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PRE 2010 DOCS• • City of Fridley, Yffim. BUILDING PERMIT Date: 4, 41z 4.3 ;V` N° 69'78 LOCATION OF BUILDING �7 No. a2 _ , Street _! T __ _ Part of Lot Lot ___ Block ddition or Sub -Division ._ Corner Lot — Inside Lot Setback �c�--_ _ _ Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING T U r Front Depth � Height . _ Sq. Ft. J�®Cu. Front Depth _ _ Height _ Sq. Ft. ._ ._ cu. Ft. Type of Constructioi�.v_t" —Est. Cc __ 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. In consideration of the payment of a fee of $ 26 , 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 uponviolation of any of the provisions of said ordinances.— 'A A � 1 Building Inspector 100- r ir • NOTICE: ihb perra t don not cover the construction, huhliation for wtrhte, phnsbing, gas heath , sower or water. Be sure to sss the Building Inspector for separate permits for thea hems. • • • /.� W'P'/�e City of Fridley, Minn. N° 10196 BUILDING PERMIT Rec # 46714 .: 7 012111111PPSML911• per: _ Roger M. Pence Builder Same Address - 3 9-6�rr qday X -E. - Address ggnP LOCATION OF BUILDING No. —59 Street Way 17--p— � Part of Lot Lot — �4 _ Block 15 Addition or Sub -Division . Fr_ ' tj? PQT Perk Corner Lot --- Inside Lot X Setback _ _ Sideyard Sewer Elevation _ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage Front 20'_ Depth 221 Height 2Q I — Sq. Ft. 440' Cu. Ft. Front Depth _ _ Height Sq. Ft. Cu. Ft. Type of Construction Frame Est. Cost _ $. 00.00 __ To be Completed ��gY 15 • 1969 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 fo and in comp with all provisions of ordinances of the city of Fridley. j In consideration of the payment of a fee of $ 7.00 , permit is hereby granted to Roger Pence 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. Inspector NOTICE. This permh don not cover tie construction, InstaWan for wiring, plumbing, gas heating, sewer or water. Be sure to sss tho Building Inspamr for separate permits for these home. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER 'S NAME ADDRESSA-2la Gj�y w/' ADDRESS LOCATION OF BUILDING NO. � � STREET X LOT ,7 V BLOCK ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT___X �SETBACK SIDEYARD`, SEWER ELEVATION TOP OF FOOTING Applicant attach to this form Two Certificates of Survey of Lot and proposed building.location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Fronto ®' Depth �� ` Height _ Square feet Cubic Feet Front Depth Height Square feet Cubic Feet ofd Type of Construction Estimated Costa To Be Completed . / p d - 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 5l�..;Fl 6 SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side.) SUBJECT ,City of Fridley P.1 4119 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. I `U-y _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � NUMBER REV. DATE PAGE OF APPROVED BY = �` CITY HALL FRIDLEY 55432 L.... A"f ".J 612-560-3450 910-F15 6/1/77 JOB ADDRESS 39 - 63h Way N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 23, A 24 15 Fridley Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry Lowe 39 = 63h Way N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Panelcraft 3615 East Lake Street, Mpls. 721-6628 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 Ij REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install aluminum fascia & Soffit 9 CHANGE OF USE FROM TO STIPULATIONS SEPERA'M PERMITS REQUIRE© F(W WIRING. I4EAYfNQI p�,UtA81NG AND S-10"t 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 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. $2,000 $l.00 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- $12.00 STRUCTION OR THEZPERFRMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $13.00 SIGNATURE OF CONTRACTOR OR AUT RIZED AGENTIRATE WHEN P OPERLY VALIDATED THIS IS YOUR PERMIT _a BLDG INSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (VIEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: � g� ` r L D &Lj tf BUILDER: �-/ Address: 3 % ��'- (o� (�� �f —Address : 3 G Tel. No.: No.: L Street: 3 �/� j LOT: vZ� BLOCK: ADDITION:� L� S/ Z46' . CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach 'to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: /A SC'/t.5-ej Front: Square Feet: Depth: Height: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: To Be Completed: Estimated Cost: $ �30d 0) Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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. See reverse side for additional information. DATE?atio7n SIGNATURE: Z/ o Stip Stix CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES Effective On January 1 1 1998 JOB ADDRESS _194:9m& Lpizii:b� I I -C - :3 9 Wl� The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work in strict accordance with the City Codes and Furnace Shell and Duct Work, Burner — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $30.00 $ 30 0D representations stated in this application are true and correct. (Side Vent — Fill Out Back) ,Q r,L-1 A/°* 1998 Gas Piping (Needed with new furnace) $10.00 $ Gas Range $10,00 $ BUILDING USED AS %)We_,,1 1 r2q Gas Dryer $10.00 $ ESTIMATED COST ��� � PERMIT N0. *Air Conditioning — All Sizes $ 25.00 $ T DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ No. of Heating Units Circle One (Steam) (Hot Water arm Air Trade Name , Size No. /lTe,50 Commercial/Industrial BTU A0, n HP EDR 1.255/o of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. TOTAL FEE $ 3b.SD BTU HP EDR MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. HEATING COMPANY //Py �a �y SAS JWr°x`a_, Signed By ro Tel No. Approved By Rough—In Date Final Date FILL OUT BACKSIDE FOft STACK VERIFICATION ON REPLACEMENT FURNACE Remarks: List ALTERATIONS Beim. Done: HEATING CO: Signed By: Date: CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes (;T'No ( ) 2. Is free from rust or deterioration Yes (.-)"' No ( ) 3. Has no foreign objects lodged within Yes (PT No ( ) 4. Is securely supported . Yes (tY'No ( ) 5. Meets all current Code requirements for size Yes (--)-"No ( ) and total BTU's connected 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes (&-yNo ( ) 8. Has combustion air been provided for water heater Yes (.-)No ( ) Remarks: List ALTERATIONS Beim. Done: HEATING CO: Signed By: Date: City of Fridley SUBJECT 33468 AT THE TOP OF THE TWINS BUILDING PERMIT r � RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. ^ (I� r 0 1 . f -CR NUMBER REV DATE PAGE OF APPROVED BY i �� "�'� CITY HALL FRIDLEY 55432 .__• 1 763-571-3450 910-F15 4/24/03 JOB ADDRESS 39 63 1/2 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 23, W$ 24 15 Fridley Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Donald & Jacqueline Bell 39 63 1/2 Way NE 763-586-0028 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 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW Cj ADDITION O ALTERATION O REPAIR O MOVE O REMOVE 8 DESCRIBE WORK of Construct a 22' x Garage Addition 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 8ef®r® digging call f®, SEPARATE PERMITS "p UtilitY locations REQUIRED FOR:45"0®2 WIRING HEAnNG IRE w PLUMBING AND SIGNS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCYLOAD 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 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 $2,000 $1.00 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 FEE TOTA FEE $/2.25 CON'RACTO OR UT IZED T IOATEI EN OP ALIO TE THISISYOU P RMIT XNAWNEROF 16�3 BL INSP flAf NE BUIL ERS (DATE, NEW [ j CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PfJWT APPLICATION Construction Address: Legal Description: DT .Z F iso'?"J o.2 Lo S FR- r/ L l • Owner Name & Address: Q01V 8LX G- t JAC Qk (C-LI/V6 N- e E L t, Tel. # Contractor: A10 N6 MN LICENSE # Address: 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 C / Height Sq. Ft. GARAGE AREA: Length �� Width Heightq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: 6ttfA<Q4E 40 ON Estimated Cost: $ rVJ0 7-b1PR-5A),0 0V7L1-S Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: O'1'2—?Lf 01 APPLICANT:LO4 Tel. # ;7k­?