AF - 34963�
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City of Fridley, Minn.
BUILDING PERMIT
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N° '7289
C� � LO TION Q_F UI D NG
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Na Sireet � P
Lat �° Slock ,� Addition or Sub-Divisi� f�. ��o
Coraer I.ot Inedde Lot � Setback �_��__._ Sideyard
SewerIIevat4on g��. �� IIevation �9�°�
�� nP �'oa �-�,eJC
DESCRIPTION OF BUILDING
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In c�ideratton of the 9sauance to me of a permit to construcE the building described above I agree to do
the prop�e8 work ffi a�rdance wlth the d�scription above set f ffi with a�l provlaions of
or8inancses of the dty of Fridley.
6
Ia cxmsdderatlon of the �yment oP a fee of $,�� , permit is herebY graabed *o
to c�nstruct the building' or addition as tiescribed above. Thispermi t is granted upon
the exPree� eondition that thep�sson to whom it ia granted aad his agenta, employe� an� worl�en� in a11 work.
8oae in, a�und aad up� esid building, or anyp� thereof, al�all oonform in all r�pects tfl the ordinant� ad
Fridley, Minn�ota loc:atlon, oanetruction, alteration, matatenance, repair aud mrn►1� a� builclia�ps
wI� dLy limiter�� pernrift may be revoked at aaY �pe upwq,�o�n oY any oP the P�vis[ons of' �td
/ ) 61fY l 1
B� Inspecta�r
N01'ICEs
lhis p� do�a nef �vsr t6s �, � IIs� rr�g. P�9. oa �, asrnr eu� watar. B� son te a�
da � let�etar [ar apaata p�mW I�Or t6as t�ns.
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APP`LIGATI01� . Ft1R , $UZZ.I�II�' P�+a,1�TT �: . , -
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. _. : CITY;OF �'BIDL�Y, �SOTA. • ;
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OWNEB' S NA���fi�'i?�As,�„�.� BUILD�R
ADDRESS_� � 3�.�..�f!� � �'7'ilJ'.F. . : ADDRE$S �•
. , . ,Lt�ATI01Q OF SOYLD� ' � . _ � .-
Nc.�/ _, � _ Street %,l/d .%�, Part of Lot -
e ��— -., ,_.,.�•_, � , _..._� -.�� ,, ; � � - ....._
Lot Hl�k Additi� v�� Sia��iv�isfoa OU� A'D /T/OlG.
.� .. � �_.........._ _ _ _ _ .�.�i�:��, �_
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Coraer Loe'�`'��nside Z,a � SBCbaak '3s�. � Side�Yard _��� �
SEWLR L�LE6ATION �� F�ATION ELE9ATYO�J '
Applicant attach to thi� Eorm Twt� Ce�i�3�ates of Survey of Lot aad proposed b�aild-
iag location'drawn oi►`C�ese C�rtiiiicates: . .
. . , . _ , . . _
DESCRI�1'ION t1F BU�D�iQG
To be �sesl a�:_ �.�. - �. �. - ; _ _ _ . . ---. .
S//r✓,�'E' li�1L.C��- 'l�roat�.1� : �.:a.�li _ o`�. �.�$eight' .�D
� Sq. FC . � Cu . Ft .�? e� m�' ��
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: � , I�rraut Dapth ' Haight � -
, . Sq.. Ft . � �Ctx.. .Ft .
Type �af CortstrucCioa ,�QA,;,,,b ���,,,,_..:_,_�stimated CQSt _ ��,�`��`''�,,,_��
To be Compieted . ' ��j. " . .
The na�lersigaed �ierabq• makee ap�iii�aCioa for, a permft . for eh� � work. hexe�:n , specifi�d,
a�reeing to do all wark in strict acco�d�nca w9.tis'the City of F�idley Ordfnances and
ruliags of the Department of Buildinge, and,hereby decla�ce� that all tbe facCs aad
represeatatic�ns �taCed �"ia this application ase true. �and correct. -�
DATE ,����„��.L.._&IGNATUBS . .
y(Scisedule of Fee Casts caa be foa�d on the lteverse Side).
