PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: ...5—:7. a.. i...........
Address......................................
N® 3898
Builder .. I
Address .......... . ..........................
6 t v.? LOCATION OF BUILDING
No. ./...� .. //Street . ...i®1V .................. Part -o Lot ...... , .p /................. .
Afs� i/tz-
j,3�I,u,%7Block ..... ........... Addition or Sub -Di .... .,0 446 .............. .
Lot ............ Inside Lot ............ Setback ........... Sideyard ...........................
DESCRIPTION OF BUILDING
To be Used
/
pp i1 ( ti
. .. .... Front If " Depth . �. 9 - Height /C�.' � Sq. Ft. /. ��� cu. Ft'?/. .7
.................... Front ........• .Depth ........ H% . Sq. Ft. ........ Cu. Ft. ........
Type of Construction ................ Fst. Cost.AV k':..... To be Completed ..............:....
In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set forth and in com Bance with all provisions of
ordinances of the city of Fridley.
40V 16�
In consideration of the payment of a fee of $J? ...... 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 with-
in the city limits and this permit may be revoked at any timeu on violation of any of the provisions of said
ordinances. .7
..., . Building Inspector
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector..jor separate permits for these Items.
I;
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
rb�
Owners Nam` ` Builder
Address ��om — �- ?� Address _
_.
N
ON. OF BUILDING
N S rest :.._ Part of Lot
f `. L of Bloc A it n or Sub 'v.
Lot Set Back
elf" 4411
Applicant attach to this �rmcertificate*of Survey of Lot and proposed:.,
building location.
DESCRIPTION OF BUILDING
To be V66d: a6
.� F -Front Depth i ` ,Height
Sq. Ft..� 8Cu. Ft.-:21
Front Depth Height -
Sq. Ft. Cum. Ft.
Type of Construction ! Estimated.Cos6"
To be completed 9S�
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,..:..
Date Signature
(A Schedule of Fee Costs can be found on the vers e)
Application for Power Plants and Heating, Coaling., Ventilation, Refrigeration and �
Air Conditioning SystenEs and Devices ..r
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. IDR Hot Water ... 8.00
Each add. 200 sq. ft. IDR Steam ...................... 2.50
Each add. 320 sq. ft. IDR 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 $ 1®. 0 e3
GAS PIPING (Up to 3 Fixtures) .........
................. 1.50 $
(Add 50c each over 3)
AIR CONDITIONING
FAN HEATING SYSTEM
VENTILATING SYSTEM
ALTERATIONS & REPAIRS
RL74 RKS:
See Fee Schedule $
TOTAL FEE $
Dept. of Bldgs. Phone SII 4-7470
--2 P A_AC)
City of Fridley:
L
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 aA true and correct.
Fridly, ' 195
Owner 195—
Kind of Building 195—
Used as
To be completed about
Estimated
Cost, $
Old. New luildina Permit No.
DESCRIPTION OF WORK
HEATING or WER PLANTS --S Hot Wate , Warm Air—No. 19 ,
Trade Nam ize No AG
Capacity Sq. Ft. EM.R � QBTU H.P.
Total Connected Load - o Kind of Fue
BURNER — Trade Name Size No
Capacity Sq. Ft. E.D.R. BTU H.P.
RAY N.WELTER" HEATING of
sign
463'1'" CHICAGO AVE.
By MoNNE7®cnLIS '�. MIp4p.4r=5t5=x7%
No,
11 POST i M-8-58 Business Phone � ���
MVillage of Bloomington
LOSS CAL O0S DPTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows I Doors Reference Out: Wall Int. Wall Ceiling Roof Floor Kind How Applied
e—,No Y=# 19.-
1 : L Room I Length " Width Height Fl.j " , ooraI Length Width iW, Height s,
Windowsand:Doois—Crackage' and Area
Width
Height
No. of Lineal ft.
Area
No. of pane
of pane'
lights of crack
sq. ft.
Coef.1
Btu
Infiltration
r.
Glass
Exp. wall
Coef.l Btu
Infiltration
Glass
Facp. wall
Net exp. wall
Int. wall M.
Ceiling 0--i x 77
}
Floor44.
