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AF - 45207VEW �DDN 4LTER ao�S j �l� �� CITY OF FRIDLEY �� 6431 University Ave NE, Fridiey, MN 55432 (763) 572-3604 Bldg Insp [] SINGLE FAMILY AND DUPLIXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: �� i�� // Legal Description: Owner Name 8� Address: �.�' �P c.�%G� -"�� Tel. #��d S��- ��`o?�_ Contractor. 1�/�Sr�a2/� MN LICENSE#�Go2o%SSidb d Tel. # Attach to this application, a Ce�tficate of Survey of the lot, with the proposed construction drawm on it to'scale. DESCRIPTION OF IMPROVEMENT LMNG AREA: Length Width Height Sq. Ft GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length � Width ^ s Hgt/Ground _� Sq. Ft OTHER: ��,. V / � / � Construction Type: �� Estimated Cost: $ � _ Drnreway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _� • 7� �✓� APPLICANT: Tel. # ?63'f %f��✓� �� DATE. � Call (763) 572-3604 for Penr�it Fees if mailing in appiication. Fax to 763-571-1287 if using cr�dit�card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL � �'/ D � $ _' $ �• � $ . 0 $ $ �`� $ $ $ $ $ Co `� �S� Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or' Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: , ' ��►I 1 BLT�DING PERNIIT FEE SCHEDLT�E 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 $1 to $5� $501 to $2,�0 $2,001 to $25,�0 $25,001 to $50,000 $50,001 to $1�,000 $100,001 to $5�,000 $5�,�1 to $1,�,� $1,�,001 and up FEES $23.50 $23.50 for first $5� plus $3.05 for each additional $100 or fraction there,of, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and includ.ing $25,000 $391.25 for first $25,0� plus $10.10 for each addidonal $1,()00 or fraction thereof, to and including $50,000 $543.75 for first $50,000 plus $7.00 for each additional $1,�0 or fraction thereof, to and including $100,000 $993.75 for first $1Q0,000 plus $5.60 for each additional $1,000 or fraction thereflf, to and including $5�,0� $3,233.75 for the first $500,000 plus $4.75 for each additional $1,0(?0 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,0� plus $3.15 for each additional $1,OD0 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet times $20.00. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hows from the tune of application to allow for proper review of the propos� structure and of the construction sitc. A Certificate of Survey of the lot, showing the location of the e�sti.ng foundation will be required before proceeding with the framing. New Houses Only From: 6513512839 Page: 2/6 Date: 7/22/200810:13:32 AM Building MECHANICAL Permit No.: C��- ,�� Inspections RESIDENTIAL APPLICATION Received By� 763-572-3604 CITY OF FRIDLEY �d 763-502-4977 FAX �,FpECT1VE 1-I-08 �� aaTe �- Z 1- OB YOUR E-�MAIL ADDRESS .I�C�I�tL�C ��}f�,� 4�l-f U� ; n Q�C� VYL SITE ADDRESS � t%,T-� �� b,�,� � }-ar �(�/� TH15 APPLICAiVT IS: O OWNER �j,CONTRACTOR PROPERTY NAME: .f OW�� ADDRESS:_JrD +-1'E-iil S� CITY STATE,�2IP S`�-uzI TENANT �l�� i � � �, �� / �j�y PHONE: {�l'Ct'Bf�1•v�� '�J' �a r �n �Z - CD %8 �O ( i0� CONTRACTO[t COMPANY NAME: �er�eCT1�11'� N�LL T7�Y1�1 a A'i r N�� CONTACT PERSON: ��l'�,bL� T� i� k tl�. SEPARATE CITY LICENSES ARE S7'pTE LICENSE /{ EXP DATE REQtJlRED FOR CiAS �DRESS: I 7Q �-� � YQIS AV 'C Cl'fY M� le wc� d. S'I'ATE AND HVAC. Jr I�. �LlP S S lbq SUBMIT COPY OF BOND pHONE �5L �'7 % • "7 (p �D FAX Ce .�J ' �T �I `7 • J� 2-S Z ANDINSURANCE PERMIT TYPE ��GLE FAMILY ❑ TWO FAMILY O TOWAIH�USE TYPE OF WORK: ��W �REPLACEM�NT O ALTLRATION/REMpDEL DETALLED DESCRIPTION OF WORK x�T ItiC.p �l�Y ML'['. PER MS ibB.665 the permit fee is a minimum of$I5.00 or 5% of t6e total cost up to $S40.Q0, whichever is gre,ater, for the improvement, installetion or replacement of a residential fixture, excluding the fi�ctu�es. (This should reflect only the cost of labor ) OR Labor cost under $3Q0 =$15.00. Labor cost between $300 to $500 = cost of tabor x.OS = FOR PRO]ECTS WHERE LAB{3R EXCEEDS SS00, FEES ARB aASED ON $10.Q0 PER FIXTURE, EXC�PT WHERE NOTED. FIXTURES: (IND[CATE TOTAL NUMB�R OF F.ACH HELOW y Equipment [nstaNed MFG: Q�q,� MODEL: y Z�e� Si7EBTU % �. C�O O MFG: MODEL: S12F./BTU MFG: iNOD£L: SIZFJBTU _A/C 524.00 _FIREPLACE (GAS) $15.00 GAS RANGElOVEN $10.00 A1R'1'O A1R EXCHANGEER $i 5 �FIREPLACE {WOOD) E35.00 _NEW OAS GRILL $10.00 DOILER $35.� �,FURNACE 535.00 _GAS UN1T HTR $IO.OD _CHIMNEY LINER S 10.� GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK EIO.UO CiAS PIPING $10.00 VENl'[LATOR $I5.00 PEltMIT FEE PRO.IECTS FUR UNDER $S00 PERMIT FEE FOR PROJECfS OVER $S00 Permit Fee $ Number of fuctures @$10.00 x$10.00 =$ Surcharge $ .SQ Numbar of fixtures (a3 $15.00 _ x $15.00 = $ TOTAL DUE $�.�, OR Number of fixtures @$25.00 � x$25.00 =$ Number of fixtures @ $35.OQ _ x $35.00 = $ State Swcharge = $ .50 MINIMUM �15.50 MINIMUM $I5.50 Total = $ THiS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSfiD 1 hereby apply for a mechanical pe�mit and 1 acknowledge that the infotmation above is complete and accurate; that the wark wili be in conformence with the ordinances and cades of the City of Fridley and with the Minnesota Construction Codes; that 1 understand this is not a permit hut only an applicatioe for a permit ar�i wodc is not to start widtout a pe�mit: thet ihe work will be in accordance with t6e approved plan in the case of all work which requires revicw and approval of p1am. SIGNATURE OF APPL[CANT L\,�Qliltl,�.11LilY3� PRINT NAME�� iCl j7P �1"-11'1 �Cll.. DATE i 21-dB APPROVED BY DATE PLEASE AiOTE: SEPARATE PERMII'S ARE RE UIRED FOR BUILDING, ELECTRICAL AND MECHAIVICAL WURK City of Fridley BaQding inspections Department 6431 University Avenue NE, Fridley, NW 55432 763-572-3604 FAX: 7b3-502-4977