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/herebr�. cerfi�iJ fhot ffiis is o frue ond carrecf �eP�es�nfo�i�n o�'a surveef �'fhe boondo��es �'�e abare c+�scri(�:d !ond, ond
nFffAe lvr.vfion a�'o// bvildin�r y, fherenn , and oll risib/e �ra�ovchn�enfs ,!����cj, �ic�n ar Un soid lond. As su�ve�ed fiy me t/us _ dotf
'���%� ������ SUBU2BAN EIVGINEE21NG, INC.
� � L-n inears E Surre ors
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City
of Fridley,
BUILDING
� �
Date: _..._ y' .. �
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. �� ��"g ,9'� `*�� � ;�.•��/,i�
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. , �� ,
Owner. . .--�a�' -�------_� .. _.----- :_..�.,-.._ _ .._
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ra �- � v �'
Address ��...� _��'m%�"�.c�:�����,...-- '`______
Builder
rr�r,�
Minn..
LOCATIO�O� BUILDING
No. --�L!:.-�:��--.... Street _---�+.�:E,".°--�'��'�'�:r--••�.•.�--.._�_ .............------_..... Part of Lot ....._....---_.._...__--�-----�---_. r
■� 7��,7� .. Addition or Sub- ivisj �n y �1 ������jff�jj � �/J
LVt .."".� .........._ .._... B1Ul:ri "_""..�. "'_" "......... . f�%• j�+ �/r""°�.K ���"�_:: � .. T'.E'L........ �� "�WW��
� �� � '� 6 ,� ' ?�-�G.*�'�"- �
Corner Lot .......................- --- ..... Inside Lot �:::. �back �`: �_. . ...._ . . . Sideyard ---.._a,�1..:..._.......---.._.......---..._...- ------.....__..
Sewer IIevation ---------.------.._. .......- ............._..---....--.----_---...--•--......_....---...... Fou�t"`�d�a,tion Elevation
DESCRIPTION OF BUILDING
Tv b�Use a�^�
�
�
, � .�
..... , '- � ---�,���--.t. Front ..�_�. Depth ..�� ---- Height .�.�__-- S4• ��-�.. .-- � �'�----��-�-�
�°
...._..._........__.... ...._ .............:......... Fro ....._..._....:..._.. Depth ' ..... � e � � .�..��... �.. Sq. Ft. ....._............._.. Cu. F� ••_---.__......._..
..
Type of Conatruction --.--- --�'�z .��-�-�'r:��..... Est. Co
- ..���......"�"'.:...._..------- To be Completed ..-�--..------�•--•--..._...._.-----...
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the prnposed work in accordance with the description above set forth and in compliance wlth all provisions of
ordinances oE the city of Fridley.
Qr
...�'i............_..._......__.....�.._____............_.._._.._..�..._.._.._..__.___.�.__.._.....
r��'�
In consideration of the payment oP a fee of $,�;�a---_�'�.... p rmit is hereby granted to....._..._...-----•--------.-----.....---...-----
�__ _.--____..�__.._ to construct the building or addition as descrii�d above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in ali work
done in, around and upon sa.id 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
within the city limits and this permit may be revoked at any time upon violation o� any of the provisions of said
ordinances. ,/���' '`
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�'.,..- `; .::.,�- � : � %� a� ,._ ..w: rr,�:o_.:::G�. � BU11f11I1g II19j�CtOP
I
NOTICE: �
This permif does not cover the wnstruction, inetallation for wiring, plumbing, gae heating, aewe� or water. Be sure 1e see
fhe 8uilding Inspedor for separate permifs for these itema.
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APPLICATION FaR BIIILDZATG PERMIT
CITY OF FRIDIEY, N�OTi
owner � s �ame :•��0 �3� � T �, I hl ID.��l��u37.der ,� �'� o n/�' � t/ �� �i' � ��
�aar888 /L � C�P� � �� � � N.F �aare8� ��� � � � ���•��..�
LOCATION OF BUZLDING
No. l� L� 3treet �/i�� ror� oy' �-1,� Part of Lot
Lot �� Block ��r dition or Subdie3s3on_���.�.�,,.� �-1
Corner Lot +,Inaide I,ot Setba.ck Side-Yard �'
SE4JER ELEVATION F�UNDATION ELE�iATION
�pplica.nt attach ta this form Cert3ficate of Surve�r of Lot and proposed buildin�
lo�a.tion.
DESCRIPTI�N OF BIIILDING
To be used ae:
Front '� � Depth � `� Iio3ght 7
-
Sq. Ft. Cu. Ft.
Front_ Depth Aeight
Sq. Ft. Cu. Ft.
Type of Construct3on ���.-P Eeti.mated Coat
To be Completed
The undersigned hereb�r ma.kea application for a permit for the work herein apecif3ed, �
agreeing to do all work in strict accordaace with the City Ord3nances and ruling of
�the Department of Buildin�s, and hereby declares that all the facts and representations
atated in thia applicat3on are true and coxrect. ��, �' ��
- � .-
(A 5chedule of Fee Costs ca.n be found on the Reverse Side.)
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HIIII�IlVG PERNlZT F7�E SL'I�QLE
Section 2. The Inspector of Buildings ehs�ll, before issuing an;y perm3t for t�he
erection of ea�y building or structure, or Por �y addition to eqy ex�.ating build-
in� or at'ructure, or for an�r al�tsrationa or: r�,p�,irs to any exiat3r� bui].ding or
structure� upon applics.tion therefor, r�uire t,he pa�yment by the gpp2icsut for
such permit of fees tfl the amouat here3n below aet forfi,h aad in the meu�ner herein
provided to-�r3.t:
2.1,�. For a�r euch permit for the erec'�ion of ar�y fire-proof buildiag, other t,haa
a garage, wasehouse, factor� or grain eleeator, or far the erect3.on of arig fire-
proo� addi�ion, for s3miler ocr.upancy, to eay exi.sting buildin� sha1,1 be at.the
rate of �]]..1�0 for each one thou�and cub3c feet, or fraction thereoF, 3n auoh
cubieal contenta.
2.2. For a,n� such perm�t for the erecfi.ion of any fireproof g�rege, varehouae,
fectory or grein eleva,tflr, or for the erection oi ar�y firep�oof addit3on' for
eita3ler occupeney� to any exi�t3ng buildiag sha13 bs at the rate of �7..25 for
each one thouaaad cubic feet, classif3�1 s� ufirepa�oof" b� Section 5Q2 of the
Minneapolis Building C,ode.
:��-��:
2.3. For e,ng such permit Por the
thaa a gsrage, w�,rehouse, faciory
addition, for sim3].ar oceupaa�y�
e�ch one t�houeand cubic Peet.
AGE3
erect3on of ar�qr non-firegroof build3n�► othar
or grain ele�ae,tor, or e�ay nor�•fireproof
to aay ex�.eting building. Permit �77..00 £or
2.1�. For ai�y euch perm�.t for th� erectioa of eny non-fireproof �ar�e, �aarehouse,
factory or grain elevator, or far the erection ot eny no�i'ireproo� addition, far
similar occupanay, to eny exiating bu31d3n� or for eech suels building or add3tion.
Ninety Cents Sar each one tbou$and cubic feet or freet3.on thereof, in the cubic�l.
eonfi.ents thereof with a minimum of �4.00.
For the purpose of computin� Fees for building perm3ts the cubical coatents of a�►
building or add3tion to a uniform height throu�out b� multiplying the ground eree.
coverecl from a goint a3x (6) ine�es below the floor 13ne of the basement or cellar
to fi.he aeerage he3ght of the upper surface or to the everage height of the roof
eurface of the �,3n gable af a pitched roof.
2.5. For repaira or alterat3ons to an existiAg structure, the fee sJzal]. be at the
rate of �3.00 for each Five I�.indred Dolle,re ($500.00), or fraetio� thereof in the
cost of all proposed work.
a.6. In no ca.se shell the f�e charged for aaay permit aa� set forth in Sectioa 2 be
less the�n �4,�.
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City of Fridley, Min�n-
BUILDING PEI�MIT
Da�: Ma.rch 24, 1969
p��; Hubert Lindblad g�� Same
Addree� 16 0 Cr own Road Ad� S ame
�
,���# �/����
N° 10150
LOCATION OF BUILDING
No. 160 g�t Crown Road Part of Ilot
� 14 _ gl�k 2 Addition or Sub-Division Carlson's Sv�it Manor N'orth
Corner Lot � Inside Lot Setback � Sideyard
Sewer Fdevation — — Founda.tion IIevation
DESCRIPTION OF BUILDING
To be Used as:
Addit ion �t 12 � Depth 12 � Height 1�� Sq. F't. 1�' (�, �, 1440
Front Depth I�eight 5q. FL Cu. Ft
Z'ype of Construction Frame �, �_ 2 000 _00 To be Completed
In consideration of the iesuaace to me oE a permft to construct the buil g descrlbed above, I agree to do
tha ProPosed work in accordance with the description above set forth and compliance wi all provisions of
ordinances of the dty oP Frfdley. '
Ea consideratfon of the paqment oP a fee oP $ 12 . 00 , pe�t � hereby granted to Hubert Liadblad
to construct the building or addition as described above. Thispe rmit is granted upon
the express conclftion that the person to whom it is granted and hia agents, employees and worl�nen, fn all work
done fn, around and u�n said huild9ng, or anypart thereof, sixall conform in all respects to the ordinaaces oP
Fridley, Mfnnesota regerding lpcation, conatruction, alterafilon, maintenaace� repair and mnoviag of bufldinge
within the dty ]imits and tbis permit may be revoked at suy time upon violation of aay of the provisiona oE said
ordiaancea. _
Official
Svildtag' �
NOTICE:
i�s peneN doss net eover t6s coestwdioe, inshlH�loe hr whtne, plumbing, eas 6sating, sswu er wat�r. B� sura to su
f6s Buildine lesp�etor Poe apuat� parmtls Po� the� Ihms.
APPLICATION FOR BIIILDING P�RRMIT
CITY OF FRIDLEY, MINN.E�50TA .. � . .
�,:�
OWNECt 'S N.AME j��zti�� �� BIIILDER
ADDR�'�SS ��� �� � ��Cp ADDRESS —
LOCATION OF BIIII,DING
NOo ��p� STREEI' /_��„z�� ,,2�
��oy �
� LOT � BL�CK o� AUDITION OR SUBDIVISIO �;��y���z�c�
CORNER LOT INSIDE LOT /�_SE°I'B9CK SZpEYAR�`�_
SEWER ET,EVgTION TOP OF FOOTING
Appli�ant attaah to thie form Two Certificates of Suxvey of Lot and
propoeed building �ocation drawn on the�e Certificates.
To Be IIsec� As:
DESCRIPTION OF BIIII�DING
_ Front � �- Depth � � Height � "'�
0� `�� ,
Square feet /01 �X �� Cubic Feet / ��'T � ?�
I T
Front Depth Height
Square feet Cubic Feet
Type of Conatruction Eatimated Cost�o��OO
/ti
� ,
To Be Comp�eted �-�� fST—
The undersi�n.ed hereby ma.kes application for a permit for the work
herein epecified, agxeeing to do all work in etrict accordance with the
City of Fxidley Ordina.nces and rulings of the Department of Bui].dings,
and hereby declares �hat all the facts aaad representations stated iu �
this applicatio�. are true and correcte
D�.TE ji �:a�iL��, ����'�� SiGNATIIRE d% �� �
(Schedule of Fee Costs can bc fourid on the Reves�e Sidee)
�� �.;�,�,
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i�1
BIIIIsDING PERMIT�FEE SCHEDIILE
SECTION �. The In�pector of Buildings shall, before issuin� perm�.ts
for the erection of any building or �tructure; or for any additiox� to �.ny
exieting struGture or building, or .for atay alteration or repaizs to aaly
existing building or structure, upon application therefore, requi�e the
payment by the applicant for such permit of fee� to the a�ount herein
below set forth and in the manner herein provided to-wit:
IIniform Building Codes Type 1, 2, & 4-�1075 for each one thousand
cubic feet, or fraction thereof, in such cubical c.nn.tents. Type 3& 5-
$1050 for each one thousand cubic feeto
For the puxpose of computix�.g fees for buildin� permita� the cubical
contenta of any�building c�r addition to a uniform hei�ht throughout by
multiplying the gz ound area covered from a point si% (6) inches b�low
the floor line of the basement or the cellar to the average hei.ght qf
the upper eurface or to the average height of the roof surface of the
main gable of a pitched roof.
For repairs or alterations to an existin� structure, the fee sha,ll be
at the rate of $3.00 per each iive hundred dollars ($500.00) or
fraction thereof i.n the cost of all proposed work.
In no case shall the fee charged for asa.y permit as set forth in Section
2 be leas than $5.00o
( �- - - NSSSD Corinectian Charges �a�ec� on�o�a�ion = ..�rrea 1 or 2 . --
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S. -e f � _ �" R'"';. _ .� S` '�. .P _
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ADDRESS I Ca �,_ C- `K��; a��",1
HOUS� FlE,AT9NG TEST EtECORD �l i 9�
FLOOR- CITY SUBURB �� G���'{"�
NER
�1EAT LOSS DATE HTG. INST. r�� -"7- `�T''7 GAS CO. AAETER BADGE #
SOLD BY ���d���•�+. S ' INSTALLED BY -
Electrical �Nerk Bv !�f .1(��=-iT�L� Gas Line By _C�!""�fi4C� (.�
'�'YPE OF HEAT G� F/��_ HW STEAW�_ SPACE HTR UNIT HTR. OTHER
GAS DESIGN
INPU7:
OF BURNER
Max. BTU Rating
AAAKE OF FURNACE
INodel
CONVERSION
�
CONTROI.S
THERMOST/�E7 h� � Heat Plu ' Vent Si=g `� ��
Valv '��°` ���--� ` ��L ' KIND OF LINER SIZE NONE�
!Im ` U ���°�` �-��=�--� raft Hood� '.�-' ��+?i��i��-� Regulator
Ltmit Seftin =����'E' �-'� � N-���-1 E-7�C� K_ Number 1
9 �" -ti Filters Si�e
Fan Seftin �`� - -°� ( !�` ` - "►C= - Chimney Location Inside��- Ou side
Pllot Type t R,�;,�� (ac> �r;'L.i�� Chimney Construction _ � L�`'�� `��9 •°--�-�`` '� �=�
Pilot Maka _�
Pilot Mode Smoke Bomb ° � Wiring �r �
Pilot Timino �(� <<�c�Y���+a� Draft '-' � Test Tag `/ ��=;
L.W. Cut Off ` Daor Pressure � ighting Inst. '✓�2 �
Pressure =����` Percent CO2 �� •�--� Date Tested 9 �� "��° �
Input CFH ��- �� Percent 02 - Company Testina � ��'»U �
Stack Temp_ -� �c�'� i-= percent CO �Name of Tester � l� !`� C'� °--�
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�:R01�15TROMS HTG. & AIR COND.� INC. Job Nome /` � ``'��� � ' �°%� ` � � ��-'�� � `
F_ �
¢�6 4410 Li[e�idar loule�ard. Minn�apolis 16, Minn. �;. ��� y =�"-�-� �
M�AT LOfi tAL�71LAT10Nf �' Job Addrons `�-�' `� � '�' - "�:�� f -�'' � ' �'°�,�
,�
A.S.H.V. .
Weatherstrips Conatructioa No. I lnsulatioa
Guide
Windows �) Doors Refereace Out. Wall Int. Wall Ceiling Roof Floor I Kiad How Applied
Yea—No Yes—No 19_
FI.� Room Length C l� Width ,1� Heigh FI.� Room Length /� Wideh r� a Height
Windowe and Doors—Crackage and Area '�`�/ Windows aad Doors---Crackage and Area
�Vldth HelBht No. oI Llneal It. Are� i— Width Helght No. ot Llneal (t. Area
No. ot pane o( Done Ilghte ot cracB eQ. [t. � 9 No. ot pans ot pane Ilgbts o[ crack eQ. tt.
�� �,�=- ( '° �.{ � � � y ,;.. ��:�
� �ti / � '� A�� �'
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In6ltration � �`T , - � ' °� f' ' Infiltration "
;, ;_
Claaa °�" r � .�-., .v ` _,-�' Glasa 1 �� � T ,
-,
- =#�zp. iva1�= -== - _° ~ - - - - - - — �p; �� -_ - = - _
Net e:p. wall �'C , " - `> � , ° _:' , ,�, Net e:p. wall / v = _ _ _ � ` ^ ' � �s
Int. wall Int. wall
Ceiling C Z- �IC C ( ' - �r _ ,< .,, Ceiling ,� ��, 2,, � ^ i'� � � _ /' � � -, _ � �
Floor F��r ,,
Total Btu. �' �i �' r�',� Total �Btu. - � � ��
Required sq. ft. E.D.R. or aq. ias. WA. l.eader area
Fl. ° Room � Length ` Width
Windows and Doors—Cracicage and Area
Wld'th Helsht No. ot Lineal fL Ara�
No. ot Dans o[ Dans Il�ht� ot erack M. !G
� � � � Co �� " `r•°
r �— �
In6ltration
Glaaa
Eup. wall
Nec e:p. walE ��'/ � Q�
Int. wall
Ceiling �' � , '
Floor
Total Btu.
Required aq. ft. E.D.R, or aq. ias. W.A. Leader area
�� �— F7.� Room I l.enSth C/ Width Height,
��� Windows and Doors—Crackage and Area
�� WIdt6 He16ht No. o! Llneai tt. Area `�,
% No. ot D�na ot pans llsht� ot crack ea. [t.
Lr
� 3- ?+LD `�-� ;' ,_q �
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Required sq. ft. E.D.R. or aq. ins. W.A. L.eader area
) F7.� Room � Length y 7 Width
Windows and Doors--Cracl�age an Area
Wldth Ha1gAt No. ot Llneal tt. Area
No. ot D�ne o[ Daoe Ilsbt� ot enek �p. tt.
v � / --- � r- ;,
?� � �� /_
/ 2 �° ?re `7�" _� ,�
1 1
Infiltration
Glaea
� F�cp. wall
Net exp. wall �, �� �,
Int. wall
Ceiling � �� "y ���",
F loor
r_ ,,.
��
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Requued aq. ft. E.D.Ft. or nq. iaa. W.A. Leader area
Btu
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Glasa - - .
Fap. wall
Net e:p. wall � "� � � z, _ �R ,.„, 4 � ;, , �� a,
�
lnt. wall
Ceiling � " , - ` �� - ` '
Floor
Total Btu. `� /
Requued sq. f� ED.R. or sq. ios. VU.A. L,eader area
/ Fl.� Room I L.ength Width �( Height
Windowa and Doora--Crackage aad Ana
W1dth Hel�ht No. ot H.Ineal [t. Are�
No. ot D�ea ot Daos Ili6t� ot crack W. t!.
1s 2 fr � ''� _ �° °� ��
Coef. Btu
Inhltration ; '� . - �
Glasa - ,,
Eup. wall
Nec e:p. wall '� � 9( � '' �_ ' �� _- � � , -- ��
Iat. wall
Ceiling _ �_' ° ' ", � " � � �= "
Floor ' '
Total Btu. -- ��� � �
Required°sq. k. E.D.R or sq. ins. WA. Leader area
- ' ,:�t - � `"
-�G`f�0l�ISTROMS HTG. & AIR COND.� INC. �ob Name - ; � �� �' �" � � � � y
n.ss y+s� M�At LOfS �'�'iAL�'iYLAT1ONS inn. Job Addro�s �° � `�` ^ ; � € - -� - '' � , a . ,; "' ;,"
� � �� ' `�� ��r=—
A.S.H.V.E.
Weat6erstrips Coastruction No. I Inaulatioa
Guide
Windowa I Doora Refcrence Out. Wall Int. Wall Ceiling Roof Floor I Kind How Applied
Yes—No Yes—No 19_
Fl.� Room Length � Width / LI-Ieight Fl.� Room Leng¢h Width Height
Windows and Doors—Crackage and Area � Windows and Doors--Crackage and Area
�Vldth Helght No. o� Llneal tt. Area Width Helght - No. o[ Llaeal t[. Area
No. o[ Dane o[ Dane ligdte ot crack eQ. tt. � No. ot pane ot Dane -� Ilghts ot crack s4, tt.
7s. z-� ?�' -2.� -, _ ^ -. -�
Coef. Btu
lnfiltration �'� - n � ` ��
Glaaa ��� ' �� -,� , �
---�p;-w�{j------- --_
, _ — - - - -_ � -- --__
Nec e:p. wall � - - - _ `��
�'`_ G� '� �°u �, �
Int. wall
��- "
Ceiling y i �,_'r�
Floor
Total Btu.
Required sq. ft. E.D.R. or aq. ina. W.A. Leader area
/ Fl.� Room � Length Width�
Windows and Doors—Crackage and Area
Wld't6 Helsht No. ot Llneal [t. Araa
No. ot Dans ot D�ne tlshu o[ cracic �q. ft.
` �- � � eJ° - � r_ " 'd
Infiltration ��3 ;'% ' ��' `
`�
Glaaa � ,!m�� ,� �
Eap. wail
Net exp. wall - b - � . - �
int. wall
Ceiling ='�� s. /�1
Floor C��
Total Btu. �
Required sq. ft. E.D.R. or sq. ins. W.A. Leader ana
Room � Length Width
Wiadows and Door
Wldth Helght
No, ot pans o[ p�ns
�11f1�if8h011
C,lass
' Ezp. wall
Net esp. waU
Int. wall
Ceiling
Nlaor
' Tbtal Btu.
and Area
oaal tt. Area
¢nek w. tt.
ired sq. ft. E.D.R. or sq. ins. W.A. Leader area
�F,_ �;,
t 7`
Bcu
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, -_ �
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i
In6ltration
Glasa
Fap. wall
Net e:p. wall
Int. wall
Ceiling
F'loor
Total Btu.
Required aq. ft. E.D.R. or aq. ins. WA. Leader area
FI.I Room ( Lengt� Width
Windows and Dooro—Cracl�age and Area
Wldth Xeliht No. o! Llneal tt. Area
. ot cane ot cane Il[hu o[ crack ea. Lt.
Infiltration
Glass
Esp. wall
Net ezp. wall
Int. wall
Ceiling
Floor
Total Btu. . ' '
Requ'aed aq. k. E.D.R. or sq. ina. Q/.A. L.eader area
Fl.� �m � t��gc� w�a�
Windows aad Doon-Crac�age aad Aroa �
, Wldth Hel�st No. ot Llneal tt. Area
IQO. o[ naaa ot oane Ileht� ot cr�ck w. tt.
Infiltration
Glasa
�p. Weu
Nec e:p. waU
Iat. wall
Ceiling
Floor
Total Btu.
Required°�q. k. E.D.R or sa. ins. WA. L.eader area
Btu
Height
Heighc
Btll
sue�ecT PERMIT NO.
City of Fridley �� 9 5 48 g
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
� ; L ----- 9 �a �%
r � � PROTECTIVE INSPECTION SEC.
1 = �
� �"�1 � CITY HALL FRIDLEY SS432 NUMBER REV. DATE PAGE OF APPROVED BV
�"'""� � ,�� 612-571-3450 910-F15
9/26/79 � /
JOB ADDRESS 16� C]COWIl Road N. E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �.4 2 Carlsoai's Slffi].'t �21.IlOr $011'�1 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
R�ald Lor�r 160 Crown Road N. E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Milton L. Johnson Co. 2513 Central Avenue N.E. 781-9548
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUIIDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage
9 CHANGE OF USE FROM TO
STIPULATIONS g�of can be second but not third roof. Install ridged galvanized
valleys.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED 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 iiEAD 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 TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�-iOOO �`. �JO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE Oii CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE E RMANCE OF CONSTRUCTION. S7•5O
PLAN CHECKFEE TOTALFEE
-,�/o ' ) $8. 00
SIGNAT REOFCONT TORORAUTNORIZEDAGENT IDATEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
y =°
S�GNATUREOFOWNERIIFOWNERBUILDEF�1 IDATEI BLDG INSP f1AT
' � o �-a'v'
; •$ E, �,'- o '; � ,
f� s 'J!� Fale;l:...�. r,
r �
' e�i'i'�iC�';"i`(�:�i� i�C3f; ('!_�:J�(:d�d�b i�`�L LE:1�,DI(��'v' f'i=ltl�1�T� ,
�/1�LF`�f �ti� t!_I\����l�e�J.D %rl��l���dt.�lt1,� �i�� I\Ll��AldllJ�
r�;•,�t,r��o Ronald Low I3iJIJlll:�t: ?�ilton L. Johnson�-�'or�pany
�,���.,,,�s . 160 CroVan Raad ����rc:, J� 2513 Centr�l �ve P1 E '
� T�1. t•;�. 0 781-9548 � ,•
�,�,� : Z6e �treet: Crown Ro�,d �
�,�J�': }3I�JCl;: �nrax�.�o��, :
�o�z��at.�z Lo�': Ii3�;?DP �T: sLT!?ACr:: SIDL•'YnRD5:
aig?plica'r,t attacl�i t�� Lhi.s fornt 7`�ro CerL-ificate� �f Survey o� �ot ar.d prot�os�d
3��t.a_lclirin lac��ic>n cir�z�rm oM thcse Certificates.
?�'�� Ee Used �s:
�i��CR:�'TIOI�d OF i3UTLDileG
� Front: YJeFth; � Heic;l�t-
o ��?uur_e �'ret : Ct!v� c Fee t e
_____ I'tioli�e f�eptti: _ Iieigk�to �
. �quare F�efi: Cubic F�et: � -
�.,>pe o:. �cns�ruction: Reroof House & garage Es1:�r.-dated Cost: $ 1,000.00
�ia �e Co:np�cte�: �l�a A T1t. B
Pxo�osed Drive"ay [ti'idtaz I� 21ew O�enii7y Is Desired $ $
(s�r•. RLV'ERSE SI'J"� or s���;F�a�)
The ��?c�crsiet��e� hernby m::kes a��p:licai.ion far a germit foz: the worl: lierei��
v}�ecificd, agreeing to d� a11 t�erk in strict acco�:dance with ti�e Ci'ty og
Fxid�.c�r Ordiz�.,iices aiic3 rt�lir.gs of thc: Dcp�.ri;me�zt of l'�ixildings, a��d .zerel�}9
dc�cla,-es L•hat all t)ie fscts and re��reseni�ativns s�at�d ia� �:lai� application
aie true a,�c3 correc�. See reverse sicic f�r acldii-.a.oizal iiaio�matioia.
DIIT�: �� - ,7 ,� n '� 9 STGNIITUF.�: �� �
�� _�._.
S�.ipulations : .
�. �'�
, ��
O
G-
�-�'
P,JEL_Di�;�� �E���y;IT 'F�L!� d�r'iCr,,.eLr
���C•PTON 2. '1'he Iiispeetor qi "tttiwldings sha11, i�c,s:c?�� .is•suinq l�eizr►its ior �he er�c�_io�L
oS any buildinc� or struc�ure, c>r for any 3r1di.L-ioi� ��� any ex.tsting builclinc; a�° st.ruet��re,
��� �or any alter�tion �r repairs �o any �sciscin� l.�uiidiilc� or st:t�ucture, ui�r�;� n��n?_ic��t:i��;�.
therEfor_�, require Uze paymen�. k,�,- the �.nplicant fcr su�h �^_rmit o� iees to tl:e d1tlCiLirzt
herein below set for ch aiz�3 in �_he manner hereYn pLOV.i::ie�J � o-wit:
J��W COidS3'RUCTIOY�I: Single �'�nil.y Homes �nu. varages: $4. ,000 cubic feet..
Pi.z12d CHECt:: 25 percent oi buiiding ����?ctit fee. �
DNIJEWAY DEPRESSION: (Concreie Curb Stre�cs Only)
Altern�t� A: �emo�ral and replac�mc.. �..�f concr_ete cu.rb and
gu�:te°r �nZ�; Driveway� v;idth plus 6 feet x$14, �0
Alternate E: R�movaJ. and re��lac�men� of �c,r.crete cu�b and
c�litLer and install a 3 f:oot wiae apprcach with
6 incrt d�ptl?; Drive�aay widtiz plus 6 feet x Y17.20
AL"�.lIlIOfV�I� I(�'FOR�iATIQN
For tY��e pu?�pose of computing fees for building permits, the cubical contents o� any
b�lilding or acidition, is deL�-rmined by multiplying �.he c�round ar�a covzred from a
point si� {6} =riches relow the floor lir_e of the 3�aser�Pnt �r th� cEllar to the
ave�age �eights af the.n�ne-r surface or to the average neight of -the roaf sarface
of th� ��ain ganle of a pitcred mof .
Fos- repa.irs or alt�rations to an existing structure, the �ee sha11 be at the rate
of $3.G� yae� eacY� five hun�.rEd dollars ($500.00) e?- iraction thereof in the vost
�f all proposed work.
?Ia S7G c��e sn�ll fihe fee cha�ged far ang ���it as set iorth iai Sec�ioii 2 b� less
than $7.50 plus $.5C s�at� su�charge,
VE�IFICRTION OF FOUtiDAiION
D30a.�: Per:�:i,t`.s` for const:+�tction will be issued a �niiiimiun of 24 hours from the time
af az�p7.ication to allow for proper review of rhe prop�sed structure a._-�d o£ the
c:ori��2�ction site.
A Certificate of Survey of the l�t, showing the locacion of the foundation once i�t
lias b�en cc'�nstructed wi11 be required befpre procef ding with �he framing a
, C�RTTF CAT€ •QF C1C�l�PANCY
Rp�?ication fnr a Cerf.ifiea�te of Occupancy sha.11 be made ten (10) days prior to �.he
use or occupancy of any° structure f��r. wh�.ch a builditig permit has �een issued; and
sa�d s�ructure shall r�et be us�d or occupied until a Ce�tificate of Occu�:zzcy has a
k:�eeii issue�. . .
ti
.. ..
SUBJECT
c�ty of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
� �
� • COMMUNITY DEVELOPMENT DIV.
� j V «���'�
r � � PROTECTIVE INSPECTION SEC.
1 = �
� �"'1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE oF
�----� � �•� 612-571-3450 9t0-F15 6/7/89 / /
JOB ADDRESS 160 CroFm Road N.E.
LOT NO BLOCK TRACT OR ADDITION
0' 99942
� ���
avaqoVED Br
1 LEGAL ' SEE ATTACHED
DESCR. �-4 2 Carlson's Summit Maaor N. ACZ(�Yl. SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
David Christensen 160 Crown Road N.E. 574-9917
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same �
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PMONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
Residential
7 CI�ASS OF WORK
O NEW �] ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
C onstruct a 252 Sq, �t. Deck Addition
8 CHANOE OF USE FROM
STI PU LATION S
See notations on plan
iIVA�NING
gcfore digging calt tocal utilities
TELEPHONE - �LECTRIC - CAS-£�e.
REQUtRED �Y LA'�i
TO
���� � A �}�, � . ,
bV�fN���H f��1411�'`lfi� �UI '
N�, p,L�� c ��b 1� _
�B�N� AN� Sl .
�::
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST.
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 OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1 � 8OO
WITH WHETHER SPECIPIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PqOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 41 � O�
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
SIGNATURE OF CONiRACTOR OR AUTMORIZED AGENT
� 4 �1 �
IDATEI
�,\-�e
GROUP
CU. FT.
OFFSTREET PARKIN(
STALLS GARAGES
� SURTAX
$.90
$41.90
$ IS VOUR
CY LOAD
fj
Hea1tY�East �;��3
i
Midway Hospital
�nue West
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ALTII2 � �
R-1 AND R-2
Builcling P�ermit Ap�lication
Effective 5/1/88
ConstYUCtion A�ddress: _ \ � U �O. ��.Z_�
LecJa1 Description: �e �, �2.�-� �
is
Ownex Name & Address: _� Q��,a L�,:.`��,��,� .��� r>�� Tel. # S`�y -gc� �-�
G'oa�tractor: ���� �. #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the Pz'opor',,ed vonstruction drawn on it to scale.
D�SCRIPTI@T aF II�VII►�Tl'
LlVIIJG AREA: Iengt,h Width Height Sq. Ft.
� �� � Width Height Sq. Ft.
D�R ARF�1: 7�xx�th Width Hgt/Gr�u�d Sq. Ft. S�.
O'I'i�it•
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Corner Ir�t [] Inside Iv'�-[ -}-- " Ft. Yd Setback Side Yard Setbac,ks
Type of Construction: Fstimated Cbst: $ ��c D O
Approx. C�anpletion Date:
Proposed Driveway Width If New � Is Desired• �t, $ $
Width + 6' See Back Page
L�B,TE: APPLICANr: �. #
�t F� s �,Pisoe�
State Sumharqe $ o
SAC Charge $
Driveway Es�row $
Park Fee � $
Sewer Main Ch�Y,ge $
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CI'1'Y IISE �Y
Fee Schedule on Rever�,,� Side
$.50/$l,00o valuation
$575 per SAC Unit
Alt. ���y�� OY' Alt. "B" AboVe
F°ee Detet�nuried bY F�gir�s'ing
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Zhe Qzief Huildirg Official s�all, before issvi,r�g permits for the erection of any
iwilding or sttuctute, �or for ariy additia�► to any e�cistirg buildirg or sttvcture, or
for ariy alteration or rq�air to ariy existing buildis�g or structure, upon ap�lication
therefore, require tl�e payme�t by the applicant for suc� permit of fees to the amcxuzt
lierein below set forth and in the manner h�rein pravided to-wit:
'POR'AL VAIUE �
$1 to $500
$501 to $2,000
$2, 001 t,o $25, 000
$25,001 to $50,000
$50,001 t.o $100,000
$100,001 to $500,000
�+�.
$15 (Min,i�aa Fee is $15 plus surcharge)
$15 for first $500 plus $2 for each additional $100 or
fractia�i thereof, to ar�d including $2, 000
$45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, t� and includirig $25,000
$252 for fiYSt $250000 plus $6.50 for each additional $1,000
or fractio�n thereof, to an3 iriclwdir�g $50, 000
$414.50 for first $50,000 plus $4.50 for earh additional
$1, 000 or frdCtion thereof, to and incltiding $100, 000
$639.50 for fizst $100,000 plus $3.50 for e,ach additional
$1,000 or fraction thereof, to ar�d including $500,000
$500,001 to $1,000,000 $2039.50 for the fiYSt $500,000 plus $3 for each additional
$1, 000 or fraction the.reof, to and includirig $l, 000, 000
$1,000,001 arid up $3539.50 for the fiYSt $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
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Alternate ��A�� ; Re�aval and replaom�ent of curb ar�d gutter only - Drive�ray width plus
6 feet ti=oc� $13.50.
Alternate "B" : R+emaval ar�d replaae�nerYt of curb and gutter and install a 3 foot wide
approach with 6 itx� depth - Driveway width plus 6 feet tia�es $15.75.
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P�ermits for oonstruckion will be �ssued a�*+��+►m+ of 24 houi�s finap the time of
application to allaa for prvper review of the pro�o�ed struc4�re ar�d of the
co�nstruction site.
A Oertificate of S�irvey of the lot, sh�owirig the location of the fo�ux3ation onoe it has
it has be�n vonstructed will be raquired before pra�eeding with the frannir�g.
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3�6(0
193 A
SUBJECT PE T�DIQ.
c�ty of Fridley 2 7 6 4 2
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T A/
�
; � RECFIP�LN{�'
� �L _ COMMUNITY DEVELOPMENT OIV. �� � �
r � � PROTECTIVE INSPECTION SEC.
� . �
� � /"'1 � CITY HALL FRIDLE� SS43Y NUbiBER REV DATE PAGE OF APPROVED BY
�----� • •', 612-571-3450 910-F15 ° 9/9/98 / /
�oe nooRess
160 Crown Rd NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. 14 2 Carlson's Summit Manor North Addn. SHEET
2 PFOPEf;TY OWNER MAIL ADDRES$ 21P PMONE
Gre & Terri 3esser 160 Crown Rd NE 5 421 57 -19 0
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO
Owner Same
4 ARCHITECT OR DESIGNER MAIL ADORESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK � REPAIFI O MOVE O REMOVE
❑ NEW ❑ ADDITION ❑ ALTERATION
8 DESCRIBE WORK
Reroof house & garage (23SQ) Tear-off
8 CHAN(3E OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTFiCAL, PLUMBING, HEATIN(i, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION IONING SO. FT. CU. FT.
AUTHORIZEO IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTpUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTEH WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
1 NEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION STALLS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALl PROVISIONS OF LAWS ypLUAT10N SUATAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1 � 97 ], . OO �. 9H
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL TNE pEpM1T FEE SAC CMARGE @
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $62.25 Fire SC y�1.9%
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION,
PLAN CHECK FEE TOTAL F
65.20
SiGNATUREOFCONTRACTOf70RAUTMORIZEDAGENT IDATEI EN OP ALIDATE IS IS R PER,lAIT
� �--����� � —r ,�r
S�GNATURE OF OWNEii�t WNER BU�LDERi IDATE� BL iNSD ��pTE
NEW
ADDN
ALTER
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ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
) C. ('vw,n
Effective 1/1/98
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Owner Name & Address : f °� �-���` � � �L' SS � � Tel . # � Z � — j �-I 3 L`y
Contractor: �e�,� MN LICENSE #
Address: Sc�M� Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width Height
Width Height
Width Hgt/Ground _
. (��c��cs�c�t�c� (�x��'
Sq. Ft.
Sq. Ft.
Sq. Ft.
, 'r.e���, nc� e� �--��� v .
Construction Type: �p��,-� Estimated Cost: $ � f�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
0
.
DATE: - � �°j � APPLICANT: � Tel. # S� I-1 �i 3C�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
S'TIPULATIONS:
$ ��� �s
$ �
� C�.
$
$
$
$
$
$
� S��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
.
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official 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 repair 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 forth and in the manner herein provided to-wit:
TOTAL VAI,UE
$1 to $500
$501 to $2,000
$2,001 to $25,00()
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site. .
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.