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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® 3704 Date: ..s... v ...7......... Owner....................................... Builder ....................... ............ Address ...................................... Address ............................................. LOCATION OF BUILDING No. . L/ ®�.. Street .. `. Part of Lot ........... ...... . Lot ... �.... Block ........ r,........ Addition or Sub -Division .. . .. ............ . Corner Lot ... ...... Inside Lot ............ Setback ............ Sideyarrl ........................... DESCRIPTION OF BUILDING To Used as: tLG! {® V-1 Depth (� Height ®� Sq. FtRAN. Ft. 07.09. Qj�/ .................... Front . � �� Depth . A01:c®" Height . (IA—0 Sq. Ft,30 r . (m Ft. Z d. kO Type of Construction ................... Bot. Co,4 .� �' �. . ..... To be Completed ..............:... . In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above set forth and In compliance with all provisions of ordinances of the city of Fridley............. ......... .�,r. �d'10 In consideration of the payment of a fee of $fL ......., permit is hereby granted to ................... ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. 1. r ..�/ ..... Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiri , plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits fop1hese Items. r t _F ^r n •g 'tt x � +Y "'' ,} _., �, ,ate, �x a'� ( ,, t^ttb,xA m� ; n c � ; f � x�4 �� u r a'- `.`. y ,� by S� r i•' � �'� .� i�� c ; ^r S' ",J.. .+ :.k.k � r 4 r a $iJiLYi� Y J!jm� JL1- E i7�RiiE3C � x' ve ah -t t M h � A — a� ! � .J f,, a Date: July 1, 1965 City of Fridley, Minn. BUILDING PERMIT Owner: Gerald Adams Builder L. W. Sat ualson Address 6301 Monroe Street N. E. Address 7800 E. River Road LOCATION OF BUILDING No. 6301 Street Monroe Street N. E. Part of Lot Lot 10 _ Block 7 Addition or Sub -Division Christie Add' n. Corner Lot _ Inside Lot — Setback — Sideyard Sewer Elevation Foundation Elevation N° 8091 DESCRIPTION OF BUILDING To be Used as: Dwelling *'g Front Depth Height Sq. Ft. Cu. Ft. Front Depth height Sq. Ft. Cu. Ft. Type of Construction EMIRS Est. Cost$ -15.350-00 _ To be Completed Storm Damage repair In consideration of the issuance to me of a permit to construct ding descrlb a e I agree to do the proposed work in accordance with the description above set forth an plias/c with ail ons of ordiaanoas of the city of Fridley. In consideration of the payment of a fee of $-I=—, permit is hereby granted to L. W. S trnul -q on to construct the building or addition as described above. This permit is granted upon the express crondition that the person to whom it is granted and his agents, employees and workmen. is all work dace in, around and upon said building, or any thereof, shall conform in aII respects to the ordinances of Fridley, Minnesota locsition, construction, alteration, maintenance, repair and moving of buildings within the dty li takaud permit may be revoked at any time upon violation of any of the provisions of said ordinances. Allen Jensen NOTICE rals permit des net cffw the construcdoe, Installation for wbhi& plumbin9. Bas heaths, sewer or wabr. Be ora to sw the Botldio8 hnwWor for sepwab psrmib for thea Items. AP1�tiTCA�ION' FOR- -BUILDING PERMIT CITY OF iRIDLLY,MINNRSOTA dNNER'S NAME, G®rald Ad'ems �„ , $UILDEIt°, L.�' S on ADDRESS 6301 ,Monroe St. N. E. ADDRESS 7800'E. Riy6t_ Id toOF -BUILDING'.yI No. 6301 Sttreet," Mont a Part` `of 'Lot LOT BLOCK ADDITION OR SUBDI"SION„ + Corner LotHeide Setb�►ck Side=Yar h L d SEWER ELLVA±tdM EkVATION 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: ' Dwelli,na Front Depth H41ght• Sq. Vt. Cu. Ft. r Front Dept � . eight ' Sq. Ft.: Cii ` Ft., Type of Construction Estimated CostI 15�350 �.r�,� ... r �' To be completed "_80on aa' possible The undersigned hereby makes application for" -a permit for,.-the-work'hereii specified, agreeing to.dcq all work in strict.accordance with 'the City -of Fridley Ordinances and rulings: ;of' .he, .Department ' of Buildings; ' 4nd-'hereby; declares• t at- all the facts and representations stated in this 4plication are a and co ec DATE J e 24 1�5 . un C*ATURE (Schedule of Fee Costs can be found on the Reverse Side).,. Y// Application for Power Plants and Hearing. Cooling. Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam .. ................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water ................. 2.50 $ OIL BURNER—to 3 gal. per hour 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL See Fee Schedule TOTAL FEE $ Dept. of Bldge. Phone 860-3480 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts, and representations stated in this application are true and correct. Fridley, Minn '--��j 2 19" Owner Kind of'�3uilding /% o Used as To be completed about / -7 /fo Estimated Cost, $ Old New. Building Permit No. (meq Permit No._3 DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Wates' Warm AiP No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) Business � HOUSE HEATING TEST RECORD '?v// j &L. i0-3ar ADDRESS o PT FLOOR— CITY SUBURB OCCUPANT OWNER HEAT LOSS T,� IjJG. INST - GAS CO. METER BADGE # SOLD BY u1°1r� INSTALLED BY Electrical Work Byr-&k-x5 Gas Line By. To&..1%bs-r "Z, TYPE OF HEAT GA_ FA_L HW STEAM— SPACE HTR. UNIT HTR. OTHER GAS DESIGN CONVERSION MAKE L �® KE OF BURNER Mode - !@� V-' Model Serials ax. BTU Rating INPUT i MAKE OF FURNACE Model CONTROLS THERMOSTAT Heat Plug a Vent Size S� Valve KIND OF LINER SIZE NONE Limit - Draft Hood C3Regulator Limit Setting 00OF _0K Filtersl=l.9_ZiNumber 1x Fan Setting ��� '®� ® Chimney Location Inside Outside Pilot Type himney Construction C Le11iz ",@.4 - S " Pilot MaLe Pilot Model —Smoke Bomb Wiring Oy- Pilot Timing —_%) O Sce4x&Q Draft— Test Tag V ms L.W. Cut Off Door Pressure Lighting Inst. �( Pressure :]i Percent CO2 17�< Date Tested .5k -a4 J-7 x Input CFH 1-4 Percent 02 — Company Testing Stack Temp_ �IC�O' C�- Percent CO Name of Tester CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Job Address /,,2e/ �� /'® a Furnace Shell s Duct Work $12.00 $ Relaces^ a:a of rhrraca 7.00 Fapairs S Alterations-up•to $500.00 7.00 S'�— City of Fr of Buildings Repairs 6 Alterations each add. $500.00 4.00 $ City of Fridley Tel. f{571-3450 NIECK-NICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTL` $12.00 $ each add. 50,L00 BTU 4.00 $ Replacement of Furnace 7.00 $�i9 Repairs S Alt-erations-up to $500.00 7.00 $ Re:airs S Alterations each add. $500.00 4.00 $ STUM OR HOT WATi:R SYSTLN Bailer &Lines up to 100,000 BTU $12.00 ea=h ad,: -n. 53,000 BTU 4.00 Boiler oily up to 100,000 BTU 7.00 each addn. 50,000 BTU 6.00 OIL BURNER- to 3 gal. per hour $10.00 each add. 3 gal. per hour 10.00 G.4S BURNER- from 100,000 BTU to 199,999 BTU $10.00 (over 199,997 BiJ see Fee Schedule) GAS FITTING FEES: 1st 3 Fixtures % x` $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU x $10.00 AIR CONDITIONING -1-% FAX HEATING SYSTEMS VENTILATING SYSTEMS _( ALTF.RATIONS `v REPAIRS R.~•Uwi INSF. Date F LXAL INSP. Date APP=VAL FOR PERMIT See Fee Schedule State Surcharge TOTAL FEE REINSPECTION FEE (.510.00) FEE FOR ANY BEATING PERMIT IS $7.50 $--k . EGD 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, Minn. U X OWNER / 9- & /-A KIND OF BUILDING USED AS ZeZrgW g&= C- to TO BE COMPLETED ABOUT ESTIMATED COST OL NEW BUILDING PERMIT NO. PERMIT NO. I DESCRIPTION OF FURNACE/BUFUNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air - No.' Trade Name le oa 7 C- Size No. < / / AF n 4EVL Capacity f2 Ajd�e Sq. Ft. EDR BTU � H? Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU H? Company r a s Signed By • Tel. 1, . s 4 UNOF FRIDLEY CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 August 10, 1988 Gerald W. Adams 6301 Monroe Street N.E. Fridley, M(J 55432 6 RE: Nonconpliarice of the Fridley City Code at 6301 Monroe Street N.E. Dear Mr. Adams: On August 9, 1988, it was confirmed by an on-site inspection that the property at 6301 Monroe Street N.E. does not meet the minimum standards necessary to maintain a pleasant and prosperous suburban environment. While major code requirements are satisfied, the following items do rmt cmply with the performance starxiaras of the City Code: 1. One vehicle with expired registration, License #Mv-424, at southeast corner of property. This car must be currently licensed/street operable or removed from the prcperty or stored in an enclosed structure (shed, garage, etc.). 2. Ratiove dirt pile and wood fram the area rear the car. Your immediate action to correct this situation would be a great improvement for your property and the entire community as well. An inspection will be conducted on or about August 22, 1988, to determine cmpliance. If you have any questions cr concerns, please feel free to contact me at the Fridley Civic Center, 571-3450. Sincerely, Steven Barg Code Enforcement Officer SB/ls C-88-371 63ol AGREEMENT INSTALLATION AND MAINTENANCE OF A RETAINING WALL BY PROPERTY OWNER THIS AGREEMENT made and entered into this L13 day of J'Ui_Y 1993 between Gerald W. Adams and Norma J. Adams, husband and wife, hereinafter referred to as Owners of Lot 10, Block 7, Christie Addition; and the City of Fridley, County of Anoka, Minnesota referred to as the City. WHEREAS, the City permits the Owners to construct a retaining wall within the boulevard adjacent to said Lot 10 with the understanding that the top of structure elevation is not to exceed 3 feet above the street curbing elevation nor be constructed less than 5 feet from the back of curb, WHEREAS, in return, the Owners agree to maintain and repair the retaining wall as the need arises or as determined by the City. THEREFORE, it is agreed the Owners shall, at their sole expense, construct and provide immediate and continued maintenance of the retaining wall on the boulevard adjacent to Lot 10, Block 7, Christie Addition, and shall eliminate thereon hazards to safety and conditions of disrepair and unsightliness and shall hold the City harmless of any liability or damages consequent upon, resulting from, growing out of, or in any manner connected with the retaining wall structure. The Owners shall also be responsible for the removal of the retaining wall, at their sole expense, in the event the City needs Jo perform excavation work or activity within this boulevard area. FURTHER, IT IS MUTUALLY AGREED that the provisions of this agreement shall be binding upon and enforceable against the parties hereto, their successors and assigns and all subsequent owners of the property herein described. An executed copy of this agreement shall be filed with the Anoka County Recorders Office and made a part of and be binding upon the above described property_. f IN WITNESS WHEREOF, the parties hereto have hereunto set their hands this Z3 day of J U J; V , 1993. This instrument was drafted by: City of Fridley 6431 University Avenue NE Fridley, Minnesota 55432 Gerald) W. Adams, Husband "".1 17, STATE OF MINNESOTA ) 44er) 00 County ofArwRa Cp )ss On this a3rci day of Q( AJ) - J , 1993, before me, a Notary Public within and'for the County of Anokand the State of Minnesota, personally appeared Gerald W. Adams and Norma J. Adams, husband and wife, to me known to be the same persons described in and who executed the foregoing instrument, and acknowledged that they executed the same as their free act and deed. G SHELLY L. UPPOLE ..'•%I - MIMM50TA HENNEPIN COUNTY My commission expires 5.3.96 s G. Flora, Director of Public Works STATE OF MINNESOTA ) )ss County of Anoka ) On this ZL ay of t y , 1993,, before me, a Notary Public within and for said County, personally appeared, John G. Flora, to me personally known, who being each by ';me duly sworn he did say that he is the Public Works Director of the City of Fridley, the municipal corporation named in the foregoing instrument, and that the seal affixed to said instrument is the corporate seal of said municipal corporation, and said John G. Flora acknowledged said instrument to be the free act and deed of said municipal corporation. •. CLYDE V. MORAVETZ Notary�Oblic NOTARY PMUC - MINNESOTA ANOKA COUNTY MY Comm. Exp. Jan. 24.1994 CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION. FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB 3 o/ , Effective On January 1,1991 n ire � S7 - RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work In strict accordance with the City Codes and Furnace Shell and Duct Work, Burner —nn a G rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $ o'® representations stated In this application are true anO correct. (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $10.00 OWNER Gas Range $10.00 $ BUILDING USED AS 61 Gas Dryer $10.00 $ d o ESTIMATED CAST � :� �D PERMIT NO. *A Air Conditioning — All Sizes $10.00 � o $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Afterations (LIST ON BACK) 1 % of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) Commercial/industrial Trade Name 4 071 A® Size No. O 006 &O 000 BTU HP EDR 1% of Value of Appliance or Work $ Fuel /Vu Total Connected Load State Surcharge $ ,60 TOTAL FEE s 3 0_ MINIMUM FEE FOR ANY HEATING/COOUNG/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE I REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Bumer Trade Name 17 "X Size No. BTU HP EDR HEATING COMPANY �h `S'G f 1 / /� vi e. Signed By Tel No.��%� Approved By Rough—In Date Final Date �sv FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. The undersigned hemby verifies that the existing chimneyor stack: 1. Has been carefully examined Yes ) No ( ) 2. Is free from rust or deterioration Yes No ( ) 3. Has no foreign objects lodged within YesY(j No ( } 4. Is securely supported Yes M No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes " No ( } 6 Has total heating BTU's of �� , ©©a w/�a�¢ ,- All other BTU's TOTAL BTU's �w O 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: e HEATING CO: 1 Q-/ e-1- s Signed By: Date: Yes ( ) No (' Yesix) No ( ) ►a SUBJECT P City of Fridley 2 7 2 6 9 AT THE TOP OF THE TWINS BUILDING P E R M I T rp REC7515:IPT NO. , _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. v� 5a I , NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 ti.__.11.' '•� 612-571-3450 910-F15 8/18/98 JOB ADDRESS 6301 Monroe Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 7 Christie Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gerald Adams571-3757 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Five Star Remodelers Inc. 1784 E. 7th St Paul MN 55119 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 IRX REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage 22 S Tear -off; Reside house and garage 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Call for building wrap inspection 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 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 $8780.54 $4.39 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. $149.75Fire $8.78 PLAN CHECK FEE TOTAL E ���"�' e /0(O/�r'.d 92 F SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI N P OP SLOG#NNSP R ALI ATE T S IS UR PER T s MATE SIGNATURE OF OWNER IIF OWNER SUILDERI IDATEI NEW - [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 C BUILDING PERMIT APPLICATION 6P zL ConstructionAddress: 03 t9% 29E2i4i 'jQ4- W, e Legal Description: Owner Name & Address: Axr-4 1 a'4" Tel. # Contractor: ArO8 2iLp 44f-". MN LICENSE # ,S7 4-A Address: -2 -.274 7` /�� S"'S`Jl Tel. # 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: 2C • S e) Z ZZ 5 . Estimated Cost: (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # Permit Fee $ < y • 7 5- Fire Surcharge $ State Surcharge $ SAC Charge $ License Surcharge $ 0o 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 [ ] Building pLUTYj INC Permit No. • Inspections RESIDENTIAL APPLICATION Received B 763-572-3604 DaAgd: _L__ CITY OF FRIDLEY DATE (] YOUR E-MAIL ADDRESS SITE ADDRESS ern 44- THIS APPLICANT IS: 0 OWNER *oNT'RACToR Gerald Adams PROPERTY NAME: 6301 Monroe Street Northeast OWNER! ADDRESS: Fridley MN 55432 TATE ZIP TENANT 7635713757 PHONE: CONTRACTOR Nom: SUBMIT A COPY OF STATE LICENSE # O EXP DATE YOUR STATE ADDRESS; -,_2 4.1 f CITY l"S STATE SfYOr e LICENSE WITH , PHONE $2%—.1/033 FAX — APPLICATION - PERmr TYPE KsINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW REPLACEMENT DETAILED DESCRIPTION OF WORK J PER MS 16B.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. CMis.should-mflect only.the cost of labor) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = '•FOP -PROJECTS WHERE LABOR EXCEEDSS500;%FEES ARE BASED ON $10.00 PER FIXTURE, 'EXCEPT`MM-RENQ:TED..:FI ES: -.(INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/IAV _FLOOR DRAINS _ SHOWER _ WATER PIPING - _ BATHTUB _ GAS PIPING (sEmcnyvcdrsE) _ SWIMMIIVG POOL _ WATER SOFTNER ($35) _ CLOTHES WASHER _ KITCHEN SINK_ WATER CLOSET _ BACKFLOW PREV. ($15) _ LAUNDRY TRAY LWATER HATER ($35) FOR IRRIGATION _DISHWASHER WATER METER OTHER ` Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x VIM = $ Number of fixtures @ $35.00 _T x $35.00 = $ 36'.Oo TOTAL DUE $ State Surcharge = $ 50 Total = $ O 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 applicati 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 or which re es review and approval of plans: ' /°' Je. DATE 5 7lDk SIGNATURE OF APPLIC N . NO/6JGJ�%�i City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building BUILDING Permit No.'?Ot W Inspections RESIDENTIAL APPLICATION Received BAAO' 763-572-3604 CITY OF FRIDLEY nate O 210 763-502-497' '. AX EFFECTIVE I-1-2010 DATE YO+�R E-MAIL ADDRESS c-— (� SITE ADDRESSON �V I . THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: -4 TENANT ADDRESS: 2 fVE CITY STA ZIP -Zq3 a PHONE: 76 3 571 37.5 7 CONTRACTOR Nps;„ SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENS N EXP DATE AND CERTIFICATE OF ADDRESS: CITY We"A STATZ" ZM&&4;)3 INSURANCE PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED XWINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MANTENANCE/REPAIR qJ2EM0DELING DESCRIBE WORK BEING DONE: llfu 4sic cgess�jji°'` a SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT K FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES 13 HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 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: 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 protect 2. 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 & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) rOTAL JOB VALUATION $ y 66 e OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge 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) $2100 per SAC Unit (Plans to MWCC for determination) -ft +6 ft= frx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach 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 applicati for 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 h cl requires review and approval of plans. SIGNATURE OFAPPLIC PRINT NAME,���,,I� A fy1Jne-. DATE �� t-, 4 i� nsm— M 1 i ,qh '01 a a _ Q Te �1031 �►fd�� grn�L WIC ? �� 1 I(q .f5 a xS �Nf/f� �n mm OO mm K�N O0DDOODf/ 0000 -CyD»> pmmn�m