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PRE 2010 DOCSCity of Fridley, _Minn.. BUILDING PERMIT N° (:59::5:5 Date: r d� Owner: Builder A_— Address Address — LO TIOft QF BUILDING No.QL-Streeet _ ___ __ _ Part of.. t Lot __ Block Addition or Sub -Division Corner Lot Inside Lot. Setback Sideyard � !' Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING Tu AV .. Front Depth . Height Sq. Ft. Cu. Ft Front Depth Height _ _Sq. Ft. Cu. Ft. Type of Construction '�_ Fist,' --Tobe 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 '"'mss ,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 thus permit may be revoked at any upon violat3of any of the provisions of said ordinances Is.� l 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 items. w Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SU 4-7470 GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 A. each add. 60,000 BTU ......... 2.00 $ Replacement of Furnace ............................. 5.00 Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam .. 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour . 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ v GAS FITTING FEES: NO RATE TOAL 1st 3 Fixtures ...................... x $1.50 $ 7 Additional Fixtures x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS &REPAIRS TOTAL FEE $ ROUGH FINAL 1W City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn AUG 13 1962 19 Used as To be completed about � OCT i 3 i962 Oo Estimated Cost, $ ®� " 9 � ew uilding Permit No. �/ Permit No. DESCRIPTION OF WORK HEATING , Warm Air—No— Trade Nam-G�.�-,�t�o Size No.,A' e.A' 7 _/!o CapaciFt.E R BTU H.P. • aZ 10 -IF 110m4f Total Connected LoaZ ' ! Kind of Fue ' BURNER — Trade Name �� Size No .¢t� Capacity Sq. Ft. E.D BTU H.P. GEO. SED ICK HTG. & AIF-COND. CO 1001 Xenia Av. S. Minneapolis 16, Minn. Signed r-1431 By 4z zM Business Phone 0- (REMARKS—OVER) SUBJECT EAMIT NO. City of Fridley 22801 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT NO. 16 COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ��� I I NUMBER REV. DATE PAGE OF APPROVED By = CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8.18.94 JOB ADDRESS 5916 & 5918 4 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 1 Holly Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim Parker 7316 Humboldt Ave N, Mpls., MN 55444 560-2075 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 Duplex 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof Duplex (20 Sq) 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 60 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 2 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 $1 )roo $.75 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHERS OR CAL LAW REGULATING CON- @ $35.00 Fire SC $1.50, STRUCTION OR THE PERFOR CE OF NSTRUCTION. PLAN CHECK FEE TOTAL FEE 1 $37.25 SIGNATURE O F CONT RAC OR I HORIZED AGENT IDATEI WHEN P LY VALI TED THIS IS YOUR PERMIT O -?49 / Jj�t _ DG INSP DATE iGNATURE OF 0 R OF OWNER BUILDERi IDATEI NEW y< Effective 1/ 1 /94 ADDN [ ] CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 -_tJ- 1 Building Permit Application ConstructionAddress: 6-% r G 9- l �� 1_1� S/ /t-,) Legal Description: Owner Name & Address: Tel.# ��0-2-07� Contractor: MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: - - — ` 4LLfA_ �_ � Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft =F x = $ DATE: c�S l 9 APPLICANT: Tel. #v �O 6720 7S_ CLU S— CLU USE ONLY Permit Fee $� Fee Schedule on Reverse Side Fire Surcharge $ / ED ..001 of Permit Valuation (1/10th%) State Surcharge $ `��— $.50/$1,000 Valuation SAC Charge $ $800 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway 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 $ 3 STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1998 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE SIGNED BY TEL N0. Approved By Rough—In Date ILI Final Date $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. FIXTURE RATES: .7— PLUMBING NO. RATE TOTAL JOB ADDRESS__?I/('=' New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 1998 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater —Electric $ 7.00 Water Heater — Gas** $10.00 Building Used As Gas Range** Gas Dryer** $10.00 $10.00 Estimated Cost PERMIT NO. of Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY © CA,., N 4L Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE SIGNED BY TEL N0. Approved By Rough—In Date ILI Final Date $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. SUBJECT City of Fridley 27035 AT THE TOP OF THE TWINS BUILDING PERMIT I ? RECEI T NO. COMMUNITY DEVELOPMENT DIV. o• � ~ PROTECTIVE INSPECTION SEC. �/�� {/r� 1 , NUMBER REV DATE PAGE OF APPROVED BY � 1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/6/98 JOB ADDRESS 5916 4 St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 1 Holly Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim Parker 5916 4 St NE 502-1489 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK kitchen windows; re -sheet rock(ceiling & walls, & new floor) Closing up one and adding two new. 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING. VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 500 .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER TATE OR AL -LAW REGULATING CON- CON- STRUCTION OR THE PERFO CEO .. CTION. $21.00 Fire SIC $.50 PLAN CHECK FEE TOTAL F �� 2 0 SIGNATURE OF C, TRACT OR AUT RIZED AGENT 1 TEIjW5p R MAP ERLY IDATED T SIS YOUR PERMIT ' 7E� SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER P4, SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ' BUILDING PERMIT APPLICATION ConstructionAddress: 2/6 Legal Description: Owner Name & Address: �j�i4l� %L Tel. # Contractor: -v e MN LICENSE # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF BIPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width HedGround Sq. OTHER: a Construction Type: Wz n1oo ccs r�z�L-+c e,Aj ems+ Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: g 6 APPLICANT: Tel. STIPULATIONS: CITY USE ONLY Permit Fee $ /, Fee Schedule on Reverse Side Fire Surcharge $ - .001 of Permit Valuation (1/10th%) State Surcharge $ S'j $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway 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 [ ] Cd' TOTAL $ STIPULATIONS: SUBJECT , P City of Fridley 3 08 86 AT THE TOP OF THE TWINS BUILDING PPRMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. 6 �� r PROTECTIVE CITY HALL FRIOLEY 53132 IL A ��� NUMBER REV DATE PAGE Or APPROVED Br ---- 612-571-3450 910-F15 5/1/00 JOB ADDRESS 5916-5918 4 Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 1 1 Holly Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Tim Parker 5916 4 Street NE 502-1489 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 Duplex 7 CLASS OF WORK O NEW 0 ADDITION O ALTERATION REPAIR O MOVE O REMOVE B DESCRIBE WORK Siding Repair 9 CHANGE OF USE FROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. 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 W 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 2 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 $500 @ $ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHE L LAW REGULATING CON- $23.50 Fire SC $.50 T CTION OR THE P R CE OF CO TRUCTION ®y PLAN CHECK FEE TOTA FEE ��— 4.50 SIGNATURE OF CON ACTOR OR AUTHORIZED AGENT MATE- EN ROP ALIO EDHIS IS YOUR PERMIT SIGNATURE OF OWNEROF OWNER SUILDERI IDATEI Bl0 INSv GATE NEW I l Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg lnsp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 \p BUILDING PERMIT APPLICATION !� U Construction Address: Legal Description: �,/ Owner Name & Address: �i�/�zi[ Tel. # Contractor: MN LICENSE # Address:Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft Construction Type: Estimated Cost: $ do. O C7 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE:-!; — i- © 0 APPLICATel. #-s O� � Y� CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ ;;;�3, W Fee Schedule on Reverse Side Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee $ 0 .001 of Permit Valuation (1/10th%) $ oS $.50/$1,000 Valuation $ $1100 per SAC Unit $$5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: $ J CITY OF FRIDLEY BUILDING INSPECTION 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Fireplace insert Gas Range Gas Dryer I n� 60 �� Effective 4/1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Fee Total $35.00 $3508 $10.00 $ $15.00 $ $10.00 $ $10.00 $ *Air Conditioning -All Sizes $25.00 $ All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work $ Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater on work less than $500.00 Commercial/Industrial/Institutional _ 1.25% of Value of Appliance or Work (List on Back) $ �� Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge $ 0.50 (if permit fee is over $1,000 multiply by .0005) TOTAL FEE $ *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE JOB ADDRESS Owner -T'5rF AI&I 50'ej Building Used As ESTIMATED COST PERMIT NO DESCRIPTION OF FURNACE AND BURNER # of Heating Uni Circle One (Steam) (Hot Water) �xl Trade Name Y4 Size No. BTU %0,000 HP EDR Fuel AZA -t 6,+5 Total Connected Load Burner Trade Name BTU HP Size 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. HEATING CO �n � /4//Z 10/,m e sai'4 Signed Tel # 7V� 79 FAX # -7 :22 Date Approved by Rough -in Date Final Date FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina 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 (o) 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 existina 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 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 Building BUILDING Permit Ivo.: ZCGQ9 d ZS Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 65% of Building Permit Fee Fire Surcharge CITY OF FRIDLEY DatV: 763-502-4977 FAX Surcharge EFFECTIVE 1-I-08 DATE -7 Z Z /ll YOUR E-MAIL ADDRESS d nv, S S ea r f l'n SITE ADDRESS �s- �I- r59 V4` /VC_ THIS APPLICANT IS: ❑ OWNER NTRACTOR PROPERTY OWNER/ NAME: tl(T TENANT ADDRESS: S I to ,L:5 g 1 d 7 � CITY STATE ZIP Erosion Control PHONE: �DI'L - 36X-^ O p 3 I $450 Conservation Plan Review NAME: CONTRACTOR C ADDRESS: CITY_�'� S STATES ZIP /y7 SUBMIT A COPY OF PHONE Q, " % 2 2 - Z FAX (,I Z ' (/ 6 5 - 2'/& / YOUR STATE LICENSE STATE LICENSE # D � l EXP DATE !3i - G PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH 0 ,WROOF ❑ DRAIN TILE El DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION AI TENA E/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: rug SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES OUSE & GARAGE BASEMENT REMODELING SUBMIT: I. Existing Floor Plan GARAGES IRTTACHED 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 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ (�q Ifc"4 OCCUPANCY TYPE Permit Fee $ -V3 jz) 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 $ $1825 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 $ a Make checks savable to: Citv of Fridlev Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I ac a 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 Minneso Cons ction Codes; that I understand this is not a permit but o an application for a permit and work is not to start without a permit onsite; that the work will be in accor th the approved plan ' e case of all work which req uir gig;� SIGNATURE OF APPLICANT PRINT NAME DATE APPROVED BY DATE II PLEASE NOTE: SEPARATE PERMITS ARE REOUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK II ,(A-7