AF - 45523�
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City of Fridley, Minn.
BUILDING PERIVIIT
Dat�: �� 28, 1966
�3�,�
N° 8799
��,; WARREN HOLT H�� GERALD GLENN CORPORATION
Addr�sa — A� 12 02 HathBwaS� Lane N. F. _ �
Fridley, Minnesota 55421
LOCATION OF BUILDING
N� 1191 ��t HATHAWAY LANE N.E. Part of Lot
Lot ? Block 1 Additton or 8ub-Div9eioa Parkview Oaks
Corner Lot _ inside r.ot Setback 35 � S�deysrd 10
9ewer IIevation � 91.2.40 IIevation 915 .40
TOP OF FOOTING
DESCRIPTION OF BUILDING
To be Used es:
DWELLIN'G �t 40 De� 26 H��t 20 �. � 1, OCrO �, �, 20, 800
GARAGE �t 2 0 �p� 2 2 gefght 1 � Sq. F't. �� Cu. F't. 4,�0
�►pe op ���q� Frame ��, �_ 17 000________ To be Completed
MAP SHOWS 1�T0 SEWER OR WATER LOCATIONS
the p�roposed work ia acc�rdeace wl�th the d�scrip�o�n above
ordiaanc�es of the ctty of Fridley.
���
I above I agree to do
wlth ef 1 provisf+�ne of
Ia ca�aideratton oP the paymeat oP a fee oP $ 25 . 00 � perrmit is hereb�► graated to GERALD GLENN
CORPORATION to c�atruct the bu9ldiag or addittan as described above. This�rmi t is graated up�
the exPress conaitlon that thepersoa tfl whom it 9e graated aad h4s agente� employees an� worl�en, 9n all work
dane ia, sround and upon eaid buiiding, or anypart ther+eof, shall conform ia all respects to the o�faar►ces oP
FridleY� Minnesota re�ar81��g lacaation, a�nstructton, alteratton, maiatenance, repair aad movlag oE build9n�s
or8iaanc��. d� ]imits and thia permit may be revoked at eay time upoa violation of ar�y oE the P��ons oP ea�d
ALLEN' G. JENSEN e�� �
NOflCBe
11ds p�emtf doa ee� eowr tia eoedroaHoe, ImtaQ�llee I�er �rWnO. P�+�o. Yp b�a. arnr er watu. B� ara te a�
dn 6upoloo tet�tor io� apanb � hr �a Nbm.
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APFLICATTON FOR Bt1TLDING PER1+�T
CITY OF �RIDLEY, MINNESaTA
OWNER' S NAl� �'" � r r� �°1 � Q f � . BUILDER � Q �' � � c1 � /t� � � (- k�' �r
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ADDRESS � � �'L1 � �,,� � �q ►� e ADDRESS J �• c� � %� q � ��� � �'i �°g
. ��
' LOCATIOAT OF BUtLDING
N0. 1 I /� STREET� � t� � .�i �, PART OF LOT
LOT BLOCR � / ADDITTON OR SIIBDIVISION Q���v ��� �� f C�
CORNER LOT INSIDE LOT SETBAC�C S�DE-YARD
SEWER LLEVATION_ %�°Z � `� U FODNDATION ELEVATI01��% �' O
Applicant attach to this form Two Certificates of Surveq of Lot and pzopoaed
building location drawn on these Cert�icates.
• ,�.�, ,�,,,,,.,,A% �
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DESCRIPTI01� OF BUS.DING
To be used as; ' '
\ ,/
,��o S ; a! �r �- e �' Front�Depth � � Height v� �
Sq. Ft._ ��,.d � Cu. Ft._r�-- /�� U
_ � � `' � � , Front ,� C� Depth�Height_�
Sq. Ft. �5� Q Cu. Ft. � y�o d
Type of Construction_�ra vv,�� Estimated Cost `�� �, ���'
,
To be completed �
�
The undersigned hereby makea application for a permit for the work herein
specified, agreeing to do a11 work in strict accordance with the City of
Fridley Ord�tnances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated �n this appl.ication
are true and correct.,
DATE_ � '�� 7 � � �, SIGNATDRE
(Schedule of Fee Coats can be found on the Reverse Side).
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BIIILDIIVG PERMIT FEE SGHEDDLE
SECTIOP 2. The Inspector of Bui�.dings ahall, before iaeuia� any permit for
the erection of �any building or structure, or for any addition to any existing
building or etructure, or for any alterationa or repairs Ca any existing
building or structure, upon application therefore, require the payment by the
applieant fo'r auch peranit of fees to the amount.herein below �et forth and in
the manaer herein provided to-wit;
2.1� For any such permit for the erection of any fire•proof building,
othei than a garage, warehouae, factory or grain elevator, or�for the erection
of any fire-proof addition, for similar occupancy, to any esiating building,
shall be at the rate of $1.40 for;each one �houeand cubic feet, or fraction
thereof, in such cub�cal contents. �
2.2 For aay such permit for ehe erection of any fire-proof garage,
warehouse, factory or graia,elevator, or for the erection of any fire»proof
addition, for sitriilar 'occupancy, to any existing building.ahall be.a� the
rate of �1.25 tor each one thousand cubic feet, classified�as "fireproof"
by Section 502 of the Minneapolis Buildiag Code. ,
SOIISES
2.3. For any such peronit for,the erection o£ any aon•fireproof
building, other than a garage, warehouae, factory or grain elevator, or
any non-fireproof addition, for s3milar occupancy, to any existing building -
permi.t $1.00 for each one thousand cubic feet.
GARAGES
2.4. For any such permit �for the �rection of aaq non-fireproof garage,
warehouae, factory or.graia elevator, or fox the erection of any non-fire-proof
addition, for eimilar occupancy, to any.egisting building or for each auch
building ar addition.- ninety centa ($0.90) for each one thous.and cubic feet
or fraction thereof, in the cubi�al contents theieof with the m�Lni�um of $4.00.
For the purpose of computing £ees for building permita, the cubical contents
of any building or addition to a uniform height throughout by multiplqing the
ground e�rea covered from a point six (6) inches below the floor line of.the
basement or celZar to the average he�ght of the,upper surface or to tlie average
height of the roaf sur.face of the main gable of a pitched roof.
2_ 5. For repairs or alterations to an existing atructure., the fee shall
be at the rate vf $3.00 per `each Five Hundred Dollars ($500.00) or frecvi�n
thereof in the cost of all proposed work.
2.6. In no case sha11 the fee charged for any permit as set forth in
Section 2 be less.than•$4:00.
STORM REPAIR DAMAGE FEES;
Residential:
E�e�cial;
Estimated Cost of work up to �� �;!?, i`0 -$° e^�
Estimated Cost of wor'.{ c°.:�: ;: �•� ��:. _�;U � Y:. ., ��0
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I her�by c�rtify ;�thai the abo�e i� a tr�+�e and �orr�ct piat of a surv�y oi�s �'
Lo� "�• BIQCk:� 1, PA�lNIEW CZAKS rIFfiST ADDITiOiJ, Anot�a_ Count�, t�3nn�soia.
A� suFVeyed� by me this 19th day of April 19f�0 A.D.
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Signed �+ �
� j �sota R�c+i�tr�iior� Pno. bd67
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GERALD GLENN CORP.
' BUILDERS
1202 HATh1AWAY LANE
_ - - -- -` -- FRIDLEY, MINN. 554,21 �
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I r��r��)+ certify' _,tha V th�: above �. �� �?"L'f? �;,r;d r:orrect �].��t af a surv�y �� :
Lr�� �, �lnct: 1, PHRKVTEVd CAk;S rTRS7 A�DITICJ,., �+,1c,�::� Cc�ur�,ty, 1.3.r�n��o�:a.
hs surv�yed cy mr �this 1.9Lh day of tipr�l 19b0 A.D.
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t;� � ���sot,� iteafytr� ��.o:, :�G. v�r�7
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GERALD GLIENN CORP.
BUlLDERS
1?02 H�►THAW/�y LANE
�RIDLEY, MlNN. 55421
0''}`:'r '° �;�';;r.S.ti :::�t:o y,�ot� 30 �80(� 2 8ID
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Lan:L Planning su���'n 6875 Highway Na.65 N.E.
Lond Survey7ng • • Minneopolis�
s�:�, re,,;,,s �%�/%j2PPiG�7'Z�j %ZC. Minn. 95432
Civll Engineerir�g Telephone 784-6068
Municipol 6ngineering Eng;n,eers & Surveyors Area Code 612
Mort�age Loan survey for NOUS� CLI N I C 5T0��
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Tl�is is a•rue and corract represeMOtion of a survay of the baundoriea of the lond above described o�d of fhe
locafion of ol! buildings� if any� thereon� ond all visible encroachmenfe� if ony� from or on soid land. This survey is
rnade ontr in connecfion with a morfgage loan now being placed on fhe property ond no liobility is assumed
eacept fo fhe holder of such mortgage w any ofher interesf acquired br the reoson of such mortgage. If is
uade�steod and agreed n_p monuments have been placed for the purpose o� establiching lot lines or boundary
" torners. Dafed this 4U0 doy of �un� A. D. 19�.
SUBURBAN EN6INEERINQ, INC.
Engina s ���* � Su�ve�;ors
.3�Z1 br�, '`"r (�'t. �. .'� ' �� .
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City of Fridley, Min.n..
BUILDING PERMIT
Date: SEPTEMBER 20, 1966
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p��.; WARREN L. NOLT g�� ALL SERVICE BLACRTOPPING I�
Addr� 1 1 HA�HWAY LANE N' _E _ ,�d�e� 313 - 9 7th Avenue ,j,Q . W.
Fridley, Minnesota 5542I Coon Rapids, Minnesota
LOCATION OF BUILDING
No. 119I. Street - ��� � R•E .—._ Part of Lot
Lot .._._ 2 .._.___ Block 1 Addition or Sub-Division .—P�W OAKS
Corner Lot _ Inaide Lot
Sewer IIevatian
Setback � Sideyard
—� Fo�mdation IIevation
To i� v�a as:
ASPHALT DRIVEWAY�ront
Front
Type of Construction
DESCRIPTION OF BUILDING
Depth Height ._._.
Depth fTeight .�
.� ��, � _�175.00
Sq. F'� C:u. Fti
Sq. Ft. CtL F'L
To be Completed
Ea consideratfon of the isauaace to me of a percnit to construct the building described above, I agree to do
the proposed work fn accordance with the deacription above set Porth and in compliance all proviaions oP
ordinances of the dty of Frfdley. �-- � � �--
( i - � � -- -
_ �; � �`. - ``�� - ,�`;i_" : .
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In conedderation of the payment of a fee oP $ �' • 00 , permft fs hereby granted to � SERVICE
R �'K'�'OPpT'�'G�C.. to construct the building or addition as described above. This �rmit ia granted upon
the express condi�lon that the person to whom ft is graated and his agenta, employees and worl�nen, in all work
dane in, around and u�n said building, or any part thereof, shall conform in all respects to the ordinanc�s of
Fridley, BRinnesota reg lacation, construction, alteralion, maiutenaace, repair and moving of building�
within the dty limits and�s perm3t may be revoked at any time upon violation of any of the provisiona of sa�d
ordinancea
G*LARENCE BELISLE g�� �r
NOTICE:
TI� psrmM doss not eovar �hs ceos�wcHoe, 6nlalladoe fe� wiring, plumbtee, gu heaHng, aw�r or wate�. 8� am to �
t6e BulWiee lespseta� fo� wparm pannifi h� f6e� Hunt.
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APPI,ICATION FOR BUILDIlQG PERMIT
CITY OF FRIDLEii, M11�IlVESOTA
OWNER'S NAME �arren L. T�olt BUILDERA�.l Servlce Blacktoppin�, Ine.
Ann�ss 1199 xat�away Annx�ss 3� 3- 97't� �ve. �v. w.
LOCATIOPT OF BUILDING
N0, STREET �i4�tT30R,LOT
� i
LOT � BLOCR �ADDITION OR SUBDIVISION � -��. =��--� -.--�= - � - `� � z � ,�r� _ /
—�
GORNER LOT INSIDE LOT SETFSACK SIDE-YARD
SEWER ELEVATION FOUNDATION ELEVATION
Applicant atCach to this form Two Certificates of Surveq of Lot and proposed
building �.ocation drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
______ Front_ Depth� Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. �t. Cu. Ft.
Type of ConstructionBlac��.op �r�:q�t�ay Estimated Cost $ i?5.�0
To be completed Job eompleted.
The undersigned hereby makea application for a permit far the work�herein
specified, agreeing to do alx work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representatioas stated in this application
are true and correct.
DATE_ 9/1 !�/66
(Schedule of Fee Coats can be found on the Reverse Side).
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Bt1ILDING PERMIT FEE SG�IEDIILE
SECTION 2. The Inapector of Buildin$s sh�ll, before iaeuing any permit for
the erection of any building ar atructure, or for any addition to any'esisting
building or structure, or for any alterations or repairs to aay existiag
building or atructure, upon application therefore, require the payment by the
applicant for auch permit of fees to the amount. herein belo� ast forth and in
the manner herein provided fo-wft;
2.1. For any euch permit for the.esection of any fire-proof building, �� ��
othei than a garage, warehouse, factory or grain elevator, or for the erection
of any fire-proof addition, for similer occupancy, to any e$iating building,
ehall be at the rate of $1..40 for each oae thousand.cubi.c feet, or fraction
thereof, in such cubical contenta.
2.2 For any such permit for the erection of any f.ire-proof garage,
warehouse, factory or grain elev�tor, or for the erection of any fire-proof
addition, for aimilar occupancq, to any esieting building ehall.be at the
rate of $1.25 for each one thousand cubic £eet, classified as "fireproof�'
by Section 5 02 of the Minneapolis Building Code.
HOIISES
2.3. For any auch perm3t for the erection of any non-fireproof
building, other than a garage, warehouse, factory or grain elevator, or
any noa-fireproof addition, for similar occupancy, to any existing building -
permit $1.00 for each one thousand cubic feet.
GARAGES .. _ _ _ . . ...
2.4. For any such permit for the erection of any non-fireproof garage,
warehouae, factory or graia elevator, or for the erection of any non-fire-proof
addition, for similar occupancy, to any esisting buildiag or for each �iuch
building or addition - ninety cents ($0.90) for_eacln one thous.and cubic feet
or fractioa thereof, in the cubical contenta thereof with the minimum o£ $4.00.
Rar� the p�ose--�f �amp�t�ft�g- fees- for buiidiug -pe�mits; tir�-c��tca�- c�ts --
of any buildiag or addition to a uniform height throughout by multiplying tha
ground area�covered from a poine six (6) inch�s below the floor line of the
basement or cellar to the average h�:tght of the upper surface or to the avErage
height of the roof surface of the main gable of a.pitched raof.
2.5. For repairs or a�terations to an existing structure, the fee shall
be at the rate of $3.00 per each Five Sundsed Dollars ($500.00) or frzct�ton
thereof in the cost of a11 propoaed work. •
2.6. In no case sha11 the fee charged for any permit as set forth in
Section 2 be lesa Chan $4.00.
STORM REPAIR DANIAGE EEES:
Residential:
Co�ercial ;
Estimated Coat of ���rk up tn ��C�.00 - S.5e�0
Estimated Co9t Of c�u�ir C•re� r:�=��:���J -,�,;:•;;,,f;Q
Est$ma.ta�.�o�r c� �a;,�is tt� i-� �.`.-" ��:: �3�J �."� ,I��'0
Estimri�e ,;ost of v;o�k �et� y �C�C+.vi1 - $� .�a .,�, ,�.�.
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City of Fridley, Minn.. �
6431 University Ave. N. E., Minneapolis, Minn. 559.32
BUILDING PERMIT .
Date: Tune 15_ 1�77_
� 10 � � $ �..�.
pwner; �hn iTll_ o�_ Builder House Clinic Sto�e
Address —.-1191 HAt�+�c�.�v T•�1�1�T E Address 39-18-�nTes t-� 9.g S-ts�e�-�l.s .--
LOCATION �OF BUILDING
No. �____. Street Hathawa,� T.?ne N_ F. _ ____ __— part of Lot
Lot 2 Block 1 _.__ Addition or 5ub-niv3�tan .—. Parkvie��� (laks lst Addition
Coraer Lot __�.._..�. Inside Lot X Setbaek - Sideyard
Sewer IIevation .- Foundation IIevation
DESCRIPTION OF BUILDING
To ue vsea as:
Patio Deck _,__,_._ Front —12� . Depth. �_ Height .�8 �._ Sq. Ft. _171� Cu. Ft
.� Front ..` Depth Height Sq. F� Cu. b't.
Type of Construction F�'ame Fst Cost .��.1�, 40SL. �� To be Completed -7„1 v 1 5 1 a71
In consideration of the issuance to me of a permit to construct e building described above, I agree� to do
t�►e proposed work in accordance with the description above set and in plian with aII provisions of
prdinanc�es oE the city of Fridley. ,%�/� �y _
In consideration of the payment of a fee of $ 9• 00 , permit is hereby granted
to canstruct the building or addition as desc�tbed above. This permit ia graated upon
the express condition that the person to whom it is granted and his agents, employees and worl�nen, �la all WoTk
done in, around and upon said building, or any part thereof, shall conform ia a]1 respecta •to the ort�in�ne� oP
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair aad moving of bwfldiIIgs
�i� � city limits and this permit may be revoked at any time upon violation oP any of the provisions oE 88id
�� I �.� � � . , •
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NOTICE:
This pemsit does aot cover the construction, inataUation for wirine. plum6in8� Bes 6eaHng� aewer or water. Be �trc to s6s
ths Building Inspeetor for .separate permth fo� fheae hems.
.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME :✓�i�n/ U�.0 �� BUILDER : /,l o uS � CG rrt� �c
Sto� �
annx��s :_ �/�'� - �� r� �- �.r�.a ys �_ nxESS : ��'i� � �- �� ��- S7' �l��.s°
N0 :._ I'/°� � STREET :/�� T�,IA c�rQ.;� G,� ,✓�
LOT:_ 7 BLOCK: I ADDITION;� �-�-�(�(� �°�t,c� O� � /s
, s �����
CORNER LOT: INSIDE LOT:,�_SETBACK: SIDEYARD:
Applicant attach to this form ltao Certificates of Survey of Lot aad proposed
buildi.ng location drawn on theae Certificates.
BESCRIPTION OF BUILDING
To Be Used As:
��Ti,o a5 E� �� Front • i'�_DePth : ,�_Height : �
Square Feet: / i/ Cubic Feet:
Front: Depth: Height•
Square Feet; Cubic Feet:
�pe of Coastructioa: Estimated Coat:_$ ��e�o ° °
To Be Campleted: '��C�-,� /'J"%'� � '
The uadersigaed hereby makes applicativn for a pexmit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and xulix�s of the Department of Buildiags, aad hereby
declares that all the facts aad representations stated in this application
are true aad correct.
nA� : .� iS 7� siGrtasuxE • O`� � ��
(See Rev�xse Side For Additioaal Infc�mation.)
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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 for any addition to any existing
building or structure, or for any alteration or repairs to any exiating
building or structure, upon application �herefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in
the manner herein pravided to-wit:
iJNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fxaction thereof, in such cubical contents. Type 3� 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
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
or the cellar to the average heights of the upper surface or to the averager
height of the roof 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 thereof in
the cost of all proposed work.
In no case shall the fee charged for any pextnit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Pennits for construction will be issued a minimum of 24 hours from the
time of application, to allow for proper review of the proposed structure aad
of the coastruction site. �
A Certified Survey af the lot, showing the location of the fouadation, once it
has been constructed, will be required before Aroceedint� with the framing.
CERTIFICATE.OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building pern�it has been
iasued; and said structure shall not be used or occup�ed until a Certificate
of Occupancy has been issued. •
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Lond Rlonning � /�n 6875 Highway Na.6S N.E.
lond Surveying u�u V • •
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so:�s te5t��9 �Z2Q�/j2Pe�L�`/'G�j �'12C. nn���. ssass
tivil @ngineering U Telephone 7$4-6066
Municipal Engineering En�ineers & Surveyors Area C,.Qele 412 -
Mortgage Loan Survey for NQ�S� ��� �`�) �� STQ�E
Draina�e � U{,����y �a�emern�
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This is a true and correct representafion of a survey of the boundaries of the land obove described ond of the
�°�°��a� oi all buildings� ii any� thereon� p�d all visible e�eroachmenfs� if any, irom or on said land. This survey is
made only in con�ecfion with a morigoge loa� now being placed on the proper►y and no liability is ossumed
eacep� fo fhe holder of such mortgage or ony other iMerest ocquired by the reason of such mortgage. It is
undersrood ond ogreed qp monuments have been�placed for the purpose ,of estoblishing lot lines or boundary
corners. Dated this 4L16 day ef Sur1e A. D. 19�,
, SUBURBAN ENGINEERING, INC.
-5��� Engine�s. M 4.} Suyve�ors
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sue�ecr i�M1T NO. "
. c�ty of Fridley 2 212 4�
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� � RE O.
� ; L __�__ COMMUNITY DEVEIOPMENT DIV. �� ��
� � PROTECTIVE INSPECTION SEC.
i i �
� �'�'1 � CITY HALL FRIDLEr 55432 NUMBER REV. OATE PAGE OF APPROVED BV
�'"""� � ,�� 612-571-3450 910-F15 �I22/g3 � �
JOB ADDRESS 1191 Hathaway Lane NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 1 �arkview 031tS First Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS Z�P PHONE
James Ba.gaason 1191 Hathawa Lane NE � 572-0350
3 CONTHACTOR MAILADDRESS Z�P PMONE LICENSENO.
Same
e ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 2�P PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WOHK
❑ NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroo� Eiouse & Gaxage (23� Squares� Tear�o,ff
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must cc�tply Hrith the State Building Code. Provide adequate
attic ventilation, Qrovide saioke detectors as per LTBC 1210 adjacent to all sleeping
areas and in l�asement.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEAT�N(i,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERI00 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 WOHK WILL BE COMPLIED $2 � 350 ' $1. �. %
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHAHGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $S4. QO Fire �C $2 � 3S .
PLAN CHECK FEE TOTAL FEE
$5�.5z
Si EOFCONiRACTORORAUTHORIZEDAGENT IDATE� WHEN PROPEftLY VALIDATED THIS IS VOUR PERMIT
— �-�-o���' l�
iGNATUREOFOWNERiiF NER ILDERi IDATE� ��BLDG �NSP On7E
NEW [ l
AnDN a I l
�-� t 1
e
CITY OF FRtDLEY
SiNGLE FAMII.Y. AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 5126/93
Consbruction Addres�: /�9 � �Ll %y��`� v/'J j' G�',� �
Lega1 I?escription:
Oaner Name 8c Address: �/"!� S�- � C%�� S� a✓ Tel. ���- 0 3��
Co�ractor: ��.' AL / �� MN LICENSE #
Address: �6�1/"�� Tel. #
LIVING AREA: Length
Attach to this application, a Certificate af Suivey of t6e
lot, with the proposed c�astruction drawu on it to sc�le.
DESCRIPTiUN OF IIMPROVEMENT
Width
Height Sq. Ft
GARAGE AREA: Length �c&h Heaght �. Ft.
DECR AREA: Leagth Width HgtlGtouad �. Ft.
OTAER: �E°- ��� � �>�'� � �'yi� C-��' � � a ����zES �/� O�F
Corn�r Lot [] Inside Lot [ j Ft_ Yd Setback Side Yard S�ks
Type of Construction: /IS'O/f�� ( Esdmaced Cost: � � , -�' �.� S�� � �,
Approx. Coa�letion �ate: � �-- ��'.� �
(Cosi on Back)
Driveway Curb Cut Width Needal: Ft. + 6 Ft = Ft x$
DATE: ���" %3 APPLICANT.
CITY USE ,� I�T ,Y.
Peimit Fee $ �`� '`� �� a F� �halule on Reverse Side
Fire Surcharge $ ���.�� .�1 of Permit Valuation (1/llyth%)
State Surchazge $ /, d 7 �.50/$1,000 Valuation
SAC Charge $ $750 perr SAC Unit
License Surcharge
Driveway Escrow
Erosioa Coatrol
Park Fee
Sewer Maia Charge
TOTAL
$
$
$
$
S
� ��`i , �`� �.
$5.00 (Stat,e Licensed Residential Contractors)
Ait. "A" or Alt. "B" Above
Conservation Plan Review $450.�
Fee D�termined by Engineering
Agreement Necessary E l Not Ne�essary [ l
STIPUL.ATIONS:
�
Tel. # �%��63�6
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or struc�ure,
or for any add.ition to any existing building or structure, or for any alt,eration or repair to any existing
building or stcvcture, upon application therefore, require the payjmern by the applicant for such permit
of fee.s to the amount herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $S00
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000 .
$50,001 to $100,000
$10U,001 to $500,0�
$5�,001 to $1,000,� .
$1�,000,001 and up
FEFS
$1 S(Minimum Fee is $15 plus surcharge)
$15 for fust $S00 plus $2 for e,ach additional $100 or
frac�ion thereof, to and including $2,000
$45 for first $2,0�0 pins $9 for �ach additional $1;000
or fraction thereof, to and includiag $25,000
$252. for Sust� $25,0� ples $6.50 for each additional $1,000
or fraction thereof, to and including $50,000
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to .and including $100,000
$639.50 for first $100,0U0 plus $3.50 for each additional
$1,(�l0 or fraction ther�f, ta aad including $500,(�0
$2039.50 for the iust $500,000 plas $3 for each additiional
$1,(I00 or fracbion thereof, to and including $1,000,000
$3539.SU for die first $1,�,000 plus $2 for each additional
$1,000 or fraction �thereof -
DRIYEWAY DEPR�SSIDN ESCROW
(Concrete Curb Streets Only)
Alternaf.e "A" : Removal and replacement of curb and gutter only - Driveway width plus b feet times
$13.50.
Alternate "B": Removal and replacement of curb and g�utter and install a 3 foot wide.
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION O� FOUNDATION
Permits for coastruction 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 �he framing.
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` FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
� COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existina furr�ace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterio�ation, obstructions,
and is securely supported and flrestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
spec�cations including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies�that the replacement 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 existinq 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 cannectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per cuRent codes.
No ( )
Yes( ) No( )
Appliance 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 Appliances Tc�al Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Applianc� #2 Vent Connector Height ft Length ft Diameter in Type
Applianc� #3 Vent Conne�tor Height ft Length ft Diameter �in Type
ALTERATIONS� (Describe)
HEATING CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DESC
PERNIIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 LTNIVERSITY AVENUE NE
FRIDLEY, MN 55432
,63) 572-3604 FAX: (763) 571-1287
: 1191 HATHAWAY LN NE
: 243024310047
: PARKVIEW OAKS 1ST ADD
: LOT 2 BLOCK 1
: PLUMBING
: RESIDENTIAL
: ADDITION/ALTERATION
�------ �`
PERMIT N�.: 2004-00994
�- �
DATE ISSUED: 06/25/2004
VALUATION : $ 300.00
NOTE: COMBUSTION AIlt SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A WATER
SOFTENER.
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPETTINGS)
# GAS DRYERS
# OF NEW FIXTURES
APPLICANT
SHILOAH WATER CO
7319 166 AVE NW
RAMSEY, MN 55303-
(763) 753-9244
OWNER
BAGAASON JAMES G& JUEL K
1191 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 constntction
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 know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cance the provisions of any other state or local law
regulating co tru tion or the performance of construction.
Bldg
PLBG PERNIIT MINIMUM FEE
PLBG FIXTURES (NEW OPEI�TINGS)
PLBG FIXTURES (EXIST OPENII�TGS)
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 # 9927
0
0
1
0.00
0.00
0.00
35.00
0.00
0.00
0.00
0.00
0.00
0.50
35.50
SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE. '`—
r