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PRE 2010 DOCSS3 City of Fridley, Minn. N° 10885 BUILDING PERMIT Owner: ,jprnmpTnll _f on Builder Same_ Address 112 P i 1 n t Aypn,, p N_ F. _ Address Same LOCATION OF BUILDING No. — _ 119 Street P i 1 n t- ezpnu per_— .,_ - Part of Lot Lot—_lQBlock - 1 Addition Or Sub -Division _Carl noon 1 a Gummi t- Manny goijf-b Addn. Corner Lot Inside Lot $ Setback __._ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: R p -sh i n g1oo f Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Esme_ Est. Cost $3o0. To be Completed 19,5/70 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 ordinances of the city of Fridley. n �� In consideration of the payment of a fee of $.R,.Sq_ , permit is hereby granted to Jeeai}e Tol,lefson to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. b NOTICE: 'fids permit don not cover the construction, butalldlon for wiring, plumbing, gn hooting, sewer or water. Be son to no the Building Inspector for separate permits for these hems. r APLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME : BUILDER :��1 ADDRESS : �� oL�s-ye�2vf.&_eADDRESS: NO • / I STREET: ce- LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: ,/ % -SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: E Front• Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost:_$ p Q. To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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. DATE:* SIGNATURE : Gc ,:, (See Reverse Side For Additional Information.) ROMAN ROAD I Esc a921k M .fit-- to Ai • i I I d � I ibY i ftl N • Z j ' .� W Q � p j I ' 2[2 ( ---ear----- � I •�---��---- lzo= i !Zo I N N A � • El 242 4 'I YL.2 N (o O ^ I $ N ^ I J z[z iu I do a lZO - II 24.2 r /ZO I I Jag - - — 14 4 .91 V7-rq $ Oi o l m ti I I MAIN STREET N.E. z '^ � ry N a o N V � m h A P, _. n 6 L7 ip Z W > �- Q m ci o � VR^0 ri u C=ut = 3r�M N� "- o m .5 g 2 � � a V A m City of Fridley SUBJECT CR AT THE TOP OF THE TWINS BUILDING PERMIT r COMMUNITY DEVELOPMENT DIV. (✓7 r PROTECTIVE INSPECTION SEC. 1 i i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 1.J 612-580-3450 910-F15 4/7/76 JOB ADDRESS 112 Pilot Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 Carlson's Summit Manor South Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerome Tollefson 112 Pilot Avenue N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Gorco Construction Co. 3384 Brownlow Avenue South 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 Ij NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 241 x 281 Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Expose lot stakes to verify set backs durring footing insp. W'-brace rafters 32 inches on center REQUIRE® FOR SrPERATE PERMITS SIGNS. PLUMBING AND N EATING, 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 672 6720 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $4,972.80 2.49 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, $12.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE Yt7tN, $14.99 SIGNATURE OF CONTRAC RAUTHORIZED GENT (DATP) HEN PROPERLY-VqIDATED THIS IS YOURPE MIT BLDG INSP DATE SIGNATUB(E OF OWNER (IF OWNER BUILDERI (DAT EI OR ADDITION•BUILDI`G PEU1IT , CITY OF FRIDLEY, MINNESOTA OWNER ' S NAME: : BUILbER: (9dreo �ons� • �ea - . • ADDRESS : 0- - - Ick ,4ve _. Iy . ; . ADDRESS:-. 3ST-4 - 5 c^oun tow- At-, STREET: -MW- Pi of A e-- ki • E IAT: l 0 BLOCK: i • ADDITION: CcL -Isa,n Summ e E CORNER LOT: INS IDE LOT: SETBACK: SIDEYARD : Applicant attach to this form Two Certificates. -if Surve .of • Lot and -proposed building location di. -Awn on these Certificates. ' • DESCRIPTION'OF BUILDING = To Be Used As: - it-cx Front: ____Depth:Height: 1 . - Square Feet: 6P76 Cubic.Feet: (gilt- 6700 Front:Depth: Height: Square Feet; Cubic Feet: Type of •Construction: FP -R me— Estimated Cost: -49�70 T6 - Be Completed: McL-q f S The undersigned hereby makes applicatiop• 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.' • j, • DATE: ` ! -, - -7(,SICNATURE - c co • (See reverse Side For Additional Information,)' �- �� Ox 4-' d • , O ,:-.� � 2,r „-�``�• Pte• ,� p;r/ SUBJECT City of Fridley 11159 AT THE TOP OF THE TWINS BUILDING PERWT i � RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r v i PROTECTIVE INSPECTION SEC. 1 NUMBER REV, DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 L J`� 612-571-3450 910-F15 4/12/91 JOB ADDRESS 112 Pilot Avenue N.E, 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 Carlsonts Summit Manor South Addn, SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerome/Lois Tollefson 112 Pilot Avenue N.E. 574-2688 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. B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION II REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (15 Squares) 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd layer but not 3rd. 06' alt new. m6fs or ac .r-a€fs and replacement roofs, State Code requires IV 2 layers of 15 Ih. felt, mopped together, be installed to a point 24 inches up from a et8dor wall line, or the use of other &P utide to menta membrane. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED 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 $780 $.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- $21,00 Fire SC $.78 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 2.28 SIGNATURE OF CONT RACTOR OR AUTHORIZED AGENT MATE) 'W EN PR PERLX A D D HIS IS Y R PERMIT BLDG INSP GATE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI t NEW [ l ADEN [ ] ALTER [ ] Construction Address: 'Ila R-1 AND R-2 Building Permit Application Effective 1/1/91 - v Legal Description: Owner Name & Address: �^ Tel. # r�, �� & Contractor:Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. r PF I IPTION OF IIKIPAMOn' LIVIM AREA: Length Width Height Sq. Ft. GRRAGS AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. Corner Lot [ ] Inside Lot [ ] Type of Constniction: Approx. Completion Date: Ft. Yd Setback Side Yard Setbacks Estimated Cost: $ 700 Prgx sed Driveway Width If New Opening Is Desired: Ft. $ $ w Width + 6' See Back Page /9 APPLICANT• Tel. # .5 7 y d Permit Fee $ O O Fire Surcharge $ %� State Surcharge $ d SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Qmarge $ r SrIPUTATIONS : CITY USE OI�II,Y Fee Scimable on Reverse Side .001 x Permit valuation (1/10th $) $.50/$1,000 valuation $650 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] SUBJECT PERMIT NO. City of Fridley '6" 6 AT THE TOP OF THE TWINS BUILDING PERMIT ____ COMMUNITY DEVELOPMENT DIV. LV PROTECTIVE INSPECTION SEC. r � i A '�',,� CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY •--- L J` 612-571-3450 910-F15 4/22/93 JOB ADDRESS 112 Pilot Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 1 Carlson is Summit Manor South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lois/Jerome Tollefson 112 Pilot Avenue NE 574-2688 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 Construct basement bathroom 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan, 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 1 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $4 X00.0 $2.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SACCHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $63,00 $4.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $69,00 SIGNATURE OF CONTRAC R OR AUTHORIZED AGENT MATEI HEN RO LY L AT THIS IS YOUR PERMIT BLDG INSP _ DATE SIGN ATU RF OF nW NFR+iF O NEA BUIL DE RI (DATE) NEW [ l ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner Name & Address: Contractor: Address: Effective 1/1/93 MN LICENSE # Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length OTHER: DESCRIPTION OF IMPROVEMENT Width Height Width Height Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ o ©0 Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: ! oZ /�-3 APPLICANT:-' Tel. # .S- 2—o? CITY USE ONLY Permit Fee $ (`. ��` Fee Schedule on Reverse Side Fire Surcharge $ y , c� 0 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: $ �9, C(! ° CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1993 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL 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 () No Type $ 7.00 �1 $ 4:00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $700 JOB ADDRESS e5� ,--e .- The undersigned hereby makes application for a permit for the work herein fj 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. Owner 15C /D '''--� �'` 74 A '( 'cP;Z ,1993 $10.00 Building Used As j)® i, -Z- $10.00 14,1 17 $10.00 Estimated Cost 19 PERMIT NO. •$5.00PLUMBING COMPANY �Q1" -4, i O-ij Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge TOTAL FEE ,21 ao $ .50 SIGNED BY L TEL N0. n -- Rough—In Date Approved By (; Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE Building Inspections 7.63-572-3604 'q ox SITE ADDRESS 11, THIS APPLICANT IS: PROPERTY OWNER/ TENANT MECHANICAL Permit No.: RESIDENTIAL APPLICATION Received By:MaL NJ CITY OF FRIDLEY DJ&d: YOUR E-MAIL ADDRESS ❑ OWNER ffCONTRACTOR NAME: 4_'0_t-ri_ rot(L.S®r, a��d ADDRESS: I I a Pt I o f A ``O I- CITY ��'� I STATE? J ZIP i,a PHONE:rTI;: CONTRACTOR COMPANY 4-1/'(t-( SUBMIT A COPY OF CONTACT PERSON: YQE YOUR STATE STATE LICENSE # EXP DATE LICENSE WITH ADDRESS: F42 0 �' Sl•. ;'JE CITY`STATE4�^IW� ZIP��`�� — APPLICATION PHONE -7" 75 � — d 19 i FAX PERNIIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW >fREPLACEMENT ❑ ALTERATION/REMODEL ETAILED DESCRIPTION OF WORK 4,(# �>3 r, A r �__ 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. ('This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FDI M, EXCEPT WHERENOTED: FIXTURBS: (MICATE TOTAL NUMBER OF EACH BELOW) r_ (� �l MODEL: QA0L_ O�J'� SIZFJBTU o `"" Equipment Installed MFG: '477 MFG: v MODEL: aJ I;• A, &. 