AF - 43548V�llage of Fridley, Minn.
BUILDING PERMIT
N� _ � i 12 Oi�ce of INSPECTOR OF SUILDINGS
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Architect Fridley, Minn., �'���-�'`��'�"� �"'' � � 19 ��
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� � ` , LOCATIOIV O�' BUILDIlVG
No. Sireet -��"''�`"�'�"' '�"`'�'� ~�"y� Pa,rt of I
� � �ot��M ''�'� Block ,� Addition or Sub-Division � �`�j E�`��'`fi°�- f �
DESCRIPTION OF BUILDING
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Front ' � � De�th ` '"'� � Height ' "°' Stories "` Manner of Construction f � �
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To be used as �` ° ° To be completed �` `�' Estimated Cost'
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Permit is hereby gra,nted to ,;,�''�.�."�"�"""�'�,^'°''''.�.'.rf.� �."�,..�•,.�'� to ��_`.'`"u``,,"`„-,`�--�`...,`
the building ��"'°��`"�"""��' `�`�""`""� , described fn the above statement. This permit is granted
upon the express condition tha� the person to whom it is granted, and his agents, empioyees and workmen, in all
the work done in, around. and upon said building, or any part thereof, shall conform in a11 respects to the ordi-
nances of Fridley, Minn„ regarding the construction, alteration, maintenance, repair and moving of buildinga
within the city limits, and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. �; 4 y�
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�"'C��" °���' , �� �%b="��.�+ Inspector' of Buildings.
AGREEMENT AND SWORIV STATEMENT
In consideration of the issue and delivery to me by the Inspector of Builclings of Fridley of
the above permit, I hereby agree to do the proposed work `in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
'sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated. � � �� �
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Subscri ed and sworn to before me at Fridley, Minneso�a., this �'"`-�''�"
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day of -'�.�.» A.D. 19� ,_ � z'`":, � ��� , ��'....�&�t���..,
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��, �kthe baxildmg'_"_„�� described in the above statement. This permit is granted ;
�-, ��� �����: uvan the express condition that the person to whom it is ; gran��d, ��and his agents, � employees�� and � workmen, � in ail ��� �� �
��� ��� �#the wo,r� done in around and upon sa.id biailding, or any pari the�eof, ;shall conform in all respects to the ordi- ;
�' `�' +na�ce� of I'ridley, ' Minn:, regarding the construct:on, alter�,tion, ° maintenance,: repair and moving of buildings �
n ;�� wxt#un ; the ciiy limits; and this, permit may' be revoked ai any time t�po violation of any of the provisions of said '.
s "*'� � E
� ����ordinances � ` �
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`�` �� h epecior of �uildings.
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'�',�" }�� #�'iaa consaderatzan of the issue and' delivery to rrfe by th� �n�pector of �3usldan�;s of I`�ic�ley of ¢
��"'��tl�e �bove germat,,;I hereby agree to 'do; the pro,� oaec�. ��:*c� �� in �,�corr�ance ;,vith th.� c�Qser�i�s�ion �
�� �,bo�e� se� forth ancl �,ccordnngw to the provisions O� tI20 OY`Ciiil�,'?iCCa of Frzc�,ie�, and, f�eing first d�ty }
�� �}�# °,sworn, Tr�hereby state and sa�y tYiat the facts statEd by me and containe� in the �.to�ve �Se��if ax�e 4
�����rtr'�e"�a.s therem stated I
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��� � � �+��� �� �R���..�Y
6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
,��TELEPHONE ( 612)571-3450
,s
August I7, 1977
Mr. & Mrs. Gerald Eliason
6401 Baker Avenue NE
Fridley, Mn. 55432
Re; Cracks in Foundation Walls
Dear Mr. & Mrs. Eliason:
Our office receivec3 a request to inspect the foundation walls at 6401
Baker Avenue N.E. on August 17, 1977. We inspected the ha�ne and found
that the basement had recently been painted and no cracks were visible
at that time.
We were told that the front and north walls had had horizontal cracks
at a joint in the blocks and that they had been there for a long period
of time, more than 10 or 20 years, without noticeabZe change.
If this is true, it indicates that at one time movement did occur and
if it did not change over the last 10 to 15 years, chances are good
that no further movement will occur. The present deflection in the
walls does not render a structural problem.
If you have any further questions on this matter, please feel free to
contact me at 571-3450.
Sincerely,
.--" _ .� �
�_.., ,
DARREL G. CLARK
Community Development Adm.
DGC/mh
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SUBJECT
City of Fridley
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T
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� ; L �����_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
I .1 �
�4 1 ����1 � CITY HALL FRIDIEY 85432 NUMBER REV. DATE . PAGE OF
"•"�' ,�� 612-560-3450
910-F15 5/26/78 � �
JOB ADDRESS 6401 Baker Avenue N.E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 12 1 Moore Lake Highlands.
2 PROPERTYOWNER MAILADDRESS
David Larson 6401 Baker Avenue N.E.
3 CONTRACTOR MAIL ADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDFESS
5 ENGINEER MAIL ADDRESS
PERMIT .w- "`
rO 4'726
REC PT NO.
9� �
\PPROVED BV
SEE ATTACHED
SHEET
ZIP PHONE
571-26$4
ZIP PHONE 110ENSE NO:
ZIP PHONE LICENSE NO.
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
S DESCRIBE WORK
Construct a 14' x 22' Addition
9 CHANGE OP ItSE FROM
STIPULATIOWS
TO
Replace all rotted and over-spanned material with new and approved
material.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CON57. OCCUPA
VENTILATING OR AIR CONDITIONING. WOOCI FY'diCl@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1. 3OS
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED TNIS APPLICATION 1 STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND OF;DINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $9OO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR IOCAL LAW FEGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �{XXS� �`%. SO
SIGNATUflE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI �
NCYGROUP OCCUPANCYLOAD
CU. FT.
2,464
OFFSTREET PARKING
GARAGES
SURTAX
$ . 50
SAC CHARGE
TOTALFEE
$$.��
_IDATED THIS IS YOUR ERMIT
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(��J�:w, i1�.�r�r;nT� ui��, /11?»zT i�►��, o;; f;c=i�ni �zs)
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LOT: %c� )iI,QCY.: ��J T�DDITJOP�: _�� �'C3����i��,L %�d l�o%� �.��/�-%�t�j
C01211ER LOT: 71dS7.Dr 1JJT: S::'TI371CY.: SIUL•'Y11RDS:
Applicant attach 'to L-his forr.� 'l�:�o CerLifir__ates of Survey of Lot and proposed
bui.lding locaL-ion dra�rm on these Certificates. �
0
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D�SCRI PTIOid OF BUI LDI I�;G . ,,,
�o l3e Used As : �
! . +� /
��f-� •.� y Fxont: Depth: d ' Height: , -
Sqaare I'eet: -� CuLic �eeL-: --��..___
rront: � Depth: � lieignt: _
�� 5quare I'eei�: Cubic Feet: ' _ �
Tj�pe a� Co��struc�.i.or.: /�_ �/�j�� ^'.5f(�G'G''� Estimated Cost: S
�ic I3e Comnlei:ed: ��G'( (( "`t /� A1.L-. A Alt. B
Px'opased llriveway [•;ici�h If l�ew O�cni�ig Is Desired $ �$
(Srl� I'u VEFw�' SIDE OF SFiF•�i:T)
The undersie�i:ed l:creZ,y makes a��plicai:ion for a permiL- for thc wor}; herein
speczf'ied, aqreei�ic� to cio all t:ork in s4rict acc�rdance wifi_h tlie CiL-y of
` i'xidlea� Orc:in�,i�ccs t�»d rul.u�gs of the Denartr,�ent oi l3uilc?ings, and hercby
{� dec�.ares th�t ali t:hc faci:s and re�?rescntaL-ion � st<�ted in this ap��licai:ion .
