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0 i City of Fridley, Minn. BUILDING PERMIT N® 3904 Date: ... �—. ./ .... .. 2 • .............. .. ..... .. .. Owner ..... ... .... .... .. ........ Budder ......................... Address ...................................... Address ............................................. T%OF BUILDING No. ..11 /. / . Street .... .j . .......... e..!.� ... ParI�Slde t . ..........�.... Lot .... // ... Block ........ /........... Addition or Sub-Divisi .. .. 6K'.. ...1. . Corner Lot ............ Inside Lot h ......... Setbacksjd.:f�... . ya ........................... DESCRIPTION OF BUILDING 106-z To Used .•. / /� Front YY� Depth 47� c� Height (X �� Sq. Ft. A Cu. FtP&4! 0/y .................... Front ...... Depth ........ Height ........ Sq. Ft......... Ca. Ft. ........ Type of Construction ................... Fast. Cost.. .A?� ....... To be Completed ................... In consideration of the issuance to me of a permit to construct the buildin desribed above, I agree to do the proposed work in accordance with the description above set forth and i compliance with all provisions of ordinances of the city of Fridley. V . . .. .............................. In consideration of the payment of a fee of $RP . . 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 with- in the city limits and this permit may be revoked at any time upon violation of any of tbje provisions of said ordinances. Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, I 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 -Address' Address _ LOCATION OF BUILDING No Street_ Part of Lot Lot Block Z._Addition or Sub. Div. Corner Lot Inside Lot Set Back Applicant, attach to this form Certificate of Survey of Lot.and proposed b iildi' iodation.. DESCRIPTION OF BUILDING To be d_ as _ FrontDepthHeight 1Sq. Ft Cu. Ft, Front Depth Height Sq. Ft.:- Cu. Ft. Type=dt Construction 'To -be completed Estimated Cost 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 truean corre --- Date Signature ro .(A Schedule of Fee Costs can be found on the Reverse Side) 0� City of Fridley Apprication for Plmbing and Gas Fi ting Pem& Dept. of Bldgs. Phone SII 4.7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Loca3iorl PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Z x $1.50 $ 1,24-4 Future Fixture Opening ................ 3 x 1.20 $ 361-6 New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTI) ...... x 2.00 $ 21016 New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code NO. RATE TOTAL x $1.50 $ x .50 $ x 2.00 $ 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 a d correct. dley, Minn 19 '� Owner -� .L j 19— Kind of Building Used as To be completed about — Estimated Cost, $ Iea d,4-'0' Old—New. Building Permit No.� Business Phone No_ /1", ,S " :v / 6 2 Description ....................................:...........$ TOTAL. FEE $�L6 ggspll POST IM -1!2-58 19_ rM 6 1*0 F N WATER HTR. GAS ELEC Base 1 I 1st 1 2nd 3rd 4th T—rT • Future Connection Openings I New Fixture, Old Openings Connected with Sewer Cesspool a PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... Z x $1.50 $ 1,24-4 Future Fixture Opening ................ 3 x 1.20 $ 361-6 New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTI) ...... x 2.00 $ 21016 New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: 1st 3 Fixtures .......................... Additional Fixtures .................... Gas Range to 200,000 BTU .............. REPAIRS & ALTERATIONS—Refer to Code NO. RATE TOTAL x $1.50 $ x .50 $ x 2.00 $ 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 a d correct. dley, Minn 19 '� Owner -� .L j 19— Kind of Building Used as To be completed about — Estimated Cost, $ Iea d,4-'0' Old—New. Building Permit No.� Business Phone No_ /1", ,S " :v / 6 2 Description ....................................:...........$ TOTAL. FEE $�L6 ggspll POST IM -1!2-58 19_ rM Application for Power Plants and Heating. Cooling, Ventilation. Refrigeration and LQ 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 $ MECIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ each add. 60,000 BTU ....................... Replacement of Furnace ............................. Repairs & Alterations—up to $500.00 ................. 'R6pairs & Alterations each add. $500.00 .............. STEAM or HOT WATER SYSTEM Ftrnace Shell & Lines—to 400 sq. ft. EDR 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 $v_ % 1 2.00 $ 5.00 $ 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 $ c f b 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 $ 3 REMARKS: Dept. of Bldgs. Phone SII 4-7470 Location60 6 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 am rue and correct. Fridley, Minn'-! t._ /c, 195 Owner 1 a .f 7 Minn- 195— Kind of Building 195— Used as To be completed about Estimated Cost, $ Old—New. Building Permit No. DESCRIPTION OF WORK HEATING or POWER PZ.ANTS—Steam, Hot Water, Warm. Air—No Trade Name Size No ---,---'i ✓t '� �� Capacityt Sq. Ft. E.D.R BTU H.P. 0 Total Connected Load Kind of Fuel BURNER —Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. a ` � Sign" s� r-�►� 11 POST IM -12-58 Business Phone No HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS Weatherstrips A.S.H. Construction No.• Guide Win ows_ I Doors Reference Out. Wall Jlnt.WaH I Ceiling I Roof I Floor s o a NNo 19IC F1.1 Room J Length I q 0 Width L Height II Windows and oors—Crackaze and Area 1 I ';V I 1,j 2; IU hPI I ci 1.7� ICoef.1 Btu Glass Exp. wall Net exp. wall Int. wall Ceiling 2,2— Floor Floor Total Btu. 1_ 741 Required sq. ft. E.D.R. or sq. ins. WA. Leader area F1.1 ® Room I Length (" Width Windows and Doors--Crackage and Area Width Haight No. of Lineal tt Area No. o[ pane of pane lights o[ era k sq. tL 7 7� � 1 - 9 Glass Exp. wall Net exp., Int. wall Ceiling - - _- Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area Fl. Room I Length Width Windows an Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of Page lights of crack eQ. tt. Coef. Btu. Infiltration - Glass Exp, wall Net exp. wall Int. wall Ceilinj Floor Total Btu. Required sq. ft. E.D.R: or sq. ins. W.A. Leader area xr-(a000)-ia.s7 1 ROSEVILLE. MINN. Insulation How Applied Fl.� ,� Room Length 0 Width / ' Height o Windows and Doors—Crackage and Area Net exp. wall 3A 13 2,b Width Height No. of Llneal tt. Area No. of pane of pane lights of crack sp. ft Coe£ Btu Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area _ Esp. wall Coef. Btu Infiltration Int. wall Ceiling Floor xRb Glass 50 Eap. wall Net exp. wall A-4 11 0 Int, wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area F1.1 Room I Length Width Windows and Doors—Ctackage and Area Wtdth Height No. of Lineal [t. Area No of pane of pane Ilehte of crack sq. ft Z 1 ?o %.� 1 ,3 � 12- Infiltration 2 Infiltration I& Glass Exp. wall Z0 2, Net exp. wall 3A 13 2,b Int. wall Coe£ Btu Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 PAT14 Room I Length Width Height Windows and Doors--Crackage and Area Width Height No. of Lineal it. Area No. of pane of pane tights of crack sq. ft. Z0 2, Coe£ Btu Infiltration Glass _ Esp. wall Net exp.. wall '®so A Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. -or sq. ins. W.A. Leader area *City oFridley, Fidl, Minn. • BUILDING PERMIT N° 4246 Date: ................ ~......qz.;�tm._...... .... _............................ Owner: .....__Cl. stap...Jobnaon.....---._............._.................... Address ....._.0181. _-_.._ 6th .....St • . �' �.....� _* ................. Miaaeapolis 21, Mina. Builder .................l7AIM9 .................. ...................... _........... _ Address ....................... _............. ............... ...................... _....... _....... ........ ........ ... _.._.._.. LOCATION OF BUILDING No. ......... 61 1....... street - 6th .......... __..... ...... ............. _.............. Part of Lot ..... ............................ .......... ... .................... _...... _ Lot ----- ---------- .1�-............ Block ..... ........ .... 1 ............................. Addition or Sub -Division ....._..Up.'La ft-y.---s#'$Gl...AdintAOM-.. CornerLot .................................... Inside Lot ....._ ----X..................... Setback ..... _............................. ........ Sideyard........................... ................................ -........... SewerElevation ..... . ........................................... -..................................................... Foundation Elevation...................._........------._......-----..............._...........-------_..._.. DESCRIPTION OF BUILDING To be Used as: Front ........... 18..' Depth .......... '4. �. Height Sq. Ft -- _.. Cu. Ft .._36 .................... _............. ......................... Front .................... __- Depth .................... Height ................0.... Sq. Ft... ................. ._.. Cu. Ft. _... _................. Type of Construction...............FP�i®.................... Est. Cost ..........._ ........ 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 orth and in complian with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $.......... permit is hereby granted to. .... ................. ..........._............._......._.. ........ _........ _._.......... .............. _....................... to 1construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. `� ......_........ Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. , APPLICATION FOR BUILDING PERMIT CITY OF FR.IDLEY$ MINNESOTA Owners Name Builder �o Address r�/ �' d Address e LOCATION OF BUILDING Street Part of Lot Lot Block_/ Addition or Sub:Dv. 2 Corner Lot Inside Lots Set Back Sid-Yaxcl, SEWER ELEVATION FOUNDATION ELEVATION Applicants attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Front ` Depth 22 Height Sq. Ft. 4 Cu. Ft. \,361 Front Depth height Sq. Ft. CU, Ft. Type of Construction Estimated Cost To be completed The undersigned hereby makes.applica.tion 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 corrget. n DATE �' � '/-' 57Y -SIGNATURE %Zd� (A Scheditlg of..Fee costs can be found on the Reverse SYo. r_ afta Now • is • City of Fridley, Minn. BUR DING PERMIT Date: - May 232 1965 owner: Gustav Johnson Builder Gus Johnson Address 6181 6the St. N. Be Address Pr . ` Q X? 7557 LOCATION OF BUILDING No. 6181 street 6th. Street N. E. Part of Lot Lot. Block 1 Addition or Sub -Division . IIQlands it 2nd Add • Corner Lot — Inside Lot Setback r _ Sideyard Sewer Elevation _. Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth Height Sq. Ft. Cu. Ft Front Depth Height Sq. Ft Cu. Ft Type of Construction Est Cost ate_ _ To be Completed Rebuild Garage, Storm Damage Repair 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 aft provisions of ordinances of the city of Fridley. „ j r-. A In consideration of the payment of a fee of $_1Q.Q , 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. NOTICE This penek don not eoaer the eonatraetion, histalla = for wMrb& phnahine, an he ffm sewer or wafer. Be wre to ase the Bulidioa hupeefer for separate permfis for than ilei. VP A APPLICATION FOR BUILDING PERMIT •CITY OF FRIDLEY, MINNESOTA OWNER'S NM_n iL •sem d-1®lfd l? S D!/! BUILDER ` '[e .� f ® or -.5--o 4 LW. -,0 LOCATION OF BUILDING No f� Street, % �`c Part of Lot LOCK % ADDITION OR. SUBDIVISION P Z,4 All- S 4,e Cotner Lot Inside -LOT Setback Side yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Tiro Certificates of Survey of Lot and proposed building location drawn on these Certificates. To be uped'as: DESCRIPTION OF BUILDING Front Depth Height Sq. Ft. Cu. Ft. FrontDept Height .;Sq., Ft. Cu. Ft. Type of Construction Estimated 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 of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in4his application are trueland correct. DATE �IA��5� SIGNATURE • • '• [ (Schedule of Fee Costs can be found on the Revers Side). u R' P� CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 572-3604 r RATE SCHEDULE Residential q - /6- /v APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer Effective On January 1, 1998 JOB ADDRESS (o l 8 I (© (�11 'jl 0 , ' The undersigned hereby makes application for a permit for the work herein Rate TOTAL 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 $ 30.00 $ 3pD representations stated in this application are true and correct. 2-9 ,1998 $10.00 $ i®' Oct OWNER.. T $10.00 $ BUILDING USED AS Q�^� $10.00 $ *Air Conditioning —;AII Sizes $ 25.00 All Others/Repairs $Alterations (LIST ON BACK 1% of Value of Appliance or Work Commercial/I ndustrial 1.25% of Value of Appliance or Work 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 $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. ESTIMATED COST 00 PERMIT NO. - `f DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water Varm Air Trade NameSize No. Z s�— BTU 1,6,VoJ —' HP EDR Fuel �� ,��° _, Total Connected Load Burner Trade Name Size No. BTU HP EDR grAWAM HEATING AND A!R CO. 410 WEST LAKE STP,- r i MUCAPHEATING COMPANY 61a-04• 298 SignedBy Tel No, 4 Approved ByRough—In Date Final Date. FILL OUT BACK SIDE FOR STANK VERIFICATION ON REPLACEMENT FURNACE Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: e CHEWNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes () 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: e GAS WORK ORDER 1072 Payne Ave. STANDARD 410 W Lake St. St. Paul, MN 55101 Minneapolis, MN 55408 612/772.2449 b H EAT I N GJ 612/824-2656 & AIR CONDITIONING FO JIPMFNT INFORMATION LAST -76 /,/,Pi -4 FIRST ADDRESS 6 / Z:/ CITY � Mol%Pei ZIP Z13.� HM..PH r -® 3 WK PH TECH ZA4a= DATE 7 '14 --P,.F- TYPE MAKE MODEL roO /�,e SERIAL O 9/ INPUT oe/ ORSAT TEST RECORD CO2 % METERED INPUT C7 Cfh CHIMNEY TYPE G 02 % LIMIT SETTING 2sG ° FLUE SIZE in. CO % PILOT OUTAGE sec CONNECTOR SIZE in. NET STACK TEMP L 0 TOTAL CHIMNEY INPUT Q btuh SUBJECT P I City of Fridley 27843 AT THE TOP OF THE TWINS BUILDING PERMIT ( i � COMMUNITY DEVELOPMENT DIV. PR P 0kSEC. 2= C/? NUMBERREV GATE PAGE OF i10VED BY t i i �r���,'� CITY HALL 1 5132 .-•- L J` 612-571-3450 910 -FIS 9/17/98 / JOB ADDRESS 6181 6th St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 11 1 Uplands, 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Barry & Barb Tolbert 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO G W Construction 7949 Lee Ave N Brooklyn Park 55443 566-4065 5802 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 O NEW ❑ ADDITION O ALTERATION O REPAIR O MOVE O REMOVE 8 DESCRIBE WORK New windows 9 CHANGE OF USE FROM TO STIPULATIONS Install smoke detectors to meet the State Building Code - in each sleeping room and on each level of house. 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 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 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 $8,600.00 $4.30 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- $149.75 Fire SC $8.60 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTA F, E Licens C $5.0 $167.65 '' S�G�TURE OF CO ACTOR OR AUTMpRi AGENTOv CO ACTOR On AUTMOai AGENT iDATE, ENMOPEAk/ A AT HIS ISR PER IT iNSP - DitE S,GNATURE OF OWNERoF OWNER BUWLDERI iOATE,BLD NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 to BUILDING PERMIT APPLICATION �� �p ConstructionAddress: �'-vr./ /yam Legal Description: Owner Name & Address: ��� ,� , , ��r6� 10/ler' Tel. # Contractor: �' z_/ moo" s '7` MN LI ENSE # jVo .2 Address: 75,1g, Z , c. Are moi/ X ,/fid /� �i-� CAA Tel. # 5 G 6 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EVIPROVEMENT 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:-.41eEstimated Cost: $ C 0 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: Tel. yv C,5— ti P CITY USE ONLY Permit Fee $ I . `�7 Fee Schedule on Reverse Side Fire Surcharge $ 860 .001 of Permit Valuation (1/10th%) State Surcharge $ .30 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ o< -O $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 $ �J . STIPULATIONS: Building PLUMBING Permit No.: Inspections RESIDENTLkL APPLICATION Received By:f4P 763-572-3604 CITY OF LEY Da , 763-502-49787 FAX EFFECTIVE 1 -1 -os DATE 17-[19!aD YOUR E-MAIL ADDRESS SITEADDRESS (Mt (00- f -r kJr THIS APPLICANT IS: ❑ OWNERCONTRACTOR PROPERTY NAME: 2V �I OWNM ADDRESS: CO (1I 0"-' 141 CITY nLA •e y STATE -ZIP s4;2- /54-- PHONE: -h*- 5$10 bbl 2- CONTRACTOR NAME: InUA i lw? co, SUBMIT A COPY OF YOUR STATE STATE LICENSE # EXP DATE LICENSE, BOND AND STATE BOND # EXP DATE CERTIFICATE OF d ADDRESS: �7,1 D ` A_ �J E # ��i CITY G( STATE /(i ZIP INSURANCE .�N[' �St PHONE ?J' '( 2(1 / FAX 1143-1721— 2-999 PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW REPLACEMENT DETAILED DESCRIPTION OF WORK &h PER MS 1613.665 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 FDC•I URE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. BATH SINKILAV _FLOORDRAINS _WATERPIPING _ _SHOWER _ GAS PIPING (NEED CITY LIC) SWIMMING POOL —WATER SOFTNER ($35) —BATHTUB _ CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15) _ _ _ DISHWASHER LAUNDRY TRAY r TWATER HEATER ($35) FOR IRRIGATION _ _ _ WATER METER —OTHER ' ,.. _.. ,, _, i r. � , �s , ! �,�r..:'P. �, r ,- al.. ',. .."f��.i��.�i•. Com' R`a`sh Permit Fee $ 0 Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ OR Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE, $ State Surcharge = $ .50 (MINIMUM $15.50) (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 for 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 the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT %,4 %Y l `!- - PRINTNAME, CfjffG(/ DATE / D y I APPROVED BY DATE �I PLEASE' NOTE: SEPARATE-PERIVIITS ARE REQUIRED FOR'B.UILDING..El E.CTRICAL AND MECHANICAL; WORD. City of Fridley 3uilding Inspections Department 6431 University Avenue NE, Fridley. NN -5432 763-572-3604 FA�i: 763-302-- 977 M Building $ , 25 BUILDING 243-7 Permit No.:,W0 -- Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Surcharge CITY OF FRIDLEY �' Date Rec'd:�� b-- 763-502-3604 FAX $ $5.00 (State Licensed Residential Contractors) SAC Charge $ EFFECTIVE 1-1-2010 Curb Cut Escrow DATE C'– � – / D YOUR E-MAIL ADDRESS SITE ADDRESS 6 f a/ 6 if Sr C THIS APPLICANT IS: ,.OWNER ❑CONTRACTOR PROPERTY OWNER/ NAMI : 'ea y T LdF`L�" TENANT ADDRESS: l 15'1 p /i 5 f IVF CITY Z&t !% = C–i f IV STATEZIP $ /6 PHONE: 7 6 L S,9 (� ` 0 3 2— CONTRACTOR CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY -STATE—ZIP- TATEZIPINSURANCE INSURANCE PHONE FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH XROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: R o o% Mofy S F SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SO FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES �— KHOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED 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 I. 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 FOR WINDOWS – PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW, OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (UySIl THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION ! ANCY Permit Fee $ , 25 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ o .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review - Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ h Make checks payable to: City of Fridley Attach Stipulations 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 application for a permit and work ist to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work which requires re Xammnd approval of plans. `� /� SIGNATURE OF APPLICANT 41PRINT NAME d�}2�L� Z l-&__'�/�DATE 4 �n