AF - 45630e
SUB:EC?
'� City of Fridley
ATTHETOPOFTHETWINS BUILD�NG �PERMIT
, ,
' COMMUNITY 9EVELOPMENT DIV.
i �4 __�___' .
r � 7ROTECTNEINSPECTION SE0. � �
�
� � �""� � CITY HALL FRIDLE� 55432 NUMBER eEV. onre
�""'� � ,'' 612-571-3450 9i0-Fi5 5/30/84
J09 AODFlESS 109 Glen CYeek Road N. E. �
1 LEGAL �OTNO. BLOCK TRACTORADOITION
DESCR. W HS� of I,ot 1 B10 l, Oak Creek Addi..tion Plat 2
2 PFlOPERTVOWNER �MAILADORESS . Z�P
Preferred Builders Inc. 10267 University Avenue N.E.
$dI60
5 ENGINEER
8
9
ResidentiaL
OF WORK
� NEW
ADORESS
GHGE OF
� /
1751
RECE4RLAI0'
l3a 7/
/'�O %�
APPROVE� BY
� SEEATTACHED
SHEET
PHONE
786-4300
PHONE ' LICENSE NO.
PHONE � LICENSE NO.
r� , C'F f
dAILADDRES9 ' . I r �' ��� �Jj Vf��,.jPFi�N�:
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❑ ADDITION ❑ ALTERATION ❑ REPAIR C MOVE
ConstrucY a 42' x 24' Dwel
OFUSEFROM
and a 22' x S2'.
TO
7 REMOVE
STIPULATIONS provide City with copy of verifying survey �e£ore capping. Provide sod
in the front and side yards. Pmvids a hard surface driveway.
NO�SERVICES STUBBED IN1�0 LOT: Sewer, in middle of 5treet, Water, 10'� S. of S
8�9iffiXSXYffixMYB�&FXxta� Sewer 11' Deep �
$756.00 Park Fee Pai.d
SEI'Ef2i�1'� ����NfCTS t,� t��)i •;� � F(?R tivir'f!4G,
i 9EATf NG, P�.IJMt !!�(� �N�. �(�;,j3�
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rrz t�n;�
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�.`:��;'.' �.�'� �;�' E?�,
_ t,
SEPARATE PEFMITS ARE REQUIRED FOR EIECTRICAL, PLUMBING, HEATING, ����
VENTILATING OR AIR CONOITIONING. WOOCZ EY2�2 .
THIS PERMIT BECOMES NULL AND VOI� IF WORK OR CONSTRUCTION ZONING � SQ.FT.
AUTHOR2E� IS NOT COMMENCED WITHIN 80 DAVS, OR IF CONSTRUCTION �
OR WORK �S SUSPENDED OR ABANDONED FOR A PERIODDF 120 DAYS AT �
ANV TIME AFTER WORK IS COMMENCED. � . � NQ, -0WLG.. UNITS �
I. HEREBV CEFlTIfV THpT 1 HAVE FlEAD AND EXAMINED THIS APPLICATION �- STALLS
ANOKNOW7NESAMETOBETRUEAN�CORRECT.ALLPROVISIONSOFLAWS �yq��qTION .
AND OflDINANCES GOVERNWG THIS TVPE OF WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT SSSi%SO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULA7ING WN- �
SiRUCTION OR TME PERFORMANCE OF CONSTfy6ETION. S3OI.00. ��
�� /� ��J /� ♦ � � PLANCHECKFEE
OF CC
iDATEi �
�I\�'
�70UP OCCUPANCYLOAD
CU. FT.
OFFSTREET PHRKING �
IGARAGES
SURTAX
si%.ss
SACCHARGE
$425.00
TOTALFEE
5829.13
NESi { l
ADDN. I �
pLTEA. I �
Construction Addresa:_�
Legal Deacription: w` �S
City oP Fridley
R-t AND R-2
Building Permit Applieation
�J�
C. � �e � C IZecIC l��
�' �of � ��ac(� 1 oaK r�� 6
Owner Ne�e & Addref.�� 1 rC.�t�•c.� %�c2: �Jc�S -•c.
�/! /r
r��a�e-� •
Effeetive 4/1/84
� %t 2
' rei. # ? �6 ``�30�
� Tel. # ? b -- 1!�°c�
Address: �o �� '7 C*c, �ut t ' � �vC_ ��� —
LI92Nti ARSA:
tiARA(i8 ARSA:
DBCS AHHA:
OTHER:
Attach to this application, a CertiPieate of Survey of the
lot, with the proposed construetion draxn on it to acale.
DSSCRIPTI06 OF B�PHOYSl�6NT
Length �� Aidth 2`'� Height
Length �- Z Nidth � 'Z Height
Length /,o_ Width < o Hgt/Ground _
Sq. Ft. f°Ya
Sq. Ft.
Sq. Ft. p°
Corner Lot [] Inside Lot [ U1�Ft. Yd. Setback Side Yard Setbaek
Type of Construetion: -1-��� Estlmated Cost: $�
Approx. Completion Date: � ����
Alt. A Alt B
Proposed Drivexay Width If New Opening Is Desired: — See Back Page for Explanation
DATE: � ��
Permit Fee
Plan Cheek
State Surcharge
SAC Charge
Park Fee
Sever Main Charge
TOT►L
APPLICANT: Tel.
CITY IISE 09LY
� ��w Fee Schedule on Reverse Side
a i Z.� 25i of Building Permit Fee
� 7+ E•50/�1,000 Valuation
y OV E425 per SAC IInit
� % ���Cw Fee Determined by Engineering
� �� Agreement Necessary C�(l Not Necessary []
#�
STIPULAI'IONS: � s �� ..
��::.� � ,z� J �
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c�.Q.�Q... �.�Q � � ' �"� � `��c►�
N_ 622
CfTY OF PRIDLEY ,�_,.,_�-rs�a 7
PUBIIC WORKS DEPARTMEN'�
TAPPING APPLICATIOPi AND RE[FNIIT
FOB INSTALLATION OF WATER � SEWER SERYICE
I} 17us form to he compteted before a tap is made to any eristing water or
_m._.. ,:__
r�
- Address " lci7 Fs v.�. �i.i►iF �A
oWna P2'a.�e.a.r�.� &-u'l�.rr..
.
°' ��m�
CHARGES TO BE PAID BEFOFtE TAP IS MA E—
ASSESSMENT HAS NOT BEEN LEVIED AGAINST PRC
II)
Water & sewez rnnnection permitmust be registered before this Tapping
Permit can i� issued.
City supplies all material and labor for 1" or under ocater tap. Con-
tractor supplies all material and labor for water tap:over 1", and alt
sewectaps. �
l�Ct o�
WATERTAP: MaterielsIIsed: S '�
�
s
�.
.
; �'�
/ /
st�PBu��� :
TOTAL:
s �/fis; aa
SEWER:TAP: � StteetPatch: � : S
III) If this property has not paid a full Lateral Chatge for its share of the
water and sewer system, additional chacges will be placed against it.
This will be in addition to the normal conttection and tapping permits,
meter dep�its, etc.
Water
TOSELEVLED: Lateral:
Sewer Lateral:
TOTALASSESSMENT: S o'2.3'�/{�.J�-�
ClerksSignatnre�����+ �O�"�
�
Sugt. of Public Wenlcs
- M!P 3f76 White P.W. Canary Finapct Pink Prop. Owrwr 6olGenroO PlumMr ��� �
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U"IYOF
ERIDLEY
CIVIC CEN7ER • 8131 UNIYERS�TV AVE. N.E.. FRIDLEY. MINNESOTA SSd32 • PHONE 16121 571-3450
Auqust 1, 1964
To Whom It May Concern:
Re: 109 Glen Creek Road N.E., Fridley, M[d
Dear Sirs:
The house at 109 Glen Creek Road N.E. is substantially complete. There are
no known Code violations on the structure.
