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AF - 47452��, � � City of Fridley, Minn.. BUILDING PERMIT DB�: MAY 10, 1966 �� 1 11T° 8$16 p�: g��, I30MEDALE BUZLDERS Ad&�s Addrese 3017 Lyn.dale Avenue South Min.neapolis, Minnesota LOCATION OF BUILDING N� 7501 �� JACRSON STREET N. E. p� oP Lot � 15 glock 1 Addition or sub-Division �+ODY MANOR, 4TS ADDTTION Coraer Lot _ Inside Lot x Setback 35 � Sideyard , 10 and 17 3ewer IIevatton ��/ � � � IIevation �� • � � 881.60 TOP OF FOOTING 884.60 DESCRIPTION OF BUILDING To be vsed as: DWN�LING �t 37 �P� 24 g��t 20 Sq. �-.t, 888 �� 17, 760 GARAGE �t 20 �P� 24 ��q�t 10 �, � 480 �� 4? 800 Type of Conetructlon � F�t. Cast �19 � 000 _ To be Completed SEWER LOCATION 153' South of Ma.nhole WATER LOCATION 143' South of Ma.nhole Ia conaideration o4 the fesuaace to me of a pern�it to construat the buflding descri}xd above I agr�ee to do the P�P�� work in accordauce with the d�scrlption above set%�� and ffi compliance� afl ons oP or8iaaaces oP the dty oP Fridley. �/� _ /� � rrf, � _ _ , In c�malderatlon oP the payment oP a Pee of � 23 • 00 , P�t is hereby granted to �OMEDALE BUILDERS to c:onatruct the bullding or addition ae deacribed sbove. This permit is �ranted uPon the exAress conditlon that the to whom it ie granted and his a�te, employees and worl�nen, in all work done fa, around aad upon buildiag, or anypa,r� thereof, shall conPorm ia ait respecte to the ordineaces of Frldley, Minnesota g lacallon, conatructCon, elteration, maintenance� repair aad movlu8 oP buildia�s wi�� dty ]imits�an�this permit anay be revoke8 st ar�y tlme upoa violation of aay of ti�e provleions og eei8 ALLEN G. 3ENSEN euu� � NOTIC6s 'I'� p�nalt d� rrof aoar tla eonmuaHon, ImtatHHon hr Yriein�, P�+ino, �a hatino, aw�r or wat�r. B� an to a� 11a 6oqdlno Inq�or k� apuaM pNmIM hr tlaa N�. 0 ' `M APPLICATIOR FOR BVtLDING PERMIT Ci7R OF 1�RIDLEY, MINNESOTA OWNER'S NAMC . ADDRESS — —ADDRESS � �4.1�d , L� ON OF IIT�DIATG � . � NO•_ �sJ ��_ STREET PART OF LOT LOT '��BLOCR ADDITION OR SOBDIVISION �� CORNER LOT INSIDE LOT`�SETBACK �� SiDE YARD /O ��`�. SEWER II.EVATZON FODNDATIOft ELEVATIQN Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTIOR OF BUiLDING To be used as; � � Front-`�u!�—Depth �Heigh� �� Q��/ �/ � J� Sq. Ft. ✓� t� r9 Cu. Ft.1`��=��- Froat ��i � Depth � � $eight �� Sq. Ft. � �u. I�`t. �� Type of Construction � � � �„%,��m��, Estimated CosC / �� °° To be completed_ �i� %� ' The unders3gned hereby makes application for a permit for the work herein specified, agreeiag to do ali'work in strict accordance wi.th the City of Fridley Ordinances and rulings of the Department of Buildings, and herebq declares that all the facts and repreaentations staCed in this applicat3on are true and correct. � ' � DATE �% � � � �� SIGNATIJRE � (Schedule of Fee Costs can be found on the Reverse Side) �� . _ L? __--�__._.��--��._, . ._ � . _- � � � � 0 .,- = g� k �� ` y � ��,. r � 3 � r BdILDING PERMIT FEE SG�EDULB SECTION 2. The Inepector df Buildinga shall, before is�uing any permit for the erecCion of any building or structure, or for any addition to any existing building or structure; or for any alteraeions or sepairs.t.o any existing buildin� or strucCurei upoti �pplication therefore, require the payment by the applicant for.sucb permit of fees-to the.amouat.herein below_eet forth aad in the manner hereia prov3ded tci��►it: �� 2_ 1. �'or anq euch permit for the erection of any fire•proof building, othe`r than a garage, warehouse, fgctory�dr $�ain elevator, or for the erection of any fire-proof addition, for similar occupancy, to any eaieting building, shall be at the ra�e of $1.40 for each one thousand cubic fee't, or fraction thereof, in such cubical contente. � 2.2 For any such permit for the erect�on of any fire-proof garage, warehouse, f�ctory or grain elevator, or for the erection of any fire�proof addition, for similar occupancy, to any esisting building ahall be,at the rate of -$i.25 for eaah one thousand cubic �eeC, c•lassified sa "fireproof" by Section 502 of the Minneapolis Building .Cade. HOIISES 2.3. For any auch permit for the erectio�.of any non•fireproof building, other than a garage, warehouse, factory or grain elevator, or any non-fireproof addition, for eimilar occupancy, to aay exiet3ng building .- permit $1.00 for each one thousand cubic feet. ' � . GARAGES - _ - - .. . 2.4. For any auch permit for the erectfon�of any aon-fireproof garage, warehouse� factory or,giain elevator, or for the erection of any nan-fire-proof addition, for similar o�cupancp, to aay esiating 1iuildiag�ar for each auch building ar addition - riinetq cents ($0.90) for each one thous.and cubic feet or fraction thereof, in the cubical coneents thei�of with the minimum of $4.00. For the purpose of computing feea for building permits, the cubical contenta of any building or addition.to a uniform height throughout by multiplying the ground area covered from a point si.x (6) inches below tha floor 1�ne of the baseanent or cellar to the average h�ight of the �ipper surfaca or to the averag� height of the roof smface of the;main g�ie`of a pitched roof. • 2_ 5_ For .repa�tre �or alterations.,.to �n existing at�ucturer j�the fee �shali be at the raCe.o£.$3.00-per eac� Five H+1n�red Dollara ($5�30.GJ) or fraction thereof ia the cost of all propoaed wo•rk. 2.6. In no case shstll the fee charged for any permit as aet forth in Section 2 be lesa than $4�00: STORM REPAIR DAMAGE rrES: Residential; Eatirl.a.�ed Cost of work up to $5��.00 •$S.�JO Estir,►aced Coat of work over $5`,�a�a4a -$iU,00 Co�nercial; Esti�.�ted�st of wo:�k up to $5�:?��00 -$10� , ' Fsstimated _.,at of wo�ie over $�Oa.00 - $20.�� ' � ' � - . .. . .. . . . - . . � � `� . . � , , "�' � � �tx�arr�`'� w�> �� ie ss ��...'� - ` � . . . �3"` �:�� "z� S'sC'.`�x # � �_ . . . . . . , � � . . .� ,� ;a. { p' . " ,�= " . • . , . . . . . Y 2 _ . � .. . . . _ . . � ' . _ . " .z.3 � . . ' . � � . . . .. . � � �- ' ' . . . - .- )•4 i . . . . . '.�:N i . � . � � � � � t�kq;. ^�` �a t�d �q po�r�� °�;-: 1 W� �� '� Y��: ��f s°�c`'�st"'� �� .�7 � �!��, ri��i. � �� - � .sz��s . f�� --�En tr�eers � ,�esrv��/Qrs ---- � ...%" �.� � �, � : �•�t�'�� !' �.t �DIl��M1�_.�� '�`i ' . . �' .� ..��....�. ,b � . � � .�I�II�At�~A lr y y _ M , . �. . ' . . . - . . �`'1 il . _ - . . . ... 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W �f f� g w J' W O tn � k n�C x w �' f�D N q 7 � rt�� N � ' O b' a M m N N V CTI O C� � n � N O � N ci� Z m � rn c� c-� x d c r rn y -v � � � D � 0 z T 0 � O � m � a � � D Z � � N C7 D -i G� O = Z D � � Z N � -C � N m� n 3 O N � D z d � m m � � n m � � -i 0 Z � m 'T1 � � m � D -i O Z D Z C c") --I � O T '� z d r m � m -n -n m � � < � a m w �c �O � � � SUBJECT IT NO. � City of Fridley 2 719 9 AT THE TOP OF TFIE TWINS g U I L D I N G P E R M I T i � � �t y �__�� COMMUNITY DEVEIOPMENT DIV. �v � r � � PROTECTIVE INSPECTION SEC. , h� `� 1 . � '..I i.••- ��"',•� CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE Oi APPROVED BY i �� 612-571-3450 910-F15 8/17/98 / / JOB ADDRESS �501 Jackson Street NE t LEGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACHED DESCR. iS 1 Melody Manor 4th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Colon 784-9030 3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO. Ea leview Construction Inc 2937 174th Ln NW Andover MN 55304 753-5469 20076043 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO. 5 ENGINEER MAILADDRESS 21P PHONE LICENSENO. 8 USE OF BUILDINO Residential 7 CLASS OF WORK O NEW ❑ ADDITION 0 ALTERATION � REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof house and ara e(24 S) Tear-off 9 CHAN(iE OF USE FROM TO STIPULATIONS Underlayment must comply with State.Building Code. SEPARATE PERMITS ARE REOUIHED FOR ELECTAICAL, PLUMBING, HEATIN(i, �PE OF CONST. OCCUPANCY GFOUP OCCUPANCY LOAD VENTILATING OR AIF CONDITIONING. TFIIS PERMIT BECOMES NULL AND VOID IF WOFK OR CONSTqUCT10N 20NING SO. FT. CU. FT. AUTHOHIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAVS AT ANY TIME AFTEfi WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION STALIS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yAIUATION SURTAX AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A pERM1T �ZOOL �L.00 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. �%({.]S Fire SC �Z.00 `' PLAN CHECK FEE TOTAL FEE - ' "� �� 9� License 5.00 8 .75 �GNAT EOFCON7RACTORORAUTMOfi12EDAGENT IDATE� EN OPE V LIDAT D (S IS UR PERMIT 4• � . S�GNATUFE OF OWNEF i�i OWNER BUILDEii� �DATE� BL iNSP D TE NEW � [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 r�� BUILDING PERMIT APPLICATION /1 �v� 11 ConstructionAddress: ��D / �� 1 ✓ � Legal Description: Owner Name & Address: .�� g�� Tel. # °2�e% �li' 3 � Contractor: �� av�� , MN LICENSE # �o%�D �3 Address: ,�137 / %� � �i��+-�. Tel. # �.�3 —SY�%' Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Length Length Length DESCRIPTION OF IMPROVEMENT Width Height Width Height Width Hgt/Ground � Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: Estimated Cost: $ �� / ` (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: S� � APPLICANT: Tel. # �� /S—`iD Permit Fee Fire 5urcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 'i�- 7� $ o �C�d $ I� v � $ $ � < C�% $ $ $ $ $ c�. �� CITY USE ONLY Fee Schedule on Reverse Side .001 of Pemut Valuation (1/lOth%) $.50/$1,000 Valuation $1000 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 [ ] 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 pemut 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 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for fust $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed 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 constructed will be required before proceeding with the framing. sue�ecT N -a� c�ty of Fridley 33083 AT THE TOP OF TME TWINS g U I L D I N G P E R M I T r � �• COMMUNITY DEVEIOPMENT DIV. ��0� � ' j L '��"-� r � � PROTECTIVE INSPECTION SEC. �//�/ 1 i � � � /�'�1 � CITY MALL FRIDLE� SS�3Z NUMBER REV DATE PAGE OF APGROYED BY �'""'�� 763-571-3450 910-F15 9/13/02 / / �oe nooRess 7501 Jackson Street NE 1 LEGAI LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHED DESCR. 1S 1 MElody Manor 4 Addition SNEET 2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE Gail Colon 7501 Jackson Street NE 763-784-9030 3 CON7RACTOR MAIL ADORESS 21P PHONE LICENSE NO RMA Home Services Inc 3200 Cobb Galleria P STE 200, Atlanta, GA 30339 763-542-8 � 4 ARCHITECT OR OESIGNER MAIL AODRESS ZIP PMONE IICENSE NO 20268257 5 ENGINEER MAIL ADDRESS 21P PNONE LICENSE NO 8 USE OF BUILDING Residential 7 CIASS OF WORK O NEW O ADDITION � ALTERATION �1 REPAIR O MOVE O REMOVE 8 DESCRIBE WOFiK Replace 5 windows within existing openings 8 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in ali sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Ua�iform Building Code. �� ,� �I�UN�O�tl10� pj ��B��II�I �� li!IN � ��e� uoi��dsu� �ltua�� SEPARA7E PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING, TYPE OF CONST. OCCUPANCY GiiOUP OCCUPANCV LOAD VEN7I�ATING OR AIR CONOITIONING TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT CU fT AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS. OR IF CONSTpUCTION OR WORK IS SUSPENDEO OR ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO OWIG. UNITS OFFSTREET PARKING I MEREBY CERTIFY 7HAT I MAVE READ AND EXAMINEO TMIS APPLICA710N 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS yp�UATION SURTA% AND ORDINANCES GOVERNING 7HIS TVPE OF WORK WILL 8E COMPLIED @ WITH WHETHER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT y�S,312 �Z.C)6 DOES NO? PRESUME TO GIVE AUTHOfiITV TO VIOLATE OR CANCEL THE pEqMITFEE SACCMAHGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- @ STqUCTION OR TME PERFORMANCE OF CONSTRUCTION �LZS.ZS ire SC y�S..31 PLAN CHECK FEE OiAL FEE Licen e 5.00 $13 .22 SIGNATUNE O� CON'AA(;TOA OA AUTMOQ�ZED AGENT IOATE� N PR ERL ATED TM IS YOUR PERMIT � �/ I� S�GNATUAE O� OWNEr+�� OWNEp BU4DEfii iD�1Ei BIOG � SD fi�rE , � �[ ] ADDN ALTER [l Il Effective 5/10/99 CITY OF �'RIDLEY SINGLE FAIVIILY AND DUPLEXES R i AND R 2 BUII.DING PERM�f APPLICATION �onstruction Address: ��'S p � �$c�,C�c�� i' , . . L.egal Description: � Owner Name & Address: (-�� C.O �a� fi � Tel. #�'�3 • ��'�{ • ��Cj� Contractor:; � � HOME SBRVICES 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 1cBC-2o26s2s r--r---- -�� M..0 ,�n.it to scale. LIVING AREA: GARAGE AREA: DECg AREA: OTHER: Construction Type: DESC�fl1�T OF ��4��;�NT � . ' Length Width Height Sq. Ft. ��h Width Height Sq. Ft. Length � YVidtli � Hgt/Ground Sq. Ft. l�[��`i� i� A � 1 . w�w wi /` . �C� f . w� _ �. . A w. . �- .L _ _ � � � ao Estimat�ed Cost: $_S, � � ai —' Driveway C�rb C�it'Width Needed: Ft. + 6 Ft =_ Ft x$ —$ � !1i :' �� ' ' /� _ � ��► �� iI . " _ Permit Fee Fire Surcliaazge � s�� s��n�ge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: � �as.as � S• 31 $ �. lo C� $ � .�.r. ��v $ $ $ $ �1 aa CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.soi$i,000 v�,�aon $1050 per SAC Unit $5.00 (�tate Lxcens�d Residential Coffiractors) Alt. "A" or Alt. "B" Above $450.OU Conservation Plan Review Fee Determined. by Engineering Agreement Necessary [ ] Not Necessary [ ] � �1� CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 PERNIIT 0.:2004-01582 DATE I5SUED: 09/13/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 7501 JACKSON ST NE PIN : 113024110021 LEGAL DESC : 1VIELODY MANOR 4TH ADD : LOT 15 BLOCK 1 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : RESIDING VALUATION : $ 18,000.00 NOTE: PER R703, 2000 INTERNATIONAL RESIDENTIAL CODE, REQUIRES THAT A WEATHER RESISTIVE BARR�R BE PLACED OVER EXTERIOR SHEATHING TO PROTECT TI� INTERIOR WALL COVERING. EXCEPTIONS FOR THIS PROVISION WOULD BE IF SHEATHIl�TG IS AN APPROVED WEATI�RPROOF PANEL OR WHEN TI� SIDING IS AN APPROVED WEATHER BARRIER VINYL SIDING IS NOT A WEATI�RPROOF COVERING UNLESS TI� MANUFACTURER STATES THIS IN TI�IlZ APPLICATION GUIDELINES. CALL FOR INSPECTION OF WRAP BEFORE COVERING OR TAKE PICTURES. RESIDE HOUSE & GARAGE; SOFFIT/FA5CIA/TRIM. GUTTERS AND DOWNSPOUTS DO NOT REQUIRE PERMIT. STATE LICENSED CONTRACTOR 1 APPLICANT BUII,DING PERMIT FEE 293.25 CUSTOM