AF - 40879Date:
Owner:
Addres�
City of Fridley, Minn.
BUILDING PERMIT
.
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N° �4601
Builder_...--_.._..__.._..._._..__ �..______.._.... _
Address _._---------__. .._.__ .._.. °" ..._ ._..t ._._.__.
TtON O� I ING
No. ._ �` � � ...__._ ._ .... . .. ..�p._..._ Part of I.ot . ... ...__._ .._..__ ._...._.____.._....�..
��.-�,� tr�eet '! �--- --..
� � � ( .....------... Addition or Sub-Dfvisi � .._.. ��/............_.._.....-------
I..ot .... ...............��... : Bl�k ..... ...... ...._...----��--�--- • � �: _ .........._ r
..-•-----.._ . _
Coraer Lot ............. �'.... Inside Lot ....._. ....... Setba.ek ......,�.� ... ..... Sideyard ....._...�.��......._.._.....__....__....._.....---__..
Sewer IIevation
Foundation IIevation
DESCRIPTION OF BUILDING
To be U ' a �, ,� o � .,,
.
_- I -- .. nt ----��. Depth ..,,��...---. I%ight .....�.._� Sq. Ft .��--. Cu. Ft f.�'�_�
...._ .............._....... -- .._....-------.......... Fro ..� ---....._.. Depth ..- �-- ...., . Height .. 39. Ft. ---.._...._.....__.. Cu. F't. ._---•--....--� --..
---- - - •
� � ��...
Type of Construction ... _.-,�'��r-�:�'�-....--- Est. Co ...�,.�_� ................._._..... To be Completed ...-----..._._._.._._--------_---------
In conaideration 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 dty of Fridley.
...lt'� _...----...._.__..._._.. _ ._._.._.. _..__
M .
_ �%
In consideration of the payment oP a fee of $_ ------�_...-.�_., permit is hereby granted to....._---------•------..._........._._....---••
.., _��._.—._.._.___.. to construct the building or addition es described above. 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
or� th�e dty limits and this permit may be revoked at any time upo� }�olatioa o�y of the pravic�ons of said
/�,�%r"r � � ,
Inspector
NOTICE:
This permh does nol eover the wnstrudion, instaileNon for wirine, plumbiag, gas heaNng, eewer o� water. Be sure to see
, the Building Inspeeto� for separate permtta for fhese hems.
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Owners Name
Addreas
BPPLICA�'�ON FOR BUTLDTIdG PERMIT
CIT3t OF FRIDLEY, �OTA
���
LOCATION OF BUILDING
No. Stree� �'srt of Lot
Lot Block Addition or Sub.Div. _
Corner Lot ?/Ins3.de Lo�a „�_.,,Set Back Side-Yard �
SEWER ELEVATION FOUNDATION ELEVAxION -
Applicant`attsch to this form Certificate of 5urvey of Lot and proposed building
loca.tion.
DESCRIYTIOIv OF BUILDING
To b� used ass.� �� � .
' e
�����,�� ����A� �Fi�ont _„�_�,_,,, Depth�
. �
Sq. Ft. _,_{, � f' Cu. Ft. �
�'ront Depth He3ght
/
Sq. Ft. Cu. Ft.
�-
e of Construct3.on "� Es�t�.ted Cost �� �_,,,__,__.,_.
�YP -�-�e—
To be completed �� �,����" ��
�`he underaigned hereby makes application for a permit for the work herein apecified�
agreeing tc do a].l work in gtri�t accordance with the City Ordina.nces and ruling of
the Department of Bu31d3ngs, and hereby declares that a11 the facts and representa-
tions atated 3n this apglication are true and correct.
� �> �' � �
DA'l�=,� A �-� �i � �'��-, . , SIGN.ATUAE ,� ' � � _ r-� .....,, � ��' � -
Y �,
� � � - � �� � � ; �
(A ScP�edule ' of �••Fee� coets cekn be found on the Reve�se Side. i�,� �-'�r
�� �
PIIILDN► G PERMIT FEE SCHIDULE
Se�tion 2a The Inspector of Buildings sha11, before issuing any permit
ior the erect�c�n of any b�ailding or structure, or for any addition 'to
a.ny exis�c-n� t-+�ildin� or st.� uc �ure, or for any alterations or repsirs
t� �,:,y er_3.stit�g bu � lding or 3tructure, upon application therefor� require
th� pa�en � h� the �.ppl� c�nt �or such permit of fees to the amount herein
telow sat �'er �;� �.r.�� ��•,� t'�.� manner herein provided to-tait:
�.1. r�Y- 2.n� ��} �'i ��l�ii; �or the erection of any fire-proof buildin�, other
than €� ,;a,: a�;e, T: �°ahause, factory or grain elevator, or for the erection of
ar.� firc�p.roof add7 �ion, far similar occupa.ncy, to any e3cisting building
31�a1I �e �� the ratc oz" ��.40 for Aach one thousand cubic feet� or fY�action
th�r�ox', in : �i�h cu:.�i ca�t :or.tentso
20'o For €:°��r sueli per�aiz ior �1:Q erection of any fireproof garage, w�tre-
rouse, facto:�► rr bra=n ele�ratory or for the erection of e,ny�► fireproof
�dditio:^ � for Gi+�.�sar �cckpa.ncy, to any existing building sha11. be at the
-rat:: os" �1.�5 fur each G319 �housand cubic feet, classified.sa nfireproofn
�y S<:�ta.�n 502 ct thP Minneapolis Building Code.
�iOUaFS
2.�::;o ror an� such permit for the erection of any non-fireproof building
ofit7F r�l,�n a�a,: �.ge� warehouse, factory or grain elevator, or any non-
f'ir- ;r;_�c�� ar�dit��on, for aimil.ar occupasacy� to sng exist�ng buildiag.
:� � fni :: �;� 0 0U for ��,ch one thousand cubic feet.
Gr r�duE.�
2�!�e :'cr �,^�* �a,^h z>�-,mit for the erection of a.ny non-fireproof gerage�
*�r�xeilo�sP, i�.ti�;_;_°� er. g� ain e'_eystor, or for the erection of an�t non-
fire�_:�oof �.c�'it�.or, fo= sam3lax occuparrcy, to at�r existing building or
f��r �:�.�h ��a�:� �:u� i����� �r ^.dc'i��ion, P1�nety Cents for each one thousand
ce�ic PeE�: ,-�� _'��L,:�c�.o� t�hE�•eof9 in the cubical contents thereof with a
mi nim�� of �1�. ^C �
�'o„ t.ze •j�� 'pc.., ��� cu�.�:�..._.n� fees for building permits the cubical contents
o� am- b�;;��u�.r::- _��,�ci=_:�,=�:�� to r u�iform height throughout by multipl�ring
thQ ground arct. ^:��r.rc:u f�-�r, a po� �t six. (6) inches below the floor line of
the.bas��ent or. c.el'ar to t;� a-reraga height of the upper surface or to the
avera�;e hsigh-c cf the : ocf N�wr�`r cf; of the main gable of a pitched roof.
2.5o For rep�ir,� o� a.7.-'�era+ions i.o an existing structure, the fee shall be
at the rate of �3000 for each Five Hundred Dollars (�5�fl.00), or fraction
thereof in the cost ���.all proposed worke
2o6e In no c��e sha11 tre fee charged for anyr permit as set forth in
�ec'cio.1 2 be less tha.� �/�.00.
I`�'1
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11�° 2�5
V�l.a.�e of �ri.dl.ey, li�inn.
1: �.:I -I: I� ' . ! <�I-' '__��! �i
Office of I1�d�P��Id O� ��II.IDINQ��S
�� f ; � _
Owner °�� ���.� z � �� �`� ��� � � i,���
nr�hite�t Frid2ey, n?alnn., ��,-%�' � � � , 18 �'�
Builder �r:''���-�
LOCATIOI�T OF BTJTLDING
No. �o�� Street �v� �A�Ph � U1 � Paxt of
Lo� �� �`� ` � �>' Block � Additfon or Sub-Diviaion °���°
Front � � ��
To be used as c`'�.N
3
$�. ,ry ,.- �,�� E� �?�=��
Permit is hereby granted
,�
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a.
...:�; ,, . .
��5�&t,IFTION OF BgJII�I3II�TG
/`� % �
_� Stories / Manner of ConsiructYon `d�
,4
To be completed a �"��''�'� �� �'� - � Estimated Cost � ��' � �` `�p"�
���- " � �. � " �, .�r� '�,...a2 `��sa ..., �y�`a..a�: � h#�':.�,.i' �a��•�Y�� Vti--"\F��
ti
,�i f`I ,.�r ..-.��'--- :. _:,�_ . �''
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the buflding •� r�^ ,�' �'���" °_ _��`, �'>� ;�� `" E; described in the above statement. Thie permit 3s granted
upon the expresa condition that the pet,�on to whom it ia granted, aad hfs �g'ente, employees and workmen, in all
the work done in, around and upon sa�d building, or aay part thereoP, shall conform in a11 respects io the ordi-
naaces of Fridley, Minn., regarding the canstruction, altera.tion, maiatenance, repair and moving of buildings
within the city lfmits, and this permii may be revoked at any time upon violatton of any of the provieions oP sa,id
ordinances. �,,
'°�i � '�` r � „1��� `� t �'?N §� � I11Sp0C{:OP OP S1131dfAg8.
�at
AG1��;EI�iT .�14TD �WOR1V STATEI�tYENT
In corisidera.tion o�f the issue a,�d delivery to me by th� Ix�spector of �uildin�� of FridB.ey of
fihe abave gernnit, I hereby a,g�ee to do the propos�d t�vork in accorc�aiace with the description
,�bove �et forth and according to the pro�risiona of the orclinances oi I'riclley, and, �eing first duly
`:'sworn, I hereby sta,te and say that the facts ata,ted by med>and co�tained in the ab�ve pe�°mit are
�irue a,s therein stfa,ted. ��' <i� .�' _ ..
Subscribed and sworn to before me at Fridley,
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��NOINEERINO M�nneapulis, M�nnewte 55432 I
ING.
a Seuth Oftice 890 6510
��Cird d� Sfwunpal Engirtevnng � Coi! Teat�ng � Land Sumeyirsg � Lartd Planrwig 1101 Cidi Roasi
�� J Bumsvdle, h4inn�sota 55337
Certifiea,te of 5urvey for KQ��CR BrRKHaLZ
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NOVEMBEt?� 1978 �
LOT51.4, I5,1C ,aNO TNE WEST 10 FEE7' OF LDT 17, '
BLOCK 19 , FR1 DLEY PARK, .ANOKA CDU1VTy! �o e�her
i he ou h Nal of vaeatec� alfe lj/�� �mrn�a'�a��
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1 h�nby urtily Mhot this is o true and co►r�cf ►�pr�a�nfolion of a urv�r o1 fhs baundaries of th� abow
d��crib�d land� and of �h� Iocallon of otl buildirt s Ih�non and afl v �ibl� ncroachnre t�� if anr� from or on
spid land. A� surveyed by m� this 2v dar of �G 1�'T �A "�.0. 1�• �.%� �
. SU�URd�N��E1�siNEERINB; INC.
L 3�% Enqin���rs �,t` � �,a* ��rvsro►•
�78� � byl^�,�'s.�<���;"' �,° 5 a ��' «�;
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Not PuhNshed: Al1 Rights Reseryed ,
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�� YtURB�N 8675 Highvuay No. ,65 N.E: _
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� (tiae! &.MnvciFa! Ertgin¢enng � Soii Testirtg � Land 3un�en ing � Land Planniny i 101 t',liff Road
Burnmlle, M�rv�esota 65337
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. Certific�te of survey for KQ�C,7E� 8���1'7�L ,,�.�, ,
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/VOVEMBER� 1978
LOT514,15,16 aNO TNE WEST 10 FEf T OF LOT 17,
BL OCK 19 , FRl DL E y PARK, ANOKA CDUNT} ;�o e�he�
wi�h fhe S'oufh Na/ o va�afed aC/e l�n immec�ra�/
ad 'ac f. Sub ecf �o all ea emenfs o�rACO�d �
� en f s �
1 hsnbr carfiiy thot fhis is a frue ond corroN repnsenfnt{on oi a
d�scribed land� ond af th� lowtioe oi oll buildfe ► th�r�on and all
said laed. As surveysd by ms.fhi• :?�- dor oi /�!; ,�r £-��.x Il�-�A.O. 1f
SUdURd�N,�l
L $7% Engin��,,/'� �'
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Not Published: All Fights Reserved
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��INEERt.nb6,,INC.
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FRIDLEY MUN[CIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
May 14, 1996
Rodger Birkholz
6103 East River Road N. E.
Fridley, MN 55432
RE: First Notice of Noncompliance at 6103 East River Road N.E.
Dear Mr. Birkholz:
The City of Fridley has established a City Code for the purpose of promoting a pleasant
and attractive suburban environment. A recent inspection of the property at 6103 East
River Road N. E. revealed that not all Code requirements are presently being met. Listed
below are items which do not comply with the City Code:
Di�continue outside storage of 7-10 bags of aluminum cans, 10+ tires, and
miscellaneous lumber and scrap materials located in the front and side yard areas.
2. . Fridley City Code requires the exterior walls of every building to be maintained in
good repair. I have observed more than 25% of the protective surface (paint) on
the west garage wall that does not meet cod requirements.
3. It has been reported that an auto repair business is being conducted at this
location. City Code does not allow the location of an auto repair business on
residentially zoned property. Please discontinue any improper automobile repair
activities and contact me if you have questions or comments.
Your prompt attention in correcting this situation would greatly assist us in helping make
Fridley a better place to live. An inspeetion will be conducted on or shortly after May 29,
1996, to determine compliance.
If you have questions or would like to discuss this violation, please contact me at 572-
3595. Thank you for your cooperation!
Sincerely,
Kurt Jensen-Schneider
Code Enforcement Officer
KJS:Is CE-96-153
sue�ecr • PE .
City of Fridley
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T ���+� �
r
� �' COMMUIVITY DEVELOPMENT DIV RECEI
� j V �"__',
r � � PROTECTIVE INSPECTION SEC. uG� �
i , � 1
l-_-- � ��'�','� CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF AaPROVED Br
L �� 612-571-3450 910-F15 2/11/97 � /
JOB ADDRESS 6103 East River Road
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],L�., 15, 16, 19 Fridley Park SHEET
2 PROPERTY N f�. O Ot MAILADDRESS ZIP PHONE
Roger & Susan Birkholz, 6103 East River Road, Fridley, MN 55432 571-0740
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO-
Home Pride Remodelers, 1408 Northland Dr. 4�106, Mendota Hts 55120 884-6106 20013090
4 ARCHITECTORDESIGNER MAILADOFESS ZIP PHONE LICENSENO.
5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOHK
Re-siding -� ��.f%�0�� '�i� � X /� � ��2. (�(.e-� S U -�I
9 CHANGE OF USE FROM TO
STIPULATIONS
Work already completed.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OH IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TNAT 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 �7�SOO.00 �p3.7S
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 $137 . ZS re SC �%. SO
PLAN CHECK F E T AL FEE
Licens SC .00 $153.50
SIGNATUFiEOFCON�AACTOAOAAUTHORIZEDAGENT IDATEI EN RlY V LI fiED THIS IS YOUR PERMIT
_ �• �- /r —{7�-
S�GNaTUREOFOWrvEA���OWNEABUiLDEfii iDATE� LDG � SP r� TE•
�ry-1J-177f n7�10 �a�r ur rrtaL�c� --- —•-
N� [ ]
A.DbN [ ]
A,LTER [ l
CIT'S�' OF FRIDLEY
SIIrTCLE FA,MILY AND DUPLEXES �i-1 ANA Yt 2
B�U'ILDINCr PERMTT APPLICAITON
Effeetive 1/1/97
�� � I
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,�ConsttuctioaAddress: C I i� �� l=. .� � v �� �� �
Legal Descxiption: � . �
�wner .Name & Address: � f'� � �, i_. 2 � SL � y-r��� ►�S � RK �.Q �- 2- � • ''�JI'el ' #.'� "��'� `�'�
. . • �::��:;
✓�ontractor: �'� � �°1 � h'R ( i� � � � r ,`�c� r�. � e_ i:� � ✓jVlN I�CENSE # � .
�AddIeSS: ( LI C► � �.+�'� 2 G"t 1 C,� rv S� � � � I C� -C-. ,�e1. # � ��S' � �-�' O �
Attacb �o . this :applicatioa, �a Certificafie of S�rvey of t�e
lot, wxth the propased construction drawn on it to sc�le.
DlES�12IP7C�ON Ok' ��4�L.�N7C
LIVING .�REA: Length Width. Height . Sq. Ft.
GARAGE AREA;: �,ength � .�Vidth Heigiit � Sq. F,t.
DECK AREA: Len�th '4Vzdth Hgt/Ground Sq. .Ft..
OT��i_ �'� _ �aia/l� � . � .
Constru�tion Type: Fsti�mated Cost; $ � �, -�1'J,
a�
. . . . -T .
� � � � • �(Fee Schedul e on Back) . �
Driveway.. Gwrb Ctiut.�.Width Neecled: : ��. .+. .6 Ft = . . . . .Ft. x �: $ . �. � . — $ .. .
' f .� � � : � � ::�=4.. � �" ' � � � .� � .: � �� .✓�.. � : � . . -
DAT'E: � . :�A►�P'LIC�AN'�: . � . . . . . -. . . .. . . Tel.� �#: .:, : � � ' �� .. .
Perm:it Fee
Fire S�rcbarge
State Surcharge
SAC Charge
License S�u charge
Driveway Escrow
Erosion Cornrol
Park Fee
Sewer Main Cbarge
TOTAY.
STIPULATIONS:
r ,
$ � �Z�
$ �,� .
$ �
� �
$ �, �o
$
$ �
$ '
$ .
$ � � ���D
I,S3� �'�
CITX USE O�T�.Y
Fee Schedule on Reverse Side
.001 of Permit Yatua.tion (1/lOth°!o)
$.50'/$1,000 Valuation
$950 per SAC Undt � �
$5.00 (State Licera,5ed Re�ide�al Contiactors)
A1t. "A" �or A1t. ":B'.' Above . . .
$450. U0� Conservation Pla�a Review �
� � �� ���
�LlSC�3ed ��
��j,�i✓ Cc/1��
/�� 9 C�, �
Fee lletermined by .Engineering . � .
t��reement Necessary j] Not. Necessary j. ] ���C�'�
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SuBJECT .` --�
City of Fridley � � � � 2 � �
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 OIV.
r �~ � PRO7ECTIVE INSPECTION SEC `? 1� �f
� � �� .� /
� � �
( � /'��1 � CITY HALL FRIDLE� 55032 NUMBER REV DATE PAGE OF APPROVED BY
�----�: �.' 612-571-3450 910-F15 5/8/97 / /
JOB ADDRESS 6103 East River Road NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
�ESCR. 14-17 19 Fridley Park SHEET
2 PROPERTY OWNER MAIL AOORESS ZIP PHONE
ROdger/Susan Birkholz 6103 East River Rd NE 571-0740
3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO
Sa.me
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
[� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WOHK
Construct a 12' x 10' Deck between house & garage
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
��������
Before �►���RB ���r �`�'`
�l1 �ttitity bc2i't��
454-�3�
REC�t���ED �Y ��
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED fOR ELECTRICAL. PLUMBING. HEAT�NG.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTpUCTION ZpNING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OH IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFiEET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 WifOOO �.SO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �3�F.%S Fire SC �L.00
PLAN CHECK FEE TO AL FEE
� $36.25
IGNATU EOFCON�RACTOA UTHORI ENT IDATEI N fiO VALI A D THIS IS�R�MIT
� f'� r c.�
_ SiGN URE OF pWNEA iIF OWNEA BU RI �DATEI -�gL �NSP � OiTE
NEW ( ] Effective 1/1/97
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 ,
BUILDING PERNIIT APPLICATION
construccionAaaress: lo �' d � �. �� � � � �� `'
.
Legal Description:
Owner Name & Address %�v al s �, � � � 45s�v � �r ����� Tel. # �5` � / - 0 7 y a
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
MN LICENSE #
Attach to ttus application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEIVIENT
Length Width Height
Length Width Height
Length joZ Width J O Hgt/Ground
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction T e: lsJ o e o( � p a
YP Y/�� Estimated Cost: $ ���C� ;
(Fee Schedul e on Back)
Driveway G�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE:�,S� ���' � APPLICANT: � Tel. #..� %J ` O %6/�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULAT[ONS:
, CITY USE ONLY
$� .��� Fee Schedule on Reverse Side
$ /. D U .�1 of Permit Valuation (1/lOth%)
$ , ,� $.50/$1,000 Valuation
$ $950 per SAC Unit
$ $5.00 (Sta.te Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ � $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
�3� . � 5'
� . s .,
1
IiUtLDING PERM["(' FEE SCfiEDL'l,(;
'['hc Chief Bui(ding Of�cial shall, before issuing perniits for the erection of any building or structure, or t��r
any addition to any existin� building or structure, or for any alteration or repair to any existing buildinv or
stiucture, upon application th�refore, require the payment by the applicant for such permit of fees to the amotint
herein below set forth and in the manner herein pcovided 'to-wit: � .
TOTAL VALUE
$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
$500,001 to $1,Q00,000
$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,OOQ plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,Q00
$349.75 for first $25,�0 plus $9.� 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 thereaf, to and including $1pp,Wp •
-r.. . .
�:� �.�
$887.25 for first $1(�,000 plus $5.00 for each additional
$1,DOO�or fraction thereof, _to .and including $5�,(�0
$2887.25 for the first $Spp,p00 pius $q,,25 for each additional
$1,000 ar fir�ction thereof, to and including $1,�0;000
$5012.25 for the first $1,000,000 plus $2,�5 for. each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets On1y)
:�lternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.�0.
4lternate "B": Removal and repiacement of curb and gutter and install a 3 foot wide
� approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued. a minimum of 24 hours from the time of application to allow �or pm�::r
:-eview of the proposed structure and of the construction site.
�� C'ec�lit7cate of Survey of tlte iot, showin� the location of the f�undation ��nce it has it has heen c�instruc�_�.i
•, i�! f�� rcquircd hcfc�rc i�r��cccdin� �;�itl� tt�e t�ramin�*.
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,ne Depot #2802, 5650 MAIN ST., N.E., FRIDLEY, NIl�T 55432,
�r 19 18:10:26 1997 -
saved as: c:�cqdesign�decks�5710740z.�DEK
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, ' ' � , SUBJHCT . ' r - . •
c�ty of F��a��y , �28
AT TME TOP OF TME TWINS g � � L D i�l � P E R M I T
� RECEIPT NO.
� � ,
� ; y _.��� COMMUMITY QEVELOP�ENT DIV.
r � � PROTECTIVE INSPECTION SEC. �����4 ��(��
i . �
(__-• A��'���.� CITY NALL FRIOIE� 65��2 NUMBER � REV DATB VAGE OF APPpOVEO BY �
i �� 612-571-3450 et0-F15 5/17/O1 / /
JOB ADORESS 6103 East River Road NE ��
1 LEGAL LOT NO. 9LOCK TfiACT Op ADDITION SEE ATTAGMED
oescA. 14-ll 19 Fridley Park S►IEET
2 PROPERTY OWNER MAIL ADOpES$ Z�P PHONE
Roger Birkholz 6103 East River Road NE 571-0740
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO
Midwest Roofing 7385 Mark St, Greenfield, MN 55357 763-416-4804
d AFiCNITECT OR DESIGNER MAIL AOORESS ' ZIP PMONE UCENSE NO.
� ��
5 ENGINEER MAIL ADDRESS 2�P PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION � REPAIR O MOVE � O REMOVE
8 DESCRIBE WOi;K
Reroof House (12 Sq) Tear-off
9 CHAN(3E OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
" TYP� CjF CONST OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING. MEATING.
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WQRK OR CONSTRUCTION ZONING SO. FT CU FT
AUTMOR12ED IS NOT COMMENCED VjIITNIN 80 OAYS. OR IF CONSTqUCTION ,
OR WORK IS SUSPENDED OR ABANQONEO FOA A PERIOD OF 12Q DAYS AT
ANV TIME AFTER WOpK IS COMMENCED. ' NO DWLG. UNITS OFFSTpEET PARKING
I MEREBY CERTIFY THAT I MAVE READ ANp EXAMIN�O THIS APPLICATION 1 STALLS GARAGES
ANO KNOW THE SAME TO BE TF1UE AND CORREC(. ALL PROVISIQNS OF LAWS VA�UATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WpRK WILL 8� Cf�MPUED @ @
WITH WMETMER SPECIf1E0 MEREIN Ofl NOT. TNE GRANTING OF A PERMIT `P1 f227 y�.61
DOES NOT PFESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TNE pEqMIT FEE SAC CMARGE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGUTATING CON• $47.9p Fire SC �1.23
STRUCTION OF THE PERFOfiMANCE OF CONSTRUCTION
PI,AN CHECK FEE TOTA FEE
� �. � �, �' ��'d' Licen C $5 .0 . 74
�
$�GNGTUAE OF CON'AACTOp OA AUTMOA�ZED OGENT �O�iE� NE PROP ALID TMIS IS VpUR PE�T
� ��
S�GNATUAEO�OWNEA���OWNENBU�LDEIii �O�TE� ' ' B �HSP - - r�6tE
. Y �
� �.
NEW [ ]
ADDN [ ]
ALTER [ ]
Construction Address:
Effective 1/1/2001
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
I o� L.�S� R�,�er ��e
Legal Description:
Owner Name 8� Address: Ro�e� `�K�o�Z Tei. # 5�� —�1W 0
Contractor. �1�v�t �t��� MN LICENSE #�(70 � Da�7
Address: � 3 d� /V1Grk 'S3 C�t��n���� Nt,/�/ �5�j5� Tel. # �63' �'I!b '��
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.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. F�
Length Width Height
Length Width HgUGr
Sq. Ft.
Sq. Ft
'IC'Ar O�
Construction Type: �e �OV� Estimated Cost: $ ��' ;�� � �� /
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ �
DATE: �-����� APPLICANT: > '' J� "�- Tel.# ��� "���V�80L�
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
rt��r_L�
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ . Fee Schedule on Reverse Side
$ /. �� .001 of Permit Valuation (1/10th%)
$ � l� / $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ � �DD $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 [ ]
$ ��i ��,
�z � -_
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 VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,0�
$25,001 to $50,000
$50,001 to $100,000
$1(�,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for fust $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,0(� plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
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 $23.25.
VERIFICATION OF FOUNDATION
Pernuts for construction will be issued a minimum 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. New Houses Oniv
_ - -.-.
����
wELL OR BORING LOCATION MINNESOTA DEPARTMENT OF HEALTH '�) ' t� Minneso a"Well and Boring H ��
CountyName WELL AND BORING SEALING R COR sealin o.
nesota Unique Well No.
p�� Minnesota Statutes, Chapter 1031 or W-series No.
�t.euve am� ir na imown�
Township Name Township No. Range No. Section No. Fraction (sm � Ig) Date Sealed Date Well or 8oring Constructed
��� Q30 24 i5 ��. SE�. SE�. W�dr►esday. June i6. 2004
GPS Letitude degrees minutes seconds
LOCATION: Depth Before Sealing � ft. Odginal Depth �'��� ft.
Longitude degrees minutes seconds ppUIFER(S) STATIC WATER LEVEL
Numedcal Street Address or Fire Number and Ciry of Well or Boring Location �( Single Aqu(fer ❑ Multiaquifer
61ai EAST RIVER ROAD WELUBORING � Measured ❑ Estimated
� Water Suppiy Well ❑ Monit. Well
Show exact locatlon ot well or boring Sketch map of weli or boring
In section grid with "X" laxtion, showing proparty ❑ Env. 8ore Hote ❑ Other � R � below ❑ above land surface
N lines, roads, and buildings. CASING TYPE(S)
-T- - -;-- - ;-- � G sc�i ❑ Plastic ❑ ria ❑ aner GaNran¢ed T8�C
o �
�
W --�- -i-- -;-- --i-- E � WELLHEAD COMPLETION
� � � �
� � .�"�"� Outside: ❑ WellHouse Inside: ❑ BasementOffset
� � � �- =:;iYF:�� 'n
---- �-- -,-- —�-- � -
��� � ❑ Pitless AdapterNnit �Weil PR
---- -;-- -i-- -- - I m
S � ❑ Well Pit ❑ Buried
S �
�-- � "'a°—� _ _ _. _ _ _ _ _ ❑ Buried _ —
PROPERTY OWNER'S NAME/COMPANY NAME CASING(S)
B��Q R0�(i�i $$U$a1� Diameter Depth Set in oversize hole7 Annular space ini�ally grouted7
Properry owner's mailing address if different than well locatlan addresa indceted above
2� in. from 6 to 54 ft. ❑ Yes � No ❑ Yes ❑ No ❑ Unknown
6103 FJiST RIVER ROAD
in. from to ft. ❑ ves ❑ fVo ❑ ves ❑ fVo p uNmown
FRIQLEI(. MN 554�34
in. from to ft. ❑ ves ❑ IVo ❑ Yes ❑ fVo ❑ unlmovm
WELL OWNER'S NAME/COMPANY NAME SCREEN/OPEN HOLE
SAME
Well owneYs mailing address N d'Aferent than property ovmer's addrass indicated almve Screen from � to ft. Open Hole from . to fY.
S� oes�ucnoNs
❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill ❑ No Obstruction
Type of Obs4ructions (Describe) RBmaY�'� X �'25� �rop Pipe 8"let Pafke�
OEOLOGICAL 6AATERIAL COLOR �RDNESS OR �OM TO Obstructions removed? RQ YBS ❑ No DeSCribe
FORMATION
If not krtown, irtdicate esdmated fortnation log hom nearby well or boring PUMP
� 4 Type Qeep WeA ,I� Pump 8 42 Gaiton Tank
� Removed ❑ Not Present ❑ Other
�� 4' � METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASiNGS, OR CASING AND BORE HOLE:
$a� �y � � � No Annular Space Exists ❑ Mnular space grouted with tremie pipe ❑ Casing Perforation/Removal
S� �� � � in. from to ft. ❑ Perforated ❑ Removed
��� � � � in. from to ft. ❑ Perforated ❑ Removed
pn.� _ �� Type of perforator
Depth - 4° X SO' ❑ Other
GROUTING MATERIAL{S) (One beg of cemeM = 94 Ibs., one bag of bentonRe = 50 Iba)
Siatic Water - 22'
Grouting Material �� from s to 6•5 ft. —� yards bags
E�YR01��u9 from s-� to � ft. 0 yards bags
from to ft. 0 yards bags
GEOLOGY FR�NI: EAST ROAD OTHER WELLS AND BORINGS
REMARKS, SOURCE OF DATp, DIFFlCULTIES IN SEALING Other unsealeii and unused well or boring on property7 ❑ Yes C� No How many2
we0 located 'm pump r�m on w�t side of b�ment UCENSED OR REGISTERED CONTRACTOR CERTIFlCATION
This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report Is
�Q d� �� � 9�e � true to the best of my knowiedge.
mdh staff vvas not on si� dur6�g v�ll �afmg �n L Matenke / Malenke Water (763) 493.3650 2a60D
Contracior Business Name icense or Registratlon No.
verification of notific�tion waa reoeived irom mdh � �ff" �-'� .`, ,_
15 030 24 44 0030 M. L Nialenke ,,.•',r�� ,r=" �"� �:��,_`..-° ���.._ Ju� 16, 2Q04
Authorized Representative Signature Date
LOCAL COP`i H (.�� ���� Nama of Person Sealing Well o� Boring
_ �
�
_ ..: :. ,_ ;:.�,. `
� � �::s
� . ._, �.�, �t`. �;� ..
���
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, ��ka�s ..
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y - d -v � e . � G .4 .� ,y
� s :' f r �� �.r P „ a�� - �y � �{ s � �'' � � N -m�."� e-r�-�
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� . � k l�� o��Q��Park..; ' °� �"�' #
� � /�� .. ` . Soufh lina at �ots 1�;13,1� �1x`� gfo� �Fr� "F .-,� :
�l :
e � �' NOVEMBEl�� 1978. �:: ; . > ' �":°
�
� � L��s �4, :��,1� ANb TN. .E il,I l�S�� � lo ���� o� �o� �r7,r� � � � a .: s } {,
; , � , � ti� r `� ,�, � � �
..f., : : �71 /"'►`r*1:J `,t�ri . *r<�[91. �1 / . E'l/ i3li !'� l/�: . ; A At1'f"i.�t'�t �'%*f'1t 111"l.T�1.�': >;.l � fr,�G _.:.t .- . ,� :; � `� �-f
�.
� �` ��'
i_ henb�e tRrtifye tl�ot -fhes is a.ir+rr"�and: corratf rapei
Building BUILDING Permit ivo.: � ����
Inspections RESIDENTIAL APPLICATION Re��� ��� j
763-572-3604 CITY OF FRIDLEY vate Rec'd: ',
763-502-4977 FAX Er�cTTVE �-�-zo�o
DATE � ` �' YOUR E-MAIL ADDRESS
srrE.4nnxESS� -��j� t� �/po-�
e
THIS APPLICANT IS: �OWNER OCONTRACTOR
PROPERTY OWNER/ NAME:
TENANT ADDRESS:6
< CITY STATE�ZI �
PHONE
CONTRACTOR NAME: � QO�
SLTBNIIT A COPY OF STATE LICENSE #� EXP DATE
YOUR STATE LICENSE
AND CERTIFTCATE OF ADDRESS: CITY STATE ZiP
INSURANCE pHONE FAX
PROPERTY TYPE SINGLE FAMII.Y/NEW CONSTRUCTION SIZE
O TWO FAIVIILY/NEW CONSTRUCTION STORIES
PERMiT TYPE O ADDITION �GARAGFJSHED ❑ WINIIOWS
❑ BASIIVIENT FINISH ROOF ❑ DRAIN TILE
❑ DECK SIDING ❑ OTHER
❑ SWIIvIlvIING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDTCION
MAINTENANCFJREPAIR ❑ REMODELING
DESCRIBE WORK BE[NG DONE: �a � I �
SIZE OF IAiIPROVEMENT LINGTH WIDTH HEIGHT S FT
FING , o ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES __ ,�?��� �� ❑ HOUSE & GARAGE
�-� Z�.� B' ,'� 1. Existing Floor Plan
GARAGFS ' ❑ ATTaCHED GARAGE 2.. Proposed floor plan
PROPOSED SIZE:_�% � DETACHED GARAGE 3. List of structural members to be used
PROPOSED HIIGHT: •
�FOR NEW CONSTRUCTION INCLUDING DECKS,
Vuryl �Soffit ADDI1'lONS. & PORCHES SLTAMIT:
0 Alwninum ❑ Trim 1• Site Plan/Survey showing the existing strucdues
� Other ❑ Fascia and Pr°p°Sea Pr°�ect
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS 01'es ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALCTE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
.u.a. rr.r,� tuc� a[�r,1� vl� v[i1.,uA11Vlv, 11�l:LULliVli 1riL+ C:UJ1 Vr LAIfVK A1Vll MA�I��l(1A1.5:
(USING THE 1997 U.B.0 FEE SCHEDULE)
J_OB VALUATION $� ��- /� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dne
$ (V,�9 �i See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ ? .001 times the tota.l job valuarion
$ .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residential Contractors)
$ $2100 per SAC �Jnit (Plans to MWCC for determination)
$ ft+6ft= ftx$24=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ �� _ Make checks uayable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all wor hich requires review and approval of plans. l
SIGNATURE OF APPLICANT 'y�ili'— f-�� V�' �PRINT NAME 7 �[ IS �i..e i2�L��X�1'M3ATE ��°> >%/ �d��
Page 2- Building Residential Application
BUILDING 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 eacisting 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 VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for ]�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1� $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1� $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1ffi $500,000 plus $4.75 for each additional$1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 forthe 1� $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for constcuction will be issued a minimum of 24 hours from the time of applica.tion to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
sue�ecr PERMIT NO.
City of Fridley ����1� ---
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � �� ��� � ,
r
� � RECEIPT NO.
� 1 y���__ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � ��
� i �
� �"'1 � CITY HALL FRIDLE� 55432 NUMBEF i1EV DATE PAGE OF pPpROVEO Br
�""� � �'' 612-571-3450 910-F15 4/30/96 / /
J08 ADDRESS 6103 East River Road NE
t LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 15,16,17 19 Fridley Park SHEET
2 PROPERTY OWNER MAIL ADURESS ZIP PHONE
Rodger Birkholz 6103 East River Road NE 571-0740
3 CONTRACTOR MAIL ADDRESS 21P PMONE IICENSE NO.
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
❑ NEW ❑ ADDITION O ALTERATION ❑ REPAIR O MOVE O REMOVE
R
8 DESCRIBE WORK
Construct an 18' x 14' and a 5` x 5`6" Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
�VV�R�f�G
B�fore digging call fot
a11 atitity lacations
454-0002
REQUIRED BY LAW
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TVPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
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 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2,159 �1.OS
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL lAW FiEGULATING CON- @
STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION. `P74.7S Fire SC �L.16
PLAN CHECK FEE T07A1 FEE
$77.99
IGNATUpEOFCON�RAC7 oRauT O iZEDnGENT �IDATE � WHEN PfiOPERLY LIDA ED THIS IS YOUR PE��
O�� `_
,
���
S NATURE OF OWN F O ER BUI Ei7� iDATE� QI,DG NSP ��FTE
rrEw
ADDN
ALTER
[l
[]
[�
- CITY OF FRIDLEY
SINGLE FA1I�IILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/96
ConstructionAddress: ���� �, 1 i tf�c 52.. 2�
Legal Description: � U / / S � / ,�
Owner Name & Address: %��c� s � r �� � � r �«U� � Tel. � � 7/ - a %y�
Contractor: MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed constiuction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECS AREA: Length / g � Width �-�� __ Hgt/Ground �" Sq. Ft. � � � � '��
OTI�R: `�' `' ' � `r % � /�9e G� �
Comer Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
Type of construction: Estimated cost: $ �%�9, �z/
�
Approx. Compietion Date:
(Cost on Back)
. : ru, �: . .
Driveway Curb C�t Width Needed: Ft. 6 Ft = Ft x$ _$
DATE: �� � -1�- �' 6 APPLICANT: • Tel. ��/ - Ui'y0
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� �y �5
� ,1�
$_ D�
$
$
$
$
$
$
$ � �
CITY USE ONLY _ -
Fee Schalule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$900 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 [ ]
�
C�ec�`-''S ��''"''`'r6%� I
--�p ` fir�e.. e("
�
� ${- ��lo
�
BUII,DING PERMIT FEE SCHEDULE
The Chief Building O�cial shall, before issuing permits for the er�tion 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 applicadon therefore, require the payment by the applicant for such permit of fee.s to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
�ZS,00i co �so,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
�Z,z,,
s°
�y �
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FEFS
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $1� or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,0�
or fraction thereof, to and including $25,0(}0
$349.75 for first $25,� plus $9.(?0 for ea.ch additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,0�0 plus $6.25 for each addirional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $1(�,� plus $5.00 for each additional
$1,0{)0 or fiaction thereof, to and including $500,000
$2887.25 for the first $SOD,�O plus $4.25 for each additional
$1,0(� or frdction thereof, to and including $1,000,000
$5012.25 for the fust $1,0OO,ODO plus $2.75 for each additional
$1,OOD or fraction thereof '
DRIVEWAY DEPRESSION ESCROW �-
(Concrete C�rb Streets Only) -
Alternate "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 fe�t times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper .��
review of the proposed structure and of the construction site.
A Certificaxe 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. �
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sue�ecr PER
City of Fridley 1521 s
AT THE TOP OF THE TWINS g U I L D I N G P E R M i.
i�
� � RECEIPT NO.
; ; L ____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � 2
1 �
i
l-__. A �r���,`� CITY HALL FRIDLEv 55432 NUMBER HEV. DATE PAGE OF APPROVED BY
L J� 612-571-3450 910-F15 5/2�"!9 / /
10B ADDRESS 6103 East River Road N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
OESCR. 4& 15 19 Fridley Park SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Rodger A. Birkholz 6103 Ea.st Ri.ver Road N.E. 566-6433
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
S�e
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDFiESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Res idential.
7 CLASS OF WORK
O NEW ❑ ADDITION �,7 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reside house
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, P�UMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
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 READ AND EXAMINED THIS APPLICATION 1 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 $5OO $.5O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY, TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $7� c,O
STRUCTION OR THE PERFORMANCE OF CON�uTRUCTION.
PLAN CHECK FEE TOTAL FEE
�8.��
ATU EOFCON�aqCrO aur R DAGENr IDATEI WHEN PROPERLY LIDATED THIS IS YOUR PERMIT
�� ��� � ���
A REO OWNER�FOWNERBWLDERi IDATEt � BLDG INSP OaT
.
cz�rY �or- r-izz��t_cY , � �
`• /1t'f'LICA"tIUit f'Oft ItI:S1U�=t��7I/1L �U1I_DIP1G f'CItMITS .
' (�`�L"W, -�L?ECi�71UfdS, �I)llITIO(J�, Of� �Ef'AIIZS)
,. , .
ow�trR: � , �� r ��� ° �ux�ui.�t: " .
Addr.ess : 6/B �- � %Z� v`�- �� Addres� :
110. :�1��
r,oT: ,�y ¢ /�
CORIJLR LOT:
� �el . »o . : �'1� !2 — � y 3�: .
Street: F ��� 'Y .f �G�• . '
e
ar,ocr.: l � . ADDX�rzor� : �ti ,� ��<<r �..� i? /�
II�SID� UJT: SETI311CY.: SIDL•'Y11RD5: '
ApplicanL- a�tach 't-o L•his foxm Z�ro Certiii.cate�. of Survey of Lot ar�d proposed
bui_�.dir�g locai:ian drawn on these Certi£icates. .
DESCRI PTI01'd OF $UILDI hG
To I3e Used As:
•�e S_�cJ�� /i�G�cS'�. Fronts Depth: . ' Hei.gh�::
�. . Square Feet: Cubic'Feet: �
'I`�:ont: Depth: � iieight:
Squaie I'eet: � GZibi.c Feet: '
Type of Construction: �p as s�����• _Estimai.ed Cost: $ v'`��G ;�_
xb IIe Completed: ��j����s � . �Alt. A Alt. B
k'xciposed Driveway Sti'idth if I�ew Opening Is Desired $ � $
' (S�� �VEFSE SIDE OF SH�ET)
., The undersigned l�ereby makes ap�lication for a permit for the work lierein
specif�ed, agreei.ng to do all �.ork in strict acco�:dance with the City of .
Fxidley Ordinances and rulings of tlie Depart.ment o� �uildings, a�id hcreby
decl.are� L-hat a11 tlze facts and re��resentations stated i�l t}iis applicaL-ion
are true and correcti. 'See revcrse side iar ac]diL-io»al inforniation.
DAT� �G�l�c, � � �i�� SIGNATURE • �
, ' .\�"
Stipulat•ions: ,
j��,�..�c �. ,��
. �"�o � .��
� � �.o�e
� �J� .
0
• - BUILDIfJG PERt�1IT F�� SCi-IEDULE
S�CTION 2. The Inspector oF Buildings shall, before issuing permiL-s for the erection
of any building or st•ructure� or for any additian to any existing buildiny or structure,
or for.any alteration or repairs to any existing building or structure, upon application
therefore, re�uire the payment by the applicant for such permit of fees to tfie amount
herein below set fori:h and.in�the manner herein provided to-wit:
NEW CONSTRUCTION: Single ramily iiomes and Garages: $4.00/1,000 cubic �eet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only) ,
• Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$J15, 75
� Alternate B: Removal and replacement of concrete curb and
. gutter and install a 3 foot wide approach with �
' 6 inch depth; Driveway width plus 6 feet x$17.85
�11 � :.. 1 �' � �l
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 bas�nent or th� cellar to the
average heights of the upper surface or to the average height of the roof surface
of the main 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 �ive hundred dollars-($500.00) or fraction thereof in the cost
of a].l proposed work. � '
In•no c�ase shall the fee charged for any permit as set forth in Section 2 be less�
than $7.50 plus $.50 state surchaxge. � �
' VERIFICAT�IO� OF FOUNDATION
NOTE: Permii:s for construction will be issued a minimtm► 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, sliowing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
_f : � � ':1
Application for a Certificate of Occupancy sha11 be made ten (10) days prior to the
use or occupancy of any structure for which a building perniit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
°--, s _
$Uilding
Inspections
763-572-3644
763-502-4977 FAX
From: 763_522 6527 Page: 2/2 Date: 1 0/20/201 0 1 2:31:38 PM
ME�HANICAL
RESIDENTIAL APPLICATIQN
CITY QF FRI�►LEY
EFFECTIVE 2-19-09
DATE �V lil� rC� YOUR E-M/UL ADDltESS
S['CE ADDRESS �D S C� i�oS ��`' I�
THIS APPI.ICANT IS: O OWNER `�ONTRACTOR
PROPERTY I NAMG:
OWNERI ! qDDRESS:
TENA]VT
� PHQNE:
Fermit No.: ��� i �
Received By:�
Date Rec'd: �'r�
STA?E ZIP
t '
CONTRAGTOI� COMPANYNAME:� \i � _��'�(;�,�"[�°�',(�j/�Q'
Su BMtT A CX�PY OF corrracr �soN: � aT-
'YOtJR STATE SfATE LICENSE # C} OU�j } �(p p.�p.y�_-
LICEI�fSE VbTTFI ADDRESS: IDtO u (��i� ri(t�f�C; ` 1W► I�U1 CITy �(� �!' D STA1E �Z1P �o�
APPLlCATTON PHaNE �n� ��I �G� FAX �—
r�wvnr �r�rrE
TYPE d� WORK:
�SINGLE F�IMILY O TVJO PAM(LY
❑ r�w �ru,cE�-Nr
DL-TAILED DESCRIPI'ION OF WORK
O TOWN1i0USE
Q ALTERATIUNIREMODEL
FEES ARF. BASED ON SIQ.60 PTR FIX7IJRE, E WHER.E 1VOTED. FI�CTURES: ( I��, T����,L,�JMBER OF EACH BELOV►�
Equipment Insmlled MFG: 140DII.: _����:1� wJ IP(L� 512FJB'TU
MFG� MOBQ.: SIZFJBTU
MFG: MUDEL: SIZFIRTU
TAIC $25.00 _FIREPLACE (GAS) $15.Q0 _Cu1S RANGE/OVGN 510.00
^AIR TO A[R EXCHANGEER $15 IREPLAGE (WOOD}.535.00 ,�NEW GAS GRILL $ IQ.D6
BOTLER $35.00 �FURNpCE$35.00 OAS Uh7TH'E'R$10,00
�'HiMNEY LINER S IO.OQ S DRYER Si 6.00 POOL FIEATEl2 a3S.40
_)UCT WORK $10.00 _ �GAS PIPING � 10.00 VENTILATOA 815A0
Alumber of fixtures (r� $10.00
Aiumber of fixtums @ $15.Oa
x$10.00=^s l�
x$ISUO=S
Numbet of fixtures � SZ5.00 x�25.00 =$
Number of fixtures � $35,00 x $35.� _ $ ��
Sia#e Surcttarge = $ �-�V� �� �, c�'
1 �
(MINIMUM FEE $35.501 Tota1= $ '
TH�$ IS AN APPL[CAIIOIY FOR A PERMIT-NOT VAL[D UNTfL PROC[•551�
I heteby apply for a building permit and I aclmowledge fihat ti�e informatian above is complete and acciu�ate; that the work vv�11 be in
co�formance with the ordinances and codes of the City of Fridley and with t6e Minnesota Construction Codes; that 1 tmderstamd ihis is
not a permit but only an application for a permit and wo ot to start without a perrnit; d�at the work wiEl be in accordance with d�e
approved plan in the case of a11 w�rk whiSrfi res�}��evi��d approval of plans.
SIGNATURE OF APPLICAN�I'
NAME pATE
I_��1�
� c,�y of F,�a��y
Buitding Inspe�tions Department
6431 Universiry Avenue NE, Fridley, MN SS432
763-572-3604 FAX: 763-502-4977