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AF - 45237City of Fridley, Minn_ BUILDING PERMIT Da�; _ August 3, 197Q p�r: _ Dav�.d A. Scott g�� Same AdBrea�s �2 GibzaJ.tar Road. �,�� Same S� � - °��f0774 �-� LOCATION OF BUILDING No. 172 s�t Gibraltar Road part of Lot Lot �3 _ Block 2 Addition or Sub-Divisian �a_rl snn �,,,,,R,i t�,a,Ot S.ovt'� Coraer Lot _ Inside Lot x Sstback —_ Sideyard Sewer IIevat3an � _ Foundation Elevation DESCRIPTION OF BUILDING To i� vsea as: G—:�.ge Front �9 �_ Depth �2b � Height .1� Sq. Ft �_ Cu. Ft �$8.Q_ Front Depth ITeight ._._.. Sq. F't Cu. F'� 1j�pe of Construci�ton Frame �, ��1500.00 To be Completed 1Q/1%70 In consideration of the issusnce to me of a permft to co et the building described above, I agree to do the proposed work ffi accordance with the description above �et forth aad comp ce with ali provisfons of or�iinancsa oP the dty oP Fridieq. , _ �t , In cansfderat[on of the payment of a fee of $�...9� , permft is hereby granted to na �d A S � nt- t to construct the buflding or addition as described above, Thisp� t is granted upon the express condition that the persfln to whom it is �ented and his agents, employeea en� worl�nen, fn all work daae fn, araund and upon satd building, or anypar� thereof, shall conform in all respecta to the ordinance� of Fridley� Nl�nnesota regarding location, conatruction, alteration, maintenaace� repair and. moviag of buildings within the dty ]fmfts and this permft may be revoked at aqy time upon violation of aay oE the provis�lons of sa�d or3inancea � Building Inapector NOTICEs 'tLts psrmh doss eot eovsr fhs eoesteaeHon, i�ta!la�ioe Po� rrtriee, plumbtng, eas 6s�ttne, ssv�n� ee water. B� w►e to se� tlu Bnlldiu8 Inspsetoe hr apuab psrmifs Po� t6as It�ms. e i�l '-°, � � ,- 6,, , APLIGATION'.FO.R�RESIDENTIAL, ALTERATION, AR �llllITiON BUILDING PERMIT CTTY OF FRIDLEY, MINNESOTA OWNER' S NAME : �/� � � � �� %�� •�� T� BUILDER : � S � %�� anDx��S :l ? Cz �./3 �� r� � I� l�. anDxESS : . 5'i� t�� NO:.I? � STREET:_��'IG�%� ?`F� - - �d. ��d/"rs,., LOT : � � ) BLOCK: � ADDITION : C� Ff �` S� �-' ..�Ge'/� �yj, % /I'j/'�/'G �a� CORNER LOT: INSIDE LOT:� SETBACK: SIDEYARD: Applicant attach to thia form ltao Certificates of Survey of Lot and proposed buildi.ng location drawn on theae Certificates. AESCRTPTION OF BUILDING ° To Be Used As; n C,7 i� � /� � � Fxont : �� Depth : ..sl � ` Height : `� � D Square Feet : � � �'_ _ Cubic Feet : —�— =� %�Q Q Froat: �pth• Height• Square Feet; Cubic Feet; Type of Constructioa: �d�� Estimated Cost• $�� '�'- �� To Be Campleted; Cy e� (, % S� /��° � The undersigned hereby makes applicativn for a permit for the work herein specified, agreeing to do all work in stfict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts aad representationa stated in this application are true aad correct. DATE : � � � �l � � SIGNATUR� : "l- � ° . / • ' ` �%� _� (5ee Rev�rse Side For Additional Information.) � � �l�.o 9 � �. V y BUILDING PERMIT FEE SCHEDULE SECTION 2. Z`he Inspector of Buildings shall, before issuing pexmits for the erection of any building or structure, or for any addition to a,ny existing buildi.ng or structure, or for any alteration or repairs to any exiating building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the a.mount herein below set forth and in the manner herein pxovided to-wit: UNIFORM BUILDING CODE: 1�pe 1, 2& 4-$2.15 for each one thousand cubic feet, or fraction thereof, in such cubical contents.� Type 3& 5-$1.85 for each one thousand cubic feet. 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 repair� or alterations to an existing structure, the fee shall be at the � rat�-of $3.OII per each five hundred dollars ($500.00) or fraction thereof in ' the cost of all proposed worko • ,- In no case shall the fee charged for any pexmit as set forth in Section 2 be les� than $5.00. VBRIFICATION OF FOUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of applica.tion, to allow for proper review of the proposed structure and of the construction site. A Certified Survey of ttie lot, showing the location of the foundation, once it has been constructed, will be required before proceedin� with the framing. CERTIFICATE OF�OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has beea iasued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. � r"'`� i"� , . - ' 23 - (�• . c�o�uw� a�d �ssoe�ates� �lr• LAND SURVEYORS � 10130 HIGHWAY 65 NORTHEAST — MINNEAPOLIS, MINNESOTA 55433 Telephone 784-5480 Certificate of Survey: Dl� V E � C. �TT 0.3�_- 75 G 1BRALTAR - � ROAD .63 � 14.60' I �' a ( I � � a�o � N ti � � jNI ENe o�� m � I ( FENGE Q ` N 3.0 �= I V�ul-� . _ �; I i-s-� til Hous� � 32.0 � O 4' . sf: d' . cU N � 32. O � � �� 30 \\ � \� cU N PrtoPOSEu GARA6E N . � N � ENC o� ---__. ENCE SCALE: I ��= ZO � Z 7 8 5— I�9-� 2, �3 —Q DENOT E S I RON LEGAL DESCRIPTION: Lbt 23, Block 2, Carlson. Summi t Manor South Addi ti on � Anoka Coun Minnesota. '1' C� H�l�',1', 30 � ' REGISTERED LAND 3.01� ; � � � � SURVEYOR �, � _ 75 _ • ��'F OF 27 ��,5�� FENCE C OR NER IS LOT CORNiGR �� 1 HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY E BOUNDARIES OF THE ABOVE DESCRIBED LAND, ANO THE LOCATtON OF ALL BUILDINGS, THEREON, AND ALL VISIBLE EN- CROACHMENTS, IF ANY, PROM OR ON SAID LAND. AS SURVEYED BY ME TNIS.....�$t,h.....DAY OF..........1��1�.j� ..........................A.D. 19.7A...... , N. C. HOIUM AND ASS CIATE INC. _ LANO SURVEYORS � ..................�� .. ... ..... ............................................... e � � �'� SuBJECT City of Fridley � ,�, � �� r AT THE TOP OF THE TWINS g U I L D I N G P E R M I T u � � � RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. ' � �: ------� r � � PROTECTIVE INSPECTION SEC. 1�� ' � ��1 � CITY HALL FRIDLE� 55032 NUMBER REV DATE PAGE OF APPqOVED BV �"""� � �'' 612-571-3450 9t0-Ft5 1/10/96 / / J08 ADDRESS 172 Gibraltar Road NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23 2 Carlson's Summit Manor South SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Rarla Richards 172 Gibraltar Road NE 571-6455 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO. R& M Associates 3 82 Au er - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEEH MAIL ADDRESS ZiP PHONE IICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR � MOVE O REMOVE $ 8 DESCRIBE WORK Reside Structure and Re lace wi dows 9 CHANGE OF USE FROM TO STIPULATIONS Replacement windows in sleeping areas must meet the State Egress Code. SEPARATE PERMiTS ARE REQUIRED FOFi ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAJ( AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $9,300 ��F.65 DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OFi CANCEL THE pEHM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $162.25 F� e SC $9.30 STRUCT ON OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECKFEE TO FEE �' %—�� 9�' Lice C $5. 0 181.20 SIG ATU OFCON7RACTOAOFAUTNOAi2EDAGENT IDATEI yy ppOP VALI AT �HIS IS YOUR PEFMIT , GL �-/o -i� SiGNATURE OF OWNEA�IF OWNER BUILDERI �DATS� % .r DG �NSP OFTE I+TEW ADDN ALTER [) [1 r� CITY OF FRIDLEY SIAiGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective,l� 1 /94 � .. �t37 ConstructionAddress: l� ` � �- I � �'�� /�'i P' � � Legal Description: Owner Name & Address: �',� � ,� `,;� � �� , � Tel. # ,� 7/ ° � �/��` �� Contractor: � -�- � U� � r � MN LICEI'�tdSE # G�,�� Address: �� 9 � � r �.r� � � T� � i �� /� C ��1 /C' Tel. # °�`��' - � 3 �2 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Length Length L,ength DESCRIPTION OF IMPROVEMENT Width Height Width Height Width HgtlGround Sq. Ft. Sq. Ft: Sq. Ft. Coraer Lot (] Inside I.ot [) Ft Yd Setback Side Yard Seffiacks Type of Conshvction: �� „s �� , � ��,�, �,,,��, �, �; Estimat� Cost: $ � y ��a 6a � � �, Approx. Completion Date: � �"�� `�`� (Cost on Back) Driveway Curb Cut Width N�ed: Ft. + 6 Ft = Ft x$ _$ DATE: / - /� -- ��. APPLICANT: J � � � Tel. # � rr -� '� � °2� _ Permit F� Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Patk Fee Sewer Main Charge TOTAL STIPULATIONS: $ /�o��- $ �..� $ � $ $ SY C �� $ $ $ $ � �°/.02� CITY° USE ONLY F� Schaiule on Reverse Side .�Ol of Permit Valuation (1/lOth%) $.50/$i,000 Valua.tion $800 per SAC Unit $5.00 (State Licens� Residential Conhactors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engin�ring Agreement Necessary [ ] Not Nece.csary [ ] BUILDING PERMIT FEE SCHEDULE The Chief Building Offtcial shall, before issuing pernuts for the erection of any bui(ding or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or strucdue, upon application therefore, require die payment by the applicant for such permit of fces to the amount herein below set forth and in the manner herein provicied to-wit: TOTAI. VALUE $1 ' � to $S00 $501 to $2,000 $2,001 to $25,OQ0 $25;001 to $50,000 - . $50,001 to $100,000 $100,001 to $SOO,OQO $500,001 to $1,000,000 . FEES $15 (Minimum Fee is $15 plus surcharge) $15 for first $S00 plus $2 for each additional $100 or fraction thereof, to and including $2,000 $45 for first $2,000 plus $9 for each additional $1;000 or fraction thereof, to and including $25,Q00 . $252 for fust�$25,Q00 pl�s $6.50 for each additional $1;OOQ or fraction thereof, to. and idcluding $50,000 $414:50 for first $50,0�? plus $4.50 for each additional $1,000 or fracti,o� t�ereof, to aad including $100,000 $639.50 for first �$100,OQ0 plus $3.50 for each additional � $1,� or fractioa thereof, to and including �$500,000 $2039.50 for the first $Si)0,000 plas $3 for each additional $1,Q00 or fraction thereof, to and including $1,000,000 $1,�,001 and up $3539.50 for the first $1,OQ0,000 plus $2 for each additional $1,OOQ or fractioa thereof - DRIYEWAY DEPRESSION ESCROVY (Coacrete Ctirb Sixeets Oaly) Alterna.f.e "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. � Alternate "B": Removal and replacement of curb and gut�er 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 structure and of the coastruction site. A Certificate of Survey. of the lot, showing the location of the foundation once it has it has been construded will be required before proceeding with the framing. �_ _� �. � � � m � � O m Q � o w m � � n o � 3 � Q; o o m 3 'a � � � n -a � � � �� Q �� ' a � � 0 � �� o �c � zn � � �� Z � n� m� � CD7 .� � t7 � � � O z � m Z � -o m n � � Z 'n m m � � N g � � � < � �. W � � 0 c cn � 1 � v � m _n � � v � � � �� I� v� � 3 Q � w � . m z O � J � � �\ L _ m � Z � � O �� ?n Z � T � ' �. ro � � o � D � r [n c -n � m � cQ � i O 1 � C1t 3 ° � 0 3 O "' o -� �' O � � N � � � � � a, �. LU -�i. C � � A y � f2� � 1 � ai �' D � r* A � � r. o � � � � N 0 o � � � � 0 z W n 3 � � 0 G � c `� 7 � � a m z pl � 2 � � A z O m� v � � oo ,� z m C Q ° W 0, �� 3 � cm � G `° � � N � � 2 � � � N � C�i o o � � � 7 � � Q � v� a� o � 3 � � O � � - 2 0 `� 0� � � CD � � n 0 7 Q � 7 � ct1 t D N � � � � YJ ¢1 N v m -, � 0 � Y' N � � � � � � 0 °o � �n � � N ip� N � � � � � � A -°a. Q m � � 9 � s m � A Z � � � � � � A� Q I � Q a?!� v -� s�� `� o�`�°a � Q � � � � � 3 � � � � � 0 0 � °o °o p:. � � � � � � �� C ° � � O m � � � m � � 6 � � Q �e � rn � � z 0 � N 1 � � � C v z � C � m v � � fA �"� � � � � (D t� n• � � y � 3 � w � m � � �" (Q y. o m � m v�• W m. m� y =. 7 Q �, g e�' �. Q. � � � � � o .< a v<-'i � � �+ ? o � A• � � "�Ci � � � � os�_'� 3 f� .n�r � 6 � � O 7 � n � � ��m� � m A �N ) � m � �� o ��:� �� S � O 3 � � � n � �� o `� o 'c � sn �. � � � N �N � � Q � � � � rn v C L 0 00 � v v � m � � � �-- � V � � N Q � � ' � ..A � � � O z� � � � � � < � N � zZ � m N � m � � O Z v < �o y m� �� mn a � -D-t O O � z -n z� v -e a�� o� v �° �Z 0 z t�n z� � �v �n = S � � � �� n �O m� �� < rn Z � D � z m c��i m 0 � c c� c � j � CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No () 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. 6 Meets all current Code requirements for size and total BTU's conn� Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Bein�; Done: HEATING CO: Signed By: Date: Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) sue�etr RMIT NO. City of Fridley "� 2 9 7 4 3 AT THE TOP OF TME TW�NS g � I L D i N G P E R M I T r ; � R�ErJ �N� COMMUNITY DEVELOPM�NT DIV. r � V � PiiOTECTIVE INSPECTION SEC. � � 1 � � i_--•� ��"'�•� CITY NALL fRIOLE� SS��i NuM8Ef1 REV O�TE v�GE Oi �PVqOVEO Br L 612-571-3450 910-F15 6/22/99 / / �oe nooaess 172 Gibraltar Road NE 1 LEGAL �OT NO. 9LOCK TfiACT OR ADOITION SEE ATTACNED DESCR. 23 2 Carlson's Summit Manor South Addn. SHEET 2 PROPERTY OWNER MAIL ADpRQS$ 21P PMONE Jerr Whiteford 3 CONTRACTOR MAIL ADORESS Burnsville 55337 ZIP PNONE LICENSE NO Four Seasons Roofin & Rem. 2107 1 2 W B v -1 O1 8 0 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO. 5 ENGINEER MAIL AODRES3 ZIP PMONE LICENSE NO 8 USE OF BUIIDING Residential 7 CLASS OF WOFK O NEW � ADDITION ❑ ALTERATION �c REPAIR ❑ MOVE O REMOVE 9 DESCRIBE WORK Reroof house and ara e 24 S Tear-off 9 CHANCiE Of USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CON T OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOFi ELECTfi1CAL, PLUMBING. HEATINCa. VENTILATING Oii AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUGTION ZONING SO. FT CU FT. AUTHOR12E0 IS NOT COMMENCEO V�?ITHIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AF7ER WORK IS COMMENCED. NO DWIG. UNITS OFFSTqEET PARKING I HEREBY CER7IFV TMAT I MAVE READ AND EXAMIN�O TMIS APPLICATION STALLS GARAGES ANO KNOW TME SAME TO BE TRUE AND CORRECT. A�L PROVISIONS OF lAW$ VALUATION SURTAX AND ORDINANCES GOVERNING TMIS TYPE Of WqRK WILL �E COMP�IEO WITH WHE7HER SPECIFIED HEREIN Ofi NOT. TME GRANTING OF A PERMIT �ZO9S �L.OS DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CMARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- STRUCTION R 7ME PERFORMANCE OF CONSTFUCTION �H3.25 Fire SC �Z. LO PLAN CNECK fEE TOTAL FEE � � � ��' � � License SC 5 .0 $91.40 $�GNATUAEOF�ON7FACTOAOp4UTNOA�Z DaGEht IOATE� WNEN PROPER � ALIDATEO TMIS IS VOUR PEpM1T ` G ��y�� S�GN4TUAEO�OWNEp��FOWNEPBUILDEp� i0�T8� LOG �NSo � - '� q6t( ��..« �w [ ] ADDN ALTER Effective 5/10/99 I ] CITY OF FRIDLEY [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUII,DING PERMIT APPLICATION Const�uction Address: /� 2 G ti �� R�t-T�� Legal Description: � �� Owner Name & Address: .� � �� t.v 1 r�. �� s �, �s � �c.2 Tel. # Contractor: ��.s� S�s� �15 ��.,,� c�,�.,,� �1�,�•� MN LICENSE # Address: z � b � /-z � � � �-.r,tis cs. ��-� �� `� � �--�'v� � v � � t � Tel. # � � � � 9� - � � 9 � Attach to this application, a Certificate of Survey of the j�� 3� lot, with the proposed consiruction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length _ Width Hgt/Ground OTI�R: '��,�� Construction Type: _ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Sq. Ft. Sq. Ft. Sq. Fte V � (��`� Estimated Cost: $ �� - (� �� Ft x $ —$ DATE: � �Z 21� � APPLICANT: a� i�- ��`�s-�i � Tel. # � r � `$ � a —1'� � Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS; $ � _,�'_ �?S� $ F�e/� $ �. U � $ $ �_�'�� $ $ $ $ $ � . �' CITY USE ONLY Fee Schedule on Reverse Side .(�1 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1050 per SAC Unit $S.QO (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary ( ] �-y__ BUII.DING 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 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 $500 $501 to $2,000 $2,001 to $25,�0 $25,�1 to $SO,Q00 $50,001 to $100,0� $100,001 to $5�,000 $500,001 to $1,(�0,000 $1,(?00,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional$1,0� or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,0� or fracdon thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each addirional $1, 000 or fraction thereof, to and including $1,000, OQO $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete C�rb Streets Only) Altema.te "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15 .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 $23.25. VERIFICATION OF FOUNDATION Permits for construcdon 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 Certificate of Survey of the lot, showing the location of the foundation once it has ii has been co�tnac� �vill be required before proceeding with the framing. � Building pI,TJMgING Pernut No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY �� DATE " � YOUR E-MAIL ADDRESS SITE ADDRESS � � . THIS APPLICANT IS: �Q, OWNER �CONTRACTOR PROPERTY NpME: �• R ,� OWNER/ ,�DRESS: %� � CI'I'Y ,e'1 STnT�zlPss�aJ TENANT PHONE: �C� � ^ S �%I "� /`'`� % CONTRACTOR N�: � SUBMTT A COPY OF STATE LICENSE # EXP DATE YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH pHONE FAX APPLICATION • PERMIT TYPE �MGLE FAMILY ❑ TWO FAMII,Y ❑ TOWNHOUSE TYPE OF WORK: ❑ NEw ,�P1.,a,cEMErrr DETAILE�DESCRII'TION OF WORK �.�. (� _ � '� L��IN�e � r' PER MS 16B.665 the pernut 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 fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS WHERE LABOR EXC$EDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (IlVDICATE TOTAL MJMSER OF EACH BELOV� BATH SDJK/L.AV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (n� ctrrucFrvsE) SWIlVIlvIING POOL WATER SOFINER ($35) _ CLOTf�S WASHER KITCHEN SINK WATER CLOSEf BACKFLOW PREV. ($15) _ DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGA ON _ WATER METER � OTE�R , . � : ,� �e � �,�Yy!r {..... _,.. aw..: ,..,.u.,,..__.:�: .,�., w.��, ,.�.. .:. ,�w.., � �d t _. "� �k � .�.�+y � � �� , � ,,,`�_. '� _ a'v.