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PRE 2010 DOCS, SUBJECT PERM City of Fridley 17403 AT THE TOP OF THE TWINS BUILDING PERMIT r CEI T N COMMUNITY DEVELOPMENT DIV. ' r PROTECTIVE INSPECTION SEC. ` h r--'1 CITY HALL FRIDLEY 55432 �.J , NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 11/25/84 / JOB ADDRESS 8181 Riverview Terrace N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 28,29 R Riverview RNMI Heights Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Randall J. Radziej 50 West 78th.Street 869--3073 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 24' x 40' Dwelling and a 25" x 21' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide City with copy of verifying survey before capping. Provide sod in the front and side yards. SEWER LOCATION: CApprox. 9' Deep In Street) 145' N. of M.H. at Hugo & Riverview Ter (Inv. 812.21) WYE ELEV: 812.79 WATER LOCATION: 11' N. of Sewer Service It" City OF FRIDLEY DOES NOT GUARANTEE PMF DRIVEWAY DEPRESSION ESCROW: N/A NCrV;?ACv OF UTILITY LOCATIONS AND ELEVA'TICt . 7!4r OAP: IS FOP, INFORMATION PURPOSES ONLY AND:' 9A X41 PL.Z : �= USING r SNOULD VE9IFY THE INFORMATION ')N THE SITt Before digging calh,Iocal utilities TELEPHONE -ELECTRIC - GAS Etc. SEPERATE PERMITS REQ0 D FOR ' 1 t t G, REQUIRED BY LAW HFATING, PLUMBING AND SIGNS. � m t;� tZc.r�v o cr>>-rc��. o� �� pv TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood Frame 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 R^^1 960 300 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 $67,950 $33.98 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- $337.00 $425.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. P FEE OTALFEE $ 84. 5 $880.23 IG AT E COVVR=UTHOR1ZEDAGENT (DATE) W< N PROPE LY D THIS IS YOU IT- - e S!GNATUREO ER SIF OWNER BUILDERI IDATEI 3 WSP DATE Randall and Cathy Radziej 50 W. 78th Street Apt. 104 Richfield, MN 55423 612-869-3073 February 24, 1984 City of Fridley 6431 University Avenue Fridley, MN 55428 RE: 8181 Riverview Terrace To Whom It May Concern: We, Cathy and Randall Radziej, intend to continue with the "A Frame" construction already approved and started by the previous owner. The plan dimensions are to remain the same except for the twelve additional inches added to the length at the back of the building. Construction is to start immediately and anticipated completion date is within three to six months. iSinc ly,4ndal J. Rad Cathy E. Radziej CITY OF FRIDLEY APPLICATIM FOR RESIDENTIAL BUILOING PL HITS (New. Alterations. Additions. or Repairs) OWNER: ADDRESS: -;,!2 TEL K0:n��7 Effective Aug. 1, 1981 QUI LDER : J n da 6)) ADDIESS: 4 e TEL 110: Construction Location STRI'T NO A i S STREET: I: e r ('911) LOT: -h - BLOCK: ADDITION: l it ) e' ` l .Corner Lot: Inside Lott Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTIOR OF CONSTRUCTION Front: 2 Depth: C�� Height: Square Feet: Cubic Feet: 1/0 0 .y Q& Q Front: 2-S Depth. Height: /, Square Feet: ?o o Cubic Feet: 5 J/co 'a'ype of Construction: A"/il e W 7�G� Rb Be Completed: _ 7/ �0 /IqSV 151 Estimated Cost: $ 5� Alt. A Al t. R Proposed Driveway Width If New Opening Is Desired. S $ SDE pivF.R ;I.' SIDE OF SHEET 9i:e undersigned hereby makes applicaticn for a permit fcr the vork herein specified, agreeing to do.all work in strict accordance with the City of rridley Ordinances and rulings of the .Del-.irtment of Buildings, and hereby declares that all t3:e facts and represm atiens stated in this applic.: DATE z 2(—D SIGNATUTE : Stipulations: Q 3-SO.n® P -Q— Esq , 70-10- 33-99 ONSTRUCTION, NS3PECTION ERVICES 234 69TH AVENUE N.E. FRIOLEY, MINNESOTA 55432 September 1.,.;1983. John G. Flora Director of Public Works City of Fridley Fridley, NN 55432 Dear Mr. Flora, /' �Y' Yx � I � , r,;: - -, C, Please be advised of my recent purchas7tisf-rdt:s9-=28--&--29-,-Block R, Riverview Heights, also knows -as 818.1 Riverview Terrace N.E.' I intend to resume construction o the :roos_ec�s.