.;,
Total Btu.
Required sq. ft. E.D.R: or sq. ins. W.A. leader area,
Fl.l ' r `Room I Lenatk A00' Widthfig" ' 'Heistht . ,
IY Windows and Doors—Crackage and Area
Width Height No. of
Width Height No. of Lineal ft. Area
No. of pane of pane lights 'of crack eq, ft.
AVII
of pefte
lights
of crack sq. ft.
Coef.1
Btu
Infiltration
r.
Glass
Exp. wall
Net exp. wall
{'=
Int. wall
0
r`a�
Ceiling.`
,
Floor
'
Win ows"-nd Doors'-Crackage and Area
Width Height No. of
Width Height'' No. ofLineal ft. Area
No. of pane of pane lights of crack sq. ft.
AVII
of pefte
lights
of crack sq. ft.
Coef•
Btu
Infiltration
r.
Glass:
Exp. wall ",
Infiltration
Net exp. wall
0
r`a�
Int. wall
Exp. wall
Ceiling
'
Floor
Total Btu.'*_WV
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl.l Room I Lenath a Width , ,� '`' Heistht
Windows and ' Dors--Crackage and Area
Width Height No. of
Lineal ft. Area
No. of pane
of pefte
lights
of crack sq. ft.
Coef. Btu
Infiltration
tl- 4
Glass
Exp. wall
'
Net exp. wall'
Int. wall
Ceiling
�' F .�
"Al"Al `
Floor,
-
Total Btu. Total Btu.. w
Required sq. it. E.D.R. or sq. ins. W.A. Leader area Required sq._. ft. E.D.R.: or sq. ins. W.A. Leader area
Fl Room I Length Width JAf Height F1.1Room I Length Width Height
Win8ows a d Doors-Crackage and Area ' Windows and `Doors-Crackage and Area
Width Height No. of Lineal ft. Area Width Haight No. of Lineal It. Area
No. of pane of Dane lfg, is of crack sq. ft• No. of pane of pane lights of erack eq. ft.
z' t N
Coef. Btu Coef. Btu
InfiltrationInfiltration
Glass
Exp. wall
}
Net exp. wall
Int. wall
Ceiling �4f .
Floor
Total Btu.
wired sq. ft. E.D.R. or sq. ins. W.A. Leader area
'' Glass
City of Fridley
Application for Plumbing and Gas Fitting Permit
Dept. of Bldgs. Phone SO 4-7
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures Location
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE �TOTAL
Number Fixtures ...................... x $1.5o $
Future Fixture Opening ................ x 1.20 $ e
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x 3.25
Water Heater (Up to 200,000 BTU) ......gf-- x 2.00 ' 0-0
New Ground Run Old Bldg . ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $ 5
Additional Fixtures .................... x .5o
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description................................................ $ ,�`'
TOTAL FEE $�
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 e and correct.
'j �Sgey, .n. 4"//// s s 190
To be completed about _
Estimated Cost,
Business Phone
19
18—
Connection Permit No . .......................................................
3 a V59 Rough Water
Sewer
11 IM -8-58
Meter Deposit
m
N
Z
z
Sa
WATER HTR.
0
3�i
=
m
y
3�
o�
u'�
S�
¢3
�g
�Gn4
�O
F
N
GAS
ELEG
Base
12-1
1st
7—
2,
2nd
3rd
4th
Future Connection Openings
Connected With
New Fixture, Old Openings
Sewer
Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE �TOTAL
Number Fixtures ...................... x $1.5o $
Future Fixture Opening ................ x 1.20 $ e
New Fixture Old Opening .............. x 1.00 $
Catch Basin ............................ x 3.25
Water Heater (Up to 200,000 BTU) ......gf-- x 2.00 ' 0-0
New Ground Run Old Bldg . ............ x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL
1st 3 Fixtures .......................... x $1.50 $ 5
Additional Fixtures .................... x .5o
Gas Range to 200,000 BTU .............. x 2.00 $
REPAIRS & ALTERATIONS—Refer to Code
Description................................................ $ ,�`'
TOTAL FEE $�
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 e and correct.
'j �Sgey, .n. 4"//// s s 190
To be completed about _
Estimated Cost,
Business Phone
19
18—
Connection Permit No . .......................................................
3 a V59 Rough Water
Sewer
11 IM -8-58
Meter Deposit
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On May 10, 1999
MARK NUMBER OF FIXTURES TC2
BE INSTALLED
ON EACH FLOOR
Wa
Urinal
I�
Wash.
: •: vri ::-: iii.:: :..•
�iFY•'.
`I'' ==:..
: Shower
'.:fiiJij ::i
i ::
tiv:;::::::.
::: •.y......._:....::y.
:Drain
Floor
I
��..............
I
---------------------
Auto. Gas
Washer ' Range
f<`-����{. Water Heater
Stories
i"'-' i':•; f2t;:?:>'
:
::...
:_>::•:
,:>..:_.- Gas
Bas emen t
.11-111
Floor 1
Floor 2.
F r
loo 3
Floor 4
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
Water Heater - Gas**
NO. RATE
I
Gas Range**
Gas Dryer**
Back Flow Preventer Required ( )Yes () No
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
Type $15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
TOTAL JOB ADDRESS zj:.—> fJUul J157Z 6eG4jJ
s20.50
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
LINDBERG, VERNON
Owner_ 6140 STAR LANE
FRIDLEY, MN 55432
Building
Estimated Cost TV PERMIT NO. 7 L�
PLUMBING COMPANY LIQ�1J��i
SIGNED BY a&G' TEL N0&2 U T / 3�
Approved By Rough -In Date Final Date c' ao2 CSD
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
I /'
-t4-
Effective 1/1/04
CITY OF FRIDLEY MOVING [ ] WRECKING [ ] PERMIT APPLICATION
6431 University Ave NE
Fridley MN 55432
(763)572-3604 FAX (763)571-1287
Job Address: 61'-16 ',3—FAA— LAME
Legal Description: Dl-dck- / L® r 0yy- 75-
Owner
'sOwner & Address: 7�Sd J►,e V- UC -T, ®1J Tel. #
Contractor: _+lG-l10dr Kit, �u tt� 2S" Tel. #
Address : (Y/41F� &i VCaL1j ST �� Uftf 553dYState License # OP -Fib—'
DESCRIPTION OF BUILDING :�>-r06 'F4)4,6D
HOUSE: Length Width Height Sq. Ft. Cu. Ft.
GARAGE: Length 2._ Width 3-2, Height Sq. Ft. Cu. Ft.
OTHER: Length Width Height Sq. Ft. Cu. Ft.
Estimated Cost $ S;7noC?) Approx. Completion Date
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CALL ALL
UTILITIES FOR DISCONNECTS BEFORE WRECKING MOVING STRUCTURE.
Water Bill Paid: Yes [ ] or Collect [$
Moving Route:
] Signature
The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to
do all work in strict accordance with the City Ordinances and rulings of the Building Division, and the State
Code which requires any water well on the property to be sealed by a State licensed water well driller, and
hereby declares that all facts and representations stated in this application are true and correct. ALL
DEMOLITON DEBRIS, INCLUDING FOUNDATION & SLAB, SHALL BE REMOVED FROM SITE.
Z —v -;> ,-
Date Signature
Moving Wrec °
Principle building into Fridley .... $300.00 For each 1,000 cubic feet or fraction...... $1.25
Accessory building into Fridley ... $ 42.00 For structures which would be impractical to
Through or within the City ...... $ 20.00 cube, the fee shall be basad on the total cost
Move a building out of City ...... $ 20.00 of wrecking at the rate of $6.00 for each $500.00
or fraction.
