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PRE 2010 DOCSSUBJECT City of Fridley AT THE TOP OF THE TWINSg JPERP�m U I L D I N G P E R M ICOMMUNITY DEVELOPMENT DIV. SEC. r � � PROTECTIVE INSPECTION CITY HALL FRIDLEY 55432 NUMBER DATE PAGE OF APPROVED BY 612-571-3450 910-F15 TREv 8/20/79 JOB ADDRESS 5826 3rd Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 22 Hyde Park SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Luise Almlie 5826 - 3rd Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Lloyd's Home Improvement Inca 1012 - 42h Avenue N.E. 788-5602 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 X 8 DESCRIBE WORK Install thennopane window in basement insulation, sheetrock repair inside with weatherstripping 9 CHANGE OF USE FROM TO STIPULATIONS, SEPERA T6 NEA TANG. P RATS ftr- M$!!,, Fps. ANO SW0 NS. 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,300 $.65 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. $9.00 PLAN CHECK FEE TOTALFEE $9.65 SIGNATURE OF CONTRAC E A RORAUTHORIZNT (DAT WHEN PROPERLY V DATED THIS IS Yr11IRPEMIT / 1 BLDG INSP DAT SIGNATURE OF OWNER OF OWNER BUILDERI IDATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: Z-6`1 S t i> l Y�'l l P� BUILDER: ADDRESS: S l 3 �d ADDRESS: TEL NO: STREET NO: S TEL NO: —7 �— s—G a ;Z - Construction Location STREET: 3 LOT: C-7 BLOCK: �� 2 ADDITION: Corner Lot: Inside Lot: 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: Squane Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction:a.acc _ r C Estimated Cost: $ Zo 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. DATE: c; % SIGNATURE : ' y - Stipulations: CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fix tures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each add. $100.00 or fraction NO. RATE TOTAL X $3.00 $ x e $ x $2.00 $ x X d x Water $ x $10.00 $ m $7.00 $ rt $5.00 $ m m w wa $3.00 $ HeaterF $1.00 $ x $7:0.00 $ 3O �O 8 �0a �N x Aj 0 a W A '4 w ro aJ N t N N kec 0 as fft�h (R) = Future Connection Opening Connected with Sewer (*) = New.Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fix tures Gas Range to 199,000 BTU REPAIRS & ALTERATIONS First $100.00 each add. $100.00 or fraction NO. RATE TOTAL X $3.00 $ x $2.00 $ x $2.00 $ x $5.00 $ x $5.00 $ x $10.00 $ x $7.00 $ X $5.00 $ x $5.00 $ x $3.00 $ x $1.00 $ x $7:0.00 $ $5.00 $ $2.00 $ State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE ($10.00) Job Address Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct . Fridley, Mn. 19� OWNER KIND OF BUILDING i+® 0 0 Q( USED AS TO BE COMPLETED ABOUT E' ESTIMATED COST (QLD = NEW BUILDING PERMIT N0. PERMIT NO. o Company Signed By Tel. No. 13 -z Y - 9,3 ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE 1.11ective AW). 1, 1781 CITY OF FRIDLEY - APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE 5826 NE 3 St. RESIDENTIAL RATE TOTAL Job Address Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 $ Department of Buildings 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ Tel. 4571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. * Air Conditioning (all sizes) $ 10.00 $ Fridley, Minn. 7 Sep 88 19_ All Others/Repairs and Alterations OWNER Louise K Almie #571.-1233 1% of Value of Appliance or Work $ KIND OF BUILDING Fr Space Htr. Replacement 15.00 COMMERCIAL/INDUSTRIAL USED AS Res 1% of Value of Appliance or Work $ TO BE COMPLETED ABOUT 7Sep 88 ESTIMATED COST 700 State Surcharge $ .50 OLD - NEMUILDING PERMIT NO. PERMIT NO. TOTAL FEE $ 15.50 Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough Insp. HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Date Trade Name Perfec.ction Space. HtrSize No. ACTi 7zZT Final Insp. Date Capacity Sq. Ft. EDR BTU - !111/1 HP Approval for Permit lb Total Connected Load Kind of Fuel n at .aaS BURNER - Trade Name Size No. Capacity Sq. Ft. ED BTU Offl MINIMUM FEE FOR ANY HEATING PERMIT IS $ .00 PLUS $.50 STATE SURCHARGE MinnegaSco 700 W. Linden Avenue Signed By Attach stack verification form with replacement furnace permits P. U. Box 1165 *Air Conditioners can not be placed in sideyard without Minneapolis, MN 55440-1115a written permission from adjoining neighbor. Tel. No. Minnegasco #342-5337 700 W. Linden Avenue P. 0. Box 1165 Minneapolis, MN 5544.0-1165 CITY OF FRIDLEY I.c iccttve Aug. 1, 1 Jlfl a "' APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE -RESIDENTIAL RATE TOTAL Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 $ Gas Piping $ 10.00 $ (piping needed with new furnace) Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ * Air Conditioning (all sizes) $ 10.00 $ All Others/Repairs and Alterations 1% of Value of Appliance or Work $ Replace Dirct Vent Wall Htr 15,00 COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work $ State Surcharge $ .50 TOTAL FEE $ Reinspection Fee ($15.00) Rough Insp. Date Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $4.00 PLUS $.50 STATE SURCHARGE Job Address 5826 NE 3 St. Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn.7 Sep 88 , 19 OWNER Louise Alml i KIND OF BUILDING Frame USED AS Res TO BE COMPLETED ABOUT 7 Sep 8H ESTIMATED COST 7r.0 / OLD -I BUILDING PERMIT NO. PERMIT NO. ` DO DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Direct Vent Trade Name Perfection SpaCeHtr Size No. Ag3j_733 per- Capacity 3l _ nnn ht77 Sq. Ft. EDR BTU HP Total Connected Load Kind of Fuel natt gac BURNER - Trade Name P fPct inn Size No. Capacity Sq. Ft. ED BTU BTU 33.0 Minnegasco #342-5337 Company 700 - 700 W Linden Avenue P. 0. BOX 1165 Signed By Attach stack verification form with replacement furnace permits Minneapolis, MN 55440-116t) Tel. No. +*+r *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. SUBJEG* PE City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 27913 r ` P COMMUNITY DEVELOPMENT DIV. V _�____ f - PROTECTIVE INSPECTION SEC.�,gz/ F NUMBER REV DATE PAGE OF APPROVED B i A ; /'�',•� CITY HALL FRIDLEY 55432 ---- L J\ 612-571-3450 910415 9/21/98 10B ADDRESS 5826 3rd St NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 22 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Louise Acmie 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Nutzmann Bros Construction 736 1st Ave NW New Brighton 55112 628-0128 20043453 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 O ADDITION O ALTERATION] REPAIR O MOVE O REMOVE B DESCRIBE WORK Reroof house & garage (13SQ) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. , NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $2,400.00 $.56 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- $40.25 Fire SC $1.11 STRUCTION OR THE PERF RMA CE OF CONSTRUCTION PLAN CHECK FEE TOTAL F Lice SC $5/0 $46.92 SIGNATU EOFL •RACTOR OR AUTMORI2E0 AGENT ',OArTE,U EN P OPE 007ALIDATEQ INS,' - T IS IS ��T OAfE S,GNATURE OF OWNER,IF OWNER BUILDER, iDATE, NEW [ ] $ ��, 2 �� Fee Schedule on Reverse Side Effective 1/1/98 ADDN [ ] 001 of Permit Valuation (1/10th%) CITY OF FRIDLEY $ ALTER [ ] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 $ $1000 per SAC Unit License Surcharge BUILDING PERMIT APPLICATION C Driveway Escrow $ `j e� Alt. "A" or Alt. "B" Above nn� ConstructionAddress: $450.00 Conservation Plan Review Park Fee $ Legal Description: Sewer Main Charge z Agreement Necessary [ ] Not Necessary [ ] Owner Name & Address: ,�,� e l/%h �C Tel. # Contractor: G—�,� �,,"„� /mss �ti MN LICENSE # Zoo�c/�� Address: Tel. # z!: � S -a,;7 6SL 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: ��q� �`�� /z timated Cost: (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ ME DATE: L APPLICANT: f Tel. #�� _ C Y USE ONLY Permit Fee $ ��, 2 �� Fee Schedule on Reverse Side Fire Surcharge $ / 001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ `j e� 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 $ Z STIPULATIONS: o c2gm Building $ BUILDING Permit No.: Inspections $ �Sb RESIDENTIAL APPLICATION Received By: & I 763-572-3604 $ O d CITY OF FRIDLEY Date Rec'd:. Curb Cut Escrow $ Erosion Control DATE /d �l YOUR E-MAIL ADDRESS $ SITE ADDRESS $ Total Due THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: ADDRESS: a G- CITY c�YI C 1) STATE ZIP TENANT PHONE: CONTRACTOR NAME: 19r ,1 STATE LICENSE # O EXP DATE 3 o L L SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: G �C CITY OYt1 C' STATE�Z� WITH APPLICATION PHONE " - . 7 FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ' TWO FAMILYINEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH PROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCEIREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: P, f UT C7 CAP 191 {q ckf SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S . Ft. ROOFING HOUSE ONLY NUMBER OF SQUARES HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES [3 ATTACHED GARAGE 1. Existing Floor Plan 2. 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 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 $ 9 OCCUPANCY TYPE - Permit Fee $ Plan Review $ <`—' Surcharge $ �Sb Fire Surcharge $ y License Surcharge $ O d SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ , O See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) tines the total job valuation – Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( } Make checks savable 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 applicatio or 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 h requires review and approval of plans. --�� j �J /L - SIGNATURE OF APPLICANT _ % PRINT NAME .1/%9 / ✓ dt-OL % �LDATE �O Q 3uilding I C2BUILDING Permit No.:I(L-60 x 20 Inspections RESIDENTIAL APPLICATION Received Z $ 763-572-3604 CITY OF FRIDLEY DJUAC 12 TrE ADDRESS HIS APPLICANT IS: PROPERTY OWNER/ TENANT YOUR E-MAIL ADDRESS ❑ OWNER CONTRACTOR PHONE: `7 10;;2 CITY _!t:�_3 �2_ CONTRACTOR NAME: See Back Page for Fee Schedule SUBMUA COPY OF STATE Budget Exteriors, Inc 8017 Nicollet Avenue South ATEto��0 4 &KO !ice 01 -�— YOUR STATE LICENSE ADDRF Bloomington, MN 55420 g CITY STATE ZIP WITH APPLICATION p ONE .0005 x Permit Valuation Minimum $.50 PROPERTY TYPE INc (952) 887-1613 SIZE SAC Charge ❑ TING , .,.,,..,„..................... . STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED DOWS Erosion Control ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE Park Fee ❑ DECK ❑ SIDING ❑ OTHER 1 Sewer Main Charge ❑ SWI MING POOL Agreement necessary ( ) Non Necessary ( ) TYPE OF WORK: DESCRIBE WORK BEING DONE: JAL & 2 lurid ALrrvVs in SIZE OF IMPROVEMENT �^ LENGTH WIDTH HEIGHT _ Sq. Ft. SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl. ❑ Aluminum ❑ Other ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia WAVDOWS IN EXISTING OPENINGSJYes ❑No LOCATION OFF OR FOR NEW OPENINGS -DESCRIBE SIZE OF L D b I OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED 10 Vk NUMBER OF WINDOWS BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 101 to • 0-0 OCCUPANCY TYPE Permit Fee $ t} 1,�1 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 $ $1550 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 $ Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for 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. review and approval of plans. y SIGNATURE OF APPLICANT 1 A41luPRINT NAME & 5 5 �C- � e ✓ DATE 1 I 'L LJ 1 U y //„ '<-"9 n '04�(r. 33 Building Permit Fee BUILDING See Back Page for Fee Schedule Permit No.: "w —00f 6 Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION $ ] 10 Received By: 763-572-3604 $ ,S I.0005 x Permit Valuation Minimum $.50 License Surcharge $ S ,QU— $5.00 (State Licensed Residential Contractors) SAC Charge CITY OF FRIDLEY $2000 per SAC Unit (Plans to MWCC for determination) Date Rec'd: 9f — S d 763-502-4977 FAX ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee EFFECTIVE 1-1-09 Fee Determined by Engineering Sewer Main Charge DATE I - I O YOUR E-MAIL ADDRESS / � En Total Due SITE ADDRESS ^S % e q THIS APPLICANT IS: O OWNER XCONTRACTOR PROPERTY OWNER/ NAME: e TENANT ADDRESS: _ C1TY F►? i PHONF� CONTRACTOR NAME:—B —"v} �x%rZiQ25 SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE 1t CO D el EXP DATE .-3 , ? I — I_=_) AND CERTIFICATE OF ADDRESS:30 i c, Lie, 5. CITY _ STATE 7�s[lIP �O INSURANCE PHONE :14) 1?3 2-14 FAX o2 - PROPERTY TYPE 0 SINGLE FAMILY/NEW CONSTRUCTION SIZE 0 TWO FAMILYiNEW CONSTRUCTION STORIES PERMIT TYPE 0 ADDITION 17 GARAGE/SHED WINDOWS O BASEMENT FINISH O ROOF DRAIN TILE O DECK O SIDING 0 OTHER ❑ SWIMMING POOL TYPE OF WORK: O NEW HOME CONSTRUCTION 0 ADDITION MMNfENANCEM PAIR 0 REMODELING DESCRIBE WORK BEING DONE: Y► `3Tft 11, {2 LLQ i )n&,- r o S Qpenilaqs SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING O HOUSE ONLY NUMBER OF SQUARES 0 HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES 0 ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: O DETACHED GARAGE 3. List of struct ual members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, 0 Vicryl OSoffit ADDITIONS. & PORCHES SUBMIT: 0 Aluminum 0 Trim 1. Site Plan/Survey showing the existing structures 0 Other 0 Fascia and proposed project. 2. Two sets of construction plans WINDOWS IN EXISTING OPENINGS XYes ONo LOCATION OF WINDOWS 3. Energy Calculations 1 E OPENINGS -DESCRIBE SIZE OF I i A -1K me ii e n1 I i- L R u aX e tl ji�00 OOR PENING 'J TYPE OF WINDOW TO BE INSTALLED U NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATMALS: HE 1"7 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ® S TOCCUPANCY TYPE Permit Fee $ , See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ ] 10 .001 times the total job valuation Surcharge $ ,S I.0005 x Permit Valuation Minimum $.50 License Surcharge $ S ,QU— $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 $ Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for 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 ork which requires review and approval of pl SIGNATURE OF APPLICANT PRINT NAME e DATE � o L PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING. ELECTRICAL AND MECHANICAL WORK I