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PRE 2010 DOCSSUBJECT ERNO. ' City of Fridley 13796 AT THE TOP OF THE TWINS BUILDING PERMIT r S R IPT N COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 1.J 612-560-3450 910-F15 10/1/76 JOB ADDRESS 5620 North Innsbruck Court 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 19 Innsbruck Villages SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Darrel A. Farr Development 7286 - 72nd Lane North, Npls. 55428 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 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 Xf7 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct_a 24' x 34' Townhouse and a 14' x 21.5' Garage 9 CHANGE OF USE FROM TO STIPULATIONS provide adequate light, ventilation and combustion air. SEMATE PERMITS REQUIRED F00" WIRING, HEATIN% PLUMBING AND SIGNS.' TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame 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 R:_1 9540 18,774 Total ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING 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 SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $24,710 $12.36 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $75.10 $350.00 PLAN CHECK FEE TOTAL FEE Al 8 456.24 SIGNATUREOF+ONTRACTOR OR AUTHORIZED AGENT MATE) EN PRO RLY VALIDATED THIS IS YOUR PER IT h� BLDG INSP ATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI, A1'1'I,ICATION F01t RESIDE'N'T.W., ALTERATION, ow • Olt ADDITION BUILDING P1iIZNIIT T CITY OF MZIDLEY, MINNESOTA r U.IA. OtlNER'S I,:ArV : Qrre1� FaPv •f eorlOp. BUILDER: s4t"r- ADDRESS: --7,16?(. 72 nd LAne /1,, ADDRESS: elkls. ow'y. '-Y-r4 a NO:. 0 STREET: /(/,0,'— LOT: BLOCK: 19 ADDITION: ..�i�nt�/'uC•� /�QgeS CORN -ER LOT: INSIDE LOT: 1' SETBACK: SIDEYARD: Applicant attach to this form Ttvo Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: Z4..o 3¢ �r.im `l ous e- Front: - Depth: Height : X-1 11�G, 4- Cubic Feet: Gda`a g e- Front: Depth: Z 1. S Height:_ /0 Square Feet;Cubic Feet: Type of Construction: klead drParr,e.. Estimated Cost: $ To Be Completed: / Q 77 The undersigned hereby makes application for permit for the work herein specified, agreeing tq. do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: 2 , Z3�, 1 J %!,v SIGNATURE 77 (See Reverse Side For Additional Information.) -!�5 o o o 1 tai k L f"1 TI �t�S ✓cq, �()"'y CITY OF FtRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE m. PLUMBING FIXTURE RATES: NO. RATE m %:iffier Fixtures % a $3.00 v Future Fixture Cpening r ro $ Water x $2.00 $ Catch Basin x $5.00 $4 c c.i H o $ © d ,�� a, G.., $ Water Softener Heater V $ New Ground Ran Old Building 9 $5.00 $ Electric 'Water Heater : $5.00 $ N mo rc� $4 14 .to M�! y V) r i O ) i +j t iJ V, N U N 0 ,, y• u rd 1j U) 0, C2 cA ,as lee UJ tq Zn3 ' 3rd I th (R) = Future Connection Opening Connected with Sevier (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL %:iffier Fixtures % x $3.00 S 60 Future Fixture Cpening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,G00 BTU $5.00 $ © d 100,000 BTU to 199,000 BTU x ,$10.00 $ Water Softener x $7.00 $ New Ground Ran Old Building x $5.00 $ Electric 'Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures % x $3.00 $ 3.00 Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ state Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE ($30-00) Job Address�� 42 �7v�ti�L Lc Department of Buildings City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and eorrecf Fridley, m. OWNERCir�. a� KIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD (�U ILDING PERMIT NO. PERMIT NO. 7 Y7 Company t r Signed By rs Tel. NO. ROUGH INSP. Date FINAL INSP. / Date APPROVAL FOR PERMIT 4elaa MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 STEAM OR HOT WATER SYSTEM: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU RATE TOTAL $12.00 $ 7.00 $ 7.00 $ 4.00 $ $12.00 $ / 4.00 $ 7.00 $ 7.00 $ 4.00 $ $12.00 $ 4.00 $ 7.00 $ 6.00 $ OIL BURNER- to 3 gal. per hour $10.00 • each add. 3 gal. per hour 10.00 s '.S.00 GAS BURNER- from 100,000 BTTUU'tcr199,999 BTU $19 go' (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: 1st 3 Fixtures _L x $ 3.00 $ Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00 $ AIR CONDITIONING $ FAN HEATING SYSTEMS See Fee Schedule $ VENTILATING SYSTEMS$ ALTERATIONS & REPAIRS_ S $ State Surcharge $ .50 TOTAL FEE $5& ROUGH INSP. REINSPECTION FEE Date ($10.00) FINAL INSP. - d� Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 Job Address `' L iJ Department of Buildings City of Fridley Tel. #571-3450 "�Yi mi ✓ T l to c 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn./' /l �7 , 19 7 L OWNER 111) G" ,- t / "— KIND OF BUILDING I USED AS �✓ .� < ( i r. TO BE COMPLETED ABOUT ESTIMATED COST © ! ` C7 (090 OLD -dg BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. /01 l O Trade Name vvi i✓ _ cSize No. V e) Capacity Sq. Ft. EDR 4' /N BTU HP Total Connected Load 2::J�i �Y a Kind of Fuel cf 'r BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP I�nPEj"'�oiany r(ji,lT0Signed By 554 i6 1(:0;J.�5 IJ1%4 Tel. No. t'Ai�JNA-�'P5451,611 HEAT LOSS CALCULATIONS HEATING '94 ;,v �0 -, � , 0, mv- I CO_ MINNEAPOLIS, PAWN. Weatherstrips A.S.H.V.E. Guide Reference 19 Construction Pio, Insulation 4Wirxdows ; Doors Out- wall i int. wall Ceiling � Roof Floor Kiri! How Applied Yes—No —Yes—No FI. Room I Length e, Width :�L YHeight / FI. d r Room Length ( Width Height Windows and Doors—Crackage and Area ' 1 Windows and Doors—Crackage and Area 4aC, i, W,tlrh ( Ha,ghY No. Ot L+nQal ft. Area , of pa of pa lights of crack sq. ft. �*2- 446 No. WL',d+h ri-gkt No. of Lsneal ft. Area 1 et ,arti- of pane lights of crack sq. ft. �� r1 r Coef; Btu Coef Btu Infiltration 7 � Infiltration i 7 Glass r®� Glass cD I -Exp. wall Exp. tarail lrxer Net exp. wall ` ! Net exp. wa11 Int. wall Int. wall Ceiling Ceiling Floor Ffoor Total Btu. Total Btu. zok Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq, ft. E.D.R. or sq. ins. W.A. Leafier area 'QUF1' ,ARoom I Length IJK Width � eight Room ( Length 6'didth;/ Height .. Windws and Doors—Crackage and Area Windows and Dotes—Crackage and Area No. Width Height No. of Lineal h. Area of arse of pane lights of crack sq- ft. Width HergRt Nc. of Lineal ft. Area No- of pane of passe lights of crack sq. h. r r Coeft' Btu ICOO Btu -Infiltration E Infiltration Glass Glass Exp, wall � Exp. v+tat l l Net exp, waII w Net exp, watt Int. wall 9rt, wall Ceiling I Ceiling 1v& .� Floor ta$ �;� Ftocx Tota; Btu. 4 Required sq. ft. E.D.P. or sq. ins. W.A. Leader area! I Total Btu. Required sq. ft. E.D-R, or sq. ins. W.A. Leader area Ff. �o v , Room Length I?1 1&6 Height ?oom 1 Length fa Width/ 2 Height Windows and Coors—Crackage and Area No.{ Wedsh + Fc g^t No. of L,neaf ft. A yea I of pane o- ^.ane hQhts of crack - ft.; y' vii Windows and Doors—Crackage and Area n w,drh He^^cwt 1 tio. of Ernest ft. Ates a3. of pane sf a3^.? t,�hts of crank S ft I i 7 I �f; Btu C Btu Infiltrattor. 6nfs ltration I Glassi :-<ass'�$ Esq_ mrall Exp. wall t '% ILetexp. stra_ p ` ° seagp. wall � 4 tnt. mail t- wall 5 CLileylTF Zi FS6C' ( t T 't Btu. i.. 1 y �9 f -Requrimd sq: -'It EZ ; -R- -S°fi j'3i�. tris. -sVA. -I Rs—-Cd1 —� �A'a 560-3450 Cit O riAe ANOKA COUNTY 6431 UNIVERSITY AVENUE NE January 3, 1977 FRIDLEY, MINNESOTA 55432 Darrel A. Farr Development Corp. 7286 - 72nd Lane North Brooklyn Park, Mn. 55428 Re: Final Inspection at 5620 North Innsbruck Court N.E. Dear Sirs: A final inspection was made on December 30, 1976.of 5620 North Innsbruck Court N.E. and the following items were noted which must be completed before the structure can be finaled out; 1. Provide house numbers by January 8, 1977. 2. Make garage weathertight by January 8,•1977. 3. Support garage header adequately by January 8, 1977. 4. Make garage steps secure - immediately. 5. Provide door closer on door between house and garage by January 3, 1977. 6. Provide sod in the front and side yards by June 30, 1977. 7. Call for plumbing final by January.3, 1977. 8. Raise hallway light by January 3, 1977. 9. Install hardsurfaced driveway by June 30, 1977. We will expect the above items to be completed by the appointed dates when reinspections will be made to determine compliance. If you have any questions on these items, please contact me at 571-3450. Since ly, RONALD E. HOLDEN Building Inspector REH/mh SUBJECT P •� City of Fridley 20976 AT THE TOP OF THE TWINS r BUILDING PERMIT COMMUNITY DEVELOPMENT DIV. _ ~ PROTECTIVE INSPECTION SEC. // 9 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 7/31/91 JOB ADDRESS 5620 North Innsbruck Court NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 19 Innsbruck Villages SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Innsbruck Townhouse Association 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Stock Roofing Inc. 289 Liberty Street NE, Fridley 55432 780-3561 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 ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Townhouse (8 Squares) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $416.00- $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $15.00 Fire SC $.42 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $15.92 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WHEN P OPER 1j, THIS IS YOUR PERMIT BLDG SP ATL SIGNATURE OF OWNER SIF OWNER BUILDER) IDATEI NEW [ ] Effective 1,/1,/91 ADM [ ] R-1 AND R-2 A= [ ] Building Permit Application Oohs muct ion Address: Legal Owner N% Address: . Tel• ZaMpw Oorztractcw: J7�c'c �� .�1aoiie �ye: Tel. # %r%)- 3 Address: Attach to this application, a Oertificate of Survey of the lot, with the proposed oonstruction drawn on it to scale. I1Vn G AREA: Length Width Height sq. Ft. QRRAM AREA: Length Width Height sq. Ft. ME= AM: Length Width �HWG�u nd Sq. Pt. C /� t+0 %e' e •., /-/c C' S Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks 'type of Oonstruction: 1111 r Z '�: / s) Estimated Cost: Approx. Cmpletion Date: Xl-�% Prgx sed Driveway Width If New Openirg Is Desired: Ft. $. $. Width + 6' See Back Page L1AZ'E: /�'%��i/ APPLICANT: l—%'' . / Tel. # Ii %' /1".6-151 Permit Fee Fire Surcharge $ y State Surcharge SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ STIPUTA27QNS : Fee Schedule on Reverse Side .001 x Permit Valuation (1/10th $) $.50/$1,000 Valuation $650 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Emji roeri r7 Agreement Necessary [ ] Not Necessary [ ] City of Fridley AT THE TOP OF THE TWINS S.BJECT BUILDING PERMIT PERMIT NO. r COMMUNITY DEVELOPMENT DIV. r I PROTECTIVE INSPECTION SEC. I i RECEIPT NO. 0-� CITY HALL FRIDLEY 55432 ' 612-571-3450 NUMBER 910-F15 I REV DATE I 5/7/96 PAGE OF APPROVED BY JOB ADDRESS See Below 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Variou SHEET I 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Various 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Columbus Exteriors - 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Townhouses 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION ❑ REPAIR O MOVE ❑ REMOVE 6 DESCRIBE WORK Reside 44 Units (11 Buildings) 9 CHANGE OF USE FROM TO STIPULATIONS 5600,5602,5604,5606 West Bav ian Pass; 5601,5603,5605,5607 West Bavarian Pass; 5610 5612,5614,5616 ee,t-$ee#enc-Fess; 5620,5622,5624,5626 West Bavarian Pass; 56 ,5622,5624,5626 North Innsbruck Ct; 1521,1523,1525,1527 Trapp Court; 5650,5652,5654,5656 West Bavarian Pass; 5660,5662;5664,5666 West Bavarian Pass; 5661,5653,5655,5657 West Bavarian Pass; 5671,5673,5675,5677 West Bavarian Pass; and 5681,5683,5685,5687 West Bavarian Pass SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SO. FT CU FT 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 I HAVE READ AND EXAMINED THIS APPLICATION 44 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION $228,800 SURTAX @ $114.40 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION R THE PERFORMANCE OF CONSTRUCTION. PERMIT FEE $1,532.25 SAC CHARGE Fire SC $228.80 oe PLAN CHECK FEE TOTAL FEE License SC $5.00 $13880.45 SiG OFCONTRACTOR ORAUTHORIZED AGENT iDATEt WHEN PROPERLY (DATED THIS IS YOUR PERMIT . - q S.GNATURE OF OWNER,IF OWNER BUILDER1 iDATEi BLDG SP GATE CITY OF FRIDLEY PERMIT NO.- 04-01978 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 10/26/2004 (763) 572-3604 k+AX: (763) 571-12137 ADDRESS 5620 N INNSBRUCK CT NE R56 PIN 243024410222 LEGAL DESC INNSBRUCK VILLAGES LOT 1 BLOCK 19 PERMIT TYPE BUILDING PROPERTY TYPE : MULTI DWELL CONSTRUCTION TYPE : ROOFING VALUATION : $ 21,739.00 NOTE: INSTALL PER MANUFACTU✓ XRS�SPEFICATIO S. UNDERLAYMENT PER STATE BUILDING CODE. REROOF BUILDING WHICH INCLUDES 5620, 5622, 5624 AND 5626 NORTH INNSBRUCK COURT. STATE LICENSED CONTRACTOR 1 APPLICANT BUILDING PERMIT FEE FIRE SURCHARGE 349.25 21.74 ALLSTAR CONSTRUCTION 840173 AVE N STE 80 STATE SURCHARGE, VALUE 10.87 BROOKLYN PARK, MN 55428- LICENSE SURCHARGE 5.00 TOTAL 386.86 PAID WITH CHECK # 65625 GASSEN MGMT CO W OWNER 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 worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to viol cel the provisions of any other state or local law regulating co ction or the performance of construction. Applicant Date_ Bld Ins ti g P `i. Date )�k- SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [] ADDN [] ALTER [� ] Construction Address: Legal Description: Owner Name & Addie Contractor: l � 1140:12- Address: �(t� I LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Driveway Curb Cut DATE: l0 /2-`j A 11 I Call (763) 572-3604 for Pe you for card number. 1 Permit Fee i Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge CITY OF FRIDLEY Effective 4/1/2004 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION 0, 1 N N 5f-6 r;- 0 0,V- CtJ027- Tel. # °1'�L- UI vZ 55�� �fP/v,'1asC:nl /n [/lM�N LICENSE# >� f /il,�/�6''�- ��itY'1.6. � K6, e'��``�'G3�L�,/�j7`I 1 C%rt- Tel.# -ho' r --)15i-7766 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft Estimated Cost: $ 21139 Needed: Ft. + 6 Ft = Ft x $ .=$ • � � L%��..7 / r Tel. # :2,J 55S- - 7766 Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call CITY USE ONLY - l ?g/ o, P % Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 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 [ ] TOTAL 4 38 L ko STIPULATIONS: Building MECHANICAL Permit No.: -®Nr z8 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY 763-502-4977 FAX EFFE«-E,_19-0,I , DATE _ YOUR E-MAIL ADDRESS ���'�GIJ ®�fer <4 e4em�/ter 401 SITE ADDRESS THIS APPLICANT IS: O ONXWM *0NTR_X(`T0R _ PROPERTY NAME71 �® OWNER/ ADDRESS�'�%� LY L 7117�S�rGIJ G l7TT r—/ STATFZIP� TENANT : PHONE6/2 - .310 �- e92243 CONTRACTOR conipalvl NAME e C oNTAIL`TPERSON: O SUBMIT A COPY OF YOUR STATE LICENSE WITH STATE LICENSE # _» DATE yi%Qr /1 CITS% ' STaT0_A_/ZIP_5_f__ ADDRESS: ,(/O7 APPLICATION PHONE ;t, 5 -- e �cJ - ��%� FAX __&_? - .5loc5_ - PERNIIT TYPE XSING F F_AAIILY O TWO F.AAIII.Y O TONk MOXISE TYPE OF WORK: '3 NEE' �EPLACRIENT E3 ALTERATION MK)DEL \ DETAILED DESCRIPTION OF WORK ( C + 9J Fie D FEES ARE BASED ON $10.00 PER FIICPURF., CEPT WHERE NOTED. FfXTURES: �TAL NUNMR OF EACH l!/ SIZFJBTU Equipmed Installed MFG t`G/`� MODEL: MFG: MODEL: SIZE&TU MFG: MODEL: SI TU XA/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGWOVEN $10.00 TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 _AIR $35.00 FURNACE $35.00 GAS UNIT HTR $10.00 _FILER LMER $10.00 GAS DRYER $10.00 POOL HEATER $35.00 _CHIMNEY DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00 Number of &doves Fay $10.00 x $10.00 = $ Number of fn -hues 16- $15.01) x $15.00 = $ Number of fodures 4*. $25.00 x $25.00 = $ � ®� Number of fixtures id. $35.01) x $35.00 = $ state surcharge = $ .50 � Total = $ THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby- apply fir a building permit and I acknowledge that the infivanation above is s�)mplete and as e-mte: that the R4xk- n -ill be in conformance «'ith the ordinances and %xxles 4 the Cih 4 Fridlec and N%A the Minnesota C.vrncww Codes: that I understand this is not a permit but only an application for a permit and «ork is n* to start Rithort a permit: that tdre x5twk- kill be in accordance kith the approved plan in the case of «auk x%luch requires revwAi and approx al t:if plans. /� / Q SIGNATURE OF APPLICANT L' PRINT NAME / Lam/ fjt /CO/!�� ATE /J -13 -L�) PLEASE NOTE: SEPARATE PE Imus ARE REQumm FOR BUILDING. ELECTRICAL AND MECIIAAMCAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977