STIPULATIONS:
Office Use Only: SAC -D form completed
i w -M � MR I
Building
PLUMBING
Permit No.: -_1- a
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
Date Rec'd:
CITY OF FRIDLEY
DATE `1- Z`5`6 G YOUR E-MAIL ADDRESS 9f C IO i U+MQ 1.4) G 1 IU C- C9
SITE ADDRESS 61' -JO S/ -AE- 4-ri
THIS APPLICANT IS: 0 OWNER CONTRACTOR
PROPERTY
NAME: _ ' , Pp%.,)sv nd
OWNER/
TENANT
ADDRESS: / o sf-A Z. 4- vv(:^ CITY (tzr ALG=`/ STATE 94/V -IP
PHONE: G` � y%
CONTRACTOR
NAME: $(2 (, P l u ".s C_
STATE LICENSE #_ SS ZO q j0rV1 EXP DATE I Z- Z 1 -
SUBMIT A COPY OF
YOUR STATE
ADDRESS:L_® i f 0 Z�1fty4-01J 24 LI&IL {Z j CITY _ _ 1\ Aciis.I STATEitiInZIP S�3 Z l
LICENSE WITH
PHONE _631 Z- Z-0 y r FAX -761- 4y?(?- b 63 L
APPLICATION
PERMTYPE
IT
0 SINGLE FAMILY TWO FAMILY 0 TOWNHOUSE
TYPE OF WORK:
QFNEW 0 REPLACEMENT
DETAILED DESCRIPTION OF WORK —4b6%m G A pjt I tS Ate. Poi2 -1-1.x._ net-) Z-6
k.Je.
,e^ -, vk. in r„a5�, c�s� rc loc�a L,i� ' e.- ��,;as / Zss�► �:x amus &P,44,PER
MS -1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater; for the -
improvement,. installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only_the-caa_of.labor)
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
s
=-FAR;sPMffi6T-S:WHERE,LABOR EXCEEDS $500, FEESARF_=BASED ON $10.00 PER FIXTURE, EXCEPT: WHERE NGTED::FW1UKE&,, C;A MT0TAL
NUMBER OF EACH BELOW)
BATH SINK/LAV _FLOOR DRAINS SHOWER WATER PIPING
_ _
_BATHTUB GAS PIPING (mm arrucEArz) SWIMMING POOL WATER SOFTNER ($35)
_ _
_ CLOTHES WASHER Z KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15)
—DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
Permit Fee $ 144tffiEW6
Number of fixtures @ $10.00 1 x $10.00 = $
Surcharge .50
Number of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $35.00 x $35.00 = $
TOTAL DUE $
State Surcharge = $ .50
Total= $ rQ
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 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; that the work will be in accordance with thel
approved plan in the case of all work which re sires review and approval of plane�s'
SIGNATURE OF APPLICANT PRINTNAME d_a°ZEA,4- JUHAA-W^J DATE 7-Zr-06
I
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building MECHANICAL Permit No.:.,
Inspections RESIDENTIAL APPLICATION Received By:
7.63-572-3604CITY OF FRIDLEY Date Rec'd:_
DATE J YOUR E-MAIL ADDRESS
SITE ADDRESS � � b
THIS APPLICANT IS: ❑OWNER �60NTRACTOR
PROPERTY NAME:
OWNER/ ADDRESS: CITY STATE ZIP
TENANT PHONE:
CONTRACTOR COMPANYNAME: 4f^ 4®A)
SUBMIT A COPY OF CONTACT PERSON: _j
YOUR STATE STATE LICENSE # EXP DATE y �
LICENSE WITH ADDRESS: 1'Q% "�� 1 s b CITY 3 � ,°� � STATE A4._ ZIP
-5
`76 �`�-� °� - Z—`� FAX �� 4 `�'� °� ^ Z �
PERNHT TYPE ❑ SINGLE FAMILY A§IVO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: ❑ NEW ❑ REPLACEMENT .TERATION/REMODEL
DETAILED DESCRIPTION OF WORK 44
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, 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 $300 to $500 = cost of labor
x .05 =
$500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
FOR PROJECTS WHERE LABOR EXCEEDS
NUMBER OF EACH BELOW) MODEL:
MFG:
SIZEBTU
Equipment Installed
MFG: MODEL:
SIZEBTU
MODEL:
SIZE/BTU
�S RANGEIOVEN $10.00
C $25.00 —FIREPLACE (GAS) $15-00 $35
AIR TO AIR EXCHANGEER $15 —FIREPLACE (WOOD) $35.00
NEW GAS GRILL $10.00
GAS UNIT HTR $10.00
—,BOILER $35.00 _FURNACE $35.00
CHIMNEY LINER $10.00 —GAS DRYER $10.00
_ HEATER $35.00
—POOL
—VENTILATOR $15.00
–F-BUCT WORK $10.00 GAS PIPING $10.00
..at.....,v. � � rau'�^rx�rwrr'1t77'W�
u£^'.�'i=r1'► t;Gu 'z F•.:, ", 1 1; as,.a4,P. .-. 15W"'. < .<.,5. ,. .-----"71..._.__...... ..