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SD�tLDI�i PSR1�T FEL SCAEDDI,E
Section 2. The Inapectar oi 8uildings ahell, before issuiz�g suu� p�ami.t for
tHe erectioa of anq buildiog or atructure, or for any addition to any e.�;ist-
in� building or etructure, 'or for aay alterations or repaire to anq esis��ng
buiiding or atructure, upon applicatica therefor, require the payanent by the
agplicaat for such permi.t of fees Co the amouat herain below ser fosth �d
iA the mannea herein psovided to-wiC; ,
2,,,.1. I�or aay auch permit for the erecCion of anq fire-proof building, other
than a garage,-ra�rehouse� factory or �raiu�elevator, or �or the esect3an of
any fire-proof addition, for s9.miler accupancy, to anp euisting buildiiag
shall be at the rate of $1.40 for each oRe thousand cubic feet, or fractioa
thereof, in such cubical contente. '
2.2. For anp auch permit-for the erect�oa of-anp ffre-proof garage; warebause,_.
factary o�r grain elavator, or for the erectioa of aay fire-psoof edditioa,
for similas� r�ccnpancq, to aap existing'building�strall be at the rate-af $1.25�
for each on� thausead cubic f�et� c�.asaified as '�firepraof"_by Section 5G2.of
the-Mi.nneapolis Building Ccde. : -
SOUSE8 . .
2� 3. For 'any such permit for the erection of� aay aoa-fireprooi build�t►.� o�:�:er
thau a$arage, warehause, factory or graia elevator; or aay noa-fi�e�sc«$
additioa, for s3miler occupancy, to eny esistiag buiid3ng - pe�t $1.Op fos �
eac� aae thoueand cub3c �eet.
G�S
a= �For eay sueh permit for the erecti�a o:r ,�.-.��; ���►-�;Q.A�s�,� gara�e,
warehot�e,, factory or grain eleeator, ��• --�r;: t, �� ��F-?�= �r� a� �ra� nor��f� rc�roof`
additioa, -��c---si�t�ar occupaacy, to ��,p ,,ti: � s.ir_� p��*,r �.��;.�o o� �or each eL�h •
_.-- bui.l,dia8 or. addition - ni�ety cent+s !'; 4;=:=a°t �;^r ;�.;{ti:;i o�e th��asand cu��.c feet
or fraction thereof, ia the cubic�i �:.�� �� _�� _:� t*;,�� �oy ��,� 8�,ni�m of $4.00.-
. _ ,v�_...._ _
For the purpoee of campue3ag fees get �,s, e;.rai�g ppn;,,i�a, tb� cubical coatenta
of enq buiid�ng or additi:oa to a uni,tc�,� -�c?';�:t tL-�°o�:�;bout by �Lriplyiag the -
ground area covered fr� a poiat sia (6) i�it,:��s b�� rw t�e fLoas lias of :�he .
baeement or ceilar to `the average heigbt- of ��•a e.=�b�er -su�ace� or 'to ti�e � -
average he3ght of t6� roof surface of the main gaule of a p�tch� roof,
2.5. For repairs or alterations te an euistiqg structure, tbe fea ahall be
a he rate , of $3.00 per eacb Five i�luadrecl pQ�.1az8 .�$Spp.pp� or frectio�
thereof ia the c.ost of all progoaed work. :
a; In no cae� sha11 the fee,_chargQd.#or--say pezmi.t.�a�g set forrh. ia
.Sectioa 2 be 1ese. �han $4:00. . . . - . .
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City of Fridley SUBJECT P� .
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ATTHETOPOFTHETWINS gUILQING PERMIT ' 1'22�2
; � RECEIPT P!O
� `L __�___� COMMUNITY DEVELOPMENT DIV.
r � � PflOTECTIVE INSPECTION SEC. /„ �� D�
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� � /"'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE . PA6E OF APPROVED 8Y
1."'�1.� `'' g,2-sso-�a�o 910-F15
7/3073 / /
JOB ADDRE$S 6620 Anoka 3traet N.T4.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],1-13 3 Osk Grove Addition SHEET
2 PROPERTYOWNER MAILADDRES$ ZIP PHONE
Mr. Arthur Del�iepere 6620 Auoka Street N.E.
3 CONTRACTOR MAILADDRESS �P PHONE UCENSENO.
38itte
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE UCENSE NO.
8 USEOFBUItDING g$aidential
� cu►ss oF wo�nc
� NEW O ADDITION � ALTERATION ❑ REPA�R ❑ MOVE � AEMOVE
8 DESCRIBE WORK Gonstruct 28' s 24' Garsge
9 CHAN(3E OF iISE FROM TO
sTiPUV�T�o�s provide a hard sur£ace drieeway. Pravide frost footing� as ger akatch�
E U1RED F�R t�11�11��,
S
EPERATE PERMITS � � SIGNS•
� HEATING, PLUN�BING A
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
YENTILATINO OR AIR CONDITIONINO. ��� �=�g
THIS PERMIT BECOMES NULL AND VOID IP WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED7S NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION R��
OR WORK IS SUSPENDED OR ABANDONEO 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 STALLS GARAGES
AND KNOW THE SAAAE TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINAIdCES GOVERIdING THIS TYPE OF WORK WILL BE COAAPLIED.
WITH WHHTHER SPECI�IED HEREIN OR NOT. THE GRANTING OF A PERMIT _ $ 3 O6Z.00 1..53
QOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF APIY OTHER STATE OR LOCAL LAW REGULATING CON- $]2,SO
STRLCTION OR T E PERFORMANCE OF ONSTRUCTION.
� � pLAld CHECK FEE TOTAL FEE
14.03 .
6NATU EoFCO TRACTORORAUT ORIZEDA�ENT (DnrE� WHEN PROPERLY ALID TED TH19�IS YOUR PERMIT
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SI6NATURE OF OWNER IIF OWNER BUILOERI IDATEI BLDG. INSP � TE
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APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : BUILDER : _ �G�,.�,_
ADDRESS : �p �a0 � �17.d�-�> S�. /f/, � ADDRESS :
N0 : . CP �p a 0 STREET ; ��j'�,4�J-�/ . /% �
LOT: �/ /� � /.3 BL(�R: .� ADDITION:IJ� �%/�--t,c-e--
CORNER LOT; INSIDE LOT: X SETBACK: SIDEYARD;
Applicant attach to thia form 7.tao Certificates of Survev of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be ,Ueed As :
� �/�/�
�-� Fxont: � � Depth:� Height: / D
���__..
Square Feet: ���ubic Feet; �9 7(0 (�
Froat: Depth: Height:
Square �'eet; Cubic Feets
1�►pe of Conatxuction: Cx�o--o--�. ���. Estitmated Cost;_$ .3j o Coo�
To Be Completed; /��/Z,
-
The underaigaed hereby makea applicativn for a permit for rhe work hereitt
apeeified,� agreeing to do all work in sttict accordance with the City of
Fridley�Qrdisiaaces and ruliaga of the �partment of Buildinge, and hereby
declares that all the facte and repreaenta9tioa�s stated in thia $pplication
are true� aad carrect,
.
n�.�: � � 7 /5'�.3 sicNa� • �'J�-o . � �,� 1� ,
_____�
(See R�vexee Side �'ar Additioaal Information. '�� • � 1 °�' � � �
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BUILDTNG PERMIT FEE SCHEDULE
SECTION 2. The Iaspector of Building� shall, before issuing permits for the
exection of a,ay building or structure, or for any additioa to aay existing
building or stxucture, or for any alteration or repaira to any existing
building or stxuctuxe, upon application therefore, require �he paytment by the
applicant fox such permit of f�ees to the amount herein below set forth and in
the s�aaner herein pravided to-wit:
UATIFORM BUILDING CODEo Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fractioa thereaf, in such cubical contents. 1�pe 3� 5-$1.85 for
each rnne thousa�d cubic feet.
ADDITIONAL INFORMATION
For tjie purpoae of computing fees for building permita, the cubical contents
of an�► building or addition, ia detexmined by multiplying the ground area
covered froia a point six (6) inches below the floor line of the basement
or the cellar to the avera�e heights of the upper surface or to the average
heigl�t ot the roof surface of the main gable of a pitched roof.
For repairs or altera�ions to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fzaction thexeof irt
the cast of all. propased work.
Ta no aase sha11 the fee cha.rged for any permit as set foxth in Section 2 be
lesa than $5.OQ,
VBRIFICATION OF FOUNDATION
NOTE; Permits fox eonstruct�.on will be issued a mini�tn of 24 houra fram the
time af application, to allo� for proper review af the propos�d structu�e a�d
of tbe coastructio�a eite.
A Certified Survay of the lot, showi.ng the loeation af the foundation, once it
has laeen constructed, wiil be required before proceedin� with the framin�g.
CERTIFICATE OF OCC�IPANCY
Appli.catior� foz a Certificate of Oceupancy shall be made Cen (10) da.ys prior
to the use ox occupancy of any structure for Which a building permit has been
iasued; and said s�xucture ahall uot be used or occupied until a Ceztificate
of Occupancy has been iesusd.
0
��.�. ������� ��� ������ �'; ���� ����• LAND SURVEYORS
10130 CENTRAL AVE. N.E. (Hwr. 65) — BLAINE, MINNESOTA 55434 Telephone
CERTIFICATE OF SURVEY:
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L�UA� DEscRiPi-ioN : �
Lors ll� (2� ANo 13� ��ocK 3�
OAK C,Rov� ADD1TtON� Ai�flKll Cou�t-rY �
I�J� I N NESoTA.
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I HEREBY CERTtFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF TNE BOUNDARIES
OF THE ABOVE DESCRIBED LAND, AND THE LOCATION OF ALL BUILDINGS, THEREON, AND ALL VISIBLE EN•
CROACHMEN45, IF ANY, FROAA OR ON SAIO LANO. '
ASSURVEYED BY ME THIS..�:"�.�.....DAY OF .......Q.�.�..�..O��r+t�r ...............A.D. 19..4.�.L..........
. N.C. HOIUM AND ASSO �TE , NC. �
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o � • Minnesoto Ray9stration No. .... .fi.%......... °�.
(
sus�ecr PERMIT
c�ty of F��a�ey :2331
ATTHETOPOFTHETWINS_ BUILDIN� PERlr1IT •
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COMMUNITY DEVEIOPMENT DIV. RECEIPT NO.
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r � PROTECTIVE INSPECTION SEC.
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, � ,
�� �"��1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPHOVED BY
��»1`•� �•� 612-580-3450
910-F15 9/26/73 � �
JOB ADDRESS 6620 Anoka S�creet N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION •
DESCR. 1�.-13 3 Oakk Grove Addition sHEETTTACt+eo
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Art Demeyere 6620 Anoka Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE WO.
.581RH
4 ARCHITECT OR DESIGNER MAtL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDUVG
Reaidential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION � REPAIR � MOVE O-REMOVE
8 DESCRIBEWORK ��nstruct breezewaq between honse and garaga. x
9 CHANGE OF USE FROM TO
STIPULATIONS
^rPER�ITE �PERF"�T^. :;�'^'.'s�ED FOR �IR►N�,
�i��i(�G, PLUi�����,;� �;�i� SIGt�S.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATIN(i, TMPE QF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. �00C1 Fr81Q@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT CQMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 12U DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION STALLS GARAGES
AND KNOW THE SAAAE TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNINO THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GFIANTING OF A PERMIT $1 522
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHEA STATE OR LOCAL LAW REGULATING CON- $� � OO
STRUC N O T E PERFOR CE OF CONSTRUCTION. �
PLAN CHECK FEE TOTAL FEE
�
SICaNATUREOFCONTRA oao AUTHOR�ZEDA (DATEI WHEN PROPERLY L TED�FHISIS YOUR PERMIT ;
e
a
SIGNATURE OF OWNERIIF OWNER BUILDERI IDATEI BLDG INSP �ATE
aPP�ICATioN FOR RL5IllENT�AL, ALTERATIt)V,
UR A�UITIOI�' I3UILDING PERMIT
CI'1'Y OF 1-h1DL�:Y, �1INNESO`.C�1
awr� � S � : ,�� T' � � ��-��UI�.D� • S � � -�
ADARESS :_ �a � Z O /�t N � �,�,� S,'�� I1`. �,ADDRESS :
1�T0S 3 STREET. � � � Q� � �B C.i���4 �1�e '�. �
�: BLOCK;. ADDTTION:
CO�NER LQT: INSIDE I�QT: SETBACK: SIDEYARD;
Apgliaau� aCtach ta this foxYn Ztao Certificates of Surve�r of Lot and pxoposed
baildirig lvcatian drawn on theae Certificates.
UESGRIPTIUN OF BUILDING
Ta Be� Uesd As ;
���� f^�. � � Front : 1 �/ � Depth : � � � Heigh� : �'"� � �
Square Fe�t ; � � Cubic Feet : � � �*� �
J
Front: Depth: Height:
Square Feet; Cubic Feefi:
�rp� of Construction: ,�tJ o Q C` Estimated Cost: $
.
To Be CQmpleted: J � � �� � �� �
,�
Th� undexeigned hexeby ma.ke� applicativn for a permit for the work herei.A,
up�cif�ed, �.$reeing to do all woxk in stt'ict accordance with the City flf
Fx'idley Ordinances and xulings of thc� Departm�nt of Buildings, and hereby
dee].axes Chat .;11 the facts and xepresentations stated in this application
ax� true and ��:rrxt•c t .
DATE: 5IGNATURE:
(Se� Revexse Side Fox Additioaal Tnforma,tion.)
p�.. -
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BUILDIhG 1'�:lti�11'T l��:E SCl-I1:llUL�:
S�QT�pN �. The Lnspect��r of Bzii.ldi.ngs shall, before issuing permits for the
ex6Ct3.on of any buiiding oX strur�t�rc�, ar fo� an�� addition to any exi.sting
bui.lding ax structure, or far ._iziy .+lter�.ti.on or r�pairs to aany eaisting
huil.ding or sL-ructure, upon applicati�n Ltiereiore., r4q�:irc the payment by the
�,pplicant fox such permit of fees to kh�� amount hexein below set fo�th and in
th� manner here.in provided to-alit:
IJN�FQRM BUI�LDING COAE: Tj�pe
fQet, ox fraction thereof, in
eaah one �housand cubi� feet.
1, 2& 4-$2.15 for each on�: thousand cubic
such cubical contents. T}•pc: 3& 5-$1.85 for
AliUITIONAL INFURh1ATIUN
Fox the gurpos� Qf computing fees for building permits, the cubical contents
of any buildin� or addition, is determined by multiplying the ground area
aavor�,d fxom a point six (6) inches below the floor line of the basement
o7C th� Gallar to th� average hei�hts of the upper surface ax to the avexa$e•
hai�ht �f ths xaof surface of ttie main gable of a pitched roo�.
ffo� x�apaix� ax aXtexations to a,n existing structuxe, the fee shal]. be at the
7cata o� $�.00 pex each five hundred dollars ($500.00) ax fraction thereaf in
the cos� of all pxoposed work.
Ia na case shall the fee chaxged for, any permit as set for�h in Section 2 be
1�as than $5.00.
VERIFICATION OF FOUNDATION
NOT$� Pc�7rmits ior construction will be issued a minimum of 24 hours from the
timi: of application, to allow for proper xeview of the proposed structuxe and
ai �he comstruction site.
A Certif�.ed Survey of the lot, showing the location of the foundation, once it
has been constxuc:ted, will be required before proceedin� with the �raming.
�'�RTIFICATE UF f}GCUPANCY
Applicatiun for a Certiiicate oi Uccupancy shall be made ten (10) da.ys prior
to the u,se or occupaiicy of any structure for which a building pen�nit has beeA
�.�su�d; �,nd s�iid s�ructure shall not be used or occupied until a Certificate
of Qceup�ncy has been issued.
.
��
�
.�
sue�ecr P " NO.
City of Fridley � 139��
AT THE TOP OF THE TWINS g U I L D I 1 �1 G P E R T
; �� RECEIPT NO
� `L �����_� COMMUNITY DEYELOPMENT.DIV. - ,!(}
r � � PROTECTIVE INSPECTIOW SEC. `f'ij
1 i �
�` /��'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
i•�«� � ,`� 812-580-3450
910-F15 i/21/77 � �
JOB ADDRESS 6620 Anoka 5treet N. E.
1 LEdAL LOT NO. BLOCK TRpCT OR ADDITION SEE ATTACHED
DESCR. �.�.-�.3 3 Oak Grove Addi�ion SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Arthur DeMeyere 6620 Anoka Street N.E.
3 CONTRACTOR " MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESI(3NER MAIL ADDRESS ZIP PHONE LICfPISE NO.
5 ENGINEER MAILADDRESS 2IP PHONE UCEN3EN0.
8 USE OF BUILDINd
Re,sidenti.al
7 CLASS OF WORK
❑ NEW ❑ ADDITION C1X ALTERATIOId ❑ REPAIR ❑ MOVE O REMOVE
8 oESC�isewoaK
� Inatall Frankl�Ln iireplace and chimney
9 CHANaE qF USE FHOM TO '
STIPULATIONS
SEPERAi� P'ERMITS �EQUtRED Ft� WIRIl�G,
HEATING, PLUMBIfVG ANp SIGN�:
riPE OF CONST. OCCUPANCY (iROUP OCCUPANCY LOAD
SEPARATE PEHMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINO,
VENTILATING OR. AIR CONDITIONIN(3.
THIS PERMIT BECOMES NULL AND YOID IF WORK OR CON3TRUCTION 20NING SQ. FT. CU. FT.
AUTHORiZED IS NOT COMMENCED WITHIN 80 DAYS, Ofl IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFF9TREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �' STALLS GARAGES
AND KNOW THE SAME TO Bf TRLIE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES (iOVERNINd THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $8OO ,�`.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIOIVS OF ANY OTHER STATE OR LOCAL LAW RE(iULATING CON- '] � SO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTIQN. S
PLAN CHECK FEE TOTAL FEE
�`N8. 00 �
�
SIONATUREOFCONTRACT ORAUTHORIZEDA6ENT (DATEI WHEN P OPERIY VALIqATED THIS IS YOUR PERMI ,i
� �'��� i a �-� � ,� i -�� -��
SI6NATURE OF OWNER IIF OWNER B IL RI IDATEI � BLDG INSP DATE
CITY OF FRIDLEY
APPLICATION FOR F�SIII�NTIAL BUILDING PE�++IITS
�NEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
OWNER' S NAME : �, UTLDIIt : c� Q.�►�..�
�nn�ss :�j ��� � i�, �°'. F`� •� . t�nnxESS : � �--,-Y� .
TEL. A10. :
LY� : • S 11�l:�1'+L : � �-��a'.�' � � O 9 •� s � ,
ZOT : �� � ,/� /�_BLOCK: � ADDITION • � �..f°� � G��.""e"�^'`'P�
CORNER LOT: INSIDE LOT• � SETBACK: SIDEYARD•
Applicant attach to this form Ztao Certificates of Survey of Lot and proposed
building location drawn on these Certificates. .
DESCRIPTION OF BUILDING
'� ' To �:�e Used As : ��``y/a�E �
�Q,��i � �ie�. ��'�-c� � .
�" ' Fxont : Depth . Height :
���
Square Feet: Cubic Feet:•
Front: Depth: Height:
Squaxe Feet; Cubic Feet:
�i�s�, G
Type of Constr �c �n: Estimated Cost: $. O� a
To Be Completed: � ��h`l.�d .
PROPOSID DRIVEWAY WIDTH IF NE6�1 OPENING IS DESIRED
The undersigned hereby makes applicativn for a pexmit for the work t�erein
specified, agxeeing to do all work i1i stiict accordanae with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representat3.oz�s stated in �his applicat�.on
axe txue aad co�rrect.
DATE: a� SIGNATiIRE: �o��r�c�---
(See Reverse Side For Additional Tnformation.)
' � ,�l",' ,��
G9���� s�"�d
( jf'���� i
, '� ��,�v
L' '
. �
s
BUILDING PERMIT FEE SC�iEllULE
SECTION 2. The Inspector of $uildings shall, befare issuing permits for the
exection of any building ox structure, or for any addition to any existing
buildi,ng or stxucture, or fox any alteration or repairs to any existing
building ar stx�ucture, 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 to-wit:
NEW CON5TRUCTION: Si.z�g�.s Family�Aomes and Garages: $4.00/1000 cubic feet �
�Driveway Depression(Concrete Curb S�reets Only): Dr�veway F7idth plus 6 feet x$11.75/LF
PLAN CHECK: 25 percent of buildi.ng permit fee.
ADDITIONAL INFORMATION
For the�purpose of computing fees for building permits, the cubica.l conten�s
of any building;or addition, is determined by multiplying the ground area�
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the averagefr
�height of the roof surface of the mai.n gable of a pitched roof.
For:-'repaixs or alterations to an existing structure, the fee sha21 be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
Ia no case shall the fee chaxged for any germit as set�forth in Section 2 be
less than $7.50.
VERIFICATION OF FOUNDATION
NOTE: Permits for eonatruction will be issued a minimum of 24 hours fram the
ti�ne of application,�to allow for proper xeview of the pxoposed structure and
of the constxuction site.
A Cextified.Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceedin� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be ma.de ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of'Occupancy has been issued.
�
w
.�
S
�
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M i T
r
i 1.
� • COMMUNITY DEVELOPMENT DIV.
r � ~ � PROTECTIVE INSPECTION SEC.
� �
I . �
� � �"'1 � CITY HALL FRIDLEY 55432 Nu�eBER
�_._..11.' '•� 612-571-345Q 910-F15
JOB ADDRESS 6620 Anoka Street NE
1 LEGA� �OT NO. BLOCK TRACT OR ADOITION
oescR. 11,12,13 3 Oak
2 PROPERTY OWNER MAIL AODRES$
Art Demeyere 6620 Anoka Street NE
3 CONTRACTOR MAIL ADORESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
REV IOATE
7/7/95
ZIP
ZIP
PAGE OF
� /
PHONE
PHONE
PHONE
��5��2
RECEIPT NO.
� I �
APPROVED 8V
SEE ATTACHED
SNEET
LICENSE NO.
LICENSE NO.
LICENSE NO.
7 CLASS OF WORK
O NEW ❑X ADDITION �O ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
9 CHANGE OF USE FROM
STIPULATIONS
1 _. 1 G � T....b •
See notations on plan
TO
, � � ���
�efore digging cail for �
ali utitity tocatiar�s � `
454-0042: .
���U 9 RE� �V L��.
TYPE OF CC
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBINti, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NIN(i
AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPIICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATIO�
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2s2OO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqM1T FEI
PROVISIONS OF ANY OTHER STATE OH LOCAL LAW REGULATING coN- �54.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION,
SQ.
STALLS
GROUP
CU. FT.
OFFSTREET PARKING
IGARAGES
SURTAX
$1.10
SAC CHARGE
Fire SC $2.20
LOAD
SIGNATUi7EOFCONTRACTORORAUTHORI2EDAGENT IDATEi WHEN PNOPER VALIDATED THIS IS YOUR PERMIT
_.r.,w.��ee ne nwuco,�c nwNCw RuIL�ERI IDATEI . � �NSP . � qATF -
.. ,, .,;.:. :. .... .,.......
. . ..... .. . :..:....... .... .... ... .......,........... ..,. _ ..
NEW ( ]
ADDN [ ]
ALTER [ J _
ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Applica.tion �
�
r
Effective 1 / 1/95
�
�G� .
�� ������
� #�po�o`l - o�/�o�
� � ����
Legal Description:
Owner Name & Address: �,�7' ��%�k�/� Tel. # J�/� S��/ 9
Contractor: MN LICENSE #
Address:
. Tel. #
pt�ach to this application, a Certificate of Survey of the
lot, widi the propos�d construction drawa on it to scale.
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
�� width Height
Width Height
Len�
�� /� width / iP HgtiGround � �
�
I, a- � l �
Sq• Ft• -
�. Ft.
s9•
!� �Ca�
Corner Lot [] Inside Lot [] Ft. Yd Setbac'k Side Yard Setbacks
�
Ty� of Construction:
Estitmaxed Cost: $ a� � � � °
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width N�d: Ft. + 6 Ft = Ft x$ _$
DATE: 30 lQ%�PLICANT: c�o�� � -�A-��� Tel. #�r//-.S� o� �' ,�
Permit F�
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
S1'IPULATIONS:
$ �°`� . �
S -� �
S G °l�
$
$
$
$
$
$
$ �7 .3 U
�'j'�'Y USE O1�I�Y_
Fee Schedule on Reverse Side
.001 of Peimit Yaluation {1/lOth�)
$.50/$1,000 Valuation
$850 per SAC Unit
$5.00 {State Licensed Residential Contractors)
Alt. "A" or Al� "B" Above
$q.5Q.Q0 Consen►ation Plan Review
Fee Dete�min�i by Engineering
Agreement Nec�y I] Not Necessary C]
�
�;u��.DING ����RMI"t' FEL SCtiEDIJ(_r:
���hc (;hi�t f3uilding Ufiiciai st�all, (x;lore issuing permits for tfie erc;ciion of any building or structure,
c�r- fi�r any a�iciition tu any cxisting buildin�; or structurc, or for any altcration or rcpair to any cxistin�;
t>uiliii�ig c�r �structurc, u�n a{�nlicetion thcrcfo�c, rcquirc thc paymcnt by d�c ap�licant for such permit
c>I� 1cc;s tc� thc auit�unl hcrcin t�clow sct ti�rth and in thc manncr liereia Providcxl tc�-�vi(:
"1'O"I'AL V A I_U l:
� 1 to $S00
$501 to $2,000
�2,001 to $25,000
�225;001 to �50,OOU -
SS0,001 to $100,000
�100,001 to $SOO,OQO
$500,001 to $I,000,000� -
$1,000,0p1 and up
r•r��s
$15 (Minimum Foe is $IS plus surcharge)
$15 for first $Spp plus $2 for each additional $100 or
fraction thereof, to and including $2,000 �
.$45 foc first $2,000 pius �g for each additional $1;000
• or fraction �SOOf, to and including $7_5,000 -
$252 for fYrst� $25,ppp plus $6S0 far each additional $1;000
or fradiou thcxeof, to. and including $50,000 --
$414.50 for fust $50,000 plus �450 for each additional
.$1,000 or frac� tfi��eof, t�o and including $lOQ,O(}0
$63950 for �st '$10Q,0� pius �$3_SO for each additionai. '
$1,0(� or frac6on tfi�eo� to aad includiug -$500,()p0 -
$203950 for the first $�0,000 plus $3 for each additiona.i
$1,000 or fraction th�eof, to and in.cludiug $i,000,000
$353950 for �e first $1,pQp,ppp plus $2 far each additiouai
$1,OUQ or fraction thercof -
DRiYEWAY DEPRE.SStOM ESCROW
(Concrete Ctirb Stireets Only)
Alternate "A": Remova! and repiacemeat of curb and gut� o,nly - Driveway widifi plus 6 feet times
� 13.SQ.
Alternate "Ii": Removal and replacement of curb and gut�ter and install a 3 foot wide
approach with 6 inch depth - Driveway width pius G foet times $15.75.
VCR[F[CATtON OF FOUNDAT[ON
Permits for coc�stiuction will be issued a minimum of 24 hours from the time o� applica�ion to allow
for proper rcvic�v of tiie pro�scxi structure and of the conctruction site_
A CerUtic:�te of Sucvey of the fot, showing the iocation of the founclation �nce it hat it ha.t been
constructexi �vili i�e rcx�uircxl befcx�e proceeding with ihe fcaming.
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10130 CENT.RAL AVE. N.E. (Hwy, b5) — BLAINE,.MIN�ESOTA 55434 Telephone
CERTIFICATE OF SURVEY:
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.! HEREBY CERTIFY THAT TtlIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OF 7HE BOUNOARiES
OF THE ABOYE DESCRIBED LAND, AND THE LOCA710N OF ALL BUILOINGS, 7'HEREON, AND ALL VISIBLE EN.
•CROACHMENTS, IF ANY, FROM OR ON SAID LAND. •
AS SURYEYEO 8Y ME iHIS..��.n.;.....DAY OF ....... ��QB,�,s� �Z
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Building
Inspections
763-572-3604
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OVI
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No.
_
' - �� : j.i..�: ��
� '..,�� �� 1 � i I
_ YOUR E-MAIL ADDRESS _kSSQ`l��C'�l a7 (�[ �', • C,(Ny��
. \ -
� OWNER '�ICON'TRqC'!'OR
ADDRESS: � � CITY STATE ZIP
PHONE:�IO� �5���� q
NAME:
STATE LICENSE #
ADDRESS:
FAMIL
Renewal By Andersen
1920 County Road "C" West
Roseville, MN 55113
License #20130983
651-264-4777
O BASEMENT FINISH O ROOF
O DECK O SIDING
0 NEW
O MAtr
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVFMRrr'r
sQu,v�s
. us__
PROPOSED SIZE:
PROPOSED HEIGHT:
O HOUSE & GARAGE
0 ATTACHED GARAGE
O DETACHED GARAGE
t STATE ZIP,
O DRAIN TILE
� OTHER
BASEMENT FMODELING SI1R1��IT•
I. Existing Floor Plan
2. Proposed floor plan
3. List of structural c�mbe�s to be u�d
FL
p� FOR NEW CONSTRUCTION INCLUDING DECKS,
OSoffit �DITIO & PORCHE tRn�I1T•
D Other � ❑ Trim I. Site Plan/Survey showing die ezisdn st�ucAue
0 Fascia g
� ProPoe� P�J�
2. Two sets ofconstruction plaffi
IN EXiSTING OPEMNGS OYes ONo LOCATION OF W[NDOWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENIMG CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED [YUMBER OF WINDOWS
ALL FEES ARE B,�,,SED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION $ NGQI '�. [� s U.B.0 FEE �� NCV �rvp�
Permit Fee
Plan Iteview
Fire Sutcharge
Surcharge
License Surcharge
SAC Charge
Cutb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$
$
$ �l . �'TS
$ , 6D
$
$
$
$
See Back Page for Fe� Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.SO
$5.00 (State Licens� Residential Contractors)
$ I550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineeruig
Agreement necessary ( ) Non Necessary ( )
Make checks �yable to: Citv of Frialev s..o�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pennit and I acknowledge that the information above is complete and accurate; that the �,►,ork will be u
conformance with the ordinances and codes of the City of Fridley and with the Minnegota Construction Codes; that I understand this is not :
permit but only an application for a pennit and work is not to start without a�it; that the work will be in accordance with the approvec
plan in the case of all work w ch requir� view and approvai of plans.
SIGNATURE OF APPLICANI' P NAME d'C[� e�n�� r� DATE I��� U�/C/
..