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AF - 43282� t�l�ntl Planniag lond Surrw�isrg �rts; T��ring Ciril Eegitteering Nl�itipol [nQiMering Mort�age �1��"lf 1�lljl , ea�s n;�hwey ko. es N. a. � � � �/ Minneapoli�, � jt�/'ClI�E�Ifjl�'� 'Y3�!'� Mlnn. 59414 Telephone 781 -e066 Eagineera BL JLFVe OI'l9 Areo tode A14 Loe,n Survey for R�C}� 1�C-I� 4N� i. ��. � � � � ,� � ao�.��o . � i F� ��.� � 4� o ,.M � � �� • ,. � i +� e a a �� . � � �, i � � �I �� A��. � �z � �� ,� �_____ � .'�p' .,� � —r �� S �c�►'�`� �'�. �a� Cou��t � �✓ �`�' � ��- �� = �: � C� �� L.o�r �, ��oc K�, ___�_ M��zr� �.�a,�E LSTATES � ,�� «m�� fbir i� O 1iLr �ntl co►r�tt. ►epra�tAto►ion �f a avrvey ol ehe aaundanes of the laad obeve d:seribad mid d tMs lecu�isn o! e11 bvAldinge� ➢1 anY� fhsraon� ortd ali risibi• ehtroosh�euMa� if anr� h�ou� o� on sald fand. fhh wrwr i� nwde ont�r !n eoanaceien trilh o marlyope loaa n�e beiaq' placad a+ the propor�r artd no IiQbilitr:s as�nmtd •�tcepf to ths katiler ef avsM mp�lQt} gs or anr o�hsr intenei acqai�sd by �hn reoeon oi •�eh enoilyar,�e. /� 3• 1�rtd;�r�tacd artd s�sts ��q�nf� avs beaa �ed 1ar �he �nrproso al ssrabla�hinq br 1'r+res o� bovndar�r rar�xrf. Qo1s� thi��da� •f �/ A. Q. 1� I SU�1IR�AN ENGINEERIN4, INC. /��py�jj/� n /!y, � �•• .V��7 �IMrwwi/v � ��J%[� ��5 lnbiae � � L [, _ MMiNfi' � `T� � ` r � f ''�.,, J �� SUBJECT 1zs14 c�ty of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � � � COMMUNITY DEVELOPMENT DIV. R��/�� i Ly � �'� r � � PROTECTIVE INSPECTION SEC. i� _ � _--_� /'�'1,, CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVEO BY i ' � si2-5so-3a5o 910-F15 / / 6/28/74 JOB ADDRESS 1561 Dana C011Y't N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 2 Harris Lake Esta.tes SHEET 2 PROPERTYOWNER MAILADDRESS 21P PHONE Brickner Builders, Inc. 6245 Ben More Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE Of BUILDING Residential 7 CLASS OF WORK 7�] NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 OESCRIBE WORK Construct a 50' x 24' & 30' Dwelling & Gaxage 22' x 22' 9 CHANGE OF USE FROM TO STIPULATIONS provide a haxd surface driveway. Provide a verifying survey before capping. See attached letter dated April 26, 1974 from Suburban Soil T�t' g NO SEfnTER OR WATER L�ATIOld INEORMATION AVAILABEL AT THIS TIME. SEPERATE pERM�TS REQUIRED HEAT�NG, PL�JMgING aND S(G��F�R �VIRING. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. WOOC� Fr3IIl@ THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOH A PERIOD OF 120 DAYS AT R�. �.40% 32,860 Tot ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 29 SC9 �.4.%8 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. GZ• OO 300.00 PLAN CHECK FEE TOTAL FEE �'�a� . SIGNA OFCONTRACTORORAUTHORIZEDAGENT IDATEI WHEN PROPERLY ATED THIS IS YOUR PERMIT L�! SIGNATURE.OFOWNERpFOWNERBUILDERI IDATEI BLDG WSP qA7E AP.pLICATION FOR RESIDENTIAL, ALTERATION, OR AllllITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME:��'�,�/L.E/2� �ui �d�rS' BUILDER: � a�1,��.�,�- -�,,, 1��aa,�o - dQ,c,ci �Ne ADDRES S : /� �1, �� ' o � %)`I l�tl�s 1 ,C�t1 ADDRES S : /�, �� v,rJ �i�G4ai � � 5 j�3� � � NO • . / STREET : /�/ LOT: L BLOCK: z— ADDITION:, �E� ��, �� CORNER LOT: INSIDE LOT: c/ SETBACK: � S STDEYARD:.% -/� . Applicant attach to this form Two Certificates of SurveY of Lot and pxoposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As; ��°�" 3� . � Front : ► D Depth : �A� Height : av ' ; -, -� _ r W � _ Square Feet: � Cubic Feet: � � ,;�� , i Front• a, � Depth: a� Height: /d � -- � �� , Square Feet;� ��Cubic Eeet: � �'� _=�___`=� ----�- Type of Construction: ��- Estima.ted Cost:_$ To Be Campleted; �. �—� � 6' " � � The undersigned hexeby makes applicatinn for a permit for the work herein specified, agreeing to do all work in stiict accordance with the City of �ridley Oxdi�.ances and rulings of the Department of Buildings, and hereby declaxes L-hat all the facts and representations stated in this application are txue and correct. . DATE : � - a 7 - � '� _ S IGNATURE : , . / � (See Reve�se Side For Additional Information ) � �� ! ,� �� '� � . � _ y-�; ,T��- /� � 1 �l� ' � /� , � ,� _ , � � �,�- ��„� � - . , �� ,,; -,; ) . , . � rr A��\� - --_�-__ - _ � _a _�. � -� ,, . . �` , � . . � BUILDING PERMIT FEE SCHEDULE SECTION 2. The Inspector of Buildi.ngs shall, before issuing permits for the erection of any building or stxucture, or fox any addition to any existing building or structure, or for any alteration ox repairs to any existing building or structure, upon application therefore, require the payment by the agplicant for such permit of fees to the amount hexein below set forth and in the manner herein provided to-wit; IJNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for each one thousand cubic feet. ADDITIONAL INFORMATION For the purpose of computing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the ground area covered from a point six (6) inches t�elow the floor line of the basement ox° the cellar to the average heights of the upper'surface or tio the average.� height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, the fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all proposed work. Tn no case shall the fee chaxged for any permit as set forth in Section 2 be less than $5.00. VERIFICATION OF FOUNDATION NOTE: Permits for construction will be issued a minimum of 24 hours from the time of a.pplication, to allow for proper review of the proposed structure and of the construction site. - A Certified Survey of the 1ot, showing the Iocation of the foundation, once it ha� been construciced, will be required before praceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building pexmit has been issued; and said structure shall not be used or occupied until a Certificate of Occupancy has been issued. � � land Plann�nq ��y� 6879 Hi�t�wo�r No.BS N.�. land Su►vayiag , �� ' . � ( , MinneapOlis, Soib Teftin �;%� t�lPQ�'t'%�'� �►�jZ�� Minn. 55�32 8 1 CiV/I ETtBiRlQring Telephone 78�t-608b Munlcipcl tnginsering Eagineers & Surveyore A.eo toda 61x C�rtificate of Survey � � / N � for /C7/�1 �/�l�'%��%E%� 85.0 o _�. �..�� - - -� b ' �'� � ��s � _. �_ i� 3 ,�_____ / � + J /, �� , m 1291 �� .�-� � DANA COu�T ScaIG� 1'"—�", �O�s� ��aT �� ocK � Haa��S l.�r� �SS�-�5 � �° � . � Qno�a �'auqfy t.hsrobr ceHifr that ih�s is o��ue oad correcf reprosaMOtian 8f a survey af Ihe boundor7�s o� the abpv� d�ssribad t�nd� ond ol the locotion of all buildings, �he.eon� and oll visible •r�sroachm�nts, ii ony� l�pm Qt on aaid (Qnd. Ab twveysd by me th9s dor of_ _A.D. 10 ° DENOTE9 �RON I�N�ENT SUdURBAN ENGIN�ERING INiC a r =��== D�N�T�g Di�►NR� �. UY�UTY EAgEMENT � � 4 . • Enginears 54rveyors 3 � �r� � �:_ �'�` � - _ 0 �� :� � � ,� : s.: : �: Si :� � ` ;F: � �: �: ,< :� - F�: �;� ;� �: .� � .,,4 �`r. � � �� . .-�$ � � � � � 0 � �!! .�v- ,!c � � �� C �y '� .a r � A � d � �+ �U� . w°� g� � ,CV! 3 q �o � �aqyd ��d� w O 1r. �u�� a �� a�� a"�oa ��a �x� � �oo� �3c ��E.c a, y or� '��a y A y � t0 C �' "�,fi`,� :o •� � o a .� � as � �, 64 �� °' °i °' � i o �� u U �' e�o � � �+ � �;�88� �o �o � e� de � g � � � ro � o w a � ��d �� O G � � � � � � � � .0 � ¢ � ��d � � � � �� W� . � Qa � � a` a � � � B �� .� � � � 1 � � � �1 � _� _ �, � ��. \ � �) � :� \ � o ` � � � � M 8 � 8 $ � o :� �c m cy � � s� : g �� : g � N � � �� b t0 � �i, a � �� 7 " `� � � � �� '�� o:s� � �, �a� � � � � � �� o�aa� � a � � a E � F � g U � w � .� a° 0 z � p. m � � 3 d � � � V► 19 W Vi R 8 8 8 a C ed ai r M di d � � �� a 9 W M � fl1 ° �' � B � � o � � r� s � v� x � ! �� W 6�+ G � ~ �.7 .� � e. � � � � q � o � v � g � �� b� a�� w� � � � � � � V 0 \ 0 �� i � � O `�' � � ° � � o � � � � �� Z �v � � N/ � � � � � � �Y � �, o � � o �� ' � � � � � M w �a� 0 � � p 00 a 0 R�q � � � � � � � � A w � e �i y I � � « � �� u C� E°� !Zi � � ( � 90 u � � � � � 4 � M � W !6� N � a g � � � d o � tf M �.�j �3 � I ( � N U � . I I � _� � � � � � � : �n .� � � w � � ti �� _� � �� .. �� M� x � � �� ..+ � � a a ��M�� 4� � � � � � �� ' � i � � . .� � � � � � ..- -� � � � �s� �: e �� 9� �a � � � e� �� N` .D ¢ e � 4� �,': �:<s `� �a �°.� c�' � � �� .,� � � u:�. � � � �� R� �� . � 1.-� k"� e:� o�fl �� ^^y �m 4'._) fl=''a c-v �a et'"�. �-..�1 � �� x� �;:D � �'� E,. �.� �� y�: .. L'S �J � � L,':A �� << �� p'�: � 6 :43 � a � � s r;�' � � � �a F� � � �1 r° � � � � � � K�� 3 � � �� M� : U� . e � �; � M�� 3�� ro �.�� a o� �u�� 37��A � u vi� 4� � � V ��''Da �•= 7 4 � � � � o..� �� , q�� .0 � R LV 8! O � y �� C C�L7 � '��a :� � �, w � ��o� � � � L %" L �, �' 01 ^ i. ° � �.� � « a�b U vai m c�e � � � � � � � �� e 0 � � � � � � W .� ��a� � �o �� a � W � r, � ., � � �+ � � , �E � � � � � � � ti � � � W '� n � a a � � � y 'O � � � �c � o `" w a � � � � � � tl � C � � o :�i � c� c i N � ' � � : $p � � O q9 � � � � � � � � �� ° a °° �C � � � � � � � � � � � �. � � � � � � Y a O F JIIn � � U � � w .� � 0 � � � Qa � � � � a � b O � M � t} Hi � � � � o C ec co a� .+ d a .� � ��.r M W M A W a � : : o � � � lN � � � � � x �'! �� &„ e� ia c°„ �i � � v � a � � � � � � � � a .� 'S �,�� a Q � N � � � � � � � � � � � � �� a � k� � , � � � CJi � � � VJ � a� L Pl�) Ir I � L � a �o �: a �� • � � M � � � � ~ a � o � � � � .� � � � � � � � � � 1 1 � .� � ro u 0 �� 1 �� ; _i � (wl� •x � � �o o� � � v: �� J + M � �si� a�J � - � � � � � � N � K st � � �3 � � � I U a j � p��. � � 6J � � � � � ..�. 6u � � �� .. � � � � � � � a �� . x m �a .d � � a a � o � � � � d v � � ., � �� s° �� 9" � �. � � � � � �� n i \ i � � � � � SUBJECT P O. City of Fridley 16 7 5 6 ' L AT THE TOP OF THE TWINS g U I L D I N G P E R M I T REC NO. r COMMUNITY DEVELOPMENT DIV. : ; � ----- , y3 � r � � PROTECTIVE INSPECTION SEC. � ` i � ��1 � CITY HALL FRIDLEY SS432 NUMBER REV. DATE PAGE OF APPROVED BV �----� • •�J 612-571-3450 910-F15 / / 9/7/82 JOB ADDRESS 1561 Dana Court N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ( 2 ��Y'].S Lake Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ' ZIP PHONE Steven Wierc]sma 1561 Dana Court N.E. 572-0188 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO. Same 4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. B USE OF BUILDIN(3 sidential 7 CLASS OF WORK ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR � MOVE ❑ REMOVE � 8 DESCRIBE WORK a F're 1 ce "Marti LF36B" 9 CHANGEOFUSEPROM TO STIPULATIONS SF'�FRAiTf F�R�11T`S .R�QUIREQ Ft�R �'b�f�?�t�C;.. �� t 1rtG, PLUM81M6 AfiIU SiG�f� TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED 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 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]_ STA�LS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFiTAX AND OFDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �`]_ � OOO $. SO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $7.7. SO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECKFEE TOTA,LFEE yS`Z8. �� SIGN/�TU EOF ONTRACTORO AUTHORI DnGEtvr �DnrEi WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT , �- �� _ �'�� .� - FOWNERii ERBUIIDER� IDATEi BLDG �NSP D E e CITY OF FRIDLCY Effective Aug. 1, 1981 APPLICIITI�J FOf� RESIDCt�TI/l� 6UILQliJG PCRi4ITS (��e►�, Alter�tions. Additions, or Repairs) OklI�ER: ��e°�o�� !!'�.��'!Lt. 1�DDRESS: ,��,�� .,�/�/!✓G�- C� TEL N0: .2r,7�—l�/�� l3UI LDER : ��`'�� ADDRCSS: TEL t�0: a.. • Constr�ttion location • ST1tI�T NO: �� STI2EET: ,D�/1%� �� LOT: �� BLOQC : � ADAITION : �.P� ( $ C�(�-� � � �S Corner Lot: Insii3e Lot: Setback: Sideyards: Ap�licant attach to this forn two Certificates of S�rvey of lot and pxoposed building locatioz� drawn on certificates to scale. DESCRIPTIOf�} OF COI�STP.UCTION �� A-� Front: Depth: Hefght: �c Q� P�-r�� Square. Feet: Qibic Feet: ��2� � Front: Depth: Height: �-F��+� �� Squar.e FePt: Qtbic l�eet: Rype of Corstruction : Estimated Costr S�� : �y Rb Be Cbnpleted: l%� p rv � t-t Alt. A Alt. B proposed Drivc�aay kidth If New Opening Is Desired: $' $ . SE� REVERSE SIDE OF SHEET �ie undersigned hereby maf:e� application for a permit for the a�oYk� herein specified, agreeinq to do ,all work it, strict accoxciarice r�ith the City of Fridle�► Ordinances �nd ruling� of the Departmc�t of Duild;ae��, and hereby declares that all the facts and repr�se�tatiens stated i� this application a;e true and correct. , D.�TE: � 22� Stfpulatior�s : � C � (� �� S� � _ �' �b'�� e SIGNATUI�: ��Iy BUILDING PERMIT FEE SCHEDIILE The Inspector of bu3ldinqs shall, before issuiag permits for the ezection of any buildinq or structure, or for any addition to any 6xistinq building or structure, or for any alteration or"repairs to any esistinq bu318inq or s tructure, upon application therefore, zequise the payment by the applicant f or such pezmit of �ees to the amouat Dezeia below set forth and ia the manner herein provided to-wit: TOTAL VAI�IATI�t A 51.00 t� 5500.00 5501 m S2,000 S2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 5100, 001 arxi up . .�.. PEES $10.00 Min3mum Fee $15.00 plus surcharge S10.00 for the first S500 plus $1.50 for each additional 5100 or fraction thereof, to and including $2,000 532.50 f�r the first $2,000 plus $6.00 for each additional $�,000 or fraction th ereof, to and includinq $25,000 5170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereaf, to and including 550,000 5283.00 �or the first $50, 000 plus S3. 00 for each addit3onal 51,000 or fraction thereof, to and including $100,000 S443.00 for the first $100, 000 plus S2. 50 for each adciitional $1, 000 or fraction thereof PL14N CHECR: 25 percent of building pexmit fee DRIViiIaAY DEPRESSION ESQtOoW: Concrete Qirb Streets O�ly Alternate °A"r Removeal and replacelnerit of curb and gutter only Driveway width plus 6 feet x$13.50 Alternate "B": Renoval and replacemeat of curb and gutter and install a 3 foot wide approach with 6 inch clepth Driveway width plus 6 feet x$15.75 VERIFYCATION OF FOUNDATION PermitB for construction will be issued a minisnian of 24 hours fro3n the time of application to allow for proper review of t,i�e propcsed structure and of the construction site. A Certificate of Suzvey of the lot, ehawing the location of the foundation once it has been constructed will be required befoae proceed��„��th tUe framing. 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Address: City: v- � t�i Ph: 763-572-3604 FAX: 763-571-1287 Mechanfcal Residentiai Application City of Fridley See Back Side For Required Information � Site Address: _ S �� 6 r� �i �-� r e� Owner ( Contractor State �h'1 � _ Permit# ��'°' �0�� Phone: '1 �`3 � ��^ � % � f� Cell: Fax: Contractor Information Company Name: 1� �� ,.-� S; 4l e I-1- � L•-v -�'aL -�- �� m.. -� Contact Person: �� L� � l� d� ar t� Address: 'L`7 � G N � � F� i ►� � ; � � City: 6L � s.. d � I� State: )°°�. 4-. ?rp: �� i 13 Phone: 6 Sl - G s`; � J� � Cell: Fax: Email: MN Bond# & Ex Date _.-� Ty e of Work (circle one : New Re lacement AlteratioNRemodel ° Detailed Description of work: `Zr� �-� w i) l�- N_� l � ��-s �� s�, I ta! / s/� 9 P� r . ._ Equipment Installed: MFG; I� MFG: Model: ' Size/BTU: MFG: Model: Size/BTU: Piease check all that apply: �Fireplace (gas) $15.00 _New Gas Grill $10.00 A/C $25.00 Fireptace (wood) $35.00 _Gas Unit HTR $10.00 Air to Air exchanger $15.00 Fumace $35.00 Pool Heater $35.00 Boiler $35.00 Gas Dryer $10.00 Ventilator $15.00 _,Chimney Liner $10.00 �Gas Piping $10.00 rn��r wnrk ��o_�o GasRanae/Oven $10:00 Permit Fee $ � S�� (Total from above-Minimum fee $35.00) Surcharge � 0.50 Total Due $ �3'S. 5 D Make check payable to City of Fridley Thls is an application for a permit- not valid until processed I hereby apply for a mechanical permft and I acknowledge that the information above is complete and accurate; tliat the work will be in conformance with the ordinances and codas of the City of Fridley and witl� the Minnasota Constructlon Codes; that I understand this is not a permit but only an applicaUon for a partnit and work is not to start without a permi� that the worlc will be in accordance with the approved plan in case of afl work which requires review and approval of plans. Signature of Appiicant: //° Date: � �S Approval Inspector Signature: Date: Please Note: Separate permits are required for Building, Plumbing, and Electrical work Building Inspections 763-572-3604 DATE C�l O SiTE ADDRESS I S L THIS APPLICANT IS: PROPERTY OWNER/ TENANT COPiTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY Permit Received By:. �i D� AlJ G YOUR E-MAIL ADDRESS �SC3`'C�(�,@ � Qo1.� QC. C,[J�r1 ❑ OWNER �ONTRACTOR ADDRESS: � CITY STATE ZIP, PHONE:_ _ TlL � ° S� �y — ��, NAME: STATE LICENSE # ADDRESS: l7i.i x Renewal By Andersen 1920 County Road "C" West Roseville, MN 55113 License #20130983 651-264-4777 ❑ BASEMENT FINISH O ROOF O DECK O SID[NG DESCRIBE WORK BEING SIZE OF IMPROVEMENT NUMBER OF SQUARES _ Rw _F PROPOSED SiZE: PROPOSED HEIGHT: SIDING ❑ Virryl O Alumiaum � Other I.��1:� ADDITION ❑ HOUSE ONLY 0 HOUSE & GARAGE O ATTACHED GARAGE 0 DETACHED GARAGE �Soffit 0 Trim ❑ Fascia W� IN EXISTING OPEMNGS OYes ONo LOCATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & t STATE ZIP, ❑ DRAIN TILE O OTHER Ft. BASE FNT FMODELIN 1RMIT• I . Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADAITIONS & PORC C CiIRMIT• 1. Site Plan/Survey showin� the existing structurc and proposed Project. 2. Two sets of construction plans 3. Energy Calca(ations ALL FEES ARE BASED ON VALUATION,INCLUDING THE COST OF LABOR AND MATERIALS: (USING TH� 199T i.� C FEE SCHEDULE) TOTAL JOB VALUATION S I i� � n�3' / nc�rimsrrrv �rw� Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge :�:i � � � �; ,r- See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuarion .0005 x Permit Valuation Minimum $.50 $5.00 (State License,ci Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agr�ment necessary ( ) Non Necessary ( ) Make checks payable to: Citv of Fridlev wtrA� THIS ISOAN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building �it and I acknowledge that the information above is complete and accurate; that the work wip be i conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an applicatio for a permit and work is not to start without a permit; that the work will be in accordance with the approve plan in the case of all work ich requires iew and approval of plans. SIGNATURE OF APPLICANT INT NAME _ O�('��. ,inCe� r�'� DATE � �U l V� �uilding inspections 7b3-�7?-3604 763-�02-4977 FA� S IT� ADDRESS THIS APPLICANT I5: PROPF�2TY OwNER/ TENANT CONTRACTOR SUBMTT A COPY OF YOUR STATE LICENSE, BOND AND C�RTIFICATE OF INSURANCE PERNIIT TYPE �� ,5 F+ �1��'�� '��1� ��'�'� ��+ �'��L�+ � EFFECTTVE 3-19-09 YOUP. L-MAiL .�.DDRESS ❑ OWNER ADDRESS:_J� b I i�� III� CITY. PHON�: '�'1'�j��fiD��D Permit N Received By: Dat� Rec' d: �'� STATE LICINSE # ' " STATE BOND # ADDRESS:$Z� �l n- I�G=�'1 CITY PHONE �'YI B ,�i �� Zi� F� TYPE OF WORK: I � � ,y ❑ TWO FAMII.Y ❑ TOWNHOUSE DETAILED DESCRIPTION OF WORK .. � � � �� EXP DATE EXI' DATE SS� FFFS ARE BASID ON $10.00 PER FDCTURE, EXCEPT WF�RE NOTID. FD�TURES: (IldDICATE TOTAL NUMBER OF EACH BELOVi�. NIIIVIMUM FEE $3550. BATH SINK/LAV FLOOR DRAINS SHOWER _ WATERPIPING —gpTHTL1B GAS PIPING (NEED QTY LI� SWIlVIIvIING POOL _ WATER SOFfNER ($3� CLOTI�S WASfIEIt KITCFIEN SINK WATERCLOSET _BACKFLOW PREV. ($IS) _DISIiW,,1SEgR _ LAUNpRy Tgp,y �WA'IER HEATIIt (S35) FORIRRIGATION WATERN1ElER _ OTHER THIS IS AN APPLICATION rOR A PERMTI' MOT VALID UAITIL PROCESSED I hereby apply for a plurnbing permit and I acknowledge that the information above is complete and accut�ate; that the work will be in conformance with the ordinances and 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 permit and work is not to start without a permit on site; that the worlc will be in accordance with the approved plan in the c e of all worlc which requires review and approvai of plans. SIGIVATUIZLOFAPPLlCANT ��'� ✓L� PRINTNAME /�/IL� � DATE �� PCEASE' NOTE: SEP:�Ri�T'E: T?ERN(PI'�. �RE I�EQUIRED F(�R B[TILDING, EL;E.CTRICAL,. A�1D N[ECHANTC:4L. W<ORI� C�i;J �� '�id.�ey �a�a�c��a� �ns�e��.ons �e��e�g� 6�31 Universiry Avenue NE, Fridley, lVIN »43? 7G3-�7?-�60� F�.Y: 763-�0?-4977 .. . ... .... .. ......__. ..