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PRE 2010 DOCS. 53-81i-s-915.51�� City of Fridley AT THE TOP " THE TWINS L r - DEVELOPMENT MY, PLUMBING PERMIT T APPL I CAT I Oi� u-------; COMMUNITY DEVELOP PROTECTIVE W$ftCYWM OW, l r«- CM HALL FMMY #HiE 1...«�.� t.J 014-000-3w NOW RQv. DATE PAGE OF A OV 0-0 Y Job Address - 0 12115/73 1 1 800 6L31 River View Terrace N. E. Owner Ad ress Phone James B. Codi Contractor 73? MARQU TF Adft&e Phone Ie9INNEGAS O M&L5., MINN, Kind of Building Use Frame Res. Comp etion DateJR-s-timatednsr 6-5-7h 1 10.00 I SNISVaagni Jl I I I I 3fleral KL" S1VNIanI 'lddrl � 1 11 ars I 1 aa1rM •mss NI I � I •eaal � 'MNIVU I I I+ er m „ aN�are I I ! H.:Y.I ! lO O SNIV"OI I I "00121 ® 1 .0 8"3MOH sl O� I I I I q 1N C HNIaaHO +f A W O w P4 J-,,23-;�Z Plumbing Fixture Rates: NO. RATE TOTAL 1 Number Fixtures x $2.00 Future Fixtures x $1.50 I New Fixture -Old Open. x $1.50 I I Catch Basin x $3.25 Water Heater -99,000 BTU x $3.00 I Ground Run Old Bldg. x $3.25 fElec. Water Heater x $2.00 E Gas Fitting Fees: lst 3 Fixtures x $2.00 I - Additional Fixtures x $ .75 t Gas Range -199,000 BTU x $5.00 Repairs & Alterations See Description; Install Gas Grill Code 5.00 State Surcharge Class "A'" Surcharge .500. .50 TOTAL FEE $ 5.50 !The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and rulinj of the Department of Buildings, and hereby declare that all'the facts and representations stated in this application are true and correct. 40* ,� rcro �� YCD'•G.'�� Signature Date SNISVaagni Jl I I I I KL" S1VNIanI .139012 aa1rM . er J-,,23-;�Z Plumbing Fixture Rates: NO. RATE TOTAL 1 Number Fixtures x $2.00 Future Fixtures x $1.50 I New Fixture -Old Open. x $1.50 I I Catch Basin x $3.25 Water Heater -99,000 BTU x $3.00 I Ground Run Old Bldg. x $3.25 fElec. Water Heater x $2.00 E Gas Fitting Fees: lst 3 Fixtures x $2.00 I - Additional Fixtures x $ .75 t Gas Range -199,000 BTU x $5.00 Repairs & Alterations See Description; Install Gas Grill Code 5.00 State Surcharge Class "A'" Surcharge .500. .50 TOTAL FEE $ 5.50 !The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and rulinj of the Department of Buildings, and hereby declare that all'the facts and representations stated in this application are true and correct. 40* ,� rcro �� YCD'•G.'�� Signature Date CityFridley AT TRE TSP 4P TOE TWINO r� ------- GOM"VNITY DEVELOPMENT DIV. 9 i i rn*Ti CCT1VQ t4Z!P-4CTtON nPT, PITY HALL FRICL4V 00,qR IJob Address •' J� � e._ is Cont^; cto Kind of Building 4r04VECT Permit No. PLUMEING PERMIT APPLICATIO ti ss nione e completion Late -stImate o s t _ ' Plumbing Fixture Rates. -- NO. RATE TOTAL �q Number Fixtures 9 1.2 (j® Ig Future Fixtures x $i.50 3DNVa svv I t4 New Fixture -Old Open. x $3..50 ryddVl I I Catch Bab -in x $3 .25 ��.m.. _ .Xld �— Water Heater -999000 BTU / x $3.00 3•00 •�slWl I I I — Ground Run Old Bldg. x 3.2.5 $ •saa7 I /ANIVaI I I I Elec. Water Heater x $2.00 I sNlstla Y, ttalvo l III I w R Gas Fitti Feest •c sNlvaal to ;r. e 1St 3 Fixtures % x $2.00 .7.00 ` ®•(�j �14 Sa3MOH$I �I I II Additional Fixtures x $ .75 �F� '1N7lOdI ( C HNlao I I I Gas Range --1999000 BTU x $`x.00 w HSV/h 0 _a irus' & Alterations Ii ^O_ jtl� SNN13) I 171 Description: Code I f0 N State Surcharge .50 SN19VE1 °r.) Hlve ! v TOTAL FEE $ �0 The undersigned hereby makes application :For a permit ! s,VNla°I I I I for the work herein specified, agreeing to do all work 81350']71 { o in strict accordance with the City Ordinances and ruling a31tlM �+ I of the Department of Buildings, and hereby declare that I — all the facts and representations stated in this application are true and correct. 'Signature 1)ate SUBJECT PERMIT City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT • Jr?, EC IPT N0. 1 L'______ COMMUNITY DEVELOPMENT DIV. (R r PROTECTIVE INSPECTION SEC. (in)9.2 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY. L J` 612-560-3450 910-F15 111/19/73 JOB ADDRESS 6431 Riverview Terrace N E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Veits' Second Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Leif Henriksen 6434 Riverview Terrace N.E. 560-4560 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO., 6 USE OF BUILDING Residential 7 CLASS OF WORK $J NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE) 8 DESCRIBE WORK Construct a 36' x 32' Dwelling and 24' x 24' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before capping. (Top of Footing and Sewer & Water Elevations; See Engineering Dept.). FOR �11R1NGf REQUIRED PER�IiTS R EQ gEpERATE AlD SIGNS' HEAN.1NG,, pLUMBING TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $35,510 17.75 TO VIOLATE OR CANCEL THE DOES NOT PRESUME TO GIVE AUT -F RMIT FEE EA SAC CHARGE PROVISIONS ANY OTHERS 8 OR LOCAL LAW REGULATING CON- STRUCTIO TH P FO ARCE OF CO RUCTION. 53.28 $275.00 c PLAN CHECK FEE TOTALFEE 346.03 SIGN 144RED ONTRACTOR OR AUTHORIZED AGENT (DATE) W N PROPERLY VALI ATED T SIS YOUR PERMIT y� p BLDG. INSP DATE � SIGNATURE OF OWNER (IF OWNER BUILDERI (DATE) Permit No. CRY of Fr'dley AT Tia TOP OF THE TWINS BUILDING PERMIT APPLICATION r< Receipt No. ------- COMMUNITY DEVELOPMENT DIV. PROTECTME INSPECTION DEPT. CITY HALL FRIDLEY 5SQ2 012- 500- 34go SERiATE AGE OF r 4PPROVED By 910 -Fl 1/15/73, 1 Job Address: _ lq,3 f - -- Legal Lot No. Block Tra t or Addition See Attached f 1 1 N Des S- 7- •'S -),j /j A) j j A sbeet Property Owner Address Zip Phone C ontracto -AWres WV 7 Zi Yhrloie p 0. 4/ Tr--chiteCL o/ Designe/ Address Zip Phone License No. Engineer Address Zip Phone License No. Use of Building Class of Work []I-*,emove IoNew 0 [DAlteration 0 Addition Repair Tove Describe Work Change of Use From To SPECIAL ASSESSMENTS: If lateral assessments have not been placed on this property, an agreep.-ient must be signed, agreeing to assume such lateral assessments before a permit will be issuedl 0. Agreement Necessary: _,. A,1,44 6 :1 "-4 Agreement Unnecessary: Finance Director OUTSIDE UTILITIES: Sewer Elevation: Water Elevation: 0 Stub Location: Stub Location: LU (h BUILDING INSPECTION pa Plumbing- H.V.A.C. Electrical Fire Insp. Signature & Date Approved 0 U- Registered Engn. Stamp. Legal Description Check Exterior Devel. Check Performance Bond Check Easements, R/W, Special Agreements Final Approval Date ,.Certificate of Occupancy Date T1TMI7TTC T()'TTC . Length: 36, Width: 321 Accessory Buildings: Length: -191;7 - FOIL CITY USE ONLY Height; Cu. Ft. Sq. Ft. Height: Cu. Ft. Width: Sq. Ft. AT APT ONT. Sq. Ft. X Cost = Valuation ) Totdl Valuation _ 34-1 d Basement X Cost - Valuation } PERMIT FEE: Residential Total Valuation Fee $1.00 to $500.00 $5.00 $501.00 to $2,000.00 $5.00 for the first $500.00 plus $1.00 for each additional $100.00 or fraction thereof, to and including $2,000.00. $2,001.00 to $25,000.00 $20.00 for the first $2,000.00 plus $3.00 for each additional thousand or fraction thereof, to and including $25,000.00. $25,001.00 to $50,000.00 $89.00 for the first $25,000.00 plus $2.50 for each additional thousand or fraction thereof, to and including $50,000.00. $50,001.00 to $100,000.00 $151.50 for the first $50,000.00 plus $1.50 for each additional thousand or fraction thereof, to and including $100,000.00. PER14I`.0 FEE: Commercial and Industrial Total Cu. Ft. X $2.15/1,000 sq. ft. Permit Fee x PLAN CHECK: Take one half of permit fee = STATE SURCHARGE: /`/, 76 Valuation X $.50/$1,000.00 x $.50/$1,000.00 PERFOR1,1ANCE BOND VAIXAT-MN Blacktop 1.50/syd. Curbing 2.00 lin. ft. Sod 0.40 sq. yd. ` Fencing -.2.0_0 lin. ft. Bushes 'and Trees 5.00- :>0.00 .29-.1-- f GR _ W AL Furnace Shell & Duet W ... ... ..$10.0 � Replacement of Furnace 6.00 Repairs & Alterations—up to $300.00 6,00— Repairs & Alterations each add. 9500.00 300 3.00 1 6.00 $� x•00 3.00 $_ — Furnace Shell & Lines—to 400 sq. ft. FMR Steam $10.00 $ --,- - - .- Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $- AV,i�__ Each add. 200 sq. ft. EDR Steam xnn $. - Each add. 320 sq. ft. EDR Hot Water 3.00 OIL BURNER—to 3 gal. per hour;.—_—.— over 3 gal. per hour—See Fee Schedule GAS s (up to BTU) &W $ S A D carer 199,000 MV See Fee Schedule GAS FITTING FEES: NO RATE 'TOTAL 1st 3 Fixtures $$ zoo $ -.,2 Additional Fixtures s .75 $ Gas Range to MM s$ 6.00~ $ Fee TOT D City of Fridley: The undersigned hereby makes application for a permit for the worse . specified. agreeing to do all work in strict accordance with the City ee and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct A Fridley, Minn _- N�,I*- /3 owe- iin r_ ofuild...,.....`..a.� Used as - _ _ •- _-- A, To be completed about Estimated Cost, $ E3#d--New. Building Permit No. _— Permit No. -g HEA77NG or Rot Water, Warm Air --No F ROBERTS-HAMILTON COMPAN HEAT LOSS CALCULATIONS MINNEAPOLIS, MINN- Weatherstrips JA 5•H•V•E• Construction No. Insulation Guide WindowsI Doors Reference Out. Wall I Int. Wall I Ceiling 1__.f!oof I Floor Kind I How Applied Yes—No Yes --No 19 � IS F1.I � v- Room I Length c. Width Height f " � F1.1 ,�'� ' '' Room I Length i4-� Width 12. fa Height s4 - Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area Width Height No of Lineal Et. Area i d. Width Height No. of Lineal ft. Area No. of pane o[ pane , lights of crack sq. ft. No. of pane of pane lights of crack sq. ft. Coef.I Btu Infiltration I Crackage and Area .. e r Glass r -r '77 ! 1 0 e, Exp. wall sq. ft. ai Coef. Net cap. wall ( 117 1 Glass Int. wall I+g Glass �. Int. wall.. ?,-i L'- G Exp. wall Ceil.or poor - � � 3 r- -� Total Btu. d �. 10 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Inc. wall '�k' rt 1 k ra___ I t _-L P- . tet:u.L x, c 1..1.:-1, ip a» Windows and Doors. Crackage and Area Width Height 9' " e r Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft Height No of nesl ft. Lt '77 ! 1 No of pane of pane itghts of crack sq. ft. ai Coef. Btu Infiltration 1 Glass Net exp. wall I+g Glass u C Int. wall.. ?,-i L'- G Exp. wall - � � Int. wall Net exp. wall d �. 10 Total Btu. Inc. wall Ceil. or floor Required sq. ft. E.D.R. or. sq. ins. W.A. Leader area A41�•- Ceil. or floor. - Total Btu Required sq, ft. E. D.R. or sq. ins. W.A. Leader area Fl.'';Room I Length/.-, " Width Height 9' " Windows and Doors_ —Crackage and Area Wath Height No of nesl ft. Lt Area No of pane of pane itghts of crack sq. ft. ai n Exp. wall I I i I JCoef. Btu Infiltration 1: 'o— Glass Glass 1. Exp. wall 9 Net exp. wall Xti' f _ Int. wall Cell. or floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I I I JCoef. Btu Infiltration I z--" 4 F c Glass Coef. Btu Infiltration Exp. wall Glass 1 Glass Net exp. wall I+g u C Int. wall.. ?,-i L'- G t s ..s - •. �%C,? t`" � � Int. wall Ceil. or floor d �. Total Btu. Ceil. or floor Required sq. ft. E.D.R. or. sq. ins. W.A. Leader area A41�•- Windows and Doors —Crackage and Area age and Area ' Width Height No. of-. Lineal ft. Area No. of pane of pane lights of crack sq. ft. C:11 t4 I Coef. Btu Infiltration ��•- Glass 1 Glass Exp. wall I+g Exp. wall ; ,P Int. wall Net exp. wall ..s - •. �%C,? t`" � � Int. wall r �. Ceil. or floor Total Btu. ttequirea sq. it. c,.u.m. or sq. ins. w .A. L.eaaer area Windows arid Doors—Crack age and Area ' Width Height No of Lineal ft. Area No. of pane of pane lights of crack sq ft. I Coef. ' &u Infiltration ��•- Glass 1 Exp. wall I+g Net. exp. wall Int. wall ..s - •. �%C,? t`" � � . ,rte. - Ceil_ or flnor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I - Effective Date May 1, 1988 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating 0Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. Type $ 5.00 S 3.50 S 1.50 $ 4.00 $ 5.00 $ ,5.00 S 5.00 S 5.00 S 5.00 S 7.00 $ 5.00 S 10.00 $ 10.00 TOTAL Yes ( ) No ( ) $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge $ .50 / ($15.00) TOTAL FEE $ / 9. 90 Job AddressV Department of Buildings City of Fridley Tel. 9571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 19 OWNER KIND OF BUILDING nn 1 USED AS . A Dn.I A 1qA TO BE COMPLETED ABOUT _ a f )-) /'?V ESTIMATED COST LVL c OLD - NEW BUILDING PERMIT NO. PERMIT NO. company Signed By Tel. No.��'(G%�� ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT V MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE N >1 N A U • % a Water V1 u o W •ro W q �Ii� 0. w a 9 Heater ar[ 3 Eb �y N a }�C( C c u .�i n 1I u w N q .c 8N V ji to S 14 �Ny 1 N� M O JCC -4 p�%y b I ,N) N U) U a co W N S a w V) W U W 3 0 £ t7 0 a3 leC 1st 2nd 3rd 4 th (R) - Future Connection Opening Connected with Sewer (") - New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating 0Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. Type $ 5.00 S 3.50 S 1.50 $ 4.00 $ 5.00 $ ,5.00 S 5.00 S 5.00 S 5.00 S 7.00 $ 5.00 S 10.00 $ 10.00 TOTAL Yes ( ) No ( ) $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS It of Value of Fixture or Appliance $ Reinspection Fee $ State Surcharge $ .50 / ($15.00) TOTAL FEE $ / 9. 90 Job AddressV Department of Buildings City of Fridley Tel. 9571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. 19 OWNER KIND OF BUILDING nn 1 USED AS . A Dn.I A 1qA TO BE COMPLETED ABOUT _ a f )-) /'?V ESTIMATED COST LVL c OLD - NEW BUILDING PERMIT NO. PERMIT NO. company Signed By Tel. No.��'(G%�� ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT V MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE 1) SUBJECT City ®f Fridley 2779 9 AT THE TOP OF THE TWINS BUILDING E R M I T r 1 7 1 06__ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. ♦✓ 1 i 1 NUMBER REV DATE 9/15/98 PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 JOB ADDRESS 6431 Riverview Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED 5 l Veits Second Addition SHEET DESCR. 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Cody 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Richard Hastings 6331 Riverview Terrace NE Fridley 55432 574-9966 4051 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 f7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage (23SQ) Tear—off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL` AND VOID IF WORK OR CONSTRUCTION ZONING MOT. 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 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,971.00 $.98 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- $62.25 Fire SC $1.97 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 7 !: q F License SC $5.0 $70.20 SIGNATURE OF CON,RACTOR OR AU04ORIZED AGENT IDATEI p PER I r SP E T IS IS R PERMIT BATE SIGNATURE OF OWNERIIF OWNER BUILDER] IDATEI 1) NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R -Z ,tq� BUILDING PERMIT APPLICATION ConstructionAddress: j5� 7 �? i t= � Legal Description: Owner Name & Address: Co � �' Tel. # Contractor: e .�� a MN LICENSE # 'O S` Address: (Z_ Tel. # :!j % " � Pjg Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF MOROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: e3 Construction Type: TEA- e- L) CF 4- 91_ iZ ;o e F Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 2,h S � ' APPLICANT:a_h Tel. # �' Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/ 10th %) $.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 [ ] Building $ 13e Z's BUILDING Plan Review Permit No.:36I6-OI hnspections Fire Surcharge RESIDENTIAL APPLICATION Received By: n 763-572-3604 $ .0005 x Permit Valuation Minimum $5.00 R: $ $5.00 (State Licensed Residential Contractors) CITY OF FRIDLEY $ nate 763-502-4977 FAX $ ft + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review EFFECTIVE 7-1-2010 $ Fee Determined by Engineering Qn^' $ a t • c OmDATE Ikq Total Due $ 14m 1 Make checks vavable to: Citv of Fridlev Attach Stipulations SITE ADDRESS q 3 1 12i 'ie rV1t-W r E Fridleq.M THIS APPLICANT IS: W -OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: 1x..Y Rin—cmelsYd TENANT ADDRESS: 6 3 1 C v ew Ttr CITY :Pr I `eT STATEMJ ZIP s 7► PHONE: C10) ,) 511 - 13% ( //O CONTRACTOR Nom; SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE K SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES__L_ PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR AREMODELING DESCRIBE WORK BEING DONE: fIts SIZE OF IMPROVEMENT Q TH a WIDTH 17, 'i HEIGHT 5 V SOFT 0 ROOFING 5 ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT +. NUMBER OF SQUARES 11HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: PROPOSED HEIGHT: ❑ DETACHEDGARAGE% r � � \A �� 3. List of structural members to be used SIDING � < �IK2,l,J/', * R NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit 1 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 FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (US G 1 97 U. C FEE SCHEDULE) TOTAL JOB VALUATION $ do OCCUPANCY TYPE Permit Fee $ 13e Z's See Back Page for Fee Schedule Plan Review $ `f . 65% of Building Permit Fee Fire Surcharge $ Q. I 0 .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $5.00 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 14m 1 Make checks vavable to: Citv of Fridlev 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 o 1 w rk whi }3�r�e�ui�re�s re ew and approval of pans•��,,�� 1� SIGNATURE OF APPLICANT ��, �V PRINT NAME jibe RIY QU P tSKQDATE O i -��r% ♦nnn �c�.r nrcnnmm�n otnwr.•ry mn 11 T-