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AF - 45638� � �� City of Fridley, Minn. BUILDING PERMIT Date: - Aug . 18, _ 1969 p�r; Clemroa, Inc . B��r Same Address 4411 Central Ave . N. E. Ad�.e� Same ��''J 6� N° 10373 LOCATION OF BUILDING NO. %S 27 StC2@t. �_ S,a�7@S S.r • N s E• PSTt OE LOt. Lot 1 _ Biock 2 Addition or Sub-Divisfan � Don's 5th Addn. Corner Lot Inaide Lot � Setback 35' Sideyard 15' 15' Sewer IIevation � 886 .27 � 889 .27 Top of Eooting DESCRIPTION OF BUILDING To be vsed as: n— W_ ��? i*+g Front �.�. Depth 2�_ Height 2 0' gq, �-t, 1125 �, �, 22 , 5 00 Garage �nt 22' �p� 25' g��.� 10' �q, �•t, 559 � F•t, 5500 Type of Construct%n Frame �� $26, 000 _ To be Completed WATER LOCATION - SEWER LOCATION - 10' South of Mattk�.ole 20' South of Maahole PILASTERS O1V BASEMENT WALLS OVER 32 � In conaideration of the 3ssuance to me of a permft to co e building the proposed work in accordance with the description above t fo and in co ordinances of the dty of FrYdley. , e/ I agree to ao provisions of $100.00 Sewer Conaection��'a.rge In camsfderation of the payment oP a Pee of $ 34. 00 , p�t is hereby granted to Clemron�Inc . to construct the bufld3ng or addition as described above. This �ermit fs granted upon the express condition that theperson to whom it is granted and hie agents, employees and worl�en, in all work done fn, around and upon said bu3lding, or any part thereof, shall coffiorm in all reapecta to the ordinsncea of Fridley, Minnesota regardiig locat3on, construction, alteration, maintenance, repa3r and moving of buflaings within the dty ]imits and thia peraiit may be revoked at aqy time u�n violation of aay oE the Provisiona oE said ordinancea. � Clarence Belisle ��8' NOTICEs 'I�s peradl d� nef eovsr �hs coestrneHoe, hishQatloe he whh�e, plumbing, ea 6adeg, awu e� rrtlsr. B� ans to a� ths Boildlu� Inspsctoe Por aparat� parmhs Po� thas Ihm�. c - - ., � . APPLICATION FOR BIIII►DING PF�tMIT • � r :r. r : � � �/ � � ` �. � �� : � � ti • ' �-!/ C..,r/� :��:a. - � _ � i • �-. � / � _ �_�':r�� - � � � -' �� `��`� � � N0. - = STREQr LOCATION OF EiTILDIATG : -, LOT BLOCR ��ADDITION OR SIIHDIQISIO � ..�`G2��i�� .� COR.'�'F� LOT INSIDE LOT SETBA!'��SIDEYARD %S '��/,S'-,� SE'MTF�t ELEYATION • TOP OF FpCTII�TG Appliaant attach to this form Two Certificates of Svrv�y of Lot and propoeed building locatior. drs,wn on th�s� Ce�tificetese DESCR.I.FTION OF Bi3ILDING To Be IIsed Ae : � � � �. � / O� � � f � ! P ^ Front �� Q Dapth �,S "C� Height �'� �quare feet �� Cubic Feet � 2 �r �� i , � ,92� -Q Depth � S� �" l� Height � - � Square feet ,�� ,j� Cubic Feet � � Type of Construction ��,��,�Estimated Cost ,��a�� ,� To Be Complet The undersigned hereby makes application for a permit for the work herein specified, a,greeing to do all work in strict accordance with the City of Fridley Ordinancee and rulinga of the Department of Buildir�ge, and he�eby declaree that all the facts and Z-. er.tations etated thie application are true and correcto DATE / SiG?dATOR d� (Sahedule of Fee Coets aan be fourid on the Reveree Sideo) n 4�' • � 6 i� � � #q"r-� � r!'-_; £' j � �! �� 8 ! ( :' �r t ,_'" .ti , � �- �' �� A-�� ' � � � f' , ��, n,_1 «.� �a ''w r� � �_ � �� ?s. � �� `� 'l'" f �, � � • � ` �- � �_. _ '� e� �,..� _� � . � .., BTJILDING PERMIT FEE SC�IILE SECTION 2o The Inspector of Buildings shall, before issuing pernita for the erection of any building or �tructure, or for �.ny addition to any exiating structure or build�ngy or for any alteration or repaire to �uy existing buiZding or structure, upon application therefore, �equire the pe.yment by the applicant for such permit of feea to the amount hereta below aet forth and in the ma�.ner herein provided to-wit: Uaiform Buildin� Code: Type 1y 2, & 4-=�075 for each one thoueand cubia feet, or fraction thereof, in such cubical contente. Type 3& 5- ;1a50 fox each one thoueand cubic feete For the pu�rpose of computing feee for building �rmits, the cubical contents of any building or addition to a uniiorm height throughout by multi�lying the ground area covered from a point si$ (6) inches below the floor line of the basement or the cellar to the avera.ge height of the upper aurface or to the average hei�ht of the roof eurface of the maiz� gable of a pitched roof. k'or �epai�s or alterationis to an existing atructure, the fee ehall be at the rate oi $3.00 per each iive hundred dollare (=500.00) or fraction thereof in the cost of all proposed worke Ix� no case aha,ll th.e fee charged for any permit ae eet forth in Section 2 be leae than $5,00� NSSSD Connection Chas�es based on location - Area 1 or 2. .4 . � � £" � ' w � -- - � - � � - - - a u �-- � � . 