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PRE 2010 DOCS01 SUBJECT P City of Fridley 2 05 7 6 THE TOP OF THE TWINS BUILDING P E R M I T Ir? i � ECEIPT NO. � 4 COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1-000 r � � i NUMBER REV. GATE PAGE OF APPROVED BV = CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/10/90 JOB ADDRESS 1645 Mississippi Street N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 2 Clark's Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Thomas Hronski 1645 Mississippi Street N.E. 572^0815 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 j] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof, Dwelling (20. Squares) Tear --Off 9 CHANGE OF USE FROM TO STIPULATIONS On all new roofs or tear -offs and replacement roofs, State Code requires that 2 layers of 15 ib. felt, mopped together, be installed to a point 24 inches up from exterior wall line, or the use of other approved underlayment membrane. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND "VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,000 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $25,00. STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $25.50 SIGNATURE OF CONTRACTOR OR AUTHORIZ AGENT IDATEI 0JHEN PROPERLY VALID THIS I� YOUR PERMIT 7� gyp' G IN r;A TE SIGNATURE•F OWNER IIF OWNER BUILDERI I TEI 01 NEW [ ] Effective 1/1/90 ADEN [ ] R-1 AND R-2 ALTS [ ] Building Permit Application Construction Address: ."2k'6 Y,-\ �SSISStV--- Kl 'e . Legal Description: Z n % r %�� (, ,R 's �/ l �9 A L, Owner Name & Address: 7T 4 C� +--, Ac--" Tel. # 5 7 Z O S IS Contractor: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DF.SQt=oK of II4PROVENEORP LIMU AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Width Hgt/Ground Sq. Ft. arty: L�amu'_ O,'.:.. U Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback =5cle°Yard Setbacks Type of Construction: _-2 c7 �� �i 13 sA F.stjmatecl; Cc�st''� $ J. OCA Approx. Ccepletion Date: Proposed Driveway Width If New Opening Is Desired",,* $ $ W + 6' See Back Page DATE: / D O APPLICANT Tel. # 572--o �/ S Permit Fee State Surcharge SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ STIPULATIMS: CITY USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT a usi d O u b •� a m o� N o� b a ae. O� A N o w 01 O W b pM O w G C N m u a� u N g�gEE W o m a s w w K u M N ar YI ci ►� t o water Heater as lec $ Old Opening, New Fixture g 1.50 $ Beer Dispenser $ 4.00 $ � $ 5.00 $ 1 let 5.00 $ Rain Water Leader $ i $ Hydraulic Valve $ 5.00 S Sump or Receiving Tank $ 5.00 S 2nd $ 7.00 $ Not Water Heater '� $ 5.0,0 $ Gae'Range $ 10.00 $ Gas Dryer $ 3rd $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type 5 5.00 $ 4th (R) - Future Connection Opening Connected with Sewer (') - New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture g 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 S Sump or Receiving Tank $ 5.00 S Water Treating Appliance $ 7.00 $ Not Water Heater '� $ 5.0,0 $ Gae'Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type 5 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1s of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Fee $ _ ($15.00) TOTAL FEE g t5_1 S�Q Effective May 1, 1990. Job Address �lO`T� GifA�I/.//1/1���J1 , AL.�V1 )2Es Department of Buildings City of Fridley Tel. 0571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. OWNER KIND OF BUILDING USED AS TO BE COMPLETED ABOUT P/60 - ! O ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company AlleE - ROUGH INSP. Date Signed By Tel. No. (?-3/ 0103 FINAL INSP. - --2 Date APPROVAL FOR PERMIT�� 41NIMU4 FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE 1 SUBJECT PERMIT N City of Fridley 5 AT THE TOP OF THE TWINS BUILDING PERMIT r REC ' ' COMMUNITY DEVELOPMENT DIV V ' PROTECTIVE INSPECTION SEC 9-9L7r NUMBER REV DATE PAGE OF APPROVED BY I "1 CITY HALL FRIDLEY 55432 612-571-3450 1 910-F15 6/13/97 JOB ADDRESS 1645 Mississippi St NE I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 2 Clark's Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mark Gardner 1645 Mississippi Street NE 572-2205 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK QX NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 10' x 12' Shed 9 CHANGE OF USE FROM TO STIPULATIONS See notations on survey. Shed must comply with the City Zoning 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 $700 $.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- $26.50 Fire SC $.70 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $27.70 SIGNATURE ONTRA TO AUTHORIZED AGENT (DATE) WHEN PROPERLLID ED THIS IS YOUR PERMIT SiGNb4jREbFy6Vv OF NERBUI DER) IDATEI e Lph INSP MATE 1 NEW ( ] ADDN ( ] CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: l �� �� SSisSr PPS S7. i(% Effective 1/1/97 Legal Description: L. o -r 7 di -z>42 Z Cz-j-2iz s Owner Name & Address: / V I AA/Zr1 _ �,4� �,,, Tel. # S7Z - 2 2U Contractor: Q v� , z MN LICENSE Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 5S4r-- [\ x 12 - Construction 2 Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: �/13 157 APPLICANT: Tel. # S�%2-2275 CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ $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 qn STIPULATIONS: xY «., .._.. -4,. �'`Ji h� r.,-' .e ..•'. ...::`. t. iir 3•� � % • wit ua'"'s :Y Ki �,„y��"+',ka�.� ��J ., {`.�'_"��^y,.y, "'�e`(S �T-. ��,s;,..+ti• b �.rfi .-t-,• :. .&. _ .t�'i. c"N.rt. w°S ,_ ..t... �4'.�vp - _ ::ara.. �..�n,+tr4,�,: rt. _ 3 �: c ' `L �`�• o Y 7. '3. �2 - w,t,. J a. �`'ti� 'k4se „ i ;j t 3. •t Tt W:. !' a t -w F a ,p, s -r e•d„ r 7 _.: l.r. '� °�•v+-4.Nf Fri. s `z'r ,d "•s .:��a, i-�Ka S-' t! a .y7 z� % P*-.� +p •x' a t,. "C�.{Y-7'a"`d, G*.r 7 L t Y •iS$"'" d• `,t�' a�, '5. �.�'s��"711t �j `• r ;' „�},r�.,ax S ',#• r f J .. T .:_. ate! Y - : e. t ,3.i vb x- . i ` r.*I�$'''�Sr }j yiwEll, �r �g •w -,.s , F x j. r .Ry° •-rr... -r'e� 1.. z P-=c'�;:i ya t �,,,. E �.r�•"'4 T+>� T�f -.;'fit. J �•r a S�f� -ryyi �x � at�'�"•u'�;''"�'�; s �-; ��1 h " �• t: *�s � r r °£ -S , v 7 a.�r.� Y � _ n"t.. �i ,�,� k tex. ��- ?z�`�.at'g �.�'-Srra , Bond Afenn /xj 3 J •rf - r - 7 -. } h Y s T~'tt `�`^^; r t +.. rte`` °�`-g�` ". &" J(//N.�It%l� S, n4-, �` vg. '' -c,• y i' -:t'L •t ry .-'s x`+r� �.t"�� ,� �, ,••Lt+7 C �... S�{f �� � �.r, _ r t}• r ,,r :e. l is 'c`. .�^ , c, y,�, 'L 4 l';' Y G •.t } .• - RF P [[o� II''7' in t J` e t J4 .Jw 'ix4t^t .q S a a •T _ u k 7T .NJiJ.7 f�iU%�4TAt �'�..:� uJ'• ritJ�J's+`$�tl���. �fr.A�F� :.35�i�i rC'.i �,.3��,7' ' J !A � �,Y�' T %� � 1.\t •. � �q�' '(W: -�rr -11P - to �• Jar L y �7,'+,'7"s• .5•d r �n9tneerin�,, �t 'Y��tON � ! ..! .a :i Fff t^ �'�4_7P•-,R✓tai t � a. •rfi t ,."rlr s, 4ss C J,` +7Jx r! .!..•,•' a•.+ i kF�g` ��— Yil� 4 ° nA 3T$ij C lrj� r k 3 � �:�"�'�`T'+.'jX .•K !!of x y' a },c: .,`T .}� �ry ;; ��#a�„ 1 s �"�... l�F..�,.t•.Sq ''JX.i`!� e.•7 _ r z�i �'a,'" • �.��'�,.t?+� -. - '� ^•7 •F•' �" '.- , i r ,�. ° 5➢ °. �' of s .}1 i J ae ai r, }' .r '` t'�•':r r8ma `' ® a Loan, urvey �"LL tf 1fa cow' _ — _ i1 i t a ! Z•o ,f t L' y,L' 3 4 i' B 111', ,` • , . ��•' `: f Q 4' r- i� %1%?is,^ f 18 This is o /rise and co��cc/ �epnesenfo7lioh . q sur•yet1 d"Me baa7dories epi"fhe %nd obere k5u- bed and of'l�P /sw�ic� a�ol1 brnld, i 'oru�, fherr,�, avid all risible e awchimrWs, 46o .i Arbor m• Ar said 47d. &sarvY a mode arl� m cfran i 4-morf9 /anna+v. Ixin� pwced a, the p�nuerhf -7"' 7d no habil;/ Is amfu ed except k the ladder e�sorh lnwtoyr a w' Aer iAresf b fi'� 1�SArJ i s,fdr 'Mff a r "If is vriders/aad and Cynid � m' we menfs fmre Axil fV#wd fa- lf�e �r rpcse abadiut9 lc�/�ixs_ � f is: bdfed this 2:..7 1 d � c.< .< <•< r Ani��? SUeII,?8AN ENG,'NfERiNG, IIVC, — J &yincers wd Su r yors Building BUILDING Permit No.;—JJqA Inspections RESIDENTIAL APPLICATION Received By: Lf 763-572-3604 CITY OF FRIDLEY eg :r, ,A An7 DATE `i L) -Q ! (t'� YOUR E-MAIL ADDRESS W go-q\A e P&mQkpc. Corn SITE ADDRESS �t I'��`JS� cSS i PD 51 THIS APPLICANT IS: ❑ OWNER OCONTRACTOR PROPERTY OWNER/ NAME: AR'f1o, 'Ph %^^ TENANT ADDRESS:__ fi CITY STATE_ZIP PHONE: -71Q5-':-,9[0 - (001S NAME: Renewal By Andersen CONTRACTOR SUBMIT A COPY OF STATE LICENSE I!_ 1920 County Road "C" West YOUR STATE LICENSE ADDRESS: Roseville, MN 55113 STATE ZIP WITH APPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/NF PROPERTY TYPE ❑ TWO FAMILY/NEW G 651-264-4777 ❑ ADDITION ❑ GARAGE/SHED INDOWS PERMIT TYPE ❑ BASEMENT FINISH 17 ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION NTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: n , SIZE OF IMPROVEMENT LENGTH WIDTH IGHT S . Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT• GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING ❑ Vinyl ❑Soffit FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Aluminum ❑ Other ❑ Trim ADDITIONS 1. & PORCHES SUBMIT, Site Plan/Survey showing the existing structur ❑ 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 ♦ i i r.r.-rr. r+,.i. r r,r,a Aa%E bAzEu uIr vALUATIUN, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 TOTAL JOB VALUATION $ �} y U.B.0 FEECUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Due $ 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 Attar 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 conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not 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 approve plan in the case of all work w ch requ' review and approval of plans. Y �/ SIGNATURE OF APPLICANT' Ot�7 PRINT NAME�//Il/] Cp�l.?J�{(L Q71 DATE Building $ jZ, k'O BUILDING Permit NO tot Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Surcharge CITY OF FRIDLEY Date Recd: 763-502-4977 FAX EFFECTIVE 1-1-08 $5.00 (State Licensed Residential Contractors) DATE ?�o r YOUR E-MAIL ADDRESS P J rr\a'tI ' Com SITE ADDRESS It• 4 5 A%, S- sr- i i S -V N E V7'r THIS APPLICANT IS: ❑CONTRACTOR OWNERJAi PROPERTY OWNER/ pp flfl /� NAME: e—V\0L k t A { No, PGGIU e, f+ -e-, ADDRESS: lu 45 lei % SS 1 SS 1 (� ► S �- CITY T, i �l.@ lA STATL:Akh_IIP 559 3a, TENANT $ PHONE: C r (p3 i 5SU u of 5 Sewer Main Charge NAME: ADDRESS: CITY STATE: "ZIP _ CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE _ PROPERTY TYPE PLSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING (OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR I&REMODELING WORK BEING DONE: b\"&L Y�4-w mots ty`tiA IrJ�C.Q,�@�W�10 DESCRIBE SIZE. OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT. 4 NUMBER OF SQUARES ❑ HOUSE & GARAGE I. 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 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and proposed project ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS3. IN EXISTING OPENINGS ❑Yes )tNo LOCATION OF WINDOWS 90r Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & Do bLL TYPE OF' WINDOW TO BE INSTALLED V%v v+ .A 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 $ 1,1 VU -VU OCCUPANCY 7Yr Permit Fee $ jZ, k'O See Back Page for Fee Schedule Plan Review $ 01 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ e .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) {I 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 $ Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED 1 hereby apply for a building permit and 1 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 t work will he in accordance th the approved plan in the case of all work which requires review and approval of plans. SIGNATURE O A LICAN '(A.