AF - 45596SUBJECT N ,
c�ty of Fridley -� � i4367
AT THE TOP OF THE TWINS g U I L D I N G P E R M i T
r
� � RECEIPT NO.
� `L _ COMMUNITY DEVELOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEC.
1 ; ,
�� � /��'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
•�"� � ,�� 612-580-3450
910-F15 9/i6/�� / /
JOB ADDRESS �498 Fiayes Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ]. 1 Gunderson Terrace SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
R�bert L. White 1289 Onondaga Way N.E. 786-5312
3 CONTRACTOR MAILADORESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 38' x 26' Dwell' and a 24' x 38' Gara e
SEPE�Ai'� `�l�IiTS REQ1�{RE� FOR � 1KtR1 .
9 CHANGE QF USE FROM NEATihiG, PLlJI�B� , " �
STIPULATIONS provide ahard surface driveway. Provide sod in tlze front and side
yards�. Provide a verifying survey before capping. Submi.t roof truss design
SERVES OFF HAYES STREET
SEWER L�ATION (Approx. 9.5' Deep In Street) 71' S. of Manhole (S. Inv. 886.92
WYE ELEV: 887.84 Top Of Footing: 890.84 Mini.mum
WATER LOCATION: Approx. ll' S. of Sewer Servi.ce
DRl�TEWAY DEPRESSIONCO5T: N/A Optional, AdditionaY Depression is Reco ended
�� � � VVARI�H�
� ��� °N� ,GUARatvtEe trie 8etore d���8 cait �ocal u�iiitie:;
ACCURACY 0� i1f�ElY °'[�Gt�fpi+13�-AND; ;iLEVATICF: �
t{�i1S DA?k Nf fOR INFOR/M110�1' �'OS�S` ; CSrrtv �,.� •�.... iEIEPHONE - EIECTRIC - GA� Etc.
F�RSoHs � rt sriou� � v�a�r� �r - Mton�ur�aN R�QU IRED BY L�►1N
ON TME Sfi6 �°
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOCZ Fidfi@
THIS PERMIT BECOMES NULL AND VOID IP WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 950 + 936 28, 823 Tota.l
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S3F�� 85O $�.5.42
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIO OF ANY OT ER STATE OR LOCA LAW REGULATI C N-
STRUCTI N R HE PER RMAN E OF ONST UCT N. � 5�-�-5.29 $3%�J.00
� /� PLAN CHECK FEE TOTAL FEE
$ 28.83 $537.54
SIGNATUREOFCONTRAC ORAUTHORIZEDAGENT IDATEI WHEN PROPERLV VALIDATED THIS IS YOUR PERMIT
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� CITY OF FRIDLEY .
APPLICATION FOR RESIDENTIAL BUILDING RER��IITS
�NEW, ALTERATIONS, ADDITIONS�,OR REPAIRS)
OWPJFsR: � O � �,_ p � BUILDER: ��� �
Address: � ��q � �� ����9� ��t�l Address: �� /�� E
Tel. No.: % � � ' � �
No. "/y"T�
LOT:
CORI�IER LOT: �
Str eet :
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-, . �' ea ��i e rSe� � �-er r� C °�
BIACY.: �_ ADDITION :
0 a
INSIDE LOT: S,^:TBACK: � SIDEYARDS: l�
Applicant attach 'to this form �ao Certificates of Survey of Lot and proposed
building location drawn on these Certificates. �
DESCRI PTION OF BUI LDI NG
To Be Used As:
/ �
�` % �tN� (�. Front: � Depth: � Height:
• Square Feet: � Cubic Feet:
/ f
a � � Front: � Depth: �� Height:
, � Square Feet: _ `��_ G�.bic Feet:
�C � -
�
Estimated Cost: $ � �'
Type of Construction: �C � 1�.�, ___�
Zb Be Completed: �� � �/ 9 Alt. A Alt. B
Proposed Drivecaay Widih If New Opening Is Desired � �$�
(SE� REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all �vork in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true an orrect. 5ee reverse side r addi ional informati .
DATE: � SIGNATURE:
Stip�alations :
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BUILDI(�G PER��IIT FEt SCHFLULE
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SECTION 2. The Inspector of Buildiiiys shall, before .i_ssuing permits £or the erection
of any buildir►g or structure, or for any addition to any existing building or structure,
or.for any a1L-eration or repairs to any exi.sting building or structure, upon application
therefare, 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:
NEW CONSTRUCTION: Single Fami.ly Homes and Garages: $4.00/1.000 cubic feet..
PLAN CIIECY.: 25 percent of building permit fee.
DRIV�WAY ll�PR�SSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$11.75
Rlternate B: Removal and replacement of concrete curb and
gutter and 5.nstall a 3 foot wide appresach with
• � 6 inch depth; IIriveway width plus 6�feet x$15.40
ADDITIONAL INFORNIATION
For the purpose of computing fees far 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 average height of the roof surface
of the mai.n gable of a pitched roof .
For repairs or alterations to an existi.ng structure, the fee shall be at the rate
of $3.00 �er 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 permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
yERIFICATIO� OF FOUNDATIO(�
NOTE: Permits fo�- construction will be issued a minimum of 24 hours from the time
of application to allow for proper review o£ the proposed structure and of the
construction site. •
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
CtRTIFICAT� 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 builciing permit has b�en issued; and
s3id structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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�` ELK RIVER CONCRETE PRODUCTS • 8609 LYNDALE AVE., S0. • BLOOMINGTON, MINN. 55�20
(612) 8847362 • INWARD WATS - 800 -I- 552-1158
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LOT S(;R7EY b iiOUSE LOCATiOy SURVEY FOtL: P.08ERT TJitITE
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i h'ereby ce�iy that fihis survey, plan or repo� was prepared by me or under my direct
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CO�lSTOCK & DAVIS, INC. � Consulting Eng,inerrs and land Surveyors
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LOT SC:�9EY b L30USC LOC�1Ti0:f Sl1RVEY F�P.: P.OBERT !r�IITE
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1446 County Road J, Mp1s., N1inn. 55432, 7849346
SUHiTEY FOFi � SIJA�EY OF
Robert White Lot 1, Block l, �underson Terrace
1289 Omondaga Way City of Frid2ey, County of A�o�ca,
Fridley, Mn. 55�32 Minnesota
_�'� 7Sth A v¢ . NE. _ �
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LEGAL DESCRIPTION
Lot 1, Block l, Gunderson-Terrace
City of Fridley, County of Anoka,
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I hereby certify that this survey, plan or report was prepared by me or under my direct
supervision and that I am a duly Registered Land Surveyor under the laws of the State
of Minnesota.
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Reg. No. Date Job No.
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Surve�a�s C�rrt�fic�te
COMSTOCK & DAVIS, INC. Consulting Engineers and Land Surveyors
1446 County Road J, Mp1s., Minn. 55432, 7849346
SUHVEY FOFi SUE3VEY OF
Fiobert White Lot 1, Block l, Gunderson Terrace
1289 Omondaga Way City of Fridley, County o� Anoka,
Fridley, Nin. 55�32 Minnesota
_�' i 7Sth A va . NE. _
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Minnesota.
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I hereby certify that this survey, plan or report was prepared by me or under my direct
supervision and that I am a duly Registered Land Surveyor under the laws of the State
of Minnesota.
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1978
�r.a��� �� �������
843t UMIVERSITY AVEMUE [�.E., FRIDLEY� MINNESOTA 654�2
TELEPHONE ( 812j57t•345A
- Mr. -�2abert white _ . .. . _
7498 HB�yes 3treet N.E. ' .� - • .
Fridley, Mai. 5.5432 �
Re: Final Inspection at 7498 Hayes.Street N.E,
Deax Mr. White:
A final insp�ction was made on January 9, 1978 of the above strucicure
and the follo�.sirig items were noted which must be canpleted before the
struc4:ure can be finaled out;
1. Provide handrai.l in garage by February 9, 1978.
2. Call for a pltunbing final to seal the water meter by February 9, 1978.
3. Call for an electrical final hy February 9, ].978.
6�e will expect the abave i.tems to be completed by ttie scheduled date
when a reinspection will be made to determine compliance. If you have
any questions on these it�ns, please cantact me at 571-3�50.
Sincerely,
RON HOLDEN �
Building Inspector
RH/� _ . .
0
SUBJECT PER - _
City of Fridley 15 8 21 '
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO.
� ; L __��__ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
� ` �
� /���1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVED BY
�'"""� � ��� 612-571-3450 910-F15 7/10/80 / /
JOB ADDRESS 7498 Hayes Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �. 1 Gunderson Terrace A:ddition SHE�T
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Robert L. White 7498 Hayes Street N.E. 786-5312
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
C� NEW O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Insta.11 an above ground swimming pool (24' x 4' Deep)
9 CHANGEOFUSEFROM TO
Sr�PULArIONS See letter from �nvirormnental Officer dated July 10, 1980.
� W�RNIN�
� di�ng r�ti ta��l y�ili#i�§
SEPERATE �'ERt�TS REQUIRED FOR I�Rt�. �«�•Etf��IC�Q���,
HEATING, PLUMBiNG AND SIGNS. REQUIRED �y ��y
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
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
WI H WHETHER SPECIF ED EREINIOR NOTOTHE GRANT NG OF AO ERMIT $�-� SOO
$.75
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S9 • OO
PLAN CHECKFEE TOTALFEE'
$9. 75
iG UREOFCONTRACTOROHAUTHORIZEDAGENT �DA7E1 � �`"4y/HEN PROPERLY ALIDATED THIS IS YOUR PERMIT
`� w� 9 i� �°� � �' � (�
SIGNATURE OF OWNEH iIF OWNEF BUILDERi IDA EI BLOG iNSP 1�ATE
CITY OF FRIDLCY • • •.
ARPLI_CIIT�OPJ FOR RESIDCPJTIIIL �UILDIPJG PCftMITS
(��ew, A]ter�ations, Rddi�io��s, or Repairs)
oa,r�Ek: (�-�— L � ��o `,�C.�
ADDRESS : �Iy q � �—�a,�� �f � A� �
TGL NO: �T �� °° � � f ��
BUI LD�R : �_____�� _W t�t�.� '
0
ApDRESS: • � !
TEL f�0: '
' Construction Location
- STRF�T NO:. �-i � STRE�.T: � 1"t.l�� �� �
LO�: •� BLOCK: � ADDITION: �,�C.�sy-��� /'�'�'°�'� C-�e
Gorner Lot: �� Inside. Lot: SetbacY.: Sideyzrds:
Applicant attach to tl�is form two Cer.tificatES of Survey of loi: and '
propos�d building ].ocation dra�an on certificates to.scale. .
DESCRXPTIO(d OF COPtSTRUCTION �
--� v
�i�� ���n1�'�t� IA�Of�. �Y�;��b� ' � Height:
, , —v .
� Squa�e. Feet: Cubic Feet:
CGi�'�'�—;-� �`° �'� 0 �"rYc...�: .
Square• Feet:
Depth:
Cubic Feet:
Height:
. . " b�' �
Tj�pe of Construc4ion: fJp�y ���.��A-� �. �st�snated Cost: $���`"�
�� .
. `-='-br`.—�' -6`.� � � . - �
Zb Be Cbmpleted: , �
, _ Alt. A A].t. B
Proposed Driveway Width If New Opening Is Desired: $' $
� � , , . SEE REVERSE SIDE OF SFiEET�
��ie undersigned hereby makes application for a permit ior the wark�herein specified,
agreeing to do all �aork in strict accordance ith the City of �ridley Ordinances and
xulings oi �he Depari-me��t of }3uildings, and ereby declares that all the facts and
representations sta�ted in this applicatio re �true ana correct.
DATE : . � S TGDiAx'II I'� : /� >�
Stipulations: .
l'��-i r�- $
���� .
. l
�, cTG' � �i� l erw—�
. �, ,� • / � �;,,,���° _ .•
�� ,� . �
%�,�. ��'� i�,c,;,-- ���- .
, � 1� i V �•`1- ��`''��
� v
0
r
. BUl U)IIJG PCR(�JT rCc: SC{IE:UULE• ,
:;1:C'�zOtJ ?.. 'Pl�e 7nr.:��r.cL-or. oL �3uil.c]ituf:; s:h�1l.�, bcforc a.�suing pennits �or Lhe crccLion
af any l�ui.J.d.inq ar. :�Ciuct:ure, or foz any �Qdi.L•�.on to a�ny er.S_:sLi_���g l�uildiny or st•rucL•uxe,
. ar f�r. a�7y �Zl4:cratiori or, r_cpair.:; Lo •ai;y cr.9.::L•.iny }�ui.].c2S.ng ar. �truci:urc, uZ�ol� a�plicat�.on
'L•her.etor.e, requ�r.e Uic paymcnti by tl�c app].i.canL• for. :;uch permzL- of fces to, tise �unoun't
herein bcl.oti•i seL- forth eind in L-lie mann.en c��re�.n �,�rovicic:cl t-o--���iL•: •
. � :
JJ);VJ CONSx'P,UCTIOI�: Singlc l.'ami].y 1lomes and Cx�rages: $4.00/].,000 cubic �'ect.
YT,Tst� C111:CY.: 25 ��ercen� of bui.lding nermi� ice. .
D1tIV��•1nY U�PRL•'SSIOI�T: (ConcreL-q Curb :;trcets Only) � �
• Alternate A: iLemoval and rep].accmenL- of concxete curb and
guL-ter only, Drivc�r�.y widi�li plus 6 teei: x Y�,S,75
. 11].ternat-e 13: Removal and replac�menL of cancreL-e curb and
. ' gutter and instalJ. a 3 iooL- wide approach wii.h �'
' . G inch depth; DrS.vev�ay widt;lz plus G ieet x$17.85 �
.� .� . ADDI T I0�!/��,, I FOR��il1T T 4N
I'or the purpose of comput.ing i'ees ior building �rmii�s, the cubical contents of any
bui.lding or addition, is dcte?�mined by rnulL-ipl.ying the ground area covered irom a
�a�.ni: s9.x (G) inches beloc•r the floor line of the bas�menL- or the cellar to the
average heights of ihe upper surface or to ihe average IleighL- of tlie roof surt-ace
of �he �ain gable of a pitched rooi.� �
For repairs or alterations to an exisi:ing sL-ructure, thc fee shall b� at the rate
. o� $3.00 rier each five hundred dollars-($500.00) or fraction ihereot in the cost
of al.l proposed work. • • .
In •no case sha].l ihe fee charqed for any pexmit a� s�t %r�h �n Sec�i.on 2 be �.es� �
t-han $7.50 plus $.50 state surchargeo �
� ' . � . �CFRT F I CATI ��1 OF FOUNnATIO(� " �
NOTE: Perriits �or construcL-ion �a�ll be issued a ru.nimtmn of 24 hours from the time
oi appla.cation to allow for proper review ai ihe proposed stxucture and of the
consti-uction site.
A Certii�cate of Suzvey oi the lo�, showinq the location of the foundation once 3.�
has been constnicted will be rec�uired before proceeding with the framing_ �
� � CtRTIFICATC OF OCGUPANCY . �• ��
' I►pplicai:ion for a Certificate of Oceupan'cy sha11. be made ten (10) da��s prior to the
use ar occu,p3ncy o� any structuLC far which a� k�uildinq perniit ha� been issued; and
said structure shal3t not be used o�- occupxEd w�i:i.l a. Certit•icate of Occupancy has
been �ssued. .
. � � �-._�; .
. , • I
. �
.
COI.TIVTY OF ANOKA
CONII1'IUNITY III'ALTH AND SOCIAL SERYICES DIVISION
325 EAST MAIN STREET
ANOKA, NIINNESOTA 55303
_ _ _�. ___ _ _
� � /�. � L� .� . �� � �
/ � �%,- � �
� �3/ 2���' ,y. �'l�
Street Address
. ss�
City State Zip Code �
�,Ci� �,t����
�� ��tG.�
�
REe ZOI�TING NOTTFICATION OF� APPLICATION FOR LICENSURE
�
Subject:. Type of License:
Name of _y_Ca_r_.�.�iome_
Agp�icant
\ Family Day Care
. �i \ Crroup Family Day Care
�
^ � %7��'1 S�' ,�a
�ity State Zip Code
Licensed Capacity
Phone No.
�—
/ f'lL
��6 -9s�y
This is to inform you that we are in receipt of an application for licensure under Minnesota Rules, parts
9�02.0300 to 9502.0445 (formerly Rule 2), Family Day Care and Group Family Day Care Standards. Issuance
of this license is subject to compliance with the provisions of 1Vlinnesota Statutes, Sections 245A01 to 245A18,
and 252.28, subdivision 2, �own as the Public VVelfare Licensing Act and the rules of the Department of Human
Services.
You should note that under Minnesota Statutes, Section 462357, subdivision 7, a licensed day care facility serving
1? or fewer persons, and a group family day care facility licensed under Minnesota Rules, parts 9502.0315 to
9�02.0445, to serve 14 or few�r children shall be considered a permitted single family residential use of property
for the purposes of zoning. Subdivision S of the same section indicates that a licensed day care facility servin;
from 13 through 16 persons shall be considered a permitted multi-family residential use of property for purposes
of zoning.
If we do not hear from you within 30 days after receipt of this letter, we will consider the above-mentioned day
care home to be in compliance with your local zoning code.
i
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CHIlVINEY AND STACB VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from nist or deterioration Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4. Is securely supgorte� Y�s () 1Va ()
5. Meets all current Code requirements for size
and total BTU's connected Yes () No ()
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided� for water heater Yes () No ()
8. Has combustion air been provided for water heater Yes () No ()
Remarks: .
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
l
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C Y AND STACK VERIFICATIO]
The undersigned hereby verifies that the e�sting chimney or stack: �
1. Has been cazefully examined Yes � No ()
2• Is free from n�st or deterioration y� � Na ��
�3. Has no foreign objects lodged within Yes � No �
4. Is securely supported Yes (�(� No ()
5. Meets all current Code requirements for s ze
—
- _ and total BTU's connected - - - Yes (� No ( )
6 Has total heating BTLT's of 7 j u� ��� �
All other BTU's ��() (�, J � ( , ' � �
-=�i
TOTAL BTU's ( f 5" (��� �
7. Has a li.ner been provided for water heater Yes (� No ()
8. Has combustion air been providec for water heater Yes �i' No .(.)
� '` .�
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Remarks: � �, 1.e , ��� � . �
°C1= ��--T /� l �1`z,d-� � ' �� � (
HEATING CO:
Signed By:
Date:
I sue�ecT p ;—
c�ty of Fridley 2 614 7
AT THE TOP OF THE TWINS g U I l D I N G P E R M I T
i �
' � E
� `L � COMMUNITY DEVELOPMENT DIV. '
� � ; PROTECTIVE INSPECTION SEC. �� % �
l_--. ,� ����� �'� CITY HALL FRIDLE� 55432 NUMBER REV DATE pAGE Of APPROVED BY
i �� 612-571-34b0 910-Ft5 6/4/98 � �
JOB ADORESS 7498 Hayes Street NE
1 LEGAL �OT NO. BLOCK TRACT OFi ADDITION
SEEATTACHED
DESCR. 1 1 Gunderson Terrace SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PMONE
Larry 1Kastel 7498 Hayes Street NE 786-9524
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Sela Roofing & Remodeling Inc 4100 Excelsior Blvd, St Louis Park, MN 55416
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
823-8046 1050
I5 ENGINEER MAIL ADDRESS ZIP PMONE UCENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WOpK
❑ NEW ❑ ADDITION ❑ ALTERATION �] REPAIR ❑ MOVE O REMOVE
B DESCRIBE WORK
Reroof House &
9 CHANOE OF USE FROM
STIPULATIONS
(21 Sq) Tear-off
TO
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE HEOUIRED FOR ELECTpICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WOfiK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 8p DAYS, Oq IF CONSTRUCTION
019 WORK IS SUSPENDEO Oii ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION ].
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
WN H WHETHER SPECIF ED EREIN10R NOT.OTHE GRANTING OF A� ERM T � 1�]S 1
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAI. LAW REGULATING CON-
STRUCTION OR THE PEfiFORMANCE OF CONSTRUCTION. �S( . 75
/� PI.AN CNECK FEE
,�a
S NATURE CONiHA T ORAUTMOp12EDAGENT License J
IDATEI
__ iDATEi
STALLS
5.00
CU. FT.
OFFSTiiEET PARKING
IGARAGES
$.88
SAC CHARGE
Fire SC $1.75
f07ALFEE
64.38
) TN �fS YOUR PERM�
LOAD
�
NEw .[]
ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FANIILY AND DUPLEXES R-1 AND R-2
BUILDING PERNIIT APPLICATION
ConstructionAddress: _ � � 6U �'� u e S � ` � � .�= �
Legal Description:
Effective 1/1/98
I ��
� �(o�
� �
Owner Name & Address: `.,.{a�1r�f jm � S' ��"�, �( �{ �'E-�u� � e S Tel. #_�$ �" C( � oZ. �
Contractor: ,S SELA R��IIVG � REMOD�I�IN�, IIV�• NIN LICENSE #����
Address: ST. OUI�S PARKOMN ��9� Tel. �� a3- � o��
Attach�� o�it �is application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA:
DECK AREA:
OTI�R:
Construction Type:
DESCRII'TION OF IMPROVEMENT
Width
Length Width
Length Width
T��rCy t��' a�'e�o0 '�
Height
Height
Hgt/Ground
5 � , C; � �' �c,
Sq. �t.
Sq. Ft.
Sq. Ft.
_� � z�
� � �
Estimated Cost: $ � ��
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + G Ft = Ft x$
_$
DATE: � _ _ �( �' APPLICANT: .�e � C,� {� v o � � � 5 Tel. # � �.3 - � U �i �
Permit Fee
�ire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ��, S
$
$ • ��
$
$ � �v�
$
$
$
$
$ �� ��
CITY USE ONLY
Fee Schedule on Reverse Side
. 001 of Permit �laluation (1 / l Oth %)
$.50/$1,000 Valuation
$1000 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 [ ]
� y y_ �
v
BUII..DING PERNIIT FEE SCHEDULE
0
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 $50,000
$50,001 to $100,000
$100, 001 to $500, 000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $1� 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 each 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,�0 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 $13.�.
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 tunes $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, sho�ving the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATIO(d
When renlacina an existinst 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 O No O
The yenting::system is. plastic/PVC and meets all current codes and manufacturer
spec�ications :including sizing, length, number of elbows and termination. �
The undersigned aiso verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's spec�cations. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existin� combustion air is sized and installed to meet the current codes
and manufacture�'s specifications.
When required to in�tall a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's spec�cations.
Yes( )•No(� )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installinst a new ventins� 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 curcent codes. Yes O No O
Apqiiance Type 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 Cb: � ' '
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Signed By: Date : �
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