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PRE 2010 DOCSCity of Fridley,inr 11718 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT mate; -----October---10, 1972 Owner: Peter Percic Builder Same ,AddressR 7 A East .TPG _ min Adm Same LOCATION OF BUILDING N . 13X35 1 0 -50 0 sit - 68th Avenue N.E. _ ._Part of Lot Lots o f 1 Block 1 Addition or Sub -Division . Brookview 2nd Addition Corner Lot Inside Lot X Setback 3 5 ' — Sideyard — Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Dwelling Front ---4 0 1 Depth 2bHeight _ _ 201 sq. Ft. 10 4 0 bu, Ft Par a g P Front ._2 3 18 a�' Depth _ 2 41 Height 10 ' sq. Ft. 569 bm p, 56 9 0 Type of Construction _ Wood. Frame Est. cost_ $20,198 To be Completed _ _1 year Stipulations: Provide a hard surface driveway. Provide a verifying survey before capping. Agreement signed on Water & Sewer Laterals, SEPTE PERMITS REQUIRED FOR 10VIRING, HEAMM, PLUMBING AND SIGNS. In consideration of the issuance to me of a permit to construct the building described above, I agree to do 'he proposed work in accordance with the description above set fo and in compliance with all provisions of Ordinances of the city of Fridley. P 1 (i nn State Surcharge In consideration of the payment of a fee of $-5Z--a0 _ _. permit is hereby granted to p? t p P p r c i c to construct the building or addition as described above. This permit is granted the express condition that the person to whom it is granted and his agents, employees and workmen, in all wrork 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 buildiag8 theme city limits and this permit may be revoked a t any tune upon violation of any of the provisions of &aid NOTICE: This permit does not cover the construction, installation for whing, plumbing, gas heating, sewer or water. Be sure to sae the Building Inspector for separate permits for these hems, H APPLICATION FOR REOIDENTIAL, ALTERATION# 7ifl-CS"ol OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWM IS aME: 2.G^z4C 1c --N wiLWcr : &vLau-9 ADDRESS :.e7 R t/ cs742-7" /w�' ADMESS: J -i9 E; -6� W04 v S D ST t /U C, Not ! 3S ITION B i go 0 U 1 C W 2 ., 4ORM LOT: J==E LOT; ^,SETBACIti 3 5 SIDEYXW*. , ti -CA" attach " ##" fvj=_ o Certificates of Sutvex of Lot and proposed Imildtag 14eation dr4ta on t#ese Certificates, DESCRIPTION OF BUILDING To Be used As w � CC, •�- �/V o : � $eight Sgaare Feet; (r Cubic Feet-; Front,,_Depth ; e0 Al Height: %U r Square Wiest; 4 Cubic Feet i `(", Type of Coastructioni w�p�� Rsti�ated Cost: , Cf60 �c io on we so 11,� 4�:p 'ate uXiderpigned hereby asoma appli.cativu for. a pelt for the work herein speciftach, agreeing to do all cork in stftct accordance with the City of I&JWley ord$,sance8 sad -rut s pf Oa Department of Buildings, and hereby deolareo dWt all the facts and representations stated ta this application exe true a4 correct, (Oft RevW60 Sfdo For Addltlonal. Inforsgation.) x a Lact �Eenr�in� : : •: . 'U %� 6075 Highway No.65 go¢cei SQ4rvey inn ° �° Minneapolis �n '60115 Testing . ��p������ � �Td/s Minn. 55433 Civil fn! s?w-erinet Telephon® 744-6666 Municipal 6.rinhicoring Engineers � Surveyors Area Code 613 1 � r . Orfl9AOMt® :®� survey for �� GerrL K4r i n tine 0� �.o�i. 'UCS 6�". F�V�'riue lVOr1�1 [C,St . ;. l� -�. .. 407.8 - •.I _ • �8°t0S e ✓ trz�a ;' o �jca�e: L1r,c�t= � }eel ' 0 1 ON 1 .:v '• 01 9 - - o'0wo&'. ,W01)monume4j _ / qly 'r �,• r ( Cycoltme 2Y1Ctl2 a: i T6, Nortk I�S feet J Lot �-•� s } PIOCe I, ProoLview ?4 Aldit�orlJn a „ C f0i.a Ime of �6 1 �'�A �ar e� }� N.�. Nve. gorU M feet. I heireby certify ,thot this Is a true and correct representation of a survey of the boundaries of the above described lznclfl and of the location of Ill . buildings, thereon, and all visible encroachments, if anyi from or on said land.- As surveyed Is' mo this 2flt day of �e `�" A.D. 1972. L Il b� SUBURBAN ENGINEEMINGi MC' r Engineerl 5uryeyors + L r byq .. 4 . ' 3 r, � r4 .�' _ t � �. ...- is ` ♦ ... -. - . ' ' -. , p •`'' }1ti •..•i::�.WiuS.•..I.e.a:rNv.Lcxa, .--..a9.rbSi6� •. AY•.,u.,.., �•�.�.ii.l+.hk%uesA•sfad4..ta§'A`fi31..x1ryt'c91MJ�.{rS�iT%Armak-0lVd.5+R9M6:iWJALLLtltio'.�i�IL.1Rd3�uL'H}:C�: �P1L.as.-ue fadlY Ay,y,k^r .++. a .f �� :!�, a ... 11 1 SW ?,/� fit gr ® 3 X17 '�vzt� '� P �� ®� �,�� d /� �� / c�aaa�a ciao. n.-t-7 BCE. L lltii� "s �:tZ'.�u c+.cef�'a -� �^�. ��`�r��4�H➢ SGB' t�•`�SP�� a�? k.��.• @�&Fs 6'4�'S`n�B FBB�., il`G�" 'yiF$3. cq La ,e� os�®�,�,�� �4a �G� g x a",�2 d ZLa8 a3 Mr-, � �. t���a� d Da�cZ&P. and heu-e � ®sem 4�n�rs �9 9a�e Ea�9 @rplibiUm mm.r,,y3 �0 o�,rre,, owner / �O /C .t®C / 7 nt E PLUMRING FU 66 4r- ZhA ES: 1906 RATE TOTAL /k/00 Numbef Plzt res , ....... a .. ®.... x X00 8 rLlum r2s:,Wrc .Cijening ... .. N 2 781.60 New Fixture Old Opening ....... o . x :1.50 ; Catch ilvdn ... s ................ x 53.0 S Water Heater fup to 99.000 BTU) • • • • ®� 53.00 S �. vy New Ground Run Old Bldg. ........ x $3.25 S EleaL4c Water Kntw............. a 52.00 $ CAIS FdT'd NG FEES: NO. RATE TOTAL lot 3 Fixtures • ........ • • • • ... 2 U00 $--2- 60 Addttlonal Fixtures ............... : $ .75 $ Gas Raw to 190.0 ............ x $5.00 $ • State Surcharge $_ •?nom F"AMS A ALTERATIONS-4Wea bCogfis ........................ ..a....... ....� TOTAL FEE $ Kind of To be completed agnea �. Estirr aced CoM,, Old—New. nuilding Frit ROWH i i. 53-84-s-915.51 City of Fridley AppGadfon for Phmbbkg and Cas l "bq Pmt Dept. of Bldoa Phone 50-M DESCENTION OF WORK 1050 NE 68 Ave Number, Kind and Location of Fixtum Loom Base 1st =1 wAM ire. City of lridley: s o p cAs ncc The undersigned hereby makes application for a permit for the vrork herein: specMed, agreeing to do all work in strict accordance with the Qty Ordinance and reeling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, mm 5/31/73 19. Owner Peter Pereik PARTIAL RATE SCHEDULE PLIVNEING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ................ x $100 $ Future Fixture Opening ........... x $1.50 : .. New Fixture Oleg Opening .......... x $1.50 $ Catch Basin ... o ................ x $3.25 S Water heater 'Up to 99,000 BTU) .... x $3.00 S New Ground Run Old Bldg......... x $3.255 S Electrk Water Beater ...... . ....... a $2.00 $ GAS FITTING TEEM NO. RATE TOTAL 1st 3 Fixtures -X3100 Additional Thaum .............. x $ .75 $ Pias Range to 199,000 BTU .. ..... 1 x $8.00 $ 5.00 State Surcharge $ .50 REPAIRS A ALTERATIO S-4Wew to Ccdo _ Description o • • .. • • • •.... • . • •.• e... • ....... • ..•.... •.$ TOTAL FM S 5 a 50 Kind of Building �'rama Used as Res. To be completed about 6/4/73. Estimated Cost, $ 10.00 GTAX-New. Building Permit No. Permit No. Q8% Signed'vg ze avomodwr 00% 0. By Mmespaw- Business Phune No ROUGH FIIitAL � -•5 - Mass "'A• ,urs . 3e s,50 AppRcoflm for Fay 1kmft and Cw9age Venfilo n, Re/ri--own oe and /qtr Caedioabq Sydem wd Derhs PARTIAL RATE SCHELE GRAVdTY WARM AIA: saw TO?11L Furnace Shen & Duct Warn ................ -.Paw 6 Replacement of Furnace ..... . ..... .. ..... ao Repairs & Alterations—up to $500.00 ... &00 Repairs & Alterations each add. $800.00 3.00 NECIL WARN AIR Furnace Shell & Duct Work to 120,000 BTU .. - .. - .. - -SIC a0 t 10.00 each add 80,000 BTU .................... Aw # Replacement of Furnace .. _ . SAO S Repairs & Alterations -up to $500.00 8,0o $ Repairs & Alterations each add. $800.00 ... .... 300 t STEAM or HOT WATER SYSTEM Furnace Shell & Lines to 400 sq. ft. EDR Sty 510-00 $ Furnace Shell & Line—to 840 sq. ft. IDR Hot Water 1000 Each add. 200 sq. ft. EDR Steam 11100 Each add. 320 sq. ft. IDR Hot Water &00 t OIL BURNER—to 3 gal. per hour 8x00 $ over 3 gal. per hour --See Fee Schedule GAS BURNER (up to 19!.000 BTUI ... &0 over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures .. . ..... =S 200 $ D U Additional Fixtures x .75 9 Gas Range to 199,000 AIR CONDIT'IONIIIG FAN HEATING SYSTEM See Fee 8dhadble VENTMATiNG SYSTEM ALTERATIONS & REPAIRS TOTAL FES 1 ROUGH (SURCHARGE $_,50) Dept. of Wdgs. Phone 8804490 E 1-r City of Fridley: 0 The undersigned hereby makes application for a permit for the work :hereir 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. -- Minim- ■, 18 — ?IrCri G Kind of Building i%1 e, LAJ — ti ' e-5 t Used as - - -- - - Q 1gn e- - - To be completed about _— cf 7 3 Estimated Cost, $__ _.