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PRE 2010 DOCS' CITY OF FRIDLEY APPLICATION FOR HEATING REPLACEMENT Y CHIMNEY AND STACK VERIFICATION THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM, LOCATIONjs/ "&R DATE OWNER `,1��/� �i5XADDRESS The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined 2. Is free from rust or deterioration 3. No foreign objects are lodged within 4. That it is securely supported 1s e ,( 5. That it meets all current Code requirements for size and total BTU connected 6. Total Heating BTU , All Other BTU TOTAL HEATING PERMIT by Add Tel Fridley City License # SUBJECT PERM City of Fridley -ILN_ 5 063 AT THE TOP OF THE TWINS ❑[RvI BUILDING r `L _ COMMUNITY DEVELOPMENT DIV.�� INSPECTION r � PROTECTIVE SEC. 1 i i CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY ---- �'j 612-560-3450 910-F15 1/29/79 JOB ADDRESS 6490 Riverview Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 3 1 Walt Harrier 1st SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Walt Harrier same as above 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Garage additinn 7 CLASS -OF WORK ,\I;] NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct 24' x 22' x 101 garage 9 CHANGEOFUSEFROM TO STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Utilities to be put in by property owner. 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 558 5580 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WITH WHETHER SP CIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 4000 2.00 DOES NOT PRESU E T GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PR S OF Y T ER ST TE OR LOCAL LAW REGULATING CON- ST; TION OR H P F RM CE OF CONSTRUCTION. 22.32 �% r /' PLAN CHECK FEE TOTAL FEE WHIN PROPERTY I VIS IS YOUR PERMIT� GNATUREOFNWACTOR OR AUTHORIZED AGENT ATE) I�k- t /® BLDG. INSP. DATE SIGNATURE OF OWNER (IF OWNER BUILDER) IDATEI ° CITY OF FRIDLEY ° APPLICATION FOR RESIDEATIAL BUILDING PEMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: MILDEI2: �,�� �✓ . Address : 9D dress Tel. No . : Street: LOT: > BLOCK: ADDITION: at CORNER LOT: INSIDE MT: r-4 SETBACK: SIDEYIIRDS: Applicant attach to this form'Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING j Pe Used -As: �? y Front: vc Depth: •�' Height:D Square Feet: _3 Cubic Feet: S5 ?50 Front: • Depth: Height: Square Feet: Cubic Feet: Type of Construction: . Estimated Cost: $ • Q� To Be Completed: Alt. A Alt. B Pr6posed Driveway Width If New Opening Is Desired $ $ (SEE REVERSE SIDE OF SHEET) The undersigned hereby mares application for a permit for the wort: 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 representati tat d in this application are true and correct. See reverse sii e for di `i 1 information. 'Ly DATE: SIGNATURE: Stipulations: 41 0Czr V ��lnu = 2z -K . z!� v �..0a 7y. CITY OF FRIDLEY 6 e,%k` o I% �� d APPLICATION FOR RESIDENTIAL•BUILDING PERMITS VCV (New, Alterations, Additions, or Repairs) OWNER: BUILDER: GC. ADDRESS: TEL NO: ADDRESS: TEL NO: Construction Location • STBEET NO: STREET: q 1 V EJU i 6A) 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: Depth: Height: Square.Feet: Cubic Feet: Front: Depth: Height: Square Feet: Cubic Feet: Type of Construction: Estimated Cost: $ lb Be ODmpleted: Alt. A Alt. B � i Proposed Driveway Width If New Opening Is Desired: .,:�2 <2— $ ✓ $ 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 hereb declares that all the facts and representations stated in this applicatig� are t e andorrect. 1 .i 4 DATE: SIGNATURE: Stipulations: 0`3 ao M ROUGW,, INSP. REINSPECTION FEE Date ($10.00) FINAL INSP. ?o Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE Capacity SqJ Ft. EDR BTU HP n/ Company l�� 1wGl Signed By Tel. No. CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND r .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL / Job Address '�d/ w Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations-up to $500.00 7.00 $ Department of Buildings Repairs & Alterations each add. $500.00 4.00 $ City o£ Fridley Tel. #571-3450 MECHANICAL WARM AIR: The undersigned hereby makes application for a permit for the work herein Furnace Shell & Duct Work to 100,000 BTU $12.00 $ specified agreeing to do all work in strict accordance with the City Codes each add. 50,000 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the Replacement of Furnace 7.00 $ facts and representations stated in this application are true and correct. Repairs & Alterations-up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 4.00 $ Minn. , 19 STEAM OR -HOT X4TER SYSTEM: �Fridley, OWNER— _ ZTg A Boiler & Lines up to 100,000 BTU $12.00 $� KIND OF BUILDING each adds. 50,000 BTU 4.00 $---- = Boiler only up to 100,000 BTU 7.00 $ USED AS each addn. 50,000 BTU 6.00 $ TO BE COMPLETED ABOUT OIL BURNER- to 3 gal. per hour $10.00 $ - each add. 3 gal. per hour 10.00 $ ESTIMATED COST GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $-/O. OLD - NEW BUILDING PERMIT NO. PERMIT NO. (over 199,999 BTU see Fee Schedule) $ GAS FITTING FEES: lst 3 Fixtures x $ 3.00 DESCRIPTION OF FURNACE/BURNER Additional Fixtures x $ 1.00 $ Gas Range to 199,000 BTU x $10.00• $ HEATING or POWER PLANTS,SSteeam Hot Water, Warm Air- No. AIR CONDITIONING $ Name ®7`i Size No.�-'��c�� FAN HEATING SYSTEMS Trade See Fee Schedule VENTILATING SYSTEMS $ �y Capacity, % (!� Sq. Ft. EDR BTU HP & REPAIRS $ .ALTERATIONS State Surcharge $ .50 Tot ad//� Kind of FuelTOTAL FEE�lBURNER �1,Coynne�dd - e Size No. ROUGW,, INSP. REINSPECTION FEE Date ($10.00) FINAL INSP. ?o Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE Capacity SqJ Ft. EDR BTU HP n/ Company l�� 1wGl Signed By Tel. No. SUBJECT PER . City of Fridley 5. AT THE TOP OF THE TWINS BUILDING PERMIT Ir • COMMUNITY DEVELOPMENT DIV. _____ w - r - PROTECTIVE INSPECTION SEC � NUMBER REV DATE PAGE OF APPROVED BY /---1 CITY HALL FRIDLEY 55432 612-571-3450 910-F15 10/18/94 JOB ADDRESS 6490 Riverview Terrace NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 25 Auditor's Sub. #23 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Shirley Severson 6490 Riverview Terrace NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Lundgren Bros. 935 E Wayzata Blvd Wa zata MN 5 735-8640 1413 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 p� ❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 15'6" x 266" 2nd Story Addition; interior alterations 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $42,922 $21.46 DOES NOT PRE U E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PRO VISIO S NY OTHER STATE OR LOCAL LAW REGULATING CON- OF CONSTRUCTION. $369.00 Fire SC $42.92 STRUCTI E ERFORMANCE CHECK FEE TOTAL FEE 1 a f p� Q PLAN License SC $5.00 $438.38 SIGN URE OFCONrRACTORORAUTHORIZEDAGENT IDATEI WHEN PROP Y VALIDATED THIS IS YOUR PERMIT B G INSP qa TE SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI NEW [ ] ADDN [ ] ALTER..: , [ ] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R -I AND R-2 Building Permit Application ConstructionAddress: ``J Legal Description: _ Owner Name & Address: La LjSe 0,e Tel. # Contractor: L4 n viii i 0X5 MN LICENSE # Address: �3� E' "eq zA¢ A "3 k V d L9 �A) Tel. # . °�3S 76c/0 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. /j l DESCRIPTION OF IMPROVEMENT U Flt 0 f // r -bl1 Length' �° Width — Height Sq. Ft. , GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width HgtlGround Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. Completion Date: (Cost on Back)h` Driveway Curb Cut Width Needed: Ft. t = Ft x $ = $ DATE: l0 !a- V� APPLICANT: Tel #'7s Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CM USE ONLY $� Fee Schedule on Reverse Side $�_ 92 ..001 of Permit Valuation (11101h%) $ Qb Ye ;$.501$1,000 Valuation $ $8W 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 [ ] A � YO CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Effective On January 1, 1993 Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS l q® RATE SCHEDULE _The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL specified agreeing to do all work In strict accordance with the City Codes and Furnace Shell and Duct Work, Sumer — rulings of the Building Division, and hereby declares that all the facts and Also Replacement Furnace $ 20.00 $ representations stated In this application are true and correct. (Side Vent — Fig Out Back) Gas Piping (Needed with new furnace) $10.00 Gas Range Gas Dryer *Air Conditioning — A I Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/industrial 1 % of Value of Appliance or Work $10.00 $ (--/ BUILDING USED AS $10.00 $ �✓ � ESTIMATED COST cf(M PERMIT NO.Jl) $10.00 $_ State Surcharge TOTAL FEE No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Sumer Trade Name Size No. BTU HP EDR HEATING COMPANY MINIMUM FEE FOR ANY HEATINGLCOOLINGNENTHATION // & REFRIGERATION/Alli CONDITIONING PERMIT IS $15.00 Signed PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Approved Tel No.'��`��. Rough—in Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE NOTE: #1 through #8 required when using a side vent furnace. CDN U AND STACK NEREE CALM The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes { } No { ) 2. Is free from rust or deterioration Yes () No ( ) 3. Has no foreign objects lodged within Yes (} No ( } 4. Is securely supported Yes {) No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes (} No ( ) 6 Has total heating BTU's of AN other BTU's TOTAL BTU's ?. Has a liner been provided for water heater Yes () No ( } 8. Has combustion air been provided fbr .water heater Yes O No { ) Remarks: � --�- �j�',E/� / � ����--�✓��. HEATING CO: Signed By: Date: 111 SUBJECT City of Fridley =0� AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. ______ I � i PROTECTIVE INSPECTION SEC a®! r NUMBER REV GATE PAGE OF APPROVED By 1 CITY HALL FRIDLEV 55432 812-571-3450 910-F15 4/30/97 JOB ADDRESS 6490 Riverview Terrace NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 25 Auditor's Sub #23 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Shirley Severson 6490 Riverview Terrace NE 574-0041 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Donnelly Windows Inc 2519 E 25 St, Mpls., MN 55406 722-4200 20092971 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION? REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install replacement windows 9 CHANGE OF USE FROM TO STIPULATIONS Replacement bedroom windows must meet the State Egress Code. Install smoke detectors on all levels and in all sleeping rooms to meet the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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. DWI,G. 