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AF - 46409� ., . �. , � City of Fridley, �ii�n. BUILDING PER.�Vi1T N°• 3� 91 ��: ...�.�.J...�..2.� -.�'�........ . Ow�r . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Builder 4!��.'��i�G?iGQI� . �ri.4ET?t. A,d�irees ...................................... Address ............................................. � � a. LOCATION OF BUILDING No. ID �./f0� Street . . . i,�� . ..�V. J�ifi.�LJ�. . . . . . Part Lot . . . . . . . . . . ��` ii% . . . . . �, Lot . . ,%� �. . . . . Biock . . .p�. . . . . . . . . . . Addit[o�n or Sub-Divisioa .�.o . . . . ��. .�. ti4.. . . . . . . . . . . \ Coraer Lot ............ Inside Lot ..�........ Setback �.S' .Q ... Sideyard ........................... DESCR[PTION OF BUILDING To Ueed as: ., . . �t Y..�-;o �, �� i� H�� =a �,. �. �� a �. �. �?�y?�► � �Y.o' � ��: ��H�t .,�d. �.a � �. �. x .9.y �. �.�9yr� Zjrpe oi Conshvction . . . . . . . . . . . . . . . . . . . Est. Coet. . �!. . .? �f . .�'.�.'-. To be Completed . . . . . . . . . ... . . . . . . . . �.--�-.. In aonsideration oi fhe iss�aance to me ot a permit to oonstruct tl� b g degribed above, I a�ee to do ti�e Propoeed work in acoordance with tbe desctipt[oa above set forth in compHance all rovisiMs �ances of tt►e city of Fridley. �c.. , .:`. ... . . .. ..� .. �� In oonaideration of the payment of a fee o! � �.�s. . . . . . ., permit is hereby granted to . . . . . . . . . . . . . . . . . . . ..... .. .. .. .... .. ..... .. . to construct the butiding or additia� as described above. This permit is granted upon the ea�ress conditian that the person to wham it ia gi�anted aad 3�is a�bs, emploYees and worlrmen, ia all work done in, around and upon said building, or any part thereof, shall oonform in all respects to the ordinanoes of Fridiey, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city li�aits and this permit may be revuked at any time upon violation of any of the provisians of said ordinances. ( �' . Buildin� Inspec69r /i' � /�1-1.� -.. ... . _ - - - NOTICE: TMs permit does not oover the oonstruotion, t�atallatton or alteraEtion tor wl�inq, plumbiny, qas heatinQ, sewer o� water. Be suro to see tde Buildinp Inspeator for separate permib fo� the�e itams . , + '� � SUBJECT � � P E c�ty of Fridley 2 0 7 6 9 t w AT THE TOP OF THE TWINS B U I L D I N G P E R M I r RE . f � �• COMMUNITY DEVELOPMENT DIV. Q �7 � � V + � RHOTfCTIVE INSP£CTION SEC. �j ��/ �`'— � , � � :� � r'��ti CI1Y HALL PRIOLEY SSI.3Y NUMBER pEV. OATE PAGE OF APPROVEO 8Y �""'�' �'� 612-571-3450 910-F15 4/19/91 � � JOB AODRESS 1056 Hackmann Circle NE 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED oesca. 19 2 Parkview Heights s►+eer 2 PROPEHTY OWNER MAIL AODRESS ZIP PHONE IIave Toews 1056 Hacl�ann Circle NE 3 CONTRACTOR MA�L ADDRESS �P PHONE LICENSE NO. �rin City Stozm Sash: 10825 Green�rier Rd, Minnetonka 55343 546-8160 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAII ADDRESS Z�P PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW ❑ ADDITION ❑ ALTERATION [� REPAIR O MOVE O REMOVE 8 DESCRIBE WOFiK Reside House 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OP CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PIUMBING. HEATING, VENTILATING OR AIR CONDITIONING. TMIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OFi ABANDONED FOR A PERI00 OF 120 OAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWIG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFV THAT I HAVE REAO ANO EXAMINED THIS APPLICATION 1 STAILS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS VALUATION SURTAX ANO ORQI ES GOVERNING THIS TYPE O: WORK WILL BE COMPLIED $4, 50.0 $2 � iS WITH WH R S CIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES T RE E TO GI AUTHORITV T VIOLATE OR CANCEL THE pEfiM1T FEE SAC CHARGE PROVI O O ANY ST TE O CAL LAW REGULATING CON- $72��Q k'ire SC $4.SO STR I TH CE ONSTRUCTION. "�--�---._._� PLAN CHECK FEE TO AL PEE r. _... $78. 75 ✓ ATUR cC0 T Ct R UTMORIZEDAGENT �OATE� yyH qpp I AT D HIS IS YO R PERMIT � r SiGNATURE OF OWNEA��F OWNEA BU�LDEA1 iOATE� i INSP nFiE � [J � [ l �'L'� [ ] Cioa�t�Cticn l�ddress: Iegal De''.�'iP�.ians _ Owt�r Name & A.�: L�: �ntxactor: ��c` �n Aa�aress: Or��i1 �t �; A'-1 AND R-2 Buildirig Fiermit Applicatian G Effective 1,/1/91 Ziel. # Tel. � Attach to this applicatian, a Oertificate of Svzvey of fihe lat, with the praposed �icn � an it tfl scale. � � c •�:,. - . r� •► r- •�:,�• � . �'JN '��+� _: • • �'�;�' .�/.% ' • s: �.; ��M �, �i' �ri*;��/: ti_ yl Width Width i'ielght Ii2�lt�ilt •.y.y G1�OtII7d Sq. F't. Sq. F't. $C;. �. Cbrner Iat [] Insic�e Iat [] Ft. Yd S�tback Side Yarci Setbacics Type of Co�stYUCtion: Fstimated dost: $ �.S-DD � Approx. Oa�letion Qate: ...__. � - . . _ •.-�. � �,, :- ti/�� . � r . . - � � � 7� � � . . . �. r - � ! � / a44 �_:�. �_,� . P�ermit Fee $ •��F�ee Sci�ec�ule an Reverse Sid�e Fire s�mharge S �f,s� .00l x Permit valuatian (1/lath �) state surcharge S �,.as S.SO�Sl,000 valuation SAC Cllarge $ $650 per SAC Unit Driveway Fscraw $ Alt. "A" or Alt. "B" Above Park Fee $ Fee L�ete�*+� bY F�rliT�eerir� sc�azr rsain Ct�arge $ Agre�ent NeoessaYY I J ��'Y [ l �� o►r� $ ,.� � . sue�etr City of Fridley AT TME TOP OF THE TWINS g U I L D I N�� E R M I T r � � � � � ; y _��_ COMMUMITY OEVEIOPM�NT DIV. r � � PROTECTIVE INSPECTION SEC. 1 . � � � �"'1 � CITY MALL FRIOLE� SSIJ2 NuuBEb �E� �""�" �'' 612-571-3450 910-F15 JOB ADORESS 1056 Hackmann Circle NE 1 IEGAL LOT NO. 9LOCK TNACT Op AOOITION DESCR. 1(� 2 Parkview Heights 2 PROPERTY OWNER MAIL AOORES$ David/Martha Toews 1056 Hackmann Circle NE J CONTfiACTOR MAIL ADORESS Affordable Custom Homes 680 63 Ave NE, Fridley, d ARCNITECT Op �ESIGNER MAIL AODRESS 5 ENGINEER 6 USE OF BUILDiNG Residential 7 CLASS Of WOFlK ❑ NEW e DESCRIBE WORK Reroof House & Ga 9 CHANGE Of USE FROM MAIL ADORESS DAT6 4/12/99 MN 55432 ZIP ��GE O: / / PE . - 9179 RECEIPT NO. � /�/ •VaROVEO Sr SEE ATTACHED SHEET PMONE 574-0455 PMONE LICENSE NO 574-0729 20055319 PHONE LICENSE NO. PMONE LICENSE NO ❑ ADDITION O ALTERATIpN � REPAIR O MOVE O REMOVE 20 Sq) Tear-off TO STIPULATIONS Underlayment must comply with the State Building Code. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. SEPARATE PERMITS ARE flEOUIRED FOR ELECTi±ICAL, PLUMBING. MEATING. �'�� v w..� VENTILATING OR AIR CONOITIONtNG TMIS PERMIT BECOMES NUIL AND VOIO IF WORK Ofl CONSTRUCTION 20NING AUTHORiIEO IS NOT COMMENCEO V�IITHIN 60 OAYS. OR IF CONSTRUCTION ON WORK IS SUSPENOED OR ABANOONE� FOFi A PERIOD OF 120 OAYS AT ANV TIME AFTER WORK IS COMMENCEO. NO DWLG. UNITS I MEREBY CERTIfV TMAT 1 MAYE READ AND EXAMINEO THIS APPlICA710N 1 ANO KNOW 7ME SAME TO BE TRUE ANO COppECT. ALl PROVISIONS Of LAWS VA�UATION ANO OROINANCES GOVERNING THIS TVPE OF WORK WI�� E COMP�IEO WITH WHE7HER SPECIFIEO HEREIN OA NOT. TME GRANTING Of A PERMIT � 1� 714 DOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CANCEL THE pEqM11 FEE PROVISIONS Of ANY OTHER STATE OR LOCA� �AW FEGULATING CON• STqUCT10N OF TME PERfOHMANCE OF CONSTFUC710N $SG.]5 Li S�GN�TUpE O� CON"aACTOp ON �U�wOp�LEO �GENT IDATE� i�GN�TUpE O� OWNEA��F OWNEpBU�IOENi �DA/f� ' ' SO.FT STA��S $5.00 ROUP OCCUPANCYIOAD CU FT OFfSTREET PARKING IGAfiAGES SURTAX $.86 SAC CHARGE Fire � $1.71 TOTA� E 64.32 !S i5 rQU �Ep►�ii /` �/ 7 r NEW ADDN ALTER [l �J ConstructionAddress: Legal Description: CTI'Y OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION s Effective 1 / 1 /99 Owner Name & Address: V a.,,�o ��i(�,r� � r Tel. #� S7y- d��S' Contractor: 1��/ �i f�.�.� � s MN LICENSE #�� Address: Q�° � r �� ,�n/ �5�1;,� Tel. #�7�.- O� �_ Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: Sq. Ft. Sq. Ft. Sq. Ft. Construction T �� .� Estimated Cost: $_� �`% � yPe� � (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DAT'E: � �� APPLICANT: Tel. # � -D CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $-�� $ � $ � �� $ $ �� $ $ $ $ $ �y 32 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 R�view Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] .�. .. - : SuB�EGt . City of Fridley 33968 AT THE TOP OF THE TWINS g� I L D I N G P E R M i T r � ` NO. � • COMMUNITV OEVELOPMENT DIV. �� j V � '�� r � � PROTECTIVE INSPECTION SEC. i . � � � �"'1 � CITY MALL FRIOLE� SSIJ2 NUMBfp nEV O�TE P�GE O� �vvqOVEO Br �""� � �� 763-571-3450 910-F15 10/14/03 � � �oe �ooRess 1056 HACKMANN CIRCLE I3E 1 IEGA� �01 NO. BLOCK TRACT OR ADOITION SEE ATTACMEO DESCR. 19 2 Parkview Hei hts SHEET 2 Pi;OPERTV OWNER MAIL ADORESS ZIP PMONE Susan Johnson & Martha Toews 1056 Iiackmann Circle NE 763-574-0455 3 CONTqACTOii MAIL ApDRESS ZIP PHONE LICENSE NO Standard Water Control 5337 Lakeland Ave N Cr stal MN 55429 763-537-4849 � ARCMITECT OR OESIGNEii MAIL AODFESS 21P PHONE IICENSE NO. 1522 5 ENGINEER MAIL AOORESS ZIP PMONE IICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WOpK p NEW ❑ AODITION Q ALTERATION ❑ REPAIR O MOVE O REMOVE X 8 DESCRIBE WORK Install drain tile 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Cauik and flash all exterior openings. ��it lnspeci��n �ards �lill Be Niai�ed �o Homeowner To Post TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV �pAD SEPARA7E PERMITS ARE REOUIqEO FOR ELECTRICAL, PLUMBING, MEATING. VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL ANO VOIO If WORK Op CONSTRUCTION ZpNING SO. fT CU iT AUTMOR12ED IS NOT COMMENCED WITHIN 60 OAYS. OR IP CONSTRUCTION O:l WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAVS AT ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I MEREBY CEFTIFV ?HAT I HAVE READ ANO EXAMINED TMIS APPLICATION 1 STA��S GARAGES ANO KNOW TME SAME TO BE TRUE AND CORRECT A�L PROVISIONS Of LAWS ypLUA710N SURTAX AND ORDINANCES GOVERNING TFIIS TYPE OF WORK WI�� BE COMP�IEd WITH WHETHER SPECIFIED MEREIN Ofi NOT. 7ME GRANTING OF A PERMIT �3,460 �I .