AF - 45458�
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City of Fridley, Min.n..
BUII.DING PERMM�T N° 3 2 31
Date: .. �..�..�.........�� .....................
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Owaer ........ Builder r :....";..,, ..........:............
Addr�s ...................................... Address .............................................
LO�CATIQN OF BUILDINC �
No. � � , ?i � . . . Str2et . � . . . . . . . : : f . . . . . . . . . . . : . �. . . . . . . . . Part=aof Lot . . . . . . . . . . . . ,
Lot . . . . . .(�. . . . . Biock . . .� : . . . . . . . . . . . Additton or Sub-Dfvision � . : �>: � . � . . . . . . . . . f. . . :-: . . '`? � r,^'� ��
. . . ........"
: ,,, ,,,s F � � � ......
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Coraer Lot ............ Inside Lot .....�...... Setback .: ::::`..... Sideyard ..'.::..
.........:::-:'.......
DESCRIPTION OF BU[LD[NG
T b� Used as: ., � `,�. R
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. . � r : : . : . :': :�:° . . . . �oat . . f:'. . . . �pth : :: : s . :'° Height . . . . . . �. Sq. Ft. . �. . . . .!. Cu. F't. �. . . . . . : �
.................... �Front ........ Depth ........ �Teight ,....,.... Sq. Ft ........ „ Ctti. Fk ........
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7�►pe of Construction �t : . : . . . . . . T�st. Cost � . . � . j . . . . . . . f — j ,
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In consideration of t'he iss�uance to me of a permit to construct the building desribed above, I agree to do
the proposed work in acc:ordance wYth the description above set forth and in compliance with all provisqons ug
ordinances of the dty of Fridley.
....................................................
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In consideration of the payment of a fee of $ .... .. ..., permit is hereby granted to , ..... .. .... ..: .... --
to construct the building or addition as described above. This permit is granted upon
the express condition that.the person to whom it is graated and hia agenta, employees and worlanen, fn all work
done in, around and upon said building, or any part thereof, shall conform itt all respects to the ordinances of
F�idley, Minnesota regarding location, construcl3on, alteration, maintena.nce, repair and moving oP buildings with-
in the city limits and this permit may be revol�ed at ar►y time upon violation of any of the pravisions of sa3d
ordinances.
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NOTICE: `" �
Thls permtt does not cove� the construotton, installatlon or alteratPon fo� wl�ing, �
eewer o� water. Be su�e to see tha BuildlnB Inepactor fo� separate permlts for these
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gaa heating,
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B� ��� .� P����r�-�v /��-�G���s �1��>TE��
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INDU87'RIAL ,-� —` C. E. C O U L T E R � .. "`� Pu�""°
BUSINEBS
FARlE BURYfirB
CITY LOTB LAND SURVEYOR �„/1KEBNORfi
TOPOORAPNIC INAPPINO REGISTERED UNDER LAWS OF STATE OF MIfVNE80TA ' �YDICIwL
LICENB6D BY ORDINANCfi OP CRY OR NiNNFJ1POLiH '
_ 3300 LYNDALE AVE. 50. MINIYEAPOLIS 8, MINN.'
TAYLOR 4A970
S v!� vEY FoR BENSa�s C'OoySTRU �'r� o�y
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I t�ereby aertify that the above is a true and correct plat of a surwey of:
Lot Eight�(E), Block Three (3), PARKVIEW HEIGHTS ADDITION, Anoka County,
Minnesota., � .
As surveyed by me this 6th day of Avgust 1958 A.�D.
, Signed � � `
Approvetl by Building Inspector ��sota �eg�strat an o. 2
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City of Fridley, lylinn..
BUILDING PERMIT
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Date: ._.._.. �..___..__.__....._...__._...� __._.._.._.._.. �.��..�....�.....-,--
Owner:
Address
N° 42'70
Builder ....... ..,.� . . �y ../...%.. � _�'.w�`.`_�_
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Addre� ........------_....-----�---...._..._-•---------------- ---- -
CATION OF BUILDING
��� ' �� * ' .. Part of Lot
No. .... --�----.. .... ----� Street ._ ...._..---•-••----•----....._..._......._. _..--••--• _-••--......_ .............---•------ -
Lot ....-- ....................._........ Block --��--�------...................._...--�--........ Addition or 5ub-Division ...-•-�---� --•-�--_..._..
Corner Lot .................................... Inside Lot
Sewer Elevation
Setback ....._ ............._...--.----..__.....--- Sideyard
......._... Fouttdation IIevation ......_.........
DESCRIPTIOW OF BUILDING
To be Used as •
. 6
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L�............_....... . eL✓t� P/ nt -l._..�---� Depth .��:.'�� Height /.....�..-�. Sq. Ft. �.�� Cu. Fk ���J�
- -.........._ ....................... Front --.._......................_Depth ........... � ---..._.. iieight ................. ._ Sq. F't. ...-•--�---�-•-- ---- Cu. F� ....._......._...._..
_.......... _.
' .. Est. Cost..- ...��..........`�-��o be Completed ....._ ............._.._..................__......
