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'-` .._ -- � '_:, 9 '. �u�serri'�6eci a�d swora to befor� me at Frnc�i��r, l�iu�ane��., �u a ��' � �`! -� - � � �� ° � �a.�3: 29�. �� " _ . � " , . da3�- o � � £ : - , � .� � ri, _ , _ .. ,. ; � �� , � , _ _ � -� .� ' " - , ,� . , . . . � � �_ ,. - �: i _ _ � � � �; i ; y � 1� 7 �� 5R" '"f �{ 1 4 ./ r c _ ' �' _ � �4,:' n: e - : .,� t 31 - � -'� � t .'fi, - ' 4 .v . . .,.z.5` c . u.�'t_w ... .AF'si.�'�'.+�--_y.. �. ,.�x•�g. ..� v ...... ..��c. ,.... .v...c> '�.a.ric ..$ . Y�w'-ac. -...e. . � .....r� ... . . . _.� �m ..x. _ sua�ecr P IT N O. City of Fridley o 186 1 AT THE TOP OF THE NVINS g U I L D I N G P E R M I T r � � RECEIPT NO � 1 y._____ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. i1 = � _---� �r��,,� CITY HALL FRIDLEv 55432 NUMBER REV. DATE PAGE OF APPROVED BV i 612-571-3450 910-F15 10/6/86 / / JOB ADDRESS 6283 Central Avenue N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1'J A11fi. Silb. #ZZ SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Gregory Stenhoff 6283 Central Avenue N.E. 571-6234 3 CONTqACTOR MAILADDRESS 21P PHONE LICENSENO 53ID� 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING RE'S1G�2ri'tl�. 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION �l REPAIR O MOVE ❑ REMOVE 8 OESCRIBE WOFiK Reroof Gara e and Siding on Garage & House 8 CHANOE QF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OF; CONSTRUCTION ZONING SO. 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 PARKING I NEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALIS GAFAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WII.L BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $8Q0 $. 5O 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. S1rJ. OO PLAN CHECK FEE ' TOTAL FEE $15. 50 SiG A REOFC tv�RAC1OAOAA No i ED ENr �DATE� WHEN PROPERLY VALIDATED THIS IS VOUR PERMIT iGNAT R O il NE � BUILDERi � � BLDG iNSP / NTE N�► [ J ADDt; . [ ] pLTER . Constr ction Address Legal Descriptlon: Ownez Name & Addzess: Contractor Address• LIVING AREA: GARAGE AREA: DECR AREA: OTHER: City of Fridley �R-1 AND R-2 � Building Permit Application Attach Lo this application, a Certlficate of Survey of the lot, With Lhe proposed construction draWn on it to scale. Effective 4/1/8c Tel. � �"� � . 4 DESCRIPTIOp OF IMPR09EMENT Width Height Sq. Ft. ______— Length __ - Length — �lidth _ Height _ Sq. Ft. - Length Width _ Hgt/Ground Sq. Ft. Inside Lot [] Ft. Yd. Setback Side Yard Setback Corner Lot [ ] �� Type of Construction: � Estimated Cost: $ ^� � �i� cge e��S� ppprox. Completion Date:. Alt. A Alt B Proposec DriveWay Width If New Opening Is Desired: See Back Page for Explanation . �.i� � � APPLICAhT. Tel. �i �� I� �°�� D�,TE. CITY DSE ONLY Permit Fee � �� Fee Schedule on Reverse Side Plan Check � 25'X of Building Permit Fee State Surchar�e S e°� 5.50/�1,000 Valuation SAC Charge � Su75 per SAC Unit Park Fee $ _ Fee Determined by Engineering SeWer Main Charge � ,�-� j pgreem�nt I�iecessar�► [] Not Necessary [] TOTAL : l °� v ' STIPULATIOt7S : BOII.DING PERl4IT FEE SCAEDIILE The Chief Building Official shall� before isauing permits for the erection of ar.y building or structure� or for any addition to any euisting Duilding or structure� ;or for any alteration or repair to any existing building or structure, upon epplicatio n theref.ore� require the payment Dy the applicaat for such permit of fees to the amount herein belo�r set forth and in the manner herein provided to-�it: ' Total Valuation �1.00 to �500.00 �501.00 to �2,000.00 Fees �10.00 (Minimum Fee is �15.00) �10.00 for the firat �500 plus �1.50 for each additional �100 or fraction Lhereof� to and including 52�000. E2,001.00 to 525,000.00 a32•50 for the first 52,000 plus �6.00 for each additional �1,000 or fraction thereof, to and including �25�000. �25,001.00 to �50�000.00 �50�001.00 to $100,000.00 �100�001.00 and up �170.50 for the first additional �1�000 or including �50,000. �283•00 for the first additional �1�000 or including �100,000. �25,000 plus �4.50 for each fraction thereof, to and �50,000 plus �3.00 for each fraction thereof, to and �433•00 for the first �100�000 plus �2.50 for each additional �1�000 or fraction Lhereof. DRIVEfiAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Drive�ay Width plus 6 feet times $13.50 Alternate "E": Remov2l and replacement of curb and gutter and install a 3 foot' wide aFFroach with 6 inch depth - Driveua} Width plus 6 feet times $15.75 VERIFICATION OF FOUNDATION Percits for construction uill be issued a mir.imum o.° 24 hours fro� thE time of aFplication to allo�. for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, shoWf ng the location of the foundation once it has Deen constructed aill be required before proceedir.g uith the framing. 6 sus�ecT PER .-- City of Fridley 2 8 356 , ,�7�:�� THE �►'NS gU ILDiNG PERMIT RECEIPT NO. � • COMMUNITY OE�ELOPMENT DIV. � � /� i VV �«�� r � � PAOTECTIVE INSPECTION SEC. � . , , � /°'1 � CITY NALL FRIOLE� SSI,i NUMBER REV OATE VAGE OF APPROVED BY �"'"�' �'� 612-571-34b0 910-F15 � � 10 21 98 108 ADDiiESS � 6283 Central Avenue NE 1 LEGAL ��T NO. BLOCK TRACT OR ADDITION SEE ATTACMED DESCR. 17 ALid. Sl1U. ��ZZ SMEET 2 PFOPERTY OWNER MAtL ADpR�S$ 21P PMONE Gre or D. Stenhoff 571-6234 3 CONTRACTOR MAIL ADORESS 21P PNONE UCENSE NO Owner d ARCNITECT OR DESIGNER MA1 ADDAESS ZIP PMONE LICENSE NO. 5 ENGINEER MAII AODRESS 21P PHONE LICENSE NO 8 USE Of BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION {� REPAIR O MOVE O REMOVE 8 DESCRI9E WORK Reroof house and ara e 20 S Tear-off 9 CHANGE Of USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. pCCUPANCV GROUP OCCUPANCV LOAO SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL. PLUMBING. MEATING, VENTI�ATING OR AIR CONOITIONING THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTFUCTION ZpNING SO. fT CU FT AUTHORIZED IS NOT COMMENCED V!!ITMIN 80 DAYS. OR IF CONSTpUCTION OFl WORK IS SUSPENDED OR ABANDONEO fOii A PER100 OF 1� OAYS AT ANr T�ME AFTER WORK IS COMMENCEO NO DWLG. UNITS OFfSTpEET PARKING I HEREBY CERTIFV TMAT I MAVE READ AND �XAM�N�D TMIS APPLICATION STALLS GARAGES AND KNOW TNE SAME TO BE TiiUE AN0 CORRECT. ALL PROVISIONS OF LAW$ VALUATION SURTAX AND OROINANCES GOVERNING THIS TYPE OF WQRK WI�L �E COMPUED r WITM WMETMER SPECIFIED HEREIN OR NOT. TME GRANTING Of A PERMIT 171,/{ •HC) DOES NOT PRESUME TO GIVE AUTMORITY TO V�OLATE OFi CANCEL TME pEqMIT fEE SAC CNARGE PROVISIONS OF ANY OTHER STATE OR IOCA� LAW REGULATING CON- STRUCTION OF TME PERFORMANCE OF CONSTRUCTION S( � S �Y'e SC 1. %1 PLAN CMECK FEE TO A� FEE 9.32 S�GNGTUAE OF CON'AACTOp OA AUTM ai E G iD�TEi MEN PR �� Y VA A D THIS IS VOUp PERMIT j �� °�\� � `� �� GNOT OFO NEp�� bWtiEpBU��OEp� iD�iE� Bl �NSo � - pitE \ N� [ l ADDN [ ] �,�R I l ConstructionAddress: I.egal Description: Owner Name & Address: CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERNIIT APPLICATION Effective 1/1/98 r' � � � � Tel. # ��/-�� Contractor: " � MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT c L1YING AREA: Length � Width � Height Sq. Ft. GARAGE AREA: Length _� Width � � Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: �/�/��/�� y�� i y (i `-� `� -1 � Construction Type: � @v � �� Estimated Cost: $ �� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: ^ ` � APPLICANT: Tel. # � �L � � � I,� �� 7 CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ � O 7S $ �� $ $ $ $ $ $ $ $ �, 3 2 Fee Schedule on Reverse Side .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 [ ] Not Necessary [ ] . - -� BUII.DING 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 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 YALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,QOO,OOU $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 $1Q0,000 $887.25 for first $100,000 plus $5.00 for each additional $1,OQ0 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1, 000 or fraction thereof, to and including $1, 000, 000 $5012.25 for the first $1,Q00,000 plus $2.75 for each additional $1,�0 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete C,urb 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. _ _ CITYOF FR[DLE,Y FRIDLEY MUTTICIPAL CEN'TER • 6431 UNIVERSTTY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 May 6, 2002 David 8� Josie Malone 6283 Central Avenue NE Fridley MN 55432 Re: Paved Driveways Dear Mr. & Mrs. Malone: In 1997, the City Council adopted an ordinance declaring gravel driveways a public nuisance. They were declared a public nuisance for a number of reasons, such as: they can cause erosion, contaminate soil with oil and other vehicles fluids, and deposit soil and gravel in the City's storm sewers and detention ponds. When gravel driveways were declared a public nuisance, the City Council gave property owners five years to have their gravel driveways paved. The five-year deadline is quickly approaching, which means all gravef driveways within the City of Fridley must be paved with approved concrete or asphalt by December 31, 2002. If on December 31, 2002, your driveway hasn't been paved a citation will be issued and filed at the Anoka County Courthouse. A misdemeanor citation is a criminal offense and is punishable by up to 90 days in jail and/or a$700 fine. If you've already paved your driveways, Thank you! Please call me at 763-572-3595, so I can update our files. For your convenience, a brochure on the City's loan program has been enclosed. You can use this Ioan program to acquire financing for your driveway improvement project. Please call Jim Hesnik at 612-335-2651, if you have any questions regarding this program. Thank you for your cooperation! As you successfully complete your driveway improvement project, please call me at 763-572-3595, so I can do an inspection of your property and update our files. If you have any other questions, please feel free to call me at the above number. Sincerely, Stac�r S omberg Planner C-02-53 _ _ C[TYOF FR[DLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 July 2, 2002 David & Josie Malone 6283 Central Avenue NE Fridiey MN 55432 Subject: Paved Driveway Reminder Dear Mr. 8� Mrs. Malone: This letter is a friendly reminder that all driveways within the City of Fridley need to be paved by December 31, 2002'. As you are aware, the City Council adopted an ordinance declaring gravel driveways a public nuisance. They were declared a public nuisance for a number of reasons, such as: they can cause erosion, contaminate soil with oil and other vehicles fluids, and deposit soil and gravel in the City's storm sewers and detention ponds. When gravel driveways were declared a public nuisance, the City Council gave property owners five years to have their gravel driveways paved. The five-year deadline is quickly approaching, which means all gravel driveways within the City of Fridley must be paved with approved concrete or asphalt by December 31, 2002'`. If you've already paved your driveways, thank you! Please call me at 763-572-3595, so I can update our files. For your convenience, a brochure on the City's loan program has been enclosed. You can use this loan program to acquire financing for your driveway improvement project. Please call Jim Hesnik at 612-335-2651, if you have any questions regarding this program. Thank you for your cooperation! As you successfully complete your driveway improvement project, please call me at 763-572-3595, so I can do an inspection of your property and update our files. If you have any other questions, please feel free to call me at the above number. Sincerely, Stacy S omberg Planner 'If on December 31, 2002, your driveway hasn't been paved a citation will be issued and filed at the Anoka County Courthouse. A misdemeanor citation is a criminal offense and is punishable by up to 90 days in jail and/or a$700 fine. C-02-83 CITY OF FRIDLEY � 6431 UNIVERSII'Y AVENUE NE � • FRIDLEY, MN 55432 J _ (763) 572-3604 FAX: (763) 571-1287 ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE : 6283 CENTRAL AVE NE : 133024430005 : UNAVAILABLE : LOT 17 BLOCK 22 : PLUMBING : RESIDENTIAL : ADDITION/ALTERATION PERNIIT NO.: 2004-02278 DATE ISSUED: 12/14/2004 VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A # ELEC WATER HEATERS 1 VALUE OF FIXTURE/APPLIANCE # NEW FIXTURES (EXIST OPENIl�1GS) 0 # GAS WATER HEATERS # GAS DRYERS 0 # GAS RANGES # OF NEW FIXT'URES 0 VALUE (FOR MINIMUM CALC) # WATER TRMT APPLIANCES 0 APPLICANT MALONE,DAVID 6283 CENTRAL AVE NE FRIDLEY, NIN 55432 OWNER MALONE,DAVID 6283 CENTRAL AVE 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 same to be true and correct. All provisions of laws and ordinances governing this type of worl� 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 constructi n or the performance of construction. ' an � Date Bldg Insp �_�'�� Datd� PLBG PERMIT MIl�TIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 29610 �� SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 0 0 300 0.00 0.00 0.00 0.00 35.00 0.00 0.00 0.00 0.00 0.50 35.50 � � W c Oam Z � � � r � m � Q v m v -� m C � n � m � O Z cn 0 .p � D Z I v � I r m D 0 D r � m m U9 �nl � � � m � c � d � rn . . D � S. � O C � � � v �: � 3 � � m a� _.► I,1"'„ �D IV � N � � 'O °,m� N V> > c � � rn �, v d, �Oo � � o c� �0 � o � v � �' z �v r�i � z � � c� z v � r� r 0 � IV N v I 0 iN W �� N N r-�► ,:w � C� rp�-► W W O N a � G � c�o c�u c�n � � ? � � 0 � fD 0 � � _ _ � � d � � O � v�" � � � �D -' �'°' �' � r N � c � � m � � � c��n Z m co � d � v -� � � � � � � � � ' � � � � �p �. ., � N ,�. I°I I I I—I I I I I I I I � r C � W z � � C � m � � z O � �� ,c'�r oo�.��+.�w+0000000 � 0 0 0 0 0 0 0 0 0.0,0 0 0 p p p O O O O O O O O O O • � c � � z ai O � D � r � m � � v n � -i a O I$ 'o m � z O W � H � � c � 0 z � N C w�°DDr m �"mnz � m p � � � m tDn �z�D � � � o � D Nm z N� m Q.► -=• _ �nl 0 O O a � 2 � � N � �, � � � C O � O c'c o� �: o y � 7 7 N o. g � �, � � � � a a d � '� �° � � g �. cD � � (D g � a n y � � � T WQ' „wa � :71 � C N�'O ;a C71 f�/ . /� T � D � � �D 3 rn� � � V � � m � � � O Z , < � � m v �a � FILL IN COMPLETELY.FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION w° When replacin�a an existina furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstruetions, 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 Fumace Venting Tables for fan assisted and natural draft appiiances. The existina combustion air is sized and installed to meet the current codes and man�fa�t�re�'s speci#;�ations. 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 ( ) Yes ( ) No ( ) Yes ( ) No ( ) When installint� a new ventins� svstem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and raianufacturer's specifications. This.•does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () 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. No ( ) Yes ( ) No ( ) Aaaliance Tvpe 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 Tdal Btu Input -- - Common Vent Type Vent Height �iameter 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• (Describel HEATING CO: � Signed By: Date : Bulldillg Pj,jJNj$jN(\'ar Permit No.: �`` � Inspections RESID]EIOTTIAL APPLICATIOlOT Received By: �' � �63-s�2-3604 CITY OF FRIDLEX D�(%�°I��R 2 2008 763-502-4977 FAX EFFECI'IVE 1-1-OS DATE ��B', �L3 � YOUR E-MAIL ADDRESS %G�CSl�' ��°� 4(�PSf� ArC T srrE aDDxESS 3 Ce�.h �--P �i-r� �/�- THIS APPLICAAiT IS: �WNER �CONTRACTOR PROPERTY NAIv�: �. c�,S%''3 f'd c'CJi2 � — TLNANT� ,�DxESS: ./, �k `' ,:p�, �� n!� crrv �r�ii ��« 1� sra� /h1/�►��`� ' PHONE: �> ! a 3 i a b� a�- CONTRACTOR NAME: SUBNIIT A COPY OF S.I.A.1.E LICENSE # EXP DATE YOUR. STATE LICENSE, BOND AND STATE BOND k EXP DA7E CER'I'IFICATE OF pDD�g; CITY STATE ZIP INSURANCE . PHONE F%� PERNIIT TYPE �1�GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � �W �p�CEMENT DETAILED DESCRIPTION OF W ORK � I c. c;e f� a.,�� .� �� -^-�-� �°'� �-� — PER MS 16B.665 the permit fee is a minimum of $I5.00 or 5% of the totai cost up to $500.00, whichever is greater, for the improvement, insta.11ation or replacement of a residential 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 = plus .50 surcharge FOR PROJECTS WI�RE LABOR EXCEEDS $500, FEES ARE BASED ON $ I 000 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (MDICATE TOTAL NUMBER OF EACH BELOV�. MINIMUM FE� $15.50. BATH SINK/LAV FLOOR DRAINS _ SHOWER _ WATER PIPiNG —gp��g GAS PIPiNG (NEED CITY LIC) SWIMMING POOL _ WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SMK WATER CLOSET _BACKFLOW PREV. ($IS) DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION — — WATER METER _ OTHER � --. � � � � � � �� ;�� .,�, ; a, � . � � _,., �. 'i' ''��3 I �;;. ��" ;: $,- � � � >.:}�s_ � Permit Fee $ � n Number of fixtures @$10 00 x$10.00 $ Surchaz e .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ OR Number of fixtures @$35.00 x$35.00 =$ State Su�charge = $ .50 (MINIMUM $15.50 (MIMMUM $15.50) Tota1= $ THIS IS AN APPLICATION FOR A PERMIT-NOT VAL1D UNTIL PROCESSED I hereby apply for a plumbing 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 approved plan in the case of all work which re uires review and approval of plans. � �` �/��%�� Q l� SIGNATURE OF APP CANT � , /��(� PRiNT NAME�!/� S� / U`C>(.�[�� DATE � % � �E', APPROVED BY DATE L C � � ' ` _ �,�� .�..�- �F E .~� " � ''"� City of �'ridley �uilding Inspections Department 6431 University Avenue NE, Fzidley, MN 55432 763-572-3604 FAX: 763-502-4977 } - r,a s�� - :;:;;s;::;;. '-._� �`�,( :''.�"h;'�, aP^'L'� ir,_C+. ��'ti�`��y��'. • � , � FRIDLEY MUNICIPAL CENTER • 6431 i1NIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, ��i1^S� G� lao� understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at � a$ 3 �P.�� h1� , 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 resale 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 to 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 city ordinances in connection with the work being perFormed on this property. Name� �. Date� /'r / � �� Building Inspections 7. 63-572-3604 DATE y � � �G� 1D L STI'E ADDRESS _�, THIS APPLICANT I5: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERNIIT TYPE TYPE OF WORK: lr g s,,�..�t�l�l �i.�`l� �S�EN�L �PLI�ATION CIT� O�' F�LEY YOUR E-MAIL ADDRESS ❑ OWNER �ONTRACTOR rctliu� iv�.. Received By: Date Rec' d: ADDRESS: CITY STATE ZIP PHONE: �� $Io��o �� COMP CONT. STA7'� ��°"�7r��3 ��x,Pi�T75�k2� �] SINGLE FAMILY ❑ TWO FAMILY o r�w �x�r.acEMErrr EXP DATE 0 TOWNHOUSE ❑ ALTERATION/REMODEL STATE ZIP DETAII.ED DESCRIPTION OF WORK �� PER MS 16B.665 the permit fee is a minimnm of 515.00 or 5% of the total eost up to 5500.00, whichever is greater, for the improvement, installation or replacement of a residential 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 PROJEGTS WHERE LABOR EXGEEDS $500, FEES ARE BASID ON $10.00 PER FIXTURE, EXCEPT WF�RE NOTED. FlXT'tJRES: (II�IDICATE TOTAL NUMBER OF EACH BII.OV� �`w,�� G�-V o�I Equipment InstaUed , MFG: ,�a «..` ��: o�� SIZE/BTU %� MFG: '�` MODEL: SIZF/BTV MFG: � MODEL: SIZFJBTU A/C $25.00 _FIREPLACE (GAS) $15.00 . GAS RANGFIO,VEN SI0.00 AIR TO AIIt EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 =GAS L1N1T FiIR $ 0100 0 _BOII.ER �'35.00 FtTRNACE $35.00 CfID�II�TEy LINER $10.00 _GAS DRYER $10.00 POOL HEATER �35.40 DUCT WORK $10.00 GAS PIPING $10.00 VEIVTII.ATOR $I5.00 — — � �. �x •��---3.:�---�---r.,,�—...�-�,�._,�-- .....:............_._.. _......_ _ . .._ Permit Fee $��. � Number of fixtures @$10.00 x$10.00 = Surcharge $ .50 Number of fixtures @ $15.00 x �15.00 = $ TOTAL DLJE $ �,� Number of fixtures @$25.00 x$25.00 =$ Number of fixtures @ $35.00 x $35.00 = $ State Surchazge = $ .SO Tota1= $ - THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Pridley and with the Minnesota-Construcrion Codes; that I wnderstand 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 bs i.n accordance with the approved plan in the case of all wo hich requir eview and approt�al of plans. SIGNATURE OF APPLICANf a PRINTNAME DATE �� I�'Q� Caty of ��-idley �uilding Inspections Depar�ment 6431 Universiiy Avenue NE, Fridley, MN 55432 763-572-3604 FA��; 763-502-�977 From: l6;i/542yUt3 Nage: 1/1 Uate:4/16/2UUy'11:'L�:iSAM rrbm; City of Fndle� Tp: 76'3'5429t7� Page: 2!4 Qat�: 4;�iEr,�UO� '11:00:09 AM :3�ui�d�,n.� � .B.II�i�wC$10115 !��-� i�-�E�� ?63-��-4�?�� .F�,';. ��Ar,� �f-- � � � ° 517L' ADDRY�S (a e�.! TljlS APFLICANT 1L'': 1PktOFF.R'�'1' pV1']YER+� a�N�rr� ��.� � ��T�� '��.�s.�'�� .� ��,� +�� Q fl Vs'N �1'i _ YnU4: E:-MA1L �.UJJ3«SS V tr i`�� '�iC;f,)hITI2A(^,T(il` . N,�Mh: K�tS�b- '�"I4d.Y'C. ADUR�SS:!a;�� C!n'@'f2..A � � Va PIiQiJ�: i'ermi� Na. F�,.eceivec� hv: Da� •�� 1Q. f �C7t..� STAT�1") 0.i 'L]P ..�►�t 3�'-- CON7PRA.G�'O�L COMnANY �AM�t lVt.r C:�4--� Sh L�� Lt"p� ( SUBVltT A COPX OF �aNTAL'T P�ASON• C �+ `� � �.��1 - YUUltS'�'ATE STATe LtCL'NS� �l _ _ ��l' DATk LIC�TI5EW[T�I AL7l51tES5: e��O '�'�0-1n �. N� C1TY ��@.�Att 5TAT�1'��GIAv��i�3�•, ,�PPLICATION �A�� ,� nL � � �.I �! � NAX 1'ERM1T TX�E �rsrp� a� �va�,tc �SUVOLt YAM1�Y D Twrq FAMiLY L7 N k.'�i� '�S 1t�,PLAC�M�NT Df�TA1L-Ei3 ULSt:Ki�'T10N O� WC3�, O Tt�wr�Haus� ❑ ALi'�RA?101Vlltk�4p�kL k i��5 ea�� sn5L0 O:� �39.n0 P�K YIXTU��, �xC�T Wl1Et31: y0'+'�D. t'lx'fUltk:S: (I�vD�Ca1 � rQTAL VUHB�t� UF �aCH A�LO�va Eqnlrme�t 1ad.�t�alted fNl'G: r n;n MOUEL: �S"� u� be1;�' 51�E�BTU .d*I^T, .,� M!t{i: M4PEL: � SL'L�JHru Mi�G: PAOD�'L: �� Sl"Lh:lk3TU � p� $�j,Qp _FiitE�L.ACL' (CAS)$l9.00 GAS ItANGtiOV�N $10,00 �'niit TO A1R �XCHANG� S 15 NIR�FLAC� (w(X�D) $35.OD NBw C,A.S GR1LL b10.00 liOILL'8L 333.00 �r U 1'tNACL'd�`.�fl �A $ U N 1T tSTR $10.00 CH1P.7Nh'Y L1N�,it310.00 _GAS DRYh'R$10.00 _PQOL Hk:AikRS35.00 UUCY WdRK$16.OQ tSAS PIPINQ S IOAO V�Nl'ILATdR $15.00 .__ — .� .r-�a� TH1515 Aiv APPLI(:AT10N FOKA P�RM17-NOT VAL1D UhTll. PROCtSS�i1 I horcby aFtpiy foT � building jx-'�nruit and I solcnowicdgc tli�t tbc irtfonnation abtrvr. is; comptcsc and accu�Cc: that thc work u�i1l bn in �o,�'arcuanoo �vith thc vrdinancoa and codati af th� City of �z�idlcy az�d �vith thC l�inncsaka Con�;tructian Cadc;.ti: LI7�it L UIl(�ta'!;Y2[I(S ?11Lti lS not a��umit but uniy an �.pplic�ation For a pc�nmiY and work i� not ro st�tt �vitbout a pCn�uit; t.ly�Y tYac wo;tk will bc in aocordancc with tb� approvc:d �lan in thc ca.�e pf al1 work whicit ra�uirc5 rcviow and appreval of' pians. SlQNA7URL' d} AFpL1C:AtV7 ti,s n1Z1NT �1AME C�+�' �$ �t�r,O,��U,�T�. �"� b� a �� . � � � ��' � �i,ttyy ayi �a�idlev �ui.�d�a� �..us�e�s��as �er��rr�mea�¢ 6431 i'Jmivezsx�y avenue `�T�, ,rzi,dlet•, �1�T ; i�3� i63-�i?-36ti4 ��:: 763-�0?-4977 Building Inspections 763-572-3604 Da� sa�/� o srrE aDD�ss lco2f 3 THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBNIIT A COPY OF YOUR STATE LICENSE VdITH APPLICATION PROPERTY TYPE P'ERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL AP'PLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS e �V t- ❑ OWNER CO CTOR �� rr PHONE: ��a ^ �I� ^ �� STATE LICENSE # O�D EXP DATE 3 3( 1! ,AnDxFSS: � j D(� ,�,c C� S r o r- � I� crrx S-� RF PHONE FAX GLE FAMILY/NEV✓ CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES 0 ADDITION ❑ GARAGE/SHED WINDOWS ❑ BASEMENT FINISH ❑ IjQOF ❑ DRAIN TILE ❑ DECK '� SIDING ❑ OTHER ❑ SWIMMING POOL ❑ NEW O ADDTfION ❑ MAINTENANCE/REPAIR ❑ REMODEL] DESCRIBE R�ORK BEING DONE: SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES _ ; GARAGES ' PROPOSED SIZE: I PROPOSED I�IGHT: LENGTH ❑ HOUSE ONLY O HOU3E & GARAGE ❑ ATTACI-�D GARAGE ❑ DETACHED GARAGE SIDIlVG ❑ Vinyl ❑Soffit ❑ Aluminu�► ❑ Trim � Other Jam25 �ri.rc� ��G ❑ Fascia WINDOWS II�I EXISTING OPENINGS,�Ces ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZ OPENING CHANGES & +� �� ; L�.£S 8/�cG TYPE OF WINDOW TO BE INSTALL'L� �emPn-f— NUMBER OF WINDOWS ��O� Permit Received By: � Date Rec'd: — ( — � 5��3 2. ��Jz� ��//b HEIGHT BASEMENT REMODELING SUBNIIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used Ft. FOR NEW CONSTRUCTION 1NCLUDING DECKS, ADDTTIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two setc of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $��f, G'�J'l� OCCUPANCY TYPE Permit Fee Plan Review 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 $ � �(� .0005 x Permit Valuation Minimum $.50 $ � �� $5.00 (State Licensed Residenrial Contractors) $ $1675 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$21=$ $ $4�0 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ � �,� Make checks pa_yable to: City of Fridlev Attach THIS IS AN APPLICATION FOR A PERMTf-NOT VALID LTNTIL PROCESSED I hereby apply for a building permit and I aclrnowledge that the informarion 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 applica.tion 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 wt ' h requires review and a proval of plans. SIGNATURE OF APPLICANT �Q�ir,�fJfG�-fi�i_ PRINT NAME «�-19n1't (�i L�G�'- DATE ��Ci/��