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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® 3731 Date: ... ..... .. Y ... ...... Owner ....................................... Builder ........ Address...................................... Address ........ ................... LOCATION OF BUILDING ....... .................... . No ............. Street ... Part Lot ......... Lot .... �..... Black ..... c2......... Addition or Sub -Division a a Corner Lot ............ Inside Lot ..X ........ Setback ". Sideyard . I n -1 t ................ . DESCRIPTION OF BUILDING To Used as: .e`er /y ... ... Front/ .� Depthy:� Height Sq. Ft . cu. Ft.1,�,�.� ��� .. Front l.2 P. * Depth .3R,9 'Height ./0—.Q7 Sq. Ft. 3..R . Gam. n a (R Type of Construction .......:........... list. Cost../_3yV r13....... To be Completed ................... Co leted ...... In consideration of the issuance to me of a permit to construct the building de Sed abo e, agree to do the proposed work in accordance with the description abov o and in wi provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $. ..�, permit is h eby 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. ..... Building Inspector NOTICE: This 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. T 4 - 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA owners- Builder &W i.:...r Address V— Address �� LOCATION OF BUILDING No. Street d Z& __ Part of Lot Lot Block _ _.� Addition or Sub. Dine f Cgr,ner Lot , Inside Lot Set Back ..� Applicant attach to this form Certificate of -Survey of Lot.and proposed building location. DESCRIPTION OF BUILDING. To be'us§4 as Front ?' Depthight A'..._____ S. Pt. - 9 Front . I2_.._ Dep MSqSq. . Ft. Cu. Ft. ,.....__�___...._ . Type*of Construction ��� Estimated, 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 he 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 orrect Date Signator (A Schedule of Fee Costs can be found'on'the Reverse Side) . . 'V.,, . 4 J e Application for Power Plants and Heating, Cooling, Ventilation, Refrigeration and Air Conditioning Systens and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-7470 GRAVITY WARM AIR: RATE TOTAL Location .' - 4 ® o? ­ � r Furnace Shell & Duct Work .......................... 8.00 $ 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 $ t/ 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. IDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. IDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ 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 $ GAS PIPING (Up to 3 Fixtures) .......................... 1.50 $ (Add 50c each over 3) AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $Ns REMARKS: a 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. Owner Kind of Building 195— Used as Oru = To be completed about Estimated Cast, $ Ol New Building Permit No. DESCRIPTION OF WORE HEATING or POWER PLANTS—Ste Hot Water �armAir—No/ Trade NameVV -4 � ��-C- -Size No -Z (� % Ii 2 Capacity Sq. Ft. E.D.R �1(4 �`BTU H.P. Total Connected Load r Kind of BURNER — Trade Name_ Size No Capacity Sq. Ft. E.D.R. BTU H.P. RAY N. WELTER HEATING. CO: Siga 63 CHICAGO VE. By M1NNEQPf11 j!+ 7, MINNEAMTA -QW11 POST I M -8-m Business Phone No—' -A Application for Power Plants and Heating. Cooling, Ventilation. ReMgeratlon and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ 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 $ 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 $ 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 $ 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 VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL Dept. of Bldgs. Phone 560-3450 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. Owner Kind of Building Used as To be completed about Estimated Cost, Building Permit No� Permit No'ZZ�'--g (,C/O/ DESCRIPTION OF WORK HEATING or POWER PLANTS—Stearn, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel BURNER —Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. See Fee Schedule � SHAY N. VVEL`�ER HEATING CO. TOTAL FEE $ :By -MINNEAPOLIS 7 MINNGEB®'I'A 42 Business Phone No �" a 7 r (REMARKS—OVER) City of Fridley 4T THE TOP OF TN# TAMMY tu-------� COMHWNITY DEVELOPMENT DIY. 1 1 PROTECTIVE ELECTION W", CITY HALL FRIOL6V 064$ P`P� .! YIA-YsO-�lYO 53 -8b -S-915.51 iUDdEGT PLUMBING PERMIT APPLICATION Job Address 0 12115/73 1 1 1 1 800 6560 N. E. 2nd Street owner Address Phone Stephan M. Matsonn566-2367 Contractor �VINNEG1ASCO A ress X33 RQUET'TE AVENUE Kind of Building Use Frame Res. ompletion Date 3-19-7h 1. O w P4 M81YMI I I f I ' 3100 -q--2 t;SLlmaLe*a UosL _ 10.00 — - ---- -- . .. Plumbing Fixture Rates: NO. RATE TOTAL Number Fixtures x $2.00_ Future Fixtures x t W New Fixture -Old Open. I $1.50 Catch Basin x $3.25 Water Heater -99,000 BTU x $3.00 Ground Run Old Bldg. x $3.25 Elec. Water Heater < a 0 Svc i •iddvl i i _._� — SYO I •x1.1 i 781N � •saa�� — •MNtva I � I `� I w SNI8Y8I Ia+�sv�l I i iO C eNlvaal i I I I I moo-Ij IQ V I s83MONSl I 0.0 11N1.13 4 HSYM 891N ISI � � I 1. O w P4 M81YMI I I f I ' 3100 -q--2 1 Gas Fitting Fees: 1st 3 Fixtures � x $2.00 I • ' Additional Fixtures x $ .75 Gas Range -199,000 BTU x $5.00 Repairs & Alterations See Description: Install Dryer Code 5.00 State Surcharge Class',mAmr, Surcharge .50o .50 TOTAL FEE $ 5.50 !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 declare that all'the facts and representations stated in this application are true and correct. Signature jWfffljtGAs,,70 Date a P t;SLlmaLe*a UosL _ 10.00 — - ---- -- . .. Plumbing Fixture Rates: NO. RATE TOTAL Number Fixtures x $2.00_ Future Fixtures x $1.50 New Fixture -Old Open. x $1.50 Catch Basin x $3.25 Water Heater -99,000 BTU x $3.00 Ground Run Old Bldg. x $3.25 Elec. Water Heater x $2.00 1 Gas Fitting Fees: 1st 3 Fixtures � x $2.00 I • ' Additional Fixtures x $ .75 Gas Range -199,000 BTU x $5.00 Repairs & Alterations See Description: Install Dryer Code 5.00 State Surcharge Class',mAmr, Surcharge .50o .50 TOTAL FEE $ 5.50 !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 declare that all'the facts and representations stated in this application are true and correct. Signature jWfffljtGAs,,70 Date a P C9 CITY OF FRIDLEY INSPECTION DIV 6431 University Ave NE Fridley, PAN 55432 6t2-3604, RATE SCHEDULE M 119,5? -3 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 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/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/industrial 1.25% of Value of Appliance or Work Effective On August 1, 1995 JOB ADDRESS 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. $ 10.00 $ OWNER � 1 Jll l(1 C; irri. "I" mej t $10.00 $ BUILDING USED AS $10.00 $ ESTIMATED COST I U L4 a -CQ PERMIT NO. $ 25.00 $ DESCRIPTION OF FURNACE AND OR BURNER State Surcharge TOTAL FEE $ No. of Heating Units I Circle One (Steam) (Hot Water) (Warm Air) Trade Name RLLLLd Size No. i,1 A Dlo BTU (n� cjDt� _HP EDI $ Fuel J CJQtQ- Total Connected Load $ .50 Burner Trade Name Size No. BTU HP EDI