REMODELERS INC (1748) FIRE SURCHARGE 18.00 474 APOLLO DR STATE SURCHARGE, VALUE 9.00 LINO LAKES, MN 55014 LICENSE SURCHARGE 5.00 TOTAL 325.25 PAID WITH CHECK # 46990 OWNER COLON JOSE A 7501 JACKSON ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT 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 have read and examined this application and l�ow the same to be true and correct. All provisions of laws and ordinances goveming 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 cancel the provisions of other state or local law regulating constructio r the perf ance constructio . Applicant Date Bldg Insp ' Dat G� ,y ., SEPARATE PERNIITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE. • N� [ l � ADDN [ ] i4LTER [ ] Construction Address: _ Legal Description: Owner Name � Address: Contractor. Address� �7 � � � �� 9`� .CITY OF FRIDLEY Effective 4/1/2004 6431 University Ave NE, Fridley, MN 55432 (763) 572,3604 Bldg Insp SINGLE FAMILY AIVD DUPLEXE� R-1 AND R-2 (763) 571-1287 Fa�c BUILDING PERMIT APPLICATION � ��'� �� >� �='� = � Tel.#�103 ��o �° �Q�d MN LICENSE # I 7 � �_______ Tel. # �Si '� �-� ,� Attach to this application, a Cert�cate of Survey of the lot, with the proposed. construction drawn on it to scale. DESCRIPTI09d OF IMPRObEMENT LBVING AREA: Length Width Height S. Ft. q GARAGE AREA: Length Width Height Sq. Ft DECK AREA; Length Width Hgt/Ground Sq. Ft OTHER: � � ��ri��,, � oe o • �C� Construction Type:� � �' Estimated Cost: $ ��,�.��D � - i�riveway Curb Cut Width eeded: Ft + 6 Ft = Ft x$ _� < DATE: "' ' � l �►PP�lGAMT: Yel. #�'` e� Ip C� Call (763) 572-3604 for Permit Fees if mailing in application. Fa�c to 763-571-1287 if using credit card arad we will call �ou for card number. �.. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee S�rrer ib'lain Charge � � ea� � $_ � ,,� � $_ q .� f� $ � �. D?� $ � $450.00 Consenration Plan Review � Fee Determined by Engira�ering � _ Agreement Necessary [ ] Not Necessary [ TOTAL $ �,y � � STI�ULATIONS: CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of @'ermit Valuation (1/10th%) $.50/$1,000 Valuation $1350 per SAC Unit $5.00 (State Licensed Residential Contractors) Alfi. "A" Qr' Alt. "B" A6nva � `� � � Building Inspections 763-572-3604 DATE � � l SITE ADDRESS �_, THIS APPLICANT IS: PROPERTY OWNER✓ TENANT CONTRACTOR PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY ❑ OWNER �CONTRACTOR ADDRESS:_ PHONE� � ADDRESS CITY SUBMIT A COPY OF STATE LICENSE tl� I,U _ EXP DATE _ YOUR STATE ADDRESS: �- �'�� CITY LICENSE WITH pHONE� �� j� D[�L@ �.P'1 ppX A.PPLICATION PERMIT TYPE TYPE OF WORK: ❑ SINGLE FAMILY � NEW DETAILED DESCRIPTION OF WORK ❑ TWO FAMILY ❑ TOWNHOUSE � REPLACEMENT � Permit No.: Received By: ATE�ZIP 'AT� `ZIP� I�p 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 BELOW) BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING _ BATHTUB GAS PIPMG �� cmuc�vsE) SWIMMING POOL j� WATER SOFINER ($35) _CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($IS) _ DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION _ WATER ME?ER OTHER Permit Fee TOTAL DUE $ Number of fixtures @ $ ] 0.00 x $10.00 = $ .50 Number of fixtures @ $15.00 x $15.00 = $ $ Number of fixtures @ $35.00 � x $35.00 = $ � � State Surcharge = $ .50 Total = $ �,�U THIS IS AN APPLICATION 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 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 req ' es review and approval of plans. 51GNATURE OF APPL(CANT ��/ /%—�-g ��-��T NAME�I�R1 �L' 4 11�� L r� DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977