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PRE 2010 DOCSi ,i Owner I 11—'1%�' Architect Fridley, Minn.,,' 18 Builder LOCATION OF BUILDING No. 0 Street Pant of Lot y iii J Lot —1-1—e Bloek .�` " Addition or Sub -Division { ,,�++ DESCRIPTION OF BUILDING Frontes Depth Height Stories `'44—Manner Iof Consiroaction To be used as _ To be completed `Z Estimated cost s' Permit is hereby granted to 4 `' to__ the building— described in the above statement. This permit is granted upon the express c dition that, the,person to whom it is granted, and }�s agents, employees and workmen, in all the work done in, around and upon -.said building, or any part thereof„ shall conform in all respects to the ordi- nances of Fridley, Minn., regarding the construction, alteration, mairenance repair, and moving of buildings within the city lbx Its, and'this permit may be revoked at any time upon violation of any of the provisions of said ordinances. t 'd spector of Buildings. AGREEMENT AND SWORN` T�TEMENT In considergtion of the issue and delivery to me by the Inspector of Buildings' of Fridley of the above permit, I hereby agree to do. the proposed work :in accordance with the description above set forth 'and according to the provisions of the ordinances of Fridley, . and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein ted. leil Subscribed swornto before me at Fridley, Minnesota ;this _ day o=-9- D. -19 CRY of Fridley Permit No. AT M TOP OF THE TWINS BUILDING PERMIT APPLICATION r Receipt No. ------- COM MUNITY DEVELOPMENT M. PROTECTIVE 04SPECTION DZPT- CITY HALL FRIDLEY 5002 012-590-3400 MMER REV. DATE PAGE O APPROVED By 910-F1.14 0 1 173 1 1800 Job Address: (Oloo sbivv-i-je- 136201: Legate Lat No. Block Tract or Addition See Attached Descr.113 1 -Nlyq�-t 1W6 Sheet ---- Property Owner Address Zip Phone wltzlmlc �504tjt,54 'Del k,- 554313 566 (W09 Contractor Address Zip Phone License No. ArcH-itect orDesignerAddress Zip Phone License NO. Engineer Address Zip Phone License No. Use of Building Class of Work�Remove IsNew DAlteration 0 [love Addition Repair Describe Work %X Change of Use From To :SPECIAL ASSESSMENTS: If lateral assessments have not been placed on this property, an agreement must be signed, agreeing to assume such lateral assessments before a permit will be issued Agreement Necessary: Agreement Unnecessary: Finance Director >- 10 OUTSIDE UTILITIES: Sewer Elevation: Water Elevation: Stub Location: Stub Location: Lu (h 0 BUILDING INSPECTION PlumbipZ_ H.V.A.C. Electrical Fire Insp. Signature & Date Approved 0 W- Registered Engn. Stamp. Legal Description Check Exterior Devel. Check Performance Bond Check Easements, R/W, Special Agreeme*nts Final Approval Date Certificate of Occupancy Date PJL-,� w� I.19 V1 DIMENSIONS: Length: Width: Accessory Buildings: Length: ' Width: VALUATION: FOR CITY USE ONLY Height: Cu. Ft. Sq. Ft. Height: Sq. Ft. Cu. Ft. Sq. Ft. X Cost = Valuation ) Total Valuation Basement X Cost = Valuation ) PERMIT FEE: Residential Total Valuation $1.00 to $500.00 $501.00 to $2,000.00 $2,001.00 to $25,000.00 $25,001.00 to $50,000.00 $50,001.00 to $100,000.00 PERMIT FEE: Commercial and Industrial Fee $5.00 $5.00 for the first $500.00 plus $1.00 for each additional $100.00 or fraction thereof, to and including $2,000.00. $20.00 for the first $2,000.00 plus $3.00 for each additional thousand or fraction thereof, to and including $25,000.00. $89.00 for the first $25,000.00 plus $2.50 for each additional thousand or fraction thereof, to and including. $50,000.00. $151.50 for the first $50,000.00 plus $1.50 for each additional thousand or fraction thereof, to and including $100,000.00. Total Cu. Ft. X $2.15/1,000 sq. ft. Permit Fee X PLAN CHECK: Take one half of permit fee = STATE SURCHARGE: Valuation X $.50/$1,000.00 = X $.50/$1,000.00 PERFMAANCE BOND VALUATION Blacktop Curbing a Sod Fencing Bushes and Trees 1.50/sq,dd. 2.00 lin. ft. 0.40/sq.---yd. _2.00_ lin, ft. 5.00 - 50.00 r TOTAL BOND VALUE i, ALAAg!5t1iy- , owner of the property located at llbt �P—C" ,5LJ �k, �J(4--, have no objection to the City allowing the construction of ao� to be located at G2 0- t1rtLV, without the required certificate of survey that the City ordinarily requires for all new construction. t &,a,�- Witness e Signed 1p tot mal;IXoUJ - r!✓G Address Date e T-1 c? 73 i a 01 SUBJECT City of Fridley 12383 F AT THE TOP OF'THE TWINS BUILDING PERMIT" ` COMMUNITY DEVELOPMENT DIV. L______ INSPECTION r PROTECTIVE SEC. 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 11/5/73 JOB ADDRESS 6100 Sunrise Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 2 1 Sylvan Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE W. E. Matthews 6100 Sunrise Drive N.E. 560-1668 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 RJ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBEWORK Construct a 24' x 22' Garage 9 CHANGE QF USE FROM TO STIPULATIONS Provide a hard surface driveway. SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 RA 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, WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,391 1.19 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. $10.00 PLAN CHECK FEE TOTAL FEE SIG%N�ATTYRREE+OFCONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY V TEAD THI$ IS YOUR PERMIT /. BLDG )NSP DATE SIGNATUREOF OWNERUF OWNER BUILDER) (DATE) 01 SUBJECT PE City of Fridley 18361 AT THE TOP OF THE