AF - 47321�
City of Fridley, Min�n_ - 113 � 8
6431 Univeraity Ave. I�. E., Minneapolis, Minn. 5543
BUILDING PERMIT
��@: - jj.nrr,�h � 1 A]9
p�; Richard A. Ma.ras g�� Tri-Co Builders Inc.
Add�ess Address 755� Van Buren Street N.E.
LOCATIOIV OF BUILDING
NO ���� Street .TA -k on R�g�et N_F_ Part of Lot
i.ot - R Siock 1 Adaition or Sub-Division e o Ma_*!�x 3rd Addi.tion
Coraer Lot Inside Lot � Setback . �p. � Sideyard .__1,.7 �& 1!� �
,q��/,�E��� 873_44 /��������/ 876.44 (gQprox.�
Wye Top of Footing
DESCRIPTION OP BUILDING
To be Used as:
Dwelling Front 29 � Depth 40 � Height 20' �. � 1030' ��
Gara�e �t 22' �p� 22' Hei�t 10' �, � 489' �� 4890'
7+ype ���� � oo d Frame �, �� fi19.S8?,s00 To be Completed Au�.• i-s 1972
Stipulations: Provide verifying survey and provide a hard surface drive.
WATER LOCATION: 10' North of Sewer Service
gEWER LOCATION: 159` South of Manhole
In considerat%n oi the issuance to me of a perrmit to construci the building described above, I agree to do
'�he prap�sed work in accordance with the descrYpt3on above � forFh and ia comp� � ce with all provisiona of
prdinancxs of the dty of Fi3d1eY• /�
9.79 St�tEe Surcharge
Ea consideration of the payment of a fee of � 48.0� , permit is hereby granted to Tri-Co Builders
to constritet the building or addition as described above. This permit is granted upan,
the express condition that the person to whom it 3s granted and his agents, employees and worlunen, in all work
done in, around and upon sa:id building, or any part thereof, shall conform in all respects •to the ordinances of
F�Ytlley, Minnesota. regarding location, cottstruction, altera.tion, maintena.nce, repair and moving of buil�ig8
o�t1�,��in � city ]imits and this permit may be revoked at any time upon violation of any of the provisions oi Bafd
�
� — �Pecto�
�r.aR�vrE BELISLE
NOTICE:
This permPt does dot eover the eooatruetion, inatallaHon ¢o� wirin8. P0��8� 8� beatinp, sewer or eereter. Be wro b sea
f6s Building laspecta� for separata permits fo� theae items.
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APPLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
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Oidi�TER' S NAME :_ �� � %�:' � � � �i4,�r*" Q � BUILI2ER: � e� -� �,��rs , s°v��
ADDRESS : ADDRESS : �s��S �`��> %�vss e��
.
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NO:. STRELT: ��'e,%��c�:v .��
LOT : � BLOCK : / ADDITION : �c � �� �,� ✓�, d y� 3 �`°� % �,�'
CORNER LOT: INSIDE LOT:_�_SETBACK: ,� o' SIDEYARD:
Appliaaa� attach to thie form �io Certificates of Survey of Lot and proposed
buildiag location drawa on these Certificates.
HESCRIPTION OF BUILDING
To Be Used Ast
.���✓,�/� F�: /� Froat : �`� Depth : `/� Height : � � �
Square Feet• /o � � Cubic Feet• °��
�•oo-� ��c �roat. '�-�- Depth • �� Height • Y -°°
Square Feet; �/E� Cubic Feet: -���' �` -� `4 --`�
:
1�pe of Qonstruction: �a..��� Estimated Coat: �O Ooo —°
To Be Campleted: / I�u� i� 9 Z l�i S��
The undereigaed hereby makes applicativn for a permit fos the work herein
epecified, agreeing tv do all work in sttict accordance with the City af
Fridley Ordinaaces and suliags of the Departmeat of Buildings, and hereby
decla�ces that all the facts aad represeatations stated in thia application
are true and correct.
DATE: �- �' � � P � 2- SIGNATURE • O �,�,,•-� � �
(See Revexae Side �or Addltional Information.) . �� �' ` '
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Iaspector of Buildinga shall, before iasuing permits for the
erectioa of any building or structure, or for any addition to any existing
building or structure, or for aay alteration or repairs to any existing
buildiag or st�ructure, upon application therefore, require the payment by the
applicanfi �or su�h permit of fees to the amount herein below set forth and in
the manner herein pzovided to-wit:
iJNIFORM BUILDING CODE: ljrpe 1, 2� 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. �►pe 3� 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpoee of computing fees for building pe=mits, the cubical conteats
of any buildiag or additioa, is determined by �altiplying the ground area
ccvered fram a point eix (6) inches below the floor line of the baseu�nt
or the cellax to the average heights of the upper surface or to the average�
height of the roof surface of the me.in gable of a pitched roof.
For repaira o� alterations to an exiating atructure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) oa fraction thereof in
the Cast of al� proposed work.
Ia ao case shall the fee charged for any pe=mit as set forth in Section 2 be
leae than $5.00. �
VBRIFICATION OF FOUNDATION
NOTE: Permi.ta for eonetxuctioa will be isaued a mini�um of 24 hours from the
tia�e of application, to allaw for proper review of the proposed stsucture and
of the coastructi.on eite.
A Ce7�tified Survey o� the lot, ahowing the loc�tion of the foundation, once �t
ha� been constzucted, wil.l be required before proceedin� with the frami�g.
CERTIFICATE OF OCCUPANCY
Appl�.catioa for a Certificate of Occupancy shall be made ten (10) days priox
to the u�e or occupancy of aay etructure for which a building permit has beea
i�sued; and said atructure shall aot be used or occup�ed until a Certificate
of Occup�cy has beea ieaued. '
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sue�ecr PER
City of Fridley � 1355
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� ; L __��_ COMMUNITY DEVELOPMENT pIV.
r � � PROTECTIVE INSPECTION SEC.
1 . �
� � ��"1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OP APPROVED BV
�----� • ,'� 612-580-3450 910-F15 6 � �
JOB ADDRESS 7371 Jackson Street N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. S 1 Melody Manor 3rd SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Richard Maros 7371 Jackson Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Dean Bartl.ow
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE IdO.
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO.
6 USE OF BUILDING
Residentia.l
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct fi.replace
9 CHANGE QF USE FROM TO
STIPULATIONS
- TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINO,
dENTILATING OR AIR CONDITIONING. COI1Cr2'te
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO 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 GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIEO HEREIN OFi NOT. THE GRANTING OF A PERMIT S�-�500 y� .%S
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- �`9 � OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
$9.75
SiGNA7uAEO CoNT ACTOR09-�UTHORI2EDAGENT (DnTEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
i � � (� A �i� ,�
�. ' r � - C� � - % � - 2..�(.1vC, �� ��Ld'ld ��' � � Y7�0 -�t -�
n �
SIGNATUREO OWN RIIFO NERBUILDERI IDATEI BLDG INSP f]ATE
F,.
AP.PLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
ow�x's r�:`�,� /;�6�:� --�! ��,� r����BUILDER:��� r-� � �- %���c�°
ADDRESS : ��.� / / � .�� m � ADDRESS :
�
NO:. .�'� STREET: � � � � 1��� sv r7 ' •S l��' L � � l ) �
LOT : � BLOCK : � � ADDITION : �!' � � � �!�%�:<.�.�.�c, �
CORNER LOT: INSIDE LOT: � SETBACK: SSDEYARD:
Applicant attach to this form Two Certificatcs of Survey of Lot and proposed
building location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As:
� Front: Depth: Height:
Square Feet: Cubic Feet:
Front:
Depth: Height:
Square Feet; Cubic Feet:
�ipe of Construction; �,,,��-s-�_�+1z�C.� Estima.ted Cost: �S �� t� C`� •°�)
To Be Completed: � Y�t� �� ; .
The undersigned hereby makes applicativn for a permit for the work herein �
specified, agreeing to do all work in stiict accordance with the City of
Fridley Ordinances and rulings of the Department of Buil:dings, and hereby
declaxes that all the facts and representations stated in this application
are true and corxect. a
%��% /� ,f/ �/�
DATE : � ��� SIGNAI'URE : ��� �1 � ,� C�f Zl� G�° �i/ - f „� �4 i � � '
�
(Sae Reverse Side For Additional Information.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Bnildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
buildi.ng or structure, or for any alteration or repairs 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:
UNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, ar fraction thereof, i.n such cubical cantents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
cavered from a point si.x (6) inches below the floor line of the basement
ox the celiar t� the average heights of the upper surface or to the average:�
�height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to a,n existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work. �
Tn no case shall the fee�charged for a.ny permit as set forth in Section 2 be
less than $5.00.
VB�IFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
tiane of application, to allow for proper review of the proposed structure and
of the constxuction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before uroceeding with the framing.
CERTIFICATE OF OCCUPANCY
Applicatiori`iox a Certificate of Occupancy shall be made ten (10) da,ys prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
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sue�ecr E .
City of Fridley _ 18258 �
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T
r
; � CEIPT
� • COMMUNITY DEVELOPMENT DIV.
� ; L ------, �� � � �
� � PROTECTIVE INSPECTION SEC.
-`1 i �
----� /'�'1,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE Of APPqOVED BY
i ' � 612-571-3450 910-F15 10/22/85 / /
10B ADDRESS
7371 Jackson Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 8 1 Melody Manor 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Richard Maras 7371 Jacic�on Street N.E. 786-5860
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO.
8 USE OF BUILDINa
R�S1C3.eTlt1,8�.
7 CLASS OF WORK
❑ NEW � ADDITION � ALTERATION ❑ FiEPAIR ❑ MOVE � REMOVE
%
8 DESCRIBE WORK
Construct a 14" x 24' Addition to Back of Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
N,� � < <� �� �.:� ������aT� ���rwp�E�"� r ��,e.�t���� ��R
�'�%������ �:���� �UBRI(V(�, 9��AT6B��, � �Cii����� ��� S���VS.
Before digging call local utiiits�s
TELEPHONE - ELECTRIC - GAS Etc.
REQIII�ED �� L�`��`'
SEPARATE PERMITS ARE RE�UIRED 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 S0. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. • NO. DWIG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED TMIS APPLICATION �. STALLS GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $19, 450 $9. 73
WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHAFiGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW FEGULATING CON- $]_�O. SO None
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKfEE TOTALFEE
5.13 18 .36
SIGNATUREOFCONiR TOR AUTHOR12E AGENT �oaTEi WHEN ROPERL VA T IS YOUR PERMIT
° a� a
(� e 9
IGNA REOfO N RiIFp N R IL I IDA EI BLO SP �1aTE
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NEW [ ]
ADDN. [ ]
pLTER. [ ]
Construction Address:
Legal Description:
Owner Name & Address:
Contractor: r v ��
Address
City of Fridley
� R-1 A�iD R-2 i
Building Permit Appliea
� � 3 ����� �
�,. �'�,
� c ��" �
Effective 4/1/84
n
� l :� �
� � 6
��� Tel. � ' a �� - �
� Tel. �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length ��t Width � Height ,� Sq. Ft. �_
GARAGE AREA: Length Width Height Sq. Ft.
DECB AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
��� x� �7
Corner Lot [ ] Inside
Type of Constructi�fn:
Approx. Completion Date:
d �1�6 � �1? ��
d. Setback Side Yard Setback
�� Q
(, �� Estimated Cost: $
�� C�� e�S�
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
. �. ����
� ` `� Tel. � �
DATE: � APPLICANT:
CITY QSE ONLY .
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
SeWer Main Charge
��
STIPULATIONS:
�
� d.�C1
$ �,� s �3
$ �.��
$
$
�
$ ���•�
Fee Schedule on Reverse Side
25� of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
- . .
BIIII.DING PERl�IIT FEE SCHEDIILE
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 alte��tion,or repair to any existing building or struature, upon application
ther;efore, require` the payment by the applicant for sueh permit of fees to the amount
`h�r�iin,:'beloW s�t forth��and in the manner herein provided to-wit:
Tot�3 Valuation Fees
� -
a1.00 to $500.00
�501.00 to $2�000.00
$10.00 (Min;imum Fee is $15.00')
$10.00 for the first $500 plus $1.50 for each
additional �100 or fraction thereof, to and including
$2,000.
�2�001.00 to $25�000.00 $32•50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
ineluding $25,000.
$25,001.00 to $50�000.00 $170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraction thereof, to and
including $50,000.
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.Q0 for each
additional $1,000 or fraction thereof� to and
including $100,000.
$100,001.00 and up
$�►33.00 for the first $100, 000 plus $2. 50 for each
additional $1�0�0 or fraction thereof.
DRIYEiiAY DEPRESSION ESCROii
, (Conerete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
_ 6 feet times $13•50
Alternate "B": Removal and replacement of curb and'
approaeh With 6 inch depth - DriveWay �►idth plus 6 feetttimesd$15s7511 a 3 foot wide
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 onee it
has been eonstructed will be required before proceeding with the framing.
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COMMON VENT, VENT CONNECTOR AND COMBUSTION A!R VERIFICATION
When replacinq an existing furance, the undersigned hereby verifies that the
venting has been examined and is ftee from rust, deterioration, obstructions,
and is securely supported and firestopped where cequired. Yes () No ()
The venting system is plastiGPVC and meets all cuRent codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the cuRent codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances. Yes () No ()
The existina combustion air is sized and installet! to meet the current codes
and manufacturer's specifications. Yes () No ()
When required to install a new combustion air. it wi0 be sized and instalfea -- --� --
To meet the cuRent codes and manufacturers specfications. Yes () No ()
When installina a new ventinq svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ()
Apaliance Tvae and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Ass�stecf��_Na� �_
Appliance #2 Type BTU Input Fan Ass�t�tl:��i` 1�[ai,�'
Appliance #3 Type BTU Input Fan As t�d�d��fi1��=�
Total Appliances Total Btu Input � u; ���� «'}
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Common Vent Type Vent Height Diameter ����, inches
Appliance #1 Vent o�cTo� Reigh� ----ft Lengih �I�iameter ' - in-Typ� - -- - - - --
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length fi Diameter in Type
ALTERATIONS: (Describe)
HEATIN� C�:
Signed By: Date :
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Inspections �i S��i �"�'�� ���j(;�'�'���j Received By: l7�
763=572-3604 ��•� �� ��� Date Rec'd: S C�
763-502-4977 FAX EFFECTIVE2-19-09
DATE 3- � I- I V YOUR E-MAIL ADDRESS
SITE ADDRESS � ��` W � 0 Cl-l� LO— F� I AI c, �
THIS APPLICANT IS: ❑ OWNER �ONTRACTOR
PROPERTY N�: �Jm�,� � � „, ,J
OWNER/ N1-` CITY ��e.i �l `, sTn� � zrn bJ� 3Z
ADDRESS: (a b�b Li 1� C4 Cl �, �-�'
TENANT PHONE: '7 6 3- �-{ � oZ — cl 7�1 �- —�
CONTRACTOR COMPANY NAME: .. L�� �` ��� � 1� �'� a- �
SUBMTI' A COPY OF CONTACT PERSON: C I,� ,� �� �
YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS:�dg o V-� o-1�.., oS$ N L CITY F�R,i �1 STATEH►-� ZIPSS`�3�.
APPLICATION pHONE �% 63 �S `f J� �i R FAX
PERMIT TYPE
�rYrE oF woRx:
�INGLE FAMILY ❑ TWO FANIILY
❑ NEW il� REPLACEMENT
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �ro5��a ( I �,0 � �+-�'�'l. �r►t Ae2- �b''v� ` � �O^"'°
FEES ARE BASED ON $10.� PER FIXTURE, EXCEPT R�RE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOR�
Equipment Installed MFG: 12 v V t0 MODEL: I/.A f' c1 � 3.i� SIZF./B� , ; ����-
MFG:
MODEL: SIZE/BTU
MFG: MODEL: SIZFJBTU
J A/C $25.00 FIREPLACE (GAS) $I5.00 GAS RANGE/OVEN $]0.00
AIIt TO AIIt EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOII.ER $35.00 FURNACE $35.00 _GAS LJNIT HTR $10.00
_CHIMNEY LINER $10.00 GAS DRYER $] 0.00 POOL HEATIIi $35.00
DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pernvt 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 work which requires review and approval of plans. �
SIGNATURE OF APPLICANT C(t/Lt O PRINT NAME �� r�J �,O iQ DATE 7w o�:- �( b
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
Building
Inspections
763-572-3604
763-502-.4977
srrE nnnt�ss_
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
F� �cTTVE i-�-ao�o
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
1NSURANCE
PERNIIT TYPE
TYPE OF WORK:
DET
YOU�R `E�MAIL
� [x� �
� i x��—
STATE LICENSE #
STATE BOND #
ADDRESS: CITY_
PHONE FAX
❑ SINGLE FAMILY
0 NEW
[ohv.oF wo�uc
V�t
❑ TWO FAMILY ❑ TOWNHOUSE
�� G�
PermitNo.�i�� L�S
Received By:_�
Date Rec'd: — J ' �
EXP DATE
EXP DATE
C�
ATE '�":
7'E ZIP
FEES ARE BASED ON $10.00 PER FIXNRE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SINK/LAV FLOOR DRAINS SHOWER _ WATER PIPING
— gp�Jg GAS PIPING (NEED CITY LIC) SWIMMING POOL _ WATER SOFTNER ($35)
CLOTEIES WASHER KTfCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15)
DISHWASHER LAUNDR'Y TRAY WATER HEATER ($35) FOR IRRIGATION
— — WATER METER _ OTHER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only 'cation for a p rmit and work is not to start without a permit on site; that the work will be in accordance
with the approved an in the c oi�ll wo w�Rjch e uii� view prov o plans. 1„ l
SIGNATURE OF APPLICANT ��'^- " ` �E � � ��. � ��ATE 1 �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
' FAX: 763-502-4977
�a � oG
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE % �Z � f �O
SITE ADDRESS� % �
THIS APPLICANT IS:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2010
YOUR E-MAII.
❑ OWNIIi BC�NTRACTOR
Permit No.:
D���,
�
PROPERTY OWNER/ I NAME: �t c� e /�I ---�
TENANT .�.nv�ss: 7 3?/ TA r/C S oN ST �v .�crt�t ir .�/ L�w sT ��
CON1'RACTOR 1vpME:1_c,rCLC .�v 9� T��v GL/d C�6�! '�' �
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE LICENSE
AND CERTIFTCATE OF ADDRESS�9 � 9 S/� RO� CITY � ST ZIP,�y�
INSURANCE pHQDiE q �Z �i''�.� � � � FAX
PROPERTY TYPE
PERMIT TYPE
� SINGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
0 BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
TYPE OF WORK: ❑ NEW HOME CO1dSTRUCTION ❑�D DTfION
❑ MAINTENANCFJREPATR ++�1ZEMODELING
DESCRIBE WORK BEING DOIV�� 1 .j ^
SIZE OF IMPROVEMINT LINGTH WIDTH
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE 8c GARAGE
GARAGES ❑ ATTACHID GARAGE
PROPOSED SIZE: ❑ DETACHED GARAGE
PROFOSID HEIGHT: - _
❑ DRAIN TILE
❑ OTHIIt
�
HEIGHT
FT
HASEMENT REMODEL,ING SUBMIT:
1. Existing Fl�r Plan
2. Proposed floor plan
-- 3. I.ist nf strucdual members Yo be ysed
SIDING FOR NEW CONSTRUCTiOld INCLUDING DECKS,
❑ Vinyl OSoffit .ADDITiONS. & PORCHES SUBMIT:
❑ Alumimmm ❑ Trim 1. Site PlanlSurvey showing the e�cisting strucUues
❑ Other ❑ Fascia 2. Two sets of co��nstruction ptans
R'INDOWS 3. Energy Calculations
IN EXISTING OPININGS Yes ONo LOCAITON OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STTCKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALL ���/ NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE CO5T OF LABOR AND MA7'F.RiAi �;
�SING THE 1997 U.B.0 FEE SCHEDULE)
'OTAL JOB VALUATION $ A�od OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Swchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
°� �� a�:�� See Back Page for Fee 5ch�ule
$ 65% of Building Permit Fee
� 1 .001 times the total job valuation
$ "'') .� .0005 x Pernut Valuation Minimum $.50
$ . L �' $SAO (State Licensed Residential Contractors)
$ $2100 per SAC Unit (Plans to MWCC for determination)
$ ii+6ft= ftx$22=$
� $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$_ �� D- k�> Make checks osvable to: Citv of Fridlev � Att.n
THIS I5 AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge 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 understa,nd this is not a
permit but only an application for a rmit and wor " to start without a permit on site; that the work will be in accordance with the
approved plan in the case of a11 wor hich req ' re ' and approval of plans. a
SIGNATURE OF APPLIC PRINT NAME SGO T% �B/ I✓ Dp� %�Z /�D
PL�ASE NOTE: SEPARATE PERMITS ARE REQUIItED FOR ELUMBING, ELECTRICAL`�,NI� T�C�-I�NdCE�i.`�/OIZK