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PRE 2010 DOCSsue,lECT PE NO. City of Fridley 18089 AT THE TOP OF THE TWINS BUILDING PERMIT RE NO. • __ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. i ,,I CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L J` 612-571-3450 910-F15 6/26/85 JOB ADDRESS 4604 - 21� Street N.E. 1 LEGAL LOT NO. BLOCK 11 TRACT OR ADDITION SEE ATTACHED Plymouth Addition DESCR. 14,15 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Don Carroll 4604-- 21� Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Statewide Builders. 4790 Lakeway Terrace 370-0535 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 ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 22' x 20' Garage 9 CHANGE OF USE FROM TO STIPULATIONS M Appeals. Commission approved a yarance to 20 feet for the.street side, side yard setback on June 25, 1905. Provide. a hard surface driveway, SE1 \,ATE „ 'd GM ii 4l�ildli�L:!ANDSI ('lrm0l WARNING I.IRING, ea Before digging call IOcal utilities ` TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BY LAW 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 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5,363 $2.68 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 - CT THE P M CE OF CONSTRUCTION. 56.50 PLAN CHECK FEE TOTALFEE $59.18 SIGNATURE OF CONT. TOR OR AUTHORIZED AGENT IDATEI WHEN PROPERL VALIDATED THIS IS YOUR PERMIT i' ger BLDG INSP TE SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI NEW [ ] ADDN. [ ] ALTER. [ ] Construction Address: Legal Description:_. Owner Name & Address: Contractor:S-/ g �? Address: Z/ LIVING AREA: GARAGE AREA: DECK AREA: OTHER: City of Fridley �R-1 AND R-2 Building Permit Application d� Gerd off 0-_T Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Length J� 9 _ Length Width Width :r 6 Width Height Height_ Hgt/Ground Effective 4/1/84 21 Tel. Tel. Sq. Ft. Sq. Ft. `'y'6 Sq. Ft. Corner Lot Inside Lot [ ] Ft. Yd. Setback Side Yard Setback Type of Construction: ��r Estimated Cost: $ Approx. Completion Date: Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Back Page for Explanation DATE: .� `� APPLICANT: Tel. 0�% CITY USE ONLY Permit Fee Plan Check State Surcharge SAC Charge Park Fee Sewer Main Charge TOTAL $ ,S7? . �O Fee Schedule on Reverse Side 25% of Building Permit Fee $.50/$1,000 Valuation $425 per SAC Unit Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] STIPULATIONS: � � C&d3i, r'0ej_)62 L -®F vwd" SUBJECT PERMIT NO. City of Fridley ----2-2 22 5 AT THE TOP OF THE TWINS PERMIT BUILDING r ' , RECEIP ______ COMMUNITY DEVELOPMENT DIV. 1 ti. -- PROTECTIVE INSPECTION SEC. 3 ��a � , NUMBER REV. DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15 9/23/93 JOB ADDRESS 4604 21� Street NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14,15 11 Plymouth. Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Dorothy Carroll 4604 2�i Street NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Viking Home Improvement 14832 24 Street NE 572--1820 4772 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION D REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof Dwelling C15 Squares) Tear -off 8 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with -the State Building Code. Provide adequate attic ventilation. Provide smoke detectors as per U3C 1210 adjacent to all sleeping areas and in basement. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SO. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 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 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1 500 $. 75 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT r PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIOS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTI NOR THE PERFO ANCE O CONSTRUCTION. $35.00 Fire SC $1.50 PLAN CHECK FEE TOTAL FEE vll� License SC $5.00. $42.25 SIGNATURE OF NTRACT " 1THORIZED AGENT IDAW) WHE RLY DATED THIS IS YOU PER IT BLD INS TE SiGNATURE OF OWNER IIF OWNER BUILDERI IDATEI NEW [ ] Effective 5/26/93 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address:f 2 �/z 5 �� Legal Description: '�y / `�� / S B Ls0 0 1< / l , ✓ �L;c U J � % -FF3337 Owner Name & Address: ��lZ T,�/ Y _ e,11CW g L L Tel. # 5'7 z - /Co 0 7 Contractor: V1/1,1A147 MN LICENSE Address: L/ a v e y® z5P 1, 7. c--, Tel. # 5'77-197-0 Attach to this application, a Certificate of Survey of the K with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground OTHER: & -%oy� 15- Corner S Corner Lot [ I Inside Lot [ ] Ft. Yd Setback Type of Construction:��'j� Approx. Completion Date: Sq. Ft. Sq. Ft. Sq. Ft. Side Yazd Setbacks Estimated Cost: $�jSDca (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE:C Z /C� APPLICANT:Tel. # CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ -3s-.00 Fee Schedule on Reverse Side $ 1,6-D .001 of Permit Valuation (1/10th%) $ , %- $.50/$1,000 Valuation $ $750 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ Conservation Plan Review $450:00 $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ I a $� STIPULATIONS: � CITY OF FRIDLEY INSPECTION DIV, 6431 University Ave NE Fridley, MN 55432 572-3604 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AiR CONDITIONING SYSTEMS AND DEVICES Residential Furnace Shell and Duct Work, Burner – Also Replacement Furnace Gas Piping (Needed with new furnace) Gas Range Gas Dryer *Air Conditioning – All Sizes All Others/Repairs & Alterations (LIST ON BACK) I% of Value of AN Ilance or Wor h Commercial/industrial I% of Value of Appliance or Work Rate TOTAL $20.00 $® , $10.00 $ 10:00 $ $ 10.00 $_ $ 10100 $ /0 State Surcharge TOTAL FEE $ .50 $ MINIMUM FEE FOR. ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE 5.50 STATE SURCHARGE REINSPECTION FEE $30.00 *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. Effective On January 1, 1993 JOB ADDRESS 6 ®G% 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 are true and correct. /(/Z'I ,199 OWNER C/ -h, 4 L BUILDING USED 0 ESTIMATED COST © a PERMIT NO. � 11 DESCRIPTION OF FURNACE AND OR BURNER 71 No. of Heating Units--/— Circle One (Steam) (Hot Water)�armAlr) Trade Name _ /fie ; Size No. BTU -S-6, HP EDR Fuel_ Total Connected Load Burner Trade Name Size No. BTU HP EDR HEATING COMPANY2 /7;"Signed By �-- v Tel No, Approved By Rough–In Date Final Date P FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE I CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes (�° No ( ) 2. Is free from rust or deterioration Yes (jr No ( ) 3. Has no foreign objects lodged within Yes No ( ) 4. Is securely supported Yes No ( ) 5. Meets all current Code requirements for size and total BTU's connected Yes No ( j 6. Has total heating BTU's of0 � All other BTU's D a TOTAL BTU's A D _ 00 Remarks List Alterations Being Done: HEATING COMPANY Signed By Date 01" WELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota well and Boring Sealing No102019 aJ County Name WELL AND BORING SEALING RECORD Minnesota Unique No. Minnesota Statutes, Chapter 1031 or W -series No. ., (Leave blank H not knwm) Townsh m_ 'Township No I Range No. Section No. I Fraction (sm. -> Ig.) Date Sealed Date Well or Boring Constructed 30 24 27 ProxSEuSSAPRTL 05, 1996 Numerical Street Address or Fire Number and City of Well or Boring Location a NE 2 112. Depth Before Sealing ft Original Depth ft. Show exact location of well or boring Sketch map of well or boring AQUIFERS) STATIC WATER LEVEL In section grid with °X°. location, showing property Single Aquifer ❑ Multiaquffer lines, roads, and buildings. N WELLIBORING [Measured El Estimated E - �� . in. from Jo ft. ❑ Yes No i I I I 1 1 1 1 I I I I I SCREEN/OPEN HOLE E - �� . in. from Jo ft. ❑ Yes No ❑ Yes ❑ No ❑ Unknown 43 Water Supply Well [IMonit Well Env. Bore Hole ❑ Other Y ft. ❑ below ❑ above land surface CASING TYPE(S) TSteel Ya mile in. from to ft. ❑ Yes ❑ No lin ❑ Plastic E] Tile ❑ Other CASINGDiameter Depth Set In oversize hole? Annualar space initially grouted? t" S ��� J��J'""" 10 mne� . �"" s" - �� . in. from Jo ft. ❑ Yes No ❑ Yes ❑ No ❑ Unknown PROPERTY OWNER'S NAME in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown Property owner's mailing address if different than well location address Indicated above. 4604 ME 2 1/2 T SCREEN/OPEN HOLE FRIDLEY, 55421 Screen from 7 to 60 ft. Open Hole from to ft. OBSTRUCTION/DEBRIS/FILL ❑ Obstruction ❑ Debris ❑ Fillo Obstruction Type of Obstruction/Debris(Fill WELL OWNER'S NAME Well owners mailing address If different than property owner's address Indicated above. ObstructionmebristRii removed? ❑ Yes ❑ No PUMP Tye RMI IM %2emoved ElNot Present ElOther GEOLOGICAL MATERIAL COLOR HARDNESS OF FORMATION FROM I TO If not known, Indicate estimated formation log from nearby well or boring. METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING CNo Annular Space Exits AND BORE HOLE: SAM Rgcam &�I Annular space grouted with tremle pipe GRAVEL aftom 4 ❑ Casing Perforation/Removal In. from to ft ❑ Perforated ❑ Removed GL" -emby --LL 14 ST PETM SA ' III i in. from to ft Type of perforator ❑ Perforated ❑ Removed ❑ Other GROUTING MATERIAL(S) Grouting Material RTL from 0 tos ft. yards bags from - to from to from to ft. yards bags ft. yards bags ft. yards bags REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING UNSEALED WELLS AND BORINGS Other unsealed well or boring on property? ❑ Yes LO 4849 I I,TY A' TffCFMED OR REGISTERED CONTRACTOR CERTIFICATION WATM LL WELL: ,1 This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is true to the best of my knowledge. 5003, 140 W -93D15.939 + A, Cont cto SONS, p g;s --Uon No., Authorized Rep ' Date LOCAL COPY e HE -01434-02 10/95R CITY OF FRIDLEY 7071UNIVERSITY AVENUE NE FRIDLEY, MN55432- // ISSUED:04202007 (763)572-3604FAX: (763)502-4977 Permit #2007-00608 4604 2 1/2 ST NE ADDRESS: PIN:263024330039 LEGAL DESC:UNAVAILABLE :LOT BLOCK PERMIT TYPE:SEWER & WATER PROPERTY TYPE:RESIDENTIAL CONSTRUCTION TYPE:SEWER REPAIR NOTE: CALL 763-572-3560 FOR INSPECTION AFTER UNCOVERING THE LINE, BEFORE ANY REPAIRS ARE MADE, AND AGAIN WHEN THE REPAIR IS MADE BUT BEFORE RECOVERING THE LINE. SEWER LINE REPLACEMENT SEWER LINE REPAIR/RELOCATION50.00 APPLICANT STATE SURCHARGE, PLBG FLAT0.50 ROTO ROOTER TOTAL 50.50 14530 27TH AVE NE Payment(s) PLYMOUTH, MN 55447 CHECKCC50.50 (763) 559-3522 Minnesota State License #: 002695PM OWNER CARROLL DOROTHY R 4604 2 1/2 ST NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 180 days or if construction or work is suspended or abandoned for a period of 180 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant____________________________Date________ Bldg Insp____________________________Date ________ SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY 7071UNIVERSITY AVENUE NE ISSUED:04/20/2007 FRIDLEY, MN55432- (763)572-3604FAX: (763)502-4977 Permit #2007-00608 4604 2 1/2 ST NE : ADDRESSPERMIT APPLICANT: PIN:263024330039ROTO ROOTER LEGAL DESC:UNAVAILABLE14530 27TH AVE NE :PLYMOUTH, MN 55447 PERMIT TYPE:SEWER & WATER PROPERTY TYPE:RESIDENTIAL(763) 559-3522 CONSTRUCTION TYPE:SEWER REPAIR CALL 763-572-3560 FOR INSPECTION AFTER UNCOVERING THE LINE, BEFORE ANY REPAIRS ARE MADE, AND AGAIN WHEN THE REPAIR IS MADE BUT BEFORE RECOVERING THE LINE. BUILDING INSPECTION RECORD 24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS. CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM INSPECTION TYPEDATEINSPECTORCOMMENTS NO RECORD OF INSPECTION FROM ENGINEERING DEPARTMENT. EXPIRED PERMIT12/02/08RONJ INSPECTION COMMENTS: IN ACCORDANCE WITH CITY ORDINANCE, NEW OR SUBSTANTIALLY REMODELED BUILDINGS SHALL NOT BE OCCUPIED UNTIL ALL WORK HAS BEEN APPROVED, AND A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED BY THE BUILDING DEPARTMENT. THIS CARD MUST BE POSTED AND VISIBLE AT ALL TIMES UNTIL WORK IS COMPLETE. City of Fridley RECD A PR 2,0 2007 6431 University Ave NE n Fridley MN 55432 69 (763) 572-3604 or Fax (763) 502-4977 Water and Sewer Permit Application All ❑ New Connection Utility Line Repair/Relocation "0W �� ❑ Existing Water and Sewer Connection Date: -1 ®- (77 Job Address: Name of Applicant (Plumber): KO �0 _ o Name of Property Owner: Existing Structure Permit # Permit Type: Sewer Fee: Water Fee: Meter Fee: Repair Fee: Relocation: State Surcharge: SAC Charge: Special Assessment Fee: Total: $1, .S-& Applicant Signature; Inspector approval: Water Meter Repair - Weekend & Holidays $125/hour Water Connections Permit $50 Sewer Connections Permit $50 tion Fee for Water/Sewer Line Repair $40 Special Assessments See En ' eerin Cost of Water Meter See Utility Billing SAC Charge $1675 State Surcharge $ .50 Water Tap See En ineerin Project Name: Project No.: MEMO TO FILE y�oy zz 5�- Memo prepared by: Date: q /-'S/11-7 Description: )/ -�t 6-6ce -->A vo /2)dT9f-- cz- CITY OF FRIDLEY 7071UNIVERSITY AVENUE NE FRIDLEY, MN55432- // ISSUED:10202009 (763)572-3604FAX: (763)502-4977 Permit #2009-01639 4604 2 1/2 ST NE ADDRESS: PIN:263024330039 LEGAL DESC:UNAVAILABLE :LOT BLOCK PERMIT TYPE:BUILDING PROPERTY TYPE:RESIDENTIAL CONSTRUCTION TYPE:ROOFING VALUATION:$2,105.00 NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. KICK-OUT FLASHING REQUIRED WHERE THE LOWER PORTION OF A SLOPED ROOF STOPS WITHIN THE PLANE OF AN INTERSECTING WALL CLADDING. CONSTRUCTION IN THE CITY IS UNLAWFUL EXCEPT BETWEEN THE HOURS OF 7:00 AM AND 9:00 PM, MONDAY THROUGH FRIDAY AND BETWEEN THE HOURS OF 9:00 AM AND 9:00 PM ON SATURDAYS. NO WORK IS ALLOWED ON SUNDAYS OR ANY LEGAL HOLIDAY UNLESS AN ALTERNATE WORK HOUR PERMIT HAS FIRST BEEN ISSUED. CALL FOR FINAL INSPECTION WITHIN 10 DAYS TEAR OFF AND REROOF OF HOUSE AND GARAGE BUILDING PERMIT FEE83.25 APPLICANT FIRE SURCHARGE2.11 WONDERFUL ROOFING & SIDING LLC STATE SURCHARGE, BLDG VALUE1.05 9340 BATAAN ST NE LICENSE SURCHARGE5.00 BLAINE, MN 55434- TOTAL 91.41 (763) 245-3373 Payment(s) Minnesota State License #: 20631183 CHECK324591.41 OWNER CARROLL DOROTHY R 4604 2 1/2 ST NE FRIDLEY, MN 55421 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 180 days or if construction or work is suspended or abandoned for a period of 180 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of work will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant____________________________Date________ 10/20/09 Bldg Insp____________________________Date ________ SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. CITY OF FRIDLEY 7071UNIVERSITY AVENUE NE ISSUED:10/20/2009 FRIDLEY, MN55432- (763)572-3604FAX: (763)502-4977 Permit #2009-01639 4604 2 1/2 ST NE : ADDRESSPERMIT APPLICANT: PIN:263024330039WONDERFUL ROOFING & SIDING LLC LEGAL DESC:UNAVAILABLE9340 BATAAN ST NE :BLAINE, MN 55434- PERMIT TYPE:BUILDING PROPERTY TYPE:RESIDENTIAL(763) 245-3373 CONSTRUCTION TYPE:ROOFING : VALUATION$2,105.00 BUILDING INSPECTION RECORD 24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS. CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 4:30 PM INSPECTION TYPEDATEINSPECTORCOMMENTS SIX FEET OF ICE AND WATER ICE & WATER BARRIER10/26/09PRONJ FINAL10/26/09PRONJ INSPECTION COMMENTS: IN ACCORDANCE WITH CITY ORDINANCE, NEW OR SUBSTANTIALLY REMODELED BUILDINGS SHALL NOT BE OCCUPIED UNTIL ALL WORK HAS BEEN APPROVED, AND A CERTIFICATE OF OCCUPANCY HAS BEEN ISSUED BY THE BUILDING DEPARTMENT. THIS CARD MUST BE POSTED AND VISIBLE AT ALL TIMES UNTIL WORK IS COMPLETE. Building $ BUILDING See Back Page for Fee Schedule Permit No.� lf:/_(/ ��3_1_ Inspections RESIDENTIAL APPLICATION Fire Surcharge Receiv 763-572-3604 .001 times the total job valuation Surcharge $ tuc_T Z U .0005 x Permit Valuation Minimum $.50 License Surcharge CITY RIDLEY OF F t) 00 Date 763-502-4977 FAX $ $2000 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ EFFECTIVE 8-19-09 ft + 6 ft = ft x $22 = $ Erosion Control DATE 4 D D YOUR E-MAIL ADDRESS q!l14u'�y��iidua $450 Conservation Plan Review SITE ADDRESS 60 $ THIS APPLICANT IS: ❑ OWNER CONTRACTOR $ PROPERTY OWNER/ NAME: Total Due TENANT Make checks payable to: Citv of Fridlev Attach Stipulations ADDRESS: CITY STATE ZIP PHONE: CONTRACTOR NAME: p SUBMIT A COPY OF YOUR STATE LICENSE STATE LICENSE #'- ZQbq3EXP DATE AND CERTIFICATE OF ADDRESS: ya- CITY J9Y STATEMZIR INSURANCE PHONE — FAX PROPERTY TYPE ASINGLE AMILYINEW CONSTRUCTION SIZE S . ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH J<ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION ❑ MAINTENANCEIREPAIR REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT SQ FT ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES 3k9OUSE & 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, ❑ 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: SING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 445'5' OCCUPANCY TYPE 91 Permit Fee $ -A01F3 See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ @ .001 times the total job valuation Surcharge $ b: .0005 x Permit Valuation Minimum $.50 License Surcharge $ t) 00 $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 application f r 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 ork which r res review and approval of plans. SIGNATURE OF APPLICANT PRINT NAMES �� a~i DATE P6