TWINS BUILDING PERMIT r RECE COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. `1 1 PROTECTIVE a 0c)� CITY HALL FRIDLEY 55432 NUMBER REV. DATEF PAGE OF APPROVED BY 612-571-3450 910415 3/31/86 1 1 JOB ADDRESS 6100 Sunrise Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 2 Sylvan Hills SHEET 2 PROPERTY 9WNER MAIL ADDRESS ZIP PHONE Will and Matthews 6100 Sunrise Drive N.E. 571-1668 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 ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 10.51.x 24' Addition to Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Side yard variance granted by Board of Appeals on March 11, 1986 from 17.51 to 13.51. Provide fire alarms in existing basement and 41 hall to bedrooms. AR -. EPARATE PERMITS REQUIRED Before digging call local a�#i�lflzx FOR HP T(Nrrr PI-1 IA.4F31 ® TELEPHONE' P... ELECTRIC CA' SIGi�t a REQUIR'F' 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 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 $5.30 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $10,600 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- $86.50 None STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $113.43 SIGNATURE OF CO TRACTOR ORA ,ZED AGENT (DATE) 7 tL'.WHENOPERLYV DATED THIS IS YOUR PERMIT SIGNATURE OF OWNEROFO NE BUILDER, D TEI BLDG INSP qA E NEW [ ] City of Fridley Effective 4/1/84 ADDN. R-1 AND R-2 j ALTER.Ir Building Permit Application Construction Address Legal Description: too Owner Name & Address: W1 i il(rC Height Tel. # l I b Contractor: Jo�h L JAC>-n GS Height #'2o li O Address: 56 4 Um e cp k &V 317 Llw-et -V( (f Sq. Ft. OTHER: f, 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 bP r Width _ Height Sq. Ft. 7,110 GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground . Sq. Ft. OTHER: ``OO— t�� I O�q d�C) Corner Lot N Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: �a91 'pt-d'w6e- Estimated Cost: $ Approx. Completion Date: 6 /� 46 , D Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: _ $ _ $ See Back Page for Explanation A ,^ DATE: Tel. # APPLICANT: Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge fDTAL CITY USE ONLY Fee Schedule on Reverse Side 25$ of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: FV"\ CI Pao Ua bc, PO rLr.. Z 0 1`2-W" " BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of ary building or structure, or for for any alteration or repair to any addition to any existing building or structure, or any existing building or therefore, require the payment structure, upon application by the applicant for such permit of fees to the herein below set forth and in amount the manner herein provided to -wit: Total Valuation Fees $1.00 to $500.00 $10.00 (Minimum Fee is $15.00) $501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000. $2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or 'fraction thereof, to and including $25,000. $25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000. $50,001.00 to $100,000.00 $263.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000. $100,001.00 and up $433.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof. DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75 VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. 7-Z 0 On00 jbti e � t � EL g y � s � N i ;71 On00 jbti e � t � EL ~i r ' ^ - 0Q � .� � r | F-- � ` ' ` � . . ! ' . i i ! ( � - - � ` ' ` � . . ! ' . i i ! ( � - SUBJECT7RECEIPT City of Fridley AT THE TOP OF THE TWINS P, BUIL®I P RMIT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC.C79 V r NUMBER REV DATE PAGE OF APPROVED BY 1, CITY HALL FRIDLEY 55432 L 612-571-3450 910-F15 //$/g JOB ADDRESS 6100 Sunrise Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 2 Sylvan Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Donna Matthews 6100 Sunrise Drive 571-3514 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. R. Miller Construction Inc. 953 Mississippi St, Fridley, MN 55432 571-3514 6354 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 O ADDITION 0 ALTERATION [ REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Re -roof house and garage (17Sq) - Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. 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 80 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 $1,417 ,71 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- $48.50 Fire Sc $1.42 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOT L FEE �_ _< PIMA"License SC- $5 0 $55.63 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI THIS IS YOUR RMIT U kFR1MoP1VAgLID7.TD BLD PAT SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/98 ADDN[ ] CITY. OF FRIDLEY ALTER [ ] SINGLE FAMILY -AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION . C, ConstructionAddress: 1/� /&0- —5� Ael'Z5 - Legal Description: Owner Name & Address: L)01'?171" ey%�'re�iS Tel. # Contractor: ,L�, I `cd e'c��t�SiG.�r�`' MN LICENSE#S Address:. 