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City of Fridley, Minn. N° 8 5 S 6
BUILDING PERMIT
DB�; ,� ftOVSN�ER 4, I965 ,�
Ovener: WILLIAM A. ffi�RSOft gu3lder SAME ----....�_..__..._ ............._. _.J
Addx�ss 65 0 H13�.EA� PLACE iv _E , �iadress __..___..__....._.__._._..
FRIDLL�iC 21, MLNNESOTA
65o LOCATION OF BUILDING
Na � Street �ERE PLAGE __ Part oi Lot _ _.._..__....___
Lot .�.. 6 __ s�ock ...�_9_ �ttan or Sub-ntv�ston ._.�D1L�Y' � r.AU�vr�_ �7DR,.___.
Corner Lot __ Inside Lot ._._..__... Setback __._ Sideyard __._ _..__.. ._......_....
Sewer IIe�vatian ____r. �_ � Fo�mdation IIevation _.._.._ ---._.__..
DESCRIPTION OF BUILDING
To be Used as:
�pI3'IO�A Fyront _..�_ DeP� --�? Heigt►t �1$_.._. Sq. F't. —I42_ (�u. F't. _3.,45b.
.� ____,� �`ront Depth Height _._.._.._.__ Sq. Ft. _..__.........._. Cu. F� _--
Zjrpe oi Ca�struction � F� ..r. Est. Cost —$3, 000 ___....._........ To be Canpleted _..._..._.._..__..._._..�._.._.
In cuoatderatlon of the isauance to me of a permit to oaistruct the building descrlbed abo�ve, I agree to do
tha p�opwed waark in accorclance with the d�scription abave set farth and in compHance with all pro�vistons ot
a�]inances o! the dty o! Fridley. �
LCLLiJI�.r�s/JQ (fj✓s-_I,Sar•.r• -�
In 000dderatian ot the Payment ot a!es o[ ; 4. 00 , P�t is hereby B�� � WILLIAM A_
EMERSON to coostruct the buildtng a� additlan as described above. Thiap�� t is gi�anted upan
the expmas canditlou that theperewu to w6om it b graated and his agents, employees and �►�rkmen, in all work
dane in, around and upan 8aid buildin�, or a�► thereof, shall owotorm in all reapecb to the ordinaacea a�
� ths�lin itseand�a permi�t may�a� �at atp► time uPm��� o! any c[ �n vid ��
a�dinaaoe�.
ALLEN G. JSASEN �� ���
I MOi1C�c
1W 'N�M � Nt e�wr flN �alk�, MahNNke �e r►NM. �Iw�1�M�, N� IMMI�M Nww K wMa. M swr N�
� fM Mil�ly 1�*M� fer s�r�h �wwN� 1'K 1M� 11�.
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APPLxCATIOR FOR $UILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
aWHI:R' S NAM6 L:[//.L.G/i9/�1 ��/�'J.6e.toi✓ Bi1'ILDER , li�. ,(9 �i�7.Ei�.°.SQ� ..
ADDRESS �ir4/7iE'iC.EN.6' /.G /Y � ADL'RBSS �SI� /7'iEi�.�i�/.Z'' �.�. /E� f
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LOCATION OF BUILDING
:�Hnt �c�0 Street�,�,C„E,�t/.E /iC,��art of Lot��
L�T K ADDITION OR SUBDIVISION
Corner Lot,Inside ?,pT Setback Side-jYard
SBWER ELBVATION FOUNDATION ELEVATI01� .
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as:
/�G,� i
�ro�r�'/�'Q�v--.�NO So.P.v�_ v___Front D pept� /� O� Height � /
Sq. Ft._ / C/ �� Cu. Ft. \� �.5 �
Front Depth �_Height
Sq. Ft. Cu. Ft.
