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PRE 2010 DOCS0' ni SUBJECT city of Fridley Pr 53 AT THE TOP OF THE TWINS BUILDING P E R M r L RE EIPT NO COMMUNITY DEVELOPMENT DIV. 9� r PROTECTIVE INSPECTION SEC. 1 i � 1 "1 CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L"-- 612-660-3450 910-F15 8/16/78 JOB ADDRESS 114 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 15 2 Rivezwood Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Leif Henriksen 6434 Riverview Terrace 560-4560 3 CONTRACTOR ' ` '' MAILADDRESS ZIP PHONE LICENSE NO. Leif Henriksen same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING House and garage 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 9 CHANGE OF USE FROM TO STIPULATIONS 1. Use 2X 10 rafters 2. Provide vapor Barkier in ceiling 5. Provide combustion air to furnace SEWER - 118.5 West of Man Hole WYE elevation 848.10 - (invert) ELEV ATION849.67 Stubbed to Property Line WATER - 10.5' East of Sewer 47' South of Hydrant 43' East of Power Pole TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood Frame 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 R-1 1152 + 576 25,800 Total 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 $36�9SO $15.49 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCt_AAPE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 115.20®®c� STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $28.80 1s �-4'� ',2r 'Vq ATU F O ORORAUTH I DAGENT (DATE) HE ARO RLY V LIDATED THIS IS YOUR PERMIT d ®� � l �, l® BLDG. NS DAZE SI ATU FOWNER(IFOWNERBUILDER) (DA EI 0' ni 3�T''q<< MINNESOTA VALLEY, ,t� OTA- -SOA�'g r W 01 SURVEYORS & ENGINEERS CORP. 12006 12TH AVENUE SOUTH BURNSVILLE, MINNESOTA 55337 up E Phone: 890.7750 Certificate of Survey for: _ HEN,E'/k'SE7V -_ W 171 L 7/ -17' WAY WE- - Curb \ G (575 is 0-iyLOCATIONS ,cUR.ACY C U(ItITY RATA IS PCa 1NFOaMA1IO11 PU RSINO f� SIi®411.4 VE�'lEX _,SOMS 7b 1 15 drai'7aye utility o Denotes /ro , 0onument 1 hereby certify tlwot this is a true and correct representation of a survey of the boundaries of the above described toad, and of the location of oil buildings, thereon, and all visible encroachments, o1 any, from or on said lend. As surveyed by me fhf%L qL day of tl A 0 I978 A ia9Ar'Z- '" S ONLY , IN fagING caN local util�►es 'Bente diggln� f,AS W* ¢O -MO()NE we ELEC1R% - 1.A RE'nulp ) 'C'e -c0 Cx� 30 DAX 001%df-D eOAGf- SII . D1� • � �GS Not L D T /5-, AI -00<1 Z, PIVWW)00 MA -,Z -AP, A -A, �lk'4 CC), , M,, N', Mlssevots Valley Surveyors & Es`(seerst Cori, f ►y .RLS s Iss. Rei. No. q2�� 38%C llawewer- J 1 a ,A-- (?/�-q - • CITY OF FRIDLEY APPLICATI M) FO`t RESIllENTIAL BUILDING PERMITS (NEW, ALTERATIONS, ADDITIONS, OR REPAIRS OWNER: �e /r1"c y. TiUiLUER: e1` Address: Address: V / `') u -jt Tel . No. 4 s7� No.: I I Street: Joe, < LOT: / BLOCK: �' _ ADDITION: CORNER LOT: IIISIDE LOT: SETBACK: SIDEYARDS: r" Applicant attach 'io this form T<vo Certificates of Survey of Lot 4nd proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING j To Be Used As: f'► /,ts Front: Depth: _ Height: _ 26 Square Feet: Cubic Feet: o Front: �T_ Depth: = ==f Height: Square Feet: Cubic Feet: Type of Construction: `AA.2 r, �Q ' Estimated Cost: $ To Be Completed: B 177 Alt. A Alt. S Proposed Drive-vay Width If New Opening Is Desired--=-�----.- $ $ SEE R>VERSE SIDE OF SHEET) ,The undersigned hereby makes application for a permit for the work herein t'v Spec ified, agreeing to do .