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AF - 46363�-� � r"� City of Fridley, Minn.. �UILDING PERMIT nate: dun� 7' 1965 owner: dame� �Telsog �� Richard Mi1].ear Homes Ada� � 1� Horizoa Drive N. E. Ad� 8256 �onroe N° �� 7 � '7765 LOCATION OF BUILDING No. 5�5 Street HOTiZOli DTi.'vE3 N. E. Part of Lot ' �_ 13 _ Block 6 Addii3on or Sub-Division Caz'lson. ��3.t MaYtor No. Add. Corner Lot Inside Lot Setback Sideyard Sewer IIevation —_..... ...._ Foundation IIevation To be vsed sa: S3Agle �ront — FA.. �� Ha�e �nt _ 'ryp2 Oi G'0178tr11Cti0II FT8m$ DESCRIPTION OF BUILDING Depth Height Sq. F't. Deptln I�ei�t Sq. Ft. � FFst, Cost �Z�t�44�.�.� To be Completed _ Cv. FL L'11. Ft. S�orm damage repair Att. Garage, In considerat[on oP the issusnce to me of a perinit to con truct the buildiug the proposed work in accordance with the d�scription above t and in co or�iiaanoes oP the dty oP FrYdley. I agree to do .provia�tons of In co�sideratton of the payment of a fee oP $�.Qs94 , Permit is hereby granted to R� �h��r3 M311 pr HOmes to conatruct the buflding or addition as described above. Thisp�� t ia granted upon the esP�ss conaition that the pereon to whom ft ia graated ead his agente, empioyees an� worlmaen, in all work 8one in, around aad upon said building, or any part thereof, shall conform in all re�pecta to the ordinaac2g of Fridley, Minnesota re glocation, constructton, alteration, maintenance, repair and moving of bufldiugs wi�� dty limits and 1this permit anay be revoked at any tiine upon violation of a�r of the provisiona of said A11en Jen,sea ��g � NOTICEa '�6b pee� doa net eener �6s eenshudtoe, �on fer �fe6. P�+h+e. 6+s 6�9. awu er rrNsr. 8� aro to a� da Bafldlu8 les�aetor Por aparat� p�r+aNs Poe th� ii�. ow�R � s APPLICATION FOR BVS,DING PERMtT CITY OF FRIDLEY, MIIONESOTA �y ,�. ��:��''�_� ��r-�._� �, - -- -- — y � i�DDRESS ��;'� � � `� ��A'-'� ' - l� �< r_; ADDRESS � '�= `, �' �'�'��'�-�-�� - LOCATION OF BUiLDING No.___ � �f � '� Sfreet ��, , Part of Lot �`�°�- K `a � �.t'�- "^„��,�� '�� l� LOT= BLOCR ADDITION OR SUBDIVISION ,-,-_' �-� =� � �� Q. � � -�-� -�- .d �- Corner Ldt�_�ne3de L �Setback � ;�, � 3ide Yard_ ;��'�°�� . � ° SEWER ELEVATXON � FOUNDATIOIQ ELEVATION . �.Applicant attach to thie fo� Two Certificates �f Survey of LoC and proposed b is�g ,�ocatfou drawn on these C�rtific tea,� � P— . �c- - � c. -�-�-�� t'�'�� DES ON OF BU��" �" _ : To be used 8s : �'�"' � ,�,,�, � . � / � � � � �. � � � �>. � o � � � . , ��. � � � ° n � �_� ; �� =i�,-�-;.�°, � i'�°=v,_,� Front "� �. Depth � `� �eight �. 2, " , Sq. Ft. Cu. Ft. �`�� -/"�``'�__Front`� � Depth_�� Height �� Sq. Ft. Cu.�Ft. Type of Caitatruction_. -��1� ,�,�__ , EetimaCed Cost� ��''`� aTo be compleCed � , ,. � ,The underaigned hereby makes��app'iicatiou for.a�permit foi:the work herein apecified, agreeing to do all work in strict accordance wiCh the City vf Fridley Ordinances .and rulings of the Departmane of Build�.ags, at�d hereby declares that all the facts .and representatiqnis etated ia thie app.lication are true and correct. � � � . �1�� /� �t �'��;,�i�`4 _, DATE �,� ° � r SIGNATURF�, �_ �, . �.. (3chedule•of Fee Coets can be found on.the Reverse Side). � ,� A _ ' � . l6 � . � /• i\ f {s� U BUILDING PERMIT FEE SCHEDULE SEG°�ION 2. The Inspector of Buildiags shall, before iasuing any permit for the erection of any building or struceure, or for any addition to any eicisting build- ing or structure, or for any alterations or repa3re to aay existiag building or a�ructure, upon.application therefore, Yequire the payment,by the applicant for adch permit of fees to the amaunt herein below set forth and in the manner herein prbvided to-wit; � 2.1. For any such permit for the erection of any fire-proof building, other than a garage, warehouae, factory or grain elevator, or for the erection of any fite-proof addition, for aimilar occupancy, to any existing building, ehall be at Che rate of $1.40 for each one thousand cubic feeC, or fraction thereof, in such cubica], coatents. � 2.2. For any such permit for the erectioa of any fire-proof garage, Warehouse, factory or graia elevator, or for the erectioa of any fire-proof addition, for aimilar occupancq, to any existing building shall be at ehe rate of $1.25 for each one tbousand cubic feet, classified as "fireproof" by Section 502 of the Minneapolis Building Code. HOUSES 2�3. For any sucU permit for the erection of any non•fireproof building, other than a garage, warehouse, factory or grain elevator, or any non-firepraof addition, for similar occupancy, Co any existing building - permit $1.00 for each one thousand cubic ieet. GARAGES • .�._ 2.4. For any such germit for the erection of any non-fireproof garage, warehouse, iactorq or grain elevator, or for the erection of anq non•fireproof addition, for s�l.milar occupancy, to any exiating building or for each such � building or addition - ninety cente ($0.90) for each one thousand cubic feet or fraction thereof, in the cubical contenta thereof with the minimum of $4.00. For the purpose of computing fees for buildiag permits, the cubical contenCs of anq buildiag or addition to a uniform height throughout by multiplying the ground area covered from a point six (6) inches below the floor line of the basemene or cellar tn the average he3ght of'the upper surface or Co the average height of Che raof surface of the main �able of a pitched roo£. . 2.5. For repaire or alterationa to an exiating atructure, th� fee shall be at the rate of $3.00 per each Five Hundred Dollars ($SQ0.00) or fraction thereof in the cost of all propoaed work. 2.6. In no case shall the fee.charged for any permit as aet forth in Sectioa 2 be less than $4.00. . ^ � �_.kPt, ^ � � _ _s- �� _ � SUBJECT PE . City of Fridley 15 6 6 4 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � r ; � CEIPT NO. � `y ___�__ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION $EC. � g��/ i . � � � /��'L � CITY HALL FHIDLEV 5S43P NUMBER REV. DATE PAGE OF APPROVED BV / �� ""�� 612-571-3450 � 910-F15 4/16/80 � / JOB ADDRESS 5445 Horizon Driv N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ],3 6 Carlson's S�n.it Manor North SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE James P. Nelson 5445 Horizon Drive N.E. 560-4702 3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO. Dav-Ko Home Improvem4nt 1325 - 42nd Avenue NE.. 788-5850 4 ARCHITECT OR DESIGNER MAIL ADDFCESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 6 USE OF BUILDING Residential 7 CLASS OF WORK 0 NEW ❑ ADD,ITION X ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK IIlS'tdl�. 8.�.lIId].I1L'� 'tZ1ID 9 CHANGE qF USE FROM TO STIPULATIONS SEPERAT� p�R � Jc�y TIMr o� � MfT� RfQ{1iRED ►�An�Arr anrn F�� k�it�IF��. Sr��S SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED yS`]_� HOQ �S`. QQ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRpNTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAVYI REGULATING CON- 7.2.00 STRUCTION R THE PERFOR CE OF CONSTRUCTION. $ \�� , PIJAN CHECK FEE TOTAL FEE �� V �i � � �_ �� / � ° �d �-�_,� $12.90 SIGNATUREOFCONTRACTOROHAUTHORIZEDAGENT �DaTEt -" WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT � �/-�� SIGNATUREOF OWNER�IF OWNER BUILDER� IDATEI BLOG iNSP �ATE . CITY Of" FRIDLCY � AP-PL1CIl7I0i� }"Oft RESIDCNTI111_ RUILDI(�G PER1•1ITS , � . (Pdew, f�]ter•.�f:i�ns, Addii:ions, or Repairs) � ObJf1ER: O��e%� �UILOCR: , � v� 15� ADDRESS: � �`/5`— � �� _ AqDRGSS: �'�•2 5' �� e �� -- . TEL PVO: �G� � — � � g%v�— TEL IdO: `7� � — � f1�� w Construction Location _A . ST123�T NO: S�� ST1Z��T: LOT: BLOC:K: ADDITION: Corner Lot: � Inside I,ot: Setback: Sideyards: � �pnlzcant attach to this form t�ao Certii'icates oi Suxvey of lot and pxoposed building �ocation dratian on certificates to scale. DESCRIPTIQ(� OF CO��iSTRUCTION - � � rront. � � Dep�h: Height: Squa�e I'eet: Cubic Fcet: � Fronfi: Depih: Height: Square� I`eet: � Cubic reete a �/�� % � ��e � Type ot Constxuction: ��`w+,, /✓1.�,,.� ' Estimated Cost: $ �.b }3e Cbmpleted: � �r, � �' D . _ � Alt. A Alt. B Pro,pased Driveway� Width If New Opening Is Desired: $' $ , ., SE� REVERSE SIDE OI' SHEET . The undexsigned hezeby makes appli.cation for a p�rmit for the ��ark herein specified, agreeing to do a1.1 work in strict accordarice with tlie Cit}� of rridley Ordinances and rulings o� the Depari-nienL- of Buildings, and herc�by declares i:hat all the iacts and repzesentations sta�ed in i:his ap�lication are� true and correct. DAZ'E : � ��, � f� r--' Stipul.a�ions : . 0 SIGNA`�UI2� : �2..vv � g� t��v � �� t � . � ° �� 1i1.►!I_JJII'iU 1"1.:.!\1'IJ I 1"I:{.: :�l.liGlJULI: . �1sC'1.'I01•� 2. '1'he Ins.:J�cctc�r. or )�ui.l.Qi.►��:. �}�ril.l., hcf��c: i.:.:::u�ricJ pc•nni�s.; l:or. t�}ie er.�:cL-.ion �t any )�uiJ.rl:i.ncJ or ;,t:ruc:t:tii:c, o�: !:c>r. ;�ny ��c:lcli.t a.c,n to ,uiy cr,a.:,L•i.�� l�tii.lcli.i�c� or. �trucLux•e, . �z: fo�- �in, til.i.crc�tioti o�: zcl?air.:; t.0 •any c:>:.i_:,Li.i�-� l�ui.lclS.�i�.J or. .,L�:ucttir.c, u��o» ar�p],icat:ion 'Llic:�'efc>r.e, rec�air.e t}�e p��ymc�nL• ��y tl�e aJ��].i.�:��nL• tur' : ucll per.�nil: v£ fees i:o tl�e amounL hc.rein bc].o�r seL Lor.th �incl iii ilic manncn c�r.ci_n pruvic]ccl L-o-�•�iL•: � � la)i47 COIaS'i']:UC7.'IOId: Sir�c�J.e 1.'am.i.].y 1lomes and Gar.aqes : $�! . 00/]., 000 cubic feet. l.'I,nt� CII1:�Y.: ?.S l�crcent of bu�.ld3.n�J a��eriru.t fec. llIZIVEi?I1X llL•'PI2L5SXOi�': (Cu»creL-e, C��r.b : t:r.cets Ui'ily) �� ' • nl.tcrnrtt:e A: l�:moval an�l r.ep.l.�zcc�rnenL of_' concrete cux'b and gutter on].y; Drzvca�ay w5.dtli plus 6 feet �t Y�;5.75 111tc�rn��fi.c 1�: �emoval. and i:c}?I.aCCil1C11L. o.f: concrete cuzb and � . � guttex' a�id insta].). a 3 �oot wzde approach with �� ' .. G S.nch de�Ui; Dri.vc�vay widt.h �,�lus G feet x$17.85 � . ,�p 1 I OI�n� i r'�f-Qfi��if� � I ON T'or the }�urpose of- compu�ing i'ees far buiZding permi.ts, tlie cubical conteni:s of any bua.ldi.nc,� or adclition, a.s dc�ermincd by multa.pJ,ying t�ie ground ar.ea covered �rom a.• po3.nt six (6) inches bel.oet the f].00r line oi i:he basemenL- or L-h� cellar t•o the avexage hcights of the upper_ suriace or io the a��crage he�ght of the rooi' surface of the r�aa.n gab�.e of a pitclied roof . � For re��airs or alterations to an existing struci�ure, the �ee shall be a� the ra�e of $3.00 �er eacli five hundred dollars'($500.00) ar £raction thereoi in th� cost o�' al]. proposed cVork. . . ' In •no case slza].1 the tee ch.:rqed ioz �.ny permit as set forth in Sec�ion 2 Ue less - ihan $7.50 plus $.50 sta�e suxchargea ' , VERTF C 0� OF FO_.�� IT Of�l NOTE: Permits �or construci��on «ill �e issued a minimum of 24 liours irom tiie time ai appla.cation to allow �Eor_ pro}�er revieca o.� tlie proposed structure and of the constructio�2 si�.e. A Certificate af Suzve�� ot the lo�, shocving the locai.ion oi �he �owidation once i� �aas becn coustruci:ed �,�ill be required be�ore nr.oceeciine� �vith the framir►g. �rizTIFTGJ�TE: OF u^_�� ;C ' npp�ica�ion �ar a CerL-ifiaate oi Occui�ancy shall be made i:en (10) da�►s prior ta the use or occupaiicy of any s�xucture for a:liicii a builcli_iig pei�niit has bec�1 issued; and s�-�id sixuc�:urc, s17a11 noi: b� used or. occupi.ed uiztil a Ceri�ifica�.e of Occupancy has been a.:;sued. � . �� s A . . .. � 0 SUBJECT City of Fridley T AT THE TOP OF THE TWINS g � I L D I N G P E R M I i � i �• COMMUNITY DEVELOPMENT DIV. �' PROTECTIVE INSPECTION SEC. � -__� r ; ; � j � REV. DATE PAGE OF � � i�"1 � CITY HALL FRIDLE� 58432 NUMBER - �--•-� � �'� 612-571-3450 910-F15 4/25/85 � / JOB ADDRESS 5445 Horizon DriveN.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. �-3 6 Carlson'-s Su�n�t Manor North Addition 2 PROPERTY OWNER MAIL ADDRESS 21P I James Nelson 5445 Hoxi�on Dxive N.E. MAIL ADDRESS ZIP 3 CONTRACTOR %$$-3128 The Satek Co. 3852 Main street N.E. 4 ARCHITECT OR DESIGNER MAIL ADDRESS Z�P 5 ENGINEER MAIL ZIP �o. � _17930 RE6.EIPT�I SY d�� APPROVED BY SEE ATTACHED SHEET PHONE LICENSE NO. PHONE LICENSE NO. PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASSOFWORK � NEW xp ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Const�uct a 12R.x 12'� Addition to Dwelling 9 CHANOE pF USE FROM SfIPULATIONS � �� r� �`��ng �a11 Iocai utiiiti�s ��Ep�{pNE - EL�CTRIC - GAS Etc. REC�UI�ED �Y LAVV TO S�P�RATE PERMITS REQU16�E� F�� 1�'SF<5��9�, i�1�A�'9N�, �LU�QIi'+1� ��1� 5��,, TYPE OF GONS i . SEPARATE PERMITS ARE REOUIRED FOR ELECTFiICAL, PLUMBING, HEATING, �O� ��e VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION VALU TION AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $6,350 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiM1T FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $62, SO S CTION OR THE ERFORMANCE OF CONSTRUCTIO � pLAN CHECK FEE a� $15.63 SIGNATURE OF CON i TOR OR AUTHOii12ED AGENT IDAT WHEN PRI •1 � _a� _._.__ .. _....,�� e��n nco� IDATEt BLDG INSP l CU. OFFSTREET PARKING STALLS GARAGES SURTAX $3 � 18 SAC CHARGE None TOTALFEE $81:31 _RLYJMLIDATED THIS IS YOUR P,EP LOAD M IT � ADDN. AI.TER. I] I] Il City oP Fridleq R-i AIID R-2 Building Permit Applieation Effective 4/1/84 ConsLruetioa Address: �. �"d�(� rruic-��v �� i�roT - Legal Deacriptioa: % � � � � Owner Name s Address :�"�%� �� Tel . i Contractor:�� _S°g� �p. Tel. i � �� Addresa: ��c.�� /�� ie ��° Attach to this application, a CertiPicate of Survey of the lot� with the proposed construction draWn on it to scale. �___--- _ DESCRIPTIOB OF II�lPB09EN�NT h LIiIING AREA:� Leagth �_ ilidth � Height �� Sq. Ft. d� ARAGE EA: Length Yidth _._. Height Sq. Ft. DECb AAEA: Length iiidth Hgt/Ground Sq. Ft. _._ OTHER: 1�c�� . � ��.�� Corner Lot [] In ide Lot [] Ft. Yd. Setback Type of Construction: �� "" ° .,�, Approu. Completion Date: _ � Side Yard Setback Estimated Cost: _� ir'j"► ► � i Alt. A Alt B Proposed DriveWay Width If NeW Opening Is Desired: a � See Back Page for Explanation DATE: � APPLICANT: �� Tel. # � ��0� 0 CITY IISE OAI.Y Permit Fee � � Fee Schedule on Reverse Side Plan Check � l ►(g� 25� of Building Permit Fee State Surcharge SAC Charge Park Fee Se�+er 1lain Charge ?OTAL STIPULATIONS: � �•�� .50l�1,000 Valuation � �' �425 Per SAC Oait a " Fee Determined by Engineering � � � Agreement Necessary L ] �ot Necessary [ ] � ° �� • �� JS� ll � .31 g ! L _ BIIII.DIKG PgRMIT FEE SC�DQLE The Chief Building Official ahall, before isauing perm its Por the erectio n of any building or structure, or for any addition to any euisting Duilding or structure, or for any alteration or repair to any existing building or structure, upon application therefore� require the payment by the applicant for sueh permit of fees to the amount herein belora set forth and in the manner herein provided to-xit: ?otal Yaluatioa =1.00 Lo 5500.00 �501.00 to �2,000.00 �2�001.00 to �25�000.00 a25,00,.00 to s5o,000.00 Feea �10.00 (Minimum Fee is �15.00) �10.00 for the firat �500 plus �1.50 for each additional �100 or fraction thereof� to and ineluding �2,000. �32•50 for the first a2�000 plus �6.00 for each additional �1,000 or fraction thereof, to and ineluding �25,000. �170.50 for the first a25,000 plus �4.50 for each additional �1,000 or Praction thereof, to and ineluding �50,000. �50,001.00 to a100�000.00 �283.00 for the first �50,000 plus �3.00 for each additional �1,000 or fraetion thereof� to and including $100�000. a100�001.00 and up ��33.00 for the first �100,000 plus �2.50 for each additional �1�000 or Praction thereof. DRIVEiIAY DEPRESSION ESCROW (Conerete Curb Streets Only) . Alternate "A": Removal and replacement of curb and gutter only - DriveWay Width plus 6 feet times B13•50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot Wide approach vith 6 inch depth - Drivexay t�idth plus 6 feet times a15.75 YERIFICATION OF FOQNDATION Permita for construction Will be issued a minimum of 24 hours from the time of application to a11oW for proper revieW of the proposed structure and of the constructioA site. A Certificate oP Survey of tbe lot, ahoving the location of the foundation once it has been c�nstructed �ill be required before proceeding With the framing. �� 3o?