Due to such short notice, we can not at this time verify that the plumbing,
mechanical and electrical final inspections have in £act been made.
The City Code, Zoning, requires that the front and side yards be sodded and
that a verifying survey be filed with the City. There may be a need foz
rain gutters alonq the west side of the gazage to control rain water from
being directed onto the adjacent lot.
If you have any questions on these itpsus, please feel free to contact me at
571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
DGC/mh
. . . ' . suu[a � � .. � . . PER .
City of Fridley 91 16
ATTNETOPOFTMETWINS g�ILDING PERMIT
��
� ; � � � � RECEIPT NO.
' ��._._� GOMMUN�TY DE�¢LOPMENT DIV. � / l ��
/ � � VROTECTIVE INSPECiION SEC. , . �U
i
� � /"'1 • CITV MALL FRIOLE� 35��2 NUMlE9 pEV D�TE P�GE Oi �iVROVED !r
�.._.�• •,, 612-571-3450 9�o-P�5 3/31/99 j /
JOB ADDRESS - �
109 Glen Creek Road NE
1 LEGAL �OTNO. BLOCN �. TNAC70M11D�ITION SEEATTACMEO
oescA. pt 1 1 Oak Creek Addition Plat 2 SNEET
2 PROPERTYOWNER � MAI��DDRQS$ 21V PXONE
Marv Kollin 109 Glen Creek Road NE 571-9522
7 CONTRACTOR MAIL ADDRE55 Z�P PHpNE LICENSE NO
All American Roofin & Remodelin 4112 97 Ln NE Blaine MN 55014
� AFCrqTECTOROE5IGNER MAILAOORESS ZIP PHONE UCENSENO.
786-6676 5160
5 ENGINEER MAIL ADDFESS . ZIP PHONE LICENSE NO
6 USE OF BUIlO1NG
Residential
7 C1A550F WOAK �
O NEW ❑ ADDITION ❑ AITERATION �] REPAIR � ❑ MOVE O REMOVE
8 DESCPIBE WORK � �
Reroof House & Gara e(28 S) Tear-off
9 CMANGE OF USE FFOM Ta
STIPULATIONS �
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK AOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
;
TYPEOFCON T. OCCUOANCYGROUP OCCUPANLV�OAD
SEPARA7E 7ERMITS ARE REOUIREO FOR ELECTRICAL, PIUMB�NG. MEATING.
VENTILATING OR AIR CONDITIONING. � � ' -
THIS PERMIT BECOMES NUII •ND VO10 IF WORK OR CONSTRUCTION ZONING SO.fT CU FT
AVTHORIZED I$ NOT COMMENGED V�!ITHIN 80 DAVS. OR IF CONSTRUCTION .
ON WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF It0 OAVS A7
ANY TIME AFiEfi WORK IS COMMENCE�. NO. DWLG. UNITS OFFSTREET PARKING
I HEREB� CEIiTIFV THAT I HA4E READ AND EXAM,IN�O THIS APPIICATION 1 $T�llS GARAGES
ANOKNOWTNESAMETOBETRUE�ANGCOF(7ECi.A�LPRpVI$IONSOFLAW$ yA�UATION � SURTA%
ANO ORpINANCES GOYERNING TM�S TYPE OF WQRK WILL BE COMP�IED @
WITM WME7MER SPEGFIED NEAEIN OA NOT. THE GRANTING OF A PEHMIT WZf 399 ' $1.20
DOE$ NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR C�NCEL THf pENMITFEE SACCNARGE
PPOVISIONS OF RNY OTHEN 57ATE OR LOCAI lAW REGULATING cor+- ��4.75 . Fire SC �Z.GO
$iRUC710N OR TME PERFOAMANCE OF CONSTqUCTION
+ � / G�AN CMECKFEE TOTALFEE
Eo� - �'3�'99 License SC $5.00 $83.35
e��tuAE �CO � sf.iOAOA�u*wOA4E0aGEM� iD�iEi yyM N �RpPEAI ALI ATED THIS IS YOUA P/E�AM/jIT�{ �
S�GN�iV�iEO�OWNEQ��iOWNEABUR�EA� �O�Ifi � p � ��p" � "
p( �NS t
a W
NEW [ ] Effective 1/1/99
�D# � ) CITY OF FRIDLEY
,e�,�g [] SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 1�D
BUILDIAiG PERMIT APPLICATION �G��`IQ
ConstructionAddress: i D� G� e nG rc �K R � \—
Legal Description:
Owner Name & Address: r �! � a l 1 Tel. /t_
ContraCtor: R �� A m�x t c a^� i400 f�� 6 Re n�t ad e�� n y MN LICENSE #.
