AF - 45148�UILDING PERIl�IIT
Vill.age of Fridley, 1Vlinn. N° 2 4 3 2
Date �� � : . . r� . . `"" �,f �,,� . . . . . . . . . . . . . .
� .1° ? �' � �`' .� �1 c.'.°'�.s
Owner �� �� ` . x .'�:' . :"`. . : 4�:r. . . . . . Builder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. .. ..:�...
Address :��.'�. :�:�. .��. �.. . �°'.:'74''� ,, ,,;.,„....;,,,� Address . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. .
.•
F ... � ��'..����
LOC�TtO�i C�F BUILDING
No. ew�v�.�'` >. . . . . . . . Street,, r. r. '� ��: : �:�:�:"? . . . . . . . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
� � . '''�"
Lot . . !� r : . . . . . . . . Block . . . . .�. . . . . . . .. . Addition or Sub-Division ��. �: �.,� �.�.�i:`,',�: �:� , ,�'�� ;!.: �#=:";�,r1. . . . �
Corner Lot ...�!:...... Tnside Lot ............ Setback,,.�'�,�.�...... Sideyard���.�.....�.J� .............
To be Used as:
r , y
� �'�,: : ` .:��':. . ... .
DES�CRIP7'IOt�d. OF BUILDINC
r � . �, �. ,,�j_ '�{�'
Front :�.�:�:°�:�..� Depth s:�:°:�.... Height*� �''SA':�!, Sq. Ft. .��.�� Cu. Ft. ........
.................... Front ........ Depth ........ Height ......... Sq. Ft. ........ Cu. Ft. ........
�` ` " °"' � �%' �'"
Type of Construction ,. j : .�:': :`.`�r�. . . . Est. Cost ,. ... . . . : � . . . . . . . . . . . . . To be Compieted �� °.':'.' �:�: �. . . . .. .
x
In consideratidn of the i•ssuance to me of a per:nit 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 Fridley.
�
��.,� . � ��i��?.t% �..a'rrv' `�.Ii.�..._y+r.:���y„__+«.+a_.._ ...
� ,.A7
r In consideration of the payment of a fee of $. ,� �-.'• permit is hereby granted to .�G '' 3�
��+' a a _,,p ;i t . . . , ,:. .�:,, :.,-. �:.r �-. � G�: . . . .
�. : .......,... io construct the buiIding or ad dition as described aiiove. This permit is granted upon
the express condition that the person to whom it is granted ancl 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, aiteration, 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. � �� ' ,.Y^�-.
%' ,�
t ,e"' �r ,� '''�t,,;'� �� �
. � .' y d v . � .. . ,: �: �;d'�ilding Tnspector
NOTICE:
This permit does not cover the constrUCtion, instalfation or alteration for wiring, plumbing, gas heating,
sewer or wa#er. Be sure to see the �uilding Inspectbr for separate perr»its for Yhese items.
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� � SuBJECT . �
City of Fridley
;,
AT THE TOP OF THE TWINS g U I L D I N G P E R M{ T
� �
� • COMMUNITY DEVfLOPMENT DIV.
.. ' jL'�---'- �
r � � PROTECTIVE INSPECTION SEG
� � �
� ' �"'1 � CITY HALL FRIDLEV 55432 NuMeea REV. 'onre
�"--•�•� ,•' b12-571-3450 9� 0-F15 3/20/80
�oe aooaess 5271 Fillmore Street N.E.
1 LEGAL LOT NO. BLOCK TFiACT OR AODITION
DESCR. ],t� 4 Horizon Heights
2 PROPERTY OWNER MAIL ADDRESS Z�P
Allen Smith 5271 Fillmore Street N.E.
3 CONTFiACTOR MAI� AOORESS Z�P
Mi].ton L. Johnson Co. 2513 Central Avenue N.E., ls.
4 ARCHITECT OR DESIGNER MAIL ADDRESS Z�P
5 ENGINEER MAIL ADDRESS ZIP
6 USE OF BUIl.DING
Residential
T GLASS OF WORK
O NEW O ADDITION X ALTERATION ❑ REPAIR
8 OESCRIBE WORK
!
9 CHANGE QF USE FROM TO
STIPUlAT10NS
SEPARATE PERMITS ARE REQUIFiED FOR ELECTRICAL, PLUMBING, HEAT�NG, TYPE OF
VENTILATING OR AIR CONDITIONINCi.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCE0. NO. D41
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OFLAWS VALUAT
AND ORDINANCES GOVERNING THIS TYPE -0F WORI(' WIIL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 3 I
OOES NOT PRESUME TO CaIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT
PROVl510N$ OF ANY OTHER STATE OR �QCAL LAW R€GULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. SZE
S�GNATURE OF CONTRAGTOR OR AUTHOR12ED AGENT
BUIL
SO.
STALLS
PLAN CHECK FEE
�DnrE� WHEN PROPERLY
s;
IDATEI 6LDG wSP
PAGE Of
/ /
PER .
° 15628
RECE�PT NO.
APPROVEO BV
SEEATTACHEp
SHEET
PHONE
571-2274
PHONE UCENSENO.
781-9548
PHONE UCENSE NO.
PHONE LICENSE NO.
❑ MOVE ❑ REMOVE
GROUP OCCUPAN^.yLOqD
CU. FT:
OFFSTREET PARKING
IGARAGES
TOTA�FEE
519. 5
D THIS IS '
IT
CzTY or r-�zn�CY
Ai?f'LZC/1TIGi�� FOR f;ESID[:f41�I/11_ f3UIl_Ul(dG f'CR(�1ITS
, (idetrr, I�lter��l:i�ns, Adciii;ioi�s, or 12cpairs)
av�r�ca: � /� � N �m ; � � ,
,
ao��tcss: -S� 1 ���-� � �,
TEL �0• -�" � i `-� �� �
.
� /.�
� UI Lf)Ef� :�,' �� r� � c��N�s �� C-.�
ADDRFSS: o�sl� �� n1 T2�1 � N�
7EL I�O: % �/ — y � `� �
Const��uction Location
sTr�� r�o : -s � 7 / s�.��u:�T: � / l rh ��,�. � � �
L07': I� BLO�Ir.: l�7- ADDITION : -/� i G^� /� E�-� i D--�
__ t� _ �
Corner Lot: Inside Lot: Se�bacY.: Sideyaxds:
�PP�zCani� attach to this form two Certi�icat.es of Suxvey of lot and
pzoposed building location dra�an on certif�cates to scale.
DESCRIPTIO(d OF CO�dSTRUCTION
�� i'ront: l�pih :
Squa�e Feet: Cubic Feet:
Front:
Depth :
Square Teet_ Cubic Feei:
Height:
H eight:
1`1�{�y�Jlir �T �•%�//I C� ✓�9`
Type of Construction: y °- � Estimated Cost: $^�; �� �
�-.� d— d-61-� �
7.b Be Cbntpleted: ,�l�Q_ �, � ��c>
---�
Proposed Dz-iveway j�id.th If New Opening ?:S n�s.irea:
�
Alt. A Alt. B
$� $
SE� 2�EVERSE SIDE OF SHEET
2'�e undexsigned hereby makes application tor a pe�mit fo.r the c�.�rk hei-ein speci�a.edr
agreeinc3 to do al.l work ir, s�rici: accord�uice �oitli tlie City o� Fzidley Ordinances �id
�-ul.�iac�s of the Depart-nient of I3uildings, and hereby declares -L,lat all the facts and
xepre�entations statcd in i.his applica i n are true and r et.
DAZ'E : �- oL..Q �J S Z Gi�A7: U I� • ��-,�-- �
Stipulations:
��.r-,�=����'
,� �a.� /, So
/9� ��
� �.�
sue�ecr P .
c�ty of Fridley � � � � ��
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � R
� • COMMUNITY DEVELOPMENT DIV. ����
� � �.------
r � � PROTECTIVE INSPECTION SEC.
' � �'��1 ' CITY HALL FRIDIE� SS4,3Y . NUMBER REV DATE VAGE OF APPROVEO B�
�""'��� �'' 612-571-3450 9t0-F�5 6/30/97 � �
JOB AODRESS 5271 Fillmore Street NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1�+ 4 Horizon Heights SHEET
2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE
Melony Prairie 5271 Fillmore Street NE 586-0464
3 CONTRACTOR MAII ADDRESS Z�P PHONE LICENSE NO
Midwest Siding & Roofing 18979 Gladstone Blvd, Maple Grove MN 55311
4 AFCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
416-4804 20010277
5 ENGINEER MAII ADDRESS ZIP PHONE IICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (18 Sq) 2nd Layer
9 CHANGE OF USE FFOM TO
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.
TVPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAO
SEPARATE PERMITS ARE REQUIqED fOR EIECTFICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUII AND VOID If WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAVS, 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 OPfSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF IAWS VALUATION SUFTAX
AND OROINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED � 1� 116 �. 56
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL 7HE pERM1T FEE SAC CHARGE @
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 4O.2S Fire SC �pl.IZ
STRUCTION OF THE PERF M NCE OF C STRUCTION. �
PLAN CHECK FEE TOTAL FEE
�jl�� License SC $5.00 $46.93
SiGNA1UREOf CONiRnCTOFOAAUTHORi2EDAGENT �DATE� WHEN PAOPER ALIpATED TH�S IS� RMIT
s �,
�fN �
S�GNATUAEOFOWNEAUFOWNERBU0.DEAr iDATEi �p INSP ��FTE
NEW
ADDN
ALTER
t)
�)
��
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
4
CanstructionAddress: �d�� 1
Legal Description:
Effective 1/1/97
�33 8�
Owner Name & Address: 1 Tel. # � g�— Q� �
Contractor: �
MN LICENSE # �� l l� �-J �
Address: �\/ Tel. # `-� t� �Z-�,gD4
� Attach to this application, a�ertificate of Survey of �-%e 1� 5��j � �
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GA.RAGE AREA:
DECK AREA:
OTHER:
Length
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width Height Sq. Ft.
. Width Height Sq. Ft.
wi ound Sq. Ft.
�� � �� ��� � �
Construction Type: Fs�t st: $ ` %//�,
� (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + b Ft = Ft x$ _$
DATE:S` ���� APPLICANT: Tel. �# �� ��— (/
�"U�t D .� �,�rl�_ � �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ -��� Fee Schedule on Reverse Side
� %. /� .U01 of Permit Valuation (1/10th%)
� • ��o $.501$1,000 Valuation
� $950 per SAC Unit
$ S� OQ $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 [ )
$ �(� .
�•�
,,, . _ �
FROM :City of Fridley
Buil,difig
Inspecti on.s
. 763-572-3f04
FAX N0. :7635711287 Mar.
surLDYNG
R�SIDENTTAL APPIIICATION
CTTY� OF FRID LEY
GAT� J ' L .,G�. .._ YOC1R L-MAIL Af)PR.�SS _._. .
srrr•. nn�x�s. .__... �._.,��% �'/� ���t/'l Z1 ��f .
T
7'HtS wPPilc:nNT IS: ❑ UWN�tt �CONTRr�CTOR
�kOPERTY OWNFR/ � � � �
�
27 2006 12:34PM P2
---�-
1'er.mit No.:�(' L'
Rcceived 13y:..�_,> .
Date Rec'd:��a �
..��
�
. . �. .NAME; �/
TENANT ,. .. .� : - ' '_--�._ * _.. . _..:.- ..-
Af�fJRNtiti:,, _.._ �-.��/� — ....__ CITY_...��.P .� �L
� STATF��✓/.IP... . .- °? �
4"ONTRACTOR
Si19M7T A COPY OF
YOUR STAT13 LfCENSL'
WfTH APPLICATION
PRUP�RTY '1'YYE
Y�RM�T TXPE
TYPE UI� WOlZK:
YHONG• _...._.. . _._.
..:...,. ... .._
—...........� . ._.:._....---
Nn1v�H, taC��l{�C� & R�MODELING. lM�:IC; _..... ... .
. .. �--
—'�C7iJlTEXCELSlOR BLVD. p�,P nA�r�_._„ ��� ` 3 7
STATF L1GF:.NSh��,}fis.p.� �rr�1�
ADDRESS: ' , C7TY_" . . STATL• 7.iP_.
....,.,._.a.zs��-��-r—.._.... . _.. _.._. ._. — . . . .._.
PI3D1V� d� ` -�� ,�° r^'� w.. .�.... ,.
SWc3LE FAMJL.YMPw (;c7NS�1xUC:TI�N ,� S►rr
❑ 7'WC) FAMl'LY/NL•W GONSTRUC.TIUN STOIiIES _,_____
___, . � ............ .. ......�_
❑ nnn�ruaN C3 GA�tAC.klSHED O WIN�C�WS
❑ I'3ASCM�Mf fIN1SII ❑ Rr.x.)r ❑ DRA..W i�T•F:
❑ nPC:x ❑ sm�rra �.'o�xrat �
.._ � ❑ S1NIMMING POVL , . ..._..
❑ IdEW ❑ AUlll1'ION
'�MAfN'i_�NANCTJfLLI'nIIZ , ❑REMC�AFLING .,,
1�ESCRT.F3F WpRK BETNG DUNE:
ST .7.E QF 1 M.�'1ZU V�;h�fl?NT
NiJM�t�R OP SQUA1tES
GARA G�S
P12C1!'Qsxb SIZE: ...._..__
PTt01'OSED FIEIG�IT:
SIDING
❑ Vinyl
Gl A.luminum
D C�llt�•
LENGTI3 " WT,t�TH
.,,..,....._ - —
� HOUSF pN1..Y
❑ HOUSC & GAIeAe��
❑ A'!"TA(;Hrb C,Akr�1GE
❑ l')L•.TAC:HLU Gt�RArE
❑Snffit
CJ Trim
❑ Ru,c:iai
m
ir1G^ �/�/ . _....., _._
I•IT.IGHT _, „_. Sy. �'t.
$ASTMiN'I' RCMQD .i,1NG Si JAMT'f:
1. P,xictirig l�lnor Nlan
2. T�'ropoacd Ilu�r plan
3. List of suY�cmra] ntcmbers ta be used
Ff.)I2 NF;W (:Ci1VS7'RUCTION INCLUDING nF�c:KS,
ADD.Tfj.OTj$,,yt. '.I.S�RCHRS SUHMI'1':
� i. Sile Plun/3urvey sltowing the caisting sr.ructureti
and praposcci projccc.
W INUnWS : TWO SM.a of conRtrucli�m plxna
IN EXISTING C�PRNINGS �Yen ONo LOrATTC�N OF WTNIx)WS 3. ��c�gy Calculat.ions
OR PoR NEW �PhNINC;S-o}:SCkI]3L SiZE OF __ _._, , � _
UYEN IN'C GiihNGL•5 &
TYPG OF WTN]�W Tn F3F iNti7'AI..L�ll ___ NTII�RRR UF WINUUWS ,,,,,W_ . '
ALi FFES�AIi�: BAS�:� ON VALL�ATTQN, TNCLUll1NG '1'1{L+' C4ST nF L.4SU12 ANll MA'Y'LRiAL�S:
(USiNG THE 1997 ' .B.0 FEE SCHEDULE}
�'OTAi� .IQB VALiJATION $ �:7b_ � QCCtJPANCY TYI'E
.. � �... . . . ...�.�
. . . .. ... _ _ _ _ . ..
1��t�nit �ee $ '� ,��"� �� S�e �3ack Page for Fee Schcdule
Plnn Rcview $__ r GS% �f ]3uilding Pcrmit :L ee
Fire Surchargc $� H �3, � ,001 timea the total job valuation
fiurchargc $ / Qd .OU05 x Pcrmil Val'uation, Minimum $.50
Licanse�Surcl�ar e � �� �
g , 5' SS,00 (Statc i.,iccnscd R�sidential �'ontrar,tc�rs)
SAC Charg� .+$ � _ $1550 per SAC Lhut (I'lans to MWCC for dztanni�ltion)
__. . .
C�rb Gut Escrow $ ft + 6 ft = fr x S20 =$_,. .,_ _,,,_.,,,
L-r.osion Control $ $4SU Conservatioa Plan Review
Park .l ee $ � Fee T�etern��ned by, Engineeriag
Sewer Main C:harbe $ i\bn�;c.-mtnt nccessxry O Nob Neccssary O
TUt�I Dl1e ' $ i O .. Mxke cUecks oavable to: CitV oP FridleY Atts�clt Sti1�l11•rtiun!t
THTS tS AN APPI�I(;A'1'R)N 1�OR A YL12MT'i-NOT VALfP UNTiI. PRC)C:Fs.tiS�U
T hercby a�p1y !"or a b�uldin� pornul and T acku��wledge that the inf'omzatiun dbove is cuutpl.ete a,ud accurate; that thc work will be in
cuul"orcaia.ncz wit�� zl�.e ordi��ances and codcs of thc City of rridlcy an� wi41i 1Jae M���ilesota Constructiou Coc1e�; th�i. T u.ndzrstand rllis is not r�
par�.rjt hut only an applicatiun fuz d permit aAd work is not to y�rt wilhi�tlt a petlrut; tliat the work will be in flccord�uce witli thc :�pproved
plfl.�.l.t� td�e ca.se of, aI� wnrk which requires rcvi- a p�ra�al of�+l�xLS, /�
SIGNATUI2.E OP APPLJCANT ���`� . PRINT NAML•�r�� _ t/c,�.,�, �% I>AT�___�„LyC�./
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4100 Exc�{sior Boulevard
� �' ' , CONTRACT
St. �ouis Park, MN 55416 �ti . ? `• "-
� : ,� . <�.
Office: 952-836-1335 ��.,��� ■ Licensed
_. �..
St. Paul: 651-644-0040 - ■ Bonded
Fax: 612-823-1078 _�'� � ' � ■ Insured
a. :.;
www.crownmasonry.com C R O W N
MASONRY
� � �.
PROPOSALSUBMITT TO PHONE DATE
f� � lv � - �� - ��o = —�6
ST EET JOB NAME
�O� � r� �.�1�'i9 L—' .
CITY, STATE and ZIP CODE JOB LOCATION
r� � / �
ESTIMATOR CELL PHONE ATTN: JOB PHONE
S�� Ic� ul`�!'�r� 6� '� p�—
WE PROPOSE hereby to furnish material and labor — complete in accordance with specifications below, for the sum of:
Payment to be / � ��
made as follows• �i � '�� L � �,/ _1%�/�����`Q�i�/1 dollars ($ ����� � )•
T-7'
n i
When Siqned $ Upon Start $ � Balance to be Paid in Full Upon Completion by Ow�er $ �(��(/
All material is guaranteed to be as specified. All WORK to be Estimated Start Date:
compieted in a workmanlike manner according to standard practices. Weather Permitting —���
Specified work and quoted price subjectto change upon discovery .
of hidden defects. All agreements contingent upon strikes, accidents Auihorized
or delays beyond our control. Owner to carry fire, tornado and other Signature
necessary insurance. Our workers are ful�y covered by Workers'
Compensation Insurance. Products and materials may be substituted Note: This Proposal may be
for equivalent products due to availability. withdrawn by us if not accepted within � days.
We hereby submit specifications and estimates for: Page No. � of l Pages
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