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PRE 2010 DOCSILI rl�l . Village of Fridley, Minn. g y� BUILDING PERM" O N. 899 Office of INSPECTOR OF BURM NGSowner. II Architect Fridley, Minn., Builder LOCATION OF BUILDING No._ — Street art of Lot Lot } t, Block _ Addition or Sub -Division DESCRIPTION OF BUILDING Front - n Dep t ;+ a Height Stories,$w Manner of Construction rr ° t To be used as ,. - h, ;, To be completed„ir> '`dEstimated Coat Permit is hereby granted to rt ;' Y ^A ! -, ,f; 4 d R Y a the building -- — 4 described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Wnn., regarding the construction, alteration, maintenance, repair and moving of buildings within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. n H' Inspector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permits' I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. me at Fri . e Minnesota, this � � 71 - day orn to before Subscribed and w s� y, ��, day of -AX. 19L— "'add BUILDING PERMIT Village ®f Fridley,Minn. 11T° 182 e Date A-6 +, ±.. ..................... . Owner ....... ,.:adC........ Builder Address ��" "+ +�•, -04 tress ......................................•.. :.fi :`�:'+ LOCATION OF BUILDING No. Street.. .. .. i.. ii .. ,r.'.... Part of Lot .. .......... . Lot ............. Block ................ Addition or Sub -Division ... Corner Lot ......IIS ..... Inside Lot ............ Setback ............ Sideyard . ' . "............ . �I DESCRIPTION OF BUILDING To be Used as: .. Front .., 'a ••=. Depth : , %' :. Height ... Sq. Ft......... Cu. Ft........ . .................I... Front ...... Depth ....... Height .... .. Sq. Ft. ..... Cu. Ft. ........ Type of Construction ,,,� : ; . Est. Cost - :. ... . To be Completed AA 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 thel village of Fridley. • In consideration of the payment of a fee of $.. permit is hereby granted to .... to construct the building o ad dition as described above. This permit is granted upon the express co;1;i1on 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, Minneso a regarding location,,, construction, alteration, maintenance, repair and moving of buildings with- in the village luniits and this permit may be revoked at any time upon violation any of the provisions of said ordinances. / ' ;e - -- -- . ding Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring-, plumbing, gas heating, sewer or wateir. Be sure to see the Building Inspector, for separate permits for these items. 6�� City ®f Fridley, Minn. ° 7723 BURDING PERMIT Date: June 4s 1965 Owner: Phil Betenbauer Builder SAME Address 7331 Van Buren N. E. Address LOCATION OF BUILDING No. 7331 street Van Buren N. E. part of Lot Lot 18 _ Block 4 Addition or Sub -Division Sheers Corner Lot _ Inside Lot Setback — Sideyard Sewer Elevation ____ Foundation Mevation To be Used as: Front Depth Height _ _ Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost 81SQ0600 __ To be Completed Storm damgge Repair 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 21 provisions of ordinances of the city of Fridley. 6,0z:��y In consideration of the payment of a fee of $ 10000 , permit is hereby granted to Rif 08tenbauer to construct the building or addition as described above. This permit is granted upon the expr�dl tion that the done in,and uponsaidFridley, talwithin tmits� permit may be revoked at any time upon violation of any of the provisions of d ordinances. Allen Jensem Building motor NOTICE: ab porn t don not cover the constructioe, kdatieson for wkhm plumbing, gas beating, sower or water. Be ams to we the Buddbig bier for separate psrnft for tbae honm DESCRIPTION OF UILDING� To be sed a Front Dept Reight, Sq. Ft. Cu. Ft. Front Depth Height , Sq.` Ft.' Cu.Ft. ' •Type of Construction " �, Estimated Cost 00 O. To be completed The undersigned hereby makes=.application fox a permit for the work herein specified, agreeing to. do all work in' strict ,*ccordance .with the City of Fridley. Ordinances and -rulings Department of Buildings, and hereby declares .that all the facts 'and representations stated' n'.'tti3 application are true `and' correct: (Schedule of Fee Costs can be found' -on the Reverse Side). - BUILDING PERMIT FEE SCHEDULE 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 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: 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. 2.29 _ For any such permit for the erection of any fire -proof 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 $1.25 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 erection of any non -fireproof building, other than a garage, warehouse, factory or grain elevator, or any non -fireproof addition, for similar occupancy, to any existing building - permit $1.00 for each one thousand cubic feet. GAS 2,4. For any such permit for the erection of any non -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 ($0.90) for each one thousand cubic feet or fraction thereof, in the cubical contents thereof with the 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 per 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 Pewer and Heathul Cooling. Watilations Re igerGOOD and 0 Air Conditioning Sys and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .. ................ .. $10.0o $ Replacement of Furnace .... . 6.00 $ Repairs & Alterations—up to $500.00 6.00 $ _. Repairs & Alterations each add. $500.00 3.00 $—___ MEC*. WARN AIA Furnace Shell & Duct Work to 120,000 BTU ...... .. ..$10.00 $ each add. 60,000 BTU .................... .. lou ; 0 Replacement of Furnace 6.00 $---(—G— Repairs & Alterations—up to $500.00 6.00 $ Repairs & Alterations each add. $5.00 .. .. ... 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $. Furnace Shell & Line—to 640 sq. ft. EDR Hot Water 10.00 $_ Each add. 200 sq. ft. EDR Steam 3.00 Each add. 320 sq. ft. EDR Hot Water 3.00 $_ OIL BURNER—to 3 gal. per hour 6.00 $ over 3 gal, per hour—See Fee Schedule ady 4:r CAB B (up to 1N,000 BTU) 5.00 $ � over 199,000 BW See Foe Schedule G&S FITTING NO RAVE TOTAL 1st 3 Fixtures x$ 100 $ Additional Fixtures x .95 $ Gas Range to 199,000 ��x$$�5,.00 $ IR COMITIONING FAN HEATING SYSTEM FloSchadub VENTILATING SYSTEM ALTERATIONS & REPAIRS TOTAL ROUGH FINAL . a �•� Dept. of BWgL Phone 8®043480 / Locallsn_a�/�G�1' City of Fridley: The undersigned hereby makes application for a permit for the work :hereir 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. /-,\ 'n .,Fridley, Minn- � / 7 . illz_z__ Owner Kind of Building . Used as To be completed about _-- Estimated Cost, Old—New. Building Permit No Permit HEATING or POWER PLANTS -Steam, Hot Water, arm Ain-, No Trade Name size Capacity Sq. Ft. E.D R BTU H.i14'. ZTotal Connected Loa of FueL� BURNER — TradeNamp size No Capacity Sq. Ft. E.D.R BTU NP (REMARKS -OVER) Business Phone No — 7 SUBJECT PERMIT City of Fridley 0 16 7 41 AT THE TOP OF THE TWINS BUILDING PERMIT P REC NO. ' COMMUNITY DEVELOPMENT DIV. 1 PROTECTIVE INSPECTION SEC. t = � CITY HALL FRIDLEY 55432 NUMBER REV. DATE OF APPROVED BY L J\ 612-571-3450 910-F15 8/25/82 FPAGE JOB ADDRESS 7331 Van Buren Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 4 Shaffer's Sub. #1 SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE G. Lucille Osterbauer 7331 Van Buren Stmt N.E. 784-5435 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 12.' x 16' Addition and a 10' x 16' Deck 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PEAM1TS REQUIRED FOR i t Pt uMSIMG ANP Si HATINIG, Be#��g�tR1C Fk TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 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 $3.93 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $7,850 PERMIT FEE SACCHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- NONE STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $68.50 PLAN CHECK FEE TOTAL FEE �� P'.e z $17.13 $89.56 PROPERLY VALIDATED THIS IS YOUR PERMIT SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) �WHEN SIGNATURE OF OWNER 0F OWNER BUILDER). IDAT,E) BLDG )NSP DA CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOfi RESIDENTIAL BUILDING PERMITS (Nett, Alterations, Additions, or Repairs) OWNER: z� � rc &-2 os 6,,- zaz .- r -- ADDRESS: ADDRESS:Cha .4-- P- BUILDER: ADDRESS: TEL N0: TEL NO: Construction Location • STRI=T NO: STREET: IAT: J9® BLOCK: ADDITION: Sh� F% e6e-R-i s Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: /� t Depth: �/ Height: Square. Feet_: Cubic Feet: Front: 1G r Depth: /�, ' Height: 0 l Square Feet: Cubic Feet: 11 yj( oca Type of Construction: %Ci �, Estimated Cost: S 7b Be Oorapleted: (-0 Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: SEE REVERSE SIDE OF SHEET Mie undersigned hereby males 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 Deih-irtment of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. BUILDING PERMIT FEE SCHEDULE The Inspector of buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any Existing building or structure, or for any alteration or"repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and Ln the manner herein provided to -wit: TOTAL VALUATION FEES $1.00 to $500.00 $10.00 Minimum Fee $15.00 plus surcharge $501 to $2,000 $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including $2,000 $2,001 to $25,000 $32.50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and including $25,000 $25,001 to $50,000 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000 $50,001 to $100,000 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000 $100,001 and up $443.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof PLAN CHECK: 25 percent of building permit fee DRIVEWAY DEPRESSION ESCROW: Concrete Curb Streets Only Alternate "A": Removeal and replacement of curb and gutter only Driveway width plus 6 feet x $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 x $15.75 VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be.required before proceeding with the framing. CITY OF FRIDLEY INSPECTION DIV 6431 University Ave NE Fridley, MN 55432 572-3604 L'�- ) t I ! ot, Effective On January 1, 1998 APPLICATI0 ,,� . ;yra PI_JIVRINrl ANrGAS FITTING; PERMIT 7.?31 t/gIl) 8aAp-^j j AJE, j o?�/0 �1 G1 CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 2001 5431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 163-572.3604 REf'RIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS, �� + c -z-faL-� __ P ATE SC,�EDULE OWNER �� L iL � C ►-I C LLC-(om Q) G (z- lesidentiai Rate TOTAL Furnace Shell and Duct Work, Burner - 60 BUILDING USED AS Also Replacement Furnace $ 30.00 $.30' (Side Vent • Fill Out Back) ESTIMATED COST 24,, PERMIT NO. Gas Piping (Needed with new furnace, $10.00 $ tut not replacement) WMIMMSELUM9 AND OR BURNER Gas Range $ i0.00 $ No. of Heating Units Circle One (Steam) (Hot Water)arm Air Gas Dryer $10.00 $ Trade Name�.�y o` ti wCo',< Size No. BTU 4 Qf2Q HP EDR "Air Conditioning • All Sizes $ 25.00 $ Fuel W ar v C� 8 --z;, Total Connected Load All Others/Repairs & Alterations (LIST ON HACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR `.ommorrcial/industrial 1.25% of Value of Appliance or Work $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with tate City Codes an State Surcharge 3 .s0 rulings of the Building Division, and hereby declares that all the facts and � � 3o, representations stated in this application are true and correct. TOTAL FEE $ DATE J Z LI _y OIINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING60 fEFRiCERATION/AIR CONDITIONING PERMIT IS $25.00 31LUS 6 o Z- 7? zt THE .50 STATE SURCHARGE Signed # REINSPECTION FEE $47.00/Hr 'Air Conditioners can not be placed in a side yard without Approved By Rough -in Date Final Date written permission from adjoining property owner. AIR VERI CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 ADDRESS : 7331 VAN BUREN ST NE PIN : 113024140074 LEGAL DESC : SHAFFERS SUB NO 1 : LOT 18 BLOCK 4 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT�20006752 DATE ISSUED: 05/20/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL DRYER AND REPLACE VALVE. # A/C UNITS # FURNACES # GAS RANGES APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304 - OWNER ANN FERREIRA 7331 VAN BUREN ST NE FRIDLEY, MN 55432 0 VALUE OF APPL OR WORK 156 0 # GAS DRYERS 0 0 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regul*ing,con§truction or the performance of construction. HEATING PERMIT MINIMUM FEE 15.00 FURNACE SHELL/DUCT WORK 0.00 GAS PIPING FEE 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 15.50 PAID WITH CHECK # 1009368 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CIT;' OF FRIDLEY BUILDING INSPECTION - 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer :. *6ir Conditioning -Ali Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater e�w Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS -2 / dz'lud Fee Total Owner $35.00 $ Building Used As j $10.00 $ ESTIMATED COST �4° PERMIT NO �- "'`i ` C � $10.00 $ DESCRIPTION OF FURNACE AND BURNER $10.00 $ # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. $25.00 $ BTU HP EDR Fuel Total Connected Load $ Burner Trade Name Size No. BTU HP EDR Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for CommerciaVIndustriaVInstitutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR 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 representation tated in this application are tr/uue, and correct. $ HEATING CO d J Signed.... ✓2�%�a��iG�`2� Tel $ 1�� //' *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE FAX #_ /6/2 2P/ • 3 9 Date Approved by Rough -in Date Final Date 3Loi FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) No( ) The existing combustion air is sized and installed to meet the current codes Appliance #2 Type and manufacturer's specifications. Yes ( ) No( ) When required to install a new combustion air, it will be sized and installed BTU Input to meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's Vent Height specifications. This does include AGA-GAMA Category I Central Furnace Appliance #1 Vent Connector Height Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after ft Length an appliance has been removed from the common vent and vented Appliance #3 Vent Connector Height separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : Building Permit Fee BUILDING See Back Page for Fee Schedule Permit No!- Labs Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604s Surcharge CITY OF FRIDLEY 333 .0005 x Permit Valuation Minimum $SO D 1 763-502-4977 FAX $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow EFFECTIVE 1-1-2010 ft + 6 ft = ft x $24 = $ Erosion Control '11 DATE -Z- 130 j YOUR E-MAIL ADDRESS cc gg SITE ADDRESS 26 t NE I" (-' 1 0 )"IQ Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: TENANT ADDRESS: Vc" EP' $ MF CITY �v lilI STATE��ZIP 't 'L PHONE: CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR[3REMODELING DESCRIBE WORK BEING DONE: 1 G l tol Gl � ' Yi at le Me A( _, - I 00 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT 0 ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE i. Existing Floor Plan GARAGES ❑ ATTACHED 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 ADDMONS. & PORCHES SUBMIT: Other �t7R I �i(o6 v°Psj Fascia 1. Site Plan/Survey showing the existing structures and proposed project. ft JJ 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: G THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ O OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ -100 .001 times the total job valuation Surcharge $ 333 .0005 x Permit Valuation Minimum $SO License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $1 r ,,5 r) I UCI Iq CMake checks pavable to: City of Fridlev 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 on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT Z�`'`g-' A- A .z / PRINT NAME T -114,r 4- 15r;tfW,` y DATE 0 Y/9 r / 10 I PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK