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PRE 2010 DOCSCity of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone 560-3, DESCRIPTION OF WORK Number, Kind and Location of Fixtures m NO. RATE TOTAL Number Fixtures ...................... 1� x $2.00 $ Future Fixture Opening ................ 2' x $1.50 �ZT New Fixture Old Opening .............. $ wZ wo • • N WATER HTR. GAS ELEC.3 Base Water Heater (Up to 99,000 BTU) ...... x $3.00 / New New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: N®. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 1st Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... 1� x $2.00 $ Future Fixture Opening ................ 2' x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ...... .....................25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $--- New New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: N®. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE $ ` H City of Fridley: i 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 � 19 Owner Kind of Building Used as To be completed about �® Estimated Cost, $ Old—New. Building Permit No _ „ , Permit No. a ROUGH l FINAL T 7 42 By ^- M, Business Phone City ®f Fridley, Alinn. N° 9499 BURDING PERMIT Date: ._,_.00TOBER 6, 1967 Owner: ZUEHLKE CONSTRUCTION CO. Builder SAME — Address 6495 PIERCE STREET N. E. Address — FRIDLEY, MINNESOTA 55421 No. LOCATION OF BUILDING 6210 Street STARLITE BOULEVARD - -- - — Part of Lot Lot ____ 15 _ Block 4 Addition or Sub -Division __SYLVAN RILLS, PLAT 3 Corner Lot _ Inside Lot _ X Setback 35' —_ Sideyard — 10' and 11' Sewer Elevation _____ 837.76 Elevation _ _ 840.76 TOP OF FOOTING To be Used as: DWELLING ATT. GARAGE Type of Construction DESCRIPTION OF BUILDING 42' 24' & 25?' Front — Depth Height 8' & 20q, 1, 038 Cu. 20,7 60 12 Front Depth 22 Height 8' & 10''q FIL 264 Cu. Ft. 21640 FRAME$14, 5 00.00 Est. Cost _.... __ To To be Completed — SEWER LOCATION - 84' North of Manhole WATER LOCATION - 71' North of Manhole 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 coinpliance with 21 provisions of ordinances of the city of Fridley. a $100.00 Nesesese In consideration of the payment of a fee of $_15 - 00 ' permit is hereby granted to ZUEHLKE CONSTRUCTION CO. to construct the building or addition as described above. This t 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 violation of any of the provisions of said ordinances. CLARENCE BELISLE Building Inspector NOTICE: Tads permit does not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be an to no the Building Inspector for separate permits for these Itenm s C S Ji.' l'i�?.S�;a�..:.y', 1'1�!' i::1S�`'►'A OWNZER' S VA2� t F,€'�f'�•i�, i; ADDRESSP t ADD:.ESS LOCATION Oi' BUILDING STREET_ _w. _PART OF LOT BLOCK_ ADD1T!.ON OR SIT -TSD VISION CORNER LOT INSIDE LUT � SETBACK �� r SIDE -YAW) M � i� A � SEWER ELEVATION . fc -7 � � 6 Applicantattach to this m Two Certificates of Survey of Lot and proposed building location drawn on the e Certificates. DESCRIPTION OF BUILDING_ To Be Used Ad: - -� - -- Front Ll' r Depths ��3'ileiglxt� Sq. Ft. M3 _ Cu. Ft. C 7 �� -- - o e• Front Depth Sq. Ft._ L Cu. Ft. 11Cy Type of Construction _ Estimated Cost To Be Completed / 1.11 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. DATE SIGt3ATURE (Schedule of Fee Costs can be found on the Reverse Side). • P ��' u� ��Ire Application for Pat,"Jor Planft and Ma r . Cooling.Ven0lation. [Ze4rigamNan and Air Conditioning Systems aid Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: IRATE TOTAL " Furnace Shell & Duct Work ....... $ $10.Q0 t Replacement of Furnace ............................. a $ 6,00 v Repairs & Alterations—up to $500.00 .................. Q{ $ 6000 Repairs & Alterations each add. $500.00 ............... $ 3.00 MECH. WARN! AIR Furnace Shell & Duct Work to 120,000 BTU .. . ........ . each add. 60,000 BTU .............. . . . . . . Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. Repairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Stearn ..... . Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... Each add. 200 sq. ft. EDR Steam ...................... Each add. 320 sq. ft. EDR Hot Water .................. Rpa $ 4110.0'.$10.O0 t !! is 6,00 R` 6.o! !! $ $10.00 fLkkx$ 10.00 jua $ 3000 R'e $ 3.00 OIL BURNER—to 3 gal. per hour ........................ $ over 3 gal. per hour—fee Fee Schedule 199 000 GAS BURNER (up to tBTU) ...../11"5.00 $ p� GAS FITTING �rg:199.9000 BTU NO RATE TOTAL 1st 3 Fixtures x $ $ Additional Fixt res x -x$ Gas Range to �TU x 2.00 $ C" v AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL_ See Fee Schedule TOTAL FEE $ Dept. of Bldgs. Phone 560-3450 /� BB �y Location _ 6 '_z '/ ® �7'-e� r /r j h Z` 'Q / V S` d U ��a O/Se` 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. Fridley, Minn �" /�' ®(/. Owners z' Kind of Building Used as � CAJ To be completed about �� wad �_e rr' 7 Estimated Cost, $ A Old Ne Building Permit No. ___ Permit No._ `7 � 9 DESCRIPTION OF WORK 6.00 HEATING or POWER PLANTS—Steam, Hot Wate Warm Ai No. .— Trade Name 0 J'r Size No. Capacity Seq. Ft. E.D.R BTU H.P. $2.00 Total Connected Load `' 7 �=o Kind of Fuel • 75 BURNER — Trade Name Size No. $5.00 Capacity — Sq. Ft. E.D.R I BTU Hp. (REMARKS—OVER) Signed_ _ HFHATING AND AIR CONDITIONING Iris ByMINNEAPOLIS 1 MI N 9?n-38QO x.4-42 Business Phone No �a . 0 y iqu, W.A. Lead r 0 C I T Y O F F R I D L E Y 6431 University Ave. N. E. Fridley, Minnesota 55421 Sept. 30, 1968 0. B. Thompson Electric Co. 12201 Minnetonka Blvd., Minnetonka, Minnesota RE: 'P/E RMIT SHORTAGE 6210 Starlite Gentlemen: Your permit for the above captioned address was short _ the following: KW $3.00 We would appreciate it if you would kindly give this matter your preferred attention. When sending in the above amount, kindly place it on a regular Minnesota State Affidavit so that we may properly process this permit. LE :bks Thank you. Yours very truly, LEONARD EICHMILLER Electrical Inspector City of Fridley 0 SUBJECT RMIT E NO. City of Fridley 12�jl AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT e COMMUNITY DEVELOPMENT DIV. 1 PROTECTIVE INSPECTION SEC. / '•1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �•"• `'� • 612-580-3450 910—F15 5/3/73 JOB ADDRESS 6210 Starlite Boulevard N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 4 Sylvan Hills Plat #3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Gemlo 6210 Starlite Boulevard N.E. 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 ices ident ial 7 CLASS OF WORK 7 NEW 11 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE El REMOVE 8 DESCRIBE WORK Construct a 30' x 26' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway Owner agrees to close up existing garage and will cease to use it for storage of motor vehicles on or before June 1, 1974 (July 20, 1973) ' , TE PERMITS REQUIRED FOR WIRING, OEATPG, PLUMBING AND SIGNS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST: OCCUPANCY GROUP OCCUPANCY LOAD 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 R 1 780 7800 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 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. $3, 533.40 $1.77 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $16.27 -/SIGNATURE OF CONTRACT9R OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT i �� . / Cj_V?3 4 7_U A JL _ A_O1QAA-� . NATURE OF OWNERtlF WNER SUILDERI IDATEI BLDG. INSP DATE K; APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME:Z-�/— .eif�'- BUILDER : _�� ADDRESS: LZ16 - , LZZ2,, °ft &2C: ADDRESS: R1 N0:. 6Z/6 STREET LOT: /S BLOCK: 1-/ ADDITION: pc' a j CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As; DESCRIPTION OF BUILDING Front:^� Depth: !�E Height: d Square Feet: %8® Cubic Feet: 9(�C9 Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: $ '5—ec cy d To Be Completed: 3673-3. �/o The undersigned hereby snakes application for a permit for the work herein specified, agreeing to do all work in st-ict 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. DATE: SIGNATURE: (See Reverse Side For Additional Info ion.) BUILDING PERMIT ?"