AF - 34949City of Fridley, Minn. N° 9 U 4 3
� BUILDING PERMIT �a� �
�
�'''1
m
��. OCTOBER 5, 1966
p�; HAROLD S. LIIITST80M g��. S,AME
Ad� 5387 A'�,TURA ROAD N.E. Addresa
FRIDLEY, N�SOTA 55421
LOCATION OP BUILDING
No. 538� Str�et ��tTURA RQAD 11T.E _ Part of Lot
I,ot 9 Black 7 Addition or Sub-Divlei� .�.��tT—�O1QS �,'UMMTT MA'IQnR� NnRTFt ADDN.
Coraer Lot _ Inside Lot Setback �.... Sideyard
Sewer IIevatfon � Fouadation IIevation
DESCRIPTION OP BUILDING
To be vsed as: �A.RA�E 8
DET. Front 24 Depth 22 Heigt►t� Sq. F� 528 c�u. 1�'t. _4,.���- .
Fr�t Depth i�eight Sq. F't Cu. FL
Type of Construction -_FR�ME_ F�t. Cost _.._ �.� Q�.�? To be Completed
In camsideration of the issttancae to me of a permit to construct the building described above I a�ree to do
the propo�d work ffi accwrdance with the d�criptioa sbove aet forth and in ce wlth a�l pro�viaiona of
ordinanaea oP the dty of Fridley. ,��L✓�s'"
�°`��_
Ia ca�ideration of the payment oP a fee of $�� , Permit is herebY granted to ��_S.
L?.1VDSTROM �����t the building or adclition as d�crlbed above. Thia� t 9s gi�anted up�
the exPre� condition that theperso to whom it is �aated and hia a�ents, employees aa� worlmnen, ffi ell uwork
done in, around and upon said nbuilding, or au�► part thereo� shall oonftorm 3n aII r�pects to the ordineacres of
�d�Y, ��ta locatton� construction, alteration, maintenance, raepatr aud moving of b �
wI� dty ]imits�� permit may be revolsed at any time upon violation of aay of the Pl'oviaiaais�of ea�d
CI�ARENCE BI�LISLE g�� �
NOTIC�
'ndt � dea em eersr f6s co�, � hr w6de9. P���6. 6+� �. �ra� or �rater. B� sw+a te a�
�ea BnUd�g le�e+ tor aPe►ah p�mHs Mr t6�a ihmr.
��
e
APPLICATI� FQR BUILDIl�G PERMIT
CITY OF FRI�LY,, MII9NESOTA . . . .
OWNER'S ATAME /�a e-o / d ��Ih v��,�, BIIILDER S�a �-►� e.
ADDRESS �3 frT G��,.�� ���=// G "_____��IDDRESS _
LOCATION OF BDILDI�G
N0. SZ'RLIs'� . , . PART OF !�T � , :
LO't BLOiR ADDITION OR SIIBDIV�SION �Ci ��, SB �i S' .,S �, ►.,.. :. �%/��� d�/ O�
CORNER �OT • . �NSIDE L `_SE�'$ACR SIDE-Y�iRD • �� � ��
SEWER ELEVATION � FaUNDATIOft ELE9ATI�
Applicant attach to this form Two Certificates of Survey of Lot and proposed
buildiag location drawn on theae Certificates.
DESCRIPTI01� OF BbII.DING
To be used as:� /°�� " � •
�
_� a 1- a�e Front �� . Depth.��` Aei�h� b' . St'K.�s ; .
�
Sq. Ft. .�� � Cu. Ft . `/� � i�
Front Dept � Height �_
Sq. Ft. Cu. Ft.�
Type of Construction %Ya y.r C�l�aeirr,cehS,St�Btimated Cos.t. ��s'L� � 1ado�
To be completed j q�� � -
, — , �..� ..._.�.
The undersigned hereby makes applicatioa for a permit far the wark herein
apecified, agreeing to do a11 work in strict accordance with the Gitq of
Fridley Ordinances and ruliu�s of the Department o��Buildings, and,hereby �
declares that a11 the facts and rep�eeentations stated in this epplicatiictn
are true snd correct. "
DATE � ce� - �� � % � �° SEGNATURE G�.z��-�,`-/� ' .
(Schedule of Fee Costs can be found on the Revers� Side}.
`� � , � . ,�, �� �' �,�� a � �+f' �� ,�' ` ��• � �� � � d`� � 39 G.! � ' �� �. �" �
� � �
� � � `� �' f� � � r� ,e.,� -�±. �" �a � �/ @� �' �' .
� `� � � � `
?� ' � _ ; . �_
- :�� — � � -
..�.
BDILDIftG P8R'NII� FEE SCgEDULB
_�, ...:.: . . .. .
... ,..,. ...,,.,; :..
SECTIOId 2. The inapector of B,uildings sha11, before iaeuing any permit for
the erection of any building:`ar etructu�rr�;;:a�,.fcr any'addition to any existing
building or etructure, or for any alterations or repaira to any eacistiug
bu3.lding or structure, upon epplicatioa therafore, require the pay�nt by the
appli�cant for auch permit _ of...feee to th� amouat herein below set forth �.�d in
the .manner he�rein provided to=wit; - - �• �
. _ _,.,. . . .
-•.... 2„ For� auq such permit f�r the •erectian of au�► fire=proof' bui�.ding,
othei than a garage, warehouse, factory or grain e�ev�tor, or foa the erection
of any fire-proof addition, for'eimilar occupancy, to any exieting buildin�,
ahall. be at th$ _rate .of .$1.44 for each aa�e thousand cubic feet, or fraction
thereof, in such cubical conteats. �"
2.2 • Fot��any, each,permit for the erection. of aay fire-proof garage,
warehouse �aetorq t�g'�ain elevator, or for the erection o� anq fire�proof �
addition, for �imilar ocaµpancy, ta any,esisCing building shall be at the
rate of $�.25 f�o�.,�ach o�e�.fha�eand-cubic feet, cl-ass-ified as, "ffreproof"
by �ctian S02''of the Minneapo�.�a. Buildiag Code. .
t . �; � • ..
HOIISES �
2r 3. For any euch permit.for the erectioa.of any non-fireproof
building, other than a garage,:warehouse, factory or �rain alevator, or
aay non-fireproof addition, for similar occupancy, to any esist3,ag bui],ding -
permit $1.00 for each one thousand cubic feet.
GARAGES - . _- ..
2.�. Far any:such permit for the erection of anp non-fireproof garage,
warehouse,-.factory or graia e�evato�,�or for ti�e erection of any non-fire-proof
additton,�.for similar occupancy, to any exi.stin� buildiag.gr for ea�h sach �
building ar additiott - ainety ceate (�0.90).fox each one thousand cubic feet
or fracCion thereof, in the cubical cvnCents-thereof with the minimum of $4.00.
For the purposa of computing £ee�',for building germits�_the ctibical contents
of any�building'or additioa to a uaiform�height throughout bq multiplying t1�e ,
ground area coverec� fs�am a point ais (6j � istches b�low �the f�.00r line of rhe
baseaneat ar cellar to the average hr��ght�of the upper eurface or to the av�rage
bei�ht of the roof eurface of the main gab,le of a..pitch,ed roof.
2.5. For �epaire or alterat3ons to an exi��ing'�atru�tur�, the fee shali.
be at Cbe ra�e of� $3..00 pc�r �ac�t` Fiva ��undred Doliar� (�S�Q0;00} or� �racti�n� �-_
thereof in the cost`:of �ll pr:oposed �ork: • ' ' � '
2.6. . In no case shall the fee charged for any permit as set forth in
Section 2 be less than $4.00. . ,
� . _ . • . _ . ..
STORM REPAIR DAMAGE FEES: . �. .
8eafdentials Bati�ated Cost of work up to $5f?0a^� � r�e�!0
Estimated Cost of work �er .^._'.�::::<.°?`:� � Y:.:.. ��U
.�
Co�ercial; Estimate�"'�oat of wog'- t,;. �:;, ":�_°;, :t�� „:;?.�"`��
` - . I;stimatea .:ost of �aoi�'_K uv��z� Y.:�d;�.°�U�: " Y1,l..JV ` � � �
�IFCR!cf�%�8�-4'� I1.SIA.
� 1 I
1
3
4
.�s��
���r
�
�
�
�? y�fi--�
�
�
1 ��`
33�''
�
I , �r�d h�
, .
� ��� b ; ��� lih P
.,� �' � • �
;
�
�,� J-'., .�.T:t ..4'�
a
.____y��•
' I�
i
!
�—
� 9�`
�o�,` sl� 7SX /3S�(�� �
LaZ` Q %�c� 7'
h.r
e�/�i �'� dd►�t;•�, �
,S 3 P' %,� / t K°Y a Rd. .�: f
�--},1 rry, M,�� .
;s
�
� �
��
�_
;�
€Rx
0. 4
� � q «I
�
Juae 6, 1972
• t• � • ughlin
5387 Al�ura Ro
, sm. SS432
• },.,s _
E�
,
.
R�= �eiver of tbe Requi�eateat to Hook Onto "
th� Sanitarp Sew�r aad A11o�f�a� Conetructtca
of a P.�aspool
D@8! �'. O�LOti�h1111:
T�e City Council, at the meeti.ng o� Juae 5, 1972, authorized
tha va�ivoes of tbe requir�nt of hoolcing on o� your aropertp, Lot E,
�egietered Laad Surney AJo. 3 nesr Central Avenue aad 69th Avenue area,
to the aanita�cy �ewer aad allowing conatruction of a cesspool rai�h the
fa11ow3a� s�ffpul..�tfona:
I) Thts wa3ver is�te�orarq e�til the adjoin3ag area is
r�a8y to Yeceive th� sew�er sezvl.c�.
�
2) Once the GYty propo�ee �o pro�id� se�er sesvice ia the area,
that the property own�r �ould aot oppo�e the i�rovem��at end would be
�illiag to acc�apt their propartionaee share of �h� cQgt af tbe improve-
ment as an asaes�meat agd will conaiecC ta ttae sanitar�r �ewer whea ude
availabl� neat to the preperty.
3) Thc� temporary cesapvol �ould be properly �aiataiaed �o avoid
eay poseibility of pollution into the tt3ca Cr�ek.
41 �e prop�rty would hook onto the w�tsrliaa� on the We� side
of Central Av�nne whea the house is conatructed on this propertg�.
�Q: ob
. A.
Y xe v�ry trulp
, %
':' • � �' �.),,�. } �
.- � � _ �
NASIM M. QUiiESEI, P.�.
City Engine�r-Director of P1.aaning
r
, - a'6°"'� �'"m .'.�F �k'�,k'�-�ti�.�? �... � e ,r� - '
... . . . . .._ �� r "�„� a�+ � Y� .:..4..... �.x.r`.:b . . ... . � _ .. _ _ _ . . . . .,- _ ." .. _.
sue�ecr PE
City of Fridley 2 0 4 8 6�
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T
�
i t '
� ; � ������� COMMUNITY DEVELOPMENT OIV. �� ��
r � � PROTECTIVE INSPECTION SEC.
1 . �
i---. ��'�';`� CITV HALL FRIOLEY SS432 NUMBER REV DATE PAGE OF APPNOVED BY
ti '�� 612-571-3450 g�aF�S 7/24/90 / /
JOB ADDRESS 5387 Altur� Road N. E.
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 9 7 Carlsonrs Sum�mi,t 1Ka�or North Addi.t�.on SHEET
2 PROPERTY OWNER MAIL ADDRES$ ZiP PHONE
Mike 5chroer 5387 Altura Road N.E.
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Richaxd Hasti.ngs Contr. 6331 Rivervisw Terrace N.E., Fridley 574�9966
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDFE38 ZIP PHONE LICENSENO.
8 USE OF BUILOINd
Res identia�.
7 CLASS OF WORK
❑ NEW � ADDITION � ALTERATION � REPAIR O MOVE O REAAOVE
8 DESCRIBE WORK
Reroof Dsaelling (20 Squares�
9 CHANtiE OF USE FROM TO
STIPULATIONS
Roo� can Yae 2nd layer but not 3rd. Tnsta.11 ridged �alyanized valleys.
Qn alt new roofs or tear-offs and replacement .r�fs�
State Code requires that 2 layers of 15 Ib. felt,
mopped together, 6e installed to a point 24 inches
up from e�cterior wrall line, or the use of other
approved underlayment membrane.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBIN(i, HEATINO, TMPE �f CONST. OCCUPANCY OROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CON3TRUCTION 20NIPIti SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CON3TRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AfTER WORK IS COMMENCED. • NO. DWLO. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW$ VALUATION SURTAX
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $]_ � OOO $. SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REf3ULATINCi CON- �`2 rjy OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
7 Z l� ia S25y �JQ
T SIGNATURE OF CON7RACTOR OR AUTHO ED AGENT IDATEI
�' EN PA AI ATED THIS IS YOUR PERMIT
��- � � � �
i SiGNATURE OF OWNER UF OWNER BUILDERI IDATEt _r BLDG �NSP �ATE �_
1�1 [ ] EffeGtive 1/1/90
AD�dJ [ ] 1�1 AND R-2
ALTIIt [ ] Building Piermit Ap�lication
caon��� ��: S 3 �'7 l�� ��t �e �4 � �
I�agal Descriptiaaz:
ownex Name & Ac�dress: _/�t �e l�'is Sc� .� r2 � tZ Tel. �
Cbntractaox': �� e C���Z t� Fi A S f r�c'G S 'I�el. # s 7(�' -�f f6 �
aa,g"c�: � 3 3 r ,\ o J E' R�% J L y� l 1z c2
l.IVII� ARF��:
GARI4GE AR�'�l:
D�lCR AR�i:
OR�R:
Attarh to this application, a C�tificate of Survey of the
lot, with the proposed oo�struction drawn an it to scale.
DESCRIPZZ@T �' Il�V�tl'
Ierigth Width Height Sq. Ft.
Iength Width Heic�t Sq. Ft.
Ler�gth Width Hgt/Gra�u�d Sq. Ft.
Corner Lat [] Inside L�t [] Ft. Yd Setback Side Yard Setb�acJcs
Type of Construction: Z c- 12 � o F Estimated cost: S 1��' /. ,r���
Approx. G`c�npletion Date: � S g' o
�o s��
Proposed Driveway Width If New Op�xiirig Is De.sired: Ft. $ $
� Width + 6' See Hack Page
�: 7 Z �( �' � �c�r: /� z�e�.. # S? �F � r � � �
Fermit Fee $ � � O O
State Surcharge $ . S7�
SAC C�arge $
Driveway Escrow $
Park Fee $
Sewer Main Criat�ge $
. �•
szz��o�as:
$ �� .� 8
CITY � �Y
Fee Schedule on Reverse side
$.5o/Sl,000 valuation
$600 per SAC Unit
Alt. "A�� OY' Alt. "B" Abave
Fee Deitermined bY �clineering
�c�re�ent Ne�� L l xot Ne�.�ssaxY I l
_
�.,- � e
:�� � � � r • :�•� � ° :�- _ �:i:��'�
Z�+e QZief Building Official shall, before issuing permits for the erectian of ar�y
building or struc4�r+e, or for ariy ac3dition to any existing building or stn�ure, or
for any alteratio� or repaiY' to an�' pY� �'�ting buil,dux! ar s�uc�re, upoai application
�erefore, require the Payment by the ap�licant for such �m+; t of fees to the am�nt
herein below set forth and in the manner herein provided to wit:
. TO►rAL VAIIJE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,OO1 to $100,000
$100,001 to $500,000
�`,+1 ��.�
$15 (Mininam Fee is $15 plus su�axge)
$15 for first $500 plus $2 for each adclitia�al $100 or
fraction thereof, t� arid inclixlirig $2, 000
$45 for fiYSt $2,000 plus $9 for each additional $1,000
or fraction thexeof, to and iriclt�ding $25, 000
$252 for fiYSt $25, 000 plus $6. 50 for eac� a�ditioa��al. $1, 000
or fraction thereof, to arid inclucling $50, 000
$414.50 for fiYSt $50,000 plus $4.50 for each ad+ditional
$1,000 or fraction thereof, to and inclwding $100,000
$639.50 for first $100,000 plus $3.50 for each a�ditianal
$1, 000 or fraction thereof, to and iricludirig $500, 000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to and includirig $1,000,000
$1,000,001 and up $3539.50 €or the fixst $1,000,000 plus $2 for each additional
$1, 000 or fracti� �f
DRIVE�iY �SI�1 ESCl�W
(Gbncrete Curb Streets On1Y)
Alt�tnate "A�� ; R,e�ava]. ar�d replacement of curb arid gutter only - Driveway width plus
6 feet times $13.50.
A1t�rnate "B": Remaval and replavement of curb and gutter and install a 3 foat wide
agproach with 6 irich depth - Driveway width plus 6 feet times $15.75.
' ?1' �' v� •3 •), °�'11 i�.� •i
Petimits fox' c�stri]�ti�1 Will be issued a mir,immmm of 24 hours fz�t the t]1t1e of
applica�,ioaz to allow for proper review of the praposed �re and of the
�uctian site.
A C�ettificate of Survey of tl� lot, showing the location of the foiux]ation anoe it has
it has been oonstructed will be required before pr�ding with the fiaming.
�.
'r�
a
�±
;���`
� � 70
�� �
� � �
O O
s� Z
�� m
� �
a �'
o m �
�a
� A
� a
-°a �
� �
��
3 �
� Q.
�
�
C
�
�
�� .
�
�
�
�� 3�y
mo a �
� � �
m a °�c° .
��
� ��co
�m� �
�
m � �°'
D � 3'
� � �
�'
��
� m
�
� ~
�
Z o
O •
Z � G
_,
� �.
t� �
_
�
Z
�
�
� �'
� ���
�
c
m �
a
��
�3
� �-
� A
O �
,�. a
� c
��
�-
o �
7-�'., "
�
W
�0
��
c
�
0
�
, �
z
�
_
�
tA
Z
a
�
�� �
�� �<
m � �
.�� �
:� � t
� � �
$ � R
0 0 �
�� �
O�
"- m
. —�
�
., � �,,�._
n
3 �
�
0
d
�
v
:�
�
�
�
�
v
�
�
�
�
a
�
0
2'
�
A
V
� C �
o �
�o � �
�y�
m W �
3 �
� �
�°
� �
� �
�
c
�
t
t ,.
� � � �
i ..� j �
� 0 Q
O O O p �
�
� � �
N Q
�0 �
� oo --i Z
� �� o
Z =
����
m �
m
�� � 3
�
_
-� � A
O A
m �
.o 0
3 m
� a,
a ��
r m 3
n' � o jC
�
a� �
m
0
��
�
I
�
m
�
D
�
0
�"�
N
�4
��
� r�
�
O
�
�
�
�
N p
� D
�p r
•o
°° 0 �2�'-�
C Z � � A �
Z � � � � n.
p � °. �- m
. �-►� �
c :o.���
v � °D � �
�p C 3 �
a�
�, . �� g�
a
�1^ 3 �o�
� � � �• �D 3
�,,(� y p 1n
'�a ` ID � O �
��
•`�
� "
�
a � �"� �
t� ��.��
'b ~m ��
� � � ��
�`�e�
��o�'.
m � s� .
Q�m�.
� ���
� �
o ���
c- ���
���
. � a � �
3
i a
�
�
�
v
�o
�
�
�
�
.����ro
�c�
i��
� �� �.
N � �
z Z
.m�
�
Z
v
<
m�
. � -o
mn
s,° �
i Z
0
Z O
� �
v�
��
A�
O �
o?
z �n
o�Z
v, v
�
_
� �
�Z
�A
�o
r
rnZ
��
. Z
;i
s
z
m
0
�
�
�
� i .
V'` �
�
�e _
�'� �7 � 0 . a��
✓� . �fl Paubtg
�� rr� � -�� .,�.+ o � s�� xx�rawo� �xrs�x
�
; .
. . „
, �� �� S
� � :auoQ uiag suoi��esa�TK �siZ
�����, 9 �.s^'1 � ,, �S � ,� ,� , .
sxsEUrag
�
( y o� �j sax
Q��c�'� . . s • tLZS , �!lKKSOS
.G��O a � : � . S � l�,�cS �u�a iT�i
QOQ Q,� 30 '1s, fl,yg bui��aq Z��o� sBg
'9
pa�auuoa s��S t��o� Pu�.azzs
�o� s:}ua�a�inbaz apo� �ua�� ZZE s�aays • y
() oH: (�j sax � pa}�oddns �tta�as s= •�i
i) old t� Sax t�-�r�'F�"i PabPoZ s�a Cqo ubiaao,� ou sBg •�
( ) oH (,� sax � uo�r�r.�o��a�.ap� �o �snx �uuo�; � aa�� sI • Z
�) oH �j sax pau�xa �t�ai� uaaq, s�g .T
:�(��s �o �Ceua�rq� -bu��s�rxa efi.� ��t� sa���CF�an �Cqa.araq paub�rs�apun aqs
Hois�r� x��as a�u$� •
d
Buildillg PLUIVIBING Permit No.• �(,�
Inspections RESIDENTIAL APPLICATION Received B.
763-572-3604 CITY OF FRIDLEY D �
DATE (.J YOUR E-MAIL ADDRESS �
SITE ADD '� �}
THIS APPLICANT IS: � OWNER CTOR
PROPERTY N�g; r '
OWNER/ ADDRESS:_�� $`� �� F�-i�'.�- CITY Ttr � r9CP s. STATE��
TENANT PHONE:-rn(�.i F=6���5�
CONTRACTOR N�: °
SUBMIT A COPY OF STATE LICENSE # L(' � f t�7 C� EXP DATE (
YOUR STATE ADDRESS: �'' � CITY�� STATE I� ;�
LICENSE WITH PHONE FAX
APPLICATION •
pERMI1. .l'YpE GLE FAMII..Y O TWO FAMII.Y � TOWNHOUSE
TYPE OF WORK: � �w t�'�E�vT
DETAILED DESCRIPTION OF WORK
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, wluchever is greater, for the
improvement, installation or replacement of a residetttial fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labo�_ ��'� x.OS =
FOR PROJEC'I'S Wf�RE LABOR EXC�EDS $5�, FEES ARE BASED ON $10.� PER FD�TIJRE, EXCEPT WEIER� NOTED. FDCTURES: (MDICATE TOTAL
NUMBER OF EACH BELOVi�
BATH SINK/LAV FLOOR DRAIIVS SHOWER W PIPING
BATHTUB GAS PII'ING (n�o crirtrc�vsE) SWIltM�ID�IG POOL � SOFTNER ($35�
CLOTHES WASHER KITCf�N SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IItRIGATION
_ WATER M6TER _ OTF�R
: �.
.r -- , � , � ,
Permit Fee $�. Number of fixt�u�es @$10.Q0 x$10.00 =$
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ �,�.� ° Number of fixtures @ $35.00 x $35.00 = $
State Surchazge = $ .50
Tota1= $
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNT[L 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 Constructian Codes; that I tmderstand 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� whicl es review and approval of plans.
SIGNATURE OF APPLICANT NANIE c� � �V � DATE
- - - � T£
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
�� ��(
Building -
.Ynspec�tions
763-572-3604
76�-SQ2-4977 FAX
����
�,��,�:
, � �.
S[]BA�' A COPY dF
YOUR STATE
L.TCSNSE, BC1ND AND
CFR'17FICA7'B OF
YNSURANCE
4�i' �ilY IiI���
TYPE OF �VORK:
From: 612 822 5408 Page: 2/3 . Date: 2/9l2010 2:28:23 PM
$ � 'Y` J/'+�
PL��11TG
�ESII�ENTIAL APPLICA,'I'IUN
. , �.
C�'I'Y O�' I+�LEY
��
_
�IS:�C,� � C�
Permit No.: 0 (i� bf
�►� By:
D��� F o9
JTATSLICBIVSFi � '' P '� II� DATE P� " S/'- %�
SCA1i 80ND # � DAT6
AnDRESS: l�l � �'-. S• r� c�nr /s 9�rAT6� S_ �' yl1
�t����� Wa � s � �t _ R�
�SIlNOI.E FAMII,Y
� iN$w
nsrnu.ED nESCRt�oN or• �toxtc
❑ TWO FAMQ.Y 0 TOWNHOU3E
' a• Nx, ru
�S AitE �ASBD ON $10.� PBii FDCilJtt$, EXCLP!' wFIFRE AICiIED. FDK1'(tAp.C: (IIVDICA7'E 71PTAL A1p1�IDIaC OF EACIi 88IA�. MAldv!(1M FEF,
$3550.
_HATlI9AtWGAV I �i►ATIItP�IIIJO
_SATgT[7B `� ��� —�0�' P J
([�3D CAY LIC) _ y�y1Nt3 rqOL
_ci..m�swn�e _xiTC�vsm� —wn�ttsor�cs�s�
_ n�was� _r.ntn�nRV TanY wAZ� c�.,ossr _ snc�.ow ra��r ts� s�
T"wnr� r�an�t (a�s� � �ttoa�cox
z � •_ Wa'rat N�[t _0�
�rs �s aiv nrr�.�ca�v rax A Psxr�m=rrar v,�.m ur,ru, e�ocessEn
I h�raby apply for a Piumbiag �rrnft and I acknowlcd�e that the infotmation above is complete and accur�te; that thc work wIll 6o in
confosm�ce with the ordln� and cales of tha C;ity of Fridlcy and with tbe M#nnesota Con.�nction Cod�; tiu�t I und�land this is
Bot a pctmit but rnily an appIicatioD for a pet7nit �nd woti[ is not to 6tari without a p�mit on aat� thAt thd wbrlc an11 be in accordance
with the aPP� pisn !n t}u cage of all wo*k wltich review and approval ofplans.
s�rnvaru�oFnrri.i�n ' �"' /� ,/� �` �'e� �D
. P�T� 4+ �Grr<<„DAT�
City of Fridley
�uYldi�ag Inspec�ions Depat�me�t
6431 University qvenu� NE, Fridl.ey, M[�T 55432
763 572-36U4
FAX: 7�3-502-4977
010
�uildi`ng
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�c� �-�-ZO�o
nn� �/ a 6// D YOUR &MAII, ADDRFSS
srrEnnnxESS _ S 3B � i4 (-(-wr� �� .
�us Arr�,tc,v�rr ts:
PROPERTY OWNER/
TENANT
SUBNIIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERNIIT TYPE
�:�i,��
Permit
Received
Date Rec'
xAME: _ � w r 2J' - -
ADDRESS: S'ct.n�,� CI1'Y STATE ZIP
PHONE: J�0 2 S 7 t� 'i 6 6/
STATE LICENSE # " EXP DATE
• ------ – — � ' - -
PHONE � � i �'3 � a� ��
�INGLE FAMILY/NEW CONSTRUCTlON
❑ TWO FAMILY/NEW COAiSTRUCTION
O BASEMEN'I' FINISH O ROOF
� DECK ❑ SIDING
O SWIlVIlVI
F,4x ��� r�� ��7�
STZE
STORIFS
DOVJ1l t{t^tf„ rn
DRAIN TILE J
❑ OTHER
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDTfION
0 MAD�TENANCFJREPAIR �REMODII.ING
DESCRIBE WORK BIING DONE: o Q r� S f uv t�n o w f' � n a �1Fit'�r w a
SIZE OF IIVIPROVEMINT LENGTH WIDTH
� � HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE 8c GARAGE
�AILAG��S ❑ ATTACHED GARAGE
PROPOSED SIZE: O DETACHED GARAGE
PROPOSID HEIGHT:
��
�
BASEMENT iZFMODELING BMIT•
1. Existing Floor Plan
2., Proposed floor plan
3. List of strucUual members to be used
SID1NG FOR NEW CONSTRUCI'ION INCLUDING DECKS,
O Virryl ❑Soffit AADITIONS & PORCHES SL�3MIT•
O Aluminum 0 Trim i. Site Plan/Survey showin� the existing strucdues
0 � ❑ Fa�ia � ProP� P*o.l�
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
�T EXISTlNG OPENIlVGS Ol'es ONo LOCATlON OF WINDOWS FOR WINDOWS – PROVIDE U-VALUE AND
OR FOR NEW OPENIIJGS-DESCRIBE SfZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES 8c
TYPE OF WIIdDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1�17 U.B.0 FEE SCAEDULE)
'OTAL JOB VALUATION $ I°� �n — OCCUPANCY TYPF
Permit F�
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dne
$
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 Residentia.l Contractors)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Citv of Frfidlev Attac
THIS IS AN APPLICATION FOR A PERNIIT NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
perrait but only an applic�tion f r a rmit and work is not to staat without a permit on site; that the work will be in accordance with the
approved plaz► in the case of a11 o hich u' es review and approval of plans.
SIGNAIURE OF APPLICAN'I' {� r PRINT NAME_Y_► l a.�` ��Te ln n fbn DATE rl ��P /� D
T �
Page 2- Building Residential Application
BUILDING PERNIIT I'EE SCHEDULE
T'he Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any altera.tion or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided tawit:
VERIFICATION OF FOUNDATION
Pernuts for const�uction will be issued a minunum of 24 hours from the time of applica.tion to
allow for proper review of proposed sixvcture and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required l�fore proceeding with the framing. New Houses Onlv
City af Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
f
�u
� ��7 d����A uC� �
i. � �
� �" �ac� � ������
� _ . .._.__ _._--- — �,r-----�,
��
��
r �`` I
. q' K i
d � /
�rvn¢
��-- i aF�.� (
o�� s�=$.�_ o���f�r���.,�
�►� J er so� `— t
�-�.( � ° q' f R@ n � �.�-°.� a� �a -�r' a.�^� �`-�
/ �/ / `
� ^ .:�51��y s�t�s�� �dQ� C� ..,-��dtfJ
l J �j�
— � 4T c ��ar o�s a.n.e�n.� w�'d'� (s o v e�
J
`� 0 i � •
L ` < < , � r
� — r� �`� S T �c M S�� � g e I�� (S 1'e drf
`T o./� I� � tl� �r�ti. `-�e o P
'+r�-�{� c�r � o. �-.�l.l w r� Ca`��-d'
License lookup
4 � f
License/Certifieate Detail
Here are the details for the license/certificate you are currently looking for:
License name: ORIGIN PARTNERS INC
License doing business as: THE EGRE55 WINDOW GUY AND MORE
License address: 505 MAGNOLIA LANE N
City state zip: PLYMOUTH, MN 55441
License number: 20396184
License type: . RESIDENTIAL BUILDING CONTR
Company structure: CORPORATION
License status: PENDING
License ori�inal issue date: s���2pp3
License expiration date: 3/31 /2010
License print date: 5/18/2Q09
Qualifying person: MARK E. JOHNSON
Continuing education hours required to renew license: �
Contractor's phone number: 763-5442775
Enforcement action: No
��� . �I�r 1����� �
,-
�� V
�".
��
� ���� '
\��
V
https://secure.doli.state.mn.us/licensing/licensing.aspx
Page 1 of 1
5I26/2010