PRE 2010 DOCSBUILDING PERMIT
Village of Fridley, Minn.
Date ' i, .............................
Owner
Address .....:'.
2148
Builder....................1i......................
Address.................. ......................
LOCATION OF BUILDING
NoALI0....... Street . � � ....................... Part of Lot
Lot ........' Block ...10.......... Addition or Sub -Division ................,
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ...
l.
l .....................
DESCRIPTION OF BUILDING
To he Used as:
s 0 -
Front - A . ..IM�"Depth A41r. Height
Front ........ Depth ........ Height .........
Type of Construction.�14,r lt.,%4 '... Est. Cost .1,7.0.60—#49 .....
Sq. Ft. ...11. .... Cu. Ft.........
Sq. Ft... ... Cu. Ft.........
To be Comple ed
In consideration of the issuance to me of a permit to construct the building
the proposed work in accordance with the description abovg set forth and in co
ordinances of the village of Fridley.
!d above, I agree to do
with all provisions of
. .......................
In consideration of the payment of a fee of $..IRj. , permit is hereby granted to ,f;„(
�►.. � ..... to construct the building or addition as described above. permit is granted upon
the express condition that the person to whom it is granted and his agents, employees d workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all resp s to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and oving of buildings with-
in the village -limits and this permit may be revoked at any time upon violation of any f the provisions of said
ordinances.
//
Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, lumbing, gas heating,
sewer or water. Be sure to see. the Building Inspector for separate permits for these Items.
�q�
City of Fridley, Minn.
BUILDING PERMIT N® 7469
Date: Z., 1965
T*iner: Mot xccA3&Z Builder Blanahe Const. Co.
_Addresh3fiQ Monroe Address 108 Pattgm Rd, KW Briffliton
LOCATION OF BUILDING
No. 635Q KQWWAet _ Part of Lot
Lot _. ___ _ Block 6 Addition or Sub -Division ._brJ stie
Corner Lot Inside Lot _ _ Setback — Sideyard
Sewer Elevation
To be Used as:
Foundation Elevation
DESCRIPTION OF BUILDING
Front Depth Height . _ Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est. Cost 4p800 To be Completed
Repair storm damage
In consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with a'll provisions of
ordinano� oP the city of Fridley. (SZ4 �
b,�s��'e%li��c
In consideration of the payment of a fee of $10. 0 , permit is hereby granted to the
COnStr'l1Cti0II Com to construct the building or addition as described above. This permit is granted upon
the express oondition that the person to whom it is granted and his agents, employees and workmen, in all work
done h►, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota reg ng location, construct�fon, alteration, maintenance, repair and moving of buildings
within the dty ]units and this permit may be revoked at aqy time upon violation of any of the provisions of said
ordinances.
NOTICE:
This permit don not corer the candruction, installation for wiring, Plumbing, an heating, sewer or water. Be sen to see
tiro Building Inspector for separate permits for thea hems.
APPLICATION FOR B ING PERMIT
CITY OF FRIDLEYO NMSOTA
OWNER' S NAME BUILDER
ADDRESS �;�� �� ����%��I.GrZ-e.i`� ADDRESS le9r- ,�����ell
LOCATION OF BING
No. Stteet. Part of Lot. .
Lot � Block �� Addition or Subdivi5sign
Corner Lot Inside Lot etV4tk Sidi Yard
SEWER ELEVATION FOUNDATION EUVATION
Applicant attach to thia form, Two Certificates of. Survey of Lot -and proposed build-
ing location driva on these Cartificates.
To be used as;
DESCRIPTION OF BUILDING
'roaC Depth Height
Sq. Ft. Cu. Ft.
Front Depth
Height
Sze. Ft. Cu. Ft.
Type of Construction_ ,t�" Estimated Coaa
--To-.be Completed
The undersigned hereby makes application for a permit for the work herein specified,
agreeing'to do all work im strict accordance with the City of Fridley Ordinances and
rulings of the Department' of Buildings, and hereby declares that all the fsacts and
representations stated in this application are true and correct.
