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PRE 2010 DOCSa BUILDING PERMIT Village of Fridley, Minn. No 2782 Date Owner ..at 4e Builder Address ..��.....f- .. Address tc� ... �:... cv• LOCATIG OF BUILDING r� .. ....................... No. ..... I: �. s� Street .. ..... .... Part of Lot Lot ... - lock ..�........... Addition or Sub -Division .. 0. .� .'..%4.... ............ .Y...� Corner Lot ............ Inside Lot .... Setback ............ Sideyard .....d ...... DESCRIPTION OF BUILDING To be Used as: ��L�Q lit --A,. Front .ak;�I Depth ..R��-Ieight ......... Sq. Ft..//O.// Cu. Ft. ........ Fr ....... ont ........ Depth ........Height ......... Sq. Fi......... Cu. Ft........ . c.� Type of Construction ?,of -0 -Est. Cost ... ......... To be Completed e.� In consideration of the issuance to me of a permit to construct the building described above, I agro do the proposed work in accordance with the description above set forth and in compliance with all vLsions of ordinances of the village of Fridley. o ......... conside tionodhe payment of a fee of $.. permit is hereby granted to . �_1.�s to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. .... c. uilding Ins ec NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE _ 2z GRAVITY WARM AIR: RATE TOTAL Job Address Furnace Shell & Duct Work $12.00 $ Replace=.ent of Furnace 7.00 $ Repairs & Alterations-up to $500.00 7.00 $ Department of Buildings Repairs &Alterations each add. $500.00 4.00 $ City of Fridley Tel. #571-3450 MECHANICAL WARM AIR: The undersigned hereby makes application for a permit for the work herein Furnace Shell & Duct Work to 100,000 BTU $12.00 S specified agreeing to do all work in strict accordance with the City Codes % each add. 50,000 BTU 4.00 $� and rulings of the Department of Buildings, and hereby declares that all the Replacement of Furnace 7.00 $ facts and representations stated in this application are true and correct. Repairs & Alterations-up to $500.00 7.00 $ Repairs & Alterations each add'. $500.00 4.00 $ Fridley, Minn. 19 STFA.'�I OR HOT WATER SYSTEM: OWNER ' LU Ciel l Boiler &Lines up to 100,000 BTU $12.00 $ KIND OF BUILDING �f s➢'� each adds. 50,00000 BTU 4.00 $ Boiler only up to 100,000 BTU 7.00 $ USED AS each addn. 50,000 ETU 5.00 $ �f ` f 21 TO BE COMPLETED ABOUT OIL BUMER- to 3 gal. per hour $10.00 $ each add. 3 gal. per hour 10.00 $ ESTIMATED COST oo GARS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ 'C?• C' OLD - NEW BUILDING PERMIT NO. PERMIT NO. 17ja r (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: 1st 3 Fixtures x $ 3.00 $ DESCRIPTION OF FURNACE/BURNERAdditional Fixtures x $ 1.00 $ _ Gas Range to 199,000 BTU x $10,00 $ HEATINNG)lr POWER PLANTS, Steam, Hot Water, Warm Air Na. AIR CONDITIONING $ ✓�' /�='� Trade Name ��?�.��� Size No. � FSS HEATING SYSTE:IS See Fee Schedule $ VENTILATING SYSTEMS $ Capacity Sq. Ft. EDR BTU ��i��,e,% �/? HP ALTERATIONS & REPAIRS3 $ State Surcharge $ .50 Total Connected LoadKind of Fuel E, TOTAL FEE S!_ BURNER -Trade Name Size No. ROUGH INSP.REINSPECTION FEE Capacity Sq. Ft. ED BTU HP Date ($10.00) ro,PAJ. JLL''�� FINAL INSP. Date Signed By /� APPROVAL FOR PEYT R*2ALT ' Tel. No. MINIM1.24 FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE SUBJECT PERMIT NO. City of Fridley ®14 AT THE TOP OF THE TWINS PERMIT ` BUILDING : CEIPT No: • COMMUNITY DEVELOPMENT DIV. r ; ,:------, I PROTECTIVE INSPECTION SEC. �I y� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 4/18/78 JOB ADDRESS 7525 University Avenue NE.. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 14 2 Osborne Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Margaret Smith. 7525 University Avenue N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. R. K. Construction Co. 4482 Churchill Street 483-1150 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 X 8 DESCRIBE WORK install exca a Window in basement, h.eating system, 100 amp service, front door, spray ceilings, repair plumbing. 9 CHANGE OF USE FROM TO STIPULATIONS Work done under Community Action Program. SEPERATE PERMITS REQUIRED FOR WIRM HEATING, PLUMBING AND SIGNS. 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. $55Q $ 5Q 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- $7.50. STRUC N OR THE PERF MANCE OF NSTRUCTION. PLAN CHECK FEE TOTALFEE x r k�e� $8.0.0 SIGN UREOFCONTRACTORORAUTHORIZ AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOURPERMIT BLDG. INSP J 1�� DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI CITY OF FRIDLEY ° APPLICATION FOR RESIDER TIAL M.,11 -DING PEIZ14ITS (ND4, ALTLRATIows, Auj)ITIOIJS, OR REPAIRS) t - OVRIBR: ce9e r �, i IMILDER: �i /� ee Address-: 7S`L5 arc iJex rr -f Address: tj&e-k,-1-4 S Tel. No. P10. �% �� Street: 1-a f V e ? `/ LOT: �L��_ BLOCK: � ADDITION: lJ L � i�� il'1 U'L CORNER LOT: INSIDE LOT: _�S� S,,TBACY.: SIDEYARDS: Applicant attach 'to this form J. o Certificates of Survey of Lot and proposed building location drawn on these c(ertificates.� S ° DESCRIPTION OF DLII LDA NG To Fie Used As: e hf,-, 0 r` -i 1' e -^ Front: Depth: Square Feet: C):aic Feet: Prone: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $ 6 -SZ) To Be Completed: )M4 Alt. A Alt. B Pr®posed Driveway Widti If New Opening :s Desired $_ $ (SET: ',ZCVERSE SIDE OF: SHEf T) The undersigned hereby makes application for a pe.—mit 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 repro sentations stated in this application are true and correct. See reverse side for additio/./z�ris.9l in ozonation. Y DATE. li� SIGNATURE: Stipulations: C ��c� BUILDING PERMIT FEE SCIFIEDULE SECTION 2. The Instector 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: NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.. PLAN CHECK: 25 percent of building permit fee. DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) Alternate Removal and replacement of concrete curb and gutter only; Driveway width plus 6 feet x $14.50 Alternate B: Removal and replacement of concrete curb and gutter and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet x $17.20 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 $7.50 plus $.50 state surcharge. 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 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. kA MAN It M-110 KIMIMA 07M 0 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. 01 SUBJECT PERMIT NO. City of Fridley2. 2 3 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 3 f r i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 1'j 612-571-3450 910-F15 4/15/92 JOB ADDRESS 7525 University Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED 14 2 Osborne Manor l.st SHEET DESCR. 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Margaret. Smith.. 7525 University Avenue NE 7845072 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. R & M Associates 3482 Auger .AveWhite_&ear Lake 770-9322 4391 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 Ij REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Reside House. 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. 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 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 $4n 900 $2.45 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 SIC $4.90 TRUCTION THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License S.0 $5,00 $84,35' SIGN OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EN RO RLY V ID D THIS IS YOUR PERMIT LDG iNSP DATE SIGNATURE OF OWNER 0F 0WNER BUILDERI 1DATEI " 01 ,ti:�:.2..:a• 1 w`v. a. _.�.>:. v.. v.a-. . ..a a�..... ..:t:a:.:t:::a..::::::: <: i:.tv:.:.::: c:.:.: v:.2v:.. . ............... ....:'tip.... ..v .... ..:.2v...�<v. v.. v. v... ...., v...... .. .. v..... v.... ..... . v... .....v v.... .v.v ....?t •. NEW [ l Effective 3/1/92 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 7'�'2 LJ �V a V r S a � a v li Legal Description: S r pt, F- Owner Name & Address: �J' Tel. # 7 Contractor: MN LICENSE #Z2 39` Address: el S�2- Zg& `-= �' f LLA ZL G'Pa A _Tel. # 2 - 7 3 2-'C— 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: ef 5, el f h40 L, ,; E f/' s /IiT/ Corner Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: Ft. Yd . Setback Side Yard Setbacks Estimated Cost: $ 4/a ft Driveways Curb Cut Width Needed: Ft. + b Ft = (Cost on Back) Ft x $ = $ DATE: 41'1 -3-- ,��ZAPPLICANT: - ,r% Tel. # CITY USE ONLY Permit Fee Fire Surcharge State Surcharge $ 0c, $ go $ '2-41s- SAC 2.4is:SAC Charge $ License Surcharge $ .� . 00 Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.501$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 [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1991 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR �r Urin I Shover Wash Floor ' Tra . in Auto. Gas 'RanWasher Water Heater Gas7sts Elecores Base e m n Floor 1 Floor 2 Floor 00 3 Floor 4 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Su.mp/Receiving Tank Water Treating Appliance Water Heater -Electric NO. RATE TOTAL JOB ADDRESS Water Heater - Gas Gas Range Gas Dryer Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $5.00 Reinspection Fe00 ,. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of State Surcharge $ .50 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the Building Division, and hereby declares that all the facts and representations stated In this application are true and correct. 199"1- Owner 7'A Building Used As 6Ar. ej, Estimated Cost � -PERMIT NO. a� 061,17 PLUMBING COMPANY SIGNED BY/o—�/' / e ��— TEL NO. 1170 Approved ByaF Rough -in Date Final Date S _ MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 TOTAL FEE $ �� �� PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1993 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR $ 7.00 VtilateC Urinal Beer Dispenser Sower .:::•..<:•::.:•: •: Tray Catch Basin Floor Rain Water Leader Auto WasherStores Sump/Receiving Tank, Gas Water Treating Appliance Water HeaterWash Water Heater —Electric ecuDrain EI Basement $10.00 10.111 Gas Range $10.00 Gas Dryer $10.00 Back Flow Preventer Required ( )Yes () No Type •$5.00 0 FI or 1 '< Flo 2 Floor H. 0 Flo r 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 $7.0 0 Water Heater — Gas 1 $10.00 10.111 Gas Range $10.00 Gas Dryer $10.00 Back Flow Preventer Required ( )Yes () No Type •$5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance I�• 0 o State Surcharge $ .50 TOTALFEE $ JOB ADDRESS -7 AhvE2s rV ,4v,�_ &jE 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. Owner M &P-6 g2[-, T Sm . T h Building Used As Pb rh f Estimated Cost 3 i l 1�g '/ '1993 PERMIT NO. PLUMBING COMPANY SIGNED BY A,cxv TEL N0. J 2l—Uysy �1 Approved By Rough—In Date Final DateY MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SUBJECT T NO. City of Fridley 3 0356 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEI PT NO. � • COMMUNITY DEVELOPMENT DIV. _ r � PROTECTIVE INSPECTION SEC. � «<CCCiii c/ CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY J\ 612-571-3450 910415 10/6/99 JOB ADDRESS 7525 University Avenue 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 2 Osborne 14an.or lst SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mar aret I. Smith 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 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 O ALTERATION X REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (18 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIREO 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 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 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 $1573 $.79 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- $57.05 Fire$ SC STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $1.57 PLAN CHECK FEE 0A FEE $59. OF CON'RaCTOR 0 uTHOR ZEb ENr �Da TES EN P OPERL IOATED IS YOUR PE/RMIT WSI�E /� (�7 OF NEROF OWNER BUWLDE i i0 Ei BL G . parE NEW[ ] ` Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: "t Owner Name & Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: MN LICENSE # Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length q Width Hgt/Ground Sq. Ft. Driveway Curb Cut Width Needed: DATE /Z' Estimated Cost: $ ' Ft. + 6 Ft = Rx $ IN19 APPLICANT: Tel. #_1� qS CITY USE ONLY Permit Fee $ 0' o s Fire Surcharge $ l �! State Surcharge $ SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1050 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 $ BUILDING $ Permit No.: Inspections Fire Surcharge RESIDENTIAL APPLICATION License Surcharge Received By: 763-572-3604 $ CITY OF FRIDLEY $ Date Recd: DATE,-�!JS YOUR E-MAIL ADDRESS $ SITE ADDRESS �a a n ty ey s l %q Imo.. NE f--,ZiJ _,4 114p ,6SLC 3 2 - $ -- THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: i-COT--.! ADDRESS: � '&q(L eyrc �/ - It/ f CITY E2r -6 STAT1�1i�LIP " TENANT PHONE: Le Z 660-39V �- CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE -8 SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ,ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMNIIIJG POOL TYPE OF WORK: ❑ NEw ❑ ADDITION MAINTENANCE/REPAM ❑ REMODELING DESCRIBE WORK BEING DONE: rPt/� SA('d f 6A u.r"d iu S4., to - q -'CJ SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES a' MOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES �� ` aATTACHED GARAGE 2. 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 I. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑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 $ OCCUPANCY TYPE Permit Fee $ Plan Review $ Surcharge $ Fire 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 (.0005) times the total job valuation - Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6 ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work whicli requires reviewpn pproval of plans. SIGNATURE OF APPLIC G `� PR1NT NAME %J$&--tf� % SY-14ff DATE !Z�5