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PRE 2010 DOCSI AGREEX= AND SWORN STATEMENT 4 . a SUBJECT PERMIT City of Fridley 13024m AT THE TOP OF THE TWINS BUILDING PERMIT r � R EIPT NO. L COMMUNITY DEVELOPMENT DIV. INSPECTION r � PROTECTIVE SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 171791 JOB ADDRESS 7676 Van Buren 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 2 Shaeffer's 1st Addition SHEET 2 PROPERTY OWNER MAIL ADPRESSZIP PHONE George Tsukichi 7676 Van Buren Street N.E. 3 CONTRACTOR MAIL ADDRESSZIP P NE IC Floodmaster Engineering Corp. 1545 Selby St. Pa>i 646292rN 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. Same 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION? ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Cover outside soffit and facigq on house w/aluminum, replace present gutters & downspouts on downspouts, install 14 aluminum anodized storm windows and 1 solid 9 CHANDOMSOVICU storing aoor on house TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. aluminum. 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 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. $1,976.00 1.00 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- 12.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 13.00 SIGNATURE OF frONTRACTOR OR AUTHORIZED AGENT (DATE)HEN R THIS IS YOUR PERMIT, d (Z =TED 00- js— lert-12-?s BLDG INSP DATE SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) 4 . a - •APPLICATION FOR RESIDENTIAL., ALTERATION, OR ADDITION.BUILDING PERMIT CITY OF-FRIDLEY, MINNESOTA OWNER'S NAIME . BUILDER ADDRESS: ADDRESS: NO:. _�f STREET: LOT: _ BLOCK: ADDITION CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates ^f Survey .of Lot. and.propose ' building location drawn on these Certificates. ~ DESCRIPTION OF BUILDING To Be Used As: Front: Depth: Height: Square Feet: Cubic.Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: To Be Completed: Estimated Cost: S 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. DATE: SIGNATURE: (See Aeverse Side For Additional Information.)' 21/3: SUBJECT City of Fridley 2 7 6 7 5 AT THE TOP OF THE TWINS B U I L ®I N G PERMIT a• ' , RECE COMMUNITY DEVELOPMENT DIV. _ v PROTECTIVE INSPECTION SEC. NUMBERDATE REV 9/10/98 PAGE OF CITY HALL FRIDLEY 55432 IL �� APPROVED BY .... �� 612-571-3450 910-F15 JOB ADDRESS 7676 Van Buren St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 2 1 Shaffer's Sub. #1 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Stanford Same 784-0161 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Solomon & Sons 1211 Olive St NW Coon Ra ids 55448 754-5875 20055664 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 ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house 15S Tear -off. 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 I 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 $1,285.00 $.64 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 PROVISI OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $43.00 Fire SC $1.28 S TION R THE PERFORMANCE OF CONSTRUCTION. on PLAN CHECK FEE OT TL FEE Lice se SC .00 $49.92 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EN RD R V LI T NIS IS BL iNSP �7p +IT0 GATE SIGNATURE OF OWNER pF OWNER BUILDERi IDATEI NEW [ ] Effective 1/1/98 ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 A BUILDING PERMIT APPLICATION ConstructionAddress: _ _ %� 11A Legal Description: Owner Name & Address: kAJ .�-� ����-� Tel. P F9 --0/6/p Contractor: 1r),-0 C Ao,/ 4 5- MN LICENSE # j �Lr66c/ ., Address:�2A— // l�/a`� for - C. Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF BIPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: LGS / S7- -9 `6 if;4::- Construction Type: A @ Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 9-0 APPLICANT: Tel. # STIPULATIONS: CITY USE ONLY Permit Fee $ 13,00 Fee Schedule on Reverse Side Fire Surcharge $ 4 o2 D .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ 9-00 00 $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 [ J TOTAL $ `9 9 91� STIPULATIONS: BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such -permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000' $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. 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. City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 Mechanical Permit# 00 �hI N Residential Application City of Fridley See Back Side For Required Information Date—(e:2-0(a Site Address: 74a7Co 1J1,®n , rr e -y\ 51- OF, Theapplicant is: (cirlce one) Owner Contractor Property Owner: -F Address:, 1v -16 UGj v) b u r n!�_, �-(- tO F, City: l State: rnN Zip: Phone: - ® (�a Cell: Fax: Contractor Information Company Name: Contact Person: Superior Heating Air & Electric Address: 3731 Thurston Ave - Suit City: AMPI, MIN 5530,2ip: Phone: (a3 -1731 Cell: Fax: Email: MN Bond# & Exp Date (4q Type of Work circle one)* New lacement Alteration/Remodel Detailed Description of work: - pir rn CL ;L Equipment Installed: MFG:Cc&Acrf Model: ize/BTU: MFG: CLmr�'r=iia,- Model::58'­'xfto?=j� Size/BTU: MFG: Model: Size/BTU: Please check all that apply: _Fireplace (gas) $15.00 New Gas Grill $10.00 J ­A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 Air to Air exchanger $15.00 J_Fumace $35.00 Pool Heater $35.00 _Boiler $35.00 _Gas Dryer $10.00 Ventilator $15.00 _Chimney Liner $10.00 _Gas Piping $10.00 Duct Work $10.00 _Gas Range/Oven $10.00 Permit Fee _ 37 Minimum fee $15 or 5% of cost of improvement Surcharge 0.50 whichever is greater + surcharge Total Due &o $ ® Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical 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 case of all work which requires review and approval of plans. Signature of Appl Approval Inspect . Icant: Date. or Signature:A60Date: y ®I Please Note: Separate permits are required for Building, Plumbing, and Electrical work Revised 6/14/2005 City of Fridley 6431 University Ave NE Fridley MN 55432(7 I '� (763) 572-3602 or Fax (763) 502-4977 1 m - ----Water and Sewer Permit Application ❑ New Connection ❑Utility Line Repair/Relocation V] Existing ❑Water and Sewer Connection Date: Job Address: Name of Applicant (Plumber):(% (2.� Name of Property Owner: © � Al Existing Structure Permit # Permit Type: Sewer Fee: Water Fee: Meter Fee: Repair Fee: 46,0 Relocation: State Surcharge: SAC Charge: Special Assessment Fee: Total: $ 0 Applicant Signature; Inspector approval: ve,ew f- N'e, Fv'�'j fir`( j44 ___ Water Meter Repair — Weekend & Holidays 125/hour Water Connections Permit $50 Sewer Connections Permit $50 Inspection Fee for Water/Sewer Line Repair $40 Special Assessments See Enginee ' Cost of Water Meter See Utility Billing SAC Charge $1550 State Surcharge $ .50 Water Tap See Engineering 04/04/05 I