�e already on file with the City of Fridley. The drainage plan that,was submitted with the structural plans will be adhered to. I intend to start filling the Lot to the specified elevations within 2 weeks. If you have any questions, please contact me. Sincerely, L'�graaf Del Zjr DZ/jh Israelson & Associates, Inc. 10100 MORGAN AVENUE SOUTH June 11, 1984 City of Fridley 6431 University Avenue N.E. Fridley, MN 55432 Attn: Darrel Clark Re: Residence for CONSULTING ENGINEERS, LAND SURVEYORS • BLOOMINGTON, MINNESOTA 55431 a (612) 884-5371 MN (Our File No"." -T02 -271C) Dear Mr. Clark: thy Radziej ew Terrace This is in reference to our June 5th telephone conversation regarding the above referenced residence. The residence is currently under construction. The purpose of Mr. Radziejts meeting at our office and our follow-up telephone conversation with you was to discuss the built up beams supporting the high roof trusses over the living room area at the front of the building and over the bedroom areas to the rear of the building. Our calculations and your calculations closely agreed and the following was concluded: 1. Over the living room area add three 2xl2is to the existing beam (i.e., the beam made up of three 2x10is with plywood fillers). The 2xl2ts are deeper and must be notched into the double cap at the ends. It was discussed how this might be accomplished. The added 2xl2ts are to be spiked continuously to the existing beam. Add multiple studs below the bearing points of the new 2x12is and spike them continuously to the existing wood post. 2. Over the bed,ur* oom areas the same comments apply except three 2x10is may be added instead of three 2xl2is. Notching into the existing double can is not reauirp-d- This June 5th meeting with Mr. Radziej and our follow-up telephone conversation represents our total involvement with this project. We have not acted in such a capacity that lets us be considered an engineer of record for the project. If there are any questions, please call. Sincerely, Frank Berg, P.E. F o. Alvin R. Rehder, R.L.S. Harold G. Israelson, P.E. Lowell E. Wenzel, P.E. Gregory R. Halling, P.E. Gregory P. Struve, P.E. Frank J. Berg, P.E. CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE QESIDENTIAL RATE TOTAL Furnace Shell and Duct Work, 00 Burner (Also replacement furnace) $ 20.00 $ Gas Piping $ 10._00 S (piping needed_ with new furnace) Gas Range 5-10.00 $ Gas Dryer S 10.00 $ O� Air Conditioning (all sizes) $ 10.00 $ All Others/Repairs and Alterations li of Value of Appliance or Work $ COMMERCIAL/INDUSTRIAL It of Value of Appliance or Work S State Surcharge $ .50 TOTAL !EB s �e Reinspection Fee ($15.00) S Rough Insp. Date Final Insp. 1 -It-%± Date Approval for Permit alkz MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 PLUS $.50 STATE SURCHARGE Attach stack verification fors with replacement furnace permits *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Effective Aug. 1, 1981 Job Address 7J;E, , ey ;t, "ge ra- Ji;,04,0 4 5&4s,3) Department of Buildings. 6431 University Ave. N.E., Fridley, HN 55432 City of Fridley Tel. #571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. A Fridley, Minn. ' C4)- OWNER a i KIND OF BUILDING ® p4,��s� ke, USED AS - TO BE COMPLETED ABOUT -� ESTIMATED COST A/00 ®� OLD - NEW BUILDING PERMIT NO. PERMIT NO. / DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Ware Air- NO. Trade Name ��r/`d % OJL� Site No. 'SS a,—,JAIL) Capacity Sq. Ft. EDR BTU . HP Total Connected Load Kind of Fuel N�kwa/ BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company a° a a r. Air Signed �By�� Tel. No. 75 7 - �; 040 HEAT LOSS CALCULATION OTEMP. DIFF., Customer Name �2 Type Cortamiction City Windows Storm Sash Dealer Name Walls _ Ins. Street RLATING & AIR CON Ceiling Ins. City 2615 GOO PI Rapids Blvd, 4 Floor - apids Minn. 55411 FI.1 oom j Length Width Height FLI Room Length Width Height Mp.dows and Doors—Crackage and Area No Wsdth Haight No. 01 Linin ft. A►om rat oono of nano Lrohts of crack b. h. Windows and Dbors—Crackage and Arm No. Width rfYight No. Of Lltwl h. Arm of of. oea Lights of cnaN� p• ft. Nn W1nfh Hppht No. of LMeat ft. Atom rat pam� of Mise ILhts of croak . ft. Coef. Btu Infiltration Coef. Btu Coef. Btu Infiltration a� G lass G lass Net exp. will _ Exp. wall (� Exp. wall' Net exp. wall Floor Int. wall Net exp. wall Ceiling Floor ' 1 Int. wall ` Ceiling Floor Total Btu. Fl.i�'J` . �J�I Room I Length Width Height p Windows and rs—Crackageand Ara No W'dth Ho,pm No. of Linoml ft. A►om of ono of ons Lights of track sq. ft. —3 iD Coef. Btu Infiltration Q Glass PO Exp. wall Net exp. wall `� Int. wall Ceiling; Flow Total Btu. F11 M'.'A-- RdemlLermth ®T Width q Heieht Windows and Dbors—Crackage and Arm No. Width rfYight No. Of Lltwl h. Arm of of. oea Lights of cnaN� p• ft. Nn W1nfh Hppht No. of LMeat ft. Atom rat pam� of Mise ILhts of croak . ft. Exp. wall Not exp. wall Coef. Btu Coef. Btu Infiltration a� Exp. wall G lass Net exp. will _ Exp. wall , Ceiling Net exp. wall Floor Int. wall Ceiling Floor ' 1 Total Btu. I (nW� Windows and Doors—Crackage and Arm No. Width rfYight No. Of Lltwl h. Arm of of. oea Lights of cnaN� p• ft. 42 Exp. wall Not exp. wall Coef. Btu Infiltration G lass a� Exp. wall -3 Net exp. will Int. wall , Ceiling Floor Total Btu. F1.1 Room. Windows ne' d Door No. I nn- i ight f Btu Infiltration Glow 42 Exp. wall Not exp. wall Int. wall Ceiling Floor -3 Total Btu. FI.j&RoomjL Width , Windows and Doors—Crackage and Arae No Wedth Mo�ht NO. of orl h. Arom O1 of no is of LihCroak h. Coot. Btu Inf iltration Glow -- Exp. wall Net exp. wall Int. wall Ceiling ® C Floor Total Btu.> t SHEAT LOSS CALCULATION 0 TEMP. ®IFF. Customer Name Type Construction City Windows Storm Sash Dealer Name. Walls . Ins. Street __ _ Ceiling Ins. City Floor / FI.I R,A I Roam i Lenath I/) Width P Fleiohf FIA Room I Length Width Height Winffows and ours–Crackage and Area Width Me aht No. of Lineal ft. Area No of pane of pane L Lights of crack q. f. d Glass Coef.1 Btu Infiltration 6 Glass Exp, wall Aq A-0 Net exp. wall Int. wall Int. wall Ceiling F loor F loaf Total Btu. 9 FLI Bj 3 Room I Length Width Windows and Doors–CrackageandAra No WidthI Nolan, No. of Lineal h. Area of cans of oone Lwh . of crack aa. ft. Btu Inf iltrat ion Glass _ Exp. wall Net exp. wall Int. wall Ceiling Flom total Btu. Windows and Doors–Cracksge and Area C00. Btu Infiltration �y Glass Coat Btu LQ 0 Exp. wall /5,),l Net exp. wall i A-0 6, &L0 Int. wall Int. wall Ceiling F loor F loaf Total Btu. F1.1 Room Length Width H' t Windows and Dbors–Crackage and Ara Nn W'nrh ►f►gnt No. 01 Lineal it Area of ranw I of twete Liahts of crack Btu Inf iltrat ion Glass _ Exp. wall Net exp. wall Int. wall Ceiling Flom total Btu. Windows and Doors–Cracksge and Area No. WktthHaig t No. of Lineal ft. Area Ira M M L a o4 crae11 tea. ft. Coat Btu Infiltration Glass Exp. wall Net exp, wall Int. wall Ceiling F loor I Total Btu. I FI -I RoomI Lwwth Width Heiaht Windows and Doors–Crackage and Area No. Width OdeiOht No. of Lineal ft. Area 09 2!ne o4 M Lwhits of pack on. ft. Cod. Btu Infiltration Glen E -Aleoi^ 30 v Exp. wall Nat exp. wall` Int. wall Ceiling Floor Total Btu. I FI_I Roeml t_en ith Width Heieht Windows and Doors–Crackage and Ara No Width Noioht No. of Lineal ft. Ares of M - of etcLighta of crock . h. Loaf. Btu of iltration Glass Exp. wall Net exp. wall Int. wall Ceiling Floor I Total Btu. I CITY OF FRIDLEY APPLICATION FOR PWMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 e Future Fixtures ro 3.50 n Old Opening, New Fixture % d $ Water $ 4.00 $ Blow Off Basin $ 5.00 14 H b W 5.00 41 04 5.00 01 Heater 5.00 $ Sump or Receiving Tank $ 5.00 S Water Treating Appliance $ 7.00 $ Hot Water Heater $ �� $ Gas Range m 10.00 $ Gas Dryer $ 10.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS la of Value of Fixture or Appliance $ State Surcharge $ .50 ($15.00) TOTAL FEE $ S o s lec ul t� lat -301 2nd 3rd 4th. (R) o Future Connection Opening Connected with Sewer (•) . New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $ 5.00 $ Future Fixtures $ 3.50 $ Old Opening, New Fixture $ 1.50 $ Beer Dispenser $ 4.00 $ Blow Off Basin $ 5.00 $ Catch Basin $ 5.00 $ Rain Water Leader $ 5.00 $ Hydraulic Valve $ 5.00 $ Sump or Receiving Tank $ 5.00 S Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS la of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Fee $ ($15.00) TOTAL FEE $ Effective Aug. 1, 1981 r Job Address (z Department of Buildings City of Fridley Tel. 1!571-3450 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 Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct �Q�J Fridley, Mn. °� o� lg� s-P�t P OWNER A AP—d, KIND OF USED AS TO BE C ESTIMATED COST'` OLD - NEW BUILDING PERMIT NO. PERMIT NO. 6? !� Company Vkc Signed By Tel. No. ROUGH INSP. Date FINAL INSP. 1 of T o� Date APPROVAL FOR PERMIT _ MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00 PLUS THE $.50 STATE SURCHARGE CIVIC CENTER • 6431 UNIVERSITY AVE. N.E., FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 July 12, 1984 Mr. Randall J. Radzi.ej 8181 Riverview Terrace N.E. Fridley, MN 55432 Re: Final Inspection at 8181 Riverview Terrace N.E. Dear Mr. Radziej: A final inspection was made on July 11, 1984 of the above noted address and the following items were noted which must be completed before the structure can be finaled out: 1. Extend Class A chimney so that it terminates 2 feet above the roof ridge. 2. Complete driveway and garage slab. 3. Sod front and side yards. 4. Provide a copy of verifying survey to City. 5.V Clean up all construction debris. 6. Post address on structure. 7. Install guard and handrail. 8. Get electrical -and plumbing finals. We will expect items #1 through #4 to be completed by September 3, 1984 and items #5 through #8 to be completed by July 23, 1984 when reinspections will be conducted to determine compliance. If you have any questions on these items, please feel free to contact me at 571-3450. Sincerely, a&� - D G. CLARK Chief Building Official DGC/mh F X300 BRUNSWICGERALD T. KOYNE AVE S. LOT SURVEYS COMPANY • GOLDEN VALLEY, MINN. MINN. REG. NO, 4741 LAND SURVEYORS RZOUM BSD 1` ENt LAWS OF STATS OF LQNNSSOTA 7601 - 73rd Ave. No. 560-3083 INDUSTRIAL — JUDICIAL Minneapolis. Minnesota 55428 COMMERCIAL — TOPOGRAPHICAL CITY LOTS -- PLATTING pyprg (Stretrate RANDY RADZIEJ -- 122M -- Lots- RAYMOND A. PRASCH 6917 IDAHO AVE N. BROOKLYN PARK, MINN. MINN. REG. NO. 6743 INVOICE NO. ij4Ti,3 F. B. NO. 242-53 SCALE I$$.= 301 Lots 28 and 29, Block R, River View Heights, Anoka County, Minnesota We hereby certify that this is a true and correct representation of a survey of the boundaries of the above described property, and of the location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. This survey is made only in connection with a mortgage loan now being placed on the property and no liability is as. sumed except to the holder of such mortgage or any other interest acquired by reason of such mortgage. It is der - stood and agreed no monuments have been placed for the purpose of establish' lot lines or boundary corners. Signed ' Smayed by us this 21 day of Mal ,SURVEYS COMPANY CITYOF FRIDLEY CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MINNESOTA 55432 • PHONE (612) 571-3450 i February 23, 1988 PW88-34 Igor Woyno 8181 Riverview Terrace Fridley, M(J 55432 Dear Mr. Woyno: The elevation certificate which you sent me a copy of was furnished by the previous owners of your home. If you can obtain another blank copy, we will be happy to fill it out for your. If not, maybe your insurance company will accept the certificate from the previous Owner since the address is on the existing certificate. if we can be of further assistance, please let me know. Sincerely, i� Mark L. Burch Assistant Director of Public Works NM/ts G L. G r N I I V IN %o G F1 I I IF I V J'% 1 16 EXPIRES: JUNE 30 1980 FEDERAL EMERGENCY MANAGEMENT AGENCY NATIONAL FLOOD INSURANCE PROGRAM This form is to be used for. 1) Post -FIRM construction only when the base flood information is available for the building site; and 2) Pre -FIRM buildings rated using Post -FIRM rules. Instructions for completing this forth can be found on the reverse side R1 R1 R;ve-na;ew Terrace STREET ADDRESS a Apt.-A/Unil-U Suites/Bldg: B NO. ROUTE BOX NUMBER Tiot 2R and T 29, Block R, R9ve_Yview Heights OTHER DESCRIPTION (Block and lot numbers.. etc.) FridlQX, MN 55412 GTYSTATE ZIP CODE This form is to be completed by a land surveyor, engineer, or architect who is authorized by state law to certify elevation information when the elevation information for zones Al A30, AE, AH, A(with BFE), VI -V30, VE, and V(with BFE) is required. In the case of zone AO, the building official, the property owner, or the owner's representative should complete the Information in Section I and may also complete the certification. Community officials who are authorized by local law or ordinance to provide floodplain management information may also complete this form. SECTION I BUILDING ELEVATION INFORMATION 1. Using the Flood Insurance Manual or the NFIP Flood Insurance Application—Part 2 Worksheet, indicate the proper diagram number_ 2. FIRM Zones Al -A30, AE, AH, and A (with BFE). The top of the reference level floor from the selected diagram is at an elevation of feet NGVD. (or other datum -see #5) 3. FIRM Zones V1 -V30, VE, and V (with BFE). The bottom of the lowest horizontal structural member of the reference level floor from the selected diagram is at an elevation of feet NGVD (or other datum -see #5). 4. FIRM Zone AO. The floor used as the reference level from the selected diagram is W feet above highest natural grade next to the building (also enter in line 8). This value must be equal to or greater than the AO Zone flood depth number listed below. If no flood depth number is available, is the building's lowest floor (or reference level) elevated in accordance with the community's floodplain management ordinances? ❑ Yes ❑ No ❑ Unknown 5. Indicate the elevation datum system used in determining the above reference level elevations: [I NGVD [I Other (describe on back) 6. Indicate the elevation datum system used on the FIRM for base flood elevations: ❑ NGVD ❑ Other (describe on back) (ATTENTION: If the elevation datum used in measuring the elevations is different than that used on the FIRM, then the elevations provided must be converted to the datum system used on the FIRM.) 7. Is the reference level based on actual construction? ❑ Yes ❑ No' ' A "No" answer is only valid if the building does not have the reference level floor in place. Fill in the elevation based on construc- tion drawings and do not complete question #8. If "No" is checked, this certification will be valid only for buildings in the course of construction. After construction of the reference level floor is completed, a post -construction elevation certificate will be required for continued flood insurance coverage. S. Provide the following measurements using the natural grade next to the building (round to the nearest foot). a. The reference level is: b. The garage floor (if applicable) is: L_J__J feet ❑ above ❑ below (check one) the highest grade. w feet ❑ above ❑ below (check one) the highest grade. LJ__J feet ❑ above ❑ below (check one) the lowest grade. J_I_J feet ❑ above ❑ below (check one) the lowest grade. SECTION 11 FLOOD INSURANCE RATE MAP INFORMATION Provide the following from the proper FIRM (see Instructions on back -Date of FIRM) and accompanying insurance application: COMMUNITY NO. ELN OF IX A 1 FIRM L L Y. U I IMATED BASEFLOOD (In AO Zone, use depth) ELEVATION ESTABLISHED FOR ZONE A OR ZONE V, IF AVAILABLE Tho of lock El glation 824.91 Elevation reference mark used appears on FIRM ❑Yes ❑No (See reverse side for details) SECTION III CERTIFICATION This certification is to be signed by a land surveyor, engineer, or architect who is authorized by state law to certify elevation information when the elevation information for zones Al -A30, AE, AH, A(with BFE), V1 -V30, VE, and V(with BFE) is required. In the case of zone AO, the building official, the property owner, or the owner's representative can sign the certification. Community officials who are authorized by local law or ordinance to provide fioodplain management information, may also sign the certification. I certify that the information on this certificate represents my best efforts to interpret the data available. I understand that any false statement may be punishabie by fine or imprisonment under 18 U.S. Code, Section 1001. Assistant Public Works Director, City of Fridley MN. #16186 CERTIFIER'S NAME LICENSE NUMBER (or Affix Seal) Mark L Burch City of Fridley TITLE COMPANY NAME 6D4�31 University Ave., N E ,' Fridlmy, sNF�T E 5P 432 SIGNATURE � I DATE PHONE The Insurance agent should attach theori91net copy of the completed form to the flood Insurance policy application. The second copy should be supplied to the polieytalder and the b copy retained by the agent. The fourth copy to for the local community permit office, H required. THIS FORM MAY BE REPRODUCED. FOR OPTIONAL COMMUNITY USE: Is the reference level also the lowest floor under the community's floodplain management ordinances? ❑YES NO If NO the elevation of the lowest floor is feet NGVD. FEW FORM e+-31(10187) 593-117 (6/87) ee: yov WK �c'm i "'� c•�,/� f74VM5- I2 fI m M a� 0 y as, l9 SOV � �� as � \ \ �• $ �F�e a 2 V O co oP _ v t S by4 it IL d¢ .: w z, -�, .� �` ��n x - 6.k' � n 'a st �, Y; �'s�-�-.,F- +,� ',�' '"'�,. .' �_ f�`"�•nt.w,Ti,.�:,: PAYABLE 1991 DIVISION # 91 COVER SHEET Division Type: COMBINATION Document Type: REQUEST Date of Transfer: 03/06/90 City: CITY OF FRIDLEY THE FOLLOWING PARCEL(S) ARE NOW OUT: PIN KEY 528218 R04-30-24-14-0019 528227 4� � 1 Maps/mylars proofed 41 Generated on 01/10/91 Proofed by JMS on 11/02/90 Written by JR on 11/02/90 To Assessor Chained? Chained? ____ DIANE'S Page 3 REQUEST FOR VALUES Div. # 1991- 91 Parcel A CITY OF FRIDLEY 04-30-24-14- OO of S LEVY: KEY 111q0'77 PARENT KEYS: 528218 528227 Notes: LEGAL: Subdivision 57593 Lot/Unit 28 Block/Tract R More RIVER VIEW HEIGHTS LOTS 28 & 29 BLK R RIVERVIEW HEIGHTS, SUBJ TO ACREAGE: 0.00 EASE OF REC PCA: STC: Com. AREA: INC: AgPres: AgCred: EXM: LAND: I ZY00 IMPR : TOTAL: a GREEN ACRE LAND USE: ,ITY. QF FRIDLEY INSPECTION DIV. Effective April 1, 2004 431 University Ave NE `ndley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 763) 572-3604, FAX (763) 571-1287 MARK NUMBER OF FIXTURES TO BE INSTAI 1 Fn nN FArM FI nnR t�. n1F)1V1�c l c 2 'LUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_ 6C1110A.¢. O -W Il M dew Fixtures $10.00 Unna $10.00 h e $10.00 Tray == C:a:Wash Floor I...:.::>:>::. Drain . �: Auto. W asher `:' <> Gas Range Water Heater =:;"`'=:>= Gas Ele Stories t e....:.....::::<..-... Sump/Receiving Tank nt Basement Nater Treating Appliance $35.00 Nater Heater -Electric $35.00 Nater Heater - Gas** _ $35.00 3as Range** $10.00 3as Dryer** $10.00 Floor () No Type $15.00 Floor 2XX Floor 3 Floor 4 n1F)1V1�c l c 2 'LUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS_ 6C1110A.¢. O -W Il M dew Fixtures $10.00 )Id Opening, New Fixture $10.00 leer Dispenser $10.00 3low Off Basin $10.00 ;atch Basin $10.00 lain Water Leader $10.00 Sump/Receiving Tank $10.00 Nater Treating Appliance $35.00 Nater Heater -Electric $35.00 Nater Heater - Gas** _ $35.00 3as Range** $10.00 3as Dryer** $10.00 3ack Flow Preventer Required ( )Yes () No Type $15.00 reinspection Fee $50.00/Hr %LL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL FEE $ .6b 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 repres-6-1--..- -'-,--A :^ .,,:� ^�;��*:^^ ,moo t�„o and correct. BECKMAN, R.J. 8181 RIVERVIEW TERRACE NE y__0 20 ®q FRIDLEY, MN 55432 (763)717-2328 OWNER _ BUILDING USED AS II< e S1 je411G1 ESTIMATED COST qo o oto PERMIT NO. PLUMBING COMPANY O 4_\0` a'VWl SIGNED BY TEL N0.1C�12J��%�Q� Approved By Rough -In Date Final Date 7/ MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST $ �S OF THE IMPROVEMENT WHICHEVER IS GREATER PLUS THE SURCHARGE. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. **PROVIDE COMMON VENT INFO ON BACK SIDE FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, 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 (n) 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 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 JFAX: (763) 571-1287 PERMIT NO.-. 2004-00787 DATE ISSUED: 05/27/2004 ADDRESS : 8181 RIVERVIEW TERRACE NE PIN : 043024140021 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 400.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL GAS WATER HEATER STATE SURCHARGE, PLBG FLAT # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0 # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS I # GAS DRYERS 0 # GAS RANGES 0 # OF NEW FIXTURES 0 # WATER TRMT APPLIANCES 0 APPLICANT NORBLOM PLUMBING CO 2905 GARFIELD AVE S MINNEAPOLIS, MN 55408-2173 (612)827-4033 BECKMEN RICHARD J & SOLVEIG M 8181 RIVERVIEW TER NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulatin*ccons ction or the performance of construction. ADbll ani t Date t uP ` ..; 00 PLBG PERMIT MINIMUM FEE 0.00 PLBG FIXTURES (NEW OPENINGS) 0.00 PLBG FIXTURES (EXIST OPENINGS) 0.00 WATER TREATMENT APPLIANCE 0.00 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 PLBG REPAIR/ALTERATIONS 0.00 STATE SURCHARGE, PLBG FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 28318 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. I CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 k'AX: (763) 571-1287 ADDRESS : 8181 RIVERVIEW TERRACE NE PIN : 043024140021 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERMIT NO.: 2004-01678 DATE ISSUED: 09/27/2004 VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL FURNACE. # 0-100 AMP CIRCUITS I APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304 - OWNER BECKMEN RICHARD J & SOLVEIG M 8181 RIVERVIEW TER NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date ELEC CIRCUIT FEE (0-100 AMPS) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 6067 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY BUILDING INSPECTION Effective 4/1/2004 v 9 3431 University Ave NE APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION 9 =ridley, MN 55432 L REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 763-5723604 FAX 763-571-1287 JOB ADDRESS D RATE SCHEDULE Total Residential Owner Furnace Shell and Duct Work, Burner & $ Building Used Ash<c�erc+� also Replacement Furnace $35.00 _35,00 Pi in New Furnace, Fireplace, insert) $10.00 $ Gas g( P ESTIMATED COST 3� O O • M PERMIT NO � �d _ � '_9 4 Gas Range $10.00 $ DESCRIPTION OF FURNACE AND BURNER Gas Dryer $10.00 $ if of Heating nits Circle One (Steam) (Hot Water (Warm Air) Trade Name�g-r- % e,r J$1l V P bQ c7 Size No. *Air Conditioning -All Sizes $25.00 $ BTU (,20 , ® ®O HP EDR Fuel . S Total Connected Load All Other Repairs or Alterations (List on Back) Size No. r 1% of Value of Appliance or Worcs $ Burner Trade Name A Minimum Fee $15.00 for Residential or 5% of cost of BTU HP EDR Y .Improvement whichever is greater on work less than $300.00 The undersigned hereby makes application for a permit for the work herein ComrnercieyfndustrialJlnstitutionat specified agreeing to do all work in strict accordance with the City Codes t 1.25% of Value of Appliance or Work (List on Back) $ and rulings of the Building division, and hereby declares that all the facts Minimum Fee $35.00 for Commercial/industriaVinstitutionai and representations stated in this application are true and correct. CENTERPOINT ENERGY MINNEGASCO Y State Surcharge $__.t.50 HEATING CO 13562 CENTRAL AVE NE BLAINE, MN 55304 J_ TOTAL FEE $3-2,s G TOTAL# 763-757-6202 Signed v Oda ,O r REINSPECTION FEE $50.00/HOUR FAX # 763-757-670 Date a m*Air Conditioners can not be placed in side yard without written approval i+ from adjoining property owner - copy to City N FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE Approved by Rough -in Date Final Date Z0, d 1d101 FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furnace, 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 (X) No( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (y) 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 ()o 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 l) No( ) When installing a new venting MMte_m, 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 1 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 L _ BTU input Fan Assisted or Nat Appliance #2 Type BTU Input o® Fan Assisted or Nat h2 At Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input 9S.o� Common Vent Type Vent Height ?� Diameter inches Appliance 91 Vent Connector Height ft Length—IS, ft Diameter " in Type Pqu Appliance #2 Vent Connector Height ' ft Length_2L_ft .Diameter toy in Type Appliance 93 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) CENTERPOINT ENERGY MINNEGASCO HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304 Signed By: Date: c' • g of 4 ;7A/?G1 1 A TRJAI.SL 01 Kl 11G 1 NA A0 ,1110 WON -4 SF : T T b6BZ-L2-Nr4b `'. s CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRMLEY, MN 55432 572-3604 r'AX: (763) 571-1287 ADDRESS : 8181 RIVERVIEW TERRACE NE PIN : 043024140021 LEGAL DESC : UNAVAILABLE : LOT BLOCK PERMIT TYPE : HEATING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION PERM O.: 2004-01677 DATE ISSUED: 09/27/2004 VALUATION NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. INSTALL FURNACE (WARM AIR, CARRIER, 60,000 BTUS). # A/C UNITS 0 VALUE OF APPL OR WORK 0 # FURNACES 1 # GAS DRYERS 0 # GAS RANGES 0 VALUE (FOR MINIMUM CALC) 3700 APPLICANT CENTERPOINT ENERGY/MINNEGASCO 13562 CENTRAL AVE NE ANOKA, MN 55304- BECKMEN RICHARD J & SOLVEIG M 8181 RIVERVIEW TER NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wort will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating constAl ion or the performance of construction. AnnI Date Bldg Insp HEATING PERMIT MINIMUM FEE 0.00 FURNACE SHELL/DUCT WORK 35.00 GAS RANGE FEE 0.00 GAS DRYER FEE 0.00 AIR CONDITIONING FEE 0.00 HEATING REPAIRS/ALTERATIONS 0.00 STATE SURCHARGE, MECH FLAT 0.50 TOTAL 35.50 PAID WITH CHECK # 6067 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received B� 0 763-572-3604 CITY OF FRIDLEY Dat 763-502-4977 FAX EFFECTIVE 1-1-08 DATEv�® YOUR E-MAIL ADDRESS — SITE ADDRESS 9 V"5 "Ld THIS APPLICANT IS: O OWNER CONTRACTOR I PROPERTY NAME: CfAJ OWNER/ ADDRESS: TENANT PHONE: '16 `' 3 t/ 3 q_ S G G S CONTRACTOR lyA SUBMIT A COPY OF EXP DATE YOUR STATE sT, Terry Overacker Plumbing, Inc. EXP DATE LICENSE, BOND AND STo 502 E Main Street CITY STATE ZIP CERTIFICATE OF AD Anoka, MN 553033 15'14 INSURANCE PH( FAX. PERMIT TYPE `)1 SINGLE FAMILY 0 TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: L NEW L3 -REPLACEMENT DETAILED DESCRIPTION OF WORK PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00; whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This shcould reflect only the cos.05 plus o surcharge abor Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10000 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE $15.50. SHOWER _ WATER PIPING _ BATH SINKILAV _FLOOR DRAINS — SWIMMING POOL _ WATER SOFTNER ($35) —BATHTUB _ GAS PIPING (NEED CITY LIC) — WATER CLOSET _ BACKFLOW PREY. ($15) _CLOTHES WASHER _ KITCHEN SINK R HEATER ($35) FOR IRRIGATION _ DISHWASHER _ LAUNDRY TRAY �WATEWATER METER OTHER �j ., .: .. Permit Fee $ 3 � Number of fixtures @ $10.00 x $10.00 = Surchar a .50 Number of fixtures @ $15.00 x $15.00 = TOTAL DUE $ OR Number of fixtures @ $35.00 x Surcharge = State SuI'charge = (MINIMUM $15.50) 3 5 -5 0 (MINIMUM $15.50) Total = $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 l 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. r� FL �� SIGNATURE OF APPLICANT PRMTNAME Jot ICI DATE DATE APPROVED BY City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 ing PLUMBING Permit No. • � 5 , ctions RESIDENTIAL APPLICATION Received F763-572-3604 By: 763-502-4977 FAX CITY OF FRIDLEY - reiVu EFFECTIVE 2-19-09 DATE J�`'IZ" YOUR E- ADDRESS e!O Ci. [� it/ ►Q q pyo • +� K,�, SITE ADDRESS '�� THIS APPLICANT IS: 0 OWNER VCONTRACTOR PROPERTY NAME: OWNER/ TENANT ADDRESS: -i CITY 41N&Y STATE 5 PHONE: CONTRACTOR NAME: IFAJ& - N SUBMIT A COPY OF YOUR STATE STATE LICENSE # ��g59 f��p/1 EXP DATE LICENSE, BOND AND STATE BOND # (&3OL1 EXP DATE CERTIFICAINSURTE OF NCE ADDRESS:J,2,2 /2Nb /�fW OTTy STATE ZII' — 3AT PHONE 3 1 2A� FAX 7*3 -gy p-3�OG9 PERMIT TYPE GLE FAMILY 0 TWO FAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW REPLACEMENT Ile DETAILED DESCRIPTION OF WORK/II� V - - 2te�rl;4' of FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). M IIMUM FEE $35.50. _ BATH SINK/LAV FLOOR DRAINS _ SHOWER ,BATHTUB — GAS PIPING (NEED CITY LIC) _ SWIMIVIING POOL — PIPING WATER WATER POFNG ($35) — CLOTHES WASHER _ KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) —DISHWASHER —LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION WATER METER OTHER Number of fixtures @ $10.00 Z x $10.00 = $ .20� Number of fixtures @ $15.00 'x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ State Surcharge $ .50 c $35.50 Total = $ 3/ 1•�d THIS IS AN APPLICATION FOR A PERMrr NOT VALID UNTIL PROCESSED I hereby apply for a plumbing 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 ll wor which requires review and approvalof plans. alall Q SIGNATURE OF APPLICANT PRINT NAME&g!(i f7�i e DATE Jam ! PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building BUILDING permit No; -20 Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY DATE w I ,� YOUR E-MAIL ADDRESS 150. t7f✓J ,,� C p C SITEADDRESS RAAn THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: Pl,(-S-1 LA It f'"n ADDRESS: n CITY STATE—ZIP— TATEZIPPHONE: TENANT TkO5 ® ``3 — PHONE: NAME: Renewal By Andersen CONTRACTOR SUBMIT A COPY OF STATE LICENSE # 1920 County Road "C" West ^ YOUR STATE LICENSE ADDRESS: Roseville, MN 55113 r STATE ZIP WITH APPLICATION PHONE License #20130983 ❑ SINGLE FAMILY/NEI 651-264-4777 PROPERTY TYPE 13 TWO FAMILYINEW C - ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS PERMIT TYPE ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING , S &CS �; r%"5b � II DESCRIBE WORK BEING DONE:t 'U L�viY�(M�� SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft.�p ROOFING ❑ HOUSE ONLY REM LING SUBMIT NUMBER OF SQUARES 13 HOUSE & GARAGE BASEMENT 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 ❑ Vinyl ❑ Aluminum ❑Soffit ❑ Trim ADDITIONS 1. & PORCHES SUBMIT• Site Phm/Survey showing the existing structure ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS. (USING THE 1997 U.B.0 FEE SCHEDULE) )TAL JOB VALU) Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 per SAC Unit (Plans to MWCC for determination) ft+6ft= 6x$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable 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 conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approve plan in the case of all work wMch re quires r v w and approval of plans. r SIGNATURE OF APPLICANT S RINT NAME t{+^ a _IDSA tti7 DATE