AF - 35228/
,
- - - — -�-•�_� .--- - -
Village of F'ridley, Minn.
B�JILDING PERMIT No
Date: . .. . . . .� !.�'. /, ���+r� .. ......
Owner ....... .....................:..
Address ..... .... ... ................
1513
Builder...................... .......... .........
Address..... ................ ............. ..
Na ���j �r ,��L AT(ON OF BUILDING
�?!"�,J. , , Street . �""�Mt���C.r�
... ,. P L
............. .....
� ... ... ,
Lot . . . . . . . . . . . Bloek Addition or Sub-Divisio , , , , , , , ,
a o o ��..��,,,. .
...
...
.................. n #
• .. .....'•. ��+�
�, � . .. .. ..
Corner Lot ........... Inside Lot .+.�..:.... Setback �.�.., Sideyard �� .................... ....
�ESCRIPTION QF BUILDING
To be tised as•
Ii��:. . . . � ,.�''.� '.� s� �,,r
•���'�'��: . . Front . . � .��.^: . Depth.�.�.. . . . I'leight . .'�'�. :�.' . Sq• Ft• ��:`, ?, ,�Cu. F� . . . . •
..................... Front Depth ... .. Height ........ Sq. Ft. ....... 'Cu. F� . .....
Type of Construction �"."':`."�'"r".`",'�";";';"', Est. Cost � !�!"`I. � . . . . . . . . '
To be Completed ....... . .....
I� cansideration of the issuance to me af a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all prpvisitmg o�
ordinances of the viliage of Fridley.
..........................................y... ... .s
In consideration of the payment of a fee ef ��� ,, permit is hereby granted to ....... ............
� • • • • • • • • • • • . • • . . . . . . . . to construct the building or addition as described above. T'his pertnit is gra�te�, u�ami
the express candition that the person to whom it is gi�anted and his agents, empioyees and workmen, in all� wprk
done in, around and upon said building, or any part thereof, shall confarm in all respecGs to the ordinances of
Fridley, Minnesota re�arding location, construction, alteration, maintenance, repair and moving of buildit�gs with-
in tne village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
�w�t � .
!
�. . . . . . . . . Building �etnr
, . ��� ��,�, i `
N07iCE: " —
This permit does not cover the construction, instailation or afttration for wiring, plumbing, gas heating,
sewer or water. �e sure to ser-� @uilding Inspector for separate permits fcr�ese items.
� BUILDING PERMIT
� . Village of Fridley, Minn. N° 212'7
`Date �����••�..... ..................... '
Owner .�N��.�j,r• Builder ...........................................
-„�,� ���,."� f • i�,'t:'tt,.►•
Address �.�.... ........................... Address . ... : .........................
LOCATION OF BUiLDING
_ No. , . . �."�.��� . . . . . Street . %�l���',,,�;` � . . . . . . . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . .
I.flt . . . . . . � . . . . Block . . . � . . . . . . . . . . . Addition or Sub-Division •.����• :/!� : �j�•
���l��
Corner Lot .......... Inside Lot ... ....... Setback �
� /�;ie . . Sideyard .�Q : . !�j, e� : . . . . . . . .
DES�CRIPT[ON OF BUILDING
To be Used as:
� K
. .� `�a,sr�!... ... Front .�,f,e�'. Depth ,��"�� Height j�.. Sq. F't. . .... ... Cu. Ft. . .. .. . ,
� �7
,���'�"� . . . . . . . . Front ,���i� Depth ,r�,'���eight �� Sq. F't. . . . . . . . . Cu. Ft. . . . . . . . .
Type of Construction „�`�.,,�„¢; . . . Est. Cosi �,�!'�Q.�1. . . .�w�. :'. . . . . . To be Completed ,�..��
t
In consideration af the i�ssuance to me of a permit to construct the building described above, I agree to da
the proposed work in accordance with the description above set forth : and in compliance with all provisions of
ordinances af the viliage of Fridley.
In onsideration of the payment of a fee of �
$•/ ,,..,.F, permit is hereby granted to ,,.,��,,,��.........
�. . io construct the building�r ati dition as described above. This permit is granted upon
ress con ition that the person to wham it is granted and his agents, employees anc�-worlunen, in,ail work
done in, around and upon said building, or any part thereof, shall conform in all respects to '�the ordinances of
x'ridley, Minnesota regarding location, construction, aiteration, maintenance, repair and moving. of buiidings with-
in the village limits and this permit may be revoked a# any time upon vialation of any of the grovisions of said
ordinanees.
t � � '
' � �:-��=r:" Builtling I2ispeetor
I
i
NOTICE:.
This permit does not cover the eonstruction, instailation or a4ieration for wrrin9, plumising, gas heating, •
sewer or water. Be sure to see fhe Building inspector for separ'_ate permits fo� these items.
/� � ,.
, �
v
sue�ecT " pE p.
City of Fridley � 16 2 9 9
f , AT THE TOP OF THE TWINS g U I L D I N G P E R M I T -�L
r
� �
' COMMUNITY DEVELOPMENT DIV.
� � �i _����_,
r � � PROTECTIVE INSPECTION SEC.
�
1
1
� � �"'1 � CITY HALL FR�DLEY 55432 NUMBER aev
� '---�: `.1
612-571-3450 910-F15
108 ADDRESS 6219 Baker Avenue NE.
1 LEGAL LOT NO. B�OCK TRACT OR ADDITION
DESCR. S 1 Moore Lake Highla
2 PROPERTY OWNER MAIL AODRESS
Stan Carlson 6219 Baker Avenue N.E.
3 CONTRACTOR MAIL ADDRESS
Darrell Erickson 3930 Xerxes Avenue No
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
6 USE OF BUILDING
7 CLASS OF WORK
8 DESCRIBE WORK
9 CHANGE QF USE FROM
DATE
7/27/81
4th
ZIP
571-
ZIP
588
ZIP
ZIP
3 � 73
PAGE OF APPROVED BV
� �
SEEATTACHED
SHEET
PHONE
046
PHONE LICENSE NO.
63 58
PHONE LICENSE NO.
PHONE LICENSE NO.
C NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
TO
STIPULATIONS gpof can be second but not third roof. Install rid ed
g galvanized
valleys.
TYPE OF CONST.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZEO IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APP�ICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�-�SOO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
�STF�UCTI N OR THE PERFORMANC ' �CONSTRUCTION. $�.00
�i � PLAN CHECK FEE
� �"�.'L4�� �` E'-!'r<�-L � �� �l
� SIGNATURE OF CONTRACTOR OR UTHORIZED AGENT IDATEI �n�u�ni noi
�4 �
_ SiGNATUREOFOWNERUFOWNERBUiLDERi �DATE� I BLDG iNSP
OCCUPANCYGROUP �OCCUPANC��LOAD
SQ
CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
$. 75
SAC CHARGE
TOTALFEE
$ 9. 75
IDATED THIS IS YOUR PERMIT
0
CITY OF ('RIDLCY
/'i('('LICIi'(I�:d F'Of: RI:SID[:FlTII',1_ f3UlLDIiIG f'EfufI'fS
(Nc�•r, !�1 �cr,�tion;, /1ddiLions,, or Rcnairs)
f' � :
� O l•, I d C R: �/i�'i�.�� ��p'-� �.� �+..,7
�
ADDRESS: �;� % � - ��—
TCL n0: � � � �. . �� ��
_ _ � .N.
L' U I L QL P. :.���'�''%�. ��. L� ��+�C ��%/`-�
/1UDRESS: �� 1��'�� X�'�z'° � /,��^-�G
7CL (d0: ��� ��,���
Construction Location '
. .
.
� _ ., .
. , �.
. s��T rio. �� f � s��r�r:T: _ �-�-r' f� �. ��` � f�.��:� � �= �� �
_._� �_ 4�C(3�C-� � f� � ' ��4t"r``p� Y� -
r,or. : sLOa:: �nnrrzov :
Corner Lot: Inside Lot: Serback: Sideyards:
Ap�lica.n4 attach to L-llis form t�ti�o Certificates �f S�.trvey of lot and
proposed building locai:ion drawn on certiiicates to scale.
