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PRE 2010 DOCS4 :5�7— CITY OF FRIDLEY Effective Aug. 1, 1981 Commercial and Industrial Building Permit Application 9 9 3/ Building Address: DESCRIPTION:LEGAL r1iUPERTT ownER✓� )/� Iv�ut-4y<<,,A(� ADDRESS: 2- 7�v�I? S % NADDRESS: - PHONE LICENSE -NO.- ENGINEER: ADDRESS: .1 I CE-N3r-N-1F- ILEASE CHECK, IF REQUIRED: IARIANC E S S1 MEIGMT CUBIC ACCESSORY BUILDINGS: LENGTH WIDTH MEI6NT CUBIC SQ. FT. SD.FT. R = COST/SQ. FT. m VALUATION ■ OTHER XA COST/SQ. FT. ■ VALUATION TOTAL VALUATION YPE OF BUILDING CONSTRUCTION OCCUPANCY GROUP CLASSIFICATION S: PERMIT: COMMERCIAL, INDUSTRIAL OR ) $ ALTERATIONS/ADDITIONS/REPAIRS: ) See Fee Schedule on Reverse Side SEWER AVAILABILITY CHARGE (SAC)• PIAN CHECK (65x OF PERMIT FEE) �� �• S-cp = g n STATE SURCHARGE ($.SO/$1.000.00 VALUATION) TOTAL FEE two da; CIAL ASSESSMENTS: 1. IF LATERAL ASSESSMENTS HAVE NOT BEEN PLACED ON THIS PRDPERTY, AN AGREEMENT MUST BE SIGNED. AGRLEING TO ASSUME SUCH LATERAL ASSESSMENTS BEFORE A PERMIT WILL BE ISSUED. 2. PARK (10% RESIDENTIAL. 3% INDUSTRIAL) (REAL PROPERTY OR CASH) 3. PERFORMANCE GUARANTY (FILED • NO YES LOCATIOh) AMOUNT AGREEMENT NECESSARY r AGREEMENT NOT NECESSARY :IAL ASSESSMENTS: DATE ITE INSPECTION: SIGNATURE DATE REGISTERED ENGINEERING STAMP DATE Nt _UM►BING EXTERIOR DEVELOPMENT CHECK A.A.C. LEGAL DESCRIPTION CHECK -ECTRICAL PERFORMANCE BOND CHECK IRE DEPT. EASEMENT, ROW, SP. AGREEMENTS INAL APPROVAL JILDING INSP. PUBLIC WORKS DIRECTOR CITY MANAGER :RTIFICATE OF OCCUPANCY ISSUED DATE 10 N $25,001 to $50,000 $S0, 001 to $100,000 $100,001 and up PLN CHECK: 65 percent I SAC Charge: $425.00 per 6431 University Ave. N.E. Fridley, Minnesota 55432 Tel. 571-3450 RECEIVED OF s F' ADDRESS FOR ( "mow '-.� I Building Permit Tee Schedules FUND CODE TOTAL VALUATION VMS $1.00 to $500.00 R\ 4 wr► (r: whil nm V.iIm to 21r. -Do Daus surchwroll $502 to MOW RECEIPT aft AI , Inc) $2,001 to $25,000 City o �ri�>Le $25,001 to $50,000 $S0, 001 to $100,000 $100,001 and up PLN CHECK: 65 percent I SAC Charge: $425.00 per 6431 University Ave. N.E. Fridley, Minnesota 55432 Tel. 571-3450 RECEIVED OF s F' ADDRESS FOR ( "mow '-.� FUND CODE AMOUNT SIDNEY C. INMAN Treasurer By 7-6 19� No. 991-1 FLATPARIT(& MOORE RV.IN.:3f. FORMS. INC. - N 3"112002306 City of Fridley sue�ECT - FOUNDATION ONLY PE O. 6 5 pl!(1 7 AT THE TOP OF THE TWINS �A A (T I R� E G. � • ______ COMMUNITY DEVELOPMENT DIV. � 1 r PROTECTIVE INSPECTION SEC. -1. P o CITY HALL FRIDLEY 55432 L NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9�7�g2 10B ADDRESS 5600 - 4th Street N.E. 1 LEGAL DESCR. LOT NO. 13,14,15 BLOCK 4 TRACT OR ADDITION SEE ATTACHED Hamilton's Addition to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE S and R Investment 2970 13 A Street N.W., New Brighton, MN 55112 631-2641 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Wiggin Inc. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO xofs =(es Ifo 5 ENGINEER MAILADDRESS �S%�:(p 9 & fP PHONE LICENSE NO M.R. Ali 631-2641 8 USE OF BUILDING Multiple Dwelling 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOV X 8 DESCRIBE WORK NTNG Construct a 80' x 30' 4-plex Structure Belore digging call local utilities 9 CHANGE OF USE FROM TO STIPULATIONS This permit is for the foundation only. Post a $5,000'letter of credit prior t construction above grade. Obtain agreement on a landscape plan prior to construction above grade. Screen refuse containers. Parking lot and driveways must be hard surface with a poured concrete curb. Parking lot must be striped. Provide separate sewer & water services if units are to be sold as;zero lot lin units. Variances for front yard and side yard approved by council on August 16, 1982. SEPERATIE PERMITS REQUIRED FOR WIRING- HEATING, PLUMBING AND SIGN& TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOA SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 4800 OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 4 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 $90.73 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $181,450 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $1,360.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $648.00 PLAN CHECK FEE TOTALFEE $4 .20 $2,519.93 AGENT (DATE) SIGNATURE OF CONTRACTOR OR AUTHOr�, W N PROPERLY VALIDATED THIS IS YOUR PERMIT VvRIZED y�AI a SIGNATOR OF WN IIF R BUIL 1 (DkTV f BLDG INSP 10ATV G jo I -., L � —, - L, 102 Building Address: LEGAL CITY OF FRIDLEY Effective Aug. 1, 1981 Commercial and Industrial Building Permit Application XJ. RL < dP LTCEWSi r I,Qr�v .�,�� r zip: PHONE: I MNWINT. ENGINEER: t HN ..LICENSE N(.- U L M: XASS OF WORK: tE ADDITION: ALTERA I I ON: RPAIR: DATE: _ RECEIPTN .. 310NS* LENGTH WIDTH SQ.�. 3LEASE CHECK, IF REQUIRED:L Y " IB:IGHT CUBIC F 1ARIANCE SUBDIVISION ACCESSORY BUILDINGS: PECIAL USE VACATIONS LENGTH WIDTH SQ. FT. IEZONING EASEVENT5DIGHT CUBIC L IT OTHER ?ALUATION: IRIm) so SO.FT. O X = ? 'Oe-)COST/SQ. FT. ■ VALUATION / 9)950 ■ OTHER __ X,i _ COST/SQ. F7. VALUATION TOTAL VALUATION ,% 'VPE OF BUILDING CONSTRUCTION �%r, Jj/j OCCUPANCY GROUP CLASSIFICATION S: • PERMIT: COMMERCIAL, INDUSTRIAL OR _ $ ' cj�.�� • ALTERATIONS/ADDITIONS/REPAJRS: ) See Fee Schedule on Reverse Side • SEWER AVAILABILITY CHARGE (SAC)0o ,,. • PLAN CHECK (65% OF PERMIT FEE) • 9rr T)c • STATE SURCHARGE ($.50/$1,000.00 VALUATION) ■ TOTAL FEE $ f CIAL ASSESSMENTS: 1. IF LATERAL ASSESSMENTS HAVE NOT BEEN PLACED ON THIS PROPERTY, AN AGREEMENT MUST BE SIGNED, AGREEING TO ASSUME SUCH LATERAL ASSESSMENTS BEFORE A PERMIT WILL BE ISSUED. 2. PARK (10% RESIDENTIAL, 3% INDUSTRIAL) (REAL PROPERTY OR CASH) 3. PERFORMANCE GUARANTY (FILED ■ NO YES LOCATION ) AMOUNT AGREE NT NECESSARY AGREEMENT NOT NECESSARY :IAL ASSESSMENTS: DATE 41 ITE INSPECTION: SIGNATUREi 1 OATS REGISTERED ENGINEERING STAMP _UMBING EXTERIOR DEVELOPMENT CHECK 'V'A'C' LEGAL DESCRIPTION CHECK -ECTRICAL PERFORMANCE BOND CHECK IIB: DEPT. EASEMENT, ROW, SP. AGREEMENTS INAL APPROVAL JILDING INSP. PUBLIC WORKS DIRECTOR CITY MANAGER :RTIFICATE OF OCCUPANCY ISSUED DATE FIP N . V CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 M_ APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1. 1997 Water Stories Closet Bath Urinal Tub Shower Sink Wash Drink. Floor Catch Auto. Gas Gas Misc, Water Heater Tray Fount. Drain Basin Washer App1. Range FIXL Gas Elec Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING. FIXTURE RATES: 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 Gas4 Gas Range" NO. RATE 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 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL JOB ADDRESS 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 1 rd_ `✓ , 199 Building Used As t— j Estimated Cost J � PERMIT NO. PLUMBING COMPANY ��'° �..--h-_ SIGN w TEL N0. Approved By --y Rough -In Date Final Date i �D $ O .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 a ®.Q CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1. 1997 PLUMBING FIXTURE RATES: NO. Water Closet Bath Urinal Tub Shower Sink WashDrink. Floor Catch Auto. 'Gas Gas I Misc.. Water Heater TrayFount Drain Basin Washer Appl. Range FiXL Gas Elec Stories Basement Floor 1 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader Floor 2 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric Floor 3 ate Heater — Gas** $10.00 Gas Range** $10.00 Gas Dryer** Floor 4 Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 ate Heater — Gas** $10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS i.5% of Value of Fixture or Appliance State Surcharge $ .50 JOB ADDRESS -�W41,;7— 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 fads and representations stated in this application are true and correct. .�/ ' g , 199f Owner /-9 Building Used As Estimated Costs Ude PERMIT NO. PLUMBING COMPANY 2 7L1441 ✓lr SIGNED TEL NO.����dJJ.r Approved By Rough -In Date Final Date — --- -r of 1~-U A OrC CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 PERMIT NO.: 2004-00525 (� DATE ISSUED: 04/16/2004 V� ADDRESS 5604 4TH ST NE PIN 233024310055 LEGAL DESC UNAVAILABLE LOT BLOCK PERMIT TYPE ELECTRICAL PROPERTY TYPE : MULTI DWELL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. REMOVE AND REPLACE FOR FIRE DAMAGE. # INSPECTIONS 2 # 0-100 AMP CIRCUITS 0 # 101+ AMP CIRCUITS 0 APPLICANT SOUTH SIDE ELECTRIC INC 9201 E BLOOMINGTON F BLOOMINGTON, MN 55420-3494 (952) 888-5500 OWNER WILSON TONY L & ANNETTE M 5600 4TH ST NE FRIDLEY, MN 55432 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 wort 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 regulating construction or the performance of construction. Applicant Date Bldg Insp Date ELEC PERMIT FEE - MIN (NON-RESI) 40.00 ELEC AMP SERVICE FEE 0.00 ELEC CIRCUIT FEE (0-100 AMPS) 0.00 ELEC CIRCUIT FEE (101+ AMPS) 0.00 ELEC PERMIT FEE - MAX (APT) 0.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 40.50 PAID WITH CHECK # 202726 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 t'AX: (763) 571-1287 ADDRESS : 5600 4TH ST NE PIN : 233024310055 LEGAL DESC : HANIILTONS ADD TO MECHANICS : LOT 13 BLOCK 4 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT O.: 2004-00583 DATE ISSUED: 04/26/2004 + VALUATION : $ 1,500.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A INSTALL THREE FIXTURES AND A GAS WATER HEATER # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE # NEW FIXTURES (EXIST OPENINGS) # GAS DRYERS # OF NEW FIXTURES APPLICANT MCCOLLUM MARK PLUMBING 15136 74 AVE N MAPLE GROVE, MN 55311 OWNER WILSON TONY L & ANNETTE M 5600 4TH ST NE FRIDLEY, MN 55432 0 # GAS WATER HEATERS 0 # GAS RANGES 3 # WATER TRMT APPLIANCES 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 wort 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 regulating construction or the performance of construction. Applicant_ . Date Bldg PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) PLBG FIXTURES (EXIST OPENINGS) WATER TREATMENT APPLIANCE WATER HEATER - ELEC WATER HEATER - GAS GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS STATE SURCHARGE, PLBG FLAT TOTAL PAID WITH CHECK # 2126 RRPAR ATR PFRMTTR RROTTTRFT) FOR WORK OTHFR THAN T)F.RCRTRFT) AR(')VF 0 1 0 0 0.00 30.00 0.00 0.00 0.00 35.00 0.00 0.00 0.00 0.50 65.50 J' CITY OF �-RIDLEY 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 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: 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** NO. RATE TOTAL Back Flow Preventer Required ( )Yes ( ) No $10.00 _ $10.00 30.60 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 _ $35.00 $10.00 $10.00 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 TOTAL FEE JOB ADDRESS ®� %l7� S/-, IF 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. DATE: 1< a�� ©� , 20� OWNER CS 0 N -� BUILDING USED AS )?c S /GAE 0 c ESTIMATED COST /.567C:) PERMIT NO. ' c?004l - 00 PLUMBING COMPANY �/f��� ���aO��/G{ �� l ;� SIGNED BY,Y� ��G�— TEL N 0.2 63 Approved By `�Q Rough -In Date Final Date OLl $ :S MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15 00 or 6% 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 1 1 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 BTU Input venting has been examined and is free from rust, deterioration, obstrugtions, Appliance #2 Type and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer BTU Input 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 Vent Height include AGA-GAMA Category I Central Furnace Venting Tables for fan Appliance #1 Vent Connector Height assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes ft Length 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 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 ( ) 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 : %.11 CITY OF FRIDLEY PERMT- 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 04/19/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 5604 4TH ST NE PIN : 233024310055 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : BUILDING PROPERTY TYPE : MULTI DWELL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 30,000.00 NOTE:. SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. LAUNDRY ROOM FIRE REPAIR STATE LICENSED CONTRACTOR 1 APPLICANT BUILDING PERMIT FEE FIRE SURCHARGE 441.75 30.00 CHRISTIANS INC (3712) 1480 PARK RD STATE SURCHARGE, VALUE 15.00 CHANHASSEN, MN 55317 LICENSE SURCHARGE 5.00 TOTAL 491.75 PAID WITH CHECK # 52573 OWNER WILSON TONY L & ANNETTE M 5600 4TH ST NE FRIDLEY, MN 55432 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 work 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 regula�* uUionyperlfbgKance of construction. Applica4t� Da Bldg In SEPARATE PERMITS RtQUIRED FOR WORK 611'IiER THAN DESCRIBED ABOVE. �' 0 NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ��%S ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: 56® C/ 9,6 6�- 'VE Legal Description: Owner Name & Address: -r-&q c„4� d,� �901-042 Aj? -x�Tel. # %3-6F6 -CW) % Contractor. l�Yl�►',� MN LICENSE # 3?/-? Tel. # q'W �® % 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: 19re- QEzc� Estimated Cost: $ . Co O Driveway 1-440 Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: 7 APPLICANT: iP � y1 Tel. # (�`i� yf� -29,5 e� o i # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ �� %s Fee Schedule on Reverse Side Plan Review $ 65% of Permit Fee Fire Surcharge $ 173O- .001 of Permit Valuation (1/10th%) State Surcharge $ 16-. ?X� $.50/$1,000 Valuation SAC Charge $ -- CU -a $1350 per SAC Unit License Surcharge $ 0 $5.00 (State Licensed Residential Contractors) Curb Cut Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NU FRIDLEY, MN 55432 F63) 572-3604 FAX: (763) 571-1287 ADDRESS : 5600 4 ST NE PIN : 233024310055 LEGAL DESC : HAMILTONS ADD TO MECHANICS LOT 13 BLOCK 4 PERMIT TYPE BUILDING PROPERTY TYPE MULTI DWELL CONSTRUCTION TYPE DECK PERMIT NO.: 2004-01611 DATE ISSUED: 09/16/2004 VALUATION : $ 5,960.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. CONSTRUCT DECKS FOR 4 UNIT PER PLAN. APPLICANT CHRISTIANS INC 1480 PARK RD CHANHASSEN, MN 55317 OWNER WILSON TONY L & ANNETTE M 5600 4TH ST NE FRIDLEY, MN 55432 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 provisionsof any oth r state or local law regulating donstruction or the porman/of construction. Bldg BUILDING PERMIT FEE 125.25 PLAN CHECK FEE 81.41 FIRE SURCHARGE 5.96 STATE SURCHARGE, VALUE 2.98 TOTAL 215.60 PAID WITH CHECK # 5717 SEPARATE PERMITS R6QUII'ED FOIL WORK OTHER TI IAN DESCRIBED ABOVE. CITY OF FRIDLEY 06q 1/1/2004 6431 University Ave NE R-3/comNmRciALmqDusTRLAL/PuBLic/iNsnftmoNAL Fridley, MN 55432 BUILDING PERMIT APPLICATION ROO(763) 572-3604 FAX (763) 571-1287(4 CONSTRUCTION ADDRESS GC CSC) �^` �� Zoning Legal Owner & Address pp CONTRACTOR & ADDRESS �1� So Architect q'oo 44 �3N A— - Tel# ( U-) TA)C_ Tel # t `� jl (90 Reg.# Engineer Reg.# '� BUILDING CONSTRUCTION 1 1 c TYPE OF WORK [] New [vl Addi ti on [b' Alteration -Describe /��o.� A2Cc �5 � ATe-r— t \�_ one5 ►.\ece �roi���.4 �t OFC. AREA: Length Width Height Sq. Ft. WHSE AREA: Length Width Height Sq. Ft. R ngth � Width lv � Height �7 _ Sq. — Ft.'J APPLICA T Tel #__M Date S� 4 = Valuation $ ) Sq. Ft. OQ x $ Sq. Ft. x $ Cost/Sq. Cost/Sq. Ft. Ft. = Valuation $ ) ==4 /0" Sq. Ft. x $ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE Building Us Construction Type �" Occupancy Group ' m� Air Conditioning []Yes []No Fire Protection Provided []Yes []No Performance Bond Amount $ See Reverse for Schedule Received []Yes []No Permit Fee Plan Check Fire Surcharge State Surcharge SAC Charge Erosion Control Park Fee $ /s� 2s— $ 1. $ $ o2, 76 $ $ Spec. Assessments $ Curb Cut Escrow $ TOTAL $ GO PERMIT FEES See Fee Schedule on Reverse Side 65% of Building Permit Fee .001 x Permit Valuation (1/10th %) $.50/$1,000 Valuation (See Sched. for > $1 Million) $1350 per SAC Unit (Plans to MWCC for determination) $450.00 Conservation Plan Review Fee Determined By Engineering Agreement Necessary [] Not Necessary [] feet x /foot ATTACH STIPULATIONS the Home Depot #2802, 5650 lyiklj, ST, NE, FRIDLEY, MN 55432, (612 Fri Jul 21 18:02:00 2000 The materials in this deck cost $1986.5 File saved as: f: 3D View (5 � �vi SIet- ,f6 0 0 6 O c- Ll 7-h 5-t� /vl:�: 56 0 q (ey MP 5606 3a 34 r. D n n't,$ Building BUILDING PermitNjBy: Inspections RESIDENTIAL APPLICATION Received763-572-3604 CITY OF FRIDLEY Date DATE YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: !3 ///t "W -1,L < 011 ADDRESS: J 6O— r= `5 71 A/AL—crry- FP1 04 it STATE ZIP TENANT PHONE: "—.5-k0l d 1 S_ CONTRACTOR NAME; SUBMIT A COPY OF STATE LICENSE # t 4Z I EXP DATE d ) YOUR STATE LICENSE ADDRESS: L'— CITY S S STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: - x,00►= - S69F1*- L iAGi,4 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Z Sq. Ft ROOFING NUMBER OF SQUARES ❑ HOUSE ONLY ❑ HOUSE & GARAGE BASEMENT REMODE G SUBMIT: 1. Existing Floor Plan GARAGES ❑ A HED GARAGE 2. Proposed floor plan PROPOSED SIZE: PROPOSED HEIGHT: ❑ D T GARAGE 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum 1. Site Plan/Survey showing the existing structures ❑ Other a and proposed project 2. Two sets of construction plans WINDOWSAft(ri► tw c 3. Energy Calculations IN EXISTING OPENINGS ❑Yes TI014 pi S OR FOR NEW OPENINGS -DESCRIBE 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 199�B.0 FEE SCHEDULE) AL JOB VALUATION Permit Fee Plan Review Surcharge Fire Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due 9 1 ,t ,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 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 pe p*t 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 whic equi revie of plans. SIGNATURE OF APPLICANT PRINT NAME DATE ?■J Engineering WATER AND SEWER Permit No.: o - ' O 1-17!5 763-572-3551 PERMIT APPLICATION Received By: k 763-571-1287 fax CITY OF FRIDLEY Date Rec'd: I l 1 Yq EFFECTIVE 6/9/09 ."e ° -le APPLICTATION DATE: / ( �� YOUR E-MAIL ADDRESS: A J`I THIS APPLICANT IS: ❑ OWNER CONTRACTOR JOB ADDRESS: S'G7(90 t/fl-1-S•/7 NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY NAME;OVVNE TENANT ADDRESS: S�[121�� � �- �� CITY 47iG( el, STATEk"d1P JJ}%f-)' PHONE: q 11 CONTRACTOR NAW: ® - rr`"- r SUBMITA COPY OF YOUR STATE ADDRESS:_ r yS 3� �7�` t ` W CITY 1470, - • STATE ZIP �j LICENSE WITH PHONE 70 = > r 3tiv� CELLPHONE: /,,I- - 5� � APPLICATION STATE LIC # STATE BOND: DATE: / A kr j 1. Narrative/written description: r7� ,/ b-94-- 2. Please attach sketch showing curb line, utility line, building, etc. with distances. PERMIT TYPE ❑ SEWER CONNECTION PERMIT $50 ❑ WATER CONNECTION PERMIT $50 WATER LINE REPAIR $40' V 0 SEWER LINE REPAIR $40 ❑ ADD STATE SURCHARGE $.50 l ❑ SAC CHARGE @ $2000 = 140 'SD OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST - SEE UTILITY BILLING SPECIAL ASSESSMENTS - SEE FINANCE WATER TAP - SEE ENGINEERING NOTE: WATER METER REPAIR,INSP OR SHUT-OFF/ WEEKENDS & HOLIDAYS $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) 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. I understand this is not a permit but only an application for a perm' - o is not to start without a permit. �/`� SIGNATURE OF APPLICANT 4yy ` `�^ PRINT NAME: �fJ DATE: � APPROVED BY: DATE: 11-0—C11 COPY GIVEN TdoOUTILITY 4LLING (only if new meter) 0 PUBLIC WORKS keNGINEERING City of Fridley / Engineering Department 6431 University Avenue NE, Fridley, MN 55432 763-57273551 FAX: 763-571-1287