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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® 3772 Date ....!..'... .r..[ ................ Owner .. Builder ............................................. Address ...................................... Address ............................................. WCATIONL�QF BUILDING No. Street .,rfPerif:.644 .1............ rt of Lot .......................... .... Lot .. ...... Block ...../........... Addition or Sub -Division ........ '.t...� Corner Lot ............ Inside Lot . )'(....... . Setback .'�.�.. Sideyard ............... DESCRIPTION OF BUILDING To U z / . ........ ... Front /10� `Depth Height !. /. ®� Sq. Ft. ,f[. Cu. Ft. l .� Front ........ Depth ........ Height . Sq. Ft. ........ Cu. Ft. ........ Type of Construction ................... Est. Cost.. /,�.C. �....... To be Completed ............. .. . In consideration of the issuance to. me of a permit to construct the building degribed above, I agree, to do the proposed work in accordance with the description above set forth and in compliance with all pUovisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $AP7 ., 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. ,- _ --�11 .. Building Inspector 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. to City of Fridley Appfrcation for Plumbing and Gays Fii#'ng PParnnt Dept. of Bldgs. Phone SU 4-7 DESCRIPTION OF WORK Number, Kind. and Location of Fixtures Location �i -0sp 3Ci z m'� Z m xj 3� zZ ou o �4i ao �Z ~� cpm O= 7� a3 yJ ¢a c�a �Z o� as coo 8+ F N N WATER HTR., GAS -T ELEG Base 1st J / 2nd 3rd 4th Future Connection Openings New Fixture, Old Openings I Connected with Sewer Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $1.50 , Z4® 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 $ •oS Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code 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, 19 Owner • , 19— Kind of Building d2 . 19— Cid': To be completed about Estimated Cost, $ Old New Building Permit No .� 1� . Signed By Business Phone Connection Permit No . ....................................................... JUN 11 v959 Rough Water Description ................................................$ TOTAL FEET $ / 7.0 0 11 IM -8-58 Sewer Meter Deposit 336®7 City of Fridley, limn.. X? 8756 BUILDING PERMIT Date: APRIL 11, 1966 Owner: DON BABINSKI Builder SQA Address 333 Rice Creek Terrace N. E. Address Fridley, Minnesota 55432 LOCATION OF BUILDING No. 333 Street Rice Creek Terrace part of Lot Lot _ 3 Block 1 Addition or Sub -Division — RIC �13F'E+ K TERRACE, PLAT _3 Corner Lot _ Inside Lot x Setback of house Sideyard 10, Sewer Elevation ____ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: HOUSE ADDITION Front 44 Depth 27 Height 20 Sq, n1,188 Cu. Ft. 2_ 3,,, 760 Front Depth Height _ _.____. Sq. Ft. Cu. Ft. Type of Construction FRAME Est. Cost _... X8.5 00 ._ To be Completed . -. — In consideration of the Issuance to me of a permit to construct a buildin�dm above I R agree to do the PP work in accordance with the description above set and in cwith ail pr of ordinances of the dty of Fridley. In consideration of the payment of a fee of S 24.00 , permit is hereby granted to DON BABINSKI to construct the building or addition as described above. This permit is granted upon the express condition that the pennon to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any pmt thereof, shall conform 3n all respects to the ordinances of E ridley, Minnesota reg location, construction, alteration, maintenance, repair and moving of buildings dty limits an� permit may be revoked at aqy time upon violai3on of any of the Prete of saidcm ALLEN G. JENSEN . Building inspector NOTICE: rok porn& doss not ema the oondmd1oe, kdalktlon ler wkb*, phnnbing, gas henog, anwr or water. Be wre to no the Building hu" ter for pparaM perm&, for thm &ema. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME ADDRESS ADDRESS J OF BUILDING N0. OF LOT LOT BLOCK Al \_1M ''PION OR SUBDIVISI CORNER LOT INSIDE LOT SETBACK SI -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 ed as; Front Depth Sq. Ft. Cu. Ft 4r Front Dept h Height Sq. Ft. Cu. Ft. Type of Construction__ ,��Z� Estimated Co C � A 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 / SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side),. � r ' 1% .3 '�(6rk Minn.City of Fridley, BURDING PERMIT Date: MAY 16, 1966 Owner: DONALD BABINSKI Builder SAS Address 333 Rice Creek Terrace N. E. Address Fridley, Minnesota 55432 LOCATION OF BUILDING No. 333 Street Rice Creek Terrace Part of Lot Lot 3 _ Block l Addition or Sub -Division Rice Creek Terrace, Plat 3 Corner.Lot Inside Lot , Setback ._._ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Enclose Swimmingrt Depth Height __ sq. Ft Pool Front Depth Height Sq. Tt. Cu. Ft Type of Construction Blg—ck Est Cost — 0 To be Compl t In consideration of the issuance to me of a permit to construct the proposed work in accordance with the description aboyre � for ordinances of the city of Fridley. �/ I agree to do provisions of in consideration of the payment of a fee of S 3.2. 00 , permit is hereby ted t BABINSKI to construct the building or addition as described a e. s permit is upon the express condition that theperson to whom it is granted and his agents, em to s and workmen, all work done in, around and upon said building, or any part thereof, shall conform in respects to the ces of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving f buildings within the city iimits and this permit may be revoked at any tone upon violation of any of the pro ons of said ordinances. WILLIAM H. SANDIN Inspector NOTICE itis pem* does not sowr the sonstrudles, kdaWlen for wiring, phnbins, on hadhI& rower or wafer. Be amo to no the BWM b* M*esfor for separate permits for these hong. APPLICATION FOR BUILDING PERMIT CITY .OF FRIDLEY, MINNESOTA f - OWNER'S NAMEOL BUILDER' ADDRESS 2 /F 61 ,� �� ADDRESS f lr LOCATION OF BUILDING NO, STREET PART OF LOT LOT BLOCK CORNER LOT INSIDE LOT, ADDITION OR SUBDIVISION SETBACK /Sris / 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; M G C a 54,A z_y- e Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction /3Z F chr - / A�o v stimated Cost. To be completed /1r1 d Al 7-l/ 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. (Schedule of Fee Costs can be found on the Reverse Side). Application for Power Plants and Heating, Cooling. Ventilation, Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ each add. 60,000 BTU 2 x Replacement of Furnace Repairs & Alterations—up to $500.00 ................. Repairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM 8.00 $ 8.00 2.00 $ 4.00 5.00 $ 5.00 $ 2.50 $ Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR, Hot Water .. 8.00 $ Each add. 200 sq. ft. EDR Steam ................ . . 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ....................... 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ 5.00 GAS FITTING FEES: 1st 3 Fixtures ..................... Additional Fixtures ................. ¢, Gas Range to 200,000 BTU ........... 4 A SIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ;ROUGH FINAL NO RATE TOTAL _ x $1.50 $ 1.50 _x .50 $ _ x 2.00 $ See Fee Schedule TOTAL FEE Dept. of Bldgs. Phone SU 4-7470 Location 333 Rice Cr®ed Terrace 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 11-246 19 _ :0 - 01• ' v M Kind of Building Used as To be completed about sidence 12-2-66 Estimated Cost, $ 1400-00 Old—New. Building Permit No. Permit No. \� g DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No 1 Trade Name Westinghouse Size No DS -300 Capacity Sq. Ft. E.D.R 300M BTU H.P. Total Connected Load 297.051 Kind of Fuel Gas BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Heating and Make Up Air unit for Swimming Pool - Heat loss enclosed - Signe FRE® VOWC®o By 32fin rnrhnm .ova o 929-6767 h St. Louis Pork, Minnesota 55426 <2 2M Business Phone No (REMARKS—OVER) e HEAT LOSS CALCULATIONS DEPARTMENT OF INSPECTION Weatherstrips, A.S. . , p Guide Construction No. In anon Windows I Doors Reference Out. Wall Int. Wall C.eiliag RooLfpoor : Kind ow Applied 19_ _.. rt•I�a,w,` •i%oom I Length 4 3 Width y Height 4/ v Windows and Doors—Crackage and Area Width Height No. of Lineal it, Area f �• '�t• ' No. of pane of pane lights of crack sq. ft. SFS Coef. Btu Infiltration Glass Exp. wall .Let exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area .—f.1 Room Length • Width Sleight Windows and Doors—Crackage and Area width Height No. of Lineal ft. Area 3,,. No. of bane of pane light* of crack eq. ft. 1 Coef. Btu Infiltration Glass Sap. waU. Net exp. wall Int. wall Ceilin Floor Total Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FL Room I Length Width Sleight Windows and Doors—Crackage and Area Widtheight No. of Lineal ft. Area rQo. of pans of pane light* of crack *q. ft. Coef. Btu Infihration Glass Exp. wall Net sap. waU Lit. wall Ceiling Ftm ToW BhL sQ. ft. E.D.R. or sq. ins, W.A. Leader area Room i Length lows and Doors—Crackage and Width I Height No. of meal of pane of cane dant. 1 of crac Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Le#derj area Fl.l Room I Length , id Windows and Doors—Crackage and Arca Width Height No. of Lineal ft. Area No. of pan* of pane liehte of crack no tt. Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. his. W.A. Leader Irea F1.1 Room I Length Vid . 14ekht Windows and Doors—Crackane and Area Infiltration Glass Exp. wall Net exp. wall Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. CITY OF FREDLEV9 Sogn Pe r M"I t LC ' �1? 4 Owner: DEE BEE CONTRACTORS Erector: C & S CARPET Address: 333 Rice CrAA•k TArrana• Address: JUMMURNIME Sign Type:_ pvrDN Sign -Dimensions: Length: R, Width: n, Sq. Ft.: Bldg. Dimensions: Length: Width: Sq. Ft.: How Installed: Roof: Flatwise on Bldg.: Ext. Fr. Wall: Pylon: Distance Fr. Prop. Line: 1 Intersections/Driveways.-_ 42 Grade: Type of Construction: Illuminated: (Revolving Beacons, Zip Flashers and Similar Devices Including Any Sources of Light Which Change In Intensity -Are Prohibited.) Valuation: 4100. on Installation to Begin: Hours Used: To Be Completed: In consideration of the issuance of this permit to construct the sign described above; I agree to do the proposed work in accordance with the description above set forth and in comps with all provisions of the ordinances of the City of Fridley. (Date) (Ldfid Owner or His Agent) In consideration of the payment of a fee of $ this permit is hereby granted to DFF: BEE, r0NT•RArMgq to construct the sign 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 sign,or any part thereof, shall conform in all respects to the ordinances of Fridley, regarding the location, construction, alteration, maintenance, repair and moving of signs within the City limits and this permit may be revoked at any time uponLolat'i'on of any of the provisions of said ordinances. rnrF 30, 1q�s (Date) (Building Inspector) Is City oFridley 13UOJEC.T j AT THE TOP OF THE TWING SIGN PERMIT APPLICATION 4 rw------ v COMMUNITY p£V9L0PR0£NT OIY, FROT€MYQ INSPUCTION PUPT, CITY HALL FR104.9Y 05M$ IdtkAM REV. PAGE Or APPROVED HV .J 012'800-3450 JPATE 00 caner Address Phone Erecto ` Address Phone Legal Lot No. Block No. Tract or Addition Desc. Corner Lot Inside Lot Zoning Classificatign Sign Type lon• Dimensions - Roof: Wall: Length: Width: sq. Ft.: Building Frontage Length: Width: Sq. Ft..: Distance From: Property Line: Z�_ Intersection or Drwy.: V7- Residential: Grade: Type of Construction: / Illumination: (Revolving beacons, zip flashers and similar devices including any sources of light which changes in Valuation: intensity are prohibited.) Installation to Begin: To Ba Gomrle ted: I hereby authorize and direct the City of Fridley to remove the sign and sign structure, at my expense, where maintenance is required and the maintenance is not furnished, but only after a hearing and after a notice of sixty (60)' days specifying the maintenance required by the City. I hereby authorize and direct the City of Fridley to remove and dispose of any signs and sign structure on which -a permit has been issued to me, but the annual fee has not been paid (billboards only). The fee is due on April 30th of each year, with a thirty (30) day grace period. In consideration of the issuance to me of a permit to construct the sign described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of the ordinances of the,City of Fridley. Date (Land Owner or His Agent) In consideration of the payment of a fee of $ , this permit is hereby granted to to construct the sign 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 sign, or any part thereof, shall conform in all respects to the ordinance of Fridley, Minnesota regarding location, construction, alter . ns, maintenance, repair and moving of signs within the City limits and this pe it may be rev ked a any time upon violation of any of the provisions of said o dinan es. /L BUILDING INSPECTOR 01 SUBJECT P City of Fridley 2087 6 AT THE TOP OF THE TWINS BUILDING P RMIT i � ECEIPT NO. • COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. LT � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED By 612-571-3450 910-F15 6/14/91 JOB ADDRESS 333 Rice Creek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Donald Babinski 333 Rice Creek Terrace NE 571-9787 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 SCJ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof- Flat Roof, (Rubber) 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. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 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 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 $2,000 $1.00 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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $45.00 Fire SC $2.00. STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $48.00 IG AT RE OF CO TRAC BORA HORI AGENT IDATEI PROPERLY VALJJ'A ED THIS YOUR PERMIT �BLDG "WHEN WNER BUILDERI IDATEI INSP WT� 01 NEW [ ] ADDN [ ] ALTER[ ] R-1 AND R-2 Building Permit Application Construction Address: -33 3 /q Y c 6P C2 9 G- /k - Legal Descripticn: Owner Name & Address: Effective 1/1/91 W. # �'7 / % �) g ooaYtractor: � 1` C /` _ Tel. # Address: G ir 1, I L'� d(' ��G` Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn an it to scale. IPPICH�T OF INFIDVFaM LIVnG AREA: Length Width Height Sq. Ft. GRPUNM AREA: Length Width Seight Sq. Ft. DECK AREA: Length Width Hgt/GY and Sq. Ft. oRMM: i("c� X e, Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: /? 4 &3&Z2 ^T gy A Estimated Cost: Approx. Cm pletion Date: Proposed Driveway Width If NewIs Desired: Ft. $ $ / + 6' See Back Page DATE: (v APPI MM:E'& Permit Fee $ ® 0 Fire Surcharge $ �: ® C) State S zdkirge $ 400 SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ STIPUTATIONS: t. CITY O6E any Fee Schedule on Reverse Side .001 x Permit Valuation (1/10th $) $.50/$1,000 Valuation $650 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] . 01 CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Rate TOTAL $ 20.00 $ $10.00 $- $10.00 $10.00 $ Gas Dryer $ 10.00 $ "Air Conditioning - All Sizes $ 10.00 $ L ` L0 3 �. All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ Commercial/Industrial 1 % of Value of Appliance or Work $ State Surcharge $ .50_ TOTAL FEE $ f- S7D REINSPECTION FEE $30.00 "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDRESS 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this applica ion are true and correct. _ ,1991 % � �r BUILDING USED AS 5`�� ESTIMATED COST �✓ n - PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (H er (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name ? Size No. BTU HP EDR HEATING COMPANY ,: E/ _ /� 0 - Signed Approved By Rough -In Date No. J _ Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE U. 9 CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( ) No ( ) 2. Is free from rust or deterioration Yes ( ) No ( ) 3. Has no foreign objects lodged within Yes ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes ( ) No ( ) 6. Has total heating BTU's of* All other BTU's TOTAL BTU's Remarks List Alterations Being Done: HEATING COMPANY Signed By Date ALL FEES ARE B ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: BUILDING PennitNo.:426DLO 7 Building TOTAL JOB V UATION $ ,ate OCCUPANCY TYPE Permit Fee Inspections b03 S RESIDENTIAL APPLICATION Plan Review Received By: 763-572-3604CITY 65% of Building Permit Fee OF FRIDLEY $ Date Recd: DATE I L' a S YOUR E-MAIL ADDRESS $ SITE ADDRESS XS f-1 ejF- C-RAk V- - MS APPLICANT IS: �MOWNER OCONTRACTOR $5.00 (State Licensed Residential Contractors) PROPERTY OWNER/ NAME: P/4 19 L-0 1! Y' Rn s TENANT ADDRESS: 2O20 VtH147yN A Jr- CITY �) IN IWJAPI!' " J STATIM!LIP: S $ PHONE: (a )Z - -S 8a,:? a ( I ft + 6 ft = ft x $20 = $ CONTRACTOR NAME: b V*J IJ STATE LICENSE # EXP DATE Z SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX Agreement necessary ( ) Non Necessary ( ) PROPERTY TYPE O SINGLE FAMILYMEW CONSTRUCTION SIZE ] �j �� . (a.5 Make checks payable to: City of Fridley Attach Sti ulations 0 TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ;50ADDMON G GARAGE/SHED G WINDOWS D DRAIN TILE O BASEMENT FINISH 0 ROOF 0 DECK 0 SIDING D OTHER 0 SWIMMING POOL TYPE OF WORK: 0 0 MAINTENANCE/REPAIR REMODELING DESCRIBE WORK BEING DONE: ,d -P Q 1T) 0 a 'V691't- tA4 \ L? SIZE OF IMPROVEMENT 'v1 12T LENGTH -2-:Z 1,o WIDTH t O HEIGHT Sq. Ft. ROOFING 0 HOUSE ONLY BASEMENT REMODELING SUBMIT NUMBER OF SQUARES 0 HOUSE & GARAGE 1 • Existing Floor Plan GARAGES2. ❑ ATTACHED GARAGE Proposed floor plan PROPOSED SIZE: 0 DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT. FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING O Vinyl OSoffit 0 Trim ADDITIONS 1. & PORCHES SUBMIT: Site Plan/Survey showing the existing structures 0 Aluminum 0 Other 0 Fascia and proposed project 2. Two sets of construction plans WINDOWS 3. Epergy Calculations IN EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANG TYPE STAL ED NUMBER OF WINDOWS ALL FEES ARE B ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB V UATION $ ,ate OCCUPANCY TYPE Permit Fee $ b03 S See Back Page for Fee Schedule Plan Review 65% of Building Permit Fee Surcharge $ 2� `j� (.0005) times the total job valuation - Minimum $.50 Fire Surcharge $ �, ,4� .001 x Permit Valuation (1/10%) License Surcharge $ $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 $ o Agreement necessary ( ) Non Necessary ( ) Total Due $ ] �j �� . (a.5 Make checks payable to: City of Fridley Attach Sti ulations 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 wor4 is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work vAich re uires revie an approval of plans. SIGNATURE OF APPLICANT(eA PRINT NAME f� t-0 I'S1Z t A DATE 0 � Buildil<ag $ 321, a5' BUILDING Permit No.: Inspections 65% of Building Permit Fee ]RESIDENTIAL APPLICATION Received 763-572-3604 Fire Surcharge CITY OF FRIDLEY Date Recdd:: DATE_ 1 2 e '0 1• o- YOUR E-MAIL ADDRESS $5.00 (State Licensed Residential Contractors) SITE ADDRESS 3 3 3 9-) `6 e_A 16-' W �n A GG $1450 per SAC Unit (Plans to MWCC for determination) THIS APPLICANT IS: `*WNER OCONTRACTOR ft + 6 ft = R x $20 = $ PROPERTY OWNER/ NAME: p p S 1.0 ,6121 p S $450 Conservation Plan Review TENANT ADDRESS: 'v ?a KW 0 M) tj N 4 CITY %VI 1 N _9A—P0t-t S STATEN�IP L � �J Sewer Main Charge PHONE: Agreement necessary ( ) Non Necessary ( ) CONTRACTOR NAME: 6W "A_ Make checks payable to: City of Fridley Attach Stipulations STATE LICENSE # EXP DATE CITY STATE ZIP SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: WITH APPLICATION PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE [3TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION O GARAGUSHED O WINDOWS ❑ ROOF D DRAIN TILE D BASEMENT FINISH D Dom{ O SIDING ❑ OTHER D SWIMMING POOL TYPE OF WORK: ❑ NEW O ADDITION O MAIIJTENANCE/R.EPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: �- ��7I- Za- L-) p f SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES D HOUSE & GARAGE 1. Existing Floor Plan GABA ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, O Vinyl O Aluminum ❑Soffit ❑ Trim ,e nrnTIONS & PORCHES SUBMIT' 1. Site Plan/Survey showing the existing structures O Other. ❑ Fascia and proposed project 2. Two sets of construction plans WINDOWS 3. Epergy Calculations IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS AANLI,L FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABUK A1ND MA 1 MAL -w c� Z <:�v, b c> C;' (USING THE 1997 U.B.0 FEE SCHEDULE) ` TOTAL JOE VALUATIONS OCCUPANCY TYPE Permit Fee $ 321, a5' See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ L0 (.0005) times the total job valuation - Minimum $.50 Fire Surcharge $ 06 .001 x Permit Valuation (1/10%) License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = R x $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 10 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 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�ich requires vte and approval of plans. SIGNATURE OF APPLICANT PRINT NAME ),-Z ATXk AS- DATE SPECIAL SERVICES CUSTOMER INVOICE �44Store 2802 FRIDLEY Phone: (763 ) 571-9600 5650 MAIN ST, NE Salesperson: MT12CY FRIDLEY, MN 55432 Reviewer: Page 1 of 5 No. 2802-170057 1802 00002 L+`�.i ilii 1!/16/05 SALE 61 MT12C1"' 01 .29 PH t:f ; Ltt1r C; rl�af't� Et1Eh1T v 17iti15"r Phis is only aTQUOTE for the merchandise and services printed below. This becomes an Agreement upon payment RECALL AMOUNT A 1420.32 [ y C�rtLE�'t TAX r7�r.. bto l fd an endorsement by a Home Depot register validation. Home Phone SALES TAX 99. it6 3 F (6121388-7411 :^ ,A " XX 'i �'`'=' rlslsTE R�_;�h.�a 1..,��f. _v AS U T K c0C,,E . 3510��.�'6021'{r_�:3 Tr, Work Phone (612) 276-9828 2820 BLOOMINGTON AVE. S A 15% restocking fee will be charged on returned mpany Nameor canceled Secial Order Merchandise. ustom ascriptionTRUSSES Orders are not refundable. MINNEAPOLIS State MN Z'P 55407 County HENNEPIN 1000TE is valid for this date: 1111612005 066&1 of 5 _ ___,.........■nr A KIM ccQVlt'IG CI 1MMARY No 2-802-170057 $1,420.82 1111111111111111111111 FEDERAL EMERGENCY MANAGEMENT AGENCY O.M.B. No. 3067-0077 I NATIONAL FLOOD INSURANCE PROGRAM Expires December 31, 2005 s� ELEVATION CERTIFICATE Important Read the instructions on pages 1.7. SECTION A - PROPERTY OWNER INFORMATION For i=rance Company Use: BUILDING OWNER'S NAME Policy Number Pablo Arias BUILDING STREET ADDRESS (Including Apt, Unit, Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Company NAIC Number 333 Rice Creek Terrace NE CITY STATE ZIP CODE Fridley MN 55432 PROPERTY DESCRIPTION (Lot and Block Numbers, Tax Parcel Number, Legal Description, etc.) Lot 3, Block 1, RICE CREEK TERRACE PLAT 3 BUILDING USE (e.g., Residential, Non-residential, Addition, Accessory, etc. Use a Comments area, if necessary.) Residential LATTTUDEILONGITUDE (OPTIONAL) HORIZONTAL DATUM: SOURCE: ❑ GPS (Type): ( W - ff - ##.##° or ##.#####� ❑ NAD 1927 ❑ NAD 1983 ❑ USGS Quad Map ❑ Other. SECTION B - FLOOD INSURANCE RATE MAP (FIRM) INFORMATION B1. NFIP COMMUNITY NAIVE & COMMUNITY NUMBER B2. COUNTY NAME B3. STATE City of Fidley - 270013 1 Anon I MN B4. MAP AND PANEL 825. 12 #) B7. FIRM PANEL 842.36 ft.(m) B9. BASE FLOOD ELEVATIONS) NUMBER B5. SUFFIX B8. FIRM INDEX DATE F_FFECTNEIREVISED DATE B8. FLOOD ZONE(S) (Zone A0, use depth of flooding) 270013M B 3.2-1981 3-2-1981 ABC 833.4 B10. Indicate the source of the Base Flood Elevation (8FE) data or base nooa oeprn entereo in tw. ❑ FIS Profile ® FIRM ❑ Community Determined ❑ Other (Describe): B11. Indicate the elevation datum used for the BFE in B9: ® NGVD 1929 ❑ NAVD 1988 ❑ Other (Describe): B12 Is the building located Ina Coastal Barrier Resources System (CBRS) area or Otherwise Protected Area (OPA)? ❑ Yes ®No Designation Date SECTION C - BUILDING ELEVATION INFORMATION (SURVEY REQUIRED) C1. Building elevations are based on: ❑ Construction Drawings* ❑ Budding Under Construction' ® Finished Construction "A new Elevation Certificate will be required when construction of the building is complete. C2. Building Diagram Number 3 (Select the building diagram most similar to the building for which this certificate is being completed -seepages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) C3. Elevations —Zones Al X130, AE, AH, A (with BFE), VE, V1 430, V (with BFE), AR, ARIA, ARIAE, ARIA1-A30, ARIAH, ARIAO Complete Items C3. -a4 below according to the budding diagram specified in Item C2. State the datum used. If the datum is different from the datum used for the BFE in Section B, convert the datum to that used for the BFE. Show field measurements and datum conversion calculation. Use the space provided or the Comments area of Section D or Section G, as appropriate, to document the datum conversion, Datum Conversion/Comments Elevation reference mark used 0205 J Does the elevation reference mark used appear on the FIRM? ® Yes ❑ No o a) Top of bottom floor (including basement or enclosure) 825. 12 #) o b) Top of net higherfloor 842.36 ft.(m) to o c) Bottom of lowest horizontal structural member (V zones only) wA : ft.(m) 0 o o d) Attached garage (top of slab) 842. 03 L(m) E a o e) Lowest elevation of machinery and/or equipment servicing the budding (Describe in a Comments area) NIA. __A(m) o f) Lowest adjacent (firdshed) grade (LAG) 828.26 ft. m) Z °' �co o g) Highest ejacent (finished) grade (HAG) 842. 03 ft.(m) Y3 o h) No. of permanent openings (flood vents) within 1 ft. above adjacent grade 0 j o i) Total area of all permanent openings (flood vents) In C3.h 0 sq. in. (sq. can) Nd S$ - SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION This certification is to be signed and sealed by a land surveyor, engineer, or architect authorized by law to certify elevation information. I certify that the information in Sections A, B. and C on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishable by fine or imprisonment under 18 U. S. Code, Section 1001. CERTIFIERS NAME Walter J. Gregory, LS LICENSE NUMBER 14889 TITLESurvey Department Manager COMPANY NAME Ulteig Engineers, Inc. ADDRESS CITY STATE ZIP CODE 5201 East River Road, Suite 308 Minneapolis MN 55421 81-31, January 2003 DATE 11-4-05 See reverse side for continuation. 763-571-2500 Replaces all previous editions IMPORTANT: In these spaces, copy the corresponding Information from Section A For Insurance company use. BUILDING STREET ADDRESS (Induding Apt, Unk Suite, and/or Bldg. No.) OR P.O. ROUTE AND BOX NO. Pobj Number 333 Rice Creek Terrace NE Cf TY STATE ZIP CODE Company NPJC Number Fridley MN 55432 SECTION D - SURVEYOR, ENGINEER, OR ARCHITECT CERTIFICATION (CONTINUED) Copy both sides of this Elevation Certificate for (1) community, official, (2) insurance agentloompany, and (3) bulling owner. COMMENTS The building contains an indoor pool. The elevation of the bottom of the pool is 827.12 ft LJ Check here a attachments SECTION E - BUILDING ELEVATION INFORMATION (SURVEY NOT REQUIRED) FOR ZONE AO AND ZONE A (WITHOUT BFE) For Zone AO and Zone A (without BFE), complete Items E1 through E4. If the Elevation Certificate is intended for use as supporting information for a LOMA or LOMR-F, Section C must be completed. E1. Building Diagram Number _(Select the building diagram most similar to the building for which this certificate is being completed —seepages 6 and 7. If no diagram accurately represents the building, provide a sketch or photograph.) E2. The top of the bottom floor (including basement or enclosure) of the building is _ ft(m) _in.(cm) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, if available). E3. For Building Diagrams 6$ with openings (seepage 7), the next higher floor or elevated floor (elevation b) of the building is _ ft.(m) _ In.(cm) above the highest adacent grade. Complete items C3.h and C3.1 on from of form. E4. The top of the platform of machinery and/or equipment servicing the building is _ ft(m) _in.(c m) ❑ above or ❑ below (check one) the highest adjacent grade. (Use natural grade, K available). E5. For Zone AO arty: If no flood depth number is available, is the top of the bottom floor elevated in accordance with the community s floodplain management ordnance? ❑ Yes ❑ No ❑ Unknown. The local official must certify this information in Section G. SECTION F - PROPERTY OWNER (OR OWNER'S REPRESENTATIVE) CERTIFICATION The property owner or owner's authorized representative who completes Sections A, B, C (Items C3.h and C3.i only), and E for Zone A (without a FEMA4ssued or community - issued BFE) or Zone AO must sign here. The statements in Sections A, B, C, and E are coned to the best of my know/edge. PROPERTY OWNER'S OR OWNER'S AUTHORIZED REPRESENTATIVE'S NAME Pablo Arias STATE ZIP CODE ADDRESS CITY RAAI 49AT) Creek Terrace NE roue DATE ��- P ..I_ _ ill 0 t o ❑ Check here if attachments SECTION G - COMMUNITY INFORMATION (OPTIONAL) The local official who is authorized by law or ordnance to administer the community's floodplain management ordnance can complete Sections A, B, C (or E), and G of this Elevation Certificate. Complete the applicable Rem(s) and sign below. G1. ❑ The Information in Section C was taken from other documentation that has been signed and embossed by a licensed surveyor, engineer, or architect who is authorized by state or local law to certify elevation information. (Indicate the source and date of the elevation data in the Comments area below.) G2. ❑ A community official completed Section E for a building located in Zone A (without a FEMA -issued or community4ssued BFE) or Zone A0. G3. ❑ The following information (Items G4-0) is provided for community floodplain management purposes. G7. This permit has been issued for. ❑ New Construction ❑ Substantial Improvement G8. Elevation of as -butt lowest floor (including basement) of the building is: ft(m) Datum: _ G9. BFE or (in Zone AO) depth of flooding at the building site is: _. _ ft(m) Datum: LOCAL OFFICIAL'S NAME TITLE COMMUNITY NAME TELEPHONE SIGNATURE DATE COMMENTS ❑ Check here if attachments FEMA Form 81-31, January 2003 Replaces all previous editions ' b Building PLUMBING Permit No.: 2606 Q00ins Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: v DATE YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: WNER OCONTRACTOR PROPERTY NAME: 0 ADDRESS: R (Go Y EA K CITY -P STATE Z OWNER/ TENANT g r PHONE: CONTRACTOR NAME: 6ii�1G) STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH PHONE FAX APPLICATION PERMIT TYPE /SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW 0 REPLACEMENT 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 ) 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) BATH SINKILAV DRAINS —SHOWER _ WATER PIPING _ _FLOOR PIPING mm Ct yuc _ SWIMMING POOL _WATER SOFTNER ($35) —BATHTUB —GAS CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15) _ _ DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION '— — WATER METER —OTHER k �� d . � Permit Fee $ —1,:T Number of fixtures @5$10.00 x $10.00 = $ Surchar a .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $1'�.,a> Number of fixtures @ $35.00 x $35.00 = $ State Surcharge = $ .50 Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case ofallwork which requires review and approval of plans. `� NAME DATEOT SIGNATURE OF APPLICANT `' O PST t9.S. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 3uilding $ ; BUILDING Plan Review Permit 1v0.:� rnS ections Fire Surcharge RESIDENTIAL APPLICATION .001 times the total job valuation Received By. f 763 X72-:604CITY .0005 x Permit Valuation Minimum $.50 OF FRIDLEY $ Date Recd: )ATE 07, 3 1- ®(o YOUR E-MAIL ADDRESS $ xrE ADDRESS[1-IIS Curb Cut Escrow $ APPLICANT IS: WNER ❑CONTRACTOR $ PROPERTY OWNER/ NAME: j%,A,p p— l ,p S $ TENANT ADDRESS: :S S -S /zl c, F, G,e4r-- k. ?'F.-,9. CITY TTP � ?_� `� STATE ZIP Agreement necessary ( ) Non Necessary ( ) PHONE: 612-366-70t( $ CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW O�ADDITION ❑ MAINTENANCEMEPAIR ODELING DESCRIBE WORK BEING DONE: 4.� i rr--PoD) - fic)L- , C�,ONJ612'i -ro f—AM IL,r A' o° -A SIZE OF IMPROVEMENT 3 2 LENGTH WIDTH HEIGHT ) 'i— Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2.Proposed Existing Floor Plan floor plan PROPOSED SIZE: DETACHED GARAGE [3Listsi 3. List ructural members to be used of 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 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 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 0 ° C- ° -0 OCCUPANCY TYPE Permit Fee $ ; See Back Page for Fee Schedule Plan Review $ a 65% of Building Permit Fee Fire Surcharge $t i ,'0() .001 times the total job valuation Surcharge $ A CAD .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 $21= $ 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 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 of to start without a permit; that the work will be in accordance with the approved plan in the case of all work w ch req res review, n proval of plans. SIGNATURE OF APPLICANT ® PRINT NAME DATE 6-2. '31 .0A rJAM C17YOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, PA FL�O )SY-1-s' , understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at &I c -F— c -.F— , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name a[�' � o Date 0-7 , -3 1 . o 4—