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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® 3262 Date: ...... / ................. . Owner ....................................... Builder ........................... Address...................................... Address ............................................. DESCRIPTION OF BUILDING To be Used as: .::........ Front .1 ..�.. Depth Height ....0 ... Sq. Ft 04... C�. Cu. Ft .................... ,Front .. , ..... Depth ........ Height ........ Sq. Ft......... CtL Ft. ..... of Construction .. l Cost. ��`.: ' To be Completed !.:..:.. Type .............. .......... mp ,�a..�: .. In consideration of the issuance to me of a permit to construct the building desribed 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. 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 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. .. ; ............ .j� ...: BuildiiN Inspector NOTICE: IThis 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. LOCATION OF BUILDING r No. .... ` Street .. g� ... :...' �....:.................. Part of Lot ................. .. ...... � ( 1 Lot ......... ... Block .... ........ .� .. � Addition or Sub -Division t �. . .. .. °� Corner Lot ... Inside Lot ............ Setback .... Sideyard ' . . DESCRIPTION OF BUILDING To be Used as: .::........ Front .1 ..�.. Depth Height ....0 ... Sq. Ft 04... C�. Cu. Ft .................... ,Front .. , ..... Depth ........ Height ........ Sq. Ft......... CtL Ft. ..... of Construction .. l Cost. ��`.: ' To be Completed !.:..:.. Type .............. .......... mp ,�a..�: .. In consideration of the issuance to me of a permit to construct the building desribed 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. 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 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. .. ; ............ .j� ...: BuildiiN Inspector NOTICE: IThis 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. City of ]Fridley, Minn.. BUILDING PERMIT N° 5657�� Date: �.. Ile Owner: Builder Builder Address _____ __ Address OC�►TION �O_F� DAG No. ___ Street Z_Fart t Lot Block Addition or Sub 'melon - -- -- Corner Lot Ins!de Lot .aback !- Sideyard Sewer Elevation __ _ _Foundation Elevation ... _ - DESCRIPTION OF BUILDING U d as: FrontA/ Depth _ Height Sq. FL%J;VCu. Front Deptht Sq. Ft.. Cu. Ft. _ Type of Construction Est. _ 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. In consideration of the payment_ of a fee of S'— , 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 granted and his agents; employees and workmeni' 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 vigWa on of any of the provisions of said ordinances. ,O'"""'t A, A / 1, Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to am the Building Inspector for separate permits for these items. .QW4 APPLICATION FOR BUILDING PERMIT (ITY OF FRIDLEY, MINNESOTA Owner's Name t e as" c� Builder l r' ter' ' 47/42 s Address �� -i:5� -1tip. Address ✓,lo-gri �✓ i�rn�c! �� v____ ---- LOCATION OF BUILDING No. Street Part of Lot,____ Lot Block Q'�' Addition or Subdivisio.(2 Corner Lot Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION this form Certificate of Survey of Lot and proposed building Applicant attach to s y P P location. DESCRIPTION OF BUILDING To be 19' Deoth --2 Z Height -7 Sq. Ft. --- ®r % Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. ted Cost 4 0 To be Completed The undersigned kereby 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 �' �/ SIGNATURE AV (A Schedule of Fee Costs can be found on the Reverse Side.) ��/� Date: JUNE 18, 1965 BYRON JOHNSON �.; t Builder N? 7959 IMPERIAL GARAGE BUILDERS Address 6862 Washington St. N. E. Address 12483 - 73rd Avenue North Osseo, Minnesota. LOCATION OF BUILDING No. 6862 Street Washington St. N. E. Part of Lot Lot 4 Block 2 Addition or Sub -Division Rice Creek Terrace, Plat 6 Corner Lot Inside Lot Setback Sideyard Sewer Elevation Foundation Elevation To be Used as: Type of Construction Front • Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Est, Cost _$16, 000.00 __ To be Completed REGUILD HOUSE ON ORIGINAL FOUNDATION 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 ail provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ l o. oo_ , permit is hereby granted to SERIAL GARAGE BUILDERS 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ALLEN G. JENSEN Building Inspector NOTICE: M penal! dos not cover thm cendrucKen, kdatWon for whdag, plumbing, ga hmating, sewer er water. Bo wre to sem dm Bulldlag WspKter for separator permits ler than ammo APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, xxNNE OTA OWNER'S XM BUILDER ADDRESS a _� DRESS LOCATION OF BUILDING No. 4 x� :2., —street—&4/4 , � � ��:� � Part of Lo LOT _,BLOCK Z. ADDITION OR SUBDIVISION Corner Lot Inside L0T ,,),_Setback Side -;Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To be used as: DESCRIPTION OF BUILDING Front -9/7Depth,- 2 — eight Sq. it. / Z,f Cu. Ft. /e /s Zd Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost SAP 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 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 �% . (Sch ule of Fee Costs can be found on the Reverse Side). K Date: November 2, 196 Address 686: I'`.. #.._ng on "I. N.E.Address 8 • A3ramjn-:L— Osseo LOCATION OF BUILDING N° 8582 No. _686____ Street Washi Mgt= StrG rst BLE - Part of Lot Rear Lot 4 __ Block 2 Addition or Sub -Division .RLS0 Greek Terrace Mal 6„ Corner Lot —_ Inside Lot _ Setback 71' —_ Sideyard 7 t Sewer Elevation ._ . — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: D.rjAr. (re ui 1d)Front _24 _ Depth _ 22__._ Height _ID Sq. Ft. 528 Cu. Ft 5,280 Front Depth Height _ _ Sq. Ft. Cu. Ft. Type of Construction Frame_ Fast. Cost To be Completed 11-.1.5-65 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 ort and compliance wi provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of S .QQ , permit is hereby granted to Imperial -G=age Punier' 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinanoes. NOTICE 'lids pennh dna not ao"r the sonatrue8on, butdlation for whfng, phnnhing, gas heating, serosa or waMr. of sure to am the Building kqm for for apmft para is for than home, OWNER'S APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA LOCATION OF BUILDING Hd•�� Street A5MiAj&$®ti Part of Lot LOT BLOCR_�_r ADDITION OR SUBDIVISION T1Cg ;rwjnL Corner Lot 'Inside LOT ,Setback 71 4c,/Side-Yard SEWER ELEVATION FOUNDATION ELEVATION 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 - Front Depth,.Height /-r� Sq. Ft. /"'cu. Ft ._ . r' Front Dept Height Sq. Ft. Cu. Ft. or Type of Construction el Estimated Cost �° �AO- 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 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. NO (Scheduleof Fee Costs can be found on the Reverse Side). e 7® AY 4 BUn.D.T.I+IG , PMWT �"! _.SCHEDUt•E ' SECTION _2. The ns ector of Buildings shall, before issuing aygAit for the erection of any building or structure, or for any addition to any existing build- ing or struct 're, or for any alterations or repairs to any existing building or structure, upo� application therefore, require the payment by the applicant for such permit of tees to the amount herein below set forth and in the_..manner'hersin_ provided to -wilt: 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 a7ch cubical contents. 2.2, For any such permit for the erection of any fire -proof garage, Waxehouse, factory or.grain elevator, or for the erection of any fire -proof addition, forlsimilar 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 arage, 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. GARAGES 2, .4. IFor any such permit for the erection of any non -fireproof garage, warehouse, faetory-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 audition - 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 purpo a of computing fees for building permits, the cubical contents of any buildingor 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 theJroof surface of the main gable of a pitched roof. 22.5. For repairs or alterations to an existing structure, the fee.shall be at the rat 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. 19°p 6700m6ae owfe 12483 73rd AVENUE NO. RT.2 OSSEO, MINNESOTA PHONE 425 - 2818 I 60 fvllel A N e AJ ci s �o 4 ►c z �lC� �r2E C kc A CC A . • 1� SUBJECT PER City of Fridley 3 499 AT THE TOP OF THE TWINS BUILDING PERMIT COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. �/�� r PROTECTIVE (/ E � i 1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 11/10/99 JOB ADDRESS 6862 Washington Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 2 1 Pdce Creek Terrace Plat 6 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Byron Johnson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings Contr. 6331 Riverview Ter NE Fridley 55432 574-9966 4051 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 O NEW 0 ADDITION 0 ALTERATION KK REPAIR 0 MOVE 0 REMOVE B DESCRIBE WORK Reside west sides of house and garage 8 CHANGEOFUSEFROM TO STIPULATIONS Call for building wrap inspection before covering. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN SO 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 $1500 $.75 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 $54.00 A Fir SC 1.50 p PLAN CHECK FE TOT F E a ! a Lice S $5.90 .25 SIGNATURE OF CONTRACTOR ORA HOR,ZED AGENT ,DATE, EN P OP ALIOA IS IS YIPU MIT Di SIGNATURE OF OWNEROF OWNER BUILDER, ,OATEN BI OG NSP MATE w 4 NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 , L - �" BUILDING PERMIT APPLICATION �J ®v[ C �(} J Construction Address: 63L L e;,d4s�.`n��Aty Legal Description: Owner Name & Address: TyA AAs oAt Tel. # Contractor: /��,A A iZZ) A "f A `c S MN LICENSE # J/2a S% Address: ejs j K, up Z a, C —FEZ Tel. # S ,;"K -i f e6- Attach 6Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: fD A: Type:_ DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. WA LLs a- J�zi� Estimated Cost: $ 1 So Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: ZIlr �'f APPLICANT: s- Tel. #. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ 'Soo 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 [ ] CITY OF FRIDLEY PERMIT NO. 2004-00691 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/12/2004 572-36U4 k'AX: (763) 571-1287 ADDRESS : 6862 WASHINGTON ST NE PIN : 143024120037 LEGAL DESC : UNAVAILABLE WATER TREATMENT APPLIANCE LOT BLOCK PERMIT TYPE PLUMBING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION : $ 200.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL AN ELECTRIC WATER HEATER. # ELEC WATER HEATERS 1 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 # WATER TRMT APPLIANCES 0 APPLICANT H P PIPEWORKS 3670 DODD RD STE 100 EAGAN, MN 55123- (651)365-1340 OWNER JOHNSON BYRON E & M[ARILOU 6862 WASHINGTON ST NE FRIDLEY, MN 55432 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 wort 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 regulating coiAtruction or the performance of construction. Anl�f n - Date PLBG PERMIT MINIMUM FEE 0.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 PLBG REPAIR/ALTERATIONS 0.00 WATER HEATER - ELEC 35.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 8783 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 51432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 -101 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT �P-`o MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures $10.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $10.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $10.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $10.00 and representations stated in this application are true and correct. Catch Basin $10.00 Rain Water Leader $10.00 DATE: , 200el_ Sump/Receiving Tank $10.00 L Water Treating Appliance $35.00 OWNER Water Heater -Electric _� $35.00 35, Water Heater - Gas** $35.00 BUILDING USED AS Gas Range $10.00 u Gas Dryer'` $10.00 ESTIMATED COST - PERMIT NO. O " Back Flow Preventer Required( )Yes O No ®�' /� Type $15.00 PLUMBING COMPANY ,moi( (v` z.,e��.Gr1�aJ Reinspection Fee $50.00/Hr SIGNED BY TEL NO., ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge MINIMUM FEE FOlk ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $96� OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. � COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. "PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMM®N VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION I 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 alsq 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 O No( ) The existing combo§tion air is sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No( ) When required to ins II a new combustion air, it will be sized and installed 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 assemblyj 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( ) Is the common vent and vent connectors sized and installed correctly after an appliance has bee removed from the common vent and vented separately as per current codes. Yes ( ) No ( ) Appliance Tvpe 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 I Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Cgnnector 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 $ AJC) BUILDING Plan Review Permit No.: O7 v Inspections Fire Surcharge RESIDENTIAL APPLICATION Received By: 763-572=3604 $ , 75 .0005 x Permit Valuation Minimum $.50 License Surcharge DR 4 07 $5.00 (State Licensed Residential Contractors) SAC Charge CITY OF FRIDLEY $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow DATE YOUR E-MAIL ADDRESS ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review SITE ADDRESS (4&�a 2- AS%I'llliL! cJ S7 AI — $ rHIS APPLICANT IS: ❑ OWN OCONTRACTOR $ PROPERTY OWNER/ NAME: Ay v se $ 0 •eta TENANT _ ADDRESS: LcrrL &zA41;� eJ CITY I STAT° ZIP4 ,3Z PHONE: -'17 S 7 I 51? --7L/ CONTRACTOR NAME: L /G�✓ v SUBMIT A COPY OF STATE LICENSE # S EXP DATE 3 YOUR STATE LICENSE ADDRESS: Z 41 ct 07}F I -A) � CITY// m -e- STATFAZIPy� WITH APPLICATION PHONE FAX % 3 PROPERTY TYPE ❑ SNGLE FAMILYNEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERNIIT TYPE ❑ ADDITION ❑ GARAGEISHIDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWINDANG POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: "OV& S >c G✓ b SIZE OF IMPROVEMENT LENGTH WIDTH IV HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vmyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WEVDOWS 2. Two sets of construction plans IN EXISTING OPENINGS 491i'es ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & ^ TYPE OF WINDOW TO BE INSTALLED I�JIJ ' 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 $ AJC) See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ /, �Sb .001 times the total job valuation Surcharge $ , 75 .0005 x Permit Valuation Minimum $.50 License Surcharge $ IJ -D $5.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 0 •eta Make checks payable to: City of Fridley 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 or s and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an appli ption f a e an ork is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work w ' r s d approval of plans. /)-� s Qj 6 / f� f� 7 SIGNATURE OF APPLICANT PRINT NAME 1'� (t�16 l { DATE