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AF - 47160City of Fridley, Minn. BUILDING PERMIT Date: .........�._� ��._�r.._.`..`.:..---� � � /� � ,�_.1�"��w... Owner : ....._�..- y�/_-_...' : i.:�-.......... Address....._ ............._...- -.................................----�•-�-----��--�--......._..........---�•-•-�----�-�--.... ,' � ' I Builder.........-� .. ....... ...................._...--�----...-----...... _............._............._.........._._........ Address... ........ -- .........�i��.�. ..:�.� .--.�.-..--�Jf• .....:........_...............-----...---...---��- LOCATIO� � ��}L,QING % � r � � No. .�I._.� .....:......... Street .-- - --�-�--��-....�.��....�.... .............. ..�........... .. i�/....... P Lot ......_.. -��- •---•---_...:. .. ....--- •-----.........L.._.._. --- • ,/ -- . �' Lot ..._p�.�-..._.._.._ Block ....................f�?....._................... A dition or Sub-Division ��.jdG� --,r...--_� ...,�.�-�1 � .. ... � � � Corner Lot - ... - -.... --- ..._ Inside Lot ... -- -.._._ ................._.. Setback .._.........'. :�!'........._......... Sideyard .........,%r.�................_...........- - � -........... Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To e . iLal�/, ... .... ... � . : ...... Front G� ... .......... Depth ..�..�. Height ..._....,�'�� Sq. Ft. �.��.�.....�� Cu. F� ,l�.....� ._� .. ......._. 1...._... F � .............. Depth ... ��.� eight ��f �..... S4. Ft. ..�'�..�.... Cu. Ft ��..- .� Type of Construction ��^�'�' ._.. Est. oat _ ��"...... To be Completed �-- ....................--......................... In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed woa�k in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. , �-� , �,� In consideration of the payment of a fee of $�:_;,� ::........................ permit is hereby granted to............._...._......_..._..... ..__.____...__._......._...._..._..._.__._.._ .............. to construct the building or addition as described above. This permit is granted upan the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, "r and moving of buildings within the city limits and this permit may be revoked at any ' po 'olation f any of the provisions of said ardinances. . 1 . " t '• , ;r�,,� ` �'`-?r ,�,E ---.... Building Inspector NOTICE: This permit does nof eover the wnsfruefion, insfallafion for wiring, plumbins, gas heafing, aewer or waNr. !s sur� fo ses the Building Inspector for separafe permifs for fhese ifems. • � 4 • _ � APPLICATION F0� BUZLDING PERMIT.. � CITY OF FRIDLEY, MINNESOTA Owners Name �, %1/ILL-//�M �iQ/q%�'1�/� Builder O w%V�'^� �ddre�s� ��/` lf��/YG' �'�- � f��. Address , , LOCATION OF BUILDING • No.--��j� � - ,, Stree-� _ � Part of Lflt . Lot Block ` Addition d� .Div. Corner Lot Inside�Lot Set Back ,., ) Side-Yard �C�' ` � � ��'Gi�.�, i, ELEVATION FOUNDATION ELEVATION ��pplicant attach to this form Certifica.te of Survey of Lot and propos�i building ior.��.tion. _ DESCRIPTIOld OF BUILDING �_ _ . To be vsad as: � • : l �-.- f Front ► � Depth � Height � �. ; . `,g, �'ta ,�� ,. �iCu. Ft. �.� .. � . ---��`-- - �t�� ,� Front / � bepth Hei�ht � .� S�o Ft.� Cu. Ft. � p '��%i� Type of Construction� %%`� � Estimated Cos.t,�� - _ ;`. To be compi�ted ` � % �O % ` . The undersigned hereby makes applia�.-�ion for a permi.t for the work herein specified, agreeing to do all work in stric� accordance with the`�ity Ordinanees and ruling of �;he PepartAent of Bui�.dings, ancl her.eby declares tha.t al1 the facts and representa- � tions stated iri'this application axe true and correct. .. � DATE �/��/ G � SIGNATURE _(� � !�'� �./22t'/!'I'wL_- --- (A ScheduZe of Fee costs can be found on the Reverse Side.) � � --- ,�:.�.�.. � � � • � � � �, City of Fridley, Minn. N° 8496 BUILDING PERMIT Da�: _._.--.s�sm�r2.�.,_..ls�. owner: __..Rosalie Cram�er _.____ Buiiaer _._C. T�hu. Gramer..�_�____..._.._._._.. _ Address _._. �l 1 Hal �nA Pl a��I..E..:.___._._.._.._._ Address __�i�_-....�.9.�'r AYf�11e _.SS3ll�_.I�� LOCATION OF BUILDING xo. _31�._...�....... s�t —Ha]..�__Pl.�r�� H.E. �....._.._...._.._.._.__ Part of Lot Lot ....._.._..._..__.......__ Block _.._......._....__..—.._.__._ Additiaa or Sub-Divisf� ._�_.._._...�. Corner Lot __________ Inside Lot ._.._.__...._..___.___ Setback _______...___._.._ Sideyard Sewer Elevatiaaz _._._�..._._..__._...._._ __._...___._ Foundation IIevation ._ DESCRIPTION OF BUILDING To be Used as: f%ar' Porch_._____ Fmnt _�12 �� nepth _. 2�' Height . 10 t..._.. Sq. Ft. �80 Cu. Ft .��. �__.Y.._..___.._.__.._...._ �ont .._._..__..__ Depth �._.._� Fieight .._._.._..._..�. Sq. Ft. ._.._ Cu. F'k Type of Constsuction _�___.._...�.._.._._.�..__.. Es� C�t _.�,s-��.� �____._.._ To be C�pleted _..._.. In co�sideration of the issuance to me of a permit to construct the building described above I agree to do th� proposed work in accordance with the description above set forth and in pliance with a'll pmvisions of ordinances oi the city of Fridley. ' , �� y�� In co�siderati� of the payment of a fee of �..�{,..QQ__._...__, permit is hereby 8�ranted to �'- �-- �'''+��' to construct the buildiug or addition as described above. This permit is granted up� the expree�ss condition that the person to whom it is granted and his agents, e�iployees and worlunen, in all wark done in, around and upon said building, or any part thereof, shall oonform fn all respects to the oidinaaces o� Fridley, Minnesota regarding location, constructfon, alteration, maintenance, repair and moving of buildings within the dty ]imits an+d this permit may be revoked at ar�y time upo�x violation of any of the provisio�ns of said ordinances. a�� ia��-�:�� :, � .� � • ,,:,�,�K �_- NOTICE: 'Ihis p�eedt doa not �ewr Ilw wns�Noe, ts�talltlia� fe� vrMiro, phnnbino. Ya h�a1Mp, nw�r or wM�r. !� son fo s� N�� suiWiao iny�sr for s�p�ratr p�emhs fer f6a� hMm. «. . . -r OWNER`S NAMS APPLICATION FOR BUILDING PERMIT CITY OF FRII�EY, MINNBSOTA 'Y. � ��, � �% ADDRESS �/l ��%t�� ,�/"�. 16 /,� , ADDRESS �.�. �- ��!��i° � , LOCATIOAI OF �BUILDIIJG� �� N0, STREET PART OF LUT LOT BLOCK ADD�TI01�1' OR SUBDIVISYON CORNER LOT INSIDE LOT SETI�ACR SIDE-YARD SEWER ELEVATION FOUNDATION ELEVATIQft Applicant attach to this form Two Certificates of Survey of Lot and progosed building location drawn on these Certificates. DESCRYPTIOR OF BUTLDING To be used as; 1� Front � .� �j Depth /C Height � �, ��.�.� _ / x \ �� Sq. Ft. � Cu. Ft._��/��Z __�� Front Depth Height ' _.____.�.,... -.-,�—� Sq. Ft. Cu. Ft. � Type of Construction Estimated Cos — To be completed The undersigned hereby makes application for a permit for the work'herein specified, agreeing to do a11 work in strict accordance with the CiCy of Fridley Ordinances and rulin� of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. � � c DATE "'� � : S�GNATURE �� (Schedule of Fee Cost� can be found on the Reversa Side}. � ., _. . ,. r . . .. . . .. � _ �_ ., T � . sue�ecr PER . City of Fridley . 15055 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r ; � RECE . � i y______; COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 9�� %� 1 . � / � 1 � /'��i � CITY HALL FqIDLEV .55432 NUMBER REV. DATE PAGE OF APPROVED BV �""� � •'� 612-560-3450 910-F15 12/29/78 � / JOB ADDfiESS �11 Helene Place N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23 ( D�nnay's LakevieRa Manor SHEET 2 PROPERTY OWNER MAIL ADDFESS ZIP PHONE Jan Jacka 711 Helene Place N.E. 3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO. Rite Way Waterproofing 7337 Lake Drive, Lino Lakes 786-0550. 4 ARCHITECTORDESIGNER MAILADDRESS 21P PHONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Install drain tile 9 CHANGE OF USE FROM TO STIPULATIONS SE YI�ARNIHG PERA rE Befor� di8g�n8 ca�l locat ut�l�ties N�A T iN�, P� ��M� rs RE TELEPHONE - ELEGTRIC - GAS Etc. ��N� Alyp ��RE� FaR REQUIRED BY LAW S��S` Wi�� . TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. ,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. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1 � 14O $. S% WITH WHETHER SPECIFIED HEREIN OR 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 LOCA� LAW REGULATING CON- STRU ON OR THE PERF RMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL PEE � �� -.7J�-7� $9.57 " SIGNATUREOF . iiiACTORORAUTHORIZEDAGENT IDATEI � WHEN PROPERLY VALIDATED THIS IS YpUR PERMIT �. Ia./z� /��4 SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI B�DG.INSP -� DATE 0 CITY or- f=1ZIllLCY ° APPLI C/1TI Of� FOR ft�S I ll(:tJTI/1L BU 1 LDI �1G f'E(Zf�1I TS . ' ��L"-W, �LTLR/1TIUtdS, �DllITiOfdS, OR REPAIRS) . , OWt2�R: � a� '- j r,�. c, rc � � A�az�s�: � // ��% � � P� . �. , � J3uILU��t: a,-�� -- I,v ��, ... •�(,(�� t�e r%io c�`�s Address : � J� �'j % �k Ke �ii, � ✓ � `�' �d Gt,�rf' , Tel . No .: �� - O 1''�-t'- C� No.: Street: LOT: �� HIACY.: � ADDITIOPJ : �6 r� l� � S ��'i � d� c � Q h d� CORNER LOT: • I2JSIDE IAT: S;:TBACY.: SID�YARDS: Applicar.t attach �i:o L-his form T�o Certi�icates of Survey of Lot and proposed bui.iding locat-ion drawn on these Certificates. . DESCRI PTI O('J OF BUI LDI �G 7.b Be Used As: �y�c�;� -�,� ��c Front: � Depth: . ' Height: ;y,: , Square Feets'i Cubic Feet: Front: � Depth: � Height: � Square Feet: 4�,ibic �'eets � Type of Construction: • Estimated Cost: $ j��D 0� 7.b Be Com leted: ✓'�� P �4 `'" � �• �;�` Alt. A Alt. B Proposed Driveway t9idth If I�lew Opening Is Desired $ $ � (S�� I2�VERSE SIDE OF SHEET) The undersigned hereY�y makes application for a permit for the work lierein specified, agreeing to do all �.+ork in strict accardance with the City of Fridley Ordinances and rulings o£ the Deoariment of Buildings, and hcreby declares that all tlzc facts and regresentations stated i�i L•his application are true and correct. See revcrse side ior ditional infozm� ion. D11T�: �� ' o� J� - � � SIGNATURE: � � . Stipulations: . , � � � CI �U , � �1 �y � 1 - . .� � 0 . . i e� ,� .. SUBJECT F'�C�: � City of Fridley ,� �- � BU ILDING PERMIT ` � `� ��5 AT THE TOP OF THE TWINS r ' ' NO. � �` _____ COMMUNITY DEVELOPMENT DIV. r � y � PROTECTIVE INSPECTION SEC. ��J 1 � l ' � �'��\ � CITY HAII FRIDLEY SS43� NUMBER AEV OATE PAGE OF APPROVED BY �""�'� �'' 612-571-3450 910-F15 6/13/95 / / JOB ADDRESS 711 Helene Place NE 1 LEGA� LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHED DESCR. 23 6 Donnay's Lakeview Manor SHEET 2 PROPERTV OWNEF MAIL ADDRESS 21P PHONE Jon Jacka 711 Helene Place NE 3 CONTRACTOR MAI� ADORESS ZIP PHONE UCENSE NO First Choice Exteriors 2405 Anna olis Ln N P1 outh MN 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS 21P PHONE IICENSENO. 6 USE OF BUIIDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION p ALTERATION X REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling and Replace front windows 9 CHANGE OF USE FROM TO STiPULATIONS Bedroom windows being replaced must meet the State Egress Code. TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD SEPARATE PERMITS ARE REQU�RED FOR ELECTRICAL, PLUMBING, HEATING, 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 DAVS, OR If CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOO OF 120 OAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALIS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED WITH WHETHER SPECIFIED HfiFEIN OR NOT. THE GRANTING OF A PERMIT lO OOO DOES NOT PRESUME TO G�VE AUTHORITV TO VIOLATE OR CANCEL THE pERMiT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION TH PE RMANCE OF CONSTRUCTION. 11%.00 F '`- PLAN CHECK FEE TOTAL FEE � �� `� License SC � SIGNATUREOf CON�RACTOROAAUTHOAIZEDAGENT IDATE� WHEN PpOP LV VALIDATED THIS IS YOUR PERMIT / � � M7 /�✓ / SiGNATUAEO:OWNEA��FOWNEABUILDEF1i iDATEi 8 G INSP ��TE NEW ADDN ALTER [l � .� . i" CiTY OF FRIQI,EY . . . . : .. . . �. . . . . SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: � / � 1� � �� ,o �L c � Effective 1 / 1 /95 Legal Description: �� 4 Owner Name & Address: �`-� „� J � c� q ?:lI � � io �.o �� Y. . t'', . : � . . . . . �ontractor: t" i1- s � � � �-� � � x'7`` � . � . . ' � MN LICEI�ISE #' �i � fo (i ,(J �( vr�oey%�, ./`�'V Tel. # S 3 3�9 l� . Address: o? � 0 J ��, v� L�-• , - , � ` � � � Attach to this application, a Certificate� of � surv�ey of the � � � � � � � lot, with the proposed construction drawn on it to s c a le. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Leng�th Width Height Length Width Height Length Width Hgt/Ground Sq. Ft. _ Sq. Ft. Sq. Ft. Corner Lot (] Inside Lot [] Ft. Yd Setback Side Yard Setbacks � Type of Co�struction: K�s, � d- �tr° N�' (.��"y � u1 �o } Estim�ted Cost: $��cz'� . Approx. Completion Date: . �o — �O " �✓ � � �9Y �° s s � (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 F= Ft x$ _$ . DATE: Co " � 3'S� APPLICANT: � � Tel. # y�� 3'l `� � d. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ .v $ /O, Ub $ �•QQ $ $ �� OO $ $ $ $ $ �3 �� CITY USE ONLY Fee Scheduie on Reverse Side .001 of Permit Valuation (1 / i0th %) $.50/$i,000 Valuation $850 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 [ ] 0 sua�ecT ERMIT NO. City of Fridley 2 8 990 AT TNE TOP OF THE TWINS g � I L D I N G P E R M I T r � . � � • � • COMMUNITY OEVELOPMENT OIV. ' j L' — / � r � � PFOTECTIVE INSPECTION SEC. Q� ' � � � � �"'1 CITY MA�L ffi101EY 551J2 NUMBFii pEV O�TE v�GE O� �PVROVEO Bv �'""�" �'' 612-571-3450 9t0-F15 3.8.99 / / lOB AODRESS 711 Helene Place NE 1 LEGAL �OT NO. BLOCK TiiACT Ofi ADDITION SEE ATTACMEO oescA. 23 6 Donnay's Lakeview Manor s►+eer 2 PiiOPERTY OWNER MAI� ADDRESS ZIP PMONE John Jacka 711 Helene Place NE 571-8951 3 CON7RACTOR MAIL ADDRESS ZIP PMONE IICENSE NO Homes Plus Remodelin 5730 uam Ave NE, Ro ers, MN 55374 428-8248 l ARCHITECT OR OESIGNER MAIL ADDFESS ZIP PMONE LICENSE NO. 20064749 5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO 8 USE OF BUIl01NG Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION �] REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WOFK Reroof House; Repair Siding 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Call for building wrap inspection before covering. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAO SEPARATE PERMITS ARE REOUIqED FOR ELECTFICAL, pLUMBING, HEATING. VENTI�ATING OR AIR CONOITIONING THIS PERMIT BECOMES NUIL AND VOIO IF WORK OR CONS7RUCTION ZONING SO. F7 CU fT AUTHORIZEO IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION ON WORK IS SUSPENDED OR ABANOONEO fOR A PERI00 OF 12p OAYS A7 ANV TIME AFTER WOAK IS COMMENCEO. NO. DWLG. UN17S OFFSTREET PARNING 1 MEfiEBY CEATIFY TNAT I MAVE REAO ANO EXAMINEO �MIS APPLICATION 1 STA�LS GARAGES AND KNOW TME SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TVPE OF WORK WILI 8E COMPLIED WITH WME7MER SPECIf1ED MEREIN OR NOT. THE GRANTING OF A PERMIT �6,256 �3. 13 DOES NOT PRESUME TO GIVE AUTMORI7Y TO VIOLA7E OH CANCEL THE pEqM17 FEE SAC CMARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $124.75 Fire SC �C).ZE) STqUCTION OR TME PERFORMANCE OF CONSTRUCTION PLAN CNECK FEE TOTAL PEE License SC $5.0 $139.14 $�GN�TUQEOFCON'FA(;TOpOp�UTHOpIzED�GENi iD�iE� WHEN PROPERL ALIOATED TMIS IS YOUii PERMIT C �� (/ V � S�GNeiUQE O� OwHEA i�F O�NNEp BUILOEp� �O�TE� �� ' V B� iNSD qcrE MAR-04-199� ��3:1 ivurr . � � ADDN [ I Ai.TER [ l �.,�, � I TY Q,F FR I DLEY TO crxX a� �Dr�EY S�h1GLE �'AMILY AND ri�'L" EXES R-1 AND R-� 428857� P.05�06 �11CLLlVC 1/ J,I `Jy - a� BUIL,D�NG P��MIT APF�SCA"TION ^'�� `b � �'i A�.� � ConstructionAddress: � � � 1 e-, e-T) � I.egal Uescripiion: Owner Name & Address: �o��r,. �'A�� Tei. # ��_� -� 15 � Contractor: me s�� U s �L e�Q � N1N LICENSE #°��? � 4� �{� Address: .S 7 3 0, u i�v� {� v e- � Tel. #�l a.- � a`6 -�6 oL� � Attach to this application, a Certi�cate of Survey of the . iot, with the proposed co�suuction drawn on it ta scate. ii'VING A1tEA: GA1tACE A1tEA: DECK AREA: OTHER: �� I.ength �� DESCRIP'��UN U�' iMl'YtQVEMEN'1' s�� VVidth Height Width �Ieight � Width HgUG� , 4e ��- R�-n A i�R si rU 1�nG Sq. Ft. Sq. Pt. Sq. Ft, � � C� t Construc�ion Type:� r-�oo c� �('l�-Yrm 2� Estimated Cost: $ �J (Fee Sahedule on Back) Driveway Ltiub Cut Width Needed: Ft. -i- b Ft = Ft x$ �=$ ___ DA�: °� � APPLICAiVT: Tel. # � o�� $ Permit Fee Fixe Surcharge State Surcha��ge SAC Charge License Surcharge Driveway Escrow Erosion Controi P�z'k �ee Sewer Main Chazge TQTAL $ o� S � n� ��n $ 3,13 � -- $ ��,oU_— $ $ $ $ �.�� • STIPULA'TIQNS: G� CTI`Y' YTSE ONL�t Fee Schedule on Reverse Side .001 of Permit V�luat�on (1llOth9'o) $.50/$1,004 VaIuation $1050 per SA� ilnit $5,0� (Stat� Liceused Residential Contractors) AIt. ��A,�� o�r A1t. "$" Above $450.00 Conser�v�tion �lan Review Fee I7etermined by �ngineering Agieemez�E Necessary [ l Not N�cessary [] . � . ,- . v�TY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICE� C.1�.L RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent • Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer �-�- ��.c, *Air Conditioning All Sizes All Others/Repairs & Alterations (LIST ON BACK) lqo of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ $ 10.00 $ $ 10.00 $ 10.00 $ 25.00 State Surcharge TpTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STA7E SURCHARGE REINSPECTION FEE $47.00/Hr JOB ADDRESS %l/ Effective On January 1, 2002 �/. �.� OWNER _ �crn. ��-c/C4 BUILDING USED AS_ �e�'' ��'l : �( ESTIMATED COST �.�� -�� PERMIT N0. S J� DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle �ne (Steam) (Hot Water) (Warm Air) $ Trade Name @�a� �'�-c � ��%µ6%K l-�cwSize Na ��,� BTU ovJ HP EDR $ Fuel Total Connected Load $ $ $ .50 $ �'� *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner� ./�p `"'L F �: i'63 i �� v!'/?G ✓ �.� � Go. /�'G�• � / C��Seo !'��% S�� Burner Trade Name Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. HEATING CO �/�� .%-�'- Signed FAX # Approved By �� Rough•In Date DATE � '� �� TEL # GS/- �3.� °�s �,� . CJ'V Final Date / �� Building BUILDING PermitNo.:,�'��`1`` �`'�5 Inspections RESIDENTIAL APPLICATION Received By• � 763-572-3604 CITY OF FRIDLEY nat 763-502-4977 FAX �� EFFECTIVE 1-1-2010 DATE — YOUR E-MAIL ADDRESS SITE ADDRESS e e THIS APPLICANT IS: ❑ OWNER �ONTRACTOR PROP�RTY OWNER/ NAME: TENANT ADDRESS: � Ct7y r' : �2 STATEM �UZIP PHONE: CONTRACTOR NAME: ✓ o h, � u c � Oc-, � n,�. SUBMIT A COPY OF STATE LICENSE # 6 / O EXP DATE — —� �� Z YOUR STATE LICENSE / AND CERTIFICATE OF ADDRESS: ��S % 7 ��1 �S�/�sn�e ,%i'. �✓, CITY � STATE�LIP s�.� INSURANCE PHONE �' - 7�! FAX - y ' PROPERTY TYPE �TJSINGLE FAM[LY/NEW CONSTRUCTION S1ZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDI7'fON ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH �"ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING � OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCT[ON ❑ ADDI1'ION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT ROOFING p HOUSE ONLY NUMBER OF SQUARES � IJ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES O ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members W be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl C1Soffit ADDITIONS_ & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction pians WINDOWS 3. Energy Calculations IN EXISTING OPENINGS �Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE S[ZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & • TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION Petmit Fee Plan Review Fire Suroharge Surohazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ `'� /�S See Back Page for Fee Schedule $ 65% of Building Permit Fee $ .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ ' $5.00 (State Licensed Residential Contractors) $ $2100 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$24=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ i�1 1 Make checks aavable to: City of Fridlev Attac 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 Construction Codes; that I understand this is not a permit but only an application r permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of al c p' 1 equires review and approval of plans. n SIGNATURE OF APPLICANT PRINT NAME �� I � 5� ��/�� DATE /—�` /-O' � 1