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DATE PAGE OF APPROVED BY �..___Jl.' �-� 612-571-3450 910-F15 5��8� / / JOB ADDRESS SOO�. CLB37: V lEtnT Lane N. E. t LEGAL LOT NO. BLOCK TRACT OH ADDITION SEE ATTACHED DESCR. 6 5 Ca,rlson''s Summit Manox 5outh SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kwok Kwong 5001 CleaxvieFr La,rie N. E, 560--4892 3 CONTRACTOR MAIL ADDRESS Z�P PHONE IICENSE NO. D.M. �xa,nb.y Siding 17220 1�xms.txong �lvd N.T�, ,. 13ncaka, 1�T 55303 441-•6399 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDINC3 ' Residential 7 CLASS OF WORK O NEW ❑ ADDITION � ALTERATION � REPAIR � MOVE ❑ REMOVE 8 DESCRIBE WORK Res:ide Dwelling 9 CHANOE OF USE FROM TO STI PU LATION S TYPE OF CONST. OCCUPANCY (3ROUP OCCUPANCV LOAD SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 APPLICA710N 1 STA�LS GAqAGES 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 $`( QOQ S3.O.O WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT f DOES N T PFiESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVI O S OF AN OTHER STATE OR LOCAL LAW REGULATING CON- STRU I OP TH ERFORMANCE CONSTRUCTION. S56 e 5O �/ i �� PLAN CHECK FEE TOTAL FEE U $5�.. 50 SIGNATUREOFCONTR � AUTHO 2EDAGENT IDATEI WHEN�PROPERLY LIDATED THIS IS VOUF PERMIT � � SiGNA7UREOFOWNER�IFOWNERBUILDERi IDATEt BLDG iNSP nAT N� �� City of Fridley Effeetive �1/1/86 ADDN. [ ] R-1 AAiD R-2 pLTER. � 7 Building Permit Application Constructioa Address: �O� � �C%�� t�tC� , �� ,�� ..� �.�-'! �� ,,..r� �G ° Legal Description: � � _ Oamer Name & Address : �-��----�-�-�=��-) �) � � �el � $ � 9 ��_,�15� �'it/�'''�f��._4G � � Tel . � � / Contraetor: ' �h ., � r� _� �� . �l"'�1�1 � �_ .��:� �y� �.s�3 c� � Address: LIVING AREA: GARAGE �iREA: DECg AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, With the proposed construetion draWn on it to scale. DESCRIPTIOH OF II�IPaOYEMENT Length Width _ Height Sq. Ft. Length � Width Height Sq. Ft. Lengt _ Width Hgt/Ground Sq. Ft. � � � � � � Corner Lot [] Inside Lot [] Ft. Yd. Setback _ Side Yard Setback '_ / � `� � Type of Construction: Estimated Cost: $ �� v' - Approx. Completion Date: Q� `�/ � � Alt. A Alt B Proposed DriveWay Width If New Openin� Is Desired: � - � See Baek Page for Explanation DATE: � �! Permit Fee Plan Check State Surcharge SAC Charge Park Fee SeWer Main Charge TOTAL STIPULATIONS: APPLICANT: � Tel. 4 , � / CITY USE ONLY g .��5'� $ � �_�� $ $ � � � �' � � Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $ 525 per SAC Unit Fee Determined by Engineering Agreement Necessary [] Not Neeessary t] BIIII.DING PERMIT FEE SCHSDIILE The Chief Buj?ding Official shall, before issuing permits �or the erection of any building or ��:ructure, or for any addition to any existiag building or strueture, or for any alter°ation or repair to any existing building or structure, upon applicatio n 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 Valuation Fees �1.00 to $500.00 $10.00 (Minimum Fee is $15.00) $501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each additional $100 or fraetion thereof� to and including $2,000. $2,001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for eaeh additional $1,000 or fraction thereof, to and including $25,000. $25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and ineluding $50,000. $50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each additional �1,000 or fraetion thereof, to and ineluding $100,000. $100,001.00 and up $�33.00 for the first $100,000 plus $2.50 for each additional $1,000 or fraction thereof. DRIVEfiAY DEPRESSION ESCROW (Conerete Curb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50 Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approaeh With 6 3nch depth - Driveway Width plus 6 feet times $15.75 9ERIFICATION OF FOIINDATION Permits for construction Will be issued a minimum of 2�+ hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation onee it has been constructed will be required before proeeeding with the framing. SuHJECT Q, City of Fridley 2 � 2 8 � AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � i � �. � i y__��_ COMMUNITV OEVELOPMENT DIV. �� r � � PROTECTIVE INSPECTION SEC. i = � � /'�'1 � CITY HALL FRIDLE� 85432 NUMBEF REV DATE PAGE Of APPROVED 8Y �""'� � ,�� 612-571-3450 910-Ft 5 8/19/98 / / JOB AODRESS 5001 Clearview Street t LEGAL LOT NO. BLOCK TRACT OR ADDiTION SEE ATTACHED DESCFi. 6 5 Summit Ma.nor - South SMEET 2 PROPERTY OWNER MAIL ADDRES$ ZIP PFIONE �1C1 RWOII 3 CONTRACTOR MAILADDFESS ZIP PFIONE LICENSENO. John Hale �1 R _ A ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS 21P PNONE LICENSE NO. 6 USE OF BUILDING Residen i 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION �c REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage (22 Sq) Tear-off 9 CHANOE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBIN(i, NEATING, TMPE OF CONST. OCCUPANCY (3ROUP OCCUPANCY �OAO VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK Ofi CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAVS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OFi ABANDONED FOF A PERIOO OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFfSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE THUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND OFiDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �IS37.SO .92 DOES NOT PRESUME TO GIVE AUTHORITV 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. ,rj9.50 Fire S�,' 1.83 PLAN CHECKFEE TOTALFEE License SC 5.0 67.25 iG iURE FCON7RACiORORAUTM DaGENT iDATEi WHEN PROPE V VALID TED THIS IS V UR PERMIT f �ll� t� � e � SiGNATUREOFOWNEA��FOWNERBU�LDEAi IDATEI BL GiNSo ��FTE N�v ' " [ l ADDN [ ] ALTER [ ] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/98 ��r � �� ConstructionAddress: �(�li% CGQ��/�(Jj �� Legal Description: � �. Owner Name & Address: /��/1/i� �'f t�G�% !J 7iJ � � �l4�� Tel. # Contractor: ��p � �,�E � ��y�C� MN LICENSE # �1Z � � � � Address: ��/ G�° /.�-�� Sc�2 � �U %� ' Tel. # �U�'- ` 3� �° Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Length Length Length DESCRIPTION OF IlVIPROVEMENT Construction Type: / ' � � � � Driveway Curb Cut Width Needed: Width Width Width � Ft. + 6 Ft = Height Sq. Ft. Height Sq. Ft. ��Ground Sq. Ft. 5 �/' �� . � l� ted Cost: $ (Fee Schedule on Back) Ft x $ _ $ DATE: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee ' Sewer Main Charge TOTAL APPLICANT: CITY USE ONLY Tel. # $__�� Fee Schedule on Reverse Side $ ,E �f � .QO1 of Pernut Valuation (1/lOth%) $ , �� $.50/$1,000 Valuation $ $1000 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 [ J $ � �, 2� STIPULATIONS: � _. . � BUII.DING 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,OOQ,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,OOQ or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,0� plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,040 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $SOQ,(}00 $2887.25 for the first $SOO,OQO plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5012.25 for the first $1,000,000 plus $2.75 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 $13.50. 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 $15.75. 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. ?w Z '" � N J a M ] �� N Z L 'c � o � = N M �c`�tiu�i � m 0 J F-a-� O � �I N C •� � _ � � 3 � � � y U cp � � � � $ � � 3 �. � � �.. � C �j +' N � � N � � A � '� N C p � L � � �1 '� .� .Q N � Q W z � � a N � � -� rn r,�, w E3 � C `�`� �?� 0 c +-� w � N�� y Y> Z o t O� C O W �� rn o ��i'� �p �C � J7 � j U J � � � � 0 .-. � � � 4C1 Y � LL � -p -�p C � ; � •2 �- — ` �. d N N � 'C � t� N N � ' a�°i N � C m. 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VENT CONNECTOR AND COMBUST!_ON AIR VERIFICATION p� When replacinsa an existinsa furnace, 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 (� The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (� 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 Fumace Venting Tables for fan assisted and natural draft appliances. The existina combustion air is sized and installed to meet the current codes and manufacturers specifications. When required to install a new combustion air, it will be sized and installed to meet the cuRent codes and manufacturer's specifications. No ( ) No ( ) Yes ('�.. No ( ) Yes (;�- No ( ) Yes �) No ( ) When installina a new ventina svstem, 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 Fumace Venting Tables for fan assisted and natural draft appliances. Yes (�� y�, 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. No ( ) Yes (� No ( ) Appliance Tvpe and Size/Common Vent and Vent Connector Information Appliance #1 Type ��y� %-�- BTU Input Ls.iJ,odv Fan Assisted or Nat ��-n� Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances _� Total Btu Input o�r� 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) i�t'//!� �+% ,�1 L•' u� TlivVl�i i'z y"�I.-v�4 /� Sr�FG v✓:l� •- �i vC � � f /' _ � ( e e21'i= �fir u:•—�n 4lG�t �- HEATING CO: � � �� . � �' �� S Signed gy: �-`— Date : j��' y CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 "�--�_'� PERNIIT 0.:2004-01893 DATE ISSUED: 10/14/2004 (763) 572-3604 FAX: (763) 571-1287 - ADDRESS : 5001 CLEARVIEW ST NE PIN : 263024230091 LEGAL DESC : CARLSONS SUMNIIT MAN SO ADD : LOT 6 BLOCK 5 PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION . NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A FURNACE (WARM AIIt, RUDD, 60,000 BTUS) # A/C iJNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIlVIUM CALC) 1250 APPLICANT HEATIl�TG PERMIT NIINIMUM FEE 0.00 PRACTICAL SYSTEMS FURNACE SHELL/DUCT WORK 35.00 4342B SHADY OAK RD GAS RANGE FEE 0.00 HOPKINS, MN 55343 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIltS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 OWNER TOTAL 35.50 KWONG KWOK K& KWAN Y PAID WITH CHECK # 1858 5001 CLEARVIEW ST NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or constntction 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 work 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 y othe state or local law regulating construc ' or the pe ormanc of consiruction. Applicant Date Bldg Ins D � SEPARATE PERMITS Q D OR WORK OTHER THAN DESCRIBED ABOVE.