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PRE 2010 DOCSDate: Address City of Fridley, Minn. BURDING PERMIT NO* '7139 OF BUILDING No. Street Part of Lot Lot _Block Addition or Sub -Division Corner Lot _ Inside Lot �� abackSideyard Sewer Elevation ____ Foundation Elevation DESCRIPTION OF BUILDING T U se: Front Depth Height.ice.... Sq. Ft. Cu. Ft. Front DepthH ght Sq. Ft. Cu. Ft. Type of Constructions 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 wi ah provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ ±f _"°" , permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that thele 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. e AA' NOTICE: 'This pemdt does not cover the construction, inda"on for wiring, plumbing, gas hosting, sewer or water. Be sur® to see the Building Inspenor for sopmee permits for these items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA . LOCATION OF $UILDING No. I -;,.,dr Street Part of Lot______ Lot Block Addition or Subdivision Carney Lot Inside Loty--Setback 'Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to ,this form Two -Certificates of Survey of Lot and proposed build- inS,lo.cation'drawn on.these Certificates. DESCRIPTION OF BUILDING To be used as: Front Depth Height Sq. Ft_'Cu . Ft. Front Depth Height Sq. Ft. CU. -Ft. Type of Construction Estimated Cost/t"�e _ To be Completed . _2=rD The undersigned heieby'make's application for,_a,permit £or.the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department.of.Buildings, and,hereby declares that all.the facts and representations stated in this application argue and correct. DATE4�� SIGNATURE Schedule of Fee Costs can be found on the 4eversd Side). 'SUBJECT - PE City of Fridley 13183 AT THE TOP OF THE TWINS BUILDING PERMIT , r RE O. _ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. r ; "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 9/$/75 JOB ADDRESS 4733 - 2i Street N.E. 1 LEGAL LOT No. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 23, 24, 25 7 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bertel Johnson 4733 - 21� Street N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Lloyd's Home Improvements 4911 - 4th Street N.E. 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. f 5 ENGINE.EH' MAIL ADDRESS ZIP PHONE LICENSE NO. ¢®"USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Ej REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re-roof Structure 9 CHANGE OF USE FROM TO STIPULATIONS SERERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Sealtap 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 $440. OO 5O 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- z �� STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. • PLAN CHECK FEE TOTAL FEE $5.50 SIGNATUR F CON AC OR ORAUTHORIZEDA IRATE) , WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG WSP DA E SIGNATUBV OF OWNER IIF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, A' OR ADDITION BUILDING P] CITY OF FRIDLEY, MINNE; OWNER'S. NAM :/J� �� 4�� �� WILDER: ADDRESS : �,% 7 3 �i�/�' ADDRESS: NO • i� STREET:— �^ LOT :� 3 - BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYAR D: . Applicant attach to this form Two Certificates_ of Suxvey of Lot and proposed building locatioi� drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Square.Feet; Cubic Feet: Height: Type of Construction:a Estimated Cost: $ To Be Complqted: The -undersigned hereby makes application.for a permit for the work herein specified, agreeing to do all work in-stiict accordance with the City of Fridley Ordinances.and rulings of the Department Iof Buildings, and hereby declares that -all the facts and representations stated in this application are true and correct. s DATE :�-` ' c SIGNATURE : , �y (See Reverse Side Foy' Additional Information.) x.00 • PERMIT NO. 27465 SUBJECT City ®f Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 1 , O i COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. I � 1 . t NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 %.j 612-571-3450 910-F15 8 31L98 JOB ADDRESS 4733 2 1/2 Street NE 1 LEGAL LOT NO. Pt BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Pt.23 24, SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jacobs 572-0491 3 CONTRACTOR MAIL ADDRESS . ZIP PHONE LICENSE NO Vikin Hm. Improvement Co.- 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 Reroof house and arae (lb-Sq) T -siding 9 CHANGE OF USE FROM TO STIPULATIONS UNderlayment must comply with the State Building Code. Call for building wrap inspection before covering. 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1334 .66 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.$45.75 Fire SC 1.33 PLAN CHECK FEE TOTAL FEE 3l `�License 35.00 .74 SIGNATURED CONTRACTOR OR AUTHORIZED AGENT (OATEt P OPE ALIDA D HI$ I$ V UR PERM T BLD )NSP i ATE SIGNATURE OF OWNER OF OWNER BUILDER) IOATE) PERMIT NO. 27465 r NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 4/ Legal Description: Owner Name & Address: )r_Wc. 6 S Tel. # X72 —0 `r I Contractor: VZ/car,- S //0 ,r- MN LICENSE # 0 7 Z Address: L/9_3A '2 % 5T: nJ,.,r--. Tel. # 5' m 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. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: g'kA0®'F 16 'Cl Construction Type: S z o r , Driveway Curb Cut Width Needed: Ft. + 6 Ft = Estimated Cost: $ / e 13-13 <1 (Fee Schedule on Back) Ft x $ _ $ DATE: �3 / o APPLICANT: Tel. # 5-?? — / 0 TOTAL STIPULATIONS: CITY USE ONLY Permit Fee $ 1 Fee Schedule on Reverse Side Fire Surcharge $ /, .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 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: E < SUBJEtT3 City of Fridley 721 4 AT THE TOP OF THE TWINS BUILDING PERMIT r � R CEIPT N �` ______ COMMUNITY DEVELOPMENT DIV. L �oj 4 - PROTECTIVE INSPECTION SEC. III I NUMBER REV OTE PAGE OF APPROVED 8r ICITY HALL FRIDLEY 55432 __--�'� 1 612-571-3450 910-F15 9/19/01 JOB ADDRESS 4733 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23,24,25 7 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE ELeanor Jacobs 4733 2 1/2 Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Viking Home Improvements 3215 Old Hwy 8 St Anthony,MN 55418 651-639-0504 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 X 8 DESCRIBE WORK Reside House, Replace windows (9) within existing openings, replace door 9 CHANGEOFUSEFROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. Provide smoke detectors in all sleeping rooms and on all levels of the welling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all exterior openings. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF C NST. 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 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 $10,000 $5.00 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISION OF ANY OTHER STATE Oft LOCAL LAW REGULATING CON- Fie SC $10.00 CTSTR O THE PERFOR N CONSTRUCTIO $181.25 IR PLAN CHECK FEE TOT L FEE Lice SC $5.0 201.25 S,GNATU E OF CO TRACTOR OR AUTHO, [ZED AGENT [DATE, H P O R VALID THIS ISJrCJJRR.MIT L 810G [NSP -AVpAtE $,GNATURE OF OWNERdF OWNER BUILDER, ,DATE, E YLRTiI ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: `1— 75-3 IVZ-- Legal Description: Owner Name & AA( Contractor: //////,4 Add LIVING AREA: GARAGE AREA: DECK AREA: Tel. # Effective 1/1/2001 (763) 572-3604 Bldg Insp MN LICENSE #,t Z (,u Tel. # ��e%� Attach to this application Certificate of Survey of the lot, with the proposed construction drawn on it to scale. 7c/o 3 _s-,/ ® 732— DESCRIPTION 3Z DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. OTHER: , 46 C stru2-0entp'q . Estimated Cost: $ �3 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 020© APPLICANT: Tel. # CITY USE ONLY - Call (763) 672-3604 for Permit Fees if mailing in application Permit Fee $ I I'. cU- Fee Schedule on Reverse Side Fire Surcharge $ 16-eO .001 of Permit Valuation (1/10th%) State Surcharge $ 5.6 $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge $ S . Q® $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 $ C20 d:� STIPULATIONS: CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Effective On January 1, 200( Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS `7 % -7,-2 Y2. S-f WG7 RATE SCHEDULE OWNER � MV®12 Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS PG eU_IYU6. Also Replacement Furnace $ 30.00 $- 3�• D U (Side Vent - Fill Out Back) ESTIMATED COST1 De- a v PERMIT N0. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ Gas Dryer No. of Heating Units % Circle One (Steam) (Hot War) arm ) $ 10.00 $ Trade Name_l BTU -----�7 P Size No. �D Air Conditioning All Sizes *Air $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON. BACK) Burner Trade Name Size No. 1%, of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.250/, of Value of Appliance or Work $ 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 an State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and TOTAL FEE representations stated in this application are true and correct. $ �. SD DAATE I D / River City Sheet Me#a , MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO X928 Bluebird St. N.W. REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Coon Rapids, St 55433 PLUS THE $.50 STATE SURCHARGE Signed 7g4-2199TEL # REINSPECTION FEE $47.00/Hr *'Air Conditioners can not be placed in a side yard without Approved By Rough-In Date Final Date l' 0 written permission from adjoining property owner. / FILL OUT BACK SIDE F STACK VERIFICATION ON REPLACEMENT FURNACE W) && KIPZIOw W?44wJa1b/5 &1V_ CITY OF FRIDLEY INSPECTION DIV. 3431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTAL I Fn ON FArH FI OOR Effective On Jan 1, 2000 a F ® Q - ® ® M®Mffl 'F . �® PLUMBING FIXTURE RATES: New. Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas*" Gas Range" _L_ Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL JOB ADDRESS _!54J"d€ ts 6t 01E, 6? 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 fuilding Division, and hereby declares that all the facts and representations stated in this application are true and correct. JACOBS, ELEANOR 20 4733 2ND 1/2 STREET NORTHEAST FRIDLEY, MN 55421 OV (763) 572-0491 Building Used As 11E61l f w ('z'- Estimated emsEstimated Cost PERMIT NO. 1 PLUMBINGCOMPANY� Q��1.Q 2_C)1✓dLalA�� SIGNED BY:�/���✓i�-- TEL NO.�Z" Q Approved By Rough -In Date Final Date COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 also 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 () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No When required to install 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 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 () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance;has been removed from the common vent and vented separately as;per current codes. Yes( ) No ( ) Appliance Type 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 Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector 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 BUILDING Permit No.: 10 R QI Inspections RESIDENTIAL APPLICATION Received By: r 763-572-3604 CITY OF FRIDLEY UAW 14 2010 763-502-4977 FAX Surcharge $ EFFECTIVE 1-1-2010 License Surcharge DATE Z YOUR E-MAIL ADDRESS SAC Charge Curb Cut Escrow SITE ADDRESS ��� 7� �y A) Erosion Control THIS APPLICANT IS: ❑ OWNER MCDNTRACTOR Park Fee PROPERTY OWNER/ NAME: Sewer Main Charge TENANT ADDRESS: % CITY STATE ZIP $ PHONE: CONTRACTOR NAME: SUBMIT A COPY YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF y� ADDRESS 5;� J/ il STATE_525_1 INSURANCE PHONE FAX PROPERTY TYPE WSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF URAIN TILE ❑ DECK ❑ SIDING PIOTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING Z�7 14 - DESCRIBE WORK BEING DONE: a SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT ROOFING Q HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, 0 Vinyl OSoffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF 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 THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge Curb Cut Escrow $ $ $21 0 per SAC Unit (Plans to MWCC for dete ination) ft + 6 ft = ft x $24 = $� conservation Erosion Control $ ,// $5 Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ ift, 00Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks vavable to: Citv of Fridlev 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 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 ape it and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of wo ich Ejequ#eyre)Pw and approval of plans. SIGNATURE OF i ' Engineering WATER AND SEWER Permit No.: 763-572-3552 PERMIT APPLICATION Received By: jo 763-571-1287 fax CITY OF FRIDLEY Date Recd: 4 EFFECTIVE 10/27/2010 APPLICATION DATE: ! 1 YOUR-MAIUFAX: THIS APPLICANT IS: ❑ OWNER lYt COO "TRACTOR / JOB ADDRESS. !moi Z NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY NAME: ADDRESS: CITY STATE ZIP OWNER/ TENANT / PHONE: to 3 O!"A CONTRACTOR NAME. ` 1 ADDRESS: E— ` SUBMITACOPY OF YOUR STATE LICENSE WITH PHONE;? ���`�S`S CELLPHONE: APPLICATION STATE LIC # STATE BOND: EXP DATE: 1. NarrativL�written description: /KZAA!°!6e2 lir 2. Please attach sketch showing curb line, utility line, building, etc. with distances on back page. 3. Stipulations: Z-2 4 2 92 �_7A A .4 Z if a_, x�e �. C�4� �Fe� `�f b It YPE 4,o Jai' .. C SEWER CONNECTION PERMIT 0 SEWER DISCONNECT PERMIT $50 ,.1 WATER CONNECTION PERMIT SEWER DISCONNECT PERMIT $50 0 WATER LINE REPAIR $40 ❑ SEWER LINE REPAIR $40 F! ADD STATE SURCHARGE $5.00 for each permit L] SAC CHARGE @ $2100 = TOTAL $ OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST — SEE UTILITY BILLING SPECIAL ASSESSMENTS — SEE FINANCE WATER TAP — SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / EVENINGS, WEEKENDS & HOLIDAYS $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and accurate; that the work will be in con rm ce with the ordinances and codes of the City of Fridley. I understand this is not a permit but only an application for a pe or iso art without a permit. J, SIGNATURE OF APPLICAN ! PRINT N EDATE: Z X11 APPROVED BY: DATE: COPY GIVE ❑ UTI ITY BILLING (o 2!—y/f w m r) .� PUBLIC WORKS - ENGIN EKING city of vrimey Engineering Department 6431 University Avenue NE, Fridley, MN 763-572-3552 FAX: 763-571-1287 I 55432 1 y� � `6 MR ROOTER PLUMBING 5155 EAST RIVER ROAD, SUITE #412 FRIDLEY, MN 55421 TEL 763 551 0555 FAX 763 5512555 Account # / AP Inv # Tck # 37014 Received 12/10/2010 4:05:11 PM Name ELLIE JACOBS Dispatcher KUNZA Address 4733 2 1/2 ST NE Promise Date/Time 12/1412010 9:30 AM City/State/Zip FRIDLEY, MN 55421 Technician HINRICHS, STEVEN Main Phone/2nd (763) 572-0491 (763) 572-0491 Our PO# Map/Directions Dispatch Code S REPAIR 3rd party PO# Z -Unknown 3rd party Auth# Make Product Model MFG# Serial # ��. �i i' RIP IM -1 ServiceFee $0.00