AF - 349473
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sue�ecr PERMIT NO.
City of Fridley . 1317
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AT THE TOP OF THE TWINS g U I L D I N G P E R I�1 I T
� i. RECEIPT NO.
� `L � COMMUNITY DEVELOPMENT DIV.
�_,
r � � PROT�CTIVE INSPECTION SEC.
�l � r"�1 � CITY HALL FRIDLEV 55432 NUMBER REY. ' PAGE OF APPROVED BY
L.«�.i`�� �`� 812-580-3450 � /
910-F15 c$$��
JOB ADDRES8 5377 A1 iura Road
1 LE(3AL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. S 7 Carl son' s SUilE11� t� NOl"tI'I SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
�lalter Olstead 5377 Altura Road� �EE.
3 CONTRACTOR MAII AODRESS ZIP PHOME UCENSE NO.
Budget Builders, �nc, 6821 Oakland Avenue South 866-1800
4 ARCHITECT OR DESIONER MAIL ADDRE33 21p PHONE LICENSE NO.
SAME
5 ENdIWEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDINO
7 CLA33 OF WO
❑ NEW �O ADDITION ❑ ALTERkT10N ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
13 x 11 dinin area
9 CHANCiE OF USE FROM TO •
STIPULATtONS
� � v1�E� F�R �iR����
��,�'E P���`iS �E� S���S.
S�,P� P������yG A
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SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBINO, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LQAD
VENTIIATING OR AIR C,ONDITIONING. VyIOO�I fPaille
THIS PERMIT BECOME$ NULL AND YOID IF WORK OR CONSTAUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CON$TRUCTION
OR WORK IS SUSPENDED OR ABAW�NED FOR A PERtOD OF 120 DAYS AT 143 1716
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PAflKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THtS APPLICATION STALLS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT. AL� PROVISIONS OF LAWS VALUATIOPI SURTAX
AND ORDINANCES OOVERNING THIS TYPE OF WORK WILL BE COMPLtED. @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE CiRANTING Of A PERMIT .Q�ZQO �. GO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOUkTE OR CANCEL THE pERM T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW RE(iULATINCi coN- �1 g. �LO
ST�CTION OR THE PERFOR NCE OF GONSTRUCTION. _
PLAN CHEGK FEE TOTAL FEE
°l � �` 20.80
IQNATUREOFCONTRACTORORAUTHO AQENT (Da E! � EN PRQ ER Y� A� ID ED THIS IS YOUR PERMIT
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SIONATURE OF OWNER I�P OWNEFi BUILDERI IDATEI " � D. SP � DATE
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APPLICATION FOR RESIDENTIAL, ALTERAmION,
OR ADDITION BUIL•DING PERMITS
CITY OF.FRIDLEY, MINNESOTA
,• OWNER' S NAME: � � O �_ BUILDER: k� �� �� S L
. AnnxESS: S ?� `� 7 � �. v � � AnDx�ss : (�, SS 3-.�,. � �Q-�. L �Utl � �i� �.
NO:�� STREET: � I' T �-{, a T/�- l�-!'/`� '
IAT: � BIACK: � ADDITION : l� �- �-� D� S s C� � Wl ( j � d�- ��.
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 BUILD�NG
0
To se vsea As: � � � � /u � �L � � a9� i lZ� �2- v r l-� � �t �, � .
• � . � � . , �� , � �
Front: �� 3 � . De,pth: .'1 � Height:
Square Feet; � � �
. ,
Fronta Depth:
Cubic Feet: � 7� � �
Height:
Square Feet: Cubic Feet: •
Type of Construction: � l�-N`�"�-�-- � Estimated Cost: �_
To Be Completed: � � G� � � (°� r} � �a �9 �
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 Buildi.ngs, and hereby
' declar�s�that all the facts and representations stated in this application
are true and corzect. ' � '
� �
• 7 S
DATE •
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. . � . � • � l3U�LDING L�.L'1s�1'1' 1��:L SI:11L`UULL' � ,� . •
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$�CTIaN 2. Thc xrispccCox af ]3uildings_ shall, -bcioxc issui.ng permi�s fox the �•
cxection af airy buil.ding or strucCuxc, oz iox 1ny 1ddiLion to any. cxis��ng .
� bui.ldi.n� ox sL•ructuxe, ox for any All%CiAt7.011 or rcp�ixs to any exisL•ing
• � � builcling ox sLrueture, u�on .appl.ication ehc•refore, xequixe tlie pzymenC by .�h� �
. appl.i.cant tor such permie of fces to �hc� amounC hcxein bclow scC �oxtii �nd in
tlie manncr I�erc�.n pxovidcd Co-wit: • . ,
. . . . • ' � � • .
� UNxTOIt��i I3UILDInG COD� : Type 1, 2& 4-'$2.15 for each one �li•ous.and cubie . .'
�eet; or �raction thexeof, in such cubical Gontents. Type 3& S-$1..85 for '
. • each one thausand Ct1V1C feei�. ' . , , '
� .
� � . ' • � . .ADDITIONAL INt�ORb�ATION � • . .
. � • , . . . . . ,: .
• '��Fox the �puxpose of computi.ng fees fox building perrnits, the cubical c4n . enCs '•
' , of any builcling ox addii:i.on, is .detexmined, by multiplying• the ground area .
' covexed from a point six. (6) inches below the flo�r line o� the basemei�ti� ,. .
'�� ox the cellax ta the avexage heights o.f the upp�x surface or Co the avexage�. `
�height of the roof surface�of the main gable of a pitched roof. . • ..
. . e . •
< Fox•repai:rs or ali:axations �Co an eYi.stii.ng� struetuxe, the fee shall be a� the
° ra�e of $3.00 per each five h�undxed dollars�($500.00) or fraction thereof in ..
• , � the cos� of all �ropDSed taork. � � . ° - � • : • � �
.. B • . , . . o
� In. no case shall the fee charged fox any permi.t� as se� for�h �in Secti.on 2 b� •�
. � kess than $5.00. . .. �- . • � � � . . . '. . . .
. � �'� • ' 'VERIFICATION OF FOUNDATION � � � � � �
. � . . -. . . � � .
. . • . . , . , i .
.�p�; pexmits fox constxuction will be issued.a mini.mum of 24 houxs fxom the �
�• time of application, to allow for proper revi.e�� of the gxoposed structuxe and,
• o� Che construction siCe. , • • .• . •
• • . . ' '. . . ° .
'�� � A Ce�:tiiied Su�.-vey o£ the lot,� sha�rins the loca�i.on of the iounda�ion, once iC
has Ueen constructcd, wi.11 be rcquixed Uefore pxoceedin� �oit-h the fxaming.
� • . ' ° . � CERTIrICAT� OF� OCCU1'ANCY ' . . •
.� App].i.enCi.on fox a Certiti.cate o� Occupancy sh�ll be madc �en (10) cY�ys . priox
' to the use ox •occupincy of �ny strucCurG for wliich a buildii�F, pexmiC 11�s been � .
�.ssued� 111C� s1i:d sCruclure shal.l noC bc used ox occupicd unCil a Certi�i�caCe
• , oi Occupaxicy has Uecn issued. , � „ • .
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• �; � � . . �, . ' • . ' ' ' � � . . . '
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SUBJECT IT N O.
City of Fridley -1 � 9 2 9
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
; � ECEIPT .
� ' COMMUNITY DEVELOPMENT DIV. �
' j L �"��',
r � � PROTECTIVE INSPECTION SEC.
! � �
� ��"1 � CITY HALL FRiDLEV 55432 NUMBER REY. DATE PAGE OF APPROVED BY
�'"'"� � ,�� 612-571-3450 910-F15 � 8 � �
108 ADDRESS 5377 Altura Road N.E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. $ 7 Carlson's Summi.t Manor North SHEET
2 PROPERTYOWIdER MAILADDRESS ZIP PHONE
Walter Olstead 5377 Altura Roacl N.E. 56Q-4669
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
L�.oyd's H�me Impronemerit Inc. 1�12 - 42� Averrue N.E. 78�5602
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIIADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION � ALTERATION O REPAIR ❑ MOVE � REMOVE
8 DESCRIBE WORK
Reroof D�ell'
8 CHANGE OF USE FROM TO
STIPULATIONS
Roof aan be 2nd hut rnot 3rd roo£. ?.nstall ridged $alvanized valleys.
TYPE OF CONST. OCCUPANCY dROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINO,
VENTILATIN(i OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. fT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING
1 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 LAW3 VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 5897•OQ �`.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S7.5O
PLAN CHECK FEE TOTAL FEE
� $8.00
SIGNATUREOFCONTRACTORORAUT DnGENr �Da�� � WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
� ' /
SIGNATUiiE OF OWNERIIF OWNER BUILDERI IDATEI BLDG INSP �A E
CITY 0� FRIDk�Y -
, APPLIC/1TI0►'J FOR RESID�.NTIAL QUIl.RIP1G PERt�iTTS
(tdew, Alter•�tions, Additions, or Repairs)
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Consi:ruction Location '
STitITT NO: � 3�_ STREET: ,�� "
IAT: � �3LLt3Cx: �� ADDITION:
r
Corner Lot: Insiiie Lat: Setback: Sideyards:
Applicant at�tach .to this form two Certificates of Suxvey of lot and
proposed building location drawn on CP.T,"t.].f1C1.'tES to scale. �
DESCRIPTIOf� OF GQNSTRUCTION �
Front: � D�pth: Height:
Squa�e. Feet: C1.ibic Feet:
. Front: Denth: Height:
i
Square- Feet: � Cubic Feet:
Tyge of Construction:
7.b $e Cb�►p].eted: � ,� / � �
Proposed Drive��ay Width If New Opening Is Desired: _
�
Estimated Cost: $ �f�%o�.
A].t. A Alt. B
$� $
SEE REVERSE SiDE OF SHEET
Tiie undersiqned hereby make� applicatian for a permit for the worl:�hexein specified,
agreeing to do ,al.l work iri strxct �ccordance with the City of �'ridley Ordinances and
rulings af �the Departanent of Buildings, and hereby declares that all the facts and
represen�.,��:ians stated in this applicatzon are true and correct.
DAT� : � S TGNATU i2E :
Stipulai:ions :
. �7-��
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• )3U1 LU11VG {'t:.l{NI1 I I-i.:L- :ii:tlf,JaUL�' � .
SIiC'.�IOhI 2. • x'ltL 7n•;��ec�or. of• l3uilc?ingJ Jtiri).7., before i. �sui.�ig pc�aniL•� for �he Greci:i.on
�f �,r�y l�uS.ld�.iic7 ar ui ruct:ure, oz ��ar an�f adcli.�a.on +.:a aisy .er,i;;Li.n� uui].dinc3 or sL-rucLta�e,
. i�r. f:�r ar,y a11:c�.rat.i��i or x'epair.a t�o •any cr.a..Liny I�ui.J.di,»q az str.ucture, u��on an��li.aation
�'�:hcr.�::to�c, xequare Ui� naymciiL by i:lic aPZ�li.cant: for. such Pexmi.L- nf fees to_ thc amount
hcxi:a,n: bea.a�•� sei: for.th and in the �nanncn c�rcin provided to-w5.t: �
. . , . :
,?3]-y�7 COI�: T1:UCTION: Sing].e rami].y Ilomes and Garages : $4. 00/1,000 cubi.c L-ee�.
�LnN . Cii�.C3;: 25 �,�erceriti ai bui.lcling }�exma.t tee.
U�V��111Y ll�rItL•'SStOT•I: (Concreie GUrb Streets Only} • ' �`
' A1L-ernai.e 1�: Removal and repJ.ac�men� of concrete cuzb and
guLi:er anly; Driveway i��idth .plus 6 feet x�:�,�,75
Al�ernate II: Removal and xeplacement of cancrete cuxb and
. � gutter and iaist�ll a 3 foot wide approach �d3.U1 ��
' ,. 6 inch depth; Drive��ay width �plus 6 feet x$1�.85 '
: � t tl�Yt[. � ; d � �
I'or the pu�rrose of computing fees for building permits, L-he cubical. contents of any
buildzng or addition, is dcL-ermined by mulL-iplying the ground area covered �rom a
poznt sir (G) inches below the tloor line of the bas�ment or th� cellar to the
-avcxage heights of fi�.e upper surface or to the average height of the xoo£ surf:ace
of tire �ai.n gabJ.e of a pitched roo�. �.
For �x��v.rs or al.terations ta an exista.ng structure, the fee shall be at the xate.
o£ $3.OQ Pex each �ive hundred do7.lars°($500.00) or frac�ion thereaf an the cost
af all pzoposed work. . . '
In �no aase sha].l the fee charged foz any penn.it as set iorth i.n Sectian 2 be less �
�han�$7.50 plus $.50 state suxcharge. ' �
L�1,� : � � � �
0
' NOTE: ?Permits �or constructian toi11 be issued a mi.nimum of 24 hours from tlie time
c>f appla.cation to al.low for proper rcuiew of the proposed siructure and oi the
:cons�ruction site. �
� .
1� �Cert3.£icate � of Su�rvey of the lot, showing the location of the faundation once it
�has b8en constructed �.fil7. be required before pr.oceeding wi.th the iraming.
CERT I F I CATE 4F OCGUPAf��CY
' App7,ication for a Certificate of Oceupancy sixall be made ten (lOj days prior L-a the
use or OCCU�3ilGj► oi any structure for tahich a k�ui.ldii�g permit has been issued; and
said stxucture sha1J. uot }�e used or occupied urii:il a Certi.fica�e oi Occupancy has
been i.ssued. -
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SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� �
• COMMUNITY DEVELOPMENT DIV.
� j y � ��
r i � PROTECTIVE INSPECTION SEC.
� _ �"'1 � CITY HALL FRIDLEY 88432 NUMBER REV. DATE
�"'"'� � ��� 612-571-34b0 910-F15
5/4/83
JOB ADDRESS 5377 Altura R03C1 N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
oescR. 8 7 Carlson' � S�mit Manor North
2 PROPERTYOWNER MAILADDRESS Z�P
Walter Olstea.d 5377 Altura iZoad N.E. 572-9�472
3 CONTRACTOR MAIL ADORESS Z�P
Durabilt Garages 7343 Ann Court, Eden Prai.rie 55344
4 ARCHITECT OR DESIGNER MAIL ADDRESS Z�P
5 ENGINEER MAII ADDRESS Z�P
PAGE OF
� �
PHONE
938-9350
_ 1711
RECEIPT .
����
APPROVED BY
SEE ATTACHED
SHEET
LICENSE NO.
LICENSE NO.
PHONE LICENSE NO.
8 USE OF BUILDING
� R@3jJ.C1P.I1't1.d�.
7 Cu►ss oF woRK ❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE � REMOVE
X
8 DESCRIBE WORK �
Construct a 14' x 22' Garage
9 CHANdE OF USE FROM
�S�tPULATIONS
TO
Provide a hard surface �X driveway.
TYPE OF
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
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. DN
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1'
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUAT
AND OROINANCES 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 pEqMIT
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
CTION OR THE PERFORM NCE OF CONSTRUCTION.
PLAN C
5-�--�.3
� SIGNATURE CONTR CTOR AUTFIORIZED A6ENT IDATEI
a"- - �
��n.�..� mc nc nww�cc nc nwniFw AuILDERt tDATEt
SQ.
� STALLS
,289.44
544. 50
OCCUPANCYLOAD
CU. FT.
iET PARKING
GARAGES
$l. 64
FEE
$46.14
IS YOUR FERMIT
CITY Di FRIOLCY Eff�ctive �ug. 1, 1981
APPLICATI�i FOli RCSIDCNT111� 6UILDIf�G PL•iiMITS
(Nenr. Al terations, Addi tions. or Rcpa i �s )
ONt�ER: j,�1 A-aI.�-F � C�L Si`�'l� � _ BUILOER: _�PA �i��r- ,� C���G�'S`,
s �s
ADDRESS: ,-�3�7 ��t�eA �►� �oa�.ss: 73 �.� ��,�, c��,�fi Fo��,�� ,�
�� �o: ,•� � ��-�- � � No: � � �3 s�
, Constrvction Location
. s�r t�: S 3 7 ssn�er: ��T� ��. �2 �
LOT: � _ HLODC: 7__ IIDDITION a(� a� �So oJS S c� an � o°P �.'t/�
Cornez Lot: InsiBe Lot: '� 6etbaet: ________ Sideyaz�:
Jlpplicar�t attsct� to t>>is fo� !wo Certificates oi S1�rvey of lot and
pzoposed builcling locatian draan on certificates to scale.
. •
OESCRIPT10i� OF �OhtSTRUCTIO��
,
Fsont s` %� __,�___ Depth: Z�- � H eiqbt r_���____
6quare Feiet: o Qtbic Feeta (8
, Front: Depth: Hefghts
Square Feet: A�bic Feeta `
' � ��8�• �
�rpe of Cbr.stzuctiar�: �t� R� Estiaiatee Cbst: S 5 oG. ��
r_ � �_ — —
9b Se O�r.�plcted: (� - �l���
. —
7�1t. 7► 7►lt. 8
prop�sed Dzivc��ay iiidth If Ncw Opening Is Des3.teda :' S
. 6E� REVERSE SIDE OF SHEET �
��e ur�dezsigned ?�ereby ma3:es applfcr►tion %r a pez�nit icz the woxk herein specffied,
egzeeing to i!o ,ali woYk it, strict accord�ce With the City of Fridley Ozdinances and
tvlin9� of the Depasbnc�t of Duildings, and hereby derlazes ti�+t all tl�e facts 8nd
=epreacntt�tions stated 3n this npplication are tzue and co:reat.
�1TEt � - �-�� SIGNATiII� a
. .�� ...�
Stipulations=
�' ��.�
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�
.� - _ _ �
dt1ILDING pERMIT FEE SCHEDDLE
�he Inspeetos of builaiaqs ahall, befcze issning pezmits foz the
•z�ction oi any nuildin9 os atrnctuze, oz tor any aedition to any
•:istinq buildiAq or stzvetnse, oz icr any altesation os sepaiss
to a�y •zistinq bvil0inq oz stzuctuse, opcn application tbezefoze,
sequize the pay�ent �y tbe applieant tos sueh pesmit ot �ees to the
aaoant b�seia bel�w set torth aad in the a�anaes heseia psovided to-wit:
'1'0�1'11L V717.UATIQ�i
�i. oo e� tsoo. o0
ssoi m t2,000
g2, 001 � .:25• 000
i25,001 to SS0,000
!'i:ES
i10.00 Misi3mum Fee 515. DO plus surcharge
=10.00 toz tht first 5500 plus 51.50 for each
�dditional 5100 or tzaction thpseof, to arid
including 52,000
:32.50 toz the iir�t S2•000 plus �6.00 foz each
additional S1.000 or frection th eseoi, to ana
° ir�cluding 525.000
5170. SO foz the fizst 525,000 plus S4. SO ioz
each additional �1,000 os fzaction thes eof, to
ar�d includfng SSO, 000
i50,001 tc 5100,000 =283.00 tos the iizst 550,000 plus 53.00 ior
each addit3onal 51,000 or tzaction thereof, to
and includiriq $100, 000
$100,001 and up . 5443.00 foz the iizst 5100,000 plus S2.50 for
each ac]ditioael 51,000 oz fraction Lhezeof
PI.�W C�C�Ca 25 pescer�t of building pe�it tee
DRSvi3,tAY DEPRESSI�t ESt:ROW: Concrete Q�zb Stseets �ly
111teznste_ 'J►": Re�aov�al ar�d zeplacelee�t of cuzb ar�d guttez only ,
Drivew+ay vidth plus 6 feet s 513.50
111terrute •B's Reuoval and zep2sceAent of cvrb aria guttez and install a 3 foot
ride appzosch vith 6 inch depth
Dzivevay vidth plus 6 teet s 515.75
VERIFICATION OF FOUNDATION
Pe�iLs ios cor�tsvctioa► vill be issued a �einir+ian of 24 hours fzan the time of
application to allov fos proper sevier+ of the proposea structure aad of the
constru ction siLe.
71 Gertificate of �rvey of the lot, showinq the location of the four�c�stion once it
has been oonsirvcted vill De requised before procee, dir�x rrith the fzaroi�Q.
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�--�� _ �� �a CHIMWEY AND STACK VERIFICATION
�
a
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined
2. Is free from rust or deterioration
3. Has no foreign ob�ects lodged with�n
4. Is securely supported
5. Meets all current Code requirements for size and
total BTU connected
6. Has To ta l hea ti ng BTU' s of
Al1 other BTU's
TOTAL
Rema rk s
Yes (; No ( )
J
Yes ( ) No ( )
,►/
Yes ( ) No ( )
Ye s ( ) No ( )
Yes � No ( )
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Cq�tpany �
S'f gned By �
Da te — 2Z� g 9
�
sue�ecr MIT NO.
City of Fridley 2 6 3 0�
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
; � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV. 2 �� �
'� � ti �.�����
r � � PROTECTIYE INSPECTION SEC. eJ
� i �
� /"'1 � CITY HALL FRIDLE� sS43i NYMBER REV OATE PAGE OP APPROVED B1'
�----� • •,, 612-571-3450 9iaF�s 6/22/98 / /
10B ADDRESS 5377 Altura Road NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. $ 7 Carlson's Summit Ma.nor North Addition SHEET
2 PROPERTY OWNER MAIL ADDRES$ 21P � PNONE
Olstead 5377 Altura Road NE 572-9492
3 CONTRACTOR MAIL ADDRESS 21P PFIONE LICENSE NO.
Viking Home Improvement Co 4832 2 1/2 St NE, Mpls., MN 55421 572-1820 4772
4 ARCHITECT OR OESIGNER MAIL ADOFiESB 21P PMONE LICENSE NO.
5 ENGINEER MAIL AODRESS Z�P PMONE LICENSE NO.
8 USE OF BUILDIN(i
Residential
7 CLASS OF WORK
0 NEW � ADDITION 0 ALTERATION �] REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (18 Sq) Tear-off; Partial Reside/Trim
9 CNAN(iE qF USE FROM TO
STIPULATIONS
IInderlayment must comply with the State Building Code. Install building
wrap and call for inspection before covering.
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBINti, MEATINd, �PE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONINCi. -
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTfiUCT10N ZONINO SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN � OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PER100 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFiEET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. 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 WFIETHER SPECIFIED MEREIN OR NOT. THE GRANTING Of A PERMIT $3,50A �I.. �S
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OH CANCEL THE pERM1T FEE SAC CMARGE
PROVISIOPIS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION O THE PEiiFORMANCE OF CONSTRUCTION. �H7 . ZS Fire SC �3. SO
PIAN CHECK FEE TOTAL EE
2.�?��� License 5.00 7.50
SIG ATUREOF NTRACTOROiiAUTMORIZEDAGENT IDATEI pp pER LIDATED T IS YO R PEPMIT
. � � �
S�GNATU�iEOFQWNERpiOWNERBUILDER� IDA E� y..� BL6G. Sp rypTE
1vEW
ADDN
ALTER
[]
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R 1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
�� �����
ConstructionAddress: �3 7 � � L T�� � /Z /J•. �
Legal Description:
Owner Name & Address: d G�s rF.Q v Tel. #�7 2-� e/ y z
Contractor: d� k.� �!� a� f 2�./��e �- e.,� r- � a• MN LICENSE #�/ � r/ �
Address• , y�.3 2 � %z .�T� •� - •F . Tel. # �� t - r � a. v
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIP�ION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECS AREA: Length Width � HgtlGround 5q. Ft.
OTHER: R e�aoF ��o � s� r- �.��c.� 40� !� C� l��}'i� -� �i-�-
� -� j�� /
Construction Type: /�.�t✓� !.��4-L � s.�,o�' �r�2,t�.� �,-o�a Estimated Cost: $ �z J� �J
(Fee Schedule. ack) ��0�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
_$
DATE: � � �- APPLICANT: Tel. �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
$ �'�J�S
$ . ,5�
$ / �%S
$
$ .� c��
$
$
$
$
$ , S—Z�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 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 [ ]
��
BUII�DING PERMIT FEE SCHEDULE
The Cluef Building O�cial shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein lxlow set forth and in the manner herein proyided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to � $1�,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,�1 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,�
$62.25 for first $2,0� plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,�0
$349.75 for first $25,000 plus $9.00 for each additional $1,0�
or fraction thereof, to and including $SO,Q00
$574.75 for "first $50,(m0 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $1�,0�
$887.25 for first $1(�,(�0 plus $5.� for each additional
$1,000 or fraction thereof, to and including $5(�,000
$2887.25 for the first $500,0� plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,0�,000
$5012:25 for the first $1,000,� plus $.^..75 for each additional
$1,�0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Coa�crete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.�.
Alternate "B" : Removal and repla�ement of curb and gutter and install a 3 foot wide
approach wi�h 6 inch depth - Driveway width plus 6 feet times $15.75 .
VERIFICATION OF FOUNDATION
Permits for construction will be issued a manimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of tbe lot, showing the location of the foundation once it has it has been constructed
will. be required before proceeding with the framing.
�- ..�..4