PRE 2010 DOCSCity of Fridley, Minn..
BUILDING PERMIT
4834
Date:
Owner:
Budder
Address ....._.......:...__......._. _ _. _ _ _ __. .
Address _.......
.....-` . ,.... _............... .......
O GAF ��UILDING
-LOCATION
f
No. ... Street ._.._ ....... _ ....... _...........
.... ��-__ � .. �+�...�'........ Part of�Lot _....... ..._- _ _.......
Lot .._ .._................. Block . ... ............... �. .........----....... Addition or Sub -Division
Corner Lot ....._ ..................._........ Inside Lot... '.......... .... Setback ....... ?......... Sideyard ...._44-).....:.
Sewer Elevation ............. ................... _............__..........._......._...._....................... Foundation Elevation
DESCRIPTION OF BUILDING
To be±jUsed as:
�� ' .. Front ,�._,......._.�
4 ✓.#.,.� s Depth ..._ Height .., .i .. Sq. Ft.
_............ _.................... .. Front ............. Depth ....... Height ......._.. Sq. Ft........... -------_ Cu. Ft... .................. _..
P
Type of Construction Est. , ; ' t.........._ � ""�........ To be Completed .................................................
�� NGS PJ GovF NDN
gv`�p�t
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.
payment $.._ -
]n consideration of the a ent of a fee of �• ° ""`
..---------y hermit 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 y'olation,a any of the provisions of said
ordinances. .: z /`'
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 PERU
CITY OF FRIDLEY, MINNESOTA
Owners Name Builder
Address Address
LOCATION OF BUILDING
No. Street !Z Part of Lot
Lot „Block Addition or Sub.Div..&y �
Corner Lot ,Inside Lot, t Back -;;� Side -Yard
SEWER ELEVATION 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 mol ^ 6 Height ....�.—
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Ou. 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 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 correct.. C
DATE y/�'a' 9 SIGNATURE
(A"Schedule of Fee costs can be found on the Reverse Side.)
Application for Power Pkmft and .Hea tg. Cooling, VentiWoe, Reh i9eion ltd �
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 ............ 8.00 $ 8.00
.each add. 60,000 BTU ..... . ............... 2.00 $
Replacement of Furnace .............................. .§.00
Repairs & Alterations—up to $500.00 .... ............ 5.00 $
Repairs & Alterations each add. $500.00 2.50 $
STEAM or HOT WATER SYSTEM
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:
NO RATE TOTAL
1st 3 Fixtures ......................
x $1.50
$ 1.50
Additional Fixtures .................
x .50
$
Gas Range to 200,000 BTU ...........
x 2.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
See Fee Schedule
VENTILATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FEE
$ 14.50
ROUGH
Plan R-1
FINAL
Dept. of Bldgs. Phone SF. 4-7470
Creek Terrade
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, Munn_ Sept. 7 , 19 60
Owner Paul Schwartz Const. Co.
Kind of Building Frame
Used as Residence
To be completed about October 7
Estimated Cost, $ 450.00
Old—New. Building Permit No. Permit No.
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Westinghouse Size No GUE 100
Capacity Sq. Ft. EM.R 10011 BTU H.P.
Total Connected Load 45 = 631 Kind of Fuel Gas
BURNER — Trade
Size No
Capacity Sq. Ft. EM.R BTU H.P.
(REMARKS—OVER]
Signed
By_ FRED VOGT a co-
�FATOMG a Age
42 zM 7_59 Business P �To a e 5t.
f~ 9-6767
St. Louis Park, Minnesota
City of Fridley, Minn. N° 8438
BUHDING PERMIT
Date: September 9, 1965
owner: Rid and E. Varcoe Builder Owner
Address 974 Rice Creek Terrace Address
LOCATION OF BUILDING
No. 974 _ Street Rice Creek Terrace Part of Lot
Lot `� _ Block Addition or Sub -Division
Corner Lot Inside Lot Setback of house Sideyard 5
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Playhouse & Tool Front 6' Depth 8' height 6' 911 Sq. Ft. 48 Cu.. Ft,
Shed Front Depth freight Sq. Ft. Cu. Ft.
Type of Construction Wood 4M Est Cost $200.00 _ To be Completed
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 wi a'll provisions of
ordinances of the city of Fridley.r��
In consideration of the payment of a fee of $ 4.00 , permit is hereby granted to Richard E.
Varcoe 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 ataay time up�y y of the provisions of said
ordinamms. �, ®/
NOTICE:
Ub permit don net corer the condmetloe, installation for Wig. plumbing, gas heating, wwar or water. Be sure is as
the Building lnsp mr for separate psrndis for then items,
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S, NAME / �� .Gt. /'-.7 � c BUILDER
ADDRESS ?7/ 4 , '?;'� c e ADDRESS
LOCATION OF BUILDING
NO, %� STREET s of it /1"'��.r 0 _ PART OF LOT
LOT BLOCK ADDITI014 OR SUBDIVISION
CORNER LOT_ INSIDE LOT.SETBACK SIDE-YARD4L�
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;
0 6 FrontDepthZHeight /
t
Sq. Ft. f -Cu. Ft.�
Front Dept h Height
Sq. Ft. Cu. Ft. 99
Type of ConstructionEstimated Cost
'l elo
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 J /� �_ �� SIGNATURE�> ° P �"��..,��'� /
(Schedule of Fee Costs can be found on the Reverse Side).
City of Fridley, Minn. 11°' :9-0:2 '7
BUILDING PERMIT
Date: Septemazr 26, 1966
owner: Mare 9. 2ieh:-ird Builder �SIn Y3oberbgQn__
Address 974 'gice Greek Tp Trace Address 6546 Lucia Une
LOCATION OF BUILDING
No. 974 _ Street Street R€"=e Cropk Terrace Part of Lot (rear)
Lot 5 _ Block 3 Addition or Sub.Division _ Brookview Terrace 2nd Add'a
Corner Lot --- Inside Lot — Setback 35 —_ Sideyard 91
Sewer Elevation ____ _ _._ _ _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: _
ATT -11 -MM G `A R. _is Front —21L Depth _ _ Height -Jl!— Sq. Ft.��� Cu. FL
Front Depth Height — Sq. Ft. _._ Cu. F,t.
Type of Construction __ Est. Cost __L2e�B_•_°� _ To be Completed Oct. 1___ 5__1966
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 21 provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 6 - OQ _ _ , permit 3s hereby granted IROBAIZ
to construct the building or addition as described above. This permit is grantedupon
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.
CMRM013 MUM. Buildinginspector
NOTICE:
Thle permit don not cover the construction, installation for wiring, plumhing, gas healing, cower or water. Be sire to see
the Building Inspector for separate permhs for thou hems.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME VA r) R t e BUILDER a
ADDRESS_' 6 TevADDRESs f
LOCA ON OF BUILDING
N0.Q 2 'V STREET PART OF LOT Re 4 t'°
LOT BLOCK ADDITION OR SUBDIVISION e
CORNER LOT INSIDE LOT�SETBACK 3S 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;
0.4 e Front Depth R ;Z, Height
Sq. Ft. Cu. Ft.
Front Dept h Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost , 1z
To be completed
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work i'dstrict 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).
SUBJECT
PER k4-
City of Fraley
'2 45
AT THE TOP OF THE TWINS
BUILDING
PERMIT11
`
RECEIPT NO.
• --------- COMMUNITY DEVELOPMENT DIV,
vPROTECTIVE INSPECTION SEC.
r i
1 . �
NUMBER
REV
DATE
9/2/97
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910_F15
JOB ADDRESS 974 Rice Creek Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
5
3
Brookview Terrace 2nd
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP
PHONE
Betty Varcoe 974 Rice Creek Terrace NE
571-5173
3 CONTRACTOR MAIL ADDRESS
ZIP
PHONE LICENSE NO
Milton Johnson Co. 525 Lowry Ave NE, Minneapolis MN
55418 781-9548 2083
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 g7 REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (22 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLU7DAYS
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK ORZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIODANY
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
$1,834
$.92
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-
$59.50
Fire SC $1.83
STRUCTION OR THE PERFORMANC OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
License SC
$5.00
$67.25
IGNATURE OF CON', RACOR ORA THORIZED AGENT IDATEI
WHEN PROPERLY V (DATED THIS IS YOUR
.PERMIT
�, BG NSP
rIATE
StGNATURE OF OWNER OF OWNER BUILDERI (DATE)
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: 974 Rice Creek Terrace
Legal Description:
Owner Name & Address: Betty varcoe
Contractor: Milton Johnson Company
Address: 525 Lowry Ave. N. E.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
Tel. #
MN LICENSE #.
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length
Length
Len
Tear -off re -roof
Driveway Curb Cut Width Needed:
DATE: 9/2/97
Effective 1/1/97
mosy-'!;-o
571-5173
2083
781-9548
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
Ft. +6Ft=
Estimated Cost: $
(Fee Schedule on Back)
Ft x $ _ $
APPLICANT: el. # 781-9548
TOTAL
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$
1 63
.001 of Permit Valuation (1/10th%)
State Surcharge
$
)
$.50/$1,000 Valuation
SAC Charge
$
$950 per SAC Unit
License Surcharge
$
4.0 0
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
0 s 1-14 , 5 � sa
CITY OF FRIDLEY INSPECTION DIViSION
Effective On January 1, 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND
HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING
SYSTEMS AND DEVICES
JOB ADDRESS
RATE SCHEDULE
OWNER
Residential
Rate
TOTAL
Furnace Shell and Duct Work, Burner -
BUILDING USED AS
Also Replacement. Furnace
$ 30.00
$
' ��
(Side Vent - Fill Out Back)
ESTIMATED COST l°ll PERMIT NO. }
Gas Piping (Needed with new furnace,
$ 10.00
$
but not replacement)
DESCRIPTION OF FURNACE AND OR BURNER
Gas Range
$ 10.00
$
No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Gas Dryer
$ 10.00
$
Trade Name Size No.
*Air Conditioning - All Sizes
$ 25.00
$ � �.�1�
BTU HP EDR
Fuel Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK)
Burner Trade Name Size No.
1% of Value of Appliance or Work
$
BTU HP EDR
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
$ .50
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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
HEATING CO
DATE 6 Zo n
-SEWNCK WKWOCi u ' f i -
9c
9"0 WelftioM
Sao
#
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes( ) No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes( ) No(
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes( ) No(
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current, codes. Yes ( ) No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input Fan Assisted or Nat
Appliance #2 Type
BTU Input Fan Assisted or Nat
Appliance #3 Type
BTU Input Fan Assisted or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter inType
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date:
Building
BUILDING
Permit riot
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
EWMCIAI. N 19 2008
763-502-4977] FAX
EFFECTIVE 1-1-08
DATE ` �.:" r / �Ae o g YOUR E-MAIL ADDRESS
SITE ADDRESS M�/r
P
�L �� r�'�ll'C6
THIS APPLICANT IS: XOWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME713197"-Y b///F'tc&!5-
ADDRESS: 976/ /�/ e� L,��`��-T�/t��c C -CITY ��P�
STATE//1-
TENANT
-'ZIP-'J/J1!-PHONE:
NAME:
ADDRESS: CITY
STATE ZIP
CONTRACTOR
SUBMIT A COPY OF
PHONE FAX
YOUR STATE LICENSE
STATE LICENSE {! EXP DATE
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
•'EDITION ❑ GARAGE/SHED ❑ WINDOWS
u BASEMENT FINISH AROOF ❑ DRAIN TILE
❑ DECK J*SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCEIREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: QIP®� "� S to
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
01Q ❑ HOUSE ONLY
BASEMENT
REMODELING SUBMIT:
NUMBER OF SQUARES
GARAGES
®� ❑ HOUSE & GARAGE
-VA1.
❑ ATTACHED GARAGE
Existing
2. Proposed
Floor Plan
floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List
of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
iny!
Soffit
ADDITIONS & PORCHES SUBMIT:
❑ Aluminum
T
1. Site Plan/Survey showing the existing structures
11 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 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee $ 11311d5- See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ aafk .001 times the total job valuation
Surcharge $ .0005 x Permit Valuation Minimum $.50
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1825 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( ) Nan Necessary ( )
Total Due $ B a 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 on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. r/
SIGNATURE OF APPLICANTA� PRINT NAML� � T��es .DATE --9p
APPROVED BY DATE
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
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 y',-2zl�'r I, ',E Ge��-1.?T��.a�e,!!�- , Fridley,
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��..
Date 1`�v