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PRE 2010 DOCSCity of Fridley, Minn. N° 9870 BUILDING PERMIT Date: August 7, 1968 Owner: Ester M. Jack Builder Clemron, Inc. Address 4411 Central Ave. N. E. LOCATION OF BUILDING No. 7369 Street _ Memory Lane — part of Lot Lot_ 3 ___Block 4 Addition or Sub -Division _ Melody Manor 3rd Addn . Corner Lot —_ Inside Lot X Setback 35' Sideyard — 10' / 15' Sewer Elevation 872.05 _ _ _ 875.05 Ton of Footing: DESCRIPTION OF BUILDING To be Used as: Dwelling Front 26' Depth 39Height 20' Sq. Ft. 1014 Cu. Ft. 20,280 Garage, Front 22' Depth 22' Height 10' S9. Ft. _484 Cu. Ft. 4840 Type of Construction Frame Est. Cost —927 000.00 To be Completed Sewer Location - 5' Norhheast of Manhole Water Location - 15' Northeast of Manhole In consideration of the issuance to me of a permit to cons the uilding described a I to do the proposed work in accordance with the description above fo and iVcomvli a'll ons of ordinances of the city of Fridley. $100.00 Sewer Connect 'n Charge In consideration of the payment of a fee of $ 38.00 , permit is hereby granted to Clemron, Inc. 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 worl�en, in aII work. done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances oP Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the dty limits and this permit may be revoked a t any time upon violation of any of the provisions oP said ordinances. Official Building Breher NOTICE: This permit does not cover the construction, Installation for whing, plumbing, gas heating, sewer or water. Be core to no the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF,FRIDLEY, MINNESOTA OWNER'S NAME BUILDER ADDRESS % ADDRESS ZZIZ 3 C LOCATION OF BUILDING :NOC—BLOCK STREET PART OF LOT ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT 1/SETBACK SIDE•YARD/ SEWER ELEVATION �7z, 0�' FOUNDATION ELEVATION g7S- 0!5– La4&-L�) - 's'�j�.�. raj �lZ 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,"_Dep th�MHeight Sq. Ft.Z Cu. Ft. :I C'Z ko Frontes –� Depth, _Height Sq. Ft. �/�� Cu. Ft.� Type of Construction Estimated Cost To be completed s �, 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 �� SIGNATURE (Schedulel of Fee Costs can be found on the Reverse Side). P. i= P� f 60 � � e V O J � 0 � u Ui U 0 tD R 3 u co v U .c ��0 uI S0 )a cl Y u CI1 V J � 0 � u Ui U 0 tD R 3 u co v ��0 uI C S0 )a cl Y {w Ui U 0 tD R h � uI C CZ o �nQ o a o �7 to m C o r� v a j C] y � y C i f) O rJ O c7 is '�' -7 E•'i ci .,.'• u ►a U � ro� O � .7 N L] O A F O c.r as c. c�• LF) co € C) no cj 6d U� u4 ca c� era 0 epi .� rmi ei m 0 ca � rs LO cl f-+3 G9 G} 63 W. G? W G3 ui p� svo SflISO'0 IF �� O HJld"JI € nA C srnynaC J aooij F "SWAHS ! O C �� , eo .p.nOj rn o a o0 U3 � � a � 1. � tj sins ; I y P� � I � " HItj -3l i y r� Ki U (f O 19 0 [a' sro mn I O �F�� " t; roti e _ a u o ea sisO �� , [04Z U EE 7 n q a "j I f'. %a E �n r99 i Q ea I C� Application for Power Plants and Heating. Cooling. Ventilation. 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 $ MECH. 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 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOT 1st 3 Fixtures ...................... x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 x$ 5.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ _ ALTERATIONS &REPAIRS TOTAL FEE ROUGH FINAL Dept. of Bldgs. Phone City of Fridley: and The undersigned hereby. es application for a permit for the work herein. specified, agreeing to do all ork in strict accordance with the City Ordinances and ruling of the Department f Buildings, and hereby declares that all the facts and representations stated in tris application are true and correct. , Owner Kind of Building.% Used as To be co 0 Estimated Cost, $ •� �j n Old -Building Permit No. D % Permit No. d DESCRIPTION OF WORK HEATING or POWPLANTS—Steam, Hot Water, �armA�14No Trade Name -P �'�'� Size No- Z61 ® Capacity Sq. Ft. E.D. Total Connected Load ff.r DD�1�/� Kind of rue BURNER — Trade Name �9 �If/' � ' Size No -- Capacity Sq. Ft. E.D.R A� BTU H.P. C41110.42 (REMARKS—O RY IgneN. WELTER HEATING CO. S d -X63'7-CHICAGO AVE. 1AM_btF._F13UO 7. MINNE90TA Business Phone No �� 1 SuBjECr E City of Fridley 237878 AT THE TOP OF THE TWINS BUILDING P E R M I T Ir?RE CEIPT NO. COMMUNITY DEVELOPMENT DIV. 1 ti PROTECTIVE INSPECTION SEC. r NUMBER REV DATE PAGE OF APPROVED BY 1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/11/95 / JOB ADDRESS 7369 Memory Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 4 1 Melody Manor 3rd SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Eugene Bjerkebek 7369 Memory Lane NE 784-3173 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 L. REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (20 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,200 .60 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 $40.25 Fire SC $1.20 PLAN CHECK FEE TOTAL FEE 42l.0 !PNATURE OFC A T IDATEI WHEN PROPE VALIDATED THIS ISYO5UR PERMIT l �S� f'/Z-7/ GNATURE OF OW BL INSP GATE 1 NEW [ ) ADDN [ ] ALTER [] ConstructionAddress: 71 Legal Description: Owner Nam Contractor: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Effective $/1/95 IC, Tel. # �jj-H - 31-7 MN LICENSE # Address: �,Xk�' WA -9 Tel. # Attach to this application, a Certificate of Survey of the _ lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length DESCRIPTION OF IMPROVEMENT Width Height Width Height Width Hgt/Ground OTHER:"- 1� 1 �.GiAc ., �, / „ Citi Dfl/U v U',4) Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: Approx. Completion Date: Sq. Ft. Sq. Ft. Sq. Ft. n v i Side Yard Setbacks Estimated Cost: $ /2()() (Cost on Back) Driveway Curb Cut Width Needed: Ft . + 6 Ft = Ft x $ _ $ DATE: t C� O APPLICANT_. Tel. #?j 1 '' 11 CITY USE ONLY Permit Fee $ '7�,•�� Fee Schedule on Reverse Side Fire Surcharge $ %.,J2C) .001 of Permit Valuation (1/10th%) State Surcharge $ . 6�0 $.501$1,000 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Alcove Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: SUBJECT PER City of Fridley 32989 AT THE TOP OF THE TWINS BUILDING PERMIT r REIPT N111 COMMUNITY DEVELOPMENT DIV. fr ��_ r PROTECTIVE INSPECTION SEC. I � 1 . � Q" NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 L 763-571-3450 910415 81/14/02 JOB ADDRESS 7369 Memory Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 3 4 1 Melodv Manor 3rd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Nancy/Paul Buerkle 7369 Memory Lane NE 763-783-3639 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Aqua Seal LLC 12821 Industrial Blvd Plymouth, MN 55441 763-249-1877 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20239509 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION p REPAIR 11�� O MOVE ❑ REMOVE 8 DESCRIBE WORK Install basement waterproofing to two bedrooms in basement 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 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 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 $1,999 $1.00 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- $69.25 Fire SC $1.99 STRUCTION O&TFrE PERFORMANCE OF CONSTRUCTION T" ) l h k PLAN CHECK FEE TOT L FEE Affd / /bTQJ Lice C $5. $77.24 SIGNAT p F kbNTFVACjOR OR AUTH FAZED AGENT (DATE, E PRE VALIOAT THIS IS YOUR PER OG 'NSp of�IAiE S-GNATURE OF OWNER of OWNER BUILDERi iDATEi NEW [ j CITY OF FRIDLEY Effective 1/1/2002 ADDN [ 6431 University Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Insp ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: ►'° l e 0 Legal Description: Owner Name & Address:( N Tel. »�7 Contractor. � Ml �N LICENSE # �y ` t� Address• ) A � c.. . - . _ , 1 J u wm�•,n �,� 74 ) Tel. # ' / 1u � A �W) / 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 I Height Sq. Ft GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: �1�kMJ \,►etircleg �5 -. �AvIno:^ ki) G Construction Type: Estimated Cost: $ J17 /A60 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ = $ DATE APPLICANT: �;�� Tel. # � �y � W1.2 Call (763) 572.3604 for Permit Fees if mailing in application or Fax to 763-571-1287 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 Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ Q 7. ®�Al 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 [ ] STIPULATIONS: CITY OF FRIDLEY PERMIT N.: 2004-01890 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 10/14/2004 572-3604 k'AX: (763) 571-12117 ADDRESS : 7369 MEMORY IN NE PIN : 113024130095 LEGAL DESC : MELODY MANOR 3RD ADD : LOT 3 BLOCK 4 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DECK VALUATION : $ 2,992.