AF - 46244�
City of Fridley, Minn.
BUII.DING PERMIT
�te: ..� -.. ��.-. �.9 ..........
�
N°
.
3674 ,
�
ow�r . .. .. ... . .. .. . . .. .. .. .. .. . . ... .. .. .. ... $��iaer .�� .W.:�f.' :� �;-� Cr..�rx .�
aaarees...................................... naaress .............................................
LOC/�AT(ON OF BUILDING
I.ot .�'G//.. Btackt....�•�:/.lA/I�V.�............ Patt��'�Y.�tClc.� ...............
. ... ...
`, . Addrtiam or SubDi.vti�si� .. �..
Corner Lot ............ L�stde Lat ..�.15....... Setbaak .,3Y..?�N SideYard lQ :r....� ................
DESCRFPTION OF BUfLDING
1b u : . • r
.. .. � .Y.a-a �, �.�-�a H�,t �� .� �,. �.1.1.3�' �. �. �;�a�
............. ..... FYont ........ DePth ..... .. H�ght ........ Sq. Ft ........ Cl� Ft. ........
Type of Construction ................... �t.
�/.3,,.?9.7 =... To � ��� ...................
In conmderation M the is�ance to me of a permit W camstruct the building de�ibed above, I agree to do
the propoeed work in accordance with the description aDove set forth in ca�plian with provLions o2
ordinencee of the dty of F�idley. �.���� �i
.i( ... ..................../�..... ................
�o V
Ea conetderation of the payment of a Pee of =.��:�.. P�t is herebY 6rented W ...................
......................... W constavet the building or additi� as deacribed above. 17�is permit is gianted upon
the ea�reas conditi� 8�at ihe person � wha� it fa �anted and Hs agenffi, emploYees ead worl�en. in sll work
done in,.around and upon said building, or auy part thex+eof, ahall mnform in all respects to ffie ordinances of
Fridley. Minnesoffi re6az'dlnS locatim, conshvcHam. alt�ation. maintenance. repair and movtng of buildm� with-
In the dty limits and thia peraut mqy be revaked at any ti� upon violation of any of tbe provisions of said
ordinances. � �
�6'c`���/ ;�., .
NOTICE:
This pe�mit doas not cove� the construotlon, Imtallation o� alteeafAOn tor wl�inp, plumbi�, qas heatlnp,
sewer or water. Be sure to ue the Buildinp Inspector for separate-permib to� these Itama �
../- �.s , �
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� City of Fridley, Minn.�
BUILDING PERMIT
� ,.:- . �
.. _ <' �,� /i�� _ _� - : /t . -
.,
.
��y��
N° 6372
/� �!y,� CATIONqQ/�, �'UI
Na .�.fl_�� . Street .�p..r,�c� ..�Z���%.�--L�l�.-�.. aM Lot --- f- 7-�
^ �ia� l2� E- ,t� iV�_Ts--
Lot .-...r�— _..._ Block ._._.._._..._.._.� .._,�._. Addition or S. /_'a�n . � •._• ��� -
Corner Lat __..�.._.�__ 7nside Lot .— ��-._._.. �slback���7�_!'..._.�..'�.... SideYaz'd ---LL_�--.-'-----
3ewer ElevaHam �--.-----._.—.._.�_.._.._........._.._._ Foundation IIevation _..------...---- —
DESCRIPTION OF BUILDING
To � �r'� L
E�t --- DePth -_. � He�i ht �.._� . Ft. _.._-...._. Cu. Ft i
..�..,._.__ ._.. __ � � S4. Fk Cu. Ft _.._.__.._
1y}pe of Constru _.._._ _.._... Est Co���'/2_� _.... To be Ccenpleted _..:_...__...__...---.-.--
In caoa[deration of the iasuance to me of a permit to construct ihe building descriUed above, I agiee W do
t6e BroP� work in accordance with the descriPtion abave set'��rl� an�} ip/c�pfigc�ce��
ordtaances oP the db' oP EYaBey. / /. // !//
�!' l' ���� �� S . ��
In caoacaeisa� or rt�e Bsymenc ot a gee of a _—....._.._..._., permit is t,erebr Brancea w— -
to c�struet the building or addition as deacribed above. Tlvs pemtit is graated upoa
the express condirion that the person to whom it is granted and his agents, emPloyees and worl�en, in all work
e in, aramd and upm said building, or an3' Part thereof, shall conform in all respects to the ordinancea of
dley. MWieaoffi regarding locati�, o�shvetion, elteratlon, maintenanee, repair and moving of buildin�
within the dty limits and this permrt m�y be mvoked at aqy ticce upon vl,ola�tioi►of any of the PI'ocn�om of esid
ordfnancee. �� / 1
Building Inspecta'
. I t,wnc�
iHs pweY detl nef tsvx 11r w�wnafiey IM�MNae 1w �4YW PI�WW N� 6�M4q. aw�r x w�N�r. B� wn b w
N� MIIdiN �� �«M� P�� fer 16a� if�ro.
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APPLICATION FOR BUILDTNG PERMIT
CITY OF FRIDLEY, M3NNSSOTA
Owner `s Name l�selC•�.�^�d ,?i ✓w�-� euilder .5'��
Addresa /G// /���, �:�n . Addrass �'.s.,.C�.�—
I,OCATIODT OF BUILDING
No. 6treet Part of Lot
Lot `� Z Block �� Addition n��
Corner Lot Iaeide Lot_,�„Setbsck Side-Yard
3EWER ELEVi+,TION FOUP7DATION BLEVATION
Applicant attach to th3e form Certificate of survey of Lot and
proposed build3ng location.
To be used ass
DESCRIPTION OF BUILDIDiG
2� � i�nth ZZ � Neiaht f�' �
Sq. Et. �S�O Cu. Ft. 3S 2- �
Front Depth xeight
Sq. Ft. Cu. Ft.
Type of Construction T.lLa�a��.�_ Eatimated Cost �� ��
To be completea /S iti.+� 1.�'4'3
Ths underslqned hereby makea application for a permit for the work
herein a,pecified, agreeing to do all work in strict accordance with
£he City of Fridley Ordinances and ruling of the Department of Build-
ings, and hereby declares that all the facts and representations
atated in this application are true and correct.
% ,� ' ` •
(Schedule of Fee Coats cari be foun� on the Reverae Side).
.
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�� � sua�ec* �� � PER .
City of Fridley 12231
"'T"ET°°°F'"ET'"'"S BUILDIN� PERMIT '
� � � � . . CEIPT NO.
� '�� � _ CQMMUNITY DEVELOPMENT DIV. � �
f � v � PROTECTIVE INSPECTION SEC. ��9C,/_
� y/
� � /'�9 � CIiY HALL FRIDLEV $S4�$ NUMBER REV. � DATE PAGE Oi APPFOVED BY
�.---'�l'� �•' a,z�ao-�,so 910-F15 7/13/73 / /
�oego0� Ss ckman circle
lOTNO�. � � � BLOCK � TRACTORADDITION
1 IEGAi�� � SEEATTACHED
�s�R: 2 1 Parkview Heigh�s sHeET
�-Y PROPERTYOWNER MAILADDRESS 21P PHONE � .
LeRoy Oquist 1011 Hackman Circle
3� fANTRACTOR MAICADDFiESS . Z�P PMONE LICENSE NO:
.5'dlil@
�� 4� ApGH1iECTORDESIGNER � MAILADDFESS ZIP PHONE LICENSENO.
5 ENGINEEP MAILAODRESS Z�P PNONE LICENSENO.� '
' 8 , U$E Of BUILUING . �
-7 �DUSSOFWORN � �
. . �1 NEW � ❑ ADDITION �7 ALTERATION ❑ REPAIR ❑ MOVE ❑ � REMOVE
8 DESCHIBE WORK � � � . � � .
eg ace an c ange win ows
9 CHAN6EpFUSEfHOM � TD � �
STIPULATIONS � �
- � TYPEOFCONST. OCWPANCVGROUP OCCUPANCY�OAD �
SEPARATEPERMRSAREREQUIREDFOR�ELECTR14AL,�PLUµBING,MEATING, Br1CR
�VENTILATMG OR AIP CONDITIONING.� � - � �
THIS PEHMIT BECOMES NULL ANU'VQID If Wf3RK� OH CONSTRUCTION ZONING . SO.FT. CU.FT.
AUTHORRED IS NOT COMMENCED�WiFHIN-BEFDAYS, OA IF CQNSTRUCiION
�Op WORK IS SUSPENDED Oq ABANDONED�. POR.A� PERIOD OF 720 DAYS AT � �
ANY TIME AF7ER WORK IS COMMENCED.-- .� . NQ� DWL6r UNI7S OFFSTREET PARKING
� I NEREBY CERTIiY THAT I H0.VE READ AND EXAMMED THIS APPLICATION �� STALLS GARAGES
ANDKNOWTHESAMETOBETRUEAND�CORRECT.ALLPROVISIONSOFLAWS yp�UATION � � SUflTAX
AND OPOINANCES GOVERNING-�FHB TVPE Of WOFK WILL BE COMPLIED ��
WITH WHETNER��SP@CIFIED HEREIN OR NOT. THE GRANTING OF A PERM�T �16OOA-OO .8O '
�DOES NOT PRESUME TO�GNE AUTHORITV TO VIOLATE OP CANCEL THE pERMITFEE �� ' �. SACCHARGE � �
PRQVISIONS'OF ANV OTHER 57ATE OR LOCAL lAW REGULATING CON. .,.�12.�d'O �. .
STHUCTION Ofl�THE PERFORMANCE OF CONSTRUCTION. � � � ��
�� � PLAN CNEGK FE � iOiALFEE
12.80'
SIGNATOREOFCONTR/RqC�TOROA�UiMOPIZEDAGENT IDATEI � W N PERLY VAU6ATED TW {$ PERMT
��/AMf/ �l /� ����' .%.3 .
SIGNA UREO WNERIIF NERB IL ER� fDATEI' BLDG.iNSP OPTE �
Clarence B�lisle
� 1
AAPLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : �!1 l/ ( / /i � � BUILDER: �� � .
���—_
ADDRESS : ��L�f� , l,y: ADDRESS :T�y,_, �
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NO•. �p I� STREET: yyLLT4U�i�v:. P.�� ��-
LOT' ,� BLOCK: � ADDITION: (rz.��..>.�� �/�
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form 7tuo Certificates of Survev of Lot and proposed
building location drawn on theae Certificates.
�ESCRIPTION OF BUILDING
To Be Ueed As;
i�.� Front: Depth• Height:
uC GO'w•�`� �Gt�l�u
Square Feet: Cubic Feet:
Front• Depth: Height
Square Peet; Cubic Feet
Type of Conatruction: %�fy��, ,�_�, '_ ��Eatimated Cost;�S °/GQJ
To Se Completed: ,/�ya--�_ �� _
The undersigned hereby makes application for a permit for the work herein
apecified� agreeing to do all work in sttict accordance with the City of
Fridley Oxdinaaces and rulinga of the Department of Buildinge, and hereby
declares that all the facte and representatione stated in this application
are true and correct,
DATE : ��S„L�,,�/, , / 3 S IGNATORE • � ��J •����
T—��
(See Reverse Side For Additianal Info:mation.) .
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� City of Fridley ° 14909
pTTHETOPOFiHETWINS gUILDING�� ��PERMIT
r,
� ��• QOMMUNITY OEVELOPMENT DIV. CEIPT NO.
' � �."" '
f � PROTECTIVFINSPECTION SEQ �{ rJ ?
� V .7J
� � /"'1 � CITY HALL PRIDLEV 55�32 NUMBER flEY. O�TE PaGE OF �vvqoVED BY
�••__J`•• ••� 6iZ3so-aa5o . 910-F15� 9�!�78 � �
�oe aooRess 1011 xacl�an Circle N.E.
7 LEGAI �OTNO. BIOCK TRACTORA�OITION SEEATTACHED
oesca. 2 1 Parkview Heights SNEET
�2 PROPE9TVO4YNEP MAILADDRESS ZIP PMONE
LeROy Oquist ' 1011 Hacl�an Circie N.E. 571-0415
�3� CONTMCTOH MAILADDRESS Z�P PHONE. UCENSENO.
83IDE
/��AHCHITECTORDESIONER MAIIADDRESS LP PHONE LICENSENO.
5 ENGINEER MAILADDAESS ZIP PHONE LICENSENO.
6 USE OF BUIlUING �
� I�2Sl.IdEII}ial
� 7 CLASSOFWOHK
. ❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE � REMOVE
e DESCPlBEWORK .
Construct a 12` x 10' Addition to Dwelling
9 CHANGE pF USE FROM . - TO '
571PULATIONS p�ide prefot�ed valleys.�Provide insulation os.interior of crawl
space. Prwide 16" x 24" access to crawl space as well as ventilation.
WARI�NG
Be►ore di�in; cdl locai uiili'ies
SEPERATE PfRMlTS RfQU1RED FOR WIRlI�G, R QUIREDTBY LP�W
HEATING, PLt7MBING AND SIGNS.
� � � � TYPEOPCONST. OCCUPANCVGROUP OCCUPANCYIOAD
� SEFARATE PERMITS ARE REOUIRED FOR ELECTFICAL.� PLUMBING, MEATING.
VENYIIATIN� OP.AIR CONDITIONING. {1�OOf1 FL'�l2
TH13�.PEAMIT BECOMES NULL ANO VOID IF WORK OR CANSTRUCTION 20NING SO.FT. CU.FT.
AUTHORRED IS NpT COMMENCED WITHIN �� QqYS: QR IF CONSTRUCTION .
. OR WORK IS SUSPENDE� OR ABANDONED FOR A PEFIOp OF 120 OAYS AT � ZZO LC)HO
ANY TIME AFTEP WORK IS COMMENCED. . NO. DWLG, UNITS OFFSTREET PARNING
1 HEREBV CERTIFY THAT I HAVE REA� ANp �EXAMiNED THIS APPIICATION T�. STALLS GARAGES
ANDKNOWTHESAMETOBETRUEANDCORRECT.AL4PRDVISIONSOFLRWS yALUATION�. � � � SURTAX
AND OH�INANCES GOVEPNING THIS TYPE�OF WQRK WILL BE COMPL�ED � $3�O6a � . ' $Z.S3
WITH WHETMER SPECIFIED HEREIN OR MOT. �THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO YIOLATE OR CANCEI TNE pERMITFEE�' �� SACCNARGE
PROVISIONS OF ANY OTHER STATE-OR LOCAL�LAW REGULATING CON- $7 5� . . � TjQNE
STRUCTION OH THE PERiORMANGE QF CONSTHUC'JION.
� � � . PLANCHECI(FEE .� � � � TOTALFEE
1.68 $10.71
BIGN n� OPORPUTHOPI aGErvT � IonTE1 U, HEN PRO �PLY�VALIDATED TH1515 YOUfl PERMIT
� 9-6-�.Y� ' 1 9-�-�A
N iUREOFOWNEPIR WNER$UILD i IDATEI BLDG iNS� DATE
ow��:.R:
CITY OF FItIllLCY ,
APPLICP,7IOt� FOi2 RL"SIll(:NTIAL BUILDIPlG PERIIIT>
iI1�L"W� IIL7LRATIOtJS, ADU1T10(JS, OR REPAIRS)
r�y DauisT .
Ac3aress: /o// fs�F/G�Ci�l•t1 (i.�
No. ��; �/
LOT: 2
Street:
nuzLU�3e: _ _ 5,4�12 � ..
AIACY.: � ADDITIOTI : -/��`-�� �/ l � `'J L � U� �j E�%s
CO12N�R LOT: It�SIU� LOT: SETI311CY.: SIDL•'YnRDS:
Applica'r,t attach 'to this fozm 7wo Cerl-iiicates of Survey of Lot and proposed
bui.lding location dravm on these Certificates. �
DESCRIPTiOPd OF BUILDIh�G
To Be Used As:
,�OD/T/Oit� Front: � 1�P�� 16 Height:
Square Feet: l2o Cubic Feet:
17ont: Depth:
Square Peet: Cubic Feet:
Height:
� 7 —
/. G 8�
�rpe of Construction: ^{VOOD rr2�t�� FstimaLed Cost: $�_
� 306 2 . �l0
Zb Be Completed: Alt. A Alt. B
Proposed Driveway t,�id:]i If 11ew Openinq Is Desired S S '
• (SI:� REVERSE SIDE OF SHEET)
The undersi9ned hereby nu�kes application for a permit for the work herein
specified, agreeing to do all c�rork in strict accordance with tUe City of
xidley Ordinances and rulings of tHe Denartment of Suildinqs, and ]iereby
� eclasres ihat all the facts and representations stated in Chis application
are trxie and correct. 5ee reverse side io�i� /'�fosmation.
0
DAT�: � r � SIGNATURE: '
Stipulations: �,,_,✓ ' �p
�i �,,.-�u(.e !�'"","r �'` d" ""-�` �il+�" �-Yj� � �, 6 8
y� ���� � � � �`�� .
,e.r,,r.e�Q.s.�� �x, t,,,�,;t /, � 3
�
� ►�� . ��� t� '� ,�c..c- z-ss � 7�`�- � � o , y/
d'� c°�-� s�•ro�, fi5 �1C • .
/4S ajlt�JTi�z�+J •
r
�F.'NERGY. COtdSF.P.�.�ATION SUPPL1itdENT TO Bi]I,DING PERMIT APFL;.CATION
/ � YI.ANNING AND INSP�CTION llEPARTM�NT
.�/ CZTY OP FRIDLEY, MIIQtdF'SOTA
7$is supplement is provided to assist the applicant in computi.ng E%TERIOR ENVELOPE
AVERF�GE °U" FACTOR INFORNIATION. This information is rec;uired so the 3UTLllING
UFFICIAL can determine that submitted plzns canply with thc ENERGY CONSERVATION
DfiSIGN CRITERiA of the STATE BUILDING CGDF (Section 60G0). It is the APPLZCA2IT'S
responsibility to accurately compute tkie data; reflect the proper DESIGN CRITEF2IA
in the plans; submit prc�duct specifications, if needed to �upport the "R" an3 "U"
£actors used; and to assure construction is per approc>ed plans. �.✓�
30B� LOCA.TION: G'a��_ � G��L/R,(� �i= , � - � / " /
OWNEfj/CONTRACTOR:
ADDRESS:
LE.� � E.
�
A. Determine the Total Eacposed Wall Area as follows:
l.
2.
3.
4.
5.
J
2btal wall window area
Zbtal door area
�.
Total sliding lq ass doo.r area
�b t�l fireplace wall area
�_----�.�
Rbtal wall framing area(average 108)
Total net wall area above floor(aceraye 90�)
7. Total rim joist area
Subtotal: 7COta1 er,posed wall area above floor
8. lbtal foundation window area
9. 2bta1 net foundation area above grade I?
Subtotal: Total exposed foundation area
GRAND TOTAL EXPOSED WALI. l�REA
PHUNE: /S 7� � O �% / j
.3.�. �
/
` i�
i pY '
� Q �_
__���
�
�FDO
B. Multiply the GRAND TOTAL EXPOSED WALL AREA X.17 =
C. Determine the Total L'acposed Roof/Ceiling Area as follows:
10. Total skylight area �
11. Total mof-,�ceiling framing area (10$)
12. 7bta1 net insulated roof/ceiling area
GRAND ZOTAL EXPOSED ROOP/CEILING AREA
D. PSUltiply the GRAND TOTAL EXPOSED ROOF/CEILING AREA X.OS =
�U�
Item I
Item II
E
C.� h.....nC'....
Determine the "U" value of each segment (1-9) and multiply by ttia area as
follow�:
_.�Lati+!__ o � / = 0i � ^ �•(;,
1. X "U" . -�
2. X ��U�� _
3 �Z X "[7" ...� �d' = 023, / _ • � ^ /D
4. X ��U,� _ G
5. X "U" _
6. X "U" _
7. X ��U�� -
8. X "U�� -
9. X ?"U" _
ADD 1-9 FOR TOTAL�WALL SEGMENTS
�
ITEM III
F. Deterniine the "U" value of each segment (10-12) and multiply by the area as
follows:
10.
11.
12.
X "U"
X "U"
X "U��
ADD 10-1'l FOR TOTAL FOOF/CEILING SEGMENTS = ITEM IV
G. If Item III is the same as, or less than It�n I, you have met the intent
oF State Builc'ing Code 6006 (c) 2.
H. If Item SV is the same as, or less than Item II, you have met the intent
of State Building Code 6006 (c) L
I. Add Item i
J. Add Item III
+ Item II
+ Item IV
�
K. If the sum of Items III and IV are less than Items I and II, you have met the
intenL- of the Code for t,otal envelope system.
The undersigned, as applicant for a building'permit, hereby affirms the above
iniorniation has been prepared and submitted by himself or under his direction,
hereby acknowledges the information to be corr.ect and accurate; and hereby
presents the information with reguired plans in support of the building permit
DATE: ` p / 4
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��City of Fridley �" 16 6 3 E'
ATTHETOPOFTNETWINS gUILDING PERMIT �
' ' RE
� •
� ____ COMMUNITV DEVELOPMENT DIV. (�
r � L PROTECTIVE INSPECTION SEC. � I�
i
� �r u
`--..� �°�1,', GTY HALL FRIDLE� 55d32 NOMBER REV. UNTE PAGE OF APPROVEO BY
ti 612-571-3450 9i0-Fi5 / /
6 15 82
10B ADDRESS 1011 Hackmann Circle N.E. �
1 LEGAL LOT NO. BLOCK TRACT OR AOOITION SEE ATTACHED
DESCR. 2 1 Parkview Hei.ghts SNEET
2 PROPERTVOWNER MAILADDRESS 21P PHONE
Leitoy E. Oqui.st 1011 Hac}�ann Circle N.E. 571-0415
3 CONTRACTOR MAIIADORESS ZIP PHONE LICENSENO.
S�e
6 ARCHITECTORDESIGNEN MAILADOPESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADORESS ZIP PHONE LICENSENO.
e USEOFBUILDING
Residential
7 CLASSOF WORK
❑ NEW � �1 ADDITION ❑ ALTERATION ❑ REPAIR G MOVE ❑ REMOVE
8 DESCRIBEWORK
Construct a 4' x 18' Ki:tchen Addition
9 CHANGEQFUSEFROM � TO
�STIPULATIONS �
seRERAr� P��
W���j utit�ies HEA FIN�. P M� f S REQUlRED FOR
�� � AND S16N� ���
iii
getae �� � �
TELEPNONE-EIEC�RIC - � ��.
REQ't11RED BY V'►�
TVPEOFCqNST. OCCUPANCYGROUP OCCUPANCYLOAO
SEPARATE PERMITS ARE REOUINED FOR ELECTRICAL, PLUMBING. HEATING, �pd F,x,�e
VENTILATING OR AIR CONDITIONING.
�THIS PERMIT BECOMES NULL AND VO10 IF WORK OR CONSTPUCTION ZONING SO.FT. CU.FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PEFIOD OF 120 DAVS AT
ANV TIME AfTER WORK IS COMMENCED. � NO. DWLG. UNITS OFFSTREET PARKING
I HEREBV CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
ANO KNOW TME SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS OG LAWS yp�UAT10N SVRTAX
ANO OliDINANCES GOVERNING TMIS TVPE OF WOHK WILL BE COMPLIED $z,600 � $1.30
WITH WHETHER SPECIFIED HEFEIN OF NOT. THE GRANTING OF A PERMIT
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMR FEE � SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �
STRUCTION OR TNE PERFOFMANCE OF CONSTRUCTION. �3H.SO NONE
� PLAN CHECKFEE TOTAIFEE
$ 9.63 $49.43
SmN E o *o A THOaiZE�nGEN* iDnTE ]QJHEN PROPERLV� LIDATED THIS IS YOUR P RMIT
` 6-� i� Z iO iS b
IGN/iIJREOF NEROFOWNE NLOEP� iDAiEi BL�G IbSG PiE
CI7Y Of FRIDL[Y Effective Auq. 1, 1981
APPLICATI�J FOf� RESIDENT111� f3UILDIilG PLRt�iITS
(f�err. Alterations. Additions, or Repairs)
OIVNER: L.E�� �, OQ�-/�S j
ADDRESS: �o t / �.�c��/�In/ C�,�C
TEL A0: S7!—o�//�
t3UILDER:
ADDRESS:
TEL H0:
Construction Location
STRIIiT NO: l � �l STI2EET: /�/�c.f{�f.4� �
IAT:
Corner Lot:
SLO(IC: ADDITION:
Inside Lot: _ Setback: ____ ___ Sideyards:
Ap�licant attach to this fosm two Certificates of S�rvey of lot and
proposed building locatim drawn on eertificates to scale.
DESCRIPTIOiQ OF COhlSTRUCTION
i'`G1a..1 ya�4 Front: �.% Depth; 1 Q) Height:
Square Feet: 7'� Qibic Feet:
Fronk: Depth: Height:
� Square Feat: Oubic Teet:
7ZX3ce.'Zt ZCo�O.'�'L
Rype of Cor,stzuctfcr�: �:L�MI'L £stimated Cost: 5
'lb Be Cbr�pleted:
Alt. A
� S�'a't �/,
�o�,
�00 d
Alt. 8
Proposed Drivc�aay 1+idth If New Opening Is DesireS: �$ S
, , SEE R2VER>E SIDE OF SHEET
Tiie undersigned hereby makes application for a pezmit fcr the ��ork herein specified,
agreeing to d�,all vork fn strict accordance with the City of Pridley Ordinances and
rulings of the Delk�rtment. of Buildings, and hereby declares that all the facts and
repres�ntatiens stated in this application are true and correct.
�
a��:
SIGNA7UIi£:
Stipula�ions:
� �0,�
� � 9,�3
PY 1
�' �'S 44•u3
�
S�B�EC*
�City of Fridley 3 3 0 2 0
ATTHETOPOFTMETWIHS gUILDING PERMIT
�� RECEIPT NO.
•
� ` _�� COMMUNITY DEVEl07MENT DIV.
f �� , PROTECTIVE INSGECTION SEG ��3 3
i
� i /•"1 � C�TY HAIL GRIDLE� 55�37 NUM�EM IIFV O�1E P�GE O� �MROVEDlv
�'"-'� � ,�' 763-571-3450 9to-F�5 8/27/02 / /
lOB ADORE55 1011 Hacl�ann Circle NE
1 LEGAL � ��TNO. BLOCK TRACTOPADDITION SEEATTACMEO
DESCN. z 1 Parkview Heights SMEET
2 PHOPERTYOWNER MAILADDNE55 ZiP PMONE
Roy Oquist 1011 Hackmann Circle NE 763-571-Ok15
� LONiRACTOR MAILADORESS ZIP YNONE LICENSENO
Sela Roofing & Remodelin 4100 Excelsior, St iouis Park, MN 55416 612-823-8046
� RRCHITECTONDESIGNER MAILADORE55 ZIP PXONE LICENSENO
1�5�
5 ENGINEER MAIL �DORESS 21V GHONE IICENSE NO
6`� USE OF BUILDING
Residential
7 CLASSOFWORK
❑ NEW O ADDITION ❑ AL?ERATION �7 REPA�R ❑ MOVE O REMOVE
B OESCHIBE wORK -
Reroof House & G -
9 CHANGEOFUSEFROM T�
STIPULATIONS
Underlayment must compiy with the State Building Code.
TYPEOFCONST. OCCU�pNCYGROUP OCCUPRNCY�OAD
SfPaRA�E PEAMITS ARE PEOUIRED FOR ELECTRICAI, PLUMBING. NEATING.
VENTIIATING OH AIR CONOITIONING.
TMIS PERMIT BECOMES NULL �ND VO10 IF WORN Op CONSTRUCTION 20NING SO.FT CU FT
AUTHORIZED IS NOT COMMENCE� WITHIN 80 OAYS. OR IG CONSTRUCTION
OR WORIC IS SUSVENDEO OR ABANDONE� FOR � PER100 OF 120 DAVS AT
ANY TIME AFTER wORN IS COMMENCED NO OWLG. UNITS OFFSTREET VARKING
I MENEBY CERTIFV TH,4T 1 MAYE REpD AND E%AMINEO THI$ APP�ICATION 1 ST4lL5 GARAGE$
ANOKNOWTHESAMETOBETRUEANDCORRECT.�LLPROVISIONSOFLAWS y��UATION $URT�%
AND OpDINANCES GOVERNING TMIS TYPE OF WORN W1LL BE COMP�IED
WITH WMETMER SPECIFIED HEREIN OA NOT iHE GRANTiNG OF � iERMIT �3rOO1 �Z.SO
DOE$ NOT pRESUME TO GIVE RUTMpRITV TO �iOIATE OF LaNCEI THE pENMITFEE SACCHAPGE
GROVISIONS OF 0.NY OT ER STATE OR LOCAL L4W PEGUTATING CON�
ST UCTI N OR TNE PER ORM NCE OF CONSTAUCTION $97.25 Fire SC �3.00
� /��� PUN CMECK FEE 70 l FEE
i.icens $S. I06.75
�GwaruAE0�C0�+'a�f.i0A0 a�rwOa¢E GEN* �O�*E� NEN RO VA�IDAT D TMIS IS YOUp PEAMIT
__ ��
S�GN>iU4fO�OWNEA�i�OWNfABWLOEA� �O�if� BlD S ��IE
NEW []
ADDN []
ALTER [ j
Construction Address:
Legal Description:
Owner Name 8 Address:
Effecdve 1/1/2001
CffY OF FRIDLEY (763) '�
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
Tel.# ��1(— Q�{(,�
Contractof: �� ��N� & 4�'�� �� � ` � MN LICENSE # r6 S�
Address: 5T. LOUIS PARK, M�< -^ � Tel. # CpfZ—�23�Sb �%
ID 110001050
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LNING AREA:
GARAGE AREA:
DECK AREA:
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
i�
Height
Height _
HgUGround
Sq. Ft
Sq. FL
Sq. Ft.
OTHER:
'%a.�a� 1� �6b -� i'fi`d 5 I ���j.-� 6a �`° oO �
Construction Type: �sS� � .rf� Estimated Cost: St�,rr "" `_"
Driveway Curb Cut Width Needed: _Ft. + 6 Ft =_Ft x$ _$
DATE: �7/��a Z APPUGANT: !ll�,�� Tel. #
CITY USE ONLY - Call (763) 572-3604 for Pertnit Fees if mailing in application
Permit Fee $ ��S Fee Schedule on Reverse Side
Fire Surcharge $ .00 .001 of Permit Valuation (1110th%)
State Surcharge $ � Sa $.50/$1,000 Valuation
SAC Charge $ $1150 per SAC Unit
License Surcharge $ _�, 00 $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL $ >[ J��, 2S
STIPULATIONS:
we,ca P
City of Fridley 3 310 4
ATTNETOPOFTMETWINS BUILDING PERMIT
�� RECEIPT NO.
•
� � .�. COMMUei7v DE�EIOPMENT Dw. G'�/y'a
r � V PROTEC7IVE INSPECTION SEC. ;J �ci-�
1
� � /"'\ � CITY M��L FRIDIE� SS�72 MUMBEP AEV O�TE P�GE 0� �>�ROYED Bv
�'""� � ,'' 763-571-3450 9t0•F�5 9/20/02 / /
1O8A0DRE55 1011 HACKMANN CIRCLE NE
1 LEGAL LOTNO. BIOCN TRACTOR�DOITION SEEATTALNED
DESCR. 2 1 Parkview Heights SMEET
Y PHOPEPTYOWNER MAllA0ORE5$ ZIP PMONE
Roy Oquist 1011 Aackmann Circle NE 763-571-0415
J CONTFACTpp MAIL ADDRESS ZIP PHONE IICENSE NO
Standard Water Control 5332 Lakeland Ave N Cr stal MN SSG29 763-537-4849
I ARLHITECTOPDESIGNEF MAIIADORE55 ZIP PHONE LILENSENO
I522
5 ENGINEER MAILADDRESS ZIi PMONE LICENSENO
6 USE OF BUIL�ING
Residential
7 CLRSSOFWORK
O NEW ❑ ADDITION �l ALTERATION ❑ qEPA1R ❑ MOVE ❑ REMOVE
8 DESCRIBE WOHK
Install interior drain tile
9 CNANGE OF USE FROM TO
STIPULATIONS
TYPEOFCONS� OCCVP�NCYGROUP OCCUOANCYIOAD
SEPARATE PERMITS ARE REOU�RED FOR ELECTNICAL. PLUMBING. HEATIHG.
VENTI�ATING OR AIR CONOITIONING
TM�S PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTpUCT10N ZONING SO.FT CU :T
AUTMORIZE� IS NOT COMMENCED WITHIN 80 DAYS. OA IF CpNSTRUCTION
OA WORK I$ SUSPENDEO OR ABANDONEO FOR A PERIOD OF 120 O�Y$ AT
ANY TIME AFTER WORK I$ COMMENCED. NO. DWLG. VNITS OfFSTREET PARKING
I MEREBY CENTIFY iMAT I H�VE READ �NO E%AMINED LHIS AVPLIC�TION 1 ST���S G�RAGES
AN� KNOW TME SAME TO BE TRUE AND CONFECT. ALL PROVISIONS OF ��WS yA�UAT10N SURTA%
AND OAOINANCES GOVERNING THIS TY�E OF WORK WILL BE COMPLIED @ @
WIiM WHETMER SPEC�FIED MEAEIN OA NOT. TME GR4NTING OF 4 PERMIT W3f $40 w1.92
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOI�TE OA CANCEI THE pERMITFEE S�C LMARGE
oROV151pN5 OF ANY pTHER STATE OR LOCAI LAW REGVL�TING CON� � 29�.25 Fire .SC $3.84
STRUCTION R TME 7ERFORMANCE OF �NSTRUCTION W
�% �� .I _ /-��� �LAN CMECN FEE TOT FEE
Ly (/L�
Licen $5.0 08.01
�� � S�G�+�ruAE0�C0�+'A�C�OAOAa�iNOA4E0�GEni iD�*E�
ME PAO YA�IDAT TMI$ IS YOUA �EQMIT
Y
i �
S�G�+a�UAfO�OwaEa���OwmFABaRDEA� �O�iE� G �a5 �<�t
NEW
ADDN
ALTER
[] CITY OF FRIDLEY Effective 1/1/2002
[] 6431 University Ave NE, Fridley, MN 55432 (763) 572J604 Bldg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description: _
Owner Name & Address:
Contractor:
LIVING AREA:
Tel.#�(0?J'S�I v7��_
MN LICENSE# /Jao2
�ya9Tel.# %�v,�—�7yOy9
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
GARAGE AREA: Length
DECK AREA:
OTHER:
Width Height_
HgUGround
_. � ,
Sq. Ft.
Sq. Ft.
Construction Type: Estimated Cost: $ �,8yd
Driveway Curb Cut Width Needed: _Ft. + 6 Ft =_Ft x S =$
DATE: �% 6i APpLICANT: �V �s� � OIYY\ Tel. #
Cali (763) 572-3604 for Permit Fees if mailing in application or Fax to 763571-1287 if using credit card and we will
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
� • aS�
$
� /. 9�
$
$ S D�D
$
$
$
$
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Oetermined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ �D -OI STIPULATIONS:
Ja�•31, 2006_12
Building
�aSpectioriS
'763-572-3604
SITfi ADDRHSS �_
THIS APPLICANT LS:
P80PERTY OWNERI
TENAI@T'
BUILDTNG
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
fl OA'NER
S�UBA'11T A COPY OP STATE LiCHNSS
YOUR STA`PE LICBNSS ���+l�
WI'IYi APPLICA'CION pHO I �
� Q SAS6)
❑ DEQC
TYYE OF WORK: N�
o Mnw•.
DESCRIBB WORK BEING AONE
SIZB OF IMPROVEMHNT
xooF
NUMBSR OF SQUAR&S
GARAGFS
PROPOSED S1ZB:
PkOPf1SED HEIaHT:
5�,�
O vinyl
❑ ,4fuminum
O Othu .... �
YOUR &MA1L
O ROOF
Ll SID1N4
❑ HOUS& & 6ARA4E
fl ATTAC[�� GARAOE
0 D6CACH5D QAAADe
OSoHit
0 1}im
O Fsacia
ND'(ROws
Iry gXS$77N(1 OPENINCi�es GNo IACATION OP WINDDWS
OR FOR NEW OPSNINGS•D55CRI8& SIZE OF
OPeNING CHANGffi &
Plen Review
Pire Surcharge
Surcharge
Liceoao Surcharge
SAC qLazge
Curb Gttt Escrow
Srosion Control
Park Fee
Sewer Nfain Chazge
No.4556— •
Peimtt No.: 6Z5
Received By:
Date Rec'd:
; r. r.�a
z'e z�P
_ _.� � - '� __ � �
� DRAIN'iII.E
❑ OTFI&R
7 v.B.0 FEE SCH�uia�j
BAS FNC RPA(6DHLING SB M17�
1. S�dsm�gFbol'P1mi
2. PmpOrdOoorPlm
3. Lirt o£ cbvcn+*e1 a�6ere m 1x uced
AORNEW CDN5IRUCT[ON SNCLUDTNG D9C1SS,
AnDmON_a. �pqg�,'HRC Cr1RMTf:
]. Site Pla✓Survey slwwing the exiating swcivres
and propoeed project
2. Irw sets af erniaeucdon pkns
]. &�w� Calwlatiaas
MA'fEItiAI.S:
fi5°k nf Bculdiag Pe�it Fce
.001 t�es the tota! job valuation
.0005 x Pernrit Valuaaon Minimum $.50
I5.00 (Stabe Licenaed Reaidential Conhxctors)
S 1550 pec SAC t3nit (Plans to MWCC for determinAtion}
ft+68= ftxS20=$
$450 Conservation Plan Review
Fee Determiaed by Engimea�ng
Agseement necesaaTY ( ) Non Necess�5� � )
FOR A PERMTf•NOT VALIA UNTi4 PItOCHSSED
I hexeby apply for a bw7ding permit and 1 ackaaowlcdga thst the informalion above is complete. and accurau; that the work will be in
confonaance wztk� the ordiusncea snd codes of the Ciry of Fridley and with the Ivii�sotn Construction Codes; that I undastend this is not a
pe�znit but only an applicatioa for a permit and woxk is not ta start without s permit; thai the work will be in accordence with the approved
plan in the case of sU w� wbich /r/��quiree�mvize� approval of plsns. ��/ (�`� �/� ? /
BIGNA'IVREDFAfIILiCA2� /C.:L✓�'�J FRB�'fNAMH�,�p LJ7�S" DAITi �7 �iL--
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