AF - 45055. � . SUBJECT � � .
c�ty of Fr�aley
AT THE TOP OF THE TWINS B U I L D I N� P E R/ 7 i� T
�
� •
� �
� • COMMUNITY DEVELOPMENT DIV.
� ; L �-.��� ,
r � � PROTECTIVE INSPECTION SEC.
� ,
� � �"'� � CITY HALL FRIDLEY 55432 NUMBER REV. DATE
�"°� � �'' 612-571-3450 910-F15
6/4/i9
JOB ADDRESS g 5212 Fil]more Street N.E.
1 �EGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. •(> 1 Marian Hill.s
2 PROPERTY OWNER MAIL ADDRESS Z�P
Dean E. Bliss 1413 - 46th Avenue N.E., Col. Hgts.
3 CONTRACTOR MAIL ADDRESS Z��
$ 3iCl@
4 ARCHITECT OR DESIGNER MAIL ADDRESS Z�P
5 ENGI
MAIL ADORESS
6 USE OF BUILDING
Residentia�.
7 CLASSOF WORK
O_ NEW ❑ ADDITION
X
8 DESCRlBE WORK
Construct a 32' x 36' Dwelli
GAGE OF
� /
PERMtT
1523� ,
Rb EIPT N0.
-! �
9s9i�
APPFOVED BY � � . .,
SEE A7TACHED
SHEET
PHONE
571-7053
PHONf LIC£NSE NO.
PHONE UCENSE NO.
ZIP PHONE LICENSE NO.
❑ ALTERATION ❑ REPAiR ❑ MOVE O REMOVE
' x 24' G�
9 CHANGE QF USE FROM TO
STIPULATIONS p�ovide a haxd surtace driveway. Provide sod in the front and side
yards. Provide a verifying survey befare capping.,
SEWER IACATION : Put in by a�wner.
WATER LOCATION: 5erved froqn Cul de sac. WARl�N�lG
`' DRtVEWAY DEPRFSSION COST: N/A �• -
1N! CI1y 41' �E�r DOGi t�Q1 Gd��tlB tNa Bebre digging ca11 tn�a1 uti�ities
;, �q�t p!� tAt►mr toci�T�c�Ns �wa ttty�t�; TElEPHONE •EC�Ci'RIC�• GAS E1�.
'� o"t� �s ��a`°�u""`n°" pu�+°s�s °n"'Y arn' REQUtRED BY lAW
�s u� Q a�cwua vc�r n� wro�u►n� .
oN � �
SEPERATE PEI�M1�'S REUtJIF�£D �OR �N!'�l�, ,
.H�AT�N ��u�e��� ac��
SEPARATE PERMITS ARE REQUIREO FOR ELECTfi�CAL, I�LUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUF OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOC� F1'dIIlQ
TNIS PERMIT BECOMES NULL ANO VOID IF WORK OR COMSTRUCTfON ZONING S�. FT. CU. FT.
AUTHORIZED I$ NOT COMMENCED WITHIN 60 OAYS, OR IF CONS7RUCTION
OR WORK IS SUSPENDED OR ABANDONEO f0"fl A PERIOD OF 120 DAYS AT R�. I.ZrJ2 + 622 34,250 Tota
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET RARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �; STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF I.AWS VALUATION SURTAX
AND ORDINANCES GOVEPNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETWER SPECIFIEQ NEREIN OR NOT. THE GRANTING OF A PERMfT ���!�"8'�Q $33. 43
DOES NOT PRESUME TO GIVE AUTHORITY 70 VIOLATE OR CANCEL THE pERMIT FEE SAC CNARGE ��av�
PROVISIONS OF ANY OTHER STATE OR LOCAL lAW REGUTATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. t��-37.00 ��I'�'�. _'� ��D /1—�"!
PLAN CHECK FEE 70TAL FEE' �
$ 34.25 s�'� av`�.�s
♦� " S�GNa7UaEOFCON'RnC70a0anU7HOR¢EOAGENT �OniE� �" `� WHEN PROPEftLY VRLIOATED THlS JS YOUR PEpM1T
� /' 3-�-s.G..d'„wr ' `i �. �L.t.(ll.U+t[J � — V �� .J
SIGNATURE OF OWNER IIF OWNER BUILDERI . IDATEI
� �o�f��� /
. ..
CI�Y O(= �=izil)LCY . . �
� ��r�r��.r c��rx o�: r-ori iz�.s r»�_��aT � n� �u ��_� x��1G f'E�(t('I i TS
• (i`�L"W, �L7�L"Rl1TIU(dS, �I?llIT10(JS, OR f�L�f'/�I(2S)
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ow�ir�z: ���e3 n . g� Iss _ r.uzr.u�,�i: n ear � F. _ � 15s
. r,aar�s : : c-. � �, c ��I � � ► ��� naar��� : I � 1�3 - � �� ,� v N �. � Coi. li�s
L �-
' I�13-�6� Ave NE. 2eZ. l,to. 57! -7DS,� .
1�0. :�'�� a Street: i �- or ,s�' ivE •
J�OT: iQ ` I3IACY.: ____�___ ADL�I�rzora: � 3 r13h tf � 1!S
COl2i�LR LO'1.': II�SID� I,O`P: )( S::x`P11CY.: � STllL•'Y11Rb5: oZ 2h� s0'i—
R�.�pla.cai-,L- attarh �L-a Lhis form Zlvo Certi�zcates of Survey of LoL and propased
bui.lding locatian dravm on these Certificates. •
DESCRI PT10(�d OF BUI LDI hG
To 33e Used As: �
. �� ` �.3� � e2 C� �
�
Front: � Depth: � . :^ Iiei.ght:N�- _
�. Sguare Fee�: Cubic Feet:
,2g�„q�o� �I'i'ont: ���v / Depth: ��� � Height: _� /(� �
Square T'eet: c�aa Cubic Feet: �'�,�-Q'
Type of Canstruction: ,�'ra� r:si�imated Cost: $ ���
'7�b I3e Completed: ,q}����-- TUn �. � qS�
Alt. A Al.t. B_
1'roposed I7rive�aay Zti'idt.� zf lsew Opening �s Desired __��___ $ $
' (SEr 12�VEI2SE SID� OF Sii}:ET)
The undersigned lie*_'eby makr_s application for a permit for the work lierein
specified, agreeing to do all tcorl: in strict accordance with the City of
Fxa.dley Ordinai�ces and ruliiigs of �he Depari:me�zt oL ruildiTlgs, at�d hcreby
declares t•ha� all thc facts and represcnta�ians stated in this a��plicaL-io:�
a�:e tr��e ancl correct. �See xeverse side fox acldit-ianal inionnation.
nn��• S- a a-� 9 sTCr�n�rvr.t:: �p��nJ ���� .
stipul.ations : .
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_ _� ts z x �z..�'-39 = Z�i, �yq ►�� _
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- ---- __-_ _ _ _,._ ��•n�►���_ 3�#.2Sa x �_ = 13�.00_
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EXTERIOR ENVELOPE AYEF;AGE "U" COt�PUTATION „
041NER ��Au �O�S� ��1SS _
-5�f-�4eeRE� �F L �.: j1���o u�} � ��5 .� k I l.0 9��o tc �4 Cov�T `�
���g{�— p w�� DATE i �"1 PHONE ��
Determine working square footage of each.
1. Total exposed wal l area ......_?� f� C� sq. ft. x. I.. = 2
2. 7ota1 roof/ceil-ing area ...... � I�aA sq. ft. X,OS -_ �5 ,
Total exposed wall area above floor = t53°I
a. Total wall window area ........................... -11
b. Total door area ... ............................ 2 �
c. Total sliding glass door area ................... ZID
d. Total fireplace wall area....... ........... --
e. Total wall framing area (average�l0�)...:....... t�
f. Total net wall area above floor .......�.......... ie �_
g. Total rim joist area ............................ (9 p
Total exposed foundati on area = I S(0 5"
h. Total foundation window area...._. ............... t(�
i. Toal net foundation area above grade ............ �s 49
Determine "U" value of each wa11 segment.
1 X"U" . 5 S 2. 35
a . ..-1 - -
b. Z� X „��� �t�.lo = _ �• �!
C• `„'' D A �I, t 11 r� C �� I• a
U
d. --- X „��� ... _ —.
' e. �:54- X ����� .!3 = ZD.o2.
f. l O-T � X�,��� ', �21 = 2�1.D8
g. (�O X „�„ p� _ 3. �
h. i(p X"u" .5 S - $. 8
; . ��.. 4q X ,.�„ .o� _ = 1 I 'l.� 2-. �
-- -----.---
3 . ...................................Tota1 = 3 5'3.�
If item R3 is the same as, or lcss,�n-.:n jtem �l, you have n:�t tne intent
of S3C 600��(c)2.
�r` ., .. ._
Total exposed roof/cei 1-i ng area = �'t�Co$
Total gross roof/ceiling area = .
j. Total skylight area .. ................... �I-
k. Total roof/ceiling framing area .. ... 11(0
1. Total net insulated roof/ceiling areaW��TTiI�- .�52
tin. �� �� �� „ �� �� �o �T�ic. .30�
Determine "U" value for each roof/ceiling seginert.
�. � X ��U« _ . �5 = 2.2. �
� k. I 1 Cp X����� . � 3 = I5.
� �, � 52 X"U�' , � ZS = i�,. 8
30 D ` 3 - 9 ,
4. . . . . . . . .� :.. . . . . . . . . . . . . . . X.� U. .Tota� � _ .d
If total of` �4 is the same as, or less tnan �2, you have met the intent of
SBC G006(c}j.
To utilized the total envelape system method, the values established by the
sum of items �3 and #4 shall not be greater than the s.um of ite*�s �1 and �2.
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3. 35..3,.0
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+ 2. SS.�4 - `�SC�. I
+ �. 4(�O = 399.0
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�PLAC� EX�5'T/N.ri S'1�'EE7' � w"••
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p•/N K/NO. GOMf{�JS/T/O/V , s v'� _ ,
r�� d�4ASE � , �Ne hereby certify that this is atr+
b t1 that this survey was
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gL. SP.f� /� �� AT A.�'�l.E' �T. O.t/
Li�T Li�✓ct' 'Of LDT �. .Bt,�/, /7�9P/.QN/�ttS.
'EV 990. �/ .
� ,Yf/T �/yp,2A.t/T •' .Soury�EST
PI✓E.P OF ,�jUG/�/1if'A�V ST. �1✓E,
�'- " - .�- f..--- -
a ove a�
Land Surveyor under the lawso
As surveyed by me this��
� .�
wpRH�NG �t;�►ti�es
�ro� d�gging �Il loca� � Etc.
j��E _ �,ECTRIC -
RE
Q�iR�D BY �'��
QOES NOi GVARANtE� TMg
M! C1tY Of FRIDI.EY `�S� � �vA�tOr#r,
�CCWRJ�CY �` �'� i{pN PU � ��'�ON
����� R SHOULD � ,
oM s�e sit�.
Notes : I
• F•y
�• A�� ►�►'k shall be in accordance �tth the City of �
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L...._ ...:a.,.. . ....... ........... ......._ —.._..._ _.— .. ._......_...... .......,._..,�.._. ..:...,,,.....,.... . .... -........,.-.... ._. . ,_..�_ ....,.... . .
. . . ,�._...
1. ,. . . . .,'-- . . . ' . . � � ��. . .
; � DATE. _. �ft�tkTUR� .
� ._ ORIGWATOR — DET/4CH AND REiAiN .
� ��
�
:��,
w ����..
:—: •,,�..�
`��,
SOBT�BHA�I�AN
����� ���
7415 Weyzata Bivd., Suite I i i
Minneapolis, Minnesota 55426
Phon�:546-6938
Dete
�l ��� l `
Arrivs Job „�,�Q _ Mil�ag� �, � ,�(lt , �
'— Total
Depert Job � e�',3� Trevsl Tim� 1�r . Chargsebls
Leb. Tim� , ��^ • Houn ��. •
Totel Hours � �
On Job 1��� r. Rsport Tim� �.'� �t- ,
)�� '
�w� ��
F
5�ti
Summa� of Technical and%or Enqinaering Ssrvice: p��formed. I�clud�n9 �ie�d To� Dat�*. Locations, Elevotions, and Depth: are
es�imatad:
Insgec�ed ���avation fQr sin�le famil�. dw�l.l_ir�ua FriAla,�� Mn
p�l� undesirable materials have been removed, to expose natural redd�sh- _
brown, fine to coarse siltv sand with some larcter acterreg�te� E vat�o __
of lower floor is at 990.8' with the up�Pr level at 1009 5' Th�� area
is dry, adequate oversizinq__(1:1) , and is _�PPROVED FOR FILL PLACF.MFNT ._
AND COMPACTION procedures. --
•- . -. . .- - -- .i�.. .�_�_. .• .
Test Report No. 1_ for tes�__resultG nd 1 catiQns_ _
DISTRlBUT40N
_I�s.�'����r�------ ------ -
�s��c�. \��.���s,�� . S��-
By ��� �-- (�� �C'S�\JY\
SUBTERRANEAN ENGINEERING INC.
Field Test Date is estimated pending
finel leboretory t�st results.
�
:�- -� BUBTERRANEAN ENGINEERIIIT(� INC.
^ffiINNEAPOLIS, MINNS80TA. Ph. 646 - 8958
Compaation A,uality Control Teste -
Project Single Family Dwelling Report No. 1
52nd Ave N.E. & Fillmore Ave., Fridley, Mn. JQb � S-79205
Sand Cone Method ❑
Nuclear ❑
Other Q
dat� t�s� location
uly 9,
979 1 5ee
uly 9, �
979 2
uly 9,
979 3 Plan
uly 9,
979 4 Below
���vw �
bd � � �
dow ti��� a�.fty
ufac�
elev.
990.8' 146.0
moi�tw� tMy maxfinum g(
coet�nt % d�nsily IabwNory �ion �xonwmndalk�s
dry�d�nsily _ �
f
8.4 �131.3 � 133.8 � 98.1 � APPROVED
990. 8' � 149.1 � 5. 8 f 130.6 f 133. 8 � 97. 6 � APPROVED
009.5'�143.8 � 5.8 �130.6 � 133.8 f 97.6 f APPROVED
009.5'�146.8 i 7.0 �130.7 � 133.8 i 97.7 � APPROVED
0
Note�c � All teste correoted for stone content. where applicable. ABTM
Indioated P+ercent Compaction ❑°�b Max. Modified Proctar Dry Den.ity D-f557
(�% Ma�c, gtandard Prootor Dry Density D-899
Distribution �
cc Doty & Sons
cc Fridley Bldg. Insp.
Dept.
�1
_
��
�
OF FRI�LEY
�S
N_ 5 8 2
��� � 1Q
Date
��BLIG WORKS DEPARTMENT
TAPPING APPLLCATIUN AND P$R1VIIT
FOR INSTALLATION OF WATER & S�PER SERVICE
I) This form to be completed before a tap is made to any e�sting water ar
sewer Iine.
i�t�Blac f dition �lA�1Arc� f�r t.Ls
, ;i�te� '�> iJ�'
� a��r
Plumber ,_=___���rs�U'.S �L,�,�,.���
CH��tGFS TO . BE PAID BEFORE TAP IS MA�?E :--4 WHEitE
ASSESSiVIENT HAS NOT BEEN LEVIID ACsA�iST PR4PERTY
II) Water & sewer connection permit must be registered befc�c this '�apging
Pern�it can be issue@.
City sugplies all materiai and labor for 1" or under wat�r �ag. Con-
t�,acta�r :supplies all material and labor for water tap over 1", and a11
�e�►►sr taps. -
WATEi� �'�lP: Materials Used: S /�?.S� 4�
Strcet Patch: �Q: S /� -l30
l � � � ' � . �.C� . . .�. . .a. .
SEWER TAP: Street Patch: x : S
:III) If this property has not �aid a full Lateral Chazge for its share of the
water and sewer system! additional chazges wil1 tie placed against it.:
This will t� in additian to the normal rnnnection and tapping permits,
meter depo�its, e�tcc. �'fj�+,L ''� s'�,� �C3 �
,
. �� � �
, . , . � - . Rtater .
ASSESSIviET�iTS TO BE LEVIED: Lateral: S
Sewer Lateral:
TOTAL ASSESSMENT: S """ � '"
C4erks S�atute
Supt. of Public Wvrks
M/P 3/76 VYhite P.Vy. Csqary Finance Pink Prop. Ow�er Goltlenrod P{um!»r
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JOB ADDRESS tiS � I ol �� I I ri1 G� e�� I�� � '
3_73- �a�f'� �'����
HEATING CONTRACTO� O vJ rl � Y� PHONE: �% I� ��,�,
o� ow�r.�� ea n� � I► s, �a�• S71 -�3 3 3 �� o, k s� �e,
nnrTmD� nraczn_ .._��_ �
** Basic information below�must be ascertained from the calculations and pl.ans approved ....
by the Buildin$ Depar�ment for the structure. Su � e r i n 5 u�a�i o �� s�u crt� �' E.
U� .
�'nc��dej Cor�c�uc.f/b���oSS�S-�orw�r��o�.���n1rydoar�5��a�io��rs �T /�r
** l. Sq. feet of exposed ti,►al1 area above gr�ade ,
x�rIIn x 82 degree design Temp. ��F a a�h� �hNE-F ;�_�, 6S
** 2. Sq. feet of. ceiling area_______+ x"U" _ x 82 degrees. � 3 9`�
S�P 3�ac(�e�. Shee"� �
3. Sq. feet of basement floor area /0�10 _ X 3• , �� 6 Q
zn �uded �n � l s qee. ��"��s exterior -�-�o��rvi ins�larted x 6. �
4. Sq. �eet of�founda�ion wall area below grade _
Sn( S c�5e m e n�' �I X 6
� 5. ,go�. feet of infiltration for windows !aQ _ X��•5) ��' � 1�
�h�r��r1�oh x( 1. 0 8) x 8 2 degree s. { b a s e d o n s a s h o p e n i n g s i z e s) w► �• P i�•
�OSSra 3 Srtee� t�5���ed X _ g (�����C
6. Sq. feet of door area ( 0 i1•25) ��1.08) x 82 de rees. �
c��� �of � doo; >, �FC.,
7. Sq. �eet o sliding door area �0 X i0•5) x(1.08)
x $2 degrees. 3 `' � �`
8. Allowance for kitchen and bath fans.
# j K�.tchen fans � 600 �''� ea. ,�� �
� � Bath fans @ 200 �''I� ea. -��_�- -__
9. Allowance for fireplaces
# 24" to 32" opening @ 1000 �I� n
# 3t;.n to 42" openin� � 1300 C)
-,_# . 44" F� larger opening C� 1500 ��
10. Sq. ft. of floors over unhQated space __ X"U"
x �2 degrees. �J c�-i �
0
].1. Total BTU loss far above items. �'� �' 7 �
12. Add for combustion air(SBC ?722)-- )(.001 x net loss from
item # 11 1 X i12.5) x i•075} x 82 degrees. y�y,`��S
13. Add # '11 & #12• -- � 7 �? �
__._.__-_-..-
14. 'Maximum increase allowable by (2 MCAR 1.16005 ) answer
above by ll�f� s�{�µ/d \io'� �t, 9die�..�rv .Q/►�n SS D�',-1
OUTPUT OF FURl`1ACE SHAI;L FALL �&� 14. .
This is the size furnace you should use in this structure� thhe code does allow you
to use the next size available, prova.ding appropriate sized equipment is not
avilable.
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CITY OF FRIDLEY
A�/�1 UNIVERSITV AVENUE N.E., FRIOIEY� MINNESOTA 55452
TELEPHONE ( ai2)571-3150
December 16, 1982
Mr. Dean Bliss
5212 Fillmore Street N.E.
Fridley, MN 55421
Re: Final Inspec tions at 5212 Fillmore Street N.E.
Dear Mr. Bliss:
Our records d�o not indicate that any final inspections have been made
on your home at 5212 Fillmore Street N.E.
If you have occupied the structure, we must inspect the.work ccxttpleted
to date to determine if it meets minimum standards of safety.
Our street depariioent did receive a c�mplaint abou t your driveway. It
is reported that so�one has deposited concrete out int�o the City street
causinq a drainaqe and snaw rem4val problem. We are oonfident that this
will be corrected when you hardsurface your driveway. Our concern is
that this has not been done in the past and that at your pace we are
worried that it may ccintinue on indefinitely.
Therefore, we have no choice but to order you to correct the problem
early next springj certainly not later than ,7tine 1, 1983.
Also, w�uld you please contact us to arrange for the necessary inspections
if you are livirg in the ha�e. Your 000peration will be appreciated.
Sincerely,
DARREL G. GLARK
C�ief Buildinq Official
DGC/mh
CC: Ralph Vollanan
Superintendant of Public �+lorks
-
May 9, 1983
��
CITY OF FRI�LEY
8�31 UNIVERSIT� AVENUE N.E., FRIDLEY, MINNESOTA 55432
Mr. Dean Bliss
5212 Fillmore Street N.E.
Fridley, NIN 55421
Re: Final Inspection at 5212 Fillsaore Street N.E.
Dear Mr. Bliss:
TELEPHONE ( 612)571-3450
A final inspection was conducted on May 4, 1983 of the above listed
address and the follawing items were noted which must be completed
before the structure can be finaled out:
1. Post address numbers on structure by May 15, 1983.
2. Finish landscaping in front and side yards by July 1, 1983.
3. Provide a hard surface driveway by July 1, 1983.
4. Provide continuous erosion control on all slopes.
We will expect the above iter.�s to be co�pleted by the scheduled dates
when reinspections will be made to determu.ne compliance. If you have
any questions on this matter, please f eel free to contact me at 571-3450.
Sincerely,
/
DARREL G. LARIC
Chief Building Official
DGC/r�h
. � � � � SuB�ECT �� � . � � PE .
City of Fridley 30869
AT TNE TOP OF TME TWINS B u I L D 1�� P E 1: M I T
r � R CEIPT NO.
; ; y �_��_ COMMUNITY OEV�IOPMENT pIY. ��� �
r � � pqOTECTIYE INSPECTION SEC.
l---. w,��"','� Ct7Y HALI FiiIOLE� 55�32 NuMOEp pEV D�TE P�GE O� AbPROVEO 0�
� �� 612-571-3450 9�Q-F15 �/27/00 / /
JOB ADDRESS 5212 Fillmore Street NE
t L£GAL ��T NO. BLOCK TfiACT OR AOQITION SEE ATTACHED
DESCR. ( 1 MSr12.ri H111S SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Dean/Joyce Bliss 5212 Fillmore Street NE 571-8333
3 CONTRACTOR MAIL AO�RESS ZIP PHONE LICENSE NO
Dave Wiger Construction 901 Rice Creek Ter NE, Fridle , MN 55432 572-8403
4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
8392
5 ENGINEER MAtI ADORESS 21P PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS Of WORK
� NEW � AOOITION O ALTERATION p REPAIR ❑ MOVE O REMOVE
B DESCRIBE WORK
Construct a 14' x 16' and 36' x 4' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
�a��
Before di
���
all utili g8��g C�11 for
SEPARATE PERMITS �' �O�ar;ons
� REQUIR� oo?
R�aurREn Fo�; D BY LqW
PLUMBINGG� qNp SNG
6�IIS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARA7E PEFiMITS ARE REOUIRED FOR EIECTRICAI. PLUMBING, MEATING.
VENTILATING OR AIF CONOITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WOfiK OR CONSTRUCTION 20N{NG SO. FT CU FT
AUTHORIZED IS NOT COMMENCED V�!ITHIN BO OAYS. OR If CONSTpUCTION
Of1 4jlORK IS SUSPENDEO OR ABANDONE� FOfi A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO DW4G. UNITS OffSTiiEET VARKING
1 MEREBY CERTIFV TMA7 1 MAVE READ ANO EXAMINEO TMIS APPLICATION 1 STAIIS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VA�UATION SURTAX
AND ORDINANCES GOVEqNtNG THIS 7VPE Of WORK Wlll BE COMP�IEO
WITH WMETMER SPECIFIED MEREIN OR NOT. TNE GRAN7ING OF A PERMIT �3,460 $1.%O
OOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEI THE pEpMIT f EE SAC CHARGE
PROVISIONS Of ANY OTHER STATE OF LOCAL LAW REGULATING CON-
STRUC OR THE PE FOR1iAANCE Of CONSTRUCTION �g7 . ZS F1 e SC �3 .�FS
�� �� PLAN CHECK FEE TOi � FEE
102.40
NATUpE OF CON'A• OA Op �UTMOp�1E0 �GENT IOA �
N OPE Y ALI� T TMIS IS Y �E�r�J�
/ ` V
S�GNaiuQE O� OwrvEQ��� OWNEpBWlOEp� � �O�TEi � BLO �h5p � ���1E
NEW
ADDN
' ALTER
� ���
I l ` �� Effective 1I1 /2000
I l CITY OF FRIDLEY (763) 572-3604 Bidg insp
(] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: `�a �� ������
Legal Description: �„
Owner Name & Address: ���!��- Ja ��°� aL � SS el. #���'— ���
Contractor. 1J�v� �,c�/��,�' MN LICE
Address: � � f Z lc,t3" �,�'��/�' )`' ,� Tel. # ��,2 " �''S�'Q
LIVING AREA
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCR1PT10N OF 1MPROVEMENT
Length Width Height Sq. Ft.
Length Width
DECK AREA: Length
OTHER:
Construction
Height Sq. Ft.
Width HgUGround �� Sq. Ft. � `� ���
C /_� -
. �� R
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
�
r
DATE: "7 ^ �`S ^a� APPLICANT: Tel. # ���`��0-3
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$�- o�� Fee Schedule on Reverse Side
$ 3 •L/-J .001 of Permit Valuation (1/10th%)
$ i �%�% $.50/$1,000 Valuation
$ $1100 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 [ ]
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civil �
'municipal
; planning
environmental
. land � surveying
: soil exploration
Denotes Iron Monumsnt O
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FOr� DEAN E_ BLISS ___
�oT 6, B�o� K r
MARIAN H�LLS
ANOKA CouNTY, MINNESOTA
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We hereby certify that this is a true and correct representation of a survey of the boundaries ot the land described above
and of the location of all buildings thereon, and all visible encroachments, if any, from or on said land, that this survey was
prepared by me or under my direct supervision a�d that I am a duly Registered Land Surveyor under the laws of the State
of Minnesota. As surveyed by me this L � T H day of S E P rE nn BE A , 1 g�_.
p.o. box j. osseo, minnesota 55369 ❑(612) 425-2181
FileNo. J`090-/ e�k /96 pepe 71
by
Minnesots R�pistraUOn No. � J� 5,
Consulting
erx�r�eers
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