AF - 35599sua�ecT �PERMI
City of Fridley o 19 9 6 6
A7 THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
' � RECEIPT NO.
{ �ti: ----- �
COMMUNITY DEVELOPMENT DIV.
r j � PROTECTIVE INSPECTION SEC. ����—/
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l.--•� ����� �,� CITY HALL FRIDLEY 55432 NUMBER REV. bATE PAGE OF APPqOVED BY
i 612-571-3450 910-F15 6/26/89 / / .
JOB ADDRESS 7919 Broad Avenue N. E.
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oESCa. _ 13,14,15 M Riverview Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James Bowe 25�6 - 3rd 5txeet N.E., Minneapolis, MN 55418 �
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Sasne
4 ARCHITECT OR DESIGNER ' MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDINCi
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a 48' x 30� Dwelling and a 29' x 23' Garage an.d a 26'
�E#ore dig�lr�.call t�ta►i�-U�dlf�iet
8 CHANOEpFUSEFROM TO r' y �
.
STI PU LATION S
See notations on plan. Provide City with copy of veriiying:��u�vey'before
� capping basement. Provide sod in the front and side yards. Provide a hard surfac
driveway. Agreement signed to release City from any and all liability caused by
building in "Flood Fringe District".
SEWER LOCATION: "WYE" �39' North of Manhole I1W ELEVATION AT Prop. Line: 812.67
MINIMUM TOP OF F'OOTING: 815.67 MINIMUM FIRST FLOOR LIVING AREA: $23.9
WATER LOCATION: 36' NE of Manhole: 59t S.E, of power pole. „�
3M�E C�TY 4E' FR�DLEY Q�ES fYOT GUaRANTE� TWE
ACCt1RACY QF UTttkT�F COCRTf01�FS �4�t'6 ELEVATIONS..
THIS OA�A IS FOR tiVFORMATt01� PURP`O�E� ONLY,
�EpARATE Pf R�ItTS R�QU'i�i�D FOR� �ND PERSONS USING THI� ltV�ORdVI'aTE�N SHOUL„�
VIR1NGs �IEATING� PLUMBI%IG ANU SIGN'� ����� !T ON iHE SITE,
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OF AIR COPIDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED 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 AWD EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME,TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yqLUATION SURTAX
AND ,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $82 �$OO' $4I..4O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $42S.00 $575.00
STqUCTION OA THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
A $1,044.40
Si ATUR FCONTFACTOPORA HORIZEDAGENT IDATEI �- W EN PRO E Y V ID T D THIS IS VOUR PERMIT
, � A
• ° Z�o e�' /� s�
IGNATURE OF OWNER IIP OWNER B ILOERI ATEI ❑G INSP ��
� �i, �
CERTIFICATE OF SURVEY
FOR --��M �wE KURTH SURVEYING INC.
IMEflEBY CENTIFI' TMAT TNIS 6UqVET.P�AM.Cq pEPORT WAS PNEPARED • 4OOY JEFFERSON STREET N.E.
._� T4E OP YNDEX MY.OIP SUPERVISION ANOTryAT I�1�1 A WLY COLUM8IA HEIGHTS MINNESOTA 4542�
R A uD XV YND R TI E LAWS pF7HE TATE OF MINNESOiA. 612-788-9769 ������ ��p
�E � � . . ' .. � OATE .1L1�L_,
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MINNESOTA REGI5fRgT ON NO. t 4.11 RG��D S'3o'�� o.
IRON MONUMENT f��Hv
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CERiIFIC�TE OF SU�2VEY
FOR --��M g�VJ KURTH SURVEYtNG INC.
IMENfBY CExTIFY TNAT TWS SuRVEY.PLAN, oq qEPOR7 NrAS PqEPppED 4002 JEFFEflSON STREET N.E.
�BYME�-O��p�UND£FMYDip SYPEqy1S10N ANO'4.�I4TIA A WLY COLUMBIA HEIGHTS IdINNESOTA 55421
n`y�� A'� Y YND TI LAWS O ME TATE OF MINNESOTA. 612-7BB-9TBY
` E�����'���"^�� DATE �-11-84
MINNESOTA REtiIS�RQT ON NO �� RG�II`.� 5-�i0-�j'°� SCA�E I"� zQ�
O�IRON MONUMENT Aa�w�a
o- bod sPiKS 9�T
atNcHP1f�R.K- �l�'� �yvT 1-l`f A- a° t",z Nu� �-r
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ELC4i>`�"I�N— P>LK.$71 ��`��R�PDSev con-rou�
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��- $�FAl-.D STRCCT' ���' (qs Pti.4TT�,0�
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R-1 AND R-2
Buildirig PeYmit �lpplication
Effective 5/1/88
Construction Address :_% q 1 cl ,C���l.sl- l)
Lsgal Description: _�a� S / � / `� /� /��v C IL �- '
,�-- ;. �
OHmer Name & �; _ � �A,rvl ES � i� � lsv � Tel. # � � 9 - S'� � l
/ n
�oritractor• _ �/���5 6� /So��,ca E.
Tel. # S�t �-�.
Adaress: o?�`�� �rl� S� �C,l ��c p� s/t�t fv ���l/�
Attach to this application, a Certificate of S�a.�rvey of the
lot, with the praposed c�o�nstructian drawn on it to scale.
DESCRIP7.'I�T 0�' Il�VF��T
LZViNG AREA: ' Ler�g'th �� Width 3� Height Sq. Ft.
cARAGE 1�iREA: I,en9th �' Width 3' Z Height Sq. Ft.
DECR AREA: Length �Cp Width � Hgt/Grow�d Sq, Ft,
OT�R: , �
Corner Ir�t [� Inside L�t�,[ ) Ft. Yd Setback �ide Yard Setbacks
Zj�pe of Construction: � ao� �/�.�„c Estimated Cost: $� � a O
Approx. c:cm�pletion Date: 9 - / �- �q ,
SZ, � °
Proposed Drive�uay Width If N�w O,pening Is Desired• Ft. $ $
Width + 6' See Back Page
�n�: _S = � �- � 9 ��tc�r: � -- Te�.. # � �'s� - � � � f
r
Pennit Fee � �}2� � 00
State Sur�harge $ 4 � . � �
SAC Charge $ '�j� ��
Driveway � $ .o
Park Fee $ —
sewer r2ain ChaYge $
. �.
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S fj y , �
f`� F�oo+l �.1 v� t
crt�r tr� a�u�c
Fee Schedule aa1 Rever^.�e Side
$.50/$1,000 Valuation
$575 per SAC Uriit
Alt. ��A" or Alt. "B" Abave .
Fee Detet�nined bY �1��
A�nent Ne�sary [ ] Not Ne�sazy [ ]
Is �L�.9 °
,�
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I:?�1� � �,. 'r�+��Y�4 ��+- �-�;:i�+� �
The C�iief Building Official shall, before lssuirig ��++; ts for the e.rec.�tion of any
building or structure, or for any addition to any existing building or sttucture, or
for any alteration or repair to any existirig buildincl or s'tructure. upon application
therefore, require the payment by the applicant for such permit of fees to the an�oau�►t
herein bel�r set forth at�d in the manner herein prwided to-wit:
'I�rAL� VAI.iJE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,Q01 to $100,000
$100,001 to $500,000
i ��
$15 (Minismn�n Fee i.s $15 plus �e)
$15 for first $500 plus $2 for each additional $100 or
fraction ther�of, t� arid ir�luding $2,000
$45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to arid including $25,000
$252 for first $25,000 plus $6.50.for each additional $1,000
or fraction ther�of, to and including $50,000
$414.50 for first $50,000 plus $4.50 for each additional
$1, 000 or fractiari the.reof, to arid inclucling $100, 000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or £raction thereof, to and includirig $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for eac� additional
$1, 000 or fraction thereof, to ar�c1 including $1, 000, 000 �
$1,000,001 ar�cl up $3539.50 for the first $1,000,000 plus $2 for each additional
�1,000 or fraction thereof
DRIVEi�i DEPRESSI�T ESCEi�
(Concr�te Curb Streets On1Y?
Alternate oAo: Reemoval arxl replacement of curb arid gutter only - Driveway width plus
6 feet times $13.50.
Alternate ��g�� : Removal and replac�nt of curb and gutter arul install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet ti� $15.75.
����• .� �. .� . . � ��.� .
Parmits for co�nstruction will be issued a rn� �� �++�'� o� 24 hours from the time of
application to all�a for proper review of the proposed structure and of the
c:onstruction site.
A Certificate of Stiirvey of the lot, shcywirig the location of the foundation or�e it has
it has been constructed will be required before proceedirig with the framing.
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STATE OF MINNESOTA
COUNTY OF ANOKA
AGREEMENT
THIS AGREEMENT between the City of Fridley (the "City") and
James P. Bowe, his successors, heirs, and assigns ("Mr. Bowe")
is dated this � day of , 1989.
WHEREAS, Mr. Bowe desires to construct a single family
dwelling at 7919 Broad Avenue Northeast legally described as
Lots 13, 14 and 15, Block M, Riverview Heights, Anoka County,
Minnesota, and
WHEREAS, the above described lots are within the Flood Fringe
District, and
WHEREAS, the City is willing to allow the construction
provided that it is released,from liability for such construction.
NOW, THEREFORE, James P. Bowe , his successors, heirs and
assigns hereby agree to indemnify and hold harmless the City of
Fridley for any and all liability caused by the construction of
the house on Lots 13, 14 and 15, Block M, Riverview Heights,
Anoka County, Minnesota.
IN WITNESS WHEREOF, the said parties have signed this
Agreement the day and year first written above..
CITY OF FRIDLEY
By : /liC��d'nn/�. - _
William J. Nee
Its Mayor
�
BY= ��_1-C�� . �1.��� �/
William W. Burns
Its City Manager
STATE OF MINNESOTA )
) ss.
COUNTY OF ANOKA )
The foregoing instrument was acknowledged before me this
day of June. 1989 by William J. Nee, the Mayor, and by
William W. Burns, the City Manager, of the City of Fridley, a
Corporation under the laws of Minnesota, on behalf of the
Corporation.
�
.
� _ s
IN WITNESS WHEREOF, the said party has signed this Agreement
the day and year first written above.
v •
� James P. Bowe
STATE OF MINNESOTA )
) ss.
COUNTY OF ANOKA )
�e foregoing instrument was acknowledged before me this
�2T day of June, 1989 by James P. Bowe.
0
ri�.� y ��vErz
NOTARY PUBL(C - MINNESO?A
AN014A COU�Y
,tr conu:,. c,�,. .t,::.. ��a. r �e
THIS INSTRUMENT WAS DRAFTED BY:
Herrick � Newman
Suite 205
6401 University Avenue N.E.
Fridley, Minnesota 55432
Phone (612) 571-3850
(AGREE5)
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CHIMNEY AND STACK VERIFICATION
The undersi.gned hereby veri.fies thaL the existing chimney or stack; ��
1. �FIaS .been. carefully_examined- � Yes (, )
2. Is .free from�rust or deterioration �� Yes ()
3. Has ra foreign objects lodged within Yes ()
4. Is securely supported .. Yes ()
5. Meets all current Code requirements for size and
total BTU connected �
6. Has Total hea ting BTU's of
All oLher BTU's
TOTAL
Rema rk s
Company
Signed By
Da te
No ( )
� � )
No ( )
No()
Ye s ( ) No ( )
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,
CIVIC CENTER • 6431 UNIVERSTTY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-34�50
November 2, 1989
Mr. James Bowe
7919 Broad Avenue N.E.
Fridley, MN 55432
R�: Final Inspection at 7919 Bxoad Avenue N.E.
Dear Mr. Bowe;
A final inspection was conducted on October 3Q, 19.89 of the above address
and the following items were noted which must kae completed befor� th�
construction can be finaled:
1. Post address on structure by November 15, 1989.
2. Provide sod in the front and side yards by June 15, 1990.
We will expect these items to be completed hy the scheduled dates wh.en
reinspections will be conducted to determine compliance. �
If you have any questions on these it�ns, please feel free to contact me
at 572--3602.
Sincerely,
DARREL G. CLARIC
Chief Building Official
DGC/mh
Building
Inspections
763-572-3604
srrE AnnxESS ��� `/
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBNIIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
�'/� � ' %
❑ OWNER CONTRACTOR
Na�: �� � � ..:�'�
.4n��ss: �°� � � / � ,�
PHONE: r� � .a �� � ' �,��'
NAME: � � � �
STATE LICENSE # �/���
aDn�ss: �ioc`x �'����'�:� �/�,�.�
PHONE °° ,�,� �"�r�',� .-
❑ SMGLE FAMILY/NEW
❑ TWO FAMILY/NEW CC
❑ ADDTfION
❑ BASEMENT FINISH
❑ DECK
r•n
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES � a
GARAGES
' PROPOSED 5IZE: � U �S
I PROPOSED HEIGHT: l�
❑ GARAGEISHED
�OOF
�SIDING �� L I�
� SWIMMIN�POC
❑ REMODELING
❑ HOUSE & GARAGE
O ATTACHED GARAGE
❑ DETACHED GARAGE
SIDING
O Vinyl OSoffit
0 A(uminum �/ 3 J�' O ❑ Trim
❑ Other ❑ Fascia
WINDOWS
IN EXISTING OPENINGS �Yes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE WSTALLED
LACATION OF WINDOWS
NUNIBER OF
0 DRAIN TILE
❑ OTHER
Permit No.:
Received By:
Date :�
��
WIDTH HEIGHT
-�`'� � e����
T� Z1P �� y/
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
J`
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMTf:
1. Site Plan/Survey showing it�e er�isting strucdues
and proposed project.
2. Two setc of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $`� �� �° OCCUPANCY TYPE
Permit Fee $ �"� �a5 See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Surchazge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Chazge
Total Due
$ �.�P g� .0005 x Permit Valuation Minimum $.50
$ � ��_ $5.00 (State Licensed Residential Contractors)
$ $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+dft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ �, I Make checks payable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID LJIVTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances an 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 rmit.and work ' not to start without a p it; that the work will be in accordance with the approved
plan in the case of a11 work which re �ires r vie proval of plans.
SIGNATURE OF APPLICANT \ � 1\ PRTNTNAMR � V l ne� I� I J� l 11 �
P�ge 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pernuts 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
including $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or firaction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
__ LA'f 1 T7T�IIIVG1�PillUG 1VL'
Fridley, MN 55432
763-572-3604
Fax: 763-502-497?
From: City of Fridley To: 651<203-0554 Page: 4/5 Date: 7/26/200612:02:13 PM C,�,S
CD�i .
Building BUILDING Permit No.: �,� -0 3
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY D °' - �
DATE �ZI�I I C�) YOUR E-MAIL ADDRESS
SITE ADDRESS ��i� �'(�,(,� n�Q• � G ��JZ.
THIS APPLICANT IS: ❑ OWNER �$(CONTRACTOR
PROPERTY OWNER/ NAME: I
TENANT pDDRESS: �(�.Q CITY STATE ZIP
PHONE: '"�p3� —I L�I —�i�LU
CONTRACTOR N,�E: iv�}� w►�u� &� ���a
SUBMIT A COPY OF STATE LICENSE # Z,GZ�I �uFF� EXP DATE 3 I'3�ZOlO
YOUR STATE LICENSE �DRESS: . CITYCY1fX�L►C�l� STAT��IP�12L0
WITH APPLICATION pHONE C�� —�,G�' l FAX
PROPERTY TYPE S1NCiLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERNIIT TYPE ❑ �DITION ❑ C3ARAGF/SHED WINDOWS
❑ BASEMENT FYI�IISH ❑ ROOF ❑ DRAIN TILfi
❑ DECK ❑ SIDING ❑ OTI�R
❑ SWIMMING POOL
TYPE OF WORK: � �W ❑ ADDITION
0 MAINTENANCFJREPAIR REA�FAHL-�ING �C
DESCRIBE WORK BEING DONE: �1��IGIC.4�1'1,U l �-nr�L6 � i �J
SIZE OF IlvIl'ROVEMENT LENGTH WIDTH HEIGHT S. Ft.
OOF G ❑ HOUSE ONLY
NUMBER OF SQUARES 0 HOUSE & GARAGE �ASE1V[ENT REMODELING SUBMIT:
GARAGES ❑ ATTACf�D GARAGE 1. Existing Floor Plan
PROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan
PROP03ID HEIGHT: 3. List of sW ctural members to be used
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl �Soffit ADDITIONS. & PORCHES SUBMTT:
❑ Aluminum ❑ Trim i. Site Plan/Survey showing the existing swcwres
❑ Other ❑ Fascia and proposed projecL
���� 2. 'ltvo sets of constiucdon pians
IN EXISTING OPENINGS �es ONo LOCATION OF WII�[DOWS � 3. Energy Calculations
OR FOR NEW OPErTINGS-D SCRIBE SIZE OF �� !��
OPENINC3 CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUA ION, INCLUDING THE COST OF LABOR A1�TD MATERIALS:
([TSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ lt (OGU • CU OCCUPANCY TYPE
Permit Fea
� Ret�i�� -
Fire Surcharge
Surcharge
Licensa Surcharga
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fae
Sewer Main Charga
Total Due
$ �7=p�
--- --
$
$ �
$
$
$
$
$ '
$ f� �-P.5
Sea Back Paga for Fea Schadule _
6��0 o�$u�in�ermit Fae �
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (Stata Licansad Rasidential Contractora)
$1550 par SAC Unit (Plans to MWCC for detarmination)
ft+6ft= ftx$21 =$ .
$450 Conservation Plan Raview
Fea Determined by Enginearing
Agreament necessary ( ) Non Necessary ( )
Make checks aavable to: City of Frtdley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I.hereby apply for a building permit and I acknowladga that tha information above is complete and accurata; that the work will be in
conformance with tha ordinancas and codes of tha City of Fridley and with tha Minnasota Construction Codas; that I understand this is not a
permit but only an application for a parmit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the casa of all work which r quiras review and approual of plans.
SIGNATURE OF APPLICANT �/�G+�i'i ��l�� PRINT NAME �10�� �I e`�c�DATE �(Xl�/� �
FFtOM :City of Fridley FAX N0. :7635711287 Feb. 01 2006 08:14AM P�� �
Blll�.d.�17�
:Lns�ecti ons
76��a / ��3fiO4
BiV�..����i
R.r SID�;�TTIAL APPI�IGA'r'TON
C1�'"Y O� FRIULEY �
PermiC No
Reoeivecl By:.
Da.te.�
DATE�: .. .... Y(lUk GMA1L AJ)))RLSS , . .. . _.....
. • 1� .,. ,� �pr �(�� '
3�TF ADDKIsSS ��,� _�„��_o_ 13��. � •� .. � � '---��..�—�..... ... • •_—
•1•i-us .��rLr.c�T �s: o c�wx�r� �Yc:c)N'lTtAI:TOR , ..» . - ,-- .. .
�:I.tOPERi'Y dWNF'RI N.AM�:, . ti1�.,{C,�� . ._. _.. . _�.
7'E:NANT AJ7I�RNCS: �WZQ„ .., ('tT3'_ .... ..sTn� z�.N__, —
PHONli:, iCO�'�1,,-�% .,.... . ., —, —
CO�ITItAC1'OR NAME; � �i�x�-% d C .�.':`4•!fLD1VlCCl , .. ..._ -• .
StJBMTT A corY OF STATP. I.i�.hNS� �r�?1,� Y:.xN r��� �..° �� •?.c� �� ,.__
.+ rnflrl
XC)L'Tk STATB LICBNSN An�tttiSS;_ .4,�C�1 �° �����. � . .—�I'1'�'���STA.�n?_, �iN `�12.�
WITH APP1df.:A'IYON PHONC C�l��' Cj� FAX .., . .. , ,..
PROPERTY '1''X�F _� 1Nt31.� rAMILY/NFtW LvNSTRUCt'1�.)1� M s��H
+ —.___ _ _ ..,�...�.. e�rnnrvc
'�.F,,�iM1T �"Y�E L'J A.nnrru�n�
D 13AS1iMiNT FIN1.5M
I� nAC�x
....,-TYYr; or wo��: �� a �::w---- � - -.�.r_..� ...
❑ ROOF `f� I)kAfN TIL.E
O SIUTNG ❑ OTIIBR
..,._. ❑ 3WA'1MlNC.i YOOI.., � _,,.., „ . �
❑ �DDITION �
_.. , _,_ L"1 RRM()llliLINU _, � _„ ., __._.
DESC�t;rF3.F, woRx 13L1NG DON'F:.. `�7e�ral c�c�ca �a c��\eAS.�� ...
SIZE OF TMPRUV � y i.EN�r7'fl , WIbTgI r,,,,,,
o� r�� � ❑t10U5E��N�.Y
�itJMk�hR c�T� SQiJARCS 0 HOUSH & faARA�C �AS��'N�' KM'M�n�LINo..SU�MIl:
HE1C31�[T Sc�, l� t.
G t:
PRC�PC)SEU St7.G;
PkOPOSL�D IIEIGHT; .,
� A'i°1'ACHRf� CiAkAC7�
❑ I)Ei1'ACIiL?D aARACR
t. C�xistingIloatPlnn
2, PropaFCCf flnor plsn
7. Liat uf btructurat mcmbFr� c� ba uaed
��p� �� Hhk NF'4V CONSTRUC7'lU'N INC;I.tlf�TNC DI:CKS,
O Vin�l ❑Svffil AUDTT[ONS. & PORCHi33 SCJLiMTT;
❑ Aluminum ❑'i'rim t. Site PIan/Surva,y showinµ lhe �.�isting eccuca�rc�
C] ntlur ❑ Fascta anA pr�imaecl projccl.
--.•°.. ...—' 2. 'I'wn vet� uPcoast�vcdan p1anR
WtNI)Owi 3. �nergyGalcuiation�
'M �XISTMG OPEMNc3S ❑Yex ONo LUt�AT1t7N pr WINDOWS
nR FOicN�W OPBNINUS-t)I'SCkIL1� SIZE OP ,,_ .,, .,, ._
CIPENIN(3 GIiAN(iF�S &
'1"YPIiUH WINDOWTOT�k? INSTALI��17 NIJMH�I:Or WIND�WS _, _,,,
���� � ALL l�k;�5 AR� BASED UN V�A%.UA,'.�.']:4N, IIVCLUliING TI-7F CnST Uk LA]34:[t .AN1)
([JSTNC: THT: 1497'U.R�C F,i+'..'F, SCHEDl7'LE)
AL
PCrmit ree
�'ixn��evtevn- �- —
Fire Surc:har�e
Surch�:ge
Liccnsc Surchar�e
SAG Char�c
Curb Cut �scruw
�rosion c:ontrol
P�rk F�e
,Sewer Muin GLarge
R1AL5:
$ `�� �. � S��'f3ack Pflge for Fe� Schedule
' �� _ — __ ---. ...'- �% n�;f3uil�lin� �crcruC �ze -- - - --
$ ��� �� �. .001 timCS the T.atal job valuralior�
$ 0005 x Pe��it Valucttion Minitnuu� $.SQ
u.
$ ��� $SAO (State Lice�used RESiclential C`ou�t�actors)
� � 1 SSO per SAL Unit (Plan�s to MWC:C �'or deternunation)
� .`�. ft+6ft= ftx�2p�$
$ $a5U Gonservation Plan Rbviewv
$ ��T Fee netcrrnined by En�ineoring
� "'��'���- ,� Agrc:cmant necessary ( ) Ncm Necess�iy ( )
'I'H IS IS AN ANPLICATION F�)R. A NHxMI'P-NOT VALIP UNTn. NkAC`:GSSCD
I hercby :+pply for a�+uilding �ernvt snd I aclazuwl�tlge Gl�at f��e inf�rn�ation Kbove is complete a.nd ac�uralc; thut t��e work wiJJ. bc in
confurmr�ncc with lho ordlnwcas aa�d c�des �f the City nC Frldl�y �n.d wLUi the Minn�sotxi Cun�lruc:l.iuu �c�ctcs; tliat I ttadcrstttnti L•bis in r►c>t �
p�rn,it bul anly �n appllcarion f.ar a permit xnd work is not xo s�art withaut a perinit; t�iat the work will be lu a.ccc►rcidnco witli ehe a.pproved
plan ita tue case of all w.ork which r�: lxes t'oviav�t�nd a}��roval of pl�,t�. _
,�1�..���'�n�, ��`'�/v ..--
3.Tt7t�fA1'l1tlE OF A�'PLdGANi' ,,,._,,. , _, rRiN'I' NAM�; _...._. .