AF - 45896Village of Fridley, Minn.
Bi1ILDING PERMIT �°• 1903
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Owner �o.. £.':: .4.�'�...tl. ..:,d.�::� 1.f.e:,::L:P Builder .bf�r'.�....�::�.�..-.. �.r.��..' ..................
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Address . � . �:� . . �. t..:;�.,�:::-n.. ,'. e''x.� address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. . . .. .
c, /� LOCATION OF BUILDING
No. . . . . .`J�p . Street ....l;G' �-.��L`�._.a ..... .. ....... Part of Lot ... .............. . ........ ...
Lot .............. B:ock .................. Addition or Sab-Bivision ......................................
Corner Lot ........... Inside Lot ........... Setback ........... Sideyard ............................
DESCRIPTION OF BUILDING
To be tised as: .
..Ttv... ,.��..<.... Front �.'�'.... Depth :e:.. i::: Height �'."`.'-.�.. Sq. Ft. ........ Cu.-Ft. ........
..........�........... Front......... Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ..:.....
Type of Construction . f. f..... :. ..�.-. r:�. . Est. Cost . . . .. � f . f. ej . .... . . . . To be Completed . .. . .... . . ...... . .
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Tn consideration of the issuance t� me of a permit to consiruct 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 village of F'ridley, � , .
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In consideration of the payment of a fee of $... ... '- permit is hereby granted to f '� `��
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�.°�"�'�� -��:3{' .,,, to eonstruct the building or addition as described above. This permrt is granted upon
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the expr�condition that the person to whom it is granted and his agents, employces�and worl�en, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to ffie ordinances of
Fridley, 1�Iinnesota regarding location, construction, alYeration, maintenance, repair and moving of buildings with•
in the village limits and this permit may be revoked at any time upon violation of of the provisions of said
ordinance5. � �' Y+ �� r�✓._ :
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NOTICE:
This permit does not cover the construction, installation or alieration for wiring, plumbing, gas heaYing,
sewer or water. 6e.sure to see t� 4vilding Inspector for separate permits for '' se items.
aTrEr+TioN oF: CITY OF FRIDLEY
r � 6431 University N. E.
ro Judy TrJelcii _ Minneapolis Minn. 55421
, 612-560-3450
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susJECT ��d of Building Permit Issued i.n Trror oprE APri1 5, 1983
Plaase make a check out to:_Johnson's Insulation_&_Reundelixx3-CamPanY:-2816 E._38th_Street,
_ Mirmeapolis, P�IN 55446. in .the amount of $90.00. This is takin9-$38.SQ_£ran Pes�ati.t.fund __
and $1.50<fxnm surcharge fund. TYu.s permit shoul.d not have_been issued_as the wozk_heing
done siqes nat need a buil<iing permit. _
Building_Pexwit_#1b945, 560 G7.encoe Street Ia,E>, issued 3/16/$3. _
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SIGNATURE �
REPLY:
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�- DATE SIGNATURE
iyitY�ro1H�l4Y6D4 — W'��4a�H .�B�1L'm �EBa1YiV
� Johnson's Insulation & Remodeling Company
2816 E. 38TH ST. • MPLS., MN. 55406
P H O N E: 721-632t /6322
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165 NO. DALE ST. • ST. PAUL, MN. 55104
PHONE: 292-8804
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C1TY 0� FRIDLEY �feetive �ug. 1, 19e1
- AI'PUCATI�� FOR RESIDENT111� 6U]LD1t1G PEIm+lITS
� (Ne►+►. Alterations. Additions. or Repairs)
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ONf�ER: BUI LDER •
ADDAESS: � iv � yl� �}�y.j2t'�PS ADDRESS: a��'�' �"
TEL M0: f.
TEL H0: �.�Z� % �02 /
Construction Location
. srrusr ro: � ar�er: i
IATs — BI,OpC: � �11DAITIOQia
Cozner Lot: �__ Inside Lot: Setback: Sfdeyards:
J►pplicant attach to this foan !vo Certificates of bl�rvey of lot and
pzoposed buil�fng locatia� drawn oa certificates to scale.
