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PRE 2010 DOCSCity of Fridley, -Minn. BUILDING PERMIT N® 3889 Date: ... .. ......... . Owner ....................................... Builder e • • •,�� ............'� Address...................................... Address ............................................. LOCATION OF BUILDING No. .0710. StreetLot�.1........../ ........... Lot ... ...... Block .. ... Addition or Sub -Division �,f�P C� . dl Corner Lot ............ Inside Lot . �......... Setback .`�:.. Sideyard . a.:.4�................. . DESCRIPTION OF BUILDING To be Used as: 17 Front -4:. 7. Depth . ),. ¢�` Height .� Sq. Ft. d�aayy4 .y / t � �I... .. Front /..�:.�o Depth ;? �•.® Height/a.._0. Sq. Ft.&W ctL yt.To2p Type of Construction ................... Est. Cost..................... To be Completed ................. In consideration of the issuance to me of a permit to construct the building desribed above, I agree, to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. X.... ... .� `�':....... ........... . In consideration of the payment of a fee of $f?L.f/......., 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 with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. } ... Bu . n'g- Inspector . e NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. City of Fridley Appliccition for Pimn ing and Gas Fitting Permit Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location PARTIAL RATE SCHEDULE PLUMBING FIXTURE BATES: NO.. RATE TOTAL Number Fixtures ...................... x $1.50 Future Fixture Opening ................ x z yr W x w 0 Z z & x WATER HTR. Water Heater (Up to 200,000 BTU) ...... O 40..7 Qm x Z $ �=O 0 GAS FITTING FEES: �4y LL Q''a 0] rj� Q �y (J `!2 C� U� O F N GAS ELEC. Gas Range to 200,000 BTU .............. U 2.00 f0 m 1/1 1-• LL N 0 U y� Q 6� Base 1st 2nd 3rd 4th Future Connection Openings Connected with New Fixture, Old Openings Sewer El Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE BATES: NO.. RATE TOTAL Number Fixtures ...................... 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) ...... x 2.00 New Ground Run Old Bldg . ............ x 3.25 $ 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 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE2 0 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, Blinn - Owner �2'�°'� ig Kind of Building a -.t 19— Used as To be completed about'' Estimated Cost, $ Old a uilding Permit No A Sign By Business Phone No Connection Permit No . ....................................................... JUL 15 1959Water OU1��_ Sewer 11 1M-8-58 Meter Deposit R 4 --4 '� RICE CREEK TERRACE N.54910'00" 100.00 95.00 ---Wt it bD P FO 22.7 49.7 100- 12.8 4 (A Ul 23.4 27.0 16,1 0 0 C5 --- 2 4 4 X 50 C1 6 X 40 LA Aj F 95.00 9-1 0 Denotes iron monument LOT 5,. BLOCK 3 SCALE: 1-= 24feet RICE CREEK PLAZA SOUTH ADDITION Anoka County, Minnesota V. P. Boflesen July 16, 1987 .r � SUBJECT ERMIT City of Fridley 17192 AT THE TOP OF THE TWINS BUILDING PERMIT R COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � ` CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/7/83 JOB ADDRESS 250 Rice Creek Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 6 3 Rice Creek Plaza South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Leon Bowman 250 Rice Creek Terrace N.E. 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 X 8 DESCRIBE WORK Reroof Dwellin 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd layer but not 3rd. Install ridged galvanized valleys. 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 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 $700 $. 