AF - 43233�
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� Vi.11age of Fridley, Minn.
t
� BUILDING PERMIT
:
Date: . . . . G����� . .'?: . 'L . . . . . . . . . . . . . . . .
Owner.......................................
Address......................................
�l
�T° 1808 �,�
,�
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Builder...................�............... .....
Address . . . . . . . `�`� � � . . ��. . . . . . . . . . . .
LOC.4T[ON OF BUII_DING
No. . . A � .?� . . . Street . . . ��: ?�. ?!:✓. .!'�. . . . ..���. . . . .. . . . Part of ot . . . . . . . . . . . . . . . . . . . . . . . . .
Lot ....��........ Block ....�� .............. Addition or Sub-Division ....... .. ...... .�.�.�c��^...Ga-....�.�/.��
Corner Lot ........... Inside Lot ...?�... Setback .��..... Sideyard .../.� ......................
To be Use as:
�. ..... .......
DESCRIPT[ON OP BU[LDING
Front . `� �-. . Depth '? : � . . . Height � . �f �. Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........
Type oP Construction .l.t'.?�.!'1.� ..... Est. Cost ..�1 ..��..�'.r�.�....... To be Completed ..................
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all. provisions of
ordinances of the village of Fridley.
.....................................................
i �(��y�
In consideration of the payment of a fee of $..� �. . . . . ., pernzit is hereby granted to . . . . . . . . . .
. . . . . . . . . . . .. . . . . . . . . . . . . to consixuct the building or addition as described abave. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worlunen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of sa.id
ordinances.
. . .� . . � . ���' • • : -- • • �. . . . . Building Insgector
�
NOTICE: _�
This permit does nat cover the cons �fittion, installatioe or alte�ation for wiring, piumbing, gas heating,
sewer or water. Be sure to se,e the Bat`�ing Inspector for separate permits for these items.
�
�,
�.
City of Fridley, Minn..
BUILDING PERMIT
Date: dul'y 6 s 1965
�-`� 9��3
N° 8116
p�; i�olaud DeBoer �� A7.. G. Anderson Constr. Co.
Ada�s _ 12F�. Cra�n Soad A�� 998 Transit �►ve. St. Pav.1, 13
LOCATION OP BUILDING
No. 12 Stseet Cro�nm Rc� Part of Lot
Lot �- Biock � Addition or Sub-Div�afon �aPieon� s�urun3.t Manor
Coraer Lot _ Inside Lot
Se�ver IIevation
Setback Sideyard
____ Fo�mdation IIevation
To be vsed sa:
Front
Front
Type oP Cflnslructlon
DESCRIPTION OP BUILDING
Depth Height Sq. F't.
Depth I�eight Sq. Ft
, �, �„�,000.00 To be Completed
Cu. Ft
Cu. Ft.` ' ..�
Storm 13amage repa�l.r .
Ea�deratlon oP the 9ssuattce to me of a perm4t to construct the building described above, I agree to do
the proposed work fn accardance with the d�scription above set f and in compliance with all provlstons of
ordinanc� oP the dty of FricIIey.
r
Ia camisfderation oP tite payment of a fee of $ 1�.00 � p�t 9s her�by granted to �• G. Anderson
,�oA�tp. C0. to construct the buflding or addition ea descrYbed above. Thisp�rmf t is granted upon
the expreess conditiaa► that thep to whom ft is granted aad his agents, employees an� worlmnen, ffi all work.
expr ers�n
doae fn, around and upon sefd building, or anypart thereoP. shall conPorm in all respects to the ordinance� of
Fridley, M9nnesota ■ariing lacatton, construction, alteration� maintenance� repair and mov7ng of buildings
within the dty ]imits�ead thia perrmit may be revoked at any time upon violal3on of aay of the P�vis�lona of said
ordinaac:es.
A11en Jensen B�� �
NOTIC�
16b p� dea eot �w� fhs eo�rudioe, �ftm ter vri�ieg, pMm6tee, ea 6uHne, mr�� er wat�r. B� wn to �
dh Bupolns le�Or ter pparata p�emib for fh�a inms.
