AF - 43219City of Fridley, inn
BIJILDING PERMIT N° 5 5 0 5
�� '� �'� �" //'�
Date: � �r .r-_ ,t,,,� � � �'
�,� � � �
Owner: � � `�_. � �, Y -� ,� � ,,r �",,� Builder ' .
� =-=�� ' ' '
_
Address - Addresa
� * C LO� DING
�,
1�To. _:_ �" � Street `�` ;. � � .�_ �.� P f Lot
Lot � _ Slock � _..._.. Addition or Sub-Division `�'� � °.� ".,��.,�; ��:3� � � „���r
� � � �
Corner Lot ,�"� Inside Lot Setback �_.... Sideyard . �
Sewer IIeval3on Founda.tton IIevation
DESCRIPTfON OF BUILDING
To �.,al� r ,r' � e�,�;� ±� f�f� ��� �r�
y � ik��'.,r- Front '' Depth '� Height :�.� Sq. Ft ��_._._� Cu. FL ���`� .
-��:.��� ��
Fron Depth ��..�'' Height ��_ Sq. Ft Cu. F�
�
r
7�pe of Construction .� -�°..�� `''--�'� F.�t. Co�� .,;r"� �^'� �'�To be Completed
In consideration of the issuance to me of a permit to construci the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances oP the dty of Fridley.
r<
In consideration of the payment of a Pee oP $�_�, permit is hereby granted to ,
to construct the building or addition as descrlbed above. This permit is granted upon
the express condil3on that the �rson to whom it is granted and &is agentas, employees attd workmen, in all work
done in, around and upon said building, or any part thereof, shall c�nform 3n all respects to tlae ordinancea of
Fridley� Minnesota regarding loca.tion, conaiauction, alteration, maintenance, repair and moving of buiidings
�� dty ]imits and thia permit may be revoked at any �n ��f any of the provisiona of said
� `�'�'' f'�/�..._ _:.��.�� ,•,��rBuilding Inspector
' .,,, ..y;,,� °,a. �. �A�^e � � _
NOTIC�
Tiil� penntt does not eove� the coestrucfloe, instaqatton Po� wL�eg, plumbleg, gu heafieg, awer er watar. Bs su» fe ses
i6s Buildieg le�peeror for �parete p�rm6� he th�ss Itemt.
� 4 /'� -
- . �-- = -1...�
t- f � __„ �_
�PZ�=c�,Taoiv �o� suir�a�a�vG �E�maT
c�� o� �anr.�x, m�r�s�rA
Owner's Name � Bui]lder �
P�ddress Address
LOCAT30N �F
No a. f�"�' Street���i�1 /�� Part of Lot
� t,
Loit__ �. Block = Addition or Subdivisio
g� ' � � s
Corner Lot ��nsi�e Lot Se�tback�,���..-Side-Yard�
SEWEI�: ET�EVAT%ON �'OLNDATI011T FsLEVATYOIIT
Applicant a�tach to �hi� �orm Certi�iCate of Sur�ey of Zot and
proposec� buildin� location.
To �e�usesd as o
DE�CRIPTTON OF BZTILLD711TG
�'ront ; Depth__�__� Fleigh�t l�
S , !G Cu . Ft . � ��' C�
q. Ft.
Front____.__ Dep•�h Height
Sc,� F�t . Cu e Ft .
� d�
Type of Construc�c�Lon ` Estimated Cos•t�����-�
..._�
�o be Completed
The undersigned hereIoy makes application �or a permit for �he work
h�Yein specif�.ed, ac�ree�.ng �o do all work in strict accordance with
tlae C�ty o� Fridley Ordinances and ruling o� the Depar�nner�t ofc Builcl-
ings, and hereby decla�ces that all the fac�s and �epresen�a�ions
s�cated in this apg�lica�cion are true and co�r�ct.
DATE � a.-m �°� SIGNATiJtaE �'`� � � .
(Schedule of �ee Costs can be found on the Reverse Side).
�
n
o_
�UILD?.1�TG PERMIT FEE �CHEDU�E
Sec�ion 2. The �nspector of Sui].din�s shall, before issuingi any
pe��ni� for the erec•�ion o� any �uilding or s�ructure, or �or any
add3�ion to any ox�s�cing building or sic:�uc�ure, or for any altorations
or repa�.rs �to any oxisfing bu�ld�ng or si:ruc�u�e� upon appiication
�h�re�or, require �he pay:nent by fihe applicant sor such permit of
�ees �to the amount herein below set forth and in the manner herein
prcov�ded to-wita
2.�,e Tor any such perm3t for the ereci�ion o� any fire-p�oo� building,
o�h.er than a garaga, warehouae, faeto�cy or grain eleva�tor, o� �or �the
erec��.on of any iir�-p�oo� a�dition,. for. s�.m�.lar occupancy, to any
exisicjng buildinr� shall 1oe at the rate of $1.40 for each ono thousand
cu'�ic �=eet, or �rac�ion thereo�E, in such culoic�], contents e
2,2. �or any auch porm,�t �or the erec�tion of any �Eire-proof garage,
waTCehouse, �actoJCy or grain elevat�r, or �or the erection of ariy fire-
proo€ addition, �ox si�nila� occupaazcy, �o any existing building shall
be at the ra�a os $1.25 �o�c each one thousand cub�.c feet, classi�ieci
as "iireproo�" by Sec�ion 502 0� the Minneapo].ia Building Code.