-,E SCHEDULE ft SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: UNIFORM BUILDING CODE: Type 1, 2 & 4 - X2,15 for each one thousand cubic feet, or fraction thereof, in such cubical contents. Type 3 & 5 - $1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical contents of an7 building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. In no case shall the fee charged for any permit as set forth in Section 2 be less than $5.00, VERIFICATION OF FOUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application, to allow for proper review of the proposed structure and of the construction site. A Certified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before proceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. •. Land Planning ��'��•` << s s Land Surveying ,1 �+ Soils Testing ()®� 1��1p�"Offl� p e�' e e Civil Engineering Municipal Engineering Engineers & Surveyors Certificate ®f Surrey for GUM) 1� e S, ctIc, � iti:�, --A �) "i'cJ L � J !� <r J' i �� ►- I �, ,L� C,'4 4, 6875 Highway No. 65 N. E. Minneapolis, Minn. 55432 Telephone 784-6066 Area Code 612 L`) I hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land, and of the location of all buildings, thereon, and all visible encroachments, if any, from or on said land. As surveyed by me this - day of.,,'' A.D. 19_L. SUBURBAN ENGINEERING, INC. Engineers Surveyors b `. ,1 1 ` y ' SUBJECT RMIT NO. City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. ' COMMUNITY DEVELOPMENT DIV. t✓ I PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 2/1/83 JOB ADDRESS 6210 Starlite Boulevard N.E. 1 LEGAL LOT NO.BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 15 4 Sylvan Hills Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Gemlo 6210 Starlite Boulevard N.E. 571-2237 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Symington Builders 4917 Ewing Avenue South 922-3778 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 ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remodel garage into bedroom 9 CHANGE OF USE FROM TO STIPULATIONS m SEPERA►TE PERMITS REQUIRED FOR WIRD HEAT)-NG, PLUMBING 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 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 ISTALLS 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 $4,500 $2.25 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- RUCTION OR THE PERFORMANCE OF CONSTRUCTION. $50.50 PLAN CHECK FEE TOTAL FEE J -2- �( 1� $52.75 SIGNATURE OF CONT ACTO OR A-011ORIZED AGENT (DATE) WHEN PROPS Y VALIDATED THIS IS YOUR PERMIT �, BLDG INSP OATE SIGNATURE OF OWNER flF OWNER BUILDER) (DATE) CITY OF FRIDLEY Effective Aug. 1, 1961 APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New. Alterations, Additions, or Repairs) OWNER: T 64�Aj ADDRESS: _ T�� t (f WI— 'I a l)D TEL 110: BUILDER: SRS a1 9,3_�� ✓-s s ADDRESS: qcl /7 ��twl 4vc r - TEL NO: q z- 2 =-3 -77,Y Construction Location • STRI3:T NO: (0 2-10 STREET: F T -A L CC W -f- 01-=_Q__ LOT: BLOOC: �� — ADDITION:S-, I V., 144 6 Ord Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION ria. Fsont: Depth: 2O� Height: l Square Feets_-'pubic Feet: 2t61.w� Front: Depth: Height: Square Feet: Cubic Feet: type of Oorztruction: �d M'D -FX A Atm Estimated Costa $ J tb Be Cbrapleted: A i Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ ' . SEE REVERSE SIDE OF SHEET tine undersi ned here makes application for • 9 by PP permit for the %-=�rk herein specified, agreeing to do.all Work ft, strict accordance with the City of Fridley Ordinances and rulings of the Delvirtment of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. MITE: 2•- 3 SIGNATUME: Stipulations: P 72 t t r BUILDING PERMIT FEE SCHEDULE The Inspector of buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application thOrefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: . L TOTAL VALOATION FEES $1.00 to :500.00 $10.00 Minimum Fee $15.00 plus surcharge $501 to $2,000 $10.00 for the first $500 plus $1.50 for each additional $100•or fraction thereof, to and including $20000 $2,001 to $25,000 $32.50 for the first $2,000 plus $6.00 for each additional $3,000 or fraction thereof, to and Including $25,000 $25,001 to $50,000 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 and up $443.