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'�. s • � � � � � � WATER � c�ose're IURtNALB IewrH T�Ba IBABtNB .• (BINKS x � � � WABH � tJ � � �� p � � TRAYB IDRINK a � � � Fourtr. a ,� � �'x � ��j I$NOWERS � Q � Q � � a p �' �� IFLOOR O O ORAINB � CATCH � � ��h• � � IBABINB m v p�" ; � �� W �,,�,. _ LDRB. � � � MIBC. �+• � IPIX. � �o � m IOAB M � � � APPL. I6AB � v RAN6E � ro � _' I � s � � � � ' tA � �� I n � �' • �• � � � �, a � � y � � M � � � a �. � f O . ti � � � rf, � • O � �' � , � � �c � � � �W � � A N 3 � � � s �, � � y y �' � p C ��Q� �o�� ,o' `°� � `S" � �. ca "' � �. �C � M�. � � O �. � � �. �i a° R, b �� , �,� � o �' � o'�,�F�•A bH o �. � � ��R�. s" � �. A. S' o �`�� r. �„ �� N � � �,ti�y A � � �• � 0 � i a� � O �c�. P1. �A �• i`7n � �K+ C �' Q � h, �•�•� � � � �. o � � � � o A � � � �� o�,�.A a r« �. o� � � �' � • � � � ��. . cbo o g �' �.�a� A�'�� s'ti� � � � N ,�� n� � �' `° � o � �. �� , �a,� � Q �'• R o � �� - � �o O � i1' �Ci, a' r. A � n �:�� •� A �. � o�'��. � � �, �. � o ��'� �`f a'� �p• � �cw+ �n' `Z a�+ t0 � � 0 � � � � � �. � O 0 w � � � n 0 � N I b b 0 � 11. Vl 0 � � � � O � � � �' � I� � � � � � to� 0 �O R. � � : 0 � �a !1� 0 e�i � � � � i. r� Q � a � � � � � � � A 0 to' -° I I � O� � � J � I 0 . �. � � � � � � A O y, � � b � �0� � � � � � � M � � ��+. � � � � O 1 a � �-A � 7Av y Q Z � � O � � A m y, A � � � � � � A � � � � � c _. — � � N : O � 1� � ' � � A � � Q �i � � �i• � � Q 0 � `°_°v � � o �/'�A � � � �I -• Q � � � � � � � � � � �• ' � y � � �� , � O 0 � � � ro f�J �, �. C � � . ,� � ,,A � 1� v� �o � �� HOUSE HEATING TEST RECORD � ADDRESS ,��-� °/A` E°.�v�lr� APT. FLOOR CITY SUBURBS �"`'��" OCCUPANT OWNER HEAT LOSS DATE HTG. INST. ^AS C0. METER BAD E# SOLD BY INSTALLED BY - �- Eleetrical Work By Gas Line By � � TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT H� . OTHER G S D.ESI � CONVERSION MAKE � ~ u.�' - 4"��° MAKE OF BURNER Model .G 0/°�� i� ��- l Model ;A Serial y%��'" %�- ��' �f Max. BTU Rating INPUT � �- �-LL � � �' MAKE OF FURNACE Model CONTROLS �► �� THERMOS.TAT - He�. P, g � Vent Size (� Valve �- 1' ��'°. ' °�:a-ut-.`i.-�°-��. KIND OF LINER SIZE NONE Limit �� Droh Hood Regulator Limit SeMing �'�'� a Filters Size �. � mber � Fan Setfing � Chimney Loeation Inside Outsido Pilor Type ��b �` c=�'z'b� �� Q�imney Construetion � � Pilot Make Pilot Model Smoke Bomb Wiring Pilot Ttming �� ` Droft Test Tao�=, L.W. Cut Off Door Pressure Lighting InsT. �� Pressure � ` '• Psrcent CO �� Daee Tssted ° � � 2 -� g Input CFH ��'@ Parcent OZ � Company Testing �� Stack Temp. •� ��=; Pareent CO '' � � Name of Tester Form 235 � � � y� � r p � � o � • � s • M . � : � � � � � � ~ y pz � � x� z x � � w � � $ � � � � � � o L� � �1 � � �o �' � �� 5 � � � � g „ � °' � � � � � � � � o � � � p �o � p y �I O � O � � � � r � �: w � �• � . : � � . : � : : � : F.., x x , y" : ii 64 PC O M?! iC iv it iC k O C" : �pi � �p �+�J�p � ,�pi � ►&°. ,t�rP � �o � ; O � O � O � O � O � O � [�7 N sn H► iN tR t» W W 0 I � � � � II" � m � � � D � � D -� m �^ ` I m C r m � � 6+tl p � y C" G C. � J � C � � � � z w � � o � o � y � .. :' �o � b' w � o S �. < x 0 00 � � I c �• � I � � I � Z� 0 I m � 0 � r .�■, .■, � , : : �� ■�■, • -��, � � I � M I ]❑ � I N a a � � » � btl n � � p � � � � � � � � � � � � . uosen uaiw� M� � �� SINKS TAAr$ DRINK. FWJPIT. SlIWR4. � �� GTCM sASINS AIJTQ WASHd � � RANGE o� OPENII�S � • Z • N � A r@ � !' � a'� a �� . � � � � ,� �� b �� 'd �f 4� (D �p - :: � � p �� o � � �� o � � � � a, w � �a�� a�'�o �� ~ �� o �� .. A ]. � 3� � � N � �� ° � � M � � w rrn � � � � O � � � � � � m � � �! �. o � � � � , � �J't W 1 � � � � � w O � , T� sue�ecr PERMI City of Fridley 12360 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � � � R IPT NO = = � � ; L _____ COMMUNITY DEVELOPMENT DIV. � �� r � ; PROTECTIVE INSPECTION SEC. , � r��1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV �""� � ,�� 612-560'3450 910-F15 �-��-%�% � � JOB ADDRESS 7527 Ha es STreet N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 2 Don' s 5th Addition SHEET 2 PROPERTYOWNER MAILADDHESS ZIP PHONE Cathr n R. Berntson 7527 Ha es Street NE 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO. Lakeland Brickla ers 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 EIdGINEER MAIL ADDRESS ZIP pHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW � ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 9 CHANGE QF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. b11CIt THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 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 CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ypLUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPIIED. y�`1 � SOO .