-ill work in strict accordance with the City of Fridley Ordinances and rulings of the Department of: L ildings, and hereby declares that all the facts and repreV ons st a in t1jis application ! % are trine and correct. See reverse siac oiaal in xmation. DATE: s SIGNATURE: Stipulations: 1 10 ,'•fie 4a o ab JA4A;ww _ Ali ENERGY CONSERVATION SUPPLEMENT TO BUILDING PERMIT APPLICATION PLANNING AND INSPECTION IEPARTMENT CITY OF FRIDLEY, MINNESOTA This supplement is provided to assist the applicant in computing EXTERIOR ENVELOPE AVERAGE "U" FACTOR INFORMATION. This information is required so the BUILDING OFFICIAL can determine that submitted plans comply with the ENERGY CONSERVATION DESIGN CRITERIA of the STATE BUILDING CODE (Section 6000). It is the APPLICANT'S responsibility to accurately compute the data; reflect the proper DESIGN CRITERIA in the plans; submit product specifications, if needed to support the "R" and "U" factors used; and to assure construction is per approved p s. JOB LOCATION: 7/ 0 �?y OWNER/CONTRACTOR: ADDRESS: A. Determine the Total Exposed Wall Area as follows: 1. Total wall window area 2. t Total door area 3. Total sliding glass door area 4. Total fireplace wall area 0 Total wall framing area(average 10%) 6� Totalet wall area above floor(average 90%) 7. Total rim joist area Subtotal: Total exposed wall area above floor 8. Total foundation window area 9. Total net foundation area above grade Subtotal: Total exposed foundation area PHONE: GRAND TOTAL EXPOSED WALL AREA 22.71 Z ,d B. Multiply the GRAND TOTAL EXPOSED WALL AREA X '�-r _ C. Determine the Total Exposed Roof/Ceiling Area as follows: 10. Total skylight area 11. Total roof/ceiling framing area (10%) 12. Total net insulated roof/ceiling area GRAND TOTAL EXPOSED ROOF/CEILING AREA D. Multiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X .05 = y0, ?9z Item I 3Z40 Item II�37106 E. Determine the "U" value of each segment (1-9) and multiply by the area as fuliuw:.;: less than Item I, you have met the intent of State Building Code 6006 (c) 2. p 2. ��i x "[1" as, or less than Item II, you have met the intent 3. 36 x 'lu„ 6006 (c) 1. 4. x fouls I + S. f / x 11{til _T � 7 P 6. '� �Q x 'fuel x glut# _ 9. _ x "U"Zk ADD 1-9 FOR TOTAL WALL SEGMENTS = ITEM II'I F. Determine the "U" value of each segment (10-12) and multiply by the area as ��� follows: 10. 11. /X� 12. % - % x "I7" x "u" 0.7 x flu's 6r ADD 10-12 FOR TOTAL ROOF/CEILING SEGMENTS ITEM IV G. If Item III is the same as, or less than Item I, you have met the intent of State Building Code 6006 (c) 2. H. If Item IV is the same as, or less than Item II, you have met the intent of State Building Code 6006 (c) 1. I. Add Item I + Item II = J. Add Item III + Item IV = K. If the sum of Items III and IV are less than Items I and II, you have met the intent of the Code for total envelope system. The undersigned, as applicant for a building permit, hereby affirms the above information has been prepared and submitted by himself or under his direction, hereby acknowledges the information to be correct and accurate; and hereby presents the information„ with required plans in support of the building permit 7 application. DATE: f 1 ` i I AWO,om . Y. q I ' ONINED f I � z tAp i ILL I I I c;w S2 X v L l'ry c5 c=,.28 Rod { I j i• x/,__66g � g i I AWO,om . Y. q I ' ONINED f I � z tAp i CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS.AND DEVICES PARTIAL RATE SCHEDULE GRAVITY WARM AIR: RATE TOTAL Furnace Shell & Duct Work $12.00 $ Replacement of Furnace 7.00 $ _- It.palrs,_,& Alterations up to $500,00 7.00 $ Repairs & Alterations each add. $500.00 4:0b . 5 MECHANICAL WARM AIR: Furnace Shell & Duct Work to 100,000 BTU $12.00 $ each add. 50,000 BTU 4.00 $ Replacement of Furnace 7.00 $ Repairs & Alterations -up to $500.00 7.00 $ Repairs & Alterations each add. $500.00 •4.00 $ STEA,tii OR HOT WATER SYSTBI: Boiler & Lines up to 100,000 BTU each addn. 50,000 BTU Boiler only up to 100,000 BTU each addn. 50,000 BTU OIL BURNER- to 3 gal. per hour each add. 3 gal. per hour GAS BURNER- from 100,000 BTU to 199.999 BTU (over 199,999 BTU see Fee Schedule) GAS FITTING FEES: 1st 3 Fixtures Additional Fixtures Gas Range to 199,000 BTU AIR CONDITIONING FAN HEATING SYSTEMS See Fee Schedule VENTILATING SYSTEMS ALTERATIONS $ REPAIRS ROUGH INSP. Date FINAL INSP. Date APPROVAL FOR PERMIT,W'r fi�� $12.00 $ 4.00 $ 7.00 $ 6.00 $ $10.00 $ 10.00 $ $10.00 $10.00 x $ 3.00 $ 3.00 . x $ 1.00 $ x $10.00 $ State Surcharge TOTAL FEE REINSPECTION FEE ($10.00) $10.00 S S S $�_ MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLUS $.50 STATE SURCHARGE Job Address 114 71st Way NE Department of Buildings City -of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. October 23 , 19 78 OWNER Leif Henriksen KIND OF BUILDING USED AS House TO BE COMPLETED ABOUT 12/15/78 ESTIMATED COST $2,100.00 OLD - NEW BUILDING PERMIT NO. PERMIT NO. . DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. _ Trade Name Bryant Size No. 394G100 Capacity Sq. Ft. EDR BTU 100 -000 HP_ Total Connected Load Kind of Fuel Nat. gas BURNER - Trach Name. a Size No. - Capacity Sq. Ft. EDR BTU HP c.pe,y Mooney Air Conditioning Corp. Signed By Tel. No. 546-0738 CITY OF FRIDLEY APPLICATION FOR PLUMBING AND GAS FITTING PERMIT PARTIAL RATE SCHEDULE m PLUMBING FIXTURE RATES: NO. >, m Number Fixtures I x v Future Fixture Opening 4i b) $2.00 Water x $2.00 • Catch Basin x E-4 h �_ yu� $5.00 b 14 W x $10.00 Water Softener Heater' x $7.00 New Ground Run Old Building O $5.00 Electric Water Heater x $5.00 GAS FITTING FEES: � 1st 3 fixtures d$4 x '$3.00 J N X $1.00 Gas Range to 199,000 BTU r8 $10.00 REPAIRS $ ALTERATIONS i V N $5.00 each add. $100.00 or fraction O 13 O $2.00 v� N o o w N 1 U M 11 N U o v D w w (n lst r 2nd 3rd 4 ti (R) - Future Connection Opening Connected with Sewer (i) - New Fixture, Old Opening Water PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE Number Fixtures 15 x $3.00 Future Fixture Opening x $2.00 New Fixture, Old Opening x $2.00 • Catch Basin x $5.00 Water Heater - to 99,000 BTU �_ x $5.00 100,000 BTU to 199,000 BTU x $10.00 Water Softener x $7.00 New Ground Run Old Building x $5.00 Electric Water Heater x $5.00 GAS FITTING FEES: 1st 3 fixtures / x '$3.00 Additional Fixtures X $1.00 Gas Range to 199,000 BTU x $10.00 REPAIRS $ ALTERATIONS First $100.00 $5.00 each add. $100.00 or fraction $2.00 State Surcharge TOTAL FEE REINSPECTION FEE (510.00) 7` Job Address 114 - Department of Buildings City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct Fridley, Mn. , 19 OWNER f;—:: /1,1 W-1 KIND OF BUILDING/�'� I s 1� K� L IL) USED AS TO BE COMPLETED ABOUT 7 F —ESTIMATED COST OLD - NEW BUILDING PERMIT NO. PERMIT NO., " l Company l-3� v 12� � i Signed By ' v Tel. No. --79S- ROUGH -795_ROUGH INSP. Date FINAL INSP. Q -,z ' P Date APPROVAL FOR PERMIT MINIMUM FEE FOR ANY PLUMBING PERMIT SS $7.50 p= $.So STATE SUMCUM SUBJECT P City of Fridley � � � � 4 AT THE TOP OF THE TWINS BUILDING PERMIT Jr? RECEIPT NO. LV ------ COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r � � PROTECTIVE NUMBER REV DATEP AGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910415 8/14/96 JOB ADDRESS 114 71 Way NE I LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 14 2 1 Riverwood Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Laurs 114 71 Way NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Stock Roofing Inc 289 Liberty St NE, Fridley MN 55432 780-3561 3112 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 Ej REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (22 Sq) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 $1,815 $.91 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OT STATE OR LOCAL LAW REGULATING CON- $59.50 Fire SC $1.82 STRUCTION OR THE ORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTAL FEE License SC $5.00 $67.23 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPERLY/141-1DATED y BLD )NSP THIS IS YOUR PERMIT PATE S)GNATURE OF OWNER OF OWNER BUILDER) IDATEI ZWITA ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application ConstructionAddress: j`1 '�/ 7/sem c" Legal Description: o Owner Name & Address: ez Tel. # Contractor: Ste,",e '- c. MN LICENSE # Address: eY Z-Zeez 11--y Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Effective 3/1/96 aifI? ?Sri -3.5) �/ Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Park Fee $ r Corner Lot [ ] Inside Lot [ ] Type of Construction: Approx. Completion Date: Ft. Yd Setback Side Yard Setbaeks Estimated Cost: $ (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: APPLICANT: Tel. # Permit Fee VY $�C1 Fire Surcharge f5 $ c�5c�- State Surcharge $ SAC Charge $ License Surcharge)Aa$ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ 62,0 STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $900 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 [ ] SUBJECT T N City of Fridley 6 AT THE TOP OF THE TWINS BUILDING PERMIT If I RECEIPT NO. ` COMMUNITY DEVELOPMENT DIV ______ L r I PROTECTIVE INSPECTION SEC./ 1 � I NUMBER REV DATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 612-571-3450 910-F15 6/11/9 JOB ADDRESS 114 71 Way NE 1 LEGALLOT NO. BLOCK TRACTOR ADDITION SEE ATTACHED DESCR. 15 2 Riverwood Manor SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Nancy Luhrs 114 71 Way NE 574-1428 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. First Choice Exteriors Inc 2405 Annapolis In N 4240, Plymouth MN 55441 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 553-1918 4266 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION j7 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Replace windows 9 CHANGE OF USE FROM TO STIPULATIONS Replacement bedroom windows must meet the State Egress Code. Install smoke detectors to meet the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 ISTALLS 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 $3,400 $1'70 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REG ING CON- $ STRUCTION H ,PERFORMANCE PLAN CHECK FEE TOTALFEE License SC $5.00 $97.35 NATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPER ZZ BEDGfINSP ALI DATED THIS IS YOUR PERMIT q T� SIGNATURE OF OWNER IF OWNER BUILDERIIDATEI NEW [ ] Effective 1/1/97 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: 11 (4 7/ Legal Description: Owner Name & Address:. Nll,[ L-)� t - o h r 5 Tel. # Contractor: - s C L, ®, c t 3 r� . ��� MN LICENSE # �a Address: Yos`- �_i, .�,,q� �S ��� / Ste. , y Tel. # S'S 3 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construction Type: e,.1 4- � •� � Estimated Cost: $ � `I ©C� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: 6 - Permit - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ SQ. $ �3, qb $ 1,1120 Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: $ �' ss - Tel. # S-:7� ( 9 /F_ Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $950 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 [ J Not Necessary [ J 06/27/01 TO WHOM IT MAY CONCERN: THE DRIVEWAY EXPANSION PROPOSED BY MY NEIGHBORS @ 114 71ST WAY HAS BEEN CLEARLY CO xED TO ME IS ACCEPTABLE AS PROPOSED. 06/27/01 TO WHOM IT MAY CONCERN: � THE DRIVEWAY EXPANSION PROPOSED BY MY NEIGHBORS @ 114 71ST WAY HAS BEEN CLEARLY CONV ED TO ME IS ACCEPTABLE AS PROPOSED. l� 3Uildi.ng $ �y. CO.( BUILDING $ Permit No.: - ) $ 1, 1'0 Surcharge $ __-Is License Surcharge $ 5"00 nspections $ RESIDENTIAL APPLICATION Received By: 763-572-3604 $ CITY OF FRIDLEY Date Rec'd: )ATE v Z YOUR E-MAIL ADDRESS Total Due ;ITE ADDRES 7/ SY-L✓ �/ --r HIS APPLICANT IS: ❑ OWNER RICONTRACTOR PROPERTY OWNER/ NAME:T� i ��. �-4- A ANC Lit 4 e -q ADDRESS: 7 i t-.) A _ r CITYc4Lt TATE ZIP S S TENANT PHONE: CONTRACTOR NAME: Z i C - STATE LICENSE # J.,/bS / EXP DATE 3 b SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS --6 131 r2 � � �' � '� T� KCITY >Z g el STATEM11P SS S WITH APPLICATION PHONE *76'y " Si / FAX PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH i; &OOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: TEA r- o FF RE F- c' F D E t e er SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING� ❑ HOUSE ONLY NUMBER OF SQUARES 2— WHOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 2. Prong fl000rPlan lid p 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: O 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 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: (USI JP THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S. OCCUPANCY TYPE Permit Fee $ �y. CO.( Plan Review $ Fire Surcharge $ 1, 1'0 Surcharge $ __-Is License Surcharge $ 5"00 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 requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME ktc t• Q I% %� Q ?` llrG1 DATE b Building $ BUILDING See Back Page for Fee Schedule Permit No. $ 65% of Building Permit Fee Fire Surcharge $ Inspections RESIDENTIAL APPLICATION $ Received By: . 763-572-3604 License Surcharge CITY OF FRIDLEY Date Rec'd: -( DATE ® r YO E-MAIL ADDRE S $ i I��O �'�THISALICANT $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow SITE ADDRESS ft + 6 ft = ft x $21= $ IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: z- yLjp 3 TENANT ADDRESS: �j7 %7D y ✓Y � _ CITYIs `�% ZIPcS�i'✓� �� Agreement necessary ( ) Non Necessary ( ) PHONE: $ l all . ") CONTRACTOR NAME: STATE LICENSE # ADDRESS:j� J q EXP DATE / 1; -IP ��^�tK S 7- CITY t `'`9 ST AFPE' ZIP s��� SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PHONE -2,�J cS%% 02 '�? % el F FAX PROPERTY TYPE MINGLE FAMILY SIZE ❑ TWO FAMILYNEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH PROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NES' ❑ ADDITION ,trkmNTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE:e'- ®a d1' SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING -It NUMBER OF SQUARES ❑ HOUSE ONLY OUSE & GARAGE BASEMENT REMODELING SUBMIT: I. Existing Floor Plan GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan PROPOSED SIZE: [3DETACHED 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 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 FLAB R AINL Iv1A i V MLAL.a: (USING THE 1997 �UX.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ?&A --OCCUPANCY TYPE Permit Fee THIS $ 17 .a See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ .001 times the total job valuation Surcharge $ 1,8 Li .0005 x Permit Valuation Minimum $.50 License Surcharge $ 'q -Q3 $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21= $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( ) Total Due $ l all . ") ti ulations Make checks payable to: City of Fridley 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 %pordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only anli ion for 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 w whit eq 're re tew nd approval of plans. SIGNATURE OF APPLICANT IAJ PRINT NAME a l r✓ lj L1 �yl p°� DATE