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AF - 43037� r � � �: � . . . . . .. . . � .. . . . � � . . � V��a�e �� '�d��3', 1�Ila�1. � �IJ Il�� I�.lA�IT �� 35i �4��e o� �TS��F o�+' ��TI��BIPeri�� Owner ��"�j,�� f;�f=,�t, �,�.•r�.�F . r�rehitect ;��.�`t'Lsf� . Fri�'ey, l�/iinn., f o� , 19� ;�' f Builder * ��,,�t�-�r � � B�}�ITv'G No, �� r Street Part of Lot +�, �,. �! Lot &lock � Addition or Sub-Division ,✓:� . r �'.Liu�`viTl'�Y��;,,j c�,P ��l'��.r��dCx t P�� i°�� F�' f .M.:�(_ � �� Zi �ont ��"`�� ,��ps,;h � >ieiaht Stories ,� I;�£anner af Construction_ ��y ,�^ �-- ' r b - � � ..� -^�1!..r'i�p 5.,� �_ 3`o Y�e used �s �.,;� ,,�fi<�':..�..�,!� „;,r .�� r��;,;r sf Mf` ' ._ �' �,� � ��, �:.'�{ � , . �,,� . � To be comUle�ed � � t Estimate� Cost �.w � .� , ° ,,,, �.,a n: ;, . ,.. �A� � � d x3. .,g > �. ,.{.r . ,;' ,. 'g, � ..,o i� g�...e �� _? . .. _..' , f t t ••+,1" t � y(` .f '`�`~ t,• �` ,, �,,'^ f _ . ., • ., , r � �, � .d .r� .f,�,.,� �.,s ,�,,�' - - ,.� t w�!,�, J s;` � � �:3 i,;' y � E. f : .ai' 'u^'r�^! . � i � i`�..�� .. . . . . r't ,a� .� . �..�. '.! _ � E .. i.� .. .. ..._ __ �... � � � _ Permit is hereby granted to j .�--� y to 4 ... fw ,�,,�f M ' . � . . . the building�"� .r> �{ described in the above statement. This permit is granted upon the express conditi that t e person to whom it is ranted , g , a n d h i s a g e n t s, e m p l o y e e s a n d w o r l n n e n, i n a l l t he wor k done in, arou,nd and �pon said buzlding, or any g�,rt thereof, shall conform in all respects to the ordi- nances of Fridley, Nlinn., regarding the construct;on, alteration, maintenance, repair and moving of buildings within the city limits, and this permit may be revoked at u.n,y time upon vi�lation of any of the provisions of sai3 ordinances. ` �� ctor of Buiidings. AGR�EI�Ea."�TT �.hTD SFRI�P�,Z�T ST� T�1�lEl�d� In. con�ideration of the issue a�id delivery to me k�y tiie ��.3��S�cter. of �u?1dinL � cf Fridley or the above germit, I hereby agree to do the pro�c�sec� E�o�k r;i �,ecc�r��nce vJi�h tlz� c�escript:on a�ove set forth and accordang to the provisions �f t.he cs�din.�.nces �f Fri�ley, anl, being fix�st duly , sworn, I kaereby sia�e and say that the facts stated �ay �e arci containecl if� t�ae a�ove per�it are j� tx�ue as therein stated. � f � . . . . . . --7`--5-`� ... i � . . . � Subscribed and sworn to before me at Friclley, I��ii.�.ne�:�tw, this r� �� , � — — day of .D. 19�. r � ,� 6. City of Fridley App�icatian for Plumbing and Gas Fitfiing Pern�it � Dept. of Bldgs. Phone 3U 4-7570 DESCRIPTION OF WORK �� Q/ ��°,�-��(C ,,,� `v�c�`t/ Number, Kind and Lxation of Fixtures L.ocatioa _./ ��`'a�' U' WATER HTR. OG VI F-� d' � S� W W Z / � w N .= y Z 2'^ x Z hc Q Z V Z O x C9 Z <O � t°0 � Z �4c sp = ,� z <~� �� a �< �a F N GAS ELEC. 3� 7 Y� m IA 3 F- � LL N LL O V m �� U� � Ci Q' C� O �� ' ■■ ■ ■■■■■�■■■ • ■■ ■ ■ ■■.■■ ■ - ■ ■� � � - _ - ■', - . . . _ - ■. PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAi. Number Fixtures ...................... x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $ Catch Basin .... ....................... x 3.25 $ Water Heater (Up ta 20Q,Q00 BTIA ...... x 2.00 $ New Ground Run Old Bldg . . . . . . . . . . . . . � x 3.25 $� a � � GAS FITTING FEES: NO. RATE TOTAL lst 3 Fixtures .......................... x $1,50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 � REPAIRS 8c ALTERATIONS—Refer to Code Description ............................................... �„ TOTAL FEE $� 1 City of Fridley: The undersigned hereby makes application for a permit for the work herei; specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the faci and representations stated in this application are true and correct. Owner Kind of Building Used as To be completed about Estimated Cost, $ Ol New. Building Permit No Permit No. Signe By �a�, � Business Phone No. ROUGH FINAL az sM SUBJECT City of Fridley , 12960 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � < < R . � `y _ _ COMMUNITY DEVELOPMENT DIV. ` '� ^ � r � � PROTECTIVE INSPECTION SEC. � �t 1 � , � �'��1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �""� � ,�� 612-5603450 910-F15 5/22/75 � � JOB ADDRESS 6391 Deii�oa Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED �escR. 23 Moore Lake Highlands lst Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joseph Bruneau 6311 Dellwood Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUI�DING Residential 7 CLASSOF WORK ❑ NEW � ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 4' x 8� Foyer and a 16' x 22�' Addition to back of dwelling 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERNfiTS R��UtRED F0� W�RlNG, HEAT!lVG, PLt1MBtIVG �ND StGNS. TYPE Of CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. WOOC� FY3ICle THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNiNG SQ. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-]_ 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 CORAECT. A�L PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMtT �.1 �.00 5.55 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. B�B� $�iO.31 PLAN CHECK FEE TOTAL FEE • $45.86 � SIGNATUREOFCONTRACT ORAUTHORIZEDAGENT IDATE) WHEN PROPERLY VAIIDATED THIS IS YOUR PERMIT ,S'— r?a— 7�..5— � �c�,�e� S"� ��— SIGNAT � EOFO NERIIF. WNERBUILDERI . IDATEI �' BLOG.INSP DA E f ' . APPLTCATION FOR RLSIDE'1TIAL, ALTEIZI�TION, OR AllDITiON Bi1ILDING P�RA�iIT CITY OF FRTDLL�', I�IINNESOTA Ojtiri�IER ` S NA.NIE : V�. �?,a \ti � di i� BUTLD�R : �P � t� . � ADDZ�SS : C„ ;� � � l��' �� , J� , ADn�S S : I10 : � �� STRE�T • � �' �.1.�� : I�--�, , . � 5't' LOT :��BLO�I:: ADDTTIOT�7 ; �nn R � �� j � COR1vER LOT : INS IDT' LOT : V SETBACY.: SIDEYA�2D : Applicar,t attach to this foxm Two Certificates of Survey of Lot and proposed buildir�g locati_on drawn on tl7ese Certificates. � IiESCRIPTION OF BUILDING To fBe iTse As : , � W, yt � - C,� � �. �� - � � Front: Depth: Height; Square Feet:��L Cubic Feet: '�$� , j � ��,,1( a_ �,�d Fxont ; Depth : Height : Square Feet; 3G� Cubic Feet:�� _ �. �i�pe of Construction: �'�� -- R�- yvi'E�' Estimated Cost: �_ To Be Conipl.eted: t_o — 7(e� � � � � � V T.he u.ndersigned hereby makes application for a pexmit for the work herein specified, agreeing to do all work in st'rict accordance taith the City of Frid.ley* Ordinances and rulings of the Department of Buildings, and hereby declares thaL all the facts and repxesentations stated in this application are true and correct. DAT�: SIGhATURE: (See Reverse Side ror Additional Information.) �, s�v K l.g�: �y.o3 . T�' s i�• �X xG.00= �•4b ��, �ov tl �3 t 2 � � yo.3 � . � ,J� z�.�� c.� o. �a� S g� � • _. �� .` . �� 1' - -- _ _ -- � . _, -_ -- - ----- _ . __ _. _ . _ � _ _ -__ _____ _ _. --- _ -- - - � --�it��."�`_ t �_iC`. _2.'L.S` s. � _� f iC 'g' �_ Z� --------- --- --- _ _ l�i4� _ 1to _ i __Z.Z._�' __ �C�4 '_ _ k __ l'�. � tt 3't.c� - -- _ ___ _ _ _ _ _� �--°---'� _ � - -- ___ _ _ -- -- - - - - �► �+o�. t.� 1( � • 3 �° _ rc 1 �. = 3�Y - -- _— - - - - --_ _ __ __ _ - _ - - _ __ - - __ --- __-- ---- - ----- _ .� � , _7 _ _34a�C _ V.S� � _ l�20 _ _ 3Go x . a�3o � 8'14$ _ _ _ _ _ 3'L. � •�+1.3 • _ � ._..�, _ _ __ � _ _ I�,l Sf S' _ dL _ l !��%o _. __. __- --_ __ -- _ _ _ ---- � --- _ '�SS�f X I.B�� _ ��1.03 __ _ _ -____ - -- - ------ ____-- _ _ _ _ l I ,1on �C b,%t�oo �,,,,�sl�.sc�-- - _ __ __ __ _ . __ - - - - _ _ _ _ _ _ _Z.. _4 �° � _ _ _ ��. 3► �_ __ __ _ _ __________ __ __ _ � �.�' � _ _ _ sue�ecr PERMIT N City of Fridley 0 9 8 4 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T i � ECEIPT NO. � � ---_._�. � • COMMUNITY DEVELOPMENT DIV. i LV��'�� , r � � PROTECTIVE INSPECT�ON SEC. /��'- , '� /"'1 � CITY HALL FRIDIE� 55432 NUMBEfi REV. OATE PAGE OF APPROVEO BV �"'"� � �'J 612-571-3450 910-F15 8/1/91 � � JOB ADDRESS 6391 Dellwood Dr'ive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23 �- Moore Lake Highlands 1S't SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Redepenning 6391 Dellwood Drive NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO. Right-Way Rpofing 11304 Red Fox Drr Maple Grove, MN 55369 557-8678 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEEH MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION O ALTERATION C� REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof Dwelling (26 Squares) 2nd layer 9 CHANGE QF USE FROM TO STIPULATIONS Roofin� can be 2nd layer but not 3rd, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONOITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 OAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APP�ICATION �- STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UATION SUFiTAX AND ORDINANCES GOVERNING THIS TXPE OF WORK WI�L BE COMPLIEO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1�352 . $.F)8 DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING coN- 33RQQ Fire SC $�..35 S RUCTION OR THE PE O MANCE OF CONSTRUCTION. $ � PLAN CHECKFEE TOTALFEE $35.03 IG� U E OF CONTRACTOA OR AUTHOA4ED AGENT IDATE yy N PROPER V ED H IS YOUR PEAMIT i'� SiGNATURE OF OWNERiiF OWNER BUILDER� �DATEi � DG �NSP DF7E � Il � L � �� [ 7 Oonstn�ctian Addres.s : �., � _.. •- « . . i�l u�1D A-2 Building Permit l�pplicatian Q I �..� �� r-- �-. Effective 1,/1/91 � . � � ► � _ [_ �.� ,•v.�� ,�, � �-}- c< <'l�-z. L� L � `t 2 3 � l � �K� 0 � c v^ ��a'C� ��I��u ��S jS� owr,er rTaane � 1��: k� c:�, � p�. h. v� � v� �� Tet. � oontrac.�to�: U2. � ��:-t — L�I.J � � L�°� l �e.t. � 5� �--�56 7t� Aaa�: � � �� R -�_ �Q � C= � � n ��1 �-� �,�/� � � �-� C-� �� c�� -� l�ttacii to this applicatian, a Oertific�te of Suzv�ey of the . lot, with ti�e p�v�oEed canstn�ction drawn an it to sc�le. ��" �� l �.l� I1VII�1G 11RFA: I�h Width iie.ic�t Sq. Ft. 11Tt�: I�ygtii Width He.it�lt Sq. F't. 3�CR AiiF�,: I�e�th Width Hgt/Grotu�d Sq. Ft. . �� • OR�R: �� c- S �'i . i��` � r-� C� c`� �: L. v. �� t�c c: v c� E� �. ) "� v.c-� l<� L, �� , Cbrner Lot [] Insi.de Lvt [ J Ft. Yd Setback Side Yazd Setbac}ts Zj�e of Gb�.st.nu.-tioc�: Esti.mated Oost: $ �� '� /.�.� �-- r �Y�DX . O�ZEt1G[I I$tE: Prq�o�ed D�iveway Width If New �ninq Is De�ired: Ft. $ S Width + 6' See Hack Page nA'I'E: APPi�CANr: Z1e.1. � Perm,it Fee $ --�~� : � t. Fire Sur+c��azge $ / � -.�_ S State S�u�c3�azge $ d �_ � SAC Qiazge S Driveway E'savw 5 Park Fee $ Sew+er Main Charge S -3:; � c� '�OT�,L s ; r� -� , ��: � C~�� i.� F1ee S�le an iaeverse Side . 001 x P�smit Valt�►tian (1/lOth $ ) $.50/$1,000 Valuatian $650 pps SAC Unit Alt• "A" oi'Alt. "B" Above Fe�e DEteY.milled by �; r�r; m � ��Y I ) x�t xeoessa�y I ] APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA _ • a� � � � � l� : i • e : � a�� ; • ' ��' • a1 ; � ��• : /� LOCATION OF BUTLDING NO . ;c :�; � J STREET � K, � �J,��L� �� . • � � -- LOT ��_BLOCK � � ADDI'PION OR SUBDIVISION �,�n,�� 4i }��H � i Vi � A N� S CORNEft LOT INSIDE LOT SETBACK SIDEYARD �S} ��'�j �� .,._._� SEf�ER ELEVATION TOP OF �'OOTING , Applicant attach to this form Two Certificates of Survey of T,ot �.nd proposed buildira.g location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As• �, c� Front �(� Depth ,� � Height_� � Square feet, ��(') Cubic Feet,�Z%bQ R �.+ � i�� ' Front Depth Height Square feet Cubic Feet Type of Construation Estimated Cost � �� o�Roo��Aq v, � C� C�-Aa� e I To Be Completed � � � , ( �'r �y 7 n � �, The undersig.ned hereby makes application for a permzt fnr�the work hereir� apecified, agreeing to do all worl� in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildin�s, a.nd hereby declares tha-� all the facts and representations stated in this application are true and correcta , DATE Y `_�� SiGNATURE (Schedule of Fee Co$ts can be found o.n th Reverse Side.� ,J ' ! .. � !:. . �#,, �' r� �, _.. s ,. • � ;i ,� ,....>._.__.,.�.�.. �� r • 0 � BUILDING PERMIT FEE SCI�DIILE SECTION 2, The Inspector of Buildings shall, before issui.ng permits for the erection bf any building or structure, or for any addition ta any axisting structure or building, or.for �.ny alteration or repairs to any existing building or structure, upon application therefore, require the payrnent by the applicant for such permit of fees to the amount hexein below set forth and in the manner herein provided to-wit: Uniform Building Code: Type 1, 2, & 4 P$1075 for each one thousa,nd cubic feet, or fraction thereof, in such cubical c.�ntents. Type 3& 5- $1050 for each one thousand cubic feeto For the purpose of computing fees for bui].ding permits, the cub�.cal � contents of any'buiTding °t�r° addition to a uniform heig'�it' thxqughout by multiplying the ground area covered from a point six (6) iMChes below the floor line of the basement or the cellar to the average he�ght oi the upper surface or to the average height of the roof sur�ace of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00� ox iraction thereof in the cost of all proposed work. � In no case shall the fee charged for any permit as set forth in Sect�on 2 be less tha.n �5.00. NSSSD Co.nnection Charges based on location - Area 1 or 2. . • • Building Inspect}c3'ris 763-572-3604 BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY DATE .l �'�-�e- � 2' �� U �� YOUR E-MA SITE ADDRESS (r� 3 �i' 1�� r � w�od � r� � THIS APPLICANT IS: ,$�.OWNER ❑CONTRACTOR PROPERTY OWNER/ I NAME: TENANT �.,. CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE � �� -�r�L PHONE: / (D � � 5 / / � K (p 'Z._ NAME: STATE LICENSE # ADDRESS: PHONE F, �SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION ❑ BASEMENT FiNISH ❑ DECK TYPE OF WORK: I �_NEW DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT x�ur�N� � NUMBER OF SQUARES L G GARAGES Z� �-i-D u-S P � PROPOSED SIZE: �j f}N'� PROPOSED HEIGHT: � SIDING � Viu►yl O Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS OYes �No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED UU � ❑ SIDING ❑ SWIMMING PC ❑ ADDITION ❑ REMODELING LENGTH ❑ HOUSE ONLY �iOUSE & GARAGE O ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF ,�� r►r� EXP DATE SIZE ❑ DRAIN TILE ❑ OTHER Permit No.: Received By: ,� Date Rec'd: � �' �-� �� HEIGHT � STATE_ZIP BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used Ft. 2 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: (USWG THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 31 g`� _�- OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow ! Erosion Control �! Park Fee Sewer Main Charge Total Due $ �a $ $ � •� 9 $ �/ - �O $ $ $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks��bie to: City of Fridley Attach THIS IS AN A�'PLICATION 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 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 w'ch requires revi and approval of plans. n SIGNATURE OF APPLICANT ' INT NAME �� h h � /C u` �l� ' �_�� _DATE J �'� �? �� - _ C[7YOF FRiDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, �JDh N j4- l 1�P�`�fOi°l�7� <�I G7 , understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at (o ��l' f.�.� /l u� O O� %7 f' r�! e�,�, Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perForm certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. _ ��,� , r ��/� i / � Date ��-e 2 2� 2 C� U� Building PLUMBING Permit No � � Inspections RESIDENTIAL APPLICATION Receivect By: 763-572-3604 CITY OF FRIDLEY Date �tec'd: DATE 7— j 2- Q(o YOUR E-MAIL ADDRESS SfTE ADDRESS � 3 Cl � j��.LL_ wvC'i.tJ Y�- N-� - THIS APPLICANT IS: �bWNER ❑CONTRACTOR PROPERTY NAME: �ww-E2 r2� )��s�1� G,� o., ,►.i Cr OWNER/ pDDRESS:_ __[Q 3Q � f��,L.t_.uc�� I� 1�t . CITY t2 STATE�yZIP SS43Z TENANT pxONE: � Co 3 � C'7 1—� la � 3 CONTRACTOR NAME: SUBMIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH pHONE FAX APPLICATION PERMIT TYPE �SINGL;E FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � �W '��pLACEMENT DETAILED DESCRIPTION OF WORK � PER MS 16B.665 the permit fee is a minimun► �f $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation_orxeplacement_af axesidential fixture, excluding the fixtures. (This should reflect only the cost of labor ) '_ Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = __ FOR PROJECTS WHERE L�4SOR=E7{CEEFD�$500,�5.A3t� BAS£D ON $10:00 PER FIXTUR�;:EXCEPT WHERE NOTED. FIXTURES:. (INDIGATE T(}TAL. �- .... �; NUMBER OF EACH BELOV� BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING pve.e�cirrucFrvsE) SWIMMING POOL WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER . . Permit Fee $�� Number of fixtures @$10.00 x$10.00 =$ Surchar e .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $1,�=. 6 Number of fixtures @$35.00 x$35.00 =$ State Surcharge = $ .50 Total = $ 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 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 1 work which requires review and approval of plans. SIGNATURE OF APPLIC T T NAME DATE ('� �a � G� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 � i.iJ.l. d.111'y� �11�.ci .�'J�. v�1�.7.�u lF�-.. � _-��c! � 5 1 .. �• �� .`� U j i �-+ _-`� _ DATL• I2' SITi:.aDDRL55 I TIiI5.1PPLIC.�NT I� PRCP��Z'1 �T owrt�v Ti�Nr�.�TT ; _ � w ��:��! � �:: �.+ 'i � . „- � �� '� �y"'�_.i,,,� _h J 7-��F.�..iJ!� J�1C� � "_l � '� � v `v �'� �� i��-'' i..i 1 1 -1 =t � %'TF�C1'7'�L', '-?-�IFi YOUP� L--��IA1L .-1DDRE�S I�iE L� OWNER �CON"CRr,C;OP NAMZ: Va y►��c�1 r-� �H � rv� ��D��s: � 3� i pc� �� PHONG: �12� `{�i' � � 5 � � °°anit No.:�.('�'-�L ; i�.�c�ived :j�: i' �t�r� QE �aze i�G.iJ� I �� ciT,� Fh�l� sT��r-�l,clz� s s Y3Z CDN'�1t�CTOR NAML-: Y�11�'W Gi -f� I�'IWWI hl�I.j1 SUBMIT A COPY OF STATL- LICLNSL � C;tI' DATE YOUR S'I'ATE .__....,..._..,,�..: LICLiJSE. DON.D AND STATEBONl7� G:`CPDATL- CERTIFICATE OF ,qDDRE55: � �i� �'/ Y wv� /1 �' %.� � �3 1 CITY ��'1 � � �i1.1 ST.1TE��LZIP S` � Z INSUIZANC� PHONE � 2J '� �S `�� I �l F�:;{ ��' 2� �$ PE�MIT TYl'y TYP£ OF �ORK: I�SINGLE FAMILY ❑ NEW DETAIZED DES�RIl'TION OF WORI� ❑ TWO FAMIL'f ❑ TOWNHOUSE �REPLACEMENT l rvt'f �'l PER MS 168.665 the permit fee is a minimnzn of �15.D(1 or Sa/o uf the totai cnst up to S50U.00, whichever is geater, for the improvement„installation or replacemeat of a residential fixture, excludin� the fix�res. �(This should reflect only the cost of labor ) Labar cast under $300 =�15,00. Labor cost between �300 to �500 = cos# of labor x.OS = ' pius .50 surchar�e � OR �� FORPR07ECT5 VTFIERE LABOREXCEEDS 5500, F'EE5 ARE BASED ON �] 0.00 PERFI�TURE, SXCEPT WHERE NOTED. FTXTURES; (ITTDICATE T01L4I. N[Ttv1BER OF' EACH BELO�. MINIML7M FEE.5I5.50. • BATH SINK/LAV ' FLOORDRAINS SFlOWER WATERPIPING '; BATFiTUB GAS PIPING (NEED CtTYLIC) SWIIvIMIILGPOOL �WATERSO.FiNER(53� CLOTf�S WASFiEiZ KTTCHEN SINK WATER CLOSET ~BACI�'LOW PREV. ($15) _ DISHWASHER _ LAUNDRY TRAY r �WATER HEATER ($3� ~ FOR IRIZIGATION _ WATEA METER _ OTI�R Permit Fee TOTAL DUE � 15.5 $ Number of fixtures (cr� �10.�0 x $10.00 = ��,_, .50 Nuraber of fi:tt�sres ('�r ,� 15.00 x� 15.00 =� � QR Number of fixtures �a �35.00 J,_ x$35.00 =$ �;v`' � . State Surcfiarge = � 50 � � � (MINIMIJM �15.�0) Tota1= � b �3ti THIS IS AN APPL1C�iTION POR A PERMIT-NOT VALID UNTIL PROCLSSED l hereby apply for a plumbin� permit and I acicnowledga that the information above is complete and accurate; that the woric will be in �• conformance with the ordinances and cocies nl�the e:itv ofFridle� and �,vitl� the Ivlinnesota runsrruction Codes: that I understand this is !-_ not a permit but only an atiplication far a permit and ti,NOri: is not tn start �Nithout a permit on size: that ihe ti.vorlc �,yill be in accordance :=_ i �.vith the approved plan in the case of all �,varic �.vhich reQUires revietiv and approval af plans. ; :ilGi�(ATt1P�G l) �''P iC.1r T � i��'_ n"l1YT' IAA�IE. 1�/I LeL- �-�'°�"W DATL___�� ,,, I ,i�t�r..�vr:� i,v ;�r��- :�r.� T�� ? �-;'c, r..r.., �� _�L-�.•((;;. ,�. ,F: =.Tr.,. ':T✓it .. ,-i. � . L;�I�IRL✓ ."� lR:.�. � �A"i Ti 1�=-=:L. -':;v r.'� .: � c��:'s: � i�; i r. �: L. : v� �rttti �.�'T ��u ":1 . �m�e,�, �R�IGCEP:I:� :�9T�'�::"�OtI� _J�;�.:�i"": �Y�E -.: � : ;:iti�er�ir,� . , e.zu� � �. -.. :dle, ::�i 1.; ; = -- - ?�-. _-�nO= -. _ _. �_ -:')_--�.