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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT -4863 Date: Owner: Builder ••_.. ; ._.x -L __..._. AddressAddress ........-.-_.._----•-----.._.._____.._..._ _�____...._._._.___.._.._._._.. LmCAT F BUILDING .'--••-r —-....... Part Lot __------------- ._ _.�._ Lot ...._.. '�.......... Block ....._... „ ......... _......._........ Addition or Sub- on ..._ , . ....y!'� rl'i Corner Lot ........................ - -.Inside Lot .............. $aback .-......... -...... .: Sideyar _.......' .... - - Sewer Elevation .... _.... _................... ___._...._......._...._•-----_.._._..._-----___ Fo dation Elevation ...... _ .......................... ........... DESCRIPTION OF BUILDING Ta -- Front _®. Depth Sq. Ft ...._.............•--- -.......................... Fron... - Depth ..._..... Height Sq. b't•-............._. Cu. Ft. ..................... iD Type of Construction .'-- � :.... Est. Cost ....:.II .p ._moo be Completed .................................................. 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 set forth and in compliance with all provisions of ordinances of the city of Fridley. I� 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 within the city limits and this permit may be revoked at any time upn violatioI of any of the provisions of said ordinances.Bl� Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these hems.' . 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name / F V - 'J� Builder 03 ®` I TO Address r7(/ ® -PYi IV,, 3 1� (2� Address LOCATION OF BUILDING No. 1 [. " Street Port of Lot Lot 1 -Block, Addition or Sub.Div.��� Corner Lot Inside Lot Set Back Side -Yard ` SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To a juLed-as Front Depth Height � � Sq. Ft. Cu. Ft.�.a;� Front Depth Height Sq. Ft. Cu. Ft. Type of Construction �, —� Estimated Cost To be completed The undersigned hereby makes application for a permit for the work herein 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 representa- tions stated in this application are true and correct. F DATE tl SIGNATURE l� (A Schedule of Fee costs can be found on the Reverse Side.) !0 , . E SUBJECT PERM City of Fridley o 18186 AT THE TOP OF THE TWINS BUILDING PERMIT _ I?r RECE • _____ COMMUNITY DEVELOPMENT DIV. - r 1 PROTECTIVE INSPECTION SEC. ! �/ i1 = � ���-�,•� CITY HALL FRIDLEY 55432 L NUMBER REV. DATE PAGE OF APPROVED BY ----� 612-571-3450 910415 8/30/85 JOB ADDRESS 711 Marigold Terrace N.E. 1 LEGAL DESCR. LOT NO. f ZI BLOCK els� TRACT OR ADDITION SEE ATTACHED � SHEET 7 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE `Tk M A 2 I C60 C-40 42943 °L SID I - 3O TRACTOR MAIL ADDRESS t ZIP PHONE sLICENSE No. , /� j �-�J /c1� ..IFC.( izi-n 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OOFF BUILDING G�. �y 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK a W 9 CHANGE OF USE FROM TO STIPULATIONS n c9� 1 �}iA-n 10 S(j2 f�- r� ®tt t Q r ►9-y 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 ZOIJING 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 f ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT n ^ a M0 I ) y' , (4, DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER ST TE OR LOCAL LAW REGULATING CON- -� STRU TIO OR THE PERFORMAN E OF CONSTRUCTION. 1 PLAN CHECK FEE TOT L FEE L� SIGNA URE OF CONTRACTOR OR AUTHORIZED AGENT ( ATE) r EN PRO R L AT D THIS IS YOUR �PERMIT BLDG WSP DATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI E NEW [ ] ADDN. [ ] ALTER. [ ] Construction Address: Legal Description: Owner Name & Address: Contractor: Address: _7D(1 01 R LIVING AREA: GARAGE AREA: DECK AREA: OTHER: City of Fridley �R-1 AND R-2 Building Permit Application 14 Effective 4/1/84 Tel. # Tel. # A Attach to this application, a Certificate of Survey of the lot, With the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF IMPROVEMENT Width Width A— Width Height Height_ Hgt/Ground Sq. Ft. Sq. Ft. —-- Sq. Ft. W[�KR11� Corner Lot [ ] Inside Lot [/Y\] Ft. Yd. Setback Side Yard Setback Type of Construction: kfQA Estimated Cost: $ 1a� Approx. Completion Date:Z��a CC Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: ���"APPLICANT: Tel. Permit Fee Plan Check State Surcharge SAC Charge Park Fee - Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side 25$ of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 4 o 01 01 SUBJECT PF W IT N City of Fridley 1_ 1.9405 AT THE TOP OF THE TWINS BUILDING PERMIT rp � R 1 COMMUNITY DEVELOPMENT DIV. r - PROTECTIVE INSPECTION SEC. ��%�� J 1 {i ".--I I � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY •---J�l L 612-571-3450 910-F15 4/22/88 JOB ADDRESS 711 Marigold Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 3 Donnay`s Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Theodore Day 711 Marigold Terrace N.E. 571-6163 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. }2uHow Can an 10107 Lakeview Drive West, Minnetonka, MN 55343 545-7290 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 X❑ 8 DESCRIBE WORK Construct a 1712" x 1412" Porch Addition 9 CHANGEOFUSEFROM TO STIPULATIONS No rigid walls or window may be constructed between new roof and existing concrete slab because slab does not have frost footing. See notations on plan. WARNI;ivg`� Before digging call local utilijpc SEPARATE PERMITS REQUIRED FOR TELEPHONE - ELECTRIC - GAS Etc. WIRING, HEATING, PLUMBING AND SIGNS. REQUIRED 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 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 Z 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 $3 300 $1.65 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 FY OTHER TATREGULATING CON- $44.50OT O SRCROF CONSTRUCTION. AN CHECK FEE TOTALFEE $11.13 $57.28 SIGNATURE 61F CONT ROR ORIZED AGENT (DATE)G HEN PROPERLY `DATED THIS IS YOUR PERMIT ;^ �O BLDG )NSP nAT SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) 01 NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. [ ] Building Permit Application j Construction Address: Legal Description: Lo /.? &-C'e 3� '66kuN 'S' Owner Name & Address: �'`� �hP� d�'e- Tel. 4 5-'7/ 6143 Contractor: L H, �� n � Tel . #Sys^� Address:_ Attach to this application, a Certificate oflSurvey of the lot, with the proposed construction drawn onjit to scale. DESCRIPTION OF IMPROVEMENT! LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Heig�t Sq. Ft. DECK AREA: Length Width Hgt/IGround Sq. Ft. o OTHER: 5--ree-'v ��o� ��1��P �• /� �'`� j 3� &W X t3. 2% Corner Lot [ ] Inside Lot Ft. Yd. Setback _ _ Side Yard Setback Type of Construction: f"V''' ` Estjimated Cost • $ ` Approx. Completion Date:J v'� �° !. i'3'Sov � Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: j $ $ SeelBack Page for Explanation DATE: /o-_ g� APPLICANT:Tel. CITY USE ONLY Permit Fee $ Fee Schedule Ion Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ ' $.50/$1,000 Valuation SAC Charge $ $ 55Q per SAC jUnit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ 1 TOTAL $ Aeement Necessary [ ] Not Necessary [ ] STIPULATIONS: ko;c- �� • - dM - Co du 6 1'i Capacity Sq. Ft. Eon STV NP HIMINU14 FEE POR ANY HFJITING PERMIT IS $10.00 cowP•M► /'f ` L PLUS $.SO STATE SURCHARGE Signed ay Attach stack verification fora with replaccsent furnace lwmits Tei. No. *Air Ganditioners can newt lir placed in %ade• yard without written am rmtssion frcw adlntntnq nrinld+nr. s CITY OF FRIDLEY APPLICATION FOR POWER PUNTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE J / Address / �� ��'/�/ / lt( �t. USIDENTIIIL RATE TOTAL .lob Furnace Shell and Duct Worker. (Also replacement furnace) S 20.00 c Ste( Department of Buildings, 6411 University Ave. N.E., Fridley, NN SS4I2 Burner city of Fridley Gas Piping $ 10.00 S Tel. NS71-34SO (piping heeded Jith net/ furnace) $ 10.00 S The undersigned hereby naked application for a permit for the work herein Cas Range specified agreeing to do all work In strict accordance with the City Code• Gas Dryer S 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. • Air Conditioning (all sizes) $ 10.00 S /6 0. Fridley. Minn. ( (✓ ,ism All others/Repairs and Alterations ONNER 1t of Value of Appliance or Work S RIND OF BUILDING COIMERCIAL/INDUSRRIAL USED AS -- •i• of Value of Appliance or Work $ TO at COMPLETED Asan' ESTIMATED COST J (� State Surcharge S .50 OLD -NEN BUILDING PERMIT NO. PEIMIT NO. TOTAL >tis Reinspection Fee (S1S.00) S oFscaPT:al or tuRrACE/sua+ER a14, Rough Insp. HEATING or PONEn PLANTS, Steam, Not Nater, Nae.)' Air- No. Date Trade Name f CJI y /( C' a ; ( size Final Insp. Date Capacity sq. Ft. Eon Approval for Pernit / Total connected load Rind of F001 BURNER - Trade Name Site No. Capacity Sq. Ft. Eon STV NP HIMINU14 FEE POR ANY HFJITING PERMIT IS $10.00 cowP•M► /'f ` L PLUS $.SO STATE SURCHARGE Signed ay Attach stack verification fora with replaccsent furnace lwmits Tei. No. *Air Ganditioners can newt lir placed in %ade• yard without written am rmtssion frcw adlntntnq nrinld+nr. s July 6, 1988 City of Fridley 6431 University Ave. N.E. Fridley, MN 55432 Re:.: Placement of:,,Air.Conditioner Compressor at 711 Marigold Terrace. To Whom It May Concern Theadore and Loretta Day have my permission to place the Air Conditioner Unit on the west side of their home. Sincerely, I 01 SUBJECT City of Fridley I�F71 7 AT THE TOP OF THE TWINS BUILDING PERMIT r EIPT 4. • COMMUNITY DEVELOPMENT DIV. r 3oZ 9S r PROTECTIVE INSPECTION SEC. 1 � i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L J\ 612-571-3450 910-F15 5/9/89 JOB ADDRESS 711 Marigold Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 3 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Ricard Day 711 Marigold Terrace N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. RuHow Co. 10107 Lakeview Drive West, Minnetonka, MN 55343 545-7290 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 Cj ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install patio dook 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. 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 $1,000 $.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- $255.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $25.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY A (DATED THIS IS YOUR PERMIT BLDG INSP )AT V SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) 01 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: Legal Description: Effective 5/1/88 X-7 Owner Name & Address: i�d�o ��/' Tel. # Contractor: y d Tel. Andress: ,�/�����i P �'P�°'� G� �,i✓ry ,�'S ,�G/3 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. •) Ir.•�ria+ LIMIG AREA: Length Width Height Sq. Ft. GARAM AREA: Length Width Height Sq. Ft. DECK AMM: Length Width 07HM: Hgt/Ground Sq. Ft. Corner Int [ ] Inside Ipt [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction:�7 �'�1�, Td��� Estimated Cost: /da©� Approx. Completion Date: Proposed Driveway Width If New Opening Is Desired: Ft. $ $ Wi + 6' See Back Page DATE: "�` APPISC�fI': i� 4J �dir� ®</l/ Tel. # j Permit Fee $ UU State Surcharge SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ STIFUTATIC NS : 6o. � 2) CITY USE CMLY Fee Schedule an Reverse Side $.50/$1,000 valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] SUBJECTO IT N: City of Fridley 3260. AT THE TOP OF THE TWINS BUILDING P E R M I T r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. __ f � --_ PROTECTIVE INSPECTION SEC. I . NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/7/02 JOB ADDRESS 711 Marigold Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 3 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ted Day 711 Marigold Terrace NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings Contractor 6331 Riverview Ter NE, Fridley, MN 55432 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-574-9966 4051 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (29 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, TYP 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 $3,109 $1.55 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- Fire SC $3.11 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $97.25 PLAN CHECK FEE TOTAL FEE 6i o'Z Lice SC $5. 06.91 SIGNATURE OF CON-RA CTOR OR AUTHOR EO AGENT ATEs LY VALIDAT THIS IS YOUR PERMIT =1-NTP PATE SiGNATUREOFOWNER ��FOWNERBUILDER� iDATEI NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 7/l Legal Description: Owner Name & Address: - Tel. # Contractor. MN LICENSE # S Address: X33 1 Tel. # S ? 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: Z i Construction Type: Estimated Cost: $ / Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 6 %Z-0ZAPPLICANT: h�i� Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee Fee Schedule on Reverse Side Fire Surcharge $ 3 // .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $5.00 (State Licensed Residential Contractors) Driveway Escrow Erosion Control Park Fee Sewer Main Charge 11191 111 STIPULATIONS: $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ /L/)/' - / Agreement Necessary [ ] Not Necessary [ ] NEW (] CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax _ BUILDING PERMIT APPLICATION - 0 6 Construction Address: Legal Description: Owner Name & Address: -T�rFQ -A V Tel. # Contractor. Z !c., AP- D A4 st a MN LICENSE # �� 5 Address: 632 11-74t, Tet. # 'S- LIVINGAREA: 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 Sq. Ft Length Width Hgt/Ground Sq. Ft FZFASFA& oFr- L?5F�'Vo r -ch C off �P'��=2vo� Construction Type: &feA -5 Zro p o ez c Estimated Cost: $ S ® 6 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: APPLICANT: Tel. # Call (763) 572-3604 for Permit Fees If mailing In application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ jJ 3.o�Jr Fee Schedule on Reverse Side Plan Review $ 65% of Permit Fee Fire Surcharge $ %;s® .001 of Permit Valuation (1/10th%) State Surcharge $�, 4 �� $.50/$1,000 Valuation SAC Charge $ $1350 per SAC Unit License Surcharge $ ig ®y $5.00 (State Licensed Residential Contractors) Curb Cut Escrow $ Alt. "A" or Alt. T" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL' $ . ED STIPULATIONS: 0-�05 �Ic DL 46n5i Building MECHANICAL Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 Date CITY OF FRIDLEY DATE YOUR E-MAIL ADD SS SITE ADDRESS / a a (A t, 1 THIS APPLICANT IS: &OWNER gCONTRACTOR PROPERTY NAME: OWNER/ ADDRESS: flip Un C&A CITY PM STATI,PZIP TENANT PHONE: CONTRACTOR COMPANY NAME: OfAwfl CONTACT PERSON: SUBMIT A COPY OF YOUR STATE ICENSE WITH STATE LIC -EN VXP DATE R/ / VR�PLE ADDRESSS'y QSTATED ZIP APPLICATION PHON?7' IbLFAX'U2"-5a, - 1 PERMIT TYPE qFSINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: N REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK PER MS 1613.665 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: (INDICATE TOTAL ( NUMBER OF EACH BELOW)I LI Equipment Installed MFG: CM MODEL: 't MODEL: '1 SIZEBTU 0 I DG0 MFG: Ckff �� �_ MODEL: '� SIZE/BTU —� � MFG: MODEL: SIZE/BTU t_A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 -:::DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00 PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ -T- TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $ 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 Rnd work is not to start without a permit; that the work will be in accordance with the approved plan in the case of 911 work which re es r view and approval of plans. , G �/ -1 W SIGNATURE OF APPLICANT PRINT NAMF��/1'� l� DATE J PLEASE NOTE: SEPARATE PERMITS ARE REQUIREDFOR BUILDING, ELECTRICAL AND MECHANICAL. WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 307