AF - 45445�
City of Fridley, Minn.
B�UILDING PER.NIIT
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Addr�ss ......................................
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Address .............................................
LOCA►TIQN OF BUILDING
No. .. ��.�.��. Street . :. ` � .......'' ' �... "�..: ".Y.. a�:�:. Part f Lot ... .... . . .. ,�,
Lot . .�. .�. . . . . . BY�k . . . :+�'. . . . . ���ddition or Sub-Dinision �� :�"s�:�":`'� 4��iF.�° �,� . �'`�,��, �
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Corner Lot ............ Inside Lot �,,...:.... Setback .��.... Sideyarrl .;¢�'� .. �,�. .i�:. ..:..
DE�CRIPTION O� BLIILDINC
be Used as: ,� �
. ..�''� �' ......... Frozrt � ... Depth��� Height ....�.. Sq. F't. .��.� Cu. Ft .�::� ���
. .. . . .. .. . . .. . . .. . . . Front . . . . . . . Depth . . .. . Heigh� . . . Sq. Ft. . .. . . .. .� �Ct�. Ft.
Type of Construction""���''�' C: ri==� . . . . . Es�. Cost���•. �`,A�°.�" �'. �";�. .. . To be Completed �. �± ,�`r: . . . . . . . .
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In consideration of f�e issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the des�iption above set forih and in compliance with all provisions of
ordinances of tlne city of Fridley.
....................................................
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In considera.tion of the payment of a fee oP $'` �..:":`. .., permit is hereby gxanted to (','f�''" 1.t; �' �, ,�; ; z�; :
....... .. ........ ........ to construct the building or addition as described above. This permit is gra,nted upon
the express condition tha.t the person to whom it is gra.nted and his agents, employees and worlmzen, fn 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 location, coastruction, alteration, maintenance, repair and moving of buildings with-
in the city li�nits and tYus permit ma.y be revoked at a�y time upon violation of any of the provisions of said
ordinances.
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,����� _, _ .���:�. B�ilding Inspector
NOTICE:
This pe�m(t does not cover the const�uctlon, Installation o� alte�ation fo�
sewer or wate�. Be su�e to see the Butlding Inspeotor fo� separate parmtte �
�` ' : �
9ng, plumbing, gas heating,
thes� ttema
INDUBTRIAL
BUBIN686
c�rv �ors
TOPOORAPMIC MAPPINO
Ba��.� 3�.�k'��r�'�� �/����a� A�.�s rir �v
C.. E. COULTER
, LAND SURVEYOR
- REGIBTERED UNDER tAWS OR BTATE OF MINNESOTA
LICENBED BY ORDINANGB OR CITr OF MINNEAPOI.IB
3300 LYNDALE AVE. SO. MINNEAPaL15 9, MINN.
TAYLOR 4-0370
S � R v�Y Fo, c' �E".v'.�o N C'orvs%C'v�'�i o�r
�sn�argar'8 �rrti#ir�tr
SC.�LE:
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I hereby certify that the above is a tru�e �and correct plat of a survey of :
Lot Eleven (11), Block Three (3�, PAAKVIEW HETGHTS ADDITIOtd, Anoka County.
Minnesota.
As sur�reyed by me this 6th da� of August 1958 A. D.
. Signed /L�� . a°
Minnesota Registrata.on No. 2584
Approved by Bui(dirog (nap�c�or �
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Date:
Owner:
Address
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City of Fridley, Mi�.. ,,:'`
,
BUILDING PERMIT No ` 7 5 s�
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..�.�.--.-_ 6 --�". � '��t° �:.. Builaer -----.._...�...�.�. ._
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..� _.. —'��; Address ........_......_....------.....__.......___...._...._ .:._.__-._.__--�----.....�...._..
--. -- - TIONY Of y��'BUILDING
No. ..%.�.....:t-�--�-..----.- 5treet •-;���� .�-- - - -� �•---�--- Part t -----...._..._.__._._---�--------.__--- -. .__
Lot ....._ ..... ..... ................. Block _..._....-- - :
�� - ��........-- ._.._........ dition or Sub- . ion _ .... . _ _._ ._........ ..__--!..�.+._.�_..�..... ._-..�
-
Corner Lot ........:................._........ Inside Lot ...._�f ............. �tback
.._, ... .. . _. ... Sideyard .--�--... ..�..�+.. ._ ............._.......---�--.......--��------�---
SewerIIevation .--�-- ............._...----.._...__...._--••--�--�-�--..._..---��---�--•--��---- .....---. F dation IIevation .....---•--..._.....-�---•--�-----�-•-----
DESCRIPTION OF BUILDING
To U as:
-, ---- -. --- .__?� �... Front ,� :lf�...._._ Depth .....�.,��„ Height .._.,�.�.... Sq. F� .-. �
...... � .....--�-. Depth _ ........... .._.. t ............. - ... Sq. Ft. .._._......._..-----
_� .._...... . Fro .....;� � - ,.� t�
Type of Construction ..... __ .:.......:.......... ...... .. ...... .. Est. Cost.........�!���f��.,,���_�o be Completed .
Cu. F� ....._�. '_�!!r"CJ
Cu. F�
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THI� ?E ��vilT `�` ��_���"`�:T. ^..`.'�-HOR6ZE Vi0L,4T-
�;_��� .:��F "�',,'y ;��;��J�, i c= Lra��d?� CuVENANTS AN�
C�UiLDiNu I���T�;;�I-f,JNS.
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 with all provisions of
ordinances oP the city of Fridley.
�..,.---•---......._..___.._..__......_...._......._.__..._...._.____......__.___..__._..___.__.._
In consideration of the payment oP a fee oP $.�"".'.�..., permit is hereby grauted to....._.._..__...._ ............._._
.___T_....._...._...._...__..__....._._. to construct the building or addition as described above. This pern►it is granted upon
the express condition that the person to whom it is gran.ted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respecffi to the ordinances of
F'ridiey, Minnesota regarding lceation, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit ma be revoked at an tixn lation of y of the provisions of said
ordinances. Y Y /�,�i�'� i
Building Inspector
NOTICE:
This permit does nof coper the eonstruetion, installatlon for wiring; plumbing, gas heating, sewer or water. Be wre to see
fhe Building Inspector for separate perrti�s for. fhese items.
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Address
APPLIGATION FOR BIIILDTNG PERMI�
� CITY OF FRIDLEY, MIlVNES03'A
� LOCATIOAT OF BUILDING
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No.
Lot _,�� _., Block .;� , v Ad.dit3on or Sub������.���- �����,�
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Gorner Lot,+,Inside Lot_,_, Set Ba.ck Side-Yard `~'
SEWER ELEVATION F'�UNDgTION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
1oca.tion.
DESGRIPTIOIG OF BUILDING
To be used as:�� •
��� F`ront lGa De th �� � Height �`
, p
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Sq. Ft. ,i ��� Eu. Ft. ��� �
. ,> d �-� fl . � � l"�
Sq. Ft. �• Ft• �
Estimated Gost ✓��
Type of Construction ��,���� .�._
To be completed � �
The underaigned hereby �oakes applvication for e permit for the work herein specified,
agreeing to do ell work in strict accordance w3th the City Ordinances and ruling cf _�
the Departanent of Buildings, and hereby declares ha.t all the fa ts and repres ta- ��-.
tions stated in this application are -true e ���y�� ` ,
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,..mc+ �1 -- a5 f � �` � STr.NnTrn�F' :e%r ��/���,�,,A�r� � v�.,�. _°��� _
(A Schedule of Fee costs can be found �n t�e�everse S�de.)
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Seet3on 2. The InspBCtor of B�.iildinga shall, before 3seu3.ng ang permi�
for the erection of ar�g builcAing or structure, or for any addit3on to
ang existing building or structure, or for any alterations or repeirs
to an�r exlat3ng building or atructure,.upon applica.tion therefor, require
the pa�nnent by the applicant for such permit of fees to the amount hese3a
beiow set forth and in the manner herein provided to-wit:
2.1. For any euch permit for the erection o£ any fire-proof bwLlding�.other
than a gara.ge, warehouse, factory or grain elevator, or for the erection of
an�r firepr.00�' addition, for s3.mi].ax occupancy, to any existin� building
sha]1 be at the r�.te of .�1.40 for each one thousand cubic feet, or fraction
thereof, in such cub3c�1 contents. .
2:2. For an� such permit for the erection of any fireproof gara�e� �aar�
bous�, factory or gra.in elevator; or for the erection of any fireproof
addition, for similar occupancy, to any existing bui].ding sha11. be at the
ra.te oi $7..25 for each one thousand cubic feet, classii'i.ed as '�f'3.reproof�
by Ssction 502 of the Minnee.polis Bui].ding Code.
OH U3ES
2.3. For any suoh perm3.t for the erection of e.n
cther than a garage, warehouse, factory or �ain
fireproof addition, for simil.ar occupaney, to any
Permit $1.� for each one thousand cubic Peet.
GARAGES
y non-fireproof building
elevator, or ar�► non-
existing building.
2.4. For an� such permit for the erect3.on of an3► non-fireproof garage,
werehouse, fao'tory or grain elevator, or for the erection of any non-
Fireproof addition, for similsx occupanc�, to am� exi.sting building
for each auch building or addition. Ninety Centa for each one thousand
cubic feet or fraction thereof, in the cubical contents thereof with a
min3mum of $4.00.
For the purpose of computin� fees for building permits the cubical contents
of any building or addition to a uniform height throughout by multiplyiug
the ground axe� covered from a point six.(6) inehes below the floar line of
the basement or cellar to the average height of the upper surface or to the
average height of tlie roof surface of the main gable of � pitched roof.
�
2.5. For repa.irs or alterations to an exiating structure, the fee �hail be
at the rate of �3.00 for each Five Hundred Dolla� (�500.00), or f�action
thereof in the cost of all proposed work.
2.6. In no
Secti9n 2 be
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case shall the fee charged for an�► permit as set forth in
less tnan �4.00•
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City of Fridley, 1�I�nn-
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUII�DIN'G PERMIT
Date: August 8, 1972
�-���d3��J
�-�'�f .115 � �
��,: Jerry Meaders B�� Leo 0. Sanders
Ad�.� 990 Hathaway Ad�$ 7813 Jackson Street N.E.
LOCATION OF BUILDING
No.. _�.�.Q...__..._._. Street �.�athaw�y Part of Lot
Lot �_.11 Block 3 _..� Addihon or Sub-Division Paxkview Heights
Coraer Lot __�_ Inside Lot X Setback Sideyard
Sewer Elevatfon �_ _ ._._ Foundatlon IIevation
DESCRIPTION OF BUILDING
To�v�a�:
Inside draia tile s t
�..._. �ron� Depth Height Sq. Fi. Cu. F%
T.� Front Depth Height Sq. F� Cu. F`E.
Type of Construction ��, �sti � 9 00 . 00 To be Completed
In considera.tion of the fssuance to me of a permit to cons the building described above, I agr�e to do
t� proposed work in accordance with the description above set and in pliance wi aII provY�tonB �
Ord�ances of the city of Fridley.
