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PRE 2010 DOCSSUBJECT City of Fridley .1 AT THE TOP OF THE TWINS BUILDING PERM r T NO. � • COMMUNITY DEVELOPMENT DIV — � i PROTECTIVE INSPECTION SEC. (� �6r CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BY 612-571-3450 910-F15 1 2/13/95 JOB ADDRESS 5861 West Moore Lake Dr NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 5 1 Donnay's Lakeview Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Patricia Winter 5861 West Moore Lake Dr 571-7064 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Panelcraft of Minn Inc 3118 Snelling Ave S, M ls., MN 55406 721-6628 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 2179 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION 0 ALTERATION C. REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reside Dwelling 9 CHANGE OF USE FROM TO STIPULATIONS 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 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 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 $5,868 $2.93 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING COW Fire SC $5.87 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $81.00 PLAN CHECK FEE TOTAL FEE License SC 15.00 $94.80 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATEI WHEN PROPERkn 4soo -'8LjFG INSP VALIDATED pp� THIS IS YOUR PERMIT 6�✓/ DA SIGNATURE OF OWNER Iff 0WNER BUILDER) IDATEI NEW [ ] ADDN [ ] CITY OF FRIDLEY ALTEP<1 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address ( W, Effective 1/1/93 On 1 -cezi q r> Legal Description: Owner Name Address: Tel. # _ Contractor: rirt/yG MN LICENSE # 000 a 1- 9 Address: % 5 8 6 Tel. # 7-21-66-22 A ch 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. T DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ Ft. Yd Setback Side Yard Setbacks Type of Construction: Estimated Cost: $ Approx. • Completion Date: (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: � 1��,7 Tel. # CITY USE ONLY Permit Fee $ /. 0Q Fee Schedule on Reverse Side Fire Surcharge $�`�, '� .001 of Permit Valuation (1/10th%) State Surcharge $ 3 $.501$1,000 Valuation SAC Charge $ $750 per SAC Unit License Surcharge $ ? $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ ( t STIPULATIONS: �J�Jh I• Building BUILDING Permit No.500 I , InspectionsRESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY Date Rec'd: 0 DATE -% -- YOUR E-MAIL ADDRESS P' - STYE ADDRESS v - THIS APPLICANT IS: WOWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: VI -J, .�- ADDRESS: \ Li+ • 'st��:sf i- 1lG CITY S •I \ STATE► ZIP TENANT PHONE: iii ^ 2 \ Z e- CONTRACTOR NAME: STATE LICENSE # EXP DATE SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE ZIP WITH APPLICATION PHQNE FAX PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ,EMECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING ONE: 'h ,,, \ c -'k— SIZE OF IMPROVEME LENGTH / WIDTH Y'Z HEIGHT —oL— . Ft. (..P-> ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan 2. Proposed floor plan PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used PROPOSED HEIGHT: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim I . 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 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 1997T.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ��a 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 .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1550 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 savable 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 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; that the work will be in accordance with the approved plan in the case of all work which ruires review and approval of plans. SIGNATURE OF APPLICANT -7V - -E� PRINT NAME1v-: =v a DATE A a JA A a JA ..a � 'q FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287 BUILDING PERMIT APPLICANT: PROPERTY OWNER I, ,, -- , 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. As the owner of the property at �- - , Fridley, am exempt from the state licensing requirement only if I am not building or improving this property for purposes of resale. By signing this document, I attest to the fact that I am improving this house for my own use and do not intend to sell 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, isl the first 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 Minnesota law, and that I would forfeit my rights to reimbursement from the Contractor's Recovery Fund in the event that any contractors I hire are unlicensed. 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 with all applicable building codes and city ordinances in connection with the work being performed on this property. Name Date