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AF - 46314� City of Fridley, i�nn BUILDING PERMIT � � : c .' .r. � • ' �_ . .�iJ -�� • � / !.� y i .L�.� I ' :`.�.. Bl� Addrese N° '7233 � �LOCATIO F U LDING No.�,�11� Stc�et ��--��1.s P P Lo Lot ��_ Block Addition or Sub-Di an ��,.� ��'� � a Coraer Lot _ Inaide Lot Setback �' Sideyard � � Sewer IIevat4on � F da.tion IIevation DESCRIPTION OF BUILDING T U : ` Front a�� Depth Height �� Sq. Ft C�. Ft - t Depth _C��Teight -_-�-� S9. Fk G�1. FL � Type of Constnict[ :��_ Fst. ��7� �To be Completed In canaideration of the fsauance to me of a permit to construct the bwilding described above, I agree to do th� proposed work in acc9ordance with the d�scrlption above set forth and ffi cw�npliance with all prwisions of ordinaacea of the dty of Fridley. .� rn� -�?�.��.� In consfderation of the �yment oP a fee of `� , pern�it fa hereby graated to to construct the buil or addition as descrlbed above. Thia��mi t is granted upoa the expr�s conclition that theperson to whom it ia graat�ed aad his agents, emPloyees an� workmen, fn all work dane in, around and u�n eaid building, or anypart thereof, alaall conform in all respects to the orainaa� of Friclley, Minnesota regardisg location, conatruct%n, altera.tion, maintenance, �air and mcviug of buildin�s within tk►e dty ]imits and thia perrmit may be revoked at anY t� upoa violatjf�in�Y aaY oE the P�visions of said ordiaancea / �� /! %� / ��8 � Nonc� i�� 'I6b psemh dosi eet covsr fla eomlruaH�, �oe ier vrMey. plumbine, �a hulleg, aw�� e� wal�r. B� an �o s� ihs Boildi�g 1�� fer pparaM p�rmht hr t6� k�s. �� 5% � - � -r�, sue�ecr PERMIT NO. City of Fridley --- ATTHETOPOFTHETWINS gUILDING PERMIT ��45� i � RECEIPT NO._. � �• COMMUNITY DEVELOPMENT DIV. ' ~ PROTECTIVE INSPECTION SEC. I�l � � � _'- r ; "� ; ' i ' � /'�'1 � CITY HALL FRIDLE� 55432 � NUMBER REV. DATE PAGE OF APPROVED BY �"'"� � ,�� 612-571-3450 910-F15 4/26/94 � � JOB ADDRESS 5179 Horizon Drive NE t LEGAL LOT NO. BLOCK TRACT OH ADDITION SEE ATTACHED DESCR. IO 9 Carlson's Summit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS 21P PNONE Teresa Bailey 5179 Horizon Drive NE 571-9126 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. American Remodeling 3700 Annapolis Ln Ste 145, Plymouth 55447 2406 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO. 5 ENGINEER 8 USE OF BUILDING Residential 7 CLASS OF WOFK MAIL ADDRESS ZIP PHONE LICENSE NO. ❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reside Dwelling 9 CHANGE OF USE FROM STIPULATIONS TO SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZOI AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO I HEREBY CERTIFY THAT 1 HAVE FEAD AND EXAMINED THIS APPLICATION AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS Of LAWS VAI AND ORDINANCES GOVERNING 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 pEl PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- - STRUCTION OR THE PERFOfiMANCE OF CONSTRUCTION. SIGNATURE OF CONTRACTOR OR AUTHORI2ED AGENT IDATEI ' .........�.....�..,.,.,�e.�cn�.rr.�cociuinca� IDATEI _ GROUP NG I S�• CU. FT. LOAD DWLG. UNITS OFFSTREET PARKING 1 STALLS GARAGES UATION SU RTAX $7,872 $3.94 MIT FEE SAC CHARGE $99.00 Fire SC $7.87 N CHECK FEE TOTAL FEE License SC $5.00 $115.81 WH OPER V ,•�-.}•��ATED THIS IS VOUR PERMIT c�� —� �v�w [ l ADDN [ ] AS.TER [ ] Consttuction Addr I,egd1 Descri.ption: Owner Name & � Contractor: � Address:.��i�� d LIVING AREA: GAR�►GE AREA= I�ECK AREA: OTHER: Comer Lot [ ] In: Type af Constnicti� Approx. Completion Driveway Curb Cut D�.TE: �"�- Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Park Fee Sewer Main Charge TOTAL STIPULATIONS: � CITY OF FRIDLEY SINGLE FAMILY AND DUP'LEXF.S R-1 AND R-2 Building Permit Application � . �1 '�. i - ��L� � �� Effeetive 1/ 1193 ��s� � Tel. 1#�`� / - �/� � MN LICENSE !� C�p o� L�Q � �, Tel. � �,�'� - t��a 6 At�ach to this application, a Certificate of Survey of the Iot, with the proposed construction drawn on it to scale. DESCI�IP"Y'ION OF IA�iPROVEA�i3EI�d`d' �ng� Width Height �n� � Width Height I,,eng� Width HgtlGround Sq. F� Sq. Ft. Sq. Ft. T � Lot [] Ft Yd Setback Side Yard Setbacks � Estimated Cost: $ `°�7� � ►ate: �� -� L/ . ---, (Cost on Back) idth Needed: Ft + 6 Ft = Ft x$ _$ 6 APPLICANT: TeL # �5,� - � � b �ITY USE ONLY � �R � Fea Scheduie on Reverse Side ; `�, �'°� �.001 of Permit Valuation (1/lOth�) � � .�d e/ $.50/$1,000 Valuation � $750 per SAC Unit � �', °� $5.00 (State Licensed Residential Contractors) � Alt "A" or Alt "B" Above - � Fee Dete�'mined by Engineering � Agreement Necessary (] Not N�y [] � � � �, � P,ry � ,��'�� ,; �� , � �`. �'��'�� a� 0 3 �DOc�A3 rcoom r-icn� uDi�z� "'� � � d x�-ir rnmc� �I�3 N 3 F-+ N O Z �P t!� Z c'� vctn °omm �O£ PJ D '� GNODD D�(li3 rcaam r-��n� D2 N � a0 -�ocne v�3"� n oz VCN� ( M °om� OrRI N{ O �-+ C� � z m oe G n. � n1 ('� •• "'� � o a �H o r oa � � zr in �' W C7 � O � �� m n� x -� p 'u O C� �• � O y PJ �o .� N O .. �, O W � W � �0 � O s m z d n 0 0 � m r-� N � c � o. 0 r � � w � � � i O W � W � �0 C� � � om �� -o �. O t7 �m►-. F-1 N Q �rN 00 � P � � D C) --i O � `��n�,��uu u ��,.. , ,.I;• ••;s��... y, . �' ..� . �re:g�:_ � a.,o• f �4 � r a��: � +, � . , �� :�'/ "` '<:�� e'`•.�'� r�,`: �b'r Y ,>�, ��'ya� 3��y', �'"`�'@:r;ir..�.,�i., a p� � w o M..rtw �ql ro� m �n d��d -�� r.Nd m �m Z"c �'F ZO � r � �I r� � c� � � � �o �u � Z t7P3< nZ -i�� N �JWCn.t �� o:n� �a '-� � ul m O ►+ cr � G7 � U1 �-+ co��rw H F+ ' (,�j r n� �, t� •- -u m -� �. u, d � ZPJC �n m fi� �0 � ct � �` ` �n OQ-3m Z �� o ��o�� D N cr -� (� N ? � � O �N T � `r O .�`°�T�:'�q� r° :! �' �� e• F n s;� � �"; m ,`�d� .� � a�; Y � :!�'Nlt�l?�'�, . .s+ sue�ecr PER Q_.__ c�ty of Fridley � AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � RECEIPT NO. COMMUNITY DEVELOPMENT DIV. � r� � L � PROTECTIVE INSPECTION SEC. , , � .1 , � 1 /"'1 � CITY HAIL FRIDLEr 55432 NUMBER REV OATE PAGE OF APVROVEO BY �"""� � ,�� 612-571-3450 910-F15 � � 8/11/97 JOB ADDRESS 5179 Horizon Drive NE � LEGAL LOT NO. BLOCK TRACT OH ADDITION SEE ATTACNED DESCF. lO 9 Carlson's Summit Manor South A di on SNEET 2 PROPERTY OWNER MAIL ADDRES$ ZIP PNONE Bruce Bailey 5179 Horizon Drive NE 788-4071 3 CONTqAC70R MAIL ADDRESS ZIP PhIONE LICENSE NO. Franzen Construction 4250 5 Street d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW �O ADDITION ❑ ALTEFiATION ❑ REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Construct a 16' x 16' Addition to House I er o 9 CHANOE OF USE FROM TO STIPULATIONS See notations on plan. �� , : SE�q�TE P�� ef°,�� di �� Yjft�l y �i'111`S RE a» gq�nbQ c G. H QUlRED �tiiiry �o a�� for EATIIVG, p�tiM81N� �� . 454•Opp� f�0�s �° 5��►S. �U�RED �Y� � TVPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD SEPARATE PEF;MITS ARE REQUIRED fOR ELECTRICAL, PLUMBING, MEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTqUCTION OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANV TIME AFTEFi WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING I HEHEBY CEF;TIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PHOVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIED WITH WHETHEF SPECIFIED HEREIN OR NOT. THE GF;ANTING Of A PERMIT �IS�OOO �].]rj DOES NOT PRESUME TO GIVE AUTHOFiITV TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR IOCAL LAW REGULATING CON- @ STRUCT OF THE PERFORMANCE OF CONSTRUCTION. �P23%.2S Fire SC �IS.SO PLAN CHECK FEE TOTAL FE6 ,�� License SC $5.00 $265.50 SiG AtUpEOFCONTRACTOR AUTHOAi2EDAG IDATE� HEN PROPERLY V DATED THIS IS VOUR PERMIT .-� � � � � d� �� - % SiGNATUFE OF OWNERUF OWNER BUILDER� iDATEi BLO �NSO - pdT NEW ADDN ALTER L] �) [l ConstruchonAddress: Legal Description: Owner Name & Address: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Tel. # Effective 1/1/97 � � ' � � � � � Contractor: �"jQ,��` � Cp.y�3�, / MN LICENSE##�',7c�/� Address: "��,s"�� "'�"'1"1 ��..r��' S S 702 � Tel. # � �'�f Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT LIVING AREA: Len � GARAGE � � Width %(�, � Height-��d�q. Ft.� �'�[ �s `� y � � AREA: Length Width Hei ht '/�� y%�' g Sq. Ft. , DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: ` ; _ _ - Construction T e: �C� � � 3'P i d Fstimated Cost: $ /�' Q�� (F.ee Schedule on Back) Driveway Curb Cut Width Needed: �� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPt_1Ln"I'IONS: $ ,� � �� $ � 7� $ $ �; clCl $ $ $ $ � �� )� Ft. + 6 Ft = CITY USE ONLY Fee Schedule on Reverse Side _� Tel. # � � �% �/ .001 of Permit Valuation (1/lOth%) $.SO/$1,000 Valuation $950 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Detertnined by Engineering Agreement Necessary [ ] Not Necessary [ ] 6 f3U[LDiNG L'ERM[T EEE SCHED[.'Lt: 'I'ite Chief Building Official shall, before issuin� 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 buildin� or stiucture, upoa application therefo^r�, reqt�ire the paytne.qt by the appiicant for such permi� of fees to the amount herein below set forth and in the rilariner herein provided to-wit: � TOTAL VALUE $1 to $500, � ,� , ', $5�1 ' ' i0 $2,00� $2,001 to $25,000 $25,OQ1 to $50,000 $50,001 to $100,000 0 \e $100,001 to $500,000 FEES � . . _ : , ' o _ _ . . .*�. , .. $21 iMinimtun Fee is $21 plus surcharge). , , e �_ $21 for first $SQ� plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,OW plus $i2.50 for each additional $1,0� or fraction thereof, to and including $25,�0 9 . . . . ,�e, .� o, .. . � '$349.75 for fust $25,000 plus $9.00 for each addirional $1.,(�?0 or fractioa thereof, to and including $50,000 $574.75 for fust.$50,000 plus $6 25. for each additional � $1,000 or fraction thereof, to'and incl��ing $1�,(M?0 _ _r. - , ' .- _.• ' -. f `$887.25 for fust $100,000 plus $5.00 for each additional h: $l,��or fraction ther��.to ,and including $5�,000 $500�001 to $1,�Q,000 $2887.25 for the first $SOO,ODO plus $4.25 for each addi6or�al. . •� � . _ • � $l;ppp=or f�acticiri�thereof, `to and inclnding $1,�0;000 * ' � � ; $1,OOO,Q01 and up $5012.25 for the fust $1,OOO,IX?0 plus $2.75 for. each additional $1,OW or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete C�ub Streets Only) :- . ., Alternate "A": Removal and replacement of curb and gutter oniy - Drive�vay width plus 6 feet times $13.�0. Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Pernlits for construction will be issued a minimum of 24 hours from the time of application to allow ior pro��r review of the proposed structure and of the construction site. �� Ceriificate of Survey ot'tlle 1ot, showing the location of tlie foundation ��rice it has it llas heen ce�nstruc°-�.: «�i;? h� rcyuiri:d hcfc�r-e J�r�,c:�cdin�� «�itti thc framin<_i. City of Fridley AT THE TOP OF THE TWINS � i � � ; L �� COMMUNITY DEVELOPMENT DIV. r � � Pf10TECTiVE INSPECTION SEC. � _ �"'1 � CITY NALL FRIDLEY SS132 �"'"� � �'� 612-571-3450 �UILDING PERMIT � �o-�;�� , : NUMBEF NEV • E PAGE O: 9/0-F/5 10/1/O1 � � �AMIT NO. 32207 RECEIPT NO. aJ�'" � ►dvqOVED Br JOB ADDRESS 5179 Horizon Drive NE 1 LEGA� �OT NO. BLOCK TRACT OR AOOITION SEE ATTACNEO DESCfi. lO 9 Carlson's Su�it Manor South Addition SFIEET 2 PROPERTY OWNER MAIL ADDRES$ 21P PHONE Bruce Bailey 5179 Horizon Drive NE 763-571-9126 � CONTRACTOR MAIL AODRESS ZIP PHONE IICENSE NO Sears Home Improvemen� 8823 Zealand Ave N, Brooklyn Park, A9N 55442 763-315-4517 4 ARCHITECT OR DESIGNER MAIL ADDRESS Zlp PMONE LICENSE NO. 5 ENGINEER 8 USE OF BUILDING Residential 7 CLASS Of WOqK MAII � NEW ❑ ADDITION � ALTERATION B DESCRIBE WORK Replace Siding 9 CHAN(3E OF USE FROM TO �] REPAIR PHONE LICENSE NO ❑ MOVE O REMOVE STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be placed over exterior sheathing to protect the interior wall covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved we�ther barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in �heir applicatron guidelines. Cail ior inspection of wrap before covering. SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBINO, FIEATING. TYPE OF CONST. VENTI�ATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULI ANO VOID IF WORK OR CpNSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED YjIITHIN 80 OAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OF ABANDONEO fOR A PERI00 OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCEO. NO OWLG. UNITS I HEFEBV CERTIFV THAT I MAVE READ AND EXAMINED THIS APPLICATION 1 AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAW$ VA�UATION ANO ORDINANCES GOVEFNING TNIS TVPE OF WORK WILL BE COMP�IED WITH WHETHER SPECIFIED MEREIN Oti NOT. THE GRANTING OF A pERMIT �994'77 DOES N07 PRESUME TO GIVE AUTMOqITV TO VIOLATE Oii CANCEL THE pERMIT FEE PROV�SIONS OF ANY OTMER STATE OR LOCAL LAW FEGULA7ING CON• STRUCTION Ofi THE PERFORMANCE OF CONSTiiUCTION �,IH,L . ZS L�C@II $C S�GNnru OFCO TO a NOpiZEDaGENr •TE� �- ME PRI � ��GNO7UNE O� OWNEA��f OWNEA BU�LOEAi iD�tH� BL iNSp ' � OCCUPA STA��S CY GROUP OCCUPANCVLOAD CU FT. OfFSTREET PARKING GAFAGES SURTAX ` $4.74 Fire SC $9.48 TAL FEE $200.47 ) TMIS IS VOUR PEF1 IT /�� D f�6fE NEVV [ ] ADDN [] ALTER [ ] Effective 1/1/2001 CITY OF FRIDLEY (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: �, �9 �-Q r i Zc� �� r- Legal Description: ,�P v/r_�P�,r�J,F- �l e �c QI� �J S� -��- r� � r�� Owner Name 8� Address: �f- ��__ '�,.—; � ,� � Tel. # �('e� -S� � /- �[ 1�2�p Contractor: ��r_.-� 4-�-r,,r•-�� ,,�.��e ,n,� ��-�- MNLICENSE#?.L2C�g��/� Address: ��,,�_ � _ �c>�. .�, Tel. # '�,� - P �4�1� LNING AREA: GARAGE A-REA: DECK AREA: 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 Width Height Sq. Ft Length Width HgUGround Sq. Ft OTHER: _ .-------..._.. _.` Construction Type: ,�eS��/Q - ��F��e�e�� Estimated Co : $ .3 ��l - S 3 `Z j`�� wl��Us Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ - DATE: APPL Tel. # � � .31�- ��' CITY USE ONLY - Call (763) 57Z-3604 for Permit Fees if mailing in application Permit Fee $ �U/• �S� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ , � $.50/$1,000 Valuation SAC Charge $ $1150 per SAC Unit License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ �• !� $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 [ ] � ~ ' �� 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 e�sting 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 FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,0(� $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,(�0 $391.25 for first $25,000 plus $10.10 for each additional $1,OQ0 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 $1,000,0� $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb 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 with 6 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 �_,,� Building Inspections 763-572-3604 DATE (7( J lN SITE ADDRESS S THIS APPUCANT [S: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY Permit N Received By: YOUR E-MA1L ADDRESS �SC�,`�� a7 �(iD �[ C• C.C1Y�'1 ' , . ., � ❑ OWNER ,�CONTRACTOR PROPERTY OWNER/ NAME:�� (a'�., Qj�G,u�,c.a TENANT ADDRESS: � C[TY STATE ZIP PHONE: � L2 � — �� I ^ � S ��O — CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE NAME: STATE LICENSE #_ ADDRESS: PHONE ❑ SINGLE FAMILY/NE� ❑ TWO FAMILY/NEW C Renewal By Andersen 1920 County Road "C" West Roseville, MN 55113 License #20130983 651-264-4777 t STATE ZIP U ADDITION ❑ GARAGE/SHED ❑ WINDOWS 0 BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE O DECK ❑ SIDING ❑ OTHER O SWIMMING POOL TYPE OF WORK: I� NEW DESCRIBE WORK BEING DONE: SIZE OF NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGH'f: ADDITION �❑ ❑ HOUSE ONLY ❑ HOUSE & GARAGE O ATTACHED GARAGE O DETACHED GARAGE RASEMENT REMODELING SUBMIT: t. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl OSoffit ADDITIONS_ & PORCHFS SUBMIT: ❑ Aluminum O Trim l. Site Plan/Survey showing the existing strucdue ❑ Other ❑ Fascia �►d P�Po�d P%I� N,INDp�rs 2. Two sets of consuuction plans IN EXISTING OPEIVINGS ❑Yes ONo LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPEN[NGS-DESCRIBE SIZE OF OPENING CHANGES 8c TYPE OF WINDOW TO BE INSTALLED NUMBER OF W[NDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $�� o I� I—' OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surchazge License Surchazge SAC Chazge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ S,�f� $ $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 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 c6ecks payabte 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 conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an application or a permit and work is not to start without a permit; that the work will be in accordance with the approw plan in the case of all work wh h requires r iew and approval of plans. SIGNATURE OF APPLICANT INT NAME81 �Q,(��, v��nh,� DATE ��/V�Q