AF - 46494�:.. i �
City of Fridley, 1Vlinn.
BIJII.DING PERMIT
Date: . . . .l�R. . . . . .�. . . . . �'�. . . . .. . . .. .
N° 3914
Own�r ....................................... Builder .... .. .� . .... .. �. �
1 r Y
A,d�d� ...................................... Addreas .............................................
LOC Tt0(V OF BU[LDING
No. . /. .� �O Street . . ��'!�S, ./. :T. . . : L.�Y'�... . . .. .. . . . Part Lot . .. .. . . .. . . .
Lot . �.�. . . . . Biock . . . �. . . . . . . . . . . Addition or Sub-Dfvision (/ . . . . . . . . . . . . . . . . . i��r4fJ. . . . ��,/�!.f►
Corner Lot . . . . . . . . . . . . L�side Lot � . . . . . . . . . Setback � d. .� .V.~ Sideyard . J Q : : a .~ . . . . . . . . . . . . . . .
DESCREPT[ON OF' BUILDING
IT
T ♦ f
�,����. .. . � 5�.�: a. �� 2�!=o Height .l..y 6 �. �./. o�Q. d' �. �. ,l �'/.�".�
.................... l�ont ........ Depth ........ Height ........ Sq. Ft. ........
Tj►pe of Construction . . . . . . . . . . . . . . . . . . . Es� Cost. �� �.�'f., Q • ��'To be Completed . .
Gtt. Ft. ........
In c�onsideration o! ihe issuance to me o! a permit to oonstruct the ding desribed above, I agree to do
the propa�ed work in aocordance with the desr.rigtion abwe set fo in compliance rovisi f
alydinances of the dty of F�idley. „�
�
.iC.. .......... ...�l... .... .. ............
/Q OQ
In consideration of the payment of a fee o! $. rl.rl. .�1 permit is hereby granted to ... .. .. ...... .... ..
......................... to constnict the building or additian as described above. This permit is granted upam
the express condition that the person to who�n it is gignted and his agent8, employe� and worlunen, in all work
done in, around and upon said building, or aqy part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, constructtaa, alteration. maintenance, repafr and moving of buildings with-
in the city limfts and this permit may be revoked at ai►y time upon violation of any of the pmvisions of said
ordinances. l �
' � Building Inspector
J i� � � •
NOTICE:
Thts pe�mit does not cover the constniatton, installation or atteration fo� wirinp, plumbinp, yas heatin�. ,�j
sewer o� water. Be sure to see the Buildinp Inspecto� fo� separata permib for these items. ,
•
•
•
City of Fridley, Minn.
BUILDING PERMIT
D$�; _,_ October 7, i968 _
pwner. Lawrence J. Berg B��r � Same
Add�s _. 1080, .Hackman Circle Ad� _ Same
r�, � �/L1S"/ /
N� 9968
LOCATION OF BUILDING
No. 1080 ,_, S�t ,_,_�acl�nan Circle � p� of Lot _—
2 Parkview Heights Addn
Lot _.. 16 .._....__ Block _.---.___ � Addition or Sub-Division _.._.._�.— ....._..__._-
Corner Lot
Sewer Elevatiam
Inside Lot ___._._..X._.___ Setback ._._—.._ Sideyard
�_._.__.__.._.._._...._. ___.�_ Foundatioa IIevation ___—.
To be Used as:
,.,_�. A1ter ._ �t
_.___.__..:_...____._._._..._._ Front
Type of Constrvction
DESCRIPTION OF BUILDING
Depth � Height ._._ Sq. Fk � Cu. FL
Depth _.._ Height ._._.._� Sq. Fk � Cu. Fk _.._
_^ � � �950.00 . To be Completed _�'•
In consideration of the issuanoe to me of a permit to caostru``7�uilding described above, I agree W do
th� Proposed work in accordance with the description above set f in compliance with provisions of
ordinanoes of the city of FridleY• il �
In cooafderatfon of the payment of a iee of ��sS2Q .., permit is hereby granted to Lawrenc`e ,�T .�eY
_ to construct the building or addition as described above. This permit is granted upon
the express oondition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall oonform in all respects to the ordinancea of
Fridley, blinnesota regarding location, construchon, alterah�, maintenance, repair and maving of buil
��� dty ]imits and this permit may be revoked a t aqy time upon violation of an�of the provisians o! d
/'� �
NOTICE:
iWs pandt doa nof eowr tfM eonstruelioe, ie�iafl�Nen fer rrieisY. Pw�W Y+s h�ipY, �w�r er waMr. !� wn to sw
tla duiWieo Iatp�tlor fer s�p�rah p�reiib fo� 16� I1�s.
_ . z ,.
AP.PiICATION �OR BUIL�INr PEftNlIT
�?TY OF FRIDLEYy MINNESOTA
� ,/ � �
� a� � � . . I_'��. _ ' _:�! � : � a�' �� �
/ �
. �� �
' � �' I . / .�� :',�/l�4%%/I��'� �.
ZCCAT�ON OF BJIi;DII�?C��
rao o s���
LO'I' � � BLOCK � A�DITION OR SUBDIViSIQ_�"+ /4 t� � << � I`�'< « �.S ��+�' �' ° ^
COR'!'ER LOT
SEtiTII� ELE��ATIOP�
II��,I�E LOT �/ SE'I'BAt":i� �I���ARD
TOt OF �'OCTI?�G
Applicar?t at �ach to this £o�m. 'I'•��c ��rtiii�ate� c�' S� �rey of Lot aru
pT'oposed buildiz^_g' locatior �ra��-� o.rs thes� �estificateso
�ES �R_T�'I' i OlvT CF BL??I� : NG
To Be Used As: �
3 . X �� , ��p�,-d
/� 7'`-�-��m^ Frent. Depth Height — –
�qua�°e fe�t �� Gubic �'E�t
Fz°o:nt
�quare ��et
Degth Height
Cubic Feet
Type of Const�°uction Estimated Cost /✓� !
To Be Completed
The unde�signed hereby makes application for a pex°mit for +he ;,-ork
herein specified, agreeing to do all work in strict accordance with th�
rity of Fridley Ordinar�ces and rulings of thc Departtaent o: Buil3ings,
and he�eby declares that ali the facts and repre�e.r. �tions statEd in
this appli�atiot� a,re true ar,d •orrecto
DATE �� SiGIVA'T[TR
(Schedule of �ee Costs car� be fou.nd on the Reverse Sideo
/_ , �
lJ
� �
.__, , . • �_.,��
�.a
,.,�. •
: City of Fridley, Minn.
- - 6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: October 26, 1971
Owner: _...-----I�x'rv Berg _._._._:._._..._ Builder ..� c^*�^� � ��„�*�.s�$e�
Address _---...._10$Q Hackman.�_ _ Address .15Q8 Bernd�le .Avo�ue
LOCATION OF BUILDING
No. ___--_1080.� Street _._._Hackman Circle � _.� g� � �t
Lot .--•-16----�-- Block _---------2_..._...._.._..-------__ Addition or Sub-Division arirv; �,g,; egh ts
Coraer Lot __.___._.._...___ Inside Lot ..�.X,__ Setback ...._.... ..�_._._ Sid�eyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
� �
��122 ��
To be Used as:
Add Fa�i_1.y Room� �nt _ 1$.� _ Depth —. � Height ___._$�__ Sq. F`k _28.8_ Gu. FL
____._._._------------_ Front .._._._.e..� DePth Height . Sq. F'L .� Cu. Fk
Type of Construction ___._Erame____......_ Est, Cost ..__$3�54Q..4A-.-____ To be Connpleted �c 1 ST19?t
��
Stipulations: Drainage approved by City Engineer 10/26/71. Permit without survey
approved by Councilman Kelshaw and by instruction of City Engineer 1OJ26/71. No license
approved by City Engineer.
In consideration of the issuance to me of a pernut to c
the proposed work in accordance with the description above
oa�dinanoes of the city of Fridley.
1.75 Sta
ttxe building
h and in co
I agree to do
pro�iedons o!
In consideration of the payment of a fee of � 21. 00 , permi�t is hereby granted to T•arrv RP�
_____.. .�____._._........_:..:__ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�en, in ali work
done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordiaances oi`
Fridley, Minnesota regarding location, construction, alteration, maintenattce, regair and moving of buildiIIgst
yyithin the city limits and this permit may be revoked at any time upon violation of any of the provisiaa�s o! said
ordinances.
�� ,�.� Bt�ilding Inspector
— NANK MfTNT('.N
NOTICE:
This p�cmit do�s not cove� the consfruetion, instaUation for wiring, plum6eng, gas hsating, sewar or w�fer. B� wn to sM
1h� Building Inspeeto� for separate psrmits for fhass Aams.
._ ,�
�
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
� . . ��
Q ER S NAME BUILDER. �
WN .
ADDRE$S � � �" ADDRESS ,�S� 0 � r^'—"
r
NO•. � D 0 STREET•
IAT; � � BLOCK: � ADDITION: *
CORNER LOT: INSIDE LOT: � SETBACR: SIDEYARD;
Applicant attach to thie form �o Certificatea of Survey of Lot and proposed
building location drawn an these Certificates.
HESCRIPTION OF BUILDING
To Be Used As:
� c / �
�cn-� Front : � O Depth • � b Height • �
Square Feet: d- 0� Cubic Feet:
Fxont; Depth: Height•
Squaxe Feet; Cubic Feet:
1�►pe of Conatruction: Estimated Cost: $�j � Q � L
.�. •
To Bs Completed: � � — �5 ' �%% _ _
The uadezsigaed hereby makes applicatian for a�enui� for the work herein
apec�fied, agreei�ng ta do all Moxk in sttict accordance �ith ttle City of
$�cidley Oxdiasnces aAd suli.ngs of the Department of Buildings, aud heraby
d�cl�tree that all the facta aad representationa stated ia tlxis appiication
are true aad corzect.
DATS : � � � — � � �� SIGNA1Z1x8:
(Sea Reverse Side For Additioaal Info�ation.j
� o� f� / l�ff ��r ,� � /�/�/ � � V L' d l� % � / r �/ F /�. : � -- ,� ,�,` �. � / _ .,' �
�'��"'�+►� �- r,��r�-� r� v r s� �py ,� -�s �,.�'o �s� E�
Y � ' � !1' Y C-' c� ��=IV C r�. �j �sJ1r'
/d� � � h��4w -.� .�Y ?/1/ s T/?LC r�o�/ e�- � if �
Y _ " �� � �. / C /� Ai S_r' � �i'aP f�' v �` v �* ii � / T �/ �, � F .1Jl; �- / ��2 G ' � /
, '' /V C
l��'�/y � T � � � -..r. � / r�.�
�T� r,= S v/�i / �—'-
�" �7'/'fL /�6� �~!� 2 .99'
� SUBJECT � �
City of Fridley
�
AT THE TOP OF THE TWINS g � I L D 1 N G P E R M I T
� �
� �
COMMUIJITY DEVEIOPMENT DIV.
L PROTECTIVE INSPECTION SEC.
� _
, 1 �__'-�
r , ;
� ,
� � �'�'1 � CITY HAIL FRIOLEV SS432 NUMBER
�""� � �', 612-571--3450 9t0-Ft5
108 ADDRESS 1080 Hackmann Circle N
1 LEGAI �OT NO. BLOCK TRACT OR ADDITION
DESCR. 16 2 Parkvie
2 PROPERTY OWNER MAIL ADDRESS
Lawrence J Berg 1080 Hackmann Circl�
3 CONTRACTOR MAII ADDRESS
Same
4 ARCHITECT OR DESIGNER MAII AOORESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUIIDING
Residential
REV. OATE
7/22194
ZIP
PAGE OF
� %
571-82
PHONE
PHONE
PHONE
PERMIT NO.
22748
RECEIP .
ag a
APPROVED BY
SEE ATTACHEO
SHEET
LICENSE NO.
LICENSE N0.
LICENSE NO.
7 CLASS OF WORK
O NEW � AODITION ❑ ALTERATION � REPAIR � MOVE � REMOVE
8 DESCRIBE WORK
Construct a 5' x 15' Deck in Eront Yard
9 CHANGE Of USE FROM
STIPULATIONS
See notations on plan.
TO
TYPE OF CO�
SEPARATE PERMITS ARE REQUIHED FOR ELECTRICAL, PLUMBING, HEAT�NG.
VENTILATWG OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID tF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED W�THIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPfNOED OA ABANDONED FOR A PERIOD OP 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. DWIG.
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS ypLUATION
ANO ORDINANCES GOVERNING THIS TYPE Of WORK WI�L BE COMPLIED
WITH WHETHER SPECIFIED HEREItJ OR NOT. TME GRANTINCi OF A PERMIT ��11
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- � 19. OO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
OF CONTRACT R AUTHO ED AGENT IOATEI
� �
fFOWNER�lGO ERBUILOERi IDATE�
1�VA�HfHG
Before digging call for
all utitity locations
454-0002
REQUIRED BY LAW
UPANCVGROUP
FT. CU. FT.
OFFSTREET PARKING
�GAHAGES
SUiiTAX
$.50
SACCHARGE
Fire SC $.61
TOTALFEE
$20.11
�D THIS IS YOUR PERM�T
�� natE�
STALIS
G
Y LOAD
NEW
ADDN
ALTER
11
{I
ri
Cons�truction Address:
Legal Description:
C1TY OF � FR[DLEY
S[NGLE FAMiLY AND DUPLEXES R-1 AND R-2
Buiiding Permit Application
�� �� �i�'.YY1 �—�—sa.../ -C-' 1 � _
Effec;tive 1 / i /94
� ��
i A /
-a•- w r.e n '� r✓+�- v
Owner Name c4i Address: f 0� Ir� �-n,��v e% /Z- TeL # �°�� �7� �Z��
Contractor: � � �� t=�7� � � � MN LICENSE # � ���
Address: :s?�'"�1 E' _ Tel. # ` .
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�iER:
Attach to this appIication, a Certificate of Survey of the
lot, with the proposed constructian drawn on it to scale.
DESCitIPTION OF IMPROVEMENT �
Length � �Vidth
Length Width
Length � / °� Width
�
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground � Sq. Ft. =#-� ' S�
Corner Lot (] Inside Lot [] Ft. Yd Setback Side Yard Sdbacks
Type of Construction: Estimat�ed Cost: $ �
Approx. Completion Date:
(Cost on Back)
Drivewa urb ut Width Needed: �I' t= Ft x =$
DATE: `� Z �� APPLICAN • Tel. #S ��— ��` G �
Permit Fee
Fire Surcharge
State Surch�trrge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
, �;�-
��
$ % �, C��� Fee Schedule on Reverse Side
$ � (r / .001 of Permit Valuation (1llOth`J�) �
� ,S C:�' $.50/$1,000 Valuation
$ $800 per SAC Unit
$ $5.00 (State Licensed Residential Cantractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Pian Review
$ Fee Determined by Engineering
$ Agreement Necessary [ j Not Necessary [ J
$ -��' � 1 I
� TT;',�� i
!HOUSTR1Al . � . � , � � � � T � � . ?� . �. �
F1�RM SURV£YS
BUSlNE9S . � �
LAND SUFIVEYOR uKesHOae
Glrv LaTS !
TQWORAPMICMAPFIN4 RE^viSi`ER�D L':�:��R LRNJS �� srnr� c� ?utyra�sor,a �. � �UD�C4tL��� �
- LiCSNS€D GY ORDINANGE �F CITY OF Itt:iNEAPOL75 �
i
3300 IYNDALE AVE. SO. PdtNtVEAPOLiS 8. MtNN: ��
T.'-�.Yi OR 4-0370
I� / �� � �
i r
� �
,..�C�'f� l� � Y' fo.- .l�r-' !��_i� � ��A � 1.� !�/'� .- _ , n,�� � � ,� LL �.,: q,, ,
; s
" �urnpgur'� 4ertifirxip �
0
\
\
`
��
�
�
�
�
V
l�
�
\
�
O
�
��
' � .;i ^ /l�'—�
�-
I hereby certify that the above is a true and correct plat of a survey of:
Lot Sixteen (16), B1ock Two (2), Parkview Heights Addition, Anoka
County, Minnesota.
As surveyed by me this lst, day of June 1959 A. D.
Signed ��o,:�/!��_�r`.�'..-rc..:�
Mi.nnesota Registration No. 2584
�a � � , _ ,:
� �� �
.
�+�; � ,:.. �; ,��. :°. . .. —
.�.. � ' . . . ,
Y
, rt• �. .. , ;'., . . �, • , � . ' , :. �' �, :z�
;� x a i ..- _ .
F , .
2 ', { . . � . . . . . a�:,
� � .
s
#�.� *, a, .:r � . . . ._. . . , .
� s,w � "°r"'z` "ae' �R `r3 �`$
. r�iu,�r �, n,.. ha�,b a > �v a .c""� ''�i � :.. < � t . f.' ' "
� �� ��i� �y�y .'N' Y ?
, �
,,,�'� ZM ' N$T.� y l `w _vY�.�y, - y' . . . y �
x 2 ; _, � /' . . . . . f`� .
�'�' w-�"'� �� ' ; � :., � -
�� . . � . z� .' � " �'': �" M �J . . . • • �. # �ro�
- . . .. . . a: . . ' � . . . , . . �
0
'i
�
�
�o
�
O
�
�
w
Q
0
�
Q
m
O
�
�
t--
O
�
w
�-
Q
�
O
z
�
w
F-
Q
�
w
�
�
F-
X
LL
�
Z
m
�
�
J
�
c
.�
ar ai '
L 'p �
Y �
3 �' '
� U ,
Y Q' '
� L �
� y �
N U �
Ll C �
� N 1
� •
O O �
'� U �
C U j
0 � J
� � �
U � �
Q �„ �
Q � i
� Y �
Y O i
�a 3 [
E � �
� o -'
� -o ,
� o :
m�.o
L �
� C �
m m :
� N .
rn .. �
rn
� � i
m � �
v
c .
3 V :
m m �
f- Ol <
1�:
rn
_�
�
�
1
V �
W
�
�
J
i
�
1
3
m
�
3
0
N
Q
�
a�
�
�
rn
c
U
�
m
�
z
H
�
�
LL1
a
�1
O
�
�
N
0
U
�
m
�
�
N
ll�
�
�
Z
Q
d
�
�
U
�
Z
m
�
�
J
a
�
�
n
0 0 0 0 0 0 0 0 0 0 0 0 0
0 0 0 0 0 0 0 0 0 0 0 0 0
� v�ri r� r; r� � o � o ci o ,ri
�» �» u9 � � � v� E» � is » » �
� � I � I 1 I y I I I � Z �
N
N
i
U
N
a� �
a� �
� U �
X Y � V �
LL � �a � � �
�
°' v rn Q W � �
Z� � m c� 1 I �
� -
m� C � C-J '� �-,C,, N d d
C
7 C a m t6 � N m N N � N 3
X n v_, � ap as � F- = 2 c � o
� O � Q �� c6 � N
� U C � C) N y� 0 y fl
3� �- O ' � ltt `�N �N y v� v 1-
zommva��'n�33c�C�m
�
�
��
n
�
�
�
� �
0
c0
O C
Z tL
�
w
�
N
�
�
c
I
L
�
7
0
�
m
�
p m
w >
Z: O
i3 °'
m ¢
.�
Z
O
�
¢
�
w
F-
J
Q
� �
Z U
a �
� �
Q �
Q �
a Q
w o
0
o � �
�
� Q X
a� Z u-
� Q O
�
7
O � �
U = �
� O O
C � o
N J
Ii Q
�
�
�
o ��
1
�
w
w
� "
� �
l0 F-
L �
U �,
7
�
m
m
�
R.;,�., .,:., _.�.�-�„�,.
sue�ec* .-
c�ty of Fridley 3 2 9 7 7
AT TME TOP Of THE TWINS g U i L D I N G P E R M i T
r
� ` RECEIPT NO.
• COMMUNITV OEVELOPMENT OIV. � �
� ; V �"�� ,
r � � PROTECTIVE INSPECTION SEC.
1 . �
`---• A �/"','� CI7Y MALI FRIOIE� SS�32 NUMBEN pEV OATE pAGE Of A►PROVEO 6�
L �� 763-571-3450 910-F 15 8/ 12 / 0 2 / /
�oe nooRess 1080 Hackmann Circle NE
t IEGAL �OT NO. BIOCK TRACT OR AOOITION SEE ATTACHED
oesca. 16 2 Parkview Heights Addition SMEET
2 PROPER7Y OWNER MAIL AODRESS Z�P PHONE
Lawrence/Geraldine Berg 1080 Hackmann Circle NE
J CONTRACTOR MAII AOORESS ZIP PHONE IICENSE NO
Same
� ARCHITECT OR DESIGNER MAIL ADOF1E55 ZIP PNONE LICENSE NO.
5 ENGtNEER MAIL AOORESS ZIG PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW ❑ ADOITION � ALTERAiION O REPAiR O MOVE O REMOVE
8 DESCRIBE WORK
Install new window in basement wail
9 CHANGE OF USE fROM TO
STIPULATIONS
See notations on plan.
TYPE Of CONST. OCCUPANCV GROUP OCCUPANCV LOAp
SEPARATE PERMITS ARE RE�UIFEO FOF ELECTfiICAL, PLUMBING, HEATING.
VENTI�ATING OR AIR CONOITIONING
THIS PERMIT BECOMES NUIL ANO VOID IF WORK Oii CONSTRUCTION 20NING S4. FT CU FT
AUTHOR12E0 IS NOT COMMENCEO WITHIN 60 DAYS. Op IF CONSTRUCTION
OR WOFlK IS SUSPENOED OR ABANOONED FOR A PERIOD OF 120 DAYS AT
ANY 71ME AfTEii WORK IS COMMENCED NO DWLG. UN17S OFFSTREET PARKING
I MEREBY CERTIfY ?HA7 I HAVE REAO ANO EXAMINED THIS APPLICATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECi AlL PROVISIONS Of LAWS VA�UATION SURTA%
ANO OROINANCES GOVEFNING THIS TYPE OF WOpK WI�L 8E COMPllEO �SOO �. SO
WITH WHETHEfi SPECIFIEO HEREIN OR NOT 7HE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIYE AUTMORITY TO VIpLATE Op CANCEL THE pERMtT FEE SAC CNARGE
�ROVISIONS OF ANY OTHEFi STATE OF LOCAL LAW REGULATING CON-
STqUCT10N OR TNE PERFORMANCE OF CONSTRUCTION �Z3.SO Fire SC �.SO
PIAN CNECK fEE T L iEE
$24.50
� 5 N�TU�7E O� CONCFA(;TOpOQ oUTMOQ� D�GENr �O�iE� WH N PR .�V VALI Ai D� THIS IS YOUp PERMIT
•
S�GN�TUQE O� OWNEp��� OWNEpBW�DEA� iO�TE� pG �p5o ����k
NEW ( j CITY OF FRIDLEY Effective 1/1/2002
ADDN ( J 6431 University Ave NE. Fridiey. MN 55432 (763) 572�604 Bidg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUIIDING PERMIT APPLICATION
Cohstruction Address: f G 1�o HQ'/�l ��
Legai Description:
Owner Name & Address: .�.c���� �/�f.e.-.�o1�'n� �2r� Tel. # S71 f�a?� _/�, � ,
Contractor. '.�Zar� - �o� u�,�if ��Sd�c/1 MN LfCENSE #
Address: Tel. #
LNiNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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. Fk
Length V�dth Height Sq. Ft
Length Width HgUGround� Sq. Ft
r�n l ��n �ase� �i� -�t/o�// " � �
Construction Type: Estimated Cost $ �� �- O �
Driveway Curb Cut Wdth Needed: Ft + 6 Ft = Ft x$ _$
DATE: �/ ��D �i APPUCANT: Tel. # �7� f�0�,���
Cali (763) 572-3604 for Pertnit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ f•�" •�• �
$ f
$
$
$
$
$
$
$
$ .�� �
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 Att. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ )
STIPUTATIONS:
�
�
�
�
�
,
.
�
N
00
�
�
�
�
�
�
�
�
�
O �
�
�
�
�
Q
-�
�
�
`
\
\
\
\
`
�
�
�
�
�
�
i
�
i
i
i
�
�
i
I
�
�
�
�
�
�
�
�'
�
�
�
' (� .
.�
I
�
J
�
h �
�
�
� �
n
,�-.z
w
Q
a
�
4
�
�
�
�
�
°� /��
� �
� �;
� w
r. �;
�` 2
�' J
''1�
`o�
l�
>
�
_�
\
`
`
\
`
\
\
\
�
\
�
`
\
�
�
�
�
� ��
� �
,
,
� ,
,
� �
�
� M
�� � �
Z,� =�'c
� ��
' 0. �
, d
' a�
' b
�
i W �
i
�
�
i
i
� Q , �
, ,
� � Q
� , ,
, � � �
� � ,
, .
, � � ,
� � , ,
� � � � �
u � �
� , � �
� � , ,
, , - , ,
� � � �
� , , ,
� �
� � ; ;
� ; � � �
� � 4 , �
, � -----------
, �-------------------------------------------------------- -----� �
� �
�---------------------------------------------------------------------------------------�
T 0 0 f�j
'9,i.}I� 'd?I0� NO,LV� 4ZOZ 66Z 5ZB Yd3 85 � SO ZOOZ/ZT/80
, �E1N
�DDN
aLTER
t�
[J
��
Construction Address:
CITY OF FRIDLEY
6431 Universiry Ave NE, Fridley, MN 55432
SINGLE FAMfIY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
i f�r
� �° 5 Jb �°��
(763) 572,3604 Bidg Insp
(763) 571-1287 Fax
Legai Description: �'
�
Owner Name & Address:
� Tel. # rlin � .s 7 � �cZ �Q'j
�,�� � � -.— MN LICENSE #
Address: Tel. #
Attach to this application, a Ce�tficate of Survey of the
bt, with the proposed construction drawn on it to'scale.
DESCRIPTION OF IMPROVEMENT
LMNG AREA: Length � W�d� Height Sq. Ft
GARAGE AREA: Length Width Height Sq. Ft __ "�l ���
DECK AREA: Length Width Hgt/Ground Sq. Ft
�oo r'
OTHER:
�� �o
Constru�tion Type: Estimated Cost: $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x� _�
DATE: �� /— O � APPLICANT: � � Tel. ��-� �S 7� � 1UJ
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we wil{ call
you for carcl number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ - J�S
$
$ � �o�
$ • S�
$
$
$
$
$
�
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Att. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ � �� � STlPULATIONS:
c
r
---------`
__ .--�
- �
�
�
��� \V1. �� �S ��
1� 1
JI �
�
-�-� `� ��`=���� (bS =
c� � �f�� �5 �� ��S
�
� ��� i�s
Ro
� � � � � � i�-i � ( � �
o� �_���
� � ,�
_, ��,, �N �
� 5� I (
��-
����, j ,'
C �� ��
y��. � s
� -F-�-
�
� n��
� ANc�- Q_.
_�__ __
�' i—�( p I�J � �
- � � �-�-I� G
,
�U �. S
�S
, �� -
_....._-____
"
\ i
:+ �\
I T_T)
l._—.
� � (o� . ���
�:s �.
I ' �
S �?� �-�
� �; � e����
_ ____ _ __ _____ ________ __ _
��� ��-s�
�� �d�
r
�U � (Yl. l��:J :�t�-�'1�
���.���
��
�
�
���
___.
� �
-�.S ( - G� � � �� � ���t �
�- i
��� ���
` ` y�SS
� 11 -e- i� ' r,t�,
�v �r� � �
c7
�-G�
�����
♦ � / ��
� �
� � � ��� ����
�
3�NY/Il��'. ,..
�3M3:
Building
Inspections
763-572=36U4
DATE �'� ti V O 7
SIT'E ADDRESS ��
THIS APPLICANT IS:
PROPERTY OWNERI
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE `
c
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
�C0T3TRACTOR
� � • • � :t��.r:+� �, - . . �
� • . ��1!?l���
STATE LICENSE
ADDRESS:
B.�fIIGLE FAMILY/NEW
O TWO FAMII,Y/NEW C(
O BASEA�NT FINISH
❑ DECK
❑ MAW7'ENANCEJREPAIR
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
OF SQUARES
GARACFS
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDIIVG
❑ Vinyl
❑ Aiuminwn '
0 Othcr .
EXP DATE
FAX
�vcnox s�z
[JCIlON S71
❑ GARAGFJSI�D
O ROOF
� SIDING
❑ SWA�IIv�JG POOL
❑ ADDITION
O REMODELING
LENGTH W
❑ HOUSE dr. GARAGE
❑ ATTACi�D GARAGE
❑ DETACIiED GARAGE
OSoff t
❑ Trim
❑ Fascia
WINDOWS
1N EXLSTING OPENINGS �Yes �IJo IACATION OF WIIdDO S
OR FOR NEW OP�iINGS- ESCRIBE SIZE OF ,/!� � n G, S; !1
OPENING CHANGES � .
OF
❑ wulnows
❑ DRAW 7TLE
❑ OTHER
PermitNo.• T �l�y
Received By:
Date Rec'd: 7 �7
HEIGHT
A��-�� v
STATE ZIP,
�ASEMIIQT REMODELING SUBA�IIT:
I . Existing Fioor Plan
2. P'roposed 800r ptan
3. List of struchiral manbus to be used
Ft
FOR NEW CONSTRUCl70N INCLUDING DECKS,
ADDITIONS_ & PORC}�S SUBtvQT:
l. Site P1arJSurvey showing tl►e qcis[ing swcWres
a� proposed project.
2. Two sds of construction plans
3. Enugy Calcula2ia�c
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF L�OR AND MATERIALS:
TOTAL JOB VALUAT� N$G�D� 97 U.B.0 FEE OCCUPANCY TYPE
Permit Fee
Plan Review
Fire S�ucharge
Surcharge
License Surcharge
SAC Charge
Gtirb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ �
$ � . �-1 ti
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum 5.50
55.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftxS21=S
$450 Conservation Plan Review !
Fee Determined hy Engineering
Agreement necessary ( ) Non Necessary (
Make checks payable to: C� of Fridley
THIS GS AN APPLICATION FOR A PERMTT-NOT VALID UNTIL PROCESSED
Attach
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Friclley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a pernnit 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 wh' requires review d approval of plans, i
SIGNATURE OF APPL[CANT �����I96�riy�'L1s�,4�—PRINT NAME��� DATE /���% ��/
. ,� � " `��� �� � ,. . . . .�. . From: unknown Page: 2!2 Date: 11 /20/2009 2:29:53 PM ��` , � , , , . 4
Building MECHANICAL Pe��t Na.�
Inspections RESIDENTIAL A.PPLICATIUN Received By:
7b3-s�2-3604 CITY UF FRIDLEY D��' 9
7b3-S02-4977 FAX ���x-,g.a,,
DA'I'� 11/1812009 YOUR I'rtitAll. ADDRESS ��aveaheedrgsndelr.cam
S1TE ADDRE3S �� �CKMP`NN CIRCLE FRIDLE�1, MN 56432
THIS APPI.lCANT IS: O OWNER C1CON'TRACTOR
PROPERTY NA�: GERALOINE RER(3
OWNER/ ADDRESS: 1080 HACKMANN GRCLE GTY ��Y SI'ATB MN �p 55432
TENANT 763.y��,8285
PHONE:
CQNTRACTOR COMPANY TSAME: DAVES FIEATlNCi. AIR d� ELECTRIC
SUBMl7' A COPY OF �NTACf PERSON. A� ��' _.
YOUR STATE STATE UCENS6 # IXP DA7E
LICBidSE WITH ppp�:1G0137TH AVE NE ��y COU11�U► Fi�IGHT3 STATE MN �p 55421
APPLiCATION ��E 763-781-8801 Fpg 763-789�8808
P��T .�,p� �NCL6 FAMILY O 7'WO FAMiLY O TOWNHOUSE
TYPE OF WORK: a xew (��r�csn�rrr O ALTCRATION/REMODEL
1_LI
DETAiLED DLSCRIP'l10N OF WORK �EPl.ACE EXISTINC3 FURNACE WlTH NEW LENNOX FuI�IACE I�q1O50UH-3BA-0TO
FE�S ARE HAS�D ON S1�:A0 PER FIX7'URf, EXCEi�T WHERE NOTE0. FIX7IJRFS: (INQICATE TO'1'AL NIJMBER OF EACH BELOW)
Equipmcnt ItWtelled MFa: � MODEL: � SIZF/BTU �"m°
MT(i: MODEL: SIZFJBTU
MPG: MOD6L: SIZAIB'N ___�____,.
t23.00 PIREPLACL' (GAS)SIS.00 CiAS RANGFJ�OVHN SI0.00
TO AIR BXCHAN4EER S15 REPI.ACE (WOOD) 535.00 PfEW OAS GR1LL Si0.00
,_BOIL6R 535.00 IiNACE 533.00 GAS lJNlT HCR S! 0.00
C}IIMNEY LtNER 510.00 �AS DIiYER f f 0.00 _POOL FIEATER 535.00
DUCT WORK 510.00 GAS PIPING f I0.00 VEI�FII.ATOR S I 5.00
Numbcr of fi�ctures Q S 1 fl.00 �„ x$ i 0,80 =$
Number of fixtures � SIS.OU x Sl S.QO =$.
Number of fiyxtures (c� 525.40 � x 525.00 =.S_,______
Numb� of fixti�res � S�S.00 � x�5.00 > S�•� �
St�fe Surcharge = $��_____,�Q
INIMZJM FEE 535.$0 Tota! _ �
THIS 1S AN APPLICATlON FOR A PERMIT NOT VALfD UPTI7L PROCESSED
1 hercby apply for a buitding permit and I acknowledge tl►at d+e info�on above is complde and accurate; that tMe work will be in
confoanance with the ' ances and codes of the City of Fridley and with the Minnesota Construcxion Codes; that 1 undorstand this is
not a permit but onry ap lication for s pe�mit and work is not co start without a permit; that the work will bo in accordance with the
approved plan in the e o t r whi i w an¢ a proval of plen . , �
SICiNATUItE OF APPLIC INT NAME L`���`"n •6
�
PLEASE NUTE: SBPARATE PER S ARE RE UIRED UR.BUiLDING E4ECTR.tGAI.. ANp MECHAN[CAL WQR�C
�.�. _a�r+_..s��---
a.ia, va i�a �viuJ
Building Inspectioas Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977