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AF - 36555sue�ecr PE IT NO. City of Fridley . 13355 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � , � R O. � • COMMUNITY DEVELOPMENT DIV. � �' <�rC%� r ; ,: ----- , rJi�^ • � � � � � PROTECTIVE INSPECTION SEC. �;,�� /'i C. i , � /"�1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY � ----�'� �'� 6t2-560-3450 910-F15 � �22��6 / � JOB ADDRESS � 579 Bri ardal e Road N. E. 1 �EGAL LOT NO. BIOCK TRACT OR ADDITION SEE ATTACHED DESCR. 4 2(2) Rice Creek Estates SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Pine Tree Builders 8535 Central Avenue N.E. 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO. SAME 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL AOORESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING residential 7 CLASS OF WORK C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 40 x 26 house plus 23 x 22 at�ached garage 9 CHANGE QF USE FROM TO STIPULATIONS Sewer: (Approx. 9' Deep) 1. Copy of truss design 34' S.W. of M.H. (Inv. 906.61) 2. Provide a verification survey Wye Elev. - 906.75 3. Provide a hard surface drive Top of Footing 910.50 (Minimum) WATER: •10' West of sewer Service *The City does not guarantee acc��of uti 1 i ty 1 ocati ons . a'� ��t��, _ .., ��,. .,, ., ti�z�� OR �ItR?c?�: � ;ri'��al\�� r �;i �ERAT� r��,�.�;►�� d�� . �'�' NG AND S�GNS. ge{o�e "�L��" � �E�-�-��°�� '�� HEATiNG, PLU�lBI �� :, TYPEOFCONST. OCCUPANC ROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, WOOCI f Y�a�CIe 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 1072+499 ��088+4990 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 AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $33�H8Z.00 �6.94 WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMIT DOES T PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PR ISIO S OF ANY OTHER STA E OR LOCAL LAW REGULATING CON. nH. �n 350. OO STR CTIO OR THE PE A C OF CONSTRUCTION. `'� �t r�'I I PLAN CHECK FEE TOTAL FEE ,��t�� ,� � �- � 1 7� 415.18 � SIGNATUREO� coNrRACTORORAUTHOR n� NT �Da7Ei �H N PROPERLY VALIOATED THIS IS YOUR PERMIT .r�� - .�, ��,� / —� .z ' �� SiGNATUREOfOWNERdFOWNERBUILDERI IDATEI � BLDG iNSP �ATE �� ------�..-e,�-- .�__.�. � . ;;i . .. , �:.}; r c — APPLICATION POIt RESIlll:N1'IAL, AL"1'I:RATION, �. � ',; _:. ..;:. - OR AllllI'fION BUI1.11ING PERl�IIT K r:' ` ` �. , CITY �F 1�RIDLEY, I�tINNESOTA '" '•. oWN�r.'s NANI�: J� lNr= ��r f= lJCtr�c�k�,i )3UILDrR: . ' � � , � .' { ADDRESS : �� j ��F "' �� q L � u c. ADDRESS : � ,/� Y � NO : � � � S TR��T : � . `:� .�� '� � �%� �7'.� . �� LOT : BLOCh: % ADDITION : � �C<<= �� - � f_ S �A�ES _ CORNTR LOT: INSIDr I,OT:�rSETI3ACi�: %S SIDI:YAI:D:�"�_1__L _ Applicant attach to this form Ztao Cer�i.ficates of Stir.ve of Lor anci ��;opoa�c� . building locatinn dratan on these Certificates. ^ �. UESCRIPTION 0}� BUILDING � To Be Used As :�' "� �/L'Y �`� <n j r : ��0 4S'E Front; �% Depth: 2 C_� Height: /�. l� 7 2,- Square Feet : �-- Cubic Feet : �- ? '�� , �f��C� �-- Tront : � 5 Depth : � �z- Height : � � � � Square Feet; �°{� `��_ Cubic Feet:_ ��yd_ _ � Z`ype of Construction: i_,�) c.�c;0 ��w��- �stimated CosC: $ ��-�'�"�� r�, 1 ��'� �i � ; � � - = ' To Be Completed: ,� S �i �� - ` � , The undersigned hereby makes applicatinn for a permit for the worlc herein �: specified, agreeing to do all ��orlc in st=ict accordance taith tiie City of , -. Fridley Oxdinances and rulings of the Dej�artment of I3iiildings, and hereby ' declares that all the facts and representations st�ted in this application are true and correct. '� : „� DAT� : 1��" I�^ l�G S IGNATiJRE : .Q,ti^� Y i � (See Reverse Side For Additional Information.) �.�'.��,.�,�,,._ J�'� y' � ��s ;`,: A�% � .[� � 7�L15,i� �� C �'"- ` t°�`.. ,��(�<'_ . . • . , _+ ,r�- „%'- � �. 9� ��Y> 'b��,� :', ..� .� %,q• �:� f. s�.�� " �_ ��° -._�_ . , ...- �. .�, �,,��--� � ' ' � , . - , . . ._...,. � �a. �° �,� � FOR CERTIFI�CATE OF SURVEY Pine Tr�ee Build�rs, Inc. W q ��C - o ct,t ,�,�.5� . :� ,�.-�� _-- _ � orQ.�- - z.! ;. b �v} `�a�e,mer� • � !I a�e �� S�O , ��. , .�—�' � , � � N � � ,� r" �y N � �� --� / .�,f .. I „ � \� � D� 5�jq�12� : � � � � �oP�� 2�� \? �� Op`'. ��P� ', . � N —IMP__ ORTqNT— fVOTIFY THE FRIDLEY ENGR. DIVfSION REGARDING CURB REMOYAL AND REPLRCEMENT AT D�IVEWAY OP�,�,�;;��;g � Denotes iron monument ��`�� Before d�gp,ing caii local utilities TEtEPN�NE - ELECTRIC - GAS Etc, RE��l��b B�l L.,�V1� Description: Lot 4, Block 2, RICE CREEK ESTATES, Anoka County, Minnesota �or.vn �' Cou�ttrc� �uruec�or� L�nd Surveying • Site Planniny Civil Enyineering 8816 70th Av. N. (I S4 at Boone Av N.) Brooklyn Park, MN 55428 Phone:533 7340 I hereby certify that this is a true and correct representation of a survey of the boundaries of the above described land and of the location of all buildings, if any, thereon, and all visible encroachments, if any, from or on said land. As surveyed by me this ___ 43��"L_— day of __.._OC�___ , 19 1S '. , �, , Minn. Reg. No. _�Q�___ Joh No. 2S� Book - Paye i , Scale 1" = 4O' / \ �w�-� ��P�Gx. 9 �'��J .i��. 