HOLTSES
a.3. For any
�.ng other tha
non-rigeproo�
Permit $1000 f
Gi�i,2�1GES
such permit fos the erect3.on of any non-f3.repsoof build-
n a garage, warehouse, fac�ory or g�cain eleva�or, o.r any
addii:�on, for simi3.ar occupancy, to as�y exis�ing build3ng
or "each on� thousaticl cubic feet.
2ea. For any such �e�mi�t for th� �rection o� any non�fireproo�
garage, warehouse, sac�toa� or grain eleva�or, or for the erect3.on of
an� non-fireproo� add�.�io�, �or simlla� occup�ancy, to any existing
building or �o�c each such buildirig' or additiono Nin�ty Cen�ts fo�c each
one �housand cubic feet or fraction �cl�.ereo�, in the cu161ca1 can�ents
thereof wi�1i a min:�num o� $�,00 a
�or �he purpose of computir►g fees for building permits the cubical con-
ten�S o� any bufl��ng or addition �to a uniform height throughoui: by
mult�.plying the g�ownd a,rea coverea� ;xo�n a point' six (6) inclzes below
�he floor line o� �he laasement or �e11a:r to the average height of the
upper sur�ace or �o 'che average heigh� of the roof aurgace ofr the main
gable of a pitched reoo�.
..�2,5.� For repairs or alterations to an exist3ng structure, �he gee
sha11 be at �che ra�e of $3,00� per� eac11. F3ve Hundred DoZlars i$500.00)
o�c i�act�.or� thereo:c" �,n �he cost o� all proposed worJc.
2.6, r.n no case sha11 tho ree chargec� ior any permit as s�t forth in
section 2.1oe less tH� $4.00, ^
.� �
sue�ecr PERMIT .
City of Fridley � 13652 �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T •
,,
.�
COMMUNITY DEVELOPMENT DIV. •
� �y__ �.�`i� J
r � � PROTECTIVE INSPECTION SEC.
1 = �
�� ����1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
""� � ,'� 612-560-3450
910-F15 7/19/76 � �
JOB ADDRESS 100 Crown Road N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9 2 CarlSOn's s�unmit Manor North Addn. SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
Floyd Knudson 100 Crown Road N.E.
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION �7 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESGRIBE WORK
Finish one half of basement
9 CHANCiE pF USE FROM TO
STIPULATIONS
SEPERAT� P'�l�MITS REQUtRED F�OR 1�t(Rt�tGr
HEATING, PLU�MBING AN� StGl�tSr
$EPARATE PERMITS ARE REQUIqED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. TRjOOd EiaIIl@
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 FOR A PERIOD OF i20 DAYS AT R 1
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE $AME 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 $'rJOO .5O
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � � y�7. SO
PLAN CHECKFEE TOTALFEE
y�`8. �0
NATUHEOFCONTRACTORORAUTHORIZEDAGENT IDATEI WHEN PROPERLY vALIDATED THIS IS YOUR PERMIT
� A
� , ��`, _���,� d � � �1�� v :Q �'� ca � %'/ � —°I� � P
� SIGNATU OFOWNERIIF,OWN BUILDERI ID EI BLDG WSP DATE
� c�
�
CITY �OF FRIDLEY
APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
OWNER' S NAME :� � O y' IJ C� � K i� �X D�� 1�( BUILDER : f( b y 7� C1 P�G'N UlA S Qhl
ADDRES S: I O o � 2 0�..i rl R�, N��. ADDRES S: l� c� �`€� � �,•� N C� 17 Q l`( P�•
�
NO :. r d d STREET : C� ? o w N A� I`� ��•
LOT • BLOCK • �- ADDITION : C.° 11- R L S a M�s S u. w� wt `i i' /1� dt RI o R�I o
CORNER ZOT: v INSIDE ZOT: SETBACK: SIDEYARD:
Applicant attach to this form �ao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As:
��a���, ja a,�,g�#����nt: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
OO
Type of Construction: �'i�sisb� OFF ��� ���+►��e�'timated Cost: $ �CryC� o`�
� To Be Completed: � ir� �
The undersigned hereby makes applicatian for a permit for the work herein
specified, agreeing to do all work in stzict accordance with the City of
Fridley Ordinances and rulings of the Departme�t of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE : ,� � I 9 " 7 � SIGNAT[iRE :� � �' , T„�..�.�c�t.e�
(See Reverse Side For Additional Information.)
� �,�5�
� S�
.
`r d,. -
� �_ D
af
e
�BUILDING PERMIT FEE SCHEllULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set ��orth and in
the manner herein provided to-wit:
%1EW CONSTRUCTIOL�: Sa,ng],e Family Homes and Garages: $4.00/1000 cubic feet
PI,AN CHECK: 25 percent.of building permit fee.
ADDITIONAL INFORbiATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
ox the cellar to the average heights of the upper surface or to the average.�
•height of the roof surface of the ma.in gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee chaxged for any permit as set forth i.n Section 2 be
less than $7.50.
VERIFICATION OF FOUNDATION
� NOTE: Permits for construction will be issued a minimum of 24 hours from the
time of application, to allow for proper review of Che proposed structure and
of the construction site. �
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
Co the use or occupancy of �.ny structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
e
�
� s
v
SUBJECT 0•
City of Fridley �° 2 0 5 9 3
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� ` RE IPT NO.
COMMUNITY DEVELOPMENT DIV.
L PROTECTIVE INSPECTION SEC. ,3 7�� �
� _
� � _"
r ; " ";
� t ,
� /'��l � CITV HALL FRIDLEv 55432 NUAABER REV. OATE PAGE Of APPROVED BY
�----� • •'� 612-571-3450 910-F15 9/27/90 � �
JOB ADDRESS 100 Cmwn Raad N.E.
t LEGAL LOT NO. BLOCK TFiACT OR ADDITION SEE ATTACHED
DESCR. 9 2 Carlson `'s: �uaani.t Manor North Addition SHEET
2 PROPERTY OWNER MAIL ADORES$ ZIP PNONE
Floyd Knudson lOQ Crown Road N.E. 572R1038
3 CONTRACTOR MAIL ADDRESS Z�P PMONE UCENSE NO-
D& D Home Improvement 7401 Central Avenue N.E., Fridley 784-7545
4 ARCHITECT Oii DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
RLS 1 C�@Il't].dl
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION � REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroo�' Dwellix�g (tear-o��1 22 �quares
9 CHANaEOFUSEFROM TO
STI PU LATION S
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIREO FOR ELECTRICAL, PLUMBING, HEATIN(3,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO 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 WIIL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�- p�-QO' $, SS
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMIT FEE SAC CHAfiGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUC O OR THE PERFORMANCE OF CONSTRUCTION. $27• OO
PLAN CHECK FEE TOTAL FEE
�'ire. SC $1. $28..65
S�GNATURE OF C NTHAC?OR OR AUTHORIZED AGENT IDATEI HEN PRO E A A ED THIS IS YOUR PERMIT
. � �' '7S !J ��
SiGNATUREOFOWNER�IFOWNERBUILDER� 1DATE1 BLDG �NSp 17ATE
NEW [ ] Effect.ive 8/16/90
ADI�T [ ] I�1 AND R-2
ALa'IIt [ ] Building Peamit Applicatioaz
��� �: ��� ����.c/ ��� ��
� ����:
owner r�ae & A�dress:
c�actor:
�' - " . / .
•��• ' './�� :% ��/
��
�. # �°�� ���'
�. # ����°"�
Attach to this application, a Caertificate of Survey of the
lot, with the pr� v�struct.ion drawn an it to s�cale.
7�IVIIJG ARFA: Lerigth
C�R1siGE ARF�i: 7�exlgth
DECK AREA: � Ierx�th
OT�R:
Width
Width
Width
���
xeight sq. F't.
Heic�t Sq. Ft.
Iigt/Gro0.nxl Sq. F't.
Corner L�t [] Inside [] . Yd etback Side Yanl Setbacks
Zj�p� of Cbnstruction: - � Estimated Cost: $ �%� �
Approx. Cxanpletion Date: �� Q � `��� P
Proposed Driveway Width If New Is Desired: Ft. $ $
Width + 6' See Back Page
L1ATE: � APPI�CArFr: Te1. #
P�smit Fee $ � %, oD
Fire SuYrharge $ /. � b
State SuratiaYge $ • ��
SAC cizarge $
Driveway Escrdw $
Park Fee $
s�wer Main cY�arge $
�'�''_
srrnt�,TZONS:
$ � c - �OS
CITY IISE �Y
I _- .��s .�_ - . � � � - �-_ .,-
.001 x Ppxmit Valuation (1/lOth �)
$.5o/S1,000 va�u�tio�
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee DeteYmined bY �1��4
� N�Y [ J � N�rY I l
I:i� � �� ��5+-i � ':�° ; a�:��+� 1
Zhe Chief Buildi.rig Official shall, before issuitig permits for the erection of any
,; i ding or structure, or for ariy addition to ariy existir�g building or struc4are, or
for ariy alteration or rep�air to ar�y existing building or structure, upon application
therefore, require the payme�zt by the applicant for suc� ��++; t of fe�s to the an�ant
hortpin below set forth and in the manner herein prwided to-wit:
� ��
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
M�+�+�-�
$15 (Minitmnn Fee is $15 plus surcharge)
$15 for first $500 plus $2 for each ac'�litional $100 or
fraction thereof, to and iricludirig $2, 000
$45 for fiYSt $2,000 plus $9 for each additional $1,000
or fraction thereof, to and including $25,000
$252 for fiYSt $25,000 plus $6.50 for each a�itional $1,000
or fraction thereof, to and incl� $50,000
$414.50 for first $50,000 plus $4.50 for each aclditional
$1,000 or fraction thereof, to and iricluding $100,000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to arid i.ncluding $500,000
$500,001 to $1,000,000 $2039.50 for the fiYSt $500,000 plus $3 for each additional
$1, 000 or fraction thereof, t;o ar�d including $l, 000, 000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction #hereof
DRIVEf�Y DEPRES3I@T ESC[iOW
(Concrete Gvrb Streets On1Y)
Alternate "A": Removal and replacement of curb arid guttex only - Drive�tay width plus
6 feet times $13.50.
Alternate "B": Removal and replacement of curb arid gutter and install a 3 foot wide
a�roach with 6 inch depth - Driveway width plus 6 feet times $15.75.
Ct1' _�1!��! �_ �_ •;
Fermits for ocnstniction will be issued a m�*+��++�TM+ of 24 hours froan the time of
application to allc�w for proper review of the pr� skructur+e and of the
c:on��truction site. �
A Certificate of Survey of the lot, shvwing the location of the fwndation onoe it has
it has been vonstructed will be. requir+ed before proceedirig with the framing.
sua�ECT PER
c�ty of Fridley �2 0 9 9 2
' , AT THE TOP OF THE TWINS g � I L D I N G P E R M I T RE •
t
� �
� 1 y� _�� COMMUNITY DEVEIOPMENT DIV.
r � � � PFiOTECTIVE INSPECTION SEC. �/�Q
i = �
� /"'1 � CITY HALL FRIDLE� 55432 NUbIBER REV. OATE PAGE OF APPROVED BY
�.._.� � ''' 612-571-34b0 s�aF�5 8����1 / /
10B AODRESS 100 Crown Road NE
1 LEGAL LOT NO. BLOCK TRACT OF ADDITION SEE ATTACHED
DESCR. 9 2 Carlson�s Summit Manor North Addn. SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Knudson 100 Crown Roa,d NE
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
D& D i3ome Improvement Inc. 7401 Central Ave NE 784-7543
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PNONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW O ADDITION C]X ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Install bay wix�dow
9 CHANGE OF USE FROM TO
STI PU LATIONS
See notations on Pl�• New �ootings must bear on sound ground.
TYPE OF CONST. OCCUPANCY GfiOUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONIN(3 SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OH ABANDONED FOH 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 ypLUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED $2 � 350 yfil, ZS
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEHMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $,rJ�.QO �ire SC $2.3rJ
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
, � PL FEE TOTALFEE
$5 53
SIGNATUREOFCONiRACTORORAUTHOqIZEDAGENT IDATEI WHEN ROPERLY AL S YOUR�ER T
�
SiGNATUREOF OWNER�IF OWNERBUILOERI IDATE� P riATE
� E3
� I ]
���
k.�,�-i+s �n •�, :.,. sw-t
Iegal De�3pttan:
Owner Na�e & A�ss:
l���S= ti!� .
Effective 8/16/90
1�1 AND 1�2
m,i 1 di m P�exmit Applicatia�n
/�� e����, ���d
! �,
d r �'
c�c� � 9, ���c.�� � �����-� r� �� �� z�b�� � ii������ �..
'� �CJ' Z�P1. # �`%� - ����(f1��
1�3dr�es.s: , —!1__`� � l �� ti't °�� f � f��' / v �
I.I�/II+� Att�s
� AR�i:
D�7�'dt �a
O�Rs
� �r, � �. � �' ��- ��y�
Attach to this applicatiaa�, a OeYtificate of Survey of ti�e
lot, with the praposed c�o�wctioal � a� it to scale.
�TI�T G�+' II�V��1'
Lenqt-li Width Height Sq. F`t.
Iength Width He3ght Sq. F't.
Ien9t'h Width iygt/Gran'�d 3q. Ft.
Corner Iat [] Inside Iat [] Ft. Yd Setback Side Yard Setbacks
Type of Cb�st�ucti.cm: _�y �•ih �"' . `� °� (o�w� F�stimated Oost: $ � ,� J � `�
Appmx. �letian Date: _ �/ -/ � g /
�
Praposed Drivearay Width If New Opening Is Desired: Ft. $ $
DATE: " 1' q I , �C�� L�� ���,,,Width + 6' See Hack Page
APPI�CANr. ' ��• � / Te1. #
Pprmit F'ee $ � � �
Fit�e � $ . � �
s'tate surc�arge S �l,.l� �
SAC Q�azge $
DFiveway Esc�vw $
Park Fee $
Sewps Main Q�axge $
CITY UBE �Y
Fee Sci�edule oQ'► Rev�e Side
.001 x Piermit Valuation (1/lOth �)
$.so/$i,000 valuatian
$600 pez' SAC Unit
Alt. "A" or Alt. "B" �i�ove
Fee Deter�ned by �; r�r; r�
� N�Y I l rto�t N��salY []
� $__=��
s��aa�s : � � r � � � s �1 �t � � C��
ti�� ��
Sa� ��D � �'—° u��
9
�� /
�o ��
��� �
�
Kr,u�spn
I o o c ro�'� R c� -
.
�,1 �k O �+o Me. �nr�('+�Vev�th+-
�
'7 �f = `1Sy3
��t'S'�"`� �10�1.Se �T�`\ + �xl �j�t^�1�� \`?���.� _ _. �
��t ��� co�s�. �
. 3�"
5hea��ng
�q P s+d+r�
=nS�1a�e �;�5, Shee-�, ;
Cxl k �a5ihoj� , ;
�.aSerrent u �r�w5. !
bqk -4-lmR� i"^a�.
% P1Ywno� Su.b -�1oo�t._�__
�'�10 � �`�'f'S •F i\1 e� wi'fV�\
F��ce,�tdss � nSv�+d�an \
yyc� �os �s
��d�r L�.-�-��ce _-____
-_
a- i
a� R�u►h�. P��� ��`
Ftq �� � �t b�-F-�orn
�.
- '�
f/�
���
�
�,�..�"�
��` �
��
! � v4 �-�' p�TS,
��w�� -
� .--.---------.__. . __...._ . _ ----
� �u €,� Fo�,� d m �
C��. c.,� �u� �2���
' Su6�eCT �
City of Fridley 2 8136
AT TME TOP OF TNE TWINS g � � L D I N� P E R M I T
� - �,��-3604
, � RECEIPT .
� `y __��� UNITY pEVELOPNIENT DIV. � ���
f � � PROTECTIVE INSPECTION SEC.
� . �
i--•.�; �'�','� CITY HALL FRIOLE� SS1�2 NUTABER pEV OATE P�GE O� AViqOVED 8�
t 612-571-3450 gt0-F15 10/7/98 � �
J08 ADDRESS
100 Crown Road NE "
1 LEGAL LOT N0. 9LOCK TRACT OR ADDITION SEE ATTACMEO
oescR. 9 2 CArlson's Summit Ma.nor North ddn SNEET
2 PROPERTY OWNER MAIL AOORES$ ZIP PMpNE
Flo d Knudson
3 CONTRACTOR MAIL ADORESS 21P PMONE IICENSE NO
Milton Johnson Co. 525 Lo -
a ARCMITECT OR DESIGNER MAIL AOORESS iIP PMONE LICENSE NO
5 ENGINEER MAIL AODRESS ZIP PNONE LICENSE NO
8 USE OF BUILDING
Residential �
7 CLASS OF WOFiK
❑ NEW O ADDITION � ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WOFiK
Re lace dama ed and missin aluminum on house and ara e
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMI7S ARE REQUIREO FOR EIECTRICAL. PLUMBING. MEATING, TVPE CF CONST. OCCUPANCY GROUP OCCUPANCV �OAp
VENTI�A7ING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULI ANO VOIO If WORK OR CONS7RUCTIOM IONING SO. fT CU FT.
AUTHOR12ED IS NOT COMMENCED VjIITHIN 80 DAYS. OR IF CONSTRUCTION
OR WOfiK IS SUSPENDED OR ABANDONEO fOR A PEF1100 OF 12Q pAYS A? '
ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG- UNITS OFFSTpEET PARKING
I HEFiEBY CERTIFV 7MAT I MAVE READ ANp EXAMINEO TMIS APPLICAlION STA�LS GARAGES
AND KNOW TME SAME TO BE TFIUE AND CORRECT. ALl PROVISIQNS Of LAW$ yq�UATION SURTAX
AND ORDINANCES GOVERNING TNIS TYPE OF WORK WIIL B� COMP�IED
WITH WHETMEii SPECIFIEO MEREIN OR NOT. THE GRANTING OF A pERM1T $1150 .S7
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TNE pEWM1T FEE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR IOCAL LAW REGUlA71NG CON-
STRUCTION OR 7ME PERFORMANCE F CONSTFUCTION 40.25 ire S 1. 1.5
� , P4AN CMECK FEE OTAL FE
���-�-=a�-�—t'� � �� � a`�� Licens C 5. 0 46 7
�
�S�GNeTUAEO�CON•AACT NOAOUTMON�2EDOGENT iOATE� EN P PER IDATED IS YOUR PERMIT
S�GHOTUAE O� OWaEp��F pWNEp BWLDEA� �D�TE� , O' ' �
BLOG NS� � natt
N E�V
ADDN
ALTL-'R
I ��
[1
� X�
ConstructionAddress:
Legal Description:
' CCTY OF FRIDLEI'
S[NGLE FAMILY AND DUPLEX�S R-1 AND R-2
BUILDINC PERMIT APPLICATION
100 Crown Road N.E.
crf����..z i i i i9�
��� �
��, �o�
�
Owner Name & Address: F7,oyd �cxiudson C�azne) Tel. //
_ ��2��n g
Contractor: Mi � t�n Tnl�nann �r. MN LICENSE# 2083
Address: 525 Lowry 1�ve. N.E. , Mp1s. 55418 Tel. � �Ri �,A54R
Attach to this applicadon, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEAZE\rl'
�n� Width Height
�ng� Width Hei�ht
�n� Wld� Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Replace dartaged and missing
Construction Type: aluminum� on house & garage ��ated Cost: $ i �
,�0.00
(Fee Schedule on Back)
Driveway C�rb C�t .Width Needed: Ft. + 6 Ft = Ft x$ �- —$ �
DATE: p-,� =�� ApPLICANT: '� ���� eI. # 7 81- 9 5 4 8
_�-`.
Permit Fee
��ire Surcharge
itate Surcharge
iAC Charge
:icense Surcharge
�riveway Escrow
:rosion Control
'ark Fee
ewer Main Charge
TOTAL
['[I'UI,A"l'[ONS:
$ �- �S
$ % / �^
$ ��'7
$
$ - C�C�
$
$
$
$
� ">�-
CITY USE ONLY
Fee Schedule on Revetse Side �
.(ml of Pecmit Valuation (1/lOth%) �
$.50/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above �
�$450.00 Conservation Plan Re��iew
Fee Deterrnined by Engineering
Agreement Necessary [ ] Not Necessary ( ]
�
a
c
�
�
� . . !
au�c.u���c: ��H �t�irc rcc scE��u��c.��.
"Clic Chief i3uilding Ofiicial shall, lu:fore is,suing pem�its for the erc:ction c�l� any building or structure, or fi►r
any addition to any existing building or stniciurc, or foc an}� alteration or repair to any cxisting buildin� or
st�ucwre, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the. ma�ner herein provided to-�vit:
TOTAL VALUE
$1 to $S00
$501 to $2,000
�2,OU 1 to $2�,000
$25,001 to $50,000
$SO,QO1 to $100,000
$100,001 to $500,000
$SOO,OOI.to $1,000,000 •
$1,000,001 and �up �
f����
$21 (Minimum Fee is $21 plus surcharge)
$21 for fust $S00 plus $2.75 far each additional $100 or
fraction thereof, to and including $2,0()0
S62.25 for frst 52,000 plus $12.50 for each additional �1,000
or fraction thereof, to and including $25,000
$349.75 for ftrst $25,000 plus $9.00 for each additional �1,000
or fraction thereof, to and including ��0,000
$574.75 for first $50,000 plus $6.25 Cor each additionai
�1,000 or fraction thereof, to and including $1p0,000
.$887:25 for first $100,000 plus $5.00. for each additional
$1,OOO�or fradion tliereof,.to and �including $500,000
$2887.25 for d� first $500,000 pius $4:25 for eacli .additioml
$1,000 or fraction thereof, to and including $�1,000,000 '
$5012.25 for the fust $1,000,0(� plus $2.75 for each addirional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION FASCROW � .
(Concrete (�ub Streets Only)
�
�lternate "A"�: Removal and replacement of curb and gutter only =�Driveway width plus 6 f�et times $�3:50.
1[ernate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.7�.
VERIFICATION OF FOUNDATION
�
;:rmits for constnlction will be issued a minic�um of 24 hours from the time of application to afilo�v �or prop�r
:��ie�+� of the proPosed st�ucture and of the constcuction site.
��.:crtil�icate of Surve�� cif thc lot, showinR the location of'tlie foundation ��nce it i�as i[ ha.rhe:zn c�nstr-uct�i:!
•'� : ��_ rc��uiru�l h�ii,r� ►�����,:crdin�� ���iti� th� fr.�min�-
,, ;
Bua.lding
Inspectians
7�3-572-36Q4
srrE annx�ss,�,,
'[1315 APl'LTCA1dT 15:
OWNER!
R
TENAS�'['
SUSMI'f A COPY OF
YC1UR S'fA1E
WC�� �
qppLlCAi[ON
PERNIIT TYPL
TYPE OF WORK:
AILED
���
...
N�EC�ANICAL
A.PPLICATION
oF ���Y
�.�, nanxFSs
, . � � �;;� .. � ,r .,.
zy
€�; � � � �
��. ;` ,
, . , x ���1 . .� � .�
_•
�I � - -
. � ;�
~ ;�;
t,
r�� r , i � � �_.. � ��'--- �
p� , /;1
Mi � :1• .a i,y}��![�� �%!�, �- �'���J��J1I•�'��
.r�� y : �A ��� ,
r
r � a , �. � � \
, • � _a�
E FAMA.Y � � 'I'VVO RAMILY
LnCF•Id�NT
WoRK 1(�S't� �
PER IVI51 fi�=6�� �� pennit fee is a mini
improvcaneat, �op ar r�pla�nent
Labor cost �mder 5300 m�15.00. I.abor oos
FOR PitOJExCS W�E 1�'R ��� ��'
NUI►�ER QF 6ACH H�t.OWi
��tlnsteUcd , �� �
I�ffG:
MFti: _
� 525.�
AIRTO NR F.7CCIiAA1G�ER S1S
BOlI.Ot 535.Ot1
p�1VII�EY 1.DJER StO.OD
'—nucr woxtt s� aoo
. . : - - �.
Pennit Fce $ I
Surc�e
TOTAL DUE �
0 TOWNHOUSE
D ALTLttR'l1UN/REMODEL
permit No.:_
Received By:�
Date Rec°d:, �' ° �� _ `�°���
n�r�Y1�.,�'�
��1 a i ■
n of 515.00 or Sele of t6e total oost np to �.BR �1u�ever is �at�r, ��' ��
�esidentia! fixtnr�� exc�ud'mg tbe i�. ��d se�ecx ot�}y th� �t �#' �abor }
S3t10 to �SOU = cost of labor _ x.OS �,�._�
ARE BASED ON S1fl.QQ P�it F[Xl't.IRE. EXCfiPT �VH�RENO'IED. FDCiVRESt (lAID1CATE TOTAL
�MODEL: �.�,�, SlZF1BTU
�y� NI�DEL: ���U(� j ��--�--
M��"' OAS RrWGiIOVEN SIO.�
�IR�'l.aCE {Gw5) 3t5.00 J�V tiA,� QRt1.L Sl'4.00
,�tEpti,pCE (V�rppD) S3s't�1 anS ui�i7' ti�x si4.�
�URNAC� 535.00 POUL l�AT�R S�S.04
iAAS DRl(Fdd 510.04 �TOR S13.U�
3AS PW� 510.� e..+•►����s! � 1K'e
Wum� of fi�tves ��10.Q0 x�54.0[► m S
Numb�r of � 8� 1�.� x S15.OQ =$
Nu�nber of �tures aQ SZS.40 x S2S.� °�_
Number of Sxt�ues aQ 535.00 x�3S.00 m$
State 5urchar�e ° S.�
Tartal ° �
THIS IS APPL�A120N FOIt A P�T �T VALlD ULJTA. F�S�
ik and l�owledge t6at the informa�on above is campiet� and atxu�ate; thet the work wilI be in
I hereby epAly far a building p�m
conformas�ce with the ardrnances and of the City af Fridiey and with the Minn�scta •Cn�c�a Cadas; that T �mdestand this is
nat a permu but only a� applirstioa for a it and wo� ��� � f�� e Pe�� � tite vvark an�l be in accotdaa►ce vviith the
approved �Ian��t f�a t�se o �k wi� , y
��. V l.� DAT'E
SIGNA'tURE OF APPLICANT
.. ' C�� Q� �tl[����
uiiding InspeGtie�ns Department �
�i43 University Avenue 1VE, Fridley, MId 55432
763-57a-36�a
FAX: 763-502-A�977
9
[7
w
REClU�RED INFUl��►�'iON NEEDEt� TO
RESIDEAfTIAL PERMI'� APPLICATtON
NEW HOMES/ADDiTI{�AIS FJCtSTING HOME
R�QUIREO F{iR NEWlEXESTt�(3 HOIUlES
1, C�mbustion Air (Sce note below} .
a. Qil or solid. fuei I1+�IC Chapter 7 witb MN AaQendm�nts
b. Naivral Cas or Pr�openelIFGC �#.�t 3 with MN Ame
2. Maice-up Air (Se,� note belcw)
at. IlVIC Chapter S with MN Amendmenls
�� Y �,C1
a. GaS appliBnC.�s IFGC Ci�apt�r � with MN 1tim�ndmcat�
' b. Fuel other tbaa gas ]MC Chapt�r 8 with MN Ame�dme
f�E?4�UfRED FOR NEW HOM'ES
4. He�t las�s � c�liag Ioed per noona
a. Required on n�w ca�ctioa TNlC 1346.�312
5. Vealilaiion . .
a. Pcr MN' Ene�gy Cods ?670 or 7672
6. Duct Design PGr ]MC 1346.Ui6ti3.2
a. ACCA M�ua1 I)
1�t4TE: Centerpoint Energy Meel�anical Code
comb�stian and make up air calculaiivns
P�R�Vi�T
AC
MAKE-UP A!R
,
0
software may be ns�� for
F�L.l���1N�
��S�E�1�A�. APPLl�C�►�l��f
�i� �i Fradle�
P10TE: IF PROPERTI SS.iVpT OWNER/OCCUPIED- A L10E�18� CONTRACT�R AAUST OBTAIM'iliE PERMiT.
na� /— ! `fi O �S
SITB ADDRESS li(�(.
7HE AFPLICANT IS: (C1RCL� ON�
YOUR E-MAtL ACDRESS
t� n _ �
r.i1.1�
PRQPEiiTY OWNF.ti! uAME _. I� I.o � ��I C�. N'1 L� ���,
TENANT ADDRESS _ �_Y4�1�
CTIY STATE �p
PHONH � m � f� �
«. .�
PERIMlIT TYPS
TYPE OF W�RK
NANE �
ADDRES9 _,p�
e+c�v 11
C1T� - - — -
PHdNE i0�,,.. _- - -
❑ NEfN
DEfA1LED DEB[�IP�T[ON OF WORK
UCENSE �
i i'ATE �p-,.__!
FAX�
11N4 �'AlIA1LY
� RBPIACEMENT'
FEE9 AR� SASED aN �10.00 PFR FIXTIIR6, BXCL�PTyVFFERE N07ED
FIX�i1RE�: (INDICATE TGTAL NUMBER OF EACP�
BATH SlNKIL.AY FLOOR DRAq+1S SHQWER �M1M1IATER PIPFNG
BATMTUB 4A� PIPiNG fNeed C7ty Ucertael SvYRM►e1DiG FOOL 4VAT�R SCF iENER (595)
C�.a7'l�1ES WA9H�t KlTf�IE{+131NK WATER t�05Ei' BAt�(FL+OW PREV. (S9�
DISMNAS!!ER 1AUNDRY TRAY �AT6R H7R (S3G� FOR tRRIGA'f10N
• WATEii lNfiT6R 4TIiER
Pennit Fee $ � � .t��
Plan Review y
Surcharge S .9�
iOTAL DUE S � S°- �C)
MINtMUM: $9S.0o or 3% of cast of the improvemerft-wh�chever is
greater on work lems than $3�0
Make checks payable to: Cfty of Fridley
� rno �a� s�n APPUGATION FOR A PERMIT - WOT VALlD UNTIL PROCESSEp
I herebY BPP�Y tar a plurnb}ng ptmtit arai 1 adcnowledge that the intormaiian above is aomptete and aocuratg; that lhe wark wifl be [n conforrnanoe with
the oMfnanops and rAdes of tl�e C1� ot Fridley and with the Minr�esoyQ Cony-Wctl�f Codes: th�t I undeisland t h� q i� not a p�mit hut only an
appliqtWm tor a pem�it and wark is not ta sfart wifha�t a permtt thal the w�k wiil Ae +n ar�o�dan� with rhe approved p�n �� the c�,qe pf aU wotk which
rEquiras revlenv and apprwa� ot p�ans.
NAME OF APPUCANT J/ v ! � �� ( �� s7 .P i� DATE - - � �'l ''� Y
PI88se type p p , - -
StGNATURE OP APFUCANT ,Pi� /��•r/
TOTAL P.01
FiOUSE HEATING TEST RECORD
ADDRESS � APT. FLOOR CITY SUBURB� �' ,
OCCUPANT �— OWNER
HEAT LOSS A E H 1 ST.
SOLD BY � INSTALLED BY �L�
Electrical Work BY Gas Line By
TYPE OF HEAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER
GAS DESIG CONVERSION
MAKE '� 7 " MAKE OF BURNER
Model --- Model
Serial _ ' Max. BTU Rating
INPUT MAKE OF FURNACE
Model
CONTROLS
THERMOSTAT �L�.- H Plu
Va Ive
c
Limit
Limit Setfing
Fan Setting L� -�
Pitot Trpe
Pilot Make '�
�� ec
Vent s�:e
KIND OF LINER � - SIZE�NONE
Drah Hood RegulaTOr
Fi Iters Size Number
Chimney Loeation de Outside _
� Chimney Constructie� � �t -� '�-� .i�/L�
Pilot Model Smoke Bomb Wiring
Pilot Timing � �-��'' Droft � Test Tag
L.W. Cut Off Door Pressuro Lighting Inst.
Prossure �� � Pereent CO2 , e Date Tested _ �1
Input CFH Percent 02 Company Testing S -t �
Staek Temp. ���% Pereen4 CO �' Name of Tester
Form 235