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PRE 2010 DOCSCity of tr Date: q Owner. Builder 6244t" %, -_ 7� Addresa .. O O O UILD NG No. StreetW%01 `V Lo Lot � _ Block Addition or Sub-Divlsio�n _ Corner Lot — Inside Lot Setback S Sideyard — Sewer Elevation — — Foundation Elevation DESCRIPTION OF BUILDING In consideration of the issuance to me of a permit to the proposed work in accordance with the description abo ordinances of the city of Fridley. In consideration of the payment of a fee of $ _°® , permit is hereby granted to above, I agree to do pith all provisions of 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 dty limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. _ 9 e_n Building Inspector NOTICE: 'fids permh does not cover the construction, h►stallatton for wirtag, phmbing, gas headog, sewer or water. Be wre to see the Building Inspector for soparaM permits for these home, APPLICATION FOR, BUILDING PERMIT CITY OF FRIDLEY, NINNE$OTA OWNER'S NAME .._ BUILDER' .DRESS Y6 3 9 , f ADDRESS --r LOCATION OF.BUILDING No. Street Fart : of Lot 6 ' Lot, _ Block Addition or Subdivision Corner Lot Inside -Lot Setback Side -Yard SLWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form.Two Certificates of Survey.of:L.ot-and..proposed build- ing. location drawn an `these Certificates DESCRIPTION OF BUILDING To be used as; ront . Depth . Heighfi sq. Ft. fob.®' 'Cu,. Ft.; Front Depth Height Sq. Ft.;! Cu. Ft.. Type of Construction Estimated Cost To be Comaleted® � 1 P The undersigned hereby makes application fora 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 AXI,,the facts and representations -stated in this application are true and correct, .,(Schedule of Fee Costs can be found on the Reverse Side). NEW [ j CITY OF FRIDLEY ADDN t [ j' 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION C J 1 — 9i Construction Address: �. 0 �� G a C r e e�� OV I `y I/Jr d Legal Description: _ Owner Name & Address: Or i d !j Ue j Lir► rL Tei. # -7 0 (6 j Contractor: 3,e L. MN LICENSE # Address: Tel. # 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 f Hgt/Ground _ V Sq. Ft OTHER: Construction Type: Estimated Cost: Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: _ ��®� APPLICANT:I -Z i n d Tel. # 71,3m �-7a—O f 65 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 TOTAL Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 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 [ ] STIPULATIONS: 3uilding BUILDING- Permit No.: [nspections RESIDENTIAL APPLICATION Received Y.. 763-572-3604 CITY OF FRIDLEY Da' 763-502-4977 FkX EFFECTIVE 1-1-08 SATE — —© E- L ADD SS _ >ITE ADDRESS lc: -2 _ -`,POUR - MIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: �y ADDRESS: CITY STATE ZIP TENANT PHONE: NAME: ADDRESS: CITY STATE ®// IP5-5- CONTRACTOR SUBMIT A COPY OF PHONE 7S�( C S FAX 3— l� —®a YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE SINGLE 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 ❑ MAINTENANCElREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LINGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 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: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS & PORCHES SUBMIT• ❑ Vinyl ❑Soffit I. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and proposed project ❑ Other ❑ Fascia 2. Two sets of construction plans WMOWS 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 BASEDONVALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: TOTAL JOB VALUATION $ '�5�, LASING THE 1997 UBC FEE SCHEDULE)OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ 0 `7 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) $1825 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: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED lations 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 we a Prov plan in the case of all work which requires review and a oval of lans. SIGNATURE OF APPLICANT /G:/%c=; PRINT NAME /Z"� �� (_DATE APPROVED BY DATE