Type o� ConstructioaJ��j�r�,;� .��� ,t� Estimated Cost 3� �
To be completed �`J �i�„��� - �q� ,�
4'he undereigned hereby makes application for a permit for Che work herein specified,
agreeing to do all work in strict accordance with the City of Fridley prdinances
and rulings of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct
DAT� ��tr = !� SIGNATURE .
(3chedule of Fee Costs can be found on the Reverse Side).
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sus�etT PER
c;ty of Fria�ey 29023
�
AT TME TOP OF TME TWINS g U I L D I N G P E R M I T
; � RECEIPT NO.
� `y ___�� COMMUNITV OEVELOPMENT DIV. ����
r � � PROTECTIVE INSPECTtON SEC.
i . �
� _ �"'1 � CITY MALL FRIOLE� SS�32 wu�9Ep pEV O�TE o�GE or �ooqO�ED sr
��"�"� � �'' 612-57�-3450 9�aF�s 3/17/99 / /
�oe �ooaess 650 Helene Place NE
1 LEGAL �OT NO. BLOCK TRACT OR AOOITION SEE ATTACHEO
DESCR. ( 9 Donna 's Lakeview Manor SNEET
2 PROPERTY OWNER MAIL AODRESS ZIP PMONE
Bill/Ruth Emerson 650 Helene Place NE 571-6594
3 CONTRACTOF MAIL ADORESS ZIP PMONE IICENSE NO
BWE Construction Co 476 H 2O058969
� ARCMITECT OR OESIGNEF MAIL ADDFiESS ZIP PMONE �IGENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO
6 USE Of BUILDING
Residential
7 CIASS OF WORK
❑ NEW O ADOITION � ALTERATION O REPAIR p MOVE O REMOVE
R
8 OESCRIBE WORK
Reroof House & Gara e 22 S Tear-off
9 CHANGE OF USE FROM TO
, STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCv LOAD
SEPARA7E PERMITS ARE REQUIqED FOR ELECTRICAL, P�UMBING. MEATING.
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NUII AND VO�O IF WORK OR CONS7iiUCTION 20NING SO. fT CU fT
AUTHORIZEO IS N07 GOMMENGED WITNIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANOONEO POR A PERIOD OF 120 OAYS AT
ANV TIME Af7ER WORK IS COMMENCED. NO OWIG. UNITS OfFSTREET PARNING
I MEREBY CERTIfV THAT 1 NAVE iiEAD AND EXAMINED TMIS APPlICA710N 1 STALLS GARAGES
ANO KNOW TME SAME TO BE TRUE AND COpRECT. ALL PROVISIONS Of LAWS VA�UATION SURTAX
ANO ORO�NANCES GOVERNING TMIS TYPE Of WORK WI�L 8E COMPLIEO
W17M WME7HER SPECIFIEO MEREIN Oii NOT. 7ME GRANTING OF A PERMIT � 1� HHS �. 94
DOES NOT PRESUME TO GIVE AUTHOFi1TV 70 VIOLATE OR CANCEL TNE pEqMiT FEE SAC CMAFiGE
PROVISIONS OF ANY OTHEFi STATE OR LOCAL LAW REGULATING CON-
STRUC710N OR THE PERFORMANCE Of CONSTRUCTION �59.SO Fire SC �1.88
PLAN CHECK FEE TOiA� FEE
License SC $5.00 $67.32
ATUpEO�CON'FACTQNOA�U�NOR�ZEO�GENT �O�TE� WMEN PqO�Epl A�IDATED THIS �S VOUQ PERMIT
Gt/. 3-/%4i
S�GHaiUpEO�OwHEp���OWNEpBU�lOEii� �O�TE� B� �NSn qatE
NEW
ADDN
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co�c���o�aaress:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R 1 AND R-2
BUILDING PERMIT APPLICATION
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Effective 1/1/99
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Legal Description:
Owner Name & Address: ,Q � �l � �► ��Y�r� �i-v� e rs � � Tel. # S � / - G S `i `/
� MNLICENSE#��Q�89(, 9
Contractor: �. (�•/' - C Ca c�,s T� �� �.1j � �r
Address• �/?6 -�{o-�„r-{'� �'�n l�� L, �v�s �a.�r �w. Tel. # 6S/- Y�`� 1 Y2i
LIVING AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length W idth
Length Width
DECB AREA: Length
OTHER:
. Width
�( � �
Height Sq. Ft.
Height Sq. Ft.
r
�i
Sq. Ft.
�r /S� �
- - - iJ, `
Construction Type: �w ro� %��"T Estimated Cost: $'��J��—`'� l C�U�
v (Fee Schedule on Back)
Driveway Curb Ciit Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 3-( !� 9 S APPLICANf :�� �x.c �!n e.�'sv� Tel. # CS/ . 5(�Y -�'' Y iu
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ � , �a
$ /. �v
$ ,g
$
$ �� (�o
$
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ �3�
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Building
Inspections
763-572-36U4
763-502-4977 FAX
���IC�
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No..
Received
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- � (o - / C� Yot7�t E-1�tan. nnnxESS /79�FS �S',�S fi�l%E2 S �' �/�'1.4 �C.. • �,yl
s�� n�nx�ss
THIS APPTdCANf IS:
OWNER/
TENAIVT
CONTRACPOR
SUBI�IIT A COPY OF
YOUR STATE
LICENSE W1TH
APPLICATION
l050 I�L�.✓E f�G �J.F
a owr�x �e�xxncrox
NAME: i ��'1 /1'l �.S ov�
�wnxESS: �r�. � crr�t s'rn� zrn
rxorrE: 7G3- 5�/_ �'�
C011�ANY NAME:�
CONTACf PER3013:
STATE LICENSE #
ADDRL'SS: ���
PHONE � / - a `%$ -
TYPE OB WORK: I`�w ��t'AC�
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DETAILED DESCRIPTTON OF WORK �✓S 1� �
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STATE�/1/.IIP S�>
w/ C�s.
FE� ARE BASED ON ilaN PF1t FlXTURE, FJCCEPT WHF1tE NOrfFD. FIXTURES: (INDICATE TOTAL fl[JMBIIt OF EACH BELOR�
PROVIDE HEE►T LOSS CAI.C'S PFR MANUAL J ZN6 ASHItAE HAPIDHOOIG
� �.nea �c: �s.� r.� 6 [.� MonII,: �fn �iN �- ?c % S sr�TV � I , txv
�c: �to�.: s��rv
MFG: MODEL: STZFZF.BTU
_A/C i15.00 � CE (GAS) 513.00 GAS RANGF/OVEN 510.00
_AIItTO AIItEX(�iANGEER SlS FII2EPLACE (WOOD) S3i.00 NEW GAS GRILL 510.00 `(�
BOII.ER S35.00 FI7RNACE 533.00 _GAS UN1T H1'R 510.00 7/
CFI�IEY LINER 510.00 GA3 DRYER 510.00 POOL HEATER 533.00 L� i
DUCT WORK 510.00 GAS PIPIIIG 510.00 VENTII,ATOR T15.00 �� i/
THIS IS AN APPLICATION FOR A PERI�T-NOT VALID UNTII, PRO(�SSED
I lyereby apply for a building permit and I ack�owledge that the infoimation above is complete and �ate; that the work will be in
cwnfonnance with the otdinances a� codes of the City of Fridley and with the Mwnesota Gonsttuction Codes; that I tmderstand this is
aot a permit but only an application for a permit and work is n�t to start witho�rt a peimit; that the work will be in aa;ordance with the
approved plan in the case o work wtrich ures i appmval of plsns.
s�cxalvxE oF n�,ic.,irrrr �����1_�Q�'' , ___ • rxn�rr x.� .� � L�zs�iLr��(. DATE 3/ � 6�l0
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l j City of Fridley
Building Inspections Department
6431 Universiiy Avenue NE, Fridley, MN 55432
763-572-3604 FAX: ?63-502-4977