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Demo'd Bldg DocsCity of Fridley SUBJECT PERMI G ® 14 2 0 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �.J 612-560-3450 910-F15 ]-$_]] JOB ADDRESS 921 Fairmnnf -qfrAAt N- 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 4 ARCHIT WMR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING residential garage 7 CLASS OF WORK )F NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK construct 22 x 24 detached garage 9 CHANGEOFUSEFROM TO STIPULATIONS Has signatures from 91jK1 neighbors on either side and with their surveys, allowed to build garage within 3 feet of property line without a verification survey. ., . ;r <. "RING, u S SEPEA pL�MB11� Alto 14Eaa11404, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. frame OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. wood THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZD IS NOT COMMENCED WITHIN 60STRUCTION ES 1120 52$ 5,280 OR WORK SUS ENDED OR ABA DON D FORAYSA PERIOD OF 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 TYPE OF WORK WILL BE $3,907.20 1.95 WITH WHETHER SPECIFIEDNING HER INIOR NOT. THE GRANTING OF AOPERMIDT 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- 21.12 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE 0 $23.07 SIGNATUREOF CONTRA TOR OR IJTH RIZED AGENT (DATE)�7 N PROPERLY VA F BLDG INSP AGATE ED THYIS YOUR E MIT SIGNATURE OF OWNER I I F'OWNER BUILDERI (DATE) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: 11; d zV/ff S L e)� N BUILDER: zzl' Address: 5�07 J F1fl 61V 0 A1 %' IVC Address: . Tel. No.. No.: C7 Street: LOT: BLOCK: �_ ADDITION: JQ) V 6a V 1 C-Ij �-� G'r � � � %- CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To B/e' Used As: Iq '46 E Front: 12 0z Depth: Height: Square Feet: Cubic Feet: Front: Deptb: Height: Square Feet: Cubic Feet: Type of Construction: W D ® To Be Completed: 3 �!? Cj_ 5 - Estimated Cost: ,$ & ® 7 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. See reverse side for additional information. DATE:?— L-7 7 SIGNATURE: Stipulations: BUILDI14G PERMIT FEC SCHEDULE SECTION 2: The Inspector of Buildings Thal]., before issuing permits for the, erection of any building or :.structure, or for any addition to -any existing building or structure, or for any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.. PLAN CIiECK: 25 percent of building permit fee. DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) Alternate A: Removal and replacement of concrete curb and gutter only; Drivewdy width plus 6 feet x $11.75 Alternate B: Removal and replacement of concrete curb and gutter.and install a 3 foot wide approach with 6 inch depth; Driveway width plus 6 feet r. $15.40 ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical contents of any. building or addition, is determined by multiplying the ground area covered from a point six (6) inches below the floor line of the basement or the cellar to the average heights of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 &r each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. In no case shall the fee charged for any permit as set forth in Section 2 be less than $7.50 plus $.50 state surcharge. VERIFICATION OF FQUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has been constructed will be required before proceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. w ""S� C A R D 3 C A R D a 9 1011 12 15 36 21-22 27 28 32 33 37 33 CAR'D-71. IP U., 16 26 27 37 38 44 S Year N� 0**. year--'. Y rs. Nlo. U NLIM"er. -Code C -rd 0:1 Acquisition L;,Pa Total Rcmz!lning I I a Ix Date (192G.01) cj i i r, i i i D�"'r Life U"E."' -01 (010 to 2' 39 40 5051 61 62 70 71 78 so Filler a 9 Ao )I IP U., 16 26 27 37 38 44 Original Accumu 'Order Pulchasc I A Cost A- J.- I -A -A S. as Numbe Ird 2' 78 so Filler a 9 Ao )I IP U., 16 26 27 37 38 44 I A A- J.- I -A -A S. Ird c se 45 SI !;'I bb "G b') L'o U, U7 73 74 110 A. L.. L t......_I_I..I :L_I._.J.__...__ P% Oft) Pi mii Il' fate nr_zzu FMpmm I, , owner of the property located at a'�3f%`j Al J , have no objection to the City allowing the construction of a /Q to be located at .J' / / g Q2 ® 1VT without the required certificate of survey that the City ordinarily requires for all new construction. f Address Datga Witness AGREEMENT owner of the property located at have no objection to the City allowing the construction of a ��1/ to be located at <R 1' d / l without the required certificate of survey that the City ordinarily requires for all new construction. Witness a ' A Siinature 72 Date STATE OF MINNESOTA DEPART14ENT OF HEALTH ABANDONED WELL RECORD I. LOCATION of WELL• MINNESOTA UNIQUE WELL NO. c°°"ty Rome Anoka (leave blank if not known) Township Name Township Number I Range Number Section No. Fraction 4. WELL DEPTH (completed) Date sealed N E % % of @ Fridley 30 sr 23 or 3 E SW NW 157 ft.August 14,1991 or Distance from Road Numerical Street Address and City of Well Location5. DRILLING METHOD (if known) Intersection 10 Cable too) 40 Reverse 713 Driven 10(3 Dug 521 Fairmont Street NE, Fridley 20 Hollow Rod 50 Air ep Bared 110_ Show exact location of well 313 Rotary 6Q Jetted g0 Power Auger (in section grid with •X•) S to map eLmILlocamon g, OSSTRUCTIONS W SME E 0®� MEN ®®®®, Froen , �A Well obstructed Q Yes Q No x Q�Pg/1 bis GGira�C 1 Obstructions removed E3 Yes 0 No If obstructions cannot be tone removed. s+ removed. contact NON E ( 1' before sealing. T 7. USE hag. 10 Domestic 4t3 Neat tort as BQ Neat Loop I 140 -3 + I 20 Irriga;ion 4® Public g0 Industry 1 I 30 Test Well 60 Municipal 100 Comma i 1 r~- 1 Mi.L--.� 2. PROPERTY OWNER'S NAME Mailing Address if different than Property address indicated above Frank Steen HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well. 16. REMARKS. ELEVATION, SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED, ETC. LH 7— IFFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) XWLS?M8 O PILE ROI'FB DMW rc a 70 Air Conditioning 110 a. CASINB(S) 1® Black 4M Threaded 70 20 Galy. 50 Welded 30 Plastic 60 Stainless Steel in. to 154 ft. in. to —ft. 9. SCREEN ® screened well from 15 4 ft, to157 ft. (If known) 0 Open Role from _ ft.- to ._ ft. 10. STATIC WATER LEVEL 2A ft. ® below E3 above land surface Date Measured 8-14-c11 11. WELLHEAD COlO•LETION 10 Pitless Adapter 40 Found Buried 20 Basement offset aM Above Grade 30 well Pit 12. OWTING INFORMATION l�jjj Neat Cement 20 sentonite 30 Grout material N t . Cmt . from ? to, 5 %ft. cu. yds 13. OF AMINATION �teet Jl direction sewer U i g e type Well disinfected before sealing? ® Yes 14. PUMP 0 Removed 91 Not Present Type: 1p Submersible 30 L.S. Turbine 50 Reciprocating go Jet 40 centrifugal 6® _Strobe IS. EXISTING WELLS (Please sketch locations of abandoned and active wells in remarks section or on back.) Other unused well(a) an property? C3 Yes ® No Abandoned: 0 Permanent 0 Temporary [3 Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my jurisdiction and this report is true to the best of my knowledge and belief. ORK WELL COMPANY INC. 02133 Licensee Business Name License No. Addr4NW. Anoka s — 20a 1Q;Ld-h Ali nil sigce 8-14-91 �,& n ani a son oat. 8-14-91 N* of Driller bags SUBJECT City of Fridley 31619 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. F COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEG. r � � 1 . � NUMBERREV DATE PAGE OF APPROVED BY I 1 I CITY HALL FRIDLEY 55432 612-571-3450 910415 1/16/01 JOB ADDRESS 521 Fairmont St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13,14 I 1 Riverview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Geraldine DuBay 521 Fairmont St NE 763-784-7186 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION) ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Remove & replace kitchen and bath sheetrock; add insulation on two walls 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE: PURN > REQUIRED FOR,' WIRING, HEATING3 PLUMBING ANDS►:,� 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 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 $7500 $3.75 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 CHARG PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK F F /OTAL $164750 SIGe TORE OF CON sRACTOR OR AUTHORIZED AGENT (DATE, EN P OPERLY ATED 1 S YOUR PERMIT I i BLDGI pA $ NATURE OF OW NER ,IF OyyNER BUI ERI IDATE, NEW [ ] Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: I ru w enon-A 5t IS L I,- M N S 5 4 3 a Legal Description: lot I3 un A 14 13I,1,e k Z R,ye+v1e,." 1+eI hi 5 Owner Name & Address: i 4v0 c�r,t t)uRm!, SPC V" E Tel. # Contractor. © VtJC MN LICENSE # Address: 5►1m C- Tel. # 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: &+ice [S� Ic�oJ Construction Type: VQOAe frames Estimated Cost: $ 7Sn� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 01-1&-01 CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: APPLICANT: 1 !&2: ► Tel. #(16'x) 7&If- -71 &(. Call (763) 572-3604 for Permit Fees if mailing in application Fee Schedule on Reverse Side $ 12-&b .001 of Permit Valuation (1/10th%) $ b�,'%S $.50/$1,000 Valuation $ $1150 per SAC Unit $ $5.00 (State Licensed Residential Contractors) "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ /6 -' 0 BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or, structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction, thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $23.25. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. New Houses Onlv /-1,01--d/ 9 W 1 s S�oa� 1C'�G►U%�'o� � ,,v Facer S/��/� �'�"►r1 .1410vdmah "I S+ F�+•d1dy, rAN 3'3}92. 071 Its . ue P-; i -C kAll n•,C� ba+l, wc. It S evr+(TIt anc� R{face 2x•�ci lva�rlL,+ Earl call 1nSKla4v vl (�4 Qla cC wi k4'\ (Zcflace tA>+h N"CK 12-19 srsulc►ha,A CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 V 763-572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2001 PLUMBING FIXTURE RATES: New Fixtures 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** NO. RATE TOTAL Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 JOB ADDRESS_ 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 (") 0zj^ q ``t(.,, e, Building Used As &u,5 e Estimated Cost PERMIT NO. /3 6 �/' �_) PLUMBING COM Reinspection Fee $47.00/Hr SIGNED BY. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS D 0 1.5% of Value of Fixture or Appliance ea'5 4 ',1 @ Approved By State Surcharge $ .50 rr GIH 8/ -2) MINIMUM I Ra m fe V00 TOTAL FEE $ � PLUS THE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. Rough -In Date "� Final Date 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 I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( ) No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's 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 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 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 FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 March 8, 2002 Ms. Geraldine DuBay 521 Fairmont Street NE Fridley, MN 55432 Re: Final Inspection at 521 Fairmont St NE Contractor: Peterson Pinney Dear Ms. DuBay: A plumbing permit was issued on January 18, 2001 to install two fixtures and gas lines for the water heater and range at your address. According to Section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the work authorized by this permit. As of this date, no final inspection has been called for. The permit fee that was paid covers the inspection to make sure the work was completed according to the Code. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for" and take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2002 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 JOB ADDRESS 5)l �-e'kvVVI 0^4 54 ►J & RATE SCHEDULE OWNER Gefal,=cre 1�-Tn�4(,1 Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS e ff v c Also Replacement Furnace $ 30.00 (Side Vent - Fill Out Back) $ .. ESTIMATED COST /00'O© PERMIT NO. Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Gas Dryer $ 10.00 $ Trade Name Size No. BTU HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an 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 $C9 ®. C� DATE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE Signed TEL # FAX# (6 03a$ REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Dat `t6-C1A' written permission from adjoining property owner. 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 COMMON VFNT, VENT CONN .TOR AND COMMISTION AIR V RIFI .ATION When rela _ing 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 I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes( ) No( ) The Laxondong combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When required to install a new comhustann air,itwill be sized and installed to meet the current codes and manufacturer's specifications. Yes( ) No( ) When installing a now venting nyc_tem, 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 2mU'je A-liy n16- i(oek16vmhi kA woe _ /-- 6teaIk 0061 6- A C t Ve✓1L HEATING CO: Signed By: Date Iris SUBJECT FT-NO. City of Fridley 3 29 6 9 32969 AT THE TOP OF THE TWINS BUILDING PERMIT r R `COMMUNITY DEVELOPMENT DIV. y_ -____ r � PROTECTIVE INSPECTION SEC. 1 � � NUMBER REV DATE PAGE OF APPROVED By I _ /"'1 CITY HALL FRIDLEY 55432 ��� �.4 763-571-3450 910-F15 8/8/02 JOB ADDRESS 521 Fairmont Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 13,14 1 Riverview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Geraldine Dubay 521 Fairmont Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Gates Roofing & Siding 4640 Ximines Lane N, Plymouth, MN 55442 763-550-0043 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 6793 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (15 Sq) Tear-off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. Permit Inspection Cards Will Be Mailed To Homeowner To Post SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 $.8O WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,608 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. $6O.lO Fire SC $1.61 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE SC $5.00 i2-'n� $67.51 SIGNATURE OF CON'RACTOR OR AUTMORIZED AGENT IDATEI PROPERLY VALIDATED THIS IS YOUR PERMIT _ s- -Inn S.GNATURE OF OWNER,IF OWNER BUILDER. IDATEISP IAIE Iris NEVV CITY OF FRIDLEY Effective IMM Apply [ ] 6431 Univerft Ave NE, Fel. MN 55432 (763) =246N SWID Inp ALTER (] SMILE FAMY AND DUPLE)MS R-1 AND R-2 BUIL MNG Ptd APPUCAMON Construction Addt+ess: Legal Descxlipdm owner Name & Address: TeL P Ca tactor: 6 T-VS % `vim ` `n f �- �•f �� S MN LICENSE#® Address: J14 0V Y -""e t ev �6 - °V • b t2,r � k.T'� �i'd Td. # Attar to this aeon, a Certificate of Survey of the K with the prqposed consmxfm drawn on It to sale. LIVING AREA: Leno Width Height Sq. FL GARAGEAREA: Length Widal HeWd. Sq. Ft - -- — DECK AREA: Length ® vVM + H903found Sq. Ft OTHER: /&06 Construction Type: -ems Estimated Cost: S .-- Md Driveway Curb Cut VWKM Needed: Ft + 6 Ft = Ft x $= S DATE: 157" 40-t- APPLICANT: i�C:k"�,s 6 Ix Tel # (44 Call (763) 572-3M for Permit Fees E maifin4 in appacation or f=ax to 7" -14297 126? it using credit card and we WK can you for card number. CITY USE ONLY - Permit Fee $ t 6, I () Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1110th%) State Sur+cWge $ $.50/$1,000 Valuation SAC Ch $ $1200 per SAC Unit License Surcharge $ J • $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Aft. "A" or Alt. "W Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by'Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ TOTAL $ ' �� OPU TION ----_. - . -I i-r•vrTv I in I I T'S I.nW-j TT •7T ?DQ7-Ci-A,4H SUBJECT P City of Fridley �00 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. x%55 1 � � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910-F15 110/27/03 JOB ADDRESS 521 Fairmont Street NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 13,14 I Riverview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Geraldine DuBay 521 Fairmont Street NE 763-784-7186 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Replace three windows within existing openings 9 CHANGEOFUSEFROM TO STIPULATIONS 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 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 $450 $ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW $23.50 Fire SC $ STRUCTION OR THE PERFORMANCE OF CONSTRUCTION .50 PLAN CHECFEE TOTAL FEE $24.45 NATURE OF CON'RACTOR OR AUTHORIZED AGENT iDATE, Cl� /o a� /v3I EN PROPERLY X14M G �N$P VALIDATED THIS IS YO R PER IT �1 ®1 MATE S-GNATURE OF OWNER iiF OWNER UILDERI IDATE� NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER N SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: 5.2I Fc�,r�nnrin� S+ nJEAA A) S�`f3a Legal Description: Owner Name & AdOE �f� ld� �u 154''^ C Arl 0R6s s Tel. # �763� 7$T r�E Contractor.. MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: -3 Wivedo,.y5 (�, L,%jiY" I AveA, G^ G Construction Type: Estimated Cost: $ y 5 C Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: /0J2716 3 APPLICANT: Tel. # Call (763) 572-3604'for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $3. $ P $ SZ� TOTAL $_ ;z S CITY USE ONLY - 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 [ ] BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined rate. Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the. proposed structure and of the construction site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only City of Fridley SUBJECT 3 4 0 4�) AT THE TOP OF THE TWINS BUILDING PERMIT i 1 `L COMMUNITY DEVELOPMENT DIV. - PROTECTIVE INSPECTION SEC. r F i 1"'1 CITY HALL FRIDLEY 55432 f ".j NUMBER REV DATE PAGE OF APPROVED By 763-571-3450 910415 12/8/03 JOB ADDRESS 521 Fairmont Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DEscR. 