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PRE 2010 DOCSC� 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 a'll provisions of ordinances of the city of Fridley. / Connecti In consideration of the payment of a fee of $ 40.00 , permit is hereby granted to Clemron. Inc. 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Official Building¢ NOTICE This permit don not cover the construction, PnshlWon for whing, Plumbing, gas hod M& sewer or water. Be son to no the Building Inspector for separate permhs for than hens. City of Fridley, Minn. N° 10124 BUILDING PERMIT • Date: March 7 1969 Owner. _ Darrel King. Builder Clemron, Inc. Address Address 4411 Central Ave. N. E. LOCATION OF BUILDING No. 1371 _ Street 75th Ave. N. E. --- part of Lot Lot _7 Block 3 Addition or Sub -Division __ Don's 5th Addn . Corner Lot — Inside Lot ._------- x Setback 35 — Sideyard _ 10' 10' Sewer Elevation • 884.21 22ft 887.41 Top ofFooting DESCRIPTION OF BUILDING To be Used as: Dwelling Front 421 Depth 26 Height 20' Sq. Ft. 1092 Cu. Ft Garage Front 20' Depth 23' Height 10' Sq. Ft. 460 Cu. Ft. Type of Construction __ _ Frame Est. Cost ` 23 2 000. 00 _ To be Completed SEWER LOCATION - 162' North of Manhole WATER LOCATION - 68' South of Manhole C� 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 a'll provisions of ordinances of the city of Fridley. / Connecti In consideration of the payment of a fee of $ 40.00 , permit is hereby granted to Clemron. Inc. 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 within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Official Building¢ NOTICE This permit don not cover the construction, PnshlWon for whing, Plumbing, gas hod M& sewer or water. Be son to no the Building Inspector for separate permhs for than hens. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OMM'S NAMEDarrel- i„g BUILDER Clemron, Inc. ADDRESS ADDRF 84411 Central Ave. N.E., Mpls. LOCATION OF BUILDING N0. 1371 –STREET—_75th Avenue Northeast Lam` _Z_BLOCK 3 ADDITION OR SUBDIVISION Donis 5th Add . COM Eft LOT INSIDE LOT X SETBACK. 3$ SIDEYARD 10-10 SEWER ELEVATION TOP OF FOOTING Curb minus 5 Applicant attach to this fora Two Certificates of Sury©y of Lot and proposed building location drawn on these Certificates. DESCRI.PTION OF BUILDING To Be Used As: Same a87331 Memory Lane Residence Front 42 Depth 26 Height s Square feet 1092 Cubic Feet Qarage Front 20 Depth 23 Height Square feet 1L60 Cubic Feet V (-, o (771 Type of Construction Frame Estimated Cost 23.000.00 To Be Completed 7-21-69 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 s.�.;resentations stated in this application are true and correct. DATE 3.6-69 SiG�TATURE , � (Schedule of Fee Costs can be found on the Reve Si ai �:-/ ( 6 Y--0 City of Fridley U Application for Plumbing and Gas Pittincj Permit Dept, of Bldgs. Phone 560.3450 DESCRIPTION OF WORK C Numbs:. Kind and Location of Fixiurea Location 4 c 2 Future CC :: _`i0n Ope - ^i Naw F'ixtnre, Old Ope: -% I u N ii Y Z p Z i Z O i Sewer Cesspool p PARTIAL RATE WATER 14TR. 0Z'Sn PLUMBINC 1':X—ME RA—ES: y �l < f N GAS ELIC V; �• x $200 U°! UK VO x $1.50 $ Base .... x $1.50 $— C z C.::.= =-::n x $3.25 $ 1st _.� x $3.00 $ New '-_xd Run :.d Bldg. .. x $3.25 $ 2nd x $200 $ GAS FITT:YJ ?'TES: 110. RATE TOTAL 3rd H is F'z :res ....../) ...... . .� x $2.00 $,�,r� , 4th 17 ; Future CC :: _`i0n Ope - ^i Naw F'ixtnre, Old Ope: -% I ••••••••�••iw wiau Sewer Cesspool p PARTIAL RATE SCHEDULE PLUMBINC 1':X—ME RA—ES: 'QD. RATE TOTAL. a s: xtures �• x $200 $ , - /S F-,tture OT- gag .... ... ..... x $1.50 $ Nc v .-. a Old C;ening ....... .... x $1.50 $— C z C.::.= =-::n x $3.25 $ Wa:- ..__ter (U .. 99,000 BTU) i' ...... _.� x $3.00 $ New '-_xd Run :.d Bldg. .. x $3.25 $ Eley_r�-TiterHeats- x $200 $ GAS FITT:YJ ?'TES: 110. RATE TOTAL Gzm is F'z :res ....../) ...... . .� x $2.00 $,�,r� , 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 ue ^ Vr"o-v Tutinn, I 1912 Owner 1 Kind of Building _ nn6;yv�2� 2 Used as • ' &00-" To be completed about U ILII , 15 Estimated Cost, Old New Building Permit No X10 Signe L C. Business Phone No- ROUGH o ROUGH FINAL jLj 3 - 7 U i Ad:',: -=a1 Fixture; ................ x $ .75 $ Gat ?.arae to 199. ,Xl BTU .............. x $5.00 $ • . 1 _ i REPAIRS AMRATIORS—Refer to Code I ... .................... ................. $_ Z9 .. TOTAL FEE $Z6d.L— .. Q N° 4930 Original Permit f®r FLUMBING AND GAS FITTING / N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for IPermit inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., Fee DESCRIPTION OF WORK II Number. Sind and Location of Fixtures Stories K tW- 0 Q J 3 U m < Z IC 7 J y.et F=. m Q 7 m F Z tll Q M 0 Y ? N = N G 4 'Q K ?+ h Y F Z G O O LL yEj O I N y G 0 Q J K Y. O y e F m Q 4 U W 'Z 0 Q O G J K E LL 0 y Q 0. tl Q O 0 z Q Q O K WATER HTR. GAS ELEC. Basement ist 2nd 3rd 4th Connected with Sewer -Cesspool Gas Piping for Openings I Permission is hereby granted / . `t' • to do the plumbing and gas fitting in the building described in tWe statement hereth attached, upon the express condition that the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and this permit may be revoked at any time upon the violation of any of the provisions of said ordinances. By Order Of The Inspector Of Buildings Roughing in Inspection Inspector. Final Inspection Date Inspector. a 42 189—"5.V City of Fridley Owner Location 13 7/ - 7 5tl 1-f f Kind of Buildings a-�n� Used as To be Completed .5, ,19-4 Estimated Cost $ / Z -6-V • 0=;' Old -New. Building Permit No. / 01 i R � Date Inspector of Buildings. App "ale for Power P1altos and HeaN m Coofinge Venitallon, Re%iger MR and Air Condrdoning Systems and Devices PARTIAL RATE SCHEDULE GNMVITY WARM AIR: MT9 TOTAL Furnace Shell & Duct Work ........................... $10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................ 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ CH. WARM Arlt Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ each add. 60,000 BTU ....................... 3.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & lines—to 400 sq. ft. EDR Steam . .. .$10.00 $ Furnace Shell & Line --to 640 sq. ft. IDR Hot Water .. I000 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ 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 GAS BURNER (up to 199,000 BTU) ....... '....... '......... We $ over 199,000 BTU See. Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ..... ................ x$ 7.00 $ Additional Fixtures . ............... x .75 $ Gas Range to 199AM ........... x$ &W $ AIB CONDITIONING $ FAN HEATING SYSTEM See Fee Sehednle VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL PEE $ . ROUGH FINAL (REMARKS -O Dept. of Bldg& Phone 90 -MM 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 Ordinance: and ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. _ -., Fridley, Mina Iwov Owner Kind of Building Used as������ To be completed about Estimated Cost, $ - �— Old- Building Permit No. Permit No.� DESCRIPTION OF WORK HEATING or PO NTSS-Steam, Hot Water, arm Air No Trade Name `� ��� Size No-��� Capacity Sq. Ft. E.D R- �u BTU H.P. Total Connected Loa � � � Sind of Fuc J BURNER — Trade Name"� :�fSize Capadty Sq. Ft. EM.R- BTU HP: RAY N. WELTER HEATING CO. S By MINNEAPOL1B 7. MINNER13TA Business Phone No.Jl�� Original 0 PERMIT for Power tants and Heating, Cool- ing, Ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of eating Plants to be nsta ltered—repaired Make , Size I✓� ®� ; Oil fired ; Coal fired ; Gas fired X ; Gas Authorization No. Approved Final Inspection Date , 19_ Inspector 73a % Permit N° 4515 Fee $ �' Office of the Inspector of Buildings City of Fridley City of Fridley, Minn., `1 191' Owner Location 1,37/ - Kind of Building - How Occupied 9- 67 Work to be Commenced U,19 -o' To be Completed 12e,19 Estimated Cost, $ 6X- 6 Old -New, Building Permit No. Permission is hereby granted toC.�l✓ to install—erect—use the material and devices described in the above statement. This permit is granted upon dhe express condition that the p&son to whom it is 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 set forth in the a$proved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings 42 2M11 -67v City of Fridley SUBJECT PER r 15727. AT THE TOP OF THE TWINS BUILDING PERMIT r CEIPT NO. ------- COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 607 i1 = i CITY HALL FRIDLEY 55432 L NUMBER REV. DATE PAGE OF APPROVED BY ---_�--,,� 612-571-3450 910-F15 5/19/80 JOB ADDRESS 1371 - 75th Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7 3 Don's 5th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dennis Webber 1371 - 75th Avenue D .IZ. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Keymen Construction Inc. 5952 Woodland Cir., Mtka 934-1218 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 ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 24' x 8' Ent Addition to Front of House 9 CHANGE OF USE FROM TO STIPULATIONS ill WARMN6 . ft TF WON digging call local utilifies HIV 4 �, p / �i p�� TELEPHONE - ELECTRIC - GAS Etc. nli9i�� A �Qjj REQUIRED BY LAW Np S/ D po? *z4/lvo 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,500 $1.25 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- $15.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. .-K, PLAN CHECK FEE TOTAL FEE &?t R, A$ 3.75 $20.00 SIGNATURE OF CONTRACTOROR THORIZEDA ENT (DATE) WHEN PROPERL VALIDATED THIS IS YOUR PERMIT BLDG INSP DAIE SIGNATURE OF OWNER 0F OWNER BUILDERI MATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: .b(�—L�1f�15 Q�S��� BUILDER:E\(Mete e.c�ptSI•.►yC ADDRESS: l 7 t"' ��lfir_ l`L,&, ADDRESS: 9q-G-2- TEL q-52TEL NO: TEL NO: q -Z, 4— Construction Location STREET NO: STREET: 1n S LOT: BLOCK: ADDITION: hots % Corner Lot: Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: Height: Squane. Feet: Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: Type of Construction: 14. oob EP -A l E S C(J CQD Estimated Cost: 7b Be Oompleted: f Me) Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET 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. DATE: S LL cq 1 5- & SIGNATURE: Stipulations: o„/ QNM 1 Isloa Pte, Teo a �a londPlwn�y Laid S iny M�ffwpb j 2. Sm/s restiy ENGINEERING, INC. I miww-wla Lcnyifyeers Sur veyor5 cewtificate of samme j'®l C1-ZW170N I NORTH DRAINAGE AND UTILITY EASEMENT LOT 7 B-LOCk "DONS 6r" ADDITION ANOVA CGUN'TY lhvv y #ld A6 n a bW Md WrMd fWVMVIONW 11fd SWWY rAV q(llk 4&JW dw.41wd Ard, Od iff 4r,11 #xmw, ffd at/ Pis 4k as mcbmeals , tf 'mj. ff vv or &7 said lad. As sw veyed � aw dwj A.D. M". SQAUSOAN ENWIVEERIJV6, INC. �CALE 1" 91 40 jy 115 NORTH DRAINAGE AND UTILITY EASEMENT LOT 7 B-LOCk "DONS 6r" ADDITION ANOVA CGUN'TY lhvv y #ld A6 n a bW Md WrMd fWVMVIONW 11fd SWWY rAV q(llk 4&JW dw.41wd Ard, Od iff 4r,11 #xmw, ffd at/ Pis 4k as mcbmeals , tf 'mj. ff vv or &7 said lad. As sw veyed � aw dwj A.D. M". SQAUSOAN ENWIVEERIJV6, INC. �CALE 1" 91 40 jy SUBJECT City of Fridley 27034 AT THE TOP OF THE TWINS BUILDING PERMIT ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r � NUMBER REV DATE PAGE OF APPROVED BY 1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 8/6/98 JOB ADDRESS 1371 75 Avenue NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 3 1 Don's 5th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kathleen Webber 1371 75 Ave NE 786-8080 3 CONTRACTOR MAIL ADDRESS Ownpr ZIP PHONE LICENSE NO 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING RpRidpnHal 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION XX REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage 25 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. 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 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 2085 $1.04 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. $74.75 Fire SC $2.08 PLAN CHECK FEE TOEE ;W.87 S ATURE FCONTRACTO AUTNORI2EDAGENT IDATEIlew If N OP ALIDAT D HIS IS YOUR PERMI SiG ATU O O sic OW E LD RI I ATEI BLD INSP GATE NEW [ ] Effective 1/ 1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 b9 BUILDING PERMIT APPLICATION 01-1' ConstructionAddress: Legal Description: Owner Name & Address: Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. # `J& ' �Offd MN LICENSE # Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width T Hgt/Ground Sq. Ft. Construction Type E A Q- 0 �: F Estimated Cost: $, '--�0e S . STIPULATIONS: (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ - DATE: (0 APPLICANT: Tel. # CITY USE ONLY Permit Fee $ r / / `/ ��� 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 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: 04/02/2004 FRI 13:21 FAX ELDER JONES 411001/001 NEW 11 CITY OF FRIDLEY Effective 4/1/2004 ADDN 11 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER 11 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address:-) f S �Lu , ft') Legal Description: Owner Name & Address:-�ir�;�,-e.j e ,�r" TeL #�03• ��lQ • �0 $Cj Contractor. MN LICENSE# ;VW9$3 Address: RENEWAL BY ANDERSEN TeL # (,oS 1-;R(o-t - q T4-+ 1920 COUNTY ROAD C WEST ROSEVILLE, NIN 55113 irate of Survey of the i drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft GARAGE AREA: Length _ Width HeightSq. Ft DECK AREA: Length Width HgVGround Sq. Ft OTHER: lkin C7 6 in t n Rk l . n r,r Construction T p y (3C Estimated Cost: $ u �l T Driveway Curb Cut Width Needed: Ft, + 6 Ft = Ft x $ = $ DATE: 0CJ APPLICANT:A1�� / Tel. # 9S a2.3(4S • �(J`L Call (763) 672-3604 for Permit Fees if mailing In application. Fax to 763-571.1287 If using credit card and we will call you for card number. a CITY USE ONLY - Permit Fee$ �� . a�5 Fee Schedule on Reverse Side Plan Review Fire Surcharge $ $_ 65% of Permit Fee .001 of Permit Valuation (1/10th%) State Surcharge $_ �(. $9 '$.50/$1,000 Valuation SAC Charge $ $1350 per SAC Unit License Surcharge $ 5.00 $5.00 (State Licensed Residential Contractors) Curb Cut 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 $ R08 9I STIPULATION a Building $ BUILDING See Back Page for Fee Schedule Permit No.: 79S inspections RESIDENTIAL APPLICATION urcharge Received By: '763-572-3604 (.0005) times the total job valuation — Minimum $.50 ire Surcharge $ Date D OCT 1200 .001 x Permit Valuation (1110%) .icense Surcharge CITY OF FRIDLEY Jr, oo $5.00 (State Licensed Residential Contractors) ATE In YOUR E-MAIL ADDRESS kO Cj 16 Q I dl S OM s1TEADDRESS 3 454'i it G —V .urb Cut Escrow !'HIS APPLICANT IS: O OWNER BCQNTRACTOR ft + 6 ft = ft x $20 = $ PROPERTY OWNER/ NAME TENANT ADDRESS: ( 1 1 S CITY FptelltySTATE ZIP 'TT Y,3 �1 PHONE: 77 G31:7 B6 - 8 Ob u ewer Main Charge CONTRACTOR NAME:_ The Home Depot A.H.S. Inc. Agreement necessary ( ) Non Necessary ( ) SUBMIT A COPY OF STATE LIC 3200 Cobb Galleria Pkwy. ode a i6i&r Jim S YOUR STATE LICENSE ADDRESS: Atlanta, GA 30339 CITY STATE ZIP WITH APPLICATION PHONE 763-542-8826 SINGLE License #20268257 PROPERTY TYPE 0 :ORiES PERMIT TYPE QADDMON O GARAGE/SHED O WINDOWS O BASEMENT FINISH O ROOF 0 DRAIN TILE O DECK O SIDING O OTHER O SWIMMING POOL TYPE OF WORK: O NEW O ADDITION O MAINTENANCE/REPAIR @AeMQPEJ:A IG t't l e" DESCRIBE WORK BEING DONE: >IZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. tOOFING O HOUSE ONLY 4UMBER OF SQUARES O HOUSE & GARAGE BASEMENT REMODELING SUBMIT: ;ARAGES O ATTACHED GARAGE 1. Existing Floor Plan 'ROPOSED SIZE: O DETACHED GARAGE 2• Proposed floor plan ROPOSED HEIGHT: 3. List of structural members to be used TDING FOR NEW CONSTRUCTION INCLUDING DECKS, I Vinyl 0Sof€it ADDITIONS. & PORCHES SUBMIT: Aluminum O Trim 1. Site Plan/Survey showing the existing structures` I Other =4scia and proposed project ifINDOWS 2. Two sets of construction plans 1 EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS 3. Energy Calculations >R FOR NEW OPENINGS -DESCRIBE SIZE OF >PENING CHANGES & YPE 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 $ O OCCUPANCY TYPE ermit Fee $ 9T ;If See Back Page for Fee Schedule Ian Review $ 65% of Building Permit Fee urcharge $ , $ g" (.0005) times the total job valuation — Minimum $.50 ire Surcharge $ 3-10 .001 x Permit Valuation (1110%) .icense Surcharge $ Jr, oo $5.00 (State Licensed Residential Contractors) AC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) .urb Cut Escrow $ ft + 6 ft = ft x $20 = $ rosion Control $ $450 Conservation Plan Review ark Fee $ Fee Determined by Engineering ewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) 'otal Due $ M/1 -.91D Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in mformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a ;rmit but only an application for a permit and Pori is not to start without a permit; that the work will be in accordance with the approved tan in the case of all work whichh it re a approval of plans. C GNATURE OF APPLICANT �'� PRINT NAMETI Nl J C-UtWo k- DATE Z �%