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PRE 2010 DOCSSUBJECT E O. City of Fridley jP 12294 AT THE TOP OF THE TWINS BUILDING PERMIT CEIPT NO. • COMMUNITY DEVELOPMENT DIV. �y r PROTECTIVE INSPECTION SEC. ' �6 I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 8/27/73 JOB ADDRESS 1482 North Innsbruck Drive N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2 8 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Bert Johnson 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. SpriLigfield Homes 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 NE NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 70 x 53'6" & 34 Dwelling and a 241 x 26 Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a verifying survey fm before capping. Provide a hard wwrfm surfs drivexay. . SEWER LOCATION: 10' West of Manhole (Inv. 956.22) Wye Elevation: 956.15 Top of Footing: 959.65 Minimum WATER LOCATION: 78' South of Stop Box to lot across the street. 35' S.S.W. of Manhole SEPERATE PERMITS REQUIRED FOR MIRING, HEATING, PLUMBING AND SIGNS, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Fraise 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 R-1 2107 42 140 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 1 ISTALLS 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. $38, 753 19.38 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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- 90.00 275.00 STRUCTION OR THE PERFORMANCE OF��NSTRUCTION. PLAN CHECK FEE TOTAL FEE �3 $384.38 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT 1-7SIGNATURE BLDG INSP DA E OF OWNER (IF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME • 011"1 0 � BUILDER • V� .� .a ADDRESS: ADDRESS: O 15 u /v NO: r I STREE LOT:- 1, BLOCK: N CORNER LOT: INSIDE LOT: Ll SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: _ 3 � -Front • Depth: .s Height: Q QS11 /�/Q Square F ee: Cub Feet• G Front: Depth:—Height: a _ 40,7 Square Feet; Cubic Feet: L 7 Type of Construction: &&091 QA�lz Estimated Cost:_$ To Be Completed: 424c, ZQ _93 v� s°3• Q / 9.3 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict 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: Z �-SIGNATURE• /z5-4W446z (See Bever Side For Additional Information.) C ?,-G G A C- woo -F4 7 s. " SIA .G R Cl 0.0 d woe P&.e-c H. S . / g • 3 � c► R C I&A -t it V S CA'* v -ex v r n City of Fridley App• Dept. of BUkpL Photo 580-345D DESCRIPTION OF WORT[ ((�� I �-� j k N i�s y c K Number, Kind and Locailou of Fr ixtug" WATER "U. City of Fridley: i I 3 3 a� $ n o N cis ncc The undersigned hereby makes application for a permit for the work hem 2 d specified, agreeing to do all work in strict accordance with the Cit, Ordinance Base ! and ruling of the Department of Buildings. and hereby declares that all the fact and representations stated in this application are true and correct Fridl . Minn ,19-- Ind _ 3rd Owner 4th bind of Building • rum" cotmeetfon Openiage wits ❑ � • Now 1Fi�e. Old Openings used as � � � %J To be completed about �' PARTIAL RATE SCHEDULE Estimated Cost, s Old --e Building FPrmit No. _permit No. PLUMBING FIXTURE RATES. NO. RATE TOTAL Number Fixtures ................ x $2.00 $ Signed Future Fixture Opening ....:...... x $1.50 i .. By New Fixture Olaf Opening .......... x $1.50 i Business Phune No -3 A Catch Basin .................... x $3.25 $ Water Heater 'Up to 99.000 BTU).. • • x $3.00 t New Ground Edon Old Bldg. .. • ..... x63.25 S ROUGH Electric Water Heater .............. a $2.00 $ FINAL /0 -/O - % V GAS FITTING FEES. NO. RATE TOTAL let 3 Fixtures ................ . _ _ x $2.00 ; �2 . C) Additional 1112du es ................ x $ .76 ; Gas flange to 199.000 BTU ..... • ...... x $6.00 State Surcharge $_ .50 REPAIRS tt ALTERATION$ —Ades to code _ Description •. •.•.•..•a.e a.o ... s..•• •. •........ ...•....� TOTAL FEE 6 City of Fridley 4uddFEGT Permit No. oZ • AT THE TOP OF THE TWINS `� ..� I HEATING PERMIT APPLICATION _______, C01JIdVNITY DEVELOPsEHT DIv. r MOTECTIV2 MVTCT" MPT. CITY HALL RRIOLQV 6soa NumsfA ACV. DATE PAGE C AGPROVEO BY 910-F17A J 0 2/15/73 1 1 800 Sob Address n Address Phone ntracto Address Phone 2 Kind of Building Se AA Completion Date ea Cost �Z3 A GRAVITY WARM A1174. MTZ TOTAL Heating/Power Plants �r Furnace Shell & Duct. S't'ork .... ....... ..$10.00 $ ' Steam Hot r arm Air Replacement of Furnace ..... . ..... .. 6.00 Z Repairs &Alterations--vp to $500.00 6,00 Trade Name Repairs & Alterations each add. $500.00 3.00 $—_ _ i_ Size No. C4�5 I 1 V= C11 WAW4 AM Capacity Sq. Ft rurnace Shell & Duct Work to 120,000 BTS ... .. $10.00 �— EBR BTU Ton. each add. 60,000 BTU.......... BTU................. ' � � ' � ' � � uu 3. $� Total Connected Load��'� Replacement of Furnace 6.00 $ Repairs & Alterations --up to $500.00 6.00 $ Kind Of Fuel Repairs & Alterations each add. $500.00 3.00 $ Burner STEAM or HOT WATER SYSTEM Trade Name .Furnace Shell & Lines—to 400 sq. ft. FDR Steam $10.00 Furnace Shell & Lines—to 640 sq. ft. EDR Hot Water 10.00 $___ Size No. Each add. 200 sq. ft. EDR Steam 3.Oo �..__ __ Capacity Sq.Ft Each add. 320 sq. ft. EDR Hot Water 3.00 $ EDR BTU Ton. OIL BURNER—to 3 gal. per hour 6,0D $ — over 3 gal, per hour—See Fee Schedule GAS BURNER (tap to L-3,000 BTU) 6.00 h i over I99,OtMJ = see F" schodul® GAS FITTIPaG FEES: NO RATE TOTAL 1st 3 Fixtures _ Z x$ 2.00 $ �Q Additional Fixtures x ,q$ $ Gas Range to 199,000 $$ 5.00 g _ 50 State Surcharge AIR COa:DITIONING TAN HEA TInG 3S ZTc_,,-j Seo Fee ache )dlrj* VENT ILATLnG S`CSTL"4 ? ALTERATIO:dS Et REPAIRS TOTS i'L~ j4S{, r, ROUGH i1NAL_ //-/y 7`�Signature I �. /; 1922' CRONSTROMS HTG. & AIR COND., INC. Job Name .D•S6 4410 Excelsior Boulevard, Minneapolis 16, Minn. / Qom. BEAT LOSS CALCULATIONS Job Addres / A Weatherstrips A.S.H.V. Construction No. I Insulation Guide Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes -No I_ Yes—No 19— I CI ---. VrF..lal. I1—:..r.r II >CI I Q�� I 1 _ ..►h 1--w"11•h Z' G tu;.ht •tel' Windows an Doors—Crackage and Area Q Width HeightNo. of Lineal (t. Area No. of pans of pane Ilthte of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane Ilghte of crack sq. ft. Width Haight No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Coef. Btu Infiltration Coef. Ptu Infiltration Infiltration �® Net exp. wallaz (-- ab Glass Int. wall y 6-0 (® ear Exp. wall -[e ► 3 f Floor Net exp. wall Int. wall -10 °i°e Net exp. wall - L= ® 1 (a Int. wall Floor Floor /-U Ceiling Floor Total Btu. Required sq. ft. E.D.R, pr Aq. ins. W.A. Leader area Heiaht Windows and Doors—Crackage and Area q�'r�� Q Width HeightNo. of Lineal (t. Area No. of pans of pane Ilthte of crack sq. ft. d Width Haight No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Coef. Btu Infiltration ®. (C' -�C Glass Exp. wall Infiltration �® Net exp. wallaz (-- ab Glass Int. wall 6-0 Ceiling e77 Net mm- wall C -t dam= -[e ► 3 f Floor Net exp. wall Int. wall -10 °i°e Total'Btu. r%equlrea sq. rt. e.u.m or sq. His. w.fs. r eager area 1 IL W 1-6— q�'r�� Q Windows and Doors—Crackage and Area d Width Haight No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Coef. Btu Infiltration Infiltration Coef. Btu Infiltration ® (to (-- ab Glass 2 6-0 Exp. wall Net mm- wall C -t dam= -[e ► 3 f Ceiling ! 24 -SP Net exp. wall Int. wall -10 °i°e o Ceiling Ceiling S -e 4,� Floor Floor /-U Tbtal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area .I Windows and Doors—Crackage and Area q�'r�� Width Height No. of Lineal ft. Area No. of pane of pane Ilghte of crack sq. ft. d Coef. Btu Infiltration Infiltration Glass Glass Exp. wall t� Exp. wall t� Net exp. wall -2-;F Net exp. waUS-- C, Int. wall Net mm- wall C -t dam= -[e ► 3 f Ceiling ! 24 -SP f (J Floor Floor 14J -AA -I Total Btu.2- Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l Room I Length 13 Width /5c Height P— Windows and Doors—Crackage and Area q�'r�� Width Height of Lineal ft. Area Na of pane lig of pane liable of crackeq. tt. 2_ ® Coef. Btu Infiltration® Infiltration 6no Glass Exp. wall Glass t� Net exp. wall -2-;F - Int. wall Net mm- wall C -t dam= -[e ► 3 f /® Ceiling Floor 14J -AA -I Ceiling S -e 4,� Total Btu. IP Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI. `K m Censth _ —Width/ -V -Height Windows and Doors—Crackage and Area Width I Height No. of Lineal ft. Ares No. of pane of pane Ilshte of crack sq. ft. Coef.1 f Btu Infiltration 6no 6--Q Glass Exp. wall Net mm- wall C -t dam= -[e ► 3 f /® Int. wall Ceiling S -e 4,� -S7 Floor /-U ITotal Btu. O ® p Required'sq. ft. E.D.R. or sq. ins. W.A. Leader area CRONSTROMS HTG. St AIR COND., INC. Job Nome— +¢ - 4410 Excelsior Boulevard, Minneapolis 16, Minn. HEAT LOSS CALCULATIONS Job Address_ Weatherstrips A.S.H.V. Construction No, Guide Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Yes -No I Yes -No 19— R4 in 9_Room I Len-idth Hei's ht 11 FI I Windows and oors--Crackage and Area W l &wasul jgr Windows and rs-Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. tt. Windows an Doors-Crackage and Area. r • Width Height No. of Lineal ft. Area No. of ppanneof®pane lights of crack eq. ft. Coef. B Infiltration Glass ® Coef. B Infiltration C) 4" 2- ' 0-V Glass m 6b 2- 2-cM Exp. wall Int. wall Int. wall Net exp. wall 6- it - 9D Ceiling Int. wall IG- 7 Floor Ceiling / Ceiling (e Floor Floor Windows and oors--Crackage and Area W l &wasul jgr Windows and rs-Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. tt. 7, b r Coef. B Infiltration Glass ® V Claw Net exp. wall � Int. wall Exp. wall Ceiling A,, Floor - m Net exp. wall Net exp. wall - Int. wall Int. wall r ,% - 9D Ceiling Ceiling IG- 7 Floor Floor Ceiling Total Btu. Required sq. ft. E.D.JgA s. WA. Leader area 1.1 ft . I . rX W mus W l &wasul jgr Windows and rs-Crackage and Area /® S 2— 2' Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. t, b r Coef.i Btu infiltration 1) Glass Exp. wap 101) Net exp. wall t) Int. wall Exp. wall Ceiling A,, Floor - m ! Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Insulation Floor I Kind How Applied F Rm -11 .-th / A Width Height Windows and Doors-Crackage and Area Width Height No. of Lineal ft. Area Naos. of pane otpanp lights of crack sq. ft. /® S 2— 2' �Ilghts �® 2- Coef. Btu Infiltration Btu 2 - Glass Glass E qo Glass Exp. wall Exp. wall m Net exp. wall 16Y '6 - Int. wall Net exp. wall r ,% - 9D Ceiling 14 IG- 7 Floor Ceiling Total Btu. 61 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl -1 Room I Lenath Width %,? eight Windows and Doors-Crackage and Area - Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. tt. �Ilghts �® 2- Coef.1 Coef. Btu Infiltration ,� Glass E qo Glass L e -b Exp. wall m Exp. wall Net exp. wall EZ& Int. wall Net exp. wall r ,% - 9D ® -z"t5 Int. wall Ceiling Floor Total Btu. 1j 0 Required sq. ft. E.D.R. or sq. ins. WA. Leader area I AM Dom_ 1 r _ .►L owltml.l. 5o1.r�:..1.a 1� N" ..� ��..o�. Windows and Doors--Crackage and Area - Width Height No. of Lineal ft. Area No. of pane of pane of crack sq. ft. �Ilghts �® 2- Coef.1 Btu Infiltration " Glass 7 2 L e -b Exp. wall � Net exp. wall EZ& Int. wall Ceiling Floor 1 otal 111u. ?- Required°sq. ft. E.D.R. or sq. ins. W.A. Leader arra Job Name CRONSTROMS HTG. & AIR COND., INC. 4410 Excelsior Boulevard, Minneapolis 16, Minn. NEAT LOSS CALCULATIONS Job Address Weatherstrips _ Guide A.S.H.V.>w Construction No. I Insulation Windows Doors Reference Out. Wall Int. WallCeiling Roof Floor Kind How Applied Yes-% I Yes—No 19— I 11M.1 • Room I LentV idth �Heiaht7 J6 II FI.I Room I Length Width Height Willows and Doors—Crackage and Area Vldth Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. ® CI IC*ef.1 Btu Infiltration 2 � Glass Exp. wall Xz Net exp. wall Ve 7L 6 13 X c, Int. wall LL Ceiling Floor le C -) Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area .I A., _ Room I Length Width Windows and Doors—Crackage and Area Width I Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of Dane of Dane lights of crack sq. It. Coef. Btu Infiltration t Btu Glass 1 33 Exp. wall 13 X c, Net exp. wall LL Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Height F1.1, Room] Length Width Height Windows and Doors--Crackage and Area Width HeightNo. of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of Dane of Dane lights of crack sq. It. Coef. Btu Coef.1 t Btu Infiltration 1 33 q0 1 13 X c, Glass LL Int. wall Exp. wall Floor Net exp, wall a E132-2-1-- /11 , Int. wall P Ceiling Floor 1 otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I Fl.l Room I Length Width Heiaht Windows and Doors--Crackage and Area Width HeightNo. of Lineal ft. Area No. of pane of Dane lights of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor ! Tbtal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ' Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area Na. of pane of pane lights of crack ea. ft. Coef. Btu Infiltration Glass 1 Exp. wall Net exp. wall Int. wall Ceilidg Floor - Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FLI Room I Length Width Height Windows and Doors--Crackage and Area Width Heltht No. of Lineal ft. Area No. or pane of pane lights of crack sq. tL Coef.1 Btu Infiltration Glass Fap. wall Net exp. wall Inc. wall Ceiling Floor i otai atu. Required°sq. ft. E.D.R. or sq. ins. WA. Leader area City W 7,.i /'y 6431 UNIVERSITY AVENUE NE Springfield Homes 3713 Foss Road N.E. Minneapolis, Minnesota 55421 Dear Sirs: ANOKA COUNTY March 25, 1974 Re: Verification Survey 560-3450 FRIDLEY, MINNESOTA 55421 According to our records, your home being built at 1482 North Innsbruck Drive -- on Lot 2, Block 8 , Innsbruck North Addn. has not been resurveyed since your foundation was completed. If you have a copy of this required survey in your file, will you please forward a copy to us. If you have not yet had the survey made, please -let this be a reminder to you that these verification surveys are a City requirement and that they are essential to meeting the City Code. We hope that this matter can be taken care of within the next 15 days so that more drastic steps will not have to be taken to gain compliance. If you have any questions, please feel free to call me. Sincerely, - L G. CLARK Community Development Adm. DOC/mh 560-3450 cit . ® I, J'r ANOKA COUNTY 6431 UNIVERSITY AVENUE NE FRIDLEY, MINNESOTA 55421 August 6, 1975 Springfield 3731 - Foss Road Minneapolis, MN Re: Verifying Survey f 1482 North Innsbruck 5629 North Danube-181'Sylvan Lane Gentlemen: Please be advised that of -this date, we have not received a verifying survey for the above captioned house. We would appreciate it very much if you would get this survey into our office no later than September 1, 1975. Thank you for your cooperation in this matter. Yours very truly, DARREL CLARK Community Development Administrator DC/cs SUBJECT MIT NO. City of Fridley 3313 � AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. r • COMMUNITY DEVELOPMENT DIV. i ♦V ------ r � � PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 5542 j 763-571-3450 910.F15 10/7/02 JOB ADDRESS 1482 North Innsbruck Drive NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 8 1 Innsbruck North Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Doug & Lynn Hankner 1482 North Innsbruck Drive NE 763-502-0662 J CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Tabor & Sons Roofing 10547 Terrace Rd, Blaine, MN 55434 612-789-1902 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20014248 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (35 Sq) Tear—off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 ZONING SO. FT CU FT 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 DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $4,052 $2.03 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 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 PLAN CHECK FEE TOTALFEE 101716 License SC $5.00 $122.33 SIGNATURE OF CON"RACTOR OR AUTHORIZED AGENT I I TEI HEN PROPERLY VALIDATED THIS IS YAUR/PERMIT _ k/-NSP V r)ATE SIGNATURE OF OWNER,IF OWNER BUILDER) IDATEI NEW [ ] CITY OF FRIDLEY Effective 1/1/2002 ADDN [ J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: d J':Ida'Ua Legal Description: Owner Name & Address: Tel. # 76 3 - 57om7 - o G-2 Contractor. MN LICENSE # 2 OG I Zl I � 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 Width Hgt/Ground Sq. Ft. OTHER: �� iP.�� ll-��L� �_ S so Construction Type: v Estimated Cost: $ �LD Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: 0APPLICANT: A�� Z� Tel. # 4/5 - 7tr `Z- /5D 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. CITY USE ONLY - Permit Fee $ �~ Fee Schedule on Reverse Side Fire Surcharge $ 5 .001 of Permit Valuation (1/10th%) State Surcharge $ ®)-03 $.50/$1,000 Valuation SAC Charge $ $1200 per SAC Unit License Surcharge $ .00 $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by'Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 1W. 33 STIPULATIONS: Building PLUMBING Permit No.: C -0/7119 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY DIB' •' - lim DATE YOUR E- L ADDRESS SITE ADDRESS ' I �� % 0 - THIS APPLICANT IS: ❑OWNER CONTRACTOR PROPERTY NAME: U OWNER/ _ ADDRESS: V ` CITY 1 STATEIPiL�� TENANT afo PHONE. CONTRACTOR N4' STATE LIC # / EXP DATE I - k) 0 6S�60 f - SUBMIT A COPY OF YOUR STATE ADDRESS: 1?7 ®): ai CITY( �/ Wn STATEA4fty / LICENSE WITH PHONECq Lj e?) L Y' H —0,21 APPLICATION PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: 0 NEW AREPLACEMENT DETAILED DESCRIPTION OF WORK 4.M &VVim/" Ct &`QJ PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor) S 213'd-. Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) SINK/LAV DRAINS _ WATER PIPING —BATH _FLOOR —SHOWER —GAS PIPING ovEED cnyLicEmE) _ SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB CLOTHES WASHER KITCHEN SINK WATER CLOSEr _ BACKFLOW PREY. ($15) _ _ _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION —DISHWASHER WATER METER OTHER PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500 Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00=$__3!5Z_9>0 TOTAL DUE $ State Surcharge = $ .50 Total = $ 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 in conformance with the ordinances and codes of theC' of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit ork is not to start without a permit; that the work will be in accordance with the approved plan in the case oUll work whi requ' review and approval of lanss� SJ�L 14 PRINT 401 ' �0SIGNATURE OF APPLICANT PLEASE NOTE: SEPARATE PERM1TS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977