-tSchedule of Fee Costs can be found on the Reverse Side).
A 1
CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 1998 q
6431 University Ave NE
Vv
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS 1,Q�) 50 M b VVbf kke
RATE SCHEDULE
Residential
Fumace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
The undersigned hereby makes application for a permit for the work herein .---
Rate TOTAL 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
$ 30.00 $_Eikb representations stated in this application are true and correct.
-��- 99 ,
$10.00 $
OWNER �,N r rf Cl -0"V- � V
$10.00 $
$10.00 $
*Air Conditioning All Sizes $ 25.00
G�a"Wf V3LO3KOON
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or.Work
Commercial/Industrial
1.25° of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOUNG/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE.
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
BUILDING USED AS d w-tW V-\ q
ESTIMATED COST raj 0-0 • 0-0 PERMIT NO. 136S
DESCRIPTION OF FURNACE AND OR BURNER
No.' of Heating Units I Circle One (Steam) (Hot Water) arm r)
Trade Name . e oy t Size No. �ETCH V b _ C) 0-10
BTU QLD 10-" HP EDR
Fuel t\j rj, G( -1) Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
Approved Byd
FILL OUT BACK SIDE FOR ST
REPLACEMENT FURNACE
BLAINE 14TG. A;�C ELECT., INC
13M CENTRAL AVE. N.E.
ANOKA MN REAM
du
Tel No. -i - ( o'�
Rough—in Date Final Date A-0)
VERIFICATION ON
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been ,carefully examined
Yes (J �
No
( )
2.
Is free from rust or deterioration
Yes
No
( )
3.
Has no foreign objects lodged within
Yes (�)
No
( )
4.
Is° securely supported
YesN
No
( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()4
No
( )
6
Has total heating BTU's of 1MY0
All other BTU's -V ®,
TOTAL BTU's Dau
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:
ULAINE HTG. A,C ELECT., INC.
13562 CENTRAL AVE. N.E.
4
C17YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287
August 9, 2000
Shirley McCarty
6350 Monroe St NE
Fridley, MN 55432
Re: Final Reinspection at 6350 Monroe St NE
Contractor: Blaine Htg. A/C Elect., Inc
Dear Ms. McCarty:
A mechanical permit was issued on May 12, 2000 for the property located at
6350 Monroe St NE for a furnace and an air conditioning unit. According to
Section 305(a) of the 1991 Uniform Mechanical Code a final inspection shall be
performed on the mechanical system.
An inspection was conducted on 6-3-99, which noted the following corrections: 1)
Provide a one -inch clearance from combustibles through wall and floor. 2)
Firestop around chimney at first floor level.
Please call for a final inspection on these corrections within 30 days of receiving
this letter. We will expire the permit if we do not hear from you and any
inspections on this installation will require a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
DAVNSEN
Buil g Inspector
OCCUPANT,
HEAT LOSS,
SOLD BY_
Electrical Work By Zta /%liha
TYPE OF HEAT GA__ FA ®L
HEATING
AIR CONDITIONING
AND ELECTRIC, INC.
1-0
HOUSE HEATING TEST RECORD
APT. P FLOOR CITY SUBURB
OWNER
IVA INSTALLED BY A&A,
Gem Line By
SPACE HTR. UNIT HTR. OTHER
CONTROLS
THERMOSTAT '7 epi, A Heat Plug
Limit
Fan!
Pilot
Pilot
Pilot
L.W. Cut Off
Pressurev Percent CO2 0
Input CFH Percent 02 d b
Stack Temp. �J�r� Percent
CONVERSION
Vent Size "i'
KIND OF LINER SIZE NONE
Draft Hood Regulator (O
Filters Size /& X Z.S' X 3 Number /
Chimney Location Inside x Outside
Chimney Construction &5S
Smoke Bomb
� � r
Draft
Test T �.E.
Door Pressure
Lighting Inst. xe=5
Date Tested — �-
Company Testing
CONTROLS
THERMOSTAT '7 epi, A Heat Plug
Limit
Fan!
