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AF - 45687, ^ �* �--r`` . BUILDING PERMIT Village of Fridley, Min.n. � N° 2795 Date /C�� .. ?�.� ......................... �A ' % Builder Owner�N`".s�� ... ................... ............................. , ........... F-�i� � Address �s.��,�...../.:7......�.4%� .. .... Address ............................_ ........... LO�CATION OF BUILDING No. �.�1%Y � . . . Street ��!� . . . � . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . Lot . . . ��.. .. . . .. . Block . . . . .�.� . . . . . .. . Addition or Sub-Division . �. . ,6,�,� ��. . /��.�.�. .��:�� . . . . . ��'� '� �+ P f Corner Lot . . . . . . . . . . . . Inside Lot . . . . . . . . . . . . Setback .�`�. �%� Sideyard .�� G�.�.� . . . . . . . . . . . . . . . . To be Used as: `�%' ' '��r : • : � • . . . . . DES�R[PTION OR BUILDING Front i�� . . . Depth .�%. . . . Tieight ��i. . . . . Sq. F't. %r�. �� Cu. Ft. . . . . . . . . �� .. .... .. . Front��. .. . Depth �.`.�: . . Height . .. .. .. .. Sq. Ft. . ?f �. Cu. Ft. . .. . . . .. s� � ��J' Tyge of Construction��.�?tiZP . . Est Cost .�� v� d.� . . . .. . . . . . . . . . To be Completed � . .��f�zy� � Iu considerati�i�n di the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of �r�inances of the village of �'ridley. 1 \ �, - . . . .. . .!'`�.... .. ........ .......... ,ry��%t ,�or�i , ration of• the payment of a fee of $. l�1. .^. ., permit is hereby granted to 6G.a�%�i.�i�t. ......... (�� '�� . to eonstruct the building or ad dition as described above. This permit ia granted upon the express cottdition that the person to whom it is granted and his agents, employees and worl�nen, in all work done in, around and upon said building, or any part thereof, shall eonform in all respects to the ordinances of Fridley, Minnes�t�, regarding location, construction, aiteration, maintenance, repair and moving of buildings with- in the village limits and this p�rmit may be revoked at any tlme on violation of any of the provisions of said ordinances. - �� /��— � Building InspectOT NOTICE: � This permit does not cover the construotlon, 9nstallatlon or alteration for wlring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permlts fo� these ttems. � � � �y � r p � � � °x � M N 0 a � r7 . � : � • �W � r f+ � � m � � �' � y ow� � � � �� N • O • � � : O . O . O . . � ; . N 0 � � � � ~ � � o o y L*J � � t% � � � � � � � x y� �� 'd : R' ,� � � 0 � , . �� o : � . � O . . �$ � � . . . � ai . . . . : �5 : : : : 0 � � � � � � W t.� ta ►+ r r',il c�i� o� o o c y ssa v> tfl �� 0 � 0 � p �. � 0 I � • �. � � � � � � • � � r D —�I m N 2 m C r m � • ��h w t� r� qi R� I �a � � q � � � StOI1@3 � WATER �� CLOSErS „, o ueiwLLs � � BATH o -rues W p enstNs � 'd SINKS �. �. WASH TRAYS DRINK. FOUNT. sHwRS. FLOOR DRAINS CATCH �% BtiSINS � AUTO � WASHER GAS APPL � GAS RANGE GAS OPENINGS -n o z � � � 8 � � a ►+ M � � �❑ a' � � � � � � � m�O" � � °'"' � 8 � � � �1 p � � � .� � � � � � � � I aa� � b �� Qw y. �. � � ��,q�� .� .. �� bow � ��o� �. � � ��p7� F�• ti+ y �i � �'i � �Q� � � ��•mb w (�� o v' cM P1 p � m a �+�op A � ap1' H P m � � '��4 N � � �� . �1 °�� ,o, � �� . � � � o �� m m o �� i I i� �� M tl � � � � a � rx � � p � �, � � � � � � � � � � �i � � � � � � V� � a '� d c� °- m � � � �, � � � � a � � � a � � , � V O �� `f�r9��}�� 1 i \ � Rec # 44816 City of Fridley, ,Minn. N� 10001 BUILDING PERMIT .: � ..- • •.: p�er; ,W,yllis G. Larson. g��r � � ,�� AdtireB3 �� i lrorSr�,l 1'� YP AddTese LOCATION OF BUILDING NO. �� Stc2et Ni c�lrnr�r llriva _ PSTt Of LOt Lot _..1q�.______ Block —.� Addition or Sub-Divfsion _�s.ima�.t .Q Th � '�� ,�lda� �a��, Coraer Lot � Ins�tde Lot — Setback �_ Sideyard Sewer IIevation ._._ � Foundation IIevation DESCRIPTION OF BUILDING To be vsed as: Gara.�Q �ont 2.Q— Depth ..�_ Height ._1Q_— Sq. Ft ��— Ca. F't ¢�� Front Depth I%ight Sq. Ft Gw. Ft 1�pe of CoI►StT1lCtfoII FrtamP �q' t, (,`pgt �.�t00.Q_.__ To be COmplet2d �Qr.Pml�r�'v� 1�tiR In consideration of the issuance to me of a permft to construct the building described above I agree to do the proposed work in accordance with the description above set forth and in compliance with a�l provisions of or8inances of the dty oE F7fdiey. y � ��-�-..�J °,�- In consfderatton of fhe paymeIIt oP a fee of $ 7_ 4LZ � permit fs hereby gr8nted to Td1�� a T.a � q nvi to construct tlae bufldiag or addition as described above. This permit is granted upon the express condition that the persfln to whom it is graated and hia agents, employees and worlmaen, fn all work done in, around and u�n safd building, or any part thereof, shall conform in all reapecta to the orainances of Fridley, Mfnnesota reg�ng lacation, construction, alteration, maintenance, repair and moving of bufldings within the dty limit� and tY�s permit may be revoked at any time upon violation oY of the Provisions ot eafd or3inancea. /� � �� I � ° �. NOTIC� 19� psemh does aet eovs� t6s coostrocHon, in�talldioe Po� vrMag, plum6tee, ga h�tteg, ssvin� or waM�. B� soro to a� t6s BaildIng lespea�or /or mparat� p�rmib Poe thas HMa. +;�4 %, APPZICATION FOR BUII,DINC PF�MIT 4 T�.' ��' ��Ta� y ��5�'��i QWNEEt 'S 1VAMF' )� �l ,�e/ 5�, �,v� // S b 4� BUILDER �v �✓ 1M lJ � v1 ADDRESS 1s, �' a2 „`� �/ C �' � t� �J Y l v�- ADDR�SS �vr � l� v / LCCATIOlU OF BUII�ID?C �o o � a � s�x�r 7�f � k � � �- D r � v� ' � �� LOT s� � BLOCK � �.DDITION OR �UBDIVISION C.�=�� ,.�,�:� ,� _<� �,�P� � L1�1 �� COR'�'ER LOT Z�TSIDE I,OT SE"I'BA(:i� SIDEYARD SE4TEl� ELEVATIOPa TOP OF �'OCTI?�� Appl icart a-ctach to this ior¢! T�ao �"erti.fieate� o�' Survey oi I,ot a.ri3 px�opo�ed buildir.tg locatiorz dr�.�rn o� i;hES•� vextif icat�s o l7�+'S�R�.l°iI' i ON ��T+' BLTIIbD�NG To Be �7��."e� As: /� � /�/ 7t c l� �� ' cl �'•� �' C' / � �' , - = � �'� Fro�+ -� �Jepth °� Height � � Square �°eet ��C� Cubzc Fe�tmo�� F�ont Depth Height Squ�,re �eet �ubic Feet Type of �onstz°uction ) a Q � Estima.ted Cest 3 a a a r- To Be Completed � �� ,� /� � � The undersig�ed hereby makAs applicat�on ior a pexm.it ior the work he�°ein �pecificd, agxeei�..g to do all raork ixb strict accordance with the City of Frzdley Ordi.nances and rula.ngs o�° the Depa.rtment oi Buildings, and h��eby decZa.res that alI the i�.ct� and rep�eae.r,.tation� stat�d in thia applicatzon a.�e txx�ze a.nd correcto �� DgTE /6 c� l� � b � S�G�TATURE ' (Schedule of Fee Coats ca�. be iou�zd on the Re�re�ee Sideo> ��-� �,--.� __ __------ �=6 � j � i �� y�L� �� ` ,� y .�r � ° s (,�% BUII,DING PERMIT FEE SCHEDIILE SECTION 2, The In�pector oi Buildings uhall, �aefore issuzn.g pernits for the er�ection of any building or �tructu�°e, o�° ior any addition to any existing str°ucture o� builc�i�.g9 or f or any �.lte�atzon or repairs to any existi.ng builciing os° st�uct-u�e y upo� a�plicat�on th�ref�� 9 iequire the payment by the applia�,z�t for� such perm.it oi fees to the amount herei� below �et iorth an�. in the ma�.er hex°e�rs �rovided toatvit: IInifoxm �uild�.ng Codeo Typ� 19 29 & 4-$1a75 fbr each one thousand eubic feet9 or �°raction thereof9 ir such cubical c:o.�atert�e Type 3& 5- $1050 for ea�h one thousa.nd �ubic ieeto m For thE purpose oi computing fees for building permits, the cubical contents of any building or addition to a uniform height throughout by multiplying the ground area covered from a point six (6) inches below the iloor line of the basement or the ceilar to the average height of the upper �ur°face or to the average hei.ght o�° the roof �uriace of the mai.n gable of a pitched roofo For repairs or alterations to a.�. exi�ti:ng structure, the iee ahall be at the �°ate of $3°00 per each f'ive hundred dollars ($500000� or fraction thereoi i.rz �he cost of all p�oposed worl�m In no ease shall -the ��e Vha�ged f'or a,ny p�rmit a� set ?orth i.n Section 2 be less than. $50000 NSSSD Co.nnection Charges based on location - Area 1 c�r 2, � � e, � l� �� v .� -- � . G� � �: � � � �. �� , , �° i 3 'F . , � �� . . . . _ . . .._.......... ...� � ��: �; . �. �:.: �. .:� . � . .-��. . . - :.�._. .. . - •s � .� " . . � . . .r: . � . . , . � . a ,. . . � . . . ' . � , .. .. . �'_ , • , . ., .. � . � ��4� ... �� ' �' � . � . . � �� .. .f rt . .. ... . • y: . ' . . "� ' . . � .. . .. . ' .. , i ' . Y� • I , � ' . . i. . :i t, � �. .. ' a .�2 � '� . _. . � � � � fi, ? �`:.� ,� . .... . . .. ... . � 5�`� .. . � P � � . � �Y� � ... _ ._ � � , e� � � � �/� <�'' -� �' � o� �� d y !� 'ti � � .� � . � . -. . : .��±:. � • . � . . _.. ......._. .� �, . ,. ... ..; . -�.i• . . � . , . � .. � .. � . - . � - ^o p .. � .. Y . .. • . ' . • �. � r 4 � .` R ` � e. . M . �� APF''.�.TCA�.'�'ON FOR C T'.'�`s t�^ .: r,� �1.1?*l. �!�?.� ri: r�-�^��.i cJ'- •e�.� 4'efT`+C-..�''' 1"7 L' ' .. . . {�J-. .l' � d .i e .� : . . FP.iFir��:a � PS::I+�f�i::;.?`.�%i 5�421 TO Ti�E HOnURA�LE CIT�I CGUt�CIL: , i �. hereevith 3�bmit a P� ,.�o�r"` _.,.,_- for licer_:e to perficr��-��-�,-�--�-�� .��:1�in tha �i�y of Fridl�y, in Bcc�rdan�e w�r_n �ize ordin::nr_QS of said City r��s:�� • I am over twenty-one yea:s of age, Subm3tted here�ith is a Certifi��.te af Insux�asice evideaciorg"�ti�e ta�ld�.rr� of Pu�lic Li�bilitq Insur�n�:e iu the i.i.��its os $25,OrJ� � cr �►erson, �SG, C��O �ex acc�dent for bostily ir��;a�Y, and �5, 0�� for pr�pe�. ty- d:��e, �ad � C-��icst.�. W-� - of Iasurance evidenzing the hoidia� of Wa�imen's Co�gensatiosi as• reepxsised bq igaw. 2,1L�,�� Oi CCP! '�kJY �.,...,.. -- 2i.�s1'f:� GT� IRLi�i[�UAL ATr�F➢.�SS C�TY T�F�iOP.� N'�,:�ER � STATE MASTER LICENSE , N�. T qe�p (4JHEN APPLICABLE) 1ii�'�9��.r' i.uiii7u.i� a�'yi TY?'F'. u+i t�^�.�i'i C� 0.�.r.: S oTt v�t.I�GES FEE $ ,_ CE��ic a��'�� 0� I'��iil?F.�?�� ; �a�a��' S C�Y�i W��1^aAN PLr,�,iC Lila:H�wt'Y RECEIP;r 2?0. LICF.�15E td�. � ~' -�' � � '> _ � r1 < G 'l ATTENTION OF: __` - --- __ _ _- - TO �^�'��___ . _ _ __ _��_ L�____.__________ __—_____ � _____ SUBJECT � � �' e ' � �_ _,.��=.. �_ -- c a _ _ __ __ __,I 1'� .- i �/ �� c E�— DATE � � �� -�� o - /.r- - �� _�_ _?_..� c�. - %/ 3ea ?.�__-��_��+--<�� E%7y�iCJ �� C�¢GT%'L�/�ii1 `� � � s P o � �:�� ` � " /� �.�_�� _ a --�--- SIGNATURE REPLY: . DATE SIGNATURE 9tEP61ER'S COPY—IF�'9'AI�1 FOR YOiDR FedFS sueaecr pE�►�. City of Fridley � � � � 2` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T f � � RECEIPT NO. � ' COMMUNITY DEVELOPMENT DIV ' ; L �'�� , �� r � � PROTECTIVE INSPECTION SEC. � . � � � �'��1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVED BV �----� • •,' 612-571-3450 9t0-Ft5 7/26/96 � / JOB ADDRESS 6922 Hickory Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1(} 4 Ostman's Third Addition SHEET 2 PROPERTY OWNER MAIL AODRESS Z�P PHONE Sandy Adams 6922 Hickory Drive NE 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO Northwest Exteriors 6500 Walker, St Louis Park MN 55426 926-8663 2577 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS 2�P PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside House; Soffit & Fascia 9 CHANGE OF USE FHOM TO STIPULATIONS Install ventilation as per State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REQUIREO FOR ELECTRICAL, PLUMBING, HEATING. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING Sa. 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 WOfiK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yqLUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �6,975 W3.'4'9 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STA OR LOCAL LAW REGULATING CON- �1Z4.75 Fire SC �G.�S STRU TION OR THE PE OR C OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $140.22 SIGNATUREOF iORORAUTH I GENT �onTEi WHEN PqOPERIY LIDATE THIS IS VOUR PERMIT / � � SiGNaTUREOFOWNEAUFOWNERBU1LDEfi� �OATE� ,,, ,��y�' �NS� OFTE NEW ADDN ALTER I] [l � ConstructionAddress: _ Legal Description: Owner Name & Address: Contractor: � Address: f�'��D r LIVING AREA: GARAGE AREA: DECg AREA: OTHER: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Applicarion _ _ . � �� % 7% G-sr'�� Effective 3/1/96 �J � d f0 -: ��^,,!��j S Tel. # `'��/� �/ �% '�-{1 MN LICENSE # � � � � � � �S el. # ��',�2 � �-�'�'�' Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTiON OF IMPROVEMENT Length Width Height Length Width Height Leng�h Width HgtlGround %/ � _ � /1 r��.� . � �,�� Sq. Ft. Sq. Ft. Sq. Ft. _� Corner Lot [] Inside Lot � Ft. Yd Setback Side Yazd Setbacks Type of Construction: Estimated Cost: $ �'��v,� o c� P- � Approx. Completion Date: -, �p (Cost on Back) � Driveway Curb C�tt Width Needed: Ft. + 6 Ft = Ft x$ _$ � DATE: � �� - g� APPLICANT: �- � Tel. #�..�-�r- �v l'o '? CTI'Y USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPLTLATIONS: $ i�`i r%s�- � �- 9� $ �. $ � � �v $ $ $ $ � ` �/o, .�2 Fee Schedule on Reverse Side .(�1 of Permit Valuation (1/lOth%) $.50/$1,000 Valuaxion $900 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 Na;essary [ ] BUII,DING PERMIT FEE SCHEDULE The Chief Building O�cial 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 $SO,QOl to $100,000 $100,001 to $500,0(}0 $5(?0,�1 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,OU0 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 $1,4U0 or fraction thereof, to and including $500,000 $2887.25 for the fust $5�,000 plus $4.25 for each additional $1,000 or fra.ction thereof, to and including $1,OQ0,000 $5012.25 for the first $1,(�0,000 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 $15 .75 . VERIFICATION OF FOUNDATION Pernuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of 5urvey of the lot, showing the location of the founda.tion once it ha.s it has been constructed will be required before proceeding with the framing. SUBJECT P City of Fridley 2�.3 � AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r ; � RECEIPT NO. � 1 y�_�_� COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. � �i%D �° � i � � �.J i---.� �r��,,, CITY HALL FRIDLE� �43P NUAABER REV OATE VAGE Of APPROVED BY i 612-571-3450 9�0-F15 4/20/98 / / JOB ADDRE��22 Hickory Drive t IEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACNEO DESCR. 1(�, 4 Ostman's 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ 21P PHONE Sandy Adams, 6922 Hickory Drive, Fridley 571-4917 3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sandy� Adams. .(same as �.bov�) - - . _ . 4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP � PNONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDINC3 Residential 7 CLASS OF WORK � NEW ❑ AODITION ❑ ALTERATION Cg REPAIR O MOVE � REMOVE B DESCRIBE WORK Reroof tear-ofr 9 CHANOE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINO, �PE OF CONST. OCCUPANCY (3pOUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOIO IF WORK OF CONSTRUCTION 20NING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OH IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOfi A PERIOD OF 120 DAYS AT ANY TIME AFTER WOHK IS COMMENCED. NO. DWLG. UNITS OFFSTREET'PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VAIUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WOqK WIL� BE COMPLIED $2 (F18.6O �1.21 WITH WHETHER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT � DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON• $74.75 Fire SC �L.�iL STRUCTION OR THE PERFORMANCE OF CONSTRUCTION . PLAN CHECK FEE TOTAL F License �$� SIGNATUREOFCONiRAC70RORAUTMOf71ZEDAGENT IOATEI�� p pp IDATED IS V P MIT S�GNATU EOFOWNEFi�i R ILD R� � IDATE� /� '� � BL iNSp DFTE a ' %a � [l ADDN [ l !�I.TER � � Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ��1�� Effective 1/1/98 �J� �J � d �aa . ;�.. � ,1.� Owner Name & Add�.cs: �-v�. Tel. #_� � � � Q/ � �ontractor: _ -.^� �._� � \� �; �1� NiN LICENSE #� � , - - � ,r - � "• ° � -�- Address:_• ��- � � �� Tel. # _ �,� � �- ' � � ,�:. , �� - 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: DESCRIPTION OF IlVIPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground Sq. Ft. Sq. Ft. 5q. Ft. �.., ; �� YO Construction Type: P � Estimated Cost: $�� f�� /�� (Fee Schedule on Back) �Jriveway Curb Cut Width Needed: �t�+ 6 Ft = Ft x$ _$ DATE: �I� 1Q APPLICA Pernait Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge $ �. �� $ , ��, � l $ $ $ $ $ $ Fee Schedule on Reverse Side Tel. # .�d `� ��//'S° .001 of Permit Valuation (1/lOth%) $.SO/$1,000 Valuation $1000 per SAC LTnit $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 [ ] TOTAL —+ STIPULATIONS: 1. � �. m BUILDING 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 $SOQ $501 to $2,(�0 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $SOO,Q00 $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 oi 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,OQ0 $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,�0,000 $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 stxucture 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. .,- � , Build'u�g PLUMBING Permit 1v . mdD � Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY vate Rec'd: � 763-502-4977 FAX EFFECTIVE 2-19-09 DATE O YOUR E-MAIL ADDRESS SAhl�y �,J I/,t ..1 wyo �. Lotyr SITE ADDRESS %�l ZZ �i Gvr�.r tir�`li2 �� THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND CERTIFICATE OF INSURANCE PERMIT TYPE ADDRESS: �CONTRACTOR 1�►ve. STATE LICENSE # STATE BOND # ADDRESS: CITY PHONE FAX �INGLE FAMILY ❑ TWO FAMILY O TOWNHOUSE EXP DATE EXP DATE STAT�ZIP 'ATE ZIP TYPE OF WORK: � NEW �'REPLACEMENT DETAILED DESCRIPTION OF WORK �, r �p " @ Q J��, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. F[XTURES: (INDICATE TOTAL NUMBER•OF EACH BELOW): MINIMUM FEE $35.50. _ BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING _ BATHTUB _ GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($ _ CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. $1 ) _ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION _ WATER METER OTHER THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 for a 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 all work which requires review and approval of plans. SIGNATURE OF APPLICANC � Y� PRINT NAME W 1 Ii4qQ,f /�0! jv% DATE ,��SI� � City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, NIN 55432 763-572-3604 FAX: 763-502-4977