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PRE 2010 DOCSJ BUILDING PERMIT Village of Fridley, Minn. N° 2 7 5 Date '� . /.�� .. .. .:. p ............... Owner J9. R.A. X1..5. .�,.�. b`��...... Builder ... ..... .......... ....... Address ..1.� -0�... !&— �� ` A1!2........ Address �3e..95. s - L%LOCA TION OF BUILDING V No. ® ..... Street .. 1.. ...:� : '.. ��' r ............... Part of Lot ....................... Lot ..� .��..... Block .. .......... Addition or Sub -Division ...... el yM.a. . ........ Corner Lot .. G/..... Inside Lot ............ Setback ..&1,3. Sideyard .. /'?//Z .. ............. . DESCRIPTION OF BUILDING Tojtq Used as: .. Front .Zvi.. Depth ..Height � ... Sq. Ft. 1051d- Cu. Ft. ........ .... Front ........ Depth ....... Height ......... Sq. Ft......... Cu. Ft. ........ Type of Construction . i Est. Cost ........ To be Completed ... ...... �l 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 village of Fridley. In consideration of the payment of a fee of permit is hereby granted to tVA,. d M/X.4... . Z. / fryl. /0.c+........ 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 his agents, employees and workmen, in all work done in, around and upon said building, or any part the sh conform in 1 respects to the ordinances of Fridley, Minnesota regarding location, construction, erationma ten Ve, air d g of buildings with- in the village limits and this permit may be revok at any ��o vi any the provisions of said ordinances. Ids' ic - 11011F. .. ding Inspector NOTICE: This permit does not cover the construction, installation or alteration f firing, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. or City of Fridley, Minn. BUILDING PERMIT Owner t 440y- y Addresse :ll Builder Gi::: .............................. Address............................................. ,}tel LOCATION OF BUILDING Street............ ................. Part of Lot ............................... Lot ............ Block .................. Addition or Sub -Division ................................ ...... Corner Lot ....... Inside Lot ............ Setback ............ Sideyard .. ... : �..... DESCRIPTION OF BUILDING ;To4Used as: .... Front .. Depth Height 1,!X9.. Sq. Ft. Cu- Ft. ........ .................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ Type of ConstructioEst. Cost.. . � ..... To be Completed b;x 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 se�h and in compliance with x,11 provisions of ordinances of the cit of Fridley. �� onsideration of the payment of a fee of $.. ....., permit is hereby granted to .4.1 �...... to construct the building or addition as described above. This permit is granted upon t'.ie 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 F<idley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at a_iy time upon violation of any of the provisions of said ordinances. c� 6�� �rV . Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring I Bing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for th6sdlltems. CITY QF FRIDLEY INSPECTION DIV, Effective On January 1;1993 6 31,UniversityAve.NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES MINIMUM FEE FOR ANY HEATING/COOLINGNENTiLA ION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Alr Conditioners can not be placed in a side yard without written permission from adjoining property owner, •°HEATING Signed By Approved By Tel No. (2 ._3 --'o V "'- r. Rough -in Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE JOB ADDRESS q FQ 3/`. RATE SCHEDULE The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner - rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $ C-.26, e representations stated in this application are true and correct, ,1993 Gas Piping (Needed with new furnace) $10.00 $ J& U U -k OWNER /11®, rk 'S m c'r Gas Range $ 10,00 $ • II ,, BUILDING USED AS 6 M�P9 Gas Dryer $10.00 $O� ESTIMATED.COST 1%._61 ` PERMIT NO. *Air Conditioning - All Sizes $10,00 $ • DESCRIPTION OF FURNACE AND OR BURNE$ All Others/Repairs & Alterations (LIST ON BACK 1% of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name ��i� ��®�SSize No, 25, oe Commercial/lnclustrlal BTU Z.goo _ HP EDR I% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $ ,50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE s. ®. e"0_ MINIMUM FEE FOR ANY HEATING/COOLINGNENTiLA ION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Alr Conditioners can not be placed in a side yard without written permission from adjoining property owner, •°HEATING Signed By Approved By Tel No. (2 ._3 --'o V "'- r. Rough -in Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 1 other BTU s TOTAL BTU'•s% ; t1a 0 . Remarks List Alterations Being Done: HEATING COMPANY Signed By Date CHIMNEY AND sTACR VERIFICATION The undersigned hereby verifies that the existing chimney or stack: .l. Has been carefully examined Yes (+� No { j. 2. Is free from rust or -deterioration Yes ( No ( ) 3. Has no foreign objects lodged within Yes ( No ( ) 4. Is securely supported Yes (✓� No ( ) S. Meets all current Code requirements for size -and total BTU's connected Yes (i) No ( j d 6. Has total heating BTU's of ROD C) 1 other BTU s TOTAL BTU'•s% ; t1a 0 . Remarks List Alterations Being Done: HEATING COMPANY Signed By Date HOUSE TEST HEATING RECORD ADDRESS03 ,c 2 ST AIF APT. FLOOR CITY SUBURB OCCUPANTS/p ,F ,Y, o,, OWNER HEAT LOSS DATE HTG. INST.' OWNER SOLD B A@ INSTALLED BY Electrical Work By ' r /11� Gas Line By TYPE OF HEAT GA FA_ HW STEAM SPACE HTR. UNIT HTR. OTHER GAS DESIGN MAKE_r Y,q s1 T Model .3t�3 /l.4 /djf-d7 !L Serial Dq�17 7 / 3 INPUT CONTROLS THERMOSTA Heat Plug ValveL.,-)� Limit ` Limit Setting_ 170 Fan Setting Pilot Type Pilot Make Pilot Model Pilot Timing L.W. Cut Off Pressure 3� g Percent CO2 Input CFH Percent 02 � Q Stack Temp. 3.?5- Percent CO CONVERSION MAKE OF BURNER Model Max. BTU Rating MAKE OF FURNACE Model Vent Size KIND OF LINER /_3 ✓evT SIZE_Ci— NONE Draft Hood Regulator Filter Size � ex Z o Number Chimney Location Inside Outside_ Chimney Construction Smoke Bomb Wiring Draft Test Tag Door Pressure Light Inst. Date Tested d -t5---7-3 Company Testing o % S Name of Tester 4, G CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1991 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON FAf.H FI MR PLUMBING FIXTURE RATES: NO. RATE TOTAL 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 Gas Dryer Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 /0100 $10.00 $10.00 .: ADDRESSi • fa� L 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 Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. /%- ?K2 Owner. • Building Used As / Estimated Cost 5/70- eS7` PERMIT NO. %L�-2 Type $5.00 PLUMBING COMPANY Reinspection Fee $30.00 SIGNED BY TEL N0. ` y ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance �,-•� Approved By / Rough -In Date Final Date State Surcharge MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS 515.00 TOTAL FEE $1L, PLUS THE $.50 STATE SURCHARGE ....:::.. I ....: Show er ............ Wash Tray ::::::: D tk :.:::: Floor Drain ik: Auto. .'..W asher :::.:::::: .. Gas Range ;...,.;.;:::..:: :<:;; Water Heater ri Sto es G s Elea B asemen Floor 1 r Floor 2 FI r 00 3 FI r 4 00 ON PLUMBING FIXTURE RATES: NO. RATE TOTAL 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 Gas Dryer Back Flow Preventer Required ( )Yes () No $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 /0100 $10.00 $10.00 .: ADDRESSi • fa� L 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 Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. /%- ?K2 Owner. • Building Used As / Estimated Cost 5/70- eS7` PERMIT NO. %L�-2 Type $5.00 PLUMBING COMPANY Reinspection Fee $30.00 SIGNED BY TEL N0. ` y ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance �,-•� Approved By / Rough -In Date Final Date State Surcharge MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS 515.00 TOTAL FEE $1L, PLUS THE $.50 STATE SURCHARGE 01 SUBJECT MIT NO. City of Fridley ? 3 4 6 4 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r i � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By "'' 612-571-3450 910-F15 6/19/95 JOB ADDRESS 4803 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 16,17 2 1 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mark Ekman 4803 2 1/2 Street NE 571-9408 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Thurs Construction 5717 113 Ave N, Champlin MN 55316 424-5624 9346 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 (Tear -off) 16 Sq 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must meet the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,200 $.60 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- Fire SC $1.20 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $29,00 PLAN CHECK FEE TOTAL FEE icense SC $5.00 1 $35.80 T— SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI HER ALIDATED THIS IS YOUR tPERMIT e'c b — SIGNATURE OF OWNERIIF OWNER BUILDER) IDATEI BLDG i P DAT 01 NEW [ ] Effective 1/1/95 ADDN [ ] `CITY- OF -FRIDLEY ALTER { ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address Legal Description: Owner Name & Address: A a fX �F Kvvxg " Tel. # - S- 7) Contractor: V ©n MN LI&NSE # 9 T Address: :S' `? _1 — I J v ,� c� Tel. .# Attach to this application, a Certiiicatc of Suivey. 