PRE 2010 DOCS,9� ® /1
City ®f Fridley, Nffi m..
(a PERMIT N® 7112
Bate: -- 'p, , /' V /-n
Owner: Builder —
Address Address
JOPT N PF BUILDING
No. JtvStreet a t Part of Lot
Lot _ _ _ ___ Block -S� Addition or Sub -Division
a
Corner Lot . _ Inside Lot Setback _ _ Sideyard
Sewer Elevation ----F6mmR29ftk, Elevation0, 17
tOl' 17F PJ'OT /46
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 t f � and i 7p nee with all provisions of
ordinances of the city of Fridley.
!;
In consideration of the payment of a fee of IT I � , permit is hereby granted to
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon of any of the provisions of said
ordinances. j—, s�
Building Inspector
NOTICE:
'fhb Permit does not gem the eensfruetion, butallstien for Whieg, plumbing, on heating, sewer or water. Be sura to see
the Building Inspector for separafo permits for Asm hems.
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
B
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Location
PARTIAL RATE SCHEDULE
PLUMBING FTZTUnE RATES: NO. RATE TOTAL
Number Fixtures ............... x $1.50 6�
Future Fixture Opening ................ x 1.20 $�,
New Fixture Old Opening .............. x 1.00 $
Catch Basin .... x 3.25 $
Water Heater (Up to 200,000 BTU) ...... x 2.00 $ -
New Ground Run Old Bldg. ............ x 3.25 $
GAS FITTING FEES:
1st 3 Fixtures .........................
Additional Fixtures ....................
Gas flange to 200,000 BTU ..............
REPAIRS & ALTERATIONS—Refer to Code
NO. RATE TOTAL
X $1.50 $
x .50 $
— x 2.00 $
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, Minn — , is
Owner X_"-1��fd�
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old ew. uilding Permit
ROUGH
FINAL
0O
F
N
WATER HTR.
GAS
ELEG
Base
01�
d
e
1st
2nd
3rd
4th
• Future Connection Openings
New Fixture, Old Openings I
Connected with
Sealer
Cesspool Ej
PARTIAL RATE SCHEDULE
PLUMBING FTZTUnE RATES: NO. RATE TOTAL
Number Fixtures ............... x $1.50 6�
Future Fixture Opening ................ x 1.20 $�,
New Fixture Old Opening .............. x 1.00 $
Catch Basin .... x 3.25 $
Water Heater (Up to 200,000 BTU) ...... x 2.00 $ -
New Ground Run Old Bldg. ............ x 3.25 $
GAS FITTING FEES:
1st 3 Fixtures .........................
Additional Fixtures ....................
Gas flange to 200,000 BTU ..............
REPAIRS & ALTERATIONS—Refer to Code
NO. RATE TOTAL
X $1.50 $
x .50 $
— x 2.00 $
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, Minn — , is
Owner X_"-1��fd�
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old ew. uilding Permit
ROUGH
FINAL
3uilding
$
BUILDING
Plan Review
Permit No.: t�
inspections
Fire Surcharge
RESIDENTIAL APPLICATION
.001 times the total job valuation
Received By:
763-572-3604
.0005 x Permit Valuation Minimum $.50
CITY OF FRIDLEY
$
Date Rec'd:
SAC Charge
$
$1550 per SAC Unit (Plans to MWCC for determination)
)ATE —
YOUR E-MAIL A DRESS
ft + 6 ft = ft x $21= $
'ITE ADDRESS
C
!
$450 Conservation Plan Review
[HIS APPLICANT IS:
A OWNER ❑CONTRACTOR
Fee Determined by Engineering
PROPERTY OWNER/
NAME: t- re
Agreement necessary ( ) Non Necessary ( )
TENANT
ADDRESS:� CITY D
>` STAi;��911`
PHONE:
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
INGLE FAMILY/NEW CONSTRUCTION SIZE
EJ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGEISHED WINDOWS
❑ BASEMENT FINISH ❑ ROOF DRAIN TILE
❑ DECK ❑ SIDING OTHER
❑ SWIMMING POOL ,41e -w
e `
TYPE OF WORK:
❑ NEW ❑ ADDITION
MAINTENANCEI MPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: e v
i
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT S . Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
I.
2.
Existing Floor Plan
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
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
IN EXISTING OPENINGS J�YYes ON, LOCATION OF WS /
3.
Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED-kVtl % 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 $ 1,? 00 ° cam— OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$ Q
.001 times the total job valuation
Surcharge
$ &0
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21= $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ 4(
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 it 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 w ' h quires ev' wand approval of plans. �^
SIGNATURE OF APPLICANT PRINT NAME i' DATEy r
.fAlla�
C11YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
®S 0 � . understmri that tha Rtato of hAinnoc^f^
requires that all residential building contractors, remodelers and roofers obtain a state
license unless they qualify for a specificcem tion from the licensing requirements. As
the owner of the ' property at �,` t- G / ,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 the work being
performed on this property.
Name
Date F - d 1-/ - 0 6
Building
BUILDING
Permit Fee
Permit No.: 6q
Inspections
Plan Review
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$
CITY OF FRIDLEY
Date
763-502-4977 FAX
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
EFFECTIVE 8-19-09
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
DATE 16 - 6 - 01
YOUR E-MAIL ADDRESS
r
SITE ADDRESS r %'� W15
$450 Conservation Plan Review
THIS APPLICANT IS:
❑ OWNER 1rONTRACTOR
Fee Determined by Engineering
PROPERTY OWNER/
NAME: qftAjz—
Agreement necessary ( ) Non Necessary ( )
TENANT
ADDRESS: 8121 tP W
CITY Fria l STATE MA)ZIP 5993 2 -
PHONE:
CONTRACTOR
NAME: M_
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE #
EXP DATE
AND CERTIFICATE OF
ADDRESS: 1AA& 4�Gi� L �V
,
CITY T ,pLi%W ,yk STATE mft✓ZIP S3�
INSURANCE
PHONE 743 ` 7S'8 -6013
FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION
SIZE
❑ TWO FAMILY/NEW CONSTRUCTION
STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
❑ WINDOWS
❑ BASEMENT FINISH OF
❑ DRAIN TILE
13 DECK ❑ SIDING
❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING HOUSE ONLY
NUMBER OF SQUARES 04r XOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES
ftATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
11 Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑Trim
I. 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:
(USING THE 1997 U.B.0 FEE SCHEDULE)
lU1ALJUS VALUAIIUIV
UUUUYANUY 1 Yrh
Permit Fee
$ Z lzC�
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $22 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ IC Q,,CJ
Make checks payable to: City of Fridley Attach Stimulations
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 hich requires review and approval of plans. 1 �,- - 1 !'
SIGNATURE OF APPLICANT PRINT NAME I vL.I JVD DATE