'i �5®`SS�r'� t �-e l 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: Length Width Hgt/Ground Sq. Ft. OTHER: Ems- a r 41�, d � / 7 � �� fe Construction Type: Estimated Cost: $ (Fee Schedule. on Back) - Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: _ APPLICANT:2 Tel. # 7r-_ X! STIPULATIONS: O CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ ' .001 of Permit Valuation (1/10th%) State Surcharge $ f $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $� $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ S_S STIPULATIONS: O BUILDING PERMIT FEE SCHEDULE The Chief Building Official 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 repair 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: TOTAL VALUE _. FEES $1 to $500 $21 (Minimum Fee is $21 plus surcharge) $501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for "first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 to $500,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $500,001 to $1,000,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,00,000 $1,000,001 and up $5012:25 for the first $1,00,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B": Removal and replacement of curb and gutter and install a 3- foot wide approach with 6 inch depth - Driveway width plus 6 feet times $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 it has been constructed will be required before proceeding with the framing. CITY OF FRIDLEY INSPECTION DIViSION = Effective On May 10, 1999 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 RAT_ E SCHEDULE OWNER LL -)s Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS Also Replacement Furnace $ 30.00 $ SDo 00 / s (Side Vent - Fill Out Back) ESTIMATED COST PERMIT N0. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units_— Circle One (Steam) (Hot Water) (Warm Air) Gas Dryer $ 10.00 $ Trade Name Size No. BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) �, Burner Trade Name Size No. 1% of Value of Appliance or Work5�-�- b� $ BTU HP _ EDR Commercial/Industrial 1.250/0 of Value of Appliance or Work $ 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 an State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and _ representations stated in this application are"true and correct. TOTAL FEE $ aS.S 0 River Cory Sheet Me 99 Inc. 9923 Biue5ird St. N.W. MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO ''a CO®rl Rapids, MN 55433 REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 (612) 72999 Fax (092) 754-2905 PLUS THE $.50 STATE SURCHARGE Signed Lr c:. / DATE / — -,2 0 — nn REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side/ without Approved By0i Rough -In Date Final Date/ written permission from adjoining property owner.7 V CH ANEY- AND STACK VERIFICATION. The undersigned hereby verifies that�>the.<existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes O No ( ) 3. Has no foreign objects lodged within Yes O No ( ) 4. Is securely . supported - . Yes O No ( ) 5. Meets all current Code- requirements for size and total BTU''s connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: List ALTERATIONS Being Done: P. „ „ HEATING CO: Signed By: Date: RiverSheet. • : bd •o; j Rapids, 1) 754-2199 Fax ;6 • 0 /— 20--00 Building BUILDING Permit No. Inspections 763-572-3604 RESIDENTIAL APPLICATION Received B CITY OF FRIDLEY Date 763-502-4977 FAX EFFECTIVE 1-1-09 DATE .-I 0� YOUR E-MAIL ADDRESS SITE ,ADDRESS l D `D �C \ �,91. THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: M TENANT ADDRESS: w o o Sku'l i� l � IJR• CITY STATE M ZIP L 2 PHONE%_e\,a' .-izy\ - S�1� CONTRACTOR NAME:_VtQS�� V\ VDe� . QMS;�O-CCh Ln SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # zCJ ' /�$ LI- a 1SO EXP DATE AND CERTIFICATE OF ADDRESS: _5 Z�X CITY FQ_�CACLA STATE IP A INSURANCE PHONE—IW 1 �� FAX --n ' 9 "7 Q a PROPERTY TYPE 'SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES 1 PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHEDWINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION AINTEN� A,NCe EIREPAIR 1�n12rE,�MODELING DESCRIBE WORK BEING DONE: �y�� l�lnol Q Its, INII(Id®w SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES 11HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR_NEW CONSTRUCTION INCLUDING DECKS, SIDING— - - Vinyl --- flit _ ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I. Site Plan/Survey showing the existing structures ❑ Other a2pascia ( and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS*es ❑No LOCATION OF WINDOWS 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: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ / (�, 006) _ - OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2000 per SAC Unit (Plans to MWCC for determination) R+6ft= ftx$22=$ $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 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 which requires review and approval of plans. p-Noq SIGNATURE OF APPLICAN^ , / �� PRINT NAME C Ul DATE Page 2 - Building Residential Application BUILDING PERMIT FEE SCHEDULE The Chief Building Official 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 repair 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: TOTAL VALUE FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 1" $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 $2,001 to $25,000 $69.25 for 1' $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for I' $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for 1' $50,000 plus $7 for each additional $1,000 or fraction to and including $100,000 $100,001 to $500,000 $993.75 for 1" $100,000 plus $5.60 for each additional $1,000 or fraction to and including $500,000 $500,001 to $1,000,000 $3,233.75 for the 1" $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the I" $1,000,000 plus $3.15 for each additional $1,000 or fraction 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 proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977