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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: Owner: " 4. Ai d 0 der — Address Address — — _ ,IL�N ® ILDING No. Street z — Part f Lot Lot _ Block ___ Addition or Sub -Division . ' ��iG-- Corner Lot __. Inside Lot AW Setback --_ Side d Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING T Vsed Front Depth Height Sq. Ft. Cu. FV" -2+" Fro t, Depth ht Sq. Ft. Cu. Ft. _ Type of Construction' Est.. 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. y ail In consideration of the payment of a fee of $ "�`� ,permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance repair and moving of buildings within the city limits and this permit may be revoked at any time uponvi ati of any of the provisions of said ordinances. .rti .. +` Building Inspector NOTICE: This permit does not cover the construction, Installation for whing, plumbing, gas heating, sewer or water. Be sure to we the Building Inspector for separate permits for these Items. - IS- APPLICATION FOR BUILDING PERMIT CITY OF FRIDIZY, M]M ESOTA ,tet f � Owner's Name f�i d c�/1? �! /��1 �r����� �� Build®r,d Address _��a �n-eexc?,! , 4, _. dress LOCATION OF BUILDING No. 's -`l 0 Street ,a- y Part of Lot Lot 7 Block / Addition or Subdivisions Corner Lot +Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Front Depth a Height f Sq. Ft. /®6-o Cu. Ft. Front_ Depth Height Sq. Ft. Cu. Ft. Type of Construction ��-a ." -9— Estimated Cost _Z4T 0 -_ To be Completed The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. �� DATE N X / SIGNATURE ---r00, (A Schedule of Fee Costs can be found on the Reverse Side.) City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone SU 4-7470 DESCRIPTION OF WORK Number. Kind and Location of Fixtures Location PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL / / 6� ..S Number Fixtures ....... .............. x $1.50 $ Future Fixture Opening ................ n $ New Fixture Old Opening .............. w �'U Z • F • N WATER HTR. GAS ELEG 4 ; j �e 4n r�90 Base 1st �t 2nd _ 3rd _ R 4thcted • Future Coanedion Openings I COQ with Sewer � New Fixture. Old Openings Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL / / 6� ..S Number Fixtures ....... .............. x $1.50 $ Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 —So Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ a a6. REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ ea TOTAL FEE OV� City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Mm Nov 15 196 19_ f� Owner / –I Al /g L G 'AL161 i' J -,a '10 13,e 7o- S Kind of Building 2 Used as ID � To be completed about Estimated Cost, $ Old—New. Building Permit No Permit No LON ®IV PLUNWING CO. Signer' By Business Phone No ROUGH FINAL J -Q3042 2M 7-59 Application for Power Plants and Heating. Cooling Ventilation, Refrigeration and Air Conditioning Systenns and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ 8.00 each add. 60,000 BTU ....................... 2.00 Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER to 3 gal. per hour ........................ 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ 1.50 Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN DATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ 14.50 REMARKS: Dept. of Bldgs. Phone SII 4-7470 Location 540 54th Ave. N. E. City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City Ordinances and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn lli 62 195_ Owner Amal gams t ed 195— Kind of Building f r 195— Used as r A s To be completed about Estimated Cost, $ 550.U0 Old—New. Building Permit No. DESCRIPTION OF WORK HEATING or POWER PI ANTS—Steam, Hot Water, Warm —No �- Trade Nam, Chrysler Size No y d Capacity Sq. Ft. E.D.R_ BTU H.P. Total Connected Load 36 , 000 Kind of FueL r1sa s BURNER — Trade Nam, Chrysler Size No Capacity. Sq. Ft. E.D.R BTU H.P. Larson -Maes Company Signe 11 POST IM -12-58 B ess Phone No w� /� / 32-3 560-3450 (Zity of 'Yr;d/y ANOKA COUNTY 6431 UNIVERSITY AVENUE NE FRIDLEY, MINNESOTA 55421 TO: CITY MANAGER and BUILDING INSPECTOR FROM: CITY ASSESSOR DATE: October 8, 1965 While making our routine inspection of property values for the 1966 assessment year, it was found that the owner at 540 -54th Avenue N. E, had built a garage about 1962 or 1963 without obtaining a building permit. The legal description according to our records is: Lot 7, Block 1, Temple Terrace 2nd Addition. SUBJECT PERMIT City of Fridley O 77771 AT THE TOP OF THE TWINS BUILDING P E R M I T r RECEIPT NO � COMMUNITY DEVELOPMENT DIV. (j r PROTECTIVE INSPECTION SEC. O 1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ,.' 612-571-3450 910-F15 10/25/8 � � JOB ADDRESS 540 - 54th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 1 Temple Terrace 2nd Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Kenneth. Snedeker 540 .. 54th Avenue N.E. 572-9083 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Smae 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 x 8 DESCRIBE WORK Reroof Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be 2nd layer but not 3rd. Install ridged galvanized valleys where necessary. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Asphatl 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 1 ISTALLS 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 $1/000 $.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 SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $17.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. LAN CHECKFEE TOTALFEE $18.00 SIGNATURE OF CONTRACTOR OR AUT ORIZED AGENT (DATE) HEN PROPERLY V Lf ED TH S IS YOUR PERMIT BLDG NSP OATE SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) NEW [ ] ADDN. [ ] ALTER. [ ] Construction Address D i tion City of Fridley R-1 AND R-2 Building Permit Application ke k Effective 4/1/84 Legal eser p Tel. # Owner Name & Address: Contractor: .l =am p Tel. ii Address Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: Length DECK AREA: Length OTHER: DESCRIPTION OF IMPROVEMENT Width Width Width oe._ . Height Height Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Side Yard Setback Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Type of Construction: -- Estimated Cost: $ 1d �O ° Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation DATE: JO - &,f- fill APPLICANT: Tel. # Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Job Address 5-40 -54�� A CQ 10.E. RESIDENTIAL RATE TOTAL . Furnace Shell and Duct Work, oo/ Burner (Also replacement furnace) $ 20.00 $ Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ Tel. 4571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 10.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. • Air Conditioning (all sizes) $ 10.00 $ to Fridley, Minn. % - aLo 19%01 All Others/Repairs and Alterations OWNER �d61n .lt\dc�7k 2 I - It of Value of Appliance or Work S �^ KIND OF BUILDING COMMERCIAL/INDUSTRIAL USED ASgC)q(AO(�'�( li of Value of Appliance or Work $ TO BE COMPLETED ABOUT�n ESTIMATED COSTSi(]� State Surcharge $ .50 OLD - NEW BUILDING PERMIT NO. PERMIT NO. TOTAL M $ 30_ Reinspection Fee ($15.00) $ DESCRIPTION OF FURNACE/BURNER Rough Insp. Date Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 PLUS $.50 STATE SURCHARGE *Air Conditioners cannot be placed in side yard without written permission from adjoining neighbor. HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name Pzc" - QC Size No. _5:'RSSb6` 0 Capacity Sq. Ft. EDR BTU000� NP Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. 'Has .been. careful ly. . 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 connected Yes ( ) No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL Rema rk s Company Signed By Date SUBJECT City of FridleyJY5 7 8 9 AT THE TOP OF THE TWINS BUILDING PERMIT -= ` RECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. 6/ / r ; CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 2/5/98 JOB ADDRESS 540 54 Avenue NE I LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7 1 Temple Terrace 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kenneth Snedeker 540 54 Avenue NE 572-9083 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 Replace windows 9 CHANGE OF USE FROM TO STIPULATIONS Install smoke detectors in all sleeping rooms and on each level of %dwelling to meet the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS 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 $3,000 $1.50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- Fire SC $3.00 STRUCTION OR THE PERFORM CE OF CONSTRUCTION. $74.75 ` PLAN CHECK FEE TOTAL FEE _WV $79.25 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPER ALIDATED THIS IS Y R PERMIT BLge INSP —� BATE S,GNATURE OF OWNER OF OWNER BUILDER, IDATEI NEW [ l ADDN [ ALTER ConstructionAddress: Legal Description: Owner Name & Address: Contractor: Address: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION -16 - 5- V /C) 4R j Effective 1/1/98 Tel.# 5-1:2-16 B"3 MN LICENSE # Tel. # 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: w i Construction Type: Estimated Cost: $ 3,00 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE:1- 9 APPLICANT: yyTel. # CITY USE ONLY Permit Fee $ %�� Fee Schedule on Reverse Side Fire Surcharge $ 7 00 .001 of Permit Valuation (1/10th%) State Surcharge $ /- .SU $.50/$1,000 Valuation SAC Charge $ $1000 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 $ g S STIPULATIONS: e SUBJECT �. City of Fridley 2 5 8 0 AT THE TOP OF THE TWINS f BUILDING PERMIT �- RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 2/17/98 JOB ADDRESS 540 54 Avenue NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DIE 7 1 Temple Terrace 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kenneth Snedeker 540 54 Avenue NE 572-9083 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 B DESCRIBE WORK Reside House & Garage (Steel) 9 CHANGE OF USE FROM TO STIPULATIONS Install building wrap and have inspection of same. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS 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 $3.25 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6,500 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 $134.50 SIGNATURE OF CONTRACTOR OR THORI2ED AGE T IDATEI HEN PROPERLY ATED THIS IS YOUR PERMIT )I(_ `ice`/ - SIGNATURE OF OW NER iIF OWNER BUILDER) IFATE I BLDG INtM DATE e NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ?� BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: l Owner Name & Address: ,, n ��" S �. a �t'� ,r Tel. # S `I 9- 9 d 3 Contractor: b c,� -�- -e r- MN LICENSE # Address:. Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER:g Construction Type:Sj -Q -e- Estimated Cost: $ 6,5-60. 66 (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: )-y\ a,�. -- Tel. # S_ CITY USE ONLY Permit Fee $ a2 S� Fee Schedule on Reverse Side Fire Surcharge $ CJ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1000 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 $ STIPULATIONS: ��° Building BUILDING Permit No.�Iu q Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date: 763-502-49777 FAX EFFECTIVE 1-1-08 DATE E-MAIL ADDRESS W t �� SITE ADDRESS q V LI ►° THIS APPLICANT IS: ,OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: lN • TENANT E_ 'C'� Lt�_ ���Z- ADDRESS: ® Al CITY �LiPSTATti ° �� ZIP t�/'I�^-l- PHONE: —7 6bS�"l ' o�A� NAME: ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE )iLSINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYNEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH 5r ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY 0 BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES e^ A HOUSE & GARAGE I. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 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. 13 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 COST OF LABOR AND MATERIALS: (JisTHE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ '� U T4 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 $ .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: 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 is not to start without a permit on site; that the work will be in accord a ce v ise of all work which requir re i w and approval f plfi s. SIGNATURE OF APPLICANTPRINT NAM I �i ► 7 � � DATB� APPROVED BY r I DATE