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AF - 47138� . City of Fridley, Minn. ` BUILDING PERMIT N° 3160 ��^ � � ^ �� Date: .. ................................... Ownerp4,�..... . .. .. '� Builder ...... . ................................ Address �y .b �. . . . . . . . . . .� . . . . . Address . . . . . .�t��".• . .� . . . . . . . . . . . . . . . . . . . . L4 TION OF BUILDING No. . . �+: . � � Stree . . . . . . ��{./.�i4�.t� . : . . . . . . . . . . . . Part f Lot . . . . . . . � . Block . . . . .� . . . . . . . . Addition or Sub-Divisio� � �? Corner Lot ............ Inside Lot ... ........ Setback .�l�..... � Lot . . . . . . . : : � . . . . �. . . . . %��"'�'�K-� ; ideyard . � . . � . . . . . . ��'T„"..'rl . �i�� DESCRIPTION OF BUILDING To Used as: . . !�!!: . . . . . . . Front . . . � .�. Depth . . . !� . v Height . . . . . Sq. Ft. . � Q.� Cu. F't. . . . . . . . . . . . Fr nt . .l. o . . Depth . . .�� . Height . . Sq. Ft. .I. �. o G'�a. Ft. . . . . . . . . Type of Con ructio . . ��tiakl/.��i.l. . . . Est. Coet. ,� ,�.� 0 . . -r,.. . . . . To be Completed . . . . . . . . . . . . . . . . . . . In consideration of tne issuanee to me of a perxnit to construct the build4ng desribed above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. .................................................... In consideration of the payment of a fee of $.. Q..� .., permit is hereby granted to (Xf . �i . . . . . . . . . . . . . . . . .. . to construct the building or addition as described above. This permit is ted upon the express condition that the person to whom it is granted and 1us agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ,.,.a:....,.,.,.� � NOTICE: This permit does not cover fhe construction, instafla#ion or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these itema . _ � . 5 3-8t�-9915051 � ' . ' . �i�� r �i�l^� I � � ' . ' •U _ . � �I . . � � � ; � .... P"' * '-• �•�%:� 19 . . ' . . ��a�.1ic�:�o� �� 'lc�rr�::x: � �,;� ��..� � �tfi;;�:� e • � ' . . . • • ,_,,,,,�.,—..,.._,..._. Dop�t. oi Sld�s. Phono S:'J•3►50 I D�5C?IpYI02i a: �'��l�r � � y�f� ' 680 F�elen 2tu�S:r. ::i.:3 a.hd Lec':ic+� oI Flxr�:es , .. • • Z = � : � N �; � ; f1 � � E 3:r 1:: � � N K j 7��.I;t 7 gZ��Z �� Z = ��f�,`�! � :o�w� 3��u� ��u�i � � � 1.^..'. 3:d �:`� _ L_. • FL`.::o Cc:: a:s:�:a CiT:•c!r.�. s }{•v ��ara. O:d O-��"•?-^•ss — ------- . n PAP.TIAL RATE SCHMDUIE � w.TC. N-,►. ► H i r,�s [�tC. City of Fcid.tcyl Thc undcrsigncd hercby :rakes s��.ica�on tor a r.errnit tcr ttie ao:Y her speei:itd, a� ee:ng ta do a1 �ti•e:k :n :::ict �eco��r.ce w•ith tre Ci� o-"�s'�' a.^.d ru?ing oi the Depa::r^cat of �ui1y.'n�, a1.a. hereby dec2ares �hat s%I L`�e 1� • and t�e�s:escr.tations s:atec3 !» •_ i= 2DF��a'�°� a� ttue z.r',d cb=Te��' ,. , i�-idley, �:ian 5-3-76 19_ Owr.er Dar I b ' . � frame Kind oi B:ulding ucaa: � Uscd as r�s. c`w�`°i p �. 5-9-76 r— To bc co:r�pleted aboui Estirs:aied CoSt, S l�'�� , �� Oid—Iv'�ii. F3ui:ding Pe: mit T'ho. _�-•—p•:"! 4• ; I,�:�:SI?tC FI:CTJ'E R1lTES: . NO. RA7E , TOTAL ��,,=�'' °� • . . Sizrc� I+':srr.ber FZx:urrs . . . . . . • •• • • • • • • • ---.--- X �'-.G�. S - � � MINNEGASCO . _ FiAi�::! L�Xi\1fC �i�)C11111$ • • • � � � � � � � • .r--� X sl.•r'�Q s , -••�•��• • $y ' x 51.50 S.._:. _. Buain��.s T��:.e �o •. 1�CW FIX:I:IC OiCi Op�fLflK • � � • � : • • • • .i.� .. X �•ZJ S - � . . C�tch F3asin • • • • • • • • • • • � � � • • • • t • . . ' �Y:tcr ile�ter '�p to �9.00A S'!'U�• ••• ------ x.3 CA S . FOUGH� � �ea C:ou�d Rua Old B:d�. ...:..:. _-.---- X:3.25 S._--�--- E:.eet.e Yla:.: Y.•aias . . . ..: . . .... .. .,...�—.. s :3•GJ 3 FINriL �.._ - iAS :Z?:StiC FLE3: ' HO. R:+ � T07AL . • lst3 Fix:L'TtS •••••��••••• .w�� X 52.� � , - � . 1►d�ltl�nal Fixtures ............... -�-'--�---- x S .75 5-----= _ , . C:s R: ::r to 1 r3.OG� B'� LJ ..... ...... --..------ x SS.CO S_-�----- . ' gril�.• �.00 � . ,50 State Surcha=5e P...�"?�:.°•3 k AL:FP.J►T2�NS--P.�:.: !o Cado . . ' .�.SCii'y:SOA • � � � � � � � � � � � � � . i � � �.. � � � �.� � � � � �.� • �.� � � ,.. � •rr �� .r� ��.� �.._., ��, ' ' � Z`O'rN. Fr'.:t. =,5. 5� _ �!ass A t .5C¢ � . • . • • � . . • � SUBJECT c�ty of Fridley AT THE TOP OF THE TWINS g U I L D! N G P E R M r � � � � � • COMMUNITY DEVELOPMENT DIV. ' � ti: ---^-� r � � PROTECTIVE INSPECTION SEC. � � � � �""1 % CITY HALL FRIDLEV 55432 NuMeea REV. DATE �"'"�� ,�� 612-571-3450 910-F15 7/3 �os Aooaess 680 Helene Place N. E. 1 LEGAL LOT NO: BLOCK TRACT OR ADDITION DESCR. 3 g Donnay's Lakeview Ma.nor 2 PROPERTYOWNER MAILADDRESS °_� 15853 RECEIPT NO PAGE OF . APPROVED BY p � / SEE ATTACHED SHEET ZIP PHONE - Daryl Sandburg 680 Helene Place N.E. 571-6834 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. The Roby �i�a3i� Company 7208 James Avenue South 869-8330 4 ARCHITECT OR DESIGNER MqIL ADDRESS ZIP PHONE UCENSE NO. 5 ENGINEER 6 LSE OF BUILDING MAIL ADDRESS 7 CLASS OF WORK ❑ NEW ❑ ADDITION 8 DESCFIBE WORK Reside House 9 CHANGE QF USE FROM STIPULATIONS �, ZIP PHONE LICENSE NO. ALTERATION � REPAIR ❑ MOVE ❑ REMOVE TO S£PERAT� PERMITS REQUtRED �AR �'IRlt�� HEATiN�. rtUMgIN� A�1Q StGIVS. TYPE OF CONST. SEPARATE PEAMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. V1I1171�AZl1Inl 7HIS PERM17 BECOMES NULL AND VOID IF WORK OR CONSTRUCTfON ZONING AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF /20 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $3,950 WITH WHETHEA SPECIFIED IiEREIN OA NOT. THE GRANTING OF A PERMIT "-- DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE +PFOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 2/�.00 ST\R`UCTI N R THE PERFORMANGE OF ONSTRUCTION. � �/ PLAN CHECK FEE i 1 SIGNATURE CONTRACTOROR HOR�ZEOAGENT �DnrEi �. WHEN PROPE SiC;NATl1RF (]f nWNER �IF OWNEF BUILDEF71 IDATEI � � Ri f1f; INSP OCCUPANCY GROUP OCCUPANCV LOAD LtM SQ. FT. CU. FT. OFFSTREET PARKING STALLS GARAGES SURTAX $1.97 SAC CHARGE ITOTALFEE $25.97 VALIDATED THIS IS YOUR PERMIT I)P � CiTY Of' �'RIOI.EY � . . � Af?C'l_ICIITIOi� FOR (tFSiD�P�l1"i/11_ (3U1l.UIP�G PCRMITS • ` ` (fdevr, Ali:cr�ations, A�ldil:ions> o�° iZepairs) • r , . � , . , . . ;_ , � 04J(dEft: �UI LDER : . AQDRESS: i�o� P�Pl�t � /�� ,� AUDRESS: �� b /�i`�v - ; - � Tr� �o: 5` �/ �- �� 3�/ rE� rra: $b i�- 8- 3.�v � � Construction Location • STR�GT N0 : � v STRTsET: � .� z,p�: . � . I3LOCY.: `�_____� AADITION : � Corner Lot: Inside.Lot: Setback: Sideyzrds: Ap�licant attach to tliis form two Certificates of Survey of lot and ' proposed builda.ng lacation dracan on certif.icates to . scale. , DESCRZFTIOfd OF CONSTRUCTION � � ��5�� s�.� Front: � D� pth: Height: � Squa�e. Feet_ _ � Cubic I'eet: • I'Yor,�: Drpth: Height: � , --,-----.-------- � • Square• Feet: ' Cubic Feet: ' L, / • �.c /11 _. ��a�� • , . 1,�� . —o - T��pe of Construction •-- Est3mated Cost: $ Vl • �.b Be Cbmp�.eted: f ,�, % � .:l� CJ . - � ' Alt. A Alt. B . � Proposed Driveway Width It New Opening Is Desired: __ $� $ . - � _ S�E REVERSE SIDE OF SHEET•. ; . . " . � 719Ye under.signed hereby makes application for a permit tor the,work herein specified, agreeing to clo all work in strict accordance with the Gity of Fzid].ey Ordinances and rulings oi the DeparUne�it of i3uildings, and hereby declares that all the facts and i repzesentations stated a.n this application are �true and correct. �, � � � � DI1TE: � � SYGNATUF�: • � i Stipulatio s: . . i � ' . �� , � • : ti � .' . - ! ' �,�,� • ' " . • . � . 1: q '7 � � � . � �; �� . � .. - � . . . � � � . . � . .�_....v sue�ecr PERM City of Fridley 19160 AT THE TOP OF THE TWINS g U I L D i N G P E R M I T i � i � • � `y _ ___ COMMUNITY DEVELOPMENT DIV. � �' r � � � PROTECTIVE INSPECTION SEC. 1 . � � � /"'1 � CITY HALL FRIDLE� SS432 NUMBER REV. DATE PAGE OF APPROVED BY � �'----�: `.� 612-571-3450 910-F15 9/9/87 � � 108 ADDRESS 680 Helene Place N, E. t LEGAI �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO DESCR. 3. g Donnay' s Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Daryl Sandberg 68Q Helene Place N.E. 571-6834 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE UCENSE NO. 5 ENGINEER MAII ADDRESS ZIP PHONE UCENSE N0: ' 6 USE OF BUILOING Residential 7 CIASS OF WORK O NEW ❑ ADDITION C� ALTERATION ❑ REPAIR q MOVE ❑ REMOVE 8 DESCRIBE WORK Change xoof line; add vaul.ted cei,ling; add patio door; and reroof entire roo£; 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan �'�R�A�� 8efor� ��g�� SEPARATE PERMlTS REQUIRED FOR� rEIEPHONE-ELECrR�_. � w�Rin�, ��AriNG, PLUMBlNG A�V� S1GNS. REQUJRED gy ��, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTI�ATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOF A PEFIOD OF 120 DAYS AT d ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CEFiTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1' STALLS GARAGES AND KNOW THE SAME TO BE TFUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $14�OOQ S%.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- •74.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $ PLAN CHECKFEE TOTAI.FEE $18.63 $100.13 . S�GNATUREOFCO AACTOROAAUTHORIZEDAGENT - IDATEI WHEN PROPERLY LIDATED THIS IS VOU�P RMIT �� - � ; ,. k G'.ai n SiGNAT REOFOWNERIIFOWNE BUILDE IDATEI BIDG WSP p TE . NEW [ ] ADDN. [ ] AI,TER. [ � Construction Address: City of Fridley �R-1 AND R-2� Building Permit Application �g� f%��Ne �� e , -- � Effeetive 4/1/86 ,v �v s~� i�3 z Legal Description: Owner Name & Address;�AR�/ C �RN�" e� g "" � "`'/�P " �Ce, //f�/d�vTel. # -S%�� 3 Contractor• Tel. # Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to seale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECR AREA: Length � F r Width � Hgt/Ground �o u� Sq. Ft. OTHER • � �c�� 11 � c� �e �/�N a�a� �// o S�idr�v ...�ao�t' S �9dd ��,;Q Corner Lot [] Inside Lo L � Ft. Yd. S ack Type of Construction: GIJn �� riPl4�'1 e- Approx. Completion Date •�_�� 9a ,L�-- Side Yard Setback Estimated Cost: $ �T�DOO Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Baek Page for Explanation DATE: 9 APPLICANT: I Tel .� s�� b�� Permit Fee Plan Check State Surcharge SAC Charge Park Fee SeKer Main Charge TOTAL STIPULATIONS: CITY USE ONLY � Fee Schedule on Reverse Side $ � 25� of Building Permit Fee $ 7��i�i $.50/$1,000 Valuation $ $ 525 per SAC Unit $ Fee Determined by Engineering a $ Agreement Necessary [ � Not Necessary [ ) $ ��.. lN�oo u �2o aa— '� �� 7�� '0e ..� � o �► ,. . . . , F� �3,.,��„_„_,_ z�sa r, �€+ N Cu� 8'" � C�X�3-16 U.G--'.;,�__: 1'C� tP�f ti� W o ��P n ��t, \ / f . /'' / ,,, _, ___ _ � �_ _ -�_, �� _— �-; - - ii � ' �� I -- ; �� . � �� K _ _� _ _ � I '. ',, � i•-=-. ;, � , . ,.. � ; � f~ 2 y0 �.B. 5 NINGL ES _ S/8" ROC K __ :_ ��„ ROCK -- __ _ /z"OXBD. UNDFRLAy - 5/8 SuBFLOOR .i" �"OqM O N 5 L A B � v� � , r, - - I i �� ,I � �.� i `' �� v i i v`� F- 5/8 R OC K , � �, i� i i� �. i � \�� ppOr \�� `� � -� �J -- � I�'� ; � � !' S � 6 Y�. �. �� n I T�` �✓�R .�� J� . � _� � ----i��_ � � � � �� o� � t w� 3 �ON 'L '�8 Qi�R +-Z�� p�e �a.i �a6r �� lo } .�-�e '� �, .. , � � � � .. �, F'� :� � SuB�ECT c�ty of Fridley AT THE TOP OF TME TWINS g � I L D 1 N G P E R M I T 2 8 0 5 3 r ; � RECEIPT NO � i L_ _ COMMUNITY DEVELOPMENT DIV. r � � � PROTECTIVE INSPECTION SEC. 57� 1 . � i--_•�; �"' �'� CITY NALI FRIDLE� 55132 NUMBEN pEV O�iE v�GE 0� �vvnOVED Br 1 612-571-3450 9t0-F�5 10/1/98 � � 108 ADORESS 680 Helene Place NE t LEGAL LOT NO. BLOCK TRACT Oii ADOITION SEE ATTACMEO oesca. 3 9 Donnays Lakeview Manor SHEET 2 PROPERTY OWNEfi MAIL AODRESS ZIP PHONE Dar 1& Jo ce Sandber 571-6834 3 CONTRACTOR MAIL ADORESS ZIP PMONE LICENSE NO Ron Miller Constr. Inc. M' s' - ♦ ARCMITECT OR OESIGNER MAIL AD�RESS ZIP PMONE IICENSE NO. 5 ENGINEER MAIL ADORESS ZIP PHONE UCENSE NO 6 USE OF BUILDING REsidential 7 CLASS OF WORK O NEW O AODITION O ALTERATION � REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof house and ara e 25 S Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPEOFCONST. OCCUPANCVGROUP OCCUPANCVLOAD SEPARATE PERMITS AFE REOUIREO FOR ELECTFICAL, PLUMBING, HEATING, VENTILATING OR Alii CONOITIONING THIS PERMIT BECOMES NUIL ANO VOIO IF WORK Op CONSTpUCTION 20NING SO. FT CU fT. AUTMORIZED IS NOT COMMENCED WITHIN 60 OAYS. OR IF CONSTRUCTION OR WORK t5 SUSPENOED Oii ABANOONED FOfi A PERIOD OF /20 OAYS AT ANV TIME AfTER WORK IS COMMENCED. NO DWLG. UN17S OFfSTREET PARNING I MEREBY CERTIFY THAT I HAVE READ AND EXAM�NEO THIS APPLICA710N STALLS GAHAGES AND KNOW THE SAME TO BE 7RUE AND CORRECT. ALL PROVISIONS Of LAWS yA�UATION SURTAX AND ORDINANCES GOVERNING �NIS TYPE OF WORK WI�� BE COMP�IED WITH WNETHER SPECIFIEO HEREIN Oii NOT. THE GRANTING OF A PERMIT 1 2 ], . O] DOES NOT PRESUME 70 GIVE AUTMORI7Y TO VIOIATE OR CANCEL THE PEqMITFEE SACCHARGE PROVISIONS Of ANY OTHER STATE OF LOCA� LAW REGUTATING CON- STRUCTION OR TME PERFOR ANCE Of ONSTRUCTION F�Y2 SC 2. L�F PIAN CMECK FEE T TA� FEE 8 6 5� ♦TUAE O� C N'FA(;TOQ O A MOA�ZED AGENT IDATE� HE PRO VALI D THIS �S ��UR�R • �♦ S�GNSiuAE O� OWNEQ��F OWNEQBU40EAi �•�E� Bl 1hS� � ` p tt NEW � ADDN ALTER [l [) Ll CITY OF FRIDLEY SINGLE FA:'�IILY AI�1D DUPLEXES R-1 AND R-2 Effective 1/1/98 BUILDING PERMIT APPLICATION �O�;i a 5 ��- ConstructionAddress: %�j �,��,r/� �'�,r�� p Legal Description: Owner Name & Address: f�/�,eyG d'�- o/��r� � 1,�,�� Tel. #��%/-- �8.�� Contractor: ,� �,� �YY��/�j� ��/r✓ MN LICENSE # ��,��ZT —�^---r.--.- -.-- A � Address: ,�.g'3 �/J�.S'f, Sl`,� �«.l �j/ Tel. # `S' / 3,5�/� � Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVE�NT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: %�'�-�� A.�.� �x�� S— 't7 l��,s� d— G��-� Construction Type: Estimated Cost: $ �� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ B DATE: �Q —/ �� APPLICANT: �� Tel. # �?��jjr/� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ `% ' S� $ �- / $ /v� $ $ $. $ $ $ S-Oo $ �j� CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.SO/$1,000 Valuation $100Q 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 [ ] M CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572— 3604 Stories Floor t Fioor 2 Floo� 3 Floor 4 PLUMBING FIXTURE RATES: APPUCATION FOR PLUMBING AND GAS FITTING PERMIT MAFiK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Bath. Wash dnnk, s Fioor Catc11: > Auto. Urinal Tub; Shower Sink `` Tray Fount ;' Drain 8asm` .' Washer NO. RATE TOTAL New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Wate� Heater -Electric Water Heater — Gas** �_ Gas Aange** Gas Dryer** Back Flow Preventer Required ()Yes () No TyPe $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ �.00 $ 7.00 $10.00 $ 7.00 $�o.00 j $10.00 $10.00 $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5°6 of Value of FixturE or Appliance �� .° D State Surcharge TOTAL FEE $ .50 5° �_� Effectfve On JanuAry 1, 1998 Gas •: . ��. • • � �,,.1 �_ `r �.�_ Water Heater Gas Elec � The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the city codes and rulings of the 8uilding Division, and hereby declares that all the facts and representations stated in this application are true and correct. �\ � � a� q � , 1998 Owner Building Used As�_� Estimated Cost 3o e�� PERMIT NO. ��/�C/ PLUM8ING COMPANY�f�� o� 5 0�{ S SIGNED B TEL N0. °�'3\, Q(�'1 � Approved By Rough-ln Date Final Date �� MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS �20 00 �i'y`' PLUS THE �.50 STATE SURCHARGE **COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SQ INCHES. sue�etr P E City of Fridley 3292g AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � � ` RECEIPT NO. � ` COMMUNITV DEvEIOPMENT pIV. � r � v �� PROTECTIVE INSPECTION SEC. �1 � i � i�_-_.�; "�;.; CI7Y MALL FRIOLE� SS��Z NUMBER REV OATE PAGE Of APPpOVEO BY� 1 763-571-3450 9t0-Ft5 7/25/02 � � JOB ADORESS 680 Helene Place NE 1 LEGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACMED DESCR. 3 9 Donnay's Lakeview Mazor SNEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PMONE Joyce Sandberg 680 Helene Place NE 763-571-6834 3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO Standard Water Control 5337 Lakeland Ave N, Crystal, MN 55429 763-537-4849 � ARCHITECT OR DESIGNER MAIL AOORESS ZIP PHONE LICENSE NO. 1522 5 ENGINEER MAI� ADDRESS 21P PMONE LICENSE NO 6 USE OF BUILDING Residential 7 CIASS OF WOFiK ❑ NEW O ADDITION �J ALTERATION O REPAIR p MOVE O REMOVE 8 DESCRIBE WORK Install draintile 9 CHANGE OF USE FROM TO STIPULATIONS / < � TvPEOFCONST. OCCUPANCYGROUP OCCUPANCrIOAD SEPARA7E PERMITS ARE REOUIRED FOR EIECTRICAI, PLUMBING. NEATING. VENTI�ATING OR AIR CONDITIONING. TMIS PEFiMtT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION 20NING SO. fT CU iT AUTHORIZED IS NOT COMMENCED WITHIN 60 OAVS. OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANOONED fOR A PER100 OF 120 DAVS AT ANV TIME AFTER WORK IS COMMENCED. NO DWIG. UNITS OFFSTREET PARKING I MEREBY CERTIFV THAT I MAVE READ ANO EXAMINED THI$ APPLICATION 1 STALL$ GARAGES ANO KNOW TME SAME Tp BE TRUE ANO CORRECT. ALl PROVISIONS Of LAWS VALUATION SUFiTAI( ANO�OROINANCES GOVERNING TMIS TVPE OF WORK WILI BE COMPLIED $3 ]OO �X �L.BS WITM WMETHER SPECIFIED MEREIN Oli NOT. TME GRANTING OF A PERMIT s DOES NOT PRESUME TO GIVE AUTMOAITV TO VIOIATE OR CANCEL TME pEqMITFEE SACCHAFGE PROVISIONS OF ANY OTMEFi STATE OR LOCA� LAW iiEGUTATING CON• @ STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �97.I,S Fire SC �p3.7O PLAN CNECKFEE TOTA�FEE Licens C $5. 107.80 S�GN�TUQE OF CON'PqCTOp OQ �UTMOQ�ZEO �GENT IOATEi E PRO� VALIOATE THIS IS YOUFl PERMIT � -V � S�GN47UQE O� OWNEA �� OWNEA 9U�LDEfii iO�TE� N$� - ��tE NEW I l ADDN [j ALTER [ ] Construction Address � Legal Description: Owner Name & Address: Contractor: � Address: ��L/.�� LIVING AREA: GARAGE AREA: DECK AREA: OTHER: CITY OF FRIDLEY Effective 1/1/2002 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Tel. # ��v�".��7 MN LICENSE# ��a7v2 z�Te�. # 7�3—.�3� y�yR Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length DESCRIPTtON OF IMPROVEMENT �IPLC�i,1 Wdth .. • .r Height Sq. Ft. Height Sq. Ft Wdth Hgt/Ground Sq. Ft. 1 (,f Construction Type: Estimated Cost: $�3 �� l Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ � _$ DATE: �� APPLICANT: � Tel. # �-1��r�� Call (763) 572-3604 for Permit Fees if mailing in application or 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 Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL � $ r�S $ ._.�� Z� � L �� $ � � .1�0 $ $ $ $ � �. � / i � 0 CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) � � $.50/$1,000 Valuation $1200 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:� . _ . .