AF - 46089City of Fridley, Minn.
BUILDING PERl�IIT
Date: ....�� � ""' . !
� /� �
Owner: � ✓' 'y^'{�. �J��vilder
Address --- _....-------- — Address
N° � 5�
�L,O,C�A�TI�O�Ng OF �IL�� G {
No. � Strcet.r—f� � *".�---�7����ijif..r Part� t, —L-� —
I,pt �.�-f��glock ---t�--�— Addition or Sub-Division _ ��� �` �f �
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Comer Lot __.-- Snside Lot ...� Setback _�__ Sideyard __� �
Sewer IIevation
Foundation IIevation
DESCRIPTION OF BUILDING
To used � � , i
��� /� � (�'1 �i4 .� � �r:f. :'iC �
_�'?�,!Y-�,+- =_:�'.� Front ..�1�^-..-- �P� -6�t— Height �� Sq. F`t. .��!.`F� Cu. Ft�.�-+.^.' �".
---- .._—....._ �— Fr° ---...__..__ DePth _._..'f HeiBht --- : �39. Ft ....._.._-- Cu. Ft __.—
- 1 ., `� .
Tyne of Constauction �.,,,.clyi-y-j� Est Cosi.�-Fr_=�_4t_I_'i�i�..rTo be Completed .-----..--..--.—
In consideratlon of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance wit6 the description above set fort6 and in compliance with all provisions of
ordinances of the dty of �idley. _
Ia cam.vderatlon of the payment of a fee oP
permit is Lereby granted
._ to �nstruct the building or addition as described abwe. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and woflanen, in all work
done in. around and upon said building. w' anY Part thereof, shall mnfoim in all respeMs to the ordinances of
Fridley, Minnesota regarding location, consTruction, alteration, maintensnce, repair and moving of buildinBa
wfthin t6e city Iimits and this pernut may be revoked at az�y time upon violation of any of the provisiona of said
ordinancee. �,. n el .�
B�aldin8 Inspector
NOTICE
Tltis p�rnM doa iwf wwr Ih� eonshutfien, McfallHion for wirin9. piup6inp/-yn he�linp. wvm er waNr. !� wn fo a�
1h� BvWlisO lospador for ssp�nfs permib fer N�u� i�mt. -_ .
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Owner'a
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Addrese
dPPLICATION F�t BIIILDING PFR?IIT
CITY OF FRIDIEY, �SOTA
ATIOH OF BD?IDING
No. "� � Street ►- iw.r,/'.!/� Part o4 Lot_V1%, � 10 � O
Lot (� '— � 2. Bioek S Additioq or 9ubdivision ��
Corner Lot Inside Lot ` Setback 3 S Sid�Yard ���'2 — I 0
g�. ELEVATIpN FOUNDATIO�i EL�YATION
Applicant attach Lo thia Porm Certificate of S�u�vey of Lot and proposed build3nB
location.
io be used as:
DSSCIiIPTION OF HIIIIDING
sQ. Ft. q�� cu. Ft. 1�' S� 0
�ont Depth Height
Sq. P`t. Cu. Ft.
T�pe of Construction �C�� Estimated Cost � �a OO �. ��
To be C�pleted
The underaigned hereby makes application for a permit for the xork herein apecified�
agreeing to do all work in strict accordance with the City OTdinances and ruling of
the Department of Buildings, aad hereby declares that all the facts aad repreaentatioas
atated in this application are true and correct. � „
(A Schedule of Fee Coets can be fow�d on the Reverse Side.)
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HEAT LOSS CALCULATIONS DEPAR'IlYff.NT OF BUILDINGS 3,3 1 9S/ �NNEAPO[1S. NIINN.
Weatheratrips AS.H.V.E, Conatruction No. � Insulatioo
Guide
Windowa Doora Reference Out. Wal! Int. Wall C,eiling Roof Floor Kind How Applied
Yes-No Yea-No II 19— II
Fl. `� Room Lengt Width Height Fl.� , Room l.engt6 Width /(o Height
Windows and oors-Crackage a d Area Windows and Doors-Craekage and Area
WlAth elg6t No. o[ L1nea1 [4 Area Wld[h Hefght No. o[ Llneal f[. Area
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Net exp. wall � � � o a pN wall �> >>^ ����
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Ceiling
Floor � � 7a
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Windows and Doora-Crackaue and Area
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Windows and Doors-Crackage and Area
Wldth Hel��t No. ot Lleeal f0. Area
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City of Fridley, Minn.
BUILDING PERNIIT
D,�: J�aae 9z 1965 `__
a����
N° 7792
Owner: Aabert C. IIastmaa �, Robert C. Sestman _..____
� 61�1 Gleacoe Street Ai. B. A�� (�1a1 Glencoe St��t�N E
Na Ste
Itggt., 82•C �
Lot � � _ Bl
Corner Lot
$ewrx' Elevat[oa —
To ee u.ea m:
'type of OonaG�vetlou
LOCATION OF BUILDING
Gleneos 3treet N. E. p� �� _.^
, 1� H7.k. .g Add[tim or SubDivisim ._._ Riv+e2'Yie1► H¢t�
Iffiide Lot
F'ront
EY+ont
Setback �._._— Sideyatd
— Famdatio� IIevation —
DESCRIPTION OF BUILDING
DeP� BdSbt �—.— Sq. Fk
DeP� -- Height 34. Fk ��
._ FBt. Cost �-�000�00 _ To be Campieted
Gl�. Ft
Cu. FL
A6Y De-GStBge
In cmdderatlan ot the issuance to me of a permit to caistruct the building deecrlbed abave, I agi+ee W do
tha propooed work in aaoidance with the descrlPaon above eet forth a� 3n ca�aRlianoe with all pmvlsiauis al
aa'dimmes d the ci�9 of EYt�eY. � .
��h� � ���
m oao�a�anm or ti� �t or a r�e or •� �e �s �ebr �usea to aobert c. Fastman
to conscruct the bulidins or add[um es deacr36ed above. This permis is gianted upan
t� exPras omdtdm that the Peraon to whom it is gi'ented and hie eBffi�. �aP1oY� and worl�nea. In all work
�dane 1n. around a� upaa said bulldin8, �' aR9part thereof. shall aoutam in aII reapecte to ihe ordimncee of
PiWIeY� aSinunota re�ardtne lacaUon. coaahuct( ffiteratlao, maiabevenre rePa3x' a� moving af buil�ngs
wi� dty limiffi and t6is peratit m0.y be revokcd at a� time upm vlolaHoa of aqy � the provislom af said
Allen Jena� B,d�mne �mpecta'
NOi10E
n�. n«�M ae.. .ee eo.. ti. es�+.dM,, irl.�te. te. n6M. r�rF r� b+i�a. w.. «.tl... e..w. a.»
�M Niliy L�ewr /er aMrw /�i4 fa� 6w b�r.
APPLICATION FOR BUILDII� PERMIT
CITSf OF FRIDLEY, MINNESOTA
LOCATION OF BUILDING
No, � �/ Street�,� �NC � f. Part af Lot
LOT��- /�i BLO � � �rj ADDITION OR SUBDI{IISION �..�r�-<----- � ,
Corner Lot Inside LOT_�Setback Side Yard �
SSWER ELEVATION FOi1NDATIOIP ELEVEITION
Applicant attach to thia form Two Certificates of gurvey of Lot and proposed
building locatian drawn on these Certlficates.
as;
DESCRIPTION OF BUILDIIdG
Sq.
t � � Depth �a Height
Ft. .6,��Cu. Ft. �7 CT lI
'T�
Front Dept _T_Height
Sq. Ft. Cu. Ft.
Type of Conatruction Eetimated Cost �� �
To be campleted
The undereigned hereby makes application for a peitnit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordiaances
and rulinge of the Department of guildings, and herebq declarea that all the facts
and representations stated in this application are true aad correct.
DATE � SIGNAT[TRE �,///l.lJ ��s� � �5�- �— �,
(Schedul of Fee Coats can be found on the Reverse Side),
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� To the Fridley'City Couaail:
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6!t], Glencoe Street N.E.
Minneapolis, Minnesota
June 17, 1965
I, the nnderaigned, wonld like to moce a garage from 3318-3� 4�►ne No.
to 61i1 Glencoe 3treat N.E. The movera srill be from Ernst Housemoving,
85th Avenue No, and Co. Ad. D-18, Osaeo� Minnesota. T'heir telephone
nmaber ie lt25-2822. The dimenaions of the garage are 2!� feet in rridth
by 22 feet ia length. The garage has trro 9 foot doors, �a�e servi.ce door
on the side� txo vi.ndoxa on the back, and a vindox on each side s+a12�a.
