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PRE 2010 DOCSDate: City of Fridley, BUILDING PERMIT May 17, 1967 S. E. Templin N9 9244 Builder S. E. Templin Const. Address 6184 Stinson Blvd. Address Same_ LOCATION OF BUILDING No. 80 Street .___ Rice Creek Way ____ part of Lot Lot 10A & 1__OBBlock 4 — Addition or Sub -Division ._._.._ Edgewater Gardens_-_ t Corner Lot _ Inside Lot X Setback 35 Sideyard -.10 & 5 Sewer Elevation ___ _ _ 821.34 824-34 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 40' Depth 24' height 20' Sq. Ft. 115 Cu. Ft. _.1,528 Garage Front 20' Depth _ 22' Freight 10' Sq. Ft. A40_ Cu. F't..-_. --4.A-00 Type of Construction Frame Fst Cost $17, 000 __ To be Completed Sett .... 1967 SEWER LOCATION - 98' East of Manhole WAXER LOCATION -'108' East of Manhole In consideration of the issuance to me of a permit to construct the uil ' cribed above I agree to do the proposed work in accordance with the description above set forth in pliance with provisions of ordinaao of the city of Fridley. �n $100. In consideration of the payment of a fee of $ 39.00 permit is hereby granted to S. E. Templin Const. Co. 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 BELISLE Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to No the Building Inspector for separate permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME ' C BUILDERC t % G�% Z�Iv' ADDRESS ADDRESS LOCATION OF BUILDING N0. STREE � 6,�` PART OF LOT LOT ��`d �� BLOCK ADDITION OR SUBDIVISION' fv"`f`�-`l � y_ CORNER LOT INSIDE LOT �/� SETBACK SIDE -YARD SEIFR ELEVATION / TOP OF ,FOOTING S;) Applicant attach o th s form two certificates of survey of lot and proposed building location dra on these two ertificates. �DESCIPTION OF BUILDING To be Used sd ' 5 Front Depth e7 Height Sq. Ft. ( Cu. Ft. Front=' Depth Height / S Ft. `� b Cu. Ft. Z_/, Typl of Construction Tb Be Completed Estimated Cost 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 ruling 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). 4 A" L I hereby certify that this is a,AJ�'ue and correct representation of a sumy of; Lot 10A and Lot 10B., -..B1 . ock 4, Edgewater Gardens As surveyed by me this year, 1961. SIGNED C4 (4.AfmW*IGHT AND OLSON It HARVEY A. CARTWRIGHT cm2vmcjm& 01"N COMBINING THE RECORDS OF J. E. HILL, CIVIL ENGINEER A,NOX^ COUNTY SURVEYS H UNNEP114 COUNTY SURVEYS LAND SURVEYORS ESTABLISHED Is" MINNEAPOLIS SURVEYS C. F. SANDHOFF 6410 PALM STREET N. W: REGISTERED UNDER LAWS OF STATE OF MINNESOTA CIVIL ENGINEER ESTABLISHED ISM SUNSET 4-7655 LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS OWNER JAMES NELSON 326 PLYMOUTH BUILDING FEoPRAL B-8721 SURVEYOR INDUSTRIAL — JUDICIAL HENNEPIN AT SIXTH - MINNEAPOLIS S. MINNESOTA ESTABLISHED 1922 13USINESS — TOPOGRAPHICALMETROPOLITAN *url;evor'g LAND CITY LOTS — PLATTING SURVEYORS, Ls'rABLISHED 1951 And Hohn 716/4O� 4 A" L I hereby certify that this is a,AJ�'ue and correct representation of a sumy of; Lot 10A and Lot 10B., -..B1 . ock 4, Edgewater Gardens As surveyed by me this year, 1961. SIGNED C4 (4.AfmW*IGHT AND OLSON It Application for Power Plants and Heating. Cooling, Ventilation. ReFrigeration and Air Conditioning Systems and Devices Dept. of Bldgs. Phone SII 4-9470 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 ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ Location 80 Rice Creek W a y 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! 19C Owner Sam Templin Kind of Building frame Used as d W g . FINAL (REMARKS -OVER) To be completed about STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Estimated Cost, $ r� 670.00 Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $ ,, , �� Permit z q� o Old -gilding Permit No. No. Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ DESCRIPTION OF WORK OIL BURNER—to 3 gal. per hour . ...................... 5.00 $ HEATING or POWER PLANTS --Steam, Hot Wa�WarmNol over 3 gal. per hour—See Fee Schedule Trade Names AFC 0 Size No AFB —100—D GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ Capacity Sq. Ft. E.D.R 100M BTU H.P. GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x 0:50 Total Connected Load 3 3 a 97 Kind of Fuel Na t . Ga S Additional Fixtures . ............... x .50 $ BURNER —Trade Name A'fir'. a Size No Gas Range to 200,000 BTU ........... x 2.00 $ Capacity Sq. Ft. E.D.R BTU H.P. AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ Signed (�(d By Mill City Heating Co. ROUGH 544-1501 Business Phone No- FINAL (REMARKS -OVER) IrAtmion Out Eap. wall Not cap. wall JOL wan Moor Z ® it gii� v I "-I/ Ot de�vr� Toorma. Rapfired sq. ft. E.D.R. or sq. ins. W.A. Leader area F7'q— F1.1 Room I Length Width Height --Windam and Doors— Crackage and Area IWidth I =t I Me ag I Lineal it. I Arms of D&RO a liff2ta of crack .. f MIT—TIMINEW-17 LIMM663 — I Ongs T�s d zi—'/' 2 Em6 waR �e Net exp. wall VIC Int. wall Ceiling Floor Tau] Btu. Rapired sq. ft. E.D.R. or sq. ins. W.A. Leader area F11 Room I Length Width Wm&m and ap andArea Width I t akirb milot Mveal ft. I Area — M 144L of mane of Mae Flff IS I of crack 0 9m, ft. 0 Infiltration Class Exp. wall Net exp. wall Int. wall Ceiling f1bor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 Room I Length Width Windows and Doors—Crackage and Area I :ldth HeghNo. 08 L A, a No. r rano ofi: lih.'k ft. Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. F.D.& or sq. ins. W.A. L r area R. Ptoom I Length Width Windows and Doom—Crackage and Asea :—.71dlh Helell1 U I No- of I n I it. I Ams t..j of ...1'.h'm of crack 00. et. ' - — -------- - [eight City of Fridley Application for Plumbing and Gas fitting Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... �� x $2.00 $ / o��0 x $1.50 $ New Fixture Old Opening .............. x $1.50 $ R N WATER HTR. GAS ELEG Base $ P New Ground Run Old Bldg. ............ x $3.25 $ Electric Vater Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ....................... .. x $2.00 $) Additional Fixtures .................... x $ .75 Ist Gas Range to 199,000 BTU .............. x $5.00 $ 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 $2.00 $ / Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ............................ x $3.25 $ Water Beater (Up to 99,000 BTU) ...... x $3.00 $ P New Ground Run Old Bldg. ............ x $3.25 $ Electric Vater Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures ....................... .. x $2.00 $) Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application,are true and correct. Fridley, Owner Kind of Building Used as i To be completed about 19 Estimated Cost, $ Old—(ew?�ilding Permit No �` Permit No. r Signe r By Business Phone No ROUGH 11 ® 2V– 17 FINAL 42 City of Fridley, Minn. BUILDING PERMIT Date: May 52 1970 blo- ""0� N <i 0631 Owner: Wm, Kasinkus Builder —Milton L. son.PAPmpAW._ AddressRice Grgek W-gy N.E. Address 2513 Centxal Am e N.K. LOCATION OF BUILDING No. - 80 Street Rice Czeek Way Part of Lot Lot 1QB�Block _ 4 Corner Lot Inside Lot Addition or Sub -Division _ Edgewater hardens Setback Sideyard Sewer Elevation __ _ — Foundation Elevation To be Used as: 1 mn Siding I Front Depth Height — Sq. Ft Cu. Ft. Front Depth Height — Sq. Ft. Cu. Ft. Type of Construction _ _ Aluminum Est. Cost �,1,L448.00 ___ To be Completed Sept. 1. ,1970 In consideration of the issuance to me of a permit to construct the building cribed above, I agree to do the proposed work In accordance with the description above set forth and in coance with all provisions of ordinances of the city of Fridley. f' 4 rl f' I/ In consideration of the payment of a fee of $ .9 . DSL _ _ _, permit is hereby granted to Milton ton .To'hn ea n C o . 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. NOTICE: This perndt does not eever the eonahuetion, hntailation for wiring, plumbing, gas heating, sewer or water. Be sure to sus the Building lusindor for separate permits for these hems. *V _V APLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S . NAME A M � �'ff 5 ) OJ Lk BUILDER: o �-` O JA . To mo j Ci f� ea ADDRESS: ®0 t Ce Cl? eEK ADDRESS:-- c�S82 1.&/,j Jew V NO:. STREET: elo& LOT? G BLOCK: ADD-IITION: CORNER LOT: INSIDE LOT:y SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of SuSu®rva of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: /_,_1"tont: Depth: Height: Square Feet: Cubic Feet: Front: —Depth: Height: Square// Feet; Cubic Feet: Type of Construction: 410 yq Silo."Estimated Cost: To Be Completed:_– ,001 The undersigned hereby makes application for a permit for the work herein specified, agieeing'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: J SIGNATURE (See Reverse Side For Additional Informs .. .... ....... +ei► b Application for Power Plants and Hearing, Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ..........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM 5.00 ' $ Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water ............... .. 3.00 $ OIL BURNER—to 3 gal. per hour ........................ 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTU) ....................... 5.00 ' $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 2.00 $ Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ L� IR CONDITIONING I FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH FINAL `2 Z? 7/ Dept. of Bldgs. Phone 560-3450 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, I •An+_ a:17 Owner I~ Kind of Building Used as To be completed about Estimated Cost, $ Old New. Building Permit No. Permit No. 4 142) DESCRIPTION OF WORK HEATING or POteam, Hot Water, Warm Air—No� 1 � Trade Name ®�Size No. 644koad Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Rind of Fuel BURNER —Trade Name Size No Capacity Sq. Ft. EM.R BTU H.P. (REMARKS—OVER) HTG. & AIR-COND. CCJ Minneapolis 16, Minn. U. 51611 OF Original PERMIT for Power Plants and Pleating. Cool. ing. ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of__ Heating Plants = to be installed--altered—repaired Make (A) , Size --6-'1,;L V– 0 Oil feed ; Coal fired , Gas fired ; Gas Authorization No. Remarks �'cQ. Approved Final Inspection 19_ Inspector XV2 3 Permit N? = 4750 Fee if Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. , 191- Owner U�WO 26�� Location F® &9=aku-kU--)Cl Kind of Building oY - How Occupied Q - Work to be Commenced—, 19 To be Completed—, 19— Estimated Cost, $ 2"-,00 Old New, Building Permit No. Permission is hereby granted to to install—erect—use the material and devices described in the above statement. This permit is granted upon the express c#4ndition that the person tow it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein men ` ned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specificatio se forth in the approved application for this permit on file in the office j°ice o f the Inspector of Buildings. Inspector of Buildings 42 2M 11-67 V CITY OF FRIDLEY Effective Date January 1, 1991 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE) AESIDEATIAL RATE TOTAL B Job Address C � t1- � �/J'� (e &JA 51 Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 $ Building Inspection Div. 6431 University Ave NE Fridley MN 55432 Tel. No. 572-3604 Gas Piping $ 10.00 $ (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. • Air Conditioning (all sizes) S_10-00 $ '199/ �T All Others/Repairs and Alterations li of Value of'Appliance or Work $ OWNERa/!! v KIND OF BUILDING �y e% C_([ � &7W --s' COMMERCIAL/INDUSTRIAL USED AS C L- ✓,e c: _, li of Value of Appliance or Work $ TO BE COMPLETED ABOUT UL7 State Surcharge S .50 ESTIMATED COST TOTAL )rEE OLD - NEW BUILDING PERMIT NO. PERMIT 00. /��L REINSPECTION FEE $30.00: $ DESCRIPTION OF FURNACE/BURNER Rough Insp. Date / Final Insp. ` �( Date Approval for Permit MINIMUM FEE FOR ANY HEATING/COOLING/VENTING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission fra• adjoining neighbor. HEATING or POWER PLANTS, Steam, Hot Water, Wars Air- No. Trade Name Size No. Capacity sq. Ft. CDR BTU NP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDA BTU HP Company sJ�r�1✓ Signed By �y Tel. No. Fill out back side for stack verification on replacement furnaces CHIM14EY 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 connected Yes ( ) No 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s Company Signed By Da to City of Fridley3 SUBJECT 5 8 P, AT THE TOP OF THE TWINS BUILDING PERMIT Ir RECEIPT NO. ______ COMMUNITY DEVELOPMENT DIV. L SEC. r � PROTECTIVE INSPECTION [� 1 � 7 ' CITY HALL FRIDLEY 55432 j NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 4/30/99 10B ADDRESS 80 Rice Creek Way NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oEscR. 10A,10B 4 1 Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dean Johnson 80 Rice Creek Way NE 574-7390 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Midwest Roofing & Siding 18979 Gladstone Blvd, Maple Grove MN 55311 416-4804 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20010277 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ( REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (26 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU. FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $ 2 228 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1.11 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $74.75 $2. ;37 PLAN CHECK FEE TOTA F Licens $5.00 .09 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE- HEN RDP Y A IDAT � HIS I$� R 7 l.� SIGNATURE OF OWNER. IF OWNER BUILDERI IDATEI BLD INS. OAtE CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 . 572-3604 P Effective On January 1, 1999 APPLICATION FOR PLUMBING AND G S FI NG PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLEn nN F:ACH 1:1 nna C� PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7,00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader _ $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Heater — Gas** J_ $10.00 Gas Range** $10.00 Gas Dryer** $16.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE 4 2 co �, 50 0 JOB ADDRESS 1� ! C. 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. d & Owner �� f» S� Building Used Estimated Cost 906'76 • PERMIT NO. J a PLUMBINGCj�M{�ANY:..;,::....:. MCGUIRE & SONS SIGNED BY r> No IIY�L1 q P 3 d n5, MN 5534 F Approved ByRough—a%"` Final Date MINIMUM FEE OR ANY PLUMBINGIGAS PERMIT IS $20.00 PLUS THE $.50 STATE SURCHARGE "COMPUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. — Fuildi BUILDING See Back Page for Fee Schedule Permit NO.: Inspections RESIDENTIAL APPLICATION Fire Surcharge Received By: 763-572-3604 CITY OF FRIDLEY Date Rec': -' 763-502-4977 FAX License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge EFFECTIVE 1-I-08 $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow DATE 6E s �� YOUR E-MAIL ADDRESS R + 6 ft = ft x $21 =S SITE ADDRESS ��_ a' c v _'t' E ` a, I ,•_ l f $ THIS APPLICANT IS: OWNER ❑CONTRACTOR Y $ PROPERTY OWNER/ NAME: 6Q or.: v- . � st" $ TENANTa �y �� /yn ADDRESS:3e" g r,. L70ak /,/!c CITY f o; STATE 1a %II' JJ % 3 Make checks payable to: City of Fridley Attach Stipulations PHONE: NAME: ADDRESS: CITY STATE_ LIP CONTRACTOR SUBMIT A COPY OI' PHONE FAX YOUR S1'A'I'E LICENSE STATE LIC1:N EXP DATE PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE CO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL. TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANpqCEIREPAIR ❑ REMODELLNG DESCRIBE WORK BEING DONE:_ Dee, SIZE OF IMPROVEMENT LENG1711 B i; _ WIDTH _ r HEIGHT SQ F.I ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES 13 HOUSE & GARAGE BASEMENT REMODELING SUBMIT 1, Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE. ❑ DETACHED GARAGE 3. List of structural members to N used PROPOSED HEIGHT': SIDING FOR NEW CONSTRUCTION INCLUDING DECKS. ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT ❑ Aluminum ❑ Trim l Site Plan/Survey showing thr ,existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS Two sets of construction plans 3. __E=nergy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING Cl IANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED CkN VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: 1 G TII 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ / r Ch�J OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ / 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $(:;2,02-.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 $ R + 6 ft = ft x $21 =S 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 1 acknowledge that the information above is complete and accurate; that the work will be in conformance with the o dinances 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 m,t to stan without a permit on site. that the wort: will be in accord nce with the apobved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT r� - PRINT NAME �L(',�S�i�IB o3Q�Cl��Z DATE APPROVED BY DATE II PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICA I- WORK 11