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PRE 2010 DOCSnum SUBJECT ° P City of Fridley 18334 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT NO. • _�- COMMUNITY DEVELOPMENT DIV. INSPECTION 1 � PROTECTIVE SEC. ✓i{ 1 iI 1 /'-n CITY HALL FRIDLEY 55432 ".j NUMBERREV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 3/4/86 JOB ADDRESS 121 - 71St Way N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Riverwood Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE McMullen -Moselle Association 430 Industrial Blvd., Mpls. 55413 378-3981 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS SEPARATE PERMIT6ENSE NO. WIRING, HEATING, PLUMBING AND SIGNS - 6 USE OF BUILDING Residential 7 CLASS OF WORK NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 40' x 48.1 Dwelling, a 24' x 24' Garage and a 12' x 10' Deck 9 CHANGE OF USE FROM TO STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards. Provide City with copy of verifying survey before capping. SEWER LOCATION: "Y" 71' West of M.K. "Y" ELEV: 848.74 TOP OF FOOTING: 851.74 Mini WATER LOCATION: Stop Box 53.5' N.W. of Property Line, 55.3' N.E. of Hydrant Paid Park Fee of $1,500.00 n Dn :-''Cl-- i'i"1 l CITY C'D "Y '•_I._J ;t%f 1 1_i�„jl.!'S TEE I J -E d1a;URACY OF UTI€_.1TY I-Ok';!TDN:3 A]:',,D i:L EV/ -TIONS. I HIS DATA IS FOR INFC (F,,`,A'MN PURR-g3sE3 ()NLY,, WARM' AND PERSOPIS USING THIS INFORP KAON DB1,0UL3- Before digging call local utdlit.€s ;iEIMI Y FF ON THE SITE. TELEPHONE - ELECTRIC - GAS Eta. REQUIRED BY LAS 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 1 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 $75,200 $37.60 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 REGULATING CON- $361.00 Credit from School STR THE PERFORMANCE OF CONSTRUCTION. r 4SIGNAT PLA H CK FEE . 25 TOTAL FEE $488.85 + PF OFCO TRAC O OR AUTHORIZED AGENT IDATEI HEN PROPERLY VAXEIATED THI YOUR PERMIT YS O SIGNATURE OF OWNER tIF OWNER BUILDERI IDATEI BLDG INS ATE num YA M NEW [ ADDN. [ ] ALTER. [ ] Construction Address: Legal Description: City of Fridley Effective 4/1/84 R-1 AND R-2 j Building Permit Application Owner Name & Address: c w1 � � z in - hA 0:2 1 I z G S S Y �n �g� Tel. # A.R15 • Contractor: C L4,i k k-ko-> l l z QSS ___.Tel. 4 3�-?L 39 X 1 Address: -y'd k, 1 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 L/ Height Sq. Ft. GARAGE AREA: Length �( Width �`� Height Sq. Ft. DECK AREA: Length Width 10 Hgt/Ground Sq. Ft. OTHER: Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Type of Construction: Approx. Completion Date: Side Yard Setback Estimated Cost: $ 114:104T 0 :51 ?100' vd 'Q f MNO Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: K)VN-$ $ See Back Page for Explanation DATE: APPLICANT:c�UJ = = _ Tel. CITY USE ONLY Permit Fee $ 2U.06 Fee Schedule on Reverse Side Plan Check $ 9 ®. :)S' 25$ of Building Permit Fee State Surcharge $ 0, (—,0- $.50/$1,000 Valuation SAC Charge $ C01 -ad, IT-. $425 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ $ n I Agreement Necessary [ ] Not NecessaryfOTAL [ ] STIPULATIONS: r r LUMBE.Td SPECIFICRTIONS TOP CHORD 2X8 0.5. STR. DRY/KO19 S. PINE BBT CHORD 2X1C 0. S. STR. DRY/KO19 S. PINE WEBS 2X4 STRNORRO DF -L LOCRTF TNTFR—PRNF.L SPLICFS R1 1/4 PRNEL LENGTH t/-- 12 INCHF5 FROM EITHER END OF THE PRNEL INOICRIED. (JOE iN) HEARINGS IMPORTANT NOTES: Truswal SyetemsCwpwaton contemn Plates are formed from 18. y6. ard20 gauge.hot.dipoed galvanuea JAStM A 446) structural grade SIMM Pimesshan Wappbea tO Win laces er the eusS at each lfMlt Wllpie dtmert84Ar88re nal ehdwn.pWeS shall be placed S)"nmetrcaey about the pN or as adreated by posihonag cacleS (0) Cul- Ing and latUrcatOn Shell be accomplshed usag equipmemwMChwllproduce snug prang polosardtuuyambeddeciplates Relerto"Ouaury CoMc)lMwuaW"bythe Trw%PWebva( lute (TPI) Only lateral braung required of nmvoual trussmeMbwS S nWed on thedesgn Tha top Chwdb assumedtobecoMnypuslylafmaaybracedbytheroWsheamng Mehl norgd Cety isa"ached Cnectty(ov*Wt rnchord.latwasybfinelwcrofdat Nerals not e-ceedug 10•.0" o c Truswal Systems Corpora on bears no reA)onsrbrwy fa em orecion of trusses Persons erectng trusses are ctlUtdrmd to seek probswnal Wvtce re- • JOINT VERTICAL MINIMUM JOB NO_ ��� (, L J2 �•) REACTION HEARING A 2220. 3.5 G 2220. 3.5 FORCES ARE FOR SINGLE UNIT TOP CHORD FORCE A —H 2751. C H —C 1613. C C —D 65. T D —E 65. T E —F 1613. C F —G 2751. C BOTTOM CHORD FORCE G —H 1610. T H —I 1610. T I —A 1610. T WEBS FORCE g -I 1160. T C —X 2034. C X —D 80. T X —E 2034. C F —H 1160. T HORIZ. DISPLACEMENT 0.0000 INCH- -0.4028 INCH - 3;2x10;8. KIM U 9.0x9.0 3.2108 3. 2x10 .8 o:OC 12 X. 3.2x3.612 \ t D 1 OLOADING THIS AREA 40 PSF LL O0 10 PSF DL .3; 0x9 .t 0 /TN 3'; 2x12.6 5 r,.� n J 9, Ox&. 8 3.2x10.8 3.2x12.6 v 9.0x9.0 14'- O" 51-011 . n n w auras nt t een�t k A� �� f MANX -Ea ,9.rx ..®�a� , �` Qi; Y tA"�• U i•'�rt•: ' •''tFtLll111'! JJ 1 lJ 1V Tl U COLORADO SPRINGS COLORRDO 80932 IMPORTANT NOTES: Truswal SyetemsCwpwaton contemn Plates are formed from 18. y6. ard20 gauge.hot.dipoed galvanuea JAStM A 446) structural grade SIMM Pimesshan Wappbea tO Win laces er the eusS at each lfMlt Wllpie dtmert84Ar88re nal ehdwn.pWeS shall be placed S)"nmetrcaey about the pN or as adreated by posihonag cacleS (0) Cul- Ing and latUrcatOn Shell be accomplshed usag equipmemwMChwllproduce snug prang polosardtuuyambeddeciplates Relerto"Ouaury CoMc)lMwuaW"bythe Trw%PWebva( lute (TPI) Only lateral braung required of nmvoual trussmeMbwS S nWed on thedesgn Tha top Chwdb assumedtobecoMnypuslylafmaaybracedbytheroWsheamng Mehl norgd Cety isa"ached Cnectty(ov*Wt rnchord.latwasybfinelwcrofdat Nerals not e-ceedug 10•.0" o c Truswal Systems Corpora on bears no reA)onsrbrwy fa em orecion of trusses Persons erectng trusses are ctlUtdrmd to seek probswnal Wvtce re- • gardng temporary etecton braturg which a akvays rrgwred to prevent s=pWxrg and -darnrwg-Refer to'"Bracing Wood Trusses Cwnmentary and Retbavritvdeltw,s lTPI)" Truswal SysumaCwporalonassunes resprms•w4gonry brtnestructwyattequecyof ere abO desgn The data upon whrCh the deltgr, a based halt been PruwOed by the buss labrcator, and mstownon pusorawug beereteltpbnS+buayofoMMtoaSCenant MVV design loaasuta Won eusdrawug novel w exceed the actual dead leads "Posed by the structure and the bye bads nrposed by the tical bwk" code w hemrcal Climate re• cords CamboollusSeatsusedbmantanwutormco"MergMawWoperappeaiance naccordance wall,the overall tincture The amwN W Cambet a alerted by nu WOWS rrbn•sirucbaal cpr&awalons. and. as such. the downmmlon of the desoed camber a outsde am scope of respweabsdy of Tr al Systems Cwpwafd I ` .tor wan usmun DESIGN CRITERIA: UBC FAtlNK:Ai N rV I JOB NO_ ��� (, L J2 �•) SPACING 2 A w q. C 4 U L TC LL ............. !.Q..PSF Q TCo=•••••••••• •••^ ••:.PSF BC Q)• ............. iTQ. .PSF � -�.." Q' PSF fPL� DURATONFACTOR DESIGNED BY CHECKED BY DATE 8/29/84 DING NO. 1 OF 1 , LUMBER SPECIFICATxm CHORD 2X4 195OF—IM MSR S--P—F CHORD 2X4 1200F -1,2E MSR S-•P—F 2X4 03/STUD S—P—F B f3 IS 2X4 165OF-1. BE MSR S—P—F BEARING REOUIREM$m BEARINGS SHOWN ARE 57 EXCEPT AS NOTED. TRUSS LOADING (x31{ 1) OR,I LL ON TOP CHORD - 40.0 PSF ORM OL ON TOP CHORD - 5.0 PSF OR;a OL ON BOT CHORD - 10.0 PSF TOTAL DESIGN LOAD - 55,0 PSF LOAD DURATION INCFEASE - 1.15 TO THE SHAPE OF THIS DWGN, SMALL AMM ZONTAL MOVEMENT WILL RMULT AS THE TRUST A'f,1/4,PANEL LENGTH +/— W THE PANEL INDICATED. MEMBER FORCES FROM LEFT TO RIGHT. TOP CHORD BOTT014 CHORD MESS REACTIONS T 1- —2957 B 1- 2337 M 1- 126 W 4- —596 REACTION 0 1- 1395 T 2- —1973 B 2- 2337 M 2- —695 V 6- 126 REACTION 6 5- 1395 T 3- —1973 B 3- 2337 M 3- 2222 T 4- —2957 B 4- 2337 PLATE I CODE SPACING DATE MULTISPIKEI UBC 1 24.00' O.C. 8/18/85 AN OPTIMAO DESIGN DwG/ C228DO28 FILE/ VILL.—MN.—DU, 2 OF 2 M.S. leis ihd�b, T ►WAkMAQ�sys Em ERUSWAL SYSIf%% CCQK)RAO(7N A SkJ+DDE CGAWANv 1 SYMMETRICAL ABOUT PLATE WATED 90 DEM. 3.2X 7.2 2.SX 3.6 v 2.6X 5.4 12 % (� 12 2x4 WEDGE / 1.3X 3.6 5.07'12 46 T I VII 5.8x10.8 I FARM BfiOrhlfBla /c22=29-2 /qv/ MFG ® IN CT r' -/s ( Off" OrA) R -aa (ie•�atOWN) R -,Rd R-,40 Gs* "FF) k yr oft"A /s j!O 2S 30.91% 'y 1954 . MINNESOTA ENERGY CODE BASED ON .. MODEL ENERGY .000E 1983 EDITION (CABO) FLOORS FLOORS HEATED N HEA OVER OVER SLAB SLAB WALLS ROOF UN- -*XTE.1101 ON ON. HEATED AIR GRADE GRADE SPACES , .OPTIONAL DESIGN METHOD ("COOKBOOK" APPROACH) R-38 ceiling; R-20 walls; Maximum glass area a 12% of exterior wall area; (10% if sliding glass door) - All windows double glazed or have•storm windows; Insulated doors providing "R" value of 3 or convential door and storm door. Primary door must have weatherstripping. . NOTE: All of the above requirements must be met if this method is to be used. FOUNDATION INSULATION REQUIREMENTS: (For below grade applications). R-5 on entire wall of full height foundations or R-10 to frogt de$tpn depth. 3 STORIES W I LU I t U Jr COMMERCIAL R-1 .238 .06 .08 .06' 8.58 6.3 RESIDENTIAL (3 ..stor•,ies •. .238 •0033 .Q8 :033 8.58 6.3 °?;_ - - �--:•. or less ) b RESIDENTIAL 3 -STORIES .28 .06 .08 .06 8.58 6.3 R-3 or R-4 .11 .026 .0.5 .026 8.58 6:3 .OPTIONAL DESIGN METHOD ("COOKBOOK" APPROACH) R-38 ceiling; R-20 walls; Maximum glass area a 12% of exterior wall area; (10% if sliding glass door) - All windows double glazed or have•storm windows; Insulated doors providing "R" value of 3 or convential door and storm door. Primary door must have weatherstripping. . NOTE: All of the above requirements must be met if this method is to be used. FOUNDATION INSULATION REQUIREMENTS: (For below grade applications). R-5 on entire wall of full height foundations or R-10 to frogt de$tpn depth. 3 STORIES COMMERCIAL .238 .06 .08 .06' 8.58 6.3 b UNDER • COMMERCIAL OVER b RESIDENTIAL 3 -STORIES .28 .06 .08 .06 8.58 6.3 .OPTIONAL DESIGN METHOD ("COOKBOOK" APPROACH) R-38 ceiling; R-20 walls; Maximum glass area a 12% of exterior wall area; (10% if sliding glass door) - All windows double glazed or have•storm windows; Insulated doors providing "R" value of 3 or convential door and storm door. Primary door must have weatherstripping. . NOTE: All of the above requirements must be met if this method is to be used. FOUNDATION INSULATION REQUIREMENTS: (For below grade applications). R-5 on entire wall of full height foundations or R-10 to frogt de$tpn depth. . MINNESOTA STATE ENERGY 1:ODE CALCULATIONS BASED ON CHAPTER 5 OF THE MOUTr—ENERGY 1;(J4E - 1 EDITtON Aduptlun Effective lil/84 owner - PLre:PWcD Phone �,/I¢`g� _a to Site Address r Contractor Phone Building Classification: Type Al 0in le Fami�S Duplex) 'Type A2 (Residential)_ % (3 stories orless) (Other) (Over 3 stories) ;ENERAL INFORMATION aa' SFT 1. Building Perimeter i?8' AA,Z- ft. ?. Wall height (ground to eave)14.3:!� wlAtA3 —f t. 34- + bi + 1834 2 3. 1. x 2. (above) gross wall am 2-231 —f t. (st,Re CWA) 1338} '7 ?_ 3. Building dimensions (L) �4Rte=s x (W) V, JJL_ a �¢/d ft. roof S floor area i. Square foot area of rim joist - Floor joist size (2 x ? to ) lo? x Perimeter a Rim joi—`st area I i ¢ ft2 -T2— 1 3'1 6 • Doors - area -34 �` 'jam s F. Thickness in. U actor 14. Type of Construction gr"r. Perimeter 410ft. Manufacturer ora® 7. Total door's perimeter 41=) ft 8. Windows: Manufacturer -pug— State approved U factor . 6-2 TYPE eA' 5AM"3 T SIZE AREA (Ft.2) EACH ZosO -1 12.5 Z& 40 5430 -2 9 2t� 34-2 _ 11 "LUMBER OF TOTAL FEET, 2 UNITS 50 2 ¢O ! 