AF - 45351�
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City of Fridley, Minn.
BUII.DING PERMIT
Date: ....� P..�....01.....( .............
Owner .......................................
Addre� ......................................
N° 3911
Builder .�.��'� .��l.`! . . .. . . . . . . . : . � .�. . .�.�-. ��°w
Address .............................................
,���"�=�``� LC?CAT OF BUILDING
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�. . street . . . k��� : �G. . . ��: r:���. . .�. . �.� . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . . . . . . .
No. . .�.�. � .
Lot . . �( . .�. . Brock . . . . . .�. . . . . . . . . Addition or 5ub-Division �G�t'L. ��e-�: ..����l. . . . . . . . . . .
Coraer I.ot . . . . . . . . . . . . Inside Lot . . . �. . . . . . . Setback .��.� . �. .�'. . � Sideyard . . .� � . .�: .� . . . . . . . . . . . . . .
DESCRIPTION O� BUILDIIVG
To Used as: ._ ,r�
e Q /�
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. .... . ... ... Frout � R� Depth ..�r..' ���Iieight /.T'. � 5q. Ft. !/. �� C.i�. Ft�� ���
. .. ...
����`� . P'ront . f .� � Degth :�. �. .P �� Height �� : � �.tl Sq. Ft. � � � G�. Ft. �f.s � ��
..........
7tiype of Construction . . . . . . . . . . . . . . . . . . . F�t. Cost. . ,��:� .l . /. . �.�.`�. lo be Completed . . . . . . . . . . . . . . . . . . .
In consideration of tihe iss�uance to me oP a permit to construct the b g desribed above I agree to do
the proposed work in accordance witlz the descriptton above set fo pliance wf o19s of %
ordinancea of the dty of FrYdley.
. �.'. . � � ., . . . . . . . . ��.
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In consideration of the payment of a fee of $�./...�.�., permit fs hereby granted to ...................
... .... .. ........ ........ to construct the building or addition as described above. This permit is granted upnn
the express condition that the person to whom ft is �anted and hia agents� emPloYees and worlm�een� in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
�idley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the dty limits and tb.is permit may be revoked at a�►y time upon violation of any of the provIsiona of sa3d
ordinances. o . — _
r�C�/r/e�/�/ � l,��.��;a dH� ild3ng InBpeCbor
NOTICE:
Thls perm(t does not cove� the construotlon, Inetallation o� altaratlon for wirin8, plumbing, gas heatlnB,
sewar o� water. Be aure to see the Bullding Inepecto� fo� separats permits fo� thesa Items
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errr�o�rs L�4ND SURYEYOR
►.nQeebose
� ToracnJt�Hle eentmtNO REGISTERED UNDER lAWB OF SrATE OP MIIYNE80TA �uDlatwt
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-" � LIG6NSED �Y ORUINANCt OF CITY OF latNNBapOUB �-
3300 �YN1DAtE AVE. SO '- MINNEAPOLIS 8. MINN.
TAYLOR��.�970 f� /
�Ul� Y�Y or �Rl//D L� C�4RL.S4/� � SD�i/ r� `;
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`-,DRA�NA�iE �' Uri��TY EASEMEa�"'
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I hereby certify that the �z�ove is a true and coarect plat of a�urvey of;�
Lot Twenty-eight (28) ,�lock Two (2) , Parkview H�ights �,ddition, Ano�ca
Ct�tanty, l++linnesota .
As s�rveyed by me this lst. day of June 1959 A. m.
S igmed � �i�:�'.��s������.
Minnesota Registration No. 2584
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City of Fridley, Minn..
�' BUILDING PERMIT
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Da�; March 23, 1970
p�r; Richard Kyro �� Roy Lund Builders
�� 98o H��k,nann Circle �,d� 241-42nd Avenue N.E.
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N° 10587
LOCATION OF BUILDING
No. 980 St�et Hackmann Circle p� oE Lot
Lot �_2.$�.__ Bloek � Addition or Sub-Division parlcS�i p�3 HeiSl(l.ts
Corner Lot � Inside Lot — Setback � Sideyard
Sewer IIevation � Foundation IIevation
DESCRIPTION OF BUILDING
To be Used as:
Finish Basement �t Depth Height Sq. Ft Cu. Ft
Front Depth fTeight S�l. F't. Cu. �.
