PRE 2010 DOCSvillage of Fridley, Minn.
BUILDING PERMIT
Office of INSPEMOR OF BUILDINGS
l��—.��,
OwnerXx
Architect Fridley, Minn., 19—
Builder
LOCATION OF BUILDING
26
NO. 1=Street Part of Lot -
U
Lot -4
Block- Addition or Sub -Division
DESCRIPTION OF BUILDING
Front –:-:�— Dep hHeight Stories yMariner of Constructiop
ji
To wed as To be completed Estimated Cost -I'S
Permit is hereby granted to�
the building----_ desc4ed In the above statement. This permit Is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in an
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, 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.
SN
V
Inspector of Buildings.
AGREEMENT AND SWORN STATEMENT
In consideration 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 Stated.
Subscribedyyy
and sworn to before me at Fridley,
4-
A.D.
Minnesata, this `
S-3-
City of Fridley, Minn. NN10802
BUILDING PERMIT
Date: August 24, 197Q
owner: C. M. Kam Builder Same
,address 120 Talmadge Way N.E. Address Same
LOCATION OF BUILDING
No. 120 _ Street Talmadge Way N.E. _ _ T.... part of Lot
Lot 2_ ___ Block — 2 Addition or Sub -Division V1 Ian l l 'q R i vPrg i c1 - NP i gh t
Corner Lot — Inside Lot K Setback — Sideyard
Sewer Elevation
To be Used as:
Foundation Elevation
Alteration-RenlaslRront _ _ Depth _ Height Sq. Ft. Cu. Ft.
Windows &Doors onieezeway Depth Height Sq. Ft. — Cu. Ft.
Type of Construction Est. Cost $600.00 _ To be Completed 1 Month
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 compliance with all provisions of
ordinanoes of the city of Fridley. .
In consideration of the payment of a fee of $ 6 - 00 , permit is hereby granted to 11- Kam
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 andmoving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinaneps_
NOTICE:
'fids permit does not cover the construction, InstailaHon for wiring, plumbing, gas heating, sewer or water. Be core to we
the Building Inspector for separate permits for these home.
.N^
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM: 0" /%7" AlBUILDER:
ADDRESS: ADDRESS:
NO:. /� STREET:
LOT:
BLOCK: _ADDITION
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.
DESCRIPTION OF BUILDING
To Be Used As:
Front Depth • Heig�t:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
.�
Type of Construction: ,Estimated Cost: $�
To Be Completed:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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 : ' 0"_ -�;L 41-- ' �4 SIGNATURE: e/In �G�✓1/�i
(See Reverse Side For Additional Information.)
BUILDING PERMIT FEE SCHEDULE
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 - $2.15 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 any 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.
R
SUBJECT
City of Fridley
77 9 2 3
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
I
COMMUNITY DEVELOPMENT DIV.
r I PROTECTIVE INSPECTION SEC.
I �
= CITY HALL FRIDLEY 55432
NUMBER.
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
4/24,185
JOB ADDRESS 120 Talmadge Way N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
2
2
Elwell's Heights. (Riverside) SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Celest M. Kam 120 Talmadge Way N.E.
571-6295
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, 20' x 5' Garage Addi.ti.on
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide hard surface driveway. Agreement signed by neighbor.
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
$1,219
$, 61
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$22.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$22.61
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
NN,
WHEN PROPERA
-d-LD6 INSP
VALIDATED THIS IS YOUR_P RMIT
O
Si 3N RE OF OWNER IIF OWNER BUILDER] ID EI
R
NEW
[
] City of Fridley Effective 4/1/84
ADDN.
[
] R-1 AND R-2
ATTER.
[
] Building Permit Application
Construction Address: L A aP 9 Q W,+`��
Legal Description: �T #� �-aG1� ;z 4wa4-P s LVE�2#� ( Al Ve-6,51
owner Name & Address: ��,44K-s7—Al 1<4 P) Tel. # 5:21-6996
Contractor: -5A/%F— Tel. #
Address:
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 �ezI Width Height fffy Sq. Ft. /00
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: den, F" N r:-, Estimated Cost:
Approx. Completion Date: c3 /4%.'/167%H
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $
See Back Page for Explanation
DATE: �-' �® APPLICANT: Tel.
CITY USE ONLY
Permit Fee $ ;)a, 00 Fee Schedule on Reverse Side
Plan Check 25% of Building Permit Fee
State Surcharge $ 4?( $.50/$1,000 Valuation
SAC Charge $ $425 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
TOTAL $ Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: 0 ew
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 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
$283.00 for the first $50,000 plus $3.00 for
each
additional $1,000 or fraction thereof, to
and
including $100,000.
$100,001.00 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.
C/ 0) -Tot
�uw coo tar
a LLu
L- d li
AGREEMENT
I, ( u , {f L' a /�lJ. , owner of the property
located at , have no objection to the
City allowing the construction of a to be
located at JAO Tj�.LM J;.,VC, gZ,q-L without the required
certificate of survey that the City ordinarily requires for all new
construction.
W' ess
Address
�z
Daae
SUBJECT
PE
City of Fridley
21892
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
� COMMUNITY DEVELOPMENT DIV.
L _
PROTECTIVE INSPECTION SEC.
1 ,
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
i CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/3/93
JOB ADDRESS 120 Talmadge Way NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
2
Elwell's Riverside Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Celeste Kam 120 Talmadge Way NE 571-6295
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
American Remodeling 3700 Annapolis in, Suite 145 Plymouth 55447553-0020 2406
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 O MOVE ❑ REMOVE
8 DESCRIBE WORK
Soffit/Fascia
9 CHANGEOFUSEFROM TO
STIPULATIONS
a /z/ v .-
C r
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
STALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$4,300
$2,15
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$72.00
Fire SC $4.30
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
License SC $5,00
$83,45
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI
WH ERLY LIDATED THIS IS YOUR PER T
BLOt IN DATE
SIGNATURE OF OWNER OF OWNER BUILDER) IDATEI
Effective 3/1/92
NEW [ 1 CITY OF FRIDLEY
ADDN [ ]
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: � � � �� �� �z
Legal Description:
Owner Name & Address:
Contractor
��e . N LICENSE #
: �/e7 � ,�� M/� �
#
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:
Corner Lot [ ] Inside Lot [) Ft. Yd Setback Side Yard Setbacks
Type of Constructio�� �'�® �" ��,�� Estimated Cost: $
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x $ _ $
DATE: APPLIC
Z__4
$ZL`
Permit Fee $ elf Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $ / $.50/$1,000 Valuation
SAC Charge $ $700 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ j Not Necessary [
TOTAL $
STIPULATIONS:
HEATING
AIR CONDITIONING
AND ELECTRIC, INC.
ADDRESS tat ® 15L 1844-4 e Y a r P f -
OCCUPANT K a m
HEAT LOSS DATE HTG. INST.
SOLD BY + 4 rt.
ElecWcal Work By 1914 -'IC
TYPE OF HEAT GA FA "L HW STEAM SPACE HTR.
MAKE
g�
6 t
GAS RESIGN
er
Model
-0 A
AiDO4
Serial
35"1
A
INPUT
— jj14dQ0
UNIT HTR.
CONTROLS
THERMOSTAT 4c ®(v+I Heat Plug
V21110ia t0h i /v1. -4_ 4 ®69 5
Limit Settin
of N U
APT.
Fan Settl
'� 0
Pilot Type
0-r sad -
A
Pilot Make
R/ kO P
UNIT HTR.
Pilot Model
711-1
Pilot Timing
4S' S aC
L.W. Cut Off
Pressure
o
Percent CO2
Input CFH
Percent Oz
Stack Temp.
Percent CO
Vent Size
,2 ' fc-
KIND OF LINER SIZE NONE
Draft Hood Regulator
Filters Size & ACL 3`X a` Number I
Chimney Location Inside Outside
Chimney Construction
Smoke Bomb Wiring
Draft Test Tag
Door Pressure Lighting Inst
Date Tested
Company Testing
Name of Tester
Pressure Percent CO2
Input CFH Percent Oz
Stack Temp. Percent CO
APT.
FLOOR CITY `' %r SUBURB
OWNER
INSTALLED BY
A
Gas Line ey
%A C
UNIT HTR.
OTHER
Vent Size
,2 ' fc-
KIND OF LINER SIZE NONE
Draft Hood Regulator
Filters Size & ACL 3`X a` Number I
Chimney Location Inside Outside
Chimney Construction
Smoke Bomb Wiring
Draft Test Tag
Door Pressure Lighting Inst
Date Tested
Company Testing
Name of Tester
Pressure Percent CO2
Input CFH Percent Oz
Stack Temp. Percent CO
CITY OF FRIDLEY INSPECTION DIVISION
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
Residential
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace)
-Gas Range
Gas Dryer
Rate TOTAL
$ 30.00 $ ?�o , b u
$10.00 $
$10.00 $.
$10.00 $
*Air Conditioning - All Sizes $ 25.00 $ E. 6y
br\t (D03 "
All Others/Repairs & Alterations (UST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25% of Value of Appliance or Work
State Surcharge
TOTAL FEE,
MINIMUM FEE FOR ANY HEATING/COOUNG/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed. in a side yard without
written permission from adjoining property owner.
Effective On January 1, 1998
JOB ADDRESS
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.
- I U ,1998
OWNER . N\ Ko,. M
BUILDING USED AS d W _LU l Y)q
ESTIMATED COST ';) b " • ( ® PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units I Circle One (Steam) (Hot Water) rm A )
Trade Name '�Ju(0..� Size No. ?)5b MY1 V 0 ?�s b ce
BTU ' M HP EDR
Fuel � r�— Total Connected Load
Burner Trade Name
Size No.
BTU HP EDR
BLAINE HTQi. AX ELECT., INC.
13562 GENTRALAVE. N.E.
HEATING P ANOKA, MN 55304
Signed By I No. -Cp 70-6
Approved ByRough-In Date Final
FILL OUT BACK SIDE FOR.ITAERIFICATION ON
REPLACEMENT FURNACE
CHDINEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been; c,gzghlly examined Yes ( No ( )
2. Is free from Mast or deterioration Yes ( No ( )
3. Has no foreign objects lodged within Yes () No ( )
4. Is securely supported Yes 0 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 (j�)
8. Has combustion air been provided for water heater Yes No ( )
Remarks:
List ALTERATIONS BeingoDone_
HEATING CO:
Signed By:
Date:
BLAINE HTG.A;C ELECT., INC.
13562 CENTRAL AVE. N.E.
Ir
N
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On January 1, 1998
Water Bath:. Wash Drink.. Floor Catch Auto. Gas Gas Misc. Water Heater
Stories Closer Urinal Tub Shower Sink Tray Fount. Drain Basin Washer Appl. Range Fixt Gas Elec
Basement
Floor 1
Floor 2
Floor 3
Floor 4
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
New Fixtures
$ 7.00
Old Opening, New Fixture
$ 4.00
Beer Dispenser
$ 5.00
Blow Off Basin
$ 7.00
Catch Basin
$ 7.00
Rain Water Leader
$ 7.00
Sump/Receiving Tank
$ 7.00
Water Treating Appliance.
$10.00
Water Heater —Electric
$ 7.00
Water Heater — Gas**
$10.00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow Preventer Required ( )Yes () No
_
T, pe � $15.00
l/R)e�i�nlsiction Fee $42. 0/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5%o f Value of Fixture or Appliance -176, ®C)
State Surcharge $ .50
TOTAL FEE $ o. 5ro
JOB ADDRESS
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.
Off+ • '2 � '1998
Owner ( M . k 0.14A
Building Used As 21 S
Estimated Cost PERMIT NO
� j ® .
PLUMBING COMPANY
SIGNED BY eul.4 TEL N0. %9•®;I 7
Approved Byej Rough—In Date Final Date
MINIMUM FEE F R ANY PLUMBING GAS PERMIT IS $20.00
PLUS THE $.50 STATE SURCHARGE
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES.
Building
BUILDING
91 1
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
D c C 112006
DATE
YOUR E-MAIL ADDRESS pe
oe • Crm,
SITE ADDRESS
THIS APPLICANT IS:
❑ OWNER U ❑CONTRA OR
PROPERTY OWNER/
NAME
TENANT
ADDRESS: n CITY
STATE ZIP
PHONE: -� Q
NAME:
CONTRACTOR
Renewal By Andersen
SUBMIT A COPY OF
STATE LICENSE #_ 1920 County Road "C" West
YOUR STATE LICENSE
WITH APPLICATION
ADDRESS: Roseville, MN 55113
-STATE—ZIP—
PHONE
License #20130983
13 SINGLE FAMILY/NF
PROPERTY TYPE
❑ TWO FAMILY/NEW G 651-264-4.777 _ —
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
PERMIT TYPE
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE.
'
SIZE OF IMPROVEMENT LENGTH WIDTH
ROOFING
HEIGHT S . Ft.
NUMBER OF SQUARES
El HOUSE ONLY
❑ HOUSE & GARAGE
BASEMENT
G " .Ec
❑ ATTACHED GARAGE
I.
REnanDEl.rtvr ct rt3M T
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2.
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural embers to be used
13 Vinyl SIDING
❑Soffit
FOR NEW CONSTRUCTION INCLUDING DECKS,
[3 Other
❑Trim
❑ Fascia
ADDITIONS
1.
& PORCHES SUBMIT:
Site Phm/Survey showing the existing structure
and Proposed projectWINDOWS
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
Ai,i. FF.F.0 A10IC sZwC n rvv vA i ., A TTA„
•ti�....w...,.,,. v'%-JuLJA11W11, 111t.LUIVil4ls THE COST OF LABOR AND MATERIALS:
(USING THE I"U .0 FEE SCHEDULE)
'AL JOB VALUATION S � ®� 1 nr�i ro A �t�•� ....�..
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
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)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Citv of Fridlev Attar
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 v
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not t
permit but only an applicatio r a permit and work is not to start without a permit; that the work will be in accordance with the approves
plan in the case of all work w r uire:=Af�
'approval of plans.
SIGNATURE OF APPLICANTP NAME (�<<+�Q �nGn v�� —DATEYP.& (�-----------------------
9
7