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PRE 2010 DOCSNOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer, or water. Be sure to :$ Building Inspector for separate permits for these items. Date: Owner; Addres _2s / 0,) - Date: ,)- N? '7141. i --ton low—TIA-MI(M Lot Block Addition or Sub -..V/%;, r DESCRIPTION OF BUILDING T Front Depth Height Sq. Ft.VY Cu. F 1 F n _ Depth jZHe t Sq. Ft. Cu. Ft. Type of Construction _ Est. To be Completed In consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compnce the city of Fridley. with all provisions of ordinances of �� , i �C��_ In consideration of the payment of a fee oft— , permit is hereby granted to to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time uponvioon of any of the provisions of said ordinances. Building Inspector NOTICE: 7hb permit don not cover the cond. Won, hwalladion for vdring, plumbing, gn hoaft, sewer or water. Be sore to ne the ButidhM Inspector for separate permits for d wso hems. OWNER' S ADDRESS APPLICATION FOR BUILDING,PERMIT CITY OF FRIDLEY, MINNESOTA,, LOCATION OF BUILDING No. ��.�.�Streeta a Lots Lot/ :-Block . Addition .or Subdiv si.on Corner Lot Inside Lot Setback Side- Yard:. SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this: form, Two.Certi'ficates of. Survey, of:Lot _and proposed build- ing.location drawn on.these.Certificates. DESCRIPTION OF BUILDING To be used as: Front. .. Depth .. Height Sq.Ft, Front Depth Height Sq. Ft Cu.,., Ft ; Type of Construction Estimated Co, st r... 1y To be Completed l The undersigned hereby makes application.for a.pe;:mit foi`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. _ DATE SIGNATURE .(Schedule of Fee Costs can be found on the Reverse Side). origmal PERMIT for Power Punts and Heating, Cool- ing, ventilation. Refrigeration and Air Conditioning Systems and Devices DESCRIPTION OF WORK No. of 7leating Plants to be installed—altered—repaired Make ,Size ; Oil fired—, Coal fired—,- Gas fired ; Gas Authorization Remarks Approved Final Inspection 19_ Inspector A Sa /-/i-7 Permit N° 4669 Fee s® ®6 Office of the Inspector of Buildings City of Fridley City of Fridley, Minn., 64 � , 192-0Owner L�16V A,41J .MA4'J Location (e 1e9 L r✓ a� Lid Kind of Building 6169 M E How Occupied A uU' 9 U(-- K) (Z: Work to be Commenced—, 19— To be Completed M,*969 64� ,19'70 Estimated Cost, $ 900-00 0 ew, Building Permit No. Permission is hereby granted to T Y • to install—erect—use the material and devices described in the "above statement. This permit is granted upon the express condition that the son to whom it is granted, and his agents, employees and workmen, in all the work dgne and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley relating to or governing the work to be done and the operation of the devices herein named, and to the specifica ns set forth in the approved application for this permit on file in the office of the Inspector of Buildings. Inspector of Buildings 42 2M 11.67 V r CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Effective On January 1, 1991 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 Gas Piping (Needed with new furnace) Gas Range Gas Dryer "Air Conditioning - All Sizes JOB ADDRESS The undersigned hereby makes application for a permit for the work Rate TOTAL herein specified agreeing to do all work in strict accordance with the city codes and ruling of the Building Division, and hereby declares $ 20.00 $ �- b ° D O that all the facts and representations stated in this application are true and correct. ,1991 $10.00 $ � $� OWNER $10.00 $ BUILDING USED AS $ 10.00 $ ESTIMATED COST 161 3 3Q PERMIT NO. $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work Commercial/Industrial 1 % of Value of Appliance or Work State Surcharge TOTAL FEE $ No. of Heating Units—,/—Circle One (Steam) (Hot Water) (Warm Air Trade Name r_ Size No. BTU 57 /'1 - HP EDR $ Fuel Total Connected Load $.50 $ � 0o S -a MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 "Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Burner Trade Name Size No. BTU HP. EDR VOGT MM& AM CIVIDITIMS GORHAM AVE HEATING COMPANY ST LOUIS PAKMN 85M AM 99 9224= SO= 10401 Signed By C—�`�-2 Tel No. Z3 Y Approved By Rough -in Date Final Date FILL OUT BACK SIDE FOR STACK VERIFICATION ON 1� REPLACEMENT FURNACE % `v CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes ( j No ( ) 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected 6. Has total heating BTU's of �Sdy v All other BTU's TOTAL BTU's Remarks List Alterations Being Done: y a� Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) ssV,�-+ �Ol / J/✓J // ��� il S d J'� rce_®� 1 �G� 1'C' e7 /�— gi HEATING COMPANY Signed By Date 4 ar ! CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS RATE SCHEDULE '�— The undersigned hereby makes application for a permit for the work Residential Rate TOTAL herein specified agreeing to do all work in strict accordance with the Furnace Shell and Duct Work, Burner - city codes and ruling of the Building Division, and hereby declares Also Replacement Furnace $ 20.00 $ b� ©® that all the facts and representations stated In this application are true and correct. 11991 Gas Piping (Needed with new furnace) $10.00 $ OWNER IJ Gas Range $10.00 $ BUILDING USED AS Gas Dryer $ 10.00 $ 36,-t6— PERMIT NO. ESTIMATED COST � "Air Conditioning - All Sizes $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ No. of Heating Units_ Circle One (Steam) (Hot Water) (Warm Air Trade Name Size No. Commercial/Industrial BTU 5 /'" HP EDR 1 % of Value of Appliance or Work $ Fuel e4::� - Total Connected Load State Surcharge $ .60 Burner Trade Name. Size No. ;? 0a 5-a BTU HP. EDR TOTAL FEE $ VOGi HWWAdm GORHAM AVE. HEATING COMPANY ST LOUIS PARK MN 55426 AM fig 929 -CM SO= =4033 MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION Com- Tel No. ©I ;Z - PLUSREFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 Signed By PLUS THE $.50 STATE SURCHARGE 3 `f REINSPECTION FEE $30.00 Approved By Rough -In Date Final Date "Air Conditioners can not be placed In a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE % `v CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: I. Has been carefully examined Yes ( ) No ( ) 2. Is free from rust or deterioration Yes ( j 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's connected Yes ( ) No ( ) 6. Has total heating BTU's of All other BTU's v TOTAL BTU's /�/D, 0 r� Remarks List Alterations Being Done: J // HEATING COMPANY ��- ,� ,��,�°� c 01 signed By Date u sueaEcr E City ®f,Fridley 722 AT THE TOP OF THE TWINS (�2 BUILDING PERMIT r ECEIPT NO. _ COMMUNITY DEVELOPMENT DIV. ------ r � PROTECTIVE INSPECTION SEC. 1 . � NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 18/17198 JOB ADDRESS 6161 Starlite Blvd. NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 18 2 ISylvan Hills Plat 2 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Deo Deora' 571-0346 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Four Seasons Roofing and Remodeling LLC 7930 Univ.Ave.NE F795-9410 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 $9C REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage (23 Sq) 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 OCCUPANCYLOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING MOT. 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 ANDORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1918 $.96 DOES NOT PRE E TO GIV ITV TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS 0 NY OTHE STATE O LOCAL LAW REGULATING CON- STRUCTION HE PERF M CONSTRUCTION. $62.25 Fire SC $1.92 PLAN CHECK FEE TOTAL FEE Licens 5.00 .13 IGNATURE OF CONTRACTOR15R AUTHORIZED AGENT (DATE) E PROP ALID TED HIS IS YOUR 5 MIT DG )NSP �lA E SIGNATURE OF OWNER IF OWNER BUILDER) IDATEI [ Effective 1/1/98-.1 [ ] CITY OF FRIDLEY An SING'LE'FAMILY -AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION -o.su uctionAddress: r 4 �CScrlptlon: t K . ° Name & AddressI Tel. # MN LICENSE#_ Tel. # Attach"t� ihis application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. ir1 SCRIPTION OF IMPROVEMENT AAE A:Length ,r Width Height Sq. Ft. a. A: Length ' Width Height Sq. Ft. iJ.t.':L;sK AR.l.+.A: Length Width Hgt/Ground Sq. Ft. t I2: -e. n+ .. h u 1 5' r � sz Estimated Cost: $ �r9 (Fee Schedule, on Back).. k _...:y Curb Cut Width' Needed• y°'' z Ft.` + ` 6 F — Ft X $ _ $ Tel. #,"� r , CITY USE ONLY Fee Schedule on Reverse Side S rcharge $ ;' 001. of Permit Valuation (1/10th%) a t Hca: Surcharge, $ �,$.SO/$1,000 Valtiationg xt r SAC Charge Y$1000 per SAC Unit, ; a o License Surcharge $ $S 00 (State Licensed Residential Contractors) ; r y� 1. r:vcway Escrow $ Alt. °"A° or A1C. "B" Above 40 4i`� i Control $ $450.00 Conservation Plan Review Determined by Engineering �.. i; cr Iviain Charge' "$"`Agreement Necessary [ ]. Not Necessary . V � 7 i4 �t - Y„ { TOTAL r k $ r i�' , v v 21 ie� .. .