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PRE 2010 DOCSCity of Fridley SUBJECT , ®14270 AT THE TOP OF THE TWINS BUILDING PERMIT i R COMMUNITY DEVELOPMENT DIV. .9q-Al-3{ i PROTECTIVE INSPECTION SEC. 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 R14 '177 JOB ADDRESS 5212 St. Moritz Drive N.E. 1 LEGAL LOT NO. BLOCK TRA CT OR ADDITION SEE ATTACHED DESCR. 8 3 Innsbruck 2nd Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Kootenia Builders Inc. 1580 Rockstone Lane, New Brighton, Mn. 55112 922-5588 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. 6 USE OF BUILDING Residential 7 CLASS OF WORK �❑ X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 44' x 37' Dwelling and a 24' x 28' Garage SEPE 9 CHANGE QF USE FROM� �� WIRINq STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. If unstable or fill material is to be built on, soil borings and/or compaction tests may required. Provide truss design copy to City before capping. SEWER LOCATION: (Approx. 14' Deep in Street) 86' N.W. of Manhole (Inv. 975.51) WYE ELEV: 975.85 TOP OF FOOTING: 979.35 Minimum WATER LOCATION: Approx. 10' N.W. of Sewer Service SERVICES OFF TROLLHAGEN DRIVE DRIVEWAY DEPRESSION COST: N/A �� Teta Ca of IFINOW D= Not e�u� THE MOM dlog call local utilities ' ` ACCURACY o0 UTItPt1f LOG4'ftot�fS, AND RVATIONS. TELEPHONE - ELECTRIC - GAS Etc. THI$ DhiA Iii fOl WFOIt11AA'fi HI PURPOSES ONLY AND P ans uta °r� stfouid rE r IME. INFoLautT,oM Mli KOUIRE;D BY LAW ON i'HE .SITE, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 1646 + 780 34,576 Total 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. $62,800 $31.40 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 AN,IREGULATING CON- STRUCTION O T 'E P f?ORNC C �1STRUC �N. P $138.30 $375.00 PLAN CHECK FEE TOTAL FEE $579.28 58 SIGNATURE OF CO ACTOROR AUTHORIZED AGENT (DATE) W �RVALIDATED THIS IS YOUP PE MIT BLDG INSP DATE SIGNATUREOF OWNERIIF OWNER BUILDER) (DATE) T r, o oze Z4 010209 /.4/z DD-Ze y .9 R OEI d6�� Ll I Y UI t KIIJLLY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIOIN-J, OR REPAIRS) ( OMIL•'R: ®✓�' `oa „�e`i�C%,�F ' BUILDER: Hca✓e,�®� �j�i��'� �'�J� Address: No. i6,-2 t LOT: If Address: /i'` � !�'-��' d �%/ Z - Te 1. No.: - /o . YZ Z - -� Street: /i ► /^ BLOCK: 3 ADDITION: ✓� g'�/�� "® A- a,-71 i j CORNER LOT: INSIDE LOT: SETBACK: -1-5 SIDEYARDS: Applicant attach 'to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To B Used As: 4444t11-1 Front: /Depth: Height: cahl Square Feet: ✓ Cubic Feet: 69� Front: - Depth: Height: Square Feet: o�O' % Cubic Feet: e- Type of Construction: Estimated Cost: To Be Completed: /Z Alt. �A/-/Alt Proposed Driveway Width If New Opening Is $ $ A (SEE REVERSE SIDE OF SHEET) 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. See reverse side for additional information. SIGNATURE: Q Stipulations: els PU 0?j Q A CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE N PLUMBING FIXTURE RATES: NO. > m TOTAL Number Fixtures o $3.00 $ (�(� d Water $2.00 d New Fixture, Old Opening x $2.00 E-1 � e Q m ro H pa, k' IHeater $5.00. $ 5 -CO -rel W b $10.00 $ m 1 41 $7.00 14 C C ' 4J FC O Electric Water Heater x $5.00 $ o 1st 3 fixtures -1 0 8 $•QV W x $1.00 $ Gas Range to 199,000 BTU mro v $ W c� vii S a w W w U ca 3 $ each add. $100.00 or fraction c� o as lec State Surcharge $ .50 TOTAL FEE $ 4J 'I. SZ 1 1' 1 1 1 1 1st 2 1 1 2 1 1 1 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 $ (�(� Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00. $ 5 -CO 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES; 1st 3 fixtures f x $3.00 $•QV Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS & ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ 4J 'I. SZ REINSPECTION FEF, ($10.00) I-- - -- -1 Job Address 5212 St. Moritz Dr. Department of Buildings City of Fridley Tel. #571-3450 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. Sept. 8, , 19 77 OWNER Kootenia Builders RIND OF BUILDING Single family - residence USED AS residence TO BE COMPLETED ABOUT 9-21-77 ESTIMATED COST 1,500.00 /7 e OLD - NEW BUILDING PERMIT NO. PERMIT NO. ROUGH INSP. Date spay Richfield Plumbing Company Signed By Tel. No. 869-7517 FINAL INSP. / / - /j`' % 7 Date APPROVAL FOR PERMIT i MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE. b GRAVITY WARM AIR: RATE TOTAL Job Address Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Department of Buildings Repairs & Alterations each add. $500.00 4.00 $ City of Fridley Tel. #571-3450 MECHANICAL WARM AIR: The undersigned hereby makes application for a permit for the work herein Furnace Shell & Duct Work to 100,000 BTU $12.00 $ specified agreeing to do all work in strict accordance with the City Codes c. each add. 50,000 BTU 4.00 $ f9s and rulings of the Department of Buildings, and hereby declares that all the Replacement of Furnace 7.00 $ facts and representations stated in this application are true and correct. Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ Fridley, Minn. STEAM OR HOT WATER SYSTEM: OWNER a i2 LLL'LL'' dd Boiler & Lines up to 100,000 BTU $12.00 $ KIND OF BUILDINGf,:�/;r �._. each addn. 50,000 BTU 4.00 $ y Boiler only up to 100,000 BTU 7.00 $ USED AS /�!✓,rz' each addn. 50,000 BTU 6.00 $ TO BE COMPLETED ABOUT ` - OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ JJ ESTIMATED COST GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ / r -, OLD -(� M BUILDING PERMIT NO. PERMIT NO. V (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures X $ 3.00 $ DESCRIPTION OF FURNACE/BURNER Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ HEATING or PO PLANTS, Steam, ,Hot Water, WaZm No. `AIR CONDITIONINGfl2/ FAT3EATING SYSTEDIS $-- Trade Name ,�. �; Size No.-� See Fee Schedule VENTILATING SYSTEMS''a ALTERATIONS $ REPAIRS $ Capacity Sq. Ft. EDR BTU;%:aa.,.' HP State Surcharge a hang $ .50 _ Total Connected Load ✓�,� Kind of Fuel A d �r mil s �- TOTAL FEE $ BURNER - Trade Name `�, ✓ - -< -� ` Size No. �n ROUGH INSP. REINSPECTION FEE Capacity Sq. Ft. EDR BTU. �' HP Date ($10.00) - a - -, Company FINAL INSP.� Date ��L` `— �F,r y-Ja Signed By �e 46 Mr ®� APPROVAL FOR PERMIT Tel. No. �9 �.,��'�� ® MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE r -- SUBJECT PE City of Fridley ,r AT THE TOP OF THE TWINS BUILDING P E R M I T� 23821 . O Ir? I � • ______ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. l e NUMBER REV DATE POF AGE APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/18/95 JOB ADDRESS 5212 St Moritz NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 8 3 1 Innsbruck .2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO, Top Gun Roofing 5014 Parish Ave NE Rodgers, MN 428-4559 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 Z REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Reroof House & Garage (33 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. 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 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 $2640 $1.32 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 PRO VI OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $74.75 Fire SC $2.64 STRU TION O TH PE ORM CE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE LZIx..'e'�— C1&-e1w9,e SC $5.00 $83.71 — 9IGNATURE0FCONTRACTORORAUTHORIZEDAGENT IDATEI W N PROPERLY VALID ED THIS IS YOUR PERMIT/ C� _ SIGNATURE OF OWNER of OWNER BUILOERI (DATEI BLDG INSP F)A r -- NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Addra Legal Description: Owner Name & Address: " Effective 8/1/95 ,?q I Contractor: Address: .S® I Y Tel. # l-,�� MN LICENSE #33 R&:" Attach to this application, a Certificate of Survey of the lot,, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height DECK AREA: Len Width Hgt/Ground OTHER:` (� c Tel.# �15,5- '? Sq. Ft. Sq. Ft. Sq. Ft. Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: �° Ce�� `rem Estimated Cost: $ Approx. Completion Date: /b — 72 (Cost on Back) Driveway Curb Cut Width Needed:. + 6 Ft — t x $ _ $ DATE: 96�APPLICANT: Tel. # 5 29— Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control :Park Fee Sewer Main Charge TOTAL STIPULATIONS: 4 $ 83j °7 f CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $850 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 [ ] ey CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1,. 1998 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 / Z 7- RATE RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 30.00 $ representations stated in this application are true and corre (Side Vent — Fill Out Back) // 3Q ,1998 Gas Piping (Needed with new furnace) $10.00 $ S` OWNER., Gas Range $10.00 $ BUILDING USED AS Gas Dryer $10.00 $ / ESTIMATED COST / � PERMIT NO. *AirConditi ning —All Sizes $ 25.00 $ ,k)d LF 1DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON CK)� 1 % of Value of Appliance or Work $ No. of Heating U its Circle One (Steam) (Hot Water arm Trade Name /r 6 L-0 v'/ Size No. Commercial/Industrial BTU �30,00-0 HP EDR 1.25% of Value of Appliance or Work $ Fuel � f) Total Connected Load State Surcharge $ 50 Burner Trade Name Size No. TOTAL FEE $BTU HP EDR S • � � HEATING COMPANY PAI (p d+°'TL f MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By No. PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved By Rough—In Date Final Date)_446 *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE 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 CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: No 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 ( ) NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER jX] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address L'26(/ea( Ot Y ) Ur -fl Z— 01 ', V C $ 1-"ff1Q 11.( 1 e L�1 , "?`� W=/ Legal Description: r I Owner Name& Address: Tel. # Contractor r 1 I , P� - MN LICENSE # Address: d qb I 13d �L ° • L Scuk r�1 , 1 � �1 n"WAXES _�3V Tel. # 903' Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK;AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 0 Construction Type: " ZEC Estimated Cost: Driveway Curb Cut Width Needed: F + Ft = Ft x $ _ $ DATE: d �� _ APPLICAN Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ Plan Review $ Fire Surcharge $ State Surcharge $ SAC Charge $ License Surcharge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] STIPULATIONS: Building $ BUILDING Permit No.: r Inspectibns $ RESIDENTIAL APPLICATION Received By: 763=�72-3604 $ q. q / .001 times the total job valuation Surcharge $ CITY OF FRIDLEY Date Rec'd: License Surcharge $ S -0(.