Pilot
Pilot
Pilot
L.W. Cut Off
Pressurev Percent CO2 0
Input CFH Percent 02 d b
Stack Temp. �J�r� Percent
CONVERSION
Vent Size "i'
KIND OF LINER SIZE NONE
Draft Hood Regulator (O
Filters Size /& X Z.S' X 3 Number /
Chimney Location Inside x Outside
Chimney Construction &5S
Smoke Bomb
Wiring Ve
Draft
Test T �.E.
Door Pressure
Lighting Inst. xe=5
Date Tested — �-
Company Testing
Name of Tester
Pressure Percent CO2
Input CFH Percent 02
Stack Temp. Percent CO
6431 University Ave NE
Fridley, MN 55432
(763) 572-3604
UIV.
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas`*
Gas Range'"*
Gas Dryer`*
Back Flow Preventer Required ( )Yes () Nc
Type
NO. RATE TOTAL
$7.00 21,06
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge .50
TOTAL FEE $-122-
JOB
JOB ADDRESS 635-0' 172on rn e- S�
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Ownerr-1 o_ /yo—��-� 741 %/
Building Used
Estimated Cost /3CO. 00 PERMIT NO.__ / 3 LIZ
PLUMBING COMPANY r PL,
SIGNED BY 7 A' TEL N0. 612-,Zo21— 37/9
FAX #
Approved By Rough -In Date Final Date2C__�
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
COMMON VFNT V NT CONKECTOR AND COMMIRTION AIR VFRIFICATION
When replar,.inn an existing ftirane-P, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes No ( )
The venting system is plasbc/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes( ) No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes( ) No( )
The Pxichnn cnmh ,stinn air is sized and installed to meet the current codes
and manufacturer's specifications. Yes( ) No( )
When required to anctall a new cnmhnstinn air, it will be sized and installed
to meet the current codes and manufacturers specifications. Yes( ) No( )
When jpgtajlann a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
spe ficabons. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes( ) No-( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( )No( )
Appleance Zype and -q17P/Cnmmnn Vent and Vent Cnnnactor Informatinn
Appliance #1 Type
--Appriance #2 Type
Appliance #3 Type
BTU Input
BTU Input
BTU Input
Fan Assisted or Nat
Fan Assisted or Nat
Fan Assisted or Nat
i otal Appliances
Total Btu Input
Common Vent Type
Vent Height
Diameter inches
Appliance #1 Vent Connector Height
Appliance #2 Vent Connector Height
Appliance #3 Vent Connector Height
oI TFRATIONS- (DPs�hP)
ft Length
ft Length
ft Length
ft Diameter in Type
ft Diameter in Type
ft Diameter in Type M
HEATING CO:
Signed By: Date:
SuB.,ECT
City of Fridley
dPE
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
`
RECEIPT NO.
`v ______ COMMUNITY DEVELOPMENT DIV.
l PROTECTIVE INSPECTION SEC.
i
NUMBER
11Ev
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
L 612-571-3450
910415
4/29/02
JOB ADDRESS 6350 Monroe Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
6
1 Christie Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Shirley McCarty 6350 Monroe Street NE
763-571-3057
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Window Lite Home Improvments 8400 89 Ave N STE 460, Brooklyn Park, MN 55445
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
763-425-2227 20039258
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION 0. ALTERATION ❑ REPAIR ❑ MOVE - ❑ REMOVE
8 DESCRIBE WORK
Bathroom Remodel
9 CHANGEOFUSEFROM TO
STIPULATIONS
See notations on plan.
Provide smoke detectors in all sleeping rooms and on all
levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform 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 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
�
ANY TIME AFTER WORK IS COMMENCED. `
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$ 10,472
$5.24
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
PAOV S OF ANY OTHE STATE OR LOCAL LAW REGULATING CON.
$195.25
Fire SC $10.47
ST CTIO OR THE P OMMAE OF CONSTRUCTION
PLAN F
TO AL FEE
94CHECK
JAI &6MoZ�
Lice e C $5. 215.96
4JTHORIZEOAGENT 10ATE
EN PROP
Y VALIOA D THIS IS R PERMIT
�IGNATUOFOWIZACTWAOR
Bl -NSF'
� 2s
r)A 1E
S-GNATURE OF OWNEA,1F OWNER BUILDER] 1DATE.
,NERi [ ] �-`� 1 ���� Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
'
BUILDING PERMIT APPLICATION
Construction T e: E)d c fflvjqj& Estimated Cost: $ /G, LI -7a -
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: a 5 G' APPLICANT: vYv� Tel. ?( �3cl� 83%O
Permit Fee
.Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee $
Sewer Main Charge
TOTAL
STIPULATIONS:
a 160 ?&
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ]
ConstructionAddress:
�2.,
r� - /` a 5 -q&,
2:, f " -
Legal Description:
Owner Name &Address:
�"
<5Kl'
�
e� ��
Tel. #(71,5-) 57 1- � 36 -7
Contractor: Z'!�
Lie
(cam d2t" " _ MN LICENSE # oZ? .V a 5,f
Address: Jh 4- pp 94M
a4
ri m k) , (W -i rn i0hJ A/0
Tel. #�7�v3� 61,;5 -teal
Attach to this application, a Certificate of Survey of the
P'C� nk4 Li� �%/aYr7
lot, with the proposed construction drawn on it to scale.
(7 3 9310
DESCRIPTION OF IMPROVEMENT
LIVING AREA:
Length
Width Height
Sq. Ft.
GARAGE AREA:
Length
Width Height
Sq. Ft.
DECK AREA: "t
Length
Width Hgt/Ground
Sq. Ft.
OTHER:
Construction T e: E)d c fflvjqj& Estimated Cost: $ /G, LI -7a -
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: a 5 G' APPLICANT: vYv� Tel. ?( �3cl� 83%O
Permit Fee
.Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee $
Sewer Main Charge
TOTAL
STIPULATIONS:
a 160 ?&
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
u
SUBJE&
PE
City of Fridley
3 71974 7
AT THE TOP OF THE TWINS
BUILDING PERMIT
r?
'
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
v PROTECTIVE INSPECTION SEC.
2-36®4
572-3604
-79
r
i ��"'t;•� CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
-__.�
L 612-571-3450
910415
6/29/01
JOB ADDRESS 6350 Monroe Street NE
1 LEGAL
LOT N0,
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
5
6
Christie Addition SHEET
2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE
Shirley McCarthy 6350 Monroe Street NE 571-3057
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Window Lite Home Imp. 8400 89 Ave N, Brooklyn Park, MN 55445 425-2227 20039258
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION 0. REPAIR ❑ MOVE - ❑ REMOVE
B DESCRIBE WORK
Replace 13 windows within existing openings
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk
and flash all exterior openings.
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
$12,829
@
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
`1 '6.42
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISI ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$223.25
Fire SC X12.83
S ION THE PERFO CONSTRUCTION
OR
^2- -ol
PLAN CHECK FEE
Li se C $5.00
TOTAL FEE
$247.50
SIGNATURE OF CON' ACTOR OA AUTMORIZEO AGENT IDATEI
,. H PROPERLY VALIDATED THIS IS YOU PERM IT/
S,GNA TU RE OF OW NERi6 OWNER BU40ERI IDATE-
BL G P
u
D�/%�
NEW S ENT"D MAY 312001
[ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress :
Legal Description:
Owner Name & Address:
Contractor: `n
Address: 94z— YqV
ci k-!
M
Tel.# J %/—J3 ,, �
MN LICENSE # a,9D ��,�
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: ` Estimated Cost: $ Z&
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT:(--
CITY USE ONLY
Tel. #�Z5 J9/?-3KK
Permit Fee
$ &03,
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1050 per SAC Unit
License Surcharge
$c.I , OrD
$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
$
STIPULATIONS: