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PRE 2010 DOCSCity of Fridley, Minn. N° 8555 BUIMING Date: OCTOBER 223, 1965 Owner: Builder CHARLES ,2'OHMSQ� Address Address 160 Hartman Circle Fridley 32, Minnesota LOCATION OF BUILDING No. 461 Street RICE CREEK BOULEVARD Part of Lot Lot ._._ 6 _ Block 1 Addition or Sub -Division .Llolida -Hilla, 2nd Additica Corner Lot _ Inside Lot _._. $ Setback 35, --- Sideyard 101 Sewer Elevation — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: HOUSE Front 43.66' Depth 26' Height 18 _ Sq. Ft x,144 Cu. Ft ..-2.0.,5..92 GARAGE Front 20.33' Depth 34' Height 12 Sq. Ft. 680 Cu Ft. 8,160 Type of Construction Frame Est Cost __1182 000.00 To be Completed In consideration of the issuance to me of a permit to construct the building d bed above I agree to do the proposed work in accordance with the description above o and in li ce with of 1 provisions of ordinances of the city of Fridley. � s In consideration of the payment of a fee of $-10 --0 0 , permit is hereW granted to CHARLES E. JOHANSON to construct the building or addition as described above. This permit is granted upon the express conditionat the person to whom it is granted and his agents, employees and workmen, in all work done aroundZZftdl ey, Minnesrwithin the city s and this permit may be revoked at any time upon violation of any of the provisions of said ordiaaaca3s. ALLEN G. JENSEN Building Inspector NOTICE Uh pemdt den net aomr the sndmatlen, IsdaWas for wUho plemblag, gas heating, serer or water. Be an to age the Bnildh* Inapeator for separate pemUe for these Items. APPLICATION FOR BUILDING PERMIT OF FRIDLEY, MINNESOTA t' OWNER'S NAMES !.� a-- BUILDER s ADDRESS her 2t� � � ADDRESS.. LOCATION OF BUILDING NO, GSTREET /(c e - PART OF -LOT _-.- LOT _BLOCK ADDITION OR SUBDIVISION c � CORNER LOT INSIDE LOTS SETBACK SIDE -YARD SEWER ELEVATION FOUNDATION ELEVATION 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; Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. 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 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 � Z SIGNATURE (Schedule`of Fee Costs can be found on the Reverse $ode). _. , NEW [ ] ADDN. [ ] ALTER. ( ] Construction Address: Legal Description:_ Owner Name & Address: Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: City of F. R-1 AND Building Permit am f ley ication Attach to this application, a Certificate of Survey of the lot with the proposed construct on drawn on it to scale. r DESCRIPTION OF IMPROVEMENT Effective 4/1/86 Tel. # Tel. # Length Width Plan Check Height Sq. Ft. Length Width Park Fee Height Sq. Ft. Length Width $ Hgt/Ground Sq. Ft. Corner Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: Ft. Yd. Set Proposed Driveway Width If New Opening Is Des A21 DATE:® APPLICANT: Permit Fee $ Plan Check $ State Surcharge $ SAC Charge $ Park Fee $ Sewer Main Charge $ TOTAL $ STIPULATIONS: Side Yard Setback a 06 Estimated Cost: $4%30-006 IN® Alt. A Alt B CZ / $ . cc $ See Back Page for Explanation Tel. # -5 74— 7 Y Fee -Schedule on Reverse Side 25 of Building Permit Fee $.50/$1,000 Valuation $475 per SAC Unit Foe Determined by Engineering nt Necessary [ ] Not Necessary [ ] Application for rower Plants and Heating, Cooling, Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3450 416 / GRAVITY WARM AIR: RATE TOTAL Location — Furnace Shell & Duct Work ...........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR 6 Furnace Shell &Duct Work to 120,000 BTU ............$10.00 $ 0 c each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTI) ....................... 6.00 $- over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ 0' ROUGH FINAL, City of Fridley: The undersigned hereby makes application for a permit for the work hereir, 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, Alin 19 Owner - Kind of Building Used as i To be completed abou Estimated Cost, $ v / ,—New. Building Permit No. Permit No. fig DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No // Trade Name t Size No�6y� hi`—/® Capacity. Sq. Ft. E.D.R, BTU H.P. Total Connected Load 2/,3,000 Kind of Fuel Ad.