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PRE 2010 DOCSVillage of Fridley, XU=. BUILDING PEIPM N° 830 Office of INSPECTOR OF BUII.DINGS owners'_'. Architect Fridley, Minn., 'f- - Builder LOCATION OF BUILDING No. `' street Lot } Block z `:"� .•— `� 4i Addition or sub -Division Part of Lot Front � Depth ' ' To be used as Height DESCRIPTION OF BUILDING stories ' Manner of Construe0on To be completed '- - Estimated CosteAr "+ Permit is hereby granted to '- = e ' _ '� - to * the building Oliz_described in the above statement. This permit is granted upon the express condition that the person to whom it 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. AGREEMENT AND SWORN STATEMENT of Buildings. In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. Subscribed and sworn to before me at Fridley, Minnesota, this day of! �'f - A.D. 19 d'6.,,� •. r - ---�. 0 0 BUILDING PERMIT Village of Fridley, Minn. No Date �. .. ..��... A� Owner ... ..... ... Builder Address v.�,�%L .✓ .. ®.� ... Address 2964 ...... ......... . .!..� .... ,................ LOCAT I N OF BUILDING No. . ! . ® ..... Street �.�, of . Part of L ....................... Lot ................ Block ................ Addition or Sub -Division .... ................ CornerLot ............ Inside Lot ........ Setback ............ Sideyard .......................... a DESCRIPTION OF BUILDING To be Used as: �. Front .� .. Depth :&�... Height ......... Sq. Ft. ` '�3 Cu. Ft. ........ .................... Front ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft........ . dti Type of Construction .............. Est. Cost ..............,7..6.. d.. 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. %�/ 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 village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. NOTICE: This permit does not cover the construction, installation or alteration for wiring,pl bing, gas Beating, sewer or water. Be sure to see the Building Inspector for separate permits for these ems. 4 53 -8b -S-915.51 City of Fridley Appla n for 11 -mag and Cim Vas Dept. of Bldgs. Phone 5ti0-3450 DESCRIPTION OF WORK Lova h808 N.' E. 3 rd. Street Number, Kind and Locatfoa of Fixtures yo WW OI; i ;� �� `Z 8o i t�2 Z l�Y< (�! jN[ ` (�! • I • N WATER MTR. GAS ELEG Base 1st Intal GasGr11 2nd 3rd 4th • Futuro Conaoctioa Openings + Now Fixture, Old Openings I coed with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................. x $2.00 $ Future Fixture Opening ............ x $1.50 $ _. New Fixture Old Opening .......... . x $1.50 $ - Catch Basin .................... x $3.25 $ Water Heater ;Up to 99,000 BTU).... x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water Heater........... s $2.00 $ SAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional Fixtures ................. x $ .75 $ Gas Range to 199,000 BTU ............ x $5.00 $ City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct' Fridley, Minn 6-17-74 19_ - Owner Warren H. Tholrias Kind of Building Frame Used as Res. To be completed about 6-2h-74 Estimated Cost, $ 10.00 Old-JFQW. Building Permit No. Permit 140. 6.=,2_ Signe dn'02 v olrst By-�--- Business Phone No ROUGH FINAL -3`-1' --7 j; . REPAIRS do ALTERATIONS—Refer to Cade .50 State Surcharge Tnstall Gas Grill 5.00 Description ..... .-............... TOTAL "M $ 5.50 Class mA® Surcharge .500 SUBJECT PERMIT City of Fridley 141 O AT THE TOP OF THE TWINS BUILDING PERMIT RECEIP NO. ___ COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. 01 1 � NUMBER REV. DATE PAGE OF APPROVED BY � CITY HALL FRIDLEY 55432 612-560-3450 910-F15 5/24/77 JOB ADDRESS 4808 3rd Street N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 13,14 2 Plymouth SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Warren Thomas 4808 - 3rd Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Professional Roofing Services 5048 Girard North 521-6888 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof dwelling 9 CHANGE OF USE FROM TO ,STIPULATIONS New roof to be second roof but not third. Install ridged galvanized valleys. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Asphalt 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 ] 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 $500 $.50 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 CONS TRU TION. $7.50 PLAN CHECK FEE TOTAL FEE zieV-27 p SIGN TUREOFCONTRAC OR OR AUTHORIZEDAG-NT (DATEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT a J .,, �1�—�. BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) CITY OF FRIDLEY . APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: Address: No.: IA9 L - Street: M, BUILDER: „ , `c e& Address: Tel. No . C — LOT: _� �BLOCK: ;L, ADDITION: 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: 1�,aFront: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Fee Cubic Feet: Type of Construction: _ e Estimated Cost: $�� To Be Completed: 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: t - Y 7 SIGNATURE: Stipulations: J SUBJECT PERMIT City of Fridley _ l 3.3 0 AT THE TOP OF THE TWINS BUILDING P E R M I T _ r RE 1 • COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. I 1 i NUMBER REV. DATE PAGE OF APPRO ED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 11/10/831 JOB ADDRESS 4808 - 3rd Street N.E. 1 LEGALLOT NO, BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13,14 2 Plymouth Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Agatha Thomas 4808 - 3rd Street N.E. 572-8881 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 S 8 DESCRIBE WORK Construct a 41 x 201 Garage Addition 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Contact the Building Inspector for approval on structural requirements. before commencing construction. Provide a hard surface drivewal►e 3 feet from the side proPrty Gne„or easel' with consent SEPER E: PERM REQUIRED WIRhP!(a6 HEATING, Pl,lM#d >D1 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 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 $854.40 $.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- $16.00' STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $16.50 SIGNATURE OF CONTRACTOR OR AUTH RIZED AGENT (DATE) WHEN PR PERLY ALIDATED THIS IS YOUR PERMIT � 1 BLDG INSP fE .SIG U E OF OWNER IIF OWNER BUILDER) (DATE) J CITY or FRIDLEY Effective Aug. 1, 1981 APPLICATIO:1 FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: A!! A it A S BUILDER: _& ADDRESS: -i9 ADDRESS: TEL SIO: 5 7Q - e'M �f TEL 110: STRMT NO: STREET: LOT: I3, /q BLOCK: Construction Location ADDITIO:i : Corner Lot: Inside Lot: i Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: Height: /Q ' Square Feet: Cubic Feet: Front: Depth: Height: Square Fent: Cubic Feet: _ 7Vpe of Construction: W000 ��/n Estimated Cost: S �' Zb Be Cbrapleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ S SEE PF.VFM-I:' SIDE OF SHEET 911e undersigned hereby makes application for a permit fcr the %:ork herein specified, a9reein3 to cb .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. DATE: 1101 C01,3 SIGNATUIE : Stipulations: od (�Z) n 2 2 � 01 SUBJECT PER City of Fridleyo 18100 AT THE TOP OF THE TWINS BUILDING PERMIT r ECEIPT 1 ` L'____-_ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 7/8/85 JOB ADDRESS 4808 - 3rd Street N.E. 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13,14 2 Plymouth. Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Joanne Thomas 4808 - 3rd Street N.E. 572--8881 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Milton L. Johnson Co. 2513 Central Avenue N.E. 781-9548 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 J] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Aluminum trim & gutter 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 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 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 $2f QOO' $1.00 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 O HER STATE OR LOCAL LAW REGULATING CON- $32.50 STRUCTION OR THE PE ORM NCE OF CONSTRUCTION/ PLAN CHECK FEE TOTAL FEE 5O 9 �• Adt" $33 . SIGNATURE OF CONT TOR OR AUTHORIZED AGENT (PATE) .W EN PROPERL BLDG INSP V LI DATED THIS IS YO R PERMIT GATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI 01 NEW I ] City of Fridley Effective 4/1/84 ADDN. I ] �R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: O Legal Description: .jTel. Owner Name a Address: AAN 0") . # Contractor: ` L ,J N Address: -Is/ 3 C�C'-JT- L •A c kw N u - 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 Lot [ ] Ft. Yd. Setback _ Side Yard Setback Type of Construction: to �� 0 � &4 Estimated Cost: $ �/VA Me�zoap pte® e Approx. Completion Date: 3 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: 7 APPLICANT: Tel. # CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Plan Check $ 2% of Building Permit Fee State Surcharge $ $•50/$1,000 Valuation SAC Charge $ $425 per SAC Unit ' Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL s STIPULATIONS: .-n .ki--7-7=77-7- -. - _ .-, - _ _.ter aA[+ - _ ` ; +r- SUBJECT PERM City of Fridley 21244 AT THE TOP OF THE TWINS BUILDING PERMIT r EIPT COMMUNITY DEVELOPMENT DIV. _ L PROTECTIVE INSPECTION SEC. r 4'' NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 3/30/92 JOB ADDRESS 4808 3rd Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DEscR. 1314 2 Plymouth. Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Assad Awaijane 4808 - 3rd Street NE 571-1146 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 ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 20 x 2W Garage Addition 9 CHANGE OF USE FROM TO STIPULATIONS Call for inspection when fo,xms_ for floor are in place with reinforcing rod. Provide 4 hard surface. driyew4 SEPARATE F Vx41TS REQ1J'IRE® FOR WARNING WI'RiNG, HcATiNG, PLUMBING AW SM& Before digging call for all utility locations 454-0002 REQUiREC� LACI TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED 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 $6x192 $3.10 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- yAgxn $90, 00 Fire SC $6.19 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $99,29 SIGNATURE OF CONT TOR OR AUTHORIZED AGENT IDATEI WHE PR ERY LI TED THIS IS YOVR PER IT 3 3Q BLDG INSP ATE SIGNATURE OF OWNER I IF OWNER B DERI (DATE I NEW [ ] ADDN [ ] ALTER] Construction Address: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ❑i C c,-,, Effective 3/1/92 Owner Name & Address: 55 IA L W N Tel. # 7/- // z/ Contractor: MN LICENSE # Address: /,/Ao,Y 34 S -v 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 t> Height Length Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Corner Lot [ ] Inside Lot N Ft. Yd Setback Side Yard Setbacks Type of Construction: 60,c,6 �, Estimated Cost: $ 1�/tk(aLJ L t�.r� Approx. Completion Date: �2 G - % y Driveway Curb Cut Width Needed: Ft. + b Ft = (Cost on Back) Ft x $ = $ DATE: J -,2 APPLICANT: Tei. # E 77 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge $ 96.00 Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL $ 9q, STIPULATIONS: 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 ( ] 7 O y 7 O U SUBJECT ;PER_M11-11 City of Fridley 212 8 5 AT THE TOP OF THE TWINS BUILDING P E R M I T r _ COMMUNITY DEVELOPMENT DIV. L �!G r PROTECTIVE INSPECTION SEC. NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 "'j 612-571-3450 910-F15 4/15/92 JOB ADDRESS 4808 - 3rd Street. NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 1 13,14 2 Plymouth. SHEET I 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Assad Awaijane 4808 - 3rd Street NE 571-1146 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 ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 23.81 x 151 Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan, WARNING SEPARATE PERMITS REQUIRED FOR WIRING, HEATING, PL.LW16MG AND SIGNS. Before digging call far all utility locations 454-0002 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED 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 $24t766 $12,38 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- $252.OA Fire SC $24.77 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $289.15 SIGNATURE OF CONTRACTOR OR AUTHORIZED ASIENT IDATEI WHEN PROPERVY VALIDATED THIS IS YOUR ERMIT DG INSP MATE SIGNATURE OF OWNER OF OWNER BUIL IIDATEI U NEW [ ] Effective 3/1/92 ADDN ,. CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: _4209 3Ctt b� d, Z 112917— d O3 Legal Description: Lc, i s /Z, /L Owner Name & Address: /i 55't�kD A w Y -A � 5 11 NL Tel. # 5 Z/ Contractor: C13 V, MN LICENSE # Address: 'tom 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 17- 17 Length Width I Height / Length Width Height Length Width Hgt/Ground Sq. Ft. S� Sq. Ft. 3 Sq. Ft. Corner Lot [ J inside Lot M Ft. Yd . Setback -7D Side Yard Setbacks Type of Construction: 'e,O A to V\- Estimated Cost: $ Approx. Completion Date: �0i9� 2/ '1� 2 o 0 (Cost on Batik Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: Z- 7- '29 APPLICANT: - Tel. CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Park Fee $ 252,. d ® Fee Schedule on Reverse Side $ 2�,'j`] .001 of Permit Valuation (1/10th%) $ ` 2.30 $.SO/$1,o00 Valuation $ $700 per SAC Unit $ $5.00. (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ Sewer Main Charge $. TOTAL STIPULATIONS: Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] 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 EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 'r'yO 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 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 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge $ P�G.5'0 TOTAL FEE $�® 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. ,1991 Owner S 6 n J9 w 41 `� Al 67' Building Used As\�QQ'V\A,'Q- Estimated Cost0,0, �c20 -PERMITNO. / 0( 7) PLUMBING COMPANY SIGNED BY TEL N0. Approved By Rough -In Date Z72 /`final Date 0919 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE Urinal Shower W sh a ��'�•`"��Tra Dt1..:. Floor Drain :::::: Auto. L#c..:.'+:. V. Gas Range Ran aF`G ` SC >>' I .:.. x::::. Water Heater Stories s Ele c B asemen Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 'r'yO 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 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 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance State Surcharge $ P�G.5'0 TOTAL FEE $�® 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. ,1991 Owner S 6 n J9 w 41 `� Al 67' Building Used As\�QQ'V\A,'Q- Estimated Cost0,0, �c20 -PERMITNO. / 0( 7) PLUMBING COMPANY SIGNED BY TEL N0. Approved By Rough -In Date Z72 /`final Date 0919 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE CITY OF FRIDLEY INSPECTION DIV. 16" �. Effective On March 1, 1996 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work State Surcharge $_,150 TOTAL FEE $65,50 MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Wate arm Air Trade Name 3. Size No. 3 S D BTU 9O,o®v HP EDR Fuel -Total Total Connected Load Burner Trade Name Size No. BTU HP EDR ilk@Ap HoU. 13 V,J F,:.R IONX-, C. 410 WELT LAKE STF7ET HEATING COMPANY WREAP61a zS, MN� Signed By Tel No. Final Date Approved By 4 Rough—In Date FILL OUT BACK SIDE F R STACK VERIFICATION ON REPLACEMENT FURNACE JOB ADDRESS 4 90?> 3 L 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 $ 30.00 $ 3b,Q() representations stated in this application are true and correct. (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) $ 10.00 $ 10,00 ,199 e OWNER Gas Range $10.00 $ BUILDING USED AS Gas Dryer $ 10.00 $ ESTIMATED COST 00 PERMIT NO._J *Air Conditioning —All Sizes $ 25.00 $ ;Z-5, b o All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work State Surcharge $_,150 TOTAL FEE $65,50 MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Wate arm Air Trade Name 3. Size No. 3 S D BTU 9O,o®v HP EDR Fuel -Total Total Connected Load Burner Trade Name Size No. BTU HP EDR ilk@Ap HoU. 13 V,J F,:.R IONX-, C. 410 WELT LAKE STF7ET HEATING COMPANY WREAP61a zS, MN� Signed By Tel No. Final Date Approved By 4 Rough—In Date FILL OUT BACK SIDE F R STACK VERIFICATION ON REPLACEMENT FURNACE CHMINEY 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 loreign 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 7. Has a liner been provided for water heater Yes ( ) No ( ) 8. Has combustion air been provided for water heater Yes ( ) No ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: 0 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 JOB ADDRESS RATE SCHEDULE The undersigned hereby makes application for a permit for the work Residential Rate TOTAL herein specified agreeing to do all work in strict accordance with the Furnace Shell and Duct Work, Burner - city codes and ruling of the Building Division, and hereby declares Also Replacement Furnace $ 20.00 $ that all the facts and representations stated in this pplication are true and correct. '199A - Gas Piping (Needed with new furnace) $10.00 $ /�� / fi OWNER �16i, I A -AJ 61 Gas Range $10.00 $ BUILDING USED AS Gas Dryer $10.00 $ y� ESTIMATED COST PERMIT NO. *Air Conditioning - All Sizes $10.00 $ DESCRIPTION OF FURNACE AND OR BURNER 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 Size No. Commerclal/Industrial BTU HP EDR 1 % of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. / BTU HP EDR TOTAL FEE $ 's MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 HEATING COMPANY Signed Approved By (� Rough -In Date _ Tel No. 3�' 0 :�- 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: ZO 4Y7�� 6Je -s 7, �- _�� sem• HEATING COMPANY / ay - Signed By Date 2 SUBJECT P City of Fridley 21519 AT THE TOP OF THE TWINS BUILDING PERMIT,,/A. r RO. _ COMMUNITY DEVELOPMENT DIV. tr �/� PROTECTIVE INSPECTION SEC. I NUMBER REV DATE PAGE OF APPROVED By � CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/2 8/92 JOB ADDRESS 4808 - 3rd Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13,14 2 Plymouth SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Assad Awaijane 4808 -- 3rd Street NE 571-1146 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. B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW X7 ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 32' x 121 & 131 x 81 Deck 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. WARON 1� SEPAMTE PERIL TS REQUIRED FOR Before digging call for loc locations ty®tions WIRING, HEATING, PWMBLNG,AND SIGNS. all utility 002 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED 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 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $3,748 $1.87 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- $ 63.00 Fire SC $3.75 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $68.62 SIGNATURE OF CONTR OR OR AUTHORIZED AGENT IDATEI HE R RLYVA IJ?A D THIS IS YOUR PERMIT -2,. �-�� SIGNATURE OF OW NER I'M OWNER IDATEI 4ral DG NSP f)ATE NEW [ ] Effective 3/1192 ADDN [ ] CITY OF FRIDLEY ALTER[ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: !-/9O ---? by Legal Description: 1)z C / Owner Name & Address: SSS p,D JA w � n( �Z &A69 3�f sj A Tel. # S 71-11�1 Contractor: !G ---- 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 �' , r "�'��*� �—' Hgt/Ground Sq. Ft. OTHER: 32- K /2- % Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: _ .-�iD Estimated Cost: i Approx. Completion Date: i 2 3 741 , (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: 7- A ti- 9;7 APPLICANT: Tel. # 571 CITY USE ONLY Permit Fee Fiore Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Park Fee $ o ®O Fee Schedule on Reverse Side $ .001 of Permit Valuation (1 / l0th %) $ A ' $.501$1,000 Valuation $ $700 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above Sewer Main Charge $ TOTAL STIPULATIONS: Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] I I Subject: Memo Pad Circulate to: _ Phone #: Date: From: Fax #: Pages to follow: Message: f A� Own Y R 0. ..4�V�� te•� i' � A i 1 � . .......... . ........... Yr" N a U 1f' tlk 1O � � 13 )q;•` t1 � 7 6JIL 2X8 J-®t-cr �-T 4" Y�. DIVISION / COMBINATION REQUEST FORM r --j Division 0 Combination Fee Owner: Contract Purchaser: Taxpayer Name: Address: Municipality Fridley Date For taxes payable in 20 zliej g,d s-Uz. 11?6 6/ack CA Pin Key# Legal Description 26-30-24-32-0019 Lots 13 & 14, Blk..2 Plymouth 26-30-24-32-0020 Lot 15, Blk. 2 Plymouth I I I I Note: If this is a request for a division of a tax parcel, the legal descriptions of the new parcels must be attached and stamped with city approval. As of June 1, 1995 there will be a fee for dividing property. Daytime Phone# X F-� Fee Owner F-lContract Purchaser Note: If the request is by a contract purchaser, the applicant must already appear as the contract purchaser in the county tax records or a copy of the contract for deed must be attached. OFFICE USE ONLY: Checked for delinquent taxes by Date: CITY OF FRIDLEY INSPECTION DIV. a Effective On January 1, 1997 6431 University Ave NE �. 9 O Fridley, MN 55432 �� APPLICATION FOR PLUMBING AND GAS FITTING PERMIT pp 572-3604 U PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the Work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all thg facts Blow Off Basin $ 7.00 and representations stated in this application are d correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 true ' Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater -Electric $ 7.00 Water Heater - Gas** $10.00 Building Used As Gas Range** $10.00 % Gas Dryer** $10.00Estimated Cost _ ®� — PERMIT NO, / �� Back Flow Preventer Required ( )Yes (} No Type $15.00 PLUMBING COMPANY AU/VtM6 (,j�. -*n 57 05 Flees AU • o • MRS - MN • 8 Reinspection Fee $42.00/HrSIGNED BY �,,�-� TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS �� 1.5% of Value of Fixture or Appliance , laooa- Approved By Rough -In Date Final Date � State Surcharge $ .50 MINIMUM FEE /QR ANY PLUMBING GAS PERMIT IS $20.00 TOTAL FEE $ PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SO INCHES. 0 :ITY OF FRIDLEY INSPECTION DIV 431 University Ave NE Wley. MN 55432 763) 572-3604. FAX (763) 571-1287 i Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES Tn RF MISTAl i Fn (IN FArN M nnR 'LUMBING FIXTURE RATES NO. RATE TOTAL JOB ADDRESS_ LIV/ o� WN Fixtures 9d Opening, New Fixture ;eer Dispenser low Off Basin :atch Basin } !Bin Water Leader a;unnplReceMrig Tank Yr VaWTreatmg Appliance ~hater Heater -Electric Veter Heater - Gas" gas Range" Sas Dryer— lack Flaw Preventer Required { )Yes () No Type $10.00 The undersigned hereby makes application for a permit for the work herein $10.00 spec ifted agreeing to do all work in strict accordance with the city codes $10.00 _ and rulings of the Building Division, and hereby declares that all the facts $10.00 and representations stated in this application are true and correct $10.00 2-3_ $10.00 DATE: .20 (�S $10.00 $35.00 OWNER --rte-S SS ! i S35-00 �^ n $35-00 Bt111.01NG USED AS il�ili $10.00 $10.00 ESTIMATED COST S=Z i PERMIT NO. $15.00 Zeinspecfion Fee $50.0OtHr +LL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fbdure or Appliance PLUMBING COMPANY-A4��` — SIGNED BY TEL NO.�1.5�� v. 50 Approved BY Rough -In Date Final Data State Surcharge $ -- MIMMUM FEE FOR ANY PLUMBINGJGAS PERMIT IS S15 00or 5°!o OF COST TOTAL FEE $ �� OF THE IMPROVEMENT WHlICHEVFR IS GREATER ON WORK LM THAN SM n .'OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. ""PROVIDE COMMON VENT INFO ON BACK SDE Building $ BUILDING Permit No.:`7-pGs" Inspections $ I ✓J RESIDENTIAL APPLICATION Received By:-/ 763-572-3604 $ SAC Charge Dat'�'�eg' h PR 13 Z Curb Cut Escrow $ CITY OF FRIDLEY $ DATE ' — ) 3 YOUR E-MAIL ADDRESS $ SITE ADDRESS W20,? 5 -A • Al L Total Due (I/�T' THIS APPLICANT IS: ;OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: F\b A UJ i 51A/1/1% TENANT ADDRESS: #205 3 S N i- CITY FRiiJ�y' STATED&ZIPS PHONE: % 4,3 - b 71 — 1 14 La CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE—ZIP WITH APPLICATION PH NE FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ O FAI, NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION MMAINTENANCEMEPAIR ❑ REMODELING DESCRIBE WORK BEING DONE:%��A��t�- SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING OUSE ONLY NUMBER OF SQUARES k Le ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE I . 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 structures ❑ Other . ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS OYes ❑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: 'w (USING THE 1997 U.B.0 FEE SCHEDULE) /[P'58), SQ TOTAL JOB VALUATION $, q(,6' 7, 00 OCCUPANCY TYPE Permit Fee $ Plan Review $ Fire Surcharge $ I ✓J Surcharge $ License Surcharge $ SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Cha_�rg''e,, II $ Total Due (I/�T' $ 17.9 . "hn See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach 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; that the work will be in accordance with the approved plan in the case of all work which requires r view and approval of plans. �/ SIGNATURE OF APPLICANT �PRINT NAME J%� ® ,� �) / �A yZ DATE G7