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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N° C 4 0 Date: .... ..__._....'" __........_.. _ �___r ..._.___.__ _.._...... _...._ ?'� _. _......._............................ __.._ __• . ..._.... Builder_._.._.__._..._.._.._ . Owner: �. _ Address 10_ Address LOTION OF BUILDING No...:.. Sticeet _�, : ! .._--_............._......_.._. Part of1140t.. '_.._..._. Addition or Sub -Division Lot ..iec'.�..�_..%.. Block ._.._.....1.�-......._......._. _. If M Corner Lot ............................... -. Inside Lot ....._.�r�" ................. Setback .....J-...,5....._...._........ Sideyard._....... zo....................... ........ ..... __._... Sewer Elevation Foundation Elevation t DESCRIPTION OF BUILDING To=be Used as: `- .�j� /Q ,{ _ ... ............- ...--�"'.. Front - Depth .. ...: .. Height ._i;f. e-- Sq. Ft. .::,J(� f QL F�.P.....if,,�S _.............._............._......._............. Front ...................... Depth Height ........................ Sq. Ft...................... Cu. Ft. ...................... s `� ! ". To be Completed ....._..._..__._..................... ......... of Construction ....- �''"'dt.. Est. Co .... r.- -... .. ... CAUTION THIS PERMIT DOES NOT AUTIHOR17_E VIOLAT- ION OF ANY PRIVATE LAND COVENANTS AND BUILDfNG RESTRICTIONS. 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 any of the provisions of said ordinances. ..1.171 410 Building Inspector NOTICE: This permit does net 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. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA Owners Name Builder ,�� 2L..2 Address CL Address ZZ— LOCATION OF BUILDING No. ' Street Part of Lot Lots .16 -?Block /� Addition or Sub.Div.A24-1 Corner Lot Inside Lot_ Set Back Side -Yard SEWER. ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUIIDING To be used as: Front Depth Height % Sq. Ft. Cu. Ft. g S Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Lfd,92Estimated Cost„ To be completed 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 representa- tions stated in this application are true and correct. SIGNATURE (A Schedule of Fee costs can be found on the Reverse Side.) Application for Power Plants and Healing. Cooling, Ventilation, Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE 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 ............ each add. 60,000 BTU ........................ Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ...:............. Repairs & Alterations each add.'$500.00 .......:...... e STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR Steam...... . Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... Each add. 200 sq. ft. EDR Steam ...................... Each add. 320 sq. ft. EDR Hot Water .................. 8.00 $ 2.00 $ 0.00 $ 5.00 $ 2.50 $ 8.00 $ 8.00 $� 2.50 $ 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 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL Dept. of Bldgs. Phone W.. 4-7470 '� &�_ _ City of Fridley: ion and j, I� The undersigned hereby makes ;application for a permit for the work herein specified, agreeing to do all work ii`i 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, Owner .1 1 1 v r Kind of Buildingj� Used as—LtX-cGrc� To be completed about 6"", Estimated Co, Old ew Building Permit No. d Permit No. DESCRIPTION OF WORK 196-4 HEATING or POWER PLANTS--Steam,of Wa , Warm Air—No Trade Nam e—� � �¢s U-114X� 02 Size No Capacity. /if Sq. Ft. EM.R BTU H.P. Total Connected Load Z'3 �vdo Kind of Fuel BURNER. — Trade Name Size No Capacity Sq. Ft. EM.R BTU H.P. See Fee Schedule $r TOTAL F$E $�_ oL/ ' SigniL' By �42 TM 59 (�'B ss Phone No— (REMARKS-OVER) Application for Power Plants and: Heating. Cooling. Ventilation, .Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, 1. 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 $ each add. 60,000 'BTU ........................ 2.00 $ _ Replacement of Furnace ............................. .P.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. IDR 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 $ /O , 00 GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ 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 Dept. of Bldgs. Phone SU. 4-7470 Location , — 3 l., S - :! 5 ' .-"� /' 7% . g 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, Mina 196-9 Owner (2.� — =®� /W Kind of Building OL - /l Used as To be completed about Estimated Cost, $ - Old ew4!. uilding Permit No. 6 44 Permit No.� DESCRIPTION OF WORK HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel BURNER — Trade Name ga a4< Size No Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS -OVER) 4Z zM 7.59 Business Phone No 879.01 City of Fridley APpkarlen for Nwnbing and Gas Rlting Pence Dept. of Bldgs. Phone 560-3490 DESCRIPTION OF WORK Number. Siad and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...... ...... `��GjnQ u7� �gQ x $1.50 $ New Fixture Old Opening Y $ Catch Basin ... .. ... ...... x $3.25 $ Water Heater (Up to 99,000 BTU) x $8.00 • • N WATER HTR. GAS ELEC. Base $ GAS FITTING FEES: NO. RATE TOTAL 1st 2nd 3rd 4th _ ° Future Coummson Openings Connected with New Fixture, Old Openings cesspoolBawer ❑ 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 ... .. ... ...... x $3.25 $ Water Heater (Up to 99,000 BTU) x $8.00 $ New Ground Run Old Bldg. x $3.26 $ Electric Water Heater z $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ Additional Fixtures . .......... , ....... x $ .75 $ Gas Range to 199,000 BTU .............. 1 x $5.00 REPAIRS & ALTERATIONS—Refer to Code Description ............................................... .$ TOTAL FFG; s --3.-(—)O Lo¢aties �5 R1E. Street 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 facl and representations stated in this application are true and correct Fridley, Minn JUL 7 1969 Owner J. Sohmitt Kind of Building Frame Used as RAsi d®n e To be completed about—JUL JUL 12 1969 Estimated Cost, $--500- 014-New. Building Permit No. Permit Sao. �9 7 Signe INNEAPOLIS G O. B Business Phone No ROUGH % 53-84-9915051 City of Fridioy Applictstlan for Plumbing end Gas Fn-U Perm* Dept. of Bldgs. Phone 5:0.3450 DESCRIPTION OF WOM-.' Numbar, hind a_nd Locrfion of Fixtures Lota5367* NE 5th Street iuturs Connacikn Opaniags New Fixture. Old Openings Sewer .C]Ccaapool PARTIAL BATE SCHEDULE UM$ING TES• NO. TOTAL NumberTURE Fixtures • ' .. • . ' • . • . • x vRA�TE $ Future Fixture Opening ............ x $1.50 $ -. Uo x $1.50 $_.__ Catch Basin .................... z • • WATER NTA. $ New ;round Run Old Bldg......... x $125 3 Electric Plater Heatar...... ..... a $2.00 $ _�� NO. RxTE TOTAL 1st 3 Fixtures .............. • • • • x S2.00 $ . Additional Fixtures ................ x $ .75 $ Gas Range to 199.000 BTU ........... L x $5.00 b .00 >r REPLACE. 1 iuturs Connacikn Opaniags New Fixture. Old Openings Sewer .C]Ccaapool PARTIAL BATE SCHEDULE UM$ING TES• NO. TOTAL NumberTURE Fixtures • ' .. • . ' • . • . • x vRA�TE $ Future Fixture Opening ............ x $1.50 $ -. New Fixture Old Opening.. ....... x $1.50 $_.__ Catch Basin .................... x $3.25 $ Water Beater `.Up to 99.000 BTU).. • • x $3.00 $ New ;round Run Old Bldg......... x $125 3 Electric Plater Heatar...... ..... a $2.00 $ LS FITTING FEES: NO. RxTE TOTAL 1st 3 Fixtures .............. • • • • x S2.00 $ . Additional Fixtures ................ x $ .75 $ Gas Range to 199.000 BTU ........... L x $5.00 b .00 City of Fridley: The undersigned hereby makes application for a permit for the- work herel specified, agreeing to do all work in strict accordance with the Citi 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. Mina 2-13-76 19_ Owner Andrew Haeehel Kind of Building Frame Used as RAS • To be completed about 2-20-76 Estimated Cost, $ 10.00 Old --=M. Building Permit No. Permit No. i Signed / ce- By MINNEGASCO Business Phone No ROUG H riNAL l8 ' -5- % .?.LIR3 & ALTERATIONS—Rafer to Code .50 State Surcharge Desrsiption .................... .................. $ TOTAL VEE S 5* 500 Mass -V uurc.liai•67e .500 �i STATE OF MINNESOTA DEPARTMENT OF HUMAN SERVICES 444 LAFAYETTE ROAD 9 C, 1 ST. PAUL. MINNESOTA 88101 Date V City of Fridley Zoning Authority 6431 University AVe. N.E. Street Address Fridley. MN 55432 City State Zip Code RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE Subject: Name of Day Care Home Applicant Street Address F t. ., nn�- City State Zip Code 42� F.t�ec 4vf- DHS-2722 (9-85) PZ -02722-02 9 ,19 A� Type of License: Family Day Care k Group Family Day Care Licensed Capacity 1,0 Phone No. S'1 ( ^ -P-V 1 -1 This is to inform you that we are in receipt of an application for licensure under Minnesota Rules, parts 9502.0300 to 9502.0445 (formerly Rule 2), Family Day Care and Group Family Day Care Standards. Issuance of this license is subject to compliance with the provisions of Minnesota Statutes, Sections 245.781 to 245.812 and 252.28, subdivision 2, known as the Public Welfare Licensing Act and the rules of the Department of Human Services. You should note that under Minnesota Statutes, Section 245.812, Subvision 3, a licensed day care facility serving 12 or fewer persons shall be considered a permitted single family residential use of property for the purposes of zoning. Subdivision 4 of the same section indicates that a licensed day care facility serving from 13 through 16 persons shall be considered a permitted multi -family residential use of property for purposes of zoning. If we do not hear from you within will consider the above-mentioned your local zoning code. Sincerely, Licensing Wo kerg9.4 Street Address I V 30 days after receipt of this letter, we day care home to be in compliance with COMMUNITY HEALTH & SOCIAL SERVICES DEPARTMENT COUNTY OF ANOKA COURTHOUSE, FOURTH FLOOR Name o A ency Organization City State Zip Code AN EQUAL OPPORTUNITY EMPLOYER STATE OF MINNESOTA DEPARTMENT OF HUMAN SERVICES 444 LAFAYETTE ROAD ST. PAUL. MINNESOTA 85101 Date QLt� tA 1Pe oni Authority treet Address IJ .�-- city CState Zip Code RE: ZONING NOTIFICATION OF APPLICATION FOR LICENSURE P Subject: Name of Day Ca&e Home Applicant Street Address F i City State Zip Code DHS -2722 (9-85) PZ -02722-02 �4jo"" 4�p' Type of License: Family Day Care Y Group Family Day Care Licensed Capacity 1 Phone No. 5-1 1 —a 9'1 % This is to inform you that we are in receipt licensure under Minnesota Rules, parts 9502.0300 Rule 2), Family Day Care and Group Family Day Care this license is subject to compliance with the Statutes, Sections 245.781 to 245.812 and 252.28, the Public Welfare Licensing Act and the rules of Services. of an application for to 9502.0445 (formerly Standards. Issuance of provisions of Minnesota subdivision 2, known as the Department of Human You should note that under Minnesota Statutes, Section 245.812, Subvision 3, a licensed day care facility serving 12 or fewer persons shall be considered a permitted single family residential use of property for the purposes of zoning. Subdivision 4 of the same section indicates that a licensed day care facility serving from 13 through 16 persons shall be considered a permitted multi -family residential use of property for purposes of zoning. If we do not hear from you within will consider the above-mentioned your local zoning code. Sincerely, Licensing Worker 30 days after receipt of this letter, we day care home to be in compliance with COMMUNITY HEALTH & SOCIAL SERVICES DEPARTMENT COUNTY OF ANOKA COURTHOUSE, FOURTH FLOOR ANOKA, MINNESOTA 55303 Name of Agency/Organization Street Address City State Zip Code r'c�� vi �..r\& AN EQUAL OPPORTUNITY EMPLOYER Sulliky P City of Fridley 2�08 AT THE TOP OF THE TWINS BUILDING PERMIT f E , O COMMUNITY DEVELOPMENT DIV. LV _ r � � PROTECTIVE INSPECTION SEC E NUMBER REV DATE PAGE OF APPROVED BY _ CITY HALL FRIDLEY 55432 L 612-571-3450 910 -FIS 10/2/98 JOB ADDRESS 5365 5th Street NE T LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 26, 27 15 I Hamilton's Add'n to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jesse Sellards 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 8 USE OF BUILDING Residential 7 CLASS OF WORK !] NEW O ADDITION O ALTERATION 3& REPAIR 0 MOVE O REMOVE 8 DESCRIBE WORK Reroof double bungalow (19 S 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 REOUIREO 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 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ti 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 $1628 $.81 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- 1.63 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $54.00 Fire SC Y� PLAN CHECK FEE TOTf FEE $5A.'44 SIGNATURE CONTRACTOR OR AU-ORIZE0 AGENT iOATE, P4OPE ALIDAT D HIS IS YOUR PERMI 7GN URE O� ER ia OWNER BUILDER- iDATE- iNS OAFE NEW [ J Effective 1/l/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION D �r XConstructionAddress: ,53 6 s ItA5 Legal Description: / X Owner Name & Address: ��S'Se gal! arcI5 Tel. # x Contractor: L5 -36S �/ S�¢� , j �- MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: Y OTHER: Construction Type: Tel. # 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. . Driveway Curb Cut Width Needed: Estimated Cost: $ 16 -cg (Fee Schedule on Back) Ft. + 6 Ft = Ft x $ _ $ • w�`C DATE: �'" APPLICANT: Tel. # Permit Fee $ '5;/00 Fire Surcharge $ /. 63 State Surcharge $ 8/ SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ �6- c G STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] C SUBJECT city of Fridley T73 592 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. __--__ v COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. ®� r 1 NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIOLEY 55132 763-571-3450 910-F15 6/9/03 JOB ADDRESS 5365 5 Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 26,27 15 1 Hamilton's Addition to Mechanicsville SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Brian Mikkelson 5365 5 Street NE 763-370-8252 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO American Siding & Window Systems Inc 1408 Northland Dr STE 305, Mendota Heights A ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. MN 55120 651-686-9444 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 20267098 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION O ALTERATION Lj REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace widows with existing openings; soffit/fascia, gutters 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all revels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all exterior openings. Install soffit ventilation to meet State Building Code. Permit Inspection Cards Will Be Wailed Homeowner To Post SEPARATE PERMITS ARE REQUIRED 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $17,932 $8.96 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- Fire SC $17.93 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $293.25 PLAN CHECK FEE TOTAL FEE Aic se SC $5.00 $325.14 SIGNATURE OF CON'RACTOR OR AUTHORIZEO AGENT iDATE, WHEN PROPERLY VALIDATED THIS IS UR ERMIT S-GNATURE OF OWNER if OWNER BUILDERS tDATE� D,N r,ATE C JUN -05-2003 15:26 FROM CITY OF FRIDLEY TO 6516869445 P.02iO3 NEW [ ] CITY OF FRIDLEY ADDN Effective 1/112003 [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 5723604 Bldg Bnsp ALTER [ ] SINGLE FAMILY AND DUPLEx S R-1 AND R_2 (763) 5714287 lsax BUILDING PERMIT APPLICATION Construction Address: S 66 S - S th c3t-r Legal Description: Owner Name & Address: iA_ _ AMERICAN SIDING &WINDOW SYSTEMS INC. '� Tei Contractor. MN LICENSE # ZO Q Address: 14"M Imun"Mm ' am- UN 551 2n Tel. # 1051 - t¢gfQ A A:14 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to state. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length width Height _ Sq, Ft. GARAGE AREA: Length Width Height Sq. FL DECK AREA: Length Width Hgt/Ground —, Sq. Ft. OTHER: Construction Type: a sQa- t# j=stimated Cost: $ 1 3 0 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x n ffi DATE: (0-5- Q APPLICAN, Tel. # � Call (763) 572-3504 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 Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - $ c�9 c4 Fee Schedule on Reverse Side s---22,- 001 of Permit Valuation (1110th%) 212, 0 $.501$1,000 Valuation $ $1275 per SAC Unit $ 7 = $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 [ $ 'Z�z50 la- STIPUI ATI[NS ZLA PURCHASE ORDER JDATE j -6`3DEPARTMENT \1 ° T141S DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY �S F096842 THIS NUMBER MUST APPEAR ON ALL CORRESPONDENCE SENT TO US (� UP ER � V 1 ADDRESS (nn n �� FMDLEY r ^�j ( PHONE NO. UI`� UNIV AVE. N.E. FRIDLEY, 763-571- 45 55432-4384 CONTACT ®� a eirV l�� 763-571-3450 PRINTED ON RECYCLED PAPER.— PAYMENT VOUCHER BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEP RECEIVED OR RENDERED AND ALL CITY GUIDELINES HAVE BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOM STATED ITEMS. DA —t l :t PAYMENT AU 9AIZ8D BY - ACCOUNT QTY. UNIT PLEASE ENTER OUR ORDER FOR THE FOLLOWING UNIT PRICE AMOUNT V4 m eck- 0� 0() TOTAL , THIS AGENCY HAS AGREES) NOT TO DISCRIMINATE IN HIRING PRACTICES ON THE BASIS OF RACE, SEX, COLOR, CREED, MARITAL STATUS, RELIGION OR NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGE: FIRMS AND OTHER AGENCIES WITH WHOM IT PURCHASES PRODUCTS OR SERVICES TO DO LIKEWISE. WHITE, VENDOR - YELLOW, PURCHASING - PINK, ACCOUNTING - GOLDEN ROD, DEPT. HD. Minnesota Department of Labor and Industry 443 Lafayette Road North St Paul, MN 55155-4342 Phone: (651) 284-5D54 TTY/MRS: (651) 297-4198 www.electricity.state.mn.us RESIDENTIAL ELECTRICAL P�EI�M�IT,BY HOMEOWNER PERMIT # 6��1V! I�� RECEIVED: = A IIA I Homeowner Request for Electrical Ins ection t D�71110 Rough-In Inspection Required? r]Yes Inspection Other Than Rough -In: ❑ Ready Now New Service/Power Supply 0 — 4D0 ampere @ $35 Homeowner Must Schedule All Rou h4h Inspections I Homeowner Must Schedule Ail Fnal Ins ectians ❑ WiII Schedule ddress of in ection — Street City/Township County At/o Owner Nama � ('j /o Project Descrip ' n Owner Telephone Numbers) — Include Area Code(s) a,)- 3 4/ 3 - <:S(c) &7 Owner MailingAddress — Street 116ef �c�Gu�G- 2� � City % f 1�icl State Zip _Code G'`//t/ if J /e Owner E-mail Address Electrical ubiity Q L� Reconnected Feeders/Circuits Feeders/Circuits a $2 Each By signing this document, I certify that I am the owner as defined by Minn. Stat § 326.01 and will legally perform the electrical work Owner Signature -- Fee Calculation New Home or Associated Structure Existing Home/Structure Remodel or Addition New Home Service/Power Supply 0 — 400 ampere @ $35 New Service/Power Supply 0 — 4D0 ampere @ $35 New Home Service/Power Supply 401 — 800 ampere @ $60 New Service/Power Supply 401 — B00 ampere @ $60 New Home Feeders/Circuits Up to 30 Feeders/Circuits - $100 New Feeders/Circuits — Up to 15 Feeders/Circuits Feeders/Circub @ $6 Each or 16 to 30 Q $100 New Home — More than 30 Feeders/Circuits (in addition to above) ( ) Feeders/Circuits Up To 200 A @ $6 Each 'New Feeders/Circuits - More Than 30 Feeders/Circuits Feeders/Circuits Up to 20D A @ $6 Each Other (Specify) Reconnected Feeders/Circuits Feeders/Circuits a $2 Each Detached Garage or Other Associated Structure Detached Garage or Other Associated Structure New Service/Power Supply 0 — 400 ampere @ $35 New Service/Power Supply 0 — 400 ampere @ $35 New Feeders/Cirrub ( ) @ $6 Each New Feeders/Circuits { ) @ $6 Each Other (Specify) Reconnected Feeders/Circu'ris ( ) @ $2 Each Other (Specify) Other (Specify) Total (the fee calculated above or $35 multiplied by the number of required inspection trips, whichever is greater) Total (the fee calculated above or $35 multiplied by the number of required inspection trips, whichever is greater) Requests for Electrical Inspection (REI) with a fee of $250 or less expire 12 months from the filing date. The owner must have the work completed within the 12 month period or submit another REI that includes the inspection fee for the uncompleted work. Inspection fees do not cavy over from one REI to another. A service charge of $30 will be added for all dishonored checks. I hereby certify that I Inspected the Rough — In Inspection(s) • on Date Date This material can be made available in different forms, such as large print, arame or on a tape. io request, TDD (651) 297-419B. REI 01 (6/07) Voice or Building PLUMBING Permit No. - Inspections RESIDENTIAL APPLICATION Received By: - 63 -572360 763-572-3604 CITY OF FRIDLEY ecjgq[�I 763-502-497,7 EFFECTIVE 1-1-09 9F_AX I ®CI �. ! DATE — � '- YOUR -MAIL ADDRESS SITE ADDRESS 1y " M THIS APPLICANT IS: ❑ OWNER ><ONTRACTOR PROPERTY NAME: OWNER/ TENANT ADDRESS: CITY STATE ZIP PHONE: CONTRACTOR NAME: (A o SUBMIT A COPY OF YOUR STATE STATE LICENSE # sq�s__o P EXP DATE Z LICENSE, BOND AND STATE BOND # EXP DATE 3 1 CERTIFICATE OF ADDRESS:' 5 -3 t1 'SIA _(�- CIT � STT ZIP INSURANCE 1 6 PHONE 'I� �� Z �'1®� ® FAX PERMIT TYPE 13 SINGLE FAMILY XWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: O NEW REPLACEMENT DETAILED DESCRIPTION OF WORK -a— PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 = plus .50 surcharge OR FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. _ BATH SINKILAV _FLOOR DRAINS SHOWER WATER PIPING _ _ -BATHTUB _ GAS PIPING (NEED CITY LIC) POOL _ WATER SOFTNER ($35) -SWIMMING -.CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION 'NVATER METER _]OTHER ::hM�t3.3' ,.. ... .,,, u, .. .. Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ ` _ State Surcharge = $ .50 INIMUM $15.50) ✓jo v (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 or a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in th c e o all w whic requi s review and approval of plans. tl �_Q SIGNATURE OF APPLICANT PRINT NAME MI i�9�-V DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977