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PRE 2010 DOCSsue�Ecr IT NO. City of Fridley 2490 9 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. � I T CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 3/20/9 JOB ADDRESS 871 Mississippi Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 2 I Meadowlands Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Vern Gustafson 871 Mississippi Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Up Top Construction 2203 N Ferry St, Anoka, MN 55303 422-8785 7712 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 6 DESCRIBE WORK Reroof House & Garage (20 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 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 1 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 $1,650 $.83 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 PROVISI S OF OTHER STATE OR LOCAL LAW REGULATING CON- SC $1.65 STRU ION 0 T E P OR F ON TRUCTION. $54.00 re PLAN CHECK FEE OT L FEE Lice SC .00 $61.48 SINp UREO OWRA,TORORAUTHORIZ AGENT IDATEI W N A VALI A D THIS IS YOUR PERMIT ' •► _ SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) BL )NSP BATE NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ( l BUILDING PERMIT APPLICATION ( C7 �7 ConstructionAddress: F71 0o%1s5 ISS 1_,,4 P / Legal Description: / OW Owner Name & Address: rye �i �,> «Fs a „i Tel. # Contractor:®�srr'ue- T o-✓ NIN LICENSE # % 7/a Address: o?o 0,3 Tel. # -2 — P %P� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF 114PROVEAIENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Len Width Hgt/Ground Sq. Ft. OTHER: O Construction Type: Z& Estimated Cost: $ (Fee Schedule on Back) &951 uLV Driveway Curb Cut Width Needed: Ft. + = F = $ DATE: 13'- c;Lo - 9 7 APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ !`V00 Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) Tel. # jl gg $.50/$1,000 Valuation $950 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 'University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLFI1 nN FACN Ft nna Effective On January 1, 1997 NORBLOM PLUMBING CO. DBA VENTCO/APPLIANCE INSTALLERS (812) 827-4033 2905 GARFIELD AVE. SOUTH MINNEAPOLIS, MN 55408 **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. JELLETT KIM 871 MISSISSIPPI STREET PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_ FRIDLEY MN 55432 , H 572-2379 W 5'71—CM New Fixtures $ 7.00 The undersigned hereby makes application for a permit forthe work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated In this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 ,1997 Water Treating Appliance $10.00 000 C b Owner J a Water Heater —Electric $ 7.00 Water Heater — Gas** $10.00 1 0 Building Used As Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost n PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING O AN A MF,�PLS Reinspection Fee $42.00/Hr SIGNED BYAl TEL N0. R7� 33 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough—In Date Final Date State Surcharge .50 MINIMUM FEE F R ANY PLUMBING GAS PERMIT IS $20.00 TOTAL FEE $20.50 PLUS THE $.So STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. c�J CL e- cu C4 r� U) cv cy CEJ CIT`! OF FRIDLEY INSPECTION DIV, 6431 University Ave NE Fridley, MN 56432 572-3604 RATE SCHEQULE, n APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Vdork, Burner Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others,'iepairs & Alterations (LIST ON BACK) 1% of Value W Appliance or Work Commercial/industrial 1.25% of Va I ue of Appliance or Work Rate $ 30.40 $ 14.04 $ X0.00 $10.00 $ 25.00 State'Surcharge TOTAL FEE Effective On March 1, 1996 JOB ADDRESS�� � '�� g�►�� \ �D� � S'lt• dU(� The undersigned hereby makes application for a permit for the work herein TOTAL. specified agreeing to do all work In strict accordance with the City Codes ar $ 60 rulings of the Building Division, and hereby declares that all the facts and .M repmentations stated in this application are true and correct, MINIMUM FEE FOR ANY HBATIN94n,-QPUtVGNENTtLATION REFRiGERATINAIR CONDITIONING PERK IJ IS 25.00 PLUS_7NEA-50 STATE SURCHARGE REINSPECTION FEE $42.04/Hr "Air Conditioners can not be placed in aside yard without written permission from adjoining property owner. OWNER��Oy %/- �C,2C BUILDING USED AS_ V fie\\ 2� ESTIMATED COST Co PERMIT NO. ME-Sr-WTION OF FURNACE AND OR BURNER No, of Heating Units Circle One (St Trader Name QzT— n BTU S, ®©�� HP am) (Hot 1^later(A�ar,l Size No. 4V\Q _ EDR Fuel Total Connected Load Burner Trade Name Size No, BTU HP _ EDR HEATING COMPANYX�+��� Sig�i�TB Tel No. - �p Approved By Rough -in Date Final Date FILL OUT BACK SIDE STACK VERIFICATION ON REPLACEMENTFUR ACE AUG -23-1996 13:22 C I T 1 ;_IF F F. I DLL 612 571 1287 R.02/02 Remarks: List ,ALTERATIONS Being Done HEATING CO: Signed By: iV I'wv ✓ Date: C", 0.0 Q TOTAL F.02 t.o11. Y AND STACK 'VERMCN The undersigned hereby verifies that the existing ch mazy or stack: I. Has been carefially examined Yes Z� No 2. Is free from . rust or deterioration Yes -4 No 3. Has no foreign, objects lodged within Yes No ( } 4. Is securely supported Yes 1 No 5. Meets all current Code requirements for size and total BTU's connected Yes) No ( ) �. 6 t Has total heating BTU's of�®C� All other BTU's TOTAL, BTU's \ La1_0C� 0 7. Inas a liner been provided for water heater (y -A ,INS Yes No ( } S. Has combustion air been provided for water heater Yes No ( ) Remarks: List ,ALTERATIONS Being Done HEATING CO: Signed By: iV I'wv ✓ Date: C", 0.0 Q TOTAL F.02 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On March 1, 1996 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS, (= ife, aEC_Vt__3 New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 �Olt � 'f59� Sump/Receiving Tank $ 7.00 JELLETT, KIM Water Treating Appliance $10.00 Owner 871 MISSISSIPPI STREET NORTHEA Water Heater -Electric $ 7.00 FRIDLEY, MN 55432 Water Heater - Gas** �_ $10.00 Building Used As (612) 572-2579 S i 1 — 69P_6 Gas Range** $10.00 Gas Dryer** $10.00 / Estimated Cost PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY 11-15 Reinspection Fee $42.00/Hr SIGNED BY TEL No. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved ByRough—In Date Final Date State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $60 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES. N o1 �o C)z N&D Wo >a IL"W s <V -U- J im®Z Z �� m D SUBJECT PER City of Fridley 27754 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. _ r PROTECTIVE INSPECTION SEC. F , NUMBER REV DATE 9/14/98 PAGE OF APPROVED BY = CITY HALL FRIDLEV 55432 612-571-3450 910_F15 10B ADDRESS 871 Mississippi St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED 13 2 Meadowlands Addition SHEET DESCR. 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Roy & Kimberly Gillette Same 55432 572-2579 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 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 8 DESCRIBE WORK Reroof house & garage (17SQ) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd Layer but not the 3rd. 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,456.00 $.73 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. $48.50 Fire SC $1.46 PLAN CHECK FEE TOTA EE SI NATURE OF CONTRACT R OR AUT RIZED AGENT IDATEI N ROP VALIDA E NIS IS R PER L� ' iDATE �GNATURE OF OW NE �i OWNER BUILDE'I I ATEI_� BL INSP NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Ix BUILDING PERMIT APPLICATION 2- ConstructionAddress: Legal Description: C� Owner Name & Address: ( Tel. # 5-7a-as7 1 Contractor: MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Estimated Cost: $ S (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE:qAPPLICANT: Tel. # -�-a aS-7 4 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL . STIPULATIONS: CITY USE ONLY $ Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1000 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 [ ] CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Effective On May 10, 1999 Fridley, MN 55432 APPLICATION TOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESSr� RATE SCHEDULE OWNER `�'1��� Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED Also Replacement Furnace $ 30.00 . $ r /L (Side Vent - Fill Out Back) ESTIMATED COST 1 �� PERMIT NO. / O Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 Gas Dryer $ 10.00 "Air Conditioning . All Sizes $ 25.00 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.251yo of Value of Appliance or Work State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr 6xAir Conditioners can not be placed in a side yard without written permission from adjoining property owner. No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name •_ Size No. BTU HP EDR $ Fuel_.__ Total Connected Load J Burner Trade Name Size No. $ BTU HP EDR $ 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 ar $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 261 RAPQS SOUMAJW C N RAPIDS. MN 65433 �c�^1-c�1((lil HEATING 12 757-5040 ' Signed Approved ByRough-In Date Final Date All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks List ALTERATIONS Being Done: HEATING CO: Signed By: Date: DEPENDABLE INDOMAIRQUALITY.INC. gig 2619 COON RAPIDS BOULEVARD COON RAPIDS, MN SW33 (612)757-5040 CHMINEY AND STACK VERIFICATION - t , 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 ( ). -No (' ) 5. Meets all current Code requirements for size ' and total BTU's connected Yes O No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes () No ( ) 8. Has combustion air been provided for water heater Yes () No ( ) Remarks List ALTERATIONS Being Done: HEATING CO: Signed By: Date: DEPENDABLE INDOMAIRQUALITY.INC. gig 2619 COON RAPIDS BOULEVARD COON RAPIDS, MN SW33 (612)757-5040 ­V- SUBJECT City of Fridley 3 213 6 AT THE TOP OF THE TWINS BUILDING PERMIT r REC . COMMUNITY DEVELOPMENT DIV. 15-6 61, f PROTECTIVE INSPECTION SEC. 672-3604 1 CITY HALL FRIDLEY 55432 NUMBER pEv DATE vAGE OF AOPROVED Br L „ 612-571-3450 910415 9/5/01 JOB ADDRESS 871 Mississippi Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 2 1 Meadowlands Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Roy/Kim Gillette 871 Mississippi Street NE 763-572-2579 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same A 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 O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reside House & Garage 9 CHANGE OF USE FROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. 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 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 PLAN CHECK FEE TOTAL FEE $46.65 TMORIZED AGENT IOATE. S,GNATUREOFCON 'AACTOR4-UIL01 WH PROPERLY VALIDATED THIS IS`YQUR PERMIT NATURE OF OW NER R� tOATE. OG iNSP r�At ­V- NEW I ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 5`J �S�I 1 Legal Description: Owner Name & Address: Tel. # 7a 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 Sq. Ft. Length Width Hgt/Ground Sq. Ft. Construction Type���� I1�I �� Estimated Cost: $ 1 Drivewaay Curb Cut /Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: ` J r 1 APPLICANT: XTel. # CITY USE ONLY - _Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application S�o2-o2S�79 r- $ . Fee Schedule on Reverse Side $ Z, O .001 of Permit Valuation (1110th%) $ 610 $.50/$1,000 Valuation $ $1150 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 [ ] $� From: 7637177228 Page: 617 Date: 1/24/20061:58:09 PM FROM :CHICILO HOMES INC FAX NO. :6516:339692 Jan. 24 2966 02:42pM P6 91/24/20®6 12;41 7637177228 FISHMLG REALTY PAR ld:)i9b Building Inspewous 763-572-3604 'A'tT SITEADrnt, O THIS APPL "*47 !& PROPaERTX Ott 77,NANT RrMLDING RESIDENTIAL APPLICATIO" CM OF FRIDLEY Femit No.:.. Rweived O:.. Rweived B;r Date Reo'd-' — G ovim WWN7WACTOR ?41tJ AJ)DRFSS: aiY 3TA•C2_ —ZIP — SUB= A CDPV OF STATA Y OUR $TATE t3CMM AMM I WrM APPUC;ATION roots DEscME'9VORK s=Nt1 r;jiV E?R Of SgJAM --•^�— PROM 6zi� PROPMO RRMT: ^ �_ 111 dMaw uo, IN oasTmao Ot NINGs *ta CM npMr4ocHAN=& D - purr Rmview Pue Sutoharde wcbwp Lica pose 6s u-ge SAC CbM9 Cvzb Cut Lsomw Pack Fee Sevim Adam Charge IN." MV K TME 0-4imt Y evISo w.w' $s OARA[,E 1�1�—�' �, AMM.AROUSE G ATf6GliS4? OARAGz 2 F aPOi� �PtiO ODETACUD40ACM ,. Ctrtof eetibeRvtabatim! FOR '.agw C'oILwRtIt:IItR vcwonlo flECKS. ft Dim � 1r3� di?�R !. tJ��nga+raC?.�ee wirm u ¢fie L Vol=. r o afeo xoerllme y iRnvue nc 16twY'1aIC wt .•tom" } 8. Finagyt7d�whuwn U34vm 61% ofBntidh*PMaitPOO A41 tttt�e the tat�i jot��siwsdon AQG5 x Permit Valuratiaa D$aaii:aur+SSC' — Eg,QO (gmu F.icmeed Raaidat ttsl Cor ftdole) EIS50 prr SAC Vail (Plana to U1wcc ft de0uft4t19* Ik}62- 8:e 320=S— '�� $430 Gasteax+�tt� Flan'Qtview Fec Vew"hod by 8agitt !A2; A¢eeetoeat �xsaeTy ( ) 'Non'��szsY{) 'I'gty � AS! APP TION I�piiA �'aspiYALiD LIIV77L P I haaeby apply far n tnuldialg q owledga that tha iftftn adon ebave is ca•nplem and acauaW; that the --,kwill be iIL n t Og£Ota�nea with the a dtnanaes And wdcsrgsslthe. Cirf of d wpr4 fs nottosmart wiRd wtlroout a peam:it; tbat the work vM 1 be in 1% The mi=osos cc-s=rjop �madord rhisP�e4 prsaat but cniy art appliaatlotl Cor a petmi ¢gpevei ofplaes G�,LL� I^—p � b plea in the cut of a�� ��_ SMNATURE of ArPL]CANT JRPAYNT From: unknown Page: 1/2 Date: 6/1/2006 3:40:25 PM Building PLUM13ING 1'erazit No.:, - L - Inspections RESIDENTIAL APPLICATION , }Recteivad By: 763-572.3604 CITY OJT F RiDLEY Date Roo' d: e '� YOUR E-Iu AIL ADDRESS erre AMR$S$ _ '7'/ rr115 AMICANT IS: ❑ OWNER eTna OWnR/ TKNAM' — � 54,/_`x. / G'ITY f G � STATB zu! Z 3eZ STATE i1CBNSls 8 'Y W2 DATE % �O StJbMfl' A COPY OF vO(YR Si'aT,�1E.�.� ADDRESS• -y i _ �� CITY-`�5' ST'ATF&JZtt' LIMSE1�61M pRortE`� `�' -f [ rAx_7�-4 APPUCAT10AT - -- p .R5UT TYP1E I fUMLE FAMI,Y M TWO FAMILY 0 TOWMMUS5 TYPE OF WOtiK i 1 o NEW OF WORK PERMS 16B665 the permit to is a minimum of S] 5.00 or 5% Of Llic tatal cost up to 5500.00, Wkichovor is mar, tar the iMFVVeme 4 lMtMWM Or replaeement of a residwdal fi tt wo, excluding the ALe ms. (This should r6 lM onlry the wet of labor) Labor cost under 5300 - S15.00. Labor cost Irerwcen $300 to 5500 _ upia of labor x .OS FOR MRDYl:C tS VMME LABOR EXCEEDS $500, FEES ARE MSED ON SJ 0.W 3' A FlXhME, EXCM WMM NOTED. FMIMM: ([WCALF TOTA[„ F.8TH �x/L.Av 70A FLOORDRAIN$ MOW12A WA'Y'Ek MING rMI is GZO:RR=S WASiiEK OAS MING a crrr=" j KITCHEN SINK. yoI'IwAUNG POOL — WATER. CLOSUr WATER SOF'fN13Ii, (05) I DiSHWAMM _ LAUNDRY TRAY _BACXFL ,-,YATBR DATER (t:SS) )W PREY. (SIS) FOR MMATION _W4T1BRMUr9 t _o7HER Permit Fee . 5e�,00 gCM�—'1 Numtyar pf fixttues (a $ I O.00 „x 60.00 - $ 0 'Number of fixtures $15 on x $15,p0 TOTAL DUE C?„ S _ ._ Number of tixturoa 535.00 x $35.00 = $ • Stabs Surcharge � a TWO t TJ US TS AN,APPL .CA*IMN FOR A Pt33MT NOT VALID UNTIL rxMMW I hereby apply for a building pelma and T aclmowledto that din iaformati & above is complete and eccundc; that the work will be in aenftmnance with the ordinances and codes of the City of Fridley and with the Mirme80ta Co»tcdon Codes; that I understand this is not a permit but only an applic* for and work is not to SW.FWt�htout a pMnit; tihttt the work wit! be in woordwioe with the approved plan in the case o;j;; W4fah r u = roview and approval of plains. — SIGNATURE M City of Fridley Buildhag bspectiow Departtxten't 6431 University Avenue h44 Fricft, MN 55432 • 'l63 -S72-3604 k'AX! 763-502-4977 U WdOS : z0 'W02 02 'RL'W 1_8Zti T .�3 -bN M-4 RalpWq 40 8410: WMIJ Building BUILDING Permit No.: Inspections RESIDENTIAL APPLICATION Received By. 763-572-3604 CITY OF FRIDLEY Date Rec'd: ( 03 DATE'S r YOUR E-MAIL ADDRESS SITE ADDRESS d WI -S 5 -XS t THIS APPLICANT IS: ❑ OWNER -CONTRACTOR PROPERTY OWNER/ NAME: Sb+SG'� Gv P, L�J Z TENANT �^ ADDRESS: $� ( U'�: S St Si,Pr/ i S� CITY FV ,,^�6 i icy STATEP PHONE: CONTRACTOR NAME: AU — Jce"."'df ou SUBMIT A COPY OF STATE LICENSE # t) -O 1555 / Xq EXP DATE �� I YOUR STATE LICENSE ADDRESS: PC Lo(:o.'). CITY STATI�+"ZIP WITH APPLICATION PHONE �(o� -335-5 FAX .6 I -W -658j PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYNEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ,'BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR 4 REMODELING DESCRIBE WORK BEING DONE: I%� SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT JI Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 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: (USING THE 19977 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 11 UOU OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ 05-- 1 Cl $ 1,00 $ 1-50 $ ��®O ,4444 See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks savable to: Citv of Fridlev Attac 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 odes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicationfor permit anwork 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 a est wand approval of plans. / SIGNATURE OF APPLICANT PRINT NAME � `� f DATE 6 r� r esc t"'TanauLty Flvu� %a --,Fhw��Nc� C*l'�1 —pa �(04wb Pot, "I �r a M^ � � 1(`f S� s q res l r. +.r e a i i4✓2 A`S