AF - 35169APPLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITiON BUILDING P�ERMIT
CITY OF FRIDLEY, MINNESOTA
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OWNER' S NAME • f��! /�'� `/� —: BUi�,DER: JC� / G'��L�i�/ C ON�ST•
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ADDRESS • ADDRESS :(0��� S OI� LG�C�
1�Lcc''' f/" i /t!i ` �/.
NO : . (D � S TREET • � _ � LC�LQ�
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LOT: BLOCK: /Q ADDITION:��aLr� /���
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CORNER LOT: INSIDE LOT: �- SETBACK: �� SIDEYARD; er��o S�oGI%`�t
`—�' "s��r�.
Applicaat attach to this form �io Certificates of Survey of Lot aad propoaed
building location drawa on theee Certificates. �
DESCRIPTION UF BUILDING
To Be Used A,s :
.
r/ -S� Front : .Z Depth : 2- Height • .S �/Q
Square Feet: �O �Cubic Feet: � � �� �� O
G`�{ .(��a'^" % �xont : 2 � Dep'th : L� Height : / s�ie.�
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Square Feet; cs O O Cubic Feet:
�pe of Construction: �IR/ �! Estimated Cost: $ � /�
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To Be Casnpleted: ,� � � �! � � �
The undereigned hereby makea applicativn for a permit for the work hexeia
specified, agreeing to do all work in stiict accordance with the City of
Fridley Ordinances aad rulings of the Department of Buildings, and hexeby
declares that all the facts aad representations stated in this application
are true and correct.
DATE : � ?�'1i 7 %, �
SIGNATUR�;
(See Reverse Side For Additional Information. ) '� �'� � �` J` � "' .S ��''y ��
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BUILDING PERMIT FE� SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erectioa of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefores reqaair� th� p��n�mmt b� the
applicant for such permit of fees to the amoun� he�ein below se� f���la �na� ia�
the manner herein provided to-wit:
iTNIFORM BUILDING CODE: Zj►pe 1, 2& 4-$2.15 fog each one thous�d �cubic
feet, or fractioR thereof, in such cubical contents. Type 3& 5-$1e�5 for
�ch one thous�xd cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permita, �he cubical contents
of aay building or addition, ie determined by multiplying the ground area
covered from a point six (6) inches below the floo�c lin�c of the basement
o� the cellar to the av��agc� hei�hts of the uppex suxface or to the average
height of the xoof �uxf�ce of the main gabl� of � pitched roof,
For repaira or alterations to an existing stgucture, the fee shall be aic the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
Iu no case shall the fee charged for any permit as set forth in Section 2 be
le�a than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a mini�um of 24 hours from the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
haa been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall aot be used or occup�ed until a Certificate
of Occupaacy has been issued.
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Caity of F�idlep, �.. � 113 4�,
6431 Univeraity Ave. N. E., Mivaeapolis, Aqinn. 56432 �
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�; .___�'_�___E Temn 7 i n C 0118 �TL? C� i OIl •$�� .�8111fl
Addr�ss �.�.1.8�4.�tinsozt Bouleva+'d N l� Addre9s SBmE
.
LOCATIOiV. OE BUILDII�IG
No. 669.2 - Btreet —Ashton Avenue N.E. p� og ��
��:9 BI� �� Aflait,ton or sub-nivisi� - Fridley Park Addition .
Coraer Lot — Ins�tde Lot -- X Setback 35' Si�y� 5� to South
�eF Elevation �42,_$� �znc. 7' Riser) �1���/�{��o�i� 845.84 (ApProx.) (Inc. 7' Rise�)
�1ye Top of Footing
— �
DESCRIPYION OF BUILDING
To be Used as:
D�e11in� ,,, Front � Depth ._..1�2! . Height ...,..2.0.�.._ �.Sq. Fk —1099.' Cn. �. ...Z,6r9$,U �
, ,.
Gaxage Froni 26 DePfi.�► 22 Hei�ht 10' Sq. Ft � Cq. F't.. SUU� r
'l�+pe of Construction wnnr7 Fx'A?�8 Fst. Cost -- �T� 002.,U.f)� To be ComPIet�d - 6 m�xtth8
SEWER LOCATION: 28' S. of Manhole WATER LOCATION: 11' N. of Sewer Service
17' S. of Manhole
Stop Box 32.2' from Ms,nhole
Stipulations; Verifying survey wi11 have to meet setbacka oa approved replatting.
Provide � hard surface driveway.
In can�tderai3on of the issuance to me of a permit to consiruct buil g desct3bed above, I�� �
fhe prnposed work in accordance with the description above set f and crompliaace aII
q�ances of the dty of Fridley.
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Ea c��sfderation of the payment of a fee ot ��n.nn � p�rmit gs hereby grant�d t� S. E. Templin Const.
the expreas condition that the�� �hom it�Sgs �graated�and his�agents�, emplo �and worl�+�,n,� aII W�o�k
done in, around and upon said building, or anY P�rt thereof, shall conform in all respects •to the ordin{tnc� oF
1�iYdley, Minnesota regarding location, construction, alteration, ma3nteaance, repe3r aad lnoviag of
WIW��th�e city ]imita and this permit may i� revoked at any time upon violatioa of any of the prov3dons pi
o�.c_,�` o p..o+f o sx�r,a� �
CLAR�NCE BELISLE
I�OOTICE:
This pernd� do� not eove� N�e wostiveNon, i4sta11allon for wtrine, plumbia9. 8� �8+ eewar or wafer. Be sons io �
t6s Build6ig fnspeeto� for separate permits hr t6� kena.
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10]30 CENTRAL AVE. N.E. (Hwy. 65) — BLAINE, MINNESOTA 55434
CERTIFICATE OF SURVEY: SAMu�L ���P�I�
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CIVIL ENG INEERS
LANDSURVEYORS.
Telephone
784-5480
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L�t 5, Block 1, 6dgewater Gardens Plat 2, Anoka County, Minnesota.
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1 HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OR THE BOUNDARIES
OF THE ABOYE DESCRIBED LAND, AND THE LOCATION OR ALL BUILDINGS, THEREON, AND ALL• VISIBLB �N.
CROACHMENTS, IF ANY, FROM OR ON SAID LAND.
AS SURVEYED BY ML THIS.....2%tN.....DAY OF ..........�:P.'�.i� .........................A 72
... .0. 19............«.
N.C. HOIUM AND ASSOCI 7ES, INC.
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Minn�sota Repishofion No. .. ...�.���.
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��•�• �������� ��� � �������� ����• LANDSNGINEERS
� URVEYORS
10130 CENiRAL AVE. N.E. (Hwy. 65) — BLAINE, MINNESOTA 55434 Telephone
� - 784-5480
CER7IFICATE OF SURVEY: ����� � TE�VI �r7L I N '
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�' LEGAL DESCRIPTIQN: � '
Lot 8 and 9, Block 10; Fridley�Park, Arioka County, Minnesota
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I HEREBY CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION OF A SURVEY OR THE BOUNDARIES
OF THE ABOVE DESCRIBED LAND, AND THE LOCATlON OF ALL BUILDIN�S, THEREON. AND ALL VISlBLE EN•
CROACHMEN'6'S, IF ANY, FROM OR ON SAID LAND.
AS SURVEYED BY ME 7H15... ����.......DAY OF ...... Febr�ary .......................A.D. 19..��.........
N.C. HOIUM AND ASSO ES,
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y Minnesota Registrotion No. ...... .��..�J.;•�;�.•••••• �
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HEAT LOSS CALCULATION5 DEPARI'MFtiT O[' iti'�PI•_ ���4�� __ •
' A.�. . .� I Constructiea Na. � l s " ���.-% ° �"' � 1nsu:ation � .
iVeatheratrips � • � . ° ,
Guide How Applie
wa ra Re4erence Out. Wall Int. Wall Ceil�ag R�of F1oor ' ind
Ps o I Yes Ne �; 1y— - — -- - — _— � ---`
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� Fl.� //Y .ftoon� i LenBth •�/idth/ — Height ' F'!.d , Room' l.ength Width � —"HeiSht .,
Wiadows and oors—Crackage and Area /°' �, ��^_ W+r. o�s and Daors—Crackage and Atea
(� i, �1:tih HetBht No. ot L1nAzt ft. Ate6 / �1
tl'Idth He18hc Au. oI L.fneal ft ArPa � � �' _� �Y� ___8 4� ,}(ghte o1 rrack sV. tt.
No. a Dane nt F^ 'iBhte of crack s y�',' , i�
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Net e:p. wall
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Int. wali
Cedmg �
Fi.�or �11 �- . �"�•.
Tot Bru.
Require . ft. E. . or aq�ina. W.A. Lx.ader area ��v '`
ti1,� ��'d�' m I ��ttt�Width / Height
Windows anc! Doors—Crackag� and Area
VVldth Helgfit No. of Lineat ft. Area
No. o* yane o' psne Ilg6t� of crack aq. tt• �� �
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_..i � a Coef. Btu
Ia6ltration _� _ �
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I�iet e=p. wall _ _
lat. wail �. .._
`Ceiling �
Floor �� __�___----°' _.
To Btu. _�.
' Required sy. ft�ElD K. or aq. ins. W.A_ asler area
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Infiltration
Esp. wall
Net esp. �
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Ceiling
F loor
Tot t�
and
ot
Infilttxtion
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Exp. wa11 af , ✓ =--
Net exp. waU _ _
Int. wall a
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Ceiliog �---�;, �
. Fl��or _ �YIG'_^����.__._--_ � .._
'fot tu.
Requ' sq. ft. E.n R. or ey. ins�W•E1• der ana �
� •/{,�/ Room � L.enBth --Width }� r- F[e:gbt
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Wictcioa•a an3Uoors--Crac�agt .:nd Arca ,
" �t'idth Hel6�•t No. ol Lfaeai t +��e� � `
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No. at Danc uf n llahte ot cr k e�t ��_ �
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Infiltration __
Glasa
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` ( � Int. wall
� Ceiling
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and Ana �
naal tt. Area �/
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k. E.D.R. or iq. ias. W.A. Leader aroa
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Windows and I
ldth tl
OL OltlB Ct
Iafiltration
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Exp. wall
Net exp. wall
Ia� w II
Ceiling
Floor .
Tot tu.
ind �q. k.
��- w� i ,r T
or sq. ins. WA. ader area
►m I Ltngth <' Wideh �-'.
-=�rackasRe and Ana /r
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a� � i�s. W.A.l�rdec aeea
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HEA7 L�.S �ALCUlATIONS , DEPARTME:�T uF' IN�PECTIUN
Weatherstrips A'S•� �'• • Conatruction No.
C,uide .
j$(indowe oora Reference Ou?. Wall Int. Wall Ceiling Roaf oor
�-No 0 19�. �. � -
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� F]•� ' oom Length .�..]►�/idth He' ht � Fl
--. ' I
Windows and Doora--Crackage and Area Windows and
Wldth HelgAt No. ��f Llneat !t. Area � Wldth 1
No. ot pa ot n9�e Itghte at erack eq tt. � � ot ps 1
r + —�' � .
��_._ _ -.. 1'�/ _
Infiltration
Glaas %- -.__..
Exa. wall
:�'et exp. wau
Int, w ] � � '
C�•,iir.g � --__.�.
1
Floor � - • � �.
T�Bcu. ' ` _� __..'�. _e.
Reyu;«d s�._ft_E.D.R. or aq. ins. W`A. f..tader area
_� Fl:� ��m �p�h w�a�h
1�indow3 and D�rs---Craekage and Area
Wldth Hel ht No. o[ Ltneal fl. Area
N;:.�o[ pans ut parc I16Aq of erack � h
I I 1 Coef
f n6ltration �- - , �� � _i -
Glass •----' _ .__ . .._
F..�cp. wall -.—.._ __._. �_.-- - _- . -
Net e:p. wall ! ! ~ . ! , -
^Int. wall
lril�r.g � � � _� }..._..
�i�nt
-ro��� s��: _ __" .____ _..
Required sq Et. E.D.R. et aq. ins. W.'.._[.eac�-• ArPa
� Fl.� Roc+m �Length ~� T�:�3th� �
Windows and Doors--Crackage aad Ar-0a
�� R•fdth H�igA: No. o[ Lfaeat tc. ` �.aa ��
No. ot pane ot pane ��ttghts ot cra�k i ea 1t.
Btu
Infiltration
Kind
Glasa —
Fap. wall -����C c
Net eup. wall
Int. waU �---_ �.
—.._..t.. —
L..eO�t}l
,
�� s ': ' �.�
� -
� ,'+�
—�
��
����
�_��
���r��l�
������
��� F��_ r ��•�~_ �-��--1~�s�� � '� l�r=
�^- � Tot Btu. . , � "
" i� �tequirec� sq. #t. C.U.R. or aq. ina. �/A. Lcader arca� �. `'`'
Height �` �Fl.l �koom I Leng� Widdi � Height .�
. __ �
. �!_ �"indowa aud lloars--(:rackage and Area
� r Width He�R�•e �iVO. ot Lfaeal !t. Area
No, ot pane o: p�.�•e 1f84�a ot �rack eQ. tt.
I' __� � � . _' __ ' . _ �+_,_, 1
I .1 � _1_�
I j
— �.
StU II —._� _ _._. �_._. � f�"_,�
____ �j __.__.1.__� .. _ ai��
4 In6liratian �f ��_ !
._.�= _ ._+ �; � Glass _ .__ .r�., _ �. .Y _ .._...� M �_._. ._ ..._.._--
t
, � +�rF.�wall ��F
_ .__._�.___. I _- Net e.p. walf_`__ .__�..._�__. .._..----. - -----•
___ � ____
_ _. __.__ _._ ... _ . .... ._ ___....
_ ____,�f _. �.,,. �,��__ _. _ _ . _.... . ___: __ . __.�__._. � .-_-_ �
Ceili�:K _ . _ _.
r�
_. — �
,: - .____...__ _. .._
,� p.i ,l� . ...._ .� . ._ _. ._..,_ .._____--
__..__+_ a� _ _�__ ..____� _
_.._.__._ ( . ..... _ ._______. . _i _ . =_.�_.'_�.. _
yTo�ai si �
..._.._�_..._. _ _ . .
� :_d{� ._Rec;�,ircti_q. ft. E±�.i '• '`'-_�• W.A: �.e.,der area . _ _
Height i -__ . �. _ ... :� . ._ - . _ _--�._____ �._._._.___. _ _ . _
--, �! ._. hl.i lF.on,�, t t..Crylt.il W�dth t{t�ghi..�
...__. __..___�.�._....� _. .....�_��. _......,... .�._..._ �..._ ___
�, 1Ciu�: �•s ai d i�c�:s_._(;.., k.�le and �A�c� .�
"..�.... __ i .N:�ith�9 --.1 ��.LTr p z �,•( i t.!t�t. :C �Ar-a
f^ ��Il �:�f f76:.�;' C•i (11if'+' % IIJ'.[p • 8.��• 1 .^ I� t
'1 . �..� _i..... �'f ...�. _�.y„�� _ .._.. .. 1-. _. ..�
I: l � { � ! �
-- �-j--- - -_. _-+. . ._._. _ . �.
�.._. i .. ... .�..._ _. _ .
I+ _ . .�.. ._ _ � ..,_. __ ' 1
p.._. �� _ .�.r _._ .... �. - -• i . ., j. . . .. . .. _ _
iJ:U � -{-._.. I ` ''h
i
In6ltration � —" _. -- .- . _ _. _ �.____._.i .} ._... _.. -+ . ,_
- _.._. _.._.. .. _ (I . _ ;nit.tc�•�_'_n ._. . .. � . ,
Glaes ;' G�as: ^ ._ �- -
Fsp. wall ._._ _. -- -- - , -.'zp. r�,l! ..._ , -
___ . ___.-_._.._ .. -----
Net e: . wall � - - .... ...
p �. �i2( f' � �63:�
Int. wall " l�..��.�.__ Y- �i ` `.. w•�!' .- ---- .
Ceiling , ' '
:,
, , ., . ,
_ �
. .— .--- - --._ ... _.. _ , _.. . _ .
Floor _. ._.. _ . �.__... ._._ � .�._ . ,_ . � __ ! �, _ . ...
Tota! Btu. _ _ �__ . __. . ': _. _ � ` �`" .
Required aq. ft. E.D.R. or sq. ins. W.ti. l.e^dei�area___.i.- - -. _._ '.._ �� .�ueu aq. i�. L.�,.,.. ur ,q. ��-.. ...;. .... ._
�� ._
u --
SUBJECT pE
��ty of Fr�aiey - - -�
;, ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T E�E�PT No
,
� `L _��_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. /��
�
1 ` �
� /°�'1 � CITY HALL FRIDLEv 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�_.'"� ' '•j 612-571-3450 810-F1 S / /
7 10 80
JOB ADDRESS 6699 Ashton Avenue N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. g� g 10 F'ridley Paxk Addition SHEHT
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Len Westphal 6699 Ash�t�on Avenue N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Blue Line Construction 4028 Garfield Avenue South M ls. NIlJ 825-3482
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER AAAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDINCi
Reside ta.al
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
X
B DESCRIBE WORK
9 CHANOE OF USE FROM TO
STIPULATIONS
SEPERiK't� PERMITS R�QUIR�U FOR �V��'
HEATING, PLUM8ING AWO 5��.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBINO, HEATING, �PE OF CONST. OCCUPANCY QROUP OCCUPANCY LOAD
YENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONINO SQ. FT. CU. FT.
AUTHORIZED IS PIOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTIOtd
OR WORK IS SUSPENDED OR ABANDONED 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 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 ORANTING OF A PERMIT $2�990 $�-.49
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATIId(3 CON-
STRUCTION R THE PER R N OF CONSTRUCTION. $�.B.00
�� � .7 �D— � PLAN CHECK FEE TOTAL FEE
$19.49
IGNATUREOFCONTRACTORO AuTHORIZEDAGENT IDATEI HEN PROPER VALIDATED THIS IS YOUR PERAAIT
�
SIGNATURE OF OWNER �IF OWNEH BUILDER� IDATE) BLOG �NSP pp E
�
0
CITY OF FRIOL�Y
, '
AP-PLICIITION FOR RESTDCNTIAL QUILpIP�G PEftMITS
(t�ew, Altcrations, Addit•ions, or Repairs)
OaJt�ER: �
... . - ADDRESS : -. . � � g `� L��''^"'
Tf L NO : �
BUZLDER:
o�,
�~ ``i.r ''.: l
.c�.s�s
c
ADDRESS: �
7EL NlO: c� a� �
' � Construciion Location -
STREET ATO: � STI2�ET; � ���'�j l�-�.� �
LOT• • O `7 BLOCK• �_ ADDITION• � � �9� ---- ..
. �. . . �
Corner Lot: ' Inside. Lot: Sefback: Sideyzards: �
Applxcant attach to this form two Certi£icates of Survey of lot and ' '
proposecl builda.ng location drac,m on certi.ficates to , scale. : ; ...
DESCRZPTIO�� OF CONSTRUCTIOP! ��
���t�� �
Front: � D�pth: � � Aeight:
� Squa�e. Feet� � � � (�bic Feet:
.�� % � f'a'"� Fror,�.: Depth: Height: .
. Squa.re• Feet: � Gubia Feet:
+ r
, � .. ' �
x'ype of Constructior�C��k��'1J°�' "�' • Estimated Cost: $�1 f� .
7.b Be O�m�l.eted: e � �' +�' � . � • :. . . . . � �
. � Alt. A A1�. B
Proposed Driveway Width If Atew Opening Is. Desired: $' ' $
, � • � . .._ .. ' SEE REVERSE SIDE OF SH�ET� .
The undersigraed hereby makes application for a permit iar the haork�herein speci�ied,
agreeing��to do all work in strict accordance with the City o� I'ridley Ordinances and
rulings oi the Department of i3uildinqs, and her�by declares that all the facts and �
representatious stated an this appli are true d co ct. �� „��
. �
�� %�r �� � ���T.
DATE: . � SIGNATU£� : � � .
Stipulations: • - �
-� ��3 �� .
J. 1�r .-
;� � .
� 1 �°- �
�ya�
. . �
. . _.�...Q
. BU)Lll11�G PCRf�f1't' rCr SCIIF�DULE' . .
f;t:C'�ION 2. `Phe 7n:.c��r.ei:or. ot l3uilcling:; Lh�1].�., t�ef•ore 3�::�u3ng pe�ni.L� fox �he erecl:ion
a� any l�ui7:clinc� or :;L•LUCt:ur-e, or tor any addi.L�.an L-o ar�y er.i.;�i:inq buildi.ng or sL•zucL•ure,
. az Loz any .altcxation ox re�,�ai.r.s Lo •any CtY,). �ti.ny }�ui.l.di.ng or �tr.ucture, upan a�,pl,icati.on
'ther,efor.c, requirc Uie �apment �iy' tlie app].i.c.ant for. :�uch per.tinxL- of _xecs. .to, t•he amount
hcxein beZow set �arLh anct iri the manner .hcre�.n �rovidcc] L-o-��a.Ls' •
. . ; _ '_
1U:Y7 GOtJS?'P.UCTIOtJ: 5ingle 1'amil.y Ilomes and Gaxages: $4.00/1,000 culiic.Leet. .
�'I,At� CIiI:CY.: 25 �,�ercen� of bui.ldinc� nexmit• Lee. . �
A1tIV�iJAX DE1�R2;SSXOIJ: (Concxe�q Carb �L-rcei:s Only) • � � -
• A1L•crnai:e I�: Itemova]. and renlaccmenL- af cancrete curb and .
quLt-er only; Driveway wiclth plus 6�ee� x Y�,5e75
. Al.tern�.�e II: Remova7. and repl.acc�ment of cancretc curb and
, ' gutter and instal•l. a 3 fooL• wide approach wa.i:h ��
• . 6�nch c�cpth; Driveway widt-h �plus G feet x$17.85 '
• �. . ^/�I)DITTON/SL IL�FOR�Il1TI�N
Ibr the purnose of computa.ng Lees fior buil.ding �zmits, the cubical. contents af any
bu�.lding or addiL-ion, is dcL-ermi.ned by mu1L-ipl.ying i•he ground area covered from a
pn�nt six (6) inches below the tloor line of the basemezit or th� cellar to the
avexage heights af L-he u�,�pGr surface or L-o the avexage heigii� of the roaL- suzf:ace
a£ the ,aain gab].e of a pitched .roof : .
Fox irepairs or alteratians ta an existinq sfix��cturer the fee shall be at ttie xate
. af $3.00 Per each iive hundred dollars°($500.00) or �raction i:hereof S.n the COSt
o� all. ,�xoposed work.. . • • _ '
�
�n •no r.ase shal.l the €ec charqed f��r any pexmit as s�t forth in Section 2}�e less •
than $7.50 plus $.50 state surcharge. � �
• � � VCRI�I�CATI0�1 OF F�UND�I7I�Of�f -
NOTE: Permits �or consta.-uction caill be issued a• minimimn of 24 hours °irom the time
oi appli.�a�ion to allow far pxo�ier review of the proposed stxucture and oi �he .
consti-uction si.t�.
1f� Gertiiicate of Survey of th� I.ot, sho�,rinq the loca�ion of �he foundation once it
has been constnic�ed will be rec�ua.red before �r.oceedinc� with the £raming. �
� �� ' CERTIFICATE QF OCGUPA CY ��� �-
' App2ica�.ion £or a Certificate ot Occupancy shall be made i:en (lOj days prior �ko the
use or occupancy ai any structuLe ior which a� buildi.nq germit l�a� been a.ssued; and
said sia:ucture sliall. not be used, or occu�ied _uni:il a. Certit�cate oi Occu��ancy has
bGC21 �.S51I8C�. _ � ., -- .
. '
M1 � `
° ..i .,� N-
� �1` '°-1'.� ��.
. � �
'� �, .
.
0
»
sue�[cr p
c�ty of Fr�aley 9283
AT TME TOP OF TME TWINS g U I L D I N G P E R M I T
�
� � RECEIPT NO.
� `V ���� COtiAMUNITY OEVEIOPMENT pIV. �� � I
r � � PROTECTIVE INSPECTION SEC.
�
� i �
� /�°�1 � CITY NALL FRIOLE� SS�3i NUMB@N 118V OATE PA6E O� AMNOVED BY
�----�' �•' 612-571-3450 9t0-F15 4/23/99 � /
JOB ADDRESS 6699 Ashton Avenue NE
t LEGAL LOY NO. 9LOCK TRACT OR ADOITION SEE ATTACNEO
oesca. g,9 10 Fridley Park Addition SNEET
2 PROPERTY OWPIER MAIL AOORES$ ZIP PMONE
Clay/Denise Johnson 6699 Ashton Avenue NE 586-0930
3 CONTRACTOR MAIL AODRESS ZiP PMONE LICENSE NO
Panelcraft of MN 3118 Snelling Ave S, Mpls., MN 55406 721-6628 2179
4 ARCMITECT OR DESIGNEN MAIL AOORE88 21P PMONE LICENSE NO.
S EN(iINEER MAII AODFiE3S 21P PMONE LICENSE NO
8 USE OF BUILOIPI(i
Residential
7 CLASS OF WOFUK
O NEW ❑ ADDITION � ALTERATION C� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOi§K
Reside; Fascia/Trim; Replacement windows
9 CNANOE OF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering.
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1994 Uniform Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAI, PLUMBING. HEATINd, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONOITIONING.
TMIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION ZONING S0. FT CU FT.
AUTMOF;I2ED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPIENOEO OR ABANDONED FOR A PERIOO OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLCa. UNITS OFfSTREET PARKING
I MEREBY CERTIFY TNAT I HAVE READ ANO EXAMtNEO THIS APPLICATION I. STALLS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORAECT. ALL PROVISIONS OF LAW$ yp�UATION SURTAX
ANO OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WI7H WNETHEF SPECIFIED MEREIN OR NOT. TME GRANTING OF A PERMIT �9�ZC')% ��F.G3
OOES NOT PRESUME TO GIVE AUTMOiiITY TO VIOLATE OR CANCEL TNE pEqMITfEE SACCN RGE @
PHOV�SIONS OF AIVY. OTHER STATE OR IOCAL LAW REGUTAT�NG CON• �162.25 F SC �p9.2'C)
STRUCTION OR TME PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE T07 L f E
L s SC 0 $181.14
- S�GNATU�IE OF CON:NACTOp Op AUTMON�2E0 pGEMT IO�TE� EN i1Q ALID MI$ I$ V�:r'�T /
♦
S�GNATUpE O� OWNEpi�� OWNEpBU�LOEp� I�AiE� f� �pgp �idit
@
NEW [ ]
ADDN [ l
ALTER [ ]
�
ConstructionAddress :
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
� % �sLi �oh �v �
Effective 1 / 1/98
�o�a'-� 3lv�l
� ��/ i�i � 3 1
�a� n..�
Owner Name & Address: __ Crg ��� e.yr i s� �`ihs � h Tel. # S�(v - D� 3U
Contractor: � a/� y�c� �7` o�' jd0� MN LICENSE # o?/ %
Address: 03// �f .S��reL�n�� �. s, i�`�/�Y ��% ,' S5� D (o Tel. # �a / - �a (oa �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
-- -- DES�RIPT_IOleT �F ��V�M�1�'� - - -- --- -- — — - - -
Length Width Height �' Sq. Ft. •
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
J'��ai n�J� �Li S G/ A�, /!^�sr��
O
� nstruction Type: �,/9�e s,•� �-, t 6r/,h ve cds Estimated Cost: $ �'a � 7, °p
{Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
,�
DATE: �/�/�9 APPLICANT: Tel. # 7a i� �lo ��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
�TOTAL
STIPULATIONS:
CITY USE ONLY
$ /�p �. oZ S Fee Schedule on Reverse Side
$ %• a �o .001 of Permit Valuadon (1J10th%)
$ �/ �O 3 $.50/$1,Q00 Valuation �
$ $1000 per SAC Unit
$ v�. o v $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 [ ] �
$ / �/� �y
a��_� � �
°�.