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PRE 2010 DOCSr City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures LOOn / ®— t Ul X 1.20 $ X 1.00 12 x 3.25 o �7i LL c V Q 3 �U'd (�9 aS Uy' (�9 O F N WATER HTR. GAS ELEG Base 1st 2nd _ 3rd 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer Cesspool [� PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin . — ...................... . Water Heater (Up to 200,000 BTU) ...... New Ground Run Old Bldg. ............ GAS FITTING FEES: 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code x $1.50 $ X 1.20 $ X 1.00 $ x 3.25 $ x 2.00 $ x 3.25 $ NO. RATE TOTAL X $1.50 $ X .50 $ x 2.00 $ City of Fridley: The undersigned hereby .makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct. Fridley, Minn •-G 19 Owner Z e ✓Z-�- Kind of Building rV-a I -le ,g-_ Used as ea f IYQF r i Z.- L'i '4- h- r,v To be completed about Estimated Cost, $ V66 7 Old—New. Building Permit No Permit No. All Signe ✓ �'/ u tui �.rs fA• By Business Phone N - l 2 ROUGH FINAL --4L'— I `& �f Description ................................................$ TOTAL FEE $ '�, 42 City of Fridley 52-84-879.01 Applicallba for Plimilbbg aid Gm FNkq Pam* Dept. of Bldgs. Phone 960-3440 DESCRIPTION OF WORK 4648 NE 29g St. Number, Kind and Location of Fixtures Locatim ® x $2.00 Y Future Fixture Opening ........... U' ZZ WATER NTR. M GAS ELEC. New Fixture Old Opening .......... . x $1.50 S d� V < (7< 1V $ replace range. 1 3 00 Water Heater ;Up to 99,000 BTU) . • . • x$3.00 $ • Base x $3.25 $ Electric Water heater .............. : $2.00 $ 1st NO. RATE TOTAL rd -PL ice ran qe 2nd 3rd 4th • Future connection Openings connected with * Now Fixture, Old Openings Sower ❑ Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Future Fixture Opening ........... x $1.50 $-- _New New Fixture Old Opening .......... . x $1.50 $ Catch Basin .................... x $3.25 $ replace range. 1 3 00 Water Heater ;Up to 99,000 BTU) . • . • x$3.00 $ • New Ground Run Old Bldg......... x $3.25 $ Electric Water heater .............. : $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional Fixtures ................. x $ .75 $ Gas Range to 195,000 BTU ... ,..... , x $5.00 $ REPAIRS g ALTERATIONS—Rater to Code Description........................, .....................$ 3.00 TOTAL FEE $ City of Fridley: The .undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Elrdinance and ruling of the Department of Buildings, and hereby declares that &Z the fact and representations stated in this application are true and correct Fridley, Minn June 14, 1971 Owner W. Ebert Kind of Building f r . Used as res. To be completed about June 21 Estimated Cost, $ Old—New. Building Permit No. Permit No. Signed _ GAS C®• Business Phune No ROUGH SUBJECT P IT NO. City of Fridley _ 17770- AT THE TOP OF THE TWINS t BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. 1 PROTECTIVE INSPECTION SEC. toIi� NUMBER REV. DATE PAGE OF APPROVED BY L ;,} CITY HALL FRIDLEY 55432 612-571-3450 910-F15 0/19/84 JOB ADDRESS 4648 - 21g Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 � 4 11 Plymouth Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Verna Ebert 4648 - 21� Street N.E. 3 CONTRACTOR MAILADDRESS 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 O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE x 8 DESCRIBE WORK Construct a 241,x 241 Detached Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. REQUIaFo FORPE aNil G AND-ink N 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 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX�gg� AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $6 456 �P.9a $3.23 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- $62.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. AN CHECK FEE TOTAL FEE $65.73 SIG FAILURE OF CONTRACTOR OR AUTHORIZED AGENT �(DATE) WHEN PROPERLY V A,TED THIS IS YOUR PERMIT �� f/l� 7l !/ /�I �/ 4 �� SIGNATURZi F OWNER (fF OWNER BUILDER) tDATEI BLDG !NSP iATE NEW [ ] City of Fridley Effective 4/1/84 ADDN. [ ] �R-1 AND R-2 ALTER. [ l Building Permit Application Construction Address: ` 3'd� V2- Legal Description: Owner Name & Address: n `� �1 �- r %�d - - Tel. # Contractor: �� °� Tel. # Address: q(0 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/ Width Height Sq. Ft. C2 4 DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot IV,] Ft. Yd. Setback Side Yard Setback 5 S Type of Construction: Approx. Completion Date: °a /•S G) Xf 'V Proposed Driveway Width If New Opening Is Desired: Estimated Cost: $ Alt. A Alt B $ $ See Back Page for Explanation DATE: % C // Ory APPLICANT: 0 E �.�,'r'T Tel. ._ Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL CITY USE ONLY $ $ $ $ $ $ 7 • STIPULATIONS: Fee Schedule on Reverse Side 25$ of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] • V I- 'f G418 as r / �I SUBJECT ERMIT NO. City of Fridley 19734 AT THE TOP OF THE TWINS BUILDING PERMIT _ rp RECEIPT NO. � � • ______ COMMUNITY DEVELOPMENT DIV. r y PROTECTIVE INSPECTION SEC. �® �� 1 . � CITY HALL FRIDLEY 55432 NUMBERREV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/31/88 JOB ADDRESS 4648 - 2% Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3, 4 11 Plymouth. Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Verna Ebert 4648 - 21-2 Street N.E. 572-8839 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. R & M Associates 3482 Auger Avenue, White Bear Lake, MN 55110 770-9322 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 8 DESCRIBE WORK Reside House 9 CHANGE OF USE FROM TO 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 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 7 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 $3x460 $1.73 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $64.73 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY V (DATED THIS IS YOUR PERMIT BLDG INSP f1A7E SIGNATURE OF OWNER IIF OWNER BUILDER] IDATEI �I NEAT [ ] ADDN [ ] ALTER [ ] City of Fridley R-1 AND R-2 Building Permit Application Effective 5/1/88 1 '7D Construction Address: legal Description: LT �, y �/ ,. // ! y r�G� 0-4/— Owner Name & Address: // C K Tel. # �7-9 - ��' `k Contr actor : t 1r7 ec Sac— Tel. # 7 %° e 3 2 Address: 31//? 2 /;a , r e ALF w k ,:n_ /3 t e,r /,,L K t - Attach to this application, a Certificate of Survey of the lot, with the propDsoed construction drawn on it to scale. LMNG AREA: Length Width Height SII. Ft. G RAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. ODrner Lot [ ] Inside Lot I ] Ft. Yd Setback Side Yard Setbacks Type of Construction: �// &k1-5i�� i w� Estimated Cost:�— Approx. Completion Date: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ 5_ Width + 6' See Back Page MM. /e,- 3/" Fri APPLICANT: MY USE ONLY Tel. # 27a -2 3 Zl-- Permit Flee $ 6-3) . ® 0 Fee Schedule on Reverse Side State Surcbarge 5 /- Q3 $.50/51,000 Valuation SAC Charge 5 $550 per SAC Unit Driveway Escrow 5 Alt. mAn or Alt. wB" Above Park Flee 5 Fee Determined by Engineering Sewer Main Charge 5 Agreement Necessary [ ] Not Necessary [ ] TOTAL SPIPULMIO NS: Js- rY '73 CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL ` RATE TOTAL Furnace Shell and Duct Work, Trade Name �.^,,tea gs,d sir�-�� Size No. D' cle"( Capacity Burner (Also replacement furnace) $ 20.00 $ Gas Piping $ 10.00 $ (piping needed with new furnace) Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ * Air Conditioning (all sizes) $ 10.00 $ All Others/Repairs and Alterations 19 of Value of Appliance or Work $ COMMERCIAL/INDUSTRIAL 18 of Value of Appliance or Work $ State Surcharge TOTAL FEE Reinspection Fee ($15.00) Rough Insp. Date Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. $ .50 Job Address --/& `ig - g Z_ Department of Buildings, 6431 University Ave. N.E., Fridley, HN 55432 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. l / Fridley, Minn. Z -22 , 19wa OWNER ll C'U's' 4r ( : KIND OF BUILDING / LCL �'7 &_ USED AS I y� TO BE COMPLETED ABOUT ESTIMATED COST420 r OLD - NEW BUILDING PERMIT.NO. PERMIT NO. Fill out back side for stack verification on replacement furnaces DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name �.^,,tea gs,d sir�-�� Size No. D' cle"( Capacity Sq. Ft. EOR BTU HP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Ck Company Signed Byi�� Tel. No. Fill out back side for stack verification on replacement furnaces CHIM14EY 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 ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes ( ) No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s Company Signed By Da to SUBJECT PERMI City of Fridley 212 82 AT THE TOP OF THE TWINS BUILDING PERMIT r ' , RECEIPT I COMMUNITY DEVELOPMENT DIV. _ND-:--_ 2 �� ` _ r ; PROTECTIVE INSPECTION SEC. J NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571--3450 910-F15 4/14/92 JOB ADDRESS 4648 2-2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 & 4 11 Plymouth, SHEET 2 PROPERTYOWNER MAILADDRESS 21P PHONE Verna Ebert 4648 22 Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Don weiderholt 8654 Van Buren.NE, Blaine MN 786--3511 4733 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 O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (10 Squares) Teak -off 9 CHANGE OF USE FROM TO STIPULATIONS Undea;layzq.ent tocoz ply with: State. Building Code, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. 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 $530' $,,50. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $17.00 Fire . SC $,.53 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE e $i:cense SC $5.00 $23.03 HEP ER Y AL ATED THIS IS YOUR PERMIT SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IJ�iATE1 71 4- — %C BLDG INSP MATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) ...:.!i`i .v......._....v I., v....v: t: .....v..`..........vi"Zi.l......v.. v .. .ti I,C i...., I I.' I � V i I,, V ..... v.. NEW [ j Effective 3/1/92 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND \ DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: / _ z l Legal Description: Owner Name & Address: 'Z(Q �%8 2 % %` Tel. # Contractor: �Q MN LICENSE # 66 0-1 7 3 3 � D-� �,�- Address: 9 G s Sf IJ 4�,, 6-fti� DI �, � n , Tel. # U6 r � 5—1 / Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF R"ROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: W, / ��i° -7z,/�/ D / -� Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot j ] ,FL d Setback . Side YardSc9backs Type of Construction: t 5'- ° Estimated Cost: $� m Approx. Completion Date: AZ o/ !2 2— Driveway, Curb Cut Width Needed: Ft. + 6 Ft = (Cost on Back) Ft x $ = $ DATE: / _ . APPLICANT: /�� c6� c�� Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow 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 $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ l SUBJECT FERMI City of Fridley /-2-9366 AT THE TOP OF THE TWINS BUILDING PERMIT f w__--_ COMMUNITY DEVELOPMENT DIV. RECEIPT N% lA4I)OL •F�� r PROTECTIVE INSPECTION SEC. P� nr1 i • � CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY 612-571-3450 910-F15 4/30/99 JOB ADDRESS 4648 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3,4 11 1 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Verna Ebert 4648 2 1/2 Street NE 572-8839 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Bradley Trane Construction 4633 2 1/2 St NE, Fridley, MN 55421 919-1960 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 20150069 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK 1 ❑ NEW ❑ ADDITION ❑ ALTERATION ❑K REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof House (17 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. 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 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 $1,094 $.54 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHA GE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON• $37.50 Fir C $1.09 TRUCTION OR THE PERFORMANCE OF CONSTRUCTION If PLAN CHECK FEE Licen SC TOTA FEE $ $44.13 SIGNATURE OF CO CTOR OR AUTHORIZED AGENT IDATEI RQ ALIDAT .HIS I$ Y "�rk_�EN �RRIT S-GNATURE OF OWNER 16 OWNER BUILDER; IDATEI I BLD -NSP ryAtE NEW [ ] Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY ALTER] SINGLE FAMILY AND DUPLEXES R-1 AND R-2. &o BUILDING PERMIT APPLICATIONP aq � ConstructionAddress: Legal Description: �s Owner Name & Address: �%,,��J,� '��Tel: # Contractor:-,��le, % �' � �✓'s¢, MN LICENSE #�011,�I Z Address:— �� 33 5�. /�/' v �� S�" 1 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 _ GARAGEAREA: AREA: Length _ DECK AREA: Length _ OTHER: e�61 Width Height Sq. Ft. Width Height Sq. Ft. Width GroundSq. t. Aw. �2A 18 'A�q �(& Construction Type: Estimated Cost: $ CITY USE ONLY (Fee Schedule on Back) Permit Fee $ �� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $. OL DATE: 31 t� APPLICANT: //%may Tel. # TOTAL $ STIPULATIONS: CITY USE ONLY Permit Fee $ �� Fee Schedule on Reverse Side Fire Surcharge $ , o 9 .001 of Permit Valuation (1/10th%) State Surcharge $ s $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ S_,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 [ ] TOTAL $ STIPULATIONS: