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PRE 2010 DOCSSUBJECT PE City of Fridley 201.25 P, AT THE TOP OF THE TWINS BUILDING PERMIT Ir RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. D 3 f/ 1 � � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 9/22/89 JOB ADDRESS 7110 Riverwood Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 2 Riverwood Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ken & Barb Tigue 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D.E. Selger Construction 13224 Kenyon Street N.E., Blaine 755-0777 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 CNEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 484-x 241. Dwelling, a 241.x 24" Garage; g_121 x 14" Deck 'SEPARATE PERMITS REQUIRED FOR 9 CHANGE OF USE FROM WIRING,TMEATING, PLUMBING AND SIGN& STIPULATIONS Front yard variance approved by City Council on 9/11/89. Minimum elevation of'856,50 dor walkout, Provide sod in the front and side yards. Provide. City with copy of verifying survey .before capping. Provide a hardsurfa driveway, Paid $1,50.0.00 Park Fee. DRIVEWAY ESCROW; 161 + 61 = 221.x $13.5.0 = 297.00. WATER LOCATION; Ep e SEWER LOCATICN;- - - 5' East from Sewer Lo 'Before digging call for all utility locations THE CITY OF FRIDLEY DOES NOT GUARANTEETME 454-0002 ACCURACY OF UTILITY LOCATIONS AND ELEVATIONS. REQU 0 R�® �YLAU�l THIS DATA IS FOR INFORMATION PURPOSES ONLY AND PERSONS USING THIS INFORMATION SHOUE VERIFY IT ON THE SITE. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF 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 $g4, 450 $42.23 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- $572.00 Credit from SChO STRU E F CONSTRUCTION. �ORTHEFORMAN 1 LZ rf PLAN CHECK FEE N/A TOTAL FEE $614.23 + DW & PF SIGNATURE OF CONTRACTOR OR AU RIZED AGENT IDA ESE) WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT •l BLDG INSP PATE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI ADM ALTER R-1 AND R-2 Building Permit Application Effective 5/1/88 construction Address: -7/ — IL 116 Veen- v ger Iagal -iPticn: 4o t le, 72 - Owner Name & Address:I IV) 0- b6A U -V- -LL Tel - # ,�-71 tOO,�-' Contractor: IFL-'v Tel - 7f3 Address: Attach to this application, a Certificate of Survey of the lot, with the PrqPOSW cOnStrUCticn drawn on it to scale. LTVMG AM: Iangth 4/cy) — Width Height Sq. Ft. GULAM, AMM: length d, LK' Width Height Sq. Ft - U= AREA: Width Hgt/Ground Sq. Ft. 07HER: t Corner Lot Inside Lot Ft. Yd Setback 3 o Side Yard Setbacks 7YPe of Construction: Estinated Cost: $ Approx. Ompletion Date: I'Vgv 2 Ie7 Tq, qSO Proposed Driveway Width If New Opening Is Desired. Ft T 7- Width + 61 See Back Page MM: V/ APPLICANT: 17 -a--- Tel. 61 Permit Fee $. s7L State Surcharge $ ,SAC Charge!a-�L, $ -Cy �, Driveway Escrow $ ✓ Park Fee $ 15CO Sewer Main Charge $ = M ONLY Fee- Schedule on Reverse Side $.50/$l, Goo Valuation $575 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering rn Necessary [ ] Not Necessary rAl , 4. Tutu. 6!5-rA.!SO WA 0 Ur. e FRIDLEY CITY COUNCIL MEETING OF SEPTEMBER 11, 1989 PAGE 11 MOTION by Councilman Fitzpatrick to adopt Resolution No. 78-1989. Seconded by Councilman Schneider. Upon a voice vote, all voting aye, Mayor Nee declared the motion carried unanimously. 14. CONSIDERATION OF RECEIVING THE MINUTES OF THE PLANNING COMMISSION MEETING OF AUGUST 30, 1989: A. ITEM FROM THE APPEALS COMMISSION MEETING MINUTES OF AUGUST 22, 1989: A-1. CONSIDERATION OF A VARIANCE_ VAR #89-16. TO REDUCE THE FRONT YARD SETBACK FROM 35 FEET TO 30 FEET TO ALLOW THE CONSTRUCTION OF A NEW HOME ON LOT 10 BLOCK 2 RIVERWOOD PARK THE SAME BEING 7110 RIVERWOOD DRIVE N.E., BY KENNETH A. TIGUE: Mr. Robertson, Community Development Director, stated this is a request for a variance to reduce the front yard setback from 35 to 30 feet to allow the construction of a new home at 7110 Riverwood Drive N.E. He stated the petitioner, Mr. Tigue, is proposing to construct a 1,220 square foot single family home. Mr. Robertson stated when the street was platted, the right-of-way for the corner had a "bubble" in it. He stated if the 35 foot setback is maintained, on one corner of the garage, would be encroaching approximately five feet. He stated in looking at the plat map, the 30 foot setback is equal to the 35 foot setback on adjacent lots due to the "bubble" in the corner of the street. Mr. Robertson reviewed alternatives which the petitioner could consider which would allow him to construct the home without encroaching into the front yard setback. He stated the city could vacate five feet of the drainage and utility easement across the rear of the yard; vacate the easement only where the house would encroach into the easement; or build over the easement with a letter of indemnification to the City which would be recorded against the property. He stated the petitioner could also reduce the size of the home or build a two story home. Mr. Robertson stated staff recommended denial of this variance due to the various alternatives available to the petitioner, however, the Appeals Commission recommended approval by a 3 to 1 vote. Councilman Fitzpatrick stated this variance would not affect the line -of -sight for this home or the homes on either side of this lot. He stated the actual encroachment into the 35 foot setback is only on the corner of the building. MOTION by Councilman Fitzpatrick to concur with the recommendation of the Appeals Commission and grant variance, VAR #89-16, to reduce 1 ,0. FRIDLEY CITY COUNCIL MEETING OF SEPTEMBER 11, 1989 PAGE 12 the front yard setback from 35 to 30 feet at 7110 Riverwood Drive. Seconded by Councilman Billings. Upon a voice vote, all voting aye, Mayor Nee declared the motion carried unanimously. MOTION by Councilwoman Jorgenson to receive the minutes of the Planning Commission Meeting of August 30, 1989. Seconded by Councilman Schneider. Upon a voice vote, all voting aye, Mayor Nee declared the motion carried unanimously. 15. CONSIDERATION OF ENTERING INTO AN AGREEMENT WITH BRUCE A. LEISCH TO CONDUCT A WATER SOURCE STUDY: Mr. Flora, Public Works Director, stated Bruce A. Leisch,and Associates has submitted a proposal to complete a water quality study for the shallow wells. He stated this agreement calls for completing the study in three months at a cost not to exceed $15,991. He stated the study will consist of assembling ground water information associated with the Fridley area and attempt to determine the source, quantities, and impact of trichlorethylene found in the Mount Simon aquifer within the Commons Park area. MOTION by Councilman Schneider to authorize the Mayor and City Manager to enter into this agreement with Bruce A. Leisch and Associates. Seconded by Councilwoman Jorgenson. Upon a voice vote, all voting aye, Mayor Nee declared the motion carried unanimously. 16. This item was deleted from the agenda. 17. CONSIDERATION OF CHANGE ORDER NO. 12 TO FRIDLEY MUNICIPAL CENTER IMPROVEMENT PROJECT NO. 189: Mr. Flora, Public Works Director, stated this change order consists of 3 Proposals Requests and 8 Work Orders for the Municipal Center totaling $10,068 and 2 Work Orders for the ramp totaling $1,870. He stated it also includes the following: 1 Proposal Request for the Fire Department for $1,195; change in a Proposal Request #53 for the Compressor Room which is a deduction of $4,167; amendment of Proposal Request #19 for the east stairwell of the ramp to add a cost of $2,242; a contract amendment for Glewwe Doors, Inc. for additional hardware $1,666 and Guillaume and Associates for additional finishing work $4,740 which was deducted in Change Order No. 10 from Country Cabinets, Inc. MOTION by Councilman Schneider to authorize Change Order No. 12 to the Municipal Center Improvement Project No. 189. Seconded by Councilwoman Jorgenson. Upon a voice vote, all voting aye, Mayor Nee declared the motion carried unanimously. CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND ' AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE 7//D RESIDENTIAL IRATE TOTAL Job Address Furnace Shell and Duct Work, Burner (Also replacement furnace) $ 20.00 $ ';A 1,0 Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 City of Fridley Gas Piping $ 10.00 $ 140,990. Tel. #571-3450 (piping needed with new furnace) Gas Range $ 10.00 $ 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 Gas Dryer $ 14.00 $ and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. * Air Conditioning (all sizes) $ 10.00 $ /0.00 Fridley, Minn. 004 /, 19 � q All Others/Repairs and Alterations OWNER 4:�pj q�+i /i S i p 1 - e9 10 li of Value of Appliance or Work S KIND OF BUILDING �!„ r✓ 7 COMMERCIAL/INDUSTRIAL USED AS .LL L, A)6, 1% of Value of Appliance or Work S TO BE COMPLETED ABOUT ESTIMATED COST State Surcharge S .50 NO. lO�L/S TOTAL FEE$ 0 , � D OLD - NEW UILDING PERMIT NO. PERMIT Reinspection Fee ($15.00) S J �� DESCRIPTION OF FURNACE/BURNER Rough Insp. / ?s `�- �--/��a` '' HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Date / j� 0 3-1--00 ade Name �5 �itltJ Size No. Final Insp. L Date r o �C Capacity Sq. Ft. EDR BTU 4,?0A HP Approval for Permit Total Connected Load Kind of Fuel /�IiCoQ. BURNER - Trade Name r —�Lw–�Lm- Capacity Spp�� NP MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00 Company dJ� / e �A� L' PLUS $.50 STATE SURCHARGE Signed By Tel. No. *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION 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 connected Yes ( ) No 6. Has Total heating BTU's of All other BTU's TOTAL Remarks Company Signed By Da to CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE m New Fixtures r 0 p, m Future Fixtures $ 3.50 v Old Opening, New Fixture % w $ Water ut M N m m Blow Off Basin $ 5.00 Sad H 0 W l� $ V ctl p, w bg' Hydraulic Valve Heater •.a+ $4 $ Sump or Receiving Tank 0 m Water Treating Appliance lCH�r V Ol $ .a a a0i a $ a' H $ 10.00 $ Gas Dryer Wy $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type pH $ 10 1% of Value of Fixture or Appliance a U State Surcharge y 3 A W [i! W ($15.00) 3 FEE $SS's% o as lec cit PO Frq tai PO 0 I � 1st �. 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures r 0 $ 5.00 v� $ �C)- 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 $ Water Treating Appliance $ 7.00 $ Hot Water Heater $ 5.00 $ Gas Range $ 10.00 $ Gas Dryer $ 10.00 $ Back Flow Preventer Required. . . Yes ( ) No ( ) Type $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance $ State Surcharge $ .50 Reinspection Fee $ ($15.00) TOTAL FEE $SS's% Effective Date May 1, 1988 Job Address L g t L)e tr, o 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. % 0 -10 , 19 OWNER VD P -�>- e L 'Q 'el C— n"' , 5 'r, KIND OF BUILDING P<n L--.) USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By Tel. No. ROUGH INSP. Date FINAL INSP. //—/I I Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450 November 17, 19.89 D.E. Selger• Construction 13224 Kenyon Street N.E. Blaine, M 55434 Re: Final Inspection at 7110 Riverwood Drive N.E., Fridley Dear Sirs: The final inspection was. conducted on November 16, 1889 of the above address and the following items were noted which.wus.t be completed before the house/ garage can be finaled: 1. Provide sod in the front and side yards. 2. Provide a hardsurfaced driveway. 3. Provide permanent garage steps, 4. Provide permanent deck footings and posts. We will expect items #1, #2 and #4 to be completed by June 1, 199.0 and item #3 to be completed by November 27, 1989. If you have any questions on these items, please contact me at 571-3450. The structure is approved for occupancy. Sincerely, DARREL G. CLARK Chief Building Official DGC/mh d 7 SUBJECTIT NO. City of Fridley 30110 AT THE TOP OF THE TWINS I I I L n I N G BUILDING P E R M I T t ® v („/ 1` 1 RECEIPT NO. - COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. NUMBER REv DATE PAGE O: APPROVED By CITY HALL FRIDLEY 55432 L J\ 612-571-3450 910-F15 JOB ADDRESS 7110 Riverwood Drive NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 2 lRiverwood Park SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ken Tigue 571-6102 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Reroof America Corp. 9508 Lyndale Ave S Bloomington 55420 888-8440 20141410 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ®X REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (29 S Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF 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 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 $2535 $1.27 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 PER AN CONSTRUCTION $83.25 Fir SC $2.54 PLAN CHECK F E TOT FEE i Licen S $5A 2.06 SIG TU OF CO TRACTOR OR AUTHORIZED AGENT IDATEI E P VALID THIS IS R P I SIGNATURE OF OWNER,IF OWNER BUILDERI IDATEI BL G INSP dF BATE d 7 NEW [ ] _ Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FA IRLY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: /"//0 Legal Description: Owner Name & Address: Contract Address: G� LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF EMPROVEMENT Width Width Width Tel. # TENSE # ;;� Of Tel. #%—o Height Sq. Ft. Height Sq. Ft. Hgt/Ground Sq. Ft. '�-Ayen -C% Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: .l1�t��j/� r♦ / i 'i CITY USE ONLY $ Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $ % $.50/$1,000 Valuation $ $1050 per SAC Unit $ , 00 $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 [ ] -__104fi -00 �3g Building PLUMBING Permit No.: Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Recd: DATE YOUR E-MAIL ADDRESS SITE ADDRESS 77 1/0 9B2eM k2Q� pie THIS APPLICANT IS: ❑ OWNER WCONTRACTOR PROPERTY NAME: ADDRESS: STA OWNER/ TENANT PHONE:_ CONTRACTOR NAME: STATE LICENSE # EXP DATE -� � ( � SUBMIT A COPY OF YOUR STATE ADDRESS: -- CITY STATE` LICENSE WITH PHONE FAX APPLICATION ,,��,,�a� 'Y/KGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE PERMIT TYPE ❑ NEW LACEMENT TYPE OF WORK: 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 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 $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) BATH SINK/LAV FLOOR DRAINS _ SHOWER _ WATER PIPING _ _ GAS PIPING (nen crrrttcEA" _ SWIMMING POOL 4_ WATER SOFTNER ($35) —BATHTUB CLOTHES WASHER KITCHEN SINK —WATER CLOSET _ BACKFLOW PREY. ($15) _ _ DISHWASHER LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION _ WATER METER —OTHER +y�`7�5' � .. �� :.. �' ...:.. >..��1�.t�7.` 9 ^S T 4 � � g� .w ��` 3"�° $^ 3b i'c�Y✓#_;. r., �� ' im.. . V ... � _ , . ....� , ";•c � i Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $ Surcharge .50 Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $35.00 x $35.00 = $ TOTAL DUE $ State Surcharge = .50 Total $ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of allQTc which and approval of plans. / SIGNATURE OF APPLICANT PRIlVT NAMEX- DATE V City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building BUILDING Permit No.: � ' ( - Inspections RESIDENTIAL APPLICATION Received By-h4ot� 763-572-3604 CITY OF FRIDLEY Date c: AUG1 2 0 763-502-4977 FAX EFFECTIVE 1-1-09 2�� 1L�/QOf YOUR E-MAIL, ADDRESS �OU�I -Co—V 5 l a IV C+ ClDATE SITE ADDRESS 7110 -,u J TiC 4114 THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: &d 'T'bqtte— TENANT ADDRESS: '94A. -f- CITY STATE ZIP PHONE: --I &3— S-71 — Col o Z CONTRACTOR NAME: ®.,C S J)t-e u (,.J{yd*,j STATE LICENSE # -201(0911"3 EXP DATE SUBMIT A COPY YOUR STATE NS AND CERTIFICATE OF ADDRESS: MY_ etlio STATEAAA ZIP x326 INSURANCE PHONE `� - 72' l FAX Za, - Z PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION L GARAGE/SHED WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER 11 SWIMMING POOL. TYPE OF WORK: ❑ NEW HOME CONSTRUCTIONC� ADDTTI0 ❑ MAINTENANCE/REPAIR ODELING DESCRIBE WORK BEING DONE: 1"�ow e &' r & o 21�`l ! ojc" fre- SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 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: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS IN EXISTING OPENINGS *es ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF E 0 CHANGES & TYPE WINDOW TO BE INSTALLED (SK+ -b e5k NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: / m/,,, _(USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due OCCUPANCY TYPE $ See Back Page for Fee Schedule $ 65% of Building Permit Fee $ Lo Ci .001 times the total job valuation $ .0005 x Permit Valuation Minimum $.50 $ GOO $5.00 (State Licensed Residential Contractors) $ $2000 per SAC Unit (Plans to MWCC for determination) $ ft+6 ft= ftx$21=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ . 07 Make checks vavable to: City of Fridley Attac THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of al work whi require review and approval of plans. y �/ SIGNATURE OF APPLICANT PRINT NAME. , "`` 4 , r ��d++l�- DATE Q -1c) �� /