AF - 44477City of Fridley, Mi�n.
BUILDING PERMIT N� 5 0 0 4
Da�: _..r.l.._�..�. --.� �..
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' •� Builder .,��G�� ���--=.-
Ovvner: ._
. _
_. _
Address �.T��� .
�._. _ ... . .__._.___. Address ___...._._.�..._.._._____._.__._..._._....._.._ _
,, CATIO OP B LDING �
No. �wi_� Street _. . ._._ �+: .__. .�..►._.__.._ P� I.ot ......_._�.__ ,
Lot ._.._..�... ,i�.__.__ Block ._.�..._.:�._...__._._...._......_ Addition or Sub- .v' � ... . � ^� �s
Corner Lot _..__.._........__...._ Inside Lot .._._.._.!!!".".._._:....... �Rback ._ . r�ideyard _._.�.� __._.._._..:..__:
Sewer Elevatian _.__._.._..._.._..______..___..._._._._......____._....____ Fo dation Elevation ._.._.._.._.�_._......�._.�._ �
DESCRIPTION OP BUILDING ,
To U
.... ...�[.i Front _�L-� . Depth .��._.. Height .��..__ Sq. F't. �+��r Cu. Ft R��
._..___.._._._.._ ..__....____ Fro t __ Depth __.._.._.._ ight __.__� Sci. Ft _�. Cu. FL �.
Type of Construction _ .�_._.. Ee� Cost"?W',�'',��_......_...._.. To be ComPieted .....__�.._
In consideration of the issuance to me of a permit to construct the building described above I agpee ta �;-°�
the proposed work in accordance with the description above set forth and in compliance with a�l prav,fe�ons at x'
prdinances of the dty of Fridley.
�
In co�..ddera.tion of the payment of a fee of $...� �--•, permit is hereby granted to
to construct the building or addition as described above. Thia�permf���' ��:�
the express c.ondition that the person to whom it is granted and his agents, employees d
done in, around and upon said buiiding, or any �art thereof, shall conform in all respects to the a�
Fridley, Minnesota regarding lceation, construetaon, alteration, maintenance, repair and maving a[�u��
�vithin the city liinits and this permit may be revaked at any time upon violation of aay � the p�ovi�doot at ,
orSinancea _ -^� _
�
�' �
NOTICE:
'�his p�rmit dou not wwr th� eanNru,atie►n, i�sfal{�Non for wiriny._plumbin�, �rs INNk�y, snwr or wN�r. !� swr to �N
fh� Buildfng Insp�etor fo� »pa�ah P�n1�M: i�` th� it�ms� ' ,
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�CiTe88
dPPLIC,ATION FOR BUILD�iG P�tIT
CITY OF FRIDLEY, MII�A�SOTA:
1
1
. ,. 1 ^ /� / .. � �Y'l_= � .r
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1 Builder�,,,� �-,r� �
� LOCATION OF BIIILDING
� � _ _ _. _��
No. stxee� ���lf !� t a �.-�--�_�___Fart o� Lot �p.l.t�d�;
�c-
Lot �� Block . Addition or �b.Div. �� S. • �%-Q ��'L'
��.-�s. .��._ �
`� , 4
Corner Lot� side Lat� '� Ha,ck Side-Yard _
SL'WE�. ELEVATION P'OUNDATION ELEYATION
Applicant attach to this iorm Certificate of Survey of Lot and proposed bu3lding
looation.
DESCRIPTTON OF BUILDING
To be used as:
: � �
�ti%�� .�. F`ront �� f Depth �� He3ght 7
f
Sq. Ft. ,.� � � Cu. Ft.
. � � 7i
Front � � Dept.h � � Height
5q. Ft. ,.�,_,.��? c� Cu. Ft. �
� C�
Type of Construction ��.� ���? � t��ed Cost �! „ �=—,,,�,.,�,____
To be completed .
