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PRE 2010 DOCSCity of Fridley SUBJECT ® 14451' AT THE TOP OF THE TWINS BUILDING PERMIT r - RE T NO COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. r*�'1 CITY HALL FRIDLEY 55432 NUMBERDATE PAGE OF APPROVED BY 612-560-3450 910-F15 =10/28/77 JOB ADDRESS 5171 cut. Tmi erDrive N.E. 1 LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 1 1 Innsbruck 5th Addition SHEET. 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Robert Granger 1306 Poppyseed , New Brighton, Mn. 784-9587 3 CONTRACTOR MAILADDRESS ZIP PHONE ;OCEita Same M 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE - L E�0. C EsTERMI I S REQUIRED FORMPHONE E 5 ENGINEER SHINN TE rri Uq 6 USE OF BUILDING HEATING,Q rn_ Residential -- 7 CLASS OF WORK Xf7 NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑7R (�{''E 8 DESCRIBE WORK Construct a 26' x 48' +,321 x 9' Dw cling and a 2816" x 24' Garage ACCURACY - r' FRBDLEY D®US @�fOi GIIAR �NTEE ®P 4JTILnY Tj7j r, 9 CHANGE OF USE FROM I IO gig; ELEVOh NFORMATIOR! PURPOSES PERSONS USING � �Y ANn STIPULATIONS Provide a har d surface driveway. Provide sod in the front ann yards. Provide a verifying survey before capping. .Increase footing width to 30" or provide calculations showing that footing as designed is adequate for as soil bearing of 2,000 psi. Provide City with copy of truss design before capping. We suggest restricting foot traffic(by means of a handrail) to 6" minimum tread run on circular stair. Provide combustion air to furnace room. Separate permit required for pool construction. Maintain basement floor no lower than 965.00 (bench mark: sanitary manhole casting & cover, in front of lot, is 971.9. SEWER LOCATION: (Approx. 9' Deep in Street) 6' N. of Manhole (Inv. 971.91) WYE ELEV: 971.64 TOP OF FOOTING: 9Fj9 975.14 Minimum WATER LOCATION: 10' S. of Sewer Service DRIVEWAY DEPRESSION COST: N/A SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. Wood Frame 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 R-1 1536+1308 63,684 Total 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, $106,170 $53.08 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 TOTAL, FEE $63.8 $746.50 OF COfyTRA R OR AU ORIZEDAGENT (DATE))W ENR P Y VALIDATED THIS IS YOUR PERMIT .q{ - YzSIG �}TURE - BLDG INSP DAT S NATUREOF WNE E' DERIIDAT ) CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: � _ �o�i BUILDER: 0 Address: Address: ®� Tel. No.: No. �17-1 Street: LOT: BLOCK: Z` ADDITION:„l� G� CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: rz�e, Front: Depth: yam. Height: Square Feet: Cubic Feet: Front: -a Depth: ;I ' Height: le Square Feet: Cubic Feet: Type of Construction: -W Estimated Cost: $ -51,5-000 To Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired ata $ $ (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 hereby declares that all the facts and representations stated in this application are true and correct. See reverse side for addition�nformation. DATE: Z® SIGNATURE: Stipulations: --136 � ,,� � ow .91 /� �vs 4too� i ��.67v� -•Y City of Fraley SUBJECT PERMIT 457 AT THE TOP OF THE TWINS BUILDING PERMIT • COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ---1 CITY HALL FRIDLEY 55432 IL---- I " '.J 612-560-3450 REC T N0. �® / NUMBER 910-F15 REV. DATE 2/10/78 PAGE OF APPROVED BY JOB ADDRESS 5171 St. Imier Drive 1 LEGAL LOT NO, BLOCK OR ADDITION SEE ATTACHED DESCR. 1 ]-TRACT 1 Innsbruck 5th, SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Robert Granger 5171 St. Imier 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Aladdin Pools 4738 - 42nd Avenue North 535-1466 4 ARCHITECT OR DESIGNER MAILADDRESS 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 X 8 DESCRIBE WORK Indoor Swiming Pool 9 CHANGE OF USE FROM TO STIPULATIONS See stipulations as p per letter dated February 8, 1978 written. by Environmental Officer. 100, 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 AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION ZONING SQ. FT. CU. FT. OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING [HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ISTALLS GARAGES 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 VALUATION $4,000 SURTAX $2.00 DOES. NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITTEE SACCHARGE PROVISIOfV OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTI O THE P ORMANCE OF CONSTRUCTION. $24.00 4�4��� PLAN CHECK FEE TOTAL FEE $26.00 SIGNATURE OF CONTRAWR OR AUTHORIZED AGENT (DATE) HEN PR Ph -r-11 3ERLY VALID TED .THIS IS YOUR PERMIT C-2 -t��- A � BLDG. INSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DATE) 00, CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OWNER: %�G' ® C. V-4, Y 0% BUILDER: Ai a J d%yA ,� O Address: 17 1- St ,T m ( C, V Address: q7.3*- 4;Zw d Ave 90 Tel. No.: "S - I 9 t, No.. Fi1471-0 Street: BLOCY.: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARDS: Applicant attach 'to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: PO O L— �g4 (00 � Front: Depth: Height: Square Feet: Cubic Feet: Front: Depth: Square Feet: Cubic Feet: Height: Type of Construction: (2 0 h C- -1 C' t @ Estimated Cost: $ A,®wed. 0 C+ To Be Completed: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired $ $ (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 hereby declares that all the facts and representations stated in this application are true and correct. See reverse side for additional information. DATE: D / iI 7 J SIGNATURE: Stipulations: February 8, 1978 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 66432 Aladdin Pools Inc. 4738 — 42nd Avenue North Minneapolis, Mn. 55422 TELEPHONE ( 812)671.3460 Re: Swimming Pool Construction at 517,1 St. Imier Drive N.E. Dear Sirs: This letter is to make clear this departments requirements for the swimming pool construction at the above address. 1. As indicated, one (1) skimmer approved by the National Sanitation Foundation will be provided. 2. As indicated, three (3) inlets of approved design for fresh and/or repurified water will be provided. 3. As indicated, a main drain of approved construction will be provided. 4. The filter and pump shall be approved by the N.S.F. and be of sufficient capacity to provide a minimum turnover of at least two (2) times in 24 hours. This department recommends a turnover rate of 6-8 hours. S. A deck of at least three (3) feet wide, measured from the pool water's edge, shall be provided which extends completely around all private residential pools. Above ground private residential pools may be provided with decking of a minimum size of 4 feet by 4 feet at pool entry points and provided that such decking has the approval of the City. 6. The diving area will be acceptable provided there is no overhead obstruction. 7. Fencing or other effective means including but not limited to walls or buildings, acceptable to the City, shall be provided to positively control all access to public and private residential swimming pools. Entrances shall be equipped with self-closing and self -latching devices which are capable of being locked. 8. An automatic chlorinator should be provied with a suitable test kit. 9. All electrical and plumbing installations shall be inspected and approved by the City Inspection Department. Aladdin Pools Inc. February 8, 1978 Page 2 10. All electrical lines must be 10-20 feet or more away from the pool surface. 11.. The pool fill spout must be air gapped or protected by a vacuum breaker. 12. Suitable safety equipment to include but not limited to a ring buoy and rope that is 1� times the pool diameter, shepherds crook pole must be provided and maintained with the pool at all times. Furthermore, these and any other requirements must meet the provisions of the Fridley City Code, Section 115, Swimming Pools. The building permit is approved contingent on final inspections and approval by the City. If any questions or problems arise from this letter, please feel free to contact me at 571-3450, ext. 170. Sincerely, STEVEN J. 01�ON Environmenficer S JO/mh CC: Mr. Robert Granger 1306 Poppyseed New Brighton, Mn. 55112 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction NO. RATE TOTAL x $3.00 $ x $2.00 $ X $2.00 U f x K a a x Water at 0 $10.00 'Q t11 $7.00 tei E+ .oi 3aa $ x 41 A tea, w pod' Heater .oi to A u M R d t� H ' a°c 8ro m 4 y ro� o W b ro 9 y} m lec N U D to W to ;t O W to V W 9 C7 c O as 71/1 1st - �• �- 2nd gf 1 f. 3rd 4th (R) = Future Connection Opening Connected with Sewer (h) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: Number Fixtures Future Fixture Opening New Fixture, Old Opening Catch Basin Water Heater - to 99,000 BTU 100,000 BTU to 199,000 BTU Water Softener New Ground Run Old Building Electric Water Heater GAS FITTING FEES: 1st 3 fixtures Additional Fixtures Gas Range to 199,000 BTU REPAIRS $ ALTERATIONS First $100.00 each add. $100.00 or fraction NO. RATE TOTAL x $3.00 $ x $2.00 $ X $2.00 $ f x $5.00 $ �e a x $5.00 $ x $10.00 $ x $7.00 $ .7 .0'a x $5.00 $ x $5.00 $ —J --x $3.00 $ 3 • © 0 x $1.00 $ x $10.00 $ $5.00 $ $2.00 $ State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE (S?0.00) e Job Address --6-% 71 5-7 a� 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. �" t -A -'Z.0 94 :3: , 197 OWNER A V A3 C;- "'3 sG' 6 C ra- KIND OF BUILDING �,,. r� C e- C--7- USED --y USED AS TO HE COMPLETED ABOUT 4��2 ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. joy Company C e-, Signed By Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE SUBJECT City of Fridley 10371 AT THE TOP OF THE TWINS ? BUILDING PERMIT RECEIPT NO. L _ COMMUNITY DEVELOPMENT DIV. ~ PROTECTIVE INSPECTION SEC. 1 CITY HALL FRIDLEY 55432 It---' NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 5/21/90 JOB ADDRESS 5171 St. Imier Drive N,E, 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 Innsbruck 5th Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Richard Reiling 5171 St, Imier Drive N,E. 574--9304 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 Change flat roof to 4/12 pitch..on Garage 9 CHANGEOFUSEFROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $5 000.$3.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT f PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $81.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $84.00 SIGNATOR OFC NT ACT RORAUTHORIZEDAGENTI ATE( sWHEN PROPERLY V.ALIDATED THIS IS YOUR PERMIT BLDG INSP/ GATE SIGNATURE OF WNER F OWNER BUILDERi IDATEI NEW ] Effective 1/1/90 ADDN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application Construction Address: j 1 % �+ % rv1 L�2 Die Legal Description: k t"r ( E t o c K i / n0 Al s &le u C k b P o n) T1 o >J Owner Name &Address: 104 1'+YZ 0 �c� l- 1 ;Q C-�- Tel. Contractor: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Lerpth Width Hgt/Growld Sq. Ft. OTHER: o io �_ _ L-1 i Y p p F TO ZI / Z- y;,r iC g IT rz,C i S3 ItS Corner Hat [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: Approx. Completion Date: Proposed Driveway Width If NewIs Desired: Ft. $ $ / Width + 6' See Back Page DATE: APPLICANT: Tel. # ? Y- q 3 OZ Permit Fee State Surcharge SAC Charge Driveway Escrow Park Fee Sewer Main Charge $_ :9 Loo $ 0-3 to c) S e >. CITY USE ONLY Fee Schedule on Reverse Side $.50/$1,000 Valuation $600 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] ';?_0 ® d �� i ��!®� CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, .but not replacement) Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25% of Value of Appliance or Work JOB i OWN Rate TOTAL BUIL $ 30.00 $ �� ESTI I $ 10.00 $ D Effective On January 1, 2000 DESCRIPTION OF FURNACE AND OR BURNER $ 10.00 $ No. of Heatin Unit Circle One (Steam) (Hot Water) arm Air) $ 10.00 $ Trade Name Size No. BTU10,0 1000 HP EDR $ 25.00 $ Fuel , Total Connected Load Burner Trade Name Size No. $ BTU HP EDR $ 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 an State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and � ;� representations stated in this application are true and correct. TOTAL FEE $ DATE i MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr L'Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Rough -In Date Final Date COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacing an existing furance, 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 O 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 -LAMA Category I Central Furnace Venting Tables for fan � assisted and natural draft appliances. Ye�) No ( ) The existing combustion air is sized and installed to meet the current codes and manufacturer's specifications. Ye No When required to install a new combustion air, it will be sized and` stalled To meet the current codes and manufacturer's specifications. Yes No ( ) When installing a new venting system, the undersigned hereby verifies that+v 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 ( ) r 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 i 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 Signed By: CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 kAX: (763) 571-1287 PERMIT NO.: 2004-01742 DATE ISSUED: 10/05/2004 ADDRESS : 5171 ST IIVIIER DR NE PIN : 253024110026 LEGAL DESC : INNSBRUCK 5TH ADD : LOT 1 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A SAVERS SWITCH. # INSPECTIONS 1 APPLICANT HUNT ELECTRIC CORPORATION 2300 TERRITORIAL RD ST PAUL, MN 55114 - OWNER REILING RICHARD L & MARY A 5171 ST 1MIER DR NE FRIDLEY, MN 55421 ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 118132 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 regulating construction or the performance of construction. Applicant Date Bldg Insp Date SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Building BUILDING Permit No.< Inspections RESIDENTIAL APPLICATION Received By: AU 763-572-3604 CITY OF FRIDLEY 1 777 See Back Page for Fee Schedule — Da. :." U G 13 2009 763-502-4977 FAX 65% of Building Permit Fee Fire Surcharge $ EFFECTrVg 1-1-08 Surcharge $ DATE - B J YOUR E-MAIL ADDRESS $ 'Q $5.00 (State Licensed Residential Contractors) SAC Charge SITE ADDRESS P AJ Curb Cut Escrow THIS APPLICANT IS: ❑ OWNER CONTRACTOR Erosion Control $ PROPERTY OWNER/ NAME: $ Fee Determined by Engineering TENANT ADDRESS _ . ' q . CTTY nU ®L���STATE fy®�. 012-1 PHONE: % 3�- t7Y-93011 _ THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED NAME: CONTRACTOR ADDRES1,15-2-lb CITY ,+nDk& STATE SUBMIT A COPY OF PHONE FAX YOUR STATE LICENSE — STATE LICENSE # EXP DATE 3-91- ,1 PROPERTY TYPE GLE FAMILY/NEW CONSTRUCTION SIZE TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: — SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING. R�3 Cl HOUSE ONLY NUMBER OF SQUARES s 13 HOUSE &GARAGE BASEMENT REMODELING SUBMIT: 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: SMING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site PhudSurvey showing the existing structures ❑ Other ❑ Fascia and proposed project WIIVDOWS 2. Two sets of construction plans IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS r.,J.. rr.r10 Fuca V AULUAIL MA, LNULUDIMU TIM COST OF LABOR AND MATERIALS: (IJSYYN. T"k 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee $ 1 777 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ �' .001 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ 'Q $5.00 (State Licensed Residential Contractors) SAC Charge $ $1825 ger SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21= $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Dae$ Make checks ble to: C' of Fridle 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 acxaamte; that the work will be in confurmaack 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 acro a wr r the app -T in the of all work which req ' review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME _ DATE APPROVRD RV DATF