%O OOES NOT PAESUME TO GIVE AUTHO:i17Y TO VIOLATE OR CANCEL THE pEpMIT PEE SAC CMARGE PROVISIONS Of ANY OTMER STATE Op LOCAL LAW REGUTATING CON- STRUC110N OR TME PERfOFMANCE Of CONSTRUCTION �97 .25 Fire SC �3 .�F� PLAN CMECK FEE TO�AI FEE 'cen e SC $5.00 $107.35 S�GNITUAE OF CON'AA(;TQAQp �UTwOQ�2ED �GENT iO�rE, MEN PROPERLY VALIOATED TM�S IS �O PER iT U S�GNa�uAEO� OwtiEa�a OwtiEpBU��DEp� �D�iE� �Ng qct . � FROM NEW ADON ALTER FAX N0. : 7635371882 Oct. 14 2003 95:58AM P2 � � �CITY OF FRIDLEY Effedive 1/1/2003 t� 6431 U�iversity Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg (�sp ( j SlNGLE FAMILYAND OUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: . Owner Name & A dress� i'! �- Tei. # 7�3 ��5�-�iS�s� Contractor. MN UCENsE # ��oZ... Address: ' Tei. #�� ' r2�% y� 9 LNING AREA: Attach to this application, a Certificate of Survey of the lot, with the propased construdion dravm on it to scale. � n�s�tiPno� a� iM�ov�n+�ntr� Length Width Height Sq. Ft. GARAGE ARFA: Length wdtb Height Sq. Ft. OECK AREA: orHER: Length Wdth � HgVGround Sq. Ft. Construction Type: . � V�a i �'1. �i � Estimated Cost $_�7[��/i �� Driveway Curb� Cut Width Needed: Ft. + 6 Ft = Ft x S = 3 DATE: ��/� `� APPLICANT: Tel. # 7� �� y�y9 . � �� Call (763) 5T2-3604 for Permit Fees if mailing in application. Fax to 763�371-128T if using credit card and we will call you for card number. � CITY USE ONLY - Permit Fee Fi�e �urct��r�� . State Surcharge � SAC Charge License Surcharge Curb Cut Escrow Erosion Control Pa�{c Fee Sewer Main Charge TOTAL . � $ S Fee Schedute on Reverse Side ��% $. - �. ..001: of P�rnit V2luation (1/10th°k) . $ %. �%D $.50/$1,000 Vatuation . $ $1275 per SAC Unit � $ . �� $5.00 (State Licensed Residential Contractors) $ Att "A" or Alt. "B" Above $ $450.00 Conservation Plan Review' $ Fee Determined by Engineering $ Agreement Necessary [] Not Necessary j.] $ I � ( r �S✓ STIPLIL ATI�NS- FROM � FAX N0. : 7635371882 Oct. 14 2003 05�57AM P1 ... �. . .. '�'� 9!'...,,.. ...�.' . . .... . ' r . ��': _ . � . . •. .: i.: �. . . . �.:. „ . ,, . . .. . �:::, , �' . ::i. '9uqy::�: . .."•!:��,. . .. ... .. . , . .... �.. �... � .. . . :..._ ...... ��:-�;a ��-ar��r�� /�#��° �o�-�-r��l �},,, :�=: �, S�si�er��, ��. •� �� t� � ^E �i.� y' � yl��. � " � • _ ��° 1' '�. ��i:� . �e`� �i K . ... w. � Date Send fo: �� From: Compony: Phone #: 763 53T-4849 Phon� #: � Fax #: 763-537-1882 Fcx #: t1R6ENT 1 1 REPLY A5,4P 1 1 PLEaSE CoMMENT i 1 PLEASF QEVrEw � FYr OJ 1�! L� TOTAL PA6E5, INCLUDIN6 COVER: CommeMs: � I �C �� b� � � � � i �a.S�` Ccx.r �� .Y � C.� �� r 0�� ^ D� �� x Dqa`,� �. 1 S �•� � ,;;�� :r�� a .� ' >�� "� �, _. ; �3�a :�tpa- 4� � ifi� Phone:763-537-4849 ��+� 5337 I.akeland Ave N , - ;n.� ��"'`� Fax: 763-537-1882 Crystal, MN 55429 ' ::.". .�'� wYWM�iw:M.'-♦ Emnil tnike@standardwater com � �tar�de�rd Website: Stnndardwnter com = . a�� a.:;�isd 'q ;��i..— ::n"s.:«�Y.]a'�r_t='x:.:a;�.:3�?.*�;riif'; ��<nwi�tt�\iat'.'...h� �. z..�..��.'.. ....� ' �..... ' l:: _ �Ji.:. '�:..�:fYt::n ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 s�z-36u4 r�ax: : 1056 HACKMANN CIR NE : 243024240050 : PARKVIEW HGHTS ADD : LOT 19 BLOCK 2 : BUILDING : RESIDENTIAL : WINDOW/DOOR REPL s�i-li� � PERMI O.: 2004-016�. DATE ISSUE�3s` 09f:E9iitltf4 VALUATION : $ 4,885.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. REPLACE SIX WINDOWS WITHIN EXISTING OPEI�IINGS. STATE LICENSED CONTRACTOR 1 APPLICANT RENEWAL BY ANDERSEN (20130983) 1920 W CO RD C ROSEVILLE, MN 55113- (763)502-4777 � .�� : TOEWS DAVID P & MARTHA 1056 HACKMANN CIR NE FRIDLEY, MN 55432 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 goveming this type of worh will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to 'olate or cancel the provisions of any other state or local law regu cons ction or the performance of constructioj� . Apulicant � Date I I Bldg Insp BUII,DING PERNIIT FEE FIRE SURCHARGE STATE SURCHARGE, VALUE LICENSE SURCHARGE TOTAL PAID WITH CHECK # 37327 Permit inspection Cards Will Be Mailed To Homeowner To Post SEPARATE PERMITS REQUIItED FOR WORK OTHER THAN DESCRIBED ABOVE. 111.25 4.89 2.44 5.00 123.58 04/02/2004 FRI 13:21 FA% -�� ELDER JONES NEW ADDN ALTER [ ] CITY OF FRIDLEI' [] 6d31 University Ave NE, Fridley, MN 55432 ( a SINGL.E FAMILY AND DUPLQCES R-'[ AND R-2 �BUILDING PERMIT APPLICATION ��C ll �% )�t=' �,' Construction Address: Legal Description_ Owner Name 8� Add Contractor. [� ooiiooi . . . ,. , : . .. .. �� - �- ..� Effective 4i1/2004 (763) 572-3504 Bldg insp (763) 571-7287 Fax � G�� `� - �/l�,''' �- . �S Address: REIVEWAL BY ANDERSEN Tel. #�S I' ��'t "' � T� T 1920 COLTNTY ROAD "C" WEST RO5EVII.LE, MN 55ll3 icate of Survey of the � drawn on it to scale: DESCRIPTION OF IMPROV�NIENr LMNG AREA: GARAGE AREA: DECK AREA: on�ER: Length wdth Height S�,q'. F� �� LengEfi 11Vidth Height Sq. Ft `' Length Width Hgt/Ground Sq. Ft. . . , . � .. , �� _.. � _ Construction Type: Estimated Cost $`� �� "rJ •� Driveway Curb Cut Width Needed; Ft + 6 Ft = Ft x$ _$ DATE: �;o APpLICANT Tel. Z � O�-f � Call (763) 572-3604 for Permit Fees if maiiing in application. Fau to 763-577-1287 i# using credit csrd and we witl call you fo� card number. � : � Permit Fee Plan Review Fire Surcharge � State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Controi Park Fee Sewer �Main Charge T07AL CITY USE ONLY - $ o� Fee Schedute on Reverse Side � 65°/a of Permit Fee $ y . �'s`� .001 of Permit Valuation (1/10th%) $ � ��1 $.50/$1,000 Valuation � $ $1350 per SAC Unit $ �� C�Z� $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Cvnservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ � � � STIPU1ATIpNS: .. � �� : � Building �q1� MECHANICAL Permitivo.: �gLe( Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY �-'��T - � -?-AA� DATE O 2 a YOUR EMAIL ADDRESS SrrE AnDxESS __[ v� � �+ k. m Qn �. � i r-e t� THIS APPLICANT IS: ❑ OWNER �lCONTRAC'fOR PROPERTY Nn1�: S a. 3� a E�� nnnxFSS: 1 oS'te ��.e.kr�ar.n � cmr �'r � STATE '*.�ZIP SSU3 PHONE: , b3 - S-1 U• �4 S S CONTRACTOR COMPANY NAME: C�TE�OINT ENERGY SUBMIT A COPY OF CONTACT PERSON: JOANN 7 INK$N YOUR STATE STATE LICENSE # E3� DATE LICENSE WITfi �D�S: 9320 EVERGRSSN sLVn s� Hrnr ��COVN �'x�rins srArEl�IId z�55433 APPLICATION PxoxE 763 — 757 -- 6202 F,� 763--757--6701 PERMTT TYPE �► �GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK• � NEW i�'REPLACEMENT � ALTERATION/REMODEL �DE ILED DE$CRIPTION OF WORK C �.r� � ��(" �,.,�c1; �- � ��n�r PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) Labor cost under 5300 = S 15.00. Labor cost between 5300 to $500 = cost of labor x.OS = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON 510.00 PER FIX'TURE, EXCEPT WHERE NOTED. FIXIURES: (INDICATE TOTAL NUMBER OF EACH BELOVI� Equipment Installed MFG: � MODEI.: �Cop 1 SIZFJBTU �� 0 MFG: V►a�.d MODII,: - SIZFBTU �C1 � � MFG: MODII.: SIZFIBN �/A/C $25.00 _FIREPLACE (GAS) 515.00 _GAS RANGF�OVEN 510.00 _AIIt TO AIR EXCHANGEER St5 FIREPLACE (WOOD) 535.00 NEW GAS GRILL 510.00 BOIT.ER 535.00 �CIRNACE 535.00 GAS UNIT H7'R S 10.00 CHIMNEY LINER S 10.00 GAS DRYER $10.00 POOL IiEATER S35.00 DUCT WORK S10.00 GAS PIPING S 10.00 VENT'II.ATOR 515.00 Permit Fee $ Number of fixtures @ S 10.00 x a 10.00 = S Surcharge S .50 Number of fixtores Q S 15.00 x S 15.00 = S TQTAL DUE � Number of fi�ctures (a3 $25.00 1 x 525.00 =$ �,S � Number of fixtures @ 535.00 \ x 535.00 =$ 3S,� State Surcharge = $ .50 Tota1= S („o�S� THIS IS AN APPLICATION FOR A PIItM1T-NOT VALID tJNTII, PROCESSED I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that �►e 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 at� 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 which requires review and approvai of plans. SIGNATURE OF APPLICANT ¢� �' � xnt� ROGER HOFFHEIN DATE O iZ Q City of Fridley Building Inspections� Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 J `� ;* CenterPoint� Energy December 12, 2007 City of Fridley 6431 University Ave NE Fridley, MN 55432 93Z0 Evergreen Blvd NW, Suite B Coon Rapids, MN 55433 Please cancel the permit(s) and send a refund, if applicable, for the following: Susan Johnson 1056 Hackmann Circle NE Fridley, MN 55432 Permit amount: 60.50 Permit number: 2007-01861 The job has been cancelled. If you have any questions, you may contact me 763-757-6202. Thank you, JoAnn Zinken PURCHASE ORDER ( PURCHASED BY 4 T1itS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY - SUPPLIER ��%Ji' � �L_L ADDRESS � l�+Cd1 CI"I'YOF FRiDLEY 431 UNIV. AVE. N.E. PHONE N0. RIOLEY, MN 55432-4384 � CONTACT 63-571-3450 'RINTED ON RECYCLED PAPER. ACCOUNT �TY. UNIT _ c.�.�c.�- � PLEASE ENTER OUR ORDER FOR THE FOLLOWING m� r —�-� iS vfi.c�G�� --- ;� � PAYMENT VOUCHER SY SIGN{NG THIS DOCUMENT BELOW i HfREDO AUTHORIZE PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEN RECEIVED OR RENDERED AND ALL CIN GUIDELINES HAVE BEEN FOLLOWED IN THE PROCUREMEM Of THE BELOW STATED ITEMS. l �- /� 6 DAT EI PAYMENTAUTHORIZ BY UNIT PRICE AMOUNT n TOTAL d� L� �. �.�.��..,�rvm�r+i � irv rnnmu rnrlt, i i�,tJ vrv � I-1t t3AS15 Uh HAGE, SEX, COLOR, CREED, MARITAL STATUS, RELIGION, R NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE A�TION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGES RMS AND OTHER AGENC4ES WITH WHOM 1T PURCHASES PRODUCTS OR SERVICES TO DO LIKEWISE. WHITE, VENDOR - YEILOW, PURCHASING - PINK, ACCOUNTING - GOIDEN ROD, DEPT. HD. 0