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PRE 2010 DOCSsusdEcr PERM City of Fridley I ' re, 12794 AT THE TOP OF THE TWINS BUIL DING P E R M I T r ECE 0. COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. 3 I � i CITY HALL FRIDLEY 55432 IL''" • •�' NUMBER REV. DATE 111/8/74 PAGE OF APPROVED BY 612-560-3450 910-F15 JOB ADDRESS 11 - 6A Way N.E. 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 21 & 2 17 Fridley Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Walter Maciaszek 6615 Anoka Street N.E., Fridley 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ 'NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK Construct a 40' x 25'-6" Dwelling and a 18.3' x 25.5' Garage 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide a verifying survey before cappi Provide state code escape windows (1 for each sleeping room). SEWER LOCATION: 23' long. "Y": 8' west of manhole. "Y" Elevation: 832.98 TOP OF FOOTING: 835.98 Minimum Inv. of Manhole: 833.02 WATER LOCATION: 231 west of manhole "PERATE PERMITS REQUIRED HEATING, PLUMBING' FOR WRING, AND SIGH TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood Frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 988 + 467 19,752 Tota 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 $21,696 10.85 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. $37.00 $300.00 PLAN CHECK FEE TOTAL FEE i�efzl �-1;9 1 $347.85 SIGNATURE OF CONTRA TOR OR AUTHORIZED AGENT rE) WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT A BLDG INSP DATE j SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME : BUILDER: i is Tom' ,Z;z /r ADDRESS: ADDRESS:- 4 1< I .e9W ok % NO • . STREET: LOT :o? I - a 2 BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: 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 As: /tfi/d Front: Depth • Height: ` r Square Feet: O Cubic Feet: F� Front: Depth: >> Height: Square Feet;` Cubic Feet: F � r Type of Construction: Estimated Cost: 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 stated in this application are true and correct. DATE: SIGNATURE: G�.�%C2 •a r (See Reverse Side For Additional Information.) 1 N 1 CIVIL ENGINEERS D 0,C. HOIRI AND ASSOCIATES, INC. LAND SURVEYORS l Telephone D10130 CENTRAL AVE. N.E. (Hwy.65)—BLAINE,MINNESOTA 55434 784-5480 712 SOUTH MAIN ST. — CAMBRIDGE .MINNESOTA 85008 689.-4798 CERTIFICATE OF SURVEY:_ WALTER MAC lAS Z EK . P. -T, I ' ------ -'.L.____.__ - - __ :i' !I D _4 .19 <O N 40 C -ug 41 O LY 4 - SCA E: I,11=30" 4248-209-25,26 _i DENOTES IRON � 89- qT' i 9 .I -Me 6. --' - - 62 %2 ' -_ WAY N, E . LEGAL, DESCRIPTION: Lots '21 & 22, Block 17, Fridley Park, Anoka County, Minnesota. 1 HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF THE BOUNDARIES OF THE ABOVE DESCRIBED LAND, AND THE LOCATION OF ALL BUILDINGS, THEREON, AND ALL VISIBLE EN- CROACHMENTS, IF ANY, FROMORON SAID LAND. AS SURVEYED BY ME THIS.. t...........DAY OF .......SEPT ,,'' ......I...................�.....A.D. 19.. 7�....... N.C. HOIUM AND ASSOCI"S,INC. .............:...1.:.e."" ...... ................... _Minnesota Registration No.....� 5.•.,�......... _. _...._ L" CLNG. EI►.otK, laCArQa I I � 1��14 Air C -,n01 1m zg � s and Dor PARTIAL PATE SCHEDULE GRAS WARM AIR: NA A= TOTAL Plarnzce Shell & Dunt Work $10.00 � Replacement of Furnare 6.00 F Repairs & Aitcrat,ons--up to $500.00 600 g Repairs & Alterations each add. $500.00 30U $ Furnace Shell & Duct Work to 120,000 BTU .51000 $ each add. 60,000 BTU 3.UU S Replcceement of Furnace 6.00 2 Repairs & A1te�ations— trp to $500.00 6.00 $ Repairs & Alterations each add. $500.00 3.00 $ STEAM or HOT WATER SYSTEM Furnace Shell & Lines --to 400 sq. ft RDR Steam 510.00 S Ft:rnace Shell & Line ---to 640 sq ft. EDR Hot Water 1000 E. Each add 204 sq. f9 EDR Steam 'Am $ Each add. 320 sq. ft EDR Hot Water 3.00 $ OIL SURNER-to 3 gal. per hour 6.00 $ over 3 gal. per hour --See Fee Schedule Od GAS BURNER (up to 199,000 BTU) 5.00 $ •S • ober 199.000 RM See Fee Scl o"o GAS FYTYING FEES. Ido RATE TOTAL 1st 3 Fixtures z$ 200 S Additional Fixtures x .75 Gas Range to M.C90 x3 5.00 $ _ AIR COND 1OF IMO State Surcharge .50 VEUlD.&0LirG MMTMI �--� ALTERA77OPM & _ TOTAL F= j;- - ;t s• r}'iE9A>ro Dept. of Bldgm. phone 1M3 - G2/ City of Mdley: The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Ordina=ftf and mling of the Depa!tment of Buildings, and hereby declares ghat all the facts and represenlatiuns stated in this application are true and correct. Fridley, Mnn � "5W 'MA.01�L Kind of Building Used as To be completed about Estimated Cost, S /- Ol New. uilding Permit No. — Permit No. ON OF WOM HEATING or POWER, PLANTS--Zteam, Hot Water, 'farm Air—No Trade Names&., G Size No_ I-AVi40G0 Capacity—// — Sq. If'4. E.D.R BTU HP Total Connected Lomd Kind of Fuel BURNER — Trade No I Size Pgo tt111MA as -O"01 City of Fridlay APpiian for Plumbing end G -M F"g Parmig Dept. of Bldgs. Phone 360-3450 DESCRIPTION OF WORIL 14 z Number, Kind and Location Loam of Fixtures / GT O$ Cr Number Fixtures ................ x $2.00 Z t7 i Z Z `i vZ�_ O ' Catch Basin .................... tf N • • N $�� WS [UG $ Electric Water Heater........... . . x $2.00 S .&AS FITTING FEES: N i nOr o t�3 # V Ua t77$ S Base 1st 2nd _ 3rd 4th Future Conaecdoa Openings t Now Fixture. Old Openings City o1 Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all; the fact and representations stated in this application are true and correct Fridley. Minn G w 1925— Owner Kind of muitaing waaa.w.a+w waaa. Sower 0 Used as CC"VOol f'l PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTALD G Number Fixtures ................ x $2.00 $ Future Fixture Opening ........... x $1.50 $—_. New Fixture Old Opening.......... x $1.50 $--- Catch Basin .................... x $3.25 $ Water Heater 'Up to 99.000 BTU).... x $3.00 $�� New Ground Run Old Bldg.......:. x $.3.25 $ Electric Water Heater........... . . x $2.00 $ .&AS FITTING FEES: NO. RATE TO�TAL�, 1st 3 Fixtures ............ • • • • • • Z x $2.00 $ Additional Fixtures .............. x $ .75 $ Gas Range to 199.000 BTU ........... x $5.00 S To be completed about Estimated Cost, $ Old New. uilding Permit No. 120 7.2 ry/ PO"Dit Signed &JAaw 04 1 ROUGH REPAIRS & ALTERATION --Refer to Code .50 State Surcharge Description ........................................ TOTAL FEE j By Business Phone No T? = n P w RamA Ali, d Pvdiccs PARTIAL RATE SCHEDULE (;"VITT WARM LM: Furnace Shell & Duct Work Replacement of rurnare Repairs & Alterat.ons_ up to $500.00 Repairs & Alterations each add. 5500.00 IQCPLL WARN AM FLrnsce Shell & Duct Work to 120,000 BTU e*ch add. 60.000 BTU Replac mmt of Furnace Repairs & Alterations—up to $504.00 Repairs & Alterations each add. $500.00 STEAM or HOT WATER SYSTEX RATE TOTAL SI0.00 8 6.00 S 600 E 300 E10 OD $ e jE-- 3.UU T 6.00 E 6.00 $ 3.00 $ Furnace Shell & Lines—to 400 sq. ft F.DR Steam 510.40 5 Furnace Shell its Line—to 640 sq. ft. EDR Hot Water 1000 S. Each add 200 sq. h. EDR Steam A on S Each add. 320 sq. ft. EDR Hot Water 3.00 $ OIL SUPKER—to 3 gaL per hour 6.00 S over 3 gal. per hour—See Fee Schedule GAS BURNER (up to 199.000 BTU) 8.00 oxer 199.000 BTU See Fee Schedule GAS FITTING FEES: NO RATE TOTAL In 3 Fixtures xs 200 $ ' Additional Fixtures _ x .76 Gas Range to 1W.000 x$ b.00 $ i . ;ter► '. .: •. MAL State Surcharge .50 A doe rev ScAaam89 3 TOTAL F= S Int. of B13gs. Phone -34,E90 City of Fridley: The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Ordinaneer and ruling of the Department of Buildings, and hereby declares that all tins fps and represPntatiuns stated in this application are true and correct. Owner — Kind of E Used as To be corn Fridley. Athan �tC ,�U 10 Estimated Cost; $ �' C, 0 Old—New. Building Permit No. __—_ Permit No. tco HEA77NG or POWER PLANI[S —Steam, Hot Water, W�—No Trade Name- ct9a pgo Odd 1�F Capacity__. ^ Sq. Ft F..D.R BTU — Total Connected Load Diad of ftelo BURNER — Ttade Naate<�rir�d9lr� aize g� capacity Sq. Ft. ZM.R— f D O� � vm .O/L.1 1.. _ 1 HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS • FRIDLEY, MINN. Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied es—No Yes—No 19_ z a� " _ t j / Fl.1 f;JvtA/C* Room l Length /,% r Width 131" Height 8' Room Length/all%t'Width /0"311-leight 77 Windows 'and Doors—Crackage and Area K Room I Length .Z'6"Width Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal it. Area No. or pane of pane lights of crack sq. ft. 3 J- V U 3 f 97 /6 m 7, " �b .3 .0 33 ICoef.1 Btu Infiltration ,� / JCoef.j Btu Infiltration I S-zo, Q ®® 1.3 � 14,0 ff Glass Exp. wall 14,xV 37150 /,r 7 V 4CZ 7PTO Net exp. wall so / 14, to Int. wall Floor Net exp. wall Ceiling Glass �' /14 ` P S-4' Floor Od $`7 1 lj-9s-- -1 otal litu. !9 Required sq. ft. E.D.R. or sq. ins. W.A. Leader area / Fl -1 Aj"rcA' Room I Length, do Width 92 Height rJ Windows and Doors—Crackage and Area K Room I Length .Z'6"Width Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width Height No. of Lineal ft. Area No. of pane of vane lights of crack eq. ft. -AY ® I10 01 7, " �b .3 .0 33 ICoef.1 Btu Infiltration ,� / Glass 4 Coef. Btu Infiltration Q ®® Int, wall A0 32.- 14,xV Glass 7 V 4CZ Net exp. wall S// so lassly Exp. wall Btu Infiltration Floor Net exp. wall 0 Glass J47 I /jC) I Int. wall Od Exp. wall Ceiling Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area . F _I i3 a -JW R. I t .. -th 67411 .d►{. -9#7 fit.; -ht Windows and Doors—Crackage and Area K Room I Length .Z'6"Width Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Width No. of pane Height of pane No. of lights Lineal ft. Area of crack sq. ft. ICoef.1 Btu Infiltration ,� / Glass 4 Exp. wall / Net exp. wall Q ®® Int, wall A0 Ceiling a / D 6� Floor 7 V 4CZ Total Btu. 2..2 Required sq. ft. E.D.R. or sq. ins. WA. Leader area Windows and Doors—Crackage and Area K Room I Length .Z'6"Width 'jr Heigh Width No. of pane Height of pane No. of lights Lineal ft. Area of crack sq. ft. / & Z / 13a 4CO Glass A0 ®Cyd' Exp. wall Iva Net exp. wall Joe Int. wall Coef. Btu Infiltration Floor 32.-/e 0 Glass Od Exp. wall Net exp. wall /40 Int. wall Ceiling / Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l, A ff EVIRoom I Length IV Width// Will Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of Dane of pane lights of track sq. ft. 6 m Coef. Infiltration 3.,� 7z Glass Am so Exp. wall Net exp. wall 0 Int. wall Ceiling /O Floor Total Btu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area e-Ti6 FI.14 fM K Room I Length .Z'6"Width 'jr Heigh Windows and Doors—Crackage and Area Width Height No. of Lineal ft. Area No. of pane of pane lights of crack sq. ft. Coef. Btu Infiltration 13a 4CO Glass A0 ®Cyd' Exp. wall Iva Net exp. wall Joe Int. wall Ceiling @ 790 Floor 7 otal Utu. Required sq. ft. E.D.R. or sq. ins. WA. Leader area %r.#/,,&710 SV$ __ ... CITY or FRIDLEY t All PLICATION 170 J{ RESIDENTIAL_ BUILDING PERMITS (New, Alterations, Additions, or Repairs) OWNER: i 57, .,moi✓ BUILDER: ADDRESS: J J - G �: -4z L�%`%Q �t/ ADDRESS: TEL NO: TEL I1Q: Construction Location STRI,T NO: STREET: 62 L' - LOT: '4Z BLOCK: J_.L_ADDITION: f2 1 �'� � 0- YZ/< --r Corner Lot:` Inside Lot: Setback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION �17uc/,r�*ont: Depth: Height: TC GL-Squaue Feet: Cubic Feet: Front: Depth: Height: Square - Feet: Cubic Feet: Type of Construction: Estimated Cost: To Be Completed: 5 o-0 GqL-o Alt. A Alt. B Proposed Driveway Width if New Opening Is Desired: $ $ _ SEE REVERSE SIDE OF SHEET The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: 61 Z e-/- sirwvf?ur, Stipulations: 1 SUBJECT IT NO. City of Fridley -AT THE TWINS r BUILDING PERMIT 28555 RECEIPT NO. ,572 i trV ----- COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 1 ' CITY HALL FRIDLEY 55432 612-571-3450 76 3� NUMBER 910-F15 REV DATE 11/10/98 PAGE OF APPROVED BY 108 ADDRESS 11 62 1/2 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 21 22 17 lFridleyPark Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Patricia M. Dunn 571-7905 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 8 USE OF BUILDING Residential 7 CLASS OF WORK j REPAIR O NEW O ADDITION O ALTERATION O MOVE O REMOVE 8 DESCRIBE WORK Reroof house and garage 17 SO Tear -off 9 CHANGEOFUSEFROM 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 AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION ZONING SO. FT CU FT 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 I STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED VALUATION SURTAX WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1 .73 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- PERMIT FEE SAC CHARGE STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $48.50 1 File SC $1.46 PLAN CHECK FEEAL FEE 11-1 / - 750.69 SIGNAWFCTOM OR AUTHORIZED AGENT IOATEI HE PR P 'OPN INSF' Y V UA D THIS I$ Y PRIT AID MATE OWNER BUIL OE Ri IDATE, 1 NEW ~ "[ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 1^ BUILDING PERMIT APPLICATION ° J ConstructionAddress: E 1 j(� Legal Description: Owner Name & Address:, Contractor: Address: Tel. # QJ-- 7 Yt _ MN LICENSE # Attach to this application, a Ce tificate of Survey of the lot, with the proposed construction drawn on it to scale. Tel. #7�✓ 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: stimated Cost: $ (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: — APPLICANT: Tel. # TOTAL $ 'S -Q "& STIPULATIONS: CITY USE ONLY Permit Fee $ 4/0 �- f0 Fee Schedule on Reverse Side Fire Surcharge $ % . `&, .001 of Permit Valuation (1 / 10th %) State Surcharge $ 93 $.50/$1,000 Valuation SAC Charge $ $1000 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 $ 'S -Q "& STIPULATIONS: NEW CITY OF FRIDLEY ADDIS! [ ] 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: — 6,3 I & x.19 o V - - Legal Description: /� Owner Name & Address: t-1Tel. # IO IA -600-5-390 Contractor: MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: 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 Sq. Ft Length Width Height Sq. Ft Length • Width Hgt!Ground Sq. Ft m� Construction Type: Estimated Cost: $L 1, — Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ —=$ DATE: � ( f © .5 APPLICANT: & N -\C, VLL—Z e a Tel. # 1� [)L-600-53916 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. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge $ 5 )0 Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 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 [ ] TOTAL $ "I1 -:3 STIPULATIONS: Ze C M Building .ter. r ��� A K H; tSA.71:1J u1V BUI LDIN(i Permit No.: ® - Inspections RESIDENTIAL APPLICATION Received By: 763-572-3604 CITY OF FRIDLEY Date Rec'd: DATEQ1q 1 v YOUR E-MAIL ADDRESS f)& ae-e—& \®iR S . CG(�'1 SITE ADDRESS . THIS APPLICANT IS: ❑ OWNER 0 PCONTRACTOR PROPERTY OWNER/ NAME: t�C�D�, G'L$-I TENANT ADDRESS"": CITY STATE ZIP PHONE: to 12 — La —• CONTRACTOR NAME:_ The Home Depot A.H.S. Inc. SUBMIT A COPY OF STATE LIC 3200 Cobb Galleria Pkwy. YOUR STATE LICENSE ADDRESS: Atlanta, GA 30339 CITY STATE ZIP WITH APPLICATION PHONE 763-542-8826 ❑ SINGLE License #20268257 M PROPERTY TYPE [3 TWO FA _ . ORIES PERMIT TYPE QADDTTION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: `{L (S --%4--% ' SIZE OF IMPROVEMENT LENGTH WIDTH HE HT Sq. Ft. ROOM NG ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SU13 Tf: GARAGES ❑ ATTACHED GARAGE I. Existing Floor Plan ?ROPOSED SIZE: ❑ DETACHED GARAGE 2. Proposed floor plan ?ROPOSED HEIGHT: 3. List of structural members to be used 'SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, 7 vmyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: :3 Aluminum ❑ Trim I. Site Plan/Survey showing the existing structures 7 Other ❑ Fascia and proposed project. W114DOWS 2. Two sets of construction plans N EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations )R FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & 'YPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS VALUATION, RqCLIUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE 'ermit Fee $ ���_ See Back Page for Fee Schedule Ilan Review $ 65% of Building Permit Fee ,urcharge $ Q (.0005) tunes the total job valuation —Minimum. $.50 ire Surcharge $ �, 13 .001 x Permit Valuation (1/10%) .icense Surcharge $ , 0o $5.00 (State Licensed Residential Contractors) ;AC Charge $ $1450 per SAC Unit (Plans to MWCC for determination) ;urb Cut Escrow $ ft + 6 ft = ft x $20 = $ xosion Control $ $450 Conservation Plan Review 'ark Fee $ Fee Determined by Engineering ewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) 'otal Due $ Make checks Pavable to: City of Fridlev Attach Stinulatinnc THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in :mformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a srmit but only an applicatio for a permit and work is not to start without a permit; that the work will be in accordance with the approved [an in the case of all work ch requ' review and approval of plans. (� GNATURE OF APPLICANT PRINT NAME ATE f