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City of Fridley, Minn. BUILDING PERMIT Date: .... _............. ........... ......... ...... _. __...__,.__...__..._.. Owner: ........... .... ......_............. .... .................. Address............................... _............... ..._.._ Builder Address N 4930 s 0°1 / 0 XOC ION OF DING No.......,.. .. - .... treet ..:.._... ------ � . Part of W-* Lot ...-._ ... '�° -�' Block -•-- =--- ..-........._............ Addition or Sub -Division _ .. �a and Corner Lot ......................-....... Inside Lot ........ _..........: -.. Setback --- ..:......._........ Si y ..................... Sewer Elevation ...... .............. .............. .... ........ ...................... ........ ..... _.............. Foundation Elevation ............ ........ .............. DESCRIPTION OF BUILDING To be as: r "� fin,/DepthY t .. eight .... _' , 'edd . M •........ De th Hei ., Sq. Ft ... .:.��..... ,� ......... Front .,,.,.. Sq. Ft. � �. _.. Cu. Ft..,.,`�` �. Typeof Constructs on ., ::..:. Est. Cost. Z ...................... To be Completed .................... ......... .............. ......... In consideration, of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $,V ....... �...., permit is hereby granted to .......... .........-.............-.............-.....__.. ......... ...... __._..........-_....._-.._..._.............. _. 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 allrespects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, r6pair, and moving of buildings within the city limits and this permit may be revoked at any times upon,�iolation of y of the provisions of said ordinances.` ;'3 , Building Inspector NOTICE: This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. 4 APPLICATION FOR BUILDING PERMIT CITY OF FRIDIEY, MINNESOTA Owner's Name f V) ®,r ,. / _� 1/! obuilderV a it l C L D &' Address Address A T P/ A�- LOCATION OF BUILDING No. Part of Lot Lot "�� A- — '7 � Block ,l Addition or Subdivision�: d, fF' 7r Corner Lot Inside Lot Setback 2-�Side-Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Certificate of Survey of Lot and proposed building location. To be used as: DESCRIPTION OF BUILDING FrontDepth 2 ,- 3 i --Height Sq. Ft. /%,,� �'-7 Cu. Ft. / ',� q s—C Front L 1-- Depth 9->.— Height, „Z . jL Sq. Ft. " 2 !f Cu. Ft. Type of Construction ,( -yT _ Estimated Cost meq" To be Completed s� p.— Z 9 � a 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. A (A Schedule of Fee Costs .can be found on the Reverse Side.) City of Fridley Application for Plumbing and Gas Fitting Permit DESCRIPTION OF WORK Number, Kind and Location of Fixtures N m a i O?4 i9 UN' Z • • WATER HTR. d 60 a� '� Z x�. �� ZZ a� 8Z 6113 J end �U (�90 R N GAS ELEC. u t�� Base ) 1 1st 2nd _ 3rd — 4th Future Connection Openings Connected with Sewer � New .Fixture, Old Openings Cesspool E] PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES:- NO. RATE TOTAL Number Fixtures ....... 'r x $1.50 $ ,a,d V Future Fixture Opening ................ --4 x 1.20 $ -e 6 New Fixture Old Opening .............. x 1.00 $ Catch Basin ............................ x 3.25 $ Water Heater (Up to 200,000 BTU) ...... � x 2.00 $ "Z &-'o New Ground Run Old Bldg. ............ x 3.25 $ OTAL GAS FITTING FEES:� .... ��— x $��$ e 1st 3 Fixtures .........)"Z�- Additional Fixtures .. l ................ x .50 $ Gas Range to 200,000 BTU .............. x 2.00 $ REPAIRS & ALTERATIONS—Refer to Code Dept. of Bldgs. Phone SII 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 Owner 2:214 Kind of Building o Used as To be completed about Estimated Cost, $ Old—New. Building Permit No �-� Permit No. Signe By e. --M!G NG & Business Phone ➢ • vu�was3 �`SYz�� "A 1-1962 ROUGH I — 3-6 I FINAL Description .............................................. $ TOTAL FEE $ zf 42 2M 7-59 Application for Power Plants and Heating, Cooling, Ventilation, Rehigerciticno and Air Conditioning Systems and Devices PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL, Furnace Shell & Duct Work .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECH. WARM AIR Furnace Shell &Duct Work to 120,000 BTU ............ 8.00 $ V, 6,0 .each add. 60,000 BTU ... — .................. 2.00 $ �Z °C _ Replacement of Furnace ............................. .§.00 $ Repairs & Alterations—up to $500.00 ... ............ 5.00 $ Repairs & Alterations each add. $500.00 ....... :....... 2.50 $ i• STEAM or HOT WATER SYSTEM tir Furnace Shell & Lines—to 400 sq. ft. EDR Steam ...... '~ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... Each add. 200 sq. ft. EDR Steam ....................: . Each add. 320 sq. ft. EDR Hot Water .................. OIL BURNER—to 3 gal. per hour ........................ over 3 gal. per hour—See Fee Schedule 8.00 $ 8.00 $ 2.50 $ 2.50 $ 5.00 $ GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ ;+ 416° GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures ...................... x $1.50 $ �e�D Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ FAN HEATING SYSTEM See Fee Schedule VENTILATING SYSTEM $ ALTERATIONS & REPAIRS TOTAL FEE $ ROUGH FINAL Dept. of Bldgs. Phone SU. 4-7470 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. �' e� .6_'. , 19� Owner _3� _--i Kind of Building Used as To be completed about Estimated Cost, $ Old—New. B�ixilding Permit No. _ Permit No. 04, 3 20 r DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No - F Trade Name � /°�' g - Size No Capacity Sq. Ft. E.D.R.1c BTU H.P. Total Connected Load Kind of Fuel BURNER —Trade Name Size No Capacity (REMARKS -OVER). 4z zM 7-s9 Sq. Ft. E.D.R_ - BTU H.P. HEATING AIR TIONING CONDI ANOKA HEAT LOSS CALCULATIONS 327 VAN BUREN, ANOKA, MINNESOTA 4 Weatherstrips A.S.H.V.E. Construction No. Insulation Guide 'I — Kind How Applied Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Yes—No Yes—No 19— rl I I --- 6L vu;,41. LA ' T -W-1,0- 11 Pi 1 Retnm I I Priath " Width i Height Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Room I Lenseth Width i Heittht Windows and Doors—Crackage and Area Area sq. ft. Lineal ft* Width Height No. of Lineal ft Area of crack No. of pane f pane lights sq. ft. No. Width Height No of of ane of pane lights Windows and.Doors—Crackage and Area Coef. Coef. No. Width Height No of Lineal ft..Area of pane of pane lights of crack sq. ft. ii P', Int. wall Ceiling Exp. wall :,x, Floor Net exp. wall Net exp. wall vi-, Int. wall 1 Coef. Coef. Btu Infiltration Floor 1L k), A", P Glass Required sq. ft. E.D.R. or sq. ins. W.A. Leader area j 'It' # ? s 6 Exp. wall 3. Net exp. wall Int. wall y�, Ceiling F, Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Room I Lenseth Width i Heittht Windows and Doors—Crackage and Area Area sq. ft. Lineal ft* Width Height No. of Lineal ft Area of crack No. of pane f pane lights sq. ft. No. Width Height No of of ane of pane lights Lineal ft. Area of crack 8Q. ft. Coef. Coef. Coef. Btu Infiltration Glass Exp. wall Net exp. wall ii P', Int. wall Ceiling Exp. wall :,x, Floor Net exp. wall Net exp. wall vi-, Int. wall 1 Coef. Btu Infiltration Floor Floor Total Btu. Y Glass Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Exp. wall Net exp. wall Int. wall Ceiling Floor y�, Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area ,�, Fl. I k, `,", Room I Lenath i - " � Width 1," ' I$eiaht Windows and Doors—Crackage and Area Area sq. ft. Lineal ft* Width Height No. of Lineal ft Area of crack No. of pane f pane lights sq. ft. Width Height No. of Lineal ft. Area No. ofpano of pane lights of crack sq. ft. Coef. Coef. Coef. Btu Infiltration Glass Exp. wall Net exp. wall y P', Int. wall Ceiling Exp. wall :,x, Floor Net exp. wall Net exp. wall vi-, Int. wall Tbtal Btu. a Required sq. ft. E.D.R. or sq, ins. W.A. Leader area Windows and Doors—Crackage and Area Area sq. ft. Lineal ft* Width Height No. of Lineal ft Area of crack No. of pane f pane lights sq. ft. Width Height No. of Lineal ft. Area of pane Of pans lights of crack sq. ft. Coef. Coef. Btu Infiltration Glass Glass Coef. Btu Exp. wall Exp. wall Net exp. wall Net exp. wall vi-, Int. wall 1 Al", Ceiling x� Floor Floor Total Btu. Total Btu. Required sq. ft. E.D.R. or sq. iris. W.A. Leader area Required sq. ft. E.D.R. or sq. ins. W.A. Leader area s, F1.1 Room I Length Width t, Height Wndnwe mnd Dmrs—Crackaize and Area I — Width Height Yo. of Lineal ft. No. of Dane of pans fights of crack Area sq. ft. No. Width Height No. of Lineal ft. Area of pane Of pans lights of crack sq. ft. Coef. Bt Infiltration Glass Coef. Btu Exp. wall Net exp. wall 9 1 Int. wall Ceiling ' x� Floor --tik Total Btu. N, Required sq. ft. E.D.R. or sq. iris. W.A. Leader area J, M-1 RmmILanath ,q WidthHeight Windows and Doors—Crackage and Area No. Width Height No. of Lineal ft. Area of pane Of pans lights of crack sq. ft. Coef. Btu -Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling --tik Floor N, Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area ANORA HEATING & AIR CONDITIONING T' HEAT LOSS CALCULATIONS 327 VAN BUREN, ANORA, MINNESOTA Weatherstrips A.S.H.V.E, Construction No. Insulation Guide WindowsI Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Find How Applied Yes—No Yes—No 19— I Gl I ZJI-d _..rz,., - I r —th -'T/-/ W;.rtr, 12/ m Length Width Height ..I 1+..6®i awG Y•v c..w... Windows and Doors-Crackage 1......b... %7�r� —.. and Area ! G1 ---.a-.- Width Height No. of Lineal ft. Area No.. of pane of pane lights of crack sq. ft. (-'oef.1 Btu Infiltration Coef. Btu Infiltration Coef. Btu Infiltration Glass �, '51 7 ® --�60 Glass Exp. wall' Net exp. wall Int. wall I I I�® /;t' e%I X A _i 1 l 1 L 0 -�"o ?6 7 ID Ceiling 511ko 1 O Floor x I A X Total Btu. 117216 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area g PA F1.1 o ,,t oom { Lenirth / / Width ° Height 0 Windows and Doors--Crackage and Area $to. of Lineal ft. Area Width Height 'Yo No. of pane of pane Ights of crack eq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lighta of crack sq. ft. (-'oef.1 Btu Infiltration Coef. Btu Infiltration a 1170 e Glass �;L® '51 Ceiling Exp. wall Net exp. wall Int. wall Ceiling Floor _5A 'K I I I�® /;t' e%I X Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area 1 Room I Length ,,I - Width 3.2 Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. 04 Dano of, lights of crack eq. ft. t ` i4nnet Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Btu Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. 04 pane of pane lights of crack sq. ft. Infiltration Glass Exp. wall 1 Net exp. wall Int. wall Ceiling Floor J39� Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area m I gMm 1 I -nath Width Heiirht Windows and Doors—Crackage and Area $to. of Lineal ft. Area Width Height 'Yo No. of pane of pane Ights of crack eq. ft. (-'oef.1 Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. iais. W.A. Leader area F1.1 Room I Length Width Height Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane llghts of crack sq. ft. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. ft. E.D.R. or s®. ins. W.A. Leader area A KA HEATING ' AIR CONDITIONING HEAT LOSS CALCULATIONS � � � � � � ,��� 327 AN BUREN, ANOKA, MINNESOTA WeatherstripsA•S•H V'E• Construction No. 'Insulation Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied Yes—No ,'es—No 19— Fl I -P. R I Le - th w W'dth -' U.; M. _Q,'` 11 f r � e . A � - Rnnm I l mirth h? " Width 1,2' Height fU� oom ng aL 1 - / t g Windows and Doors—Crackage and Area 3 it^ ps.ne .,-a h f _ ` • &� it c3,. f Width Height No. of Lineal ft. No. of pane of pane lights of crack Area sq. ft. —7T— f, eppw► if( - Infiltration 1 W'13 Aly Coef, Btu Infiltration e r Class Coef. Btu Infiltration ' a, Int. wall Int. wall Glass ,A2 av-qo e�pa�eae� p:: o Exp. wall/r e ;x X Net exp. wall Int. wall Ceiling Floor y ; ` ; , 1 12, -' /09P 172.0 Total Btu. ttswl Required sq. ft. E.D.R. or jsq, ins. W.A. Leader area Room I Length ;i,,a Width 1;4,,s Height Windows and Doors—Crackage and Area - / t No. Width Height No. of Lineal ft. Area of pane of lights of crack sq.. ft. 3 it^ ps.ne .,-a h f _ ` • &� it c3,. f �� Btu Infiltration 1 W'13 Aly Coef, Btu Infiltration e r Class 3 1.0 Exp- wall Net expo wall Exp. wall Net exp. wall ' p, Int. wall Int. wall Ceiling Floor ,A2 av-qo Total Btu. 1 OTT Required sq. ft. E.D.R. orsq. ins. W.A. Leader area R Fl"i A Roorn 1 L.enath -3$ Width 5V Hleiaht Windows and Doors—Crackage and Area Doors—Crackage and Area Width Height No. of Lineal ft. Area.; No. of pane of Dane lights of crack eq. ft. - / t 1 Lm,.. 4Ila. 7 /pane 3 it^ Coef. Btu Infiltration 1 W'13 Aly 410 Glass f W 3 1.0 Exp- wall Net expo wall P O b f , Int. wall Int. wall Ceiling , I Ceiling Floor Floor" xk e Total Btu. r3 m � V Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Windows and Doors—Crackage and Area Doors—Crackage and Area Width Haight No. of Lineal ft.. Area No. of pane of pane I l ghts of crack sq. ft. Width Height No. of pane of 1 Lm,.. 4Ila. 7 /pane 3 it^ Coef. Btu Infiltration Coef.1 /161) GlaSSr Exp. wall f s Exp, wall Net exp. wall P O b 11 1' Int. wall Int. wall Ceiling . I Ceiling Floor Floor" e Total Btu. 177hP Required sq. ft. E.D.R.,®r sq. ins. W.A. Leader area rtl ;,'. "_ ti R.. I L.enath A /o Width JA 14eight f Windows an Doors—Crackage and Area Width Height No. of Lineal ft. Area No. > of pane of pane .; lights of crack eq. ft. Width Height No. of pane of yo. of Lineal ft. Area ighte of crack sq. ft. /pane 3 it^ Coef. Btu Infiltration Glass Coef.1 Btu Infiltration Glass 1 117 Exp, wall t' X, Net exp. wall 1' Int. wall Ceiling . I Floor" Total Btu. I jqil,76 Required sq. ft. E.D.R. or sq. iris. W.A. Leader area Fl_I ` _ b" �4.. Rnnm I L.enath J Width 19– Heighu?" Windows and oars--Crackage and Area Width Height No. of Lineal ft. Area No. > of pane of pane .; lights of crack eq. ft. Coef. Btu Infiltration Glass I , .6-0 Exp. wall Net exp. wail 117 X 01 Int. wall Ceiling Floor' s=' Total Btu. Required sq, ft. E.D.R. or si ina: W.A. Leader area j ANOKA HEATING �& AIR CONDITIONING HEAT LOSS CALCULATIONS 327 VAN BUREN, ANOKA, MINNESOTA Weatherstrips A.S.H.V.E. ,Construction No. Insulation Guide Windows I Doors Rference Out. Wall Int. Wall (veiling Roof Floor Kind How Applied e Yes—No YesLL-No 19_ Fl.� ®Room Length cd 1 jZj Width Height oom Length Width Height Windows and Doors-Crackage and Area Windows and Doors—Crackage and Area wtd.th Height No. of Lineal ft. Are�a wldth Height No. of Lineal ft. Area No. of pane o[ Pane lights of crack nq.,ft. No. of pane of pane lights of crack eq. it. g : o ,.: E Windows and Doors—Crackage and, Area - Width Heig t ro. of Lineal ft. Area No. of Dane .., of pane Ights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. -8t *1' Coef. Btu Infiltration Coef. 170 , T, 60 Glass alnfiltration PH .' Exp. wall 170 % Exp. wall Net exp. wall na m A010 Int. wall Ceiling If m it -:14, 710 Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Net exp. wall Total Btu. Required sq. ft. E.D.R.-or sq. ins. W.A. Leader area F1.1 J,"1,640ftoom I Lenath Width Height Windows and Doors—Crackage and, Area - Width Heig t ro. of Lineal ft. Area No. of Dane .., of pane Ights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. -8t *1' AT, Coef. Btu Coef. Btu Infiltration Btu alnfiltration PH Glass Int. wall 170 % Exp. wall JA w Net exp. wall Int. wall Ceiling Floor ix If m r f Total Btu. 1D Required sq. ft. E.D.R. or sq. ins. W.A. Leader area a®S v�R n Rnnm ll_enath _'T'Width-SA Heiaht 7` Windows and Doors—Crackage and Area - Width Heig t ro. of Lineal ft. Area No. of Dane .., of pane Ights of crack sq. ft. Width Height No. of Lineal ft. Area lights of crack sq: ft. No. of pane offJ ,pane i} ws�e-' AT, Coef. Btu Infiltration Glass Coef. Btu alnfiltration Net exp. wall Exp, wall Int. wall 170 9 80 Glass Floor Int. wall 6 Exp. wallt� Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Net exp. wall _ ;� �. it e*ft q!°` 196 Tbtal Btu. ' Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Coef. Btu Infiltration Glass AV A Exp. Wall Net exp. wall AV 11 x Int. wall Ceiling Floor Total Btu. / Required sq. ft. E.D.R. or sq. ins. W.A. Leader area &'1 I R. m I 1 math Width Helaht Windows and Doors---Crackage and Area Width Heig t ro. of Lineal ft. Area No. of Dane .., of pane Ights of crack sq. ft. Coef. Btu Infiltration Glass Glass Net exp. wall Exp, wall Int. wall Net exp. wall Floor Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area m I RFh'ftm I I.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. Coef. Btu Infiltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. at sq. ins. WA. Leader area 6 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 .......................... 8.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 .................. 5.00 $ Repairs & Alterations each add. $500.00 ............... 2.50 $ MECIL WARM AIR Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ each add. 60,000 BTU ....................... 2.00 $ Replacement of Furnace ............................. 5.00 $ Repairs & Alterations—up to $500.00 ................. 5.00 $ Repairs & Alterations each add. $500.00 .............. 2.50 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines—to 400 sq. ft. EDR Steam ..... 8.00 $ Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ... 8.00 $ Each add. 200 sq. ft. EDR Steam ...................... 2.50 $ Each add. 320 sq. ft. EDR Hot Water .................. 2.50 $ OIL BURNER—to 3 gal. per hour 5.00 $ over 3 gal, per hour—See Fee Schedule GAS BURNER (up to 400,000 BTU) ....................... 5.00 $ GAS FITTING FEES: NO RATE TOTAL 1st 3 Fixtures x $1.50 $ Additional Fixtures ................. x .50 $ Gas Range to 200,000 BTU ........... x 2.00 $ AIR CONDITIONING $ 6 (fir � 0 a FAN HEATING SYSTEM VENTILATING SYSTEM ALTERATIONS & REPAIRS ROUGH FINAL See Fee Schedule TOTAL FEE $ Dept. of Bldgs. Phone 5W-3450 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- �% 9 Owner) Kind of Building 4e� Used as To be completed about 'V�J9 Estimated Cost, $®, Old. New. Building Permit No. �1-9 Permit No. JT7�- DESCRIPTION OF WORK HEATING or POWER PLANTS --Steam, Hot Water, Warm Air—No Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Total Connected Load Kind of Fuel BURNER — Trade Name Size No Capacity Sq. Ft. E.D.R BTU H.P. Signe , By P 4 z Business Phone No ' %©19 (REMARKS -OVER) Original • PERMIT for Power Rants and Heating. Cool- ing, ventilation, Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORTS No. of Heating Plants to be installed—altered—repaired Make j� , Size—, Oil fired—, Coal fired—, Gas fired ; Gas Authorization No. Remarks Approved Final Inspection 19_ Inspector Permit N° 4362 Fee Office of the Inspector of Buildings City of Fridley City of Fridley, Minn. % , 19-61 Owner te - 22�Z _ Location -�/-d /U Kind of Building How Occupied - e Work to be Commenced ,19� To be Completed /17 19--k-9 Estimated Cost, $�®` Old -New, Building Permit No Permission is hereby granted MW ,° to install—erect—use the material and devices described in the above statement. This permit is granted upon Yhe express condition that the pers6n to whom it is granted, and his agents, employees and workmen, in all the work done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the spec' ations set forth in the approved application for this permit on file in the office of the Inspector of Buildings. �`�' , Inspector of Buildings 42 2M 11-67 N INSPECTOR IS NOTICE TO SERVE ON OCCUPANTS OWNERS, AGENTS, OR PUBLIC OFFICIALS IN CHARGE OF LANDS WITH TALL GRASS, WEEDS, OR NOXIOUS GROWTH N O T I C E DATE: June 28, 1990 TO: Kennard Littler ADDRESS: 41 Rice Creek Way N.E. A visual inspection indicates that tall grass, weeds, and/or noxious growth are being allowed to grow on your property described as: DESCRIPTION: Lots 7A and 7B, Block 1, Edgewater Gardens Section 15, Township 30, Range 24, Anoka County, Minnesota. To maintain our City in a healthful condition and to alleviate suffering from allergies, unsightly tall grass, weeds, and noxious growth must be removed. I am requesting you to mow the tall grass, weeds, and/or noxious growth on your property within ten (10) days of the date of this notice or the City will cut, destroy, or otherwise abate the condition. In the event it is necessary for the City to abate the condition, you will be served a notice in writing of the work done and the costs and expenses involved. If the total amount is not paid to the City of Fridley within thirty (30) days following such notice or before the following October 1, whichever is later, the costs and expenses shall become a lien in favor of the City and a penalty of fifteen percent (15%) will be added to the amount due as of the date, with the total costs, expenses, and penalty thereupon to be certified to the County Auditor and entered by him on his tax books as tax against the land. If you have sold the property or have any questions regarding this notice, please call (612) 572-3595. CITY OF FRIDLEY Weed Inspector City of Fridley 6431 University Avenue N.E. Fridley, MN 55432 This form notice will be forwarded by Certified Mail. C-90-406 T NO. � 1744 SUBJECT P City of Fridley AT THE TOP OF THE TWINS BUILDING P E R M I T r 1 � 1._ COMMUNITY DEVELOPMENT DIV. v r PROTECTIVE INSPECTION SEC. NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 IL.... •� ,�� 612-571-3450 910-F15 2/17/93 JOB ADDRESS 41 Rice Creek Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7A & 7B. 1 Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kennard Littler 41 Rice Creek Way NE 572-9089 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install egress window in basement 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 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 $200 $.50 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 HER STATE OR LOCAL LAW REGULATING CON- $30.00 DF Fire SC $.20 STRUCTION O THE ER ORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE ah `7 $30.70 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDA EI H P PE Y VALI TED THIS IS YOUR PERMIT 47 BLDG INSP qa TE SIGNATURE OF OWNEROF OWNER BUILDER] IDA' T NO. � 1744 NEW [ l ADDN [ ] ALTER[] Construction Address: Legal Description: Owner Nam Contractor: Address: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application c Effective 1/ 1 /9_ L C / L ,, � Tel. # < is -cr R,9 MN LICENSE # 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 f Width Hgt/Ground Sq. Ft. OTHER: :11) S �� / I.4, , Aj o o cd , ° � Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ 00 Ca . f c Approx. Completion Date: / 7 19 (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: I 7 APPLICANT: Tel. # �5 70 STIPULATIONS: w CITY USE ONLY Permit Fee $ /k� e ® ® Fee Schedule on Reverse Side Fire Surcharge $ ► 2- ® .001 of Permit Valuation (1 / 10th %) State Surcharge $ r $.501$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOT $ ®� STIPULATIONS: w METROPOLITAN COUNCIL Mears Park Centre, 230 East Fifth Street, St. Paul, Minnesota 55101 Metro HRA 291-7428, TDD 291-0904 Weather -Deferred Items Noted During Inspection During the recently completed inspection of tt Al( it was noted lthat the following condition existed � ('�<<'--Sad �t� �1 ��� As this condition cannot e conditions permit, assistance will begin as scheduled. However, the above named condition must be corrected by If the condition is not corrected by this date, it is understood that assistance will be terminated. Please sign, date, and return this form at Signa very earliest convenience. CIiYOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287 February 23,1998 Kennard Littler 41 Rice Creek Way Fridley Mn 55432 Dear Mr. Littler, I received a call this morning from Kari Foley your resident in your lower unit. Kari stated the repairs were completed for your deck. During our conversation on Thursday February 12th we discussed the need for the Building Inspector to determine the extent of repairs needed for your deck It was decided you would call me on Feb 17,1998 to make an appointment for the Building Inspector. There was no response from you regarding this matter and when I checked with our Inspection Department there had been no permit taken out for any deck repairs. Due to the deteriorated condition of the deck it is necessary to have the City of Fridley's Building Inspector approve the repairs or replacement that has taken place. Please call me to set up a time for the inspection to take place. Or you may call the building department to set up the appointment. The rent assistance for Kari Foley will not begin for March 1, 1998 until the deck has been approved. Ms. Foley may be held responsible for the full rent until the Section 8 matters are completed. Thank -you in advance -amour cooperation. Sincerely, -l'atricia J. Wolfe Section 8 Coordinator 572-3597 cc Kari Foley of Fridley Inspection Department Metro HRA 01 SUBJECT P City ®i Fridley9 r AT THE TOP OF THE TWINS PERMIT BUILDING P o COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. r 8 � NUMBER REV DATE PAGE OF APPROVED BY � CITY HALL FRIDLEY 55432 ti'"""Jl•� �'� 612-571-3450 910-1715 4/2/98 JOB ADDRESS 41 Rice Creek Way NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7A & 7B 1 Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kennard Littler 41 Rice Creek Way NE 572-9089 3 CONTRACTOR MAIL ADDRESS ZIP PHONE' LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO, 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Ij REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House (24 Sq) 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 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2,001 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- Fire SC $2.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $74.75 PLAN CHECK FEEL E $ 7.75 SIGNATURE O AC OR 9R AUTHORIZED AGENT DATE, P PER ALIDATE T IS IS YOU ERM IT gl � iI .��/�/[ � � BLDG SP DATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI 01 NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 � 3 BUILDING PERMIT APPLICATION X16 �a ConstructionAddress: �� s R c /� / G ,�2lJL 3— Legal —Legal Description: Owner Name & Address: Kegli(Au o 2 t -r-7tj— A_ Tel. # ' S`7; 9,059 Contractor: MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: LC Estimated Cost: $ t/ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ DATE: -9 — ; - APPLICANT: LC E ]0(kii D L t7 -7"L E-2 Tel. # ^79- �Z2-5-1 CITY USE ONLY Permit Fee $ `� Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ , c0 $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ 7, . STIPULATIONS: CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1999 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 Rain Water Leader $ 7.00 - 9-.9 , 1999 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner i Water Heater -Electric $ 7.00 Water Heater - Gas** $10.00 / Building Used As Gas Range** Gas Dryer** $10.00 $10.00 �U� Q"`, 1 Estimated Cost ? PERMIT NO. Back Flow Preventer Required ( )Yes () No Type $15.00 PLUMBING COMPANY Reinspection Fee $42.00/Hr SIGNED BY c EL No� 4� ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Date` �U State Surcharge $ .50 MINIMUM FEE OR ANY PLUMBING/GAS PERMIT IS $20. TOTAL FEE $jj PLUS THE $.50 STATE SURCHARGE **COMBUS11ON AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SO INCHES. �`� gd 0 02 -12 - Effective November 3, 2000 Receipt # Fee: $ ®. o CITY OF FRMLEY LAND ALTERATION PERMIT APPLICANT R4 i Tel. # 763 S ' 9'0 Address Zl f t c a O)e a &jL 60A, A/ 6 FR i st f aq (V Y 55y3Iq PROPERTY OWNERS Address NAME Address Tel. # Tel. #_ LEGAL DESCRIPTION OF PROPERTY Lot 2 L7 J5 Block Addition _ cl4 is diER 2 dPi)-'3 DESCRIPTION OF LAND ALTERATION Value of Work: $ Q6®0- oO Starting Date: a ejJi "-- Completion Date: f d `SIO d Source and Composition of Fill: / PURPOSE ``OF/LAND ALTERATION L /dC !� R!� To4 i� ea C� e9. 1 / 40 M ATTACHMENTS TO APPLICATION The following plans, drawings, calculations, bonds and/or statements may be required by the Public Works Department: [ ] Half -section map or sketch of property showing all adjacent property indicating the existing buildings and/or structures. [ ] Grading plan showing existing and proposed finished contours and evaluations. [ ] Drainage plan showing existing and proposed drainage structures, stabilization walls, retaining walls, cribbing, dams, or other protective items. [ ] Calculations for and approximate quantities of excavation and/or fill required. [ ] Signed statement from the property owner accepting responsibility for the operation and granting permission for land alteration/mining operation. [ ] Statement to be attached to deed advising of potential need for soil tests prior to any construction on lots where additional fill material has been placed. Rice Creek Watershed District Approval. [ ] Soil Borings [ ] Other STIPULATIONS READ BEFORE SIGNING APPLICATION A surety bond or certified check in the amount of $ (5% of value of work to be completed) must be submitted after approval of application and prior to any work commencing. This bond or check is to ensure satisfactory performance and compliance with the below stated stipulations. The surety bond or check shall be kept active until the completion of work and/or expiration of permit and can only be released by written notification of the City after a satisfactory final inspection has been performed by the City. 2. All access and street frontage of the land alteration site must be controlled by a fence, a minimum of four (4) feet in height. All entrances must have gates that are capable of being locked. 3. Only rock, sand, gravel, dirt, or similar natural earth fill is permitted. No concrete, asphalt, or demolition wastes will be permitted as fill unless a demolition landfill permit is first obtained from Anoka County. 4. Operations shall be limited to daylight hours and shall not interfere with the health and safety of surrounding residents and the premises shall be maintained at all times so as not to create a nuisance. 0 Stipulations Continued 5. Any explosives used must be done so in accordance with Chapter 212, subsections 212.07.5A, .5B, .5C, .5D, and .5F. of the Fridley City Code and any other applicable standards, e.g. Federal, State, Industrial, etc. 6. At the end of each season's operations and no later than the last day of December each year, the site is to be left in a neat and orderly condition, with maximum slopes of 2:1 with no overhang or vertical banks and with a level bottom. 7. On the Friday of each work week, or when required by the City, material from this operation that is found to exist on City streets shall be cleaned to the City's satisfaction by the applicant. 8. Upon completion of land alteration operations, the land must be left according to the plans and contours submitted with this application and planted with suitable vegetation to prevent erosion. 9. Upon completion of land alteration operations or expiration of this permit, an inspection will be made by the City of the premises and adjoining streets. Any damage found to have been caused by these operations will be corrected by the applicant upon notification by the City. Signature Property Owner's Signature Property Owner's Signature Date: ! dk- a A 0 Date: I d -/r -)-/o '�L Date: FOR CITY USE ONLY Recommended for Appr al By�e, Date: l ooz- Approved By: Date: PERMIT EXPIRATION DATE: LAND ALTERATION PLAN-CHECIONG FEES 50 Cubic Yards or Less ....................................................... No Fee 51 to 100 Cubic Yards ....................................................... $ 23.50 101 to 1,000 Cubic Yards ..................................................... $ 35.00 1,001 to 10,000 Cubic Yards .................................................. $ 49.25 10,001 to 100,000 Cubic Yards ................................................. $ 49.25 for the first 10,000 cubic yards plus $24.50 for each additional 10,000 Cubic Yards or fraction thereof. 100,001 to 200,000 Cubic Yards ............................................... $269.75 for the first 100,000 cubic yards plus $13.25 for each additional 10,000 cubic yards or fraction thereof 200,001 Cubic Yards or More .................................................. $402.25 for the first 200,000 cubic yards plus $7.25 for each additional 10,000 cubic yards or fraction thereof. LAND ALTERATION GRADING PERMIT FEES 50 Cubic Yards or Less ..................................................... $ 40.00 51 to 100 Cubic Yards ........................................................ 7.50 101 to 1,000 Cubic Yards ..................................................... $ 47.50 for the first 100 cubic yards plus $10.50 for each additional 100 cubic yards or fraction thereof. 1,001 to 10,000 Cubic Yards ................................................... $167.00 for the first 1,000 cubic yards plus $9.00 for each additional 1,000 cubic yards or fraction thereof 10,001 to 100,000 Cubic Yards ................................................. $273.00 for the first 10,000 cubic yards plus $40.50 for each additional 10,000 Cubic Yards or fraction thereof. 100,001 Cubic Yards or more .................................................. $662.50 for the first 100,000 cubic yards plus $22.50 for each additional 10,000 cubic yards or fraction thereof. I� SuBjECT- - PER_MIT.__ -. City of Fridley 33526 AT THE TOP OF THE TWINS BUILDING PERMIT r? � RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. / r CITY HALL FRIDLEY 55432 NUMBER REV DATE v�GE OF APPROVED BY L 763-571-3450 910-F15 5/19/03 F/ / JOB ADDRESS 41 Rice Creek Way NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7A, 7B I Edgewater Gardens SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Kennard Littler 41 Rice Creek Way NE 763-572-9089 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sade 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 D NEW [j ADDITION ❑ ALTERATION ❑ REPAIR p MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 242 sq deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. Bef®re digging all Utility locations SEPARATE PERMITS 45 0002 REQUIRED FOR: "U'"r'D WRINGHEATING SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 @@ @ $1.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,005 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- F''ire SC $3.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $97.25 PLAN CHECK FEE TOT FEE 101.75 G RE CRN'�AC ROR AUTHORIZED AGENT iDATE, V12 6 0 EN ROP VALI T D THIS IS Y UR PERMIT Bl -NSP PATE SIGNATURE OF OWNER I� NEW [ ] ADDN ALTER [ J Construction Address: CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 (763) SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION'�� Effective 111/2002 572-3604 Bldg nsp 11 5 Legal Description: I=, Owner Name & Address: Tel. # -74-3—,-S; 90 F, - Contractor. Ow & 12 MN LICENSE # Address: Tel. # LIVING 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 rev Length Length Width Width Height Hgt/Ground f it Sq. Ft /A Sq. Ft -3 y56 L Construction Type: _ W,o c! Estimated Cost: $ 1-700, o 0 .'5' �-1 Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $ DATE: L9Z1 ®APPLICANT: Tel. # �6 �� {�®29 Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL $ W STIPULATIONS: