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Ldw'.n E. Er �.ckson, b575 Anoka St. , N.E. , I�ls. 21, Td3nn.. , SII I.-$586
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C,ity of Fridley, Minn..
BUILDING PERMIT
Date: March 25 1970
p�r; Rov ,i. �usse g�� Rog J. �us�e� R� r
�� 5355 Topel Rd., Mpls., Minn. �d�e� Same
� � °'��
N° 10589
LOCATION OF BUILDING
No. 6535 g.�t Arthur St . N.E . � ,__,_, p� of Lot
� No .� of_ gl� 4 Addition or Sub-Divisian � Oak Grove
Lot 20 & 21 17_ each s�.de
Coraer Lot — 7ns�lde Lot — X Setback 35 �— Sideyard
Sewer IIevation ?� $�� • 17 � , ���� . $80.17 (Apnrox �
TOP OF FOOTING
DESCRIPTION OF BUILDING
To be Used as:
.�g]„e D[�e1 1 i n,� �nt �,� �p},h S�4____ Height LS�.QX.Y Sq. F'� -�O�Q— C�. �
w�attached garage Frunt Depth I�eight Sq. Ft. Cu. Ft
Type of Construction Frame �, �_ 20 000 To be Completed 7/1/70
i�'\ Certified varification of location of basement necessary before continuing
construction above grade.
��
Council approved 3/23/70 construction of basement prior to license approval of ineeting
of 4/6/70.
In cansideration oP the isauance to me of a permft to construct the building descrlbed above I agree to do
the proposed work in acc�rdance with the description above set fo�� in �liance with afl Prov �ons of
ordtnanc�s of the city of Frfdley. // � Q, �
In conafderation oP the payment of a fee oP $_4Z.9� � pernait fa hereby granted to R g�t J- B u G G e _
to construct the buflding or addlition as described above. This Qermit fs gran'ted upon
the express condition that the person to whom ft fa granted and hia agent�, employees and worl�nen, in all work
done in, around and upon said buildiug, or anypart thereof, sY►all cronPorm fn all respects to tt►e ordinan� of
Fridley, Minuesota regarding locat3on, construction, alteration, maintenanc�, repair and mevin� of bufl�ngs
witbin the dty limits and this permit may be revoked at any time upon violatfon of aay of the P��� of sa�d
ordinancea
, ` �
� �/ �.. Suildin8 ��
�7l�NK MUHICH
NOTIC� •
'�his permit does aof eovsr ths eomfrue�tee, insta0diee toe whtee, plumbie9, ea heaHne, s�wa� er w�is�. B� aRa to sse
the &riWiuB lespeetae [a� aparafs parmhi fo� fh� tt�na.
. � _
J
. . .
��� �
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
S��- 7��,3
--- �
t __--) _ � _ _' ' � / ' � � � � �
OWNER S . NAME : . � �" �^°' ��` , �.5�5'.� BUILDER : � `-� .s°r � LcOP,
ADDRESS :��'SeS ^ `Te�7 -eL v�c�' ADDRESS : So�ivt °e
/�1�`S°.� �5's' ��2Z
NO : . � ��3 S STREET : ��P ���,p �S� �t/ �,
LOT; N'o �� �� BLOCK:
� ADDITION : �.� � ��o v �
tc� .20 � to� � / , �•
CORNER LOT : INS IDE LOT :,,�_SET�ACR: �S�S � SIDEYARD : � �' ''S ` �'a � `� ' ; '`
,
.�.�' � icr�e
Applicant attach to this form �ao Certificate� of Susve�r of Lot and proposed
building �ocation drawn oa these Certificates.
HESCRIPTION OF BUILDING
To Be Used A�:
�i,vgl � Front s .2 �S Depth : � ¢ Height : � `��" '��
°�`���� ���� Square Feet: /d �" D Cubic Feetc t
GL`"` �,�Ar�i � � Front : Depth : Height :
����y�
Square Feet; Cubic Feets
1�►pe of Conatruction: ��,a,,^� Eatimated Coat: $�o oo�
��. .,. . ....�
To Be Completed: „� �,�.,v .�� s i �' �% �7c' )
/
,�� The undersigned hereby makes applicatirnn for a permit for the work }�erei,a
speci�ied�, agreeing to do all work in ettict accordaace with the Citq o�
Fridley Ordinancee aad auliiags of the Depart�n� of Buildinge, aad hereby
declares that all the facts and representa�iona atated in thie applicativn
are true an� correct.
nA� : �>� S s� � s icru�� : ` .�-� ..�`�.
, ,
���
�
(See Raverae Side For Additioaal Information.)„ ,� y,��`" ���;
� f �d� � . � �. ' / � �.� . �..'i -_ . _ . - _ � '� �� .. .- � , / �s�,°"°'�
a.__� =� �'�-''-'��' _�•__
�� � � ' ���.
C` �' `v=. ,�
n
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,� �. : �� �' � � ��� � � -� �� ��. � y _ , i�� �;� �°
� �- �',
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� � ,�
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inepectox of Buildiag� shall, before $s�uing pexmita fox tb�e
erection of any building or stxucture, or fox axay adciii�ion to aay existing
building or etructure, o� for �ay alteration or repairs to aay existiag
buildiag or structure, upon �,pplicatian thezefosea requise the paya�ent'by the
applicant for such permit of fees to tfl�e amount herein below set forth and ia
the manner herein prwided to-wit:
UN1FORbd BUILDING CODE: Type 1, 2� 4-$2.15 for each oae thousaad cubic
feet, or fraction thereo£, in such cubical conten�s. Tqpe 3� 5-$1.85 for
each one thousaad cubic feet.
ADDITIONAL INFORMATION
For the pu$poee of co�putin� fee� fos baxilding permi�D tye cubical con�eate
of aay building or addition, ie determined by mul�iplyin� �he �rousid area
cavered from a poiart six (6) in,ch�s below th� floor line of the b��t
obs� tl�� cellar to the avarege hei�h�s of tho up�ex auafac� or to the a�e�cag�w
height of the roof euYface of the m�i:a g�ble of a pitehed roaf.
For repai.re os alterations �o an �isti�g streac�ase, �th� f�e 8�11 b� at tthe
rate of $3.00'per each five hundred dolltar� ($500.00� os �r�ction th�rnof ia
the coet of all propoeed work. .
Ia ao caee shall the fee ch�rged for �,ny pe�it ae ae� for�%i � Section 2 bs
leea th�nn $5.00.
VARIFICt�T�ON OF FOIiNDATION
D�TE: ,Pexwits for e�onstsuctioa will be ieaued a miaimum of 24 houre from the
ti�e of application, to allaw for proper review of the propoeed e�suctura aad
of the �onetruction eiteo
A Certifi4d Su�rey of the lot, ehawiag the losati.on of the famdatioa, once it
ha�_�been coast�cted, will be required befor� pro�esediae With the framing.
CERTIFICATE OF OCCUPANCY
Applicatiaa for a�ertificate of Oceug�aacy Bhall ba made ten (10) daqe prior
to tine use or occupan��r of � atsuctuse for which a building pasmit hu beeu
�.seuad; aad eaid Qtxucture ahall aot be used or occu�l�d until a Cartificate
of bc`cupancy hae b�ea iasued.
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HOUSE HEATING TEST RECORD
ADDRESS �S• S�'M�nr APT. FLOOR CITY SUBURB �'itlle�_,
OCCUPANT N+�n� OWNER ����
HEAT LOSS DATE HTG. INST. - ^-AS C0. METER BADGE #
SOLD BY INSTALLED BY I7.�b13tt�' H'�g-
Electrical Work By Gas Line By
TYPE OF HEAT GA FA x HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIGN CONVERSION
MAKE Intern+ati�rnaY Heater Co ►�pKE OF BURNER
Model H�'-7� D� Model
Serial �9� Max. BTU Rating
INPUT 7�+��0 B�� • MAKE OF FURNACE
Model �
CONTROLS
THERAAOSTAT �7�` Heat Plug
Val�e s.Z.. TF �88
Limit CTC 2�E3—lA—I�CW
Limit Sefting 2d0' �
Fan Setting 121i f
P i I ot Type �"+0ax►1$
Pilot Make ,
Pilot Model
Pilot Timing 7a "�g�����
L.W. Cut Off
Vent Size 4"
KIND OF LINER ��ta1b!GetE1li SIZE �� NONE
Drah Hood Vertic�.l RegulaTOr
Fi Iters Size �������� n�umber L
Chimney Loeation Inside Y�� Outside
Chimney Construetion �@'Ca�-���'�d�
Smoke Bom6 Wiring
Draft �g Test Tag YQ�
Door Pressure
Lightirtg Inst.
Prossure 2•7�•�+• PereantCO $•S/a Date Tested $l'`LQ�7�
Input CFH Z� Pereent OZ 8-Q� Company Testing �
Staek Temp. ��Q��' Percent CO2 p-�� Name of Tester
Form 235
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
AP�LICATION WILL BE RETURNED
. .�, r•► � � r•►
• �i ri • ► I ► I ► ■M��►��►�i.►.�■:�:�_,:•�.�-,_...;._ - --- - - '
When �^�""�^° an aYietin0 furance, the undersigned hereby verifies that the
ven�ng has been examined and is free from rust, deterioration, obstructions, Yes (Rl No ()
and is securely supported and firestopped where required.
The venting system is plasticlPVC and meets all current codes and manufacturer Yes (x1 No ()
specifications including sizing, length, number of elbows anci termination.
The undersigned also verifies that the replacement unit is a listed assembly .
and meets the current codes and ma�naufF inace V nt ng�ables fo I fan�es
include AGA-GAMA Category I Cen Yes (� ) No ()
assisted and natural draft appliances.
The is sized and installed to meet the current codes Yes �) No ()
and manufacturer's spe 'cif'ications.
When required to ._.^.�` " 9 ne�y cemh�,�tien_ai,�it will be sized and installed yes �) No ()
to meet the current codes and manufacturer's specfications.
When i�stallia" ""°•••••°='-t'-na cvc pm, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
spet�fications. This does include AGA-GAMA Category I Central Fumace Yes �) No ()
Venting Tables for fan assisted and natural draft appliances.
Is the commo as been removed from the commonv nt a'nd ventedtly after
an appliance h Yes (x) No ()
separately as per current codes.
�`�PP�
y T e a d S'� � m m�n ��'°^+ and Vent C
ance #1 T e v�v�� BTU Input �7'ST an Assis ed or Nat Y�%}
Appli YP ,�� g� Input 3�!. Ba-D isted or ��
Appliance #2 Type � gTU Input Fan Assisted or Nat
APPlianc� #3 Type —
—ii�tatRppiiar�ces �- — Tofal �#�t {t�put
Common Vent Type C'-l—
� Vent Height � � Diameter � inches
Appliance #1 Vent Connector Height � ft Length =ft
Appliance #2 Vent Connector Height _,.�ft Length ? ft
Appliance #3 Vent Connector Height _ ft Length =
� r - � r•► �- •,.
Diameter _�.�n
Diameter,�� ".�n
Diameter �n
-ry�e cs-
Type �
Type �
HF�4TING CO: CenterPoint En � 13562 Central t�ve NE, Anoka, MN 55304
Signed By: ,___��� Date : //�',�/��
s ���//�v
�6�
Minne asco
ADDRESS � r �� � �
OCCUPANT �'l ,� C i�
HEAT LOSS Yes DATE HTG. INST.
SOLD BY CenterPoint Enerav Minneaasco
ElecMcal Wo�lc By
TYPE OF HEAT FA SPACE HTR.
,' �' y ��5�! r �. � ," �
APT. FLOOR CITY rr� u,e
OWn�ER L:A�A �SA/�C41✓�`
�
INSTALLED BY r
Gas Line By �
URlIT HTR. OTHER
GAS DESIGN COPiVERSION
MAKE � �L/(
M�e� ' � � Vent Size �
� � __7SIL� U ER SIZE �g `�
NPUT ,� D� Cg NONE ^- -C� /1 - — —
Draft Hood I�l 4° Regulator �
CONTROLS Fiiters Size umber
THERMOSTAT S��� Heat Plug �—� Chimney Location In e Outside
Value ti� �� P� Chimne Construction Ph
. . .. �. P . _ .s� y
Limit
Fan ;
Pilot
Pilot
Pilot
Pilot
Pressure 9 aS Z �-- Percent CO2- ���
nput CFH ��/ E�`3 � Percent 02 �
Stack Temp. 3 7�i o Percent CO�
�ring �✓ /
Test Tag
Lighting Inst.
Date Tested ' `�"
Com�ny Testing t int E inne a
Name of Tester � �o
- r
NEW
ADDN
ALTER
[ ] CITY OF FRIDLEY
[] 6431 University Ave NE, Fridley, MN 55432 (763j 572-3604 Bldg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AWD R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description:
Owmer Name & Address:
Contractor: �
w rr____. / �! _ P.. / .�._L�
LMNG AREA:
GARAGE AREA:
�
Te�. # � (� 3 - � 7! - �.� aC�
Attach to this application, a Cert�cate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
DECK AREA: Length
OTHER:
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: t�GQ� � G�( � Estimated Cost: $ ��� � Q(�
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: o�(' � � APPLICANT: � �l�' Tel. # �7 (.Q � � `? � ° � 3 �C�
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
���s.a�
$
$ f i v
$ 7 � l�
$
$ �= D�
$
$
$
$
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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 [ ]
TOTAL $ � �� , % � STIPULATIONS:
BUII�DING PERMIT FEE SCHEDULE
The 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 alteration or repair to any existing building or
st�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: .
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $SQ0,000
$500,001 to $1,0�,000
��
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional$1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,�
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,�0
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5,608.75 for the first $1,O�,Oi30 plus $3.15 for ea.ch additional
$1,Q00 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.00.
VERIFICATION OF FOUNDATION
Permits for consiruction will be issued a mini.mum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the founda.tion once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv '
NEW
ADDN
ALTER
� —
�D�S- ���7�
CITY OF �kIDLEY Effective 4/1/2004
[] 6431 University Av� N�, Fridley, MN 55432 (763} 572�604 Bldg insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R 2 (763) 571-1287 Fax
� BUILDING PERMI'i'APPLICATION
_ _ _ _-- -
. - -- --
Construction Address=i��3-��, �+(�[)� � �' , � �
'�i �. -- -
Legal Clescription����,e ��- � l `E�� �c`aC�R.
Ovmer Name & Address:� a �c�� ��a (� �� _ Te�, #�U � 1- ���
• P _�
Ccrrtractor. MN LIC�NSE #
Address•t-�I1 i� l i Tel. #�.0,2-'�qC) -�Z�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTH�R:
Attach to this applicat°ion, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESGRIPTION OF IMPR�VEMENT
Length Width Height� Sq. F't.
Length Width Height Sq. �t
Length �dth Hgt/Ground Sq. Ft _
Construction Type� �'� G�'�� Estimated Cost $
' � � ��
Driveway Curb Cui VCRidtFi hJeeded: ... Ft + 6� Ft
DATE:� l0 � �5
Call (763) 572�604 for permit Fees if
you for card eumber.
Permit Fee
Plan Review
Fire Surchar�ge
State Surcharge
5aC Charge
License Sur�harge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
, ;�Q. , ,
TOTAL
$ � �� ��
$
$ �6���
$ �6��
$
�, � � ��
$
�
�
$
$ �� � . ��
x $ _$
Tel. # l � �,� • ��7� ' ���-�
Fax to 763-57'1-1287 if ustng crediE card and we will call
C11Y USE ONI.Y •
Fee Schedule on Reverse Side
65% of Perttnit Fee
,001 of Permit Valuation (1/10th°!o)
$,50/$1,000 Valuation
$1350 per SAC Unit
$5,00 (State Licensed Residential Contractors)
Alt, "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee aetermihed by Engineering
�greement Necessary [ ] Not Necessary r �
STIPULATIQNS:
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� 70 SHUVSYt'ICK AVE S
GvLDEN VAILEY. MINN. LAiVU ��iR��E.� UJtS EROOKIYN N^RK, MINN
$EOIBTSiED IIDiDEIt LAWS OF $TASE UP MINNLbt1TA
LICElfSED BY OItDINANCE O? CITY OF 2[INNEAPOLIB
691i Idaho A��e. \. :,33•9422
\iinnrapulis, �tinnP����a :�id2R
,�D. ;TR,,�.. �i�GICIAL �n�[.!N�r c i;�F r��Tti 10 rEARS Jf
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CiTY LOTi � Pl_ATTING ..SE RIiPOII "n,� �APfA
Survyy �'or
Izrvvio• No, 2889
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Se�l� 1" = 20�
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35.0 No. 6545
o (129.0 Plat )
a; `Fence I ��. 9 Mea_�ured
35.3�
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PROPOSED
NOUS.E
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PROPOSED
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I-Story—Frome
No. 6529
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O�lt Or�r►� Additi�a t� 1l�.a�spa3is
41�e hereby certify thaf tllis �s a frue ind cocroct �eprssente-
fio� of a w��sy of �he bounderisa of 1he tbov� doccribed
�and rnd tMe location oi aN build�ngs ani visib�e ancraac6
erinnft, +f �ay, from or on s�id �end.
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