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PRE 2010 DOCSDate: May 3, 1967 Owner: Address City of Fridley, Afinn. BURDING PERMIT Charles E. Sohanson 160 Hartman. Circle I'/ -s -e9 N9 9216 Charles E. Johnason Builder 160 Hartman Circle Address LO !ON OF BUILDING Rice Cree vd. No.. _ Street _ Part of Lot Lot _ 13 Block 1 Addition or Sub -Division . Holiday Hills Corner Lot — Inside Lot Setback 35 __ Sideyard Sewer Elevation 821.79 824.79 Top of Footing DESCRIPTION OF BUILDING To be Used as: Dwelling 50 ' 27.6' 20' 1375 32,780 Front Depth Height ........ Sq. Ft. Cu. Ft Garage M'T X21 12- 440 5,280 Front Depth — Height Sq. Ft. Ca. Ft. Type of Construction Frame Est. Cost — $20,000 _ To be Completed SEWER LOCATION - 19' North of Manhole (Service off West end of lot) WATER LOCATION - 61.5' From Catch Basin - 51.5' From manhole In consideration of the issuance to me of a permit to cont building e d e bedabove, I agree to do the proposed work in accordance with the description above set o and in compli ce th all provisions of ordinances of the city of Fridley. n In consideration of the payment of a fee of $ 49.00 , permit is hereby granted to Charles E . 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 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 Ridley, 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. CLARENCE BELISLE Building Inspector NOTICE: This permit doer not cover the construction, Installation for wiring, plumbing, gas heating, sewer or water. Be sure to no the Building Inspector for separate permits for them items. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME i -N 5, );N N 5 c -A I Iq e- BUILDER ADDRESS / o l+e,i 'V*.' Aj 6"'xe-A-c ADDRESS `J A LOCATION OF BUILDING NO. '� STREET I a C PART OF LOT LOT / BLOCK / ADDITION OR SUBDIVISIONn� CORNER LOT INSIDE LOT SETBACK '� SIDE -YARD SEWER ELEVATION 30P OF FOOTING 7 Applicant attach to this form two certificates of survey of lot and proposed bu''j�ldding location drawn on th se two certificates. `` DESCIPTION OF BUILDING To be Used as: V - Front ,J�� Depth Height ', a Sq. Ft. .w- Cu. Ft.�� 41 &__Front '), G Depth 7, 1- Height -!�f - " / Sq. Ft.�� `_ Cu. Ft. r'T Type of Construction 1/'�-77t-e_ Estimated Cost , I-e'd 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 ruling of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. eL 01 DATE q % - i SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). ® /w City of Fridley Application for Plumbing and Gas fitting Perndt Dept. of Bldgs. Phone 860-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures y NO. RATE TOTAL. Number Fixtures ......................10 x $2.00 $ '" Future Fixture Opening ................ x $1.50 Y New Fixture Old Opening .............. Z $ PS x $3.25 w a Z *0O x $3.00 N WATER HTR. GAS ELEC. m x $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 $ Base •Q� ,at 2nd 3rd 4th • Future Connection Openings Connected with New Fixture, Old Openings I Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL. Number Fixtures ......................10 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 $ . d–e New Ground Run Old Bldg. ............ x $3.25 Electric Water Heater x $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 ................................................$ TOTAL FEE $ S, 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. Owner Kind of Used as To be completed about Estimated Cost, $ Old ew. uilding Permit No �1A Permit No. Signe /7✓c s 1 . /i " ROUGH �' f FINAL 42 Business Phone AlV�x Application for Power Plants and Healing. Cooling, Veni lation. 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 $ MECIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............$10.00 $ 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 GAS BURNER (up to 199,000 BTU) ....................... 5.00 $� . over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL lst 3 Fixtures ...................... x$ 2.00 $ a Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL �,►Rl• TOTALSee Fee Schedule E -' Dept. of Bldgs. Phone 560-3450 Location City of Fridley: The undersigned hereby makes application for a permit for the work hereir. 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 applicationAWe true and correct. Fridlpv- Minn- Y , rr Kind of Building Used as To be cc Estimate Old—New. Building Permit No. q4�/4 Permit No. k54?je� DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No Trade Name Size Capacity. Sq. Ft. E.D.R. BTU H.P. Total Connected Load Kind of Fue BURNER —Trade Nam t- Size N 6 "�®� Capacity. 4200 (° FA/7 ma -22A60 (REMARKS -OVER) s Application for Power Plants and Heating. 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 Furnace Shell & Duct Work to 120,000 BTU ............$10.00 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 GAS BURNER (up to 199,000 BTU) ....................... 5.00 $ ®!q over 199,000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x$ 2.00 $ai2, d G Additional Fixtures ................. x .75 $ Gas Range to 199,000 ........... x$ 5.00 $ AIR CONDITIONING FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL $ See Fee Schedule TOTAL FEE $ to Dept. of Bldgs. Phone SM -3450 Locatio- 37-16-6 �� ° 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 19 _ Owner Kind of Building Used as To be completed about Estimated Cost, $ 914—New. Building Permit No. Permit No. DESCRIPTION OF WORK HEATING or POWER PLANTS , Warm Air—No Trade Nam Size No-4� 12t'l - /10 Capacity. Sq. Ft. LR BTU H.P. Total Connected Load .�, 3 _`/3� Kind of Fuel -�+ BURNER — Trade Name Size No f d Capacity Sq. Ft. E.D.R BTU H.P. (REMARKS—OVER) Signed' 'ftf'lei Allgy e411110. <e Business Phone No- es CL D-56 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS FRIDLEY, MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation _ Guide WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No Yes—No 19_ E FIJ jtna -1. Room I Length ./ Width t/N Height R- II f$ F1 L'3 L& Room I Length Width l Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Windows and Doors—Crackage and Area _ Width Height No. of Lineal ft. Area No.of nano of pane lights of crack sq. ft. Coef. Btu Infiltration Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. Glass If S Coef. Btu Infiltration A q Int. wall (, y Glass Floor 6 '° 0 Exp. wall 0_0 Int. wall i /1 Net exp. wall Net exp. wall Int. wall 5- °O 7 g"® Int, wall Ceiling Ceiling S 1—;1 Floor Floor G (j % 7 Total 13tu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area FI.1 Room I Lenath Width Height Windows and Doors—Crackage and Area A , J Width Height No. of Lineal ft. Area No. of pane of pane lights of crack eq. ft. Windows and Doors—Crackage and Area a10l6ua C"p tlo Coef. Btu Infiltration Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. Glass If S Exp. wall Net exp. wall Int. wall Net exp. wall - v Int. wall Btu Ceiling Floor Floor 6 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ■ a. - A , J nluau Windows and Doors—Crackage and Area a10l6ua C"p Windows and Doors—Crackage and Area Infiltration 13 4d Width Height No. of Lineal ft. Area No. of Dane of pane lights of crack sq. ft. NO '10 If S 2 Net exp. wall Int. wall //3 v Coef. Btu "Infiltration Floor Exp. wall 6 6 Glass 9Exp. wall P 0_0 Int. wall i /1 Net exp. wall . if . r . 5- °O 7 g"® Int, wall Ceiling 17 S 1—;1 Floor G Total Btu. ft. E.D.R. or sq. ins. W.A. Leader area Windows and' Doors—Crackage and Area Wldth Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. JV 1.1 12f'_ `, i\Wua i a.aaysua 6,/ n suua .v a acaEua Q/ Windows and Doors—Crackage and Area Coef.1 Btu Infiltration 13 4d 7 Glass . Eap. wall If S 2 Net exp. wall Int. wall //3 v Ceiling w Floor Exp. wall (o Total Btu. Net exp. wall D0611 P Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Int. wall i /1 . _, f Wt. r., .1 2 . if . r . JV 1.1 12f'_ `, i\Wua i a.aaysua 6,/ n suua .v a acaEua Q/ Windows and Doors—Crackage and Area Width Height. No. of Lineal ft. Area No. of pane of pane ' 1 hts of crack qq. ft. Coef. Btu s Net exp. wall Coef. Btu Infiltration Q Glass w Exp. wall Net exp. wall D0611 All V Int. wall i . "7 2 0r Ceiling Floor Q Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l Room I L.enath Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Infiltration Glass Coef. Btu Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. h. E.D.R. or sq. ins. W.A. Leader area D-56 -:.,42 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS Weatherstrips A.S.H.V.E. Construction No. Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roo# Floor Kind Yes—No Yes—No 19- - 1 1. - ra.• v. I r r err .. • ,1f inn 1 ■ .r .� a a.� 1 a�wua 1 acu�ua � / � auua Width HeightNo. of Lineal ft. Area No. of Dane of pane llghts of crack sq. ft. • aca�ua Windows and Doors--Crackage and Area Width Heisht No. of Lineal ft. Area No. of pane of pane ligbto of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pa//ne lights of crack sq. ft. 3,2 L 1 '36 '20 py, i t/ &"j- �® 601 1760 Coe£Btu GlasstZ Infiltration ,°� L/ Exp. wall (10 P/ v a Glass Exp. wall Net exp. wall / 5 Z ✓moi O.7® Net exp. wall Int. wall Int. wall 2. Int. wall Ceiling Ceiling IP 12 66 1:2 3 IJV, Floor 7 ® 919 264 Y 194 ;t, Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area R F1.1 P;hnv,'Pe v Room I Length 1175 Width 1-2—Height 5�- Windows and oors—Crackage and Area Doors—Crackage and Area Width HeightNo. of Lineal ft. Area No. of Dane of pane llghts of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pang�ee lights of crack sq. ft. Sc Width Heisht No. of Lineal ft. Area No. of pane of pane ligbto of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef.1 Btu Infiltration �® 601 1760 Glass GlasstZ 1- /a/0, Exp. wall 'Exp. wall Q Exp. wall Net exp. wall Net exp. wall t' Net exp. wall Int, wall Int. wall 2. Int. wall Ceiling CeilingFloor IP 7V Floor ,�°� 7 1 7 ® 919 Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I 1 Fi.l I a oI l L � Room I Lenath e 7 Width I U Heiaht 19' Windows a Doors—Crackage and Area Windows and' Doors--Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pang�ee lights of crack sq. ft. Sc Width Heisht No. of Lineal ft. Area No. of pane of pane ligbto of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Btu Coef.1 Btu Infiltration Btu Infiltration Coef. GlasstZ 1- , 'Exp. wall Q Exp. wall 9A, Net exp. wall t' Net exp. wall vog Int. wall 2. Int. wall 5V0 CeilingFloor Ceiling Int. wall Total Btu. ft. E.D.R. or sq. ins. W.A. Leader area FRIDLEY, MINN. Insulation How Applied vv t.- au _a.cus a j,✓ Windows and' Doors--Crackage and Area esg t Windows and Doors—Crackage and Area Width Heisht No. of Lineal ft. Area No. of pane of pane ligbto of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Btu t) (r, Coef. Btu Infiltration Coef. (e 1- Glass , .��577D Q Exp. wall 9A, t' Net exp. wall vog / 2. Int. wall Net exp. wall Ceiling Int. wall Flood® %p Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Le a Wath H ' hCC FI.) L,ROOM I. ngth 1 Width Height No. of Lineal [t. Area No. of pane of pane lights of crack sq, ft. esg t Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Btu t) (r, Glass (®6-57 Coef. Btu Infiltration 1 13 Net exp. wall ! d Q Glass t' Exp. wall Floor 2 6 Net exp. wall 2o7l Int. wall Ceiling Floor /79 7 13 't Total Btu. 17Plio Required sq. ft. E.D.R. or sq. ins. W.A. Leader area I Fl.l 12 a -ft Room I Lenirth .37- Width / ® Heistht %Z Windows and Doors—Crackage and Area Width Height No. of Lineal [t. Area No. of pane of pane lights of crack sq, ft. Coef. Btu Infiltration (r, Glass (®6-57 Exp. wall 16 q Net exp. wall % Int. wall 3 6 Ceiling 6 Floor 6 Total Btu. ft. E.D.R. or sq. ins. W.A. Leader area v 97-81,-bi6051 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE ' PLUMBING FIXTURE RATES: NO, RATE TOTAL bier Fixtures x $3.00 $ Future Fixture Opening •F-e i $2.00 $ Water x $2.00 $ Catch Basin x $5.00 $ i.watar Heater - to 99,000 BTU, x $5.00 $ _ 100;000 'BTU to 199,000 BTU x $10.00 $ Water Softener Heater $7.Q0 r u A.•.. C N Electric Water Heater .K L � N .0 C d r '� tl 1st 3 fixtures u tll $3.00 $ Additional Fixtures 0 .OrNq $ .Gas Range to 199,000 BTU x W4b $ 22 W 0 x ��pp IppA U W a p K x tl� lN7 a rN�a lJ O s ' l e C 0 u' L3 G1 q tn 3 A [w Ln w lstep ac ar' c nd'ti es• 2nd Ar la CB 36 0 4 th L (R) - Future Connection Opening Connected with Sewer (11) . New Fixture, Old Opening Water PARTIAL RATE SCHEDULE ' PLUMBING FIXTURE RATES: NO, RATE TOTAL bier Fixtures x $3.00 $ Future Fixture Opening •F-e i $2.00 $ Now Fixture, Old Opening .._.