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AF - 47827City of Fridley, Minn. � BUILDING PERMIT � � ^ � ,� �1 Date: Owaer: OCTOBER 6, 1967 ROBERT DEGARDENER � � r�-�-� 1�0 9500 N'ORTS SUBURBAN BIIILDERS Builder Address Add�,esB 3218 - 67th Avenue North Minneapolis, Minnesota LOCATION OF BUILDING No. 550 S�t KTMRAT.T. STREET N. E. � Part of Lot � 48, 49 , 5 0,_ glock $ Addil3on or Sub-Divis�ton .� ��RVIEW HEIGHTS ADDITION Corner Lot � .� Inside Lot .— x Setback 35 —._._.._ Sideyard __ OK Sewer IIevation ____ 856.00 � IIeval3on $59.00 TOP OF FOOTING DESCRIPTION OF BUILDING To be Used ea: DWELLIftG �nt �30 �p� 34 Height 20 Sq, �, 974 �� 19,480 Front Depth ITeight Sq. F't Cw. Ft Type of Construction � ��, �� , $13�000.00__ To be Completed ...._ San. Sewer - 84.5� East of Manhole Water - 11' East of Saaitary S�wer In conaideration of the iasuance to me of a permft to construct the building descrlbed above I agree to do the proposed work in accardance with the description above aet forth and 3n compliance with afl provisions oP orrlinances oP the dty oP Frfdley. ��hL� , �� I`s 6 1! G�2.�.e�� 4�A�ArAB-�-ssi-S�isr- "� In consfderation of the payment oP a fee of $ 29 . 00 , p�t is hereby granted to�.�ORTH SIIBiTRBAN BUILDERS to construct the buil ding or addition as described above. Thia �t is grented upon the express condition that theperson to whom it ia granted aad his agenta, employees an worl�en, in all work done in, around and u�n said building, or any part thereof, shall conPorm itt all respects to the or�linaacea of FridleY� Minnesota reg location, conatruction, alteration, maintenance, repair and moving of buildiuga witl�in the dty ]imits an� permit may be revoked at any time upon violation of any of the provislons oi sa�d ordinanc�s. GZAREIVCE BELISLE B��g �r NOTICE: Tl� permtt does nef eevsr 1hs eoestrucHoe, installation fee wirtng, plumbine, ga heatiog, asw�e er water. 8� mro to � tlro Buildieg lespsetae fer �perafs asrmhs Por �6as It�mt. s �, c s � . , � " ` -,'__ • ' ,. AJi`S ''�'" i nl 1•�i ur•s•,,�_ . A t.��:C.�_�.G:� 'ti:.t ., 7�i,D.��.G ..�_.t_�.T Ci:t� Ox i f��il:a`.'i�� Pi�I��;rSi;?'1'. � - ,��-r��-��,._. �.�.� .�/ . . , � . - - . Oj-I�IEfi' S NAi•1r: , - ?:��^__.__�_ F��r'i.IiLi'. � . � .. ��M ADDP.ESS -- -� A[1�i:I;SS � �..a.a,w..,�...�..,.,�.s��..��._._._..... a_.�d'��.., _�'��-_ � 3 � / �'" -. � T� �- �1�CT �. � r.o�ts:,�a.GN 0�� BUTS:J)l.�;ct � � . . 1�Oo �•;j �C� � .�.�......�..._..STt ;L��'� �. ... ...,,_.r._�_._.�....� P�RT 0�' T,42'_..�.....�__._.._....�....�. . �Q'�,�f � , - . L0�`��'`-% ��-BI��C�:�� ADJ�T�.UIr' OF: 5U's�i)�:VXS7:�'r��_ � CO�tl`�EY. LOT iNS i:DE I,O� �{.-..DSE ±`"�iACK-.�•---�.� --�_S�DuvYARD C�� ..�, SEjdEPi EI,E�tA'�'7Q�i ��.�Z>..._........-- FOI1IyDA'CZOiv �"LF,Vc'1'E'70i1�'��a Applic�nt at�ach t� �hi.s forca Two C�rti.f?ca�es o�"Su-rvey of Lot and pZoposed bui7.ding xocation drawn on these Cert��icates. � - . . DESCRTPTZO;y Ot� EUXLD�:P:G . - _ To Ee Us ed As ; . . � . . .. . . _ . � ' �' . _ " . �, �.a....G.� , �.' � . - ,,,��,� Fxon� � Depth �� Hei ht `.� Q _�___...,......_�.. g ..,.._....._.........�.� . , . S 4. Ft . � ,� Cu . Ft ..,b...�'�""i`� � � . � �Front _ _ •_ _ Dep�h Height _... �. _Sq. Ft.�„�.---- -- ' Cu. Ft.. Type of Constructian __ Estimated Cost__ ��j �� To Be Completed . . .. . � .. -. . �he undersignad her�by makes apgiication for a germit for the work her�in specified, 8greeing to do all taork in strict &CCOiC13I1C2 caith the Ci�y of Frid?ey Ordir.ar�ces and rulings of the D�gatrtm�nt of Eui�dings, an� hereby declar�s th�t alI the facts and regresentations st2ted in this appiication are true and correct. - ' - y / . DATE �`'°� C� � • �� SIGtdATUF�E�_�� -- �_ . � (Sch2�ule o� F'e� Costs can be fcu� d a:� th2 Ravarse Side) . � �- �1 �`�g, oa � � . � � � � � � . � � �, �,� �- � �� , �� . , �, � �� . r � �� , �-► �� . � � � C � �C�d � - � � � 12 � °� . .- _ . . � sr�-N, sw2- y�c,,g. � `� " � °�M- lf o 0 �� ' `v,�?--i ,� �, �a // ' � ob . v.E4-N. SLt/,2.. LoG,f}� �� , e� h, . { i_ . � [and Plannin9 Land Surveyin9 Soils Testin9 Gvil b A4umeipal En�ineermy � � � 6875-Hi9hnoy ��S NE. MinreeaPn/s)f. EN G I NEE R I N G, I N C. M�nnesofa SUnief 4-6066 � En9ineers �' Surveyo�s cesti�scate o� r� � � r� ��A . �� _ �� . 3 � � �� ao ` � � r+ �� r.:. �7 r� �'�1 �,, �a`s S-,� � °„1 0 0 s� s��e� �e: ��- � �. �� r , r,��' � , . f. 6�.� r��'��4`',�, ��' �; � a �; ', � , 1 � ,t i :% ,�� 5 1 N, � ',1 � �� 1 `h , V �i ./ ,�y : °> .�jJL` �/�J/ �4 Ci0'�"Ys�t/' 6'/1 Y,..� ��9F�r`~;'.�I/i''G. .. e� '� �: 1 � � - a-, . ' � -� t� sa�.. � . �„ a �� ' : � r`s �� `� � .. , � y� 5` 1j �� E �� d._ � �i �� + - , ��'°� c. �?'"_"? �� lu� �`" 9°� �k �!. 1. 7� ,�� N� � � �; $CALE -- 1 = ?(� o - �Fr��z--�� r� o„�'jC�-G � 5G'� C� lY"`� � �� , `'c�'�" � �� Gf,�.`�' , ',�-F�� `%{.� 4'./%O`��.J � ��",� � �" �e��''�`'-` ;� ``�'''�";'� �tr"�' � �� '�'�p��. � ' ``. ` : � � ` � � 61NOit.�' � �.° :rv"�' 6-° / bveby urfi�y flwt �Jiis rs o�rue arrd cor�cf rePresenfofrun o�'o survetf g�'lhie bo�ndar�es qi�e obo�r a�escr�6�d /m�,d�, ond �Iocvfio,n o�ol! Gui/din9s , ff�ereon , a�o// r;s'ible �rrnachm�nfs , i!'o�, �rn or ar�so;d /a� As surveyed 6� me fhi.s °'� °`` a chy G,��cer.a � A.D. l9 P' :'' , SUB (lRBAN ENGlNEE21NG , INC. �s� �' ' Enqi,�reers E Sarreyars . a�.�, ` �„� 4y� �� C� �' ,.,�� _ � � "` � - , n , r `,`"�/L?—�i� _.. . � ..�- � G � �. � a � p �. : � . 7i : � ' M : M : o . � . m � � "� � c� a� � pz �� z� z z ��w��n � p � � � x � � r� � N " �' � + � � 5' � � � � � � � � ro : O � � � � � : � p �d ¢'' ,a � ,'p�r � . . � � . � � . � W p � �' . 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D -_ . _ � � � _ �1 .. �` v '' i� , � � �-- ------ - - - - - -- � -- - — — - -- - — - j� - - � � . • r� - ;f V ' - �� . «r . � ' � �' � _ . . . bp � , � V � � v � � a � � � . ;� . .�W -- ` � ,; � � , :F Lt ° � � � � 'O �+ tt y p �,'� : y : x : � . m . m • M : o : � 0 ' � . �� > � � N � � � � � a � M p� � � � � � x � � w x � � � � � � � �p � � � � y� � � � � � � � � � � � fA � �. � . tD � �' � '�' � � � p��-', � bd � : � � � � : : � ¢ o : � � : M � : : W � : �• � : .. � : . � � . . . . : : : � W : ' : ' : : : : � : : : : N 0 0 iC 74 94 M �4 k �4 k k k C� � t� � W�i � N� L:a 'd g � o �� $ � � o a � �� .�� o 0 � � � V \c � � � � � �n. y � p � D � r � —1 m N _ m C r m Q � � � y a {�-� � � � ro � � �� _ o �9 _'" � C� �_, � `; m � �► �;, �� o °3 ��, •�p � �' � � � „ - ....1 - : .�.' � i ��1 � � ■■■■, ' ■�■, � .�■1 �� 8 M �� Q V~J Ex. � � a ('i � r'b o � � a � p a on g I�. i N � � M D � N WATER aos�s URiNALS e�rH � �� SINKS wnsE+ rw�rs DRINK. FOUNT. sHwRS. �ooa DRAINS GTCFi BASINS �wro W�iF�E� GAS APPL GAS RANGE GAS OPENINGS �. Z. � � > m A � � aa� � � � °�, �� `� �a� � y � � �ooga � H' � fD fD ��C � `� O lD P� �•• ��o� 3 � ��°� � �� 1 � � ro � � m � �! } b � �� m � � N Q - � � -�.7 p � � o � � � � ]. �.� ►i. r. � m ►�i �� w � � �.� �� `� `�° •°� ,•�� ► o0 �av�' � � � �o I 3�� ' � r`C � � � aM R� �� p � M � �� . � �i 0 � � � • � � � � � � �� o b � o � M � � � b � � � � om � �� . � 1-' c�f \J1 N 1 � � � t�' APPLICATION FOR BIIILDING PERMIT CI'I'7C OF FRIDLEY, NlINNESOTA ... � � � owrr� �s� Na� ��Y �,� °��r� �zz�nn3 .� �� ' ,,._.. ADDR.�SS �.�� B� f�4 L��" �. �. D �� P ADDRESS ��) Os'l �. , � LOCATION OF BUILDING N0. .�� a s�t�r �' � �� a 1 �L �TP A� � � � � � �� LOT ay �4 °!� 9 ,3�^ �LOCK �� A�DITION OR SIIBDIVISION � d� �� 1 � h� � �a � � � I ,G hl l � , COI�NER LOT INSIDE LOT SE'�'BACK�SIDEY.,�D�� `' SEWER ELEVATION TOP OF FOOTING � � ,,¢/, � �� p �t �� „� �pplioarlt a�ttaoh to this form Two Certificates of Survey of Lot and pro�osed bua��,d,img locata�on draw.n. on these Certificatea. DE�CRTPTION OF BIIILDING To Be IIeed As:. �� $ � � Fror�t ^,�� Depth � � � Height . . Squa:ee feet Cubic Feet Front Depth Height Sqtze,re feet Cubic Feet Type of Conetruction ��d �i'a��I,� l�O�stima,ted Cost % � � �' �' � To Be Completed The undere�.�ed he�eby makes application for a permit for the work � herein apeQii�.ed, e.�reeing to do all work in strict accordance with thQ City of Fridley Ox�din�.nces and rulinga of the Depaxtment of Bu3ldings, and hereby dealare� that all the facts and representations atated in � this app7.iaati,on are �rue and correcte DATE � !� y� SiGNATURE ' C{. Q � (Schedule of Fee �osta can be fourid on he ever�e Side.) Z � % � — � — �—�'�' � � r � .� �� y�� n � � _ �. ; - � BiTILDING PII�MIT � FEE SCH�DULE SECTIOIV 2o The Inepector of Buildings ahall, before issuiYa.g permits ior the erection of any building or �tructure, or for any addition to any ��i�ting atructuxe or building, or .for axJ.y alteration or repaa.r� to an� exieting building or stxucture, upon application the�e£ore, require the pay�nent by the' �.pplieant for such permit of fee� to the amount herein. below set forth and ixb the manner herein provided to-wit: Unifoxm Build' Code: Type 1 y 2, & 4-$1 075 for each one thousaaa.d cubic feet, or fraction thereof, ir auch cubical c.nn.tents. Type 3& 5- $1050 for each one thousand cubic feete For the purpose of computing feea for building.permits, the cubical _ � �o:�t�nta o�f �b�i�di.�i�°'aclditibil°�ti �. un,i�orm hei'��-'th�su�o�"�y� ° ° multipJ.ying the ground area covered from a point eix (6) inches below the iloor line of the basement or the cellar to the avera.ge hei�ht of the upper aurface or to the avera.�e height of the roof aur�ace o� the main. gable of a pitched roof. � For repaira or alterations to an existin.g atructure, the fee shall be at the rate oi $3.00 per each five hundred dollare ($500.00) or fraction thereof is� the coet d£ all proposed worke I.n no case shall the fee charged ior a�.y permit as set forth in Section 2 be lesa than $5v00o - �D �onnec�i6n CYiarges based �on Zocation -- Area� 1 or 2. -~ �1 I"1 � . �y �, . .� � [ond plrn�niny Land Surveyin� Sorls Testri,y fivrl b Alunicipa! fn�ineerin9 ./ � t. i 6$7s-fl,9hnvy •cs .e�£ Mm�evft.!; �:. E� (� I N EE R I N GO ��`/� Mnnr-;�9!� � SUiscf �'-v0.>�; ---- En ineers � Su�ve ors 9 v . ��►�� [/�,� /�J ,�/'] �`-� f> : , �� ' �� i f �J�'t^/�j �/♦ / (��,�J� �/ �F~%�lL ... � �� S 1 � . _ ��n� r :j� �'~ � . �� S � /�/M�� . NG 7� � � L �Y � -: L � SGALE ._ � •� ��; � - DE��1�7TE.r..' iF=�;r .�,(�'G. �5G'� . cx � � �� u � � ///� � ` i , \J�"� � � �c, C�� f - s .> , -�,9 �y/.��y �y`G n ' /� • J.• . . ` , , • ', _ � K//N `✓ � ��3 "�' .• ^ �/��F'� i / �,-��' r C.^/��.y�i�� ~ = i • �,, nf , . ` '°� � � . ; , ,q o �z„e c„ ANoh'�9 C'� � ,ti'7 ✓ � .�. ,,.., �:, p � �g��d �leccf�cfi�i �.rfs�i!' ��O Su/'v¢y ��1�'B fiovndO�iBS o�'the a6are a(cscr%!�d •'v��, Y �a/ . • . �y, �'i or cr�soid /and. As su�veyed � me l�'�!� - •�� ' ' - � • . �.� � '' �,c�,�<. ��/tr�n�Ml FN�;�NFF-/'/Nr. INC `�'�h�,z��s{� �:�:�� ' � - . "'� �°=''°�-� ._.. -. __ - - • .. . �1 a , F I �: � , . * � D m � 1 � � O N ,� � 'o � � n � r. � �• � O N. � Z N � � .. rn -.. n� m � � � .o . � rr . 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Yes � No () The venting system is plastiGPVC and meets all current 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 current codes and manufacturers specfications. This does indude AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. �jQ PY� I�Cfll'1A _eme��on a�r is sized and installed to meet the current codes �,nd manufacturers specifications. VVhen required to ��au a r,pw _emh �cl�ien air�it will be sized and installed to meet the current codes and manufacturers specifications. Yes � No ( ) Yes Qy, No ( ) Yes � No ( Wj�en ine allin� n_w v_nfin8�y�m, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers 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 () �.. .� �.- ... �- ..��.. -. ... -� .�.-.,. .�..��.,.� Appliance #1 Type �I.�VIQI � BTU Inp 5 Q�D Fan Assisted or Nat ��-t ° Appliance #2 Type BTU Input � Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted .or N�at Total Appliances � Total Btu Input - — - � Common Vent Type Vent Height Diameter ' a�' inc�es Appliance #1 Vent Connector Height ft Length ft Diameter "�m =Type Appliance #2 Vent Connector Height ft Length ft Diameter � in ;Type Appliance #3 Vent Connector Height ft Length ft Diameter '�"ne�Type ,.. AI TEROTIONS� (Describe� ; °+ .. .>. HEATING CO: ��`g? C�ENT �N 55E�4N�� Signed By: ¢n. � . � Date : � � � � � � � � `' � HEATING AIR CONDITIONING AND ELECTRIC� INC. � `�"`y HOUSE HEATING TEST RECORD ADDRESS� � a1 O(xUPANT "' HEAT LO DATE HTG. INST. ''r SOLD BY ' Electrical Work By TYPE OF HEAT GA FA� HW S SPACE HTR. • �. ,� :� �. : : : �i�L�ri��. - � �. ! , y L'': ,1'� ,. � � � CONTROLB THER ST � G� Heat Plua Value Umi�y� ' Limit Settina �Di� Fan SeIDn Pilot Type t�.1 � Pilot Make Pilot AAodel Pilox fiming L.W. Cut Qif Pressure ��i a� � S� C.. Percent COa � Input GFH Peroent Oa Stack Temo. y Percent CO APT. FLOOR CITY SUBURB OWNER INSTALLED BY Gas Line By � UNIT HTR. OTH R � Ci1:1'1�.�9C�I:l „ vent size KIND OF LINjER - SIZE �I NONE Draft Noad - - Regulator ��i�.�� Fliters Size � Number Chimney Location Inside Outside Chimney Gonstruction Smoke�b Wiring � D►aft_ _ ... Test Tag �or Pressure Lightlng Insn.� Oate Tested l� � Company Testi Name of Teater Preasure Percent COZ Input CFH Percent OZ Stack Temp. Peroent CO ADDRESS PIN LEGAL DESC PERMIT TYPE CITY OF FRIDLEY 6431 UNiVERSITY AVENUE NE FRIDLEY, MN 55432 �631572-3604 FAX: f7631571-1287 : 550 KIlVIBALL ST NE : 033024220103 : UNAVAII.,ABLE : LOT BLOCK : BUII.,DING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOW/DOOR REPL PERMIT O.: 2004-00 6 � _____. __-___�, DATE ISSUED: OS/07/2004 VALUATION : $ 3,189.00 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. REPLACE 5 WINDOWS WITHIN EXISTING OPENINGS. STATE LICENSED CONTRACTOR 1 APPLICANT RMA HOME SERVICES INC (20268257) 3200 COBB GALLERIA P ATLANTA, GA 30339- (952)345-6047 � .C�%►�� ZIEBARTH JERRY A & LILLIAN 550 KIlVIBALL ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes nu11 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 cerrify that I have read and examined this application and lrnow the same to be true and conect. All provisions of laws and ordinances governing this type of wor� 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 any other state or local law regulating constru4ction or the performance of constructio�. Bldg BUII.,DING PERNIIT FEE FIItE SURCHARGE STATE SURCHARGE, VALUE LICENSE SURCHARGE TOTAL PAID WITH CHECK # 34844 SEPARATE PERMITS REQUIRED FOR WORK OT'I-IER THAN DESCRIBED ABOVE. 97.25 3.19 1.59 5.00 107.03 04/02/2004 FRI 13:21 FAg NEW ADDN ALTER i-�; .ELDER JONES (�Zj001/001 . . � . .. � . � ��g � � � � �'� �. .. ��..:: � �.o� �- � ��: �� CITY OF FRIDLEY Effective 4/1/2004 I 1 6431 Universii�r Ave NE, Frid.ley, MN 55432 (763) 572-3604 Bldg Insp I I SINGGE FAMILY AND DUPLQ�S R-'I AND R Z (763) 671-1289 Fax BU(LDlNG PERMIT APPLICATION Construction Address: SS � Legal Description_ � _ Owner Name & Address: �..C� I �;11 � J(f ��r�in CpntraCtor. � HOME SERVICES INC. Home Depot Installed Sales Addr�ss: 3200 Cobb Galleria Pkvry., Ste. #200 Atlanta, GA 30339 763-542-8826 BG20268257 .�L Tel. # ��0� - � �i-�.�Z __ MN LICENSE # Tel. # �ficate of Survey of the �n drawn on it to scale. DESCRIPTION O� INIPROV�NIEN7 LMN� AREA; Length Wdth �, Height� Sq, Ft GARAGE AREA: Lengt� Wdth Height ___ Sq. Ft DECIC AREA: Length �dth � Hgt/Ground Sq. F't OTHER: �CA C_9.� � C.,i n t�nf �� . °9� i . ) ' �� ni� � ' .� .., Construction Type: �� Estimated Cos� $ �� `R� Driveway Curb Cut Width Need�d: Ft, + 6 Ft =_,Ft x$ -$ DATE: � � -U "I qpPlICANT: Tel. # 1 S � - = .S,' n ( . � Call (763) 572-36Q4 for Permit Fees if mailing in applica6on. Fax to 763-577-7287 i# using credit c�rd and wa will call you for card number. Permit Fee Plan Review �re Surcharge � Staie Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer �Main Charge TOTAL � CI1Y USE ONLY- $ v� �" � a 5 Fee Schedu(e on Reverse Side � 65°fo of Permit Fee $ � . I °) ,OOy of Pennit Va�uation (1/10fF�%) $ � � ��I $.50/$1,000 Valuation � � $ $1350 per SAC Unit $ �• Q $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering � Agreemerrt Necessary [ j Not Necessary [] $ � � STIPULATIpNS: ,� , Building Lnspections 763-572-3604 DATE SITE ADD � THIS APPLICANT IS: ; BITII1DIi�TG RESIDENTIAL APPLICATION CITY OF FRII�LEY ❑ OWNEIt YOUR E-MAIL ADDRESS ��-� � �� _ � �� Pernut Na.. Received By: � Date Rec'd: �' � � �� i'R�PERTY OWNER/ N.vv�: �/LL�e4�+/ Z/ �' � � %/� � TENANT ,�DDRESS:_ �� l %�.�� crrY STATE znP PHONE:_ �� a � � � � ° � SZ � CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICEiTTON PROgERTY TYPIC PERMIT TYPE �rE oF woxx: N��— The Home Depot A.H.S. Inc. sTA� Lte 3200 Cobb Galleria Pkwy. anD�ss: Atlanta, GA 30339 Pxor� '763-542-8826 �rwo FA License #20268257 � BASENIENT FINISH ❑ ROOF � D� ❑ SIDING ❑ SWIIvIl�IDQG POOL � DESCRIBE WORK BEING DONE: SFZE OF �TZ' STATE ZIP ❑ DRA1N TILE ❑ OTHER HEIGHT Ft. NUMBER OF QUARES ❑ HOUS & GARAGE BASEMENT REMODELING SUBMIT• GARAGES O ATT GARAGE 1. Existing F1oor Plan PiZOPt?S SIZE: ❑ DET CI�D GARAGE 2. ProPosed floor plan PROPOS HEIGHT: 3. List of shvchual membets to be used 3IDIlVG FOR NEVJ CONSTRUCTION 1NCLUDING DECKS, �� 3'1, � OSo t .ADDTTIONS_ & PORCHFS SUBNIIT• � T 1. Site PlanlSutvey showing the existing structvres 7 Oth ❑ cia �d P�� P�� ADOR'S 2. Two sets of consh�uction plans N E3�STII•IG OPEI�TINGS �lYes ONo LOCATION OF WIIVDOWS 3• �e�Y �1cuIations �R FOR NEW OPENINGS-DESCRIBE SIZE OF �� mg �� PENING CHANGES & " s� "YPE OF WWDOW TO BE INSTALLED NUMBER OF WII�IDOWS ✓ ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF L.A BOR AND MATERI�jLS; ([JSING THE 997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ /' � �� _ OCCUPANCY � F 'ermit Fee � 'lan Review �urcharge � ire Surcharge ,icense Surcharge ;AC Charge :urb G�t Escrow >rosion Conlrol 'ark Fee ewer Main Charge 'ota.l Due $ $ 1. � � � .o� $ $ $ � $ See Back Page for Fee Schedule 6�% of Building permit Fee (.0005) tames the total job valuation — Minimum $,50 .001 x Permit Valuation (1/10%} $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determinaiion) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agr-eement necessary ( ) Non Necessary ( ) Make checks payable to: City of FridIev Affach THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTII, PROCESSID hereby apply for a building permit and I aclmowlecige that the information above is complete and accurate; tha.t the work will be in �nformance with the ordinances and codes of the City of Fridley and with the Minnesota. Construction Codes; that I understand this is not a �rmit but only an application for a permit and ork is not to start without a permit; that the work will be in accordance with the approved lan in the case of a.11 work which r uires evie d approvai o�plans. _ �� GNATURE OF APPLICANT l� PRINT NAME � � DATE � Page 2- Builda.n.g Residential Application BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issui.ng permits for the ereciion of any building or stra.cture, or for any ad.�ition to any e�cisting builda.ng or s#�u.ct�are, or for -any al�ration or repaar to any existing buil.ding or structure, upon application therefore, require the paym.ent by the applican.t for su.ch perm.it of fees to the amount herein. below sei forth an.d in the manner herein provided to-wit: VERII{'ICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure an.d of the constru.ction site. A Certifica.te of Survey of the lot, showing the location of the existing foun.dation will be required. before proceeding with the fram.ing. New Houses Onlv City of Fridley � Buildi.ng Inspections Depaziment 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 w� �� Building MECHANICAL Permit No.• ` Inspections RESIDENTIA.L APPLICATION Received By: 7. 63-572-3604 CjTy OF FRIDLEY Date Rec' DATE l� � d�� YOUR E-N1AIL ADDRESS SITE ADDRESS TMS APPLICANT IS: O OWNER OCONTRA O PROPERTY NpME; / . OWNER/ �D�S: CITy F STATE,�ZIP� TENANT PHONE: 7L� � ' � � O 'r7�- � CONTRACTOR co�vrnnivr Nn�: OG � SUBMIT A COPY OF �NTACT PERSON: � YOUR STATE STATE LICENSE # EXP DATE . LICENSE WITH pDDRESS: ��%— ��j6f /fjiC �� CITY i�� STATE�ZIP_rt` c3 APPLICATION pHONE 3' 1 S�i � L,O� FAX , PERNII'i' TYPE � SINGLE FAMILY O TWO FAMILY O TOWNHOUSE TYPE OF WORK• ��W O REPLACEMENT O ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK � , PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, instailation or replacement of a residential fixture, excluding the fixtures. (T'his should reflect only the cost of labor ) Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor _�� x.OS = 1�G'Q FOR PROJECTS WHERE IABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV� Equipment Installed .� MFG: MODEL: SIZE/BTiJ MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU _A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGFJOYEN $10.00 AIR TO A1R EXCHANGEER $ IS _FIREPLACE (W�D) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 _FURNACE $35.00 GAS UNTf H1'R $10.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $I5.00 . _ .. . . . �.. ��%+�; � � . . ��:« > � � �''��i�;. .. .. ;'� � YEE� R �';C��t s ��q� ,�A�.�.� . ��n S .�,--4��-'�k�� . _::. :.. _� �' ��'i?�"� ' �` r� Permit Fee $ Number of fixtures @$10.00 x$10.00 =$ Surcharge $ 50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $�.� Number of fixtwes @$25.00 x�25.00 =$ Number of fixtures @ $35.00 x $35.00 = $ State Surchazge = $ .50 Total = $ 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 requ' s review and approval of plans. � ��b�� %J S =�� SIGNATURE OF APPLICANT PRINT NAME /J� � DATE 9�' , . � L,�:SE �b., � �SE ;. E�Eit1VI1�'S�AR�itE - I:a1RED3�p��BC�P `LDIN�G, �T„�CT� .CA3�`��,A�Ti� ��7�A�IG�i?�� .'. " ;. �� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 �.• REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC _ ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR � REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) . a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/1FGC Chapter 3 with MN Ame�dments ' 2. Make-up Air (See note below) a. TMC Chapter 5 with MN Amendments . - 3. Venting a. Gas appliances IFGC Chapter S with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooli.ng load per room a. Required on new construction IMC 1346.0312 5. V entilation . a, per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations Building Inspections 763-572-3604 D.aTE L 1 ° � ' SITE ADDRESS THIS APPLICAI�TT IS: PROPERTY OWNER/ TENANT ', CONTRACTOR �i'. SUBMIT � COPY OF i YOURSTATE LICENSE V,'ITH t A�PLI�.�"IL�iV PERMIT TYPE TYPE OF WORK: � PLUMBING RESIDEN'TIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS O OWNER �NTRACTOR STA' EXP DATE �� Pernut No.: Received By:� Date Rec' d: ( � ' AD�� A�, ��1 C��. CITY STATE ZIP � ..n ��e -v-ea PHONE � � �,-�:� F� _ - — -- - �IGLE FAMILY ❑ NEW DETAILED DESCRIPTION OF WORK ❑ TWO FAMILY ❑ TOWNHOUSE `�PLACEMENT PER MS 16B.66� 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 =$15.00. 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 WI�RE NOTED. FlXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV� BATH SINKlLAV _FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING R+�'o crrruc�s� SWIMMING POOL WATER SOFTNER ($35) CLOTHES WASHER KTfCHEN SINK WATER CLOSET _BACKFLOW PREV. ($15) DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION — WATER METER OTi�R Permit Fee TOTAL DUE $ �0� _. , Number of fixtures @ $10.00 x $10.00 = $ .50 Number of fixtures @ $15.00 x $15.00 = $ $ . -r°j� Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Tota1= $ 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 a Gork +' h requires review and approval of plans. SIGNATURE OF APPLICANT a PRINTNAME i S� 01�b'1 DATE `�s �� — ---�,l�j' O� �Y'1(��- — -- Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 �✓ HOUSE HEATING TEST RECORD ADDRESS �� s �� APT. LOOR CI SUBUR � OCCUPANT OWNER � �� '� -- HEAT LOSS DATE HTG. INST. GAS C0. METER BAD SOLD BY INSTALLED BY + �� - �- Elsetrical Work By Gaa Line By TYPE OF HEAT GA FA ��HW STEAM SPACE HTR. UNIT HTR. OTHER G DESIG � CONVERSION MAKE MAKE OF BURNER Model �' /� Modsl Ssrial �s�-2 � � �� Max. BTU Rating INPUT ��% MAKE OF FURNACE Model CONTROLS �9 THERMOSTAT T�/��' Heat Plug Vsnt Size Valve �l�z�� KIND OF LINER E NONE Limit -� ��'6y� Draff'Hood ��/' Regularor Limit,5stfing �'�' Filters Size �lumber Fan' Setting _T ,� �!�� Chimney Loeation (nside � Outaide Pilot Type �r/ Chimney Construction Pilot Make ' -�� Pilot Model �.'�-2 r� �� Smoke Bomb �jJ� Wiring �� Pilot Timing ��-�'o Draft ��°`-- Test Tag `� L.W. Cut Off Door Pressuro Lighting Inst. � Prsasure •� Psreent CO2 Dote Teated '��— �� Input CFH �� Perunt OZ • Company Testing Stack Tsmp. ;��-`� Percent CO �� Name of Tester �� Form 235 � �uilding rn.spections 763-572-3604 ,�� 30 0 >�� aDDxESS ' = HIS APPLICANT IS: �R�t ERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERNIIT TYPE �rYrE oF woux: BUILDING Pernut No. RESIDENTIAL APPLICATION Received By: CITY OF FRIDLEY Date R�� MAY - 2; YOUR E-MAIL ADDRESS J�o d � s cD G�c�� r,i.�ne s o� � .�1 4�- xr�- ❑ OWNER C�20NTRACTOR C�7 �� i N��— The Home Depot A.H.S. Inc. sTA� Lic 3200 Cobb Galleria Pkwy. .a�Dx�ss: Atlanta, GA 30339 PHONE '763-542-8826 �o A License #20268257 QADDTI'ION ❑ GARAGE/SHEI � BASEMENT FINISH ❑ ROOF 0 DECK ❑ SIDING ❑ SWIIvIIvIIIQG PC 0 NEW 1�!p Ib 0 ADDTITON CZb�IAWTEI�ANCE�P� � REMODELING �ESCRIBE wORK BEING DONE: >IZE OF IMPROVEMENT dCJMBER OF SQUARES _ �ARAGES �ROPOSED SIZE: 'ROPOSED HEIGHT: LENGTH ❑ HOUSE ONLY 0 HOUSE & GAR.AGE ❑ ATTACHED GARAGE ❑ DETACi�D GARAGE CITY Ar�i� S S4 37 �rsa j 3ks� Lay7 - - - cTfl' STATE ZIP �E _ .'ORIES �1�ows ❑ DRAW TILE ❑ OTHER Y�� b o,D r11Cy aJIDTH HEIGHT S . Ft BASENID�TT REMODELWG SUBMIT• 1. Existing Floor Plan 2. Proposal floor plan 3. List of s�tructural members to be used �TDING FOR NEW CONSTRUCTTON IIJCLUDING DECKS, 7 Vinyi ❑Soffit ,ADDITIONS. & PORCHES SUBMIT• �� T� 1. Site Plan/Survey showing the existing structvres 7 Oti�er ❑ Fascia and proposed project F'INDOWS I 2. Two sets of construction plans V EXIST'ING OPENINGS f]-SFcs ONo L(?CATION OF WINDOWS b AT�I rd Of1') 3. Energy Calculations >R FOR NEW OP�TINGS-DESCRIBE SIZE OF >PENIIJG CHANGES & 'YPE OF WII�TDOV✓ TO BE INSTALLED D� NUMgER OF WII�IDOWS I ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIAI,S; (LTSING THE 1997 U.B.0 FEE SCHEDITLE) TOTAL JOB VALUATION $_ � 1 V� � pC�p�Cy TypE ermit Fee Ian Review urcharge ire Surcharge icense Surcharge AC Charge 'urb Cut Escrow rosion Control ark Fee ewer Ma.in Charge 'otal Due O $ .,� $ .6A $ 5 ,00 $ $ $ $ $ $ � .��., - See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valnation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: Citv of FridIev Atfarh THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII. PROCESSED hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in �nformance with the ordinances and codes of the City of Fridley and with the Minnesota. Construction Codes; that I understand this is not a �rmit but onIy an applicatzon for a permit and work is not to start without a permit; that the work will be in accordance with the approved ian in the case of all� rk which re u�eview andapproval o€plans. GNATURE OF APPLICANT � pRINT NAME T m 5� h a n k DA�_ �( a o l o� Page 2- Building Residential Application BUII�DING PERNIIT FEE SCHEDULE The Chief Bu.ilding Official shall, before issui.ng permits for the erection of any building or structure, or for any add.ition to a.ny ea�isting buildi.ng or s#n�.cture, or for -any a1��ration or repaar to any existing building or structure, upon application therefore, require the payment by the applicant for such perm.it 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 min;mum of 24 hours from the time of application to allow for proper review of proposed siructure an.d of the construction site. A Certificate of Survey of the lot, showing the location af the e�sting foundation will be required before proceeding with the fram.ing. New Houses Onlv City of Fridley Building Inspections Deparlanent 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 Building Inspections 763-572-3604 �ATE � SITE ADD S _� THIS APPLICANT IS: PROPERTY OV4'NER/ TENANT CONTRACTOR sc.rB�r A corY oF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERNIIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY O O YOUR E-MAIL ADDRESS > b r /�/� L�. 5 /�- 0 ownrEx �cot�rx�croR N�: L. �' �� Z ADDRESS: .� �0 es' i�i, h► L L ,_, PHOIdE:�� ? g � Q � � � NAME:�O p �► .� STATE LICENSE # % � annx�ss: � _ �„�,, �n� �,� � PHONE �6 � — %�' EL :90/Z FAX ❑ BASENlENT FWISH ❑ DECK u DESCRIBE WORK BEING SIZE OF IlvIPROVEMENT NUNBER OF SQUA1tFS � GA�AGF.S PROPOS£D SIZE: PROPOSED HEIGH'f: SIDIIVG ❑ V'myl ❑ Alumintun ' ❑ Otfier . �tOOF ❑ SIDING � �HOUSE & GAR.AGE ❑ ATfACHED GARAGE ❑ DEfACHED GARAGE Permit No.: Received By: Date Rec' d: AT�! ZIP�� DATE �CITZ' � ! STA'f�ZIP� Z ❑ DRAW TILE ❑ OTHER HEIGHT BASER�M' REMODELING SUBMIT• 1. Fxisting Fioor Plan 2. Proposed fl�r plan 3. List of shuc�ral members to be �sed F� FOR NEW C,ONSTRUCT70N lNCLUDING DECKS, OSoffit � ADDITIOAIS 8c PORCHES SUBMTT• ❑ T�" 1. Site Plan/5urvey showing tlie existing strucwr� ❑ Fascia �1 P�� ProJ� WIIVDOR'S 2. Two sets of conshvrdion plans 1N E}QSTING OPENINGS �Yes ONo L�A110N OF WD�IBOWS 3• E"e�' Calculatiort� OR FOR NEW OPENINGS-DESCRIBE StZE OF OPENING CHANGES & � TYPE OF WIIQDOW TO BE INSTALLED NUMBER OF�WIIdDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee - Plan Review Fire Surcharge S�uchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Chazge Total Due $ $ $ - � .��C� $ $ $ $ $ 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) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= $x$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable tor City of Fridlev Attach THIS IS AN APPLICATION FOR A PERMTf NOT YALID UNT[L 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 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 ch requires view and approval of plans. � , SIGNATURE OF APPLICANT �� pRINT NqME Dq.I,E �// %/ "1 t� � .1`O Page 2- Buildi.ng Residential Application BUII.DING PERNIIT FEE SCHEDULE The Chief Building Official shall, before issuing permifs for the erection of any building or s�fructure, or for any a.d.dition to any existing building or stru.cture, or for any alteration or repair to any existing buildi.ng or stru.cture, upon application therefore, require the paymeni by the applicant for such permit of fees to ihe amoun.t herein below set forth and i.n th.e manner herein provided to-wit: VERIFICATION OF FOUNDATION Pemuts for constructi+�n will be issued a minimum of 24 hours firom the time of application to allow for proper review of proposed structure and of the constructi.on site. A Certificaxe of Survey of t�e lot, showing the location of the existing foun.da.tion will be required before proceeding with the framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 3uilding �nspections f 63-572-3604 �:�� t-1 l `I � � �ITE ADDRESS _� i HIS APFLICANT IS: i'RO-PERTY OWNER! TENANT CONTRA.CTOR SUBNIIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROFERTY TYP� PERMIT TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY u� S ❑ OWNER L3e�iTRACTOR .� I ,llinn tG A � - (� �' N��— The Home Depot A.H.S. Inc. sTA� uc 3200 Cobb Galleria Pkwy. anDx�ss: Atlanta, GA 30339 PHONE '763-542-8826 ❑ sINGr� License #20268257 ❑ TWO FA QADDITION ❑ GARAGE/SHEI ❑ BASEMENT FINISH 0 ROOF � DECK ❑ SIDING �rE oF woxx: o � a ��scx�E woxx BEII•rG >IZE OF Il��PRUVEMENT dUMBER OF SQUARES '>ARAGES 'ROPOSED SIZE: 'ROPOSED HEIGHT: ;IDING � Vinyl ] Aluminum ] Other 5'INDOWS "1 EXIST'ING OPENINGS Li�es �No )R FOR NEW OP�TING&DESCRIBE SIZE OF >PENING CHANGES & ❑ SWIIvA�JG POOL � ❑ HOUSE ONLY 0 HOUSE & GARAGE � ATTACHED GARAGE ❑ DEfACHED GARAGE �Soffit ❑ Trim ❑ Fascia LOC TION OF WS �4'St i*t e n Permit No.: Received By: en�s.co� ,5Sk3� d� ��litP �l 34S-Go�7 CI'TT' STATE ZIP ❑ DRAIN TILE ❑ OTHER 1'ri�l� M* Ft. BASEMEI�TT REMODELING SUBNIIT• 1. Existing Floor Plan 2. Proposed floor plan 3. List of siructural members to be used FOR NE9J CONSTRUCTION 1NCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT• 1. Site Plan/Survey showing the exis6ng shvctures and proposed project 2. Two sets of construction plans 3. Energy Caiculations YPE OF WII�TDOW TO BE INSTALLED D C'� NUMBER OF WII�IDOWS 3 I ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (ITSING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION � a � 0 0 pC�p�Cy TypE 'ermtt Fee 'lan Review urcharge ire Surcharge .icense Surcharge AC Charge :urb Cut Escrow :rosion Control ark Fee ewer Main Charge 'otal Due $ L4. � $ � �. ou $ � . b l� $ '�'. D Ci $ $ $ $ $ $ z i. � s See Back Page for Fee Schedule 6S% of Building Permit Fee (.0005) iimes the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridlev Attach THIS IS AN APPLICATTON FOR A PERMTf-NOT VALID UNTIL PROCESSED hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in �nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a ermit but only an application for a permit and work is not to start without a pertnit; that the work will be in accordance with the approved lan in the case of all work wluch requ' s review andapprovat ofplans. JNATLJRE OF APPLICAN'1��Z�� PRINT NAME ' I/"� � L�� 1� �` DATE_ 1 l l�� V$ Page 2- Building Residential Application BUILDING PERMIT FEE SCHEDULE The Chief Buildi.n.g Official shall, before issuing permits for the erec�ion of any buildi.n.g or .structure, or for any ad�.ition to a.ny �isting buildin.g or structure, or for �xy a1��ration or repair to any existin.g 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 man.ner herein. provided to-wit: VERIFICATION OF FOUNDATION Permits for constru.ction will be issued. a min;mum of 24 hours from the time of application to allow for proper review of proposed structure and of the constru.ction site. A Certificate of Survey of the lot, showing the location of the existi.ng foundation will be required before proceeding with tb.e framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 � uilding ' nspections �63-572-3604 �a� L'r 1 � 0 �i7'E ADDRESS �IIS APPLICANT IS: �'R�t ERTY OWNER/ TENANT , CONTRAC'TOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUYLDING RESIDENTIAL APPLICATION CITY OF FRIDLEY PermitNo.: �t�Uq-oU Received By: ,Nl ' Date �� J U 1 g� E�L.,�D�S __�od�sa��1�,r�on�s.rvr� �m � OWNER �EONTRACTOR Pxoi•rE: `i 4 3��i $�! - � 5 2� N,6,i„�: rHD At- Home Services, Inc. sTa� r�c 2690 Cumberland Pkwy, Ste 300 ��5 Cumberland Office Park PHONE Atlanta, GA 30339-3913 �G� Lic# 20268257 Ph. 763/542-8826 ❑ TWO FA � ❑ ADDITION � GARAGE/Sf ❑ BASEMENf FINISH ❑ ROOF ❑ DECK ❑ SIDING ❑ SWIIvIIv1II•1G � 3ESCRIBE WORK BEING >IZE OF IMPROVEMENT - dUMBER OF SQUARES _ 7ARAGES 'ROPC?SED SIZE: 'ROPOSED HEIGHT: �IDING ] Vinyl ] Aluminum ] Other ��nvnows 1 EXLSTATG OPENINGS}�Yes pNo �R FOR NEW OP�IINGS-DESCRIBE SIZE OF >PEIIING CHANGES & YPE OF WINDOW TO BE INSTALI Fi� DI �CE/REPAiR 0 REMODEL w�c�elow t`Q� lor�m� LENGTH ❑ HOUSE ONLY O HOUSE 8c GARAGE 0 ATTACHED GAR.AGE � DETACI�D GARAGE �Soffit ❑ Trim ❑ Fascia LOCg ,TION OFw�o WS LSASl1YUl� T' ' NUMBER OF Wirmows 3 CITY ��1 ��t V STA"TE��ZIP�sk3% Jod� � F d�r Jbn< s qSa t 3Y5- (.O y � CITZ' STATE ZiP ❑ DRAIN TII.E ❑ OTHER t�, z ��n a o��cnr � WIDTH HEIGHT BASENIENT REMODELING SUBNIIT• 1. Existing Floor Plan 2. Proposed floor plan 3. List of strucinral members to be vsed F� FOR NEW CONSTRUCTION 1NCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT• 1. Site Plan/Survey showing the existing siruclnres and proposed project 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MA (L7SING 1997 U.B.0 FEE SCHEDLTLE) _ TOTAL JOB VALUATION $ �� ,3 OCCUPANCY TYPE ermit Fee 'Ian Review urcharge ire Surcharge icense Surcharge AC Charge :urb Cut Escrow rosion Control ark Fee ewer Main Charge 'otal Due $ G q. � 5�' $ � _ 4 �— � / 47 $ � ,. p o _$ $ $ $ $ $ —� Z. 2� See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/14%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTIL PROCESSED hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in �nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a �rmit but only an applicaxion for a permit and work is not to start without a permit; that the work will be in accordance with the approved ian in the case of all work which requires review an ap rovaf o€plans. GNATURE OF APPLICANT P NAME � I M S� �/� 1C DATE �� l� O—/ Page 2- Building Residentia.l Application 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 stru.cture, or for -amy a1�-eration ar repair to any e�cisting building or structure, upon application therefore, require the payment by the applicant for such permit of fees to ihe aznoun� herein below set forth and in the manner herein provided to-wit: VERIFICATION OF FOUNDATION Permits for construction will be issued a m;n;mum of 24 hours from the time of application to allow 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 fram.ing. New Houses Onlv City of Fridley Building Inspections Depariment 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fa�c: 763-502-4977