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PRE 2010 DOCSCity of Fridley a Application for Phnibing and Gas Ming Pamit DESCRIPTION OF WORK Number. Kind and Location of Fixtures dl e , WATE11 MM. GAS ELEG Base 1st 2nd 3rd 44th • Futuro Connection Openings * Fixture. Old Openings Consactad with sownNew Cesspool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES:NO• RATE Number Fixtures ..............'. x $ sT� Future Fixture Opening ........... x $1.50 $ _ New Fixture Old Opening .......... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater ;Up to 99,000 BTU) .... x $3.00 $ New Ground Run Old Bldg. ........ x $3.25 $ Electric Water heater .............. x $200 $ ZAS FITTING FEES: Ist 3 Fixtures ............ • . • .. . Additional Fixtures ................ . Gas Range to 199,000 BTU ............. REPAIRS & ALTERATIONS—Refer to Code NO. RATE TOTAL x $2.00 $ x$.75 $ X $5.00 $ Description .............................................$ TOTAL F'EE • y. -S-D Dept. of Sidon. Phone 960-3450 Location 3 -2 � & CQ OAJk � u, City of Fridley: The .undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Chdinance and ruling of the Department of Buildings, and hereby declares that alk the fact and representations stated in this application are true ^� and®® correct /�,, ,', Fridley. Minn 19--2jOwner ''�""v"� Kind of Building i --2 Used as A cyw� To be completed about Estimated Cost, $ s f 5 l o 0 Old—New. Building Permit No. ,, yPermit No. K Signed Yvz� - " " '�►�+ i By Vwl lP � `�- Business Phone No -7A A (1n ROUGH CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 1998 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE 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 $ representations stated in this application are true and correct. (Side Vent — Fill Out Back), ,1998 Gas Piping (Needed with new furnace) $10.00 $ OWNER t I Ja `(`Q_ _ 6_/\a&- Gas _/\a Gas Range $10.00 $ 113 r BUILDING USED AS Gas Dryer $10.00 $ *Air Conditioning —All Sizes $ 25.00 $ ESTIMATED COST � PERMIT NO. 13330 �'(� 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) (Warm Air) Trade Name Size No. Commercial/Industrial BTU HP EDR 1.25% of Value of Appliance or Work $ Fuel Total Connected Load State Surcharge $ .50 Burner Trade Name Size No. BTU HP EDR TOTAL FEE C� 0+ry) uca�, -m� � HEATING COMPANY MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Signed By (, i�`�, Tel No. PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Approved ByRough—In Date Final Date *Air Conditioners can not be placed in a side yard without FILL OUT BACKSIDE FOR STA K VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE Water Supply Well ❑ Montt. Well ❑ Env. Bore Hole C1 Other ft. 06low ❑ above land surface E 2 CASING TYPE(S) Steel ❑ Plastic ❑ rile ❑ Other f4 CASING(S) Diameter Depth Set in oversize hole? Annular apace Initially grouted? S J I mae-�b I oN �I I'� wr�'cE� � ro'��-Rq gr•ry� 71 h. ❑Yes No ❑Yes C]No [3 Unknown in. from to MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boling -*"""No- H WELL OR BORING LOCATION County Name WELL AND BORING SEALING RECORD unlqueWen No. Anka(�u"vnotlo ,party owner's mawng address if different than well location address Indicated above.. Minnesota Statutes. Chapter 1031 or W -series NO. ) ft.. Township Name Township No. Range No. Section No. Fraction (sm. i Ig.) Date Sealed Date.Well or Boring Constructed Fri B 71 24 14 w ,v q 9-22-" Screen from to Numerical Street Address or Fire Number and City of Well or Boring Location 76 OBSTRUCTIONS' 374 66thAve. KF Fridley Depth Before Sealing ft. Original Depth ft. Show exact location of well or boring Sketch map of well or boring AOUIFER(S) STATIC WATER LEVEL d. . in section grid with 'X". location, showing property 'a Single Aquifer ❑ Multiaquifer _Type of Obstructions (Descriribe") ""} N Rues, roads, and buildings. WELL/BORING Obstructions removed? [9kes Z Measured ❑ Estimated Describe Water Supply Well ❑ Montt. Well ❑ Env. Bore Hole C1 Other ft. 06low ❑ above land surface E 2 CASING TYPE(S) Steel ❑ Plastic ❑ rile ❑ Other f4 CASING(S) Diameter Depth Set in oversize hole? Annular apace Initially grouted? S J I mae-�b I GROUTING MATERIAL(S) (One bag of cement a 84 lbs., one bag of bertonNe = 50 iia) Grouting Material At cm`s from 6 to 76 ft yards 3 bags from to n. yards bags from. to n. yards bags from to ft. yards bags in, from 6 to 71 h. ❑Yes No ❑Yes C]No [3 Unknown in. from to ft. ❑. Yes ❑ No ❑ Yes C]No ❑ Unknown IIO�PEERRTY OWNER'S NAME ter Name of Person Sea ft Well or Boring ,party owner's mawng address if different than well location address Indicated above.. in. from to - ft.. d. Yes . ❑ No ❑ Yes, ❑ No ❑ Unknown Sam SCREENIOPEN HOLE 71 �t 76 Screen from to ft. Open Hole from to n. OBSTRUCTIONS' :LL OWNERS NAME �, Rods/Drop Pipe 0 Check Valves} -❑ Debris ❑ Fill [:]No Obstruction l k $ d. . P jet II owner's mallhtg address it different than property owner's address indicated above. _Type of Obstructions (Descriribe") ""} Obstructions removed? [9kes [:1 No Describe Pump GEOLOGICAL MATERIAL. . not known, i ukate estimated to REMAR103, SOURCE OF DATA; DIFFICULTIES Qi SEALING Type - FROM ' TO ❑ Removed [XNot Present . ❑ Other METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR No Annular Space Exists ❑ Annular space grouted with.tremle pipe ❑ Casing PertorationtRemovai tn. from to ft. In. from to n Type of perforator ❑ .Other ❑ Perforated ❑ Removed ❑ Perforated ❑ Removed GROUTING MATERIAL(S) (One bag of cement a 84 lbs., one bag of bertonNe = 50 iia) Grouting Material At cm`s from 6 to 76 ft yards 3 bags from to n. yards bags from. to n. yards bags from to ft. yards bags OTHER WELLS AND'SORINGS Other unseated and unused well or boring an property? ;A Yes ❑ No How many? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This well or boring was sealed In accordance with Minnesota Rules, Chapter 4725. The Information contained In this report Is true to the best of my knowledge. `k Well Cs. $ inc. 026" Name 1 Lkwise or Reglsbatlon Pio. 9-24--99 A � • ,y^"r � Auff o iW/4 nature j Dada Ron Danielson Name of Person Sea ft Well or Boring veil #2 WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH MMi Innesota Well and Boring WELL AND BORING SEALING RECORD Minnesota Unique Wel No. Minnesota Statutes, Chapter 1031 or W -series No. (l.—M kerotxnwm) H ,i 0 �"'j+� 0 �` County Name Township Name Fri�iSF� Township No. 3A Range No. 24 Section No. 14 Fraction (sm. -w Ig.) % 1, 'a Date Sealed a 9-22—" Date Well or Boring Constructed Numerical Street Address or Fire Number and City of Well or Boring Location 4 66th AVO N$ F L1ii O Depth Before Sealing 98 n. Original Depth n. Show exact location of well or boring Sketch map of well.or boring in section grid with "X'. location, showing property N Imes, roads, and buildings. W - r - -T- -?-- - i- E , - �--i-- --I-- -4---CASING(S) S AOUIFER(S) Single Aquifer ❑ Multiaquiler STATIC WATER LEVEL Measured [I Estimated 43,❑ n. (bekwr C1 above land surface WELL/BORING Water Supply Well ❑ Monff. Well Env. Bore Hole ❑Other CASING TYPE(S) Steel C] Plastic ❑-Tile ❑Other Diameter Depth Set in oversize hole? Annular space initially grouted? 3 in. from 6 to 9E3 n. ❑Yes N No (3 Yes ❑ No C] Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown in. from to ❑ Yea ❑ No ❑ Yes ❑ No ❑ Unknown PROPOrrWNERa�S�NA�iM.E Ma#t 4krieii� 'iis di aL Properly owners mailing address n different then well location address indicated above. SCREENIOPEN HOLE Screen from to 90, it. Open Hole from to n. OBSTRUCTIONS Roda(Drop Pipe ❑ Check Valves) ❑ Debris ❑ fig ❑ No Obstruction Type of Obstructions (Describe) •Y 1.15 d • p. & ' Jet Obstructions removed? [5Yes ❑ No Describe WELL OWNER'S NAME Wen owrxu+s ma9(ng addraw ff dlffererdftn.pmpeny owner's address indicated above: PUMP Type .W Jet L5 Removed 13 Not Present :❑ : Other HARDNESS OF - GEOLOGICAL MATERIAL COLOR . FROM TO FORMATION 11 rwNmown, brdicate estimated formation log from nearby wen or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2.CASINGS, OR.CASING AND BORE HOLE: X No Annular Space Exists ❑ Anular space grouted with freMe pipe ❑ Casing Perforation/Removal In. from to n. ❑. Perforated ❑ Removed in. from to fL ❑ Perforated ❑ Removed Type of perforator ❑ Other - GROUTING MATERIAL(S) (One bag of cartterlt a 94 g;., one bag of beMoNte a 60 11m) Grouting Material Ifr ftt from Is to 98 n. yards 4 bags from to n. -yards bags from to n. .yards bags from to ft. yards bags. REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING OTHER WELLS AND BORINGS Other unseated and unused well or boring on property? ❑ Yes 25 No How marry? LICENSED OR REGISTERED CONTRACTOR CERTIFICATION This wen or boring was waled in accordance with Minnesota Rules, Chapter 4725: The information contained In this report is bus to the best of my knowledge. WO Cos it I r 026156 Ctort License or Registration No. `} 9-24-99 Aulhodzed Represl�tive Slgnafure Gate Danielson LOCAL COPY Nam of Person SeaftWell orSwing 1 SUBJECT P City of Fridley 31630 AT THE TOP OF THE TWINS BUILDING PERMIT 1 NO. i bV _ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. _(/^/PIT r PROTECTIVE �• I 1 � i 1 'P"'1 CITY HALL FRIDLEY 55432 �'' NUMBER REv DATE vAGE OF APPROVED BY 612-571-3450 910415 1/23/01 JOB ADDRESS 374 66 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Rice Creek Terrace Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Paul Mattson M 374 66 Avenue NE 763-502-6750 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Window Lite Home Improvements 8400 89 Ave N, Brooklyn Park, MN 55445 20039258 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-425-2227 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 B DESCRIBE WORK Replace 14 windows within existing openings 9 CHANGEOFUSEFROM 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. Pe'mit Insp9010n Cards Will B® Mailed T Homeowner To Post SEPARATE PERMITS ARE REOUIREO 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 @ @ 11 747 $5.87 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 CH GE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $209.25 Fire C $11.75 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FE TOTA FEE Licen S $5.0 $ 31.87 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT tDATE, EN O R ALIDAT D HIS IS YOUR PERM! deop h5 ff S,GNATURE OF OWNER SIF OWNER BUILDERI IDA TE- 1 NEW [ ] ®`�� tive 1/1/99 ADDN [ ] (j CM OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-12?�/,i70Eff BUILDING PERMIT APPLICATION ConstructionAddress: �� �p((�D ,� �/`�a�� %�1�� �cJ'7`,: Legal Description: Owner Name &Address: t ,` Tel. # 7,vJ ,SOS Contractor: MN LICENSE # Address: F400 &1 4L , M�� Al -If Tel. # 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: Construction Type: Estimated Cost: $ ��� �% %; 00 r4J" S%z ee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: APPLICANT: L",lT e 1. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY $ a®9, o� J Fee Schedule on Reverse Side $ /f, %5 .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1050 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 [ ] sTIPuraTToxs: - 10'F ��O,�F Q�£'Yt�f�QS 6•V �.�C61 S�fED�NC/ SUBJECT RM1'T1�O. City of Fridley ( 31646 AT THE TOP OF THE TWINS BUILDING PERMIT - RECEIPT NO. COMMUNITY DEVELOPMENT DIV. ��------. � INSPECTION SEC. f � PROTECTIVE X35' i A �•; CITY HALL FRIDLEY 55432 NUMBERREY DATE PAGE OF APPROVED Br ;"' ---- L J` 612-571-3450 910-F15 2/12/01 JOB ADDRESS 374 66 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Rice Creek Terrace Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Paul & Dorothy Mattson 374 66 Avenue NE 651-642-0846 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Window Lite Home Improvements 8400 89 Ave N STE 460, Brooklyn Park, MN 55445 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-425-2227 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION IR ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 0 DESCRIBE WORK Remodel bathroom 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. 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 Permit Inspection Cards REQUIRED FOR: Will Be Mailed AHEATING NIGkS TO HoWla ner 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,706 $1.35 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 TAL FEE Licen C 5.00 f $9/.30 SIGNATURE Of CONTRACTOR OR AUTMORiZED AGENT IDATEi N P R Y I AATTEED T IS YOU P/MIT 7R, V144e/ _ L BLDG . S. BATE SIGNATURE OF OYVNER.,f OWNER BUILDER, IDATEi NEW ' [ ] t5� 3 / n Effective 1/1/99 ADDN [ ] CM OF FRIDLEY / ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress : Legal Description: Owner Name & Address: Contractor: # (05/- (P Vd-okg4:;, MN LICENSE # L/( Tel. # % L3 - 425 -01 7 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. V 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: &4fA-vo. Op rA od 2 L -,s" /D-,7)je.A 0d /PAS Construction Type: Estimated Cost: $ �7) (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 0 / APPLICANT -129 Tel. # j q /- e3 /d CITY USE ONLY Permit Fee $ " IT Fee Schedule on Reverse Side Fire Surcharge $' a . .001 of Permit Valuation (1/10th%) State Surcharge $ �, .®,r- $.50/$1,000 Valuation SAC Charge $ $1050 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 $ �'. o� o �l�Yl�Jkoe. (Y6-er aae s- 4"/.021 4"/.02, 9'2, UQC. STIPULATIONS: l �cAL. E- %z''= Foul I DoroA / (a4l5en 371 66f6 Ave. mg - (76 -S) g- (763) 50 Z - 6750 1nstIA-11 a Cf/llc +Lf6 I i ►ieyr ®j-,96m)l 3%1 heii* acr_Ylic— TL)) SnOWc'�' SUfrOone) , w/ 4UM corner aAda es 0 3�r)SW) 11e J f A:) c !�,keat,Wer -ruvt-ef AelwIr �goaljpFal �ojoe — 9:/eco. Plum UlVF SM le e (Y�i��ojPs /^/ EWcij PmM off' fhF hoc&rc ANdoa Sects 3 /d, 9, !�? 97 ox �S CAGF- %z "= f Fail Z Dcr©Ay Ma-Ff rl 371 66fb Awe_ AJC �idIey �763� 5o z - 675d (D .Ynsfodl acrylic +Lfb 11 Aer © �ASfGt�� 3�� �el gCry/IiC_ �tJ� , : lower Sir roUne) w/ 4uz Ccriler Q�Grc�iC'S 0 X4A;L11 fie") f LJID I Slr maer -raueef —SE,oevlF O(Floct/ozs- IN eod s��F kp/g:� ArM �1NQ� ON Fd CIFVLcl � �`1E hOqSe �Jf,2 s�<aAv 3uilding $ BUILDING $ Permit No.: inspections Surcharge RESIDENTIAL APPLICATION Received By: 763-572-3604CITY SAC Charge OF FRIDLEY Date Rec'd: C) $ Erosion Control $ )ATE U` C.a YOUR E-MAIL ADDRESS Sewer Main Charge ;ITE ADDRESS 3-7,�Y�- Total Due $ 1 (:)6 WL 7IIS APPLICANT IS: ❑ OWNER-9WNTRACTOR PROPERTY OWNER/ NAME: ADDRESS: 3 CITY G/1��OLC- rY STAT6N/ffP TENANT PHONE: CONTRACTOR SUBMIT A COPY OF STATE LICENSE # 2,,;,t -?2153 EXP DATE ` ���ZUd 7 YOUR STATE LICENSE ADDRESS: �L/�"T�� �� CITY �I `d�%�� STAT&-OA-ZiP,�® WITH APPLICATION PHONE 76 1, 4&i9' FAX `jG 3 " lla & PROPERTY TYPE XSINGLE FAMILY/NEW CONSTRUCTION SUE -25- ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH PROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ADDITION LING ❑ MAINTENANCE/REPAIR }REMODELING 541A fid' %,JM 1�&204C DESCRIBE WORK BEING DONE: 'r - `-� ✓�°'�'L�i��� LGS" SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING� OUSE ONLY NUMBER OF SQUARES ❑HOUSE &GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SEEDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I . Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WWWWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No DATION OF WINDOWS OR FOR NEW OPEMNGS-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: (USINgTHE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 01 1 OCCUPANCY TYPE Permit Fee $ Plan Review $ Fire Surcharge $ Surcharge $ License Surcharge $ ..X� SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ 1 (:)6 WL 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) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks pavable 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; that the work will be in accordance with the approved plan in the case of all work which requires revi and approval of plans. n / SIGNATURE OF APPLICANT PRINT NAME '- DATE G