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. �_ •' . .
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.: . . . ._ ., .
.. � _. APP'LICATIOIQ FOR BUILDiNG . PERi�IIT
� CZTY � OF FRIDLER, � MINNESOTA
, ����
�`� ���1� �
OWNER�S� NAME Roland DeBoer .�iT�DE� �• .a,� And�rson Conet, Co.
ADDRESS 1� Cro�n .Road . � � ADDIrESS �g �'rarieit A�e', .�t. 1'�.7., .13.
LOCATION OF B�ILDING
No: . � . . ' Street � � ParC o# Loti
.:, , ,
.'LOT �� � BLOCR_i��ADDITION OR SUBDIVISI01���%������r , ��.�..���
- . �'
Cornex Lat 3ns3de LaT Setback Side Yard
—�— ----- . , . � .
SEWER ELEVATION " � FOUI�DA�'IQR ELEVAZ`ION
. .. . � . .. , . . , •
Applicant-stCach to this form Two Certificates of Survey of Loe and:propoaed
building.lo�atio� drawn.on theae Cert�.f�ca�es., . ,
. • r. ` DESCRIPTII3DT OF Bt�LD�1G . .
To be used.as=. • • - � �
� Front Depth �fle$ght
S.q. Ft. Cu. Ft. �
� � �'rant , L�epth � fleight �
Sq. Ft. Cu::Ft. •
Type.of Caaetruction Eetimated Coat ;� 6,000
To be campleCed �� �
The underaigned herebq makes application for a permit for Che work herein specifie@,
agreeing to do all work in strict accordance with the Citq of Fridley Oxdinances
and rulin�s of the Department of Buildings, and hereby fleciar'es Chat all:the facte
and representations stated in thie applicaCion are true and correct.
DATE
(3chedule of Fee Coats can be found on fhe Reverse Side).
0
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BOILDING PER1�T FEE SCHEDtILE
SE�ION 2. The Iaspector of Buildings shall� before issuing any permit for the
erect3on of any b�tilding or structure, o� for any addition to anq egisting build-
ing or structure, or for any alterations or repairs to any exietiag building or
-structure, t�pon.application therefore, require the payment bq the applicant for
such permit of fe�s to the �mount herein b81ow aet farth and in the manner herein
provided to•rait;
2.1. For any such permit for the erection of any fire-proof building,
other tl�an a garage, warehouse, factory or grain elevator, or for the erection
of any fire-proof addition, for similar occupancy, to any existing building, '
sha11 be at the rate of $1.40 for each one thousand cubic feeC, or fraction
thereof, in such cubical contents. "
2.2. For,any such permit fo� th� erectibn of any f�re�proof gara�e,
Warehouse, factory or greia elevator, or for thE erection o£ any �ire-proof
addition, for siim�ilar occupancq, to gny existing building shall be at the rate
of $1.25 �or each oae thousand cub3c feet, classified as "fireproof" by
Section 502 of th� Minneapolis Building Code.
HOIISES
2.3. For anq such permit for the erection of any non•fireproof buildin�, ,
other than a garage, warehouse, £actory or grain elevator, or any non-fireproof o
addition, for aimilar vccupancy, to any existing building - permit $1.00 for each a
one t�ousaad cubic feet.
G�
2.4. For any such permit for the erection oi any non-Fireproof gara�e,
warehou�e, factorq or grain elevator, or for the erection of any non-fireproof
addition, for similar occupancy, to any euieting building or for each such
buildiag or addition - ainetq cents ($0.90) for each one thousand cubic feet
or fraction the�eof, 3n the cubfc�l conteats theseof with the minimum of $4.00.
For the purpose of camputing fees for building permits, the cubicai contents
of any building or addition to a uniform height throughaut bq �ltiplying the
ground area covered from a point aix (6) inches below the floor ].iae of the
basemeat or cellar to the average height of the upper surface or to the average
height of the roof �urface of the main gable of a pitched roof.
2.5. For repairs or alterations to an esisting structure, the fee sha11
be a he rate of $3.00 ger each Five Huadred Dollara ($500.00) os fraction
thereof in the cost of all proposed work.
2.6. In no case shall the fee chaxged for any permit as aet forth in
Section 2 be less than $4.00.
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SUBJECT P .
City of Fridley -15 2 3 3
AT THE TOP OF THE TWINS g U I L D I N G P E R M I
�
; � ECEIPT NO.
• COMMUNITY DEVELOPMENT DIV.
� �.:- q`'9�
r � � PROTECTIVE INSPECTION SEC.
i' i '
--_-� �����,', CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
z 612-571-3450 910-F15 6/4/79 � �
JOB ADDRESS 12� CXOFTl1 Ri)�C; N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ].]_ 2 Carlson°s Sum�it Manor North SHEET
2 PROPERTY OWNER MAII ADDRESS ZIP PHONE
RQland DeBoer 124 Crown Rc�ad N.E. Fridle 1�.�T 56 5 47
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
5ame
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Add �zmer
7 CLASS OF WORK
❑ NEW O ADDITION �] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
9 CHANGE QF USE FROM TO
STIPULATIONS �
b ��d�'�H�A►
�fPyAN f�ng G
IQ��v £������ai �ti�jt�as
S�PE �R�� By GASE�.
RA TE f��RMI TS � � !�4 !�r
��'I�Tt�� P�,UM811VG q E�VI�EO FB�q ��Rtl��;,
ND SlG�.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCZ FY3IILH
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]: STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT ��J� OOO �2. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 3O. OO NONE
PLAN CHECKFEE TOTALFEE
4Q 00
SIGNATUREOFCONTRACTORORAUTHO EDaGENr �oA7Ei �,� _ WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
' � � �r�. �� � /9y � 1 � (�
SIGNATUREOFOWNERIIFOWNEPBUILDERI IDA 1 BLDG iNSP �A�
.
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CzTY �or- r-«�1��cY .
' /�f'('LI C/1TT U!1 f"OR �2L"S 1llf::Pd-I' I/1L L'U ) LllI i'!G f'Citl'II TS
• (('�L"W, �I..1'L'R/1TIUfd5, �l?llIT101J5, OR RC.f'/�1fZS�
. . , . .
OWt2�R: � � A � � � �„ �:uxr,u�,�t: � �' f?a e.� �
�aaz4s� : .��.�! � �4� r� � �1"� naaz��� : � 191�--�.�
�r��.. iso.:��,� � �° �,�: .
• _ . � � .
No.:, �� ? _ Street: ��C2 (� /V /\ /�' .
T�OT:
l3IACY.: �, ADIIITIOP] : �/1��, V C�
COit11i.R L�J7.': ItdSID� IA'P: S; xB11CY.: SIU�Y11TtDS:
Ap},�licanL' attach to this form 2�ao Ceri:ificatcs o£ Survey of Lot and pxoposed
bui.l.clir�g locai:ion dra4m on these Certificai�es. •
.
DESCt�I PTI01'd OF BUI LDI nG
'xo 33e Used As:
/ !
�, b� � o �i4�� Front: DepL-h : P� ��5� ' Height: 7 lo y .
�, Square Feet: Cubic £eet:
'rront: Depth: � Height:
Sauaie I'eet: � Cubic Feet: �
Type o£ Cons�ruction: `��� Esi:S.mated Cost: $p� �� Z�
7�b I3e Completed: � �/ � . Alt. A Al�. B
Pxoposed Drive�+ray Width It I�ew Opening Ts Dc�sired $ $
• tS�� 2Z�VERSE SIDE OF 5HEET)
The undersigned he�'eby makes application for a permit for the work lierein
speeif.i.cd, agreeing to do all �.ork in strict accordance with tlie City o£
Fx'�dley Ordinaiices and r.ula�igs o£ the Departmen� ot ruildings, and hereby
declarc� L-hat all the facts and representations stated in i:his ap�lication
axe t-rue ancl coirect. 'See xeverse - acldi4:ional a.nfornlation.
DAT�: �° � � - � � 5TGN1�'1`UP. • � .
. . •
� Stipu].ations : .
�C�+r►i�. 3�.�0
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BUILDI�JG PGR��IIT FEt SC}1EDULE
SECTION 2. The Inspector of i3uilclings shall, before issuing pei�nits for the erec�ion
of any building or struc�ure, or £or any addition to any existing building or structure,
or for any alteration or repairs �o any existing building or structure, upon application
thereiore, req,uire t.he paymen� by the a�plican� for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
NSW CONSTRUCTION: Single ramily Homes and Garages: $4.00/1,000 cubic Pee�.
PLAN CHECK: 25 percent of builcling permit fee. .
DRIV�WAY D�PRESSION: (Concrete Curb Streets Only}
• Alternate A: Removal and replacement of concrete curb and .
gutter only; Driveway width plus 6 feet x$�,5,75
AlternaL-e B: Removal and replacernent of concrete curb and �
. gutter and i.nstall a 3 foot wide approach with ��
� 6 inch depth; Driveway width plus 6 feet x�17.85
; 1 � : . l +' ' �►
For the purpose of computing fees for building pex�mits, the cubical contents of any
building or addition, is determined by multiplying the gr�und area covered from a
pbint six (6) inches below the floor line of the basement or th� cellar to the
average heights of the upper surface or to the average height of the roof sur�'ace
of the main gabl� 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 charged for any permit as set forth in 5ection 2 be less
than $7.50 plus $.50 state surchaxge.
' : � � � �1� �1
NOTE: Permits for cons:truction wi11 be issued a minimum of 24 hours from the time
of application to allow for proper review of the propased structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed wi.11 be required before proceeding with the framing.
: : � ':►
Applica�.ion for a Certificate of Occupancy shall be made �en (10) days prior �to the
use or occupancy of any structure �or which a buildi.ng permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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. 3
CHI�IIIEY AND BTACR VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioration
��
3. Has no forei��Ttobjects lodged within
4. Is securely °supported
5. Meets all current Code requirements for
size and tota�l �TU's connected
_ �: :,
6. Has total he�a'�ing BTU's of /DD� ��"U
Al l other BTU�' s -� 7� �?Y1�
TOTAL BTU' s l� � �I�
Remarks
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Yes ( ) No ( )
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Yes ( ) No ( )
BLAINE HTG. A/C � ELECT. INC.
13582 CENTRAL AVE N.E.
HEATING COMPANY ANOKA� MN 55304
Signed By � � ,�
�� �
Date � — °f — 9�
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C�"d �d101
FILL IN COMPLETELY FOR REPLACEMEN7 FUEL BURNING APPLIANCE PERMITS
COMMON VENT VENT COPINEC�OR AND COMBUSTIt�N AIR VERIFiCATION
When replacin� an existina fumace, the undersigned hereby �erifies that the
venting has been examined and is free from n.�st, deterioration, obstructi�ns, Yes (� No (}
and is securely supported and firestopped where required.
The venting system is plastic/PVC and meets al{ current codes and manufacturer
specfications including sizing, length, number of elbows and termination. Yes (� No ()
The undersigned also verifies that the replacemeni unit is a listed assembly
and meets the current codes and manufacturer's specifications. This do�s
include AGA-GAMA Category I Central Fumace Veniing Tables fior fan
assisted and natural draft applianc�s.
The existinq combustion air is sized and installed to meet the current c�des
and manufacturer's specfications.
When required fo install a new combus�ion air, it will be sized and installed
to meet the current codes and manufacturer's spec�cations.
Yes ( � No ( )
Yes ( x�
Yes � )
When installinq a new ventina svstem, the undersigned hereby verifi�s that
it is a listed assembly and meets the current codes and manufacture�'s
s�ecifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft applianc�s. Yes (�
Is the common verrt and verrt connectors sized and installed correctly a�ter
an appliance has been removed from the common vent and vertted
separately as per current cfldes.
No ( )
No ( )
No ( )
Yes � ) No ( )
A liance T e and Size/Common Vent and Vent Cunnector Information
Appliance #1 Type ��°� ��. o_ BTU lnput � Fan �-lssisted or Nat �
Appliance #Z Type BTU Input Fan �hssisted or Nat �
Appliance #3 Type BTU lnput Fan Assisted or Nat
Total Appliances Tatal Btu lnput �
Common Vent Type C-���� � Vent Height ��f Diemeter ��� incJies
Applianc� #1 Vent Connector Heigh�ft Length �_ft Diameter 4� in Type G=�
Appliance #2 Vent Connector Height ft Length ft Diameter �in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS• (Describe)
w CENTERPOINT ENERGY
HEATING CO: 13562 CENTRAL AVE NE BLAINE, MN 55304
Signed By: ±� ��. �� �'i _ Date : /v - �a-t'�
n
�Gt/rA' �I ZGt1.91.SL Dl J�3"1Q 1�I� �0 J,11 � WCJ?!-� S� : T T tr00Z-L�-�dH •
-`- - -- ._ � ,..... �... ,.� � �..u�.�.�
NEV1f .- ` [ ]
A�t� Il
ALTER [ ]
Construction Address: �
Legal Description:
Owner Name & Address:
Co�tractor. a r�
Address: �?� � � �
i �, 0...�7LV�5e�, .r. e,�, �,.
CITY OF FRIDLEY Efiective 1/1/2003 ` p,.����
6437 University Ave NE, Fridley, MN 55432 (�63) 672-3604 Bldg Fnsp ��1C.��(,��
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (T63 571-128Tfax '���
BUILDING PERMIT APPLICATION � � '� � �
� ,�r� � d-, I� � _ �
�1��/ '
Tel.#��e�� ° ��.� � ����
MN UGENSE � 010 O o�� c'L �
� 7e1.# �p�l •1e2�-�j[r��
Attsch to this application, a Certificate of Survey of the
lot, wlth jhe proposed consVuction drawn on it to scale.
DESCR1PTIpIV OF' IMPROVEMENT
LIVING AREA: Length Width _ Height Sq. Ft _
OARA�E AREA: Lengih ,_,_ W�dth Height Sq. Ft.
OECK AREA: Length �_ �dth Hgt/Ground Sq. Ft.
OTHEJ�:
�� � �
�
ConStruCtion Type: � ('� �� � ��n�G r o �stimated`Cost: $�
t �
� �Lt�
J�°��l c�c�
��riveyray Curb Cut Width Needed: Ft. + B Ft = Ft x$ _$
J DATE: I APPLICANT: Tel. i� l� I- A'� L� - 9� `�
Call (763) 572�604 for Pemtit Fees if mailing in application. Fax ta 763�7f -1287 if asing credit card artd we will
call you for card number. -
CITY �JSE ONLY -
Permit Fee
Fire S�+rcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Cor�trol
Park Fee
Sewer Main Charge
TOTAL
� �i
$� °1
$
$ �.�
$ _
$ .—
$ _
$
s �°=
Fee Schedule on Revers� Side
.0�1 of Permit Valuation (1/10th°k)
$.50/$1,000 Valuation
$1275 per SAC Unit
$5.00 (State Licensad Residentiat Gontractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Nec�ssary [ ] Not Necessary [ ]
_ .,
2 � �, � � L
� , ...... �.� .._..:.b.._....�,.._.. . .__ ._ — . .. . -... .. ._ _ _
. _ . . . .� ... . � _ _.,...�,.; �.�,
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License Detail
Unclaimed Heating Weights & Minnesota petrofund
Property Assistance Measures Relay
Here are the details for the license you are currently looking for:
Licensee Name: TWIN CITY ROOFING CONSTR SPECIALISTS INC
Licensee Address: 2345 RICE ST , STE 162
City State Zip: ROSEVILLE , MN 551170000
License Number: 20020943
License Type: Residential Building Contractor
License Status: ACTIVE
License Effective Date: May 18, 1999
License ExpiratioNRenewal Date: Mar 31, 2007
Qualifying Person: JAMES GEISEN
Number of hours of continuing education required to renew license: 7.0
Enforcement Action: No
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