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AF - 46174- _ T �� ,��:, ,. :�- , . < .<... . :: . ,,. r. _ i � < _ ;. : - - ' ; _ , Villag� of Frirlley, Minn. :_ : � . 11i° � -- 1.96? : �UILDiNG PE�i,MTT � . . �,. . ,. .� � > � - �. :� Date:,e�� .�� . ;�"','; °� f�. , . : f� • � �'� ' - Aa''' f� ... . . - . ' . . . .�wner ��.'��-. ' �- � .�`�-��"•�`� :�. �s�.� . Builder . . Address .'�'��,1. .��..�� Address . . . . . .. . . . , i _ < 1.4CATi0 OF pU1LDtNG � No. �� . $treet , , , . . . Parrt of Lflt Y I •� .. .. .. ' .... .. .. .... . , . ,: „ . . . . , o . Lot . . � . . .. . . . Blcick .a.� . . . . . . . . . . . . . .,�'�.,� . � Addition or' Sub-Divisio .�.�,st�'t°�`;�':$ ..��+'��'; .�� ;�: . . . . . . .. , _ ' Ct>rner i.ot . . : . . . .: . . : '„_ ` . . Inside Lot . . . . . . . . . . . Setbaek ,�.'� : . . . : Sideyard . . �� ."�"`.� f'..�„ � .. .. � �� DESCR1PTfON O� BiJILDING � . � To be Used as: 3 � . ° ��p�,�ry�. �,'� ;> �r � ,�'.°. , .' 4"."7Y�. . . . �. • , �' ' _ . . . . D2 fih �, . . : Front ,�� P f..... °Height�� Sq. F�t. .:...... Cu. Ft, ........ � � Front DEpth . Height Sq. E`t. �„ �,: ....... ' - .: ; ,. • ,... ... .. ...... ' Type Qf Construction�;�Y,�!`�k xF �t: . . . . . F:st. �ost ��:�:+�.�. . . . .�. . . p � � ' Ta be Com le�Eed .+�� . :� .. !�d i��-r �O � � � ;. ,; _ ,. �., . , ,_ , i . , ,.. ; ;: . < , M '`" . : ' ' `__ , � .. . : : * �. - � _ , , : . , -: _ , ; }; � consideratfon oP the issuance #a me af a permit to `canstriict the building descr�tbed abo�re, i agr,�e to do � �' ��, the propaser� work in accordance with the descripfion above set forEh and in ` compl3ance with all prnvIsions o� _ � � , ordinances of #he `t�llage of Fridley. .; �� .�: . . '�.ra�!'.' . . . . I •{� q in consideration of t1�e a ent -of a fee, of `� P 3'�ri = � � F $••�.�...., perxniti is herebY granied to ��'.,�....;... Pxnt . ... -�,�� "^�'�� - " �. .... tn construct the buiIc�ing or addition as deaeribed �bove. Thia permit i� graated npoa 'the express con 'tion tha� the persan to whom it fs granted and hfs agents, em.PIoyees and workmen, 3n all work : done in,-;arbund : and upon saicI }auilding, or sny part ttiereof, shall conform in a11 respects to the ; ordivano�s of ` Fridley, NlinnesQta. r h egarding locaiion, cons�truction, alteration, maintettanee, -repair and moving of buitdings with_ fn fih� village Iitnits ancl this permit may� be revoked at any #irne upon yfo2atiQ�,of any af .the prov3sions of sai$ ordinances. � ." - . . *�., � � . .. i . . . . ,. � t � ��'��Y } .. i• , ' �. . Y ." . - . ; ' - , - , ,. .: . ,. �- • �, �� . .�+'„'�U��lg �p t , _; ,, : WOTICE: ; . < _ : ; This pe�mit does not cover the'consfruction, in�tallation or aiteration for wtring, plumbing, gas heating, sewer or water. Be sur� tn see t, �Building inspector for separate Asrmits for fiese items. ` � �,� ; c ,�r �' ;..� - ' . Lo,rs 13 � .14 � �LOCK 3 � � c_' M.00�0.E LAKE� H I LLS ..�NOKA COV�ITY �.: � � . . . . . , �po� �qa� . �. . . G p � . �ao►� - ' . ;NW Cor. 60 . , � Zp • . , � . � , [of:J3'`;' NwCo,: . � Lof !4 ' � � . . ; :; . . . � :,�r��;� �� _ . - ;, � .. Lor 1 Lo 14 , . K�:� �; . . , �' �� 4 �,... _ �'� > - � . ' x - ;�� N ;�I , , _o ,„ _ � � o . ti . . ' �.5 4 ,�,� � . N . F s� �, . . . �y.,4,; � . :+ `�� ° �•-6- � "°4 Sco% - /,. _ � , � . . ° /F ^ � c, : / �� R E5. � m � F • I . ` '9 .135 "' ,�� G4a. � � � N /34,8 . . 2 � 5' ..�4.:. � to• '" zr . �3'.. r E. �:�d ;�x:t � � � . � �i �` a ` �" `':5E Cor. ' � V � $E Cor. /3 ti ' , f J� ~� 36.2' � 4$.8 ' � lLOf l�4 . ,• / �� , . _ . � 80 , _ ,� �; . . . , r,. . �_:.�;�. ._ _ __ �� . ` . NILLCR�ST ORIVE . .. .. i ,�� ' i' .. ' • . • � � • • 1 _ 1 � . �, � �:;° ;' �> � � ,� �;�� ,'�;; . i , I, her�by,�'cer-fi�y tho� fhe obove plof is o f�ue ond correc� copy oFo ,su�ve y� o� �. ! "jhiof porfoF Lof/3, Jyinq Eosfofo /ine ext�nding �'roin fihs Soufheosfco,^ner�f soidLof/3, �� ' to�'opoi�f� on, fhe No�h /ine of soid Lof, diSfonf 60feef �osf fi-orn the �'Vorfhwesf corner of soid `Lof,:;,.,together wi�h thot porf of Lot /�l, �/ying Wesf of o/in� exfendin9� {r�arn fhe 5oufheosf ccirner of Lof /4, fo o poinf on the No�th /ine ofLof /�, disfonf 2Af'ezf Eosf � from � fh..� No�fh wes� eornero{Lot /4 , o// in �/ock 3; Moo.�~e Lok� f�1i//s ,"os sur. veyed by. I7�e this 22nd doy of Mvrch �l. !) /96 0. , . . , .��. .:� . � . , � � � �� d� , �� ;7�,,� --,�` ' . ,i � ^� ,� ..h� . 4 : r - �r�: a ,.�tu :� a.--wu,+.. �k �k �,'�,t ,� �. - , t ��'. ►tG F G � ., � ' �i�'s � � N^ � < z . `Na ` ��'� i: ' •4 a vvd:�w-.. . t � ( � ! { �,«H�.- w�-*-*�- �.�.�" r , � � �r �P kAV.�Y+++;S�'}��ei'k' *j�p...'.�-`.�`"J, d�'`� �-,.'S �+..�. t '4 i : � �: �ii.S .. ._y �� i -� ' u it 3Y�} �'`t�. k�'o �++ e r`�Y'+ �� H'`�'�'$i'� ,� X!iFr?.:�} Y�`'� � � _ :t h .. a . . c R ; s' y � 5 c.'i w)�-. > 9. r..t v y r S� ,A' � v �.'h?eL i�k l•h � t �" ,�' �� .« Ye; _ ..3'..•. .. x.... . .� .u�.. ... P�� i n4mii:bFarYm+�:. ,. �i.�w.0 .,».. ��rr.Yesv1'�Y^i.s�,di.�ei:t1.� ,�.�7�7 w`i+f}v�'U. i�:" . -. . ..�{ . . .... � SUBJECT Pyr�*+�1, 1 N�• �� City of Fridley � 215 8 4 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r ; � R NO. � • COMMUNITY DEVEIOPMENT DIV. � C� � LV � �� r � � PROTECTIVE INSPECTION SEC. � � � i � � r'�'1 � CITY HALL FRIDLEw 55432 NUMBER REV OATE PAGE OF APPROVED BY �'"'"� � �'� 612-571-34b0 910-F15 9/30/92 � � JOB ADDHESS 1352 Hillcrest Drive NE �� / Z' t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. P't. 13 � Moore Lake H11�.S SHEET 2 PROPERTY OWNER MAIL ADORESS 21P PHONE Bruce Kath 1352 Hillcrest Drive NE 571-7535 3 CONTRACTOR MAII AODRESS 21P PHONE IICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICEN3E NO. 5 ENGINEER MAIL AODRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK 0 NEW ❑ ADDITION ❑ ALTERATION I� REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK xeroof House (30 Squaxesl Tear�o�� 9 CHANGEqFUSEFROM TO STIPULATIONS Undexla�nent must c�mplx with. th�e State Huilding Code. SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OR AIH CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONIN(i SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED fOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �' STALLS GAFiAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX ANO ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIED 1 590 WITH WHETHER SPECIFIED HEHEIN OR NOT. THE GRANTING OF A PERMIT '$ f '�a 79 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $37e OO Fire SC y�`l. �J9 PLAN CHECKFEE TOTALFEE $39.38 SiG TUREOFCONiRACTOFORAUTMO .EDA r iDArEi HE PR ERLY ALI TED THIS IS YOUR PERMIT �� p %°',��,�L/�,� �X..� �� 'J�"/ 6� SiGNATURE OF OWNEF tiF OWNER BUILDERI �DATEi LDG �NSP riaiE NEW [ ] ADDN [ ) ALTER [ ] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective 3/1/92 s Construction Address: r�p �,�� 1/�(;%�� S� d/�I v� Legal Description: c7 "�" �'� ��t� �'- K. .` i�� 1� D jf � � a Owner Name & Address: ' , f�✓ a f 1 �R�. � �� Contractor. (� � � L �, M� LICENS Address: Tel. # Aitach to this application, a Certificate of Survey of the lot, with the propos� construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IIVIPROVEMENT Length Width Height Length Width Height Len Width Hgt/Ground lNp �0��(� !� w�,�2�'-'. .� 1 (`�l c111A�;Q�' .� ��4- �� f �i l�� 71��- ?� � � 's �` Sq. Ft. Sq. Ft. Sq. Ft. _.�� _ �1-{-,` 0 Corner Lot [] Inside Lot [ J Ft. �d Setback Side Yard Set6acks % , Type of Construction: Estimated Cost: $ /�'�., =; "( % Approx. Completion Date: (Cost on Backj Driveway Curb Cut Width Nealed: Ft. + b Ft = Ft x$ _$ DATE: �'% °' � !� � �°I � APPLIC�NT: � �l/ �. TeI. # � � %"' �v �� ITY USE ONLY Permit Fee $ ��`.�� G' C� F� Schedule on Reverse Side Fire Surcharge $ �'- S�e� .�1 of Permit Valuation (1/lOth%) State Surcharge $ � i�i" $.50/$1,000 Valuation SAC Charge $ $'100 per SAC Unit License Surcharge $ $S.i� (State Licensed Residential Contractors) Driveway Escrow $. Alt. "A" or Alt. "B" Al�ve Park Fee $ Fee Determined by Engin�ring Sewer Main Charge $ Agr�ment Necessary [] Not N�essary [] TOTAL STIPULATIONS: $ �`% =�� BUILDING PERMIT F�E SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing bnilding or sbructmre, or for azty alteration or repair to any existing huilding or shucture, 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 $25,0� $25,001 to $50,000 $50,001 to $1�,� . $100,�1 to $500,(1Q0 $5�,001 ta $1,000,� $1,�,001 and up FEFS $15 (Minimnm Fee is $15 plus surcharge) $15 for first $500 plus $2 for each additi.onal $100 or fraction thereof, to and including $2,000 $45 for first $2,000 plus $9 for each additional $1,000 or fraction thereof, to and including $25,000 $252 for first $25,0� plus $6.50 for each additional $1,000 or fraction thereof, to and including $50,0� $414.50 for first $50,� plus $4.50 for each additional $1,000 or fraction thereof, to and includ.ing $100,000 $539.50 for first $1�,�Q plus $3.50 for �ch additional $1,� or fraction th�eof, to aad including $500,�0 $2039.50 for the first $5�,000 plus $3 for each additional $1,000 or fraction ther�f, to and including $1,(H?0,000 $3539.SU for the first $1,�,000 plus $2 for ach additional $1,�0 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Str�ts Only) Alterna,te "A" : Removal aad replacement of curb and gutter only - Driveway width plus 6 f�t times $13.50. � Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 iach depth - Driveway width plus 6 feat times $15.75 . VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been consbructed will be required before proceeding with the framing. �� sue�etT PE c;ty of Fr�a�ey 313 6 2 AT THE TOP OF TME TWINS � � I L D I N G P E R M I T � � � RECEIPT NO. � ' COMMUNITY DEVELOPMENT DIV. 'a�� r � y • � PROTECTIVE INSPECTION SEC. � 1 � , 1 � �'�� CITY MA�L FRIOLE� SS�� NUM�ER 11EV OATE PAGE OF AbPROVED 9Y �""'� � �'� 612-5��-3a50 9�aF�s 9/5/00 � � JOB ADORESS 1352 Hillcrest Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACNEO oescR. 13 3 Moore Lake Hills SFIEET 2 PROPERTV OWNER MAIL AODRES$ 21P PHONE Bruce/Julie Rath 1352 Hillcrest Drive NE 763-571-7535 3 CONTRACTOR MAII ADORESS 21P PMONE LICENSE NO Same 0 ARCNITECT OR DESIGNER MAIL AODRESS ZIP PMONE �ICENSE NO 5 ENGINEER MAIL ADOIiES3 21P PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WOFK ❑ NEW � ADDITION O ALTERATION O REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK EXISTING WITHOUT PERMIT: 15'9" x 10'S" Screen Porch 9 CHANOE OF USE FROM TO STIPULATIONS Variance approved for side yard variance 8/2000. Any construction corrections will be noted in field when final inspection is called for. SEPARATE PERMITS ARE REGUIREO fOR EIECTRICAL, PIUMBING, NEATING, TYPE Of CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OF AIq CONOITIONING TMIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTpUCTtON 20NING SO. FT CU FT AUTMOR12E0 IS NOT COMMENCEO V�1ITHIN 80 OAYS, OR IF CONSTfiUCTION OR WORK IS SUSPENDED OR ABANDONED fOR A PER100 OF 120 OAYS AT ANY TIME AFTER WOHK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I MEREBY CERTIFY TNAT I MAVE FiEAD ANO EXAMINEO TMIS APPLICATION 1 STA�LS GAAAGES ANO KNOW TNE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF �AWS yq�UATION SURTAX ANO OROINANCES GOVEqNING THIS TYPE OF WORK WILI BE COMP�IED @ WITM WME7MER SPECIFIED HEREIN OR NOT. TNE GRANTING OF A PERMIT W3,044 � $1.52 DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL TME pEqMIT fEE SAC C RGE PROVISIONS Of ANY OTMER 57ATE OR LOCAL LAW REGUTATING CON- STRUCTION OF TME PERfORMANCE OF CONSTRUCTION �9% . ZS Fi e SC �3.O�F PLAN CMECK f TOT � FEE � 1.81 S�GN U E O� CON'iiACTOpO TMO E ENi �D�iE� EN RO E ALIOA E MIS IS f PFy1MIT /J� Z e��TiG+GR- � / �/ / J S�GN4TUAE 0� OWNEA�� OWNEpBU�lO@ � iO�TEi b L/v BLOG NSP � r�pTt NEW [ J ADDN [ ] ��R I ] Constru�tion Addres : Legal Description: � Owner Name 8� Address: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION � ��/.�.�� t�� r Effective 1/12000 (763) 572�604 Bldg Insp � �� _. �� # =7�.�--�11-7��.� Contractor. �-- MN LICENSE # """— Address: • —'"'' Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. r • � DESCRIPTION OF IMPROVEMENT LMNG AREA: Length Width Height Sq. Ft GA�AG� AREA: Length _�� Width Height Sq. Ft s�'DEC�c A Length % fl Width � HgUGround � �Sq. Ft lIA V�LS, � ��p OTHER: .. � � � ��0�1 � Construction Type: d X�.,Sv�£e��% Estimated Cost: $ ,� _ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ .�► DATE: "!/ "�� APPLICANT: P�� Tel. #��" �,,�� e. - r,�2� CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application � i Fermit Fee 9r% �S $ � a� Fee Schedule on Reverse Side ,� Fire Surcharge $ ��O .001 of Permit Valuation (1/10th%) �► State Surcharge $ /� �� $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement ecessary [] Not Necessary [] TOTAL $ �D � � C7l l.l1'" c� � ! /�� . ?�� `n� n_,,I �� STIPULATIONS: �l�o"C� ' � q,�-� �� SUBJECT , c�ty of Fridley 33876 AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r ; � RECEIPT NO. � `y �� COMMUNITY DEVELOPMENT DIV. � '� � r � � PROTECTIVE INSPECTION SEC. �, 1 . � i---.�; "' �� CITY MALL FRIDLE� 3S�J2 NUMBER nEV O�TE v�GE O� �vvqpvED Br t 763-571-3450 9t0-Ft5 9/12/03 / / 10B ADDRESS 1352 Hillcrest Drive NE t LEGAL LOT NO. BLOCK TiiACT OR ADDITION SEE ATTACMED DESCF. Pt 13 3 Moore Lake Hills SHEET 2 PiiOPERTY OWNER MAIL ADDRESS ZIP PHONE Steve & Raren Gilmore 1352 Hillcrest Drive NE 763-572-0174 3 CONTqACTOH MAIL ADDRESS 21P PFIONE LICENSE NO Same 4 ARCMITECT OR OESIGNER MAIL AODRESS ZIP PMONE LICENSE NO. 5 ENGINEER MAIL ADDqESS 21P PFIONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION � REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof screen porch - rolled roofing, sheathing & ice shield 9 CHANOEOFUSEfROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARA7E PERMITS ARE HEQUIRED FOR ELECTRICAL, PLUMBING. NEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAD VENTI�ATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL ANO VOID IF WOfiK OR CONSTRUCTION 20NING S�. FT CU fT AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTqUCTION OH WORK IS SUSPENDED OR ABANOONEO FOii A PERIOD OF 120 DAVS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UN17S OiFSTREET PARKING I HEREBV CERTIFV THAT I MAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING TNIS TYPE OF WORK WI�L BE COMPLIEO @ WITM WMETHER SPECIFIED MEpE1N OR NOT. TME GRANTING OF A PERMIT WSOO �.SO DOES NOT PRESUME 70 GIVE AUTMORITY TO VIOIATE OR CANCEL THE pEpMIT FEE SAC CMARGE PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGUTATING CON- $23.SO Fire SC �.SO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE $24.50 5� N UAEO�CON'iiA OAOpAUTMOp�2E04GENT iD�rE� W EN PROPEfiIY VALIDATED THIS IS YO R PER IT 1 � S�GNeTU�7E O� OWN w EpBu4DEiii iD Ei �OG �hSo ryt t � � NEW ADDN ALTER �� CITY OF FRIDLEY E.ffective 1/1/2003 �] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-128T Fax BUILDING PERMIT APPLICATION Construction Address: Legal Descrip6on: Owner Name & Address: Te�. # -7Ca 3- �%�-O/7�% Contractor. C� ( x)✓l�P V MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. _ Length Width Height Sq. Ft. _ DECK AREA: Length Width HgUGround _� Sq. Ft. . � � � � • �i7�!��.:�i/iTi�ii�� /�.� � � � � � � . . .- �' . �.' `_�I -. . �� '` Driveway Curb Cut Wdth Needed: Ft. + 6 Ft = Ft x$ _$ . DATE: 2- � APPLICANT: �-� ��% Tel. # �7�0 - �7a ��%� Call (763) 572-3604 fo� Pennit 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 Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ �3s S1D $ � �'C� $ � S�� $ $ $ $ $ $ $ �`�� 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" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ J Not Necessary [] ��1._`�r.�� R, s BUILDING PERNIIT FEE SCHEDULE The Cluef 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,�1 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES �23.50 �23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,OQ0 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,(}00 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each addidonal $1,000 or fraction thereof, to and including $SQ0,000 $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 $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and 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 s � � Building Inspections 763-572-3604 763-502-4977 FAX 'O SITE ADDRFSS ,1 THIS APPLICAIV'f IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOURSTATE LICENSE, BOND AND CERTIFICATE OF 1NSURANCE PERMIT TYPE TYPE OF WORK: PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE ?-1-2010 YOUR E-MAIL ADDRESS o r�S' �' n, ❑ OWNER �ONTRACTOR (�G.� 'v�_ �'� .,�_ a t� C� - t/�? 5' , Permit No.: �� I Received By: ° na��:5 � p 2 � STATE ZIP STATE LICENSE # ��F %(�� Y EXP DATE /�oZ �/� STATE BOND # EXP DATE ADDRESS:�Z� /�j vtl�J'�elO � CITY ��yl- STATF�°V ZIP.�"��3 PHONE J�,� � S�C'-'uo� � FAX 7�c� —o�S �—�� SINGLE FAMILY � NEW DETAILED DESCRIPTION OF WORK ❑ TWO FAMILY O TOWNHOUSE �REPLACEMENT FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: ([NDICATE TOTAL NUMBER OF EACH BEL01�. MIAiIMUM FEE $35.50. _BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPiNG _BATH1'UB _ GAS PIPING (NEED CITY LIC) SWIMMMG POOL WATER SOF7NER ($35) _ CLOTI-�S WASHER _ KITCHEN SAJK WATER CLOSET BACKFLOW PREV. ($15) _ DISHWASHER _ LAUNDRY TRAY _�WATER HEATER ($35) FOR IRRIGATION _ WATER METER OTHER THIS 1S 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 veill be in accordance with the approved plan in the �o� all w k�' h quires review and appro pl a. SIGNATURE OF APPLICANT1!%?�e.rA"� �'�� PRINT NAME_ _�� '�''�� DATE�O ♦onnnv�r ntencn�r�nnnr..�..�,.....,. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977