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PRE 2010 DOCSN? 151 Owne cl, Architect Builder Village of Fridley, Hhm. "I" I _1 locus W NJI10 I V Office of INSPECTOR OF BUILDINGS FrUtley, Minn. - LOCATION OF BUILDING No.StreetPart of Lot. Lot Z CR-- /`eS Blo Ze Addition oar Sub -Division DESCRIPTION -OF BUILDING 210 %7 ront-=2— DePth-4tZ Height—L7— Stories Manner of Construction 1;6 i 2t ) 4 -s- i Estimated Cost-ZU-6 To, be, used as To be', completed NUitn' 11 - Permit is hereby granted to 14 1 to, 4_,A Ut the building. dcscrii lj�j"� RnA� above statement. This permit Is granted upon the express - condition that 4e person i6 whom k, is granted, and his agents, employees and workmen, In all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., regarding the 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. L --Inspector of Buildings. AGREEMMU AND SW;' -)RN STATEMENT In consideration of the issue and delivery to min by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the propo&A word in accordance with the description above set forth and according to the provisions of toe ordinances of Fridley, and, being first duly I q sworn, I hereby state and say that the facts stated )y me an contained in the above permit are true as therein stated. Subscribed and sworn to before me at Fridley, Min!pso- day oA.D. 19 L— I- 3 -W • • • City of Fridley, Mian.. BUILDING PERMIT Date: Nov. 19 , 1968 Rec. # 45070 N° 10029 Owner: Raymond Borg Builder Same Address 4610 3rd St. N. E. Address Same LOCATION OF BUILDING No. 4610 _ Street 3rd St. N. E. Part of Lot Lot 12 & _12B1ock 10 Addition or Sub -Division _ Plvmouth Addn . Corner Lot Inside Lot — Setback Sewer Elevation Sideyard Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Bedroom Front 13'6" Depth 18'6" Height 12' Sq. Ft.2! 99 Cis. Ft, 2988 Front Depth _ _ Height Sq. Ft. Cu. Ft. Type of Construction - frame Est. Cost _ 2500, 00 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 , rth and inpli with ;h provisions of ordinances OY the city Of Fridley. r In consideration of the payment of a fee of $----L- 00 , permit is hereby granted to Raymond Borg 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 reg location, construcMaTon, alteration, maintenance, repair and. moving of buildings within the city limits and permit may be revoked at any time upon violation of any of the Provisions of said ordinances. r / 1 Clarence BelislT— NOTICE: Thh permit does not cover the construction, hrstallatlon for whing, phnnbing, on heating, sewer or water. Be sure to ase the Building Inspector for soparate permhs for these horns. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA iff�,VTWAYZM M, LOCATION OF BUILDING N0. STREBT LOT BLOCK ADDITION OR SUBDIVISION C010M LOT INSIDE LOT SETBACK SIDEXARD SEWER ELEVATION TOP OF FOOTING 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: ie u ,�?,®®m Front — Depth � � � Height Square feet _ Cubic Feet' e Front Depth Height Square feet Cubic Feet Type of Construction Estimated Cost AfO O, ®c9 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 the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and iwAesertations stated in this application are true and correct. DATE AIOU 0 9 (Schedule of Fee Costs can be found on the Reverse Side.) Original• PERMIT for Power tants and Heating. Cool- ing. Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of - Heating Plants to be installed--altered—repaired Make 1.c P'a'l'a , Size / °--O 4 °`&� h 7-a— ; Oil fired , Coal Remarks Approved ; Gas fired ; Gas Authorization No. Final Inspection Date , 19_ Inspector Permit N° 4566 Fee $ / Le - Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. , I9 -g Owner / L" Z Location Le 1 ® Kind of Building How Occupied Work to be Com19.a To be Completed ,19_ Estimated Cost, $ 56-e, ` 6---) Old -New, Building Permit No. Permission is hereby granted to to install—erect—use the material and devices described in the above statement. This permit is granted upon the e&ess conditiorPthat the person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named and to the speci ations set forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings 42 2M 1 1.67 V Orighw PERMIT for Power Plants' and Heating. Cool- ing. Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. o- I Heating Plants to be installed—altered—repaired Make (p �Jl- �-"W?T 6 Oil fired—,- Coal fired—,- Gas feed ; Gas Authorization No. . -A. - A . ^ • . 1 n -A, / Remarks Approved Final Inspection Date , 19_ Inspector Permit N° 4740 Fee $ 1106 Office of the Inspector of Buildings City of Fridley City of Fridley, Minn./.I , 1996 Owner 1616 -a'zo 1 . E Location Kind of Buildin �wvt ® 2 How Occupied Work to be Commenced ,19_ To be Complete / ,19 Estimated Cost, $ 4-16--00 old- ew, Building Permit No. Permission is hereby granted tom" C -1, to install--erect—use the material and devices described in the above statement. This permit is granted upon the express condition that t1le person to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation df the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specifacatio set orth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings 42 X 4 2 2M 11-67 v Application for Power Plants and Heating. Cooling. Ventilation. Refrigeration 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 os 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 $ AIR7 CONDITIONING ' C�T.�f• — Q��e FAN HEATING SYSTEM °2 See Fee Schedule VENTILATING SYSTEM 14" ALTERATIONS &REPAIRS TOTAL FEE $Ig _ ROUGH y / FINAL t - / Dept. of Bldgs. Phone SU 4-7470 Location 9(e / 6 Z 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. Fridley, Minn_ 6-10 19;7Q Owner (! Kind of Building Used as��K/�� J To be completed about Estimated Cost, $ New. Building Permit No. Permit No. % � b DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, 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. (REMARKS -OVER) By / 42 2M dnassq Phone No - 01 SUBJECT P City of Fridley 2 8 4 798 AT THE TOP OF THE TWINS BUILDING PERMIT i � COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC �3 ; CITY HALL FRIDLEY 55432 NUMBERREV DATE PAGE OF APPROVED By L J` 612-571-3450 910-F15 10/30/98 10B ADDRESS 4610 3rd Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DEscR. 12, 13 10 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Curtis Nitschke 571-5402 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 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION fk REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage (22 Sq) tear -off; Install 3' x 6' back entry garage door 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State $uilding 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 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 1985 $.99 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 $62.25 Fire SC $1.98 PLAN CHECK FEE TOTAL FEE 65.22 IDATEI WHEN PROPERLY A IDATED THIS IS YOUR PERMIT aSIGTUeRlOFCONIPACTORORAUTHORIZEDAGENT SURE OF OW NEA nF OW NER BUIL DE RI IDATEI �O INSo gAtE 01 NEW [ ] Effective 1/1/98 ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION u �'J ConstructionAddress: Legal Description: 2 - Owner Name & Address: Tel. #'"7-J�'d Contractor: to e22"ti 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: Length 4;7 - GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF E%IPROVEMENT Width Height Length Length 9� Width ? �'r Height Length Width. Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. *W-0r9f IAI�IWas3D" X �'u� ,��&2 - �cz c Construction Type: Estimate Cost: $ ala64, 96 M5 (Fee Schedule on Back) / �(s_ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE: a 9 dam- i,' APPLICANT• eve`» Tel. # �7/_s ler 7 - Permit Fee Fire Surcharge State Surcharge SAC Charge CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $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_ \ ✓ �t t �` WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H 106835 sealing County Name WELL AND BORING SEALING RECORD ❑ Yes ❑ No ❑ Unknown ❑ Yes ❑ No ❑ Unknown [ ,Steel ❑ Plastic [:]Tile [j Other 3 a +?) : ' L C Ya Inge� I to Unique No. pA ��Fr yypp�� a.Idi.- IMY&'-.XM QNOKA Minnesota Statutes, Chapter 1031 or W -series No ,116th - :' uA St,raet, NE Screen from to (Leave blank If not known) Township Name Township No. Range No. Section No. Fraction (sm. -i Ig.) Date Sealed Date Well or Boring Constructed yo r i idl�.`�e T H t� la y4 Y4 Q} / /08/96 + 1 �3 } g Sf a (08/ 96 Numerical Street Address or Fire Number and City of Well or Boring Location 4610 — 3rd Street N E Depth Before Sealing d -y 2 fL Original Depth fL Show exact location of well or boring Sketch map of well or boring AQUIFER(S) STATIC WATER LEVEL In section grid with "X". location, showing property Q Single Aquifer ❑ Mulflaquffer N lines, roads, and buildings. Measured ❑ Estimated WELL/BORING E_ \ ✓ �t t �` [.Water Supply Well ❑ MonfL Well �F�tv. Bore Hole ❑ Other R [:L below 11 above land surface CASING TYPE(S) , I T-11, �i E_ \ ✓ �t t �` [.Water Supply Well ❑ MonfL Well �F�tv. Bore Hole ❑ Other R [:L below 11 above land surface CASING TYPE(S) in. from to In. from to �i ❑ Yes ❑ No ❑ Unknown ❑ Yes ❑ No ❑ Unknown [ ,Steel ❑ Plastic [:]Tile [j Other 3 a +?) : ' L C Ya Inge� , y�'V --� V 4 � 1 • CASINO Diameter Depth Set In oversize hole? Annualar space initially grouted? �fi-- t mile .h ��, a •+ F' (yin. from d " 10 2 ft. ❑Yes 0 No ❑ Yes ❑ No ❑ Unknown in. from to In. from to ft ❑ Yes ❑ No fL ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown ❑ Yes ❑ No ❑ Unknown P�lOPF( O• N �:=� � ' � �)�IAS stmar-dl Property owner's mailing address It different than well location address Indicated above. GAUDETTE M THOMAS & SHERRI SCREEN/OPENHOLE ,116th - :' uA St,raet, NE Screen from to � g ft Open Hole from to ft. OBSTRUCTION/DEBRIS/FILL R Obstruction ❑ Debris F-1Fill❑ No Obstruction WELL OWNER'S NAME +1 Type of Obsfructlon/Debris/FIII ..,,-' ''- as.. -a 4 " `' t ' g R "` - 'i . -` L 't ". Well owner's mailing address If different than property owner's address Indicated above. ObstructionlDebris/F)II removed? ❑ Yes ❑ No PUMP Type ❑ Removed El Not Present ❑ Other GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION If not (mown, Indicate estimated formation log from nearby well or boring. METHOD USEDtb SEAL ANNULAR SPACE Q No Annular Space Exits BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: Annular space grouted with tremie pipe ❑ Casing Perforation/Removal In. from In. from Type of perforator ❑ Other to ft to ft ❑ Perforated ❑ Removed ❑ Perforated ❑ Removed GROUTING MATERIAL(S) Grouting Material t c to t from LL' to 6) '� ft yards '-. bags from to ft. yards bags from to from to ft. yards bags fL yards bags REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑ Yes ❑ No in well r o c> w un east LICENSED OR REGISTERED CONTRACTOR CERTIFICATION amide of 1:a--emerit ... Measured from t Q p rs f c a .sing' 5' This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained In this report is true to the best of my knowledge. beIow Qt'_tde Ieve,I r Contractor 9uslness Name - cense or Regisfiatlon No. r Authorized Representative S/gnaWre Date Pi r►; - - - LOCAL COPY H 106835 Name o1 Person Sealing Well or Boring HE -01434-02 10195R SUBJECT PERrt City of Fridley 3885 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. v �_��_ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 1 ; NUMBER REV DATE PAGE OF APPROVED BY CITY MALL FRIDLEY 5532 763-571-3450 9t 0-Ft 5 9/15/03 JOB ADDRESS 4610 3 Street NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 12,13 10 Plymouth Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Karen Kubiak 4610 3 Street NE 651-329-7218 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 O ADDITION O ALTERATION D REPAIR x O MOVE O REMOVE 8 DESCRIBE WORK Install door & window 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. 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 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 $700 •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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE $30.80 iG�O=C� ICTOPON uu OR�� iOATE� [•/�I ,pq pEgLY VALIDATED THIS IS_OU TV'( cq SIGNATUAE OF OWNEROF OWNEP BU4 DERi iDATEi 8 OG iNSP OAtE NEW [ i CITY OF FRIDLEY Effective 1/1/2003 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 Construction Address: IqGIt� .S -T- Legal Description: Owner Name &Address: tj �� f' �I� Tel. # 6S i " 9 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. Hgt/Ground Sq. Ft. Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: � I �� 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. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ 6 Fee Schedule on Reverse Side $ %p .001 of Permit Valuation (1/10th%) $ S D $.50/$1,000 Valuation $ $1275 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 [ ] Qw OLD WtND6d0, Dooms c SZ i Z C7 0 t j IQL Permit No�-7 — ®'P 1 SZ, Building AMCHANICAL Received By: Inspections RESIDENTIAL APPLICATION Date Recd: a Ey, 7.63-572-3604 CITY OF FRIDLEY DATE YOUR E-MAIL ADDRESS crTE ADDRESS THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PERMIT TYPE TYPE OF WORK.: 0 OWNER ACONTRACTOR A COMPANY NAME' - CONTACT PERSON: STATE LICENSE # EXP DATE CtTV � 11(1df.1 a STATEJ _OZ ADDRESS° FAX ,3tPGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE ❑ NEW REPLACEMENT D ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK , for the PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $SOO.O0, whichever is is hould reflect only therc st of labor) improvement, installation or replacement of a residential f xture, excluding the fixtures. (Th Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =,__ EXCEPT WHERE NOTED. FI3CTiJRES: (II`1DICATE TOTAL �� SIZEBTU FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE�— NUMBER OF EACH BELOW) MFG: MODEL: SIZE/BTU Equipment Installed MODEL: SIZE/BTU C'' MODEL: __— MFG: GAS RANGE/OVEN $10.D0 A/C $25.00 ,_FIREPLACE (GAS) $ $35 NEW GAS GRILL $10.00 _AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 GAS �T HTR $10.00 BOILER $35.00 ✓FURNACE $35.00 —POOL HEATER 535.00 DHIIOIIEY LINER $10.00 _GAS DRYER $10.00 ��LP.TOR $15.00 DUCT WORK $10.00 ,_GAS PIPING $10.00 -MEN . $ _ Number of fixtures @ $10.00 Permit Fee x $10.00= Permit Surcharge $ 50 Number of fixtures @ $15.00 x $15.00 = $ — $ Number of fixtures @ $25.00 x $25.00 = $ TOTAL DUE Number of fixtures @ $35.00 1 x $35.00 = $ State Surcharge = $ 50 Total = S L J_D THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED t thwork ill be in I hereby apply for a building permit and I acknowledge that the information above is complete and accuratee ; thawthat I understand this is conformance with the n application n for aes of ermitand1ty of work isldley and not o startlth the without Minnesota 1 permit; that the work will be in accordance with the not a permit but only an appl p uires review and approval of pl s. - approved plan in the case of a rk w is q DATE Q 7 SIGNATURE OF APPLIC PRINT NAME - w City of Fridley Building Inspections Department . 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 V A v. '742_Sm_AQ 7 REQUIRED INFQRMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC NEW HOMESADDITIONS 219XISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEVVEXISTING HOMES 1. Combustion Air (see note below) �. Oil or solid fuel WC Chapter 7 with MN Amendments b. Natural Gas or Propane/1FGC Chapter 3 with MN Amendments 2. Mike -up Air (See note below) a. 19C Chapter 5 with MN Amendments 3. Venting a. Gas appliances ]FGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a_ Required on new coustruciion IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACOA Manual D N pTE: Centerpoint. Energy Mechanical Code Guidelines software may be used for coinvustion and make up air calculations Building AND MATERIALS: BUILDING Permit No.:� Inspections TOTAL JOB VALUATION $ RESIDENTIAL APPLICATION L s' Received 763-572-3604 $ Ill , a See Back Page for Fee Schedule Plan Review $ CITY OF FRIDLEY Fire Surcharge DR2'c' 763-502-4977 FAX .001 times the total job valuation Surcharge $ C a 0 .0005 x Permit Valuation Minimum $.50 EFFECTIVE 1-1-09 $ DATE b /a� f/ D 9 YOUR E-MAIL ADDRESS f=q1 i<LC ✓B I At0 S A) • �'-di'>'l SITEADDRESS 417(0 7386 S7 FJ "-- $2000 per SAC Unit (Plans to MWCC for determination) THIS APPLICANT IS: XJWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: 7<"-5—W Ku B I K - $ TENANT ADDRESS: 4/010 3P'6 S -r A)E CITY Ili y STATE NWZIP SS42/ $ PHONE: -7(.,3 -S74--2 Fee Determined by Engineering CONTRACTOR NAME: SUBMIT A COPY OF Total Due $ YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: '-- CITY ^---_ STATE ZIP INSURANCE PHONE -" FAX PROPERTY TYPE CWSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ,KSIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION 1,0 MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: -S/i6/(JG OK) A-1-0Yn4-- /9 SQu #R25 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING NUMBER OF SQUARES ❑ HOUSE ONLY 11 HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 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: SEDIN SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, JVVin❑ []SoffitADDITIONS & PORCHES SUBMIT: Aluminum El 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 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 $ L s' OCCUPANCY TYPE Permit Fee $ Ill , a See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 3 iO .001 times the total job valuation Surcharge $ C a 0 .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ (0.4 a< Make checks savable to: Citv of Fridlev Attach Stioulations 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 a permit 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 all work which requires review and approval of plans. ` SIGNATURE OF APPLICANT e -d"�i�- PRINT NAME W#REA) ?(Q& ,< DATE (126 /09 1 PLEASE NOTE SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK I FK FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (763) 571-3450 - FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific eemption from the licensing requirements. As the owner of the property at 4-640 3 S7" /U<ff- , Fridley, I am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Date_ !�9