AF - 40231%^1 �
City of Fridley, Minn.
BUILDING PERMIT No
` � � a
Date: ..--_ __� � .__------__._._...� .____--•-------_.
��.�� - _
Address
4229
!!�� � � �_�
Builder ..... .. __���.�� .,�.._M...__ ___._..—...._
Address.....-�---�-----......_.....------�----------
LOCA OF BUILDING
No. ....�..�.�_....'�� Street ���1•�..�...�..._.@�---l�. -•- ------_.�........�----�--.....----�-----_..... Part o Lot _..._....---_...._...__...._.._.._._.._..._ _...
Lot ........,�.._........ Block ---.--•.� ............................. Addition or Sub-Division .. ����
�° `� ...�� ...C�.,�.:_�:......_..__....._._:.
n °� � �
Corner Lot .......................�--.......... Inside Lot %................................ Setback ... .........---�
-•-�---...._....---- Sideyard �----�-....... �.........--�--........._.
............_..__..
Sewer IIevation -----�-. -..�i_C2�,...�-�-.......---•-_---•----- .................•----- Foundation Elevation _.�...�.11.�._.�.1........_...__.
To be Used as:
....������...
Zj�pe of Construction
DESCRIPTION OF BUILDING
,(� r � i�% � '� j�` � � .,e�.�
Front .��_c.�_� �Depthr��.f_.!�..._� Heightl-7�-�`� Sq. FL/�.�� Cu. Ft�-�..__..._�`'�
Front � . ..�°�.� Depth ��:_� Height ��...��.� T �
� .. . _ ... . . . �. F� �Y'�s.. �. �. Y��
/ �
...................................................... Es� �..�..��f�-..�.�.....-."�ro be Completed ...---�-•-�----•--.__............----��-�----.....
/
In consideration of the issuance to me of a permit to construct the bui.lding described above, I agree to do
the proposed wark in accordance with the description above set forth and in compliance with all provisiona of
ordinances of the city of Fridley.
, � �
�-------����`� -_�`�..
In consideration of the �
Pe.yment of a fee of $..:.�_�......._..------.-, permit is herebY bnanted
.....__............_........---.-•--.--------......._ .............. to construct the building or addition as described above. This perinit is
the express condition that the person to whom it is �� upon
granted and his agents, employees and worlrnien, in all work
done in, around and upon said building, or any part tt►ereof, shall conform in all respects to the ordinances of
Fridley, Minnesota. regarding location, construction, altera.tion, maintenance, repair and moving of buildings
within the city ]imits and this pernut may be revoked at any time upon violation of any of the provisions of said
ordinances. _ _ , ��'
Building Inspector
NOTICE:
This permh does not cover the eonstruetion, Installation for wirfng, plumbing, gas heating, sewer or water. Be aro to aas
the Building Inspeeror for separete permits for these ifems.
4
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1PPLIGATION FOR.BUILDING PERMIT
, .CITY�OF FRIDLEY, MINNESOT$ .
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Owners Neme Builde:r
�ddre�s gddress . � �'
LOCATION OF BOILDING
No. � �/ Stree����.� �� (/�!!� Paxt of Lot o�
� . � i-- : c����,�%
Lot a5� Bloek� �:le gd.dition or Sub.Div.
Corner Lot Inside Lot_�_5et Back � � Side-Yard 1�-��
SEWER II,EVATION�� �� 7 � �� �/ � FOUNDATION ELEVATION,� � �` � �
Applicant attach to this form Certifica.te of �vswey of Lot and �roposed b:u3ldin�
loca.t3on. . � . . �
To be used as:
�11�� FrOrit
DESCI�IPTION OF BUILDING
o�� � �e i � w *s . 1
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Sq. Ft.� � �_ C�t: �Ft. ,�',�=c/ ,� � . � ,�' -
, �
-- ��� � - ��
� �'i�ont ' `' De�th � � � Height / c3 J �
Sq. Ft. L� � Cu. Ft.i���G/C �
Type of � �Construction � ' Estimated �Gost � �, �--�
To be comnleted � �� %� . _ �-
The undersigned hereby makes applica,tion for a permit for the work herein specified,
agreeing to do a7.1 work in strict ac.cordance with the Cit� Ordina.nces and ruling of
the Department'of Bui].rlings, arxd hereby deG].are� that a17. the facts and representQ-
tions stated in�thi.s application are true and correct.
. ,
DATE �� / `Q : �,��SIGNATtJRE . `" .
(A Schedule of Fee costs can be found on the Reverse Side.)
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BIIILDING PERMIT FEE SCHEDULE
. _
Sec�on�.� �'he �nspector� of Bui.ldi.ngs skiall, tiefore issuing any �permi.t � �
for the erection of any building or st.r.uet�a,re, or for any addition to_ ___. .,_
any �ex�s��ng �buildingV or structure, or for any alterations or repa.ir.s
to any exiati�ng building or structure,, upon application therefor, req,uire
the payment by the applicant for such permit of�fees to the amount herein
�elow set forth and in the manner herein provided to-wit:
2.1. For any such permit for the erection of any fire-proof bu:i.lding, other
than-a-g��$e,--�rar�eh�se, factory'or grain elev�.-�or�;� or for� the� erection-of
any fireproof addition, for �imilar occupa.ncy, to �.ny existing.builda.ng
sha.l�• be• �.t-the •�a�e� of'' �]::40 for�-each o�e �housarid cuhic feet� or fre,ctio�
thereof, in such cubical contents.. .
2.2. For,any such permit for the erection of any fixeproof garage, ware-.
housa, ��:ctory� or grairi elevator, �or`�•for the 'e're�tion of any fireprobf
addition, fbr similax occupancy, to any existing building shall be at the
rate of �1.25 for each orie thousanci:�cubic feet, c�,lassified as "fireproof"
by.Section 502 of the Minneapolis Building Code.
HOUSES
.� : - .-� .
.,.. ..._ .
2.3;�or a.ny such permi.t for the erection of�any��non-fireproof building
other than a garage, wax°ehouse, factory or grain eleeator; or.an�r_non-
fireproof addition, for similax occupancy, to any existing building.
Permit �1.00 for each�. ane thousand cu°bi�c �feet. �
GARAGES
,
2,l,. For any su.ch permit�;�qr ;the erection of any nan-fire�roof garage,
waxehouse,�fac�ory or grain elevator, or�for the erection of any non-
fireproof addition, for similar occupancyt to ariy existing building or
for eacli�sii.oli� �btiild.ing� o`r` addition.�� Ninety Cents for each one thousand
cubic•.feet,.pr, f�a,ct3on, thereof' �:in the cubical �or�tents thereof with •a
minimum -.o�; `�4r ����: . . .. . � � � � � . � . . . � .
For the purpose of computing fees for•building permits the ctzbical contents
of an� l�uilding or additzon to a uniform height throughout by multiplying
the ground area covered from a point six (6) inches below the floor line of
... . _
the basemen�"o"r'"ce`Trar'�o the average height of the upper surface or to the
average height of the roof su-r.fa�e .of the main :gable of a•pitc�ed roof.. �-
2.5. For repa.irs or alterations to an existing structure, the fee sha11 be
at the rate of �3.00 for each Five Hundred Dollars (�5�0.00), or fraction
thereof in the coat of all proposed work.
2.6. In no case sha.11 the fee charged for any permit as set forth in
Section 2 be less than �4.00.
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BL4Cif � OSTMANS ..3R� ADD/T�'��/ . �
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INDUSTRIAL - C. E. C O U L T E R ��""'''�°� ��� �
��UfINE86 . � �'A���Y� .�.
crtr �oTe LAND SURVEYOR ��- .. .
rorooenrH�e MM��NO REGlSTHRED UNDER LA{NS OF BTATH OF MINNESOTA -:?��� <-°
. � � LICENS[D sY ORDINANO[ OI CITY OF NINNiA!'OLIB- - � � � . � . � -
3300 I.YNDALE AVE. SO. MINAIEAPOCIS 8. MINN.
/ TAYLOR 4-0370
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I hereby certify that the above is a true and correct plat of a au�v�y of� � t�
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Lot Five (5) , Block Four (4) , OSTMAN'S TfiIRD ADDTTION, Anoka, Count�r, , ��x ��
Minnesota. �� �"
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As surveyed by me this �Oth. day of March 1959 A. D. , �=�
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Minnesota Registration 1'�, ,' - � � ��
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SUBJECT T N O.
City of Fridley � 15124�
AT THE TOP OF THE TWINS g U I L D I N G P E R M�� '
r
� � ECEIPT NO. .
COMMUNITY DEVELOPMENT DIV.
r� � L � PROTECTIVE INSPECTION SEC. � �/ I
, ,
i� � , �
.-N A �'�',,� CITY HALL FRIDLEY 55432 NUMBER REV. �ATE PAGE OF APPROVED BY
t �� s� 2-5so-sa5o 910-F 15 4/13/ 79 / /
JOB ADDRESS 6941 East River Road N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCH. 5 L.� OS'�,[Rdll � S Til].YC� SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Jim Sandstram 6941 Ea.st River Road N.E.
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Adams Home Impravements 2622 Polk Street N.E., Mpls. 55418 789-8424
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE — LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
M
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install aluminum sidin and trim and soffits
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3, 600 yS`1. $O
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE` pERM-'IT FEE SAC CHARGE
PROVISIO S OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCT OR THE PERFORMANCE OF CONSTRUCTION. � y5`Z�..F)O
PLAN CHECK FEE TOTAL FEE
° . $23. 40
SiG REOFCONraAC70RORAUTNORIZEDAGENr IDa 1 WHEN PROPERLY VALIDATED THIS IS VOUR PERMIT
�� � v � _ ��_� ��Z� �-� '� �-.
SIGNATUREOF OWNERIIF OWNEH BUILDERI (DATEI BLDG INSP DATE�
s, �
,
CITY or-
f�tIllLEY ,
' APPLiC/1TIOPJ FOR RESIllCNTI�L BU�LDING PERI�IITS
' ��VCW, �ILTCR/1TIONS, ADDITIONS, OR REPAIRS)
0
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OWtiER: �� � � SUILDER: '
. �
� � � � ���r '�
Address : � 9' � ,j� �y ��� Address : ��� �
Tel. l�;o. : %�� lS J�• o� f�
No.: Street: �
LOT: BLOCY.:
CO�iNER LOT: INSID� LOT:
ADDITION:
S,^:TBACK: 5IDEYARLS :
Applicant attach to this form 7.tao Certiiicates of Survey of Lot and proposed
building location drawn on these Certificates. .
DESCRIPTYON OF BUILDING
�u�� To Be Used As: ' ' •
V
�V �Opas Cm�-�fL� �vl'�' Front: Depth: � � Height:
�'r �l � Square Feet: Cubic Feet:
3
Front: � Depth: � iieight:
� Square Feet: Cubic Feet: � •
Tyge of Construction: ^ Estimated Cost: $ �' ��
7.b Be Completed: ��� .� � Q/
Proposed Drive��ay Wi th If New Opening Is Desired
Alt. A Alt. 8
$ $
tSEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified� agreeing to do all work in strict accordance with the City of
•Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
DATE: � c SIGNATURE:
Stipulations:
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BUILDING PER��IIT FEE SCHEDULE
. ..._ ..�...
SECTION 2. The Inspector of Buildings shall, before issuing pennits for the erection
of any building or structure, or for any addition to any existing building or structure,
cr for any alteration or repairs to any existing building or structure, upon application
therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
LJEW CONSTRUCTION: Single Family Iiomes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee. .
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
• Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$��.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 � � ► �' : �\
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determi.ned by multiplying the ground area covered fram a
point six (6) inches below the floor line of the basement or the 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 five hundred dollars-($500.00) or fraction thereof in the cost
of aZl proposed work.
In•no case shall the fee charged for any permit as set forth in Section 2 be less
�hau $7.50 plus $.50 state surcharge. �
• ; � � � ► � :i���
NOTE: Permits for construction will be issued a minimtnn of 24 hours from the time
of application to all.ow for praper 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 been constructed will be required before proceeding with the framing.
; � � � •:�
App].ication for a Certificate of Occupancy shall be made ten (10� days prior to the
use or occupancy of any structure for which a building permit has been issued; and
said structure shall no� be used or occupied until a Certificate of Occupancy has
been issued. •
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SUBJECT P
City of Fridley � 15 6 9
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..
i ; V ����� �
r � � PROTECTIVE INSPECTION SEC. � � f%
� . ,
�
, � /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�"""'� � ,�' 612-571-3450 910-F15 5/1/80 / /
JOB ADDRESS 6941 Ea.st River Road N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 5 4 OS'l1�dI1�S Third Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James Tc�. 5andstro�a 6941 East River Road N.E. 571-4549
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
S ame
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE N0.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Reroof house
9 CHANGE OF USE FROM TO
STIPULATIONS Roof can be 2nd but not 3rd roof. Install ridged galvanized
valleys.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY 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 BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINE� 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 $.80Q �`� SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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. $7. SO
PLAN CHECK FEE TOTAL FEE
$B.Q�
SIGNATUREOFCONTRACTORO AUTHO 2EDAGENT IDATEI WHEN PROPER�Y LIOATED T IS IS YOUR PERMIT
.�1� r ' 'S�� � � � � � � C��,1 d^ - � '�� �
SIGNATUREOFOWNER(IFOWNERBUILDERi IDATEI BLDG INSP �ATE
�
CITY OF FRIDLEY
9
ARPLICATION FOR RESIDCNTIf1L QUILQIPJG PERMITS �
(fJew, Alterations, Additions, or Repairs)
l �
1 ' /t� ' � � %I � �
r
� ��r � i , �� � � �i�
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.
BUI LDER : . ����� �
AQDRESS: -
TEL tVO: '
Cons�truction Location
� � y� A
STRF�T NO : � �� � STREET: �GC,�' _ ���.� i �
� �
BLOCK: � ADDITION : �� I �� � � �S � �" / �-�J �� � �
LOT: ,
Corner Lot: Insicle Lot: Setback: Sideyards:
Ap�licant attach to this form two Certificates ot Survey of lot and
proposed building location drawn on certificates to scale.
����� � DESCRIPTIOt� OF CONSTRUCTION � .
C�=��� Front: � Depth: Height:
Squa�e.Feeta
G1�bic Feet:
Front: Depth: Height:
Square•Feet: Cubic Feet:
r�S��-,!-r� � � .
1 .
Type of Construction: Estimated Cost: $ g�0 , GG
Zb Be Oc�mpleted:
Alt. A Alt. B
Proposed Driveway Width if New Opening Is Desired: $� $
SEE REVERSE SIDE OF SHEET
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
ruli.ngs of the Departmeni: of Buildings, and hereby declares that all the facts and
represeni:ations stated in �his application are true and correct.
DATE: S" I°' D� SIGNATURE
Stipulations:
�'�`/�
6 -��
' �
C� � . (�' �`�
�
BUILDIIdG PERMIT FE� SCHCDULE�
5rC'PI01� 2. The xn�.;l�ector. ot 13ui1dincJs vh�.11, before a.s ,uing penniL•s for the erecL•ion
ot any l�uilding or sLrucLUrc, oT- for any additi.on to ariy cr.i;;i:inc� buildiny oz' strucL-ure,
oz for any a].terat�ion or zel�airs to •any exi.�ting building or structure, upan application
L•herefoze, require the payment by t]ie applicant for. sucli �,�ex�miL- of fees to, t•he arrtount
hcrcin be�.ow seL• �orth and in the manncr herein provi,ded L-o-wiL-: �
I�li{rJ CONSTI2UCTION: Single ramia.y IIomea and Garages: $�.00/1,000 cubic teet.
PL1�N CIiI.CY.: 25 percent of bui.lding pennit fee.
DRIV���TAY D�PRL5SIOiJ: (Concrete, Curb Streets Only) '
' Alternate A: Removal and replacement o£ concrete curb and
qut�er only; Driveway wiclth plus 6 feet- x Y��.75
Alternate B: Remova]. and replacement of concrete curb and
.� � gutter and install a 3 foot wide approach with �'
' _ 6 i.nch depth; Driveway width plus 6 feet �: $17.85
A:���tI��L. ► � _ � ►�
I�'or the purpose o.f computing fees for building permits, the cubical contents of any
building or addition, is determined by rnultiplying the ground area covered from a
point sir. (6) inches below the floor line of the basement or the cellar to the
average heights of the upper surface or i:o the average heiyht of the roof surface
of the riain gable of a pitched r_oof.
For repairs ax alterations io an existang structure, the £ee shall be a� the rate
of $3 .00 �ier each five hundred dollars -($500. 00) or fraction thereof in fihe cost
oi' all pxoposed work. . , '
In•no case shal.l the fee charged for any permit as set forth in 5ection 2 be less�
than $7e50 plus $.50 state surcharge. '
VERIFICATION OF FOUNDAiIO(�
NOTE: Permits �ar construction will be issued a minimiun of 24 houxs from the time
of applicata.on to allow for proper review of the pro,posed structure and of the
construction site.
1� Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
_GERTIFICI�TE OF OCGUPANCY
' Application for a Certificate of Oceupancy shall be made ten (10) days prior to the
use or occupancy of any s�ructure for which a buildiiig perniit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
�
City of Fridley
TO: William W. Burns, City Manager PW96-247
Richard D. Pribyl, Finance Director
�i
FROM: John G. F1ora�Public Works Director
DATE: Octobez 30, 1996
SUBJECT: East River Road Assessment
At the council meeting of October 28, 1996, Mr. Jim Sandstrom of 6941 East River Road.,
presented information that the front of his property had been reduced from 117 to 113 feet.
At the meeting we were unable to confirm any dimensions based upon the data presented.
As a result of Mr. Sandstrom's presentation, I met with the City Assessor and found that
the County had purchased 19 feet of frontage along hi.s property for the East River Road
improvement. Based. upon that information, we checked the plat files and by moving the
property line 19 feet inward, it appears that the new frontage property line is 113 feet.
Based upon this new information, I suggest that the assessment to Mr. Sandstrom's
property for the East River Road curb project be reduced by 4 feet or a net $36.00. Please
make this change in his concrete curb assessment. I have contacted Mr. Sandstrom and
indicated this new information and related. to him that the assessment will be changed
accordingly.
JGF:cz
sue�ecr RMIT NO. f
City of Fridley 2 6 9 4 0
AT THE TOP Of THE TWINS g � I L D I N G P E R M I T
�
i �
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� ; v __��� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
i . �
i.---� �"' �'� CITV HALL FRIDLE� 55432 Nu�+BEa
� 612-571-3460 910-F15
J08 ADDRESS
6941 East River Road
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 5 4 Ostman' s,
2 PROPERTY OWNEfi MAIL ADDRESS
.Tames Sandstrom
3 CONTRACTOR MAILADDRESS
NPw Haven Conct. 4208 83 Ave N Br.Pk_, 5
4 ARCHITECT OR DESIGNEFi MAIL ADORESS
5 ENGINEER MAILADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
REv
RECEIPT NO.
� 7 7�
DATE PAGE OF AVPROVED BY
7/31/98 / /
SEE ATTACHED
S►i EET
ZIP PHONE LICENSE NO.
20077950
ZIP PNONE LICENSE NO.
ZIP PHONE LICENSE NO.
❑ NEW ❑ ADDITION ❑ ALTEFiATION $] REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
9 CHANGE OF USE FROM
STIPULATIONS
Tear-off
TO
Underlayment must comply with State Building Code.
TYPE OF CONST. OCCUP�
SEPARATE PERMITS ARE REOUIFiEO FOR ELECTRICAL, PLUMBING, NEATING,
VENTII.ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SO. FT.
AUTHORIZED IS NOT COMMENCEO WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOH A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CEFTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALIS
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS Of LAWS yALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED NEREIN OR NOT. THE GAANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMIT FEE
PROVISI NS OF ANY OTHER STAT OR LOCAL LAW REGULATING CON-
STRU N OR THE PERFORMA OF CONSTRUCTION �]L�.. ]S
PLAN CHECK FEE
�L ��� � License�C $5.0�
QF
AGENT � 1DA�
iDA7Ei �
s, = G
OCCUPANCVLOAD
CU. FT.
' PARKING
GARAGES
Fi e SC $2.16
A EE
2.99
s
O7/2T/98 22:56 FA% � � 02
NEW [ ] ��� �� � ��� � Effectivg 1/1/98
ADDN [ ] CTTY OF FRIDLEY �� �
ALTER [] SINGLE FAN�.Y AND DUPLEXES R-1 AND R-Z � ��1�� �
BUII.DING PERNIIT APPLICATION .F� �-5 � �
Coa�aruc uonAdciress: �
L,egal Descripdoa:
Owner Name & Address:
Contraceor:
Aaaress: ���'
e
� / 1'�
7�' �
�6 ��
� 'iel. �Y
MN LICENSE � T b U 77 ``7S�
LIVING AREA:
GARAG� "AREA:
DECK AREA:
Aaach to this application, a Ccitificate of Survey of che
lot, with the proposed consccucaon drawn on ic to scale.
Tel. #
` �s?/y3
DESCRIPTION OF 1MPROVEMENT �
. . . � "' � � - -
Width Hei t S. Ft. �
I.e�agch � q
Length Width Height Sq. Ft.
Lengrh wiach xgt/Ground Sq. �'t.
OTHER: • �
� � , --' ��C.� ��
C�nstructi�n Type: T�Q.r a�'� /''�iY/ a Esc;mar.ed Cosc: $
.s 7�
� ' � (Fee Schedul e on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � Z7— ��
C1TY USE ()NLY
Tel. � '� �.����
Permit Fee $ L�, ��� Fee Schedule on Revetse Side
Fire Surcharge $ �. /� .001 of Permit Valuation (1/lOth�)
State Surc�arge $ �o C�? �''�; $.50/$1,000 Valuation
SAC Charge $ •$1�0 per SAC Unit
License Surcharge � $ �`� ) � $5.00 (State Licetued Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservadon Plaa Review
Park Fee $ Fee Determined by Engineering �
Sewer Main Charge $ Agreemeat Necessary [] Not Necessary [ j
TOTAL
STlPULATlONS:
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' 11I26I2007 14�12 , 6514647913 BEYDND B�IRRIER$ , iPAGE 33/0�
� - G I � �C�`� - ��� � .
hROM :City of Fr�dley ; FA?{ N0. :7��711�87 ,N�av. 2E 20�i? 1'4I1AM P:y'
� ' ' �C'D NOV� 2 � 2001
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3. , List of s�uuc�u a membas tn ne u�ad
FO�r� W COt�9�AUG'! Y 91a 1NC�m�IA D6t':�c9,
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CITY OF FRIDLEY MINNESOTA
(763) 572-3604 ^ ,�, �
OWNER
BUILDER
DATE
�
If no corrections are listed above, approval hereby g' to proceed. You will be in
violation of the ordinance if you do not call for th oper inspections and make
corrections as called for.
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� Becccuse Health Mcitters
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The ideal solution to assist
in liftina and transferrina
indi�
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What is the best choice � � �
for you? A "J"-shaped
track for easy point to
point transfers? A room-
covering "H" or "X-Y"
track system with a
movable 3rd rail? Or a
personalized track system � �
covering the entire room
and adjoining bathroom? ��J" SHAPED TRACK SYSTEIVS
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HAND CONTROL
At the touch of a button
the simple to use hand \` �;, r,�
control allows you to � `'� �
raise, lower and move
the lift left or right. ,
There is even an
optional wireless hand �
control available. �
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As a care provider you face numerous challenges
through-out the day. Safely lifting and moving your
loved one shouldn't be a strain on your back.
Take care of your loved one and yourself too with help
from BHM's V4 ceiling lift. The most technologically
advanced lift on the market, the V4 safely and
effortlessly lifts and transFers individuals from a chair
to bed, bed to chair, into the bathtub or to the toilet.
Powered by a high capacity rechargeable battery pack
the V4 does all the work then waits in its charging
station for when you need it again.
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The BHM family of ceiling to point transFers. The
lifts glide smoothly under addition of a curved
their own power, or track allows access to the
manually along our bathroom for toilet and
KWIKtrak ceiling mounted bathing needs. Optional
tracking. KWIKtrak's low turntables, exchangers
profile design blends nicely and gates eliminate almost
into any rooms decor. all mobility barriers and
A simple straight track allow you to use the V4
design provides basic point to its fullest potential.
TURNTABLE EXCHANGER GATE
Tumtable allows the Exchanger functions Gate for transiting
main track to intersect like a branch in the from an X-Y (movable
a secondary track road. Allows the lift 3^' rail) rystem to a
section. The tumtable access from one care single track rystem.
requires no power area to separate care
connection of its areas. The exchanger
own — the V4 I'ift's is also a power sharing
power-sharing feature device - actuated by
actuates the tumtable. the V4 lift.
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Using a mechanical lift and Children through to seniors,
transfer assistance device is the of all body types and weights,
safest way to help you provide will benefit from the gentle
quality home based care. and secure lifting V4.
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available to suit all needs.
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Because Health Matters
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Beyond Barriers
24078 Greenway Road Suite � 2
Forest Lake, MN 55025
�, �651) 464-7102 / 800-561-2223
HAMMOCK SLING
For most transFers. Head-
rest incorporated. Suitable
for most individuals.
Excellent for bathing.
Suggested weight
Suggested height
Hammock
Hammock 6
Quick-fit
Hygienic
QUICK-FIT SLING
For general transfers.
PerFectly suited for stocky
or obese patients with
strong hips or large thighs.
45-100 Ibs.
(20-45 kg)
4'-5'11"
(120-180 cm)
THA-S
THA6-S
TIR-S
THY S
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HYGIENIG SLING
Ideal for transFerring to the
toilet. It also permitr an
eary way to change, dress
or undress the individual.
100-200 Ibs.
(45-90 kg)
5'-5'11„
(152-180 cm)
THA-M
THA6-M
TIR-M
THY M
200-600 Ibs.
(90-272 kg)
6' +
(181 cm +)
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V4/4 Way Powered up/down/left/right
V4/4 Way - Infrared Wireless Remote Powered up/down/left/right
V4/2 Way Powered up/down
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V4i/4 Way Powered up/down/left/right
V4i/4 Way - Infrared Wireless Remote Powered up/down/left/right
V4i/2 Way Powered up/down
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Printed In Canada C U S �` �
BHM Medical Inc. Reserves the right to change or dluontlnue any specfficatlons, design, features, model or acceswrles shown wtthout nodce.
TM' Trade-mark of BHM Medical Inc. All rights reserved. � 8HM Medlcal inc., 2006
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Building PLUMBING Permit No.: o�oo ��i
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Da �� 2 20
DATE ,��� 1' ^� YOUR E/-% A�� ADDRESS
SITE ADDRESS � 7 � �Li' � `rO •
THIS APPLICANT IS: � OWNER �CONTRACTOR
PROPERTY NAME:
OWNERI qDDRESS: � y 1 CITY STATE ZIP
TENANT
PHONE:
COIVTRACTOR Np�; , �
SUBMIT A COPY OF STATE LICENSE # ,�� % EXP DATE �Z ��/— � 7
YOUR STATE ADDRESS: ��� �'. � CITY STAT�1_�ZIP�
LICENSE WITH PHONE �iJ`,�% `7 7-%%�U FAX C�/ ` 77c� — 7,� j
APPLICATION
PERMIT TYPE 1°��GLE FAMiLY O TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW �EPLACEMENT
i -
DETAILED DESCRIPTION OF WORK �
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of t6e total cost up to $500.00, whichever is greater, for the
improvement, insta.11ation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOI�
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING pv�oGrruc�vsE') SWINIMING POOL WATER SOFI'NER ($35)
CLOTHES WASHER KTTCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
WATER METER OTi�R
_ .:. �, }i��,�
�y�� � �� . �� . � i ���f ?' �' � YT 3� ���+£ B�� 4Y . �v � �+� F�F � �� �„�Y,_. ���. �T:,, �.
k � . T . ...�"�.,. aw�.Sn"�ca a,.Rk�. ,� `�`..��i �� � .i.._,.
.;: _ u.�.. , r 's.�- .....n..rtr .s ,__ �., .,..,w , ,,,. ._, ._.a, .�,:� , ...t, M, ., , #. �_ _ ,� ..., , . . _._ _,:. ......, .,. , . . ..
,,. - u:-. ., :,-� .
Permit Fee $ Number of fixtures @$10.00 � x$10.00 =$�. CTU
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ Number of fixtures @$35.00 x$35.00 =$
State Surcharge = $ 50
Tota1= $ �
THIS [S 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; that the work will be in aocordance with the
approved plan in the case of a re u' • s �ie`� and approval of plans.
SIGNATURE OF AL'PLICAN PRINT NAME ��I �Z�✓����6 DATE 11 ��'2 !U %
�_.
`.:"� �� �'�'`��.: .,,�., . r,:; .�� '_ ,-:Mr.� '� � ` ��.��i , �.� � ���� � . Ak
�. ��
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
�� '� i
INSPECTION REPORT
CITY OF FRIDLEY MINNESOT� C�� ���
(763) 572-3604
ADDRESS
OWNER
�
if no corrections are listed above, approval hereby given�fo proceed. You will be in
violation of the ordinance if you do not call for the proper inspections and make
corrections as called for.
Building
Inspections
763-572-3604
DATE �`°� s
STtE ADD _
'iEiIS APPLICPNf IS:
PROPERTY
OVVI�IER!
TEI�TAN'T
CONTRAC'TOR
SUgMIT A COPY OF
YOUR STATE
LICENSE WI1"H
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATIQN
CITY OF FRIDLEY
YOUR E-MA�1- ADDRESS
0 OWNER '�CONTRACTOR
PHONE:
C�t�ANY N/�ME.—
CONTACf PER50N:
STATE LICII35E �_
ADDRESS: 3 �
PHONE �"('/ �`c
9�SINGLE FAMILY ❑ TWO FAMILY
p �w ❑ �uc�'r
DETAILED DESCRIPTION OF
Pemut No.:
Received By:
�
�A.1.E�' �.
-�_ EXP DATE
� __�_CITY G�✓ C %`,�%��� sT�+���
FAx /. / — ��� — .Z/l ,2.—_
O TOWIIHOUSE
�,v,�nowx�onn.
v
PER MS 16B.665 the penait fee is a minimnm of $15.00 or 5% of the toia.l cost np to 5500.00, whichever is g�eater, �r e
improvement, installaiion or replacement of a residential fixture, excluding the fixt�res. (This should reflect only the cost of labor )
Labor cost under $300 =$15.40. Labor cost between $300 to $5� = cost of labor x.O5 �
FOR PROJECtS Vi�RE LABOR EXCEEDS SSOD. FEFS ARE BASID ON SlO.OD PER FIXTURE, EXCEPT WI�RE NOTED. FDCT[]RES: (II�DICd4TE TOTAL
NLINIBER OF EACH BELOV� MODEL: SIZElBTU
EquiPment Instalted , MFG: SiZFJBTU
�: MODEL:
N1FG: MODII.: STLE/BTU
A/C $25.� _FIREPLACE (GAS) 515.� GAS R.4NGFJOY�T1$10.00
AIR TO AIR EXCHANGEER S15 FIREPLACE (WOOD) $35.00 NEW GAS GRII.L 510.00
BOIL.ER $35.00 • _FlJRNACE $35.00 GAS UIrIIT H'TR $10.00
CF�IDvWEY UNER $I0.00 �AS DRYER $10.U0 PUOL HFATER �ii5.00
DUGT WORK $]0.00 L�'AS PIPING $10 00 � IJ�G�� �� �TOR 515.00
����
�. �.L..'�. ...�. �8�.'�cR-.: .� ,,.a�.,��w,r,.�.., - ---- �-
Permit Fee $ Number of fixtures @$10.00 � x$10.Q0 =$
Surcharge $ .50 � Number of fIICh�res @ $15.00 x $15.00 = $
'TOTAL DiJE $ / �, �2 ����,��ber of fixt�res @ $25.00 x $25.00 = $
� Number of fixtures @ $35.00 x $35.00 = $
(,�`� �,�W�.t State Surcharge ° $ .50
Total — $�
�
THIS I5 AN APPL3CATION FOR A PERMIT NOT VAL PROCESSID
I hereby apply for a building permit and I acknowledge that the information above is complete and accura.te; that the work will be in
conformance with the ordinances and codes of the City of Fridtey and with the M'uu►esota �Construction Codes; that Z understand this is
nat a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which �equires review and approval of plans. � �^
SIGNA7URE OF APPLICAIJ7'
City of Fridley
Building Inspections Depariment .
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-5.02-4977
DATE ����•� i/
�-
REQUIRED INFORMATION hDEEDED TO PROCESS PERMIT
�� .� � � RESIDENTIAL PERMIT APPL{CATION HVAC
❑ NE111( HOMESIADDf�IONS ❑ EXISTlNG HOME ❑ MAKE-UP A[R
p�EQUIRED FOR NEW/EX�STING HOMES
1. Combustion A.ir (See note below) .
a.. Oil or so}id fue11MC Chapter 7 with MN Amendm��
b. Nafiiral Gas or PropanellFGC Chapter 3 with MN Amen.dm.ents �
2. �e_up � (See note below)
a. IMC Chapter 5 with MN Amendm.ents
3. Ventin.g
a. Gas app]i.ancss IFGC Chapter S wifih MN Amendm.ents
b. Fuel ofiher t]�aa. gas 1MC Chapter 8 with MN Amendments
REQU(RED FOF2 NEW HOMES
4. Heai loss & cooling load. per room
a. Itequired on new consfru.ction IMC 134-6.0312
5. Ventilati.on .
a. Per MN Energy Code 76'70 ar 7672
,
6, �uct Design Per TMC 1346.0603.2
a. ACCA Manual D
NOTE: Cenierpoint Energy Mechanical Code Guidelines sofiware may be used for �
coml�ustion and make up a.i� calculations ,.
0
Building
In.spections
763-572-3604
DATE yZ
SITE ADDRESS ��
THIS APPLICANT IS:
PROPERTY
OR'NER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE �
�rYrE oF woiuc:
MECHANICAL
RESIDENTIAL APPLICATION
, CIT�' OF FRIDLEY
� OWNER
NAME:
ADDRESS:
PHONE:�.
CoMPA1•tY Np,tv�;-
CONfACf PERSC�
ADDRESS
��=�ii
a :.1�:
�
Permit
Received
�..
STATELICENSE�1 ~ - ^f� �INN���� MN 55408
2,• s�'n� zir
AbDRESS:
PHONE
� .r
FAX
pp��y p �p,rp pp�,y ❑ TOWNHOUSE
DETAILED DESCRIPTION OF WORK
❑ ALTERATION/REMODEL
PER MS 16B.665 ti�e permit fee is a miuimum of $15.00 or 5% of �he total cost np to SSOO.00,,whichever is greater, fot the
improvement, installation or replacement of a residea�tial fixdue, exclu�ing.ii�e.�es•. .(�is should reSect_only.the cost of labor )
� . ..:, . . . .. . .
Labor cost under $300 = $15.00. Lalior cost between $300 to $500 � co� of laboi � - : � . � x .03 = . . � � .
FOR PROJEC°CS �E LABOR IXCEEDS SS , FEFS $ASED ON •$10.00 PER F13[i'[1RE,.EXC�PT NOTED. FLICI�R�S: N`IDICATE TOTAL
NUMBHt OF EACH BEI.09Jj � ' � . •. MOD�_�•�J !/ � SIZFJBTU � + �
Bqnipmcntlnstelled . M�' ' � �
MFG: � MODF�;. � S�. �
M G S�B.fU
i�/ �p; MODEL:
7�JC $25.� FIRBPLACE (CAS) $15.00 (�AS RANCr�/OVEN 510.00
AIR TO AIR fiXCHANGEER $15 FIItEPi.ACB (WOOD) 535.00 NEW CiAS (iRII.L 510.00
BOILER $35.00 CE $35.00 (�AS 1A`IlT HTR 510.00
Ci�vII�EY LWER $10.00 ��� YER 510.� P'OOL HEAT�dt 535.00
DUCT WORK S1Q00 QAS PIPIN� $lU � VENI��ATOR S15.OQ
Permit Fee $ Number of £och�.s @ $10.00 x �lo.vu = �
� $ � ,Sp Nmnber of � �a $15.Od x $15.00�t $
TOTAL DUE $ � Number of fixtures (a3 $25.00 � x �25.00 � $ �
� Number of fixt�es C3a $35.OQ ,� x 535.00 =$ +a0
s�#e surcharge � $ ��
Total ° $
TFIIS IS AN APPLICATION FOR APPdtI�'IlT�IOT VALID UNT1L PR�SS�
a that �e informatian above is compleba and accurate; that the work w�l be in
of Fddley and wrth d►e I�nne.aotaConstru.dion Codes; that� underst�nd this i.
�rk is nat to s�tart witho�rt a getmi� that the work will be in acxordance with the
iavaand approval ofRlans: . �", 9 . � � �
I hereby" �pply for a building p�mit and I
conformance with ti�e o cas sad �
not a parmit but o aa li for
approved plan ia e �Of o whic�
�
SI(3NATURE OF
T Citg of Fridle�
Bnilding Inspec�ons Department
6431 �Jniversity Avenue NE, Fridtey, MN 55432
� . 763=572 3604
RAX: 763-502-497'1
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMES/ADDITIONS EXISTIt�G HOME ❑ MAKE-UP AIR
R�EQUIRED FOR NEW/EXISTIN��°hIQM��:S :�,:.:.:.. � .,�.� .. .;,
-.;.�ys,_ _�r.e � t�:j.,j� � . . .
-e �:: ::�: .1:3�4>'J'f;; '
1. Combustion Air (See note belo`vv�j� _' _a�, ��.,, .
�.�- ..
a. Oil ar solid fuel IMC Chapter 7 with MN Amendments
b. Naiural Gas or PropanellFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Am.endments
3. Ven.tin.g
a. Gas appliances 1FGC Chapter 5 with MN Amendments
b. Fuel oiher tlian gas 1MC Ghapier 8 with MN Amendmen.ts
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room �
a. Required on new construction IlVIC 1346.0312
5. Ventila�ion .
a. Pe� MN Eaiergy Code 7670 or 7672
6. Duot Design P�r�IlVIC 1346.060�:2 . .... __.
a. AC7CAManual D
NOTE: Centerpoimt Energy Mechanical Code Gnidelines sof�ware may be nsed for
co�nbustion and make np aiur calcnlations _