%S WITH WHETHER SPECIF�ED HEREIN Ofi NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 9� OO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. - PLAN CHECKFEE TOTALFEE 9.75 SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT IDATEI E PROPERL ALID D THIS YOUR PE MIT'�.{ C� � � /o � �� C2�� v �7-� SIGNATURE OWNER IIF OWNER BUILDERI IOATEI BL P.?�' =;;, - q�� t�PPI,Ti;ATION FOR RL5IllENT1AL, ALTEIta'1'Ii?�V, UR �1i)UI'I'I�1�` �UILDING PERMIT C I'1'�' C1F 1-1:1 ULL:i', �11 NNESO'�� AWN�i � S NAME : � ��, ��° �-� BUILDER • ��+C.. �Lc �� _ �' ,ADDRES S : %� � % //cr.�.�,eo ,� /�/ �O` ADDRES S : �— NO.. � STREET: L0� : � BLOCK : � 02. ADDITION : �-a-v�o .`j �` Q��c �:�. CQRNER LOT: INSIpE 1.OT: y�. SETBACK: SIDEYARD; Applicant aCtach to this form Z�ao Certificates of Survey of Lot and proposed bui.ldittg location drawn on these Certificates. T �ESGRIPTIUN OF BUILDING To Ba Used As; � � � Front: Depth: Height• Square Feet: Cubic Feet: Front; Depth: Height: Square Feet; Cubic Feet: Typ� o� Construction: �- p� __ �,o.�a�.e,�, Estima.ted Cos�:_$ /,.� D o�° , �, --�.• , To Be Completed: �/�--w / , / 9 %3 The undezsigned hezeby ma.kes applicativn for a permit for the woxk hereit� specified, agreeing to do all woxk in sttic� accordance with the City vf F7'idley Qrdinances and rulings of thc� Uepartment of Buildings, and hereby deelares that .;11 th� facts and representations stated in this application axe true and ��urr.•c t. DATE: fQ _ /% %.� SIC;yATURE: �� ,,t__, (Se� Reverse Side For Additiona.l Tnformation.) -��, � . �s �� r, � . w BUILDING !'�Jt�"��1'I' ]�� 5Ct-1}:llUI_k: S�GT�pN 2. The tnspect��r �st B�ii.id�n,�s shall, before issuing permits for the exeCtion of any buiiding or strur;:��re, ar .Eo� any addition to .�ny exi.sting building ox structure, or For ..uiy .�lterati.on or r�pairs to any e�isting huil.din� or structure, upon application L.lierelorc:, r�g�,irc the payment by the appliaant fox such permit of tec:s tc rh�� ;�mount hexein below se� forth and in the manner hexein provided to-�•�it: UNI�ORM BUILDIN� CODE: Type 1, 2� 4-$2.15 far each onc: thousand cubic faet, ox fraction ttLE:reof, in such cubic��l contents. T�•p� 3& 5- $1.85 for eaah pne �housand cubic feet. :1llllITIONAI, tVPORr1ATION F'ox the purpos� of computing fees f�i building permits, the cubical contents of any buildins� or .zddition, is detennined by multiplying �he ground area Cc�V�7:�d fxom a point six (6) inches below �he floox line vf the basement ox �h� �e11a� to tl�� average heiKhts of the upper surface or to the average- hei$'ht �£ ths roof surface of ttie main gable of a pitched roof. FOx' xapaixa ox al.te7:ativns to an existing structure, the �ee shall. be at the 7Cate o� $3.00 per each five hundred dollars ($500.00) ox fraction thereaf in the 6os� af all proposed work. _ ;" " IA AG aase shall the fee chaxged for any permit as set forth in S�ct�on 2 be 1e�s than $S,OQ. VERIFICATION OF FOUNDATION NQT'�E �'�sxmits ior canstruction will be issued a minimum of 24 hours from the t3�ae o� application, to allow for proper review of the proposed structure and ot the cotistxuction site. A Gertified Survey of the lot, showing the location of the foundation, once i,t haa been eonstructed, will be required before proceeding witti the framing. �'GRTIFICATE Ui' {7CL'UPANCY Applieation for a CerGiiicate o� Uccupancy shall be made ten (10) da.ys prior to Che u�e or occupancy of any structure for which a building permit has been �.c�8u�d; and s,iid s�ructure sha11 not be used or oceupied until a Certificate oi Qccupancy has been isaued. � a� ,� ° . �-- • City of Fridley r 4T TMR TOP OP TII� TM�IN� i � , rV-'°�--� GOMMVNITY DEV[t.OM/ENT OIY, � � � MOT�CTIVR wf�CT10N Otr'r, � � prr �� siuo�Rr �M�� .--- � ....J`.� `d M�-eW-s�s0 �on eaaresa ner Contractor Rind of Bui 53-84-s-91.5. 51 i��EGT 7527 N. E. �ayes Street Cathryn R. B�nson on yate 5-80-7l.� i I j; . d � ' 3 I ' %�� PLUMBI�Vr, PER��IT APPLICATI��J ,aaress ress �3� frh�6FcC�UE�TE A s e �. . Res. stimate os � ��9 . io,00 Plumbin Fixture Rates: N0. RATE TOTAL Number Fix tures x $2.00 �_ Future Fixtures x $1.50 New Fixture-Old Open. x $1.50 Catch Bastn x $3.25 Water Heater-99,000 BTU x $3.00 Ground Run Old Bldg, x$3.25 E1ec. Water Heater x $2.00 ?as Fittin Fees: lst 3 Fixtures x $2.00 Additional Fixtures __ X $ .75 Gas Range-199,000 BTU x ,55.00 tepairs � Alterationa I See IDeacription; Install G�s �rill �ode „ 5.00 � tate Surcharge Cras�' �A°� �urcharge ,�0� • 50 TOTAL FEE $ 5•5� ndersigned hereby makes application for a permit he work herein specified, agreeing to do all work . rict accozda.nce w ith the City Ordinances and rulin e Department of Buildings� and hereby declare that he �acts and repxesentations etated in thia ca�ion are true and correct. �° . = ",,� �a% �i� � �:dt�� - nature �.�GA�' Date • f � t�+ h� r [• G� � � � w iQ ?u A tri W O 71 � µ w� p P� O W G'C W a r m h+ G m � �� R R e a w �* o m a n s m �p M� M W W � O F�� O O�O m F► � <� �t 5 rr H. M 1�+ W W re r� fp M a m m w a M r,. a►e m��o ,� � r K m M m pt e to m �o r r 6 a c a m n r m m e K M � � m w m a r° m m°" m a a � o n� a e a a M z m °�i y '�'' � ~�o w� M s m 8 M �7 'C h0 G � r p N m � 5 9�e' G O y m � h � m ro d N �0 b a� w y K � t�! m � O M � O "- b 7 tZq r a ro a N N N N N N N N fI1 N N N N tn o � r t�l O O N �I 1,1� N� U� y� yi A f+ W y� . . . . . 0 0 0 0 0 0 0 0 o O tn �n o 0 0 0 0 0 0 0 0 0 o O o 0 b r dy z c� tin H c �n° � Ct1 N � m N Sm 2 C O r 1�7 � y � N N N N t/! N N N N tI! V! N N N N N � Q ►�-1 p� o r ro� N� �3 'h N � �� O H� � �� n� M �� ro � � H N �.�� N 0 'a o �o J ro � 0 � i� � � � � � M y ro e �N m � � 0 c � � � w $ 1-' i0 ��tpps Z W �O � I � �, � 1 � � � � 1 � C Mr M n � � H O ��p M H 0 � �� m v � y � � w � � ° M aN F' Storiea : �e �r a a eO°+ � o z � � closets � � Oiinale �i �° � � Hath Tubs m �a � Basina 0 a � � sinks ,��, � Wash Trays � � Drinkinq Fountains Showers � Floo! DrHi �$ CBtch o Basins � Autamatic � Washer � Gas Appl. Misc. Fixt � � Gas Ranqe n � h Other � � � �t � � y � � w z v �°o C Mr M L� � �a� � ��b �p M 1Cy W fD M l�1 F+ r G t�n rOn � �aa�a r�� p fD 1 M R p'r�i�� a om "' M IE 7 'C Rt ►�0, m �c a � �� '� ° g m O � �' OHi f0 R ~ W m � � M � W � �w5� � :� wam w a w rr w � xme� F� � R � � M � � O � a�"�� a3 o�m� y G� E n W o � ►+ � M �� . w (a,' rn► '� � �n�x � Srah $ � n 0 tr � � � m � �' n I` � �b � � r C') a � 0 Z � O � "O E �' 3 —�-1 bD -< C+� O T D Z C � G1 a c� N � T � � 2 G� � m � r�'r rt � M C � � : � � a � SUBJECT City of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T i � � � � 1 v_____ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. i-__-� ��"" �,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE i 612-571-3450 9t0-F15 6/18/84 JOB ADDRESS 7527 Hayes Street N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. 1 2 Don's 5th Additi:on 2 PROPERTY OWNER MAIL ADDRESS Cathryn R. $erntson 7527 Hayes 3treet N.E. 3 CONTRACTOR MAILADDRESS $3IIl@ 4 ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER MAILADDRESS B USE OF BUILDING Residenti.al 7 CLASS OF WORK 8 DESCRIBE WORK 9 CHANGE OF USE FROM ❑ NEW ❑ ADDITION PAGE OF � � PER _ 1756 EIPT N � �� APPROVED BY SEE ATTACHED SHEET 784-0861 ZIP PHONE LICENSE NO. ZIP PHONE LICENSE NO. ZIP PHONE LICENSE NO. ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE TO STIPULATIONS P�ovide a�ower vent �an if no wi.ndavs axe located in bathroa�. Provide fire alarm in lower level of residence. SEPERA T,� PE�I�f �,� HEATIN�. P�UMBtN�(; : ��[�� E�R �SI�R��Q ��GNS. SEPARATE PEPMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORI2ED IS NOT COMMENCED WITHIN 80 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. UN I HEFiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �' AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �S`3OO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $],rj.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. OF CONTRACTOf:OR AUTHORI2ED AGENT (DATEI t�'� �Gc/G�vv/L-�'/` � % 6 � Q 7F OWNER iIF OWNER BUILDEFii IDATEI OCCUPANCY GROUP OCCUPANCY LOAD S0. FT. CU. FT. OFFSTREET PARKING STALLS GARAGES SURTAX $ . 50 SAC CHARGE 'AL FEE $15.50 HIS IS YOUR N� [] City of FridTey Effective 4/1/8� ADDN. L 7 r_ R-1 AHD R-2 pLTER. � Building Permit Application Construction Address: � S� 7 'U�'° �' N� Legal Description: °�� ``� ��°�" °�°� � Owner Name & Address : �z�-�� °'`"'�""° � Tel. #�%8 y' 0 8'� / , Coatractor: � �^�`- . � Tel . # Address: LIVING AREA: GARAGE AREA: DECB AREA: OTHE :R Attach to this application, a Certificate of Survey of the lot, with the proposed construetion drawn on it to scale. DESCRIPTIOH OF II�IPROYEMENT Length Length Length ��A /�a-�-� �k Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. �4� Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setback Type of Construction: Estimated Cost: $ �� Approx. Completion Date: Alt. A Alt B Propoaed Driveway Width If New Opening Is Desired: � $ See Baek Page for Explanation DATE: -..'�`� —/�' Jy �' APPLICANT: �%� � Tel. � ��y�� g6 � U CITY IISE ONLY Permit Fee $ �� Fee Schedule on Reverse Side Plan Check $ "�� 25� of Building Permit Fee Stat� Sureharge $ �� $•50/$1,000 Valuation SAC Charge $ $425 per SAC Unit Park Fee $ Fee Determined by Engineering SeWer Main Charge $ �e�� Agreement Neeessary [ ] Not Neeessary [ ] TOTAL $ STIPULATIONS: ° . L / � ` � �� - ''� . - �; 0 r1 , ` z �%�� BIIILDING PBRMIT FSE SCHSDIII.fi The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to anq existiag building or structure, or for any alteration or repair to any existing building or structure� upon applicatio n therePore, require the payment by the applieant for such permit of fees to the amount herein belot� set forth and in the manner herein provided to-wit: Total Valuation �1.00 to �500.00 Fees ` / $10.00 (Minimum Fee is �15.00) �501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each additional �100 or fraction thereof, to and ineluding �2,000. �2�001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for each additional a1,000 or fraetion thereof, to and ineluding �25,000. �25,001.00 to $50,000.00 �170.50 for the first �25,000 plus $4.50 for eaeh additional $1�000 or fraetion thereof, to and including �50,000. �50,001.00 to $100,000.00 $283.00 for the firat $50,000 plus $3.00 for each additional �1�000 or fraction thereof, to and including �100,000. $100,001.00 and up �433.00 for the first $100,000 plus $2.50 for each additional $1,000 or Praction thereof. DRI9EfiAY DEPBBSSIOA ESC80ii (Concrete Curb Streets Only) Alternate "A": Removal and replaeement 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 approaeh With 6 inch depth - Driveway Width plus 6 feet times $15.75 9ERIFICATI08 OF FOIINDATION Permits for eonstruction Will be issued a minimum of 24 hours from the time of application to a11oW for proper review of the proposed structure and of the construction site. A Certificate oP Survey of the lot, showing the location of the foundation onee it has been eonstrueted will be required before proceeding With the framing. .... _ . .. _ �. =--�--'—�--7---}--� -1--�- � i - r--i---- ----r---- - �-- � � - • ! . i i � � � � ; � � , --� -jy+ ��_ ---s—l--�- � - ' - - , � � , _ . . � ; = : � , � � . �1--� '—� _ , � _. , � � � a __. , _ � i ; , -��'- � � � ; - -- ; c�- _! __. ,� �� --.,'---� - - �, � � � ; zT _ _ , �,� � � ', 1-�---;--�--;-- - -�'7 -1-- - ; ' '� ' ��-'=� ' : • , j t . ; �'� � t I� I-�� - � j �-�.�, � _ E '� : _� _ ' � � `t= �' , � � _ _ — -�- -- - �..�,.� .-- A `� -� t I � � � , � �,' � ,� � , — � , � >> .,�,. r � i �-- �� v i , � f. . _ � � -�--�__T_-- __. �_ i I_� i - _ -- ° � � ' . , i - � -- . ' --} ' -r-- �- _. . -- - ' � � r � i i � .�.�• �_ � �— _ , , -r-- ; � . ; ' r �� , -�-r- , � . � _ � ---� ` . ; , � -� _ —.--�---.__. ; , - --�- � - - � - � _ � < < . . ' __-�-+- _ � � � � � . � r - - i--• I I 1 , � � �- . 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I . __• T--�--: _ I y� ` � 'i � f+--� �--rt-r- i -i-+- -+---� 1 � i I � ' � �T�` . ~ -�-7 Y-�--%-� _ • -. � ' i i I I , ' � . I i i I . --�--�-- +--�- -. r ' � � ' � I � ' 1 � � � ' � � � , � � , ,� ' ; --}-- �--- �- --j- 1-- - - -- � �� i{ i�� i � I `, j i� � I . � � � •--+�-+ ; --r�---�--r- � ��T-; F i � �--f-•_-�T. i � I _,_� --� --�_ ._.._ _ , . ; , ' , , i---t--,--rt-- � i . I —i-- �-----1-1— — — - — —� — __� � r � � • , I � 1 ,--�-_.�- I -i- i � � i , j � � � ' � , --�_.._,-' • �� , ; ! � � � � , I � � I { , � , , -'-- �--; -;-- -- - i � i � ' � ' + , ' � � � ; i i—�--�r_1--. _.1—.r c ! ..—-� -- ! � : � i i � ; � , ��~ 1 , , , , �-'_1 ' `«---- ,--• ,__;___�--. � � , , � ':, , ; —' � . r I , ! �--!--- i -�-f / � i � i—�— j . —. __' . _ � i 1 i ` I � �,, �- T?I i _ i � i � ; I f � � i I 1 � j ! 1 ; _r'__'_- . ---�-____-�{-_-� r---T- � —L�-1_�__.. _i__� ..1 SuBJECT c�ty of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T i � � � � ; y ___.. COMMUNITV DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 1 = � � �'�'1 � CITY HALL FRIOLE� SS432 NUMBER REV DATE �""'� � �'' 612-571-3450 g�aF�S 11/20/97 JOB ADDRESS 7527 Ha es Street NE t LEGAL LOT N0. BLOCK TRACT OR ADDITION DESCR. 1 2 Don's 5th Addition 2 PROPEHTYOWNER MAILADDRES$ ' 21P Mike/Joyce Quesnel 7527 Hayes Street NE 3 CONTRACTOR MAIL ADDRESS 21P Tabor & Sons Inc 3716 St Francis Blvd, Anoka, MN 55303 A ARCMITECT OR OESIGNER MAIL ADDRESS ZIP 5 ENGINEER 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW MAIL PAGE OF / / .YtliMll NV:' , 25697 RECEIPT NO l �f� APVROVEO BY SEE ATTACMED SNEET PMONE 780-3922 PNONE LICENSE NO. 789-1902 20014248 PMONE LICENSE NO. ZIP PHONE UCENSE NO ❑ ADDITION ❑ ALTERATION �7 REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (19 Sq) Tear-off 9 CHANOE OF USE FROM STIPULATIONS TO Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY (3ROUP VENTILATING OR Alii CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTpUCT10N OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFS' I HEFEBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS,APPLICATION 1 AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PqOVISIONS OF LAWS ypLUAT10N AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OFl NOT. THE GRANTING Of A PERMIT $1,584 DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �S1.LS �,�'� PLAN CHECK F � =� �� .��a /�° �� - e `�° e SIGNATUiiEOFC NTRACTOf70RAUTFIORI2EDAGENT IDATEi ...�.� � STALLS SC .00 LY Vq�l ATI .� i , ./� / . NCV LOAD CU. FT. � PARKING GAHAGES $.79 1C CHAqGE Fire SC $1.58 )TAL FEE $58.62 THIS IS VOUR PERMII y r�w ADDN ALTER [] [] [] ConstructionAddress: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/97 ��1 � �� Owner Name & Address: ��f `� �f- � ,� �'� - � �°�. n• L a� ��, G��a-y�` Tel. #�xc� - 3e� � Contractor: _ / � �Z �� ,_,�-2�. � MN LICENSE # � ��'� �� '"� Address:_� j� � � ,�� ` � Tel. # � � ,� -r�-� '�<� �—�� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECB AREA: DESCRIPTION OF IlVIPROVEMENT Length Width Length � Width Length Width Height Sq. Ft. Height Sq. Ft. � Hgt/Ground Sq. Ft. OTI�R: 1�� y��-�-�� --, �� -� �a � ��, �� Construction T e: � - y,� �� f`�' �� `rO� yp -�.s.�L-e �°�� z,�s� Estimated Cost: $ � � � (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ , DATE: ! �.� � C, -- "1 '% APPLICANT: � �,��i' �:� ��, Tel. � �- ��, /�L-{ ,� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ a� � $ �a�� $ �i �'� $ CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $950 per SAC Unit $ �, F;'�� $5.00 (State Licensed Residential Contractors) $ _ Alt. "A" or Alt. "B" Above $ $. $ $ ��t�� $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 4: � r. BiJILDING 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 $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75� for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5012.25 for the first $1,000,000 plus $2.75 for each additional $1, 000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "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 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 structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. s . � D �� p a � co a: � � �• � � � N. � O N 7 n � � o � � � 0 a� 0 �•-� �� d � A fD � Q O � � �' � N �G Q- o � � � fD a . � � � 0 c � n v v 0 � a � � 0 C O�i � � 0 � m � � � 0 � m � � � � m z � � n --1 O Z � m m E!� -P V 0 0 � _ � � � � aa� � fD a � � 1 � v � � o U�7 � � � o, � d � c=u o, � rt D �+ � °' c�' � m 0 � O 1 � o � D N r N m � m � � � 00 m � � � � � � . o Ci _ � z c� r('�,J .� ;�S �� m �� `, � ��si-,.� � �-�' � 'r�.�-rn � -. � y _I � � � � � � � � (�D � p � h o n, � � °-�-'. � ma y. O �D � �U <D � N � � � � _' � a s � � o � a �n Q � �•go� „q, � a' � �' N' pl d �. � N a � �'o.�-�a �?� �. m � � � � � � A � fp Q A ""ti � A p O c �, � � N � � -a ? N � f�D fl. � � � � �, � o r+ � _.,, � �, o � � — �- ,.* :-t ? CD �' �� o v o '' � �' c=D N Q N � � ?. � D � _ � Q °, � < fD � � N � c m m �� . 01 D �� N 'p Qo o�� D � � �� o .�; �o � N � r � -� 0 Z W D c� � � D � C7 0 n; o' � �� 0q � � m m G� 01 N v m � G� L� D �'I e�D � fl1 y 1 fA fl1 � � '� n 3 � -o, v_? m � .« m p�p � n�—i cn ci �- �� < � m � � � � � � Q . > > o � .« Q � � � T 0 __ a � o � c�i � � � � < � � ao � o � � � � ��v W � � � � � � � � � � � �» N � � � w cn o 0 0 0 o° o° o° °o °o � m � tfl t� 4� t� � � � 0 8 r C W � m � � � a N Z � � 2 -D N N Z O v � � —�I � O m � — C � o z= � � � �' � � � �c _ � y _ - � � c) � A n � o p > > � fp ,-nr ^ � � �- cn m .� Gt �t7 � � Q � Z � O � 2 0 � � v � 0 � � v m � -� D � m v n � � -� .� \ � m � � � z O � �. � W c r 0 z � C � m 0 � � m N c'i _ m v C r m O � � O W m D w. cn-nrnCS' v �. .� — N a W � �� C � O � �3�•� Z m � �� v W < � N cu Z z� m� m n � O z � � a � � z � r � -�i � O �Z m� �O �� O� Z� Z � v .� a� � oN vz �v o= Z m a � Z �� n m0 N O aZ � vm vz �� ci � NO Z � fD � <' m O � L N _ c � � r N O O O r� � , ; COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and flrestopped where required. Yes (� No () � The venting system is plastic/PVC and meets all current codes and manufacturer specfications including sizing, length, number of elbows and termination. Yes �j No () The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. The existina combustion air is sized and installed to meet the current codes and manufacture�'s specfications. When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturers specfications. Yes� No ( ) Yes� No ( ) Yes (� No ( ) When installina a new ventina svstem, the undersigned hereby verifies that it is a listed assembly and meets the cuRent codes and manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes� No () Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes�,(� No ( (� A�pliance Tvae and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat ' Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances � Total Btu Input Common Vent Type Vent Height Diameter inches - -- — - ___ — _ _--- - — - - - - - Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Conneetor Height ft Length ft Diameter in Type ALTERATIONS• (Describel HEATING CO: Signed By: � �2 ��a� �,.; -_;,., , A�'�6tA� N'PW� '�, ti:'-�� xl Date �=�% - �� . � � H�►�eN� AIR CONDITIONING AND ELECTRIC, INC. ADDRESS i �L7 1 �g< <� � �• OCCUPANT ' I ZGe� Qf��S nP� HEAT LOSS DATE Cfi INST. SOLD BY r Electricel Work By ` TYPE OF HEAT GA FA,j[_ HW STE SPACE HTR. MAKE �/l✓ � 3 � �f 1% s�T� `� Nbdel �—^ � Serial '2i90D �� INPUT . — - - _ CONTRQLS THERMOSTAT Heat Plug � Value �°i/ ~ v r Limit es �t �t?f,fl Limit Settin Fan Seron / � Pilot Type .� � Pilot Make Pilot Nbdel PiloR Timing_ey(,�.s�'L L.W. Cut Off Pressure �„� �� e� Percent COZ � o A Input CFH � d��! Percent Oa�O StackTemp. •�S� PercentCO f.� � tl HOUSE HEATING TEST RECORD APT. FLOOR CITY � � SUBURB OWNER 1 t INSTALLED BY r Gas Line By /Z UNR HTR. OTHER CONVERSIrJN ��I Vent Size KIND OF LINER SIZE y NONE 6raft�lood — `- — F�egu�ator - _ — _ Filters Size Number Ghimney L�on Inside � Outside Chimney Construction � � �'Crr � Smoke Bomb Vlfiring .� Draft �%") Test Tag � Door Pressure Lighdng Inst. a( Date Tested �d _ , Company Tesdng � Name of Tester � Pressure Percent COZ Input CFH Percent OZ Stack Temp. Percent CO ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 iJNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 r'AX: : 7527 HAYES ST NE : 123024120005 : DONS STH ADD : LOT 1 BLOCK 2 : BUII.,DING : RESIDENTIAL : RESIDING 571-1287 _ _ � PERNIIT O.: 200400757 DATE ISSUED: 05/21/2004 VALUATION : $ 7,380.00 NOTE: PER R703, 2000 INTERNATIONAL RESIDENTIAL CODE, REQUIRES THAT A WEATHER RESISTIVE BARRIER BE PLACED OVER EXTERIOR SHEATHING TO PROTECT TI� INTERIOR WALL COVERING. EXCEPTIONS FOR THIS PROVISION WOULD BE IF SHEATHING IS AN APPROVED WEATI�RPROOF PANEL OR WHEN TI� SIDING IS AN APPROVED WEATI�R BARRIER VINYL SIDING IS NOT A WEATI�RPROOF COVERING UNLESS THE MANUFACTURER STATES THIS IN TI�IR APPLICATION GUIDELINES. CALL FOR INSPECTION OF WRAP BEFORE COVERING OR TAKE PICTURES. RESIDE HOUSE & TUCK-UNDER GARAGE. STATE LICENSED CONTRACTOR 1 APPLICANT WII..LS GREG EXTERIORS (20037840) 4246 ROYCE ST NE MINNEAPOLIS, MN 55421- OWNER QUESNEL MICHAEL J & JOYCE 7527 HAYES ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing tlus type of wor� will be complied with whether specified herein or not. The granting of a pemut does not presume to give authority to violate or cancel the provisions c� any other state or local law regulating co tion or the perfo wc of conshuction. A�5 licant Date Bldg Insp Dat � � � BUII.,DING PERNIIT FEE FIRE SURCHARGE STATESURCHARGE,VALUE LICENSE SURCHARGE TOTAL PAID WITH CHECK # 8478 SEPARATE PERMITS REQtiUIItED FOR WORK OTf�R THAN DESCRIBED ABOVE. 153.25 7.38 3.69 5.00 169.32 NEIN [ ] ADDN [] ALTER [ ] Construction Address: 7� CI7Y OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION �� EfFective 4/1/2004 (763) 572-3604 Bldg Insp (763) 571-1287 Fax �� '� Legal Description: Owner Name & Address:.e�.� � T�'�+G� � � �� ./l/�!� Tel. # Contractor. �,�� i�i^`l� � ��'T� � t � �.� � MN LICENSE # `�- O/� ✓ � � �� Address: �-%a'�%(� D�e.� �`,lJr� ,!ls��.S .,��) �,�Tel. # °7 b3� %�'�'�D�� % LMNG AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certific�te of Survey of the lot, writh the proposed construction drawn on it to scale. DESCRIPTIOId OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Length Width Height Hgt/Ground Sq. Ft Sq. Ft Construction Type:� ( �Si�J��'�i .�G�iT r.�Estimated Cost: $ � ��'� Drivewray Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ DATE: APPLICANT: _��.�P/ � Tel. #�,� '"%�� %s�/ Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL � ��.� 9 as� $ � m , � .3. �9 $ $ A7 -� $ $ � $ $ I�9,3� CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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: BUII.DING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the ere�tion 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,Q01 to $25,�0 $25,001 to $50,000 $50,001 to $100,040 $100,001 to $500,0� $5�,001 to $1,000,000 $1,000,�1 and up FEES $23.50 $23.50 for first $5� plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,�0 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional$1,000 or fra.ction thereof, to and including $50,000 $643.75 for first $50,0� plus $7.(� for each additional $1,000 or fraction thereof, to and including $100,� $993.75 for first $100,(�0 plus $5.60 for each additional $1,(�0 or fraction thereof, to and including $5�,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,(�0,�0 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal a.nd replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined rate 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 construction site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onlv - � � Building BUILDING Permit Ivo.: '( � v Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY vate xec'd: �'�'0� 763-502-4977 FAX EFFECTIVE 1-1-OS DATE -� � S�U � YOUR E-MAIL ADDRESS SITE ADDRESS 7�a —J 1'� �Vi-Q S .� � THIS APPLICANT IS: ❑ OWNER �iCONTRACTOR PROPERTY OWNER/ NAME: Pi (� TENANT ADDRESS: % �� C� �..5� CITY /� / STAT�/�-�ZIP �� PHONE: �C� �„ %�i� — � � � �— NAME: 5 P R CONTRACTOR ADDRESS: LtJ � �O �SluY� ��i/ CITY�. �.s' �� -YSTATFl�'✓%�IP S3^S�� SUBMIT A COPY OF pHONE S�- �/ S�- �a a L� FAX �'L �� -`�,v -��% �� YOUR STATE LICENSE STATE LICENSE # Od �� EXP DATE .��3�� "j PROPERTY TYPE �INGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑�DI1'ION � GARAGE/SHED � WINnOWS ❑ BASEMENT FITRSH J�-ROOF ❑ DRAIN TILE � DECK O SIDING ❑ OTF�R ❑ SWIMMING POOL TYPE OF WORK: � NEW HOME CONSTRUCTION � ADDITION � MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: TPr. i o�� ?st'iu� `jd,��„p SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ Ff ROOFING � HOUSE ONLY BpSEMENT REMODELING SUBMIT: NUMBER OF SQUARES � ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACFIED GARAGE 3. List af structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl OSofiit ADDITIONS_ & PORCHES SUBMIT: ❑ Aluminum 0 Trim 1• Site P(an/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plaos WINDOWS 3. EnergyCalcula6ons IN EXISTING OPENINGS ❑Yes ONo LOCA7'ION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINBOW TO BE INSTALLED NUMBER OF WINDOWS ALL r��5 AKr: BA��ll UN VALUA"l lOI�I, 1NCLUllllVG "1�H�: C057� UN� LABOR ANll MATERIALS: TOTAL JOB VALUATION $ �% , 3��ING � 19�7 j�B� S� CCUPANCY TYPE Pa�� Permit Fee Plan Review Fire Surcharge Surchazge License Surchazge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ '�3.�5 See Bac�C Page for Fee Schedule $ 65% of Building Permit Fee $ , .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ r ,p� $5.00 (State Licensed Residential Contractors) $ $1825 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$21=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ I l_�0 Make c6ecks pavable to: City of Fridlev Attach 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 Construct' n Code 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 accor ce wi e r p in the case of al I work which require � review and approval of plans. SIGNATURE OF APP N PRINT NAME �-P� DATE� � APPROVED BY License lookup s: a�y", x � � ■ � ConstrucKion Codes � Building Codes � ElecVicity � Plumbing � Boilers/HPP ( Residentlal Contractors License Detail Here are the details for the license you are currently looking for. Llcense name: SELA ROOFING REMODELING INC License doing business as: License addre.ss: 4100 EXCELSIOR BLVD Clty state zlp: MINNEAPOLIS, MN 55416 Llcense number: 1050 Llcense type: RESIDENTIAL REMODELER Company structure: CORPORATION License status: ISSUED Llcense orlglnal Issue date: 12/9/1991 Llcense explratlon date: 3/31/2009 Quallfying person: PAZ . SELA Cont(nuing education hours required to renew Ilcense: 7 Contractor's phone number: 612-8238046 Enforcement actlon: No Page 1 of 1 searchfo� 0 https://secure.doli.state.mn.us/licensing/licensing.aspx 5/28/2008