9 s I 3d /7 I 4� g. Total ft.2 Glass_ Zo/.f' 106 Fireplace area: Width x height = x 4.2 Ft .2 11. Exposed foundation: Height x Perimeter .4p& x_ 13-7 Ft.2 ;)MPLETION OF THIS FORM IS REQUIRED FOR ALL hEW CONSTRUCTION, MAJOR REMODELING AND BUILDINGS BE LIVED WHERE ENERGY, OTHER THAN THE MINIMAL CODE ALLOWANCE, IS USED. 12. Fuming area = 10% of gross wall area. 13. Gross wall area ZZ 31 ft,2 Window area A Zo 5 ft.2 U windows = , s-Z U x A = to t.78 PATI• QAA944 40 2 U PAT. D. = -#7 u x .A i a Rim joist area A 114- ft. U rim-Joist = _,o41 U x A = ¢• &7 2 Door area A 38 ft. U door area = _4 U x A =32 Fireplace area A 413 f t .2¢ err^ a`U fireplace = '41 U x A' `__ Exposed foundation A .9 / ft.2 U foundation = o82 U x A = 7.4& Framing area A ZZ¢ ft.2 U framing area = .o74 U x A 21,0(0 Net wall area A 14, 0 . S ft. U wall = ,o 43 U x A'-- (13B) TOTAL . . . . . . . . . . U x A 14. Gross wall area x 0.11 (A-1 single family 8 duplex = allowable U x A/Code (13. above) x 0.23 A-2 other residential) x .23 Other buildings) x .28 (Over 3 stories) BTUH Must be larger tha A 2237 x U Cgde. . 11 Z 07. 136 above 246.¢3 15. Ceiling framing area (Af) equals 10% of ceiling area C or the. same as) 12 SLOPE a q. M. Gross ceiling area x (W) -%AAJZ_IMs = j zp5b ft.2 156 Joist area (Af) = 10% ceiling area i8sWe -4W_.) 134• ft.2 15C. Net ceiling area (Ac) (15A - 15B) !k400ac ccG) /20¢ ft.2 o scop•¢ c-L•g Y QC - . o 3'2 414- 2.O 5' U ceiling x A c= .o2Z x 24P 4. 4-9 U Supe fes, x A+s .082- 6 <p U framing x A f= • o Z�4 x 13 �• 3,48 150. TOTAL U x A........................................ 3 2,&b 16. Ceiling area (15A) x 0.026 (A-1 single family b duplex - code allowable U x A x 0.033 (A-2 other residential) • x 0.06 (other) BaUH Must be larger than 150 (above) A (15A) 14-10 x U (code)= 36, lo(o F (or the same as) , &Zto 100 •, IoFT F(Ca0/- YO MV& Ie-'dd JOWLA T/ON CIA- 74 V VA LUS, O1-- 0�3 NOTE: Use U and A values obtained from ops 1, 3 od 4. WALL SECTION STUD SECTION 2ND WALL SECTION RIM JOIST U VALUE CALCULATIUNS VALUE U VALUE Inside atr fibs .68 Interior wall 1/Logw)At1 .+S* (Wall) U= 1 =043 Insulation Co" 110 Sheathing 2.04. Siding .&-7 Outside air film .17 R TOTAL 2503 Inside air film .68 Interior wall ,45- '6N + stud R=te (Framing) U = R. : o 94 Sheathing Z.olp Siding ,&7 Outside air fila .17 R TOTAL /D.7/ Inside air film no .68 Interior wall Insulation (Wall) U Sheathing Exterior wall covering Exterior air film R =.17 ' R TOTAL Interior air film R= .68 Insulation 19.0 1 lei inch soft wood R=1.88 (Rim U s Joist) X04/ Sheathing 2.oly Exterior wall covering .L 7 Exterior air film Rz .17 R TOTAL 2#44, Interior air film R= .68 Insulation 10.0 1 Foundation x.28 (Fdn.) .0 = Exterior air film R= .17 D�2 R TOTAL / 2 • % 3 xposed Block V. 0 CEILING 'CJI?H VENTED ATTICSPACE ABOVE R VALUE R VALUE FRAMlt% CEILING 0.61 Air Film 0.61 33.o Insulation +4.0 Wow,_ ¢. 3S Jo is t 000 Ceiling , s¢ • 3. 0.61 Air Film 0.61 - Total R 1 ©2Co U ,oZ2 FLAT ROOF OR CATHEDRAL CEILING Value R VALUE FRAMING CEILING 0.61 Inside air film 0.61 S¢ Ceiling 10.9,s ?*/qjoist (stud Insulation 30,E Air space Roof decking - Insulation Built-up roof 0.17 Outside air film 0.17 J'Z, Z7 Total R 51'.3 2 U 032 R Jindow infiltration .5 cfm/lineal foot of crack tes.idential door ''infiltration 0.5 cfm/square foot or door and minimum code requirement 1cn-residential door infiltration 11.0 cfm/lineal foot of crack Jb 12" concrete block no insulation = .47 R 2.1 Jb 12" concrete block insulated cores = .26 R 3.8 15 12" lightweight block = .32 R 3.1 lb 12" lightweight block insulated cores = .12 R 8.3 J single glass = 1.13; with storm window .54 J double glass = .55 J triple glass = .41 kil exterior walls and ceilings must have a vapor barrier (0.10 perm max.). vapor barrier must be on the inside (heated side) of wall. ,apor barriers of the,.polyethelene thin film have no R value. SUBJECT City of Fridley r7(20 9 4 AT THE TOP OF THE TWINS BUILDING PERMIT RECEIPT N _ COMMUNITY DEVELOPMENT DIV. v PROTECTIVE INSPECTION SEC. C/ y� i A �/'-';•� CITY HALL FRIDLEV 55432 NUMBER REV DATE PAGE OF APPROVED BY ---- l J` 612-571-3450 910-F15 7/15/91 JOB ADDRESS 121 - 71st Way NE I LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Riverwood Park Addn SHEET 2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE Sheldon Berquist 121 - 71st Way NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Harold Sybrandt Construction Inc. 6405 - 116th.Ave N Ch lin 421-0725 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 6 DESCRIBE WORK Construct a 161.x 10' Addition; a 12".x 10' Deckp and remove existing deck 9 CHANGE OF USE FROM TO STIPULATIONS See notations on plane WARNgIG Before digging call for ill utility locations 454-0002 SEPARATE PERMITt REQUIRED POO REQUIRED By LAW Q WIRING, HEATING, PLUMBING AND SIGNS. 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 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $8x976 $4.49 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $108..00 Fire SC $8,98. STRUCT ON OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 9::Az*_40/7-1S---q1_ 1$121.47 SIGNATURE OF CONTRACTOR O UTHORIZED AGENT (DATE) AIOEN PROPERLY VALIDAT D THIS IS YOUR PERMIT tt AILDG I SP D4 TE SIGNATURE OF OWNER IIF OWNER BUILDER) IDATEI N [] ADM [ ] AL'I'T [ ] Legal Description: L, 0 Effective 1,/1/91 R-1 AND R-2 Building Permit Application 17 1 .w OL0�2 t K � - 4� ( v -r i- woe -L f Q j-,` a4cc c Tl ew owner Name & Address: 5 h -e G d D�V 6 -P Y f c t S T- Tel. # Contractor: J f" 4 L Q Ke) (ef W p -r ( 0 V5 I- ��-� Tel .# V74-0 7 2 S� rem: �a I{0 C l �P f� -� q't'r' ' C % �rm r Attach to this application, a Certificate of Survey of the lot, with the proposed rmw xuctinn drawn on it to scale. LIMM AMM: Length / Width Height sq. Ft.R&M�VIP GRRAGE AREA: length Width Height Sq. Ft. Lem AREA: length Width Hgt/Gr=d --�or-7� sq. Ft. l `z -o (� 7-� 87240 oma: rn'q a/ 4/-4 r A/ Ci D e c Corner Lot [ ] Inside Int [ ] Ft. Yd Setback Side Yard Setbacks Type of Ommtn=tion: WO -O i FY`t-M f Estimated Cost: Approx. CaWletian Date: 0 C -t- al t Proposed Driveway Width If New Opening Is Desired: Ft. $. $ DATE: 10-q 'dth + 6' See Back Page . APPZICATTr: Wez,,�d,y Tel. 2- Permit Fee Fire Surcharge $ . State Surcharge $, SAC Qzarge $ Driveway Escrow $ Park Fee $ Sewer Main Charge $ TOM $ /Z(, 17 -3 Is- - sTI ulATIM: 1. -C= CITY TBjE ONLY Fee Schedule on Reverse Side .001 x Permit Valuation (1/10th $) $.50/$1,000 Valuation $650 per SAC Unit Alt. "A" or Alt. "B" Above Fee Determined by CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES 5 JOB ADDRESS 2 i RATE SCHEDULE The undersigned hereby makes application for a permit for the work Residential Rate TOTAL herein specified agreeing to do all work in strict accordance with the Furnace Shell and Duct Work, Burner - city codes and ruling of the Building Division, and hereby declares Also Replacement Furnace $ 20.00 $ that all the facts and representations stated in this application are true and correct. ,1991 Gas Piping (Needed with new.furnace) $ 10.00 $ Ge..�.a.l G..'%•��*- ro [ / s OWNER 6►"0.n�-- Gas Range $ 10.00 $ BUILDING USED AS Gas Dryer $ 10.00 $ ESTIMATED COST 3 O PERMIT NO. *Air Conditioning - All Sizes $ 10.00 $ All Others/Repairs & Alterations (LIST ON BACK) 1 % of Value of Appliance or Work $ CommerciaVlndustrial 1 % of Value of Appliance or Work $ State Surcharge $ .50_ TOTAL FEE $ 5. MINIMUM FEE FOR ANY HEATING/COOLINGNENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $15.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $30.00 DESCRIPTION OF FURNACE AND OR BURNER No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) Trade Name Size No. BTU HP EDR Fuel Total Connected Load Burner Trade Name Size No. BTU HP EDR HEATING COMPANY_ Signed By i t+4-ok 'g 6, le -0 we 414-1(f 1. If Approved By—04�Rough-In Date Tel No. q? -'7 _ Z 3 L"/ Final Date *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE 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 ( ) 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 ( ) 6. Has total heating BTU's of All other BTU's TOTAL BTU's Remarks List Alterations Being Done: / oC a i h 9 3 A eaJ s K / S �c ti GL r C 42 ek t r HEATING COMPANY mac. °� a."I Signed By , 04 C, Date CITY OF FRIDLEY INSPECTION DIV. Effective On January 1, 1991 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT 572-3604 MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Water > Bath Wash Drink. Floor Catch ' Auto. Gas Gas Mi Sc. Water Heater Stories Closet Urinal Tub Shower Sink- Tray Fount. Drain Basin Washer Appl. Range Fitt: Gas Elec Basemen Floor 1 Floor 2 Floor 3 Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures Old Opening, New Fixture Beer Dispenser Blow Off Basin Catch Basin Rain Water Leader Sump/Receiving Tank Water Treating Appliance Water Heater -Electric Water Heater - Gas Gas Range Gas Dryer Back Flow Preventer Required ( )Yes () No Type $ 7.00 $ 4.00 $ 5.00 $ 7.00 $ 7.00 $ 7.00 $ 7.00 $10.00 $ 7.00 $10.00 $10.00 $10.00 $5.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1 % of Value of Fixture or Appliance _ State Surcharge .50 JOB ADDRESS 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. co"aKera l can Owner Building Used As 1` s de h C4 - 1 — /D .1991 Estimated Cost X40 - PERMIT NO. �, C� PLUMBINNY t*CT SIGNED B.= =•/: • TEL N0. Approved By Rough -In Date Final Date'�5'16 -� MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $15.00 TOTAL FEE PLUS THE $.50 STATE SURCHARGE SUBJEtT P City of Fridley 2985 AT THE TOP OF THE TWINS BUILDING PERMIT r PT NO. `v ______ COMMUNITY DEVELOPMENT DIV. � PROTECTIVE INSPECTION SEC. r � NUMBERaEv DATE PAGE OF APPROVED By CITY HALL FRIDLEY 55432 L J` 612-571-3450 910-F15 7/12/99 JOB ADDRESS 121 71st Way NE T LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 I R i verwood Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Barbara Berquist572-3884 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Sela Roofing & Rem. Inc. 4100 Excelsior Blvd. t Louis Pk 55416 823-8046 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 �ff REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house and garage 25 S 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 OCCUPANCYLOAO VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT 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 OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 2185 11-09 DOES NOT PRESUM TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF A OTHER S E OR LOCAL LAW REGULATING CON- STRUCTION TM C F CONSTRUCTION 83.25 Fire C $2.19 7R PLAN CHECK FEE TA EE XTO Licens 5. 3 S,G TUR O •RAC O 0 Au R,ZEO AGENT ,DAT ,EN _ RO ALIDAT HIS I UR PER/"0-003-MIT 7— S,GNATURE OF OWNEROF OWNER BUILDER, ,DATE, G ,NSP OA/E NEW -0 [ ] ADDN [ ] ALTER [ ] ConstructionAddress: Legal Description:' CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION - 21 ll ,k�, Effective 1/1/99^ Owner Name & Address: Tel. # v/'/� Contractor: BELA ROOFING & REMODELING, IWC. MN LICENSE #4100 Address: ST. LOUIS PARK, MN 55416 Tel. # 6o 12-,7y3-(Yv�1-6 D #000 05U Attac to this application, a -Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DES.GRIPT'1EON 4� ' I1ViPRQ — — NT ... 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: 4&WW--' Estimated Cost: $ ��� ����✓�-�`� �� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ c93., . X $ /,09 $ ado i ,f✓ stI!�� / / CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%). $.501$1,000 Valuation $1050 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 [ ] 'CITY OF FRIDLEY INSPECTION DIV. �-�N-Eifectr.e On January 1, 1997 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR DOWER PLANTS AND HEATING, COOLING, VENT1LATFON, m 572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMSAND DEVICES LL a-� JOB ADDRESS- PO DDRESS L � V �o �r P RATE 9CHEDULE " - The undersigned hereby makes application for a permit for the work herein Residential Rate TOTAL speolied agreeing to do all work in strict accordance with the City Costes and Furnace Shell and Duct Work, Bturre(— rulings of the Building Dlvislon, and hereby des that all the facts oral `° Also Replacernent Furnace $ 30.00 $ 3 representations stated in this application are tr a corned. (Side Vent -- Fill Out ftlo Gas Piping {Needed Qh new funRace) $ 10.00 $ f • r Gas Range $1000 $OV+NER� BUILDING USED AS �•i ; l Cum Dryer $ 10.00 $ ESTIMATED COST � � � PEANUT N0. 13 %c? "Air Conctitloning — All Sizes $ 25,00 $ RIESCRIIET19N OF FURNACE AND OR BURNER All Othersfflepairs & Alterations (LIST ON BACK) 1%of Value of Appriance or Wark A $ No. of Heating Units Circle One {Stearn,) (HN Wl ter' CW rm Airj Trade Mame v� Size No. Carnmerdaljlndustrlar BTU_�O tSpR 1.25% of Value of Appliance or Work $ Fuel 9 � , Total Connected Load ' State Surcharge ;—.50 Wrner Trade Name Size No. � BTU _HP EDR TOTAL FEE HEATING & COOLING TWO, INC. MINIMUM FEE FOR ANY 4EATINGCO0UgW9 TILATI©N HEATING COMPANY 18 Q CQUAly Rd -W—. �y REFRIGERATIONIAIR_CONDITIONING PERMIT IS 3M.00 Signed Maple Grove MN 55369-9231 PLUS THS STATE SURCHARGE a4 — -- is f' CpIr�t;� REINSPECTION FEE $42O/Hr Approved 8 Rough -In Date Final Dal5L w 0 %rConditioners can not be placed in a side yardwithout FILL OUT BACK SIDE F0 STACK VERIRCATK)N ON written permission from adjoining property owner. REPLACEMENT FURNAC OCT -16-1997 08 48 CITY OF FRIDLEY 612 571 1287 P.04/04 QMANEY. AND STACK )�I .A TJQN The undersigned hereby verifies that the existing ch n ney or stack: X. Has been carefully examined Yes (4 No ( ) 2. Is free from rust or deterioration Yes 6Q No ( ) 3. Has no foreign objects lodged within Yes (V� No ( ) 4. Is securely supported Yes *) NO ( } 5. Meets all current Code requirements for size and total BTU's connected Yes*L) No ( ) 6 Has total heating BT'U's of All other BTU's TOTAL BTU's jjifk 7. Has a liner been provided for water heater Yes (} No ( ) 8. Has combustion air been provided for water heater Yes ) No ( } Remarks: . HEATING -CO: HEATING & COOLING TWO, INC. Signed oun W. By:185'0 rc Date: (61 2) 428-3671 TOTAL P.04 CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2001 6431 University Ave NE Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 763-572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES JOB ADDRESS a/ RATE SCHEDULE OWNER Residential Rate TOTAL Furnace Shell and Duct Work, Burner - BUILDING USED AS 2t C Also Replacement Furnace $ 30.00 $ 4f-06 ' (Side Vent - Fill Out Back) ESTIMATED COST PERMIT N0. Gas Pi (Needed with new furnace, $ 10.00 $ ut not replacement) DESCRIPTION OF FURNACE AND OR BURNER Gas Range C C� $ 10.00 $ / f�S - No. of Heating Ugqits Circle One (Steam) (Hot Water) (Warm Air) Gas Dryer $ 10.00 $ Trade N me/'���1). 2' J-lD Size No. BTU C—) HP EDR *Air Conditioning - All Sizes $ 25.00 $ Fuel ^'A4 F Total Connected Load All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No. 1% of Value of Appliance or Work $ BTU HP EDR Commercial/Industrial 1.25% of Value of Appliance or Work $ 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 an State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and TOTAL FEE $ C�2f' S representations stated in this application are true and correct. DATE 1co ^ C/- & I MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr HEATING CO 6-��-Ta�+ai-���Q.Q -E `. l� *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date %O aj CSI written permission from adjoining property owner. BACK SIDE MUST 16E FILLED IN ON VENT SIZE, VENT CONNECTORS AND COMBUSTION AIR VERIFICATION COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replacina an existing furance, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes () No ( ) The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes () No () . The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturers specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) The existina_ combustion air is sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturers specifications. Yes () No When installina a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Furnace Venting Tables for fan assisted and natural draft appliances. Yes () No ( ) Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes( ) No ( ) Appliance Type and Size/Common Vent and Vent Connector Information Appliance #1 Type BTU Input Fan Assisted or Nat Appliance #2 Type BTU Input Fan Assisted or Nat Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances Total Btu Input Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter. in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS: (Describe) HEATING CO: Signed By: Date: 1 SUBJECT P NO. .�: City of Fridley 3 3 2 0 2 33202 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. �• COMMUNITY DEVELOPMENT DIV.�� ___ __ r y PROTECTIVE INSPECTION SEC. E . � REV GATE PAGE OF APPROVED BY CITY HALL FRIDLEY 55432 L J` 763-571-3450 [;UM;97BER 10/23/02 JOB ADDRESS 121 71 Way NE 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 9 3 Riverwood Park Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Barb & Sheldon Berquist 121 71 Way NE 763-572-3884 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO American Eagle Exteriors 19512 Country Cir E, Rogers, N,N 55374 763-420-3107 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 20159912 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION Ck REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reside house & Garage 9 CHANGE OF USE FROM TO STIPULATIONS Per Section 1402, 1997 Uniform Building Code, requires that a weather resistive barrier be paced over exterior sheathing to protect the interior wail covering. Exceptions for this provision would be if sheathing is an approved weatherproof panel or when the siding is an approved weather barrier. Vinyl siding is not a weatherproof covering unless the manufacturer states this in their application guidelines. Call for inspection of wrap before covering. 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 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 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 $9' 000 @ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT WW4 �,ro DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. 167.25 Fire SC $9.00 TRU TION O E PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TO AL FEE Lice C $5 185.75 1 ATU�11-RACTOR R AUT.OR�ZED AGENT iDATE, HE PRO Y VALIDA D THIS IS YOUR RMIT _ D S-GNATUREOfOWNEROFOWNER BUILDER � +DATE' 8L G �N �E 1 NEW [ J CITY OF FRIDLEY Effective 1/1/2002 ADDN (] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER [ j SINGLE FANULY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address:/ Z 7Z S T W1 V Legal Description: Owner Name & Address: --45A<13-t- 66i QV t ST— Tel. # %� 3 S% Z 3 9 9 Y Contractor. /� �q-kr G—SC / /�/���' MN LICENSE # Address:_ 1141°v7 -4y r'o -z C Lam,' 4� Tel. # 76-? ego R/6? Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LMNG AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width . Height Sq. Ft. Length Width Height Sq. FL Length Width Hgt/Ground Sq. Ft. u� Construction Type: /V Estimated Cost: $ 5?9W Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ =$ DATE: 1) z �7� �'Z-,APPLICANT: �a9'G Tel. # 1/ 2 - Z1-3 /J�2 Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by*Engineedng Agreement Necessary [ ] Not Necessary [ �– TOTAL $ c _, ') STIPULATIONS: