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PRE 2010 DOCS0 0 BUILDING PERMIT Village of Fridley, Minn. No Date Al../ % ......... . �. Owner ..../.. f `........ /� t� Address Qe+ 6G! .// . s ..... �i7� ... ........ .... . 2945 Builder............! .............................. Address ........ .......... ... -- LOCATI N OF BUILDING No.__ // .... Street . ... ........ ........................... Part of Lot ... ...... I/.. ��.. / ... :. .. . . .. .... Lo ... Block " . '............. Addition or Sub -Division . Corner Lot ............ Inside Lot'............ Setback .�"�....., ideyard ... �e DESCRIPTION OF BUILDING To be Used as: .... , .... Front .. Depth ...�!.... Height . �z, Sq. Ft. fl� Cu. Ft. ........ Fent ........ Depth ........Height ... .. Sq. Ft......... Cu. F`t......... , �d / Type of Constructio ...? Est. Cost `fid . �� ...... 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 with all provisions of ordinances of the village of Fridley. -7 ...... .....�r...... . ... . �.. .......... In consideration of the payment of a fee of $ /. , permit is hereby granted to ........ ............. . ...................... to construct the building or addition as described above. This permit is granted 6 on 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 village limits and this permit may be revoked at any time upon violation of any.,of the provisions of said ordinances. _ 117 1^ A 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. City of Fridley, Minn. BUILDING PERMIT Date: .. l ....:!....L........... Owner .. r� . .. .. � .. .. ........ . .. . Address .......................... ........... • N® 3732 Builder ... Pit, -?i44 ............................ Address........ ..................................... ATION OF BUILDING No. Street . ..................... Part of Lot .. ...............i . Lot. Block ... (. ...... Addition or Sub -Division .ltaz� A Corner Lot ............ Inside Lot ............ Setback ............d ........................... DESCRIPTION OF BUILDING -be Used as: Tom:!.. ... �nt /...- Depth Height . �!� rl. e`sq. Ft4. cu. Ft. . .................... Front ........ Depth ........ Height ........ Sq. Ft......... Cu. Ft. ........ Type of Construction ................... Fbt. Cost..................... To be Completed ................... 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 set forth and in compliance with all provisions of ordinances of the city of Fridley. -X .. t'e. � In consideration of the payment of a fee of $. .........., permit is hereby 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. A_ ..`.`.".`.... 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. SUBJECT P T NO. City of Fridley ® 13953 AT THE TOP OF THE TWINS BUILDING PERMIT r EIPT N COMMUNITY DEVELOPMENT DIV. L r PROTECTIVE INSPECTION SEC. I . i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 3/21/77 JOB ADDRESS 6011 - 2' Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18,19 6 Hyde Park SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE F.ucrene Woehler 6011 - A Street 3 . CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 529-9216 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 Fire Repair 9 CHANGE OF USE FROM TO STIPULATIONS Provide ft fire detector. Call for a pre -inspection to determine what has to be repaired or brought up to Code. SEPERAIM PERMITS REQUIRED FOR WIRING, EATINC>a, pi.UMBING AND SIGNS. ,,,... TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Frame VENTILATING OR AIR CONDITIONING. Wood 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 R-1 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. $10,000 $5.00 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- $60.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE `' 1/ $65.00 SIGNATURE FCONT C RORAUTHORIZEDAGENT DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT BLDG. INSP - DA E SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: �—�V (of ty i 1�9.' ),a yaL C,-- 62 BUILDER:. ZL, VA, Address: C; - Address: a Tel. No.: �aG-qa\b No.: 6D1\ LOT: Z8, I9 Street: &T-, P - _ BLOCK: _ ADDITION: qa,rQ dnaJ CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: FiLcs— lP, n- Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: V-EPq- y_ Estimated Cost: $ 10. OOO_ To Be Completed: M t9' ; �O , lq �►'1 /Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby makes application for a permit for 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 are true and correct. See reverse side for additional information. DATE:/7`7 SIGNATURE: Stipulations: ZI 100 Al esu CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Rate TOTAL $ 20.00 $ $10.00 $ $10.00 $ Gas Dryer $ 10.00 $ *Air Conditioning All Sizes $ 10.00 $f� ,may 5'?C?#0 All Others/Repairs & Alterations (LIST ON BACK) JOB ADD 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this appli tion r true and correct. ,1991 OWNER J EAN VLJC3� BUILDING USED AS ®�����G" ESTIMATED COST l �V PERMIT NO. 9-3 DESCRIPTION OF FURNACE AND OR BURNER 1 % of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. Commercial/Industrial BTU HP EDR 1 % of Value of Appliance or Work $ Fuel Total Connected Load State SurchargeBurner Trade Name Size No. U HP EDR TOTAL FEE $ �� WATING, AIR CONS# �.o ® EMU, 1K. EATING COMPANY 1_ (I79nuA Am; M e MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 Signed By. Approved By Rough -In Date Q 5530 Tel No. fig= Final Date *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 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 ( ) No ( ) 4. Is securely supported Yes ( ) No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes ( ) No ( ) 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Being Done: HEATING COMPANY Signed By Date M SUBJECT PER City of Fridley 212 ;9t7 AT THE TOP OF THE TWINS BUILDING PERMIT r COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. s r CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/22/92 JOB ADDRESS 6011 - 23 Street. NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 � 19 6 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jean Woehler 6011 - 211 Street NE 571-4091 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 Cj REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (12 Squares)- Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment to comply nth_. State. building Code, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 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 $636 $,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- $19, QQ Fire SC $,64 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $20,14 SIGNATU OFCONTRACTOR0 THORIZED AGENT IDATEI PROPERLY V D ED THIS IS YOUR PERMIT L]jHEN .' 4- 2- DG INSP MATE SIGNATURE OF NER I IF OWNER BUILDERI r IDATEI M NEW ( ] Effective 3/1/92 ADDN [ ] CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: �� l�S�`/� e Alt/ Legal Description: / �oj l l Owner Name &Address: Tel. 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. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length �1 Width \ Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ l Inside Lot t4� Ft. Yd Setback Side Yard Setbacks /'C Type of Construction: Oct 4- Estimated Cost: $ t,, 3 0C) Approx. Completion Dater (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: —2Z-2- PLICANT: e /Y l 0 P / �� Tel. # 5 7� 7 % Permit Fee Fire Surcharge $ /9; no $ • 6 LI State Surcharge $ HCl 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 ( ] SUBJECT City of Fridley � �; 9714 AT THE TOP OF THE TWINS BUILDING PERMIT RPT NO. ECEI 1f � � • COMMUNITY DEVELOPMENT DIV _ r I PROTECTIVE INSPECTION SEC NUMBER REV DATE PAGE Of APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 2/9/96 JOB ADDRESS 6011 2 1/2 Street 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 18,19 6 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerome Woehler 6011 2 1/2 Street NE 571-4091 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 Alterations to basement bathroom 9 CHANGE OF USE FROM TO STIPULATIONS 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 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $500 $ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $21.00 Fire SC $.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTALFEE $22.00 5WOOTURE NTRACTO R AUTHORIZED AGENT ATEI WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT (( � BLDG INSP OAK TE S A URE OWNERUF OWNER BUILDERi tMATEI NEW [ ] Effective 8/1/95 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: _ Legal Description: Owner Name & Address:Tel. # S 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 Hgt/Ground Sq. Ft. OTHER. Corner Lot [ ] Inside Lo, ] Ft. Yd Se acv Side Yard Setbacks Type of Construction: 4 �, Estimated Cost: $ 00 Approx. Completion Date:r,.l Z s (Cost on Back) Driveway Curb Cut Width Needed: Ft. +: 6 Ft- Ft x $ _ $ DATE: RPh y _ APPLICANT:6 Tel. CITY USE ONLY Permit Fee $ 5;2 `R' 0 Fire Surcharge $ State Surcharge $ , SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee Sewer Main Charge TOTAL STIPULATIONS: 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 [ ] SUBJECT PER City of Fridley 30822 AT THE TOP OF THE TWINS BUILDING PERMIT � RECEll P O. r.v COMMUNITY DEVELOPMENT DIV. _____ I7 •� PROTECTIVE INSPECTION SECa/� NUMBER REV74/12/00 DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 JOB ADDRESS 6011 2 1/2 Street NE 1 LEGAL LOT NO. I BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 1 18,19 6 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dan Larson 6011 2 1/2 Street NE 571-8880 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Cross Replacement Windows 500 E Traveler Trail #500, Burnsville MN 55337 20158185 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 .0 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install two bedroom egress windows 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. 