AF - 46198BUILDING PERMIT
Village of Fridley, Minn. N° 2 3 U 5
Date %li$�,.�'6 .................................
Oaver . _` y��� Bu'slder�isi� ............................
�l �V��.GF�'/tid�0� 1+ ��YL
Address..,,,.. ...�.�.....-�;� e .......... Address .........................................
�6�����w-6.
- LaCA ION OF BWLDING
' ;s'�3''�S ����,?l �%
No. . ...-..... Street • ✓�?•. • •�. • ,./�;- � .Q......... Part of Lot . ......................
��t°r �is/ �[�
Lot ....... ....... Block ...:............ Addition or Suh-Division ... . ... ....... ... ........
� � �:-/`F�P].ct.u1 � /���s.er�?
Corner Lot ............ Inside Lot ............ Setback .. �.... Sideyard
. ... .............
� .fll �d " �a^"/:.-
DESCRIPTION OF BUILQiNG
To be Used as;
..���f{ � ���.j..... Front ;a,�.i..... Depth ...s;.... Height � .�....... Sq. Ft. ........ Cu. Ft. ....... .
?✓`�(J.t'G'�,a�st�`i L`. `3 ;� L !. V F
. .� f � Front . �� . . . De th .. L
. .. . . . . p . Height . .. .. 5q. F`t. . . . . . . .. Cu. Ft. . , . .... .
(,t�,��...... �LX ��.. i S ...
�� T
Type of � onstruction . . .......... . Est Cost .. ..,,,, . . .... ........ .. . To be Completed ..... ..
.�rZsv r� ' fli GO�F -^^ � �J{%�j . . . . . . . . .
In consideration oF the issuance to me nf a permit to eonstruct 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 villege of Fridley. �
...................................................
In consideration of the payment of a fee of $........ , permit is hereby granted to ......... ..�. P..
.. ................ to construct the building�ffi addition as deseribed above. ��grS�sd u an
��that the person to whom it is granted and his agents, employees and worlanen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to �the ordinances oP
Fridley, Minnesota regarding location, construMion, alteration, maintenance, repair and moving of buildings with-
in the village 13mits and itiis permit may be revoked at any� Yime uppn violation .of any of the provisions of said
ordinances. . /1
� ........ Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be suro to see the Building Inspector for separate permits for these items.
��
SUBJELT � � P
City of Fridley 125
"TT"ET°"°FT"ET"""S BUILDlNC ;PERMIT
S� � . . � . - . � .. . � � CEIPT NO.. .
, �.
�- - � � _ COMMUNITY DEVELOPMENI DIV. . � . '�
� Y �� � PROTECTIV€ INSPECTION. SEC. I� ��/.�
% i
1
, �- �'�'� �� CITY MALL FRIOLEY 55432 NUMBER REV. UATE PAGE OF APpflOVEO BY
�..__�.' '•� e,z.sso.�.so 910-F15 5/28/74 / /
708 ADDRESS ri845 Hackman AVenue N.E.
7�.LEGAL �OTNO. BLOCK� TRACTORADOITION SEEATTACHED
DESCR. �� � t� 3� Parview MdIlOi . SMEEt
2 PROPEATYOWNEA . MAILADDRESS ZIP PNONE
_Gerald Bloms 5845 Haclanan Avenue N.E.
�3 �CONSRACiOfl � MAILADDRESS Z�P PMONE UCENSENO.
CJ�i ,
e� ARCH7ECTOR �ESIGNER �� � MAIL ADDRESS ZIP PHONE UCENSE NO.
� 5 BNGINEER MAILADOXESS . ZIP PHONE LICENSENO.
8 �::USEOF BUILDING � �
ara e
� c��ssoswomc
. � .. � ❑ NEW ❑ � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK� � .
constsuct 29' x 22 ' ara e
9 CMAMOEOFUSEFROM TO �
STIPUW1TiONS ' � .
1. Provide a hard sur£ace driveway.
Special Ose Permit apgroved by Council 5/20/74
��TE PERMITS REQ�iRED F_OR iNfR[lyG,
71NG. RLUMBiNG ANQ StGNS.
-SEPAPATE PEflM1TS ARE REqUIRED FOR ELECTRICAL, PLUMB�NG, HEATING, � TYPE OF GONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIA CONDITIONINQ. �� - OOCI fYai1R0
THIS PERMIT BECOMES NULL AND VOID IG WORK OR CONSTRUCTION ZONING � SO.FT. CU.FT.
AUTHORRED IS HOT COMMENCED WITHIN 60 OAVS, OP IF CONSTRUCTION<
OR WORK IS SUSPENDEO OR ABANOQNE� iOR A PERIOD OF 120 DAYS. A7 ' � SZ H S� ZH O
ANV TIME AFTEH WORK IS COMM�MCEDe.. � "�'NO. DWLG. UNITS� � � OFFSTREET PARKING
I MEREBY CEfiTIFY THAT I NAVE REAO AND E%AMINED THIS APPLICATION � � STALLS GARAGES
ANDKNO�N7MESAMET08ETRUEANDCOflAECT.ALLPROVtS�ONSOFLAWS yq��� pry � SUF�TA%
AN� OFDINANCES GOVERNING TMIS TVPE�OF WOfiK WILL 8E COMPUEO �L��]Q�Q.40 1.39
WITN WHETHER SPECIFIEO.HEREIN OR NOT. THE GRANTING Oi A PERMIT
DOES MOL PRESUME TO �GIVE AUTMORITY �TO. VIOLATE OH CANCEL TME pERMITFEE SAC CHARGE
PROVISIONS OF ANY -0THER STATE OF LOCAL LAW REGULATING CON. lO rQO
STRUCTION OR THE� PEfiFORMANCE OF CQNSTRUCTION.
� . � . PLAN CHEp(FEE TOTALFEE
� $11.39
� SIG� �OFCONrRACTOPORn�THORI �nGENT (DnTEi y�H PROPEliLY VALID IS S VOUR i`ERMIT
--�.,� o��.,.�
SIGN�UREOiOWNERU%OWNEPBNLDER� i�ATEI BLOG.MSP naiE
APPLICATiON FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, h1INNESOTA
OWNER'S NAME: lrr,�A.p ��Om3 BUILDER: SA���.
ADDRESS : 5�y�� �i3G Krrl,yn/ AvE. .l�� �DRES S:
NO: Sll�� �ti:REET: /7ACKniA.n/ /i I/L- - rL�,
LOT:�_BLOCK: �j ADDITION: /iy,�K �//E�J MJa.�/Nfj2
CORNER LOT: INSIDE LOT: SETBACK: SIDEYAP.D:
Applicant attach to this form ltao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
3JESCRIPTION OF BUILDING
To Be Used As:
/fRA6-E Front • �
'z � Depth• 2 2— Height: 1 4
Square Feet: ,rZ� Cubic Feet: S, Lffp
Front: Depth: Height:
Square Feet; Cubic Feet
Type of Construction: �Op,p y�QAfiE Estimated Cost: $���`���0
To Be Completed: � t%EN�
The undersigned hereby makes app�icativn for a permit for the work herein
specified, agreeing to do all work in stiict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that a11 the facts and representations stated in this application
are true and correct.
DATE: �A�/ Z�, (S7� SIGNATURE: ��.(�% �(�GX,r,���
. (See Reverse Side For Additional Information.) f� � , � � / L� "L.., /
� . /
/ O � I _• t . r' � -� S ; � .3 ; /� 1 , �i.7 j _ � _ �G c- i : � � �`
/ � . '
1 � M� � ;.
Dec. 1, 1999
To: City of Fridley
Dear Sirs:
ti ���
�,� �,��
I am giving pernussion for Thomas Carney, 5853 Hackmann Ave. N.E., to
add to the width to the southwest side of the driveway at that address.
We have agreed that all snow will be moved to the opposite side of the
driveway.
1�,�,� .
�</� � rlC'�/+nA � �L'�-
f
Building
Inspections
7'HIS APPLICANT IS:
OWNER/
TENANT
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT TYPE
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWNER
CONTACf PERSC
STATE L]CENSE H_
ADDRESS:
PHONE
'g'SRJGLE FAMIL.Y
YOUR E-MAIL
�
❑ TWO F�VvULY
TYPE OF WORK: I��W i�PLA���N.{
DETAII,ED DESCRIPTION OF V✓ORK
55408
❑TOWNHOUSE
❑ ALTERATIONlRFMODFI.
Pemut No.:
Received By:
TE_ZIP.
PER M5 16B.665 the permit fee is a minimum of 515.00 or 5•/. of ffie total cost up to 5500•00, afiichever is greater, for the
improveanent, installation or replacement of a residential S�cwre, excluding #he fixtmes. (This should reflect onty the wst of labor )
L,abor cost �mder $300 = E15.00. Lalior cost between 5300 to 5500 = cos[ of labor x.OS =
FOR PROIECfS W3�RE LABOR
NUA�FR OF EACH BELOW)
Equipmentlnstalled .
�/C S'L5.00
p11t TO AIEt EXCHANGEER SIS
_BOII.ER 535.00
CHIb49EY LINER SI0.00
Pemut Fee
Surcharge
TOTAL DUE
MFG:
FEES ARE B ED ON 570.00 PFR FIXR7Rfi, E7CCEPI WHERE NOTED. FIICfURES: �B'IDICATE TOTAL
- MODEL: ��' � . � SIZFJBTU��' eOD
� . MODII.: � � � SSZFiBTU �--.�-- g. �
On� MODII.: �� SIZF/BTU�L—'�
F7REPLACE (GAS) 515.00 GAS RANGFJOVQJ f I0.00 �¢i^+�'1
FREPI.ACE (WOOD) f35.OD _NEW GeVS GRII.I. SI0.00
J�FVRNACE 535.00 GAS UMT HTR 510.00
_GAS DRYER 510.00 POOL HEATER 535.00
CrAS PIPIIJG SI0.00 VF7i1ll.A1'OR S15.00
a .50 Numberof£ixduesQS15.00_xS15.00=5
g Number of 5xtures (� 525.00 � X s�s.00 = s�-�
Number of fixtures Q 535.00 �_ x 535.00 = S��
Stau gureharge = $ .50
Total = S�$�?
TfffS IS AN APPLICAT[ON FOR A PHU9T�]OT VAI.ID UNCIL PROC�SSID
I hereby apply for a building permit and I acknowledge that the infamation above is complete and acc�Ye; d�at the work will be in
conformance with the ordinances �d codes of the City of Fridley �d with the M'innesota Conshudion Cades; that i imderstand this is
not a armit but onl li for and work jg not to start witbout a permit; that d�e work wHl be in accord ce with the
approved plan in the e o�rk w� review and approval of�� ' �( � '��l�
SI6NA7VRE OF
� City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-5723604
FAX: 763-502-4977
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS �EXIST(NG HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTINCx MC3!MES� ::: - _
:.�', i c� .. 1 .::.,'�: ; .. : . .
1. Combusrion Air (See note belawj ;;;
a Oil or solid fuel IMC Chapter 7 v✓ith MN Amendments
b. Natural Gas or PropanellFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a. IMC Chapter 5 with MN Amendments
3. Venting
a Gas appliances IFGC Chapter 5 with MN Amendineuts
b. Fuel other than gas IMC Chapter 8 with MN Amendments
REQUiRED FOR NEW HOMES
4. Heaf loss & cooling load per room
a. Required on new conslruction lMC 1346.0312
5. Ventilation .
— „ _ _ a—� 1vH�i ��'�59(i� 7692 — — _
6. Duct Design Per IMC 1346A603.2 ..
a. ACCA Manual D
_ _. . _
NOTE: Cenferpoint Energy Mechanical Code Guidelines software may be nsed for
combustion and make up air calculations
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE !L' /
�
SITE ADDRESS _
TN1S APPLICANT [5:
BUILDING Permittlo..`�6�Q �5
RESIDENTIAL APPLICATION Received By:�_
CITY OF FRIDLEY Da,�anc±� i� 3n1
YOU,/R E-MAIL ADDRESS iok„ e Jt„t4e. � nC . Cbw�
.ri.i._ ��i'
❑ OWNER �CON'fRACTOR
TENANT
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT
PHONE: 7l0 �i — S%7' �bf/,$�
STATE LICENSE
�SQJGLE FAMILYMEW CONS7RUCIlON
❑ TWO FAMILYRJEW CONSTRUCTION
❑ BASEMENT FIMSH
❑ DECK
TYPE OF WORK: ❑ NEW HOME CONS7RUC770N ❑
❑ MAINTENANC&REPAIR �
DESCRIBE WORK BIING DONE: S` .'� c�' CX'" `
J �
SIZE OF IbffROVEMFIJT LENGTH
ROOFING ❑ HOUSE ONLV
NUtvBER OF SQUARES ❑ HOUSE & GARAGE
GARAGFS ❑ A7TACH6D GARAGE
PROPOSED SIZE: ❑ DETACHED GARAGE
PROPOSED HEIGHT:
❑ Aluminum
❑ ONer
WINDOWS
RJ EXISTQdG OPENINGS �{lfes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
ALL FEES ARE
�Soffit
❑ Trim
❑ Fauia
LOCA770N OF WINDOWS
ALUATION,
' S3''f��
EXP DATE
O DRAIN T1LE
❑ OTHER
BASEMENT REMODELING SUBMIT�
L Ezisting Floor Plan
2. Proposed floor plan
3. List of structuml members m be used
FORNFW CONS7RUCI70N RJCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
l. SitePlanlS�aveyshowingtheexis[i�sWCnuu
a�d propoud project.
2. Twosetsofwnswclionplans
3. Energy Calculffiions
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACNRE Si7CKER ON WINDOW.
OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VAWATION S d— OCCUPANCY TYPE
Permit Fee S See Back Page for Fee Schedule
Plan Review $ 65% of B�ilding Permit Fee
Fire Surcharge E .001 times the total job valuation
Surcharge S .0005 x Permit Valuation Minimum 5.50
License Surchazge $ $5.00 (State Licensed Residential Contractors)
SAC Chazge $ $2 (00 per SAC Unit (Plans to MWCC for detertnination)
Curb Cut Escrow E ft+ 6 ft= ft x$24 = S
Erosion Control S $450 Conservazion Plan Review
Pazk Fee S Fee Determined by Engineering
Sewer Main Chazge $ Agreement necessary O Non Necessary O
Total Due - $ Make checks a able to: Ci of Fridle Attach Sti ulations
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pertnit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance witti the ordinances and codes of the City of Fridley and with the Minnesota Conswction 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 orl ich r ' s review and approval of plansJ.� /
SIGNATURE OF APPLICANT - PRINT NAME </°'1H Q 6.CKi' DATE l� d