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AF - 37074,•�, � Village of Fridley, l�iinn. � �,. BUILDING PERMIT N� - s� 8 O�ce of INSPEGTOR OF BUII.DINQrS �� owaeT .: �`�'"�.� �'�`°�. • ,,��e�.� �.�, � ..:� ' r� k � "P �� 18�*., ArCi►ite�t - - Fridley. Minn•, y ` . `' .� !�� Builder j ,- LOCATION OF BUII.DING � ,� - �� No. �"'° `�� s� � 8treet � �,.�"�"-z--°`=_� ; ` r"' �_ �'"„�,.�.` ' Part oP Lo* I�t Block Addition or Sub-Division r DES�RIPTION OF BUILDING pA�y,j �° "'�,,.,3 '� � '��r,...,r��..-g°-� " F'TOIIt�� De�th �'°`°' Height Stories rs' �-- Manner of Conetrnctfon �- 1: � `�; c',.�..° ! `� To be used ae�- �� .& �'° To be completesi �''� "� = '� "�` Estimated Cost � ``'�= � c �" � _; F �1` � •r `'� °�:,. �,� � d.' r �,r Parmit i8 hereiry grante8 to '�''�•�'°-�� r. "` �'�`�`�� `�� `' ��"` tO �; - � ��, ,�.�' � the building �rv�,� ='-�.$�°�� s described in the above statement. Th9e permit ie grant�i upon the egpreas condition that the peraon to whom it ia graated, and t�ie agents, employees and worl�nen, ia all the work done ia, around and upon safd building, or any part thereof, sha11 conform fn all respects to the ordi- nances oP Fridiey, Minn., regarding the construction, alteration, maintenance, repair and moving oE buildinge withia the city limit�, and thie permit may be revoked at any time upon violatton of any oP the provisions of said I1Tf�i1�OTf��O AGRE�TT AND SWORN STAT�NT In conaideration of the isaue and delivery to me by the Inspector of Buildings 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 aworn, I hereby state and �ay that the facts stated by me and contained in the above permit are � �` _, ; true as therein sta,ted. ��?.� ,;r o � �� . t _tI . �. � } C _ � .¢_. � � � -d �``` � }-� k �-a � � Z � . tr gi� Subscra'�ed and sworn to before me at Fridley, Minaeaota, this , ; y °� ,�`a,.� � "�� . f � ,�," ' � ; _ ��- �"�' A-D. 1�� ,,,�� <- - � � - day of " ;�� ,-� �� ,�, City of Fridley, inn BUILDING PERMIT N° 5 s s� na�: ,�""""" _� �'"� -- - .� . _ � � r �� pwIIer: Builder Address � — Address ,, � LOCATIO O.� ING No. �i��.�� -�–�- Street �� ' � P . �t �z� r gl� � Addition or Sub-Divis�ton �'"�`'`"'� cL� - .�-.�..�- Coraer Lot � Inside Lot � Setback _,..�— Sideyard _.. �� — Sewer IIevation ____ — Foundation IIevation � DESCRIPTION OF BUILDING T a� ,r�"��+ fJ � .�� Front , Depfih .��` Height �� Sq. Ft. °��-.��[ Cu. Ft _. Fro t Depfih ��efght � Sq. Ft. Cu. F't. Type oi Construction F�t. Coat �� -- To be Completed In consideratfon of the issuance to me of a permit to construct the building described above, I agree to do ordinan� of the dty oE Fri edl y�� e ��p�on above set forth and in compliance with a11 Provisions oE � In, consideration oE the paYment of a fee oP $�� , Aermit is hereby granted to to construct the buitding or addition as described above. Thispe rmit ia granted upon the express condition that the person to whom it is granted and his agents, emPloyees and workmen, in all work done in, around and ugon said building, or anypart thereof, shall conform in all resPects 'to 'the ordinances of Fridley, Minnesota regarding location, construct%n, alteration, maintenance, repair snd moving of builciings within the dLy limits and this peranit may be revoked at anY 'time uPon violation oP any of the provlsions of said QPdiII8t1CC8. ,,�"°-� 1,�� -= ...� Bl7��IIFi �� NOTICE: This panat! does aot eover �hs eoestrueHon, iaslalla�toe fo� wiring, plumbing� Bes heatin8� sowee or water. Be wra to sas 16s Building le�pxtor Mr asparats p�rmiM for thas hems. - „ _ .. _,. �^, 4 � My � . �x-_ c` . � yy APPL�ICATI0IT FO� BUILDING PERMST C%TX OF FRID�LX� NL��INESO�'g1 Owr�e�'s Name�E•��L � JC +�� "So�✓ Builder � E' /� 6r�Liiy �,�s� � ss /z �/ �� LOCATYON OF BUS�D�LL�TTG r -A— No� �� '� Stree �� ,__ Part o Lot Lo� S1ock Addition or Subdivision ______ Corner Lot inside Lot Setback ,,,,,Side-Yasd SEWEI2 ELEVATION FOUNDA�T011T ELEVATi011T Applicant a�t�ach to �his �o�rt Certi�icate of Survey of Zot and proposec� buil.ding �oca�ion. DE�CRIPTION O� �UILDTNG i o be used as o � -�-�-Q--� ` ��° / �ront_„�Depth Z Z I3eight ?' �� —�' e7�s r 1.• v v0 �+�s 1'�• �sont______ �ep•�h Height Sq. Ft. ��d� Cu4 �'t. . /� oo_o ,,..,_.__ ,._.__.. riype of Construc�cion �`-¢— Es��.mated Co�•� �i °°° To be Compl The unders�.gned here�y makes applicat�on �or a permit �or �he wo�k herein speci�ied, ag�ee�ng �to do all wo�ck in strict accord,ance wi�th tYae City of Fgidley Ord�.nances and ruling of the Depar�nent of eu31c1- ings, and hereby declarea that all the facics and �epresen�:a��.ons s�cated 3n this apg��.ication are true and corroct. D�1TE s�� /.,� � / SIGNA3'iIRE . (Schedule of Fee Cos�s can be found or� the Reverse �Sidle) . �\ �1 . � w w� r s. /•r � / 1 �� ✓� � � `,� � 7 sv 3 � �00 �UILD�C1tTG PERMIT FEE SQ3EDULE sec�ion 2. �he 3�spector o� Buildinr�s shall, befcore issuing atzy pe��if-. for the e�ec•�ion o� any %uild�tng or structure, or for any addition to any ex�st�nc� bu31d3ng ar s�cuc�ure, or for any alterations or �epairs to aay exisic�.ag bu�.lding or st�uc�u�e, upvn application �hQ�efor, require the paymeat by the a�plicant �o� such permit of rees to �the amount herein below set �o�th and in the maruiar herein provided to wito 2.1. For any such pe�cm3t gor th� erect�,on of any fire-proo� building, o�her tha,rl a garaga, wa;�ehouse, facto�.^y or gra�.t� elevator, or for �he erec�ion o:c any :cire-p�oo� addition, �or similar occuparicy, to any exieic��g building s1�a11 be at the rate o� $1.40 for each on� thousand cu�ic �eet, or frac�tion thereof, in such cubical contentso 2� �o= a�Y Buch por�nit �or �che e�ec�tion o� ariy �E3re�p�oof garage, wagehouse ��cacitory or grain elevator, or ior the erection o:c , any �ire- prao� ado�it�.on, io� s�.1a�c occupancy, �o any existing bu�lding sha11 be at the ra�ta oi $1.25 �or each one thousarid cu�ic �Eeet, ciassirieci as "�ireprooi" by Section 502 of the M�.nneapclis Build�.ng Code. HO_ ES 2_3. For ariy such perm�.,t for the erecicion oi any non-filceproof build- ing othar than a garage, warehouse, fac�ory or grain elevator, or any non-rixepscoo� addi'rion, for similar occupancy, to any exis�ting building Pe�m3t $1.00 �or each on� thousand cubic feet. �GES 2- °-- �Or �� gu� Pe��►�.�� Eor �he erection o� any non-fireproo� gaxage, warehouse, �acto�y or g��n eleva�osc, or for the erection of any non-�ireproo� addition, fos similar occupanc}t, to any ex3.sting building or �or each such bui].ding or additione N3.noty Cents for each one �housand cubic ieet or fract3.on �hereo£, 3n the cubical contents �thereof wi�h a minifmum or $�,00 0 �ar �he purpose o:c compuicing fees for building peranits the cubical coa- ten�a of any buiZ�ing o� addition to a unifoscm height throughouf by multiplying the c,�ound ascea covesed �xom a po3nt six (6� inches below �he rloor line o� �the basement or cellar to the average height of the uppe�c surface or �o che average he3.gh� of the roo9E surface o� the main galole o� a pltched rooi. 2�.5. For repa�rs or alteratio�s to an existing atructure, the fee shall be at �the�ra�e o� $3.00 per each.Five Hundr�d Doliars ($500.00) or �ractio� �hereo•r' in �the cos� o� all proposed work. 2_.6_._ 3n no case sha11 �ho ree charged r"or any permit as sot forth in section - � � 1es8 tp-4n $4.00. � � �-- - � � � a � 0 � � 0 � x r�� x x � � � � � ° x x � m � 6� O RP � � Z � � � � � �--�,-- � _ $ � o � � � 0 =.�. a E�� N � � � .,� z� v � � � � � y � � � �� M w a � 'j � �' � � p p � hq � ~ C � O �, �"o y N � o � o � O y • O • � : : p� p� � O N � O O 9 � � � � � � � �i z � � 0 � 0 0 O 0 O � cn G O {� 0 r � � x °c � �' o w a� W �� M � 'J� y o a � O � � �. �: �: �� cn O O � � O w y � � � m w � � �° � � � � � � � � O � � � 0 Q ro � eo 0 v) � � � �. �-_� . y � C' Cr � o m P7 � n N ,a¢. a `D fD �C w w d�-' "�(/1' „0,� 0 0° � � � s� s� R° R° � � � � � � H �� O � p � � �� ; � � : : � � � � o � . . � � : : � � : : � : � �� .�� ;� R° R� � � � � � � `� � G � � � � � � � o � o � 0 � � � 0 � � �' : o�' � ¢ � • y O a, � : G � � � . . Q o� o .° �. : : � � �a ��5 m m '� ' � �y� m � � R' R° � � y � m � � � o � � w � � � 0 o a .. �� ' ,� � ° g : � m � � : : � . . � ° : : o g . . o . . � : : : n� n� oo w N ca �cn N ao N ca cn eo � C7� F7� G C tr C G C O F71 G O O � O O O O O O O O O O O O O {fl &a fA" {fl {!i �A QA �' � � �� , �" � � °x 0 � 0 � � � cz �r m a � � � � � � � �. z O I C � m � 0 � � � O y �Qy, � N � A � O "f � �, � � � � ¢ � �. � I ��I i � � I � � �w ao.� � �� b y ��'`� � �� o �� d-� ��°� � p p� ��a �°°� D°i � � � ��b a�� p� �� m � �,�o � � ., ��.�� `� �'� �. a � �. � ��► ��y s��n� �� D G�o ��Dr rp p. � � S� 5' D � D r � � m � 2 m C r m G ro M � � � � a � � V O ��p �: . � � � �� w � i l� � � .� �• .<y � � ' � h � , O.� v< �' �'s � � � � � � 0. � � e � � � � �� n.ss � s -�%P/�t'f�' �'/i�l�OrP �O��R �%/��/l'/l "�� HEAT LOSS CALCUL.ATTONS �q /�y� DEP TIVENT OF BUILDINGS NIINNEAP0I.IS. MINN• � Weatherstrips A.S.H.V.E. Construction No. Insulation Guide Win ws Do Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied —No I No 19— Fl,� Room � Leagth Width Height Fl.� L� Roo Leagth �L Width � Height �' , Windows and Doors—Crackage an Area Windows and Doora—Crackage and Area �Yfdth HetBht No. o[ Lineal f. Area Wldth Hefght No. ot L1nea1 tt Area No. of pane of pa e lighte ot crack eq. ft. No. of pane ot pane liBbte ot crack s9. ft. , � �• i � i Coef. Btu Coef. Btu II, In6ltration � 1l Glass Eap. wall Net esp. wall � Int. waU Ceiling � � � Floor f� � � 1'otal Btu. Required sq. ft. E.D.R. or sq. ins. W.A. Leader area F1.� Room � Length Width Windows and Doors—Crackage nd Area Wldtd HetBkt No. oL Lineal It. Area No. ot pang ot pane lighte ot cre�c e. tt. Coei. � Btu Infiltration Glaaa �p. Wa�i Net esp. w Int. wall Ceiling %��'IJ Floor JJ Total Btu. Required sq. . E.D.R. or sq. ins. W.A. Leader area Fl. Room � Length Width I Windows and Doors—Crackage an Area Wldth Helght o. ot Llneal ft. Area No. ot Dane ot pane ghta ot crack e9. [t. � � / �'_ B i /9. ?> . � Infiltration � Glaas Exp. wall ; Net eap. wall L iInt. wall Ceiling '��-- I Floor Total Btu. ft. E.D.R. or sq. ins. W.A. Leader area ��I Btu Glasa Eap. wall � Net eap. wal Int. wall Ceiling j�,� Floor Total Btu. Reauired sq. ft. E.D.R. or sq. ins. W.A. Leader area Fl.l I��► I Windows and Doors—C Wldth Hetght N No. ot pane oL pnne 11 � Width e and Area :.taeal tc. Area ot crack aq. tt. � '• _ -� � �n�� /r �� Infiltration Glaas �p.,�u Net eap. wall Int. wall Ceiling Floor -- - -- - Total Btu. Requued sq. k. E.D.R. or sq. ins. WA. Leader area F7,� Room I Length Width Height Windows and Doora—Crackage and Area Wtdth Helght No. of Llneal tt. Ares Na ot Dane ot.pane llghte ot crack ep. it. Infiltration Glass Exp. wall Net eap. waU Int. wall Ceiling Floor "fotal Btu. Required sq. ft. E.D.R. or sq. ins. WA. l.eader ana Btu � � ��'1 (;ity of Fridley, Minn. BUILDING PERMIT Date: June 2s 1965 �r: Gerald 8. K�utson ��, Same A� 6��,G�annel Ba.. N. E. aaa�ss N� '7628 � � � �; � LOCATION OF BUILDING No. � 5treet ��A� �� • E• Part oE Lot � t�T � o£ 9_ Bl�k Addition or