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PRE 2010 DOCSVillage of Fridley, Minn. 123 BUHMI ATG PERMIT N° 3 Oflfice of INSPECTOR OF BUILDINGS Owner Architect Fridley, Minn., 19 Builder .�� LOCATION OF BUILDING No. " Street of Lot Lot Block " Addition or Sub -Division — &:!t� DESCRIPTION OF BUILDING ' Front Depth Height Storie Mannerof Construction ' �'" t''r�'"" OW V To be used as iL. To be complete„ Estimated Cost °•� Permit is hereby granted the building described in the above statement. This permit is granted upon the express condition that the to w di n it is granted, and his agents, employees and workmen, in all the .work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., regarding . the construction, alteration, maintenance, repair and moving of buildings within the city, limits, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. . of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the' Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit.are true as therein stated. Subscribed and sworn to before me at Fridley, Minnesot nthis day o A.D. W,% CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL ` RATE TOTAL Job Address A2-- 1. Furnace Shell a Burner (Also replacement furnace) $ 20.00 $ Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 9 Gas Piping � - $ 10.00 City of Fridley Tel. #571-3450 (piping needed with neo furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 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 $ J Fridley, Minn. 7 19 L�-� All Others/Repairs and Alterations OWNER �fA L 18 of Value of Appliance or Work $ KIND OF BUILDING COMMERCIAL/INDUSTRIAL USED AS �. 1% of Value of Appliance or Work $ 70 BE COMPLETED ABOUT / G� - / •S ESTIMATED COST State Surcharge $ .50 NEW BUILDING PERMIT NO. PERMIT NO. TOTAL FEE Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough Insp. Date ( HEATINGr POWER PLANTS, Steam, Hot Water, arm Aim- No. / �`- Final Insp. Trade Name e Size No. All /J�/ - -? Date Capacity Sq. Ft. EDR BTU /GJ/�,' HP Approval for Permit Total Connected Load -'� ��-, nd of Fuel —V BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP 0 _ MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 Company PLUS $.50 STATE SURCHARGE Signed ByLx Tel. No. ,!-75 -7 *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Fill out back side for stack verification on replacement furnaces CITY OF FRI DLEY APPLICATION FOR HEATING REPLACEMENT CHIMNEY AND STACK VERIFICATION THIS FOR14 MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM. m � LOCATION 0 I,., ATE r' OWNER __I_—? ADDRESS The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined f/ 2. Is free from rust or deterioration 3. No foreign objects are lodged within 4. That it is securely supported 5. That it greets all current Code requirements for size and total BTU connected 6. Total Heating BTU /,�'Ia, c> 0 All Other BTU TOTAL REMARKS SIC by Address52 Telephone ® -7 ; HEATING PERMIT # Fridley City License / EA SUBJECT City of Fridley 8 aNOT AT THE TOP OF THE TWINS BUILDING PERMIT r . • _ COMMUNITY DEVELOPMENT DIV. � SEC. r � PROTECTIVE INSPECTION 1 � � CITY HALL FRIDLEY 55432 REV DATE OF APPROVED BY 612-571-3450 rUM98ER 10-Ft5 5/19/00 ;GE / JOB ADDRESS 411 Mississippi Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 2 Rice Creek Terrace Plat 1 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Andrew Molitar 411 Mississippi Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings Contr 6331 Riverview Ter NE, Fridley, MN 55432 763-574-9966 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 4051 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE B DESCRIBE WORK Reroof House & Garage (18 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 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 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 $.79 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,573 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 Fire SC $1.57 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $57.05 a PLAN CHECK FEE T AL FEE Licens $5. $64.41 SIGNATURE OF CON TRACTOR OR AUTHORI G AGENT I ATE. HE VALI AYtO THIS IS YOUR PERMMIIST /P/ROP V� SIGNATURE OF OWNE R, IF OWNER BUILDERIIRATE, BLQt INSP BATE EA 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 0004 Construction Address: "�// AAe SS S S / r S Legal Description: Owner Name & Address: AAN) 9 w L� T'i Z- Tel. # Contractor. -iZ:, c k A iZ n �4 As -r, we S MN LICENSE # C) S / Address: 6 33 , ;:�, fiZ J .` t ,-) TFZ, Tel. # S 7 1� -!FY 6 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: Construction Type: / `A-iL © FF A a r Estimated Cost: $ 173 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ 6 DATE: -5 / ovo APPLICANT: Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee Fee Schedule on Reverse Side Fire Surcharge $ 1, $�� .001 of Permit Valuation (1/10th%) State Surcharge $ `7�i' $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge $ S- ® $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 $ t a 7 -/-/-/ STIPULATIONS: CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Relidential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fep Total $35.00 $ $10.00 $ $10,00 $ Gas Dryer $10.00 $ *Air Conditioning- All Sizes $25.00 All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of improvement whichever is greater on work less than $500.00 Commercial/ Ind ustria I/Ins ti to tiona I 1.25% of Value of Appliance or Work (List on Back) Minimum -Foe $35.00 for CommerciaVIndustrieVinstitutional JOB ADDRESS I YY l I Sr��S51I✓�0� I r� ��I� Owner Li � sa i -/A r(NkA n Building Used As ESTIMATED COST [ , W -D " 0 b PERMIT NO ff of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU HP Size No. 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. State Surcharge $ .50 HEATING 00 ZiV�Y Ci:Lj r'� 6Y" -X het TOTAL FEE $ 25 u Signed Tel -7OL--7Sq2/gq REINSPECTION FEE $50.00/1-10UR FAX 6 Date C013 6 05 *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACs( SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date 0 Building MECHANICAL Permit No.:. - Inspections RESIDENTIAL APPLICATION Received By: Al 763-572-3604 CITY OF FRIDLEY DafndJUNO 763-502-4977 FAX EFFECTIVE 1-1-08 DATE YOUR E-MAIL ADDRESS C' 1� [N }lit I•Cd� SITEADDRESS y�� /y1i13 S1t��Sr NL THIS APPLICANT IS: ER ❑CONTRACTOR PROPERTY L NAME: I K ,)P -e✓' OWNER/ ADDRESS: �/ I ( M • S,: S) � ; S f NC CITY FiCJ l cO STATE ZIP "C`13�' TENANT PHONE: 65 ( '/� Z - �23 / � CONTRACTOR COMPANY NAME: CONTACT PERSON: NOTE: SEPARATE CITY LICENSES ARE STATE LICENSE # EXP DATE REQUIRED FOR GAS AND HVAC, ADDRESS: CITY STATE ZIP SUBMIT COPY OF BOND PHONE FAX ANDINSURANCE PERMIT TYPE 01SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK' ❑ NEW ❑ REPLACEMENT ..ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK PER MS 161B.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 ) OR 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) Equipment Installed MFG: MODEL: SIZEBTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZEBTU $25.00 (GAS) $15.00 _GAS RANGE/OVEN $10.00 _A/C _FIREPLACE TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00 _AIR _FIREPLACE $35.00 $35.00 _GAS UNIT HTR $10.00 _BOILER _FURNACE LINER $10.00 DRYER $10.00 _POOL HEATER $35.00 _CHIMNEY _GAS DUCT WORK $10.00 GAS PIPING $10.00 _VENTILATOR $15.00 1 MI -11 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ ge=$ 50 MINIMUM $15.50 M IMUM $15.50 otal = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical 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. SIGNATURE OF APPLICANT PRINT NAME - 6 ,F- DATE APPROVED BY DATE R City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building $ BUILDING Permit No.: a�0 Inspections V611 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-57Z'=3604 Surcharge CITY OF FRIDLEY DVS' 763-502-4977 FAX $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) EFFECTIVE 1-1-08 $ DATE (� _ �� 0 YOUR E-MAIL ADDRESS SITE ADDRESS St /VL $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering THIS APPLICANT IS: R ❑CONTRACTOR necessary( ) Non Necessary ( ) PROPERTY OWNER/ NAME: C .��ltr� ��n�t v,.� Li(U16 /Make checks payable to: City of Fridley Attach Stipulations TENANT ADDRESS: CITY Ole. STATE fWZiP i -!y�� PHONE: 61-1 I CM2 '31 19 NAME: ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES I �/2 PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED PIWINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING JAOTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION OA inoN ❑ MAINTENANCE/REPAIR '.REMODELING DESCRIBE WORK BEING DONE: AcAcl +u, Skd, ti„� �Nc.. , �s�14f•�►^� 15)W .tu?+<K SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used. PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS. & PORCHES SUBMIT: ❑ Vinyl ❑Soffit I. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS XYes []No LOCATION OF WINDOWS S,& OR FOR NEW OPENINGS -DESCRIBE SIZE OF jt°i td-LNN Aavt S&W a,I �I OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED j�ir�t4a'n Iy^+� NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $_�� OCCUPANCY TYPE Permit Fee $ � 0) 5 See Back Page for Fee Schedule Plan Review $ V611 65% of Building Permit Fee Fire Surcharge $ o .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 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 $ Li(U16 /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 wi be in accor�ce with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE 1 ANT moi, PRINT NAME a:�V /l c�, H DATE I 10 rvf-7�0 APPROVED BY DATUn 7i 3� Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received BYAW 763-572-3604 CITY OF FRIDLEY Dat ec'd: 763-502-4977 FAX EFFECTIVE 1-1-08 11 IKI nn DATE YOUR E-MAIL ADDRESS sm ADDRESS y11 Ar04)&i ,Tr -4 THIS APPLICANT IS: EfOWNER OCONTRACTOR PROPERTY NAME: left ti, OWNER/ ADDRESS: �/// /h. jj'*D"7 Si' IVC CITY 1 ni df _ ' STATE r'*WZIP TENANT PHONE: S y2 "��I `t CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE . PHONE FAX PERMIT TYPE --S?NGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW -r.-REPLACEMENT DETAILED DESCRIPTION OF WORK Alta S. —Q sk�kj'�s �'-( Zp� /2'V&. -,/ 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 = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. BATH SINKILAV DRAINS _ SHOWER —WATER PIPING _ _FLOOR _BATHTUB GAS PIPING (NEED CITY LIC) _ SWIMMING POOL —WATER SOFTNER ($35) WATER CLOSET BACKFLOW PREV. ($15) _ CLOTHES WASHER KITCHEN SINK _ _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER m mom Permit Fee $ k. WKw Number of fixtures @$10.00_'Cx $10.00 = Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ OR Number of fixtures @$35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = $ 50 (MINIMUM $15.50) (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL 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 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 and approval of plans. C CI SIGNATURE OF APPLICANT PRINT NAME%/✓-u�"' DATE APPROVED BY DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building MECHANICAL Permit No.: InspectionsRESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY Ked 0 0 0 763-502-4977 FAX EFFECTIVE 2-19-09 DATE YOUR E-MAIL ADDRESS c SITE ADDRESS �,/t I H/ S . i s m� ►C c �� �� 1'�� �( THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERNM TYPE TYPE OF WORK.. NAME: i-1 L ( 1 -%-%& K a® �✓% .rvn 0 -- ADDRESS: q I I )+'" CITY J � STATE MV ZIP, COMPANY NAME:_ CONTACT PERSON: In i' P rT L E cl STATE LICENSE # EXP DATE ADDRESS: ,-0/ ® Q_t St t" CITY Feu t c I STATE H -ZIPS �� L PHONE -716 � 7 T4 Jl 4 4 FAX ZrSINGLE FAMILY ❑ TWO FAMILY ❑ NEW "(3 REPLACEMENT DETAILED DESCRIPTION OF WORK ❑ TOWNHOUSE ❑ ALTERATION/REMODEL *-LA 4v_ FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: 12vy P MODEL: LIG P_ 1-- Off. SIZEBTU 6 MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGEIOVEN $10.00 AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOILER $35.00 5FFURNACE $35.00 _GAS UNIT HTR $10.00 LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 _CHIMNEY DUCT WORK $10.00 — GAS PIPING $10.00 _VENTILATOR $15.00 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. SIGNATURE OF APPLICANT l_ � k l,) ✓ C- &g rC PRINT NAME Q LN if DATE % c7 '.3 - n c% City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 I )L3D-a-7 j Building $ BUILDING Plan Review Permit No.: OT Inspections Fire Surcharge RESIDENTIAL APPLICATION .001 times the total job valuation Received By: ' 763-572-3604 .0005 x Permit Valuation Minimum $5.00 CITY OF FRIDLEY $ Dat 763-502-4977 FAX $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ EFFECTIVE 7-1-2010 $ $450 Conservation Plan Review Q DATE 9-10 — 10 YOUR E-MAIL ADDRESS Fee Determined by Engineering SITE ADDRESS 411 MISS T5S i pp j S+. N E Agreement necessary ( ) Non Necessary ( ) THIS APPLICANT IS: ❑ OWNER CONTRACTOR a a . Q —7 Make checks payable to: City of Fridley Attach Stipulations PROPERTY OWNER/ NAME: C ky l e r + A e (i S S c+ 144 0" h Yna n ADDRESS:: L411 .M i S S ► ) . CITY Fr rd U W STATE /Ill ZIP Sb`Na a TENANT PHONE: 6$ J g a a 3 l 9 SI NE CONTRACTOR NAME: 1 yt 8 0 W CO V\Ct.� �-S STATE LICENSE # o'Z (P 3 L1'9 EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: '7 90 L O ne Oct K 12 d //q CITY C �q a h STATE 1AUZIP �S�a l♦ INSURANCE PHONE 651 c705 O l 0 5 FAX PROPERTY TYPE XSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ACWINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ArmAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: Ve p la CA. W71 p a O w S Ih 2'K't S } i r, o one n7 r%% S SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: 1 S+-oti r 5 INCLUDING DECKS, SIDING ❑ Vinyl { ❑Soffit A 3 �r0 O Y1'�. FOR NEW CONSTRUCTION ADDITIONS, &PORCHES SUBMIT: ❑ Aluminum [3 Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia a L 5 � dro oma 2and proposed project. . Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS )(Yes ❑No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & N a Ls TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: ' J (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ NI D // • U O OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $5.00 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ a a . Q —7 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 g-w�o_rwk whi r wires review and approval of plans. SIGNATURE OF APPLICANT J"`� PRINT NAME --- --- --------- ----- --- err -oar -rte— -�4—T= � �� PLEASE NOTE: SEPARATE PERNOTIKkiR REOUMED FOR PLUMBING, ELECTRICAL AND MECHANICAL`WORK I