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AF - 45547City of Fridley, Minn. BUILDING PERMIT �A s o s� Date: _�� Owner: Bu91de Adaress Address No.�� F/ Street ��e�_—__._�� Lot ��,,� , � � Block ��' Corner Lot _ Inside Lot � Sewer IIevation -- Foundation IIevation � DESCRIPTION OF BUILDING T Used Front �� Depth � Height �� Sq. F'L G1. Fro �' Depth - ITeight �� S�l. F� G�t. Type of c�on r� Es� C ��"�To be Completed I � a� C '� , �i � � % Ea consideration of the issuance to me of a permft to construct the building described above, I agree to do the proposed work 9n accordance with the description above set Porth and ia compliance with all provisions oP or8inanc�ss oP the dty oP Fridley. � In consfderation of the payment oP a fee oP $.�,�.._�- , permit is hereby granted to—. to construct the building or addition as described above. Thispe rmit is granted nPon � the expresa condition that the person to whom it is granted and his agents, employees and worl�en, in all work ,'� done in, around and upon seid building, or any part thereof, shall �nform in all respects to the ordinances of Fridley, Minnesota regardfng location, conatructiion, alteration, maintenance, repair and moving of bufldfugs within the dty lim�ite and this permit may be revoked a��Oa��on of aay of the proviaiona of said ordinaacea �� NOTICE: 71ds p�rmM doa eet emror ths coestrueftoe, te�tall�fioe ior wUisy. �tumblea �a 6..�+a a�w� e� rraNr. 8� sun to +» t6� Buildieg lesp�eto� fe� apar� p�rmNi for fh�a itfms. � � _a �� . �= -� �.-.� .,,.- : : �NDUBTRIAL SUBINEBB c��'r �ors 70F�ORAPMIC MAPPINO °_` � ; �, BLDCK Z, Rp,,R�C�lEW/ bAKS FIR"a'� ADL�S'�►dn� C. E. COULTER P�"'�'"° LAND SURVEYOR a�pM su�vers uKesNO�e REGISTERED I�NOER LAWS OF STATE OF MINNESOTA �uDiCi�� LIC[NSHO sY ORDINANCLB OF CITY OF MINNEAPOLIB 3300 LYNDALE AVE. 50. MINNEAPOLIS 6. MINN. � TAYLOR 4-0370 SURVE`�' •."ar JONt�1 4�►• PA�1�iER , lburbepot'g �ertiticate � �� HATNA�htA�( .^ 0 �� LA�1E � tiROu i 6t� � ` 'r� � . I � � aQ� � :� W a � 0� �� w � �m '�. `� � � . .� J � 1.' 7 I � � I � � 2 Q � Aa I .�_ p ` 1R4�1 � _ —�1 "� �5.o L /V Scea��. � �" = 3�' � I hereby eert2fy tYiat the above 3s a tru.e and correct plat of a surve� of t Lot 2b� ffiock 2, PARxVIEt� t1AKS FIRST ADDITION, Anoka Co�ty, .��nesata. �s s�rv�rea �y me t�t8 zbth aa� of auiy i96z �.�. � �' .��.,' 4� �: ��_ � ♦ .,.. =/ f�P�r.��`'" ".� ��•"t��.'^�r.e t�3.nnesota Rsgistration No. 25�4. .: . �i_ � �� (�Ai � � � ti � � � 'd �-�i �� p : � . °x :Y . m ; M : o � a y�7 . t' : � � �» 0 N � FA "� � a � � � w �"x� � � � � � o � � � N � . o • � � : o . o . o. 00 : : � . . � �a x oa � � � °o 0 o y �*J � tn r�s H O G � I c � � � � � � � � � x e � � � � � � � � � � � �� y : a � � � ', a ro . ¢ �, � � 00 ,��. y �N: ��: � � o : � : a o . � . °� o : : : : : w : : : : : � : : : : �f � x �e x k x �a tn � w n� w r� � �- e�» °p c�i� o 0 0 ts� tfl tn tfl tts tn � /`" � y � � O � �I L c o 0 CQ x � � Y � � D � D r D � m �^ lI _ m C r m o � I � � a � � � � � N � 0 �r � 0 b � � w � � �. . �a. w p •• pi �7 �s cz �,, �' o 8 � 1 \ �m �� . 1 � p � WATER URINAIS enrti � sASi� k7 � I � SINKS �� W�, � �� DRINK. FOUNT. sHwRS. � FLOOR DRAINS �T� �i BASINS 0 Au7o �✓w�r�Eii GAS APPL GAS � RANGE GAS i OPENINGS � �a� $ M �. � �� bd � a � � a • z • � � A �� b � aa�" � � a`� °�, "�a`° � ti � � �o�� °a m a�a. oi� y � 0 � b � � � O � � �' � � '4 � �°��.� � � � �� b �� p ` � o � a o p �'�,o ��w iyo a�� ° �� w � ,� `° 4 �� 3�� C �" G x� � a. w� R� & �°n p � M � �, i+a � � W -p � Oi ', � � � � �' � '� d o. °- � '� � � � � � �. 'd � 0 � � A �i � 1 , ,� � � 0 � x � N � � � w � p A � � � �� 7+xx� o "4: (A n � 0 �y � � � ^ � ~ � �� .. 0 � � � : O y � : : � �:� a � H � � � Z Z � C tn � 3 a z m 0 D D '( Z m � �I m � Z^ YJ n ❑ x „�a„o N � C O Q � � � � � � �� a b � e O O � � e O � \ 0 r � � C � M I w� �W �� y O �� : �: �: �� W W � a O O �� 0 � � � M � O � y �� N � � � 0 0 0 0 �� A � � p R I � � � ^ � V , � �' � z � � � � ,� � d �� ; � �b � � � P � 0 � �q x ° o � �� _ o � 8,� a � � � A � I o � � � � � a � . � � �� ' �' � � R � FT �j � p" � M A � � � �° � � o p � ��°� �� ° �� ,�R� � �, ; � � �' ; �. � : � � � : : � : � � � : : �� : �;;:� �;:; �� ,� ogoS� �g��r� 0 � � � � `�. � � � � �t M ��p (� tA M p+ O A ro c� � a ��} � �• I g � N �. _ � c a a� � � �� M� � � � � "� a � � � ,� .. d��. �� o� � p�� °�� , �. � ��ro � �� o�� c � � �a�p �� '' ��. ar1 �� \ �y �M � �� o � �' � �. D � � �' €� 5' D �"' � � � n m c° � � � M � b O � � A V O � � �' 0 � �� . � � � 0 �• � � �r � �IA o.�A � W A A �. �, � � �� s � � � � d � ��`�' �' � �� . .� ., . �= ,. ,.� ° „ / / .�. $ �r �� .t'�i�c� �°h �c� �. y .,,.r �. n � e �s �� h � �� /HNAT LOSS CALCULATIONS DEPARIINENT OF BUILDINGS �'r �"'j' �;, g/ MINNEAP0I.IS. MINN• Weatherstrips A.S.H.V.E, Construction No. Insulation Guide Windows Doors Reference Out.�a�`j, Int. Wall Ceiling Roof •Floor ' d�� How Applied —No I e No 19_ � "' *�� / � . '. ` Fl.��(,, r'�.t � vt. Room � Length ,�, � Width �+�� eight ,� � �1.� ,�s-� Room Length /�f %' Width Height ; Windows and ors—Crackage and Area Windows'and Doors--Crackage and Area Nldth Hefght - No. ot Llneal f. Area WIdt6 Sefght No. ot Ltneal it. Area No. ot pane oP pane llghte of crack eq. tt. No. ot pane of pane llghte ot crack eq. ft. ,1` � t` � �% � � � v �{ ' �' � ,p c/ rf � �/ �f r �T'S` ' �' Coef. Btu Infiltration '� '� � � ;�.� l :� Glass � �� 'S`A �„ �' G s� Exp. wall g` .�'` $ ;� ��' Net exp. wall l! '� Int. wall _Ceiling �r ,�,r / `� � �� $ ,� .�1 Floar Total�Btu. !� Required sq. ft. E.D.R. or sq. ins. W.A. Leader area • Fl,�. �. Room � Length. �, -- Width �''f,� �' Height Windows and Doors—Crackage and Area Wldth Helght No. ot Llneal tt. Area No. o[ pane ot pane llBhta of crack eQ. ft. �- '�"cl ,l � � �. �= /�,"�l Coef. Btu In6ltration �- � � � Glaaa �� S G' Eap. wall � �/ ,X `e�' J '� Net exp. wall �U Int. wall Ceilin8 ��f � � �' ."� � �'' /1 I�i'� Floor Total Btu. • � Required sq. ft. E.D.R. or sq. ins. W.A. Leader area � ,f F7, ��D Room � Length Width � Height �P� Windows and Doors—Crackage and Area Wldth Hefg6t No. ot Lfneal tt. Ares No. ot Dgne ot pane Ifghte ot crack eq. ft. r[ `� � � d a� �% .�, .y L/ � � �' '�•� 9', Coef. Btu Infiltration � i f! � Glass "�'f '`!� i� � b Exp. wall � .,'�",+ . �' � � Net exp. wall '� ' Int. wall ` ` Ceiling /''�,.�' '� !d i � �loor Total Btu. ' Required sq. ft. E.D.R. or sq. ins. W.A. Leader area � � Infiltration Glass Esp. wall ,�? Net esp. wall Int. wall Ceiling �d,� Floor Total Btu. 0 � Coef. Btu � ,�� a�r �r� �v l'a� G� � i ,2,, :-� �" �o v � ��i / � ci :�� S �'f i e/`�"'� Required sq. ft. E.D.R. or sq. ins. WA. Leader area °s � Fl,� Room ( Length f�% �' Width a5' – Height Windows and Doors—Crackage aitd Area Wfdth He16ht No. ot Lfneal ft. Area No. of pane of Dane llBbte ot crack eq. ft. t � t-# S"c' ! � � �' g�4 Infiltratioa Glasa Exp. wall .