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AF - 43235sue�ecT PER City of Fridley 18 8 4 6 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � . R — � � . � ; y _ COMMUNITY DEVEIOPMENT DIV. �/ r � � PROTECTIVE INSPECTION SEG. � �/Q �% 1 � , � /"'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPFOVED BY � ----�•� �•� � 612-571-3450 910-F15 3/31/87 � � JOB ADDRESS 1379 Creek Park Lane N. E. t LEGA� LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED oesca. Tracts C G Reg. Land SuYVey #94 SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Bob & Donna Buksa 1379 Creek Park Lane N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Brickner Builders Inc. 6230 Highwa #65 N.E., Suite #104, Fridle 55432 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 574-9871 5 ENGINEER MAILADDFESS ZIP PHONE LICENSENO. 6 USE OF BUILDING F� S 1 C1Eri'tl a.�. 7 CLASS OF WORK �I NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Cons truc t a 51. 5' x 2 9` Dw el li ng and ` -' � WIRING, HEATING FOR� 9 CHANGE OF USE FROM TO 'e :: STIPULATIONS provide City with copy of verifying survey before capping. Provide sod in the front and side yards. Provide a hard surface driveway. Storm water drainage per attached plan. , SEWER LOCATION: 11' East of Manhole WATER LOCATION: In same Trench Driveway Escrow: 18' -� 6' = 24' x$13.50=$324.00 �� i'H� C17Y Of FRIDLEY DOES NOT GUARANTEE THE g �� ;;i ��;f�:'� ACCURA�'Y ��' UTILITY LOCATIONS AND ELEVATIONS. �� fl��E��.��C w��,�;�;:�;;, THlS DAT�1 IS FOR INFORMATION PURPOSES ONLY, , � y C�#' AND PERSONS USING TH1S INFORMA710N SHOULD � �� g^� ��`� � v�a'�:� VERlFY IT ON THE SITE. �'� "' �� SEPARATE PERMITS AFE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIF CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS N07 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. DWIG. UNITS OFFSTREET PARKING I HEREBY CERTIFY 7HAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GAAAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND,ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIED $88�2SO $44.13 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GF;ANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE RROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- t�OO.00 S RUCTION OR THE PE�RFORMANCE OF CONSTRUCTION. � $525.00 �' �� / n ,e PLAN CHECK FEE TOTAL FEE i� �/\ ��,, ,_�� ,�y1i�� ,.� ��-�f7 $100.00 $1,069.13+PF,Lat,S .A S�GNATUAEOFCON'RACTOROAP.UTHORIZEDAGEN7 IDATEI r WHEN PROPERLY VALIDATED TFLL�IS y,gt�q pERM1T ci llw SiGNATURE OF OWNER UF OWNEA BUILDERI IDATEI BLDG iNSP ` � DAT �ses: � � ___ � NEW [`� ADDN. [ ] AI,TER. � � Construction Addre Legal Deseription: Owner Name & Add Contraetor:� Address:� LIVING AREA: GARAGE AREA: DECK AREA: OTHER: City of Fridley �R-1 AND R-2� Building Permit Application Effective 4/1/86 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to seale. DESCRIPTION OF IMPROYEMENT Length Width Height Sq. Ft. �� Length Width Height Sq. Ft. �_ Length Width Hgt/Ground Sq. Ft. _______— � Corner Lot [] Inside Lot 1/�] Ft. Yd. Setbaek Side Yard Setbaek' �� Type of Construction: ��"^`-P �/�� ' Estimated Cost: $ Approx. Completion Date: �� f� ��/ �i�"'—'� � Alt. A Alt B Pro osed Driveway Width If New Opening Is Desired: �� "�� $� 0 v $ P See Back Page for Explanation � � ( . � - a►� '��/ �� .,�.,.... ,:�°' Tel. # �7 7 � / �%� DATE: ,I APPLICANT: - --- �f� r �` J CITY IISE ONLY Permit Fee Plan Cheek State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: �R�w�i w� �� ST. 5�� $ �C� . n f� $ v (J � (�J � ,J3 $ S�2_�, tJC) $ � ��d $ '_. $ ZSt,9,1'� 3��f ,�C) y� b3S. 3` , �.So I 3,89 �.9�j S�ro�.