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PRE 2010 DOCSJ �1 Village of Fridley, Minn. BUILDING PERMIT N? 950 Office of INSPECTOR OF BUMDINGS Owner , Architect Fridley, Minn., 18 Builder LOCATION OF BUILDING No.StrePart of Lot_ � Ar Lot Block Addition or Sub -Divisions.' DESCRIPTION OF BUILDING , Front Depth___fL Height St.:ories Manner of Construction To be used asr� _L -a_ To be completed I+]stiated Cost A IIS Permit is hereby granted to the building u .r described in the above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., regarding the construction, alteration, maintenance, repair and moving of buildings within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. -nsuector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector ofB ' dings of Fridley of the above permit, I hereby agree to do ' the proposed work in accordance with the description above set forth and according to the provisions of the ordinances of Fridley,',; and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. Subscribed and sworn to before me at FridlV, day A.D. 19 Minnesota,, this f n City of Fridley, Minn. N9 9884 BUILDING PERMIT Date: August 12, 1968 Owner. Douglas E. Johnson Builder Same Address 6388 N. E. Pierce St. _ Address Same LOCATION OF BUILDING No. 6388 Street Pierce St. N. E. __ Part of Lot Lot 9 _ Block Addition or Sub -Division _ 14Qore Lake Highlands 1 t Addu. Corner Lot — Inside Lot _ _ Setback _ _ _ _ Sideyard — Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Garage Front 24' Depth 24' Height 12' _ Sq. Ft. 576 Cu, Ft, 6912 Front Depth _ _ Height _ _ Sq. Ft. Cu. Ft. Type of construction — _ Frame Est. Cost .— To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above t forth in con fiance wi ons of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to Douglas Johnson to construct the building or addition as described above. This yrmit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Official Building NOTICE: ibis permit does not cover the construction, hutallation for whine, plumbing, gas heating, sewer or water. Be sun to see the Building inspector for separate pennhs for these hems. APPLICATION FOR BUILDING PERMIT TTY OF FRIDLEY, MINNESOTA OWNE6 IS NAME Cir J"4L y�.-�ty.�' BUILDER � ADDRESS ,�= < V., ADDRESS LOCATION OF BUILDING NO o _� _ STREET LOT BLOCK ADDITION OR SUBDIVISION COR -'\M LOT INSIDE LOT SETBACK SIDEYARD �3 r SEWER ELEIIATION TOP OF FOCTING Applicant attach to this form. T-ao Oortificates of Survey of Lot and proposed building location drawn on thea: Certificates. DESCRIP'T'ION OF BGTILD.I.NG To e Used As Front Depth eight l Square feetCif:z ubic Feet - (0 9/ Z Front Depth Height Square feet Cubic Feet 00 Type of Construction (, Estimated Cost ' �j °'"� To Be Completed The undersigned hereby makes applicatio.Vfor 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 /07 Ip SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side.) oma` 6 J(�o/Y _ .. Roly J 4L L SUBJECT City of Fridley 'P. 128 AT THE TOP OF THE TWINS BUILDING PERMIT � RECEIPT I • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 1 � NUMBER REV. DATE PAGE OF APPROVED BY _ �---1 CITY HALL FRIDLEY 55432 IL " ,�� L. ---A 612-560-3450 910-F15 11/26/74 JOB ADDRESS 6388 Pierce Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. I 9 Moore Lake 1st Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Douglas Johnson 6388 Pierce Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. RoMar Builders Inc. Route 6 Anoka Mn. 