�� y; y� Net eap. wall Int. wall Ceiling ,� �' Floor Z'otal Btu. � ,� �� -� �� m� � nired sq. ft. E.D.R. or sq. ins. W.A. Leader area f'' s��,y� Room I Length ��' ° Width �' °� Height �"` , I Wiadows and Door Wtdth HetBht NO. ol pane o[�pane IIn6ltration Glass Eap. wall Net exp. � Int. wall and Area neal ft. Area crack aQ. it. �'_. � � f� Coef. Btu i;J � .� �G ,�� r c� �'� 1'�. fL a� � f� Floor j L� `� Total Btu. Required�'aq. k. E.D.R. or sq: ins. WA. Leader area . F7.� � � Room ( Length �. V�lid�;, / Height � ' Windows and Doors—Crackage and Area Wtdth Helght No. ot Ltneal ft. Aree No. ot pane of pane llghta of crack eq. tt. • � � :i V � 7 '� ✓ e� _ Coef. Btu In6ltration � '` 3 �ta� c/3 �Q � f �� Eap. wall / ,�{� � �'$ Net exp. wall Int. wall Ceiling „� �, '7 Floor � � ;. ToEal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. �� oom � Length /,�,p � Width Windows and Doors—Crackage and Area Wfdth Hetght No. oL Llneal tt. Area No. of pane of pane Ilghte ot crack eq. ft. ! �• � � ? , �a s s� / �g.a ��.� Infiltration � � '� ��1' Glaas '� -� �P. W8u ,� �,� � o� Net exp. wall � r/'` Int. wall Ceiling �/ � / � '� 1=1oor p �J � Total Btu. Required aq. ft. E.D.R. or aq. ins. W.A. Leader area -Ieight :� B� �/�� /G r �s �� Fl.l Roam �L�e�th �/' j - Width ;l Windows and Doors—Crackage and Area Wldth HelSbt No. of L1nea1 [t. Aree No. 01 pane of pane llghte of crack eq. Yt. 1f 3`° �� v. /�!`f Z4 '� ��' � � / 2..0 ,f� � .��5 �� .�,L Coe � ■ Infiltration �'J ` ? ,;� ,3 O � Glass Eap. wall ,;� � X .� !�I �' �" Net exp. wall �t. wall t�•�� r ��/ fs E�,v r.� -6oi� +� �z `� �i-�f Floor 'S/ G e� t *t Total Btu. " , �� 3 0 �a � �� "�C,� .�2 +� U � �� g�� - s`� ! � �'�� '�% �` Z � � Kequued sq. t� r:.U.K. or sq. ins. W.A. Leader area �°} 9, AR/ °�. F7•� Room I Length �° Width �" Height �'' Wiadows and Doora—Crackage and Area Wldth Helght No. of Lineal f4 Area No. ot pane ot pane Itghte o[ crack ep. !t. . J' .�' d" � e.f �' � 5 �r� Infiltr Glass Eap. wall �'►' Y � Net exp. wall �Pt: wall � �vsrre., Ceiling = Floor � JC `� Z'otal Btu. � m � � - � � ft. E.D.R. or sq. ias. WA. 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A � Q. �, A�, � � D� O � � A 7 ' s o 0 ;� a� Q w � . � � m � � � � � -�.�'o rt � �' � A � � � p � �' Q. 7' � N � � � r C � W Z � � C � m � � rn C/) z 0 � � m 0 D r L O w v v � m � � N a � � j "� ��o o � � Z � � cn v� — � � I�fl N C -C tD z m� m n � O Z < m m � �' � O � L 7 C 9D Z (O � N � D m 1 � = O V m � � � � .o � �� z � � m o � m � � a � iv o m g 7 '� � (� A � �Q Q. o � � � m � N o m � � (� Q. � O � � T � � rn o � �n ` a �� W �� v m -n n � m � � � !T1 � � I � � v � � � O Z 0 Z � � v � m � � � D � D � Z Z � v � � VI v_� co � Q. � C m m � � 2 � Z Z 0 � 1 c� � � _ � Z � 8 Az � O D r m m � � m � C A � cfl � �� N � � � o � a��i � � `D a o � � 1 � �. � � � m 0 O � � � e � � � � � 1 � � a � z _� \ _ � � � N m � Z O � v � � � -� �� I� � D o Q o � < � � o �, v f� � � o � � o ~ -+ O � N 7�" r � O Z n n � D 0 � a 0 � � c� 1 D � � � g � � � � � o _ a �o z 3 � �� c �� .. o ��n A� n m o � � � � ^ m � � � � � � �i a � o = 0 �� L° -- �'e� OD vi n�i � v m � m � � � _ m � n�� c� � �'�� m �� Q �?!� v � � � � � � � o � A � C � � C 1 � � �"� I � t� � t� �� J � (� g g g g � � � � � 0 � m � � 0 0 � N c C m � � � z 0 � � �� c 6 � � rn v D � 0, � 9 - : .. � m 2 � � � � � � N � 7 = O, a � � � m � ��.� �, s. 5 a. �, s:� � Q� o � � v o � ��'°_' 3 v,o'��' A> > O cD � j �, A�i �� °'' -"�a_ o � � � � m � v � `� c�'�i � ^► Q' O O � � � � � � j �j A N � �Q. .. �D � � � 1 0 �'. .: �; < ��=-m � � n� � ��o N �� a. �i m � > > � Q r�i � n _ m v C � O � v m � � � ❑� N a; � � i � -• � O � � O �z� � � v �� N � Z Z rn� rn n � O Z � O � � Z ma � O Z Z � Z � v� n �� o� z -D v� � o� zN Z � fi) �n v �� z �� v� � O n C Z �� D O Z � �M \ � � m 0 � � w a � � t I CHIlVINEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully exaznined Yes () No () 2. 3. 4. 5. 6 Is free from nist or deterioration Has no foreign objects lodged within Is securely supported . Meets all current Code requirements for size and total BTU's connected Has total heating BTiJ's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: . List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes()No() a sue�eeT PE MIT NO. City of Fridley 321 � 0 AT THE TOP OF TME TININS g�J � L D I N G P E R M I T � ` � RECEIPT NO. � • COMMUNITY OEVELOP��NT OIV. ��_��o� � q �� j V �"�� , r � � PROTECTIVE INSPECTION SEC. x � . � � � /"'1 � CITY HALL FRIOLE� SSI$P NUMBER pEV DATfi VAGE OF AVVqOVEO 8� �""� � �'' 612-571-3450 et0-F15 9/10/O1 � � J08 ADDRESS 1280 Hathaway Lane N�, � t LEGAL �OT NO. BLOCK TRACT OR ADDItiON SEE ATTACMED oescR. 26 2 Parkview Oaks First Addition s►+eer 2 PROPERTY OWNER MAIL ADpR�S$ 21P PMONE Bill Driggans 1280 Hathaway Lane NE 3 CONTiiACTOR MAIL ADORESS 21P PMONE LICENSE NO Trendy Construction 210 Zachery Lane, Plymouth, MN 55441 763-591-9433 d AHCHITECT OR DESIGNER MAIL ADDRESS ' ZIP PMONE UCENSE NO. 20027543 5 ENGINEER MAIL ADDRESS Z�P PMONE LICENSE NO 8 USE OF BUILDING Residemtial 7 CLASS OF WORK p NEW O ADDITION O ALTERATION �7 REPAIR O MOVE 0 REMOVE B DESCRIBE WORK Reroof House & Garage (30 Sq) Tear-off 9 CHANOE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCV GROUP OCCUPANCY �OAD SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING. VENTIIATING OR AIR CONOITIONING. THIS PERMIT BECOMES NULL ANO VOIO If WORK OR CONSTRUC�TION ZONING SO. PT CU FT. AUTMORIZED IS NOT COMMENCED WITNIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANQONED FOR A PERIQD OF 12Q OAVS A7 ` ANV TIME AF7EH WOfiK IS COMMENCED. ' NO DWLG. UNITS OFFSTREET PARKING 1 MEREBY CERTIFV TNAT I MAYE READ ANO EXAMINEO TMIS APPLICA710N 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TVPE OF WORK WILI flE COMPUED @1.( 1 WITH WMETMER SPECIFIED HEREIN Oii NOT. TME GRANTING OF A PERMIT $3 � 216 W DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TME pEqM17 FEE SAC CNARGE PiiOVISIONS OF ANY OTMER STATE OR LOCAI LAW REGUTATING CON• $97 � 25 Fire SC �3 . 22 STqUCTION OF T E PERFORMANCE OF CONSTRUCTION PLAN CMECK F TOTAL FEE � �� Lice e $5.0 107.08 S�GN4TUpEO�C CTOpOp4UTMOA�ZE ENT IOATE� HE PROP � VALIDA THIS i UR_PERM� y �i� � f S�GNniUAEO%OWNEAi��OWNEABULLO.ER� �OAiE� � OG��NS� � �i°TE N� � � Effective 1/1/2001 ADDN [] ', CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: � Legal Description: � Owner Name 8� Address:�;�� : a�c,.c�.-1�,5 Tel. # Contractor. � v � c� ^ ,n MN LICENSE # oZOO `�� j�( � Address: ( O`Za� � Te�. � C�3 .��II -- `l�l 3 3 LIVING AREA: GARAGE A�REA: DECK AREA: OTHER: 1 ` SSLI'-� f Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft Length Length Width Height Sq. Ft. Hgt/Ground Sq. Ft Construction Type��e�. �� e� 0�� Est mated Cost: $��"�°� ��1� Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ DATE: l`� � 0 1 APPLICANT: TeL �F t�3 S��"��`� � �o�� 5'�� CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ Sv Fee Schedule on Reverse Side $ > ` � .001 of Permit Valuation (1/10th%) $ /, („/ $.50/$1,000 Valuation $ $1150 per SAC Unit $ ,� - C) O$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 [ ] $ �� - �� BUILDING PERMIT FEE SCHFDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided tawit: TOTAL VALUE $1 to $500 $501 to $2,OOfl $2,001 to $25,000 $25,001 to $50,000 $50,001 to $1�,000 $100,001 to $500,�0 $500,001 to $1,000,000 $1,000,0p1 and up FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fra�tion thereof, to and including $50,000 $643.75 for first $50,�0 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1, 000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Ct�rb Streets Only) Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach witli � inch depth - Driveway width plus 6 feet times $23.25. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. New Houses Onlv . � ADDRE5S PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 iTNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 FAX: : 1280 HATHAWAY LN NE : 243024310079 : PARKVIEW OAKS 1 ST ADD : LOT 26 BLOCK 2 : BUII.,DING : RESIDENTIAL : ADDITION/ALTERATION 571-1287 � � - -� C,� 4' PERMIT�TQ.:.200400214 � DATE IS5UED: 02/17/2004 VALUATION : $ 3,000.00 NOTE: SEE NOTATIONS ON PLAN. CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER SECTION 310.9.1.2 OF TI� 1997 UNIFORM BUII,DING CODE WHEN ADDITIONS, ALTERATIONS OR REPAIItS IN EXCESS OF $1,000 ARE MADE TO RESIDENTIAL DWELLINGS. REPLACE THREE WINDOWS WITHIN EXISTING OPENII�TGS. APPLICANT WELLINGTON WINDOW & DOOR CO 3938 MEADOWBROOK RD ST LOUIS PARK, MN 55426 (952)933-6300 OWNER DRIGANS WII,LIAM A & JA1�IICE 1280 HATHAWAY LN 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 l�ow the same to be true and correct. AIl provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a pernut does not presume to give authority to violate or cancel the provisions of any other state or local law regul construction or the performance of construction. Applicant Date Bldg Ins � � �� BUII.,DING PERNIIT FEE FIltE SURCHARGE STATE SURCHARGE, VALUE TOTAL PAID WITH CHECK # 72487 SEPARATE PERMITS REQUIItED FOR WO�tK OTI�R THAN DESCRIBED ABOVE. 83.25 3.00 1.50 87.75 NEVV [ j ADDN [ ] ALTER [ ] �7ov� a Construction Address: Legal Description: Owner Name 8 Address: Contractor: �e ��i� �� CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-9 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/2004 (763) 572-3604 Bldg Insp / (763) 571-1287 Fax � ✓ MN LICENSE # � � 51� `�� Attach to this application, a Certificate o� Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length DECK AREA: Length OTHER: Width Width Height Hgt/Ground Sq. Ft. Sq. Ft. �x;.. )� "� ��= ` = � � ., 3v �� . Construction Type:K G111�c� .3 �r'n�%a1,�1� Estimated Cost: $ __ ��b �. °� Driveway Curb Cut �dth Ne'eded: � Ft. + 6 Ft = Ft x� _$ DATE: �I APPUCANT: Tel. # �7r�" ��`��dp Call (763) 572-3604 for Permit Fees if maili in applicati Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge �p,� �� C�-�•°� $ $ ��°00 $ /, S � $ $ : 'Lp�� " $ $ $ $ CITY USE ONLY - ' � TOTAL $ . �� Fee Schedule on Reverse Side �� .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ . ] STIPULATIONS: � BUII.DING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such pemut of fees to the amount herein below set forth and in the manner herein provided to-wit: . TOTAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up M�I��•v $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional$1,Q00 or fraction t�ereof, to and including $25,0�0 $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.00 for each additional $1,000 or fraction thereof, to and including $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof CURB CUT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6,feet, times the annually determined rate. Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. VERIFICATION OF FOUNDATION A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onlv � �_3 « ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 1631572-3604 FAX: (763) 571-1287 : I280 HATHAWAY LN NE : 243024310079 : PARKVIEW OAKS 1ST ADD : LOT 26 BLOCK 2 : BUILDING : RESIDENTIAL : WINDOW/DOOR REPL PERMIT NO.: 200402078 DATE ISSUED: 11/29/2004 R62�,� VALUATION : $ 3,075.00 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. APPLICANT DRIGANS WILLIAM A & JANICE 1280 HATHAWAY LN NE FRIDLEY, NIN 55432 OWNER DRIGANS WILLIAM A & JANICE 1280 HATHAWAY LN NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 clays 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 conect. All provisions of laws and ordinances goveming this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regula ' truction or the performance of construction. Applican�� Date�� Bldg Insp. BUILDING PERMIT FEE FIRE SURCHARGE STATE SURCHARGE, VALUE TOTAL PAID WITH CHECK # 75543 l- � SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 97.25 3.07 1.54 101.86 NOU-16-2004 10 � ZS NtVV ! 1 ADDN (j ALTER ,� �, { j � %070Co Construction Address Legal Desc�iption: Owmer Name & Address: Contrador. � �/�/� i � 1 �[ � LMNG AREA: GARAGE ARFA: DECK AREA: OTHER: C I TY OF FR I DLEY � • ��` i_�- �.�� v� � �.��"� �....,....� .. ..--- • 6431 Univet,ity Ave NE, F�idley, MN 5543Z (?63) 57Z�604 Bldg lnsp S[NGLE FAMILY ANp DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING P�RM1T APPLICATION I 2 g a �a`�-�,a w a.W �av►.e JV � il ia� � �. I�/ � Jah;c� C�r � K/ � � a n , . . . a�S�ei.# ?��`i'-�� 3 O J LICENSE # -- r��.# �S2- 933 -6 300 Attach to this application, a Certificate of Survey of the bt, with the proposed cottstruction dravim on it to scale. pESCRIPTION OF 1MPROVEMENT Length 1Nidth Height Sq. Ft. Lengt� Width Height Sq. F� Length Wsdth Hgt/Ground Sq. Ft. �,. „ � i - - - ^ a^ • i Construction 7ype: Estimated Cost: $ 3�, d%5 • C) D Drnreway Curb Cut Wdth Needed: Ft + 6 Ft = Ft x$ _$ � DATE: �� 2 0 APPLICANT: V �i Tel. #�S �' 3 3'"�0 3 0 a Call {763) 572-3604 for Petmit Fees if mailing in appiication, F o 763-579-9287 if using credit card and we will cali you for card nurnb2r. Permit Fee Plan Review Fire Surcharge State Surcharge. SAC Charge License Surcharge Curb Cut Escrow Erosion Controi Park Fee Sewer Main Charge TOTAL CITY USE ONLY.- $ �%• 25 Fee Schedule on Reverse Side $ 65% of Permii Fee $ .001 of Permit Vaivation (1/10th%) $ � $.50/$1,000 Valuation $ $1350 per SAC Unit .� $5.00 (State Licensed Res�dential Contractors) $ Alt. "A" ot Alt. "B" /�bove . $ $450.00 Conse�ration Plan Review $ Fee Determined by Engineering $ Agreement Necessary [] Not Necessary [ J $ ' �'' $ � STIPUtATlONS: IYUV-lb-�bb4 1b�25 CITY �F FRIDLE`f BiIYLDING Y�KM�.�r r�� r��►�� F' . t?t� -�- The Chief Bui�ding Offacxal shall, before issuing permxts �for the erection of any building or structure; �r fo R�r additio� to azry existirng building o� stiucture, or for any alteratioa or z'epaiut to any existing bui�din� �. sst�eucture, upon applicati.on tberefore, xet�uire the payment by the applicant fox such permit of fees to the an�c�t:; � : herein below se� forth and in the ma.nner herein pxovid� to-wit: T�TAL VALUE $1 to $500 $501 to $2,000 $2,001 to $25,�0 $2$,001 to $50,000 $SO,IX11 to�1�.,000 e r �� .�, � � �'�T� $5�,00� to $1,000,0�00 $1,{1b0,0U1 and up �� $23.50 $23.50 for��ust�$500 p]us $3.05 for each addit�onal $100 ar . fraction ther�f, tQ and including $2,(�10 $69,25 for first $2,000 plus $14.00 �ar each additional $1,000 or fraction thereof, to and including $25,�00 $391.25 for. first $25,000 plus $10.10 for eac� addit�ona� $1,OQ0 oz fraction thereaf, to and including �50,000 $643.75 far first $50,000 �lus $7.� for eack� additional $1,040 or �'xacaon thexeof, to and including $100,000 $993.75 for first $100,QQ0 plus $5.60 for each additiona.l $1,Q00 or fractxon tl�.ereof, to and including $500,000 $3,233.75 for the first $500,0(�1 plus $4.75 for each additional $1,000 or fractian thereof, to aud iucrud'u�g $1,000,000 $5,b08.75 for the f�rst $�,000,000 plus $3.15 �or each additional $�,,000 or fraction thereof cvu cu�r Esc�ow (Cancrete Curb Streets Only) Removal and. replac�ment of curb and gut�er only � driveway width plus 6 f�t, times the almuallY decerm�;:� rate Permits for constiuction will be issued a miuixnum vf ?A� hours frozn the time of application to aliow f�r pr; �: review of the pmgfls�d sm�cture and of the constru�t�on site. � VERIFiCATION OF FOUNDA,TION A Ceztificat,e o€ Sua�vey of the �ot, showin.g t�e location of the e�sting foundation will. be xeqni�ed he:; gr�eeding with the fiaming. New Houses 4nlv TnTAL �.: Building Inspections 763-572-3604 763-502-4977 FAX DATE � �! ' �� SITE ADDRESS TB� THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING D� SIZE OF IMPROVEMENT BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-08 YOUR E-MAIL ADDRESS l'f��a �✓� y L�Av�� ❑ OWNER °�CONTRACTOR C[TY °°'�. py� 0 �- • � � � �s � ' - - - . : � I:�� , r:�.;�� ,�. � '� � STA n PHONE ��0� � 7�9 %�� FAX ��I "' /�� STATE LICENSE #�� EXP DATE �� ° 3�' Z.�� SINGLE FAMILY SIZE TWO FAMILY/NEW CONSTRUCTION STOR[ES ❑ ADDITION 0 GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH �ROOF , � DRAIN TILE ❑ DECK O SIDING ❑ OTHER ❑ SWIMMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR �REMODELING ROOFING NUMBER OF SQUARES � GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Od�er ❑ HOUSE ONLY �'HOUSE & GARAGE ❑ ATTACHED GARAGE O DETACHED GARAGE OSoffit � Trim 0 Fascia WINDOWS IN EXISTING OPENINGS ❑Yes ONo LOCA1'ION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE IlVSTALLED NUNIBER OF � HElGHT BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDTfIONS, & PORCHES SUBMIT: l. Site PIanJSurvey showing the existing structures and proposed project 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: G THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ �rS �� . OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge , Curb Cut Escrow ' Erosion Control Park Fee Sewer Main Charge Total Due $ �„� � See Back Page for Fee Schedule $ 65% of Building Permit Fee $ .001 times the total job valuation $ , .0005 x Permit Valuation Minimum $.50 $ �o (� � $5.00 (State Licensed Residential Contractors) $ � $1825 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$21=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ � � Make checks pa_yable to: City of Fridley 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 permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accord with the ap e plan in the case of all work which requires review and approval of plans. SIGNATURE OF LI NT � � PRINT NAME S�' f�Pl� �!M DATE �°�7' APPROVED BY DAT� Page 2- Building Residential Application BUILDING PERNIIT FEE SCHEDULE T'he Chief Building Official sha11, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 1�' $500 plus $3.05 for each additional $100 or fraction, to and includin $2,000 $2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and includin $$25,000 $25,001 to $50,000 $391.25 for 1�` $25,000 plus $] 0.10 for each additional $1,000 or fraction, to and includin $50,000 $50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and includin $100,000 $100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to and includin $500,000 $500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or fraction to and includin $1,000,000 $1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Pemuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 ' 763-572-3604 Faz: 763-502-4977 Building Inspections 763-572-3604 763-502-4977 FAX � SITE ADDRESS _ TH`IS APPLICANT IS: PROPERTY OWNER/ TEIVANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE BUI�DING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-OS YOUR E-MAIL ADDRESS ❑ OWNER �ONTRACTOR �DDRESS: i �S�Z' �e�L�lct�l L-r�! Y1f� CITY PHONE: �.G�� I �� allUxrss: �i ! / h — /N i ' - �t✓c— � lVL�J CITY� PHONE_ �jPJ.3'�a�a� �L��3I FAX STATE LICENSE # I�% �33�p � EXP DATE PROPERI'Y TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMTT TYPE ❑ BASEMENT FINISH ❑ DECK TYPE OF WORK: ,a❑ NEW HOME CONSTRUCTION DESCRIBE WORK BEING SIZE OF IMPROVEMENT_ ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING � Vinyl � Aluminum ❑ Other ❑ GARAGE/SHED ❑ WINDOWS ❑ ROOF � ❑ DRAIN TILE 0 SIDING � �B:OTHER � SWIMMING POOL ❑ ADDITION ❑ REMODELING ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia WINDOWS IN EXISTING OPENINGS ❑Yes �No LACATION OF WINDOWS OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF � TOTAL HEIGHT P�rnut No.: i�- - -� : �i� I� ��-�" :t .. � � � � i� STATE�ZIP�,��3� ►� STATE7�ZIP �`�.3�`7 � i �1�1 �1 e BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMTT: 1. Site Plan/Survey showing the existing strucd�res and proposed project 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) VALUATION $ �%�� = OCCUPANCY TYPE Permit Fee Plan Review Fire Surchazge Surcharge License Surcharge SAC Chazge Curb Cut Escrow Erosion Control Park Fee Sewer Main Chazge Total Due $ $ $ $ See Back Page for Fee Schedule 65% of Building Petmit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1825 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks pa_yable to: City 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 1 understand this is not a pertnit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordan approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT � �G�G PRINT NAME_ �� F�jti�r� j� DATE �� 1 Z�� APPROVED BY / � DATE Page 2- Building Residential Application BUILDING PERNIIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to a11ow for proper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 ' 763-572-3604 Faz: 763-502-4977