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AF - 47205N° . Owner 655 � � Village of Fridley, Mina. BUILDING PERMIT Office of INSPEGTOR OF BUII.DiNG3 Fridley, LOCATION OF BUILDING � i I No. <- I Street �-:� t.�it�',r_�+ly � . Part of ... ( Lot Block 'Addition or $ub-Divieton DESCRIPTION OF BUILDING Front �- '�� Dep[h Helght :".� Stories Manner of Cons[ruction 19_ � . r� .i ..' i... To be uaed ae To be completed � "-.- Eetimated Cost �� -'^ Permit ie hereby grented the building � described fn the above statement. Th1e permlt Sa grented upon the expreea conditlon that the person to whom 1t is granted, and hie agenta, employees and workmen, fa all [he work done in, amund and upon said btilding, or any part thereof, ehall conform in all respecte to the otdi- nances of Fddley, Minn., tegarding the construction, alteration, maintenance, repatr and movtng of buildinga within the city limits, aad this permit may be revoked at any time upon violation of any of the provieions of satd ardinancea. of BWldings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. Subacribed and sworn to bePore me at F'ridley, Minnesota, � day of A.D. 19—. • • m l � , `� )J/' �/ �� r.r:c�c,°r r•o2 CIiR'I'IPIG1l'C ^P 'I'ITLC . —....___C.�--�0.---�.._�_� 19_7S Rcccidrd of ihe City oi fiidley o(` Anoha Cowity, hlinncsoC:i, O�rner's. Dupli.cnte Ccrti.Ei.ca:c of Titic No.��.C� . //�Jy/�{y� � �1 //�� ". 1 v _=t-�--� t-L-�^-�i / �_-`^-!v Y=��w / °"� 'ili.tnC55r,y srr:rr or•�/��1�5��_---�,:: n ) Cou,.ty o`---/�1 Np �jq _ ) 0;� this y� � day oE �/E,_ G. _, A.U. ]9.Z beforc me, a �.'otarv i'ul>_�'�_______.:i!i�in a;�d lor ;aid CounC}', Pcrsonally appca^cd -�.o �tS _1_-��-_.__ __ _------- to inc knomn to bo ,lio pertnn_�escribs.l i;� nnd t,i�,o execuCed thc forc�oing ins*.rument ai:.l ;icl::;o��oleiltied t;ic:;;�i�.e ezecu[ed ti�.c s�r:c .�s . �° �_Pree act and <ieed. � _ _� / �r/�— ---�?.-�_o_- zs�`�- �;�� F- i� t..s. 2'Si � ��; 7 f-/�cfcc,� ;' -S'r�� c-r � Village of Fridley, Minn. � BUILDING PERMIT N° 995 OIHce of INSPECTOR OF BUILDINGS Owner - � �'� � • - � � , � ArChitect Fridley, Minn., � � � �� . 18�_� � LOCATION OF BUILDING of Additton or Sub-Divlaion DESCRIPT'ION OF BUII.DING Front � Depth � Height Stories__ Manner of Constructton To be used as � � To be completed � Eetimated Coat Permit is hereby graated to � � the building described In the above statement. 7Zia permit is granted upon tLe expreas condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, amund and upon said bullding, or any part thereof, ahall coaform in all respects to the ordi- nances oP Fridley, Minn., regarding the constructio¢, alteratlon, malntenance, repalr and moving of buildings within the city limits, and this permit may be revoked at any time upon vlolation of any of [he provielons of said ordinaaces. of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. Subscribed and sworn to before me at Fridley, bliimesota, day of ' A.D. 19—. , � � �� /� - �_ ;; July �2, 1a75 . � �� 1 .��t., � � City of Fridl.oy � �f �� ; ,� .,, 6431 Univ�rsity AvP. N. E. �, � e� Fridley, MN 55432 -"� Attr�: Richard Sobiech . Public Works De�artmant GpntlAmAn: ' The following is a list of itAms damagPd ir� our basomAnt dua to sowPr back-up tho night of June 26� 1975• ' (2) CarpAts bair�g c1Par�Ad and dPodorizAd at Anaka Ca�pAt � C1Aaners� Anoka, MN �46.�0 (2) RAplac�ment of pads undor carpet 69�6� (3) SuitcasAs stainQd� unusablQ� dAstroyAd 1�.00 (6) ChildrPns� gam�s - Monoply- Atco� stained, unusablA� dAstroyed � 22.�0 RPpair of DaughtAr � s St�rPo 5, pp Fabric and patt�rns for sAwing stainpd and uri- � usablo 9.Q0 GarmAr�s �tair�od - unwAarablp 21.00 Washing and drying of clothAs bQing storod 6,OQ Soap compoux�d � d is inf�ct ant and d Aodor izing Spr�ys 9.80 (26) Hours C1Aanir�g TimQ Thank you for your considorati.on of our claim. SincPraly� , � / ,,.,. -.. / % � � � SERyj � _ ,. . . � � . I�- *=� /-��. �.-2- G= ' �� .-Z_u� �. Mr. & M►s. B.V. Berg � � � �F ` , // :• 6809 Hickory Street U • �� Bla�.r V. BPY,g :.: Minneapolis, MN 55432 i � � /6809 'rIickory St. N. ro . `� 2� ,�u� �,� �/ Fr id ley , MN 5�432 �9 �=• , ,s... � _ City of Frid1.� : 6431 Ur�iv�rsit Fr idley i � : . . . � . . . � . � � � � . � . �. : � . f L 1 .� _ � nT� � � .� ' w ' J APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VEN7ILATION� REFRIGERATICN AND ' ,.AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE � ' _ _ . �. s GRAVITY WAR2�S AIR: Flirnace Shell & Duct Work ' Replacesaent of Flirnace Repairs s Alterations-up to $500.00 Repairs 6 Alterations each add. $500.00 MECEiANICAL WAR�f AIR: FUrnace Shell & Duct Work to 100,C00 SZV each add. 50,000 BTU Replacea.ent of Furnace Repairs s Alterations-up to 5500.00 Repairs 6 Alterations each add. $500.00 S"TF1L�! OR tiOT WATiR SYST�1: Boiler 6 Lines up to 100,000 BTU ea�h addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 5�,000 BTU OIL BUR\ER- to 3 gal. per hour each add. 3 gal. per hour GAS BUR\ER- froa 100,000 STU to 199,999 8TU (over 199,999 BTU see Fee Schedule) R�TE $i2.00 7.00 7.00 4.00 $12.00 4.00 7. 00 7.00 4.00 TOTAL S S S S S S� S S S $12.00 S 4.00 S 7.00 $ 6.00 $ S1o.00 S ao.00 s S �0. 00 $ �O. �`►� S GAS FITTI�rG FEES: lst 3 Fixtures x S 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 STU x$10.00� $ AIR CO\'DITIO\IVG � ' � g FA.\ H�ATING SYSTE:�fS See Fee Schedule $ VEtiTILATI\'G SYSTEbiS g ALTERATIONS F, REPAIRS $ State Surcharge S .50 TOTAL FEE $� ROUGB SI3SP. Date P�i1�I. INSP. Date 1►�??RDYAL FOR PERMIT /� RBINSPEGTION FEE �510.00) l3INIMUK FEE FOR ANY HE71T2NG PERMIT IS 57.50 Y�LUS $.50 STATE SURCHA2iGE Job Address Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby ma;;es application !or n pezmit for the wrk k�ereia specified agreeing to do a1Z work in strict accordance with the City CoBes •. and rulings of the Department uf Huildinqs, and hereby declares that sll the facts and representations state3 in this application are true and cozrect. ridley, Minn. 1C� �o��o , 4f� I � OWNER �� ICIND OF BUILDING � U5ED AS TO BE COMPLETED ASOUT O��°"�O '�� s--� '= ESTIMATED COST /`. OL - NEW BUILDING PERMIT NO. PERMIT N0. �• , DE5CRIPTION OF FURNACE/BURNER , HEATZNG or POWEA PLANTS, SL-eam, Hot Water��,3.Y� No. Trade Name � � L Size No. (`�'L[� /0`d /I°/l�rdZ Capacity aq. Ft. EDR BTU ��i�i"a FtP ��i �� —r Total Connected Load Kind of Fuel SUTtNER - Trade Name� Size No. • Capacity Sq. Ft. EDR BTU HP Company � ' �-r • Signed By , �� •� • Tel. No. �� ` . . , i CITY OF FRIDLEY � APPLICATtON FOR HEATING REPLACEMENT _ . CHIMNEY AND STACK VERIFICATION THIS FORM NlUST ACCOPIPAP�Y STANDARD APPLICATION FOR HEATING PERMIT FORM. LOCATION � �CJ DATE /� ,?-!o/�-J� � OWNER � AODRESS �a.-.x�-- The undersigned hereby verifies that the existing chimney or stack: 1. Nas been car�fully exarnined '� 2. Is free from rust or deterioration '`' 3. FJo foreign objects are lodQed within ___ __?� ___ 4. That it is securely supported � 5. That it meets al] current Code requirements for size and total BTU connected v 6. Total Heat i ng BTU /�_ o�-v All Other BTU TOTAL � �; �� REMARKS " � ' 1 SIGNED � . . � License � by �l�:...w j�. _ . � '/ �.�. , Addres s 'T/ Z c' — �-� ! � /t� � � � Telephone �oZ �� 3 3 ' HEATING PERMIT # ' � Fridley City License �� f , i SUBJECT MIT NO. City of Fridley 716 9` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � � RECE . � ' COMMUNITY OEVELOPMENT DIV. a � ; V �� / / i r � ' � PROTECTIVE INSPECTION SEC. l---- A;�'��;'� CITY HALL FRIDLE� 55432 NUMBER REV OATE PAGE Of AVPROVED 8Y i ,\ 612-571-3450 � 9�0-F15 8/13i98 / / J08 ADDRESS 6809 Hickor St NE t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ,r 2 Ostman's iSt SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PFIONE Vincent Blair & Lois V. Ber 6809 Hickor St NE 571-1667 3 CONTqACTOR MAI� ADORESS ZIP PHONE LICENSE NO. Owner 4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE UCENSE NO. i 5 EµGINEER MAILADORESS , ZIP PHONE UCENSENO. 6 USE OF BUILDING I Residential I 7 CLASS OF WORK � NEW � ADDITION O ALTERATION REPAIR O MOVE O REMOVE 8 DESCRIBE WORK ' R oof hou e and ara e 20 S Remove 2 la ers and r lace , 9 CHANGE OF USE FROM TO I STIPULATIONS Underlayment must comply with State Build�tLng Code. i � � I TYPE OF CONS . OCCUPANCY Gi;OUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIRED fOR ELECTRICAL, PIUMBING. HEATING, ' VENTILATING OR AIR CONDITIONING. ' THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING ' SO. FT. CU. FT. AUTMORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT I ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. U ITS OFFSTNEET PARKING I HEREBY CERTIFV THAT I HAVE fiEAO ANO EXAMINEO THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATION ' SURTAX AND OR�INANCES GOVERNING THIS TVPE OF WORK WILL BE COMPUED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GfiANTING OF A PERMIT .83 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERM1T FEE ' SAC CHAfiGE PROVISYONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE Of CONSTRUCTION. F�Y'@ SC 1.66 PLAN CNECK F E TOTA FEE .49 S�GNAIUAE CT"OAOA THOA�ZEDAGENT �DATE� ,N�P P LIDAT,� HIS IS R P RMtT �� 'i �� 1 ,� S�GNn'UAEO:OWNEaii:OWNEABULLDERi �OA Ei g� � gD q�TE , �. ,�'��,. I I — NEW ADDN ALTER �� Ll Ll �ConstructionAddress : Legal Description: -�'Owner Name & Address: .�Contractor: � CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION O� /s/� Effective 1 / 1 /98 t �- . v / �'a \�� r) ! (O . �`, . # �S-' � % � /( � -� SE # Address: � Tel. # Attach to this application, a Certificate o� Survey of the lot, with the proposed construction drawr� on it to scale. DESCRIPTION OF IMPROV�MENT LIVING AREA: GARAGE AREA: DECK AREA: � OTHER: Length Width Length Width Length Width %�tw �vo� �- .� p � a � � I Height I Height ', HgdGround �; Sq. Ft. Sq. Ft. Sq. Ft. � � G� C�► ..P _ r S Construction Type: Estimated �ICost: $ ��LnU � (Fee Sl,chedule on Back) Driveway Curb Cut Width Needed: F,�,,,t�./� 6 Ft = Ft x$�� _$ �/�r- �-� �---� �DATE: �j � 3 APPLICANT: Gt.�.-� � � Tel. # � %� � I CITY USE ONLY ' Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ S'7 Q� $ - �o $ �3 $ $ $ $ $ $ $ � L Fee Schedule on Reverse S�de .001 of Permit Valuation (1'/lOth%) $.50/$1,000 Valuation �' $lOQQ per SAC Unit ', $5.00 (State Licensed Residlential Contractors) Alt. "A" or Alt. "B" Abovs $450.00 Conservation Plan �teview Fee Determined by Engine�ring Agreement Necessary [ ] Not Necessary [ ] � .� w _ _ UTY OF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNNERSTTY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (6l2) 571-1287 Dear Property Owner: Effective January 1, 1992, Minnesota Statutes requirelthat most residential building contractors, remoctelers, roofers, and manufactured h4me installers be licensed by the state. Specialty contractors who perform only one sp�cial skitl (e.g. concrete � masonry, excavation, carpentry, interior finishing) are �xempt from state licensing. Contractors who generate less than $15,000 in gross'annual receipts are also exempt from state licensing, but must obtain a certificate of ex�mption from the Minnesota Department of Commerce. The state licer�se number of a residential building conttactor must be placed on atl buildirtg permits and permit applications issued by a city or county. A license number must also appear in a site plan review and aii zoning piermits. Cities and Counties are prohibited by state law from issuing permits to unl�censed contractors who are not exempt from licensing. In addition, it is a misd�emeanor to perform contracting work without a license unless the contractor is exempt frorr� licensing. ' State licensing is intended to ensure a minimum level �f Gampetency and to affor�d consumer protection. To accomplish these goals, licemsed contractors must pass a finro-part examination relating to the construction trade$ as well as business administration and law. Licensed contractors are also'required to take seven hours of approved continuing education each year and provide'p�oof of liability insurance and workers' compensation insurance (if required by taw) ais well as business ownership documents to the state. Also, licensed contractors and remodelers must contrib�te io the Contractor's Recovery Fund. This Fund is intended to reimburse homeowners who obtain judgments of up to $50,000 against licensed cc�ntractors and are unable to collect on their judgments. Homeowners who use unli�ensed contractors will forfeit their rights to access this Fund. Licensed roofers and manufactured home installers do not participate in the recovery fund, but instead are required to hold a surety bond in the amount of $5,000 and $2,500 respectiveiy. ' Contractors are licensed and regulated by the Minnescita Department Commerce. To determine the licensing status of a particular contracto�, call the Department's Licensing Division at (612) 296-6319 or 1-800-657-3978. Compl�ints against ficensed contractors can be directed to the Department of Commerce, Enfotcement Division at (612) 296- 2594 or 1-800-657-3602. The license number of a licensed contractor must appear in aN advertising, business cards, lien notices and statements, contracts and prop�sals. � � �� . � �� -.w �_ . �-_ . . . . . � �.. �§�'... � _ _ UTY OF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNNERSITYAVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287 BUILDING PERMIT APPLICANT: HOMEOWNER I understand that the State of Minnesota requires that aA residentiat building contractors, remodelers and roofers obtain a state lic�nse unless they qualify for a specific exemption from the licensing requirements. By signing this document, I attest to the fact that I am building or improving this house myself. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building on speculation or for resale and that the house for which I am applying for this permit, located at C�o ff � �� o � Y1 , is the first residential structure I have built or improved i the past twen four (24) manths. I also acknowledge that because I do not have a state license, l forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring inde�endent contractors to perform certai� aspects of the construction or improvement of' fhis hause and 1 understand that some of these contractors may be required to be IiceMSed by the State of Minnesota. 1 understand that unlicensed residential con#racting� remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that i would forfeit my rights to reimbursement from the Contractor's Recovery Fund "' ir� the event that any contractors I hire are unlicensed. !�� ^`s��c� � Signature of Homeowner g',•f 3. $p Date � ' Licensed residentlal buitding oontractors a�d remodelers are covered by the re�overy fund. Licensed res�dentlal rocters and manufactured home installers are not �vered by the recovery fund but are required to hold a surety bond. To determine whether a particutar contractor is ret�uired to be licensed, or to check on the licensing status of individual contra�tors, please call the Minnesota Department of Commerce, Enforcement Division, at (612) 296-2594, or toll fcee at 1-800-657-3602. � <xy��; ;�.. ?::�;. ;'; CITY OF FRIDLEY INSPECTION DIV. 6431 Universfty Ave NE Fridley, MN 55432 572— 3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1, 1998 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7,00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 JOB ADDRESS ��d � e'� � � Ko 2 y �� --� 7he undersigned hereby makes application for a perm it for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby deciares that all the facts and representations stated in this application are true and correct. �,� a 3 , � ssa Owner ,�S �A 1�.. � l� � /2.� S� % � ' � � �j % — _. _ _ — ___ _ _ _--- _ _ . __ _ _ _ _ _ _ . _ _ _ _ _ Water Heater — Gas** �_ $10.00 Building Used As Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost J'�a a• PERMIT NO. 1�� '� Back Fiow Preventer Required OYes O No / Type $15.00 PLUMBING COM NY �a F� I�i S o oJ �- S o�" Reinspection Fee $42.00/Hr SIGNED • TEL N0. �u�G � • �' �:3 � ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.596 of Value of Fixture or Appliance o�-c. , Approved By � Rough—In Date Final Date State Surcharge $ .50 MfNIMUM FEE R ANY PLUMBING/GA5 PERMIT IS � TOTAC FEE $ aaSd PLUS THE $.50 STATE SURCHARGE **COMBUS110N AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SGl INCHES. sue�ecr RMIT NO. City of Fridley 3 3 7 6 5 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � ` RECEIPT NCCC%%% . �• _ COMMUNITY OEVEIOPMENT OIV. ,� / ^ �� V • � PROTECTIVE INSPECTION SEC. � �� 1 . � � � �"'1 � CITY HALI FRIOLE� 55�32 NUMBER pEV O�TE P�GE OF �ivppvEO Br �'""'�'� �'' 763-571-3450 910-F15 8/4/03 / / JOB ADDRESS 6809 Hickory St NE 1 LEGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACNED oesca. 5 2 Ostman's lst Additior� SNEET 2 PROPER7Y OWNEF MAII AODRESS 21P PMONE Blair Berg, 6809 Hickory St NE, Fridley, MN 55432 763-571-1667 J CONTRACTOR MAIL ApORESS ZIP PHONE UCENSE NO Same as above 1 AfiCMITECT OR OESIGNER MAIL AODRESS ZIP PMONE LICENSE NO. 5 ENGINEER MAIL ADDRESS IIP PHONE UCENSE NO 6 USE OF BUILDING Residential ' 7 CIASS OF WORK � NEW O ADDITION O ALTERATION O REPAIR O MOVE O REMOVE 8 DESCRIBE WORK , Construct deck � 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plans. ��i��iING Before digg+ng call for ' ali utility locations , 45�UO2 '."��.�� 1� �.�A�' TYPE OF GONSI OCCUPANCY GROUP OCCUPANCV LOAO SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING. MEATING. VENt1�ATING OF AIF CONDITIONING. TNtS PERMIT BECOMES NUII AND VOID IF WORK OR CONSTRUCTION ZONING ' SO. fT CU FT AUTMORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONS7RUCTION OR WORK IS SUSPENDED OR ABANOONEO FOR A PERI00 Of 120 �AYS AT ANY TIME AFTER WOtiK IS C�MMENCED. NO. DWLG. UMITS OfFSTREET PAqKING 1 MEREBV CEATIFV THAT I MAVE READ AND EXAMINED THIS APPUCATION ' STA�LS GARAGES AND KNOW THE SAME TO BE TRUE ANO CORRECi. ALL PROVISIONS OF �AWS VAIUATION SUATAX AND ORDINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED �2 � 782 � p� � 1. 39 WITM WHETHER SPEGFIEO MEAEIN OR NOT. TME GfiANTING Of A PEqM1T DOES NOT PRESUME TO GwE AUTMORiTV TO V�OLATE OR CANCEL THE pEqMIT FEE SAC CHARGE PAOVISIONS OF ANV OTHER STATE OR LOCA� LAW REGULATING CON• $83.25 , F�i SC �Z.%8 S7RUCTION OR THE PERfORMANCE OF CONSTRUCTION �� ^/� � 'U� PLANCHEC T 87F42 �J`�"-� i S�GNATUpE O� CON�AACIOAON AJ OAi2E0 �GENT iD�iEi E. PFO AU THIS IS UQ P 1 I S�GN<tuQEO�OwtiEA��fON�NEABU�IDEAi �O�TEi a G �ti5� r�ctE NEW ADDN ALTER [] CITY OF FRIDLEY Effective 1/1/2003 [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Canstruction Address: Legal Description: Owner Name & Address: Contractor. ` ; MN LICENSE # Address: Tel. # LIVlNG AREA: GARAGE AREA: DECK AREA: Attach to this application, a Ce�tificate df Survey of the lot, v►with the proposed construction drawh on it to scale. I DESCRIPTION OF IMPRO�I/EMENT Length Width Heigq�t Sq. Ft. Length Width Height Sq. Ft. Length f Width HgU�round Sq. Ft. o�% OTHER: �?"e2 ,�/'��?