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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: Z 1,5_71 . . ............. - ............... ... N? 4374 Owner: ...... ............. . .... ...................................... ..... ... . ... . ................... . ................. Builder Address..... .............. . .. ... . ... . ..................... ............. .. . ...... Address ....................... . ... ............. ........................ ...... . ....... . ...... __ ................ ....... LOCATIONF BUILDING ..... . ............... Part of Lot ..... . ............................ . ......... ....... . No. Street .. -......./.....!...... ... 4 ...... * Lot _3 ............. Block ..... ........ ......... :? .................. Addition or Sub -Division Ae, 2. - -...s--------------- Comer Lot .................................... Inside Lot . .................... Setback Sideyard-0/ . 6 e� .. .... ... ......... . ........................ Sewer Elevation ..... . ............................. ............. ............................. . ....................... Foundation Elevation DESCRIPTION OF BUILDING To be Used as: .... A " .. Front el .. Depth -;I....... . .. Height Sq. Ft. .//.-& Cu. Ft. e,-1 .......... .... . .............. ....................................... Front ........................ Depth ........... Height ........................ Sq. Ft . ........................ Cu. Ft....................._.. Type of Construction ........................... ....... . . ..................... Est. Cost To be Completed ............................................ '7_ In consideration of the issuance to me of a permit to construcfnthe building described above, I agree to do the proposed work in accordance with the description above set ,7Z and in comp11 nee provisions of 1 ordinances of the city of Fridley. wit�f In consideration of the payment of a fee of $.............//, pem-dt is hereby granted to .. . ... . ............. I - ... . ... . ....................... 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. -1 - Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. .000.4 CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND 4.00 .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE $ each addn. 50,000 BTU 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 _ d 3 ` GRAVITY WARM AIR: RATE TOTAL Job Address .7 v -3 Furnace Shell & Duct Work $12.00 $ 199,999 BTU $10.00 Replacement of Furnace Repairs & Alterations -up to $500.00 7.00 7.00 $ $ Department of Buildings Repairs & Alterations each add. $500.00 4.00 $ City of Fridley Tel. #571-3450 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STEAM OR IST WATER SYSTEM: The undersigned hereby makes application for a permit for the work herein $12.00 $ specified agreeing to do all work in strict accordance with the City Codes.'. 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the 7.00 $ facts and representations stated in this application are true and correct. 7.00 $ 4.00 $ Fridley, Minn. Boiler & Lines up to 100,000 BTU $12.00 $ each addn. 50,000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ each addn. 50,000 BTU 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ A GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ jCf (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONDITIONING - FAN HEATING SYSTEMS See Fee Schedule $ VENTILATING SYSTEMS $ ALTERATIONS $ REPAIRS $ State Surcharge $_ .50 • TOTAL FEE $- 17.$b ROUGH INSP. LGLtl FINAL INSP. Date APPROVAL FOR PERMIT REINSPECTION ($10.0 l - MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE OWNER KIND OF BUILDING_ USED AS 1,j TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO, 7 DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, r- No. t� Trade Name ®P_ �� Size No. OE'7 4 V1 ecc' Capacity Sq: Ft. EDR BTU Ma HP 22 Total Connected Load Kind of Fuel BURNER - Trade Name Capacity Size No. Sq. Ft. EDR BTU HP Company A o.t, " %RlIC-, Signed By `p Tel. No. W I •+ V sueJEcr SUBJECT PERMIT NO. City ®f Fridley 17 2 AT THE TOP OF THE TWINS BUILDING PERMIT COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. Q r 1 = i CITY HALL FRIDLEY 55432 NUMBER REV GATE PAGE OF APPROVED BY ,'' 612-571-3450 910-F15 1/28/93 JOB ADDRESS 5833 Tennison Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 Parkview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Arthur Moore 5833 Tennison Drive NE 571-0854 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. American Remodeling 3700 Annapolis Ln Suite 145, Plymouth 55447 553--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 ❑ MOVE O REMOVE B DESCRIBE WORK Cover soffit & 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 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 NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 1 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 TOTALFEE License SC $5.00 $83.45 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EN R R Y A.�I TED THIS IS/YOUR PERMIT DG INS BATE SiGNATURE OF OWNER OF OWNER BUILDERI IDATEI •+ V &"�S � ly WGA 6 tel- S�� EtYective 3/1/92 NEW j l ADDN CITY OF FRIDLEY o R ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: cgs .3 Legal Description: Owner Name Address: / '��✓� Tel. # aJ Contractor: g,C4 e "n �� MN LICENSE # Addres �D m � �, s2a— �✓X �i -m ®��!�O' c,�WZ 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: Corner Lot [ J Inside Lot [ J Ft Yd ack Side Yard Setbacks D Type of Construction. - OW � ® r�` �e&0- 1 Estimated Cost: $ Approx. Completion Date: (cost on Back) Driveway Curb Cut Width Needed: Ft + b Ft = Ft x $ _ $ o�(rr 9, C--� � o� Ct Tel. DATE: APPLICANT. 6J Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow CTry USE ONLY $ Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $ o? $.50/$1,000 Valuation $ $700 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ AIL "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary j ] Not Necessary [ ) TOTAL $ _0 STIPULATIONS: �r� PURL . ASE ORDER JDATE',_ DEPART NT ���tiJ F32116 RASED BY THIS NUMBER MUST APPEAR ON ALL CORRESPONDENCE SENT TO US THIS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY SUPPLIER 6-117 kIE :; llmn'bELW60 ADDRESS 3 QDb /7 R) it) A Pe)b S LA) p�s Lea�hDU_. >'Yl ti JJr�7 C I T'Y OF ,� -� f FRIDLEY PHONE NO. ��� � � —bCQV 6431 UNIV. AVE. N.E. ^ FRIDLEY, Mj�N 55432xW CONTACT 'SUE i� _1077_ 1 z— 612-571-3450 PRINTED ON RECYCLED PAPER. PAYMENT VOUCHER BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEN RECEIVED OR RENDERED AND ALL CITY GUIDELINES HAVE BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOW STATED ITEMS. DATE R WED � OeAl PAYMENT fITIORIZED BY , ACCOUNT OTY. UNIT PLEASE ENTER OUR ORDER FOR THE FOLLOWING UNIT PRICE AMOUNT ;�KJIZ LLU Obi 3 &m-- r" , %r A) L 0AJ 'aac -3 VU - 7 o o t 5 / 4-c 'j7/30 l al -ocro • .�©.'-d 00 a/ i// 300 5.00 TOTAL THIS AGENCY HAS AGREED NOT TO DISCRIMINATE IN HIRING PRACTICES ON THE BASIS OF RACE, SEX, COLOR, CREED, MARITAL STATUS, RELIGION, OR NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGES FIRMS AND OTHER AGENCIES WITH WHOM IT PURCHASES PRODUCTS OR SERVICES TO DO LIKEWISE. EXEMPT FROM SALES TAX AS A POLITICAL SUBDIVISION OF THE STATE OF MINNESOTA CITY OF FRIDLEY NO. 8030301 WHITE, VENDOR - YELLOW, PURCHASING - PINK, ACCOUNTING - GOLDEN ROD, DEPT. HD. J SUBJECT PER _ City of Fridley -(21897 AT THE TOP OF THE TWINS BUILDING PERMITRECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. e11 � CITY HALL FRIDLEY 55432 NUMBER REV. GATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/8/93 JOB ADDRESS 5833 Tennison Drive NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 3 2 Parkview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Arthur Moore 583.3 Tennison Drive NE 5710854 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. PanelCraft of Minnesota Inc. 3118 Snelling 721^6628 2179 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 O ADDITION ❑ ALTERATION ❑x REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Sof fit/Fascia/Gutters 9 CHANGE OF USE FROM TO STIPULATIONS Provide adequate attic ventilation. Install smoke detectors as per UBC 1210; adjacent to all sleeping areas and in basement. 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 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX $ l OQ AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING TYPE OF WORK WILL BE O MPLIED IOR $2 , $2, Q0. Fire. SC WITH WHETHER SPECIFIED HEREIN NOT. THE GRANTING OF AS PERMIT {OCC 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- $45,0.0. License. SC $5,00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $53,00: SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN LY DATED THIS IS YOUR PERMIT 6, - BLDG INSP DATE SIGNATURE OF OWNER, IF OWNER BUILDER, IDATEI J i Sal NEW [ ] ADDNJ ] ALTER [ ] Construction Address: Legal . Description: _ Owner Name &wAdd Contractor: Address:` LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Effective 3/1/92 CITY OF FRIDLEY SINGLE FAMILY AND. DUPLEXES R-1 AND R-2 Building Permit Application MN LICENSE # RAseh—to—this applicetiox Cer tate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION j Length, Widt1 ,D Sq. Ft.. Length Widt] u k (_Z1 ® Sq. Ft. Length Widd Sq. Ft. Corner Lot [ ] Inside Lot [ Ft. Yd . Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ CW , ,00 Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ r DATE: hp 3 APPLICANT: Tel. # Permit Fee $i ,on Fire Surcharge $ a State Surcharge $' SAC Charge $ License Surcharge $�, Driveway Escrow $ 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 $700 per SAC Unit $5.00. (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ J Not Necessary [ J 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 $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,00,001 and up FEES $15 (Minimum Fee is $15 plus surcharge) $15 for first $500 plus $2 for each additional $100 or fraction thereof, to and including $2,000 $45 for fust $2,000 plus $9 for each additional $1,000 or fraction thereof, to and including $25,000 $252 for first $25,000 plus $6.50 for each additional $1,000 or fraction thereof, to and including $50,000 $414.50 for first $50,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $100,000 $639.50 for first $100,000 plus $3.50 for each additional $1,000 or fraction thereof, to and including $500,000 $2039.50. for the first $500,000 plus $3 for each additional $1,000 or fraction thereof, to and including $1,000,000 $3539.50 for the first $1,000,000 plus $2 for each additional $1,000 or fraction *thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "An: 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. I Ar SUBJECT City of Fridley 25 1 .9� AT THE TOP OF THE TWINS BUILDING PERMIT Ir RECEIPT NO. COMMUNITY DEVELOPMENT DIV PROTECTIVE INSPECTION SEC. NUMBER - REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 5/29/97 JOB ADDRESS 5833 Tennison Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 1 Parkview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Art Moore 5833 Tennison Drive NE 571-0854 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Midwest Siding & Roofing 18979 Gladstone Blvd, Maple Grove 55311 416-4804 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20010277 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK a ElNEW El ADDITION C3 ALTERATION X REPAIR ❑ MOVE ❑ REMOVE X B DESCRIBE WORK Reroof House (26 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the 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 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 I 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 $2145 9 $1.07 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- $74.75 Fire SC $2.14 STRUCTION OR THE PERFORMAN E 9F CONSTRUCTION. PLAN CHECK FEE XTAL FEE C License $5. $82.96 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEIE PR Y VA D TED THIS IS YOUR PERMIT SIGNATURE OF OWNEROF OWNER BUILDER) FDATEI DG INS DATE I Ar NEW ( ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: _ S q 3�3 l Legal Description: Owner Name &Address: rn Mr 3 1 S (M Tel. # 5 -71 — O F S Contractor: 1 DQ MN LICENSE # a00 I D a Address: B Tel. # Attach to this application, a Certificate of Survey of theF� . 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/Gr and Sq. Ft. OTHER:�� Construction Type: 8 Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: � Z APPLICANT: Tel. # 4 l L.p L- p V Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control 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 PERMIT FEE SCE#EDUI.I; 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 $625 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 $1,000,000 31,000,001 and up $5012.25 for the first $1,000,000 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. .Niternate "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 "eview of the proposed structure and of the construction site. %.Certificate of Survey of the lot, showing the location of the foundation <mce it has it has been construe° :{ k)e required before hrOccedwith the frainin<g. 410N. LAKE ST. MINNEAPOLIS, MN 55408-2988 612/824-2656 (LCREATINGAMAIRMNI)ITIONING Swwiiv rho 7wn cities Siam 193r ORSAT TEST RECORD ADDRESS 5,F-5 CITY _ OCCUPANT OWNER��� DATE HTG. INST./' "�7 INSTALLED BY -' - ;` . e 'r2 GAS LINE BY TYPE OF HEAT: GA FA k HW STEAM SPACE HTR. UNIT HTR. OTHER CONVERSION OF BURNER BTU RATI OFACE CONTROLS 'l'" THERMOSTAT HEAT PLUG S4/A � WENT SIZE 'Vol VALVE KIND OF LINER SIZE_.5— NONE LIMIT DRAFT HOOD REGULATOR LIMIT' SETTING ", CHIMNEY CONSTRUCTION s ,���.✓ FAN "SETTING DRAFT,� EST T G n4g5; PILOT TYPELIGHTING INST. PILOT MAKE PILOT MODEL PILOT TIMING PRESSURE r �� / PERCENT CO2 . ,�^ DATE INPUT CFH ® PERCENT 02 STACK TEMP._PERCENT CO NAME TESTED W1 OF G S DESIGN MAKE MAKE MODEL MODEL SERIAL MAX. INPUT C> 0 MAKE CONVERSION OF BURNER BTU RATI OFACE CONTROLS 'l'" THERMOSTAT HEAT PLUG S4/A � WENT SIZE 'Vol VALVE KIND OF LINER SIZE_.5— NONE LIMIT DRAFT HOOD REGULATOR LIMIT' SETTING ", CHIMNEY CONSTRUCTION s ,���.✓ FAN "SETTING DRAFT,� EST T G n4g5; PILOT TYPELIGHTING INST. PILOT MAKE PILOT MODEL PILOT TIMING PRESSURE r �� / PERCENT CO2 . ,�^ DATE INPUT CFH ® PERCENT 02 STACK TEMP._PERCENT CO NAME TESTED W1 OF CITY OF FRIDLEY INSPECTION DIV. 643T University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE EffectiveQn January 1, 1997 APPLICATION FOR POWER PLANTS AND HEATING, COOUNG, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Residential Rate TOTAL Furnace Shell and Duct Work, Burner – Also Replacement Furnace $ 30.00 $ ZLV0 (Side Vent – Fill Out Back) Gas Piping (Needed with new furnace) $10.00 $ %p, od Gas Range $10,00 $ Gas Dryer $10.00 $ *Air Conditioning – All Sizes $ 25.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ Commercial/industrial 1.25% of Value of Appliance or Work $ State Surcharge .50 TOTAL FEE y0' S -V MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION 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. e ,'fit JOBADDRESS S. The undersigned hereby makes application for a permitIcAhe 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.aft-he facts and representations stated in this application are true and cbrreef. OWNER BUILDING USED AS ESTIMATED COST PERMITNO� DESCRIPTION OF FURNACE AND OR. BURNER No. of Heating Units__ Circle One (Steam) (Hot Water Warm Ai� 'r) Trade Name Size No. ; 3 BTU_ ! G , ®� HP EDR Fuel— Total Connected Load x Burner Trade Name Size No. BTU HP EDR`: RARDARD RA°fUG A�D AIR IW{1Y e" I",i6 Da 410 WEST LAKE STR W. RMEAPOL(s, MN HEATING COMPANY 612-824-: Signed By ell.L., % Tel No. a Approved By Rough–In Date Final Dai. FILL OUT BACK SIDE FO STACK VERIFICATION ON REPLACEMENT FURNACE P } CHEMMY AND STACK VERIFICATION The undersigned hereby verifies that the -existing chimney or stack: 1. Has been carefully examined Yes {) No ( ) 2. Is free from nest or deterioration - Yes O No ( ) 3. Has no foreign objects lodged within Yes O No ( ) 4. Is securely supported Yes () No ( ) 5. Meets all current Cale 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 ( ) 1'�Ii'm List ALTERATIONS Being Done: HEATING CO: Signed By: t� a Date: Building Permit Fee BUILDING See Back Page for Fee Schedule Permit No.: _-0,44 $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ RESIDENTIAL APPLICATION License Surcharge Received By: 763-572-3604 SAC Charge CITY OF FRIDLEY $1550 per SAC Unit (Plans to MWCC for determination) Date Rec'd: DATE_/"o - 0(- YOURS-MAILADDRESS A494CS 7,0-60- d-0-SITE Erosion Control SITEADDRESS _5b 33 -'_s6, % V1 Z $450 Conservation Plan Review THIS APPLICANT IS: ❑ OWNER 000NTRACTOR Fee Determined by Engineering PROPERTY OWNER/ NAME: 5; t9d ✓Je-5 Agreement necessary ( ) Non Necessary ( ) ADDRESS: _"5B33 CITY o� STATWd-lP 3- TENANT PHONE:/2 -4108 CONTRACTOR NAME: 6d1f STATE LICENSE # o7d5 Z ff e V 3 EXP DATE o3 ^ 3 / ""7 SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: YOV3 T 2 >_f,0, S°i. AJiF- - CITY WITH APPLICATION PHONE Z- a -$ 70 FAX U.6 PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISHROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: D NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR WREMODELING DESCRIBE WORK BEING DONE: 7e_owo � �/� ly J�� r r� ," C SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES C2 ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE I. 2. Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WENDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 197 U. $.0 FEE SCHEDULE) TOTAL JOB VALUATION $ S . OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ (. .0005 x Permit Valuation Minimum $.50 License Surcharge $ $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 $ - Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for 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 wh'*h,�rect!i Ss review and approval of plans. SIGNATURE OF APPLICANT /`� 9 " PRINT NAME N; Lk- &L JALj f n JZ iP DATE /® -- aB 0 f, I