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PRE 2010 DOCSCity of Fridley App ication for Plumbing .and Gas Fitting Perndt Dept. of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixtures • hAure Wnaection Openings 0 New Fixture, Old Openings Sewer M Cesspool M PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Beater (Up to 200,000 BTU) ...... New Ground Run Old Bldg . ............ NO. RATE TOTAL — x $1.50 $ — x 1.20 $ — x 1.00 $ — x 3.25 $ x 2.00 $- -.x —.x 3.25 $ ■NRON RRAIi0 ■o AN . �iiMOUR'NfllrWKWEEN IN AVAM AM • hAure Wnaection Openings 0 New Fixture, Old Openings Sewer M Cesspool M PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures ...................... Future Fixture Opening ................ New Fixture Old Opening .............. Catch Basin ............................ Water Beater (Up to 200,000 BTU) ...... New Ground Run Old Bldg . ............ NO. RATE TOTAL — x $1.50 $ — x 1.20 $ — x 1.00 $ — x 3.25 $ x 2.00 $- -.x —.x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ TOTAL FEE ac) 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. 19 0 Kind of Building Used as To be completed about Estimated Cost, $ New. Building Permit No Permit No. Signe al'lzz ROUGH FINAL 4 z 2M 7-59 Business Phone 01 SUBJECT City of Fridley 30119 AT THE TOP OF THE TWINS g U I L D i N G PERM'TCjAeeswT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE 1 NUMBER REV DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/24/99 JOB ADDRESS 30 62 1/2 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3, 4 18 1 Fridle Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Walt Pies 574-2308 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Midwest Roofing 18979 Gladstone Blvd. Maple Grove 55311 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 ❑ ADDITION ❑ ALTERATION ®x REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage (19 Sq) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code Permit Inspection cards Will Be Mailed To Homeowner To Post 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 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 $1661 $.83 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 $60.10 Fire SC $1.66 PLAN CHECK FEE OTAL FEE Lice C $ 0 $67.59 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI NE P Y V L E THIS UR b SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI B G INS DATE 01 Building BUILDING Permit No.:aOl " 37 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 Plan Review $ 65% of Building Permit Fee CITY OF FRIDLEY Date IAN 2 � '� 763-502-4977 FAX J. $ ,7 14 EFFECTIVE 1-1-2010 License Surcharge DATE—� YOUR E-MAIL ADDRESS SAC Charge SITE ADDRESS 96 $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR Erosion Control PROPERTY OWNER/ NAME: Wl,0- S Park Fee TENANT ADDRESS: CITY A, viK.-G .f% U ( ('5 STATE ZIP $ PHONE:_{QS( — 73 Lf - Sly, /70 Total Due CONTRACTOR NAME: ZV,1, P-\ SUBMIT A COPY OF YOUR STATE LICENSE STATE LICEN E # EXP DATE AND CERTIFICATE OF 75 ADDRESS: • U r i CITY STATE ZIP INSURANCE PHONE (P,—, 1— 3 S `r a FAX PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHEDWS ❑ BASEMENT FINISH ROOF ❑ DRA IN TILE ❑ DECK SIDING ❑ OTHER. ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION jX_FMAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: �� tic �� l K, S SIZE OF IMPROVEMENT LENCA WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES MOUSE & GARAGE BASEMENT REMODELING SUBMIT: / 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: w14 ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: �„D„v„ FOR NEW CONSTRUCTION INCLUDING DECKS, y ADDITIONS_ & PORCHES SUBMIT: �; ❑ Aluminum Trim 1. Site Plan/Survey showing the existing structures ❑ OtherFascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS Q!5s ❑No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U -VALUE AND OR FOR NEW OPENINGS-bb—E_SCRIBE SIZE OF { . IrIq MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & / S h 4 TYPE OF WINDOW TO BE INSTALLED /t (.. NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: �r SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ CZE lr V[. OCCUPANCY TYPE Permit Fee $0 i (� ' See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ G .001 times the total job valuation Surcharge $ ,7 14 .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 $22 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ ,1 I Make checks Davable to: City 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 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 a1 requires review and approval of pi SIGNATURE OF APPLICANT / PRINT NAME 7J YAP 1311 ((CA' DATE L� Building PLUMBING Permit No.. Inspections RESIDENTIAL APPLICATION Received By. 763-572-3604 CITY OF FRIDLEY Da MAR0 120 763-502-4977 FAX EFFECTIVE 1-1-2010 DATEC/ Lo YOUR E-MAIL ADDRESS G� SITE ADDRESS : ve ,�� THIS APPLICANT IS: ❑ OWNER JCONTPLACTOR PROPERTY NAME: ' Gi c r^ L ADDRESS: CITY STATE ZIP OWNER/ TENANT PHONE:// CONTRACTOR NAME: as .4 � l/ /� y &,29, 7 'Q;� 0 C / EXP DATE STATE LICENSE # ®�J SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND STATE BOND # EXP D TE CERTIFICATE OF ADDRESS: /a7%S� //tel <�) �GN CITY TSTA �J ZIP, INSURANCE PHONE. - /„2 -,;)d' —,1'227 FAX PERMIT TYPE SINGLE FAMILY * ❑ TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: ❑ NEW REPLACEMENT i DETAILED PEsTION OF ORK 141e", �.✓ rt o FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $5.50. DRAINS WATER PIPING BATH SINK/LAV FLOOR _ SHOWER GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB _ CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREY. ($15) _ _ DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER Q�R�s�a Kf,S -,o w3'4�� d� i3 > '. +• `^`�? ,i'tt:. kz'�h«� r'2'x 1 r.i f�� d s-�s�::St ='A ,:C3 „+'tr`�a .. ..„.,:3a`�•°`�`�'ar� 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 cas of all work h' h requires review and approval of plans. % J SIGNATURE OF APPLIC PRINT NAME A DATE- City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977