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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N? 4 s z ,. Date: Owner: Builder _.. _ _ Address .... ---/Address TION OF BUILDING No. ... .... ....... Street II ,r_............ Part pf lat ...... Lot ..... _........-................ Block .............-................. Addition or Sub -Division Corner Lot ....................... _........ Inside Lot ....._..------_--_--.._........ Setback _J.:1 ..... _.._...__.. Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be /U as: a - (.._. �...... Front ..._ _ . Depth... ' - Height Z.4.. Sq. Ft. �_ [�` fCU. Ft.,J ... ...--............... .............................. road. --_-•------_----- Depth�' ....._Helght� ..... ................... Sq. Ft......_............._Cu. Ft. .................... Type of Construction,,-7,..,--A-.—A-.,Ata :........ Est ........., ."''""To be Completed ....._.....__.._....._....._.......-........ i {Wli'r PERMIT DOES NOT AUTHORIZ6VIOLAD ION OF ANY PRIVATE LAND COVENANTS ANQ BUILDING RESTRICTIONS. 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. In consideration of the payment of a fee of $...lam.:.._... ___, 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 tinW upron violati n f any of the provisions of said ordinances. / ; b Z A .,, 1 .o 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 FRIDLEY, MINNESOTA. Owners Name 6,46?2 ; Fi eal%fo /r Builder a50 /1" e - - Address 741- -:S f tI �fJe Alf. .Address �4sem✓e - - LOCATION OF BUILDING No. �� Street S^� Ale • Part of Lot Lot �lock Addition or Sub.Div.z1nr-7 Corner Lot Inside Lot+ t Back —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: Ki , 716K -Wj lea G Front �2 � Depth Hsight�,__ A Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu,. Ft. � � L Type of Construction Estimated Cost 2Lk!��-- 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 representa- tions stated in this application are true and correct DATE SIGNATURE? (A Schedule of Fee costs can be found on the Reverse Side.) 9 63-8L-116051 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE a PLUMBING FIXTURE RATES: NO. >, a ti_ber Fixtures � $3.00 o rate:re Fixture Opening K m $ Water x $2.00 $ Catch Basin x $5.00 54 a -.c+ a 4 m � ro H � w � Hater Softener Heater $7.00 $ New Ground -zin Old Building x $5.00 $ H x $4 o00 ►, G c s v a iC 1st 3 fixtures 1+ $3.00 $ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS K+ o x ti o $ each add. $100.00 or fraction n i c " ci tn .� o 4 8.00. ro n a $ roroa �{{c�� ;as leC N v U 7 G V: 3 ❑ �+. N W U R7 Q s C7 S. t7 O 2nd 3rd - Future Connection opening. Connected with Sewer - New Fixture, Old Opening E Water' PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL ti_ber Fixtures x $3.00 $ rate:re Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ :later heater - to 99,000 BTU x $5.00 $ IC01000 B7J to 199,000 BTU x $10.00 $' Hater Softener x $7.00 $ New Ground -zin Old Building x $5.00 $ Electric water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x $3.00 $ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 S State Surcharge $ .50 8.00. TOTAL FEE $ REINSPECTION FEE ($10.00) Job Address 742 58 Ave. NE Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and roprosontations stated in this application are true and ecrrect Fridley, Mn. 4-27-81 19 (7=-R BIDRON KIND OF BUILDING frame USED AS res. TO BE COMPLETED ABOUT 5-4-81 ESTIMATED COST 50.00 OLD - NEW BUILDING PERMIT NO. PERXIT NO. CompanyM;;"-- Signed _s By ANN IMASC® Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT d 4 -le MINIMUM FEE FOR ANY PLUMBING PZRMIT IS $7.50 PLUS $.50 STATE SURCHARGE SUBJECT PlrRMIT NO. City of Fridley 32013 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. f F � 1572®366®4 F , NUMBER REv DATE FPAGE OF APPROVED BV CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/19/01 JOB ADDRESS 742 58 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 6 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Chuck Biedron 742 58 Avenue NE 571-7839 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Midwest Roofing 7385 Mark St, Greenfield, MN 55357 763-416-4804 20010277 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (26 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with 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 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 OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 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 $2,659 $1.33 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- $83.25 Fire SC $2.66 STRUCTION OR THE PEREORMANCE OF CONSTRUCTION (� PLAN CHECK FEE T AL FEE Licens C $5. 0 $92.24 IG nTUREOFCON' CTORORAUTHORIZEDAGENT IDATEIHEN ROP VALIDA ED THIS IS YOUR PERMIT ' ��EUILDER, Bl0 INSP �E S-GNATURE OF OWNEROF OWNER BIDATEI NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 5 BUILDING PERMIT APPLICATIONa % Construction Address: �Wa' 100t" 1+.'g Legal Description: Owner Name & Address: Duck Tel. # 11 -1g 31 Contractor: R 22n MN LICENSE #GO I 0 a 17 Address: `13 5 /��.rtC 9.(,rwj--�e(d I[AN 5<,3S--7 Tel. # 16�-I-IId �-180 -F 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 DECK AREA: Length Width OTHER: e#r-off rt reo-aA Height Sq. Ft. Hgt/Ground Sq. Ft. + % a HAckeA Construction Type: d -U Estimated Cost: $ U C5� tps 7 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ = $ DATE: Ob 1-101-01 APPLICANT: Tel. # CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ - _ Fee Schedule on Reverse Side $� .001 of Permit Valuation (1/10th%) $ /..733 $.50/$1,000 Valuation $ $1150 per SAC Unit $ e Q® $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 [ ] SUBJECT City of Fridley 33112' AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT N DEVELOPMENT DIV. �COMMUNITY 3 ` r � PROTECTIVE INSPECTION SEC. I 1 NUMBER REV DATE PAGE OF APPROVED BY CITY MALL FRIOLEY 55I32 ' 763-571-3450 910-F15 9/24/02 JOB ADDRESS 742 58 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 6 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Rosemary Biedron 742 58 Avenue NE 763-571-7839 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Wellington Windows 3738 Meadowbrook Rd, St Louis Park, MN 55426 952-933-6300 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 O NEW O ADDITION O ALTERATION REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Replace 15 windows within existing openings 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2,of the 1997 Uniform Building Code. 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 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 $10,123 $5.06 WITH WHETHER SPECIFIED HEREIN OR NOT THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FE TOTAL F C cense : $2 .43 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE, EN OPER LIGATED BLO INSP T IS Y PE IT 1.0tW FIATE S-GNATURE OF OWNERoF OWNER BUILDER. -,DATE, NEW (] CITY OF FRIDLEY Effective 1/1/2002 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: -742 5 V4 c !N Legal Description: fir, Owner Name & Ve'.. re d Int O Tel. # Contractor. r- (i(% MN LICENSE # Address Tel. # q5� LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft Length Width Height Sq. Ft Length Width Hgt/Ground Sq. Ft �j f o � Construction Type: I I Le � & -t' Estimated Cost: $ 10_ Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: �" `� 6e�- APPLICANT: Tel. # 5"63da Call (763) 572-3604 for Permit Fees if mailing in application 4ax to 763-571-1287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $ m 25 Fee Schedule on Reverse Side Fire Surcharge $ W .001 of Permit Valuation (1/10th%) State Surcharge $____ �� 0 $.50/$1,000 Valuation SAC Charge $ $1200 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 [ ] �3 TOTAL $ —D/0. STIPULATIONS:. PLUMBING RESIDENTIAL APPLICATION City of Fridley ZcO(o-00®-2 P i mber Rece e DaA Re ed NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE --r2 --%-bS YOUR E'L ADDRESS SITE ADDRESS —":7 V2— THE APPLICANT IS: (CIRCLE ONE) OWNER CONT R Q Sef"a)- Aied NAME rorl PROPERTY OWNER/ ADDRESS h'IL 4-1 TENANT 6ca CITY STATE