AF - 45085Date:
Owner:
Address
City of Fridley, Minn.
BUILDING PER.MIT
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No. . � �
.. �-._�_��.. Street
Lot ...........�.7°�.�.... ....... BioC
Corner Lot
Sewer Elevation
� l,�CATION
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N° � 460'7 �'
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Builder .....,�t.� ..: .. ..... ..: �._....:.:.::t°..`_..t�._��:�....�::=�"-� •-•---........
Address ...... � - --
.--rr..:._-.�^�.� ....::::�:s��:...r..::�'.°'f•- � -� -���i��-�Part of Lot
. .... .. ......_.....
.... Addition or Sub-Divisio �...._ ����,.�.�'4,,,:�`-x,,,� � g
k -- --_ _... .._ ...... �: �x...f�;.l._` �� . �.
.... ....
Inside Lot .. ........ �^^'"'`�..._.. Setback ..........:. ._�............ Sideyard .------....... . � •
..
Foundation Elevation
DESCRIPTION OF BUILDItVG
To be Used as: �, "
{ •� r°f � ,�" �
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. `�s �` �`�� � ��,.� �a� Frdnt ��. _ ��Depth �_� ... �Height � �: . S Ft ,�''. �t _;
�w 9• � ` E
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,�.�` 1g r�,�. Sq. Ft ,.,�af...�� .....
., fN� • ""t." e f� •y ¢ Yj f.', � Yy�...:y�^
Type of �onstruction . ; - �;s �' :�,:_,r =�,t' __ Est. Cost ` � � `� ��
� � -; � ,,:�. ...... To be Completed ...
� �,
Cu. Ft.� ��.�. _'�`�
Cu. Ft. � t� ,� �,.,
In consideration of the issuance to me of a permit to construct the building described abave, I agree to do
the proposed wark in accordance with the description above set forth and in campliance with all provisions� of
ordinances of the city of Fridley.
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In consideration of the payment of a fee of $.; ..� ...................... rmit is hereb
� Pe Y �'anted to....... - ...............�-- ..._........-- - - -...
•--•--••-•------•••••••-�---��-•----�� ................................ to construct the building or addition as described above. This permit is granted upon
the express conditian 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 confarm in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, rep&ir and moving of buildings
O'�n�th�e. city limits and this permit may be revoked at any time.,u�}��iolation Qf any of the provisians of said
Building Inspector
NOTICE:
This permif does nof eover fhe eonsfruelion, inafaliafion for wiring, plumbing, gas heafing, sewer or wafer. Be surs to see
the Building Inspeetor for separafs permita for these items.
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� SUBJECT � � IT .
City of Fridley � 79 � 2
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AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
� � RE •
� ; v � COMMUNITY DEVELOPMENT DIV.
r � �� � PFOTECTIVE INSPECTION SEC. /� 3��
1 � i
� � /'�'1 � CITY HALL FRIDLE� 55432 NUMBEF REV. bATE � PAGE OF APPROVED BV
�""� � ,�' 612-571-3450 9t0-F15 4/16/85 / /
10B ADDRE5S g222 �illmore Str•eet N. E.
1 IEGAL LOT NO. BIOCK TRACT OR ADDIT�ON SEE ATtACHED
DESCR. 5 1 arion Hills AIC�C�il't.].Ori SHEET
2 PROPERtY OWNER MAIL ADDRESS ZIP PHONE
Raymond Forss 5222 Fillmore Street N.E. 571-8513
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
: dICte
d ARCHftECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE UCENSE NO.
8 USE OF BUILDINO
Residenti.al
� cuss oF woaK
❑ NEW ❑ ADDITION �1 ALTERA710N ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Tnstall alwminum sof�fit & tz'ini � ���%
9 CHAN(3E OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE HEC7UIRED FOR ELECTRIGAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHOFI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABAN�ONED 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 ANO EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS YALUATI�ON� � O SURTAX
AND,ORDINANCES GOVERN�NG THIS TYPE OF WORK WILL BE COMPUED
WITH WHETHEF SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT y�. SO
pOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
5TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ZS OO
P N CHECK fEE TOTAL FEE
$15. 50
I A?UREOFCON�i7ACTORORA THOAIZEDAGENT IDATEI WHEN FROPERLY V ATEO�THIS IS YOUR P MIT
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$i NATU OFOWNERU OWNERBU�LDERI IDATEI 840G iN.SP � qpT
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ADDN. [ �
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Conatruation Addreaa:
Legal Description:�
Owner Name i I►ddress :
Contractor: .,Lz�
Addresa
City of Fridley
R-1 A�D R-2
Building Permit Applieation
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Attach to this application, a Certifiaate oP Survey of tbe
lot, with the proposed construction draWn on it to aeale.
DESCRIPTIOIf OF IMPa0Y8l�NT
Effective 4/1/84
�
Tel. �
Tel. # 8 �`�
LIYIi1G ARBA: Length Nidth Height Sq. Ft.
QARAGE ABEA: Length Nidth Height Sq. Ft.
DB�: Length iiidth Hgt/Ground Sq. Ft. _________
ViAiiA: � JII( NL�.-,/ % ° T� [ / L`i � Y�-��� ' � 1 -
Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setback
Type of Construetion: Estimated Cost: � �CX�
Approx. Completion Date:
Alt. A Alt B
Proposed Drivexay Yidth If NeW Opening Is Desired: � �
See Baek Page for Explanation
DATE: �—f APP� ANT: Tel .#�71 g'31
Permit Fee
Plan Check
State Starcharge
3lC Cl�arge
Park Fee
Sas►er Main Charge
?OT�1.
STIPULATIONS:
CITY IISE O1�I.7
� /.S• Q O Fee Schedule on Reverse Side �
� 25f of Building Permit Fee
= S� �•50/�1,000 Valuation
t =425 per SAC Unit
; Fee Determined bq Engineering
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Agreement Necessary [ ] Not Neceasary [ ]
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sue�ecT PERM
City of Fridley �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��'��
r
� � RECEIPT NO.
� • COMMUNITY DEVELOPMEN7 OIV.
� � �.--•--- Q�"! a(J
r � � PROTECTIVE INSPECTION SEC.
� �
' � �'��1 � CITY HALL FRIDLE� SS4,32 NUMBEA FiEV DATE PAGE OF APPROVED B�
�""�' ,'1 612-571-3450 910-F15 5/7/96 / /
JOB ADDRESS
5222 Fillmore Street NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 5 1 Marian Hills SHEE1
2 PROPERTY OWNEi; MAIL ADDRESS ZIP PHONE
Ra ond Forss 5222 Fillmore Street NE 571-8513
3 CONTRACTOR MAIL ADORESS Z�P PHONE �ICENSE NO
Same
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE UCENSE NO
6 USE OF BUILDING
R d
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION O REPAIR O MOVE O REMOVE
X
8 DESCRIBE WORK
R 1 ce
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOFi ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTqUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PEHIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VAI.UATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE Of WORK WIIL BE COMPLIED
WITH WHETHER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT �1SO �.SO
OOES NOT PFESUME TO GIVE AUTHORI7V TO VIOLATE OR CANCEL THE pERMtT FEE SAC CHARGE
PiiOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFORMANCE OF CONSTRUCTION. �2.1 .00 Fire SC �. LS
PLAN CHECKfEE TOTALFEE
$'11.65
7 �'y1�(,` AUTM� �_� iDarE� WHEN PFiOPE VAUDATED THIS IS YOUR PERMIT
/ C. �C�—� � L!V r � / !.L
SiG TU NERiiFOWNERBUILDERi IOATEi � Bl INS� DaTE
NEW [ ]
ADDN [ ]
ALTER []
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/96
-%�10 �
ConstructionAddress: _ ��� �'a'� %`� / L �jo� � �/�G .
�
Legal Description:
Owner Name & Address: �%9 J�`yjoh� � ��U fc S�' Tel. # S� i/ ��%�
Contractor• ���-� - - -��. --. - ;s:,��.-_____ ..G��- `-,� c MN LICENSE`�� ^
Address_��. -�� a�3�—._ �'f2 ��,� �— � —7�i.,� Tel. #-`.•"� � ��1
- �� n _ _ < ` T---__.._.
�lttach to this application, a Certifi�ate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: _�ZG���/3-c- c,� �O lsc-K. �� S��—
Comer Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $ /.SC �
Approx. Completion Date: �
(Cost on Back)
Driveway Curb �t Width Needed: Ft. + 6 Ft = Ft x$ _$
�
DATE: APPLICANT: fj G- �'i� 5 S Tel. #%�� �' ���
G/ � NLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Eserow
Erosion Contrsl
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ .�'/. OD
$ . /S
� .�n
$
$ '
$
$
$
$
� �?l. ���
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth°�)
$.50/$1,000 Valuation
$900 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ) Not Necessary [ )
_ y _ .t
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ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�z-36u4 r�aac.:
: 5222 FILLMORE ST NE
: 253024220021
: MARIAN HILLS
: LOT 5 BLOCK 1
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
571-12If7
PERMIT NO.: 2004-01308
DATE ISSUED: 08/12/2004
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VALUATION .
NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. CHANGE SERVICE AND BOX.
200;200 # 0-100 AMP CIRCUITS 15
APPLICANT
SHERWOOD ELECTRIC
� 1211 OLD HWY 8
NEW BRIGHTON, MN 55112
OWNER
FORSS RAYMOND L& MARIE I
5222 FILLMORE ST 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 eacamined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date.
STATE SURCHARGE, ELEC FLAT
ELECTRIC FORM FEE
ELEC AMP SERVICE FEE
ELEC CIRCUIT FEE (0-100 AMPS)
ELEC PERMIT FEE - MAX (RESI)
TOTAL
PAID WITH CHECK # 3171
��YAKAl'r; Y�KMf15 K�CZU1Kr;ll r'UK WUKK U"1'H�,R "THAN llESCK1B�D A13UVE.
0.50
1.00
0.00
0.00
85.00
86.50