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PRE 2010 DOCSA-4 of Fridley, Nkm. BUEMING PERMIT N° 45 0 Date: Owner: ^ , ` der Address ___ Address ---.••••--•— --- LO ION OF, L .. „ G No. , Street``. +'. Part Lot Lot __ Block ___ _ _ Addition or Sub- ivi!o, Corner Lot __ Inside Lot , _ Setback _�, ,Sideyard Sewer Elevation _ Foundation Elevation DESCRIPTION OF BUILDING T 7be Used Front Depth Height-- Sq• Ft. ,y Front Depth Height Sq. Ft. Cu. Ft. Type of truction Est. cosi To be Completed 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 ordinances of the city of Fridley. 1� In consideration of the payment of a fee of $ , permit: is hereby granted to....._... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is grantedand 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 violaf any of the provisions of said ordinances. x2ia 07 Building Inspector NOTICE: .e This permit does not cover the construction, installation: for wiring, plumbing, gas beating, sower or water. Be sure to see the Building Inspector for separate permits for these items. 4' APPLICATION FOR BUILDING PERMIT CITY OF FRIDIEY, MINNESOTA r s Owner's Name Builder Address No. Lot Corner Loz insiae .4oti f-1-111- aetioacx �� e.� alae—aara�� _, SEWER. ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To beeQsed as: DESCRIPTION OF BUILDING Sq. Ft. Cu. Ft. RAN V Sq. Ft. CU.. Type of ConstructionEstimated Cost ��'� To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE j =:_��SIGNATURE, (A Schedule of Fee Costs can be found on the Reverse Side.) BUI1DING PERMIT FEE SCHEDUIE Section 2. The Inspector of Buildings shall, before issuing any permit for the erection of any building or structure, or for any addition to any existing build- ing or structure, or for any alterations or repairs to any existing building or structure, upon application therefor, 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: 2.1. For any such permit for the erection of any fire -proof building, other than a garage, warehouse, factory or grain elevator, or for the erection of any fire- proof addition, for similar occupancy, to any.,existing building shall be at the rate of $1.40 for each one thousand cubic feet, or fraction thereof, in such cubical. contents. 2.2. For any such permit for the erection of any fireproof garage, warehouse, factory or grain elevator, or for the erection of any fireproof addition, for similar occupancy, to any existing building shall be at the rate of 01.25 for each one thousand cubic feet, classified as "fireproof" by Section 502 of the Minneapolis Building Code. HOUSES 2.3. For any such permit for the than a garage, warehouse, factory addition, for similar occupancy, each one thousand cubic feet. GARAGES erection of any non -fireproof building other or grain elevator, or any non -fireproof to any existing building. Permit $"1.00 for 2.4. For any such permit for the erection of any nor -fireproof garage, warehouse, factory or grain elevator, or for the erection of any non -fireproof addition, for similar occupancy, to any existing building or for each such building or addition. Ninety Cents for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with a minimum of $4.00. For the purpose of computing fees for building permits the cubical contents of any building or addition to a uniform height throughout by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or cellar to the average height of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. 2.5. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 for each Five Hundred Dollars ($500.00), or fraction thereof in the cost of all proposed work. 2.6. In no case shall the fee charged for any permit as set forth in Section 2 be less than $4.00. Application for Pourer Plants and Heating, Cooling, Ventilation, .Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470 GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 It Replacement of Furnace 5.00 $ Repairs & Alterations—up to $500.00 ................... 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ •00 each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ s Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ 50000 GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ 14.50 .:.' ROUGH 4 FINAL City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Amon 9-1_61 , 19 Owner Di Btri Ch– rgM nj a Kind of Building Fxame Used as Residence 10-1-&1 To be completed about Estimated Cost, I• Old. New. Building Permit No. �� Permit No. f DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, _Warm Air—No 1 Trade Name Wes-tingheus^ Size Nom75 Capacity Sq. Ft. E.D.R 7 5M BTU H.P. Total Connected Load 45,815 Kind of Fuel Gas BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Signed FRED Vc)Gy & CC) IDEATING & AIR CONDITIONING By West Lake t. a WE. 9.6767 w 42 2M 7-59 Business PhO& L*8is Pork,. Minnesota HEAT LOSS CALCULATIONS DEPARIWNT "OF BUILDINGS M[INNEAPOLIS. Weatherstrips A Construction No. ation Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Ye— a -19T 119_ ll.1Roonn Length v Width ® bight Ft.l Room Length Width Windoo0i and Doors--Crackage and Area Windows and Doors---Crachage and Area Width Heigh, No. o Ll al it, Area Idth Helsht No. of Linin t. Are No. at paw of pant lights of rock ag. Yt. No. of pane of pane dlsh4a of trot a�. f4. -Itl 1 / �� L It r a �- Coef. Iku I scion I Glan Exp. wad ' o Net exp. wad �. lot. well Ceiling dd' Floor Total Btu. Rewired sq. ft. E.D.R. or sq. init. VV.A. Leader area / .- Infiltration Glan Exp. wall „1 4 Net exp. wall Int. wall Ceding Floor MY! Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area sL F1.1 &aj Rom I Legh a Width // HeiAt r, Windows and Doon--Craclags and Width IIielsht No. of Lineal ft. Area Na of pane of pano lights of crack sq. ft. Infiltration OEM wall ,3. Z Net exp. wall Int. wall Ceiling Tow Btu. - EA PFMW Required sq. ft. E.D.R. or sq. ifis. W.A. Leader area 1 10, .1.I ' I Length Zd- Width W andDoors—Crackage and Arm w dth lelsht No. of Llnoal !. Area o! peso of peso 19shta of trot set. tt._ 0 eS1 i -ll i.... �•� ®� Coef. Btu Infiltration Glass f �-- Exp. wall Net exp. wall / Int. wall Ceiling Floor Total Required rq. ft. E.D.R. or sq. ins. W.A. Leader arra City of Fridley Application for Plumbing and Gas Fitting Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures NI p. F K H Oz N 1�3z W Oux! w t9 ? z O k k N WATER HTR. GAS ELEC. Base 1 1st 2nd _ 3rd 4th • Future Connection Openings I New Fixture, Old Openings Conceded with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... � x $1.50 $ /0 - Future Fixture Opening ................ x 1.20 $ C New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Z• v Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description................................................ $ TOTAL FEE $ Dept. of Bldgs. Phone SII 4-7470 'g /' Location 4 A 7 0— �� .rte.. L �4 City of Fridley: The undersigned hereby makes application for a permit for the work here! specified, agreeing to do all work in strict accordance with the City Ordinancs and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this applicatio are true and correct. Fridley, Min`in 19� r Owner G c Kind of Building Used as r To be completed about 6 X� LLe I ) Estimated Cost, $ / ;_e__Q Old—New. Building Permit No _*57_74,5 Permit No. d Signe v By Business Phone No es f s 3 ROUGH FINAL 42 2M SUBJECT PERMIT NO. City of Fridley AT THE TOP OF THE TWINS P, BUILDING PERMIT 2 3 9' Ir • COMMUNITY DEVELOPMENT DIV. L _ PROTECTIVE INSPECTION SEC. / I` r ; [%� r'-'1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY � , ,•J 612-571-3450 910-F15 4/19/95 JOB ADDRESS 6270 Van Buren Street NE 1 LEGAL LOT N( CK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Irene Henry Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John/Mary Ann Anderson 6270 Van Buren Street NE 571-4838 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. T W Remodeling 9323 Magnolia Lane N Maple Grove MN 553425-9073 1489 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 �❑ El NEW X ADDITION ❑ ALTERATION ❑ REPAIR MOVE REMOVE X 8 DESCRIBE WORK Construct a 14' x 18' Addition to Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. I Before digging call for all utility locations 454-0002 REQUIRED BY LAW 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 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 $14,326 $7.16 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- $162.00 Fire SC $14.33 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE _ License SC $5.00 $188.49 r SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHPPROPE Y VALIDATED THIS IS Y UR PERMIT BOG INSP DATE S.GNATURE OF OWNERIIF OWNER BUILDER) IDATEI NEW [ ] Effective 1/ 1/95 ADDN CITY OF FRIDLEY ALTER [) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: t/,4n®,6a z6- / -57-- tJ E - Legal Description: Owner Name & Address: � t, �o � mlw-" i'A Nli Aw ef�5 4r, --)Tel. # X71 ` A � � Contractor: '• P/- /2 �� r d MN LICENSE # Address: '93,9--3 MA6AjAC4 Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT 1 1 LIVING AREA: Length_ Width Height 1Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: - Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: �� -- Estimated Cost: $�, T Approx. Completion Completion Date: ls� 3 (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ Tel. # DATE: APPLICANT: CITY USE ONLY Permit Fee $ 162, Fee Schedule on Reverse Side Fire Surcharge $ /y, 53 .001 of Permit Valuation (1/10dl%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $850 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: , BUILDING PERMIT FEE SCHEDULE: Thc- Ciricf B1111(fin}; 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 fires to the aniount herein below scat fOrth and in the manner herein provided to -wit: TOTAL VA!_UI: FF -I ---,S $1 to $500 $15 (Minimum Fee is $15 plus surcharge) $501 to $2,000 $15 for first $500 plus $2 for each additional $100 or fraction thereof, to and including $2,000 - $2,001 to $25,000 $45 for first $2,000 plus $9 for -each additional $1;000 or fraction thereof, to and including $25,000 $25;001 to $50,000 $252 for fust $25,000 plus $6.50 for each additional $1;000 or fraction thereof, to. and including $50,000 $50,001 to $100,000 $41450 for fust $50,000 plus $4_50 for each additional 1. $1,000 or fraction thereof, to . and including $100,000 $100,001 to $500,000 $63950 for first -$100,000 plus -$3-50 for each additional $1,000 or fraction thmeof, to and including -$500,000 $500,001 to $1,000,000- - $2039-50 for the first $500,000 plus $3 for each additional $1,000 or fractidn thereof, to and including $1,000,000 $1,000,001 and up $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 "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times S 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 fx-aming- NUNDEaRwGiNuEiaiNG CO.,INC ENGINEERS AND SURVEYORS LAND SURVEYING SOILS TESTING CIVIL b. MUNICIPAL ENGINEERING LANG PLANNING 6418—SGT" AVENUE N. MINNEAPOL15 27, MILAN• KE 7- 3637 41: fe it -t ii 6 n is 411 it 41! 410 IF !i iN n"`► 4v 'r (.-s' I oT t� L- c') -7 X 100.0 Xcnq _ C. ex+�i �^% '�I'JUn'-"• WE HEREBY CERTIFY THAT THIS IS A TRUE ANO CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE LANG ABOVE DESCRIBED ANO OF THE LOCATION OF ALL BUILDINGS, IF AMY, THEREON, ANO ALL VISIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND. MINDER ENGINEERING CO., INC. DATED TN15 O►Y OF N� �r +r' - �� A.0.19�p� ENGIN E 5 � AIM) SURv YOR c by �. CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1997 6431 University Ave NE Fridley, MN 55432. APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work,. Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning — All Sizes All Others/Repai�s & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work JOB ADDRESS_ &2.70 00n &roa 54-. iv f . The undersigned hereby makes application for a permit for the work herein Rate TOTAL 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 $ 30.00 $ representations stated in this application are true and correct. ,1997 $10.00 $ �- / _ OWNER. ado 4-x/ L ML Sq'9 ly $10.00 BUILDING USED AS �Y U $10.00 $ nn ESTIMATED COST PERMIT NO. $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR $ Fuel Total Connected Load State Surcharge TOTAL FEE .50 MINIMUM FEE FORANY 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. Burner Trade Name Size No. BTU HP EDR HEATING COMPANY Signed By 44 Tel No. Approved By Rough—In Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Final Date )� 3J . CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the -existing chimney or stack: 1. Has been carefully examined Yes O No ( } .2. Is, free from rust or deterioration Yes O No ( ) 3. Has no foreign objects lodged within Yes ( No ( ) 4. Is securely supped Yes () No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes O 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, beenprovided for water heater- ..Yes(.,) No Remarks: . _ SUBJECT PER O. City of Fridley 7 AT THE TOP OF THE TWINS BUILDING PERMIT r O. • ______ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC r I NUMBER REV DATEPAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/11/97 JOB ADDRESS 6270 Van Buren Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Irene He SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Anderson 6270 Van Buren Street NE 571-4838 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Panelcraft 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 ❑ ADDITION p ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside House &Garage; 9 CHANGE OF USE FROM TO STIPULATIONS Install building wrap and have inspection for wrap unless manufacturer's specifications state it is not required. 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 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 $3.07 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6,145 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- $124.75 Fire SIC $6.14 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 1 $138.96 SIGNATURE OF CONTRACTOR OR AUTHORIZEDAGENT IDATEI WHEN PROPE VALIDATED THIS IS YOJdR PERMIT BI&G INSD zi DATE SIGNATURE OF OWNER]IF OWNER BUILDER] (DATEI NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 � al D-6 BUILDING PERMIT APPLICATION ConstructionAddress: 4�2%0 Q' 7YCe-"'-/ /Ug— Legal Description: Owner Name & Address: Tel. # Contractor: �12ell-l'qz-*71 Q/ IVIV MN LICENSE # Address: a,*Z0 V-12ell X29 �1/^�f�GL! C �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: Construction Type: U /a/�& `�y Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. +-6 Ft = Ft x $ = $ DATE: APPLICANT: Tel. # Permit Fee $ Fire Surcharge G'J t $ State Surcharge $ O % SAC Charge $ License Surcharge $ 31" 0 Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $-Jig 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 SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE FEES $1 to $500 $21 (Minimum Fee is $21 plus surcharge) $501 to $2,000 $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $1()0;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 i $1,000,001 and up $5012.25 for the first $1,000,000 plus $2.75 for each, additional / $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (^oncrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide, approach with 6 inch depth - Driveway width plus 6 .feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it. has been constructed will be required before proceeding with the framing. Building $ /it BUILDING $ PermitNo.: Inspections Surcharge RESIDENTIAL APPLICATION License Surcharge Received By: 763-572-3604 $ CITY OF FRIDLEY $ AWAY - 010 763-502-4977 FAX EFFECTIVE 1.1-08 $ Sewer Main Charge DATE !75 0 YOUR E�-Me ADDRESS $ SITE ADDRESS Q� s� �� _ g L Jl oI THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: _ ADDRESS: CITY 5_. , _dd� STATE IP i TENANT PHONE -591 " 1451 �>_2� CONTRACTOR NAME: ADDRESS:c7i v (I t?_ L'._ ' 12, ,ve_r i] dP CITY `y� 4 !_STATE E" Y�EIP SUBMIT A COPY OF PHONE q U23—�_T'1 9 9 FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH 2 ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENVTH WIDTH HEIGHT SQ FT ROOFING P� HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING O Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia 2. and proposed project. 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: �y (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ �), �t,(�) - OCCUPANCY TYPE Permit Fee $ /it Plan Review $ Fire Surcharge $ Surcharge $ License Surcharge $-� SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1825 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 navable to: Citv of Fridlev Attac THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and 1 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 1 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 w' I be in accordance with the approved plan in the case of all work which requires review and approval of plans.-. C SIGNATURE OFA ,ANT— � PRINT NAME rig C a'(A� � DATE APPROVED BY PLEASE NOTE: I SEPARATE PERMITS DATE ELECTRICAL AND MECHANICAL W