ZIP PHONE # 7� ' ,��/ - i L932 NAME LICENSE # S52aJI1� ADDRESS o CONTRACTOR NW CITY 0e/0W 0000 0--98i STATE ZIP PHONE # I -H FAX# PERMIT TYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK ❑ NEW REPLACEMENT DETAILED DESCRIPTION OF WORK r,e d CC FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FIXTURES: (INDICATE TOTAL NUMBER OF EACH) BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (Need City License) SWIMMING POOL WATER SOFTENER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREY. ($15) DISHWASHER LAUNDRY TRAY WATER HTR ($35) FOR IRRIGATION WATER METER OTHER Permit Fee $ 3E- MINIMUM: $15:00 or 5% of cost of the improvement -whichever is Plan Review $ greater on work less than $300 Surcharge $ .50 TOTAL DUE $ Make checks payable to: City of Fridley 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; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. J NAME OF APPLICANT DATE / Z �— Plea or SIGNATURE OF APPLICANT A,h� Y 5 -fie a;•' f �7�ru° r J a e yrs, X'.t Pi.EASE'TIOTE SEPARATPE�tMITSARE'REQUJF,011� 111:�1D(,E�RICAL�s)IAEC}i/NiCtL�1UQRI�' ' .. , R S -� Jn77, CITY OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTMENT 6431 UNIVESITY.AVENUE NE, FRIDLEY, MN 55432 (763) 572-3604 'fl 3-� .s°lip Engineering WATER AND SEWER Permit No.: -6 101 763.572-3551 PERMIT APPLICATION Received Bye 763-571-1287 fax CITY OF FRIDLEY AGUM Yo 200 EFFECTIVE 6/9/09 APPLICTATION DATE: ;17—z YOUR E-MAIL ADDRESS: rtLtXG , fr , et?r% _ THIS APPLICANT IS: OWNER ❑ CONTRACTOR JOB ADDRESS: < - �>/ Z ��Q�( U. �C • Z , NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY NAME:.' Z � U OWNER/ 7— ,,fi�rr /—) _ /� _ ADDRESS:_/ z s�� 7 a �U, �. CITY /C.z.D STATE/X/�IP � </ TENANT PHONE: G' CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE ADDRESS: CITY STATE ZIP LICENSE WITH PHONE CELLPHONE: APPLICATION STATE LIC # STATE BOND: EXP DATE: 1. N g tive/w 'tten description: e-eFm NIJ 2. Please attach sketch showing curb line, utility line, building, etc. with distances. PERMIT TYPE ❑ SEWER CONNECTION PERMIT $50 ❑ WATER CONNECTION PERMIT $50 ❑WATERLINE REPAIR $40 %�J �f SEWER LINE �' REPAIR $40 l ❑ ADD STATE SURCHARGE $.50 ❑ SAC CHARGE @ $2000 = ®'Jb OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST – SEE UTILITY BILLING SPECIAL ASSESSMENTS – SEE FINANCE WATER TAP – SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / wEEKENDs & HOLIDAYS $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) 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. I understand this is not a permit but only an application for a permit and work is not to start without a permit. �J //(n� ��yy�� SIGNATURE OF APPLICANT < "Oi `l `! PRINT NAME: A6rQLGC�Al f 4�wg1 DATE: 710 U O Or APPROVED BY: DATE: 7Aj A ': 3, COPY G O: UTI BILLING (only if new meter) ❑ PUBLIC WORKS ❑ ENGI EER G City of Fridley Engineering Department 6431 University Avenue NE, Fridley,.MN 55432 763-57273551 FAX: 763-571-1287 Building BUILDING Permit No.: ILU Inspections RESIDENTIAL APPLICATION Received BY: LI&L 763-572-3604 CITY OF FRIDLEY Date Reil® 763-5y 2-4977 FAX Plan Review $ EFFECTIVE 1-1-2010 Fire Surcharge I0� 1 DATE --77—/D YOUR E-MAIL ADDRESS Surcharge SITE ADDRESS? q7 15 .0005 x Permit Valuation Minimum $.50 License Surcharge THIS APPLICANT IS: DOWNER OCONTRACTOR SAC Charge PROPERTY OWNER/ NAME: Curb Cut Escrow TENANT 5� 4 d'L STATE ZIP $ ADDRESS: /� G Its CITY Park Fee $ PHONE: Sewer Main Charge CONTRACTOR NAME: Total Due STATE LICENSE # EXP DATE I • I i Make checks payable to: City of Fridley Attach Stipulations SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS: CITY STATE -23P INSURANCE PHONE FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE TWO FAMR Y/N1EW CONSTRUCTION STORIES PERMIT TYPE O ADDITION O GARAGEISHED O WINDOWS O BASEMENT FINISH `WROOF O DRAIN TILE O DECK O SIDING O OTHER O SWIMMING POOL TYPE OF WORK: O NEW HOME CONSTRUCTION O ADDITION 1 O MAIId1ENANCE/REPAIR O REMODELING DESCRIBE WORK BEING DONE: S12E OF IMPROVEMENT LENGTH WIDTH HEIGHT FT ROOFING P` O HOUSE ONLY WEMRNT REMODELING SUBMIT: NUMBER OF SQUARES MOUSE & GARAGE 1. Existing Floor Plan GARAGES O ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: O DETACHED GARAGE 3. List of structrnal members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING O Vinyl OSoffrt ADDITIONS_ & PORCHES SUBMIT: 1. Site Plan/Survey slowing the existing shuctum O Alnmiunm O Trim and proposed project O Other O Fascia 2. Two sets of construction plans WINDOWS 3. Ensrgy Calculations IN EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS FOR WINDOWS —PROVIDE U VALUE AND OR FOR NEW OPENINGS -DESCRIBE S12E OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF VIDIDOW TO BE INSTALLED NUMBER OF WINDOWS %�� ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MA'FERLM b: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ '77 Zb See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ 15 .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 $ I • I i 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 accordance with the approved plan in the case of all work whic requires review and approval of plans. SIGNATURE OF APPLICANT �Z��PR1Nf NAME�'J( DATE NOTE: Building BUILDING Permit No. • l0 ^® 59 Inspections RESIDENTIAL APPLICATION Receive"By:WT 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFECTIVE 1-1-2010e DATE YOUR E-MAIL ADDRESS SITE ADDRESS (JCS KT THIS APPLICANT IS: O OWNER OCONTRACTOR PROPERTY OWNER/ NAME: P0e,_ma-1 ` w fly TENANT ADDRESS: 'i 11 Au� V\4, CITY_r �° Y �l� STATE PHONE: CONTRACTOR NAME: L/e— ®� SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # Q 0 G 3 ---) 4 `7 5— EXP DATE 1 AND CERTIFICATE OF ADDRESS:_ `h h_ /j v.1 CITY 5L �Q� s q �— STATE (4 kip 4 INSURANCE PHONE ' -- C B FAX PROPERTY TYPE C9 SINGLE FAMILY/NEW CONSTRUCTION SIZE O TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE O ADDITION O GARAGE/SHED O WINDOWS O BASEMENT FINISH O ROOF O DRAIN TILE O DECK O SIDING ROTHER O SWIMMING POOL TYPE OF WORK: O NEW HOME CONSTRUCTION O ADDITION ❑ MAINTENANCE/REPAIR XREMODEL NG DESCRIBE WORK BEING DONE: r 5 SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING O. HOUSE ONLY NUMBER OF SQUARES O HOUSE & GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan GARAGES O ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: PROPOSED HEIG�_ O DETACHED GARAGE 3. List of structural members to be used IDING FOR NEW CONSTRUCTION INCLUDING DECKS, m 1 Soffit ADDITIONS. & PORCHES SUBMIT: O Aluminum K1 Trim I. Site Plan/Survey showing the existing structures O Other Fascia and proposed project. 2. Two sets of construction plans VVIT ROWS IN EXISTING OPENINGS `,Yes ONo LOCATION OF WINDOWS 3. Energy Calculations 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: (USING THE 1997 U.B.0 FEE SCHEDULE) COTAL JOB VALUATION $ g, 1"0OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach 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 accordance with the approved plan in the case of all wor�ich requires review and approval of plans. / I SIGNATURE OF APPLICANT PRINT NAME 6A ak-A or DATE CITY OF FRIDLEY FIRE DEPARTMENT FIRE MARSHAL'S OFFICE DEPARTMENT OF FIRE PREVENTION NOTICE OF BUILDING FIRE To: Building Inspection Assessing Water Billing City Manager From: Ralph Messer, Fire Marshal Date: March 19, 2010 Subject: Fire Damaged Building Location of Fire: 742-58 th Avenue, N.E. Date of Fire: March 15, 2010; 1717 hours Other pertinent details: This fire involved a single family residence at the above address. The fire is believed to have started from a fire which occurred in a refuse container outside the home. The container was kept under the eave of the home. Flames burned through the soffit area and entered the home's attic. Fire damage is evident in the soffit and attic areas and heavy smoke damage occurred throughout the residence and attached garage. There were no injuries to civilians or firefighters from this fire. It is believed that the home is not habitable at this time. If you have any questions concerning this fire, please contact me at x3621.