The roofing is in g'ood condition. The rralls are insnlated vith Bilt
Right Insu7.ation. ds the Redvood �iding is in bad need oP paint, I
shall do so immediatelp. There ia a vacant lot to the aeat of �
property� thua making it easier to move the garage in.
I would appreciate yrour immediate attention in this matter.
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Ci. of Fridley, Minn. N° 8107
� � � PERMIT
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oavner: _ Lsater a. &rnst ��,. Sa.e � z
p,a� 8„� Oaseo� i�inei, p�,
� � LOCATION OF BUILDING
x� 6W. � (�Yenco• N. �. _ Psn ot r.ot
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Lot � -- "�.° —.� :, Addttlon or Sub-Divlalon �_.
Caaner Lot _� Instde I.ot � Setbnek _._ Slde9ard
3ew� EkvaNae �� Famdatim Elevattaa
To ae ueea ae:
DESCRIPTION OF BUILDING
Finat �� Depth Height 9a. Ft (U. Ft
ki+Mlt --- Depih Hdght -- 34. FL (�1. FL
lype of Camhvedw� .�_.� Fat Cost �_.9S? _---� To 6e Completed
� �Y�D$���ai,8Q6
to 61�i alsacoe N. �.
In aoodderariam of the iesuance w me of a P�t to Uu buildinB�dye�ec�ipib�ed above. I a6� to do
tha propo�ed woHc 1n acooidence wit6 the dexriPtiaa ebove and inc�om�lla�oe wl�h sil pi+nvidons ot
md�orncea � the dty of FYiBey. ��"�//"'
b► aodd�attan d the paym�t oP a ice d�10�� pamit ia herebY 6ranted
to cooahvct the Mdlding or additka ae described above. T6iape rmit ia �anted aPm
tLe e:pc,eas oonditian tLat t6eperaon to whom it b gi'anted and his agents. emP1oyees and wor�. in all work
dooe ln. ero�md and upm eaicl building, ar aqypart thereot. ahall o�form in all reepects to the o�dinenaes a�
FridleY. Miuneeoffi iegardin� IacaHm. caosuvctiaq elta'attao. meintena�e. teP�' end mwin8 of bulldings
w1� dty limib and ttue Pendt maY be revoltai at aqy time uPm violatla�n oY any of the Dl'ovidam d seid
�.�.� d6D86II B��nB' �
�
iW P� /w wt awr tM aW�Me. 4w� fae �NM. P��. P MYYa. �wnr x�rWr. 4 aw� to sr
M� Nllity Y�p�e�x� far Mpra1► yr�Y� fee IMw i�eu. �
��
��
. �
,. .. _< ... _. ,_
�
Inapector of Buildinga,
6431 Univ. Ave. N.E.
,
APP'LJGA110N FOR MOVING PfRMIT
���
. �.:'r:..e:._.�.;-
:.�,,,y� No
,. � I�idley, blinn. 9�
The undersigned hereby makes application for permit to move building as herein specified, agreeing to do all
wark in atrict accordance with the City Ordinancea and rulings of the Department of Buildings, and hereby de-
clares that al] the facta and representations atated in this application are true and correct.
Lot Blcek
Present I.ocation:
'� � 1 � s�rr,� �S�C�ll" _�
>
To be moved to:
__
_. __ _ _
C�l .���- �t _ ,
'y ��Y
Addition
� �
� 1 1 � � � .ia_i. _ �_�� / / � //
Distance move�l ft.To be completed
.� / f
Taxes paid? Estimated cost $`�6 d Foundation and alteration permit numbers
Certification as to cost:
I hereby certify that the above designated building is worth at least si y(60) per cent of the coat of a simi-
lar new building.
3igned L��7''�'L�r_ _ _, .
Ow�r or Agen!
Approved by:
Utilities Notified:
(Title)
& Sewer Department
Gas Co. (date)
Northern States Power Co. (date)
(Tifle)
rTOrthwestern Bell Telephone Co. (date)
iTlttPi
City Engineer
� � Mover
. -.��� (See re��se side for indsaetions) � . � . .
