PRE 2010 DOCSCity of Fridley
Appueation for N=611ng tamed Gas Rttbg Pan*
Dept. of Bldgs. Phone SW -3450
DESCRIPTION OF WORK /l
Number. Kind and Location of Fixtures Lcmuoa �+' / IV M ��' A? "
�ee
_
qq
yy
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f
.
N
WATER 11TR.
GAS
a�
7
c
t�a
3
o
0
ELEC.
Base
lot
�
2sad
3rd
--
4th - --
° Futuro Connection Openings
Now Fixture. Old Openings I Sewn ❑
Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
Number Fixtures x $2.00 $
Future Fixture Opening ... ... ...... x $1.50 $
New Fixture Old Opening x $1.50 $
Catch Basin . .
Water Heater (Up to 99,000 BTU)
New Ground Run Old Bldg.
Electric Water Heater
GAS FITTING FEES:
x $3.25 $
x $3.00 $
x $3.26 $
_ $2.00 $
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 .... . .........................................a
TOTAL FEE $L. -
City of Fridley:
The undersigned hereby makes application for a permit for the work herei
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.
Owner
Kind of Building
Used as
To be completed about
Estimated Cost,
Old—New. Building Permit No. Permit No.
Signed-
Business
ignedBusiness Phone ?-1
ROUGH
FINAL -j- 3 Z/
SUBJECT
PERMIT N
City of Fridley
2 9140'
AT THE TOP OF THE TWINS
BUILDING PERMIT
IPT
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC
r PROTECTIVE
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REv
DATE
PAGE OF
APPROVED BY
612-571-3450
910415
4/2/99
JOB ADDRESS 6721 4 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
3
3
Rice Creek Terrace PJT 3 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Donald Johnson 6721 4 Street NE 571-2298
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Renewal By Andersen 350 73 Avenue NE, Fridley, MN 55432 502-4777
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
20040630
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION J3 REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Replace 3 windows in home with new completes
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1994 Uniform Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
Permit Inspection Cards
Will Be Maildd
To Homeowner To Post
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
$3,145
$1.57
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$87.25
Fire SC $3.14
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
Li en C $5.0
$9 .96
SIGNATURE OF CON-RACTOR OR AUTHORIZED AGENT IOATEI
ENP PER (DATED HIVIS YO ERM I
7-7
" BLOC NSP - T1AIE
S-GNATURE OF OWNER,.F OWNER BUILDER& IOATEI
Prepaid Plan Check $ Effective 1/1/99
Estimated Cost $ CITY OF FRIDLEY
Receipt # R-3, COMMERCIAL & INDUSTRIAL . I b
BUILDING PERMIT APPLICATION L 1''t
Construction Address (p l a r y A, Zoning
Legal
Owner & Address
I is
&-7ai—LM a-7/ V — Tel# 5`71-959; 98
2jXjv,u= 350 . 7 ►3 Tel# _z:9DP -q-7T7
.# Engineer Reg.#
BUILDING 1 1
TYPE OF ONew .. o - on -Desaribe Rel 1 ♦ �r .�
i
l .)t1._� � _._1111 .•' -��.♦ � L ! _ 1 ! i�. '��.
OFC. AREA: Length Width Height Sq. Ft.
WASE AREA: Length Width Height Sq. Ft.
OTHER AREA: Length Width Height Sq. Ft.
APPLICANT Tel # &9(-98Gi Date 313o/R9
VALUATION
Sq. Ft.
x $
Cost/Sq.
Ft. =
Valuation $ ) s
Sq. Ft.
x $
Cost/Sq.
Ft. =
Valuation $ 3;�y5/
Sq. Ft.
x $
Cost/Sq.
Ft. =
Valuation $ ) 'I+0'TAL VALUE
Building Use
Construction Type
Occupancy Group
Air Conditioning
[] Yes
(]No Fire
Protection Provided [] Yes [] No
Performance Bond
Amount
$
See Reverse for Schedule Received []Yes, []No
Permit Fee
r+ek
GSu� %e
state .°9e
SAC Charge
Erosion Control
Park Fee
S
Spec. Assessments $
Driveway Escrow $
T07ZL $ q �• �
See Fee schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.001 x Permit Valuation (1/10th %)
$.50/$1,000 Valuation (See Sched. for > $1 Million)
$1050 per SAC Unit (Plans to MWCC for determination)
$450.00 Conservation Plan Review
Fee Determined By Engineering
ng
Agreement Necessary [] Not Necessary []
feet x $13.50/foot
ATTACH STIPULATIONS
�G t ��E"�i�✓ �r�
':;�no s - Cnsa q
NEW [ ] CITY OF FRIDLEY Effective 4/1/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: -7 L/ 4-�j S)�-
Legal Description:
Owner Name & Address: oti,% ( J p4v-use-ka 67 a1 - qi-k S3 -,V e Tel. # 763 - 57! - x-99
Contractor: b av, IV ",k(?MN LICENSE #
Address: /3057-/,o qA Lr-,_ NC B i'1°I IV 5-5'4/34/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:
Construction Type: 7VAW - Offd- yJ= Estimated Cost: $ 5- 7 0 0 eo
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: APPLICANT: jgi4
nC�Tel. #
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.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ c/ToQ5
$ 30 10
$ /.55'
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
TOTAL $ /(,)/ - 910 STIPULATIONS: