AF - 45950sue�ecr PER
City of Fridley � 17 0 4 8
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��
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� ` ____ COMMUNITY DEVELOPMENT DIV. �� � ,3 O
� v � PROTECTIVE INSPECTION SEC. /� B 3
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� /"'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�"""� � ,�� 612-571-3450 910-F15
7/14/83 / /
JOB ADDRESS 6570 Fiickory Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9&N�.O 6 Fridley Park Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Chas. E. Jahanson Inc. 424 Rice Creek Boulevard N.E., Fridley 571-8021
3 CONTRACTOR MAILADDRESS 21P PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO.
6 USE OF BUILDING SEP�RATE PERM(TS REQUiREb FoR wi
Residenti.al
7 CLASS OF WORK �± e�'^
p NEW � ADDITION �� ALT A I `f�E�AA1R�' ��7I�4VE ❑ REMOVE
X
8 DESCRIBE WORK
Construct a 38'�x 38' Dwelling and a 22' x 22° Garage
9 CHANGE QF USE FROM TO
STI PU LATIONS
Provide a hard surface driveway. Provide sod in the front and side yards.
Provide City with. cxapy of vexifging survey.
SEW'ER LOCATION: Served frcen M.H, in Alley (Service near N.W, carner of Lot -
approxa.mately 23 feet deep.
WATER LOCATION: 78.1' 5outh of corner fence post. 64.6' W. of
DRIVEWAY DEPRESSION ESCROW�: NjA
VyAR�i'�� � � of ��.�►
Dp�g
BE�otE diQ$+�g �,a114aca1 ul+lities +►�Nrt,nC�
t�t�s a�t� ���� IOCA NOT W,�►NtE� rh�
ELECtRIC - GAS Etc. '��`` � �� � FLEVAIIOM�.
jEIEPHON� - BY lA� � n�� � s�c r s�ou� �, TM�s oN�r �No
RE(�UIRED '"FO�+noH
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR E�ECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOd �'l�le
THIS PERMIT BECOMES NUIL ANO VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOH 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
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $F'i1�7OO $3O.S5
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEHM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- 319sOO $425�00
STRUCTION T PERF CE OF CONSTRUCTION. $
PLAN CHECKFEE TOTALFEE
$79.75 $85�.60
SIGNATUREOF-C"CSNT ORORAUTHOR12EDAGENT �DATEi WHEN PROPERL VALIDATED THIS IS YOUR PERMIT
" � ti, �
SIGNATUREOF OWNERIIF OWNER BUILDER� IDATEI ,p BLOG �NSP l+TE
� ueuResN
NOINE6RIN0
��— _INC.
� Mam Otfice 5? 1 60G6
E875 N�ghwa� No 65 ti��—�.;- —
�� R��nnea{w�w, Minne;otn �$43�1� '�
—. � _--•-- _ �;
� SouthGthcc "6906510 ;
� � 1�� J& Slumrtpal F.ng�nerrmq ��ml T.•.sunp � Land .Curcey�nq � Land Planrung I � 101 QAf R�aJ
B�ur,sVille, Minne� to 55337
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Certificate of Survey for CNARLES ,10NANSON �NC-
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LOT 9 AND r�� �vD�T�wFSrE�L� N,4L�oF�or�o,
�BL OCK 6,�"R1�LEy ��RIC l ANOKa co�NTy �
� Denotes iron rnonurnen� Sea�e: 1= 30`
NorE :
As v�he ori¢in�� plai o{� `i-�c�Iey l�ark h�s 90 r�any rn�ssin�
derneny�on5 , we used iron �rror�urnPn�s found in �he �fovnd ,
lines ai ocevpaf�on end ,�/a �-�%�r,� o�' EDG�WATER �',,aRoe,us
�o e�a6/isti �he Corners o{� �tiis �o�op�riy; ,UVe recommend
�ha� �he corners o{� �his preper�y ,6e `/ud�c�a�ly dP-�ines.
SU�JE�t To EASEMEMTS OF RECORD , IF �4d1tY.
1 h�r�br e�rliir fhoT Fhis Is a frue and corr�ef r�pr�s�neo�Ion of o sur��r of ths boundarias oi fh• abov�
d��cr{b�d lond, and ef Ihe loco�ion e1 all bvildinp����h�r `n� ond oll vf;ibl• encrooehm�nts� if anr� f►om or on
�oid land. A� survey�d by m• thh day o/ �;:�d! ,� L. A.O. 19�' � � �
� SU�U�td,AN EI��NEERI,Nt�., INC.
, Eegin���� �'� Surr�rors
� ,by 9 �r' , .
N 8 3o(n� _ .t�
Not Published: Au Rights Reserved .; ''" -
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CITY Of FftIDLCY
Effective Aug. 1, 1981
APPLIGATIO'J FOt� RCSIDLi�TIA� BU1LDIi1G PE�if ITS '
(��e��, A1ter•iLions, AddiLions, or Repairs)
OHf(�ER:
�f/� a ;1 D� ,�_�/�o�/ �[3UI LDER : �I��/.5 • � 41 �o �i �s►. �rs b ,,� / l�(c
no�r;ESS: �� � � �> .�.
TEL �0: �7/- �o�.�
non�css: �a�y �', e. ,3-
TEL t20: -�%/-- �o� /
Construction Location
STItI�T NO: /PS/ O STItEF.T: // i%/Yf�/P�''
., � o sr,00c: � AnniTiota: _ �Pi ,� ��.y , L�AIr
Lo� 9 r,��� �
Corner Lot: Insicie I,ot: o>"' Setback: ,3 � Sideyards: 1/
Applicant attach to tliis form two Certificates of S�rvey of lot and
propo�ed building location dracan on certificates to scale.
�S � DESCRIPTIO�� OF C01•jSTR�JCTIOPJ
� � � ��
Front: �� Depths Height: �
Squane Feet: Qibic Feet:
��1�'� � r'ront: �� � Depth: �� ` Neiglit: /� �
_-r—
Squar.e Fe�t: Nbic Teet: _
Rype of Construction : �i� ��15 )_� —
Zb Be Wr.�pleted: _ � C� - / —
� ��,%� o0
. �
Estimated Cost: $ O ���
Alt. A A1t. B
Proposed Drive��ay �r'idth if New Opening Is Desired: $� $
g�� p,c^,VF:R�E SIDE OF SiIEET ,
ZSie undersigned hereby ma}:c� application for a permit fcr the �:�ork herein specified,
agreeing to do .all work ir� strict accordance ��ith the City of I'ridley Ordii�ances a�id
rulin�s of the Deik�rtmen� of Builc3ings, and hereby declares that all the fact-s and
rc�resentZtions stated in this application are true and c�rect.
na�: 7 3 �� ` sicrtnTa,r.�:
A SLiI�u ticns :
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P. e . �� �. ��.
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� 3�`; $�'
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The Chief Building OfPicial shall, bePore issuing permtts for the ereetion
oP any building or structure� or Por any addition to any existing building
or structure or for any alteration or repairs to any existing building or
strueture, upon application therePore, require the payment by the
applioant for such permit oP fees to the amount hereia below set forth and
in the manner herein provided to-wit:
Total Yaluation
�1.00 to �500.00
�501 to �2,000.00
Fees
�10.00 (Minimum �15.00)
�10.00 for the first �500 plus $1.50
for each additional �100 or fraction
, thereof, to and ineluding $2,000
$2,001 to �25�000 �32•50 for the first $2,000 plus $6.00
Por each additional $1,000 or fraction
thereoP, to and ineluding $25,000
�25,001 to �50,000 �170.50 for the first �25, 000 plus
��.50 for each additional $1,000 or
fraation thereof, to and including
$50,000
�50,001 to $100,000 �283.00 for the first $50, 000 plus
�3.00 for each additional $1,000 or
fraction thereof, to and iacluding
$100,000
�100,001 and up S4u3.00 for the first $100,000 plus
$2•50 for each additional $1,000 or
fraction thereof
Plan Check: 25 percent of building permit fee.
Drivesiay Depression Esero�: Concrete curb streets only.
Alternate "A": Removal and replacement of curb and gutter only -
DriveWay Width plus 6 feet times �13•50
Alternate "B": Removal and replaeement oP curb and gutter and
install a 3 Poot Wide approach With 6 iaeh depth - Driveway Width
plus 6 feet times �15.75 �
9erifieation Of Foundation
Permits for aonstruotion Will be issued a minimum of 24 hours Prom the
time oP application to alloW Por proper revieW of the proposed structure
and of the construction site. �
Ca92t��• Z?. "3x �i �7 � Sd `
A Certificate oP
� oaee it has been
Praming.
� ��%Of� �, o�
s'd, b� � — Z$
! � 3 3� a
� 1 cj
Surveq oP the lot, showing the location of the Poundation
eonstrueted Will be required bQfore nroceedina vith the
t S�0 �ipi
%,�� 1�+ t, �ln Rvt . 'L X$.67� '-
ti zyl �-��3.4�,r s�� �Z��. l�� �
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ci� oE �ua�a�c D�pA a�Nr
�YERIOii CE "U" COit�UT�TION
(To b� subaitt�d �ritb build�t� pe�it application)
�93328
�ne or Cwo f�41.�► dvallie� �_,� Oan�r _
All ather
�it• addr�ss
Contrac�or _��AI�L � JD�A(VSDJ�� Dat• - s 8 one
LIMF.AL �T. OF , �
EYPOSED bIALL S� �D�CS{�7 ft. above �rade -
?OTAL F.XPOSED WA � v. •
OPAQUE aAY.�. CONSTKUCTION: "U" value x area
Detail reference
1 �om
attached sheets
A�« �
°' U" x
S lC. "U" x
��� x
Go N CA " U",�-,�_ X
"U^ X
"U" x
nUre �
"U" x
"U11 x
WI NDOWS :"U" va 1 ue z a roa
l�lake �r. type "U" x
er n wuw X
w n / � "U w � 5� �
N w wUro x
n w NUw X
n n wUw x
s��. Ct. - ��1(%
sq. ft. r_— ��) (�
sq. i%•_ 3• a 5',nU iUl1�
sq. ft. -
SQ• 1 t.e o SZ.O�' �U /\•
3 !'t. � (U) (`
sq. :'� � �U��%
sq. ie. - (U)(�
sq. ft. - _ (U)tA
�q. f t. ' + (U)f�
sq.
sq.
�q.
Sq.
3q.
Sq.
ft. � (U)(Q
ft. - (U ) (1�
ft. �� = r! (U)(A
ft. - (U)(A
i'L. - (U)(�
ft. - (�)(A
�R$: pV� Va1t1C X aY'!�
Make � Lyp� "U" x sq. ft. - (U)(A
w � � _� MU� X 3q. iL. D� 5,2� ( U)( A
w " "U" x sq. ft. � (U)(A
" " "U" a sq. ft. � (U)(A
TOTALS�, Z- sq, ft. z-3 .3 ( u f i
TOTIIL ( U)(A ) VALUES 23G/, 3�- � A JG:�'II" -
DIYIDED BY TOTAL IdALL AREA �-1-Iq �q � 'i
t �
AVERAGE "U" ,185.� or l�s� for 1 k 2 faoily d�nlling9
,23..� or less for all other buildin�s
ROOF/CEILING :
TO?A L A REA : �,�Z � s q. t t.
Detail refer�nce "U" x
f rom _____ �"U" . dz s x
attached �heets. "U" x
D�scribe openin�s "U" z
1:1 t'OOf . ^Up X
sq. fc. - cU)(A
�q. ft. - 3�,�o fu)(A
sq. ft. - (U)(A
sq. ft. � (U�(A
sq. ft. - (U) (A
♦ 2 ?OTA L3 _S q. f t. 4 Zv ( U)(
TOTAL �U � �A � �%ALU� . 7di i.� � A�e
DIVIDED 8? TOTAL ROOF/ �d�.s'
CEILIRIG A REA ( Z�° � �_
��
IVERAGE "U" ,U4:l� for ventilet�d roof� °
,Q� .� for all other con9truction
.�
a4
'D�'E�M iN INLa
-= WA�L
" U" VRLUEs
s�cT � oN -
A� �ooF,
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W���� I�tM, ANp cnNG. BLK.
Roo� � c.Ell.(NU
c�� �A���
Q Ir�TERIo� A�r� FI�M a�l
O �ls� c�YP. B�a, . s�
� INSU�A�'IoN 3$,�
O EXTERIa(� AIR FILM .(ol
. CSTILL�
''U" = I /�z = ..�z� To-rA� CR�= 3q.��
. _--
WALL (�z� VA�u�
Q INTERIoR- AFfZ f I�M O. �a�
O �%2" UYP, 8D.' - .�-S
O 3�/z" INsU�ATIoN . _ �3.ab
O �,U I.l-�'� �1�'�r ' � �� �.or�
►o MASONIT� SID�NC� •1a'�j
� EX'(ERIDt� A1R FI�NI .1�
'' U'� = I / R = .oSB ToTAC_. (R) _ �,a3
�— .
�IM �
C R� VAIUE
Q INT�.T�lorc A�R � lu� '� o. �S
�3 5��Z INS��ATIoN � q,po
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a� -�;�.1�,� ��Ifi��� . 2,ot�
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i0 ��CT�.��oR A�R ���M . �-i
���u = I/IZ=.
_ � � ToTA� Cn) = 2�,='�
�o�1N�AT�oN
(C�� VALUE
OQ ►N TEtZ-lo� A►tz F ��M o. �a
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2� 12" �N�, $�K� , 1.28
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LOT �1 AND THE NORTHWE�i�RIY �IALF OF
LOT ID , BLD�K 6, FRI pLEY PARX (nNoKA counrY)
�ca l e : 1 "= 30
,
NorE:
q�, fh� ori¢ina� Pla-� of Fr�SIeY PQrk ha�, tio many m����n� demensions , we
u�d �ron monurnenfs found in -�tie �round , ��nes o� occup�►��on and PlQ�ih�
o-� �DGF WA7"ER GARDE N5 �o etifq 61 i� ti-�he cor�c�rs o-� �hiS proper�y . I�/P
recommend �haf-f�►e cornPrs o� �hiS PropPr�y bP �udiciQlly dP��'ned .
This is a frue and correcr representolion of a s�rvey of the buundariee o1 the land above described and,oltha
location of all buildings, if any� rhereon� ond all visible encroochments� if ony� irom or on soid la�d. This survey is
made only �n to�nection with o morlgoge loan now being placed on fhe property and no liability is assumed
eRCept to the holde� 01 sdch mortgoge or any other interest acquired by the reason of such morfgage. If is
�nderstood ond agreed no.anonumen1s have been plated for fhe purpose of sfoblishing Ipt lines or bou�dary
J.��� � corners Duted this�_day of_'�.C�'.� A.D. 1Vk;%.`'°�, -
�' � SUBURBA E �ER11�8',�INC.
�- Sudje�-� �o eaSemen-is reco�ded , i�any, E�bY ae._ J.`� s��: kYo.,
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N_ 611
0�
0 CITY O� FRIDLEY
PUBLIC WORKS DEPARTMENT
TAPPING APPLICATION AND PIItNIIT
FOR INSTALLATION OF WATER & SEWER SERVICE
I) This form to be completed before a tap is made to any esisting water or
sewer line. _
Address [�►�'!U f�-�cC j�� �9°�" 1��t_.
Owaer ��_L�F. � - J�/-�a150� . l�clC .
Plumber
CHARGES TO BE PAID BEFORE TAP IS MADE — WHERE
ASSESSMENT HAS NOT BEEN LEVIID AGAINST PROPERTY
II) Wafer & sewer connection permit must be registered before this Tapping
Permit can be issued.
City supplies all material and labor for 1" or under water tap. Con-
tractor supplies all material and labor for water tap over 1", and all
sewer taps. ,�c / ��
WATER TAP: Ma.terials Used: $ •
�' a�
� ��
SEWER TAP:
Street Patch: Y . $
TOTAL: $
Street Patch: x . $ C.� � �
III) If this property has not paid a full Lateral Chazge for its share of the
water and sewer system, additional charges will be placed against it.
This will be in addidon to the normal connection and tapping permits,
meter deposits, etc.
Water
ASSESSMENTS TO BE LEVIID: Lateral: $
Sewer La#eral: $
TOTAL ASSESSMENT: $
Clerks Signature
Supt. of Public Works % t�s''Q�lu�i C� ►�-.�_
M/P 3/76 Whlte P.W. Cenary Finence Pink Prop. Owner Goldenrod Plumber
ADDRESS
PIN
LEGAL DESC
PERMTT TYPE
CITY OF FRIDLEY
6431 iTNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�63) 572-3604 FAX: (763) 571-1287
: 6570 HICKORY ST NE
: 153024130062
: UNAVAII.ABLE
: LOT BLOCK
: BUII..DING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : RESIDING
' e ,
. �
PERMIT N : 2004-01369�
DATE ISSUED: 08/18/2004
VALUATION : $ 14,000.00
NOTE: PER R703, 2000 INTERNATIONAL RESIDENTIAL CODE, REQUIltES THAT A WEATI-iER RESISTIVE BARRIER BE
PLACED OVER EXTERIOR SHEATHING TO PROTECT TI� INTERIOR WALL COVERING. EXCEPTIONS FOR THIS
PROVISION WOULD BE IF SHEATHING IS AN APPROVED WEATHERPROOF PANEL OR WHEN THE SIDING IS AN
APPROVED WEATI�R BARRIER VINYL SIDING IS NOT A WEATI�RPROOF COVERING UNLESS TI�
MANUFACTURER STATES THIS IN THEIR APPLICATION GUIDELINES. CALL FOR INSPECTION OF WRAP BEFORE
COVERING OR TAKE PICTURES. RESIDE HOUSE & GARAGE; SOFFIT & FASCIA.
STATE LICENSED CONTRACTOR 1
APPLICANT
MINNESOTA RUSCO INC (2173)
5558 SMETANA DR
MINNETONKA, MN 55343-9003
(952)935-9669
OWNER
GONZALEZ CHARLES H& CYNTHIA T
6570 HICKORY ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 da,ys 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 l�ow the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions o any other state or local law
regulating construc ' or the p orm e of construction.
Applicant Date__ � e
Bldg
SEPARATE
BUII.,DING PERNIIT FEE
FIltE SURCHARGE
STATE SURCHARGE, VALLTE
LICENSE SURCHARGE
TOTAL
PAID WITH CHECK # 29863
�
FOR�ORK OTI�R THAN DESCRIBED ABOVE.
237.25
14.00
7.00
5.00
263.25
NEW
ADDN �
A TER
�� �7.3
[ ] CITY OF FRIDLEY
[] 6431 University Ave NE, Fridley, MN 55432
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: (U5 /V
Legal Description: �r'
Owner Name & Address: . '
�,��►' �p��`� � `� �a��y��
Effective 1/1/2003
�763) 572-3604 Bidg Insp
(763) 571-1287 Eax
.���� `�1 � ��� �'�
Tel.# %Oc3'✓��7��//
Contractor: `�C I U. LiI.Q/�J (_.(,lU�%U � vY'�`�' • " M�1 UCENSE # vf/ �
Address: 5558 J/Y�p.f"Q,�1A, ��U/l� . �.� .P�7r� 553�3 Te�. # g�`Z • 935• QiLole`�
�� f5Z • 935' 9Sz/y
Attach to this application, a Certificate of Survey of t
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: Estimated Cost: $��. QVo � ao
�Q��vf' a,nd !� '
Dri way Curb Cu idth Needed: Ft. + 6 Ft = Ft x$ _$
9�Z� �
DATE: " � O APPLICANT: � Tel. # � ��
Cail (763) 572-3604 for Permit Fees if maiiing in app ication. Fax to 763-571-1287 if using credit card and we wiil
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge .
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
�.f � .
$ ��� ��-� Fee Schedule on Reverse Side
$ ` .Q01 of Permit Valuation (1/10th%)
$ d�� $.50/$1,��00 Valuation
$ $1275 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 [ ]
$ �� :� � $TIP ATION •