�, w a�a�. 4a�r��c �. 4�- � - ��o P � � Fee Sehedule on Reverse Side 25� of Building Permit Fee $.50/$1,000 Valuation $ 525 Per SAC Unit Fee Determined by Engineering Agreement Necessary [y(1 Not Neeessary [ ] gg, �o, o� � oo � . �. ��3,0� � 3 � �Q � _- ,..._.l �� pv, �d � � f ~ � �±�,��,,.. i�'n. ��.J" 1 , � � �- t �` V � ^/P !4,t��. � I�� i� x �z z 5�� - ��y . a� r��,;n �, �!� f,�� = ��. X /V.UI x i�,o� �A�.r. t,cw�� 13, 5x I'1, � 1 �OZ � �8 � 3� _ �� -� ��S �"" o�n,�� 1 �. �`3 �c � � �, (�� s�� (,...^� [.�� e �.i V t �, y��,y�P �, q7 �,5� � �S, ��,o�Q C� �� f , . �• , , . _._ _ / � / a e EXTERIOR ENVEI,OPE A��ERP.GE "U" COMPUTATiON , Q�lJ%TuR 1.7 �?1� ol-`oc5[ lj �'. SCw SITE AD�RySS 1�7 g ve e� P0.v 1� L�C CONTRACTOR C�� c k veY- I"� c.< < I rQ e�� .� nA� I O-►3 '�� PIiONE � 3/—/frk� • Determine working square footage of each. 1. � Total exposed wall� area ....� C`�G� sq. ft. x �= __�!�� , . Total roof/ceiling area . . . . ! % � sq. ft. x� _ � �' �� 1 . Total exposed wall area above f lc�c�r = a . Total wa 11 window area . . . . . . . . . . . . . . . . . . . . . . . . . . t �..�.e ��__ b. Tctal . door area.. ............................�... �7. (� � c. Total �liding glass door area.. .................. 33, O • d. Tota1 fireplace .wall area..•......... � ............_�_ e . Tota 1 �wa 11 f raming area (average 10/) . . . • • - - - • - • (C. � • S � f . Total net wall area above f loor . . . . . . . . . . . . . . . . .� ��_ .g. Total rim joist area . ... .. . .. .... .. . :. . .. . ...... i `1 /_ . , • Total exposed foundation area = � , . . , • �I � a . • h. Total foundation window area .................... � i. Total net foundation area above grade........... . , . Letermine "U�" value of each wall segment. , a . I iQ 9 , �l (a_,x ��U �� 3 � = G �l , `� b � ��. _ 3-�. �� X „U„ . � �� = a�. �� , �. �3,�� X„U„ ,3 k � a�, a, �/ � d . y e X .,U „ � a � _ ��. � e . 1 � /, � � X ��U �� , i� t�� .._ = 1 �-�, S �/ f . I ��5 Y X „U ,� , p �-� = S � . ,� i� g i 71 X „U .. � � �� = f + � '�-/ ,..— . n �5 �� X „U„ *-��.. _ � - . • �. �s. � o x „U„ � , y7 = Yt�, �� " � . . . . . . . . . . . . .Total = �3% .9 j �. i �•�. i � -2- � �---. ✓ J y IF ite.. #:� on �revious page is the same as, o� less than itern i 3, . you have m,et the intent of SBC 6006(cj2. Total exposed roof/ceiling area =_ � 3��/� . , j. �'otal skylight area ......................�,,.. C�. k. TotaT roof/ceiling framing area (average 1C�96) �. Total net insulated roof/ceiling a�ea.......,. � � . -:. Determine "U" vaTue for eac:� roof/ceiling segment. - � X ��U �� , _ ' � • . k 'X ��U �� _ � , . . 1. 13-��1 X •��U,� � p'� _ _ �7,�/� 4 ......... ........................Total = . , ; , . • � If total o� #4 above is the same as, or less than ##2, you have me� the ::ntent of SBC 600Er (c) 1. . • r� . A lternate Buildinq Envelope Desiqn '� •• To utilize the total envelope system method, the values esta�lishec by the sum of items #3 and #4 shall not be greater than�the �ura of items #1 a;�d #p2. 1.• . +2. _ , 3. +4. � ' , , , - , . ll . .- � L(�- . � i �� - �� ,,., a-�_ � �� ; ; ., � ��z ��;�� • /S" � z '� ��z _ . _ --- � • 2 � � �' •. - � s' i ,�'��D � � �'% ��:� ��- - •� i . �. r,� � ' ��rZ �i� �. �� __2_./3.= �7 I ,� ^ , �� , �� ,�� _ � � -- _ __ ; f -t �, a�:�. - � ' ��f �;, �� ---- - �/ � � � �� l, • � 9� _ _ __ z �',��_ - s' ; . o�=. 7 _ y ; �-�v �� , � _ __: _ _ � ____ _ � : � L� �:�,,� , 6 �' _ _�%�_G�.: . _�� _,,: '�� . _ . i ' .�,�,�� - na� 8. � , . �. ; �i � y _ ��S'� _--- __- .-_- ----�7__ - __ ; , _ . _ _' G �� Q�� t' , . ' ' � _ _ __ __ _.. . .. __ ._.