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PRE 2010 DOCSA i Village of Fridley,, Minn. a ING PERM" �T lr 190 Office of INSPECTOR OF BEINGS Owner `t t L L 4q Y - e a � Architect Frid'.ey, Minn., � � 4• � 19' --r Builder i ( LOCATI OF BUILDING No. I Street Part of Lot Lot (Block Addition or Sub -Division { DESCRIPTION OF BUILDING Front Depth Height-' Stories.Manner of Construction To be Tobe '±)Estimated Cost used as - completed . d AL °-- ii V to Permit is hereby granted d , described in the above- statement. This permit is granted {tion the building upon the expres con t the person to whom it is granted, and his agents, eImployees and workmen, in all the work done in, arpund and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Pridley, 34nn., 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. l f Inspector of Buildings. AGREEMENT AND SWORN STATEMENT •(C; In considerate n of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description , being first duty above set forth a according to the provisions of the ordinances of Fridley, and, sworn, I hereby s to and say, that the facts stated by me and contained in the above permit are true as therein tgz-� ��7 id Subscribed and worn to before me at Fridley, Minnesota, this day o t ��'' A.D. 19` 4 . A SUBJECT .p R . City of Fridley tit 18642 AT THE TOP OF THE TWINS BUILDING PERMIT P REC&ET •_ COMMUNITY DEVELOPMENT DIV. U.r PROTECTIVE INSPECTION SEC. I 1 1 1 "1 CITY HALL FRIDLEY 55432 t NUMBER REV. DATE PAGE OF APPROVED BY ,.j 612-571-3450 910-F15 9/12/86 JOB ADDRESS 4757 - 2nd Street N.E. 1 LEGAL LOT NO. Pt. 29,3 BLOCK 6 TRACTOR ADDITION SEE ATTACHED Plymouth Addition SHEET DESCR. 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Kenneth S.Ochocki 4757 - 2nd Street N.E. 572-8939 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'251 x 164 Living Area Addition 9 CHANGE OF USE FROM TO STIPULATIONS Provide hard surface driveway for existing garage. variance approved on 8/26/86. AIG Bef"e digging calf: I OW utiluips TELEPHONE - ELECTRIC SEPARATE PERMITS GAS Etc. REQUIRE F �E '��tIIRING, HEATING, FOR REQUIRED �Y PLUMBING ��` ANIS SIGNS. 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 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 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 $10.88 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $21,750 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. $152.50 PLAN CHECK FEE TOTALFEE $ 38.13 $201.51 SIGN TUREOFCONTRACTORORAUTHORIZEDAGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT ZIP L oy SIGNATURE OF OWNER OWNER BUILDER) (DATE) v BLDG )NSP )ATE NEW [ ] City of Fridley Effective 4/1/80 ADDN. [ ] R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: 41-7S--7 Legal Description: Owner Name Address: .S° ®�#®r rli�� 75'� ��- A Tel. # Tel. # Contractor: Address: 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. Zo 0 GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width _______ Hgt/Ground Sq. Ft. OTHER: Corner Lot 54 Inside Lot [ ] Ft. Yd. Setback _ Side Yard Setback Type of Construction: Estimated Cost: Approx. Completion Date: ZAP /yi 11 1 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: �% /� 6 APPLICANT: Tel. Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sever Main Charge TOTAL CITY USE ONLY $ IS2. Fee Schedule on Reverse Side 25% of Building Permit Fee $ 0. $.50/$1,000 Valuation $ "ft% $475 per SAC U ni t $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] t CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures p $ 5.00 U Future Fixtures X d $ Water w $ 1.50 m •-1 Beer Dispenser till $ 4.00 $ q um $ 5.00 $ N p, u. $ Rain Water Leader Heater •.i N y W Hydraulic Valve $ 5.00 $ Sump or Receiving Tank �•Rt1 43 Gl pH .0 •pN W it $ Hot Water Heater 4 $ 5.00 $ Gas Range O $ t�ppr�ny $ 10.00 N ••� O O O a� N t� .N.{{ roNro �C f�N A U P fA GA y 3 W 1�A W U GQ 3 Cro7 £ C7 O as leC 1st 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (") = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type S 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ t -(S)(, State Surcharge S .50 Reinspection Fee $ ($15.00) TOTAL FEE Effective Date May 1, 1988 Job Address Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. �0`--50 , 199 U OWNER L'O S (L KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ( G --�1 G - cj U ESTIMATED COST -2S cz:(7 , Q C) OLD - NEW BUILDING PERMIT NO. PERMIT NO. ® /( ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT Company Signed By Minnegasco #342-5,31! 700 W. tinden enua Tel. No. P. 0. Bnx 1 i 6;; Minneapolis, MN 554.4:: : ;_, MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE SUBJECT City ®f Fridley 31290 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. ' COMMUNITY DEVELOPMENT DIV. � LV __ •___ INSPECTION SEC. � r � PROTECTIVE 11__.` CITY HALL FRIDLEY 55432 '•j NUMBER REV DATE PAGE OF APPROVED BY .' 612-571-3450 910-F15 8/8/00 JOB ADDRESS 4757 2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 29,30 6 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kenneth ®chocks 4757 2 Street NE 763-572-8938 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 j1 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remove 16' x 20' Garage; Construct a 2:21' x 22' Garage 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. Provide a hard surface driveway. SEPARATE PERMIT REQUIRED FOR: WIRING NG PWMBINd AND�SIGNS 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 @ $6.80 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $13,622 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW $237.25 Fire SC $13.62 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION A PLAN CHECK FEE TOTAL FEE $257.67 Si NATURE OF CONTRACTOR OR AUTHORIZED AGENT ,DATE, RO Y VALI ED THIS IS Y R PITr'.i �`C-l��GNATUREOF &A',SP _/ O NER OWNER BwLDERi IOA EI rIAtE NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Ins�� ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: '7 6" "� c Legal Description: Owner Name & Address: -S vh ritmex-,r Tel. # '7 --S 7 2 Contractor. 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 Sq. Ft. GARAGE AREA: Length 2— Width Height _4 e7 Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: _ R #I-^ rh 4 1110 leao-T-pf- 1WC / !o x 2- Ir & "4G '--� Construction Type: Estimated Cost: $ j-3 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $, DATE: 7btL-Y? 1, ea a APPLICANT: ,r,� e,-( 4— Tel. # 7 � CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application �SFee Schedule on Reverse Side $ / .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $_$1 100 per SAC Unit $ $5.00 (State Licensed Residential Contractors) "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] 3uilding BUILDING $ PermitNo.: e Ali $ 1 ."I Surcharge $ Cts License Surcharge $ 5,m inspections $ RESIDENTIAL APPLICATION Received By: 763-572-3604 $ CITY OF FRIDLEY Date Rec'd: d )ATE YOUR E-MAIL ADDRESS Total Due ;ITE ADDRESS /'1-1 t -1 Si HIS APPLICANT IS: 0 OWNER CONTRACTOR PROPERTY OWNER/ Nom: h } _ &n c) Lk z) (4 v ADDRESS: � cl rn e_ CITY i L 1( STATEMeJZIP E41 TENANT PHONE: CONTRACTOR NAME: STATE LICENSE # EXP DATE IPCQ'r"`�' SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: b6ko I S+`` Nue, CITY STATEr"'kZIP��3`'� WITH APPLICATION PHONE FAX PROPERTY TYPE 0 SINGLE FAMILY/NEW CONSTRUCTION SIZE 0 TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE 0 ADDITION 0 GARAGE/SHED 0 WINDOWS 0 BASEMENT FINISH '1XROOF 0 DRAIN TILE 0 DECK 0 SIDING 0 OTHER 0 SWIMMING POOL TYPE OF WORK: 0 NEW 0 ADDITION 0 MAINTENANCFAtEPAIR 0 REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING 16 HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES 0 ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: 0 DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, 0 vinyl OSoffit ADDITIONS. & PORCHES SUBMIT: 0 Aluminum 0 Trim 1. Site Plan/Survey showing the existing structures 0 Other 0 Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS OYes ONo 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: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee Plan Review $ Fire Surcharge $ 1 ."I Surcharge $ Cts License Surcharge $ 5,m SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ w7,;k) 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) $1550 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 savable to: City of Fridley Attach 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; that the work will be in accordance with the approved plan in the case of all work which requires lreview pand approval of plans. \ a� SIGNATURE OF APPLICANT Lit, i� evVt�+" PRINT NAMEyL��M ow 2- DATE ! - aI'll fl `O '� b HE -01434-12 1(;# 140-0423 9/09R MINN66i� DEPARTMiNT 4 H'EALT-+1 Minh&sDta Well and Boring r -,f Sealing �" WELL AND BORING SEALING'RECORD MinnesotaNoUnique Well No. or W -series No. Minnesota Statutes, Chaptgr 1031 PM blank 9 W knom) H WELL OR BORING LOCATION County Nam ANOKA Township Name Township No. TRange No. Section No. (sm. — Ig.) Data Sealed Date Well or Bodng,Constructed FRIDLEY � 30 24 1 26 �Fradon SW, NW/-, W 7/27/11 Unknown GPS Latitude— degrees minutes- seconds LOCATION: Longitude— degrees—,'— minutes_ seconds Depth Before Sealing 50 Original Depth 50 —ft FER(S) ingle Aquifer El Multiaquiter STATIC WATER LEVEL 7/27/11 easured [:] Estimated Date Measured 50 ft. E�21ow E] above land surface Numerical Street Address or Fire Number and City of Well or Boring Location ?�ND IRT NE FRIDLEY 55421 4757 SIRF BORING ter -Supply Well I% _] Monit. Well El Env. Bore Hole ❑[1 Other Show exact location of well or boring Sketch map of well or boring in section grid with "X." location, property Ines, r buildings. ds, ang N CASING TYPE(S) Ft4Wel El Plastic Ej Tile El Other ----------- L -- --- ...... WELLHEAD COMPLETION W E t Outside: El Well House E] At Grade Inside: Ygaement Offset 33 1h mile J-1--- 8 1 Mile F1 Pftless Adapter/Unit El Buried well Pit Ll Buried F1 well Pit F1 Other F] other PROPERTY OWNER'S NAME/COMPANY NAME EY CASINGS) Diameter Depth Set In oversize hole? Annular space initially grouted? 1�^ L— 2 in. from 0 to 47 ft. EI Yes El Yes Ag� El Unknown Property owner's mailing address ff different than well i location address indicated above 6431 UNIVERSITY AVE NE FRIDLEY, MN 55421 It* In. from to ft. El Yes 0 No Ej Yes El No El Unknown In. from toL_ ft. Ej Yes Ej No El Yes El No El Unknown WALL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE Screen from 47 to 50ft. Open Hole from to ft. Wellowner's mailing address If different than property owner's address indicated above OBSTRUCTIONS s/Drop Pipe El Check Valve(s) El Debris El Fill [I No Obstruction & PIPE JET CEMENT Type of Obstructions (Describe) Obstructions removed? F1 No Descdbe� GEOLOGICAL MATERIAL COLOR f I HARDNESS OR FORMATION FROM TO PUMP Type E] ed I Present ❑ Other i RemovP— If not known, indicate estimated formation log from nearby well or boring. FILL BLAC) 0 i� SAND — LM LE GRX IEL 8 1� I- D USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: FAnnular Space Exists El Annular Space Grouted with Tremie Pipe E] Casing Perforation/Removal in. from to ft. E] Perforated El Removed in. from to ft. El Perforated El Removed Type of Perforator FINE SAND 13 4.' SANDY CLA:Ir B"O IN 43 5, FINE SAND BROWN 52 6. Other GROUTING MATERIAL(S) (One bag of cement = 94 IbS., one bag of bentonfle = 50 lbs.) Neat Grout 0 50 1 Grouting Material from toLft_ yards bags from to It yards.— bags from to ft._ yards bags According tq WN 6qte Reg OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? El Yes How many? REMARKS, SOURCE OF DATA, DIFFICULTIES .IN SEALING LICENSED OR REGISTERED CONTRACTOR CERTIFICATION Geology From: 4800 EAST RIVER p JD This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is true to the best of my knowledge. I Water Level in Above Well: 23 I E.H. Renner & Sons, Inc. 1431 Date Water Level Taken: 01/24/1992 Licensee amft,"WIlyne License or Registration No. 1' WELL CLOSET ON RECORD .1; cm 8/2/11 Unique 462987 a Amp Aq f�� Certified RepresentativMignature Certified Rep. No. Date Kevin Scheiterlein LOCAL COPY H I Z r"'97508 Name of Person Sealing Well or Boring HE -01434-12 1(;# 140-0423 9/09R Building BUILDING Permit No.l Inspections RESIDENTIAL APPLICATION Received By:� 763=572-3604 CITY OF FRIDLEY Date re : I AN 763-502-4977 FAX EFFECTIVE 1-1-2011 DATE — /3 — *®// YOUR E-MAIL ADDRESS S lo w I Ulveuo 6 us lVer SITE ADDRESSd�-�$� 7 P ~d .5 f /y� THIS APPLICANT IS: ❑ OWNER )4CONTRACTOR PROPERTY OWNER/ NAME: TENANT ADDRESS: Gk"to e -c 4 Nt , u 42( ITY ,-r I' d (e—. t STATE_11�Akll`1f* PHONE: CONTRACTOR NAME: L ? e r YOUR STATE LICENSE SUBMIT A COPY STATE LICENSE #_ 90 6 J � „S tV ? EXP DATE 3 a o rl AND CERTIFICATE OF ADDRESS: �� ,,cA e d-5 /<d CITY c(/ STATE�ntgl? INSURANCE PHONE / _ — 4/ FAX $— PROPERTY TYPE INGLE FAMILYINEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE J ❑ DECK ❑ SIDING ;9 OTHER a O ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ' REMODELING DESCRIBE WORK BEING DONE: a n -g -1e 1 1 A)4Q r , c r &A cue 44 , c � SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES 7 0HOUSE & GARAGE BASEMENT REMODELING SUBMIT: — pct GARAGES �kQ ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING �B �1 �— FOR NEW CONSTRUCTION INCLUDING DECKS, KV—myll ❑Soffit—� C C� � ADDITIONS. & PORCHES SUBMIT: ❑• Aluminum 11 Trim 1. Site Plan/Survey showing the existing structures / ❑ Other ❑ Fascia ` ? S and proposed project. WINDOWS j (� l lv 2. Two sets of construction plans 3. Energy Calculations IN EXISTING OPENINGS Yes ❑No LOCATION OF WINDOWS � FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENING�ESCRIBE SIZE OF .$e Q AI A ry 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: (USING T E 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ d OCCUPANCY TYPE Permit Fee L1,3 1, See Back Page for Fee Schedule Plan Reviewfi� $ G 1 65% of Building Permit Fee Fire Surcharge �_ $ Q e _ .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $5.00 License Surcharge $ ECIC _ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2230 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 $ U7 q i Make checks payable to: City of Fridley Attach Stipulations THIS 1S 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 cas 11 rhick reytri es re 'wand approval of plans. r r^ SIGNATURE OF APPLICAN �f/I� /� �, /t _ PRINT NAME DATE, Adaptive Reuse