MINIMUM FEE FOR ANY HEATINGICOOUNGNENTILATION REFRIGERATIONIAIR 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. HEATING COI4ANY 2615 E IND AI MALITY. ilk. N RAP S OULEVARD Si el No. —� Approved ByJACRough—In Date Final Date �� q FILL OUT SACK SIDEK VERIFICATION ON REPLACEMENT FURNACE i Remarks: HEATING CO: Signed By: Date: CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes) No ( ) 2.', Is free from rust or deterioration Yes ( No ( ) 3. Has no foreign objects lodged within Yes (X) No ( ) 4. Is securely supported Yes (x) No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes (�) No ( ) 6 Has total heating BTU's of 15-60 All other BTU's 5z; 5-290 TOTAL BTU's /do, eq 'n C� 7. Has a liner been provided for water heater Yes) No ( ) 8. Has combustion air been provided for water heater, Yes (�Cj No ( ) Remarks: HEATING CO: Signed By: Date: SEP -07-1999 17:42 6560 2nd at Job# SALES ADM fill 6 Zone: 612 321 5220 P.09/22 Entire House I • � I. IM. LNF �....rr. �.�.. ��-u. .i. Y. L'L� .•...LLY lO NBmeofRoom Entire House whole house 2 Rmai1ig Ft Exposed Well 123.o FL 128.0 Ft Ft. Ft. 3 Room Dunaaslaaa.Ft 0.0 t 24.0 x 4o.0 Ft x r1 x Ft 4 Celings, Ft Condit. Option 8.0 d 8.0 heat/cool TYPE OF RTM &a Do* Ata DtuhArea &uh Ana Btuh EXPOSUPE NO. Htg Cls LengthHtg Cls Length HtS Cig Length Htg CIA Length Htg Cig S Cdnss a 12C 6.1 1.9 1024 •+'+ ••'+ _ 1024 •••, ...• *rvr •..+ .••• 0.00 Exposed b L4A 45.9 6.8 120 ass wa 128 0400 +••• 0►w. +«sr .... ..+. Wells mid. 0 ISE 7.6 0.0 168 +•401 *401* 768 0000 fttt ass Barr utt 01001 P01twon4 d LSA 11.3 0.0 a 0940 0.00 0 ++«« •.•, •..s •,.. .,,+ ••w - e 0.0 0.0 00140* *sa 0 Best ate sass 044e ■•ww 90•• f 0.0 0.0 0 *00* •+rr 0 .•s, ,e, •w* rt** tett •+,. 6 Windows end a 2A 42.8 +• 140 5985 ++•+ 140 5988 ••'+ .rw ..•r Olos4Doots b 0.0 490 0 •s's 0 0 0ss0 •+s. s•tw Heaft c 0.0 001 0 00** 0 0 t.r. 0000 see d 0.0 001 0 0 •4•. 0 O .e• 01,4. *e, e 0.0 •. 0c 0044 0 a.rrt fit! f*w0 f 0.0 •. 0 •s, 0 0 ,s•• .*•• .•.• 7 Windows and Nwtb 27.0 .3 +,++ 810 30 ++.t 810 •,•• .•*• Glass Dom NEAM 0.0 aas. 0 0 a.*s 0 a•• ••,. Cooling vW 85.0 s •+++ 6800 80 ■rrr 0000 sr• e.r• SU/SW 0.0 a 0 •tow 0 .,.♦ •.,. Smith 44.0 30 rtfs 1320 30 *0•r 1220 art sa. 8 Mud= d= a LOP 28.8 6.6 42 1210 217 42 1210 277 b 0.0 0.0 a 0 0 0 0 0 9 Net a 12C 0.1 1;9 $42 6820 1561 842 6820 1561 Exposed b 14A 45.9 4.6 128 $075 868 128 5875 866 Wells 8114 C15E 7.8 0.0 768 60.13 0 768 6013 0 panitians d 1 11.3 0.0 0 0 0 0 0 0.0 0.0 0 O 0 0 f 0.0 0.0 0 0 0 0 0 10 Callings 8 16D 4.82.2 960 4579 2086 960 4519 2086 b 6.0 0.0 0 0 0 0 0 0 a 0.0 0.0 0 0 a 0 0 0 11 Floats a 21A 2.2 0.0 960 2074 960 2074 0 b 0.0 0.0a 00 0 0 e 0.0 0.0 0 0 0 0 ' 12 ftfilttation a 41.9 4.0 18 7618 720 182 7615 720 13 SubtotBM LAww*6+8..+11+12 ;+++ 40175 +•+. w+++ 40115 •.►. ,•.• 0000 0000 ••.• 14 Duos Btoh Loss - - ISIX, $024 10 6026 sits o sea o *est 15 ToW Btuh Loss = 13+14 '•'• 46201 +*r. +,+, 46201 •s.s ,•+. •,ss 0000 .•.. 16 In G&Sr POOPIC @ 300 4 .aa 1200 4 ++++ 1200 *r64 sss• Appl. 9 12(10 1 •.•• 1200 1 •+++ 1200 +•.► *•+0 17 S -MARSH Qdn-7+8..+12+16 n.0 +*tr 16942 tett ars• 16842 test serf .rr. a►• is Duet Stuh Gain 15 '+•• 2526 15 ++++ 2526 "'• "'• 19 Total RSH Ga"I7+18)+PLP 1.00 19368 1.00 `••• 10368 ■4,. •++• 20 CFM Air RcWimd 04+0 103 1036 ++++ 103 L036 ss*s •.e• Printout certified by ACCA to meet all requirements of Manual J Forth SUBJECT -. City of Fridley _ 3102", 9-- AT THE TOP OF THE TWINS BUILDING E R M I T RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. ►v ___ -__ PROTECTIVE INSPECTION SEC. r 6 a , CITY HALL FRIDLEY 55432 I`J NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 6/1/00 108 ADDRESS 6560 2nd STREET NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 2 Rice Creek Plaza South SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Nels Raabolle 5660 2nd St. NE 574-2241 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 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 O NEW ADDITION 0 ALTERATION O REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Addition of 241 x 121 Deck 8 CHANGE OF USE FROM TO STIPULATIONS See Attached Plan for Stipulations. 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 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 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 COMPLIED4 $2707.20 $1.35 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT R'A.,� 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- STRUCTIO10 N OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTA FEE ,,-I '.. / $87.30 Si TORE OF CONTRACTOR OR AUTHORIZET IDA TE, VIA �� EN ROP Y AUO �M�S I MIT IDA EI 'S,GNATURE OF OWNER, OWNER BUILDER, BLO INS gAfE - NEW [ ] Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Jr 0 Legal Description: Owner Name & Address:.,W-� &4,,A� (0 56o Tel. # 574 _ 2— 2 Contractor. MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. .DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Construction Type: 'i , �` Estimated Cost: $ SUN Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: SlCA �� Tel. # CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ e Fee Schedule on Reverse Side Fire Surcharge .001 of Permit Valuation (1/10th%) State Surcharge $ % s $.50/$1,000 Valuation SAC Charge $ $1100 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: CITY OF FRIDLEY PERMIT .. 2004-01210 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 07/29/2004 572-3604 FAX: (763) 571-1287 ADDRESS : 6560 2 ST NE PIN : 143024230023 LEGAL DESC : RICE CREEK PLAZA SOUTH ADD : LOT 9 BLOCK 2 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 2,663.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE (23 SQ) TEAR -OFF STATE LICENSED CONTRACTOR 1 APPLICANT AMERICAN CONTRACTING ASSOC 20393450 502 2 ST STE 110 HUDSON, WI 54016- AFN ' ANN KUNST 6560 2ND 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 worl will be complied with whether specified herein or not. The granting of a permit does not pr ume to give authority to violate or cancel,%e provisio of any other state or local law regulatingrns&cti n r�teperformance of construction. Ap icant Date BUILDING PERMIT FEE 83.25 FIRE SURCHARGE 2.66 STATE SURCHARGE, VALUE 1.33 LICENSE SURCHARGE 5.00 TOTAL 92.24 PAID WITH CHECK # 2270 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [) CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION /d / oo -70 � S A I - �- Construction Address: ' Z — Legal Description: Owner Name & Address: Aa) 411),nl S' I— ,0 2�vo S! A✓ Tel. # 7� 3 – S' 71' 3 �� Contractor.)Cr1r> n/i SS' MN L I C E N S E # ZV..39 4'<70 Aririress- 012- 2,ki ® Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVINGAREA: Length Width Height_ Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: PF 16V5e2 3 ,2a"S L_S!E 2 D Fr_ Construction Type: – 7Q, 0 E I d6-7 Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 F Ft x $ _ $ DATE: 7 z o/ –o � APPLICANT: Tel. # -7 _!5 7 _7Z Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY ­ Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] STIPULATIONS: