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AF - 38583Date Owner Addres BUILDING PERMIT Village of Fridley, Minn. �}::-�-.�:�.:�-.s � .. .. . ... . ... .. .. .. .... . . .�3:�/�r:'�:�: �-.'c.�. .. .'�'�"'f. . �?w .�"-:�-�' s �.i.4?f� . .��'.tf..a�':�".Lp. .'p�':.uc;.,:,,:i�:O. . . . N° 242� Builder . . . . . �':W''r,! . . . . . . . . . . . . . . . . . . . . . . . . Address......................................... LOCATION OF BUILDING No. .'�� . . . .. . . . Street . �^':4,s"�'.1!�!.G�'�•t,l . . . . . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . . Lot . . . :��. . .. . . .. . Block . . . . . .�?. . . . . . . . Addition or Sub-Division ��.�'� �`'1iA►'�. . . . . . . . . . . . Corner Lot ............ Inside Lot .:'�'.P........ Setback �� !� . Sideyard ��f.�'A"�':'"","."............ DES�CRIPTION OF BUILDING To be Used as: • .Nf`!!��'. . . Front . .��`. . Depth .�.'�.►�. . . Height .�t L�!. . . Sq. F't. .'� �°Q, . Cu, Ft, , , , , , , , , .................... Front ........ Depth ........ Height . ..... Sq. Ft. � ... , Ft Type of Construction !Jf� , , Est Cos�,%;�,�0�! ,�� , , , , , , , , , To be Completed � . :'i�!� , , In consideration of the issuanc� to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. „�� Pnsideration of the payment of a fee of $. /.�. .., permit is hereby granted to � .,,j-;'�, , i�`+c�sr/S"Q7"�.l- ....... to construct the building or ad diiion as described above. This ernut is ant �� P gr ed upon the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work done in, around and upon said building, or any part thereof, shall conform in a11 respects to the ordinances of b'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any' time upon violation of any of the provisions of said ordinances. � � � � �� r/!. Building Inspector NOTICE: This permit does not cover the construction, instaltation or alteration fflr wiring, plumbing, gas heating, sawer or water. Be sure to see the Buifding inspector for seaarate permits for these items. 9 � City of Fridley, Minn. BUILDING PERMIT No 4 9 s 5A�`� , Date: � �! ._.._.! . r �— � � l� ..----• -.._... .._.._.._._._...._..._._..__. __. _ l�' Owae ; -- --�'-�=��=--------- ,�c��-�r-�� • �; s' __ . -----•----_�___.._---•s•---••------.--. Builder ...._.....--- .-_•- •--•---__ _---- .�.._...___..__�.._.._._____.� r" Address ----_...:: °:�..�--1-�-.__ _��`G=��..:_..-��e-�_'�' Address ........--�---.._ .... .......... _..........%�:��:._._.---_..__. LOCATION F BUILDING ._ NO. :�:� � � �€�-�t;�_�.=�-�_-�,�� •--. ---�----...I.�....-------- S -�` -•---._...._..._..�....__..__...r..._....._..-........._.._.----.._ Part o Lot . � /�� ---------•-•--••----.__.._._-- -••- - -- Lot .._ -..�.---.�.._.._ Block --•-•---........_ :................................. Addition or Sub-Divis�ton .....(....c.-::?�:�-:�� r.....�._.. _. .�`� eM1. �C_>�-� , � -- • �-- - ......---�---.....- •--____... ..._�r . CornerLot ......................._........ Inside Lot ..._�......._........ Setback ---�---......_...._-�-•------•--...---.. Sideyard ....._......__..._......--•-�--_.........-----............_......._. Sewer IIevation Foundaiaon Elevation DESCRIPTION OP BUILDING Tu j�e usea as: ° _.._='��_. �. ��_�''Front ...1.:...��_...._s. De th �--_.11!. Hei ht ...- -- �.--- S Ft. .L' �' �'..�---� c? �-- - A -_--.......- - g �- q• �--"------ Cu. F� ...................._.............--�--��--.............. Fro ------�--.........__.. Depth .............._...�. �ieight ..... --.............. Sq. F� ---�-- .....---....... Cu. F't. / Type of Construction ... ._......�-�.-?- ........:..... Est. Cost......._/,.�:..�..._�'........................... To be Completed ....._..------.------- � In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed wark in accordance with the description above set forth and in complisnce with all provisions of ordinances of the city oP Fridley. In consideration of the payment of a fee of $�.�.-_..d.--•-�--......., permit is hereby granted to...._ ............._.....-----.--.----.-----..------- _.._ to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this perttiit may be revoked at any ti�e upon violation of any of the provisions of sa.id ordinances. � ...� � � �' -�'`� -------------_�___.._...__.:...___.._.... .__.._.... Building Inspector NOTICE: This permif does nof cover the eonstrudian, installafton for wiring, plumbing, gas heating, sewer or waler. Be sura to see fhe Building Inspector for separate permita for these itema. �., 4 ^�, � � _. . .�, APPI►TCiTItJN FOR BOII,DING P�MIT " CITY OF F�tTDLEY, �TA , r,,,.F, ^�• `'�.r^ .?`A"" 1 "" -�a �^ f``� ,^. . �-1, � jw,�=� d �t,Il�e='8 NBme ,�,,,,:�:�`"'°� � ��.' � `� i �' '�"` ,�� $u3lde:c ��1 ��.� � �,�,a—p -' ,"r c`;.,,,, / p r.- � �, � i�.�n..�IL ��...�..� •�.�...�r�.rr. ..�Y �� .i�. � ' i.�w� � /� ,- -,-' �� '- � �., sa� � �/ �� ?% ''�� l'��.- � �1�eB� '�.A��/l � ^ ✓ v ��.�"r, c � �%+� CA� _�', A' A ?''i c--:•i ��8i�i `�y. __ r�! .:`' G1' l- i., r"� L' w 4. - n' � �n.r�.nr.wr�� ■.�rr �'i��r� ��r�� LOCATION OF BIIILDING �o. '� � Stree�,L',/" F�'� ��° f;�- �,� r Part oP Lot .. ' ,� ,,�, k� �_ � `� Lo'� � �' �i Hlock . ,� �� Addition or � S�b.Div.,� � °�.i,�,.�� :,�,;; � ; f;_, �;�,� � ' r ��' �-� Corner I�t= aide Lot " Se� Ba.ck S3.de-Yard K� 3� ELEVATION FaUNDATION ELEVgTION Applican� attach to this Porm Cer�ificate of Survey of Lot and proposed building locaticn. DESCRTPTION OF BUILDIlJG To be used as s .,� �.��°'�' �-� 4� �' T� ,, , , � � d�.. � �� 0 +.,i� :� �; , � ��, �� _, F'ront ��,'� �' Depth. '� �1 - --�3�t � Sq. Ft. Cu. Ft. Front Aepth He3.ght Sq. Ft. Cu. Ft. Type of Const.ruction `� ;� �' �'� �� Estimated Cost To be complet�d The undersigned hereby mekes appl3catinn for a permit for the work herein �pecified, agreeing to do al�.t�ork 3n �triet aecordance with the Cit�r Ordinences and ruling of the Department of Buildings, and hereby declares that all the facts and represent�- t3ons sta,ted in ti�.s appl3cation are tru� end correot. � DAT.� SIGN1�Tt)RE � (A Schedv�.e of Fee costa c�n 'be fa�.md on the Renerse S3de. ) �"� � _ � - �° ' ; 1 � ! 1 1 • �3• 1 ' � � "1�11 1 ' �Seot3an 2. The Inepector of Buildings ahall, before 3sauing ar�► pera�it for the ereati�n of any builaling or� s'tructure, ox for an� addition to a�r esc3.ating building or structure, or for ang alteration� or repairs to.any exi$tiag �bu37-ding or structure,.upon epplication therefcr, r�uire the payment by the applica.nt for suck► permit of feas to the amount herein �3.d►a set £orth and in the manner herein provided to-wit: 2.1. For e.ny such permit for the erection of any fire-proof building�.other tha,n a gara�e, warehouae, fac4.ory�or grain elevator, or for the erection oP s.ny £irepro�f addi�ion, for similar occupanc�r, to any existing build�.n� shall be at the rate of �]..40 for each one thous�nd cubic feet, flr f'raation thereof, in such.eubic�7. Qontents. a.2. For an�r such permit for the erection of �.rty fireproof g�x'a.ge, w+ar'e- hou�Q, factor� or grain elevator; or for the erection of any f'ireproof addition for aimilar oceupsncy, to any exieting bui].ding shall be at the rate of �]..25 for each one thoueand cubic feet, classified ae nfireprooft1 . by Section 502 of the Minneapolia Building Code. OH QSES 2.3. For an� �uoh permit for the erection of an�r non-fireproof building other than a garage, warehouse, factory or grain el�vatar, ar �ny non- fireproof addition, for aimilar occupancy, to any exiat3ng building. Permit �7..� for ea.ch one thousand c�u.bic feet. � ,. G (xES , a.l�. For any such permit for the.er.eation of any non-f3reproof,garage, warehouse, faatory or grain eleaator, or £or the erection of an� noa- �ireproof adc13tion, for �sim�lar occupanc�, to arry existing buildin� �r � for sach such bui}.din� or addition. Ni.nety Cente for each one thowgand cubic �eet or fraction thereoi', in the cubical contents thereof with a min3mum of $4•00. � ' . For the pvrpose of compu�i.ng fees for bua.lding perm3.ts the cubicel contents of eny 'building or addition to a uniform he3ght throughout by multiply3ng the ground �rea covered from a point s3x.(6) inches below the.i'].00r li.ne aF the basement or cellar to the average height of the upper surface or to the �serage height of the roof svrface of the main gable of a pitched roof. 2.5. For repaira or alterations to an exiating structure, the fee shall be. at the rate of �3.00 for each Five Hundred Do11a�'c,g (�5�0.00), or fraction thereof in the cost of all proposed work. 2.6. In no-ce.ae shall the Fee charged £or any permit sa set forth in Secti9n2" be less than �4.�. ^ ' /'� �``, F � � � � . ��' _ � � � r�l � � 9- � t � � � � � a a�� 0 � � � -v � L� � � �� s� � _ ��.. �/] � I�i � Oe � � � � 0 � 9 �� 4 M � z �� d � r � � � �� M � � � M �� 0 M � 'C 91 G � �o '.�,7 �0 � � • � � �a �� °�� O � � � � �� o � ��o� � � Tt � M � O ,�y � u � �� J Q i � u • : .. SON�N3d0 �� r.�tva S1nJ '1ddV sv� �IIbYM O1f1Y ��Sh �1� SNIWG � .ar�rw� '71NIM0 s�vaa NSbM b71N�5 �� N1N � � IIIIYM � m � � d � � � N I � � y �-i � � � � Z N � � � � x � � � � a � � $ � � h � � ti O �r � a U � ►. o � �y � z �' a V � � .O � �� i D F c� O & � � . � �� ,■... : .� ,■■■■ • • �� i . ,■.■. : - 1�� ' 1�� W J � W _ •�w Y I W � cc J H�/ iT � � u N bL' � u � J) a � e� ��. � I �a g ("� I F+ N c'rl w N K w t9 y M M °� � «r $ � �3 i� � °� !�i w '�$ • � 1! k' % �I k PC M k k 11 i � Z • r1 : . . . . . . . . • • • • • • ♦ t • • • • • • � • � � • • • • • � • • • • • , • ♦ . . . at . . . : : �� : : ' ' . $ : ' : ' , . . � � a : : : o�o �o� .°� '� � . y Q � F . G � � � � .'i ; • �L'S dp , � y � 'G , � a . v+ O � w oi O • iC � '°� �.�..� �+ �P�C � ai ' � 'O � � +g v � � � � � d � g W � �+� o � � � w � x � w � � � '� a a � � � a � � s � "' � ��, � x z� z � e z ��•�� o� � � r 4 � a � • � � � I SUBJECT City of Fridley ' , AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � � � ; y _.�� COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. , , i, _ , .---� i""1,� CITY HALL FRIDLEY 55432 NUMBER L ' , 612-580-3450 910-F15 JOB ADDRESS 5096 Clearview Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. 21 6 Summi 2 PROPERTY OWNER MAIL ADDRESS Bruce Heath 3 CONTRACTOR MAILADDRESS Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS REV. DATE PAGE OF 3/21/73 � � i on r _ .Addition PE . . 12069 ECEIPT NO. ��i�'�' APPROVED BY SEE ATTACHED SHEET Z�P PHONE LICENSE NO. ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Dwelling 7 CLASS OF WORK ❑ NEW ❑ ADDITION �7 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Add Fireplace in Basement 8 CHANGEOFUSEFROM STIPULATIONS TO ��p��ATE PERMITS R�QU1RED F�R �RIiRiNG, HEAT1�4�. P�U��NG AND S�GNS. � SEPARATE PERMITS ARE REQUIFED FOR ELECTRICAL, PLUMBING, HEATING, �� VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORI2ED 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 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1 350 , 00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE PROVISIONS OF ANY OTHEH STATE OR LOCAL LAW REGULATING CON- STRUCTION OF THE PERFORMANCE OF CONSTRUCTION. � yfi9 . OO PLAN CHECK FEE ��c-e_.e_ .� ,� .��' /�-3 ciGNATUREOFCONTRACTORORAUTHORI2EDAGENT IDATEI �-.iniucn� oan OCCUPANCY GROUP OCCUPANCYLOAD Sa. FT. CU. FT. OFFSTREET PARKING STALLS IGARAGES SAC CHARGE )TAL FEE $9.68 T IS IS YOUR P �° SIGNATURE OF OWNER UF OWNER BUILDERI IDATEI � BLDG INSP pATE�- I� � �FP�I��TT�� AE�IA��T��. t�T�I�ATI��, 0� ADA�TIO� $�ILDI�G P�RNdI� ��T� oF �Ri��Ys MINN�50T� i�i�A�1:Wr�4� L�� I f � ��•� •� � 1 f�l�(�DY�L+iL'+iTiv �-` - i *�,'.�� .��T � ��nei a ADYDRESS s,� Q% G� [� %P � fi Ls >+� tf+� aL'G��ES3 t ��3.� S � 9 � s��, ._,.�cq .�-c;�.�-�' . �. � , ,,. g� $ � � BLOCI� � �' ��I0�1 z,� . � ., ��' �r� ;' �R iOT: ��AE LOT: `� =S�TBACRy '3S' � SIDEY�i,RD:� ��.3,� �t�c.� �aa ��+pm�t_�a Certi�icatee of SuxveX o� I.�a� a�►d prop��ed �,�.�,� �,r.�cati,� d� sn� #�se Certificates, � �a Be iia� ,!� : ��CRI�'TZtJN OF BUILDING ��;� _,.�.-0 .� �" � � �th: �ight: k�° � �.� ��_ S��aace �'��3 Cabi� �e�3 �'rc�� : Deprh ; Heatght ; S�ua��s �'�et; Cubic Feett �#� °f �o��truc��.�� , G /;�,l= /,�/-F C �- �atim,ared Cost• $ � ,� S^U , � � �� : 3 -�� .�, - � � . , _ ... ih:s �t��ed hereby �c� a�1�Lcativrt for, a pe�ait f�x the w�;k be�reiu �e�i,f�#�d� agxee;Ls� � do a�.� �� n att�.ct accoxdance wftt� �kire ��,� paf �'�,�d�.�' t��d�es �ad ��,�,gm� �� e Depar#aaten� c�f Bu�$d�.n�e, �d ?�exeby ��.as� � a�.� �h� �acts a�8 ��reseata�i.one stated i� tisie a�►Ii,catipn � � aa�d a�rrec� . �f� � �� T � �Pl�t! e� sea�i �i �� e:.iwe �. s ��i,r,tlY/i _ r �(i�- °✓�t,?- ee .s. �a.� e e.e i� �� Tt+a�►�� S�� o� �dd�t�ona�. In�ost�atic�n..) ��, �� _- � � �' _� 1� '" � s� d � � �� , , , � � ,.,.. _�� -;:c-�--_.., � ,_.z s —p . �:�� _� �.-� �%" � 4�`' '� Q -aU��,�TN� ��zT F�� H�nu�,� S��T�Q1Y �. 'i'h� Inepecto� pf �ui,lding� $k�a11., befoxe i.�aui�g genui�� for �he ��.on o�' auy bu�.ld�ng A� structure, ox for any addition to any �acis��.tig ��,�d� oz st�cutGture, or fo;� any alter$tion ox re�airs �o any ex�.b��i�.g ��i,�d� o� stxt�c�uxe, upcax� �ppli,�ation th�ref�sea xequ%re the paym�� by �hs �.�,��.i��t fo� such pex�,t o� �ees �o the aastoant herein below set far�h �d #xi �� uaaa�a:�r h�x��n p��vided � �o�wix s UNT�°OR�i Bd1�LDT1vG CODEs �Pe �s 2��r -$Z.15 �or each cpme t.lious$ad cubic �e�� f�aGtion �h�7cea�, in at�+� cubical co�,�ents. �pe � & 5 = $�.8� �o�e �cb onQ t�ousand �b�.c �se�, , . A�D�TIUI�iA�, INF1)#tMATiON F�� pu�go�e af �annpu�� ees for building permits, the cubical contents o� �y building or additioa, is determiaed by mui�iply�n� the $�ound area �ay�g�a1 �pa� a poi�� (�ij ine�es below the f�.00r line Q� the basement �► �� .�a� �o the average heights of the uppe� surface or to the avera�e� �C �� e �o�� face o� �he uiaiu �ab�e of � pirched xoof, ��i�'s o� a1��t�ot�$ � aa existin� s�su�tu#�'eF �ae f�e shall, be �� he , �.�� o� $�.fl0 #� �� five h�c,�red dollaxs ($�OQ.f�}) � £��ti.an �h�ac'e�o� in �� ac�� a�.]. p�ca�sed wv��C. �� ea� a�a�l 1�� +�a fo� a�y- pe�it as se� �o�rt� �.n Se��ian 2 b� �.�a �an $5. t�1. w V��1�TiQ�1 0� ��UNI3I�TION WQ�1 i'��.ts �Qx c��sik�t��loa� will be i.�$ued a�ia�� o� �4 i�auxa �xout 1;he .�a a# ��licat#�aa, �a a�.�+oad �px pra�er �rev�ew of the pxopo�ad s�acu�tt�re amd p� �i►e �t�u�tion &ite. ' � C��.�i�1 i�ua��y v� �h� �.u�, ��is$ t� �ocat� vf t.1iQ �au�cta�ti�, Q�� ns�t.�d� wii� b� �e�uised bef�e proceeding w�#:h ��r�i�� , c��a�� Q��P�v�Y ��.�at�.�a€a �c� � GeT��.�af� c►� Uaeupancy �hal�. bs mad� �ea (14) �,Y� pxiax �o t;h� �sg �x �c�up�y a�{ �ty ��ic�re f��r which a bu�.ld� pex�ai� ha� been isst�ed; �ttc{ �s��.�l st�ucku� �iia].�, pot t� used ag occup�ed ctatil a��tifi.cate af p��upa�cy � b�t �.savt�sl, � y y SUBJECT � 1369 Cit of Fridle AT THE TOP OF THE TWINS g U I L D I N G P E R M I T • � ' CE . � � � `v _ COMMUNITY DEVELOPMENT DIV. �� /_ / r � � PROTECTIVE INSPECTION SEC. (p ' i ' �l /��'1 � CITY HALL FRIDLEY 55432 NUMBER REV. OATE PAGE OF APPROVED BY ""'� ♦ ,�� 812-560-3450 910-F15 � � JOB ADDRESS 5096 Clearview N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 21 6 Carlson's Summit Manor South SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Richard Paulson 5096 Clearview 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Merle's Construction 860 Randol h St. Paul. n 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. SAME 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDING residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK New aluminum siding 9 CHANGE QF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. � UITI� iIU�I THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING S�. 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 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 ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,550 .78i WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CAPICEL THE pERMIT FEE - SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � 9.30 � � PLAN CHECKFEE TOTALFEE ,'L'1��=l�-i`�ti� r,'��_ , O�� U. O8 SIGNATUREOFCON RACTORORAUTHORIZEDAGENT � TEI �HEN PROP Y VALIDATE � THIS IS YOU PERMIT � � �� ` SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI B DG I P f1ATE ^' CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL ALTERATION, ADDITION, OR REPAIR BUILDING PERMIT OWNER' S NAME :�„�, ICf�L�i� f.� �/��'L 5�r�'t-- BUILDER:��•P �� ' S C 0� 5�� ADDRESS : JrL� �°� �% �,q,�ve �% cc1 /�/ � ADDRESS : �/�O ��e�i'/�G'�-/�/� �J"° /- �� ' � � �� `Z- NO : . .i�G �'( STREET : �� p�?•� (� F � cs� //,/ , � LOT: �}--� BLOCK: �' ADDITION: ,�°`:�2i��,s.� i�%.�/��K � CORNER LOT: INSIDE LOT: SETRACK: � SIDEYARD: Applicant attach to this form �ao Certificates of Survey of Lot and proposed building location drawn on these Certificates. HESCRIPTION OF BUILDING To .'Jsed As : Front: Depth: Height: Square Feet: Cubic Feet: • Front�: Depth: Height: Square Feet; Cubic Feet: Type of Construction; � ' Estima.ted Cost: $ �� — To Be Completed: � � . The undersigned hereby ma.kes applicativn for a permit for the work herein specified, agreeing to do all work in stfict accordance with the City of Fridley Oxdinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. G� �,� DATE: �i'�L SIGNATURE: ��z�Zi�� ,� (See Reverse Side For Additional Information.) � � � �tz� � �� e �U. � � 0 e ,�� . 'a BUILDING PERMIT FEE SCHEllUL� SECTION 2. The Inspector of Buildings 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 repairs 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: 1�TEW CONSTRUCTION: Si,ng],e Family Homes and Garages: $4.00/1000 cubic feet PLAN CHECK: 25 percent of building permit fee. ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average� �height of the roof surface of the main gable of a pitched roof. For��pairs or alterations to an existing stxucture, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or traction thereof in the cost of all proposed work. In no ca.se shall the fee charged for any permit as set forth in Section 2 be less than $7.50. ' VERIFICATION OF FOUNDATION NOTE: Permits for �onstruction 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 Certified Survey of the lot, showing the location of the foundation, once it has been constructed, will be xequired before proceeding with the framing. C�RTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be ma.de ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occup3ed until a Certificate of Occupancy has been issued. n ,-> >.,�� sue�ecr pE City of Fridley 19 6 96 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � � � ECEIPT NO. � • COMMUNITY OEVELOPMENT DIV. ' j y �� r � � PROTECTIVE INSPECTION SEC. i1 ` � --_-� �r"',,J CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 810-F15 10/5/88 / / JOB ADDRESS 5096 Clearvie�r Lane N. Ew 1 LEGAL LOT NO. BLOCK THACT OR ADDITION SEE ATTACHED oescR. 21 6 Ca.rlson�'s S°umm�it Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE James. Tra�as� 50�6 ClearvieFr Lane N,E, 572-8236 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 5ame d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS 21P PHONE LICENSENO. 8 USE OF BUILDINd Res iden tial 7 CLASS OF WORK � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 1Q � x 12 � Shed in Rear Ya,�d 9 CHANGE OF USE FHOM TO STIPULATIONS Sh�d must be.3t from side and back 1ot lines or off from any easement. 5hed must be on a slab or tied down witTi. �x ancTior ties, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OH ABANDONED FOR A PERIOD OF 120 DAYS AT 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 VA�UATION SURTAX AND ,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEHEIN OR NOT. THE GRANTING OF A PERMIT S�-�200 ��Q $�6O DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- `�,, STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 1l11$��X $29CQO PLAN CHECKFEE TOTALFEE $29,60 SIGNATURE OF CONTRACTOR OR AUTNORIZED AGENT IDATEI Y�t@� EN PROPER VALIDATE THIS IS YOUR PERMIT SIGNATUREOFOWNERiIFOWNERBUILDERi �DATE� BLOGiNSP �� E � �� City of Fridley Effective 5/L88 �1 � � R-1 At1ID R-2 ALZER [ l Qonstruction Addr� r�� Descriptian �,;�ding Permit Application Owner N�ne & Adc]ress:_��i� h'l�'S' �%�- ��? S Tel. #��. ��.3� �bntractor: �� lQ � . Tel. # Address: _ ��? !»a � �„��/�- � Attach to this appl ication, a Certif i,cate of S�uvey of the lat, with the proposoed construction dracwn on it to scale. �S(RIPPIOri OF II�'ROSTII�� T_TVTIS ARF'.L. �� Width � vZ Hei t --- --- gh 9q. I�t. (�1RAGE ARFA: L�'igth Wic�th eeight St�. Ft. DEC:� ARFA: Length Width flgt/Groimd 9q. �. �:. T.�,x� .� s��. 4�rner Lot [] Insia�e Lot [] Ft. Yd Setback Side Yard Setbacks Type of Construction: -��, et ,��i,� Est�mateol Cost: � f�/,�� Approx. Completion Date: Al� A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ Width + 6' See Back Page n�: %D �. y- ��ic�rrr: Te�.. � S7� - r�'�3� I QTY �SE �iII�Y �t � State Surcharge SAC Cbarge Driveway Escrow Park P�ee Sewer Main Qlarge � SPIPUI��I�i1iS: s � �. Un S �o� S S S S � � �� rlee Schedule on Reverse Side 5.50/51,000 Valuation $550 per SAC Unit �llt. "�" or Al� "B° Above I�1ee D�e�ermined by �gineering Agre�nerit Neoessary [] No� Neaessary [ l '' 1 . � �, ' �;�,+Ip �+a� �«:i��,�) The (�ief Building Official shall, before issuing permits for the erection of any building or sstructure, or for any a3dition 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 anc] in the manner herein pra�rided to�oiit: � TO'PAL VALOE �1 to $500 5501 to $2,000 52,001 to $25,000 525,001 to �50,000 550,001 to 5100,000 5100,001 to $500,000 �� S1S (Minimtan Fee is S].5 plus surcharge ) Sl5 for first 5500 plus S2 for �ch additional $100 or fraction thereof, to and incluc7ing S2, 000 S45 for f irst �2, 000 plus �9 for each additional $1, 000 or fraction thereof, to and including 525,000 5252 for first $25, 000 plus $6.50 for each additia�al S1, 000 or fraction thereof, to anc] including 550,000 5414.50 for first 550,000 plus 54.50 for each ac�itio�al 51,000 or fraction thereof, tro anc7 including 5100,000 S 639.50 for f irst �100, 000 plus $3. 50 for each additional �1, 000 or fraction thereof, to anc7 including �500,000 5500,001 to $1,000,000 52039.50 for the first $500,000 plus �3 for each additional � $1,000 or fraction thereof, to and including 51,000,000 51,000,001 a�d up 53539.50 for the first �1,000,000 plus S2 for each additional $1,000 or fraction tlzereof DRIVEk�iY DEPRESSION ESQtQ�I (Concrete Curb Streets Only) Alternate °A°: Renwal �d replaoement a� curb and e�tter oa�ly - Driveway width plus 6 feet times 513.50. Alternate "B°: R�naval and replaoement a�f wrb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times 515.75. /�� a� y �� •' a�:�l�� •�.I Permits for construction will be issued a minimum of 24 hour s f rom the time of application to allow for proper review of the proposecl structure and of the aonstruction site. A Certi.ficate of �,ixvey of the lat, shawing the location of the foimdation oncQ it has been aonstructed will be require�3 before prooeeding with the fraaning. � � 1� � � � � � �� c� � � o � � � avi _ 1� W "�. Z 0 I- y W � ; ~ W Z 0 � � ,�° Z Z a � N � W V � Z y cs W Z =O �� _ - Q Z v� O Zv J Q � � � � �a oz �o �Q O� W O� F- �+ W V � J a z a O a � � � Z � � �/' U ww �z- Z > N � Qm d� �� L!i N N l�i � � � C � _ �� ,� N M � M 'a N � 'C 1� U t0 � tn � �J �� J � � � � .�I � p N w � N W � � � � z Q w o m � O m W J � � w � � � 6L9 � � `� �,__ � � � Z H � W d. � ��w V l H � O U � �.IJ Q � f-- � W 0 J b H � � � H 64 � � °o, 0 M � � Q E � � � � f� O v �' �Zw c�v � _N J ,4? !n 'a v 'a'' U N � C C O O � U i � U o 0.. 1-- _ N � c� 00 \ � C � N � = Z {� o � �� O � � � Z 1— �D ti . � O Z d N � a. 2 � � Z d � � � `m m m d "1 � d9� 69 H4 EA d4 o° o°, °o, °o, O O O N � � � � � U i � 7 L � m � � C d i � � � > U m � V � � � � fC � �� a��i -a -� � °' o C � ' � C R � �' � �-+ � U � z � � � � d � � :i� � �' '� '_ � C U � � .�' �C G� N�� ` N V1 N � ti Q C3 C7 � L >, � N ca C'3 N d N a � C :� � C O U Q � Y U Q m Z 0 � � v i O O � � +� O N U -� c � a � Q f6 0 d � � \ � N > � a� ,� -C O O � — .--� Q c � � .� y C � � lC � V N 3� � � U � ,t d +' U L O � � � `�" r�,,, ++ O .+.+ • � U 3�a � U N � 0. � � � � � U � � U �O d C � >+ c0 � U i O U ,f � '�'' � .aN-� U d.0 C Q �Y � .Q c f° ,Y �+y .o v, � N i � {g •> ++ A p � c � � �� L O � � � t' i �� N -� c � c � m � pp i � O b0 � r� L � 'Fr � � � � � 3�`' �a N � .0 i Q F— V�'i i � � C •� LtJ � Z O � V Q � � Q Q O �.� c d G U �� .= p0� `p d'.. N � o '�o � � vf �} b4 Y O � i O N U R .: ¢ N O � C � � j 10 �i O � o � � N t� � � � ca L W � w � � � J � Q � � � O N H � z ¢ W 2 � u� d� O N � � �v� !� � N � 0 LL W Q � N � � C t 00 � O � ` m � a> v > � o G Q bD Cn Q _ \ � 0 n � .� W W � Z O H U W � � Z W � � O t 3 -� i � a� >+ 3 � O � � N � co a C � � a � � U � fQ . � O .II � +r � °c E. c ° U C i O N y o �� a C U � � +� ¢ 3 :a��Q :�g pau�is �O� JI�iI.L��H :auoQ uiag S1�OI,LH2i�,L'IH �sT'I : sx.z�uzag () oN ( 1 sa� �a��aq ia��enz .�o� papt�.o.zd uaaq n� uot�snquto� s�g • g () o� () sa� .za��aq �a��nc� io3 papinoid uaaq iauii � S�H ' L S�nig �ios S�l1ZS Ia�o Iid � �o s.f1.LS �ui��au T�io� s�H 9 ( ) aad ( ) �� Pa��a�a� s�fl.�� I�fl� p� — - -- a�s io� s�uauzannba.� apo� �ua.un� i� s�aay� � S ( ) oN ( ) sa� pauoddns �iain�as sy •� () ou () sa� uiq�inn pa�pol s��aCqo u�ialo3 ou s�g •£ () o� () sa� uota�e�oua�ap io �sni uio� aa.� sI ' Z () oN () sa� pau�xa �ijn�a.�� uaaq s�H ' i � :x��is io �autuiqa �ut�sixa ay� l� saguan �qaia� pau�TSiapun aq,I, l�iOIZ��I3I?I�A A��'�S QI�i� 1��1IIH� Building Inspections 763-572-3604 DATE t`>/ c S1TE ADDRFSS � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR BUILDING RESIDENTIAL APPLICATION CIT'Y OF FRIDLEY ■ � I . SUBMIT A COPY OF STATE LICENSE YOUR STATE LICENSE ADDRESS: �� WITH APPLICATION pHpNE "� b3 YOUR E-MAIL ADDRESS � -5� a- PROPERTY TYPE INGLE FAMILYMf ❑ TWO FAMILY/NEW PERNIIT TYPE ❑ BASENIENT FINISH O DECK �rYrE oF wox�c: EXP DATE ❑ SRIING � SWA�Il�IIIVG POOL � Permit No.: QD� 0 Received By: Date�c�: rc; � �� sTA�aa�� s�� a ❑ DRA1N TILE ❑ OTF�R DESCRIBE WORK BEING DONE: C� - R?p� - SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES � LENGTH WIDTH HEIGHT C] HOUSE & GAR.AGE GARAGES ❑ ATTACF�D GARAGE PROP05£D SIZE: 0 DETACHED GARAGE PROPOSEU HEIGHT: SIDIlVG 0 Yinyl OSoffit � ❑ Aluminum ' ❑ Trim ❑ Other . • ❑ Fascia R'IlVAOR'S IN EXISTAiG OPENII�IGS OYes �No L.UCATION OF WII�]DOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENWG CHANGES 8c TYPE OF WINDOW TO BE WSTALLED M]MBER OF�WIM �� BASEMENT REMOAELING SUBNIlT: 1. Existing Floor Plan 2. Propose.d fl�r pfan 3. List of stru�Uual members to be used F� FOR NEW CONSTRUCT[ON IIdCLUDMG DECKS, ADDITIONS. & PORCHES SUBMIT• 1. Site Plan/Survey showing the existing strueh�res ar�d pmposed project 2. Two sets of wnstruction 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 V, l' � � � � Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control park Fe� Sewer Main Charge Total Due $ $ $ $ $ $ $ $ $ $ OCCUPANCY TYPE See Back Page for Fee Schedule 65% of Building Perinit Fee .001 times the total job valuation .0005 x Permit Valuarion Minimum $,SO $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determinaxion) ft+68= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks pavable 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 aclmowledge 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; that the work will be in accordance with the approved plan in the case of all work hich equires rev'ew and approval of plans. SIGNATURE OF APPLIC� � _ PRMT NANIE ��A� \� �`�+ �►`�1 DATE p� i U Page 2- Building Residential Application BUILDING PERMIT 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 altera.tion or repair to any exisiing building or structure, upon applica.tion therefore, require the payment by the applicani for such pemut of fees to the amoun.t herein below set forth and i.n the manner herein provided to-wit: TOTAL VALUE FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus swchazge) $501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 � $2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraciaon, to and including $$25,000 ' $25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fracrion, to and including $50,000 $50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional 51,000 or fraction to and including $100,000 $100,001 to $SQ0,000 $993.75 for 1� $100,040 plus $5.60 for each additional$1,000 or fraction to and including $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 including $1,000,000 $1,OOO,Q01 and up $5,608.75 for the 1�` $1,000,000 plus $3:15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Permits for construction will be issued a minunum 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 found.ation will be required before proceedi.ng with the framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fasc: 763-502-4977 i JUN-29-2007 03: 34P FROM: FT}{CEL R�OF INC� 121�''c78123 TO:.'�11�7 rrom: c;��y ar rnmey io: io�rieia.sa � rage: u� uate: o�tm►tuu� s:ta:ay rnq Building Inspections 763-572-3604 l3UI�.D�NG RESID►EN'�CIAI:, APPLI�ATIOPJ �IT�� 4F .�I�IDLEY DA�B _. b�._. t±_� ... .. YO[JR li-MA[L ADDttES3 � ... _.. _. _ � c�� , S1TB ADDR�BS �� ---a�-�/��s.�a.—�� _.. �-------.._. THTS Al'PLICANT I3: 0 OWNIIt �ONNTR,A(:TOR PROPERTY OWNERI �p�g; ��y _ � TENANT ------- �.,� � P.1 Pem� ifi AIo.: � C9� _ Rece ived By: Date Rec;'d: e �� .�1G�lo., -----s1'A��l PFTOtaF: ib�' 7 td-'ad`«i(v CONTRACTOR NAM�:.. �X��1 --� ---_ _. _-.—__— SLBMTf A COPY OF 9TA1� LICTsN� �f ��4� EXP DATE 31 (] _ YOUR STA'1� LtCENSE ADD�RS:_ .'7�5_ i 13 � .��Gi►� _.__ _ ... _.._.___..CITY � �►!�.. ._..rl sTAT�. SS`>].�v WtTti APP1.iCATTON PHdt�E �b�"11ai -U75rt FAX `163'�71 �' {� �f '�j - - _ TYPL PERNIIT 1 YPE �i.a_+_a��, O B14SEMENT F1NL'�H 17 ROOF a a�crc o sron�a CI DRAIN 'I'I iLE r� o� DESCRIBE WORK J3L�IlITG DONE:�� 7� � dd�2 W1v ��w i/1 ��;,�„t�ll\Q.� - --..._ SIZE OF IlvIPROVEMBNT SQUARFR �ARAGES PR+4POS� SiZE: PItOp(?S1ID iffit3H'i': � p Virryl O AUimiaum O Other D'Fi0U3B UNLY CI H4US8 ei QARACiE O ATTACHF� dAitACiB O DFPACHID C3ARAQE dRoPtit O Trim C Faqc�a H�'lGI:['f :i1 B,�9Fy 1r(�f'�' RF.AIOUE(.IN4 sU13MIT: 1. Tsnsting Flo� PRan Z. Propo�l #I�ror plaa 3. [.isl of struchugl �mtrcis lo be ��sod RORNEW GOTlSTRL'CfyOAI iNCLUt)iNt; AECKS, ¢I} :ll� TION3,y!�. PAR.C�,� 1. Site Plan/�urnysbowingfhe exi�ing sructure� and prapo�t d pr�ojett. 2. 1tv� sqs of cor�tustion plat� IN�t�OPEN1NtIS CJYts �Atd LO�:A jON QFW�[NDOW3 3. Eixrgyc;aba�fatiama � OR AOR NH6V OP$NINUS-DESiCWHB SDE OF ._ .��,�i`�.� ... .. ..__ .— TYPE F WINDOW TO BE TNTSTALL'�D l J ��3ER QF 1Vi1�JmW5 � - — ALL k EES ARF. BASED ON A'Lt�ATiON, IN CL'UDI[NC T'RE CO3T OF LABOR AND MA'CE��]AI.S: (USIl'TG 1� 19�►7U.H.0 FEE SCHEDULE� Parmit k'ee Plan Reviow Fffe Stacharge 5urch�e I.icense Surchar�e SAC Chargo Curb G"�t Eacrow Erosion Control Park Fee Scwer Main CltOSge � .'�_ Saa 13avlc Page for Fee Schedule $ � 65% of Building Permit Fee $ ,�� .pOl timos the total job valuation $ _ ��C� _ .00OS x �ermit Valuation Minimum $.SO $ .�_ � _ $5.00 (Sls9:e T,icensecl Re�idential Contrnotorc�) ; $ +$1675 p��r SAC Unit (Plans to M91iC�C for determu�aLion) $ _ftf68= Bx�Zl �$ ' $ $45b Cana�ervation Plan Revic�w $ i�ee iDetermineri by Engineering n n $ ._ .__ — Agreamont necess$ry i) Non Necessary i) ' �' `� � �_� Mel,:$ elhocks navablo to: CIly af Fridley Aita� TJi1S IS I.AT APPLICAT'�QN FOR A Pi�:RM1T NOT VALID UN77T. PROt:E9SF.D ' 1 hareby �pply far a building permit and I acknowledp;e that the �ormation above ia �mplete and ac.�utate; that ihe �ra-k wi[I bo in j cflnformance with the ordinences end cadea ofti�e City pf Fridley �nd with the Mirmesota Canstmction Code�; that I undersrand this i� not a p�nit but anly an application for a p it F� vwrk is iot ta start wirhaut a permi� thAt the work will be in accordance with the a�proved plan in the case of all work which vieat pt�val o1i p3a�ns. SIGNATURE pF APPLICANT � 2____PRINT NAdA�! i� L�!1�DA7'E_ ��-1 ��= � Building Inspections 763-572-3604 DATE�—` SITE ADDRESS ,_ THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR giJBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERNIIT'TYPE TYPE OF WORK: PLUMBING RESIDEN'TIAL AP'PLICATION CI'I'Y OF F1aIDLEY YOUR E-MAII. . O OWNER `�ONTRACTOR . � �� '/.�i_1��1't!'r.rfi� r r � �I� I � • i � ' STATELICENSE# V�i'dfilpl0fl r�� v r.n ,�wDx�ss: 651-�5-134A PHONE .. .� . .� o FAX � SINGLE FAIVIIL.Y o r�w DETAILED DESCRIPTION OF VJORK p TWO FAMILY �xErr..ACE�rrr DATE � 7 ❑ TOWNHOUSE Permit Received By: STATE ZIP, � PER MS 16B.665 the permit fee � ment of a s dential �fixture� xc lding theSfixtureso (SThissh u1d refl ct only thercost of labor ) improvement, installation or replac Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.05= FOR PROJECfS WHERE 1-AB�R EXCEEDS $500, FEES ARE BASID ON $10.00 PER FTXTURE. EXCEPT WI�RE NOTm' FIX'��S' (INDICATE TOTAL NiJMBER OF EACH BELOV� SHOVdER _ WATER PIPING BATH SINK/LAV FLOOR DRAINS S��q�qNG POOL _ WATER SOFI'NER ($35) BATHTUB —GAS PIPING (�CJn'uC�s�j — WA,� ��. _BACKFLOW PREV. ($15) CLOTHES WASHER —�TC� S� Wp'1�R HEpTER ($35� FOR IRRIGATION DISHWASHER _ LAUNDRY TRAY � WATER MEI'ER _ OTF�R Permit Fee TOTAL DUE $ � r . %~,�,�f��%� � «�,.a�� r,n�<. � .s*�. � .,,�,_ _.,...., . � Number of fixtures @ $10.00 x $10.00 = .50 Number of fixtures @ $15.00 x $15.00 = $ _� Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $i50 Tota1= $ THIS IS AN APPLICATION FOR A PERA�IIT-NOT VALID UNfII- PROCFSSID 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�CiW�okF� not o start withoutM permit; tha� wo wll be in accordan�with the not a permit but only an application for a perm approved plan in the case of all work hich r uires review and approval of plans. A� �- �� .� �jf� PRIN'f NANIE ( 1 XYY/ iS � __._..��- : SIGNATLJRE OF APPLICANT � - '< , , Y�. S �x ,� _ . .. ._._,.........�..-.e....�_..,-ae�5d�,�..."'.,'F4-9'��.C.N�,.i92}rY.n'6�it - ��R'.in.�`41 �4r`.�v.i City of Fridley Building Inspections Department 6431 Uruversity Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 ��_ `o� �-� D