PRE 2010 DOCSU
C3 tui n aty testinq
corporation
.O.t YC p4 i
662 CROMWELL AVENUE
g ST. PAUL, MN 55114
PHONE 612/645-3601
REPORT OF: Soil Compaction Tests
PROJECT: RESIDENCE
7108 RIVERWOOD GATE: August 25, 1986
REPORTED TO: FRIDLEY, MINNESOTA
McMullen-Mozelle COPIES TO: City of Fridley
430 Industrial Blvd
Mpls, MN 55413 _ -If .
LABORATORY No. 4132 86-1304
INTRODUCTION
This report concerns the compaction testing we performed for the Residencet 7108 Ri erwood
in Fridley, Minnesota. Happy Mozelle of McMullen-Mozelle authorized this ork on Au st 25,
1986.
SCOPE OF WORK
The scope of our recent work consisted of the following activities:
1. Performance of the soil compaction tests as requested by Happy Mozelle.
2. Determination of the moisture -density relationship for each type of"soil encountered
in our compaction tests.
3. Comparison of the test results to the compaction levels required by project
specifications.
TEST METHODS AND RESULTS
Details of our recent testing are included on the attached data sheets. The compaction
tests and moisture -density determinations were performed in general accordance with the ASTM
procedures indicated on the data sheets.
Review of the test results indicates compaction meets project specifications in the area of
test #2, but is below specification in the area of test #1.
REMARKS
The samples from the individual compaction tests have been discarded. A representative
sample of each of the soils on which moisture -density relationships were determined will be
retained at our laboratory until November 1986.
16 - / Atoo 04.0* ltw
AS A MUTUAL PROTECTION TO CL16NT 3 THE PUBLIC AND OURSELVES, ALL REPORTS ARE BUBMITTHO AB TME CONFIDENTIAL PROPERTY OF CLIENTS, AND AUTHORI-
ZATION FOR PUBLICATION OF STATEMENTS, CONCLUSIONS OR EXTRACTS PROM OR REGAROINS OUR REPORTS 18 RESERVED PENDING OUR WRITTEN APPROVAL-
Twin
PPROVALTwin City Tqsting Corporatio
By V=�
4
REPORT OF:
RESIDENCE
PROJECT: 7108 RIVERWOOD
FRIDLEY, MINNESOTA
REPORTED TO: McMullen-Mozelle
430 Industrial Blvd
Mpls, MN 55413
LABORATORY No. 4132 86-1304
twin city testlnq
cimocvat3o 7 662 CROMWELL AVENUE
ST. PAUL, MN 55114
PHONE 612/645-3601
DENSITY TESTS OF COMPACTED FILL
TEST NUMBER:
1
DATE TAKEN:
8-25-86
UNIFIED SOIL CLASSIFICATION:
Sand with
(Moisture -Density Sample Number)
silt and
gravel, fine
grained, brown
`
(SP -SM) -1
LOCATION: 3'S & 20'W
of NE corner
of house
DEPTH BELOW FOOTING GRADE: 1.5'
DEPTH BELOW EXISTING GRADE: 1.5'
FIELD DENSITY DETERMINATION:
DATE: August 25, 1986
COPIESTO: 1- City of Fridley
2
8-25-86
Sand with
silt and
gravel, fine
grained, brown
(SP -SM) -1
1.5'N & 20'W
of NE corner
of house
.5'
.5'
Method Density in Place by Sand -Cone Method, ASTM:D1556-82 (44 Basis)
Dry Density (pcf) 105 110.5
Moisture Content (%) 7.5 7.5
Plus #4 Material (%) 2 1
LABORATORY MOISTURE -DENSITY RELATION OF SOIL:
Method ASTM:D698-78, Method "A", (44 Basis)
Maximum Dry Density (pcf) 113.0 113.0
Optimum Moisture (%) 11.1 11.1
COMPACTION TEST RESULTS:
Compaction (°k) 93 98
Specified Compaction (%) 95 95
ATTENTION: Density tests are valid at the location and elevation of the test only. No representation is made as to
the adequacy of fill and compaction at locations and elevations other than those tested. These
tests were performed by John Seikmeier and Terry Metz.
AS A MUTUAL PROTECTION TO CLIENTS, THE PUBLIC, AND OURSELVES, ALL REPORTS ARE SUBMITTED AS THE CONFIDENTIAL PROPERTY OF CLIENTS AND AUTHORI-
ZATION FOR PUBLICATION OF STATEMENTS, CONCLUSIONS OR EXTRACTS FROM OR REGARDING OUR REPORTS IS RESERVED PENDING OUR WRITTEN APPROVAL.
Twin City T g Corporations
Ski -225 (6/85)
13 twin c1ty test1nq
COrpordtion 662 CROMWELL AVENUE
G �.iM71D/yD/b • ST. PAUL, MN 55114
+c' PHONE 612/645.3601
g
ESIDENCE MOISTURE -DENSITY CURVE sAmm No. 1
PROJECT: 7108 RIVERWOOD DATE: August 25, 1986
FRIDLfY, MINNESOTA
REPORTEDCOPIES TO: 1- City of Fridley
McMullen-Mozelle
.LABORATORY NO. 4132 86-1304
METHOD OF TEST: ASTM: D698-78, Method "A", (44 Basis)
TYPE OF MATERIAL: Sand with silt, fine grained, brown (SP -SM) -1
MAXIMUM DENSITY: 113.0 11b. /cu. ft. OPTIMUM MOISTURE 11.1 ok
114
11C
109
SG -232(2184)
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9 10 11 12 13 14
MOISTURE CONTENT
Twin City Testing and Engineering Laboratory, Inc.
By
SUBJECT
RMIT
City of Fridley
® 18633
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
REC
COMMUNITY DEVELOPMENT DIV.
r 1 PROTECTIVE INSPECTION SEC.
-7
1 �
1 i � CITY HALL FRIDLEY 55432
,.j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
9/8/86
JOB ADDRESS 7108 Riverwood Drive N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
] 1
2
Riverwood Park
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP PHONE
Wallen
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
McMullen/Moselle & Assoc. Inc. 430 Industrial Blvd.
Mpls 55413 378-3981
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO,
6 USE OF BUILDING
Residential
7 CLASS OF WORK
Ek NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 40= x 40' Dwelling and a 241 x 24" Garage
SEPARATE PERMITS REQ1:l1T?ED fO'R
9 CHANGE OF USE FROM 1
Nam
a
STIPULATIONS provide a hard surface driveway. Provide sod
in the front and side yards.
Provide City with.copy of verifying survey. Remove
all debris from rear of
excavation. Remove old french.drain structure from
southeast corner of
escavation. Submit energy calculations. Paid Park Fee of $1500.00
SEWER LOCATION: Approx. 10' SW of Water Service
WATER LOCATION: Locate in Field (culdesac street)
DRIVEWAY DEPRESSION: 161+61=22 x 13.50 = $297.00
WANING
Before digging CA .100M utilit'2-t
THE CITY OF FRIDLEY DOES NOT GUARANTEE THE
Ti:i.��HaNE �r�l�s�o
ACCURACY OF UTILITY_ LOCATIONS AND ELEVATIONS.
THIS DATA IS FOR INFORMATION PURPOSES ONLY,
REQUIRED BY LAW
AND PERSONS USING THIS INFORMATION SHOULD
VERIFY IT ON THE SITE,
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYP5OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SQ. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$85,500
$42.75
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-
$391.00
CREDIT FROM SCHOOL
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
7.75
$531.50 + DW & PF
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
W N PR PE VA ID ED THIS IS YOUR PERMIT
y
LDG 1NSP
/
TE
SIGNATURE OF OWNER IIF OWNER BUIL DER1 (DATE)
s
f
NEW City of Fridley Effective 4/1/86
ADDN. [ ] �R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: 7-zoa Q d d � `,` 1
Legal Description: c- ® /f ie Ice 2 V e e- 412'5"
Owner Name & Address: _UA 1 Tel. #
Contractor: � � de Tel. #
Address: Y3 _7-, V"' /��/��� - - -
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
YO' Height _ Sq. Ft.
GARAGE AREA: Length�f P Width__j/ Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [ ] Inside Lot [ Ft. Yd. Setback 5Side Yard Setback A -
Type of Construction:Estimated Cost: $
Approx. Completion Date:
Alt. A Alt -B
_'
Proposed Driveway Width If New Opening Is Desired: $ �o�$See Back Page for Explanation
DATE:
�® _ r� APPLICANT: Tel .
CITY USE ONLY
Permit Fee
$
��<<��_
Fee Schedule on Reverse Side
Plan Check
$
q), 7 S
25% of Building Permit Fee
State Surcharge
$
.�J
$.50/$1,000 Valuation
SAC Charge
$
$475 per SAC Unit
D-1, Fee
$
/'5-66-® ®
Fee Determined by Engineering
a
Sewer Dain Charge $ —�
® �� Agreement Necessary [ ] Not Necessary [ ]
TOTAL
� $ ®(
STIPULATIONS: '" 4 00
ice,aaa, ce
CITY OF FRIDLEY
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
RATE SCHEDULE
PLUMBING FIXTURE RATES:
Now Fixtures
Future Fixtures
Old opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
NO.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
Reinspection Fee $
($15.00)
RATE
$ 5.00
$ 3.50
$ 1.50
S 4.00
$ 5.00
$ 5.00
S 5.00
S 5.00
$ 5.00
$ 7.00
$ 5.00
$ 10.00
$ 10.00
State Surcharge
TOTAL FEE
TOTAL
s'35— 00
s--16,
S
Ettective Aug. 1, 19bi
Job Address I 0'X R /l!y^-P'�
Department of Buildings
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
Fridley, Mn. Il U , 1917D
KIND OF BUILDING � 0 -h7
USED AS 1) UV-eL' L) A/ 4
TO BE COMPLETED ABOUT
n 7�
1 V v )
ESTIMATED COSTyll U V b , -D - .
OLD NEW>OU'ING PERMIT NO. PERMIT NO. (p
company J C' '
Signed By V
Tel. No. 1/ �f L`
ROUGH INSP.
Date
FINAL INSP. l/ - /-/
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
a.
p
U
x
W
Water
0
In
�
°w
C a
m
G
�
p,
w
Heater
vu1d
b
tll
['
C
41
0�y
•
►4
ccS
N
u
a
pi
a�
'A
3i
o w
U,g
u
O
as
lec
let
v
1
2nd
3rd
4th
(R) Future Connection Opening
Connected with Sewer
(t) New Fixture, Old Opening
Water
RATE SCHEDULE
PLUMBING FIXTURE RATES:
Now Fixtures
Future Fixtures
Old opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Hydraulic Valve
Sump or Receiving Tank
Water Treating Appliance
Hot Water Heater
Gas Range
Gas Dryer
NO.
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
It of Value of Fixture or Appliance
Reinspection Fee $
($15.00)
RATE
$ 5.00
$ 3.50
$ 1.50
S 4.00
$ 5.00
$ 5.00
S 5.00
S 5.00
$ 5.00
$ 7.00
$ 5.00
$ 10.00
$ 10.00
State Surcharge
TOTAL FEE
TOTAL
s'35— 00
s--16,
S
Ettective Aug. 1, 19bi
Job Address I 0'X R /l!y^-P'�
Department of Buildings
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
Fridley, Mn. Il U , 1917D
KIND OF BUILDING � 0 -h7
USED AS 1) UV-eL' L) A/ 4
TO BE COMPLETED ABOUT
n 7�
1 V v )
ESTIMATED COSTyll U V b , -D - .
OLD NEW>OU'ING PERMIT NO. PERMIT NO. (p
company J C' '
Signed By V
Tel. No. 1/ �f L`
ROUGH INSP.
Date
FINAL INSP. l/ - /-/
Date
APPROVAL FOR PERMIT
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $10.00
PLUS THE $.50 STATE SURCHARGE
Effective Aug. Ir 1941
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
.RESIDENTIAL RATE
TOTAL
Job Address
Furnace Shell and Duct Work#
Burner (Also replacement furnace) S 20.00
$ 0�) �
Department of Buiidings, 6111 University Ave. N,t., Fridley, MN SSI32
City of Fridley
Gas Piping $ 10.00
$ _
Tel. 1571-3150
(Piping needed with net furnace)
Gas Range S 10.00
_
$
The undersigned hereby waked application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
Gas Dryer $ 10.00
S
and rulings of the Department of Buildings. and hereby declares that all the
facts and representations stated in this application are true and correct.
Minn.
• Air Conditioning (all sizes) $ 10.00
S
Fridley.
All Others/Repairs and Alterations
OWNIER
11 of Value of Appliance or Work
S
KIND OF BUILDING
COMMERCIAL/INDUSTRIAL
USED AS
It of Value of Appliance or Work
S
TD BE COMPLETED Asan
G �%
ESTIMATED COST
State Surcharge
$ .50
� O
OLD - Nk11 BUILDING PERMIT NO. PERMIT N0.
Reinspection Fee ($15.00)
S
DESCRIPTION or rU1WACE/BURNER
Rough Inap.
ANTSHEATING or POWER PL, Steen, Hot Nater. _ rn Alr No.
Date
� (g ^
Trade Name 111 size No.
Final Insp. 11 ,
�
Capacity �.�� Sq. Ft. EDA BTU NP
Approval for Permits ��%!
Total Connected load Kind of Fwl
BURNER - Trade Name Size No.
Capacity Sq. Ft. EDR BTU NP
MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00
Company !
PLUS $.50 STATE SURCIUIRGE
Signed By r
Attach stack verification rots with replacement furnace
permits
Tel. It).
*Air Conditioners can tint lir placed in %ids• yard without
written pvtnission from adloininq nrigl4vor.
CITY OF FRIDLEY PERMIT0.:
2004-01646
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 09/22/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 7108 RIVERWOOD DR NE
PIN : 103024420068
LEGAL DESC : RIVERWOOD PARK
: LOT 11 BLOCK 2
PERMIT TYPE : HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
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 GAS PIPING FOR FIREPLACE.
# A/C UNITS 0
VALUE OF APPL OR WORK
0
# FURNACES 0
# GAS DRYERS
0
# GAS RANGES 0
VALUE (FOR MINIMUM CALC)
0
APPLICANT
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
15.00
0.00
FIRESIDE HEARTH & HOME
225 COUNTY RD 81
GAS RANGE FEE
0.00
OSSEO, MN 55369
GAS DRYER FEE
0.00
AIR CONDITIONING FEE
0.00
HEATING REPAIRS/ALTERATIONS
0.00
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 607825
0.50
15.50
OWNER
LARSON MICHAEL L & LORI M
7108 RIVERWOOD DR 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 work
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 o y other state or local law
regulating construction or thep orm ce of construction.
Applicant Date
Bldg Insp Da:;
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
.-CITY•OF•FRIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-571-1287
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS '7 16 9 le►Verwcy"6` EN r
Fee Total
Owner o ke L e.r son
$35.00 $ Building Used As RD'S%c`enc'e
$10.00 $ ESTIMATED COST PERMIT NO 45RO04 ' 01(e l
$10.00 $
DESCRIPTION OF FURNACE AND BURNER
Gas Dryer $10.00
$
# of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name 0�4 h &/C7 Size No.
*Air Conditioning -All Sizes $25.00
$
BTU 01 HP EDR
Fuel Total Connected Load
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
$
Burner Trade Name Size No.
Minimum Fee $15.00 for Residential or 5% of cost of
BTU HP EDR
Improvement whichever is greater
The undersigned hereby makes application for a permit for the work herein
Commercial/Industrial/Institutional
specified agreeing to do all work in strict accordance with the City Codes
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/Industrial/Institutional
and representations stated in this qWipaw are true and correct.
dba FUeslde Headh & Home
Ltem#20MII
State Surcharge
$
HEATING CO 2700 N. Fairview Ave
Roseville, MN 55113
651!633.2561
TOTAL FEE
$ 1 S�
Signedr Tel #
REINSPECTION FEE $50.00/HOUR
FAX # Date a///,,/ Le l'
Mod Ftrestds
*Air Conditioners can not be placed in side yard without written approval
dWHft'ti'&HO1*
ReSWO
tense #20090811
from adjoining property owner - copy to City
2700 N. Fairview Ave
RosevM, MN 55113
651/633-2561
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
Approved by Rough -in Date Final Date
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 () No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No( )
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes () No( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input Fan Assisted or Nat
Appliance #2 Type
BTU Input Fan Assisted or Nat
Appliance #3 Type
BTU Input Fan Assisted or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe) /ns �� I s l r��/a�� �`�s e,r
AMW�F �f,B Ham
27W It FWMew Ave.
HEATING CO: p,�„me MN 55113
Signed By: �r�.�..��,i Date:
Building
$
BUILDING
Plan Review
$
Permit No.: e /
Inspections
$
RESIDENTIAL APPLICATION
Fire Surcharge
Received By:
763-572-3604
License Surcharge
CITY OF FRIDLEY
: .00 $5.00 (State Licensed Residential Contractors)
SAC Charge
Date Rec'd:
DATE .2— 1 ®S
YOUR E-MAIL ADDRESS
$
ft + 6 ft = ft x $20 = $
SITE ADDRESS Ri i 6PA_-'-C ® ® 1::) 0 --
$
$450 Conservation Plan Review
THIS APPLICANT IS:
❑ OWNER CONTRACTOR
Fee Determined by Engineering
Sewer Main Charge
PROPERTY OWNER/
NAME: IUL6, LOei S®n!
$
Make checks payable to: Citv of Fridlev Attach Stipulations
TENANT
ADDRESS: °7 rQ s R i 1I Get wWo 'Oyz. - CITY
STATF&riJLIP Z
PHONE: 2 ig i — s 71 — 5 g 12
CONTRACTOR
NAME: .%,tet f S
STATE LICENSE # 2D 1 Gp & Ct 3 EXP DATE
-
®5
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: m Sar.
CITY
`u fes— sTATAJziP.S5330
WITH APPLICATION
PHONE •- Z- ra FAX 74 3 & — 6(4
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ O FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED
OWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK IDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
I ❑ NEW 13,ADDITION
❑ MAINTENANCE/REPAIR REMODELING
DESCRIBE WORK BEING DONE: ca.J S t I N g vj w oe w1
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING
❑ HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2•
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
FOR NEW
CONSTRUCTION INCLUDING DECKS,
inyl
Soffit
ADDITIONS. & PORCHES SUBMIT:
Aluminum
rim
1.
Site Plan/Survey showing the existing structures
❑ Other
ascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS es ON, LOCATION OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS ESCRIBE
SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
V.Y-14 NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 1 '4 ' b ® ® — OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Surcharge
$
- ® ® (.0005) times the total job valuation — Minimum $.50
Fire Surcharge
$
.001 x Permit Valuation (1/10%)
License Surcharge
$
: .00 $5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $20 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$ y .Agreement necessary( ) Non Necessary( )
Total Due
$
Make checks payable to: Citv of Fridlev Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application f r�ad work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work ichew and approval of plans. _-_r^
SIGNATURE OF APPLICANT PRINT NAME 1 O Q Z 4;�?mT_ DATE . Z