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PRE 2010 DOCSCity of Fridley, Minn. BUILDING PERMIT N® 3 9 41 Date: .... , o 'Y ....... -Z' Owner ....................................... Builder �.. ..... Address ...................................... Address ............................................. j; yip LOCATION OF BUILDING No. Street .. ...... ....F: ....... Part of 4t ...... ...... ...... . Lot ...6 ...... Block ......c�..... .. Addition or Sub-Division� :.�......... . . ... ....... Corner Lot ............ Inside Lot A........ Setback Sideyard ..�............ DESCRIPTION OF BUILDING mocorls Me_ .. Front 4. 1: Depth .�f . 9 Height 1. !" A Sq. Ft.130 � Cu. pt. ..L!j�. Front .... Depth .. Height Sq. Ft Cu. F't $r' " on ............. ... Est. Cost. r ..:To be C leted ............... .,/ �. Completed ... .. . In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the city of Fridley. c1\ C101 In consideration of the payment of a fee of $��®.., 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 wham 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 regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. :. r.,:7" 41e! .. Building Inspector NOTICE: This permit does not cover the construction, Installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. H17rT.� fi 4 Sfi�, R FS_ V#1siV i+ l4ia s� "T,r * rrv!*";...w - City of Fridley, YUnn.. BUILDING PERMIT Date: June 18, 1969 Owner: Everett Utter Builder., Address 6 084 Woody Lane Address No. 6 084 Street Lot _ _ _ __ Block Same Same LOCATION OF BUILDING Woody Lane — Part of Lot Addition or Sub -Division Corner Lot — Inside Lot — Setback Sideyard Sewer Elevation Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Alterations Front 14' Depth 13' Front Depth Type of Construction Frame _— Est. Cost Height . Height . $500.00 Sq. Ft. Cu. Ft. Sq. Ft. Cu. Ft. To be Completed N9 10295 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 compliance with all provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 5 .00 permit is hereby granted to Everrett Utter 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 worlonen, 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 regarding location, constructionalteration, maintenance, repair andmoving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Clarence Be1is NOTICE: 'f9ds permit does not cover the construction, butalldion for wiring, plumbing, gas heating, sewer or water. Be core to we the Building Inspector for separate permits for these items. r APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER Is it �� ADDRESSi i �I 1ADDRESSI r I LOCATION*QF BUILDING NO. STREET LOT BLOCK ADDITION OR SUBDIVISION CORNER LOT INSIDE LOT SETBACK SIDEYARD SEWER ELEVATION TOP OF FOOTING 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'Aa:- &IL tL"e�%SFront Depth Height Square feet Cubic Feet Front Depth Height Square feet Cubic Feet Type of Construction Estimated Cost �® To Be Completed The undersigned hereby makes application fora 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 a plication are true and correct. DATE & SIGNATURE T (Schedule of Fee Costs can be found on the Reverse Side. City of Fridley, Yffim 155 6431 University Ave. N. E., Minneapolis, Minn. 55432 BUILDING PERMIT mate; _ July 251,--19-72 owner; Everett Utter Builder Same Address - 6084 Wandy lane N F. Address Same LOCATION OF BUILDING No 6084 Street _ Woody -Lane N.E. Part of Lot lot 6 Block _2 Addition or Sub -Division oore Lake Hills is Addition Corner Lot inside Lot X Setback — Sideyard Sewer Mevation Foundation Elevation DESCRIPTION CSP BUILDING o be Used as: Garage,- Front Depth __ Height _ Sq. Ft. _7ifey=. Cu. Ft. Front Depth Height - Sq. Ft. - Cu. Ft. Type of ConstructionWood Frgme Est. Cost � _ s � To be Completed — ly -1 1973 .7,60!9 �2r2 Stipulations: Provide a hard surface driveway. Provide frost footings under garage. 