,-� � DESCRIPTIO�� OF COFISTRUCTIOPd •
� ��� {�s,�� �> = I'ront:
6quar.e. k'eet:
Aepth : Iieight:
C�ibic Feet:
Front: Depth: Height:
Squar.e F'eAt: C1�bic I'eet:
,
_ �.�� �
�
�
Type of Construction: �-' .j�f j7�1 _( Estimated Cos �: $ - ' �
Zb Be d�r,�pleted:
` . . Alt. A Alt. B
Proposed Urive�aay S�vidth rf New �pening Is Des:ized: $� $
. . S�L R�VERSE SIDE OF SFIEET ,
Ziie undexsianed hei-eby ma}:e� applic�-�ticn for a permit fcr the �:nrk herein specified,
agreeing to c� ,aZl wor}: ir, strict accorc�3nce e��itil tlle .City of I'ridley Ordiiiances a�ici
rulings oi L-he Depzrtmcc�t. of Buildings, and hereby decl�res thzt all the facts and
represent.ltieus stated :ii this applicutian are t;ue and correc�. �,
D11TT : ��.� �� ��� S I GN ATU F•E: :
,�F , „e--,
�t:i��ul��tions :
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, �,,, �_.
�-----------"�.._--�
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BUILT)1hlG t'Cf2t1JT FE�_ SCf(�nUt_E � ,
;):C'!'i01�7 ?.. 7'hL 7n�.:��ccLor oL j�tl].1CG111(J :::}iril.l, bcfor.c �_:; .uitig Z�cnnits for t:hc crecLion
c>f a>>y )�u�.]_cl:ii��1 c�r :,t:�-uct:urc, o�- fai• any �dcli.i::i��n L-o aczy cr.i�L-ii�c� I:LtiilclincJ or stzucLur_c,
. ci�- J:o�' c,�;y ci].t.crltioi� or. rcl�air.s Lo •any c;:i. :t:ing )�ui.).di_�ig or sLr.ucturc, uJ��n ar���li.cat.i.on
tticr:�f.or.c, r.cquire tJi� 1���ymenL }�y tlie ar�pl.i.can?: for. sucll per.ma.L• of- fees to tlse �rno�ant
hc�r.c�.ri bc].c>�•r sr.l- for.tli an4 �_�i tlic manncr_ hcrei.n �,rovicicci L•o-a:ifi: •
113:t�; COI��:I7:UC'�IQI�: Sing].e 1'amil.y Ilomes anci Gar.ac{es: Y4.00/1,0�0 eubic feet.. •
PJ�F:':d C1t1:C1;: 2.5 I�er_cer�t: of hu;.lclincJ }�e�-miL- tce.
UIZI��L•'l•;111' llLPP1:5S70I•:: (Concretc_ �irb SLrccts Only) '
' 11].ternai:e n: ltcmoval ai�d replac�ment of concrete cuzb and
gutt-er only; l�riveway t�ridth pl.us 6 feet x$13. �0
A1L•�rnate B: Removal and rei�Iacem�•nt of concrete curb and
• � guttcr and iiistall a 3 �ooi: wic3e aPproach t��ith �'
� . 6 inch aepth; Driveway width plus 6 feet x$1a�75
� �DI i� onn� i t��on�.�T r o.�
For the purl�se of computing fees for_ building permits, i�he cubical contents of any
build3.r�g or. addition, is deter:nicled by rnuliiplyir�g �;he ground area covered frorn a
poiri� sis: (6} inches belo��� ihe floor ].ine of tlae basement or the cellar to tile
average heights of the �upper sw-face or to the average iieight of the roof. surf:ace
of i�iie ;aain gable of a pitched rooL-. �
For. ze�ai.rs or a�.terations to an existing strEicture, tne fee shall be at the rate
of $3.Q0 rer each fivc hundred do7.lars °($500.00) er fracL-ion ':liereaf in the cost
of all proposed wor.k. . '
In �no case JI1C�J.� the fee cliarged for any pennit as set iorth i.n Section 2 be less
tiian $?.50 plus $.50 state surcliarge. •
VERTFICATIO� OF FOU��(DATIO(�
NOTE: Permits for construction ���ill be issued a minim� ai 24 hours from L-lie time
oi applicatian to al.lo�a for proper review of the proposed structure and of the .
construction site.
A Certificate of Survey of the lot, shocaing the location of tiie foundation once it
has been cons�ructed ��till be required before proceec�inq 4J1�1 t}l� framing_
�,P,ZI F I CA�E QF �C�UPAf��C1' .
F�pplicatic�n ior a Certificate of Oceupancy shall be mad:� ten (10) days prior to the
u�e o•r. occuraricy of- any sti�zcture for ��iiich a builcli2�g pexznit has been issued; and
said struct.ure sliall. i�ot be used or. occupied L,riti� a CerL3.fica�e of Occuj�zncy has
been �ssued.
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CHIM��EY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes ()
,,
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. Meets all current Code requirements for size and
total BTI; connected
6. Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
Com pa ny
Signed By
Da te
,
No ( )
No ( )
No ( )
No ( )
Ye s ( ) No ( )
.__ a���-���1�3�
fEW ( J Effective '1I1/2007
.DDi�E j j CI'tY OF FRiOL�Y {�f►3j 5T2-3604 6ldg iasp;
1TER ( j 51NGLE FAMtLY AND DUPLEXES R-1 AND R-2
8UilDlt�tG PERMIT APPLiCATlON
;onstruction Address: �,Q� ����'�� �� ,.
.egal Description_
)wner Name � Address: � � � `{�'� �� �11��_ Tei• #�'� �5 � L - � 4 � K
:ontrado� �,�c,�hLLW�- � � � U � .•, MN UCENSE #��},.(�_
�ddress2�r� � n xlw�. � Y�j �►��{ ►M (� h� I 1_ Tel. # �� � 1 U�ia �l �3 S�
.IVlNG AREA:
�ARAGE AREA:
�ECK AREA:
�THER:
Attach to this application, a Certifica#e of Sucvey of ttse
iat, with the proposed cror►structi�+ drawn on �t to scale.
DESCRIPTl4N OP lMPROYEItl�NT
Length Width Height Sq. Ft
L� V�idth HeiyM "� Sq_ Ft
�g� Vifidth Hgt/Graund Sq. Ft _
�ln�� � O C�
;onstruction TYpe: W L�i, ,��,.5 VCD.�,� 0,�, (�1 u' ` n Estimated Cos� $ ��
;..�BWey CU1'b Ctlt Wld�h N�dP.d: Ft + 6 FC = Ft x S =$
� , � `/ � UI �_ Tel. # l ft71 + �lCJ� �1`�� �
)A�: � � _C�� APPL(CANT: ,
:ITY USE ONLY -
�etmit Fe2
=ire Surcharge
StaGe Surcharge
SAC Charge
Lioense Surcharge
Driveway Es�row
Erosian Corrtrol
Park Fee
Sewer Main Charge
TOTAL
s-r ��a-noNS:
Ca11(T63) 572-3644 tor Pen�rii Fees if mailing i� app[ication
��� l,� Fee Schedule on Reverse Side
$ � .c� .00'1 of Pesmit Vatuation (9I14th°!n}
$ l , b� $_50/$1,000 Vateiatio�
$ $1 �50 per SAC Unit �
$ �,o _$5.00 (State l.ioensed Residenfiai Contractors)
$ � ,.A�, or Aat. ,�B�. �ve
$ �450.00 Conservation Plan Review
$ Fee Detemvned by Eng"meerin9
� Ag�eement Necessary [ j Not Necessary � j
� � � �� ���
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as/05/2005 10:44 9529208992
AUG-@5-20� 11�02 CITY 0� FRIDI�Y
Buildu�g
7nspectic�ns
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NORTHSTAR HOME IMPRO
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PAGE 02
P.02i05
Permit No.: �?Gl'��L =
Recei.�cd By: .-
D�te Rec'd:
YOUk E-t�I.�1L ADbR�SS ,� 1� �,,,,,�4 `��1Q. �/�'O L_ LD/`?
� O�R �9CONTFUCi'OR
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O M.tINIFNaNCE/RE
DESCRtHE WOi`iK BEING TJ021E.
S1ZE UF T2vTE'ROV��:(h:'�Tf
N171+tfiER �F SQUAR&9
G:+��..iiik�
PRVPGSED 3IZE;
YR��FGSF.6 i-l6iGH i:
Si{2]�G
G Vin�i
O Aluminum
❑ Otbor
N' fNtr[�,!��
itv G?:15�MG OF�.NI?�GS t7Y'cs ONo
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EXP D�.TE �„-��� L —
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❑ ROOF
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t� ,�rr�cx� t�r�uce
O [�ET�.CHE.D C3ARi4G6
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p F�ac1a
LACA1'ION � WINDOWS
GF
p DRA1N T1.LE
O 07H�R
c�7
�GT��R��C�FL�N4 SUBIvdT:
1. �austlng Florr Plin
1, Propowd lSOar plan
3. L{it of �wcaueJ members to bt us�d
FOR �IEaV C4NSTRliCfION [NCLUUING DECKS,
.�Dl'nOr�S_�I?aACN�� c�r.aT�
1. S1Ce P►�q/$urvq� &howin� C1� eztttSeII saw:arr�t
�Dd D�P�ad D+oJ�.
2 7`YW 2cds of ooruwetion plane
3. Fatt�y Glcul�iot�a
��,L�. l��:�S .�itL tt�15L�u Uh b' ll:l.� 3'1'[O:'� l,'vC�.U1,�INC Trl� CQST OF LABUI� AND i►�ATERY.AI.S•
��-��� r��
Piui FCcvicH�
5urc'r,argc
Fire Surcbetyc
�iceaise S+uet�arge
inC Cl,a; gc
�urb Cut Escrow
�����sic,x, Conaol
?ark f'ce
>u���er 2.Iain Ch�rgr,
1'Jtal liuc
(US�tYG E �7 U.B.0 F.�E SCi�DULE)
J(1D Yr��.L�t�7'l(1,`'r s '� O OCCUYANCY TXX$
��� Sr,c �3ack Paye for Fec Schaduio
� �, 65°rb oY B�tllding Pannit �oc
�� (.G005} 4orxos che to4l Job valua�ion - Mitiimum $.50
� .�O 1 x Pumtit vglu�[iors (] 110°,'0)
_� �, �?� 55.00 (Stnu Licansed R�s�dcncial Contrectors)
� W _ S� �aso �exr SAC Unli (Plsns t�o MwCC for decrrmination)
� ftt6it� ftx.S20��
� 3'450 Cans�r��ntion P1an Reviow �
� Fa� Dettnnincd by Er�.�inaoring
� A�ccmcnt nrcass�uy ( ) Non Neccssary ( )
- � -.r1 ��—_ Itilrkt i4srJt3 p�yaL1� io: Cilv �t Fri�i.,v nii,...a
1'H15 IS .c+N A.PALICATION FOR A PEW�tIT NOT VALiD (1TJ►'ll„ pitpCES:IED
har�by apply Por a buildin� p��iz and I acknow)edi7c ihat thc information wbova ts carnpletc and accurar,e; that the work w11! be in
-onfom-,nnce H(ch rhe ordfnanecs ;��d codvx of thc Ci�y� of Fridlcy and with the Minncao� C�nstructlon Codcs; that I undetstsnd this is not a
�ot;�,it r,u� �nly an npp�(cadon far a permit and „ork is noi to sr�rt without a permir, [hat t e work wzll be ln aecordancd wlCh the approved
�lnn in the casc of all work which r uiros vlow and approva► of plans.
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FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
.' COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
; When replacinq an existina furnace, the undersigned hereby verifies that the
� venting has been examined and is free from rust, deterioration, obstructions,
`�,�an�d is securely supported and firestopped where required. Yes �Cj
The venting system is plastic/PVC and meets a0 current codes and manufacturer
`' specifications including sizing, length, number of elbows and termination. Yes �Q
- The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
' assisted and natural draft appliances. Yes�
The existina combustion air is sized and installed to meet the current codes�
and manufacturers specifications. Yes ( )
When required to instalf a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes �
When installinq a new ventinq svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category 1 Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes �C)
Is the common vent and v�nt connectors sized and installed correctly after r
an appliance has been removed from the common vent and vented
separately as per current codes. Yes (�I
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type Tk�ni� %�ui2 BTU Input 80� Fan Assisted or Nat �_
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type �3 Vent Heighf �o � Diameter �_ inches
Appliance #1 Vent Connector Height ft Length ft Diameter ` in Type
Apprliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ` ft Diameter in Type
_. ,
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' ALTERATIONS: (Describe) R �R �UR. �
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HEATING CO: 1fiJ �
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Signed By: ``� % - Date : F°1 � - a -o�"'� '
, :��,
No ( )
No ( )
No ( )
No ( )
No ( )
No ( )
No ( )