PRE 2010 DOCS"'�� BITTED
Village of Fridley, Minn. 2
930
Date / •mac .�.�. S.~I ......................
Owner./..... ......... ...............
Address .�.1.®�.... ...... .... .... .
Bui.der...........................................
Address.........................................
LOCATION OF BUILDING
No. ,{.�� ...... Street..10. . ..1! .......................... Part of Lot ............... ..... .
Lot . :':. ....... Block ....':....... Addition or Sub -Division .
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ..........................
DESCRIPTION OF BUILDING
To be Used as:
as Front . r 1 .... Depthl`G..... Height IC,.... Sq. Ft. 7.01. Cu. Ft. ........
................ Front ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft.........
/�1
Type of Constructioa� ... Est. Cost J 21PA! .. ..... .......
To be Completed �..T./�.
In consideration of the issuance to me of a permit to co ruct a building described above, I agree to do
the proposed work in accordance with the description above set o and in col ce with all provisions of
ordinances of the village of ')pl
.. . .......4 . • 4.1. i .................
In cons! of the payment of a fee of $.�' .. , permit is hereby granted to
✓��r`� to construct the building or addition as described above. This permit i�sted upon
the exp ress 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 with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. J/ ®
'...V ..°. Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
Ci t3' mof dleY, Minn •
BUILDING PERMIT
Date: ............. ....... ..._....... - ..._...._..
Owner:..... ........................ Builder
Address ....._.. �-_ �J•-,... ... ........ _.......... Address
N° 4209
�OCATIO OF BUILDING
No. ..k ..: ..®Street ....._..Oct....- --....�—:7.._...._.....--�••....--•......---.._.............. Part of t ..._ .._.
Lot ........................ Block -..._......._...... Addition or Sub -Division .1x�tr'� �••".. _ ...__..
CornerLot .......................... _........ Inside Lot..X....................... ........ Setback ..... _........................ ............. Sideyard.�._`.'.._............................ -••-------...._...... _...
Sewer Elevation ...... ............. _............. _............. .............. _.............. _............ _........ Foundation Elevation
DESCRIPTION OF BUILDING
To be Upfi as:
/'.- ............. Frontwr•••:••• Depth.' Height���...�._ Sq. Ft./..._._ Cu. Ft.�(�.�
........................................ Front ...................._.. Depth ............... .. Height ...................... Sq. Ft. ..................... .. Cu. Ft. ....._.................
Type of Construction ........................... .... .............. .__...._... Est. Cof.l .t?efl ..... ............ 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. c An A
In consideration of the payment of a fee of $ .... I ........................... 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 of any of the provisions of said
ordinances. / -
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.
4
APPLICATION FOR BUILDING PERMIT
IDLEY;` MINNESOTA
CITY OF FRr
0
Owners Name -1 + Builder
Address Acldrss
..
LOCATION OF. BUILDING
No. Street a Part of Lot
Lot r Block , Addition or Sub.Div.AA
-���i�oa
Corner Ldkt-, �Inside Lot_.X,_Set Back - yr� Side -Yard
SEWER EMAT20N " FOUNDATION: ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
Tobe used -
.�f
�' Front r Depth__2_2_25;�Height
Sq. Ft. Cu. Ft. • .
' Front- Depth Height
Sq. Ft: Cu. Ft.
Type of Construction aA4 6 Estimated Cost
To be completed -
The undersigned hereby makes applic�aion for a permit for the*work`here:bn"speoified,
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.
DATE SIGNATURE
(A Schpdu3.e,of Fee costs can be found on he Reverse Side.)
CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1,'1999
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS S63 0 �31A lt)5
RATE SCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Bumer - rulings of the Building Division, and hereby declares that all the facts and
Also Replacement Furnace $ 30.00 $ 50, s o representations stated in this application are true an corr
(Side Vent -Fill Out Back) i a ,1 -
Gas Piping (Needed with new furnace, $10.00 $
but not replacement) OWNER C // 92.6 Ar t_* -rr
Gas Range $10.00 $
BUILDING USED AS Xe -S / Doeu S e
Gas Dryer $10.00 $ � / `/
J ESTIMATED COST 3� ` O 415-CPERMIT NO. i 3( L o
*Air Conditioning — All Sizes $ 25.00 $ S.'1
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs &Alterations (LIST ON BACK)
I% of Value of Appliance or Work $ No. of Heating Units / Circle One (Steam) (Hot Water)
Trade Name 9AeRiCAa Size No. ?,iy 5�2,Ps
Commercial/Industrial BTU (:)o HP Vl EDR
1.25% of Value of Appliance or Work $ Fuel 6-,s Total Connected Load
State Surcharge $ .50 Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE $ SS.
HEATING COMPANY(' NAedr4/ CL rid _
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed B Tei No. 7 CO
Y
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr Approved By Rough—In Date Final Date c[.
*Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR ST K VERIFICATION ON REPLACEMENT FURNACE
written permission from adjoining property owner.
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
CEMMEY AND STACK VERIFICATION
The
undersigned. hereby verifies that the existing chimney or
stack:
L
Has been carefully examined
Yes No ( )
2.
Is free from rust or deterioration
Yes (-)r No (. )
3.
Has no foreign objects lodged within
Yes (-,)No ( )
4.
Is securely supported
Yes ( No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes(-)' No ( )
6
Has total heating BTU's of
All other BTU's
TOTAL BTU's
7.
Has a liner been provided for water heater
Yes ( ) No ( )
8.
Has combustion air been provided for water heater
Yes ( ) No ( )
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
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CIT`! OF FRLDLEY ."NSP_CTIONJ DIV.
8431 University Ave NE
Fridley, IAA' 4-5432
572-3W4
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
Effective On January 1, 1999
PLUMP-ING FIXTURE FATES: NO. RATE TOTAL
Nam Fbaures� 3
$ 7.00
MARK NUMBER
OF FIXTURES TO BE INSTALLED
ON EACH FLOOR
$ 5.00
Bto'w Off Basin
$ 7.00
Waier'r`
aitlr4fi:
Ram Wrier Leader
i° `": Wash
Orinit: s'
Floor
;GEitieli ;Auto.
Gas::;;:;
Gas NtiV.
c:> Water Heater
Stories
cs�:;> ;J:in�
Tu. :Shower
Gas Range**
.Sifj(C Tray
- Dura):> '
Drain
Ba51RA_ Washer
AR .. °
Range > xt ' Gas Elec
Basement
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PLUMP-ING FIXTURE FATES: NO. RATE TOTAL
Nam Fbaures� 3
$ 7.00
Old Opening, New F a
$ 4.00
Beer Dispenser
$ 5.00
Bto'w Off Basin
$ 7.00
Catch Basin
$ 7.00
Ram Wrier Leader
$ 7.00
StrnprReoeWjng Tank
$ 7,00
Waver Trig Appsionce
$10.00
Waw Healer - Electric
$ 7.00
wabw Feater — Gas**
$10.00
Gas Range**
$10.00
Gas Dryer**
$10.00
Back Flow ?.revenber Required ( )Yes {) No
Tye
$15.00
Reinspeefon Fee $42.00,11t
ALL OTHERS ANDjOR REPAIRS AND ALTERATIONS
1.5% of Value of Facture or AppUanoe
State Surcharge .50
TOTAL FEE $�
JOB ADDRESS St/o
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.
Owner
Building Used As I�I C �® ula
i
Estimated Cost PERMIT NO.
PLUMBING COMPANY R L� J j f l CS �' s:
SIGNED BY TEL NO.?!:;/+-? Id
F�T
Approved By Rough -in Date Final Date 3'a?D'Ci/
PLUS THE CSO STATE SURCHARGE
"COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 Sr) lmr;NFC
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 Jan 1, 2000
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
NO. RATE TOTAL
3
Water Heater - Gas"`
Gas Range**
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 $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
JOB ADDRESS 5 Lao L+ _ 51• NjF-
1. oo 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 `4612-2 S, iZ-LA-M—
Building Used As H 6M I -
Estimated Cost 5bb5
(f Y-% I1 ,2005
PERMIT NO. I,;? ! /
PLUMBING COMPANY
SIGNED BY W TEL N0. g?'s /-5 7D y
Approved By Rough -In Date Final Date '® -0
$ .50
MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00
$ Z L .-2PL PLUS THE 5.50 STATE SURCHARGE
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, 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
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 existing combustion air is sized and installed to meet the current codes
and manufacturers specifications. Yes () No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturers 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 manufacturers
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:
SUBJECT
ITNO. .
City of Fridley
(�:.'
1 31506
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
1 . �
NUMBER
REV
OAT E
PAGE OF
AP VED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
10/23/00
JOB ADDRESS 5630 6 Street NE
1 LEGAL
LOT NO,
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3,4
2
Hamilton's Addition to Mechanicsville SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Richard Klatt 5630 6 Street NE
763-571-5704
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
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION j] ALTERATION O REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct basement bathroom
9 CHANGEOFUSEFROM
TO
STIPULATIONS
See notations on plan.
SEPARATE PERMITS
REQUIRED FOR:
PLUMBING ANATSOWS
SEPARATE PERMITS ARE REOUIREO 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 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. OWL,G. 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
$5,000
$2.50
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACC RGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLANZ FE
TOT L FEE
14
118.75
SIG u�E F CON' A� OR OR AuToffiRIZE0 AGENT IDATEI_VfHE
Y VALIDAT THIS IS%°UR P "�T
B OG INSP OATS
Si NATURE OF OW NER I OWN RBUILDERI IDATEI
NEW [ l v Effective 1/1/200
ADDN CITY OF FRIDLEY ' (763) 572-3604 Bid 1
ALTER] SINGLE FAMILY AND DUPLEXES R-1 ANDR� 2
BUILDING PERMIT APPLICATION
Construction Address: .5L30 (,t�, '5-1 N£ 1''
Legal Description:
Owner Name & Address: Q1e1+A PL0 14"'ri 500, 0-lk S -r, NE Tel. # 7b3 -S 71-.5- 7o4/
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.
JYA-rkQ.c�oM I W EM1Q-T-
Construction Type: Wow F9AM%NCr Estimated Cost: $ .5"oo0
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: 10-19 - 2000 APPLICANT: e Tel. # -57j-5
/
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ ///,9747 Fee Schedule on Reverse Side
Fire Surcharge $ 6 -,OD .001 of Permit Valuation (1/10th%)
State Surcharge $.50/$1,000 Valuation
SAC Charge $ $1100 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 $ / ( 5 :C -
TOTAL
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SUBJE&T
City of Fridley3724465
AT THE TOP OF THE TWINS
4 BUILDING PERMIT
r
1
RECEIPT NO.
' • - ------ COMMUNITY DEVELOPMENT DIV.
I;� PROTECTIVE INSPECTION SEC.
/ L
1 • �
NUMBER
pEv
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
L 612-571-3450
910415
3/19/02
10B ADDRESS 5630 6 Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DIE
3,4
2
Hamilton's Addition to Mechanicsville SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Richard Klatt 5630 6 Street NE
763-571-5704
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Midwest Roofing & Siding PO Box 47920, Plymouth, MN 55447
416-4804 20010272
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 O ADDITION O ALTERATION REPAIR
O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (16 Sq) Tear -oft
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building
Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
$1,715
$.86
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.
$63.15
Fire SC $1.72
STRUCTIO OR THE PERFO ANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
•
License $5.00
$70.73
S NATURE OFC'RACTORORAu MORiZEDAGENT iDATE.
EN ROP;VALIOAT THISYOUR PERMIT
WL-0 C N, -
'/9- r Z
PATE
SIGNATURE OF OWNERdF OWNER BUILOERt 1OATE1i
NEW [ ] CITY OF FRIDLEY Effective 1/1/2002
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 3 A16
-
Legal Description: 4 (/
Owner Name & Address: PLOTel. # �7/��- s�1- 7C' 7
Contractor. 114(d Lv`L�LG� 1 MN LICENSE # 200/0Z7?
AAArece* ®h 94-%V (-1-7q� r`� ��ti�� % Y 7 Tel. # V 9'Q
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: J
Construction Type:
Estimated Cost:
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: 9-0APPLICANT: d ka-d R c C �urjf Tel. #1v[ 2
Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 $ _ ®' 3 STIPULATIONS:
su6jEtT
IT NO.
City of Fridley
d
33946
AT THE TOP OF THE TWINS
BUILDING
PERMIT
RECEI NO.
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
�o
I
aaa000O
NUMBER
REV
DATE
PAGE OF
APPROVED Br
CITY HALL FRIDLEY 55432
763-571-3450
910-F1 5
10/6/03
JOB ADDRESS 5630 6 Street NE
1 LEGALLOT
NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
3,4
2
Hamilton's Addition to Mechanicsville SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Melanie Klatt 5630 6 Street NE
763-571-5704
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Wellington Windows 3938 Meadowbrook Rd, St Louis Park,
MN 55426 952-933-6300
A 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
B DESCRIBE WORK
Replace 3 windows within existing openings
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 1997 Uniform Building Code.
Caulk and flash all
exterior openings.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
$6676
$3.34
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
$149.27
SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT IDATEI
- EN PROPERLY VALIDATED THIS IS VO RP RMIT
&OG INSP
01 '91N
r)ATE
S-GNATUAE OF OWNER.IF OWNER BUILDERI IDATEI
NEW
ADDN
ALTER
91955
(] CITY OF FRIDLEY Effective 1/1/2002
[ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
[ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Name & Address:
Contractor.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
4
rAI
Tel.# e `J;7t-5705/'
MN LICENSE #
Attach to this application, a Certificate Suryy 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
/1 r7/ CPO
Construction Type: i ljkj� c� G� stimated Cost: $ (.� 61�.
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: d� APPLICANT. Tel. #
Call (763) 572.3604 for Permit Fees if mailing iapplication or F 763-571-1287 if using credit card and we will
call you for card number. "" `
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ 3
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ ]
STIPULATIONS:
Building
PLUMBING Permit No.; " " -
Inspections
RESIDENTIAL APPLICATION R
763-572-3604D
ITY OF FRIDLEY
DATE
YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS:
[3 OWNER *ONTRACTOR Richard/Melanie Klatt
5630 6th Street North
PROPERTY
Nom; Fridley,MN 55432
TENANT
ADDRESS:7635715704 aTE ZIP
PHONE:
CONTRACTOR
NAME:
SUBMIT A COPY OF
STATE LICENSE # C% EXP DATE
SO�
YOUR STATE
ADDRESS ti CITY /f STATE LLIP
LICENSE WITH .
PHONE — M-033 FAX —
APPLICATION
e
PERMIT TYPE
SINGLE FAMILY 1:1TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW REPLACEMENT
DETAILED DESCRIPTION OF WORK
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. (Thisshould_ reflect only. the cost of labor)
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOP -PROJECTS WHERE LABOR EXCEEDS -S -500, -FEES ARE BASED ON $10.00 PER FDCrURE,•EXCEP1T"WHERE_ND T7E9 :F XT4JR£S:-.(INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH SINK/LAV
DRAINS _ SHOWER _ WATER PIPING
_
BATHTUB
_FLOOR
_ GAS PIPING prFmcnruc. NsE) _ SWIMMDVG POOL WATER SOFTNER ($35)
_
CLOTHES WASHER
_ KITCHEN SINK_ WATER CLOSET BACKFLOW PREV. ($15)
_
_LAUNDRY TRAY I -WATER HEATER ($35) FOR IRRIGATION
_DISHWASHER
WATER METER OTHER
Permit Fee
$ Number of fixtures @ $10.00 x $10.00 = $
Surcharge
.50 Number of fixtures @ $15.00 x $15,00 = $
TOTAL DUE
$ Number of fixtures @ $35.00 _� x $35.00 = $ 3S.Oo
State Surcharge = $ .50
Total = $
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 'cation 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
of o h'cl quires review and approval of plans.
SIGNATURE OF APPLIC
/
Fid IE JC /YO/Olyl DATE Ud
low
IN
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977