AF - 45993City of Fridley, Minn.
BUILDING PERMIT
Date: �_�ri� 16, 1970 ----
� 5��33 �-
x. �oso�
p�r: __Tri-Co Buildera____ _ B„��r _ Same __.
Addieaa ...__...7561 Van Buren St. N.S. p�� _ S� -- --
LOCATION OF BUILDING
Na _..._616 _ Srieet —Glencce --- —..---._..... Part of Lot
_ � _ 51 � 52-- �O� —T ---------- Addition or Sub-Divlsi� $iverviev Hei,�hts _
Corner Lot ----- Inmde Lot _.._....,�........__ Setbnck _�_� _....-- 3ideyazd --
Sewer IIevati�
Foimdat3m Elevation
DESCRIPTION OF BUILDING
To be Uaed as:
�. e� � GaraQe Flroat __4L._._ DePih -- Heig6t --20�._ Sq. Ft -1028_ Cti. FL 2p�56Q
-'------ �t _20� ..__ Depth 22�— xeie,�t _.._l�� _ Sq. Ft 440 �� 4400
Type of Constiucti� Frame___ _.__. ���16,000..._..._.._...._ To be Completed — J�e 1970
1
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Verify lxati� of basement bafore c�tiauinQ fram� coaslruction
above foundation,
Sign agreement for REC chargea.
7n consideratton of the issuance W me of a permit to c�struM the bullding described aUove, I agree to do
the psopoeed work in acooxdsnce wittt the description abave aet fg�h and in oompliance tviffi all provlsfona of
aidinances of the Cit,y of Fridley. i_1 � /' n
7n emetderatioa of the payment of a fee of E��--�--., permit ia h�eby �anted *a T.x�i -C.o
Buildera tp ���et the building or additlon as �cribed above. 1t�ia permit is granted upon
the expreas c�ditlon that t6epe rson to whom it Is �ented end his agenta, �npbyeea end worl�en, fn ell mork
dame in, aramd and upaa said buildinB. rn' aav Pert thenrof. shall aomform In all reepecta to tLe ordinan�.�es of
F+'itIIeY� Min�eota regarding loeatron, constructim, siteratim, maiatenance, repair a� moving of buildings
wit6in the dty limits and thia P�t may be revaked at aqy tlme uPm vtolatloa ot any of the Pro�� of saW
orclinanoea
NOTICE
nds vMaN ae.. .a �w.. Ih. eee�s�. iqldw.n fe. �Nsr. v�a re hwYeO, w`r.r «...�... M... a.»
11r MiWiY �MWx� for wpvM� P�b fer 1b br�. . �
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AGREEMENT '
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//G[xh��J /3, / 9 7 O
/,J ��p�� DATE �7
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. �_ �P `
v,, %J the owner of the
. follo ing descri6ed property ��i �� d�
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���� ��.,TP1-ei �T %� �—
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Hereby agree to pay in cash $;;;,.�_-,�.-`�(f� -. �����
to the city of Fridley to cover my proporti�����
� � , share of the utility system, or in lieu thereof agree
to have the City levy an assessment against the
property described above to-cover the cost of my
proportionate share of the utility system as pro-
, vided in Section 2 of Ordinance No. 113, passed
- by the Council of the City of Pridley on December
_ - 11, 1455. /l`y���-, �.7�'c<<{�v
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_
OWNER$ SIGNATURE
Tapping Permit No.
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APYLICATION FOR BUILDING PIIiMIT
CITY OF FRIDLEY, t�IINNESOTA
6 3 8- a?a�
OWNF,R 'S NAME .it'i7i1 �.. �,;, .��� BIIILDER � - �,,,_, �r��c,y
nnnxESS �SG/ Il�� I.�-�,�,,, � ,�.� AnD�ss �.-...�-
LOCATION OF SIIILDING �A,..,�, �3 3' � % �'
NO.��STREET � h P y/ � U ^P
LOT b'% �-S �BLOCK� BDDITION OR SIIBDIV'ISION GWt�'"c� �,"�c,i-�i�%tLL,
CORNER LOT INSIDE LOT�SETBACK �� SIDEY9RD
SEWER F,LEVATION TOP OF FOOTING
ApplicarAt attach to thie form Two Certificates of Survey o£ Lot and
propoeed building location drawn on these Certificates.
DFSCRIPTION OF S[TILDING
To Be IIeed �e: / %��^'�ti`".s' 'CZ�'���
�`-� a2 t/ . Front �/ Depth � Height ��%
Square feet Q� Cubic Feet Zp , S�t a
��Front aa Depth � '�,� Height � �
Squase feet yyd` Cubic Feet G�L�c�
Type of ConstructK� �ix�y,-,�,z Eatimated Coat /(e, p-pt�• W/� .�'d+�C
To Be Completed_� / �%O � 3'� �
f
The undereigned hereby makee application £or a permit £or the work
herein epeoifi�d, agreeing to do all work in strict accordance with the
City of Fridley Ordinances and rulings of the Department of Buildings,
and hereby declarea that all the facts and representations etated in
thia application are true and correct.
19?.
(Schedule of Fee Costs can be found on
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the E verse Side.)
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- SUBJECi � ��
;� City of Fridley
"'T"ET°°°FT"E�'"s gUiLDING: PERMIT
� �
' � ' COMMUNITY OEXEIOPMENT ON.
' � v'-"'",
r � PROTECT4VE INSPECTION SEC.
f � �
i,.__-� �"'�,� GTY HALL FRIDLE� 55432 NUMBEfl-
t � 812-580.3�50
910-F15
JOB qDORESS
_�,16 le coe Street N E.
7 LEGAL L6TN0. BIOCK � - TRACTORADDITION
�
a
fl�.
DESCR. SZ�SL T Riverview Heighta Addition
USE OF
OFUSEFROM
Garage
� NEW
616 Glencoe Street N.E.
MAIL AODRESS
MAII ADDRESS
55432
21P
P�GE OF
� �
° 12061
NO.
(o�! 9�a.
APGROVEO BY
SEEATTACHED
SHEE7'
LICENSE NO.
PHONE LICENSE NO.
❑ ADDITION D ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
TO
STIPULATIONS - � � �
Stipulationa; Provide a hard aurface driveway..Get a latter from N.S.P.
approving building garage 3 feet fzom back property line.
SEPERATE PERMITS REQUfRED FOR WIRING,
HEATING, PLUMBlNG AND SlGNS.
SEPAPATE PERMITS ARE RE�UIRED FOF ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WO(iK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PEHIOD OF /20 DAYS AT
ANV TIME AFTER WORK IS COMMENCED.
1 HEFEBV CERTIFY THAT 1 HAVE HEAD AND E%AMINED THIS APPIICATION
ANU KNOW THE SAME TO BE TRUE AND CORRECT. ALL PPOVISIONS OF LAWS �
�AND OROINANCES GOVERNING TNIS TVPE OF WORK WILL BE COMGLIED
WITM WHETHER SPECIFIEO HEREIN OH NOT. TNE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEL THE
PPOVISIONS OP ANY OTHER STATE OR LOCAL LAW REGUUTING CON-
STRUCflON OR-THE PERFOHMANCE OF CONSTRUCTION. �
:ONTRA i HORAUT OH�ENT �D�A/iEI
�`- n. _ t 3 �'f/73
9.00
;Y GROUP OCCUPANC
CU. FT.
440 4400
OFiSTREET PARKING
CaARAGES
SURTAX
.99
SACCHARGE
TOTALFEE
$9.99
AF.P�ICATION FpA RE$IAENTIA�� AbT�R�4TIQN,
QR AAAITION BUILDING P&RMTT
GITY OF FRID�EY, MINN�SOT�
9WNE8'S NA1lE:,SrEFR[Q �• S4Eiatia�st BUILABR
nnn�tess: (, 1�, C<c 6N�o E s+. W, e. nn�ss
�IOSs� (�a ST&EETt b�f; Lfdc o,� S i. r+/, �.
IAT:, S' /___ ^____T.S �- gLOC&; T�F ADAITIONe, �.J Cle � i�E �✓ +f r: v l�ts
T
LORNBR LOT: �IAE Lf?T: � S$TBACRt SIDEY(fRD:
�i.i4uqqt 8,t�:ac� *p f��,s �ps7�_ io Certificatea of Suivev of Lot aad proppaed
bq�,idiag lacation sir�R oa tl�ese Cartificates,
��SCRIPTION OF BUIL�ING
9bo Se Wed As:
GRQAq€. B� a a' �rn- �l ' ae�she• �o '
�
square Baes; '%�O cub�c F�ets '�/�/00
Fropts Depth; Height•
6quaFe j�eet; Cubic 8eett
7j�{�e of �oaetrucCiaA; Weao ftq,y E Bstfa�ated Coat: $/��J�3. �U
',T4 �Di! QOI�i4tRd7 � M oN 7�� Z .
Tba nmdespigned hereby �kes apPl�ca[irnt for,a peslait for the posk herein
•peCLfied� agseeing fia do all Moik 1=t sttict accordance with Che Glty of
Fll�dl� Qid�ASncee 8ad tttlis�gi 7i£ �►a Departmen* of Bu�idixt�a, epd he=eby
i�wlareai i�at all the #+teu a�pd represertatione atated �t this application
i�s �sue aa� correct, .
ADZ9S; 3,,,�/ 3,17,3,_, BIGNATURE: r
(Bp 1tsvK�e S�de Pos Add�ti,onsl Infosv�atian.) -k.� � ,+ � '� f� 1` � � �'`^�
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Building
Inspections
763-572-3604
- �:
BUILDING
RESIDENTIAL APPLICATION
SITEADDRFSS (e!/s G-lYw�r 7%
THIS APPLICANT IS: ❑ OWNER
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATfON
PROPERTY TYPE
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
o�
PHONE: �Gt' �SD' RZ6p
STATE LICENSE #_
ADDRESS:y��i
PHONE S� � �
INGLE FAMILY!
❑ TWO FAMILY/NE
FAX
PERMIT TYPE � �+DDITION ❑ GARAGFJSHED
❑ BASEMENT FMISH ❑ ROOF
❑ DECK ❑ SIDING
TYPE OF WORK:
DES(:RIBE WORK BEING DONE:
SIZE OF
NUMBEROFSQUARES_
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
/.t�7U1�hJJ
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATIACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Tnm
❑ Fascia
WINDOWS
IN EXISTING OPENINGS �Yes �No LDCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF W INDOW TO BE INSTALLED NUMBER OF �
i�
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ Z/U �°� OCCUPANC'
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chazge
C�rb Clit Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Due
6DRAA1 TILE
❑ OTHER
Received
Date Rec'd:
HEIGHT
�i��Y 3Z
BASEMEN'f REMODELAIG SUBMTT:
l. ExisOmg Floor Plan
2. Proposed floor plan
3. List of sW cWnl members to be used
FORNEW CONSTRUCTION INCLUDMG DECKS,
ADDITIONS. & PORCHES SUBMIT:
L Site Plan/Survey showing ihe ezisting swcNres
and propose�projec� �
2. Two setwof construction plans
3. Energy Calculations
TYPE
See Back Page for Fee Schedule
65% of Building Pernut Fee
.001 tvnes the total job valuation
.0005 x Pennit Valuation Minunum $.50
TERIALS:
$ S, p� $5.00 (State Licensed Residential Contracrors)
$ $1550 per SAC Unit (Plans [o MWCC for determination)
$ ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ (, (� Make checks payable to: City of Fridley _ Attac
THIS IS AN APPLICATTON FOR A PERMTT-NOT VALID UNTIL PROCFSSED
I hereby apply for a building pemrit and I aclmowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the Ciry of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permi[ but only an application for a pertnit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work wluch reqques review and approval of plans. � _
SIGNATURE OF APPLICANT
Building BUILDING Permit No.�I3 $�
Inspections RESIDENTIAL APPLICATION Received By:�
763-572-3604 CITY OF FRIDLEY Date�''� EP 2�
763-502-4977 FAX EFFECTIVES-19-09
DATE l��D'0 / YOURE-MAILADDRESS_ ��G I'Z3�IS ���M�cS%, I✓L° j
SITE ADDRESS b l6 (!e r� Co C 5� !^-(� l d!< Y /''� � S�`!3
THIS APPLICAM IS: p OWNER OCON'IRACTOR
PROPERTYOWNER/ Nq�: �V�{,�j �' �c�,f �1 C•r
TENANT pDnttESS:_(� /� Ce[{niCoe Sr cmt F�� elCY STATFI"'��✓ZIP S�J �/'S Z
PHONE: %� �- �$�O� 97l`7�
CONTRACTOR Nq�„�:
SUBMIT A COPY OF STATE LICENSE # EXP DA'I'E
YOUR STATE LICENSE
AND CER"[TF[CATE OF ADDRESS: CITY STATE ZIP
INSURANCE pHONE FAX
PROPER7'Y TYPE �SMGLE FAMILY/NEW CONSTRUC770N SIZE
IWO FAMILYMEW CON57RUCTfON STORIES /
PERMIT TYPE O ADDI770N ❑ GARAG&SHED ❑ WINDOWS
❑ BASEMENT FINISH �ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ S W IMMMG POOI.
1TPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDfIION
❑ MAINTENANCE/REPAIA ❑ REMODELMG
DESCRIBE WORK BE[NG DONE: R� I�ODF -
SIZEOFIMPROVEMENT LENGTH WIDTH HEIGHT S FI'
NUO� OF SQUARES ��I ❑ HOUSE & GARAGE BASEMENT REMODELIN MIT
L Ezis[ingFloorPlan
GARAGES ❑ ATTACHED GARAGE 2. Proposcd Floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structu�al membcrs ta be used
PROPOSED HEIGHT:
gIDING FOR NEW CONSTRUC770N MCLUDING DECKS,
��'��Y� �Soffit ADD1770NS. & PORCHFS SUBMTI�
� Aluminum ❑ Trim �� Site p�ar✓Sw'eY showing the existing strucWres
❑ Other ❑ Fascia � and proposed projecl.
2. Two sets af construction plens
WINDOWS � � 3. ErwrgyCalculations
INEXISTMGOPENINGS DYes ONo LOCA770NOF WINDOWS FORWINDOWS-PROVIDEU-VALUEAND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WMDOW.
OPENING CHANGES &
TYPEOFW[NDOWTOBEINSTALLED NUMBEROFWINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE WST OF LABOR AND MATERIALS:
YY�]I 1
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Charge
Cur6 Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
[USLNG "fHE 1997 U.B.0 FEE SCHEDULE)
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times [he total job valuation
.0005 x Pertni[ V aluazion Minimum 5.50
55.00 (State Licensed Residential Contracton)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftxS22=S
5450 Conservazion Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
checks
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
Atfach
I hereby apply for a building permit and I aclmowledge that the infortnation above is complete and acwrate; that the work will be in
conformance with the ordinances and wdes of the City of Fridley and with the Minnesota Construction Codes; [hat I understand this is not a
permit but only an application for a permi[ and work is not to start without a permit on site; that [he work will be in accordance with the
approved plan in the case o�f all �wor�yvjhich requires review and approval of plans.
SIGNATURE OF APPLICANT T...,iC,C/ ��--� PR1NT NAME ��I/E ('E7'"r �„ {�7 e�DATE 'nl'1�G `0 F