-5yb" 0d,.2-8 Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - $ $ Q .00 $ I ►O® PC P --f 2.. 0 ) Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 per SAC Unit $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 [ ] l� olo Ole !Z;r'ec'r'\ 1) �� MEQ i s t- �6 77/ LJ ALL"o LLS %ANl ( I, 1 � } � ' Z '111 ; � � � � /�J �.. 1/1/ �,�%�1'C �2-X G RO D 0 15O =r-1 oi\)e V e RT' I Ll Ce NIS "/S "/'' l Olt ESTIMATE FOR: Ph: i Alt. Estimate From STORE # 3018 FRID PHONE: (763) 571-8689 5351 Central Ave. NE FAX: (763) 571-1932 Fridley, NIN 55421 ESTIMATE BY ESTIMATE DATE AL 04/17/03 SKU NUMBER DESCRIPTION QTY TO ORDER 102-1075 2X4X6' STUD GRADE 40 EACH 111-0818 2X4-8' AC2 TREATED AG ARSENIC FREE LW 2 EACH 111-0821 2X4-10' AC2 TREATED AG ARSENIC FREE LW 1 EACH 111-0834 2X4-12' AC2 TREATED AG ARSENIC FREE LW 1 EACH 102-1101 2X4X8' STUD/#2+BTR GRADE 4 EACH 102-1114 2X4-10' STUD/#2+BTR SPF 2 EACH 102-1127 2X4-12' #2+13TR SPF 2 EACH 124-2728 7/16"-4'X8' ORIENT STRANDBOARD -WHITE 15 EACH 102-1761 2X6X10' #2+3TR SPF 18 EACH 102-1897 2X8X10' CONSTRUCTION LBR 1 EACH 102-1907 2XBX12' CONSTRUCTION LBR 1 EACH 103-1133 1X6-12' #3 STANDARD BD 1 EACH 103-1120 1X6-10' #3 STANDARD BD 3 EACH 125-1010 3/8" (11/32)-4'X8' BCX ULPINE GREEN 2 EACH 151-2924 SUPREME FBGLS 25YR DESERT TAN 8 EACH 414-1033 CP1 FLUSH STEEL DOOR PH 32X80 LH SS 1 NOSO 155-1134 STYLE "D" 10' ROOF EDGE WHITE 4 EACH This is an estimate. It is given only for general price information. This is not an offer and there can be no legally binding contract between the parties based upon this estimate. The prices stated herein are subject to change depending upon the market conditions. The prices stated on this estimate are not firm for any time period unless specifically written otherwise on this form. The availability of materials is subject to inventory conditions. MENARDS IS NOT RESPONSIBLE FOR ANY LOSS INCURRED BY THE GUEST WHO RELIES ON PRICES SET FORTH HEREIN OR ON THE AVAILABILITY OF ANY OF THE MATERIALS STATED HEREIN. All information on this form, other than price, has been provided by guest and Menards is not responsible for any errors in the information on this estimate, including but not limited to quantity, dimension and quality. Please examine this estimate carefully. MENARDS MAKES NO REPRESENTATIONS, ORAL, WRITTEN OR OTHERWISE THAT THE MATERIALS LISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDERED BY THE GUEST. BECAUSE OF WIDE VARIATIONS IN CODES, THERE ARE NO REPRESENTATIONS THAT THE MATERLALS LISTED HEREIN MEET YOUR CODE REQUIREMENTS. Estimate # 12500 Page 1 of 1 ADDITIONAL ITEM INFORMATION ON SALE THRU 04/27/03 ON SALE THRU 04/27/03 ON SALE THRU 04/27/03 ON SALE THRU 04/27/03 ON SALE THRU 04/27/03 ON SALE THRU 04/20/03 ON SALE THRU 04/27/03 ON SALE THRU 04/27/03 ON SALE THRU 04/27/03 SUB -TOTAL: 480.81 GUEST COPY PAGE 1 OF 1 fjLIN S i J'Q G its q Dz► P CAP c0 Z ( �Z N ave. � 10 - x x - a � f FL NT G I D RA FR9,3 Y/ rA5C)A Land Planning. 6675-9i hwoy ;Cs NE. laid scrwreyir MinneoPols32, SoilsTestlny ' r ENGINEERING, INC. M�nncsolo Clvl/ b Municipal, SUnsef 4 6066 En�,neern9, Enyineers Surveyors t%fscate of, su,�ry for � 12' 'Pu�L�G � f�'�..LE�(• ' . iso,, .. - c..�.._ --' �,•oh ` +y ,, '(`' j `7 1 ` _ - �. a •• f f 4, o ; NaCl S'r I r+G t m i.1ouSE ��y O% /.brr�zGy ceri,ify fYraf is a true and wrad -nePresenhitka 0 a Arvey �'�he bavndoiies o� lccafi� #fall bvdd1n9s, therew , wdad risible mroacbmenfs , il'on¢�, fm or P7 mid' / ly A.D. I:L. SUB �'?Y3, _ a . - , -%A 1�1 3uilding $ BUILDING Permit No.:1 G Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Fire Surcharge CITY OF FRIDLEY Date Rec'd: )ATE `' li-, _aYOUR ,E-MAIL ADDRESS $5.00 (State Licensed Residential Contractors) ITE ADDRESS'3�1 `` (� l� A� $1450 per SAC Unit (Plans to MWCC for determination) 'HIS APPLICANT IS: ❑ OWNER 0d&TR.ACTOR ft + 6 ft = ft x $20 = $ PROPERTY OWNER/ NAME: 4 $450 Conservation Plan Review 1 _ CITY�%Z`� STA ZIP TENANT Sewer Main Charge ADDRESS: necessary ( ) Non Necessary ( ) Total Due PHONE: Make checks payable to: City of Fridley Attach Stipulations CONTRACTOR NAME: -,b `� �c7lk� STATE LICENSE 4 EXP DATE — ' Z 7y d fi SUBMIT A COPY OF " CITY �t� STATE ZIP YOUR STATE LICENSE ADDRESS: WITH APPLICATION PHONE FAX MISINGLE FAMMY/NEW CONSTRUCTION SIZE PROPERTY TYPE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ V9NDOWS ❑ BASEMENT FINISHr�90F [3 DRAIN TILE ❑ DECK IDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ ADDITION ANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: ;;:�' t OV -P `l SIZE OF IMPROVEMENT 'LENGTH WIDTH HEIGHT Sq. Ft. ROOFING �I �� OUSE ONLY AJMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: -lam— I. Existing Floor Plan 3ARAGES ❑ ATTACHED GARAGE dim floor plan "ROPOSED SIZE: 133. DETACHED GARAGE 3. List of structural members to be used 'ROPOSED HEIGHT: 5EDINIG ` FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS & PORCHES SUBMIT: inyl offrt :3 Aluminum ❑ Trim I. Site Plan/Survey showing the existing structures :3 Other U-6scia and proposed project 2. Two sets of construction plans WINDOWS 3. Energy Calculations N EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS JR FOR NEW OPENINGS -DESCRIBE SIZE OF DPENING 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) TOTAL—TOB VALUATION S OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ .001 x Permit Valuation (1/10%) License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ 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; that the work will be in accordance with the approved plan in the case of all work which requires w and approval of plans. p /�_ // // SIGNATURE OF APPLICANT PRINT NAMED0 � GC ,/vl Q jG� DATE ff - D� Building PLUMBING Permit No. -2c - - a-)3It Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY Date Recd: 31 ti (o, 7 DATE - Iv % YOUR E-MAIL ADDRESS ZSADDRESS APPLICANT IS: ❑OWNER CONTRACTOR PROPERTY NAME: c K, E bELL ADDRESS: 3 9 (� 3 ' i Li) a n t_ CITY %/S c�0�e rr STATi�Gi�r ZIP Sl Y� x_ TENANT PHONE: � & 3 _ f, 0 a— P NAME: Terry Overacker Plbg Inc CONTRACTOR SUBMIT A COPY OF STATE LICENSE # 51 1628 County Hwy 10 YOUR STATE ADDRESS: Spring Lake Park, MN 55432 TATE ZIP LICENSE WITH PHONE (763)572-RRRO APPLICATION kSINGLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE PERMIT TYPE TYPE OF WORK: 0 NEW REPLACEMENT DETAILED DESCRIPTION OF WORK &4 v A 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 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FD(TURE, EXCEPT WHERE NOTED. FIXTURES: MMICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV DRAINS —SHOWER _ WATERPIPING _ _FLOOR BATHTUB —GAS PIPING (mw c 7y=vs) _ SWIM[MING POOL _ WATER SOFTNER ($35) iCLOTHES WASHER SINK WATER CLOSET _BACKFLOW PREV. ($15) _KITCHEN DISHWASHER LAUNDRY TRAY t WATER HEATER ($35) FOR IRRIGATION — — WATER METER _ OTHER r. Permit Fee $. ® Number of fixtures @ $10.00 x $10.00 $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ s- . d State Surcharge = $ .50 Total = $ 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; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. 31" I0 PRINT NAME �� /C R J °`) DATE ? SIGNATURE OF APPLICANT �`':'x...,u�:�'��otr''x1"[5��3�'#:�G;�Ft�Y►"i'H�7��?12�iI��A�r�i$���I:REI�..RI���:,��3��_'.�. ::.. .,�x...s��. �� '� ;;�,�..�. City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977