AF - 45017BUILDING
PERMIT
f N° 25�9
Village of Fridley, Minn.
Date •�w�.� . � . �. : .*w.. . . . ,� �'"'� . . . . . . . . . . . . . . . .
Owner ,tt� ;�.� . . . . . Builder .�� �.�. . . . . . . . . . . . . . . . . .
�t✓� ,'.. i�� ' ' " �L G'1t...�'"�'�r . . . . . . .
Address .,..����Z,�'�.�,���.....�:.L'-�a:.�►' Address .........................................
f . '� LOCATION O� BUILDING
No. .�"rr� t. .. . . . Street �..+�i+.�' �=�%'+�:-`i..:l�. . . ;,::�:". . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
��r j
Lot . . . .. .. .� . .. . Block . . .� .. . . . . . . . . . Addition or Sub-Division . ��.�,,�.,��,�. . %�'+�y+�`�'. . . . .
Corner Lot ............ Inside Lot ............ Setback . /r[�r Side ard �/�/ �
��'Mi i+/I�l� Y / +Fi'� ��.:t':w:r . . . . . . . . . .
DES�CRIPTION OF BUILDING
To be Used as:
` Front . ��. Depth .�� #'�FIeight Sq. Ft. . �� � Cu. Ft. . . . . . . . .
�
� . . . . Front . � �. Depth . �� Height . . . . . . . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
Type of Construction ��,..�ti��; Est. Cost .'���1. ,� �:"��„ �... To be Completed .�t.,l. ;,��r���,.;�•
f
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of �'ridley.
�*�� �
_ � n consideration of the payment of a fee of $. ,, j�.,«,,, ermit is eby granted to f''� `
"'�.�,,,�','Y1.w •
.. .........
. . . . . . . . . . . . . . . . . . . . . to construct the building�o ad dition as described above. This rmit is granted upon
at the person to whom it is granted and his agents, employees and workmen, in ail work
one in,' around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
F'ridley, Minnesota regarding location, construc�ion, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. �„ �r �
e
Inspector
iVOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for se�arate permits for these items.
City of Fridley, Minn.
�a s�G �
BUILDING PERIV�IT NA '715 0
� --
nate: _ —...� `J � . . __��.
� ��
Owner: _ .. _._.. _ .__. _. .__.._ Builder . _._._.. . .. .. ..:.. ... ............_.... ..._...._..__
Address._.__..�.M._...____..__.__....�....�._..._...._..._..._..__..__._.___..:.._.._ Address _.�.._.__._..__.....__.........._.._.._ ............._......_..._.._..__....__._..._...._..._.._.
�
.
►- CATION BUILDING
No.�s�5-..�,�._.. Street _.. .._...��.��-t-fr��.�./,�r....�.••.e_ .,�i.�t'.✓..... P of Lot ....._.._..._....___._ ._..._. __..._.._._._._.�
� � /��;
Lot ...__...�.__.._._..._ Block _._._._._...__�._...._._....------_. Addition or Sub- i on . ._ . . _ . _ . .__�`L�a�_.._.._:.'_..___�•-
Corner Lot ..__....._...,.__ Inside Lot ...._...._��..--.---.... Setback :�1��.�'.'�.-�..-�..'Q. Sideyard ......_C�....�...__._......_.....__.__..._...
Sewer IIevation _____�_._...___..._..._._..._.____..__ ............._...:.._ Fo dation IIevation ....._....__...__...._...._...._._.._.__..._._.._..._...._.._.._.._._.
DESCRIPTION OF BUILDING
To U ,.,./�
• Frant �. �. DePth .... f�..._ Height .��..._.. Sq. F� �.�� Cu. Ft �..1..�
� . Depth _.._. �_. I-�eight Sq. Ft. ._.._..........._. Cu. F� ....._...._.._._
__..._._.._._......_.._.._._._._......_ Front _�_.. _._
...� ..
Type oP Conetructton _... . . _ . . .. Es� C t .../ �.,�. � ....... To be Completed ....:_..._........__..._..._._.._....__._
6�E�{,�•-...._....__.
In consideration oY the issuance to me of a permit to construct tbe building described above, I agree to do
th� proposed work in accordance with the d�scription above set forth and in compliance �'}th all provisions of
ordinanoes of the city of Fridley. � � � ,/ �_ _
�
In cociaideration of the payment of a fee of $. _.._.�....._..._.._.., t is hereby ted to...._.—.._.__._......___._._.._._.
to construct the buflding or addition as descrfbed above. This permit is granted upon
the express condition that the person to whom ft is granted and his agents, employees and workmen, in all work
dane in, around and upon safd building, or any part thereof, shall conform in all respects to the ordinances af
Frldley, Minnesota regarding location, construction, alteration, maintenaace, repa.ir and moving of buildings
within the dty limits and this permit may be revoked at a�y time upoz� vio 'on of aay of the provisions of said
ordinancea � . /7
Building Inspecto�
NOTICE:
1Ns p�nnit doa no1 eowr t1N eonifrudtoe. inshl�allon for vr(r6�y, Plumbino. �as h�atin�, s�w�r er wN�r. B� wn to a�
fh� WiWino Insp�elor for s�p�rat� p�neih for fha� it�ms.
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HEAT LOSS 'CALCULATIONS DEPARTMFIVT OF BUILDINGS
Weatheratrips A•S•H.V.E. Construction Na
Guide
Mmr�aPO�ts.
Insulation
Windowa Doors Reference Out. Wall Int. Wall Ceiling Roof F7oor Kind How.
Yes—N Yes—No 19—
Fl.� Room Length Width Height FI.� Room L.ength Width
Win s and Doors—Crackage and Area x 1 Windowa and Doors--Crackage and Area
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City of Fridley, Minn. � � 5 8�
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
�te: - Aug i a t � 19 7�
Ovvnex: _.�S2uS_TeT17' te Builder A�RS—.�: d� n�..._§,. R� SLf ixlg_�.SZ .._
Addre�t __..5,21.�.� ' � mo���]�'P�� N-E - Address _ 4591 - 2'� S tr�.e�.l`I..�.�.__._..._._�...:_._
LOCATION OF BUILDING
Na 52.11 Street ��..1„l�n,ore _Street N.E ._.__..._....._..__..� Part of Lot _�___.___._._
Lot _ g Block ._._ 1 ._...___._.__.._ Addition or Sub-Division Ma.rion Hi11s _Addition .____�
Corner Lot Inside Lot X Setback _..� .............u....._� Sideyard _._...._...._.__.__.�...__.W____._..__�._.
BCwer Elevatian �...— � Foundation IIevation ....._._..........__._. .__..�.__..:.__..._._.
DESCRIPTION OF BUILDING
To be Used as: . Roofing Repair �.7F�yidYi around chimmmey
Front ._....._...._...... Depth ._..... Height Sq. Ft. --.----....__...._ Cu. Ft ..,.___.._._
� Front .._._. Depth _... Height —...._:. Sq. F� -------•------. Gu. Ft __.__......_._
Type of Co�struction _.._._......._._.........__ Es� Cost .._.-�.l.iQa.RQ To be Completed .._.__..1._�l�h___�
In co�sideration of the issuance to me of a pexx�ut to construct the building described above, I agree to do
t1�e propoaed work in accordance with the deseriptioa above se�t forth and '�ry�oo mpliance with��rrllll provisians oE
04'd�anees ot the city of Fridley. `,/" // %�� '�
�f / A .. O.� .� I � /..s
In consideration of the paymettt of a fee of $ 5.00 , permit is hereby granted to �C__ Siding & l�oofing
to construct the building or addition as described above. This permit is granted upoII
the express condition that the person to whom it is granted and his agents, employees and workmen, 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 buil '
�� city limits and this permit may be revoked a t any time upon violation of any of the provisions of�
. `��^��'�-t'!L�, .._ _._ ` ding Inspecto�
CLARENCE BELISLE
NOTICE:
ihis permiT does not eover the construetion, installafion fo� wiring, pivmbing, pas hsating, sewer or wafer. B� son to sM
th� Building I�spaetar fo� saparata permits fo� theae itsms.
�
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�
APP�ICA�ION FOR RESIDENTIAL, A�T�RATION,
OR AllllITION BUILD�NG P�RMIT
CITY OF FRIALEY, MINN�SOTA
o �
OWNBIi� � S �1AME s BUILDER: � � � �
O . /� '
��ss . �a„ --��� , y�� ��S . ��9�- � ,�`�° i� �
a a r
.
�10c,=„J'�a// STREET: o��G-�it�-c-e_, �
�,01' : � BLOCK • j ADDITION
CORNER LOT: INSIDE LOT: �TBACK: SIDEXAR�?;
�...............
Applicaat attach to thia form Z�o Certificatea of Survey of Lot and pxopo�sd
buildiag location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Ueed A�:
Front• Depth• Height•
Square Feet: Cubic Feet:
' Front: Depth: Height:
Square Feet; Cubic Feet:
0 0
7�►pe of Constructian: Estimsted Cost: $/o��. °—°
� ,.�.� �.� �..
Ta ae Ccmpleted:
The undersigned hereby makes applicativn for a perp�it for tt�e wp�l� ���c��,�
�peci�ied, agreeing to do all work in sttict accordance with the C��y �t�
F�i,dley Ordi.nancee and rulinge of the Department of Buildiags, aad �e�r�bY
d�claxea thst all the facts aad representations stated in this app�.��t��,�pn,
a�re true aad correct.
��[.: �-�- 7a sicru� :G���_
(See Raveree Side For AdditionaY Information.)
.���,
. �
� �• ��
�
sue�ecr PER
C�ty af Frid�ey 1263
KT THE TOP OE THE TWiNS B U I L D� i �� P E li'1 � l I T
' � , RECEIPT N
� ` __��� COA#MUNITY DEVELOPMENT DIV. �
� � v � PROTECTIYE SNSPECTIOPI SEC. �
'� �
.,. 1, � . .l � � . . . . .
� ` �"�"l ! CITY HALL FRIDLEY .�4$Z NUMBER REV. DATE PAGE OF APPROVED BY �
�••--� ' �•l s� 2-5so-3a5o 910• F15 %�1 �� 7 4 I �
los.noop� s
l Fi1 ore r N
t LEOAL LOT NO.. BLOGK TRACT OR ADDITION SEE ATTACHED
DESCR. � 1 SHEET
2 PROPEHTY OWNER: MAIL ApDRESS ZIP PHONE
3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICEN$E NO.
d`ARCHIT�CT OR DESI(iNER MA.IL ADORESS ZIP PHONE UCENSE NO.
5 ENGINEER MAILADDRfSS ZIP PHONE UCENSENO.
6 USE OF BUILDING
7 CLASS Of WORK
O NEW ❑ ADDITION � ALTERATION O REPAIR O MOVE O REMOVf
8 DESCRIBE WORK
Reroo€ removin o 1d roof
9 CHANGE OP USE FROM TO
5TIPULATIONS
�kPERATE PERMtiS REQ�UfREQ; FOR W�RING,
. HEATIN{',�„ PL�t1MBING J�Nfl S�it�4,
SEPARATE PERMITS ARE REQUIRED FOR Et,fCTRtGAI, PCUMBtNG, HEATING, TYPE OF CbFtST. DCGUPANCY ORQUP OCCUPRNCYiOAD
VENTILATING OR AIR CONDITtQNING.
THIS PERMIT BECOMES NULL AND VO1D IF <WORK OA CONSTRllCT10N ZpNING SQ. FT. CU. FT.
AU7HORIZED IS NOT COMMENCED WITHIN §0 pA�IS, OR iFCONSTRUCTION
Ofl WORK lS SUSPENDED OR ABANDONEO fOA A:�'ERIOD OF 120 DAYS AT
ANY TIME AFTER WOBK IS COMMENGED: NO. bWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION S7ALLS GARAGES
AND KN4W iyE SAME TO BE TRUE AND CORRECT: All PROYISIONS OF I,AWS VA�UATION - SUR AX
AN� ORQINANCES GOYERNiNG THIS TYPE OF WOAK WILI. BE COMPLIED.
Wii'H irlHEfiHER SPECfFIED HEREIN OEi NOT. THE GRANTING OF A PERMIT 9 QO • 4 Q - •�U
DQES'.NOT PRESUME TO GIVE AUTHOFITY TQ'VIOLATE OR CANCEL THE pERM1TFEE SACCHARGE
P'ROVISFONS OF ANY OTHER STATE OR IOCAL LAW REGULATtNG CON-
STRUCTiQN OR TME PE FORMANCE OF GONS7RUCTION. G. OO
� �, PLAN CHECK FEE ' LOTAL FEE
%-/G•� 6.50
��_ fIGNATUREOiQ � AC70RORAUTHORIZEDAGENT IDATEI y�jH PfR P� LI TED THIS IS YOUR PER�MIT
,� _ , � r`� .t`
� � tG.MAT�lA� �6F OWMEi�11E OWNER BUILDERI �� � IOh7E) �� LDG. �N P DATE � �
APPLICATION FOR RESTDENTIAL, ALTERATION,
OR AllDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA.
(,� � /�
OWNER' S NAMh' �o I�s W�''� �! Lr BUILD�R: �; ��'or.l �.� � 4 y{,�,, sa n( (��
�
ADDRESS : �oZ �l �' /I m._o s� d � � ADDRESS : � S/ 3 � � ^' � rL,� t �l/ � _
N0 :. � Z/ ( S TREET :�i ! Jm-�� a' 6t% c s •
LOT: BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form �tao Certificates of Survey of Lot and proposed
building location drawn on these Certifica�es. ^
To Be Used As:
DESCRIPTION OF BUILDING
Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Squar Feet; Cubic�eet:
� ° �-.,� � T ° CA
�rpe of Construction: g� �ad� __ Estima.ted Cost: $��� a d
To Be Completed; f–/6- 7 Y
The undersigned hereby makes app�icativ� for a permit for the work herein
specified, agreeing to do all work in st'rict accordance with�the City of
Fridley Ordinances and rulings of the Departmen� of Buildings, and hereby
declares that all the facts and repxssentations stated in this applicat�on
are true and corxect.
DATE : _ 1 — f 6 - � `� S IGNATURE : � �1
�
(See Reverse Side For Additional Tnformation.)
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� a 3
sue�ecr PER
city of Fria�ey � 95os
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
f
; � RECE .
� � ` ___� COMMUNITY DEVELOPMENT DIV. �
r � L � PROTECTIVE iNSPECTiON SEC. ����5
� �
1 � �
, � ����1 � CITY HALL FRIDIEv �55432 NUMBER REV. DATE PAGE OF APPFOVED BV
�'""�" �'� 612-571-3450 9�0-F15 6/2/88 � /
J08 ADDRESS 5211 Fillmore Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
OESCR. 8 1 Marion FIl1�.S SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Douglas White same 571-8763
3 CONTRACTOii MAIL ADDRESS ZIP PHONE UCENSE NO.
Milton Johnson Co. 2513 Central Avenue N.E. Minnea olis 781-9548
4 ARCHITECT dR DESIGNER MAILADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE UCENSE NO.
6 USE OF BUILDING
Residential
7 CIASSOF WORK `
❑ NEW 0 ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOFiK
Partial reroof and utter.
9 CHANGE QF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED 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 SQ. FT. CU. FT.
AUTHORIZED IS hOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PEFIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG: UNITS OFFSTREET PARKING
1 HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINEO THIS APPLICATION STALLS GARAGES
AND KNOW 7HE 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 ��� OOO $. SO
DOES NOT pRESUME TO GIVE AU7HORVTY TO VVOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUC N OR THE PERFORMANCE OF CONSTRUCTION. �2S .00
• PLAN CHECKfEE TOTALfEE
� $25.50
IGNATUREOfCONTRACTOR6RAUTHORl2,£DAGENT IDATEI VVH N PROPE LY A D Hr IS VQUR �tMT fj, .
/ _ � cy
i . �� ci�
--SiGNATUREOFAWNER11fOWNERBU�LDERi IDATEI ` LDG �NSP DP7E .
l�w [ ]
AIDN [ ]
ALTER [ ]
City of Fridley
R-1 ArID R-2
Building Permit Application
(bnstrLiCti�[1 AddiesS: � -2// � � � � ^�/ ��
Legal Description:
Owner Name & Address
Gbntractor :
Address: � 5'/�
�`
EEfec�ive 5/1/88
TF1. # s�r- ��� �
Te1. ��/- SSUp
�S�i
Attach to this appl ication, a Certif icate o� Sl�rvey of the
lot, with the proposoed v�nstructian drawn on it to scale.
�ESQtIPrIOId OEr Il�'12WS�!��
LIVING ARFA: Length Wicith Height �. Ft.
S�B�G�.BB' '. Length Width Heiqht St� Ft.
.
�� �• Length Width Hgt/Gro�nd St�. Ft.
�. �� � � �'�
Q�rner Lot [ I Inside Lot [] Ft. Yd Setback Side Yard Setbacks
Type of Construction: L,° Estimated Cost: S �ODC5.00
Approx. Completion Date:
P1t. A Alt. 8
Proposed Driveway Width If New Opening Is Desired: S $
Width + 6' See Back Page
�E: �o --a^ � � ���� � T�.. � 7��—s� � �
QTY OSE QiLY �
Pe=mit Piee
State Surcharge
SAC Charge
Driveway Escrow
Park l�ee
Sewer Ma,in Cllarge
��,
sPIP[lI1�I�S:
$ asa'�e Schec3ule on Reverse Side
S . �v $.50/SI,000 Valuation
$ 5550 per SAC Unit
8 Alt. '�," or A1t. '�" Above
S F�ee Determir�ed by E�gir�eering
S Agreenent Neaessary [ 1 Nat Neoessary [ 1
$
ca���� V�
C�°� �1�`��0� -
� _
��°L o�o��u
� �v G
sus.,etT �
c�ty of Fr�aley 311
AT THE TOP Of TNE TWINS g � � L D 1 N� P E R M I T
r
� � O.
� • COMMUNITY OE�ELOPMENT DIY.
� ; v ----- � y/��
r � � PFi0TEC71VE INSPECTIQN SEC. V
i . �
l__--�; �'��,'� CITY NAI,L FRIDLE� SS�aZ NVMOEN pEV OATE PAGE OF APPROVEO BY
i 612-571-3450 9t0-Ft5 6/26/00 � �
JOB ADpRESS 5211 Fillmore St. NE
1 LEGAL �OT NO. 6LOCK TRACT OR ADOITION SEE ATTACHED
DESCR. $ 1 Marion H111S SNEET
2 PROPERTY OWNER MAIL ADDRES$ IiP PMONE
Geneva Eshweiler 5211 Fillmore St. NE 574-9024
J CONTFACTOR MAIL AODRESS ��P PHONE IICENSE NO
Beitler Building Systems 13531 Oakhill Road No., Scandia, MN 55073 65I-433-5802
1 ARCMITECT OR OESIGNER MAIL AOORESS ZIP PNONE LICENSE NO.
3533
5 ENGINEER MAII ADOfiESS ZIP PHONE IICENSE NO
6 USE OF BUIIDING
Residential
7 CLASS OF WORK
O NEW � ADOITION O ALTERATION �] REPAIR D MOVE O REMOVE
8 DESCRIBE WOfiK
Reroof - No Tear off 2nd layer 2/12 pitch SIS Rolls
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Manf. Specs. and State Building Code
Roofing can be 2nd layer, but not 3rd layer
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV lOAO
SEPARATE PERMITS ARE IiE�UIREO fOR ELECTRICAL, PLUMBING. MEATING,
VEN?ILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZpNING SO. fT CU fT.
AUTMORIZED IS NOT COMMENCED V�!ITMIN 80 DAYS. OR If CONSTpUCTtON
OR WORK IS SUSPENOED OR ABANDONED FOR A PER100 OF 1T0 OAVS AT
ANY TIME AfTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING
1 MEfiEBY CERTIFY THAT I HAVE REAO AND EXAMINEO TM�S APPLICA710N 1 STA�LS GARAGES
AND KNOW THE SAME TO 6E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UATION SURTAX
ANO ORDINANCES GOVERNING THIS TYPE Of WORK WILL BE COMP�IED @
WtTH WHETMER SPECIFIEO MEREIN OR NOT. THE GRANTING OF A pERMIT W4 �415.00 �2.2.1
OOES N07 PRESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEL TME PERMtT fEE SAC CMqqGE
PROVISIONS Of ANY OTHER STATE OR IOCAL LAW REGUTATING CON- $111.2� F1Y SC ��F.�FZ
ST ON TME PERFORMANCE Of CONSTRUCTION
� PLAN CMEGK F TOT � FEE
1
Lice C $5. $122.88
- S�G ru EOFCON'AACTOAOA�UTMOA�ZEO�GENt � �tE� ME PiiO VALIO TE THIS IS V UQ PEQMIT�
��j •r=7 �
S�GN�TUAE O� OwNEQ��F OWNEpBUI�DEAi � iD�TE� 6/
BL ��N r�cfE
NEW ( j
ADDN [ ]
ALTER [ J
Effective 1/1/2000
CITY OF FRIDLEY (763) 572-3604 Bldg lnsp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �
Constnaction Address: ��.�1 �O�-��� � %/� �
�� �1`
Legal Description:
Owner Name
Contractor:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
�
�
Tei. # 57�{-1�o2`i�
��%ru�r� MN LICENSE # .�S .� 3
', ���i,� 6t�fi[, Te�. # �5/- �f3.3 --.�02
SSo73
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. Ft
Length Width
Length r; �„ � � ���ith
Height
HgUGround
Sq. Ft
Sa. Ft
- �,/ �o
Construction Type: �2 - Estimated Cost: $ �`���
/�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � APPLICANT: � Tel. #�� �'l �33 rS�D2
� (/L —S5'D SSOB
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ / �� a� � Fee Schedule on Reverse Side
Fire Surcharge $ .� .001 of Permit Valuation (1/10th%)
�tate Surcharge $ vZ- � ( $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ �-G� $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary ]
Q � � � �� � �� �-r
��� � �`
TOTAL $ la�� �� �°`v
sriPU�a-rioNS: j��� i��%�'�� � � � ���� �'v� ����9`� �l�-1��.%ti/��
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ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
VALUATION
CITY OF FRIDLEY PERMIT N: 2004-0036r 8 J
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 03/22/2004
�631572-3604 FAX: (7631571-1287
: 5211 FILLMORE ST NE
: 253024210021
: MARIAN HILLS
: LOT 8 BLOCK 1
: PLUMBING
: RESIDENTIAL
: ADDITION/ALTERATION
: $ 0.00
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS 1
# GAS DRYERS 0 # GAS RANGES 0
# OF NEW FIXTURES 0 # WATER TRMT APPLIANCES 0
l(�.E� �'� � � � .� ES ( / D� ��) e� � �`� i��-�- � �� �1 �� /
C� 1� �%��
�
APPLICANT
RIVER CITY SHEET METAL INC
9928 BLUEBIRD ST NW
COON RAPIDS, MN 55433
(763)754-2199
OWNER
ESCHWEILER GENEVA S
5211 FILLMORE 5T NE
FRIDLEY, MN 55421
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
ganting of a permit does not presume to give authority to
violat cel the provisions of any other state or local law
regul ' g con tion or the performance of cons ctio .
Applicant Date �,
Bldg Insp
PLBG PERMIT MINIMUM FEE
PLBG FIXTURE5 (NEW OPETTINGS)
PLBG FIXTURES (EXIST OPENINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 12639
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
20.00
0.00
0.00
O.OQ
0.00
0.00
0.00
0.00
0.00
0.50
20.50