Address: '� << 2 R� f`' Lnr � ti. Tel. #_
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTi�R:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
I.ength
I.ength
I.enBth
TeQ,e-oFF
571- �Sa a
��(�o
?'�G -�67G
Width Aeight Sq. Ft.
Width Height Sq. Ft.
Width HgdGround _ Sq. Ft.
�onstruction Type: �Y�Koo� Estimated Cost: $ �C� �/
(Fee Schedule on Back)
Driveway G�rb Cut Width Needed: ,Ft. + 6 Ft = _Ft x $ _ $ — " "�
DATE: 3" 3� - 9^1 APPLICANT: L y.l�n� _ Tel. ���� -G � 7G
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
SITPULATIONS:
� , �J
$ o�. 5lb
$ /. �O
$—�--
$ �-QO
$
$
$
$
� ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Penmit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residendal Contractors) ; ,
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
g _ ,._
lp�llaS4. ��
Building BUILDING Pernut No. � (D�'
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Da,�'�a�E� 17 Z00
763-502-4977 FAX EFFECTIVE (-I-09
onre rebr�a�-„ 11� �1 Yovae-nv+�Lnn�a�ss Ni�o�e.J�en.te.n @-�ec.rec.�o�acc�r,-�
SITEADDRESS�E� �rE,P�C_ i�,pqC�
THIS APPLSCANT IS: ❑ OWNER �ONTRACTOR
PROPERTY OWNER/ NpME: y
TENANT �p�ss: i Ool U1e Y Rd eTTV �r i d teu srn� Mt�! z�P 55`k3a
PHONE: ��a- s-� � - asaa
CONTRACTOR Nnrv�: Miehe)lP We�ss -Crew�
SUBMIT A COPY OF STATE LICENSE i! o"Z O.�i� �3 i0O EXP DATE
YOUR STATE LICENSE
ANDCERTIFICATEOF ADDRESS: c'1loSO m;��e.ti,�.a. Av� CITY M(�IS STATEf1l4�ZIP��gOlO
INSURANCE pypNE '�. - - 1 i o� FAX (D 1 Z- - 1 $ a
PROPERTY TYPE �Sa�GLe enMavm�w coNSrxucrioN S�ze
❑'IWOFAMILYMEWCONSTRUCTION STORIES
PERMIT TYPE � ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING �OTHER
❑ SWU�9NG POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDTTION
❑ MAINTENANCElREPAIR �REMODELING
DESCRIBE WORKBEINGDONE:RECh(J' VC D�hol � C1CF�� GAb n4I"'S � Y�LTOVC W0._l�.
SIZE OF IMPROVEI��NT LENGTH WIDTH HEIGHT SQ F'I
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
GARAGES ❑ ATTACI�D GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACf�D GARAGE 3. List of strucWral members to be used
PROPOSED HEIGHT:
SIDRV FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑So�t ADDITTONS & PORCHES SUBMIT:
❑ Aluminum ❑ Trim L Site Plan/Survey showing the exisung struchues
❑ Other ❑ Fascia and proposed project.
2. Two sets of construaion plans
WN]DOWS 3. EnergyCalculations
IN EXISTING OPENINGS �Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPEOFWINDOWTOBEINSTALLED NUMBEROFW[NDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
Pumit Fee
Plan Review
Fire Surchazge
Surcharge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Chazge
$
$
THE 1997 U.B.0 FEE SCHEDULE)
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuauon Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21°$
�450 Conservation Plan Review
Fee Deternvned by Engineering
Agreement necessary ( ) Non Necessary ( )
THIS IS AN APPLICATTON FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and acewate; that the work will be in
conformance with the ordinances and codes of the Ciry of Fridley and with the Minnesota Consiruction 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 on site; that the work will be in accordance with the
approved plan in the case of all work which requ'ues review and approval of plans.
SIGNATURE OF APPLICANT ��inn�rn.� PRIN'I' NAME (�ji cc�l e SCl1 cPf� DATE o� I 1 o�i� O�
PERMII'S ARE
i
_�
FEB-O6-200A OB:OAA�1 fROM-
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add panels and doors
PV112730 PW2730
panel ---rp cut
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Building PLUMBING PernutNo.: ` a�°I
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY D�°dWA '� 200 '
763-502-4977 FAX ��c„v�Z�,9_ov
DATE "O %/� roua E-a�uL.aonxess i¢le,� � sourberP ( k 5- Ca
SITE ADDRESS �O % � ��.� rPtK Q04!`�
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY N,,n,�E: M ar� t n a l� � n 4 n,
�WNER/ ADDRESS: IO9 6ll.s �rtl� �ol. CITY }'/�� S'CA7F�Z[P�Z
TENANT
PHONE: 76 '3- 3^T/ — I Sao`Z
CONTRACTOR NAME: SO
SUBMIT A COPY OF STATE UCENSE # OS9 3 S� EXP DATE `a� :3 / O�
YOURSTATE
LICENSE, BOND AND STATE BOND # ��%�i// /% / EXP DATE ia- 3i- 0 9
CERT�ICATEOF ppDRESS: J�O• �Uy� JBS Ct1'Y C2cC /i, STATFjY�'J�ZIP G!
�rsuRaxcE PHO� 7Es�763.i�rytt�9a FAx 63- `ly`/-�3�5"7
PERMIT TYPE � SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNfI0U5E
TYPE OF WORK: ❑ rrew �fase[ nc�rrr
DETAII,ED DESCRIPTION OF WORK Ad� � � i�. � D. W.
FEES ARE BASED ON 510.00 PER FIX'PURE, EXCEPT WHERE NOTED. FIX'CURES: (INDICATE TOTAL NUMBER OF EACH BELON�. MININNM FEE
assso.
BATHSINK/LAV FLOORDRAINS SHOWER WATERPIPING
BATHTUB 6A5 PIPQdO (NEID CITY LIC) S WIMMiNG POOL WATER SOFTNER ($35)
CIATHES WASHER �f HITCHEN SINK WATER CLOSEf BACKFIAN PREV. ($15)
� DISHW ASHER _ LAUNDRY TRAY WATER HEATER (S35) FOR IItRIDATION
WATER METEIL OTHER
Isumber of fixtu�5tss �'S1t}.40 � x $10.00 = $
Number of fixtures (r�'$iS.QU x $15.00 = $
Numb� uf fixtuxea Q$35.00 ` i x$35.00 =$
State Surch S "SQ
s3s.sa To�=$ 35•�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I he�eby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the wock wilt be in
conformance with [he ordinances and codes of the City of Fridley aud with the Minnesota Construction Codes; that I understand this is
not a permi[ but only an application for a permit and work is not to s[art without a permit on si[e; that the work will be in accorda�ce
with the approved plan in the case of all work which requires review and approval of plans.
SIGNATUREOFAPPLICANT n��l�'` _. PRP]TNAME� �!�`rilGi DATE �'✓ ��/
� Ntji�:: SEPAR ATE FfiRIvt1T'S A�'E U`TRED FQRBLiIGDiNG ELECTRICAL AND MECAAN3CAI, W9I�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: '763-502-4977