__. __--- . � 2% ,�,,,;,� � , v.� � � _ . _ _ _ . _ _--- ---- _ - . --- . . . � ; ��L � �Y! Gc2ti,�-cJ��-� .. C�� _ j ' ;r . . - __-- ___ . _ __ . ._ . ' �-�f f � �� f '� _ _ _ --- ------�._ � - - -..__.__ _ _. . _ _ . , � 23.�3-.0 3y � _ _; __ _ _ _ _ _ _ _ _ _ _ _ . _ _____ _ _ _.__ ____ _ __ _ , , � _;_ � ____...________ ._._____ i �� , �� . �� _ _ __. _ __ __ ____ _ ___ _ __ _ ; _ _ _, , . �� `" � g __ ___ __ _ _ ______.__ . , � , � , . ��%v' i� l-�y ' ; � _ _-__-- -- _ _ ; �zs _ ; � i L �/ . ' ; . L, o� - , � , _ , _ _ _ - -- � ' �� , , � 7 , � _ .._._ �. - . _ ---- _ ' .. v , � �,� ` �� ._...�z_ _ . � � , _ , � � ' ��• `11 ' �� S _ , � o � ! . __ _ __ _ ----- ___ _ . . � � ; _ _ ; . _. _ _ _ __ .____. � ..�. , , � ; � � � I _ � �, � CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PEF�11T H r a a u • x d Nater ,� a� m � N C�-+ fm� o u a r.�. �C�tl Heater �.ui W A C ytn F � u W 1� .0 G ro 0~i � • c� ►� � �� .� A •Na C N � O L � q b� b �A tui� u�oi � m U D W w v� 3 o u. vi d. u cG 4� �! � ta O as 1 ec � I � f � '' � lac j � � 2nd ! 3rd 4th (R) � Puture Connection Opening Connected with Sewer (�) � New Fixture, Old Opening Water RATE SCHELULE PLUMBING FIXTURE RATES: N0. RATE �Ner Fi:tures S 5.00 Puture Pixtures S 3.50 Old Opening, New PiYture $ 1.50 Bear Dispenasr S 4.00 Blow off Baein � 5.00 Catch easin $ 5.00 Rain Mater Leader g 5.00 Hydraulic Valve S 5.00 Sump or Raceiving Tank S 5.00 Mater Treatinq Appllanca $ �.00 Hot Wster Heater g 5.00 Gas Range g 10.00 Gas Dryer S 10.00 � ]►LL OTNERS AND/OR REPAIRS AND ALTERATIONS lt of Value of Pisture or )lppliance Reinapection Fee S (515. 00) State Surcharge TOTAL PEE TOTAL s '10.00 S S S S S S S S S g 5 �UO S S S S .50 S �.s s� tttective Aug. 1, lvnl Job Address ' �� ( �jZ�Ek ��,�� LIJ Department of euildings City of Fridley Tel. N571-3450 The undereigned hereby makes application for a pareit for tha work herein specified aqreeing to do all work in strict accordance wi[h the City Codes and rulings of the Department of Buildings, and heraby declares that all the facts and represen[ations stated in thie application are true and correct Fridley, Mn. � �L Z , 19 �� owrrEtt !'c� � �� -�rJE '� C-o �Je �. KIND OP BUILDING �E � � C,I� �.4 �p-1,_, USED AS �' P-i"`� L TO BE COI�LETED ABWT _ �p �,Z �- ESTIMATED COST 2;—I U U OLD NEW B LDING PEANIT NO. PERMIT NO. i oompany {-I w f--�o� r fZ o;.IE 1 ��1L - Signed By __J�� '-"'""' Tel. No. L� Z�- Z� Z' ROUGH INSP. Date FINAL INSP. � ��^^O � Date APPRONAL FOR PERNIT 11INIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE S.SO STATE SURCNARGE 0 � C11Y OF FRIDLEY APP�ICATION FOR PONER P�ANTS AND HEATING, COOLING, VENTILAtION, REfRIGERATIOH AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCNEDULE lLSIDtKTIAL �urnece Shell •nd Duct Mork, Bu[ner (Al�o r�pl�cwnt lurn�cv) Ga� Plpinq lplpinq n��d�d vlth nw� [urn�c�) Gas Renqe G�• Dryas • Air Conditioninq lall �i:e�) /� � % RATE TO'CAL ��b Addrevs "' S 20.00 S��O� S 10.00 $� S 10.00 S S 10.00 S S 10.0o S A21 Other�/Aepeir• and Alterstion• 1� of Value of Appliance or Mork COMMBRCIAL/INbUSTRIIIL 1• o! Valu• ot Appltanca or Mork Stste S�rcharqe 'PO'f'!1L !EL Rsin�pection �e� (S2S.00) Rough In�p. ' Datt Fin�l In�p. ""� �� ate Approval for P�rwit �� MINIMUM FEE FOR ANY HFJITINC PERMIT IS 510.00 PLUS 5.50 STATE SURCIIARC;� S S S .50 _i.• � / �{/ lltt�ch st�ck verftic:ation [ots rith r��l�cn�ont (urnacc {��twits ' •1►ir t'c+ndlt►oners can n�t IN• �+laccd in •:�d�• yard vitlwut rr►tten p�rw�s.lun frn� ndi��n��q rr��t�dK,r. ....r..�v�• nuy. . �'�n► Oe�+arta�ent o[ eulldtnq s 6�l! Universlty J1v�. N.[.. Frldl�y. MN SS�l2 Ctty of Frldtey Tel. �571-)�50 The underelqned hereby �ake/ •ppllc�tlon [o� � pen�lt [or tA� wrk h�r�ln a�xc1(led �qreeieq to do �ll wrk 1n •trlet Necocd�nc� �1tA [h� C1ty Cod�• and �ulinq+ o� the Dep�ruent o[ llulldlnq�, �nd hereby d�cl�cs• tA�t �11 th� f�cta snd repre�ent�tlo�• • uted Ln thl• •pplieatlon •r� tru• �nd cor��ct. � �7 O � rriai.y. �u��. __,_,_.._,., /�'f � i9Q/ / OMNER �� R�ND OF SUII.�IN9' (��CTL�'G� � USED AS ro sc coMVt�rco usarr ESTIIWTEO_C06T l�' ��<� p �� -- �� d' OLD -- N� slyilDING ►EIMIiT NO. �f6iMI! NO. � _, DESCRIPTION OF FUAlIUN�/�UTAi'L11 NFJ►TiNG or P N PL►N7'S. St�a. Not M��r� IN�f Alr� M��7�! _ 7tade 11e�t sfs� tb. _, Gp�clty Sq. Ft. [DN 07V � N� 7bu 1 Connected Lo�d � � Klnd o� ►Yil BUANER - Tr�de Ma�t Sli� Ib. Capactty Sq. Ft. EDA _ Compeny Siqnwd E Tel. No, � � ' CITY OF FRlDLEY fNSPECTION DIV. 6431 Unsversity Ave NE Fridley, MN 55432 5�2—asoa APPLICATION FOR PLUMBING AND GAS FITTING PERMtT nnnRk Nt innR�R nF F�xTURFS TO BE WSTALLED ON EACH FLOOR � l ll Qo Effective On January 1, 19A9 Pi.UMBING F(XTURE RATES; NO. RaTE TOTAL New Fixtures -3 Old Opening, New Fixture Beer Dispenser BIoW Off Basin Catch Basin Rain Water Leader Sump(Receiving Tank Water Treating Appliance Water Heater -Electric Water Heatec - Gas** Gas fiange** Gas Dryer** Back Flow Preventer Required OYes ( y No Type $7AD o2��a $ 4.ao $ S.OQ $ 7.00 $ 7,OD $ 7.00 � 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.OQ Reinspection Fee $42,QOJHr ALL OTHERS AND/OR REPAIRS AfVD ALTERATlONS 1.59'0 of Value af Fixture or Appliance State 5urcharge T�TAL FEE $ .50 $� � �,,,o ..�L�_ JOB ADDRESS / 3 `� `� � � =•=� �:�-,2 �c L � ✓ � The undersigned hereby makes application for a permit for the work herein specified agres+ng to do all work in strict accordance with the city codes and rulings of the Buiiding Division, and hereby declares thai all the facts and representations stated in this application are true and correct. �/C� , 1999 Owner "Tv,7� � c�.�,�.is �' n� Buiiding Used As �"� � '�'' � d �� > .— — Estimated Cost 1�:,2y- PERMIT NO. l�.�-� �� PLUMBING GOMPANY ��2/' vU'6,�r+4,�.�2 ��'��' SIGNEE3 BY l,-2, TEL N0. �� '�� Ap{�raved By Rough-In Date Final Date MtNIMUM FEE F�flR ANY PLUMBI�dGj PLUS �HE $.50 STATE SURCHARGE **COMBUSTIO�iK,A!R SHALL BE PR�ViDED PER UMC SECTION 504(� AI�D TABLE 6-A. UIINIMUM SIZE 9 SG� INGNES. - _ C[lYOE FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287 September 11, 2000 Tom Johnson 1379 Creek Park Lane NE Fridley, MN 55432 Re: Final Inspection at 1379 Creek Park Lane NE Contractor: Terry Overacker Plumbing Dear Mr. Johnson: A plumbing permit was issued on May 10, 1999, for the above noted address, to install three new fixtures. According to section 4715.2800 of the State Plumbing Code, a final inspection shall be conducted on the plumbing authorized by this permit. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (763) 572-3603. Sincerely, DAV�ENSEN Buil g Inspector sue�ECr RMIT NO. City of Fridley 2 947 3 � AT THE TOP OF THE TWINS g � I L D I N G P E R M! T ; � RECEIPT NO. � ; y �� COMMUNITY DEVELOPMENT DIV. � �� r � � PROTECTIVE INSPECTION SEC. 1 . � , ' /"'1 � CITY MALL fR10LE� SSI,3Z NUMBEii pEV OATE PAGE OF APPAOVEO BY �""�" �'� 612-571-3450 9t0-Ft5 5/17/99 / / �oe AooRess 1379 Creek Park Lane NE 1 LEGAL �07 Norracts BLOCK TiiACT OF AOOITION SEE ATTACHED OESCR. & SHEET 2 PROPERTY OWNER MAIL ADORESS 21P PMONE Thomas R Johnson 571-7375 J CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO Owner � ARCMITECT OR DESIGNER MAIL ADOFESS ZIP PHONE LICENSE NO 5 ENGINEER MAII ADDRESS ZIP PHONE IICENSE NO 6 USE OF BUILDtNG Residential 7 CIASS OF WORK ❑ NEW O ADDITION �S ALTERATION ❑ REPAIR p MOVE O REMOVE 8 DESCRIBE WORK Basement bath emod in 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on pTan. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIRED FOR ELECTfi1CAL, PlUM81NG. NEATING, VENTIl.ATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZpNING SO. FT CU fT AUTMORIZED IS NOT COMMENCEO WITHIN 60 DAYS. OR IF CONSTpUCT10N OR WORK IS SUSPENDED OR ABANOONEO FOfi A PERIOD OF 120 OAYS AT ANV TIME AFTER WORK tS COMMENCED. NO. OWLG. UNITS OffSTREET PARKING 1 HEREBY CERTIfV THAT I HAVE READ ANO EXAMINED THIS APPIICATION STA�LS GARAGES AND KNOW TME SAME TO BE TRUE AND CORRECT ALL PROVISIONS Of LAWS VALUATION SURTAX AND ORpINANCES GOVERNING THIS TVPE OF WORK WI�� BE COMPLIED WITH WHETHER SPECIFIEO MEREIN OR NOT THE GRANTING OF A PERMIT $3500 �I.7rJ DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL THE pEqM1T fEE SAC CMARGE PROVISIONS OF ANV OTHEFi STATE OR LOCAL LAW REGUTATING CON- O STRUCTI OR THE PERF RMANCE OF CONSTRUCTION �p%. ZJr FT P� SC 3, rJO PLAN CNECK fEE TOi L EE $ .50 S�GN4TUAE C N'PA OQOQ�UTMOQ�2EDeGENt IOATE� EN R P ALID THIS I� �� 7 SiGNYTUAE O� OWNEQ�� OwNEQBwIDEfii iO�TE� , BL �NSo r�FtE NEW [ ] ADDN [ ] ALTER [ l CITY OF FRIDLEY SINGLE FAMILY� AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/99 ,� p"` �� . .�M �.>r.'�ii�l' . .. .. � � . .. � � � . . . . , p " ' i. .'�•��ryit.. i'�i��.. .' . � �� 1� �J�—�1.. �` 4. f`)�l\ �lvC' . . � . , . , , � .Construct�onAddress: � Legal Description: '� N s� tJ Tel. #� 7('��5� Owner Name & Address: (� � �S � � Contractor: 0 w� � MN LICENSE # � _ � Address: ' Tel. # , ; Attach to this application, a Certificate of Survey of the , lot, with the.proposed construction drawn on it to scale. � DESCRIP'rION OF IMPROYEMENT 4� , �� ,.,;: , . LIVING AREA: GARAGE AREA:�; ` : DECK AREA: OTI�R• . �ng� �� • ' Length _ � Length � S-£'v.��►n..� Width Height Width , Height Width Hgt/Ground ��r. !' ,� v�t� � (�. v�4 Sq. Ft. Sq. Ft. Sq. Ft. . � 9,1 � , . . ., � . : ,� b� �� Construction Type: � � Estimated Cost: $ 3� i�� :. + � (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft.x $_ _ _$ DATE: ` � r��x �. �::,. � APPLICANT: °� ,�� - Tel. #{ S i I �7�75� � . . � CITY USE ONLY l,ti•tr rtt :2r , . , . . . Permit Fee $ �S� Fee Schedule on Reverse Side Fire Surcharge $ 3- 5c� .001� of Permit Valuation (1/l0th%) � �State Surcharge $ � /�'S� � $.50!$1,000 �Valuation SAC�Ch�a./�ryge $ $1050 per SAC Unit �rnf�M��!'S;„i7'CiJSi»..��i' -`�.-it.. . . License Surcharge $ � � � ' � $5.00 (State Licensed Residential Contractors) Driveway�Escrow $� Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering --�4SewerrMain.Charge;;��;$ � � Agreement Necessary [ ]. Not Necessary [ ] �, �O �.�y�j.a,TfpT�� ,: �,�: . $- . . . ST'IPULATIONS: . 0 S,�'� L° �aarn�.�Ci ua��.h,�,5�n ��ra.►h�.S�I�C� t��. � �° ,�..- i ? ( . f . � �'w..sl+�SrY/+�.i7.��Mti�' k ��r [ ;. 1f w;�'-, � � --....,..,. � , . . ,V;....�..t'w•...c•��.w�w+�..a"ar w�...w�.�..�.rva.�►at��r=a=-+� S �.. �/� ai�,�� . � �� «W %% . . . �w . �.. ..ti-+.... e . ,._:.w. � ��T/L.�"T /CSJ�. j � ' � . / I � ��1. .!_ _ l � /i %L1.% l� � � . � � •YN�"..�.•�I'r`'V'"N-y^. � ( � ��.r ��►:4�`�'y { .J/ � � I. !Ywr " S ; � .. , . ,. . ��y ,`, � w�.�t�r.�nn�`.�v�'a~• } . . � � ' - � � � SuB�EGT �.. . .. � � � P . City of Fridley "� 29733 : � AT THE TOP OF THE TWINS g �� L D I N G P E R M I T � � RECEIPT NO. � • COMMUNITY DEVEIOPMENT DIV. ' j y - � r � � PROTECTIVE INSPECTION SEC. � � . � � � �"'1 � CITY NALL FRIDIE� 55��2 NUMBEA nEV O�7E P�GE Or �bnnOVED Br �'""'�"� ,'' 612-571-3450 910-F15 � / 6 21 99 ,oe AooRess } 379 Creek Park Lane NE t LEGAL ��T NO. TY,aC.t BLOCK TRACT OR AODITION SEE ATTACMEO DESCR. SHEET 2 PROPERTY OWNEFi MAIL ADORESS Z�P PMONE Tom Johnson 3 CONTRACTOR MAIL ADORESS 21P PMONE UCENSE NO � North Me�ro Const. 525 Tower Pond Ct _ �x�r�t��t�x a ARCHITECT OR DESIGNER MAIL AOORESS ZIP PHONE UCENSE NO. 20098397 5 ENGINEER MAIL AO�RESS 21P PHONE IICENSE NO 6 USE OF BUILDING Residential 7 CLASS Of WORK O NEW � ADDITION O ALTERATION �?C REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage (28 Sq) Tear-ofif 9 CHANGE OF USE FfiOM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING. MEATING, VENTII.ATING OR AIR CONDITIONING. THIS PERMIT BECOMES NUIL AND VOIO IF WORK Ofi CONS7RUCTION ZpNING SO. FT CU fT. AUTHORIZED IS NOT GOMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION . OR WORK IS SUSPENDED OR ABANDONEO FOF A PERI00 OF 120 OAYS A7 ANY TIME AfTER WORK IS COMMENCED. NO OWIG. UNITS OFFSTREET PARKING I MEfiEBV CERTIFV TNAT 1 HAVE REAO ANO EXAMIN�O TMIS APPLICA710N STAILS GARAGES AND KNOW THE SAME TO 8E TRUE ANO COFiRECT. ALl PROVISIONS Of LAWS VA�UATION SURTAX ANO ORDINANCES GOVERNING TMIS TVPE Of WOF1K WILL BE COMPUED $2447 $1. ZZ WITM WMETMER SPECIFIED MEREIN OR NOT. TME GRANTING Of A PERMIT OOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL TME pEpMIT iEE SAC CMARGE PROVISIONS OF ANY OTHER STATE OF LOCAL LAW REGULATING CON- Q83.Z5 Fire SC �Z.Y�J STR �ION OR TME EAFORMANCE OF CO �STFiUCT10N •1+ �`^ /- �� PLAN CHECK FEE TOTAL fEE L License SC $5. $91.92 S�GNATUREO�CON"�7ACTOQOQ�UTHOA�ZEDAGENT iO�iE� WHEN PiiOPER VA�I ATED THIS IS /Y�OUQ PEFlMIT � / � � i �O S�GN4TUAE O� OWNEQ��F QWNEABWIOEp� �D�TE� � � B�0 '�HSo � � ��tE � ' � �w [ ) ADDN ALTER Effective 5/10/99 [ ] ` CITY OF FRIDLEY [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUII,DING PERMIT APPLICATION Construction Address: l � � 7 �, Legal Description: � Owner Name & Address: ��i� � )��f/��j�%i Tel. # Contractor: - / /'t. , \ fi �J � � I •� �%� MN LICENSE # Address: 7� � l��"d T� Tel. I �� Attach to this application, a Certifcate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: DESCRIPTION OF IMPROVEMENT Length Width Height � Sq. Ft. _ Length Width� Height Sq. Ft. _ Length Width Hgt/Ground Sq. Ft. . OTHER: / � y� /� Construction Type: - Q� ! �5 • Estimated Cost: $'��QCJ Driveway Curb C�t Width Needed: Ft. + 6 Ft = Ft x$ _$ , DATE: � APPLICANT: Tel. #�� 7��'C�-T�°�' Pernut Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee �ewer Main Charge TOTAL "'TIPULATIONS: $ 3�Z� $ � ) $ j^ Z Z $ $ -�', � $ $ $ $ $ /, �" Z CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1050 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 [ ] CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: Urinal APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR r ` '�ti��<>::>;:: Auto. Wash ��1��:::::;;:;<>:::>` Floo � .:::::::::::::::: :::;::: Dr in :::::>-:: Washer a .;:;:>:::::�':::... :<:;:;:: ::::::«::>::::::>:::<:::>> >:;_<::::>::>::::«<;;:; >::> ::;::» Shower �i�k::<;>`: Trav :�c�i��k�k::>:::..,.. �3a�E..:..:.... NO. RATE New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader SumplReceiving Tank � Water Treating Appliance Water Heater -Electric Water Heater - Gas'`" � Gas Range"' 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 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTALFEE TOTAL JOB ADDRESS ` �� Effective On Jan 1, 2003 Gas Gas � Elec The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the ciry codes and rulings of the Building Division, and hereby declares that al1 the facts and representations stated in this application are true and c rect. C�' � , 2� 3 Owner �� Building Used As � �S[��c � � Estimated Cost PERMIT NO. � � �� pLUMBING ( SIGNED BY Approved By .