(��I; PRINT NAME A M& �C�Clld Q 4-k � DATE y 4 � _ C PLEASE NOTE: SEPARATE E ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK 6 d ;MID V,.-OL&gx- oY. $ tt��r►�o n sua r can bark. wOLU� ��4 jka �-j- P\ -L 15,;A tot , C�� J-. � "cls Rc Building Equipment Installed MECHANICAL Permit No.: Inspections MFG: MODEL: RESIDENTIAL APPLICATION Received By: 763-572-3664"• SIZEBTU ��.�� �� ��� D , 763-502-4977 FAX _ TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _AIR $35.00 EFFECTIVE 2-19-09 _GAS UNIT HTR $10.00 DATE J_- 3 — I 0 YOUR E-MAIL ADDRESS SITE ADDRESS _j (4 SeJ I�PIQ i PE THIS APPLICANT IS ❑ OWNER 'CONTRACTOR PROPERTY NAME c w 14 -111 ADDRESS:_1 V q e9 fjjS31,SQ p i a a-+ c-- CITY FAL � STATE f'?ZIP g JL OWNER/ TENANT PHONE: -7 G2 `" ' 3 9'a S -7 CONTRACTOR COMPANY NAME: CTs,, S 1� rt `E e -- SUBMIT A COPY OF CONTACT PERSON: & rIe p YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS:J-1i ../ O ` 1 t�t1 , I -iia CITY�STATE H" ZIPS&"+II'A- APPLICATION PHONE t. 1 "i S L4 J 14 b FAX PERWr TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 1 ❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: aNDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: P_y V iQ MODEL: K& Kri o L t !7 A ES SIZE/BTU-616, 04 (4 MFG: MODEL: SIZEBTU MFG: MODEL: SIZEBTU A/C $25.00 _ FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _ TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _AIR $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00 _BOILER 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 C"ILl�' ktieP PRINTNAME 01'dJ �Ri0t7 DATE s)-�- D City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 T:kUllairzo 111S70eC-[10T1,-, _5 722 - -16 0 4 TIY OF rd E 8 a 20 i 7/ -1 _1_..rte'JIM 7 6 -5 0 2 - z -9 DATE YOURE-MAILADDRESS SITEADDRESS 1,S 'S I THIS APPLIC.:kNT IS; 0 OWNER CONTRACTOR PROP= NAME: L, L TE, NAINT ADDRESS. I t E' rl i 3 k 1 5 S AQk). X, C1717-1 P& STA -,-Z t-1 tj ZIP ZI PHONTZ:--1 &,I . q:1 q - qs� -3 CONTFUCTOR NAME. Alk-rttl a 'T SUBMIT A COPY OF YOUR STATE STATE LICENSE 9 DATE LICENSE, BOND AND STATE BOND # DATE- CERTIFICATE OF ADDRESS: h6l b Sj- we CITYr,0-16?A STATE (1 ZIP� 5543 � INSURANCE PHONE FAX PMUT TYPE '*INGLE FAMILY 13 TWO FAMILY M TOWNHOUSE ME OF WORK- ONEW �IrREFLACMVIENT DETAILED E -ESM 'KNOFWORK --r-r14nj( a- 6p- L tu-,- i- WA ".0 PER MS 16B.665 the permit fee is -a minimum of S15.30 or 5% of the total cost up to 5500.00, whichever is greater, for the improvernent,,filstalladon or replacement of a residential fature, excluding the fzturm *(This shoald reflect only the cast of labor) Labor cost under S300 = $15.00. Labor cost between S300 to $500 = cost of labor X.05 = plus -50 Surcharge OR FOR PROJECTS VIM:LE LABOR EXCEEDS S500, FM ARE BASED ONSIO.00PM=rJIU7,EXCEPT V=NOTED. FIXTURES: C3NDICATETOtAL NUMBER OF EACH BELOW). MINIMUM FIM 515-50. BATH SI14X2AV --YLOOF-DRAINS SHOWER WATEREVING _BATHTUB — CAS FMING (N= CITY LIC) —SWM01MTrzP00L --WATMS0yTMM(335) — CLOTHES WASHER — MCIM SINK WATER CLOSET _BACKFLOW ?nV. ($15) —DISHWASHER _LAUNDRY TRAY \2WATIMHEATER (S35) FOR MMGA71ON —'WA= M=R OTHER MUM= Permit Fee 4 Number of I-v=es @ $20.00 x $10.00 = 3 Surcharc-re .50 Number of fixtures @ 3 15.00 x $15.00 = S OR Number of fbitures @ 3325-00 x $35.00 = S 6 6 TOTAL DUE S 'A K T6 State Surcharge= S .50 (MmsiuMUM S15.50) (MINIMUM 515.50) Total =S -2 5ZS7 THIS IS AN APPLICATION FORA PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a p lumbing 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 Fridlq/ and with the Minnesota Construction Codes: that I understand this is not a permit but a �11�v 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 approve- pl the e Of all -%varic which requires review and approval of plans. IGNATURC OrAPPL1(;1,NT KA- U k-3 9 rafTf I A M E. C, Ln, A A-) (-P 10 r)A=' BY V ;(--,--4cfler-� 7 A ding -uspecrions llpnari enr nue