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In consideration, of the payment of a fee of $ 6.00 ,�t is hereby granted to Leo Sanders
to construct the building or addition as described above. This permit fs granted u�i
the express condition that the person to whom it is granted and his agents, employees and worl�en, in all Work
done in, around and upon said building, or any part thereo% shall conform in a]1 respects •io the orc�inaac� oP
I�`ridley, Minnesota regarding location, construction, alteration, maintenance, , repair and moving of buIIdiIIgB
vyithin the city ]imits and this permit may be revoked at any time upon violatton of any of the provisiona of s�id
ordinancea �
/ .�
Strlldln8 Inspector
CLARENCE BEL�SLE
NOTICE:
This permit do� not eover the eonafruefion, inafallation %r vvtrins, plumbtng, gas heatiug, sewe� or water. Be surs to �
t6e Building Iespeero� for aeparate permih for the� hems.
�
AP.PLICATION �OR RESIDENTIAL, ALT�RATION,
OR AllD�T�ON BUILD�NG p��tNjIT
CITY OF FR�DI,EY, MINN�SOTA
OWIYEA � S �TAME t BUILDER • �, � �- � .
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ADD�tESS s � J ADDRESS :� / � �./ '' �- � �
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N0: � � STREET:
�,0'1' ; l BLOCK : � ADDITION t �G�i�cr�.•� .�
� .. +�res�i
CORNER LOT: INSIDE LOT:_�_SETBACR: SIDEXARAo�
ppp�.i.cant attach to this form 1�,�o Certificates of Survey of Lot and pxo�p�e�d
building location drawa on these Certificates.
HESCRIPTION OF BUILDING
To �e Used As: l
� ��� ront: Depth• Height:
Square Feet: Cubic Feet:
' Front: Depth• Haight:
Square Feet; Cubic Feet:
7.jrpe of Conetruction: Estimsted Coet: $ ��� �m'��
To Be Campleted;
The unc�ereigaed hereby malces application for a pes7ait for ti�e _w4�7�1� ��7c��
specif�,ed, agraeing to do all work ia ettict accordance with the C,ity p�
F�idley 0ldinaacee and suliags of the Department of Buildinga, aad'b�e��b,
d��la�es that all ti�e facte aad repreeentationa atated in thie ap�1�,g���,g�
axe ttue and correct.
�AT�; �� '� � �" SIGNATUItE : � ��¢�� 'zz°��7
� e e ■�eeee
(Sep Reveree Side For AdditionaY Iaformation.)
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$UILDING PERMIT FEE SCHEDULE
S�CT�ON 2. The Tnspector of Buildings shall, before issuing peimit� foz the
erection of any building or structure, or for any addition to any existin�
building or structure, or for any alteration or repairs ta any ex�sting
bu�l$�ng ox str�cture, upon application therefore, require the paysne�� by �h�
app�icant for such permit of fees to the amount herein below set fa�th �Rd iR
the manner herein pravided to-wit:
tJNI�'ORM BUILDING CODE: �pe 1, 2� 4-$2.15 for each one thousand cubi,c
�p�t, ox fraction thereof, ia such cubical contents. 1�►pe 3� 5-$1.$S �4x
each one thousand cubic feet.
ADDITIONAL INFORMATION
Far the purpose of computiag fees for building pe�i.ts, the cubical contents
of any buildis�g or additian, ia determined by multiplying the ground area
covered from a point six �6) inches below the floor line of the base�ent
or the cellar to the average heights of the upper surface or to the average�
height of the roof surface of the msin gable of a pitched roof.
�or repaire or alterations to an existing atructure, the fee ahall 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, ao case shall the fee charged for any permit as set forth in Sect3.a�i � be
less thaa $5.00.
VFRIFICATION OF FOUNDATION
NpT�; Pern�its for eonstruction will be iseued a miai�tm of 24 houxs f�o�pa th�i
�ime of application, to allow for proper review of the proposed structu�e atnd
o� the construction site.
�i Ce�tified Survey of the lot, ehawing the location of the foundat�o�� pi�c�e� ��
haa been coastructed, will be required befo�e proceedinA with the fxamin�,
CERTIFICATE OF OCCUPANCY
Application for a Certificate.of Occupaacy shall be made ten (10) days �xic��
xp the use or occupancy of any structure for which a buildiag permit ba� it��
ieaued; and eaid structure shall aot be used or occupied until a Certi�ica��
o� Occupancy ha.s beea isaued.
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- CITY OF FRIDLEY
�.;� 8431 UNIVERSITY AVENUE N.E.� FRIDLEY, MINNESOTA 55432
TELEPHONE ( 812)571-3450
July 22, 19s3
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� PaciPie Pool � Patio
b922 - 55th Street N.
North St. Paul, lIl�i 55109
Re: Sxi�ing Pool Construction at 990 AathaWay Lane N.E.
Dear Sirs:
This letter is to make clear this department�s requirements for the
sWimming pool coastruction at the above address.
1. As indicated, one (1) skimmer approved by the National Sanitation
Foundation rrill be provided.
2. As indicated, tWO (2) inlets of approved design for fresh and/or
repurified Water xill be provided.
3. As indicated� a main drain oP approved eoastruction xill be
provided.
�. The filter and pump shall be approved by the N.S.F. and be of
aufficient capacity to provide a minimum turnover oP at least two (2)
times in 24 bours. This department recommends a turnover rate of 6- 8 0
hours.
5. A deek of at least three (3) feet Wide� measured from the pool
Waters edge� ahall be provided Which exteads completely around all
private residential pools. Above ground private residential pools may
be provided With decking of a minimum size of 4 feet by 4 feet at pool
entry points and provided that such deckiag has the approval oP the
Citq.
6. The diving area xill be aceeptable provided there is no overhead
obstruction.
7. Fencing or other effective means including but not limited to �alls
or buildings, acceptable to the City, shall be provided to positively
control all access to public and private residential sWimming pools.
Fencing shall meet the follo�ing eriteria:
(a) The feneing shall prevent the entranee of children and be
�ithout hand or foot holds that r►ould enable a person to climb over
it.
(b' The fencing a�a12 �e at least 6 feet high aad entrances shall
b� ec�uipped With self-closing and self-latching gates capable of
Deing locked.
(c) Se1P-closing and self-latching devices shall be plaeed at the
top of the gate or otheririse inaccessible to small children.
(d) The opening betWeen the bottom of the fenee and the ground or
other surface shall be aot more than Pour inches.
R
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PaoiPic Pool � Patio
duly 22, 1983
Re: 990 IiathaWay Lane N.E.
8. An automatia ahlorinator should be provided With a suitable test ldt.
9. All electrical and plumbing installations shall be inspected and
approved by the City Inspection Department.
10. All overhead electrical lines must be a minimum of 10 feet
horizoatally from the pool surfaoe, and 18 feet straight line distanae
from the waters edge. An alternative is to bury said lines.
11. The pool fill apout must be protected by a vacuum breaker or
air-gapped.
12. Suitable saPety equipmeat to include but not limited to a ring buoy
and rope that is 1-1/2 times the pool diameter and shepherds erook pole
must be provided and maintained with the pool at all tim(es.
Furthermore, these and any other requirements must meet the provisions of
the Fridley Citq Code, Section 115, Swimming Pools. The building permit
is approved contingent on final inspeetions and approval of the City.
If any questions or problems arise from this letter, please feel free to
eontact me at 571-3450.
Sineerely,
STEVEN J. OLSON, R.S.
Environmeatal Officer
SJO/mh
CC: Mr. Thomas Reed
Page 2
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A high performance totally
corrosion-proof filter series that
combine superior filtration and
features with ease of operation.
Designed with the pool owner
in mind, the S-200 and S-240
filters produce clear, sparkling
water with only the very least
attention and care. From "see-
thru" dome and maintenance-
free construction to convenient,
easy-to-use control valve, the
S-200 Filter Series is the ulti-
mate in high rate sand filtration.
F�ATUR S F' `TiiE S-200 (ES
�IIANUAL AIR RELIEF for easy, safe manual re-
lease of air from system.
f���l� VIEW LEXAN� DOME. Clear 6" threaded
inspection dome lefs you see operation of filter
and provides convenient access to top of filter. O
°�OP �IFFUSER. Assures even distribution of water
over the top of the sand media bed. All internal pip-
ing is 2" to give smooth, free-flowing pertormance.
�&��°�IIAe4TIC AsFd 63�LIEF, Automatically purges
filter of any entrapped air during operation of the
filter system.
�OR�i��I�N-PR��F, HEAVY-DUTY FILTERi
�ANK. Injection molded of tough, durable ABS
for dependable all-weather pertormance with only
minimum care.
I�OLTED CENTER FLANGE. Provides extra
strength and securely and safely fastens tank top
and bottom together. Allows for future service ac-
cess to all filter components without disturbing
piping and connections.
6-POSITION HAYWARD VARI-FLO CONTROL
VALVE with easy-to-use lever action handle to let
you "dial" any of the 6 valve/filter functions. FIL-
TER, WASTE, BACKWASH, RINSE, CLOSED or
RECIRCULATE.
�lNIAR! I�OCKNUTS make assembly or disassem-
bly of the control valve easy.
EFFICIENT MULTI-LATERAL UNDERDRAIN AS-
�l�M�6X, These precision engineered, corrosion-
free, self-cleaning laterals give totally balanced �
flow, even when backwashing. Laterals individu- �
ally thread into center collector hub to assure
posltive sealtng, and allow for fast, easy servicing.
�I�PPORT SKIRT. Rugged and attractively styled
to provide strong, stable support for the filter as-
sembly. Totally corrosion-proof, too.
��AI� �IPE A�SEMBLY allows for total draining
of filter for winter or service. 3/a" garden hose con-
nection thread for easy hose attachment. Draln
assembly is replaceable from outside of filter.
ALL FILTER COMPONENTS are serviceable using
only a screwdriver and wrench.
The S-200 and S-240 High Rate Sand
Filters are available with three base options:
1. Standard pump mounting base.
2. Pump/filter platform base.
3. Deluxe pump/ftlter piatform base.
The System II Series is furnished complete with
Hayward UL Super Pump and clear Lexan union.
All components factory assembled on deiuxe
platform base.
System tl Series available with �/a, 1, 1�/z and 2 HP
pumps. Your deater will recommend the model with
the pump horsepower that wiil provfde opt(mum
performance, at the lowest operating cost.
+ System II separate components system also available with
choice of Super or Max-Flo pumps, %a thru 2 HP.
� HAYWi4R� ��0�, �����'�'S, INCo
900 FAIRMOUNT AVENUE, ELIZABETH, NEW JERSEY 07207 / Phone: (201) 351-5400
�
Printed in U.S.A.
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A new dimension in swimming pool pumps, combining
strong, corrosion-proof space age materials and high per-
formance into one efficient, engineered unit. The result of
extensive research and development, the self-priming
Super Pump has all the features and qualities you expect
from Hayward. From "see thru" easy access strainer and
Service-Ease design to extra electrical integrity and safety,
the Super Pump sets a new standard of excellence.
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MODEL HP S��E DIM."A" MODEL HP S�ZE DIM."A"
SP-1600 1/3 1'h" 11-1/4" SP-1808 3/4 7'h" 11-7/8••
SP-1605 1/2 1h" 11-6/8" SP-1611 1 1h" 12-1/4••
SP-1607 3/4 1i�" 11-7/8" SP-1816 7i� Y' 13-1/4••
SP-1610 7 1f�" 12-1/4" SP-1821 2 2" 13-3/4••
SP-1616 1 f� 2" 131/4••
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�Heavy-duty high performance motor with air-flow ventilation
for cooler operation and maximum dependability. Built-in
automatic thermal overload protection. Electrically isolated
and insulated from pool water for extra safety.
� All components molded of rugged, corrosion-proof fiberglass-
filled resin for extra durability and long, long life. This mate-
rial gives high strength and heat resistance characteristics
and is immune to all types of pool chemicals and water. Inte-
gral super-size pump-strainer housing has extra air handling
capacity to assure rapid priming and continuous operation,
even under extreme conditions.
� New, Service-Ease design affords simple access to all internal
parts. Motor and entire drive group assembly can be re-
moved, without disturbing pipe or mounting connections, by
disengaging just four bolts.
� Heat resistant industrial size ceramic seal. Long wearing
and 100% drip-proof.
� Totally balanced corrosion-proof Noryl� impeller hassmooth,
wide openings to prevent fouling or clogging. Engineered
for maximum performance-tuned efficiency.
� Unique mounting base provides stable, balanced, stress-free
support for motor and pump, plus versatility for any installa-
tion requirement.
� Super-size 110 cubic inch capacity hair and leaf strainer
basket gives longer time between cleaning. Rigid con-
struction and load-extender ribbing assures free flowing
operation for even the heaviest debris loads.
� Exclusive, Swing-Aside hand knobs make strainer cover re-
moval easy. No tools required ... no loose parts ... no
clamps.
� Clear Lexan� Full-View strainer cover lets you see when
basket needs cleaning ... eliminates guesswork. Tab-Lock
design and special self-adjusting seal assures positive seat-
ing and dependable sealing.
Aiso avaNable with Dua/ bpeed Power Saver �� Moto�
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900 FAIRMOUNT AVENUE, ELIZABETH, NEW JERSEY 07207 / Phone: (201) 351-5400
��
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SUBJECT P N O.
c�ty of Fridley q- � � o
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r
; � RE O.
� • COMMUNITY DEVELOPMENT DIV. o � �
' j L �"��',
r � � PROTECTIVE INSPECTION SEC.
1 = i
' ����� � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVEO BV
�"""� � ��� 612-571-3450 9�0-F15 8/3/83 / /
JOB ADDRESS g90 Hathaway LIl. N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],]_ 3 Paxkview H2]. il'tS SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Thomas Reed 990 Hathawa Ln. N.E. Fridle Minn. 55 32
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Pacific Pool and Patio 6922 55 S -
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Iri ' '
9 CHANCiE OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY IOAD
SEPARATE PEHMITS ARE REOUIRED 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, OR IF CONSTRUCTION R 1
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. 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 8E COMPLIED $10,550.00 $S.2%
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 CHARGE
PHOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $$Fj. SO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
R PLAN CHECK FE TOTAL FEE
��'�r ,1 t�r� , - - � 3 ° � � $91. 77
SiGNATUFEOFCON ACTORORAUTHOFIZEDAGENT IDATEI �/�IH �.Y IDATED THIS IS YOUR PERMIT
«_ r._ ��-�'°��
SIGNATURE OF OWNER iIF OWNER BUILDERI (DATEI B DG INS �PTE
�
CITY OF FRIDLCY
: Effective Aug. 1, 1981
� APPLICATIO'J FOI; RCSIDCi�ITI/ti_ [3UILQ1ttG PCfL'f ITS
(Ile►r, AlteraLions, Additions, or Rc�airs)
� G� �[3UILDER: � ' � � ��
OtJt�ER: l�c�i.�.� �)
ADOi�ESS: %l�e5!'�'`���� .�.� � AODRCSS: �S'a�- S',�'l� �/z✓�,
TEL h0: �,�f- SC?c�Z TEL t20: %�Q ,. 3��
ConsL-ruction Location
ST72IIIsT NO : �/ � STItEF.T: �,
LOT: l� BLOQC: � ADAITION:
Corner Lot: Insicie Lot: SetbacY.: Sideyards:
�
Ap�licant attach to tliis form two Certificates of S�rvey of lot and
p=oposed building location dracan on certificates to scale.
- �-._, f,���au,� y� DESCRIPTIO�� OF COt��STF�JCTIOtJ '��� S
/ r I "
- Front: �(� Depth: �c� Height:
Square t'eets (�ibic Feet:
Front: Depth: Height:
Squar.e FeAt: G11bic Peet: _
Rype of Con,truction: �'�_/v".� A�% � p �r�,,, Estimated Cost: $/�j� S`�� °_—�'
Zb Be Oor.�pleted: _ ��� l ��� �` "
V t Alt. B
A1 . A
Froposed Driveti�ay �Sidth If New Opening Is Desired: $� S
, S�� P.EVF:RS� SIDi OF SiIE�T _
9iie undexsigned hereb�► ma};c� applicatian for a permit fcr the �:vrk herein specified,
agreein3 to do .all work it� strict accordance with the City of I'ridley Ordir�ances and
tulings of tlte DeparUnri�t of Builc3ings, and hereby declares that all tlie iact� and
represesitatiens stated in t.has applsc.�tios► are true and correct.
���
D.':T�: r�� SIGNATUIir.:
Stil�ulations : ` �„ ��'1 F rb1 /��+'c�S
� � i � �-� e S
. .. �� �Ie ��
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The Chief Building OPficial shall, before issuing permits for the erection
of any building or structure, or Por any addition to any euisting buildiag
or strueture or for anq alteration or repairs to any existing buildiag or
strueture, upon applieation therePore, require the paqmeat by the
applieant Por such permit oP fees to the amount herein below set Porth and
in the manner herein provided to-xit:
Total 9aluation
�1.00 to �500.00
Fees
$10.00 (Minimum $15.00)
�501 to �2,000.00 $10.00 for the first $500 plus $1.50
for eaeh additional $100 or fraction
thereoP, to and ittcludiag $2,000
$2,001 to �25,000 $32.50 for the first $2,000 plus $6.00
Por each additional $1,000 or Praction
thereof, to and ineluding $25,000
�25,001 to �50,000 �170.50 Por the first $25, 000 plus
�4.50 for eaeh additional $1,000 or
fraetion thereof, to and ineluding
550,000
�50,001 to �100,000 $283.00 Por the first $50, 000 plus
. �3.00 for each additional $1,000 or
fraction thereof, to and including
$100�000
$100,001 and up
$433.00 for the first $100,000 plus
$2.50 for eaeh additional $1,000 or
fraction thereof
Plan Cheek: 25 percent of building permit fee.
briveWay Depression Esorow: Concrete curb streets only.
Alternate "A": Removal and replaeement of eurb and gutter only -
DriveWay xidth plus 6 feet times �13.50
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 �15.75
_ - .� �� '. �.: .�
Permits Por aonstruetion �ill be issued a minimum oP 24 hours Prom the
time of application to a11oW for proper review of the proposed strueture
and oP the construction site.
A Certificate of Se�vey oP the lot, shoWing the loaation of the foundation
once it has been corastrueted vill be require� b�fore nroeeedina With the
framing.
��
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Toroauw�M�e rw�iNo
BLOG�t'' -3 PA,�KY/E�'�/ �if/GHT.� /�DO/ T/OA/
C. E. COULTER N """"°
. 1 ►A11M �UAVtt�
LAND SURVEYOR 11 u►K�sNOec
REGICTERED UNOER LAWS OP aTATE OP MINNECOTA JYDICIAL
LIC[NSlD \r ORDINANC[ Or C177 OF MINNt1►rOLI�
9300 LYNDALE AVE. 50. MINNEAPOLIS 8. MINN. .
TAYLOR 4-0970
SuRvEY fOR 8f'tiSoN �'pi✓ST�PvCTio�r
Surneqor'e msrlttirgte
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I hereby cestify that the above is a true and correct plat of a survey of:
Lot Eleven (11), Block Three (3 ). P�►RKVIEW HEIGi�iTS ADDITION, Anoka County.
I�li.nnesota.
As surveyed by me this 6th day of August 1958 A. D.
Signed �Lo� . �•_,�-�%��
Minnesota Registration No. 2584
Appraved by Building (nspecfor
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CHIM�dEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney o r stack;
1. Has been carefully examined Yes ()
,,
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. Meets all current Code requirements for size and
total BTU connected Yes ( )
6. Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
No ( )
No ( )
No ( )
No ( )
No ( )
Com pa ny
Signed By
Da te _
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CHIMt�EY AND STACK VERIFICATION
The undersigned hereby veri.fies thaL the existing chimney or stack; ��
1. 'Fla� .beer� careful ly. examined. � Yes (,�
2. Is .free fran�rust or deterioration �� Yes (�
3. Has no foreign objects lodged within
4. Is securely supported
�,_ Meets a�ll current Code requirements for size and
total BTU con�cted -
6. Has , To ta 1 hea ti ng 6TU' s of
All other BTU's
TOTAL
Yes (�
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Signed By '`"
Da te
NOUSE NEATING TEST RECORD �,�.y�>'� �o�/,
ADORESS � 4_'�'•y����' ��•✓C= IVT. ftOOR CITYt'�'c�c SUdURs
OCN�ANT �.,-o.�-...s /F��a . O�tER �sroy�
MEAT LOSS �''�"�E GATE MtG. INST 6—�o �YJ
SOI.D �Y o•� -,�• r ���,�ac-t - IN�STALLED sY f�o•bs� F,d,e�� y.�.��E,�
El.ewicst r..k i�► •r - ��� C.s ttw� i� �� •r .,
TY►E O� liEAT W fA M� STEAY 5'AC� Mt�. IJNIT ltTR. OTMER -
6AS GES14rr CONVERS�ON
Mr►KE �d�-�'�_.� G�•d�.Cy✓�, �C�o.w:o.e� /ui,�a:c.t •rE OF 6URMEIt
w��l ��;.�f.'e�/o0ii�-:�:� .5:',c> �
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IIiPUT � 0' �' IMKE OF R1IRMAGE �
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TMERIIQSTAT � ' 11Me rtu� 1l�wt 3ia• �
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, 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 plastiGPVC and meets all current codes and manufacturer
specifications 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 cuRent codes and manufaaturer'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 manufacture�'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 installin�a 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 () No ()
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. 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 Total 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 :
� �SUBJECT . .
City of Fridley 3 i 6 8 9
' , AT TH E TOP OF TNE TW�NS � � I L D 1 N G P E R M I T T NO.
�
, � r��.�
� `y __��__ COMMUNITY DEVELOPMENT O1V.
r � � PROTECTIVE INSPECTION SEC.
� . .
� _ /"'1 � CITY NALL FRIOLEV SS�32 NUMqHN REV DATE PAGE Oi APpROVED B�
�""� � �'' 612-571-3450 et0-F15 3/20/O1 / /
JOB ADDRESS 990 Hathaway Lane NE
1 IEGAL LOT NO. BIOCK TRACT Oii AOOITION SEE ATTACMED
DESCR. 11 3 Parkview Heights Addition SHEET
2 PROPERTY OWNEA MAIL AODiiES$ ZIP PHONE
Thomas/Priscilla Reed 990 Hathaway Lane NE 763-571-5007
3 CONTRACTOR MAIL ADORESS Z�P PNONE LICENSE NO
Cities Home Improvement 640 Mendelssohn Ave N, Golden Valley, MN 55427
4 ARCHITECT OR DESIGNER MAiL ADDRESS ZIP PMONE LICENSE NO.
763-591-0332 20076414
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION C� FiEPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOFiK
Reside House; Soffits
9 CHANOEOFUSEFqOM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Call for inspection of wrap
before covering.
TYpEOFCONST OCCUPANCY GROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIFED FOR EIECTFICAL, PLUMBING, HEATIN(i,
VENTILATING OR AIF CONDITIONING
1HIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION jpNING SC. FT CU FT
AUTMORIZED IS N07 COMMENCED V�1ITHIN 80 OAYS, OR IF CONSTRUCTION
OF1 WORK IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG- UNITS OfFSTREET PARKING
I HEfiEBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPIICATION 1 STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE Of WORK WILL BE COMPLIED �
WITH WME7MER SPECIFIED MEREIN Ofl NOT. TME GRANTING Of A PERMIT �lO�OOO �S.00
DOES NOT PRESUME TO GIVE AUTMOAITY TO VIOLATE OR CANCEL TNE pEqMIT FEE SAC CNAFGE
PFOVISIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON•
STRUCTION OF TME PE FORMANCE OF CONSTRUC710N �ISZ.ZS Fire SC �LO.00
PLAN CHECKFEE TOTAIFEE
i''F �� � � � L nse C $5.00 $201.25
5� NATUpE O� N"AACTOA Op AUTMOA�2ED OGENT iO�TE� N PROPERLY VA�IOATED TMIS IS YOUR PEAMIT
��/ �
S�GNnTUpE O� OWNEp��f QWNEp BU4DERi �OAfE� �` �" e B� �NSP ' f�h1E
N� � � Effective 1/1/2001
ADDN [] . CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
Construction Address:
Legal Description:
Owner Name 8� Address:
Contractor. c � 1—� es
Address: /� /1il o ti �
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
i�t � L�`t 2
c � �lq e�
d �..0 wK e r2 �
�i� �� l�
�
rG� �
Tei.# 763-57/-��oa?
MN LICENSE # �11D i 6� �¢
; ll,� Tel. # '��3 -�< -0�,3 a
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
Length Width
Length T_ Wi,d�/
.-�.c' f�. S' > � S d�r
Height Sq. Ft.
Hgt/Ground Sq. Ft.
/ �c
Construction Type:__ ,�r`�r h 4 �- ��' �i� 7�s Estimated Cost: $ l�, ���
J
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ,� .,z o O� _ APPLICANT: � � ,� �.�/��� Tel. # "7� 3 — ,S� /- � 3 3 �
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$/�/. �s Fee Schedule on Reverse Side
$ /�. �� .001 of Permit Valuation (1/10th%)
$ � c�c� $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ � -�C� $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 [ ]
$ ���. ��'
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing germits 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
$ i to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$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 $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1, 000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,0�
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
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.
Altemate "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. New Houses Onlv
' � � � SuB�BCT • � ' � .
City of Fridle� " 3 i 9� 3
�
AT THE TOP Of TME TW�NS g u I L D I N G P E R M I T
;� .
NO.
, �__, COMMUNITY OEVELOPN4ENT DIV. ���O��O� ry���
r � v � PROTECTIVE INSPECTION SEC �
i . �
� _ �'�'1 � CITY MALL FFiIOLE� SS4�2 NUAABER pEV OATE PAGE OF APVqOVED 8Y
ti.__.11.• •,� 612-571-3450 e�0-F15 6/28/O1 / �
JOB ADDRESS 990 Hathaway Lane NE -
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACMEO
oescR. 11 3 Parkview Heights Addition SFIEET
2 PROPERTY OWNER MAII ADpR�S$ 21C PMONE
Tom/Priscilla Reed 990 Hathaway Lane NE 763-571-3007
3 CONTRACTOR MAIL ADDRESS Z�P PFIONE IICENSE NO
Cities Home Improvement 640 Mendelssohn Ave N, Golden Valley, MN 55427 20076414
a AFiCNITECT OR OESIGNER MAIL ADORESS ZIP PMONE LICENSE NO
763-591-0332
5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO
8 USE OF BUILOING
Residential
7 CIASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATIpN � REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Replace windows and patio doors
9 CHANGiE OF USE FiiOM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk
and flash all exterior openings.
" ' TYP� O CONST. OCCUPANCY GROUP OCCUPANCV�OAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTfiICAL, PIUMBING, NEATING.
VENTILATING OR AIR CONOITIONING
THIS PERMIT 9ECOMES NULL AND VOIO IF WQRK Oii COf�STRUCTIOM 20NING SQ. FT CU fT.
AUTHOR12E0 IS NOT COMMENCED V�1ITMIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOEO OR ABANqONQD FOii A PERIOD OF 120 OAV$ AT �
ANV TIME AFTER WORK IS COMMENCED ` NO DWLG. UNITS OFFSTREET PARK�NG
I MEfiEBY CERTIFY TMAT I MAVE READ ANO EXAMINEO TMIS APPLICA710N 1 STA��S GAiiAGES
ANO KNOW TME SAME TO BE TqUE ANO CORRECT. ALL PROVISlON$ Of LAWS yALUATION SUfiTAX
ANO ORDINANCES GOVERNING THIS TVPE OF WORK WIIL BE CQMPUED
WITM W ER SPECIFIED MEREIN OF NOT. TNE GRANTING OF A PERMIT �9 � OOO ��F . SO
DOE OT P SUM AUTMORITY TO VIOIATE OR CANCEI TME pEqMtT FEE SAC CHARGE
PR VISIONS ANY OTHER STATE OR LOCAL LAW REGULATING CON-
S UCTIO O PERFORMANCE OF CONST UCTION �167.2.5 Fire SC �9.��
PLAN CMECK FE TOiAL FEE
Licen S $5.00 $ 5.75
S�GNATUN N'AA A Op 4UTMOA�ZEO AGENT IDAiE� ` EN P � IOA� I$ I$ VQ PEA Il
� '�•�
$�GNATUpE O� OWNEp��� ON�NEA BU4D.EQ� iDAiE� BLOG� hS� - ���Jt
� _' '�
NEVN [ ]
ADDN [J
ALTER [ ]
Construction Address:
Effective 1/1/2001
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
p.T�
�
Legal Description:
Owner Name 8� Address � �+ f e' �c � �t Tel. # � �.� � �� ��e�`�
Contractor: � � : �a e*�. �� �. MN UCENSE # P� � � � �o °7 �/ / �
Address: �� 4� � a�eA- I Tel. #'�3 ��i d� ���
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certficate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width
Length Width
Length Width
� / . �� a�
Height Sq. Ft.
Height Sq. Ft.
HgUGround _�,,,�_ Sq. Ft
Construction Type: Estimated Cost: $�� c� �. �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: I � APPLICANT: `� � ���R��� Tel. # `I �� ` S 7/— ����
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ `(0 r/,,,?,t� Fee Schedule on Reverse Side
$ � pC� .001 of Permit Valuation (1/10th%)
$ �S U $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ � - c�J $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 [ ]
� �' �
�
�d � �
BIJII,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erectioa 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,OOa
$25,001 to $50,000
$50,001 to $100,000
$1(?0,001 to $500,000
$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 $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,0(�
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each 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 $1,000,000
$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)
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
Pernuts 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
� , �.
Building
.�
I�xspections
763-572-3604
763-5-02-4977 FAX
DATE '�J,f� I l!
SITE ADDRESSO_
Tf-IIS APPLICANT IS
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
❑ OWNER
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
F_FFECTIVE 1-1-08
YOUR E-MAIL ADDRESS
l�� �i�,�`--� l�1�
Permit No.: � � I � �
Received By:
• -h '
Da ' �
ADDRESS: �ea`ll`� rl�'�l'1J��1 1�-+� CITY �1�C2"1 STATE.v7�ZIP CS�t� Z
PHONE:'1k, ��• S�7 [ °�U��"l
NAME:
ADDRESS: CITY STATE ZIP
PHONE F�
STATE LICENSE #
❑ SINGLE FAMILYMEW CONSTRUCTION SIZE_
❑ TWO FAMILYMEW CONSTRUCTION STORI'
PERMIT TYPE I O ADDITION
0 BASEMENT FMISH
0 DECK
TYPE OF WORK: I O NEW HOME CONSTRUCTION
SIDING
❑ SWIMMIIdG POOL
0 ADDITION
❑ REMODELING
EXP DATE
❑ DRAIN TILE
� OTHER
DESCRIBE WORK BEING IIONE: � �- 4
____ .... .. ..........-.....,.r I..RNrTH WIDTH HEIGHT
ROOFING
NUMBER OF SQUARES �
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
0 Vinyl
❑ Aluminum
❑ Other
WINDOWS
M EXISTING OPENINGS DYes �Alo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIl�iDOW TO BE WSTALLED
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION Q OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surchazge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due _
,�HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used.
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS & PORCHES SUBNIIT:
❑Soffit 1, Site plan/Survey showing the existing strucwres
❑ Trim and proposed project
❑ Fascia 2. Two sets of construction plans
3. Energy Calculations
LQCATION OF WINDOWS
OF
$ See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ .001 times the total job valuation
$ .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residential Contractors)
$ $1825 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21 =$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ ; Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowiedge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes
of the City of Fridley and with the Minnesota Construction Codes; tha I understand is is not a permit but only an appiication for a pertnit and work is not to start without a
permit on site; that the work will be in accord � ith�� oved �' the case f all k which requires review and approval of plans. �
OF APPLICANT � 01 ��/ NAME DAT��
SIGNATURE _ �
/ � �•
. . . • � : i � � `�` / .�,
Page 2- Building Residential Application
e BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official sha11, 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._�i:rructure, 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,OO1 to $50,000 $391.25 fo,r 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $I,000 or fraction to
and including $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
� fraction to and including $1,000,000
$1,000,001 and up $5,608.75 for the ]�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
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 proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Oniv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432 �
763-572-3604
Faz: 763-502-4977
_
FRID�Y
FRIDLEY MUNICIPAL CENTER •(431 UNNERSTTY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
. ���
7�
�' understand that the State of Minnesota
requires that all residential building contractors, remodelers and roofers obtain a state
license unless they qualify for a ecific e em ion ro the licensing requirements. As
the owner of the property at � L�J , Fridley, I
am exempt from the state licensing requirement onl if I am not building or improving
this properly for purposes of resale. By signing this document, I attest to the fact that (
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forFeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.0?.
Furthermore, I acknowledge that I may be hiring independent contractors to pertorm
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activiiy is
a misdemeanor under Minnesota law, and that I would forfeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the Ciiy of Fridley for compliance with all
applicable building codes and city ordinances in connection with the work being
pecformed on this property,
,� ��-�, c�%�' `�' `
Name
�
/(� �� � �
Date