3 �f � S c.�1, d r/1� �-,/, �`�'D �. C�� G�� - 9C�6,�s' �v �' c:��- ��o i�,►v G' 9% �� S O �/' (//V iat um � 3 Y ya •�� jvG . � � �oG � � �f� ?` � /�. lO � �, 0 � ��cu�/z JS £�Y/G� ---�g',�.�..�`�.`s-�-'.",....�'.�.�.�....�.,.�.�.�,.� ��,'��.s�-,- �;� %�£ �/T j' �b �S N� T a � CJ7"'i c. � � � , �,v �9 R � � t� F �- �C. C GI /�' � +C. y ,LaG��v� 5 , � .�s ' � � _ '� � } � ai ' � Z�' . . �� s� � k �� ' � s Y, , t � y •° y �, p �, . � . r� � " . . . �., � j;'j }\ ': ' • . - _ i . �::, k t . . . ' { F G ��:' _ , �� q , � "` PINE TREE BUII.DERS. INC. � 17745 BLUEIIIBD ST. . �✓ CEDAR, x[xx. aaoii ...�'�" w•�- ' ,,,�,,,'." � � . . . ��-; 6 � ' � j �� .� . 3 �..of � � `. �`� � 4 � Y" Ft f.�¢�e�f �s�l� � ° e, ,( I�� ' : � r , �, r . ,`, � ,i,: � � �y..,� i r �', � � . � . . . JY�ti � - . . ., � _ :. . � a ' . �^: � ., . i .:�"r. � �� . � � � _ � �a�°c�. . � � - � � � � . . . . . . , . � s.; � � �« . , ,�. s �i. ,� �.` � � . . - . . . � . - �-`y *,� . . . . . . . . [.: . 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'111. . , _ � .t�ES %/��,� i ��7 y 6,e� �,Z ,i�4� �/�sE�,2��i T-- - 5'a �--X � �-`�'-? - --_ �6 �-g � Z X _ � " -- g'2 °�=-��- -�_ ___ _ -_. I / s r �-Pe�rr, — — a --- - -t _ � - - _-a� � a5�� X y°--"- - /o � � z �a� %3n �_ �`� z _ _ ��%-�_ X , o?a 'n 21 . i� = -`�� 9 x -� 3 /d� 'l-Z1�6�/�_3_- �o'_= �91� 3 , B � �a � s� .� _l' - ��, ��y _ a� 0 8 8 _ ------ --- - - --- - --- � . ''�_-- _�9�'a __ -� _ --� — --- - -- - - -- — _ _ a G o� g----� 3-- ��0 3 �. ---- ` �- _ � � a y _ _ __- —� ' ..��v x �aZs � � - ��' . __ _ _ _ - � z� _ -- --- _ ,>- `�az-�a x �� 2 ; ay 2z7 --- - - -_ __ _ _�- _ -- _ l�- � � � y� x- _ �� = __ � _ � 9 3 � �� 5� _ . _ _ �� X _�� - _ ��, i�___ __ . --- _ _ _ -- - —; �'�. z `/ ��z — �z _ C y� �� , "i 5,4c '�' ,3,�d, o� i- -- - - - _—_ ___ �- _ , � � �g • ' . _ - ---- -- ---- _ � � � i I _ - � � �iy`°� �� 'ri�loy , • � •., � . :�;i5��36ri:ic?� �CSe' �'�(Fi�c�'n i� �.,�� '�rw L bi�;�:� b ��`�'•i: . ti . _ � _.^_.,________„_� ^ _.-_._.--_ De�t. of Bldas. Phono S:yJ-3S50 D�SC�YP7IO:i G� V; OI;i. ��,�y�„ .� � � / ?iva:�:•, �� ;;i�.3 e.nd I.ecr!��n o! Fl�h.:�e� I I � w�TEa H7k. Cli}� Oi �"1�C}�:, I� o K z o e '`__�� . C'''Y /��," � /'. �, �- I t 7 '��UNIo�, uI ` ' � �� ~ � ': 1�� I�� I �' �� ';`<' I�? � 7�, 7�' r ►+ c�s c�cc. The undersibr:ed hereby rr..3kes a��'.Scation for a prrmit ter t`:e vozY he-e; ^'I: N i; � � S� � �! f? I� ; �� ;,, �,, S I< � Eu � Iu � iu � speci:i^d, a� eeinE to do �ll �ti•o:k in s:ric: acce:r'an.e w.,th t!:e Ci�t �:r-�'=-e - / � / ^� ar.d ruling of the Depa::r^er.t oi IIuila'a�s, a^d he:eby decl2z�s �hat a:I L':e faei E3sr � L � �` j�'"� •, and rapresc-ntatlons stated ia L�:s a�Dlicatson are true and co:rec: 1:; • _. ��7 �i I r�idleY. blinn � 19:,._ 2�� I —_ . . 3: C f I � Owr,er —��I r _ � I �_� J _ _ Kind o2 Euitding . . Cc: r.z_:.:d �iYz � F u:.: o Cc :::.; t.'._- a Cr�. �? r_ : -- S�aar ❑ Used as � Nsa F"i::��:�o, O;d Crfs4:^.�s Cc�.pcAl � - - To be co:r,pleted abaut ��`� - P��',T1AE. RAT� S�H�DUL� : L7:dBI?ZC FI:CTU;?E P.ATES: ii0. RATE TO:AL K;:rz.ber Fflx;ures . . . . . . . . . . . .. . . . .____�_� - X �3.��. $_�''='= Fl�l�re Flxt::re (��cr.ing . . . . . . . . . . . . x S1.�A S . -• :�ew Fix:ure O;r! Oyening.......... . x$1.50 3-----• C�tch B.;<_in . . . . . . . . . . . . . . . . . . .. x 53.25 3 . r e �_C?O • ' ' R'ater fieater 'l;p to rs3.004 �3'Iti)• ••• x 3 CA 5 • ::e�r Ground Run 013 B:dg. . . . r. . . . __._ x :3.25 3 E!ect�..c 4`1,:er Y•sstas . . . . . . . . . . . . . . _ z $3.00 � ."s!S FZT;I`iG Fir3: :i0. Rn1� T07AL ..�L— x 52.co y d U O • Ist3 Fix:ures •••••••••••••••• . Add! ti�nal F�xtt:.res . . . . . . . .. . . . . . . _------- x ;. .'15 $ � Gu P.;...^Ee to 1�3.00x1 HTV .. ... ... ... r----- X S5.00 ,�i Estimated Cost, S / S Q� ""° �� Old New. ui:ding Permit Iro. P�r�it ?70. ti-s� �-t � • Signe�� • Bx, �-C/�K �/�`--��j� Busir.��.s Ph�ae No 7��/ � 7� ROUGH FINA.*., �-'7 - % � '- 0 . �.50 State Surch�ge . °.E?.l:StS � AL: EF.ATS�HS—P.a:er Sa Codo . . T)c:cri;.'�on . . . . . . . . . . . . . . . . . . ... . . . ,.. . . . . ... . ... . ; • . ' TO': A!. F�'.:.F. S��' U � �� • • • . . /��r:!^,�..s-!t.!A '%�.,.np f'�.�,.ti•,..y �'-�--,r,�., �.;: �3 $�..�»`*` ,.� �.,..£? ,y F� .-r.°F.�*n,..,' �!w°�-5�'!`-+,r-^`'�.. • Y.�.�am,¢vl:r..J! ��'a W wci�.::. � . ..c;a^ .�.�4 G��,..� _�� w+e��eiiv��' 3 :�. .y:y.ai�wt's,� •e....�.�.,.�G.:iL�J� �i'.�s�w:•� � 2 •^LfAa"..,.5° �.°m,..�°..t �w ,;...{!, t�^.+,�ra �!.°,'�.•_^� G�J� 'o¢':vu�waJC�..�•�.:x� s��..:.i.at2.� ..E.�:�3 ':�v':,:u@�::-.•is ,d P�R�'ir,� �T� ��i �i�;.�� GF.l�YITY `�tAR?� AIR: F.r-nzcr S}:�12 � I'rJC-t �''i oric Rr,�I:ccmrnt of 'e�:rnart P,r;,ai-s l� A`tc�ra;.cns-- up to S.`.UQ.00 Re�a:rs Z.�.;t�ra�ions each add. E500.L'0 �iCii. �k Aiil3 11.I� Fi:;T1bCt S.�:t�� it Til1G'� �nr'+S iA i�tii,� B� . CY'...�1 i��. �0,�� BN . . . �D'sCe^%ey: of r^srn:ce Re�ain & l,lte=aUon,s--uD to SSr?0.p0 Reyairs f: A}t�ratiocLS ea<h add. 5500.00 4'�. : . r TL'': T.L . . 3le.co 3 6.00 � 6 �0 S . 3 t� b � `�-c7 :1� � s � 3.W S s oo a 6.00 S 3.00 a �TEAM o: HO i ^r�/A3�R SYSTE?� r`..�r.:n:r S'��21 Sc Ltr,es-- to 4^0 sa. 1i F.DR St�¢r.i. 5:0.!x? 5 flzrnace Sh�11 Sc Lsne----te 6�G sG ft. EBR F?ot Water IOC?0 S.. Each �dd 20�3 sq. tt EI�K Scer,m 3 tlfl g Each add. 32C sq. :t EDR Hot Wa:r. 3.00 S OIL BII3ih�P.-to 3 gal. per hour 6.�1 S. � over 3 gai. per hour-See Fee Schedule GAS BV'�i K£R (up � I.�J.� BTU) ov:�r 2S3.Ot�0 B"I"J See F�e �chad_lo L',.�.5 FITii*iC �i:5: I+p RAi"r: TOTAL --- Xo 2W S �` �� -- X .7b !--• � -.- _ �S 6.tA � _ State Surcharge .50 k� T,o�a Fc� £c�.zaa 'FO'i AL a'"""un. $�_L'1SC d.a� s � �O lst 3 flx:ures Add�tional F1ztUres G;s Ftar.gr Lb I..�.OJO AIR CJ:S�iT20�IF:Cb' �: .'F :r:.1.Z.`2G LY3i"�"" 7�TLrZiZ�v II7'o; �^-3 RLa'�:iA°7CF;8 :k F.:.'P1�.:.�3 xouax �.�s, f i'/ G - �' C ��ae. o� :��-!�. �� :��-✓�� 0 �\ /� 7 City o4 Frid?ry: Thc �:nders'qnE.� hercby makes applicatie� for a flcrr.iit !o: L'�e wori� 2:e:d- spec�iied a�rc�e•ir.g tr� dc all work �n st:ict ac;ordan:e with Lhe City Ordir��c�- and r�,�ir.g of the Depa:tm�nt,of P,u:ldir.es, an3 hereDy decla:�s Ltiat aI] tbr fae�,z and reNre.Senta[iur�; stairti �n this appUcauon arr true at�d correri . � Frid ey, :titian- �- - ! � 18�(� (1wnPf �� .!J��C � ,0 Kind ot Buildin�.�Lr Used a� T� f>e compieteri about _, _ �L%� C/ (/ �9v Es!ima+c�3 Cos;, S � ,� Old-New. Huilding Pernvt No. -•-- ---�.._— Porm�t No._ r.� '` .� �•..,...' =•,;-•-c? � TI a�7 U,F W G:ts FiEATTNG or FO�R Fi.r'tNT`°',r-t�tcs.� f:ct Fa•,�er, i��Ido 7'rade Name ..__� Sisr Pia- �/� -Q 3 i Capacity�..--.--- -- SQ. FL i.D.R �� B'i(J 3.P TotaI Connected I.c�d�� isind cf F1i¢ BURh'ER - Ttr�..e Name_ Si:e Na L��.�``�, � Cay+�city 3q. lP't. E.D R- IiTiJ �'_ c��xaxs.�.ot�t�) �,' / /, / . s I i --' - - . ,. ♦ . .� ..,�:. , : .� . . • � . � ' ��y�� ; ►�;l�y . . � � � ' s a^-6 a • � - •,ti • � . . , � . . ��.�e �3C�i`ic�� : �!(,�i��.:,:s i°� �.�r �.'�w h'la'�ii!'� b ��"e'.".'�is . • - -- .____._.___ Dept. of E;d4-s. Phono S:.�•3SS0 , - •- ' D°QC�IP � IOii Gc V; OI;:. ' .� � � /_ i� � �� ,C° l- `_�,?= j ,i, �r 4r I XLa:`�.•,z. !:i�d n.^.d I.ccr•i�a o! Fl�h�re� . . : ��r � ��:�� ` �� o I< L S�2 � N�s �L ; t� 1 ; 4 � ,� --- � E�<_r ;,^�,` �. � . 2rd ` 3:d 4::� i � • F u�: o Cc y..._ •.s.- .. C� =- _ i ?isa Fi::��^o. Old Cl',.o _"•�s � � WATC4 NTK. U R I 7 ��I,i,z o� o � � e �� { � ; < � ? � I 7 � 7 � r ++ c�s ucc. _ a I,, < 3 �u u a;u a :;>d P�P.1'lAL RATE S�H�DULE City oi F�-idlcy:. Thc ur.dersi�r.ed hereby zr.akes s��ca�on fcr � perr.'tit fcr thr ao:Y her�i specifi^d, a,;.eeinE to do all «•c:k in stric: acco:�'ar..e w:th t`:e Ci� �i:.::::t ar.d nling of the Dr:pa::r:zer.; cf B::ila.'�Zs, a^d he:eby dec:ares L'�aL z:l L':e fzct and r2Dreser:tations sta:ed in L'�.is a�p'.ica'�:oa are t: L� a.r',u co��C � sYid:ey, b:inn �9-.. _ �i + . Owr.er �� /` , � �'- z � - - - �.�'J7AJ! � Cc::pcol (-] ; L�'�SBI2ZG FI:CTJ?E RA7ES: ,ti�. RATE TOTAL N::r..bet FZx;u:es . . . . . . . . . . ... . . . (�—.- x �'-.C��, g �� -� � �/ �' F1�ture Flxture C�,,cr.ing ........... .�— x 51.� S=1=. 5 ::ew Fix:ure Ot�f Oyening.......... . x 51.5Q b----• C�tch B.;<_in . . . . . . . . . . . . . . . . . . .. x 53.25 E � � � , � i' . ��';,ter iieater 'Up to �,000 BTU� •••• x 3 G? S `:e� G:��1r.d Run Old B:dg. .. x:3.25 S ..�.... iiectr'.c 4`ia:ar i:+,�tar. . . . . . . . . . . . . s $?.C:� � il.S F17TI�iG FEE3: :IO. R�TT..' T07AL • • • • • • • • • • • � .Y VL.� I '� �� - Ist 3 Fix:;:res • • • • � • • . Addlti�na? F�xtt:res . . . . . . .... . . . .. x � .75 3 � C�s P.�.^Ea to 1�3.00� BTV ...... ....• . x SS.CA G Kind cf Bt:i?din; Used as To bc coT,ple!ed ab,�ut Estimated Cost, S . Old-New. F3ui:ding Permit 2vo. -- P.zn;t ::o. !' �� 1� % /; �-. �' ,�i�'„ ,,? .�'� • • Signed,�•_ �,-_ ROUGH FINAL�� - � - % � � . � : .5C S�ate Surcha.rge °.�?.1::i3 bc IILTr°JITI�t1S--P.�:o� So Codo . . Pc:.c:�i;,'Jon . . . . . . . . . . . . . . . . . . ... . . . , .. . . . . .... �. ... . -S . . ' ;'O'i'A.L F'''.:.E s : � .-� . � - i' • ' •4� • ~ � . By - -- - - �_ Busin�Krs Ph�r.t .Io_ - - • � . • -. �� ' : ,';� ( �' � l�� __._... _ . . ,�. �, , / �---__ � .._ / : �I' ��.,_..��..__�.:J.� `�� `��i;� : i.; � ��:' � \'\�� % �, f l`� %�; May 14, 1976 , � ��'�'Y O� ��I��.E Y 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 `.� Pine Tree Builders Inc. 8535 Central Avenue Minneapolis, Mn. 55434 TELEPNONE ( 612)571-3450 Re: Final Inspections at 1578 6��oodside Court and 1579 Briardale Road Dear Sirs: Final inspections were made on the above addr.esses and the following items were noted and must be completed before the construction can be finaled out; 1579 Briardale Road l. Sod the front and side yards by June 15, 1976. 2. Provide house numbers on structure by May 28, 1976. 3. Provide smoke detector in basement by May 28; 1976. 1578 Woodside Court 1. Blocic wall and top plate on north�end in basement by May 28, 1976. 2. Nut; on anchor bolts in garage are missing by May 28, 1976. 3. Provide sod in the front and side yards by June 15, 1976. We will expect the above items to be completed by the appointed dates. If any problems arise that wi.11 prevent you from completing these items by these dates, please contact us. Reinspections will be conducted on or about the appointed dates to determi.ne compliarlce. Sincerely, RON HOLDEN Building Inspection Officer Q`,��UT:O�y ec, ? ': a V ¢ �� ^a. i; �6 _ �yjb �� c � , �v�' �rDs �' � ;'�.` :' ,.,i�: � �. �, E S1 l " L.h r �-, � � ,� -� �.�<, ,., , �; �. `� :c ' :;;: CITY O� FRiCiL.EY 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPFIONE ( 612)571-3450 October 10, 1979 Mr. Richard Becker 1579 Briardale Ftpad N. E. Fridley, MN 55432 � Re: Junked, Street Inoperable Veh.icle Stored at 1579 Briardale Road N.E. Dear Mr. Becker: It was confirmed by an on-site inspection on October 9, 1979 that you were maintaini,ing a 1973 Ford Pinto, with expired License #BQS 891, on the above listed property in a junked, street inoperable condition. Chapter 123 of the Fridley City Code requires that all vehicles in the City be currently licensed and in a street opera�ile condition. An alternative is to store said vehicles within a building or at an approved location, e.g., a licensed junk yard. Therefore, the City must require you to renove said vehicle from this property or bring it into compliance with the City Codes by either licensing and putting the vehicle in a street operable condition, placing it withiri the conf ines of a building, or renoving it to an approved location. A reinspection will be conducted on or about ten (10) days fran the date of this letter to determine canpliance. We are conf ident in your coogeration and desire to make Fridley a better community to live in. If any questions or problems result from this letter, please contact me at 571-3450. Failure to abate this violation may result in this matter being turned over to the City Prosecutor for his legal consideration. Sincerely, S � N J. OLSOIQ Environmental Officer SJO/mh 0 Fr.i_c�l Pv pc�1 ; �e ctati�n Fridley, MN 55369 Several of us neighbors have noticed a junker car parked at 1579 Briardale Road for some time. We do not wish to be complaining neighbors, but we do feel it is an eye sore. Is there some ordinance that junk cars cannot be parked over a certain length of time? Thank you for looking into this matter. , � , � j� �y,� �, - % � � �� / ��-7� �,�x � �� c.C�f . ��,� —? � � � _ U � � C � m � i5 ..•��.- 1!! i0�d �ti101 � � � W � :9 Z � � N Q C7 � 2 a O z � i � J � � O � Z O F e U J a � Q � � Z O t= CUii � W � Z � ; t;,� Q M J � � � � u� � � � o � �c O � � � � Q a � U m � � i i f t f C � L C � u L 0 � � u u C � LL Q � Z � a a � T�iLO'd LS�T ILS ZI9 m !� 'lr � Q � \ � 0 � w Q Q � Q � O � � � 0 w � Q � �. N 11J 1-- � W � � F- X � (7 Z G7 � J J a W � � � m M 'm � - bo mm� _�� ► � V m O L `, �' � U Cf V i0 � � I� « m � .. � y U O ,C � .Q ae -� y � ( E m � m d t� U � a c m ._. � � � m °� � � � o � � � a R � � � m �r U � � U � C .Q � � Q � � � c � 'Q � x "' r > � `o • � 3 -o'- c � � � � � �, p c � m � � � � � O � y � m -p c� m o � � � � � a� � `o c m � y N '� � � m � a , � 7 � � m � t7 U c � m m � � � O Q v � N � � C � .� m �'��. � � \� 1 ` \ � � � � z �r � � Q W U. � i � � a . � D �� a � U O � � � Z � � w Q � O O O O O O � O O O O p O O O O O O O O O O Q O d i: Q ui r� n r. r• o c. o 0 o u� v� ea en ui fn er� v� y� a> � in i� `- � Ilf��ll��llfzl N Cf } a m m � '3 3 a X Y R � � CL LL � -- � q � �S `� f- 4 �1 t0 � Z� 'O t7� Q CLJ � m• N c � c p� I r � N � m C m Q C ` � C N m s ♦ � �•� a m m m ��'i io m� d � � iZ � � O m`° � F-- S 2�� d � �'� a m d�� a m � m ° � 'R � � � � � m � f-'. z O m m U a�n 3 3 3 c7 C7 m J,3�Q I �i� �0 Jll I � � � � � O Z w t- � 0 w Z c� � m � � m c � m N O � r m � 0 ¢ T m v � O a a � � e0 O �� N! � z a F Q ¢ w � J � 0 U � Z � fi Q �R U lA 4 7 QC Q cn � O U O � Q � O � � N j� � � LL m � O Z � 4 j O � j y � O � O � Q Q ~ w w [L � � rS : Z i 966I -6�-J,HW vi W _ U Z d � � W N � � � z � d � �o W J m � Q z Q v 0 � Z O t= U w � v g � Q W d � w � > � � a w m J J Q _ � ¢ Q Z � F � � 0 V i CITY OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 572-3604 RATE SCHEDULE Effective On January 1, 1997 APPLICATION FOR POINER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES ' � � � ,r - ._�,�,: JOB ADDRESS � �-� � l ,� ��'' JT�t � - <-� �� E'- �,I ,�`� Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace) Gas Range Gas Dryer Rate $ 30.00 $ $ 10.00 $ $ 10,00 $ $ 10.00 $ *�onditioni�g - All Sizes ,.,. - $ 25.00 �lJ/'1 � YrJ �i i�-�� i� / (�--'�� r;i ��--- All Others/Repai� & Afterations (UST ON BACI� 1% of Value of Appliance or Work Commercial/I ndustrial 1.25% of Value of Appliance or Work State Surcharge TOTAL FEE $ ,� The,:undersigned hereby makes application for a permit for the work herein TOTAL specified agreeing to do all work in strict accordance with the Ciry Codes and rulings of the Building Division, and hereby declares that all the facts and _ _ repre5entations stated in this application are true and correct. . .—_ i��___�� —,19�J7 OWNER .��Y1 � �r I�> r` 5� �� BUILDING USED AS ��_ �, , ��_" �-_ �- ESTIMATED COST :�c �' �� PERMIT N0. �� a DESCRIPTION OF FURNACE AND OR BURNER $_ No. of Heating Units �' Circle One (Steam) (Hot Water) (Warm Air) Trade Name �;';�-t-� � � �,�- Size No. BTU .�__?� ,CCc" HP EDR $ Fuel , � �''�/� Total Connected Load $ .50 ��sz� MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $42.00/Hr *Air Cond�ioners can not be placed in a side yard without written permission from adjoining property owner. . , �,. - Burner Trade Name BTU HEATING COM Signed By Approved By, Size No. � EDR Y ��t�� 1��-��.� S�r �- � C� s FILL OUT BACK SIDE FtbR REPLACEMENT FURNACE �� Tel No. y/� '_ �,�'� C`� , , _ Rough-In Date �� Date �- �� STACK VERIFICATION ON �� CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: L Has been carefully examined Yes O No O 2. Is free from rust or deterioration Yes () No () 3. Has no foreign objects lodged within Yes () No () 4. Is securely supported Yes () No () S. Meets all current Code requirements for size and total BTU's connectPd Yes () No () 6 Has total heating BTU's �f All other BTU's TO�!'AI, BTU's 7. Has a liner been provided for water heater Yes () No () 8. Has combustion air been provided for water heater Yes () No () Remarks: List ALTERATIONS Bein'g Done: HEATING CO: Signed By: Date_ CITY OF FRIDLEY INSPECTION DIViSION 6431 University Ave NE Fridley, MN 55432 APPLICATI()N FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, 572•3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DE4'{CES RATE SCHEDULE Residential Furnace Shell and Duct Work, Burner - Also Replacement Furnace (Side Vent - Fill Out Back) Gas Piping (Needed with new furnace, but not replacement) Gas Range Gas Dryer �*Air Conditioning • All Sizes All Others/Repairs & Alterations (LIST ON BACK) 1% of Value of Appliance or Work Commercial/Industrial 1.25yo of Value of Appliance or Work JOB ADDRESS_/� � Effective On May 10, 1999 �� . � / �1 OWNER_�v'� �--IU��1J�n� Rate TOTAL BUILDING USED AS S/ �� G� $ 30.00 $ 10.00 $ 10.00 $ 10.00 $ 25.00 State Surch��rge TOTALFEE MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 PLUS THE $.50 STATE SURCHARGE REINSPECTION FEE $47.00/Hr *Air Conditioners can not be placed in a side yard without written permission from adjoining property owner. $ $ ESTI MATED COST PERMIT N0. /-� %i'�� DESCRIPTION OF FURNACE AND OR BURNER $ No. of Heating Units Circle One (Steam) (Hot Water) (Warm Air) $ Trade Name Size No. ,,�,, BTU HP EDR $�" Fuel _ Total Connected Load $ $ $ .50 $�� Burner Trade Name Size No. BTU HP EDR The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes an rulings of the Building Division, ar}c�`hereby declares that all the facts and representations stated in this a,�plication are true and correct. .:,;�y� HEATING C`"� Cnd f=.�� ond�ti ning . , . . � � r V@. ,,, . . ' �5 i`,`i 5� -.; i Signed - D E ✓ ough•In Date Final Date � 9 App CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes () No () � � Is free from rust or deterioration Has no foreign objects lodged within 4. Is securely supported 5. Meets all current Code requirements for size and total BTU's connected 0 7. : Has total heating BTU's of All other BTU's TOTAL BTU's Has a liner been provided for water heater Has combustion air been provided for water heater Remarks: List ALTERATIONS Bein� Done: HEATING CO: Signed By: Date: Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( 1 No ( ) Yes ( ) No ( ) Yes ( ) No ( ) � <:::�iv-'u:i-z�l�� U.'7.4rj �:r;i��nt�:;iir'i` t;i��it � �l�'�� r. 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TIITIIT T.lf/1= �uu �: �m ea. 1 Name W roun 6ntiro Ho„aa whde nouee 2 Length otexQospd w�p 118.Q rt 118.0 Q � Room dirnansicns �b.D x 24.0 A � CeW�ys Co(ufiL Option B.0 @ d 8.0 Il heatlUppl TYPE OF . CS HTM Aror Load (Btult) A�qi Loatl {6Wt� AreB /4va acposu� No. n� c,y r� H�v c�o cn� H� c�� ►,cq ca � cw 5 Groas a t2C &.t 2,1 wt� •••• •••• y44 •••• •••, •.•• •..• •••• •••• Expbsetl b 14A 15.0 9,S 236 "" •••• 238 •«• •.•• •••• •••• •.•• ,••. vw�u•�d c �w �t.a a.v aeo .... .... y� .... .