PRE 2010 DOCS1>tf:11CiI'll 3tweaP 1
SUBJECT
PERMIT N
City of Fridley
12336
AT THE TOP OF THE TWINS
BUILDING PERMIT
R EIPT NO.
• COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 . �
L CITY HALL FRIDLEY 55432
NUMBER
REV. DATE
PAGE OF
APPROVED BY
-_-_/"'f;•�
L 612-580-3450
910-F15
0/1/73
JOB ADDRESS 4701 Main Street N.E.
1 LEGAL
LOT NO. , 6
1
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
,
$
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
nnath E- shaw 4-70-3 N-3-3- Main Street
3 CONTRACT MAIL ADDRESS 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
Porch
7 CLASS OF WORK
❑ NEW ❑ ADDITION XQ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Enclose back stoop 9' x 515" x 8'
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.
wood f ram
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
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
$400.00
X50
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-
$5.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FE
TOTAL FEE
SIGNATURE OF CONTRACTOR OR AUTHORIZED GENT (DATE)
HEN V L ATED THIS IS YOUR PE IT
o '� J Da>'lin G7l s
PRO`P'ERLY
BLDG INSP DATE
SIGNATURE OF OWNER IIF OWNER B,1, (DATE)
1>tf:11CiI'll 3tweaP 1
APPLICATION FOR RL•SIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF 1-R1DLLY, �IJNNESOT.A
OWNER'S NAME:/,:!»12 ,� S gl f BUILDER:
ADDRESS: #7C11 //,(' /!?W //I -57- ADDRESS:
NO;. % C j T STREET: /I /
LOT: 161, l 7 BLOCK: 1✓ M' ADDITION: P / C, /%% e C/ 74i
CORNER LOT: Lie J INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
buildirig location drawn on these Certificates. T
DESCRIPTION OF BUILDING
To Be Used As:
-CI)C/65t B13cK Stcee Front: % f -tDepth:
J_ F7 .S n
Square Feet: Cubic Feet:
Height: 9 C
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: h) 6 0 J {' r n n2F
To Be Completed: /ii G IJT� -,,,
Estimated Cost: $ '/ e
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in Suitt accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that -ill the facts and representations stated in this application
are true and corr,-ct.
DATE: / S� /�J3 SIGNATURE:
t -
(See Reverse Side For Additional Information.)
4'e 0 0
SZ) J,,,)
-7-
�,5_6
01
SUBJECT
PERMIT N
City of Fridley
. A456
AT THE TOP OF THE TWINS
I I L D I� I G D[ D M I
BUILDING PERMIT
�
Dv Iv
ECEIPT
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
U
1 . �
CITY HALL FRIDLEY 55432
�.J
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-560-3450
910-F15
111/2/77
JOB ADDRESS 4701 Main Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRA CT OR ADDITION SEE ATTACHED
DESCR:
16,17
5
Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Kenneth Shaw 4701 Main Street N.E.
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 Ek ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct stove chimney
9 CHANGEOFUSEFROM TO
STIPULATIONS
WMMNG
Before digging call local utilities
TELEPHONE - ELECTRIC - GAS Etc.
REQUIRED BY LAW
SEPERATE PERMITS REQUIRED
FOR WIRING,
HEATING, PLUMBING AND
SIGNS.
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 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
$250
$.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-
7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$8.00
OFCONTRACTOR ORAUTHORIZEDAGENT (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
�SIGNATURE
00IL11A, ) fljw- L� // 2 - 77 o
_ //,2-72
SIGN ATUR OF O NER lIF OWNER BUILDER) (DATE)
BLDG INSP DATE
01
Address: All
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PEWTS
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
BUILDER:
Address:
Tel. No.
No.:
f 2,o / Street: 222,9
LOT: J / % BLOCK: ADDITION:
CORNER LOT: _� INSIDE LOT: SETBACK: SIDEYARDS:
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:
Front: Depth:
Square Feet: Cubic Feet:
Height:
Front: Depth: Height:
Square'Feet: Cubic Feet:
Type of Construction: Estimated Cost: $ �[3
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. See reverse side for additional information.
DATE: d - oZ rIj 77 SIGNATURE:
Stipulations:
�JU
9
SUBJECT
PERMIT NO
City of Fridley
667 8
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
COMMUNITY DEVELOPMENT DIV.
L PROTECTIVE INSPECTION SEC.
r
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
•
L J\ 612-571-3450
910-F15
7/14/82
JOB ADDRESS 4701 Main Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
16 7
5
Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Doris Shaw 4701 Main Street N.E. 572-8956
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
B DESCRIBE WORK
EM Reroof Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd but not 3rd roof. Install ridged galvanized valleys.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
XXV Asphal
t
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
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
$900
$.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-
$16.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$16.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
.WHEN PROPEW VALIDATED THIS IS YOUR PERMIT
BLDG I IATE
SiGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
9
CITY OF FRIDLEY Effective Aug. 1, 1981
APPLICATI94 FOR RESIDENTIAL BUILDIIIG PER141TS
(New, Alterations, Additions, or Repairs)
OWNER: _-Q��
ADDRESS: TEL NO:
BUILDER: h
ADDRESS:
TEL NO:
Construction Location
• STREET NO: ` STREET: /ll'q-14)
LOT: / 1r7 BLOCK: �� 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
Front: Depth: Height:
Square. Feet: Cubic Feet:
Front: Depth: Height:
Square -Feet: Cubic Feet:
Type of Construction: Estimated Cost: a
%b Be ODrapleted:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ S
SEE REVERSE SIDE OF SHEET .
Mie 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
ruling,. of the Deiklrtment of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: 7 SIGNATUVE:
Stipulations:
�l/0JOTY tl W 1 4) W I/:N1:IlA7 M
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
TELEPHONE ( 612)571.345D
rf -
OBS�TRfUCTI%ON:
Lot Block
Addition
��PIIETA4 E SAI14 W
Property Oi%ner-Address
RE -CORD OF COMAIU ICNTIONS :
2.
J.
4.
S.
G.
7.
CITY OF FRIDLEY INSPECTION DIV. Effective On August 1, 1995
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR •POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION•AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
Rate TOTAL
$30.00.- $
$10.00...
$10.06 $
$10.00 $
$25.60- $
All Others/Repairs & Alterations (UST ON BACK)
1% of Value of Appliance or Work r d-� CGL Z . $
Commercial/Industrial
1.25% of Value of Appliance or Work $�
State Surcharge X50
TOTALFEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $26.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without'
written permission from adjoining property owner.
JOB ADDRESS VO / /271' 4--' �%/ .0 65
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.
'? ,1995
OWNER /_)C1L.- L-,, _S 4 e�j "s S %;? - S % 5<6
BUILDING USED AS
ESTIMATED COST 1yCO ' PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of -Heating Units Circle One (Steam) (t-Ipt Water) (Warm Air)
-.Trade-Name I tIiIT-1- 1� e Si o` ��� �-
BTU SL) 0C;� HP EDR
Fuel Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
HEATING COMPANY H
Signed
<!,._.
and Air Conditioning
urnbia Heights. MN 55421
_1.612: 572.0459Tel No.
r
Approved By Rough -in Date
FILL OUT BACK SIDE OR STACK VERIFICATION ON
REPLACEMENT FURNACE
Final Date
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes ()
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
8. Has combustion air been provided for water heater
Remarks:
HEATING CO:
Signed By:
Date:
Yes ()
No
( )
Yes ()
No
( )
CITY OF FRIDLEY INSPECTION DIVISION
Effective On January 1, 1998
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
ff
JOB ADDRESS '' `4 1 u 1 M NIL V1 S
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 -
rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00
$ -6 -0®
representations stated in this application are true and c rrect.
(Side Vent - Fill Out Back)
-7 a ( ,1998
Gas Piping (Needed with new furnace) $10.00
$
OWNER
Gas Range $10.00
$
�U� V\
BUILDING USED AS q
Gas Dryer $10.00
$
_
ESTIMATED COST Q ITS • PERMIT NO.
*Air Conditioning - All Sizes $ 25.00
$
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Applianpe or Work
$
No. of Heating Units Circle One (Steam) (Hot Water) MCA
Trade Name Size No. �°I S L° AV b31o0� 0
Commercial/Industriat`
BTU (Q �� I nO HP EDR
1.25% of Value of Appliance or Work
$
Fuel (1,C . Total Connected Load
State Surcharge
.50
Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE, $ ,�
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
BLAINE HTG. A,C ELECT., INC
13M CENTRAL AVE. N.E.
HEATING P ANOKA ane.
Signed By el No. -7 D-6 0
Approved By Rough -In Date Final Date k �� J
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
M
7
0
Has total heating BTU's of
UtP,a�ro
All other BTU's L4 D I �-"
TOTAL BTU's IQ L.o , no
Has a liner been provided for water heater
Has combustion air been provided for water heater
Remarks:
List ALTERATIONS Being Done:
BLAINE WO. AM ELECT- INC.
13562 CENTRAL Alf . N.E.
HEATING CO: ANOKA, MN
Signed By: fXAA
Date: 2 q
Yes () No
Yes No ( )
M
4
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney or stack:
1.
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 i�)
No ( )
5.
Fleets all current Code requirements for size
and total BTU's connected -
Yes (bpi
No ( )
M
7
0
Has total heating BTU's of
UtP,a�ro
All other BTU's L4 D I �-"
TOTAL BTU's IQ L.o , no
Has a liner been provided for water heater
Has combustion air been provided for water heater
Remarks:
List ALTERATIONS Being Done:
BLAINE WO. AM ELECT- INC.
13562 CENTRAL Alf . N.E.
HEATING CO: ANOKA, MN
Signed By: fXAA
Date: 2 q
Yes () No
Yes No ( )
M
4
CITY OF FRIDLEY INSPECTION
6431 University Ave NE
Fridley, MN 55432
763.572-3604
RATE SCHEDULE
DIViSIO N
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
lajo of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
Rate
TOTAL
$ 30.00
$
$ 10.00
$
$ 10.00
$
$ 10.00
$
$ 25.00
$ (R5-. CQ
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
$ .50
Effective On January 1, 2001
JOBADDRESS_gf/0 MCt (A
OWNER
BUILDING USED AS..
ESTIMATED COST PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units__ Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
BTU
Fuel
Burner Trade Nam
BTU
HP
Lid
Total Connected Load
Size No._
HP ED
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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE 9 -?J 1—CQ
HEATING CO ROYALTON HEATING & COOLING
4120 - 85th AVENUE -NORTH
Signed BROOKLYN PARK, MN5443
-333
Approved By/ Rough -in Date Final
IBACK SIDE MUSS" BE FILLED IN ON VENT SIZE, VENT CONNECTOR'S
AND COMBUSTION AIR VERIFICATION
�R
ROYALTON HEATING & COOLING CO.
4120 85TH AVENUE NORTH • BROOKLYN PARK, MINNESOTA 55443
PHONE: (612) 424-8333 • FAX: (612) 424-8651 • E-MAIL: royalton@wavetech.net
www.royaltonheating.com
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NOIlVOl�la3/1 NIV NOI1Snew00 mmv N 11'�anlmn, I., 2.
Building
$$
BUILDING
Permit No.•
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
.001 times the total job valuation
Surcharge
Date Recd: D-3
.0005 x Permit Valuation Minimum $.50
License Surcharge
CITY OF FRIDLEY
$5.00 (State Licensed Residential Contractors)
DATE L( — 2,7—
YOUR E-MAIL ADDRESS
$1675 per SAC Unit (Plans to MWCC for determination)
SITE ADDRESS 417:: O 1 r4 AW Y �- ,AIC
$
ft + 6 ft = ft x $21 =$
THIS APPLICANT IS: ® OWNER
❑CONTRACTOR
$450 Conservation Plan Review
PROPERTY OWNER/
NAME:
r p Slg ,C t
Sewer Main Charge
TENANT
ADDRESS: L%
e' /in it ai 5- A, G CITY Fr -10114
STATE IP Z
Make checks payable to: City of Fridley Attach Stipulations _
PHONE: !j� 3
— X42 — 1111
CONTRACTOR
NAME:
STATE LICENSE #
EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS:
CITY
STATE—ZIP
WITH APPLICATION
PHONE
FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION
❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH p ROOF ❑ DRAIN TILE
❑ DECK
Q SIDING ❑ OTHER
❑ SW AMING POOL
TYPE OF WORK:
❑ NEW
❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
�
SIZE OF IMPROVEMENT
6NG4 WIDTH HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
PROPOSED SIZE: `Z 4
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
1. Existing Floor Plan
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
11 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:
(USING WE 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
$ 1, ��
.001 times the total job valuation
Surcharge
$ a
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1675 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
$ 'Th
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 requires review and approval of plans. I /
SIGNATURE OF APPLICANT A Ld---��--� PRINT NAME C 61 S t i Q et . �I /tis 1s�' DATE /142 43 — 4