The URL can be used to link to this page

AF - 45598�--, Ci.ty of ��i�c�ley, Mi.nn. BUILDING PERMIT Da�: Sept. 4, 1968 �� 1�T� 991'7 Owaer: Clemron, Inc . B�� Same Ad� 4401 Camtral Ave. N. E. Ad�� 4401 Central Ave. N. E. LOCATION OF BUILDING No. 75 �Q Stceet _.. Hayes S t. N. E. ,� p� of Lot Lot � 4 _ Block 3 Addition or Sub-Division .� Don' s 5 th Addn . Corner Lot _ X Ineide Lot Setback 35' —_ Sideyard 17 � 10 � Sewer Elevatian ____._.._ � 885 .16 � 888.7.6 Ton of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 40 � Depth 25 � Height 20 � Ga rag...P Front � Depth 23' ITeight 1 �� Type of Construction Frame �� $22, 000 _ �. � 1000 � � 20,000 �, �, 460 � � 4600 To be Completed SEWER LOCATION -78' North of Ma.nhole WATER LOCATION - 89' N'orth of Ma.nhole In constderation of the issuance to me of a the proposed work in accordance with the desc= ordinances oE the dty oP Frldley. F �� to c�struct the l above, I agree to do with all grovisions of In consfderation of the payment of a fee of $ 37 . 00 � � permit i�``hereby granted to Clemron, Inc . to conatruct the building or additfon as described above. Thffs permft ia graz►ted upon the express condition that thepera�n to whom ft is granted aad his agents, employees and worl�en, in all work done in, around and u�n said building, or anypa� thereof, shall conform in all respects to the ordinances of Fridley� Minnesota regardin� location� conatruct�on, alteration� maiatenance, repair and movlu� of buildings within the dty ]imfts aad this permit may be revoked at any ttme upon violation of aay of the provis�tona of said ordinances. — Officia�. Huilain8 � n NOTICE: 76b peemit doss no� eevsr �6s eoesteocNoe, IesqUdton tor vriAes, phimbtee, ea 6s�tina, ww�r er w�er. Bs sura te � firo Bulldiu� lespulee for mparaf� parmhs for fhsa it�. . � APPLICATION FOR BVII�DING PERMtT CZTY OF ,FRIDLEY, MII�SOTA OWNER' S NAME��/�'��'�� . BUILDER ADDRESS AD�RESS; LOCAT�OAT OF BOIT,bING 1V0._�.5�'� STREET PART OF : � fyOT BLOCR �� ADDI�'ION OR SOBDIVISION f CORNER LOT INSIbE LOT SETBACR �i�— � SIDE YARD S�WER II,EVATION FOUNDATION Applicant attach to this form Two Certificates of Sutwey of Lot and building location drawa an these Certi.ficates. DESCRIPTIOft OF BIIILDING To b ed as; � . � Front `j�Q Q Dept / Type of Construction_.= �� To be completed_ ,_. � �. i �--� A V..l.�L4�w X � Sq. Ft. /'/��J� Cu. Rt.��Y . � � � Front ,�°��D Depth�� O H� Sq. Ft. ��Q Cu. FC. ��^',� timated Coat 7.'he undersigned hereby makea application for a permit for the work he� specified, agreeing to do all work in stxict accordance with the City Fridley Ordinances and rulings of the Department of Bui�ldings, and he� declares that a11 the facts and representations sCated in this applic; are true and correct. �-, _ DATE �� v�� SIGNATITRE ,P� (Schedule of Fee Coste can be found on the Reverae � �, � ��.� _ � !�-� � ,� ' x ` _ p ' � ° �, /"'� � e . A . ��...�_ ight� � � �: ,y , ` ,� �= � r' �E � ; I � n J f � �� . �, �� 1/lfl t�,ds�yl� �1 �1 � sg_; :. �, a �s-X,y�„� �rs �. ��,G�3z. .��sT�`� ENGINEERING tf�IG. �� Qv�� b,urs►xipaJ • sli�sef4,�'166 . �� — En�ineers � Sur veyors -- cesrta„��cate o,� sut�e ��: �'� � � f�'��' �'� � . � � � �- .o i-----� � � ,, I i 4�� ,� , ��l ± I a T � � r-= 9 ! � � ( P, � t � � I � � I I ' � . � 90 ' ._ . ._ � - _ -- - -- q =.� � _ _�._ _ _. _ _ _. _.� �1 � �� ., _ t, � � - ro . '` i � � s. ;r; � I ni.�: 4 �� -- :�T � "L-. 1 1 � 7 � , �.�. 'ii �_ r 1 R, . .� � , .� � . . J �'�` _ ! �` _ � . ��; NC�ATH rrs �� DAAINAGE AND UTiLITY E A6EM�raT ' LOT � �LOGk ��ON'� Sr" ADD��'t0�1 i1 PJ C/ K 11 {.�,^ C° �'�? �1 , ��bt&� "" ".�7, !!�lhts er olr� a►�d mn2cf n�a�sa�fa!'�an o�('o scrney �'!Et d�r+ndori�s �'!da adr� dsrribd lar�0,mxi °�� 0�� 9�� %�s .1hn°ar� . sad d/ rrs'��ft a�ma�fs ,�,�'ay, �an ar n.to�d /aad. As surrryed Gy r� ihs=_ � � _ A il � l�T A.D. �. SUBURBAN ENGI/VEERIN6 , JNC. +'¢� "�,.s �r ..t�,,,' � �^ ALF ' !" .9. �. ;=� r �� , �� v � - - y � � � �- .. F�,; i - �.."� L..�; `^�-., . � `•� 'I`�?'C . Q � � Q w ,� � '`J' � � n � �. �°C7 o `� � � � . � � "-y�' I O m . y . � . � . �, p � � � f!i C� Q O � N � �n 01 �� C 0 � n �61 � � a � y � � z � z � � � � � � � � � � � � � o �,i e G: '� � �! ro � � � aS � � � � � � �`�. � O � � � a �. � � � � � � � � � F, ,.�eY `� � � � O � � �9 m�e � a°u p' o N� N M � o w w O O '� �, iG1 G. � � � �' P1 � � o � Oq � . . O . . � � . . . � � � � � �e x x � x x x x x� � �r � � (g! !i! ffl GD9 �! EA G� W W N a` N � O Gl O � G G1 Gi C87 � � � � 4� -f� t�J �� rA {1! f�! C3� ffi� E6J � � � � � � � . � • � � � O. � � � �� y � � � � 0 � 0 � � ! � � � d� � � � � � � � � � O t� '-9 a �: °U, I � � ro � � � � o C� '� � � !'�• � ¢ �' � � � � � � � � � � � � � ) � O � �� ° r' ti p re PJ �' a p, �' y � ►r� r� � � . � � � �pi � ° I � � � � �O U�J fJ G-'�' � I I 0 � � � � �� m � � x � 0 � � QQ • 0 D � K �FlATER CLOSETS uaiwn�s 6ATH 7UD5 �� SINKS WASH TRAYS DRINK. FWNT. SITYlRS. FLOOR DRAINS CATCH BASINS AUr TO — I WASHE2 GAS MPL G/S I RANGE � GAr 5 OPENING$ I ca O 2 e N 1 A I f' � fl A ��b � a a ; � °~�C � � � oa � � � C � m � y p �o�� tCo y `.e. 0 � a• � � � � � w � � � " '� O y a �� . � � � G �C � ��.� .� ��p� n �� . � o � ` � p � � e y p' o � f°�a� N ~ °' " �� w �� a� �� n .� e� "� �' w O�y M � O f~D � � `� � � a " �: �' �� w �o� �a�' ..__ �� m � ro I�` 3 � a � � � �i' �y H V �a � � � �' o�y � � � � � � � � � � �' � � � � R7 tJ p G� � _� (`. �' " � �r�� l7 � 00 � c. o � � � �� 4.�J • c� � c � c ��' ��.� e( i � � � � � � � � '� � � �i � �,a � � � G�; � C O � � � 0 �/�^] 0 VJ cn � � c� , �o � c�� .S� � � �. � . ' ` i ' � SUBJECT . City of Fridley � 12192 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ! � R � • COMMUNITY DEVELOPMENT DIV. / � � , /� r � L � PROTECTIVE INSPECTION SEC. �� -� 1 1 � {�i' / � 1 /�"1 � CITY HAIL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED 8Y �----�' �•' s�z-ssaaaso 910—F15 6/19/73 � � JOB ADDRESS g� 7500 Hayes Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. l} 3 Don's Sth Addition 2 PROPERTYOWNER MAILADDRESS Donald Johnson 7500 Ha.yes Street N.E. 3 CONTRACTOR MAILADDRESS Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER MAILADDRESS SEEATTACHED SHEET ZIP PHONE ZIP PHONE LICENSE NO. ZIP PHONE IICENSE NO. ZIP PHONE LICENSE NO. 8 USEOFBUILDING gesidential 7 CLASSOFWORK � NEW 0 ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct 5' x 30" Fireplace 9 CHANGE QF USE FROM TO STIPULATIONS TYPE OF CONS' SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, Brick 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. Nd. DWLG. UI I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO BE TFUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �900.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE PROVISION F ANY OTHER STATE OR LOCAL LAW REGULATI G CON- �6.00 STRUCTIO O THE PERFO ANCE CO, STRUCTION. �� S� � PLAN CHECK F � ` SI TURE OF CONTRACTOR OR T ORI2ED AGENT IOATEI f{En �� IDATEI OCCUPANCY GROUP I OCCUPANCY LOAD S�. FT. CU. FT. OFFSTREET PARKING STALLS IGARAGES TOTALFEE 50 y ~ RLY VALIDATE S I YOUR PERMI��' .� a r� � . .^�.: � d:- ` �''� iq?= A�PLICATION FOR RESIDENTIAL, ALTERATION, OR AUDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA owlv�'s r�ar� : ��i � �� G��i.�a �i Butzn�x: �� 2,,,� f �r ann�ss : �� i � 5 �; �� annxESS : ��, �� - NO • . � �G° �� S TREET : /� � P ,` � / t �e � � � . � ��Z LOT . BLOCK • J ADDITION • �D<<' � � CORNER LOT: � INSIDE LOT: SETBACK: SIDEYARD; Applicant attach to this form i�wo Certificates of Survev of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As; s� ��'',� ��dG�, Front: �� De th: JU I� P Height: Square Feet• Cubic Feet• Froat: Depth: Height: Square Feet; Cubic Feet: � �/ 1�►pe of Construction; _ �%�"r�-!u Estimated Coet; $ �� '• To Se Ccnnpleted: � �LL�.t�`'4� Tha underaigned hereby makee applicati�n fo�a permit for the work herein epecified� a�reeing to do all work in stiict accordance with the City of Fridley Ordinances and ruliaga of the Department of Buildinga, and hereby declares that all the facte and represeatationa atated in this application are true azt cox ect. � l l • � � ` DATE: �' 3IGNATUItE: � '��r: � �� ' �� " ,�, %- �` (See Revezae Side Far Additioaal Information.) .� � p _, �% � �� C) r .{ �f � U � � � — �� _ : __. _ �� sue�EC* P . City of Fridley 29597�� AT TNE TOP OF THE TWINS g � I L D I N G P E R M I T r � � RE�I�NO. � `y _�� COMMUNITY DEVELOPMENT DIV. � r � � PiiOTEC7IVE INSPECTION SEC. i1 = . --_- A �r"' �'� CITY MALL FRIOLE� SSI32 NUMBER NEV D�TE v�GE O: AvanOVEO Br L �� 612-571-3460 9t0-F15 6/2/99 / / 108 ADDRESS ]500 HdyeS Street NE t LEGAL �OT NO. BLOCK TfiACT OR AODITION SEE ATTACHED oescR. 4 3 Don's 5th Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Al1en Mavis 786-5026 3 CONTRACTOii MAIL ADORESS 21P PHONE LICENSE NO Owner I ARCHITECT OR OESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO. S ENGINEER MAII ADDRESS ZIP PNONE LICENSE NO 8 USE Of BUILDING Residential 7 CLASS OF WOFiK O NEW O ADOITION 7�( ALTERATION yp�( REPAIR p MOVE O REMOVE 8 DESCRIBE WORK Install e ress window in basement bedroom 9 CHANOEOFUSEFROM TO STIPULATIONS Install smoke detectors to meet the State Building Code - in each sleeping room and on each level of the house. TYPE OF CONST OCCUPANCY GROUP OCCUPANCV LOAD SEPARA7E PERMITS ARE RE�UIREO FOR ELECTRICAI, PLUMBING, MEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOIO If WORK OR CONSTRUCTION ZONING SO. FT CU fT AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS, Op IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING I HEREBV CERTIFV TNAT I HAVE READ AND EXAMINEO THIS APPLICATION STALLS GAiiAGES AND KNOW TNE SAME 1'O 8E TRUE ANO COFRECT. ALL PFOVISIONS OF LAWS yALUATION SURTAX AND ORDINANCES GOVERNING TNIS TYPE OF WORK WI�L BE COMPLIEO WITM WMETMEq SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �800 �. �JO DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME pEqM17 FEE SAC CMARGE PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGUTATING CON- $3Z. GrJ Fi re SC �.00 STRUCTION OA THE PERFORMANCE OF CONSTRUCTION PLAN CMECK FE TO L FEE 33.95 S�GNAT NEOFCON•AACTOpOp NOp�2EDaGENT IOATE� FIE O Y VALI ED TNIS IS OUR PER IT G��-�� f � ,R► � � S�GNOiU O� OW� Ep�� OWNEp BU4DEp� iD��E� OG �h5� �+�Tk rrEw [ j � ADDN ALTER Effective 5/10/99 [ l CITY OF FRIDLEY [ J SINGLE FAMII.Y AND DUPLEXES R-1 AND R 2 BUII.DING PERNIIT APPLICATION Construction Address: % S U V ��" � � _ �� o� > Legal Description: � Owner Nazne & Address: fj,t} �e h y� �v i _ Tel. # � � �- 7 � 6 -� � � r} � Contractor: 1 � �-� �— MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 1 Yl 5�' �� e. G, i e 5 S �^+ i r� � o�1 1 r-� %-.� <n Ce ti� ,e r� �- �e a�' o vv� Construction Type: Driveway Curb Cut Width Needed: Estimated Cost: $ Ft. + 6 Ft = Ft x$ ��.J'� _$ DATE: � " ci� � � APPLICANT: �� `� %� Tel. � � � �-" � � 6 ' � `� c} 6 Permit Fee Fire Surcharge State Surcharge 5AC Charge License 5urcharge Driveway Fscrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 2, � � $ � e� � -; �� $ $ $ $ $ � $ $ 3.� CITY USE ONLY Fee Schedule on Reverse Side .Wl of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1050 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.� Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] � \ . � C � �� ,~ � � Building p Inspections 763-572-3604 DATE �' � � SITE ADDRESS � � O THIS APPLICANT IS: PROiPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDIl�TG RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS �� ❑ OWNER �(CONTRACTOR PHONE: N�ME: /5e4''- /�� r� ''" fi 0 �' STATE LICENSE # a o 3� gsyo 9 EXP DATE _ aDDxESS: 02 / /S��- %'c.�-�-a ce �, �. PHONE ��'� f�+�.3�6.J FAX ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE, � TWO FAMILY/NEW CONSTRUCTION STO� ❑ ADDITION ❑ GARAGE/SHED ❑ BASEMENT FINISH ❑ R�F ,;�DECK ❑ SIDING ❑ SWINIIvIING POOL l o ❑ NEW � ADDTI'ION . v \ DESCRIBE WORK BE1NG DONE: SIZ� OF IlvIPROVEMENT NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl O Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS OYes ONo OR FOR NEW OPININGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE WSTALLED � Pernut No. •v`�1 � � ° Received By: Date Rec'd: a CrrY y@,,.d,,o6,�6�, sz'A��i� -�.�//� ❑ WINDOWS ❑ DRAIN TILE ❑ OTf�R �� LENGTH WIDTH HEIGHT ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit � Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of str�clnral members to be used F� FOR NEW CONSTRUCTTON INCLUDING DECKS, ADDTTIONS. & PORCI�S SUBNIIT: 1. Site Plan/Survey showing the existing str�ctures 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: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S�, 0 OB ,� o OCCUPANCY TYPE Permit Fee Plan Review Surcharge Fire Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due ��,. ��_ See Back Page for Fee Schedule $ / 65% of Building Permit Fee $ , �- (.0005) times the total job valuation — Minimum $.50 $ � � f'i � .001 x Permit Valuation (1/10%) _- . $ � � (� $5.00 (State Licensed Residential Contractors) $ $1450 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$20=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ . Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclaiowledge 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 applicaxion 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 whi requires ' v ndappro al of plans. SIGNATURE OF APPLICA� � PRIN'T NAME !�C y� C/ "`�� DATE Y1 �� D� � c� � � �� r � ' . .. � �� ' 1 --- + � � � `'� '�i � � � L� � � � �� -_. ---- , �.� .� _ . _ � � � �' W _� 4�� \� � � � � � �'�.�' O . .,� � ,� � ♦ � a � � J � � / � a� � � � � �m�y �, � . � v � � � � '� ' t � � � � W � �o � w� �..,�,.. � O � �..�. � +so.wr�. � e b � � � � � � �, � �l. , � � � � � =� � � � �� 'C r�a ► A�� , � � � �� ` °� � �� y � `� --�f�- �, � � � � �. � � r� � � � � / � �C � � �� y � [� � � Building Inspections 763-572-3604 BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY DATE %� `Z� C`� YOUR E-MAIL ADDRESS SITE ADDRESS �5 (71 THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE OCONTRACTOR ' •� l.� ��i .1/ STATE LICENSE # EXP DATE Permit No. Received By: Date Rec'd: ADDRESS: CITY STATE ZIP. PI�ONE FAX GLE FAMII.Y/NEW CONSTRUCTION SIZE ❑ ADDITION ❑ GARAGE/Sf ❑ BASEMENT FINISH �ZOOF � DECK O SIDING ❑ SWIIv1MIIJG �rE oF woxx: o �W o� DESCRIBE WORK BEING DONE: SIZE OF IIvIPROVEMENT k2�OFIlVG NUMBER OF SQUARES �I GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl O Aluminum ❑ Other R'INDOWS IN EXISTING OPENINGS ❑Yes �I�To �R FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINIIOW TO BE INSTALLED__ __ 'CE/REPAIIt O REMODELING � -�flt V� 0� (�, {'� d LENGTH ❑ HOU3E ONLY �HOUSE Bc GARAGE ❑ ATTACHED GARAGE ❑ DETACI�D GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF �VINDOWS NUMBER OF WIIJDOW ❑ DRAIN TILE �OT� T�I�O �1 f WIDTH HEIGHT BASEMENT REMODELIlVG SUBMIT• 1. Existing Floor Plen 2. Proposed floor plan 3. List of structural members to be used Ft. FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. 8c 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: TOTAL JOB VALUATION $ N�S�7�7 �B•C �E OCCU�D AN� TYPE Permit Fee Plan Review Surcharge Fire Surchazge License Surcharge SAC Charge Cwb Cut Escrow Erosion Control Park Fee Sewer Main Charge Totat Due �� $ $ $ � Sf.� $ $ $ $ $ $ � See Back Page for Fee Schedule 65% of Building Pernut Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination} $+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMI'f-NOT VALID UNTII, 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 pemut 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' h requires review and prov o s. � SIGNATURE OF APPLICAN� �� NAME S��n �'P S�I}A�� GV �i7�� u�i Building Inspections 763-572-3604 763-502-4977 FAX srrE Annx�ss ___/,�� s arr�cArrr �s: PROPERTY OWNER/ TENANT CONTRACTOR SIJBNIIT A COPY OF YOUR STAT'E LICII�TSE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: nESCx�E woxx BEn�to m SIZE OF II�PROVENIENT ROOFING NUN�ER OF SQUAItES ' GARAGFS PROPOSED SIa+: PROPOSED HEIQHT: � Ahm�imm� ❑ or�� BUILDING RESIDENTIAL APPLICATION. CITY OF FRIDLEY � C.• ' . . � �:�� rAOt+� Lco � l,l 6-��fr STATE LIGH�TTSE # / � B.SINQLE FAMII,Y ❑ TWO FAMII,Y/NEW CONSTRUCTION O BASENIHIVT FINISH 0 ROOF 0 DECK O SmIIV(� O SWIlWM o�wao�cortsrRUCriox WIIVDOVVS 1N E7QSTII�TQ OPENIN(3S OYes pNo OR F8R NEW �I+ENII�T(i13.D8SCRIBE SIZE OF OPENINCi CAANQES 19t TYPB OF. WIlVDOVJ TO BE INSTALLED COTAL JOB VALI Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb C�t�Escrow Erosion Control Park Fee Sewer Main Charge I hereby apply for a birild'mg of We City of Piidley end wi permit on srte; thatthe wo � SIGNATUItE APPROVFD BY- ��s►i��T �.,T� J r � I;' _ M /� �� I 1 ��[%�'a��!l�� •��... � i ' ' y .I/� ,s � a�� . — r� •�r ' y�ia� �-c�n � � ■ ��-r i . ■ • :i:�• n o ��• . .►� . . •:, .�:� � � � HOUSE ONLY ❑ HOUSE 8c GARA(�B O ATTACF�D QpRppE O DETACHH,D (}pRpC�g osut�c � / ,. f�.,�:t,t�-?�wC�d O Trim o F� �-- G-�. C�� ! �.w / �•+ �_ � y,�.,,►,� CAITON w �� r Y11�_ �.�C.t 117,QJl�yr.� :1uN,11VCLUDING THE COgT OF T� 1997 UBC FEE 3CBEDULE) �. a . �° Permit No.: �� °� ; �" Received By: D��'�� r rttsttitil' SQ Ff BASEII�N'P REMODFLINa SUBNIIT I. Existing Floor Plan - 2 ProPosed floor plan 3. Liet of etruatucal mwnbw�s to ba used FORNEW �NSTRUCTION INCLUDII�TQ DECKS, ,AUDITiONS. & PORCt�e cr,Jg�. 1. Site Pl�ey ahowmg the sxiating atruchaes andproposedP�.l� 2. 7�vo seta of coash�ucticn plaas -- 3 i3ne�g,y Calcalations — — - '-� �"" • ' . OCCiTPANCY TYPE $ '7, �. 5 See Back Page for F�e Schedule $ ' 65% ofBwlding Permit Fee $ / . Sb .�1 t�es the total job valuation $ . 7 .OU05 x Permit Valuafaon M'miraum $so $ 5- • �$S.� (State Licensed Residential Contractors) •$ $1825 �a SAC Unit (Plans to MWCC for determination) $ ft+6R= �$x$21=$ $ $450 Conservation Plan Review � $ Fee Detemrined by Engin�ring . $ Agreement necea�e�y () Non Ne�smy' i) $ �.� �iatce cbec.ks nayabte.to• cpty otFr,t�ey • attach THIS IS A1�T APPLICAITON FORA PERMIT NOT VALID UNTII, p1t�BS� rmit �d I aclmopvledge that ti�e informatton above ie complete mad acwuat� that the work wiD be in Conformance with the ord'u�ances and codes � Cons�ucdon Co�; timde�ad this is aot a permit but onty an application for permit and work ia not to etmt widmat a 1 be ut wi8i Use ' tha case ofall work which requirea 'ew and o p CANT� PRINTNAME � �G� � DATB�' %!- f D t�l��d\ n _ �