�" a S`l'iPULATIONS Building 1 r,1+l BUILDING Permit No. 6lq -575 Inspections RESIDENTIAL; APPPLICATION Received By: ' 763-572-3604 763-502-4977 FAX CITY OF FRIDLEY EFFECTIVE 1-1-2010 DATE YOUR E-MAIL ADDRESS SITE ADDRESS &V92, THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME-.— -7-140POC TENANT ADDRESS:/ / S`t'�'%ZL .� 5 `j' STATg"Z1P .i� ZJ3 �i . PHONE: Za �` 4 -" s r CONTRACTOR NAME: SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY STATE ZIP INSURANCE PHONE FAX PROPERTY TYPE'SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE P DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORD: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE:_ `�oAl r 12-<tyR2PO R rx j J L L F A),9Y /-f y F" 010rN a `►1 f 1 C� l� i ^�� �! SIZE OF IMPROVEMENT We( ZC1T --:P LENGTH � - WIDTH— HEIGHT " SQ FT ROOFING NUMBER OF SQUARES ❑ HOUSE ONLY ❑ 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: -* 20 0 kFOR SIDING (�c�k -S-4-p> ^�U��� �'tJ��� NEW CONSTRUCTION INCLUDING DECKS, 0S off ADDITIONS. &PORCHES SUBMIT:❑Vinyl [3 Aluminum 11 Trim 1. Site Plan/Survey showing the existing structures ❑ Other 13 Fascia and proposed project. 2. Two sets of construction plans WINDOWS 3. Energy Calculations IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U -VALUE AND OR FOR NEW OPENINGS -DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW. OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) COTAL JOB VALUATION $ :5 to 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 $ 1 r,1+l $ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determination) - —ft +6 ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks savable to: Citv of Fridlev Attach THIS 1S 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 all work which regyjres review and approval of plans. SIGNATURE OF APPLICANT. _PRINT NAME,5ddO � Mht— DATE 4/ BUILDING PERMIT APPLICANT: PROPERTY OWNER 1, 7 Go J`/ , understand that the State of Minnesota requires that all residential building contractors, remodelers and roofers obtain a state license unless they qualify for a specific exemption from the licensing requirements. This license requirement applies to owners of residential real estate who build or improve such property for purposes of speculation or resale. By signing this document, I attest to the fact that I am improving this house for my own use and am not building or improving this house for. the purpose of reselling it. I hereby claim to be exempt from the state licensing requirements because I am not in the business of building or remodeling on speculation or for resale and that the house for which I am applying for this permit, located at / <, �-��Q L ri is the only residential structure I have built or improved in the past 24 months. I also acknowledge that because I do not have a state license, I forfeit any mechanic's lien rights to which I may otherwise have been entitled under Minn. Stat. §514.01. Furthermore, I acknowledge that I may be hiring independent contractors to perform certain aspects of the construction or improvement of this house and I understand that some of these contractors may be required to be licensed by the State of Minnesota. I understand that unlicensed residential contracting, remodeling, and/or roofing activity is a misdemeanor under Minn. Stat. §326B.082, subd. 16 and can also result in a fine of up to $10,000.1 further state that I understand that the filing of a false statement with The City of Fridley may also result in criminal prosecution and/or civil penalties to applicable city ordinances and/or state statutes. I have also been informed and acknowledge that by listing myself as the contractor for this project, I alone will be responsible to The City of Fridley for compliance will all applicable building codes and city ordinances with the work being preformed on this property. Signature of rope Owner Gl-ems✓�o Date For questions or information on contractor licensing, or to check the licensing status and enforcement history of a particular contractor, call the Minnesota Department of Labor and Industry, Construction Codes and Licensing Division, at (651) 284-5069. The web site is: http://www.dli.mn..izov/Ccld.asp