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 Z ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 20' x 16' Addition to dwelling 9 CHANGE OF USE FROM TO STIPULATIONS IIS ED 1 GR WIRING, 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 R-1 320 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS i 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 $7,900 4.00 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. $14.00 PLAN CHECK FEE TOT'ALFEE 4, 1 '0907 $18.00 SI TL(AE OF CONTRACTOR OR THORIZED AGENT IDATEI PROPERLY A ATED TP,�IS IS YOUR•PjERMIT/ (/�J��/W``H��EN�� ] &L'l.dC.j&j®/ cD `P / BLDG INSP DATE SIGNATUREOF OWNERIIF OWNER BUILDERI MATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA BUILDER: OWKER'S NAM: edt I -A& ZIL e�L ADDRESS:- o6 3 0� ADDRESS: NO:.613 T STREET: ( tI tr V_ LOT: BLOCK: ADDITION: m'-er" CORNER LOT: INSIDE LOT: ><SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: 4 st Front: 6 Depth: 9 eight: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: LL0* -4-"Estimated Cost: cell. To Be Completed: -4 The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in sttict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: Z '2 41 SIGNATUPX: I/C-0 g.Z4 (See Reverse Side For Additional Information.) q . j Air b 0 c; 4k"Ug ':78C::$Lb Q:$Od D04= PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATZ TOTAL Furtasce Shell & Dutt Work $10.00 $ Replatom,*nt of Furnace 6.00 Repairs & Atterat:ons---up to 4500.00 600 g Repairs & Alterations each add. 4500.00 300 $ Furnace Shell & Duct Work to 120,000 BTU .41000 $ each add. 60,000 BTU 3.W i Replacement of Furnace 6.00 11— Repairs Repairs & Alterations—up to $500.00 6.00 Repairs & Aherations each add. $300.00 3,00 $ STEAM cz HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft F.DR Steam SI0.W $ Furnace Shell & Line ---to 640 sq. ft. EDR Hot Water 10.00 S. Each add 200 sq. ft. EPR Steam 3 on $ Each add. 320 sq. ft EDR Hot Water 3.00 $ OIL RUPNER—to 3 gal, per hour 6.00 $ over 3 gal. per hour—See Fee Schedule GAS BURNER (up to M000 BTU) 6.00 $ over 199.000 VM Soo Fe* Schodule GAS FITTING FEE73. NO RATE TOTAL Ist 3 Fixtures x$ 200 $ Additional Fixtures x .76 4___ Gas Range to IM.000 x$ 5.00 $ State Surcharge .50 8 S" Fee schoduk TOTAL. rn $ (0 0 D*pt. of Bld%% i. Phone RO-V20 Locc—'— i< d '? E � % 4Pfr_ %. City of 11t4'idley: The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Ordinaneei: and niling of the Department of Buildings, and hereby declares that an the facts and repreaantations stated in this application are true and correct. Fridley, Minn- WIVi/ '- % 1&�L T Owner . ) Kind of Building p��/✓�.T Used as 3 To be completed about fd`d - i sr Estimated Cost; E �o 0 Old—New. Building Permit No. ______ _ PormitNo.- HEATING or POWER PI.ANrS Steam, goj Water, Warm Air—N Trade Name Siwe No Capacity_ _ Sq. Vt E.D.R BTU HP Total Connected Lwd Kind o4 g+uet BURNER — Trade Name Size N® Capand4y Sq. Fi. R.D R tRIeASKS—Otltttl City of Fridley APplimfo a for Plumbing end G= Feej fit Dept. of Bldaa. Phone 550-3450 ' DESCRIPTION OF WORM'/' L' � Numbar, Kind and Location of Fixtures M s! p it O N • N I; s � G M Z 3 I< �n ��► Z� oe O r �Q oil J r O S O 3 7 l'J ` U �< V a (� Z Z 7$ f1 e I • N WATER MTA. GAS EIEC. Base 1st X Y, 2nd _ 3rd 4th Future Coanoct an OpaninS7s Sewer ❑ a New Fixture, Old Openings Ccupool ❑ PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL C? Number Fixtures ................. 02 x $2.00 $% Future Fixture Opening ........... x $1.50 $—_• New Fixture Old Opening.....:.... x $1.50 $ Catch Basin .................... x $3.25 $ Water Heater 'Up to 99.000 BTU) - - . • x $3.00 $ New Ground Run Old Bldg......... x $3.25 $ Electric Water Heater ............ . z $2.00 $ :.AS FITTING FEES: NO. RATE TOTAL 1st3 Fixtures .................. x $2.00 $ Additional Fixtures ................ x $ .75 $ Gas Range to 199.000 BTU ........... x $5.00 $ REPAIRS k ALTERATIONS—Refer to Code City of Fridley: The undersigned hereby makes application for a permit for the- work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the fact and representations stated in this application are true and correct Fridley, Minn Owner VQ cr La Kind of Building f�'��r/ Used as �� 3 r moi, 6x1- 'e S To be completed about �' �� T it i 5 Estimated Cost, $ Io d Old—New. Building Permit No. Permit Ho. �y0 Signed O Bye` 1�z �i- Business Phune No ROUGH FINAL • .50 State Surcharge Description . .. . . .. . . . .... .......................... TOTAL FEE $ y� 1 6, 1978 Roger Roelofs RoMar Builders Inc. Route #6 Anoka, MN 1 k � :. t ti x Lam' oar ;. W jr- 8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 613)571-3450 Re: 6388 Pierce Street N.E., Fridley, Minnesota Dear Mr. Roelofs: I was contacted by Mrs. Johnson of 6388 Pierce Street N.E. this morning. who indicated that she had a problem with squirrels entering her attic through a hole in the roof. Our records show you to be the contractor for the addition work that was done. No final inspections were called for. After inspecting it today, I find that the roofing was not installed with proper flashing and that because of this, there exists a hole for rodent access. Please contact me on Monday to discuss corrections that are required at 571-3450, between 8:30 A.M. and 5:00 P.M. Sincerely, -�Ot RON HOLDEN ..... Building Inspector RH/mh CC: Mr. Douglas Johnson SUBJECT PE MI T677 City of Fridley 5 AT THE TOP OF THE TWINS BUILDING PERMIT • _ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. �L 0. -'1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY �----J%l 612-571-3450 910-F15 12/16/82 , JOB ADDRESS 6388 Pierce Street N. E. 1 LEGAL LOT NO. BLOCK TRACT ORA DITION SEE ATTACHED DESCR. 9 Moore (Lake Highlands lst Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Doug Johnson 6388 Pierce Street N.E. 571-6348 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Roger Harju Construction 10800 Xavis, Street N.W., Coon Rapids 427-7330 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 ElMOVE E]REMOVE 1- 8 DESCRIBE WORK Construct a basement bathroom and add a slab in existing crawl space 9 CHANGE OF USE FROM TO STIPULATIONS Use treated bottom plates. PERMITS RtQU"Rtt) FOR "'` k HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood Frame/Concrete 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATf'N SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $/'000 $3.50 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 ROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- CTI THE PERFORMANCE OF CQNSTRUCTION. $62.50 NONE. AAr PLAN CHECK FEE TOTAL FEE $15.63 1 $81.63 SIGNATUREV&CONTRACTORORA HORIZEDAGENT IDATEI, WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI 6 DG INSP OAT CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATION FOR RESIDENTIAL BUILDIpG PERNfiTS (New. Alterations, Additions. or Repairs) OWNER: ADDRESS: 38� fere TEL M0: 1' Sal BUILDER: �i ,1 ADDRESS: TEL NO: _ �2 7 -x.3.36 Construction location . STRITT NO: 3f STMr: l4wee LOT: BLOCK: ADDITION: Ayre4e� Corner Lot: Insiiie Lot: ; _ Setback: _ _ Sideyards: Applicant attach to this form two Certificates of Survey of lot and pro sed building location drawn on certificates to scale. i4S '► JT - DESCRIPTION OF MNSTRUCTION 6 'SC.A98 Front: Depth: Height: cf--XiS 1 • 42AAw1L- Square Feet: cubic Feet: �— Front: Depth: Height: Square Feet: Cubic Peet: Zype of Constructions Estimated Cost: S Tb Be Cbripleted: _ , /±k- Z - Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: SEE REVERSE SIDE OF SHEET Tile undersigned hereby makes application for s permit for the work herein specified, agreeing to do.all work in strict accordance With the City of Fridley Ordinances and rulings of the Delkartment of Duildings, and hereby declares that all the facts and representations stated in this application a and correct. DME: 2-//6 Z� SIGNATUiE: Stipulations: P s �c'U 097 ' UBJECT PER City of Fridley 20854 AT THE TOP OF THE TWINS BUILDING PERMIT i • O. COMMUNITY DEVELOPMENT DIV. _ r PROTECTIVE INSPECTION SEC. t CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED By 612-571-3450 910415 5/29/91 JOB ADDRESS 6388 Pierce Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 Moore Lkae Highlands lst SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Douglas Johnson 6388 Pierce Street NE 571-6348 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 Ij ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 22t,-611 x 1816"' Deck 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 SO. 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 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 $3,150, $1,58 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- $63.00 Fire SC $3.15 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. P CHECK FEE TOTAL FEE $67.73 �GNA UREOFCON'RACT ROR AUTHORIZED AGENT IDAATCEIf WHEN PROP R V LI AT IS IS YOUR PERMIT INSP BATE SIGNATURE Ot,,OWNER OF OWNER BUILDER$ IDAT EI NEW [ ] Effective 1/1/91 ADEN [ ] H-1' AND R-2 ALTER [ ] Q Building Permit Application Constructicn Address: O r� % �y'�L° �t, A,E Legal Description: 4C k owner Name &: Oa+4910 Jibnsdn 63?? /,�ree 5k, Tel. # 571-63Y9 Cmitzactor: CA Address: 696- A,-&re'e- sf Attach to this application, a Certificate of Survey of the lot, with the proposed ccnstruction drawn on it to scale. laVIM MM: Length Width height Sq. Ft. GUM= AIM: Length Width Height Sq. Ft. DEM RM: Length DYO/ Width r `/ Hgt/crow ILC Sq. Ft. ate- Corner lot [ ] Imide llot[ Ft. Yd Setback Side Yard Setbacks Type of Construction: �ar Pre¢r.Ied Estimated Cost: $ 'MQ Approx. Completion Date: y'- i r qj Proposed Driveway Width If New Opening Is Desired: Ft. $. $ Width + 6' See Back Page DATE: 5��1 APPLICANT: 22,47— Tel. my usE cwz Permit Fee $L7-�,Fee Schedule on Reverse Side Fire Surcharge $ .001 x Permit Valuation (1/10th �) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $650 per SAC Unit Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined byi * *+g Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] 9 TOTAL $ s STIPULATIMS : �I� I to- 06 347cl;-;Z, Building 76i/3,57A , ej BUILDING Permit Na ® Inspections Fire Surcharge RESIDENTIAL APPLICATION Received Dy:_ 763-572-3604 5PU CITY OF FRIDLEY Hate Rev'd: � l � ®(0 {,,YJ YOUR &MAIL AuuR14.48 SrrH ADDRESS Co THIS APPLICANT IS: 0 OWNER ONTRAUrQR PROPERTY OWNER/ NAME; TENANT--' ADDRESS bier e S C crrY ��\ems ti'eAT IPS f3� $ PIIONE:� CONTRACTOR NAMB; ...., - SU$MI'L' A COPY OF STATE LICEN.%k # r OVI �iQ k ® HXP DATE ..... . YOUR SPATE LICENSE ADDR SS; c� C1TYJDf,,--3z CL h 'r1ATE� P WITH APPLIC A'!'lON PHON �- PROPERTY TYPE 0 SINGI E FAMILY/NEW CONSTRUCTION SIZE_...., 13 TWO FAMILY/NF.W CONSTRUCTION STORIES PERMIT TYPE 0 ADDITION 0 GARAGEISHED 0 WINDOWS 0 BASEMFN'I' FINISH ❑ ROOF ❑ DRAIN'I'1LFi 0 DECK )AIDING Q O'FHER ❑ SWIMMING P(.X)L TYPE OF WORK; ❑ Nr. w 0 ADDITION Q MAIN'rENANCEME-PAIE 0 it UDELING DESCRIBE WORK BEING DONE: e SIZE, OF IMPROVEMENT LENGTPI WIDT14 HEIGHT Sq, Ft. ROOFING O HOUSE ONLY NUMBER OF SQUARES m 0 HOUSE & GARAGE RA- i Yl5N1,,,I3EMODELING SUIlMIL CAIiAc:F:rt 1:1 ATTAGIIED GARAC.Ip 1. Existing Mom Plan PROPOSED SIZE: 0 DETACHED GARAGE 2. Proposes( floor plan PROPOSED HEIGHT: ... J• List of structural members to he umd Vinyl o(iit FOR NEW CONSTRUCTION INCLUDING DECKS. ADD TI N. SUBMIT: Aluminum Trint I. Site PlanMurvey showing tho existing structures 0 Other Ulu and proposed project WOWS 2. Two sats of construction plans IN EXIS'T'ING OPENINGS L1Yes ONO IMATION OF WINDOWS 3• Enft$y C:aleulations OR FOR NEW OPENINGS -DESCRIER SIZE OF OPENING CHANs •F„S & _ TYPE OF WINDOW TO BE 1NKI`AI,LED NUMBER OF WINDOWS ALL PEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USIN 1997 IHC P%E SCHEDULE) TOTAL JOB VALUATIONS ":;-• — nrrirrANV.V 11VOW Permit Fee 76i/3,57A , ej Plan Review %/-, 99 $ — Fire Surcharge $ Surcharge 5PU $ License Surcharge {,,YJ $ S SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ __ Sewer Main Charge $ Total DueD/o See Back Page for Fee Schedule 65% of Building Permit Fee .00T times the total job valuation .0005 x Permit Valuation Minimum x.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) it+6 ft_ :2x$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary { ) Make checks oavable to: City of Fridlev Attac THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED I hereby apply for a building permit and 1 acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an appliotion for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all worwhich requites rex" approval of plans. l SIGNATURE OF Td WdOT:30 9003 90 '^ON LOETLLS29L: 'ON XWJ Fiaiptad JO 61IO: WOdJ Building BUILDING ING THE 1997 U.B.0 FEE SCHEDULE) Permit No.,, -40 10 Zo Inspections OCCUPANCY TYPE RESIDENTIAL APPLICATION Received By: J 763-572-3604 Plan Review CITY OF FRIDLEY 65% of Building Permit Fee D N6*AY 4 h1b 763-502-4977 FAX 1 Z; -D .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge EFFECTIVE I-1-2010 $5.00 (State Licensed Residential Contractors) SAC Charge DATE �Z D YOUR E-MAIL ADDRESS Curb Curt Escrow SITE ADDRESS 63 P4:7 Erosion Control THIS APPLICANT IS: ❑ OWNER XCONTRACTOR Park Fee PROPERTY OWNER/ Nom;'- Sewer Main Charge ADDRESS:ik3N F25 isr- 44E CITY STA�ZIP TENANT $ PHONE: — CONTRACTOR NAME: TiA� &V4]zs R5M7 0047 I, STATE LICENSE # EXP DATE e-9dJ e!!!4 SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF ADDRESS:2Zge n lPo�— A CITY s STATE/JL LIPy RDC, INSURANCE p PHONFL & /i3� FAX % .3 PROPERTY TYPE I SINGLE FAMILY N SIZE TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING 'OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑NEW HOME CONSTRUCTION ❑ ADDMON jbfAINTINANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: r -a-4 --xV zzXle-40 ZWK SIZE OF IMPROVEMENT '"r LENGTH WIDTH HEIGHT SQ FT ROOFING �. NUMBER OF SQUARES ❑ HOUSE ONLY ❑ HOUSE & GARAGE BASEMIM REMODELING SUBMIT: 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSEDHEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ❑ Vinyl ❑Soffit ADDITIONS_ & PORCHES SUBMIT: ❑Aluminum ❑Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed p%1ect. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: — ING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ (.' OCCUPANCY TYPE Permit Fee $ 54. eLl See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 1 Z; -D .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Curt Escrow $ R + 6 ft = ft x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks payable to: City of Fridley Attach Stipulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I kno edge that the information above is complete and accurate; that the work will be in conformance with the ordinanc and es a ty of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only anapplicatio or a k is not to start without a permit on site; that �the —work will be in accordance with the approved plan in the case o work c review and approval ofpl$ '/� 5�L SIGNATURE OF APPLIC PRINT NAME AAM�� a DATE I PLEASE NOTE: SEPARATE PERMITS ARE REOUIRED FOR PLUMBING. ELECTRICAL AND MECHANICAL WORK I a Minnesota Pollution _ Control Agency 520 Lafayette Road North St Paul, MN 55155-4194 Instructions SSTS Abandonment Reporting Form Subsurface Sewage Treatment Systems (SSTS) Program) This form is offered to meet the abandonment requirements of Minn. R. 7080.2500 and Disclosure Requirements of Minn. Stat. § 115.55, subd. 6. Future water supply well placement can also be affected by an abandoned SSTS. The use of this form is not mandatory; however the information on this form must be submitted to the local government unit (LGU) within 90 days after the abandonment. This form may be completed by a certified SSTS practitioner or by an individual who has direct knowledge of how the system was abandoned. Property Information Date of abandonment: 1116) Reason for abandonment: Property owner name(s): Property owner's adir City: ` 4 1i Site address (if differer t/} City: t Compliance Information 1. All solids and liquids removed from alltanks? � es No Disposal Site: i /G�Gt� r State: State: 2. All electrical devices and devices containing mercury removed? des ❑ No Disposal Site: 3. All underground sewage tanks crushed and filled with soil or rock material? [0,Pes ❑ No or Removed and disposed off site? ❑ Yes ❑ No Disposal Site: 4. Contaminated materials" removed and disposed off site? 24es ❑ No Disposal Site: 5. All underground cavities' crushed and filled with soil or rock material? Removed and disposed off site? ❑ Yes ❑ No Disposal Site: 6. Future discharge to system permanently denied? Method(s) used: Yes ❑ No ❑ No or: n Zip: *Contaminated materials = Distribution media, soil or sand within three feet of the system bottom, distribution pipes, geotextile fabric/rosin paper/straw, tanks, contaminated soil around leaking tanks, any soil that received sewage from a surface failure (7080.2500 subp.3). "Underground cavities = Cesspools, leaching pits, drywells, seepage pits, vault privies, pit privies, pump chambers (7080.2500 subp. 1). Does not include chamber media, drop boxes, or distribution boxes. www.pca.state.mn.us • 651-296-6300 800-657-3864 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-03 • 11121108 Page 1 of 2 Map Include location of building sewer, septic tank(s), soil dispersal system, cesspools, seepage pits, and other pits. Also include a permanent reference point(s) and dimensions. Certification I hereby certify the system was Name (please print): Address: L City: Phone: . Date: c 7///-1 T North accordance with Minn. R. 7080. 0 and pny local requirements. Title: . Signature: State: #Nat Zip: www.pca.state.mn.us • 651-296-6300 • 800-657-3864 TTY 651-282-5332 or 800-657-3864 • Available in alternative formats wq-wwists4-03 • 11121108 Page 2 of 2 424 IhAI � Ids CL1(4 4 U06o4W rk- s� F7