AF - 45239City of Fridley, Minn.
BUILDING PERMIT
N° 6232 ��
Date: '! "".
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Ovvaer: J T�� 1 � �� �' Builder , '�{ .� �r
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Addxess Addresa
� + CAT � O�F� DING
No. Street %�� ,L— P� Lot
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Lot _ Bl k,��� Addition or Sub- vision . �� �_�
Corner Lot —��� Inside Lot S�tback ��--_ Sideyard —...,,"�
Sewer IIevatfan �— — Foundation IIevation
DESCRIPTION OF BUILDING
�� �
�" >'�" < " Front �� Depth ..���Height � S�l. r't. .�. C�. Ft�1-s��—+�'
-�--�—
� � Fro Depth I�eigh Sq. F't. Cu. FL
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Zj►�e of Constructi Es� . _ To be Completed
r�.
Ea consideration of the issuance to me oP a permit to construct the building described above I agree to do
the proposed work in acc�rdance with the description above set Porth and in compliance with a�l Provlsions of
ordinancea oE the dty oE Fridley.
�
In consfderation oP the payment of a fee of $_�; �'"`� , permit 9s hereby granted to
to construct the building or addition as described above. Thispe rmit is gra.nted u�n
the egpress condition that the person to whom ft is gi�aated and 1us agenfs, emPloyees and worlu�nen, in all work
done in, around and upon said buildiug, or any part thereof, shall conform in all respects to the ordinance� of
Fridley, M3nnesota regarding location, construction, alteration, maintenance, repa�ir and moving oY bufldiugs
within the dty limits and thia permit anay be revoked at any time upon violation of any of the provi�lons of said
oPdiIIaIICCB. �%'°r w . r���`1
B11��II$ �Sp8Ct07'
NOTICE:
1hb pemdi doss eot eew� ths eeestrueHee, IestallaMoe ter vrhina. �tumbtna �a 6..Nna anwr or rral�r. B� wro to ne
th� Butidiag lesp�etor fe� �p�rat� p�rmih Po� 1h�a tt�ms.
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Otaaer' e
Addresa
APPLICATION FOR BUILDING PERA�T
CI�t OF FRIDLEY, MINNESOTA
LOCATION OF BUII�DING
No. Street
Lot B1ock�Addition or
of Lot _ ���, ��
a _ _ 2. _ '��L
Corn.er Lot �c/" Iaeide Lot 3etback Side-Yard
�....,...._ � -
�EWER L�LEVATION FOUNDATION LLEVATTORT
Applicant attach to Chis form Two Certificates of Surveq of Lot and proposed
building locatioa drawn on these Certificates.
DESCRIPTION OF BU7ZDING
To be'used as: �
Front _ Depth��,Height
SQ. Ft. _ , ��tl Cu. Ft.
Froat Depth Height __ �_
Sq. Ft. Cu. Ft.
� - �G
Type of Conatruction EstimaCed Coet
To be Completed % �� ��� (,� � � �
The undersigned hereby makes applicati� for � permit for the work hesein
specified, agreeing to do alI work in aerict accordance with the City of
Fridleq Ordinaaces aad rulings of the Department of Buildin�s, and hereby
declarea that all the facts and representatioas etated in this a ation
�re true and correct.� � �
DATE
(Schedule of Fee Costs can be fouad on the Reveree Side).
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BUII,DING PERMCT F�E SCHEDULE
Section 2. The Inspector of Buildin�e �hall, before i�suin� anX permit for
the er,ection of any buildiag or structure, o� for auy addition to affiy ex3�C-
ing building or structt�re, or for any alterationa or tep�irs to any exis�iag
building or st�ructure, upon applicataon Cherefor, require the paymenit by the
applicant for such perm�Lt of feea to the.amount hereia below set forth and
�.n the manner here3n provided to-wi�: �
2.1. For any such permit for the erecCioa of aay fire-proof buildin�, other
ti�an a garagea warehouse, factory or grain elevator, or for the erectioa of
any fire-proof addition, for similas occupancy, to any existing building
shall be at ti�e rat•e of $1.40 for each one thousand cubic feet, or fraction
th�reof, in such cubical coatenta,
2.2. For any such permit for �the erection of any fire-proof garage, wasehouse,
factory or grain elevator, or for t�ie erectioa of any fire-proof addition,
for similar occup�.acy, to any existing building sh�ll be at the rate of $1.25
for each one thousand cubic feet, cl�ssified as °1f3reproof1° by Section,-502 of
'the Minneapolis Building Code, •
HOUS£�S
2.3. l�or any such permit for the erectioa of any aon-fireproof building other
,.�� _ than a_�arage�_warehouseL factor�r_qr �rain_ ��eva�a_r, 9�_an�►_ noa-fire�rQOf
'`�dd.ition, fo� sim3lar occupaacy, to e�ay existing building - peranit $1.00 for
�each one thousaad cubic feet.
GARAGES
2.4. For any such permit for the erection of any aon-fireproof garege,
warehouse, factory or graia elevator, or for the erecttion of any non-fireproof
addition, for similar occupancy, to any existing buildiag or for each such
building or additi.on - nine�y cents ($0.90) for each on� thousarad cu'�ic feet
or fraction thereof, in the cubical conteats thereof ��ith a mi,nim�am of $4.0�.
For the purpose of compu�ing fees;for building permits, the cubical con�tents
of any buildiag or addition �o a uniform height throughout by mul�iplying the
ground area covered fram a,point six;�6� inches below the floor Zine of tbe
basement or cellar to the average height of-the upper surface or to the
average height,.of the roof surface of the maia gable of a p3,tched roof.
2.5. For regairs or alterations to an exis�ing structure, the fee sha9.1 be
at �lxe'rate of $3.00 per each Five Hundred Dollara ($500.00) or fraction
thereof in the cost of all progosed work.
2.6. In no case sha11 the �fee charged for any permit as set forth in
Sectioa 2 be less th�n $4.00.
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City of Fridley, Minn. N° 8058
BUILDING PERMIT
Date: J� 28 � 1965
�: VERN LAMBERT �� STUAR.T CONSTRUCTION COMPANY
Ad�resa 184 Gibraltor Road N. E. Ad�� 109 LowrY Avenue N. E.
Fridley 21, Minnesota
LOCATION OF BUILDING
No 1�' Sis�et Gilbraltor Road N. E. p� of Lot _
Lot Block �ddition or Sub-Division
Corner Lot L�tde Lot Setback Sideyazd
Sewer IIevation ____ Foimdation IIevation
DESCRIPTION OF BUILDING
To be Used as:
Addition �t 16 Dep� 14 g��t 8 gq, �, 224 �, �
F�rant Depth i�ei�ht Sq. Ft Cu. Fk
Zj►pe of Construc�tion �, �_, 2, 400. 00 To be Completed
In conslderatlon oP the 9s�uancae to me of a permit to c the buil g described a agree to do
tha ProPosed work fn acr.ordance with the d�scription above fo and c�mplianc+e Provisions of
ordinancea oP the dty of FYldley. �
In camslderation oP the payment oP a Pee of $ 5.00 ___.__� p��t is herebY granted to STUART
CON'STRIICTION C0. ta ��� � buflding or addition as descrlbed above. Thia permit fs granted upon
the.express c�ndition that the person to whom it fa granted and 1�is agents, employees and workmen, 9n aIl work
done 94 around and upan eaid huilding, or anq thereof, shall conform ia all respects to the ordinaac� of
Fr1�IIey� Minaesota regarding lacation, constru� alteration, maintenanc�. repafr and moving of bufldinga
within the dty liaaits and this permit may be revoked at any time upoa violation of aay of the P��ona oP said
ordinancea
AT T•FN G. JENSEN � �r
n N017Cgs
'I1ds pqrmN dou eot eeru ths eees�maHee, testallaHee for rrWeA� piumbteg, ea 6satin�, awa� ae wafsr. B� wn to s�
tln Buildiu8 I�r tor a►paraf� p�m�(fs fo� thw ibms. •
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�'R' 3 IdAME
APPi,ICATION FOR $UILDIATG PERMIT
CITY OF FRIDLEY, MINNESOTA
��. ,//
LOCATION OF BUILDING
�
�.� street Part of Lo�
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I.OT R ADDITION OR SUBDIVISION
Coraer`_ Lot�Irtside LO ____,_ Sr�tbaclt ', Sitie�Yard_,,3�� 1
SE�1ER �LEVATIOId FOUNDA�'IO�I �E�1�'1`IC111�, ...,.� �
Applicant attach to this form Two Certificates of Survey of LoC and proposed
building location drawn on these Certificates.
DESCRiPTION OF BIIILDING
To be used as:
f�' Front_/ f�—, Dept `� Seight �
Sq.. Ft. � �� Cu. Ft.
Frant DepCh I3eight
� Sq. Ft. Cu. Ft.
Tqpe of Cou�truction� Estimated C��t ��F�
� ..
�o,� �`
To be ccmpleted z°-/�°��
The undereigned hereby makea applicatiou for a permit for the work herein apecified,
agr�eiag to do all work in strict accordance with the Citq of Fridleq Ordinances
and rulin�s of the Department of Buildings, and hereby declarea that all the facts
and repres�ntationa etated in Chis application are true and correct.
� �
(3chedule of Fee Costs can be found aa the Reverse Side)
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BUILD7I�IG PERMIT FEE SGI3EDULE '
SEGTION_2. The Inspector of Buildings ehall� be#ore iesuiag any �rmit for tihe
erection of any building or sti`ucture, or for ang addition to any esistin� build-
ing or structure, or for any alterations or repaira to any exiatiag building or
atructure, ugQn application.therefore, require the payment by the applicant for
such permit of iees to the amount herein below set.forth aad in the �aaser hereia..,
provided to-wit;
2.1. For anq auch permit for the erection of any fire�proof building,
other than a garage, warehouae, factory.or grain elevator, or for the erectioa
of any fire-proof addit�ton, fo� similar occupencp, to any existing building,
eba11 be at the rate of $1.40 for each one thoueaad cubic feet, or fraction
thereo£� in such cubical contente.
2.2. For any euch permit for the erectian of any fire-proaf garage,
Warehauae, factory or grain elevator, or for the erection of anq fire-proof
addition, for similar occupancy, to anq exiating building shall be at tha rate
of $1.25 for each oae thousand cubic feet, classified as "fireproof" by
3ection 502 of the Minaeapolis Building Code.
SOUSES
�_
2_ 3. For anq sach permit for the erection of any non•fireproof building,
other than a garage, warehouse, factory or grain elevetor, or aay non-fireproof
addition, for similar occupancy, to any eJCisting buildir,�g - permit $1.00 for each
one thousand cubic feet.
GARAGES
�-
2, 4_ For any auch permit for the erection of any noa-fireproof garage,
warehouse, factosq or grain elevator, or ior t&e erecCion of anq non-fireproof
addiCion, for aim�tlar occupancy, to any existing building or for each such
buildin� ar addition - ninety cents ($0.90) fos each oae thousand cubic feet
or fraction Chereof, in the cubical contests thereof with the minimum of $4.00.
For the purpose of computing fees for building permits, the cubical eontents
of any building or additioa to a.uniform I�eight throughout bq�multiplying the
ground area covered from a poiat six (6) �nchea below the floor line of the
baeement or cellar to the average height of the upper surface or to the average
height o� the roof su,rfaee of the main gable of a pitched roof. .
2.5. For regairs or alterations to an exieting structure, the f�e sha11
be a he rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction
thereof in the c�st of alI proposed work.
2.6. In ao case ahall the fee charged .for any permit es set forCh iri
Secti n 2 be less than $4.00. . '
_ � �_��
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SUBJECT
City of Fridley �� 16 7 9 7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEI .
• COMMUNITY DEVELOPMENT DIV.
' j y- - � �
r � � PROTECTIVE INSPECTION SEC. � �
! _ �
� /"'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�""'� � ��� 612-571-3450 910-F15 10/1/82 � �
J08 ADDRESS 184 Gibraltar Road N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 24 2 Ca.rlson's Summit Manor 5outh SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Vern La�bert 184 Gibra].tar Rr�ad N.E. 572-8782
3 CONTRACTOR MAILADORESS ZIP PHONE LICENSENO.
Stuart Gbnstruction Co. 4611 Lyndale Avenue North 529-9C61
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW X ADDITION ❑ ALTERATION ❑ REPAIFi ❑ MOVE � REMOVE
8 DESCRIBE WOHK
Construct a 14.5 x 5' Addition t,� Dwellin
9 CHANGE OF USE FROM TO
STIPULATIONS
� F PERq TF
�ef ����� �T���: p p�RMjl
ae drgg��g call loca� u��iJa��
S
iE1.Et�lONE - ELFCTRiC - �,� . ���N�' R'��(!j�
RE�'ud��C� �;y� � S ���
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`� � �j�,/� .
G,
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
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 ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEFEBV CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,650 $1.33
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $38�SO NONE
STRU TI O PERFORM CE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
; �` � /� � $ 9.63 $49. 46
Si Tu OFCONTR RORAUTMORIZEOAGENT �DA � WHEN PROPER Y VALIDATED THIS IS YOUR PERMIT
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SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI BLDG �NSP �P E
c�rv �r Fl2IDLCY
0
APPLIC/1'fIU:�d fOft (:l�SI[)[:i��TIi1i_ QUILf)It1G PE�'udTTS
(tJeti�r, Al �ei•ati�ns, Additions, or Rcpair,sl.
Ot�FtER: Vern Lambert
/1UDf:E� S: 18 4 C ibra ltar Rd
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�UILDER: �t»art CozaG�.r°�.c'�i�n �� •
/IDDRESS: �6Z1 L�mdale A��e. P7.
7EL h0: 572-8782 TEL �'d0: 52�-9663
" Consi:tuction Location � '
STRL�;T ri0: 1�4 � STREET: Gibraltar Rd. N.E. •
LOT: . 24 BLOQC: 2 ADAITZ0�3: Carlson � s sumntit – south acld? ti_�n
Corner Lot: x Insic3e Lot: SetbacY.: Sideyards:
Ap�licant at�ta�h to tliis �orm ��a Certificates oE Survey o� lot and
' pro�sed building location drawn on certi£icates to scale. °.
DESCRIPTTQiv OF COI1SThUCTIGN - �
� De th: � xeigh't:
' D�, �T-4 �� Front: P
Squa�ee. k'eet: � � {lxbic Feet: .
�'rort• �P�=
1 j iiei�h�: _
Square� Feet: � � Cubic Feet:
� � � 3�. �� � �� �� _�i� . .
x'}�p� of Co?istruction: Frame
. � ��
EstimaL-ed C�s L: $ 3�A�A-a-i� �
iU $e Cbr,�pleted: C� � �—
, A3t. A Alt. B
Pro�sed Drive�•�ay Width If New Opening Is Desired: $� $_
., S�L Rc,VERS�: SIDr. OF SFIE�T .
�.�ie undez signed hereby m�}:c� appl�.c�ticn ior a permi.t fcr L-he �:�ork� i-ierein specified,
agr.e��ing to c?o ,all wor}; ir� s'tr�c� accordunce wi�h the Ci':y of I'ridley O�c?iriances �nd
nYling� of the Department. af I3uildings, and ;zere;�y decla�es that all tlie tacts and
�:epr.esent�l�ians statcd �� this applicatian art true and correcti.
Aj'!2r : �� ��� S IGPJA7.'U ItE :
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IIUJLAII�IG l'f�f2Ml'f FL;�: :rCflf:raUt_E� �..
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S1.C'.C��1�7 2. 7.'li� 7n�:��eci:c�r. of 1zua.ldi»�� ;::1ir�]..1, r�cf•or.c i.•,•�:��i.►i� pw�niL;; for t:hc arecL•i.on
uf• .xny )�u:i.l.�l.in�j az :.:i:ruct:urc, or. �a�: �,ny adcli.t:S��n !:� aiiy cr,i�Li�u1 l�tiildi�tc� c�r :�i;zucL•ur.�:,
. cir. l:a1- �u,y aJ.t.r_rat:irn� or. r.c�;�air.:; �o •c111j� 4i:i. .�.�.�,��, y�t,s.�.a�.,��J or st�:ucturc, u1wn aT�pli.cat.i.on
�ttir_1:�f.or.c, r.cqu.�r.c tJ�� Paymci�L 1�y t]�e .�pi�l.i.c�nt: f•c»- :;uch ��cr.miL• o!' tec.^, to tl�e a�n�unt
hcr�in beJ.c�c•1 scl• for.th ���d 5.» �Iic mannez tic�:ci.n provicic:cl L•�-�•:a.t; •
I�:LI•1 CONS'l7;UCTTOIJ: Sing].c l�amil.y lloincs and Garacres: ;:4.00/7.,0�0 cul�ic fecr. .
1'L1;E� Cit):CI;: ?.5 j�CYCCIIL' ot l�uilcling }�c�7nit fee.
llItl'VI:I•d11Y llEYP1:5SI01•l: (ConcreL•q G�irb �L-rcets Only) '
' Al.ternai:e n: lt��noval and replacement of concrete curb and
c�uLL-er only; nrivea�ay ��idtii plus 6 fee� x�:�.��, 75
Al.icrnat•e II: Removal and re��acemcnt of concrete curb and
• � . gutter and install a 3 toot ��ide approacl� taith ''
� .� 6�i.r,ch depth; Driveway ti•�idth �plus G feet x$17.85 '
• . J�DDI i I0�/1L I P�FOR��1�T I OP�
I'or the purl�se of co�nputing �'ees for building permit5,. ti�e cubica]_ contents of any
buildi.ng or a.ddition, is dei:er.:ni.ned by mu1L-iplying i-he ground area covered fro:u a
p�a.nt sis: (G} inches below thc iloor ].ine oi tlie base��ent or th� cellar to t�he
avexage heights of the •u�per surface or to ihe average height of the roo� surf-u.ce
oi the nain gable of a pitched roof. '
Fox re�v.rs or a].teratio:�s to an existang stnicture, the fee shal]� be �t the rate
..of $3.00 rex eacii fivc hundred dollars -($500.00) or fracL-ion tller�of. in the cost
oi all proposed wor.Y.. -
in •no case sha�.l th� ��e cIiarged fcsz any pennit as set iorth �.n Sectian 2 be i.ess �
th�n $7.50 �lus $.50 state surcharge. � .
TFICATIO�! OF rour�nnrior�
" NOTE: Permits �or c�nst�-uction will be issued a minimur� ai 24 hours �rom the time
of ak�j�lication to a].lo�� fox proper revieca of L-he proposed structure and of the
construction site. '
A Certi�icate � oL- Su�.z•�y of the lot, shoc,►ing the loca��.on oi the founclation once it
has beEn cons�nictcd t.*a.11, be required bef.ore proceedinq with the �Lraming.
.�RTI F I GAi"E �F ���UP11��Cti' '
� i►pplicatic+n foz a Certificate o% Occ�.ipancy shall L�e mad;� ten (10) days priar to t;�e
u� c or. occur�iicy oi any st�ucture for �a2iich a J,iuil��i.�iq pe=mit l.as been issued; and
s�-�acl siruct_ur� shall uot l�e uscc3 oz- occu��ied t:nti.�. a Ccri:S.iicate oi' Occuj��ncy has
uC`CIl xssued. .
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sue�ecr P .-
City of Fridley � '� � �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T A
r
� �
, � RE EIPT NO.
� • COMMUNITY DEVELOPMENT OIV. �
� `a: ------�
r � � PROTECTIVE INSPECTION SEC. �Q S
i �
� � �"'1 � CITY HALL FRIDLE� 55432 NUMBER AEV DATE vAGE OF nPVROVEO Br
�---'�'� �'' 612-571-3450 910-F15 5/31/95 / /
J08 ADDRESS 184 Gibraltar Road NE
1 LEGAL ��T NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2L► 2 Carlson's Summit Manor South Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Vern Lambert 184 Gibraltar Road NE
3 CONTRACTOR MAIL ADORESS 21P PHONE LICENSE NO.
A1-Ro Home Improvement 8090 4 Avenue, Lino Lakes MN 55014-2008 788-5850 1927
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIIADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION � ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WOF;K
Reside House & Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, Ofi IF CONSTRUCTION
OR WORK IS SUSPENOED OH ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY 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 CORRECT. ALL PROVISIONS OF LAWS VAlUAT10N SUFiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEHEIN OR NOT. THE GRANTING OF A PERMIT �E)�900 3.45
DOES NOT PRESUME TO GIVE AUTHO V TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE R LOCAL LAW REGULATING CON-
STRUCTION OR TH RFORMANC OF CONSTRUCTION $90.00 Fire SC E).9O
� PLAN CHECK FEE TOTAL FEE
� ' License SC 5.00 105.35
S�GNATU�7E OF C �RACTOR R A H �ZED AGENT IDATEi WHEN 9 LY VALIDATED THIS IS YOUR PERMIT
� �1�� ��_�14_� 1/�
SiGNATURE OF OWNEA UF OWNER BU�LDER� �DATEI BLOG �NSP pp1E
NEW [ l
ADDN [ ]
ALTER []
Construction Address: �
Legal Description:
Owner Name & Address:
Contractor: ' �
Address: �zj��'�__�_
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Applica.tion
`�"l� �/ ! . � ��a ,� �s,,�r-� �i _
c
+I� � �`S
�-.s � � .
Effective 1 / 1 /95
Tel. # ��% �' ��
MN LICENSE # ��� �
Tel. # ,� % � =�-�-�' ���
�-.--�,
Attach to this application, a Certificate of Survey o e
lot, with the proposed �anstruction drawa on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AR�A- �� width Height
GARAGE AREA� Len� Width Height
�
DECK AREA:
OTHER:
1 --Y
rs��� �c.s�
Sq. Ft. _
Sq. Ft.
Sq. Ft.
Comer Lot [] Inside Lo [ 1 Ft. Yd ck 5ide Yard Setbacks _
�
Type of Constructio :
'� ,� � Estimated Cost: $ �� � �
Approx. Completion Date:
(Cost on Back)
F $ —�
Driveway Curb Cut Width Needed: Ft. + 6 t= Tel. #`` "!`� ��
�" �
DATE �'2 � 2 � � � APPLICANT: � �
�"
Permit Fee
Fire Surcharge
sr� s�naz�e
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park F�
Sewer Main Charge
TOTAL
$ ��-��
$ �- ,�
$ ��- �'
$
$ �. C� L�
$
$
$
$
$ j��.-�s°
('ITY USE ONLY
Fe� Schedule on Reverse 5ide
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$850 per SAC Unit
$5.00 (St2tte Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$q.5p,pp Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ l Not ivecessar3► I l
STIPULATIONS: , _
�;uxi,DING ���:RMI'(' TEL' SCHEDULE
I�hc (;I�i�t t3u�idin�; Otiicia! shall, l�efore issuing permits for the erection of any building c>r structure,
��r tix any .►�lditicm to any cxisting building or structurc, or for any aitcraiion or rcpair to any cxisiin�
(�uiliii�i�; <„- st�z,cturc, u�n applicaUOn thcrcfore, require the payment by the aE�plicant for sucti Permit
c�t- Ice;ti t<� the amc�unt hcrcin t�clow sct ti��th and in thc mannen c�rein providcxl to-�vil:
"1�0"I'AL VAI,1Jl:
� 1 to $500
$501 to $2,040
$2,001 to $25,OQ0
$25;001 to �SO,OOU
$50,001 to �100,000
$100,001 to $SOO,OQO
$500,001 to $1,000,000
$I,000,0p1 and up
FEI:S
$t5 (Minin�um Foe is $15 plus surcharge)
$15 for fust $SQQ ptus $2 for each additional $100 or
fraceion thereof, to and including $2,000 -
$45 for first $2,t1pp pius $9 for each addifioual $1;000
or fraction thereof, to and inciuding $25,000 • .
$252 for first �$25,Opp ptus $(SO for each additional $1;000
or firadion thereof, to. and including $50,000
$414�0 for fust $50,000 plus $q.Sp for each additional
$1,000 or fraction th�eof, to and includiag $100,000
$63950 for f-ust •$100,0� plus� $3_SO for each additional-
$1,000 or fradion thereo� to and includiug -$500,000
$2039.50 for the fust $�p,ppp ph� $3 for each additional
$1,(?00 or fracteon thereof, to and including $I,000,000
$3539_SO for the firsr $1,OU0,000 plus $Z for each additional
$1,000 or fractiou th�eof -
DRIVEWAY DEPRESStON ESCROW
(Concrete Ctirb Streets Oalyj
A(ternate "A": Removal and replacecne.at of curb and gui#er only - Driveway width pIus 6 feet times
�13_S0.
Alternate "f3": Removal and replacement of curb and gutier and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15_75.
VCRIFICA"ftON OF FOUNDAT[ON
['ermits for constniction will be issued a minimum of 24 hours from the iime of application to allow
for proper revie�v of ttie propc�soci stnic(ure and of the construction site_
A Cccvfic;:ite of Survey of the lot, shvwing the la:aUon of the fou�ciation once it has it hac t�een
constructeei will bc rc;yuirui i�efore proceeding with the framing.
sue�ecT R£A�MI .
City of Fridley 2 5 6 2�
AT THE TOP OF TNE TWINS g�J I L D I N G P E R M I T
�
; � RECEIPT NO.
� • COMMUNITV DEVELOPMENT DIV. �� ��
i LV �����-�
r � � PROTECTIVE INSPECTION SEC.
1 = �
� /"'1 � CITY NALL FRIDLE� SS4$Z NUMBEF REY DATE PAGE OF AVPROVED BY
�----� • •,, 612-571-3a50 e�aF�S 10/23/97 / /
JOB ADDRESS 184 Gibraltar Rd NE •
t LEGAL LOT NO. BLOCK TflACT OR ADDITION SEE ATTACMED
DESCFi. 24 2 Carlson's Su�it Manor South Addn SHEET
2 PROPERTY OWNER MAIL ADDRESS IIP PHONE
Vern Lambert 184 Gibraltar Road NE 572-8782
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
A1-Ko flome Improvement 8090 4 Ave, Lino Lakes, MN 55014 788-5850 1927
d ARCNITECT OR DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
5 ENGINEER MAIL ADDFiESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION �7 REPAIR � MOVE O REMOVE
8 DESCRIBE WOFK
Reroof House (17 Sq) Tear-off e
9 CHANGEOFUSEFROM TO
STIPULATIONS Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPAHATE PERMITS ARE REQUIRED FOR EIECTRICAL. PLUMBIN(i, NEATINO,
VENTILATING OF Alii CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONINCa SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAVS AT
ANY TIME AFTEF; WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I NAVE READ AND EXAMINED THIS APPLICATION 1 STAIIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � 1� 417 �• 71
DOES NOT PRESUME TO GIVE AUTHQRITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANV OTHER STA OR LOCAL LAW REGULATING CON-
STRUCTION OR T E PERFORMA E OF CONSTRUCTION. ��iS.SO Fire SC �1.4Z
, PLAN CHECK FEE TOT FEE
'� � Lic C $5. $55. 63
SIGNAT FEOF 'RACTOA AAU OAIZEDAGENT IOATEI FIEN R P ALIDAT D HIS IS VOUR PERMIT
SiGNATUREOFpWNERiiFOWNERBUIL0ER1 IDATE� � BLD iNSp ,��+ "°�� r��
1VE��V
ADDIV
ALTER
fi
LI
(1
ConstructionAddress: _
Legal Description:
Owner Name & Address:
Contractor: •� �
,
Address: �` �� �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
' C[TY OF FRIDLEI'
S[NGLE FAMILY A.ND DUPLEI�ES R-1 AND R-2
BUILDING PERMIT APPLICATION
� -�—
���� , . L , � �S �" ��10,° �
Effecti��e 1 / 1 /97
a�a �
�p l �
Y
Tel- � ��'�� �� -' 02
'�',--L -t ,�,
MN LICENSE # %f �� �
Tel. # ����,r - ���`L�%
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIP'rION OF IMPROVEME\T'T
Widt�
Width
Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
` , _ ' _°G�
Construction Type• Estimated Cost: $ �
:� -
(Fee Schedule on Back)
Driveway C�rb C�t .Width Needed: Ft. + 6 Ft = Ft x$ � _$ l �,% �%
� - � �����
DAT'�• � � APPLICANT: � � '' `" Tel. # � ; : ` `J �
. �
Permit Fee
Fire Surcharge
State Surcharge
SAC Gharge
License Surcharge
Driveway Escrow
Erosion Control
i'ark Fee
�ewer Main Charge
TOTAL
�"I'IPUI_n'CIQi�IS:
$ P. ��
$ �. �/�
$ . rJ /
$
$ 5 � C" ��
$
$
$
$
� ��.�-�
CITY USE ONLY
Fee Schedule on Reverse Side
.(JOi of Permit Vaivation (1/lOth%)
$.50/$1,000 Valuation
$950 ger SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt_ "B" Above
-$450.00 Conservation Pian Review
Fee Determined by Engineering
Agreement Necessary j] Not Necessar5� []
�
�cc;«,ui,vc E•� tt�rr�c rcE scE{c���c,t:
'I'lie Cliief Building Ofticial sliall, l�efore issuing pern�its for the erection c�f any bui(ding or �tructure, or f<�r
any addition to any existing buildiiig or sttuciure, or foc any alteration t�r repair to any existing building or
structure, upon application t}�erefore, require the payment by ihe applicant for such permit of fees to the amount
herein i�elow set forth and in the manner herein provided to-wit: �
TOTAL VALUE
$1 to $S00
$501 to $2,�0
$2,OU1 to $25,000
$25,001 to $50,000
�SO,Q01 to �100;000
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $SOO plus $2_ 75 for each additionat $100 or
fraction thereof, to and including $2,000
S62.25 for first 52,000 plus $12.50 for each additional �1.000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional � 1, 000
or fraction thereof, to and including $�D,000
$574.75 for first $50,000 plus $6.25 for each additionai
$1,000 or fraction thereof, to and including $1(?U,�O
$100,001 to $500,000 .$887.25 for first $1�,000 plus $5.00 for each addition�l
$i,�0�or fradion tliereof, .to .and including $S�,p00
$500,001 to $1,000,0(�
$1,000,001 and�up
$2887.25 =for .the first � $SOO,OOO pius $4:25� for each .additioffi1 . . � : . . F
..$1,OQ0 or frac�ion thereof, to and including $1,�,000 '- �
$5012.25 for..-the first $1,pQp,ppp plus $2.75 for each additional
$1,0� or fradion thereof
DRI' �'WAY DEPRESSION �ESCROW
(Concrete C�rb Streets Only)
;�►Iternate "A"-: Removal and replacemeint of curb and, gutter oniy - Dri�ecvay width plus b feet times $13_50_
'�(ternate "B": Removal and repiacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway.width plus 6 feet times $15.7�_
VERIF[CATION OF FOUNDATION
'crcilits for construction will be issued a minimum of 24 hours from the timc of application to allow �oc prop�r
cvie��� oi' tlie proposcd stiucture and of the construction site.
��:�c:rtiticate of Surve�� c�f tlie lot, sl�owinn the location ofthe foundatio,a e���ce it has if has hc:�n c�nsiFUC.=,cc{
': '�� r�c�uirccl hct<�r� i�r<�,:���din�� �t�iti� tli� fr:lI]liil�_
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIAIVCES OR THE
APPUCATION WILL BE RETURNED '
� CC)MMnN VFNT� VFNT _nNNF .TnR A(�D rnlL�Bl iSTl�f�! AIR �! RIFI ATInA!
When rp �a _�r,0 an,_ pY�ng �rar, , the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstrucfions, �
and is securely supported and firestopped where required. Yes � No ()
The venting system is piastiGPVC and meets ail current codes and manufacturer
speafications inGuding sizing, length, number of elbows and termination. Yes (� No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacfiurers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The eY,��g _en,tH,_�en a�r is ��ed �d irtstatled to r�eet the currerrt codes
and manufacturers specifications.
Whe11 i2qUl�ed t0 inefall a new r_em6 �etien ��r ���I be sized and installed
to meet the current codes and manufacturers specifications.
Yes � No ( )
Yes � No ( )
Yes�No()
Wh@� inc�fallinA a nPw v_nfin��c,��„ �e undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
speafications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. • Yes (� No ()
Is the common vent and vent connectors sized and installed coRecdy after
an appliance has been removed from the common vent and vented
separately as per wrrent codes. � Yes�No ()
_ • • . � M' l� - . � � ►' _ • 11 11 • / ' � . � • " �Y • � � ' y • � � ■11 . 1 • �
Appliance #1 Type �NV� � BTU Input,Z,`� Fan Assisted or Nat dL�Q� �
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
App6ance #1 Vent Connector Neight ft%�gth ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
;
, - �
— Center Point Energy MGCO
13562 Central Ave NE
HEATING CO: �oka, MN 55304 � ,
Signed By: � Date : � I� Z� -� °2�
�
HEATING
AIR CONDITIONING
AND ELECTRIC, INC.
ADDRESS � I 'iPi��'T�P^ r� . �� C l�- �°
OCCUPANT
HEAT LOSS;, �� DATE HTG. INST. ��- ��•_ �� Z
SOLD BY _ L�' dT/�Pa �i+:. � ��J �i'Glv1
Elecvical Work By .isv�i�J-� ��
NPE OF HEAT GA FA� HW STEAM SPACE HTR.
GAS DESIGN
MAKE l.��l'�
Model % �
Serial f�`� L,r" `� /� c� � �
INPUT ��'?��2 �
CONTROLS
THERMOSTAT Heat Plug
VelUe
Limit � �O
Limit Settina
Fan Settin
Pilot Type� �1( y°e e � Cr9CL�7 ��'
Pilot Make
Pilot AAodel
F "t Timina
L.W. Cut Off
Pressu� � �, � Percent COz � �
Input CFH Peraent OZ _ � %
Stack Temp. � g'�] Peraent CO L�'/
h10lJSE HEATING TEST RECORD
APT. FLOOR CITY SUBURB
OWNER
INSTALLEDBY ��.vl�� ��d�r_� � ��j-C-79ti/
Gas Line By �____.��_-»
UNIT HTR. OTHER
CQNVERSION
��
Vent Size �1
KIND OF LINER SIZE NONE �
Draft Hood Regulator
Filters Size Number �
Chimney Locauon Inside �/ Outside
Chimney Consvuction � � .��
a
Smoke Bomb wring
Draft Test Tag
Door Pressure Lighting Inst.
Date Tested �� — � � � c� �Z°'
Company Testing %p.a,�tdv �4��° �+'`�.��liLl
Name of Tester
/
Pressure Peroent CO2
Input CFH Peroent O2
Stack Temp. Percent CO
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Build'u�g BUILDING Permit rto.: ��� C���l
Inspections RESIDENTIAL APPLICATION Received By: G�`��
763-572-3604 CITY OF FRIDLEY na d n
763-502-4977 FAX EFFECTIVE I-1-2010 "" 4O
DATE � � L�� d� YOUR E-MAIL ADDRESS � W� e� � b1 Q/"S (ss �/ Gti � m b. G 0�'1.`
srrE�wn�ss � ��b��.�,1$�a,r �t �
THIS APPLICAATT IS: ❑ OWNER �ONTRACTOR
PROPERTY OWNER/ NAME:
TENANT ADDRESS: ��`{_�'.,3 bI`A� � °�,r � CITY �r.�►e� � � e.p STATE�ZIP �'
PHONE: �� ��`� 1 �° � � � P�
CONTRACl'OR NAME: iar � I� i� �
SUBMIT A COPY OF STATE LICENSE # P_� �,� EXP DATE ���, p��:� � I
YAND CERTIFICATE OF ADDRESS: ���� �.d�ra�t➢ �I/di CITY ��
y` � u�Lr'" STATE �61.ZIP � �
INSURANCE PHONE "' O FAX
PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE .
❑ TWO FAMILY/ATEW CONSTRUCTION STORIES
PERMTT TYPE 0�DITION ❑ GARAGF/SHED wtNDOws
❑ BASEMENT FIIdISH �ROOF � DRAIN TILE
❑ DECK �i SIDING � OTHER
❑ SW[MNIING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
�MAINTENANCF./REPAIR ❑ REMODII.ING
DESCRIBE WORK BIING DONE:
SIZE OF IMPROVIIvIINT LENGTH WIDTH HEIGHT S FT
IiOpFING � ���� Q HOUSE ONLY �ASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES . �r HOUSE & GARAGE �, Existing Floor Plan
GARAGFS ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: �.DETACHED GARAGE 3. List of swctural members to be used
PRO�SED HIIGHT:
_�___ FOR NEW CONSTRUCTION INCLUDING DECKS,
� �' ADDITiONS_ & PORCHES SUBMIT:
Vi►ryl ���� �_ OSoffit 1. Site Plan/Survey showing the exisdng structiues
❑ Aluminum � Trim and ro sed ect
❑ pther �� 0 Fascia 2, Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISI7NG OPENIIVGS �Yes ONo LOCATION OF WINDOWS FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPININGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WIN�W.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLID NUMBER OF WINDOWS
ALL FEES ARL BASLll UN VALUA11Viv, llv(;LUli11vcJ 1t1�; �:u�i vr i.�►�svx �►�vu ivia►i�n��,a:
S�NG TAE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �. � � /'I ��` � OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surchacge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
$ �,�� See Back Page for Fee Schedule
$�' 65% of Building Permit Fee
$ .001 times the total job valuation
$ � .0005 x Permit Va.luation Minimum $.50
$ " >' $5.00 (State Licensed Residential Contractors)
$ $2100 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$24=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ . _� Make checks aavable to: City of Fridley Attach
THIS I5 AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an appli 'on a pe it an ork is not to sta.rtt without a permit on site; that the work will be in accordance with the
approved plan in the case o ork ic���s �view and approval qf plans. '� �
� . . , . . . � �'����i1/�/�L/��I . , J�11!�;._n��u�l � • � �.�c•�
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Claief Bu�lc�ing Official- sh�.11,, be,fore° �issuing permits for the erection of any building or °
structure, or for any addition to any existing building or struc.ture, or for:.an�! alt��ation Qf 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: . - � - . � ,
. � • . _ . � ,, ,.-..,. �
�'ERIFICATION OF FOUNDATION
Permits for conshuction will be issued a minimum of 24 hours from the time of applicat'ron to �
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will b�
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977