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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N? 2136 Date•, ............................ OwnerBuilder ........................................... Address I� °"� r�`.. ............... Address .. ... ......... LOCATION OF BUILDING No. . ......i4 Street,iv, �­, ...................... Part of Lot ....................... i Lot .......,rBlock .....� ....... Addition or Sub -Division k. ff 1 Corner Lot ....... II, .. Inside Lot ...f ..... Setback ..S Sideyard , To be Used as: Type of Construction DESCRIPTION OF BUILDING Front .. Depth . ,.�;... Height ':. Sq. Ft......... Cu. Ft. ........ Front .# Depth .. .. Height , ., .. Sq. Ft......... Cu. Ft. ........ _�.r..� .. Est. Cost.. .. ,, , , , , , To be Completed , 7 In consideration !'of the issuance to me of a permit to construct the building described above, I agree to do the proposed work' accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. l AI J In consideration of the payment of a fee of $...,�,y, . , permit is hereby granted to ia+.. .. • • • to construct the building'�or" Wdition as described above. This .. is granted upon b&W° on •tionjjthat the person to whom it is granted and his agents, employees and workmen, in all work done in, around and ippon said building, or any part thereof, shall conform in ail, respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repeir: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. P u.. .s a?,uilding Inspector NOTICE: This permit des not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. B,, sure to seethe Building Inspector for separate permits fcr k`hese items. City of Fridley Application for Plumbing and Gas F•N#ing Permit Dept. of Bldgs. Phone 860-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Future Fixture Opening ............... New Fixture Old Opening ............. Catch Basin ...... .................... Water Heater (Up to 99,000 BTU) ..... New Ground Run Old Bldg. ........... Electric Water Heater GAS FITTING FEES: 1st 3 Fixtures ......................... Additional Fixtures .................. x $2.00 $ x $1.50 $ x $1.50 $ x $3.25 $ x $3.00 $ x $3.25 $ s $2.00 $ NO. RATE TOTAL 2 x $2.00 $ 2.00 x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ install (1) gas grill & (1) lite 6QOo REPAIRS & ALTERATIONS—Refer to Code 53-84-x915.51 Location 7553 NE, Universitty Ave. City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn- June 250 1970 1 19_ Owner Dwight Wickland Kind of Building f raMe Used as residence To be completed about sh= 2q 970 Estimated Cost, $20.00 Older New. Building Pe o Perm' By PM t ���� Business Phone No ROUGH Description ................................................$ TOTAL FEE $ 19 00 Q10.42 0 �O F N WATER HTR. GAS ELEG Base 1st 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer Cesspool � PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Future Fixture Opening ............... New Fixture Old Opening ............. Catch Basin ...... .................... Water Heater (Up to 99,000 BTU) ..... New Ground Run Old Bldg. ........... Electric Water Heater GAS FITTING FEES: 1st 3 Fixtures ......................... Additional Fixtures .................. x $2.00 $ x $1.50 $ x $1.50 $ x $3.25 $ x $3.00 $ x $3.25 $ s $2.00 $ NO. RATE TOTAL 2 x $2.00 $ 2.00 x$.75 $ Gas Range to 199,000 BTU .............. x $5.00 $ install (1) gas grill & (1) lite 6QOo REPAIRS & ALTERATIONS—Refer to Code 53-84-x915.51 Location 7553 NE, Universitty Ave. City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn- June 250 1970 1 19_ Owner Dwight Wickland Kind of Building f raMe Used as residence To be completed about sh= 2q 970 Estimated Cost, $20.00 Older New. Building Pe o Perm' By PM t ���� Business Phone No ROUGH Description ................................................$ TOTAL FEE $ 19 00 Q10.42 01 SUBJECT City Of Fridley 32 CRE AT THE TOP OF THE TWINS ' I L ®I N G ❑ [ D � A I BUILDING PERMIT R'�1 r V COMMUNITY DEVELOPMENT DIV. INSPECTION ^� r PROTECTIVE SEC. 1 . . NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-560-3450 910-F15 110/19/77 JOB ADDRESS 7553 University Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 2 Osborne Manor. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bohdan Jankowski 7553 University Avenue N.E. 786-5171 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 E� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 28' x 22' Detached garage aril convert existing garage to living area 9 CHANGE QF USE FROM TO STIPULATIONS provide a hard surface driveway. Remove existing garage door by November 30, 1977. WARNING digging call IOC91 utilities SEPERATE PERMITS REQUIRED FOR WIRINGe Before HEATING, PLUMBING AND SIGNS. TELEPHONE -El�Cl'PtC- GPS Etc. REQUIRLD By LAV' TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Foame 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 616 6160 OR WORK IS SUSPENDED OR ABANDONED FOR. A PERIOD OF 120 DAYS AT R-1 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. $41459'84 $2'22 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- $24.64 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE l'I, $26.86 SIGNATURE OF CONTRA TOR ORALTHO IZEDAGEN (DATE)WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT v� - BLDG. INSP - DATE SIGNATURE OF OWNER (I WN ER BUILDER) (DATE) 01 CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PEMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) I, OWNER: 0 Hb A P k0 LS� bC ( BUILDER: t4 DA) 0 3 /4 0-4b 0 Address: 175-JC3 1 U G 5 i Address: (2 U e, 0, G- T 9 i D Tel. No.: '186-S 171 No.: .5� Street: UAJ IVERS,T-1 oye_ Wry , LOT: J 0 BLOCK: ,, ADDITION: O -SZ O K P (s I I A P 0 i'�- CORNIER LOT: INSIDE LOT: SETBACK: SIDEYARDS: 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: T �- � L� Front: / Depth: � � Height: UST �x 1S —11,0 (e, Square Feet: (U % Cubic Feet: /'o b vet c- Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction/: �Q�Am Estimated Cost: $ .3!��5 7 8y To Be Completed:; �)Q �S � Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. See reverse side for additio al information.I DATE: +'�' G 4 l q- 77 SIGNATURE: 1,� '" ( A Stipulations: ?'m0,0' is r4Alea �fh (0 LIE & IgTi J� V 13 L_ 10 J5L_. I Q',j CILP U 1.111; T§#-I,,$Nj0t4 e%�`ERTP Fl CATE OF SURVEY JAM EM L. MUnTH LACED SU n-VUVOM AM JEFFERSON ST. ME COLUMBIA PCIGHTS 55421 783-9769 O*n'rl.-T THAT THIO CUnVZY. PI.Am. on R:-;,cnT WAS PPM?An=D Dy MM Ort UND=R IMV 01' Z" ---T CUP-=VM01.4 t:,*A'r I A?J A CULY r:=Gf3Tcm=0 LA11,73 cu. -m --van urm=n THM LAW3 C7 TW -P STAT"M 07 A. 7 DATE SCALE I"= IM M22"GISTrIATION NO. 5332 O=1R0Mi NI 0 N UM 2 N T 0 L� Ld LJ V4 • 5- CROWNI "Q'i -L07 10 ?3LOCA4% I 'AN! OKP�\ CO Bklo IS a1 01, SUBJECT PE City of Fridley 28282, AT THE TOP OF THE TWINS BUILDING PERMIT r ` RE O. VCOMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC (_l°A �q i n r 0) ICJ e NUMBER REV GATE PAGE Of APPROVED BY /"'1 CITY HALL FRIDLEY 55432 IL-""A� 612-571-3450 910415 110/16/98 JOB ADDRESS 7553 University Avenue NE ­ 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 2 Osborne Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS IIP PHONE Bohdan Jankowski 786-5171 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 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION O ALTERATION 5x REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house (21 Sq) Tear -off 9 CHANGEOFUSEFROM 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 v OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $1799 .90 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 $56.75 Fire SC $1.80 PLAN CHECK FEE TOTAL FEE 59.45 SiYG NATE OF CONTRACTO OR AUTMORI D AGENT IDATI, WHEN PROPE VALI ATED THIS IS YOUR PERMIT ,'j S-GNATURE NER .I O ER BUILOERI IDATEi 8LOOG INSP IiAlk a1 01, NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION _ ConstructionAddress: 7 5 5-3 � I v r-- 4 5 l �'x a v� Legal Description: Owner Name & Address: A P 6/, ® Ll ,S 1 Tel. # 796-517 Contractor: — 5 ( -- MN LICENSE # Address: 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 GARAGE AREA: Length Width Height DECK AREA: Len Width Hgt/Ground OTHER: t /� F z'iS E- , o) / . Construction Type: P Pi (Ij P ® D - Driveway Curb Cut Width Needed: Ft. + 6 Ft = Sq. Ft. Sq. Ft. Sq. Ft. Estimated Cost: $ / 1-7 (Fee Schedule on Back) Ft x $ = $ f t DATE: L C c APPLICANT:-, l Tel. #766-571? CITY USE NLY Permit Fee $o l Q Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ (' $.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 STIPULATIONS: SUBJECT PERMIT City of Fridley 3133 AT THE TOP OF THE TWINS BUILDING PERMIT P � EIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. iso Q�� y r PROTECTIVE vy CITY HALL FRIDLEV 55432 NUMBERDATE PAGE OF APPROVED BY L 612-571-3450 910-F15=8/24/00 JOB ADDRESS 7553 University Ave NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 2 Osborne Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dan Jankowski 7553 University Ave NE 763-786-5171 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal By Andersen 350 73 Avenue NE, Fridley, MN 55432 612-502-4777 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 20130983 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Replace 5 full frame windows; 1 picture window; a bay window; 8 window inserts within ex st ng openings 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Permit ins eown Cards Will Be Mailed To 140meow, ner To Post SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $17,932 $8.97 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 $293.25 Firo SC $17.93 PLAN CHEC4FE L FEE Lice e$5V 73j25.15 SIGN ATUREOFCONTRACTOR OpAUTHORIZED AGENT iDATE, HEP VALI T O 7H1$ ISR IT 7111 64G oNSP// $,GN A TUAE OF OWNEAiIF OWNER BU40ERi (DATE, NEW [ ] Effective 5/10/99 ADDN [ 1 CITY OF FRIDLEY ALTER [X] SINGLE FAMILY AND DiJP,M R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: x- 55 3 ��'� ®' C,- t �S .d1-e_vA , M K-) Legal Description: Owner Name & Address:`Zp,g� Tel. # � g 6 -� I I Contractor:;_ RENEWAL BY ANDERSEN MN LICENSE # 350 -73RD AVE. NE Address: FRIDLEY, MN 55432 Tel. # ( 612) 502-4777 o LICENSE #20130983 lcatef Survey. of the _..r._____n drawn on it to scale. DESC ,ON OF MUMMENERNT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: I < �o&cu Construction Type: Estimated Cost: $ H-1933 CP Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ - DATE: 8'GQ ..00 APPLICANT: 'CC' \•-e-w' `j 1%a't lQ _ _ Tel. # 953 (0 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 $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 [ ] '000�e4�' 197 ��E: From: City of Fridley To: 763434-4255 Page: 4/5 Date: 1212612006 1:31:00 PM Building MECHANICAL Permit No.;R06'7 06'7 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Dat: A 4fA -2 DATE 7- P O YOUR E-MAII. ADDRESS �P +C k f0 f- a 0 4 O` o� 1'1 y SITE ADDRESS 7 S ,5 � l�Y� 1y� L� i 1 l�y� V THIS APPLICANT IS: O OWNER CONTRACTOR PROPERTY NAME; c,- i &, y- l t 4e_ 1t} ok-r -1- e-1 se OWNER/ ADDRESS: ` S S'-3 lK n . g e. r S t' 1I t ArrY F f . a 1.C. STATE�ZIP TENANT PHONE: A baa '1& S y% ct p CONTRACTOR COMPANYNAME: E CLS 4- 84 -4 -y. -i I+eCl +-s „o, 4 A %r SUBMIT A COPY OF CONTACT PERSON: P -j-i: r ChO u iN tai- .4 STATE LICENSE # 3 / R 6 '77 EXP DATE ' YOUR STATE LICENSE WITH ADDRESS: 1904 0 t) 0 f)W o r. 4 S+- 14 F CITY 0 0- K G I a J a. STATEKAf zIpS 6o 1 APPLICATION PHONE -7 b l 4:1q 11010 FAX -763" 43 4 42-5.s PERAUT TYPE lq SINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: NEW OPMLACEMENT 0 ALTERAnONMEMODEL DETAILED DESCRIPTION OF WORK " (A c r n0.0 A_ PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Co Equipment Installed MFG: M r 4-mek ec MODEL: C 01 K P 41075 P 12-C I STLElBTU �7 E ,®0d MFG: MODEL: SIZE/BTU MFG: MODEL: SLTjBTU A/C $25.00 _FIREPLACE (GAS) 515.00 RANGFJOVEN 510.00 _GAS _AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 GAS GRILL $10.00 _NEW _BOILER $35.00 FURNACE $35.00 UNIT HTR $10.00 _GAS _CHNNEY LINER 510.00 _GAS DRYER 510.00 HEATER 535.00 _POOL __DUCT WORK $10.00 PIPING $10.00 VENTILATOR $15.00 _GAS ;=:;;=:?;;::figi=?i::-;?3sii=>s»:3st<tt;::_:_:_;,>._:�t„_>::.;�- - - Permit Fee $ Number of fixtures (7a, $10.00 x $10.00 = $ Surcharge $ 5 Number of fixtures (7a, $15.00 x $15.00 = $ TOTAL DUE $ ? Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures (a7 $35.00 1 x $35.00 = $ ,S 5 . o 0 State Surcharge = $ .50 Total = $ 3 5,55 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 Cases; 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 offj work which requires�revle and approval of plans. /� a' Com( C" SIGNATURE OF APPLICANT a ��� PRINT NAJ�2+t r t+u rI& r ci DATE `t ®`7 . :::..:.:::::.::: .........._. :Rei¢ -i-1.0 Fii I 1 1 ' .G-' I , Ile -4 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 J )o% Building BUILDING Permit No.. Inspections RESIDENTIAL AIPPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Recd: 763-502-4977 FAX EFFECTIVE 1-1-09 DATE YOUR E-MAII ADDRESS SITE ADDRESS � �� C� in i l z 4/ g e l N THIS APPLICANT IS: ,,OWNER 13CONTRAC YOR PROPERTY OWNER/ NAME: ADDRESS: v A V CITY ` C e se STATE IP TENANT PHONE: ! 7 CONTRACTOR NAME: STATE LICENSE #1 EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE (RSINGLE FAI4IILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE O ADDITION O GARAGE/SHED RWINDOWS O BASEMENT FINISH D ROOF D DRAIN TILE D DECK D SIDING D OTHER D SWIMMING POOL TYPE OF WORK.: D NEW HOME CONSTRUCTION D ADDITION D MAINTENANCE/REPAIR D REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING D HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES D HOUSE & GARAGE 1. Existing Floor Plan GARAGES D ATTACHED GARAGE 2. Proposed floor Plan PROPOSED SIZE: D DETACHED GARAGE 3. List of stmctural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SJM Ann NS & PORCHES SUBMIT: VinylDSofflt 1. Site Plan/Survey showing the existing structures D Aluminum D Trim and propos project. D Other D Fascia 2. Two sets of construction plans WINDOWS Ae�Y BSS WINDOWS `I�Q$tr 718, 3. Energy Calculations IN EXISTING OPENINGS V -Yes ONo LOCATION OF $ OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & d -UMBER WINDOWS TYPE OF WINDOW TO BE INSTALLED OF ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: SIN THE 1997 U.B.0 FEE SCHEDULE) 'OTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 1 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 $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$- Erosion $Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Detemained by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) 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 riNiew and approval of s. hp At _ SIGNATURE OF APPLICANT �„ J,(ey S`3`K32 CIAAv►q e L.) Li �- 2A TO �.Ir.lEcTo2s �� .,c. wa rJE N BLDG SEC R1063-1 I