AF - 45470�
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City of Fridley, Minn.
, BUILDING PERMIT N° 3 2 3 3
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Ilate: .....'�: �..�.... .�� ...................... .
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Owa�r ..............................:........ Builder ....................... .................
Address ...................................... Address .............................................
�, LCaCATI�IV OF BUILDING
No. ,'�.`�. ��� . Street . . �...�. ...... :s...:...�.. .. : �. Part}oi Lot .. e .. ..... f. .. .� ... �,�.. ,
... . ..F ..
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Lot . . . . . . . . :��. . Biack . . . . . . . . . . . . . . . . . .. A�idition or Sub-DivIsion'�-. :�. . . : . . . . . .'. . . . f . . . . . . . . . � . . . . �
R..� �-., n+�_ / � i.� .. ��_. • .�
Corner Lot ............ Inside Lot ............ Setback .::°::...... Sideyarrl :.:=:.....�...s'::'�...........
DESCRIPTION O� BUILDING
To b� Used as: �, �' ,� ,� �� -
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. .. .. :. .. . . : .. .. .. . Froat . : : . !'. . Depth G : :`. :. . He3ght . . . ./. . . . Sq. Ft. . w . : .; . Gw. Ft.-:'.,. ,.
. . . . . . . . . . . . . . . . . . . . � . . Depth . . .� Height y . � . . Sq. Ft.�. . . . . . . . �,Cu. F't. ; . . . . . . .
�. , . . : . . . . S�t. Cost. ��. .=. : . C. . �. �. . . .. : . To be leted . �t .! . . . . . . . . . . . . .
Zj►pe of Construchton . s�:�..E.. . . .
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In consideral3on of tihe iss�uance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accrordance with the descrlption above set forth and in compliance with all prov3sfons oi
ordinances of the dty of Fridley.
....................................................
. �
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Ea consideration of the payment of a fee of $:......... permit fs hereby gran�ted to ;. ` , F-
.e.�- � :.. .......... �__
. . . .. . . .. . . .. .. . . . . . . .. .. to construct the building or addition as descrlbed above. This permit is granted upon
the express condition that the person to whom it 9a granted and ixta agents� employees and worl�en, in all worI�
done in, around and upon said bu3lding, or any part thex�eoP, shall conform in all respect� to the ordinances of
Fridley, Minnesota regarding location, construction. alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at aq►y time upon violation of any of the provisions of said
ordinances.
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NOTICE:
Thls permlt doea not cove� the const�uotion, Ir�atallatlon o� altaratlon fo� wl�l , plumbing, gas heating,
sewer o� water. Be aure to sea the Bullding InspeaEo� fo� separate permlt� for thosa Itema
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BLOGK' J� PA�k�/�W /��"/Gre%TS �Ota/T/ON �
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INDUBTRIAL C. E. C O U L T E R
� BYBINE88 � .
��,n �o� LAND SURVEYOR ,
TOPOORAPHIG MAPP/N0 REOISTERED UNDER LAWS OF STATE`t7t MINNE80TA
LICPNBBD BV ORpINANCE OP CI':Y�OF MINNBAFOLIB
3300 LYNDALE AVE. 50. MINNEAPOLIS 8, MINN.
� TAYLOR 4-0370
SuR rEY ,�-o,� b'�',Mson� G'�'o�vsi�'�rcr���v
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PLATfINO
FARM BUfJVErt
uKeeHOR¢
JYDICIAL
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I hereby certify that the above is a true and correct plat of a surv�y of:
Lot Six (6), B1ock Three (3), PARKVIEW HEIGNfS ADDITION, Anoka County.
Minnesota.
As surveyed bq me this 6th day of August 1958 A. D.
Signed ,� �- � � ..yF-� . �_-�� .�
Minnesota Registration No. 2584
wPP�oved by Building Ins
, pcctor
����r����r i
r�rr..,.�r
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City of Fridley, M�nn.
BUILDING PERMIT No 4 0 3 s�
Date: ._._..�� ._......� ..._..._.:� .� _..._...�.....__._..
.
Owner: .....�,./_'�l.._....----------'� -�.�_.�--------•--. Builder ....._...;. .....__. _.... .. ... . .._. .._.._._._. ....__._._..___
Address ....._.._.._---._..__.__._......_---•— G�l�� ._...._._..._ Address ..._...__...-----------�------- — -- - - _
L ATION OF UIL ING
No. ..l_:.GC...1..._..Q..... Street _.._. ���. ......_.....:_.._._....---•------ ------(�...... .--..._....__ of Lot
Lot....--� ....................--��---.. Block .--•--............_............._................. A on or Sub-Division .-�--- ---..._........-- �
Corner Lot ....._.......__.....-•-----...... Inside Lot
5ewer IIevation
Setback....._ ............._....................... Sideyard _...._. `�:........_......._...._.....---...__........._.._..__..
._........ Foundation Flevation ....................--�--�•-�--•--............._...--•...._.._......._....__...__...._..
DESCRIPTION OF BUILDING
To be Used as:
. �t � ���� e 9� ��'� �
...�.��...�i� Front --��1-----_.C�� Depth � ............._.. Height _l.Le.-C� Sq. Ft,�../.�.....Sm. Cu. Ft ... _....
..._ .............._...........-�--��-�---��---.......... Front ....._............._......._Depth .............._...._.. Height �........._.. Sq. F� ....._....---•-�--..... Cu. Fk
7�pe of Construction .............._............................... Est. Cost..._�/.��J....._�.�-.-- To be Completed .....----------•------_.
In considera.tion of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance wlth all provisions of
ordinances of the city of Frldley. _/;
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•-•-•--�-•---...---••----------._.�� _. __.1.._���'r�... _..__._..
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In consideration of the payment of a fee oP $.......�........._........., permit is hereby granted to....__.._........._ ............._.
_.._......_._._._....------------...----.--......_ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding l�ation, construction, alteration, maintenance, repair and moving of buildings
within the city li�nits and this permit may be revoked at any time upon violation of an�y of the provisions of said
ordinances. _ � � .. i //�
Building Inspector
NOTICE:
This permh does not cover the wnstruction, inatallaHon fo� wiring, plumbing, gas heating, sewer or water. Be sure to aea
the Building Inspector for separafe permhs for fhese hems.
4
,
May 24. 1962
I�. Ke�etb A. Tigue
1040 ��hawaq Lane �I. S .
�ridl�y 21. Mianeseta
Dnas Sir:
The irar► staka� and �ire f�nca ala� y�r �t lins bave
ba�n z�moved. Y� did in ary vpinion ca�stitute a lu�esrd, anud t'hst
was Ctu raesao �cir rsqu�st�g �ha a�r o� eaid �ancs� to remove ig.
i aacaiged s e�ii fram �iir. Pad$raao �.n segard eo the �+�nca.
It �u hia s�quaet that you da noe bo�h�r a�i�g bis Ps"oP�tey a�►► tha
asrt aid� of bi.s �$dwao� fat►e� a� hm pr+�Pars ta tal�� aare o� ie at �is
own canv�a�ance. T'his ia ��ufectly pe�cmissibie and a iegitimate r�qws�
ar it is i►�.s @svparty • .
A03=cias
cc: Mr. Vern Pederson
1030 flathaway L�ae N. E.
Fridley Z1, Minneeota
�tewrs � �erp fi�rulg.
�1LL�l1 G. JE�SEP 3
Suilding Iuf�ctar
�CALi� 11NCN��
. o«�.h. �� .h•
SURYEY FOR:
D�SCRIBED AS:
J
LE ROY H. WINNfR 8 ASSOCIATES, tNC.
.1'� Sr�yo�
R�gi�tend Under Law� o/ Stah oi Minn�talo
8398 Center Drive • MinneapoFia, Minn. 5543�
Phone 784-0210
CERTIFICATE OF SURV/EY
DENNIS HEJ�DRAIVEK
JOa NO. ...... 75 - 99 ..._
�, __A34� ,�, ., 43 '
Lot 6, Block 3. Parkview Heights Addition, Anok� County,
Minnesota.
Subject to a d�ainag� and utility easement over the
South 6 fe.et thereof.
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DRAWAGE 8 UTILITY EA9EMENT
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I harepy a►Iify thaf fAb arw�� �ian�M n�N1
ras pr�rb O�t ea a wid�r in�► dinCt w/wrM�b�
anA tAef I� a�I�i RpiafK�d La� �
w�d�r 1M lan of th� $fof� 01 MIm�sOt�.
• Oot�_ _,� � �% � 7✓'r Rp. IYo. : �IN?
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24 - 30 - 24, ANOKA OOIRJTY, MWNESOTQ
sua�ett P .
C;ty of Fridley 29412
AT TNE TOP OF THE TWINS g � I L D I N G P E R M I T
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� ; v __��� COMMUNITY DEVEIOPMENT DIV.
f � � PROTECTIVE INSPECTION SEC.
1 = �
� �"'1 � CITY NALL FRIDLE� SS�,Z NUMBER pEV OATE VAGE Of APVROVED BV
�"""� � �'' 612-571-3460 910-F15 5/6/99 / /
JOB ADDRESS 1040 Hathaway Lane NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
DESCR. 6 3 Parkviera Heights Addition SNEET
2 PFOPEiiTY OWNER MAIL ADDRES$ 21P PMONE
An 11Tguyen 1040 Hathaway Lane NE
3 CONTRACTOR MAIL ADDRESS Z�P PMONE LICENSE NO
Four Season Roofing & Remodeling 7930 University Ave NE, Fridley, MN 55432
A ARCHITECT OR OESIGNER MAIL ADORESS ZIP PMONE IICENSE NO.
795-9410 20138780
S ENGINEER MAII AODRESS 21P PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADOITION ❑ ALTERATION Ox REPAIR O MOVE O REMOVE
6 DESCRIBE WORK
Reroof House & Garage (22 Sq) Tear-off
9 CHANdE OF USE FFOM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TVPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SO. FT CU FT
AUTHOii12E0 IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIO� OF 120 DAYS AT
ANY TIME AF7ER WORK IS COMMENCED. NO. DWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIfY THAT 1 MAVE REAO ANO EXAMINEO THIS APPLICATION 1 STAlLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WI7M WHETHER SPECIfIEO MEREIN Ofi NOT. TNE GRANTING OF A PERMIT 1 885 .9�F
OOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEI TNE pEqMIT FEE SAC CNARGE
PROVISIONS OF ANY OTMER STATE Op LOCAL LAW REGULA7ING CON-
STRUCTION R 7ME PERFOfiMANCE OF CONSTNUCTION �rj9.,rJ� Fire �'i �1.88
PLAN GMECK F TOTAL EE
�o L se C 0 � 7.32
S�GNATUAE OF CON"AACTOA Op 4UTHOp�2ED OGENT iD4TE� MEN Pq VA AT 5 IS� PEij�AIT �
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S�GNATUaE O� OWNEp��� OwNEp BU�IDEFi� IDATE� � INS� ���TE
NEW [ ]
ADDN [ ]
CITY OF FRIDLEY
GLE FAMILY AND DUPLEXES R-1 AND R-2
Effective 1/1/99
pLTER [ ] SIN
BUILDING PERMIT APPLICATION �. � � ��
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ConstructionAddress: �v �fD /�J4'r'N lkc,.� /tX �- � � �
Legal Description:
Owner Name & Address: �} 1�1 /UG � Y�� � e�1c� I-��-TtF �4� A�/ L..IJTeI: #
Contractor: � � -��5 o N S �� N � �R£ �o� E(.t � � MN LICENSE #
Address: �9 � o c�. � l l, � dts t T Y A� � F IJ E Tel. # G I�-'7 ��`� t f( o
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width HgtlGround Sq. Ft.
OTHER: R�R� F �dj--s.e -�- �a1��P�_-1�—�' �
Consiruction Type: Estimated Cost: $^ ��S
(Fee Schedule on Back)
Driveway Gbrb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$.
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DATE: �-�- � % APPLICANT: os�� � Tel. # �'/�2- 7� .� �l�//D
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STTPULATIONS:
$ S,So
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$ ��
$
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$
$
$
$
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CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 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 [ ]
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BUII.DING PERMIT FEE SCHEDULE
The Chief Building O�cial 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 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
$2,001 to $25,000
$25,001 to $SO,OQO
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,�1 and up
FEES
$21 (Minunum Fee is $21 plus surchazge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100, 000
$887.25 for first $100,000 plus $5.00 for ea.ch additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1, 000 or fraction thereof, to and including $1, 000, 000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPItESSION ESCROW
(Concrete Curb Streets Only)
Alternate "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 times $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.
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FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacina an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the repfacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air,_it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
Yes( ) No( )
Aqpliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliance� ___ _ Tc�al Btu_Input
Common Vent Type
Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 i7NIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 FAX:
: 1040 HATHAWAY LN NE
: 243024310042
: PARKVIEW HGHTS ADD
: LOT 6 BLOCK 3
: PLUMBING
: RESIDENTIAL
: ADDITION/ALTERATION
571-1287
P T NO :' �2�-00_789�^
DATE ISSUED: 05/27/2004
I VALUATION : $ 400.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL GAS WATER
HEATER.
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPETTINGS)
# GAS DRYERS
# OF NEW FIXTURES
APPLICANT
NORBLOM PLUMBING CO
2905 GARFIELD AVE S
MINNEAPOLIS, MN 55408-2173
(612) 827-4033
OWNER
NGUYEN AN VAN & TAM THI
1040 HATHAWAY LN NE
FRIDLEY, MN 55432
0 # GAS WATER HEATERS
0 # GAS RANGES
0 # WATER TRMT APPLIANCES
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construcrion
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby cerrify that I have read and examined this
application and lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of worls
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 cons�ruction or the performance of construction.
Bldg
PLBG PERMIT 1��[INIMUM FEE
PLBG FIXTURES (NEW OPENII�TGS)
PLBG FIXTURES (EXIST OPENINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 28318
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
1
0
0
0.00
0.00
0.00
0.00
0.00
35.00
0.00
0.00
0.00
0.50
35.50
f