PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT 4 2
J7
Date: ....... ... . .. _ ............ ..... ............................
Owner: ...._........... ............_............._................._........_......_--- --- -- .. Builder ." _ ...... _ r
Address ................ .._._._.............-.._.._ __ _ __ _ ._. __ Address
LOCATIONF UILDING
No.../........ Street _...__..." ....f __._.. _�.....e:.. Pari of Lot ....._.,..........._. _
Lot ...._.. /F .................... Block .............. _ ............ Addition or Sub -Division ... r ...: !. ' : ?' ....� .:� .. fr
Corner Lot ................._.. .............. Inside Lot .......... ........... Setback ........_ ....... Side and r ?.
SewerElevation -----=---.................... -.................... _........... ................. _............. _........ Foundation Elevation .................... _............. _........................... ........... .....................
DESCRIPTION OF BUILDING
To Used ..._.. ....� . � .. ...... S F �, � : �
Height q. Ft.,h-10-
..........................
Cu. Ft.
Front Depth ... - Hei ht ..: ` � Zb
_ ...... - - .........._..:.. �J .... - ................... Sq. Ft. ......................_ Cu. Ft........................
Front Depth . Height
Type of Construction`s ".:9!.1?.. Est. Cost......p,,�....y....._..°""' To be Com leted..... _..........._........... ..._......._
_ 'UTI0
THIS PERMIT A JTZ—IOR17_E VIOLAT-
ION OF AfVly N,;s,,,i'E 4 COVENANTS AND
BUILDING; RES -Fr' fCTIONS.
In consideration of the issuance to me of a permit to construct the building described 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.
------ ----._._..._..___._.�...___.._
In. consideration of the payment of a fee of $..4;,'
.. � �+ `.
' r�.+.'.,,�....................., 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
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
No.
` / Street i ;!2�_, � Part of Lot
� r
Lot / % Block®Addition or Sub,Div.
n
Corner .Lot___�In side Lot„ Set Back ^ cvSide-Yard /C
SEWER ELEVATION I FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location..
DESCRIPTION OF BUILDING
To be used as:
Front.. Depth Height
Sq. Ft. Cu. Ft.
ont% Depth � �Height
Sq. Ft. Cu. Ft,
G
Type of Construction �� ______r 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 Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true and orrect.
DATE _; P/14 r � .. SIGNATURE - �✓ .`
(A Schedule of Fee costs can be found on the Reverse Side..
9- 7 6
City of Fridley, Minn. N 10626 "
BUILDING PERMIT
Date: Mu L 1970
Owner: Joseph Civille Builder Donco Builders, Incorporated
Address _ 741 Rice Greek Tezrace Address 7 052 OGhnrnP
LOCATION OF BUILDING
No. 747 — Street _ _ Part of Lot
Lot 11 Block 1 Addition or Sub -Division . Brookview Terrace 3rd Addition
Corner Lot ._ Inside Lot — X Setback 35.2_—_ Sideyard
Sewer Elevation — Foundation Elevation
1"111 *7f471' iW1*1Z1K6Y;Mj--111 I[71"ki[
To be Used as:
--Caxage .— Front �$! _ Depth 241 Height 19 I Sq. Ft. 432' Ca Ft. 4320
Front Depth Height -- Sq. Ft. Cu. Ft.
Type of Construction Frame Est. Cost ._42110-0() ____ To be Completed —30 days _ r
Provide Hardsurfaced Driveway
Frost Footings
In consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with a'll provisions of
ordinances of the city of Fridley.
A�----
In consideration of the payment of a fee of $---8 —'00, permit is hereby granted to Donco Builders, Inc.
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and. moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
CLARENCE BELISLV
NOTICE:
This permit does not cover the construction, InstalloMon for w6dug, plumbing, gas heating, sewer or water. Be sure to see
the Building inspector for separate permits for these hems.
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER®S.N= : Joseph Ci ville BUILDER: Donco Builders, Inc.
ADDRESS: 711 Rice Creek Terrace ADDRESS: 105? Osborne Rd. N.E.
NO:. 741 STREET: Rice Creek Terrace
LOT; 11 BLOCK: 1 ADDITION: Brookview Terrace 3rd Addition
CORNER LOT: INSIDE LOT: 85 x133 SETBACK: 35.2 SIDEYARD:
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:
yarage Front: 18' Depth • 21,1 Height • /0
Square Feet: 432 Cubic Feet: 4
Front; Depth: Height;
Square Feet; Cubic Feet:
Type of Construction: Frame Estimated Cost: $ 2,600.00
To Be Completed: 30 days
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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•
(See Reverse Side For Additional Information.)
r:
0
SUBJECT
PERMIT N(
City of Fridley
116
AT THE TOP OF THE TWINS
BUILDING
PERMIT A.
r?
I 16U -------- COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
Y-2
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-560-3450
910-F15
6/16/77
JOB ADDRESS 741 Rice Creek. Terrace N.E.
1 LEGAL
LOT NO. BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
11 1
I
Brookview Terrace 3rd Addn. SHEET
2 PROPERTY OWNER MAIL ADDRESS
zip PHONE
Mr. & Mrs. Joe Civilla 741 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
El NEW Q. ADDITION El ALTERATION L3 REPAIR El MOVE El REMOVE
8 DESCRIBE WORK
Construct a 111 x 161 Porch.Addition
9 CHANGE OF USE FROM TO
STIPULATIONS X XRX Provide 2" x 61V minimum rafters 16" on center.
RMT Provide 42" minimum depth frost footings around entire perimeter.
VIAMN
SMERA71 PERMITS REQUIRED FOR WIRISC4
HEATIN01 PLUMBING AND SM&
Before figg�ri�
CA Etc.
jEjUjiONELECTRIC.
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
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 IGARAGES
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,
$560.00
$.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
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$8.00
SIGNATURE OF CONTRACTOR OR AUTHOFE AGENT (DATE)
WHEN PRPPERLY VALIDATED THIS IS YOUR PERMIT
Z'
SIGNATUREO WNER IIF OWNER -.RI
BLDG. 'NSP
DATE
0
CITY OF FRIDLEY
APPLICATION FOR `RESIDENTIAL BUILDING PERMITS.
(NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
a
OWNER: BUILDER:
Address:.Z�A�dd ess
Tel. No . /02 U 6
No. Street:
LOT: / BLOCK: �_ ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS:
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:
GG���rilt /l l / p / g /
Front: Depth: ��p Height.:
Square Feet: Cubic Feet:
Front: Depth: • Height:
Square Feet: Cubic Feet:
Type of Construction: Estimated Cost:
To Be Completed: Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
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. See reverse side for additional information.
DATE: i�b — /0 - % 7 SIGNATURE:
Stipulations:
?40(19f- xz 'p
e
load Plantany
Setts Tot' INSC I
Illy ENGINEERING IN
clvl/ 6- AlUnKlpal M.,
AllflecrIng—Eny,veers Surveyors
P IUL J. SCHWARTZ 7T
Z,&"CL
a ,rQ6
POW,
- — RIcz-- Cge,---K -
0
N I
0
a
sc,q /e / 1'.- 50,
-Z 0 7- / /, a/- OcK /)
9,qooKv1.5w 7,--,=,?I?A cz�-
3RD Awl r/ olv.
OT
hereby cerliPy fbai &6 K a bw and corrbcl re)pre5enfafion 110.5mrveu elhe boonder;e5 iO4c &We eC-so-;bed,'vid, and
/ - do
"'V �5 f" or W S4d fond 5 surveyed me flusA
A. 0
SUB URHAAJ fN6!N[[A,'lNCj INC.
[,twincers f- So" teqor.s
A., e
I
u; '00*n uuq,4 ssol eq Z uo-r,4osS
l)t3 t',lh lTuljod Xut? joj p92 -"D'qo 9'9J syr. TIMIS OSRO OU UI •9 0Z
civic q
FNTER • 6431 UNIVERSITY AVE. N.E.. FRIDLEY, MINNESOTA 55432 . PHONE (612) 571-3450
14, 1985
. Joseph Civila
7 1 Rice Creek Terrace N.E.
F idley, M 55432
Mr. Civilla:
is letter is in regard to the conversation I had with you concern -
g your mugho pines, and the complaints we have received. During
r conversation, you expressed your feelings that you wouldn't re-
ve them just because your neighbors wanted them removed. After
r conversation, I went out and looked at these trees. Granted
ese trees do not protrude into the street yet, but within a year
two, I believe we Mould be contacting you asking for their re -
Val. I feel that an oncoming car, or any person walking or running
, has no advance warning if you, or your neighbor to the west of
Li, would pull out of the driveway.
the interest of safety, we are asking you to reconsider your stand
take a second look at the problem. If you could remove this hazard,
her by trimming the trees or removing them, it would be greatly
reciated by this department.
2
ph Volkman,
erintendent of Public Works,
.lp
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential
Rate
TOTAL
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
$ 30.00
$
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace)
$ 10.00
$
Gas Range
$10.00
$
Gas Dryer
$ 10.00
$
*Air Conditioning - All Sizes
$ 25.00
$
All Others/Repairs & Alterations (LIST ON BACK)
1tZ
°lue of pliance?vva-e�
$
Coa Ind atrial 7
1.Value of Applian$
State Surcharge .50
TOTAL FEE o$
MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effective On August 1, 1995
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
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
% �0A/ / ' ,1995
OWNER %,7_tj -P �RC(C iii . L C
BUILDING USED AS
ESTIMATED COST
'" e�V
PERMIT NO.
I J /&-�
DESCRIPTION
QF FURNACE
AND OR BURNER
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name -�� 07` Size No. 'Y-11BTU % 5;a" HP EDR
Fuel 666 Gimes Total Connected Load
T—
Burner Trade Name
BTU
Size No.
HP EDR
r__d
HEATING COMPANY Lf��o®�,t4��
Signed BTel No.
Approved By Rough -In Date Final Date
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
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
3. Has no foreign objects lodged within
4. Is securely supported
5. Meets all current Code requirements for size
and total BTU's connected
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
Yes No ( )
Yes No ( )
Yes k-) No ( )
Yes ( ) No ( )
Yes () No ( )
Yes () No ( )
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 7 ILe E i�2euy- f &nP-A-ee
Legal Description:Owner Name Name & Address: JZ o -1W Jw LL,4 Tel. # - 35
Contractor: MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: Estimated Cost: $
t (Fee Schedule on Back)
Driveway Curb Cut Width Needed: �� Ft. t,6, -ft = Z-4 Ft x $ / 3,5 0 = $
DATE: � Z Z APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Tel. #
CITY USE ONLY
Z ° O7 -) Fee Schedule on Reverse Side
.001 of Permit Valuation (1/1D %)
$.50/$1,000 Valuation
$1000 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 [ ]
32-4 , Or-)
SUBJECT
City of Fridley
0
32469
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
T NO.
`L -------COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
i
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED Br
612-571-3450
910-F15
3/21/02
JOB ADDRESS 741 Rice Creek Terrace NE,
1 LEGAL
LOT N0,
BLOCK
TRACT OR ADDITION SEE ATTACHED
DEscR.
11
1
lBrookview Terrace 3rd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Joe Krazynsky 741 Rice Creek Terrace NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Greg Wills Exteriors 4246 Royce St NE, 11 Columbia Heights, MN 55421 788-0529
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
20037840
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
0 NEW 0 ADDITION 0 ALTERATION XQ REPAIR 0 MOVE 0 REMOVE
8 DESCRIBE WORK
Reside House
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive
barrier be..placed over exterior sheathing to protect the interior wall covering.
Exceptions for this provision would be if sheathing is an approved weatherproof
panel or when the siding .is an approved weather barrier. Vinyl siding is not a
weatherproof covering unless the manufacturer states this in their application
guidelines. Call,for inspection of wrap before covering. Caulk and flash all
exterior openings �-
SEPARATE PERMITS ARE REOVIRED FOR ELECTRICAL, PLUMBING. HEATING,
TYPE OF CO ST.
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 ABANOONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. `
NO DWLG. UNITS
OFFSTREET PARKING
1 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
$9,180
$4'59
WITH WHETHER SPECIFIED HEREIN OFF 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-
$181.25
Fire SC $9.18
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL F E
�06,e4
Licen SC $5.00
$ 0.02
—
SIGNATURE ON'RACTORORAUTHORIZED AGENT iDATEi
H PROP ALIDA'EO IS IS YOUR PERMIT
3 -&2
OG INS ' MATE
SIGNATURE OF OWNS A. IF OWNERSU4.OERI IDATEI '
NEW [ ] CITY OF FRIDLEY Effective 1/1/2002
ADDN [ J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: —7zl! xl / cs�
Legal Description:
_ Tel. #
LICENSE #
Tel. # -7 D �
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: ts� / deJ � Z14Estimated Cost. $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: �) APPLICANT: Tel. # -70-7 o"J" 20J- -;z
Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-5714287 if using credit card and we will
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ ]
TOTAL $ �2o®' o-� STIPULATIONS:
:ITY OF FRIDLEY INSPECTION DIV
431 University Ave NE
ridley, BAN 55432
763) 572-3604, FAX (763) 571-1287
Urinal
Floor 1
Floor 2
Floor 3
Floor 4
Effective April 1, 2004
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
'LUNGING FIXTURE RATES NO. RATE TOTAL JOB ADDRESS %yJ _%LD 4���i— -AE
lew Fix t wes
lid Opening, New Fixture
:eer Dispenser
gow Off Basin
:atch Basin
r Win Water Leader
CI ;ump)Receiving Tank
r Vater TreatingAppli-ance
yYater Heater -Electric
Vater Heater - Gas"
Sas Range"
;as Dryer"
tack Flaw Preventer Required { )Yes {) No
Type
$10-00 The undersigned hereby makes application fnr a pem* far the work herein
$10.00 specifed agreeing to do all work in strict accordance with the city codes
$10.00 and rulings of the Building Division, and hereby declares that all the facts
$10.00 and representations stated in this application are true and correct
$10.00
$10.00 DATE:
$10.00
$35-00 OWNER f7.�1i Y11 ,�z l/h S
$35.00
$35.00 iaultDING USED AS Uy p
$10.00
$10.00 ESTIMATED COST �S"OZS PERMIT NO.
$15.00
teinspeciion Fee $50.001Hr
^� +LL OTHERS AND/OR REPAIRS AND ALTERATIONS
-4 1.25% of Value of Fbdure or Appliance
S) State Surcharge $
.50 Approved By
M!1'QIMUM FEE FOR
TOTAL FEE
' n
:OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
OF THE IMPROVEMENT VMICHEVER IS GREATER ON WORK LESS THAN
"PROVIDE COMMON VENT INFO ON BACK ME
NEW [ ] CITY OF FRIDLEY
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: %
Legal Description:
Effective 1/1/2003
(763) 572-3604 Bldg Insp
(763) 571-1287 Fax
f
Owner Name & Address: Q 0 E: V d U Zj4I`ISIGI ` Tel. # -7
ContractorTfto SuAroorasMN LICENSE #
Address: SRA 0 Lukl Tel. # -k - g 3 Wo
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Surveof the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width . Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type: 141���ou� S Estimated Cost: $ o�D00
ACL S11 ftq rook .
Driveway Curb Cut Width Needed: Ft. + 6 Ft GFt x
N
T)
DATE: < < 3 APPLICANT:LA16 Tel. # -7
3(a
Call (763) 572-3604 for Permit Fees.if mailing in application. Fax to 763-5714287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ et,G-
$ 1,01 cp
$ G'06
$
$
$ 30t Q5
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 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
Inspections
763-572-3604
DATE 7" t1—
SITE
GSITE ADDRESS
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING Permit No.: -�
RESIDENTIAL APPLICATION Received By:
CITY OF FRIDLEY Date Rec'd:
YOUR E-MAIL ADDRESS
❑ OWNER
ADDRESS: 7,46C e Com' ®C.120
PHONE: 74 50z— 9233
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
STATE LICENSE # ZACoUt
ADDRESS: 9
PHONE 'A 4 — 79f-
FAMILY/NEW
9 d
FAMILY/NEW CONSTRUCTII
MILY/NEW CONSTRUCTION
❑ ADDITION
❑ BASEMENT FINISH
❑ DECK
❑ NEW
WINDOWS
IN EXISTING OPENINGS ❑Yes []No
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPF OF WINDOW TO BE INSTALLED
EXP DATE
FAX
/ ;; STATESTATEX421P SEV
jDFARAGEISHED ❑ WINDOWS
OO ❑ DRAIN TILE
IDING ❑ OTHER
❑ SWIMMING POOL
❑ ADDITION
�E/REPAIR ❑ REMODEL:
LENGTH _
❑ HOUSE ONLY
HOUSE & GARAGE
TTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF VIM
WIDTH HEIGHT
Ft.
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 $ OCCUPANCY TYPE
Permit Fee
$%
�� Q
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
o J
.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
S
&a I
Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN
I hereby apply for a building permit acknowlei
conformance with the ordinances and d of the City
permit but only an application for a e 't and ork
plan in the case of all work c ires revA
FOR A PERMIT -NOT VALID UNTIL PROCESSED
that the information above is complete and accurate; that the work will be in
idley and with the Minnesota Construction Codes; that I understand this is not a
to start without a permit; that the work will be in accordance with the approved
,val of plans.
PRINT NAME '��� �/ ' ` / _DATE