In the event that the movin
eermit is to be a
letter must be com
Inapector of Buildinga,
6431 University Ave. N.E.
F'ridley, Minnesota
Please issue the bearer of thia application, Mr
a permit to move builcling from
for by the ownet or 1
�ied by said mover•
� �
� T L
license
rs�
t
to: to which I hereby authorize him to sign my nami
Signed
I.faeased Moves
GENERAL INSTRUCTION3
The following muat be secured before moving permit will be issued:
1. A building permdt for new location of building to be moved. To obtain this building permit, the following i
required:
(a) The building to be moved must be inapected for atructural soundneas by the building. inspector. Phone thi
office for inspection. SUnset 4-7470.
(b) A survey of lot to which building is to be moved. This survey must be made by a licensed surveyor.
(c) The building and moving permit must be obtained at the same time.
2. Tax receipt showing that all real estate taxes due have been paid. Duplicate receipts may be obtained at Anok
County Auditor.
3. Approval from the Fridley Water and Sewer Department showing that bills chargeable against the property t
be moved have been paid and water connections have been diacontinued at the eurb line or at the main. (Se
reverae side af form.)
4. Approval from Fridley Director oi Public Works office approving routing.
5. Notification to, and signature of utility companies. (See reverse side of form.)
(a) Minneapolis Gas Co., 739 Marquette Ave., Engineering Department, Fourth Floor.
(b) Northern States Power Co., 15 South 5th Street, Application and Extenaion Department.
(c) Northweatern Bell Telephone Co., 224 South 5th Street, Business Office, First Floor.
11 . '�$ ' � . � - =,. � �'
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t, C
SuOJECi
c;ty of Fridley
ATTHETOPOFTME�WINS gUILDING PERMIT
.
� .
�
� ' COMMUNII'Y DEVEI�PMENT OIY.
� lV��..���'
r � ppOTECTNE INSFECTION SEC.
�
i �
� ' i'-'1 � CITY NALL FRIDLE`/ 55/72 HuMeen
�.---� • •'� 612-571-3450 970-F15
JOB ADDRESS 641 Glencoe StreeC NE
t LEGAL LOT NO. BLOCII TRALT OR ADDITION
oesca. 0,1,12, S Riverview He
2 PROPERTYOWNER MAILADORE55
Robert Eastman 641 Glencoe Street NE
3 CONTNACTOR MRILADDHESS
SAME
d ARCHITECTORDESIGNER MAILADDRESS
6 USEOFBVILDING
Residential
7 CLASSOFWORK
B DESCHIBE WORK
Reroof House
9 CHANGE OF USE
MAIL
5 '� 4
? �, �
RECEIP7 NO.
7/21/95 I / / I
SEEATTpCHED
SHEET
ZIP PHONE
784-5897
ZIP PMONE LICENSE NO
ZIP PMONE LICENSE NO
ZIV PHONE LICENSE NO
❑ NEW O ADDITION ❑ ALTERATION � REPAIfl
Tear—off
❑ MOVE ❑ REMOVE
STIPU�ATIONS
Underlayment must comply with the State Building Code.
�d &�� c�,a,�a�,e� �I - a �/- 9S .
d
SEPARATE PERMITS AqE pEOUIflED FOR ELECTRICAL, PLUMBINCa, HEATING,
VENTILATING OF AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOFK OR CONSTRUCTION
AUTMORIZED IS NOT COMMENCED WIIHIN 60 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 OAVS A7
ANY TIME AFiER WORK IS COMMENCED.
I HEflEBV CERTIFV TMAT 1 HAVE READ AND E%AMINED 7HI5 AG7LICATION
AND KNOW THE SAME TO BE TRUE ANO CORRECT. A�� PHpY151�N5OF �AWS
AND ORDINANGES GOVEANING THIS 7YPE OF WORK WILI BE COMP�IED
WITH WHETHEF SPECIFIEO MEHEIN OH NOT. TME GRANTING OF A PERMIT
DOE$ NOT PFESUME TO GIVE AUiHORITY iQ YIOIAiE OA C11NGEl TME
PROVISIONS OF ANY OTHER STATE OR LOCAL LGW REGUTATING CON-
STRUCTION OR THE GERFORMANCE OF CONSTRUCTION.
IORTEi
50. FT. CU Fl T.
OFFSiREET PARKING
STRLIS G/.AAGES
/ SURTAX
�lO.SU �O . �
SACCNARGE
.�i U� /6.L
TOTALFEE , / ��
CZl1 R!1 7�. 'Yi�
NEW
ADDN
ALTER
I1
fl
fl
CITY OF FRIDLEY
SINGLE EAMILY AND DUPLEXES R-1 AND R-2
Building Permit Applicarion
Effective 8/1/95
Conshvction Address: �' �/�___ G �� J1%C p EE S J �'_L __ � %�9 / �� � � _
Legal Description: _
Owner Name & Address: �f,,,d �,� �� L!�S f�lA N Tel. N 7 Ft�/- 5� 9 7
Contractor. Diyt�c��-e� . , MN LICENSE #
Address:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale_
DFSCRIPTION OF IMPROV'EMENT
LIVING AREA. Length
GAAAGE AREA: Length
DECK AREA: Length
OTHER: op rv c�_
Cornet Lot [] Inside Lot [] Ft. Yd Setback
Type of Constluctioa:
Approx. CompleUon Date: _
Width xeig�►c
Width Height
Width Hgt/Ground _
Side Yard Setbacks
Sq: Ft_ _
Sq. Ft. _
Sq, Ft. _
d F-F
Fstimated Cost: $ ���� �
(Cost on Back)
Driveway Curb Clit Width Needed: Ft. Ft — Ft x$ _$
DATE: % a, g APPLICANT: ����=��� t� �.h.�—i�c� Tel. # Z$ �'`v g�/ �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ��%�fJG
s i.a�
$ (00
$
$
$
$
$
$
$ ��.�D
CITY USE ONLY
Fee Schedule on Reverse 5ide
.0p1 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$850 per SAC iTnit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ } Not Necessary [ ]
� `
SoBJECT
City of Fridley 2 6 0 8 5
ATTHETOPOFTMETWINS gUILDING PERMIT
f � O
i �
� �� _�� COMMUNITY DEVELOPMENT OIV, �]
r � � PPOTECTIVE INSPEGTION SEC. �/ 73
�
�
� t /'°1 � GTY FIALL fRIDLE� 55�J2 NUMBEP MFV D�TE >�GE O% �roqO�ED p+
i"-'� � �'' �12-571-3450 9io-Ft5 5/26/98 / �
ioe nooAess 641 Glencoe Street NE
1 LEGRL LOT1NO. BLOCK TRACTORADOITION SEEATTACMED
DESCP. Wg 10, 11 12, Block S, Riverview Heights SNEE7
2 PROPERTV pWNEH MAIL /1DONE5$ Z�O PNONE
Robert Eastman 641 Glencoe Street NE 784-5897
3 CONTFACTOR . MAILAODFESS LP PNONE UCENSENO
Same
< ARCMITECTORDESIGNEN MAILADOFESS 21P PNONE LICENSENO.
5 ENGINEER MAILADDFESS , Z�P PMONE LICENSENO
6 USE OF BUILUING
Residential
7 CLASSOF WORK
❑ NEW ❑ ADDITION ❑ ALTERA710N �7 qEPAIR ❑ MOVE ❑ REMOVE
8 DESCPIBE WORK
Reside House
9 CMANGEOFUSEFpOM TO
STIPUlATIONS
Install building wrap and have inspection of same.
TYPEOFCONST. OCCUPANGYGROUP OCCUPANGYIpA�
SEPARATE PERMITS ARE REOUIRED FOA ELECTRICAL, PLLIMBING, NEATING.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR GONSTRUCTION ZpNING SO.FT. CU.FT.
AUTMORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTqUCT10N
OR WORK IS SUSPENDED OR ABANDOHED FOq A PERIOD Of 12p ORVS AT
ANY TIME AFTEF WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PAFNING
I HEREBY CERTIFV THAT I MAVE fiEA� ANO E%AMINED THIS APPLICATION 1 S7ALl5 GAPAGES
ANDKNOWTNESPMETOBETRUEANOCORRECi.ALIVROVI5�ON50F�AWS yp�UATION SURTA%
AND ORDINANCES GOVERNING THIS TVPE OF WORK WI�� BE COMFLIED
WITM WHETMER SPECIFIED HENEIN OH NOT. TME GRANTING OF q PERMIT �I �?OO S• 6O
DOES NOT PRESUME TO GIVE AUTHOHITV TO �IOLATE OR CANCEI THE pERMITFEE SACCMARGE
PROV�SIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON- y @
STRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. y�LO.ZS Fire SC y1.ZO
P�AN CHECKFEE TOTALFEE
$42.05
tUPEO�CON:P<CiOPOR• OA�IEUIGENT I��1TEi HEN PROVERLV 1011i p TM151S VOUQ PEpMIT
r � �' '� �j,�
5 NA FEOFOWNEA��fOWNEABUILDEP� ID�tEi � BIOG 5� � D 1f
NEW
ADDN
ALTER
[]
[I
Ll
ConstruCtiOnAddre
Legal Description:
Effective 1/1/98
CITY OF FRIDLEY �
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATTON ��� ,�3
n�
Owner Name 8c Address: �vf� �- w t 1` k eg s� rnr� .� Tel. # 7 Fr �l - S 8' 9 7
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
MN LICENSE #
Attach to Uvs application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
DESCRII'TION O� Il4IPROYEMENT
Width
Width
Width
Tel. #
Height
Height
Hgt/Ground _
Sq. Ft.
Sq. Ft.
Sq. Ft.
�onstcucdon Type: �/-vrI �" a 1-- Fstimated Cost: $�� a G c. o 0
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: _Ft. + 6 Ft =_Ft x$,
_$
DATE: �' �. G- 9 S'APP'LICANT: s�z2-� (, r°�m��1 Tel. /f 7��1-5�8'`l7
Perarit Fee
Fire Surcharge
State Sutoharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Conuol
Pazk Fee
Sewer Main Charge
TOTAL
STII'ULATIONS:
$ D•�S
$ /. �a
$ • %7�
$
$
$
$
$ �- pS�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth°rb)
$.50/$1,000 Valuation
$1000 per SAC Unit
$S.QO (State Licensed Residential Conuactors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Detemvned by Engineering
Agreement Necessary [ ] Not Necessary { ]
.,. _r
,
_�
PLUMBING
RESIDENTIAL APPLICATION
City of Fridley
NOTE: IF PROPERTY IS NOT OWNER/OCCUPIED-A LICENSED CONTRACTOR MUST OBTAIN THE PERMIT.
DATE ���02' S YOU�RL E-MPJLADD/R'ES�S' ��h�5 �qS�rmR�J/�o aaa-Co�
SITEADDRESS� �%� //� � 71�i �y�, %%%7% cis�3�.
THE APPLICANT IS: (CIRCLE ONE) - OWNER COHTRACTOR
NAME �' I H fS (70 � �. � 1
PROPERTYOWNER/ qpDRESS 6 �// ��en�oe �('ee�" �
TENANT
qTY �� 1 D LF Y STA7E /%�N ZIP
PHONE# '%6 �' 75��-� 89 � .
NAME � �/ LICENSE#_
CONTRACTOR �DRESS
CITY STATE ZIP
PHONE# FAX#
PERMIT TYPE
TYPE OP WORK � ❑ NEW
DETPJLED DESCRIPTION OF WORK
FAMILY
FEES ARE BASED ON 510.00 PER FU(TURE, EXCEPT WHERE NOTED
FIXTURES: (INDICATE TOTAL NUMBER OF EACH)
_BATH SINKlLAV _PLOOR DRAINS
^BATHNB _GASPIPING (NeedCitylicense)
_CLOTHES WASHER _KITCHEN SINK
_DISHWASHER _LAUNDRYTRAY
Permit Fee S lS, QU
Plan Review $
Surcharge $ .50_
T�l'AL DUE $ / S� �
TWO FAAAILY
❑ REPLACEMENT
_SHOWER
_SWIMMING POOL
WATER CLOSET
WAIER NTR (33�
(�WATER METER
TOWNHOUSE
WATER PIPING
WATER SOFTENER (Z35)
_BACKFLOW PREV. (S75)
FOR IRWGATION
_OTHER
MINIMUM: 575.40 or 5% of cost of the improvement-whichever is
greater on work less than $300
Make checks payable to: City of Fridley
� n�.� w ra� �rr���.nuvn rvrt n rctin� r- nv� �wv �n ��� rnwc.a.a��
I trereby apply fa a plumbing pertnit and 1 acknowledge that the infottnation above is complete and aaurate; tliat the work will be in conformance with
the ordinances and oodes of the Cily of Fridfey and wiN the Minnesofa Consbuction Codes; that I u�Merstand tlns is nW a pertrrit but ony an
application for a permit and work is rwt to sTart without a permit; Mat the work will be in accordance wifh the approved plan in fhe pse of all work which
requires review and approval of plans.
NAME OF APPLICANT
SIGNATURE OF APPLICANT
�• G.�JST�iiAA% DATE 7 ��0�-O Sr
se type ar print
� ,� ����
5
I=
a.
V OF FRIDLEY COMMUNITY DEVELOPMENT DEPARTM
6431 UNIVESITY AVENUE NE, FRIDLEY, MN 55432
(763) 572J604
Building
Inspections
763-572-3604
SITE ADDRESS (i% Y /
THIS APPUCANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR SfATE LICENSE
VJ(TH APPLICA7'ION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
��IWNER
STATE LICENSE k
CITY OF FRIDLEY
YOUR E-MAIL
OCONTRACTOR
EXP DATE
f•-��i� i�.�
Received By:
Date Rec'd:
TF�J�$IP s s y.��
ADDRESS: CITY STATE_ZIP,
❑ BASEMENT FIIJISH O ROOF
❑ DECK L] SN113G
DESCRIBE WORK BEING
SQUARES
G G
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDIIVG
❑ Vinyl
❑ Numinvm
❑ Otha
❑ HOUSE & GARAGB
❑ ATIACHED GARAGE
❑ DEI'ACHED GARAGE
OSoffit
❑ Trim
❑ Fascia
WINDOWS
INEXISTAIGOPENINGS OYa ONo LACA770NOFWINDOWS
OR FOR NEW OPENWGS-DESCRIBE SIZE OF
OPENWG CHANG£S &
ALL FEES ARE BASED
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
S
a
$
S
$
$
$
❑ DRAIN TILE
❑ OTHER
(USIlVG THE 1997 U.B.0 FEE SCHEDULE)
Ft.
BASEWEN7 REMODELING SUBMIT�
1. Ezisfing Floor Plan
2. Proposed Oow plen �
3. List of strucW�sl members m be uad
FOR NEW CONSTRUCf10N MCLUDING DECKS,
ADD1710NS & PORCHFS SUBMIT'
l. Siu ManfSurvry sfiowing tlx existing strucCxes
� P��� ProJ�-
Z. Two uts of construc[ion plans
3. Enc�gyCalcWatians
AND MATEI2IAIS:
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times t6e total job valuation
.0005 x Permit Valuation Minimum 5.50
$5.00 (State Licensed Residential Contractors)
51675 per SAC Unit (Plaus to MWCC for detem�ination)
ft+6ft= ftxS21=$
E450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessazy ( ) Non Necessary ( )
Make checks pavable to: Citv of Fridley Attac
THIS IS AN APPUCATION FOR A PERMIT-NOT VALID UN'fIL PROCESSED
I hereby apply for a building permit and I ac}�owledge that the infortnation above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and wit6 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 petmit; that the work will be in accordance with the approved
plan in tt�e case of all work w ich requires review and approval of plans.
SIGNATUREOFAPPLICANT� � a! � � PRIN'tNAME/n��G�G'7 S. �/�S%/l9iJ„�/DATE �' �� ��
. �.,�,..
�
CCiYOF
FRIDLEY
FRIDLEY MUNIC7PAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-(287
BUILDING PERMITAPPLICANT• PROPERTY OWNER
�� ��� ?�� �-�l -<!��`�>�� understand that the State of Minnesota
requ+res ttYat aff residentiat buiiding contractors, remodelers and roofers obtain a state
license unless they qualify for a speci,,fy� exemption from the licensing requirements. As
the owner of the property at �rf f,�/�,�',�� ��c , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to se{I it, I hereby Gaim to
be exempt from the state iicensing requirements because I am not in the business of
building or remodeling on specutation or for resale and that the house for which I am
apptying for this permit, isi the first residential structure I have built or improved in the
past 24 months. I a{so acknowledge that because I do not have a state license, I forFeit
any mechanic's lien rights to which I may othervvise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowiedge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
u�derstand that unlicensed residerrtial contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would fo►feit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone wilt be responsible to the City of Fridtey for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
Name ���2f s� . ' �,�ifia,tr
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�T�g PLUMBING Permit No.: � C�f31
Inspections COMMERCIAL APPLICATION Received By: I
763-572-3604 CITY OF FRIDLEY Date xec'd: o�`
DATE J"�Y G 7 YOUR E-MAIL ADDRESS .$ 2(1 C TmG n���`�� C'C � 1�
SITE ADDRESS � / ,�Z/r n c c � �'� �e e t .L�- � � ;^ ; � v /1JA/ 7 S �/9' ?
TENANT � SUITE NO.
PROPERTY Nnree: j . ��./74 U
OWNER/ ppDRESS:�i � I� � CTfY 5fA1E�ZIPS �.� °�
TENANT
� PHONE: �� � - %�' �� . 5 �Y �7 _
CONTRACTOR NnME:
SUBMIT A WPY OF STATE LICENSE # EXP DnTE
YOUR STATE ADDRFSS: CITY STATE ZIP �
LICENSE WITH p�.�ONE F.47C
APPLICAT[ON
PERMIT TYPE ��STITUTIONAL ❑ MULT[-FAMILY _ O SWThllNIIJG POOL
❑ TOWNHOUSE ❑ COMI.¢32CIALINDUSTRUIL O O7HER
TYPE OF WORK: � �W ��p�CEA�4lJT ❑ ALTERA770N/REMODEL
DETAILED DESCRIP7TON OF WORK
- . �� h � � ,:T> �n��'� �� : f t .?� - �'s °,
, ., <�. .._. _�..._ . ,,,, : :,�,_ �� ..
, _ � � w _ . �an � .� �� 3���` _ � -� �. `" �� ,'� �_ .,
� CIATHFS WASHEA _ FIAOR DRAMS _ RPZ VALVE _ URiNAL
DISHWASHER GAS PIPING BACKFLOW PREV. WATER HEATER
DRINKING FOUNTAIN GREASE 7RAP � ROOF DRAINS WATER M6TER
FAUCEf KITCHEN SINK SHOWER WATER PIPING
FLAMMABIE WASTE TANK _ I.AUNDRY TRAY _ SCAP SINK _ WATER SOFfENER
LAVATORY SWiMMINGPOOL WATERCLOSET
- - . , , w �' m-a. � � s. „ rE � � < 3 � h..3F^.u» _ _ �^- �;�. -T'�z� � _ -
a#�
Totsl Job S 6 cc' All fees are based on valuation, including the cost of labor and materials. �
Valaation
PetmitFee $�_ (1.25%ofJobValuation/Minimumfee:S35)
Swcharge S Valuation X .0005
Total Due �.S r Make Checks Payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT-NOT VALiD UNfIL PROCESSED
I hereby apply for a buildit�g permit and I aclrnowledge that tlie information above is comple[e and accurate; thaz the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Conswction Codes; that I undetstand this is
no[ a permit but only an application for a permit and work is not to stact withou[ a permB; that the work will be in accordance with the
approved plan in the case of all work which requires review and apprmal of plans.
NAMEOFAPPLICANT �/IAfS�CT S, �fyS%/%%f%� / {�p�, �'��-O %
SIGNATURE OF APPGCANT Y' , �.� .�Y-61s4m.
c:�ry ot r ndiey �sw�ding mspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
__�
�
CENOF
FRIDLEY
FRIDLEY MUNICIPAL CENCER • 6431 UNIVERSI7'Y AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I, r�/C������ ���`��� . understand that the State of Minnesota
requires t at all residentiai building contractors, remodelers and roofers obtain a state
license unless they qualify for a speaf exemption from the licensing requirements. As
the owner of the property at 6y/ �%�-te �,�' , Fridley, 1
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure 1 have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forteit
any mechanic's lien rights to which I may othervvise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forfeit my rights to
reimbursemeni from the Contractor's Recovery Fund in the event that any contractors �
hire are unlicensed.
l have atso been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
performed on this property.
Name�//GG9 a� ���drU
Date 3�.�1�07
v Y, •
Permit No. 7 "� GJ' �-
Do NoT
Lath or Gbver the interior of tLis Bailding nntil
the following Ins_pectors have made their inapec- -
—� --`---- __�_�
�?on an8 signed �his card.
dnspectora comments: �- i- G 5
C/�, �_�lC .r � u x/ �f' �� —
� d� i(� c1 R/ c, .R � o/L/ �
Plumbing Insp.
Electrical
. _ ' _- _ __
H£g., Ven�.,' Air Cond. Insp. —
Bldg. InsP• � i(J -,� / � 5 / —P — �— 3 — G 5
Footings
Rough In
Final
ClTY OF FRIDLEY
560-3450
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