- __ -- Old—New. Building Permit No. Permit No. DESCRIPTION OF WORN HEATING or POWER PLANTS--Steamq Not Water, Warm Air—No Trade Name Size Ne- Capacity , 60 0 Sq. Ft. E.D.R- BTU H.P. Total Connected Load Rind of Fuel - BURNER — Trade size No Capacity Sq. Ft EDR BTU IBP. (XIM►RaS—OWRI Business Phone X'-'7 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS Weatherstrips A.S.H.V. . Construction No. Guide Windows( Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Yes—No Yes—No 19_ FI.I L i ., i m.tRoom I Length 1 Width `!o Height S II Fl Windows and rs—Crackage and Area f �- aacaaau Width Height No. of Lineal ft. Area No. of panne of Dane lights of crack sq. ft. I C1 O L1 70, Coef. Btu Infiltration Coef. Btu Glass Exp. wall Net exp. wall Int. wall Ceiling Floor 1 otal 13tu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area r -i 1 i\ . % n I r . . , ....._. , ..I r Vt k.t ..I ..c..au. f .r.& f �- aacaaau Windows and rs—Crackage and Area I C1 Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. L1 70, Coe£ Btu Infiltration Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor 1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1 c, a P YdRoom I Length l 6 Width / Height Windows and Doors—Crackage and Area L, rieign[ Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. I C1 Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. L1 70, Coe£ Btu Infiltration Coef. Btu Glass Exp. wall Net exp. wall Int. wall Ceiling Floor 1 btal k5tu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FRIDLEY, MINN. Insulation Kind How Applied .� Koom I Length I U wiata L, rieign[ Windows anJ Doors—Crackage and Area 3� Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. L1 70, Coef. Btu Infiltration Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I- Fl.l a Room I Length /'2i Width /q G"Height V Windows and Doors—Crackage and Area v V •.6.a.• Width Height No. of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. 3� 7 L1 K 36 Coef. Btu Infiltration Coef. Btu Glass Exp. wall Net exp. wall Int. wall Ceiling Floor L .ate i .lam .8.1 V -G- f{ a%vv.w 1 &/luau. 1 — n..a... v V •.6.a.• Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. L1 K 36 Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor 1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Effective On January 1, 2001 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 763.572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES C JOB ADDRESS_/022g-=}' -4W. IVIE. RATE SCHEDULE OWNER ��J/%(.L�'U,Q, ��d�C, • Residential Rate TOTAL Furnace Shell and Duct Work, Burner BUILDING USED AS Also Replacement Furnace $ 30.00 $-2,3100 -�® (Side Vent - Fill Out Back) ESTIMATED COST 1300-6-0 PERMIT N0. LA— Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ No. of Heating Units_ Circle One (Steam) (Hot Water Warm Air) Trade Name i�e.i I Size No. O *Air Conditioning - All Sizes $ 25.00 $ BTU °ZS�, O� HP EDR Fuel N Total Connected Load Sy4,3bb 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 State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. TOTAL FEE DATE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr ROYALTON HEATING & COOLING HEATING CO 4120 86th AVENII IE NARTH BROOKLYN PARK, MN 55443 Signed 424 TEL # _ O *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Daii written permission from adjoining property owner. 4 BACK SIDE MUST$E FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, Yes No ( ) and is securely supported and firestopped where required. The venting system is plastic/PVC and meets all current codes and manufacturer Yes () No (' specifications including sizing, length, number of elbows and termination. 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 ) No assisted and natural draft appliances. Yes ( ( ) The existing combustion air is sized and installed to meet the current codes Ye451No t/ - and manufacturer's specifications. " When required to install a new combustion air,_it will be sized and installed specifications. Yes No( ) to meet the current codes and manufacturer's When installing a new venting 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 No Yes ( ( ) Venting Tables for fan assisted and natural draft appliances. Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented Yes- A No( ) separately as per current codes. Apaliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type A"�� BTU Input �' 40 Fa Assi or N �11 Appliance #2 Type 1�V BTU Input an ssisted r Nat Appliance #3 Type BTU Input Fan Assisted o at Total Appliances Total Btu Input ja La h � lr Common Vent Type LcU� Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type C. Appliance #2 Vent Connector Height �_ft Length �ft Diameter in Type C.. Appliance #3 Vent Connector Height ft Length ft Diameter in Type LTERATIONS: (Describe) 4120 - 85th AVENUE NORTH BROOKLYN PARK, MN 55443 HEATING CO: / Signed By: '�� Date uliF�tT LOSS CgL,C�1LAT101VS DEPARTMENT OF INSPECTION '�lersirips � , Coaalntction No. Wca Kind 3lindaas Dvon Reference Out. Wall Yat. Wall Ceding Roof Floor _ 71IRT I 19_. Room, I R.I boom Length Width Height F1.I Windows and Door& --Cr MJP1N. laanlatioa How Applied Wkkk H - Windows and Door s--Crackacc Wad Ates Glans 1e� u.trac Ho. of cries �i_ti 1V 14&h of oom Ilrn i of n cY .Aa� t4 Nei exp. wall Na of PA-4of Pon. l -$v of of panii Coling Floor Total Btu. a�72, E.D.R. or sq. ins. WA Leader area F11 C z c Coef. Bin _ ' ( X5(00 ao Infiltration Ghm Glass wan ExpFsp. wall Zec Net e*. wall Net ra p. waU Net Int. wall lot. wall _ Caiiiag Ceiling Floor Floor i Total Btu. Total Btu Rrqutred aq. ft. FrDR or sq. iris WRequired sq. ft. ED.R or aq, ins. wA. Leaderrea Width Height FlJ Room I L.aagtb Room Length Wmdows and Door*—Crack&Sc and Arra Windmows and Doo—Crackage and Are+ llsAu of cr.cta oa �rL. w latA . ArM Noleat N. at Or:at .O- rc No, of Sana. of t+e. No. et V&m of Pa.*IcrAu lnbJtration Glans Esp. wall Nei exp. wall Int. waU Coling Floor Total Btu. Rcauircd sq. ft. E.D.R. or sq. ins. WA Leader area F11 Ronin I Length width Windows and Doors—Crackagc and Area Width it.laat No. at 13.0 tt. Aha 11 so,of a'". aq• tt. No, .f vaho of D.IN Jrlhltr+tioA Ci: aa1 gyp. wall Net ezp. waU Int. wall Ctlling Floor Total Btu. _ Required K. ft. or sq. it1s. W.A. L.raoer area Glass Exp. wag Net e:p. wall lot. wall Ceiling Flaw Total Btu. Rtevoirod at}. ft. J(n(tlt.atsoa Calaw Exp. wall Net tzp.. mall {at. wall Ceiling Flow &v or s4 iaa. WA Leader area 1 stn { I ems+ W khh Hei at _['sae3caaoe atxi An• Eku ftE.DR or aq.inn. W.A. Loader arra l ... TOTAL P.03 3uilding BUILDING 6.3 Z! Permit N • ZED �nspectians r RESIDENTIAL APPLICATION Received By:., 763=572-3604 CITY OF FRIDLEY Date Rec'd: AIL ADDRESS SATE — © YOUR E -M ;ITE ADDRES u crltaz� r, n -IIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: �}�%1 G i c' ADDRESS: CITY STATE ZIP TENANT / PHONE n(o5 — S-7 i — t 9 3 CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEw ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENTJ LENGTH WIDTH HEIGHT Sq. Ft. ROOFING HOUSE ONLY NUMBER OF SQUARES 411HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE I. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -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: (USING THE 1P97 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $_ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due 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 payable 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 requ es review a approval of plans. SIGNATU1tE OF APPLICANT PRINT NAME 5 hon lG 2 rZk—'DATE $ r $ 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 payable 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 requ es review a approval of plans. SIGNATU1tE OF APPLICANT PRINT NAME 5 hon lG 2 rZk—'DATE FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, understand that the State of Minnesota requires hat all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. As the owner of the property at_ 105r) (og�+h t, N k, , Fridley, am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that am improving this house for my own use and do not intend to sell it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, isl the first residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. 514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to the City of Fridley for compliance with all applicable building codes and city ordinances in connection with the work being performed on this property. Name,,�,� Date_Otv-;