 O. �� APPROVED BY SEE ATTACHED SHEET LICENSE NO. LICENSE NO. LICENSE NO. 6,7 REPAIR O MOVE O REMOVE STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATINCi, TYPE OF CONST. OCCUPi VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. fT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED POR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STA�LS ANO KNOW THE SAME TO BE TRUE AND CORREC7. ALl PROVISIONS OF LAWS yALUATION AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �Y2sOSC).00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STpUCTION OR THE PERFORMANCE OF CONSTRUCTION. �7�F. JS TURE OF CONi auir+UMi[ n N7 �DATEI BUIID IDATE� t � i OCCUPANCVLOAD CU. FT. �REET PARKING IGARAGES 4X $1.03 MARGE Fire SC $2.06 .FEE $77.84 T NEW ADDN ALTER [] L] �� ConstructionAddress: L�gal Description: _ Owner Name & Addr Contractor: � Address: LIVING AREA: GARAGE AREA: DECK AREA: OTI�R: N CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ' z !� �i�.- ��/�i/ ��/�� r �� cn�-- ��/'i Effective 1/1/ 8 G`� �� b Tel. # �' Z — ��3 MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground Tel. # Sq. Ft. Sq. Ft. Sq. Ft. �y ��° �f�r=�`�� Construction Type: � �— Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: �� APPLICANT: �. �''�� Tel. � Permit Fee Fire Surchazge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY U5E ONLY $ -� Fee Schedule on Reverse Side $ �•U� .001 of Permit Valuation (1/lOth%) $ /, (�� $.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 [ J Not Necessary [] $ �U ..�7 Z - ��,� BUII..DING PERMIT FEE SCHEDULE The Cluef Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration 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: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $1Q0,000 $100,001 to $500,000 $SQ0,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2, 000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,O(?0 or fraction thereof, to and including $1,000,000 � $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. 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 the proposed structure and of the construction site. � A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. � ;� C�TYOF FRtDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNNERSTTYAVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287 BUILDING PERMIT APPLICANT: HOMEOWNER 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 specfic exemption from the licensing requirements. By signing fhis document, I attesf to the fact that I am buildin� or improving this house myself. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building on speculation or for resale and that the house for which I am applying for #his permi�, located at �� '�'/ Go �"�/� f��; is the first residen4ial structure I have built or improved in the past twenty four (24) months. I also acknowledge that because I do not have a state license, I forFeit any mechanic's lien rights to which I rv�ay otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to pe�forrn 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 ofi Minnesota. I understand that unlicensed residential contrac#ing, remod�ling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my righfis to reimbursement from the Contractor's Recovery Fund �` in the event that any contractars I hire are unlicensed. �r � Si nature of Homeowner � �� Date ` Llcensed residentlal buildfng contractors and remodelers are covered by the reoovery fund. Licensed residentlal roafers and manufactured home inshallers are not covered by the recovery fund but are required to hold a ssirety band. To determine whether a pariicular contractor is required to be licens�d, or to check on the licensing status of individual contractors, please call the N1ir�n�sota Department of Commerce, Enforcement Division, at (612� 296-2594, or toll free at 1-800-657-3602. � ¢ � � i - O � a C� � � v m O � � n � < m � � � O ----� O Z � m � m m Z � � � � Z � m � � < �. � � N � O Q. 3 � � o oa � m O N v � � � �� o � � � m ,� ,� � a o � n N �� m � Q � -a � � � m � m $ a < � � m z � m � 0 � '� rn � 0 � _ 0 c �o O m r � m m s � � � C ° � °, � m c �m °� �� o � 0 � 0 � r 0 � � m � .� !�, o Y 03°.�� m � � o $ �� D � i-� �, tn � o w g o� � � o � � � � o � �° � � q �� co C � � � °� o o � ta � � � Q` v � x a � a 0 � � � �, r � �� N O � � � N C�u � m � � c�» o 0 � O � � � � � � � � _ � � � �� . � � � � � 2�� m 3 n � --� � m � � °��Q3,� Qa C o �� -� Q (p `� d o�a � 3 � � o � � � �� _ 3 � � � � 7 � � 7 `�am � �� ° 3 0 � m z � � g�i � ° w n cn �� o m � �� m � � � m � \ � � L� W C � N � � $ � � � � � � z � � _ � � m � c � � � � � � � m � o m ?� � 8 � � c� � � � � o w � O O � � .��i � � � � � � v O -�i � �� 'O � � � Z 0 � � � � � I � � Q a � � c � � .� 0 � v v � � . ti � YJ rl � .1� .� . a t�.il .,�� w� z�� o cn � 'r'� � �� N m � � z I�r� � m W � C '' v o�o � � � Z � � C� �-�1 -- — - --�-- - � �T'1 Z7 � r L7 D m --� �z° °z� z -v v O � � � m n� -o vz -�1 � � �, Z z 0 � � � � � � � � 3a O � Z 0 vz v� �` m m � Z � � � � O � Z � N O �, A FILL IN COMPLEYELY FOR REPLACEWIENT FUEL Bl7RNING APPLIANCE PER�AlTS COMMON VENT dENT CONNECTOR AND COMBUSTION AIR VERIFICATION 1Nhen nealacinct an existin4 furnace, the undersigned hereby verifies that t�he venting has been examin� and is free from rust, deterioration, o�ctions, and is securely supported and firestopped where requireci. Yes � No (} The venting system is plastic/PVC and meets all currerrt c�des and manufacturer speafications including sizing, length, number of elbows and termination. Yes � Rlo () The urtdersigned also verifies that the replac�ment unit is a listed assembly and meets the aarrent cades and manufacturer's s�cfir.ations. This does include AGA-G�MA Cat�ory I Central FumacB Venting Tables for fan assist�! and natural draft appfiances. The exis�na cor�nbus�on air is sized artd 'mstalled to m�t the c�arrent cades and manufac�urer's specific�tions. When required to ir�tall a new combustion air,_� wnll i� sized and instaAed to meet the currerrt c�des and manufacturer's specifications. Yes� No ( ) Yes( ) No(�, - ►� When installinst a new ver�tinn svstem. the undersigned hereby verifies that it is a listed assembly and meets the currerrt c�des and manufacturer's spec'�'ications. This d�s indude AGA-GAMA Cat�ory i Ce�rtral Fumace Venfmg Tables for fan assisted and natural draft appliances. Yes � Is fihe c�mmon verrt and verrt cannectors s¢ed and installed correctly after an appiianc� has been removed from the common verit and verrted separately as per current codes. No ( ) No ( ) Yes� No ( ) Apaliance Tvoe and Si¢e/Common dent and Vent Connector Ir�forn�a�ion Appliance #1 T �� e BTU Input d b�v Fan Assisted or Nat �� A IiancB #2 T w�°�r � BTU Input a. v Fan Assisted or Nat � PP Y� F►PPliance #3 Type BTU Input n Assi�t�l or ldat Total Ap�liances �. Tatal Btu laput U 6�° __ �� U__� �- -- - - -- �, � �� - _ �j----_ — �_ Z _ _ _ _ Common Vent Type S" f,'n�r' Vent Height 20' Diameter �_ inches Appliance #1 Ver�t Connec�or Height ft Lerigth ft Diameter in Type Appliance #2 Ver�t Conn�or Height ft Length ft Diameter in Type Appliance #3 Ver�t Connector Height ft Length ft Diameter in Ty� ALTER�►TIONS (De�cribel �c�l� �� ° ° ° ��i t�",�� V � HEATING CO: 4-i� 1 Signed By: � � Date : ADDRESS PIN LEGAL DESC PERNIIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: : 6216 CAROL DR NE : 143024440019 : SHOREWOOD : LOT 4 BLOCK 2 : HEATIlVG : RESIDENTIAL : ADDITION/ALTERATION 571-1287 _---- �—_°-� PERN�°f � NO.: 2004-00808 a DATE ISSUED: 06/Ol/2004 VALUATION : $ 6,852.00 NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A FURNACE (WARM AIR, CARRIER, 60,000 BTUS) AND AN AIR CONDITIONER # A/C iJNIT5 1 # FURNACES # GAS DRYERS APPLICANT I{NIGHT HEATING & AIR CONDITIONING 13535 89 ST NE OTSEGO, MN 55330- OWNER OLSON RALPH D 6216 CAROL DR NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and l�ow the sa.me to be true and correct. All provisions of laws and ordinances goveming this type of wor� will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the perFormance of construction. Bldg Insp 0 # GAS RANGES HEATING PERNIIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONII�TG FEE STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 5347 SEPARATE PERMITS REQi71RED FOR WORK OTHF.R TFTAN T�FCruTU�n n nn« 1 0 0.00 35.00 0.00 0.00 25.00 0.50 60.50 e ADDRESS . PIN . LEGAL DESC . PERMTT TYPE . PROPERTY TYPE . CONSTRUCTION TYPE . CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 s�z-36u4 r��ac: 6216 CAROL DR NE 143024440019 SHOREWOOD LOT 4 BLOCK 2 ELECTRICAL RESIDENTIAL ADDITION/ALTERATION 571-1Zii7 PERMIT NO.: 200400845 ��G��1 DATE ISSUED: 06/08/2004 �° VALUATION . NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERNIIT ISSUE DATE. REPLACE FURNACE AND AIlZ CONDITIONER. # INSPECTIONS 1 APPLICANT ROBIN50N J M ELECTRIC INC 5015 FERN DR INDEPENDENCE, MN 55357- OWNER OLSON RALPH D 6216 CAROL DR NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this applicarion and l�ow the same to be true and correct. All provisions of laws and ordinances governing this type of wor� will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date. ELEC PERNIIT FEE - MIN (RESI) STATE SURCHARGE, ELEC FLAT TOTAL PAID WITH CHECK # 6839 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 20.00 0.50 20.50 Building PLUMBING Pe�t 1vo.;��1-�� (� Inspections RESIDENTIAL APPLICATION R� B''�' 0 763-572-3604 D�°� CITY OF FRIDLEY � DATE YOUR E-MAIL ADDRESS srrE nvp s $aw►t as ��.�a✓ Italph Olson THIS APPLIC.��I�IT IS: ❑ OWNER �corrr�uc�'oR 6216 Carol � Northeast PROPERTY N�: Fridley, MN 55432 owNERI �D�S: 7635722113 � rA� z� TENANT • PHONE: cox�acroR N�: NOR�LOM PLLIMBIN� � SUBMIT A COPY OF STATE LICENSE #��v S (��p�� YOUR STATE ADDRESS; STATE ZIP LICENSE WITH PHONE • • APPLICATION � PERMIT TYPE �� F�'Y ❑ T�O FAMILY 0 TOWNHOTJSE �rYrE oF woRx: ❑ "�w � tp��c�r,T DETAILED DESCRIPTION OF WORK Rt��t GIJa�C✓ /S�_ rG✓ � PER MS 16B.665 the permit fee is a minimum of $15.00 ar 5% of the total cost ap to $500.U0; whichever is greater, for the . iinprovement, installaxion or replacement of a residential fixture, excluding the fixtures. (T.his.shouIdrefiect only.the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 tq. $500 � cost of labor x.OS = ��.FOR�'ROJEGTS WI�RE LABOR EXCEEDS�04;�EES ARE BASED ON $10.00 PER FD�'LTRE, E7CCEFT•�REP'01:1�iii.;F.fICF:d'IR£5:..(A�DICA.TE T.QTAL ' M)MBFR OF EACH BELOVi� BATH SINK/LAV �FLAOR DRAINS • SHOWER WA1ER PIPIIJG BATHTUB _ GAS PIPWG pvEm crrrucFrvsEj SWIMMDQG P�L WATER SOFT'NER ($35) _ CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($3S) FOR IRRIGATION _ WATER METER OTHF.R Permit Fee $ Number of fixtures @$10.00 x$10,00 =$ Surchar e .50 Number of fixtures @$15.00 x$15,00 =$ TOTAL DUE $ Number of fixhues @$35.D0 � x$35.00 =$ 3S. � . .. State Surcharge = $ .50 Total � $ . SD THIS LS AN APPLICAT30N FOR A PERMIT NOT VALID UNTIL PROCESSED � I hereby apply for a buiidmg permit and I aclmowledge that the information above is complete and accurate; that the work wilI be in conformance with the ordin ces and codes of the City of Fridley and w+ith the Minnesota Construction Codes; ffiat I understand this is not a permit but only an ap tion for a germit and work is not to start without a permit; that the work vkill be in accordance with the approved plan in the case work w h requires review and approval of plans. SIGNATURE OF APPLIC PRINT NAME �QTT O/��I10l�Y1 DATE Z . . � . , City of Fridley Building Inspections Depariment 643I University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building Inspections . 763-572-3604 763-502-4977 FAX DATE < v SITE ADDRES _ THIS APPLICANT IS PROPERTY OWNER/ TENANT ❑ OWNER BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-08 .XOUR E-MAIL,,ADDRESS �� d�� —� �3CONTRACTOR /a� aSa� : (40��/��J's-�� Ce /� l� CITY ► � � 7�.3 S'i� �//� � i� - � ,� � ' 1� � i,. . _ ,- _ � - - - � : ., �. - � �,�:,��. i ; � �� STATE,�LIP .3 � CONTRACTOR ADDRESS:_ � d� �`oi.� .� � c� t� � CTfY ��,ie�"G, �.s.ps�. STATE�ZI� SUBMIT A COPY OF pHONE �/ 2�/ ��"� � FAX c� �Ci� c�, �/_� �,3 3 YOUR STATE LICENSE STATE LICENSE # t�Cl U� Co �� EXP DATE {%G',s c�G� �' p PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILYMEW CONSTRUCTION PERMIT TYPE ❑ BASEMENT FINISH ❑ DECK TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR DESCRIBE WORK BEING ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED StZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum i ❑ Other � � 1 WINDOWS M EXISTING OPENINGS [�es ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED�i,, i— ❑ GARAGElSHED ❑ ROOF l�'S�IDING � ❑ SWA�IMING PO( ❑ ADDITION I�REMODEL Tr.l G., k. v ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE SIZE STORIES ❑ WINDOWS ❑ DRAIN TILE ❑ OTHER HEIGHT W � �� p � , c-r "' �e W+ BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, �, „�t ADDITIONS. & PORCHES SUBMIT: —�' 1. Site Plan/Survey showing the existing structures �nm and proposed project. Gd�escia 2. Two sets of construction plans 3. Energy Calculations LOCATION OF WINDOWS OF WINDOWS c� ALL FEES ARE BASED ON V LUA ON, INCLUDING THE COST OF LABOR AND MATERIA.LS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $_ � 3C1 �.� OCCUPANCY TYPE Permit Fee ' Plan Review Fire Surcharge Surcharge , License Surcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Total Due $ ��, ,� ,� See Back Page for Fee Schedule $ � 65% of Building Permit Fee $ ^ �� 1 .001 rimes the total job valuation $ . / .0005 x Permit Valuation Minimum $.50 $ �� $5.00 (State Licensed Residential Contractors) $ $1825 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$21=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necess�ry ( ) $ � �� Make checks pa_yable to: City of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowiedge 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 Cons ction Codes• at 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 accordan th the in the case of all work which requires review and approva^I of plf s. � SIGNATURE OF APPLICANT PRINT NAME �c-,,r ��, � a�3/I�/fat,� DATE � Q APPROVED BY DATE ' Page 2- Building Residential Application BUILDING PERNIIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing liuilding or structure, or for any alteration 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 applicati.on 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 -�,, � u City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 ' 763-572-3604 Fag: 763-502-4977 Building Inspections 763-572-3604 DATE S1TE ADDRESS THIS APPLICANT 1S: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOURSTATE LICENSE WITFi APPLICATION PERMIT TYPE TYPE OF WORK: PLUMBING R.ESIDENTIAL APPLICATION CITY OF FRIDLEY E-MAIL ❑ OWNER �ONTRACTOR PHONE��p_ --�-o�i�� NAME�1'C�.f'L��(o`F- l�C��{� STATE LICENSE H [o7-7�y G�✓�� ADDRESS: PHONE� ° % �SINGLE FAMILY O TWO FAMILY O NEW DETAILED DESCRIPTION OF WORK 1�3�i14�Y� Permit No.: Rec��Y � Date Rec'd: i" .'1'�_/�LL�i�/� • � J �, r �EPLACEMENT �� TOWNIiOUSE A STATE�ZIPi!�� PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacementof a residentiat fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor _� x.OS = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURE3: (INDICATE 7'UTAL NUMBER OF EACH BELOW) _ BATH S1NK/LAV FLOOR DRAINS SHOWER WA►'ER PIPING 9ATHTUB GAS PTPING p✓ECn cnrucF�v.sF) SWIMMING POOL Z WATER SOFTNER ($35) CLOTHES WASHER KITCHEN S1NK WATER CLOSET DACKFLOW PREV. ($IS) _ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATER METER OTFiER Pennit Fee 1'OTAL DUE o� Number of fixtures @$10.00 x$10.00 =$ � Number of fixtures @ $ I5.00 x $15.00 = $ _ � Number of fixtures @ $35.00 __ x $35.00 = $ State Surcharge = $ .50 7'otal = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VAL1D UNT(L PROCESSED I hereby apply for a building permit and 1 acknowledge that the information above is complete and accurate; tl�at the work will be in conformance with the ordinances and codes of the City of Fridley and witl� the Minnesota Construction Codes; that 1 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 witl� the approved plan in the case of all v ork "�� hich requires review and approval of plans. � SIGNATURE OF APPLiCANT `�.�"�' PRINT NA G-/ �ATE h� City of Fi•idley Building Inspections Department G431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 7G3-502-4977