PRE 2010 DOCSVillage of Fridley, Minn.
BUILDING PERMIT
NU 761 Office of INSPECTOR OF BUMDMGS
Owner,+
Architect Fridley, Minn.,`` rr 19
Builder
LOCATIOOF BUILDING
e, 4L� � �`� Part of Lot
No. Ak street
Lot Block_ Addition or sub -Division
g DESCRIPTION OF BUILDING
x 6� �
:�3 r t , ri!':'i �5.,,,�_
Front Depth Height stones Manner of Construction
To be used as �'a�' To be completed`{' Estimated CosC`
Permit is hereby granted 4 �_- •<to
the building t,`�.. n described in the above statement. This permit is granted
upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all
the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the 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.
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit, I hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated.
Subscribed and sworn to before me at Fridley,
day of a a' � A.D. 19
Minnesota this ,�
0
Village of Fridley, Minn.
BUILDING PERMIT
J11
Date: .'L... �r�............
Ownerd
Address .... i.0 ... `.•...�........ ...
is
N? 1822
Builder..............................................
Address.............................................
1631 LC)CATIO F BUILDING
No. ?.. Street .. 4 r.... ,.............. Part of Lot ......
Lot ...... ....... Block ...... / ....... Addition or Sub -Division .... .
Corner Lot ........... Inside Lot .!'........ Setback ........... Sideyard ............ ......
DESCRIPTION OF BUILDING
To be tise as:
ront .. Depth Height Sq. Ft. ... Cu. Ft.
..................... Front ........ Depth .. Height ........ Sq. Ft. ........ Cu. Ft. ........
Type of Constructiono....... Est. Cost ..� ... �........ 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 village of Fridley.
Aw:.Ij
?!.....� ........ .
6 C7 V <
In consideration of the payment of a fee of $4?.. ��., 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 with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
.... Inspector
r-)
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
City of Fridley
Application for Plumbing cmd Gas Fitting Permit
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin ...... ..................... x 3.25 $
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 Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Olde Building Permit No Permit No. CC a/I
ca
Signed � • E7`�
Water Heater (Up to 200,000 BTU) ...... x 2.00 $
New Ground Run Old Bldg. ............ x 3.25 $ .3 . ROUGH
GAS FITTING FEES:
1st 3 Fixtures ..........................
Additional Fixtures ....................
Gas Range to 200,000 BTU .............
REPAIRS & ALTERATIONS—Refer to Code
NO. RATE TOTAL
x $1.50 $
x .50 $
x 2.00 $
FINAL
Description ................................................$
TOTAL FEE $ `' v _40042 2M
Business Phone
=111mmuMMMIMMINME■■MEMEMENN■■o
1
WE
E
■NNEM■MENEW 3 0
NEE
/EEZ%1 Mr FRAM
■
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ...................... x $1.50 $
Future Fixture Opening ................ x 1.20 $
New Fixture Old Opening .............. x 1.00 $
Catch Basin ...... ..................... x 3.25 $
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 Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct.
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Olde Building Permit No Permit No. CC a/I
ca
Signed � • E7`�
Water Heater (Up to 200,000 BTU) ...... x 2.00 $
New Ground Run Old Bldg. ............ x 3.25 $ .3 . ROUGH
GAS FITTING FEES:
1st 3 Fixtures ..........................
Additional Fixtures ....................
Gas Range to 200,000 BTU .............
REPAIRS & ALTERATIONS—Refer to Code
NO. RATE TOTAL
x $1.50 $
x .50 $
x 2.00 $
FINAL
Description ................................................$
TOTAL FEE $ `' v _40042 2M
Business Phone
0
C�
00/CP--
City of Fridley, Minn. N9 9803
BUILDING PERMIT
Date: June 20, 1968
owner: _ John V. Mickman Builder Same _
Address 1631 661 Avg. N E- _ _ Address Same
LOCATION OF BUILDING
No. 1631 Street M 66k Ave. N. E. —_—_ Part of Lot
Lot _ 3 __ Block 1 — Addition or Sub -Division .._._ - __ Moore Lake Park 1st Addn.
Corner Lot w x Inside Lot Setback --- Sideyard —
Sewer Elevation
To be Used as:
Foundation Elevation
DESCRIPTION OF BUILDING
Outside Balcony Front 49' Depth 7 r Height Sq. Ft. Cu. Ft
Front Depth _ _ Height _ Sq. Ft. Cu. Ft.
Type of Construction Wood Est Cost ^ $200.00 ____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 rth and in compliance with aft provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 5.00 permit is hereby granted to_.._.John V. Mickman
to construct the building or addition as described above. This permit is granted upon
the express crondition 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, A2inuesota regardinng location, construction, alteration, maintenance, repair and moving of buil
within the dty limits and this permit may be revoked at any time upon violation of any of the provisions of d
ordinances.
Official
/146,c-✓ Building MWfAW
Jcbl Breher
NOTICE:
This permit does not cover the construction, installation for wiling, Plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these Items.
APPLICAT:tON FOR BUILDING PERMIT.
CITY OF FRIDLEYf MIIINESOTA
OtJ1VElt'S
ADDRESS �� j` (� /�Ak �F- ^{,iv ADDRESS
�.
._ _. 3 ,_ - ..
LOCATION OF BUILDING
No. J _ STREET to 6 r2- IV,AAO oft
LOT _ BLOCK ADDITION OR SUBDIVISION F�i?-s r X�� ,
CORIER LOTINSIDE L SETBACK SIMARD
SEWER ELEVATION TOP OF FOOTING
Applicant attach to.this•;form Two Cetdiicates of Survey,,of Lot and proposed
building location dr4im on these Certificates,
DESCRIPTION'OF BUILDING
9 X ,
To Be Used As: •
2 UJB, .1-7 i x r
JLLj5 �� � l�UG 1 Fron Dept Height,
Square feet Cubic Feet
Front Depth Height
Sggare•• Beat a- J CubicFeet
Type of Construction ''i�' � Estimated Cost '->06
To Be Completed /27 %8 _
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.
1
DATE_ _ _ l (� _SIGNATURE I.(.0�/G _
(Schedule of Fee Costs can be found on the Reverse Side).
Original0
PERMIT for Power ants and Heating. Cool-
ing, Ventilation. Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of_- Heating Plants to b installe —altered—repaired
Make Lr , Size E� �// ®M ;
Oil fired—, Coal fired ; Gas fired V/; Gas Authorization No.
Remarks &x-A�, '-U 6-,J�
Approved
Final Inspection Date , 19_
Inspector
Permit N° 4613
Fee $ /3.00
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn. AJ1,1 ,19 L9
Owner : -o 4 A3 m, CJ� M A 1
Location 16 1— G 6 Va. O J E
Kind of Building pp �K 14 M E,
How Occupied l W E LL t YU Co
Work to be Commenced—, 19—
To be Completed /I - -2 V,19 6 q
Estimated Cost, $ 3O® • t) 6
Qlld- Vew, Building Permit No
Permission is hereby granted to to install—erect—use the material and devices described in the
above statement. This permit is granted upon the express co dition that the person t whom it granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specifications s=fththeapproved application for this
permit on file in the office of the Inspector of Buildings.
Inspector of Buildings
az 2M 11.67 V
ATTENTION OF:
TO --- lPAW-9t on __ad _Assessing Departments
SUBJECT 1631 -661 five• N•E• DATE Oct• 239 1970
a
City of Fridley, Mian..
BUILDING PERMIT
Date: October 26, 1970
per: J. Mickman Builder Londer Company
Address �1631-Wi Ave" ..nue N.E. Address 2909 Nib-o11Q.t Avent,e
LOCATION OF BUILDING
No. 1631 Street ___. 66-2 Avenue N.E. _ _ _ part of Lot
N. 10872
Lot _ _ _ _ _ r_ Block 1 .— Addition or Sub -Division Jkg= ?sake Park First Addi-tion
Corner Lot ---- Inside Lot
Sewer Elevation
To be Used as:
Fire Repair to H
Type of Construction
Setback -- Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
Depth . — Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Est. Cost$6.00.�ok.__ To be Completed 90 Slays
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 compliance with ill'provisions of
ordinances of the city of Fridley.
'V1 /4-0 OZ -1 -
In consideration of the payment of a fee of $_ __ 36, 00 , permit is hereby granted to Londer Company
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 andmoving 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.
CLAMCE BEL
NOTICE:
This permit dons not corer the construction, Installation for wiring, Plumbing, gas heating, ewer or water. Be am to no
the Building Inspector for separate permits for these Rema
0
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME:—I, 144 Ick k f V A f / BUILDER : /�o aJV /7
ADDRESS : _ AL, N-CADDREs s : Ab c a./- T
NO:. STREET:
LOT: 3 BLOCK: l ADDITION: Wo aajvc,l�L-
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.
DESCRIPTION OF BUILDING
To Be Used As:
r
/ c=na L Front: Depth:. Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
---
Square Feet; Cubic Feet:
Type of Construction: //�� /�,� p,¢ J /� Estimated Cost:_ $ t,/0 O o 0
To Be Completed: Cl? O ��,�,�; �1
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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:' / O ;? [ — G SIGNATURE: * ��_
(See Reverse Side For Additional Information.)
I
r
CITY OF FRIDLEY
HOUSE TRAILER APPLICATION
It is hereby requested that I be issued a house trailer permit in compliance
with Chapter 41, City Code of Fridley, Minnesota, 1963 by reason of the
following:
A. Name of Appli-ant: fJ� VC Tdt�
Address: 4( 3/ &e. "",in,
",i e -
B. Ownership of Trailer:
C. Description of Trailer (Make and Size) :
D. Name of 0
Address:
E. Period of Time Trailer is to be Stored or Occupied: (J&4 (
F. Use of Trailer:� �/ C -KC 1416=
�
G. Signatu es of Adjoining Property Owners Granting Approval:
H. Location of Trailer on Proposed Property (Attach Plat Plan of Property): .
I.
Where Trailer is to be Occupied, What is;
1. Relationship between Trailer Owner and Land Owner: 1-6515 JR 7-0
2. Names and Ages of All Occupants: FA ala #w Y►
3.
4.
5.
Facilities For Sewage Disposal, Water and Electricity: 5 JfYS
Employment of Applicant: YVAY141C?
Whether Applicant is Constructing Home in Area: R15� 4i o-
The application, when presented to the City Council, shall show the recommendation
of the Zoning Adi,.inistrator and/or Building In-pector.
Please find attached check in the amount of $5.00 for parking/$25.00 for
occupying a house trailer.
5
APP a
Receipt No. Lua
License No. 7-919--
Approved
9/9Approved By: �.ou�a1 i PFER MAAiAC.Fae
....s kava A..4. ►. ►•,n►
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
RESIDENTIAL
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
Gas Piping
(piping needed with new furnace)
Gas Range
Gas Dryer
• Air Conditioning (all sizes)
RATE TOTAL
$ 20.00 $ ZO'C ,
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 10.00 $ 10,W
All Others/Repairs and Alterations
It of Value of Appliance or Work S
C0141ERCI AL/ IN DUSTR IAL
It of Value of Appliance or Work
State Surcharge
TOTAL. In
Reinspection Fee (s15.00)
Rough Insp.
Date
Final Inep. - 1 b~ 871
Date
Approval for Permit W"'�d
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
PLUS $.50 STATE SURCIUARGE
Attach stack verification form with replacement furnace permits
*Air Cnnditioners can not be placed in -tide yard without
written p►rmission frcm aduo►n.ixl netgldwir.
Job Address
Department of Buildings 6411 University Ave. N.C. Fridley. MN 55412
City of Fridley
Tel. 0571-7450
The undersigned hereby maked application for a permit for the work herein
specified agreeinq to do all work in strict accordance with the City Godes
and rulinqs of the Department of Buildings. and hereby declares that all the
facts and representations stated in this application • true and correct.
Fridley. Minn. o� . 19,W
OWNER
RIND 0
USED AS �j Q
TO BE COMPLETED ABOUT
ESTIMATED COST `�$3&b >
OLD - NEW BUILDING PERMIT NO. PERMIT NO.�
DESCRIPTION OF'FURNACE/BURNER
NEATING or POWER PLANTS, Steam. Not Mater, Nara Air- NO -
Trade Name —T9. e l Sime No. L)K
Capacity Sq. Ft. EOR
Total Connected Load // Oy Rind of fuel o
BURNER - Trade Name Size No.
Capacity Sq. Ft. EOR STUU����/e 'NP
Company
Siqned By
Te 1 . Pto . 4EW3
FAA
SUBJECT
PER
City of Fridleyr?
3 05 86
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
LV ------ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
7V ��
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
12/15/99
JOB ADDRESS 1631 66 1/2 Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
3
1
Moore Lake Park First Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Home Owners Improvement Co 9767 Brighton Lane, Eden Prairie MN 55347 903-5005
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
20146454
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION] REPAIR
O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (30 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
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
1
1STALLS
GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GV
GING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SP IFI HEREIN OR NOT. THE GRANTING OF A PERMIT
$2,622
� �v���
+� $1.31
DOES NOT PRE E T IVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISI O Y T ER STATE OR LOCAL LAW REGULATING CON-
STRUCT ON 0 E ORMANCE OF CONSTRUCTION
$83.25
FireAC $2.62
in
PLAN CHECK FEE
License $5.
TOTA F E
.18
GNATUAE OF . RACTOR OR AUTHORIZED AGENT IDATEI
N P OP f ALIDA IS IS )LIA PERMIT
BLD INSo -
` BATE
S,GNATURE OF OWNEROF OWNER BUILDERI IDATEI
FAA
NEW[ ] Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAINELY AND DUPLEXES R-1 AND R-2 O ��
BUILDING PERMIT APPLICATION
Construction Address: 66 4 4,) V L
Legal Description:
Owner Name & Address: Tel. #
Contractor: Abw owVk-tvs j MN LICENSE # 26 y
Address: �, �'31_Tel. # 6 r.2 9 3 � �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF BIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length / / Width Hgt/Ground Sq. Ft.
OTHER: - v�� �Y 3 d C7
Construction Type:
Estimated Cost: $ a % &S� --'26a -)-
Driveway Curb Cut Width Needed:
Ft. + 6 Ft - Ft x $ _ $
DATE: ( APPLICANT:
Tel. #
CITY USE ONLY
Permit Fee
$ v o1
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$ /
$.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
$
STIPULATIONS:
70
Building BUILDING Permit No l
Inspections RESIDENTIAL APPLICATION. xeceived ByO
763-572-3604 CITY OF FRIDLEY DC,Q C T
763-502-4977 FAX q EFFECTIVE 1-1-08
DATE /to O / YOUR E-MAIL ADDRESS
SITE ADDRESS `�
THIS APPLICANT IS: ❑ OWNER ((CONTRACTOR ,
PROPERTY OWNER/
NAME:
TENANT
ADDRESS I le G IUB CITY CITY STATE 21P SS�j=3
PH027 S7/—//a :x
NAME
CONTRACTOR
ADDRESS: Z/7 • STA�,SS-O/tl
SUBMrf A COPY OF
PHONE e4411) -7SV - 2-4�4 FAX
YOUR STATE LICENSE
STATE LICENSE # /% P 1 l
EXP DATE
PROPERTY TYPESINGLE
FAMILY pN SEM
❑ TWO FAMILYMEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAUBISHEDWS
13 BASEMENT FINISH [3 ROOF DRAIN %
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
MAINTENANM?MPAIR ❑ REMODELING
DESCRIBE WORK BEING
I300FiNG
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ vinyl
E3 Aluminum
❑ Other
❑ HOUSE ONLY
O HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No LOCA ON QF �iVDQ
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES �--"'
TYPE OF. WINDOW TO BE INSTALLED D-* i 9&AiW NUMBER OF WINDOWS J O
ALL
TOTAL JOB VALI
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
BASED ON VALUATION, INCLUDING THE COST Of
�/ q SING THE 1997 UBC FEE SCHEDULE)
6 d i JZT0 nrgrR
BASEMENT REMODELING SUBMIT:
I. Existing Floor Plan
.2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITION& a PO&CE ue SUBMIT,
1, Site P1amlSurvey showing the existing structwuv
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
TYPE
$O ` See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ 123 Q 001 times the total job valuation
$ 1/5 .0005 x Permit Valuation Mmimum $.50
$ -$5.00 (State Licensed Residential Contractors)
$ $1825 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 payableto: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMrf 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 ATmr Construction Codes; I understand this is not a paradt but only an application for permit and work is not to start without a
pennit on site; that the work will be in with the p ' the case of all work which requires 'aw and o p
SIGNATURE OF L SANT PRINT MME l� DATE_ ' /'0 C'
'o d�
7,1,7
Building BUILDING Permit No.:,,JC -06
Inspections RESIDENTIAL APPLICATION. 'Received By: L�
763-572-3604 CITY OF FRIDLEY EF
763-502-4977 FAX EFFECnVE 1-1-N
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMrr A COPY OF
YOUR STAT)S LICENSE
PROPERTY TYPE
TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
S'iZE OF IM[PROVEMM rr
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAIN 11 NANCE/REPAIR ❑ REMODEL
FAxS1 7
EXP DATE Z
❑ DRAIN TILE
❑ OTHER
ROOMG
YOUR E-MAIL DRESS
Permit Fee
�� ��
❑ OWNER P(CONTRACfOR
NAME:
ADDRESS: `
6 YA t
PHONE: .S%
—
NAME.
ADDRESS- 1
l •
PHONE
PROPOSED HEIGHT:
STATE LICENSE # A
%�
ffSIIVGLE FA MII Y
N
❑TWO PAMIL EW CONSTRUCTION
❑ ADDITION
❑ GJ9Uid-FM=
❑ BASEmBNT FINISH
O ROOF
❑ DECK
❑ SIDING
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAIN 11 NANCE/REPAIR ❑ REMODEL
FAxS1 7
EXP DATE Z
❑ DRAIN TILE
❑ OTHER
ROOMG
❑ HOUSE ONLY
Permit Fee
- --
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT
REMODELING SUBMIT;
GARAGES
PROPOSED SIZE:
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
l •
ExistingFloorPlan
ed floorplan
PROPOSED HEIGHT:
7. .0005 x Pmm3it Valuation Mini=m $.50
3.
Lint of members to be used
❑i' vmy)
/— 3� 5L-�O'B
FORNEW TION INCLUDING DECKS,
$1825 per SAC Unit (Plans to MWCC for determination)
� f
ADDITIONS
8c PORCONSTRUC
❑ ���
C3 Other
❑ Trim / r1 ��
d- A
I.
Site Plan/Surm showing the existing structures
$
E3Fascia /
Sewer Main Charge
and proposed project
WINDOWS
,� -i;
_ SSL— %% Fes►
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yea bio
LOCATION OF WIIVI�WW$$
3.
E=V CalculaUtons
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF. WINDOW TO BE INSTAi T Pn
NTMAM n
ALL FEES ARE BASED ON
OF LABOR AND
TOTAL JOB VALUATION $ 1,;;Z
%rty Tru: LVW UBC FEE SCHEDULE)
® OCCUPANCY TYPE
Permit Fee
$
S". " See Back Page for Fee Schedule
Plan Review
$
_ 65% of Building Permit Fee
Fire Surcharge
$
. ` .001 times the total job valuation
-'70
Surcharge
$
7. .0005 x Pmm3it Valuation Mini=m $.50
License Surcharge
$
. DD -$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = 'ft x $21= $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Detmviined by Engineering
Sewer Main Charge
$�'
Agreement necessary ( )Non Necessary ( )
Total Due
$
Make checks a ableto: PHbr of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply fora b,2' ' and I acknowledge that the above is complete and acewat ; that the work will be in conformance with the ordinances and codec
of the City of Fridley the nstruction Codes; understand this is not a permit but only an applicatio for a permit and work is not to start without a
permit on site; that the work be in rdan the ved of all work which review d f plans,
SIGNATURE OF APPIJI PRINT NAME YYI DATE • i SS ��,
APPROVED BY i VOW,1 ,114 I -