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��4T,E'S . �QON "— — DENUTES UT/�/T}' � p�Q,q/��' E,�S£MENT
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City of Fridley, Minn.
BUILDING PERMIT
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�.# �5a5yc
N° , 71'75
LOCA N� OF BUI ING
Na .���.� 3tcept C yr_ __�_ ..;�,���� Part o! --.._.._..__._.._.___T_ . �•� �
—�� -*iC.l�_
� -��-� Btock -..-� ._._._._. Additton or Sub-DivJatan
Coraer Lot __ 7mdde Lot _ __._.._.._.__._ Sztback .�.�' ..�_ Sideyard .�t'„�-�- �-�� �____.__
9ewer IIevadan _c��. -� -'
.r�.�.a5-..-�—•---.__._...--- __ F�naBa� n�aa� __:8r3 3.5._ _�._.`._
DESCRIPTION OF BUILDING
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ne�cf, _.__��t _T sq. �. _.__.__ c�. �t. _..__�
TYDe ot caoosavcttoQ &7 jy`�"'�- � Q�� �-� he Completed _:_.._._------
OUTSIDE APPEARANCE Of THIS BUILDING h1UST 8� �DF
APP„OVED VARIANCE WITH OTHER BUILDINGS lN itAS
bLOGIL , _ . -- —
--- .._......._ ............. _ . ....�.._..:.�
In caadderatlon ot the iseuance w me ot a permit to canstruct
���� the dtq � with the descriptlon e6ove a�..fax
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Ea cansideratton of the �I►�J �
PBY�ent of a fee ot a0�++�--�---�-, Pg'�t fs herebY S+'�ted
W do
su ot
to omstruct t6e buflding or additlaa as described above. T►ila Permit Ss granted upon
tde expr�e condiUaai tLat the pereon to whom it is �anted a� 6is agents, emPloyees and worlmien, in all work
�daoe 9n.� atound md upam seid ruuune. �' aAY �az't thereof, st,�u conrorm tn au re�ec�a w tne o=asnances of
W1�Wn the�]imfta�snd�this Bermft ����' 8lterattaa, maintenance, rePalr and moving oP buil��
� may' be revokad at aqy tiroe upon violatiam of any of the Drovimona of eeid
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;,j.>.-°-- --�-- .day of --'�IA C.: �.1__. ._._.._., 19.�7_�-
betu�een__..H2.11S._�D4�--T�.Xlfl�_Lx..scho�aten....._ .::........:.......---.--- ,
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. ojthe County of--°-..AIIOk� ---- ------- arzd State of .Mitlnesota_
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paft�Qs. o( the Jirat part and---�dl'y .B --,tulkontski ...._�.....
--°- -....- -- ..... ___ ................ --°
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"' oJt/ce Countg of _..Anoka ------ ...... and State of... ..Minneso.ta.------._----._...._
... .---. ....
--- - - -°°-.
partX.._._ of the aecond part,
�lttttgBCl�j, That the said part ies of the Jlrst part, in consideration of the sum of
_--•S2n�_-7h�11ar .j1..QD)_.and__nLher_valuahle_.consideraiions _..._._ ....DOLL.�IZS,
-- ----_ ---
�--2-1a �s._Y.r. in hand paid by the eaid p¢rty_._._ of the aecond part, the receipt wTaereof is hereby
acknowled�ed, do __ ker.eby C#rant, Bar�Cain, Qecitclaim, and Conyey unto the said p¢rt,y ..___ of the
seto�d AaT�;--- ��L`�----------..hesra and asai�ens, Forever, all the tract.... or p¢tcel_.. of land lying ¢nd
beiujia t1u Con�aty of .---d110k3-------------
u -----_---------------and State of.Mtinneaota, deacribed as followa, to-wit:
Naintenance easement
i i hereby grant.a tHO foot maintenance easement £or the purpose of maintainin�
� a garage located on Lot 13, block 1, Meadowmoor Terrace, Anoka County
� described as follovs: the north two feet of Lot 12.� block 1, Meadowmoor
Terrace, Anoha County
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thereurtto belonging orin anywise appertaining, Lo Lhe said part.y.... ajthe.aecond p¢rt,._.......__..
..---_... _.
heirs and assde n.s, Foreuer.
�lI �.t��lItt01Tp �fjfCtOf, The aaid p¢rt.._.... of the JDrst part hµ........ hereunto set......_ ........................
7+and.... the dayand yearJtrst aboae ioritten.
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. L�_ �-
On tkia. �� --- day o/ ) �a i c �
- �---- - --- - � 19.�?-2'--� bejo►e me,
a.... kl �..---�--'`�-�' -�•----°:�7L� 411.t_t.. ......._ ._... witjhirz and Jor s¢ed Count
J{ „ y, person¢Lly appeared
f1��1.1< + l�I�.11�L: �C.��Ul1 IC�
to me known to be the peraon_S.,_.____._.__ deacrtbed in, and who executed the ore oin instrument
/ � ¢ ,
--------°---°--------°-------------°------------°--- -----------°-- and acknowledged that --;-he::;. �e,xer,uted �
-----'--� °---°--°'-`--°
(sa x«�) � . . . .
tFce same as ------ ._:.;_�.:_;-° - ---- -f�ee ¢ct ¢nd deed--° ---°- � --- ---
( .. - -° ._
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i -THIS )NSTRUMENT Wq5 �jtAFTED BY � (. -.� �CL�� `
' � � , . _"" _' .1 ' -"- S. _.. '-v
; : . . It � ;,. � . , --- -�-�--- ------
� J�r: �( .�.,�1; (Namel -v _� Xotarg Public.-_ '�� B. R. JULKOWSKI C nty,�.lfznn.
r
f / .. � � {� � ; 1� � (Addnss) ' . N�ry �`ublic,'AnoKa CouriTp, �nn. .
� '�- - •. My Commission Expires Oct.15, 1977
� _.,. _ �_ rr— My eommaasaon expares- - -- --�- ---- - -°---- - -°- -- --, 19-°----°--
I, NOT6: 'Ihe bLOk Snn m�ried "8ee Note" ne fer or �hen tLe iwvummt u emeuted M m atturne� in hct.. . � .
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: � City of Fridley, Minn.
6431 University Ave. I3. E., Minneapolis, Minn. 55432
` BIJILDING PERI�iIT
�e; _ _tulx�F1972
p�; Garv Julkoswski g��, Same
p� 7639 Bacon Drive N.E. Addreas �°� _
' LOCATION OF BVl�lING
� .. 1'Po;,. � ��_,_ gtreet Bacon Drive N.S. _ ._� Part of Lot � .
y� 13 � 1 Addition or Sub-Divisian .��adowmoor Terrace
C�mCr IAt Iaside Lot _-- X Setback �—,---- Sideyard
BeWer F.IevaHam
Fo�mdatlai Elevation
DESCRIPTION OF BUILDING
Rb ba vsed u:
�tached,��Gara¢e �nt 18! �P� 30' geieht 10� Sq. r�t. _540
E'ra�t Derth xeight sn. Ft. ---
Rype of Gmstructf� `_,,Wood Frecae Fat Cost ._$2446.20 To be t'.ompleted
� � 5400
Cu. Ft. �_
Nw. 1972
`Stipulation; -Provide frost footings under garage. Provide a hard surface driveway.
Prnvide gutters and downspouta on the aouth side of the garage. Fire Code prohibite
anq opanings within 5 feet of the lot� line (includea doora and windowa).
1 foot aide ysrd approved by Board of Appeals on April 25� 1972.
.. Ia oon�deratios oP tlte issuance to me at a permi4 to c�
��8le P�Po�d work ffi aecordance with t6e 3escelption aba�ve
� �t:os � the eft,y o1 Fridley. �
22 S
e iwilding� described above, � I agree bo �
and ffi compliance with all. ProNSions �
. In cm�[derat[aat oE the� payment of a fee of $ 10 _ 00 ���. �. � pesm3t is herebY graated to__G.�y_,7ulkowski .
tA�construct the bullding or addltfoa ps��ibed above. This�permit�is granted uppa
��Pr�� ���at th�� person to whom it is graated and his agents, empluyees and workmen, in all work
d iullimB. or aW' Part thereoE, sha]1 conform in �11 resPe�te �to the urdinsnc� �
���� �locati�, construction, alterati�, malntennace, repair �and moving oE b d�
permtt may be revoked at any Lme.upon violation of any �. the provisions�of sald
L
�SELISL �--'---- �.�Pecto�
NOTICE:
lhit pMmh doa pet eev�r }M. eooahutlion. WNII�Nor 1sr vrs�r ��I%�Y� Y� �G��ttiey: »w�r�� M vrMa...b� �sun M w
�����0 �wM� �+�ParaN-qrsits for tlla�..W�es.. . � . . . . .- . . . � . . .
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,. � S�il► N��t{MR , ' . .. 4 .�"'Y�"�s��5�vv�'�. � . Minn. SS4b1 � � .
(ir�l4yi�qlpp . . f1 . � Fsl�phew� 7M-6066
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` IlMs �u16,t�ryr SI�A �rnat qpnwrraefew �f ��yrwg M�h• bwetw�i�s �t �N.: bad aYSv� de.crib�d wd d eM.. �. .�� �
v ��+.�? �"��M.i i} awya tAen�y-oadafl vpiiNe rKrsr tiwy� iraw. �r sn �oui iww. This sarv�y ir
x � i�ne�cff09 w�ift' o�eTi��� IMn wew Miw� plpea� i�t .. ��rfy end np lln6ilNy ia assYm�d �
�,� '��rN�ir f�re� Mn�Mr �f.+wfi w.enq��e w wny ��6�. im��ise atN�t� i#M r��s�n e/ sucM me.�yoye. .It fs :� � .
�,.� �:� � fs�6ero Mew la��d tm�:Ma�pvrNSe-M W�bH�binq Me�liwas er bouMery
.�: tits�rf. 11�iNif1- t ai a. o, t9,��% : . .
¢ . `' SU�URiAN fNq}y�#�lpi�, tl1C.
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APPLICATION FOR RESIDENTIAL, A�TERATION,
OR AllllITION BUILDING p�RMIT
e
CITY OF FRZDLEY, MINNESOTA
OW�TER' S NAt�
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anna�ss :%b3 �' �o,� �� vc ann�rss: 7 G 3 4' f3,�.,�, l�, r�=
No:, 7�3 9 sx��. ��tco,�t1 �,e � v�
LOT; l 3 BLOCK: ! ADDITIONi �1�19AOWNoaK �E.�i �G�
CORNER LOT: INSIDB LOT:�_S&TBACK; SIDES�pRAt�„�„�„�,.
Applicant attach to thie form lkro Certificates of Survev of Lot and propo8ed
building locstion drawn an these Certificatea.
➢ESCRIPTION OF BUILDING
To Be Osad As:
�irw.+ P�6r' Front:�_Depth: ?� � Height:��T
Square Feet: �y 0 Cubic Feet: �! O �
' Front: Depth• Height:���
Square Feet; Cubic Feet:
7�j+pe o£ Conetruction; W��� �I�'i}M£ Eatimatad Cost: $ d 7��- �a
To Be Coopleted: �y � , �% % � �
The underaigned hereby makes applicativn for a pexmit £or the wprk he�'ei,A
specifled, agreeing to do all work in etlict accordanca wxth the G�ty v�
Ffildlay 0ldinances and ivlinge of the Deparement of Buildinge, ead be�'eby
decla�t'ee that all the facte and representatione stated in this appllapR�pp
alre tsve and correct.
t
�+z�: �1 (R7� s���: 4+��
(9ea Revessa Side For Additioaal Info�ation.)
� �� d'�Po�ioc�. �usi -�do,—,�J6S r.cNDfe �A.eA�F. �.eo�.d�
�6. �� �I�,e.4 Su,� �Ac�. �D�e� d� w�y . P,�a ��,D�, G'� � ���s .4�+//J
.�. ? � /JO��SPo�i ar1 �o�TN Si�� OF �A�P�46 c� • •
..//,� �
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inapector of Buildings ahall, before issuing permits fox the
eXection of any building or atructure, or for any addition xo any existing
building or structuxe, or for any alteration or repairs to any exi8tiag
bui.lding ox structure, upon application therefore, require the payme�t by the
applicant for such permit of fees to the amount herein below set forth and xA
Che manner herein prwided to-wit:
1JNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thoueand cubi,c
�eet� or fractian thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computiag feae for building pexmita. the cubical contenta
of aay building or additian� ie determined by ucultiplying the ground area
cwered from a point eix (6) inchea below the floor line of the baaeaient
ot the cellar to the avezage heights of the upper aurface or to tha average-
height of the roof surface of the main gable of a pitched roof.
por repaire or alteratione to aa exiating atructure, the fee shall be at the
rate of $3.00 per each five hundred dollara ($500.00) or fraction thereof in
the cost of all propoeed work.
In no case ahall the fee charged for any pesmit as eet forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
Np'PF; Permits for eonstsuction will be iasued a minimum of 24 hours fxom ths
tioe of application, to allow for proper review of the proposed structure and
of the conetniction site.
A Ce7ctifiad Survey of the lot, rhot+ing the location of the foundat�,oA� px�GO !�C
has.been canatructed� vill be required befor,e proceediws with the ftamf.ng,
CERTIFICA'PE OF OCCUPANCY
Application for a Certiflcate of Occupaacy ehall be made ten (10) days p7Cios
-. kP the use or occupancy of any etructure for which a building pes'miC has b6�A
istued; snd said structure ahall not be uaed or occupied until a Certificat4+
o� Occupancy hae been iseued.
,
,. . , j
.. sueoetr � . . .
� ` �ity of Friciley� � 16080
AT THE TOP OF TME FWIN§ �'
F �°;�' 'BUIL[�I�IG PERMIT
�� � � � � � RECEIPT NO.
�. � � � j COMMUiJ{T( BEYQIOPMENT DIV. � � . .
r I � ' "� PROTECTIVE MS9£C710N SEC. . . . . a S-0 � . � �
� l 6
� ' �� /"K�, j'yRYNkL� FFiIDLF�� bS432. HUMBEP REV � DATE PAyE OF APPROVEOBY. � �
�"'--.1�•• •�� 612-571-345U 9�0-Fis
3/30/81 / /
�oe nooness 7634 Bacon D�ive N. E.
. �L �LEGAL �aTN6�.. �� BLOCK � . � 7RACTORADDITION � � � SEEATTACHED �
oESCa 13 1 Meadoe,�or Tarrace sneer
? PRpPER7YOWNER� � . � � . MAIL AOORESS � � . . � ZIP � � PHONE �
, �7�k.8. fdo�iriay 7639 Sacon Drive N.E. 786-6305
- $ G,QF{4T.AkCT�A . . ,MAILAODRES9 - . . � �� . ZIP ' PHONE UCENSENO.
` � ��@ . . . . . ..
t ,kkl�}tili�CiT6RDE61GNEf3 MAILADDRESS � � . � ZIP PHONE LICENSENO. � �
S �FIGI�EER '" - � � . MAILADDRESS � � ZIP . PHONE LICENSENQ ��'
' . 8 BSE�OF BUILDING � . � .
� �I�@81tlfTYt�.8j,� . � . � � � '.
7 CtASSOR;WORK - � � �
.� ❑ NEW ❑ ADDITION � ALTERATIOM �. ❑ REPAIR ❑ MOVE Q REMOVE
8 DESCRIBEp/ORK .: � � � � � : .
Gonstruct a maso fire i ce
� 4 �CHANGE.pPU6E�FROM . � . TO � �� � � �
� � � � � STIPULATIONS� � . � . . . . �. . - � � � . . �
- SEPARATEPEflM1TSARE REOUTAEO FOR ELECTRICAL, PLUMBING, HEATING, T�PE OP C6N5T. �� OCCUPANCY GROUP � OCCUPANCV LOAD
� VENtH,A71NGOR:AIR CONiNT10NIN6. � � . � � � �
.� TH16 PERMlT BECpMES NULL�AND YOIp IF WORK OR CONSTRUCTION ZONIN� � � SQ.FT. CLL FL � �
�AUTMORi2£0 IS NQ4 GOMMENCEO WITHIN 6p OAYS, OR IF CONSTRUCTION � �� � � . �
OR WOAK� 4S Sk1SP�ND�6 OR, ABANDONEO FOR �A PERIOD OF9N1 DAYS AT � �� �
- ANW TIME;�FFEH WOftK iS COMMENCED. ' � . �}6 ;pWLG..:UNiT9� . OFfSTREET PARKING
1 HEF&8V';G£RTIFV THAT I HAVE READ ANO EXqMINED �THIS APPLICATION ], ' S7ALLS � .GARAGES �
ANb:KNOW TME SAME TO BE TFlUE ANO CORRECT. ALL PROVISIONS OF LAWS- yp�U.4T10N .. SURTAX . �� �
� ANO:ORDINANCE5 GOVERNING TNIS TVPE OF WORK WILL BE COMPUED -�'j,.�OOQ �S.SO � f
. -�� WITHYiHETNER SPECIFIED NEREIN OR NOT. TME�GRANTING OF A PERMIT � � � - �
.00ES NOT'�PRESUME TO GIVE AUTHORITY.TO VIOLATE OR CANCEI THE� pERM1tITFEE ��� � � SACCHAFGE �� �
k� � PRpVI510NS OF ANY�OTHER STATE OR�LOCAL�LAW REGULATING CON- �"]� SO �
STRUCTION OR�THf-PERFOAMANCE OF CONSTBUCTION:� � .
� � ' � � . � 7UNCHECKFEE TOTALFEE . �� �
� � � � $8.�0 - .
S�G kTUREOFGOa aCT UTHORI?ED ¢ENi �ontEi VNiEN PROPERLY VAUOATEO THIS IS V6UR PERMIT � -�
u a'�
� a �
NA U F pfRtiiO iE BNLDEPf ipATfl gt G.tk3P .0 E
_ .. _..� . . .�.`... . .�.� . �.�.�..�.. __�.�.. �._,. _�, , .::.�, . . .
: CITY (1f FRIDL[Y .
Ahf'LTGA'fI0'1 FOfi RESIf)L+�ITIAi_ I3U1LlJI[t6 PCRt�IITS ',
(tJerr, �lteratians, Additions, or iiepairs)
� OWt1ER: �_.. [3UILD'ER: . ;�_�
�����9�
'ADQRESS: 6 3 `� �f . � - ADDRGSS: �
T[L N0: �%�6 `6 3 0� TEL t10: . . .
.. .y
1- -.
�.
Construction Location
STREBT NO: 7�- 3 S STREF.T: ,�1C�t�s�,/dw`�/-
I+071: I � BLOCK: % ADDITION; . �
CoYner Lot: Znside Lot: SetbacY.c Sideyards:
Applicant attach to this fosm two Certificates of S�rvey. of lot and
proposed building location drawn on certifieates to scale.
DESCRIPTIOid OF COt•tSTRUCTIOfd
��� l��`
�� �ront: Depth: ' iieight:
� Square.Feet: Wbic Fcet:
_ Fmnt: -- - Depth:
Heiglit:
Square Peet: Cubic Peet:
. . .. �. . . - � �00
Type of.Construction: Estimated Cost: $/� � Q_ `
—*7-----
Rb $e Oonpleted: (p
' Alt. 21 Alt. B
Proposed Driveway Width I£ New Opening Is Desired: $' $
. . SEE Re^.VERSE SIDE OF SFiEET .
4ise undersiaRed hereby maF:c., agplication for a permit fcr the �:ork'herein specified,
a�jreeinq to c�.all work iti strict accorclanee with the City of Pridley Ordiizances znd
rul,ings of C1te De17artmctzt of Duildings, and hereby declares that akl the facts and
representatiens stated :.n this �.pplication are true and correat.
D3TL�: ,� � � 0 -��� SIGNhTURE:
Etipul.ztions:
��
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0
S1;C:'L'1017 ?. 1'I�L 7n >>cctor. oT: riai.ldiur�:: lifl).1� I)( IhT:f: ).:, :aiucj pcnniCs for 4hc crccL•i.on
tif <u�y 1�Lti:].d.i.i7p or .�t:ruci:urc, wr for ciiiy addi.t:i�m !:n aiiy cr.iaCi:nq ),uilclir�g nr ::tzuctur.r,
eir. f'c»' arry u]:tcraCirut or. r.ci,eiir.s t:o •any c, �r:t:.inq 1i»ti.J.di,n<� or. sL�.ur.turc, u�w�i ar>��licat;.i.o�i
Lhr.r.�:foYC, r.equ.ire th^ payment: l�y Uie �r�p].i.cant. f.c�r such �ienni.L• oJ: fee.^, to Ll�e amowit
hcr.�..isi bc].brr �c�L f-or.Ch <inQ i.�i t.iic m�nncr, hcrc3.n Z�ro��zdacl Lo-�•:it:; •
1.IiYJ C9N5'79:UC'fTON: Singl:c l•'amiJ.y ]lon;es and Gar�zycs: v�.00/1r0�0 cubi.c LecL. .
l'LTLI Cll]iCl:: 25 per.ceut: oi- bui.ldi.�x� peYmiL fee.
UI;II'I:l1nY llL•'YRL•'55'f.01•;: (Concxet•c, C.t�r.b SLrcets Only)
• Al.icrnat:e n: ]u:moval mid replacement of concrete cur.b and i
qut-LCr only; Driveway uridth p3:i�s 6 ieet x� i.3.�D
n].ternaL•c 7i: Removal and rep2accment of concrete curb and
, guttcr and install a 3 foot, riide approach �aiL•h ��
• � b inch depth; Dzivev�ay �•iidth �plus G feeL x�>S.�S
' ��-r��nn� tr�r-oa��nTtor _
Fbr the puri�se of computing tees far k�uilding permits, ilie cuvical cor.tents of any
buildi.ng or. addition, is detcr..ni.ned by multipJ.ying ':lre ground ar�1 cc�vered irom a
poznt sir. (6) inches bela.� the iloor J:ine oi L-he basement or th: cellar L-o the
avera9e heights of-the upper sw-Pace or to ihe average heig}ct of the mof surf:ace
of tlie nain 9alile of a pitched roof.
For. repai.rs or aJ,terations to an existing strueture, the iee shal7. be at the rate
o£ $3.00 per each five hundrecl do7.lars-($500.00) or fracL-ion :chemof in the cost
of all propased wor.k.
In •no case sha3.1 the fee ciiarged L-or any penni.t as set f.orth i.n Section 2 be less
t2:an $7.50 pl.us $.50 state surcliarge.
VERTFIr�iou �F� r-c�u,,tn_r� �or�
NOTE: Permits ior construction cvill be issued a minimum of 29 hours f:rom Uie time
of ak�glication to aJ.loc•r for pro}?er review of fil�e proposed st-uckure and of the
construction site.
A Certificate of Suxvey of the lqt, shocaing the location of the ioundation once it
has been constnicted will be required before pr.oceedi.nq with the framing.
�r,j3TIFIC��E OF OCr�P/�ACY
' n�pli.cati�n ior a Certiiicate ot- Oceu��ancy sha11 be mac�e ten (10) days prior i:o the
u�e or. occupancy oi any siructure for !ahich a builcli.ng pennit }:as been issued; and
said structure shal):s�ot be used or. occupied L:util a CertS.£icate of Occurancy has
been i,ssued.
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SUBJECi
t�City of Fridley
ATTNETOPOFTMETWINS gUILDiNG PERMIT
, .
` _ COMMUNITY DEVEIOPMENT OIV.
t � � � PROTECi1VE INSPECTION SEC.
,�
� � �"'1 � GTV MRLL FRIDLE� 55132 NuMBEn nEV oarE
�°"� � �'' 612-571-3450 9t0-Fi5 10/
J08 ADDRESS 7639 Bacon Drive NE
t LEGAL LOTNO. BLOCK TRACTOHRDDITION
DESCR. 13 1 Meadowmoor Terrace
2 PROPERTYOWNER �� - MAILADDRESS
Carolvn/Jerome Bush 7639 Bacon Drive NE
Same
a ARCMITECT OH DESIGNER
8 USE
7 ClA55OFWORK �
❑ NEW
9 CHANGEOFUSEFROM
MAIL ADORESS
❑ ADDITION O ALtERATION
R
bathroom
TO
V�GF O�
� �
24704
��a
RcVROVEO BY
SEERTTACHED
SMEEi
PMONE
785-0733
CHONE LICENSE NO.
PNONE LICENSENO.
PNONE UCENSENO.
❑ REPA�H ❑ MOVE ❑ HEMOVE
STIPULATIONS
See notations on plan. Install smoke detectors per State Building
Code on each level of dwelling and in each sleeping area.
SEF�ARATE PERMITS REQUIRED FOR
WiRt%fG, NEATING, PLUMBING AND SIGNS.
TVPE OF
SERARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUM9ING, MEATING.
YENTIIqTING OR AIR CONDITIONING.
THIS PERMIT BELOMES NUIL AND VOID IF WORK OR CONSTHUCTION ZpNING
AUTHORIZEO IS NOT COMMENCE� W�TMIN 60 DAVS, OR IF CONSTRUCTION
OF WORK IS SUSPENDED OR ABANDONED FOR A VERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. N0. DW
I HEREBY CERTIFY TNAT 1 HAVE RE/1D AND E%AMINED THIS APVLICATION
AND KNOW TME $AME TO BE iRUE ANDCORRECT. ALL PROVISIONS OF LAWS yp�UATI
AND OROINANCES GOVERNING TMIS TVPE OF WOPK WILL BE COMPUED_
WITH WNETHER SGECIFIED HEREIN OR NOT. THE GRANi1NG OF q PERMIT �6 �
DOES NOT PPESUME TO GIVE AUTHONITV TO VIOIATE OR CANCEL THf pERMITI
PpOVISIONS OF ANY OTMER STATE Oti LOCAL LAW FEGULATING CON� Q'
STRUCTI N OR THE 7ERFOg ANCE OP ONSTRUCTION. p
� PLAN CL
��k�-9G
SIGNaIUPEOFCON:IACiOPORRUTHOAI2E�<GENT IDATEI /�
/ ,
1
500
OCCUPANCYGROUP OCCUPANGYLOAD
SO.fT. CU.FT.
OFFSTREET PARKING
STALLS GAPAGES
SURTA%
$3.25
SACCHARGE
ire SC $6.50
T LfEE
$134.50
VA 0 1 7H15 IS VOUR PERMIT
�.r/ /ii �11 /�- -r'i�
NEW
ADDN
AL'I'ER
i]
�I
[l
ConsuuctionAddress:
Legal Description:
Owner Name & Address:
Contractor:
LIVING AREA:
GARAGE AREA:
DECg AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
v
Effective 3/1/96
Tel. # 7Bs "0732
LICENSE #
Attach w this application, a Certificate of Survey of the
lot, with the proposed conshuction drawn on it to scale.
I.ength
I.ength
Length
DESCRIPTION OF Il14PROVEMENT
Width -Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground _ Sq. Ft.
, �/lL��
Corner Lot [] Inside Loi [] Ft. Yd Setback _.> , ro° Side Yard SeWacks
Type of Construction:' /`O V`�Estimated Cost: $'�/ .� D 1�
Appmx. Completion Date:
. �.,.h, �,
,_._ . � (Cost on� Back) � � � �
Driveway Ctiuh C�t Width Nceded: _Ft. + 6 Ft = Ft x$` _$
DATE: �['�� APPIdCANT: _{�`���� �j"jl�� fo Tel. # ZI�S 'l� �3_�
.,.�
: C1TY USE ONLY
Pemut Fee
Fire'Siircharge
State Surcharge
SAC Charge
License Sutcharge
Driveway Escmw
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 2.�5;:
$ �,so�
$ 3,25
$
$
$
$
$
$ i�;��
Fee'Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation "
$900 per SAC Unit
$5.00 (State Lioensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�� �
BUII.DING PERMTT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or suucture, or for
any addition to any existing building or s�re, or for any alteration or repair to any eusting building or
structure, upon application therefore, require the paymern by tbe applicant for such permit of fees to the amount
herein below set forth and in the maaner herein pmvided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,b00
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $50(?,000
$500,001 to $1,000,000
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for fust $2,000 plus $12.50 for each additional $1,(�00
or fraction thereof, to and i�luding $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or frac6on thereof, to and i�luding $50,000
$574.75 for fust $SO,OOQ plus $6.25 for each additional
$i,00p or fraction thereof, to and iucluding $100,000
$887;25 for firse $100,000 plus $5.00 for each addational
$1,U00 or: fiaction thereof,.:to.and including $500,000
.. ;:
$2887 25 for the first $500,000 plus $4.25 for each additional
$1,000 or f�action thereof, to and including $1,i100,000
$1,000,001 and up $SOiZ.ZS for the fir� $1,000,000 plus $2.75 for each additional
, $1,U00 or &action tttereof • .
DRIVEWAY' DEP'RESSION ESCROW
(Conciete C�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and instali a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
YERIFICATION OF FOUNDATION
Permits for construcdon will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure a� oP the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been consrivcted
will be required before proceeding with thc framing.
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�T�TNETOPQfTN@iWiNS g�l�p��� pERMIT
�_� CW.�MIIN�TY OEyELOPM¢NT DIV.
�� PIiQTECT1YElN8PECTION $EC.
••"t � CITY HAL4 iPIpLEV 35�3t NWli.
�'� 612-571-3460 91Q-Ft5
�oe�ooness 7639 Bacon Drive NE
1 LfGAI �OTNO. B�OCN �� , iNACTOR DOITION
DESCP. 13 1� Meadowmoor Terrace
2 PNOPERTYOWNER � MAILAOOAESS�
Jerome Bush 7639 Bacon Drive NE
4/2/99 � /
Iq MAIL AD�NQ55 ZII
, �tm Inc 5014 Parrish Ave NE, Roger',s, MN 55374
MAIL
Of
/
29138
,--.
l7a9
SEEATT�CNED
SNEET
VNONE LICENSE NO
428-4559 20155030
NO
7 CLASSOiWONI( � � '
❑ NEW Q AODITiON ❑ AITERA71pN. i�7 � REPAIR O MOVE O REMOVE
B DESCRIBE WORK �
n....,.,.c u....�o .c r_araoP f26 Sa) Tear-off
8'CHANOEOFUSEFROM
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
. . . . . . - � ' 7VP Of CbN �
SE��RATE PEpM1T5 �RE REOU�NED GOR ELECTNILAL. GLUMBING. NEATING.
VENTILATING OR AIR CONDIiIONING � � ' '
TMIS PEAMIT BECOMES NULL AND VOIO �F WORK OA GONSTRUGTION zONING
•UTMpRIZED IS NOT CpMMENCED Yj(ITXIN 60 OAYS. OR IF CONSTRUCTION
OA. WOPN IS SUSPENDED OF ABANDONEO FOR A PERIQD OF 120 DAYS �7
ANY TIME AFTEN WORN IS COMMENCED. . NO� OW4G. UI
1 MEpEBY CEATIFV THAT I XA4E pE�D AND E%AI.�IN{0 TN�S APPUCATIQN 1
♦HD KNOW THE SAME 70 BE TqUE �NO CORRECT. �LL PRO�i5�ON5OF UW9 . yALUATION �
ANO ORqN�NLES GOVERNING iMIS TYPE OF WpRN WILL 9E COMPLIED �2 2•1$ �
WITH WHETMEN SPEC�FIED MEAEIN OR NOT. TME GAANi1NG Of � CERMIT �
DOES NOT:VFESUME TO GIVE AUTHORITY TO V�OIATE OR GANCEL TNk pEp{.r�T�REE
PROVISION8�Of ANY OTMER STATE OA IOWL L�W REGUUTING CON- c74.,75
STRUCTION OA TME PEAFOAMANCE OF CONSTFUCTION � �! .__ ._
�O��E�
... . ._..,:k.'.�w. .
Permit Inspection Carda
W(II Be Meiled
To Homeowner Ta Poat
$5
FT
.pl.11
�ACCNA E
Fire G $2.23
OTAL E
_ .09 /
LOAO
F�2-25-1999 16�14 FR�t CITY OF FRIDLEY TO 4288626 P.01i02
T1EVV [ ] Eff�fIVG j/1/99
ADDN [ I CiTY OF FitIDLEY
ALTER (] SINGLB FAMII.X AND DUPLERP'S R 1 AND R-2
BUILDING YERMIT APPUCATiON �A��j`�OGt
co���oAnaa�: 7(�39 �'� ,C`?'I. 6
us� �x���:
Owner Name & Addrass: �2_d7'Y1.0/ �1 ���i U,�'`�"i�r.'1 N' Tel. i'
Contractor: TnP r_U�I, 1(�16 MNLICENSEi o?D/���30
p��: 5014 PARRISH AVE I� TeI.+Y���yz�-y�9
o� v.�-rcrr-rsr.�—
Atiaicti"tb'@!tS'i�fp'l�Cilidit, a Ceitificace � Survey of the
lot, with che proposed coasauction drswa on it to acaie.
DESCAIFTION OF IINPROVEIV�M'
LIVIIaTG AREA: L.eagth Width Height Sq. Ft.
GARAGE AREA: i.en�th W�th Height Sq. Ft.
DECS AREA: Len��th DVidth Hgt/Ground _ Sq. Ft.
C�iM:'-i�,�
Constcuction 1ype: %�C -"� uf. %����'!/2 -C� Fstimated Co� S ��• -- �ao� o
�— ��— (Fee Schedule on Sack1
Driveway Ctiub (�t Width Needed: _Ft. + b t= Fc x S � S
__. ;; —
naa�: 3l30 99 �cArrr: "'ff—' �L,.�'!� xd. �,i2 S/2&'-�LSSg
re�i� Fee
Fite Surchuge
Sate Surcharge
s�c c�
L,axau Surcharge
Driveway Escrow
Erosion Coatrol
Park Fee
Sewer Maisi C1�atY�
�
S1'IPULATlONS:
s % .7s
S �.�
3 9. //
3 -U0
$
S
S
S
s g3 .0 9
•�� • �.i
Fce ScheJute on Revcrse Side
.001 of Pcrmit Valuation (1/20th96)
a.sasi,000 v,�a�
uoso � snc v��
ss.00 (smte L,icwised xesia«►cial eoncraccors)
Alt. "A" or Alt. "8" Above
5450.00 Cooservation Plan Revi�v
Fa Ddenmined by F�gineertn�
Agreanent Necessary [ J Not Nxeasary []
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