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PRE 2010 DOCSI Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices J. PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3480 GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... $10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ............. .... 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ f ®1 O each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam .... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTL) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 200 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL $ See Fee Schedule TOTAL FEE $�� City of Fridley: The undersigned hereby makes application for a permit for the work hereir. specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application aretrueand correct. / r Fridley, Minn_ 16), Owner Kind of Building Used as To be completed about Estimated Cost, $ Old—6 Building Permit No. �ro %� Permit No. 1042674 DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water,Air—No Trade Name ,,r/L��r Size No- Capacity. o Capacity Sq. FL E.D.R BTU �DS H.P. Total Connected Loa Kind of FueL. BURNER —Trade Name Size No Capacity Sq. Ft. E.D.R. BTU H.P. (REMARKS—OVER) Siga 2936 FOURTH AVE. SO. . TA. 3.5287 ae Busin",q-; 1 Ri1,qo City of Fridley Application for Plumbing and Gas fitting Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ....... .............. x $2.00 $ Future Fixture Opening ................ x $1.50 $ Z go N 18 W <3 �� W �� Z �p + F ` N WATER HTR. GAS ELEG Base ®Ci 3, Water Heater (Up to 99,000 BTU) ...... x $3.00 $ J x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL l Z 1st o0 �' 1st 3 Fixtures .......................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ 2nd 3rd 4th • Future Connection Openings * New Fixture, Old Openings I Connected with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ....... .............. x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ...... ..................... x $3.25 $ ®Ci 3, Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg. ............ x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL Z o0 �' 1st 3 Fixtures .......................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ..................................... $� ........... TOTAL FEE $�_ City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the facl and representations stated in this application are true and correct. Fridley, Minn- 2' " -d2 '�'— 6 Q - —19(.8, 19%8, Owner U -`f- � Kind of Building Used as To be completed about Estimated Cost, $ OW New. uilding Permit No- Permit N ----k-5 Signe o-k- ROUGH FINAL 42 Signe Business Phone No City of Fridley, Minn.. N° 9618 BUILDING PERMIT 41109,1 Date: Feb. 26, 1968 owner: Chester Maciaszek Builder Sam Address6380 Quincey St. N. E. Address Same 210 LOCATION OF BUILDING No. _____ Street _ Longfellow St. _ Part of Lot Lot 21 & 22Block 3 Addition or Sub -Division .�_ Spring Brook Park Corner Lot -- x Inside Lot ^ Setback 35 _ _ _ Sideyard _ 10' & 22,;;' Sewer Elevation _ __ 8� 9 3 '7 " 3 9 l O fd o Fn 'X - DESCRIPTION OF BUILDING To be Used as: Dwelling Front +2732-' Depth 40' Height 20' Sq, F, 1100 Cu. b t, 22000 Front Depth ____ Height _ Sq. Ft. ____ Cu. Ft. Type of Construction Frame Est. Cost ^ $15, 000 To be Completed 90 Days i OF %))/q,oY-i In consideration of the issuance to me of a permit to construct the building described above I agree to do the proposed work in accordance with the description above 8�� orlh and gompll ce with a'll provisions of ordinances of the city of Fridley. `i / ion In consideration of the payment of a fee of $ 33.00 , permit is hereby granted to Chester Maciaszek to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, is all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildtnga Vthe dty limits and this permit may be revoked at any time upon violation oof the provisions of safd ordinances. NOTICE: This permN does not cover the construction, Inift tion for wiring, Plumbing, gas heating, sewer or wabr. Be sun to sae the Building Inspeetor for separate permits for these Nems. AFPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA. _B'_ ILDER ADDRESS�Q ADDRESS _ .L:! - LOCATION OF BUILDING No. STREET t; 4:'I ---A 4 d L� LOT I t 2 BLOCK 3, ADDITION OR SUBDIVISION 5P12/N& COMB, LOT i% INSIDE 'LOT SETBACK .aS - SIDEYARD /0 SEWER ELEVATION _ TOP OF FOOTING 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: y--FrontlL Depth 410 - Height Squard feet // Cubic Feet ..Front Depth Height Square feet Cubic Feet' Type of Coustruction�vd OP f -4A A -If . Estimated Cost • To Be Completed ! O P The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict 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 this application are true and correct. '' 7 DATE'k4 Cg/v / e - Sr SIGNATURE a _ (Schedule of Fee Costs can be found on the Reverse Side CJU..e* 94otum a►id (4ssoecates, One. 10731 MISSISSIPPI BOULEVARD N.W. COON RAPIDS, MINNESOTA Certificate.of Survey: Chester Maci aszek 1 d LONG T. FELLOW 5 A�LLE Y (NOT 0FEtiEID� Lots 21 and 22, Block 3, Spring Brook Park Anoka County, Minnesota LAND SURVEYORS Telephone 421.6340 1980-147/45,72 W Z ` IJU F a .I d) --� DENOTES IRON I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE ABOVE DESCRIBED LAND, AND THE LOCATION OF ALL BUILDINGS, THEREON, AND ALL VISIBLE EN- CROACHMENTS, IF ANY, FROM OR ON SAID LAND. AS SURVEYED BY ME THIS ....... 1.1.1.h...DAY OF......4gt4be!"........................A. D. 19.... N. C. HOIUM AND ASSOC ES, C"' LAND SURVEYORS M. ...................... ......... ...n .................................................... Application for Power Plants and Healing, Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... $10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water . ................ 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ O over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 200 $ 1-700 Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL See Fee Schedule TOTAL FEE $ �� Dept. of Bldgs. Phone SM -3480 / O City of Fridley: The undersigned hereby makes application for a permit for the work hereir. specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application �aar�'ree true and correct. Fridley, Minn �j, e&t,/° Z 19 Owner Kind of Used as To be completed about Estimated Cost, $ -5--2_0,00 ` ld Oew Building Permit No. �/n?/� Permit No. --,Ye -7 o6 DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, W4; Air—No./�L� Trade Size Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel BURNER —Trade Name Size No Capacity Sq. Ft. E.D.R I BTU H.P. (REMARKS -OVER) signed Niels n Gass Heat 4e Business Phone No 722-1961 D-36 a 8 f vv HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTION,,! Weatherstrips A.S.H.V.E, Construction No. Guide Ml\lEA OUS, i�Jll�lr. Insulation f Windows Doors Referent ut. Wall Int. Wall Ceiling Roof Floor Kind How --Applied YesNoYes—No 19--j 1 Fl Room I Length Width Height ly Fl. oom I Length 140`0 Width j Height Windows a oors—Crackage and Area Windows and Doors—Crackage and Area Width eight No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width No. of pane Height No. of Lineal ft. of pane Tights of crack Area sq. ft. & / i, q- 16/ 1 1z Coef. Btu Infiltration 4461 40A90 Infiltration Glass o Glass V116a Exp. wall t Exp. wallNet exp. wall 0 Net exp. walls Int. wall+ // j' Int. wall Ceiling Ceiling Floor Floor Total Btu.. Total Btu. Required sq .R. or sq. ins. W.A. Leader are:,eoe Required sq. ft. E.D.R. or sq. ins. W.A. Le der area F1.1 �. Room I Length Width C9 Height F1.1 oom I Length Width Windo s and Doors—Crackage and Area Windows and Doors—Crackage and Arm Width Height No. of Lineal ft. Area Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. No. of pane of pane lights of crack sq. ft. /410 16 / /Pew Infiltration Glass Exp. wall / t') a ' Net exp. wall Int. wall Ceiling Floor Total Btu. Require,A sq. E.D.R. or sq. ins. W.A. Leader a Fl. oom I Length I / Midt Windows and Doors—Crackage and Area Width Heighanet No. of Lineal ck aq: ft. tt. Area No. of pane lights of cra of p Infiltration Glass Exp. wall T11 Net exp. wall Int. wall Ceiling Floor Total Btu. Btu ? 67 Glass Exp. wall 0 96 Net exp. wall Int. wall z.$ -S'— ,/ 7 t-471 Ceiling Floor Btu z l,Fr Total Btu. .001Z I"® T Required sq. ft. E.D.R. or sq. iris. W.A. ad a e Fl.l . m I Length Width �' Height Windows and Doors—Crackage and A ea Width Height No. of Lineal ft. Area No. of Wane of pane lights of crack eq. ft. Coef. Btu 116 Infiltration Glass Exp. wall 1.-0 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Btu 14ed Net exp. wall Int, wall -0, Ceiling Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. der area City of Fridley, Minn. BUILDING PERMIT Date: May 20, 1968 Owners — Chester Maciaszek Builder Same Address 21-OLLongt'ellow Address Same t� LOCATION OF BUILDING No. 215..-- Street _ Longfellow --- Part of Lot Lot 21 & 22 Block 3 Corner Lot ---- Inside Lot Sewer Elevation Addition or Sub -Division — Setback Sideyard Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Cage Front 22' Depth 262 Height 10 Type of Construction Front Depth _ _ Height ._.. Est. Cost A1 ,200.00 X9 9'744 sq. Ft 572 Ca. A 5720 Sq. Ft. — Cu. Ft. To be Completed 30 Days In consideration of the issuance to me of a permit toc the buildingdescribed above I iagree to do the proposed work in accordance with the description ab ov set f and mp ance with a& provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 9.0 , permit is hereby granted to Chester ma, oia.-,7ek to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmena in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Ridley, Minnesota limits regarding location, construction, alteration, maintenance, repair and moving v of b of said w thi tithe ty this permit may be revoked at any time upon violation of any of the pro & ac4ung Inspector Fil a.rP-n .e Rel i -0 NOTICE: This permit does not cover the construction, Installation for wiring, plumbing, ea heating, s wor or water. Be sero to see the Building Inspector for separate permits for those Nome. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MIk=SOTA OWNER'S NAME -,_BUILDER ADDRESS / 0 N � ADDRESS LOCATION OF BUILDING N0. R I ® STREET � � � �/��-•�� (� IU�,C LOT 2 BLOCK __ fit : r ADDITION OR .' SUBDIVIS ION CORNER LOT. t/ INSIDE LOT SETBACK SIDEYARD SEWER ELEi AT%O�..,,._ _ ,.,.� TOP, OF FOOTI1J "' 'c' . Applicant attach to •this,fgj:m Two veirtUicates of*Survey of Lot 'anc proposed building location drawn:qn these.Certificates. DESCRIPTION OF BUILDING To Be ,Used 4s r r Front_ Depth-'i.Heigh► Square feet ��% �— Cubic Feet Front r Daptix+' Height—� t, $quare. feed x : E.. Cubic • Feei ' T*pe of'Construction ,Estimated Cost To Be Completed Th� undersigned hereby makes application for a permit for the vorkl'herein specifiied, agreeing to do all work to strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares --t ' hat all the 'facts an4 retpresenta ons stat Id this application are' true d correct* DATE_,��f� SW,4;ATM (Schedule of Fee Costs can be found on the Reverse Side). r -e �• C• "340ium aild ('Assoelates, One. LAND SURVEYORS 10731 MISSISSIPPI BOULEVARD N.W. COON RAPIDS, MINNESOTA Telephone 421-6340 Certificate.of Survey: Chester Maci aszek LONG F'E L L 0 W S T, 1980-147/45972 A L L E Y (NOT OPENED Lots 21 and 22, Block 3, Spring Brook Park Anoka County, Minnesota E F 7 a Y d) --q DENOTES I Rosi I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE ABOVE DESCRIBED LAND, AND THE LOCATION OF ALL BUILDINGS, THEREON, AND ALL VISIBLE EN. CROACHMENTS, IF ANY, FROM OR ON SAID LAND. AS SURVEYED BY ME THIS ....... 1.1.0 -DAY OF......Q.;tQber ........................A.D. 19...67.... N. C. HOIUM AND ASSOC ES, SURVEYORS Xh�\w a � ` . r V u suB�Ecr PE City of Fridley 15 -746 AT THE TOP OF THE TWINS BUILDING PERMIT r RISUZI NO. `L ______ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/27/80 JOB ADDRESS 210 Longfellow Street N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 21,22 3 Spring Brook Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lawrence B. Davis 210 Longfellow Street N.E. 786-8733 3 CONTRACTOR MAIL ADDRESS 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 El REMOVE % 8 DESCRIBE WORK Install free-standing fireplace 9 CHANGE QF USE FROM TO STIPULATIONS 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 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 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 $850 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 11-1 $8.00 SIGNATUREOFCQNTRACTCR AUTHLWIZED AGENT (DATE). _ .. WHEN PROPERLY VAWPATED THIS IS YOUR PERMIT F � ✓ ,.) rD- BLDG )NSP f1ATE SiGMTURS OF OWNER 0F OWNE B ER) (DATE) u CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: hAyi S BUILDER: - OWNE-el ADDRESS: 210 D4 Loyj !!E?T: !� E- ADDRESS: TEL NO: 31le- '733 TEL NO: Construction Location STREST NO: Z 10 STREET: LOT: 122p2i1� �RAoK .�Aray BLOC::_ ADDITION 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 :�i __ LACE— Front: Depth: Height: Squane.Feet: Cubic Feet: Front: Square -Feet.: Type of Construction: d" STAY-4r)I &- 9.b Be Completed: Depth: Height: Cubic Feet: Estimated Cost: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict 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 this application are true and correct. DATE: _s'. -_: ^ SIGNATURE.- Stipulations: IGNATURE: Stipulations: N 11 SUBJECT City of Fridley 1158257NO. AT THE TOP OF THE TWINS BUILDING PERMIT rECEIPT COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. I 1 � i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 7/14/80 JOB ADDRESS 210 Longfellow Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 21, 22 3 Spring Brook Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lawrence B. Davis 210 Longfellow Street N.E. 786-8733 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 ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Finish basement (install bathmom stud walls & sheetrock) 9 CHANGE OF USE FROM TO STIPULATIONS SeApERATE p EMITS 1�TjNG. PL REQUIRED F OR WIRIAr 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 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 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 $1000 $.5O WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $7.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $8.00 SIGNATURE OF CONTRACTOR OR AUTHORIZEDAGENT (DATEI/g WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG INSP E SIG UR OF OWNER IIF OWNER BUILDER) IDA EI N 11 CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: DAyf s BUILDER: /xj' ADQRESS: SIO bj6FF.L-L&6j 5i N -E, ADDRESS: TEL NO: k-7 TEL NO: ' Construction Location STRIMT NO: STREET: S, f LOT: -��i. BLOCK: ADDITION: �5fPNC- 620-aL&tom 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. A L� DESCRIPTION OF CONSTRUCTION Front: Depth: Height: Squane.Feet: Cubic Feet: 4 Front: Depth: _ Height: Square- Feet: Cubic Feet: Type at Construction: Ub PPmE, Estimated Cost: $ 11000 A To Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: SEE REVERSE SIDE OF SHEET. .The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict 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 this application are true and correct. DATE: ZG SIGNATUF.E Stipulations: �L • . P19 Building T BUILDING Pell S Inspections j�5 RESIDENTIAL APPLICATION 65% of Building Permit Fee Received By: y 763-572- 3604 CITY OF FRIDLEY Surcharge Date Rec'd- 763-502-3604 FAX License Surcharge $ Ze, p c> $5.00 (State Licensed Residential Contractors) SAC Charge EFFECTIVE 1-1-09 $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow nn DATE `—_06 r Q YOUR E-MAIL ADDRESS ft + 6 ft = ft x $22 = $ SITE ADDRESS 9N AG 11 c AZ -9 f7 NE $ THIS APPLICANT IS: ❑ OWNER 'CONTRACTOR Park Fee PROPERTY OWNER/ NAME: —TZJ54-,f\, W %A Sewer Main Charge TENANT Agreement necessary ( ) Non Necessary ( ) Total Due $ ADDRESS: S CITY STATE ZIP PHONE: CONTRACTOR NAME: S ` SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE..3 AND CERTIFICATE OF ADDRESS: -U 2O Ca ! CITY STATEJ�LAIZIP. Y9 INSURANCE PHONE i FAX C® -6 B PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYNEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED AMINDOWS ❑ BASEMENT FINISH #9:ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR MODELING DESCRIBE WORK BEING DONE: �iC7C> F n do id 5 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING EMOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES 3 7 ❑ ATTACHED GARAGE 1. Existing Floor Plan 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: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS IN EXISTING OPENINGS ores ❑NoLOC%,T]�N OF WINDOWS45-00OR 3. Energy Calculations FOR NEW OPENINGS -DESCRIBE SIZE OF /fY7 `! OPENING CHANGES & p� TYPE OF. WINDOW TO BE INSTALLED f -e NUMBER OF WINDOWS 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 $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ /40,7./ .001 times the total job valuation Surcharge $.,7: i .0005 x Permit Valuation Minimum $.50 License Surcharge $ Ze, p c> $5.00 (State Licensed Residential Contractors) SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $22 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ a Make checks payable to: City of Fridley Attach Stipulations 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 fora ermit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all r hich requires review and approval of plans. ry� / % q SIGNATURE OF APPLICANT PRINT NAME ' / ®�e-C ` DATE 06