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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT Date: Sept. 14, 1967 Owner: Charles Johanson Builder Address 160 Hartman Circle Address Same Same LOCATION OF BUILDING N® 9450 No. 413— Street Rive Creek Blvd- Part of Lot Lot _ 2 __ Block 1 Addition or Sub -Division _ __ Holiday Hills 2nd Addn. Corner Lot — Inside Lot x Setback 35 ____ Sideyard 11 Sewer Elevation _ 849.46 --852.46 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling Front 47.5' Depth 26 Height 20' Sq. Ft. 1287 Cu, Ft 25, 740 a a e Front 20' Depth 23' Height 10' Sq. Ft. 460 cu. Ft. 4600 Type of Construction — Frame Est. Cost — $20,O!QQEX _.. To be Completed SEWER LOCATION - 84' South of Manhole WATER LOCATION NU 74' South of Manhole In consideration of the issuance to me of a permit to c building cribed above I agree to do the proposed work in accordanwith the description abovco:V,,,ff, Ora �y with ail provisions of ordinances of the city of Fridley. $100.00 inconsideration of the payment of a fee of a 39.00 permit is hereby granted t , Charles Johanson 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 anworkmen, in all work. done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Mhmesota location, construction, alteration, maintenance, repair and moving of buildings within the dty ]innits� permit may be revoked at any time upon violation of any of the provialons of said ordinances. CLARENCE BELISLE Building Inspgetor NOTICE: 'lids permit does sof cover the construction, install toe for whdng, plumbing, gas heating, sower or water. Be sore is ace the Building Inspector for soperste permits for these home. A1PrL1CM1r .q FOR BT71114D NG PE sk1T Ci't i OF T'f IDLE Y-, r-1ti;NESOTA OWNER'S NAME Charles E. Johanson �...� sr�n Charles E. Johanson R:lz DER 160 Hartman Circe Ridley, Minn. 55432ADDRESS Eaidiey, Mien. ADDRESS LOCATION Or BUILDING N0. STREET .{CC ��e PART OF LOT e_ LOT BLOCK ADDITION OR SUBDIVISION *9L CORNER LOT INSIDE LO SETBACK 3 SIDE -YARD S WLR ELEVATION P-V�% FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location yawn on these Certificates. DESCRIPTION OF BUILDING To Be Used Ad: ' s Front41P/ Depth ;z Height �� d Sq. Ft. Z4 Cu. Ft . 5 , Front e Depth 2.3 Height Sq. Ft.-�� Cu. Ft.�Q® Type of Construction_ _ Estimated Cost® To Be Completed 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 /-SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). City of Fridley Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone BM -3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TO��TT/AL O) Number Fixtures ...................... x $2.00 $1L— Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ............................ x $3.25 $ p�aC x $3.00 $ New Ground Run Old Bldg. ............ x $3.25 $ 12 Electric Water. Heater a $2.00 $ K Z N � w 61 a R N WATER HTR. GAS ELEG Gas Range to 199,000 BTU .............. x $5.00 $ U a 0 Base let 2nd 3rd 4th • Future Connection Openings Connected With New Fixture, Old Openings I Sewer � Cesspool El PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TO��TT/AL O) Number Fixtures ...................... x $2.00 $1L— 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 a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $2.00 $ Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ REPAIRS & ALTERATIONS—Refer to Code Description ................................................$ ® C2, TOTAL FEE $� 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 pre #ue and correct. _ IPRdley, 6 16 19— Owner ion Kind of Building Used as To be completed about f - Estimated Cost, $ r� r. Old Ne uilding Permit No Permit No.r- Signe e r By Business Phone No ROUGH FINAL -41w4a Application for Power Plants and Healing, Cooling. Ventilation. Refrigeration and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work ..........................$10.00 $ Replacement of Furnace ............................. 6.00 $ Repairs & Alterations—up to $500.00 .................. 6.00 $ Repairs & Alterations each add. $500.00 ............... 3.00 $ MECH. WARM AIR .00 Furnace Shell & Duct Work to 120,000 BTU ............ $10.00 $ ®' ® d each add. 60,000 BTU ....................... 3.00 $� Replacement of Furnace 6.00 $ Repairs & Alterations—up to $500.00 ................. 6.00 $ Repairs & Alterations each add. $500.00 .............. 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... $10.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 10.00 $ Each add. 200 sq. ft. EDR Steam ...................... 3.00 $ Each add. 320 sq. ft. EDR Hot Water .................. 3.00 $ OIL BURNER—to 3 gal. per hour 6.00 $ over 3 gal. per hour—See Fee Schedule O GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE T%T�L 1st 3 Fixtures ...................... x$ 2.00 $ v — Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL Dept. of B�� I' L_illdgs. Phone 360-3450�c Location / l-7 R _.��L City of Fridley: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City 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. /? Fridley, Minn 3 -,2 (S 19 V Owner �✓ �✓� Kind of Building Used as PG� To be completed about Estimated Cost, $ �� <• � n Old ew. uilding Permit No. %.a Permit No. �02 DESCRIPTION OF WORK HEATING or POWER PLANTS—.Steam, Hot Water, Warm Air—No- Trade Nam Size No J 4,3 Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of FueL P 7— BURNER —Trade Name P r y Size No. Capacity Sq. Ft. E.D.R if BTU H.P. Coft. 4E Business Phone No- 7 (REMARKS—OVER) CITY OF FRIDLEY Effective May 1, 1990 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer • Air Conditioning (all sizes) 1 � RATE TOTAL Job Address 1 $ 20.00 $ �Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley $ 10.00 $ Tel. #571-3450 All Others/Repairs and Alterations 1% of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 1• of Value of Appliance or Work $ 10.00 $ 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 $ 14.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. $ 10.00 $ FrAdley, Minn. Ula 1 0 U i�.)w , 19 OWNER OCT 3 0 KIND OF BUILDI_.(iG State Surcharge TOTAL !EE Reinspection Fee ($15.00) Rough Inap. Date Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in !« de yard without written permission from adjoining n ulldx,r. $ .50 S USED AS To BE COMPLETED COST /- BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACV ER HEATING or POWER PLANTS, Steam, Hot Water,Air- Trade Name---jPAA,fl.,QK Size No. Capacity 100 Sq. Ft. EDR BTU ncyu- Total Connectd Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR® NP Company i d� s Floc. Inc r D' -! Icn Signed y z „"Pei i N— , Tel. No. 1lIJ Fill out back side for stack verification on replacement furnaces 7 CHIM14EY 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 ( 1 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 connected Yes ( ) No ( ) 6. Has Total heating BTU(s of All other BTU's TOTAL Remarks Com pa ny Signed By Da to , I ... , , , ,:.n . t...R z,. , NEW I ] Effective 8fi ADDN [ ] CITY OF FRIDLEY /-, 4, ") ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 I Building Permit Application �gal nstructionAddress: �- `� ��Description: VjAqz�—(c CoCoZ Owner Name & Address: Tel. # A s -t 4 - -7 1 Contractor: _ MN LICENSE # Address; Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # -LIVING AREA: Length Widtf j- Height Sq. Ft; GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: - Comer Lot [ I Inside Lot [ ] Ft. Yd Setback Type of Construction: Approx. Completion Date: Side Yard Setbacks Estimated Cost: $ -� (Cost on Back) 00 Driveway Curb Cut Width Needed: 'Z-zFt. + 6 Ft = Ft x $ c� _ $ DATE: APPLICANT: Tel. # Permit Fee $ . Fire Surcharge $ State Surcharge $ SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ STIPULATIONS: CITY USE ONLY Fee Schedule On Reverse Side .001 of Permit Valuation (1/10th%) $.501$1,000 Valuation $850 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 =*by ation Plan Review Fee DeteEngineering Agreement Nrsary [ ] Not Necessary [ ] CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: Urinal Effective On January 1,1995 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Wash FloorPsi h Auto. has Gas IllusShower n Tra o Drain n_ Washer pRama Ft NO. RATE TOTAL New Fixtures Old Opening, New Fbdure 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 ype $7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS c L 1 % of Value of Fbdure or Appliance O — State Surcharge .50 TOTAL FEE 1) JOB ADDRESS Ok' Water Heater Gas I Elec 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 K -c, 0( Building Used c1 � Estimated Cost () PERMIT NO.