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. Ez OTHER: .e �0 01�' i � � + �q ®� F V Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Type of Construction: R e-rD®-F- Approx. Completion Date: (Cost on Side Yard Setbacks Estimated Cost: $� pp- /�L� a U Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: - J l ` i APPLICANT: L-02 1 Permit Fee $_,j2- O 0 Fire Surcharge $ /' do State Surcharge $ .60 SAC Charge $ License Surcharge $ 6_00 Driveway Escrow $ Erosion Control $ Park Fee $__ Sewer Main Charge $ TOTAL STIPULATIONS: $ js.ao CITY USE ' ONLY Tel. # qa�Z_Ga <-/_ Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $850 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 [ ] m I SUBJECT ' P N City of Fridley 32265 AT THE TOP OF THE TWINS BUILDINGr PERMIT E"AIT ` • ______ COMMUNITY DEVELOPMENT DIV. IPT NO. 31,4�� r L PROTECTIVE INSPECTION SEC. oM 1 NUMBED REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/22j01 JOB ADDRESS 4803 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 16,17 2 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Paul Turpin 4803 2 1/2 Street NE 571-5577 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 e USE OF BUILDING Residential 7 CLASS OF WORK C3k NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 241 x 121 Deck 8 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNiNG Before digging Call for all utility locations 454.0002 REQUIREDLAW 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 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 1 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 $1.35 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,700 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- $.83.25 Fire SC $2.70 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE T0TA E $67.30 ACTOp kT{�-A6iaTiDATE. OPE ALIDA D MI5 1$ YOURPERMITI 4SIGNUDE�.N X QE Oi B DERi iOATEi rIAYE m I NEW [l ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION � Construction Address: Legal Description: -;� Owner Name & Address: dive 1/1/200'6 604 Bldg Insp Tel.* 571— -�75 77 -�, Contractor: L cJfi e%- 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 Width Height Sq. Ft. �( DECK AREA: Length 2 y , Width 12-/ Hgt/Ground -%' 10 ' Sq. Ft. Z 8W OTHER: Construction Type: Estimated Cost: $ s Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: �O0— APPLICANT: I c1� �° Tel. # s �/ J CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Call (763) 572-3604 for Permit Fees if mailing In application $ Fee Schedule on Reverse Side $ `%d .001 of Permit Valuation (1/10th%) $ %•e.�, $.50/$1,000 Valuation $ •�''� $1100 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Park Fee $ Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: r �r .� .�-fir-' • •' •r� rr 1.1 a •i Nisp e' • CERTIFICA.TE.:OF• SURYE'Y J•i Amar 04WEL ".c F.,.•_ .' Foe Yi � 34� 3' . 1343 0 S7 OESM.PTIQN:. 'LOTS 16-& - jTR BLOCK 2, faLrNlOUTN.. °jj p: .rr.. .'t - Y1'fH• 1 r i ,t a1��91 SCALE:— I 2A We hereby certify.` #het '.this' is:.a true' end'cdt•rect represen gtifl(n :4f asur^;�of,�' the'. bouadari es of ` the - I and • abbve descr. i bed':t�and `sof •the;. l oc�a.H.,pn OU, 1 bu if any,.. -thereon, and eII •visi.ble encroacbmerits;"`if eny, f_"om'.:or on Sei;d fa Dated; this TH- day_ of FEBRUARY1'9 : �t*aA.N, F19.Q .& NOWAK Sey rs•'- r-Xymrt -, tir:lN , a .i to No' -45. S3 HBook No 1434-2''n ��Y w " I / SUBJECT City of Fridley 32 6 37 QRE AT THE TOP OF THE TWINS BUILDING PERMIT P r • _____ COMMUNITY DEVELOPMENT DIV. r y- INSPECTION SEC. r PROTECTIVE ,?6 NUMBEF REV DATE PAGE O: APPROVED BY IL"'�'� CITY HALL FRIDLEY 55432 L ---. 612-571-3450 910-F15 5/24/02 r 10B ADDRESS 4803 2 1/2 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 16,17 2 Plymouth SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Paul Turpin 4803 2 1/2 Street NE 763-571-5577 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 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK COnstruct a 12' x 10' Deck and remove concrete steps 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. AIR WANIK Before digging call foir all utility locations 454 0002 ae IRED BY LAW SEPARATE PERMITS ARE REOUIRED 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 1 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 $1,320 $.69 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 TOT FEE 53.02 SIG RE OF CO OR OR AUTHO iDATE' HEN RO VALI�?A;Tr THIS IS YOUR PERMIT 40t,GNATURE OF O aF OWNER BUILDER, iDATEI BLOt iNSP OarE " I / NEW [ J CITY OF FRIDLEY Effective 1/1/2002 ADDN [ J 6431 University Ave NE, Fridley, MN 55432 (763) 572.3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 11-903-2- 4 '�'( oe' Legal Description: Owner Name & Address: Tel. # 763-57/-557 7 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 Width Height Sq. Ft DECK AREA: Length '' Width a e Hgt/Ground Sq. Ft o �0 OTHER:-eF-1h00 _ a Construction Type: 1 '4 Estimated Cost: $ Driveway Curb Cut Width Needed: Ft +6 Ft = Ft x $ _ $ DATE:O APPLICANT: Tel. # 76,9- � 7�'SS 77 —�—�. Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-5714287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ ,,SD. %$� Fee Schedule on Reverse Side Fire Surcharge $ ,.� _ .001 of Permit Valuation (1/10th%) State Surcharge $.50/$1,000 Valuation SAC Charge $1200 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'Engineenng Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ z STIPULATIONS: