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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT T Date: Owner: _ Builder Address Address N° 5003 % LOC 10 O R ING No. _ ! Sheet6p�- Part t Lot _ _ y __ Block _ _ __� Addition or Sub -Division �---- - Corner Lot _ _ Inside Lot _ _ Setback--�1�-_ _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To Used Front Depth s Height -- Sq. Ft. Cu. Ft. Front O Depth eight Sq. Ft. Cu. Ft. Type 'jConstruction - y� � Est. Cost _ ,,�' .-17--'To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do orcin ance=s of twork In he city accordant with the description aby. Iove set forth and in compliance with all provisions of In consideration of the payment of a fee of $'rj 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 violation of any of the provisions of said ordinances. Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to no the Building Inspector for separate permits for these hems. N APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA CLE ®N, ,INC.*'* Owners Name � Bu"ilde ECONTRACTORS 2500 22nd Ave., ..N. E. Address _ __ _. Address MAmmalis I8� Mi LOCA ION OF BUILDING ry No. Stree art of Lot tot Block .. - Addition or Sub. Div.' Corner Lot` ✓ Tnside Lot Set Back Applicant'attach to this form Certificate of Survey of Lest and propos,ed building location.' DESCRIPTION OF BUILDING To bused as Front Depth.,,,, Hei ht Sq. Ft. Cu. Ft. Front Depth Z21 Height Sq. Ft. ��ge Cu. Ft. _ Type of Construction ' Estimated Cost To be completed The undersigned hereby.makes-application for a permit for the work herein specified, agreeing to do all work in strict accordanco.-with.the, City Ordinances and ruling of the Department of Buildings, and'hexeby declares that all'. the facts and representations stated in this application G are true and cor ect. Date Signat (A Schedule of Fee Costs can be found on the .c �--'-'-'r Side) 6, Application for Power Plants and Heating. Cooling. Ventilation, .Refti ion and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR / Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ .each add. 60,000 BTU ........................ 2.00 $ Replacement of Furnace §.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam....... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water ................. 1 2.50 $ OIL BURNER—to 3 gal. per hour 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.Oo $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FFE At ROUGH FINAL Dept. of Bldgs. Phone SU. 4-7470 Locatfona O I— ' 4-"" ��/ - City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application arg4rue and correct. Owner +� Kind of Buildingh—� , Used as To be completed about (- ` N{ F.efima4cul n + Q` C6 19 Ol New.-puilding Permit No. l% G� Permit No. DESCRIPTION OF WORK HEATING or PO PLANTS team, Hot Wa �Warm No Trade Nam Size No 1,010 o Capacity Sq. Ft. E.D.R d BTU H.P. Total Connected Load "%� p i g Kind of Fue r' , BURNER —Trade Name . Size No Capacity Sq. Ft. E.D.R BTU H.P. Signe rti i T N. WELTER . . E, 00 By 4637 CHICAGO AVE. MINNEAPOLIS 7, MINNESOTA EQZfl-42 2M 7-59 Business Phone No c ✓ �'� (REMARKS—OVER) 46pity of Fridley, Mm. PERMITBURDING N® 6391 -- 10 Owner: Builder A Address., et9MMO BUILDING ® .,No. + Street _ - --art Lot Block - e Addition or Sub -Division . Corner Lot _ Inside Lot _ _ Setback S eyard Sewer Elevation __ Foundation Elevation DESCRIPTION OF BUILDING WEV �.. —4 Cu. FL�. Z::n' Depth Height Sq. Ft.._ cu. Ft.Type of ConstructionEst. r st _ To be Completed In consideration of the issuance to me of a permit to const the proposed work in accordance with the description above set ordinances of the city of Fridley. In consideration of the payment of a fee of building described abov , I agree to do id in comms withfall provisions 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 bufldings within the city ]units and this permit may be revoked at any a upon violation any of the provisions of said ordinances. Building inspector NOTICE M permit doss not cover the cond. coon, hwagWon for wkino, phtmhhte, gas henthm sower or water. Be sure to we the Buihih►o hupector for separae permhs for these Menai. cy�� APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA owner's NameS'� ..i.lAIi44..Builder ,i �. �••._.. ' .t y r No LOCATION OF BUILDING of Lot Lot Block Addition or Subdivision_r__r_�_ Corner Lot Inside Lot Setback Side --Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to'this form Certificate of Survey of Lot and proposed building location.' To be.used as: DESCRIPTION OF BUILDING r � � _„ Depth �1height „ Sq. Ft. Cu. Ft• Front Depth Height Sq. Ft. Cu. Ft. Type of Construction__ �J .. Estimated Cost To be Completed 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 ruling of the Department of Build- ings, and hereby declares that all the facts and re resentations stated in this application are true and corre� DATE_J SIGNAT (Schedule of Fee Costs can be found on the RsvdX06 Side) . Application for Power Plants and Heating. Cooling. Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—ta 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x $1.50 $ Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $1 ROUGH FINAL Dept. of Bldgs. Phone SU 4-7470 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn g o� 19 4-13 Owner _ Kind of Building Used as To be completed about Estimated Cost, $� Building Permit No. Permit N DESCRIPTION OF WORN HEATING or POWER PLANTS—Steam, Hot Water, -- Trade Name Size No __A6E�_ Capacity. Sq. Ft. E.D.R-- BTU H.P. Total Connected Load Kind of Fue, BURNER — Trade Name , Size No �� • �' Capacity Sq. Ft. E.D.R BTU H.P. RAY N. WELTER HEATING CO. Signed 7 el"SAGG AVE. By MINNEAPOLIS 7. MINNESOTA 42 2M Business Phone NO (REMARKS—OVER) . City of Fridley AT THE TOP OR TME TWINE 16. '`L ------- COMMUNITY OEVELWMdENT QiV, i PNOTECTIVQ W9ftCT*N 99W, CITY HALL f1110LgV 0001t Job Address Owner Contractor Kind of Bui Completion— CD omp etion 53 -8h -S-915.51 SU6dECT PLUMBING, PERMIT APPLICATION 201 N. E. Rice Creek Blvd. Romona Schumm MINNEGASC® Frame 2 -11-74 i i I 0 w * (,i6"a-, E:i11 ,aaress Phone 784-0648 .ddress Phone ,733 MARQUETTE AVENUE se MPLS., MINN, Aes. Gas Fitting Fees: 1st 3 Fixtures x $2.00 I - ` Additional Fixtures x $ .75 i CGas Range -199,000 BTU x $5.00 Repairs & Alterations See Description: Instgll r Code 5.00 State Surcharge Class 'Al Surcharge .505� _50 I TOTAL FEE $ 5.50 !!The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and Tulin of the Department of Buildings, and hereby declare that all"the facts and representations stated in this application are true and correct. —moi Signature &R.IOA�- Date .10.00 Plumbing Fixture Rates: NO. RATE TOTAL Number Fixtures x $2.00® Future Fixtures x $1.50 New Fixture -Old Open. x $1.50 Catch Basin x $3.25 Water Heater -99,000 BTU x $3.00 Ground Run Old Bldg. x $3.25 Elec. Water Heater x $2.00 Gas Fitting Fees: 1st 3 Fixtures x $2.00 I - ` Additional Fixtures x $ .75 i CGas Range -199,000 BTU x $5.00 Repairs & Alterations See Description: Instgll r Code 5.00 State Surcharge Class 'Al Surcharge .505� _50 I TOTAL FEE $ 5.50 !!The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and Tulin of the Department of Buildings, and hereby declare that all"the facts and representations stated in this application are true and correct. —moi Signature &R.IOA�- Date g Lt IT ur rKII)LCT APPLICATION FOR PWMBING AND GAS FITTING PERMIT .PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. ON IN hu=ber Fixtures x q Um M Future Fixture Opening _ 3i $2.00 $ Water Heater M J C Catch Basin �_ '^ •►� $ k. Water Heater - to 99,000 BTU x $5.00 N � N• x $10.00 $ water Softener __ x $7.90 $ Now Ground' Ran Old Building x $5.00 .�' Electric Water Heater - x $5.00 �w GAS FITTING FEES: 1st 3 fixtures y $3.00 o as lea a %U a w m $10.00 $ REPAIRS $ ALTERATIONS w circ $5.00 $ +� each add. $100.00 or fraction $2.00 S `_ State Surcharge $ _50 8.00 TOTAL FEE $ �� 1st , tad 3sd ' ash • (R) - Future Connection Opening Connected with Sewer (�) - Iiew Fixture, Old Opening Water .PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL hu=ber Fixtures x $3.00 S Future Fixture Opening _ 3i $2.00 $ NOW Fixture, Old Opening x $2.00 $ _- Catch Basin �_ x $5.00 $ k. Water Heater - to 99,000 BTU x $5.00 $ _ 100;000 BTU to 1990000 BTU x $10.00 $ water Softener __ x $7.90 $ Now Ground' Ran Old Building x $5.00 $ Electric Water Heater - x $5.00 $ •_,__ GAS FITTING FEES: 1st 3 fixtures x $3.00 $ A3ditional Fixtures x $1.00 $ .Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ +� each add. $100.00 or fraction $2.00 S `_ State Surcharge $ _50 8.00 TOTAL FEE $ �� REINSPECTION FEB Job Address .c.....�—d2Q_l -P TrF. _ r-R'REK � Department of Buildings City of Fridley Tel. 6571-3450 The undersigned hereby makes application lora permit for thework her specified agreeing -to do all work in strict accordance with the City Codi and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and co Fridley, Mn. 5727-77 OWNER RAMONA SGHjIMM - - KIND OF BUILDING frame _ USED AS res. TO BE COMPLETED ABOUT 6-17`7 ESTIMATED COST �,. n ��, qa OLD - NEW BUILDING PERMIT N0. Sam EMT N0 A9 cZ Company a, INNEGASCO Signed By _- Tel. No. ROUGH INSP. Date FIN4L INSP. Date APPROVAL FOR PERMIT . MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 SUBJECT P City of Fridley Y 5 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 'See a NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 7/10/96 JOB ADDRESS 201 RICE CREEK BLVD NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 2 Rice Creek Plaza North SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Sandra Pflipsen 201 Rice Creek Blvd NE 571-3337 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 8 DESCRIBE WORK Reroof House & Garage (28 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the 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 SQ. 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 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 $2,310 $1.15 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $78.21 SIGNATUQE OF ! TRACTOR R EDAGENT IDATEI WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT `J 1- ��Aa-& !� �/ OF OW fF O BUILD I IDATEI 9L IN v �11 --iOATEb NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: 10/ —%Ge" (Ile Legal Description: Owner Name & Address: ; Contractor: s Address: i11%2 Effective 3/1/96 Tei. # :57/ "�� MN LICENSE # Tel. # Attach to this aZlosed lication, a Certificate of Survey of the lot, with the prconstruction drawn on it to scale. OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length DATE: /G� �ll/ Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: USE ONLY Permit Fee $ Comer Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: Ft. Yd Side Yard Setbacks f Estimated Cost: $ STIPULATIONS: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6,Ft = Ft x DATE: /G� �ll/ APPLICANT: __.._ %'"- - E� Tel. # -C� Wr . CITY USE ONLY Permit Fee $ �`��® Fee Schedule on Reverse Side Fire Surcharge $ p, _ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 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 $ / STIPULATIONS: SUBJECT PER N City of Fridley 2 9 9 25 AT THE TOP OF THE TWINS BUILDING PERMIT -WEPT NO. Ir � `v ------COMMUNITY DEVELOPMENT DIV. SEC. W63 f PROTECTIVE INSPECTION 1 � = I I CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY J 612-571-3450 910415 7/23/99 JOB ADDRESS 201 Race Creek Blvd. NE 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 2 Rice Creek Plaza North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Christopher Carlson 574-1297 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Allied Fireside 2700 N. Fairview Ave. Roseville 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 jOc ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install wood insert into masonary fireplace 9 CHANGE OF USE FROM TO STIPULATIONS Install per manufacturers specifications 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND QRDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 2400 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1.20 DOES NOT PRESUME TO GIVE AUTH RITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY O HER STAT O OCAL LAW REGULATING CON- STRUCTION R THE P FORMAN E ONSTRUCTION $83.25 Fire SC $2.40 PLAN CHECK F TAL FEE 24�k % 301 86.85 SIGNATURE OF CON' ACTOR OR UTHORQED AGENT IDA E) VALI ED THI OYUE IT4ff OY 7,LrGA-NSF-P-- r FIAtE S-GNATURE OF OWNER.IF OWNER BUILDER, IDATEi NEW [ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (�a' BUILDING PERMIT APPLICATION �� N Construction Address: Legal Description: Owner Name & Address: Contract Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: # ATZ-y-9 Z MN LICENSE # Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. ,Length Width l Hgt/Ground� Sq. Ft. �s. 4��AA b�hfV �'SL4/P� ��.Te4 .vr.r_1B✓Id4'V '7ii`� ��I�� Estimated Cost: $ a2�/�. evO Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # CITY USE ONLY Permit Fee $ 83,o?s- Fee Schedule on Reverse Sid 47 c S Fire Surcharge $ o2• '�1® .001 of Permit Valuation (1 10th%) State Surcharge $ /. off® $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contrac 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 $_ C� STIPULATIONS: r Effective June S, 1995 Receipt 9 -7 Fee: $ 6 ? e 3 0 CITY OF FRIDLEY LAND ALTERATION PERMIT APPLICANT Address PROPERTY OWNERS NAME Jur-aw2� 61A�' Tel. # Address NAME . if aj, r r , Tei. Address LEGAL DESCRIPTION OF PROPERTY Lot _ Block Addition s t/ 2/ k A 7 �t 112� Address: jW DESCRIPTION OF LAND ALTERATION Value of Work: $4 000 Starting Date: Completion Date: Source and Composition PURPOSE OF LAND ALTERATION ATTACHMENTS TO APPLICATION TI following plans, drawings, calculations, bonds and/or statements maybe required by the Public Works Department: -° [ ] H f -section m�i or sketch of property showing all adjacent property indicating the existing buildings an or structu es. [ ] Grading plab showing existing and proposed finished contours and evaluations. [ ] Draina elan showing existing and proposed drainage structures, stabilization walls, retaining walls, cnMing dams, or other. protective items. [ ] Calcu do s for and approximate quantities of excavation and/or fill required. [ ] Si d state ent from the property owner accepting responsibility for the operation and granting pe , ission f r land alteration/mining operation. [ ] S tement to a attached to deed advising of potential need for soil tests prior to any construction o lots where dditional fill material has been placed. [ ] ice Creek Wa ershed District Approval. [ ] Soil Borings - [ Other STIPULATIONS READ BEFORE SIGNING APPLICATION 1. A surety bond or certified check in the amount -of $ (S% of value of work to be completed) must be submitted after approval of application and prior to any work commencing. This bond or check is to eiisure - satisfactory - performanee -and compliance with the below stated stipulations. The surety bond or check shall be kept active until the completion of work and/or expiration of permit and can only be released by written notification of the City after a satisfactory final inspection has been performed by the City. - 2. All access and street frontage of the land alteration site must be controlled by a fence, a minimum of four (4) feet in height All entrances must have gates that are capable of being locked. 