Type oP Construct3on Fxame F�t, Cost _�Z.000.00 _ To be Completed �Y 30, 1970
In c.ons�ideration oY the �tssuance to me of a germft to construct the buildin des�tbed above, I to �
the proposed work ffi accwrdsnce with the descrlption above set forth and in pliance th ons of
orrlinances of the dty oP Fridley.
In consfderatfon of the payment of a fee of $..._�A�., permit fa hereby granted to Rov Lund
to c:onstruct the build3ng or addition as described above. Thispe rmit fs gran'ted aPon
the express condition that the person to whom it 9s granted and his agents, employees and worlunen, in all work
daae in, around and u�n safd building, or aaypart thereof, shall c�nform in all respecta to the orrlinances of
Frldley� �urj*+*+�,ta'regarding local3on, conatruct�on, alteration, maintenance, repair and mov7ng of bufldfnge
within the dty limits and this permit may be revoked at any time upon violation of aay oY the provisions oP said
ort8inan�.
�� �
NOTICE:
'16�s psrm(� das ao� eovs� Hro eoualrueHee, testallation for wirfee, Pbmblee, ea 6ea�tne, awu er wmr. B� sun to a�
t6a Buildiu� inspsetor for ssparats parmt�s Poe thas Inms.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
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OWNER' S. NAl� ://// ��1 itl v c{ /�i►' 0 BUILDER :_�E}lCy��. �i C•, •>�' T r+
ADDR�ss : -�i ��U .�/A�frh.r,aAr ��'��� ADDRESS : ,� � / 5�� ���vP. ��P ,�'
NO:. grP�B STREET: �-�°_1'2�v►'l dL�c�vJ C'� s�� � J ,
LOT; v� BLOCK: � ADDITYON: J'�� f
-� .
CORNER LOT: INSIDE LOT: SETBACR: SIDEYARD: "�
Applicant attach to thia form �o Certificate� of S�gvey of Lot and proposed
buildiag �ocation d�awa on these Certificates.
HESCRIPTION OF BUILDING
To Be Used A�: �j.as�e�p�)` t'i�r��s1�
Front: Depth: Height:
Square Feet: Cubic Feetc:
Froat: Depth: Hefghta
Square Feet; Cubic Feets
0
�rpe of Conetruction: f'rA�+•t,� Eatimated Cost: $ aD 4C>• �
To Be Completed: J�l•Ay 30 ./��D
The uaderaigaed hereby m�akes applicativn for a permit for the work herei.n
speci�ied, agieeing to do �11 work in sttict accordance with the City o�
Fridley Ordinaaces and ruli�ge of the Department of Buildinga, and 1�ereby
declares that all the facts and representatione atated in thie application
ase true ead correct.
D�ATE : 3`� 3- 7 D SIGNATURE : ° ��
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(See Raveree Side For Additional Information.) �
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspectox of Building� shall, before #.s�uia� pe=mits fox tb�e
erection of any buiYding or atxiac�ure, or for axiy additioa to any existing
buildiag or structuse, or for auy alterattioa or repairs to axiy exietiag
building or s�ructure, upon applic�ti�n therefore, require the payment�by the
applicant for such permit o£ feea to the amoua� herein below aet forth 8ad i.m
the maaaer herein pgavided to-wit:
UNIFORt�d BUILD?sTG CODE s�pe 1, 2& 4-$2 .15 for each oaie thouaaad cubic
feet, or fgactioxa thereof, in such cubical contenta. �rpe 3� 5-$1.85 for
each one thous�nd cubic feet.
ADDITIONAL INFORMATION
For the purpose of computfn� fees for buildiag p��mitr�, the cubical con�ente
of eay buildin,g or additi�, ie determined by �ltciplyin� the grouaid area
cayered fram a point six (6) inch�e below the floor lixsa of the ba�e�tatt
o� �e cellar to th� avarage heighta of thm up�er aurf�� or to th� a�e�ag�,
•height of the roof aurface of the m�in gable of a pit�d roaf.
For repaire os al�exations to an �istix�g str�a��aas�, ��the f�e s�ll b� at the
rate of $3.00 per each five lnundred doll�g� ($500.00) o$ �actioa th�reof i,a
the coet of all propo�ed wo$k. .
Ia ao case eball the fee chsrged for �ay g��x�i.t ae set for�a �a Section 2 ba
le�� th� $5.00.
VARIFIC�T7ION OF FOI�NDATIOAi
NOTE: ,Pesmits €or s�aastruction will be isaued a mi.mi�rm of 24 houra from ths
tt�oe of application, to allow fo� proper review cf the psopoeed etructuse and
of tLe coastructioa eitee
A Certifiad Suxvey of the lot, ehowin� the losation of the fouadatioa, onca iC
hs�-�been coaetructed, will be required b�fore proc��dia�a �rith t1De grami,ng.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupaacy Ahail ba madn ten (10) daye prior
to tiae use or occupan�y of � stnacture for which a buildi�g �smit haa beeu
., �seu�d; and eaid atructure ehall not be used or occupied until a Cartifie:ate
of bccupeacy hae been iaeued.
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SUBJECT P •
City of Fridley ° 16 5 2 6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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; � RECEIPT .
� ; L _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � a-�
i � �
� � /'��1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'""� � �'� 612-571-3450 910-F15 4/15/81 � /
JOB ADDRESS 9$0 Hackmann Ciscle N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 28 2 Parkview Heights SHEET
2 PROPEHTYOWNER MAILADDRESS ZIP PHONE
Mel Nelsan 980 Haalcmann Circle N.E. Fridley 55432 571-3032
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Milton L. Johnson Co. 2513 Central Ave. N.E. 781-9548
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residenti.al
7 CLASS OF WORK
❑ NEW ❑ ADDITION %1 ALTERATION 0 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
l�e-ti.le and sheetrock bathroom.
8 CHANGE QF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, ceram:i.c
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR If CONSTRUCTION R 1
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AfTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �`],�OOO.00 $. SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY O ER STATE OR LOCAL LAW REGULATING CON- $].'J. ,rJO
STRUCTION OR THE PE F RM NCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
ei' - I S - � �o $18. 00
SIGNA UREOFCONTa C RORAUTHORIZEDAGENT IDarE� WHEN PROPERLY A ATED THIS IS YOUR PERMIT
,�� �� �r �r�
SIGNATUREOPOWNERIIFOWNERBUILDERI IDATEI IBLDG WSP Dl.TE
� CITY OF F(tIDLCY •
, APPLICI1TIa`d FOf; R�SIDLfdTIll�_ QUILDIt�G PEf��ITTS
(tJe��r, A1 �er.�tions, Additions, or Repairs)
' OtJPJER: D a I C[, ���- S d�
ADORESS: � �� �J�C�/%l�� �- e`,���e�
TEL n0: S�/ �.3 � 3 v
0
/ �
[3UI LDE. R : , ; �. D`�•f l - �� /i� s �'J . .
/1DDRESS: q���`� �/U/�'��<"/� �� ,
�
TEL IdO: ��/ ��''�f��
Construction Location '
STRI�T NO: D � � STREET: /�/� �j��°y/ i9 /� �; /�G � �'
� __.__
LOT: � � � SLOQC: r ADDITION : ��-i�l� V ! L� .� %`7 '� 1 � /d � S • .
__._.T .
Corner Lot: Insicle Lot: SetbacY.: Sideyards=
Ap�licant attach to t2iis form two Certificates ot Suxvey of lot and
proposed building locai:ion drawn on certificates to scale.
DESCRIPTIOtd OF COi•�STP,�JCi"IOPd -
I'ront: � Depth: Height:
Square. r'eet_ Qzbic Feet:
�ront: Depth: � Height:
� Squaxe• Feet: � Cubic I'eet:
Q Q//n i
Type of Construction: CV2,-%.�� ��`if� `� 0.�/��/��c%EstimaL-ed Cost: $%, �• -
7.b Be Oar,�pleted: �� �� Jr •
r !�' � Alt. A A�t. B
Proposed Drive�tay Width If New Opening Is• Desired: $' $
, ., SE� R�VERSE SIDE OF SHEET _
�.�ie undersigned hereby ma�;e� applic�ticn for a permit for the �:�ork� herein specified,
agreeing to Zo .all work in strict accordance ��ith the City o� I'ridley Ordinances and
rulings of L-he Department of Buildings, and he.reby declares that all tlie iacts and
represent�itions stated :n this applicatian are true �d correct.
n -_ � 9.� �
DI1T�: � � /J ' 'y� SICNATUF�::
Sti��ul�i:ions :
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;L:C'.CIOI•� 2. • 7.'li� 7n�..��ccLor. af• l3uS.lc'.in�� :::f�ri].1., bcf:or.r. i.::.uz�icJ J�c�-►nit:; !.'nr 4hc crr.cL•�.on
Ut: .u�y l�u:;.l.cl:in�l c�r :;i:ruct:urc, or. �a�: a,iy adQi.i:ic,n L•o a�tiy cr,i;;l:i_�ul l,uilcling or ::rzucL•ur.e,
. i�r. l:or. any til.t.c.•r<<tiau or. r.cl,��ir.s L� •any c.:3,:.t:iii�,� hui.l.di,�ig or �Lr.ucturc, uj�c,i1 ar���l�.c:ata.p�1
•L'�1C):��OJ"Cr r.cquirc t:l�e L�aymc��L• I�y tl�c api�].i.c�nt: �o�' s�uch per.�ni.L• ot.� fceN to tl�c arnount
hcz4iti bcl.c�t•� sc:l- for.tli �ulcl i.�i tlic mai�ricl: hczcin ��rovxdccl L•o-�1a.L-: � .
. J�Ji;I•I CON�:TI;UC'.CIOtd: Sinc�l.c 1'amil.y 1loracs and Gar.ac{cs: Y4.00/7,000 cuUa.c tec�. '
l?LT42d CIII:rI:: 25 I��rcel�t: �L• bu�.lclincJ J�er.mii: fee.
URI��L•'l•:A]' llEl'P.I:SSIOI•I: (Cpncrctc GUicb �trcets Only) � ��
' A}.tcrnnt:e n: ltcinoval and rej�].accment ot concrete curb and
yuLtcr only; l�riveway c•ridth p].us 6 ieet• x$13. �0
1�].ternate II: R�moval and replacem��nt o£ concrete curb and.
_• ' guttez and iiist�ll a 3 fooL- rride approach �ti�ith ''
.• 6 inch aepth; Driveway �•�i�th plus G feet- x$15.,.75
• � �DDI T l 0��/1L I f�lFOR��I/IT I O_ C�_, .
ror the purl�se of computing iees for buildinc� pczmits, the cubicaJ_ contents of any
ktuild5,ng or. addition, is deL-ermi_iicd by multipl.yir,g L-he ground area coverecl �ro:n a
p�S.nt sis: (G) inches belor� ihe floor ]_ine oi L-he basement or tha cellar fio thc
average hei.ghts of the •unper surface or to the average }2eight af t?�e roof surface
oi the r�ain gable o€ a pitched rooi. '
Fox ze�ai.rs or alterations L-o an existing sti-�icture, the fee sha].1 be at the xate
of $3 . Q0 �iex eacli fivc hundred dollars °($500.00) cr fraction thereof in fihe cost
of all proposed wor.Y.. .
In •no c.ase �ha1.l the fce charged fctz any pa�ni.t as se� i'orth i.n Sec�i�n 2 be less �
ti�n $7.50 plus $.50 staie suxcliarge. . • . -
' _ VEQI F I C�TI 0�! OF Ftl 1F�(D1�1' I Ofd
NOTE: Pcrmits �or construction c�ill be issued a minim�n a� 24 hours from tlie time
a� �.pplicatian to al.locv for proper review of tha proposed structure and oi ihe
constxuction site. . -
; �
A Certificate � of Survey of the lot, sho��ing the location of L-iie �oundation once it
has be�n constnicted ��Ti.11 be required before p.r.oceedinc� �rith the framinq.
. �FI�TIFIGATE OF OCGUPAI��CI' ' '
' hrplication f-or a Certificate o:C Occupancy sha11 i�e mad:� ten (10) da�►s prior ta the
use or OCCUZ?�11Cjr of an}► stzucture for �rhich a L�uilcling �erm.it has hcen xssued; and
said structure sliall 1�ot l�e uscd oz- occupied t;iitil a Ccrti.�ica�e or Oecul�zncy has
bcen x�su4d. .
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CHI�Y AND BTACR VERIFICATION
The undersiqned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioration Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4. Is securely supported Yes () No ()
5. Meets all current Code requirements for
size and total BTU's connected Yes () No ()
6. Has total heating BTII�s of
Al1 other BTU�s
TOTAL BTII's
Remarks
List Alterations Beinq Done:
HEATING COMPANY
Signed By
Date
.o . ._.._ .. ..,�-r[n.--,� r .:.. ,-�E„ .; ' y:_ �} �.; .�,' v;� w--. iy.s��. ��hr-ji�.i :# `.' -�_ s�i.:,�:..v ., �S� � . . -�. .. : - .;,y �y i �""`iK' .�`�.J :.?`�� ��--�t'y.r,' �:'" .- -
, -�, R a s �"� :n:... w .
�,. '� � �.
SEDGWICK HEATING & AIR CO'I�D'ITIONING CO. � ' ` ' ' ' ' ' HEATING ' JOB NO.�����
8910 WENTWORTH AVENUE SOUTH • MINNEAPOLIS, MN 55420 •(s�2) ee�-s000 TEST RECORD
ADDRESS ���� ,.�-?C',�'7�� il ��C °� CIN �'� ( D �. L �
OCCUPANT /�I��Ci /-L �f�1! OWNER ���/�
SOLD BY �lr� C-�Ld/�L� INSTALLED BY���A.�✓/
�
MAKE e-L��Ii� MODEL �/J�.� fJ� � � � �-�
SERIAL NO. � � � � � < I � � l, INPUT �-� s�v�
THERMOSTAT � ` � � VENT SIZE � ''
VALVE �S TYPE OF LINER N�d1
LIMIT ��,�CC�% LINER SIZE " .��/�
LIMIT SETTING �� FILTERS: SIZE ��y��5 NUMBER
o�...
FAN SETTING T/M� WIRING
PILOT TYPE ,�L.� °��°,�d.e��f � TEST TAG �—^
IGNITION MODEL � � .�
PILOT TIMING �N��,��✓ %r
PRESSURE ��°� ��'� PERCENT COZ ��0
INPUT CFH -/✓ PERCENT OZ �� G�
STACK TEMP. 3� 'r..�' PERCENT CO �
FOHM 235 (REV. 11189)
..�.���
LIGHTING INST.
DATE TESTED e�- �- � Z'
COMPANY TESTING %� �e1 G0/��
NAME OF TESTER �-�`a� ��i ,
FORM DISTRIBUl70N: W E CAPY - JOB FILE YELLOW COPY - CITY
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' ' � � SuB�BCT � � ' � �
c�ty of Fridle� 3 i 9� 3
� p
AT TME TOP OF THE TWINS g u I L D I N G P E R M I T
� � COMMUNITY DEVEIOPNt�NT DIV. ����3��(�`i RE�i�IPT�.
� •
r � v � PROTECTIVE INSPECTION SEC. � � P� �
� � ��
� _ �
( /'�'1 � CITY NALL FRIDLE� SSIJ2 NUMBER pEV OATE PAGE OF APPROYED BY
�""�" �'' 612-571-3450 910-F15 7/11/O1 / /
JOB ADDRESS 980 Hackmann Circle NE �
1 LEGAL �OT NO. 9LOCK TRACT OR ADDITION SEE ATTACMED
DESCR. 2$ 2 Parkview Hei hts SNEET
2 PROPERTY OWNER MAII AOqR�S$ ZIP PMONE
Nancy Hemp 980 Hackmann Circle NE 763-572-1258
3 CONTpACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Twin Cities Glass Block Inc 2817 2 St NE Minnea oli 612-520-0944
d ARCMITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MIAII AOORE$S tIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOFK
Install five solid glass block windows
8 CHANOE OF USE FFOM TO
STIPULATIONS
" riPE OF CONST. OCCUPANCV GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REGUIHEO FOR EIECTRICAL, PLUMBING, HEATIN(3,
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WQRK OR COt�STRUCTIOM 20NING SO. FT CU FT.
AUTHOR12ED IS NOT COMMENCED V�1ITHW 80 DAYS. OR IF CONSTpUCTION
OR WORK IS SUSPENOED OR ABANqON�O FOR A PERIQO Of 140 DAYS A7 '
ANY TIME AFTER WOHK IS COMMENCED. ' NO. DWLG. UNITS OFfSTpEET PARKING
I HEREBV CERTIFY TMAT I HAVE REAO AND EXAMIN�O THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TFlUE AND COFiRECF. ALL PROVISIONS O� LAWS VALUATION SURTAX
ANO ORDINANCES GOVERNING TNIS TVPE OF WORK WILL 9� COMPLIED @ @
WITH WHETMEii SPECIfIED MEREIN OFi NOT. TME GRANTING OF A PERMIT W'OO y�.SO
DOES NOT PHESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL THE pEqMIT FEE SAC CMARGE
PROVISIONS OF ANY OTHEFi STATE OR LOCAL LAW REGULATING CON-
STRUCTIpN OR TME PER ti ANCE OF CONSTRUCTION �29 . 60. Fire SC �.%O
PLAN CNECK F TOTAL PEE
,�s -// $ .80
- S�GN upE ON'AACT OpAUTr10p�ZE0oGE IDATEi N P OP R IOATE MIS IS R P RMIT�
� �
S�GNATUAE O� OWNEQ��� OWNEp�U4DEAi �DATE� ' BLOG �NSD ' � � �1vTE
t', H
JUN-29-2�01 10�19 FRQh1 CITY OF FRIDLEY TO
NEIA! [ j
��N ( ] � . C1TY OR FRIDlEY
�-T�R I� �tNt�L� FAAAII,Y ANQ DUPLEX�$ R-1 A►Np R-Z
SUILDINl3 PERMIT APPLICATIOPI
Cor�b'uction Address: _
Legal Desctiptiom
Owner Nam� & Address:
Crontrat�os- ��
LIY1N3 ARE,4:
GARAdL' AREld:
DECK AREA:
orH��e:
%-� Gtc �n yh� �,� C`� � �.1� �
6125�0945 P.02f�
�m,�a v�rzoa�
�'183) �`12-5804 Bldg Insp
_ re�. �,�r�.' � �� 7d ��5��
MN LlCENSE #_ `�1C�W1l1 J �
� � � _��. # [oC�+ S �O � � i'
Attach to thi� ep�"�eatian. a Certificate of S�rvey of the �'� � lZ _Sap — O��.s
t�t, with the pro�oosed emrtstn�dfon drawr� on it t� scale.
DE�iC�1�Tl0[�1 OF IA6PRt�V�BAENT
��9� �N� .,,_� Heiqht �� ^,xa. F�,
Ler�h Wfdth Height Sq. Ft.
L�rtgth Width HgtlGrotutd Sq. Ft �,
�onstructian TYPa: E�iirr9ated Cast: � � 8
c�rew�y cur6 cut �dth N�ded: Ft. + s Ft � Ft x s -$_
a��: 7-/ -� � n��c � s�. � G �� S�o -09��
�
C�'iV tJSE QO�IILY - Cait (y63} 57Z-3804 fnr Pe:enit Fee9 if rnaiGn� in appliaation
P�rrnit Fee $��'. �D Fee Scha�dule on Rev�rse Side
Fir� �urcharfge $ .001 of Permit Veluation (1/1 �h%)
State Sur�h�rge $�,�-� $.SOt$1,0�0 4�aluatior�
SAC Ch�rg� $ l_ $1`I50 per SAC Uni�
Li�ense �urcharge $ $S.OU (St�te Licensed Resid�nti�l Gontractors)
D�veway Escrow � Alt. "A" or Alt. "8" Above
Eresion Contrvl $ $�54.�� Conseroatlon Plan Review
�a� F�� $ Fee Determined by Enflineering
Sewer M�in Charge Agreement Necessary �] P(ot Necessary [ 1
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T�TAL
s-��PUU�TroNs:
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ADDRE5S
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 iJNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57Z-36U4 r'AX:
: 980 HACK:MANN CIR NE
: 243024230004
: PARKVIEW HGHTS ADD
: LOT 28 BLOCK 2
: BUII.,DING
: RESIDENTIAL
: ROOFING
571-1287
__ _
PERMIT �0.: 2004-00817
�_ �'
DATE ISSUED: 06/02/2004
VALUATION : $ 2,315.00
NOTE: UNDERLAYMENT AS PER STATE BUILDING CODE. REROOF HOUSE & GARAGE (20 SQ) TEAR-OFF.
STATE LICENSED CONTRACTOR 1
APPLICANT
DORE JOHN CONTRACTOR (20276047)
5538 SUMTER AVE N
NEW HOPE, NIN 55428
OWNER
HEMPNANCYI
980 HACK:MANN CIR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construcrion
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 that I have read and examined this
application and lmow the same to be true and conect. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construct�on�jthe performance of construction.
Bldg
BUII,DING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALLJE
LICENSE SURCHARGE
TOTAL
PAID WITH CHECK # 3743
Date �-2�t7�(� " "
83.25
2.32
1.16
5.00
91.73
N� �� CITY OF FRIDLEY ���� Effecfive 4/1/2004
ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPUCATION ,
� ��
��,���` _ __.� i ' � %
Construction Address: ��� �� �^° �° � �
Legal Description:
�
Ovmer Name 8 Address: �C e C i� ��� Tei. #
Contractor. ^�° �w'' %� �� MN LICENSE #
Address: � S�G 0 � � � �C� l� Iti r- i( /7/C' ��o c � ��✓ �� � Tel. # �� 2 � ? Z. Z %
LMNG AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Hgt/Ground Sq. Ft
QTHER: � o� c�,v .� i �- o
,
` �, C� ? �-
Construction Type: �e� q a�� l?� 5����/,� Estimated Cost: $-Z /�� � �J�°� �
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
. � Z '� 5" UCANT: �Y� Tel. #
DATE. APF
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card 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
$ �3 ��'
$ -_,�'
$ o� � ��
$ l, /�
$
$ � . (� �
$
$
�
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$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 [ j
TOTAL $ , STIPULATIONS:
BUII.DING PERNIIT FEE SCHEDULE
The Clrief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or
sttucture, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,�1 to $25,000
$25,001 to $50,000
$50,601 to $100,000
$100,001 to $500,0�
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for�first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,�0
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,0�
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,OQ0 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,�0
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1, 000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
Permits for construcdon will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the lacation of the e�cisting foundation will be required before
proceeding with the framing. New Houses Onlv '
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
+�i!�j11L'!,'1►o�:F
: 980 HACKMANN CIR NE
: 243024230004
: PARKVIEW HGHTS ADD
: LOT 28 BLOCK 2
: BUII,DING
: RESIDENTIAL
: WINDOW/DOOR REPL
571-1287
_. ��--....�_'__��
_ ....,�...�1.
PERMIT NO.: 2004-01434 `�tl
DATE ISSiTED: 08/30/2004
VALUATION : $ 18,000.00
NOTE: P�OVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER R317
OF TI� 2000 INTERNATIONAL RESIDENTIAL CODE. CAULK AND FLASH ALL EXTERIOR OPENINGS.
RESIDE HOUSE & GARAGE; REPLACE WINDOWS WITHIN EXISTING OPENINGS.
STATE LICENSED CONTRACTOR 1
APPLICANT
FISHER BLDG & REMOD (20290562)
2420 96 WAY
BROOKLYN PARK, MN 55444-
OWNER
HEMPNANCYI
980 HACKMANN CIR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or constntction
authorized is not commenced witin 60 days or if consttuction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and laiow the same to be true and correct. All .
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a pe it does not resume to give authoriTy to
violate e provisions of any other state or local law
re a c truc or the performance of construction.
Apu ican _ Dat� 30-,� �I
Bldg Insp
SEPARATE PERMITS
BUII,DING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALLJE
LICENSE SURCHARGE
TOTAL
PAID WITH CHECK # 6046
WORK OTI�R THAN DESCRIBED ABOVE.
293.25
18.00
9.00
5.00
325.25
N�/ [ j CITY OF FRIDLEY Effective 4/1/2004
ADDN (] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [] � SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
� �� �
Construction Address: FI-� � v� '�� �
Legal Description:
Owner Name & Address: ���t. 1�.�� Tel. #%G'3-�"��-�%���
c
Contractor.
MN LICENSE #�,f�R�'�C�Z
Address: ��f� � �6 ��i ��✓��c:�� ��� � ��a �� Tel. # ��`3 --��o°$�a�
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Cert�cate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
,��a� -
Construction Type:���J �� .�n f��-� G�%�ws Estimated Cost: $��� � �e� 3�
Driveway Curb Cut Width Neede • 6- _$
DATE: �3'3�- � `� APPLICANT: Tel. #%63--�Z� �
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$ ��� . o�Sq
� �,
� l��• Db
$ , C�O
$
.$ �� C�a
$
$
$
$
$ �. p��..�
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$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 [
STIPULATIONS:
b
BUII.DING PERNIIT .FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or
stntcture, upon application therefore, require the payment by the applicant for such pernvt of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $5�
$501 to $2,000
$2,001 to $25,0�
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,Q00,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.OS for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each addidonal $1,000
or fracdon thereof, to and including $25,�
$391.25 for first $25,000 plus $10.10 for each additional $1,0�
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each addidonal
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,�0 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the frazning. New Houses Onlv
4� . . „+