PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N° 7020
Date:
-��
Owner: ��� Builder
Address Address
LOC TION Q# BUILDING
No. Street ,� e(/ ,Part of Lot
Lot _ Block Addition or Sub-DivisioLai
Corner Lot _ // Inside Lot _ _ nom♦ Setback �� _ Sideyard �lL � d
Sewer Elevation I® 3' %f ---Vvtm4Mion Elevation 6 • l
'*c(' OF (=-cT fhlo
DESCRIPTION OF BUILDING
A
To Used AW"P
Front �� Depth s� Height ,�- Sq. Ft.Cu.
nt Depthey Height Sq. Ft. 4 Cu. Ft.
Type of coon Est. � '��o be Completed
In consideration of the issuance to me of a permit to co described above, I agree to do
the proposed work in accordance with the description above t fo pliance with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ ''�-
, 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 reg location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and permit may be revoked at any timeupon y�alation of any of the provisions of said
ordinances. �® .1 1
NOTICE:
M permit don not eovw the construction, butaMen for whim plumbing, gas hearing, sorer or water. Be sure to see
the Buibiing hopedor for separdo pernft for these haw.
APPLICATION FOR BUILDING-;?ARMIT
CITY o
_ .. F FRIDLEY, MINNESOTA_ , •:,; `:: ":. �:.' r. `.
OWNER'S NAME BUILDER
ADDRESS.. ADDRESS
LOCATION OF BUILDING.
No. Street art . of. Lot
Lot Block Addition or Subdivision &fP
Coiner Lot Inside Lot SetbackSide-Yard,.. -7t/t
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach. to this. form ,Two Certificates of ;Survey ;of Lot and -proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
Front Depth Hgight
Sq:, Ft:, Cu,, ft.,
Front Depth Height
Cu.. Ft:
Type of Construction l' Estimated Cost
To be Completed
a
The undersigned heiebyinakes application••for:a•permit -for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings ef.,the;Department,.of. Butldiggs,, and hereby decd that sll'.the facts and
representations stated 'in this application are,,prue erect::
DATE411
'1% ! -(rte SIGNATURE
_(Schedule of Fee Costs can be found on the Reverse Side).
y
,,1 9/ y_._
City of Fridley, Minn. N° 7897
BUILDING PERMIT
Date: June 15, 1965
Owner. M Potee Builder Erco, Inc.
Address 6771 Overton Address 3231 Central Ave. N.E.
6771
No.
Lot 4
Corner Lot ,—
Sewer Elevation
To be Used as:
Overton.
Street
Block 1
Inside Lot
Front
Front
Type of Construction
LOCATION OF BUILDING
Part of Lot
Addition or Sub.Division Meadowlands 2nd
Setback Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
Repair Storm Damage
Depth Height
Dept 30
_._._ Est. Cost _
In consideration of the issuance to me of a permit to c
the proposed work in accordance with the description above
ordinances of the city of Fridley.
Sq. Ft. Cu. Ft.
Sq. Ft. Cu. Ft.
To be Completed
zg described above I agree to do
compliance with af1 provisions of
In consideration of the payment of a fee ofl� o , permit is hereby granted to "co, Inc.
to construct the building or addition as described above. This permit is granted upon
the empress condition that the person to whom it is granted and his agents, employees and workmen, in all work
done around and upon said building, or any paw thereof, shall cenform in all respects to the ordinances of
Fridley, Minnesota location, construction, alteration, maintenance, repair and moving of buildings
within the city lts and permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Allen Jensen
Building Inspector
NOTICE:
Ibis pmO don not aerar the aondruc6m, dutaMm for vArtn& plumbing, gas heatlng, ewer or wafer. Be sure to no
the BUM29 hsps r for spam* permits for thus Items.
APPLICATION FOR BMIDM PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S BUILDER
07
ADDRESS ADDRESS
LOCATION OF BUILDING
No.Part Of Lot
P.M.
LOT BLOCK ADDITION OR SUBDIVI6100,A
Corner .Lot ..._Inside LM2C" Setback Side -Yard
'Aft ELEVATIOk,
SEWER ELEV ON FOUNDATION'
Applicant attach to this form Tw6,Certificates of Survey,of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BU=Md�
To be used
Front Depth' Height
Sq* Ft. Cu. Ft.
—Front- Depth Height�_
Sq. Ft,- Cn. Ft.`
Type of construction Eatimated*'Cost
To be completed' e __/-r_466
The undersigned hereby makes application for a permit for the work herein'specified,
agreeing to do all work in strict accordance with the City ofFridley ordinances
and,rulingi of the Department of Buildings, and he'reby,-#eclar 1 69 'that 'all -the facts
'
and representations stated in this application are vfvo and cotreet
DATE SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side'),,
o"
Ci f Fridley
tY o
Application for Plumbing and Comas Ming Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Loaatio 71 ® w
m
m
a
�U' O
•
F
+
N
WATER HTR.
GAS
ELEG
Base
2-
1st
2nd
3rd
4th
_
• Future Connection Openings
e Fixture, Old Openings I
Connected with Sewer
E]New
Cesspool
City of Fridley:
The undersigned hereby .makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application/ re true and correct.
Fridley, Minn
Owner
Kind of Building
Used as
To be completed about
PARTIAL RATE SCHEDULE Estimate cost, $
PLIIMBING FIXTURE RATES: NO. RATE TOTAL
Old Ne ding Permit
Number Fixtures ...................... x $1.50 $
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin .... x 3.25 $
Water Heater (Up to 200,000 BTU) ...... x 2.00 $ '2K, O O /
ROUGH
New Ground Run Old Bldg . ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $ SO
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description................................................$
TOTAL FEE $ c
/ 7. a
FINAL
J
42
By--%-�
Business Phone
City of Fridley
AT THE TOP OF THE TWINS
SUBJECT
BUILDING PERMIT
PERMIT NO.
c _ 19037
r
COMMUNITY DEVELOPMENT DIV.
tr ______ PROTECTIVE INSPECTION SEC.
r 1
1 ` �
1 ---n CITY HALL FRIDLEY 55432
A, J 612-571-3450
RE
6-47
NUMBER
910-F15
REV.
DATE
16/26/87
PAGE OF
APPROVED BY
JOB ADDRESS 6771 Overton Drive N.E.
1 LEGAL
DESCR.
LOT NO.
4
BLOCK
1
TR ACT OR ADDITION SEE ATTACHED
Meadow Lanes 2nd Add.itlon SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Philip Bodine same 571-5424
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 ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
16' x 23' Wood Frame Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
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
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
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
$35,85017.93
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
H3433
11 .56
S OF CON ACT R OR THORIZED AGENT (DATEI
L A THIS IS YOUR PERMIT
P
o J?f %
3�=
BLDG INSP DATE
SIGNATURE OF O IIF OWNER BUILDERI (DATEI
0
NEW
City of Fridley. Effective 4/1/86
ADDN. [ R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address:
Legal Description:
�
Owner Name &Address: ' Z �
Tel. #
Contractor:
P -A / � l ,� ,7���/ /J�- - Tel. �
Address: 4:�, 77i 0Vt-R70yJ Dig. /V.4
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Corner Lot [ I
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length _ 1 -
Length
Length
Height
Width -
Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
Tn miA_ o Ft. Yd. Setback - Side Yard Setback
Type of Construction:
Approx. Completion Date: S5 Pr l i7 -7
Estimated Cost: $
3$ ig� •oA
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
�
o -71''5�z%
DATE: � %
APPLICANT: �
._ __ .�i�-J= -�-�
Tel.
CITY
USE ONLY
Permit Fee
$ js��
Fee Schedule on Reverse
Side
Plan Check
$ $ �s
25$ of Building Permit
Fee
State Surcharge
$ ( �� 3
$•50/$1,000 Valuation
SAC Charge
$
$ 525 per SAC Unit
Park Fee
$ _
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ]
Not Necessary
[ ]
TOTAL
$
j s gjCa 00
STIPULATIONS:
dS► 00C —
y 4 -so
4Q -SO
ter_
� �.�.ti. ht t
u ,.f
land Planning WS -Al' hivoy ACs ALE.
Land Stewy n' y Mirn�a�n/n Zl,
S0115Teslv,9 ENGINEERING, INC. ''*;ws°ta
Owl & Afmi6ml smut 440"
r �
E e� Engineers Survey&.s
C@ timicate of surve
T
Joe 1 2111
/ .Qa �... i =•{-, :,,3 ,� 1`�, � � i4 � ._ . _1 i -, ter,, `.� �
\- \�
/
i
i
fbaE lliis is a fine and c rad re o Aan of a swve e& &w doMes flir 060M akaykd land m d
r a&0 yf'.dJ t�►ldu�y , fM&eW and d/ risible dxroatrimenfs ,!,rang, f vn 0,r unsaid /and. As Surveyed by me tMs day
A.v.
SUBURBAN ENGINEERING, INC.
Enginerrs Fr s�r-ruJors
SUBJECT
P NO.
City of Fridley
2 8 02
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r?
RECEIPT NO.
a: __--� COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
4q
r � PROTECTIVE
,
NUMBER
REV
DATE
PAGE OF
APPROVED BY
I CITY HALL FRIDLEY 55432
612-571-3450
910415
9/29/98
JOB ADDRESS 6771 Overton Drive NE
T LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
1
1 Meadowlands 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Paul & Rose Lundequam
574-1648
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Attleson Constr. Inc. 3916 Willow Rd. Brooklyn Pk M 55443
427-6431 20099630
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
T CLASS OF WORK
O NEW O ADDITION O ALTERATION ia REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Reroof house and garage (33 S) Tear -off; Front foyer addition 6' x 3'
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
N See notations on plan.
WARNING
Before digging call for
all utility locations
454-0002
REQUIRED BY LAUD
SEPARATE PERMITS ARE REOUIRED 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
6828
$3.41
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVIS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRU TIO OR THE PERFOR NCE OF CONSTRUCTION
$124.75FiretSC
$6.82
PLAN CHECK FEE
TOT FEE
��
3 8
SIGNATURE OF QN'RACTOR OR AUTHORIZED AGENT IDA I
RO
VALIDAT TMI$ I$g PE MIT
olkI
S-GNATURE OF OWNER SIF OWNER BUILDER, IDATEI
BAG INSo
gAtE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 22
BUILDING PERMIT APPLICATION
ConstructionAddress: (07-71 Llizo-Tz
Legal Description:
Owner Name &A"d'd�ress: �Gct,,//�►►'�-��it �X e q !,� c v,� Tel. # 74 `161 b
/�
Contractor: /'� '! a Scrn t...ar-a► S G -k ah AC-. MN LICENSE # 212x%6 3 U
Address: A46;(. pod%! , keA- -,S el. # 42-7- (v43/
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 142
Sq. Ft.
GARAGE AREA: Length
Width
Height
Sq. Ft.
DECK AREA:
Width
Hgt/Ground
Sq. Ft.
��Lennngth
OTHER: Iia F
11
/'to4s� 1-
3 S. !W
" �Igaa-r -
Construction Type: Fv'Onf FayeW
44J-1,6,
Estimated Cost: $
��o000
$
.001 of Permit Valuation (1/10th%)
(Fee Schedule
on Bac L
Driveway Curb Cut Width Needed: Ft.
+ 6 Ft =
Ft x $
$1000 per SAC Unit
DATE: 18 APPLICANT:
A/C4-
"C,%%
Tel. #
$
Alt. "A" or Alt. "B" Above
Erosion Control
CITY USE ONLY
$450.00 Conservation Plan Review
Permit Fee
$ 42��
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 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 $ l
STIPULATIONS:
of.
SUBJECT
PE
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
P E R M I T z
28180
572
EIPT N
� • N Y DEVELOPMENT DIV.
,-369
'
V-
SEC.
PROTECTIVE INSPECTION
E
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
,j 612-571-3450
910415
10/9/98
JOB ADDRESS
6771 Overton Drive
1 LEGALLOT
NO. BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4 1 iMeadowlands,
2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Paul & Rose Lunde uam
574-1648
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Owner
4 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
❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Bathroom alteration - new sheetrock around
tub
9 CHANGEOFUSEFROM
TO
STIPULATIONS
SEPARATE PERMITS ARE REOUIRED 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
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
$1200 $.60
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
S UCTION OR THE PERFORMANCE OF CONSTRUCTION
$40.25 Fire S $1.20
PLAN CHECK FEE TOTAL F
A -
- 42 5
I NATURE O ONTRACTOR OR AUTHORIZED AGENT tOATE,
N P OP R V IDATE S IS V UR P IT
NATURE WNERa00W R UILDM iDAT'
MATE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ v]' SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: (o '77 Al l)li
Legal Description: 40 T Al, i3 LOC, / M &--7V,Qd 6J
Owner Name & Address: PPu i— leo SE (Jnl OEQ UAB Tel. # /6 e-/6
Contractor: 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 BWROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: A L -T ZZ — lel ELL) f)F -E- T k-OQ,�- Al&) UlU n --J-U&
Construction Type: b2VTTRROO fn PQ ATE Estimated Cost: $ / / a0 0 ..aa
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: /d 9 Qj APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ Q,o2S'
g /. ,2 0
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 [ ]
1
Building
$ 1 G1 �4ci
BUILDING
$ Gln C-1 I
Permit No.:APOI
Inspections
Surcharge
RESIDENTIAL APPLICATION
Received B
763-572-3604
SAC Charge
CITY OF FRIDLEY
Curb Cut Escrow
DalMd
763-502-4977 FAX
$
Park Fee
$
Sewer Main Charge
$
Total Due
EFFECTIVE 1-1-2010
DATE% �% ' I ° J
YOUR E-MAIL ADDRESS
L�b
—C/
SITE ADDRESS 7 -20
25i- Al 1- F rZ ' o
THIS APPLICANT IS:
GYOW�NER ❑CONTRACTOR
PROPERTY OWNER/
NAME: ` Ar.a 1
t
ADDRESS: Cv ? b, CITY F
f`- > STATEI'w! � ZIPS-SY341
TENANT
PHONE: �(1 ��(-/fo`Cg CU'
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE #
EXP DATE
AND CERTIFICATE OF
ADDRESS:
CITY STATE ZIP
INSURANCE
PHONE FAX
PROPERTY TYPE
INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
DECK ❑ SIDING ❑
OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: Z¢, d� 1i s3L 7�:c' K - A D D
SIZE OF IMPROVEMENT
LENGTH . 5' WIDTH )3'
S� HEIGHT 3 � r SQ FT L
ROOFING
O HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE 1 '
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:
�� X 1 �.
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
_
ADDITIONS. & PORCHES SUBMIT:
❑ Vinyl
❑Soffit — -c'd �A
1. 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 ❑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:
�Q.[S]INQ THE 1997 U.B.0 FEE SCHEDULE)
'OTAL JOB VALUATION $ W d : `t'
Permit Fee
$ 1 G1 �4ci
Plan Review
$ Gln C-1 I
Fire Surcharge
Surcharge
$ I
License Surcharge
$
SAC Charge
$
Curb Cut Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge
$
Total Due
$ ) i
IiT41
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+6ft= ftx$24=$
$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 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 ofl 11york whictl requires review and approval of plans.
SIGNATURE OF APPLICANT C/1� PRINT NAME i L. DATE / q
-' �" LZy
q0, 0o
Building
MECHANICAL
Permit No. '51
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
763-502-4977 FAX
EFFECTIVE 7-1-2010
DATE 2� YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ OWNER XONTRACTOR
PROPERTY
z
NAME:
OWNER/
ADDRESS: CITY STATE IPZS�43
TENANT
PHONE:
CONTRACTOR
COMPANY NAME:_5f
SUBMIT A COPY OF
CONTACT PERSON:
YOUR STATE
STATE LICENSE # _ , EXP DATEd
Q�� aTY q. POLL L STATE�N�ZiP S�1O
LICENSE WITH
ADDRESS:�G j'�'�-f >tl
APPLICATION
pHONE tiaS / f _9j2 FAX I0S-1
AINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
PERMIT TYPE
0 NEW PLACEMENT 17 ALTERATION/REMODEL
TYPE OF WORK:
DETAILED DESCRIPTION OF WORK CLL de-
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
PROVIDE HEAT LOSS CALCIS PER MANUAAJ 2006 ASHRAE HANDBOOK o
Equipment Installed MFG: MODEL: , r i C 3 SIZE/BTU
MFG: MODEL: SIZEBTU
MFG: MODEL: SIZE/BTU
$25.00 (GAS) $15.00 _GAS RANGEIOVEN $10.00
_A/C _FIREPLACE
AIR TO AIR EXCHANGEER $15 (WOOD) $35.00 NEW GAS GRILL $10.00
„FIREPLACE
BOILER $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 DRYER $10.00 POOL HEATER $35.00
_GAS
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
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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 ca` ee•of all work which requires reetie` and approval of plans.
NA
SIGNATURE OF APPLICA
DATE
APPROVAL INSPECTORS SIGNATUREN >
F777MR71 IMF
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977