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PRE 2010 DOCS"If-/ SUBJECT PERMI City of Fridley 2 V 14 AT THE TOP OF THE TWINS BUILDING PERMIT ECEIP COMMUNITY DEVELOPMENT DIV. INSPECTION PROTECTIVE SEC. c /C 1 � = CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �j 612-560-3450 910-F15 11/20/74 JOB ADDRESS Robert Burdick 1316 66th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 arcel 157 Aud. Sub. #10 SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Robert M. Burdick 1316 66th Avenue N.E. 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 CX ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK convert existing garage into living area 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMIT) REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS, 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 CON 3TRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CON 3TRUCTION 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 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. 1.10 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF, A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pAjIf R9 SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $15.00 Sr- ATU FCONT ACTOR OR H RIZEDAGENT (DATE) �/' '�7� JWAEN PRO ERLY PL ATED HIS IS YOUR PERMIT (✓rami %' — y, BLDG INSP DATE SIG ATU OF OW ER I F OWNE BUILDERI IDATEI "If-/ APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME :,9 b 2 rit l3Lt r p BUILDER: ADDRESS:, 3 / 6 — 6 '"- e— Al A7 -ADDRESS: 10 NO:. �� STREET LOT: BLOCK: -7e ) ADDITION • e 4-rl • '4 'lo CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. a DESCRIPTION OF BUILDING x Gia CMZ ¢O To Be Used As: ��,� ������+�� '2"�•`• .� • (�(d B� Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: $ To Be Comp] ted: rV\ The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stfict 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: nZ C7 h SIGNATURE: / M (See Reverse Side For Additional Information.) '� � '. � "'PY, �' �� 4f %r '�:+ - F r ¢P�+ - s � •- p .LCA , at rz- � PARTIAL RATE SCHEDULE GRAVITY WARM AM: IMTE TO` JU . Furnace Shell & Dust Worts ... ... ..... .. $10.00 $ Replacement of Furnace 6.00 $ Repairs & Alterations—up to $300.00 600 $ Repairs & Alterations each add. 3500.00 300 $ IMC3L WPB AM Furnace Shell & Duct Work to 120,000 BTU each add. $0.000 BTU . ......... Replacement of F tumace Repairs & Alterations—up to $500.00 Repairs & Alterations each add. $500.00 STEAM oa HOT WATER SYSTEM ..510.00 $ 3.00 i 6.00 $ 6.00 3.00 $ Fu -nate Shell & Lines—to 400 sq. ft. F.DR Steam 310.40 $ Furnace Shell. & line to 640 sq. ft. EDR Hot Water 20.00 S. Each add 200 sq. ft. EDR Steam xon $ Each add. 320 sq. ft. EDR Hot Water 3.00 $ OIL BURNER—to 3 gal per hour 6.00 $ over 3 gal. per hour—See Fee Schedule C? C9 CAS BURNER (up to 149,00 ETU) 5.00 $ -5- 01M 190,000 BIU See Fee Schedule CAS FITTING FEES: NO RINE TOTAL Ist 3 I%xtures x$ 2.00 $ '. �d U Additional Fixtures x .75 $_ Gas Range to 19.4.010 x$ 5.00, $ State Surcharge .50 0 ilea Fes TOTAL F= SS O Roast. of Bides. Phone 500-3M L�sm J316 — 6 (. I" fc�v � - City of Fridley: The undersigned hereby makes application for a permit for the work herd specified. agreeing to do all work in strict accordance with the City Ordtnativ and ruling of the Department of Buildings, and hereby declares that an the fac and representations stated in this application are true and correct. -y--Fridley, Minn `; C Owner o L9 0_ M /?J U , JF G Kind of Building E2a2='e' Used as-� U 0 A/Z---_ To be completed about. -:2 Estimated Cast; $ Old ew. Building Permit No. _L�� Permit No. HEATING or POWER PLANTS—Bteam, Not Water, Warm Air—No r �� Trade Name) else Ia'0- Capacity—_-- Capacity—..__. — Sq. IM E.D.R 3 d ®'-' z:;' BTU_L_ lid Total Connected Load Iliad of Fleet BURNER — Trade No size Ffo Capacity sq. F -L EM -R- BTU Im t Nts—ovull SUBJECT PE City of Fridley2 7 7 0 0 AT THE TOP OF THE TWINS BUILDING PERMIT No _ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 1 , NUMBER REV GATE PAGE OF APPROVED BY = CITY HALL FRIDLEY 55432 612-571-3450 910415 9/10/98 JOB ADDRESS 1316 - 66th Ave NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6Parcel 15 O lAud. Sub. #10 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert M Burdick Same 55432 571-4492 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 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 ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house-_ d= "ge (20SQ) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING, 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 1 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 $1 14.00 $.86 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- `V STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TO7EF -.0111 $59.32 iG TURE CONL ��1CD�THOR AGENT I/D'A�TEi EN OP�ALIDA H SIS R/P/p-RMIT ^ �+ _(DATE1 BL 1NSP 11 DATE RoF OWNER BLD 1 U,Gr4ATURE OF OWN BO NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: ('�;' 16 — c 6 AV Ls 0{) 6�- Legal Description: Owner Name &� Address: o p � yV1 l ,,c , c��C Tel. # -:f %/- q 4 9 Z Contractor: 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 EWPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: OL- U-� F Construction Type: lZ, cw��--d2cs�� Estimated Cost: $ s - (Fee Schedule on Bac ) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # 57 / — q 2 Z Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ J . STIPULATIONS: CITY USE ONLY Permit Fee $ %S Fee Schedule on Reverse Side Fire Surcharge $ ( .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 Escro $ 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 $ J . STIPULATIONS: SUBJECTR Aity of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 2 9 2 � 9 COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBERREV DATE PAGE OF APPROVED By 612-571-3450 910-F15 4/23/99 JOB ADDRESS 1316 66 Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. I Parcel 15 0 1 Auditor's Sub. 410 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robe t Burdick 1316 66 Avenue NE 571-4492 3 CONTRACTORI 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 ❑ NEW ❑ ADDITION x ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Wind w Replacement 9 CHANGE OF USE FROM TO STIPULATIONS Safety glazing required in bathroom tub location. SEPARATE PERMITS RE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR Al� 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 W�RK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HERCERTIFY NAT I HAVE READ AND EXAMINED THIS APPLICATION EBY 1 ISTALLS GARAGES AND KNOW TME SAM TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES )VERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPE IFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $900 @ $.50 DOES NOT PRESUM TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF AN OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE�PERFORMANCE OF CONSTRUCTION 32,00 Fir C $.90 PLAN CHECK FEE TOTAL E 3.40 .GNATURE OF CC NTRACTOR UTHORiZED AGENT IDATEi EN ROP LIDAT HIS IS R P RMIT ZPI 99 AGN T i OW NE...' OWN R BU40ERiDATE, �D iNSP GATE NEW [ ] Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY ALTER[ SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION o f ,Constructioss: C Al �J Legal Description:' Owner Name & Address: Qy 1 e ^7t-rn u, r c'— Tel. # a S �'� `�`�J Contractor: Address: MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with die. proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width _ Height Sq. Ft. GARAGE_ ::.: , :, , Length _ Width _ Height Sq. Ft. DECK AREA: Length Width _ Hgt/Ground Sq. Ft. OTHER: w Construction Type:� �— Estimated Cost: q .ago .. (Fee Schedule on Back) Driveway Curb C�t Width Needed: Ft.. + 6 Ft = Ft.x. $ _ $ DATE: { APPLICANT: bT7Ei2Tel. •STIPULATIONS: CITY USE ONLY Permit Fee 30 $_ 00 Fee Schedule on Reverse Side Fire Surcharge $ D .001• of Permit Valuation (1/10th%) -State Surcharge $ $.50/$1,000 -Valuation c� SA►C 3Chare $ $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 - .Sewer4Main:Charm !.$, 'Agreement Necessary [ ]„ Not Necessary [ ] •STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On January 1, 1999 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 8/4, G6 70�A 144"�6 'j New Fixtures $ 7.00 4.00 The undersigned hereby makes application for a permit for the work: herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 J/ Rain Water Leader $ 7.00 , 1999 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner 6 a pbie-f : Water Heater —Electric $ 7.00 Water Heater — Gas** / $10.00 Al -40 Building Used As l.km Gas Range" $10.00 Gas Dryer** $10.00 Estimated Cost PERMIT NO. n Back Flow Preventer Required ( )Yes O No Type $15.00 PLUMBING COMPANY Reinspection Fee $42.00/Hr SIGNED BY xt.'� — TEL N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance hd Approved By Rough—In Date Final Date State Surcharge .50 MINIMUM FEE F R ANY PLUMBINGJGAS PERMIT IS $20;00 TOTAL FEE $39. _06 PLUS THE $.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 80 INCHES. CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2000 16431 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 (f0 �3 ��o �o �oTy' J, .. RATE SCHEDULE 11 � Residential Rate TOTAL OWNER 0 \o- Furnace Furnace Shell and Duct Work, Burner - BUILDING USED AS_ w Also Replacement Furnace $ 30.00 $ 30.00 / (Side Vent - Fill Out Back) ESTIMATED COST 'A500. 0 G PERMIT N0. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) arm Air Gas Dryer $ 10.00 $ Trade Name 1 eta j & �. Size No. 9a°7o BTU HP EDR *Air Conditioning - All Sizes I-WYA $ 25.00 $ 5.0 Fuel_ ---.0—1�,?,A t . A s Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 an Wij► s�° t State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and L64A -.jpµb $ �• representatiRivetaD�iISfpjigfigaere true and correct. e b TOTAL FEE 9929 Bluebird St. N `''C�,, 1e4 `A ®0l1 Rapids, A/IfV 5541'A TE — 3 v _ 0 U g1� MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATINGIF 1-14-2199 Fax (612) 754.2 REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed TEL # 4 —a 1A A REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By/6 Rough-In Date Final Date -1-31-ol written permission from adjoining property owner. \316- 60 AIRIA COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION I=A.J (e_ When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes() No( ) AA The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. YesX No ( ) The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances, Yes No( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes() No( ) /V A When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes W No ( ) When installina a new ventina system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes f1' No( ) Is the common vent and vent connectors sized and installed correctly after ' an appliance has been removed from the common vent and vented separately as per current codes. Yes A No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type / BTU Input - Assiste r ld 10 t� dc__� Appliance #2 Type BTU Input 3 ,.�sra Fan Assisted Na Appliance #3 Type BTU Input Fan Assisted or at Total Appliances Total Btu Input r( Common Vent Type Vent Height / Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) k HEATING CO: o° - Signed By: Date: 4P �/-e9Z' CITY OF FRIDLEY PE O.: 2 04-01963 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 10/25/2004 (763) 572-3604 FAX: (763) 571-1287 ADDRESS : 1316 66 AVE NE PIN : 133024130012 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : RESIDING VALUATION : $ 5,400.00 NOTE: PER R703,2000 INTERNATIONAL RESIDENTIAL CODE, REQUIRES THAT A WEATHER RESISTIVE BARRIER BE PLACED OVER EXTERIOR SHEATHING TO PROTECT THE INTERIOR WALL COVERING. EXCEPTIONS FOR THIS PROVISION WOULD BE IF SHEATHING IS AN APPROVED WEATHERPROOF PANEL OR WHEN THE SIDING IS AN APPROVED WEATHER BARRIER. VINYL SIDING IS NOT A WEATHERPROOF COVERING UNLESS THE MANUFACTURER STATES THIS IN THEIR APPLICATION GUIDELINES. CALL FOR INSPECTION OF WRAP BEFORE COVERING OR TAKE PICTURES. RESIDE HOUSE. STATE LICENSED CONTRACTOR 1 APPLICANT BUILDING PERMIT FEE 125.25 WINDOW ACADEMY INC (20398809) FIRE SURCHARGE 5.40 13405 PINEVIEW CT STATE SURCHARGE, VALUE 2.70 DAYTON, MN 55327 LICENSE SURCHARGE 5.00 TOTAL 138.35 PAID WITH CHECK # 5005 OWNER BURDICK ROBERT M & DORA M 1316 66TH AVE NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not resume to give authority to violate or cancel the rovisi of other state or local law regulatin o ct'� p ance of construation. Applicant ' to�� Bldg Insp UZ PARATE PERMITS PQUIVED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [) ADDN [] ALTER [ ] CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATI �3 Construction Address: 1316 (_641 6 4` vt x l Effective 4/1/2004 (763) 572-3604 Bldg Insp (763) 571-1287 Fax L1 -1q0 Legal Description: Owner Name & Address: I 1 1 d e, I c. (C Tel. # 76 3 - S 7/— Contractor. e. GJo_id®ems cecle&44 v MN LICENSE# Address: 13 y O 5- G f- , 1 e, do? , N,X) Tel. # ' 63 - 7/.2 - l 2 V( 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: S/CI ti Construction Type: I c of:F g— Sf Cie- m Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ --=$ ' DATE: 1014 r 0 APPLICANT: (0 k e 4�,t CC (( Tel. # G/ Z - 6/6 -3`/ y 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 Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY - $ � J_Fee Schedule on Reverse Side $ 65% of Permit Fee $ `/� .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $ $1350 per SAC Unit .$ 6.00 $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 [ J $ 0-3 STIPULATIONS: