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PRE 2010 DOCSCity of Fridley SUBJECT P ® 14143 AT THE TOP OF THE TWINS PERWTIol i ` BUILDING RECEIPT N COMMUNITY DEVELOPMENT DIV. L INSPECTION SEC. ��r i PROTECTIVE 1 CITY HALL FRIDLEY 55432 ,•� NUMBER REV. DATE 16/8/77 PAGE OF APPROVED BY """ 612-560-3450 910-F15 JOB ADDRESS 6120 Starlite Boulev and N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Sylvan Hills Plat2 SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Dale Ownes Jr. 1211 Gardena Avenue 571-0813 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK WMNNJCj IBI Construct a 60' x 24' Dwelling and a 201 x 24' Garage fm u l avol;RALMp i ITS REQUiREU FOR WIRING# VLEPHONE - ELECTRICcall - CJ 9 CHANGE OF USE FROM MU"ING AND µEAT1�h11G, REOUlRE® BY D STIPULATIONS provide a hard surface driveway. Provide sod in the front and side yards. Provide a verifying survey before capping. Provide copy of truss design to City. Any fill material encountered to be properly removed and replaced prior to calling for footing inspection. Provide frost footings in walkout level. Install 1i inch anchor bolts 6 feet on center in entire sill plate. Resubmit energy calculations for approval (square footage is incorrect). SEWER LOCATION: (Approx. 7.5' Deep in Street) 123' North of Manhole (Inv. 847.08) WYE ELEV: 845.36 TOP OF FOOTING: 849.36 30 DAY NOTICE'� C' WATER LOCATION: 13' North. of Sewer Service D D ON COST: ALT. A 16 . + 6 x $11.75 = $258.50 DIV, EEQt#REp FOR �' T DOW NW GUAMU �e REMOVAL AND REPLA I ACCM-0 QE UMM LOCAMNS AND 'OVAMN3. 11115 DATA 1S ECA WfORMATION PURPOSi3 ONLY AN.) AT DRIVEWAY OPE PERSONS UNNG Of SHOULD VERIFY THIS INFOWAVON SEPARA EP I S RE 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 R-1 1020 + 480 24 720 Total 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. $3Or925 $15.46 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- $98.88 $375.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE $24.72 $514.06 SIGNATURE OFCONTRACTOAUTHORIZEDAGENT (DATE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT J C C�' f A BLDG )NSP DATE SIGNA RE OF 52t OWNER I' E I (DATE) ifl a Etc. 1M r ENG. CURB WENT ZINGS. HARVEY A. CARTWRIGHT ANOKA COUNTY SURVEYS HENNEPIN COUNTY SURVEYS MINNEAPOLIS SURVEYS LAND SURVEYORS 7IVEYO 3 8410 SHADY OAK LANE N.E. REGISTERED UNDER LAWS OF STATE OF MINNff90TA SUNSET 8-0079 LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS OWNER 948 PLYMOUTH BUILDING LINCOLN 8521 INDUSTRIAL — JU04CIAL - ye t BUSINESS — TOPOGRAPHICAL CITY LOTS PLATTING 11 i �IATYtpOi'z Certificate Fridley Building Corp. b ff��roq 3 COMBINING THE RECORDS OF J. E. HILL, CIVIL ENGINEER ESTABLISHED 1995 C. F. SAND HOFF CIVIL ENGINI$EFg- ESTA B L.IS94 EO 1900 JAMES NELSON SURVEYO8& ESTABLISHZQ 1e$4 METROPOLITAN LAND SURVEYORS. ESTA641S1.1E4. teat Inv. 13534 3® DAY TO T® CITY ��. ' 'ter of tt noes NOT cv DIV. RE�UtRED FOR CURE AC�C1r OF UMffy LOCAIJONS D REPLACEMENT r�Is DATA � FOR INFORMATION 1 U�P®SFS ONYYAND REMOVAL SNS USING, R SHOULD VERIFY TtIE p AT O®PE�1EE RMWAY ON THE S SMAnoN I hereby Ce rtify that this is a true and correct plat of a survey., of: Lot 4, Block 3, Sylvan Bills Fiat 2® As surveyed by rj ie in December 1954 A. D. Ca11 �e#ote di3O Et� X31 asp SIGNED RIGHT AND OLSO C ,7 5- ��2 S "Of ��re4 CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL BUILDING PERMITS. (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS) OW14ER: ��/ t Q��.�� % �Z BUILDER: Lr Address: 12 // 6,4 tZ I-)E;d,4 Address: Tel. No.: 71- 08 / 3 No.: Street: MZ LOT: 9 BLOCK: 3 ADDITION: SYly9'� /��LL j PI,,l7 Z 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: Front: 0 Depth: � Height: Square Feet:0 Cubic Feet: Front: Depth: ` Height: Square Feet: Cubic Feet: "(Do Type of Construction: Estimated Cost: $ To Be Completed: .Se 11,77 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 f di nformation. DATE: C� V ^ ;7/SIGNA RE - Stipulations: ®/� 01 �.AVy �� ®6-- 16e," -3,29 o e �� / d1 CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND .AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: Furnace Shell & Duct Work Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU each add. 50,000 BTU Replacement of Furnace Repairs & Alterations -up to $500.00 Repairs & Alterations each add. $500.00 �VV:060019OliI&V�4101uf Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to 199,999 BTU (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: /._ _ ....__...r I RATE TOTAL Job Address $12.00 $ 7.00 $ 7.00 $ Department of Buildings 4.00 $ City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein $12.00 $ specified agreeing to do all work in strict accordance with the City Codes.. 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the 7.00 $ facts and representations stated in this application are true and correct. 7.00 $ 4.00 $ Fridley, Minn. ��, 19-' OWNER $12.00 $ 4.00 $ 7.00 $ 6.00 $ $10.00 $ 10.00 $ $10.00 $ Id 'AA 1st 3 Fixtures x $ 3.00 Additional Fixtures x $ 1.00 Gas Range to 199,000 BTU x $10.00 AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS & REPAIRS State Surcharge TOTAL FEE ROUGH INSP. REINSPECTION FEE Date 777 ($10.00) FINAL INSP..�// Date APPROVAL FOR PERMIT RIND OF BUILDING USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD -40 UILDING PERMIT NO. PERMIT NO. 96 /3 $-. DESCRIPTION OF FURNACE/BURNER $ HEATING or POWER PLANTS, Steam, .Hot Water,arm No. $ Trade Name Size No.��/d�� $ Capacity �•,,�y Sq. Ft. EDR BTU . HP $ .50 Total Connected Load% y �� Kind of Fuel $ °fitf� BURNER - Trade Name _ ��/ Size No. Capacity Sq. Ft. EDR BTU ' /�/,6 T,✓J HP MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $,50 STATE SURCHARGE Company 'RAY 'N. WELTER H;:A:ANn ICE) Signed By 4637 Chicago Ave. Minnea ors, Minnesota 55407 Tel. No. s -4�� 5 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: RATE TOTAL m /yNO. s x $3.00 $ o x x $ New Fixture, Old Opening Water y $ Catch Basin x m $ E�+ .04QRai $5.00 $ 100,000 BTU to 199,000 BTU _� x, $10.00 Ga Water Softener x Heater W e oei b $5.00 a m .0 $5.00 3 GAS FITTING FEES: v .ci o x ci x '$3.00 $ .dam=__ Additional Fixtures x U � M x $,:0.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 W cA U D M, $ .50 W 3 in vii REINSPECTION FEE cei a� � 3 ($10.00) o as lec 1st 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: RATE TOTAL Number Fixtures /yNO. s x $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening x $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 BTU x $5.00 $ 100,000 BTU to 199,000 BTU _� x, $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: lst 3 fixtures x '$3.00 $ .dam=__ Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $,:0.00 $ REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge $ .50 TOTAL FEE $ REINSPECTION FEE ($10.00) Job Address 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 OWNER KIND OF USED AS Fridley, Mn. '19-22 TO BE COMPLETED ABOUT ESTIMATED COST J OLD - NEW BUILDING PERMIT NO. PERMIT NO. O Company Signed �! Tel. No. ROUGH INSP. Date FINAL INSP. �- - ` 7- — -2 7 j Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE 1977 6431 UNIVERSITY AVENUE N.E., FRIDI.EY, MINNESOTA 55432 TELEPHONE (612)571-3450 Mr. bale Owens 6120 Starlite Boulevard N.E. Fridley, Mn. 55432 Re: Final Inspection.at 6120 Starlite Boulevard N.E. Dear Mr. Owens: A final inspection was made of the above address on November 4, 1977 and the following items were noted which must be completed before the structure can be finaled out; 1. Provide handrails where needed. 