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PRE 2010 DOCSCITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On May 10, 1999 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR ; Urinal .,....::.:.:..... :.: ::...... �: Shower :It1#::<: Tray FQtit<:,<::::::. oor..:..::::::.::;. Drain )'il°I' Auto. ... Washer ': : ....: Gas Range `��"-� n«r:: Water Heater Stories '`:::'. .> .:..: ><I:`: ::>,.>.... 'F ice....: Gas a Elec Basement Floor 1 Floor 2 Floor loo 3 Floor 4 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser + Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas" Gas Range" NO. RATE Gas Dryer" Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ '1.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL JOB ADDRESS._ J>�M.& zf5 ©W/l q5L bi5lolj 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 Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. GIRARD, MARVIN �� s , 1999 6531 MCKINLEY STREET N.E. FRIDLEY, MN 55432 Owner_ (612) 571-9677 Building Used As �3' i Estimated Cost PERMIT NO. PLUMBING COMPANY Mo K6LO'. PZ-VA18out, SIGNED BY 44& TEL N0. 97, Approved By Rough -In Date Final Date / $ ' .50 MINIMUM FEE R ANY PLUMBINGIGAS PER I MIT IS S20,00 $ 2o• 5O PLUS THE 5.50 STATE SURCHARGE "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A MINIMUM SIZE 9 SQ INCHES. 01 SuBjECT . PE34 City of Fridley 4 AT THE TOP OF THE TWINS BUILDING PERMIT r L _---_ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. �A, NUMBER REV DATE PAGE Of APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 9t0-Ft5 5/1/03 JOB ADDRESS 6531 McKinley Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Clark's Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ivan Pugachov 6531 McKinley Street NE 763-571-4436 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 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 O NEW ❑ ADDITION ❑ ALTERATION R REPAIR O MOVE O REMOVE B DESCRIBE WORK Replace 28 windows within existing openings 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all exterior openings. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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. 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 $6,000 $3.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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- $125.25 Fire SC $6.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FE Cal $13 .25 SIGNAT ON"RACTOp OR AUTMOR� EO AGENT ATEA NPR ERl IOATED T SIS YOUR PERMIT BL NSP DATE S-G+NATUAE OW E ���OWN LL ERS iDAT i 01 NEW ADDN ALTER [ ] CITY OF FRIDLEY Effective 1/1/2003 [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: W i t Owner Name & Address: Contractor. W ssq3 D"', 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: Q Construction Type: 4LaShEstimated Cost: $ 6 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: O APPLICANT: Tel. # Call (763) 572-3604 for Permit Fees if maili application. Fax to 7V3-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $ �. �� $.50/$1,000 Valuation $ $1275 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 [ ] $ 13 STIPULATIONS, m Building $ BUILDING See Back Page for Fee Schedule Permit No.: (,: Q 6 Inspecrioris � /, of .2 RESIDENTIAL APPLICATION Fire Surcharge Received By: 763-572-3604 .001 times the total job valuation CITY OF FRIDLEY $ Date Rec'd: � '® License Surcharge $ DATE YOTDRESS� $5.00 (State Licensed Residential Contractors) SITE ADDRESS C THIS APPLICANT IS: K OWNER 11&ONTRACTOR $ PROPERTY OWNER/ NAME: Erosion Control TENANT ADDRES ITY STATE Park Fee PHON(-26 CONTRACTOR NAME: $ STATE LICENSE # EXP DATE Agreement necessary ( ) Non Necessary ( ) SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE—ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE XSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW OADDITION ❑ MAR4TENANCE/REPAIR P REMODELING DESCRIBE WORK BEING DONE: cQ SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT 1 Sq. Ft.0 ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE I. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used 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. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes [No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION (USING v-'7941997 35U.B.0 FEE OCCUPANCY TYPE Permit Fee $ 3a. 6 57 See Back Page for Fee Schedule Plan Review $ � /, of .2 65% of Building Permit Fee Fire Surcharge $ el A .001 times the total job valuation Surcharge $ Sb .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 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 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 l' es review agAApproval of plans. // PUW140 f l�j1�SIGNATURE OF APPLICANT el PRINT NA"���kt V DATE 5 0 ®S