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Caty of Fridley, M�nn.
BUILDING PERMIT
; �7�s�
N° 6348
Date: _...� —..L ` _.._..___._._...._
Ovvner: _ _ Builder . ---..._ _ .__ 1---------.._.._�._ �
Addresa........_.._...._.._..._ _______._�...._..._._.._..........._....__�.___._ Addr�ess _�_.__.____....._........_.---•---....._..__.......___..._..__._..__....�--
LOCATI QF UILDING
No. .��..SP_sl Street .� .. �- —! ....__.... Part o! t ._._._ .. .._._____._
Lot _.._..� ..._.__ Block ._...._......_...,�........_.._...._....._. Addition or Sub-Division � �i� �._-.._....—.._....
Corner Lot _�_.._.._._ Inside Lot ....._....�.. Setback �s�2.. ._�.._ Sideyard .........__.�...,�_. �.�..r__.�...�..
Sewer IIevatia� �___._____..___._......_..__.....__._.....___--_--- Foundation Elevation
DESCRIPTION OF BUILDING
To vsed � �,/
.. . F�ont _!. � Depth � � Height ...�.Q Sq. Ft. .�� Cu. �L���•�
._._.._.._......___.._......... ..._ t__.__........� DePth _...._.....—. eight _� Sq. Ft. ._..__...�.__. Cu. F� _.._.._....._._
1j+pe of Construction �`���•nw•� `,—�
.. Est. Cos _..fl�! ._........ To be Completed ....._..._.._..._.._.._.._._..______
Ia caasideration of the issuance to me of a permit to constru �uld
tht propoeed work in acoordance with the description above set f in
cxdinaaoes o! the dty of FridleY• /1 � ,
to do
ns of
In c�sideration of the payment of a fee of �..Ll�� .—_. � —
.. ., permit is hereby granted to—
to construct the building or addition as described above. This permit is granted upon
the expre�ss condition that the person to whom it is granted and his agents, employees and worl�ien, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota reSarding location, construction, alteration, maintenance, repair attd moving of buildings
within the dty limits and thia permit may be revoked a t a�y time upon violation of any of the provisi�s of said
ordinanaes. � ,. ^
Buildiag Inspector
• NOTIC�
16is p�e�tt do« not eowr 11w eonnruelioa, is�ail�Non for vri�iaY. P����W Yas h�atino, arw�e oe wahr. 8� sun to aw
fiw lvfldte0 lo�cloe for aprah Pwwhs fo� f6� t�rs.
� �
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APPLICATION �OR BUILDIIQG PERMIT
CITY OF FRIDI.BY, MIIZNTSOTA
Owner'a Name Builde� '
Address l�dd�'f68
�rl
LOCATION OF�BUILDING
No. 3treet Part of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot Setback Side -Yard
SBWBR ffi,BVATION FOUNDATION SLEVATION
Applicant attach to this form �ao Certificatea of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as:
DESCRIPTION, OF BUILDING
Front Depth Height
.�-.--
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Gonstruction Bstimated Cost
To be Campleted
The undereigned hereby makea application for a permit for the wark herein
specified, agreeing to do all work in strict accordance with the City of
�'ridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations atated in this application
are true and correct.
DATE SIGNATt1RF �
____, �
(Schedule of Fee Coste can be found oa the Reverse S e). �
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Mix�ER��,NGiNEERiN(� Co.,INC.
ENGI NEERS AND SURVEYORS
u.Np buRVE�r►NO 9ot�3'fE8TtN0
GIVIL �, MIJNIGIDAI ENOINEERIN6 LP.NO �ANNINO
6418-5�'eT" AVENUE N.
MINNEAPOl.15 7(. MINN.
KE 7- 3637
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WE HEREDY CERTIFY TNAT TH�S IS I► TRUE IWO CORRFCT RPPR�SENTATIOIJ OF A St)RVEY OF THE BOUN�AR.IES OF TME
�lWO ABOYE pESGRtBEO AND OF TNE IOCATION OF ALL BUlLO1NGS � IF A13Y, iNEREON , AND Al.l Vt518LE ENCROACHMENTS�
►F ANY, FROM OR ON SNO tJ�ND. -�
— -- — M-��#�R ��+Gtt�lE:�R�NG C(7., INC.
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HfAT LOSS CALCLJLATIONS DEPAR'I'MENT bF BUILDINGS ��►��• �.
Weatherstrips G�� Conatruction No. Inaulation
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No ( 1— es—�No 19_
J Fl.� j� ��►'Room i.ength �(,y'� Width /� Height �� .� y Room Lengt6 � Vf/idt6 � Height ;
Wiadowa and Doora—Crackage and Area Winc�wa and Doors--Crackage and Area
Nidth Hefght No. o[ Lineal It. Ares WIdt6 Hetght No. ot Llneal ft. Area
No. ot pane at pane If6hts ot crack �q• [t. No. o[ pane ot pane lighte of crack sQ. tt.
� z �� � zc 3 ��.
3 zv � +L � �
Coef.l Btu
Infiltration �' /7/p
Glaas LQ p p
F�cp. wall
Net ezp. wail jo / S �
Int. wall
Ceiling [J g /.3'3�
Floor L s Y�
Total Btu. 7t �
Required sq. ft. E.D.R. or aq. ias. W.A. L.eader area /,Z� $
F7.� �j Room Length D' Width//'�" Height f'
Windows and �ors--Crackage and Area
W1dth Helsht No. ot Llneal ft. Area
No. ot Dane ot Dane litht� of cracic w. it.
In6ltration
Glau
Ezp. wall
Net ezp. wall
Iat. wal!
Ceiling
Floor
Total Btu.
G O /O
/i6 !
ft. E.D.R. or aq. ina. W.A. L.eader area
�s�Fl. F' ��L Room � Len�
Windowa and�Doora—Craclu
Width Helght No. ot
No. ot pan• ot Dane Ilsbu
� I � ,B
2 t �t
I / o / �.
Infiltration
Gla:s
Eup. wall
Net exp. wall
Int. wall
Ceiling
� � Width
and Area
neal tt. Area
� crack sa. ft.
Bcu
/�
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i3� �!
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Coef. Btu
,. �3 �
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/ l ��
�g a �i��
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}� loor � l 7 t o
Total Btu. /
Required aq. ft. E.D.R. or aq. ins. QI.A. Leader area 2x� �3
I
Infiltration
Glaaa
Fap. walt
Nec e:p. waU
In� wall
Ceiling
Ftoor
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= i�
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Tocal Bc�. _ 2a3 �
Required sq. ft. E.D.R. or aq. ina. WA. I.eader area ,s'�
' Fl.I Room (1-�nSt11 2 Width 3s� Height��
Windows and Doors—Crackage and Area
Wldth Helght No. 01 Lfneal tt. Ares
No. o[ pans oL Dsne If�hq ot crack sQ. tt.
� 3� ts /1.
i�rauac�n 3 a i
Glasa !j E /D 30
Fap. wau i�l !f �• �?� o
Nec ezp. wall /� G .>Z a t p p t
Int. wall
Ceiling
Floor 7w ;�' �l.00
Tocal �u. � Z Z �
RecNired u�. k. E.D.R. or aq. ina. W.A. I.eader area iCS' a 3
Fl.� �#toom I l.ea8th / Width � Height$'
Windows and Doors—Crackage and Area
Width Hel�ht No. ot Lineal [t. Ares
No. ot pans ot�pane 1lghte ot crack W tt.
Z /8 1N t �
! lG L � 1�- ,
Coef. Bcv
Infiltration 3,,0 �
Glass / 0 4� - -
Exp. wall
Net exp. wall �p
Int. wall
Ceiling �� 3 �
Floor � ,
T'otal &u.
Required x�. k. E.D.R. or sq. ins. WA. L.eader area
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HEAT LOSS CALCULATIONS DEPARTME{VT' C�F BUi�DINC�S I�o-NeRrwrnn Cr� 4�e6E M[NNEHPOLiS• NIIMV•
Weatherstrips A G�� Conatruction No. Inaulation
Windows Doora Reference Oat. Wall Int. Wall Ceiling Roof F7oor Kind How Applied
Yea—No Y s—No 19—
� Fl. � y�: Room Length �'D, Width '3 � Height Fl.� T Room Length g� Width $' Height $
Windowa anc� Doors—Crackage and Area Windows and Doors—Crackage and Area
Width Helght No. ot Ltneat tt. Area Widtb Heig6t No. ot Llneal It. Area
No. o[ pane o[ pane lighte ot crack W ft.- No. ot paos o[ Dane tlghte of crack sQ. it.
• 4 �- —
,Zt� / i,
� 3� � � �O
t I t 77- �L Coef. Btu Coef. Btu
lnfiltration / L Infiitration —
Glaas / 2 9 `$ S 'L Glaas
Eup. wall Exp. wall
Net ezp. wa�l .2�7 �0 2 t70 Net ezp. wall `
Int. wall Int. wall
Ceiling z b 4 O Ceiling 7• E / is
Floor Y� •Zo e Floor .SY b� � n
Total Btu. I. 4 Total Bcu. L 7�
Required aq. ft. E.D.R. or aq. ina. W.A. Leader area '$ Required aq. ft. E.D.R. or sq. ina. W.A. Leader area �$°j
I Fl.� � Room ( Length // � Width I 2� Height $' �.I — oom � Length S' Width � Height g'
Windows and Doora—Crackage and Area Windows and Doors—Creckage and Area
Wldth . Hefght No. o[ L1nea1 tt. Ares Width Hefght No. 01 Llneal ft. Area
No. of pane ot Dane ll�hts ot crack �q. ft. No. o[ Dans ot Dane Itghta ot crack eq. tt.
�� l 3G .2� / �-
Coef. Bcu
In6ltration ,Z,L 3 $ $
Glass i � Lq / �1�
Exp. wall
� Net ezp. wall /� /p / `�.a
Int. wall
Ceiling / / D �
Floor "
Total Btu.
Requirsd sq. ft. E.D.R. or aq. ins. W.A. Leader area
�. �l -�liiN oOm �t.engtb I Qildth // =
Wiadows and Doors—Crackage and Area
Width Hmisbt No. ot Lineal It. Ares
No. ot Dsns oE Dane li[b�� ot enck sq. tt.
3� 7 �
In6ltration
Glaia
Exp. wall
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
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Required sq. ft. E.D.R. or aq. iaa. W.A. Leader area / y�
Btu
>'f 4'
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In6ltration / �J/ 3i `f ✓�`
Glau $ G$ �S:
Ezp. wall
Nec ezp. wall L O � v L C 0
Iac. wall
Ceiling 3� S 2 S L
F7oor �„ b� / L �
Total &u. - Zo/ L
Requued aq. ft. E.D.R. or sq. ina. W.A. Leader area ',�
! Fl.� � Room I Length 17 L Width /� Height t
Windowa and Doors—Crackage and Ana
Wtdth Hel�ht No. of Lineal Lt. Ares
No. ot pana of D�ae lights of crack �Q. tt.
�' �, i s i �
I � y� 2� �L
Coef. Bcu
Infiltration j' ,3 8 � Z,
Glasa .Z Z � 4 / �
Exp. wall
Net exp. wall ,i,Jp O .Z/�C
Int. wall
Ceiling ,Z p $ / bp $
Floor / ,� �
1'otal Btu. � /
Required p, ft. E.D.R. or sq. ins. WA. Leader area t t' $
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City of Fridley �" 16 4 51
AT THE TOP OP THE TWINS B U 1 L D I 1 \� P E R 1 1 1 I T
i�
i � .
• COMMUNITY DEVELOPMENT DIV. � /� � h
� � v � PROTECTIVE FNSPECTION SEC. V v
r , ,
� ; ,
l-_-.� ��'���;,, CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
j� 612-571-3450 910-F15 11/2/81 � �
10B ADDRESS 160 Hartman Circle N.E.
1 LEGAL �OT NO. BIOCK TRACT OR ADDITION SEE A77ACHED
DESCR. 7 1 SdI1�YLL1�S'� SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
F�ank Walz 160 Hartman Circle N.E. 571-5904
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Conc'�or Co ration 819 Sible Meffiorial H 45I-2674
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OP BUILDING
Residenti.al
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
Construct a 16' x 16' Addition to Back of Dwellin
9 CHANGE Of USE FROM TO
STIPULATIONS
SEt'ERATE PERMITS REt�UIREO FOR iNiRtNG. WA���'�`��
EATING, PLUMBiNG AND SIGN�. ��►e digging ca11 local utiii�i�>�
TELEPHONE - ELEC7RiC - GAS Etc.
REG?UERED BY LAW
SEPARATE PERMITS ARE REQUIRED FOfi ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENT�LATING OR AIR CONDITIONING. NIOOC3. F1'3TnQ
THIS PERMiT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTiiUCTfON
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 256
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. t1Nt7S 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 PROVIS�ONS OF �AWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $7, 500 $3. %S
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHOAITY Tp VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVIS�ONS OF AfVY OTHER STAT R LOCAL LAW REGULA7ING COM-
STRUCTIpN O H ERFO M F CONSTFiUCTION. �68. SO NONE
PLAN CHECKFEE TOTALFEE
$17 . ].3 $ 89 . 38
NATURE CON'RACTOROR UTHOR12EDAGENT (DATEI WHEN PROPERLY VALIDATED 7HIS IS YOUR PERMIT
�� � � ���L �
�SiGNATUREOFOWNEH�IFOWNERBUILDER� IOATEI Z"' � B�O�G �NSP � D TE
CI7Y OF FRIULEY Effective Aug. 1, 1981
Ai'PLIC/ITIO:'d FOft RCSIOL"i�ITI/ii [3U1LDIi1G PEfL`�iTTS
(t�e►•r, Alteratians, Additions, or Re�airs)
Ol•JNER: �� Vll
ADORESS: �[o � l°LGI✓L� �n., l�t.�t..��
T
TELt�O: ����5���
t3UI LOER :
0
no��ss: A/
TEL t1Q: �.5�"° o�/b � � (.
,
Construction Location
• STJ2ITT NO: % C� c.,� STREET: ������� Q�y� '
-----�- � .
LQ7.': ! BLOQC: �� ADDITION: �
Corner Lot: J�J Insicie Lot: a"`/�9r` SetbacY.: �� Sideyards: /�" �
T— --7-----
Ap�l.icant attach to this form two Certificates of S�rvey of lot and
proposed building location drawn on certificates to scale.
DESCRIRSI4i� OF COflSTP,UCTIO�i �
� � � i i
� Front: � (� Depth: � � Height:
Square.Feet: c� Qibic Feet:
Front: Depth: Height:
Squar.e Fept: W.bic I'eet:
� . ,
)��7 �s o
Zype of Cor,struction :��rC� ��0-4-� ��(iy►�(� Estimated Cost: S/�� C�.:
Zb Be O�r,�pleted: /�
Alt. A Alt. 8
Proposed Drive�iay kidth If New Openinq Is Desired: $� $
, . SE� i�VERSE SIDE OF SHEET .
ZSie undexsigned hereby ma};e� application for a pernnit fcr the �rorJ: herein specified,
agreeing to cb ,all work in strict accordance with the City of I'ridlel� Ordinances and
ruling� of the Dep��rYment of IIuildingst an hereby declares that all the facts and
rcpres�n t�itions statcd :n this applicatio�ire�Er�, and correct.
.
D.7'i'E: � a Z �%�� SIGNATUItE :
Stipulations: � �!
�VA'J�
� �., � �,��
� .. � ��
;*; g� � �
M �
� SUBJECT � P .
City of Fridley 18685
�
' AT THE TOP OF THE TWINS g U I L D I N G P E R M! T
; � CEIPT NO.
COMMUNITY DEVELOPMENT DIV. `�,! �
r � v � PROTECTIVE INSPECTION SEC. p ��
� �
' � �'��ti � CITY HALL FRIDLE� SS4�j NUMBER REV. DATE PAGE OF APPiiOVEO BY
�""'� � ��� 612-571-3450 9t0-F�5 10/7/86 / /
JOB AODRESS 160 Hartman Circle N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. % 1 Sandhurst Additi.on SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Frank Walz 160 Hartman Circle N.E.
3 CONTRACTOR MAII ADDRESS Z�P PHONE UCENSE NO.
Richard Hastings 6331 Riverview Terrace 574-9966
4 ARCHITECTOH DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE UCENSENO-
6 USE OF BUIIDING
Residenti.al
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Reroof Dwellin
9 CHANGEOFUSEfROM TO
STIPULATIONS
Rpof can be the 2nd layer but not the 3xd, Install ridged
galvanized valleys.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CON$TRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PER�OD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. . NO. DWLG. UNITS OFFSTREET PARKING
1 HEFEBY CERTIFY THAT I HAVE REAO AND EXAMINED THIS APPI.ICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX
WI H WHETHER SPEC�F ED EREINIOR NOTOTHE GRANTING Of AOPERMIDT ��� 5�-►700 $. SS
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMtT FEE SAC CHARGE
OVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON-
S UCTION OR THE PERFORMANCE OF CONSTRUCTION. $ZB.00
PLAN CHECKFEE TOTALFEE
ld 7 G $28.85
SiGNATUi:EOFCONTRACTOAORAUT iZEDAGENT � niE� WHEN PFOPERLY IDATED THIS IS YOUR PERMIT
.a a �!
SiGNATUREOFOWNERiIFOWNERBUILOERi IDATEi �� BLDG �NS� ia7E
NE1� [ l City of Fridley Effective 4/1/8c
ADD2; . I ] �R-1 AND R-2 (
pI,TER. ( ] Building Permit Application
Construction Addr�
Legal Description: 1� � - �
Ownez Name i Address: �RA'� � ����' Tel. f
Contractor: l�i u� PiZD �+�5"���c Tel. # S��'����
Address � 6 3 3/ i J� 2 1J ► c�.J T'E �.
LIVING AREA:
GARAGE AREA:
DECR AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, xith the proposed construction draWn on it Lo scale.
DESCRIPTION OF IMPROYEI�NT
Length �iidth _! Height Sq. Ft.
Length Width �_ Height Sq. Ft.
Length Width .__ Hgt/Ground Sq. Ft.
Corner Lot [) Inside Lot [] FL. Yd. Setback ,_..__ Side Yard Setback
Type of Construction:
� � � o p � Estimated Cost : S • � � � n °
Approx. Completion Date : 10�3 D�S�
Alt. A Alt B
Proposec DriveWay Width If Neu Opening Is Desired: � �
See Back Page for Explanation
D�TE: 0 d� APPLICAKT: �"� �%��� Tel .� S}�-�y�,�'
CITY DSE ONLY
Permit Fee � .� Fee Schedule on Reverse Side
Plan Check � 25i of Building Permit Fee
State Surcharge � • , �.50/�1,000 Valuation
SAC Charge � �u75 per SAC Unit
Park Fee � Fee Deiermined by Engineering
Serer Nain Charge �
� Agreement Necessary [] Not Necessary [ 7
TOTAL � �
s
STIPULATIONS:
�%a v
$�j � - /t� �l
Iz� �.� �
�. ..
.Z.�•v�
sue�ecr P
Gity of Fridley 2 � 7 2 7` �
�
AT THE TOP OP THE TWINS g U I L D I N G P E R M I T
„ .
� � COMMUNITY DEYELOPMENT DIV.
' � 3 93 a3
~ PROTECTtVE INSPECTION SEC.
, � ._.' ,
r , ;
� � � NUMBER REV. DA7E oAGE OF APPROVED 8�
� �•"1 � CITY HALL FRIDIEv 55432
�""'� � �'� 612-571-3450 910-F15 3/11/91 / /
J08 ADDRESS 160 Hartman Cixcle NE
1 IEGAI. LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 7 1 Sdndhux'st Ac3dition SHEET
2 PROPEFTY OWNER MAIL ADDRESS ZIP PHONE
Frank Walz 160 Hartman C�.rcle NE 571-5904
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
R& R Constructa.on Corp. 548 Heinel Dr, Roseville, MN 55113 484-1697
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGtNEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Res idential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Construct a I2• x 18c Three Seaspn �orch_Additian
9 CHANGEOFUSEFROM TO
STtPULATIONS
See notations:on plan,
WI�RHIHG �,EpARAT� PERMlTS REQUIRED Ft3�
`Before digging caii for W!RlNG, MEATIMG, PLl#MBlNG AND S1GNS.
811 U�Ility IOCBiiOQ4
�J�•O�2
REQUIRED BY LA1N
TYPE Of CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING.
VENTILATING OR Alq CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOFi!( OR CONSTRUCTION zONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 OAYS, OFi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY 71ME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APP�ICATION �- STALLS GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORREC7. ALL PROVISIONS OF LAWS yp�UAT10N SURTAX
AND ORDINANCES GOVERNING TMIS TYPE OF WOHK WIIL BE COMPLI�D $3�2QO $Z�6Q
Wl7H WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER ST TE OR IOCAL LAW REGULATING coN- $63. OO �ire SC $3. ZO
STRUCTI R THE PERFORM OF CONSTRUCTION.
PLAN CHECK FEE TOTAI FEE
`,lj // $67.80
SIGNATUREOFCON�A TOAOA THOA�ZEDAGENi io rEi •� WHEN PROPERIY IDATED THIS IS YOUR PERMl7
� �/
SiGNATU:�E OF OWNEA ��F OWNEA BUILDER� iDATE� BlD �NSP pa
� [ ]
A� [ J
�'I'� [x ]
i�-1 AI�ID R-2
A,; � cling P�mit Applicatioci
•�� ti • � . �� - . 1 . �rn _ � - y • - u • � - .�
Effective 1/1/91
Legal Desc'riptiori: r t 7 Block . Sandhurst Addition —
55432
Owt�x Name & Addl�es.s: Frank Wal�,�, 160 Hartt[�a�1 ri r�l P_ F`►-i c31 �y, NY�I 'Pel. # i 612 ) 571-5904
Qor�trac.�bo�': R R R C'nnGtr►t�-i-lOri Corn.. 548 Heinel Dr. , Rosevi� 1�e5-PIlV T�1. # r�, �� dszd_i �a�
=,','. �:
Attach to this application, a Gertificate of St�vey of the
lat, with the p�.roQo�ed ca�stxuction � an it to scale.
�;� ��. . � � : i-,
I � � c •�:,� - . . - •� •
r •�• r- ��:,�• - . . - •� •
I�:aW •i:,�• - . . . H . i • •
• r:�=�� i � � - • �• � �� 1 � �i =�� �;� - - � • •.�
Oorner Iat [ J Ir�ide Iat [] Ft. Yd Setback Side Yaztl Setbacks
Zj�pe of don.stx�c.�ti�: w� F,-a� Fsti.mated Cbs-t: $ �, �nn � i
.Approx. Oong�letio� Date: 04/15/91
Prq�osed D�iveway Width If New Is Des' Ft. $ $
� Width + 6' See Back Page
DATE: �' � � APPi�ICANr: Te.l.. # �
QTY � �1LY
P�ermit Fee $ Fee Schec�le on �aevezse Side
Fire suirctx�ge S . ool x Penait valuatic� (1/iath �)
State Sutti'hal�ge $ -+ $- `.�0/$1, 000 Va�t3atio[i
SAC Charge $ $650 per SAC Unit
Driveway � $ Alt. "A" o�r Alt. "B" Above
Park Fee $ Ftee DetQxmined bY �9��4
sew�er Main cl�arge $ Agre�nt Ne�essaxY I] ����Y [ J
�I�lI, $ � `�4
�,ts c� � �'2ov .
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City of Fridley 31 12 9
AT THE TOP OF TME 7WINS g � ��, D I N G P E R M I T
r
� � RE O.
� .
� • COMMUNITY OEV�LOP►dENT DIV. / � �
� V V �".� � . . . .
r � � PROTECTIVE INSPECTION 'SEC.
� . �
� � �"'1 � CITY MALL FRIOIE� 551�2 NUM�EN NEV O�TE P�GE Of •vvqpvED 8r
����'� � �'' 612-57�-3450 s�aF�s 7/5/00 � �
109 ApORESS 160 Hartman Circle
t LEGAL �aT NO. BLOCK TNACT Oii AODITION SEE ATTACHEO
oesca. 7 1 Sandhurst SMEET
2 PpOPERTY pWNEit MAIL AOORESS ZIP PHONE
Frank Walz 160 Hartman Circle, Fridley, IrII�1 55432
3 CONTRACTQit MML ADORESS ZIP VHONE UCENSE NO
Richard Hastings 6331 Riverview Terrace, Fridle , MN 55432 574-9966 4051
� ARCMITECT OR DESiGNER MAIL AODRESS ZIP PHONE IICENSE NO
5 ENGINEER MAII ADORESS ZIP PHONE IICENSE NO
8 USE Of BUILDING
Residential
7 CIASS OF WORK
O NEW O ADDITlON O ALTERATION � REPAIR p MOVE O REMOVE
8 DESCRIBE WORK
Reroof - Tear Off (30 Sq) House & Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
riPE Of CONST. OCCUPANCY GROUP OCCUPANCV LOAp
SEPARATE PERMITS ARE tiEOUIRED FOq EIECTRICAL, P�UMBING. HEATING.
VENTI�ATING OR AIR CONOITIONING
THIS PERMIT BECOMES NUII ANO VOIO IF WORK OR CONSTRUCTION 20NING 50. fT CU FT
AUTHOR12ED IS NOT COMMENCED WITHIN 60 OAYS. Oii If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PER100 OF 120 DAYS AT
ANY TIME AF7ER WORK IS COMMENCED. NO OWLG. UNITS OFfSTREET PARKING
1 MEqEBY CEiiTiFV TMAT I MAVE READ ANO EXAMINEO TMIS APP�ICATION �. S7A�LS GARAGES
ANO KNOW THE SAME TO BE TRUE ANO CORRECT. ALl PROVISIpNS OF �AWS VALUATION SURTAX
AND ORDINANCES GOVERNING 7MIS TYPE OF WORK WILL BE COMP�IED
WITH WHETMER SPEC�FIEO MEiiEIN OR NOT. THE GRANTING Of A PERMIT �2 � GZZ . OO �1 . 31
OOES N07 PRESUME TO GIVE AU7MORITV T� VIOIATE OR CANCEL THE pEqMIT fEE SAC CNARGE
PROVISIONS OF ANY OTMEFi STATE OR LOCAL lAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �H3. 25 Fire SC �2 . GZ
• -
P�AN CHECKi�E TOTA EE
7 � �� Licens $5.00 $ .18
$�GNOTUpEOFCON'�7AC1OpOpA NOA�ZED�GENi �O�TE� EN� ROPE UOATE HIS IS YOUA PERMIT
$�GN�TUAE O� OWNEp��� OWNEpBU�IDEpi IOAIE� �Nsp ' �����
_ � t
i� ° ♦
Y
NEW [ ] Effective 1/1/2000
ADDN [] CITY OF FRIDLEY (763) 572-3604 Bidg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: /�o �,4R�.c.�A�✓ c<� .
Legal Description:
Owner Name � Address: r`���'� �A� L- Tel. #
Contractor. 1C �ch s�� � l�as�� �6 S MN LICENSE# �DS/
Address: � 3 3 1 i2 � �� �� ��. �?��'� Tel. # S> 1/ ' �'i ��G
LMNG AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn an it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length VYdth Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER: � D S
Construction Type:%�4Ge D�i-' �- ��' 1Z oa t� Estimated Cost: $ o� ��' ?"—
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 7 S o a APPLICANT: � Tel. #� 7 Y S�F�6
CITY USE ONLY - Call (763) 572�604 for Permit Fees if mailing in application
Permit Fee $�.3. �.5^ Fee Schedule on Reverse Side
Fire Surcharge $ �. G�' .001 of Permit Valuation (1/10th%)
State Surcharge $ % 3 � $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge
Driveway Escrow
Erosion Control
$ �- � $5.00 (State Licensed Residentiai Contractors)
$ Alt. "A" or Aft. "B" Above
$ $450.00 Conservation Plan Review
Park Fee $
Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not I�fecessary []
TOTAL
ST{PULATIONS:
$ ,�, l�
� ._
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