The undersigned hereby makes application for a permit for the work herei.n apecified,
agree3ng to do al�. vork in strict acaordance with the City Ordinance� and ruling o�'
the Departanent of B�ti].d9.nga, and hereby declares �hat a1.J_ the Fact ari re esentd- -_
tions stated in this applicatian are true an correat. �-0. ,�`'�--
DATE � �,��"t "� i .�L%SIGNATURE •P � - �
{A Schedule of Fse costs can be found on the Reverse S de.)
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City of Fridley, Minn.
BUILDING PERMIT
nate: _._..._ June_ 9, 1965 _ .`.�
������
N° '7805
owner: __..���1-� M�.asz�a __..._.._ Builder _..__.. Cit�Wide .Btxilders...---.._..____
Address _.._..��`.1�..._�.tt��,_._D�iY6 N..�.E...___.__.___ Address _.__.bL�IaO� AYe.�._N._..�........__.____
LOCATION OF BUILDING
�vo. _._....�45.�__..... street . Altura .Drive N� E± __. _. __•_---._.____.._. Part of Lot _.�._....._.
.... . CeTIBOA S Stt�t.
Lot ____. 16 _...._.__ Block _..r_. 7._.__...._.-.---.._..._ Addition or Sub-Ihvision ..___._._._.._r.. � __._M�1t"lor� North Add•
,,
Corner Lot _.___..._..____ Inside Lot ....._.__....._..�....___ Setback .__.__.__.._...._._.__._ Sideyard __._—..___.... _ �..
Sewer Elevation
Foundation IIevation .._�..._._._._..._._.__ �._._..._..
To be Used as:
Type of Construction
DESCRIPTION OF BUILDING
Front _...__�.� DePth .,.___._.__ Height ._._...._.___.. Sq. FG .__.__._.._ Cu. F't
Front ____ Depth �.._._.__.._. H`eight ._._......._.___ Sq. F't. ._.._..._...__ Cu. F't.
_.._._.._.._._.._...__..._.___. Esk Cost ._�Z��.Q�lS1,�.4Xi....---...... To be Completed _.._ _r
Storm damage repair
In consideration of the issuance to me of a permit to constru th uild
th� proposed work in accordance with the description above set o and in
ordinances of the city of Fridley. /j
I a�ree to do
_pravisions of
In caa�aideration of tIze payment oP a fee of �._ 10• �.._.__.._.., permit �s hereby grantea to Ci� �ide Bldrs �
to cAnstruct the building or addition as described above. This permit is granted upoa
the expree�ss condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances o�
Fridley, Minnesota regarding location, constxuction, alteration, maintenance, repair and moving of buil
within the dty limits and this permit may be revoked at any time upoz� violation of any of the provisions of�d
ordinances.
. - --.
� . -
NOTICE:
Ih& p�nntt dou nw eowr 11u eon�ruelios, fnstalltNNion for wtefn�, pWmbiep, yn 6�aNna, sww► or wabr. d� sun to sN '
' th� duiMin� Is�p�elo� fer s�puah p�emits fo� f6�a it�ms.
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APP'LICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
.
OWNER'S IdAM1:����1�-�-,,%(�. 1BUILDER O �
ADDRESS � ADDRESS_,��g� ��. �.v� c �
� „ 5��� /
LOCATION OF BUILDING
Na-. ���� Street /�� ��l /�%+ i��Part of Lot
/J���� <
LOT j Cc� BLOCK ��_ADDITION 0$ SUBDIVI$ION ��i(���`� /.[�_���
Corner Lot Inside LOT ✓ Setback Side�Yard ��%���"�"' '
SEWER ELEVATTON FQUNDATIOR ELEVATION
Applicant attach to this form Two Certificates of Survey vf Lot and proposed
buiiding location drawn on these Certificates.
._.._..�
� �� �' `�--�� DESCRIPTION �F BUILDIN
,' .. -�_�.
�._,._ , ��. -- ��--�..�� t�..,,�:__,f c-____„�.� ���f�--�-� „��j�� ---,�-�`�t-.
To be us d ��; ;%
Front Degth Height
Sq. Ft. Cu. Ft.
Frcmt Depth ��Height
Sq. FC. Cu. Ft.
Type of Construction Estimated Gost � ��p c� c:�
J
To be cc�pleted` g - .� � '-�, �
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances
aad rulings of the Department of Buildings, and.hereby declares that aI1 the facts
and representations stated in this application � true and correct.
DATE % '"' � ^ �
0
(Schedule of Fee Costs can be found on the Reverse S�ide),
` , . .
. . 9 . � •
�
Au�uet 27� i965
City �'ide Sui��ers
64� Lowry Ave��e N. E.
�i�n��p�iis, �inaesot�
�e: 54�5 Alt�ra Rtx�d N. �.
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�°€ 5 f,,, f.. u. ,ro t <.. f., � � � � M. .� .
t, ti r.. �,, f.` S :.I' e_. � a�. ' 1�'- C''«; c� i� � �. l.� cr.:-� t4, .L.�iz �!�:,.,;±.; ._ C::'<
�sG:�e..i.i:: P�:::�: C:i;.�Gl''.�G �'i„L$' ?_f?,,..�;�.: 7'C��" C: C.�':."{w +c,.. :S �7:i..� �"::v i".�T.'__�i.s; .., a' �,IE.:,>�.�:
�
�`c:C�"t �i,i«�: �.it `�-"2;.i"Y..OLk.�. �E�2�'.i.��� e
I�. Vcr�r por�� c�csrl�nst�ip on ��ee f�.cis ��d CtE'�il%CC
retur�s.
2) . Sidi�eg �� twc> dif€ere�at ieva3Ea ore csne t�ll..
3). �io she�t�.ing crn t'he otstesid� c�f th� +��csds on the
ga.bles af the ��,ra�e, �.ich I: �self, �peci-
fic€tlltr� xeque�teci.
T€ �hese matt��� �.re ncst e�.kera c�re Qf, thi� �ob is rejccted.
Sc�aeo�ce cm. t�e �cb �ee�d te� t�3.�.k tha�t t�r. i�e�.i��.e ca�
f.rac+anspete�.t . I�n ����erc yau t�a�t he �s nat . He has ha� c�sr►.-
��da�rable txgerienee and whatever decision he ma�a on tt�e ,fvb,
� �.l.l back czp.
If qou h�ve a�xy q�ee�tians in r�gards to aay o� the�e pcints,
��asiip contact me �at my �ffice.
A�.i s cks
� li3Cer��� s
1�+T.� Ca. ��rNJ�}�
Buiidiag i�sgectar
City of �tid�.ey
SUBJECT P
City of Fridley _ 19507
AT THE TOP OF THE TWINS B U( L D I N G P E R M( T
r
; � R T NO.
� �y______ COMMUNITY DEVELOPMENT DIV. ���/�
r � � PROTECTIVE INSPECTION SEC.
i �
i
`� /'�'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APGROVED BV
'��'�./ �.J
612-571-3450 g�0-F15 6/3/88 / /
JOB ADDRESS 5455 Altura Road N. E.
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 16 7 Carlson's Summit Manor North Addn. SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Walter Lach 5455 Altura Road N.E. 572-9508
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO.
6 USE OF BUILDING
Residential
7 C�ASS OF WORK
O NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 16' x 14' Deck
9 CHANGE QF USE FROM TO
STIPULATIONS
See notations on plan
SEPARATE PERMITS ARE REQUIfiED 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 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PEFiIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINEO 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE Gi;ANTING OF A PERMIT $1, 550 $• 78
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• 2'] � OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
PLAN CHECK FEE TOTAL FE�
$2%.%
�SIGNA7UREOFCON7RACTOR nur RiZEDAGENT IDATE� WHEN PROPERL LIDATED THIS IS YOUR P RMI
j���� � . . �•
� NATUREOFOWNER�IFOWNERBU�L ERI IDATEI BIDG INSP f1�T
1�V [ l Ci.ty of FYidley EEfective 5/L88
A�N [ ] R-1 AND R-2
ALZER [ ]
�,; i ding Permit Ap�al ication
Gbnstruction Address:_ ���5� %�L-�1��' ,��
Legal Description-
Owner N�ne & Address: Gs1�7Cr G/�-c� S'5�,5'�S' ,�Grv/�A� /� e� Tel. # S7d�-�"� �
Cbritractor : SJ��, -e, T�. #
Address:
Attach to this appl ication, a Certif icate af Sluvey of the
lat, with the proposoed construction drawn on it to scale.
�ESatIPPI�I �' II�'ROVII�TP
LIVII� AREA• Length Width Height St�. Ft.
C�RAGE ARE'A• Length Width Height Stj. Ft. '
DDC�c ARE',A: Length i' width � xgt/Gro�ma � stj. Pt. 2?-�
�
2�/ lC -�i'L 2 � j�'Z�
Gbrrier Lot [] Inside Lot ['� Ft. Yd Sett�ack Side Yard Setbacks
Type of Construction: Estimated Cost: S %JJ�
Approx. Comple�tion Date:
Prop�sed Driveway Width If New Opening Is Desired:
Width + 6'
,
DATE :„� � 3� Cf v APPL IQ1NP : W �r���'u
Penait Fpe
State Surd�arge
SAC Charge
Driveway Escraw
Park F�ee
Sewer llain Qzarge
R�OTAL
3�I0[d.S:
S c�7, 0C1
S .7$
$
S __ _
E�
$ 0�7.�
CCrY DSE Q�Y
S
Alt. A Alt. B
S
See Back Page
T�.. � _� 7d� ' iS� �
F�ee Schec�le on Reverse Side
5.50/51,000 Valuation
5550 per SAC Unit
A1t. '�" or Alt. "B" Above
I�e Determirnd by E�gir�ering
Agreeaexit Neoessary [ ] Nat Neaessary [ ]
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sue�ecr PERMIT NO.
City of Fridley ,�� � �,8:
AT THE TOP OF THE TWINS g � I L D I N G P E R M i T
r
; � NO.
� COMMUNITY DEVELOPMENT DIV. ^'/`
r � L i PR07EC71VE lNSPEC710N SEC 37�C//_
� ' T�
i .
' � /'��1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE VAGE OF APPROVED B`/
�""�'� ,'' 612-571-3450 910-F15 8/28/96 / /
JOB ADDRESS 5455 Altura Road NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCF. 1( 7 Carlson's Summit Manor North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Walter Lach 5455 Altura Road NE 521-3652
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO
Midwest Sidin & Roofin 3533 Perr Ave N, Cr stal MN 55422 521-3652
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
2�01�2��
� 5 ENGINEER MAII AODRESS ZIP PHONE UCENSE NO
6 USE OF BUILDING
Residential
7 C�ASS OF WORK
❑ NEW ❑ ADbITION CJ ALTERATION � REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Gara e(22 S) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIOIVS
Underlayment must comply with the State Building Code.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REQUIiiED FOR ELECTRICAL, PLUMBING, HEATING,
VENTIIATING OR AIF CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IG CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOFK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
ANO KNOW THE SAME i0 BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS �q�UATION SURTAX
AND ORDINANCES GOVERNING 7HIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �1,815 �.91
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING corv- �59. SO Fire SC � 1. HZ
TRUCTION OR TH�RFORMA E OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
a�� �� E Lic se C$ 0 $67.23
siGrvnTU EOFCON7RACTORORAUTM0�71ZEDAGENT IDATEi pA Y VAL ED THIS IS Y UR PERMIT
� �
SiGNATUE7E OF OWNEP iIF OWNER BU�LDER� iDATEi DG �NS� r�ti7E
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: Sr `-/ SJS� ���-v � �
Legal Description:
Owner Name & Address:
Effective 3/1/96
���
Tel. # -5�� ' �� �--�.
Contractor: ��, ,'� �„rs � S. c�, � � .�- �v� {; .,, ; MN LICENSE # �doJ� � 7 �
� �
Address: � S� .� �t � r.�._ .�zl-� �v �- C:� f �_ -t�-, � Tel. # S'3/ -.�'� S��
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
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
✓�C �Y f � �C'
Corner Lot [] Inside Lot [] �Ft. Yd Setback Side Yard Setbacks
Type of Construction: _ %�U - � -�� d- /� � - � � � i � Estimated Cost: $ �.5--� ���°�'G
�
Approx. Completion Date: �� 3 0� %( /�,/.� `��'
tCost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 t= Ft x$_ _$
DATE: � d- �� ��, APPLICANT: Tel. # S� %-� � S`�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ � j_ �-��,
� �. ��.�
$ � (
$
$ 5 ���j
$
$
$
$
$ �„ �
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.501$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 [ ]
STIPULATIONS: ` . �
CITY QF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604 .
�
1
APPLICATION FOR POWER PLANTS AND HF_ATINC, COOLING, VENTILATION,
REFRIGERATION �4ND AIR CONDITIC►NING SYSTEMS AND DEVICES
Residential
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace
(Side Vent — Fill Out Back) �
Gas Piping (Needed with new furnace)
Gas Range
Gas Dryer
*Air Canditioning — All Sizes
All Others/Repairs & Alterations (LfST ON, BACl�
1% of Value of Appiiance or Work
Commercial/I nd ustrial
1.2s�� -�.. . 2 y, �og
�.�:�a�KS �'£rM�k •
��a �/�b M;awts+ s:a�.1 t
( aa'�
AAINIMI
REFRfG
PLUS TI
REINSPECTION FEE $42.00/Hr
Rate TOTAL
$ 30.00 $ Q � 4
$ 10.00 $
$ 10.00 $
$ 10.00 $
$ 25.00 � $p���J �%
$
� $
: �.�
3i�/ �
LATION
j5•UU
*A,ir Conditioners can not be placed in a side yard without
written permission from adjoining property owner. •
�o F� Z
Effective On August 1, 1995
JOB ADDRESS ��sri S ti �G 7'/�J � A__�,.� �
The undersigned hereby makes �pplication for a permit for the work her�in
speciffed agreeing to do a!I work in strict accordance with the City Codes and
rulings of the Building Division, and hereby declares that all the facts and
representations �tated in this application are true an c rrect.
, ,1995
OWNEFl�%q,LT�,�,,,�AG � 5 70� ,�5 °�
BUILDING USED AS
ESTIMATED COST �-� `d � PERMIT N0. r �,� ^°
�,F�.iCRIP�lO[,�, OF FURNACE AND OFl BURNER
No. of Heating Units Circie One (Steam) (Hot Wa r(Warm A�i )
Trade.ldame (�' ,e,e��,p Size No. � ' �
BTU_ + "�� ov �i HP EDR
Fuel�� Total Connected Load ' _
Burner 7rade Name Si2e Nn.
BTU : HP EDR
HEA7ING COI�iPANY
�
Tel No. �C�/ �2.`��
Approved By�l Rough—In Date Final Date
FILL OU7 BACK SIDE R STACK VERIFICATION ON
REPLACEMENT FUR�iACE
����.; �-- �x�� � �� ��� 4
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that tke existing chimney or stack:
1. Has been carefully examined Yes (� No {)
2. Is free from rust or deterioration Yes (t� No ()
3. Has no foreign objects lodged within Yes (� No ()
4
5.
0
7.
v.
Is securely supported
Meets all current Code requirements for size
and total BTU's connected
Has total heating BTU's of `%�U� �
All other BTU's . � � L� O O o �
�-' _
TOTAL BTU's 1 I ��
Has a lir�er �een provided for water heater
��as co�ii'�;�,uuu air i�een �ruvi�eci %r water heater
Remarks:
List ALTERATIONS Bein� Done:
Yes ( vj No ( )
Yes (rf No ( )
Yes (vYNo ( )
Yes (c� No ( )
HEATING CO: ., 7.. q� `�s ,� ,
Signed By: ' '�~'
Date: �� � � �y`�
' � � � � � � SuBJEGT .. . . . � �
c;ty of Fridley 3 0420
AT THE TOP OF THE TWINS g � f L D I�1 G P E R M I T
;,
, � o.
COMMUNITY DEVEIOPMENT DIV. ! �—
r � � � PROTECTIVE INSPECTION SEC. /�j'"� ��
i ,
� � �vv
i----����"' �.� CITY NAIL FHIOLE� SS132 NUMBEN REV D�iE P�GE OF �nvqOVEO Br
L 612-571-3450 9�0-Ft5 10/19/99 / /
JOB ADDRESS 5455 Altura Road NE
1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. 16 7 Carlson's Summit Manor, North Addn. SHEET
2 PROPER7Y OWNER MAIL ADOR�SS 21P PMONE
Walter Lach 572-9508
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Suburban Exteriors 9701 Penn Ave S#107 Bloomin ton 55431 881-8232 4289
d ARCHITECT OR OESIGNER MAIL AODRESS 21P PMONE UCENSE NO
5 ENGINEER MAII ADORESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK � qEPAIR O MOVE ❑ REMOVE
O NEW ❑ ADDITION O ALTERA7IQN
B OESCRIBE WOfiK
Reroof house and garage (25 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPEOFCONST. pCCUPANCYGROUP OCCUPANCVLOAO
SEPAiiATE PERMITS AqE REOUIRED FOR ELECTR�CAL. PLUMBING, HEATING.
VENTILATING OR Alii GONOITIONING
THIS PERMIT BECOMES NUIL ANO VOIO IF WORK OR CONS7RUCTION 20NING SO. FT CU FT
AUTHORIZEO IS NOT COMMENCED V\!ITHIN 60 DAYS, OFi If CONSTtiUCTIQN
OR WOiiK IS SUSPENDED OR ABANDONED fOR A PER100 OF 120 OAYS A7
ANV TIME AFTER WORK IS COMMENGED. NO DWLG. UN17S OFfSTREET PARKING
I HEREBY CEATIFV THAT I HAVE FEAO ANO EXAMINED TMIS APPLICATION STA�LS GARAGES
AND KNOW TME SAME TO BE TRUE AN� COFiRECT. ALL PROVISIONS Of �AWS VALUATION SURTAX
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMPlIEO
WITM WHETMER SPECIPIED MEREIN Oii NOT. TME GAANTING OF A PERMIT $2185 ' $1.09
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pEwM1T fEE SAC CHAqGE
PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGUTATING CON-
S RU TION OR TME PERFORMANCE Of CONSTFUCTION $83.25 Fire SC .�2. 1�
` �/ PLAN CNECK FEE TOTAL FEE
G'" �t /C Z� �7 Licens $5.00 9 3
SiGNAfU�7EOFCON�fiACTOQOA�UTM iZEO�GENt io�TE� EN ROP � VALIOATE NIS IS VOUR PERMiT
O ��
S�GN4TU�7E O� OwaEQ ��F OWNEp BWLOERi �D�iE� B� �ti5� - �+<<E
NEW [ ] Effective 1 / 1 /99
ADDl� �-[] CITY OF FRIDLEY �� I� 3
ALTER [�.� SINGLE FAMILY AND DUPLEXES R-1 AND R-2 U
BUILDING PERMIT APPLICATION '` � n�
IX t
�,�.� n�p � b�
ConstructionAddress: 5 k 5�, WCx�� n�, W�-
Legal Description: � .tL.� � h _iUt, -2.v-�-�
Owner Name & Address: J,, ) Q�� `�, Q,e�. S�t Ss ����,c._ � Tel. # 5'� a- Q So�
Contractor: � � ,�Q�.�A -Q-�.n,,,, �,� �� � .a MN LICENSE # `�� � % 9
Address: �t '� d % l� :e�vvv� �e � . ��D *� / cs h Tel. # 8 � � � - �a 3 a
Attach to this application, a Certi�cate 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: Estimated Cost: $ ���-�-�-.� ���
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: / C,� �- l � ��i �( APPLICANT: � 't-Q�r� Tel. # � S � - g � 3 a
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �.� �� �
� �./�
� /, ��;
$
�V J ` � �` �
$
$
$
$ _
$ �i/� S _3
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$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 PERMIT o.: 20o4-o�s22 �
6431 UNIVERSITY AVENUE NE - �
FRIDLEY, MN 55432 DATE ISSUED: 09/Ol/2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 5455 ALTURA RD NE
PIN : 233024330101
LEGAL DESC : CARLSONS SUMMIT MAN NO ADD
: LOT 16 BLOCK 7
PERMIT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 400.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER
HEATER.
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 1
# GAS DRYERS 0 # GAS RANGES 0
# OF NEW FIXTURES 0 VALUE (FOR MINIMUM CALC) 400
# WATER TRMT APPLIANCES 0
APPLICANT PLBG PERMIT MINIMUM FEE 0.00
NORBLOM PLUMBING CO PLBG FIXTURES (NEW OPENINGS) 0.00
2905 GARFIELD AVE S PLBG FIXTURES (EXIST OPENINGS) 0.00
MINNEAPOLIS, MN 55408-2173 WATER TREATMENT APPLIANCE 0.00
(612) 827-4033 WATER HEATER - ELEC 0.00
WATER HEATER - GAS 35.00
GAS RANGE FEE 0.00
OWNER GAS DRYER FEE 0.00
VICTOR PEREZ SALAS PLBG REPAIR/ALTERATIONS 0.00
5455 ALTURA RD NE STATE SURCHARGE, PLBG FLAT 0.50
FRIDLEY, MN 55421 TOTAL 35.50
PAID WITH CHECK # 28974
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 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 ` give authority to
violate or cancel the provisions of an other sta or local law
regulating construction or the pe o ance o onstructiqn.
Applicant Date
Bldg Insp - �� ,� � i � a "�l
SEPARATE PERMITS Q IRED FOR WORK OTHER THAN DESCRIBED ABOVE.
�ITY OF FRIDLEY INSPECTION DIV.
�431 University Ave NE
=rid4ey, MN 55432
763) 572-3604, FAX (763) 571-1287
Effective April 1, 2004 �� i(�� �
`7
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE {NSTALLED ON EACH FLOOR �
�LUMBING FIXTURE RATES: NO. RATE TOTAL
Jew Fixtures
�Id Opening, New Fixture
3eer Dispenser
31ow Off Basin
;atch Basin
�ain Water Leader
� 3ump/Receiving Tank
Nater Treating Apptiance
Nater Heater -Electric
Nater Heater - Gas**
�as Range**
3as Dryer*`
3ack Flow Preventer Required ()Yes () No
Type
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$10.00
$35.00
$35.00
$35.00
$10.00
$10.QU
$15.00
�einspec6on Fee $50.00/Hr
4LL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.25% of Value of Fixture or Appliance
State Surcharge
$ •�
TOTAL FEE $ �S �
�7 � S� � � _%C.� �% ��
JOB ADDRESS_ . �nnn,2 � aS o'1.�.�Yl�n%
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 fads
and representations stated in this an�lication are true and correct.
SALAS, VICTOR PEREZ
5455 ALTURA ROAD IVORTHEAST
FRIDLEY, MN 55421
OWNER ��63) 502-6982
BUILDING USED AS �51 ae�✓t�
��� , 20 aY
ESTIMATED COST `l 6 O� PERMIT NO. ����� �� ` L-'` ����
PLUMBING COMPANY O i�F-�� �'W� Ca�1M, i
SIGNED BY ���� ��, — TEL N0. ��o1Z� �Z%-�033
Approved By
Rough-In Date Final Date
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. *'PROVtDE COMMON VENT fN�O ON BACK SIDE