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PRE 2010 DOCSCity of Fridley, Minn.. BUILDING PERMIT Date: ..... . "..,e! s) ._...... ......_.... .._ ....._.-_.._.._...._....._ .. _ Address� ,�` • '......4 .�/ Builder ................ Address............. '" ... .................. I........... LOCATION BUILDING No... „... Street_...`-ra_ ................ ..... Part cif Lo Lot ... ....-------.._...---- Block ....._... s Addition or Sub -Division CornerLot .........................._ ........ Inside Lot ... ......... Setback . ............ Sf ' " _ .. _............. .............. _.......... .-............ Sewer Elevation ...... ........ ............................. _.---.---.---.._...------...._.------_....__---- Foundation Elevation DESCRIPTION OF BUILDING To be Used ash. �r tr.._......... Front .._.. Depth ............ Height .... Sq. Ft. :::_. Cu. ....... .... ....................... Font .. . Depth ,........ fightSq. Ft ............... ........ Cu. Ft. ..... _................ Est. . Type of Construction __.. �.�....- .,� ... Cost:........ ............. To be Completed co v PERMg �- LR�id CO 6aN`�PS,R�C\a�As" gU1LD`N�' R 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 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 regarding location,- construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violatif any of the provisions of said ordinances. ' k141M..Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer, or water. Be sure to see the Building Inspector for separate permits for these Nems. 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA _._ ... _.... Owners Name .. Builder. Address 2 // Address LOCATION OF BUILDING No. "z, Street '� jV. e Part of Lot Lot Block -:Z_ Addition or Sub.Div. Corner -Lot Lot Inside Lot Set* Back Y/ Side4ard SEWER ELEVATION FANDATION..ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION. OF. BUILDING To be' used as.: Front 1-2 Depth 2 Heigh S,q Ft. Cu. Ft. f Front Depth Height. Sq 'Ft. Cu: Ft. Type of Construction Estimated Cost; • 4,0'q be: completed •r, TYie undersigned hereby -makes application for a permit, for the' vrork . herein specified, agreeing to do all work in strict accordance with the City Ordiriandos and ruling of the Department of Buildings,•and hereby declares that all the fadto'and representa- tios stated in this application are true and correct. DATE�_SIGNATUREa .(A Schedule of Fee costs can be found on the Reverse Side.) CNy of Fridley 53-84-S-91:5.51 Dept. of Bldge. Phone 560-3450 DESCRIPTION OF WORK� 6211 N. E. Rainbow Drive Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................. x $2.00 $ Future Fixture Opening ............ x $1.50 $ _. New Fixture Old Opening .....:.... x $1.50 -$ 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 are true and correct Fridley, Mnn . 6-27-74 19� Owner Leonard Passon Kind of Building Frame Used as Res. To be completed about 7-h-74 Estimated Cost, $ 10.00 Old—New. Building Permit No. N Signed Catch Basin .................... x $3.25 $ Water Heater :Up to 99,000 BTU) . • .. x $3.00 $ ROUGH New Ground Run Old Bldg.......... x $3.25 $ Electric later i€eat®r........... s $2.00 $ FINAL �� 3AS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 ; Additional Fixtures .................—x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS --Rotor to Code .50 State Surcharge Description ..... Install. Gases Grill .............. 5.00 TOTAL ym 5.50 Mass -p aureharge .500 By Business Phone No H WATER MTN. GAS ELEC. C S O S �d / '1i ; i0�► n < (�!p Base 1st to 1 Cras Grill 2nd 3rd 4th • Future Conn tion Openings connectedWith SowerNow E] * Fixture. Old Oponings Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................. x $2.00 $ Future Fixture Opening ............ x $1.50 $ _. New Fixture Old Opening .....:.... x $1.50 -$ 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 are true and correct Fridley, Mnn . 6-27-74 19� Owner Leonard Passon Kind of Building Frame Used as Res. To be completed about 7-h-74 Estimated Cost, $ 10.00 Old—New. Building Permit No. N Signed Catch Basin .................... x $3.25 $ Water Heater :Up to 99,000 BTU) . • .. x $3.00 $ ROUGH New Ground Run Old Bldg.......... x $3.25 $ Electric later i€eat®r........... s $2.00 $ FINAL �� 3AS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 ; Additional Fixtures .................—x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS --Rotor to Code .50 State Surcharge Description ..... Install. Gases Grill .............. 5.00 TOTAL ym 5.50 Mass -p aureharge .500 By Business Phone No SUBJECT O• City of Fridley 27151 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. _ rr PROTECTIVE INSPECTION SEC. cJ NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEV 55432 612-571-3450 910-F1 5 8/12/98 JOB ADDRESS 6211 Rainbow Dr 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 2 $ lvan Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Passon 571-8558 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Vikincy Rome 1= 4832 21/2 St E 572-1820 4772 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Ravnnf hQuse and garage (23 SQ.) Tear—off 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 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 .96 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. S62.25 Fira SC $1.92 PLAN CHECK FEE TOTA EE xa& , - -r`�� � V 0.13 IGNATUREO -CONTRACTOR OR AUTHORIZED AGENT IDATEI - EN OP BL INSP IDA THIS IS' 7;MI 6A TE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: /,,�Z// Legal Description: Owner Name & Address: Tel. # ,J 7 ! -A, r-3',? Contractor: MN LICENSE # Address: 41W,7, -g u-5 > Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF E%IPROVEMENT 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: 12 -do 27 Estimated Cost: $ (A (Fee Schedule on Back) Driveway Curb Cut Width Needed: 'Ft. + 6 Ft = Ft x $ _ $ DATE: —SSI APPLICANT: Tel. # �-t- e -®,,a CITY USE ONLY Permit Fee $ • �� 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 $ 0,1-3 STIPULATIONS: Building $ 5,400 BUILDING $ Permit No.: Inspecti.ons $ RESIDENTIAL APPLICATION $ Received By: , 763-572-3604 CITY OF FRIDLEY Da* DATE �� I ® T YOUR E-MAIL ADDRESS SITE ADDRESS 6Z(( A THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME:1414g[i I?sea h$ TENANT ADDRESS: 6° 2- % t RA 114 T3o)g 'D R u CITY� 9-t 0 JP STATE 4,3 PHONE:6 3 5-71 IM R CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ OOF ❑ DRAIN TILE ❑ DECK SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE:V (bN L �3'f�7 !,Y SIZE OF RVIPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES 13 ATTACHED GARAGE 1. 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: PROPOSED HEIGHT: 11 DETACHED GARAGE 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, inyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other. ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 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 AND MATERIALS: TOTAL JOB VALUA Permit Fee Plan Review Surcharge $ 5,400 License Surcharge $ SAC Charge -'�$ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge Total Due � I _--OCCUPANCY_ See Back Page for Fee Schedule 65% of Building Permit Fee .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks savable to: Citv of Fridlev 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; that the work will be in accordance with the approved plan in the case of all work which .squires review and approval of plans. (r IGNATURE OF APPLICANT 'I "Aa PRINT NAME l4f� iJ 5SO {., DATE / T CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER 1, Lgiows41?-y pA5,r,061 , understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a s ecific exemption from the licensing requirements. As the owner of the property at ( )wwy p P , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name Date 0 ( Z ® 01