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AF - 40971N° 939 ,.� ,+.. � � Vilii�ge o� FA'lrll.ey, MinII. BUILDING PEIi...� Oi6ce of III�TSPE�OR OF BUILDINGS _ y _ � _ �� �. �° • �,o:.. Oavnem :.�. �� � ,�� ��.��:.s��r'��� ,--- , < �•" �" Architect FridIey, Mina., • .yz_ ..K- �� , ig ' '��.��_�;.� �f��} �-.f� � �' � "'� � " ; � ��... "��^�� � , Builde�= T � LO�A�'ION OF BiJILDING Na �.:, d�� �:� P P 8treet �� � �~ ��� �-� °�.- � � �o�.� � Part of Ta�� �� c�. �C? ° Lot Block Addition or Su�rDivie4on ���- � � �� � �' �� ° -4 �° � ����T— I�ESCRIPTION �F BiTILDING F'ront �� Depth =''�� Height 8torlea�'3" >__--�. Manner of Constructio - - r^^ To be used ��-s.,.:� s� ti��Estimated Coat a� �' To be completPci� ` ° `"` ' �- � �^ _ ._° , . '.� ��a. _- , ,_. . ;. - `•� �. Permit ie hereby granted tti- - ,a :_ � r� � ��°'�'"� =�'�`=�`°s�° � +' > .. , . `.,y — - i � , -'- �, the building � s�=-° descri� in the above statemeni. This permit is granted upon the expresa condition that the person to whom ft ia granted, and hie agenta, employees and workmen, in all the work done in, arouad and upon sai�i 'building, or an.y part thereof, sh�ll conform in all respecte to tha ordi- nances oF Fridley, Minn., regarding the conetruction, alteration, maintenance, repair and moving oP buildings withia the city limits, and t1�is permit may be revoked at aay time upoa violation of any of the proviefons of said ordinances. `� . --�._ "�, _x-, � . ` �' _ "' -__3�asnector of Buildings. ��' _ _ ._'•,�—a�' -- AGREEMFNT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of �uildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisions of the ordina.race� of Friclley, and, beiag first duly sworn, I hereby state a.nd say that the facts atated by me and contained an the above permit ax�e true as thereia stated. �, �,�+� ,� � �' x f � �� �� � � ,� �f: ,�r ' .�-�. .a�..���t �e �...�. �;;tis;.�`�-_� Subscribed and aworn to 'before me at Fridley, day o � ��� D. 19`� �� � �� � ,�� � Minaesota, tbi� �: �= '�. � ' ° � � . f' e,� _.p, _ N ., .� ,•.. � i sue�ecT PERM City of Fridley ,79$ , AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � � RECEIPT NO. � `v _ COMMUNITY DEVELOPMENT DIV. ��� / r � � PROTECTIVE INSPECTION SEC. L1 ` � __Y J �/"�,'J CITY HALL FRIDLEV 55432 NUMBER flEV. DATE PAGE OF APPROVED BY 1� J\ 812-580-3450 910-F15 �.1��.2�%4 � � JOB ADDRESS 7661 East River Road 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ( & 4 6 A,Zj(� . S't],]7 . # %% SHEET 2 PROPEFTYOWNER MAILADDRESS ZIP PHONE John C. Van Krevelen 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. .�AMF: 4 ARCHITECT Oii DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING ara e 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 9 CHANGE QF USE FROM TO STIPULATIONS l. To be located 7'10" from North of house. 2. Provide frost footings. or owner agrees never to attach garag to house and will notify any new owner of this stipulation 3. Provide a hard surface driveway SEPERATE PERMITS i�Ep����E� F�R �is� HEATING, PLt1MBING �q��, �t��S� I��. SEPARATE PERMITS ARE HEQUIflED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY IOAD � VENTILATING OR AIR CONDITIONING. O�, frame THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 4S4 4 840 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE flEAD AND EXAMINED THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINAPlCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2 � 783 • OQ ].. 39 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW FiEGULATING CON- $9 � OO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � PLAN CHECKFEE TOTALFEE ,. .� $10 . 3 9 ' �'SIGNATUREOFCONTRACTORORAUTHORI2EDAGENT I ATEI WHEN ROP Fi ALID ED THIS IS OUR PERMIT � 9 IP�� �y� 'L�,`. �s o �i.- I�� � SIGNATUREO OWNERIIFOWNE B LOERI (DATEI � BLOG �NSP DATE �� ��ty �f F�i��ey �-� AT T� Y6P o� TME TW�b� � � � � . ' �'t; ------� COMI�Ut91TY DEVELOPMENT.00Y. r 1 i PROTECTIYg IS14�ECTION O��T. � S � � � �'°'\ i CITY MSI.L FRIDLB� 8�452 ��_�� � �,� �I2�S�0-34�0 Job Address: , BUILDING PERMIT APPLICATIOid 910-F1� I 0 I 1 Legal Lot No. lock �Taact or Addition l)escr. � � �f � - actor tect or Desi�n �ngineer Use of Building Class of Work Descri e Work New ! o �. _ ,.. � ..�/_1 i.�^. Address � �� � � � .� Addr�ss Address Address �ip Zip Zip S� Zip ❑ Additian ❑ Alteration Phone Phone Phone Permit No. Receipt No. See Attached Sheet Phone License No. License No. License No. 8 Remove ir. I�ove ��� %O�- � �hange of Use� rrom . To Signature, �SPECIAL ASSESSMENTS: � � ' " If lateral assessments have not been placed on this property, an agreement urist be signed, agreeing to assume such latexal assessments before a permit will be issued �,greement Necessary: Agreement Unnecessary• Finance Directflr � OUTSIDE tJTTLIT.IES : • , � Sewer Elevation: Water Elevation• O •� . Stub Location: Stub Location: u.� � � BUILDING INSPECTION } � Plumbing H.V.A.C. , Electrical Fire Insp. V Signature & ' � -' �_ Date Approved �' � � Registered Engn. Stamp. Lega1 Description Check Exterior Devel. Check Performance Bond Check Easements, R/W, Special Agreements Final Approval Date � �I Ce�tificate of Occupancy � � ✓ '_ _ � Date � � . , _ "/- 3 i�,.�� FOR CITY USE ONLY DIMENSIONS• Length: Height: Cu. Ft. Width: ' Sq. Ft. Accessory Buildings: � Length: ' Height: Cu. Ft. Width: Sq. Ft. VALUATION• Sq• Ft• X Cost = Valua�ion )� ) To�a1 ) Valuation Basement X Cost = Valuation , ) ) ) PERMTT FEE: Residential Total Valuation � Fee = $1.00 to $500.00 $5.00 . $501.00 to $2,000.00 $5.00 for the first $500.00 plus $1.00 for � each additional $100.00 or fraction thereof, to and including $2,000.00. $2,001.00 to $25,000.00� $20.00 for the first $2,000.00 plus $3.00 for each additional thousand or f,raction thereof, to and including $25,000.00. $25,001.00 to $50,000.00 $89,00 for the first $25,000.00 plus $2.50 for each additional thousand or fraction thexeof, to and including $50,000.00. $50,007..00 to $100,000.00 .$.151.50 for the first $50,000.00 plus $1.50 .£or each additional thousand or fraction • thereof, to and including $100,000.00. PERMIT FEE: Commercial and Industrial Total Cu. Ft. PLAN CHECK• X $2.15/1,000 sq, ft. X � Permit Fee Take one half af permit fee = � STATE SURCHARGE• Valuation X $.50/$1,OOO.UO _ X $.50/$1,000.00 v� PERF�R1•iAtJCE BOND VALUATiON Blacktop 1.50/sa. ya. • Curbing 2.00 lin. ft. �Sod � . 0.40 sq. yd. �"�encing 2.00 lin. ft. Bushes and Trees 5.00 - :a0.00 TOTAL FEE TOTAL BOND VALUE k �1V� ` W� �^�0 ��� (� � � , Minnesota Well and Boring WELL OR BORING LOCATION MINNE90TA DEPARTMENT OF HEALTH Sealing No. }� � 9 3 4� Counry Name WELL AND BORING SEALING RECORD M+��esota u��q�e No. Minnesota Statutes. Chapter f03/ or W-series No. ILeave blank d no� known� Township Name Tawnship No. Range No. Section No. Fraction (sm. � Ig.) Date Sealed . Approximate Date Well ������ or Boring Constructed . �ia � a � � d Numerical Street Address or Frre Number and Ciry of Well or Bonng Locatian Depth Before Sealing k. Original Depth ft. Show exact location of welf or 6oring ' '''� Z- e�ch map of well or boring Static Water Level � Accurate in seclion gnd wAh "X" locatjc�i. showing property lines. N � ��,_� Z roads. and buitdings. ❑ Approximate _i i i _ �.,�—.�-.�.., i - i- -i � � Single Aquifer ❑ MultiaquMer ft. � below above land surface � _ � _ _ i _ w � � CASING TYPE W � i i i E � � � , , � ? i -� -,- -r- -� i � i i �� ❑ Steel ❑ Plas6c ❑ Tile ❑ Other _i i i _i_ y i i i i � S Screen from —�-- to �-�-- ft. Open Hote trom to ft. �— 1 mfre--� �> `i r a OBSTRUCTIONlDEBRIS/FILL I q� �-1,.4n:; r- i"��. � , � Obstruction ❑ Debris ❑ Fill PROPERTY OWNER'S NAME z Type of debris/obstruction � � � �"'�'�� ��—���� � � '� � Mailing Address if different than property address indicated above. ObstructionlDebris/Fill removed7 � Yes ❑ No ��5�'i�. �'s I���'� ���� N�a PUMP ����� y � �f ��$ �.} �"Removed ❑ NotPresetrt ❑ Other CASING _ GEOLOGICAL MATERIAL COLOR HARDNESS OF FpOM TO FORMATION Diameter Depth Set in oversize hole? Annular space initially grouted? If rrot knnwn, indicate estimated formation log from nearby well or boring. � in. from —� to � k. ❑ Yes ❑ No ❑ Y� ❑ No ❑ Unkrrown in. from to fl. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown s: :< in. trom to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown a METHOD USED TO SEAL ANNUTAR SPACE BEIWEEN 2 CASINGS, OR CASING AND BORE HOLE: �' No Annular Space Fxis[s ❑ Annular space grouted with tremie pipe ❑ Casing Perforation/Removal in. hom to ft. ❑ Perforated ❑ Removed �. {� to ft. ❑ Perforated ❑ Removed Type of perforator ❑ Other OROUTING NIATERIAL Grouting material from � to � ft. yerds � bags trom ro ft. Yerds ba9s REMARKS. SOURCE OF DATA, DtFFlCULTIES IN SEALING from ro ft• Ya�s �9S \a.G�' S#3sffiN� �` �L66� : R,!!'s��rJi�� i9[ '4,/aJ�� - _ �.L a ��l��.'�'s�. �+�"a��s �� .�����'a ���-�,�a e ��j r from to ft. yards bags ��� ��+�� ��� �'�' +'� a � � }( �"�„ s� �' +f"j � UNSEALED WELLS AND BORINGS Other unsealed well or boring on property7 ❑ Yes `� No LICENSED OR REGISTERED CONTRACTOR CERTIFlCATION ��� ��� This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is �i���s_ � � true to the best of my knowledge. �1/ Ac�trr�in�, to �N �tat� +R���lati��s �� -cr _ Sm - - � a - Licen �o g 6onNo. �, -. _ .. � �f _ _ � r_�. .��z �'� °�F --�F � � � � �4 nAr, LOCAL COPY I �"� � 9 3 4 2 I �/ son S`ea i o I 1 _ I Sue�etr p � C�ty of Fridley 9 5 9 4� AT TNE TOP OF THE TWINS g � I L D I N G P E R M I T r � � ECEIPT NO. � `V �_���. COMMUNITY OEVELOPMENT DIV. r � � PfiOTECTIVE INSPECTION SEC. �� �`� � 1 i � � �"'1 � CITY MALL FRIDLEV SSIJ2 NUMBEP pEV O�TE v�GE OF �VVpOV80 Br �""'�"� �'' 612-571-3450 s�aF�s 6/2/99 / / JOB ADDRESS 7661 East River Road NE 1 IEGAL ��T N� t. 6 BLOCK TRACT OR ADOITION SEE ATTACMED oesca. par. 1450 Revised Aud. Subdivision 4{'77 SHEET 2 PROPEiiTY OWNER MAII AODRES$ 21P PNONE Kris Schroeder 572-0908 3 CONTqACTOR MAIL ADORESS ZIP PMONE LICENSE NO Owner 4 ARCNITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADORESS 21P PHONE LICENSE NO 8 USE Of BUILDING Residential 7 CLASS OF WOi;K O NEW O ADDITION O ALTERATION � REPAIR O MOVE O FiEMOVE 8 DESCRIBE WOfiK Reroof house and garage (16 Sq) Tear-off 9 CHAN(iE Of USE FFOM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAO SEPARATE PERMITS ARE REGUIRED FOR ELECTiiICAL, PLUMBING. MEATING, VEN?ILATING OR AIR CONDITIONING. TMIS PERMIT BECOMES NULL ANO VOID IF WORK Oq CONSTRUCTION ZONING SQ. f7 CU fT. AUTNORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANOONED FOFi A PER100 OF 1� DAYS AT ANY TIME AFTER WOpK IS COMMENCED. NO OWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICA710N STALLS GAFAGES AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIEO WITM WMETMER SPECIFIED MEFEIN OR NOT. TME GRANTING OF A PERMIT $1398 �.70 DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL ?HE pEpMIT FEE SAC CNARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON- STRUCTION Of1 TNE PERFOiiMANCE OF CONSTRUCTION �SO . 9S Fire SC � L.�FO PLAN CNECK FEE TOTAL FEE $53.05 S�GN U E fCON'AA TOaORAUTMOAiIEOeGEN1 �OA E� � WMEN PROPEALY LID TED THIS IS YO R PEQM17 � 2 � -?� S�GNATU E O� OWNEA ��F OW p WLO i �DA� i Bl0 �NS� 06TE 0 �L � ADDN ALTER Effective 5/10/99 [ ] CITY OF FRIDLEY [] SINGLE FAMII.Y AND DUPLEXES R 1 AND R-2 BUII..DING PERMIT APPLICATION �� �� , ��� � �,t° / � �� � . r�� Construction Address: ��'�� i �_ �2� ��� fc �� Lega1 Description: � 1 � �' (� �� � ���11 L` _ j � 1r J �C.�, � (V� Owner Name & Address: �� t � �� C�(.� �.0 � � Tel. �t �t 2 ��7 � C� °J � Contractor: '��(�F' MN LICENSE # Address: �� � � Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTI�R: Construction Type: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPRO��:MENT Length Width Height Length Width Height Length Width Hgt/Ground � ��� � �� ����� �� � � Driveway Curb Cut Width Needed: DATE: Ca� �. @j � APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATTONS: � 0, r�`, $ , U $ .,�0 $ $ $ $ $ $ � �3, (�� Estimated Cost: $ Ft. + 6 Ft = Ft x$ _$ , ���� CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation Sq. Ft. . Sq. Ft. _ Sq. Ft. 9%i', c2° Tel. # �� 2���Z'�`� U 6 $1050 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 [ ] � s ._ J 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 $25,000 $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 $23.50 $23.50 for first $500 plus $3.05 for each addirional $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 first $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 $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $5�,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,OOO,Q00 $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 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 Certificate of Survey of the lot, showing the location of the foundation once it has it h� beeen co�tructed will be required before proceeding with the framing.