AF - 44917SUBJECT .
City of Fridley � � ? � �
AT THE TOP OF THE TWINS gU I L D I N G P E R M I T
r
� � COMMUNITY DEVELOPMENT DIV RECEIPT NO.
' j L ""' , � / /
r � � PROTECTIVE INSPECTION SEC.
� � _
� � �""1 � CITY HALL FFIOLEV 55432 NUMBER AEV DniE PnGE OF A�PROVEO BY
�""'��� �'' 612-571-3450 910-F15 3/2/95 / /
JOB ADDRESS 1068 Fillmore Court NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE A7TACHED
DESCR. 9 1 Hillwind Townhomes SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Twin Cit Townhomes Inc 1250 East Moore Lake Dr Fridle 55432 572-8872 8269
3 CONTRACTOR MAI� ADDRESS Z�P PHONE UCENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADDFESS ZIP PHONE LICENSENO.
5 ENGINEER MAII AODfiESS ZIP PHONE LICENSE NO
6 USE Of BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE O REMOVE
X
B DESCRIBE WORK
Construct a 27' x 32' Townhouse and a 17'6" x 18' Gara e
9 CHANGEOFUSEFROM TO
STIPULATIONS See notations on plan. Paid Park Fee of $750.00. Variances approved on .
8/15/94 to reduce the front yard setback from 35' x 30' and to reduce setback from
25' to 18'9" for front patios and to increase the width of the driveways from 32' to
36'.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBiNG, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPIICATiON 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMP�IED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT �91fOOl ��FS.SO
DOES N PAESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE Fire SC
PROVIS S OF ANY OT R ATE OR LOCAL LAW REGULAT G CON-
STRUC N OR THE PE O ANCE O CONSTRUC �oN. $599.00 �HSO.00 �91.00
PLAN CHECK FEE TOTAL FEE
Z � License SC $5.00 $1,590.50 + PF
S�GNATUAEOFCON;RACTOAORAUTFIOA�ZEDAGENT IOA7EI WHEN PFiOPER VALI ATED THIS IS YOUR PERMIT
C �i
S�GNATUaEOFpWNEaiiFOWNERBUILDER� iDA1E� -��Sa ^ qaiE
NEW
ADDN
ALTER
�
��
Construction Address :
Lega1 Descriphon '_�
Owner Name & Address:
Contractor: � I
Address: /7_S�7 F_ � �
Effective 1 / il94
CITY OF FRIDLEY �
SINGLE FAMILY AND DUPLEXES R-I AND R-2
Building Permit Application /� � _ ,
, .1 _n n _ � ,�t
�—
LIVING AREA:
GARAGE AREA:
DECS AREA:
OTHER:
J�. Tel. # 5 l Z. --��1 z_
MN LICENSE # ��. �� C/
Tel. # ��7Z_ �-� � 7 2_
Attach to this appiication, a Certificate of Survey of the
lot, with the proposed constniction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length _� Width 32 � Height
I.ength j7_ �� � Width �! Height
Length Width Hgt/Ground
����
s>
sq. Fc. '��' � �„�'
Sq. Ft. 3l�
Sq. Ft.
Corner Lot [] Tnside Lot [] Ft. Yd Setback Side Yard Setbacks
Type of Construction: ,�,� Estimated Cost: $�f��^,_
Approx. Completion Date:
(C t on Back)
Driveway Curb C�t Width Nceded: Ft. + Ft = F –$
DATE: APPLICANT: Tel. #
Permit Fee .
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�
$ �`�9, °U Fee Schedule on Reverse Side
$ �/, �'� .041 of Permit Valuation (1llOth%)
$ �S, }� $.50/$1,000 Valuation
$ jj'S�. �'° $800 per SAC Unit
$ g, '=�' $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ �750 .� o Fee Deterrnined by Engineering
$ Agreement Necessary [] Not Necessary J�
D, S
$ � � `/C. �C%
. � � �
.� '��' ��
.
a
rn
rn
T
�
�
�
c
l�
�
C
�
>
�
w
\
�
0
�
`
Z �+�
�
g oJ
Z �
� �
� �
Z V
J j
O o �
vZ w
�
Z (� Q
1= � Q
W � m
_ } O
� �
a z.
�z
Zo
� �
az
�o
�U
�
O Q
ao
O a
LL Z
O �
Q
U �
a�
a�
�
0
Z
O
U
w
a W
� Z
Z �
� N
Q
Q ' n ui
� � � O
� � � M
�
U � li ii
c a
.� � �
m � c
L 0 l0
'� U Y
U
3 � �
� U u►
� � Y V
O � � �
±+ � (C �
3 � �
N U � C
a c� � �a
� �_
� � � �
0 o m •-
o � �' a
�
�
� � m �
.Q N '� f�
Q C � U
c Q
���
Y � � �
� 3 o u,
� N +�.+
�c -
a o p �
�a �
� o � m
� �� �
.� '�
_ m
d
c c
o� m o
i � +t-� �
c d a�i �
� � � N
m d � a
�- N i i)
�
�
� �
1
�
�
0
Z
t--
� �
< a�
S W
S a
� .
(� - J
� -
� �
� �
�� r
_� Q �
r3 0 0
t � U
� N
� �
� �
Z
Z � �
O m W
� �
Q � a
H �
0
� �
m
� o °o,
0 0
N r
� �
�
N U
C �
3 i
m � ,�
U
Y � 3
3�,m�
� � � �
� ` O �
� lL jL m
� d ` �
�
m
c
Z
� � � d �
C V N � Q
d � Q � d
w � N �
��a cs
Q
�
m
�
o _ �
= O p
Z w �q�
N J
m � m
� �
m =
O °
U
m� �
� �.
U� � '
7
9
O .
t� tfl � t� t�
o °o, o
0 0 0
T T r
� �. �
d
�
c
�
Q
N
�
c�
�
0
N
aa
�
�
N
�
Q
i
�
c
c
O
'�
c
/0�
V
Q
�
�
U
Q
m
z
0
�
J �
��
a�
c
o �
;�, o
� U
m c
Q �
� �
�
'� o
m m
7
H ;�
m �
L 0
Y
O o
Q �
O
�
0
� �
'�O Q
C 0
=
� m
3
.m >
�C O
G \
o �
U
�
0
W
0
Z
N
�
�
_
m
�
Z
m
�
t-
m
C
m m
� J
. \(1
�
d
�
t W
i W
� �
cn Q
� o
� �-
�
�
�
S
�
O
U
C3
Z
Q
W
_
� . �
�
�
l �
� �
0
lG
c
�
0
Z
m
�
�
�
0
C
i �
�
0
; �
A �
m m
-a >
c �
� �
fn Q
0
0
0
M
�i
W
W
�
Z
O
F-
U
LiJ
a
�
Z
W
�
z
O
z
O
Q
U
�
�
>
Y
Q
�
�W
O V
,� a
wZ
o �
��
U Z
m W
~ U
�
O
J �
W
� �
�
0
�
3
� L
� �
� �
� o
� �
� m
� �
O
� O..
U �
lC C
a 'c
� o
'a
o �
C
C O
U �
� �
O
N N
O N
O �
C
U �
Q 3
�
�
T
�
�
c
�
�
C
O
U
�
W
�
�
Z
O
�
U
W
d �
� Z
Z �
�- Q N
� �
� H �
� m Z �
� � � O
O � � r�i
�r {
C� � N
' U c�o ti �
�7
�
�
�
�
�
�
�1
�
�
W
�
�
°a
m
O
�
J
Q
F�-
O
E-
w
Q
�
9,-r'
rn
rn
T
�
N N
L � ,��6
i V 4► �'.
3 � Y � �
m � � m � �
t N «' O
o +� -C V �1 c�
.� L'+�
.= 3 � � _.a �
N U V i �
Q � � �
N �
� -a � �
'� U NL C
C U y � �
O t� � ' � �
O
U � C 'Q
Q. N � �
� C O N �
� O ,tll L
� C �
� 3 0 •
�
T
a O � m V
a�:°�
s�m� �
� .� � � �
m � 0 � �
.i � � � �
� � C Q
� � 2 L �
m m-a� 3
L Q. G C
f- u, ca � O
�
�
�
�
C
�
m
I
� �
�� �
II � �
I� O �
I , Z �Q`
1- � �
I �
� �
W
n.
�
�
�
z
a
�
o U
U �
� Z
� r
� m
N ?
W a
� Q
O
.,.
g g� g$ o� o g o 0 0 °o
ti�����:�oi:cioo ,ri
������������ �
z � I I I I( I((�I I I? I
N
�
�
� m
3
oaC 3 c t� �
W � c � � '-
� V N, m
� 3 �I`� am� c
Z N C ��� W � N
�
� ' � � ►-.
� d c' � R= ��a � c' °' �
Z 3 C Q m �+-d� �j Ni N N� N 3
�p � Qy�m 2� �►-__ � ��° d
�` IL O� O � 7 Q L L l. � Q Q
� � ` ..V. _ � � +' .� M rA V A
� d—�3�a�s� ~
a Z O m oo U o[ cn � 3� c� C� m
��^ �
1
�
� '
, I
� � �
� o �
p c I
Z ►i �
� I I
I
i
m -�
0 �
w o
Z Q
� p
cn a-
•
�
z
0
F-
�
�
Q °'
�
� o, �a
Q C i
lC
� Q �
d
�
►� `o v�
O ¢ d
� � I�i
� Z O
,� a �
o � �
W
_
Q O O
� J o
� � T
LL
�l
�
w
w
�
Q
�
H
_
_
CITY`OF
FRIDLEY
FRIDLEY MUNIC►PAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 5543? •(612) 571-3450 • FAX (612) 571-1287
June 9, 1995
Twin City Townhouses Inc
1250 E Moore Lake Dr NE
Fridley, MN 55432
Re: Final Inspecdons at 1067, 1071, and 1075 South Fillmore Circle NE, and
1068, 1072 and 1076 Fillmore Circle NE, Fridley
Dear Sirs:
A final inspection was conducted on June 8, 1995 for the above noted addresses. We found that
the construction of the building complies to the best of our knowledge and belief, with a�l the
requirements of the buiiding codes of the City and the State of Minnesota relating thereto, and
permission is hereby given for the oceupancy of said building.
If you have any questions on this matter, please feel free to contact me at 571-3450.
Sincerely,
�r/ ��
BARR RIESCH
Bui�ding Inspector
: � ��
♦ a.., t
SUeJECT
c;ty of Fridley
,� 57�-���� T"E TW'"S g U I L D i I� � P E R M i T
� ; y _���� COMMUNITY OEVELOPMENT DIV.
r � � PFOTECTIVE INSPECTION SEC.
1 . �
i----�� �"' �'� CITV MALI FRIOLE� SS�32 NUMBEp
i 612-571-3450 9t0-F15
�oe op ess
1�6� Filimore Circle NE
t LEGAL �07 NO. BLOCK TRACT OR AODITION
oesca. g 1 Hillwind T�w
2 PROPERTY OWNER MAtl, ADORES$
3 CONTqACTOR
Ton Gun In
1 ARCNITECT OR DE
5 ENGINEER
6 USE OF BUIIDING
Residentia
7 CLASS OF WORK
8 �ESCRIBE WORK
9 CHANGE OF USE FROM
STIPULATIONS
ER
MAIL ADORESS
MAIL AODRESS
REv
OATE PAGE O�
12/31/98 � �
ZIP
IIP
ZIP
PMONE
PHONE
28794
AVPROVEO BY
SEE AT7ACMED
SHEET
UCENSE NO
��7 1
UCENSENO.
IICENSE NO
O NEW ❑ ADDITION � ALTERATIpN � REPAIR O MOVE O REMOVE
TO
Call for building wrap inspection before covering.
SEPARATE PERMITS ApE REOUIREO FOR EIECTRICA�, P�UMBING. MEATING. "`�. �v..�
VENTI�ATING OR AIF CONOITIONING
TMIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONS7RUCTION ZONING
AUTHOR�2E0 IS NOT COMMENCED WITHIN 60 OAY9, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANOONED FOR A PERIOD OF 120 DAYS AT �
ANV 71ME AFTER WORK IS COMMENCED. NO DWLG. UN�7S
I HEfiEBY CERTIFY THAT I MAVE iiEAO AND EXAMINEO THIS APPLICATION
ANO KNOW TME SAME TO 9E TRUE ANO COFRECT. All PROVISIONS Of LAWS VALUATION
ANO ORDINANCES GOVERNING TMIS TVPE OF WOFK WILL BE COMPLIED
WITH WME7MER SPECIFIEO MEpEIN OR NOT. TME GRANTING OF A PERMIT y�SOO
DOES NOT PRESUME TO GIVE AUTHORITY TO v10lATE ON CAMCEL THE pEqMiT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGUTATING CON- b
STqUCTION OR TNE PERFOpMANCE Of CONSTRUCTION q� 1.00
S�GNSTUFIE O� CON'PACiOQOp AUTMOQ�LEO �GENi IO�TEi
��GN4TU�7E OF OWNEQ��� OWNEABU�IDEp� �O�TE� . �
STA�LS
ROUP OCCUPANCVLOAO
CU FT
OffSTREET PARKING
(GARAGES
$.50
SAC CMAFGE
Fire $.50
TOTA E
j IS �R P�pM
. L � ��
r��tE
NEW° � "[ l
ADDN [ ]
ALTER [ ]
ConstruciionAddress :
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
,
Effective 1/1/98
����
�
Legal Description:
Owner Name & Address: � � � _ Tel. #
Contractor: %��G� J��_ MN LICENSE #
,
Address: � /�,d Tel. # ��-S� S d`f
�tach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length Width Hgt/Ground
OTHER:
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: � Estimated Cost: $
� � • � (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ^ �i $ � �APPI:ICANT: � Tel. # �� ���
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge .� �
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer'Main Charge
TOTAL , .
. STIPULATIONS:
�:
�Q
$ � '
$ � S�
$ � S�
$
$ S^ � °
$
$
$
$
a��
$ `
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 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 [ ]
� �
�
)
3 �
o ��
)
� �
U � /
J �'"�
H
�
�
w
G.
�
Z
H
�
�
Q
�
0
Z
a
�
Z
m
�
J
G.
�
O
LL
Z
�
F
a
v
�
a
a
a
�
N
N
G1
i
N� i
m
�
�
l0
f9
� �
� ° m
O Q �
V ;�>:;;;.:;:::::;,
u��'4'�I
:�::<;�.
ta..,,�
z ,��:�>�
o . .:
�
� Q C
-i o �
FQ,,, U_ �
Z
-� s;''�.v,•:4:i::
L!1 �::. C
m :::L:;>;�
�;;>.<:>�
� 'G1:>:LL
h_ ._.
�
� � �
? � N
H � ~
x
LL vti::::
o : ,..:<::�
Z o
� . J�,, �
� '•E .i::i;ti�`;z:
� ti
� �
N
Z r'
O�
— i
U �
Cll �
� W �
Z Z
N c�
•�QM� -
� :Z` � o
Z � � �
� � Z M
u-'c�ti
O � >. us
r � � M
t�- �''� :° in
(,i (fl �.L. v
C
�
++
C
v► � �- N M d'
O � O O O O
ci� m ti u. u. �
0
�
�
�
LLJ
�
�
�
Q
m
O
�
J
�
0
w
�
0
z
i!i
L1J
Q
�
�
�
�
X
ti
i�
z
m
�
J
C
� N
N � U
L a r°-
Y V N
3 �' � �
N V �0 �
� �% � p
` � L U
O +� Z}
y � N C
� '3 N N
� � N
d C N w�''
� co -� m
� T �
O O � �
V � O
O � t N
c"a �i v .�
U '� C ¢
a �, `° �
o- c c
� " O N
� O !n "�
>
m 3 � c
E� m�
� ° � �
a� � �°_ u
L O m C
� o
'� C y �,
� N w N
y
� � a c
�. N
� � � a
7 4= � +�..3
L Q C C
f- u� co m
T
O�
0
N
�
�
�
V
�
F-
�
�
u
a
'.
�
'� �
�. � '
y 8
q� N �
V Q
� � O
N U
� � �
rn �
� � N
� � �
O m �
�
Q
O
�
4 �
�
m
�
Z <o
J C
L11 �=-
F-- �
m
d fO
� o
c
L
N �
�
.� �
z
a
�
�
U
�
Z
m
�
�
J
o.
�
O
�
0 0 0 0 0 0 0 0 00 °°° °
0 0 0 0 0 0 0 0 0 0 0
r� v ui � r� r� t� o r� o ti o �
� � � � � � � � � � � � �
� I I
I I � �
II
lill o
Z
.�
N
�
}
�
�
a�
�
v
� U �
� C �
X Y � � # �
C •
!1- � f6 d U f9 G
3 -�p ~ Q � (� �
Z `' m � � w ' ay
vl � c�in C`•� � y 4; �* L%-
m m �
X a�i N� m�0 � t= _= c�o 2` ��
�,., o O�� Q oc o
n � � � n.
O L 3� c�� m m� m m t-'
Z O m m U � � � � � � � °�
�v m
m .o
� �
W �'
Z O
� a
N Q
•
� • ��'
''i
. �,
, .
�
Z
O
�
w
J
Q
� U
Z
Q (Cp
� •a.
Q Q
�a a
d � �
O � �
ti Q
� 0 w
O
Lt- a �
�
� W 7
v = O
NO�
� J �
� Q �
a�
rn
c�
U
�
�
N
�
�
W
W
�
J
H
�
W
�
�
Y
Q
lY7
Z
O
0
�
Z
r
Z
w
>
z
�
0
�
Q
�
11.1
J
Q
I--
�
Q
a
0
�
� o
�
U
W
�
U
S
�
�
�
a
0
W
�
�
�
�
W
m
_.l
J
Q �
_
�
�
Q
Z
O
F-
�
' m
O
U
ADDRESS
PIN
LEGAL DESC
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�i-36u4 r�aa�:
: 1068 FILLMORE CIR NE
: 243024320093
: UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : PLUMBING
PROPERTY TYPE : TOWNHOUSES
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL A GAS WATER
i HEATER.
'# ELEC WATER HEATERS 0 # NEW FIXTURES (EXIST OPENINGS) 0
S"/1-1Lif7
.
�_.....� _ _.... _ _ .
PERMI NO.: 2004-01330 � =
DATE ISSUED: 08/13/2004 �
# GAS WATER HEATERS
# GAS RANGES
VALUE (FOR MINIMUM CALC)
APPLICANT
TIMS QUALITY PLUMBING INC
523 CENTRAL AVE
OSSEO, MN 55369-
(763)571-0454
ZARKIN JANICE E
1068 FILLMORE CIR
� FRTbLEY, MN 55432
1
0
700
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 know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor}
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
regulating cons�uction or the performance of con�lruc�tion.
Bldg Insp
# GAS DRYERS
# OF NEW FIXTURES
# WATER TRMT APPLIANCES
PLBG PERMIT MINIMUM FEE
PLBG FIXTURES (NEW OPENINGS)
PLBG FIXTURES (EXIST OPENINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 8944
SEPARATE PERMITS REQL7IRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
0
0.00
0.00
0.00
0.00
0.00
35.00
0.00
0.00
0.50
35.50
�-
��
J
From: unknown Page: 4/10 Date: 9/22/2009 9:35:49 AM
Building BUIL�IN�
Inspections ���'�ENTIAL A,PP��CA,T�UN
7b3,s�z-36o4 C�7'Y OF FRi�3L�Y
76�-502-4977 FAx �F�y�� � ��9
�nTr: yiia►o�
SI7'E ADDRESS �
'I'H13 RPpL1C'ANT IS:
PItdP�R�'Y OW
T�NANT
SUBMIT A GOFY OF
Y�UR S'1'ATG UCGNSE
AND CERT1FICnTE Ar•
INSURANCL
PROPERT'Y TYP�
PEltMIT
�.r i U l� `6� ,
❑ UWWCR �1NTRACI'OR
NAMr;
NAME' J� Kl
s�r�•r� �.,csKSE
O SIMGLC FAMILY/NFW C�NSTRUCTION
C1'I'wC? NAMILY/NCW CONSTRl1C'f1tlN
G 9A5EMENT F1NIS11 6'a�ON
0 DECK O �dING
0 SWIMM
.._,��'�'�pIC�!��
n� .
GXP DA F
� CI7Y„�i
r•ax R'�
SI7,E��_
8'MRIF:3
p wlNnOwS
C7 OttAIN T1LE
O QTH�R
TYPE OF WORK: 0 NEw HOME CONSTRUCI'tON D aDDITION
O'F�IatNTI:NANChIkFrn�R O RRn�c)pEla
DESCRIBE wORK BEING DONE; � G
51ZE 0� 1MPROVBMEN7 4ENG'!'t�l • W1I
NU� M�BER OF SQUARES �� �FIOUS� k GAttAGE
���
PROPOSE.ri 5lZE:
PRQt'OS�A HEItiFlr:
S1DlNC
�' diml
O Aluminpm
O�
�
1N �X13TINC; nP�NINCMS DYes ONn
OR FOR NEw OP6NINGS-D�SCRIBE SILF:OF
UrEN[NG Cru►r�ES �
O nTTnCWEd OARAGt
D ��TncHr•p GnRnGF.
Perrnit 1Vo.
Recoived gy: 1�
Date R��D � � P �
A_A9XMI:NTREA�1pp�1�IT1� U��MI,I•:
l. Ez�g�mg Floor Plan
2. Pro�w+ed floor plen
3, Lisl of swcurtal membcrs to bC used
FOR NEW CUNSTRLIC7'IpN INCLUDING DECKS,
DSoflii AODITIATIS__ � pp�}�ES SllAM1T:
O Trim I. 5ns PImJSurvey showm� the exisiing wrucWrc.s
� �o�c+o and proP� t�'J��
2. Tun► seu ef mnenuc�ion p1an�
3. Energy Calc�fations
I.�X'A'T1qN Qf WIN WWS
ALl. FEES ARE BASED ON VALUATIQN, INCLi►D[NG THE COST OF LABOR AND MA
USING 'y"H� 1997 U.B.0 F'EE SCHED(1L�)
.10� VALUATION S �� ld rI . 7� OCCUFAIYCY '
Plsn Raviow
Fire Suroharge
$urcharge
Licenso Sureherge
SAC Charge
Curb Guc Escrow
Erasion Canwl
Psrk Fae
5ewtr Main Cherge
S f iS i,� S Sce Bnck Page for Fee Schedule
S 65°!e of �uilding Permil Fee
S , .00! timas the tatal job valuation
S .00OS x Pormit V�luation Minimam 5.50
$ fi t�(� SS.00 (State Licensed Residentiai Contractors)
S $2004 per SAC Unil (Plans w MWCC for determina�ion)
s �fl+�ft= ftxazi=s
$ 3450 Cpns�rvation Plan RcviEw
S Fee i7etermined hy �ngineering
$ Agroement necessary { ) Non Necessary ( )
$ n. h iNa4e eherks nevs6le to: Cltv af F�Idl�v Attac
'I'HIS IS AN APPLICA'flO1V FOR A PCRMIT-NO'C vALiD UNTiL PROCESS[D
1 btrcby apply for a building permit end I aeknowledge that the information above is complete snd accu�; Uiat the wurk will bC in
canformanoe wilh thc ordinanees and •COdc� of the City of Fridley and with the Minnesote Cpnstruction Codes; that 1 undersrand this is not a
pertnit but only an application for a permil end wo�lc IS rrol lo stall without a permit on site; �h�t the work will be in accordance with the
approved plan in cha eass of all work whicl+ requ res review and upproval ot pi ns.
SIQNA'I'UR� «APPLICANT �_:�i'�%�'�. ��,��t'�AME �� � PATC.`-11�p�D !