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PRE 2010 DOCSCity of Fridley6, SUBJECT MIT NO.` 1384 AT THE TOP OF THE TWIN BUILDING PERMIT s , � • ______ COMMUNITY DEVELOPMENT r L PROTECTIVE INSPECTION DIV. SEC. 1 � i CITY HALL FRIDL Y 55432 NUMBER V. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 110/25/76 JOB ADDRESS 40 Osborne Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Leigh Terrace SHEET 2 PROPERTYOWNER MAI ADDRESS ZIP PHONE S. J. Construction, Inc. 6305 East River Road N.E., Fridley 560-2970 3 CONTRACTOR MA LADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAI L ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK WARNMO Construct a 26' x 42' Dw ling and a 28' x 22' Garage SEMATT Before digging call local PERMITS REWIRED TELEPHONE - ELECTRIC, - G 9 CHANGE OF USE FROM HEATING', PLUMBING ANDTQSIGNS. REQUIRED BY $. STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. Builder understands that this house cannot be occupied prior to connection to approved sewer and water system. UTILITIES ARE NOT IN. SERVICES WILL BE INSTALLED THE WEEK OF OCTOBER 25, 1976. `NOF- FI 0M NOT `V ra —IMPORTANT--., ACCURACY OF UTILITY LOCATIONS AND NAVATIO. P:o I :. i DATA IS FOR INFORMANON PU!'POSES OwlLY i•P! a NOTIFY THE FRIDL.EY ENGR P-45ONS:USING IT SHOULD VERIFY THE INFORAAAtION DIVISION REGARDING CURB ON TH9 Ste. REMOVAL. AND REPLACEMENT AT WW WAY OPENINGS, 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 R-1 1144+616 28,624 Total 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. $34,620 $17.31 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEESAC CHARGE PROVISIONS OF ANY OTHER ST E OR LOCAL LAW REGULATING CON- $114.50 1 $350.00 STRUCTION OR THE P NC OF CONSTRUCTION. L PLAN CHECK FEF", TOTAL FEE 2 - :/If:� $28.652__s% $510.43 SIGNA UR FCONTRACTO OR HORIZED AGENT (DATE) N PRO ERLY VALIDATED THIS IS YOUR PERMIT -L ` ®12_ BLDGNSP - DAT SIGNATURE OF OWNER (IF OWNER BUILDERI IDATE) Mies 3 Etc. CITY OF FRIDLEY APPLICATION FOR. RESI DENTIAL BUILDING PERMITS 1 (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER'S NAME: �1� CONS i .e cJ � TiO�tl ��C BUILDER: S, j, C iI✓S 1c7-i0,J /h�G ��85 y V, raj �c ADDRESS: °� � '� �� ADDRESS: �6zo_i TEL. NO.:_6o 9 7 NO:. 4-® STREET: ® S E3®d_- LOT : BLOCK: a. ADDITION: CORNER LOT: INSIDE LOT: SETBACK: `2,'3_ SIDEYARD:/0 Applicant attach to this form dao Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Bq Used As: Z� Front: 54�_ Depth: Height: 1-y Square Feet: 114y— Cubic Feet: -•g-16�•- �� 'i�� Front: Depth: Height Square Feet; /t r Cubic Feet: -6/d46 M Type of Construction: EgAmF Estimated Cost: $.-t! 'C+•• To Be Completed: - - 7 7 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. 0 i FF DATE: /d - - % li SICNATURE4:_j4Ak,1,,/,) 4�1 "_� (See Reverse Side For Additional Infos ion.) r/ e4 eta sue cl 7. 31. '► 35v, ® o + G®��aG Al 55•e r I Lot e B1©cl 2 * LEIGH TER"I CE Revised to show proposed residence Oct. 29, 1976 We hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land and the location of all buildings and visible encroachments, if any, p from o• am said land. Sin�t`� ±�Y'� surveyed by us this 26 day of. May 19 76 �OT SURVEYS COMPANY 1 GERALD: T.•COYNE ` LOT SURVEYS COMPANY 3DO BRUNSWICK AVE. S. RAYMOND, A. PRASCH' GOLDEN VALLEY, MINN. MINN. REG, NO.'474I LAND SURVEYORS" .6917 IDAHO AVE.. N. BROOKLYN PARK, MINN. MINN. REG, NO, 6743. REGISTERED UNDER LAWS OF STATE OF MINNESOTA LWENBED 5371 BY ORDINA14CE OF CITY OF 1I 1NNEAPOLIS INVOICE NO. 5747 W. Broadway 533-9922 F..& NO. 161-36 INDUSTRIAL — JUDICIAL Minneapolis, Minnesota. 55429SCALL: COMMERCIAL — TOPOGRAPHICAL CITY LOTS — PLATTING Oururgart F�`#�ftPtt Q — DENOT.ES, IRON dj - Denotes Wood Hub Set �, S J« COASTRUCTIoh INC, For Excavation Only Proposed Elevations from profile furnished by owner. 0� /V aAf G r ..A 1 7V. at `, i7ID.� i •,.9r�' .yam �i . `�. (G' 0 N 1 d 55•e r I Lot e B1©cl 2 * LEIGH TER"I CE Revised to show proposed residence Oct. 29, 1976 We hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land and the location of all buildings and visible encroachments, if any, p from o• am said land. Sin�t`� ±�Y'� surveyed by us this 26 day of. May 19 76 �OT SURVEYS COMPANY 07 iL rim A.)o-r / , j 401 14 jb e, I A)��CE. - G �e w ie epe 0 p CITY OF FRIDLEY• APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE I I a+ r `o I I x( u .,tune _iYt.re C?ening Water r y New Fixture, Old Opening r. $2.00 r Catch Basin x $5.00 $ Water :eater - to 99,G00 BTU r. Heater 1C1,SS0 BTU to 199,000 BTU r. $10.00 $ Water Softener x $7.00 $ Now Gro=- F.:.. Old Building x $5.00 $ _le_tric :rater Heater x $5.00 $ GAS FITTI::G FEES: V)o w v x v'¢ v - U o :a.: :lee Gas Pz nge to 199,000 BTU r. $10.00 $ P,7 --PAIRS V ALTERATIONS First SIGO.GO $5.00 $ each add. $-00.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ f� 3rd 4th� �• � 1 I � I � i L ( I r � (:) Fu;ture CO:ect on Opening CO:iected with Sower o (•) e:+ Fiy.ture, Old t Water PARTIAL RATE SCHEDULE PLUV ING FIXTURE RATES: NO. RATE TOTAL ..�' er Fir ti res x $3.00 S .,tune _iYt.re C?ening x $2.00 $ New Fixture, Old Opening r. $2.00 S Catch Basin x $5.00 $ Water :eater - to 99,G00 BTU r. $5.00 $ 1C1,SS0 BTU to 199,000 BTU r. $10.00 $ Water Softener x $7.00 $ Now Gro=- F.:.. Old Building x $5.00 $ _le_tric :rater Heater x $5.00 $ GAS FITTI::G FEES: Ist 3 fixtures x $3.00 $ Additional Fixtures x $1.00 $ Gas Pz nge to 199,000 BTU r. $10.00 $ P,7 --PAIRS V ALTERATIONS First SIGO.GO $5.00 $ each add. $-00.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ f� RE -,::S? ..__-., F ($10.00) Job Address •�() �`/>t�.:fTdt inG (,��G1t/ feC, Departmont of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a per -tit for the work herein specified agreeing to do all work in strict accordance with the City Codes :.nd rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. , 19 OWNER l �l r 7 i rit- S KIND OF BUILDING �) Qy, USED AS TO BE COMPLETED ABOUT ��rr11 ESTIMATED COST l7 0 0 OLD - NEW BUILDING PER:SIT NO. PER.NIT NO. 7 Company Signed By�� Tel. No. -y a7 ) - ROUGH INSP. Date FT -NAI. INSP. - % Date APPROVAL FOR PEI :IT MINIMUM FEE FOR ANY PLUMMING PERMIT IS $7.50 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin I -later Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction x $3.00 x w x $2.00 > N _ x ro x v x x o $5.00 Water $5.00 c � r. •ci N q � 04 r; r. Heater y v N L 11 N F ro �, m ro s4 w � •.I $4 0 rdC ,lN� N �C L C) k .0 C E O < p0 0 .�i 1�) N C. •�-1 O O 101 N L N N N N a .0 L ro t u ro ro rn ro 3 s+ o A W c m �+ D, ro rd U M o ro R' $ (d U H 't. C7 O as lec U) U 7 PQ M r I ( lst TO 2nd �! P 3rd 4th -7 (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin I -later Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction x $3.00 x $2.00 x $2.00 x $5.00 _ x $5.00 x $10.00 x $7.00 x $5.00 x $5.00 x $3.00 x $1.00 X, $x:0.00 $5.00 $2.00 State Surcharge TOTAL FEE REINSPECTION FEE ($10.00) $ 3oc? Job Address 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 correct C Fridley, Mn. / L , 19 %6 OWNER d T KIND OF BUILDING /7A4A .,. USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - g BUILDING PERMIT NO. PERMIT NO. Company vZO KW Signed By Tel. No. 2 SS's S ROUGH INSP. Date FINAL INSP. J - ;� -7 Date APPROVAL FOR PERMIT, MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 560-3450 Croy of ;{;Al,y ANOKA COUNTY 6431 UNIVERSITY AVENUE NE February 7, 1977 FRIDLEY, MINNESOTA 55432 S. J. Construction 6305 East River Road N.E. Fridley, Mn. 55432 Re: Final Inspection at 40 Osborne Way N.E. Dear Sirs: A final inspection was made on January 31, 1977 of the above address and the following items were noted which must be completed before the structure can be finaled out; 1. Construct temporary steps on both the front and the garage. 2. Adjust door closer. 3. Render upstair patio unit inoperative. 4. Post address on structure. S. Post performance bond on sewer and water. 6. Provide a hard surfaced driveway. 7. Provide sod in the front and side yard. We will expect items 1 through 5 to be completed by February 15, 1977 and items 6 and 7 to be completed by October 1, 1977 when reinspections will be made to determine compliance. If you have any questions on these items, please feel free to contact me at 571-3450. Sincerely, DARREL G. CLARK Community Development Adm. DGC/mh SUBJECT City of Fridley 165 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T r RECEI O. V ...... COMMUNITY DEVELOPMENT DIV. �D 7 Y r PROTECTIVE INSPECTION SEC. I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �.; 612-571-3450 910-F15 4/30/82 JOB ADDRESS 40 Osborne Way N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 2 2 Leigh Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Les Watkins 40 Osborne Way N.E. 571-1068 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 R 8 DESCRIBE WORK Construct a 12' x 10'6" Detached Screen Patio 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR WIRINGIb HEATING, 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 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 $1,000 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $17.50 NONE STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $ 4.38 $22.38 SIGNAT OFC NTRACTORRAUI ORIZEDAGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT a • 5� a3 d�p��s��,�/ g /ladi SIGNATURE OF NER IIF OWNER BUILDER) (DATE) BLDG INSP 2 TE CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATION FOR RESIDENTIAL BUILDING PEWIITS (Um. Alterations, Additions, or Repairs) OWNER: ej1eA1%Vl IV -f ADDRESS: _ zlap TEL NO: - STREET NO: O STREET: LOT: BLOCK: BUI LDER : ADDRESS: TEL NO: Construction Location s 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. arr.L114ra S'i-R l rl'O DESCRIPTION OF CONSTRUCTION "meront: Depth: z o ° Height: - /0 + Square Feet_ fa ( Cubic Feet: Front: Depth: Height: Square- Feet: Cubic feet: Type of Construction: ®®® Estimated Cost: $ z000 • "V - 7b Zb Be Completed: b'0 4 e If Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET Mie undersigned hereby makes application for a permit for the work -herein specified, agreeing to do,all work in strict accordance with the City of rridley Ordinances and ruling-. of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. W - DATE: !&f `" J!Z SIGNATURE: Stipulations: r (� U !;(.)a ZZ,3� 1 SUBJECT P City of Fridley 19 6 6 5 AT THE TOP OF THE TWINS BUILDING PERMIT _ r R E C E I P_T_bIa--' COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. e'— i / --I il­--ICITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY .� L 612-571-3450 910-F15 9/9/88 JOB ADDRESS 40 Osborne Way N. E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 1 Leigh Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Leslie Walkins 40 Osborne Way N.E. 571-1068 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. AMRE 3700 Annapolis Lane Plymouth, MN 55447 553-0020 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 ❑X REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwellin 9 CHANGE OF USE FROM TO STIPULATIONS 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. 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 �� RX $12 OQO $600 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 $141.00 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY V LIDATED THIS IS YOUR PERMIT BLDG W$P DA'E SIGNATURE OF OWNER 0F OWNER BUILDERI (DATE) 1 NEW City of Fridley Effective 5/1/88 ADDN R-1 AMID R-2 AMER ,YJ� Building Permit Application construction Address ill Description:_ Owner Name b Oontractor: Address: 4�' 6�Iew�14:e Attach to this application, a Certificate of Survey of the lot, with the proposoed construction drawn on it to scale. DESCRIPTION OF IMPROVMTP LIVING AREA: Length Width Height Sg. Ft. GARAGE AREA: Length Width Height Sg. Ft. DECK AREA: Length Width Hgt/Ground Sg. Ft. MMIt ODrner Lot I I Inside Lot I I Ft. Yd Setback Side Yard Setbacks Typeof Construction: Estimated Cost: - � Approx. Completion Date:' Proposed Driveway Width If New Opening Is Desired:_ Width + 6' DATE: � � APPLICM CITY USE ONLY Permit Flee State Surcharge SAC (barge Driveway Escrow Park Fee Sewer Main Charge TOTAL STIPU MIONS: $ A6 Y Alt. A Alt. B $ See Back Page Tel. #��'��® Free Schedule on Reverse Side $.50/51,000 Valuation $550 per SAC Unit Alt. "A" or Alt. 'B" Above Fee Determined by Engineering Agreement Necessary I I Not Necessary [ ] ER IT NO. ' SUBJECT P City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT f RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. �y ------ r I � PROTECTIVE INSPECTION SEC. I i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/4/96 JOB ADDRESS 40 Osborne Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 2 Leigh Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mark Olson 40 Osborne Way NE 723-7765 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Netko & Sons Roofing 11880 Utah Ave N, Champlin MN 55316 421-2546 20061670 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 Ij REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (28 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 1 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 $2310 $1.16 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- $74.75 Fire SC $2.31 STRUCTION OR THE,PER AN E O P}6%RCCTTIII� PLAN CHECK FEE TOTAL FEE .�� �Y License SC $5.00 $83.22 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPER VALID TED THIS IS YOUR PERMIT BLD INSP DATE _ SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) ER IT NO. ' NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: o s z 0 V K 2yV 0. Legal Description: �' , ' „� G �, /'- �c' � "I Owner Name & Address: L Contractor: e 1- Address: // � 'o ei- /, h Effective 3/1/96 Tel. # %? -7 7 7 4/,T MN LICENSE # ® a 7 O S�Tel. #� �%, j� y 0/ Attach to this application, a CertifiEate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EUPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width H�Ground S . Ft. OTHER: �P IO 4 > . ; L Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: s1seoz _ 'n (Cost on Back) Driveway Curb Cut Width Needed: _ Ft. + 6 Ft = Ft x $ _ $ DATE: �2- s - �- APPLICANT: Tel. # CITY USE ONLY Permit Fee $ L . �%� Fee Schedule on Reverse Side Fire Surcharge $ Q.3 J .001 of Permit Valuation anoth%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $900 per SAC Unit License Surcharge $ .� C`� $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 [ ] 11 TOTAL $ .t MC�3 STIPULATIONS: 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 RF INRTAl I Fn nN FArN FI nnR Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 4,o . 05bcsme- im 103i "l%"—®aD 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 The undersigned hereby makes application for a permit for the work herein $ 4.00 specified agreeing to do all work in strict accordance with the city. codes $ 5.00 and rulings of the fuilding Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct $ 7.00 $ 7.00 $ 7.00 $10.00 Owner ' 1 ���� $ 7.00 $10.00 Building Used As ��61fl4vj cz $10.00 00 $10.00 Estimated Cost PERMIT NO. �y $15.00 PLUMBING COMPANY o POLO 4PLO 1 ✓l&A) & ( -A Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance SIG N0. [Z-gZ7-410 Approved By Rough -In Date Final Date State Surcharge $ .50 ANY PLUMBINGIGAS PERMIT IS - -MINIMUM TOTAL FEE $ !• PLUS THE S.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE S4 �MINTPMTIW IMM PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 4,o . 05bcsme- im 103i "l%"—®aD 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 The undersigned hereby makes application for a permit for the work herein $ 4.00 specified agreeing to do all work in strict accordance with the city. codes $ 5.00 and rulings of the fuilding Division, and hereby declares that all the facts $ 7.00 and representations stated in this application are true and correct $ 7.00 $ 7.00 $ 7.00 $10.00 Owner ' 1 ���� $ 7.00 $10.00 Building Used As ��61fl4vj cz $10.00 00 $10.00 Estimated Cost PERMIT NO. �y $15.00 PLUMBING COMPANY o POLO 4PLO 1 ✓l&A) & ( -A Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance SIG N0. [Z-gZ7-410 Approved By Rough -In Date Final Date State Surcharge $ .50 ANY PLUMBINGIGAS PERMIT IS - -MINIMUM TOTAL FEE $ !• PLUS THE S.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE S4 COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, the undersigned hereby verifies that the BTU Input venting has been examined and is free from rust, deterioration, obstructions, Appliance #2 Type and is securely supported and firestopped where required. Yes () No( ) The venting:, system is, plastic/PVC and meets all current codes and manufacturer BTU Input 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 manufacturer's specifications. This does Vent Height include AGA-GAMA Category I Central Furnace Venting Tables for fan Appliance #1 Vent Connector Height assisted and natural draft appliances. Yes () No ( ) The existing combustion air is sized and installed to meet the current codes ft Length and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed ft Diameter in Type 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 :