�;_». � � .�� .M2�- �.,,. g 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 � Tota1= $ 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 understand this is not a permit but only an applicarion 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 which requires r v'ew and approval of plans. SIGNATURE OF APPLICANT . RINT Id�_�^�� Iti, lJ�h, �"1'0!'� DATE �� J�� .-^ 4 �� , ;�� ,��.�-,�. � � , f.�,. .��. �..� �.�1�� , �' � °k ��& � '�y " City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, NIlV 55432 763-572-3604 FAX: 763-502-4977 �uildxng Inspections 763-572,3604 �6�-soz-a9�� SiTL ADDRFS3 _� 7'FT15 APFLiCANTlS: TTNAN'I' SUBI�IIT A COPY OF YOUR. STAT� Lrc�rrSE AND C�x.TT�rCA1� or• 1NSiJRANCE 1'ROPERx'y TypE OF DF,SCRIBE WpR.K SLiNG SIZE OF iMpRAV�t�rr.�rr From: 7634216672 Page: 1/1 Date: 10l6/2010 3:25:43 PM 1 vr.u��.. a� v- •• -{p.J�'in�s�' 4�+'�RlU-v��';' ��',�4 L.�'� �jj� , �. � �u�n.uv+� RES�D��TTLA�L A�'PL��AT��N CI'�'Y O� F�',IDL�Y YC7UR F,.MpIi ADDRESS ❑ OWNER �iCONTRAC70R STATE Li�N3� O 31tVGLE FAMiL,Y/NEW COI�IS1'R(TCT(i � TWO FAMIT,Y/NEW CpN9TRUCTTON � BA3T�M�NT FfNiCN � DFsQ{ �QOEIIVG t'� '�RJMBF]L OR 3QUAR.ES G� � i � � PROI'OSED SiZTs: Pi2.QAaSEb HSl"GitT G inyl O Aluroim,m � Othet �„` HOM� CONSTRUC1i0iV p ApDrnON ITETTAAfCFJREpAiR O REMpDELiNiG � �� ` �,. � �ENGTH�� ° '' WIDTH �� ' ❑ HOUSE olvl.Y � HOUSE & C;ARAGE � ATTACHED CARAGE �� nL•TACHEo rsqRAGE QSo .i�''it ❑ Trim Q Fescia � [N 6XT3'1'QdG OPENIrTGS DYaa �iVO T,pGq'nON OF W W DOwg OR FOR TdEW OPENINGS.DESCRIBE 81ZG O� OP6NIWG CHANGES dt 7'`!PE QF WAIDOW HE IIVSTAL ��F �� ALL FTy�S ARE �,A,S�D O1V VAI.IJA770�N. INCLi161n�r_ Txr� rne�r � Permit Fee PI� Review Fire Surcharge Sut�harge License Suroherge SAC Charge Cur�i Cut Escraw �rosion Contr+�! :Park Fco Sewer Main Charge 1997 U.�.0 FEE SCHEDU[,E) L�xCP DATC � DRAIN TILE a a-r�t Permit No.: R��V� sy:��1;��. n� �� OCT 1 � 2 �� C�D BAS�M,�NT RT'MObET [Nd 1t�1�rt1T• 1. Bxisding Floor Pi� 2. Pr�pose.d floer p�en 3. I.�ac oPstruat�aal mzmbe�s co he used TOR Nfiw CpNSTttUCC17(ON 1JVCI.UDIlVG DHCK3, AADI'RUNS. Rc �pRCF�F'i3 SC�_gM1T• i. Sitc P1tiNSurvcy SHOwing thc �eistlttg struaair�,y and F►oU�g+� AmjeCt. 2. 'I'vm acts of aanetruction p1m�s FOR WIN w�3 � ROVIDE U VALU& ANp MnNUFACTURS 577CKE1t P�a WIM30w, LABQ� � �:�? `� ��_` See Back Page for Fee Schcdule � 65% of Buiiding Pormit Fee $ �� , .001 tim� the total job vsluetipn $ �� .00flS x �'crmit V$lutttion M,inirnum $5,00 $ !.- $5.00 (State Liaensed Residential Contractars}. � �2100 per SAC U�1it (Plens to MWCC for detetmin�tion) $ ti ft+6 ft= ftxS24�$ � $450 Conservation Pl� Review " $ Fee Detecminctd by EngineerinB $ AgrcEment ncc�ssary ( ) Non Necessary ( ) � $ fl 'o.. �� .' -'- - • • - - . . _ . .-'------- ►S I3 AN APPLICA7ION FOR A PERMPI:NOT VnL1D UNTfL 1'ROCE,SS�p � 1 hcreby app(y fbr a building permi� �d J acknowledga tha# the infrnmation ahovc is cpmplcte and �tc�urate; t1t&t the wprk will be in confo*mance " e ordinances and aades of tha City of Fridley and with the Minnesota Constnaation Cc�cies; that I underatand this is nat a p�+t Gut cmly �n appl c for a perr�nit and w r s not to start w;thout a permit on site; that the work will be in accor�nc� with the �pl�� Plan in the casc ofal�w�-w6i�h re iew and aPProval of P1Ans. IdNA'R1RF OF APPLICANT ,,-_.. -- � PR1NT NANlE � PPROYAL INSP&CTOfi SIGN DA7E 10 � Z/`�-0 l� ` �T.'f��`!@�'.-�i'i1�'h�.!�'L f9u n � mre w..., 4 ........ �. �. � -- -" - �` , =.�, :