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AF - 45459� rN�Tio�►r► � �v�as 6Q. �10, �-�9 RAM/3�E�- �R'y,q9 NET. 3 f•� 3 3�► �" HEAT LOSS CALCULA7'IONS DEPARTMENT OF INSPEC�IONS Weatherstrips A.S.H.V.E, Construction No. Guide Windowa Doors Reference Out. Wall Int. Wall Ceiling Roof F1oor Kind Yes—No � Yes—No 19_ Fl.� t Room Length Width / 7 Height / Fl.� �",2 g�D Room � 1 Win a Doors—Crackage and Area Windows and Doors—Cr Wldth Height No. o[ Llneal [t. Area Wldth Height No No. ot Dane o[ Dane lighta of crack aq. ft. No. ot pane of pane Ifg / �4 6 n �c. / 9 Z n / 3� zo z Coef. Btu In5ltration p Glass Exp. wall Net exp. wall p Int. wall Ceiling �'loor � Total Btu. p Reyuired s. ft. E.D.R. or sq. ins. W.A. Leader area F7.� y oom ( Length Z Z Width // Height Win s an rs--Crackage and Area W►dth Hei6ht No. ot Lineal ft. Area No. ot pane � o[ ➢ane -� Ilshts ot crack eQ. ft. / -� 8' /: n o. i 9 /P' Coef.l Btu In6ltration Glaaa Exp. wall Net exp, wall Int. wali Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. �' Room � Length / Width Windows and Doora—Crackage and Area Wldth He1Bht No. ot Ltneal ft. Area No. of y4ne of Dane Ifshte ot crack eq. [t. Btu Infiltration � ' . Glaas � Exp. wal! Nec exp. wall Int. wall Ceiling Floor Total Btu. Required aq. ft. E.D.R. or sq. ins. W.A. Leader area Infiltration Glaaa Exp. wall ; Net ezp. wall Int. wall Ceiling Floor � Total Btu. a MINNEAPOLIS, MINN. Insulation ' How AF � / $+ Width // e and Area Lineal tt. Area ot crack eq. tt. i3 Q' Coef.l Btu IRequired aq. ft. E.D.R. or sq. ins. W.A. Leader area F1.1'�3 E� Room I i.ength Width Windows and Doora--Crackage an Area Width Helght No. ot Lineal ft. Area No. of cane ot pane Ifahte ot crack aq. ft. In6ltration Glasa Exp. wal! 2 (e x Net exp. wall Int. wall Ceiling � X / Floor , Total &u. IRequired sq. ft. E.D.R. or sy. ins. W.A. Leader area � l•� $�q-fN Room I Length � Width Height Windows and Doora—Crackage and Area Width Helght No. ot Lfneal ft. � Area u[ 9ane o[ Pane Ilghte ot crack sQ. ft. z [/ i ` -� / � S?' lnfiltration Glass Exp. wall Net exp. wall Int. wall Ceiling � Floor I Total Btu. uired sq. ft. E.D.R. or sq. ins. W.A. Leade� ana Btu ;�� rT � . N � {�� y •N O � H ,C U i0 � � ' . . 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BLOCK TRACT OR ADDITION DESCR. 4 1 �� Larry � s 2nd Addition 2 PROPERTV OWNER MAIL AODRESS Z�P Marge Rolland 15f1 Gardena Avenue NE 3 CONTRACTOR MAIL ADORESS Z�P Best Siding Co Inc� 12612 Central Avenue, Blaine, MN 4 AFiCHITECT OR DESIGNER MAIL ADORESS Z�P 5 ENGINEER MAiL ADDRESS PAGE Of � � PERM . 20819 RECEIPT NO. � �Pa3� avaaoveo Br SEE ATTACHED SHEET PHONE 571-0919 PHONE LICENSE NO. 754-1888 PHONE LICENSE NO. ZtP PHONE LICENSE NO. Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION �7 REPAIFI 8 OESCRIBE WORK Reroo�' Dwelling (22_Squares� 8 CHANGEOFUSEfROM TO STIPULATIONS �o� can be 2nd layex b�ut not 3rd, On all new roafis or tear-aff, and replacemeni roofs. State Code requ�res tha� 2 tayers of 15 Ib. feit, mopped toEetfiEr, be instailed to a point 24 inchEs up from exterior wall line, or the use of other approved underlayment membrane. TYPE OF CON57. SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING. VENTIt,ATING OH AIR CONDITIONING. THIS PERMIT BECOMES NUII AND VOID IF WORK Oi; CONSTRUCTION 20NING AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONEO FOR A PERIOD OF 12p DAVS AT ANY TIME AFTER WORK IS COMMENCED. ' NO. DWLG. UN I HEFEBY CERTIFV THAT 1 HAVE READ ANO EXAMINED THIS APPLICATION 1 AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS ypLUATION ANO ORDINANCES GOVERN�NG THIS TYPE OF WOFlK WILI BE COMPLIED $1 � i44 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NO7 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqM1T FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- $29RQ� STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. OR AUTHORIZED AGENT ❑ MOVE ❑ REMOVE OCCUPANCY GROUP OCCUPANCYLOAD SQ. FT. CU. FT. OFFSTREET PARKING STALLS GARAGES SURTAX $<57 SAC CNARGE Fire SC $1.14 TOTALFEE fl $3�.%1 � � ] � [ l 1°�I�'F.�t [ ] ��. �Y_ . . . - _ Effective l,/1/91 I�l At�ID i�2 R,;lding Permit Applicatian 0 7�eqa1 Des�'iptiCn: � � & �: a�� i� 11�. � �. � �`7f-�� r� ��: ��5� � �� . � -7� �-� �� Aaa�: 10� [� t �_ C LIPII�IG PiRF.A: C�R�GE ARFA: D�CK AREA: ORi�R: �� I��1� : �� Attach to this applicatian, a �ertificate of S�vey of the lat, with the p�osed vocistn�ctian drawn m it t;o �cale. � :: a,: �JV .� � •i- �,�*; ��s„��'��a I,�s�yth Width H�e.ight Sq. F't. Iei�gtti Width H�eic�t Sq. Ft. Ier�qth ididth ( ��G��d Sq. Ft. �( h e vz�'� �� "�(. �-t c i �� su ci, � v� O�rner Iot [] Inside Iat [] Ft. Yd Setback Si,de Yani SetbacJcs Zj�pe of Ooa�struction: Estimated Cbst: $ /��`�' Approx. �leticti Drate: Prq�osed DriveGray Width If New Openirr� Desired: Ft. $ $ Width + 6' See Back Page DATE: cS �l �� APPLSCANr: �l/� �. Z�1. # �ermit Fee $ �• , D � Fire S1�d�arge $ � � state surc�harge $ � �- SAC Cl�arge S Driveway Escxtiw $ Park Fee $ sewer Main Qzarge S . �. srs�a�s: � s �3 �. 7 1 M 1�_1: • 11.. . F�ee ��>> e an Reverse Side � . 001 x P�ezmit Valuatia[i (1/lOth $ ) . $.50/$1,000 Valuatian $650 per SA�C Unit Alt. "A" o�' Alt. "B" Abvve �ee Det+eYmined by �qirieerirg � �S�Y [ J � N�-�Y [ I .� _ _ � sue�eeT IT NO. c�ty o� Frialey 30517 AT THE TOP OF TME TWINS g U I L D I N� P E R M I T r ; ` RECEIPT NO. � ; v �_�� COMMUNITY DEVEIOPMENT OIV. �� / � f � � PiiOTEC7IVE INSPECTION SEC. �j � � . i.--- A �"' �'� CITY MA�L FRIOIE� 55�132 NUMBEN AEv D�TE P�GE O� •PPROVED er L J` 612-57�-3a50 s�aF�s 11/16/99 / / JOB ADDRESS 1561 Gardena Avenue NE t IEGAL �OT NO. BLOCK TRACT Oii ADOITION SEE ATTACMED DESCR. L� 1 Larry's, 2nd Addition SHEET 2 PqOPERTY OWNER MAII ADOqESS ZIP PMONE Ma.rjorie Rolland 571-0919 J CON7RACTOR MAIL ADDRESS ZIP PMONE LtCENSE NO Sela Roofing $ Rem. Inc. 4100 Excelsior Blvd. St Louis Pk 55416 823-8046 1050 � ARCMITECT OR DESIGNER MAIL AODRESS ZIP PMONE LtCENSE NO. S ENGiNEER MAIL ADORESS IIP PHONE LICENSE NO 6 USE OF BUILOING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION �Q8 REPAIR O MOVE O REMOVE B �ESCRIBE WORK Reroof house and ara e 19 S Tear-off• Re lace soffits on front of ara e 9 CHAN�E OF USE fROM TO STIPUlAT10NS Underlayment must comply with the State Building Code. TVPE OF CONST. OCCUPANCV GROUP OCCUPANCv IOAO SEPARA7E PERMt7S ARE REOUIRED FOR ELECTNICA�, PLUMBING. MIEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING SQ. fT CU FT. AUTHORIZED IS N07 COMMENCED WITMIN 60 OAYS. Oii IF CONSTRUCTION OR WORK IS SUSPENOEO OR ABANOONEO FOR A PER100 OF 120 OAYS AT ANV TIME AfTER WORK IS COMMENCED. NO. OW4G. UN17S OfFSTREET PARKING I MEREBY CERTIFV TMAT 1 MAVE READ ANO EXAMINEO TMIS APPLICA710N STA�LS GARAGE$ ANO KNOW 7NE SAME TO BE TRUE ANO CORFECT. ALL PROVISIONS Of LAWS VA�UATION SUR7AX AND ORDINANCES GOVERNING TNIS TYPE OF WORK WI�L 9E COMPLIEO WITN WMETMER SPECIFIEO MEREIN OA NOT. THE GRANTING OF A PERMIT $1661 . S3 DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL THE pERMIT fEE SAC CHARGE PROVISIONS OF ANY OTMER STA7E LOCA� LAW REGUI,ATING CON- STRUCTION fl 7HE PERFOFMANCE f CONSTRUCTI ✓ ()0.10 Fire .SC 1.66 PLAN CMECK fEE TOiA EE , 'l 1 ��1.1 i .59 Si AEO�CON'i7�(;TQAOpAU7�+0 D�GENi iD�iE� EN PR` VALIOA THIS I$ VOU PERMIT � � S�GN�TUAE O� OWNEp�� OWNEp BU�LDENi �DAif� Bl �N$� /�aIE NEW [ �] ' � 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: �� (� � � .��"t �7(�-- /�-\ �Y) � �n � . \� Lega1 Description: - ' /�,, bl� �s� Owner Name & Address: // ` a �J �1'�-� ` el. # �7/—D f /� Contractor: �� ROOFING & REMODELING, IN . �J �CENSE #�(' �d 4�BA �X(,:�I��I�O�t RT Vn Address: ST. LOUI� PARK, MN 55416 Tel. #(01 Z G�' 3 4��6 Attach to this application, a Certific�te of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: Length Length Length UESCRIPTION OF IlVIPROVEMENT ' ' " Width Height Width Height Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. , OTHER: � S' G2 �a � 9 SQ a�r �- s' _ �� -,�'e+�F H� � s,� �`G-� �-e- �� i. ��..� s` �/a �.� � , � �o-�.?-� '�� Construction Type:��la « G,.,7r�rc � CJ�� f/�� µT Estimated Cost: $ �q fo � i Driveway C�ub C�t Width Needed: Ft. + 6 Ft = Ft x$ _$ - DATE: � APPLICANT: Tel. # 0`i rG�� Pernut Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ $ 1�� $ $ $ .p6 $ $ $ $ $ � CITY USE ONLY Fee Schedule on Reverse Side 001 of Pernut Valuation (1/lOth%) $.50/$1, 000 Valuation $1050 per SAC Unit $5.00 ;State Liceased Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] Building Inspections 763-572-3604 DA7'E I � � — d SITE ADDRESS �� THIS APPLICANT iS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION BUILDING Permit No.: RE5IDENTIAL APPLICATION Received By: CITY OF FRIDLEY Date xec'a: YOUR E-MA1L ADDRESS a'JICl AUt� /v —� ❑ OWNER �COMRACTOR 5"6 t GA�lfO�� --d� 7- 3SSf� _ L1, :/e CI'CY F�I�L�`/ STATEM�IP SS Y�' ,c_ G' STATE LICENSE � AZ�S I b� �� EXP DATE O 3' 3�+� 6 � ADDRESS: a7I �� SC J�G�c�I Ij'! �5 I o(/ 71/� [ uC� CITY CI7�i9S%Tdi STA'TEm�L� �SS /� PHONE l� - $'G 6 - (� 6 $-�- pp}( L /.t — �6 6 - l6 �o PROPERTY TYPE I � O LE FAMILY/NE FAMILYMEW PERMIT TYPE O ADDITION lJ (JAKAl7tlJriCU U�'�'11VLV ��J D BASEMENT FWISH �l ROOF O DRAM TILE ❑ D� � 51DING ❑ OTHER ❑ SWIMMMG POOL TYPE OF WORK: �! DESCRIBE WORK BEING DONE: i��R ��i ��U°� �� U� ��' ��/Y SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARFS �,d GARAGGS PROPOSED SIZE: PROPOSED HEIGHT: � SID G �� O Vinyl 1 ° O Aluminum � O Otha 1'1'WDOWS IN EXIS7TNG OPENMGS OYu ONo OR FOR NEW OPENMGS-DESCRIBE SIZE OF OPENING CHANGES dc LENGTH J�O HOUSE ONLY �i�/-7� a^' O HOUSE dc GARAGE O ATfACHED GARAGE D DETACHED GARAGE �Soffit O Trim ❑ Fascia LACATION OF WINDOWS HEIGHT �CFh�Ft�1'I' RFA�ODE1 �IG SUB1vIIT: I . Existing Floor Plan 2. Proposed floor plan 3. List of swctural mcmbers w be used Ft. FOR NEW CONSTRUCTION INCLUDMG DECKS, �DITIONS & PORCH�S SlIBMIT: l. Site PlanlSurvay showing the existing structures and proposed project 2. Two sets of construction plans 3. Epergy Calculations TYPE OF WMDOW TO BE INSTALLED NUWuBER OF WINDOWS I ALL FEE5 ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (LJSING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ o� q 86 �°� OCCUPANCY TYPE Permit Fee Plan Review Surcharge Fire Swcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ �� ° $ , � .� $ �: L�¢._ $ $ $ $ $ , See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) 51450 per SAC Unit (Plans to MWCC for detennination) ft+6ft= Rx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATlON FOR A PERMIT-NOT VAL1D UNT1L PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conforivance with ths ordinances as�d codes of the City of Fridley and witl� the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work ich r quir s re ' w d a oval of plans. �^- SIGNATURE OF APPLICANT PRINT NAME�v�P%�� C�/ �/�' DATE !/�� r bv �� , ��/�� " �, `w .„��, ,„�, ,. From: unknown Page: 2/3 Date: 9111/200712:25:15 PM � ; � t:3�d . V. V V�;QI Wc�£i :2Y I� 9002�bZ-�� ' 1V�C�.NYC�AL ��tNo.:�cb�- �� Building; R�i� sy: ; �,spectians RESI�E�T�'�A►� A,��'LICA►T N �� P ' ?63�572-3604 �j'X'Y' Q�` F�L�Y� Si�E ADDR�SS _,_ � ,�'1.IGANT IS. p�VN�1 . 1'B�iAIP1'T 0 YO'l� ��.v o C0�1'['R�►GTO�c coti!!',�t�nrru� Kline C4rp. � -- gvgM{T � COPY OF �A� � aBA: PraCtical SysterrlS �,0� �� sr�re � 43426 Shady C�ak Raad �,tC�tg� wTt'� nnDtt�ss:,� Hopkins, MN 55343 APP[.tCf►Ttc�r+t �� 952 933-186$ PERMIT TYP� � o� woxx: �'Sn'1GL�FAMfLY D'r'VJOFAMILI! oN�w o�Y D�'Y'AI[.ED DESCRIPTtU:�1 O� WORK Q TOWNI'l00.7S� f!!, . ..:« . STA7Z��1P -- � F'ER MS �68.665 tbe penait fes i4 s minimQa ot 515.00 or 5Y. ottbe tatai cosE np to 5500.00. �t'�i�C� �� !be �e improvQr�ect, i�l3adaa� ar rcplacemrnt of a resldanual ftxrure. excluQing $►e fixc�ues. ('fiia sho�uM reflets �!Y tbe oost a�tabvt i. � �.a1pt eost tmde�' �30Q � t1S.00. L�bor cast bctweGn 5300 to SSOU = ctisi of lnbor �'� x.OS Q..._-,�.� I � F� fltO1ECT��E�� ExCF,.ED5 SS00� FEBS A1tE8.�SED Gl� t3o.W �Elt f1,XTlittL. ��' �'�K�• � �'�� 'U., , �t�r�Di i �� i�G: �� MOf)Fd.; Ur•`.�--e�� yWauad . 5�B7ZJ,�....�— � t�G: �... �� : ^ - S1ZF/8TV _� . �r '—""�""� �AS RAT� i10.00 • ,_„JUCS=5.00 LAGE((fA5)SlS.00 ,,,,,,AtR To �rx nccw►tacr� s ts �x�acE (woaa) sss.00 ---�v� y� io o� ,_,�cxLete s;s oo c� s3s.00 c�af�a�"r ur� =raob —Gn�S �RYP.1t s) o.00 ,�I+OOI. k�A7'�1t s3s,00 -- ts� ..........,. �.� ns, Y�7'D..A�OR SlSAO guroh�rgo T'pTfAL DUE � Niunber af fact�uas � 510.� �� Y S1�.Q�1° s_ /�`__--._ _ �r.--.� Number of fatfuues (�j Sl S.t� �,,, x S15.M1 �� 15— s Number of' fbtRires � x25.00 x$25.Oq �' 5�..,�_ 'Numbor of fixau�s � 535.00 x S35.00 R'5.,.�.— SWt Sarct�rSe � S `! Tatat W S� Ti�S 1S JW ATYI.lGi10N FOR A PEIWU'f.NO"f YA:.1�7 UIY'[1L �� 1 hercby aP'P1Y fos a bulSding psimit md ��kmowledge ihat �tse informatioa abors is s:omplete aad accurate; that the arork wili be ia coa�fviailurrrsbat a� sn� Ucatk� ar�a perun�aad�work is�o�w stsn w;thout $ parmta ConstrveCo� wCockB�t�t i u�eo wiih �c nat.a pernsi nh' ePP l� sp�aved ptau ia tbe cusu��o€� wa�'i��hisb requiras ra�ieu and appm�el of p U�r .,,. �.r� ��er�.,� ��/%% SICNATUR6 OF City of Friciley Suitding Ynspectians Dep�►rtment . 6431 Univcr�ity Avenua NE, �ridleY-• MN 55432 7C�3-577.-36U4 � tid w�t;iz 9eee dz 'Q�j � zs� 5� oN xb� r. ��lAi�d Jo �it�: I�e�i � Building ` BUILDING Pennit rto.: -o� � � [nsp�ciTOiis RESIDENTIAL APPLI�ATION Received B C O 763-572=3604 C j T Y O F F R I D L E Y Dat�C�: �AT'E %/a7 YOUR E-MAIL ADDRESS G�`i a,.,fiv � St.. m n. �?52,. C� i?� . _ . � >ITE ADDRESS / S 6 / I'HIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WI'I'H APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: �OWNER OCONTRACTOR � ADDRESS: / S�6 / �'�G. �,r%... Ada. NC CITY PHONE: i6 3- S�O Z. " dU ) Z-- STATE LICENSE # EXP DATE ATff+?NZIP-rsti$L ADDRESS: CfTY STATE Z[P PHONE FAX ❑ ADDITTON ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRA1N TILE ❑ DECK ❑ SIDING _ ___ J�OTHER �� ADDTITON DESCRIBE WORK BEING DONE: �{ i�16 e� ' SIZE OF DvIPROVEMENT � o�' LENGTH / 7�� WIDTH g� HEIGHT Sq. Ft. NUIviBIIt OF SQUARES _ GARAGFS PROPOSED SIZE: PROPOSED I�IGHT: ❑ HOUSE dc GARAGE O AT]'ACHED GARAGE ❑ DETACFiED GARAGE BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of swctural members to be used SIDIIVG FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIOATS. & PORCHES SUBMIT: ❑ Aluminum ' ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Otha . • ❑ Fascia and proposed project. WINDOwS 2. Two sets of construaion plans IN EXLSTING OPEIIINGS OYes DIJo LACATION OF WINDOWS 3. Enagy Calcutations OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENDJG CHANGES 8c TYPE OF WII�TDOW TO BE WSTALLED NUMBER OF�WIIJDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ yoa OCCUPANCY TYPE Permit Fee Plan Review Fire Surchazge S}ucharge License Surcharge SAC Charge Gbrb Cut Escrow Erosion Control Park Fe� Sewer Main Charge Tota! Due $ $ $ $ $ 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) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21 =$ $450 Conservatton Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks aavabie to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; 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 pemnit but only an applieation for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires v � ova! of plans. SIGNATURE OF APPLIC � PRINT NA1��i�rL �'1Vc..✓1'r.� DATE � 2%� 7 _---�— r, �-- R , � �, ;%-�' ;J � �-� f^ i.'., �y� � 1 f �,,�a, �>�' � 5 ; ---___ � �ek = ,-- �] ��..��._� �� f i i ; � � � Y_,� r''1� � ��; �� c � �� i c��`� __�.___� _ � � � r 1 � �^ Q(�j,.i� '� V� 1A.i � 2`�Ce� i i � 4� �i � � � I zc: u�'l �-(� � � �c �,( I �;�t�\��(0`�U ir�.. ��C j��t.� � � �� . ,� �C�� , -- 1��,b� -- �.�� !�{/� I 3(, �i �� /or � � 6 �� u d,��...d-,?! hea.,��. w�� +'`�-�-' �',� �v� �� oPs�4-St�y REVlEVk/Ep P,�l�E �% Engineering WATER AND SEWER Permit No.: '`�� -� �� 763-572-3551 pERMIT APPLICATION Rece' - y'�'��"�`- ` ' �.�;�. �� 763-571-1287 fax CITY OF FRIDLEY Date Rec d. £FFECTIVE 4/8/09 APPLiCTATION DATE: d-'"I�'"'L"'��'� YOUR E-MAIL ADDRESS: ____ THIS APPLICANT [S: ❑ OWNER �J, CONTRACTOR JOB ADDRESS: ��tL^l G'ra�°i�;[-•i t� ��i: �.f� F .�c�I� �' %'i1�.rt �:� �i3 �, NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY NqME: j'��E �,,�,,;d OWNER/ ADpx�ss: 6��I C°�v-rita��F ��'� �•�, C1TY �°+'��Tt STATE/%i� ZIP��3� TENANT PHONE: �� Z��° f��"% CONTRACTOR NAt�: ��+��.:i<. '�is•s�k.:�s �YC, SUBMITACOPYOF ApDRESS: gL• '�� .� CtTY N��v.-~. STATE�'� ZIP��3q� YDUR STATE LICENSE WITH PHONE �e+Z �Z.1-id °t 3 CELL PHONE: �` �� ZZ� ° l°7�% APPLICATION STAT� LIC # �.�:2.�i STATE BOND: E ," 4 EXP DATE: ►•-2`�a- �� 1. Narrative/written description: �+ y �,i �e�?i�S�',»./ �`�iMC"�'J�C� •�vv:'w �! if�'� � `` iS F��CR..C'Cl� ti.s4i�t'2� '�%v'�.�:, 'lF'uC:`i''�'P .C'{d..et�.� �� Pa2 � tt c�� C'�ri z�- �:wc.ke � �` c`;,��- � � �s t� �� :s„ ��°t� r°a, o� _� � �; ��i �a-�.)t {=. �'i�a°� . 2. Ple�se �td�ch sketch shoovoaeg eaarb l�ne, ut6�ity 6bne, �esi9d6e�g, e�c. �v��h c�ist�mees. PERI�'FIT 'T1'PE "] SEWER CONNECTION PERMIT $50 G WATER CONNECT'ION PERMIT $50 ❑ WATER LINE REPAIR $40 , : � ��: �j � SEWERLINEREPAIR $40 `"';'��:� ��%'�� , ". ' ��„i 0 ADD STATE SURCHARGE $.50 �`� • �, ��, �,� --� � SAC CHARGE @ $2000 = ��,r i...> OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLII�IG � NEW WATER METER COST — SEE UTILITY BILLING SPECIAL ASSESSMENTS — SEE FINANCE WATER TAP — SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / wEE►cENDS & HoL[DAYS $125/HOUR-BILLED THIS IS AN APPLICATfON FOR A PERMIT-130T VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ardinances and codes of the City of Fridley. I understand this is not a permit but only an application for a permit and work is not to start without a permit. SIGI�IATURE OF APPLICANT i ..� :� PRINT NAME: �1Fa.t�,' �-- ��.1'-... DATE: Ei�Ett. i...- -..... _.. . _ APPROVED BY: -"'s � ,1�'+.... DATE: t I:L7 � COPY GIV�` � i�: ❑ UTI ITY BILLING (only if new meter) ❑ PUBLIC WORKS [::; ENGINEERING �,iry oi r riuiey Engineering Department 643 ] University Avenue NE, Fridley, MN 55432 763-572-3551 FAX: 763-571-1287 En�ineering WA�ER AND SE WER 763-572-3551 pERMIT APPLICATION 763-571-1287 fax CITY OF FRIDLEY EFFECTIVE 6/9/09 APPLICTATION DATE: �" �"� � YOUR E-MAIL ADdRESS: THIS APPL3CANT IS: ❑ OWNER ONT[tACTOR JO$ ADDRESS: [ � �� Q C��r_ ; -,�' �.�� =� =s r ; �`�.1 f',� � NEW CONSTRUCI'ION PERMIT# (1F APPLICABLE): PROPERTY OWNER/ TENANT CONTRACTOR SUBMITA COPYOF YOUR STATE LICENSE WITH APPLICATION ADDRESS: �.S�sg � ��e^c: ; Jt�'.-, v�'Ld :,'s i • :✓ �ITY PHONE: Permit No.: Recei � ed $ �' " , � D�e��c"��. J TATE�ZiA �.w .. t�� —[../.�s� �c� P�+rr'�i�°T.e. NAME:_ ��.J .�, .,� ... � C� ADDRESS:� CJf�c�? ,`� r,�c � t�=*t,^ " 1';±_��`�,`, CITY �s+ ��' STATE�ZIP� �"� PHONE `r��9„3�'•.9�� ?'s�.� CELLPHONE:('S�f�--�a,��;'>L-./�( STATE LIC q STATE BOND: EXP DATE: 1. Narra�t''i�ve/written descript'on: ;— �y � '� �+.� �-'^�; � � �� "w,� 87" 9 i F i J `� � E..�4 E'4 � � ..� "� %..9c'! ,�,,• 2. Ple�se att�ch sketch showiasg curb line, utal6ty l8ne, basildeng, etc. r�it�Z c9i�tances. ��lft1VIIT "�'I'PE ❑ SEWER CONNECTION PERMIT ❑ WATER CONNECTION PERMIT ❑ WATER LINE REPAIR � SEWER LINE REPAIR ❑ ADD STATE SURCHARGE � SAC CHARGE @ $2000 = $50 $50 $40 __� $40 � �.50 . .� r"" OTHER CIiARGES (IF APPLICABLE) PAY T� UTILITY BILLING NEW WATER METER COST — SEE UTILITY BILLING SPECIAL ASSESSMENTS — SEE FINANCE WATER TAP — SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF I wEEKENDS & HoL[DAYS $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley. I understand this is not a permit but only an application for a p it d w�1�is not to start without a permit. SIGNATURE OF APPLICANT APPROVED BY: COPY GIVEN TO: '�� `� PRINT NAME: ��" / T � �'''� � DATE: � 'I �✓ % . . . � � � rX� , ;w, _.�-°,""" _.. DATE: i' �: � ,� BILLING (only if new meter) ❑ PUBLIC WORKS C ENGINEERING City of Fridley Engineering Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3551 FAX: 763-571-1287 � a�, 1 d. � � a C � � � 0 � � �` a X m • .o � a .� L1�. � O C � U � ii 0 � ��m 4 M a M �� w O o 30 w� o� �a F � a M � � W a � � z � � 0 .� U u .� � � � A v � � ti� OQ�.. 3 � i °' " � � U Y U "'��o •+ .0 � v �3b� �v� ��' .� �� c�� .° � ca q a�� '.��a �x� y �a°� � � � .� � .� � ��'�� a� � y � °0 d a .�.�y.� C7 � � � � DO y �, 'd • a v �, �� a�� J = w � 3 < � i Z • � 59NIN3d0 SvJ a�rvva �� '�ddV sv� aaHSVM olnv SNISVH HJlYJ SNIVMO aoo�� •sa,vws '1Nf10� '71NIN0 SAVN1 HSVM S�NIS st�nsve saru H1V9 rnNiun s.�so-n aatvM � o � ag � � O � � ❑ ❑ : m'a � o V � �� o� a •o � O � C) � �� Q • � w� � ya b b CQ �-�i N M � • '1F � � � Y :: i+ � � � 0 F :: a � � b s � U 'd � � z W O LJJ J � W U � W Q J !"� � a`�. x � a � �� F � � F , � f? EA Fi} Vi V! 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V► H t9 !R O O O O u� 00 N �ci �[i N � : : : o g : � g g � : : � � � : � b .�� :� � .� �s°''� u � � � � .'�� iri aii � O � d � � � � � � � � � � � � u � .., .�a �� ar� � a $ � °; � U a� � H F � � a � F x 0 � w dEi � � � z � a b I z � a �. ;� � � U Y � � W � 0 3 0 a v a O � t z I �z � � � � 0 x � � o � � Q a� W Y 0 � � �i � � F �"� vi vs ar� v� u� O O � � O 00 00 N N �[i � 3 : : x : Q : W w � � � d O � � xN y � W �, W W � �'i w a � � � � o 0 � N M � � � � � w w � �rr O O � � . � : � � : : � y: � ti � � � � �� " � O �' a � 0 cE ' d� °� � o M 00 '�"' M � .� � � .a o a W � � z a � � aa oa a �' O i9 V v � a tw� � M s � � U Y H z N � � c`�, H � � � � F � N \ E� � � �+ � � o � N 0 k k k z E-� 0 � O � � y,, O N .x+ N vi °c.' fw ° W � �C. � �" M ° � F '" d C7 w � t9 O � w � � . � O F � v� w N ,..�.�.�-. MI � M V, E �y a x � y a� ° � � z � F F o W a � 0 � x a z z Na 4 w > 4 �. L � r �o '� < �; � �. z A .a° q a � � : � x �, a �w K 1 � Y K ` W v �,.�.__ ._-,.� ,. . ., -.. -. - , yN�?Tiorrh � �'��oS 62. �o, �-�9 . RA�n�s�E�- �0'�,..99 Ncr. 3`, 3 g� �" HEAT LOSS CALCU[.A7'IONS DEPARTMENT OF INSPEC IONS MINNEAPOLIS, MINN. Weatherstrips A.S.H.V.E, Construction No. Insulation Guide Windowa Doors Reference Out. Wall Int. Wall Ceiling Roof Floar Kind How Applied Yes—No � Y,es—No 19_ Fl.� �F Room Length Width � 7 Height / FI.� � Room Length /$� Width // Height Win a Doors—Gackage and Area Windows and Doors--Crackage and Area Wldth Height No. ot Lineal tt. Area Wldth Hefeht No. ot Lineal tt. Area No. ot pane o[ pane lighta ot crack eq. ft. No. ot pane ot Dane ifght• ot crack ea. tt. 0 6 1C / O z t.. c1P' / �Q �� i �r/ //_ -� /3 Q' Coef. � Btu Inhltration Glass Exp. wall Net exp. wal! Int. wall Ceiling �'loor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. l.eader area F7.� y oom � Length ,2 Z Width � Win an rs--Crackage and Area Width He1Eh�' 'No. ot Ltneal [t. Aree No. o[ Dane ot Dane -� llahts of crack eq. tt. In6ltration CJaaa F.xp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. �1.' Room � Length / Width Windows and Doora—Crackage and Area � � Wldth Helght No. ot Lineal tt. Area No. ot Dsne o[ pane 116hte o[ crack aq. ft. Infiltration � j Glass t Exp. wall Net exp. wall Int. wall Ceiling }� loor Total Btu. Required aq. ft. E.D.R. or aq. ins. W.A. l.eader area Coef.l Btu Infiltration Glasa Exp. wall Z � x � Net e:p. wall Int. wall Ceiling / Floor Total Btu. Required aq. ft. E.D.R. or aq. ins. W.A. Leader area Fl.l'�3 SSD Room ( Lengt Windows and Doors—Crackag Wldth Helght No. o[ No. ot pane of Dane llahte Bcu —� — J �� Infiltration z_ o o Glass Exp. wall 2 (e � � Net exp. wall Int. wall � ? 3 Ceiling � X / Floor Z_�_ �_ 7'otal Btu. h Width e an Area Lineal ft. Area ot crack ea. [t. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area •l•� 8�?'N Room I Length �/ Width Windows and Doora—Crackage and Area Width Hefght No. of Llneal ft. Area ot yane ot pane lights ot crsck ep. tt. � z�. .� z T �� sr e�u I I � Inhltration ^Cd Glass Exp. wail G �_ Net exp. wall Int. wall � Ceiling / Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leade� arca Height Z Btu r � s��.,, c �i . m �, }� rU�8 �I � `; ro ��p � x b � � 3 U ++ v �, �, �, � O � M a' �' ro v oo \ `S .�f � a�+ u m tV� 00 0o p � � 3 � o 00 �S.y '�' �roHU a d z ,A1 F�° � roo'°a � s O r-1 V1 E ♦ � � �UA � uro a � Q� W+� ro� c� a d � � � O '� b � � � �,.. � � � p y��.+� a G� �� 1d N TJ •ri 0 � � �PaO � 'd n � ro�sxiwi� �H � ' o�"a O W N 3 O ul G. �k q Z z AC •-I C C � � . ro � Ea� o � � ro+� i� � H c'{!a1 F N A v° ro � � � � c s�, o°i a�i � w •.� y ,.r �' m '"'� � a O � v.�� a � � � w�u°, �' � oro •c�d ~p �W Ev� H N °�° M ►Ni m N ro � H a U � aNi aw� rob e�y c� p �7 � 0 � � o a � w 7� p a U E ,� �, v•.� �, w a w � � a wy�.� � a�i roC .Ca, z w °p° t� h O U C-�� m �tl a� � � D4 � F W O u a�i v +�+ '� N Qrol N 3 ]C ro zaq}0 �+ � 3 +� a ro abu� se� � 3 ax?3 '�s?W X ' jfTC�Fj 8�� 1� � zauseM 3 �t�euroanft � SSSZSB$ V � tj��E.'� 0 TE3Q 200'[3 U ssaMOqs su�Qauno3 � � bv��T.zQ � � sd2zy yseM �, a[i sKutS o � a�+ O suTSeg u°i . � sQtLL tT3e8 c� L� L�i W sTeutzp � +� 3 s;asoT� � z a u u ++ b ro x� a « �atxo35 .�°fi n�i r�i v � t0 � � : � >�� Z :m� ,Q N � a �. � � \ � G � � a z H O x a � z N z M w � � ~ � a G. a a � . 0 0 � � � H E H � a �� a~o x U �� az� w RC aE�, a vEi w� w� w � H H tA H a �a a o ° o Q o �n F � • � O � � F f? 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AT THE TOP OF THE TWINS BU ILDING PERMIT 20819 ; � RECEIPT NO. � �` .�_�_ COMMUNITY OEVELOPMENT DIV. -/ �� r � V � PROTECTWE INSPECTION SEC. �� . � � _ �"'\ � CITV HALL FRIDLE� 55432 NUMBER �REV. DATE PAGE OF APPROVED 8V �""'� � ,'� 612-571-3450 9t0-F15 5/17/91 / / �oe nooRess 1561 Gardena Avenue NE t tEGAL �OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED DESCR. 4 1 $� Larry � s 2nd Addition s►+eeT 2 PROPERTY OWNER MAIL ADDRESS 21P PHONE Marge Rolland 1561 Gardena Avenue NE 571-0919 3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO. Best Siding Co Tnc, 12612 Central Avenue, &laine, MN 754-1888 4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE UCENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION �7 REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reroo� Dwelling (22.Sq,ua�es� 9 CHANGE OF USE FROM TO STIPULATIONS �£ can be 2nd layer laut nat 3rd, Qn all new roais or tear-Qif, and reptacement roofs, State Code requ�res that 2 layers of 15 Ib. felt, mopped to�ether. be instailed to a point 24 inches up from exterior wall line, or the use of other approved underlayment membrane. TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYIOAD SEPARATE PERMITS AR� REQUIRED FOR ELECTRICAL, PIUMBING. HEATING, VENTILATING OR Alq CONDITIONING. THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. fT. CU. FT. AUTHQR12E0 IS NOT COMMENCEO WITHIN 60 OAYS, OR !F CONSTRUC�ION OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. � NO. DWLG. UNITS OFFSTREET PARKING 1 HEFEBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND OFiDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $1 � 344 $, S% WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pERMiT FEE SAC CHAFGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $29eQQ Fire SC $1.14 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEf TOTAL FEE $30.71 � NAT fiE F ON'RACTORARAUTHORREDAGENT IDATE� HEN PROPE �Y TED HIS IS YOUR PERMIT �� i� � SiGNATUR �FOWNERUFOWNERBU�IDERi �DATE�'� -� � BLOG �NS� �AT� � �� [ J �� [ ] Ooristtvcticn Addre�.�: Legal De.criptian: owner rTame � A ��: O�tzacto�': k7�S � �: c-� R-1 AND R-2 �►,;1 ding Pezmit Applicatian 0` � i � • �a��c r2.��I�� d f h.cP � . ��t � � � Effective l,/1/91 � l�i�, �l . # �'7f - � `� Te1. � �7� � � � � �� Attach to thi,s applicatian, a Oertificate of �vey of the lat, with t]�e p�osed axstnxtiaci dra�wn an it to scale. .�- �,�i�.,•�-�r�:�,�a LIYII�IG l�RF.�i: I�ngth Width Heic�t Sq. Ft. (�RAGE !�: Ier�gt2i Width Heic�t Sq. Ft. �ClC At�: Iength Width /Gramd Sq. F't. . 0�: x h C�'� �� ,� "�((. %i-C C. 1 �y Scc �e� � f�/ o�rner Lo�t �� iae iot � � �. Yd Setback Side Yard Setbac.ks Zj►pe of vonstxwction: Fstimated dost: s �f �%� - Approx. �oa�leticn DatQ: Prq�osed D�iveway Width If New Openir� Desired: Ft. $ S �� Width + 6' See BacJc Page DATE: c� � APPI�CANr: �/.�,II�L JL�v. Tel. # Permit Fee $ *� * � � � Fire S�arqe $ � � state stiirdzarge $ � � SAC Q�ge S Driveway F�crow $ Fark Fee $ sew�er Main Charge S . �. s�rz�zass: � s �3 �. 7 ! «�_ � _�3.�� . Fee Sd�ule an Revexs�e Side � .001 x �mit Valuation (1/lOth $) � �$.50/$1,000 Valuatirn $650 per SAC Unit Alt. "A" C�" Alt. "B" Above F�ee Determined by F1'�g; r�r; m A�e�ent NeoesSazY I] Na�t Neoes��xY [] � _ � sus�ecr IT NO. c�ty of Fr�diey 30517 AT TME TOP OF TME TWINS gU I L D 1 N� P E R M i T r ; � RECEIPT NO. � `v __ COMMUNITY OEVELOPMENT DIV, �� f � � PRO7ECTIVE INSPECTION SEC. i � i-__.� �"'�'� CITY MA4L fR10lE� 55132 NuMBER pEV O�TE n�GE O� •CVROVED Br L 612-571-3450 910-F15 11/16/99 / / JOB AODRESS 1561 Gardena Avenue NE 1 LEGAL �OT NO. BLOCK TFACT OR ADOITION SEE ATTACNEO oesca. 4 1 Larxy's, 2nd Addition SMEET 2 PROPERTY OWNER MAII ADORES$ ZIP PHONE Ma.rjorie Rolland 5'71-0919 3 CON7RACTOR MAII ADORESS ZIP PHONE LICENSE NO Sela Roofing � Rem. Inc. 4100 Excelsior Blvd. St Louis Pk 55416 823-8046 1050 � ARCMITECT OF OESIGNER MAII AO�RESS 21P PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUtLDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION �48 REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house and ara e 19 S Tear-off• Re lace soffits on front of ara e 9 CHANGE Of USE FpOM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PEpMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING. MEATING, TYPE OF CbNST. OCCUPANCY GROUP OCCUPANCV LOAO VENTILATING Oii AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING SO. fT CU FT. AUTMORIZEO IS N07 COMMENCED WITH�N 60 �AYS. OR IF CONSTpUCTION OR WORK IS SUSPENOED OR ABANDONE� FOii A PERI00 Of 120 OAYS AT ANV 71ME AFTEfi WORK IS COMMENCEO. NO DW4G. UNITS OFiSTREET PARKING 1 MEREBY CERTIfY THA7 1 MAVE NEAD ANO EXAMINED THIS APPLICATION STALIS GARAGES ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS yALUATION SURTA% ANO OROINANCES GQVEiiNING THI$ TVPE OF WORK WI�L BE COMPLIED WITH WHETHER SPECIFIEO MEREIN OA NOT. THE GRANTING Of A PERMIT $1661 . H3 DOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CANCEL THE pERM11 fEE SAC CMARGE PROVISIONS OF ANY OTMER STATE LOCAI LAW REGUTATING CON- STqUCTION R TNE PERfORMANCE F CONSTRUCTI ✓'�� EiO. 1Q Fire SC 1.66 P�ANCMECKfEE TOTA EE . '� 1 '�� 'G i . 59 5� AEOFCON'AA�TOAOpAUTtiO D�GENr �O�rE� Ek p VALVOA TMIS IS YOU PEpMIT � ♦ S�GN�TUAE O� OWNEpi�� O�NNEA BU�IDEpi iOATE� BL �NSD / r�<<E NEW [ ]' � ADDN ALTER Effective 5/10/99 [ ] CITY OF FRIDLEY [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUII.DING PERNIIT APPLICATION �� h � �n � /� ��.,/�� . \� Construction Address: �� V� f �L e✓lJ�t I7(�-- Legal Description: ' Owner Name & Address: /"/'� a�JrJ�I'/-� ` bl� �� el. #�7f—D�� SELA ROOFING & REMODELING, IN • Contractor: . , MN LICENSE # �!i �d 4=8A �XfiFi�Si�(1R RLVn Address: ST. LOUI� PARK, MN 55416 Tel. #.�� Z�s3 ��f b Attach to this application, a Certific�te of Survey of the lot, with the proposed construction drawn on it to scale. - LIVING AREA: GARAGE AREA: Length Length DESCRIPTION OF IlVIPROVEMENT Width Height Sq. Ft. Width Height Sq. Ft. DECK AREA: Length Width HgtiGround Sq. Ft. � _ 4THER: � S' Q�a � 9 SQ ��r F. S / �� ' —/Q2 �F �� '� S� a� G-�+ v�°d'Q' �'v G �. v..P 4` /O�R [.e � , T �e�+�.Tr� v� i Construction Type: ReP��► �� G,.rf-��- � d��-� �nv uT Estimated Cost: $ ),�9 6( / - 1 Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ � DATE: APPLICANT: Tel. # 0� i�G�l�� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ $ /� �l� $ � $ $ � .p6 $ $ � $ (l� CITY USE ONLY Fee Schedule on Reverse Side 001 of Pemut Valuation (1/lOth%) $.50/$1,000 Valuation $1050 per SAC Unit $5.00 ;State Licensed Residential: Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] J Building Inspections 763-572-3604 DATE I� �' '� — d SiTE ADDRESS �� S THIS APPUCHNT 1S: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE BUILDING RE5IDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS = /� '� ❑ OWNER J�COMRACTOR Permit No.: Received By: _ Date Rec'd: l9fUrlG. - ' ' - _ _ _ . ,�nnr�ss: 1 S6 � G�l-/��9 CITY F/I ��G�� STATEM�IP SS Y� PHONE: %6 �' a� 7- 3 8�� rtnME /�} � �s��%� � � fy.;��nB 7_'.crG' STATE LICENSE ��S I b$ $�- EXP DATE O 3' 3� �� nnnt�ss: a 1�? sC /f Wl �t �s l.� �' DR c �� _ciTV C/f�9Sh'�9 STATFim�LIP �Sf /� PHONE l� -�G 6- 6 6 5"L FAX �/� - P6 6--l6 �o SWGLE FAMILYMEW CONSTRUCTION S1ZE d s ❑ TWO FAMILYMEW CONS7RUCT10N STORIES / PERMIT TYPE o �Drr�oN u `'"'�"' O BASEMENT FDdISH ISl ROOF � DECK O SIDING D SWIMM O DRAM TILE O OTHER TYPE OF WORK: ��' u nuu, i,vn p MAWTENANCE/REPAIR O REMODELING DESCRIBE WORK BEING DONE: ;��R ��i ��U°� /��'�'1 U�= �� o�/y SIZE OF IMPROVEMENT Kwrinv D NUIvIBER OF SQUARES �_ � PROPOSED SIZE: PROPOSED HEIGHT: � S DIIVG � 1 O Vinyi � ° O Aluminum D Otha �� W IN EXISTMG OPENMGS OYes �No OR FOR NEW OPENINGS-DESCRIBE S[ZE OF OPENING CHANGES dc TYPE OF WMDOW TO BE MSTALLED LENGTH _ WIDTH HEIGHT O HOUSE d� GARAGE O ATfACHED GARAGE O DETACHED GARAGE OSoffit O Trim � Fascia LACATION OF WINDOWS BASEMENT RF►�ODE1�iNG SUBMIT: 1. Existing Floor Plan 2. Proposed floor plen 3. List of structural members w be used Ft. FOR NEW CONSTRUCTION INCLUDING DECKS, AnDIT10NS 8c PORCHES SUBN� 1. Siu Pian/Survey showing the wasdng sWcwres and proposed projeet 2. Two sets of construction plans 3. Epergy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ o? q 8� 40� OCCUPANCY TYPE Permit Fee Plan Review Surchazge Fue Surcharge License Surchazge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Total Due $ �� :� r_• �� See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for detennination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach TH1S IS AN APPLICATJON FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; lhat the work will be in accordance with the approved plan in the case of all work ich r quir s re ' w d a oval of plans. ��,,,, SIGNATURE OF APPLICANT PRTNT NAME/ /D�PV ��C�/ ��' DATE !/�� ?,�4 �; ��/�n�r .._. __ "�,. _� _ �.��, ; 13uilding ± �fSpectiOriS ' �6�^� / �-3b04 bA'y'6 ~ S17E ADD1i�'SS _..� : Tl�SS AJ'P'1.1GANT GS: i ; � � I I i p�Wp�N�E�R�+�1`. 1 Crl�!°Y� a From: unknown Page: 2/3 Date: 9l11l200712:25:15 PM . v. V, v� ;dI Wc�i �2T IL� 9C102-b�'-�� jr�./�J.il'7�.i�i��i� rGiu�a�.v..��C LICA,T N� R�i�►�a sy:_ RES�E�'X`�A.� A��'� �1��E P CI'1'Y' O�' FRIDL�� 0 YOL1R �/�Y� COnI'['It�G�eOk conep�urrw+� Klir�e COrp. —. .— — SV$MtT A COPY OF �rA� � DBA: Pt�dCfiCal $ystenlS �0� gT�� sr�rE � 43426 Shady C}ak Road �,iCEt�1g6 w1T�i nnpttP�s:,_„_ Hopkins, MN 55343 APP[.tC�,TioN �� 952�933-1868 PERl4IIT TYP� 1YP� OY+ WORK: �'SIAIGL� FAMfLY D'C'WO FAMILY fl 13E'�► 0 R�1�� q�'1"AIL�b DESCR.�TIp��I O� vVORK �'fAT��.ZIP, r � - STATE��'� O TO�T�VSE ��.�� . . ..:, ' �t ie u miaimuo, of SI5.00 ort 53�• Olth� tot>t1 cost �tp to 5500.0Q► �4�iCh�� s� �� t ihc � p'�.R MS 168.665 tbo po�nri %t . ; ��, �itanos� or replacemeat of s residant[al ttxlure. excluding �c iucc�ues. ('fbia shau{d refl�t oa15► tbe oo�t o� labvr � '" a.05° Lebot co�t tmdet S3W � 515.00. L,abor cost bctwew 5300 to SSOG = cost of l�bor � "'�"" tCA'[8'tCr�v., � w �ttmes: c� � � �1toJECTS w�E U►apR sxc"EIDS ssw, F�BS AREB.�sF.D a!� sia.4b tEx FlxruRP. 8xc�i"j' t�RSNORB�. � �E EACI� B�l.aWl MFG; ��jAK/C�t�U hSOD�L: �—' ^"� " 51�JB'N �� gqyiro�pt L��4+lNd . � �`'�-" MOD�1.t .�,.�� .�.� �"� h'¢'G: ��+ W1S RAIaG�IiDVF�v i10.00 ' � .-..��• _ ; �� s � LAGE (OA5) i15.00 , �1R T� AIR E7►C}tAh�GF.FR S l5 �tiEPLACE {V+�OODi 535.00 �" �g UTaT i�E7R'�l0 00 � S3S 00 C� S35.00 �pRy�R. a� o.00 t�40�1. k�/►'r8R sas,00 . C�1' [it�! if QOD Ttr . a a.�.ft e � n M Y�+Tl1LATOR Si3 00 �rr��.++�rr* SuroherB� 7�TAi. DUE � Nuitiber of frxt�uts � S10,Op 1.,, x 510.00 � S/�,� �"'-"''""— Number o� fixbares (� S 1 S.Qp _ t x 515.00 ��_ 5� � � s.�. Numb�r o!'t'oct�iras � 525.00 x S23A0 � S�,_ br Numb�r of fixaues � i35: S�ta � xutch�rSa ��_r .SQ Tota1 � � � , SL� TiiLS 1S AN NPLiG►TION FOR A PEitMlT NO'!' YA:s171MCiL PROC�S�D 1 hereby aFplY fo�' a buildiag permit and 1 dtkr+owledge �it tho info,a►atian above is complcts aad accurate,; thst the work will be in confot��ne with the w'diu+ances snd wc�r.s of �c Ciry of Fridley a�d with Use Mi�esota Consttue�atf C�; dWt i urideratand this is �pt.a pee�it but oaly sa a�QU�s=iw� f� a permit �ad wnrk is nOt to SsurC, w+thou�' P��t+ Ulat che work will bo in aceordenee wtiti► tlhC spproved ptan � tbe aa�� W��'hie� requu�at re`ievv and ap�proYai vf P tnr ... •V ✓�� . i.eer�..,� ��/%% StdNATUR6 OF 'Ld WC6i�iI 9� bz 'Qaj City a# �'riciley Buiidi�g �nspections D�p��'�N 55a32 6431 Univtr�icy Aven�� NE, Fridle}'�, 763-57Z-36U4 �AX: 7G3-502-4977 LBZi TLS£9Z : 'ON Kti� Ra�AI�� Jo hit3: t�d� � Building ' [nsp�c�iis 763-572=3604 �ATE_�/ `,�C / /a iITE ADDRESS ►HIS APPLICANT IS: / PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERNIIT TYPE TYPE OF BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY Permit No.: Received By: Date�l�c�: � YOUR E-MAIL ADDRESS Gf�t k,..7�i an Sa m/� �%�e.. C� i'h a �OWNER �CONTRACTOR -. ADDRESS: / S'6 1 C'x• �-.f�.,.. Av�. �vr CITY Pxor�:_ _�6 3- 5oz �� voi z._ STATE LICENSE # E3� DATE AT�?NZIPSS�i3L ADDRESS: CITY STATE ZIP FAbIIL ❑ sASS��rrr Fu�tlsx ❑ DECK ❑ MAINTENANCFJREPAIR ❑ ROOF ❑ STDING O SWA4M 0 REMODELING ❑ WINDOWS ❑ DRAIN TILE ,�OTHER DESCRIBE WORK BEING DONE: �;. �/�<6 e� ' SIZE OF IMPROVEMENT _ G 6_ �' LENGTH /%�� WIDTH 9� HEIGHT Sq. Ft. NUMBER OF SQUARES GARA PROPOSED SIZE: PROPOSED I�IGHT: SIDIIVG ❑ Vinyl ❑ Aluminum ' ❑ Other . ❑ HOUSE & GARAGE ❑ ATTACI-�D GARAGE O DETACHED GARAGE �Soffit ❑ Trim ❑ Fascia wnvnows IN EXLSTING OPEIIINGS OYes ❑No IACATION OF WWDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & BASEMENT REMODELWG SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be usod FOR NEW CONSTRUCT[ON MCLUDING DECKS, ADDITIONS. & PORCF�S SUBIvIIT: 1. Site P1an/Survey showing the existing swcwres and proposed projec� 2. . Two sets of construction plans 3. Energy Calculations TYPE OF WII�TDOW TO BE WSTALLED NUMBER OF WINDOWS � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING TIiE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S �/an OCCUPANCY TYPE Permit Fee $��j. � See Back Page for Fee Schedule Plan Review S/� -a Cb 65% of Building Permit Fee Fire Surchazge $ �� .001 times the tota.l job valuation S�rchazge S ,� .0005 x Permit Valuation Minimum $.50 License Surcharge $ 55.00 (State Licensed Residential Contractors) SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determination) Gtiub Cut Escrow $ ft+ 6 ft= ft x$21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary O Non Necessary O Total Due __ _$�}', (�� _ Make checks payable to: City of Fridl� Attach THIS IS Al3 APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I fiereby apply for a building pernut and I acknowledge that the information above is complete and accurate; that the work will be in confotmance 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 applieation for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires v oval of plans. SIGNATURE OF APPLIC � PRRJT NA 'Nc...✓�ci DATE j.� 7� 7 �► � � M � � ��;'r�� / v � i= � � S�r `�,Y. � `�� e: � w� �,y.�� <� ��.: a� ��' � C�7 � . f�� ,�� , ; ,��i�( ^ �, � � �� , -� �� - �� ;. ,, � � c�� "'�`� � � __—__–�- r ' Y-� � ' � 36 �� of 1 ^ , U( �\ n F \/'•� \ �� 5�` t� . � � V� l tv C �`c ��Z'�1�°� � � ttZ� �� U�'l �=C;s ��'� Co�i ia'�:. ��i��n.� <-- � `/T� lU Q�vt�..✓'-�/ G��.,�� :/� �-u-,�- ��t� �v� ��- �oP,,�s�:. REV�EWED a� Engineering WATER AND 5EWER Permit No.: ;``� �� PERMIT APPLICATION ��J � 763-572^3551 Recei��y�: � � � 763 571 1287 fax CITY OF FRIDLEY Date xec d. EFFECTIVE 4/8/09 APPLICTATION DATE: �-'°{�'"4"�•j YOUR E-MAIL ADDRESS: _ THIS APPLICANT IS: ❑ OWNER � CONTRACTOR JOB ADDRESS: ��1: l irA�-r'+�[:S Fr ��:: ��E. ! :-��IZ t' %Z1� .``�� i � �,. NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY NqME: Jjr�.� ;�{.u.,,,.¢�,� TNANT ADDRESS: �� c?t.t+�k !��'� �•�`, C1TY �r"%� ��"�� STATE!'/i�' ZIP ��3� PHONE: �� Z�3�c ii�"j CONTRACTOR NA�: �A��'°�1^a �jr:."�"JirS �rlti�o SUBMIT A COPY OF ,, � y, �,� 3 qr YOUR STATE ADDRESS: g�• �� CiTY ��°'. STATE � ZIP LICENSE WITN PHONE r �Z-t-ia �4'3 CELL PHONE: ��Z 2-ZI -1 �� APPLICATION STATE LIC #1 �.�,�r STATE BOND: E EXP DA7'E: �•-Z�a- I�` • 1. Narrative/written description: . ,t � �i �. zaa�,✓ C� ri� C~i-s c a 0 ��: t�w Kt i"+`� �" `` i 5 � � �t k['t� �.r 9 ti� Zti �-4v°e t, i� �c.:si"� �' r'i iefiS � B-K L� C� e F'Y.�C� �J � vii'N{. � CR � �44Y` � 1 i'i � `�'.. �� i�f� f 1��. C'{ �'a� �'A�'f'e d��('� � . v 2. Y'le�se att�cE� sketch sho�ving ea�rb lane, utiAity 6ine, �e�ildimmg, egc. �wa�h �Bista�ces. s PERI�IT TYPE =] SEWER CONNECTION PERMIT $SO G WATER CONNECTION PERMIT $50 0 WATER LINE REPAIR $40 � SEWERLINEREPAIR $40 "';'��,' 6��''� �. ' ��;i ❑ ADD STATE SURCHARGE $.50 �F • ' t, ; � 0 SAC CHARGE @ $2000 = �`��r ��` OTHER CHARGES (IF APPL�CABLE) PAY TO UTILITY BILLING NEW WATER METER COST - SEE UTILITY BtLLING SPECIAL ASSESSMENTS - SEE FINANCE WATER TAP - SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / wEE►cENDS & HoLtD,avs $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley. 1 understand this is not a permit but only an application for a permit and work is not to start without a permit. SIGNATUREOFAPPLICANT i , � PRINTNAME: �1Ec..G.� L- �`{+'��. DATE: �-E�€ � �'' 4 . ! ��...�.�.�-...... � APPROVED BY: ' �.�+ � �" °° DATE: � ��i �' COPY GN�`� �: 0 UTI ITY BILLING (only if new meter) L, PUBLIC WORKS f_; ENGINEERING �,iry oi r riaiey Engineering Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3551 FAX: 763-571-1287 En�,ineering WATER AND SEWER Permit No.: ��: ', i:y' �'i�� 763 -5 72-3 5 51 pERMIT APPLICATION Recei } ed ��'�'r" "� 763-571-1287 fax D�� .�� CITY OF FRIDLEY EFFECTIVE 6/9/09 APPLICTATION DATE: �' /'°'�.! x� YOUR E-MAIL ADDRESS: THIS APPLICANT IS: ❑ OWNER ONTRACTOR JOB ADDRESS: �f?�' G �`�f:_; �� E� � d (� f.,r—' � NEW CONSTRUCTION PERMIT# (IF APPLICABLE): PROPERTY NAME: �' ' OWNER/ qDDRESS: �S�✓1 C-�c. :��e:�'�a �• i•:✓�ITY i 4'�i0�� STA7'E�ZIP TENANT ; �- PHONE: CONTRACTOR N,�ME:_ `�".� Y"`.� v�-.�," c=i.,r�.°7'� °r� E,,r,��°T'�._ SUBMITA COPYOF YOUR STATE ��RESS: '-i C✓��4°p �-� i G>: t'=�Lc"` �� CITY �.�'e �� STATE�ZIP � �'',�` �-s,� LICENSE WITH PHONE `i�i;4 -S'. y�> ,� �,'-"t„�� CELL PHONE: �f�--�a,�'�; = C; d�.l APPLICATION STATE LIC # STATE BOND: EXP DATE: 1. Narrative/written descript'on: � � _ _� tJ �—� ` � t:1 � �' �� ' j � � � � ' � �° � ,{ � ��..�..�.�-.� ,s' -r�� .� 2. Pl��se at�mch sketeh showieag eanrb 1'ane, ut's9ity lea�e, fl�e�ild'ang, etc. with distances. �E�21VV�IT T'Y�E ❑ SEWER CONNECTION PERMIT $50 ❑ WATER CONNECTION PERMIT $50 ❑ WATER LINE REPAIR $40 � � SEWER LINE REPAIR $40 � ❑ ADD STATE SURCHARGE �.50 � � "" ❑ SAC CHARGE @ $2000 = � �. OTHER CHARGES (IF APPLICABLE) PAY TO UTILITY BILLING NEW WATER METER COST — SEE UTILITY BILLING SPECIAL ASSESSMENTS — SEE FINANCE WATER TAP — SEE ENGINEERING NOTE: WATER METER REPAIR, INSP OR SHUT-OFF / WEEKENDS & HOLIDAYS $125/HOUR-BILLED THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a water or sewer (new connection or repair) permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley. I understand this is not a permit but only an application for a p it d wo 's not to start without a permit. SIGNATURE OF APPLICANT .L.''!�--�v PRINT NAME: _.,.�.1 �° / T a�''� � DATE: y% �I �'r✓ f �; ,a� � ,t e, APPROVED BY: I i�`�� ,�. _ �-�°'" �� DATE: � � � �.' � � . e ,t r� COPY GIVEN TO: UTILITY BILLING (only if new meter) ❑ PUBLIC WORKS C ENGINEERING � �� City of Fridley � �� Engineering Department `°` 6431 University Avenue NE, Fridley, MN 55432 763-572-3551 FAX: 763-571-1287