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PRE 2010 DOCSVillage of Fridley, Mum. BUILDING PERM" N® 257 Office of WSPECT01 OF B ING Owner �voA t Architect Fridley, Mlnn.,_),\'�1�11 19 Builder € LOCATION OF BUILDING NO. Street L%L� �-�� ° 1�¢� Part of Lot { A Lot Block � Addition or Sub -Division DESCRIPTION OF BUILDING Front—a-41— Depth ' height 0 Stories Manner of Construction— V, onstruction, ra To be used as NJ'-'"tl� �. 'R°�• To be completed y p i ' `� Estimated Cosh AB "Q`�°,6 "�""W"�e'�+, � d^��=m t�j� r,a u '�.,Au a° � � � � '.:r'�,eT'P �•' Permit is hereby granted to__ the building "y described in the above 'statement. This permit is granted upon the express condition that the peri to whom it is granted, and his agents, employees and workmen, in all the work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, Minn., regarding the construction, alteration, maintenance,; repair and moving of buildings within the city limits, and this permit may be revoked at any time upon"violation of any of the provisions of said ordinances. 1spector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to nye by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set . forth and according to the provisions of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and,contained in the above permit are true as therein stated. Subscribed and sworn to before me at Fridley, day of 'r A.D. 19-L, U I— Village ®f Fridley, Minn, BUILDING PERMIT �� Date: .....dam.. — . Owner....................................... Address...................................... 1745 Builder ... /i✓. ...../.`a �+'. / .�? . . �� Address .... LOCION OF j5UILDING No. .... 7. fi d... Street .... / �. c . `. .... �... E 4C.. � Y®4es m art of Lot ...... %.�..... . Lot .....IX ...... Block ....... I.......... Addition or Sub -Division ...!!. Corner Lot ........... Inside Lot ..:.... Setback ..®. Sideyard ... ....................... DESCRIPTION OF BUILDING To be used as: V! !.! '.� y ..... Front .. Depth .s .. i Village ®f Fridley, Minn, BUILDING PERMIT �� Date: .....dam.. — . Owner....................................... Address...................................... 1745 Builder ... /i✓. ...../.`a �+'. / .�? . . �� Address .... LOCION OF j5UILDING No. .... 7. fi d... Street .... / �. c . `. .... �... E 4C.. � Y®4es m art of Lot ...... %.�..... . Lot .....IX ...... Block ....... I.......... Addition or Sub -Division ...!!. Corner Lot ........... Inside Lot ..:.... Setback ..®. Sideyard ... ....................... DESCRIPTION OF BUILDING To be used as: V! !.! '.� y ..... Front .. Depth .s .. Height .. �..i�." Sq. Ft. ........ Cu. Ft. ........ 6 .�.: f1 j. f......... Type of Construction Front .."� .. vQ./'ri. ..... Depth Est. Cost ........ Height . % ®e)& ` ®... Sq. Ft. ........ Cu. Ft. ........ To be Completed .................. In ,consideration of the issuance to me of a permit to construct the building described above, I agree to do the* work in accordance with the description above set forth and in compliance with all provisions of or( antes of the village of Fridley. //111 – �d In consideration of the payment of a fee of $. permit is hereby to l�l.V /(:;, ......................... 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 Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ...... ... .. Building Inspector NOTICE: V This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these items. SUBJECT PERMIT NO City of Fridley 1461 AT THE TOP OF THE TWINS PER r BUILDING ECEI 1 COMMUNITY DEVELOPMENT DIV. 9 y 1 PROTECTIVE INSPECTION SEC. 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 3/31/78 JOB ADDRESS 400 Rice Creek Terrace 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 11 3 SHEET 1 Rice Terrace Plat 3 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. 560-4857 SIGNER ADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DEMA 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 Reroof structure 9 CHANGE OF USE FROM TO STIPULATIONS Roof can be second but not third roof. Provide ridged galvanized valleys. 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 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. $970.00 $.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- $7. 5Q STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 3_ � dzQJ $8.00 SrcATURE OF CON TRACTOR O UTHOFiIZ A NT (DATEI WHEN PRO ERLY VALIDA ED THIS IS YOUR PER IT BLDG WSP DA7E SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) CITY 01 FRIDLEY APPLICATION FOR RESIDENTIAL LSUILDING PEIMITS (NEW, ALTERATIONS, ADD T I ONS, OR RCPAI RS) OWNER: -� . � � , c BUILDER: Address:ZL Address: CY Tel. No. C/ d No.: Street: LOT: % / BLOCK: ADDITION: ��' 77'(-,(�`�L- CORNER LOT: 114SIDE LOT: SETBACK: SIDEYARDS: Applicant attach *to this form Wo Certificates of Survey of Lot and proposed building location drawn on these Certificates. To Be Used As: DESCRIPTION OF BUILDING Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: . r Type of Construction:. Estimated Cost: $ To Be Completed: �� / y Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) 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. See reverse side for additional information. DATE: / SIGNATURE: `2 Stipulations: City of Fridley SUBJECT PERMI - 16 6 51 AT THE TOP OF THE TWINS B U I L D I N G PER I T � •COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. CITY HALL FRIDLEY 55432 L �\ 612-571-3450 R NUMBER 910-F15 REV. DATE 6/28/82 PAGE OF APPROVED BY JOB ADDRESS 400 Rice Creek Terrace N.E. 1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 11 3 1 Rice Creek Terrace Plat 3 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Josephine Zawislak 400 Rice Creek Terrace N.E. 571-2748 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Ron Johnson Builder 3724 Chandler Drive 781-0663 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 x 8 DESCRIBE WORK Construct an 18' x 12' Porch Addition 9 CHANGE OF USE FROM TO STIPULATIONS SEPERATE PERMITS REQUIRED FOR WtRrN6, WAR HtAT4WG, PLUMBING AND SIGNS. MON digging call local utillti. TELEPHONE'- ELECTRIC - G -AS Etc. REQUIRED BY LAW SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. TYPE OF CONST. Wood Frame OCCUPANCY GROUP OCCUPANCY LOAD THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ZONING SQ. FT. 216 CU. FT. 1.728 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT VALUATION $3,550 SURTAX $1.78 DOES NOT P_ ME TO GIVE AUTHORITY TO 064TE OR CANCEL THE PERMIT FEE SAC CHARGE PROVIS S OF A Y OTHER STATE ORCAL REGULATING CON - R TION O T E PERFORMAN CONST CTION. $44.50 NONE f PLAN CHECK FEE TOTALFEE $11.13 $57.41 SIGNATURE OF CONT ACTOR OR AUTOXED AGENT (DATE) ERMIT WHEN PROPERLY VALIDATED THIS IS YO%U�Rd/[-_)-a 4_ •/ IA Ai i._� BLDG INSP 7ATE SIGNATURE OF OWNER t IF OWNER BUILDER) (DATE) CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDENTIAL BUILDING PER14ITS (New, Alterations, Additions, or Repairs) OWNER: �r5.-�i& BUILDER: Z121V t7_0 ADDRESS:y�� %'iGc G' 7�1��'',�CG ADDRESS: ,g'2g y' C,;�dsr//, ZgfZE TEL NO: _J1�s —��y TEL 140: Construction Location STREET NO: 75/Go STREET: LOT: // BLOCK: ADDITION: Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: le_© Depth: 42 eP Height: Square. Feet: A/�? Cubic Feet: Front: Depth: Height: Square -Feet: Cubic Feet: Type of Construction:�,g,�� 710 Be (bripleted: �100 Estimated Cost: Til Alt. A Alt. B Proposed Driveway Width If New Opening Is essired: $ $ SEE REVERSE SIDE OF SHEET . Mie undersigned hereby makes application for a permit for the Cork' 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 applic< D�TF:I ~ 5 SIGNATURE: Stipulations: V `/�-J� 6P C T)d — tf-7 4 4 I SUBJECT PERMIT NO. 674 City of Fridley AT THE TOP OF THE TWINS BUILDING PERMITy REC COMMUNITY DEVELOPMENT DIV. ' r � PROTECTIVE INSPECTION SEC. C, � 1 i CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE Of APPROVED By 612-571-3450 910-F15 7/11/94 JOB ADDRESS 400 Rice Creek Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 11 3 Rice Creek Terrace SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Barbara Zawislak 400 Rice Creek Terrace NE571-3450 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO: All Quality Construction 506 Polk St Ano427-9582 4256 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 X REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage 24 S 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. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT 1 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 $1,800 $.90 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- $ 41.00 Fire SC $1.80, STRUCTION OR T E PER RM F NSTRUCTION. PLAN CHECK FEE TOTAL FEE '0'.' - License SC $5.00 $48.70 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT DATE) *HEN PROPERLY VALIDATED THIS IS YOUR PERMIT ' :MG INSP DATE SIGNATURE OF OWNER i IF OWNER BUILDER) IDATEI NEW II ADDN (] CITY OF hRIDLEY ALTER (� SINGLE. FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address Legal Description: _ Owner Nan Contractor: Address: LIVING'AREA: GARAGE. AREA: DECK-'AREA:- OTHER: ECKAREA:- OTHER: Effective 1/ 1/94 of Tei. MN LICENSE #Z9�P1g�/�� _Tel. # �• - I C Attach to this application, a Certificate.of Survey of the lot, with the proposed construction drawn on it to scale. VESCRIPTiON OF IMPROVEMENT Length' Length Width Height Sq. Ft--.'. Width Height Sq. Ft. Width- . HOG r 'und " Sq: Ft. e s -o Comer Lot [ ] Inside Lot[ ] t. Yd ck Type of Constructi Approx. Completion Date: Side Yard Setbacks Estimated Cost: $ ®� (Cost on Back) Driveway Curb Cut Width Needed: Ft. +� 6 = x = $ DATE: — G� APPLICANT: Tel. #, STIPULATIONS: ._Ob CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ / L7 .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $800 per SAC Unit License Surcharge _ $Z $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: ._Ob HE-01434-09IC# 140-0423 II e/06R MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and, Boring H n 2604 WELL BORING LOCATION No. Sealing ta Unique Well No. WELL AND BORING SEALING RECORD, County Name Na ANOKA � Minnesota Statutes, Chapter 1037 o°r �eni�,� o Township Name Township No. Range No. Section No. fraction (sm. -� Ig.) Date Sealed Date Well or Boring Constructed 30 24 14 "SE '� Tuff; 07.2W GPS Latitude degrees_ minutes_ seconds Depth Before Sealing ft. Original Dept40 h no (+cold ft: LOCATION: Longitude_ degrees_ minutes_ seconds AQUIFER(S) X Single Aquifer ❑ Mult aquifer STATIC WATER LEVEL Numerical Street Address or Fire Number and City of Well or Boring Location FUCE CREW E. d X Measured ❑ Estimated Date Measure400 WELLIBORING ❑ Water -Supply Well ❑ Monit. Well ❑ Env. Bore Hole ❑ Other 35 ft. X below ❑ above land surface Show exact location of well or boring Sketch map of well or boring in section grid with "X." location, showing property N lines, roads, a d bui ings. CASING TYPE(S) X Steel ❑ Plastic ❑ The ❑ Other 11391111f2fliZilkil TSC - WELLHEAD COMPLETION W Outside: ❑ Well House"Inside: [jBasement Offset At Grade f ca 'h mile ❑ Pitless Adapter/Unit ❑ Buried ❑ well Pit T -- -- --- I ❑ Buried s L L1 well Pit ❑Other (--1 Mile ❑ Other PROPERTY OWNER'S NAME/COMPANY NAME CASING(S) Diameter Depth Set in oversize hol ? Annular space initially grouted? 2-00 in. from 0 to 40 ft. ❑ Yes X No ❑ Yes ❑ No ❑ Unknown Property owner's mailing address if different than well location address Indicated above 400 RICE CREEK TERRACE in. from to ft. Yes [-]No ❑ Yes ❑ No ❑ Unknown FRiE� NN in. from to ft.❑ Yes ❑ No ❑Yes ❑ No ❑ Unknown WELL OWNER'S NAME/COMPANY NAME SCREENIOPEN HOLE Screen, from to ft. Open Hole from _ to ft. Welldloownners mailing address 9 different than property owner's address indicated above OBSTRUCTIONS SAME Rods/Drop Pipe ❑ Check Valve(s) ❑ebris ❑ Fill [j No Obstruction 36 A 1-2W Dmp P�pe &Jet Pa&er_--- Type of Obstructions (Describe)ReFlOWUldl Obstructions removed? X] Yes E]No Describe�'� GEOLOGICAL MATERIAL COLOR FiARDNESSOR FORMATION FROM TO PUMP Type Deep PiBltp---- If not known, indicate estimated formation log from nearby well or boring. Removed ❑ Not Present ❑' Other Sand Glamlei 0 8 METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: X No Annular Space Exists E] Annular Space Grouted with Tremie Pipe E] Casing Perforation/Removal (s"Rgy� $ 14 In. from to ft. ❑ Perforated ❑ Removed Clay 14 17 In. from to '' ft. ❑ Perforated ❑ Removed Clay Nue 17 24 Type of Perforator Sand 31W 24 44 ❑ Other RoCkS Hm4m - Hard 44 s2 Clay Hardpan 3rom. 52 105 GROUTING MATEAIAL(S) (One bag of cethent = 94 lbs, one bag of bentonfte = 50 lbs.) Grouting Material t C from --5 t, ---L ft. 0'0815 bags from 1 40 6.357 bags 105 119 SSC_ to ft. from to ft. U bags OTHER WELLS AND BORINGS Other unsealed and unused well or boring on property? ❑ Yes $] No How many? REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING aid Pull 2Cr West OF House LICENSED OR REGISTERED CONTRACTOR CERIPICATION This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report Well Dep% McOlStued Ftt m Graft Lavel is true to the best of my knowledge. 11 D.H. +f or Was Not On'Sfte DWW9 Wei Sealling, Myron L Malaft I Mall8inke Wc-d l' (763) 493.3650 1426. A LMH Conhactorusiness Name r License or Registration No. F WedSea"Fwm M ! W. A Rugust07, 2007 14 W 24 24 OM Certi ed Representative Signature Certified Rep. No. Date Ali LOCAL COPY H 016 r. 0430 Name Person Sealing Well Boring of or HE-01434-09IC# 140-0423 II e/06R Building BUILDING $ Permit No! . f d ® 1'51 $ .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY ft+6ft= ftx$24=$ $ 763-P5�02-4977 FAX $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) EFFECTIVE 1-1-2010 Make checks savable to: City of Fridley Attach YOUR E-MAIL ADD/SS, DATE V ✓� �`` �y�, i2A U— 6- SITE ADDRESS 6 `-� THIS APPLICANT IS: ❑ OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: lz k6— /l z Ct-C°J� �r'St7 CC A/JC CITY t rri % STATF ZI� TENANTADDRESS: PHONE:�p S ,�� 7/ CONTRACTOR Nom: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE 0 TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH 4' rROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ CE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: El --,A a SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING USE ONLY OUSE & GARAGE BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES 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 I. Site Plan/Survey showing the existing structures ❑ Aluminum 13 Trim t. and proposed project 13 Other ❑ Fascia 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS – PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPINING 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 Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due /vr4ri $ 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) $ $2100 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$24=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ Make checks savable to: City of Fridley Attach 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 on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans.(� SIGNATURE OF APPLICANT A9z", ,�� PRINT NAMEAkckZ- DATEQ (ATY Y OF FRIDLEY iia: i'EGTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Effective On Jan 1, 2000 PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** Gas Range** NO. RATE Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $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 $ -o 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. 3/7 20� I — ZAWISLAK, T.R. Owner _ 400 RICE CREEK TERRACE N.E. FRIDLEY, MN 55432 (612) 571-2748 Building Estimated Cost `'*'Tyo PERMIT NO. �i / 19 PLUMBING COMPANY r/pi- SIGNED BY �� TEL N0. */'Z Sz 7 Lik33 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE 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 O 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 :