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AF - 47034City of Fridley AT THE TOP OF THE TWINS f 1 '� � �• COMMUNITY DEVELOPMENT DIV. r � �' � � PAOTECtIVE fNSPECTION SEC. � '. � � � �"'1 � CITY HALL FRIDLE� 55432 �"""�'� �'' 612-571-3450 SuBJECT BUILDING PERMIT NUMBER REV. DATE PAGE OF s,aF,s �/io/90 / / JOB ADDRESS 6196 Heath.er Place N. E. t LEGAL �OT N0. BLOCK TRACT OR AODITION DESCR. S 1 Aeather Hills West 2 PROPERTY OWNER MAII ADDRESS George/Ann Bateson 3 CON7RACTOR MAIL ADDRESS Brickner Builders 6240 Highway #65 N.E. #208L Fr 4 ARCHITECT OR DESIGNER MAI� AQORESS 5 ENGINEER MAII 21P ZIP ZIP 1�.•,' .-.��c� 3 � ��d APPROVED BY SEE ATTACHED SHEEi PHONE LICENSE NO. 574-9871 PHONE LICENSE NO. PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS Of WORK � NEW ❑ ADD{TION ❑ ALTERATION ❑ REPA{R ❑ MOVE O REMOVE 8 DESCRIBE WONK Construct a 54' x 30' Dwe.11ing and a 24� x 32' Garage; and approxi.mately 1052 sf of 9 CHANGE pF USE FROM TO STIPULATIONS pmyide City with copy of verifying survey before capping. Provide sod in the front and side yards, Provide a hard surface driveway. Paid $1,Q00 Park Fee. Lowest walkout elevation is 1 foot .�It�X� above top of stornn sewer outfall structure. Additional approval for deck encroachment into easement is required by City �gr. De� apply in writing. SEWER LOCATION: (Off Heather Circle) 65` S. of M.H. At Q, Heather Place & Circle INV. 899.78 WYE ELEV: 903.28 TOP OF FOOTING: 907.00 Minimum DRIVEWA�DEPRESSIQ�i COST� 4�+ 6ervi30' x 13.50 =$4Q5.00 WARNl�G Fill in Curb Cut on Heather Place: 38` x 13.50 =$513.00 Before digging call for all utility locations 454-0002 REQUIRED BY LAW, SEPARATE PERMiTS ARE REOUIRED FOR ELECTRiCAI, PLUMBING, HEATING. VENTIIATING OR Alq CONDITIONING. 7Hi5 PEHMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTiON 20NING AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED Oii ABANDONED FOR A PERIOD OF 120 DAYS AT R"�- ANY TIME AfTER WORK IS COMMENCED. NO. DWLG. UNITS I HEHEBY CERTIfY THAT t HAVE READ AND EXAMINED THIS APPLICATION 1- AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION AND ORDINANCES GOVERNING THIS TVPE OF WORK WI�� BE COMPLIEO $lc.�'� � OOO WITH WHETHEfi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE QERMtTFEE PROVISIONS F ANV OTHER S TE OR LOCAL LAW REGULATING CON- $97��00 STRUCT R THE PERFOR CE OF CONSTRUCTION. ` �PLAN CHECK FEE � �/ - 9�v SIGNATURE Of CONTFA OR AUTMORi2E0 AGENT l0ATE1 �/yHE PR� e.r.ueriiocncnwu[a��cllwNFFAl11L�ER1 IDATE� G INSP OCCUPANCYGROUP OCCUPANCYLOAD SQ. FT. CU. FT. OFFSTREET PARKING STALIS GARAGES SURTAX $98.50 $60Q.00 TAL FEE ��677,50 + PF & DW �� �E1U�d 1�T [ ] 4�'' ,.� ' { ` Effective 1/1/90 AD�N [ J R-1 AND R-2 ALTER [ ] Building P�ermit Application o�nstructio� Aadress: �/%-� ��<.�6 i%iC�C- � G� c C L�gal Description : � a � .S'� 1� G �� / y�i��i�<�- /7 %� (�- t `��/ � Si , owr�r r� & Aaare��: vC c�-iQ /"J fJ �'/,j%'c sv ,�/ �. # c�antzactor: _ d3 � � � k �✓ C r� ,r3 1 fi �-1 Tel . # J � �/ � ..� � 7� Aaare�: __� ? y a �l tv �i � J' 1�- 2� �, --T , Attach to this application, a Certificate of S�.inrey of ti�e lot, with the prvpo�ed oorLStniction drawn o�n it to scale. LIPII�IG AREA: L�e.r�gth t�R7�GE AREA; Length Dd�3CR ARF��: 7�engtiz ��r_ �• . .�- � �• •.. • r ��, Width Width Width Height Height Hgt/Grauxi Sq. Ft. Sq. Ft. Sq. Ft. OTi�R: �rner Iat Inside Int � / � [] Ft. Yd Setback � S Side Yan3 Setbacks Zj�pe of Construction: �� J► Estimated Oost: $ � Approx. Oattg.�letion Date: )) � 1- g� � c/ � G I tb� Piro�ossd Driveway Width If New Openirig I ired: � Ft. $ $ Wid� + 6' See Bacac Page �: �� �- 9 - ga ��: � ,�.�. �. # ��y - ��� i P�ermit Fee $ . State Surrharge $ SAC Chan�e S (p�j.�d Drive�aay Escrow $ �i i}� , C� �k F�e S i bE� , on Sewer Main Crian�e $ . �. srz�,TTa�s: U �.°'�+e.ss s 308'�.5� CITY DSE �Y Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A�' OL' Alt. nBn AbOVe Fee Uetermined bY IItigir�eerir�g Agreement Neoessary [ J Not Neoessaly [] �►�w4ou� ��,,�w�'f�e�.r �s � Foor A�vE 'TdP a< s�rw� SEc.�tti aura�►� S�auc.�n� � � AOA►'�101��- RPPaova�. Fbh, �iC6L �i�GttO�x�wi �'� � � ��'� �� Q�4� �a � Q �r� �N��. ��' ���`+ i.�J ��� � !3) - . �Cf;-..'�-.:; i_� .�,.^.a,.`.".. _ 1 �\. . _ ���`-�" _ _ _ � — - ` !� � � ""c . - �.. _ � _ _ _ -� _ _ � �{ �r a �o � � H _ _ _. _ _ ____ _ ___ _ ' 1-,�b'� � _1�► ��v � : 01 i �. r� ��� _ _ � � �'��..�.. . _ _ . I� �� � �'� �` 1 G i'�� ���� ` g 1, t��,� _. -_ _ � ___ _ _ -- _ __ __ :�1�t�� �� _ _ -- __ __ -�.� �� -- �i _ �30 �y � �� � �� _..,. �,1�' ��.,,�"� � _ + . _�.�� � � � _ _ � _ _ _ _ _ _ . _ _ �t� ��.� �, �,S`�- �a ra y. 3c� ���'��- ____ _ . �:'�� ��� �g� � Y. �� -��-�- � � , �- � gx _ _ t �i �, b� b, � � �..� _ _ _ _ _ _ _ _ _- — _ J �t°`�, ,�t� �� 4 C% __ _ _ _ �-� ��� .� � ���,,�� _ _ _ � ��.�� 33 s� ���,c� i - - " - L•'t�JT:ItGY C;UNSL.RVA'�IUIJ SUYT%LI;MLNT TG T�t�ILDYM� P�Rl�II'P AYPLICATION �+'"'� �� E'I,l►fIt1I�1G 11r11) INrP1,C�rzori D�PAR'PM1'stdT . C7'�'Y UI' 1'kIUJ,I:;Y, MZt�NESC)7'n This supplemc�nt is providr.d �i:o assist tlic a���pli.car�t iri compui-.iny I:XTLI2IOR ENVEL,GP� AVl;kJ1G}� "U" I'11C`l'OR It1rUR.^-11�1'IOI:I. Th�.s inf:c>�-mal:i.or, is .•:c,qiaired so the BUILDING OF'FICL'�I, can detennine Lhat submittcd �lans c�m�p]_�l with the EIZLRGY CONS:;RVATION D�SZGr CRITERIII of the STA'!'E ut).CLDIP7G C�)DF. (Sec:tion 60��) . It is the 11PPLICANT' S responsibility to ar.curat�Jy c:ompute thr data; rc�fl.ect the proper DESIGN CR7T�RIA in ti�e pl.an:.�; subrnit product ;;r,F�cificati.ons, if nQedFd to support the "R" and "U" factors us�d; and. to assix��e c<�nsL-r_uction is pz�: appr.oved plans. JOB IAC::A7.' TOri : � I -� (p -- I /�C�LI �/�t,. ..� �—��� — OTVNLF,/CON'PRACTUi:: i�� G����� I� ---- `� L.� � ��.� ADDRESS : d ��iJ �.. �i i..•�' � Z a � _ _._ YI30NE : �'S � � Q , y����----___.__..___.__._ A. Deterntine the 'rotal P�:pose:l IJall Area as fol.l.ows : �_ . �. 3. 4. 5. 6. 7. 7.bta1 wa].1 wind�w ar.ea Zbtal door area Toi-al s:Liding glass daor area Zbtal fireplace wall area Zbtal wall frami.ng area (average 10b) 7.btal nei. wall �-�rea above f?oor(a��ez�aqe 9Qo) Total rim joi.st ar.ea Subtotal: T�tal Facposed wall area ��bo��_ �l�or 3 s'3. � Ss' y� / 9�. � ti� L i16.p3 1a • 6'✓ 3 � 3 9 8. Total foundation window area 9. •Zbtal net foundation area above gr.ade ti • Subtotal: Total er.posed foundation area L_� �___ GRAND TGTAI, EXPOSED WAI�L AItF.A 3 L q B. Multiply the GRANf� TOTAL �XPOSED WALL I�1tEA X.17 = Item I. �� • q� C. Determine the Total Exposed Roof/Ceiliiig �1rec as follows: 10. Total skylight area 11. Total roof/ceiling framing area (10�) 12. Zbtal net insulated roof/ceiling area GRAND TOxAL EXPOSED ROOF/CEILII�� 11R�A � D. Multiply the GRAATD TOTAL EXPOwED ROCF/CEILttdG ARE.A X.05 -- .,,,. Item II _ � / ' v i• � i �, `..., ,. , .l(.v- 47�'�'v-" ifL � ��'�/�=� s` z '' ,��� �-� �i � z �'��.c..e� �.u.� � . v� � „ �w ,�,�„� a • 9 3 �-� �;, a��,,�, - i - ,1/,I�� ' o �9� ,, -�� . �J � � �'� �'� �; �� / ., .�.i 2 .�,�:��f�-� � •r lat��i'�""' �i�t �� n �!% �,��z; ,f �� �w��� ���,: ,t� -�, � � ; �_ �-: �.�._. ,� .6 • �.s''� / � z , v� � y3 ,, _ 2 3. �..q� = . ��'�,1 . .-1 .:� . �� �� • � � ' � �� t��uP / g / lL �� , �- i�.- % - � � . ^ Z � L f � ��-�-�/�� � . C� (� � �' �'w ,,���..z, a 9.3 ��%' t . � ��,t � � 'Z,�•; i r : ��. �� - . �,�� y �� � a� r �� lz"' l�"�i l- 2� C,� �,,. �-LP� •! Z 2./3 = �7 �,� �;, �� . � � % '',G�'�i:� - �� � rr - �'����,,�.� sv �� �,,, � .� � ��l•78 ' �0�93 _� - _ ��� �.J� FRfDLEY FR[DLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • EAX (612) 574-128? JLtly 17, 1990 Mr. Z�om Bric]m�+x BriClmer' Builder5, IriC. 6240 Hic�rdy 65, S�.iite 208 FYidley, NIl�T 55432 SUBJDCr: 6196 �ieatl�r Plaoe Dear Tom: PW9Q-201 ��J Y� letter of July 12, 1990, �n►►i �; ari will be gr�ted to oor�tnx,.�t a clec,k that enGroaches irttA th�e storm water eas�ent wxier ti�e follawing aorXlitians: 1. 2. Dec]c to be c�oa�.stru�fied as per tiie plarLS suianitted for the buildir�q pertt�it. A letter is plaoed oaz fi.le with the City frcm t2�e aar�er that holds the City of Fridley ha�mless for all damnages related to the oo�struction or use of thi.s deck within the stoYm �ter easan�zt. 3. A letter is plaoed on file with the City frc�a the aar�er stating ti�at th�e owr�er aooepts all responsibility ar�d liability for the r�oval ar�d subsequent rebuildirig of th�e dec.3t �ia�ld the City r�eed to gain aooe�s to the storm �rater oontrol stnycture a�lor stoxm sew�x linEs within tlze eas�rer►t. S' y, ��� . ����� A. Wi1�so�'i, P.E. AssistarYt Public Works Director MAW/ts Brickner Suxlders / //��,/ � I 6240 Hwy. 65, Suite 208, Fridley� MN 55432 574•9871 July 12, 199� Ci ty of ��'ridley Mr. Maxk Winso�i - 6�1�31 Universi ty Ave . N. E. ��'ridley, Mn. 55�32 Re: 6196 Heather Place We are rquesting permission to a11ow us to encroach into the rear easemm�t tirith the decks as per plan. Thank you for your consideration. Sincerely� Tom Brickner Bricknex� i�,.tlders', Inc.�� ..�;r `��' .�-:- �,�'' .. � GG" ' �. � � M � � i+ v w v.. W } W J A � L�.. � O } H � C 2 < 2 O � a' W nn OC � W � Z 0 � 5 `� W ... V _ � > Ga . 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M � fi V1 � � q m � � a � '� � y � y U 4 fr C E c� � u cg � [�+ 'O u V � S E U F m � � � - ; � � � � �, N tA Vl tA \ � ow 3 m � .a M ii� iA � a o G H � � � > N C�i � � + � u O �y 4 � u M p 7 � wi m �.+ b a� � O 0 v; � N v m ar O .� � � . C +1 �i � � a 0 a � ►.� � � • o B w 0 ar • O o. w M 1O � O -.r'A Oai � � m x � a � .i � � a U (g � m q m � � a -+ Ci t�i! E 0 0 � M y ►y H ty � a �� �a x� �.7 4 tA oF �N W tA a� _ � �r y Z sa v � �7 ._ �o 4 e CI 4 �v � m L' M .r � :g �� �� oe C �� e O �. � � � E � •+ i1 � CL c 8� V 4 .�1 < i N d v c L � w •+ d � q a d i e 0 c 0 a � �L d > Y u i0 N i O � � N Y u �O a � O � � Ey / _ UIYOF FRIDLEY �[G�� r � � ��P �����-�,� ,� � l,t� --� r �_ �, �� �C� FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287 August 3, 1990 Mr. Tom Brickner Brickner Builders 6240 Highway 65, N.E. Suite 208 Fridley, NIl1 55432 PW90-227 SUBJECT: Drainage Structure on Lot 5, Block 1, Heather Hills West Dear Mr. Brickner: I have enclosed a sketch of the modification that needs to be made to the drainage structure behind the house you are currently building on Heather Place. Notches 12" deep by 18" wide should be cut into the top of the existing structure. The grate should remain in place. If you have any questions, please contact me. Sincerely, ��-•�.� • �%�.-�.� Mark A. Winson, P.E. Assistant Public Works Director MAW/ts Enclosure �p1�`'1/•. fi �► +.1�".f"T s' �`"t`�'�C' Jt` � ,'Ui.. tl . . w . . r . �:n '-y „ � , .. _ �• ..,,�r., et�.�� �M` s16�.ar =�. . .. •r . ,. a' �� �Y�lA��M..�r�i+�-I.�.w���M�..O.i1���Me�i11l.4r�i ' ' _ _ _ — ' __ — '►..r A'�. . ' ....'" i� . . • , . - . . . . . . � , ' . . � . . . .• - ... O.�'" ��(rl /i �� "� . PROPOSED YEIR � � �r�. NEATHER NILLS WEST STORM SE�IER COMTRO� � • • Scate � 1• ■ 1.0' � . � � ^ : Z k � a > :+ � w W � � d c� Z H N W � J y Q � � � � {„L O Z < L,L O t� Z � �. u � � O � z O N a � J d d Q � W � � � e R 0 w � 0 h � e � • M OI I r � � ��ypp� V\ 4 r � + � gu�� Y Y M Y � � �. 4 L �1 M w.wi Y � Y � � � �' C :: I . ���� � � . � . 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M h a ar � � � C �! 4 � • • m • = M C � � � � � i 7 . � • a 'r �.�i C • o E � �► O C• C > V Y= � �.xy M !1 C • O.� M • � Y � Y �r G • M �.Y .�i K y 4 • Y a V K •.� a. e�.r w h.�+ � ��„ � e .� • p, O O �„� ~ ~ � O M ` � • 4 � = O+G C �. � s �' 4 • o .ui ..�i V~ • �+ u � � x • � •r • .� u a E b O, o� C~i �� m= x t+7 t,~! � o W a � M � a z u h M p j4r 4 u � � c o w � .+ a + � �t a m c i 4 M 0 H � O M 4 � � g u x aL -r vi C � N � O �+ '� o � � � ` C 0 �i Ii > � ,'L M � . � o e r • � a '" 4 : �a� MEMORANDUM TOs Darrel Clark, Chief Building Official PW90-361 FAOI(= Mark A. Winson, Asst. Public Works Director f� DATSs September BUBJ$CTs De at 6196 Heather Place '�(j �� ` � I have received the attached letter from the owner of the above- referenced property and feel it is allowable for the construction of the deck over the drainaqe easement. MAW/ts • .�� � �. 3112 North Snelling Avenue Roseville, Minnesota 55113 3eptember 9, 1990 Mr. Mark A. Winson, P.E. �sistant Public Works Director City of Fridley 6431 University Avenue N.B. Fridle�, Minnesota 55432 Dear Mr. Winson: This letter aCknowledges your penaission to construct a deck which encroaches into the storm Water easement at 6196 Heather Place. We aleo wish to confirm the following: 1) The deck will be constructed in accordance with the plans submitted for the building permit. 2) i�e agree to hold the City of Fridley harmless for all damaqes related to the construction or use of this deck within the storm water easement. 3) We aqree to accept all responsibility and cost for the removal and subsequent rebuilding of the deck should it be necessary to remove the deck in order for the City to gain aacess to-the stona water control structure and/or the storm sewer li.nes within the easement. We very much appreciate your cooperation with this matter. Sincerely, , � � George F. Bateson, P.E. �,,,,.. �- / <��t�'tJ ann L. Bateson - cc: Mr. Tom Brickner, President Brickner Builders a - - c _ _ C' l l V■ FRfDLEY FRIDLEY MUNICIPAL CEIYTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287 �uly l�, �o Mr. Ztnn BricJm�r Bric]mer Builders, Inc. 6240 Hic�w'ay 65, Suite 208 1�7id1�'lr, I�Pt 55432 SUHTFX.T: 6196 H�eather Plaoe Dear Tom: �o-aoi Rega�dir�g yaur letter of July 12, 1990, permissiaz will be qrarYtred to oor�stn�t a dec]c that e�ccroaches irtto the stozm water easaaenit ut�der the follawir�g ooa�ditians: l. Deck to be oonstnu.-ted as per the plans submitted for the building peimit. 2. A letter is plaoed on �ile with the City from the aat�r that h�lds the City of Fridley haYmless for all daamages related to the o�xctioaz or use of this decac within t2�e starm water ease�ment. 3. A lett�ex is plaoed on file with the City fxnoa tl�e aar�er statirg that the awner aooepts all respa�si.bility ar�d liability for the re�noval ar�d subsec�nt rebuildir�g of the clec]c should the �'ity r�eed to gain aooes.s to the stoYm water �t�rol st�re and,/or storm sewer lir�es _/ within the eas�exit. y . 3i.-�cei , .�L� G��,�i�-�w A. Winson, P.E. Assistant Public Works Direc.�tor NAW/ts _ C11YOF FRlDLEY FRIDLEY ��1UNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(bl') 571-3450 • FAX ((�I?) �71-I'?2+7 November 1, 1990 Brickner Builders 6240 Highway �65 NE #208 Fridley MN 55432 Re: Final Inspection at 6196 Heather Place N.E., Fridley Dear Sirs: A final inspection was conducted on November 1, 1990 of the above address and the following item must be completed before the structure can be finaled: � �9 Provide sod in the front and side yards by June 30, 1991. �►�`' � We will expect this item to be completed by the scheduled date and a reinspection called for. If you have any questions on this matter, please feel free to contact me at 571-3450. Sincerely, D G. CLARK Chief Building Official DGC/mh � O� 01 .-1 'i � � C7 .,'a � U m w W W H � d � Z H H W LL J N G Q �.. � � 0 Z < O � � � � 3 Q. � 0 � z O 1- t u J a Q N U , � � � � � � � � N N L 7 t a O ^f ai � • � � �a�g t�: M v � � � Q u � • Y V 4 � � • � y � � I r s � C ,�i+ Y • � O � a � s � �. 1 " 5' / � � � o � M � �^ Y • • ,�J � ~` u . ..� � � y g, " � „� st a� rr� u u r C � a1 q � + w q w -r7� � w C � � • � V g�m� b p �, � s • m Y��a � `" i G � � E q � � � � � � • � N � N G 9q~ V � � r� T 3+ CYL C � i ~ M O a :1 � t c m � U r ,p w t � �y �i C > C Y Y W .Vi � �� 4 Q Zi /y O 9 n Y A m j (•�. �� n C Y C� �Y.�n �-.... u e�.s t uy w W � ..+ r E" 6 C d O � G F N q � � p � i � 9 � � � w 7 3 O < � _ � m � iL 7 F 4i u ►� Y L Cl .r ✓ q 2 x 4 Si{�iQ �y' � ) J N j abutl� seg Sxt3 •�s� . I ddY sa� '� $/' � iayseM �t�vuc3nY M sutseg � y» �J t��Q ioot3 � s nwovs surv�uno3 g a 6u��ussQ � y s,tesi k=*Il $. � s�+?S o v � o J s�'� � � O Y SQ� �� (7 � � ` sTw�cip s3asoT� � � � � .+ v a rJ °: �. sstsass � n � � 0 iy Z � O v E a Z � z � IY E a � a �G � .� ! � i G t � 0 F V► N N N M N N N N N N N N N � F < �i A = W t� N W 1� � H � F o� � F Yt {i� V : � a � d 0 0 0 0 0 0 0 0 0 0 0 0 0 o�n �e, o 0 0 0 0 0 0 0 0 0 ui w� .r •�n u+ ui �r+ vi ��n o 0 H .N N N M N N M N N N N N H N • • r u O Y C V C � .�. 1�- : � y O d � � 'O • � S • • s Y C �> > p Y ti � � • .+ w C � • Y p� C � C,> 4 r � �+ M C • � 1 M • � � � � a • • V � • M • Y ++ � e • .. � .+ .� M • e • M • .� r � � .� w h �+ C �. -� � a o o s� o •. � � Y O t � M 7 1[ G ! u a• 0 N•Ci 9■ r�+ • r s� O i� u s i a s i v o 0 � �� � N , ( a � > 3 Y is rN � � � � 4 d ��� Y u � m g M H [� a�t � a � zz m= .�.1 � G N } � < t ¢ VS � �o � :] • � N 4. Ff : y 2 ; � G � � �: L� � N N N m m rt .'r (� Y , .s � � O «y 7 f E+ Y Y1 < � aC c m w s .+ E �� � ..� ., .+ t a H c C < 2 < � 0 ayt • �1 M d V � m � oc -. � � N � O �+ � \ 0 � ` j C .r Q H � � � � ! _ " s (+ O + � r � ,� .. a � < Building BUILDING PermitNo.:1—�1bt� v�'" Inspections RESIDENTIAL APPLICATION Received By� 763-572-3604 CITY OF FRIDLEY vate �� �� g 763-502-4977 FAX EFfECTiVE 8-19-09 DATE "! � Z�� D'1 YOUR E-MAIL ADDRESS SITEADDRESS �_� 1-�Lcrili�r GC L THIS APPLICANT IS: D OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: Y t t� SG�1 TENANT ADDRESS: � L�i //' _ CITY i 1� STA'fE� �ZIP PHONE: %l� � � %�% % S^� Z CONTRACTOR NAME: SI� i i i SUBMIT A COPY OF STATE LICENSE # O EXP DATE YOUR STATE LICENSE � — AND CERTIFICATE OF ADDRESS: � D%�%�& U�• CITY A' STATF�//�LIP% INSURANCE PHONE — FAX PROPERTY TYPE O SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO �AMILY/NEW CONS"fRUCI70N S70RIES PERMIT TYPE ❑ ADDITION ❑ RAGElSHED O WINDOWS D BASEMENT FINISH �OOF O DRAIN T1LE O DECK ❑ SIDING C] OTHER ❑ SW[MMiNG POOL TYPE OF WORK: ❑ NEW HOME CONSTRUC7'fON ❑ ADDITtON O MAINTENANCElREPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: ' C/ I- � SIZE OF IMPROVEMENT LENGTH WIDTH HE[GHT S FT ROOFING � ❑ HOU3E ONLY NUMBER OF SQUARES f ❑ HOUSE 8c GARAGE �ASEMENT REMODELING SUBMIT: 1. Existing Floor Ptan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: O DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCT[ON INCLUDING DECKS, � Vinyl ❑Soffit ADDI770NS_ & PORCHES SliBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures and Qroposed project. ❑ Other ❑ Fascia 2. 7'wo sets of wnstruction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS �Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES 8c TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS Al.l. N'�:�5 AK�: SAS�:U UN VALUA"1'1VlV, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) VALUATION Permit Fee Plan Review Fire Surcharge Surcharge License Surchazge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Chazge Total Due a �.�aS $ a- $ $ S $ $ $ $ $ f� �i. I ANCY See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Va(uation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2000 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftxS22=$ 5450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridlev Attach TH13 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 compiete 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 accordance with the approved plan in the case of all w k h' e ires review and approval of plans. SIGNANRE OF APPLICAN� _ PRINT NAME �C.�tCI%�� DATE �