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PRE 2010 DOCSSUBJECT ERMIT N City of Fridley ®Q266, AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT N COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION + Ir/ r SEC. 1 � � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 8/7/74 JOB ADDRESS 323 Logan Parkway N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 17,18 1 Oak Creek Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE William A. Nelsen 323 Logan Parkway N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK K NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 12' x 23' Garage 9 CHANGE QF USE FROM TO STIPULATIONS Provide a hard surface driveway. Neighbor and owner in agreement on where lot line is located, agreement signed.. FO�t WRING, PERMITS REQUIRED SEpERATE WD S"Gt4& H EATING, PLUMBING TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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, $1,462.80 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .75 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $5.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE it $5.75 GNATURE OF CO ACTOR Urrlo DAGENT ( ATEI WHEN PROPERLY VALID D T S YOUR PERMIT V7(2'e --e� SIGNATURE OF OWNER IIF OWNER BUILDERI ID TEI BLDG INSP DATE APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAM: /►1 ZY�5 BUILDER: '5� ADDRESS: D /� 2�ll. Y ADDRESS: NO • STREET: .LOT: / l� BLOCK: � ADDITION: *4 CORNER LOT: INSIDE LOT: %/ SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: G �AZAZ< Front: ' Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: /a/ Square Feet; Cubic Feet: Of Type of Construction: 440 TA'h'►"e Estimated Cost: $ �� yZ• To Be Completed: / R14-4 The undersigned hereby makes application 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 Buildings, and hereby declares that all the facts and representations stated in his application are true and correct. DATE: / SIGNATURE: (See Reverse Side For Additional Information.) -7 7 4 owner of the property located at O ,� have no objection to the City allowing the construction of a �� —� to be located at 3-7 without the required certificate of survey that the City ordinarily requires for all new construction. Signed Address Date s - 3TC�///� Witness • r r • r, N City of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT PER • ____ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 1 . i CITY HALL FRIDLEY 55432 j612-571-3450 NUMBER 910-F156/28/8 TREv DATE PAGEOF APPROVED BY JOB ADDRESS 323 Lo an Parkwa 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 17 1 Oak Creek SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Wm A Nelson 323 Iogan Parkway 571-1928 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ® REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK repair roof 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. asnhalt ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 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. 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 SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 400.00 .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 15.00 PLAN CHECK FEE TOTAL FEE 15.50 SI NATURE OF CONTRACTOROR AUTH['yRIyZEED AGENT (DATE) (� EN PROPE LYI� TH IS YOURPERMIT SIGNATURE OF OVNER OF OWNER BUILDER) (DATE) BLDG INSP DATE CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDCNTIAL BU1LDIIG PE•MITS (New, Alterations, Additions, or Repairs) P -- ADDRESS: -311 TEL 110:7 /- jig BUILDER: ADDRESS: TEL NO: Construction Location STRITT NO: �_ _ STREET: I-V LOT: . BLOCK: -/ ADDITION : 0 Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Roos Qoat11 Front: Depth: Height: QC.. t*1%jCL/Z3 Square. Feet_ Cubic Feet: Front: Depth: Height: Square- Feet: Cubic Feet: Type of Construction: Pooh Qvcpcj% L Tb Be Completed: Proposed Driveway Width If New Opening Is Desired: Estimated Cost: Alt. A Alt. B SEE REVERSE SID£ OF SHEET . Me undersigned hereby makes application for a permit for the work herein specified, agreeing to co,all work in strict accordance with the City of Fridley Ordinances and rulings of the Delprtment of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE:' SIGNATURE: Stipulations: p�-•�: 15.0ej TIX ;GO Effective Date May 1, 1988 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. . Type RATE TOTAL $ 5.00 $ 3.50 $ 1.50 S 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 Job Address 323 NE Logan Pkwy Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a Permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 17 Mar 89 , 19 OWNER Wm, A Nelsen #571.1928 KIND OF BUILDING Fr USED AS Res TO BE COMPLETED ABOUT 17Mar ESTIMATED COST 350, OLD - (}(BUILDING PERMIT NO. PERMIT NO. /c.232 $ ' .s $ Signed By�,� $ $ Tel. No. Uinneggasco *342-5337 $ 700 W. Linden Avenue $P. 0. Box 1165 $ ROUGH INSP. Date jnne--�nniis. MN 55440-1165 S $ FINAL INSP. Date S �s_nn d J $ APPROVAL'°F6R-R1 1 / '9 Yes ( ) No ( ) S 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance Reinspection Fee $ State Surcharge ($15.00) TOTAL FEE MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE O WaterNCO Novm e •Q r u m N 0. "�a'� Heater .i 0 : m !(.i w p [ K H O O -4 :5 N mt u C U � tn 13 w tJtq Wp u 4HOro 3a�'i Vu O s Elec 1st 1 2nd 3rd 4th (R) Future Connection Opening Connected with Sewer (�) New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. . Type RATE TOTAL $ 5.00 $ 3.50 $ 1.50 S 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 Job Address 323 NE Logan Pkwy Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a Permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 17 Mar 89 , 19 OWNER Wm, A Nelsen #571.1928 KIND OF BUILDING Fr USED AS Res TO BE COMPLETED ABOUT 17Mar ESTIMATED COST 350, OLD - (}(BUILDING PERMIT NO. PERMIT NO. /c.232 $ ' .s $ Signed By�,� $ $ Tel. No. Uinneggasco *342-5337 $ 700 W. Linden Avenue $P. 0. Box 1165 $ ROUGH INSP. Date jnne--�nniis. MN 55440-1165 S $ FINAL INSP. Date S �s_nn d J $ APPROVAL'°F6R-R1 1 / '9 Yes ( ) No ( ) S 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance Reinspection Fee $ State Surcharge ($15.00) TOTAL FEE MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE V It/ SUBJECT IT NO." - City of Fridley Q 25 3 8 9-_.- AT THE TOP OF THE TWINS BUILDING P E R M I T - r �• REPT NO. ______ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. A / �I r NUMBER REV DATE ;1P,AGE OF APPROVED BY CITY HALL FRIDLEY 55432 j 612-571-3450 910415 8/19/9T - JOB ADDRESS JOB 323 Lo an Parkwav NE ' 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 17 1 1 1 Oak Creek Addition"" SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE William/Marie Nelsen 323 Logan Parkway NE 571-1928 3 CONTRACTOR MAIL ADDRESS Same ZIP PHONE LICENSE NO 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ 'NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 22' x 32' Garage Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Provide a hard surface driveway. P till taqIriG Lf�� E Ifo ,.r a digging calf for 30 -9'7 r 1�� all utility locations CC 454.0002 EPARATE TE PCRMITS `REQUIRED BY LAVE/ WIRING, HEATING, R�QU11RED FOR p LU g1N�. AND S1�N5. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL; PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF, -WORK OR CONSTRUCTION ZONING SQ. 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 COMMENCE=D. NO. DWLG. UNITS OFFSTREET PARKING IHEREBY CERTIFY THAT I HAVE,4AD AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUfE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIOHEREIN OR NOT. THE GRANTING OF A PERMIT $13,016 $6.51 ' DOES NOT PRESUMErTO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF 40 OTHER STATE OR LOCAL LAW REGULATING CON- Fire SC $13.02 STRUCTION OR- HE PERFORMANCE OF CONSTRUCTION. $212.25 PLAN CHECK FEE TOT FEE 231.78 N EOF�ONTRAAUTHORIZEDAGENT (DATTE,N OPE ALIDA THIS IS V UR PERMI r BLOt INSP riaTE BUILDER] (DATE] V It/ NEW ( ] ADDN CITY OF FRIDLEY ALTER ( ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: L NEl �Spw cl Owner Name &Address: rv% �� 2 Ivo � � Tel. # t �" � o A Contractor: ZS Q - MN LICENSE # Address: GL Yy', e-- Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF Il"ROVEMENT Satm e— LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: OAA Length�.� Width 7; Height t 0_ Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: ra V -r- E! Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = —Ft.x $ _ $ 8 DATE: ?7 APPLICANT:. Tel. # cep Permit Fee $ 2, 25�- Fire Surcharge $ State Surcharge SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ :�9 f, iy STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $950 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 ( ] MEMORANDUM PLANNING DIVISION DATE: September 30, 1997 TO: Jean Michaels, Accounts FROM: Scott J. Hickok, Planning SUBJECT: Refund of Building Permit Fee 31�19 /: Luff CR-19--Vl� William and Marie Nelson, 323 Logan Parkway NE, have requested a refund of their building permit fees. Upon receipt of the Nelson's permit, it was discovered that the Nelson's garage would require a variance. The Nelson's evaluated their options and decided not to build. No building inspections occurred. Therefore, Nelson's request is for a refund of $231.78. This amount breaks down in the following manner $212.25 permit fee, State surtax $6.51, and Fire surcharge $13.02. SUBJECT P City of Fridley 2 610 AT THE TOP OF THE TWINS BUILDING PERMIT t ` RECEIPT NO. `U - _ __ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 9-3/ r I � NUMBER REV DATE PAGE OF APPROVED BY I = 0.-1 CITY HALL FRIDLEY 55432 ,', 612-571-3450 910-F15 6/1/98 JOB ADDRESS 323 Logan Parkway NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 17 1 Oak Creek Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE William/Marie Nelsen 323 Logan Parkway NE 571-1928 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO, 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Cj REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (30 Sq) Tear—off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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. DWLG. U141TS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS 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 @ $1.25 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,502 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- Fire SC $2.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $74.75 PLAN CHECK FEE TOTALFEE $78.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERL LIDATED THIS IS YO R PERMIT 011 BLDfi INSP e �� GATE SIGNWRE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 10 BUILDING PERMIT APPLICATION a ConstructionAddress: o c� Saco �;'- Legal Description: Owner Name & Address: @ A- r,%- Ver; e c� ti 9A S 2 VA Tel. # s 7 Contractor: S eA MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: ®off ii-0QLS e 30=' & eq _r o �� Construction Type: Estimated Cost: $� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: Cn —k —T� APPLICANT: Tel. # S 71 R / CITY USE ONLY Permit Fee $ ��7 , Fee Schedule on Reverse Side Fire Surcharge $ 0 .001 of Permit Valuation (1/10th%) State Surcharge $ Z, $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary00 [ ] TOTAL $ C, 44 ) STIPULATIONS: CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1,1999 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS Qy u_)a RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - Also Replacement Furnace 30.00 �4 0 rulings of the Building Division, and hereby declares that all the facts and $ $ representations stated in this application are true and correct. (Side Vent - Fill Out Back) 4 -. , } Gas Piping (Needed with new furnace, $10.00 $ but not replacement) OWNER__ Gas Range. $10.00 $ BUILDING USED AS YcJ-IS 1" c( ev1c •� Gas Dryer $10.00 $ ESTIMATED COST gro PERMIT NO. /3 *Air Conditioning - All Sizes $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (UST ON BACK) 1% of Value of Appliance or Work $ No. of Heating Units f Circle One (Steam) (Hot Water)(Warm Air) Trade Name (Arrt e r Size No. -S Commercial/Industrial b��-"( BTU T ,00 o HP EDR 1.25% of Value of Appliance or Work $ Fuel Cka S. Total Connected Load State Surcharge $ .50 Burner Trade Name TOTAL FEE $ SS •9b MINIMUM FEE FOR ANY HEATING/COOUNG/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr BTU X17 Size No. EDR HEATING COMPANYP0LP_rLC(4v\ `V Ic�'` AC, U Signed AVV4P&4�, Tel NO'L 1gez b..J - Approved By Rough -In Date Final Date M4/4e/7 *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE written permission from adjoining property owner. CHAMY AND STACK VERIFICATION The undersigned. hereby verifies that the existing chimney or stack: L Has been carefully examined Yes (.) No ( ) 2. Is free from rust or deterioration Yes () No (. ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Building BUILDING Permit No.:'2-0 10' Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date 763-502-4977 FAX 4 EFFECTIVE 1-1-2010 zu DATEp.t.- 2 O/D YOUR E-MAIL ADDRESS SITE ADDRESS Q y) �A-t- L j W THIS APPLICANT IS: ❑ OWNER ONTRACTOR PROPERTY OWNER/ NAME: M, %I/, -s .62 e 5-el� TENANT ADDRESS: -CITY STATE ZIP PHONE: CONTRACTOR NAME: b rV SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE #0 EXP DATE 71 / v AND CERTIFICATE OF ADDRESS: �� /7— hP Cly n p �� 1i' STATE?)PS�� INSURANCE PHONE FAX PROPERTY TYPE -0-sINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYNEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminqu❑Trim 1. Site Plan/Survey showing the existing structures and proposed ❑ ❑ Fascia project 2. Two sets of construction plans WINDOWS IN EXISTING OPENINGS IXYes ❑No LOCATION OF WINDOWS 3. Energy Calculations FOR WINDOWS - PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & J TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE TOTAL JOB VALUA' Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due ON 4VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: CJ�) ) THE 1997 U.B.0 FEE SCHEDULE) 10 (J OCCUPANCY TYPE $ 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) $2100 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach 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 Ci of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a pe an w is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of c view and approval of plans. %% C SIGNATURE OF-APPLIC PRINT NAME J;/I W DATE /%11.4 �� ZO16