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CONSTRUCT AN 18'9" X 13' DECK PLUS LANDING. APPLICANT BUERKLE PAUL J & NANCY K 7369 MEMORY LN NE FRIDLEY, MN 55432 OWNER BUERKLE PAUL J & NANCY K 7369 MEMORY IN NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law reeulatine costruction or the DSformancetuf construction. Bldg Insp BUILDING PERMIT FEE 83.25 PLAN CHECK FEE 54.11 FIRE SURCHARGE 2.99 STATE SURCHARGE, VALUE 1.50 TOTAL 141.85 PAID WITH CHECK # 9762 C JRl'AKAIt FKKMll S REQUIRED YOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ ] CITY OF FRIDLEY P- W 8 q 6J-' 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 (76 571-1287 Fax BUILDING PERMIT APPLIrATAON Construction Address: ti Legal Description: Owner Narr Contractor. Address: Tel. # b I oz -ILO 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 SWIdth PgtIGrou h Sq. Lengtht d t, Sq. -- Construction Type: �,Es imate Cost: �-"9 9c). 5? Gh Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: C1�'� APPLICANT: �PLO Qe:�kt 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 Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 $ ZZ/1,95-STIPULATIONS: Building PLUMBING Permit No.• Inspections RESIDENTIAL APPLICATION Received By; 763-572-3604 CITY OF FRIDLEY Date Rec'd: i 2 763-502-4977 FAX crcwr--rwa.t.s-na DATE J 1 n i YOUR E-MAIL ADDRESS SITE ADDRESS '-7 3 fa `j %Yl E Ih o 2 y L A Al 0 - THIS APPLICANT IS: i'A•'OWNER ❑CONTRACTOR PROPERTY OWNER/ TENANT 4 ADDRESS: 7 3 fo 9 /YI E; J &Y d, A CITY FR r r) C � y STA PHONE: '7 b 3 - -7 83 - 3(03 CONTRACTOR NAME!Te weracker Plumbing, Inc SUBMIT A COPY OF STATE LICENSE a_ ge YOUR STATE 502 E Main St LICENSE, BOND AND STATE BOND Of Anoka, MN 55303 CERTIFICATE OF ADDRESS INSURANCE PHONE PERMIT TYPE 10 SINGLE FAMILY O TWO FAMILY Q TOWNHOUSE a LIP .SS V32 EXP DATE EXP DATE STATE —w — I TYPE OF WORK: 1 Q NEW REPLACEMENT I DETAILED DESCRIPTION OF WORD PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to 5500.00; 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 5300 - $15.00. Labor cost between $300 to $500 = cost of labor x AS = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS 3500, FEES ARE BASED ON S 10.00 PER FIXTURE. EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL, NUMBER OF EACH BELOW). MINIMUM FEE $15.50 _ BATH SINKMV FLOOR DRAINS SHOWER WATER PIPING _ BATHTUB —GAS — GAS PIPING (NEED CITY LIC) SWNMING POOL WATER SOFTNER ($35) _ CLOTHES WASHER ^ KITCHEN SINK � WATER CLOSET —BACKFLOW PREY. ($[S) DISHWASHER LAUNDRY TRAY WATER HEATER (S35) FOR IRRIGATION ___ WATER METER OTHER armit Fee $ Number of fixtures @ $10.00 x $10.00 - $ lurchar a .50 Number of fixtures @ $15.00 1_ x $15.00 - $ AL DUE S OR Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = S 50 41915-501 (MINIMUM $15.50) Total_ -$ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UN7L PROCESSED I hereby apply for a plumbing 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 or Fridley and with the Minnesota Construction Codes; that 1 understand this is not a permit but on an applicationfor a permit and work is not to start without a permit on site; that the work will be in accordance with the approved pla in the of w rk��iiw-h''ich requires review and approval of plans, SIGNATURE OF APPLIC T t�.h/A. PRINT NAME CrA C.% E l'C A- 6,)L- _DATE ,�Z ( �� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley. N C* -J 55432 763-572-3604 FAX: 763-502-4977 .. Wd L£:90:C 600Z(U6 :ale(] Z2 :bBWj 6888ZLS£9L :uia� .. """'� �" .."" rrom: r0020Z0ZU'I rage: -in uaTe: 'uwzuua m-im,io /Am Building WAT. , R, A AID FEWER Fermi Inspections PERMIT APPLICA'T'ION Rece' 763-572-3604Datel' ITY' #�F FIIIDLE'"� 703-502-4977 fax B"FCCT)VE Inrny APPLICTA-TION DA'1'rt1 T'? ' OQ YOUR 13 AMAIL ADDRESS:_-- - THIS AFFLWANY IS; . ❑ OWNL•R �CC�NTAACTOR 1011 AUURC99: - - ?,3 C5 I )W IL NftW CONSTWICI'ICA PL'RMr1'# (IF AFMICABLE):...._ . PRVPgW 1 _ NAhlF;••'_ _•n _. OWNER/ ACiDiti;S9�,_ %f? ��t'{Ty TI'i.AIAN7` ._ —. '�,, • �'1fGi'dlg; _ CONTRACTOR NAM&.! Kq&A4 v 0 %' 44- f - C • No. A'l.Wrn'OeiLP. . . , .. .SURR+st7 Q CIdIPY 01" ADRSB: 'VoS- ep 9 CITY � 0 YOUR&TVArz ATEW� dP f•3c�' LfGF1YSfsWiFlf PHt)hl>: t:Rl.l.PHtN11F.:11A_V/9— 99'7. — Ci .. .4P1'�f`Gl 17t?AV STAT6 t,lG tI b+ ]G L I� l9 til %� STATU (SMD. ] ��i� 3 a j �"6 "E}a' DATE! d PERMIT TYPE rl SFWFR CONNRCTION POW S50 ....... .. �_..__ L.1 WATEIt CONMCTION PERNGT $50 A7'L' SEWER LINT? REPAIR $40 df d.° R ADD S•IATE SURCHARGE 5.50 5d i.l SAC: t;I•IA RGE+,-, Q $2000 = UT"EM +t:l• ARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WA'T'ER MG"I'ER COgl'- SEI UTILITY BILLING SPECIAL ASSESSMENTS -SEE FINANCE WATER TAP - SRF,. FNGINEF..R1NG NOTE: WATER N1I3'1'ER I7EI+AI INSI' OF, SHUT -01T / wErxi lus & HOLIDAYS $125/HOUR-BILLLD '11-11s I AN APPLICA'l'I(M FOR A PLRMI'I'-WYI' VALID UNTIL PROCESSED I herby *ply ror at water or a3ewer (ncw connection or mpair) pemiit and I acknowledge that the inthmatio a above is eamplabo and accme , that the work will be in conformance with the wthmt:es and codes of they City of Ndley, I undema d this io not a permit but 0* an applivatlon for a peri d Word is nol to stut Without a permit . SIONA'1Z)RB OF APPLICArri I%j kit 504-'- DATE:S-•-o�i' APPI OVER BY: F7 , /� y ��r rt -- - --. _.._.... DATE COPY GI E [J: LJ I'm .1TV 'I W. fnnlu it now 1121 vr• wrwvu n clue. City of Fridley Building faispectioanDepartmont 6431 Ux iversity Avenue N] , Yridleyr MN 55432 763-572-3604 FAX: 763-3024977 P UIJ x Ali:): 1061 Building BUILDING Permit No.. —'d` 01 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY D PT 0 R _1 763-502-4977 FAX $ L EFFECTIVE 8-19-09 _ DATEJo— l 'CD A Caf✓�t v SITE ADDRESS -7361 morl Lea4 �iE THIS APPLICANT IS: ❑ OWNER PCONTRACTOR PROPERTY OWNER/ ;] NAME: r0. k J cr q cl MQ H e-y 6 ,tcrkl 'L ADDRESS: 73 6 Alernt)f L.C.L A.) E7 CITYFJ� STATEMAI ZIP SSY.3d- TENANT SAC Charge PHONE: 743-7 3-3691 CONTRACTOR NAME: f Price 60n S CIo �`f �4 r i ova - 5� U e- Po' i ef STATE LICENSE # A0 6 - a 9- EXP DATE Y,,4Ar' 8 SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: -7 VyL2lo rid-e- OJEL CITY r ` Ie STATE!% ZIPSSY3a2 INSURANCE PHONE 0`- - 6 6 1 FAX PROPERTY TYPE ISINGLE FAMILY/NEW CONSTRUCTION SIZE XS Sewer Main Charge ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE WADDITION ❑ GARAGE/SHED ❑ WINDOWS $ 14(o. ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ,'ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: % 44',,,)A - L- .n'-r, SIZE OF IMPROVEMENT / I LENGTH WIDTH 6 HEIGHT SQ FT 30 ROOFING NUMBER OF SQUARES firliOUSE ONLY ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Man GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: — ❑ DETACHED GARAGE 1 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 0ther1 A (rccf e aCr 13 Fascia �¢ 1 � `� and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes 040 LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED �— NUMBER OF WINDOWS r ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) '1'U'1'AL JUB VALUAIIUN UCUUPANUY 'I*YYL Permit Fee $ See Back Page for Fee Schedule Plan Review $ L 65% of Building Permit Fee Fire Surcharge $ , 740 .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ 'S'00 $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 $ 14(o. 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 on site; that the work will be in accordance with the approved plan in the case of all work which requires review d approval of plans. } SIGNATURE OF APPLICANT, 1\ . ��1.� PRINT NAME � _f U 2 v� Pr' ICP DATE l D - t/ 0 1