Permit Fee $ Number of fixtures @$10.00 x $10.00 =
Surcharge $ 50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
Total = $
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 appTcation 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 a hi Ch
re es r view and approval of plans.
�J
SIGNATURE OF APPLICANT PRINT NAME
DATE T
--
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
AND MATERIALS:
BUILDING
Permit No. — 6-
Inspections
TOTAL JOB VALUATION $ c q 0 C/7 ,S_,A OCCUPANCY TYPE
RESIDENTIAL APPLICATION
Received By:
763=!�72-3604
Plan Review
CITY OF FRIDLEY
Date Rec'd:/S-h 1
DATE I o ®-dire
YOUR E-MAIL ADDRESS !''a Ct7iS7%C.L`>' &!,/f447-I6C11G®e.aS, A/<_ -
SITE ADDRESS 61418ip/,STI�d�
L ,q,,s 05 ®®4 � ,411p 5'.T IY2 7-
THIS APPLICANT IS: 61 7 `a ❑ OWNER XCONTRACTOR
PROPERTY OWNER/
NAME: ZS -1 en t C tU f R'i L_ PA vi i _So d
TENANT
ADDRESS: 4Ao,* 61 YV ,5TAf? "A'E CITY e0,fX`-J STATEfte IP SSY 2—
SAC Charge
PHONE: -76 3 ® 639 ` 6 6719
CONTRACTOR
NAME: /_I1G111&blw 4&a/ele f Al L <.1
STATE LICENSE # 2 ® of y 90& Z_- EXP DATE MAR
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: ®&Ia''1gr Z®AJe_4e t ,y'7'®!/ aas CITY AIAIV 44KC STATE#t. ZIP 04V
WITH APPLICATION
PHONE 763- 766-7 FAX 76 ®i96 - ffri
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
Sewer Main Charge
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION GARAGE/SHED ❑ WINDOWS
$
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
KNEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: 0EAa Eyay' me. 4 a- p 6F A^0 ofF64 &4' Alf dal
SIZE OF IMPROVEMENT LENGTH - R -Z, WIDTH g,HEIGHT q,Sq. F
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES ❑ATTACHED GARAGE
PROPOSED SIZE: 3 .27`&'x -?�P'V"
�AETACHED GARAGE
1. Existing Floor Plan
2. Proposed floor plan
'z
�o ��� �®m+�.+� t`�C.,c,`,r � / �f ,k
PROPOSED HEIGHT: �'U%
l�7
3. List of structural members to be used
SIDING
�a
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
*Soffit !�
^ ----�'
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
W Trim
I. Site Plan/Survey showing the existing structures
lfOther AA
0,Fascia
and proposed project.
WINDOWS
2. Two sets of construction plans
IN EXISTING OPENINGS ❑Yes Ao LOCATION OF WINDOWS
3. Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE
SIZE OF°•✓� 5 &�� -"X Z
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED 1ft/QOkV-' aB NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR
AND MATERIALS:
(USING THF, U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ c q 0 C/7 ,S_,A OCCUPANCY TYPE
Permit Fee
$
4( ,11_ See Back Page for Fee Schedule
Plan Review
$
,.!�-i . L4( 65% of Building Permit Fee
Fire Surcharge
$
r 14 . 10 .001 times the total job valuation
Surcharge
$
VA , 65' .0005 x Permit Valuation Minimum $.50
License Surcharge
$
00 $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
$
, o' ( Make checks payable to: City of Fridley Attach Sti ulations
I THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I
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; that the work will be in accordance with the approved
plan in the case of all work which requiZevie and approval of plans.
SIGNATURE OF APPLICANT ,�� 4 PRINT NAME �'®�°�� I���S�'�� °P DATE /2 --'?C7-06