�.. x $2.00 $ Catch Basin x $5.00 $ i.watar Heater - to 99,000 BTU, x $5.00 $ _ 100;000 'BTU to 199,000 BTU x $10.00 $ Water Softener x $7.Q0 $ New Grourd•Run Old Building ®x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: , 1st 3 fixtures x $3.00 $ Additional Fixtures x $1.00 $ .Gas Range to 199,000 BTU x $10.00 $ REPAIRS 6 ALTERATIONS first $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge, $ .50 TOTAL FEE $ 8,0n RE2NSPECTION PER Job Address 460 Rice C_ eek Blvd, � Department of Buildings City of Fridley I Tel. 1571-3450 The undersigned hereby makes application for permit for the work he specified agreeing -to do all work in strict accordance with the City Cc and rulings of the Department of Buildings, and hereby declares that n; the facts and representations stated in this application are true and c Fridley, Mn. 7-27-77 , 19_ OWNER CLIFFORD ASN__ KIND OF BUILDING USED AS res. TO BE COMPLETED ABOUT ESTIMATED COST lo. no OLD - NEW BUILDING PERMIT N0. PE&NIT NO. � Company signed By* e Tole Noe ROUGH INSP. Data FINhL INSP. / o Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 SUBJECT PERM City ®f Fridley 75242�O3 AT THE TOP OF THE TWINS BUILDING PERMIT � CEIPT N0. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 . i NUMBER REV DATE PAGE OF APPROVED BY i �i,•J CITY HALL FRIDLEY 55432 --e- �'� i 612-571-3450 910415 8/24/93 JOB ADDRESS 460 Rice Creek Blvd NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 13 1 Holiday Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerome Cichosz 460 Rice Creek Blvd NE 572-8364 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 Ek NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 16' x 8161 Deck 9 CHANGEOFUSEFROM TO STIPULATIONS See notations on plan. Provide smoke detectors as per UB.0 1210 adjacent to all sleeping areas and in basement. WARNING Before digging cell for all utility' logatione 454.0002 REQUIRED BY LAW 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 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 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 $lt55oa $.75 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- $35.0.0 Fire SC $1.50 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $37,25 SIGNATURE OF CONTRACT RO AUTHORIZED AGENT WHEN P PERLY LIDATED THIS IS YOOU�RJ PER IT 7lDATEI J IN OA ,��iGNIXTURE O .OWNER OF W ER BUILD I t A EI NEW [ ] Effective 5/26/93 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 'f, C(, 0 /� /C /e- C��/�,�/C X "'— t.1 e-) Legal Description: Owner Name & Address: J 6ef2 Y z-- $ / , ;�—o Tel. # Contractor: $.50/$1,000 Valuation MN LICENSE # Address: $ $5.00 (State Licensed Residential Contractors) Tel. # Alt. "A" or Alt. "B" Above Attach to this application, a Certificate of Survey of the $ Fee Determined by Engineering 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 �(d 'o Width _ '_ Hgt/Ground Sq. Ft. 156 OTHER: Corner Lot f j Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: 4 Tf> ei.,W Estimated Cost: $ / Soca f—o— Approx. Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft / - Ft x $ /) A DATE: �S �i 1 APPLICANT: C1TY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ STIPULATIONS: Tel. #.� �os� Fee Schedule on Reverse Side $ / , ;�—o .001 of Permit Valuation (1/10th%) $ '%� $.50/$1,000 Valuation $ $750 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ Conservation Plan Review $450.00 $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ $ STIPULATIONS: Tel. #.� �os� SUBJECT City of Fridley AT THE TOP OF THE TWINS BUILDING P E R M I T r -v -------COMMUNITY DEVELOPMENT DIV. I PROTECTIVE INSPECTION SEC. r CITY HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY 612-571-3450 910-F15 5/12/97 JOB ADDRESS 460 Rice Creek Blvd NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 13 1 I Holiday Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry Cichosz 460 Rice Creek Blvd NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Midwest Siding & Roofing 18979 Gladstone Blvd, Maple Grove MN 55311 20010277 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 416-4804 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION C REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (28) 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 REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT i HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,310 $1.16 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $74.75 Fire SC $2.31 STRUCTI N OR THE PERFOR ANCE OF CONS N PLAN CHECK FEE TOTALFEE (� -'s ` License SC $5.00 $83.22 SIGNATURE OF CONTRACTOROR AUTHORIZEDAGENT (DATEr WHEN PROPE VALIDATED THIS IS YOUR PERMIT 1)216e141_1111 1 o SIGNATURE OF OWNER IIF OWNER BUILOERI (DATEI BrOG INSP DATE NEW [ ) Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION I ConstructionAddress: 4W—D (p L P) �d Legal Description: Owner Name & Address: Tel. # Contractor: III MN LICENSE # Address:Gjcjcj!z-4 Attach to this application, a Certificate of Survey oTtheS'S-':StI 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: Width Hgt/Ground Sq. Ft. r OTHER: �.G) r°�� 1 e /1 ..� --S 9_ Construction Type: t cca Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: { cs Tel. # q s — LL 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 $ -3 S .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $950 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 [ ] $ PD•--), � 2 Rice Creels watershed 3585 LEXINGTON AVENUE NORTH, SUITE 330 ARDEN HILLS, MINNESOTA 55126-8056 TELEPHONE (612) 483-0634 FAX (612) 483-9186 www.mnwatershed.org/rice.htm March 3, 1998 John Flora City of Fridley Fridley Municipal Center 6431 University Avenue N.E. Fridley, MN 55432-4383 SUBJ: City of Fridley, Creek Bank Stabi i ation Project -Jerome Cwhosz Property Dear Mr. Flora: Board of Managers Regular Meetings: 2nd and 4th Wednesdays at Shoreview City Hall KATE DREWRY, District Admin. BONITA TORPE, Admin. Assist. This will confirm that the RCWD Board has approved the inclusion of the Cichosz property for cost sharing under the District's SBBS program. The District's "not -to -exceed" cost share amount was incased by $2,719 to a new total of $119,250 which represents 50% of the efi&1e costs. jak c: Jerome Cichosz, 460 Rice Creek Blvd., Fridley, MN 55432 SBBS File BOARD OF MANAGERS A.J. CARDINAL, SR. DAVID T. COOPER ROBERT M. HULT BARBARA A. HAAKE EUGENE L. PETERSON ANOKA COUNTY RAMSEY COUNTY WASHINGTON COUNTY RAMSEY COUNTY ANOKA COUNTY MONTGOMERY WATSON Consulting Engineers 593-9000 • Co -Counsel: HAROLD H. SHEFF 332.1000. ,MICHELLE I. ULRICH 699.9845 J--/ (0 6 wl�� CENOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 LICENSE AGREEMENT The undersigned and , being the fee owners of certain property located in Fridley, Minnesota, at , and legally described as: 14-30-24-21-0013 hereby grant to the City of Fridley, Minnesota, and that the City's employees, a license for the purpose of gaining access across the above-described property to a retaining wall and other structures adjacent to Rice Creek. This license is only for the purpose of allowing the aforementioned persons access for maintenance purposes. This license is intended to last ten (10) years from the date of its execution, and is not transferable or useable by any persons other than those designated herein. By accepting and using this license, licensee hereby agrees to repair any and all damage caused by the City or its employees while using this license on the above-described parcel. Signed: J om� R. Cichosz 0 v Barbara Cichosz Subscribed and sworn to before me this �� day of &rf'1998. �--ti n _(ot'gsPublic pApp AAAAA(4 JOY E. MILLER �? MWMV PU13UC - MINNESOTA ANOKA COUNTY @My Commhudon Expires Jan. 31, 2000 `T SUBJECT PVRMIT NO. City of Fridley 2 6 7 7 2 26772 AT THE TOP OF THE TWINS BUILDING PERMIT � RECEIPT NO. COMMUNITY DEVELOPMENT DIV. e B I v _ �� r PROTECTIVE INSPECTION SEC. "/'@`/ NUMBER REV DATE PAGE OF APPROVED BY "...1 � CITY HALL FRIDLEY 55432 i .---� L 612-571-3450 910415 7/23198 JOB ADDRESS 460 Rice Creek Blvd 1 LEGAL - LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 3 1 Holiday Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jerry Cichosz 572-8364 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Midwest Siding & Roofina 18979 Gladstone 416-4804 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20010277 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION E) REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house (15 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 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 I STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERN MIS TYPE WORK WILL BE COMPLIED WITH WHETH SP E HER N OR N . THE GRANTING OF A PERMIT $1251 $.63 DOES NOT R GIVE UTH TY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISI S O A THER TA R LOCAL LAW REGULATING CON- STRUC ON O E CONSTRUCTION. $43.00 Fire SC $1.25 / PLAN CHECK FEE TOTAL FEE �x\ License SC $5.00 49.88 SIGNATURE OF CONTRACTOR - UTHORIZED AGENT (OATEi WHEN PROPERLYqALIDATED THIS IS YOUR BLDO INSP ✓PERMIT DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Y-�22 ) ' Ce— (r fe- - lJ 1 V 0( Legal Description: Owner Name & Address: 6'rf 'e0u/L- 1 ✓ Tel. # -S-% Z - L? �-z Contractor: MN LICENSE # Z�p O /v Address: / (� l ��,.•-� %3�J 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. GARAGEAREA: Length Width Height Sq. Ft. DECK AREA: Length l Width Hgt/Ground Sq. Ft. OTHER: / S% - qLsG 6�C 1 Construction Type:Lk-r Estimated Cost: $ l (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft ip $ _ $ _2 DATE: l - 2 �3APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ .3, Gb $ /. �2S Park Fee $ Sewer Main Charge TOTAL STIPULATIONS: $ 9.a(ID3 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1000 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 [ ] cInroF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 June 8, 2004 Mr. Jerome Cichosz 460 Rice Creek Blvd NE Fridley, MN 55432 Re: Final Inspection at 460 Rice Creek Blvd NE, Fridley Contractor: Shiloah Water Co. Dear Mr. Cichosz: A plumbing permit was issued on May 16, 2003 to install a water softener at your address. According to Section 4715.2800 of the State Plumbing 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 Code. 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 take no further action. To set up the inspection or to have any questions answered, please contact the Building Inspection Division at (763) 572-3604. DJ/mh CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Stories Basement Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: Urinal Eitective un Jan 1, 2OU3 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR z»> Gas L_.. » Water Heater Floor tai ;I:;> Auto. has::::»`::::.: ............... Wash ;.;:.; :.:.::::.: Gas she Ran a `<>< Ga Elec : Shower 1>#�::::> Tray �a�trf Wa 9 NO. RATE New Fixtures $ 7.00 Old Opening, New Fixture $ 4.00 Beer Dispenser $ 5.00 Blow Off Basin $ 7.00 Catch Basin $ 7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank —7— $ 7.00 Water Treating Appliance t $10.00 Water Heater -Electric $ 7.00 Water Heater - Gas** $10.00 Gas Range** $10.00 Gas Dryer** $10.00 Back Flow Preventer Required ( )Yes () No Type $15.00 Reinspection Fee $47.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance State Surcharge TOTAL FEE TOTAL JOB ADDRESS ICG 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. ` htolo3 Owner C_ Building Used As/ Estimated CostNo i PERMIT NO. PLUMBING COMPANY ��Y/lc l"J �dt `� �� U SIGNED BY TEL NO. Approved By Rough -In Date Final Da1F COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE HE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED When r nom, lacing an-xisting f Iran _ _, 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 manufacturers specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The E, ix eting.nemei isfinn air is sized and installed to meet the current codes and manufacturers specifications. Yes () No ( ) When required to install a np-w rnmhnnfinn air. it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When ins alling_a new venting cyStem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers 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 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 HEATING CO: Signed By: , Date : CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 �•Yr�iz�L � ►r �.� ADDRESS 460 RICE CREEK BLVD NE PIN 143024210013 LEGAL DESC HOLIDAY HILLS LICENSE SURCHARGE LOT 13 BLOCK 1 PERMIT TYPE BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ROOFING VALUATION : $ 2,778.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE & GARAGE (24 SQ) TEAR -OFF STATE LICENSED CONTRACTOR 1 APPLICANT LEE STEVEN CONTRACTOR 9465 IRVING AVE N BROOKLYN PARK, MN 55444 - OWNER CICHOSZ JEROME R & BARBARA 460 RICE CREEK BLVD NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating con uc -on r the performance of construction. Appli �M_ Date �f 5"/1-1LIf7 PERM NO.: 2004-00538 DATE ISSUED: 04/20/2004 BUILDING PERMIT FEE 83.25 FIRE SURCHARGE 2.78 STATE SURCHARGE, VALUE 1.39 LICENSE SURCHARGE 5.00 TOTAL 92.42 PAID WITH CHECK # 7305 Bldg Insp j SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 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 1�3 Construction Address: �6 ) CA- C Legal Description: Owner Name & Address: CA ®s Contractor. MN LICENSE #. � 7 Address: �l5' fir" �.��' Tel. # 7(J- P LMNG AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length I Width Height Sq. Ft. Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft + 6 Ft = DATE: Ftx $ =$ APPLICANT: L --r— Tel. # 7 Lj- �`�� "P-4" Pd Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763571-1287 if using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL 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) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: Building $ BUILDING Perrnit No.: - Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By: 763-572-3604 Fire Surcharge CITY OF FRIDLEY Date Rec'd: VZO $ $5.00 (State Licensed Residential Contractors) DATE YOUR E-MAIL ADDRESS $1450 -per SAC U't leas to MWCC for determination) �O S ft + 6 ft= S ft x $20 EADDRESS � C® fflC& om' &C%%DIS $450 Conservation Plan Review ZAPPLICANT IS: .OWNER ❑CONTRACTOR Fee Determined by Engineering PROPERTY OWNER/ NAME: Agreement necessary ( ) Non Necessary ( ) ( TENANT ! / / T ADDRESSFttPD` ff e,�.x 6,e -a 3m .6G'�.D CITY f,,�e0MF1/ STA A6PP'S y ` PHONE: CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILYINEW CONSTRUCTION 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 ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: ' � Area d14.2— SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: PROPOSED HEIGHT: ❑ DETACHED GARAGE 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ 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) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Surcharge $ (.0005) times the total job valuation – Minimum $.50 Fire Surcharge $ .001 x Permit Valuation (1/10%) License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge X Curb Cut Escrow $ (00 $ L /g e:;/ $1450 -per SAC U't leas to MWCC for determination) �O S ft + 6 ft= S ft x $20 Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks Davable to: Citv 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 application 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 work whic review and approval of plans. % �+ S�GNATURE OF APPLICANT PRINT NAM4!:/ FM -LU 1_ PEr�L DATE -r/T2 4 / 10 S� Building X3"3' . �. °�• - BUILDING Permit No.: (� Inspections $ RESIDENTIAL APPLICATION Received. By: 763-572-3604 $ CITY OF FRIDLEY Date Rec'd: DATE 0!5 YOUR E-MAIL ADDRESS C CL (2 'e LA -Cf,; D nits . c6iY-i _ SITE ADDRESS Gln ® '� � Ci r -44--u THIS APPLICANT IS: 0 OWNER W-ONTRACTOR PROPERTY OWNER/ NAME: G-e,g ctrl r?.Ly 1 TENANT ADDRESS: CITY PHONE: �" ��J .�� •�j� �®� STATE ZIP CONTRACTOR NAME- RENEWAL BY ANDERSEN SUBMIT A COPY OF STATE L; 1920 COUNTY RD. "C" W. YOUR STATE LICENSE * ADDRES ROSEVILLE, MN 55113 CITY STATE zrn WITH APPLICATION PHONE 651_2644777 0 sINGL 0 Two F. LICENSE #20130983 PROPERTY TYPE —0i PERNIIT TYPE O'ADDITION 0 GARAGE/SHED 0 WINDOWS 0 BASEMENT FINISH 0 ROOF 0 DRAIN TILE 0 DBCK 0 SIDING 0 OTHER 0 SWIMMING POOL TYPE OF WORK: - D NEW 0 ADDITION 0 MA IINTEATANCE/REPAIR 0 REMODELING )ESCRIBE WORK BEING DONE: t :JCA [ O w- CA ° 0 , :IM OF IMPROVEMENT LENGTH WIDTH HEIGHT S FtL .00FING 0 HOUSE ONLY . (UMBER OF SQUARES D HOUSE & GARAGE BASEMENT REMODELING SUBMIT ,ARAGES 0 ATTACHED GARAGE I. Existing Floor Plan ROPOSED SIZE: 0 DETACHED GARAGE 2. Proposed floor plan ROPOSED HEIGHT: 3. List of structn -A members to be used mLNG IAlum OSO� FOR NEW CONSTRUCTION INCLUDING DECKS, � 0 T ADDITIONS_ & PORCHES suBMTT- IOther 0 Fascia 1. Site Plan/Survey showing the existing structures and proposed project. 'INDows 2. Two sets of construction plans I EXISTING OPENINGS t?Yes ONo LOCATION OF WINDOWS 3. Energy Calculations R FOR NEW OPENINGS -DESCRIBE SIZE OF PENING CHANGES & RE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS A T.T. FT<`,RN A R 1? R A -CVR AxT -.7A r rT A 1PTr.w: . ru.rvn.i avi'q, 11N1.1,u1/1JNU 1ti K: l:Ua•t' Uk* 11"UK AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S ! L4 _ A nn., nr-°raru A,vrIv mcr"i xmit Fee - an Review ircharge re Surcharge cense Surcharge W Charge irb Cut Escrow osion Control rk Fee wer Main Charge ital Due $ X3"3' . �. °�• - $ 14 .00 $ $ See Back Page for Fee Schedule 65% of Building Permit Fee (.0005) times the total job valuation — Minimum $.50 .001 x Permit Valuation (1/10%) $5.00 (State Licensed Residential Contractors) $1450 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridlev Attach THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED tereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in iformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a 'mit but only an applicat;Ii-ch for a permit and work is not to start without a permit; that the work will be in accordance with the approved n in the case of all work requir-eview and approval of plans, i NATURE OF APPLICANT PRINT NAME f'&r0. t�n S Oyu DATE A�00-O Building $ BUILDING See Back Page for Fee Schedule Permit No.: Inspections -- RESIDENTIAL APPLICATION Surcharge Received By: 763-572-3604CITY (.0005) times the total job valuation — Minimum $.50 OF FRID�LEY $ Date Recd: DATE /'I 6 YOUR E-MAIL ADDRESS $ SITE ADDRESS !� 407 rK el- Al SAC Charge THIS APPLICANT IS: )(OWNER ❑CONTRACTOR $1450 per SAC Unit (Plans to MWCC for determination) PROPERTY OWNER/ NAME: e'e4- 'f l /+� ADDRESS:46nCt IG,�a-AWzG 0iy6i CITY Erosion Control TENANT PHONE:I Park Fee CONTRACTOR NAME: Fee Determined by Engineering STATE LICENSE # EXP DATE $ SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHONE FAX INGLE FAMILSt/NEW CONSTRUCTION SIZE PROPERTY TYPE ❑ TWO FAMII Y/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING P11MMR ❑ SWIMMING POOL�� TYPE OF WORK: ❑ NEW ❑ PDITION ❑ MAINTENANCE/REPAIR MODELING DESCRIBE WORK BEING DONE: &MQ2� �IJ��/�� 'y� `�Z� �/�✓�� i� SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. 2. Existing Floor Plan 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 structures ❑ Other ❑ Fascia and proposed project. 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 1991 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ �� OCCUPANCY TYPE Permit Fee $ &,9..Z ' See Back Page for Fee Schedule Plan Review $ -- 65% of Building Permit Fee Surcharge $ ?,Ob— (.0005) times the total job valuation — Minimum $.50 Fire Surcharge $ J C)O .001 x Permit Valuation (1/10%) License Surcharge $ $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 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 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 application 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 work' es review and approval of plans. SIGNATURE OF APPL PRINT NAME'S//;� rz ss�r� � 4. P'-*'�—_DATE 3uilding Inspections 763-572-3604 )ATE .ITE ADDRESS _ d 'HIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS 81- VD. N4- - WNER .CONTRACTOR Permit No.:,� Received By, Date Rec'd: 6 ,sr . PROPERTY OWNER/ NAME: <:57 nejeo- Plan Review $ 2�E5 , fi0// ADDRESS-442129!r—o- a 151 -VD CITY STA VCA� Z TENANT $a (( PHONE: I&!5 License Surcharge $ $5.00 (State Licensed Residential Contractors) CONTRACTOR NAME: $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ STATE LICENSE # EXP DATE $ SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: Fee Determined by Engineering CITY—STATE—ZIP— WITH APPLICATION PHONE FAX Make checks payable to: City of Fridley Attach Stipulations PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE f� o ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TTS ❑ DECK ❑ SIDING V OTHER ❑ SWIMMING POOL'e, 14 TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCEWPAIR ODELING DESCRIBE WORK BEING DONE: A121=-4490-- ? 1T%I AAI II� ASW tV—A1 FP` WiTly SIZE OF IMPROVEMENT L ,C f LENGTH % WIDTH HEIGHT 1 Sq. Ft. ROOFING ❑ HOUSE ONLY 7� NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: ❑ ATTACHED GARAGE 1. Existing Floor Plan GARAGES 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 structures ❑ Other ❑ Fascia and proposed project. 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 1 7 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ E1000 OCCUPANCY TYPE Permit Fee $ :5 &; -15 See Back Page for Fee Schedule Plan Review $ 2�E5 , fi0// 65% of Building Permit Fee Fire Surcharge $ h o6 .001 times the total job valuation Surcharge $a (( .0005 x Permit Valuation Minimum $.50 License Surcharge $ $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 $20 = $ Erosion Control $ $450 Conservation Plan Review Park Fee ¢ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ t _ Make checks payable to: City of Fridley Attach Stipulations THIS IS AN ARP11CATION 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 application for 't 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 work w s review and approval of plans. SIGNATURE OF APPLI T PRINT NA.4 �'IC� 14 2—/ DATE ' `7