Sub-Divisian BTOOkv3e�r �cidit3on Corner Lot Inafde Lot Setback Sideyard �� II�ra�� _ _ Foimdation IIevation To be Used as: DESCRIPTION OF BUILDING Front DeP� Height Sq. FL Ca. Ft F�ont Depth fTeight Scl. F't. Cu. F't. Type of Construction Fast Cost �+a �•�i To be Completed StOS� Damag@ R@pa3s In consideration oP the fssuance to me of a permit to construct the building descril�d abave I agree to do the P�P�� work in sccordance with the d�scription above aet forth and in compliance th a�l provisions oP ordinances oP the dty oP Fridley. ,�'/ In c�dderation oP the Payment of a fee of � 10.0�- --, Permit is herebY granted to C,era� ri RinrF aon to construct the buflding or addit%n as described above. This �ermit is granted upon th¢ express conditian that the person to whom ft fs granted and hie agen'te� emPloyees and workmen, in ail work done fn, around and upon seid building, or anypart thereof, at�all conPorm in all respects to the ordineaces oP FiirIIey, Minnesota lacation, construct�Ton, alteration, meintenance, repair and mcving of bufldinSs within the dtq ]imita�eand� pernnft may be revoked at e�Y time upon violation of aay of the ProvYsiona oP said ordinancee. , A71 g � naen Suilding Inspector NOTICEs a 'IYs p�rmU doa eef ceru t6s eoastrudlae, te�taUadoa �sr rrWn9. R�+�9� 6a 6�aHne, awu� er ara�s�. B� so� to a� t6o BuiWios Iu�aetor tor ap�raM � tor 1h�» h�ms. ,� _. � � � � r - .. AFPLTCA`!'ION FOR`''BVIiDING PERIMIT . � ' • � �C�TY''OF �'RIDLEY; ��50TA : � . e .. ... _. , ... . ._ , . . s� . °' . ... _ . . t .. .- . : ._ _ �° �u ,�1, � Oi�NEB' S NAME �"'i�� -� /�� ,�' F � ,� �,� ,`�� „=y ;;,, ' Bt1ZLbER ` vL� % i �v . •�� . . _..�._ . � « . . , _ . Ann�ss ��.�� r ,� r�� % �� Ann�ss - � , - , _..._ _. _._,_ . . � . LOCATIBN OF BUILDING • , No. , ` ° ' . Street � • ' 'Pa�t of Lot _,_ LOT �� BL�R ADD�TION OR SUBDI'VISIOI� � �� , . -- . , - , _ . . Co�rner Ld►t�;,�;Ine3de i.0't�,�, Setback _ . ---. Side�Ygtd .'.. � . . . SEWER `ELEVA�t}N `- . � ' FCIUNl�A�1'Yd� �E`�A�ON _ � �;�,� �._.� . . � , - - Applicant attach to thie form Two Certificates of Survey of Lot and propoaed building location drawn on these Certificate�. -� . � , . . . � DESCRiPTION.'OY� BUILDII�TG '� � . , , To be �r�ed �'s - � . -. ��. = Froat Depth Height Sq. Ft. Cu. Ft. _ �: , . , . - : ,. � . � � _ � �� =a �-� • . . Front Depth � _ � Height — . � . .. . . . . 5q., Ft. . . . . � Cu. Ft. � . : . :; � � , : � . . ... _ ; �� ? � � Type of Conetruction � �a�. �e�_��2 � �. Estimated Coat �� : —.�....�—.,,..,�---� ,--- . , � . . . << _. .' ',--,��—"'—�' ., - To be' c�aplet�d ' • ,. . -,: �- � , , ��. .. , . . • - ,_ , �.�^_..�._� ,.__.�._, . � . . . � , . . . . . . � . � � � ,. , . . . ,,_ .. . The undersigned hereby makea � applicaticin ' for a' perml:ti for the i�ark hereit� '�pecified, agreeing,to do all work in strict accordaace with the City of,Fridley Ordinaacea and rulings af:� Ehe��iep�rtnieri't� o�-B�iildifngs, arid` herebq declare� that a11� the facta and representations'stated in�tbis'app�3cat�on �re'tirue-aad correc�.`' � ' � � : G�'d� ��.r DATE � �� ' `, �� " SIGNATURE d�I �-�� '�=� ` . .�� _. (Schedule of Fee Coets can be found oa the Reverse Side). J, _ �"�� n � � BUILDING PERMZT.FEE SCHEDULE SECT_ ION 2. The Inspector of Bui]:dings,shall, before issuing ang permit fos the erection of any building or structure, oa for any addition to any esisting build- ing or structure, or for anq alteratioas or repaira to anq esiaCiag building or structure, upon applicaCion therefore, requira the payment by the applican�,for �uah permit of �feea to�the amoune herein b�low s�t forth and in the manner lierein provided to�urit ; _ 2.1. For any such permit for the erection of any fire-praof building, other than a garage, warehouse, factory or grain elevator, or for the erection of any fise-proof addition, for �imilar occupancy, to any existing building, shall be at the rate of $1.40 for each one thousand cubic feeC, or fr�ction thereof, in such cub3cal contenCa. � 2.2. For any euch permit for the erection of any £ire�-groof garage,` Wareh uo �e, fact4ry or graia elevator, or for the erectiou of any fire-proof � additian,�for similar occupancy, to any existing bnilding shall be at the rate of $1.25 for each one thousand cubic feet, classified as "fireproof".by " Section�502 of Che Minneapolis Building Code. HOIISES 2.3. For any.such permit for the erection of any non•ffrepraof building, other than a garage, warehouse, factory or grain elevator, or aay non-fireproof addition, for similar occupancy, to any exiating building - permit $1.DO for each one thoueand cubic feet. . GARAGES . _ " �— 2.4: For any such permit��for the erection of any non-fireproof garage, wareho se.,,factory or grsim elevator, ar for the erect�ton of any non-fireproof addition, for similar occupancy, to any exieting building or for each such buildiag or addition - ninety cents ($0.90) for each one thousand cubic feet or fraction thereof, in the cubfcai contenta thereof with the minimum of $4,00. For the purpose of computin� fees for building permits, the cubical contents of anq building or addition to a uniform height throughout by multiplyaing the ground area covered from a poinC six (6) inches below the fioor liae of the basement or cellar to the average he3ght of the upper surface or to the average ,.,1�eigh:C of the roof.surface o£ the maia gable of a p3t�hed roof. 2.5. " For repaira or alterat3ons to an exieting structure, the fee eha11 be a he rate of $3.00 per each �ive �Iundred Dollars ($SQ0.00) or fraction thereof in the coet of all proposed work. 2.6. In no case shall the fee charged. �or anp permit as set forth ia- Section�2 be leas than $4.00. �� - -. �, � � � �- � sue�ecT P MIT NO. City of Fridley ° 15 7 5 5 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � ; � RECEIPT NO. � ; L �_�__ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. 1 . � � � /�"1 � CITY HALL FRIDLEY SS432 NUMBER REV. DATE PAGE OF APPROVED BV �"""� � ,�� 612-571-3450 910-F15 5/29/80 / / JOB ADDRESS 6845 Cha.nnel Road N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. �lg g Brookwiew Addition SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Judy Bjork 6845 Ghannel Rc�ad N.E. 571-0206 3 CONTRACTOR MAILADORESS ZIP PHONE LICENSENO. Milton L. Johnson Co. 2513 Central Avenue N.E. 781-9548 4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW � ADDITION ❑ ALTERATION 0 REPAIR ❑ MOVE ❑ REMOVE % 8 DESCRIBE WORK �X Roof re aa.rs 9 CHANGE OF USE FROM 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 SO. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 80 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 APPIICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT yfiSOO . SO DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTH STATE OR I.00 L LAW REGULATING CON- STRUCTION OR THE PERFO NCE OF CO TRUCTION. %. SO PLAN CHECK FEE TOTAL FEE 5-�-� s8.0o SIGNATUHEOFCONT A ORORAUTMOR12EDAGENT IDATEI WHEN PROPERLY V�LIDA� IS IS YOUR PERMIT � � � P1v SIGNATUREOFOWNERIIFOWNERBUILDERI ' IDATEI �NS� DATE CITY 0� FRIDLEY • • ARPLICl17'I.Oid FOR RESID�PITI/IL fiUILUIi�G PCRMITS (tdevr, A11:er�ations, Addii:ions, ot° (tepairs) O�JI�JE(t: �% �C.,D � , � . ADDRESS: � $ �5��' C�/4 n10U gL �D . Tf:L�iO: S�/''0�� i . � / / f3ul LaER : �i �-�'-� ,� �+. J ° N a� s o ,J � . I� D DR E s s: o2•S� ��i�.�/�..� �D c� .t1.�' . TEL �'d0: %c�� -9 �`F � . � Construction Location 6 Q � STI2�ET: �V �3 � �� STRF�Fi:T NO: _„_______ , LOT: �,,,-l.�`�,, � % BLOCK: _ ADDITION : � { Cornez Lot: ^� Inside Lot: SetbacY.: Sidey�rds: ! Apn].icant attach to this form two Certifica�es oL Survey of loL- and Propos�d building ]�oca�ion dra�m on certificates to scale. pESCRIPTIOW OF CONSTRUCTION � 0 Fxont: � Depth: � Height: Squa�e. Feets Gtiibic Fcet: Front: Depth: Heights � Square• I'eet: Cubic Feet: ��/ g� � �� Lstimated Cost: $ �� • Type of Consi.ruc�ion: � , • �b Be Cbmpleted: Alt. A ��• B Proposed Driveway C�idth If Ne�a Opening Is Desired: $ - $ . ' . . SEE REVERSE 5IDE OF SFiEET ��ze unde.i: signed hereby makes application for a permit for �he h�ork� her�in speci�ied, agreeing to do all work in strict accordance with the City of �'ridley Ordinances and rulinRS oi the Depariment of Buildings, and l�ertby declares i:hat all the facts and represent:ations stated in �his application axe true and rect. D�TE: �' a 9' �`� SiGNATUR�: Sti�ulations: � , . � �%. �� . �,� � �.aa 0 _ -_ - . nu��uii�c f'CR(11T r-r� scFir_nut_r-_ � . :;lsC'!.'I01•I ?.. 7'l�e xne.;pect.or. ot fs��i�.a�.��:� ::#i�il.�., bcforr_ i:�suing penniL� �nr Lhe craction ot• any )�uiJ_d.i.nc� ar. :;Liuct:ux-c, or �o� any acicli.L•ion L•p any er,i:;t5.>>� building ox stnicL-wre, . dr �o�' at�ry �Z1�craL-ion or. zcpair.:, t;o •ai�y cr.i:.L•iny }�ui.J.di.ng or. :;Lr.ucL-urc, uZ�on ar,l�licatS.on �L•I�cr.efor.e, rec�uirc U�c paymenL• by tlic app].i.cai�C for. :,ucl� }�crm�L o£ fces to. tl�e arnount her.cin beJ.00� scL- forth �ind in Llic mannen c�rcin Z�ravic]eQ to--r��iL•: • P�1341 COt�]�Tl?UC7'IUt�: Sing]_e l.'ami].y Iloines and Gar.ages: $4.00/J.,000 cul>i.c �ec�. . � Y.7.T�tJ CJi1:CY.: 25 percent- of bui.ldinq F�exmii: fce. D17TV�t•?Al' llEPRL•'SSIOIJ: (Concrete, Cur.b �trecL:s Only) �" ' ' AlL-crnat:e A: Removal and repJ.acemenL- of concrete curb and guL-ter only; Dr.iveway widt}i plus 6 teeL x Y�, ,.� 75 . Alternate II: Remova]. and replacemenL- of concrete curb and • � c�ut�cr and ].Il5t�-�,].]. a 3 fooL- taide approach with �' � ,• G a.»ch c3e�th; DrS.� eway wi.dL-h p].us G feet x$17. 85 � • . A DD I T I 0(��/1 I F `�F3�/1ZI 0� I'or the purpose oi compiiting fees ior bui�.ding pexm5.ts, the cubi_cal contents of any bui.lding or addition, zs det-erm3.ned by mu1L-iplying t11e ground area cavered �roni a poznt six (G) inches below the floor l.ine of the basement or i:h� cellar to the average heights of t-he upper surface or i:o the averac�e llei117� of ih� roof surf_ace oi the ;nain gable of a pitched roof. � For rep�irs or alterations to an existing structu•r_e, thc fee shall be at '�he rate of $3.00 per each £ive hundred dollars-($500.00) or fractian ihereof iri the cost o� all proposed work. • Tn •no ca�� sha].l the fe� charged for any permit as �et iorth i.n 5ecti.on 2 Ue less � than $7.50 plus $.50 state surcharqe. . • _YCRTFICATIO�.OF FpUNDATIOf� � NOTE: Permits �or construction will be issued a minimiun of 24 hours fr.om the time of applica�ion to al.low for proper review oi L-lie proposed structure and oi' the cansti-uction sa.te. A Certi�icate o:C Survey o� the lot, s}io�aing the location of the ioundation ��nce i�. has been constiZicted will be required bef�re proceedinq with the £raming. _G�RTIFIGATE OF ��CUPANCY '. '. '%p�Iication for a Certificate oi Occupancy shall be made ten (10) days prior. ta the use or occupancy ot any si:ruci:ure tor whicl� a� building pei-mit ha� been �.ssued; and said. st.i:ucture shal�. not be used o�: occupied until a. Ceri:it-a.cate ai� Occupancy has been xssued. 3 .. - ` • , '. . � ' , • ' • � . 1 Minnesota Well and Boring � � � � � WELL OR BORING �.00ATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. }� i �o��,� Name WELL AND BORING SEALiNG RECORD M��eso�a u��q�e No. d��e�a Minnesota Statutes. Chapter 103/ or W-senes No. � ILeave blank d not knoxm) Township Name Township No. Range No. Sectian No. Fraction (sm. • Ig.) Date Seated Approximate Oate Well z � � 4 y_ey�� or Boring Constructed Fridi�y 3� 23 �� i�,41�E ,�i� ,4 =� � NumQerical Stre�+e! Address or Fire Number and City. 7of Weli or Boring Location �Q�J 4r��i'�� 5�� ' i`� i��,� Depth Before Sealing �� fl. Original Depth �� H. Show exact Iocation of well or boring Sketch map of well or boring Static Water Levei ❑ Accurate in section grid wilh'X-. location. showing property lines. roads, and buildings. � Approximate N i i i � � � Z ��LL� �SingleAquifer 1 ❑ Multiaquifer ft. � below above land suAace i i i I E _� _ a _ _ i _ _i_ � � CASING TYPE W i i i i E ;�� .�,..� 1 I 1 1 Y � � �Q � -�- - � - - i - -i � y i��°`7p � Steel ❑ Plastic ❑ Tile ❑ Ottrer h mile - -; - ;- - � - -�- � µ0-,,.�.k x i . __�. %� %S S 'r, � Screen from to fl. Open Hote from to ft. �- 1 mue --�I � ..,,.. �,..... � -_�� OBSTRUCTIOWDEBRIS/FILL � Obstruction ❑ Debris ❑ FiII PROPERTY OWNER'S NAME ��y i��1�� 36' 1�� d.p. wit�► jet Type of debrislo6shuction Maiiing Address it diBereN than property address indicated above. - Obstruetion/Debris/Fill removed? �Yes ❑ No - - ��.�� PUMP � Removed ❑ Not Present ❑ Other CASING GEOLOGICAL MATERIAL COLOR �RDNESS OF �OM TO FORMATION Diarneter Depth Set in oversize hole? Mnular space initially grou[ed? If not known. indicate estimated fortnation log from nearby well or boring. s � in. from � to �`� ft. ❑ Yes � No ❑ Yes ❑ No ❑ Unknown in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown in. (rom to k. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE: � No Mnular Space Exists ❑ Annular space grouted with tremie pipe ❑ Casing PerforatlonlRemoval in. from to ft. ❑ Per(orated ❑ Removed in. from to ft. ❑ Perforated ❑ Removed Type of perforator ❑ O[her GROUTING AAATERIAL P+��tl ar�d 3 i"� 3 Grouting material from to k. yards bags trom to ft. yards ba9s REMARKS, SOURCE OF DATA, DIFFlCU�TIES IN SEALING from to ft. yards ba9s from to ft. Yards �9S UNSEALED WELLS AND BORINGS Other unsealed well or borirtg on property? ❑ Y� �No LICENSED OR REGISTEHED CONTRACTOR CERTIFlCATION This well or boring was sealed in accordance with Minnesota Rules, Chepter 4725. The infortnation contained in this report is true to the best af my knowledge. �a�r�k '�e11 �t�., Ir�e. fl21.�3 Contract i Na e „/� License or Registration No. �1� il��-9� Aufhonzed Representative Signature Date LOCAL COPV' H � 5113 �� Name ol Person Sealing Well or Boring HE-01434-01 sue�ecr ,r-�c nm.i i- �v. ' c�ty of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � ��a � � ; � RECEIPT NO. � • COMMUNITY OEVELOPMENT DIV. �--� r �~ � PROTECTIVE INSPECTION SEC. (�J J i � � . � � � /'�'1 � CITY HALL FRIDLEV 5S4J2 NUMBER REV DATE PAGE OF APPROVED Bv �""� � �'' 612-571-3450 910-F15 5/11/95 J09 ADDRESS 6845 Channel Road NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. Pt g Brookview Addition 2 PROPERTY OWNER MAIL ADDRESS Z�P Adam Hardy 6845 Channel Road NE 3 CONTRACTOR MAIL ADDRESS Z�P Right Way Roofing Inc 16475 45 Ave N, Plymouth MN 55446 4 ARCHITECT OR DESIGNER MAIL ADDRESS Z�P 5 ENGINEER MAILADDHESS Z�P � � SEE ATTACHED SNEET PHONE 557-8678 PHONE UCENSE NO 7-8678 3999 PHONE LICENSE NO. PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASSOFWORK 0 NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof Dwelling (Tear-off) _ 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF COI SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OH ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED NO. DWLG. I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �3 640 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �E).3.00 SIGNATUiiE OF CON7RACTOR OR AUT110RIZED AGENT IDATEI OWNEA �IF OWNEA BUILDENi �DATE� OCCUPANCY STALIS 4UDA •- _ OCCUPANCVLOAD CU f PARKING GARAGES �1.82 iAC CHARGE Fire SC $3.64 fOTAIFEE �73.46 IT NEW ADDN ALTER (� �� [l Construcdon Address: Lega1 Descripdon: Owrier Nam Co�tractor: Addtess: CITY OF FRIDLEY SINGLE FA11tIILY AND DUPLEXES R-1 AND R-2 Building Permit Applic:ation � Effective 1 / 1 /95 � ��.� ��. .:.Tet. #: ss:I ��`1 � . . MN LICENSE # � ��g . Tel. # � � Attach to`�tiis application, a Certificate of Swvey .of the . . lot; wi�h the proposed constructi�n drawa on. it to scale. � .� � LIVING AREA: GARAGE AREA: DECK AREA: OTHER: ' Length Length Length DESCRIPTION OF IMPROYEMENT Comer Lat (] Inside Lot [ 1 Ft. Yd Setba.ck Ty� of Construction: Approx. Completion Date: Width Height Width Height Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. � Side Yard�Setbacks � �r�a co�c: � ?��0, ° (Cost on Back) Driveway Curb Cut Width N�ed: Ft. + 6 Ft = Ft x$ _$ DATE: � �� I � �� APPLICANT: �� .,.r._ Tel. # �!S 7-��L� �� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL CITY USE ONLY $ �r� fr�� Fee Schedule on Reverse Side $ .00�1 of Permit Valuation (1/lOth%) $ 3 P � $.50/$1,� Valuation $ � � $850 per SAC Unit $ � d�� $5.� (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ) Not N�essary [ ] $ • STIPULATIONS: _ .� � �;uu.��iNC; �>i:KMi'(' rc�. scr{r�tJr.r: "I�hc: (;hi�t l3uiidin}; Utticial �hall, liciorc i�.cuing permits for thc erection of any bui(ding c>r structure, c>r fi�r any :i�iclition tu any cxisting buildin�; or structure, or for any altcration or rcpair to any cxistin�; (�uiliiing c>r s�-ucture, u�n aPplication lherefore, reqaire the payment by d�e a��plicant for such �ermit c,1� icc:ti tc� the aniount hcrcin t�clbw sct fi�rtfi :�nd in thc manncr ficrein Providcxi to-wi(: "1'O"I'AL VA[_lll: � I to $500 . .�501 : to : $2;000 � $2,001 to $25,000 �25;001 to �50,000 $50,001 to $1{?0,(}00 . � r-r_t�s $15 (Minimam Fcc is $15 plus svrcharge) : . $15 for. �fust $SQO plus: $2 for each �additional $100� oc . � fraction thereof, to and .including $2,U00 - .$45 for fiist $2,000 plus $9 for each additional $1; 000 or fraction th�eof, to and including $25,000 � $252 for fust $25,00p plus $6_50 for each additional $1;000 or firaction thereof, �o. and including $50,000 $41450 for fust $50,000 plus $4S0 for each additional $1,000 or fradi�_ ther� to and including $100,OD0 $100;001 to $500,000 -$63950 for €lrst -$i00,0� plus- $3_SO for each additional� � $1,000 or fraction tf�ereof, to and including -$SOO,OQO $500,001 to $1,000,000 $1,000,001 and up $2039_SO for die 5rst $�0,000 plas $3 for each additional $1,000 or fracteoa thereof, to and including $1,000,000 $3539_SO for �e fust $1,OU0,000 plus $2 for each additionai $1,000 oc fradioa thereof - DRCVEWAY DEPRESSION ESCROW (Conccete (�erb S�-eets Only) Alternate "A"_ Removai and replacement of curb and guiter only - Driveway width plus b fee.�t times S13_50_ Alternate "I3": Removal and replacement of curb and gutter and install a 3 foot �vide approach with 6 inch depth - Driveway width plus 6 feet times $15_75_ VLR[FICA"CION OF POUNDAT[OIV 1'ermi�s for corut�uclion w711 be issued a minimum of 24 hours from the time of application to aliow for J�ro�cr review of tt�e pro�osc:ci strt�ciure and of the constn.+ction site_ A Certilie::itc ol Survcy of tlie lol, shvwing the location of dic founclation once it has it has heen constructeci wiU be reyuired beft�re proce�ecling with lhe framing.