V
x'e t�.ue .-�zd correct:. Sc�e xeverse si.ci� for �zcic?iL-ioz. ]. i»to�-�uatior�.
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SUBJECT �
City of Fridley - 17 7 0 7'
AT THE TOP OF THE TWINS g U I L D I N G P E R M i T
' ' RECEI
, � .
r• COMMUNITY DEVELOPMENT DIV.
j ,: ----- . � y 3 � %
i � PROTECTIVE INSPECTION SEC.
� � �
� � /�'�1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE Of APPROVEO BY.
�----�' ,'� 612-571-3450 910-F15 9���84 / /
�os AooRess 6401 Baker Avenue N.E.
1 LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACHED
DESCR. Pt. 12 1 Moore Lalce Highlands SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
David Larson 6401 Baker Avenue N.E. 571-2684
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
S a.ITle
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAllAODRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION L� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Alter Window and Vaulted Ceiling
9 CHANGEQFUSEFROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOF 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 HEFEIN OFi NOT. THE GRANTING OF A PERMIT S8OO y5. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ��.`J.00
PLAN CHECKFEE TOTALFEE
$15.5Q
. SIG REOPCON�anCr RAUTHOR EDAGENT �o.a WHEN PROPERL VALIDATED THIS IS YOUR PERMIT
` � . . �
TUREOFOWNERi OWNER UILDER� �DATEi BLDG iNSP D E
NEw [ l
ADDN. [ �
pLTER. [�
Construetion Address:
O '
Legal Deseription:
Owner Name & Address: _�
City of Fridley
�R-1 AAD R-2
Building Permit Application
0
Effeetive 4/1/84
�
T Tel . # � � 7
Contractor: S�,�YI � � ��50�7 + � Tel. #
Address•
Attach to this application, a Certificate of Survey of the
. lot, with the proposed construction drawn on it to scale.
� DBSCRIPTIOA OF IMPROQBMENT �
�/� � � /�
LIVIAG AR �� ength Width Height v Sq. Ft. ��
GARAGE AREA: Length Width Height Sq. Ft.
DECB AREA: Length Width Hgt/Ground Sq. Ft. _
OTHER:
Corner Lot [� Inside Lot [] Ft. Yd. Setbaek Side Yard Setbaek
Type of Construction: ���/%�l � Estimated Cost: $ � ���= �1 .�
Approx. Completion Date: �✓ � �
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: � � $
See Back Page for Explanation
� ��
DATE: � �APPLICANT: � Tel. #� �
CITY IISE ONLY
Permit Fee $ ��`� � Fee Schedule on Reverse Side
Plan Check $ 25� of Building Permit Fee
State Surcharge $ �� $.50/$1,000 Valuation
SAC Charge $ �425 per SAC Unit
Park Fee $ Fee Determined by Engineering
SeWer Main Charge $
`S �� Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ �
STIPULATIONS:
... - > `
SUBJECT P
City of Fridley 21 81�
AT THE TOP Of THE TWINS g U I L D I N G P E R M I T
i � RECEIPT N .
� �
� • COMMUNITY DEVELOPMENT OIV.
r � L '� PRO7EC71VE INSPECTION SEC. �// �%��
� � �
1 � /'��i � CITY HALL FRIDLEV 55432 NUMBER iiEV. OA�E PAGE OF APPROVED BV
�""'� � �'� 612-571-3450 910-F15 9/25/91 / /
JOB ADDRESS 6401 Baker Avenue NE
t LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACHEO
DESCR. �'t. 12 1 Moore Lake Highlands SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Hattie/David Larson 6401 Baker Avenue NE 571-2684
3 CONTRACTOR MAI� ADDRESS Z�P PHONE LICENSE NO.
Same
d ARCHITECT OR OESIGNEF; MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAI� ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION C� ALTERATION O REPAIR ❑ MOVE O REMOVE
S DESCRIBE WORK
Insta,ll Bay Wi�dow
9 CHANGEOFUSEFROM TO
STIPULATIONS
See notations on plan.
WA��i��
Before digging calt for
SFPARATE P����1TS R������RED FOR a11 utility locat�ons
4�;�.=;'si'� ;, I�'�6`,Tli'��', �'Ls�„�1���vG Hiv1'J SlGNS.
454-0002
REQUIRED BY LAW
TVPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPAAATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIF CONDITIONING.
THIS PERMIT BECOMES NUIL AND V010 IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED 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 OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED $1 � 3QO $• 6r�
WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING Of A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEFMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL �AW REGULATING CON- $31t OO Fire SC $1.30
S7RUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
$32.95
S�GNATURE OF CONTRACTOA ON AUTHORIZED AGENT IDATEI HE PR PE LY ALIDATED THIS IS YOUR PERMIT
�`- z� -Q/
S�GNATUREOFOWNEAUFOWNEABUILDEF71 �DATEi �DG �NSo qF7E
� [J
� [i�'"
AI�Z�t � �
Oonstn�ctian address:
I�aqal D��P'tian:
R-1 1�ID 1�2
Aiitdir,e �t �pp1iU��Q1
EffeCtiv�e 1,/],/91
0
owner rTaane � Aaaress: �'� �I P� �' !✓a v!� Ldt- �j Z+el. ��'i /`+L6'g�
�
«��: _ I�a vi� �La.��or� _ �. � �-�' �
Aaare�: ��o� L�r f��- l�`G
l,ttaci� to thi.s applicatian, a Dertificate of S�vey of tiye
lat, with ti�e p��o�o�sed oanstzvctian drawn an it to scale.
/ � �l
LIVII�G !►Fl�: I�gth � ^ / i'
�►RAL� I1�: L�gth
� JM 'I]/' J •
• �'�]�'
F�CR�D�1 � D�AO�VH�tT
'} / ll /
Wif11.i1 �/' ~ V ��� ��
i�lidth Heic�lt
wiath __� �t/c��a
/ A / LI _ .
�. �. z '7
Sq. Ft.
sc�. Ft.
O�rner Int � Inside Lo�t U
[] Ft. Yd Setb�3ck Side Yazd Setbacks
Zype of C�anstnx.-tian: ,���C f� ,o F�timateci c�ost: S . DO
��. ���� ��: � � 30,� �q/
Prq�osed DriveGray Widtii If New Openin3 Is Desired: Ft. $ $
, idth + 6' See Bac,k Page
n�: �`��� c�,rrr: �. �_�� -� Z�'gS�i
Permit Fee g .�' /� 6 �
F.ir+e s�x�charge S / � 3 �
State S�an7e s �� 5�
SAC Qzarge S
D�iveway Fscx�ow $
Park Fee $
Sew�er MaiTi Q33rge $
+•1�_
��M�:i�Vy • .ti .
l
g ✓ Z � �lS
«��c � :�_ . ��
P�ee Sd�ec�ule an i�ev�exse Side
.001 x P�ermit Valuatian (1/lOth $)
$.5o/$i,000 vaivatian
$650 per SAC Unit
l�lt. "A" o�' Alt. "B" Abwe
F1Be L�e�te�r�ri ]� �; r�ri r�
� �� I ] � N�rY [ ]
/5�
/6
3
� , 3 IS
,6�
3�
<<
��
�� , � � �
J, _
�� �,;
_- --- -----_ --- _
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` �j,
� /� �7� � �,
� �
� � '
,
_ __
SuBJECT '�
c�ty of Fridley ?�� 9 8�
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T �
r
� ' RECEIPT NO.
� �` COMMUNITY DEVELOPMENT OIV.
1 � V � PRO7ECTIVE INSPECTION SEC. L��3
� �
� . � _
' 1 �'��I � CITY HALL FRIDLE� 55432 NUMBEF AEV DATE PAGE OF APPROVED BY
�"'"�'� ,�' 612-571-3450 910-F15 � /
11/9/94
JOB ADDRESS 6401 Baker Avenue NE
t LEGAL LOT NO. BLOCK TAACT OR AODITION SEE ATTACHED
DESCR. Pt. 12 1 Moore Lake Highlands SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
David Hattie Larson 6401 Bake A e 571-2684
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO
Same
a ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO
5 ENGINEER MA�L ADDFESS ZIP PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WOF1K
❑ NEW ❑ ADDITION X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOFiK
Install new window in dwellin
9 CHANGE OF USE FROM TO
STIPUlAT10NS
Room on south side of house is separated from main house and considered
a three season porch. Remainder of house must conform to Energy Code in regards
to installation of increased number of windows - submit Energy calculations.
SEPARATE PERP�IITS REQ[1lRED FOR
WIRING, HEATING, PLUi�BING AND SIGI�S.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, .
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING SQ. FT CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OF IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPL�CATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF �AWS VAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT �I �300 �.65
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PEFiM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �31.00 Fire SC �1.30
PLAN CHECK FEE TOTA� FEE
$32.95
SiGNATUAE OF CONTRACTOFl OFl AUTHOAIZED AGENT IDATEi WHEN Pf;OPERL ALIDATED THIS IS YOUA PERMIT
� � �i-�-��
SiGNATUFEOFOWNEAiIFOWNER0UIL0E�71 �DATEI BLO �NSP T ��4TE
NEW
ADDN
ALTER
[]
[1
[J
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-i AND R-2
Build'utg Permit Application
Effective 1/i/94
��{S�i 3
ConstructionAddress: ��' �' ���`��- ��itt� �
Legal Description:
Owner Name & Address: �'�:��'��" �!1'[� /�' ��`".� Tel. # .S%/ — �- � S � _
Contractor: ,�t„ � G-' MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Leng�th Width
Leng#h
Length
Width
wiclth
Tel. # .
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
OTHER: � �%`/t D�,r,� �
� vv !iL'/h a�iv (�f ��,�ai-S� GYi �. ih ow
�Q'}/ye� Q%�l�, .S/�� L�JG't1L�f,$� �.S S���T� �c�'�? /�ji✓ f;f,l/.fG�r � oNS� `ci�ld„f .3����� !�R',G19 "�J1��`/
Comer Lot [v�Inside Lot [] Ft. Yd Setback Side Yard Setbacks C���' �'�"h' �� `'
Type of Construction: i h D wS Fstimated Cost: $ �,� D a �'r `��
Approx. Completion Date: ���ST ��v'�`�'L
- �� �l��� f�J� �N .P�'�rr�.�
' (Cost on �ack) .rv Yws�$LG�r�J �.�c��i��
Driveway Curb Cut Width Needed: Ft. + 6 Ft — Ft x$ —$��'�. c�� w•w�w �.
DATE: N 0 c% �`7 � APpLICANT: ��L� G a f- 5 0� Tel. # S%/— 2��I �
Permit Fee
Fire Surcharge
State Surcharge
SAC Gharge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ _O�
$ .30 _
$ ,6S
$
.$
$
$
$
$
$ �z .qs
�ITY USE ONLY
Fee Schedule on Reverse Sitk
.001 of Permit Vatuation (�ll{�h9E}
$.50J$1,000 valuation
$800 per SAC Unit
.�,
i,��r� L--�/��� GAt.�:
,
$5.00 {State Licensai Residentiai Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Pian Review
Fee Determined by Engincering
Agreement Necessary [ ] Not Necessary [ ]
. Building
Inspections
763-572-3604
763-502-4977 FAX
SI7'E ADDRESS '
THTS APPLlCANT LS:
PRQPERTY'
OWNERI
TENANT
CONTRACTOR
SL'BMIT A C�P�t' OF
YOURSTATE
uc�sE wz�
APPLICAT[OI�
P�RMIT TYPE
From: 763 522 6527 Page: 2/5 Date: 3/16/2010 11:50:37 AM
MECHANICAL Permit
RESIDENTIAL APPLICATION !
CI'T� OF FRIDLEY
YOUR E-MAIL ADDRESS
C3 OWPiER 1�COI�TIRACTOR
ADDRESS: ' CI
PHONE:
CQMPAIVY NAME;
COKTACT PCRSON:
STATE LICENSE �!
PHOiVE
F.�SMILY ❑ '['WCl PAM[LY
TYPE UF WORK: I ❑ �� '7l,�PLACfiMENT
DETAIF.ED DESCRIPTION 4F �IQRK
Received By:
Da#�pq�
Rr t I.1
EXP DATE �� � �P f O
� Y`tCJI �Lti.tl C1TY ° � V�s'l
---------T
FAX
Q TUI�'NHOUSE
D ALTERATIOAI(R�MODEL
(2 r�a \� Il a!' /1r�C1� : '�i i�ilYF
STA7'E ZIP
ATE 1"R�ZIP "-��
FEES ARE BASED ON SIU.00 PER FIXTURE, EXCEPT WHERE NOTED. Fi7iTiJRES: (INDTCATE TQTAL NUNBER UF EACH BELOti'V)
PROVIDE AEi►'f LpSS CALC'S PER MATU.#L J 06 AS}IRAE IiAND�00K.
Equipmentlnstalled MFG: ��`L � MOD81.: c�Ja���i��io��i4G SIZEJB7'[J iQl����
��: " ��' MODEL: 1a�'*►lv��;�l s�s�-u o� '�6Y�
�'C S25.00
_AIR TQ aIR EXCHANGEER 315
�BOILER S3S.00
CHIMNEY LINER 510.00
I7UCf WORK $I0.00
Number of fixtures (a� $3 Q.Ofl
1v1FG: MODEL:
FIREPLACL (GAS) $15.00
_FIREPLACE (WOOD) $35.00
�FURI� ACE �i5.U0
GAS DRYER 310.00
G!\S PIPING S10.0�
�i--�
7i � 1 �.0� _ $
Nutnber of fixtures @ $i5.00 x $1�.00 = $
Number of fixtures Q$25.00 � x$25.00 =$ G!�
i
Number of fixdires Q. $35.00 � x$35.00 =$�_
3tate Surcharge = $ .50
SIZFJBTU
GAS RAI�GE/OVEN 510.00
_NEW GAS GRILL 510.00
_GAS l]NTf HTR S 10.60
POOL HEATER 535.00
VENI7LATQR 515.U0
�Cotal = $_ _ _ 11! l/.:✓"
TH1S !$ AIV APPLICATtONI FOR A PERMIT-NOT VALiD UNifL PROCESSED
i hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work witE be in
confamance wi.th the ordinances and codes of the City of �ridley and with tt�e Minnesota Construction Codes; that I undexstand Wis is
�ot a pexmit but only an application for a�ermit aa rk is n t4orstaR withoui a permit; that the work wiEl be in accordancc with the
approved plan in the case of atl work ' ir ;�e,v � � gval of plans. _ ,� C
�.
SIGNATURE OF APPLICA,�1T � � , � rY �� � F PRIt�Il' NAME �.}�� �: � ^ f % i ' DA7E � �t? T,.l
APPROVAL INSPECTORS S1GNA7'URE � flnTF. ���
'ERMIT� RE U1RED FUR BUIL,DWG ELECTRIC,
City o� Fridley
Building Inspectians Department
64;1 UniversiTy Avenue NE, Fridley, MN 55432
763-572-3b44 FAX: 763-502-4977
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From: 763 522 6527 Page: 4/5 Date: 3/16/201011:50:38 AM