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City of �'ridley, Minn.
BUILDING PERMIT
Da�: _. � -�� � �
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owaer: - su�uaer .,
AdBresa Adc]resa —
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N° 644'7
�(J Q� LOC TION -BU DING
11Ta ��� stceet _ _� art Lot
Lot ._.__�_ Bl�k � Addition or Sub-Divisio -
Corner Lot — Ineide Lot — ��� Setback s�.3 ��� Sideyard ,_�� %f �� �
ge�yer IIevation ____ ...._ Founda.tion Elevation
` DESCRIPTION OF BUILDING
To Used �' �+
F'ront �;�L ,/S� . Depth � Height .��-.. Sq. �-d�
Front _� Deptt► fTeight � Sq. F� �:l��
of ction Fst.rC��L��l �'% be Completed _
TYPe
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In co�ideration oP the 9ssuance to me of a perrnit to construct building described above, I agree to do
th� proposed work in acc�rrodanice with the d�scription above set fo in com ce with all prov3aiona oP
ord9nancea oE the dty o4 Frfdley.
A
In conaideration of the payment of a fee of $� , permit is hereby granted to
to conatruct the buflding or addition as described above. This �ermit ia granted upon
the express c:onclition that the perafln to whom it ia granted aad his agents, employees and workmen� in all work
daae fn, around and upon seid building, or any thereof, ahall c�nform in all respects to the ordinance� of
cn
Fridley, 112fnnesota regarding location, constru on, alteration, maiatenance, repair and moviug of buildinge
wlthin the dty ]imits and thia permit may be revoked at aqy ti�ne upon viol�on of aay oE the provisions of said
ordinaac�s. � ,. r� � )
Buildia8 Inapector
NOTIC�
'llds psrmb doei uet eorer �hs wntlweHee, imtallnioe fer wlrtng, plumbtee, en 6uHee, wvne e� arats�. B� wrs to �
fha BuiWiee IespKtor toe aparaM W►m6s tor thas inna.
o, e t, v
APPLICATION FOx BUILDING PERIKIT
CI�Y OF FRIDLEY, MTNNE30TA
�� � -
OF�R' S NAME � BUILDER ��
ADDRESS ADDRESS �� -S � ��'� �
LOGATION OF BUiLDING
,
No. �v � O� Stree.t ,s�� � Part of Lot
Lot Block Addition oY Subdivisi ,����! � ' ''�
Corner Lot Inside Lot� etback P� �ide Yard �� /�
SEWER ELEVATION e3� FOUNDATION ELEVATION ��
Applicant attach to this form Two Certificates of Survey of Lot and pro�osed build-
ing l.ocation drawn on these Certificates.
DESCRIPTION OF BUILDING
To be uaed as:
/ Front � � Depth� Height �
Sq. Ft. ����� Cu. Ft.
Front_��_Depth � Aeight ���
Type of Construction
To be Completed
Sq. Ft. Cu. Ft.
t�maCed Cost r��� o �
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the CiCq of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declarea that all the facts and
representationa atated in this application ar erue and correct.
DATE � �`L�S IGAIATiTRE • `—'� �
(schedule of Fee Costs ce.0 be found on the Reverse Side).
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BUILDZNG PEIiMIT FSE SCHEDULE
SeGtion 2. The Inspector of Puildings e6a11, befcre issuing �ny per�it for
the erection of eny building or structure, or for any addition to anq ex�.st-
ing building or strucCure, or for any alterations or repaiYe to any exia�ing
building or srcructure, upon applicatioa therefos� require the paymeat by the
appl3cant for such permit of fees to the amounC herein below set forth and
in the manner hereia provided to-wit:
2.Z. For any such permit for the erection o.f any fire-proof building, other
than a garage� warehouse, faetory or grain elevaCor, or foa the erection of
aay fire-proof addition, for aimilar occupancy, to any existing building
shall be at the rate oi $1.40 for each one thousand cubic feet, os fractioa
�hereof, in such cubical contents.
