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PRE 2010 DOCSSUBJECT PERMIT_ N City of Fridley 15.2 9 s AT THE TOP OF THE TWINS BUILDING PERMIT t 9 • COMMUNITY DEVELOPMENT DIV. d e PROTECTIVE INSPECTION SEC. 3 NUMBER REV. DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 L J� 612-571-3450 910-F15 6/28/79 JOB ADDRESS 5429 West Brenner Pass N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 4 1 Innsbruck North Townhouse Plat 5 SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Darrel A. Farr Development Corp. 7286 - 72nd Lane North Brooklyn Park 55428 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. Same - O:5 4 ARCHITECT OR DESIGNER MAILADDRESS ZIP PHONE LICENSE NO. - 5ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO, 6 USE OF BUILDING ReSidential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK I 9 CHANGE QF USE FROM TO STIPULATIONS Party wall must be two separate 1 hour walls from bottom to roof. Firestop soffits. Provide combustion air to furnace from outside. WARNING tles SEPERATE Before a�E' EtECTRtC�tGAS�Et�. PERMITS R TELEPNO REQUIRED F� WIRING, HEATING. PLUMBING AND SIGNS. REQUIRED BY LW TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 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 $24,360 $12.18 DOES NOT PRESUM TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS -4F OT ATE OR LOCAL LAW REGULATING CON- $425.00 STRUCTI E PE ANCE OF CONSTRUCTION. $50.72 PLAN CHECK FEE TOTALFEE $12.68 $500.58 SIGNATURE OF CON ACTOR Oge4THORIZEDAGENI IDA E WHENXROPERLY VALIDATED THIS IS YOUR PERMIT r5fTE SIGNATURE OF OWNER dF OWNER BUILDER) (DATE) APPLICATION I=OR 11171 IDE -IT I AL BUILDING PEW1I TS (NEW., L-1'ERATIons, hDITIONS, OR REPAIRS) otMtrR: Lltihh l�l� . ,2 �1. �p DUILUl3Jt: Address: AddrC Tel. I•b.:, �! I/1� • j. Street LOT: 44'. - ADDXTION: ------ COPMEIt LOT: INSIDE LOT: �, S, Ti3ACY.� SXDEYARD�: Applicant attache to this form IN -7o Certificates of Survey a£ Lot and proposed - building location drawn on'these Certificates. DESCRI PTION OF BUILDING To 33C Us�d As _�,%c.r..�...... Front: Depth _ ' = Neigh -t:8 Square Feet: /3 3 Cubic Feet: /�� 79 2'xont: : Depth Height: - - Square Feet:'. Cubic Feet: Type of Construction: G Cvyt Estimated Cost: $' To Be Completed: Alt. A Alt_ R - l Pr6posed Drivaizxy Width If Neil Opening Is Desired $ . (SEE I'.I;VERSE 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 ruliigs of the Dcs-)artmcnt of Duildings, and hereby declares that all the facts and representations stated in this application are trite amid correct. See reverse side for additional bzformation. _ DATE: G/� �2 � - SIGNIN R.13: 5tip:aiations: - , _ . q�,S7- oo �,71;y 1'510o.15 8' CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERM 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 . Fridley, Mn. h , 19 OWNER < KIND OF BUILDING USED AS TO BE COMPLETED ABOUT "or Ap PARTIAL PARTIAL RATE SCHEDULE 0 - ro C W PLUMBING FIXTURE RATES: NO. RATE OLD - BUILDIN ERMIT NO. waterA d m m n H W C M+ W A Company + ) -1 a, x $ Heater eda Catch Basin x $5.00 C m F Water Heater - to 99,000 BTU t t $5.00 C Id 6 i 44 100,000 BTU to 199,000 BTU - x N $ C 4+i�.0 $7.00 $ 3 O Ua 4 O C ROUGH INSP. UC Electric Water Heater O $5.00 $ Date 14 FINAL INSP. lst 3 fixtures x $3.00 $ N U 5 to KI $1.00 y $ n W to W U M r$ $ C7 C7 O 3 leC 1st 2nd 3rd 4th (R) = Future Connection Opening Connected with Sewer M = New.Fixture, Old Opening Water 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 . Fridley, Mn. h , 19 OWNER < KIND OF BUILDING USED AS TO BE COMPLETED ABOUT "or Ap PARTIAL PARTIAL RATE SCHEDULE 0 - ESTIMATED COST PLUMBING FIXTURE RATES: NO. RATE TOTAL OLD - BUILDIN ERMIT NO. PERMIT NO. Number Fixtures x $3.00 n Future Fixture Opening =-� x $2.00 $ tea'% Company New Fixture, Old Opening x $2.00 $ t Catch Basin x $5.00 $ Signed BY Water Heater - to 99,000 BTU x $5.00 $ 10�� Tel. No. 44 100,000 BTU to 199,000 BTU - x $10.00 $ Water Softener x $7.00 $ New Ground Run Old Building x $5.00 $ ROUGH INSP. Electric Water Heater x $5.00 $ Date GAS FITTING FEES: FINAL INSP. lst 3 fixtures x $3.00 $ Date Additional Fixtures x $1.00 $ Gas Range to 199,000 BTU x $10.00 $ APPROVAL FOR PERMIT 2L REPAIRS $ ALTERATIONS First $100.00 $5.00 $ each add. $100.00 or fraction $2.00 $ State Surcharge S .50 TOTAL FEE $�E� REINSPECTION FEE ($10.00) MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE CITY OF .FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Job Address �? • 1';I�o ).sem A'[ ms`s Furnace Shall & Duct Work $12.00 $ *Replacement of Furnace 7.00 7.00 $ $ Department of Buildings Repairs 6 Alterations -up to $500.00 4.00 $ City of Fridley Repairs & Alterations each add. $500.00 Repairs Tel. #571-34-50 DSECHA\ICAC WAR,�I•AIR: The undersigned hereby makes application for a permit for the work herein Furnace Shell & Duct Work to 100,000 BTU $12.00 $ specified agreeing to do all work in strict accordance with the City Codes each add. 50,000 BTU 4.00 $ and rulings of the Department of Buildings, and hereby declares that all the 7.00 $ facts and representations stated in thig application are true and correct. *Replac -nert of Furnace Repairs & Alterations -up to $500.00 7.00 $ rl 4.00 $ Fridley, Minn. 7 19% Repairs & Alterations each add. $500.00 STEkti OR HOT WATER SYSTEM: OWNER rCK-C i Boiler & Lines up to 100,000 BTU $12.00 $ RIND OF BUILDING cl,� each addn. 50,000 BTU 4.00 $ ` Boiler only up to 100,000 BTU 7.00 S USED AS each addn. 50,000 BTU 6.00 $ TO BE COMPLETED ABOUT � OIL BURNER- to 3 gal. per hour $10.00 $ ��� each add. 3 gal. per hour 10.00 $ ESTIMATED COST _� GAS BURNER- from 100,000 BTU to 199,999 BTU $10.00 $ OLD - BUILDING PERMIT NO. PEP-14IT NO. --1 P741 (over 199,999 BTU see Fee Schedule) $ GAS FITTING.FEES: 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. Date FI:1AL INSP. 25'P IS/ Date APPROVAL FOR PERMIT ''r'9� REINSPECTION FEE ($10.00) MIh'IPWM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE *Attached stack verification form DESCRIPTION OF FURNACE/BUIUNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name �L !( ��' Size No. /" An gn i ) 6_ Capacity Sq. Ft. EDA BTU HP Total Connected Load %Qe),� nM Kind of Fuel Lrx L BURNER - Trade Name Size No. Capacity Sq. Ft. EDR BTU HP Company ? Signed By Tel. No. SUBJECT PERMIT NO. City of Fridley 04 5 ®- AT THE TOP OF THE TWINS BUILDING P E R M I T r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC r CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 1/9/97 JOB ADDRESS 5429 West Brenner Pass NE 1. LEGAL LOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 5 4 I Innsbruck North Townhouse plat 5 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dennis Thoreson 5429 West Brenner Pass NE 572-3819 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 la ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE R 8 DESCRIBE WORK Finish Basement 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plan. SEPARATE PERMITS REQUIRED I'M WIRING, HEATING, PLUMBING AND SIGNS. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3,000 $1.50 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- Fire SC $3.00 STRUCTION THE PERFORMANCE OF CONSTRUCTION $74.75 PLAN CHECK FEE TOTAL FEE $79.25 SIGNATU E OF CONTRACTOR TH NT IDATEI WHEN PAOPERL ALfpATED THIS IS YOUR PERMIT /m9—Q BLOd INSP F)A E G ATURE OF OWNER IIF O R BUIL ERI IDATEI NEW [ ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R -B Building Permit Application ConstructionAddress:l 10, OR r-1v",c- z Y/ i� ry, �5 y 3::? Legal Description: Owner Name & Address: QC,,/iv, Contractor: Address: Tel. #,�;-7a-3 8/ c� MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Tel. # LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: /3/?,S4716----V T .s // Comer Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks ------- Type of Construction: � Estimated Cost: $ 3, e!��d Approx. Completion Date: st on Back) Driveway Curb Cut Width Needed: Ft + Ft = Ft x $ _ $ DATE: J - - 7 APPLICANT: Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation 4 �C 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 f ] Not Necessary [ ] STIPULATIONS: , CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Effective On March 1, 1996 Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT o 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Wash Floor Auto, as W terHeater S tories Urinal Shower ..... �ray: Drain Washer ...... tlec Basement ;:....:.RangeGas . . . . . . . . . . . . . . . . . . . . . . Floor I ........... Floor 2 FI o r3 FI or 4 21 PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures$7.00 3L The undersigned hereby makes application for a permit.tor the work herein Old Opening, Now Fixture $4,00 specified agreeing to do all work In strict accordanoe with the city codes Beer Dispenser $5.00 and rulings of the Building Division, and hereby declares that all the facts Slow Off Basin $7.00 and representations stated In this application are true and correct. Catch Basin $7.00 Rain Water Leader $7.00 _ 1996 Sump/Recelving Tank, $7.00. Water Treating Appliance $10.00 Owner /S 72_';�® f 6 3 U Water Heater -Electric $7.00 Water Heater - Gas** $10.00 Building Used As /-"'o Gas Range" $10.00 Gas Dryer** $10.00 Estimated Cost PERMIT NO. Back Flow Preventer Required )Yes No Type $15.00 PLUMBING COMPXN� Reinspection Fee $42.00/Hr SIGNED BY ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ .50 TOTAL FEE MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 $_'9410 PLUS THE $.50 STATE SURCHARGE "COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES. F SUBJECT RMIT N" -Pr City, of Fridley - 3'12 0 3 AT THE TOP OF THE TWINS BUILDING PERMIT i RECEIPT N � COMMUNITY DEVELOPMENT DIV. L ------ r � PROTECTIVE INSPECTION SEC. I -'-f CITY HALL FRIOLEV .55432 ti----� NUMBER AEV DATE " PAGE Of APPROVED BY - 612-571-3450 910-F15 7/14/00 / / JOB ADDRESS 5425 .- 35 West Brenner Pass 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1-6 4 1 Innsbruck North Townhouse Plat 5 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Innsbruck Townhome Association 651-224-5482" S CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Garlock -French Roofing Corp 2301 E. 25th St. Mpls., MN 55406 612-722-7129 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 00001423 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O ADDITION ❑ ALTERATION CK REPAIR p MOVE p , REMO,VE 8 DESCRIBE WORK Tear Off and Reroof Townhouse Building 8 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. Permit inspection Card_ s Will Be Mailed To Homeowner To Post TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REOUIRED 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 80 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 IHEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 6 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 $11.30 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $22,594.75 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- $363.25 Fire SC $22.59 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE OTAL FEE '? $397.14 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT 40ATE. EN P RLY VALI ATED THIS IS YOUR PEAWT JbLOG iNSR Orr,ATE S-GNATURE OF OWNERdi OWNER BUILDER1 F a SUBJE& PER *O__ City of Fridley(�12568 AT THE TOP OF THE TWINS BUILDING PERMIT t v RECEIPT NO. • COMMUNITY DEVELOPMENT DIV. , VV ____ INSPECTION SEC ��� r PROTECTIVE CITY HALL FRIDLEY 53132 NUMBER nEv GATE PAGE OF APPROVED er 612-571-3450 910-F15 5/7/02 JOB ADDRESS 5429 West Brenner Pass NE I LEGAL LOT NO. BLOCK I TRACT OR ADDITION SEE ATTACHED DESCR. 5 4 I Innsbruck North Townhouse Plat 5 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Brian Prokop 5429 West Brenner Pass NE 763-572-0094 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO RNA Home Services Inc 3200 Cobb Galleria Pkwy STE 200, Atlanta, GA 30339 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 763-542-8826 20268257 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION j] REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace two windows within existing openings 9 CHANGE OF USE FROM TO STIPULATIONS Provide smoke detectors in all sleeping rooms and on all levels of the dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Permit Inspection Cards Will Be hailed To Homonwnpr To Pnt!t 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 80 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 $1,795 $.90 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 Licen $5.00 $ .85 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE. P MIT ' ENRO ALIDAT D IS IS�_ ® � r o _ SIGNATURE OF OW NEA ��F OWNER BURDERi -,DATE i BL NSP - DACE a NEW[ ] Effective 5/10/99 ADDN [ l CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: O� U �QS - 7�6tntrNrex' Legal Description: Owner Name & Address: -b c �o.N '� r o '�`' Tel. #4U-6 Contractor:; RMA HOME SERVICES INC. MN LICENSE # Home Depot Installed Sales Address: 3200 Cobb Galleria Pkwy., Ste. #200 Tel. # Atlanta, GA 30339 A 763-542-8826 urvey. of the kBC-20268257 in4t to scale. - r- -r -- DIESCRI IfIN OF 3EPROV NT .. . LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Widdi Hgt/Ground Sq. Ft. OTHER: rL�ength s� q► fit f !+ 0 Z kww l X_A n. . YL , . ; oA . l_ •. — . h rk. e k v,, 1 • e"r,� b Construction Type: Estimated Cost: $ j ,4go0— Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT:. t�.0� Tel. # CISa-34S. UCM4- CITY USE ONLY Permit Fee $ 10 3.1`.D Fee Schedule on Reverse Side Fire Surcharge $ 1.` b .001 of Permit Valuation (1/10th%) State Surcharge $ .10 $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ S,.:QQ $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 $ l®. STIPULATIONS: