AF - 41848sue�ecr P •
City of Fridley 215 6 4
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
i � RECEIPT NO.
� �
COMMUNITY DEVELOPMENT DIV. R+� � �
� � � � � PHOTECTIVE INSPECTION SEC. �
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i---- A �/'�';.� CITY HALI FRIOLE� 55432 NUMBER FEV. OATE PAGE OF APPROVED BY
L J\ 612-571-3450 9t0-F15 9/21/92 / /
JOB ADDRESS g161 East River Road NE
1 LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. �- 2 Bourdeaux's Spring Brook Addn. SHEET
2 PROPERTY OWNER MAIL ADDFESS ZIP PHONE
Anthony/Kaxin SpeXlaeck 8161 East River Road NE 784--8472
3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL AOORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL AODRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Res.idential
7 CIASS OF WORK
❑ NEW C� ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Constx�uct a 22� x 18� Garage Additipn
9 CHANGEOFUSEFROM TO
STI PU LATION S
�royi,de a hard sux,�ace dxiveway� See notations. an plan.
ti��'�����G
Before digging cali for
ail utility tocations
' 454-0002
REQUIRED gY LAW
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PEf;MITS ARE REOUIRED FOR ELECTfi1CAL, PLUMBING, HEATING,
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHOiiIZED 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. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW ?HE SAME TO BE TFUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $( 23� $3. 12.
WITH WHETHER SPECIf1ED HEREIN OR NOT. THE GRANTING Of A PERMIT �
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEpMITFEE SACCHARGE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON- �Qs OO Fire SC $6. 23
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
PLAN CHECK fEE TOTAL FEE
$39,35
SIGNATUpEOFCONTRACTORORAUTHOpIZEDAGENT IOATEi �WHE PR R�Y LI TED THIS IS YOUR PERMIT
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SiGNATURE OF O �IF OWNE U�LDER� IDATE� BIDG �NSP �1A7E
NEW [ ]
ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: � � � � � � s d � v �• ^2c� � �
Legal Description:
Owner Name & Address: -�N`�lav�.
Effective 3/ 1192
`� (C,�-iZ � ,v ��,fz v Irr�e c. � # � C��'► �—
Contractor: MN LICENSE #
Address: �\ (.v ( o�a �- �, v � � �� � . Tel. � ��4 - �-( � Z
� Aitach to this application, a CertificaLe of Survey of the
lot, with the proposed construction drawn on it to scale.
DBSCRIPTION OF IMPROVEMENT
LIVING AREA: L.ength Width Height
GARAGE AREA: Length 2 Z Width (`� Height $
DBCK AREA: Length Width Hgt/Ground
OTHER:
Comer Lot [] Inside Lot [) Ft. Yd Sexback
Type of Coa�vction:
Approx. Completion Date:
Driveway Curb Cut Width Needed: Ft. + b Ft =
DATE:
APPLICANT:
Permit Fee $ '� �iD
Fire Surcharge $ � � Z 3
State Surcharge $ 3, I Z
SAC Charge $ —
License Surcharge $ "'—'�
Driveway Escrow $
Park Fee $ '
Sewer Main Charge $
TOTAL $ � �J�
�,
Sq. Ft.
Sq. Ft.
Sq. Ft.
Side Yard Setbacks
Estimated Cost: $
jCost on Back �GJ �• ��
Ft x $ _� $ �
Tei. #
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth9b)
$.50/$1,000 Valuation
$700 per SAC Unit
$5.00 (State Licensed Residential Conh�actors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary ( ] Not Neces,sary ( )
STIPULATIONS: -
� �::
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or struchire,
or for atry addidon to any eaisting bailding or struchire, or for auy alt,�rarion or repair to any existing
building or stivcture, upon applicatioa therefore, require the payment by the applicant for such permit
of fees to the amount herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to �50,000
$50,001 to $100,000
$100,001 to 5500,000
$500,001 to $1,000,000
$1,0OO,OU1 and up
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for first �500 plus $2 for each additional $100 or
fraction thereof, to and including 52,000
$45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to and including $25,000
$2S2 for first $25,000 plus $6.50 for each additionaY $1,000
or fraction thereof, to and including $50,000
$414.50 for first �50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and including $500,000
$2039.50 for the fust $500,000 plus $3 for each additional
$1,000 or frdetion thereof, to and including 51,000,000
$3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DRIYEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal aad replacement of curb and gutter only - Driveway width plus 6 feet times
$13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth� - Driveway width plus 6 feet times $15.75 .
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow
for proper review of the proposed structwe and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been
consbn�cted will be required before procceding with the framing.
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Building
Inspections
763-572-3604
763-502-4977 FAX
DATE_ I � 30 09'
SITE ADDRESS _ _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERNIIT TYPE
TYPE OF WORK:
PLUMBING
RESIDENTIAL APPLICATIQN
CITY OF FRIDLEY
EFFECT'IVE 2-19-09
, � EAS fi
}$OWNER
YOUR E-MAIL ADDRESS _ �=P �c y b r
i V�2 21� �/Zi D l�v r1,v
❑CONTRACTOR
ADDRESS:�� / / �`I57' ��/L /Cl.� CITY
PHONE:_ ��J " �b —'S(�.S _
NAME:
STATE LICENSE #_
STATE BOND H __
ADDRESS: _
PHONE
�SINGLE FAMILY
❑ NEW
❑ TWO FAMILY
�REPL ACEMENT
CITY_
FAX
❑ TOWNHOUSE
Permit No.: �j
Received By:
Date Rec'd: , , _ _ _ z
��'1 �y'��}iiao. Go/n
�" 3 Z _
�f}� — STAT']
�
EXP DATE _
EXP DATE
STATE
��Z
ZIP
DETAILED DESCRIPTION OF WORK N���l �TD ��Li¢CC T�NE M/�/i✓ L•//¢f� -�7���
Vq-Lu� C�F F�,�r� 7�%� �►E`�'h-
FEES ARE BASID ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINK/LAV FLOOR DRAINS _ SHOWER ZC WATER PIPING
BATHTUB GAS PIPING (NEID CITY LIC) SWIMMING POOL WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK _ WATER CLOSET BACKFLOW PREV. ($15)
DISHW ASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
— WATER METER OTHER
,�r,..,�,�,a.. �.€ r;;.r,,,-er n Qi � nn
State'S�rcharge
IMMIl`�MU�1 �35 �i1�
� 1�.� _ �
� ���.iu�= �
� �35.0€� = �
: $ 3 5 5�'
't'otal = �
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approved plan in the case of 1 ork which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME VI'�l� ��[ '!�o S� DATE f I �`� /
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
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