•S� �� ° �� ,. SALES REPRESENTATIVE � JIM 5T. ONGE ,�---m- --�- , � � W`' CEDAR - ST, CROIX - BOX 40 -;:, . : , _ PRESCOTT, WI 54021 w,,,�.,.cra;a, n�, C.Ome hOmC t0 QtteGlx ' 71 �r262-3345 C.01Ite hOOle t0 Atldet5C11. DATE Jpg � 1`� � Z. 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I6� r � v � PROTECTIVE INSPECTION SEC. °` � . , � � ��"1 � CITY MALL FRIOLE� ��aZ NUMBEN NEV DAT@ PAGE Of APPiiOVEO BY �""�' �'� 612-571-3450 910-F15 4/25/02 / / � JOB AODRESS 5445 Horizon Drive NE t LEGAL �OT NO. BLOCK TRACT OF ADDITION SEE ATTACHED DESCF. 13 6 Carlson� s Summit Manor North SNEET 2 PiiOPERTY OWNER MAIL ADOR�S$ 2�P PNONE RMA Home Services Inc 3200 Cobb Galleria Pkwy STE 200, Atlanta GA 30339 CONTRACTOR MAII ADDRESS Z�P PMONE LICENSE NO Laura Bernstein 5445 Horizon Dr 763-574-2050 763-542-8826 2026825 a ARCNITECT OR DESIGNER MAIL ADDiiESS ZIP PHONE UCENSE NO. 5 ENGINEER MIAII ADDRESS 21P PMONE LICENSE NO 8 USE OF BUILDING Residential � 7 CIASS Of WORK p NEyy � ADDITION ❑ ALTERATION �7 REPAIR O MOVE D REMOVE 8 DESCRIBE WORK Replace 7 windows within existizg openings 9 CHANOE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all 1eveTs of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. �� n�pec�w�� r�� '� �e Ma�Ied �� wne� �� Po�� " TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAD SEPARATE PERMITS ARE RE�UIRED FOF ELECTHICAL, PIUMBING, MEATING, VENTILATING OR AIR CONOITIONING THIS PERMIT BECOMES NULL AND VOIO IF WQRK OR CONSTRUCTION IONING SO. FT CU fT AUTHORIZED IS NOT COMMENCED Y�1ITHIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANQONED FOR A PERIOD OF 120 OAY$ A7 ` ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNITS OFFSTREET PARKING I HEAEBY CEfiTIfY THAT I HAVE READ AND EXAMINED THIS APPGICATION 1 STALLS GAFAGES AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW$ VALUATION SUIiTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE CG1MP4�E0 $6 � 6O8 �3 .31 WITM WMETHER SPECIf1ED HEREIN OR NOT. TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEI TNE pEqMIT FEE SAC CMARGE @ PROVISIONS OF ANV 07HER STATE OR LOCAL LAW REGULATING coN• $139.ZS Fire SC y�6.C)1 STRUCTION OF TME PERFOflMANCE Of CONSTFtUCT10N PIAN CHECK fEE TOTA� FEE Lice e SC $5. $154.17 S�GNATUpE O� CON"AACTOA OA AUTNOp4E0 AGENT IOATE� N pq �V VA 1 ATED THIS IS VO �-P R � l� v S�GN4TUAE Of OWNEA�� OWNER BU�LDEp� iD�fE� ' OG �N fj°TE a1 N� [ ] ADDN ALTER Effective 5/10l99 [ l CITY OF FRIDLEY [ l SINGLE FAMII.Y AND DUPLEXES R i AND R 2 BUII.,DING PERMIT APPLICATION Constcuction Address: �Sy�S �pt ��IV �C ��:St.� - ' . Legal Description: � Owner Name 8e Address: Lo�to� "�t nS�c.�1�J �' Tel. #�(o3•S}'�i •�' �b Contractor:. � HOME SERVICES INC. � j;j��E # ' Home Depot Installed Sales Address: 3200 Cobb Galleria Pkwy., ste. #20o Tel. # Atlanta, GA 30339 A 763-542-8826 i�vey. of t�e � lc BG20268257 _�___...,.. ,K...... ,�n��ii to scale. � — — •r— —r ---- — . DESC�A�1 OF ��EM�NT. . . � ' LIVING AREA: Length GARAGE AREA: DECB AREA: �� C 1 ' Wirlth Height � Sq. Ft. Lengih Riidth Height Sq. Ft: Length � Widtli �� Hgt/Ground Sq. Ft. :� e ••i . -' � — _ . � � • . � . . 1 COIlStR1Ct10II T�: EStl1TT�t� COSt: $�.Q � �Q�� Driveway C�rb C�t Width Needed: Ft. + 6 Ft =_ Ft x$ _ $ - DATE: I�• ; •� APPLICANT: _t�, — Tel. # 9�a � �Jys ��`I 7�' Permit Fee Fire Surctiaige � State Surcharge SAC Charge License S�ircharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIl'LTL.ATIOI�TS: � �39.as $�,p . �II 1 $ 3.� l $ $ ..�.d� $ $ $ $ � � sy.1�- CITY USE ONLY Fee Schedule on Reverse 5ide .001 of Permit Valuation (1/lOth%) $.50/$1,OQ0 Valuation $1050 per SAC Unit $5.� (State L�cens,�d Residential Contractors) Alt. "A" or Alt. "B" Above $450.(� Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Nece.ssary [ ] q. ��- �- �. CITY OF FRIDLEY PERMIT NO.: 2004-00182 ��r�,� 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 02/09/2004 (763) 572-3604 FAX: (763) 571-1287 ' � _:; ADDRESS : 5445 HORTZON DR NE �� PIN : 233024330065 LEGAL DESC : CARLSONS SUMIVIIT MAN NO ADD : LOT 13 BLOCK 6 PERNIIT TYPE : BUII.,DING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 3,000.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTII.ITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER SECTION 310.9.1.2 OF TI� 1997 UNIFORM BUII.,DING CODE WHEN ADDITIONS, ALTERATIONS OR REPAIRS IN EXCESS OF $1,000 ARE MADE TO RESIDENTIAL DWELLINGS. INSTALL INTERIOR BASEMENT DRAIN TII.,E SYSTEM. �e� �� ns��ctio� ��rd� �Nill � �lailed � o H�m�ow��r T� Po�� APPLICANT BUII..DING PERMIT FEE 83.25 RITE WAY WATERPROOFING FIRE SURCHARGE 3.00 448 LILAC ST STATE SURCHARGE, VALUE 1.50 LINO LAKES, MN 55014 TOTAL 87•75 PAID WITH CHECK # 13085 OWNER BERNSTEIN, LAURA 5445 HORIZON DR NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construcrion authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and l�ow the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a pernut does not presume to give authority to violate or cancel the provisio of any other state or local law regulating constntction or e perfo e of construcrion. Applicant Date . Bldg > SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE. !;�;�',., NEW :[ � : ;' CITY OF FRIDLEY ADDN [ J' ' 6431 University Ave NE, Fridley, MN 55432 ALTER (� SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Effective 1/1/2002 � (763) 57236�4 Bidg insp BUILDING PERMITAPPLICATION � L � � � ��,1�� ,�� . . � �� Cohstruction Address: /, ?�o Legal Description: '� Owner Name & Address: � n ��.r�c� �_�_r,r�ct,e.� �„� Tel. # 7 Co�-57 �/ -�� Cont�aCtor Rite-Wav WaternroofinQ MN LICENSE# Address: 448 Lilac Street, Lino Lakes MN 55014 Tel. # 651-786-0550 LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certiflcate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Fk Length Width Height Sq. Fk Length Width HgUGround Sq. Ft �_ . �� - �� Construction Type: Estimated Cost: $ `�`'�' Driveway Curb Cut Width Needed: F� + 6 Ft = Ft x$ _$ DATE: �-�-o � APPLICANT. Tel. #/ S/-��-� .C'� O Call (763) 572-3604 for Permit Fees if mailing in appl tion or Fax o 763-571-1287 if using credit card and we will call �ou for card number. PeRnit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - $ �t'3 • � S $ �°.�. �'� � 1. �Sv $ $ IJ,�_ $ $ $ $ Fee Schedule on Reverse Side .001 of Permit Valuation (1l10th%) �� $.50/$1,000 Valuation $1200 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 [ ] $ �� c�=�. `�� STIPULATIONS: _ �, ,_ � _� - ,_ �, � 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 $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,(� 1 to $100,000 $100,001 to $500,0(� $SQ0,001 to $1,000,� $1,000,0p1 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 �2,0�0 plus $14.00 for �ach additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $SO,Q00 plus $7.00 for ea.ch additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.6D for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fra.ction thereof, to and including $1,000,000 $5,608.75 for the first $1,0�,000 plus $3.15 for each additional $1,000 or fraction thereof DRIV`EWAY DEPRESSI011�TT ESCIZOW - - (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.�. 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 5urvey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. New Houses Onlv � CITY OF FRIDLEY 6431 iJNIVERSITY AVENUE NE FRIDLEY, MN 55432 PERMIT .: 004-2 0198 DATE ISSUED: 10/26/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 5445 HORIZON DR NE PIN : 233024330065 LEGAL DESC : CARLSONS SUMNIIT MAN NO ADD : LOT 13 BLOCK 6 PERMIT TYPE : BUII,DING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOW/DOOR REPL VALUATION : $ 2,000.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER R317 OF TI� 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. INSTALL BASEMENT EGRESS WIlVDOW TO MEET TI� IRC CODE. STATE LICENSED CONTRACTOR 1 APPLICANT BUII,DING PERNIIT FEE 69.25 ARSENEAU CONTRACTING LLC 20426591 FIltE SURCHARGE 2.00 7408 120 AVE N STATE SURCHARGE, VALUE 1.00 CHAMPLIN, MN 55316 LICENSE SURCHARGE 5.00 TOTAL 77.25 PAID WITH CHECK # 9338 OWNER BERNSTEIN, LAURA 5445 HORIZON DR NE FRIDLEY, MN 55421 AGREEMENT AND SWORN 5TATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I ha,ve read and examined this application and l�ow the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cel the provisions of any other state or locallaw regula ' g co ` trucri n or the performance of construction. Applic Date 2 �/ Bldg Insp Da� � , SEPARATE PERNIITS REQUIRED FOR VJORK OTI�R THAN DESCRIBED ABOVE. NEW [ J CITY OF FRIDLEY Effective 4/1/2004 ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION `1 R��62 Construction Address: .� �I `�I.i i� t� \� � �� • �� Legal Description: Owner Name 8 Address: l..au�� °'P�.��' t� Tel. # Contractor. �LNfr�u� �oa��. �� MN LICENSE# adi �.� �$I Address: 7�9 0� e.�� • Il� � Tel. # lv I2^4�2� �i� LMNG AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate 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 Length Width Hgt/Ground Sq. Ft G�e r�� (.R� � � �'�+� � � � ° Construction Type: Estimated Cost: $ �.D�Q� Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ ' DATE: � o � 0 s APPUCANT: �N."4J��'� �� 1• a l� � Tel. #�'a' �1(t�. °OQ 2'� Call (763) 572-3604 for 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 Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ �'� �� - $ .a � ,, $ ,� $ .$ __ $ $ � $. $ Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ) TOTAL $ �� ' � .:� ,_ STIPULATIONS: r? BUII.DING 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 $5� $501 to $2,000 $2,Q01 to $25,000 $25,001 to $50,�0 $50,001 to $100,000 $100,001 to $500,0� $500,001 to $1,000,000 $1,OOO,Q01 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 $1,000 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,�0 $643.75 for first $50,000 plus $7.00 for each additional $1,�0 or fraction thereof, to and including $100,�0 $993.75 for first $100,Q00 plus $5.60 for each addidonal $1,000 or fraction thereof, to and including $5(K),000 $3,233.75 for the first $5�,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,Q00,�0 $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 ' � �� i �� , �E t � I �� — , _ j, \L Y � � �° -- X � �/ � � � � t� � � � .� � ` � � � /` � � � � � � � __- -- ---I � : � � � � � � � � 1 � � �, � � . 1 ?� � � '� ' rs � � � I I � � I '�� % � � \J I �n I n� � � � � � � V V 1 � � � � � � � � N � � � � �d6' N e � -0 � � .�' � � � � Building Inspections 763-572-�604 r DATE l, SITE ADDRESS �J" y THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL r��vn �1 r. /ll � �'OWNER ❑CONTRACTOR '7l� 3 - STATE LICENSE # ?�vn � r� 1� �, crrx o� EXP DATE Pernut No.: Received By: Date Rec' � �54<�/ ADDRESS: CITY STATE ZIP PHONE FAX �SINGLE FAMILY/NEW CONSTRUCTI( ❑ TWO FAMILY/NEW CONSTRUCTION O BASEMENT FINISH ❑ ROOF ❑ DECK �SIDIN DESCRIBE WORK BEING DONE: f SIZE OF IlVIPROVEMENT OF SQUARES GARAGES PROPOSED SIZE: PROPOSED I�IGHT: ❑ ADDTITON O REMODELIlVG ❑ WINDOWS ❑ DRAIN TILE ❑ OTHER LENGTH �KJ WIDTH o xousE oivi.Y O HOUSE & GARAGE ❑ ATfACHED GARAGE ❑ DETACI-�D GARAGE HEIGHT BASEMENT REMODELING SUBMIT: 1. Existing Fl�r Plan 2. Propased floor plan 3. List of structural members to be used Ft. SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, �'Vinyt ❑Sof6t ADDTfIONS, & PORCHES SUBMIT: ❑ Alum;nnm 0 Trim 1. Site Plan/Survey showing the existing structures � Other O Fascia and proposed project WIIVDOWS 2. Two sets of construciion plans IIV EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR AIEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WWDOW TO BE INSTALLED NUMBER OF WMIIOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 1. S�C7• f�C � OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Chazge Total Due � $ l. $ .�1 $ $ $ $ $ Q. $ 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) $IS50 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 c6ecks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMTf-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 work which requires review and approval of plans. SIGNATURE OF APPLICANT ,f,{/l,ec PRINT NAME l.Ll Ll f'l�l UQ C(�5�1 �l DATE lIi —�CP ' 0� Page 2- Building Residential Application BUII..DING PERNIIT FEE SCHEDULE The Chief Building Official sha11, 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: VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to a11ow for proper review of proposed structure and of the construction site. 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 City of Fridley Building Inspections Depart�nent 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 E K 6 y: �, iV k ' �fY ��;�'�" � � �6 �� y. M� V1y;': • , FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, ,�'il�v� � r�LS'�-�� , understand that the State of Minnesota requires that ali 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 ��1�5 i�(izon 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 I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors 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 Minnesota. I understand that unlicensed residential contracting, 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 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 compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. , - � , -1 � r!.� �!� � Date l0 " � �o — � � City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 � e�,r ., � �� Mechanical Permit# �,�,� Residential Application � , �'' City of Fridley See Back Side For Required Information Date �%%�S-C1�i Site Address: S��S _iiY� 7c�» �r �l1 � The applicant is: (cirlce one) Property Owner. Ui.u>rn Address: �4 y S /f�„r i` City: - �`�1 Phone: -S �/ - Contractor Information Company Na :�� Coro�ac� Pers Address: City: ' Phone: 7L�� /�-17d I Email: Type of Work (circle one): Detailed Description of work: Owner C Contractor )Cell: g ir � ect€I� ve - ui e 1 Q� _ Cell: New Replacei Zip: Fax: 7(� �- y aa �� s� MN Bond# & Exp Date Alteration/Remodel Equipment Installed: MFG: C�l,vrr �� ModeL• .�SS n'IV t�j�Size TU: p MFG:,�r�r � �° �P�i Model:�W A�FF �va`f Size/ :��'ee�Y MFG: Model: Size/BTU: Please check all that apply: Fireplace (gas) $15.00 New Gas Grill $10.00 / A/C $25.00 Fireplace (wood) $35.00 Gas Unit HTR $10.00 Air to Air exchanger $15.00 �Fumace $35.00 Pool Heater $35.00 Boiler $35.00 _Gas Dryer $10.00 Ventilator $15.00 _Chimney Liner $10.00 _Gas Piping $10.00 Duct Work $10.00 Gas Ranqe/Oven $10.00 Permit Fee $ �oo •�o Minimum fee $15 or 5°l0 of cost of improvement Surcharge � 0.50 whichever is greater + surcharge Total Due $ CDO • SC7 Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical permft and I acknowledge that the information above is c�mplete and accurate; that the work will be in confortnance with the ordinances and codes of the City of Fridley and with the Minnesota Construdion Codes; that I understand this is not a permit but only an application for a pertnit and work is not to start without a pertnit; that the work will be in acxordance with the approved plan in case of all work whlch requires review and approval of plans. Signature of Approval Inspector g�� Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005