2017-02249 ROOFINGADDRESS
PIN
LEGAL DESC
f��1.�uTIlI1�lY•i�iJ
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432-
(763) 572-3604 FAX: (763) 502-4977
: 6489 RIVERVIEW TER NE
: 153024420088
: UNAVAILABLE
: LOT * BLOCK *
: BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ROOFING
VALUATION : $ 4,932.00
NOTE: UNDERLAYMENT AS PER STATF. BUILDING CODE.
* 2 O 1 7- 0 2 2 4 9*
ISSUED: 11/07/2017
Permit # 2017-02249
CONSTRUC"CION IN THE CITY IS UNLAWFUL EXCEPT BETWEEN THE HOURS OF 7:00 AM AND 9:00 PM, MONDAY TFIROUGH
FRIDAY AND BETWEEN THE HOURS OF 9:00 AM AND 9:00 PM ON SATURDAYS. NO WORK IS ALLOWED ON SUNDAYS OR ANY
LF.,GAL HOLIDAY UNLESS AN ALTERNATE WORK HOUR PERMIT HAS FIRST BEEN ISSUED.
CALL FOR FINAL INSPECT[ON WITHIN 10 DAYS AFTER COMPLETION.
"I'EAR OFF AND REROOF HOUSE ONLY 32 SQ
INCLUDING 6489, 6491, 6493, 6495
APPLICANT
SAMS ROOFING INC
61 CIMARRON
LAKE ELMO, MN 55042-
(763) 464-0447
Minnesota State License #: GENR-BC637622
OWIYER
THORNTON, CAROL L
6489 RIVERVIEW TERNE
FRIDLEY, MN 55432-
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 11/7/17
BUILDING PERMIT FEE 111.25
FIRE SURCHARGE 4.93
STATE SURCHARGE, BLDG VALUE 2.47
LICENSE SURCHARGE 5.00
TOTAL 123.65
Payment(s)
CREDIT CARD 8553 02249
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
123.65
ADDRESS
P[N
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432-
(763) 572-3604 FAX: (763) 502-4977 ISSUED: i iio�iaoi�
6489 R[VERV[EW TER NE
153024420088
UNAVAILABLE
LOT * BLOCK *
BUILDING
RESIDENTIAL
ROOFING
PERMIT APPLICANT:
SAMS ROOFING INC
61 CIMARRON
LAKE ELMO, MN 55042-
(763)464-0447
VALUATION : $ 4,932.00
BUILDING INSPECTION RECORD
24 HOUR NOTICE REQUIRED FOR ALL INSPECTIONS.
CALL FOR INSPECTIONS WEEKDAYS: 8 AM TO 5 PM
INSPECTION TYPE DATE iNSPECTOR COMMENTS
ICE & WATER BARRIER
IN5PECTION 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 Inspections BUILDING � 53 Permit No.: 4�7 • D
763-572-3604 RESIDENTIAL APPLICATION Received By: ��
763-502-4977 FAX CITY OF FRIDLEY �.� � 7
EFFECTIVE I/1/14 Date Rec'Cl:
DATE ��/' 3�" �% YOUR E-MAIL ADDRESS S �n S r4t% ,�✓ 1 i a h oc,. Cc
�
SITE ADDRESS I`�� � vc! v� C � /�O � � �
THIS APPLICANT IS: ❑ OWNER [�ONTRACTOR
PROPERTYOWNER/ NAMg: ,uL ��,J ' ni�7
TENANT ADDRESS: F� �"��°S � l �'N l�/ �� � �� CITY /" � � ' STATE�ZIY�' `�Z
PHONE: ([� � ' � o� � - y5a �
CONTRACTOR NAME: <, � , ivG
SUBMIT A COPY OF STATE LICENSE # C(c 7G .� LEAD CERT NUMBER EXP:
YOUR STATE LICENSE /
AND CERTIFICATE OF ADDRESS: �,_/ �,� ,� f ��'✓ �� `"-'- ��/hC� yvi .�/ CITY4�{%.�, � �.s,�' STATE�j/`ZIP,SS�G�z
INSURANCE PHONE % � � G' �` � FAX
PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCT'ION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WiNDOWS
❑ BASEMENT FINISH [�ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: e. ' Ci�,
SIZE OF IMPROVEMEN LENGTH WIDTH HEIGHT �� SQ FT ���
ROOFING �HOUSE ONLY
NUMBER OF SQU S 3� % ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES � ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit SIDING/SOFFIT/FASCIA �DITIONS & PORCHES SUBMIT:
❑ Aluminum ❑ Trim REMOVED? ❑ YES ❑ NO �� Site Plan/Survey showing the existing shuciures
❑ Other ❑ Fascia and proposed project.
2. Two sets of const�ucrion plans
WINDOWS 3. Energy Calculations
IN EXISTING OPEI�IINGS �Yes ONo 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:
(U�>J���E 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 7`�4� L OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ �/. a� J See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ � .001 times the total job valuation
$ % .0005 x Permit Valuation Minimum or .50
$ . � $5.00 (State Licensed Residential Contractars)
$ $2485 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$26=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ . D Make checks navable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby appiy 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 pernut on site; that the work will be in accordance with the
approved plan in the case of all wo,Jr c w�tyh�equir •e ' approval of plans.
SIGNATURE OF APPLICANT
APPROVAL INSPECTOR SIGNATURE
PLEASE NOTE: SEPAIL
/ � L ���jr� �l DATE // � � 7
P T NAME
c�l t i � �,
PERMITS ARE REOUIRED FOR PLUMBING. ELECTRICAL AND MECHANICAL WORK