2. Cover bead board insulation in laundry room. 3. Block sliding glass door to be unoperable. 4. Install operable smoke detector. 5. Provide house numbers on structure. 6. Install door closer on door between house and garage. 7. Provide nuts on garage anchor bolts. We will expect the above items to be completed by November 30, 1977 when a reinspection will be conducted to determine compliance. if you have any questions on these items, please contact me at 571-3450. Sincerely, RON HOLDEN Building Inspector RH/mh 97-84-416051 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PER41T PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Ptsaber Fixtures x $3.00 Future Fixture Opening x $2.00 New Fixture, Old Opening x $2.00 Catch Basin x $5.00 Water Heater - to 99,000 BTU x $5.00 100,000 BTU to 199,000 BTU Water $10.00 a a $7.00 New Ground Run Old Building x E4 M o a GAS FITTING FEES: 4 Id 04 w x •$3.00 Heater +a+ $1.00 G-:13 Range to 199,000 BTU �9 a REPAIRS & ALTERATIONS ,'y[' u First $100.00 0 each add. $100.00 or fraction ,a $2.00 State Surcharge TOTAL FEE fl 0 - 4 1J 01 den( C. V) -H a • O Qw O u[ +� NV U) N tl! fl Cr u m t� In S o w W w u o -asiec 1st 2:,d 3rd 4 th (R) a Future Connection Opening Connected with Sewer (°) = New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Ptsaber Fixtures x $3.00 Future Fixture Opening x $2.00 New Fixture, Old Opening x $2.00 Catch Basin x $5.00 Water Heater - to 99,000 BTU x $5.00 100,000 BTU to 199,000 BTU x $10.00 Water Softener x $7.00 New Ground Run Old Building x $5.00 Electric Water Heater x $5.00 GAS FITTING FEES: 1st 3 fixtures x •$3.00 Additional Fixtures x $1.00 G-:13 Range to 199,000 BTU x $10.00 REPAIRS & ALTERATIONS First $100.00 $5,90 each add. $100.00 or fraction $2.00 State Surcharge TOTAL FEE REINSPECTION FEE i' . 7 $ $ .50 8.00 Job Aldress 6120 Starlite '-6l1d:' -• Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the vork hernia 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. 6-U-78 , 19 OWNER MN8 RIND OF BUILDING frame USED AS Peg. TO BE COMPLETED ABOUT 6-21-78 ESTIMATED COST 20.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By MINNEGAS)CO Tel. No. ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.So STATE SUS CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures X $3.00 u • x a $ Water d a� $ �+ M at $5.00 to i� w x w $ 100,000 BTU to 199,000 BTU Heater $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building �a $5.00 $ Electric Water Heater x $5.00 $ �lecj 'a r7 ' y a b 8 w u 5 oa ai v� 3 w° vii w c�0i a r o as 1st 2nd 3rd 4th (R) - Future Connection Opening Connected with Sewer (•) - New Fixture, old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures X $3.00 $ Future Fixture Opening x $2.00 $ New Fixture, Old Opening X $2.00 $ Catch Basin x $5.00 $ Water Heater - to 99,000 STU x $5.00 $ 100,000 BTU to 199,000 BTU x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ Electric Water Heater x $5.00 $ GAS FITTING FEES: 1st 3 fixtures x '$3.00 Additional Fixtures x $1.00 Gas Range to 199,000 BTU x $10.00 REPAIRS $ ALTERATIONS First $100.00 $5.00 each add. $100.00 or fraction $2.00 State Surcharge TOTAL FEE REINSPECTION FEE (sio-00) .. �z - A- Job Address _ /Ci / � (� • y _ - - --�-_ P'Ei4"el 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. , 19 C OWNER KIND OF BUILDING/c"'ate USED AS TO BE COMPLETED ABOUT ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. Company Signed By Tel. No. 1/ 2 ( S' A ( Z ROUGH INSP. Date 0 FINAL INSP. ' Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.SO STATS SCBE SUBJECT 0. City of Fridley 718-970 AT THE TOP OF THE TWINS BUILDING PERMIT r ECEIPT NO � • _ COMMUNITY DEVELOPMENT DIV. ,: ----- , r � � PROTECTIVE INSPECTION SEC. ` i 1`j CITY HALL FRIDLEY 55432 NUMBER REV. DATE P AGE OF APPROVED BY ----� L 612-571-3450 910-F15 5/29/87 JOB ADDRESS 6120 Starlite Blvd N, E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Benedict 6120 Starlite Blvd N.E. 574-1561 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Metro Summit Builders- 9401 James #130'. Bloomington MN 55420 888-8095 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling (_20 6qu4resl 9 CHANGEOFUSEFROM TO STIPULATIONS goof can be 2nd layer but not 3rd, Install ridged galvanized valleys. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $1'1001 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- $17,50 T CTIO R THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE n2I ^� $18, 00 IGNATUREOF-CONT W TOR OR AUTHORIZED 09ENT tDATEI WHEN PROPERLY VA ATED Ty YOUR PERMIT ' BLDG INSP 5'/o2 O TE SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) NEW [ ] City of Fridley Effective 4/1/86 R-1 AND R-2 ADDN. [ ] ALTER. [ 7 Building Permit Application Construction Address: Legal Description: k-Y Tel. # �� 1 Owner Name & Address: RE P # Contractor: �"'`2 S kV , ° Tel. � LI Uk SIA\I t3U (3) VALA-. a Address • Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft.,_ DECK AREA: Length `WWiidpth� Hgt/Ground Sq. Ft. OTHER: VE Ft. Yd. Setback Side Yard Setback Corner Lot [ ] Inside Lot L ] ` Type of Construction:Estimated Cost: $ Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: S �a I�'APPLICANT: �- Tel.��^�UT f CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Plan Check $ 25$ of Building Permit Fee State Surcharge $ SD $.50/$1,000 Valuation SAC Charge $ $ 525 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: . , . SUBJECT City of Fridley ® 19771 AT THE TOP OF THE TWINS BUILDING PERMIT _ r RECEI COMMUNITY DEVELOPMENT DIV. /� r PROTECTIVE INSPECTION SEC. �I/� X.3 1 � ----111,� CITY HALL FRIDLEY 55432 {l NUMBER REV. DATE PAGE OF APPROVED BY --_-� L 612-571-3450 910-F15 JOB ADDRESS IZ-5T A OLLnr 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. SHEET 2 PROPERTY OWNERS MAIL ADDRESS ZIP PHONE ,{ ` �l Na'.' ( ` e.l� �i�. c -r Z- R.L l L# a -Z. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Pi2.® iYl qL1 2C —or-4-,"sn-1 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. �S SBO 44 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE BUILDING ��OF t# 7 CLASS OF WORK ❑ NEW ❑ ADDITION ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK IJ 9 CHANGEOFUSEFROM TO STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONIN SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION I 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 5m. 00 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 TOTALFEE SIGNATURE OF CONTRACTOR ORAUTHORIZED AGENT (DATE) PRO BLDG )NSP WVALI EDTHIS IS YOUR PERMIT 2-0 �� DATE _q�HEN SIGNATURE OF OWNER (IF OWNER BUILDER) )DATE) NEW [ l City of Fridley EEfective 5/1/88 ADDN [ ] R-1 AMID R-2 ALTER [ Building Permit Application ODnstruction Address Legal Description: Owner Name & Address: VtA O�MiUkr--7lCV e,l2 Tel. # Oontractor: Tel. # QZ° &jk' : Address: 2La �4 rt `mss -�7� A54"OVAEV d Attach to this appl ication, a Certif icate of Survey of the lot, with the proposoed construction drawn on it to scale. DESCRIPTION OF IM ROVEMEMU T.MWG AREA* Length Wim Height ,Sg. Ft. GARAGE AREA: Length Width Height Sg. Ft. DECK AREA: Length Width Bgt/Ground Sg. Ft. ODrner Lot f ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Ounstruction: Estimated Cost: $ a Approx. Completion Date: Proposed Driveway Width If New Opening Is Desired: $' Width + 6' Permit Free State Surcharge SAC Charge Driveway Escrow Park Flee Sewer Main Charge TOTAL STI MUCIONS: % lam_ Alt. A Alt. B See Back Page Tel. # 422---%06 ;7 $ 00 Fee Schedule on Reverse Side $.50/$1,000 Valuation $ $550 per SK unit $ Alt. OA" or Alt. "B" Above ^$ Fee Determined by Engineering $ Agreement Necessary I I Not Necessary [ ] sueJEcr PERMI City of Fridley 2110 3 AT THE TOP OF THE TWINS g U I L D I lel G PERMIT � , RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r s PROTECTIVE INSPECTION SEC. p CITY HALL FRIDLEY 55432 NUMBER REV, DATE PAGE OF APPROVED BY 612-571-3450 910-F15 10/7/91 / JOB ADDRESS 6120 Starlite Blvd NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Randy/Sue Benedict 6120 Starlite.Blvd NE 574-1561 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW Ck ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Construct a 201 x 211 Deck in Rear Yard. 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan, BefereYi"I al!fggifl utility g call for atfo REYUI66 44 s �� 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. I 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 $3,150 $1.58 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SACCHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 00 Fire STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. • PLAN CHECK TOTAL FEE 7.73 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT 10 EI - WHEN PR Y� A A D HIS I YOUR PERMIT w�xe SiGNATUREOF OWNER)IF OWNER BUILDER) (DATE) SP F) Alf E NEW [ ] Effective 1/1/91 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: 4167® ,S'fa, r- /; 7�e 13I y �/.i(/, Legal Description: L ®t 9 , S/®ci -3 9 T 1s �l� z4 .�,�lh o ko. 61, h f Owner Name &Address:/?aN a/�.� See $p ,tet, /� /a®sfua [ f� Alva/ & �� Tel. Contractor: s 1 _ Tel. #-��;_.� Address: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width —� Hgt/Ground 2" Sq. Ft.0 OTHER: 4a 0 15r Corner Lot (] Inside Lot Ft. Yd Setback Side Yard Setbacks Type of Construction: -1r a f, � — Estimated Cost: $�!nn&I Approx. Completion Date: 5 h imm er / 2 9a Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ coat m am*) DATE: het "] l APPLICANT: 'JZa„��Q�� % / p_h��Ir`�ZL Tel. # 5-7'1-/S(ol Permit Fee $ (01,60 Fire Surcharge $ G tjL State Surcharge $ SAC Charge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: $ II Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.501$1,000 Valuation $650 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necdhary ( ] lSIM C) Cj JL4 OU civil municipal planning ert�fMa environmental land surveying 0 soil exploration For MILE EE OvyENS Z07- 9, BLOC; 2 X < Denotes Iron Monument 0 9 Scale— 40 S) -Z' 1141V 1-711ZZ,5 7- �33 20 L cl o 0 �N � N FEn CE 0.3 A J (1 FENCE 20 3-3 1 We hereby certify that this is a true and correct representation of a survey of the boundaries of the land described above and of the location of all buildings thereon, and all visible encroachments, if any, from or on said land, that this survey was prepared by me of under my direct supervision and that I am a duly Registered Land Surveyor under the laws of the State of Minnesota. As surveyed by me this 107"1 day of 19 REV/56D L)' (INC /5, /977 coraAfing p.o. box j. osseo, minnesota 55369 n (612) 425-2181 ergneiers dNerSifed File No Book page. Minnesota Registration No. SUBJECT City of Fridley 26268 AT THE TOP OF THE TWINS BUILDING PERMIT r RECE�I/PT NO �• ______ COMMUNITY DEVELOPMENT DIV. y r I I PROTECTIVE INSPECTION SEC. gzI6 TTT 1 . � NUMBER REV DATE PAGE OF APPROVED BY I S ---n CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/17/98 JOB ADDRESS 6120 Starlite Boulevard NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Sylvan Hills Plat 2 SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE Randall Benedict 6120 Starlite Boulevard NE 574-1561 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Panelcraft of MN 3118 Snelling Ave S, Minneapolis, MN 55406 617-2878 2179 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHON _ LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 13' x 11' Addition to Dwelling (Three Season Porch) 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. W"R Before digging call fof all utility locations REQ`11�R��Qo2 BY LAW 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 SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1.87 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,732 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- $87.25 Fire SC $3.73 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE License SC $5.00 $97.85 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERL VALIDATED THIS IS YQU R PERMIT SiGNATURE OF OWNER IIF OWNER BUILDER) IDATEI~ 1319t INSP DATE NEW [ ► Effective 8/1/15 ADDN j J CITY OF FRI DLEY Al TEM SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: 0 Owner Name & Address: _2CA �� ` _ – 1 C_ — Tet. #'__6_7 /�/j� Contractor: )20 Y —e RZE i _ . _ � .. .__ MN LICENSE # _ C;2-/ � c/ S._ ._ _Tel. #' ZZ2 Attach to this applicatiora Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPRO'YEMENT 0 LIVING AREA: gth .._Widdi Weight Sq. Fl. _Width Height _ _ Sq. Ft. OARAO]C: AREA: Length _ i� DECK AREA: Length _ Width Hgt/Ground Sq. Ft. ^� _ OTI JER: Corner Lot [) Inside Lot [ J Ft. Yd Setback Side Yard Setbacks Type of Construction: �.cc - n . , .Estimated Cost: Approx. Completion Date: Driveway Curb Cud Width Needed: _ DATE: APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge '4L S -121-1L. (Cost on Back) Ft. •+- 6 Ft = Ft x $ fM USE ONLY_ Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $850 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary j ] &V C SUBJECT RMIT NO. . s City of Fridley 33582 AT THE TOP OF THE TWINS BUILDING P E R M I T r ` RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. V------ r PROTECTIVE INSPECTION SEC.317/ E NUMBER REVDATE I PAGE OF APPROVED BY SCITY HALL FRIDLEV 55432 L 763-571-3450 9�aF�5 j 6/9/03 JOB ADDRESS 6120 Starlite Boulevard NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 1 Sylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Randy Benedict 6120 Starlite Blvd NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Renewal By Andersen 1920 Co Rd C W, Roseville, MN 55113 651-264-4777 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20120983 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace 11 windows within existing openings 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke deter'ors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1 2 of the 1997 Uniform Building Code. Caulk and flash all exterior openings. POWInspection Car elle Mailed T Ileowner Post SEPARATE PERMITS ARE REQUIRED FC R ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDC NED 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS WITH WHETHER SPECIFIED HEREIN OF TYPE OF WORK WILL BE COMPLIED NOT. THE GRANTING OF A PERMIT $11,000 $5.50 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE DR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE F CONSTRUCTION $195.25 Fire SC $11.00 PLAN CHECK FEE TOTALFEE AGENT (DATE- ce se SC $5.00 $216.75 SIGNATURE OF CONTRACTOR OR AUTHORIZED WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT LpG INSP r,ATE S.GNATURE OF OWNER,Ir OWNER BUILD RI IDATEI &V C NEW[ ] Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ l SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: (,a 11® &v 1 i k '-1vd Legal Description: Owner Name & Address: dih d ; �, Tel. # Contractor:; MN LICENSE # 6`]01309��, Address: 1s a CO�.�n �ao►d Ce weS�:"•c�c�citc, rn� 54S I Tel. # (a51.104 •4�-�- Attach, to- this application, a`Certificate of Survey. Of the lot, with the 'proposed constriction drawn` on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: DESCRIP ON CSF I JPR0VEMENT ' Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width' Hgt/Ground Sq. Ft. Estimated Cost: $ 4 606 ®/ Driveway Curb Curt Width Needed: Ft. + 6 Ft = Ft x $ DATE: 23 APPLICANT: s� C,1a�1�,_', Tel. # 95a •345•c1 - TOTAL STIPULATIONS: CITY USE ONLY Permit Fee $ 19S. -Q!5 Fee Schedule on Reverse Side Fire Surcharge $ 11.0o .001 of Permit Valuation (1/10th%) State Surcharge $ S. Sb $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ .0 tj $5.00 (State Licensed Residential .Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: CITY OF FRIDLEY PERM- 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 07/13/2004 763) 572-3604 FAX: (763) 571-1287 ADDRESS : 6120 STARLITE BLVD NE PIN : 153024440070 LEGAL DESC : SYLVAN HILLS PLAT 2 : LOT 9 BLOCK 3 PERMIT TYPE : BUILDING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : WINDOW/DOOR REPL VALUATION : $ 10,882.00 NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER R317 OF THE 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS. REPLACE 9 WINDOWS AND 1 PATIO DOOR WITHIN EXISTING OPENINGS. STATE LICENSED CONTRACTOR 1 APPLICANT RENEWAL BY ANDERSEN (20130983) 1920WCORDC ROSEVILLE, MN 55113- (763)502-4777 OWNER BENEDICT RANDALL D & SUSAN 6120 STARLITE BLVD 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 regulating construction or the performance of construction. BUILDING PERMIT FEE 195.25 FIRE SURCHARGE 10.88 STATE SURCHARGE, VALUE 5.44 LICENSE SURCHARGE 5.00 TOTAL 216.57 PAID WITH CHECK # 36159 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 04/02/2004 FRI 13:21 FAX ELDER JONES la 001/001.. -- NEIN [ ] CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPLICATION Construction Address: I a ® 5�0,(VAS,'�AurA NO Legal Description_ Owner Name &Address:�`�� a Tel. # Q Contractor. MN UICENSE # ;j01 - 9 3 R1 Address: RENEWAL BY ANDERSEN Tel. # Ca5 �' �qq " q 4-1—+ 1920 COUNTY ROAD "C" WEST ROSEVH.LE, NIN 55113 icate of Survey of the - ,i drawn on it to;scald DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length OTHER: Width Hgt/Ground Sq. Ft Construction Type- Estimated Cost: $ L Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x DATE: 510`U 04 APPLICANT: ®1°�_ °�y�� TeL # 5,01-3 LI Call (763) 672-3604 for Permit Fees Ef mailing in application. Fax to 763-571-1?P7 If using credit card and we will call you for card number. Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer -Main Charge TOTAL CITY USE ONLY.- Permit NLY- �®I Fee Schedule on Reverse Side $ 65% of Permit Fee .001 of Permit Valuation (1/10th%) $ 5. Llq $.50/$1,000 Valuation $ $1350 per SAC Unit $ 5e 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 [ $ alb. - STIPULATIONS_ Q CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-3604 YAX: (763) 571-1287 PERMIT NO.: 2004-02184 DATE ISSUED: 11/29/2004 ADDRESS : 6120 STARLITE BLVD NE PIN : 153024440070 LEGAL DESC : SYLVAN HILLS PLAT 2 : LOT 9 BLOCK 3 PERMIT TYPE : PLUMBING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : ADDITION/ALTERATION VALUATION : $ 0.00 NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A # ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE # NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS # GAS DRYERS 0 # GAS RANGES NN 0 1 0 # OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 200 # WATER TRMT APPLIANCES 0 APPLICANT PLBG PERMIT MINIMUM FEE PLBG FIXTURES (NEW OPENINGS) 0.00 0.00 H.P PIPEWORKS 3670 DODD RD PLBG FIXTURES (EXIST OPENINGS) 0.00 EAGAN, MN 55123- WATER TREATMENT APPLIANCE 0.00 (651) 365-1340 WATER HEATER - ELEC 0.00 WATER HEATER - GAS 35.00 GAS RANGE FEE GAS DRYER FEE PLBG REPAIR/ALTERATIONS 0.00 0.00 0.00 OWNER BENEDICT RANDALL D & SUSAN 6120 STARLITE BLVD NE STATE SURCHARGE, PLBG FLAT 0.50 FRIDLEY, MN 55432 TOTAL 35.50 PAID WITH CHECK # 10433 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. M�Mxu1 . SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 Effective April 1, 2004 IL APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR PLUMBING FIXTURE RATES: New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas** NO. RATE ME Gas Range** Gas Dryer** Back Flow Preventer Required ( )Yes () No Type $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $10.00 $35.00 $35.00 $35.00 $10.00 $10.00 $15.00 Reinspection Fee $50.00/Hr ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.25% of Value of Fixture or Appliance State Surcharge TOTAL JOB ADDRESS !g o _NV4 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 representations stated in this application are true and correct. DATE: ' 1- a0•_ 04 20 OWNER e "&4`,dy _di& BUILDING USED AS `e�i6tbn6-P-- ESTIMATED COST *BOO 1) PERMIT NO. PLUMBING COMPANY �( IOW SIGNED BYTEL NO.�� " (a Approved By Rough -In Date Final Date MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 or 5% OF COST TOTAL FEE $°�® 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 PERMIT.. COMMON VENT; VENT CONNECTOR AND COMBUSTIOMAIR VERIFICATION When replacing an existing fOrnace, 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 BTU Input Fan Assisted or Nat specifications including sizing, length, number of elbows and termination. Yes () No( ) The undersigned also verifies that the replacement unit is a listed assembly BTU Input Fan Assisted or Nat and meets the current codes and manufacturer's specifications. This does Total Btu Input 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 O 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) HEATING CO: Signed By: Date : ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE 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 BUILDING 65% of Building Permit Fee Permit No. - r SS Build_ ing Ins •tions r .0005 x Permit Valuation Minimum $.50 RESIDENTIAL APPLICATION Received By: 763-572-3604 $1825 per SAC Unit (Plans to MWCC for determination) CITY OF FRIDLEY ft+6ft= ftx$21=$ 763-502-4977 FAX $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary ( ) $ Make checks payable to: City of Fridley Attach EFFECTIVE 1-1-08 DATE 3 3 (- ®� YOUR E-MAIL ADDRESS SITE ADDRESS (2 /2 ® �j-+-A2 It 4AC— L��(1 THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME: A S en i ADDRESS: I I S& -r -F 4A -j:!! CITY FI D t! 1 STATE /w�/ZIP 53�`ti3 Z TENANT PHONE:7 & .3 - S / 6--L / NAME: o cw ac ADDRESS: 4l7Y/ Ui1 1dErsi�y M CITY /hn1 S STATE AI ZIPS,�YL CONTRACTOR SUBMIT A COPY OF PHONE 76 3 - 5760 - 6 ! `r% FAX YOUR STATE LICENSE STATE LICENSE # oZ 0 of b6 '?& % EXP DATE PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH %KV0OF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION 0- AAINTENAN�CE/REPAI-Rt-� ❑ REMODELING DESCRIBE WORK BEING DONE: / �® SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE I. 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 ADDITIONS. & PORCHES SUBMIT: ❑ Vinyl ❑Soffit I. Site Plan/Survey showing the existing structures ❑ Aluminum ❑ Trim and proposed project. ❑ Other ❑ Fascia 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 UBC FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE 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 $. 10 .001 times the total job valuation $ l � -b '5 .0005 x Permit Valuation Minimum $.50 $ $5.00 (State Licensed Residential Contractors) $ $1825 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$21=$ $ $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 in conformance with the ordinances and codes of the City of Fridley 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 'll be m rdan v ' h the ap ed plan in the case of all work which requires review and approval of plans. SIGNATURE OF AP 'Ll PRINT NAME ��DATE3 1-0 e .