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMI7 IS $20.00 $ / PLUS THE $.50 S7ATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WlLL BE RETURNED �nMMnN VENT� VFNT CnNNFCTnR AND CC)MBL1STInN AIR VERIFICATInN When !� la _inaan _Yic in� f�ri anr_p, 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 plastiGPVC 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 Fumace Venting Tables for fan assisted and natural draft app(iances. The pYictinQ _emb ,stien air is sized and installed to meet the current codes and manufacturer's specifications. When required to in� a11 a n_w _emb ��tien air�it will be sized and installed to meet the current codes and manufacturer's specifications. Whe11 inc allin� a new ventinq�y�, 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. !s 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 ( ) Yes ( ) No ( ) Yes( ) No( ) Yes( ) No( ) Yes( )No( ) ! . . . � - . - . � • - • � � i � . � - � . � • - � . � � - • � • r � � . • � 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 Tota! 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 � : � •► �- ..- HEATING CO: Signed By: Date : ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 FAX: : 1379 CREEK PARK LN NE : 133024130108 : UNAVAILABLE : LOT BLOCK : HEATING : RESIDENTIAL : ADDITION/ALTERATION 571-12237 /,.,,,,..�.---•------� _ r PERMI�' : 2004-00739 ,1 ,.�..- DATE ISSUED: OS/19/2004 VALUATION : $ 197.00 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 DRYER WITH APPROVED FLEX LINES AND SHUT OFF VALVE. # A/C UNITS 0 VALUE OF APPL OR WORK #FURNACES # GAS RANGES APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304- OWNER JOHNSON THOMAS R& CHRISTINE R 1379 CREEK PARK LN NE FRIDLEY, MN 55432 0 # GAS DRYERS 0 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 conshuction. Applicant, Date Bldg Insp ,(��I(h.P� Date ��l g HEATING PERMIT MINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 1009041 SEPARATE PERMITS REQUIRED FOR WORK OTH�R "1'HAN ll�SC;Ki13�;ll AIiUV�;. 0 1 15.00 0.00 0.00 0.00 0.00 0.00 0.50 15.50 , CI�Y OF FRIDLEY BUILDING INSPECTION ` 6431 University Ave NE Fridley, MN 55432 763-572-3604 FAX 763-571-1287 RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner & also Replacement Furnace Gas Piping (New Furnace, Fireplace, Insert) Gas Range Gas Dryer *�4ir Conditioning-All Sizes All Other Repairs or Alterations (List on Back) 1% of Value of Appliance or Work Minimum Fee $15.00 for Residential or 5% of cost of Improvement whichever is greater Effective 4J1/2004 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS I�� ( r�� ( ✓�L I Cv Fee Total �' � _—}-� Owner $35.00 $ Building Used As_ ��/ �Gt1/ ��y�''I $10.00 $ ESTIMATED COST I % % �� PERMIT NO ; -[�i �S-' $10.00 $ $10.00 $ $25.00 $ $��j•c� Commercial/Industrial/Institutional 1.25% of Value of Appliance or Work (List on Back) Minimum Fee $35.00 for Commercial/Industrial/Institutional State Surcharge TOTAL FEE REINSPECTION FEE $50.00/HOUR $ $ `� DESCRIPTION OF FURNACE AND B RNER # of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU �r HP EDR Fuel Total Connected Load . Burner Trade Name BTU � � The undersigned hereby makes application for a pern specified agreeing to do all work in strict accordance and rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. � HEATING c $ � � � Sign �' *Air Conditioners can not be placed in side yard without written approval from adjoining property owner - copy to City FAX # �� .� l�;u Tel # ?/�.3 • � �'U�� Date_ � �� v " a�d �y,,� ��'-F v�� : FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough-in Date Final Date �, 7 d� ;1TY OF FR{DLEY INSPECTION DiV. �431 University Ave NE �ridley, MN 55432 763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 APPLICATION FOR PLUMBING AND GAS FITT�NG PERMIT �� `�`�� MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR 'LUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS �r.�nnn.2 � o�,S o'�,J y�� dew Fixtures )Id Opening, New Fixture 3eer Dispenser ilow Off Basin ;atch Basin tain Water Leader �ump/Receiving Tank 'Vater Treating Appliance 'Vater Heater -Electric llater Heater - Gas*' 3as Range** �as Dryer'* 3ack Flow Preventer Required ()Yes () No $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.OQ Type $15A0 teinspec6on Fee $50.00/Hr �LL OTHERS AND/OR REPAIRS AND ALTERATIONS ; 1.25% of Va1ue of Fixture or Appliance State Surcharge TOTAL FEE �, . � $ �3S 5� 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 afl the facts and representations stated in this anolication are true ancl correct. JOHNSON, CHRISTINE 1379 CREEK PARK LANE FRIDLEY, MN 55432 OWNER (763) 571-7375 BUILDING USED AS �SI �en�tG� 09 30 Q �,20 ESTIMATED COST �6 � � PERMIT NO PLUMBING COM SIGNED BY Approved By No.��2)827—�l033 Rough-In Date Final Date OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. i� :OMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. *'PROVIDE COMMON VENT INFO ON BACK SIDE Building Inspections 763-572-3604 DATE �� p � SITE ADDRESS �� TH[S APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY Permit No.: Received �.�T—:L YOUR E-MAIL ADDRESS �J�}�a�C� C ^D�d�DI"� ' �i I n, v� n ❑ OWNER ,�6pNTRACTOR ADDRESS: CITY STATE ZIP PHONE: �lQ J-' �� -� �� S NAME: STATE LICENSE �! ADDRESS: ❑ SINGLE FAMILY/NI ❑ TWO FAMILY/NEW ❑ ADDITION ❑ BASEMENT FINISH ❑ DECK DESCRIBE WORK BEING SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED HEIGHT: NE W Renewal By Andersen 1920 County Road "C" West Roseville, MN 55113 License #20130983 651-264-4777 t STATE ZIP. ❑ GARAGE/SHED fd'WINDOWS O ROOF � DRAIN TILE O SID[NG ❑ OTHER ❑ ADDITION ❑ REMODELING ❑ HOUSE ONLY ❑ HOUSE & GARAGE 0 ATTACHED GARAGE � DETACHED GARAGE WIDTH BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used Ft. SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl OSoffit ADDITIONS_ & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing siructure ❑ Other ❑ Fascia and proposed pmject. WINDOWS 2. Two sets ofconstruction plans IN EXISTING OPENINGS DYes ❑No LOCATION OF WINDOWS ' ?1 3. Energy Calculations OR FOR NEW OPENINGS-DESCRIBE SIZE OF ,�"� �. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR A1�1D MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ �,i- I i-I — OCCUPANCY TYPE Permit Fee Plan Review Fire Surchazge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due __ $ t�s.r5 $ $ r $ , � lo $ S.nU $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Pians to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( Make checks payable to: City of Fridlev THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED Attach I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be 'v conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not ; permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approvec plan in the case of all work wh' requires review and approval of plans. SIGNATURE OF APPLICANT �^, ' !�V' SUY1 PRINT NAME f� O��ATE /� ��-Q "