3. Only rock, sand, gravel, dirt, or similar natural earth fill is permitted. No concrete, asphalt, or demolition wastes will be permitted as fill unless a demolition landfill permit is first obtained from Anoka County. 4. Operations shall be limited to daylight hours and shall not interfere with the :health and safety of surrounding residents and the premises shall be maintained at all times so as not to create a nuisance. Stipulations Continued 5. Any explosives used must be done so in accordance with Chapter 212, subsections 212.07.5A, .513, .5C, .513, and .517. of the Fridley City Code and any other applicable standards, e.g. Federal, State, Industrial, etc. G. At the end of each season's operations and no later than the last day of December each year, the site is to be left in a neat and orderly condition, with maximum slopes of 2:1 with no overhang or vertical banks and with a level bottom. 7. On the Friday of each work week, or when required by the City, material from this operation that is found to exist on City streets shall be cleaned to the City's satisfaction by the applicant 8. Upon completion of land alteration operations, the land must be left according to the plans and contours submitted with this application and planted with suitable vegetation to prevent. erosion. 9. Upon completion of land alteration operations or expiration of this permit, an inspection will be made by the City of the premises and adjoining streets. Any damage found to have been caused by these operations will be corrected by the applicant upon notification by the City. Property Owner's FOR CITY USE ONLY Recommended for Approval B- -. Approved By: PERMIT EXPIRATION DATE: cif% Date: Date: Date: Date: Date: ///Z af ago Building Inspections 763-572-3604 DATE ..Z= SITE ADDRESS AC' 1 THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR MECIIANICAL RESIDENTIAL APPLICATION CITY OF FRIDLEY 'D I? YOUR E-MAIL ADDRESS 11 OWNER 1'T® Permit No.• U Received By:AM Date Rec'd: 5 -1 —61? COMPANY NAME: Anderson Heating and Air -Conditioning CT PERSON: SUB1.�tIT A COPY OF CONTA YOUR STATE STATE LICENSE # �/� 4347 Central Ave N,E. LICENSE WITH ADDRESS: ft _STATE ZIP APPLICATION PHONE Zl? s- l- f�sf/ CAI. fits, Mn 55421 PERNIIT TYPE *INGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW XREPLACEMENT ❑ ALTERAnoN/REMODEL DETAILED DESCRIPTION OF WORK PER Me ent, installation the permit fee antof minimum esident Of a fixture excluding the fixtures. (Thi 0 or 5% of the total cost up to shou dwhichever reflect onlygreater, the cost of labor ) improvement, installation or replacement 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 FIXTURE, EXCEPT WHERE NOTED. FIXTURES: ?(INDICATE TOTAL I, UIJIBER OF EACH BELOWMODEL: SS % 7:�"I SIZEBTU5l Equipment Installed MFG: MODEL: SIZEIBTU MFG: _____ _ --- SIZE/BTUMFG: MODEL: GAS RANGE/OVEN $10.00 A/C $25.00_ FIREPLACE (GAS) $15.00 _NEW GAS GRILL $10.00 _AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 GAS UNIT HTR $10.00 BOILER $35.00 _FURNACE $35.00 —'POOL HEATER $35.00 GAS DRYER $10.00 CHIMNEY LINER $10.00 — VENTILATOR $15.00 GAS PIPING $10 DUCT WORK $10.00 .00 _. 1 TEE':PRUJEC�S rt�x t�.IvlJ�n:�3vu ��r: ��.::�,� 4� v,, 4,.N.�� , �.�.-�.� .e..-._ Permit Fee $ . DO Number of fixtures @ $10.00 x $10.00 = Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $25.00 x S25:00 = $ TOTAL DUE $ PIS -'._64 Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ 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. �O 6 G1�1 i �P e/) k ey 6j DATE SIGNATURE OF APPLICANT C AX -4 -�►---PRINT NAME City of Fridley ]Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977