AF - 42798�,� a���.�
City of Fridley, Minn.
^ BUILDING PERMIT N� . 7 0 3 0
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r.. _ Address .— _..___..__.—..
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� � TIO F BUILDING
No. 1�..�=? Sts+eet � �._.�.,(�..L._. Part o! t ._.�.�
Lot ...� � __ Block _—r._.,�.—._..._..__ Additiaa or Sub-Divlsio�, ._. _ _.._.._.°
Corner Lot .___..___...._ Inside Lot __.._ 4� ._...._.._ Setback __��.._____.... Sideyard __.__._.�.Q _....,,�s6�! ._.._
Sewer Elevatiaai __.____..__...______._.�._.._�._.._._..___.._ Foundation Elevation
� DESCRIPTION OF BUILDING
To Uaed
Front ��.. Depth �� Height ..,��_. Sq. Ft �=lQ.L� Cu. Ft .l�,c.E',�'
� ..�..� Fro t_._. Depth _____� H t._..__.� Sq. Ft � Cu. FL _
Z�►pe oi Construcl3� FBt Cost ..�!��(�� �o be Completed _.�..
OUTSIDE Ar PEAR�NCE OF TNlS E'UILDIf��u F.'UST BE OF
APRROVED VA�IAhCE WITH OTHER BUILDINGS IN THIS
BLOCK. -
In co�nsideration of the issuance to me of a permit to canstruct the building described above, I agree to do
the proposed work in accordance with the descrlption abave set forth and in compliance with all praviaions of
o�dinances o! the dty of FridleY• � „
Ia cansideratioa o! the PsY��t o! a fee o! ��_°/ ., pennit is herebY Sranted to�
to c�struct the building or additi� as described above. This permit is granted upon
the exPresa condition that the P� to whom it is granted and his agents, employees and worl�en, in all work
dane in, around end upoal said building, or ax�y gart thereof, shall oontorna in all respects to the ordinances o�
FridleY, Minn�Ota re8ardi�►8 locatt�y construction, alteratio�, maintensuoe, repair and mavin8 of buil�
within the dty limits aad this permit may be revoked at aqy time upon violatiar► of aqy � the P�visians a[ sa�d
o�inancea. � . � �1
Butldin8 inspecta�
NOTICEs
'INs p�e�it do�s eet cewr tla eaahwqie�, faMqMie� Mr vrkMO. P��W fas hwNp, s�ww e► wMa. !� wn M sN
1b� �uildip 6ap�lor for s�pwlr p�whs fer fl� 11�.
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Oi�ll�ER' S �aF M �}C � i4 S �.�' � BUILDBR . , � : �'�rc�r:�.�- _. �: ., k;..r
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LOCATION OF : ��A�,A�i . . . ;� . , :.z � � � . � �: �
I�A. .r...10..�4:•���� �. -�:;.. �s.,S�zee� _ .�. ,� a�z�;of.�Qt,__
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Lot� Y. Y 9 � si���,� ,� 'a�. , _ .. ���. �� . ��..r,�..� ��� -
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- . . �ic�; �r � � ,b_ h,,�,y_ t�, �• _ b I�
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corner+ Lot�_Inside "bot� (� . serback � { $ ,_
�� �: .�: ����Y�.xt ���-i�.�, i�� ,
SBWER EL�VATtON �. � _ FOUNDATION ffi.EVA1't0� •. - • �+ � �
, .. . � ,_.� - -
A�pli,�aot .attach ,�P..�1��,s ;�os�n :Tao �a;t���catlra�, of:�S��eY�;c�:�Lot=;�ad:Yp�'opp:Od build-
ing�qg�t�on drawg_on.•�l�e!�.�t�if��gs , . , . , . , _c � -,
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DESCRIPTION OF BiJILDI�IG
%r.�"^.rJ.n J.'T f 3'^�
To be used as : . ._. .� �
I,_ �.. � :,..; ..,. �. .. , .'4.J J..;.;�;J ..,r ( �i`J Y.i'3t ! tav.,'tr ti ':' �e?'' �3� 7 � t1 .�
,.. . ,. , 3. ' . .. .. . . '. f, j�� �r �'-
�''n.w ��j.F � � L .� }Tr�, � ' �� t:i�irYrr.i:i.ii.� °�' "'' 2' �r:.' �+B+N�r _t. i' ;IrCti �:�
. ! i r i �r�e' i I�i.^r ir �� r'�rr:�+. � � �ii.ii�.+�r�
, ' •1 _, � r( � ; � , . ••t. ; '_, , . �. �, � r K�O
•
. . . . .. . ., . " . � � �'� $�, i� r i 1 �7i1 Q.�, �t . rrrw�-+v�F+� �lJ� � i?I : � te� -
r ' � , 1 ji t i: F3tj S � -• r�
. - , .. . . . . . � . �. . � . , ., ., .. . .. . � i. .. . , ... . . . .. .. . .. .
Froat �, �.Dspth Height
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T � o Cons �ruct . k � ��,• � � ' � �
YPe � � �!R .,.;,. �i �� ':L ,.._:..�:�'t�wa��d �a�C � ��r�O�.Q � .
. To be 'Ccmpleted , � ,. :t .. ,.,��.a � c:� � � _ � .. .. �_ _ . �� , . ; . , .
.� - �. � - . . > � . . , . :i - _ ,i�. ;') ';? � e.;•�' .
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The undersignec� hereby ms'kea applicat�o�, �cL,�4,��,�., fp� t.#.e►.,�t3� �r��r,�acified,
agreeing to do all �ork in strict accordaace �rith the City of Fridley Ordinsnces and
ruliags. �f, the D�p,�r�Oep�„�p£;By,�d�„�8s�,_ aa�;��'�Y:;�tc��,�,r �irt �lr,:zhe facts and
representacions atated in this applicatioa sre t�te, �dr-,c�acr�sa�.; �>c� �•f � �.
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�Schedule of Fee Coats caa be found o�n the Boverae Side).
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BUII.DI�TG PBRMIT FSB S(�EDULE
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Sectian 2. The ��gC� �er�'- �af�'�'��s s��l�l, ��efore issuing any permit for
the erectioa of nt�p building or structure, or for aay addition to aay exiet-
iag building or att�t�`�;-=�r< � e�a�► g'lteta�ions or repaira to any euistiag
building or structure, upon agplication therefor, require the payment by the
applicant for such permit of feea tv the amount herein below set forth and
ia the mannex here�a provided to-wit: .
_ __ ___.....__ �_�_.,_._.. . ---_.. _._. _
_ _ . . _ _
2.1. For any such permit for the erection o.f any fire-proof buildinga, other
�., , � :
_._._..Cl�...a.�r��, _r��r�ha�e.e,�-�act+o�`�.flt::.graia.elevr$tac,..or_._£or t#�e -erecti�dn �of
any fire-proof additioa, for similar occupancq, to aay exiatiag building
shall be at the rate oi $1.40 for each ane thousaad cubic feet, or fraction
thereof, in sucb cubical��'cbtiE�ei�s . ' `
_. _ 2�y�. F��t"e�Y-. �b..p����_...Chs..e.rettioa-of..an�_ fir.e�»proof- garag�,� wareha�se,_
factory or grain eleaator, or for th� erectioa of say fire-pr�oof addition,
.. ._..�for_.$��7lc _+�s�P�z���: 'to�-ti��t��exi��titig=buf�diag._sha11--.be at the rate of $1.25
fQr each one thousand cubic feet. classified as "fireproof" by Section 502 of
.. . ., ; , , ,
.
_ _._ ti�_��_.g+o�����a���a�s�ae� _ . , _ . . _
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;. �,;3; �<��t�r' +�y:%stitc��pgi�t� fa� .��e- e=�ctfau o�' 'ett�r noa�ifreproof building o�hez
� than a garage, warebouae� factory or•g�atn el�iator', -or� auq noa-ffr�proof
additiea, for aimilar occupancy, to mny exieting building - permit $1.00 for
each one thousead cubic feet.
,;_,-� __ ,
GAxAGBS
�_
2.4. For any such �ermit for the esectiaa of any aon-fireproof garage,
_---. _war�hqus�;.;�f��cL�t,.�r_.g�cmitii `+�'�es�atnr., :ar._..fa�r �the_ .e�ect,ioa _ o€• an,� �-€t�aof
additio�, €or--similar occupancy, tp any existiag building or for each such �
-���8., ��__��iott�--_.�at�ty r.e�s �$.0.90� fcYr� each one thousand cubic feet
or fra�tiai thereof, in the cubical coatents thereof with a minimu�m of $4.OQ�-
.. . . ,._�... ._._... _ _ _. . _
_._.
For the purpose of camputiag fees for building,permits, the cubical conteats
of auy_ buildiag� o� acid�.t.i.�oi ta, a...uniiorm_ h8ig1� throughout by uultiplying the
ground area cavered from a point eix (6) iache8 below the �loor line of the
bos.0ment or cei� �t=�+��he� �v�zs,�_.�e#�t..� ..the t�Pper_..sRUrtace or to the
nverage height of the r�of surface of the main gable of a pitched roof.
_ _ .
. .. _ _ _.
2.5. For repairs or alteratioas to an eacistiag structnre, the fee shall
at the rate of $3.00 per each Five Huadred Dollars ($500rfl0) or frnction
� � ti�es+ebf=�i �e a�t �e�#� a1�"�r"oFos�' �lork.��� : : � _ �
_ . . ,. .. , .
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3�6� .=lalao 4�� s�a��^��.;���.
'ahas�ed-�or''a�►-permit, i�.p set forth in
Sectioa 2 be l�s� �ian� ��l►.�;; :� ,. ,. . �
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J�. C. c�oiu�1 a�d v4ssoecates, ��e.
LAND SURVEYORS
Anoka, Minnesota
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Telephone 421-6340
CERTIFICATE OF SURVEY:
JnSEPN M'AC 1 ASZEK ((2�`� I;�O�Ei�?2
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LOTS S AND 9
B�ocrc i, OAK GP.OVE A001TtON,
ANOKA COUNTY� M�hNESOTA
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I FIERE6Y CERTIFY THAT THIS IS A TRUE AND CORRECT REPRESENTATION Of A SUItYEY Of TF� �OUNDAICES OF TME A�OVF
DESCWiED IAND, AND THE LOCATION OF All BUILDWGS, TMEREON, AND AlL VIS�LE ENCROACHM9dTT5, IF ANY, FROM OR ON SAID
LAND.
AS SURVEYED BY ME THIS .....I.S..T..... DAY Of ...................M.AT.......................................... A.D. 19..��j....
N. C. HO{UM AND , SS�IATES, — LAND SURVEYORS
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City of Fridle�, M'inn.
6431 Univeraitty Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
��� a�aa Z33-1�7i
QRy,�; _ Dotig,las Rtdol� g�� Susse�j. �_
Addrees -��� F�i alP� � treet N_ F. _ Address �-1850 Como Avent1e
—
LOCATION OF BUILDING
�q, 664,� Street -�rid7ey Street N.B. __— ---_.... Part of Lot
±+o�t ---Q��,-.-T.— 81ock - 1 Addition or Sub-Division Oa3r, Gtove
Corner Lot ..._________ Inside Lot ,� Setback __._ __.__.__ Sideyard ______.�..
$evve� IIe�vatian � Foundati� Elevation
DESCRIPTION OF BUILDtNG
To be vsea as:
n_�,-��� F`ront _22—. Depth _.22-_ iieight _.1.0�.- Scl• F� _.�$.Q.__ Cu. Ft 1�.�.$II11
Front ._ Depth Height —._..�.. Sq. F't ....___..._._M Gti. F�
'j'ypg p# �� Frame �, �t .,,�1� 500 To be Completed $�� 1
Set slab elevation 4" above existing driveway.
7n ea�aideration of the issuance to me o# a permit to construct the building described above, I agree tq do
the P�P� work in accordance with the d�txiption above set forth snd ia compliance 'th all provisions at
at�ances a� the dty of Fridiey.
In caa�gideration of the payment of a fee of $.$�QQ_ , permit is hereby granted to h
to construct the building or addition as described above. This permit is granted-tipa�i
the express coadition 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 ordinanc�s o�t`
1�ildley, Minnesota, regarding location, construction, alteration, maintenance, repair aad moving of buildirigs
W3�� dty limits and this permit may be revoked at any time upon violation of any of the provisions o! said
i �� ��n Q� Buildit►B Inspecto�
CI�ARENCE BELISLE
NOTICE:
This p�rmit dws not eowr fh� eonsfrudion, instapdion fo� wiriny, plumbin9. yas h�aBng, twvK or waNr. 6� wn b aN
ib� 6uiWfn� Inspedo� fo� s�paraf� p�rmifs foe th�s� iNms.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
��S �:�����i�� ����.��, BUILDER: � ��ss ,
annuss :_�� �12 t 0�.-�� ST. ��,� � an�ss : � �SC� ��.�` �Y1c ��� .
,,/ �
NO :.��p L-��) , STREET :�� I. I� L� Y ST •- Iv •�_
LOT: S(-� G BLOCK: I ADDITION:��� �VQV�
CORNER LOT: INSIDE LOT:�_SETBACK: SIDEYARD:
Applicant attach to this foxm ltao Certificates of Survey of Lot and proposed
building location drawn on these.Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
ar� Front:_ �� � Depth: �-�.t Height: /b - - -
Square Feet:�_g� Cubic Feet: '�/ c�Op
Front: Depthr Height•
Square Feet; Cubic Feet:
Z�►pe of Construction: � � n � �����_Estimated Cost: $ � � � �Q�.�S a0.00
To Be Caapleted: I ST AJ� � �
The uadersigned heraby makes applicativn for a permit for the work herein
epecified, agreeiug to do all work in attict accordance with the City of
Fridlay Ordinances and rulings of the Department of Buildiags, and hereby
declarea that all the facte and repreeentations stated ia this applicatian
are true and correct.
• V �} F • . ( ►'�
DAT�. � �3 � � � I SIGNATURE .
(Sae Rrvar�e Side For Additional nformation.) r
� K � O 1 r ��-e /2 ti.� � ,
U 0 U z� � a^� t�J f� c� � e G� .�-e �;.
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.+�
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings 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 repairs to any e�cisting
building or structure, upon application therefore, require the payment by the
applicant for such pes�it of fees to the amount herein below set forth and in
the manner herein pravided to-wit:
UIVIFORM BUILDING CODE: 1j�pe 1, 2& 4-$2.15 for each one thousand cubic
feet, or fxacbion thereof,>in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building pez�its, the cubical contents
of any building or addition, is deterniined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average�
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
_. -__ rate_ �f $-3.�4.pe� eseh -€�.-ve hundred duiiars ($5�0.00) or-fraction thereof in
the cost of all proposed work.
1�
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Pe�nnits for construction will be issued a minimum of 24 hours fram the
ti.me of application, to allow for proper revie�a of the proposed structure and
of the canstruction site.
A Certified Survey af the lot, showing the location of the iouadation, once it
has beea constructed, will be required before proceedi�Q with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupaacy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said atructure shall not be used or occupied until a Certificate
of Occupaacy has been issued. -
$
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SUBJECT P
City of Fridley 15 2 6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r
� � RECEIPT N
� ; y _ COMMUiJITY OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. D 9
1 �
1
l.--_ � �r���,,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE � PAGE OF APPROVED BV
i• �� 612-571-3450 9t 0-F15 6/18/79 � /
JOB ADDRESS 6645 Fridley Street N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE AT7ACHED
oesca. 8, g 1 Oak Grove Additioaz SHEET
2 PROPERTYOWNEH MAILADDRESS ZkP PHONE
Douglas Rudolph 6645 Fridley Street N.E. 533-0352
3 CONTfiACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Sawhiors! Inc. 6325 T�ieloome Avenue 533-0343
4 ARCHITECT OR OESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAI� ADDRESS Z�P PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct a 25' x 20' Hause Additi.on
9 CHANGE OF USE PROM TO
STIPULATIONS
���aTE ��n�rs R��� �� v��c,;
HEAtING� �'IU�Ir1���iG �t� Si�+1�. �AR�G
� �t �1! l�cat vtiiitics
��NE • �tECTRf�. � �tc.
RFQUr�FO BY cAw
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC� Fi�CIE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. fT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PEfiIOD OF 120 DAYS AT SOO
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES �
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAlUAT10N SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�.2�700 �G.3S
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �%S.00
PLAN CHECKFEE TOTALFEE /
�l ��.��.� $19.50 $93: 8S , D �.e��
SIGNATUAEOFCONTRACTOFlORAUTHORIZEOAGENT IDA EI WHEN PFiOPERLY VALIDATED THIS IS YOUR PERMIT
��Cl C N
SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI � BLDG WSP DA
CITY OF FRIDLEY
�
APPLICATION FOR RESIDENTTAL BUILDING PERMITS �� �
(New, Alterations, Additions, or Repairs) '
OWNER: i]ou���n s�v�o���-1 BUILDER: S��/Kc�LZS� I�'uL,
ADDRESS: f�O 4-� �t►��-CY ST N�ADDRESS: �3z►-� �`zc�t.�t�
TEL N0: s3-3-o3`�z TEL N0: �33-��43
Construction Location
ST3�T NO s��j 4'� STREET: �rZ'( � L L y S I i�I �;
LOT: �� Q� BLOQC: ___L__ ADDI.TION: �� �,e�(f�, �-.UQi�J .
Corner Lot: Inside Lot: Setbacle: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOtJ OF CONSTRUCTION
' j-� C� L^ i , � �1 ��
�1 i"� D � �i0 � Front: Z.S — � , \
Depth: ZD —C� Height: lZ—c�
Squa�e Feet: u Clibic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
� � Z ��0�
Type of Construction: v�cvva �'jZ,q,�t�l� Estimated Cost: $ �
Zb Be �mpleted:
1 ���l�19��+
A1t. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE REVERSE SIDE OF SHEET ,
Zize undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Departmerrt of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE: �o���f7� SIGNATUF�:
Stipulations:
P�
_ v+ �
�
ZS .35 x�'a �= I 2, C.S� •�,
t�x �z i$.00
I �i • �
♦
- �
�r���
IZ, ���
1
�
�
BUILDI(dG PER��iIT FEt. SCHEDULE
SECTION 2. The Inspector of }3uildings shall,,before issuing pennits £or the erection
of any building or structure, or L-or any additi.on to any existing building or structwre,
or for any alteration or repairs to any exis ting 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:
NEW CONSTRUCTION: Single ramily Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
Dk2IVEWAY llEPi2ESSION: (Concrete C�rb Streets Only)
• Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x��'��.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with �
6 i.nch depth; Driveway width plus 6 feet x$17.85 �
;11 � ; ► �'► : �1■
£or the purpose of com,puting fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or th� cellar to the
average heights of the upper surface or to the average height of the roof surface
of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 per each five hundred dollars-($500.00) or fraction thereof in the cost
of all proposed work. .
In�no case shall the fee charged for any permit as set forth in 5ection 2 be less
than $7.50 plus $.50 state surchaxge. '
VERI.EICATIO� OF FOUNDATION
NOTE: Permits for construction will be issued a minimwn 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 been constructed will be required before proceeding with the framing.
_► : � ':1
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building ,permit has been issued; and
said structure shall not be used or occupied until a Certificate of�Occupancy has
been issued.
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��SEDGWICK HEATING & AIR CONDITIONING CO.
HOUSE HEATING"TEST RECORD
.� � ..v,,.. �}.A�'�t �'l1'�t.� '�.t• ' ..
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ADDRESS �'� �J '�� �� � '� c �' � �` CITY � � / �
OCCUPANT ���; e S /� v�:J':� i/� nwNER
HEAT LOSS DATE HTG. INS .
SOLD BY � --��%� `� �� �'� INSTALLED BY ' r � �- �
Electrical Work By -� �� Gas Lioe By ` -- �-
TYPE OF HEAT GA_ A_ HW_ STEAM SPACE HTR. UNIT HTR. OTHER
�� GAS DESIGN CONVERSION
MAKE !��Y Y ^ �� �
Model � ?� ;� ° ' � �
Serial C �
INPUT � � G U� � u %
if' �� � t �' CONTROLS
THERMOSTAT f"' � �"'�' Heat Plug
Valve � k 3 N�""2.�,,1i'S X/.�.
Limit 'J� � .=' f,,; �-,,-
Limit Setting � � �
Fan Setting L/b
Pilot Type �'�'�"'+"'�"F"
Pilot Make _5���r` r(,,% —� .::� K � f o 6�'
Pilot Model _Trn��' '" � •�� "
-�,. y
Pilot Timing -r t � ` r!
L.W. Cut Off
Pressure � ' � � � ��` � � - Perce�t CQz �
Input CFH ��- p Percent 02 �
Stack Temp. r� f' F Percent CO r� ��
Form 235
MAKE OF BURNER _
Model
Max. BTU Rating —
MAKE OF FURNACE
Model
Vent Size
KIND OF LINER SIZE NONE
Draft Hood --' " � ' �"� RegWatar
Filters Size Number �
Chimney Location Inside L' Outside
�' � �.�y -' .
Chimney Construction �-�'
Smoke Bomb Wiring
Draft Test Tag
Door Pressure Lighting "Inst.
) . ; � _. -- ---
pate Tested - �e �'� ,
Company Testing � '" ' ��i i !' r
Name of Tester a�'' ' ��� '' �` `t Y
�
City of Fridley
AT THE TOP OF THE TWINS
r
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� ; L ___.�_ COMMUNITY OEVEIOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
� _ �"'1 � CITY HALL FRIDLE� 55432
�""'�'� �'' 612-571-3450
J08 A�DRESS 6645 Fridley Street NE
SUBJECT
BU ILDING PERMIT �
NUMBER REY. DATE PAGE OF
9t0-F15 �/26/�3 � /
1 LEGAL LOT NO. BLOCK TRACt OF ADDITION
DESCR. H� � 1 Oak Grove Addition
2 PROPERTY OWNER MAII ADDRESS 21P
Doug Rudolph 6645 Fridley 5treet NE
3 CONTRACTOR MAIL ADDRESS Z�P
Richard H.astings Contr. 6331 Rivervi.ew �rr NE, Fridley
d AHCHITECT OR DESIGNER MAIL ADDRESS Z�P
5 ENGINEER
6 USE OF BUILDING
R�s identia 1
7 CIASS OF WORK
MAtL
❑ NEW ❑ ADDITION O ALTEFIATION
8 DESCRIBE WORK
Reroof House (28 Squares� 2nd Layer
8 CHANGE OF USE FROM
TO
ZIP
[� REPAIR
21994
NO.
�,3 � �
APPNOVEO 8V
SEE ATTACHED
SHEET
PHONE LICENSE NO.
574�9966 4051
PHONE LICENSE NO.
PHONE LICENSE NO.
O MOVE O FiEMOVE
STIPULATIONS goofing can be the 2nd layer but not the 3rd. Install smoke detectors as
per UB.0 121Q adjacent to all sleepi.ng areas and in basement. Provide adequate
attic ventiiati.qn.
TYPE OF CONST. OCCUP/
SEPARATE PERMITS ARE REQUIRED FOR ELECTHICAL, PLUMBING, HEATING,
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK Oii CONSTRUCTION ZONING SQ. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WOFK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFV TMAT I HAVE READ ANO EXAMINEO THIS APPLICATION �- STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED $2 � 3QQ
WITH WHETHER SPECIFIED HEfiEIN OR NOT. THE GRANTING Of A PERMIT
DOES NOT PRESUME TO GIVE AUTHOiiITV TO VIOLATE Ofi CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $54.00
STR CTION OR THE PERFORMANCE OF CONSTRUCTION.
� PLAN CNECK f EE
, �� �J� License SC $5.00
SiGNATURE OF CONTRACTOR OR AUTMO ED AGENT OATEI WHEN PE VA
iDATE�
P IOCCUPANCVLOA
CU.
OFFSTREET PARKING
GARAGES
SURTAX
$1.15
Fire SC $2,30
$62,45
NEW
ADDN
AL1'ER
[l
[l
�J
CITY OF FrRIDLEY
SINGLE FAMILY AND DUPLFJC�.S R-1 AND R-2
BuiWing Permit Application
Effective 5126/93
c�av�;�, aaa�: _ GG Ys rR � d z�y s�.
I,egal nescdption:
4wner Name & Address: A o 4 q �. u d c L p i, Tel. #
Coahactor: R► L��a � il ,C�,4S f� iv' 6 S MN LICENSE � pS
Address: � 3,31 R i VE� v i� � �!Z Tel. � S��/^ 9�� �
LIVING AREA: Length
GARAGE AREA: Length
DECK ARBA: Leagth
� ��
Attaeh to this a�lication, a Certificate of Survey of the
lot, with the pnoposed �on drawri on it to scate.
DESCRIPTION OF iMPROYEMENT
W�th
Height Sq. F�
W�tt Height Sq. Ft.
W� HgtlGrc�uid Sq. F�
Cotner Lot [ l Insi� Lot [] Ft. Yd Sed�ck Sic� Fard Set�acks.
TyQe oi G�sav�tion: R�� v� �" Es�nated Co�: � Z 3 0 0. o 0
Approx. Co�l�tion Date: 8��4/9_3 �.� s� .
{Ca�t � Back)
�►e�y c� t�r w� Nee�t: F�. + 6 Ft = Ft x S =�
DA1'E: 7 i� 93 APPLICANf: ,�i����� Tel. # S7 �^P�.��
Pe,rmit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion (:ontrol
Park Fee
Sewe,r Main Charge
TUTAL
S � , od
� �� .� O
� f ���
$
� �-U�
S
$
S
S
� ������
� M ' 1 .1
Fee Schedule on Rew�rse Side
.001 of Ptxmit Vah�ation (1! itkh %)
S.SO/�i,000 Valuation
$750 pex SAC Unit
�s.00 (StaLe iace�ed Resici�ential Contractors)
Alt. "A" c�r A1t. "B" Abave -
Conseavation Plan Review 5450.00
Fee D�mi�cl by Engineering
Agreemart N�r [ ] Not Necessary [ )
STIPULATIONS:
i � � � :�� i • :�� .i� �
The C6ief Building Official shall, before issuing pernit� far the erection of any building or structure,
or for any addition to any eais�ting bnilding or structure, or for atty alteration or repair to any existing
building or st�ucture, upoa application therefore, require die paymeAt by the applicant for such permit
of fees to the amount herein below s� forth and in the manne,r he,rein provicled to-wit:
TOTAL VALUE
Sl to 5500
$501 to $2,000
$2,001 to $25,000
�25,001 to 550,000 - .
$50,001 to �100,000
5100,001 bo �500,000
5500,001 to $1,000,000 �
S��,OOO,OQ1 and up
FEES
a15 (Minimum Fee is $15 plus s�mcharge)
�15 for first SS00 plus S2 for each a�ditional $100 or
fiaction thereof, to and including $2,000
S45 for fust �'2,000 plus $9 far each additional $1;000
or fraction thereof, to and including $25,000
�252 for first� 525,000 plus �6.50 fvr each add�itional �1,000
or fiac�ion tl�eof, to and including 550,000 -
�414.50 for first �50,000 plus 54.50 for each additional
$1,000 or fraction thereof, to and incltuling $100,000
�639.50 fo� first �100,000 plus $3.50 for each additionat
51,000 or fraction the�eof, to .anc� including �500,000
�2039.50 for the first �500,000 plus $3 for e�ch additional
$1,000 or fracti�► thereof, tn and iacluding $1,OOO,U00
$3539.50 fo� tl� fnst 51,000,000 plus $2 for each addifional
S1,U00 or fraction �thereof .
DRIVEVI/AY 13EPRESSION ESCROW
(co� ct� S� o�y)
Altemaie "A" : Removal and replacement of cu�fi and gut� only - Driveway width plus 6 feet times
$13.50.
Alternate "B": Removal and replacement of curb and gut�er and install a 3 foot wide.
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for constructioa 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 constnuction site.
A Certificate of Survey of the lot, showing the loc�adon of the foundation once it has it has been
coastcucted will be required before proceeding with tfie framing.
- -� ��
3uilding
nspec�tions
�63-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�A7� YOUR E-MAIL ADDRESS
ITE ADDRESS
'HIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATTON
PROPERTY TYPE
PERMTT TYPE
TYPE OF WORK:
O OWNER ❑CONTRACTOR
NAME:
STATE LICENSE #
%
FJtT DATE
l'1
Permit No.:
Received By:
Date Rec'd:/ � �� ��
ADDRESS: CITY S'TATE ZIP
PHONE FAX_
O BASEMENT F[NISH
O DECK
DESCRIBE WORK BEING
SIZE OF
NUMBER pF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
Vinyl
Aluminwn
❑ Other
WIIVDOWS
IN EXISTMG OPENMGS DYa ❑No
OR FOR NEW OPENWGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WDdDOW TO BE INSTALLED ___
�O OOF
SIDING
❑ SWDvIMWG
❑ ADDTfION
P,� o �oD�a.n
-�4CE�E.rr'T a �
LENGTH
� HOUSE ONLY
O HOUSE dc GARAGE
O ATTACHED GARAGE
0 DETACI-�D GARAGE
Soffrt
Trim
Fascia
LACATION OF WINDOWS
�i 1,�1: ; •
� DRAIN TILE
0 OTHER
� � D ti i+� G C) �f I-E�w�.E — t,v'R.F}-1� �—r'K.i v�
FL
�ASEMENT REMODELMG SUBIvIIT:
1. Existing Fio� Plan
2. Proposed floor plen
3. List of slructural members to be used
FOR NEW CONSTRUCTION INCLUDI1iG DECKS,
ADDITIONS. � PORCI�S SUBMIT:
I. Site Plan/Survey showing the cxisting structures
and proposed project
2. Two sett of construdia� plans
3. Energy Calcutations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(LTSIN ,'T�IE� 7 U„�.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ f7`t� � r�'� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Sutchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ t�(• a`S' See Back Page for Fee Schedule
� 65% of Building Permit Fee
$ �( ,(� .001 times the total job valuation
$ �,c.E�j .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residential Contractors)
$ �1550 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftxS21=S
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ 1 l?� S� Make checks payable to: City of Fridley Attach
THIS [S AN APPLICATION FOR A PERM[T-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and cndes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all ich require ' w n approval of plans.
SIGNATURE OF APPLI i PRINT NAME����-�S��pDt"P` � DATE I°Z I a D � b
Page 2- Building Residential Application
.,_
�
�
BUILDING PERMIT REE SCHEDULE
The Chief Building Official shall, before issuing pernuts 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:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for pmper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Only
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
.
CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
�, �`���5 2'�'C�o LP�- understand that the State of Minnesota
requires that atl residential building contractors, remodelers and roofers obtain a state
license unless they qualify for a specific exemt� ion from the licensing requirements. As
the owner of the property at h6 �� '�u��� � 9'fi • Y�1lE . , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forfeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forfeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
appticable building codes and city ordinances in connection with the work being
pecFormed on this property.
Name
�
Date � � � °� � � 0 �
�
�� 1���
Building
Inspections
763-572-3504
763-502-4977 FAX
DATE �� 3 v �� r� C
S[!E ADDRESS � � L/_S
1�II3 A?PI.ICANT IS:
OWNER/
TENAIV'T
suHMrr n c�orv or
YOUR SfATE
LiCENSE, BOND AND
cs�tr�cn� oF
INSURANCE
PERMIT 1'i'PE
From: 612 822 5408 Page: 2l2 Date: 7/16/20101:1734 PM
�'�3�(5`.�� �
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
� YOUR &MAiL ADDRESS
F�;G//e;. Sf ✓v�
O OWNER � �ANTRAGTqR
`t.5 i-.. c�lP si /Y'
-S%t��d�7
.�rn.,: s � f. _ . � _.Ol� �
����o• ac� ;
PT� .�b �'p'
ne���a 8�:.
STATE LICENS6 i{ � CJ S'r/ �� � SXP DATE _/.� '�/-/ i+
5TATE BOND �Y �c� o� r 3�'� I P.7CP DATE ,
ADDRBSS= ��I.a �( � ralr J� CffY �I'�'J .N�S STATE/l�'LIP i�
PHONE G%at -$'.�.�. — 5'_j �'1'�+ FrVC
3IIJGLG PAMfLY ❑ TWO FAMILY ❑ TUWNHOUS�
TYPE OF WORK: I � �
DETAiLED DESCR�P'I'ION OF WORK
• ' ' M I�
'3
r� Afi� BAS'k.D ON SiU.00 PER FfKRJRH, �[CF.PT WyE[Z� Np'fEp, FDC�URES: (DVD[CATE TOTAL NLlMfiF.R OF F3ACH BELOWj. M1NiMUM FEE
S35�0.
_ BA1'H SIIVIUL.AV RL,pQR DRAIN$ $F�OwER WATER PtPlNC
_ BATH'fUB GA5 PIPING (N�RD Ci['Y LFG7 _ SaRMM[NG n00T, WAT6li SOr i'N�lt ($3s�
_CLO'fHI:S WASHk�R K17C;HFIVSINK WATERGIASET BACKFLOW Pltr,V. ($15)
_ �rst�w,►sHee =[,�,�7Np�y �y j�VyATER jjEA'IER (j35) ' FOR IRRIGATION
_ WATER MCfER 0'I�iF.R
� v� r, nt ��� ;►��5,,� . �•':�t! . � ;. �
.yM ����,.�t '��,�;�''���' ' ',�„'h:y�y;,,'' {. `, :,i
��AVG+NS�i. ,��`r� �1�� ..i. .i .n . ' !i" :�'� •.�: .'.��i�i+{� ' �f�i4I1� � 1
{{:••:. • � � �'. i:.•''':: _.. .�ir. � ;';� i�� �
.. � � v •:::: :. :• �,:� :; �.;+.`.:., �[::;:;i;•, �•; :•i.::1*.>,p, �: • `. ,+ p :r,�
: : �;y_
' ' ' •'r.•;1d • � � : �:., ..: .. . .. . , � : •:i��, .
, �'� �.. �y. i::��:. •: r'inti'i:r:!�: '•. .":; � f� ,aT :�i •�. _:.yr
!�'+r.#y '::•t;,: t:,;�.,�. ••g:;�:+.�.�
����" a..: �:�f�'� �, ..... . .�.:; '';{ - -
•• ;� y..>:.:> •. � ;: ,� .,�...:. s: . �� .•..:.. .. •�.� ., • ; .. �':.: :�..:
.,zy.�..::..�. 4?' * �����i.�`7���fx s '��^'..• L :•:•1.; _, ''•.+_: ,..•:.•
_ ��ta'; ' ;., ,�. � _ ��?r_�:.���fi` ; a �; ,im ' �'': :. .. _ . ...��.`!•' ;�';r, •..�!M'i.•::;;.,:
:•. i
�....
r:.:� :'
�s�u!.i�L���7V/'Tt'ltYi.'r<;. _, ..::� � "�W7cii=� :i'S5@:•: �4.Pi!✓�...,_,..,;.. � .�y � .•�"�{��
: �
THIS IS AN MPLICATION FOR A PERMff-NOT VnLID UNTII. P1i0CESSED
I h�reby epply far a plumbing ptamit end I aclrnowlcdgc that thc information above is compIctc a�►d accmrete; that the work wilt be in
c�1fo[inaziCe with tif� oordinauets and codes of thc City af Fridley and with the Minnc�ota Constudiaat �odcs; d�at I undastand this is
not a pamit but only an spplicsaam for a pGraiit azid work is not to �art without a perneit on �itc; that the wa�k wi!! be in aceordancx
with the eppro'�ed pl�ut in the ca�c of all work which roquires review and appmval of plans.
SIGNATURfi QA
r
City of �idley
Building Inspections Deparhnent
6431 Univ�rsity Avenue NE, Fridley, MN 55432
� 7G3-S72-3604
�AX: 763-502-4977
�v