PRE 2010 DOCS0 4P
BUILDING PERMIT
Village of Fridley, Minn.
Date ....� ..................
Owner ... )-
Address .a.�.�....:.� ..� !�. ... .
N° 2967
Builder ..........`? � M. 4 ....................
Address ey ... 81o,�o
�p /
LOCATION �-OF BUILDING
No.. AS l : /..... Street .... ." ....t�T2 CCT ........... Part of Lot .......................
n� � )o
Lot ....2X?....... Block ... .�........... Addition or Sub -Division .0. N.1�.Y .....P.Oa
Corner Lot ....Inside Lot ............ Setback 345...... Sideyard ... /'? .............
DESCRIPTION OF BUILDING
Tobe Used as:
Front ... [ Depth ..'1... Height Sq. Ft.Cu. Ft. ... . .
f P
. Y _9�v &R -r... Front Depth . ... HeightSq. Ft. ,�9.? . Cu. Ft........ .
Type of Construction . p. ail:°�d� q, Est Cost .. J. 9 91.1........... To be Completed ..68.&.w., ......
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 village of Fridley.
... �%.+�/.e• . (.✓.. .. ............. .......... .
• colts deration of. the payment of a fee of %�O.sv °�granted
P Ym $. ,permit is hereby to
SYS. 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 with-
in the village limits and this permit may be revoked at any/t'h>Qe upot tin_ of jny of the provisions of said
ordinances. 1 r(DD I
...........
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plum , gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these, Items.
7
SUBJECT
PERMIT NO.
City of Fridley15
7 4 3
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
�,
ECEIPT
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
A,
r PROTECTIVE
U
I = I
CITY HALL FRIDLEY 55432
NUMBER
REV,
DATE
PAGE OF
APPROVED BY
s 612-571-3450
910-F15
5/23/80
JOB ADDRESS 5981 - 6th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
22
5
1 Bonny Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Michael Moore 5981- 6th Street N.E. 571-6708
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
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
area.
9 CHANGE OF USE FROM TO
STIPULATIONS Tn converting the existing garage to living area, there is to be no
windows on the south wall which must also be a firewall. Remove garage door
when detached garage is complete.
WANA
tiEPERANG 7r
pER
TI PERMITS 8410N digging call 10cal utilities
HG. PCU�BING REQUIRED TELEPMNE
- ELECTRIC - CAS Et,
AND` OR
SIGNSr *QW. REQUIRED BY LAW
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 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 I 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
$ 5039 & 2,000
$2.52 & $1.00
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-
$22.88 & $12.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
'
$38.40
SIGN OF ONT C GR AU ED AGENT(DAT )
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
�� ®
Qy�
CJS➢
I ATURE OF OW NER IIF WNE B I DERI ATEI
BLDG INSP f)ATE
7
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OWNER:. AEL BUILDER:
ADDRESS: f - �� �i�cc� ADDRESS:
TEL NO: 5"71 9C%8 TEL NO:
Construction Location
STREET NO: STREET:
LOT: BLOCK: ADDITION: O t`S A) AU/n/
Corner Lot:_ Inside Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
;�r JJ.0 'A DESCRIPTION OF CONSTRUCTION
Front:
Square. Feet:��
70 b Lj Square, Feet:
Depth: ;?Q Height: /®
Cubic Feet: 5`7Q
Depth: Height:
Cubic Feet:
Type of Construction: t�JU��i�A z Estimated Cost: $
lb Be Completed:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated in this application aren,j�rue And e .
DATE: �`r.�® SIGNATURE:
Stipulations:
s
/,✓ eoijv&pT-1&j6 cEyl.,5r)
,66 AJ() W,,AJ8aJS o,J
(-JCjCfI i2A6e- 7-0%l2�4 i�� Gt%e-C_
,&nLIP4 OJA-LL
CA 2AG- , Zooms
SUBJECT
City of Fridley
?7� 1.27
AT THE TOP OF THE TWINS
BUILDING PERMIf
RE
COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
PROTECTIVE
HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
4/17/81
JOB ADDRESS 5981 - 6th_ Street N.E.
1 LEGAL
LOTNO.BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
22
5
Bonny Addition SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Michael Paul Moore 59.81 -� 6tFi Street N.E. 571-6708
3 CONTRACTOR MAILADDRESS 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
Residential
7 CLASS OF WORK❑
NEW ❑x ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 15'$ 20' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQUIRED FOR WIRHEATING.
PLl1MBING ANO SIGNS.
WARNIING
�f ore digging call Incl
utilities
TELEPHONE - ELECTRIC-
CAS EtC.
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ.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
$5500$.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$8.00
OF NTR O UTH AI EDAGENT pIDATEI
WHEN PROPERLY V LIDAT'ED`THIS IS YOUR PERM (T{0 r LyOS
fA E
N RE F OWNE IIF OWNER BUI RI 10 TE
CITY OF FRIDLEY
APPLICATION FOR RESIDtNTIAL BUILDING PERMITS
(New, Alterations, Additions, or Repairs)
OWNER: d//jWLae ( ka U 466 (Z`— BUILDER:
ADDRESS: J9 g ( 9kA 61 it e ADDRESS:
TEL NO: %� _ �'7d $ TEL NO:
Construction Location '
STREET NO: = � STREET: 6Y- Al
LOT: P 9 BLOCK: 5 ADDITION:
Corner Lot: Inside Lot: Setback.: Sideyards:
Ap-plicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTION OF CONSTRUCTION
1�
front:
Depth:
Q Height:
Square.Feet:
Cubic
Feet:
Front:
Depth:
Height:
Square -Feet:
Cubic
Feet:
DeC-�
�21�
Type of Construction:
��C�
Estimated Cost: $
J
To $e Completed:
� U Ae
Alt. A
Alt. B
Proposed Driveway
Width If New
Opening
Is Desired:
$
$
SEE REVERSE SIDE
OF SHEET ,
Me undersigned hereby makes application for a permit for the %.nrk'herein specified,
agreeing to do.all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that all the facts and
representltions stated in this applici
D,NTE: r0 l SIGNATUM:
Stipulations:
I
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
763) 572-3604 FAX: (763) 571-1287
ADDRESS : 5981 6TH ST NE
PIN : 233024210082
LEGAL DESC : BONNY ADD
: LOT 22 BLOCK 5
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
PERMIT NO.: 2004-00175 p%
DATE ISSUED: 02/06/2004
VALUATION : $ 1,000.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS.
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 WHEN ADDITIONS, ALTERATIONS OR REPAIRS IN EXCESS OF
$1,000 ARE MADE TO RESIDENTIAL DWELLINGS. BASEMENT ALTERATION
IS APPLICANT A CONTRACTOR? 1
APPLICANT
CASTLEROCK DESIGNS
2850 LINDGREN LN
INDEPENDENCE, MN 55359 -
OWNER
ENTERPRISES, MJA
408 COYOTE TRAIL
LINO LAKES, MN 55014
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 specifie herein or not. The
granting of a permit does not presum to give authority to
violate or cancel the provisions of y 70;
tate or local law
regulating ��onstructi the e rmconstruction.
AnvlicantlA�� Date 24.17 -cry
BUILDING PERMIT FEE
38.75
FIRE SURCHARGE
1.00
STATE SURCHARGE, VALUE
0.50
LICENSE SURCHARGE
5.00
TOTAL
45.25
PAID WITH CHECK # 5095
Bldg Insp0-Da
SEPARATE PERMITS REQ IRED FOR WORK OTHER THAN DESCRIBED ABOVE.
NEW [ ] CITY OF FRIDLEY Effective 1/1/2004
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: N31f, (�
Legal Description: L"F- �i t>LK- .Sri ecus OV*6. . f ,
Owner Name & Address: M--s-o Go4v*-avr4 C '� ice, , �m z:44�j Tel. # t, iZ - if -0409
Contractor: ��M� LICENSE# 66 Z -0-Z-4-0-->590
Address: 2,2550 Tel. # 640-3016-6-A32-
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 q. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hot/Ground Sq. Ft.
OTHER: A�hllerO/
4 `°9
Construction Type: Estimated Cost: $ i—w*r1 ann
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$
Ci
DATE: X116 2 °°I APPLICANT: 0 0*�1 s�3 MP 3 Tel. # 4-,tL - 6t&- L%`iZ9
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
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$ - ` Fee Schedule on Reverse Side
$ .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 [ ]
$ K .� STIPULATIONS:
..al iy
2x 4 F��h
�'•i �t�l Q - l � �Sv �2-�-C � N
Vti
�p
ult IF &J u c
EVIEWED
R gbDE
90h , ►ANCE
I,.� BLD
` I s�" 0�PIctor/
'ties..
l` UNIC.
5 "I►3
t4ti4
CITY OF FRIDLEY PERMIT NO.: 2004-00181
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED:
02/09/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 5981 6TH ST NE
PIN : 233024210082
LEGAL DESC : BONNY ADD
: LOT 22 BLOCK 5
PERMIT TYPE : HEATING
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADDITION/ALTERATION
VALUATION
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
INSTALL FURNACE (WARM AIR, PAYNE, 88,000 BTU)
# A/C UNITS 0
VALUE OF APPL OR WORK
0
# FURNACES 1
# GAS DRYERS
0
# GAS RANGES 0
ENTER VALUATION
2400
APPLICANT
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
0.00
30.00
PERFECTION HEATING & AIR COND INC
10800 66 ST N
GAS RANGE FEE
0.00
STILLWATER, MN 55082
GAS DRYER FEE
0.00
AIR CONDITIONING FEE
0.00
HEATING REPAIRS/ALTERATIONS
0.00
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 2499
0.50
30.50
OWNER
ENTERPRISES, MJA
408 COYOTE TRAIL
LINO LAKES, MN 55014
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
regulating construction or the performanc f construction.
Applicant Date
Bldg Ins Data��
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
CITY OF FRIDLEY INSPECTION DIVISION Effective January 1, 2004
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
FAX (763) 571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.2510 of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
TOTAL
S .50
JOB ADDRESS_ S'
';'S
BUILDING USED AS 7��5
ESTIMATED COST o� two PERMIT N0.a�:'
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Unit Circle One (Steam) (Hot Water) arm Ai
Trade Name Size No._ S� ®moo
BTU 5�'?0 0 HP EDN
Fuel AJC T" Total Connected Load
Burner Trade Name_ l�X ,/,u P Size No.
BTU 0�r?0y —7 HP 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 an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE Q
HEATING CO ��) c�i�WAS
Signed TEL #
FAX # &,c-/ 7I al
Approved By� Rough -In Date' Final Date
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
When mnl_ acing an�istina, 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 plastictPVC and meets all current codes and manufacturer
spedfications including sizing, length, number of elbows and termination. Yes V' ► 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 Y( No( )
TheeY_p cnminustrnn air is sized and installed to meet the current codes
and manufacturers specifications. P N14U -eW Yes rid No ( )
When required to install a new rnmhi istinn airy it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes No( )
Wf }en jnatallipg a new ventingeyc pm, 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 6 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 (,1 No (: )
Appliance #1 Type PAXu e AtO BTU Input & 020eo an Ass' Nat
Appliance #2 Type 4tirhF BTU Input Fan Assisted oxj*'
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances oO Total Btu Input /a, OO
i
Common Vent Type A &,/ T' Vent Height A 5- ' Diameter -< inches
Appliance #1 Vent Connector Height :j_ft Length ! ft Diameter in Typedc — /-3
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type N
AI _TFRATIANS- (nmr-r-ribgj �a!�P�/ �i��f7 L ✓ K� ��
6e 10e t -Z-1 r,U�Zs ?(44&V a..,I Z
HEATING CO: )
Signed By. 25� '1% Date: ��%�-�
Building
BUILDING
Permit No.:
Inspections
RESIDENTIAL APPLICATION
Received By: AT b
763-572-3604CITY
OF FRIDLEY
Date 20
DATEYOUR
(®
E ADDRESS
srm ADD
THIS APPLICANT IS:
O OWNER OCONTRACTOR
PROPERTY OWNER/
NAME:
ADDRESS:_teJ J;p I 1Q — - Ap4, CITY
STAT ± IP 3,-2,-
TENANT
PHONE: 7Ze 3— 5 &P — gig
CONTRACTOR
NAME: Cedar Valley Exteriors Ip
STATE LICENSE # 20630613 EXP DATE3 i v O i c)
a
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: I
S STATE
WITH APPLICATION
PHONE 7637SS222i FAX 7637555390
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
GEISHED ❑ WINDOWS
O ADDITIONSIDING
O BASEMENT FINISH O DRAIN TILE
O DECK MOTHER Fa<cl a,
O SWIMMING POOL
TYPE OF WORK:
G NEW O ADDITION
O MAINTEN CE/REPAIR O REMODELING
DESCRIBE WORK BEING DONE: A'LIL4
EQ
SIZE OF IMPROVEMENT C J WID
GHT Sq. Ft.
ROOFING O HOUSE ONLY
NUMBER OF SQUARES_
O HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT:
GARAGES
O ATTACHED GARAGE
I. Existing Floor Plan
2. Proposed floor plan
PROPOSED SIZE:
O DETACHED GARAGE
3. List of strucnual members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
O Vinyl
OSoffit
ADDITIONS.
& PORCHES SUBMIT:
O Aluminum
O Trim
1. Site Plan/Survey showing the existing structures
O Other
Fascia
and proposed project.
2. Two sets ofconshwion plans
WINDOWS
IN EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS
3. Energy Calculations
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
11
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: ''
(USING T�I1 9 .B.0 F SCHEDULE) gat y9 9. .
TOTAL JOB VALUATION $ I OCCUPANCY TYPE
Permit Fee See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001 times the total job valuation
Surcharge $ (D .0005 x Permit Valuation Minimum $.50
License Surcharge $ Y $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1550 per SAC Unit (Pians to MWCC for determination)
Curb Cut Escrow $ R + 6 ft = R x $21= $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary( )Non Necessary ( }
Total Due $ Make checks a able to: C& of Fridley Attach Stipulations
THIS IS AN APPLIC ON FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building perrnit and I ackno ed that the , nformation above is complete and accurate; that the work will be in
conformance with the ordinances d codes of ty Fridl d with the Minnesota Construction Codes; that I understand t is is not a
permit but only an applicati n f a it isnot to rt without a it; that a rk in accordance with t e approved
plan in the case of all work hi u' es �' a appy f plans.
SIGNATURE OF APPLICANT PRINT NAME Y / `I _. . ,J/W'WDATE ® /
eat