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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT �0 C!!3 8 a Date: Owner: ....------ ... _.._......_.... Builder Address _.___.__ _ _ _ _ _ _ _. Address _.. ........ ,. :........... ........ .... ... _ _.._..._.._...___._.... O T ON'BUILDING No -6 Street --j . . c� _.......... _.......... _._.._..._ Peg Lot . - ............ _........ Block X3 ............... Addition or Sub -Division Corner Lot ........_1..... Inside Lot ..... ............... .................. Setback .......... Sideyard ...... -....................... ..... Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To b Used as: �► - - Front --.. Depth-; ......_.. Height _.... Sq. Ft. r _ Cu. -........... ............................... __... cont.._...------------- Depth ....._...... Height ..................... Sq. Ft....................... Cu. Ft.. ... ................. PP Type of Construction .. ................ ......._...--- Est. Cosl �±!��...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 $4. ` ..., 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 atanyu�ory�violatic,of any of the provisions of said ordinances. s ///'`,fir'' Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these hems. • �.•� Y y{r.,: A.= JM d`Y' , � 4 4' + s^:: 3 �1�f. A 4 ,f nn l fFe Ce, JACKSON RiIIISTRRsq Yt10RR L""or'OVATR or MHUSWDTA .... 3616 INAST SSTM STRIM PA. 4-4681 „- ( ) •�:�y .� $$i`,k, All Ave N. E, 4, vi '.� }• ,IV �4 , —�— r 4 a Y ( t Y d k _ I I�1 •' �w �fi 1 �1 1 1{ 1t 130.7 y 2. OI 'MMs AWW2 MI 4 TOM AMM gOwMOCT RAT OP IC'ftRVRY � .'��Ii'�O r 11rr dlwiritY T1ucl: tg £M s . } Lot 1 and the Worth 1/2 of Lo t 8, k{, Elook 13 q � i ffminlion'S Additlon to Meahanicurille s. + 19th. May 1940 As fURYRY[D my Mt THIS _.—DAY OF—_ A.D. Sioux =I la F: C. JACKSON. MMZ91Aii ` SS Y i r" City of Fridley, :nom.. 11311 6431 University Ave. lei. E., Minneapolis, Minn. 55432 BUILDING PERMIT owner: John AndergBn Builder Giertsen Compal Address 1x$0 --_4t_k Street N.E. Address 2840 Chicago Avenue LOCATION OF BUILDING No. -518.Q_ Street — 4th Street N. E. Part of Lot Lot _1, —.—_ Block 1Addition or Sub -Division 'rami 1 -ton Is Addn _ to Mpehani caville Corner Lot ___.___.._ __ Inside Lot X Setback Sideyard Sewer Elevation To be Used as: Eire Repair ____ Front Front Type of Construction Foundation Elevation DESCRIPTION OF BUILDING Depth Height Sq. Ft. Cu. Ft. Depth Height Sq. Ft. Cu. Ft. _._. Est, Cost 6 000.00 To be Completed April 1. 1972 Stipulations: Plumbing, Heating and Electrical rough in inspections have to be made before any work is covered. "E,��. E`.� �� E ^�', 9 ��4.,3,� ll� -�.p �1�g-a, �.—.��,-P s i'S '•'q'c4• 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 afl provisions of Ordinances of the city of Fridley. A_ 3.00 State Surcharge In consideration of the payment of a fee of $-36 - 00 , permit is hereby granted to Gierts en Co. 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 add ordinances. CLARENCE BELISLE Insl� ct� NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure fo no the Building Inspector for separate permits for these items. APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME •aa_�✓�'7 BUILDER: ADDRESS � 86 �— y /� ADDRESS: i/ NO:. STREET • LOT: BLOCK: I_ ADDITION: i Odd. CORNER LOT: INSIDE LOT:X_SETBACK: SIDEYARD: 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: 032L)Front : Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: &,L�i at �foy� Estimated Cost: $ (000 T� "P To Be Completed:tel — The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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.) e City of Fridley SUBJECT I� -_ 17 2 4:5 AT THE TOP OF THE TWINS BUILDING P E R M I T rp • _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 I i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/13/83 JOB ADDRESS 5380 -- 4th. Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1,2 13 Hamilton's Addn. to Mech. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lawrence Zimmerman 5380 - 4th Street N.E. 572-9322 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 8 DESCRIBE WORK Construct a 24' x 22' Detached Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. �yAttH1HG 108Elh��SEPERATE PERMITS REQUIRED FOR vrRln(G ucngal6 � I � _Flj.r' S`6-GQS Et" HEATING, PLUMBING AND MN& i@E.D BY LAW 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5,639 $2.82 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- $56.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $59.32 SIG ATUREOFCONTRACT ORAUTHOPIZEDAGENT IDA EI WHEN PROP LY VALIDATED THIS IS YOUR PERMIT BLDG INSP JIATE NATURE OF OWN E WN ER BUILDER)i (DATE) C CITY OF FItIDLCY Effective Aug. 1, 1981 ' APPLICATIM FOR RESIDENTIAL BUILDING PLEMUTS (New, Alterations, Additions, or Repairs) OWNER: dz"'�7 ADDRESS: TEL NO: ADDRESS: TEL 110: Construction Location STRECT NO: STREET: LOT: /' .2I BLOCK: 13 ADDITION: s �f n�f �j j /, /J�/ / (hCfi Corner Lot: Inside Lot: ZJ Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certifi-cates to scale. DESCRIPTIOR OF CONSTRUCTION _ Front: .2 -�41 Square Feet: �oZ� Depth: Height: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Teet: _ Type of Construction: �� �/�/�l/F Estimated Cost: To Be mr.-pleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE PF.VF.RSL' SIDE OF S11EET . Mie undersigned hereby makes application for a permit fcr 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 applicatio azo true and correct. p r Stipulations: .5�9 . �z C) tj AI►A'A MAN LA ' 39 of M.I4/. 40 � We 29 fie, 8 _ 7G NA ,%r`1 a� i2 � I ea ti SUBJECT P City of Fridley 21418 AT THE TOP OF THE TWINS BUILDING PERMIT r R �` COMMUNITY DEVELOPMENT DIV. _ _��_ - PROTECTIVE INSPECTION SEC.JI L CITY HALL FRIDLEY 55432 NUMBER REV DATE OF APPROVED BY 612-571-3450 910-F15 6/24/92 FPAGE / / JOB ADDRESS 5380 4th Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 & Pt 2 13 Hamiltons Addn to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lawrence/Joyce Zimmerman 5380 4th Street NE 572-9332 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Citywide Home Improvement 1005 W Broadway, Mpls., MN 55411 529-2489 3013 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 x❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroo;� House (20 Squares) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. 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 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 $1060 #jM $.53 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT F 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- $27,00 Fire SC $1.06 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE License SC $5.00 $33.59 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI '4EN P P Y ALID T THIS IS YOUR PERMIT 6-2 LOG INSP DATE SIGNATURE OF OWNER) IF OWNER BUILDER) (DATE) N>✓v� r, 1 uffective J/1192 ADDN [ J CITY OF PRIDLEY ALTER [) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application L EConstruction Address: K2. Legal Description / 1(4t` Owner Name cot Address Tel �i,� Contractor: _ _ MN LICENSE #a% Address: _ Tel. # `�2 Attach to this application, Certificate of Survey of the lot, with the proposed construction drawn on it to sale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width _ Height , Sq. Ft. DUCK AREA: Len _ Width Hgt/Grotmd Sq. Ft. OTHER: �} � .20 S , i ��61 , D �., .... Corner Lot [ ] Inside Lot [ J Ft. Yd Setback _ Side Yard Setbacks Type of Construction: _ lsstimated Cost: $^ Approx. Completion Date:,. IDD (cosi: on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $, _ = $. DATE: APPLICANT: ^�1— Tel. # CIjY --USE ONLX Permit Fee Fee Schedule on Reverse Side Fire Surcharge $__ .001 of Permit Valuation (1/10th%) State Surcharge $ - - J $.50/$1,000 Valuation SAC Charge $ $700 per SAC Unit License Surcharge $ _ $5.W (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "I3" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $� Agreement Necessary ] Not Necemary [ J TOTAL S STIPULATIONS: - ' CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING. (763) 572.3604 REFRIGERATION ANDA COOLING, VENTILATION, ATE SCHEDULE IR CONDITIONING SYSTEMS AND DEVIC//ESS� JOB ADDRESSD�XO 1 Residential Rate TOTAL ` Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 $; (Side Vent Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 $ but Trot replacement) Gas Range $10.00 $ Gas Dryer $10.00 $ *Air Conditioning • All Sizes $ 25.00 All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work $ :ommercial/Industrial 1 -25T. -of Vafue of i4ppliance or Work $ State Surcharge TOTAL FEE 4INIMUM FEE FOR ANY HEATING/COOLING/VENTILATION IEFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 ILUS THE 5.50 STATE SURCHARGI, EINSPECTION FEE $47:00/Hr Air Conditioners can not be placed in a side yard without ,ritten permission from'adjoining property owner. $ 50 s;55-50 Effective On January 1, 2002 OWNER •P (�� t' (J 1 C� �' \ Vr-� ��Fti�ar BUILDING USED ASJPQ: IC�r? ESTI MATED COSTAL C) PERMIT NO. DESCRIPTION OF FURNACE ANDOR BURNER No. of. Heating Units I Circle One (Steam) (Hot Water) Trade.Name r1 Size No. F 4704 BTU 70 000 HP V.S . EDR Fuel � C Total Connected Load ' Burner Trade Name Size No. BTU HP EDR 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 an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and. correct. DATE ,.HEATING CO nw, low. a: Signed TEL FAX # X103- Approved ByRough•In Date Final Date OUT BACK SIDIFF S7 TACK VERIFICATION ON RE Ill M NT FU A E r THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When , the undersigned hereby verifies that the venting has. been examined and -is free from :rust, deteriortion; obstructions, and is securely supported and firestopped where required. The venting system is plasstic/pVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. 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. The exisfing enis sized and installed to meet the current codes and manufacturer's specifications, When required to install a n w r!emhusfinn aor it will be sued and installed to meet the current codes and manufacturer's specifications. When installoon a OM vantinn , the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I COntral Furnace Venting Tables for fan assisted and natural draft appliances. Is the common vent and vent connectors sized and Installeq correctly -after an appliance has been removed from the common vent and: vented._' ,. separately as per current codes. ATIM Yes .-No Yes () No' 4 �ruaAlal, Yes No ( ) Yes No ( ) Yes ( No ( ) Yes (A No( ) Yes (V{ No ( ) Appliance #1 Type /I AV46CBTU Input lavao Fan Assisted or Nat Appliance yi� �- BTU Input - Fan Assisted or Nat Appliance Type BTU Input _,_ Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type - Vent Height 150'- P ., Diameter S inches Appliance #1 Vent Connector Height .� ft Length fzjjt Diameter. in Type Appliance #2 Vent Connector Height _ft Length Z® -ft Diameter 3' _in Type Appliance #3 Vent Connector Height ft Length _�ft Diameterin Type HEATING CO: Signed By: Date CITY OF FRIDLEY PERMIT NO.: 2006-00972 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 06/06/2006 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 5380 4 ST NE PIN : 233024340028 LEGAL DESC : UNAVAILABLE LICENSE SURCHARGE : LOT BLOCK PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 2,948.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. CONSTRUCTION IN THE CITY IS UNLAWFUL EXCEPT BETWEEN THE HOURS OF 7:00 AM AND 9:00 PM, MONDAY THROUGH FRIDAY AND BETWEEN THE HOURS OF 9:00 AM AND 9:00 PM ON SATURDAYS. NO WORK IS ALLOWED ON SUNDAYS OR ANY LEGAL HOLIDAY UNLESS AN ALTERNATE WORK HOUR PERMIT HAS FIRST BEEN ISSUED. H/O: 763-572-9332 CONT: 763-633-2378 X1006 ROOF STATE LICENSED CONTRACTOR? 1 APPLICANT AMERICA'S BEST ROOFING & SIDING 9942 HWY 10 STE 104 ELK RIVER, MN 55330 (763)633-2378 20157905 OWNER ZIMMERMAN JOYCE L 5380 4TH ST NE FRIDLEY, MN 55421 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 convect. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to gi a authority to violate or cancel the provisions of any o r state or local law regulating construc - or the rforman a of construction. Applicant Date Bldg BUILDING PERMIT FEE 83.25 FIRE SURCHARGE 2.95 STATE SURCHARGE, BLDG VALUE 1.47 LICENSE SURCHARGE 5.00 TOTAL 92.67 PAID WITH CHECK # 1143 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE INSPECTION TYPE I ICE & WATER BARRIER I FINAL INSPECTION COMMENTS: CITY OF FRIDLEY PERMIT NO.: 2006-00972 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 06/06/2006 (763) 572-3604 FAX: (763) 571-1287 5380 4 ST NE PERMIT APPLICANT: 233024340028 AMERICA'S BEST ROOFING & SIDING UNAVAILABLE 9942 HWY 10 ELK RIVER, MN 55330 BUILDING : RESIDENTIAL : ROOFING BUILDING INSPECTION RECORD 24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS. CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 5 PM DATE INSPECTOR INSPECTION TYPE DATE INSPECTOR IN ACCORDANCE WITH CITY ORDINANCE, NEW OR SUBSTANTIALLY REMODELED BUILDINGS SHALL NOT BE OCCUPIED UNTIL ALL WORK HAS BEEN APPROVED, AND A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED BY THE BUILDING DEPARTMENT. THIS CARD MUST BE POSTED AND VISIBLE AT ALL TIMES UNTIL WORK IS COMPLETE. Building, Permit Fee BUILDING See Back Page for Fee Schedule permit No.: �- �, Inspections 65% of Building Permit Foe RESIDENTIAL APPLICATION $ d - Received By; 763-572-3604 $ l • �— CITY OF FRIDLEY License Surcharge nate Recd: DA11i 4 1z 196 _ YOUR E-MAIL. ADDRESS -4a, (� --i oo • Gam -n SiTP AIX)IMSS �!i%i�w Li fv► �y . ,. . THIS APPLICANT IS; 0 OWNER JdCON'I'RACTOR $ PROPERTY OWNER/ NAMH; Jo`(Lt`- 24A -P^ -(L fv"&N $ TENANT ADDRESS; 5-3-%t-) E„ ,_ _„_GI'1'Y Fa -t a yeti _,�S'I'A'T6 zIP 55N2/ Agreement necessary ( ) Nun Necessary ( ) PHONE: .=5.'7 ? ^ Ct. 2 $ 92-, G '7 CONTRACTOR NAMR; f 't M >< iZl LA �S i3ES C&V cb 1 SURMIT A COPY OF STATE LICENSE H,—'D162 9 OS EXP DATE P.7 .....,.. YOUR STATE LICENSE ADDRIMN; CH Ll A- tfhAd l D SV ITE 104 CITY t; t 4,1 ,f1. STA7'6MriLA' S533O WITH APPLICATION PIIONg 7p-6,63-23?s x toorg rAx IV-6--6a3-2--70c PROPERTY TYPE E3 SIN LF MAMILY/NEW CONSTRUCTION SIZR 0 TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE 0 ADD IO ARAGE/SHED 0 WINDOWS O HASSMENT FINISH jaROOF 0 DRAIN TILE O DECK 0 SIDING 0 0THER 0 SWIMMING POOL TYPE Dir WORK: El NIJW 0 ADDMO D MAINTENANCEJRUPAIR 0 REMOAISLINO DESCRIBE WORK BEING DONE: _�_,,,,• ,_ _ ,,,,, SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT sq. Ft. ROOFING, 0 HOUSE ONLY NUMBER OF SQUARES fkH'OUSE & UARAGB BARPMENT RhMQDiJIJ Q SUBMIT: RAGFY 13 Xrl'ACHN) UARAUE I. 2. L•`dAing Flow Plan Proposed floor plan PROPOSED SIZE: PROPOSED HEIGHT; U DETACHED GARAGE 3. List of structural me nbars to be used SIDING POR NLW (;t)N8*rR1iOrI0N INCLUDING DECKS, O Vinyl ©Soffit ADDITIONS. & PORC:HRS SUBMIT: 0 Aluminum 0 Thin 1. Site Alan/Survey Omwing the existing stmotures O Other O Fascia and proposed project. _ WINDOWq 2. Two acts of construction plans IN LXISTINO OPRNINUS C]Ycs t7No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS-DBSCRiHE SI/.LI OF OPENING C14ANO&I & TYPE OF -WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASM ON VALUATION, INCLUDING THE COSH' OF LABOR AND MATERIALS: (USING THE 1. 7 U.B.0 FEE SCREDULE) ..TOTAL JOB VALUATION $ .7 � 9r� �' OCCUPANCY TYPE Permit Fee S T 15 • 5 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Foe Fire Surcharge $ d - .001 times the total job valuation Surcharge $ l • �— .0005 x Permit Valuation Minimum $.50 License Surcharge $ 5-00 $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ R + 6 tt = ft x $21 � $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Detartnined by Engineering Sewer Main Charge $ Agreement necessary ( ) Nun Necessary ( ) Total Due $ 92-, G '7 Make checks payable to: City of Fridley Attach Stipulations T141S 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 complato and accurate; that the work will be in conformance with the ordinances and codas 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 equirgs-jq new rawal ai+plans. SIGNATURE OF APPLICANT V C DATE, (0! 2' I CA Ed Wd4b:60 9002 ZO 'Unf 4823W -S 92-: 'ON Xdd Ralplad da FI10: WONJ