��2 j BURNER — Trade Name p Size No / /L P if 0 0 Capacity Sq. Ft. E.D.R BTU H.P. Signed it Business Phone No -71 V City of Fridley Application for Plumbing and Gas ung Permit Dept. of Bldge. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 99,000 BTU) ...... New Ground Run Old Bldg . ............ Electric Water Heater GAS FITTING FEES: 1st 3 Fixtures ...... ................... Additional Fixtures .................... Gas Range to 199,000 BTU.... . . install (1} g..as lite REPAIRS & ALTERATIONS—Refer to Code x $2.00 $ X $1.50 $ X $1.50 $ x $3.25 Y F X $3.00 K Z Z O ( w O 6 2 �O • F • N WATER HTR. GAS ELEG Base 3.00 Ist 2nd 3rd 4th ° Future Connection Openings e New Fixture, Old Openings I Connected with Sewer El Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Heater (Up to 99,000 BTU) ...... New Ground Run Old Bldg . ............ Electric Water Heater GAS FITTING FEES: 1st 3 Fixtures ...... ................... Additional Fixtures .................... Gas Range to 199,000 BTU.... . . install (1} g..as lite REPAIRS & ALTERATIONS—Refer to Code x $2.00 $ X $1.50 $ X $1.50 $ x $3.25 $ X $3.00 $ x $3.25 $ z $2.00 $ NO. RATE TOTAL 1 x $2.00 $ 2.00 x $ .75 $ X $5.00 $ 3.00 '- City of Fridley: 53-84-5915.51 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 facl and representations stated in this application are true and correct. Fridley, Minn Aug. 29a 1970 , 19_ Owner C. Mark Hakenson Kind of Building frame Used as residence To be completed about Aug. 25t 1970 Estimated Cost, $ 10* OldX-New. Building Permit n Permit No. 0 By Business Phoneo ffv" POL1S Co® ROUGH FINAL % k ' L` ? 0 Description ................................................$ TOTAL FEE $ 5' 00 -9610. az 53-84--9-915.51 City of Fridley Application for Numbbig and Gan R"I" FanWt Dept. of B1d9o. Phone 364-3450 Blvd. DESCRIPTION OF WORK 4.61 N. E. Rice Creek fmnm 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 $ Catch Basin .................... x $3.25 Water Heater 'Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water Heater .............. x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ............... _ x $2.00 $ Additional Fixtures ................. x $ .75 $ Gas Range to 199.000 BTU ...... , ........ x $5.00 $ 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, Minn 10-8--71 19� Owner C, Mark Hokenson Kind of Building Frame Used as Re s • To be completed about 10-15-71 Estimated Cost, $ 10.00 XXX—New. Building Permit No. Signed. p By�' a'u �� � - Business Phone No ROUGH f FINAL // REPAIRS & ALTERATIONS—Refer to Code Description........ Clothes Dryer, .: 5.00 r MM Come -A-Sur-charge x.50 TOTAL FEE $ 5 s 00 $'v�H1 N 7WAT111 ELEG <�j Bax I t ll Dr r 1st 2nd 3rd 4th ° Futuro Connection Openings Connected wift * Now Fixture, Old Openings Sewer 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 $ Catch Basin .................... x $3.25 Water Heater 'Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water Heater .............. x $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ............... _ x $2.00 $ Additional Fixtures ................. x $ .75 $ Gas Range to 199.000 BTU ...... , ........ x $5.00 $ 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, Minn 10-8--71 19� Owner C, Mark Hokenson Kind of Building Frame Used as Re s • To be completed about 10-15-71 Estimated Cost, $ 10.00 XXX—New. Building Permit No. Signed. p By�' a'u �� � - Business Phone No ROUGH f FINAL // REPAIRS & ALTERATIONS—Refer to Code Description........ Clothes Dryer, .: 5.00 r MM Come -A-Sur-charge x.50 TOTAL FEE $ 5 s 00 LLApplication for Power Plants and Healing. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices s PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone 560-3480 GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ..........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water . ................ 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING 6 la FAN HEATING SYSTEM See Fee Schedule Sd VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE 0 $ 6 ROUGH FINAL-1—`Z®� City of Fridley: The undersigned hereby makes application for a permit for the work hereir. 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 age true and correct. Owner Kind of Used as To be completed about Estimated Cost, $� Old— e1�Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS- Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Si _'e"d"g k"�I' By Atm -4/ as Business Phone No- �':� S 7'53 (REMARKS—OVER) 53-844915051. cagy of r-, -10Y j�P 36; i 'n for MuTflb? ::S end �,--s t bl�."U Vc` lrt ... --- Dept. of 131das. Phona =- -3:50 D::SC?.1PTI01i 0: V"Ori LOCAL ;= �_ Num!>e:. Xind and Lc<r<:rn of Fixtures. • FL: -a Gc::x:..n C' :4r-1 ! t -.-- ---- Sonar Ij * ?lav F -m! -ars. Old 0,-,sz1nc% — C=–pool El PARTIAL RATE SvHEDULE City Of Fridley;. "h61 13ic n,.�Ab 3l rr7 - The underligned' hereby snakes application for a permit for the vozkc herei specified, agreeing to do all work its strict accordance with the Citi Or-d=ct and ruling of the Department of Buil w'ngs, and hereby declxr es that all the fact and representations stated it, L%..s zpplicat?on are true and correct* Fridley, Man 4-a-76 Owner Arden, Foss "Pi Kind of Building frame Used as res • - To be completed about I' -28-76 - Estimated Cost. $ 10.00 i'st36Y'3o. ��� Old . Building Permit No. L�fSI?tG f-1XTV-,E RATES: ttq. RATE TOTAL . Signed 2\'utr.ber Fixtures .... 1 1 1 1 ....... x 52.0-0. s - -- MINNEGASCO - Future Fixture Opening .......... • x $1.50 S _._� wwtra M7a. ` $y Burin= Phone No _ few Fixture 011dpyening.. • 111.1... L Z - 0<'j x $3.25 $ — u 0 i� �A5 rite . ROUGH New Ground Run Old Bldg....:.... - — x :3,25 5_-.--------- • . . Elsctek 4'latar V.&atar..... d . ► 4 ......�..-. x S2.Ca 5 rutin :MS T1TTING FEES: NO.iinTd: TOTAL D3St Ist 3 Fixtures . a .............. 6.0 ._._.--- x 52.00 S — � x + .75 $ - o G:s Rs: +a to 10.9.000 BTU ........... ^----- x $5.00 $ . - 5.00 .50 State S=Charce XLTZ AT1OXS•—Rorer to Cod* ...... .Ik: 4;tIon ...............:..TOTAL ,............. . I" It 2nd_... -- 3:d • FL: -a Gc::x:..n C' :4r-1 ! t -.-- ---- Sonar Ij * ?lav F -m! -ars. Old 0,-,sz1nc% — C=–pool El PARTIAL RATE SvHEDULE City Of Fridley;. "h61 13ic n,.�Ab 3l rr7 - The underligned' hereby snakes application for a permit for the vozkc herei specified, agreeing to do all work its strict accordance with the Citi Or-d=ct and ruling of the Department of Buil w'ngs, and hereby declxr es that all the fact and representations stated it, L%..s zpplicat?on are true and correct* Fridley, Man 4-a-76 Owner Arden, Foss "Pi Kind of Building frame Used as res • - To be completed about I' -28-76 - Estimated Cost. $ 10.00 i'st36Y'3o. ��� Old . Building Permit No. L�fSI?tG f-1XTV-,E RATES: ttq. RATE TOTAL . Signed 2\'utr.ber Fixtures .... 1 1 1 1 ....... x 52.0-0. s - -- MINNEGASCO - Future Fixture Opening .......... • x $1.50 S _._� • ` $y Burin= Phone No _ few Fixture 011dpyening.. • 111.1... X $1.50 $._ 1111 -- • � - Catch Bain ............ 1 1 1 1 .. x $3.25 $ — Nater I{eater ILJp to 09.000 BTUY.. 0 . x $300 $ . ROUGH New Ground Run Old Bldg....:.... - — x :3,25 5_-.--------- • . . Elsctek 4'latar V.&atar..... d . ► 4 ......�..-. x S2.Ca 5 rutin :MS T1TTING FEES: NO.iinTd: TOTAL Ist 3 Fixtures . a .............. 6.0 ._._.--- x 52.00 S — Additioaal Fixtures ..... 4 4 — 1 4 0 0 . w----- x + .75 $ - o G:s Rs: +a to 10.9.000 BTU ........... ^----- x $5.00 $ . 5.00 .50 State S=Charce XLTZ AT1OXS•—Rorer to Cod* ...... .Ik: 4;tIon ...............:..TOTAL ,............. . I" SUBJECT PERMIT N City of Fridley ® AT THE TOP OF THE TWINS BUILDING PERMIT -17955 r � RE • _____ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE X 93 1 i CITY HALL FRIDLEY 55432 NUMBER REV. DATEP AGE OF APPROVED BY 612-571-3450 910-F15 5/7/85 / / JOB ADDRESS 461 Rice Creek Boulevard N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 1 Holiday Hills 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Arden Foss 461 Rice Creek Boulevard N.E. 574-0427 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. T. G. Home Builders, Inc. 120 Collen'.Street, Wyoming, MN 55092 464-5945 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Resident%al 7 CLASS OF WORK NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Three Season Detached Porch. .(W Octagon) 20.8 Sq. Ft. 9 CHANGE OF USE FROM TO STIPULATIONS L ' ` ^.�� � SEPARATE PERMITS REQUIRE® FOR WIRING, IDEATING, PLUMBING AND SIGNS. Before digging call load utidit Ps TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BY LAW 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 SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION 208 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 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 $3,900 $1.95 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- $44.50 S RUCTIO R THE PERFORMANCE OF CONSTRUCTION. P AN CHECK FEE TOTAL FEE P�. $11.13 $57.58 SIGNATURE OF CONTRACTOR OR AUTHORIZE ENT IDATE) WHEN PROPE RLY .BALI DATED THIS IS YOUR PERMIT n SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) SLOG WSP D TE NEW [ ] City of Fridley Effective 4/1/84 ADDN. I R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: 46 CrPP k, )3)V Legal Description: 1, T ./ D to cl( f 440 / i N w Ur #i II S 2 /d,; -T;'9 -I �7 Owner Name & Address : tlr de -, F055, IL i C � e r, W vd Tel. # `r 7y Contractor: 6- Ho Tel. Address: 120 Ce Pr n 5L 1 e 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/Gro)und Sq. Ft. OTHER: `� f w s c� �a c e 1 y c `� a019)e 18 1 8 1L_ T_ 61 Corner Lot [ ] Inside Lot KI Ft. Yd. Setback Side Yard Setback IK Type of Construction: Estimated Cost: $ -- J5 �� 5 Simi Approx. Completion Date:01 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: / 7 APPLICANT: Tel. Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] ;1 3pive'Rity Ave NE Iley, MN 55432 ►3) 572-3604, FAX (7s3) 571-1287 Floor 1 Floor 2 Floor 3 Floor 4 LUMBING FOCTURE RATES. ew Fixtures ild Opening, New Fixture eer Dispenser ,low Off Basin .atch Basin '.ain Water Leader P" v FJ sn b_ 4i L Ak IA as AU_ftl d 1A) 1&utj) ®fj S 0 2:h e.. S �o� l0�� . NO. APPLICATION FOR PLUMBING AND GAS FITTING PERMIT OF FIXTURES TO BE INSTALLED ON EACH FLOOR ..T y Auto. -as ;F Wash ''t Floor...,_ ,...., RATE TOTAL JOB :ump/Receiving Tank vater Treating Appliance Vater Heater -Electric Vater Heater - Gas** )as Range` ;as Dryer** —"'— lack Flow Preventer Required ( )Yes (} No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.0Ei $10.00 $15.00 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 3 l 20-0 Owner Building Used As Estimated Cost PERMIT NO. PLUMBING COMPANY SIGNED TEL No. BY r� {einspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5%. of Value of Fixture or Appliance Approved By Rough -In Date Final Dat State Surcharge-�— ' MI•; UM FEE FOR ANY PLl)MBING/GAS PERAAIT IS 4� PLUS 'TME $ �0 STATE $LIRCFIARGE TOTAL FEE "MC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE ,OMBUSTION AIR SHALL BE PROVIDED PER U APR -04-2003 12 13. FROM CITY OF FRIDLEY TO 6513651332 P.02/02 THE BELOW MUST BE F LLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION IMLL BE RETURNED When oplaring an epi din , the undersigned hereby verifies that the venting has been examined and is tree from rust, deterioration, obstructions, and Is securely supported and firestopped where required. Yes( ) No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications Including sizing, length, number of elbows and termination. Yes( ) No( ) The undersigned also verities that the replacement unit is a listed assembly and meets the anent codes and manufacturers specific adons. This does Include ACA -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The sin nnmhi,atin aiir, is sued and Installed to meet the current Godes and manurtac turer's specifications. Yes( ) No( ) When required to insftu ita"aMt1sanaat it will be sized and installed to meet the current odes and manufacturer's specs cations. Yes( ) No( ) When , the undersigned hereby verifies that it is a fisted assembly and meets the current codes and manufacturers specifications. This does include AGA -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances_ Yes () No( ) Is the common vent. and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) Appiie= #1 Type BTU Input Fan Assisted or Not Appliance #2 Type BTU Input Fan Assisted or Not Appliance fir' Type BTU Input, Fan Assisted or Not Total Appliances Total Btu input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Applimc a 42 Vent Connector Height ft Length ft Diameter In Type Appliance #3 Vent Connector Height ft Length ft Diameter ---_in Type �.�• 4�•._ HEALING CO: Signed By. Date: TOTAL P.02 I� CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 June 8, 2004 Ms. Jeanne Osgood 461 Rice Creek Blvd NE Fridley, MN 55432 Re: Final Inspection at 461 Rice Creek Blvd NE Contractor: H P Pipeworks Dear Ms. Osgood: A plumbing permit was issued in December, 2003 to install a gas water heater at your address. On December 12, 2003 a final inspection noted that the following correction needed to be completed before the permit could be finaled; Provide combustion air per manufacturer's instructions and UMC Section 602. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspections, we will mark the permit "no inspection called for by homeowner after notification" and the permit will be expired. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. RinrPrPly DJ/mh Building $ BUILDING See Back Page for Fee Schedule Permit No.: -0/ Inspections J 9 .&1 RESIDENTIAL APPLICATION Surcharge Received By: 763-572-3604 (.0005) times the total job valuation - Minimum $.50 CITY OF FRIDLEY $ Date Rec'd: DATE'S YOUR E-MAIL ADDRESS License Surcharge ,f SITE ADDRESS q 9 C �-n �� �t u'p �, 1 Jnr $5.00 (State Licensed Residential Contractors) THIS APPLICANT IS: ❑ OWNER 90—QNTRACTOR PROPERTY OWNER/ NAME: t C, a,5 �- a ,D $ y ADDRESS: LA P-1 et�— C—Itk-c'i- `�DCITY T TA P TENANT $ PHONE: $450 Conservation Plan Review CONTRACTOR NAME; f� 4 35 B L4 m �a►� f STATE LICENSE # 610/4X EXP DATE !S -0(e Sewer Main Charge SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS:/m.)®-1S /,M- CITYLOPL& a R. n W STAT ZIP �'S 37 1 WITH APPLICATION PHONE % le 3 - '�7S -3 3 FAX Make checks payable to: City of Fridley Attach Stipulations PROPERTY TYPE INGLE FAMII Y/NEW CONSTRUCTION SIZE ❑ 0 FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR 3kREMODELING DESCRIBE WORK BEING DONE: V1 "Il ]�`qszs m taru+ ;-7' Lis s cru ► e�rw s. 1110 c ¢F v d1fJ�c�1� 7V �� SIZE OF IMPROVEMENT LENGTH A" WIDTH HEIGHT Sq. Ft9bC) ROOFING ❑ HOUSE ONLY r" NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE f 1. 2• Existing Floor Plan 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 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: (USING 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ / ,CSCd OCCUPANCY TYPE Permit Fee $ c) 3,'<I 6- See Back Page for Fee Schedule Plan Review $ J 9 .&1 65% of Building Permit Fee Surcharge $ , on (.0005) times the total job valuation - Minimum $.50 Fire Surcharge $ e .001 x Permit Valuation (1/10%) License Surcharge $ S®® $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Jam' 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 ordinan es and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an applicati fora perm" d work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all wor hick requ' s;.e roval of plans. ' (� SIGNATURE OF APPLIC 1�e f + PRINT NAZP SSG l (,,Ali [ O PLUMBING RESIDENTIAL APPLICATION City of Fridley ®= Off/ Permit Number Received By Date Received NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. /0- V� C 5— DATE YOUR E-MAIL ADDRESS �- SITE ADDRESS l� / k. ' G c CY e e © 7' THE APPLICANT IS: (CIRCLE ONE) OWNER CONTRACTOR ; �'c- ' 05:•Cc,./ NAME C PROPERTY OWNER/ ADDRESS TENANT CITY STATE ZIP PHONE # / NAME LICENSE # ADDRESS CONTRACTOR CITY _ -STATE ` ZIP PHONE # � 3 '-S �o� °- G 72 S� FAX# PERMIT TYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK ® NEW ___%Q==lREPLACEMENT z DEBT]AILED DESCRIPTION F�/jWjORK �44C) -le / ey ' S f-Lrl �y /�- s-G� IF aJOJ / A �G `Y ./—L T FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (Need City License) SWIMMING POOL WATER SOFTENER ($35) CLOTHES WASHER KITCHEN SINK f WATER CLOSET BACKFLOW PREY. ($15) DISHWASHER LAUNDRY TRAY WATER HTR ($35) FOR IRRIGATION WATER METER OTHER Permit Fee $ ®b MINIMUM: $15.00 or 5% of cost of the improvement -whichever is Plan Review $ greater on work less than $300 Surcharge $ .50 TOTAL DUE $ /-/0,s-,6 Make checks payable to: City of Fridley THIS IS AN APPLICATION FOR A PERMIT - NOT VALID 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 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 /oof tans. �! C-GS /® 1--05 NAME OF APPLICANT ✓ DATE ase SIGNATURE OF APPLICANT 00 OTEI:R� By SCI R(G �L a y �. _ + Y Yx CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT 6431 UNIVESITY AVENUE NE, FRIDLEY, MN 55432 (763)572-3604 -7�' P" 6 fi. F.64 P Building MECHANICAL Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 4�g 763-572-3604CITY OF FRIDLEY Date Recd: DATE� YOUR E- ADDRESS �/6 ` %�� �� AL ` �RESS THIS APPLICANT IS: 0 OWNER ONTRACTOR/�' PROPERTY NAME: Fri -c -a ev OWNER/ DRESS: `i�E1I STATE%LIP TENANT PHONE: CONTRACTOR COMPANY NAME: ter' 6' "y " `�e/.('L' �-' �� SUBMIT A COPY OF CONTACT PERSON: 1-17 /4C r �k� S C'YOU STATE LICENSE WITH STATE LICENSE # t�11 '� EXP DATE 2 � y - '� AV b . r. CITY f fY� �� • STATE�'E�ZIP S % APPLICATION ADDRESS: PHONE FAX PERNUT TYPE SINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: D NEW REPLACEMENT LTERATION/REMODEL DETAILED DESCRIPTION OF WORK .S tf` ��.3' /c �i'�d�dia✓ ���`� PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost u to $500.00 w�h1c1 eater, for the P improvement, installation or replacement of a residential fixture, excludin a fnttures reflect only tine oflabor) LOO Labor cost under $300 = $15.00. Labor cost between $300 to $ = cos�oflabo�r x AS = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10. ED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) SIZE/BTU Equipment Installed MFG: MODEL: MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU A/C $25.00 _FIREPLACE (GAS) $15.00 GAS RANGEIOVEN $10.00 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 CHIMNEY LINER $10.00 --GAS DRYER $1000 POOL HEATER $35.00 _DUCT WORK $1000 _GAS PIPING $1000 VENTILATOR $15.00 10D ro "• 9r AN _ Permit Fee $ 00 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 = $ fixtures $35.00 x $35.00 = $ Number of @ State Surcharge = $.50 Total = $ THIS S 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 whic requires review and approval of plans. PRINT NAME /71®� C, '� DATE in SIGNATURE OF APPLICANT . -L City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEWIEXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propan&UGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new -construction TMC 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 air calculations -� - - CITY OF FRIDLEY Y 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: ADDRESS 461 RICE CREEK BLVD NE PIN 143024210032 LEGAL DESC HOLIDAY HILLS 2ND LOT 6 BLOCK 1 PERMIT TYPE ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ELEC SERVICES, UPGRADE NOTE: BASEMENT FINISH - SERVICE UPGRADE TO 200 AMPS LAR'S ELECTRIC , 612-275-2250 CALL FOR ROUGH IN AND FINAL INSPECTION ELECTRIC PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE ENTER ELECTRICAL FEE 80 APPLICANT LAR'S ELECTRIC 16460 WOLFRAM STREET NW RAMSEY, MN 55303 (612) 275-2250 OWNER OSGOOD ERIC D & JEANNE H 461 RICE CREEK BLVD 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 wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp, Date 571-1L51 PERMIT NO.: 2006-00144 DATE ISSUED: 02/06/2006 ELECTRICAL PERMIT FEE 80.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 80.50 PAID WITH CHECK # 4406 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY PERMIT NO.: 2006-00206 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 02106/2006 572-3604 FAX: (763) 571-1287 REPRINTED ON 2/8/2006 ADDRESS : 461 RICE CREEK BLVD NE PIN : 143024210032 LEGAL DESC : HOLIDAY HILLS 2ND : LOT 6 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ELEC SERVICES, UPGRADE NOTE: BASEMENT FINISH - SERVICE UPGRADE TO 200 AMPS LAWS ELECTRIC 612-275-2250 ENTER ELECTRICAL FEE n 80 LARSON ELECTRIC 7331 BAKER ST NE FRIDLEY, MN 55432 OWNER OSGOOD ERIC D & JEANNE H 461 RICE CREEK BLVD 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 permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date ELECTRICAL PERMIT FEE 80.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 80.50 PAID WITH CHECK # 4406 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ck /651/6 Building BUILDING Permit N Coz,9657 Inspections RESIDENTIAL APPLICATION Received By: ?'q,:,_7/_ 763-572-3604 CITY OF FRIDLEY nate Recd: /o 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 199,;U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ '2)QQ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Tntnl nue 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) $1550 per SAC Unit (Plans to MWCC for determination) —ft +6 ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley 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 whichequine/sJreview_ and approval of plans. SIGNATURE OF APPLICANT CJ ) OR&'11 '— PRINT NAME fYlg% DATE 02—/0-060 DATE ✓�" � � , � � YOUR E-MAIL ADDRESS THIS APPLICANT IS: ❑ OWNER *ONTRACTOR PROPERTY OWNER/ NAME: �L�C]C71 TENANT ADDRESS: �� 0 ��C EK 3�V D n CITY �" O, VE- STATE T PHONE:y(1n!a- -7 `t 3 — 55- �- (o CONTRACTOR NAME: t w -s Co., -ST CO STATE LICENSE lOa-(oS % EXP DATE 3 — 31 SUBMIT A COPY OF 9 -7(s(,. Ay L CITYiS� ► �Ct=t� o STATE�a YOUR. STATE LICENSE ADDRESS: l-SILL®N WITH APPLICATION PHONE 3 FAX ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE PROPERTY TYPE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED FINISH P�R.00F ❑ WINDOWS ❑ DRAIN TILE ❑ BASEMENT ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCEIREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: -/ ` D �0 0 — !WTH SIZE OF IMPROVEMENT LENGTH HEIGHT Sq. Ft. ROOFINGOUSE NUMBER OF SQUARES ONLY HOUSE & 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: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ❑ Vinyl ❑Soffit ADDITIONS & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. 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 199,;U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ '2)QQ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Tntnl nue 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) $1550 per SAC Unit (Plans to MWCC for determination) —ft +6 ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley 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 whichequine/sJreview_ and approval of plans. SIGNATURE OF APPLICANT CJ ) OR&'11 '— PRINT NAME fYlg% DATE 02—/0-060 3uilding BUILDING PermitNO.:�0 0.0- q( Inspections RESIDENTIAL APPLICATION Received By: �l 763-572-3604 CITY OF FRIDLEY Date Rec'd: )ATE YOUR E-MAIL ADDRESS ISISut WOt IM 1 N W ;ITEADDRESS 4jj n CI �dl�li &L b 'HIS APPLICANT IS: DOWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: �1, L CITY di'1f l�b"_STATE VIP TENANTADDRESS: PHONE: CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX X SINGLE FAMILY/NEW CONSTRUCTION SIZE PROPERTY TYPE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH )iYROOF ❑ DRAIN TME ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: Ve-►r6& SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other VV"OWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED ❑ HOUSE & GARAGE 0 ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ VIA I OCCUPANCY TYPE 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 $20 = $ 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 IS AN AULfCATION 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 wo which re//�� es review and approval of plans. pp SIGNATURE OF APPLICA 0 aQ PRINT NAME � 1 G (%l9/� DATE