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AF - 37097�a�: Owaer C�ity of Fridley, inn BUILD�G PERMIT N� 8� z .� � . ��G � �=- ' �� Builder -� Address Address � 8 �� ', �, �o�� Q LD0��7 No. � Streeti — Part f t. Lot .,.�� _ Block ___. Addition or Sub-Division ��-�"� ,� � , Corner Lot _ Inside I�t '�'"'i'�� Setback �' ..,d�� — Sideyard __�„/�f•ri' � Sewer IIevat9on Foundatfon IIevation DESCRIPTION OP BUILDING To��'��e' vsed `'� � �� `� Front ��.. Depth Height �._..� Sq. F't. ,�� * Fro t pl�� .,'�--�... � Depth Height �� Sq. Ft�� Type of nstructi Est. �� be Completed _ Cu. I�'t�� Cu. Ft. �;�� Ea consideration of the issuance to me of a permft to construci the building described above, I agree to do 'the proposed work in accordance with ihe description above set forth and in compliance with all provisions oi ordinan� of the dty oP Fridley. � In consideration oP the payment of a fee oP $�'�` , permit is hereby granted to to construct the buflding or addition as described above. This permit is granted upon the express condition that the person to whom it fs granted and his agents, employees and workmen, ia all work done in, around and upon said building, or any part thereof, shall conform ir� al]�, respect� to the ordivances of Fridley, Minnesota regarding location, construction� alteration, mainten,�c+�e, re and moving of buildings within the city limit� and this permit may � revoked at any �e ��violation�any of the provisions oP said ordinances. � 9 l�,i Suilding InspeCtor NOTIC� ' T6is permif does eof eove� fhe oonstrueNon, 6tstapetion Po� wiring, plumbieg, eas 6eaMr�g, sewer er wata�. Be wre M aes �hs Bntidteg lespetlor for sepsrate perm6s fo� t6esa hema. /�� 4 �� r. =�:.s- � --� Owner's Name APPLICAT�OI� �'OR BUILDING PER1�T Addreas � - -- —.�...� No. , �� S OF BUILDING _� r Lot �Block�_Additioa or Subdivi�ion Corner Lot Ineide Lot �etback ��B S �F�WBR ELEVATION � � FOUNDATION ELEVATTOBT of -Yard �� Applicant attach to this form Z'wo Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDSIJG To b used as: ° , Front Hepth�- � Seight_ �� _ � � /� Sq. Ft. Cu. Ft. `� Front � Depth Height /L�� - , � Sq. Ft. ,,� � � Cu. Ft. � � � �� Type of Construction ��,� �� Estimated Co t To be Completed The undereigned hereby makes application for.8 permit for the work herein specified, agreeing to do a11 work in strict accordaace with the.City of Fridley Ordiaances and rulings of the Department of Buildinge, and hereby declares that al,l the facts and representationa stated in this application are true nd co rect. �/ DATE � `� � � STGN�4TtIRE (Schedule of Fee Coete can be fouad on the Aeverse Side). � -�� BUILDIA�G PERMIT F�E SCHEDUf,E Section 2. The Ynspector of Buildin�s ehall, before ieauing �ny permie for �he e:ection of any building or structure, or for any addi�Cion to any exist- ing bui.lding or strucCure, or for any alteratiot�s or repaira to any existin$ building or sicructure, upon application therefor, require the paymea� by the applicant for such permit of feee to tha amount herein below set forth and �n the maaner herein provided to-witi 2.1. For any auch permi.t for �he erection of �ny fire-proof building, other than a garagea warehouae, factory or grain elevator, or for the erection of any fire-proof addition, for similar occupaacy, to any existing buildiag shall be at the rate of $1,40 for each one thausand cubic feet, or fractioa thereof, in such cubical contents. _ 2.2. For aay auch permit for �he erectioa of any fire-proof garage, warehouse, f�ctoay or grain elevator, or for the erection of any fire-proof addition, for similar occupancy, to any existing building shall be at the rate of $1.25 for each oae thousand cubic feet, classified as °Bfireproof0° by Section 502 of the Minae�polis Building Code. IiQUS1�S 2.3. For any such permit for tfie erectioa oi any non-fireproof building other than a garage, warehouse, factory or grain elevator, or anq noa-fireproof additioa, for similar occupaacy, to any exiating building - permit $1.00 for each one thousaad cubic feet. GAttAGES 2.4. For any such permit for the erection of any non-fireproof garage, w�rehouse, factory or grain elevator, or for the e�ection of a.ny non-firepsoof additioa, for similar occupancy, to any existing buildiag or for each auch building or addiCioa - ninety cents ($0.90) for each oae thouaand cubic feet or fraction thereof, in the cubical contents thereof with a minimum of $4.00. For the purpose of comput�3ng fees for building permits, the cubical contents of anp buildia� or add3tion Co a uniform height throughout by multiplying the ground area covered fram a poin� aix (6) inches below the floor line of the basemen� or cellar to the aver�.ge height of the upper surface or to the average height of the roof s�rface of the main gable of a pitched roof. 2.5. For repa3rs or al�erations to a� exis�ing structure, the fee ahall be at the rate of $3.00 per each Fiv� Huadred Dollars ($500.00) or fraction thereof �tn the cost of all proposed work. 2.6. In no case shail the fee charged for any permit as set forth in Sectioa 2 be leas th�n $4.00. � /`s� . . � . �. _-�=:�1:.._L Lond Plannrn9 _ 6875-Hi9h�voy *C5 �t/E. Lwtd Survetfin9 MinreeaPa/s 2/, SoilsTestiny EN G I NEE R I N G, I N C. ��f° Civil b Municipal ' . SUnsef4606b � i �� , ,_ .�,�_• , En�ureermy -=.En9►ineers � �� Surveyo�� cesti,�scate o� s�,s�e �o: r� Donald Tessmer T�, �� N � � �� Io� � � �� .__---- _ � � o+� I 2 5. 4,�4 — -� ;,� , � I,�-+- _ _ ' `. 2 >': s - I �, - ,,..� •� • [] d �� ' , � N , �l I p a •. N { � L11 �`•.C£ � t � � � - LY I di ' 4 I � � � LOT �} m ��. ,s o .� . ti � c; ��',� � " 3s �-- N J ° � I II "' �, �, \ W T . 3 � � . 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' � ��e� �f fr reyors -� a c.� - �,� i� �•.. i.< f L_- - -_=- -- =-- � -_ -° ---- =- --_ _ ---= - - =-_ — - G � d-�. . - - .� � _ - , _ M E� fl N � N �' w s� p E n 0 � x r t�i* � '�'_' y x x � � � � p M � M d x x^ x^ � � y, q+ � � � � x � � � � f�A �� m o � � � m � � � J � � � m y w a�. � � � � � � d k � .. o �1 � N � � � o� 0 °o v�i : �d • � : : � � � x �a x k 9 N � c o o � t» t!� tis '� H �f � � � � � � � 0 � 0 0 0 0 0 � � 0 0 �a � � b � ° b � w � � w � O �! i � �� ' �z � � � � � � � � b b � � C N i� � I � A � � a � > V L � !b jd 0 r bd '�A x < � M I W aa " m� � � � 't a � ,�y O � � � . 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N � � � � � o 0 0 0 0 0 0 ts+ O t" �.a� � ;��y ,d �p � r�s �� b� w � .�i �4 ��H� W pd°v� � ��, � ��°� � pp��C �� y. y y i�i �� d �� w �a�a ��p,o H y � � � m A a�� l�D M �� QO �,•,i7 � �� D � i � "� m H _ m C m , d b » • M C�0 r � � V � � � b a V V O � \ V � � � � 'O v ' � O � � � � n � 0 D p d � o. Ri. D = � �'� . .. �� A � o. =o v< `Aj�� '�• �I � 0 � 70 � � � D � o. n e e d ,�- ADDRESS NAME �. d � FLOOR DATE ciTV- VILLA ounuc /7—G z— � •.� � - � SEQ. N0. AUTH, N0. CERT. N0. MAK� OF � GWA MWA� �H / S V SPACE FIREPOT SIZE PLANT ❑ ❑ U ❑ ❑ ❑ GAS LENGTH SIZE YEAR TYPE MD/HR SERVICE FT. IN. FT. REMARKS � ► �/� :./ _I��,T►7!f�s�r�a:�1?�?I�l��'i SOLD BY .lveattng ..��+«° �ll ►N. 7th ST. - CA. 7-7573 - ST. P RANGE W. H. REFR. MISCL. H. H. TOTAL HEAT LOSS MCF �F/DD �STIMATE 0 CHECKED BY ELEC. MD HR CF CF CF CF CF � � E " e �A � g � � e ► r o. ti � � O m O M I� N p p I \ ��I� � � a � e m � p� o� e �� p a �;��li�vl� � � � � �`,��c�'M 6� d1 � � o�a;s�o . � 4 �`' N (`* a�w��C�d �6�` �W wN� c � � � O � 0 m bo F JI� I�I� � oe � c -� G �1 O � �I�� m �' 8 0 �� 8 � b �. � m�a d�� o 0 0 -7 I H � � * �v o •\ �� A • m' r rlr � • ^ p^,r O p O 1 �,�� ... s �� a ' m � .+ �> 8 8 8 � � a o. & p ' &' ^v � ^ oC � . a � � � � �d �q y y � d' �°r � � � � ~ w � � � 0 8 ,� a O1 � � a � — � o H � � � � � �� y w QQ 8 � � " o `� � �� — � C � � �I � z 0 SUBJECT PE . c�ty of Fridley . 121i5 AT THE TOP OF THE TWINS g U I L D I N G P E R M i T r ; � R EIPT . � • COMMUNITY DEVELOPMENT DIV. ��/ � Ly �� r � � PROTECTIVE INSPECTION SEC. 1 � � �` /'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APVROVED BY L��—'� � ,'� 812-580-3450 910-F15 5 2 73 / / 108 ADDRESS 6890 Channel Road N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Z 1 Valley View Manor SHEET 2 PROPERTYOWNER MAIIADDRESS ZIP PHONE Donald Tessmer 6890 Channel Road N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO. Same 4 ARCHITEC70RDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASSOFWORK � N� � ADDITION ❑ ALTERATION ❑ REPAIR 0 MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 7.8'6" x 18' Addition to back of garage for storage 9 CHANOE QF USE FROM TO STIPULATIONS Storage addition to be 6'4" from side lot line. SEPERATE PERMITS REQ�t�E� F�R �f��(�, HEA�TIN(�, PLU1�6ilU� A�i[� �t�t��. TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR EIECTRICAL, PLUMBING, HEATINt3, VENTILATING OR AIR CONDITIOIdING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED POR A PERIOD OF 120 DAYS AT R�1 334 3340 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND OHDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WITH WHETHER SPECIPIED HEREIN OR NOT. THE GRANTING OF A PERMIT �1� 5�.3. OO . 75 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OFi CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $( .00 STRUCTION OF THE PERFORMANCE OF CONSTRUCTION. PLAN CHECKFEE TOTALFEE �A��" e�t ,s= �_�i $�.75 SIGNATUREO CONTRACTORORAUTHORIZEDAGENT (DATEI WHEN PROPERLV VALIDATED THIS IS YOUR PERMIT _ �� _ � ` � SIGNATUREOFOWNERUFOWNERBUILDERI IDATEI BLDG WSP DATE � AP.P��I4� �� R��IA��TA�, �LT�R,ATIA�, �R ADA�TT�� UILDI�G P�lZMIT ��TX �F F�T��e ��NN��QT� � � � >. ;i ��' y % � � < � Ji� �1 ., 1 1 ' �, / � � / .� i' : i i;' i�� ` � ' � �� .( � go �f�i�91��'��w w�V � w ■ e i�■ s � � e i■ �� 2 �LOCZ�: / ` ��z��ta � �c� �' , , ...,._., '�. LMi e JF+�7.l:t/5 b+�/1. ►a ^4 riiA�lCAi �7L3/aii�� .��3,�� fit.�c� ��+�a.�i,a Certificates of SuYVBy of Lc►t a�d propcs�ed �,�,�� ,�ati,om d� t� !�$e Certif�.cates, � � � i�t� A� : ��CI��T�fJN OF �i1iLA��iG � i� ; .n ��e ;��„��t : /� ��a... � ��0 ,� ,� i�rc�.� s nepr.h : sei�ht : St�usx�a �'get; Cubic Reett �{� v� �oA�tx��i+�a#; WC�C�.e� /ZC�/rvL-�eti�,ared Cost• $„/.�-? /�' Q` d w+.s sw � dbM � �� T � �� R� / �-f'" �'K.J � u�'t�p�ttQd hereby �a a�l�ce�tio� for, a pe�t fa� the w��ck l��reiu ��lL�ied� ag�eeix� to aa a�.�, �qsic iu stt�.c� accordance witt� the !Ci��j,r p£ �'�.td8.�' �xd�asc��e �d �euli�e a�� he+ Ds�,rrart�en� Qf Bu��di�a, a�i '�esebp d��+� � all �h� �acts a#�$ s�rese=►ta�i,o�s st$ted i� �1ais a�►I�,catian � � � c�rrec�., . 1�,�: �� SI�NATU�� : �� t��4i� 1�#.cl� �'og ��id��o�aal Infos�atioa! ) ��c�Z ,e� C� c9 �i .� ,C.�-e� � � �,� i 9 �S �' �� / �'y" �� ..Q.c � .��- -�—�z--� . ., � BUI��ING P�RMIT F�� S�H�DU�E ��,Q� �. '�h� Inepecto� pf �u�ldings s�a11, befo�e �ssui�g penni�� for �he ��on o� a�y bu�lding p� structure, ox for any addition to any e�i�t�ng ��d�� oX stxuG�ure, o� fo� any alteration or repairs to any ex��fng �� o� st�uctuxe, upo� �pp��ation thexef�sea xequire the pa��t by Cits ��i��t �a� �u�h p�r#ait p� fees t:o the a�tonnt herein below aet ��r�h ��d �� m�n�ac ha�� p�ravided � �o*wi�: [TN9CFQR�'I B,U�LDTNG COAE= Type �.' 2&�+ -$2.15 for each a�rae zlious�ad cubic �e��a �p� f�actioa tt�,�7cea�, in s�tc.ia cubical co��ents. �`ype 3& 5-$�.�85 fo� �cb ons �ousand �sb�.c �set. , � — -- — - — . __ — ��A� �'��OI�iA� � 'i`�OT�____ - F�� urpp�e of C�npu��.� �ees for building perniits, the cubical cantents oi any building or addition, i� det�rmined by mul��.pl��n� �$e �raund axea �av�'� �9�'pm a. poi�� s�x (�i) in�ies below the f loor line o� the basement i� f�e ��la� �o �he average �eights of the upper surface or to the averag�4 �i�3t s�� e �o�� ace o� Che main �abk� pf a pifiched xoo�, �' �ai� ox� a1��Pa��.ot�s � an existing s�tv�ey �a� f�e shal�. be a� �c: �� o� $3,�0 �' ,��+�h f�,ve h�dared dollar� ($300rf?0) �r f.��tioa theacso� �.n �� ccr�� a� al� p�Q�se� ��1��, 3� � cat� sha�.l �� ee� fo� a�€ pe�na3.t as set �o�a �. Se��a.o�a 2 be �.� �tflt $'� . �e � V�i��d�TiQN �� t��iNUATI�N --- - — �� Es �Qx �o�s��.L�a� wil�. be i��ued a �.�Cu� r�� + ��trs ��r �he '—'" —`� � �a o� A�+�2icat�.oa, �v a��vw �p� PrQ�ex rev�ew of �he proposad a��u�Cure �Ad p� �e �stxu�tion �i�e. ' � CB��,�i.� iSua�r�y a� �ii+� 1�r�:, ��i�g t� �ocatf.� p� Itt�� aunc�tia�, o�ce �� a� �s�t.�d� �iil � gequired before �roceedin�, w��h t� fr�i�$. C�It�'TF��,A'�� (�F lJ��PAN�Y �g��.3.+�.t3.�a £� � Ge��.��aataa s►t Oaeu�aacy �hall bs mad� tea (1Q) �y�s pxiox �o t;hc� ��se c�x �cs:upa.�eg at �tay �c�ure far which a, buildin,� pextai� haa b�sn i�sst�e+d; �tud �a�ic� sttttctxt� �ha2� �ot !>e used � occupied u�til a��tificate Qf 4��up,a�ey ha,� b�ezs �ssueti, . � , ,� �. ��..� _, ��t�� ; Lond Plamrin9 6By5-Xi�h� �G'S el.E. � . twwd Sc�e�t/� _ : . 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'_--��-____, = -� - - - -- — -- -r----�- ,_ - - � � _ _ _ _�.- ��-= � - -� � _ - _ �----- _ _ . �_ .. _ - L.�T 2. , _ BL.C��4�C � � ��LLEY �I EW MA�1�R ��-�=- - - � _ � - ; , ., . � 4 _ _ __ _ _ �.�, . ,� - - -- - - � _� _ �_ _ �. ___ _�t_ _ : � . _ _ _ ___� �T� = --� -- - �� _ _ . .. . - ,. . ' . . _"' . , . , . . F . _ - ,a //r�ne6y carfi�'y �� is a fi� mk/ mr�cf re�eseniat�r o�'a sutiey �i'�► � q�'� a6�eNS c�b�d larid, and ��slccof'a�ri o�'ol/ d�aldnr9s, f�erecr�, ornld/ rr�ridde c�!�ine�%s ,��'my, �'n �r m�aid /am�d. As srrrre�r ed G� m�e' /!ns_.- a(o� ��Ylarc h A.D. /9.�. SU6 UQBAN E'NGIAIE€R/NG ,/NC. , ��/ ��C,fi � �°'��(= -, = . ,� . (.�� C"PF ��}a t��i.si'/._ - . . �i �/ � . N ..�. .,- . ' . k � � 0��.. . .. .. . . . , � . . . ..... � �. ��. � - �. '- _�. ��.. ..� � , .. .. ra�. .. . �_ .. � . . . , . � .. _ .. .__� ... �. , -.'.. =J� � -- _� �.m- �. _ ..8� � " .. . i�:� _ , ._ �� . . - : .- . .._ . -� . .c...__ _. . . . . .. . _.. � , - • . • � . �. . ' � . • ' -. . , � • . .. . . � � `� . ' � . . . � _ . . .I� �;�� ,�� ;� �� , oamer of the property located at � � � ,, . � � �'� �(F�� . � � � � have ao ob�ection to the City . — alla�aing the canstruction of a ` . o be located at . /��°i�'(� ��_�L� �ithout the required certificate of survey th�t the City ordinarily requires for all new construction. _ .�� •�' � ' ''� � � . � . - . • � � . �' � � Signe ; � . %. � . � � Address � • � �� ,�r��,�; � - - /� %� � � nate �itn s . . . • . . . •• � : . . . • . 4 • • . • , . A . � �� ' . . .� ; _ CITYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55�32 •(612) 571-3450 • FAX (612) 571-1287 October 16, 1995 Terri Mau 6890 Channel Road Fridley, MN 55432 SUBJECT: Single Family Housing/Rental Regulations Dear Terri: Single family dwellings are the principle use in the R 1 zoning district. As a single family dwelling in an R 1 district there are two specific require,ments in relation to who can inhabit and maintain residency. They are: 1. The rental of guest rooms to not more than two persons per dwelling is allowed. 2. Not more than five unrelated p�ple can r�ide at a single family home. In order to be considered a City Code violation the �tuation you have described must exceed these requirements or be clearly divid� into two separate living units (duplex). This situation does not appear to violate City Code or zoning requirements, however, the concerns you have expressed regarding egress windows✓doors are legitimate. I would recommend to any property owner that they improve safety related items immediately. Unfortunately, the building code does not require these improvements unless a reconstruction or remodeling project is taking place. ff I can be of any further assistance or if you have qu�tions or concerns about this letter, please contact me at 572-3595. Sincerely, CITY OF FRIDLEY r� � � -.�� Kurt Je Schneider � Code Administration KJSre CE-95-287/mauterri City of Fridley SuBJECT P�� .5 � AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � ; � RECEIPT NO. � • COMMUNITY DEVELOPMENT OIV. /a � j V � " � � , Fl�� r � � PROTECTIVE INSPECTION SEC � . � � ' ��"1 � CITY HALL FRIDLE� SS432 NUMBER i1EV DATE PAGE OF APPROVED Bv �""�� '� 612-571-3450 910-F15 4/14/97 � � J08 ADDRESS 6890 Channel Road NE 1 LEGAL LOT NO. BLOCK TRACT OH ADDITION SEE ATTACHED DESCR. 2 1 Valley View Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Terrie Mau 6890 Channel Road NE 574-1606 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO Same 4 ARCHITECTORDESIGNER MAILADDFESS ZIP PHONE LICENSENO 5 ENGINEER MAILADDRESS Z�P PHONE LICENSENO 6 USE OF BUILDING Residential 7 CLASS OF WOHK ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WOi;K Construct a 20' x 18' Deck 9 CHANGE OF t1SE FROM TO STIPULATIONS See notations on plan. TYPE OP CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTI�ATING OR AIR CONDITIONING. THIS PEFMIT BECOMES NULL AND VOID IF WORK OR 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 ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFEET PARKING I HEREBY CERTIFV THAT I NAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFiAGES AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WOFiK WI�L BE COMPLIED $3 193 �1.60 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEHMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- $87 � 2S Fire SC �p3. 19 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE � $92.04 SIG ATURE O�NTRACTOA OR AUTHOAIZED AGENT IOATEI PA Y VA D ED THiS IS v R P MIT . �, - � � "'� I '�— r Si ATUAE OF OWNERiiF O N IL ERi �DAT6 LDG �NSP �1 • E � . � NEw ADDN ALTER [] F [ ] CITY OF FRIDLEY [] SINGLE FAMII.Y AND DUPLEXES R i AND R-2 BUII.,DING PII2IVIIT APPLICATION co�m��tto�aa��s: / � %o ��i� �r n �e r i �/ Legal Aescr�ption: � Tel. # � %�i �C� G � Owner Name & Address: � e r,r,'� ,/1/1c� �-`. � Contractor: S � �� MN I,ICENSE # Address: LTVING AREA: GARAGE AREA: DECK AREA: Tel. # Attach to tbis application, a Certificate of Survey of the lot, with the proposed const�uction drawn on it to scale. DESCRIPfiION OF IlVIPROVEIIZENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length �! Width �� Hgt/Ground �° Sq. Ft. � ' OTHER: �� Q� �'p � � � �� ,`n construction Type: �o o� �� Estimated cost: $ �� C3 O Cj (Fee Schedule on Back) Driveway Curb Cu.t Width Needed:. Ft. + 6 Ft = Ft x$ _$: DATE: �/ � `�/ APPLICANT: � � Tel. # � °7 `/�� O Cp . y — . — Permit Fee Fire Surcharge 5tate Surcharge SAC Charge , License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: � C .�� $ .l � i . �� $ $ $ $ $ $ $ ��-c� C11'Y USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1llOth%) $.50/$1,�0 Valuation $950 per SAC Unit $5.00 (State Licensed Residential Cantractors) Alt. °A" or Alt. "B" Above $450.� Conservation Plan Review Fee Determined by Engineering Agreement Ne�essary [ i Not Necessary [] .� ' BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erecNon 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 applica.tion therefore, require the payme� by the applicant for such permit of fe�s`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 $SO,U(?0 , $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,(}00,001 and up FEES $21 (Mimimum Fee is $21"plus" surcharge) . - $21 for first $Si� plus $2.75 for each additional $100 or fraction thereof, to and inclnding $2,000 $62.25 for first $2,� plus $12.50 for e�ch additional $1,0� or fraction thereof, to and including $25,000 $349.75 for first $25,()00 plus $9.00 for each additional $1,OOU or fiaction thereof, to and including $50,� $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and inciuding $1p0;� r,�, $887.25, for first $1�,(�0 plus $5.00 foi each� additional _ _._ $1,�0 or fraction thereof,,tp and mcluding. $5�,�0 .; :, _ �,, , �:... > _ . � �,. .: ; �, � : � > , . $2887.25 for the first $SOO,OI�f plus $4 2� for each additional. .,,, J ,:i � . � � ' � . . ... : - - : . .y:at . :,:. . .�. . ', . ' ;:, . , ... . _ . ._ $1,000 or fra.ction:ihereof, to and inciudtng`$1,(�,000 - . � _ . . .. _ �` _._ ' .`k_ . . . _ . . . _. . -. . ...�...., "_ _" _'.... . . .... _,. ;._. . $5012.25 for the fust $1,000,000 plus $2:75 for each, additional $1,OQ0 or fraction thereof . . � DRIVEWAY DEPRESSION,:ESCRO�V `' (Concrete, (i�rb Streets Only) - .,�.> :. : _ Alternate "A": Removal and replacement of curb and gutter only - Driveway�width plus 6 feet times $13.50. Altemate "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 $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum af 24 hours from the time of appl�cation to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the loca.tion of the foundation once it has it has been constructed wi ll be required before proceeding with the framing. . �� > �_ � c � � � C �s -� � �� I .._�� .._r_� �� -- � � _ , `L,� � . � �--. N � �,.., � � �� , �� a >� - �;: a` .; .; ., ,., , �. „ :,, -,: �. � �� . 4:�, � � � � e a � _� � �(\�i �� _ ,.,� -,; � . � , I �'''� �,, � I � - � . -.�=— - `.— �._;..; _ � - -- , e:�, ;; . �� ;� -__-___T__ j� ""_'._.`__ �` G �� J C ^ � ti7�— .� -� � � ' � -- -- —� � � `� � l� 1 / � - �— 1 ` _ '_ �� - ` C� _� — � � � , , (�' v. �� ! 1 � � � � �` � c.. '.'1 _� ,.� _ �:. � ,A . _ � � . � � k , k � �: v j r , �� :� :� � .; � -�.; ,, ,�, ,��.:: -ti - __; ,� P�a�� I .� ;� � f - .... ��j ,�� . - � �'� � , .,�, ,--.� , : -�� I �� .�;; � u _;. � � � �' �. � � �� ` � �' � �' � � � - �_ �, . �, . -� ✓ /%:- �'� � ,-, - sue�etr I NO�. City of Fridley AT TME TOP OF TME TWINS B U I L D i N� P E R M I 2 9 0 5 8 r � � � . � ; v ______ COMMUNITY DEVELOPM�NT DIV. / � � r � � PROTEC7IVE INSPECTION SEC. 1 � i 1 � /'�'1 � CITY NALL fR10LE� �132 NUMBEii pEV DAT6 VAGE Of AVPqOYEO B1I �""�' �'' 612-571-3a5o 91aF15 3/24/99 / / JOB ADDRESS ' 6890 Channel Road NE t LEGAL L07 NO. BLOCN TRACT OR AODITION SEE ATTACHED DESCR. 2 1 Valle View Manor SHEET 2 PFOPERTY OWNER MAIL ADOR�S$ 21P PMONE Terrie Ma.0 6890 Channel Road NE 574-1606 3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO Sela Roofin & Remodelin Inc 4100 Excelsior Blvd St Louis Park, MN 55416 4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PMONE IICENSE NO. 823-8046 1050 5 ENGINEER MAIL ADDRESS 21P PHONE IICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WOFiK ❑ NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE O REMOVE B DESCRIBE WORK Reroof House & Garage (32 Sq) Tear-off 9 CHAN(iE 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. SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING. HEATING, TYP� OF CONST. OCCUPANCY GROUP OCCUPANCV IOAD VENTILATING Oii AIF CONDITIONING THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT CU FT AUTHORI2ED IS NOT COMMENCED V�!ITNIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOO OF 12p DAYS A7 � ANV TIME AfTER WORK IS COMMENCED. NO. DWLG. UNI7S OFFSTREET PARKING I HEREBY CERTIFV THAT 1 HAYE READ AND EXAIV�1N�0 THIS APPLICA710N 1 STALLS GARAGES AND KNOW TNE SAME TO BE TAUE AND CORREC7. ALL PROVISIONS Of �AW$ VALUATION SUFTAX ANO ORDINANCES GOVERNING THIS TVPE Of WOqK WIIL �E COMPUEp WITM WNETMER SPECIFIED MEREIN OF NOT. TME GRANTING OF A PERMIT 2 742 $1..37 DOES NOT PRES E TO GIVE AUTHOWITY TO VIOLATE Op CAMCEL THE pEqMIT FEE SAC CM GE PROVtSIONS OF NV F STA E OR LOCAI LAW REGULATING CON- STRUC OR E RF R OF CONSTRUCTION ]L�,.�rj �'ii e S'(', �'L.�L�. PLAN CHECK FE TOT L F E L e $ , 3.86 NGTUAE OF LON7FACT R AUTMQF12E0 AG T 1DAfE� EN I TMIS�O� ERM U - . S�GN4TUpEO�OWNEA��FOWNEABWlOEp� �D�rE� _ B ANS� - a1f _/ NE'� [ ] ADDN [ ] CITY OF FRIDLEY ALTER []�� LE FAMII.Y AND DUPLEXES R-1 AND lt-2 �,� l•�. � BUILDING PERMIT APPLICATION (� - - . . �ffective 1/1/99 �� :.; (��) �� - : ConstructionAddress: _" _ � � � ' � � �'; . . G��n r,` � /�Q � ' , . . . . .. .�-. , Leba1 Des�ription:' . � - _ . .. - � � . - . - � � : i . _. . . ._. :, . � _ Owner Name & Address: "�-(� I� �'� ,e !�/1 g, (� Tel. # � � %�� Contractor: ��L� ��pFINO 8 ��MOpELIIVG MN LICENSE # ,/ D.SU A�idress: �T, LOUIS PARK MRl ��1� . Tel. �� 3��G — �i � �*��x,=-- LIVING AREA: GARAGE AREA: DECS AREA: OTHER: �- �w�a el�� Attach to this application, a Certificate of Survey of the lot, �with the proposed construction drawn on it to scale. �.: �ES�RIPT��F Q1��I1l�'RE�V�lY�NT . - -. . �. , . Length w�ar� Height Sq. Ft. Length Width Height Sq. Ft. Length Width HgtlGround Sq. Ft. � . � � .�' �c � ��-- Construction Type: � � - . �v�r� ' Estimated Cost: $ �, � �y� ��`� �'t' � �� (Fee 3chedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ ) ` SEL� ROOFINQ � �€MODELING, INC. � `' ,� 3 �o(�� DATE:� d�� APPLICANT: 4100 EXCELSIOR BLVD. ��1.` b ` . �� . _ �/ ., Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: ID #000105Q CITY USE ONLY $ /'�� S Fee Schedule on Reverse Side $ o?` .001 of Pea�ii Valu�tion (1/lOth%). $ � �. � �f $.50/$1,000 Valuation $ $1050 per SAC Unit $ �� (� b $5.00 (State Licensed Residential Contxactors) $ Alt. "A" or Alt. "B ° Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ � Agreement Necessary [ J Not Necessary [] �_ � � Building Ins�ections 763-572-3604 DATE �I �o�' O� SITE ADDRESS ,�i THIS APPLICANI' IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMTT TYPE TYPE OF WORK: BUILDING Permit No.: RESID�+ NTIAL APPLICATION Received By:��_ CITY OF FRIDLEY vate Rec'd: o— zc� -�� YOUR E-MAIL ADDRESS B•��G��y ��J�a'' �. CO/Yl ❑ OWNER �jCONTRACTOR i� T �» .��Q SLi 5�' /��l AnDxFSS: �89l� iUE �ia.�IAe/ Rd crr5r_fr� d/e r,r STATE/�I�iP S�'I3�. PHONE: l�l � ' �/a? ' SDOLo NAME: Cre+.fiMas7lrr.t fZer!'lo� i� y STATE LICENSE # 2oL�7a y 3 EXP DATE �� 3�� 9 anDxESS: ?yS �osaiQC•�n i�ve ��`a9 crrr w al sra�S// PHONEGS/ ? �� FAX�sI %sJ �ID�Y �II�G�Y/NEW CONSTR[iCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STOR�S O ADDITION ❑ GARAGFJSHED ❑ WWDOWS ❑ BASEMENT FMISH O ROOF 0 DRAIN TILE ❑ DECK ❑ SIDR�IG j�f 07'HER ❑ MAD�IENANCE/REPAIR DESCRIBE WORK BEINC� STZE OF INIPROVEMENT ZE NiJIvIBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Ajnmin�m ❑ Other wnvnows IN EXISTING OPENIIJGS OYes DI�To OR FOR A1EW OPENINGS-DESCRIB£ SIZE OF OPENING CHANGES & TYPE OF WWDOW TO BE INSTALLED ADD1T10N nq �r �r Sur� ��--`T� M:i ❑ HOUSE &. GARAGE O ATTACHED GARAGE ❑ DEtACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATTON OF WINDOWS Qo�:.r� — te�o�aai�q bn,�+ ,F; Yiures — ins�,l l V�IDTH FiEIGHT S . F� BASEMENT REMODELING SUBMIT: 1. Existing Fl�r Plan 2. Proposed fl�r plan 3. List of slrucwral meanbers to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDTfIONS. 8c PORCi�S SUBMIT: 1. Site Plea/Survey showing the existing struchues and proposed project. 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING TI� COST OF LABOR AND N[ATERIALS: (LTSING THE 1947 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ S, d�3• oo OCCUPANCY � TYPE Permit Fee Plan Review Surcharge License Surcharge SAC Charge Curb G�t Escrow Erosion Control Park Fee Sewer Main Chazge Total Dne _ $ i� 5�a 5 See Back Page for Fee Schedule $ � I,1-� � 65% of Building Permit Fee $ S .0005 x Permit Valuaxion 1VIinimum $.50 $ �,;� $5.00 (State Licensed Residential Contractors) $ $1675 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= 8x$21=$ $ $450 Conservaxion Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ � I ,�l Make checks payable to: Citv of Fridlev Attach 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 Fridley and with the Minnesota Construction Codes; that I understatid this is not a permit but only an application for a pertnit 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 hic require evie and approval of plans. SIGNATURE OF APPLIC ��U�� PRINT NAME iJ6CK l„Qi' � S Un Dp� 7'—a�- �� Page 2- Building Residential Application BUII,DING PERNIIT FEE SCHEDULE The Chief Buildin.g O$`-icial 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 pemut of fees to the �amount herein below set forth , and in the manner herein provided to-wit: TOTAL VALUE FEES $1 to $500 � $23.50 (Minimum Fee is $23.50 plus surcharge) ' $501 tp $2,000 . $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and includin $2,000 $2,001 to $25,OQ0 $69.25 for 1� $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for I� $25,000 plus $10.10 for each additional $1,000 or fraction, to and includin $50 000 $50,001 to $100,000 $643.75 for 1�$50,000 ptus $7 for each additional $1,000 or fraction to and includin $100,000 $100,001 to $500,000 , $993.75 for lg $100,000 plus $5.60 for ea.ch additional $1,000 or fraction to and inc�udin $500,000 $500,001 to $1,000,000 $3,233.75 for the 1�$500,000 plus $4.75 for each additional $1,Q00 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the 1�` $1,000,000 ptus $3.15 for each additional $1,000 or fi-action VERIFICATION OF FOUNDATION Perm.its for constru.ction 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 founda.tion will be required before proceeding with the framing. New Houses Onlv City of Fridley � , Building Inspections Department Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 ,�_: ,'Q _ , �; .. � ��''� �- ,:� �'L� `" (.� �i � � � ��,: � � �� " �' � ` ` f " _ . .� _ � ry ��/ =.. �'. � �:�f . � ... . .-_� , _.. �� . ■ � . .�.�,_ -. . �: � � �` � � � . ��. . 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' � t : � ' : # • ; � � �• � '# � i i ' I ; ': � I , i ' � i � . j i . r � � � i � : � i t. : . ' : � ' ' � � { l : {. ; f .; � � ; ' � � � ; � � � � � ' � . .: �_ . . � � t . ' z � ?- � � - . - i ' � - � �- i � , . i .. � j ' ' ____--- �_...—�_., — — �� j r � � ?� o.�; £. ��. . � ��#1�W�� . R . ��`,,i �...: � F� . � ¢ � �, �,; ti„pY �V {�� \ - Pi� �. � - �� f � � � 4�^4F � . ( " �"• x ' �,� t 1 �-�^ .. _ � �� ," �'..'"'�.�r„ �i � ��a,��,z�.,� �" � ^ F�� --_' �� — ��.;,� �i �sy,��_ .` r r _ � - � �.a- � �a '. _ Y ti"�K� '. �t I 'R'i� 3+ ��:�� ?':' r � '�;,`�€ ,95�� '� �. 1 . . ` , z � �� y.�-� +�'� ��.�y� �� Building PLUMBING Permit rto.� ; Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY vate Re�'d:' �� c��' 763-502-4977 FAX EFFECTIVE I-I-09 DATE YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY N,�:_" � � ,� /� ; e , � ,-� TENNA�N�T ADDRESS: �� f` G'� (. (/( �/ y!� Y,/ I� � CITY�r � G� �C �` STAT l�ZIP �7 PHONE: ��' -� 7�—l(Oro CONTRACTOR NAIvtE: SUBMIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF pDDRESS: CTTY STATE ZIP INSURANCE PHONE FAX PERMIT TYPE ��GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � �W ��PLACEMENT DETAILED DESCWPTION OF WORK � sf 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 replacement of a residential fixtwe, 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 OR . FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. F[XTURES: (INDICATE TOTAL NUMBER OF EACH BELOV�. MINI M FEE $15.50. �BATH SINK/LAV ��LOOR DRAINS SHOWER _ WATER PIPING BATHTUB GAS PIPING (NEED CI?Y LIC) �WIMMING POOL WATER SOFTNER ($3�) _ CLOTHES WASHER KITCHEN SINK �� WATER CLOSET BACKFLOW PREV. ($15) DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER ;��'` �`:� �`?� _., ,. ,' , .��'��, �l'��, `�� 3 :� ` ' � � ' � �� .�`��'S C� � '� 1 5 -.. � t z �,F , ,�- �� _ . . ,. � ��'; _ . „_ .. ...., . . � ,,. _ �, z"". ... , _ . ,� � „ „�. . . .. .. .,.,.., 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 fixtures @$35.00 x$35.00 =$ State Surcharge = $° .50 (MINIMLTM $15.50) (MINIMUM $15.50) Tota1= $ THIS IS AN APPLICATION FOR A PERMiT-NOT VALTD UNTIL PROCESSED I hereby apply for a plumbing 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 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 on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT -_- f—�-'ri(ti2 .'��% !�,G�-'� PRINT NAME I�' ►'r `� %� �c� �( DATE �r Z�'C�'L <..°= a, �'�.«�, � . � .�_,��i.��i!��'�'.;��1.��_�.' , .,,: . , �,. ;:�w� . ��.�i�.� �,�;��`i��;%� �� .. � City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 B�ilding Inspections 763-57d2-3604 763-502-4977 FAX BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY Permit Received By: Date Rec'd: DATE �-o� 7'C�G YOUR E-MAIL ADDRESS �Z�t2��r �-3 f'�2+2r �r `� I� IMCPi Cd��-� SITE ADDRESS ['o�K c� ��• E L" �� c� c� THIS APPLICANT IS: C9-6�IER �CONTRACTOR � PROPERTY OWNER/ N,e,�: �P f, ,�. � p y�q ,� � r.� ; TENANT pDDRESS: �� t�/ t-�' � y��, „ ,� ( �,�TY �r � d I n � STATE�ILZIP .5�� ' PHOi•rE: ��,,a� 71n3- �'7y -l�ofP — '"'�,� � ' SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: STATE LICENSE # EXP DATE ADDRESS: CTTy PHONE �GLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION O BASEMENT FINISH ❑ ROOF o-�CK ❑ SID(NG ❑ SWIMMING FAX SIZE STORIES ❑ wnvnoWs ❑ DRAIN TILE ❑ OTHER ❑ NEW HOME CONSTRUCTION C�,P�ITION ❑ MAMTENANCE/REPAIR 0 REMODELING DESCRIBE WORK BEING DONE: /-D c1 c�� ,f, � c� e.� jC r.,J / j a ri ,.� �_r� � t�, —, SIZE OF IMPROVEMENT_ _ LENGTH /!� �� WIDTH r2' a�� HRi�i-IT ^i '' ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED STZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE OSoffit 0 Trim ❑ Fascia WINDOWS IN EXIS7'ING OPENINGS ❑Yes DIVo LOCATION OF WINDOWS OR FOR NEW OPEN[NGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OEWWDOW TO BE INSTALLED NUMBER OF V TE ZIP ��r BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed flaor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION,INCLUDING THE COST OF LABOR AND MATERIALS: �1 .�(U'$ ING THE 1997 U.B.0 FEE SCHEDULE) 'AL JOB VALUATION $�j '(3� o� OCCUPANCY TYPE Permit Fee Plan Review Fire Surchazge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Chazge Total Due $ "(' . o� See Back Page for Fee Schedule $ 'J � 65% of Building Permit Fee $ � o I('� .001 times the total job valuation $�—.-r'i '�� .0005 x Permit Valuation Minim 3 $5.00 (State Licensed Residential Contractors) $ $2000 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$22=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ • ��— Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building 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 1 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 ork which requires review and approval of plans. SIGNATURE OF APPLICANT ��i�%��U PRINT NAME ,^� ..' �� i.,v 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 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 FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and includin $2,000 $2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and includin $$25,000 $25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to and includin $500,000 $500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75�for each additional $1,000 or fraction to and includin $1,000,000 $1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Pernuts 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 7��-,��o--� Fax: 763-502-4977 �D�� i g n #: 5789 ° ° � 513112 �s� =T� �...-.....:. ,. _�� ... ; . .. > ,� .:::: : ; : : : : ; a,�,.. R�'+'':` R''-: ?+:� < (�+m, $". � , @�.:a� ti::: �i•:.� .. *** Take this sheet to the Building Materials desk to purchase your materials. ** You s�lected a 1 level deck with: ' Belowr is a section of the railing style �� Press�re Treated Framing Material options you have selected for your de�� 4 x 4 �raming Posts B ds Pou� e�� Footin s 12" Tube 4' dee m�um o Combo Drive Screws �l Galvar7ized Framing Fasteners , _ u1/111 Handrail selections: 36" !��ite Ultradeck Fusion 1-11�'� � 3/4" White Fusion Spindles 4" x��' x 38" UVhite rusion Railing Posts 1-11� Y 3" x 6' 1Nhite Fusion Hand Rail _ � � ((Y1��t �� Spindle placement is approx, 4" apart depending on st� You may buy all the materials or any part at low cash antl carry prices. Because of the wide variable in codes, Menards cannot guarantee that materials listed will meet your code requirements. Check with your local municipality for plan compliance and building permit. These plans are suggested designs and material lists only. Some items may vary from lhose pictured. We do not guarantee the completeness or prices of these structures. Tax, labor and tlelivery not mclutled. `{�f;�e�� , � � � � � �i � � n � / - _..`��l.= - _ -=- _- = •�=��: ��' . � ; �. �� ,, �;°::::::.. �.�.::�::,. �.� ; , ;; s;; .. �� , �S� ..��; °13� �� `'�t-�=� �„ ° �O�t , 4 ��a� fY/\` �`(5 • - :::;:::>,�.::, i 'v'•, � � � � � � � � � ,g �� '� s-�-�►1'l � lS� I�.S �N `"1 oP ��.�..._(,�S�e-S . �G:.;� `� . Illustration intended to show general deck size and shape. Some options selected may not be shown for picture clarity. To��y's cost for materials estimated in this design with options:$2,311.2� �The base pnce includes: 40 PSF deck live load, AC2 treated - horizontal 2z6 *(BASE price); $1081,49 deck boards, 4x4 posts, 2xB joists and 6eams, galvanized framing fasteners, '`�If purchased today, you save: '�02.09�' AC2 treated 36" Uertical handrail to joist without posts, and premium screws, *'"'Monthly B1G Card Payment would be: �66.59�` D��ign #:5�89 .,:�.:....::.::.::.:..ax..:��. :,� 513112� � :�::��ry :�...zS: ..,� � , ��.� :: :��::��:�.o; � �. ��:::�:'w'C;i'i:a: �`: .�s�'u'.� *** Take this sheet to the Buildin Materials desk to purchase your materials. **�� -- -- _ - ---� - _ --. ------ ---- -.--- - _ -_ _-. �- - == =- — -__ Level 1: 22' x 10' _ +' o th gro i cl -= - - � Horizontal Decking —� = 2" x 8" Jois T �--- cantile � s — =J 2' x eams � 40 PSF Deck Live Load �x (�1' � �� T'o+z� I o 2� �� V`1 � ' ��. ��2�' � C �� U \ Ta�� 's cost for materials estimated in this design with options:$2311.Z� Y he base price includes: 40 PSF deck live load, AC2 treated • horizontal 2x6 *(BASE price): $1081.49 # deck boards, 4x4 posts, 2x8 joists and beams, galvanized framing fasteners, �'`If purchased today, you save: 102.09�`* AC2 treated 36" Ve�ical handrail to joist without posts, and premium screws. �'`Monthly B1G Card Payment would be: �66.59**' �� t��4 � � �� {��2 vV1 r � Post and Beam Dimension Sheet . Design# 5789 i ' � � N �� I' � I N N � O � ?osts; — 1'-2" 22� 1'-3" � 1'-9 1'-2" 5'-4�� 4�_g" 6�_7�� - I � - •" __ — � �1r1/t ��C W� N1 �N � � - � � �` � � � � °'�" - . -� - � � C; _. �`� C ��5 l(,Q � Ntl�1 S tMt( �1 �� (�u O G. �,3 ._ � � ' L -, � � .�: �Qo� � ��p r�� .Q �-��.��1 �U�, b�Q : � - - ` � ��C1� ir�tG . �qtS �Vl1�.��i�S' �►� GoNaV oi�S __ � :.: av�h� . �� c � � 1�.� • ,��.� -�' � �� - I�h � �'t�--�. 1 N S��c l lOrtsti ►._. .o f� �I` � �� - . v_: m � - � - a3 m - - v, m - c, - .. �. = , e. �?% i a v � z-` � a� m ' � 1� � 'U �� ll �, CB ._ �. f_• " . _ m c ° `� .. -� cv -: � J Q. � rJ7 � ' �_ � " L�1." vJ Oi . -.6.� � ; � 2� � } � • �' � a� _.:�fl, `m'.:�' ca �u�- � , _, a -: Q7'�,� L B �' _ � C � ;7J CC � �- C }.�.C6 CC �� Q � � �' � .� o O ,� U � _�. ., � .-�. �. Layout dimension sheets are intended as a construction aid. Not all options selected are shc�wr �eam Layout for Your Deck The Scale is 1l4":1' Design# 5789 �_�-- _-- A � _ O�� s:`i�rk -- � Len th 14'3-3/8" 7'8-6/8" I I i � - - — -- � _ .. � � " .,i O�t ' i _ _ _I Description 2-2x8 Micropro Treated 2-2x8 Micropro Treated �,� C�Icsi -7 k s',� �-z� I�S = l 75� Ib s__ �� Zs� � �s) �� • 'z-.2�X�� a�2W�S Nt�l � �� IC� � — rvtt�.i �,—�'� c`��►\ �c� � � C ' �` C ►.� �' r. .u\ -`_�e�l {`1 �� Q �^ \� � � S - ♦ `�� ' ` �Q�N�i2.S �,: � �� - �, � .� � �, m � ._ R. _. .j � -�� "_ �� ..: ,.._ n: o -� �� - mt � .� � U 'Q. Lr' N `. U � G t U.� 2 C> ti �:_ .. m— _ �� '_ . C.� � cU O �? � � �.- �, ,., � .� �;.: v�==:: S�� -? �, . Us - =. �' .: � m �—;,c`„ : . �4_ U � — r �'cct � � � � � � � : r; : G � . c.> . � . �. . Layout �imension sheets are intended as a construction aid. Not all options selected are s��vr� e 0 Joist Layout for Your Deck The Scale is 114":1' � Design# 5789 =��e�rk ,, - -- -__ -- -__��. �. � : �; � � �� I ' �I '' � '; �, '� � '�; '� !I �� i � i i : i i li �i' � � � i � !�I ` l� A A A� I� � � � !, �I !i Ii ' ! I � �'� �� .� ,, I .j I i I i I ;� i _ __ �.T._ i ., .�, Length 9'9" 20' �,9�� 9' 10-1 /2" 2' � Description Usage 16-2x8 Micropro Treated Joist 2-2x8 Micropro Treated Ledger 1 m2x8 Micropro Treated Ledger 2-2x8 Micropro Treated Rim joist 1�2x8 Micropro Treated Rim joist �: .�ts to be on 16" centers. �ts to be hung ftom the ledger with joist hangers. sts to be toe-nailed to beams with 3-U2" (16tl) galvanized nails. , �77 joists to be face-nailed to joists & ledgers with 3-1/2° (16d) galvanized nails. Layout dimension sheets are intended as a construction aid. Not all options selected are sh�� :. ESTIMATE FOR: Plash, Tom 6890 channel yd Fridley, P'II�1 55932 Estimate From , ! ! STORE # 3018 FRID PHONE: (763) 571-8689 5351 Central Ave. NE FAX: (763) 571-1932 Fridley, MN 55421 Estimate # 57�9 Page 1 of 3 � Ph: (763) 574-1606 ESTIMATEBY ESTIMATEDATE PROJfiCT DESCRIPTION: est rh 05/31/09 SKU NUMBER DESCRIPTION QTY TO ORDER ADDITIONAL ITEM INFORMAT'ION 111-0423 1X8-12' AC2 TREATED AG ARSENIC FREE LW 2 EACH ON SALE TARU OS/31/09 Stair Riaer 111-0614 6' AC2 THICK CUSTOM DECK AG 1 EACH ON SALE TIiRU 06/14/09 Deck Boards 111-0669 16' AC2 THICK CUSTOM DECKAG 3 EACFi ON SALE THRU 06/14/09 Deck Soards 111-0685 20' AC2 THICK CUSTOM DECKP.G 22 EACH OAT SALE THRU 06/14/09 Deck Boards 111-1312 2X8-6' AC2 TREATED AG ARSENIC FREE LW 1 EACH Rim Joiet 111-1312 2X8-6' AC2 TREATED AG ARSENIC FREE LW 1 EACH Ledger Joist 111-1325 2X8-8' AC2 TREATED AG ARSENIC FREE LW 2 EACH ON SALE THRU OS/31/09 Beams 111-1338 2X8-10' AC2 TREATED AG ARSENIC FREE LW 16 EACH ON SALE THRU OS/31/09 Internal Joist 111-1338 2X8-10' AC2 TREATED AG ARSENIC FREE LW 2 EACH ON SALE THRU O5/31/09 Rim Joist 111-1367 2X8-16' AC2 TREATED AG ARSENIC FREE LW 2 EACH ON SALE THRU OS/31/09 Beams 111-1383 2X8-20' AC2 TREATED ARSENIC FREE LW 1 EACH ON SALE THRU OS/31/09 Ledger Joist 111-1383 2X8-20' AC2 TREATED ARSENIC FREE LW 1 EACH ON SALE THRU 05/31/09 Rim Joist 111-2214 4X4-8' AC2 TREATED GC ARSENIC FREE LW 6 EACH ON SALE THRU 06/O1/09 Rail Posts 111-2214 4X4-8' AC2 TREATED GC ARSENIC FREE LW 1 EACH ON SALE THRU 06/O1/09 Poets 111-3912 3 STEP STRINGER HT:21" AC2 TREATED 5 EACH ON SALE THRU 05/31/09 Stair Strngre Tl»s is an estimate. lt is given only for general price infoimation. This is not an offer and there can be no legally binding contract between the parties based upon this es6mace. The prices sfated herein are subject W change deprnding upon the market canditions The prices stated on this estimate are not firm for any time period unless specifically written otherwise on t6is form. The availability oP materials is subject to invenWry conditions. MENARDS IS NOT RESPONSBLE FOR ANY LOSS INCURRED BY THE CUEST WHO RELIES ON PRICES SET FORTH HEREIN OR ON THE AVAILABILITY OF ANY OF THE MATERIALS STATED HEREIN. All information on this form, other tlian price, has been provided by guest and Menards is not respons�ble for any errors in the information on this esdmate, including but not 1'vnited to quandty, dimension and quelity. Please examine this estimate GUEST COPY carefully. MENARDS MAKFS NO REPRESENTATIONS, ORAL, WRITTEN OR OTHERWISE THAT THE MA7'ERIAIS LISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDERED BY THE GUFST. BECAUSE OF WIDE pAGE 1 OF 3 VARIATIONS IN CODFS, THERE ARE NO REPRESENTATIONS THAT THE MATERIALS LISTED HEREIN I1�ET YOUR CODE REQUIREMENTS- 0 � 0 ESTIMATE FOR: Plaeh, Tom 6890 channel yd Fridley, NIN 55432 Estimate From ) ! � STORE # 3018 FRID PHONE: (763) 571-8689 5351 Central Ave. NE FAX: (763) 571-1932 Fridley, MN 55421 Estimate # 5789 Page 2 of 3 Ph: (763) 574-1606 ESTIMATE BY ESTIMATE DATE PROJECT DESCRIPTION: est rh OS/31/09 SKU NUMBER DESCRIPTION QTY TO ORDER ADDITIONAL ITEM INFORMATION 111-4063 2X12-6'TRTD STAIRTREAD AC2 TREATED 3 EACIi Stair Treads 112-2048 48" WIiITE POST SLEEVE&CAPUD FUSION 12 EACH ON SALE THRU 05/31/09 Rail Posts 112-2051 6'WX3'H WHITE RAILING KITUD FUSION 8 EACH ON SALE THRU O5/31/09 Deck Railing 112-2054 6'WX3'H WHITE STAIR RAIL UD FUSION 2 EACH ON SALE THRU OS/31/09 Stair Railing 157-1010 8' DECK FLASHING PLASTIC BLACK 3 EACH Ledgr&RimFlash 189-1030 PREMIXED CONCRETE MIX 60 LBS 26 EACH Poet Footing 189-5159 12"X4' REMOVABLE CONCRETEFORMING TUBE 4 EACH Post Footing 191-7668 HOW TO BUILD - DECK PLAN G90050 1 EACH Deck Plan 227-1507 NAILS 1-1/2 JOIST HANGER 1LB GALV 3 EACH Joist Hangers 227-1742 2 X B JOIST HANGER 18 GAUNS28-T2 17 EACH Internal Joiat 227-1750 4 X 4 POST ANCHOR PA44E-TZDP 4 EACH Post Footing 22�-1760 4 X 4-6 POST CONNECTOR PB44-6TZ 8 EACH Posts 227-1788 ANGLE 1-3/8" X 4-1/2" MPA1-TZ 4 EACH JoietCrnrAnchr 227-1789 ANGLE 2-1/4 X2-1/4 X4-5/8MP5-TZ 10 EACH � Stair Hangera 229-5473 NAIL 8D GALVANIZED BOX 1 LB BOX Z B�X Sandwhich Beama This is an estimate. It is given only for general price information.l'his is not an offer and there can be no legally bind'mg contract between the parties based upon this eslimate. The prices stated herein am subject to change depending upon the market conditions. The prices stated on this eslimate are not firm for any dme period unl� specifically written otherwise on this form. T6e availability of materials is subject to inventory conditions. MENARDS IS NOT RESPONSIBLE FOR AIYY LOSS IIVCURRED BY THE GUEST WHO RELIES ON PRICES SET FORTH HEREIN OR ON THE AVAILABILITY OF ANY OF THE MATERIALS STATED HEREIIV. All infomtation on this form, other than price, has been provided by guest and Menards is not respons�ble for any errors in the infortnation on this estimate, including but not limited W quandty, dimension end quality. Please examine this estimate GUEST COPY carefully. MENARDS MAKES NO REPRESENTATIONS, ORAI., WRI7TEN OR OTHERWISE THAT THE MATERIAI.S LISTED ARE SUITABGE FOR ANY PURPOSE BEING CONSIDERED BV THE GUEST. BECAUSE OF WIDE VARIATIONS IN CODES, THERE ARE NO REPRFSENTA7'[ONS THAT THE MATERIALS LISTED HEREIN MEET PAGE 2 OF 3 YOUR CODE REQUIREMENTS. ESTIMATE FOR: Plash, Tom 6890 channel yd Fridley, MN 55432 Ph: (763) 574-1606 PROJECT DESCRIPTION: est Estimate From , ! � STORE # 3018 FRID PHONE: (763) 571-8689 5351 Central Ave. NE FAX: (763) 571-1932 Fridley, MN 55421 ESTIMATE BY ESTIMATE DATE rh OS/31/09 SKU NUMBER DESCRIPTION QTY TO ORDER 229-5499 NAIL 16D GALVANIZED BOX 1 LB BOX 2 BOX Post Hardware 229-5499 NAIL 16D GALVANIZED BOX 1 LB BOX Framing 229-5570 NAIL 16D GALVANIZED BOX 5 LB SOX Framing 230-5512 2-1/2 PREM DECKSCREW GLD CONI80 1LB Deck Boards 230-5512 2-1/2 PREM DECKSCREW GLD COMBO 1LB Str Dk Bds 230-5552 2-1/2 PREM DECKSCREW GLD COI+IBO 5LB Deck Boards 232-4373 3/B X6GALV.LAG SCREW 7PC 34373-1 LB. Ledger Joiat 232-4755 3/BX6GALV.CAR.BOLT 6PC 34755-1 LB. Post Fastenere 232-5628 3/8X16GALV.HEX NUT 24PC 35628-FAT PACK Post Fastenera 232-5709 3/BGALV.FLAT WASHER 24PC 35709-FAT PACK Post Fastenera 232-5709 3/BGALV.FLAT WASIiER 24PC 35709-FAT PACK Ledger Joiet 232-9000 1/2"X6" HDG ANCHOR BOLT AS126FIDGBMC BAG Post Footing 563-4235 PAINTER'S PREMIUM CLEAR WL0037720 100Z Flshing&LagScr 1 BOX 1 BOX 4 EACH 1 EP.CH 1 EACH 4 EACH 4 EACH 1 EACH 1 EACH 1 EACH 2 EACH 4 EACH n Estimate # 5'389 Page 3 of 3 ADDITIONAL ITEM INFORMATION ON SALE THRU 06/14/09 +�+ If purchased today, you save $244.95 •** This is an estimace. It is given only for general price informe6on. This is not an offer and there can be no legally binding contract � TODAY S SUB-TOTAL: 2, 22e . a i, between the parties based upon this estimate. The prices sbted herein are subject to change depending ugon the market condidons. REGULAR SUB-TOTAL: z, 4 73 . 3 6 The prices stated on this estimate are not firm for any time period unless specifically written otherwise on this focm. The availability of materials is subject to invenwry conditions. MENARDS IS NOT RESPONSIBLE FOR ANY LOSS INCURRED BY THE GUEST WHO RELIES ON PRICFS SET FORTH HEREIN OR ON THE AVAILABILITY OF ANY OF THE MATERIALS STATED HEREIN. All infortnallon on this form, odier than price, has been provided by guest and Menards is not responstble for any errors in the infomiation on this estimate, including but not limited to quandry, dimension and quality. Please examine this estimate GUEST COPY carefully. MENARDS MAKES NO REPRESENTATIONS, ORAL, WRITTEN OR 07'HERWISE THAT THE MATERIALS LISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDERED BY THE GUFST. BECAUSE OF WIDE pAGE 3 OF 3 VARIATfONS IN CODFS, THERE ARE NO REPRESENTATIONS THAT THE M�►7'ER1A►LS LISTED HEREIN MEET YOUR CODE REQUIREMENTS. z _ .,� ,_ ..,.�. � e ,,, , Lond Plonnin9 LondSui-ver�in9 Soi/s Testiny CTvil b Municipa� 6B7s -fli�hn�oy *�GS N.E. 'Minrieo�aols 2/, EI'�! � 1 NEE R I N C'.�►, I N C. AAinnesofa ' � SUnsef 4-60bb En9rneerin9 E/�9ineers � Sur veyor,s . �. +�e�'t�, z��t1e o�' r�,�v"e Fos Cor��ld T��,mer- � :, N . � `�` �- � � � � ! 4 �, ti � e�' ` `c I o�. �1 _. _ . �'�-+- I � a IF a N I� w I � f � � .� i� I W I � � i� �� LJDT �? _._ I 2 5. 4,A� — —.� � — . ._........ '� z� ,.. m 4 ea +.� � N ;, r� _ � _ . _ _ 4 m '. ` . ., � . �� 4: �� f � ` \ ,` �' ; '�, �� N --125.�$ — � � i � _._ �.t° � , I Q,.. �'l � �r � � � a z Z Q � �� L�'T �. ,��....C��;�'� I.� �,i� L� EY �' �� UV M;1 ��,lu�R scale: � ": 3!�' ��fiis �s o fr�e wrd mrr�cf �epre.s�»f�frcn o�'a su^vey g�'� bourrdor�es ��1.e oba►r 6�d �ond, �d .: �'. s, �o�, arx,�alJ ris'ib/e � . � �vcfir��en�S , i�"onr�, fittri a- al soi�/ /mx/. As su�veyed by me �uy _ d�, ' ? �,�,,��C'��' , A.D.19.�. , : ., SUBUR$A1V EIVGlMEER/NG , INC. ' ` 6npinerrs Fi' r�ors �y 1:� , � .f C... �L.':� °,. 7.•6. .s. e�' .,� �. i/" � � � � �-� � � �� ; � CS � � 0 � � � � � G� �,� � � ��/ �� j N�� y � a, c � � �� u Building Inspections 763-572-3604 763-502-4977 FAX STi'E ADDRESS _ THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE, BOA1D AND CERTffICATE OF nvsux�vcE PERM[T TYPE PLUMBING RESIDENTIAL APPLICATION I■ � ':/.l�l; STATE LICENSE STATE BOND # Pxorr� �SINGLE FAMII.Y TYPE OF �VORK: I ��' DETAILED DESCRIPTION OF WORK P��t R��a CITY OF FRIDLEY n$� �� AU G 1�'' d10 �crn� �-�-zoio YOUR ADDRESS �_rc� � �� CONTRACTOR (��- CITY STATE ZIP � TWO FAMII.Y ❑ REPLACEMENT FAX 0 TOWNHOUSE �►�� : ra EXP DATE �_STATE�2�3� FEES ARE BASID ON $10.00 PER FIX1'URE, EXCEPT WHERE NOTED. FIXTIJRES: (INDICATE TOTAL NUMBER OF EACH BIIAV�. A�f1MUM FEE $35.50. BA'Igi SINK/LAV FL�R DRAINS SAOWER WATER PIPING _ BATHTUB _ GAS PIPING (NEED CITY LIC) SWIIVIlVIQVG FOOL WATER SOFINIIt ($35) _CLOTHES WASI�R _ KITCHEN SINK WATER CLOSEI' �ACKFLOW PREV. ($IS) _ DLSHWASI�R _ LALJNDRY TRAY _WATER HEATER ($35) FOR IRRIGAT[ON _ wa�x � o� N� of fi�res C3a $10.00 x$10.00 =$ Ninnber of faatiu� @ $15.00 x $15.00 = $ Number of fix�res @ $35.� x $35.00 = $ State Surcharge $ 50� rn�nvrnrr�avr �� qn� T,..A� � e��.1 n_ lS�' THIS IS AN APPLICAT[ON FOR A PERMIT NOT VALID UNTIL PROCESSID I hereby apply for a plumbing permit and I actrnowl�ge that the information above is complete and accarate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota �onstruction Codes; that I understand i�is is not a permit but only an appli ' for a d work is not to start without a permit on site; that the work will be in accordance with the approved plan in the of all wo hich require.s review and approval of plans. SIGNATURE OF APPLICAN'I' PRINT NAME �� l�A.1S (/L DATE ��/'l S ARE City of Fridley Bnilding Inspections Department 6431 University Avenue NR, Fridley, MN 554�� 763-572-3604 FAX: 763-502-4977 , : •;, r - �D