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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: .. ... � ...... � fJ............. . Owner....................................... Address ...................................... • N° 3397 Builder .� 1 ............... Address...Lf........................................ LOCATION F BUILDING No ............. Street ........ . 1....... . -Division .. ......... Part Lo!tdt .. ........... ........ . / Lot .....17- ... Block .... ....... Addition or Sub A..� Corner Lot ............ Inside Lot ..... ..... Setback —3,1i~ s fj � � Sideyard ................. DESCRIPTION OF BUILDING To be Used as•Depth-7.5-'o a .... Frohn .T. r � Height . !. f-. � Sq. F't. 101. Cu. Ft..... �.. .................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ....... Type of Construction .. /e.401-3.4— - - .. Bret. Cost./ To be Completed ................... In consideration of the issuance to me of a permit to construct the building desribe above, I agree to do the proposed work in accordance with the description above set forth and in comp ce with all provisions of ordinances of the city of Fridley. .. ..., .f ....................... l s In consideration of the payment of a fee of $07L..�.., permit is he ygrained 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 the provisions of said ordinances. �.. . R . Building Inspector I 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. • City of Fridley, Minn. N° 8079 BUILDING PERMIT Date: dune 30, 1965 Roman Builder [:�t<�t�.S'.�71 1' T r 6859 7th StreetAddress;li'iClit;�'.itis`rt��1.�"2:T��S�(5"vela1251 GARDEM LOCATION OF BUILDING No.6859 _ _ Street 7th Street N. E • Part of Lot Lot 7 Block 5 Addition or Sub -Division Rice Creek Terrace, Plat 7 Corner Lot _ Inside Lot Setback _ Sideyard Sewer Elevation Foundation Mevation 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 -h x 000.00 --To be completed Storm Damage: Rebuild on existing foundation In consideration of the issuance to me of a permit to construct building described above I agree to do the proposed work in accordance with the description above set f in ce with a& provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $10.0 , permit is hereby granted to S • E • MMLIN to construct the building or addition as described above. This t is granted upon the express ndition that the peon to whom it is granted and his agents, employees an workmen, in aII work done in, 7=nE d anduponsaid buildsota locatioty limitsr� permit maq be revoked at any time upon violation of any of the provisions of sefd .ALLEN JENSEN Building Inspector NOTICE Ub permh den no a►rar Ha coahuaHm, hutalbHea for whim p1=h1ne, hm heaHne, rower or wafer. as sun to mo the 6uU ftng bopwer for sgwde permit for them ham. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'SNAMLZBItILDER �-- e `� `; ADDRESS DRESS_ LOCATION OF BUILDING Streat Part of Lot LOQ ADDITION OR SUBDIVISION%U"1 Corner Lot Inside LOT Setback Side -Yard SEWER. ELEVATION FOUNDATION ELEVATro Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILD To b used as; Front pth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost fps er c3,. 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 in this application are true and correct. DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). Application for Peww marts and Heaft% Cooling, Yenffid onR -Rand Air Co oiling S" nes and Devien PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ........................... $10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .............'..... 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ NECH. WARM AM x .78 Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace .............................. 6.00 $ Repairs & AlEerations--gag to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT-WATER SYSTEM FAN HEATING SYSTEM Furnace Shell & Lines -to 400 sq. ft. EDR Steam .. .$10.00 $ Furnace Shell & Eine—to 640 sq. ft. EDR Hot Water .. 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 Each add. 320 sq. ft. IDR Hot Water . ... ........ ... 3.00 $ OIL BURNER—to 3 gal. per hour .. ... ... ..... 8.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199,000 BTI) ....................... 8.00 $ over 199,000 BTU See. Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ..... ................ x$ 2.00 $ Additional Fixtures ............... x .78 $ Gas Range to 199,000 ........... is SAO $ AIR CONDTiIONING $_/h FAN HEATING SYSTEM See Fee Schednb VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ ,L ROUGH Dept of Bldge. Phone 880-3460 Locsilon`% _7 City of Fridley: The undersigned hereby makes application for a permit for the work hereit 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 facts and representations stated in this application are true and correct. Fridley, Kind of Buildings c Used as G A To be complete Estimated Cost, $ el Old—New. Building Permit No. Permit No. 8 to q �ESlPMMON OF WORK Trade Name— Size No CWAJI Q 66) Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load 6 �7� Kind of Fue BURNER — Trade Names Size No Capacity Sq. Ft. E.DR- BTU Ir;F FINAL (REMARKS -OYER) 1 Business Phare No. S� 12' %Z 1 A sueJEcr IT NO. City of Fridley 277 3j) AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. `• __ ___ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. r 1 NUMBER REV DATE PAGE OF APPROVED BY i CITY HALL FRIDLEY 55432 ti_._.11•' '•� 612-571-3450 910-F15 8/21/98 JOB ADDRESS 6859 7th Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 5 Rice Creek Terrace at 7 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Roman Trautt 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Jayson Lindsay - 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 3a REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage 22 SO 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 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 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 1834 $.92 DOES NOT PRESUME TO GIVE AUT RITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STA R LOCAL LAW REGULATING CON- STRUCT ON OR THE PERFORMAPeCE/OFIFONSTRUCTION. $59.50 Fire SC $1.83 PLAN CHECK FEE FE TOTALFE �9 Licens $5.0 $67 SIGNAT E OF CONTRACTOR OR A ORIZED ENT IDATE) N ROPE BLD9 INSP VALIDATED TE09 IS Y R PERMIT I /J- BATE S,GNATURE OF OWNER OF OWNER BUILDER) (DATE) NEV „ 1, ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: b8 5c� % s4 . tJ.& � Legal Description: Owner Name & Address: Tel. # Contractor: MN LICENSE Address: el. # r%%�l Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: 1z� ST, Construction Type: p/ V Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x = $ DATE: �/- �i APPLICANT: Tel. # -7 q,A / 6,s- % STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ /. vii .001 of Permit Valuation (1/10th%) State Surcharge $ o $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ S 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 $ - 2Y— STIPULATIONS: Building $ BUILDING Permit No. o 96 Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received BT.__4L- 763-572-3604 Surcharge CITY OF FRIDLEY Datel". MAR 11 -moll o 763-502-4977 FAX EFFECTIVE 1-1-08 $5.00 (State Licensed Residential Contractors) SAC Charge p YOUR E-MAIL ADDRESS Na 615 Dib 7 - DATE r Curb Cut Escrow SITE ADDRESS 6 9 53 7Th 5�1' _AJC—c Erosion Control $ THIS APPLICANT IS: ❑ OWNER MCONTRACTOR PROPERTY OWNER/ NAME: l C K Rij)ALChk TENANTADDREss: S eT CITY /` 10 L,Q STATE MA(ZIP 5 S 4� $ i PHONE: 7 4. 3-.211 - CONTRACTOR NAME: A/ ADDRESS: �vLl� S �'� CITY �%. �� STATEZIP SUBMIT A COPY OF PHONE ,6S /-.;14 ' FAX YOUR STATE LICENSE STATE LICENSE EXP DATE PROPERTY TYPE [;SINGLE FAMILYINEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING MTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR (,REMODELING Q (4cQ &semewr WOW" �3'�1 P '26 i• 53 � '3,;? P� DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SO FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES PROPOSED SIZE: ❑ ATTACHED GARAGE ❑ DETACHED GARAGE 2. Proposed floor plan 3. List of structural members to be used. PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COSI OF LABUK AIV U IVIA I EMAJUS- (U_ S�1VG THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION S Xft r OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ �/ , Q 5 65% of Building Permit Fee Fire Surcharge $ d® .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft 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 payable to: Ci of FridleyAttach 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 is not to start without a permit on site; that �w°i will be in accord a proved in the case of all work which requires _review an approval of plans. SIGNATURE OF APPLI A PRINT NAME cJo d ar (�Tj DATE 3440 f APPROVED BY �! �� DAT?��' , - , Stats of Minnesota K Department of Labor and Indus Construction Codes and Licensing Division 443 Laiyette Road'N. Telephone: (651) 284-5065 St. Paul, MN 55155-4344 E-mail address: dli.contractor@state.mn.us V%bsite address: www.doli.state.mn.us ResidenjW BuNing Contractor License Legal Name: HANDLOS SIDNEY Business Structure: DBA: SIDNEY HAi•RXOS INDIVIDUAL PROPRIETOR Address: 735 P-ARKSIDE DR ST PAUL, MN 55127-3650 License Identkaticn Number: 20364530 Qualifying Person: SIDNEY KENT HANDLOS License Expiration Date: 3/31/20D8 Continuing Education: 7 hours due by 3/31/2008 ieh��d C��Ceh 763-ai3-9�S9--- C 0 fer(Ac@- A.4 St04RIv r f ej �5/v s.s IJJ A/Jo a Ar K3 f2ck F�EV4 ED y� F� �. ftftDEi C ANCE L® I�ts(p Building MECHANICAL Permit No.: 208`® v Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 763-502-4977 FAX CITY OF FRIDLEY D 20 EFFECTIVE 1-1-08 DATE YOUR EE MA L®ADDRES S- SIT'E ADDRESS o + G' � t� Io0 1 THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: El F AA OWNER/ TENANT ADDRESS: 14 CITY STATE IP - PHONE: e s CONTRACTOR COMPANY NAME: 1 12 NOTE: SEPARATE CITY __WJAd CONTACT PERSON: �1kh STATE LICENSE # EXP DATE, LICENSES ARE REQUIRED FOR GAS ADDRESS: ® �J AND HVAC. CITY STATEIP SUBMIT COPY OF BOND PHONE GSI -W- to FAX ANDINSURANCE PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT ❑ ALTERATION/REMODEL 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. (This should reflect only the cost of labor) OR Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) Equipment Installed MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU _A/C $25.00 _FIREPLACE (GAS) $15.00 RANGE/OVEN $10.00 _GAS _AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 GAS GRILL $10.00 _NEW _BOILER $35.00 FURNACE $35.00 UNIT HTR $10.00 _GAS _CHIMNEY LINER $10.00 _GAS DRYER $10.00 HEATER $35.00 _POOL _DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 Permit Fee $ Number of fixtures @ $10.00 X$10.0 =$ Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $25.00 x $25.00 = $ r - Number of fixtures @ $35.00 1 x $35.00 = $W_ State Surcharge = $ 50 MINIMUM $15.50 MINIMUM $15.50 Total = $4 THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a mechanical 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; that the work will be in o ante wi the approved plan in the case of all work which requires review and approval of plans. SIGNATURE O NT PRINT NAME 30-A 11� DATE APPROVED BY DATE M, C . 'AN?:I4��f3�..` City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 O City of Fridley Residential Mechanical Application Page 2 REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME ❑ MAKE-UP AIR REQUIRED FOR NEW/EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make-up air calculations. Building PLUMBING Permit N� �� 54 o.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY DaTM'cSFP 17 200 763-502-4977 FAX EFFECTIVE 1-1-05 DATE - � � OUR E-MAIL ADDRESS . SITE ADDRESS S � S N THIS APPLICANT IS: ❑ OWNER WONTRACTOR PROPERTY NAME: G A-101C `i _ ADDRESS: G Sk' CITY �'i�g%�CSi STATE/ IP OWNER/ TENANT �5f pHONE: � L/ 3 9 CONTRACTOR NAME: r ,r (r P& Ak 611 h STATE LICENSE # 0161729 — C! EXP DATE IZ D8- SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # '7.93766 M2 EXP DATE Z 9 D Da erre CITY & STATE MN ZIP Sr/2e– $72eINSURANCE CERTIFICATE OF ADDRESS: Wig fL/,3raD/K s-n. INSURANCE PHONE /L s i 3 36 410( FAX PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY O TOWNHOUSE TYPE OF WORK: [3 NEW VREPLACEMENT DETAILED DESCRIPTION OF WORK I�LV k 1%00Qllo.y 6.a S tVA1 .er he ei i e%Z A✓/ 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 DRAINS — SHOWER _ WATER PIPING _FLOOR —BARB _ GAS PIPING (NEED CITY LIC) SWIMMING POOL —WATER SOFTNER ($35) KITCHEN SINK T WATER CLOSET BACKFLOW PREV. ($15) _ CLOTHES WASHER _ _ DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION _ — WATER METER —OTHER Permit Fee s45 Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ TOTAL DUE $ OR Number of fixtures @ $35.00 x $35.00 = $ �j., State Surcharge = $ .50 (MINIMUM $15.50 5 7l� (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 e case of all work which requires review and approval of plans. with the approved plan in thh SIGNATURE OF APPLICANT e�y� PRINT NAME ��r� Y �r6 Ertl a i� _DATE 0 `we __ APPROVED BY DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building BUILDING Permit No.5 --0 «5 Inspections $ �1:3� RESIDENTIAL APPLICATION Received By: 763-572-3604 $ 1- , a-( 65% of Building Permit Fee Fire Surcharge $ CITY OF FRIDLEY Date Rec'd: 1 763-502-4977 FAX $ kCj .0005 x Permit Valuation Minimum $.50 License Surcharge EFFECTIVE 1-1-08 DATE N"✓ I t'I 7.Ooe YOUR E-MAIL ADDRESS R -TC it k152 , WA-LCN @ W A -ICK -cam SITE ADDRESS R- Sy — Jfi Ll- Al F THIS APPLICANT IS: -;W6WNER ❑CONTRACTOR PROPERTY OWNER/ NAME: « 4,k Vhtc TENANT ADDRESS: CITYyy FliJ -ty STATE 41N ZIP ft + 6 ft = ft x $21 =$. PHONE: -765 rj 3S' LI Stix 4 $ NAME: ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE Sewer Main Charge $ STATE LICENSE # EXP DATE PROPERTY TYPE !$SINGLE FAMILY/NEW CONSTRUCTION SIZE ) 6 ! D f� I- $ ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS )iOASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR DWEMODELING BAOL ewe. -I' DESCRIBE WORK BEING DONE: 1 O SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 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 1. Site Plan/Survey showing the existing structures El Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ aj OCCUPANCY TYPE Permit Fee $ �1:3� , 51j' See Back Page for Fee Schedule Plan Review $ 1- , a-( 65% of Building Permit Fee Fire Surcharge $ (4 .001 times the total job valuation Surcharge $ kCj .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft 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 Davable to: Citv of Fridlev 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 Minnesot Condes; 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 accT�� oved plan in the case of all work which requires r jew and approv I of plans. SIGNATURR-OrPRINT NAME 7�c wk `� -DATE_M I N APPROVED BY DATE\ C�,� t �^ 41 41 w j T- i o S Z-