-, $5.00 (State Licensed Residential Contractors) DATE YOUR E-MAIL ADDRESS SITE ADDRESS 52-1 2- 529Wa'g- i 72- rX'r b e f e THIS APPLICANT IS: ❑ OWNER q#GNTRACTOR PROPERTY OWNER/ NAME: 6+XLl TENANT ADDRESS: 52 0 T b'bTci-z- CITY a b z STATEM"ZIP $ PHONE:��IP— CONTRACTOR NAME: �01 SUBMIT A COPY OF STATE LICENSE # �' I� D EXP DATE S -'31- b YOUR STATE LICENSE ADDRESS: �d C��z'� �=� �'ia CITY STATE�°ZIP / 9 -f WITH APPLICATTON PHONE FAX AV -1a V4/- ® 7®I PROPERTY TYPE gtINGLE FAMILY/NEW CONSTRUCTION SIZE $ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE `;DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION WLTgENANCEIREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: /Ijb �� ' R**44 SIZE OF IMPROVEMENT /19 LENGTH / WIDTH ��' e" HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELINU SUBMFE GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2• Proposed floor plan 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, « ❑ Vinyl ❑Soffit ' ADDITIONS, & PORCHES SUBMIT: ❑ Aluminum ❑ Other ❑ Trim C:, ; p. 1. Site Plan/Survey showing the existing structures ❑ Fascia \ and proposed project. WINDOWS ` 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations 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: (USIlvr_ SMV •t�ao�_rr B,C FEE SCHEDULE) TOTAL JOB VALUATION $ tj'i L ,4 _ OCCUPANCY TYPE Permit Fee $ / / J . ,� g See Back Page for Fee Schedule Plan Review $ '79, 3 65% of Building Permit Fee Fire Surcharge $ q. q / .001 times the total job valuation Surcharge $ 'P.2 f .0005 x Permit Valuation Minimum $.50 License Surcharge $ S -0(.-, $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 $ � l 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 Oermit 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 whic equires review and approval of plans. SIGNATURE OF APPLIC PRINT NAME �� s� �m a DATE 1,5-2 7^ FROM :City of Fridley FAX NO. :7635711287 Jun. e6 2007 04:26PM P2 permit No.�. Building PLUMBING Inspections Received By: RESIDENTIAL APPLICATION Rece ' J U 763-572-3604 CITY OF FRIDLEY cg5c_ -Com DATE YOUR E (pDRESSIT P. AUD S9 _ ¢ TIM APPLICANT IS; �...Mtn DTRAt rO PROPERTY O%WIEW ISAME7 1,10 A RWS:r. � e ' CITY .. TATB— TENANT G C(.lNTRACTOR I 1AME: 10�; .�® ® 7 VYIMMIT A COPY OF TATE LICENSR -1-� EXP DAfE "- STATE_Al.1P ®1 / — YOUR STATL* LICENSE VYn 19 DRESS; -, ]]ONE -7�o �, ~,•� �(G S� FAX i`v� . — Appl_]CATION PERMIT TYPE Swan FAMILY O TWO FAMILY 0 ,TOWNHOUSE TYPE OF WORK: NEW O REKAC;EMENT DETAILED DESCRUM3N OF WORK ' PER MS 16B.66S the i[ fee Is a minimum of $15.00 or 5% of the total eost up to 5500.00, whichever is greater, for the improvemem, installs ' or replacement of a residential fixture, excluding the fixtures. (This should reflect Only the cost of labor ) Labor cost under $300 = 915,00. Labor cost between $300 to $500 =cog of labor _ x .05 _.. FOR PRO.IRCTS WHERE LA R EXCEEDS SS00, FEES ARE BASED ON $10.00 PER FIXnAM EXCEPT W"FRE NOTED. FIXTURES: (INDICATETOTAL, NUMBER OF fLACH BELOW,, WATER PIPING _ RATH S1NYJLAV _> LOOR [RAINS SHOWER - WATER SOFTNER ($35) BAq}F(Ug —GAS PIPING INWjC ' LM -MM) — SWIMMING PWL RACKFLOW PREY. (SIS) �C:I.(YPMWASHER —KITCHEN SINK —_1�+ATLRCLt)SET �fORIFLOW HUN DI3FIWASHUX LAUNORY TRAY WATER HEATER ($3i) WATER MM -K — OTHER ON Permit Fee Number Of fixturag @ $10.00 —X $10.00 Surcharge ,50 Ndmber of fixtures @ $15.00 x $15.00 TOTAL DM $ A IS ...4. 'Number of fixtures @a $35.00 ,,.__ x $35.00 $_ State Surcharge = $ Total = $ THIS 15 AN APPLICATION FOR A PERMIT -NOT VA01) UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and aeel'We; that the work will he in conformance with the or linances and codes of the City of Fridley and with the Minnesota Construction Codes; that 1 understand this is not a permit but only an application for a permit and work is not to start with(nd a permit; that the work -will he in accordance with the approved plan in the cam I WOrN w h re5uirps review and approval. of plans. s� SIGNATURY, OP APPLI__. _ City of Fridley Building Inspections Department 6431 University Avenue NF, Fridley, ASN 55432 7663-572-3644 FAX: 763-502-4977 PPP,OVED By i iLCTf1c,:A:HTC,1L.--'VARIL !)A . i' dle--r 3 --hiding I18LPecr UI3.S _:JR:'„3.a -ment .1� I �;liver�i�� .-.�,�eaue ..rL-.-ridle�� ::�ii'•f ::--._ lIlSU00Zi011SRE S 1 DENTLL ,, _L2PL.IC A "I10IN ' Received 31. 63-5 i_-31604 0:1F Try .q- _ am 76�-HOZ-=!� % , a F y EFFEC= 1-1 18 �qj DATE � ?7� � I ., YOURE-MAILADDRESS SITE ADDRESS W j THIS APPLICANT IS: Q OWNED.CONTRACTOR FROP=Z NAME: OV'rNIbI ADDRESS: 5,7,17 Y+, 'noYI `! f 7- YiY CITEj � STATEMZIP Es_ TE SMV PHONE: Til- 511- n 19' CONTRACTOR NAME: (Lyfi �i-+ Pf SUBMIT A COPY OF YOUR STATE STATE LICENSE # I MP DATE _ I' LICENSE- BOND AND STATE BOND # L:{P DATE- CERTIFICATE OF ADDRESS: %i PZ' !I. S�' iG?�Gl CITY r Affpq STATE ZIP INSURANCE PHONE I 7' 54' FAX ' 1,5 s G 01 I'LI,RMIT TYPE SINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: ❑NEW Nf1�tEPLACEIYIEAIT DETAILED DESCRIPTION OF WORD %1 -Vj��i{' h � PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to 5500.00, 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 5300 to 5500 = cost of labor X.05 = 'plus -50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS S500, =ARE BASED ON SI 0.00 Pmuna U M EXCEPT WH au NOTED. FIXTURES: (DTDICATE TO;XAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. _BATH SIINTK/LAV IFLOORDRAINS SHOWER WATERPIPING Q —' BATHTUB _ GAS PIPING (NEED CITY LIC) SWDAMI ATG POOL _ WATER SGFTNER (S35) CLOTHES WASHER KITCHEN SINK WATER CLOSET—BACEnOW PREV. (515) _ _DISHWASHER LAUNDRY TRAY TWAMMEEATER (53.5) FOA IRRIGATION _ _ WATER METER _ OTHER 5� PermitFee S Number of fixtures @ $10.00 x $10.00 - S Surcharge .50 Number of f xtures @ $15.00 x $15.00 = S OR Number of fixtures @ $35.00 x $35.00 - S- TOTAL DUE $ State Surcharge = $ 50 (MINIMUM $15.50) (MINIMUM 515.30) Total = $ —T&113— THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 N not a permit but only an application for a permit and work is not to start without a permit on site: that the work hill be in accordance with the approved pian in the case of all work which requires review and approvalof plans. Ca t SIGINATURL' OF APPLIC ANT /(/!!' lam" /L� PRII11fT i FAME. Mal— al— _"'P&- DATE Je I01JJq PPP,OVED By i iLCTf1c,:A:HTC,1L.--'VARIL !)A . i' dle--r 3 --hiding I18LPecr UI3.S _:JR:'„3.a -ment .1� I �;liver�i�� .-.�,�eaue ..rL-.-ridle�� ::�ii'•f ::--._