06 �1a1 A ij SMMTU • MFG: MODEL: SIZEBTU A/C $25.00 _FIREPLACE (GAS) $15.00. _GAS RANGE/OVEN 510,00 AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 BOI[.ER $35.00 � FURNACE $35.00 GAS UNIT: HTR 510.00 _CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 VENTII.ATOR 515.00 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ Number of fixtures @ $25.00 _ x $25.00 - $ Q—T- 4 G Number of fixtures @$35.00 �_ x$35.00=$ State Surcharge = $ .50 Total = $ 0 - ' 0 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 ��a'�� 9 (Z -PRINT NAME C /'1 S (Z@- -_DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 f• REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMESIADDITIONS EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fue11MC Chapter 7 with MN Amendments b. Natural Gas or Propan&UGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. TMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances ]FGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES m 4. Heat loss & cboling load per room a. Required on new construction IMC 1346.0312' 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346:0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up airs calculations CrrY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT TOTAL P.01 PLUMBING Permit Number RESIDENTIAL APPLICATION Rete y City Of Fridley Date Receivea RECD JUN 1. 008 NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- A UCENSED CONTRACTOR MUST 013TAIN THE PERMIT. DATE - q "' G) F YOUR E-MAIL ADDRESS SITE ADDRESS 7/ e 6 7 Auz' THE APPLICANT 1S. (CIRCLE ONE) OWNER NTRACTOR NAMEJLPL PT k® PROPERTY OWNER! TENANT ADDRESS -112- Pa I b -j• A tr t— CITY FA a r❑6 d. STATE ri tj PHONE°fi% ��°4� NAME _Qt, lre r 0- t _ _ LICENSE # CONTRACTOR ADDRESSr9AQ0 WAft COE CITY 0--d "- r STATE PHONE 0 7 S 4 4111 FAU PERMITTIME SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK ❑ NEW —Zf' REPLACEMENT' DETAILEDDESCRlPT10NOFWORK�Ga�.�Q.9 �s.„�J��t��"-h'F (L�.���e.� (�Yo-�' � � FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FIXTURE& (INDICATE TOTAL NUMBER OF EACH) BATH SINKILAv FLOOR DRAINS SHOWER WATER PIPING BATHTUB OAS PIPING (Need City License) SWBIININGi POOL WATER SOFTENQi ($35) CLOTHES Wg9tIER KITCHEN SINK WATER CLOSET BACKFLOW PREY. ($15) DISHWASHER LAUNDRY TRAY WATER HTR (SM FOR IRRIGATION WATER METER OTHER Permit Fee. $ ° U) `' MINIMUM: $45.00 or 5% of cost of the improvement -whichever is Plan Review $ greater on work less than $300 Surcharge $ .50 TOTAL DUE S Maize checks payable to: Ctty of Fridley THIS 13 AN APPLICATION FOR A PERMIT- NUMB UNTIL PROCESSED I hereby apply for a plumbing 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 Wnnesota Construction Codes; that I understand this is not a permit but only an appliption for a permit and work is not to start wittwut a permit; that the work will be in accordance with the approved plan in the case of aU work which requires review and approval of plans. NAME OF APPUCANT r°' t S (�--t' EO DATE " Please type or print SIGNATURE OF APPUCANT C6—" -C' D 4�t ,. + CrrY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT TOTAL P.01 From: City of Fridley To: 651-203-0554 Page: 4/5 Date: 7/26/200612:02:13 PM % 1 U-7cb- 0 Building $ BUILDING Permit No.: Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received B. 763-572-3604 Surcharge CITY OF FRIDLEY cN DATE ( I S l YOUR E-MAIL ADDRESS $5.00 (State Licensed Residential Contractors) SITE ADDRESS $ $1550 per SAC Unit (Plans to MWCC for determination) THIS APPLICANT IS: ❑ OWNER ONTRACTOR ft + 6 ft = ft x $21 = $ PROPERTY OWNER/ NAME: LixC tirrrmo �,1lkS�v+n $450 Conservation Plan Review ADDRESS: ';�ZCnYVIX CITY STATE ZIP TENANT Sewer Main Charge PHONE Agreement necessary ( ) Non Necessary ( ) CONTRACTOR NAME: LA1t{r tJUAA MAL f =JUCCA Make checks payable to: City of Fridley Attach Stipulations STATE LICENSE # EXP DATE C;Ej,2011orl SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: UCX 1 V1(• rO O A -A .A j • [-- CITY YLI�ILeD L� STATE IF= d2� L0 WITH APPLICATION PHONE ALAQ % FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED AMINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR WkEMODELING ft (AUU' DESCRIBE WORK BEING DONE: lU_LN —7 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. OR OFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: I. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: 13 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 IN OUSTING OPENINGS )des ❑No LOCATION OF WINDOWS XI 3. Energy Calculations 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 AYEJ MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION OCCUPANC Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) 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 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 whi requires review and approval of plans. SIGNATURE OF APPLICANT . ��n —PRINT NAME��O r., � DATE ��