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PRE 2010 DOCSSUBJECT City of Fridley _ AT THE TOP OF THE TWINS BUILDING (M1076 PERMIT � T COMMUNITY DEVELOPMENT DIV. rr ______PROTECTIVE f INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBERREV DATE GE OF APPROVED BY 612-571-3450 910-FIS 6/20/00 P — JOB ADDRESS 1140 Mississippi Street NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. N J of 9 Auditor's Subdivision #88 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Keyland Homes 17021 Fish Pt Rb Prior Lake, MN 55372 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Keyland Homes 17021 Fish Pt Rj) Prior Lake, MN 55372 428-8900 xxxxxxxx 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK NEW O ADDITION O ALTERATION O REPAIR O MOVE O REMOVE B DESCRIBE WORK New Single Family Construct a 48' x 28' Dwelling and a 19' x 22' Garage 9 CHANGE OF USE FROM TO STIPULATIONS For stipulations see attached plan. Submit a verifying survey to the City before capping. Provide sod in the front and side yards. Provide a hard surface driveway. WARNING SEPARATE PERMITS REQUIRED FOR: ®efora digging call for WIRING HEATING all utility locations MOM AND SIGHS 4540002 REQUIRED BY LAW SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING 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 FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO D UNITS OFFSTREET PARKING iLG. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION It SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED / c"� WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT , 0 �' !Od $86 .83 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGEFire SC $173.6. PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTIONSHE PERFORMANCE OF CONSTRUCTION $1,408.00 $1 100 .00 -,' PLAN CHECK TOT L FEE C/(J f:;gL Pa s 9� 77 55 000 $3,523.00 S- y OFCON• AC UTHOWZEDAGENT iDATEt HE ROP VALID TE THIS IS Y UR PERMIT i r ' $GNAIURE O� OWNEA,�F OWNEp BUILOEfI� iOATE� B G iNSp gArE NEW c(/—,.Tc'%�rY Effective 1 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 BU ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION /l Q Construction Address: 1ISSLSS I'lo e/ -S FL Legal Description: ZU K2 2�E AoT `T s "W Owner Name & Address: _ fS �► P ,�� /.� �,��� �o �-- Tel. # Contractor. 'Lj MN LICENSE # AMIftE / 5Y3 Address: F v- L to f Tel. # '%yD q00 4aS-Flo o Attach 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 Sq. Ft. GARAGE AREA: Length Width LI, Height Sq. Ft. % /9 DECK AREA: Length Width HJt/Ground Sq. Ft. OTHER: [� /'Gi'D 4S em or 16pq SQ 675 Construction Type: jV S'e le V%" ` r Estimated Cost: $ d f 49 Driveway Curb Cut Width Needed: /b Ft. + 6 Ft = Ft x $ _ $ DATE: -3 —c;2 7'6/)69 APPLICANT: Tel. # CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $ Q� $.50/$1,000 Valuation $1100 per SAC Unit $ , O $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ 74Z.00 Fee Determined by Engineering snct $ Agreement Necessary [ ] Not Necessary [ ] yf� EXTERIOR ENVELOPE AVERAGE "U" COMPI.ITATION OWNER: DATr: SITE ADDRESS: -00 ' WwsS s1Pgk S�( PHONE:- CONTRACTOR: HONE:CONTRACTOR:PLAN # Determine working square footage of each 1. Total exposed wall area..sq.-ft. x .11 = 2. Total roof/ceiling area..... 1(,o4- sq. ft. x .026 = ��• Z Total exposed wall area above .floor= Z Z(oQj a. Total wall window area ........................................... 2.0q 4 b.' Total door area .......................... ....................... SS • i c. Total sliding glass door area .................................... 31jr9 d. Total fireplace wall area .......... ............... ............ e. Total wall framing area (average 10%) ............................ 2Z&P-V-.� f. Total rim joist area ... ........................................ ZZ91 Z g. net wall area above floor .................................... I'l4'L�,F� h. wall area above floor ..................................... i. wall area above floor ....................................., j. frame wall area at foundation Total exposed foundation area= IUI..Z k. Total foundation window area ...................... 1. Total net foundation area above grade ............. to(--z- Determine "u" value of each wall segment (e.g. window, door, each separate wall section) a. 2o4, 4- X ��U„ � � _ � ,0 b. X "U" . d. X X "U g. 1 X flat . 044 h. X "U" - X "U" _ X "U" _ X "U„ _ • j• k. 3. .................................Total = 144.A' If item 03 is the sar as, or less than ite- #1, you have met the intent of SBC 6006 �." TOTAL EXPOSED ROOF/CEILING CALCULATIONS: Total exposed roof/ceiling area.,,,.,,, 11:64 sq ft j) Total skylight area...... sq ft x "U" a k) Total roof/ceilinq framing area (Average 16%)..... ,4' sq ft x'"U" 1) Total net insulated roof/ceiling area....... ! sq ft x "U" . �Z� 2� •� • TOTAL j) thru 1) If total of vli is the same as, or less than tit, you have met the intent of 2 `.iCA_R 1.16005 -k and 0. ALTERNATE BUILDING ENVELOPE DESIGN To utilize the total eriyeIope system method, the values established by the.sum of items .-'3 and ,-"4 shall not be nreater than the sum of items #I and u2. E + 2. wc: I -�,% o� moque tit I area -6)r fYarr2 CL�si�r�tC� ior% 0 rAsmc FIG. #1 Si Lx.. I<-E-4Ls, W�eLL PRAM� wA L L f � Y y � D � r w� • . r r�.:43 L �� 0 R- VALUE CONSTRUCTIOI,�,- FRAMING - - 1. INTERIOR AIR. FILM 0.68 2. 2 GYP89- .4 3. 5 1/2" SOFT WOOD -6.87 4. 2S 3Z'_ g %.A.Va m . o 5 . SIDING - lg%( -. , 21 6. Ey TER TOR AIR FILM 0.17 TOTAL = ID.44 U= . ot5 UNA I. INTERIOR AIR FILM 0.68 2., *1/2" GYPBD .45 3. 9" INSUL. 19.00 4. FucpVjTE - 2 -oto S. SIDING-- Y, ta-t .2 t 6. R AIR 2Z • 5, U= • 044 I. INTERIOR AIR FILM 0.68 2. 6 ZNSUL. 19.00 3. JOIST 1.89 4 • SOLii TF- 2.01y 5. SIDING ,µYL-•. •21 6. P=IOR AIR FILM 7f7 U= . 0 4l BLOCK I. INTERIOR AIR FILX 0.68 2. 12111BE-Ml< 1.28 3 • u�.SP�rc�tas,l to.c 4. 'SPRAY - Fob _ 5. 6. EXTERIOR AIR FILM 0.17 TOTAL R= 12.1', U= v Sz SLAB ON GRADE f r - r - IL 3 NOTE : INDICATE TYPE, "Rrr VAUM. DEMV, AND PLACEMENT OF INSULATION. ROOF -CEILING HEAT FWW uUP FIG. #5 HEAT FLAW UP FIG. #6 NQN-VENTED HEAT FLAW -. UP ' FIG. #7 2. 58 3. j►.1�VAT .y 4- TMAL �►r� �i�.r--t , cPt A5• E5 U = OZ! e I 2. 3 • Z -l- 114SULATicn4 3�.6 4 . lei TZ.l t�iL, A,,M. -_—rj _ V 1 6. 1,-, U 2. 3. 4. 5. A 1. 2. 3. 4. 5. r U _ 1. 2. 3. 4. 5. TOTAL U = NOTE: USE ADDITIONAL SHEETS IF ?'ARE SPACE IS NEEDED FOR DETAILS AND CALOMATIONS. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** NO. RATE TOTAL 15 W Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance JOB ADDRESS 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 Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. 0 Ownerl ey I(Wd AVM �g / Building Used As Estimated Cost PERMIT NO. State Surcharge $ .50 TOTAL FEE $ PLUMBING SIGNED Approved By an ?luIV W �lC�✓'G J TEL No. -/&3q, 3 � � - �l3L) Rough -In Date Final Date �1J COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existina combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No ( ) When installina a new venting system, 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 Furnace 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 Type and Size/Common Vent and Vent Connector Information 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 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 ALTERATIONS: (Describe) HEATING CO: Signed By: Date : COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No ( ) When installing a new venting system, 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 Furnace 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 Type and Size/Common Vent and Vent Connector Information 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 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 L_enggtth� ft Diameter in Type r ALTERATIONS: (Describe) J � =�4' (i`< -d CLQ OR Fireside emw HEATING CO: Lk�e 020090911 Signed By: CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work Effective On January 1, 2000 Skit _ JOB ADDRESS I i`�-� IS��S�� S►�L�l QE OWNER Rate TOTAL BUILDING USED AS���A 41� $ 30.00 $ - ESTIMATED COST PERMITIZi.N „. _w Z 41,2 $ 10.00 $ 10.00 $ DESCRIPTION OF FURNACE AND OR BUk" ��`�� / No. of Heating Units / Circle One (Steam) (Hot Water) (Warm Air) $ 10.00 $ Trade Name !=:kJ=l,lU Size No. DO - BTU �47, CTC -,Q) HP EDR $ 25.00 $ Fuel Q (I— Total Connected Load State Surcharge TOTAL FEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. $ BTU HP EDR $ 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 an $ .50 rulings of the Building Division, and hereby declares that all the facts and $ �S representations stated in this application are true an correct. DATE HEATIN CO / Signe TEL # �0� Approved By -4 Rough -In Date Final Date 0b SEP 28 '00 02 c 37PM KEYLAND NORTH � /D A �� P.1 Certificate of Sur ey for' KEILM D HOMES 1140 MOSSM"I W aW-m CueNT—LANE Q&A.H. N0. 6 (WSE=PPI STR�ETj 75.00 R mai EM W SDENAIX • .'r I � � a 790 I aaa= T 3 � I L. V 1 tui PAWWAY N BaA9 I I A I I M. V V ICS • { V I+ ia�is • Mara I Ole, j OIi6 I ie lase ao-..—a 79.E f. � . o e l I N r + ' l� z � I Q • SIi7 ' ` s� Lg ' I o I esasmaa 7 a �• I f I�.7Im.A I v L� � = Base ism" I wo al - X" . I o I eeA, I .� • z "ata 11 e I I P X15 11 own" SNED+N easelk �D �Tq+'t6L► U1WTM �' 75.00 =4% amf R MSM 9-25—•00 AS—BUILT Baa we cum maNta Pae Ovum PLW an N■mR mlulxe mP�ae.e flNhM ARa iaa ' w MWOo< ue� • 'eumAe n mYO�als� jIIp1Azca"I roR m�em�a.tie � 4016 NNit I'm 1 aI a4.4 W QaagAT !>O4.LNC NOS . Plwt a Nm Ta 11Lvomm or 7m ani m OM MGM, T Nm PupaeRT W mm 24300M oA01 VON 1 aast�a na ateee� wnc "m eattaec,ea no % a fiam tr elan. Nem E940li6 SMAN MS SAME W AM 49LOO RAIN WC-RMWW W CERTIFY TO NMAND HOMES THAT TM IS A I= AND CORRECT RBPREBENTATION Of A SUS Of TME BOUNOAMM Or. 7he1 pm{ Af tM NorBl enrltd"01 of Let 9fAYDROR'9 SUIaIMSfON Na BB Iy6tg Eget of Urc west eB,oa feat of saw ¢at to 5 ad Wareef ae fGe and of eco Fn 1h. o1Re� of Im Regwltar of Qeada in aM far AnWw County, WlMwola . IT OOES KOT PURPORT Tb Slm MPRO14ammu OR DwmD Qam% Can AS'SMOL AS w MEM WO BY NE GPI UNOER MY May SUPERM M " 3.DAV Or MARCH, 3000.. � F=ML+•■2n1 •' I 'L," .3t 0A , �..+ S.••rr •tri E 'rl V41J INSIM VA Uwe Bees JNe4,I M NOUSS ELEy_ iMON LOWR ROOK D"AMOM TOP 13F Mm ELEVATION: 1^7 MAGE BAs ELEVATOM . AMU TO O LOOKOUT ELEVATIONr t mm 000,o Immm nmu" C eem I DOM vaauam gLMTma _ quanta ee amm Am utm K4%vw a, mm MAWAK PLOW Pae MM • —PI•— E4 m s a stt MA en' y /PhOP m EN P.A. __ e CITY OF FRIDLEY INSPECTION DIViSION' 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Rate TOTAL Furnace Shell and Duct Work,;Burner - k Also Replacement Furnace $ 30.00 (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) Gas Range $ 10.00 $ Lb Gas Dryer $ 10.00 o� $ *Air Conditioning - All Sizes $ 25.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work _ $ Commercial/Industrial 1.25% of Value of Appliance or Work $ State Surcharge $ .50 TOTAL FEE $ &D'SZi MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT _IS ?_5.00 4A9 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr JOB ADDR OWN Effective On May 10, 1999 V — BUILDING USED ASt��ub'JL ESTIMATED COST PERMIT NO. DESCRIPTION OF FURNACE AND OR (BURNER / No. of Heating Ynits Circle One (Steam) (Hot Water Warm Air Trade Name Size N . BTU HP EDR Fuel .z — Total Connected Load "I L, U -Un Burner Trade Name BTU HP Size No. EDR 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 an rulings of the Building Division, and hereby declares that all the facts and representations stated in this application are'true and correct. H EATI P Signed *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date '2d'co written permission from adjoining property owner. 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes () No ( ) Yes () No ( ) CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No ( ) 2. Is free from rust or deterioration Yes ( ). No (' ) 3. Has no foreign objects lodged within Yes () No ( ) 4. Is securely supported • • Yes O No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes () No ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater 8. Has combustion air been provided for water heater Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: Yes () No ( ) Yes () No ( ) CIIYOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 September 28, 2000 Key -Land Homes 17021 Fish Point Rd SE Prior Lake, MN 55372 Re: Final Reinspection at 1140 Mississippi Street NE, Fridley, MN Dear Sirs: A final reinspection was conducted on September 28, 2000 of the above address and the following item was noted which is still incomplete and which must be completed before the structure can be finaled out; Provide sod in the front and side yards by June 15, 2001. The structure is approved for occupancy. We will expect the sod to be installed on or before the scheduled date and a reinspection called for. If you have any questions on this matter, please feel free to contact me at 763-572-3603. Sincerely, RON JULKOWSKI Building Offs ial - SUBJECT City of FrialeyqP3205 AT THE TOP OF THE TWINS BUILDING PERMIT 11-1 r ' ' RE COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 572-3604 4 1 . � NUMBER REV DATE PAGE OF APPROVED �� CITY HALL FRIDLEY 55432 612-571-3450 910415 8/2/01 7 JOB ADDRESS 1140 Mississippi Street I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. N1/2 of 9 Auditor's Subdivision #88 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Monica Lane, 1140 MississippiSt., Fridley, MN 55432 763-572-2524 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Monica Lane 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK IN NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Deck 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS See notations on plans. REQUIRED FOR: WIRING PLUMBId AD SIGNS WARNURD Before digging call for all utility locations 454-0002 REQUIRED BY LAW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED 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 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $3, 036.00 $1.52 WITH WHETHER SPECIFIED HEREIN OR T. TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHO IT TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE P ISIONS OF ANY OTHER STATE R L CAL LAW REGULATING CON- $97.25 Fire SC $3.04 RU ION OR T4E PERFORMANCE C NSTRUCTION I � ` PLAN CHECK FEE TO It FEE Y $101.81 SIGNATURE O�CONCRACTOR OR AU ORIZED AGENT (DATE, ENRO VALID T 'THIS IS YOUR PERMIT 45z BLO ,NSP pAfE _ S-GNATURE Of OWNER,6 OWNER BUILDER, IOATEI NEW I l Effective 1/1/2001 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: ? '; ` t�� J ` PP Legal Description: Owner Name & Address: a 'Lo Tel. # Contractor. W'f- "cc MN LICENSE# Address: Tel. # Attach 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 Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length ls.` g Width 17. Hgt/Ground 7, Sq. Ft. OTHER: Construction Type: Estimated Cost: $' d3`. 00 Driveway Curb Cut Width Needed:t. + 6 Ft = Ft x $ _ $ DATE: 00 " APPLICANT: �% `` Tel. # CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ 7. *S-, Fee Schedule on Reverse Side -- - $ .3.0 .001 of Permit Valuation (1/10th%) $_ A S'Z— $.50/$1,000 Valuation $ $1150 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 [ ] $�-