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof PLAN CHECK: 25 percent of building permit fee DRIVEWAY DEPRESSION ESC4tO1W: Concrete Curb Streets Only Alternate "A": Removeal and replacement of curb and gutter only , Driveway width plus 6 feet x $13.50 Alternate 08": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth Driveway width plus 6 feet x $15.75 VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required beforeroceeding with the framing. rZ G 43 G 3yt t g•®� a -a lw --L : w / � 2 � --L r SUBJECT RMIT N City of F'raaley 26620 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. �• COMMUNITY DEVELOPMENT DIV. v -------- PROTECTIVE INSPECTION SEC. 0( r 1 NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/13/98 JOB ADDRESS 6210 Starlite Blvd. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 4 lSvlvan Hills t 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Gemlo 571-2234 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Twin City Exteriors- 4 ARCHITECT OR DESIGNER MAIL ADDRESS Z P PHONE LICENSE NO. 2595 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 Repair-Fascia 9 CHANGE OF USE FROM TO STIPULATIONS 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 SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN BO 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 1 ISTALLS 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 $500 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .50 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- $21.00 Fire $.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOT L FEE icense .00 $ 7.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEi HE PRO VALID THIS ISSYYOUR PERMIT - iNSP �, / �� ' DATE S.GNATURE OF OWN ERpF OWNER BUILDER) iDATEi r NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION11 Old- 0 Qt ConstructionAddress: P Legal Description: Owner Name & Address: �T��Ln 25A10ig- Tel. Contractor: MN LICENSE #��`r Address:'70 66 ;?Acff.92 y # Q Q ,AP1F Tel. # 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: Width Hgt/Ground Sq. Ft. OTHER: Construction Type: R,5:22Aig _ � �� Estimated Cost: $ �QQ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT:�! L/i fir► '� �1/ Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ l.on 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 $950 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 PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY DateppRec'd: DATE ®Z_ — C7k�® YOUR E-MAIL ADDRESS-, 0' 4_4 aOO SITE ADDRESS &0/0 0 f &�' Vl THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: OWNER/ ,�a� ADDRESS: 6zlo c5gwlL/ 7F -o Ix--- CITY ��O(A! STATE^4 TENANT PHONE: r CONTRACTOR NAME: /Cid G®� °'% IMOPAX, STATE LIC E# EXP DATE l 3 Od— CITY �i?�d�'_� STAT) �ZIIy3 SUBMIT A COPY OF YOUR STATE ADDRES7 • B�C� LICENSE WITH PHONE—®C� FAX 7&"��S °"Z/ APPLICATION PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW REPLACEMENT DETAILED DESCRIPTION OF WORK ,E'MJZt b44 �G "V IC 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 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV DRAINS _ SHOWER _ WATER PIPING _ _FLOOR GAS PIPING fro crrrucEm) _ SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB _ CLOTHES WASHER KITCHEN SINK —WATER CLOSET _BACKFLOW PREV. ($15) _ _ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER ;^ , Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ 10::� Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ 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 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 a 0 1 h requires review and approval of plans. SIGNATURE OF APPLICANT v " PRINTNAME� 0C/ � /r AW' &f1: DATE ( � 6� City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977