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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N° 7492 Date: May 22, 1965 Owner. T. E. Janutka Builder Self (homeowner) Adder160 Pilot Ave. N.E. Address same — LOCATION OF BUILDING No. 160 Street — Pilot Ave. N.E. Part of Lot La 14 __ Block x Addition or Sub -Division Carls ons Summit Manor SouSk Add. Corner Lot ,_ Inside Lot _ _ Setback — Sideyard Sewer Elevation _ __ _ _ — Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front _ __ __ Depth Height Sq. Ft. Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Est. Cost40Q0.a1V__ To be Completed New Kitchen Addition 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 aboveat t forth and in compliance with a'il provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 2s00 , permit is hereby granted to T- Be_ J>4ti dJM XOM Owner to construct the building or addition as described above. This permit 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 there% shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the dty limits and this permit may be revoked at any tune upon violation of any of the Provisions of said ordinances. Allen Jensen NOTICE: Ibis pwmk don not cam the construction, Inift aMen for whing, phnnhing, gas heating, s wer or water. Be sura to we the Building inspector for separate permits for thea Items. 03N 133HIS ' NIVW L L 6 «I � � ,� -sir • I o � I � � 4!b W N �• I I O o _ N ifT I H w, Liz___ V N OZ� C 0 v QZl 27Z I � W �y ZVZ b Lia 1 --- ;�--- E cr= 11, O 021 : �-----ani--- C C. OZI • I . � w YOZI �� •-•Cfif--' A � I Z1Z yrA g .14 ,- M N zsz � I M� sa I ' K I v of � 'iii v � ♦i6f r— FC,* Z w u � ¢• f.s V m m • C `L�1 •` �� � u ti ra� \ � r . 0 n o a 03N 133HIS ' NIVW L L 6 «I chlou NVWOU �ml � � .f -sir •-----� :♦ n _ I o � I � � g• M W N �• I I O o _ N ifT I I . w, Liz___ V N OZ� i QZl 27Z I � �y ZVZ b Lia 1 --- ;�--- E 021 : �-----ani--- OZI • I . � � i YOZI �� •-•Cfif--' A � I Z1Z g ;I M N zsz � I M� ♦ 'LL I ' —zJt. z � I v of � 'iii v � ♦i6f r— chlou NVWOU �ml SUBJECT City of Fridley 12'785 AT THE TOP OF THE TWINS BUILDING PERMIT t ECEIPT 16 COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION r SEC. 760 1 � = "I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 10/28/74 JOB ADDRESS 160 Pilot Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 1 Carlson's Summit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE T. E. Janutka 160 Pilot Avenue N.E. 3 CONTRACTOR MAILADDRESS 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 CX ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK construct a 18' x 12' Addition to back of garage 9 CHANGE OF USE FROM TO STIPULATIONS Agreement signed by neighbor for "No Survey" SEPERATE PERMITS REQUIRED FOR WIRING, HEATING, PLUMBING AND SIGNS. 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 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 $500.00 .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 PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $5.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $5.50 v IDAM WHEN PROPERLY VALIDATED THIS IS YOUj%RJ�PERRMIIT ' &TURE,0FCONTRACTORORAUTHORIZEDAGENT �J BLDG WSP DATE SI NATURE OF OWNE (1 OWN BUILDER) (DATEI APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME : T, l-. S R w u.T k A BUILDER: SE L F ADDRESS: 11v o V1, L-0 A�o 1E - N• E. ADDRESS: NO :. 161) STREET: ?I b U r:7 LOT: ( 4 BLOCK: ( ADDITION 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: Qn M Front : c` Depth: , Height: Square Feet: zp/fir Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: c_ Estimated Cost: $ To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stiict 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: SIGNATURE • )�) - cam, (See Reverse Side'For Additional Information.) Is J owner of the property located at have no objection to the City allowing the construction of a %Ao, to be located at A'1) IAF without the required certificate of survey that the City ordinarily requires for all new construction. Signee$ p Address W mess - 'Date !2D` 7$ 3`f 59' G AGI 24 125 ifs® PIS -OT - O E ju oT- 1 ------ _bac - - �-- - - _ s - SAT _ 10-2.7-7y r� SUBJECTPE City of Fridley 16 2 2 2 AT THE TOP OF THE TWINS BUILDING PERM r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. PROTECTIVE Ij CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY --_. L J \ T 612-571-3450 910-F15 6/3/81 JOB ADDRESS 160 Pilot Avenue N.K. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 1 Carlson's Stuomit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Thomas E. Janutka. 160 Pilot Avenue N.E. 560-5591 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAILADDRESS 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 16' 22' Construct a.M' x SI' Addition to Rear of Garage 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. 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 M 352 11iiIM 3520 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 $3,326.40 $1.66 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 4XIMM 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- $14.08 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $15.74 I ACOA OR OR AUTHO JI ED AGENT (DATE) OF I HEN PROPEFMY V- ID TED THI S YOUR PE MIT BLDG INSP GATE SIGNATURE OF WNERI OWNER BUIL ER) 9 (DATT) r� CITY Or FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PEW41TS (New, Alterations, Additions, or Repairs) OWNER: 7APMAS E Z-"UTKAt ADDRESS: I�D P/�-OT a -UE .A1F TEL NO: 5 66 BUILDER: SEL E ADDRESS: TEL NO: Construction Location STRICT NO: STREET: P1 LOT Imo/ Z AJ �. LOT: , BLOC:: �� ADDITION: Corner Lot: Inside Lot: ^ Setback:_ Sideyards: Ap-ilicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION X ,14L�'rD'flnt 09 Depth Height: Z'L Squane. Feet_ Cubic Fee : Front: Depth: Height: Square -Feet: Cubic Feet: Type of Construction: %M Ala Estimated Cost: To Be Cbripleted: Alt. A Alt. B Proposed.Driveway Width If New Opening Is Desired: $ $ SEE MVERSI,' 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 Fridley Ordinances and rulings of the Department. of Buildings, and hereby declares that all the facts and rcpr:esent.�ti.ons stated in this application are true and correct. D,%TP: 6 e Z0- 8/ SIGNATURE: �U. E Stipulations : ,� /7 f"106 14 -Ce 14WI Lu sueJEcr City of Fridley �PERMIT 18998 AT THE TOP OF THE TWINS BUILDING _ PERMIT r? , w_ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 19yy 1 � i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 6/5/87 JOB ADDRESS 160 Pilot Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 1 Carlson "s Summit Manor South.. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Thomas Janutka 160 Pilot Avenue N.E. 572-8825 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 Reside House & Garage 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. Redwood 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 ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,500 $1.25 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- $38.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $39.75 ORIZEDAGENTD TEI WHEN PROPERLY DATED THIS IS YOUR PERMIT XISUATTUREOFCONTRACTORORAU /� BLDG INSP BATE {J SiGNATURE OF OW RIIF OWNER BUILDER) (DATE NEW [ ] City of Fridley Effective 4/1/86 ADDN. [ ] R-1 AND R-2 ALTER. L`7 Building Permit Application Construction Address: Legal Description:_ Owner Name & Address: Contractor: Address: rMI Tel. # Tel. # - Attach to this application, a Certificate o Survey of the lot, with the proposed construction drawn o it to scale. DESCRIPTION OF IMPROVEMENq LIVING AREA: Length Width Hei t Sq. Ft. GARAGE AREA: Length Width Hei ht Sq. Ft. DECK AREA: Length Width Hgt Ground Sq. Ft. OTHER: RAS ! n✓ �' !Z t v 6 / -�►- 6 6 I Corner Lot [ ] Inside Lot Jed Ft. Yd. Setback Side Yard Setback dv Type of Construction: ��5� d �� � Es imated Cost: $ iO�'�DO....- Approx. Completion Date: Proposed Driveway Width If New Opening Is Desired: DATE: G 8 APPLICANT: Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY Alt. A Alt B Back Page for Explanation Tel. # ,572-1 Plis TEL.o- `l�q- /9? -7 $�. �d Fee Schedul on Reverse Side $ 25% of Builing Permit Fee $ /. �5 $.50/$1,000 Valuation $ $ 525 per SA Unit $ Fee Determi ed by Engineering Agreement N I [ ] Not Necessary [ ] 1 <t/ CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 �- 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING,COOLING. VENTILATION, 572-3604 , EFRIGERAT_ IQI-ALNIQAIR__CQNDIIlONIN.G_SYSTEMS AND DEVICES JOB ADDRESS L&O /`"/ l& AC, NE RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning - All Sizes Rate TOTAL $ 20.00 $ Q. $10.00 $ /0,� $10.00 $ $10.00 $ $ 10.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1 % of Value of Appliance or Work State Surcharge TOTAL FEE 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 ruling of the Building Division, and hereby declares that all the facts and representations stated in this application are true and correct. MY. ,-- '199Z OWNER �Dt_a QS II� e BUILDING USED AS ESTIMATED COST MAO Ov PERMIT NO. a�// � L DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units--!— Circle One (Steam) (Hot Water)(Warm Air) Trade Name Cont)CJ K Size No. BTU 1 C1217D HP EDR $ Fuel 1Vd7i - C 4LS Total Connected Load $ .50 $3®_ E-0 Burner Trade Name Size No. BTU HP EDR HEATING MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION //� REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 /� , Signed Tel No.� LT - PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 Approved B6ZE Rough -In Date Final Date *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes) No ( ) 2. Is free from rust or deterioration Yes (yQ No ( ) 3. Has no foreign objects lodged within Yes ( No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU's connected h Yes No ( ) G. Has total heating BTU's of J S, ® 00 All other BTU's :5 7 000 TOTAL BTU's OZ®QUO Remarks �C-C/ 2 -- List Alterations Being Done: HEATING COMPANY Signed By Date 011 R 1, Eva."". �� r U SUBJECT City of Fridley 25952 -' AT THE TOP OF THE TWINS BUILDING P E R M I T r I i _ COMMUNITY DEVELOPMENT DIV. L PROTECTIVE INSPECTION SEC. r ; NUMBER REV DATE PAGE OF APPROVED BY "1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 4/20/98 JOB ADDRESS 160 Pilot Avenue 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 1 Carlson Summit Manor, South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lora Pyka, 160 Pilot Ave, Fridley 574-2084 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Lora Pyka (same as above) 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION EX ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK BAsement remodel 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plans. SEPARATE sPtR!'',41TS REQUIRE-D 7`1­11R WIRING, HE ATING9 PLUMBING AND LIEN& 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 S0. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR 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 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 $1,500.00 $.75 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- $48.50 Fire SC $1.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEEAL FEE 7$50.75 INiNATURE OF CON'RAC7 RA ORI EDAG N7 IDATEI NR VALI D THIS I$ UR PER /J Cr do -7 BL INSP �r V fiAT .GNATURE OF OWNLa- RII OWNER UI D IDATEI U R 1- TEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY }— ALTER [ ] SINGLE FAM3LY AND DUPLEXES R-1 AND R-2 P BUILDING PERMIT APPLICATION ConstructionAddress : Fr ( d l ec-o Legal Description: _V r i SQ1i Q u /h M Owner Name & Address: — Contractor: Address: MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EMPROVEMENT LIVING AREA: Length Width _ GARAGE AREA: Length Width _ DECK AREA: Len Width _ OTHER: �h'xJT Construction Type: Driveway Curb Cut Width Needed: Ft. + 6 Ft = DATE: 4rff Tel. # Height Sq. Ft. Height Sq. Ft. Hgt/Ground Sq. Ft. Estimated Cost: $ (Fee Schedule on Back) —Ft x $ =$ APPLICANTe4 s9 Tel. # % —;0�� CITY USE ONLY Permit Fee $,�D Fee Schedule on Reverse Side Fire Surcharge $ l% .001 of Permit Valuation (1/10th%) State Surcharge g $ %) $.50/$1,000 Valuation SAC Charge $ $1000 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 TOTAL $ STIPULATIONS: CITY OF FRIDLEY INSPECTION DIVISION Effective On January 1, 1999 6431 University Ave NE L Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner — Also Replacement Furnace (Side Vent — Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer *Air Conditioning — All Sizes S All Others/Repairs &Alterations (UST ON BACK 1 % of Value of Appliance or Work it Commercial/Industrial 1.25% of Value of Appliance or Work Rate $ 30.00 $ $10.00 $ JOBADDRESS l&® PJ'1&14VC /VE The undersigned hereby makes application for a permit for the work herein TOTAL 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 M01 ue and correct. 6 ,'- $10.00 $ $10.00 $ $ 25.00 State Surcharge TOTAL FEE $ .50 MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. OWNER— J.,Q r6 BUILDING USED AS_ ESTIMATED COST '1971,66 PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name BTU Size No. HP EDR I Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: ,. i ( ) CHMMY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: L Has been carefully examined Yes ( ) 2. Is free from rust or deterioration Yes ( ) 3. Has no foreign objects lodged within Yes ( ) 4. Is securely supported Yes ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes ( ) 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water heater Yes ( ) 8. Has combustion air been provided for water heater Yes ( ) Remarks: List ALTERATIONS Being Done: HEATING CO: Signed By: Date: ,. i ( ) CI7YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 August 9, 2000 Lora Pyka 160 Pilot Ave NE Fridley, MN 55421 Re: Final Inspection at 160 Pilot Ave. NE Contractor: Maple Grove Heating & Air Conditioning, Inc. Dear Ms. Pyka: A mechanical permit was issued on April 5, 1999 for the property located at 160 Pilot Drive NE for an air conditioning unit. According to Section 305(a) of the 1991 Uniform Mechanical Code a final inspection shall be performed on the mechanical system. As of this date no inspection has been called for. You will be given thirty (30) days from receipt of this notice to respond. If we do not hear from you, we will expire the permit and any inspections on this installation will require a new permit. Any questions can be addressed to myself at (763) 572-3603. S DAVESEN BuildiyV Inspector GilY OF FKDLEY INSPECTION DIV. 0431 University Ave NE Fridley. MN 55432 572-3804 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT Effective On January 1. 1997 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB New Fixtures �y x:: -r.:.>::;> (t�SBf MARK NUMBER �%`ilii >;< ItUrinal Ttd �Y Shower OF •sS'•i ... •.: ., SM FIXTURES TO Wash Tray BE INSTALLED ON EACH FLOOR .. ,.< _ tt :%; ;Floor Ca�tf Auto. G >> Gas Alii Water Heater i{ «: Drain sJ K:� ; d� x: Stories Basement Catch Basin x .ca Rain Water Leader $ 7,00 r Washer y Rangel; r a . Gail Gle�i $ 7,00 } �Y" f R r_ .:. $ 7.00 .K-0:'jt->;K_ >: : , t • � t Y' 00.:7. %:y�'•• Floor 1 Gas Range* $10.00 Gas Dryer** $10.00 Back Flow Preventer Required { )Yes {) No Type $15.00 Reinspection Fee $42.00/Hr d Floor L Floor 3 . Floor "it .... -..... } .. Y.I.JR V •....• .. y-y� PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB New Fixtures $ 7.00 Old Opening. New Fbdure $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 ~ Catch Basin $7.00 Rain Water Leader $ 7,00 SUMP/Receiving Tank $ 7,00 Water Treating Appliance $10.00 Water Heater —Electric $ 7.00 Water Beater — Gas- _ �_ $10.00 Gas Range* $10.00 Gas Dryer** $10.00 Back Flow Preventer Required { )Yes {) No Type $15.00 Reinspection Fee $42.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS I S% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ k,-,Ef The undersigned hereby makes application for a perm it for the work herein specified agreeing to do ail work in strict accordance with the city codes and rulings of the Building Division. and hereby declares that aU the facts and representations stated In this application are true and correct. 5 141a W,198f, Owner (-6c Building Used As� Q �j Estimated Cost PERMIT NO. PLUMBING COMPANY Q SIGNED 8Y ` � Q ® , Approved By Rough—In Date_ Final Date MINIMUM FEE FOR ANY PLUM®INGIGAB PERMIT IS 820 Odd PLUS THE 50 8TATE BURCHAt3E "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A, MINIMUM SIZES 80 INCHES, SUBJECT PERMIT NQ -- City of Fridley7 6 51 AT THE TOP OF THE TWINS B U I L D I N G PERMIT RE NO. _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. "c r NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 j 612-571-3450 910-F15 9/9/98 JOB ADDRESS 160 Pilot Ave 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 1 Carlson's Summit Manor South Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lora P ka 160 Pilot Ave 55421 574-2084 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Four Seasons Roofing &795-9410 20138780 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 tJ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof >dxt house & garage (27S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED 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 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 $2,313.00 $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 VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $74.75 Fi SC $2.31 STR CTI OR THEPEAAMANCE OF CONSTRUCTION. PLAN CHECK FEETOTA FEE o n C $5 $83.22 SIGNATURE OF CONTRAR OR AUTHORIZED AGENT IDATEi EN ROP V LIDAT T IS IS flift INSP R PER GATE S,GNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CI'T'Y OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 /�I& S1 BUILDING PERMIT APPLICATION oZ ConstructionA: //d ti/�i Legal Descriptio: oww Nmw.4 Mdrew. LZ (-0— Py kA Tel. # 574, 94 Contractor:Selc. !2 oc� ej tMN LICENSE # Address:. L r t%�t P� �� • Tel. # ehtoiW6application, a Certificate of Survey of the lc*,, wil% tpaad tm wr-drawn on it to scale. L�:�CRIPTION OF IMPROVEMENT LIVING AREA.: � 'S�Di�1i�n.,.�® Height Sq. Ft. GARAGE AREA A: �In� � $�a�'irh� Height Sq. Ft. DECK AREA: Le M_VT 1 Hgt/Ground Sq. Ft. OTHER: W eOW-V to—' A el na Construction Type: mr f .d.R�e I W6c) ated Cost: $ �J (Fee Schedule, on Back) Driveway Width Ft. DATE: b' (APP[,t.C"i�T: Permit Fee Fire Surcharge / State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control 3 Park Fee Sewer Main TOTAL A _63, )a STIPULATIur�: Ft x $ = $ Tel. # W5-17416 ,&"%Mw verse Side .001 (1/10th%) $._bill Aow wodvm #00 per spy V6%* Residential Contractors) Aft, "A" or Alk, "B" Above J0,50,000DCWuc4�pmPIan Review 9 ,t'A�neering AqtetpRM [ ] Not Necessary [ ] SUBJECT city of Fridley =305064 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. � ►v __�___ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r / 1 i CITY HALL FRIDLEY 53432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910 -F15 11/12/99 JOB ADDRESS 160 Pilot Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 14 1 1 Carlson's Summit Manor, South Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lara P ka 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Eagle Window Dist. Co. 19300 Linden Dr. Rogers 55374 428-2883 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ®x REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace windows 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the house. 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 1 HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $8800 $4.40 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 PERFORMANCE OF C NSTRUCTI $167.25 Fire SC $8.80 PLAN CHECK FEE TOTAL EE Cit $ .45 SIGNATURE OF CON'RACTOROR AUTHORIZED AGENT i T i N P OP BLD 114SP R' LIDAT HIS IS YO ERM GATE S,GN4TORE OF OWNERoF OWNER BWLDERi iDATEI NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF F UDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ®� BUILDINAPPLICATION - G PERMIT CATION AP L e Construction Address: % P , r 0 Legal Description: Owner Name & Address: y ca Tel. # Contractor: �f e („j,� �o4j DJ L— C 0, MN LICENSE # Address: '� C) c) 10-1 c�--Z 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: & "w rtz'j s Construction Type: Estimated Cost: $ Ota , Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: f f Z APPLICANT: Tel. # CITY USE ONLY Permit Fee $ (+ '/. -VS- Fee Schedule on Reverse Side Fire Surcharge $ 9, 90 .001 of Permit Valuation (1/10th%) State Surcharge $ 4(40 $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ Ci $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 /-i'(! Parse STIPULATIONS: $ y®. qS- 3 a,�� 4s CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jain 1, 2002 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS 10 Pd0_( sZj6e�c � New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner ,- Water Heater -Electric $ 7.00 Water Heater - Gas** $10.00 AQ Building Used As Gas Range** $10.00 Gas Dryer** $10.00 Estimated Cost PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMP Y Z /1 Reinspection Fee $47.00/Hr SIGNED B TEL NO.��_� ALL OTHERS AND/OR REPAIRS AND ALTERATIONS FAX # 1.5% of Value of Fixture or Appliance Approved By An Rough -In Date Final Da _( State Surcharge .50 MINIMUM FEE F R ANY PLUMBING/GAS PERMIT IS $20.100 TOTAL FEE PLU§ THE .5 ATE SURCHARGE O T5O4?) COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTIOAND TAB 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCE J�R THE APPLICATION WILL BE RETURNED When rP la _ing an exacting flr___ anr_ m, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes ( No( ) The venting system is plastic/PVC and meets all current codes and manufacturer 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 include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes ( No( ) The exert=na cnm6 uctinn air is sized and installed to meet the current codes and manufacturer's specifications. Yes (E No ( ) When required to inc_ta11 a new cnmbietinn air,it will be sized and installed to meet the current codes and manufacturer's specifications. Yes ( No ( ) When installing a new venting nyc Pm, 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 #1 Type Appliance #2 Type Appliance #3 Type Total Appliances BTU Input BTU Input _ BTU Input Total Btu Input Common Vent Type Vent Height Fan Assisted or Nat Fan Assisted or Nat Fan Assisted or Nat Diameter 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 HEATING CO: Signed By: Date : 01, SUBJECTP AWIIT City of Fridley 12505 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEI/�jP�JT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY ,• CITY HALL FRIDLEY 55432 L J` 612-571-3450 910415 4/15/02 JOB ADDRESS 160 Pilot Avenue NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 1 Carlson's Summit Manor South Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Lora Pyka 160 Pilot Avenue NE 763-574-2084 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 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION Ck ALTERATION O REPAIR ❑ MOVE - ❑ REMOVE 8 DESCRIBE WORK Remodel bathroom and kitchen 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE PERMITS REQUIRED FOR: PLUMBING ANATSIGNS 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 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 $4,000 $2.00 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- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTE .25 SIGN RE OF CON�TVRAUA0)qoZEOjGENT (DATE. N "OPER LIOAT 7 IS IS YO R RMIT ,G ATURE OF O N ,IF OWNER 8 RI [DATE.. BLDG ASP gAtE 01, NEW ADDN ALTER Construction Address: 4 Legal Description:' Owner Name & Address: [ ] CITY OF FRIDLEY Effective 1/1/2002 (] 6431 University Ave NE, Fridley, MN 55432 (763) 5722604 Bldg Insp (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Tel. #76 ?�, S 7 41O0a'5l Contractor. J A MN LICENSE # 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: r>>v�oi��I� ii Construction Type: r e m od t i Estimated Cost: $ I r� Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: 44'0_ APPLICANT: t! Q /-z:�L L o /%I K4 Tel. 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. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1.000 Valuation $1200 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL $ lan— STIPULATIONS: / • 4/Alll Vo P IAI Built ing . $ BUILDING Permit No.: Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 .001 times the total job valuation CITY OF FRIDLEYY Date Rec'd: 763-502-4977 FAX .0005 x Permit Valuation Minimum $.50 License Surcharge SAC Charge $ $ $5.00 (State Licensed Residential Contractors) $1825 per SAC Unit (Plans to MWCC for determination) CD EFFECTIVE 1-1-08 Ariy A ®0 YOUR E-MAIL �7 / 4f/ (��L {% DATE ADDRESS A &7 Q SITE ADDRESS / 1/ ,J �t�E THIS APPLICANT IS: -�<WNER ❑CONTRACTOR $ PROPERTY OWNER/ NAME:Do e-}}-- Y ADDRESS: ria %� l/� �VCGITY N STAT ZIP=, SY g/ TENANT $ Q' / PHONE � � % 7 2- �% ZS Y NAME: ADDRESS: CITY STATE ZIP CONTRACTOR SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE STATE LICENSE # EXP DATE PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILYINEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING >( THE ❑ SWIMMING POOL {� TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING d' DESCRIBE WORK BEING DONE: QY= a rLL<JeuiI'®h PSCC �(L SIZE OF IMPROVEMENT LENGTH WID H HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: FOR NEW CONSTRUCTION INCLUDING DECKS, SIDING ADDITIONS. & PORCHES SUBMIT: ❑ Vinyl ❑Soffit 1. Site Plan/Survey showing the existing structures ❑ Aluminum p Trim and proposed project. ❑ Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation �- Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge SAC Charge $ $ $5.00 (State Licensed Residential Contractors) $1825 per SAC Unit (Plans to MWCC for determination) CD Ariy A Curb Cut Escrow $ $ -5 �_ft +3 ft = ft x $21 = $ ,Ulf �� Erosion Control $ $450 Conservation Plan Review ,J �t�E Park Fee $ Fee Determined by Engineerings 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 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 nstruction ;that understand this is not a permit but only an application for a permit and work is not to start without a permit an site; that the work will be in or with the app v pl the case of all work which req}ices review and approv of pl S. ll// SIGNATURE OF APPLIC NT PRINT NAME / C/� DA APPROVED BY DATE PURCHASE ORDER (DATE DEPARTMENT THIS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY F®97985 THIS NUMBER MUST APPEAR ON ALL CORRESPONDENCE SENT TO US �%� � ��,� l.� SUPPLIER lJ���,��� a� �y� (�� _ ADDRESS 1100 AY E NF-- G M � e 55 � � �� I a , Cl� 1 l DLEY PHONE NO. rl& �� r 7 — c2pFq 6431 UNIV AVE. N.E. FRIDLEY, MN 55432-4384® CONTACT 763-571-3450 PRINTED ON RECYCLED PAPER. PAYMENT VOUCHER BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEN RECEIVED OR RENDERED AND ALL CITY GUIDELINES HAVE BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOW STATED ITEMS. � 7 /�/ ( o DATER CEN .- ' P TA 0RIZEDBY ACCOUNT OTY. UNIT PLEASE ENTER OUR ORDER FOR THE FOLLOWING UNIT PRICE AMOUNT 315�� TOTAL THIS AGENCY HAS AGREED NOT TO DISCRIMINATE IN HIRING PRACTICES ON THE BASIS OF RACE, SEX, COLOR, CREED, MARITAL STATUS, RELIGION, OR NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGES FIRMS AND OTHER AGENCIES WITH WHOM IT PURCHASES PRODUCTS OR SERVICES TO DO LIKEWISE. WHITE, VENDOR - YELLOW, PURCHASING - PINK, ACCOUNTING - GOLDEN ROD, DEPT. HD.