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AF - 45441.� . COUNTY OF ANOKA �o��.�& ENVIRONMENTAL SERVICES DEPARTMENT Anoka. County Government Center (763) 422-7063 2100 3� Ave. Room 360 Fax (763) 323-6150 Anoka, MN 55303-2264 Daniel L. Disrud Environmental Health Specialist FAX (763) 323-6150 Phone (763) 422-7062 June 25, 2002 City of Fridley. C/o Scott Hickock 6431 University Avenue NE Fridley, MN 55432 Re: Norling Residence; 975 Hathaway Lane NE, Fridley Dear Mr. Hickock: On May 17, 2002, at your request, Daniel Disrud of the Anoka County Community Health and Environmental Services Department visited the Norling residence located at 975 Hathaway Lane for the purpose of investigating health concerns related to indoor air quality in the residence. Observations were limited to readily accessible surfaces within the subject residence. The following was noted during the visit: 1. The building had not been occupied for a period of time. 2. Surtaces throughout had significant mold growth. 3. The basement had an accumulation of standing water. 4. Building materials were saturated with water for a long period of time. 5. A consistent source of moisture was present to provide a relative humidity above 70% within the house, which supports mold and bacteria growth. 6. There was sufficient organic fibrous material and surFace dirt to act as food for mold and bacteria. Based upon our investigation we would recommend the following: 1. The moisture source should be identified and corrected. 2. All porous materials (including drywall, plaster, wood products, carpet and carpet pad) should be removed. 3. Mold contaminated material should be bagged and discarded through an approved waste management firm. 4. Cavities within appliances, equipment, and materials should be further evaluated to identify and remove all contaminated liquids and soil. 5. Any materials intended for saving should be cleaned, disinfected, and dried. The interior of the subject residence has been exposed to a severe amount of mold spores. This indoor air condition can be expected to cause allergies, asthma, and other respiratory problems for people. Any materials intended for reuse will require significant effort to remove the mold spores and other microbial material. Demolition and disposal may be the easiest and most cost effective option in the long run. Please feel free to contact me at (763) 422-7062 if we can be of additional assistance. Respectfully, Daniel L. Disrud, REHS Environmental Health Specialist sue�ecr p City of Fridley wx�cxz�c 3 2 9 0� AT THE TOP OF TNE TWINS �� p E R M I T r ; � RECEIPT NO. � ; v�_��_ COMMUNITY DEVELOPMENT DIV ,/� S� r � � PROTECTIVE INSPECTION SEC !� � i . � L M-- L; r��';.; CITY NALL FRIDLE� SS13Z NU4BEA NEV OATE VAGE Oi AVPROVEO BY t �� 763-571-3450 s�aF�s 7/19/02 � � JOB ADDRESS 975 Hathaway Lane NE t LEGAI LOT NO. BLOCK TAACT OR AODITION SEE ATTACHED DESCR. 31 2 Parkview Heights Addition SNEET 2 PROPERTY OWNER MAIL AOORESS 21P PNONE Novak-Fleck Inc 8857 Zealand Ave N, Brooklyn Park, MN 55445 763-424-4955 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same 4 AfiCHITECT OR DESIGNER MAIL AOORESS ZIP PHONE I.ICENSE N0 5 ENGINEER MAII ADORESS ZIP PMONE LICENSE NO 8 USE Of BUILDING Residential � CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION ❑ FiEPAIR O MOVE C� REMOVE 8 DESCRIBE WOIiK Wreck House & Garage 9 CHANGE OF USE FROM TO STIPULATIONS Remove all demolition debris from property including foundation and slab. Call all utilities for disconnects before wrecking. Sewer and water lines must be disconnected and capped at the stop box and and inspection called for. SEPARATE PERMI7S ARE REOUIRED fOR ELECTfi1CAL. PLUMBING, MEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAO VENTILATING OH AIR CONOITIONING THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTtiUCTION ZONING SQ. fT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO fOR A PERIOO OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OfFSTpEET PARKING I HEREBY CERTIFV THAT I MAVE READ AND EXAMINEO TMIS APPLICA710N 1 STALLS GARAGES AND KNOW THE SAME TO BE TNUE AND CORREC7. ALl PROVISIONS OF �AWS yALUATION SURTAX AND ORDINANCES GOVERNING TMIS TVPE OF WORK WILL BE COMPLIED @ WITH WME7HEq SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT `V3fOOO —O— DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME pEqMIT FEE SAC CMARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- �36.00 STRUCTION OR 1ME PERFOFMANCE OF CONSTRUCTION PLAN CNECK FEE TOTAL FEE $3 .00 S�GNATU�7E 0� LON'AACtOp Op AUTNOpIjED OGENT iDATE� NEN P OPE IIDAT IS IS V U'R' P R ��^ S�GNnTUAE O� OWNEp ��F OWNEA BU40EA� �DATE� G�NSP q TE '7 4 / / JUL-10-2002 10�16 FROM CITY OF FRIDLEY TO crr� o� �� MOVIlVG [] WR�CI�TG j� 6431 Un��rersity Ave NE Fridley MN 55432 PERMM��TT APpLIC,A,TYpN (763)572-3604 4241030 P.02i06 Effective 1/].IO2 � �' j Job Address : . 975 Hathaway Lane N.E. Lega]. Description: A11 of Lot-31, Block-2, lyinq north of no ine o -, Owner & Address : u r s 763-424-4955 � Tel. # Contzactor: 'Novak-Fleck, Inc. " Te2. # 763-424-4955 Address : 8857 Zealand Av. N. , Brooklyn Park 55445 S�tate License ## 0001631 DESC��TION OF BIJII,DING HOUSE: Length �� Width �� Heiqht �`�� Sq. Ft. Gu. Ft. GAR�GE:Length �(� Width �� Height Sq. Ft. Cu. Ft. OTHER: Length Width Height 5q. Ft. Cu. Ft. Estimated Cost $�_ Q� ^ ,Approx. Completion Da�e C.ALL GOPHER 5TATE ONE AT C5I-454�0002 FOR UTILITY LOCp,TIdNS ��s.r. p,�,i, UTILITIES FOR DrS CTS BEFORE WRE�qNG MOVING STiuTCTCThE . � Water gill Pa�d: Yes [�r Collect [$�� ] Signature Movzz�g Route : ,, The nndersigned hereby makes application for a permit to wreck/move the building described above, agreeiu�g to do alI work in strict aeeordance with the City Ordinances and ruiingg of the Buiiding Division, and the State C'ode whic& requires any water well on the property tv i�e sealed by a State licensed water well ci�riller, and hereby declares thai all fa�ts and representations stated ii! thls annIlC2�tion are tn�e. ancl rnrr�.•t A t' Y n�►,rr�s rr��r °� iz � Date M� Prineiple building into Fridley . . . . $300.00 Accessory building innto Fridley .... $ 42.Q(l 'I'hrough or within the City . . . . . . $ 20.00 Mwe a build.ing out af Ciry ......$ ZQ.OQ PERMrr FEE: MI�V[UM $20.00 � �Q � �� For each 1,000 cubic feet or fraction.. ....$1.25 For structures wb�ich would be impractaca� to cube, the fiee shall be based on the total cost of wrecking at the rate of $6.00 for each $SOU.00 or fraction. . � STI�'U[.ATIO�IS: * � D r+ -�' � O � � � � �' � � � N. � O. N � n -� n� o � 3 � 0 fl/ '� a� `o_ �� • � oa � m a Q' o � m �' � N � Q o fD � � � Q . � � � 0 c � D � � 0 < m a W � � 0 c � S � 0 � N � � N � � � � � �, � rn z � � m C7 � � Z '�'I m rn i�i � V O 0 \ 2 � � N 2 ►-' O � � �i 1D -a O A� � \ m a C o � D =, a °= v� � A m 0 � 0 � O � N D m r � m � n m � a� �a fD � � I . � 0 � � w � ��-�� 'a �-m m m� cp�� a �o a� � r. a� y � W � � y C. � Q � = ov � � � � � a� a � �•oo� ��°_' 3 � v�' d � ?. � N � a' � n' �'a.�v v, — � � � A. �D = � � 'A'► �' � � � � C�D f1 f� "�' � A p O � c � o- c� ��°'v m � fl1 y n fD Q � � � f7 N -. .rt O � 3 -w � � O � � — �' ,-r ��D � (D Ci � �� 0 � O � �, a � nm �' m � _. � � D � Q � ? < fD � N � (�D o � D '�' a y -o Qp d' D � � m � o � �o � N �i � � O Z W D C) � � W W C � � m � v Q m z d m 2 � � N� N z 0 m' � � D � n 0 � Q O � �� Oq D � IV m N � N � 0 0 � fl1 N � m � � i--� 0 0 0 � c� n„� N fl/ y � fA � � � '� n � � -p, V? m � .. c�p p=G m C> N oi n � p- � C ry fD � � � � � n, � � o � ,� ,�- a � Q'--r7� —c m g c � � O � � � � � � �- � � W � o � � n � � -� � v � W � � � m � � O 0 0 � � � (�1 0 0 0 0 � O o � � � � � � � 0 . a • r � � Z �, o �' O cfl �, � � � � � '� O � C? r. � � A ci � o p � � � �p N .n-r ^ CD � a �� r N � Q �T1 z v � o � • _ O .�r � .+ fD 1 � � D m � � D � m � c� 0 � -� � m :i7 � z � �� -'� � � c r � z G� C � rn � � � m N . n 2 r*f v C r m O � g o Z � � � � � � ^ -r1 Ol C7 OViQw--1 v (p i"'� �-G c.1� `-� C � V � �N,,z`m � � N � � �' � m W < -< N m Z Z � m � m C� -� � z � < � y O � z � r �� O �! Z rn� �O �� o� z° � z� v� a� �Z ON oz .� v o= zD �Z �� A m 0 3r� yZ G� v< v "' �z � n� N � � Z rn � m n G fD � L � � c � � N O O N THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED •ii�i�► l ► I ► •►► •: �►� •i�: •► � : : � •► Whe11 re la _ing an Pxi�ing f��ranr_p, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No () The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No () The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. --- - e pY��ng_�emt� ��t;en air is s�zed -and"insfalled to meet the current codes and manufacturers specfications. When required to in�tau a r,pw �nme ��on air�it will be sized and installed to meet the current codes and manufacturer's specifications. Yes ( ) No ( ) Yes() No() Yes ( ) No ( ) Wh2f1 inc±allinA a new �► _ntin� �•�t m, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () No () Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes () No () �... .. - .- ... - .,,,,.. -, ... -, .,.-�. . ..,,. .. Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appkances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type � r :� �•► .- r.- HEATING CO: Signed By: Date : n � � � C � -� Z D � � _ D r r � m � � 0 v m v -D m � c � n � m n � O Z cn 0 � D D z v D W r m rn _D c� � � O z m z � z � 0 0 z � D n � � v m � n� m � � � � � D �° r � � m m � � � �, o � D � � �fD � �O � fD � m o � � "n O Z N � O � �O � � o m = -, � � a � -° tn �v a � m � O z � � � y N G< G C 0�7. N W� O(D N N N � 7 n� �' � .o � 0 � m m m -a � ? � O -n � ° rn � m m � m °« nWi � � �. �. � *, � °: .°�' � � � �' nWi > > c�u < * N f� (� �� Z m � m cfl m � N � � � � f � * � — � T � � � � c m �' m a . � � � z � � r C W z � 'n -� C � m � m � I�) I I I I I I I� o � �� cn o 0 0� o�.i ;.i � cr,� as �t m 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 � O � ` D , � r' o c � � � r y � � = v Z C 3 a � � � o W °� �o �'. o- Z a � c� � y `� n o c, � 0 � D c� � � y C 1 .� I � � 0 c m � � v � m -n �m � r � z v ° � � � � w G � � '� .� r F/ m � T � n � � � � � � 4 r � O W D v v � � V T w °' � m N � c;aZm O � N � �� ' D N C m z m � �� THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNiNG APPLIANCES OR THE APPLICATION WILL BE RETURNED GpII�ILAOf� t�N!T t�l`T (]I�I`EGT�R N!D C�MBI ISTI(�I` AIR VFRIFIGATI(�N When :_ �a _i an eYie_tin��rance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes (► No () The venting system is plastiGPVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (► No () The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does inGude AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. The pY�g -emb ��+�en air is sized and installed to meet the current codes and manufacturer's specifications. Whet1 required to jp�'all a n w_emb ��on a�r�,it will be si�ed and installed to meet the current codes and manufacturers specifications. �@n jp�jp0 a new ventinQ,iy�m, the unde�signed hereby verifies that it is a listed assembly and meets the current codes and �nanufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes() No() Yes( )No( ) _ � • . � �!' � ' . � � ' • 11 11 • � ' � . � • ' � • � � ' • 1 � ■11 . • � Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connedor Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type � r - r•► .- ..,- HE4TING CO: Signed By: Date : _ CtTYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287 November 18, 2002 Novak Fleck Inc 8857 Zealand Ave N Brooklyn Park, MN 55445 Re: Final Inspection at 975 Hathaway Lane NE, Fridley Dear Sirs: A final inspection was conducted on November 18, 2002 for the completion of the dwelling at the above address. It was noted during the inspection that the following item needs to be submitted before the construction can be finaled out: Provide the City with a copy of a verifying survey by December 1, 2002. The dwelling is approved for occupancy. If you have any questions conceming this matter, please feel free to contact me at 763-572-3603. I�11ii�i SUBJECT City of Fridley 3 3 0 2� AT THE TOP Of THE TWINS g � I L D I N G P E R M I T � ; ` RECEIPT N -. � �,y _.��_ COMMUNITY OEVELOPMENT DIV. �� A .� r � � PAOTECTIVE INSPECTION SEC. 1 ; � � � �"'1 � CITY NALI FRIDLE� SS132 Nu4BER AEV O�iE v�GE OF �vvaOVEO Br �----�: �., 763-571-3450 siaF�S 8/29/02 / / 10B ADDRESS g�5 Hathaway Lane NE 1 LEGAL LOT NO. BLOCK TiiACT Oii ADDITION SEE ATTACHED oesca. 32 2 Parkview Heights SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE J CONTRACTOH MAIL ADDRESS 21P PHONE LICENSE NO Novak-Fleck Inc 8857 Zealand Ave N, Brookl Park, MN 55445 763-424-4955 4 ARCNITECT OR OESIGNER MAIL AODRESS ZIP PMONE LICENSE NO. 1631 5 ENGINEER MAIL AODfiESS 21P pNONE LICENSE NO 8 USE OF BUI�OING Residential 7 CLASS OF WORK � NEW O ADD�TION ❑ ALTERATION ❑ REPAIR p MOVE O REMOVE 8 OESCRIBE WORK Construct a 42' x 26' Dwelling and a 29` x 22' Garage 9 CHAN(3E OF USE FROM TO STIPULATIONS See notations on plan. Provide a hard surface driveway. Provide sod in the front and side yards. Provide the City with a verifying survey before capping. See City Engineering Department for sewer and water locations. ��" �efore t�i�gin� ��II for :�EPARATE PERNifTS �� itv �o��t�ons �EQUIREQ FOR: 4�� l.UI��ING A�D�S°G�� REQUIRE� �Y LAVV SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, FIEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD VENTILA7ING OR AIF CONDITIONING TMIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTAUCTION ZONING S�. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS. OR IF CONST�iUCTION OH WORK IS SUSPENDED OR ABANDONED fOFi A PER100 OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCEO NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY 7HAT I NAVE REAO ANO EXAMINEO THIS APPlICA710N 1 STA�LS GARAGES AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UATION SURTAX Fire SC ANO OROINANCES GOVERNING TNIS TVPE OF WORK WILL 8E COMPLIED WITH WHETMER SPECIFIED HEREIN OR NOT. TNE GRANTING OF A PERMIT �10.3,371 �S],.C)8 �103.3] DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION Ofi THE PERFORMANCE Of CONSTRUCTION �Z�OI,I.7S Credit /� �% , PLAN CHECK FEE T AL FEE �/ "`� � �g Lic e C 0 $1,181.80 SiGN4TUAE OF CON�AACIOA OA AU�HOp�2ED AGEN. IDATE� EN PRO V VAUO ED TMIS IS OUR PERMIT � ^� S�GN4TUAEO�OWNEp��OWNEpBUIlOEpi �D��E� Bl �NS� r��TE ? � faUG-21-2@t�� 9 � 35 F�OM C I Tti' LiF FF� I DLEY' TO �2�1�3d P. 04i�t� .N�w ' D4 c�n og �Riol�r AppN �i�ective 1h/2002 ALT�R �� University Ave NE, �ridtey, MN 55432 (763) �72-3804 Bldg Insp I 1 SlNGLE FAMILY AND DUP'L�XES R-i AND !'� 3 BUILDING PERMITAPPLlCATtQN Consdre�ction Address: 975 Hathaway Lane NE LL'9�I D@SCRp�lpil: Lot-32, Block-2, Parkview Heights Owner Name ��ddress; Novak-Fleck, Inc. �-�t # 763-424-4955 �ntractor. Same MN LIC�IVSE # 0001631 ~ q�� 8857 Zealand Avenue North, Brooklyn Park 55445 T�,� # 763-424-4955 LlVitd�; A�tEA: �FdAGE Al�A: �ECK qREA: O�'F'f�t�: Attach to this application, a Certifcate of Survey of the lot, with tt�e proposed construction drawn on it to scale. Length R�,su, �� ' Length � bESC1iIPTIUN O� iM�RQYEM�NT Wrdth Height VYdth Z Heaght � wdm,�G ' f� HgtlGround s�. Ft �o„��.�!C /l % %i Z7/a' °� Sq. FL Sq. Ft. Ct�tlstruCtion Type; New home construction Estimated Cost: $ � �� %�, � /' I'lOY'�e r��c-� - i�'1G-Fc��u� �P_J��-� 1 Driveway Curb Cut INrdth Needed: _�F� + 6�t = Ft x$ �_ � �q7'E: 8/21/02 APPLICANT;, ' -� ' � . Tel. � CaII (i�3) 572�604 gor Permit Fees if mailing tn application o� �'ax to 763v71-12$7 if using credit caPd and we wipl c�ll you fo� card a�uat�ber. Permif Fee Fire Sc�rcharge Sta% Surcharg� �A� Gharg� License �urcharge Q�reway Escrow Erosion Cvntro! �'ark Fee �ewer Main Ch�rge i�TAL $�a�/.,�,� ��3_ _ �► $ �"` $ $ �_� � $ S � $_ $ � �% C�TY USE QNI.Y - �ee Schedule on R�verse Side .00� �f P�rmit Valuation (1/10th°!o� 5.50l� 1,Q00 Vaiva#ic�r� $ � 2Q0 per SAC Unit $5.00 {State Licensed Residenfiai �ontractors� Alt. "/a" or Ait. "8" Above � $45Q.00 Conservation Plan Review Fee Determined by Engineering Agr�emeni Necessary j J Not Ne�ss�ry { � STIPULATIONS: HY-LAND SURVEYING, 90�•44 Top of Block �D SURVEYORS �o�•� � Garage Footing Loweat Footing Type of Building — N W +�$ E S \ � 8700 Jefferson Highway Ossea, Minnesota 55369 PHONE:(763)493-5761 FAX:(763)493-5781 �iurvr��ars �rriifir�ir NOVAK—FLECK. INC. "AS—BUILT" — 210.33 " � � `�r1 P.A. � � \�Q a.G� £ INVOICE N0. 24938 F.B. N0. SCALE 1'= 30' O Denotes Iron Monument ❑ Denotes Wood Hub Set For Excavatian Oniy z000.0 Denotea Existing Elevotion Q Denotes Proposed Elevatian � Denotes Surface Drainage L.OVNE-Y '['4,114 On `-0�1CV?J�P "' i m� �� LOT 31, BLOCK 2, PARKVIEW HEIGHTS ADDI110N n�e oni .�ernent, �,.n � rr� �. m r«ord w t�rarr�attm proMaed er m�t A4 tru8�rtq dtm�slam m�d Anar dmatima muet be vaiifbd by dls�t r... I hmeby emtHy thot th� �rvey wue prapared by me ar undar my dhsct supervisfon, and thot I mn a duly Ragfsterad Land � � Surveyor und� the Imre of the Stato of Mlnneeota 5lgned Surveyed by ue thia 19T1'� day of NOVEMBER 20 02 Mtlton E. Hyland, Mlnn. . No. 20262 sue�ecr P 1T N . City of Fridley 3 3 7 5 5 AT THE TOP OF THE TWINS g U I L D i N G P E R M I T r ; � RECEIPT NO. � `L _�� COMMUNITY DEVELOPMENT DIV. �� r � � PROTECTIVE INSPECTION SEC. � . � i--_.�; �"�' �•� CITY NALL FRIDLE� SSIJ2 NUMBEN pEV O�TE v�GE O� �vvNOVED Br t 763-571-3450 s�aF�S 8/1/03 / / JOB AODRESS 975 Hathawa Lane NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACMED oescA. g2 2 Parkv3ew Heights SNEET 2 PFOPERTY OWNER MAIL AODRESS 21P PHONE Dennis Williams, 975 Hathawa Lane NE, Fridley, NtN 55432 763-571-0159 3 CONTRACTOR MAIL AODRESS ZIP PNONE UCENSE NO Same as above 4 ARCMITECT OR DESIGNER MAtL AODiiESS 21P PHONE LICENSE NO. S ENGINEER MAIL ADDRESS 21P PHONE IICENSE NO 8 USE Of BUILDING Residential 7 CLASS OF WORK C� NEW � AODITION � ALTERATION ❑ REPAIR � MOVE O REMOVE 8 DESCRIBE WORK Finish basement / exterior walls 8 CHAN(3E OF USE FiiOM TO STIPULATIONS Vapor barrier over block Treated bottom plate �EPARATE PERMIT� REQUIRED FOR: PLU�N� N�� ANDnSIG�S TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYIOAD SEPARATE PEiiMITS AqE REOUIRED FOR ELECTRICAL, PLUMBING, MEATING, VENTILA7ING OR AIR CONDITIONING TMIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING SO. FT CU fT AUTHOiiIZED IS NOT COMMENCED WITNIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOO OF 120 DAYS AT ANY TIME AF7ER WORK IS COMMENCED. NO DWIG. UNITS OffSTREET PARKING I HEREBY CERTIFV TMAT I MAVE READ AND EXAMINED TNIS APP�ICATION STA�LS GARAGES AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yq�UATION SURTAX AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED �SOO. OO �. SO WITM WME7MER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT DOES N07 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEpMIT FEE SAC CHARGE PROVISIONS O ANY OTNER STAT� OR �OCAL LAW REGUTATING CON• �23.SO �.50 Fire SC STRUCTION OR�HE PERFOFi ANCE OF CONSTWIICTION PLAN CHECK FEE TOTAL FEE —1�-�j �a .50 -- S�GN4TUAE OF CON"AACT ORAUTMOp�ZEDOGENT �D�rE� MEN OP Y ALIOATE TM S IS VB'� P�I� � f �� S�GNniUAE O� OWNfQ�� OWHEpBWIDEti� iD�TE� G�p o p�tE y NEW [ ] ADDN [ ] ALTER [ ] CITY OF FRIDLEY Effective 1/1/2003 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: `''"" � � ` �- � Legal Description: �m� � 1 ��,� a-- r Owner Name 8� Address: Tel. #��°� ��d t� � S G� Contractor. �„� vvi � iiC �5� -� �� l-S MN LICENSE # Address: � ��.�.A.. Tel. # L11/ING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Wdth Height Sq. Ft. Length Width Length Width Height HgUGround Sq. Ft. Sq. Ft. �d` �� r �� Construction Type: �:.��s-�'� Estimated Cost: $ � Driveway Curb Cut Width Needed: Ft. + s Ft = Ft x$ _$ � p J DATE;�� APPLICANT: �-�'" Tel. # ��—�— Call (763) 572-3604 for Permit Fees if mailing in application. 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 � ��• .S� $ •Sb � e �� $ $ $ $ $ $ CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation � $1275 per SAC lJnit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" �4bove $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL $ �� STIPULATI�NS� ��l . �'��ld�`i�. ___ _� - � , , . � � -- ., � �, , -_ , � � � �� , - , ; ,, , ,. . � � , , _ BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permits for the erection of any building or stntcture, 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 $1 to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,004 $100,001 to $500,400 $5�,001 to $1,000,000 $1,000,001 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,OQ0 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.?5 for the first $500,0� plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,000,000 $5,608.75 for the first $1,000,0� plus $3.15 for each additiona`i $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 Only BUl1C�.lrig; Inspections 763-572-3604 DATE � '� STfE ADDRESS �, THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS �i1�„ �� OWNER OCONTRACTOR [E: -�.�L� � � t `O�l, Y �ss: � �- v�• °7 i � '� — � '� i.� � � �!i Permit No.. � � �� Received By � �� Date Rec'd: (r A , �3� SS SUBMIT A COPY OF STATE LICENSE # EXP DATE YOUR STATE LICENSE ADDRESS: C1T'I' STATE ZIP WITH APPLICATION pHONE FAX PROPERTY TYPE n�tGr.E F�m.,Y/1vEw CoNS�tucrI� ❑ TWO FAMILY/NEW CONSTRUCTION PERMTT TYPE rYrE oF woxx: ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE H�ECK � SIDING ❑ OTHER ❑ SWIMMING POOL ❑ MAINTENANCF./REPAIIt DESCRIBE WORK BEING — -- � � ` � � SIZE OF IMPROVEMENT NUMBER OF SQUARES GARAGES PROPOSED SIZE: PROPOSED I-IEIGHT: SIDING ❑ Vinyt ❑ Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS OYes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZ.E OF OPENING CHANGES & TYPE OF WWDOW TO BE INSTALLED 0 REMODELING � HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS NUMBER OF ALL FEES ARE BASED ON VALUATION, (USING � TOTAL JOB VALUATION $_ _ _ Permit Fee Plan Review Surchazge Fire Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due .�C HEIGHT BASENIErTT REMODELING SUBIvIIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used Ft. FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the e�tisting struc4ues and proposed project 2. Two sets of construction plans 3. Energy Calculations JG THE COST OF LABOR AND MATERIALS: F�CHEDULE) a OCCUPANCY TYPE $ �'-(�� - See Back Page for Fee Schedule $ .� 65% of Building Permit Fee $ (.0005) times the total job valuation — Minimum $.50 $ �, G�_ .001 x Permit Valuarion (1/10°/a) $ $5.00 (State Licensed Residential Contractors) $ $1450 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$20=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ �--� Agreement necessary ( ) Non Necessary ( ) $ (� . �� Make checks payable 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 applica 'on for a perm°�k and work ' not to start without a permit; that the work will be in accordance with the approved plan in the case of all wor w'ch requires r' pproval of plans. SIGNATURE OF APPLICANT PRINT NAME ��'^ � S w 1� I4��DATE �� ., e _t _�n a 1 . 9 G .il . a _ o� — - - e . �� . . . � . _ � Page 2- Building Residential Application BUILDING PERMIT FEE SCHEDULE The Chief Building O�cial 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 altera.tion or repair to any e�cisting building or structure, upon application therefore, require the payment by the applicant for sucl� 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 fracrion, 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 $10.10 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 addirional$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 Pernuts 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 conshuction site. 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