«. ..,. «» .... .... va�u�ima a o.o o.o o .... .... o .... .... .... .... .... .... • e o.a o.o o ...,. .... a ».. .,.. .... .... .... ..» r a.o o.o o •... ..» o .... .... .... «.. .«. «.. o m��x,w�ar,ni a 7i► sz.e •- ro Z99s "" 70 2099 ^" "" •� pdasa doors b OA ° � 0"" 0 0^" "" •"• NeaCrg G OA ° 0 D"" 0 p^° "" ^" d U.D " 0 0""' 0 0°" "" "" ! .� ° G � 0 0 '«� «« .... t ,0 " 0 0"" 0 0"" "�' "" 7 Wmc�9 arq North 31.0 QS •°^ 776 2b ""' T75 "" ""' e dvors NEINW Q.9 9"'" 0 0"" 0 °" "" inp ElW 8�.0 �S '^" J�'Na 25 '•'° a�6 •^� �-'� SEl9W D.0 0"� 0 0"" 0 •°• "" Soufh 48.0 2G "" 960 20 "" 660 •••• •»• MaZ o.o o^^�� o o� o --� �-- 8 Ott�erdads f� 1f1F �A,$ 7.8 49 t210 31T �2 1P10 �1T 0 o.a o.a o 0 0 0 0 0 c o,o o.o 0 0 0 0 o a 9 Het A 12C 0.1 27 8J2 8739 7767 SS2 6790 1787 .xpe.ad b t�n �6.o a.s 2JO tou9z 19e2 2JO 1oa�z 11iti2 welE� end G 15A 11.3 0.0 500 Ba38 0 590 6838 0 �raaan e o,o o.o 0 0 0 0 0 0 0 0.0 0.0 0 0 0 0 0 9 f 0�0 D.D 0 0 0 0 0 0 10 Ce�inps e t6G 7,9 3.7 Mp 08b7 306a 6{0 6663 9098 b 16C 7,9 3.7 0 D 0 U D 0 a 0,0 0.0 0 D 0 0 o U a o.o o.o 0 0 0 0 0 0 e 0.0 U.o 0 0 0 0 0 0 � 0,0 6.0 0 D 0 0 0 D 11 Flvp�i o 21A 2,2 0.D d40 1814 0 040 1814 0 (NObe: r9om E 0,0 0.0 0 0 0 n p 0 pan�n�r e 0,0 0.0 0 0 0 0 0 0 b dtsW. d 0,0 D.D 0 0 0 0 0 0 �a s4� s 0.0 o.a 0 0 G D 0 0 noon> r 0.0 0.0 0 0 0 0 0 0 ,z m6mpuoo � �e.z �.a ti,z aa7o az, „z es�o e2, _ �� su�oaa� ioss=e+e..,».�s �-�- 4s��9 �- »� 4a�ae � .... .... ..,. .... t.ess ernm.� neanng »» o ..» .... � .«. .... .... .... .... L.eas t�nsfnr p .... .... p .... .... _... .... ..,. MMtlrg 1CdWfibutlOn '"" p "" mi. p .�r� .«. ..» .«. ..« 14 DuCllppy 0 Q ""' D 0 "'• "" "" 15 Totel bn � 13+1� "" 4671D "" '"^ 45749 °° "" "" "'" "" 16 Irn. �eins_ Pooplo � �OD � "" 1=00 4 "'• 1'LUU °° ""' ., : ppt � 1200 1 •••• 1200 1 "" 1200 •••• •••• !? Subto4 RSW gbin 7a8..N2+18 •••• •»• �t� •••• •••• �42D5 •••• •�• •••• ••» Less e.�rn:! �;cL4tig .... .... p.... ..._ d.... .... LESS Comtet '"„ p .... .... p .... .+.. .... .... Coolby todWriDuyon •••• •.•. 9 •••. .� 0 •••• •••• •••• •••• 78 Dud Sein 0 M' 0 0 "" 0 "" "" 20 Air�qu'ued �t�i8)'PL,F �1.00 � 14� 1.00 �"�� 14 �6 .... •••• � •••• ... .... Building MECHANICAL Permit No.: C�� Inspections � RESIDENTIAL APPLICATION Re ' By:� 763-572-3604 CITY OF FRIDLEY Dat��'dJ 2� $ 763-502-4977 FAX EFFECTivE i-i-os DATE--- I— Q(^}_ Sp..!�..G---=- YOU��L ADDRESS SITE ApDRESS � � 1 1 �LCJZ�� THIS APPLfCANT IS: ❑ OWNER CONTRACTOR PROPERTY NAME: J � OWNER/ ADDRES�—S:7 CITY 'l� STAT�IC�Z1�3°oi TENANT pHONE: /Lrj J�"J�%I — � J I CONTRACTOR COMPANY NAME: v% `' L I�JIV }`��" �� r � r'�r ' NOTE: CONTACT PERSON: 4 12� - BrJtI1 A�iE=i� Ri,�_-r i SEPARATE CITY �F UCENSES ARE STATE LICENSE k__ BROOKLYN Pf�RK; �',jD��j�.� REQUIRED FOR GAS 763°[d� c�,-C.�i�-? CITY S'iATE_ZIP AND HVAC ADDRESS: {� `/� ,/� � S�BMIT COPY OF BOKD pHpNE FAX /�O�-'7� i"' QS� l� ANDINSURANCE PERMIT TYPE � SINGLE FAMI�Y ❑ TWO FAMILY ❑ TOWNHOUSE TYPE OF WORK: O NEW �REPLACEMENT ❑ ALTERATION/REMODEL DETAILED DESCRIPTION OF WORK � PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of the total cost up to 5500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) OR Labor cost under �300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW) --7 �� Equipment Installed MFG:'�� MODEL: � �� I SIZE/BTU �� MFG: MODEL: SIZE/BTU MFG: MODEL: SIZE/BTU AiC 5?5.00 FIREPLACE (GAS) $I5.00 _GAS RANGE/OVEN $10.00 , AIR TO AIR FXCHANGEER $IS FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00 BO[LER 535.00 �FURNr��E a35.G0 _G.AS lm1IT HTR SI0.00 CHIMNEY LINER $10.00 GAS DRYER $10.00 _POOL HEATER $35.00 DUCT WORK $10.00 GAS PIPING $10.00 _VENTILATOR $I5.00 PERMIT FEE PROJECTS FOR UNDER $500 ' ' PERMIT FEE FOR PROJECTS OVER $500 Permit Fee $ _ F .00 Number of fixtures @ $10.00 _ x $]0.00 = $ Surcharge $ .50 Number of fixtures @$ I 5.00 _ x$15.00 =$ TOTAL DUE � ��• Fj� OR Number of fixtures @$25.00 _ x$25.00 =� Number of fixtures @ $35.00 _ x $35.00 = $ State Surcharge = $ .50 MINIMUM $15.50 MINIMUM 515.50 Total = $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED ' I hereby apply for a mechanical permit and l acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; [hat I understand this is not a permit but only an application for a pertnit and work is not to stan without a permit; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME DATE APPROVED BY DATE PLEASE NOTE: SEPARATE PERMITS ARE RE UIRED FOR BUILDING ELECTRICAL AND MECHANICAL WORK City of Fridley Bui►ding Inspect:ons Depa:t:r�cut 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 From: 7634248651 Page: 1/1 Date: 1/25/2008 2:46:06 PM LibP'4:l.'£S: 'X�? 'v0'�£-�G�-cSe. uN3s 'rw `rS.t: ' : ` :ti c•�3z.Y :;;=�= ••�si�, ;;;:^; e�v»or °-- i�Jy�YM+�iL __JS1SliPV��}�n ^^�li�s•'vi:' �'3� � ' `: : a� " � � �� rc�� e� � ' +� �( ..��--� b ��°—� `��''�' ��f j �a�� .x.�►�°�a �.. . .