PRE 2010 DOCSLO TIO
IL NG
No. 4 Street j.. Part_ f Lot
Lot _ _ __ Block Addition or Sub- As!
Corner Lot Inside Lot Setback __ _ Sideyard
Sewer Elevation Z,`�
� • 7 6 .� e n IIevation � ��
DESCRIPTION OF BUILDING
T Used
Front Depth Height ��`_--�� Sq. --�'ca.
Depth Height ��Sq. Ft. Cu. Ft.
Type of Construction Est. Completed
In consideration of the Issuance to me of a permit to construce'� ding des above I agree to do
the proposed work In accordance with the description above set fn,�Ompli ce th provisions of
ordinances of the city of Fridley./
In consideration of the payment of a fee of permit is herebygrantedto
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, Mirmesota regarding location, construction, alteration, maintenance, re and moving of buildings
within the city limits and this permit may be revoked at any t poY ola f any of the provisions of said
ordinances. / 11 il
NOTICE:
Tide permit does not cover the construction, Installation for grill+®, plumbing, gas hendn& sewer or water. Be sure to as
the Building hupector for soperate permits for these itomt.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNED ° S NAME BUILDER
ADDRESS � � ADDRESS �
LOCATION OF BUILDING
No. Street Part of Lot
Lot Block Addition or Subdivision
Corner Lot Inside tot Setback Side Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
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 hereb declares tha ll the facts and
representations stated in this application art =e q4 core ct. /^
DATE
(Schedule of Fee Costs can be found on the Reverse S
.- .4
City of Fridley
Application for Plumbing and Gas F'*ting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK - 9
Number, Kind and Location of Fixtures
PLUMBING FIXTURE RATES:
yKs,
RATE TOTAL
y
V1
$1.50
v1 Q
,�
u�
aQ[ QZ
6 u01
O T�i
v!
N w
Z
u1 Z
`
i
WATER HTR.
GAS
ELEG
�Cx
2.00
$ cA
New Ground Run Old Bldg . ............
x
3.25
$
UO
Base
1st
2nd
3rd
4th
° Future Connection Openings
Connected with
New Fixture, Old Openings
Sewer
0
Cesspool
PLUMBING FIXTURE RATES:
RATE TOTAL
Number Fixtures ......................
�NO.
x
$1.50
$
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ..... .....................
x
3.25
$
Water Heater (Up to 200,000 BTU) ......
�Cx
2.00
$ cA
New Ground Run Old Bldg . ............
x
3.25
$
City of Fridley:
—3
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.
Owner
Kind of Building
Used as
To be completed about
stimaFst, $
ld(:N�e g Permit
ROUGH 4-,Z - q- 6
GAS FITTING FEES: NO. RATE TOTAL FINAL
1st 3 Fixtures .......................... x $1.50 $
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description ...................................: $
TOTAL FEE $ 0 d
42
By C
Business Phone
194?�
Application for Power Plants and Healing, Cooling, Ventilation, Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
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 $ Lo 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 199,00 BTU) ....................... 5.00 $ S O
over 199,000 BTU See Fee Schedule
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x$ 2.00 $ o
Additional Fixtures x .75 $
Gas Range to 199,000 ........... x$ 5.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH
FINAL
See Fee Schedule
TOTAL FEE
Dept. of Bldgs. Phone 560-3490
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 19 Ly
Owner
v
Kind of Building
Used as A re'a"�
To be completed about
e e
Estimated Cost, $�(�®
OM—New. Building Permit No. Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name > Size Nozd-?'�;" d
Capacity. Sq. Ft. E.D.R BTU H.P.
Total Connected Load— �� Kind of Fuel
BURNER — Trade Nam Size No- 'go 0C
i
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS -OVER)
Signed
GCMD.42 Business Phone No -
SUBJECT
PERMIT
City ®f Fridley
20429
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r
NUMBER
REV.
DATE
OF
APPROVED BY
CITY HALL FRIDLEY 55432
j 612-571-3450
910-F15
6/18/90
FPAGE
JOB ADDRESS 561 Rice Creek Boulevard N.E,
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
2
Holiday Hills Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Kathy Gagnon 561 Rice Creek Boulevard N.E. 571-7536
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Addition & Remodeling Spec., Inc. 10800 Xavis Street N.W., C.R. 55433 427-7330
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW Gk ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 201 x 161 Deck Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
WARNING
letori digging.call #or
all Unho locations
X54-0002
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SQ. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
I
I STALLS I 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
$2,300.
$1.15
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
PROVISION F A Y OTHER STATE OR LOCAL LAW REGULATING CON-
$ 54.00
ST UCTI OR PERFORM CE OF CO STRUCTION.
PLAN CHECK FEE
TOTAL FEE
?"1EJ
$55.15
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
I(yl N PROPS T HIS IS YOUR PERMIT
ZLYVD
- - ' DG INS, QATE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI *
NEW [ ] Effective 3/1/90
ADDN [ ] R-1 AND R-2
ALTER [ ] Building Permit Application
Construction Address: P— ! G' 6F C -A &< 49 C-
Legal Description:
Owner Name & Address: _/4:f -- `tl Y e oxl SAXle As A& Tel. # S`71- -753a
Contractor: AOZ>17/10A-( P-CNODeCJA, y SIbEC, Tel # 4Z7 -77Y®
Address: /0900 kA V-1 S ST, I Z, SeC:.. 0-6®/-4 R -14 -Pt /0 S '5-5'4'33
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DE.SCRIBTION OF MEMENT
LIVIIJG AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length 0�0 Width / Hgt/Ground /!®N Sq. Ft. Z
oTHER:
o v W7
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Y-tO O 7 10 A/C- Estimated Cost: $ —
Approx. C mnpletion Date: '3 1 Q , J
Proposed Driveway Width If New opening Is Desired:
Ft. $
idth + 6' See Back Page
DATE: �p e% O APPLI Tel. # ¢Z-`7 - TYSIO
Permit Fee
$
State Surcharge
$
SAC Charge
$
Driveway Escrow
$
Park Fee
$
Sewer Main Charge
$
STIPULATIONS:
3'00
CITY USE ONLY
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Neoessar
3.5-f- - -
I
LOT Z 3L 0 OK Z
LL)
hereby cerfiPy ffmi NI's a Inx ad wmed repfr5entation 00 survey e* bwndwies q('#w dwr desayhed Im7d, and
&il67gs,ttwrr#n, ordall ris4le wawchwenls,irofr , fun or &7&o;dlwd. As A.0 -surm — *y
y� �(me Ni -
-INEEIZIN5, /IVC.
SUBUR46M L
1 J
NO.
City of Fridleysue�ECT
r6O 6 2
AT THE TOP OF THE TWINS
BUILDINGPERMIT
• COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
�/®
r o �
1
NUMBER
REVDATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
�"'"'�°� �',
612-571-3450
910415
5 / 18/98
JOB ADDRESS 561 Rice Creek Blvd NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
2
1 Holiday
Hills Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Mike Osterby 561 Rice Creek Blvd NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
D & B Home Improvements 4901 105 Ln NE
Circle Pines MN 55014 784-0922 7773
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO,
8 USE OF BUILDING
Residential
7 CLASS OF WORK p
❑ NEW ❑ ADDITION ❑ ALTERATION X REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Reroof House & Garage 23 S 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 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
1
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
$.96
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,918
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 PERFO MANC OFC STRUCTION.
f f
PLAN CHECK FEE
TOT L EE
Lice $ •
70.13
SIGNATURE OF CO NTR CT R OR AUTHORIZED AGENT IDATEI
EN VALID T THIS IS YOUR PERMIT
J
BLD INSP DATE
S,GNATUREOFOWNER OFOWNER BUILDERI IDATEI
9z
ADDN [ ] CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address:
Contractor:
Address:
Effective 1/1/98
LICENSE # -%
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
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: /\P e �C Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
MATE: �f APPLICANT:OATel. #I eq
TOTAL $ 17n, LL
CIPULATIONS:
r
CITY USE ONLY
Permit Fee
$/.S�
Fee Schedule on Reverse Side
Fire Surcharge
$ ! .
.001 of Permit Valuation (1 / 10th %)
.ate Surcharge
$ c
$.50/$1,000 Valuation
:QAC 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
:'ark Fee
$
Fee Determined by Engineering
'ewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ 17n, LL
CIPULATIONS:
r
01
sue�Etr
MIT NO.
City of Fridley
2 9249
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
COMMUNITY DEVELOPMENT DIV.
j PROTECTIVE INSPECTION SEC.
��
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
4/19/99
JOB ADDRESS 561 Rice Creek Blvd NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
2
Holiday Hills Addition
SHEET
2 PROPERTY OWNER MAIL .ADORES$
ZIP PHONE
Mike Osterby 561 Rice Creek Blvd NE
571-7536
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Addition & Remodeling Spec Inc. 2618 Coon Rapids Blvd NW, Coon Rapids, MN 55433
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
427-7330 1109
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION X] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Back of House; Bathroom remodeling
9 CHANGEOFUSEFROM TO
STIPULATIONS
See notations on plan. Call for building wrap inspection before covering.
Provide smoke detectors in all sleeping rooms and on
all levels of the dwelling
per Section 310.9.1.2 of the 1994 Uniform Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
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 ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$9
$4 75
W
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
'500
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CMA E
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$162.25
Fir C $9.50
STgU THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK F
TOTA FEE
Li e C
$5.0///
$181.50
SIGNATURE OF CON'RACTOR OR AUfPORIZED AGENT - DATE-
HEN RO
VALID�KI� I$ U PE 01
S-GNATURE OF OVVNER i1F OWNER BUILDER, IDATEI
�„- - BL4 iNSR
s "�
TIATE
01
NEW [ l
NEW[ ] CITY OF FRIDLEY
ADDNALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Effective 1/1/99
Legal Description:
Owner Name & Address: % t
. �' � Tel. #
Contractor: ` !Z.'V"` MN LICENSE #
Address: Q
` Tel. # W r
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
O .:111
DESCRIPTION OF P"ROVEMENT
$ S�
LIVING AREA: Length
Width
Height
Sq. Ft.
GARAGE AREA: Length
Width
Height
Sq. Ft.
DECK AREA: Leng
THER•
Width
G Ci E ��
Hgt/Ground
�i��
Sq. Ft.
`" � r �
Construction Type:\)3AN Estimated Cost: $ Soo,
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: A AA-
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
APPLICANT: Tel. # 6k - L9
CITY USE ONLY
$ ` / lo� o2S^
Fee Schedule on Reverse Side
$ S�
.001 of Permit Valuation (1/10th%)
$ ° S_
$.50/$1,000 Valuation
$
$1050 per SAC Unit
$ s ®
$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 [ ]
$
r
08/22/2005 09:52 7634344933 HARMONY HOMES INC
RUO --22-2005 10:45 CITY OF FR I DLEY
PAGE 02
F;x-F1,9ffr1Tr.]
Building -
13UI DING
Permit No.: -,W669-6)6
Inspections
RESIDEN LAL APPLICATION
Received By:
763-572-3604
CITY OF FRIULEY
Daft Rec'd:
DATE �'' �
YOUR E-MAIL A•DDMS 'A 1army
=Zlm
SITE ADDRESS
Rlkd.PJ • [A I ex J Z
THIS APPLICANT IS!
NTRACTOR
PROPERTY OWNER/
TENANT
ADDRESS:
PRONE
CONTRACTOR
NAME: r
SUBMIT A COPY ';"'—STATE
YOUR STATE LICENSE
UC�406;10 O W DATE
ADWL" �,N,Ct7Y
AIN Q
%� A78_,ZlPf�� /
WITH APPLICATION
PHONE % ' .,J FAX U' 3
PROPERTY JW -6
0 rr0-1,SFAYvftYINEW CONSTRUCTION sin
0 TWO F,6Jvfl ,Yf MW CONSTRUCTION STORISS
AD37M7N D GAR.AOEMED WS
Li D;:S avlEtdl FINISH G ROOF 0 DRAIN TILE
0 1)RCx 0 SIDING 0 OTIOR
i a SWBrfMiNO Pool
TYPE OF WoxY,
MDW®DA4 IP
0 =I
4g§j6PAIR I Na n atmlieg
lwaAq .
DESCRIBE WORK BEING D01gE: � I v o ate
SIZE OF RAPROVEXE T LENGTH WJDTH
HUGHT Sq. Ft.
AZEM
0 ROUSE ONLY
NtRvMP—k OF SQUARES
O HOUSE & GARAGE
9&8&M
D ATTACHED GARAGE
1.
Btlsd z Floor Plan
PROPOSED SIZE:
0 D7TACfX Ji GARAGE
2.
PrapovA fioorplan
PROPOSED t IC3FiP:
3.
List of smcwrPd membra to be used
i)Prj� 9
FOR NEW CONSTRUCTION INCLUDING DBMS,
0 Vinyl
®got
�,I?I>iiidiyt
FORQS Sr rgt l�
D Aluminum
D O°.ha;
0 Trim
1.
Silo P18fl/SIJri Ey SllOwitig ilte Cd�dti4 sLtmhrras
/ 0 Fascia
WINDOWS q 0
2.
and p pry
Toro teis of ruction pians
all EXISTING OPENINGS Ycs
CCJjJ
Leo LOCATION OF WINDOWS k GA'A L
3.
Spew Calculgdow
OR FOR NEN OPENINGS-DESCR.Mr; SIT )FJ..
OPM,QNG CHANGES & (y.QLM
TYPE OF WINDOW H d?l#""464INU1d8ER Q
TO BE INSTALL-- Op W$
AYr intro ..r.n r. __ __ _ — __
ru.er Raya.� .nA %A Jo.A�.0. JaoM VIr
TOTAL JOB V q
f�crclit k"'ce
Fue Sucliarge
LloenrA aurobarga
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
U4
VALUAn MAIN, 1lPiCLUDING TIM COST OF LABOR ANA 1MATIERIALS:
(tr1'SilitO 'li')a 1997 t�•B.c FEE � CrJ�'A1VC TYPEI $
Sege Hack Page for Fee ScbWule
y 65% of Buildiag Permit Fee
;.uuu5) times the total job valuation — Minimum $.S0
S /4of .Gill x Permit Valuation (1/1OOA)
.177r� $3.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Flans to MWCC for determination)
$ it+6 ft- ftx$20m$
$ S450 Conservation Plan Review
$ Fee Determined by Engi oeeribg
$--�t,(, Agreement necessary ( ) Non Nr nary ( )
_ . / (� Ma ke checks ouvable in: Ckv of Rridtw A"Go
THIS IS AN APPLICATION FOR A, PERNOT NOT VALID UNTIL PR0CESSS1p
I hereby apply fol a buildii,g palati arid I acknowledge that the information above is complete and accurate; that the work will be in
conformance with Ux ordlnancos and codes of We City of Ffidley and with the M;nncsora CoAsa actirua c;Qdes; ttat I undelsttsnd this is nota
permit but only an application ivr ra permit marl work is not to start witbout a pe rah; that the work mvill be iia accurdanee with the approved
plan is the ruse OT all tivork�i r to a vie and approval ofplans.
SIGNATIMOFALPPLICAN7 PRINTNAME _._PATS*4j
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
Mechanical Permit #
Residential Application
City of Fridley
See Back Side For Required Information
Date Q29 9 Site Address:
The applicant is: (cirice one)
Owner Contractor
Property Owner: 0e,
-1, 01, - "4 �, _Si -F, ar ^ : e- r,
Address: 5 -tel R; c e
C r, e k 81 deb .
City: ` : T�tj
State: Zip:
Phone: e05-'7 • �59 7
Cell: Fax:
Contractor Information
Company Name:
Contact Person:
Address:
City:
Zip:
Phone:
Cell: Fax:
Email:
MN Bond# & EXp Date
Type of Work (circle one):
New Replacement Alteration/Remodel
Detailed Description of work:
`r s I �� `� ` 6� d t "
Equipment Installed: MFG: Model: . �'6Aar-,_-•-,e VYSize1BTU:
MFG:
Model: SizeBTU:
MFG:
Model: Size/BTU:
Please check all that apply: ffFireplace (gas) $15.00 New Gas Grill $10.00
_A/C $25.00
_Fireplace (wood) $35.00 _Gas Unit HTR $10.00
_Air to Air exchanger $15.00 _Furnace $35.00 _Pool Heater $35.00
$35.00
Gas Dryer $10.00 _Ventilator $15.00
_Boiler
_Chimney Liner $10.00
4° Gas Piping $10.00
Duct Work $10.00
Gas Range/Oven $10.00
Permit Fee $
° (Total from above -Minimum fee $35.00)
Surcharge
0.50
&.0
Total Due $
Make check payable to City of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical 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 case of all work which requires review and approval of plans.
i
Signature of Applicant: Date:
Approval Inspector Signature: Date:
Please Note: Separate permits are required for Building, Plumbing, and Electrical work