2.2. For aaq such permit for the erection of say fire-proof garage, warehouse,
f�.ceorq or grain elevator, or fos the erection of any fire-proa€ addition,
fos similar occupancy, to any existing building sha11 be at the rate of $1.25
for each one thousand cubic feet, clasaified gs "fireproof" by Section 502 of
the Minneapolie Building Coda.
fiOUSES
2.3. For any sucb permit for the erection of any nou-firepsoof bnildiag other
�han a garage, warehouse, factory or �rain elevator, or anq noa-fireproof
additioa, for similar occupaacy, to aiay exieting building - permit $1.00 foac
eac& one thousand cubic feet.
GARAGES �
2.��. For any such permit for the erectioa of any nou-firepraof garage,
w�rehouse, factory or grain elevator, o� for the erection of any non-f�epr�
additi�,,, €or s.imilar occupancy, to any es�atiag building or for each auch �
�lding or addition - niaety cents ($0.90) for each one thousand cubic feet
or fraction theseof, in the cubical contents thereof with a min�um of $4.00.
For the purpose of camput3.ag Eeea for building perm�its, the cubical contents
of any building or addition to a uniform height throughout by multipiying t�ae
ground area covered fram a point six (6) inches below the floor �ine of �be
basement or cellar to the average height of the upper surface or to the
average height of the roof surface of the main gable of a p�tched roof.
2.5. For repaira or alterations to an existiag structure, the fee shall be
at the rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction
thereof in the coat of all propt,sed work.
2.6. In no case shall the fe.p,chargad fnr anp pesm3t as �set forth ia
5ectian 2 6e less than $4.00.
� ° � _ r''� ,-��.. _
�-; - . _� _
MARVEY A. CARTWRIGHT
ANOKA COUNTY BYRVEYS
li[NNE►IN COUM:Y BURVHY8
MINNEAROLID suRVers
8410�F'ALM 9TREfiT N. W.
6UNSET 4•7833
OWNBR
INDUfTRIAL - JUDICIAL
BUa1NBf8 - TOPOQRAPFIICAL
CtTT LOT� - PLATTING
Sam Templin
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LA1VD SURVEYORS
REOIlTtR�O YNOtR LAWf OF fTATE OF MINNEpOTA
LICBNS[O SY ORpINANCS OF CIT1 OR MtNNQAPOLId
926 PLYMOUTH BUILDING FEDERAL 8-8721
HENNEPIN AT SIXTN • MINNEAPOLI3 3. MINNESOTA
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COMBININQ TME RECORD8 OF
J. E. HILL, CIVIL ENOIN6ER
wrweusNSO �sa
C. F. SANDHO�F
GIVIL ENCi1NEBR
esTwsuaHEO ��oe
JAMEffi NELSON
SuRVtrat
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MErROPOLITAN LAND
SURVHVORB, E9TAYLISM[D �as+
Invoice 2287� � I
I h�r�by cer�ify i,hat �:his is a tru� an,d correct representation of a survQ�r
o�':
Lot 5, Block l, Gard�na P�:eloland Gardens ,�
As surveyed by me thie �y�.,�f�;� �" �.� i� s`� � �� .�t ,` �� N `� ��
ALA • d�� Op ��� y��� SIGNlD RTW GHT �AND OL9ON �
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HEAT LOSS CALCULATIONS � DEPA�2TMENT OF BiJILDINGS d�'� NIINNEAPO , M�N.
Weatherstrips A.S.H.V.E. Construction No. � Insulation =�' �'� ,�'
Guide
1��ws `=�I�o�rs Reference Out.'Wall Int., 11 q Ceiling Roof Floor ' �°' y'
�'Ye �lo ��, Ye �No 19_ "�"'."�'. � �'
< ��
�Fl.� k,,: � p�,,. g,� t*�''f Room � Length �� >' �Vidth � f'� Hei t�,�� � FI �, �� oom Length Width �Ieight
'� Windows and'Doors—Crackage and Area r�. ~_,� Windows and Doors=Crackage and Area
�Vldth Hetgnt No. ot Lineal f. Area Width Helght No. oE Llneat ft. Area
No. o yane ot p q- lig s ot crack e. tt. . � �"*� No. ot pane ; a llghte � of creck eg. ft. �� ,r;.„
�� � .,,, A' . � , , ; " � � .�" �II�' � � °�+t" .
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ef B ' e . Htu
Infiltration ;,: � q , . ?":��r � � In6ltration � �
Glass >� �`r -`°, � � Glasa "`? �'�'_�
Eap. wall �-,� ,, -.�« ,�"' ,� Ezp. wall
- Net exp.-wall --- - - , °. . �,. `` ��,;, ',` -- ---Net tap:wall= - -
- - ; - — ---- �;,
Int. ll In� w 11
Ceiling Ceiling ,
Floor .;' ` _�' - � �e • �
,: _ ..- :s Floor. .�`= 4 �
T Btu. x. To Btu. , ��,,,, ;
Requi ed sq. . E.D. �or sq. ins. W.A. Leader area Recfli ', sq. R. or sq. ins. W.A der area
F7.� �� t�,�' Y eagth Width. ;� ,�ieight �l �` �; oom ( Len ,�-- Widch Height
� Windows ana Doors—Crackage and Area � - VVindows and Doors—Crackage and Area �
Wldts Hetght No. oL L1nea1 ft. Ares Wldth HelBht No. o! Linesl ft. Area '�
No ' of Pane c�- a IiBhtq of k � �
� ��,, ��"� , No•�� o�t pane o.- a e : Y1 , te o! cr eq. [t.� ,
�+ 8➢' � �" �� R� .rr �: �?! �_� ... } . �Y: �
' '. , . , - - .. ' .4�- -
CO ,a COC � tll
In6ltration ,� � In6ltration �
Glasa
Exp. wall
Net exp. wall
Int. . 11
Ceiling ,
Floor tr
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Tot "$tu.
Requin� + Iq.�
FI. ,;� . Y:�
Windows and !
Wldth FI�
N of Dane
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In6ltration
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--T -- Btu. k .�
or sq. ins. W.A. Leader area „" Requue a .R. or sq. ins. W.A. Leader area, ''�
im � Length � Width , ` � Height F7. . .� :: . �;�. ,Room I Lengt6 Widt ' ,�":= Height
—Crackage and Area '' Wi�dowa and Doora—Grackage and Area
No. oL L1neQ1 ft. Area �,', Width Helght No. oi Llneal tt. Area �
Ilg e ot c k eq. tt. No. , of pane a nne I1g te ot crack ap. !t. �', -
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In6ltration � ;�`+ u-;�
— .
Glaas ` �,*^�., �,+��:,,�� Glass_ _ ; � �: � �... , � �
Eap. wall � �3 .� .: � Eap. wall ; �r +r3` . �;� �`. .
Net exp. wall 4�� `;�'` � �, Net e�ap. wall '�, �
Int. Il ";
Ceiling '
�
Floor - � � :�
T l Btu. �
"Required aq. ft. E.D.R. or aq. ins. W.A. Leader area
Int. w Il � ' ��";
Ceiling' �' "e
.� °
Floor �g.• �.. �v � > -_�
Toc tu.
Required sq. ft. E.D.R. or sq. ins. WA. I.eader; ana k' I�'
' .. as,. ' ' � ' --'s---ar: r
1Y56 ''�9 " . ' �
HEAT LOSS CALCULATIONS DEPARTMENT OF B�JILDINGS NIINNFAPOLIS. NIINN. I
Weatherstrips A.S.H.V.E, Construction No. Insulatioa �+ ',
Guide ..
' dows I ors Reference Out.'WaU Int. Wall Ceiling Roof Floor Kind How Applied
- Ye N es No 19_
Fl.� :._ ��<: oom � Leng Width " HeiBht . Fl.� Room Length Width Height
Windows and ors—Crackage and Area � Windows and Doors—Crackage and Area
��Vidth He gh . No. ot Llneal ft. Area Width Halght No. of Lineal tt. Area I
N" ot pane o Ilg e ot crack eq.. . No. ot pane ot pane Ifghte ot crack ep. tt. I�
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Infiltration - � �
Glass � � 1
Exp. wall �
Net exF. wall _° _ - -
Int. w ll ,
Ceiling" >
Floor�
To Btu. �
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area �
F7.� . Room � Length Vf/idth Height
Windows and Doors—.Crackage and Area
Wldth Height No. of Llneal tt. Area
No. ot pana of pane llghte ot crsck e4. !t.
Coef.1 Btu
In6ltration
Glaaa
Exp. wall
Net esp. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. . Room � Length Width Height
Windows and Doors—Crackage and Area
Wldth Aelght No. ot L1nea1 tt. Area,
"No. ot pane o[ pane Ilghte ot crack eq. it.
�
Infiltration
Glaas
Exp. wall
Net exp. wall
` Int. wall
Ceiling
Floor
Total Btu.
ft. E.D.R. or sq. ins. W.A. l.eader area
�
Infiltration
Glass
Eap. wall
_ l�l�t eap: wall" - - —_ _- -
Int. wall
Ceiling
Total Btu.
Reguired sq. ft. E.D.R. or sq. ins. W.A. Leader area
F7.1 � Room ( Length Width
Windows and Doors—Crackage and Area
Wldth Helght No. ot Llneal tt. Area
No. ot pane ot Dane lighta of crack eq. tt.
Btll I
Infiltration �
Glass
Eap. wall
Net eap. wall
Int. wall
Ceiling
�oor
Total Btu.
�
Requued aq. ft. E.D.R. or sq. ins. W.A. Leader area '
F7.� _ Room I Length Width Height
Windows and Doora—Crackage and Area �
Wldth Helght No. of Lineal ft. Area
No. oi Dane ot Dane Itghte . ot crack eQ. ft.
Btu (
� InFiltration
C,lass �
F�cp. wall
,Net exp. wall
Int. wall
Ceiling
Floor
T'otal Btu.
Required sq. k. E.D.R. or sq. ins. Q/A. Leader ana
Btu I
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SuBJECT -
City of Fridley 3 3 4 9 3
AT TFIE TOP OF THE TWINS g U I L D I N G P E R M I T
�
; � RECEIPT NO.
� • COMMUNITY OEVEIOPMENT OIV.
� j V �'��� , �� �
� � PROTECTIVE INSPECTION SEC.
1 = �
� /"'1 � CITY HALL FRIOLE� SS13Z NUMBER pEV OATE PAGE OF APPqOVED BY
�'""'� � ��� 763-571-3450 s�aF�s 5/5/03 � �
108 ADDRESS 6UO3 Gardena Lane NE
1 LEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACHED
DESCR. 6 1 Gardena Meioland Gardens SNEET
2 PROPERTY OWNER MAIL ADORESS 21p PMONE
Brent Carlson 6003 Gardena Lane NE 763-586-0266
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO
Americas Best Roofing 10303 Lyndale Ave S, Bloomingto�, MN 55420 952-884-1656
4 ARCMITECT OR DESIGNEli MAIL ADORESS 21P PMONE LICENSE NO.
20157905
S ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUI�OING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION �] REPAIR O MOVE O REMOVE
B DESCRIBE WOFiK
Reroof House & Garage (28 Sq) Tear-off
9 CHANCiE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Bui4ding Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PEFMITS ARE FEOUIRED FOR EIECTRICAL, PLUMBING, FIEATING.
VENTILATING OR AIF CONDITIONING
TMIS PERMIT BECOMES NULL AND VOID If WOFK OR CONSTRUCTION 20NING SO. FT CU fT.
AUTHORIIED IS NOT COMMENCED WITMIN 80 DAYS. OR IF CONSTqUCTION
ON WORK IS SUSPENDED Oii ABANDONED FOF A PERIOD OF 120 DAYS AT
ANV TIME AFTER WOpK IS COMMENCED. NO DW�G. UNI7S OfFSTREET PARKING
I MEFEBY CERTIFY 7HAT I MAVE flEAO AND ExAMINEO TNIS APP�ICA710N 1 S7ALLS GARAGES
AND KNOW TNE SAME TO BE TRUE AND CORREC7. AlL PqOVISIONS OF LAWS VAlUAT10N SURTAX
ANO ORDINANCES GOVERNING TNIS TYPE OF WORK WI�L BE COMPLIEO
WITN WMETMEii SPECIFIEO MEREIN OR NOT. THE GRANTING OF A PERMIT �3 � 242 � 1. 62
DOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CANCEL TME pERMIT FEE SAC CNARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON• $97.25 Fire SC �p3.2�F
STRUCTION OR TME PERFORMANCE OF CONSTRUCTION
PLAN CNECKFEE TOTA�FEE
License SC $5.00 $107.11
- S�GN4TUNE OF CON��7ACTOp OA oU�MOA�2ED 4GENT iOATE� � M N PROPERLV VALIDATED TMIS IS VO R P MIT
S�GNATUQE O� OWNEp��F OwNEa BuitDEA� IDATEi BLOG �NS� / f�b E�
NEW ( J
ADDN [ ]
ALTER ( j
Consttudion Add�ess: G
Legal Descnption: �
Owmer Name � Address:
Contractor. �fY1P.�C`iGL
LNING AREA:
GARAGE AREA:
DECK AREA:
OTN�R:
I
�
C1N OF FRIDLEY • Effedive 1H/2803
8431 Universiiy Ave NE, ��idley, MN 55432 (�b3) 672-3604 Bldg Insp
SINGLE FAMILY AND DUPLE)(�S R-1 AND R-2 j763) S7l-1�87 Fax
BUILDING PL'RMITAPpLlCATION
Te�. �� 3:��LZ2 6�
MN LIC�NSE #_ �� 7 � S
Te�.��5'Z'�L)-' 656
Attach to this appltcation, a Certiflcate of Survey of the
lot, with the p�oposed constnution drawn on �t ta acale.
DESCRIPTION OF IMPROVEM�NY
Length Ulfidth Heipht `�_ 3q, Ft �_�
Length � Wtdth ,� Height Sq. Fi.
Width
. 59_FI.
. . • �.
Construction Type: Estimated Cost: a_ ��I'�� `�
Driveway Curb Cut Width Needed: Fl. + 6�l = Ff x$�,+ _$
DATE: `� � APPLICANT: � ^ � � —( � i'� C Tel. # Z � �c ' . � ��
Call (i63} 57Z-s6041'or Permit �'ees if r�ailing in applicadon. Fax to T63S71-1287 if using credit card and we wil)
call you for card number.
Permit Fee
Fire Surcharge
State Suecharge
SAC Charge
License Surcharge
Curb Cut Escraw
Eresic�n Control
Park �ee
Sewer Main Charge
TOTAL
CI'TY USE ONLY -
$ �. S� Fee SChedul� On RevePSe Sfde
$ .�01 Cf Pe�mll VelUa�ion (1l10th°/a)
$ $.50/$1,000 Valuation
$ $1275 pet SAC Unit
$,,.�D O _ $5.00 (State Licensed Residential Contradors)
$ Alt. "q�� or Alt. "B" Above
� $450.00 Consecvatian Plan Review
S Fee D�termined by Engin�ering
$ Agreement Necessary [ ) Not Necessary [ ]
$
1
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