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PRE 2010 DOCSDate: Owner: Address City of Fridley, Minn. BUILDING - PE T N° 5 3 0_5) OCATIONY BUILDING No. , Streett_,e� Part t Lot___ _Block Addition or Sub -Division -'- Corner Lot _ Inside Lot +f"' Setback �s Sideyard Sewer Elevation _ Foundation Elevation DESCRIPTION OF BUILDING T UAIL Front Depth Height Sq. Ft.11Y_' Cu. Ft. 96 Front Depth Height Sq. Ft. - CU. Ft. -� Type of gnstruction - +.-_W Fat. Cott -i - 7 01 -.-_ To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do ==work 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 $ , permit is hereby granted to— to oto 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 the provisions of said ordinances/' �p Inspector NOTICE: This perms does not cover the construction, Installation for wiring, plumbing, gee heating, sewer or water. Be sure to see the Buildino Inspector for separate permits for these Items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY.. MINNESOTA Owner's Name Builder Address Address LOCATION OF BUILDING No. ! `l Street (o �/ V Part of Lot Lot Block Addition or Subdivision,, Corner Lot Inside Lot /b Setback Z� Side -Yard /0 SEWER ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. DESCRIPTION OF BUILDING To be used as: Front _Z4 Z�®"fight Sq. Ft. P q 9 Cu. Ft. -® Front 2- 1b Depth 2 Z Height Sq. Ft. U !;j (0 Cu. Ft. Type of Construction Estimated Cost0 92 Q To be Completed . / ` 6 j The undersigned hereby makes application for a permit for the work herein 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. c� DATE S L q — Ca 1 SIGNATURE (A Schedule of Fee Costs can be found on -the Reverse Side.) City of Fridley ApplicaA m for Plumbing and C =fitting Permit DepL of Bldgs. Phone SII 4-7470 DESCRIPTION OF WORK Number, Kind and Location of Fixftres PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ............. ......... (2 s $1.50 Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Rim Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code City of Fridley: The undersigned hereby makes application for a permit for the work herein 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 'RMnn. and correct. -/' Fridley, nn Z! /tr19i—. Owner Kind of Building / / Used as e To be completed about Estimated Cost, $ lop _ Old -0 Building Permit No Permit No. 12 76 Signed �� -*1 7 By Business Phone No -� Ji j ROUGH 1 -%$ — G FINAL Description................................................1 TOTAL FEE $ 48 2M 7-59 3 w iF cu a n 3 0� m c3 Z n0 • . WATER HTR. GAS Eur- Base 1st 2nd _ 3rd I 4th Ll 1 d -1 • Fntnre Connection Openings e New Fixture, Old Openings Connected llh w Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ............. ......... (2 s $1.50 Future Fixture Opening ................ x 1.20 $ New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Rim Old Bldg . ............ x 3.25 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 Additional Fixtures .................... x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code City of Fridley: The undersigned hereby makes application for a permit for the work herein 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 'RMnn. and correct. -/' Fridley, nn Z! /tr19i—. Owner Kind of Building / / Used as e To be completed about Estimated Cost, $ lop _ Old -0 Building Permit No Permit No. 12 76 Signed �� -*1 7 By Business Phone No -� Ji j ROUGH 1 -%$ — G FINAL Description................................................1 TOTAL FEE $ 48 2M 7-59 it Application for Power Punts and Healfitg. Cooling, Ventilation..Relriigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $- Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work to 170,000 BTU ............ 8.00 $ .each add. 60,000 BTU ........................ 2.00 $ _ Replacement of Furnace 0.00 $ Repairs & Alterations—up to $500.00 .... ............ 5.00 $ Repairs &Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. IDR Steam....... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water ................. 1 2.50 $ OIL BURNER—to 3 gal. per hour ......................... 5.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ......... I ............. 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ..... x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ ' AIR CONDITIONING $ 4 i FAN HEATING SYSTEM See Fee Schedule b VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FFE ROUGH FINAL Dept. of Bldgs. Phone SII. 4-7470 t City of Fridley: The undersigned hereby makes application for a permit for the work herein 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 applicationJULarrtrue and cogrrect. idle Mips JU17 O Ii , 19 Efi� Y. — Owner :' 14 --al Kind of Building Used as To be completed about SEP CC, _ Estimated Cost, $ -5t-o7 New.building Permit No. Permit No.k-61 DESCRIPTION OF WORK HEATING OERMW ) -Water, Warm Air—No Trade Nam 0' `� �' -_� .� Size Nod Capacity Sq. Ft. E.D.R J2 2 -L BTU H.P. Total Connected Load L- ' Kind of Fuel BURNER — Trade Nam �!�' r%'`�� Size No. .; �z % Capacity Sq. Ft. E.D. j '!,L A ��BTU � H.P. GEO. S GWICK HTG. & AIR -CONN. CO 1001 Xenia Av. S. / Minneapolis 16,. Minn. SignBy��• 4.42 2M 7-59 Business Phone! No (REMARKS -OVER) . Y , r&A11!1A t6t�gJ-/iP� �1 6A— -Y — /J-." J., 3)( _ . , r . Ddb 41ffiak.79 4&/L � L VCv '— 37, 6.31. HEAT LOSS CALCULATIONS DEI AR�'�l M OF BUILDINGS MINNEAPOLIS. MINN. Weatherstrips A.S.H.V.E. / Construction No. Insulation Ceiling Guide Floor Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No I Yes—No 19— Coef.1 Btu Infiltration I/➢/ 11000'1' -- F1.1 Lig t 0I Room I Leng _Width Height Fl. Room ILength ! Width e Height Windows an oors—Crackage and Area Windows and Doors—Crackage and Area Width Height No. of Lineal f . No. of pa e f p ne lights of c ck Area sq. ft. / �o; dd Width Height No. of Lineal f . Area No. of pane of pane li hts of crac eq. P a Infiltration % Glass Exp. wall `'i <� Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI fp Room ( Length Width - Windows and Doors—Crackage and Area Wldth Height No. of Lineal ft. Area Nof pane of pane lights of crack sq• ft. Y/. o 2_/ 1 / -7 1'0 Btu Infiltration Glass Exp. wall 3t/V Net exp. wallVb1 Inc. wall Ceiling Floor Total Btu. a Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl. dj Room I Length ,,a Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pan of pane lights of crack sq. ft. Infiltration vp Mo Glass f"1S'�7�Y•: Exp. wall Net exp. wall Int. wall —� Ceiling MINK• Floor Total Blu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area lip Glass Exp. wall Net exp. wall Inc. wall Ceiling Floor Total Vu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area —9 94M Fl.IRoom I Length l Width !� Windows and Doors—Crackage and Area Width Height No. o! Lineal ft. Area No. _ of pane of Pana lights oP cracker sq• f Glass Infiltration j Glass Exp. wall Net exp. w1111 7 % / Int. wall Ceiling / `. Floor Total Bru. Required sq. ft. E.D.R. or sq. ins. WA. Leader area ® Fl.V 313.4 Room I Length / 0 Width // Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. I Area No. of pane of panej lights of crack sq. ft. 9q 30000' 0/7 Coef.1 Btu Infiltration I/➢/ 11000'1' -- Glass Exp. wall / (� Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader ud CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PEt4IT PARTIAL RATE SCHEDULE PLUDMING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 . $ Catch Basin x $5.00 w q C• x $5.00 S u x $10.00 0 water Softener Water A a �! N 0 .i x 0 $ H 4 .1 h m o N b 4 a CL w 1st 3 fixtures x lieater ,•i64 O d O14 h $1.00 0 x q 3 O .[t O .0 u 0 $ each add. $100.00 or fraction 41 4 State Surcharge * �o�yyf TOTAL FEE 3 4 W 0 C N U A N N a 9 N .,,N{{ ryNp leC 9Q W to W N 0, s (7 O a3 1st gri Li 2nd 3rd 4 (k) s Future Connection Opening Connected with Sewer f•} New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUDMING FIXTURE RATES: NO. RATE TOTAL Number Fixtures x $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 . $ Catch Basin x $5.00 $ Water Heater— to 99,000 BTU x $5.00 S 100,000 BTU to 199,000 BTU x $10.00 $ water Softener x $7.00 $ New Ground Pun Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x '$3.00 $ Additional Fixtures x $1.00 Gas Range to 199,000 BTU x $10.00 $ REPAIRS & ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $$2.00 $ State Surcharge TOTAL FEE $ 8.00 RF.Zt:.^..riF:!'TIr�!! F•1?F. 97-84-416051 Job Address 271 69th Av NE Department of Buildings City of Fridley Tel. #571-3450 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 and rulings of the Department of Buildings, and hereby declares that all the Pacts and representations stated in this application are true and correct Fridley, Mn. 5-31-78 , 19 OWNER WAGES KIND OF BUILDING frame USED AS res TO BE COMPLETED ABOUT ESTIMATED COST 20.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. Com A ., Signed 69�� MfNNEGASCO. Tel. No. ROUGH INSP. Date FINAL INSP. /— / 5 Date APPROVAL FOR PERMIT 1 MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SUrj=m iGE o� SUBJECT PE City of Fridley 1834 AT THE TOP OF THE TWINS BUILDING PERMIT i � • COMMUNITY DEVELOPMENT DIV. r ; ,;------, INSPECTION � �- � PROTECTIVE SEC. / ?.4 1 ` -'1.� CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY ----� L 612-571-3450 910-F15 3/24/86 JOB ADDRESS 274 - 69th Avenue N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 3 Rice Creek Plaza North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dr. Sharon Wachs 274 - 69th Avenue N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Richard Hastings 6331 Riverview Terrace N.E. 574-9966 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 CR ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling 9 CHANGEOFUSEFROM TO STIPULATIONS Roof can be the 2nd layer but not the 3rd. Install ridged galvanized valleys 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 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 1_1 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,500 $.75 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. $25.00 LAN CHECKFEE TOTALFEE 21 ^-� $25.75 e- �? SIGNATURE OF CONTRACTOR OR AUT ORIZED AGENT (DATE) WHEN PROPERLY INSP YALIDATEDIS IS YOUR PERMIT 7 I DA SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI o� NEW [ ] City of Fridley Effective 4/1/84 ADDN. [ ] I R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: % L/ AVE Legal Description: 1. 7F 64 �� 3 K:cc c Reza K -A ze-, Mo. _ Owner Name & Address: I�AA-d OAck s Tel. # Contractor: ` "CL' FLtZO /YA i11/6S T.e1. # Address: 6331 T�riZ 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: _ Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Type of Construction: i a Z' F Approx. Completion Date: �l SAz Side Yard Setback Estimated Cost: $ —ZSb C> _ D8 Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: _ $ _ $ See Back Page for Explanation DATE: _ APPLICANT: Tel. # S7V^?ZGC CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Plan Check $ 25% of Building Permit Fee State Surcharge $ 7�� $.50/$1,000 Valuation SAC Charge $ $425 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ f 0TAL $ STIPULATIONS• I Ar 01 SUBJECT - PE City of Fridley 2661-2 AT THE TOP OF THE TWINS BUILDING PERM Ir r 1 ______ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. i; J r i 4" 1 I ((( NUMBER REV DATE PAGE Of APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 7/15/98 JOB ADDRESS 274 69th Ave N. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 3 Rice C SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bob Garrett 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Roof Ddesi n Partners 4026 7th St. NE Columbia 14pightF.9 99421 789-6566 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 M REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house 25 Sq-) Tpar—iniff 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 BO 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 NCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED AND ORpt WITH W ET ER SPECIFIED H IN OR NOT. THE GRANTING OF A PERMIT $2085.00 $1.04 DOES N T RESUME TO GI E UTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISI NS OF ANY OTH TE OR LOCAL LAW REGULATING CON- STRU R THF ERF RM CE OF CONSTRUCTION 74.75 Fire gC $2.08 PLAN CHECK FEETOTAL E icens S .00 8 .87 SIG AT UREOFCONTRACTORORA HORIZEDAGENT IDATEI N P PE LIDA E41S IS Y UR PERMI BLOC IK! ?5— PATE S.GNATURE OF OWNER OF OWNERS -ILDERI IDATEI I Ar 01 NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Z7/ (oAJ% , Legal Description: Owner Name & Address: Tel. Tel. # r Contractor: MN LICENSE # ?GMc/D 7 Address: Tel. # ` K-? —/ S L&2 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: -F,,-- 9 1 6c-,00' Driveway Curb Cut Width Needed: Ft. + 6 Ft = Estimated Cost: $ (Fee Schedule on Back) Ft x $ = $ DATE: -7-15 -%Y APPLICANT: -P' T�'S z ti Tel. # -7?9- (54 - STIPULATIONS: 9 CITY USE ONLY Permit Fee $ 7,A 75 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 $ 37Lk> $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 [ ] STIPULATIONS: 9 SUBJECT City of Fridley C30858 AT THE TOP OF THE TWINS BUILDING PERMIT � RECEIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. � [%� P�� r PROTECTIVE F �'j CITY HALL FRIDLEY 55432 NUMBEF+ pEv GATE PAGE OF APPROVED By L 612-571-3450 910-F1S 4/25/00 JOB ADDRESS 274 69 AVENUE NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 9 1 Carlson's Summit Manor South Addn SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Garrett 274 69 Avenue NE 572-8860 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Mon -Ray Inc 801 Boone Ave N, Golden Valley, MN 55427 546-8625 5111 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 O ADDITION O ALTERATION 6 REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Replace 5 window sash & 2 casement windows within existing openings 9 CHANGE OF USE FROM 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. Permit Inspection Gatus Will Be Wails To Homeowner 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 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 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 $3.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6,000 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- $125.25 Fire SC $6.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL F E License $5.00 $ 39.25 SIGNATURE OF CONTRACTOR OR AUTNORiZEO AGENT (DATE. EN LIDAT D HIS IS Y ERMIT MPR ASP qA S-GNATURE OF OWNEAoF OWNER BUILDER, DATE,BLDG NEW f l Effective 5/10199 ADDM - [ l CITY OF FRIDLEY . SINGLE FAMILY AND DUPLEI S R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: 274 69th Avenue NE Legal Description: Owner Navane & Address: Robert Garrett 274 69th Ave NE Fridley Tel. # 572-8860 Contractor: MON-RAY, INC 801 Boone Ave. No. MN LICENSE # 0005111 Adm; -Golden Valley, MN 55427 Tel # 546-8625 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LPMG AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width height Sq. Ft. DRAM AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Replace (5) Window Sash & (2) Casement Windows Construction Type: Residential Estimated. Cost: $ 6,000.00 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft a $ _ $ DATE: APPLICANT: Tei. # 546-8625 CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee . Sewer Main Charge TOTAL STIPULATIONS: S 125.25 $ 6.00 $ 3.00 $ $ 5.00 $ 139.25 Fee Schedule on Reverse Side .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 [ J Not Necessary [ J R0iz0 ' d LL689bS Ol A3 -1Q I dd d0 Al. I O WONJ 62:60 666 T-LT-Nnf -ITY OF FRIDLEY INSPEC•1 iUN DIV. 1431 University Ave NE Fridley, MN 55432 763-572-3604 Urinal Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF Shower NO. RATE TOTAL New Factures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas" Gas Range" Gas Dryer" Back Flow Preventer Required ( )Yes () No Type TURES TO BE INSTALLED ON EACH FLOOR WashD >-<: Floor Auto. Trav 'I`it~w' " Drain 5i' Washer $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00!®_ 08 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge $ 50 Effective On Jan 1, 2001 Gas JOB ADDRESS o?7 19 Cl Dive_ IVE, Gas Heater 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 and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. Owner W (� s ' ,20Q% Building Used As -ES Estimated Cost oL'/9P. i�0_ PERMIT NO. ` PLUMBING COMPANY C- 12�- SIGNED BY �' TEL N0.76 3 -SW 8�r6o Approved By Rough -In Date Final Date 02 _6 TOTAL FEE$0-1-5:021'"'S THE S.60 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE 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, and is securely supported and firestopped where required. Yes ( ) No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes ( ) 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 1 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 ( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturers specifications. Yes ( ) No ( ) When Installina a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) 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( )No( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input 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) HEATING CO: Signed By: Date : 11 ;ITY OF FRIDLEY INSPECTION DIVISION 1431 University Ave NE =ridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 763) 572-3504 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE lesidential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON RACK) 1%® of Value of Appliance or Work :ommercial/Industrial 1.259 of Value of Appliance or Work Rate TOTAL $ 30.00 $� $ 10.00 $ $ 10.00 $- $I0.00 $110.00 $$25.00 $4�s� State Surcharge TOTAL FEE :-INSPECTION FEE $47.00/Hr Air Conditioners can not be placed in a side yard without rritten permission from adjoining property owner. 3- .50 JOB ADDRESSL"�,T BUILDING USED Effective On January 1, 2000 elC��C-0� ESTIMATED COST&)D _ PERMIT NO. DESCRIPTMN OF FURNACE AND 40 RURNFR x 0 3 2 No. of Heating Units Circle One (Steam) (Hot Waterr(=WarmAir) -mac Trade Name�� 'j%/ Size No. 0 BTU HP EDR T Fuel _. Total Connected Load Burner Trade Name_ _. Size No. BTU .._ HP EDR The undersigned hereby makes application for a permit for the work here! n specified agreeing to do all work in strict accordance with the City Codes an rulings of the Building Division, and hereby declares that alI the facts and representations stated in this application are true and correct. o DATF Signe 1ATEL # m Approved By R®ugh-In Date Final Date'o� lel c' Q1 BA K DE FORIATACK 1 0 N PLACE T F NA 'o m `H3 l� N Z®'d -1b101 COMMON VENT, VENT CONNECTOR ANP COM011STION AIR VERIFICATION When replacing an existing furance the undersigned hereby verifies that the venting has been examined and Is gree from rust. deterioration, obstructions, and is securely supported and firestopped where required. Yes (✓'No ( ) The venting system is plastid C and meets all current codes and manufacturer specifications including suing, length, number of elbows and termination. Yes (-1'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 -LAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (.,,;tN o ( ) The exis 'ng goM_ku_jAqn air is sized and installed to meet the current codes and manufacturees specifications. Yes (-J'No ( ) When required to Install a new combustion air. it will be sized and installed To meet the current codes and manufacturer's specifications. Yes (-J'No ( ) When installing a neve venting system, the undersigned hereby verifies chat it Is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMiA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes (-�'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 O/No ( ) Appliance Tye and SizeJComrnon Vgnt:and Vent Connector Information Appliance #'I Type t 1� 1i1 IIS BTU Inpu4 Fan Assisted or Nat Appliance #2 Type STU input Fan Assisted or Nat Appliance 93 Type _ , BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #f 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 &JE TIO S: Descri e HEATING Co - e - A Signed By: Date Z0/Z0 ' d se5868L 01 ATI I bd do Al I a W02rd BS : Zi 0002-ZZ-nDN J / Lj 01 SUBJECT City of Fridley (34042 AT THE TOP OF THE TWINS BUILDING PERMIT � RECEIPT NO. COMMUNITY DEVELOPMENT DIV. i /� r � PROTECTIVE INSPECTION SEC. /�T/� 6 � NUMBER REV DATE PAGE OF APPROVED By ` CITY HALL FRIDLEY 55432 ` ��'�',•� -.__ L J ` 763-571-3450 910-F15 12/1/03 JOB ADDRESS 274 69 Avenue NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 9 1 Carlson`s Summit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Garrett 274 69 Avenue NE 763-572-8860 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Modern Concept Builders Inc 10748 Direct River Dr, Coon Rapids, MN 55433 3114 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 763-427-6163 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION (i ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Remove basement paneling and install sheetrock, R-11 insulation, p and i 09f barrier 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 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 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 WITH WHITHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT @@ W8,500 @@ W4.25 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- STRUCT ON OR THE PERFO MANCE OF CONSTRUCTI N $167.25 Fire SC $8.50 / / PLAN CHECK FEE Licn C 5.0 TOTA EE .00 SIGN. TUBE O CO ACTOR OR AUTHORIZED AGENT iDATE� EN0 P*CyifALID MIS IS YOU7P#'M IT �3 SIGNATURE Of OW NER dt DINNER BU4 DE Ri —[DATE, BL iN o r rt 01 NEW [ ] CITY OF FRIDLEY ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 ALTER [ J SINGLE FAMILY AND DUPLEXES R4 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Ai Contractor. 1 v� Address: / & 7 4e LIVING AREA: GARAGE AREA: DECK AREA: 7 41 % cd,C._r_ Je;r- I)tprJt'. I Effective 1/1/2003 (763) 572-3604 Bldg Insp (763) 571-1287 Fax Tel. # J 7Z Pf66' MN LICENSE:03 % Tel. # 14:2- 77 /TTS C&c'Ff-%(" /")ice Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Length Width Height Sq. Ft. Width Fie LPSq. Ft. I a - rr. OTHER: /I. ' ��r.-.•� Construction Type:A_"V�-��_ Est,mated Cost: r � � Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ DATE: b APPLICANT: Call (763) 572-3604'for Permit Fees if mailing in application. Fax to 763-571-1287 if call you for card number. CITY USE ONLY - Permit Fee $ Fire Surcharge $ o State Surcharge $ 5 SAC Charge $ License Surcharge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ Tel. 0 n4 credit card and we will 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 [ ] Apf kw&( eoo1� l� I� s�C tints 1n beaeft wad f,o Framed with double headed, proper size. � rel ► — THIS JOB COPY SHALL. BE AVAILABLE ON THE JOB SITE FOR THE FRAMING AND FINAL INSPECTIONS O} fICiA,f. f"EVIEW Atilt) Ej _il}..�IiiU �,ii'i},• 4i U`,f10?} f',Eie'il r� PF,I%4i 10 C1iP.F}G:S, P.,QDfl0A1101i9 OR AL'fEf":r+tlV :� I VAps�t �2rr�t1 `a.�o v i e CITY OF FRIDLEY INSPECTION DIVISION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, (763) 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES FAX (763) 571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of AppliaWE= g, ��- Commercial/Industrial 1.25% of Value of Appliance or Work Rate TOTAL $ 30.00 $ $ 10.00 $ $ 10.00 $ $ 10.00 $ $ 25.00 $ State Surcharge TOTAL FEE $ .50 C��_ MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATIO REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. JOB ADDR Effective January 1, 2UO3 OWNER Ltd- _ BUILDING USED AS ESTIMATED COST % 6. 0 PERMIT N0. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units_ Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR 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 rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. HEATING CO DATE TEL #IT3--��-17— FAX # Z4 Approved By Rough -In Date Final Date /,V/ J 163 FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED r -QM QK1 VFNT Vr=NT CQNr%1FGTQR AI`D r.QMR1 IRTIM AIR WRIFICATIMI When a ina an exietina fitranne, 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 (1 No ( ) The venting system is plasbc/PVC and meets all current codes and manufacturer BTU Input specifications including sizing, length, number of elbows and termination. Yes( No( ) The undersigned also verifies that the replacement unit is a listed assembly Fan Assisted or Nat and meets the current codes and manufacturer's specifications. This does BTU Input include AGA-GAMA Category I Central Furnace Venting Tables for fan Total Appliances assisted and natural draft appliances. Yes () No ( ) The is sized and installed to meet the current codes Vent Height and manufacturer's specifications. Yes () No ( ) When required to rnetall a new enmhusfen airy it will be sized and installed ft Diameter in Type to meet the current codes and manufacturer's specifications. Yes( No( ) When jpctnifinn a new ventingiysWm, 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( ) 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( )No( ) Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input 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 M HEATING CO: Signed By: Date: 0 3uilding $ BUILDING Permit No.: , ' hspections RESIDENTIAL APPLICATION Received By: 763-572-3604CITY Surcharge OF FRIDLEY nate Recd: '06 "(I License Surcharge $ SAC Charge $ Curb Cut Escrow $ i HIS APPLICANT IS: ❑ OWNER ZCONTRACTOR PROPERTY OWNER/ NAME: ADDRESS: ?�' 6V • C CITY /l STATRIP_ jc� TENANT Total Due PHONE5T,e�� o t -i . CONTRACTOR NAME: /VD �s ( L® xe- +e-62 41'--f �- STATE LICENSE # EXP DATE --4r 7 SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS-,fd ;13�°� "� ZV E CITY vi A%Q/ 2 STATE�IP�y WITH APPLICATION PHONE — 768= / � FAX PROPERTY TYPE MNGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYNEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING R OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: -7 �.a� SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & 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 I . 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 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 1,-0®. 04-r-' OCCUPANCY TYPE Permit Fee $ ,®-s 6---3,0-s Plan Review $ Fire Surcharge $ 1 . (o Surcharge $ %k License Surcharge $ SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ o t -i . 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 wor hich requires review dd proval of plans. SIGNATURE OF APPLICANT /f�� n�S n_ PRINT NAME �'/9/�I BS Xh6e&ODATE 3'-,- �� Building Inspections 763-572-3604 BUILDING RESIDENTIAL APPLICATION CITY OF FRJIDLEY" DATE -q - Q -1_ YOUR E-MAIL ADDRESS SITE ADDRESS THIS APPLICANT IS: O OWNER *.ONTRACTOR TENANT ADDRESS: ` - L'i LO'A� try � . P G Cyry—Un-a—U PHONEZI) -S�O .. CONTRACTOR NAME. sin e V+ e is V) oy _ , STATE LICENSE' p EXP DA'rs -3 (- O SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: -1 V Gl e .-CTT) WITH APPLICATION I pMNa - r•Ax (P51- Z8-7—QV 1PR0I'ERTY TYPE _ ANGLE FAM-_. Y/NEW CONSTRUCTION 5 _QTADITZQ PERMIT'1'Ygl, ,,,,.....�.. EN t] --•-- -- O BA.'+13Mh'N.TFINISH ROOFRAEN TILE E7 DECK 13SIDING i:7 OTHER CJ SWII�MRnVG PUQL TYPE OF Wd]tK; 1113, NEW M" MAIl DESCRIBE WORK BEING DON] SIZE OF IMPROVEMENT _ _ NUMBER of SQUARES GA><tACF� PRO]?OSE?D SIM PROPMED HEIGHT: O Vinyl 0 Aluminum Q lather �� WIN IN BXISTING Oft-NNGS E140S IiNo OR FOR NEW OPENINGS -DESCRIBE SIVE OF OPENING CHANGES & `rwT; ne WiNnnw TO BE INSTALLED—L ALL V T-- - LENGTH WIDTH ❑ HOURS ONLY 17 HOUSE & GARAGE 0 ATTACHED GARAGE Q DETACHED GARAGE E]SoYiit . G Trim Fastin LOCATION OF WINDOWS BR OFVINDOWS JLUAT'ION, IN•CLUAING THE COST OF Lj SING THE 1997 U.B.0 IME SCHEDULE) fiTATE ZIP 55113 Ft. 1. Existing Flair Plan 2. Proposed fic or plan 3. List of strueural members to be used FOR NEW CONSTRU C110N INCLUDING DF�CKS, 1. Sita PIWA ey showing Ute existing structures and prop 2. Two sets oectct on plain 3. prmgCtiom S �� TOTAL JOB VALUATION $ r7il OCCUPANCY A A A Permit Fee $ See back Page for Pee Schedule Plan Review S 6so/o of Building Permit Fee Fire Surcharge S D .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 $5.00 Staff SAC Charge $ Licensed Residential Contractors) lade Surcharge $ $1675 ft+ 6 ft = — ft x $21 - $ r SAC Unit {Plans to MWCC for determi Curb Cut Escrow $ _ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering sewer Maid , .ge $ Agreement necessary ( ) Non Necessary ( ) Total Ilue $ Make checks PaYablE to: Cft of Fridle THIS IS AN AppLICATION FOR A PBRMrr-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknawledge that the informatieur above is complete and accu conformance with the ordinances and codes of the City of Fridley and with the Minnesotta Construction Codes permit but only an application for a permit and work is not to start without a permit-, that the work will he in plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICAI�0 T NAR4E„ Attach ite; that the work will be in that I understand this is not a ,ccotdance with the approved 7d ldd?0:b0 LOOZ Z0 'Int Z8zZZLS£9Z: 'ON XUA FiaiptaA !o F�I7: W0�1A