AF - 34969�
City of Fridley, Minn.
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��� Y���� L��O�ON BUIL ING
Na Street .� _ _.L._. Part Lot —
Lot -L--� !o_._ Block _�_.__._.._._.._.--• Additiari or Sub-Divlsio� ... .�-- —
Corner Lot w_ Ineide Lot _._ � Setback _.�;� � - Sideyard ___� , � �
Sewer IIevati� ���s _.._...._._._ P�biert IIevatian _�i•�.�-��.s .Y
?o.� o � � c,o7iw G
� DESCRIPTION OF BUILDING
v Fro�t .�� Depth �I� Height �v 3q, F't, `�D (�, Ft,�.�-'�-'�/
� t Depth _..._ H ght �� Scl. F't. Cu. F't _
Zj►pe of Constructi ..._.__���%Q._..__. ��To be Completed _..._.._�_�____.___,_
. Est, .. 77�;!'y� ._.._. -- -
In oo�sideration ot the issuance to me of a permit to co�struct the building described above, I agree to do
tha proposed work in accordance with the d�scrlption abave se�t fo and in compliance wlth all Pravisions of
aTdtnances o� the dty of Fridley. � �
In caosid�atian oi the payment of a fee oi �.�i.,�..�_•-� Pernnit is herebY Sranted to
to construct the building or addition as descrfbed above. Thia permit is 8ranted aPo�
the exPre�s oonditioa that thepereon to whom it is granted and his agents, e�►Ployees and worlanen, in all work
done in, around and upon said Luiliin8, or au►Y �art thereof, shall conforrn in all respects to the ordinances o�
Frldley, Minne�ota regardin8 locati�, construcho�, alteratioz►, maintenance, repair and mavin8 of buildinSs
within the city linoits aud this permit may be revoked at anY t�e uPan violati� of any o� the Bz'�� of sa�d
ordinancx�a. i^1 �, /7
Buildin8 Inspecta�
NOTICE:
iYs ptndt de�s eet eewr tM eoaMeudios. � fer vrMip. pWwWnW Y�s INMtn�. awrw er wahu i� wn to s»
fla loiWip I�p�ee hr ap�tah p�tts /er f6a� b�ns.
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c�t� C c� ar� �ssac a��. �.
LAND SURVEYORS � •
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Anoka, Minnesota '
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CERT1FtCATE OF SURVEY: .
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WALTER MACIAS2EK �-S-F ���Q����"6: 65
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` 129 PLAT '
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I-S-F 8 STONe,-
No. 6600
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LOTS 9 ANO IO� BI.00K 3�
OAK GROVE ADOITION, �
ANOKA COUNTY� h'INNESOTA
1 HEREBY CERTlFY THAT THIS IS A TRUE AMD CORRECT RE►RESENTAitOk OF A SURVEY OF THE 60UNDAR�S OF TME Al01/E
pESCWBED UND, AND THE LOCA710N OF ALL 6UIlDiNGS, THERfON, AND All VISIBLE ENCROACMMENTS, !f ANY, FROM OR ON S/t1D
IAND.
IST � NOV�MBER 63 /
AS S�JRVEYED YY ME TFiS ..... ........ DAY OF _ _. .. __ _...... A.D. 19............
N. C. HOIU.�1 AND ASSOCIATES, I .- tAND SURVEYORS
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°'�A�' LOSS CALCULATIONS DEPARTMENT OF INSPECTIONS NQNNFAFOLIS. MINN.
-Weatherstrips A.S.H.V.E. Constructioa No. Insulation
Guide
Windows Daors Reference Out. Wall Int. Wall Ceiling Roof F1oor Kind How Applied
Yes—No Yea—No 19,_ �
Fl.� " Room � Length Width !+!/ Height �' F1.� Room Length '"'�� Width � Height�
Wiadows an oors—Crackage and Area Windows and Doora—Crackage and Atea
Wldth eight No. ot Lineal t. Area Wldth Height No. of Lfneal LC Area
No. ot Daue o! pane IfBhta of crack ep. Lt. No. ot Daoe ot pane tlghte ot cracg ep. [L
� . � .� � ` �� � +� '�y' '�. � ��
� �
�E �� � �� �
- � � �` � � � � Co f B
Infiltration ��
Glass • �
£ap. wall � iys'
Net eap. wall 7y rre
- Int. wal!
Ceiling . : �"i, �''
Floor
Total Btu.
Reyuired sq. ft. E.D.R. or� sq. ins. W.A. L.eader area
Room ( Length �� Width
wre—Crackage and Area
�ht No. of Llneal tt. Area
ine 1l¢hte of crack ea. ik
In6ltratioa
Glaas
Esp wall
Net ezp. wall
Int. wall
� Ceiling
;"_ �-IOOT = � _ ��_-- — -- ` "- — -° _. --""_`- - ----_
Total Btw
uired sq. k. E.D.R. or sq. ins. W.A. Leader area
m � Length ,� 'a° Width
Windows and Dctors--C,�ackage and Area
In6ltration
Calaaa
Exp. wall
Net eap. waU
Int. wall
Ceiling
Floor
1'otal Btu.
- � ue a�`q: �E. E
Btu e . tu
� �° � Wiltrarioa �''!� � � � "
a`�� '��" � C�lass �� � ��
Fsp. wall ' .'��
� d1 t3 Net eap. wall ��' �aa .�'./`�r +�
Int. wall
�' i •`e7R � . Ceiling - - +� ' e/ � �'e i�
Floor
P,�'_o �i�! - Tocal Bcu. �`�+
Requi;ed sq. ft. E.D.R. or sq. ins. W.A. Leader area
-teight ;�'�'` ,/r .I �-+� Room I Length ' ,�►�. Width ',� Height ,�" .
Windows and Doore—Crackage and Area
Wldth Hetght No. of Lineal [G Area
No. ot pa.ne ot Dane lighte ot orack eQ. tG
� �r �� �°' �"� .. ,� �
g� Coef. Btu
��' � Infiltration +�a �� �, a�
e,1� Glaea d/ '.�a� :7m�
Eap. wall °�d�e
�',� � Net esp. wall ,i t� � +�
Int. wall
.,� e� ds Ceiling
—TT .
!.__,___ .---`- �AOT--- _ _._-.____:_�__.--�._-�.��... , � -d��: - - -�
� � it r� Total BEu. '8� � '',
T Requued aq. k. E.D.R. or aq. ins. W.A. I.tader area
�Iei81►t ,�'' .� Room I Length'. idth ,�` Height
IWiadows and D�ra—Crackage and Area
�
Coe£ Btu Coef. ` Btu
- In6ltration �, � �',�g
Glass �
, ' Eap. wail ¢' �
� , , � Net eap. wa�l _ ''.9�'� a� " .." :
� Int. wall
I ' � �!� � Ceiling ' ,
Floor t/ " "
____ -_ = - --
. _Total�s� _ �:.�. -
er airea Required sq. k. E.D.R. or sq. ins: W.A. Leader area
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Ca.ty of Fridley, Mi.nn.
BUILDING PERNIIT
� : = � i � � e
Rec. #418g6
Na 9675
• ' �iU � � � � :� 7 � s ' � (�L�.. • � � ��.,.. • / •
i 1 • � I � L / � . ' I I � AA � � � �
LOCATION OF BUILDING
No. ��... St�eet a n nlra. �� N�F � Psrt of Lot
Lot �._$�7.,..g,..._ B10Ck ____�z..._ AdditiOli oT Silb-DiVSBion n� Crnv _ A r3 r3 i i:i n�n
Corner Lot Inside Lot �. Setback �� Sideyard _—.1� t
Sewer Elevatq� Fotmdation IIevat3on
DESCRIPTION OF BUILDING
To be vsed as:
�,a.ra.��_ Froat —22= Depth __22 i Height � 89. Ft. �q.84_ Cu. Ft .�.�.9—
Front DEpth I�eight Scl. Ft Cu. Fk
Tqpe of Conatruction Fra.m@ F�t. Cost —�1,,.�00,00 To be Completed �'jL....�., 1�C,�8
In c�aideration of the issuancae to me of a permit to construct the building above I a�ree to do
tha p�opoxd work in accbrdance with the d+escription above set f ia ce a'11 Proviio%� of
or8inances of the dty of FrYdley. ?��� .� �/J i A /
In caa�deratton of the payment of a fee of $� _ 00 , perrmit is hereby gi�aated to �-..�--A+Q�
Construction Co. ta �� .� building or additfon as d�scribed above. 'Tl�is permit ia granted uPam
the e�mr� c�dition tliat thepe�on to whom it is �anted aad hits agents, emsp and workmen, ffi all work.
done in, around and up� seid buildin�, or anY thereof� ahall coffior� 3a �resp�ts to the or�]inant�es ad
F'rldley, n�inn�ota �ar�in� lacat[o�, «�aetrt�� alteration, matnr�eneace, repatr auei movin� oP buil8i�s
wltbin the dty ]imits�a �this permit may be reva�ed at a}��time uiion v�atto�yof a�► oP\th/e Provisiona of said
ordinancea / 1 l./ // ��
icial
NOTICEs
^ Thb pe� does ee! ��hs �dt�. te�aRaden Mr �ng, Plumbme. 6a h�g, ssw�r er wdsr. B� wee to a�
� � tho Bnilding I�r �!er apnala pa�b hr Nnss It�.
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; � 1►PFLIC�TION � BIIIi�TATG P�T
. - CITY OF FR3DI�Y, NBNNESOTI �
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Owner's BTaae�ffiR �IIGT�TE���E,� $u3lder ��ER�1' CO��TBIiCTTO� CO�PI�Y
���fl �8� :�TRE�� ,
�/��ry� ��p��..�..,, ,'�11'� L3�.bS�E 90IITlI
�.__ __ :
; __. __ �Vt�.� -_-°°-_�...-� .��tr L�i _' - . _. -_ � � . � �41+-1�si��,�p�s-. �s�l�ni r d:sll•�..� i.�a- � .
- .. .. , . -. - .- _ . . . '- _^1
l�CATTON OF BUILDI�
No. �6'�� S�reet .�'fl� �`��' �• �• Part o� �ct
Lot °�' � � Block _ � _ --_ . Addition or S'ubdieision �'/� � 6 �� /-/� �
�
i��eMl��sP
c�� �t ,���:a� �t s�t�� siae-rara
SEWER ELEV�TTOA1 � ' FOU�D�TIO�T ELEIilTION
�ppl3cant Bttach tfl th3.s form Certificete of Survey of LQt and propasai- building
location.
DESCRIPTI01� OF BIIILDING
_ � _�,::.:.�� __ _.. --
_ -- �__ . ._-__ ���_.._-_ ----=----�_ _ , _�_> ---�e -._���__._,� -- _�-R�=----. ---�_= z-- -- _
To be used as:
��NAa� Front! epth ��. Height °1
�. Ft. 484 Cu. �'t. 484I? �
Front pth �ight
�. Ft. Gu. Ft.
Type of Conatruat3on �'� Eat3�matsd Coat �,4�.�, �;,_
To be Comp].et,ed JIIL7 l, 1�68 ---
The undars�gaed Y�reU� makea- �PPlica�3on fer a per�t f�r the �aor� here3�a epecif�ed,
agreeing to do ell work in �trict accordence w3.th tdae City ardinances and rulin� of
the Department af Bui].dings, and hereby declares that a11 the facts and representat�.ona
atated in this applicat3on are �true and correct.
O
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(A Schedule o� Fee Costs can be %und on t'he Reverse Side.)
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3ection 2. The Ins�ctor of B�iil.diugs eha11, before iasuing an�r perm9.t for the
ereation of any 'building or �tructure, or for ex�y addition to eny ex3etin� build-
ing or structure, or for a�r alteratioas or repa3rs to any ezi�tin� building or
stacucture, u�on applica.tion therefor, require the peyment by the spp7:ic�t Far
suah permit of fees to the amo�nt here3.n below eet fort�h and in the mBnner hereia.
p�`rovi�ed to-w��E: � � =- -- - - �:-- - _ - --- -- ____ �-�-__.... _ _ .__. _
2e1. For aqp auch parmit for the erection of aqy fir�proof buildin�, other than
a garage, warehouse, factory or grain elevator, or for th� ereQtion of eay fire-
proof a.ddition,.for similar occup�n�� to any exi.stin� bu3lding-shell be at the
rate of �7..1iA for each one`�thousaad cub3c feet, or f5ce;ction thereof, in $uch
cubical cont�nts.
2e2. For any s.uch p�rmit for the erecti,on of a�r firep�coof:,�era�e, warehou��
factor3r or �rain elevator, or for the erection of aay firepsoof addit3on, for
_ s3m31ar occuPancy, to any -ex?:sting building ahal7. 't� at the rste of �1..25 �or;
sach orae thousand cu�ic feet, classified as nfiseproo�K" b3► 3ection 502 of the
MinneappYi� Build�g Code.� �; • _
Fi0IIS�3
`.`� __- - - �e 3.. - �r �-s�� permit- for the ereet�on -of a� �c�-fireproo� build�g other —
th�t �. garage, warehouae, factory or grain eievator, or at�r non-fireproof
addit3.on, for sim3lar occupaney, to ar�r existing buildin�. Permit �1.QO.for
ea�a one thoueand cubic feete
G�1�G� . .
�:�4s �'o�' any^°s�-h-g�� fo� the er�ction of eay nor�-fireproof garage, warehouse, ,
°actorar or grain elevator, or for the erection of aay,.no�fireproof addition, Por
�3.ai3.].ar occupanca*, to an3r 'e�i'stixig buildin� or f6r ea.ah �uucb bn�3d3.n�- or add�tion.
�T3.nety Cents for each one thousand cubic feet or fraction thereof, in the cubical
`eon�.ents tfiereof with a m�++i�'+� of ��.e00.
For the piaarpo`�•n af computing fees for buildin� perm3ts the cubic,a], contenta of 8ay
building or addition to a uni"orm height throughout b3r ma7.tiplyin� the �round area
covered f`rom a poin,t aix (6) inche� below the f7.00r Yine of the basement or c=ellar
___.tsL�e -ayer�e.Y}�eigh�_ o�. the up�e� surf�ce or to the_ avera�e _he�t of the roof
s�u�face of the main gable of a pitched xoofo ' � ��-
2m5e For repairs or alterations to an exiati.n� structure, the fee shall be at the
rate of �3e� for ea,ch Fine Hundred Dollars (�5�e00), or i'�act3on°thedreof in the
cost of a11 propossd work.
2e6. In no case shall the gee charged for any perm9.t as set fc�rth iu-S�ct3on 2 be
lesa than �4.�. .. ,
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sue�Etr PE
City of Fridley 2 8 945
AT TME TOP OF TME TWINS g U i L D I N G P E R M I T
r
; � RECEIPT NO.
� • COIiAMUNITY OEVEIOPMENT DIV. �. f I
' j L �"��•, L�
r � � PROTECTIVE INSPECTION SEC.
1 = �
� �•"t � CITY MALL FRIOLEY SSIJ2 NUMBEA pEV WtTE v�GE oc �vvqOVEO er
�.---� • •', 612-571-34b0 910-Fi8 2/25/99 / /
JOB AODRESS 6640 Anoka Street NE
t LEGAL �OT NO. BIOCK TiiACT OR AODITION SEE ATTACNED
oescR. 9,10 3 Oak Grove Addition SNEET
2 PNOPERTY OWNER MAIL ADDRES$ Z�P PMONE
Perry Hart 6640 Anoka. Street NE 571-1460
3 CONTRACTOR MAIL ADDRESS . �P PMONE LICENSE NO
New Ha.ven Construction 4208 83 Ave N, Brooklyn Park, MN 55443 566-5225
4 ARCNITECT OR DESI(iNER MAII AODRESS 2iP PMONE LICEN3E NO.
20077950
S ENGINEER MAIL ADOiiE33 21P PMONE LICENSE NO
8 USE OF BUILDIN(i
Residential
7 CLASS OF WOFiK
O NEW O AODITION 0 ALTERATION �l REPAIR ❑ MOVE O 1iEMOVE
8 DESCRIBE WOFiK
Reroof House & Garage (22 Sq) Tear-off
9 CHANGiE OF USE FROM TO
STIPULATIONS
Ux�.derlayment must comply with fihe State Building Code.
TYPE OF CONST. OCCUPANCY aROUP OCCUPANCY LOAO
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, MEATIN�i,
VENTILATING OR AIR CONOITIONINti.
THIS PERMIT BECOMES NULL AND VOID IF WORK Oii CONSTRUCTION 20NIN(3 SO. FT CU. fT
AUTHORiZEO IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OA WORK IS SUSPENOEO OR ABANDONED FOii A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFfSTREET PARKING
I NEREBY CERTIFY THAT 1 HAVE READ ANO E%AMINEO TMIS APPLICATION ], STAILS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAW$ yALUATION SURTAX
AND ORDINANCES GOVERNING TMIS TVPE OF WONK WILL BE COMPLIED
WITH WMETMER SPECIFIEO HEREiN Oti NOT. TME GiiANTING OF A PERMIT �1 �885 �• 94
DOES NOT PqESUME TO GIVE AUTHORITY O VIOLATE Oii CANCEL T►IE pEqMIT FEE SAC CMARGE
PROVISIO F ANY OTHER STAT OR L AL LAW REGULATIN(i CON- @
STRUCTION TME PERFOR N Of C NSTRUCTION y�59..50 Fire .SCi �1.88
PLAN CMECK fEE TOTA EE
,y� ''� � License $5.00 67.32
S�GNA O� ON•NACT O AUTMO 2E0 NT IDATEt EN FOP ALIO E TMIS IS VOU^R PERMIT
' �� �
S�GN4TU�iE O� OWNEp ��� OWNE�i BU�IDEp� �DAT�� BL �hSp �i01E
Feb 25 99 1U:21a
riL�V�► [ J
ADDN [ ]
ALTER [ ]
co�uu��o�aa�:
Kerri
566-7183
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPI.EXES R 1 A.ND R 2
gUII,DING pERNIIT APPLICATION
p.l
Effective 1/1/99
��
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a�
Legai Description:
Owner Name & Address: ��1 '/'� Tel. # �
Contractor: .PrLt� �G.�'� �... J 1 MN LICENSE #�� 7� i�
A.ddress: �'�� � ��, ��- � Tel. # ,�U�P'S�l�.�
Attach w this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. •
LIVING AREA:
GARAGE AREA:
DECK AREA:
DESCRIPTION OF IlVI�'ROVEMENT
Length
Length _
Le'�gth —
Width Height � Sq. Ft.
Widtlt Height ____� Sq. Ft.
Width Hgt/Ground Sq. Ft.
OTSER:
r " c
, r--
Constiuction Type: ! � � � � - � �� �� � Estimated Cost: $ � � `-� S
(Fee Schedule on Back)
Driveway Gtiub Cut Width Need�: Ft. + 6 Ft = Ft x$ =�
DATE:
APPLICANT: T�. �
Permit F�
Fire Surcharge
State Surcharge
SAC Charge �
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
s�ur.a�oxs:
CITY USE ONLY
$ ��. � �Fee Schedule on Reverse Side
$ .001 of Permit Valuation (1/lOth%)
� $.50/$1,OQ0 Valuation
g � $1050 per SAC Unit
$ � D v$5.00 (State Licensed Residential Contractors)
$ Alt. °A" or Ait. "B" Above
$ $454.00 Conservation Plan Review
$ Fee Determined bY Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
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COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIF1CATiON
When reatacina an existinq furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where requi�ed. Yes () No ()
The venting system is plastiGPVC and meets all cuRent codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specfications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
Whe�t-required to instaN a new combustion air it will be sized and installed
To meet the current codes and manufacturers specfications.
Yes ( ) No ( )
Yes { ) No ( )
Yes ( ) No ( )
When installinq a new venting svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables far fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and verrted
separately as per current codes. Yes () No ()
Aapliance Tvae and Size/Common Vent and Vent Connector Infortnation
Appliance #1 Type BTU Input _ Fan Assisted or Nat
Appliance #2 Type BTU lnput _ Fan Assisted or Nat
Appliance #3 Type BTU Input _ Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Desc�ibel
HEATING CO:
Signed By: Date :
sue,,eCT . NO. '
City of Fridley 313 6
AT THE TOP Of TNE TWINS � � I L D i N G P E R M I T
r
� i. RECEIPT NO.
� ; v ���� COMMUNIri DEVELOPMENT OIV.
f � � PfiOTECTIVE INSPECTION SEC. �
�
1 = �
� �""1 � CITY MALI fRIOLEY SS132 NUMyEq nEV a►TB PAGE Of AOvqpVEO BY
�----� ' ••' 612-57 �-3a5Q s� aF� s 9/5 / 00 / /
J08 ADDRESS 6640 Anoka. Street NE
t LEGAI �OT NO. BLOCK TRACT OR AODITION SEE ATTACMED
oESCR. 9,10 3 Oak Grove Addition SNEET
2 PNOPERTY OWNER MA4L �1DORE8$ IIP PMONE
Carmell/Perry Hart 6640 Anoka. Street NE 763-571-1460
3 CONTRACTOR MAIL ADDRESS 21P PFIONE LICENSE NO
Renewal By Andersen 350 73 Avenue NE, Fridle , MN 55432 612-502-4777
4 ARCNITECT OR DESIGNER MAI ADDRES8 ZIP PMONE LICENSE NO.
20130983
S ENGINEER MAIL AODRESS � ZIP PMONE LICENSE NO
8 USE OF BUILDINti
Residential
7 CLASS OF WOFiK
❑ NEW O ADDITION � ALTERATION l� REPAIR 0 MOVE O REMOVE
8 DESCRIBE WOpK
Replace 12 windows and 3 full frame windows within existing openings
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code.
Perr�it Inspection �ar��
`Nil! �o �ailed
To Mome��n�r �'o P��t
TYpE Of CON T. OCCUPANCY dROUP OCCUPANCY LOAO
SEPARATE PERMITS ARE REOUIRED FOP ELECTHICAL. PLUMBINa, MEATIN(i.
VENTILATING OR Alp CONDITIONING.
TMIS PERMIT BECOMES NUIL AND VOIO IF WORK OR CONSTRUCTION 20NIN�i SO. FT CU fT.
AUTNORIZEO IS NOT COMMENCEO VtIITHIN 80 DAYS. OR IF CONSTRUCTION
OR WOf;K IS SUSPENOED OR ABANDONQO FOR A PERIOO OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DW�G. UNITS OffSTREET PARKING
I HEREBY CERTIfY THAT I HAVE READ ANO EXAMINEO THIS APPLICATION ], STA�LS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIpNS Of LAWS yp�VATION SUpTAX
AND ORDiNANCES GOVERNING TMIS TYPE OF WOpK WIIL BE COMP�IED �
WI7H WHETMER SPECIFIEO MEREIN Oii NOT. THE GRANT�NG Of A PERMIT �lO�SO6 �S.�FO
DOES NOT PRE$UME TO GIVE AUTMORITY TO VIOLATE OF CANCEL TNE pEqMIT FEE SAC MARGE
PROVISIONS OF ANY OTHER STATE OR IOCAL LAW REGULATING CON-
STRUCTION Ofi TME PERFpqMANCE Of CONSTRUCTION $195.25 re S�.' �1�.81
PLAN CMEC E T TA� FEE
Lic e C $5 $216.46
S�GNATUpEOFCON-AACTOpOAMUTMOp�ZEDOGENT �OAT�i ME R P VALI TMIS IS R P MIT
f
S�GNATU�iE O� OWNENU� OWNE�1BWl0@R� 1•�E� 8� �NSP � q6fE
y _�
N� [ l
ADDN
��
, � Effective 5/10/99
L l crrY OF ��,. �
Q�] SIlVGLE FAMII.Y AND DUPLEXFS R i AND �t 2
BUII.DING PERMI'T APPLICATTON
Constivction Address:
LegalI?escription: _
Owner Name & Address:
Contractor:;
,,� -
L1VING AREA:
GARAGE ABEA:
DECg AREA:
� .� .
�onstruction Type:
�� ''�
R�NEWAL BY ANDERSEN
350°73RD AYE. NE
� � Tel. # �-(0 3 - ��-1--I U [oC7
MN I:,ICENSE # �
FRIDLEY, MN 55432 Tel. # _
( 6121 502-4777 _ �,� Qf the
IICEMSE �ZOI30983 y�
� �n it to scale.
DESC�'i.�N O�' �l€��.I��NT . � �
Length
Length
I ength .
Wirlth Height � Sq. Ft.
Width �IeigUt Sq. Ft:
Widtb � Hgt/Ground Sq. Ft.
Estimated Cos�: $
Driveway Curb Cut W idth Needed: Ft. + 6 Ft =_ Ft x$ _$ �
� � �ys���
nA�: � arpLieArrr: �o.� �' ,�A ,�,� ��. # 9�a ��
Permit Fee
Fire surcliaige �
State Surcharge
SAC Charge
Licsnse 5urcharge
Driveway E.scrow
Erosion Control
Park Fe,e
Sewer Main Charge
TOTAL
$ 1�5 ��
� �� $�
$ �J y
$
oa
$ r-�. -�-
$
$
$
$
$ �u�
CITY U�E ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation �(1/lOth%)
$.50/$1,�0 Valuation �
$i050 per SAC Uni.t
$5.� (State L�c�ns�ci Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fe,e Determined by F�gineering
Agreement Necessary [ ] Not Ne�cessary [ ]
STIl'ULATIONS;%��4�/�� ,� l/1�4.C��' ��sT"" /•�+e'�LG ��;�/��-���
/j�'rra a�/ ���' ,�G�'�.f ��" 7?+�l�` �' e�.,, ,�C. �LD.;I 1--
,c��� ��',.G. . _ . �
ADDRESS
PIN
LEGAL DESC
PERNIIT TYPE
PROPERTY TYPE .
CONSTRUCTION TYPE .
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�7[r_�cS1�L � � �t4�
6640 ANOKA ST NE
133024140070
UNAVAII.ABLE
LOT BLOCK
ELECTRICAL
RESIDENTIAL
ADDITION/ALTERATION
571-1Zif7
PERMIT NO.: 2004-01808 �� t
DATE ISSUED: 10/05/2004
VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A 5AVERS
SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAiJL, MN 55114-
� :I�t '
HART PERRY B& CARMELL L
6640 ANOKA ST NE
FRIDLEY, MN 55432
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 laiow the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regularing const�uction or the performance of construction.
Applicant Date
Bldg Insp Date
ELEC PERMIT FEE - MIl�i (RESn
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 811132
SEPARATE PERMITS x�(�uu�ll r�ux wv� uir�x �r�ar, li���x�sr,L �svv�.
20.00
0.50
20.50
Building
Inspections
763-572-3604
SITE ADDRESS _�
THIS APPLICANT IS:
PROPERTY
OWNE12!
TENANT
CONTRACTOR
gtJBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT 'I'YPE
TYPE OF WORK:
PLUMBING
RESIDEN'�IAL APPLICATION
CITY OF FR�DLEY
E-MAII. ADDRESS
■ • , �� �-� .� .�irr��
,4nnxFSS: S �
PHONE:_ � ,
-� , l:
Permit No.
Received By:
A�[z��3 2.
STATE LICENSE # cnampion � DATE l L- v l% —
C� STATE ZIP
ADDRESS: , ,
PHONE �� ���oFAX
�SII•iGLE FAMILY
❑ NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FANIILY ❑ TOWNHOUSE
'�S2EPLACE1vtENT
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the to �cost�npeto $� �� reflect only the cost of labor )
improvement, insi�llation or replacement of a residential fixture, excluding �
� x.05=
Labor cost under $300 = 515.00. Labor cost between $3Q0 to $5� = cost of laboz t�,,� TOTAL
FOit PROJECTS WHERfi � OR EXCEEDS $500> FEES ARE BASID ON $IO.OQ PER FIXT(JRE. EXCEPT Wf�RE NOTED� ��'PIPING
NUMfBER OF EA F7,ppR DRAlNS SHOWER
BATH SINKJI.AV '— g�NG POOL ,_ WATER SOFI'NER i$35) .,:?
BATHTUB —GAS PIPING (t�mCm'ttc� — WATER CLOSET _BACKFLOW PREV. (�1� : .
CLOTHES WASHER _. KITCHEN SINK WATER HEATER ($3� FOR IRRIGATION
DISHWASHER _ LAUNDRY TRAY � WATER METER _, OTHER
_. — ,��: �
permit Fee
TOTAL DUE
. . . ,: , a, . . _ .
$ � � Number of 5xtures @ $10.00 x $10.00 = $
.50 Number of fixtures @ $15.00 _ x $15.00 ° $
$ �� Number of fixtures @ $35.00 x $35.04 = $ .50
State Surcharge = $
To,�1= $ �
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNI'II- PROCESSID
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 Ciwork�is notyto startlwithout a�perrmit; tbax�the work v►nll be m accordan�with the
not a permit but only an application for a permrt and
approved plan in the case of all wark which requires review and approval of plans. DATE ""
_ ., PRINT NAIVtE ���5 �
SIGNATURE OF APPLICA'NT � v
. ; - , •
� • - •_
City of Fridley
1Buildiag Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
F,AX: 763-502-4977
3����
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