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PRE 2010 DOCS53 —81► ZMX 87 9.01 Cory of F?adlsy and QT '"ORIE 6459 N. E. Pierce street =,b, r4 . &6 PARTIAL RATE SCHEDULE F-Th-13'ez........ ...... .e — x $2.00 r,us:um F%Z; a Cpening ...., .. - u . -,— --- m Ncw Fixture Old inning ...... Catch BasAn .................... : 83.25 $ rater Heater `up to 99.00 BTU) $3.®® i New Ground Run Old Bldg. ........ x $3.255 Ekeirk FaQ; GAS w® stw tm . . . . . . . . .. .. .. 4 8 VLW rg� VI1TTIIIN�. FEES. 110. RATE TOTAL Cbv crm dMiz7: Gustafson Kind of Building Frame �- Used as Res. lot 3Fixtures ••••••......••• •O x$1.00 $ Additional Fixtures ...............-x$.75 S • $1 -.— State Surcharge $�, .5Q. RUAJM$ it ALTERATIONS—Rd rto Description M. .......... OPU0.0. NW90............-.. S �.00 TOTAL FM i 3.50 • �•IAGQ l•Fia ,2U(C-�13Tg0 '5.50 By Business Phone Ido City of Fridley SUBJECT P 1426 AT THE TOP OF THE TWINS BUILDING PERMIT e�- r RECEIPT N L'�_____ . COMMUNITY DEVELOPMENT DIV. INSPECTION r PROTECTIVE SEC. 1 � 1 ! � 1 o "n CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY J 812-560-3450 910-F15 8/4/77 JOB ADDRESS 6459 Pierce Street 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 Auditor's Sub. #88 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joe Burmis 6459 Pierce Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Inter City Builders 2500 MurrayAvenue N.E., M ls. Mn. 55418 789-9009 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 ❑ NEW ADDITION El ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 14' x 30' Garage Addition 9 CHANGE OF USE FROM TO STIPULATIONS Submit engineered roof design or extend porch rafter to ridge of garage. Provide firewall on south side adjacent to property-line (5/8 inch type X shee ock to rafters, no openings). Install firedoor(s) with automatic closer.(s). INK Porch is not to be heated or used for other than storage. WARNING PERMITS REQVIRP FOR WIRING, Before digging call local utilities SEPERATE TELEPHONE - ELECTRIC - GAS Etc. HEATING+ PLUMBING AND SIGNS. REQUIRED BY lAVII SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 420 5040 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 $3,108 $1.55 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY 01-HER STATE OR LOCAL LAW REGULATING CON- STRUCTION ORTHE P &ORMANCE OF CONSTRUCTION. $20.16 PLAN CHECK FEE TOTAL FEE zllx/ �. �;, $21.71 NATUR FCONTRAC OR OR AUTHORIZED AGENT (DATE) PROP R WHENLY VALIDATED THIS IS YOUR PERMIT BLDG INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) z W I Y UI I MULLY APPLICATION FOR RESIDENTIAL BUILDING PERMITS ('JEW, ALTERATIOPIS, ADDITIO1115, OR REPAIRS) OWt1ER: 0BUILDER: /y �6� i� Address: Address: Tel. No.: No.. LOT: Street: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: 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: CJS Front: Depth: 40 Height: 1 Square Feet: Cubic Feet: 4 Front: Depth: Square Feet: Type of Construction: To Be Completed: Cubic Feet: Height: Estimated Cost: $ 3/ Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby makes 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 of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. See reverse side for additional information. DATE: SIGNATURE: Stipulations: . &4�m ��vzp cv ' 0-7.- ,a� , -tea.-- 63-84-879001 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Beater Gas Range Gas Dryer $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 S 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 19 of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge $ .5o ($15.00) TOTAL FEE $ 10.50 Errective Aug. 1, 1981 Job Address 6459 Pierce Street NE Department of Buildings City of Fridley Tel. #571-3450 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. 11-20-81 . 19 OWNER B'TRMTS KIND OF BUILDING F RAME USED AS TO BE COMPLETED ABOUT 11-27-81 ESTIMATED COST K159M225• OLD - NEW BUILDING PERMIT NO. PERMIT NO. Q L Company Signed By MiPlR1SQaAb'�— Tel. No. ROUGH INSP. Date FINAL INSP. Date / Q APPROVAL FOR PERMIT � 1-6A MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE a Water 0 m m M d•M C m A s6Ni p, w Heater o g 4th .ci Q w W w u a Am � � � O s lec 1st cjasE B h e 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Beater Gas Range Gas Dryer $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 S 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 19 of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge $ .5o ($15.00) TOTAL FEE $ 10.50 Errective Aug. 1, 1981 Job Address 6459 Pierce Street NE Department of Buildings City of Fridley Tel. #571-3450 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. 11-20-81 . 19 OWNER B'TRMTS KIND OF BUILDING F RAME USED AS TO BE COMPLETED ABOUT 11-27-81 ESTIMATED COST K159M225• OLD - NEW BUILDING PERMIT NO. PERMIT NO. Q L Company Signed By MiPlR1SQaAb'�— Tel. No. ROUGH INSP. Date FINAL INSP. Date / Q APPROVAL FOR PERMIT � 1-6A MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE 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 ` Job Address RESIDENTIAL RATE TOTAL �` Furnace Shell, Burner (Also replacement furnace) $ 20.00 $ Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping] $ 10.00 $ Tel. #571-3450 (piping need with new ce) 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 $ All Others/Repairs and Alterations 18 of Value of Appliance or Work $ COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work $ State Surcharge $ .50 TOTAL FES $ Reinspection Fee ($15.00) $ o Rough Insp. Date Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Fridley, Minn. KIND OF USED AS TO BE COMPLETED ABOUT v ESTIMATED COST 6 c2ie-; NEW BUILDING PERMIT NO. PERMIT NO. I(./,� DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, arm Airf No. Trade Name :�y2 — __ Size No. Capacity Sq. Ft. EDRF BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU `HP SCompany Signed By ii�rC Tel. No. .3 ? —h—, V 5 Fill out back side for stack verification on replacement furnaces CITY OF FRIDLEY APPLICATION FOR HEATING REPLACEMENT CHIMNEY AND STACK VERIFICATION THIS FOR14 MUST ACCO11PA11Y STANDARD APPLICATION FOR BEATING PERMIT FORM. LOCATION DATE a — OWNER ADDRESS The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined 2. Is free from rust or deterioration 3. No foreign objects are lodged within 4. Uat it is securely supported S. That it meets all current Code requirements for size and total BTU connected 6. Total Heating BTU All Other BTU REMARKS G TOTAL SIGNED��Y Licensee by � Address /,-9, Telephone �5 -3 -7 HEATING PERMIT # Fridley City License SUBJECT city of Fridley r25985 AT THE TOP OF THE TWINS BUILDING PERMIT r ECEIPT NO COMMUNITY DEVELOPMENT DIV. 1 L PROTECTIVE INSPECTION SEC. !, c V T� i CITY HALL FRIDLEY 55432 NUMBER REV DATE 4/27/98 PAGE OF APPROVED By 612-571-3450 910415 JOB ADDRESS 6459 Pierce Street 1 LEGALLOT NO. BLOCK Pt. 15 (Pa Icel 1290), TRACTOR ADDITION Auditor's Subdivision #88 SEE ATTACHED SHEET DESCR. 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Della Mae Burmis, 6459 Pierce St., Fridley 55432 571-6355 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO R & M Associates, 3482 Auger, White Bear Lake 55110 770-9322 4391 A 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 REroof (tear-offl vinyl windows, patio door 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building 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 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 1 HAVE READ AND EXAMINED THIS APPLICATION 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 $10,700.00 $5.35 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- $174.75 Fire SC $10.70 STRUCTIO R THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE —A� License $5.00 $195.80 SIGNAT UREFCO TRACTOR OR AUTHORIZEDAGEN T ,DATE. WHEN�9PROPER VALIDATED THIS IS YOURPERMIT _ tea/ � � /✓ d BLtG INSP / � (/ �� DATE S,GNATURE OF OWNEROF OWNER BUILDERj iDATEi NEW [ ] ADDN [ ] ALTER [ ] ConstructionAddre Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/97 4' Owner Name &Address: Pf iY1Q (3 u r w► c S Tel. # 3 S Contractor: -F M �} SSo c— MN LICENSE #- 113 Address:� Q £ � (j �"S'I r a - �— 302, i9 � Tel , , . # 77® g322— 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: _ ce _ rg r o f r" -r izavt u., an Q0 5 Estimated Cost: $ 15; 7®o $ lQ,746 .001 of Permit Valuation (1/10th%) (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 61-2-,-7- 9P' -APPLICANT: Tel. # / 6/ - CITY USE ONLY Permit Fee $ Z 741. 75— Fee Schedule on Reverse Side Fire Surcharge $ lQ,746 .001 of Permit Valuation (1/10th%) State Surcharge $ 6-73.�' $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ 5—,,66 $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: STIPULATIONS: /e- �1.�2 '1-- PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRES////liD JIWI-6 New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work In strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated In this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 /A Sump/Receiving Tank $ 7.00 Z13 -9 1997 Water Treating Appliance $10.00 Owner Water Heater —Electric $ 7.00 Water Heater — Gas** _L $10.00 _ Building Used As_,O_ /4:7 Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost _sG- PERMIT NO. Back Flow Preventer Required ( )Yes O No Type $15.00 PLUMBING COMPANY, Reinspection Fee $42.00/Hr SIGNED BY TEL No.� ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough—In Date Final Date State Surcharge $ .50 JTOTAL MINIMUM FEE FR ANY PLUMBING/GAS PERMIT IS $20.00 FEE $J� PLUS THE $.50 TATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. CITY OF FRIDLEY PERMIT NO�- 2004-00856 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 06/08/2004 763) 572-3604 FAX: (763) 571-1287 ADDRESS : 6459 PIERCE ST NE PIN : 133024310017 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : DECK VALUATION : $ 993.60 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651454-0002 FOR UTILITY LOCATIONS. CONSTRUCT AN 8'X 10' DECK. STATE LICENSED CONTRACTOR 0 APPLICANT STEPHENS MIKE HOME IMP (20046773) 3484 GLENARDEN RD ARDEN HILLS, MN 55112 OWNER BURMIS DELLA M 6459 PIERCE ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permi do s not presume to give authority to violate or canc isions of any other state or local law regulat' c r the performance of construytoJa_ Bldg Insp. BUILDING PERMIT FEE PLAN CHECK FEE FIRE SURCHARGE STATE SURCHARGE, VALUE LICENSE SURCHARGE TOTAL PAID WITH CHECK # 5618 U SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. cgwwu . 38.75 25.19 0.99 0.50 5.00 70.43 91319- NEW [ ] CITY OF FRIDLEY �-" Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 57 -124 F BUILDING PERMIT APPLICATION p 00 Y-1 �t Construction Address: �P �.��% Ti P r c P Sf OV S Legal Description: Owner Name & Address: - L� 1 S Tel. # Contractor. 1 c.,IAPI Sfe XJhPtis MN LICENSE# 73Q 2-c:)Cq(0 73 Address:3 caip/t)%t ✓'c�eeu ��Pw / ��/-r Tel. # (-6 J /) 6 7-�� Z - 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. FL GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width 10 Hgt/Ground _3 Sq. Ft 920 QTHER: Construction Type: Estimated Cost: $ 3 2, / 9360 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: V7 1 o V APPLICANT: �-� 2 i Tel. # 6 J-/" 69 ? - —0.F G Z Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] TOTAL $ "-10.1-15 STIPULATIONS: 730 -40TH AVENUE N.E. COLUMBIA HEIGHTS 55421 788-9769 1 HERMEY CERTIFY THAT THIS SURVEY. PLAN. OR REPORT WAS PREPARED BY ME OR UNDER MY DIRECT SUPERVISION AND THAT 1 AM =11113TURZO LAND SURVEYOR UNDER THE LAWS OF THE STATE OF MINNESOTA. DATE OCT. ZS , -7 v SCALE 1 " 30 MINNE50 A EGISTRATION NO. 5332 O= IRON MONUMENT itc,q • '3 - L 8-11 i 01 NORTH �-II.IG Lo -r IS -'�, N d IRON FGNLG ao- r o � v 40 0 32-S a 1 � B-7 #b41S9 �d I O � S+ . 7 co (CC T � ----15Z2.8- o� _ ° 3,o y8.5 zz R Survey of The South 85.00 feet of the North 213,00 feet of that part of Lot 15, Auditor's Subdivision Number 88; Anoka County, Minnesota, lying East of the East line of Moore Lake Highlands 1st Addition. F. ' gOARDNO- S ,ZG % ANG LD• Q 1 Building $ BUILDING Plan Review Permit No. Inspections Fire Surcharge RESIDENTIAL APPLICATION .001 times the total job valuation Received BA, 763-572-3604 .0005 x Permit Valuation Minimum $.50 CITY OF FRIDLEY $ '500 DateM:JUN 9 763-5` 02-4977 FAX $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $22 = $ EFFECTIVE 1-1-09 $ $450 Conservation Plan Review. a 0 $ Fee Determined by Engineering DATE ' YOUR E-MAIL ADDRESS Agreement necessary ( ) Non Necessary ( ) SITE ADDRESS ' 4 V- ^ C -2+ -- Make checks payable to: Citv of Fridlev Attach Stimlations THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: TENANT� ADDRESS: � ( : e . - 54– CITY �/^ � � •� STATEINLZIP� `, �. ?2V PHONE: CONTRACTOR NAME: t t ' ��".,a C SUBMIT A COPY OF STATE LICENSE YOUR STATE LICENSE EXP DATE AND CERTIFICATE OF ADDRESS: -k ! L-),-5 ,t' CITY c ,� `�� STATE n�T�ZI1�3rh INSURANCE PHONE FAX PROPERTY TYPE =GLE FAMILYNEW CONSTRUCTION SIZE O FAMILYNEW 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 ❑ REMODELING DESCRIBE WORK BEING DO E: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ. FT ROOFING ELHOUSE ONLY NUMBER OF SQUARES ?0iOUSE & 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 I . Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF 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) TOTAL JOB VALUATION $ 31 OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 3 kv .001 times the total job valuation Surcharge $ 122 .0005 x Permit Valuation Minimum $.50 License Surcharge $ '500 $5.00 (State Licensed Residential Contractors) SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $22 = $ Erosion Control $ $450 Conservation Plan Review. Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ r(; (r Pn Make checks payable to: Citv of Fridlev Attach Stimlations 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 ford Krmit and work is not to start without a permit on si ; that the work will be in accordance with the approved plan in the case of �Il:� ,ork which rgqutTs review and approval of s SIGNATURE OF APPLAPPLICANT�' • 1 y �`��. _ ..:-�-- PRINT NAM o' DATE