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PRE 2010 DOCSNEW [ ] City of Fridley Effective 4/1/84 ADDN. �R-1 AND R-2 ALTER. [ ] Building Permit Application Construction Address: Jrf2- q 6A4/)�id-�`��✓� Legal Description: Owner Name s Address:�el bo, Sur r-0 Tel. # T 7/-- 7 7 -1Y9 - Contractor: y9 Contractor: Tel. # Address: LIVING AREA: neAenF ARTA. DECK AREA: OTHER: 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 Length _ Width Height Length Width Hgt/Ground Corner Lot [ ] Inside Lot [L3' Ft. Yd. Setback Type of Construction: Approx. Completion Date: Proposed Driveway Width If New Opening Is Desired: DATE: Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: APPLICANT: CITY USE ONLY $ Sq. Ft. Sq. Ft. Sq. Ft. Side Yard Setback Estimated Cost: $ Alt. A Alt B $ $ See Back Page for Explanation Tel. #_ Fee Schedule on Reverse Side 25$ of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] SUBJECT City of Fridley 6 3 8 7 ';: AT THE TOP OF THE TWINS BUILDING PERMIT r RE NO.COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/14/81 JOB ADDRESS 5924 Oakwood Manor N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 1 Alld. Sub. #92 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gaylord Burrow 5924 Oakwood Manor N.E. 781-0477 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Decor Builders Inc. 2955 Bunker Lake Blvd._ N.E. 755-9526 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 x 8 DESCRIBE WORK Construct a 301 x 301 Second Story to Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS Variance granted August 11, 1981 for a front yard setback. �EPERATE PERMITS REQUIRED FOR Y IRINC, HEATING, PLUMBING) AND S1G� TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood Frame 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 900 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 $301000 $15.00 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- $193.00 NONE STR CTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $ 48.25 $256.25 SIGN T REOFCONTRACT RAU IZED ENT (DATE) WHEN PROPER VALIDATED THIS IS YOUR PERMIT r4ijkLL SIG URE OF OWNER IIF OWNER BUILDER) IDATEI BLDG )NSP CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATION FOR RESIDENTIAL BUILDING PER4ITS (New, Alterations, Additions, or Repairs) OWNER: ADDRESS: IL TEL NO: �c��' e141-7% i BUILDER: OFF66? U bE,Q T.&Jef', ADDRESS: 5 S QKaA /r TEL NO: rl Construction Location STREET NO: STREET: A'�4 LOT: z / BLOCK: ADDITION: Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: ®` Depth: 3 0 Height: Squame. Feet_ Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: _ 00 0 Type of Construction: �E�yj p ®,� Estimated Cost: $- .00 %b Be Oornpleted: / — .'�2_ Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: W O N F $ $ SEE REVERSE SIDE OF SHEET . The undersigned hereby makes application for a permit for the work herein specified, agreeing to 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: � �- � � I SIGNATURE: Stipulations:Q_C'�Z'A lq f 1, P0, og- Ty o U CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT m u m o r o� m E aq [ ow m � m w t�iw a'� w 1 a c� w water Heater lec 1st 2nd / 3rd 4th -L I FT (R) = Future Connection Opening (*) = New Fixture, Old Opening Connected with Sewer Water PLUMBING FIXTURE RATES: RATE SCHEDULE NO. New Fixtures- Future ixturesFuture Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL $ 20'o -c ALL OTHERS AND/OR REPAIRS AND ALTERATIONS IS of Value of Fixture or Appliance $Z Reinspection Fee State Surcharge $ .50 $ TOTAL FEE $ Z c"S- T Job Address BLLWL; Va Aug. L, 1Vol ueparrmenz or auiiaings 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 correct OWNER _ KIND OF USED AS Fridley, Mn. G�� , 19 p / A'). / TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. 59(cab V ROUGH INSP. Date Company Signed By ��--- Tel . No. 57 K! — QV 212 FINAL INSP. 13— YZ�Z Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE City of Fridley SUBJECT P O. 17064 AT THE TOP OF THE TWINS BUILDING PERMIT rp RECEIPT NO. COMMUNITY DEVELOPMENT DIV. rL r PROTECTIVE INSPECTION SEC. i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 17/25/83 JOB ADDRESS 5924 Oakwood Manor LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. F2t 18 Aud. Sub. NO. 92 SHEET PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gerald W. Burrow 5924 Oakwood Manor 571-7748 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 ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK construct a 23'4" by 26' attached garage 9 CHANGE OF USE FROM TO STIPULATIONS 1, Provide a hard surface driveway. -SFPERATI� PERIyMI'TS REQUIRED FOR WMM HEAT .Nal PLIJ48ING AND SIGNS. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. wood frame THIS PERMIT BECOMES NULL AND VOID IF WORKA CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS,"0R' 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 EXAMINE THIS APPLICATION TAL'LS, 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 __' ' 6,450 3.23 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- 62.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 65.73 GNA/T'®AUREEOOF CONTRACTOR OR AUTHORIZED AGENTs/MATE) %LIDATED `� .5 - 16 PROPERLY VA THIS IS Y�jJ� R I/T3� BLDG )NSP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IOATEI nlo CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATI94 FOR RESIDbITIAL BUILDING PEFU41TS (New, Alterations, Additions, or Repairs) OWNER: i�c� ��'�� 9��Ga��? BUILDER: �#00" ADDRESS: ,AM ,q AeADDRESS: 5A -Xy gr TEL n0: 5- 7 7!V R TEL NO: # r Construction Location STRITT NO: 59 7- q STREET: 6JA K ege-4 Al09f O LOT: BLOCK: ADDITION: Atf e' :nj !ta Corner Lot: Inside Lot: Setback.: Vo" Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION �111 j4 y Ace ,�` ront: Z am Depth: ® Height: Square feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: Zb Be Oor,ipleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE PEVEMSE SIDE OF SHEET . 19ie undersigned hereby makes application for a permit for the work herein specified, agreeing to 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: Stimulations: p"j w. v SIGNATUIE : r HARVEY A. CARTWRIGHT _•MTWMCM & OLSON ANOKA COUNT► SURVEri OWNNEPIN COUNTY SURVEYS Rya :''` •` Z,�ND SUR Vh'YORS MINNEAPOLIS SURVEYI ': . 5410 PALM STRERYNOEA, LAWD OM STATS OF 14MMMOTA SNfnaT AOOIE - :USED K bRO""mm IR CITY OF "ISINEAPOLM ,. • ani PLYMOUTH BURR MIO FEDERAL • 07, R+mYSTRNI r .wpIQIAL ' _ j'.. - . •WIII/SS - .lii�i�tpoCs LtTl�i�i#�t GTtt Lois• Oay8 mm ' Wig`+ l -/j 3. ea - +7 1 .0 t ra � v ' f •.. �.' ' 7. MA. � OW • :J � �?C„ �y►''�:. '� '':• •'aIle;• • • 26.6 K �n b 0 ' i • "' AU z - L COMBINING THE RECORDS OR J. E. HILL. CIVIL ENGINEER OTA�WMm fM� C. F. BANDHOFF CIVIL ENGINEER OT/IKWMiO f� JAMES NELSON BURVETOR ff►YLYNm foga METROPOLITAN LAND 'BWIVEYORS, s4TASLISHM IMS invc ce 18291 651-7 u •. . f . 4 r• ,• •• 1 f r ' tt .. I hereby certify that this is a true and correct plat of survey of Lot 18 and the North 20 -feet of Lot 19, Auditor's Subdivision No 92, Anoka County, Minnesota I.Bubjeet to the rights of the public.over the E 20 feet thereof for roast Purposes,, as +eyed by me this 8th day of A 1956, A. D. t , ' �'r I:z. i '+ t� •-^ -s -- ter..-•-.. •� � • _ � -ti :a .. : tip• �_• • • 00 16 ` r c v t NGNED-- r RIGHT AND OLSON ' t CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT FLOOR Effective On May 10, 1999 PLUMBING FIXTURE RATES: NO. RATE 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** 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 State Surcharge TOTAL FEE TOTAL Ido $ .50 $ a�1s_a JOB ADDRESS_ % �� be—e,)o e__p d� _ 4 0,� 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. Owner Building Used "" & '-0 /-At 7 oC 4 Estimated Cost 4 ® 6 d PERMIT NO. /"), C' J 0 PLUMBING SIGNED BY Approved By ,1999 TEL N0._,:� ��%•�� "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. P. %1 SuBjECT P R11AtT-Ri6� City of Fridley33695 AT THE TOP OF THE TWINS BUILDING PERMITC� RE CEIPT NO. 16. t ______ COMMUNITY DEVELOPMENT DIV. V : PROTECTIVE INSPECTION SEC. 5F317r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910415 7 / 14103 JOB ADDRESS 5924 Oakwood Manor NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DES CR. 18 Auditor's Subdivision #92 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Cameron 5924 Oakwood Manor NE 763-502-0997 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Roof Design Partners 4026 7 St NE, Columbia Heights, MN 55421 763-789-6566 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20004817 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION O ALTERATION REPAIR X ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof House (12 Sq) Tear -off' Reroof Garage (8 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Roofing can be second layer but not third. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD 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 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 ORDINAN GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,085 $1.04 WITH WHETH RSP CIFIED HEREIN NOT. THE GRANTING OF A PERMIT DOES NOT P ESU E TO GIVE A HO ITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS F A Y OTHER STTE LOCAL LAW REGULATING CON - 1 $83.25 Fire SC $2.08 TRU TIO E PERF R AN E CONSTRUCTION PLAN CHECK FEE TOTALFEE -kis se SC $5.00 $91.37 SIGNATUREOF CONTRACTOR OR AUTHORI OAGENT IDATEP VALIDATED THIS IS Y URPE MIT 6HENPERLY e gAtE R,w OWNER BwIDEM iDATEi P. %1 NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: Legal Description: - Owner Name & Address: Tel. C��. ��- Tel. # 763 - SO2 - 0,7177 Contractor. v -l- 2=t" MN LICENSE # zoco Y�f 7 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: °` x[ J'4 Al2 - ,6 Construction Type:_ a�i� C yN Estimated St.. $1 g 67, Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 76 �y 03 APPLICANT: s4lae 1-114 z Tel. Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-5714287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee $� e� Fee Schedule on Reverse Side Fire Surcharge $ -6 E) .001 of Permit Valuation (1/10th%) State Surcharge $ 1.0 �Z $.50/$1,000 Valuation SAC Charge $ $1275 per SAC Unit License Surcharge $5.00 (State Licensed Residential Contractors) Curb Cut 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 $ 7 Iw 7 SUBJECT AWOR - City of Fridley 1371 1 AT THE TOP OF THE TWINS BUILDING PERM IT 16. >r _--��_ COMMUNITY DEVELOPMENT DIV. r : PROTECTIVE INSPECTION SEC. 1 NUMBER nEv oATEvAGE of Aavnov D BY CITY MALL FRIDLEY 3532 It---- "'' 763-571-3450 910-F15 7 / 17/03 JOB ADDRESS 5924 Oakwood Manor NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 18 Auditor's Subdivision #92 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Cameron. 5924 Oakwood Manor 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Greg Wills Exteriors 4246 Royce St NE Columbia Heights. NN 55421 763-788-052 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20037840 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION ❑ ALTERATION 0 REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reside House 9 CHANGE OF USE FROM TO 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 panes or when the siding is an approved weather barrier. Vint' siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering or take pictures. Caulk and flash all exterior openings. 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 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $9,870 Y4.93 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHERS ATE OR LOCAL LAW REGULATING CON- $181.25 STRUCTION THE PERFORMANCE OF CONSTRUCTION Fir SC $9.87 PLAN CHECK FEE TO TA FEE I Licens S $5. 0 $ 01.05 SIGNAiuREIf CON'RACTOR OR AUTHORIZED AGENT iOATEiEN ROP ALIDATED HIS IS.)�OU PERMIT %Y J If _ S-GNATURE 09 OWNER,-f OWNER BUILDER. iDATE, 7 NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax BUILDING PERMIT APPLICATION Construction Address:�� Legal Description: Owner Name & Address: Tel. # Contractor. 64�l�%i 11S ��7 ��C MN LICENSE # RP 03 `7 �'�Cl Address: zd Tel. # ?4,. %fe ®S"a 9 LIVING AREA: GARAGE AREA: DECK AREA: OTHER: 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 Hgt/Ground Sq. Ft. Construction Type: Estimated Cost: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # r Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-5714287 if using credit card and we will call you for card number. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ] 101, TOTAL $y�• ®L STIPULATIONS, SUBJECT P NO. City of Fridley 33752 AT THE TOP OF THE TWINS BUILDING P E R M I T r � R EV VIPT NO. L'______ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r : a CITY HALL FRIDLEY 35132 NUMBER REV DATE PAGE OF APPROVED BY 763-571-3450 910-F15 7/31/03 JOB ADDRESS 5924 Oakwood Manor NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 Aud. Sub. #92 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE John Cameron, 5924 Oakwood Manor NE, Fridley, MN 55432 763-502-0997 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Pella Windows & Doors, 15300 25th Ave N Ste 100, Plymouth, MN 55447 763-745-1400 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20165884 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK C NEW O ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Replace 10 windows within existing openings. 9 CHANGEOFUSEFROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulking and flashing for all exterior openings. 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 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $7,393.00 $3.70 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. Fire SC STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $153.25 $7.39 PLAN CHECK FEE TOTAL FEE 00 License $169.34 SIGNATURE OF CON'AACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY VALIDATED THIS IS YOUI PEQRMIT BLDG -NSP f1A IE _1 SIGNATURE OF OW NEA -IF OWNER BUILDER. -,DATE, NEW[ J Effective 5/10/99 ADDN [ l CITY OF FRIDLEY ALTER [ ] SINGLE FAA1ILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Consftruction Address: Legal Description: Owner Name &Address: ®hh Com , '� Tel. # 5Z9 Contractor:; PELLA WINDOWS & DOORS MN LICENSE # Address: 15300 -25TH AVE. N. STE. #100 PLYMOUTH, MN 55447 Tel. # Attac 763-745-1400 ye . of the LICENSE #20165884 lot, o - _ _ _ _-- __ .. ...: to scale. DESCRII. ON- OF IWMUVEM M. LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft: DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: *:K ^n1 n r n 1 1 : ; b, An, .1 C,', \ IL M"'. n '-V lac ,c-+- °' V -'n- nr-�', n ,A Construction Type: Estimated Cost: $ -- `'M 3 Driveway Curb Cut Width Needed: Ft. + 6 Ft = _ Ft x $ _ $ DATE: 1 '3 o APPLICANT: 11 eAle6L,,�Tel. # tog CITY USE ONLY Permit Fee $ IS 3. �3 s Fee Schedule on Reverse Side Fire Surcharge $ 'j-, M .001 of Permit Valuation (1/10th%) State Surcharge $ 3 -In $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ ��. �.(� $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 [ J �y3" TOTAL ��ea� WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring WELL AND BORING SEALING RECORD Minnie�No. No. ^ ^ H 3 y � e nique Minnesota Statutes, Chapter 1031 or W -series No. (Leave blank ff riot known) > Town�iy,[do. C� Fjne No. eFtlon N� ret I�smgJ i Data Sea( s 1 �� IE aJ �3I295 Date Well or Boring Constructed 01 Ya Ya M Numerical Street Address or Fire Number and C' of Well o ring Location i 5924 O '° � �� Depth Before Sealing ft. Original Depth ft. Show exact location of well or boring Sketch map of well or boring pUIFER(S) STATIC WATER LEVEL in section grid with °X°.location, showing property le Aquifer Sin A g q [:1 Muitlaquffer Tines, roads, and buildings. N Measured ❑Estimated WELL/BORING l Water Supply Well [I Monit. Well E] Env. Bore Hole ❑Other ((! It. below ❑above land surface W -�- -' - -r- --�-- E CASING TYPE(S) Steel ❑ Plastic ❑ Tile ❑ Other 0 mUe - - -�-- -i-- --i-- CASING Diameter Depth Set in oversize hole? Annualar space Initially grouted? 4 In. from 0 to 140 It. ❑ Yes No ❑ Yes ❑ No ❑ Unknown in, from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown PROPERTY OWNER'S NAME JCIAN BURROW In. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown Property owner's mailing address if different than well location address Indicated above, 5'924 OAKWOO i MANOR NE SCREEN/OPEN HOLE FRIDLEY, MN 55432 Screen from 140 to 3 so ft. Open Hole from to ft. OBSTRUCTION/DEBRIS/FILL Obstruction ❑ Debris ❑ Fin ❑ No Obstruction Type of Obstruc ion/DebrislFlll 7 m C WELL OWNERS NAME P Wan owners melting address if different than property owner's address indicated above', Obstructiotl/DebrWRI removed? ❑ Yes ❑ No PUMP Type ❑ Removed 17 Not Present ❑ Other GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO FORMATION If not known, Indicate estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS,i OR CASING AND BORE HOLE: No Annular Space Exits ❑ Annular space grouted with tremie Pipe MUCK BLACK 0 1:5 RE 15 30 ❑ Casing Pertoratlon/Removal In. from to ft. ❑ Perforated ❑ Removed CLAY HgCon SAND Ham 11 R 1391 In. from to R ❑ Perforated ❑ Removed Type of perforator ❑ otlter CLAY BLACK 130 142 SANDSTONE GRAS .42 145 GROUTING MATERIAL(S) PORTLAND 150 SURF 24 Grouting Material from to fL yards bags from to it yards bags from to IL yards begs from to It. yards bags REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS on property? ❑ Yes No LICENSED O CONTRACTOR CERTIFICATION WATER LEVE, IN AVE WELL: 2 DATE WATER LEVEL '3 AKA -. 02-05-69 This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The infonntatlon contained in this report Is true to the best of my knowledge. W4. 4 5DO4 . 541 W093DI3 E.H. RENAER LNS p INC. 71015 Contractor Business UcenseorRegistrationNo. According to ISN State RegulationS 6/21/97 resentetivesignature Date Auffrorized A Illo KEVIN SCHEITERLEIN/'KET+ IN HOPPE Local COPY I1 t1 1 3 q 3 H 1 d 9 Name of Person Seeiing Well or Boring HE -01434-02 10/95R