AF - 46246`
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City of Fridley, Minn.
BUII.DING PERNIIT N° 3912
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Ow�r ....................................... Builder -�:!'.'.�.°.........� �....
Addrees...................................... Address .............................................
LOCATIOiV OF BUILDING
Na �/Ql Y. . Street ..4�14Gs4t. �i«Ka........... Part of I.ot .......... .
Lot .�.y...... � ...... .a......... ,� � su��,�� ��..:��::�
�/ qs�� /. � /j `+
C.OTIIES I.Oi . ........... T21.4QE I.Oi d4 ......... .S2tt184t�C �(�.l...�... $If�eY&1'd ..V. -� ........... .. ....
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� , ..
7y�pe of Cons . etion
DESCRIPTION OF BU[LDING
�om y��..-�la. ' nernh%� �=. �'ae;s�,t �, ,l�,`.� S9. r-r. ,/� 1.a c�. Fr. ��..�c. /
� ��'a �� �� 'o H�;�,�.�pQ:��g' S�9. �.a.Q.� �. �. a.,� s�❑
.......�............ Eat Cast.../S�y�.l./..�"IobeCompleted ...................
Ea conaideration of 1Le issuance to me ot a permit W cons[ruct the b ding desibed above, I agiee W do
the propoaed work in accordance wiffi the dmiaiption above set forth fn c�pliance th roviaiams
rnd'mancea of the aty oY Fridley.
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�J'�%Od
In rnnatderation of the payment of a fee of $'f..F• •�� Permit 3s herebY Breutefl to ...................
......................... to conshvet the building or additi� ae descri6ed above. This permit is granted upon
the exprese oondition that the person 10 wham it is granted and hia agente. emPlo9eee and worl�en. In all work
done in, around and upon said building, or aqy part thereof, shall o�form in all resPects to the ordinances of
FridleY. Minneeota reBaTdinB locatioe. wnshveti�, alteratton. maintenance� repair and maving of buildin� wNh-
In the c[ty limits and thia permit may be revoked at aqy time upon vIolation of any of the proviffions of snid
ordinancPS. .I _-
... Building Inspeckor
NOTICE:
Thfs permit does not cover the construotion, Inslallation or alteratfon fo� wirinp, plumbiny, pae heaUnp,
sewer o� waten Be sure to see the Buildinp Inapacto� for ceparate permib fo� tha�e Itema
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.
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SUBJECi . ��
� City of Fridley
* ATTHETOPOPTHETWINS �BUILDI��G PERMIT
1 1
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� � COMMUNITY DEVELOPMENT DIV.
' j Y �' � •
. r �... � �... pqOTECTIVE INSPECTION SEC. �
, ;
i-.--� ��'�'� %� CITY HALL fRIDLEV 55632 NUMBEH
L �'� 6i23ea-ae50 910-F75
ioa nooaess 1016 Hacl�an Circle N.E.
� ��A� LOTNO. 6LOCK TRACTORADDITION
oescre. Z4 2 Pazkview Heig
� 2 PROPERTYOWNER MAILADDRESS
A. FL�dol h 1016 Hacl�an Circle N.E.
� 3 CONTMCTOR MAILADDRESS
e
MAILADDRESS
❑ NEW ❑ AbDITION
a
8� CHANGEOFUSEPROM
STIPULA710NS
PAGE OF
9 � �
RE PT NO.
a �� � o
APPROVED BY -
SEEATTACHED
SHEET
PHONE
�74- 0452
PMONE LICENSENO.
PHONE LICENSE NO.
PNONE LICENSE NO.
ALTERATION � 0 REPAIR ❑ MOVE ❑ REMOVE
nve aF cor+
'SEPARA?EPEpMITSARE REQUIRED FOR ELECTflICAL,�PLUMBMG, HEATING.
V�NTILAiING OR AIR CONDITIONING.
.THI$-PERMIT BECOMES NULL AND VOID� IF YtlORK OR CONSTHUCTION ZONING..
AUTHORI2E0 IS NOT COMMENCED WITHIN 60 DAYS, OR If CONSTRUCTION .
QR�WOAK IS SUSPENDED OR ABANDONE�fOR A PERIOD OP 120 DAVS AT
�ANY� FIME AFTEH WORK IS CAMMENCE�. NO. DWLG.
1 HEFEBY CERTIFV THAT I HAVE READ AND EXAMINE�: TMIS APPLICATION 1
ANDKNOWTHESAMET08ETRUEANDCORRECT.A0.PfiOVIS10NSOFLAWS VAIUATION�
AND DRDIt1ANCES GOVERNING THIS TYPE OF WORK WILL�BE COMPLIEO
WITH WHETNER 3PECIFIED HEREIN OR NOT. THE GRANTING OF� A PERMIT SSOO
-00ES NOT�PRESUME TO G�VE AUTHORITY TO VIOLATE OA.CANCEL TXE pEFMITFEE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TM8 PERFOR E OF CONSTRUCTION. S7. SO
. PLAN CHECK
. .. � . . �. _>�
$IGNRNREOFLONTRAG OR.OAA ORREDAGENT IOATEI WHf
. .. . .. _:�... �c . 1
STALLS
$.5�
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CITY Of FftIDLEY
APPLICA7IOi� FOR RESIllENTIAL BUII_DING PER(�1ITS
�NEW, �iLT[RATIONS, ADDITIOtJS, OR REPAIRS)
OWt7GR: �����0 G 07� BUILDER: S�Yh� � -' :
Address :/ a(,f, /7� /¢ C.0 yn A n� e12 Address : :�+-�:o
Tel. iro. : e"� �" CJ S�S�.�—
r�.: lo I 6 s��t:__1-T��c r� +�+� p rtl �i �2 �
LOT: � SI.00Y.: 03_ 11DDITION:
COiiNER IAT: INSIDE LOT: � S.'•:TBI�CK: SIDEYARGS:
Applicant attach 'to this fosm 4tuo Certificates of Survey of Lot and proposed
huilding location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
�e LC�!'l, Front:
Depth:
Square Feet: C1�bic Feet:
Front:
Depth:
Height:
Height:
�
Square Feet: Qibic Feet:
Type of Construction: �i4i I D �oef Estimated Cost: $ �1�. U V
110 Be Completed: 7 _ �T � ��
Alt. A Alt. B
Proposed Driveway Width If New Opening is Desired $ $
tSEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a pezmit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Puildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for addi ' nal information.
D11TE: _ 7 � / � SIGNATURE: L.�/l/
Stipulations:
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City of Fridley 15 3 8 3
^TTHET°P°`T�E'W'"S gUILDING PERMIT
�� RE
� �y __�� COMMUNITY �EVELOPMENT DIV. .� �� � ��
1 � � � PROTECTIVE INSPECTION SEC.
�
`-_'. A'�"�1,,� CITV HALL PRIDLE� SS<32 NUMBER AEV. DRTE GPGE OF APPHO`/ED 8Y
i ��' 612-571-3450 910-Ft5 g�g��g � �
JOB ADDi7E5S 1016 Hacl�ann Circle N.E. �
��i : LEGAL ��T NO. BLOCK TRACT OR ADDITION SEE ATTACMED
oesca. 24 2 Parkivew Heiqhts sNEET
2 PPOPERTVOWNEH � .h1AILADDRESS ZIP PHONE
Al1an H. Rudolph 1016 Aacl�ann Circle N.E. 574-0452
3 CONTRACTOR MAILA�ORESS I�P PHONE� � LIGENSENO.
Same
4 ARCHITECTORDESIGNER MAILADOFE55 ZIP . PNONE IIGENSENO.
5 ENGINEER MAllA0DRE55 � ZIP PHONE LICENSE NO.
8 WSEOFBUILOING
Residential
7 .CLASS OF WO(iK
� . ❑ NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
e �OESCA�BEWORK �
� �.CQII$Y.�'llCt 3 �.$� X i$� POOI
9 CHANGEQFUSEFPOM TO
SYIPU�A7ioNS See letter dated Aug. 7, 1979 with sti.pulata:ons fmm Environmental
Officer.
�EpfRATE PERMiTS REQUIRE� FOR w1R�NG.
H�xt�t�c. a��ud�e�r�a At�u s,�t�s. ee�. �,A�G ..
TELErNONE.����, ut►hN�s
� � REQUIREO 8Y L��;�
� TYPEOFCONST: OCCUPANCYGROUP OCCUPANCYLQA�
SEPARALE PERMITS ARE REOUIREO FOR ELECTRICAL, PWMBING, HEATING. � �
VENTILATING OR AIP CONQITI�N4NG.
iH13-PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�:FL � CU.FT.
AUTHORRED IS NOT COMMENCED WITNIN 60 DAYS, OR IF CONSTNUCTION �
OR �WORK IS SUSPENDED OR ABANDONED fOR A PERIOD OF 120 OnYS AT
ANV TIME AfTER WORK IS COMMENCED. NO. DWLG. UNITS .� OFFSTREET PARKING
I HEREBY CEiiTIFY TNAi I MAVE REA� AND EXAMINED 7HIS�APPLICATION ], STALLS GARnGES
ANDKNOWTHESAMETOBETRUEANDCORFECT.AILPROVI510NSOFLAWS ypLUATION �� SURTAX
AND ORDINANCES GOVEPNING THIS TVPE OF WORK Wlll BE COMPLIED �
WITH WHETHER SPECIFIEO MEREIN OR NOT. THE GRANTING OF A PEflMIT SZ/OOO . yS1.OQ .
DOES NOT PRESUME TO�GIVE AUTHORITY TO VIOLATE OF CANCEL THE pEHMITFEE SACCHARCaE
PROVISIONS OF ANY OTHER STATE OP LOCAL LAW RECaULATWG CON-
STfVUCTbN OR TME PERFORMANCE OF CONSTRUCTION. $12.00
� . � - PLANCHECKPEE TOTALFEE� � �
$13.00
� S�GN<TUREOfGgy7Aac*onoanUrhOR¢EOnGEN� IoarE� � . WHEN PROPERLY VA ATED THIS IS VOUA PERMIT
51GN>T�EOF�RIIF�WNEP0U4DER� IDATEI���` BLDG�NS� 9Pl �
�
CITY OF FRIOLEY
ARPLICATION FOR RESIDENTIAL BUILDI��G PERMITS
' (IJew, Alterations, Additions, or Repairs)
OWPdER: �ll�� N �GVa�P�"l BUILDER: - �K/a%�Su.� �du �,
ADDRESS: IU)B J�AC�2nnr�nl Uy/� ADDRESS: 1?u��lo i� A/ ,
TEL N0: Si �'� �F i� TEL N0: �
Construction Location
STREET NO: /O 1(o STREET: �"� AGeG �»,}w/ V�1 �2 --
IAT: �`�_ BLOCK: _�_ ADDITION: ���-C UI�J-l� �'d-�
�
Corner Lot: Inside Lot: l� Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale. �_
DESCRIPTIOId OF CONSTRUCTION
O�L Front: %.S� _ Depth: o�'S Height: /�
Sguane Feet_ Qibic Feet:
Front:
Depth:
Height:
Square Feet: Cubic Feet: .
4ype of Construction: iQ.1�3o! F' 17�2ou .0 D�ooL Estimated Cost: $ c'Ddd�
�Y'rA/CN QT�D RDl7• , '
2b Be �mpleted: � ' T — 7 %
Alt. A A7-t. B
Proposed Driveway Width If New Opening Is Desised: S $
SE� REVERSE SIDE OF SHEET .
The undersigned hereby makes application for a permit for the wvrk herein specified, �
agreeing to cb all rrorl: in strict accord;:nce with the City of Fridley Ordinances and
rulings of the Department of IIuildings, and hereby declares that all the facts and
representations stated in this applica*_ion are true and co�ct. '
DATE• /j ' � SIGNATORE:
Stipulations:
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�� CITY OF Ft�iDLEY
8431 UNIVEHSITY AVENUE N.E., FAIDLEY, MINNESOTA 66432
r, TELEPHONE (812)571-3450
P/� ; s August 7. 1979
Mr. Allan H. ILidolph
1016 Haclanann Circle N.E.
Fridley, MN 55432
Re: Swimming Pool (b nstruction at 1016 Hacl�ann Circle N.E.
Dear Mr. Rudolph:
This letter is to make clear this department's requir�ents for the
swimming pool �nstruction at the above address.
1. As indicated, one (lj skirmner appmved by the National Sanitation
Foundation will be provided.
2. As indicated, one (1) inlet of approved design for fxesh and/or
repurified water will be provided.
3. The filter and pump shall be appmved by the N.S.F. and be of
sufficient capacity to provide a minimum turnover of at least
two (2) ti.mes in 24 hours. This department recommends a turnover
rate of 6- S hours.
4. A deck of at least three (3) feet wide, measured fran the pool waters
edge, shall be provided which extends completely around all private
residential pools. Above ground private residential pools may be
provided with decking of a minim� size of 4 feet by 4 feet at pool
entry points and provided that such decking has the approval of the
City.
5. Fencing or other effective means including but not limited to walls
or buildings, acceptable to the City, shall be pmvided to positively
oontrol all access to public and private residential swimming pools.
Fencing shall meet the following criteria:
(aj Zhe fencing shall prevent the entrance of children and be without
hand or foot holds that would enable a person to climb over it.
(b) The fencinq shall be at least 6 feet high and entrances shall be
equipped with self-closinq and self-latching gates capable o£
being locked.
(c) Self-closing and self-latching devices shall be placed at the top
of the gate or othezwise inaccessible to small children.
(d) The opening between the bottom of the fence and the ground or
other surface shall be not more than four inches.
6. An automatic chlorinator should be provided with a suitable test kit.
7. All electrical and plumbing installations shall be inspected and
appmved by the City Inspection Department.
. -
_ . ,„:.. :. _: .
., __
:::.:�..:�� .,a.�,�.aw.aH,: � ����.�
Mr. Allan H. lhidolph
August 7, 1979
Re: 1016 Hackmann Circle N.E. Page 2
8. All electrical lines must be greater than 15 feet away from the pool surface.
An alternative is to bury said liaes.
9. The pool fill spout must be air-gapped or protected by a vacuum breaker.
10. Suitable safety equipment to include but not limited to a ring buoy and
rope that is l�s times the pool diameter, and shepherds crook pole must be
provided and maintained with the pool at all times.
Furthezmore� these and any other requirements must meet the provisions of the
Fridley City Code, Section 115, Swvmning Pools. The lruilding permit is approved
contingent on final inspections and approval by the City.
If any questions or probl�s arise fran this letter, please feel free to contact
me at 571-3450,
Sincerely,
S J. ON
Environmen ta 1 Off ic er
SJO/mh
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City of Fridley 2 8 2 0 9
.� 577-��n�'""W'"S gUILDING PERMIT
� EIPT N
a
� � COMMUdITV DEVELOPM�HT DIV. .
� � ° �� iROTECTIVE tNSPECTION SEC. � �/a
� �
� �
;____ � t� •�';,, (',ITV MALL FRIDLEV SS�JZ NU��FP MEV O�TE ��GE Oi �MROVEO !v
t '� 612-571-3a50 siaFis 10/13/98 / �
JOB AOORE55 1016 Hacl�ann Circle NE
t LEGAI �aTNO. BLOCK �� 7RACTORADDITION SEEA77ACHE0
DESC0. 2(� 2� Parkview $01 IlYS SHEET
3 PfiOPERTYOWNEN MAILADDpESS 217 PHONE
Paul Becker 4
J CONTRALTOR MAILADDRE55 ZIP PMONE LICENSENO
Four Seasons Roofin & Rem. LLC 793 n' -
� ApCHITECTORDESIGNEN MAILADDRESS ZIP PNONE LICENSENO
5 ENGINEEN MAILADORESS . ZIP PHONE LICENSENO
6 USEOFBUILDING
Residential
7 ClASSOFWppK
O NEW ❑ AUDITION ❑ ALTERATION y� qEPAIR ❑ MOVE �❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (26 S) Tear-off
9 CHANGE OF USE FROM T�
STIPULATIONS
Underlayment must comply with the State Building Code.
� iYP OFCONST. OCCUPANCYGFOUG OCCUPaNCYLp40
SE�ANATE PERMITS ARE REOU�pED FOR ELECTHICAI, PlUM81NG. NEATING.
VENTILA7ING OR AIR CONpT10NING.
TMIS PEFMIT BECOMES NULI AND VOID IF WORK OR CONSTRUGTION 20NING SO. FT CU FT.
AUTMpR12E0 IS N07 COMMENCED WITMIN 80 DAYS. OR IF CONSTRUC710N
OR WORK IS SUSPENDED OH AB�NDONEO fOA A PERI00 OF 1Z0 DAYS �T � �
ANY TIME AFTEA WORK IS GOMMENCED. - NO OWLG. UNITS OFFSTFEET P�RKING
I HEREBV CEFTIFV TMpt I NAYE REAO ANO E%AMINEO TMIS APPLIC�710N ST���S G�R�GES
ANO KNOW THE SAME TO 8E TBUE ANOCORNEC7. ALL PROVISIONS OF �AWS �yp�UpT10N SURTA%
AND OAOINANCES GOVERNING TMIS TYGE OF WORIC WI�I, 9E COMPUEO � �
WITM WMETHEN SPEC�FIEO MEAEIN OR NOT. iME GRANTING Of � GERMIT 'L'Z'L8 1. 1
DOES NOi FRESUME TO GIVE �UTMORITV TO VIOUTE OR CANCEL TNk pERMITFEE� SALLHARGE
PRO ON$ OF 0.NY OTHER $TATE OF LOCAI LAW REGUTATING CON�
ST CT N R TME�fRFORMANLE Of CONSTAUCTION Fire
Y ,, �/J r%/ti GLAHCNELK FEE TOTAL FEE
/ /'1 /
1//—/
�___�—
G� uAEO� ON' . OAOa�u��OA�ZED�GEhi �U�iEi yyHEN PROPERLY LIDATED THI$ IS VOUA PEAMIT
�' � /r�a /
S�Gw�*veEO�Ow�+Fa���Ow�+fnBW��EA� iD��Ei � •� v.5o �k
�. ,
NEW [ ]
Effective 1/1/98
ADDN [ ] CTTY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEYES R-1 Ai�ID R-2 �
BUILDING PERMIT APPLICATION
ConstructionAddress: � i� ���-�(,GK�� C i,r C.� �e � D I�
Legal Description:
Owner Name & Address:
Contractor: � U r 5
Address: 7 93 Ci �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
�2 GKG I�
Tel. #�,�%�-U�'/�_
MN LICENSE #
Tel. � ��.�- %��U
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF �IPROVE�NT
Length Width
Length Width
Len th W idth
�e.w� ov�. d i�-��
Height Sq. F[.
Height Sq. Ft.
HgdGround _ Sq. F[.
Construction Type:�f�,6�/�d-- (2-e.�(c�CP. �o-�� Fstimated Cost: $ ��� �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: _Ft.
DATE: ! U'" � 2�"! b APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �'?S�-
$ a3
$ � /i
$
$ �� Cj0
$
$
$
$
$�
6 Ft = Ft x
/ �—
CITY USE ONLY
_ $
Tel. N
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Deterrrtined by Engineering
Agreement Necessary [ ] Not Necessary ( ]
,� ,_,,,,_ . �. - . _.,-._.� _._
�s�e�[tr � P .
c�cy of Fridley 3131
ATTHETOVOFTMETWINS gUILDING PERMIT
� � RECEIPT NO.
: `
� _ COMMUNITY OEVEIOPMENT OIV. �^��
r � L PROTECTIVE INSOECTION SEC. �
1
�--'.� �•"�,.J CITV NAII FRIDLEY SS�li �41FR �EV D��E ��GF � �hNOVEDlr
612-571-3450 9t0-Fi5 8/16/00 / /
lOB ADDRE55 1016 Hackmanl�Circle
t IEGAL �07N0. BLOCK TRACTONAODiT10N SEEATTACHED
oesca. 24 2 Parkview Heights SMEET
2 PROPEPTYOWNEN MAIIADDPES$ ZIV PMONE
Paul E. Becker 1016 Hackman�Circle (763) 571-0294
7 CONTRACTOR MAILADORE55 Z�P PMONE IICEN5EN0
Owner
a nRCNITELTOROESIGNER MAILADORE55 ZIP PXONE LICENSENO.
5 ENGtNEER MAII �DORE55 ZIV VMONE �iCENSE NO
� 8 USE OF BUILDING
Residential
7 CLASSOFWORK
. p NEW ❑ ADDITION O ALTERATION KI REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reside House and Garage
9 CHANGEOFUSEFROM � T�
� STIPULATIONS .
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering imless the manufacturer
states this in their application guidelines. Call for inspections of wrap
before covering.
TYPEOFppNST. -OCCUPANCYGROUP OLCUP�NCY�OAD
, SEPARA7E PERMITSARE NEOU�REO FOR ELECTRICAL, 7WMBING, NEATING.
VENTI�ATING OR AIR CONDITIONING. �
TNI$ PERMIT BECOMES NUIL AND VOID IF WONK OR CONSTPULTION zONING 50. FT CU FT
AUTHORIZED IS N07 COMMENCE� N(�TMIN 60 DAYS. OR IF CONSTRUCTION
OA WORN IS SUSPEN�ED OF ABANDONE� FOR � PERIOD OF 170 �AYS AT
ANY TIME AFTER WORR I$ COMMENCE�. NO OWLG. UNITS OFFSTREET PAFNING
I HEREBY CERTIFV THAT I MAVE READ AND E%AMINED THI$ APG�ICATION 1 ST��L$ GAN�GE$
AND I(NOW TNE SAME TO BE 7RUE M1NO CORRECI. R�� iROVI510N5 0F LAW$ ypLWTION SURTA%
AND ORDINANCES GOVERNING TNIS TVPE OF WORN WI�� BE COMP�IED p1�1A9•OO � �.S%
WITM WHETMER $PEC�FIEO HENEIN ON NOT. TME GRANTING OF A PERMIT � Y
DOES NOT PqESUME TO GIVE AUTMORITY TO VIOL.eTE OR CANCEI TMf vERMITFEE SA��MARGE
PROVISIONS OF ANY MEF STATE OR LOCpL LAW REGULATING CON� Ov�$xgXX �44. HS Fli SC ��.. iS
STRUCTION OR T RFOFMANCE OF NSTRUCT 45�
� GLaN CMECKFEE TOT FEE
f 4 .57
S�Gw— �— un�ON� eC�IOtiOA�o*�L A2ED�GE - ��� p E A�ID E MI$ IS���T�
/ i/ �
S�Gw1uaEO�OwpEAetOwnEABw�DEa� �O�i(r p �.�go q��E
NEW []
ADDN []
ALTER []
Construction Address: �
Legal Description:
Owner Name 8 Address:
CRY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
L%
Effective 1/1Y2000
(763) 5723604 Bldg Insp
Tel. # 76.� S7/ 0071�.�
Contractor: MN LICENSE #
Address: Tel. #
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed consVudion drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length
Length
.�
• �1
Height Sq. Pt
HgtlGround Sq. Ft
. �y G�
Construction Type: .� � Estimated Cost: $ //.�/./`
Driveway Curb Cut Width Needed: `Ft. + 6 Ft =_Ft x$ = S
DATE: ��s 000 pppLICANT:
CITY USE ONLY - Call (763) 5723604 for Permit Fees if mailing in application
Tel.
Permit Fee $ �t'Y� �4S � Fee Schedule on Reverse Side
Fire Surcharge $ /. %� .001 of Permit Valuation (1/10th%)
State Surcharge $ , S� $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Aft. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ Fee Determined by Engineering
$ Agreement Necessary [] Not Necessary [ j
$ ��' � f
h
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�63) 572-3604 FAX: (763) 571-1287
: ]016 HACKMANN CIRNE
: 243024240055
: PARKVIEW HGHTS ADD
: LOT 24 BLOCK 2
: HEATING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : FIREPLACE
VALUATION
NOTE: INSTALL FIREPLACE INSERT
APPLICANT
BECKER PAUL E
1016 HACKMANN CIR NE
FRIDLEY. MN 55432
OWNER
BECKER PAUL E
1016 HACKMANN CIR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify tttat I have read and exaznined this
application and lmow the sazne to be true and correct. All
provisions of laws aud ordinances goveming this type of wor}
will be complied with whether specified herein or not. T'he
grariting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construcrion or the performance of construction.
Bldg
-�
PERMIT�NO.: 2004-00411 `
`-..____- �--_'.-:``'
DATE I5SUED: 03/31/2004 •
HEATING PERM[T MINIMIJM FEE
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 17844
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
25.00
0.50
25.50
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