50 Y 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- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $15.50 SIGN EO CON- CTO OR AUTHORIZED AGENT (DATE) WHEN PROPERK VALIDATED THIS IS YOUR PERMIT g -7 U2/8 3 SIGNATUR WN RUFOWNERBUILDER) )DATE) I f5iftE .r � Effective Aug. 1, 1981 CITY OF FRIDLE.Y APPLICAT194 FOR RESIDLiMAL BUILDING PERifiITS (Nclw, Alterations, Additions, or Repairs) ADDRESS ,Sd TEL N0: �5 71 BUILDER: ADDRESS: TEL NO: Construction Location STMET NO: �'C7 STREET: ^/�j c f' 1�sz' Te �^ LOT: BLOCK: ADDITION: Corner Lot: Inside Lot: a/ Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION oFront,: Square Feet: Front: Square. Feet: Depth: a 5r Height: Cubic Feet: Depth: Height: Cubic Feet: _ Type of Construction: , a q Estimated Cost: $ zo 0 Zb Be Cbrapleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ * $ SEE FEvF.RSE SIDE OF SHEET Mie undersigned hereby makes application for a permit for the %•:ork herein specified, agreeing to do.all work,in strict accordance with the City of Fridley Ordinances and rulings of the .De1xirtment of Buildings, and hereby declares that all the facts and representations stated in this application ice true,,pn'"rrect. DATE: r SIGNATU Stipulations: w N SUBJECT PERMI City of Fridley 19559 AT THE TOP OF THE TWINS BUILDING PERMIT i � •COMMUNITY EVELOPMENT DIV. r ___; I PROTECTIVE INSPECTION SEC. -_- r : CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-671-3450 910-F15 6/24/88 JOB ADDRESS 250 Rice Creek Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 6 Rice Creek Plaza South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 250 Rice Creek Terrace N.E. James M. Tracy 571-3374 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 Construct a 17' x 14 Shed 9 CHANGE QF USE FROM TO STIPULATIONS Remove all s - compact all fill I SEPARATE PERMITS ARE REQUIRED FORT 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 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 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,500 $1.25 DOES NOT PRESUME TO GIVE AUTHO ITY 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. $54.00 L`AN CHECK FEE TOTAL FEE $55.25 SIGNATURE OF CONTRACTOR ORAUTHO IZED ENT (DATE, WHEN PROPERLY VALI AT IS YOUR PERMIT �THIS SIGNATURE OF OWNER tlF OWNER ILDE41 r ( ) BLDG INSP DAT ;/ N NEW [ ] City of Pridley Effective 5/1/88 AMN [ I R-1 AND R-2 ALTER [ I Building Permit Application Oun truction Address: ® Rrce- LegeaDescription at 6 6 /aekoE i�G �Q Nwrrr Name & Address: Z i en i w- � � -G Tel. # w®�®c Contractor: _ lye Tel. 6for Address: Attach to this application, a Certificate of Survey of the lot, with the proposoed construction drawn on it to scale. 0 LMNG AREA: Length Width Height Sq. Pt. GARAGE AREA: Length Width Height sq. Ft. ' DECK AREA: Length Width Hgt/Ground Sq. Ft. : i / se" (brner Lot [ I Inside Lot Ft. Yd Setback Side Yard Setbacks Type of Construction: baa° Estimated Cost: $ .2.5-0 02 01� Approx. Completion Date: A844 &A v4 e Proposed Driveway Width If New opening Is Desired: DATE:(0124e-M-APPLICANT: Permit Flee $ .00 State Surcharge $� SAC urge Driveway Escrow $ Park Free $ Sewer Main Charge $ TOTAL 4c 11 Ian: (k,CMavr, 44.%. Alt. A Alt. B Width + 6' See Back Page Tel. # CITY USE ONLY Epee Schedule on Reverse Side $.50/$1,000 Valuation $550 per SAC Unit Alt. "A" or Alt. 08" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] Sao LA- r w► . _�1.0 2 S® a IVC v oo SUBJECT MIT NO. ,.. City of Fridley 21731 AT THE TOP OF THE TWINS BUILDING PERMIT f 1 � COMMUNITY DEVELOPMENT DIV. �q L _ PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 E, JOB ADDRESS 250. Rice Creek Terrace NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 3 Rice Creek Plaza South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James/Marnie Tracy 250 Rice Creek Terrace NE 571-3379 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Citywide Home Improvement 1005 W Broadway #A, Mpls 55411 529-2489 3013 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 j] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 1 STALLS 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 $5,000 $2, 50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $72,00 Fire SC $5,00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE License SC $5,00 SM $84,50 SIGNATURE OF CONTRACTOROR AUTHORIZED AGENT (DATE) - EN_ ROP , D THIS IS YOUR PERMIT aLYVALIDA LOG WSp DATE SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI Effective JAM ADDN [ J CITY OF FRIDLI3Y(-�� ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description. Owner Name c4c Address: SUMPig- _ Gfii�-� .� ' Tel. #-<S Contractor: _ _ M LICENSE # 13. Address' _ -Tel. # Attach to this a lication a" Certificate of Survey of the PP y lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Lenixth _ Width Height Sq. Ft. GARAGE AREA: Length Width u� Height � Sq. Ft. DECK ARE-sA: Length �Width Hgt/Ground Sq. F. Ft. OTHER: Corner Lot [ J inside Lot [ Ft. Yd Setback Side Yard Setbacks Type of Construction: . —Estimated Cost: $ -5�a_ -1 _ Approx. Completion Date: (Cost: on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $_., _ = $ _ DATE: APPLICANT: 291) _ ^ Tel. #��y Permit Fee $ Fire Surcharge $ State Surcharge SAC Charge $ License Surcharge $ ....... Driveway Escrow $ Park Pee $ Sewer Main Charge $� _ TOTAL $ ,CI'T'Y _. U E ONLY Nee Schedule on Reverse Side .001 of Permit Valuation () /loth %) $.501$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ J Not Necessary [ i , STIPULATIONS: 0 e_ rempanles 6875 lhyhwuy 65 NE PO liux ;12.308 M,nneopolis. AM 55432 (61:') .5716066 SUBUMMAN ENWNEERjN6. INC. 12203 Nuullet Ane .Su Hurnswile. MN 55337 (6 1 2) 11911'6510 t'nnl. Murottaul 6 f.nuYan„yntel EnWuenrg • Lend —wWng 0 Lu/nd Pb." • Sad r. mpg Cortifleat• of 6urvoy foryE/V V L, 5 A% Bearings Shown Are Assumed o Denotes Iron Monument ® Denotes Foundation Corner Offset Stake, PROPOSED ELEVATIONS : Denotes Existing Elevation ODenotes Proposed Elevation Top of Block Denotes Direction of Surface Drainage Lowest Floor -- Denotes Drainage and Utility Easement Garage Floor 1J- Scale 1"-: 30' * Vertio+es iron Monarnen7' Fo,,,,d Lot 5., Oock 3 o•nd A, SOUAYYesterly 5;0 Feet- o. ' 1 L o -r 6 , No c, h 3 RiceCreek Pour SlibJecf To Ec.sernen+s Anoka Couni-y I hereby certify that this survey, plan or report was prepared by me or under my direct supervision and that I am a duly licensed Land Surveyor under the Iaws of the State of Minnesota. Tlf _ Signed this qday of N! .4 A.D., 1917'. — cs Companies Ai��,RL Not published: All rights reserved Copyrlght 14tH St Companies, Suburban Fiigine-rtng SUBURBAN E/YWNEER NS. III K. ,-V Inc. ,,Ann- Licxnse No. 101 ti, U I Y UF- FHIULEY INbFLU I IUN UIV. - 6431 University Ave NE Fridley, MN 55432 572-3604 cuecuve Un Oaiulaiy 1, iaao APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Ii�'��::. Urinal . Shower ..�... Tray ::�..in.(�s::<:. ' loo Drain ..�.�.�`...:.....`..... :.'. Auto. Washer ....��................. Gas a Range "'Q' : �t�>'-Gas ................. Water Heater Stories E lecS-::::>::<:�•<:��.': Basement Floor 1 FI oor 2 Floor 3 loo F r 4 PLUMBING FIXTURE RATES: NO. RATE New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving'Tank Water Treating Appliance Water Heater —Electric Water Heater — Gas Gas Range Gas Dryer Back Flow Preventer Required ( )Yes () No TYPe. $ 7.00 $ 4:00 $ 5.00 $ 7.00 $ 7.00 $7. 60 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL JOB ADDRESS >4_1� &1) _ LE.= $ .50 $ 6) 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. Owner Estimated Cost -tom PERMIT NO. PLUMBING COM SIGNEDBY TEL N0. S' " Approved By/ Rough—in Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE 1993 01 SUBJECT P RMIT NO. City of Fridley 3 0029 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 5— 1 ; a 1 , -'--i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 8/10/99 JOB ADDRESS 250 Rice Creek Terrace 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 6 3 Rice Creek Plaza South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Tracy 571=3374 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Rasmussen Construction 26525 Lake Ave. Zimmerman MN 55398 856-4372 20112713 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 O ADDITION O ALTERATION X® REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage (28 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINAN GOVERNING TYPE OF WORK WILL BE COMPLIED WITH WHETH R S ECIFIED H EIN R NOT. THE GRANTING OF A PERMIT 2447 $1.22 DOES NOT RES ME TO G E AU HORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PRO SOF ANY OTH RST E OR LOCAL LAW REGULATING CON - IT N O TH PERF RM CE OF CONSTRUCTION 83.25 lre SC 2.45 X'A PLAN CHECK FEE TOTAL FEE a J v I 1A A9L -M -46Licens C 5.0 $9/.92 IGNATUkOFCON CTOROR4UTHORIZEDAGENT ID TE, N P OP BLD INS ALIDAT THIS IS V R PERM T ,2 1 FTATE 01 S.GNATURE OF OWNER,IF OWNER BUILDER, IDATEI 01 NEW • i ] Effective 1/1/99 ADDN [ l CITY OF FRIDLEY ALTER [) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal -Description: Owner Name & Address: �I&Le-5 Y iccTel. # S71 ,� %T— Contractor: 2&�SSe [�r�� . MN LICENSE #®I L2 -7 % 3 Address: � `� l AlT , Tel. # M (43 ?� 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/Ground Sq. Ft. OTHER: Construction Type: 91-A, 5 le fi&#=-efr Estimated Cost: $�C _(Fee Schedule on Back) Driveway Curb Cut Width Needed: DATE: a APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge STIPULATIONS: $--2- L, za_ Ft. A- 6 , t = f IYt x $ CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation IWI Tel. # Qm 95-4 Y3 7z, $1050 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 [ ] Building MECHANICAL Permit No.:,j Inspections RESIDENTIAL APPLICATION Received By:.> 763-572-3604 CITY OF FRIDLEY D* z 763-502-4977 FAX EFFECTIVE 1-1-08 - o OURozE-MAIL DATE ADDRESS , •/ SITE ADDRESS D 1 �' V,Y�^a THIS APPLICANT IS: ❑ OWNER PROPERTY rn ,CONTRACTO NAME: VVI""vS l�(/�uu K-2 ADDRESS:S�2111 Lj ITY STATE OWNER/ TENANT .ZIP PHONE: k— �� CONTRACTOR COMPANY NAME: Nut 1APAI)AAU NOTE: SEPARATE CITY CONTACT PERSON: STATE LICENSE # EXP DATE LICENSES ARE REQUIRED FOR GAS AND HVAC. ADDRES J� J 1" ke, ti, -CITY(�ivldml M TATE 11' 41P SUBMIT COPY OF BOND y� PHONE`M - � C)1 `, `j FAX -E 17 J y I t ANDINSURANCE PERMIT TYPE 1P SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW C REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor) OR 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 NUMBER OF EACH BELOW) A A/ ` `, �l � MVI° ®®v .14 Equipment Installed MFG: VV MODEL:IG SIZEBTU MFG: MODEL: SIZEIBTU MFG: MODEL: SIZEBTU –/A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00 _AIR TO AIR EXCHANGEER $15 _F}REPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 NEW _BOILER $35.00 ./FURNACE $35.00 UNIT HTR $10.00 _CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 _DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00 PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM $15.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED 1 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 Co ; hat 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 i accordance with the appro ani the case of all work which requires review and approval of plans. d SIGNATURE OF APPLICANT (j RINTNAME�ybik % V Wl ATE " APPROVED BY DATE PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING,, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977