Type of Construction ..................................�---........ G�
In consideration of the issuance to me of a permit to constxuct the building described above, I agree to do
the proposed work in accordance with the description above_ sq� fo th ar� in comp nce with all rovisions of
ordinances of the dty of Frldley. �
�
In consideration of the payment of a fee of $ ...... .......................-.-_., Permit is hereby granted to....._............._............._.....---•--.._......._..
_.�____...___....._.__...._....._._._._.._ to construct the building or addition as described above. This permit is granted u�n
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done 3n, around and upon said building, or any part thereof, shall conform in all respects to the ordina,nces ag
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving oP bwtldings
o� �e. city limits and this permit may be revoked at any time upon violation of� ttie provisions of said
Building Inspector
NOTICE:
Thia permif does not eover the construction, installalion for wirfng, plumbing, gas heating, sewer or wa��r. B� wrs te �
the Bullding Inspeetor for separate permits for these hems.
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sue�ecr P IT N O.
City of Fridley � 12501
AT THE TOP OF THE TWINS g U i L D I N G P E R M I T", •
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� `v _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �/l7 Q�
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� /'�'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�•"'�'� ,•� 612-580-3450
910-F15 4 22 74 � �
JOB ADDRESS
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. SHEET
2 PROPERTYOWNER MAILADDRESS P PHONE
James Sevauson 1020 Sathawa
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Sussel Com an
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDINa Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK Construct a 16' x 12' Addition
9 CHANGEOFUSEFROM TO
STIPULATIONS
If garage is relocated on.same lot, survey will be required
SEPERATE PERM{TS REQUIRED FOR Vi11RING�
- HEATING, PLUMBING AND SIGIVS.
SEPARATE PERMITS ARE RE�UIREO FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. �it�00d Fp•�e
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT R-],
ANY TIME AFTER VHORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 8E COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT y5`3 � gOO ].,
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRU TION OR THE PERFORMAN OF CONST UCTION. � 24.00
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PLAN CHECKFEE TOTALFEE
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SIGNATUREOFCONTRACTORORAUTHORI AGENT �DATEI HEN PROPERLY VALIDA D T IS YO R PERMIT
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` SIGNATURE OF OWNER UF OWNER BUILDEPI lDATEI BLDG. INSP pATE "
APPLICATTON FOR RESIDENTIAL, ALTERATION,
OR AUllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
. _ . ����-�'�1
OWNER.' S NAME • BUILDER •
ADDRESS: � ADDRESS: � ���
No:, l� �o s�E�: � i .�
LOT:_�BLOCK: � ADDITION: ��/�f�(%> �,�� �� 1��7-5
CORNER LOT: INSIDE LOT: ✓ SETBACK: SIDEYARD:
Applicant attach to this form �ao Certificates of Suxvey of I,ot and proposed
liuilding location drawn on these Certificates.
' DESCRIPTION OF BUILDING
�'To Be Used As :
� � Fr�nt : ! lP De th : � � Hei ht : �
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Square Feet:� � Cubic Feet:.
Front; Depth: Height:
Squaxe Feet; Cubic Feet:
�rpe of Construction: ��i��� Estimated Cost: � (7'�' ^Q�
To Be Completed:
The undersigned hexeby makes appJ�icativ� for a permit for the work herein
specified, agreeing to do all caork in stzict accordance with�the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
�%� � � �'� �c��ZZ�i ��.�'ti— •
DATE: / � SIGNATURE:
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(See Revexse Siy�e For Additional Informa.tion. ) .' . — � �1
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�BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or fox any addition to any existing
building or stxucture, or for any alteration or repairs to any existing
building or structure9�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:
UDTIFORM BUILDING CODE o-, Type l, 2& 4-$2.15 for each one thousand cubic
feet, ox fraction there�f, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORI��IATION
For the purpose of computing fees fox building permits, the cubical contents
of any building or addition, is determined Uy multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
ox the cellar to the average heights of the upper surface.or��o the average�•
height of the roof surface of the main gable of a pitched roof.
k'or repairs or alterations to an existing structuxe, the fee shall be a� the
xate of $3.00 per each fa.ve hundred dollars ($500.00) or fraction thereof in
the cost of all prop•osed work.
Tn no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE; Permits for construction wi11 be issued a minimum of 24 hours from the
ti.me of application, to allow for proper review of the proposed structure and
of the construction site.
.. '
A Certified Survey of the 1ot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be ma.de ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Cextificate
of Occupancy has been issued.
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sue�ecr PE IT NO.
c�ty of Fridley � i378o
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T
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ECEIPT NO
' j y ����`��
COMMUNITY DEVELOPMENT DIV. �����
r � PROTECTIVE INSPECTION SEC.
� �
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�� /'��1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVEO BY
""� � ,�� 612-580-3450 r'
910-F15 9j2%��8 � �
JOB ADDRESS
2 Hathawa Lane
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 Parkview Hei hts Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Tim Swanson 1020 Hathaway Lane N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Sussel Com an 1850 Como A�renue St. Pau1
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
same
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
B USE OF BUILDING
residentia1
7 CLASS OF WORK
�� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 22 x 26 attached garage
9 CHANGE OF USE FROM TO
STIPULATIONS
1..Provide a hard surface drive.
� , ° � ' RMtT�• REQUit�EO F,�i �NG�
SEPE��►� �
�]EAi1NG, P1-U�18tNG� AN� S1GNS.
SEPARATE PERMITS ARE REOUIRED FOR ELECTpICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED 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.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �L��L3�L�SO �L.�Z
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � �L�L.SO �L.��L
PLAN CHECK FEE TOTAL FEE
� s -�`"`� 24.92 ';
� SIGNATURE OF CONTRACTOR R AUTH 12ED AGENT �DATEI EN PROPE ALIDAT D THI IS YO P RMIT
� �� ����
�-�'SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI BLDG iNSP pA7E �
� �
�/7. 1 1 �.71 1 f\A��1_6.r
APPLICATION FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
OWNER' S NAME : � � W► � �� � BUILAER : �� 5'-eJ< �
ADDRESS :_ /D�O /jl��� te�ti-ey ADDRESS : ��5-l� �a /Y� - �� ��
NQ•, STREET•
LOT: BLOCK: ADDITION: '
CORNER LOT: INSIDE LOT: � S�TBACK: SIDEYARD:
Applicant at�ach to this forra Two Certificates of Su�.�T�r_ of Lot an.d proposed
building locatian drawn on these Certificates.
llESCRIPTION OF BUILDING
To Be Used As ; �-f ���� ��u..e�2_
tl —
Front : ��- Depth : ._, �'.Cp . Height ; /C�
Square Feet: Cubic Feet:
Fxont:. Depth: Height:
Square Feet;
Cubic Feet:
7.`ype of Construction: �I^�c�„ Estimated Ccst: $ �, %,3� ,��
To Be Completed: �@ � �
The undersigned hereby makes applica�ivn f�+r a pertnit for the �•aork herein
specified, agreeing to do all work in st�ict accordance with the City of
Fridley Ordinanees and ru.lings af the Departinent of Builciings, and hereby
declares that all the facts and representations stated in �hi:s applicatian
are true and correct.
DAT� : �2� � � %' °7C� S IGNATIJF.E : C.t� �- .�('
(See Revexse Side For Additional InfQxmation.)
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BUTLllING PEI2MIT FE�: SCHEllULL'
S�CTION 2. The Inspector of Buildings shall, before issuing pennits for the
erection of any building or structure, ox for any addition to any existing
building or structure, or for any alteratiion ox repaixs to any existing
building or structure, upon application thereiore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in
the ma.nner herein provided to-wit:
iVEW CON5TRUC�ION: Sing],e Family Iiomes and Garages: $4.00/1000 cubic feet
PLAN CHECK: 25 percent of building permit fee.
ADDITIONAL INFORA�ATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
ox the cellar to the average heights of the upper surface or �o the averagel
height of the xoof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction tliereof ii�
the cost of all proposed work. .
Tn no case sha11 the fee charged fox any permit as set forth in Section 2 be
Iess than $�.50.
V�RIFICATION OF FOUNDATION
NOTE: Permits fo.r eonstruction will be issued a minimum of 24 hours fram the
time of application, to allo�a iox proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constr.ucted, will Ue requixed before proceeding with the fxami�g.
CERTIFICATE OF OCCUPANCI'
Application for a Cextificate of Occupancy shall be m�de ten (10) days pxior
to the use or occupancy of any structure for which a building pennit has been
issued; and said structure shall not be used or �ccupied ur►til a Certificate
oi Occupancy lias been issued.
�
s
.
������
SUSSEL6ARA6ES SUSSELICOMPANY. INC
Permit by � r� � � � �—
Legal Description
Lot
Blk
Add'n
Value
Type Const.
SLAB:
�By SUSSEL
❑ By Owner Approx.
Oln
2-STARTINGS POINTS ONLY
S.P. L.
S. S. P. L.
R. P. L.
AI ley
� F�� � House
F. Stree
Other
Square With �u S �=
Q(1 Mesh
C� Sod Rem. - By
❑ 5-Bag Mix
6-Bag Mix
Tamping
❑ No Tamping���
j'�A.B.U.
[I�QGrade Point
� B� oCks�t❑ By Owner(�J By Sussel
❑ Maintain 8' Total Wall
Height including Blocks
❑Maintain 8' Wall Height on
Top of Blocks
❑ Other
� O.H. Dr Offset
� S.D. Location
�
❑ Att Gar Roof Tie-in
Drawn on attached pictures
Existing garage: No�
❑ Detached ❑ Attached Yes [
Size of existing: — x —
Existing garage will be:
❑ Left as is
❑ Converted to L.S. - By owner
❑ Removed By: Owner [.1
Sussel f� 1
lunk Must Be Removed By Own
❑ Specify removals by Sussel
Or owner - trees, bushes, etc.
❑ Show approx. dist. garage to
house and all prop. lines
Stakes visible - ❑ �1'es L� No
Survey available -❑ Yes [ J No
❑ Special instructions from
owner:
WORK ORDER
HOME PHONE: ���� 7��'�
NAME v� �"� � Z-U r� 1`� SC� i�� BUS. PHONE:
JOB ADDRESS
BLDG CODE AREA �� j ��-��
SALESMAN /`r 1�� CONTRACT DATE �/Z-' SIZE Z�� 2�
FOR OFFICE USE ONLY
CONTRACTOR �2�'ST JOB # � —� 7
5 `�- '� Z °� a
PURCNASER'S INITIALS: oiRecrioN
.• �
� `� lond Planning
lond Surveying
Soils Testing
Civil Enginsering
Munfcipal Engineering
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Mort�age
sf �!'� r� � 1'� �r� � �� 6875 Highway No. 65 N. E.
� a � � � , Minneopolis �
' !�l��s�l PPI !I �(�� ��'ltC. M�„� . ssasz
Telepho�s 784-6066
Engineers & Surveyors A�Qa code eis
Loan Survey for V�M "L-5 SW�41�lSOt�l
1.1 l�� ►-I J�`�v ��
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N� I-SToQY FRAMC'� �
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� I�r�r�i�v►c v� I�-I G i i-��r's /�►���� � �► o�
�uok4 �-ounT�
Thisis a true and torrect representation oF a survay of fhe boundaries of the land above descri6ed ond offhe
lotation of all buildings� if any� thereon� and all visible ene�oachments� if any� from or on said land. This survey is
mnde only in connection with o mortgage loon now being placed on the property and no Iiability is assumed
except to the holder of such mortgoge or any other interest acquired by the reoson of such mortgage, It is
understood ond agreed 4,� monume ts have been laced for the purpose of establishing lot lines or boundory
corners. Dated this15 day of �EP7. A. D. 19�
SUBURBAN ENGINEERING, INC.
L3� 4 Engineer Surveyora
57 � bY_� �l� (f�L�_ -L1. G-�., `.._. .
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�
CITY OF FRIDLEY
8431 UNIVERSITY AVENUE N.E.. FRIDLEY, MINNESOTA 55132
TELEPHONE ( 612�571-3450
lrlay 2, 1983
Mr. Larry Wright
1020 Hatha�+ay Lane N. E.
Fridley � l�i 55432
Re: Sump Pump Discharge
Dear Mr. Wright:
An inspection on April 28� 1983 of y,our address noted that your sump
pump �►as discharging into the City sanitary seWer system. City
ordinance prohibits the discharge of foundation or sump drains into
the City sanitary se�er system.
A reinspection Will be conducted on or about May 16, 1983 to
determine compliance. If you have any questions on this matter,
please feel free to contact me at 571-3450.
Sincerely�
HILLZAM H. SANDIN
Plbg.-Htg. Inspector
IdHS/mh
sue�ecT PER NO.
City of Fridley o 18429
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RECE .
r
r ; v__���_ COMMUNITY DEVEIOPMENT DIV. �O ���
� � PROTECTIVE INSPECTION SEC.
1 i ,
l.--.� �r���,.� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
L 612-571-3450 910-F15 5/16/86 � �
JOB ADORESS 1020 Hathaway Lane N. E.
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. 8 3 Paxkview Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Larry �idright 1020 Hathaway Lane N. E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
T. J. Roofing #5 Inner Dxive, Circle Pines, N.�T 55014 786-9687
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO.
8 USE OF BUILDING •
RESlClCiri't7.3�.
7 CLASS OF WORK
❑ NEW O ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
REYY)O� DWe��.].T19'
9 CHANOE OF USE FROM TO
STIPULATIONS
Roof can be the 2nd layer but not the 3rd. Insta.11 ridged galvanized
valleys.
SEPARATE PEflMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBINCi, HEATINCi, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
ND KNOW SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
A ORDI AN S GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $8�O yS`.SO
WIT WHE HER PECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRES E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CFiARGE
PROVI ION OF A Y OTHER STATE OR LOCAL LAW REGULATING CON-
STRUC ION R THE, E OF CONSTRUCTION. 5�..6.00
PLAN CHECK FEE TOTAL FEE
� $16.50
SIGNATUR'OFCON RACTO RAUTHOR12EDAGENT TEi WHEN PROPERL VALIDATED THIS IS YOUR PERMIT
_ ' � G
SIGNATUREOFOWNERI�FOWNERBUILOERI IDATEI BLOG INSP �ATE
NEW [ ]
ADDN. [ ]
ALTER. [ ]
Construction Addre�
Legal Description:�
Owner Name & Addr
Contractor:�
Address:
LIVING AREA:
GARAGE AREA:
DECR AREA:
OTHER:
E
,
City of Fridley
R-1 AND R-2
Building Permit Applieation
�
i
�
J
Attach to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to seale.
DESCRIPTIOH OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Effective 4/1/86
Tel. �
Tel. � ^ C1 I
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Ins Lot [] Ft. Yd. Setback Side Yard Setbaek
�
Type of Construction: Estimated Cost: $ ��
Approx. Completion Date: 3
Proposed Driveway Width If Ne enin
DATE: � �' APPLICANT: �
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� r �_
�
�
$
�
$
�
� �,
� :_
Alt. A Alt B
s Desired: $ $
� See Back Page for Explanation
CITY IIS� Ui�iL.Y
Tel. �
Fee Schedule on Reverse Side
25$ of Building Permit Fee
�.50/$1,000 Valuation
$475 per SAC Unit
Fee Deter�ined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
ti � � .�
BIIII.DING PERMIT 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 strueture, or
for any alteration or repair to any existing building or strueture, upon applicatio n
therefore, require the payment by the applicant for sueh permit of fees to the amount
herein beloW set forth and in the manner herein provided to-wit:
Total Valuation
$1.00 to $500.00
Fees
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for eaeh
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00
$25,001.00 to $50,000.00
$50,001.00 to $100,000.00
$100,001.00 and up
$32.50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
including $25,000.
$170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraetion thereof, to and
including $50,000.
$283.00 for the first $50,000 plus $3.00 for each
additional $1�000 or fraction thereof, to and
ineluding $100,000.
��33.00 for the first $100,000 plus $2.50 for eaeh
additional $1,000 or fraetion thereof.
DRIVEWAY DEPRESSION ESCROY
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13.50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approaeh xith 6 inch depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
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.
A Certificate of Survey of the lot, shoWing the location of the foundation onee it
has been constructed will be required before procee¢iing with the framing.
� ._ � �-
SUBJECT P •
City of Fridley 210 8 0
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� � RECEIP .
� ; y __��� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. L�/ ��
1 . , �
� ` /'��1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE GAGE OF APPROVED BV
�""� � �'' 612-571-3450 910-F15 9/25/91 / /
J08 ADDRESS 1020 Hathaway Lane NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCH. 8 3 Parkview Heights SHEET
2 PROPERTYOWNER MAILADORESS 21P PHONE
Heidi Habel 1020 Hathaway Lane NE 571-8893
3 CONTqACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Addition & Remodeling Specialists 1�800 Xavis St Nfni, Coon Ra ids MN 55433
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
427-7330
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Res idential
7 CLASS OF WORK
� NEW ❑ AODITION ❑� ALTERATION 0 REPAIR � MOVE � REMOVE
8 DESCRIBE WORK
Lower level alteration �or bath & bedroom
9 CHAN(iE OF USE FROM TO
STIPULATIONS
See notations an plan
5����� ������ ��Q�«�� F�i�
�IV��t�i���G, HEAT��IE�, PE.t1k�l�6l�(� �,�'D� StGi�S.
TYPE OF CONST. OCCUPANCY OROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE FiEOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
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, OH IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OP 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6,300 $3.ZS
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEL THE pEpMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $9O, OO Fire SC yfiG. 3O
TRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
�.� /�C�-GL �'�-C-'f�[r� �� Z� % � ` $99.45
S�GN TUREOFCONTRACTOf70RAUTHORIZEDAGENT IDATEI WHEN ROPER Y LIDATED TNIS IS VOUR PERMIT
� � �-z S- �/
SiGNATUREOFOWNERiiFOWNERBUILDER� �DATEi DG �NSP �ATE
� [ ]
� [ l
�'1'� [ ]
1�1 AND I�2
�i�air�g Perm,it Applicatian
�
�ffective 1/1/91
oo�nstnictiaai Addi�ess: � t� 2.0 ,�s�--�r�s� �.a � ��c ��t�7`
i�gal Desc,riptia�n: ,� `/ �.� 1 � (� � � �v 1 /� � (J 1 � C,�� 7�7 � � �/-/� :� �-�1 tlA l ,
owrier I�kzme & Addt�es.s • �� � s $� �- Tel . # uP''7 f � �893
o�ntractor: A-dJ�l T���L �/2-�i�-c.�e��u.��y �'���>�-�S'� Ziel. #�.�7— 73�0
Ad,dres�: ! G� � �� ,C �-�"� � �'T. ,c� 9� C��� ��-��Q��S �, �
Attach to thi,s applicatiaai, a Certificate of S�vey of the ���
lvt, with the pr�o�ed cw�stn�ctian drawn cai it to scale.
.i: � r� �,• � � ta+�.
I.IVII�]C3 �►RE�►: i�gth Width Iteight Sq- Ft.
C�d,R�GE AREA: I�es�gtl'1 Width Heic�lt Sq. F`t.
D�lCR ARE�I: Iei�gth Width F�gt/Grau�d Sq. Ft.
OT�R: .�.� Vs�C?� L-�il � /� � � � � � �
Corner Lot [] Inside Lot [] Ft._ Ya SetbacJ� side Yard Setbacks
Type of Qon�truction: , F�i�ted Qost: $���� �
Approx. Ooa�letion Date: p c-�- �: ,_! 4�1' /
�
Proposed Driveway Width If New Openirig:� Desired: Ft. $ $
��° Width + 6' See Back Page
n�: 9 — ��� — �0 ��c�,xr: ��c� - � - - z� • # �f' �`� " � � 30
� crFx os� a�t
., ;:- .
P�e.rmit Fee $ ��, �� Fee.' �hedule a� Reverse Side
Fire S�rharge $ a� .Ob1 5c: Permit Valuation (1/lOth �)
State S�rci�ge $ 3a /� $. 50/$l, 000 ValuatlN'1
SAC Charge $ --- $650 �er SAC Unit
DY''lVeW'ciy ESCL�DW $ °°' Al�r-;. nAn OI' Alt. ��B" AbOVe
Park Fee $ °-' Fee Determined bY �9��
Sewer Main (�Yge $ �°' Agr.eOO�t IJe�sarY [] Not Ne�s1rY []
ZO�,L $ �
�� �' � �� � �'i�.�s t�
uIP,TIQKS: _�--_.._,_ ___._�_---,
�� "7 ' 7�
l�
i:���■ � t, r :�;�t�Yty+ :y:�° : a.:t�a��tP .
Z�e Quef Buildir�g Official shall, befare issuing petmits far the erec,�tion of ariy
buildir�g or �, or far any additian to ar�y e�cisting buildirg or sttuctuYe, or
for arYy alteraticn or repair to ariy existir�g iuilding or strvcture� u� a�ii�ation
th,erefore, �+equire ti�e paymerrt by the applicant far such permit of fee.s to the a�aoa��
herein belaw set forth ar�d in the marmer hernin provided to-wit:
�OrAI, VAIDE
$1 to $500
$501 t,o $2, 000
S2,00i to Sas,oao
$25,001 to $50,000
$50,001 to $100,Q00
$100,001 to $5Q0,000
i��
$15 (Minimnn Fee is $15 plus suxrhaYge)
$15 for fixst $500 plus $2 for each ac�ditional $100 or
fnctiaa� tt�ereof, t� and 31'�ltrlil�g $2, 000
$45 far first $2, 000 plus $9 fC�' eaCh 3dditiorial $1, 000
a�' fiactiaa�► th,ereof, to and frx:ludirig $25, 000
$252 foZ' first $25,000 plus $6.50 for each additior�al $1,000
or fract,iaai thet�eof, to arid includirg $50, OQO
$414.50 for first $50,000 plus $4.50 for each ar1ditional
$1, 000 or' fraCtiaai thet+eof, to arid including $100, 000
$639.50 for first $100,000 plus $3.50 for each sdd.itional
$1, 000 or fractiaa� the�f, to and includir�g $500, 000
Ssoo,00i to Si,000,000 $2039.50 for the first $500,00� plus $3 for each additio�,al
$1, Q00 or fractiaa�► th�ereof, to ar�d ir�cltxling $1, 000, 000
$1,000,001 ar�d up $3539.50 for the first $1,000,000 plus $2 far each additional
$1, 000 or fractia� thereof
�t1VEW�lY �ffiSI@? ESQiOW
(C+aa�+ete Ctu� Streets �tY)
Alternate ��A�� ; Removal arri replacement of s�rb arrl gutter only - Drive�way width plus
6 feet times $13.50.
Alte,rnate "B": R�noval and replaoaoent of curb and gutter and instail a 3 foot wide
appraac'h with 6 ir�ch dep�th - Drive�,ray width plus 6 feet t]mess $15.75.
• �+• �� �,. ,r. .i- -�,�i i� • •�
Permits for �o�t�vc�t.iaa�► wi11 be issu�ed � minimun of 24 im�s fr� th,e time of
application to allvw far pYnper review of the prapo�ed structure and of the
oo�nstruction site.
A Oertificate of S�vey of the lot, shcwirrg t��e locatian of the fau�datia� or�oe it has
it has been oo�strvcted will be required before prooeedir�g with the framir�g.
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AT THE TOP OF TME TW�NS g u I L D I N� P E R M I T
' ` R E� TN
� �• COMMUNITY DEVELOP�riENT OIV. ���m������ �
� ; V ����� . .
f � � PpOTECTIVE INSPECTION SEC.
i . �
`---- A ��'�',,, CITY NALI FRIDLEV Sj132 NUMBEN pEV DATE PAGE Oi APiROVEO B�
L �� 612-571-3450 g�0-Ft5 7/11/O1 / /
JOB ADDRESS 1020 Hathaway ,Lane NE e
t LEGAL �OT NO. BLOCK TfiACT OR ADDITION SEE ATTACMED
oescR. 8 3 Par.kview Heights Addition SNEET
2 PiiOPEiiTY OWNER MAIL ADQR�S$ 21P PNONE
Timothy/Elaine Murray 1020 Hathaway Lane NE 763-571-9282
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
d AqCMITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII AODRESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
0 NEW O ADOITION ❑ ALTERATION �7 REPAIR ❑ MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof House & Garage (43 Sq) Tear-off
9 CHAN(3E OF USE FROM T�
STIPULATIONS
Underlayment must comp�y with the State Building Code.
TYP� OI� CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPAqATE PERMITS ARE REOUIRED fOF ELECTRICAL, PLUMBING, MEATING,
VENTI�ATING OR AIR CONDITIONING.
TMIS PEFMIT BECOMES NULL ANO VOID IF WQRK OR CONSTRUCTION jpNING SO. FT CU FT-
AUTHORIZEO IS NOT COMMENCED Vj!ITHIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANQOMQO fOR A PERIQO OF 120 DAYS A7 �
ANY TIME Af7ER WOIiK IS COMMENCED. ` NO DWLG. UNITS OFFSTREET PARK�NG
I HEREBY CERTIfY THAT I HAVE READ AND EXAW�INED TMIS APPUCATION 1 STAILS GAi;AGES
AND KNOW TME SAME TO BE TAUE AND CORRECT. ALL PROVISIONS OF LAWS ypLUAT10N SUFTAX
AND OROINANCES GOVERNING THIS TVPE OF WQRK WILL �� CpMPl�ED @(E,397 $2.LO
WITH WHETHER SPECIFIED MEREIN OF NOT. TME GRANTING OF A PERMIT Y�
DOES NOT PRESUME TO GIVE AUTMORI7Y TO VIOLATE OR GAMCEI THE pEqMl7 FEE SAC CMARGE
PROVISIONS Of ANY OTHEF STATE OR LOCAL LAW REGULATING CON- @
STRUCTION OR THE PERFOWMANCE OF CONSTRUCTION �111.2.5 Fire .5�.' y��►.�F�
P�AN CMECK f EE OTAL f EE
$117.85
�G TUAEOF�QN'RACTOAOp4UTNOA�ZEDAGENT IDAiEi M p �V VALI TED TMIS IS V UA PEpMIT
� i� / —o � -� .
S�GNATUAE OF O�NNEA��F QWNEpBU0.DEA� �O�rE� � B �NS ��`Tf
NEVN [ ]
ADDN []
��R Il
Construction Address:
Legal Description: _
Effective 1/1/2001
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Owner Name & Address: f i/��n�ll �/ � �i,ai � � �i �'s"� � Tel. # %�,3 -�5 �/- J�Z
Contractor. �� � � MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft �
Le�gth Width Height Sq. Ft
DECK AREA: Length
OTHER:
�—
Sq. Ft
�, , r
• • • - � � \ / % �\ % � � I �/. //'� - • • �riCil�r
� ' -
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: - �'D APPLICANT: ��GL'1/� i.� ��%G��`'G'��� Tel. #�1.�-c5�/�9`0���
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permi� Fee $ /, ��� Fee Schedule on Reverse Side
Fire Surcharge $ , L .001 of Permit Valuation (1/10th%)
State Surcharge $ �� $.50/$1,000 Valuation
SAC Charge $ $1150 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $,
Sewer Main Charge $,
TOTAL
STIPULATIONS:
$ 1�s
.Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BI,TII,DING PERMIT 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 structure,
upon application therefore, require the payment by the �pplicant 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
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,�0
$1�,001 to $SQ0,000
$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,�
$69.25 for first $2,000 plus $14.00 for each additional $1,OQ0
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each addirional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.(� for each additional
$1,000 or fraction thereof, to and including $1�,0�
$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
$1,000 or fraction thereof, to and including $1,000,�0
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet tunes $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
.r � �,
sue�eti P
c�ty of Fridley 2�82°
�
AT TME TOP OF THE TWINS g � I L D I N G P E R M I T
; � RE O.
� i �__��_ COMMUMITY OEVEIOP�MENT OIV.
r � � PROTECTIVE INSPECTION SEC. �� °3�
� . ,
� _ �"'1 � CITY HALL FRIDLE� 33132 NuMeEp Ev 0�►TE vAGE OF �vvaOVED er
��'"'� � �'' 612-57�-3a50 s�aF�s 5/10/02 / /
108 ADORESS 1020 Hathaway Lane NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. g 3 Parkview Heights Addition SHEET
2 PROPERTY OWNEii MAIL ADOR�S$ ZIP PMONE
Elaine Murray 1020 Hathaway Lane NE 763-571-9282
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
Standard Water Control 5337 Lakeland Ave N, Crystal, MN 55429 763-537-4849
4 ApCHITECT OR DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
1522
5 ENGINEER R11All ADDRESS ZIP PHONE IICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION O REPAIR O MOVE � O REMOVE
B DESCRIBE WORK
Install d�aintile system
9 CHANGE OF USE FROM TO
STIPULATIONS
���mi� InS�e�iio
I�Illl B� � � Cards
�� �o��A�n ailed
�r T� Posf
SEPARATE PERMITS ARE REQUIRED fOR ELECTRICAI, PLUMBING. MEATIN(3, TVP� OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO
VENTILATING OR AIR CONOITIONING.
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. fT CU FT.
AUTHORI2ED IS NOT COMMENCED VjIITHIN 80 OAVS. OR IF CONSTRUCTION �
OR WOFiK IS SUSPENDED OIi ABANQONEO fOR A PERIOO OF 120 DAYS AT
ANY TIME AFTEfi WORK IS COMMENCED. ' NO DWLG. UNITS OfFSTpEET PARKING
I HEREBY CERTIFV 7MAT I HAVE REAO AND EXAMINEO THIS APPL�CA710N 1 STAIIS GARAGES
ANO KNOW THE SAME TO BE TI�UE AND CORRECT. ALl PROVISION$ Of LAW$ VALUATION SURTAX
AND OiiDINANCES GOVEpNING THIS TYPE OF WORK WILI BE CpMP�lEO $3, 360 � 1. 68
WITM WHE7HER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL TNE pEWMITFEE SACCMARGE
PROVISIONS OF ANY OTMER STATE Oii LOCAL LAW REGULATING CON- @97.25 Fire .SC. �p3.36
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION y�
PLAN CNECK FEE TOTAL F
� L e e SC $.0 07.29
S�GNATUpE OF CON'NACTOp Op 4UTMOA�ZED OGENT iD�iE� EN P OPER LIOATED T IS IS VOUR PERMIT
� ��/V � � r/
S�GNOTUAE O� OWNEp��� OWNEA BU4DEp� iOAT�� . ' BLDG �hSo � q`tE
�
n J
C
FROM : FAX N0. � 76353718B2 _ May. 08 2002 06'33AM P1 �
�X' � ;�� S��%
N�w [ l
ADDN (]
ALTER [ j
CITY OF FRIOLEY Effective 1/1/2002
6431 University Ave NE, Fridley, MN 55432 (763) 572�604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
Construction Address:1�� D l�a��tO�,Wa,u �,,y� � �` � � • � �
Legal Description: �
Owner Name 8� Address: � i�l ' uv�r� . Tel. # - �., a�'(�
Contractor: ��pt.n d;�d� 1.Cj�-Q o� (' r�• MN UCENSE � %���
Address: .�� � Lak�lar�cP 14uQ �I Cr^us� � Tel. # 7(a3-.537 ��' ��
' T
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certific�te of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Len9� Width __ Height � Sq. Ft ' '�
length wdth Height � Sq. Ft
Length Width � Hgt/Ground Sq. Ft
Construction Type: �(�'O�,�i � Estimated Cost: S (�
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ = g
DATE: � D a` APPLIGANT- . . T�. - -
# %/�..5. �7 ����
Call (763) 572�3604 for Permit Fees if Mailing in application or Fax to 763�71-1?,$7 if using credit card and we �nn71
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
70TAL
C1TY USE ONLY -
, 6
� ���� Fee Schedule on Reverse Side
$ �-F ,"� .001 of Permit Valuation (1/10th�%)
�� . A 1�,��� , $.50/$1,000 Valuation � � � � � � � '
� $1200 per SAC Unit
�:
$ r � G`�> $5.00 (State Licensed Residential Contractors)
$ Ait. "A" or Alt. "B" Above
� $450.00 Conservation Plan Review
$ Fee Determined by Engineering �
� � Agreement Necessary [ ] Not Necessary [ ]
S ��'�d ,��
STIPULATIONS:
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THE BELOW MUST BE FILLE� IN WNEN �tEPL�►CING FUEL BURNiNG APPLIANCES �R THE
,p►PPLlCATION WILL BE RETURNED
nn�aRen�1 �/CILIT �/C{�T �RRE['T�R /�1RQ CnMBLISTtnN
�@n �nEacina an eYistin� i'��, the undarsigned hereby veri�ies that: �a
ven�r�q has been examined and is free from rust, deterioration, obstructions, Yes � No
and is securely supporte�i and firestopped where required. ( ��
The vet�ting system is plasticJPVC and meets ai! current codes and manufacturer
specificafions including sizing, length, number of elbaws and termination. Yes (� No (}
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufadurers specc�flcations. This does
�ncfude AGA-GAMA Category 1 Central Fumace Venting Tabtes far fan
assisted and natural draft app�iances.
rne is sized and install�d to meet the current codes
and manufacturer's spedficatians.
When requir�t to ' will be scced and installed
#o mee# the cu►rent codes and manufacture�°s specificatlons.
Yes ( ) No { )
Yes ( ? No ( )
Yes ( ) Na { )
�� , the undersigned hereby verifies that
it is a listed assembly and meets the currerit codes and manufa�urers
spea�ications. This does indude AGA-GAMA Category i Central Fumace
Venting Tabfesfor fan assisted and natura! draft appliances. Yes () No (}
Is the common vent and vent connectors sized ar►d insta{led correctly after
an appliance has been removed from the comman vent and v�nted
separately as per current codes. Yes () No (}
! • � , � ►;_. /�i� , / • • Ik 11 • 1 "' 11 . 1 • ' � • � � ' H • i • �fl . 1 � �
Appliance #1 Type BTU {nput ,_ Fan Assisted or Nat _
Appllance #2 Type 8TU Inpu# ________ Fan Assisted or Nat �
q�liance �3 Type 8TU tnput � Fan Assisted ar Nat ____,____
Tata! �,ppliance� � Tc�taf Ei#� Input,��,
Common Vent Type Vent Height ________ Diameter inches
App�ance #1 Vent Connedor Height fi Length ft Diameter _in Type �
Appliance #2 Verrt Connector Height ft Length ft Diameter „�in Type
Appli�nce #3 Vent Connector Height ft Length ft Diameter in Type a
�l TFRLITIDNS iR�dh�l � 1(1 � I� a�� (�`fi1,�� �.� X i L T
HEATING CO:
• -�� " "��!l��J�'�:!,ill� . = I��
_
�
CfiYOF
FR[DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
Apri120, 2(�4
Ms. Elaine Munay
1020 Hathaway Lane NE
Fridley, MN 55432
Re: Final Inspection at 1020 Hathaway Lane NE
Contractor: Dave's Appliance Heating & AC
Dear Ms. Murray:
A mechanical permit was issued on September 5, 2003 to install an air conditioner at
your address. According to the 1991 Uniform Mechanical Code a final inspection shall be
conducted on the work authorized by this pernut. As of this date the inspection has not
been requested. �
The permit fee that was paid covers the inspection to make sure the work was completed
according to the Codes. We will keep your pemut open for another 30 days and if we do
not hear from you within this time to set up the inspection, we will mark the permit "no
inspection called for by homeowner after notification" and the permit will be expired.
To set up the inspection or to ha.ve any questions answered, plea.se contact the Building
Inspection Division at (763) 572-3604.
Sincerelv.
DJ/mh