� -' '.. .L�Y'�: �� u�d �n:rcc:d�'ti�s w.::w:: 7CL'tlbCa :e!1`�'µ i"'"` iiLSQ �' = N: . — 7�!,� i�a\7J7 S: ."".� :(1f!'! 7,.r.�w st; ,,; rm u.,=„ oa, y.s�.� .,,,v, ym�an�s a� z..x: ,:.:i uuuad v wu a�,r.;. P�r�� i �e� :eaWJ u=`i'�'='s�SLY�� W��iYti aY� Ns!-�` "'ru �Ww :x «�uct�; 7: agS ".Hm aaw��Jr•r.� o: eG g..n �rc �;. :a,7 �n�:di C�C ot�l4:�7! 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Sii(3�i��:s� ��i¢pai�ii� r� w�z-�� ,� �'U" r��ti�tic�r: �;�, �-t n��z.�� C� h'iF:l: t�'c�� _t.� . , n 0 Building Inspections 763-572-3604 763-502-4977 FAX DATg � / ��% (J % SITE ADDRESS 1 `� 7 �� THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE L[CENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-09 � YOURE-MAIL�ADDRESS �I�I� � � OWNER NAME: : —� Y- L� _✓ .-�- .. ADDRESS: I S 1 Gj � 1/ I G� �Gi �' PHONE: %�+' � — � �7 I — �� S_'�I . � � NAME:` J �� _ 7 I.�j - STATE LICENSE # `� � PHOJ)TE � C 1� —�� ' O O C E'.(SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILYlNEW CONSTRUCTION ❑ ADDITION ❑ GARAC Y / Permit No.: Received By: Da��dttl� 0 S / � EXP DATE -' � � � � � � t'1 V`'L • CITY./_/ IrYn�2 YmCt,r�STA �i.o F�c -7CG� -� X�(o — 55� SIZE ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ S[DING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ApDITiON ❑ MAINTENANCE/REPAIR F�'REMODELING DESCRIBE WORK BEING DONE:�{�' >> I G' L t_ ��C SIZE OF IMPROVEMENT LEN ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES O HOUSE & GARAGE GARAGES ❑ ATTACHED GARAGE PROPOSED SIZE: ❑ DETACHED GARAGE PROPOSED HEIGHT: SIDING ❑ Vinyl ❑Soffit ❑ Aluminum ❑ Trim ❑ Other ❑ Fascia WINDOWS IN EXISTING OPENINGS ' es ONo LOCATION OF OR FOR NEW OPENINGS-DESCRIBE SIZE OF 17 � r� , OPENING CHANGES & �� — �� BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structwal members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT: 1. Site Plan/Survey showing the exisring structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations I TYPE OF WINDOW TO BE INSTALLED'r�' ��SY—NUMgER OF WINDOWS_�_ � ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: ��iJ�$ING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $' OCCUPANCY TYPE Permit Fee $�/-rs, ��" �� 7,5 See Back Page for Fee Schedule Plan Review $ 65°/a of Building Permit Fee Fire Surcharge $ /. OU .001 times the total job valuation Surcharge $ •s� .0005 x Permit Valuation Minimum $.50 License Surcharge $ � UD $5.00 (State Licensed Residential Contractors) SAC Charge $ $2000 per SAC Unit (Plans to MWCC for determinarion) Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary () Non Necessary () Total Due $ �� ,�_S Make checks pavable to: City of Fridley Attach THIS I5 AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all y►ork whichleq 'res review and approval of�s. � � � . . , , //, ! I SIGNATURE OF APPLICAN� �� ` � f� PRINT NAME ��r� � � � �' �/l / `Y'�f'DATE � b � Y PLEA TE: SEPARATE PERMITS ARE REOUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK MINNESOTA DEPT. �F LABOR 8� INDUSTRY Construction Codes and l.icensing Division 443 Lafayette Road N. St. Paut, MN 55156 JPS CONSTRUCTION INC 12879 277TH AVE ZIMMERMAN, MN 55398 � ��a S#�te ai fVlinnesota Departrrm�nt of Labor and Industry ` `443 Laf$y�tte Road N. *�, � St. Paul, MN 55155 ' RE��D��I"�IAL B Constru�tio�t. C�es and Licensing Division Tel�p#�on�: (651 � 2$4-5065 E=mai! address: dii.l'icensedListate.mn.us Website address; www.doh.state mn us �1LDING CONTRACTOR LtCEI�S� ;�� ; JP� �d�1ST�UCTION INC E��asir��es� �iructure: `'�.�� ' > GORPC7RAT'ION Address: 12879 277TH. A�fE > ZiMMERMA�f, M'f�f' S53f�8:' Licanse Identification Number: 20633454 Qualifying Person: JAMES G WHtI'� " Li�nse �acpi��tion �ate: :Q3/31/2010 Cor�tir�ui�g E�uca�ion; 7 hau'rs dus b�r' 43/31l2010 Minnesota Department of Labor and Industry Construction Codes and Licensing Division Licensing and Certification ServiCes PO Box 64217 St. Pau4, MN 55164-0217 Phone: (651)284-5080 Fax: (651) 284-5743 www. d o f i. state. m n. us/l i ce nse dti.license�state, mn. us PRINT IN INK or TYPE. Certifica#e of Compliance Minnesota Workers' Compensation Law THIS FORM MUST BE COMPLETED AND SIGNED BY A�L BUSINESS TYPES Minnesota Statutes, Section 176.182 requires every state and focal licensing agency to withhold the issuance or renewal of a license or permit to operate a business or Engage in any activity in Minnesota until the applicant presents acceptable evidence of compliance with the workers° compensation insurance coverage requirement of Minnesota Statutes, Chapter 176. If the required information is not provided or is falsely stated, it shall resuft in a$2,000 penalty assessed against the applicant by the commissioner of the Department of Labof and Industry. A valid workers' compensation poficy will be kept in effect at all times by emptoyers as required by law. (if applicable) a-s ��" �S�' �� name only if no company name �-�s C t�/i �Tf� U�.' �_�T I/1 C� DBA (domg business as namaj (if applicable} 12�7 �RESS (PO �-� .?� � �ox must maune street addi � �'� ��'o� �S� �� z � �.� cin -- $S � - .�S � rwr v►� c 2�+ �� 'vl � IL ZiP CODE ss3��; YOUR LICENSE WILL NOT BE fSSUED WITHOUT THE FOLLOWING INFORMATION. You must cornplete number 1 or 2 below. NUMBER 1 INSURANCE COMPANY NAME (not the insuranoe agent) M�� s�- �-,� v�:- �- Y vv, u°; r� ,� �. �•� � �, ,� ru � - c� c.�� 3 3 l � I �/ -1 � w � � � �- C:2:� �9 �� _�.�- ..r�.��M.,, , : � ... OR NUMBER 2 ! am not required to have workers` compensation liability coverage because: � ❑ ! have no employees. ❑ f am self-insured (include permit to self-insure). ❑ I have no employees who are covered by the workers' compensation law. (These inciude: spouse, parents, children and certain farm employees.) ❑ Other: the DATE - � __ =,=--,'='=�% //�-. NDTE: You must notlfy us if there is any changes to your Workers' Compensation Insurance infarmation or Empioyee 5tatus Change by resubmitting thls form. This materi�l can be made avallable tn dlfferent forme, such as large print, Bretlte or on a fape. 7o request, cal! 1-800-342-5364 {DiAL-DLI} Voke or TDD (681) 287�t88. UC 04G (5l08� Minnesota Department of Labar and Industry ConsYruction Codes and �icensing Division Licensing and Gertification Servioes PO Box 6A228 St. Paul, MN 55164-0228 �'+mr�e•. (851) 284-5080 Fax: (651) 284-5743 TlY/MRS: (651) 287-4198 E-mail: OLI.License@state.mn.us www. doli. state. mn. usllicense PR1NT IN INK or TYPE your responses. Unreadab�e or illegible certificates wiil be denied. Form must be completed by the insurance agent or insurance company, ryq� by the business/contracto�. LICENSE TYPE Residential Contractor/Remodeler Certifcate of Insurance Covering General liability and Property Damage (This cornpleted Certifcate of Insurartce must be submitted with an application form, renewaf form or whan updating insuranr.e poBcy coverage. An ACORD form or anv other Certific�te �� Insurance will net be acceofed.) Liability tnsurance Coverage This is to certify that the insurance �olicy listed below has been issued to the named insured for the policy period indicated and tnat the policy meets the minimum coverage requirements applicab(e under Minnesota Statutes, section 326.94, Subd. �. LICENSE NO �if applicable) I AOLICY NUMBER (pending is not acceptable; INSURED (Use the persfln(s) name if business str,acture is so:e proprie:or or pertrrersMp {i.e., ,tohn Doe, or John Doe and Jane Doe), otharw�se the insured is the legal nama otthe cusiness errtity.) JPS CONSTRUCTION, INC. ACMN 0560029503 FROM (mm/dd/yyy�) 04/12/2008 General Liability Genera! Liability DBA ("doing business as" or also known as an assumed name) (if applfcable) STATUTORY REQUIREMENT STREET ADDRESS (no PO Box) 12879 277TH AVE CITY S7ATE ZIP CODE ZIMMERMAN P,AAILiNC ADDRESS (if different from above} PU BOX 91 TO (mmldd/yyyy) 04/12/2009 (Policy) ✓ 111 �11 11 Policy provides commercial general liability insuraiice, which indudes premises and operations insurance and products and completed operations insurance, with limits of at least $100,000 per occurrence, $300,000 aggregate Eimit for bodily injury, and property damage insurance with limits of at least $25,000 or a policy with a single limit for bodily injury and property damage of $300,OQ0 per occurrence and $300,000 aggregate limits. Check MN 55398 � Insurance policy meets the minimum statutory requirements NAME OF WSURANCE COMPANY MIDWEST FAMILY MUTUAL CITY STATE ZIP CODE INSURANCE AGENT'S NAME (Print) ZIMMERMAN MN S7EVEN CARLSON Data Practices Notice Minnesota law requires that contractors licensed by ihe fUinnesota Department of Labor and Industry, Canstruciion Codes and Licensing Divisson maintain on fi!e witfi the Commissionar a certif,cate evidencing compliance with the fiability insurance requirements prescribed in the applicable statute. Data provided on this form is used to determine compliance with the applicable Minnesota law and becomes public upon the issuance and/or renewal of the f#cense. Cancellat(on Notwithstanding the expirat;on dates set forth in this certificate, should this policy be canceled or not renewed, the issuing company will provide 15 days advance written notice to tfie Certificate Ho!der of such cancellation or nonrenewal. 4FFICE USE �NLY Qate of DLI Receipt LIC•01G {7/08) M!�! INSURANCE AGENT'S L{CENSE NO. (� Residenf 1005412 � ❑ Non-resident NAME OF INSURANCE AGENGY/CO SAFEGUARDINSURANCE ADDRESS PO BOX 97 PHONE NUMBER (320) 983-6106 ICITY STATE Z!P CODE jM1LA A MN 56353 INS CE .AGE ' SIGN RE DATE � 01/06/2009 /'� Certificate Holder Minnesota Department of Labor and industry Construction Codes and Licensing Division Licensing and Certification Services PO Bbx 64228 5t. Paul, MIV 551�4-0228