`z����D _ I e DESCRIPTIOit� TRUCTIOfi
��I_ �OA1�li�ae
� �r�tts� ��u ��� :
Square Feets Wbic Feetz
Heiqhts
Fsont: Depth: Heiyht:
Square Fest: Wbic reet:
4ype of Gbratruction: l'""^^„'� Est3mateE Cost: 8�/_�_
7b Sa Cbr.�pleted: �
I►lt. A Alt. 8
fzoposed Dziveway i:idth If Ncv Opening is DesireQ: j' S
. SEE 1�VER;E SI� OF SHF�T
iS�e undersigned Tereby makc� appiieation fos a permit foz the work hereis� specified,
agztefng to do,all work ir, strict accordsnce Mith the City of Fridley Ozdfuances and
ruling� of the Del�.utment of IIui2dingc, and hereby declares t}u�t all U�e facts aa8
represontrtiens atated in this npplication are true and correct.
LL1TFs � 6 � SIGNATU7E: ,����_
Stipnlatio�»:
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s�e�cc* PERMiT NO.
� City of Fridley „.-,
, qTTMETOPOFTHETWINS gUILDING PERMIT R ` �'��4
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� �' COMMUNrtY DEVELOPMENT �IV.
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� FROTECTIVE INSPECTION SEC.
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�---1 • CITV HALL FRIDLE� 55�32 NuMBEP RE`/ D�rE v�GE Ur aovEO Br
�""'� � ,'' 612-571-3450 g70-F15 / / �
)08 ADDRESS 560 GLENCOE ST NE
1 LEGAL ��TNO. B�OCK TRACTORADD�TION SEEATTACHED
oesca. 40-41-42 I RIVERVIEW HEIGHTS sneer
2 GROPERTVOWNEP MAILADOAES$ ZIP PHONE
JEFF TEREBAYZA 560 GLENCOE ST ERIDLEY MN 55432 783-0024
3 CONTRACTOR MAIL AODRESS Z�P PMONE LICENSE NO
DESIGN CRAFT 2641 LOUISANA AV S ST LOUIS PARK MN 55426 922-1400
d AFCHITECTOfiOESIGNER MAILADDRESS ZIP PHONE UCENSENO.
5 ENGINEER MAILADDRESS ZIP PNONE LICENSENO
6 USEOFBUILOING
RESIDENTIAL
7 CLASS OF WORK �
❑ NEW ❑ ADDITION O ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCNIBE WORN
VINYL SIDING
9 CMANGE Of USE FROM TO
STIPULATIONS
TYPEOFCONST. OCCUPANLYGROUP OCCUPANGYLOAD
SEPARATE PERMITS AflE REOUIRED FOR ELECTRICAL. PLUMBING, NEATING,
VENTILATING OR Alq CONDITIONING.
TMIS PERMIT BECOMES NULL AND �OID IF WORK OR CONSTRUCTION ZpNING SO.FT. CU FT.
AUTHOAI2ED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION
OR WORK IS S45FENDED OP 0.BANDONEO FOR A PE�710D OF 120 DAYS Ai
ANY TIME AFTER WOFK IS COMMENCE�. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THI$ APPLICATION STALL$ GARAGES
ANDKNOWTHESAMETOBETRUEANDCORRECT.ALLPROVISIONSOFLAWS yqLUAT10N SURTA%
AND ONDINNNGES GOVERNING THIS iYPE OF WOHK WILI BE COMPLIED 67)ro•QO 3.38
WITH WHE7HER SPECIFIED HEREIN OA NOT. TME GRANi1NG OF A PEPMIT
�OES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF � OTHER SiATE OR LOCAL LAW REGULATING coN- 124.75 FIRE SC 6.75
STRUCTION O THE DR F ONSTRUCiION.
9a� PLAN CNECN FEE TOTAL FEE
� 139.88
SIGNPiUREOiCpN�A<RDRORAUTNOPIZE�AGENi I�AiEi WHEN PNOPERIY L��ATED TMIS tS YOUR PERMIT
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S�GNAiUFEO�OWNEAi60WNERBWLOERi rD4TE 8L0 �NS� ����E
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ALTER
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ConstrvctionAddress:
Legal Description:
Owner Name & Address:
Conh�actor:
LIVING AREA:
GARAGE AREA:
DECg AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 8/i/95
Tet. # $3 --C�c�.�
MN LICENSE 1� O� `fS�F��
SS Tel. � _1��0�
Attach w tLis application, a Certificate of Survey of the
lot, with the proposed construction drewn on it to scale.
Lzngth
I.ength
I.ength
DESCRIPTION OF IMPROVEMENT
Widd►
Width
Width
Height _
Height _
Iigt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Iaside Lot [] Ft Yd Setback Side Yard Setbacks
� of co�,«;on: 1,� � ��� �cea c�c: s 7so °-� _
Approx. Completion Date: / — _
(Cost on Back)
Driveway Curb Glrt Width NeEdetl: Ft. + 6 Ft = Ft x$ _$
DA1'E: ��-l�% �J APPLICANT: Tel. #�o�.��
�ITY USE ONLY
Permit Fee
Fire Surcharge
sr�c� s���ge
SAC Charge
Lacense Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ /` 'T
$ �S.%Sr
$ �, � Y
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/1()th%)
$.soisi,000 v��on
$ $850 per SAC Unit
$ �`j , �.�'�� $5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by EnB��erin8
$
$_���
Agreement Necessary [ ] Not Necessary ( ]
Building
Inspections
763-572-3604
sire nnn�ss `_� t o V
THIS APPLICANT IS:
PROPERTY OWNERi
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WI'1'k3 APPLICATION
PROPERTY TYPE
PERMIT TYPE
BUILDING
RESIDENTIAL APPLICATION
❑ OWNEA
STATE
CITY OF FRIDLEY
Permit No.:
vouxsnu�Lnun�ss C,��'v�ctnctAi�o�}w�rfinocl�om
�t �
'�ON7RACTOR
❑ BASEMENT FINISH
❑ DECK
QESCRISE WORK BEING
NOMBEROFSQUARES
G GES
PROPOSED SIZE:
PAOPOSED HEIGHT:
p ROOF
❑ SIDING
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑ DRAIN TILE
❑ OTHER
HEIGHT
T�2�r��'1'J2
BASEMENT REMODELING SUBM[T:
L ExistingFloorPlan
2. Proposed floor plm
3. List of structwa] membels to be use8
Ft.
SIDING � � FOR NEW CONSTRUCTION QiCLODING DECKS, �
❑ Vinyl , . . � OSOflit , ADDI710NS & PORCHES SUBMI7'��
❑ Aluminum . . ❑ Trim � .1. Site Plan/Survey showing the erzis[ing struchves
❑ Other ❑ Fascia -� � and p`oposed project �
WINmWS 2. Twose[sofconsWC[ionplans
IN EXISTING OPENINGS �Ya ONo OCATION OF WINDOWS r, 3. Energy Calculatiom
OR FOR NEW OPENINGS-DESCRIBE S1ZE OF �'� U\ 1�.6� . i P�Q . r�UY C 1'� U F�� ( Q.�'�'i
OPENQ�]G CHANGES & — -� —�—
TYPEOF WINDOW TOBEINSTAL[.ED ��S °F" D NUMBEROF W[NDOWS
ALL FEES ARE BASED ON VALUAT[ON, INCLUDING TAE COST OF LABOR AND MATERIALS:
(USING� H,wE —199�7,,U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S 45�0�7CY OCCUPANCY TYPE
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chsrge
G�trb Cut Escrow
Erosion Conhol
Park Fee
Sewer Main Charge
See Back Page Yvr Fee ScheAule
65%of Building Permit Fee
.001 times the total job valuetion
.0005 x Permit Valuation Minimum $.50
$5.00 (Shte Licensed Residential Contractors)
51675 per SAC Unit (Pians to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agcement necessary ( ) Non Necessary ( )
THIS IS AN APPLICA7ION FOR A PERbffT-NOT VALID UN'17L PROCESSED
I hereby. appty for a building pern�it and I acknowledge 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 ihe Minnesota Construction �Codes; that I w�derstand this is not a
permit but onty an application for a pertnit and work is not to start without a permit; that the work will be in accordance with Ute approved
pVsn in the case of all work which requires revi w and approval of plaus. Q !
SIGNA"1'URE OF APPLICANT ��_ `p / r PRINT NAME �/'J� Z�UI�/ S� DATE��7i�7i/ O�
�3°I �ZS