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PRE 2010 DOCSCity ®f Fridley, B ,0 Date: j - - � N Address Address CATI F B DING No. Street Part f Lot Block Addition or Sub- on ®,r® Corner Lot Inside Lot aback _ Sideyard Sewer Elevation _ _ F dation Elevation DESCRIPTION OF BUILDING To Front Depth Height -off Sq. Ft.IL5� Cu. Ft.12240 ont Depth Height 5q. Ft. Cu. Ft. Type of Construction :. .. t.®To be Completed _ In consideration of the issuance to me of a permit to c the roposed work in accordance with the description above ordinpances of the city of Fridley. In consideration of the payment of a fee of (I permit is hereby granted to '=onto to do provisions of to construct the building or addition as described above. This permit is granted upon the express condition at thperson to whom it is granted and his agents, employees and workmen, in all work done in, aroundEdjNsridley,within hdtyta� permit may be revoked at any tie upon vio of any of the provisions of said ordinancxe. Building Inspector NOTICE 'fids perm* doss not sever the contraction, hatAWan for wiring, phm1bh►g, gas heating, sewer or water. Be sere to we the MIA* hupestor for aparate pern*s for then home. '7�,/ /" ",I tr� I �( 1.3 APPLICATION FOR .BUILDING. PERMIT CITY OF FRIDLEY, MINNESOTA t UM2,313 ° S NAME �i`d1f� � ��ig %ll- .. BUILDER 91-ecO 6'Q4T�' LOCATION OF BUILDING No. ^��(� Street d0,eE LJOC�g Of Part of Lot Lot Block Addition or Subdivisi -- '¢ // Corne Lot Inside Lot Setback Side -Yard SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates, of Survey of Lot and proposed build- ing location drawn on these Certificates. DESCRIPTION OF BUILDING fl --- To /bye �us d ash lV`I�i(?-A &E Front /6 / Depth P Height Sq. Ft, Cu. Ft. Front Depth Height Sq. Ft. Cu. Ft. Type of Construction Estimated Cost �1021® d To be Completed 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 started in this application are true and correct. DATE SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. . . Yes ( ) Type RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL S No ( ) $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance State Surcharge Reinspection Fee $ ($15.00) TOTAL FEE Effective Date May 1, 1988 Job Address I e 0 �(S t� lUo v t e— (_ k r or I 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 /V 1 Fridley, Mn. 4-�vJ� /!, 19y OWNER �a !f KIND OF BUILDING '!!�Za 4-Z21 -f USED AS ��.(� -e TO BE COMPLETED ABOUT 3 ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. / C)4 312 Company i fe CV Signed By —' i.t. Tel. No. ROUGH INSP. Date FINAL INSP.' Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE EQ > m m o x a) Water F d ro v Heater H ronr ❑❑ y' ,W ,lC�. at Q x C C� i67 ,� O 1 0ro m R U) -I O O +' N +� N aI M m U a0 ti 3 A W En W U�� roN Rang- yl 1st 2nd 3rd 4th (R) Future Connection Opening Connected with Sewer (*) = New Fixture, Old Opening Water RATE SCHEDULE PLUMBING FIXTURE RATES: NO. New Fixtures Future Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Hydraulic Valve Sump or Receiving Tank Water Treating Appliance Hot Water Heater Gas Range Gas Dryer Back Flow Preventer Required. . . Yes ( ) Type RATE $ 5.00 $ 3.50 $ 1.50 $ 4.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 5.00 $ 7.00 $ 5.00 $ 10.00 $ 10.00 TOTAL S No ( ) $ 5.00 $ ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance State Surcharge Reinspection Fee $ ($15.00) TOTAL FEE Effective Date May 1, 1988 Job Address I e 0 �(S t� lUo v t e— (_ k r or I 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 /V 1 Fridley, Mn. 4-�vJ� /!, 19y OWNER �a !f KIND OF BUILDING '!!�Za 4-Z21 -f USED AS ��.(� -e TO BE COMPLETED ABOUT 3 ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO. / C)4 312 Company i fe CV Signed By —' i.t. Tel. No. ROUGH INSP. Date FINAL INSP.' Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE suBjEcr PERMIT--AkQ-r-_$ City of Fridley AT THE TOP OF THE TWINS BUILDING PERMIT 23285 f RECEIPT"NCS. • COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r "1 CITY HALL FRIDLEY 55432 NUMBER REV GATE PAGE OF APPROVED BY 612-571-3450 910-F15 4/17/95 / / JOB ADDRESS 5840 West Moore Lake Drive NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 4 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jay Lowinski 5840 West Moore Lake Drive NE 571-7463 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Hendricks Roofing Co 2521 Jones P1 W, Bloomington MN 55431 881-7274 20032276 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 Q ❑ NEW E] ADDITION ❑ ALTERATION X REPAIR X ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Reroof House (24 Sq) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roofing can be the 2nd layer but not the 3rd. 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 SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 1STALLS 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 $1,320 $.66 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 F ANY OTHE kSTAT OR CAL LAW REGULATING CON- $33.00 Fire SC $1.32 T UCTI TH PE AN Q`F NSTRUCTION PLAN CHECK FEE TOTAL FEE License SC $5.00 $39.98 SI NA URE OF NIRA ORO UTHORIZ DAGENT IOATEI WHEN PROPER VALIDATED THIS IS YO R PERMIT] / 0E SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) BLOG )NSP ')ATE NEW ADDN ALTER Construction Address Legal Description: Owner Name &. Contractor: Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application sa') P]l nm"t U 9J. Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground ;ro-1 ( --,?A— s,2, 0_0 CALL- /L Comer Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: _ Effective 1/ 1/95 Tel. # Al 727, Sq. Ft. Sq. Ft. Sq. Ft. Ft. Yd Setback Side Yard Setbacks Estimated Cost: $ a (Cost on Back) Driveway Curb Cut Wi�d h Needed: Ft. 5 Ft — x $ _ $ DATE: 'I Z ' APPLICANT: Tel. IF ry # 7 CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ % - 3,� .001 of Permit Valuation (1 / 10th %) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $850 per SAC Unit License Surcharge $ S • $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 $229A STIPULATIONS: SUBJECT PERMIT NO. City of Fridley4 AT THE TOP OF THE TWINS BUILDING PERMIT f NO. 16. � COMMUNITY DEVELOPMENT DIV. INSPECTION SEC- r � � PROTECTIVE NUMBER REV DATE PAGE OF APPROVED BY I = 1 CITY HALL FRIDLEY 55432 �..__1`.' '•� 612-571-3450 910415 2/2/99 10B ADDRESS 5840 West Moore Lake Drive NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 7 4 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Steve Carda 5840 West Moore Lake Drive NE 327-4958 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO David Kaas Construction 10231 Sunrise Drive, Fridley, MN 55432 986-8464 City 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 Cj REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside House & Garage 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering. SEPARATE PERMITS ARE REOUIRED 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 1 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 $4,800 $2.40 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACARGE P OVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON4- S TION OR THE PERFORMANCE OFC UCTION $99.75 F SC $4.80 PLAN CHECK F FEE 9 / 7$106.95 I', SIGNATURE OF CONTRACTOR R AUTHORIZED AGENT IDATEI HE P VALI D THIS IUR RM FFF S-GNATUREOFOWNER.IFOWNER BUILOERI IDATEI 8LG INS f)ArE NEW [ ] Effective 1/1/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: J 1® �- (�C)p �'� •ak 0 f , V Legal Description: Owner Name & Address: yg. �r� Tel. # SPL �py�� r(�.0 �'o �., MN LICENSE # Contractor: �� C Address: Loa--�A q- pr.yr� C�� ei,� ter. Tel. # 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 Sq. Ft. OTHER: 'A0 k �ky-!k Construction Type: Estimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $, DATE: APPLICANT: c� Tel. # c EMG Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1 / 10th %) $.50/$1,000 Valuation $1050 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL. $ STIPULATIONS: PURCHASE ORDER BY DATE o/_5- THIS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY F 60461 THIS NUMBER MUST APPEAR ON ALL CORRESPONDENCE SENT TO US SUPPLIER Aq-416s Is ADDRESS ��7�� -� ®b )q/,6 Ls:s1w, c CITY OF � -�� (�/ FRIDLEY PHONE N0. 6431 UNN. AVE. N.E. FRIDLEY, MN 55432.4384 CONTACT ON RECYCLED PAPER. PAYMENT VOUCHER BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEN RECEIVED OR RENDERED AND ALL CITY GUIDELINES HAVE BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOW STATED ITEMS. -.5 4ATE612-571-3450PRINTED VAUTHOEM00 ACCOUNT CITY. I UNIT PLEASE ENTER OUR ORDER FOR THE FOLLOWING UNIT PRICE AMOUNT At ® it TOTAL �,-ae, THIS AGENCY HAS AGREED NOT TO DISCRIMINATE IN HIRING PRACTICES ON THE BASIS OF RACE, SEX, COLOR, CREED, MARITAL STATUS, RELIGION, OR NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGES FIRMS AND OTHER AGENCIES WITH WHOM IT PURCHASES PRODUCTS OR SERVICES TO DO LIKEWISE. WHITE, VENDOR - YELLOW, PURCHASING - PINK, ACCOUNTING - GOLDEN ROD, DEPT. HD. SUBJECT PER City of Fridley 2 96 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r � � PROTECTIVE 1 , NUMBER REV DATfiPAGE OF APPROVED BY = -'Ti CITY HALL FRIDLEY 55432 612-571-3450 910 -Fl! 2/4/99 JOB ADDRESS 5840 West Moore Lake Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 4 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Steve Carda 5840 West Moore Lake Drive NE 986-8464 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO David Raas Construction 6231 Sunrise Dr NE, Fridley, MN 55432 586-9707 City 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 O NEW Q ADDITION O ALTERATION REPAIR O MOVE O REMOVE 6 DESCRIBE WORK Replace windows 9 CHANGE OF USE FROM TO STIPULATIONS Install smoke detectors to meet the State Building Code - in each sleeping room and on each level of the dwelling. REFUNDED $5.00 License Surcharge collected in error. 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 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 $2,200 $1.10 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRA PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VI 7E OR CA CEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCA AW REGUL ING CON. T CTION OR TME PERFORMANCE OF CONS RUCTION $74.75 Fie SC $2.20 PLAN CHECK FEE TOT FEE 78.05 SIGNATURE OF CON'RACTOR OR AUTHORIZED VENT IDATEI HE PROP VALID E HIS IS YOUR PERMIT PIS —efor. -NSP ' y na TE S-GNA TURF OF OWNER OF OWNER BUILDER& IDATEI NEW [ ] ADDN [ J CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 5S I- 0 Legal Description: 1<� UP,. q P - Effective 1/1M- Y Owner Name & Address: �t--e.�,r� C Tel. # <::1196 -M (a � Contractor: �Gc�.S MN LICENSE # Address: D t Si,,h �;� 2 �; �`'� Tel. # 66 1C( 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 Sq. Ft. OTHER: Construction Type: t ; �� Estimated Cost: $ a�� c (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: p'2 l ' Ci APPLICANT: N"� Tel. CITY USE ONLY Permit Fee $ Fee Schedule on Reverse Side Fire Surcharge $ �. .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ $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 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 Rate TOTAL Furnace Shell and Duct Work, Burner - Also Replacement Furnace $ 30.00 $m ®® (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) $10.00 $ 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 $10.00 $ $ 25.00 $ , State Surcharge $ .50 TOTAL FEE - MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr Effective On January 1, 1998 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 aqq true and correct. n , /A e BUILDING USED AS ESTIMATED COST 32-75 e "0 PERMIT NO. DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Named f Size No. BTU HP EDR Fuel S Total Connected Load Burner Trade Name BTU HP HEATING Signed By Size No. EDR Approved By Rough -In Date Final Date *Air Conditioners can not be placed in a side yard without FILL OUT BACK SIDE FOR STACK VERIFICATION ON written permission from adjoining property owner. REPLACEMENT FURNACE CHIlVINEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes (xj No ( ) 2. Is free from rust or deterioration Yes(} No K-_,) 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 O No 6 Has total heating BTU's of 04P® All other BTU's 3 TOTAL BTU's 7. Has a liner been provided for water heater Yes No ( ) 8. Has combustion air been provided for water heater Yes No ( ) Remarks: HEATING CO: Signed By: Date: L sueJEcrIT NO. City of Fridley -34012 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T r ` RECEIPT NO. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. r F NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 763-571-3450 910-F1511/6/03 JOB ADDRESS 5840 West Moore Lake Drive NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 7 4 1 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE MIke & Heidi Bruder 5840 West Moore Lake Drive NE 763-786-3255 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO David Schweich Construction 21716 Kenrick Ave, Lakeville, MN 55044 952-469-3222 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20262622 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION Cj ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Install one basement egress window 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. Caulk and flash all exterior openings. iA bell 6' `rsE I; 10 Hna r To Paw 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 SQ. 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 1 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 $1,800 $.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 SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $63.15 Fire SC $1.80 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTALFEE is se SC $5.00 $70.85 SIGNATURE OF CON'RACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY VALIDATED THIS IS YO R PERMIT 1 OG -NSP r!A E S-GNATURE OF OWNERIIF OWNER BUILDER! IDATEI NEW [ j CITY OF FRIDLEY Effective 1/1/2003 ADDN [ J 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: -Sq 4 o Moore--Ln-" Legal Description: Owner Name & Address: IM 14'?� r� a I h� �� Tel. # Contractor: botAn rj e � p. (� �,_„ �;�-,C , �,yy MN LICENSE Address: �,1� i.� (��y�.ie.P��, / WO�y,^ Ut] Tel. # q 3a -q-69 - Attach to this application, a Certificate of Survey of the lot,�vith 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 Sq, Ft. OTHER: �,(�S �Jo rvs86 W �.p Construction Type: / 1'4C�L 6/�/�' ,� Bit i5EstimatedCost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ DATE: / _a; APPLICANT: L�L Tel. #1��" Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ —70. &5 CITY USE ONLY - Fee Schedule on Reverse Side° .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ] Building $ 95 . _ BUILDING Permit No.:'A U' Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received Byx,/ 763-572-3604 Surcharge CITY OF FRIDLEY D A P 2 763-502-4977 FAX $ ,JLv(, $5.00 (State Licensed Residential Contractors) SAC Charge $ EFFECTIVE 7-1-2010 Curb Cut Escrow DATE C) YOUR E-MAIL ADDRESS SITE ADDRESS"IU��'� �) THIS APPLICANT IS: ❑ OWNER MEONTRACTOR PROPERTY OWNER/ NAME: I C_ kk re -1., NEW I6<11 -1100f/6 TENANT ADDRESS: 5i' 4/0e 9 % C.CITY l � � 6 d STATE .a�ZIP.� $ PHONE:_��c7 3 — 415- % 5 7 CONTRACTOR NAME: S A COPY YOURUR STATE LICENSE STATE LICENSE # � j sk0 EXP DATE d / AND CERTIFICATE OF ADDRESS: �Q % 8 CITY w 1qE=' W STATE, ZIP INSURANCE PHONE 63 - FAX '-s - 7P, 3 PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑�iARAGEISHED ❑WINDOWS ❑ BASEMENT FINISH OOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION 0MAIN17ENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: r Lo et E6'0i:- SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING 19:HOUSE ONLY NUMBER OF SQUARES M& GARAGE BASEMENT REMODELING SUBMIT:OUSE 1. Existing Floor Plan ARAGE i — ❑ ATTACHED GARAGE PROPOSED SIZE:_ ° ❑ 2. Proposed floor plan DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl psoffit ADDITIONS_ & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. 2. Two sets of construction plans WINDOWS 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 A -Li . FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: } 1I�G THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S rJd nrr> lV A1%TJ rw� Permit Fee $ 95 . _ See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 3 1411 .001 times the total job valuation Surcharge $ LF .0005 x Permit Valuation Minimum $5.00 License Surcharge $ ,JLv(, $5.00 (State Licensed Residential Contractors) SAC Charge $ $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = #t x $24 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 600 .. 41 Make checks vavable to: City of Fridlev Attach Stinulations THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and wor 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 w i lr re res ew and approval of pl SIGNATURE OF APPLICANT PRINT NAME DATE O APPROVAL INSPECTOR SIGNATURE