PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 4969�,
Date:_...1.._. ` '..�!:._.' ._.._"_
Owner:*_. Builder - ..._.._....... _...... _ _ _ ... __.._._........
Address _.._Lw.._. ..... _. Address _...__.._._......._....................
LOCATION OF BUILDING
No. ....... . Street .. .. ..... :. .........---......_..... P of Lo;....._..., ... _ ::....... ...
VOF
Lot ....._.'f. - ......_..... Block ....._....--., .-......_.......- - Addition or Sub -Division
�......... Sxdeyard `
Corner Lot .................................... Inside Lot ......... ............ Setback ....._114.. ...._...._.. .P .._............._. ::....._...._...........
SewerElevation .. ............................... _.._--------_......._........---.._..._......._...._....._ Foundation Elevation ....._ ........................ _................................................... .....
DESCRIPTION OF BUILDING
To Used as: A
.:: Front Depth ...... /-jHeight ..... Sq. Ft. ,�' Cu. Ft.
. ....a........ Front -1- Depth ._...... � Height .A'r� Sq. Ft." ... Cu. Ft......
Type truction ..:....: Est. Cost..... -°r '"'"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 with all provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $. ...."":`. '.., 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 revolted at any time upon violation of y of the provisions of said
ordinances. j
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 BUIIDING PERMIT
CITY OF FRIDIEY, MINNESOTA
Owner's Name l 7- " (- . F j Builder l el ll _,
Addressli
, Address'' v�
LOCATION OF BUIiDING
No. �„f Street Part of Lot
R e ,
Lot ZBlock / Addition or Subdivision
Corner Lot Inside Lot Setback /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:
1 �L/
1p
Sq. Ft.
Ft.
U4- /
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cost .,��,_
To be Completed
Z
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.
TJATR (n--4 j/ 7� ,196,el STMATIME A-)
(A Schedule of Fee Costs can be found on the Reverse Side.)
Application for Power its and : Heating, Cooling, Ventilation, .Refrigeration and
Air Conditioning Syste ns 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 $ - ® u
each add. 80,000 'BTU ....................... 2.00 $ _
Replacement of Furnace 0.00 $
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 $
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $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 $
ROUGH
FINAL
Dept. of Bldgs. Phone SII -
Lecalien / ! /_
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.
Owner
Kind of Building
Used as
To be completed about
I
Estimated Cost, $ :f �
.-New. Building Permit No. Permit No. 6
DESCRIPTION OF WORK
HEATING or POPOR PLANTS team, Hot Water( M
Trade Name - � i7 No 4� �9 '/6 / OAC
0
Capacity Sq. Ft. E.D.R,/' 0 44 — BTU H.P.
Total Connected Load - a a' U 6 Kind of Fuer ,
BURNER — Trade Name Size No
Capacity Sq. Ft. EM.R, BTU H.P.
(REMARKS -OVER)
. ar 42 2M 7-59
Application for Power Plants and Heating, Cooing, Ventilation, R Frigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL,
Furnace Shell & Duct Work ........................ 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $
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 $
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 $
OIC BURNER—to 3 gal. per hour ........................ 5.00 $
4 over 3 gal. per hour—See Fee Schedule
tl v
G�18 BURNER (up to 400,000 BTU) ....................... 5.00 $ \3
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU ........... x 2.00 $
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
ROUGH-
OUGH
FINAL—
FINAL
See Fee Schedule
TOTAL FEE $
Dept.
Dept. of Bldgs. Phone
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 aretrueand correct.
Owner''^
Kind of Building
Used as
To be completed about
Estimated Cost, $ a C�
-New. Building Permit No. Permit No.�/`�"�
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
Total Connected Load Kind of Fuel
BURNER —Trade Name Size No
Capacity Sq. Ft. E.D.R BTU H.P.
(REMARKS—OVER)
Signe y'
4- a z TM 7-59 Business Phone No (0,
City of Fridley
Appiication fcw Phunbing and Gas Fitting Porntit
Dept. of Bldgs. Phone SU 4-1
DESCRIPTION OF WORN ,� ?�
Number, Sind and Location of Fixtures Location
td
03
TOTAL
— x $1.50
$
Za
$
— x 1.00
F
— x 3.25
O4
Z
$
— x 3.25
W
6
Z
M
N
WATER HTR.
GAS
ELEC.ra
?�F
3F
on
a'Zo
t�x
a3W
Ud
U
UO
Base
1st
2nd
3rd
4th
Future Connection Openings
Connected with
New Fixture, Old Openings
I
Sewer El
Cesspool El
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
Number Fixtures ......................
Future Fixture Opening ................
New Fixture Old Opening ..............
r Catch Basin ............................
Water Heater (Up to 200,000 BTU) ......
New Ground Run Old Bldg . ............
NO. RATE
TOTAL
— x $1.50
$
— x 1.20
$
— x 1.00
$
— x 3.25
$
— x 2.00
$
— x 3.25
$
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $ i�
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Reefer to Code
Description ................................................$
TOTAL FEE $
City of Fridley:
P
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, 1Vlinn
Owner 19—
Used as
To be completed about a "�
v -
Estimated Cast, $
Old—New. Building Permit
11 POST l M-12-58
I
Bye
Business Phone
19
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
.RESIDZKTIAL
RATE
TOPAL
Job Address
Burners Shell plachmand,Duct Work,
Burner (Also saplac�ant furnace) $
20.00
$ .�
Building Inspection Div. 6431 University Ave NE Fridley MN 55432
Tel. No. 572-3604
Gas Piping $
10.00
$
(piping needed with now 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 applica ion are true and correct.
• Air Conditioning (all sizes) $
10.00
$ �U- Pb
All Others/Repairs and Alterations
10 of Value of Appliance or Work
$
e
KIND OF BUILDING -
COMMERCIAL/INDUSTRIAL
USED AS
10 of Value of Appliance or Work
$
TO BE COLLETED ABOUT���
ESTIMATED COST
State Surcharge
$ .50
NO. PERMIT NO.
`
OLD - NEW BUILDING PERMIT
TOTAL Fn
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 from adjoining neighbor.
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
-�X'rX�'d G a
41Adan
Trade Name e4� Size No. J
Capacity Sq. Ft. EDR STU HP
Total Connected Load ((1 ;� Kind of Fuel 111,67
BURNER - Trade Name
Bize No.
Capacity Sq. Ft. EDA BTU o HP
Company
Signed By
Tel. No. Ae
Fill out back side for stack verification on replacement furnaces
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the
existing chimney or stack;
1.
Has been carefully examined
Yes
(,) No ( )
2.
Is free from rust or deterioration
Yes
No ( )
3.
Has no foreign objects lodged within
Yes
No ( )
4.
Is securely supported
Yes
( No ( )
5. Meets all current Code requirements for size and
total BTU connected / Yes L-)' No ( )
6. Has Total heating BTU's of
All other BTU's
r�
TOTAL
Rema rk s
Company
Signed By
Date /,5/
SUBJECT
771—TRUF�_—
Cityof Fridley
20949'
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
�•
COMMUNITY DEVELOPMENT DIV.
_
PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV._.[DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
7/19/91
JOB ADDRESS 7179 Riverview Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
1
1
Mississippi View SHEET
DESCR.
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Ronald Pipes 7179 Riverview Terrace NE 571-6463
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.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling (19 Squares) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Lce and water shield must meet the State Building Code,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$9$8
$,50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$ 25.00
Fire SC $.99
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
KF
TOTAL FEE
.49
SIGNATURE OF CONTRACT�09 OR AUTHORIZED ENT IDATEI
WH PROPE Y V I TE T S S OU PERMIT
SIGNATURE OF OWNER IIF OWNER BUILDERI (DATEI
INSP r)TE
MW [ ] Effective 1,/1/91
A= [ ] I-1 AND R-2
ALMM [ ] Building Permit Application
Construction Address: '7 /7 f 9; V t p Y i eyy 7-,e r fru c -e / V. E,
r�� ��M •
I
owner Na®e & dd •
Address:
7179Rive;
af,gTeov vie
1
ew
rTel. # 6"2 6 3
W1- # 5' 7 /- G 416.3
Attach to this application, a Certificate of Survey of the
lot, with the proposed oorn-truction drawn an it to sole.
LTVM AREA: Length Width Height Sq. Ft.
tB1MM ARBA: Length Width Height Sq. Ft.
r F ' " AREA: Length //ss Width Hgt/Gramu:d Sq. Ft.
OMt: K / g a -u ay e s
Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard
Type of Construction: Estimated Coat: $
Approx. Ccepletion Date:
Proposed Driveway Width If New openirg Is Desired: Ft. $ $
Width + 6' See Hack Page
DAA: 7 0/1 APPLM,Prr: Teel. # 97 / G 5f6 1
Permit Fee
Fire Surcharge $ r—
State Surcharge $
SAC Qharge $
Driveway Escrow $
Park Fee $
Sewer Main Ct uW $
SI�ULATICHS:
1.
Pee Schedule an reverse Side
.001 x Permit Valuation (1/10th $)
$.50/$1,000 Valuation
$650 per SAC Unit
Alt. "A" or Alt. "B" Above
Flee Determined by;,+�r;,,g
Agreement Necessary [ ] Not Necessary [ ]
ti
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEOM
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential
Furnace Shell and Duct Work, Burner –
Aiso Replacement Furnace
(Side Vent – Fill Out Back)
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Conditioning – All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
Commercial/industrial
1.25% of Value of Appliance or Work
Effective On August 1, 1995
The undersigned hereby makes application for a permit for the work herein
Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and
rulings of the Building Division, and heFeby declares that all the facts and
$ 30.00 $ Qtmo. 4940 representations stated In this application are true and correct.
��-- ,1995
$ 10.00 $ o
OWNER
$ 10.00 $
BUILDING USED AS
$10.00 $
ESTIMATED COSTS ' PERMIT NO.
$ 25.00 $
DESCRIPTION OF FURNACE AND OR BURNER
$ No. of Heating Units / Circle One (Steam) (Hot Water) arm Air)
Trade Name AO—K7; -c, Size No.
BTU 6, HP EDR
$ Fuel 11Total Connected Load
State Surcharge $ .50 Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE S
HEATING COMPANY_
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.
Signed
U (14Z.1
Approved By Rough–In Date Final Date
FILL OUT BACK SIDE iOR STACK VERIFICATION ON
REPLACEMENT FURNACE
?ecy'-X4 TxoiJ Al �- �IASP(
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 ( )
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney
or stack:
1.
Has been carefully examined
Yes ()
No ( )
2.
Is free from rust or deterioration
Yes ()
No ( )
3.
Has no foreign objects lodged within
Yes ()
No { )
4.
Is securely supported
Yes ()
No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No ( )
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
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 ( )
Building
Inspections
763-572-3604
DATE
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PLUMING Permit No.
RESIDENTIAL APPLICATION Received By:
CITY OF FRIEDLEY Date Rec°dL
o YOUR E-?# A L ADDRESS
71 `7e-7 7 e<'V i(!v.3 Te�See., rV, E
0 OWNER KMNTRACTOR
NAME ® e.
ADDRESS: `71 `7 o'iQ `C'\Y o C� [' e-)6
STATE z>P SS��
PHONE:
NAMIs. Y ,
STATE LICENSER (�� �°ii EXP DATE a o
ADDRESS:J� Ce- 1 Avev\wL arY ®-'��ca STATE -_zip �(®
PHONE 7 .a 71"®!! 'rfAX 763"
1 PERMIT TYPE I *1' EFAMILY ❑ TWO FAMILY 0 TOWNHOUSE I
I TYPE OF WORK. I O NEW g(RE LA
DETAILED DESCRIPTION OF WORK
PER MS 16B.665 the permit fee is a minimum of 515.09 or 5% of the total cost up to $500.10, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor)
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 =
FOR PROJECTS WHERE LABOR EXCEEDS 55W, FEES ARE BASED ON $10.00 PER FDCPURE EXCEPT VnIERE NOTED. FI(TURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
—BATH SINK/LAV FLOOR DRAINS —SHOWER _ WATER PIPING
—BATHTUB —GAS PIPING (AM30CUMCENNj _ SWIM) M POOL —WATER SOFrNER ($35)
CLOTHES WASHER K]TCHEN SINK —WATER CLOSET _BACKFLOW PREY. ($15)
DISHWASHER _ LAUNDRY TRAYWATER HEATER (i3) FOR IRRIGATION
WATER METER
—OTHER
:Tnlit Fee. $ G-cj0 Number of fixtures @ $10.00 x $10-00 _
'urch a SO Number of fixtures @ $15.00 x $15.00 = $
AL DUE Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ 50
Total = $
TMS 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 odes of the City of Fridley and with the Mumesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work whi?q:= rjviland approval of plans. �q
SIGNATURE OF APPLICANT PRINT NAME 0 " DATE 1 4406
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
L-61
Building
BUILDING
See Back Page for Fee Schedule
an Review
Permit No.:
nspections
55% of Building Permit Fee
RESIDENTIAL APPLICATION
$
Received By:
763-572-3604CITY
re Surcharge
OF FRIDLEY
1.00
D 'A� �0•
i 3 o 6
$
'5.o o
ATE
YOUR E-MAIL ADDRESS
$
1TE ADDRESS -1(-ip t iy e i y'I 'l l "e ` rd "
arb Cut Escrow
$
ft + 6 ft = ft x $20 = $
'osion Control
$
'HIS APPLICANT IS:
❑ OWNER ❑eaNTRACTOR
trk Fee
$
2ROPERTY OWNER/
NAME: pn�
;wer Main Charge$
TENANT
ADDRESS: 1 (-7 Ct R 11f1 rlIIC w (I 1`
CITY rp/d/tv
STAT0^GIP-6-6 Y 32
Make checks payable to: City of Fridley Attach
PHONE:_ V 31 l l .-L—
Windows & Doors
odd
Q Reel P Jaw S
CONTRACTORPella
NAME._ 15300- 25th Avenue N.- Suite 100
5 %
i3 K S ' 4 6 �( 7
SUBMIT A COPY OF
STATE LIC
Plymouth, MN 55447
YQLJR STATE LICENSE
ADDRESS: 763/ 745-1400
crTY
STATE—ZIP—
WITH APPLICATION
WITH
PHOS
PROPERTY TYPE
BUNGLE License# 20165884
�E
❑ TWO FA.'
_ .DRIES
PERMIT TYPE
QADDITION ❑ GARAGE/SHED
G -WINDOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
84AA-INTENANCE/REPAIR ❑ REMODELING
>ESCRIBE WORK BEING DONE: �l W s1c1v r,�r re �1 r c� �.c
r n x r s n �i o�� �► I14 <
IZE OF Il�IPROVEMENT LENGTH
WIDTH
HEIGHT Sq. Ft.
OOFING
❑ HOUSE ONLY
UMBER OF SQUARES
O HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1.
Existing Floor Plan
_AR.AGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
ROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
20POSED HEIGHT:
MING
a
FOR NEW CONSTRUCTION INCLUDING DECKS,
I Vinyl
❑Soffit
ADDITIONS & PORCHES SUBMIT:
I Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
Other
❑ Fascia
and proposed project.
2.
Two sets of construction plans
'INDOWS
3.
Energy Calculations
T EXISTING OPENINGS Comes [No LOC�AI,TIO,Jq O SOWS
-4
V AA, /A
R FOR NEW OPENINGS -DESCRIBE SIZE OF R -c . Iii boom
q, a 1-4 Q
PENING CHANGES &
RE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S I, a 0 t3 OCCUPANCY TYPE_
-m-it Fee$
4 `1. ?
See Back Page for Fee Schedule
an Review
$
55% of Building Permit Fee
zrcharge
$
(41S o
(.0005) times the total job valuation — Minimum $.50
re Surcharge
$
1.00
.001 x Permit Valuation (1110%)
'cense Surcharge
$
'5.o o
$5.00 (State Licensed Residential Contractors)
4C Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
arb Cut Escrow
$
ft + 6 ft = ft x $20 = $
'osion Control
$
$450 Conservation Plan Review
trk Fee
$
Fee Determined by Engineering
;wer Main Charge$
Agreement necessary ( ) Non Necessary ( )
)tal Due
$
) g
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
rmit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
an in the case of all work which requires revievd ant approval of plans.
3NATURE OF APPLICANT !�� PRINT NAME f//T) '5 1 n DATE 713/1)(
Building
$
BUILDING
Ilan Review
$
Permit No. -0165
Inspections
$
RESIDENTIAL APPLICATION
ire Surcharge
Received BY'k
763-572-3604
.icense Surcharge
CITY OF FRIDLEY
D!&d:1t11 18
DATE�71 OYOUR�E}--MAIL ADDRESS ,�'
0 d I j f L U F ('
�ll `�0 I . C 0 m
SITE ADDRESS 7711
R _ (w r� V I 'L w / c rrtl t l�
:rosion Control
$
THIS APPLICANT IS:
13 OWNER CONTRACTOR
$
PROPERTY OWNER/
Nom;
'otal Due
TENANTADDRESS:
1l it L W i{
CITY Fri f h 1
STA _ZIP
PHONE:
CONTRACTOR
NAME'— The Home Depot A.H.S. Inc.
D a l
-fl-dor oiv J
SUBMIT A COPY OF
STATE LIC 3200 Cobb Galleria Pkwy.
17 S e l *all S- G N 7
YOUR STATE LICENSE
ADDRESS: Atlanta, GA 30339
CITY
STATE ZIP
WITH APPLICATION
PHONj: 763-542-8826
Two FA License #20268257
,oma
PROPERTY TYPE
PERMIT TYPE
❑ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF
❑ DRAIN TILE
❑ DECK d<SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
MAINTENANCEMEPAIR UWEMODELING !
A LA
DESCRIBE WORK BEING DONE: 9tSid DIA.t Re flOrsG
U Q
Jii
>IZE OF IMPROVEMENT LENGTH
WIDTH
HEIGHT Sq. Ft.
tOOFING
❑ HOUSE ONLY
4UMBER OF SQUARES
0 HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
JARAGES
13 ATTACHED GARAGE
I.
2.
Existing Floor Plan
Proposed floor plan
IROPOSED SIZE:
13 DETACHED GARAGE
3.
List of structural members to be used
IROPOSED HEIGHT:
UDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
I Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
7 Other
❑ Fascia
and proposed project.
h'INDOyYS
2.
Two sets of construction plans
❑
14 EXISTING OPENINGS ❑Yes No LOCATION OF WINDOWS
3.
Energy Calculations
)R FOR NEW OPENINGS -DESCRIBE SIZE OF
)PENING CHANGES &
-YPE OF WINDOW TO BE INSTAL ED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S 163 r i OCCUPANCY TYPE
'ermit Fee
$
Ilan Review
$
;urcharge
$
14.
ire Surcharge
.icense Surcharge
$
;AC Charge
$
:urb Cut Escrow
$
:rosion Control
$
'ark Fee
$
;ewer Main Charge
$
'otal Due
$
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1110%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
$+6fi= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks Davable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
onformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
ermit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
Ian in the case of all work=requirese and approval of plans. 6 y
IGNATURE OF APPLIC PRINT NAME 1 • J i .r i DATE(1-? U
:wilding
BUILDEIiG
Permit No.: n�
[Inspections
RESIDENTIAL APPLICATION
Received B
1
763-572-3604CITY
OF FRIDLEY
Dated: o
-)ATE I t 0 IS. YOUR E-MAIL ADDRESS __46
dl S ht f PJ
0 Af S.
31TE ADDRESS `i t -i a
I U (P U l t W 7--e P i6 c't
HIS APPLICANT IS:
❑ OWNER I?CONTRACTOR
?ROPERTY OWNER/
NAME: D n CL / i
TENANTADDRESS:
i Z K 1 V! P I / t✓ / ( `
CITY H I B
STATP) ZIP s�
PHONE: ? 63.( ,5Z ! -4Y43
CONTRACTOR
NAME:_ The Home Depot A.H.S. Inc.
SUBMIT A COPY OF
STATE LIc 3200 Cobb Galleria Pkwy.
YOUR STATE LICENSE
ADDRESS: Atlanta, GA 30339
CITY
STATE ZIP
WITH APPLICATION
PHONE 763-542-8826
❑ SINGLE License #20268257
❑ TWO FA
"E
.DRIES
PROPERTY TYPE
PERMIT TYPE
QADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH A�WOOF
❑ DRAIN TILE
❑ DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
YANCE/REPAIR ❑ REMODELING
)ESCRIBE WORK BEING DONE: W1- f 6 0 m but, j e/
Y r j !Il
In vI i '
IZE OF IMPROVEMENT LENGTH
WIDTH
HEIGHT Sq. Ft.
:OOFING ❑ HOUSE ONLY
T UbIBER OF SQUARES R a • 3 0 -HOUSE & GARAGE
BASEMENT REMODELING SUBMIT.
;ARAGES
❑ ATTACHED GARAGE
1.
2.
Existing Floor Plan
Proposed floor plan
ROPOSED SIZE:
El DETACHED GARAGE
3.
List of structural members to be used
ROPOSED HEIGHT:
FDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
I vinyl
❑Soffit
ADDITIONS & PORCHES SUBMIT:
7 Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
I Other
❑ Fascia
and proposed project.
2.
Two sets of construction plans
.1 INDOR'S
3.
Energy Calculations
d EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
R FOR NEW OPENINGS -DESCRIBE SIZE OF
,PENING CHANGES &
YPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USINGTHE 199 BWE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
ermit Fee $ See Back Page for Fee Schedule
Ian Review $ 65% of Building Permit Fee
urcharge $ ki - 5 (.0005) times the total job valuation —Minimum $.50
ire Surcharge $ .001 x Permit Valuation (1/10%)
icense Surcharge $ $5.00 (State Licensed Residential Contractors)
AC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
urb Cut Escrow $ ft + 6 ft = ft x $20 = $
rosion Control $ $450 Conservation Plan Review
ark Fee $ Fee Determined by Engineering
-wer Main Charge $ Agreement necessary ( ) Non Necessary ( )
otal Due $ Ct too Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
)nformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
:rmit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
.an in the case of all work which requires r w and approval of plans.
GNATURE OF APPLICANTI®> /rre!;� PRNTNAME -r m .J D k /
DATE