� ¢ 2 � Construction Type: Estimated'Cost: $ ,�7i��. �b ?� 31 � Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ + _$ DATE: �r i I ° 3 APPLICANT: � � Tel. # �G-� - � �7 � �-I6 6, Call (763) 572-3604 for Fermit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will cali you far card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ ��Z $ . $ � $ $ �� $ $ $ $ CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation' $1275 per SAC Unit ! $5.00 (State Licensed'Residential Contractors) Alt. "A" or Alt. "B" Aborie $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary'[ j Not Necessary [ � � _i •► � � y J �,, `L�-_ \; � . � ; � � ( �' 'i � � ' `V I' V � �I � � , �� o � � y� �� ._ _ . Y � 1__ __ ___ , __ _ __._. _ _ ___ . __ �� J . ____ __ � _�--� ; , . � ' .-t� II �.. 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I + i � , , i I , ' < i j ; _.__ _ . _ --- — ------ - � i t_ i j __ _� ._ ..__._1_ — --�-- -----i___ �� _ � _ _ < t i I t, l �` � r� ` .� i � �S _ _ _� � _ _ _ _ . ._ __-------..__ __ ____ � v , ._ , . _ _ _____ __ __ _ _ ____ � ; _ , __.._.�.__�_�_ __ :. , �, : _ _ _ _ __ _ __ ;1 . �� -_ ► �' � fi _ __ __ __ _ _. _ _ _ : : � � _ ._ _ _ - . - - -_ __ _ _ _ _ -- _ __ _ _ � �� , � � ' _ _ � �� ___ __ � 3 , � _ ___ _______ . _ _ _ _ . _ ___ ___ , . s I� __ _ _ _ __ ._._ __ __ _ r �� ____ __ __ _ _ . : ��,;� __--__---_____ _. � . ____ _ _ ___. _ _ . _ ��.�._ _ _ � _ ____ _ ___ _ _ _ __ _ ____ __ __ __ __. _ _ _ __ _. ' �' �-----� _ _ _ _ ___ _�: __ __ _ _ _ � � --__ .__-------- _ ,. _ _ _ __ _ _ _ ___ � �� n�___ __ ___.____� _ _ _ _ ___� _ _ : �� ,f- : �� _ . _ ,�� .� _ NEW • [ ] ADUIV [ ] ALTER [ ] a.s - G�� CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATfON �. ` ' l Construction Address: �o � 0 9 l� � G T� ��__ � ! � � , � �' � � ` Legal Descript+on: • � Owner Name & Address: ; � �° �� ° �'' Contractor: l� �' // �. b r,o ��.. t n _ Tel. # 7� � S' -Z�-I�.6_�7 / LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Cert�cate of Survey of the bt, with the proposed construction drawn on it to scale. • DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Sq. Ft. �— � / /S� �� Construction Type: �4�� `Estimated Cost: � Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _� �� DATE: �' �� b SAPPLICANT: �� - � �° r� Tel. # ? � � ��7�' f 6 67 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. CITY USE ONLY - Permit Fee P1an Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge � �� r 6.� $�, ; — $ � ��— $ � �.� . $ $ $ $ Fee Schedule on Reverse Side 65°Io of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determi�ed by Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL $, �.�� STIPULATIONS: :� G�/ - r � � � � � n � �'� � o �' � �1 6 �, � ')7hiD _ , _.--�.___.___..._____..____...f.__ _.__ _. , � ��,� � ---- � -- � -� - _ . y ' � �' � {, � _;�1'� � -b'"; , ��; y� ' � , � ,.,� . __ , _...�...M....._�.�.�...,�..�. � j � � .' �, �' � k;�� .. ,� �,, r' l '� , �_�h J `c� ' _ - �� '�" � . �-- �� . . _-,�.--�---�_��—.� - _'------� � II A �'�� -= � S ^ � �% S � ��%� �; "�/� � � � � Vl�� 'S�' ( V� C�31J1.��F lL9 �� r"�a C,.�� 1 �' �.s � I�t �n �N �.— i � OC � � � ��o� . ..._' � 1 N ��g` �-I�t�( S �-----�- �-� _._.---� �r� � � ti�. �� Y Z `�� V , - ___-- ; , �: ' h/'L �� C��' �� Ii �� _ � — _ t5 �1a� ��.5 " � � ��, � t N S � ��'N .� �C)V �''� � � i i o� s�"s � `�r1L� � ; � x 3 'C'fe.a-� � � c�� 4-c � � I � ; � / ; !� t c...`� o�c,,. ` L�v� ��e , / 'i � � i i ( � %/ I v s.� c� i�'o�•`.� dk �- ��`�'i R lOt�lS ( � ` °� n ► ; ; � � � � o� CF�, i 1 1�►, � �e ' � - i � �,. . ,. � 4 ��, I Y � 1 � � � � . �� ' __ ��i� ��" J , V 1 � �� '; i � aS%�i �la , �� . � ��j - �- I _ < � � 7 ��-� ��2 C� 1 -� / c �� lGc-- � Y � C, �` S (�j � 1.— .� �� c� C'.y ,%.l r�- 1� o t ..J� � ----.�._.___� --,�, . � NEW [] CITY OF FRIDLEY Effective 4/1/2004 ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER ( J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION � ��` C �� (�� Construction Address: �� Legal Description: Owner Name 8� Address: � 1� � f�t� �' _ Tel. # Contractor. 2� c�i �l iZZ l� �A �� 6 S MN I.ICENSE # �0 S� Address: � 33 r �� `� �r� �"j �I� �� Tel. # � � L � � ` �� Attach to this application, a Certificate of Survey of the bt, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LNING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length _ Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: .��SG ..�-� � o ��- -i- �2�R.Oa � � �� s imated Cost: $ Cons�cuction Type:� FR -'i' � F f� li S� '�` � Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$_ I � DATE: � �' S APPLiCANT: �,5==-�--� - -� ��`"`�� Tel. # Call (763) 5T2-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ $ � � $ .$ $ � � $ $ 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 Consenration Plan Review Fee Determined by Engineering Agreement Necessary (] Not Necessary [ J TOTAL $ STIPULATIONS: � /� �f— — Building PLUMBING Permit Ivo.: �: ��-� ti Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date xec'd: `� � t" DATE ` � �C YOUR E-MAIL ADDRESS SITE ADDRESS �Q�'7 — �,�Y � THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY NAME:��C./��Y2. Q`°t/'9 OWNER/ ,,�DRESS:__ ��) -�f-['c(lUY r S"1 CITY �� STATE'L.l�ZI�Z TENANT pHONE: �r+= 7/_��'a � % CONTRACTOR NpME: S SUBMIT A COPY OF STATE LICENSE # �{CJCi cJ C.. EXP DATE % Z� 3�' d� YOUR STATE ADDRESS: � CITY /!/�7 �c S� STATE�P IP� LICENSE WITH pHONE FAX APPLICATION PERMIT TYPE �GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: � �W �YLACEMENT DETAILED DESCRIPTION OF WORK s� PER MS 16B.665 the permit fee is a minimum of $1S.00 or 5%0 of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement afaresisiential: fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = FORPROJECTS WHERE [;ABOR EX£EEDSi$5��£"�A�':Bk'��'f�3I+I��0.0iJPER:Fi3{TURE, EXCEPT:��Jfif'ED. -FIXTURES:. {INDICATE'FOTAL : `t � : _ NUMBER OF EACH BELAV� BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPiNG BATHTUB GAS PIPING pv� c��rucFrvsE) SWIMMING POOL � WATER SOFTNER (S35) CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) DISI-IWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER Permit Fee $ Number of fixtures @$10.00 x$10.00 =$ Surchar e .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ Number of fixtures @$35.00 x$35.00 =$ State Surchazge = $ .50 Tota1= $ THIS IS AN APPLICATION FOR A PERMTf-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 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 w k wh' h requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME �- �-( / V � DATE d� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Biuild�g BUILDING Permit Na �— Inspections RESIDENTIAL APPLICATION Received By: � 763-572-3604 CITY OF FRIDLEY nate xec'c� � DATE � � �S � � 7 SITE ADDRESS (�� U 7 YI t UCo2y b"t _ THIS APPLICANT IS: �OWNER YOUR E-MAIL ADDRESS PROPERTY OWNER/ NAME: �-b l S a�2 �t TENANT �DRESS: 6 �a �i �� o r-� �' = CITY PHONE: 5� � ^�� 6 7 CONTRACTOR SUBMIT A COPY OF STATE YOUR STATE LICENSE ADDRF WITH APPLICATION pHONE PROPERTY TYPE � S�� PERMIT TYPE TYPE OF WORK: � �iTi�T✓�! ❑ TWO FAMILY/NEW ❑ BASEMENT FINISH ❑ DECK � D MAIN7 DESCRIBE WORK BEING DONE:. SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDIlVG ❑ Vinyf ❑ Aluminum ' ❑ Other WINDOWS IN EXISTING OPENINGS ❑Yes ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED EXP DATE ❑ ROOF ❑ SIDING ❑ SWIMMING POOL REMODELING � ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE OSoffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF ❑ WINDOWS ❑ DRAIN TILE �OTHER t AJ.,I(�,� � � I WIDTH� ATE��IP �Y � Z— HEIGHT � I?$' Sq. Ft. BASEMENT REMODELING SUBIvIlT: 1. Existing Floor Plan 2. Proposed flaor plan 3. List of swctural members to be used FOR NEW CONSTRUCTION MCLUDING DECKS, ADDITIONS. &c PORCHES SUBMIT: i. Siu Plan/Survey showing the p�isting structures and proposed project. 2. Two s�ts of constructioa plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: T��/B� (USI1�iG THE 1997 U.B.0 FEE SCHEDULE) Tt�L JOB VALUATION $—�� OCCUPANCY TYPE ,/Permit Fee �Plan Review /Fire Surcharge /Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ � fl,��° $ .S�OO $ $ $ $ $ � $ See Back Page for Fee Schedule 65% of Building Permit Fee .401 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks aavable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclrnowiedge that the information above is comptete 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; that the work will be in accordance with the approved plan in the case of all work whicl�equires review and approval of plans. SIGNATURE OF APPLICANT �. ^ ��p�„� _ _ PRINT NAME _ � �_ �� E /- oZ �- o -7 �- � - ��{ - �w�h - rvt�� h �� ; � .. �`�`�� S t�4�u�it ��R ��.: =---: - ,.-- _. . , ��-�„ M�..� � `� �c w�a� w�-� ►.ra .r----- 3� �,. �._ �- � 1�,. �; �'--�-� -- _ -` - - . , k �� i � 4i � ; ;�, � �, � { 'fH ; i �� I i� �� i� i I 'll I I� � i ;i , �� i`I i ! � _`��___ _-- T , � ( - .---- � � � `'i .{ , , ' __� _-�-�--- ; r2'�a�r�+ 7'-8" x 3._ 1" ' � ��W_� � -- �� d�.-��.s �� .kh '�� aw� ar� �c (� ��:�. --.�,� ��-' �'�° , �� . �N.,NQS ��c ------- -- � �'„'\.: .-1 � 2X4 �TU� 1iVALLS l6 OC � R13 BJ�7 INSU�ATION 26s8 , �. (Y��u. �� 1USt� � ��.' ��s�� Vu� i V4�,��'a'-im2t`r �t` ,, � �,i� .�.� � , � :4��8� : � ��, � . : �� • �; � N � � IN � � .�....�-.� � TlLE (?VER CO�ICR�TE N iti711�F�00R HEAT ----- ---- -, i - .-- �.:r�, =,,._.. _ l . I '. �- _. i � I i �-_. i i-1, - - -- �_�_. ._-� �' I ►f - ___ �� -- f• �t�i , �! j1�1V� ��p�- � '� � ► ''j i _-�_ �- _ -- ----..� � j • I `i I r`� ; �.'i � `�� : ,,1, . _, _`_ � �� i -------�- �_.� -._._____-#-.� �� . � I LAUNDRY; MUi�RQaA� `•. ;' � , 7�-�� x ,2�,,.. 1 � `' -, ! - : ----- ----- - � !-�;._. �� ,--------�--------------- - , . !� � . � i� �' i� � i �; ' I ---�- .T _ � } _ . _ . . ; . .. 'i� :�� RE�ZINA� C�NVERI"IC?N �088 OPENING �� I�Jd�"ts �� t�o�Vw�� Zw� �S � �� w �. .. ..-'-°-�-�°~ . � � _ C[1YOE FRIDLEY FRIDLEY MUIVICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, ��S � understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at �.�`D �! �-I< <.�, r�., ��, , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which t may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contraators to perForm certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of AAinnesota. I understand that unlicensed residential contracting, remodeling, and/or ro�ng activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for corripliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name �../ Date t 3 a 7 Building MECHANICAL Permit No.: - �� Inspections RESIDENTIAL APPLICATION Receivect By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: ��a 7 DATE 2 c��7 YOUR E-MAIL ADDRESS SITE ADDRESS � Sa y ��o<-z; �f F�r� d� THIS APPLICANT IS: �'OWNER OCONTRACTOR PROPERTY NAME: LO 1 S Qi� r OWNER/ ,�Dx�ss: 68�9 ��c�Ca� �• CITY �ri[aQ� STA'fElH1f ZIP �S 3Z TENANT pHONE: S�7 l— j(� G'Z C.( J�. CONTRACTOR COMPANY NAME: SUBMIT A COPY OF CONTACT PERSON: � YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ,r�DRESS: CITY STATE ZIP APPLICATION pHONE FAX PERMIT TYPE ��GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ��W ��P�CEMENT t�'ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK �onYear�=�� ('c�cr,e�t�W fiD CAaw�.�T-� $' 1�2— �1�'iti� ��y a � " . PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 =$ I5.00. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI� Equipment Installed MFG: MODEL: SIZEIBTU MFG: MODEL: SIZEBTU IviFG: MODEL: SIZEIBTU A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN 510.00 AIR AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL 510.00 ER $35.00 _FURNACE $35.00 _GAS UNIT HTR 510.00 HIMNEY LINER 510.00 _GAS DRYER $10.00 _POOL HEATER $35.00 DUCT WORK �10.00 GAS PIPING $10.00 _VENTILATOR $15.00 Permit Fee $�. � v Number of fixtures @$10.00 x$10.00 =$�_ Surchazge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $_ j�.� Number of fixtures @$25.00 x$25.00 =$ Number of fixtures @ $35.00 x $35.00 = $ State Surchazge = $ •• .50 Tota1= $ /D , S� THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application 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 rk which requires review and approval of plans. SIGNATURE OF APPLICANT � PRINT NAME �G � S DATE �"�'�^' z' % C:ity of l+'rialey Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Buildin� Tnspecti�ns 763-572-360A� UATE,_. ,,, m �c $1'I'� ADDRCSS _ mLS APPLICANf �s: �LiJMB�G RESIDENTiAY.. APP.LiCATI4N CITY OF F12IDLEY YOU'R E-MA1L ADDRESS �.��__..._.S� `�� .._ ❑(?WNAR �:oN•n�►ero►� ��Z � �� b �� I'eznnit Nt�.: ReceiveCl J3y: Date R�c;'tf : � d 4 PRO�ERTY N,�;: .._._ .,__..._.... - ---_ OWNEYiI ADDRCS3: _. CI'1�',.. _T- 3TATE 7.,IP TE1�lANT wHONE:�_,..___.._.....� _...�.,_ _.. corrrRwcrox ,wa►M�:_ �lel..... an. . __� S bn� << , ,_....-- Sl7BMIT A COPY OP STATE WCEIVtS�E � � �6�. P� C1� 17A'!'E _(�-3 j-D � A,�/ YOUR STATE A1yURE.SS: J��!._� �.� Wl �!'� i�'��. CITY DLt. �'1'A'NH^•��,2lf'�u l LIC'ENSE WIT[i rrwr�� S= v��l � FAX �.�; `!d ��566 PSRMI7 ?YPE TYPE OF WORK: �GLE FAP1lL7 17 NFw DETI�IL.ED DE$CRIPTION OF WORK C] 7"WQ PAMILY ❑ TOWNHOUSE �RNp�.acf:Mr;nrr � — �►c� ��- I �^� . �°M' ' ,-.,—� PER MS � 6B.66S the p�srmit ic� i� a mioimum M' S15.ifd or 5•� of tie total eos! np to �5fl0.00, whicl�ever s� gtq�ttx. for tho improveme��t, installatino cK replacement of a residentiai fixture, exduding ihc� fixtur�s. ('This should r�flect only the cost of labar ) �+bor cost under $300 =$15.00. Labor cost between 5300 to $500 = cost o�' labar _, ^, „� ,.., x.OS = F�c�u Y�rcu� w[�tEtr� t,nsrnt �cc��s ssoo, CEES A[CE BASED ON Sl�.OQ PER FIXfLiRE. �xcFxr wt�tts Mo�ren. Pixru�s: (�ronK:aze �rA� N tw»BR or� �:nc.H ��ww} ,r,�, BATH 3MIULAY �rLOOtt DRAMS _ SHUWBR ,,, _ WATER PIPINCi l3A'!'�l'I'UB CA.q PY4�tNC3.�att�or.�rr�c�ast) SW[MMING I�UOL WATgR SUFI'N(iR (535) rCTATtff?S WA�SFIER ~1�ITC'HEN SINK. � wA�r�� cWS��r _k�ACKFt,ow p��V. (S15) � DL4fiWA3iQ�L � LAUNDltY TRAY ,,, WATGR IiGATER (S35) FOR •IRRICATI(�N _ WA�TSR METER ,�O'iii�R S'�p,j�_ Foo $ _, NumbeT of �ixtures (� S 14.00 � x: � 10,00 =$.l� p. �QO e SU Number of fixtures Q�15.�U x$15.UU -• $� ►UE $ _ Number �f f'txteyrcx� (� $35_Op x $35_00 = S _, y Siste Surcharge = s .SO Tolei � $ 7TiI3 LS AN APPLiCATInN FOR A P�.►LMI'i`-N(�t' VA41ll UNTtL PROCE33BD i hereby apply for a building pertnit end ! aoknowlcdgu th�t the in.�o�nation abnre is complete aad accucat�; thwt the work will be in confoi�rl'iance with the ordinances and codeg of ttu; City of Friclley and with the Minnesota CoastructIoa Cod�s; tb�at 1 understand this is not a p�rmit but unly an upplication for a permit and work is not to stsrt. wittrout a pem,it; th,at t�e work will bo in accordanc:c; witi� the approvCC� plab it� �e ease �f alt work whie t�eyuires reviuw and approval of ptaus. 31GNATt1R�c�APN�.iCANT� . PRINTNAME_�•N� SvLdNI ,.._.Dal't: � a.�� ,_,. C��+` Of �I1tllCy Building YmspectaoQS Dep�rtment �431 Uaiversity �venue NE, I�ridley, MN 55432 763-572-3604 ' rAx: 763-SU2-4977 Zd WtiSS :0S L00� Z0 "�(a� L8ZS T�.SE9Z :'ON Xti� �a I P? �� .�o Fi�. t �: W02� �AR-26-2007 11:37A� FRO�-VEIT DIPOSAL ;�RV +763-428-6779 T-6 P.001/� O1 F-7A5 � i..��i. viy �� i n.��rJ �a.._ ......�..,..� �.. , +.�—. ..— —' ' ' � �� -� „�� I� � APPLICATIQN #� ZQO'7 C%� �y� . � i.U��'� �YT'i' OF TY��ALEY 2007 LQ�AD LIMIT MC►DZFICATYO�T PERMYT . J'C}B ADDRESS: � � DATE: � _ MATERIA�°► - _.�--.' � - � �' � - BE HA�JI.ED: BEiNG TI�[TLED BY: PERMTT REQUESTEI3 BY: �S/..JY _ DA'Y'ES UF DELIVBRY: �'�� _ (UP To 3 Days) THIS PERMIT IS ISSiJED TO 1�L.LC]W AN TNCFtEASE OF AXLE WEXGHT FR{]M FOIJR {a) Ti�NS PF.R A7�T.F TO FiVF (51 TONS P'f:R AZLE O'VER'. THE �OLLOWING DESIGNATEI) R�UTE: NOTIC�: '�'his petmit is valid on:ly far vehiclzs enr�ute to cpnshvction address durin� the ho�trs of 8:04 am to 5:00 prn. � _ .-. PFRMIT FEE: �25.00 REGE�P'T � ISSCJE�] B �� Building Inspec�ions 763-572-3604 DATE � C ' �I" �� srrE ,a�DxESS � THIS �4PPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPL TYPE OF WORK: � PHONE: � MECHANICAL RESIDENTIAL APPLICATIQN CITY OF FRIDLEY_ � G/(c9r � OWNER YOUR E-MAIL ADDRESS .t �pTi7'RACTOR ��G 1_ � . � ,. S� �� CAMPANY NA1v�: vE"I COMACt PERS0T1: STA'fE L}CII�15E # . ADDRESS:� D L`�X �`"lQ - PHONE �� `I �' �-I — �LI � % FAX l�1NGLE FAMILY ❑ TWO FAMILY o t�w '�x��+cE�xr DETAILED DESCRIPTION OF WORK Perm.it No.: Received By: Date�c�[�: ATE ZIP EXP DATE ,�% CITY �As e STATE � � ZIP �a�� p TOWNHOUSE ❑ ,a�Rnnow�MOnn. PER MS 16B.665 the permit fee is a minimum of 515.00 or 5°/. of the total cost up io S�OO.OQ, whichever is greatcr, fa t�e improvement, installation or replacement of a residential fixture, excluding the fvctures. (T'his should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.DS = FOR PROJECTS WHERE I.A�OR EXCEIDS SSOU. FEES ARE BASED ON S]0.00 PER FIXI'URE, EXCEPT Wi�RENOTID. FtiCi'tJRES: (II�DICATE T�TAL NUMBER OF EACH BIIAV� G D c� 3 SU A6 � SIZE/BN %, �J Equipment Install�d . NffG: r.s��o MODEL: S�g.I,V MFG: MODEL: MFG: MODEL: SIZE/B7'U A/C 525.00 FIREPI.ACE (GAS) S15.� GAS RATIGFIOVEN i10.D0 _AIR TO AIR EXCHANGEER S15 FtREPLACE (WOOD) 535.00 _T1BR► GAS GRILI. S10.OD BOILER 535.00 - �FIJRNACE S35.00 GAS UNTf H1R S10.OD �HI1vINEY LINER S] 0.00 _GAS DRYER 510.00 POOL I�]EATER 535.00 DUCT WORK 510.00 GAS PIPING 510.00 Y_� VEN'I'II-ATOR SI5.00 �;�;",�;li�• ��..��tc::��x��:n,�,�Y�. ��4--�,R�.a-�,.,�.....�.._ �..__ � Permit Fee $ Number of fixtures � $10.00 � x $10.00 = $ Surcharge $ .50 Number of 5xtures Q$15.00 x 515.00 =� 70TAL DtTE $ Nwnber of fixtures @$25.00 x$25.00 = S Number of fixtures @ $35.00 / x $35.00 = $�S — State Surcharge = $ .50 � Total �= S�SZ> Tl-IIS IS AN APPL3CATION 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 codes of the City of Fridley and with the Minnesota�Construction Codes; that t understand this is not a permit but only an appli n fo 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 o or h' requires review and approval of plans. SIGNANRE OF APPLI PRINT NAME �l L "�` � /�f'I Ml£'-�'�"�'' DATE � 2 � � �� O % City of Fridley Building Inspections Department . 6431 Universiry Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 �. fi.EQUtRED WFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMtT APPL{CATION HVAC ❑ NEW HOMESIADD{�IONS �E)CtSTlMG HOME ❑ MAKE-UP A[R REQUIRED FOR NEW/EX�STING HOMES 1. Combvstion A.ir (See note below) � a. Oil or solid fwel IMC Cbapter 7 with MN Amendm�� b. Na�ural Gas or Propane/IFGC Chapter 3 with MN Am.endments � 2, Make-up A�r (See note below) a. IMC Chapter 5 with MN Amendm�ts 3. Venting a� Gas appliances ]FGC Chapter 5 with MN Amendments b. Fuel other t]�an gas IMC Chapter 8 with MN Amendme�.ts REC�UtRED FOR NEW HOMES 4. Heat loss &�ooling load Per room a,. Required on new consf.n�.ction IMC 134-6.0312 5. Ventilaia.on . a. Per MN Fnergy Code 76'10 ar 7672 6. Duct Design Per IlvIC 134b.0603.2 a. ACCA Manual D NO'TE: Cenierpaint Energ� Mechanical Code Guidelines software may be ased for � combv.si�on a.nd make up ai� calculations .� : . v