13,14 I Riverview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gerri DuBay 521 Fairmont Street NE 763-767-8166 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Jabez Exterior 2210 154 Lane NW, Andover, MN 55304 763-757-8166 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20315089 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Ck REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reside House 9 CHANGEOFUSEFROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. Caulk and flash all exterior openings. 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 WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,500 $1.75 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- SC STRU OR THE PERFORMANCE OF CONSTRUCTION $97.25 Fire $3.50 PLAN CHECK FEE TOTALFEE a �� -,F-e.3 ense SC $5.00 $107.50 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI EN PROPERLY VALIDATED THIS IS YOUR PERMIT BLD INSR "1 riAtE _ S-ONATURE OF Ow NERSIF OWNER BUILDER, IDATEI u NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: Owner Name & Address: Contractor. 'i�g Z/j/ MN LICENSE# 1,Y, 7A3L-QZ2 Tel. # 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: Construction Type: 'C Estimated Cost: $ 5��o Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 12 g `o3 APPLICANT: kolel Tel. #A3 7l7 0'/&40 Call (763) 572-3604'for Permit Fees if mWng in application. Fax to 763-5714287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ - /% 9, 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 [ ] BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined rate. Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the. proposed structure and of the construction site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 YAX: (763)571-1287 ADDRESS : 521 FAIRMONT ST NE PIN : 033024230088 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : BUILDING PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION PERMI . 22004-00038 DATE ISSUED: 01/14/2004 VALUATION : $ 400.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. 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 WHEN ADDITIONS, ALTERATIONS OR REPAIRS IN EXCESS OF $1,000 ARE MADE TO RESIDENTIAL DWELLINGS. LIVING ROOM REMODEL; REMOVE AND REPLACE SHEETROCK, REINSULATE, POLY APPLICANT DUBAY GERALDINE C 521 FAIRMONT ST NE FRIDLEY, MN 55432 OWNER DUBAY GERALDINE C 521 FAIRMONT ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction orpe Aerformance of construction. Bldg Insp. BUILDING PERMIT FEE 23.50 FIRE SURCHARGE 0.40 STATE SURCHARGE, VALUE 0.50 TOTAL 24.40 PAID WITH CHECK # 6213 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ ] CITY OF FRIDLEY Effective 1/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: l`� 1 Ca v -n o n -C -5T N� SN, �+ �, M � S5113 4 Legal Description: Owner Name & Address: ��° ���Y'e �u��'� - 5�i ���.nt�i �� �►� Tel. # ��3°7�sY�s� Contractors --- MN LICENSE # ---- Address:---- --- Address:--- Tel. # 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 Width0Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: Al -(el lj?' V'-' o de I Estimated Cost: $ /Yck�)' o Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$ DATE: C�( l 3'0 `( APPLICANT: Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ .LA® CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] TOTAL $ a'LA 'j—(C) STIPULATIONS: BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to -wit: TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined rate. Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Only L So li Miami u m nI CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: (763) 571-1287 d06-9-7 PERMIT NO.: 2004-00039 DATE ISSUED: 01/14/2004 ADDRESS 521 FAIRMONT ST NE PIN 033024230088 LEGAL DESC UNAVAILABLE LOT BLOCK PERMIT TYPE ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. # INSPECTIONS 2 # 0-100 AMP CIRCUITS # 101+ AMP CIRCUITS 0 APPLICANT DUBAY GERALDINE C 521 FAIRMONT ST NE FRIDLEY, MN 55432 OWNER DUBAY GERALDINE C 521 FAIRMONT ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date, ELECTRICAL PERMIT FORM FEE ELEC PERMIT FEE - MIN (RESI) ELEC AMP SERVICE FEE ELEC CIRCUIT FEE (0-100 AMPS) ELEC CIRCUIT FEE (101+ AMPS) STATE SURCHARGE, ELEC FLAT ELEC PERMIT FEE - MAX (RESI) TOTAL PAID WITH CHECK # 6213 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 0 1.00 40.00 0.00 0.00 0.00 0.50 0.00 41.50