__ TJX_ PLUMBING COMPANYZA n SIGNED BY M1 , Al P_ %%! i=1 nin Approved Rough—in Date Final Date al i SUBJECT P, City of Fridley 3096 L AT THE TOP OF THE TWINS BUILDING PERMIT i � • COMMUNITY DEVELOPMENT DIV. SEC. r PROTECTIVE INSPECTION i CITY HALL FRIDLEY 55432 � NUMBER REv DATE vAGE OF APPROVED BY ••_- L J` 612-571-3450 910-F15 T5/23/00 / / 10B ADDRESS 413 Rice Creek Blvd NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Holiday Hills 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary/Shannon Anderson 413 Rice Creek Blvd NE 574-0871 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal By Andersen 350 73 Avenue NE, Fridley, Mn 55432 502-4777 20130983 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 ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace patio door within existing opening 9 CHANGE OF USE FROM 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. permit Inspection cards Will Be mailed To Ho eowner Te Post 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 1 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 $/� 456 0 �• A7� 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 TOTA FEE Licens S $5.00 122.90 SIGNATURE OF CONTRACTOR Op AUTHOp12E0 AGENT IDATEI N R P L V LIOAT MIS IS VO PFT HE44 bLP1 NSP rIA1E S,GNATURE OF OWNEROf OWNER GUILDER, IOATEI i NEW[ 1 Effective 5/10/99 ADDN [ l CITY OF FRMLKY ALTER SINGLE FAMILY AND DUPLEXES R-1 ANI) R-2 BUILDING PERMIT APPLICATION ba . � o Construction Address: Legal Description: Owner Name & Address: �.s v, d- S�r,� Qs�o N Tel. # Cil • �� ¢ 0 e�� I Contractor:, RENEWAL BY ANDERSEN MN LICENSE # 35073RD AVE. NE Address: FRIDLEY, MN 55432 Tel. # (612) 502-4777 Al LICENSE #20130983 urvey of the 10, n it to scale. LIVING AREA: Length GARAGE AREA: Construction Type: Width Height Length Width I -1 -eight Length Width Hgt/Ground .,kob.0 Q -.3rl in �c 'k \ kr\n yr o 1 IN i �Jl -,r\ Sq. Ft. Sq. Ft. Sq. Ft. Estimated Cost: $ y , 00 Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ M SATE: APPLICANT: Tel. # 9�a ' ��l • CZ5- Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee - Sewer Main Charge TOTAL r aD �o CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th,%) $.50/$1,000 Valuation $1050 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 [ J Not Necessary [ J STIPULATIONS: �F Ul�� i /•c,/ GG ��/./� „ SuB.,ECT PERMIT NO. City of Fridley 3106 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. COMMUNITY DEVELOPMENT DIV. SEC. 3& r PROTECTIVE INSPECTION 1 1 1 1 '- CITY HALL FRIDLEY 55432 1.4 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 6/16/00 JOB ADDRESS 413 Rice Creek Blvd. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 1 Holiday Hills, 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Anderson 413 Rice Creek Blvd. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Richard Hastings 6331 Riverview Terrace Fridley, MN 574-9966 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 ADDITION 91 ❑ NEW ❑ ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof with Tear -Off 23 Squares 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING. TYPE OF CONST. OCCUPANCY GROUP 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,010.00 $1.01 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 $83.25 1 F . e SC $2.01 BV�- PLAN CHECK FE TFEE 1/TO �Lice /'O e $5 0 7$91.27 SIGNATURE OF CON TRACTOROR AUT RIZED AGENT E� T T HEN R P VALID TE THIS IS U;071T v BSO INS C PATE S,GNATURE OF OWNER,IF OWNER BUILDER,--- IDATEI .-NEW- [ J Effective 1/1/2000 ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: '4/ 3 Com,/ Legal Description: Owner Name & Address: Tel. # Contractor. _ MN LICENSE # �Q 5 / Address: Tel. # 5 �4 - !F 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: 2-3 Construction Type: ,..,- Estimated Cost: $ j G r o VW U Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ -=$ DATE: C 0 APPLICANT: I Tel. # S 7 Y CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $ S"Fee Schedule on Reverse Side Fire Surcharge $ 0 .001 of Permit Valuation (1/10th%) State Surcharge $�f $.50/$1,000 Valuation SAC Charge $ $1100 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 [ ] TOTAL STIPULATIONS: sueJEcr MIT NO. City of Fridley 31479 AT THE TOP OF THE TWINS BUILDING PERMIT P RECEIPT NO. COMMUNITY DEVELOPMENT DIV.�� r PROTECTIVE INSPECTION SEC. 1 "'1 CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910415 10/12/00 JOB ADDRESS 413 Rice Creek Blvd NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DEscR. 2 1 Holiday Hills 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary/Shannon Anderson 413 Rice Creek Blvd NE 574-0871 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO 10131 Renewal By Andersen 350 73 Ave NE, Fridley, MN 55432 612-502-4777 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20130983 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Sp REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace two window inserts 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. Permit Inspection Cards will Be mailed, . To Homq®Wngr To Post 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 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 $1.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT T000 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHAGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $69 25 Fire C $2.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK F TOT FEE Licen S $5 $177.25 S-GNATURE OF CONTRACTOR OR AUTMORQED AGENT 10ATE. p VALID T) THIS ISS PUR PERMIT BL G�. TiATE NSP S-GNATURE OF OVVNER of OWNER BUILDER1 [DATE, INEW[ ] Effective 5/10/99 ADDN CM OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES It -1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: -q Legal Description: Owner Name & Address: Contractor:; Address: LIVING AREA: GARAGE AREA: DECK AREA: RENEWAL BY ANDERSEN 35073RD AVE NE Tel. MN LICENSE # . . FRIDLEY, ° MN 55432 Tel. # ( 612) 502-4777 Lte of Survey of the LICENSE #20130983 yawn on it to scale. Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: A fki'E4%L Estimated Cost: $ tom Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ STIPULATIONS: CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fare Surcharge $ — .001 of Permit Valuation (1110th%) State Surcharge $ $.501$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "E" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL a� $ — STIPULATIONS: CITY d FRIDLEY INSPECTION DIViSION Effective On January 1, 2000 x6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE OWNER Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS Also Replacement Furnace $ 30.00 $ (Side Vent - Fill Out Back) ESTIMATED COST`' v PERMIT N0.� Gas Piping (Needed with new furnace, $ 10.00 $ but not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range $ 10.00 $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) EOthers/LRepairs $ 10.00 $ Trade Name Size No. BTU HP EDR Size � � �a ,Y$ 25.00 $ Fuel Total Connected Load Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25/ of Value of Appliance or Work $ 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 an State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and TOTAL FEE $ representations stated in this application are true and correct. ` RICHMOND & SON@LFEC. INC. dba: GOLDEN VALLEY HTG & AIR MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING CO REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 , RYSTAL, MN 55429 6" PLUS THE $.50 STATE SURCHARGE Signed. ' 006EL # REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without Approved ByRough-In Date Final Date written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed To meet the current codes and manufacturer's specifications. Yes () No When installing 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: C[TYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 June 8, 2004 Mr. Gary Anderson 413 Rice Creek Blvd NE Fridley, MN 55432 Re: Final Inspection at 413 Rice Creek Blvd NE Contractor: Golden Valley Heating & Air Dear Mr. Anderson: A mechanical permit was issued on June 16, 2003 to install an air conditioner at your address. According to the 1991 Uniform Mechanical Code a final inspection shall be conducted on the work authorized by this permit. As of this date the inspection has not been requested. The permit fee that was paid covers the inspection to make sure the work was completed according to the Codes. We will keep your permit open for another 30 days and if we do not hear from you within this time to set up the inspection, we will mark the permit "no inspection called for by homeowner after notification" and the permit will be expired. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh Su8jECT City of Fridley33677 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. ,,�f r PROTECTIVE INSPECTION SEC. .7 � �I 1 � � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 ' 763-571-3450 9t0-F15 7/8/03 JOB ADDRESS 413 Rice Creek Blvd NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2 1 Holiday Hills 2nd Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Gary Anderson 413 Rice Creek Blvd NE 763-574-0871 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Jansick Inc 6480 Squire Drive NE Fridley, MN 55432 763-574-9679 8618 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 O NEW Q ADDITION O ALTERATION ❑ REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Construct a 14' x 14' Deck Replacement 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. WARNIMG Before digging call for all Utility locations 454.0002 REOUIRED BY LAW 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 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 $2,322 $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- $83.25 Fire SC $2.32 OF CONSTRUCTION PLAN CHECK FEE TOTALFEE "RUCTIONERFORMANCE 11 .ANY-�- CA ce se SC $5.00 $91.73 TRACTOR OR AUTHORIZED AGENT IDATEI HEN PROPERLY VALIDATED THIS IS YO R P RMIT LOG ,NSP 014 1E S-GNATURE OF OWNER,IF OWNER BUILDER, IDATEI 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: GJ/3 Ar -e Legal Description: Owner Name & Address: e-1 S Tel. # N3 -S74`0821 Contractor. 6rAA) _'ICiC IAI(- ° MN LICENSE # 9'v l -q Address: '/ Ito SQ & "� P %2 , 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 1,V Hgt/Ground� Sq. Ft. OTHER: Construction Type: &'Pl wre Ar< Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft - Ft x $ _ $ � e DATE: 7- 2 - 03 APPLICANT: Tel. # 7vl'3 Call (763) 572-3604 for Permit Fees if mail in application. Fax to 763-571-1287 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 a TOTAL $ 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 [ 04/02/2004 FRI 13:21 FAX ELDER JONES Iij001/001 o S NEW [ ] CITY OF FRIDL'E:Y Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ I SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-7287 Fax BUILDING PERMIT APPLICATION Construction Address: �Aud . Legal Description: Owner Name & Address: CqpLf Tel. #�� 3 • �{- O T '7- I Contractor. MNLICENSE#; W9OQ3-1 —1 Address: RENEWAL BY ANDERSEN Tel. # (05 I' �R(Dq - q T4 1920 COUNTY ROAD "C" WEST ROSEVII.LE, MN 55113 [cater of Survey of the .i 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 � w Sq. Ft OTHER: 1 nw .a� o (.�.LaAa % �� c i mCJ1c S dam, g D o Construction Type: Estimated Cost $ � r � ®C °® Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: 11 -Y1D%A-05- APPLICANT: ATel. # qS2 •-3q5' 64 T Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Pian Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1350 per SAC Unit $5.00 (State Licensed Residential Contractors) Ali. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineedng Agreement Necessary [ I Not Necessary [ TOTAL $ IQ -3.) 5 STIPULATIONS: Building $ 3 , A!; ( BUILDING Plan Review Permit No.:70 Inspections Surcharge RESIDENTIAL APPLICATION (.0005) times the total job valuation – Minimum $.50 Received By: 763-572-3604: .001 x Permit Valuation (1/10%) CITY OF FRIDLEY $ -S-%33 Date Recd: DATE YOUR E-MAIL ADDRESS S $ SITE ADD S 2— THIS APPLICANT IS: ❑ OWNER CONTRACTOR $ PROPERTY OWNER/ NAME: V ii, $ TENANT ADDRESS: ° 11d CITY ° STATENIZIP ,32— Agreement necessary ( ) Non Necessary ( ) PHONE: $ �,� CONTRACTOR NAME:_ RENEWAL BY ANDERSEN sclltcd� SUBMIT A COPY OF STATE LICE 1920 COUNTY RD. "C" WEST a `z '0 o YOUR STATE LICENSE ADDRESS:_ ROSEVILLE,M STATE ZIP WITH APPLICATION PHONE 651-264-4777 ' �� #20130983 PROPERTY TYPE F�^LICENSE -)RMS PERISM TYPE 17ADDITION ❑ GARAGE/SHED ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWDA IING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION AN ❑ REMODELING DESCRIBE WORK BEING DONE: ` SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE 13ASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2• Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS IN EXISTING OPENINGS gYes ❑No LOCATION OF WINDOWS 2. 3. Two sets of construction plans Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OFA`G 4 &-- OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: irJSIING 1997 U.B.0 FEE SCHEDULE) i TOTAL JOB VALUATION $ �� OCCUPANCY TYPE Wb Permit Fee $ 3 , A!; ( See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ 1 ,� 3 (.0005) times the total job valuation – Minimum $.50 Fire Surcharge $ .001 x Permit Valuation (1/10%) License Surcharge $ -S-%33 $5.00 (State Licensed Residential Contractors) SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $20 = $ Erosion Control $ $450 Conservation PIan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ �,� Make checks payable to: City of Fridlev 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 Construction Codes; that I understand this is not a permit but only an applicatio for a permit an work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all wor hick requites evi d approval of plans. SIGNATURE OF APPLICANT _ _ PRINT NAME —r/ Bah !� M ek– DATE /2i a 14 4a Building BUILDING Permit No.a c-oe Inspections RESIDENTIAL APPLICATION Received BYA-C-4 ''K'n 763-572-3604 CITY OF FRIDLEY Date 1 DATE a?CO ®F YOUR E-MAIL ADDRESS anaa C_(.iC • C.C�i1'1 SITE ADDRESS 40,'4'�('" C(e-r � 61 $ THIS APPLICANT IS: 0 OWNER NTRACTOR $ PROPERTY OWNER/ NAME: fL1 °F'{SOr�� $ TENANT ADDRESS: ^ CITY STATE_ZIP PHONE: NAME: Renewal By Andersen $ CONTRACTOR SUBMIT A COPY OF STATE LICENSE #_ 1920 County Road "C" West YOUR STATE LICENSE ADDRESS: Roseville, MN 55113 r STATE ZIP WITH APPLICATION PHONE License #20130983 0 SINGLE FAMILY/NEI PROPERTY TYPE 0 TWO FAMILY/NEW G 651-264-4777 _ PERMIT TYPE 0 ADDITION 0 GARAGE/SHED 0 WINDOWS 0 BASEMENT FINISH 0 ROOF 0 DRAIN TILE 0 DECK 0 SIDING 0 OTHER 0 SWIMMING POOL TYPE OF WORK: 0 NEW 0 ADDITION ❑ MAINTENANCE/REPAIR 0 REMODE 1NG DESCRIBE WORK BEING DONE: G.A'3 ; t,,,D L,QJ�C t SIZE OF IMPROVEMENT LENGTH WIDTH HEI611T Sq. Ft. ROOFING 0 HOUSE ONLY NUMBER OF SQUARES 0 HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES 0 ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: 0 DETACHED GARAGE 2. Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, 13 Vinyl OSoffit ADDITIONS. & PORCHES SUBMIT. 0 Aluminum 0 Trim I. Site Plan/Survey showing the existing structure 0 Other 0 Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS Oyes ONo LOCATION OF WINDOWS 3. Energy Calculations 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 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 1 00 --- OCCUPANCY TYPE Permit Fee $ 3 S - Plan Review $ Fire Surcharge $ DO Surcharge $ �90 License Surcharge $ L; 0 SAC Charge $ Curb Cut Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ Total Due $ , See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks savable to: Citv of Fridlev Attac 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 i conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an applicati for a permit and work is not to start without a permit; that the work will be in accordance with the approve plan in the case of all work hich requir view and approval of plans. /� SIGNATURE OF APPLICA RINT NAMEAQ t'r+ JJe y,.5dy� DATE � 6 Building $ cl_�, Q 51 BUILDING Permit No.: Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Surcharge CITY OF FRIDLEY MWAY DATE o?® e ' " 'v YOUR E-MAIL A7RSS EWS0kr%aQig? 0(21,C-0C • C Cyy-% P SITE ADDRESS �-5 \C`•e. G�`�' t y?) SAC Charge THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR Curb Cut Escrow PROPERTY OWNER/ NAME: G-0-44 T-\r\Cx-e, UIr�t Erosion Control ADDRESS: CITY STATE ZIP TENANT $ 1JT PHONE: dbG 3 • `i dJ I NAME: Renewal By Andersen Sewer Main Charge CONTRACTOR SUBMIT A COPY OF STATE LICENSE #_ 1920 County Road "C" west $ _ C5o _ R (V YOUR STATE LICENSE ADDRESS: Roseville, MN 55113 r STATE ZIP WITH APPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/NEI _ 651-264-4.777 PROPERTY TYPE ❑ TWO FAMILY/NEW C ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS PERMIT TYPE ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: TI&O V&-CQ Gtr S LJ ,1+0 'InAa SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S . FIP ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT• GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS-& PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structure ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations 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 U.B.0 FEE SCHEDULE) Permit Fee $ cl_�, Q 51 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 $ S , M $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ _ C5o _ R (V 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 conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an application f r a permit and work is not to start without a permit; that the work will be in accordance with the approve plan in the case of all work wh requires rev' and approval of plans. j� SIGNATURE OF APPLICANT NT NAME{ 1 Q(r11�50 Y� 7 DATE