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AF - 44120City of Fridley, Minn. � B�TILDING PERMIT N° 4�' � l: Date: ......- �...�....'r."'.--,i�•••.--�.".".".. ..�,�.....�.�!. ..._ .........:..._.._........._.. � �y Owner: .... .. .. ..... . . . . . Builder .................._........._. ................._.....-----....._._....._..w_._._......�_._....._._.... .... . Address ... . ,� Address --......_.- --...... .�:..�_!�!'_.._...._._.._._.._..._._..........._..W -•--�� -�--- .._ LO T10N OF ING No * . � �.r�-�....... Street . _... : - . ...._.'�....��1�' . .:.. ....�.. P of Lot •-.:._..._... .......__ . __ _._.._..�. ' � ; , Lot .........�..'� ......:........ Block --�--.... ..�:........ .. .......:. Addition or Sub-Division .. . . �,�,++�,.��'y¢........ _ ' w._...__._ w Corner Lot ............. ...... ......... Inside Lot ...i�!!.*.!'....:.................. Setbaek ....�.w�r..�.�........... Sideyard .,��+......._....�"..r...��......_......_..._._._..:. Sewer Elevation ................:...............................--�-=-..._........_.......---..._.-------------.. Foundation Elevation .........---....._..-------_....._..........----.._. . ' , DESCRIPTION O� BUILDING To e Used as: � . : ....:. ..._ ...: Front� ��.+.... Depth .�..-�. -- �.�....:. Sq. Ft��" ��. - Height ;� Cu. --- �, � ; . Fron � �, ...... Depth ��...- Height � � � .. Sq. Ft. ._.... ::�,� (�. F'L �� Type Construction ... ��+!��..... Est. t�� r,..._�""�'�. To be C�npleted ....._..........._. __.�_ _..�. �, ;a In consideration of the issuance to me of a permit to construct the buiiding described above, I agi+ee tin do the proposed woa�k in accordance with the description above set fiorth and in co�nplianoe with all prowLio�fs c� o�rdinances af the city of Fridley. ; �...........:_ ............._......._.__............___.__.._._.._._.........._..__._..._..J._..._._,...�...._. _ . .r Ixi'consideration of the payment of a fee of .* ....:..-•.---.-------, Permit is herebY granted #o....._.:.....__..-.•---_..._...___........___:. ••--._ ................__...........----•--••-•---•---........---......... ta construct the buflding or addition a$ described above. Z9�is pernut is granted t�pan . the express condition that the person to whom it is granted and his agents, employees and wo�n, in sii wark done in, around and upon said building, or any part thereof, shall conform in all respecta to the ordfnaiice�t � Fridley, Minnesota regarding location, construction, alteration, maintenance, repair arxi moving of btuldingu within the city ]imits and this permit may be revoked at any time upon violati of any of the proviai� �t said ordinances. . - :...��' NOTICE: This permi! dees eof. eowr tha eonstruefion, insfallalion fer wiring, plem6ing, �as bsatir�, �r�r er waNr. !� wM b�! , the Buildina inspec�or for �»Ma�at� p��nuts for fh�s� iMms. y"' ,� � a�4 � _ .. �.��_.� 1 } .� APP'LICATIDN FOR HUII�DING PER�QT � CITX OF FRIDLEY, MINNF.�S{1TA I , •� - : ,; _ � 1.��_., � '� ' • = �' � � ' � ��:.� - �.,.�r� . , , �I / i r i • . . - _ _ : . . : - � . � , �.:�. �.ir _ _ --' . LOCATION OF BUILDING No. ,5 � .� ,�_,,,Stxee� ,�,,.U�� Part of Lot yot / .2 a7,fl� , ,�, Addition or Stiib.Div. %%� � ' � _,._ Corner Lot_____Inside Lot_,�,_,3e� Back Side-Yard ~� ' 3EWF� ELEVATTON FOUNDATION ELEVATION � Applican� attach to this form Certificate of Survey of Lot and proposad building location. DESCRIPTI016 OF BUILDING To be used as : �� 5� �� or�t a`�� Dept,h � � Height t i� x �� .Sn 7 Sq. Ft. � � � % Cu. F�t. .� 3� �_S• � �.-�s��-� ' � � �' a ,,,...��, _� J_ uo�t s�,+ /� v �,� �/ 1// �• Fl�• �� / �� VU• i'�• 'k� / �� ;7'L'c�t1' Est3m�sted Cost � 7 d a z+ � _, Type o� Construction �,_, - -- - _ �� . To be comp7.eted `i ��' - -- • •• --- The undersigned hereby makes application for a permit for the work herein specified, agree3.ng to do al�.�rork in striet accordance with the C3t� Ordinances and ru].ing of the Department of Buildings, and hereby declares that e�1.1 the facts and representa- tions sta.ted in this application ax�e txue and correct. DATEY /� d � SIGNATURE �ihr,�/ � _,..,,�,. .r____..�..�.-•.-- (� Schedule of Fee costs can be founc3 on the Reverse 5ide.) � • ..�.._ � , � � � /� � . I� Appiicc�rion for Rawer P�ants nnd He�ti�g. Coating, Ventilntion� Refrigerntion c�d � Air Cand�tianing Systems and Device�s PARTIAL RATE SCHEDULE Depi. of B�a�. Phoae SU 4-7470 , GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work . . . . . . . . . . . . . . . . . . . . . . . . . . 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up ta $500.00 . . . . . . . . . . . . . . . . . . 5.00 $ Repairs & Alterations each add. $5Q0.00 . . . . . . . . . . . . . . . 2.50 $ MECH. WARM AIR Furnace Shell & Duct Work ta 120,000 BTIT . . . . . . . . . . . . each add. 60,000 BTIJ ............. ..... .... . Replacement of Furnace ............................. Repairs & Alterations--up to $500.00 . . . . . . . . . ... . . . . . Repairs & Alterations each add. $50Q.00 . . ... ... .. .. . . 8.00 $ v a.00 � �._. 5.00 $ 5.00 $ 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines--ta 4U0 sq. ft. EDR Steam ...... 8.00 $ Ftizrnace Shell & Line—to 640 sq, ft. EI�R Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . . . . . 2.50 $ Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50 $ OIL BURNER—to 3 gal. per haur . . . . . . . . . . . . . . . . . .. . . . . . 5.00 $ over 3 gal. per hour—See Fee Schedule � GAS BVRNER (up ta 400,000 BTTJ) . . . . . . . . . . . . . . . . . . . . . . . 5.00 $ GA5 FITTING FEES: NO RATE TOT1�I. lst 3 Fixtures ...................... x $1.50 $ � Additional Fixtures .. ......... ..... x .50 $ Gas Range to 200,000 BTLT . . . . . . . . . . . x 2.Q0 $ AIR CONDITIONING � FAN HEATING SY3TEM See Fee Schedule V�NTILATING SYSTEM ��7Y' "� AL.T'ERATIONS & REPAIRS TOTAL FEE $ � RF7MAAKS: � City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all wark 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. �,; ;; %' 1 Fridle�, 1VIinn._�I �� d �960 , 195— Owner 1�� . Kind of Building Used as 195_ 195_ To be completed about - / Q��+ � �_ o Estimated Cost, $ , �� ' Permit No. �� -� / DESCRIPTION OF WORK HEATING or _ Warm Air—No.- ,, _ Trade Name��/1/ Size N°o:�� .�/�� Capacity Sq. F't. E.D.R�i ��G BZ`U H,p, Total Connected Loa � � +� Kind of Fue� - �� BURNER — Trade Name � Size No�'��>.��Le�`� Capacity Sq. Ft. E.D.R�� TU g,p, � GEO. S GW��K h3G. � A; �-CO�t:D. CO �" �°z� 1G01 X�.7ic3 l;v. S. Minneapolis 16, Minn. Sign sy 11 ppST iM-12-58 Business Phon No �:,.�.. � , . .� �4�XAn/A�✓ �R� 1�f6 s ' "o l./�11�� //� R1 �{ � HEAT LOSS CALCULATIONS: DEPARTMENT A.S. .V.E. Weatherstrips Conatruction' T Guide Windaws ( Doors Reference Out. Wal1 Int. Wall Ceiling e e 19_ Fl. ,p� Room Length „�, Vilidth Q Height WiRdows and Doors-Crackage ancf Area '� � +' Width . Hetght No. ot . Llnea'j-ft. Area � �� No. ot pane of Dane �- 1iBhta ��ot Cr#ck � eq, ft. � � �� y'.3 � � Coef. � Btu Inhltration �" ��+` � � ' Giass p v : p ►� Exp. wall ,,Y � Net exp. waU Int. wall Ceiling Floor ' Total stu. „r I Required sq. ft. E.D.R. or aq. in�: W.A. I:eader area FI.� Room � Length Width Height Windows aad Doors—Crackage and Area . � Wldth -�Helght � No. of Ltaea! tt. Area � Na ot pane ot pnne lights ot crack eq. ft. G� :.�' „�► �' co��. sc�. ` In6ltration �' ��Q' Glaas � Exp. wall f NeE exp. wall Int. wall Ceiling �' Q 'Floar Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1• t.�'T/�i Room ( Length,,� �,.• Width Height Windows and Doors—Crackage and Area � Width Helght . No. oL Lineai tC. Area � � � No. of yane of pane lighte ot crack eq. ft. � �. � Infiltration Glaaa Exp. wall � Net exp. wall Int. wall Ceiling � I� loor Tota) Btu. �� , � �� ' �� x Required sq. ft. E.D.R. or sq. ina. W.A. L.eader area �-- >S S ��'�!i � + „� ✓c:T �' , l.31 ,;: OF BUILDINGS ' MINNE.�Pt�S. � o. . . Inaulatia� Roof Floor Kind How Fl.� Room Length Wid� �' ' Height � Windows and Doors-Crackage and Area ... . Wldth Height No. ot Ltnwl ft Aeaa No. of pane ot Dane Ilghta oi er4et e�: t{. .�. .� ��, .� �. g� � Infiltration Glaaa . ,�, �' Exp. wall ' � Net exp. wall � Int. wall ' '� Ceiling _ � f loar Total tu. Required sq. #t. E.D.R. or aq. iaa. W.A. Lieiide� �� F1.1 Room (1.e�gth '�f,�It1►;. #�t Windows and Doora—Crackage and Ate�' �, ��` Wldth Hefght No. o! Liaeal !t. 11t�e�y No. of Dane of pans llghts o! esack sq. IC.' � ,� .s. �+��' . f. In6ltration - �i Giaaa Exp. waIl Net exp. wall Int. wall • Ceiling . Floor Total" Btu. Required sq. ft. E.D.R. or aq. ins. WA: der are� Fl.� Room � Leng �li�t . Windowa an Doora-Crackage and Area' Width He1gAt No. of Lineal [tr' - AraRy; NO. ot DaAe oLpane lights OL cr�clt x 4�{. Rt.. � � �� - >� C.�e� �1�cy In&Itration r Glasa :� Exp. wall y. Net exp. wall � Int. waIl . �, �.: Ceiling , �- Floor Total Btu. . Required aq. fi. E.D.R� or sq. ins. W.A. I.,eackr :area �. � ` ,�''3�,� �uc.�,r�.✓�+n/ ` � , � �....,� �/ ' ' D•S6 ��.. I1 � � . b ��0 , `� 9 � � � � `� HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS MWN�APOLL�.' iV�ilVri: � Weatherstrips A.S.H.V. . Construction No. , Insulation Guide Windows� � Doors Reference Out. Wall Int. Wa11 C.eiliag Roof Floor Kind How. A�1ied e 19� Fl.� �/ra Room �.Length Width Height Fl.� Room l:eagth ' Widt�► -Height ` Windows and Doors—Crackage and Area Windows and Doora---Crackage and Area �'Vidth Hefght No. of Lineat ft. Area Wldth HeiBht No. ot Lineal it. Area � No. � o[ pane� of pane 1'tehta ot crack s4. ft. � � No. ot pane ot pane ll�hta of CraCk �!. 1t.. .. .. � �� - � ,�� • Coef. Btu Coef. Btu In6ltration Glass � Exp. wa11 Q,,N;�� W Net exp. wall p � Int. wall Ceiling �,�" Q Floor Total Btu. Required sq. ft. E.R.R. or sq. ins. W.A. L.eader area FI.� �'�' Room � Length ,?,r Width Height Windows and Doora-Crackage and Area Wldth Height Na: of Llneal tt. Area No. ot pana ot pane � lights of crack eq. ft. � + �� r„_F R�,. Infiltration Glaaa Exp. wall �,p,,� Net exp. wall Int. wall Ceiling Floor Total tu. : �uired sq. ft. E.D.R. or sq. ins. W.A. Leader area f Fi.� �.� ,�i�' Windows and Width No. of pane < Infiltration Exp. walt Net exp. wall Int. wali Ceiling 1� loor Total t Requirei Length /�, Wic�th rackage and Area � �. of Lineal f�t. Area �hta ot crack eq. [t. ��%� �� 8 � ,� . � . Btu � aq. ft. E.D.R. ot sq. ins. W.A. Leader area Infiltration " Glaaa Exp. wa�l Net exp. wall *-- ----n Floor Total Btu sq. ft. E.D.R. or aq. ina. W.A. Lea�r area Windows and Doora--Crackage and Ana Wtdth Helght No. o! Lin�al !t. Ares No. ot Dsne ot pane llghts oierack p. Lt. f. tu ` In6ltration Glasa Exp. wall i Net exp. wall Int. wall Ceiling Floor - Total Btu. Required sq. ft. E.D.R. or aq. ins. W.A. Leackr area Fl.� Room I L.ength - Wn1ih � Heighc , f. :Windows aad Doors—Crackage and Area Width Hefaht No. ot Linsal ft. Area- . No. ot psne ot.Dane tlgha oL crack �. !4 ' Coef. Bw .� Inhltration , Gtasa Exp. wall ;, Net exp. wall Int. wafl Ceiling Floor � 1'otal Btu. Required aq. fi. E.D.R. or sq. ins. WA. Leadec arts Application for Power Plants and Heerting, Cooling. Ventilation, Re�frigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE 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.OQ . . . . . . . . . . . . . . . 3.00 $ MECH. WARM AIR Furnace Shell & Duct Work to 124,QOQ BTLT . . . . . . . . . . . . $10.00 $ each add. 60,000 BTLT . . .. . ....... . ... . ... .. . 3.00 � Replacement of F�rnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 . .. . . . . . . . . . . . . . . 6.00 $ Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . . 3.00 $ 3TEAM or HOT WATER SYSTEM Fixrnace Shell & Lines—ta 400 sq. ft. EDR Steam .... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water .. 10.00 $ 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) . . . . . . . . . . . . . . . . . . . . . . . 5.00 $ ''r over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL lst 3 Fixtures ...................... x$ 2.00 $ � Additional Fixtures . ............... x .75 $ Gas Range to 199,000 . x$ 5.00 $ AIR CONDITIONING �__7_ A� FAN HEATING SYSTEM See Fee Schedule � VENTILATING SYSTEM $ ALTERATION3 8c REPAIRS TOTAL FEE � ROUGH FINAL Dept. of Bldgs. Phone 560-3450 Lxation�,� !'�� " �1��.�� City of Fridley: The undersigned hereby makes application for a permit for the work hereir. 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. � ' ey, Minn. '�°�" , 19 �� Owner Kind of Buil `'hg ��`"�`�"✓�''�=� Used as � y � �' To be completed about � Estimated Cost, $ � ' �J- �—New. Building Permit No. Permit No. �-�> '� DESCRIPTION OF WORK G � �'�'�� , HEATING or POWER PLANTS�team, Hot Water, Warm Air—No.� Trade NameJ ��1�'G Z�S Size No. ��- �G�� Capacity -� Sq. Ft. E.D.R. BTU H.P. Total Connected Load� �� _,/ Kind of Fue �� BURNER — Trade Size N Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) �.: By. Business Phone M �'Z�LLa...r2$ �-- , > sue�etr PE c�ty of Fr�a�ey _._--� � AT THE TOP Of TN£ TWIhS g � i L D I N G P E R M i T 3��$ 5 ., ,� . � • COMMUNITY DEVELOPMENT OIV. ' � �: ----- , r � � pROTECTIVE INSPECTION SEC. � O � � 4 , � �"'1 � CITY MAL� FRIOLE� SS�32 NUMBEii pEV OATE PAGE Of APPROVED 8Y �"""�" �'' 612--571-3450 9�0-Ft5 9/11/00 � � JOB ADORESS 5231 Buchar.an Street NE 1 LEGA� �OT NO. BLOCK TRACT Op AOOITION SEE ATTACME� oesca. 12 2 Marian Hills SHEET 2 PFOPERTY OWNER MAIL ADDRES$ ZIP PHONE Bill/Mary Young 5231 Buchanan Street NE 763-571-8807 3 CONTRACTOR MAII ADONESS ZIP PHONE IICENSE NO Rite Way Waterproofing 448 Lilac St, Lino Lakes, NIN 55014 651-786-0550 1 ARCHITECT OR OES�GNER MAII ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAfL AOORESS 21P PMONE UCENSE NO 6 USE Of BUIIDING Residential 7 CLASS OF WORK � NEW � ADDITION C� ALTERAT101J O REPAIR O MOYE O REMOVE B DESCRIBE WORK Ir�stall interior basement drain tile system 9 CHANGE OF USE FROM 70 STIPULATIONS Provide smoke detectors in all sieeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Electrical extension cords ca� not be used as part of the power source to the pump. Perr��t inspectio� Car�s SEPARATE PERMITS �41i1� �� a�� EQUIRED FOR: To �iomeor��e� 3'� ��s� PLUMBINGG� A D SNG�I S 7YPEOFCONST. OCCUPANCVGROUP OCCUPANCVlOAO SEPARATE PERMITS ARE REOUIRED FOR ELECTiiICAt, PLUMBING. 1/EATING, VENTI�ATING OR AIR CONOITIONING. TMIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CpNS7RUCTION ZONING SO. fT CU FT. AUTMOR12ED IS NOT COMMENCED V�IITHIN 60 OAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO fOR A PERIOD OF 120 DAVS AT ANY TIME AFTER WOfiK IS COMMENCED NO DWLG. UNITS OffSTfiEET PARKING 1 HEREBY CEFT1fY THAT I MAVE READ AND EXAMINEO THIS APP(,ICATION 1 STA�LS GARAGES AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS Of LAWS VAIUATION SURTAX ANO ORDINANCES GOVEANING THIS TVPE OF WORK WILL BE COMP�IED WiTM WHETMEq SPECIFIED MEREIN Op NOT. THE GRANTING Of A VERMIT �2�099 $1 .OS DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OFi CANCEI THE pEqMIT FEE SAC CNARGE PROVISIONS OP ANY pTHER STATE OR LOCAL LAW REGULATING CON- $83.25 Fir SC �Z.IO $TRUCTIpN OA THE PERfpRMANCE OF CONSTRUCTION PLAN CNECK FEE TO FEE Licen C $5 $91.40 S�GN�fUAE Of CON'FACTOQ OA �UTMOQ�IEO 1GENi �D�TE� }{E p VALI A THIS I �PE,R+ iT _� � � v $�GN4TUAE O� OwNEA��F OWNEA BU�LDERi �DATEi � B G�NSP ' �1L1E NEW [ ] ADDN [ ] ALTER c[�p Effecrive 5/10/99 CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R 1 AND R-2 BUILDING PERMIT APPLICATION � � �g� � �� Construction Address: 5a 3� �UC,�nQ)nci� S�e.c�-- ��z. . Legal Descriptivn: � � � � ��.� � �-- � r�,�,,-� -�� ,�.�.�� Owner Name & Address: �; � t �}- (�RC� ��,_�� Tel. #'7(0� - S? l- C�B'O'`t Contract� Address: LIVING AREA: GAaRAGE AREA: DECK AREA: OT�R: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. ��:5��'1'�Q'v �1F �MfPl?��'�'��' Leng�th _ L.�ngth — Length _ Width Height Wi�ith Height Width Hgt/Ground 'ENSE # Tel. # 1a�1 �7k?� 'vSS� Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: Cl��'1r _ Estimated Cost: $��/. � Driveway Curb Ciit W'fr��h 1�1�eec�ed �t ,�1- 6 �t � Ffi x�' �i '' �' _,� � �'� � a. .,� ,. , ,. � ,. � � � " �, , , . -. ; ,� . . � , � A DAT'E: C� -(� --� C� APPLICANT: Tel. #] '�o -D � S C� Permit Fee �ire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY $ $' 3�aS Fee Schedule on Reverse Side � o�• 1 O .Cln1 nf Pert�it V�1�zat��..n_ (1/IOt1!%) $ j� e S $.50/$1,000 Valuation $ $1050 per SAC Unit $ S . � $5.00 (State Licensed Resid�ential Contractors) $ Alt. "A" or Alt. "B'' Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ I . �l0 STIPIJLATI�NS: /� // 1 sue�ecr P . City of Fridley 33745 AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r ; ` RECEIPT NO. • COMMUNI7Y DEVELOPMENT OIV. ' j V ��'�� , �� r � � PROTECTIVE INSPEC710N SEC. 1 . � i___•�'��"� �,� CITY MALI fRIOIE� SS�32 NUMBEn pEV OATE PAGE OF APPROVED 8r i 763-571-3450 9t0-F�5 7/29/03 / / 108 ADDRESS 5231 Buchanen St NE t tEGA� LOT NO. BLOCK TRACT OR AOOITION SEE AT7ACHED oesca. 12 2 Marian Hills Addition SMEET 2 PROPEiiTV OWNER MAIL AODFESS ZIP PHONE Mary & Bil1 Young, 5231 Buchanen St NE, Fridley, MN 55421 763-571-8807 � CONTRACTOR MML AOORESS ZIP PHONE LICENSE NO Budget Exteriors, 8017 Nicollet Ave, Bloomin ton, MI3 55420 952-887-1613 b564 4 ARCMITECT OR DESIGNER MAIL ADDRESS ZIP PHONE �ICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK Q; NEW � AODITION O ALTERATION p REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Window replacement 9 CHANGEOfUSEFROM TO STIPULATIONS Provide smoke detectors in all sieeping rooms and on all levels of the dwell�ng per Section 310.9.1.2 of the 1997 Uniform Building Code. Cau�king and flashing for ail exterior openings. TYPEOFCONST. OCCUPANCYGROUP OCCUPANCvIOAD SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, MEATING. VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NUII AND VOIO IF WORK OR CONS7RUCTION 20NiNG SO. fT CU FT. AUTHOR12E0 IS,NOT COMMENCED WITHIN 60 OAYS. OR IF CONSTfiUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 pAVS AT ANV TIME AFTER WORK IS COMMENCED NO DWLG. UNITS OFfSTREET PARKING I MEREBV CERTIfV THAT I MAVE READ AND EXAMINEO 7HIS APP�IGATION STA��S GARAGES AND KNOW THE SAME TO BE TRUE ANO CORRECT ALL PqOVISIONS Of LAWS VALUATION SURTA)( AND ORDINANCES GOVEqNING THIS TVPE OF WORK WILL BE COMPLIED �j�j,950.00 �3.�FH WITH WMETMER SPECIFIED MEREIN OR NOT TME GRANTING Of A PERMIT DOES NOT PRESUME TO GIVE AUTMOfiITV TO VIOIATE OR CANCEI THE pEqMIT fEE SAC CHARGE PROVISION$ Of ANY OTHER STATE OR LOCAL LAW REGULATING coN. �139.ZS Fire SC �6.95 STRUCTIpN OR ?HE PERFORMANCE OF CONSTRUCTION PLAN CMECKfEE TOTALFEE $5 00 License $154.68 S�GN�TUAE OF CON"FA(;iOQ OA �UTtiOA�2ED �GENi ID�TEi WHEN PqOPERI� VALIOATED TMIS �S V UR PEQ li ---� �► % S�GNnTUAE O� OWNEp�� OwtiEABU��OEAi iDATEi �O iN$0 �I�tE � .� NEW [] i� � CITY OF FRIDLEY Effective 1/1/2003 ADDN [ `� 6431 Universit Ave NE Fridle MN 55432 763 572-3604 Bid Ins l � Y , Y> ( 1 9 P ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION _. Construction Address: �Jo�3 3( �L�.LH�f 17�,) I}-IJ 5T P� � Legal Description: � Owner Name 8� Address: !`��fLu �+i-�i LC., �-tuL{0�l (r Tel. # 7�03 -5"7/- 8�80� Contractor: �ua7Cr�r�t �'sxTT�t'Z� o2S MN UCENSE # �Sh �f Address: �'SD l 7 nJ► �-O i�4�T �� •�Loom�/l(G-"TD�tI ��kl. # gS d-$�7 f�..l3 LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTlON OF IMPROVEMENT Length Width Height Sq. Ft. Length Length Width Width Height HgUGround Sq. Ft. Sq. Ft. Construction Type:��%t�i3Dl.c� F.�!'I��LLP�►'�"l'�Yl� Estimated Cost: $�g�� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: _�� ` 3 APPLICANT: C�� T�/1 S Tel. #gsa '" O��-��o �� Call (763) 5T2-3604 for PeRnit Fees if mailing in application. Fax to 763�71-1287 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 CITY USE ONLY - $ / 3R'. o� Fee Schedule on Reverse Side $ � � .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1275 per SAC Unit $ r% U 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 $ •�� l� �o � f � •.