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 compliance Uhn all p visions of Ordinances of the city of Fridley. 1.02 State SurGhar e" r In consideration of the payment of a fee of permit is hereby granted to Everett Utter 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 rddley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings o� city limits and this permit may be revoked at any time upon violation of any of the provisions of said dthanBuilding Inspector CLARENCE BELISLE NOTICE: V& permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to a" . the Building Inspector for separate permits for these items. #; TYPICAL SLAB DETAIL O The above is a substitute design for frost footings, however, it is not yet accepted by the State as an amendment to the Uniform Building Code, Section 2905,a. Therefore upon using this method of construction, I agree to hold the City of Fridley harmless of any possible claim for foundation failure or structural damage caused by foundation failure. Witness Date Property Owner Address of Property gal Desc. a APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PRRMIT CITY OF FRIDLEY, MINNESOTA. f OWNER IS NAM: ADDRESS: /00 g1v•� da"'—tDR NO: b STREET: /it/ a2nk';e2 LOT; BLOCK: ig— ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEXARL:� Applicant attach to this form Two Certificates of Su_ rvp of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: 01 Front: //Depth : Height:/ O Square Feet: Cubic Feet: 4 Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: Estimated Cost: 3 To Be Completed: The undersigned hereby makes application for a permit for tine.vQrk heretu specified, agreeing to do all work in sttict accordance with the City 9f Fridley Ordinances and rulings of the Department of Buildings, and hetebT declares that all the facts and representations stated in this applia4tim. are true and correct. UATF. SIGNATURE: (see aerse Side For Additional Information.) SUBJECT P City of Fridley V 16_238 AT THE TOP OF THE TWINS BUILDING PERMIT __. r RECEIPT . COMMUNITY DEVELOPMENT DIV.�� y PROTECTIVE INSPECTION SEC. r 1 1 � � `•--_/'�',,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY j J\ 612-571-3450 910-F15 6/15/8/1 JOB ADDRESS 6084 Woody Lane N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 2 Moore Lake Hills SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE E. Utter 6084 %Toody Lane N.E. Fridley 55432 571-5181 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Owner 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 12 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof 9 CHANGE QF USE FROM TO STIPULATIONS Roof can be second but not third. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Asphalt 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 R-1 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 $.50 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,000.00 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. $7.50 PLAN CHECK FEE TOTALFEE $8.00 N�RECN a �D AGENT tDATEI WHEN PROP LY A ATED HIS IS YOUR PERMIT �RA BLD INSP DATE SIGNOWNER IIF I. DE RI 1 TEI CITY OF FRIDLEY APPLIC'ATioN FOR RESIDb,1TIAL BUILDING PEMiTS ' (New, Al aerations, Additions, or Repairs) OWNER: ADDRESS TEL NO: STRL`GT .NO : ®� STREET: LOT: BLOCK: � BUILDER: ADDRESS: TEL NO: Construction Locati" 2offl� �/_ Corner Lot: Inside Lot: Setback: Sideyards: Apblicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION • Front: Depth: Height: Square. Feet: Cubic Feet: • Front: Depth: Height: Square - Feet: Cubic Feet: Type of Construction: Estimated Cost: $ xb Be Clompleted: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE PZVERSE SIDE OF SHEET 7.iie 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 repres tati.ons stated in this application true d correct. MTE: SIGNATUFG : C Still, lations Easement Individual(s) to Corporation(s) or Partnership No delinquent taxes and transfer entered; Certificate of Real Estate Value () filed () not required Certificate of Real Estate Value No. 19_ County Auditor STATE DEED TAX DUE HEREON: Date , 1997 FOR VALUABLE CONSIDERATION, Everett F. Utter and Pamela A. Utter (husband and wife), Grantor(s), hereby conveys an easement to The City of Fridley, Grantee, a Municipal corporation under the laws of the State of Minnesota, real property in Anoka County, Minnesota, described as follows: A permanent drainage and utility easement lying upon Grantor's real property legally described as Lot 6, Block 2, Moore Lake Hills. The drainage and utility easement shall lie northerly and northwesterly of a line being 10 feet southwesterly as measured at right angles to the northeasterly line of Lot 6, Block 2, Moore Lake Hills. The City of Fridley hereby accepts this easement for drainage and utility purposes. William A. Champa - City Clerk Subject to easements of record. Everett F. Utter Pamela A. Utter STATE OF MINNESOTA ) )ss County of Anoka ) The foregoing instrument was acknowledge before me this — day of , 1997, by Everett F. Utter and Pamela A. Utter (husband and wife), Grantor(s). Signature of Person Taking Acknowledgment THIS INSTRUMENT WAS DRAFTED BY: City of Fridley 6431 University Ave NE Fridley, MN 55432 (612) 572-3550 STORMPOSED 15* R HDPE O• r,. PROPOSED `1\` EX H EASEMENT 12" CMP H1 TO BE ABANDONED MH1 / CB1 EX CB City of Fridley TO: Address File - 6085 Central Ave (6084 Woody Lane Lot Split) PW98-181 FROM: Jon Hukaas, Assistant Public Works Director DATE: August 25, 1998 SUBJECT: Water and Sewer Service As a stipulation for plat approval, the property owner was to have water and sewer utility services extended to this lot prior to the repaving of Central Ave (CSAH 35). Anoka County completed the paving August 21, 1998 and the utility extensions had not been completed at that time. No open cut excavation will be allowed across the new pavement for the first five years. To provide water service to this lot, a line must be tapped off Woody Lane east of where it intersects with Central Ave and extended to the lot south along the Central Ave right-of-way. To provide sanitary sewer service to this lot, a line must be bored under Central Ave into a manhole on the west side or an additional manhole must be installed in front of the property and a line extended south to the sanitary manhole in front of 6067 Central Ave. This work must be done in conjunction with any future building permits for the site. SUBJECT - PE . — City of Fridley 20167 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. -3 e i ,`� CITY HALL FRIDLEY 55432 NUMBER REV. DATEPAGE OF APPROVED BY •-_-� j 612-571-3450 910-F15 10/19/89 JOB ADDRESS 6084 Woody Lane N.E. 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 6 2 Moore Lake Hills. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Everette Utter 6084 Woody Lane N.E. 571-5181 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. D & D Home Improvement Inc. 7401 Central Avenue N.E., Fridley 784-7543 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 V REPAIR ❑ MOVE ❑ REMOVE 6 DESCRIBE WORK Install aluminum siding & trim 9 CHANGEQFUSEFROM TO STIPULATIONS 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 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 $� $l' 98 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT T� 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. $63. G0 P AN CHECK FEE TOTAL FEE $6.4,98 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) C v WHEN PROPERLY VA17DATED THI§ IS YOUR PERMIT J[l(.P BLDG INSP X�COA �� TE SIGNATURE OF OWNER 0F OWNER BUILDERI IDATEI NEW ] City of Fridley Effective 5/1/88 AMN [ ] R-1 AND R-2 ALTER [ ] Building Permit Application 1 Legal Description.- Attach escription: Attach to this application, a Certificate of Survey of the lot, with the proposoed construction drawn on it to scale. DESCRIPTION OF IMWEMU LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. Corner Lot [ ] Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks Type of Construction: Raw. ��Ai Estimated Cost: S -c� Approx. Completion Date: Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ Width + 6' See Back Page CITY USE ONLY Permit Flee $ 6 6 Free Schedule on Reverse Side State Surcharge $ /, ei $.50/$1, 000 Valuation SAC Charge $ $550 per SAC Unit Driveway Escrow $ Alt. 'A" or Alt. 'B" Above Park Fee $ Foe Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL STIPULATIONS: r; n MEMORANDUM TO: Jahn Flora, Director of Public Works FROK: Lois Witte, Public Works Secretary DATE: June 2, 1993 SUBJECT: Sewer Backups on 6084 Woody Lane Ie*" " �'e'l i el el I checked back through our City backup files, and discovered that prior to the sewer backup at 6084 Woody lane on May 16, 1993, there was only one other backup at his address in our records dating back to 1972. The previous backup was on December 23, 1977. The backup in 1993 was caused by roots, and the one in 1977 was unknown, except that when the backup was relieved they discovered a large piece of plastic, which could have caused the backup. So frc4n 1972 to 1993, there were two backups only, and very little damage in either of them. Mr. Utter called in two other backups on July 29, 1992, and October 29, 1990, but in both of these calls the City main was clear. In other words, the backups were in his own line. I did not go back beyond 1990 for sewer backups in his own line. As for any televising dare on this line, the only record I could find on Woody Lane was on October 16, 1970. C17YOF FRIDLEY FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. ,N1N 55.332 • (612) 571-3450 • FAX (612) 571-1257 July 30, 1997 PW97-111 Mr. Everett Utter 6084 Woody Lane Fridley MN 55432 Sul',ject: Storm Water Repairs Dear Mr. Utter: As a result of the exception rains that the City experienced during the first part of July, the City staff has been reviewing the storm water effects and possible improvements that can be made to the surface water system as a means of reducing damage and/or precluding further reoccurrence of some of the experiences this past month. As a result, the City proposes to accomplish the following action adjacent to your property as a corrective measure. If you have any concerns or questions regarding this proposal, please contact me at 572-3550 so that we may answer any of your concerns and schedule the appropriate work. We propose to execute a 10 -foot drainage utility easement along the northerly property line. This utility easement will allow the City to install an outlet from the catch basins on Woody Lane to a manhole at the vertical drop along your property line and the neighbors retaining wall then extend the line westward to Central Avenue for connection to the existing storm water drainage system. This work would be accomplished by a contractor at no cost to you once the easement agreement has been e?cecuted. Sincerely yours, 4ohn G. Flora Director of Public Works JGF:cz -- - sueJEb.RMV946� City of Fridley 3 0 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. i rr L — _____ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC VOW CITY HALL FRIDLEY 55432 NUMBER pEv GATE PAGE OF APPROVED By ......I L J` 612-571-3450 910-Fl 9/27/99 JOB ADDRESS 6084 Woody Lane I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 2 Moore Lake Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Salvador Mendoza 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO 5112 HBI Hoskin Business Inca 2311 26# 651-639-0794 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO B USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION )9 REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house and garage (29 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 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 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 $2535 27 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1, DOES NOT PRESUME E AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISI S OF ANYSTATE OR LOCAL LAW REGULATING CON- TR 10 OR E P VFORMANCE $83.25 F- SC $2.54 OF CONSTRUCTION PLAN CHECK FEE T FEE 7.06 S+ ATURE OF ACTOR O A i++OR+2ED AGENT IIATE, ME PRO VAL D THIS I R P RMI S-GNATUAE OF OWNERoF OWNER BUILDER, IDATEi 90G 5 T+A E NENV [ � ] - Effective 5/10/99 -ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: `, Legal Description: Owner Name & Address: C5A(')"DP— Tel. # Contractor: MN LICENSE #�OG'S�S`� Address: 073 // e:2�6ft, fegve- M. .) Tel. # 105- —6�� � ®2q el 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 �H/ gt/Ground Sq. Ft. OTHER: � � d� S�� �' l �1f�— `O , Construction Type: I ' -��p Estimated Cost: $— _ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ DATE:L7 In APPLICANT:a) T� i�c�s �. �� �E r 1 Tel. # (6571-63 r - a ,,3 e/ TOTAL $ STIPULATIONS: CITY USE ONLY Permit Fee $ o`3 Fee Schedule on Reverse Side Fire Surcharge $ FE� .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: I SuBjECT PER City of Fridley 33417 AT THE TOP OF THE TWINS BUILDING PERMIT ` R O. r.v �_____ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. I; 1 . � NUMBER REV DATE PAGE OF APPROVED BY i A ��'�'�'� CITY HALL FRIDLEY 55432 •_-• l J ` 763-571-3450 910415 4/10/03 JOB ADDRESS 6084 Woody Lane NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 Everett Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mendoza 6084 Woody Lane NE 763-502-9913 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sears Home Improvements 5512 Lakeland Ave N, Crystal, MN 55433 612-382-5491 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20090017 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 six 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. Caulk and flash all exterior openings. 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 @ $2.00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4,000 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, ONSTRUCTION PLAN CHECK FEE TOTAL F E License 5.0,0 $ 8.25 SIGNATURE OF CON -R&TOR OR AETHORIZED AGENT (DATE. ENP OPE ALIOAT D IS IS Os MIT ♦' SIGNATURE OF OWNEROF OWNER BUILDER. [DATE, BLOC INSR �IArE I NEW [] ADDN [ ] CITY OF FRIDLEY ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: Legal Description: Effective 1/1/2001 (763) 572-3604 Bldg Insp Owner Name & Address: Z) o7 Tel. # 763- $off.- !39 1 Contractor '�P?c25 Avlorne � L,�— �S MN LICENSE # /RC Z009 l 7 la Tel.#Coli-3g2-Sqq I Attach to this application, a Certificate of Survey of the (Sl) 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: � 6 ea � s� Construction Type: X16 en2 imated Cost: Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$ DATE: APPLICANT:- Tel. #4/Z7 / l CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application Permit Fee $- Fee Schedule on Reverse Side Fire Surcharge $ oc.> .001 of Permit Valuation (1/10th%) State Surcharge $ co $.50/$1,000 Valuation SAC Charge $ / $1150 per SAC Unit License Surcharge $ U $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 $ J STIPULATIONS: AUG -31-2005 1155 CITY OF FR I DLEY PLUMBING RESIDENTIAL APPLICATION City of Fridley P.01i01 Received By Date Received NOTE: IF PROPERTY IS NOT OWNER(OCCUPIEED-- A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT. DATE �D ` i N L O S YOUR E44 L ADDRESS SITE ADDRESS 609.A Waaw THE APPLICANT IS: (CIRCLE ONE) OWNER Q ��j NAME ___ A�.�1 A1JtSU �'e n CkOZ.R PROPERTY owailEw TENANT ADDRESS S AYri2...+ CITY _ STATE alp PHONES 'l In 3 - SO A — CkCt � CONTRACTOR NAME River City Sheet Metal, Inc. ADDRESS 8290 Main St. ., alta 3 CITY N 55432. STATE LICENSE ZIP PHONE Spffi)754--2199 Fax (7683)76 4 -2900 PERMITTYPE SINGLE FAMILY TWO FAMILY TOWNHOUSE TYPE OF WORK ® NEW P( REPLACFAENT DETAILED DESCRIPTION OF WORK a► M� . O.nnnc w: c 101 1-10 S 4 a FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED FDMIRES: (INDICATE TOTAL NUMBER OF EACH) BATif SINK/LAV FLOOR DRAINS SHOWER WATER PIPING BATHTUB GAS PIPING (Need Cily License) SWIMMING POOL WATER SOFTENER ($25) CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREY. ($15) DISHWASHER LAUNDRY TRAY WATER HTR (U5) FOR IRRIGATION WATER METER OTHER Permit pee $ 3 b . OV MINIMUM: S15.00 or S% of Lost of the improvement whichever is Pian Review $ greater on work less than $3W Surcharge $ . .sp TOTAL DUE $ 3 -S • $ y Dake checks payable to: City of Fridley THIS IS AVAPPLICATION FOR A PEWIT- NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I admowledge that the information above Is oomptete and accurate: that the work will be In oatforn mm with the ardin8noes and codes of the City of Fridley and with the Minnesota Construction Codes: that 1 undesland Oft 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 accohdance with the approved plan in the case of all work which requires review and approval of Plans. NAME OF APPLICANT SIGNATURE OF AppucA UT TOTAL P.01 City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287 6431 University Ave NE Fridley MN 55432 Mechanical Permit# Residential Application City of Fridley See Back Side For Required Information Date k0 OS Site Address: (0 0 S6 4 t.u0oem-t l.1'1 A 2— The applicant is: (cirlce one) Owner Contractor Property Owner: SAI U A Zai Ole Address: 5.A rtn e, City: State: Zip: Phone: n (pS -.5 a 3'-89 13 Cell: Fax: Contractor Information Company Name: River C1W Sheet Metes, Inco Contact Person: 8290 Main St N E , Suite 39 Address: F4oriLmo hAKI 55432 _9 City: -2W8 'P:Phone: x,1�eg C Ifs Fax: Email: MN Bond# & Exp Date Type of Work (circle one): New Replacement Alteration/Remodel Detailed Description of work: Equipment Installed: MFG: pxrken_► Model: 3$iX 630 Size/BTU: a7S b pe MFG: Model: Size/BTU: MFG: Model: Size/BTU: Pl�ea�se check all that apply: _Fireplace (gas) $15.00 New Gas Grill $10.00 i/A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00 Air to Air exchanger $15.00 _Furnace $35.00 _Pool Heater $35.00 _Boiler $35.00 _Gas Dryer $10.00 _Ventilator $15.00 _Chimney Liner $10.00 _Gas Piping $10.00 Duct Work $10.00 Gas Range/Oven $10.00 Permit Fee $ 3S� o 0 (Total from above -Minimum fee $35.00) Surcharge $ 0.50 Total Due $ 3.5. !S7 Make check payable to City of Fridley This is an application for a permit- not valid until processed I hereby apply for a mechanical 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 case of all work which requires review and approval of plans. Signature of Approval Inspector Date: 3 l Lo 5 Date: Please Note: Separate permits are required for Building, Plumbing, and Electrical work REQUIRED INFORMATION NEEDED TO PROCESS PERMIT RESIDENTIAL PERMIT APPLICATION HVAC ❑ NEW HOMES/ADDITIONS ❑ EXISTING HOME [:1 MAKE-UP AIR REQUIRED FOR NEW]EXISTING HOMES 1. Combustion Air (See note below) a. Oil or solid fuel IMC Chapter 7 with MN Amendments b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments 2. Make-up Air (See note below) a. IMC Chapter 5 with MN Amendments 3. Venting a. Gas appliances IFGC Chapter 5 with MN Amendments b. Fuel other than gas IMC Chapter 8 with MN Amendments REQUIRED FOR NEW HOMES 4. Heat loss & cooling load per room a. Required on new construction IMC 1346.0312 5. Ventilation a. Per MN Energy Code 7670 or 7672 6. Duct Design Per IMC 1346.0603.2 a. ACCA Manual D NOTE: Centerpoint Energy Mechanical Code Guidelines software may be used for combustion and make up air calculations Building BUILDING Permit No.: Mj�__o X011 Inspections RESIDENTIAL APPLICATION Received By:��t�°"r 763-572-3604 CITY OF FRIDLEY Dat :DEC 07 200 763-502-4977 FAX Surcharge $ EFFECTIVE 8-19-09 License Surcharge DATE O % -- ® 9 YOUR E-MAIL ADDMESS6Qrjeg$ N , SITE ADDRESS 642Y al a fd X LA' lil Curb Cut Escrow THIS APPLICANT IS: ❑ OWNER VICONTRACTOR Erosion Control PROPERTY OWNER/ NAME: cc Park Fee TENANT ADDRESS: 412P4 I -A CITY • 1 ei %y STATE ZIP, $Agreement PHONE: Total Due CONTRACTOR NA iQ� S SUBMIT A COPY YOUR STATENS STATE LICENSE #�Q 7 �'fj� j EXP DATE AND CERTIFICATE OF ADDRESS:2.� 5 �� CITY /& STATE i/IZIP IjS INSURANCE PHONE .1- —0- 0916 FA PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL -.TYPE OF WORK: 11NEW HOME CONSTRUCTION ❑ ADDITION #'14 01 0yj ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: 14° eA' SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ 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: SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, O Vial ❑Soffit 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 ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: >� SING THE 1997 U.B.0 FEE SCHEDULE) �Y, TOTAL JOB VALUATION $ -f OCCUPANCY TYPE Permit Fee $ 1;p91S See Back Page for Fee Schedule Plan Review $ a.tel 65% of Building Permit Fee Fire Surcharge $ - 50 —.00 1 times the total job valuation Surcharge $ .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $22 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $Agreement necessary ( ) Non Necessary ( ) Total Due $ Make checks payable to: Citv of Fridlev Attach Stipulations 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 applicatio 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 o work w ' h requires review and approval of plans. ryry SIGNATURE OF APPLICA PRINT NAM4Jt Z a / ��/12 DATE J -- 0 P vyTiloi � 2A .60 � A i 4. s �v14�x 6-1 V�✓ a" t>F� t Goo tarFl ._ r Building Inspections 763-572-3604 763-502-4977 FAX L`1 PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY Permit No.: Received By: Date Rec'd: 0— DATE�r"G'_ C__• �— ZA��_ YOUR E-MAIL ADDRESS _ M A 2 SITE ADDRESS (�© L{- W p �, y ,Ckv\(_ N � i7' - THIS APPLICANT IS: 0 OWNER OC' ONTRACTOR PROPERTY OWNER/ TENANT W OG �CXVWJ -fTY v ATEkM ZIP_'5 , 2_ PERMIT TYPE TYPE OF WORK: 1 0 NEW DETAILED DESCRIPTION OF FAMILY 0 TWO FAMILY `7o REPLACEMENT FEES ARE BASED ON $ 10.00 PER FIXTURE, EXCEPT WHERE NOTED. rnurvt: l- tco �) L L t— U S I r _ BATH SINK/LAV CONTRACTOR NAME: _FLOOR —GAS PIPING (NEED CITY LIC) _ CLOTHES WASHER SUBMIT A COPY OF YOUR STATE STATE LICENSE # in3 2 _ - EXP DATE I? LICENSE, BOND AND STATE BOND # EXP DATEA,, CERTIFICATE INSURANCE F ADDRESS: �5 SS � SE- � • (,G, cA CITY-'"'��`�"� tt STATK�t/'+ ZIP PHONE_ I 32_Z--:� FAX Co St '-f- 23 --S �'�"�- PERMIT TYPE TYPE OF WORK: 1 0 NEW DETAILED DESCRIPTION OF FAMILY 0 TWO FAMILY `7o REPLACEMENT FEES ARE BASED ON $ 10.00 PER FIXTURE, EXCEPT WHERE NOTED. $35.50. _ BATH SINK/LAV DRAINS —BATHTUB _FLOOR —GAS PIPING (NEED CITY LIC) _ CLOTHES WASHER 4-- KITCHEN SINK DISHWASHER —a LAUNDRY TRAY ".1� ❑ TOWNHOUSE FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE SHOWER _ SWIMMING POOL WATER CLOSET _WATER HEATER ($35) WATER METER THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED _ WATER PIPING _ WATER SOFTNER ($ _BACKFLOWPREV. $I FOR IRRIGATION I hereby apply for a plumbing 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 requires review and approval of plans. SIGNATURE OF APPLICANT ^ !�',Q��� PRINT NAME J\ACL v'6& E j i q S DATE zoo City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 I.I., Building Permit Fee BUILDING `' See Back Page for Fee Schedule Permit No. -2A6 - Inspections 65% of Building Permit Fee RESIDENTIAL APPLICATION Received By - 763 -572-3604 Surcharge $ '-J .0005 x Permit Valuation Minimum $.50 License Surcharge $ CITY OF FRIDLEY SAC Charge Date R l A h 1 1 % 763-502-/4977 FAX Curb Cut Escrow $ ft + 6 ft = ft x $22 = $ �° $ $450 Conservation Plan Review EFFECTIVE 1-1-2010 $ Fee Determined by Engineering DATE I — YOUR E-MAIL ADDRESS I �I ff-S I COM �7 SITE ADDRESS 0 b U) 4141 t Make checks Davable to: Citv of Fridlev Attach Stiaulations THIS APPLICANT IS: ❑ OWNER CONTRACTOR PROPERTY OWNER/ NAME:Psid TENANT ' 1 ADDRESS: 4 CITY I- \'ley STATFOZIP PHONE: CONTRACTOR NAME: S SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE # EXP DATE AND CERTIFICATE OF ADDRESS: CITY L STATE -"ZIP INSURANCE PHONE S (% ^ FAX PROPERTY TYPE i7 SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER. ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING ®(fT 'ma DESCRIBE WORK BEING DONE: L+ c/ 5c a v tiyi ?Q nae SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT: NUMBER OF SQUARES ❑ HOUSE & GARAGE 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: IDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑. Vinyl ❑Soffit 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 ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ �� OCCUPANCY TYPE Permit Fee $ `' See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ '-J .0005 x Permit Valuation Minimum $.50 License Surcharge $ 5 )0 $5.00 (State Licensed Residential Contractors) SAC Charge $. $2100 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $22 = $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ 4141 t Make checks Davable to: Citv of Fridlev Attach Stiaulations 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 on site; that the work will be in accordance with the approved plan in the case of 1 work w h requires review and approval =IaAl pi S. J ` SIGNATURE OF APPLICANT PRINT NAeo_iArq _S DATE fd w L From: 763 684 3964 Page: 4/4 Date: 1/26/2010 3:24:54 PM Building MECHANICAL Permit No.. Z_A� Inspections RESIDENTIAL APPLICATION RoBy: 763-572-3604 CITY OF FRIDLEY Dad:N 763-502-4977 FAX EFFECTIVE 1-1-2010 DATE_j 01 Q YOUR E-MAIL ADDRESS <je r4V Jq . SITE .jjt��..CV.y ---- ta THIS APPLICANT IS: 0 OWNER '18fCONTRACTOR PROPERTY OWNEW S'r MU1.1 ADDRF.SSi._(o_a&.Y_ WI-c-cwLy— &—CITY. J I-( ATE�_ ?,Sa _FJL— Ce TENANT P[IONE-_...-- CONTRACTOR COMPANY SUBMIT A COPY OF YOUR STATE CONTACT PERSON: DEZI L STATELICENSEN LICENSE WITH 16! 2 3RD AVE NE�� ADDRESS:. STATE.... ZIP—... APPLICATION PHONE _� — - - -------- ------ ---- B �171FALIaW=13 PERMITTYPE (7830) 684---3965 XSMLEFAMILY OTWOFAMILY 0 TOWNHOUSE TYPE OF WORK: 0 NEW KREPLACEMENT 0 ALTERATIONiREMODEL DETAILED DESCRIM ION OF WORK P' -Q ac ' L -F o f�:R FEES ARE BASED ON $10.00 PER FLXTURE, EXCEPT WHERE NOTED. FIXTURES. (INDICATE TOTAL NUNIRrR OF EACH BELOW) PROVIDE HEAT LOSS CAL.C'S PER MANUAL J 2006 ASHRAE HANDBOOK Equipment Installed MFG: MODEL: SIZEIBTU MPG: Ch(jrn -o/ __cto q . c %J /10 MODEL: SIZI:VBTLJ MFG: MODEL: SIZE/BTU. $25.00 —FIREPLACE (GAS)SIS.00 —GAS RANGRIOVLN $)O.OfJ —A/C __AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) 535.00 _NEW GAS GRILL $10-00 335.00 )_CFURNACE $35.00 _GAS UNIT HTR 510.00 —BOILER LINER $110.00 DRYER S10.00 —POOL HEATER $35.00 _CHtMN5Y —GAS . _DUCT WORK $ LO.00 GAS PIPING $10.00 VENTILATOR $15.00 Number of fixtures @ $10.00 x $10.00 = $ Number of fixtures @ $15.00 X $15.00 = $ Number of fixtures (a) $25.00 x $25.00 = $ Number of fixtures @ $35.00 x. $35.00 = $ State Surcharge = $ .5 (MINIMUM FEE $35.50) Total = $ 3 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 requires review and approval of plans. 4��' AA i Kno De 2- it. DATE.__ X�/ I C) SIGNATURE OlAPPLICA e —PRINT NAME APPROVAL INSPECTORS SIGNATURE -DATE PLEASE NOTE: SEPARATE PERMITS ARE "QUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL WORK City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-5024977 iff