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 10,593 $5.30 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE License SC $5.00 TOTAL FEE $195.64 t SIGNATURE OF CONTRACTOR OR AUTHOR E A � T IDA EI WHEN% PROPERL VALIDATED THIS IS YOUR PERMIT 8L* INSP ,9J Z6 V-- % ' QAi SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI 111 NEW [ Effective 1/1/94 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R -Z Building Permit Application ConstructionAddress: t,,q 90 tjEMvcrvier,� Legal Description: Owner Name & Address: & a ®n � y D ff s uerase � ; Q ,� Tel. # � � / Contractor: MN LICENSE # Gt O ®9'®i 9'71 Address: mss, q r. os Plh $ T m�15, rn tJ SLI o6 Tel. #. moo- qa go 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: Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yazd Setbacks Type of Construction: j7;, II ReelQces���sa /�rvr� Estimated COSI: $ f-0,593, _Approx. Completion Date: y (Cost on. Back)': Driveway Curb Cut Width Needed: Ft. t = F = $ DATE: APPLICANT: Tel. # 0 Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: 00 146 *IaU6 OU USE ONLY $ IfY, 75" Fee Schedule on Reverse Side $ /J, :�2 ..001 of Permit Valuation (1/10th%) $ $.50/$1,000 valuation �ly1ow,g $ $8M per SAC Unit- $ i $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Pian Review r s�Ix $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ l SUBJECT IT NO...> City of Fridley (25848 AT THE TOP OF THE TWINS B U I L ®I N G P E R M I T P RECEIPT NO. `y ______ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r 1 NUMBER REV DATE PAGE OF APPROVED BY iI 1 �'�'1 CITY HALL FRIDLEY 55432 �---- 11•� j 612-571-3450 910-F15 3/12/98 JOB ADDRESS 6490 Riverview Terrace NE 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. Pt 25 Auditor's Subdivision #23 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Shirley Severson 6490 Riverview Terrace NE 574-0041 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Donnelly Windows Inc 2519 E 25 St, Mpls., MN 55406 722-4200 20092971 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 0 MOVE ❑ REMOVE 8 DESCRIBE WORK Replace windows; Reside Dwelling; Metal Garage Door; Aluminum Trim 9 CHANGE OF USE FROM TO STIPULATIONS Install building wrap and have inspection of same. Install smoke detectors to meet the State Building Code. 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $33,790 $16.90 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 $33.79 STRUCTION OR THE kERFORMANCE OF CONST TION. $430.75 C� PLAN CHECK FEE TOTAL FEE License SC $5.00 $486.44 SIGNATURE OF CONTRACT6R OR AUTHORIZED AGEN IDA EI WHEN PROPERLY LIDATED THIS IS YOUR PERMIT 7 r � BLD INSPTE SIGNATURE OF OWNER �iF OWNER BUILDERI IDATEI NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Legal Description: Owner Name & Address Contractor: Address:e1519 6 Effective 1/1/97 q Tel. #__ 5714 -®/ MN LICENSE#,960ga c171 Tei. # -7Rc-? -- 41& 6 6 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF 11"ROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft: DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: M4.1 60-v,1Joear �du�� 6 �' �eLrn���-f 5r e�iza, �� -- Construction Type: a�i A '':moi C��}�-i0"'.5 stimated Cost: $ t y7 .(Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x * $ = $ DATE: . /f APPLICANT.Y Tel. # -70e,-- CITY USE ONLY Permit. Fee $ 1 Fee Schedule -'on Reverse Side Fire Surcharge 332J .001 of Permit Valuation (1/10th%) State Surcharge. $ �.� $.50/$1;000 Valuation SAC Charge $ $950 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 j ] Not Necessary [ j TOTAL $ STIPULATIONS: SUBJECT P O. City of Fridley 3 3 9 2 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. ►y-- COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. /3& NuMBER REv DATE PAGE OF APPROVE BY 1 "'1 CITY HALL FRIDLEY 55432 763-571-3450 910-F15 3/24/03 JOB ADDRESS 6490 Riverview Terrace NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 25 1 Auditor's Subdivision 423 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Shirley Severson 6490 Riverview Terrace NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Daco Inc 14510 45 St NE St Michael MN 55376 763-497-3900 3180 a 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 .0 REPAIR 0 MOVE ❑ REMOVE B DESCRIBE WORK Remove and replace damaged sheetrock and insulation on two walls in basement 9 CHANGE OF USE FROM TO STIPULATIONS 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TFIUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $8,000 $4.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $153.25 Fire SC $8.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHE FEE TOTALFEE ����y� cen SC $5.00 $170. SIGN—d URE OF CON'RACTOR OA AUTHORIZED AGENT IDATE� H N PROPERLY VALIDATED THIS IS Y UR P IT B OG INSp naT i S-GNATURE OF OWNER�IF OWNERBUILDERI IDATEI NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: y �0• ice/ V �w ���ai ic� 1`e� . Legal Description: Owner Name & Address: Tel. # Contractor. D Gtr (L� LY0 MN LICENSE # Address: / X37/l> �.5� 1 `,5 7 '- /�� SF Micher, % aan 5Y3 7 � Tel. # X -7-'I F, , G /2 -2:2 / -oa3l 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: Leng Width Hgt/Grounjd Sq. Ft. OTHER: ° AJ C e'4_ rte io- �/ Construction Type: s C r estimated Cost: $ Q© d Or— 70 CIL+ oe fie! L s S Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x DATE: 3- O70 ?_ APPLICANT: Tel. # Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. TOTAL $ / 1)n' Z_ STIPULATIONS' CITY USE ONLY - Permit Fee $ JS . S Fee Schedule on Reverse Side Fire Surcharge $ 5, .001 of Permit Valuation (1/10th%) State Surcharge $ 4�s $.50/$1,000 Valuation SAC Charge $ $1275 per SAC Unit License Surcharge $ S $5.00 (State Licensed Residential Contractors) Curb Cut 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 $ / 1)n' Z_ STIPULATIONS' Building Inspections 763-572-3604 SITE ADD1iM __ THIS APPLICANT IS: OWNER/ TENANT MECHANICAL RESIDENTIAL APPLICATION CITY OF FRIODLEY -(' t YOUR EMAIL ADDRESS (:�' PjL= Ater_L3 !f. O OWNER NTRACTOR ADDRESS:--t� PHONE; !E�`?Lf . 00<4 I Permit No.:.o ®` G eUL Received By: Date Recd:' SUBMIT A COPY OF CONTACT PERSON'- . ,, ',V,) + e lies �,-he YOUR STATE STATE LICENSE M DATE LICENSE WITH ADDRESS 5 b4Cffi Aid ® 1 A VV APPLICATION PHONE LLD I PAX PERMIT TYPE INGLE FAKL'Y 0 TWO FAMILY Q TOWNHOUSE TYPE OF WORK: ° NEW ❑ REPLACEMENT PiLTERATIONMEMODEL DETAILED DESCRIPTION op woRi� M /e/7 r` 2P—I 4- A� PER MS 165.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to 5500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor) labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x .05 - FOR PROJECTS WHERE LABOR EXCEEDS 8500, WM ARE EASED ON s 10.00 PER FIXTURE, EXCEPT WHERE NOTED• FDMMM. MOICATE TOTAL NUMBER OF EACH BELOW) MFG: MODEL: 51ZFJBTU,r 5jWpmcnt Installed MFG: m6DW _ SIZE/ETU _ �A�, K2G! �.� mom, FIREPLACE (GAS) $15.00 � SIZEIBTU _,�.._ GAS RANGElOVEN 510.00 $25.00 TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00 AIR BOII SO $35.00 CMINEY LINER S10.00 �FUitNACE 535.00 _GAS DRYER $10.00 ,,,_CTAS UNIT HTIt $10.00 POOL Y#EATEtt 535.00 r,TTr-r WA&V C1 n m GAS PIPING $10.00 YENTELATOR 515.00 Permit Fee $ _,. _ Number of fixtures.{3a $10.00 x $IU.VV = Surcharge S .50 Number of fixtures @ $15.00 x $15.00 = $ a o TOTAL DUE 5 _ Number of fixtures @S25.00 x $25.00 = i-20> Number of fixtures @ $35.00 x $35.00 - S State Surcharge m S 50 Total = $ L THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit afad I acknowledge that the information above is complete and accurete; 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 appli n for a permit and wor is not to start without a permit; that the work will be in accordance with the approved plan in the case o ll rho wht �!�,approval of p�� I NATURE OF APPLICANT -PRINT N a SG City of Fridley Building Inspections Department 6431 Ulliversity Avenue NE, Fridley, MN 55432 763-572-3604