AF - 45602City of Fridley, Minn..
BUILDING PERMIT N� 5350
Date: ___.T __`�J...; Y' �''"�._`..� I____.____
�� / �
Owner: �.p��"}2.----5.��...�-e.��-�--f�_�ss�_ Builder €��� .._ .. . � -tt��e%.�....�y..�IG�i,�..jy[...
Address __.._._......_.._.__.._...___._....._. � .
......-.........__........_....__..... Address _..._....---�.__._._......_...._..__._. . _.
��� � CATaON O UILDING
No. ... _ . Street 1_..... P of Lot ....,_........._.
_. _
� .....—.._..---....._..._. ^
Lot -.-.....�.�.!__._ Block __._..._._. .. Addition or Sub-Division .� ��
---.._. ._. _.../t�-s2.t._--
Corner Lot ....._._..._._.._ Inside Lot _..___%sE�._.__ Setback _.�y�2 M-.--. Side ard . / �'R �
. y ......I-�_.._..._...----�---___
Sewer Elevahon
To Used �
_.�f ��(,�
Foundation Elevation
DESCRIPTION OF BUILDING
Front _;f"'�.�._.... Depth ��.^'.�{x..._,_ Height >!!.CTs_F.._. Sq. Ft r�°s��.�.�..�Cu. Ftf� .f�.:.�"L,!
-�-. ... .`�� P � Height ..._ Sq F't. . _ _ _.. Cu. FG
. . _...� Front ......._.. De th ._ �
Type of Constauction �'� .. ,� � +%t �e�x�� �i ��
w�r�"'r-i-�^�7RS.� -�-.. Est. Cd'st �,,,�;f;,��".�' � t�E Completed
._..._...._ .............
In conaideration of the iasuance to me of a. pernilt 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 city of FYidley. � .
� In caa�sideration of the payment of a fee oP� permit is hereb
�+��-J�- —..__, y grantea to_..____�_
to constnyct the buildi or addition as described above. This permit is granted upon
the exPrnss ca�ndition that the person to whom it i�s �anted and his agents, employees and workmen, in ai] work
done in, around and upon said building, or any Part thereof, shall cqnform in all respects to the ordinancea of
��IeY� Mwnesota re8�`ding location, construction, �lteration, maintenence, repair and movuig of buildinga
�� a�l' 1�its 8°d this Pei'mit may be revoked at aqv time upon vioiytion of any of the provisions of said
Buildin8 Inspector
NOTICE:
T6is parmif dwr not wver fl�� wnchuction. i�rapNion for wiring, PIum61nB. 9y 6eaffng� zeM.or or wahr. Bs wn fo w
1M building ImpsROr for sepueM permk� for 1Lesa ifemt,
4
.�_�. � �
`...
APPLICATION FO�t BIIILDING PSR1+II.�'
CITY �' FRIDIEY, MINNESQTA
Owner' a Na� GU/A�L /�� Huilder
Address
%D
iN OF
.--
v
No. / y Street �� Xit.�–� ��1�Part of Lot
Lot� �— Block 6ddition or Subdivision ��A�.%!'f5�
� � -
Corner Lot Inaide I,ot �� Setback_�_Side–Yard ���
SE��i. ELEVATION FOU1�D&SION ELEYATION
ipplicant attach to thia form Certificate of Survey of Lot and proposed building
location.
To� uaed �aj� �
DFSCRIPTION OF BUII�DING
�1•
��� /� .`' i
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction ���, Estimated Co �,�
����
To be Completed
The undersigned hereby makes application for a permit for the work herein apecified,
agreain8 to do all work in atrict accordance with the City Ordinanaea and ruling oY
the Depertmeat of Buildinga� and hereby declarea that he faots and repreaentations
atated in this application are true and correct.
nn� �' .� �L � % � RT�NATTiRit �� r�,l� � __ _ _
(A Schedule of Fee Coste can be found on the Reverse
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City of Fridley _ � � � 2
ATTHETOPOFTHETWINS BUILDING PERMIT�
��� �i .:' ` .. . . � CEIP7 .
� � �____ COMMUNITY DEVELOPMENT DIV.
�~ � PROTECTIVE INSPEGTION SE0. . 9'� 9D
r �
i.-_-� �"" �'� CITV HALL PRIDLE� 5$432 NUMBEa REV. OATE vAGE OF APPRpVEO BY
i 612-571-3450 9i0-Fi5 5/10/83 � �
�oe aooRess 1410 Glacier Lane N.E.
1 LEGAL �OTNO. BLOCK TRACTORADDITION SEEATTACHEO
DESCR. � 2 4� � Innsbruck lst Addition SHEET
2 PROPERTVOWNER � MAILADDRESS ZIP PHONE
Pau1 8erg 1410 Glacier Lane N.E. 571-4521
3 CONTRACTOR MAILAD�RESS Z�P PHONE LICENSENO.
Same
a ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADORESS ZIP PHONE LICENSENO.
6 USE OP BUILDING �
Residential
7 CLASSOFWORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE ..
X
8 DESCRIBEWORN �
Reroof Dwellin
9 CHANGEOFUSEFROM TO �
STI ULATIONS
Roof can be 2nd layer lut not 3rd. Install galvanized valleys,
SEPARATEPERMITSARERE�UIRE�FORELECTRICAL,PWMBING,MEATING, TVPEOFCONST.� OCCUPANCYGROUP OCCUPANCYLOAO
VENTILATING OR AIR CONDITIONING. �
TNIS PERMIT BECOMES NULL AND VOID � 1F WORK OR CONSTRUCTION ZONING � SO. FT. - CU. FT.
AUTMORIZED IS NOT COMMENCED WITHW�60 DAYS, OR IF CONSTNUCTION
��OR WORK IS SUSPENDED OR ABANDONED FOR A PER�OD OF 120 DAYS AT � ��
ANV TIME AFTER WORK IS COMMENGER � � NO. DWLG. UNITS OfFSTREET PAPKING
I NEFEBV CERTIiV THAT I MAVE READ� AND EXAMINEO THIS APPLICATION ,' STALLS GARAGES
ANDKNOWTHESAMETOBETRUEANOCOHREGT.AILPROVISIONSOFLAWS yp�UATION SURTA%
AND OFDINANCES GOVERNING TMIS iYPE OF WORK WILL BE COMPLIEO �`SOO S.SO
�WITH WHETHER SPECIPIEO NEREIN OR NOT. TME GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHOflITY TO VIOLATE OR CANCEI TNE pERMITFEE SNCCHARGE
PROVISIONS OF ANV OTHEP STATE OR LOCAL lAW REGULATING CON- $'],S. OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � �
� PLANCHECNFEE TOTALFEE�
$15.50
5� OicOrviRnCro OAnUT 2EOAGENi �DniEi � N.'HV�J PROPERU' LIDATEO THIS IS VOUR PERMIT
�..�.Q, .5 =/D� �3 ��o
i NATUREOFOWNER WNER fLOER! i0ATE1 BLDG �NSP PiE
c�Tr or Faio�.cr �=f�°t1�� "°9. 1, 198]
APPLICATIQ� i0R RCSiDCNTl11L lUlLDlilG PLRNfITS
(Nc�r. Alterations. Itdditions. or RepairsJ
ON►�ER:
ADDP,ESS: �
�� �o: �7�— SL.s~-z / .
. srx�r «o: /�/ d srn�r: g����
dUIIDER: ' .
ADDRLSS:
TEL f�0:
wr: �— si.oac: � �anirsaei: —
Cozner Lot: inciac Lot: Cetbaak: 5ideyezds:
11p�]ieant ait�eh to Ll�is foae fsro Certifie�tes of S1�rvey of lot �nd
pzoposed building locatian drawn on oeztifie�tes to seele.
DESCRIPTJOit OF COHSTP.UCTIOH
mnt: Depth: Neiqht:
iquare Faets Wbie Feet:
Fzont:
DeptA�
iquare Fest: Qabie Peet:
7ype oi Cbrstruetionc ,Q�'
YD Ee CDr..plcteE: �
HeiqAts
S
-� op
istimateE Cost: t �J d4 �
J►lt. I► 7►It. 8
Yroposed Drivc�+ay i�idtA If NCV Opening ie Desized: _' j
6EC RiVER;E S7D'c OF SNf�T
�s,� �e�siQ��a n�r�vY makcs applieation foz a per�cit fcz thr �,ork rercin speeificd,
•greeirg to do,all vozk in striet •ceozdsnee with the City of Fridley Ozdi��ances e»d
rulin9s of the Del>ulanmi of Duildings, and TrscDy dec7a:es t?u�t �ll the faets nnd
zcpzeanftaticas stated ir� this Appli
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City of Fridley 018 5
� �"�E'°°°f'�E'W'NS gUiLDiNG PERMIT Na
r
�
� � ��� COMMUNITY DE�EIOPMENT DIY. . /
f � � PROTECTIVE INSPECTION SEC. . ��
� KJ
� � /'�9 � CITY NALL FRIDLE� SSta2 NUwBER RE'/ D�TE o�GE OF �IiNOVEO !r
�----�' ••� 612-571-3450 9t0.Ft5 9/8/99 / /
J08 ADORESS 1410 Glacier Lane NE � � �
1 LEGAL LOTNO. BLOCK TRACTORADOITION SEEATTACMED
DESLR. 2 4� � Innsbruck lst Addition. s"EET
t PROPEPTYOWNER MAILAD09E5$� 21P PNONE
Roger Gri£fis 571-4036
J CONTRACTOF MAILAOONE55 Z1°55337 PHONE LICENSENO
American B1dg. Contractors Inc. 12247 Nicollet Ave S Burnsville 707-6959 20169383
� ARCNITEC70RDESIGNER MAILADDNESS � ZIP PMONE UCENSENO.
5 ENGINEER MAIUDORE55 . 21V VXONE LICENSENO
8 USE OF BUILDING
Residential
� cuss o� wonK
❑ NEW ❑ ADDITION D ALTERATIpN. �[ pEPAIR O MOVE � iiEMOVE
B �ESCFIBEWORK
Reroof house and ara e 23 S Tear-o£f
9 CHANGE OF USE FROM TO
STIPULATIONS .
Underlayment must comply with the State Building Code.
TYPEOFCONST. OCCUPANCYGROUP OCCUPnNCV�OnO
SEPARATE PERMITSPRE FEOUIREO FOF ELECTRICFL, PLUMBING, HEATING.
VENTIUTING OR AIR CONOITIONING. � �
THIS PERMIT BECOMES NULI 4N0 �O�O IF WORK OF CONSTRUCTION zONING SO. FT CU. FT.
AVTMORIZED IS NOT COMMENCED N(�THIN 80 OAYS. OR IF CpNSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR 4 PERIOD OF 12p DAY$ AT �
ANY TIME AFTER WOAN IS COMMENCED. NO. OW4G. UNITS OFF57REEi GARKING
1 NEAEBV CERTIFV THA7 1 HAYE fiEAO I1ND EXAMINEO THIS APPLIC�TION STA��S GARAGES
.CN01(NOW THE SAME TO BE TRUE ANDCORNECT. ALL PROVISION50� �AWS yq�upTION $URTA%
nND OR�INANCES GOYERNING THIS TVPE OF WOAK WILL BE COMPLIED � �,
WITM WMETMER SPEQFIED HEREIN OA NOT. THE GRAN7ING OF A 7ERMIT ZOlO I.OI
OOES NpT PRESUME TO GIVE AUTMORITY TO VIOLATE OR C�NCEI TME pERMITFEE � S�CLMA E
�qOV1510N5 O� ANY OTMER STATE OA LOWL lAW REGUL�TING CON� �
STRUCTIpN OR TME �EAFORMANC£ OF LONSTRUCTION � $ `Lrj . � �
pLAN GHECN fE TOT l E
N t�RE ONCO n •U*N EO�GENi iO�lE�
NEN R V IOA TNIS IS U 7 T
< SG�+aipqtO�OwnEa��iOWNEaBw�OEPi iO�TEi B� �aSP' ��tt
NEWj'T"` � 4� Effecdve 5/10/99
ADDN [ ] CTTY OF FRIDLEY
ALTER [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII..DING PERMIT APPLICATION
Construcdon Address: ��//l� /.-�i,� c i`P.r_ � rv�
1��'��
��
I.egal Descripdon:
Owner Name & Address: e q*,� �-,��' G�, � s Tel. # S%/- t/ 0 3 L
Contractor:
MN LICENSE #� o/ b g 3 P3
Address: /22�/7 � c��(a� iT�c S. Tel. # 7 a 7-� ss F
Attach to this application, a Certificate of Survey of the
lot, with the proposed construcdon drawn on it to scale.
1 ' I' I 1 1 I' t•/_ �1 ►Yi
LIVING AREA: Length Width Height- Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground _ Sq. Ft.
OTHER: �-3 s ��
Construction Type: �f ^� o u/� Estimated Cost: $ �___
Driveway C�ub G�t Width Needed: �Ft. + 6 Ft =_Ft x$
_$
DATE: 9' - 3-Q y APPLICANT: �����,�¢C-, y��_ Tel. # Q/�=� 7� t--
Pemut Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ���as�
$ .d/
$ , D/
$
$�
$
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (i/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ) Not Necessary [ ]
$ �.`�`�'
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Building
Inspections
763-572-3604
763-502-4977 FAX
SI7'P ADDRESS _�'
THIS APPI.ICANT IS:
PROPERTY
OWNERI
TENANT
CONTRACTOR
SUBMTT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT 1'YPE
TYPE OF WORK:
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWNER
COMPANYNAME:
CONTACTPERSON:
STATE UCENSE #
PHONE
DETAILED DESCRIPTION OF
ADDRESS
FAMILY ❑ TWO FAMILY
❑ REPLACEMENT
❑ TOWNHOUSE
❑ ALTERATION/REMODEL
ATE 'LIP
ATE_71P
FEES ARE BASED ON SI0.00 PER FIXTURE XCEPT WHERE NOTED. F[XTURES: QNDICATE T TAL NUMBER OF EACH BELOW)
Fquipmentlnstalled MFG:��Q�� MODEL:(�1,�� SIZEBTU �JQ��YYZ
—. v7°._ _
NC $25.00
AIR TO A[R EXCHANGEHR SIS
BOILER $35.00
CH�MNEY LiNER $]0.00
MFG:
MODEL:
MFG MODEL�.
FIREPLACE(GAS)SI5.00
FIREPLACE(WOOD)$35.00
FURNACE$35.00
GAS DRYER $10.00
SIZEBTU
SIZEBTU
RANGE/OVEN $10.00
GAS GRiLL $10.00
UNIT HTR $10.00
�� HEATER $35.00
THIS IS AN APPLICATION F02 A PERMIT-NOT VALID UNTIL PROCESSEP
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate•, that the work will be in
conformance with [he ordinances and wdes of the City of Fridley and with the Minnesota Construction Codes; tha[ 1 understand [his is
not a permit but only an lication for a permit and work is not [o start without a permit that [he work will be in accordaoce with the
approved plan in the cas o I work which requires review and app ov s. Q ��
SIGNATURE OP APPLiCAN ` � T NAME � � � DATE � � "V�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977