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 S OMME D. NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT H VE AD AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO ET UE NO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVE NI G HIS TYPE OF WORK WILL BE COMPLIED $2.20 WITH WHETH SPECIFIE R IN OR NOT. THE GRANTING OF A PERMIT $4,391 `P DOES IESLIME TO E AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVI 10 S OF ANY O ER TAT OR LOCAL LAW REGULATING CON- ' $111.25 Fire SC $4.39 ST Ti O TH R OR A E OF CONSTRUCTION PLAN CHECK FEE TOT FEE o License $5.0 $122.84 NATUREOi ON RAC ORORAUTHORIZEDAGENT IOATEI EN RQP VALID TE THIS IS Yp R PERMIT S-GNATURE OF OVVNEROF OWNER BUILDERI IOATEI BL INS FiAiE NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: (,b ( ( A --',I -- S+" Legal Description: Effective 1/1/2000 (763) 572-3604 Bldg Insp Owner Name & Address: 1)(AN a c A AA1)Y Tel. # x'17 f=92 9'c-' Contractor: Lm- m It Lao- emet4 ujzm Cb kMN LICENSE # Z h Address:5-00 t= %,eZ Tel. # g?q--r7 76 STIPULATIONS: 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: (rl -, Construction Type: O(X�) S Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft - Ft � _ $ DATE: Y / U V APPLICANT: Tel. # I CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ // oZ— Fee Schedule on Reverse Side Fire Surcharge $ ,,3 .001 of Permit Valuation (1/10th%) State Surcharge $ 07.11�0 $.50/$1,000 Valuation SAC Charge $ $1100 per SAC Unit License Surcharge _ $ C)D $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 $ / C541 STIPULATIONS: CITY OF FRIDLEY PERMIT .: 2004-00651 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 05/05/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 60112 1/2 ST NE PIN : 233024220027 LEGAL DESC : UNAVAILABLE : LOT 00 BLOCK 0 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOW/DOOR REPL VALUATION : $ 1,500.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. INSTALL A BASEMENT EGRESS WINDOW STATE LICENSED CONTRACTOR 1 APPLICANT BUILDING PERMIT FEE FIRE SURCHARGE 54.00 1.50 EGRESS WINDOW SYSTEMS 5932 53 AVE S STE C STATE SURCHARGE, VALUE 0.75 FARGO, ND 58104- LICENSE SURCHARGE 5.00 TOTAL 61.25 PAID WITH CHECK # 9509 OWNER BRITA, GIVANCE 60112 1/2 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 work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violateor cancel a provisions of any other state or local law regulating cons tion or the a ormanc of coLo Applic '`� Dat Bldg Insp Dat� SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [] ADDN [] ALTER [ ] Construction Address: &,a)-640 CITY OF FRIDLEY Effective 4/1/2004 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION �V 1 6e 6 7- it , �J e r a Legal Description: Owner Name & Address: i2-t-�J6s A-•/ L 4 Tel. # 7 (.3— Contractor. F—r- t—' S"' cry �'��" MN LICENSE # — Z -z 3 It d' / 4 Address: '5-1 2 53 �- k-✓ i Tel. # 4 l a i2Z , 'SSG -z 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: Construction Type: f4 /'CSJ j / Mb� Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: �r�� v Lf APPLICANT Tel. # 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. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - 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 [ ] TOTAL $ s STIPULATIONS: Building BUILDING Permit Inspections RESIDENTIAL APPLICATION Received By: 763-572=3604 CITY OF FRIDLEY Da' SATE -I '% "®r% YOUR E-MAIL ADDRESS t`✓C1t ,C-0nc-�s� m C� 31TE ADDRESS 6t)<< A .0005 x Permit Valuation Minimum $.50 THIS APPLICANT IS: ❑ OWNER 4ONTRACTOR $ PROPERTY OWNER/ NAME: tit r SAC Charge TENANTADDRESS: 6c> l ( oR CITY STATENWZRSMW Curb Cut Escrow PHONE: 763—J®r Z CONTRACTOR NAME: a, ®` $ SUBMIT A COPY OF STATE LICENSE # 9QQ EXP DATE Park Fee YOUR STATE LICENSE ADDRESS: b CITY P7I,C4,i STATF� WITH APPLICATION PHONE ,( FAX $ PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE Total Due $ O TWO FAMILY/NEW CONSTRUCTION STORIES Make checks payable to: City of Fridley Attach Stipulations PEP -AM TYPE l] ADDITIONGEISHED E3 WINDOWS ❑ BASEMENT FINISH IV= ❑ DRAN TILE ❑ DECK ❑ SIDING ❑ OTHER ` ❑ SWIMMING POOL /2 TYPE OF WORK: I ❑ NEW ❑ ADDITION ANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING HOUSE ONLY NUMBER OF SQUARES IQ --:5-& ❑ HOUSE & GARAGE BASEMEN' REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2• Existing Floor Plan Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing aruchues ❑ Other ❑ Fasein and Proposed Project. WINDOWS 2. Two sets of construction plans IN EXIS71NO OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations 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 $ gII5 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 $ $1675 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = R x $21 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( } Total Due $ 'l- a0 . Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMITNOT 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 workeAuires review and approval of plans. SIGNATURE OFAPPLICAbON __ PRINTN��cSr��� 0.� DATE LS L-?