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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Address Address LO TI F BUILDING No.Street +�=-r'F Part nfwTt Lot :C'- $lock � Addition or Sub-Divisio � � �— Corner Lot __ Inside Lot — Setback ideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To/� i� Used ��--� � ,��, i Front; Depth Height Sq. Ft. ''=', i Cu. Ft. Front Depth A''e� Height, Sq. Ft. ._ _ Cu. Ft. Type of Construction I A *Mo- Fast. Cost :311& r To be Completed _ In consideration of the issuance to me of a permit to construct the building described above, I agree to .do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of , permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Building Inspector NOTICE This permit does not cover the construction, Installation for whing, plumbing, gas heating, sewer or water. Be sure to see the Building inspector for separate permits for these home .Q004 0 dir .APPROVED SUBJECT TO C=170 32V,11TCE VO .APPLICABLE C S O nI ANCE'S. _ ON FOR BUILDING PERMIT B ILDING I ECT($TY OF FRIDLEY, MINNESOTA r' (.I.TY. OF LEY, MIMSOTA Owner's Name Address Al Address LOCATION OF BUILDING No. ® Street e3`"P S 7-, A)o Part of Lot Lot Block __41 Addition or Subdivision ® �j�J� Corner Lot Inside Lot SetbackSide-Yard�f�� SEVIER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING Front_Depth Height Sq. Ft. / S'l�Cu . Ft .L24, 4/ fo FrontDepth_ Height AP Sq. Ft. Cu. Ft. Type of Construction FVAdz& Estimated Cost®T,B®.n To be Completed 4evr, 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 ruling of the Department of Build- ings, and hereby declares that all the facts and representations stated in this application are true and correct. , DATE/ �j SIM9ATURE �V,6'/� i. (Schedule of Fee Costs can be found on the Reverse Side). City of Fridley Application for Pim ing and C= Fitting Pem* DESCRIPTION OF WORK Number, Kind and Location of Fixtures Tr NO. RATE TOTAL Number Fixtures.............. ........ �gi $ o H x 1.20 o12 Z New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... Z x 2.00 $ - c WATER HTR. GAS ELEG Base NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $—,1�� Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ 1st 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings Coaaeded with Sewer e Cesspool E] PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures.............. ........ �� x $1.50 $ o Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... Z x 2.00 $ - c New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $—,1�� Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE Dept. of Bldgs. Phone SU 4-7470 City of Fridley: The undersigned hereby makes application for a permit for the work here! 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. Kind of Building _ Used as To be completed about Estimated Cast, Old Building Permit No Permit N ewo. Signe By " Bus' ess Phone No ROUGH ,V 30'6, 2– d2 2M City ®f Fridley Appricafts ftw Fkabling and G�n Dept. of Ridge. Phone 980-3450 DESCRIPTION OF WORK—e� 'may Number, Kind and Location of Fixtures IAM1102 (� PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL N Z x $200 $ 12 x $1.50 Y _ � C � � <~ O 7 �,s% W � �gz e I e N WATER H". GAS ELEG Base let New Ground Run Old Bldg. x $3,25 $ Electric Water Heater = $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional Fixtures ..... .............. - — 2nd x $5.00 $ 3rd 1--HIEL _ 4th -- • Future Connection Openings * New Fixture, Old Openings I Connected with Cesspoole❑ ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $200 $ 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 = $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures x $2.00 $ Additional Fixtures ..... .............. x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description .... .......... $ TOTAL FEE $ z �'� City of Fridley: The undersigned hereby makes application for a permit for the work herei specked, 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_ Y9 Owner Kind of Used as Z-/ 6111�; / To be completed about o Estimated Cost, $ (�—New. Building Permit No. _ _ _Permit No. ROUGH FINAL 2- � - % f/ Signed By- - - Business Phone sueJEcr PE City of Fridley 6 AT THE TOP OF THE TWINS BUILDING PERMIT r I �RECEIPT NO. • COMMUNITY DEVELOPMENT DIV r � � PROTECTIVE INSPECTION SEC I � � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910-F15 6/5/95 JOB ADDRESS 5980 3 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1,2 11 1 Hyde Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Williard Guimont 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sussel Corporation 1852 Como Ave, St Paul, MN 55108 645-0331 1934 4 ASQ,HITECT 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 j] NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 40' x 22' Garage 9 CHANGE OF USE FROM TO STIPULATIONS See stipulations on plan. Provide a hard surface driveway. 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 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 $7.42 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $14,836 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE ROVISIONS ANY OTHER STATE OR LOCAL LAW REGULATING CON- $162.00 /� Fire SC $14.84 UCTION O THE PERF RMANCE OF CONSTRUCTION PLAN CHECK FEE License SC $5.00 TOTALFEE $189.26 `? SIGNATURE OF CONTRACTOR ORA HOR r (DATEi HEN�PQR�OPERLY ALIDATED THIS IS YOUR PERMIT "`BLD .NSP 4A E SIGNATURE OF OWNER OF OWNER BU(LDERi (DATEI NEW ADDN [ ] CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address:q 4'� ►��+ Legal Description: Owner Name & Address: W 1u.A,(c-� Tel. # S-1 l — ® FR S Contractor: MN LICENSE # ! 9 Address: A --j. 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 +fib Width "LZ Height �' Sq. Ft.Sib C3 DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: _ Corner Lot 0 Inside Lot [ ] Ft. Yd Setback aO% Side Yard Setbacks -!:p Z-' Type of Construction: WcDc� Estimated Cost: $ Approx. Completion Date: x e36. io (Cost on Back) Driveway Curb Cut Width Needed: OCD Ft. + 6 Ft = Ft x $ _ $ DATE: -ZZ_Q APPLICANT: ,,. *-I --1- s Tel. # S-0331 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ /6Z, CITY USE ONLY 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 [ J Not Necessary [ ] MINDER'ENGINE EKING CO.,INc. ENG[NEERS AND su'QvEYORS LAND SURVEYING CIVIL 8� MUNICIPAL ENOINEERINO SOILB TESTINQ 6418 - S6 TNLP.ND PLA.NN I N d AVENUE N. tA 1,/IINNEAPOLIS 27, MINN. ,� KE 7- 3637 / fir? F C +th 1194 n IF n Ir ,t or 410 IF !b �� iN •► �� . ,.T j''� /3.55, ; '.•s,= i I Ali, N 1 I bn. TS o �1p, WE HEREOY CERTIFY THAT THIS 15 A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES of THE LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF AMY, THEREON , ANO ALL VISIBLE ENCROACHMENTS, IF ANY, FROM oR ON SAID LAND. _QI�TED THIS Ilt^Of.YOF S-ebY':a r� MINDER ENGINEERING CO., INC. - -..� EN61 i E fL5 �O SVRv@Y S i iT 1 T/1, .. _ — Mott SS"aT Arf ,7., TTAT'11�Q of Fridley AT THE TOP OF THE TWINS SUBJECT BUILDING PERMIT 23577 Ir?City 1.COMMUNITY DEVELOPMENT DIV ______ i I v PROTECTIVE INSPECTION SEC CITY HALL FRIDLEY 55432 612-571-3450 RECEIPT NO. �� NUMBER 910-F15 REV DATE 7/25/95 rGE OF / APPROVED BV JOB ADDRESS 5980 3 Street NE 1 LEGAL DESCR. LOT NO. 1 , 2 BLOCK 11 TRACT OR ADDITION Hyde Park SEE ATTACHED SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Willard Guimont 5980 3 Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Sussel Corporation 1852 Como Ave, St Paul,MN 645-0331 1934 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 4-Plex 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION J3 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Building (23 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SO. FT. CU. FT. 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 4 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED VALUATION SURTAX WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,265 .63 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIO OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- TRUCT ON R THE PERF MANCE OF NSTRUCTION$31.00 Fire S�, 1.27 PLAN CHECK FEE TOTAL FEE License 2C $5.00 1 $37.90 NATO OF CON' A ORORAUTHORIZEDAGENT (DATEI WHEN ALIDATED THIS IS YOUR PERMIT /pPPRiOPERL &✓ C BLED INSP ! 1� f)AT _ SIGNATURE OF OWNERIIF OWNER BUILDERi (DATEI :z :z; . ............... NEW Effective 8/l/95 ADDN CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R -I AND R-2 Building Permit Application Construction Address: "'6 c) -3 Legal Description: Owner Name & Address: 1A) LC t Tel. # MN LICENSE# Contractor: C_-) S _S 4-� ca.- —Tel. # Address: (L 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. Length Width Hgt/Ground Sq. Ft. DECK AREA: . _5'rz:�p--AJn_ 25(C OTHER: Comer Lot [ ] inside Lot Ft. Yd Setback Side Yard Setbacks . _777-c— Type of Construction: Estimated Cost: $ Approx. Completion Date: (cost on Back) Driveway Curb Cut Width Needed: —Ft4 6 7 Tel. # DATE. APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ -3400 $ /1,927 $ L3 $S__ -XI CITY USE ONLY 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 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 VAX: (763) 571-1287 PE NO.:2004-01190 DATE ISSUED: 07/28/2004 ADDRESS : 5980 3 ST NE PIN : 233024220101 LEGAL DESC : HYDE PARK : LOT 1 BLOCK 11 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 200.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER HEATER. 0.00 0.00 0.50 # ELEC WATER HEATERS 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 1 # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 200 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) 0.00 0.00 NEWMECH COMPANIES INC 1633 EUSTIS ST PLBG FIXTURES (EXIST OPENINGS) 0.00 ST PAUL, MN 55108-1288 WATER TREATMENT APPLIANCE 0.00 (651) 642-5558 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE GAS DRYER FEE STATE SURCHARGE, PLBG FLAT 0.00 0.00 0.50 OWNER THOMAS SCHAFF 5980 3RD ST NE TOTAL 35.50 FRIDLEY, MN 55432 PAID WITH CHECK # 162754 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 worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regqlaft,,construction or the performance of cons"ction. Bldg SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CIN OF FRIDLEY INSPECTION DIV. 6431 University Ave NE .Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT k*0 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Tr�_"'' Old Opening, New Fixture Vit` >::: ... .: Urinal J< Blow Off Basin .. Wash Tra lft.::.:... �t. Floor Dra'n .:::... Auto. Wash r a:<:>::>::>:::: Gas Ran e ftl s<'• Water Heater $35.00 Water Heater - Gas** 1 Gas EI ecStones Basement •:'•:€ Gas Dryer*" $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance I F o0 r1 Floor loo 2 Floor 3 Floor 4 **Replace owner f=hished water heater PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $10.00 Old Opening, New Fixture $10.00 Beer Dispenser $10.00 Blow Off Basin $10.00 Catch Basin $10.00 Rain Water Leader $10.00 Sump/Receiving Tank $10.00 Water Treating Appliance $35.00 Water Heater -Electric $35.00 Water Heater - Gas** 1 $35.00 35.00 Gas Range** $10.00 Gas Dryer*" $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge $ .50 TOTAL FEE $-15.50 JOB ADDRESS 5980 - 3rd Street 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. OWNER DATE: 7/22/04 ,20 Thomas S. Schaff BUILDING USED AS Rental (4 -plea) ESTIMATED COST $200 PERMIT NO. �� t I PLUMBING COMPANY NewMech Companies, Inc. It SIGNED BY Approved By Rough -In Date TEL N0. 651-645-0451 Final Date MINIMUM FEE FOR IANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No (.) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No( ) When installing a new venting system, the undersigned hereby verifies that it is a fisted assembly and meets the current codes and manufacturer's specifications. This does include AGA -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date : Building $ BUILDING $ Permit No.:'' Inspections Fire Surcharge RESIDENTIAL APPLICATION License Surcharge Received By: T-�t 763-572-3604 $ CITY OF FRIDLEYI� $ Daze Recd: DATE �� J _ YOUR E-MAIL ADDRESS ISI i��/"s/rpt`/-�I ^'�/ 001'^ i9 � r Total Due SITE ADDRESS THIS APPLICANT IS: ❑ OWNER XCONTRACTOR PROPERTY OWNER/ NAME: c ADDRESS: CITY —STATE—ZIP- TATEZIPPHONE• TENANT PHONE: n CONTRACTOR NAME: 4 - STATE LICENSE # oZ ® q G /,0'f> EXP DATE 3- u SUBMIT A COPY OF I ct93 6 STATIL./LZIPYqh YOUR STATE LICENSE ADDRESS: A t,, CITY WITH APPLICATION PHONE FAX u r ^ oAq PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH W ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWRvIlvENG POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: �t s SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING❑ '7310 HOUSE ONLY BASEMENT REMODELING SUBMTf: NUMBER OF SQUARES )0 HOUSE & GARAGE 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: 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 FEE SCHEDULE) TOTAL JOB VALUATION $ sa Pr OCCUPANCY TYPE Permit Fee $ Plan Review $ Surcharge $ Fire Surcharge $ License Surcharge $ SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $' See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times 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 application for a 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 wluc r s eview and approval of plans. ff�j� SIGNATURE OF APPLICANT ; PRINTNAME I• `�L DATE I I' ®-e-