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PRE 2010 DOCSCity Fridley, of FMinn. Y� BUILDING PERMIT N® 3459 Date: .� .............................. Owner ....................................... Builder .�%.. ... ..!!..•.••••.• Address ...................................... Address ............................................. LOCATION OF BUILDING No. �. . ®. Street ... ...M�f ................. PartofLot...............................j. Lot ...Y ..... Block .. :4E........... Addition or Sub -Division f/ 1 rLC� . O X14. ► rt.A ..f.� � Corner Lot ............ Inside Lot ... ....... Setback .37-71p" Sideyard ... lA ' b. ............. . DESCRIPTION OF BUILDING To be Used as: y Vy" pth gh /.: ® Sq. Ft. /� .lea Cu. Ft.� 0 Q.. 7 9d$M ... �..... k 11 Front ....... ® De ... �.. Hei t . e�. ... Front ��. .. Depth a``� IHgght . f�o.�. Sq. Ft. ei�4' Cu. Ft. sf4—0 4 ! Type of Construction ................... haat. Co l.O. -A .� To be Completed .................... In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. �!. ................ .. ......... A �C fd In consideration of the payment of a fee of $.'.., permit is hereby granted to ................... ......................... 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, in 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 buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ...... Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building inspector for separate permits for these items. I su9JEcr PER City of Fridley AT THE TOP OF THE TWINS P, BUILDING PERMIT 237 RE Ir � • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 3 NUMBER REV DATE PAGE OF APPR CITY HALL FRIDLEY 55432 612-571-3450 910-F15 JOB ADDRESS 6750 MADISON ST NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 5 RICE CREEK TERRACE PLAT 6 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE DAVE SEINES 6750 MADISION FRIDLEY MN 55432 571-5790 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. B & B ROOFING 6760 MADISON ST FRIDLEY MN 55432 571-0248 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 REROOF 2ND LAYER (24Sq) 9 CHANGE OF 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 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 STALLS I 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 HER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1440 00 79 DOSS NO PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIO S OF ANY OTHER TATE OR LOCAL LAW REGULATING CON- 48.50 SERUCT NOR THE PERFO ANCE OeFC TION O�s FIRE .71i 1.44 PLAN CHECK FEE TOTAL FEE LICENSE SC 5.00 55.66 SIGNATOR OFC ACTOR OR AUTHORIZED AGENT IDATEI WHEN AALIIDAATTED THIS IS YOUR PERMIT /fPROPERL 9L ,NSP _ DATE SIGNATURE OF OWNER IIF OWNER BUILDER, IDATEI I 'NEW [ ADDN CITY OF FRIDLEY ALTER j) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address • f J91 _rte 7 Effective 8/1/95 Legal Description: �S ( �' /L Owner Name & Address: Tel. # S 71 S D Contractor: 8 �.46 / 1� �5 _ MN LICENSE # 5 It L'tj62� Address:,�7&_C_)��/ SlJYI S 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. oe OTHER: c — Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Qirb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: % _ APPLICANT: Tel. #7/dam CITY USE ONLY Permit Fee $ , �0 Fee Schedule on Reverse Side Fire Surcharge $ 1 N -q •001 of Permit Valuation (1/10th%) State Surcharge $ -7-a $.50/$1,000 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ `j O© $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 Necessary [ ] TOTAL $ e STIPULATIONS: SUBJE& PER City of Fridley 2 8 26 AT THE TOP OF THE TWINS BUILDING PERMIT ` IPT NO. COMMUNITY DEVELOPMENT DIV. (�/J�,� r PROTECTIVE INSPECTION SEC. �� F NUMBER REV DATE PAGE OF APPROVED BY CITY MALL fRIDLEY 5332 612-571-3450 910415 12/8/98 JOB ADDRESS 6750 Madison 1 LEGALO. LOT N4 BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Rice Creak Tprrmnp PInt 6 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dave & Lil Seln sS71-5790 9 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Alliance Ho - a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW 6jx ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Garage addition (24' x 20')• Covered patio 616" x 17'6" along North side 9 CHANGE OF USE FROM TO STIPULATIONS MPARATE PERMITS REQUIRED FOR MRiNG, HEATfNG, PLUMBING AND SIGNS. See notations on plan. WARNING Before digging c;'il far all utility locations 454-0002 REWIRED BY LAW 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 S0. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 80 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 1 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 0,ffift $9120 $4.56 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $162.25 1 Fire C $9.12 PLAN CHECK FEE TOTAL EE JJA �— Lice C 11 5.0 $1 0.93 SIGNATURE OF COI 'QAC TOA OR AUTHORIZED AGENT IRATE, PERMIT ENP OP IDA D H� IS Y7.f4q-: / BLD ,NSF' OAtE SIGNATURE OF OWNER IF OWNER BUILDER, IOATEI NEW [ ] Effective 1/1/98 ADDN CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 11-41 a4 Its =1 11� � W G Legal Description: L at CtA q- R-, e -0_C 1 .a k< Te Owner Name & Address: a 'e__1� Tel . #_�1 Contractor: AUQV\C_&' bA a)VA L U atk%ke i . ZV%<, MN LICENSE # 82 S Address: ���5® ��Q������ �����ti , ��� X32 Tel. # X12 �'11-�1335 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 - S Width Height EV Sq. Ft. 00,/, DECK AREA: Length Width H�t/Ground Sq. I = /Z� �" OTHER: ®u-��¢ ►.. A ea�'��� _ adn v� r �1� yC 61 a�c7ke t-3 SQLe Driveway Escrow $ Alt. "A" or Alt. "B" Above z Construction Type: �- lr-�, w�. Estimated Cost: $ $ Fee Determined by Engineering Sewer Main Charge (Fee Schedule on Back) MA Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ E99 DATE: d I, 3 — IS APPLICANT: 0 7VAz1__1 I.,- <�: . k ' Tel. # 7-1(-4 33 5 CITY USE ONLY Permit Fee $ & 2,25 Fee Schedule on Reverse Side Fire Surcharge $ Z .001 of Permit Valuation (1/10th%) State Surcharge $ $.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 Necessary [ ]. TOTAL STIPULATIONS: City of Fridley AT THE TOP OF THE TWINS ? sueJEcr BUILDING PERMIT 2 9 472; 7 : v _����_ COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. ` �.� CITY HALL FRIDLEY 55432 1 .-_.612-571-3450 CEIPT NO. o,7465 J NUMBER 910415 REV DATE 8 5/x/99 PAGE OF APPROVED BY JOB ADDRESS 6750 MADISON STREET 1 LEGAL DESCR. LOT NO. 4 BLOCK 5 TRACT OR ADDITION Rice Creek Terrace Plat 6 SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE David Selnes 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO B & B Roofing Service 6760 Madison Street Fridley 5432571-0248 9042 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION VC REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (22 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION ZONING SO. FT CU FT 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 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION $1885 SURTAX $.94 DOES N PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROW O S OF ANY OTHER STA OR LOCAL LAW REGULATING CON- E TI OR THE PERFORM E OF CON LIC PERMIT FEE $66.20 SAC CHARGE F e SC $1.88 _ — � PLAN CHECK FEE Lice C $5 T TAL FEE $74.02 /11 SIGNATURE OF ON'RACTOR OR AUTHORIZED AGENT iOATE, H P Y VALI THIS IS YOURPERMIT ff S-GNATURE OF OWNEROF OWNER BUILDER, ,DATE,B 6Xi IN gAtE NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �a BUILDING PERMIT APPLICATION Q� Construction Address: ��� �����/_� —T Legal Description: E-57 //) 5-W 70J Owner Name & Address: Tel. # 5 7) 7 lb Contractor: ] � ��;�t U �ti S MN LICENSE # �� y� Address: 15> !M/�z�/ d Tel. # , Z/ ca�yc� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: DATE: Ft. + 6 Ft = Ft x $ mul Tel. # f 21-6 a `1rl�' ,71PULATIONS: CITY USE ONLY // Permit Fee $ �(o - Fee Schedule on Reverse Side Fire Surcharge $ y .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ - 00 $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 Necessary [ ] TOTAL $ ,71PULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2002 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** NO. RATE TOTAL Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type Reinspection Fee $47.00/Hr $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge '?% () U JOB ADDRESS % 5_6 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. Owner _TD A.y-e- S e 1 et't_ 5 S Building Used As 14.61 'LC k3 60eo Estimated Cos J ' PERMIT NO. /RW � .20 o'Z PLUMBING COMPANY J o `e S b�^ O i' -., N L SIGNED BY �./ (/V TEL N0. �G 3 /-/ A. -7/3Zi FAX 4-7G3 y-? If P `f/ bl�s Approved ByRough-In Date Final Date �- $ .50 Al �j1 MINIIY UM I rVR AIYi M JIVIONM31%amo rr-MV111 10 TOTAL FEE $ 91'S l/ PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED COMMON VENT. VENT CONNFCTOR AND _OMRIISTION AIR VFRIFICATHIN When _ra I� a ring an existingf iM=, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes( ) No( ) The venting system is plastictPVC 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 specifications. This does include AGA-GAMA Category I Central .Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The px�g cnmhnstinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to install a new cnmh"stinn air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When installing a new ventingsystam, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace 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 Appliance #2 Type Appliance #3 Type Total Appliances _ BTU Input _ BTU Input _ BTU Input Total Btu Input Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type HEATING CO: Signed By: Date MIY NO. 2 SUBJECT R City of Fridley 326 3 AT THE TOP OF THE TWINS BUILDING PERMIT( r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. f PROTECTIVE INSPECTION SEC. 1 . � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/22/02 JOB ADDRESS 6750 Madison Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 5 Rice Creek Terrace Plat 6 SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE David/Lillian Selnes 6750 Madison Street NE 763-571-5790 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 CR REPAIR ❑ MOVE - ❑ REMOVE 8 DESCRIBE WORK Install basement egress window; Replace windows; finish basement walls 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPIA REQ R� WIRING HEATING. PLUMGINd AND SION'S SEPARATE PERMITS ARE REOUIRED 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 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 $3'000 $1.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE $87.75 G TUREOc TRACTORO uT RIZEDAGENT IOATTE--I�/�j N PROPERLY VALIDATED THIS IS YOUR PERMIT OG SP / GATE ,GNATUAE OF OVVNE ,IF OVYNERBUILDEA IDATEI MIY NO. 2 NEW [ ] CITY OF FRIDLEY ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address'': ff 675-0 /' W t'-,5 Legal Description:-lO//-- Owner Name & Address: 715 D _ MA 6Q 161 P Oy— Tel.# Effective 1/1/2002 (763) 572-J604 Bldg sp KIV Contractor: MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft Length Width Height LeMth Width _ Hgt/Ground Sq. Ft Sq. Ft. Construction Type:Estimated ost: $ Driveway Curt Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 'r/ 4? APPLICANT: Tel. # Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-5714287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 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 [ ] TOTAL $ a 1� STIPULATIONS: PLUMBING RESIDENTIAL APPLICATION City of Fridley 9Ld1 . P t umber R By S E P 20 NOTE: IF PROPERTY IS NOT OWNERfOCCUPIED- A UCENSEO CaNTRACTnR MUST nBTAIN,i tF peaturr ® DATE YOUR E-MAIL ADDRESS SITE ADDRESS THE APPLICANT 1S: (CIRCLE ONE) OWNERNTRACT NAME PROPERTY OWNER! TENANT ADDRESS CITY 1r 1 STATE N ZIP PHONE NAME M L 1-11VVIA10111bbig Co ADDR � tZ CONTRACTOR QTY N el PHONE 'i -3STATEe N3�� N ;. lE F Ys 00 ul n - 8 PERMIT TYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPtn OF WORD 13 NEW REPLACEMENT DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $ID.00 PER FIXTURE, EXCEPT WHERE NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINKILAV FLOOR DRAMS SHOWER WATER PIPING BATHTUB GAS PIPING (Need CityLicenBW) SWGy DIG POOL WATE'RSOFTENER ($30 CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREY. ($15) DISHWASHER LAUNDRY TRAY WATER HTR (1M FOR IRRIGATION WATER ME -MR OTHER Permit Fee, 35-20 MINIMUM: $15.00 or 3% of cost of the improvement whichever is Plan Review S greater on work leas than $301) Surcharge TOTAL DUE S� ( Make checks payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT— NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and i acknowledge that the i nfa mation above is oornplete and aomwate: that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Wnnesota Construction Codes: that I understand this is not a permit but only an application for a permit and work is not to start wifhou permit: that the work wig be in accordance with the approved plan in the case of all work which requires review and approval o s.. y NAME OF APPUCAN7' DATE r 2 ' C SIGNATURE OF APPUCANT I l / C �✓ y" 01 ter, T yr rrsrUL&-r COMMUNITY DEVELOPMENT DEPARTMENT TOTAL P.01 Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FR.IDLEY 9 200 DATE D YOUR E -MALI, ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: e ADDRESS: 1 Sa C STA SSS OWNER/ TENANT PHONE: CONTRACTOR NAME: �i �.cINa STATE LICENSE # EXP DATE 5-A SUBMIT A COPY OF YOUR STATE ADDRESS- : CSP ei !!!!!! Ve ` �Tl' ®.�Se& STAN LICENSE WITH PHONE ! � 3 "` _ 7 / — 0 +4:_5� FAX 7_63 - ffQS-- % e}'�, APPLICATION PERNM TYPE 0 SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW AREPLACEMENT DETAKE14 DESCRIPTION OF WO n Q_ eS c, � q 8 G PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 =cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (IlVDICATE TOTAL NUMBER OF EACH BELOW) _ BATH SINJULAV FLOOR DRAINS _ SHOWER _ _ WATER PIPING —BATHTUB _ GAS PIPING gvuD crrrucmm) _ SWIlVIINING POOL _ WATER SOFTNER ($35) _ CLOTHES WASHER —KITCHEN SINK —WATER CLOSET _ BACKFLOW PREY. ($15) _ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATER METER —OTHER PERMrr FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS DYER $500 Permit Fee $ _IS -.0 G Number of fixtures @ $10.00 x $10.00 = $ Surchar .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ 1__6-0 Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .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 w rk is rica to start without a permit; that the work will be in accordance with the approved plan in the case of all work whichre proval of plans. & / kA SIGNATURE OF APPLICANT PRINT NAME DATE If - PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK � City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977 0