AF - 45708BUI�ING PERMIT
Vil.lage of Fridley, Il�I�.n.n. N� 2 3 6 3
Date . . . . . . . . . ��:�. !'�. .�. . . . .'�$. . � . . . . . . . . . . .
Owner ......'`.� ...� .. .�'��^:?�;��. .. Builder . ... ... . ..��:�'?"'.?'°:''p:"�► . . .. ..... . .......
Address ... !.�..':°'.���..:�.:..� �..... Address .........................................
LOCATION QF UILDING
�r �" a
No . . . . . . . . . . . . . . . . . Street . . . . �,� ,.��F ,��'+�. . .�! .� . . . . . . . . � �' Part of Lot . . . . . . . . . . . . . . . . . . .
�+�., .� s C'�� �
Lot . . . . . . :"�� . . . . Block . . . . . , . .1.°. . . . . . Addition or Sub-Division . %":' �: . . :�:�``� .'�. �:�'; , � �
�r �
Corn�er Lot . . . .. . . . . . . . Inside Lot . . . . . . . . . . . . Setback . .!� .��.' `� Sideyard . . . . . �.��. . .�'�� ;' . , ,
DES�CF�IPTION OP �LIILDING
To Used as: � �f� � / ��r +!�%,���,,�, ... �' ��-°�
:� �'�� '
.....��.. Front ........ Depth ..`�"�"�.'.�Ieight ......... 5q. Ft. �•�,��"�,� Cu. Ft. G
�� ........
. . . . . .. . . . . .. .. . . . . . Front . . . . . . . . Depth . . . . . Heigat . .. . . . . . . Sq. Ft. . . . . . . . . Cu. F't. . . . . . . . .
� � r t��.,
Type of Construction�e:��� Est Cost�.::��..`?�:�.�...... To be Completed .�. r'�:'.�:!......
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
4he proposed work in accordance with the description above set forth and in compliance with a11 provisions of
ordinances of the village of Fridley.
�...•.�....� ..............�...... ... .. �y.
,..� ���
Yn consideration of the payment of a fee of $. . . . .. . , permit is hereby granted to . . . .. .: . . .. ...
to construci the building or ad dition as described above. This permit is granted upon
the.e�cpress condition that the person to whom it is granted and his agents, employees and worlunen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances oP
Fridley, Minnesota. regarding loca.tion, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. E� �
�:� r
....°.�..is�-.. :�..5::��.�;�;� �r..... Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspe�tor for seParate permits for these items.
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CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (,j�r No ()
2. Is free from rust or deterioration Yes (� No ()
3. Has no foreign objects lodged within Yes () No (�� ��a�
��o�
4. Is securely supported Yes (� No ()
5. Meets all current Code requirements for
size and total BTU's connected
6. Has total heating BTU � s of ���� D�
All other BTU's �0 00 D
TOTAL BTU' s �' 9 e� 0 b
Yes ( � No ( )
List Alterations Beinq Done:
HEATING COMPANY
Signed By
Date
.�
��b
.� , � ��
�iYMJ��:L'ii7IS\4�A1�1�1A�
BROOKLYN PARK, MN 55443 �'��%�'��"
PIH�NE 424-8333 � � � -
�__ _ ..
HOUSE HEATING TEST RECORD
; ' � �.
ADDRESS '� " " ''�- '`_'�� f' ",-� ��� n ', '�� � � _ APT. FLOOR CITI( SUBURB ' � �� ' � � � �
OCd1PANT �� � 0 � C� :��-�f� ��° OwNER
HEAT LOSS DATE HTG. INST.
SO�D BY INSTAI.LED BY
Elsetrieal Work' By Gas Lin� Br
TYPE OF HEAT GA FA `F� HW STEAM SPACE HTR. UNIT HTR. OTHER
_ . ; -- GAS DF�SIGN CONVERSION
MAKE � � ��� ��, �� ",.�;� > �''�a"`:'._r MAKE OF BURNER
Mod•1 ; _ ` � � ���.,�� =^�a
', . 9 _ 1 __ d ' AAod.l
S�rial - � ' �_ � �='-o �'`-�`�� °`� Max. BTU Ratin9
INPUT � ���' � ` �
� ���-» � � �� MAKE OF FURNACE
Model
, � CONTROLS �� ,,-,
THERMOSTAT r'� ��__ ''°'' Hsat Pluy �'� V�nt Size
9
Valvs + � '� � � ; � KIND OF LINER ��d� �° SIZE -�� �� NONE
Limit �� � °�i� � a, �, Droft Hood R�pularor
Limit S�tfing � ''� Filtns Siz� � �^�'� �a���� ('�lun�b�r
Fon Sstting Chimn�r Location Insid� �, y Outsid�
Pilot Typs " ^` '! � Chimnsy Construdion �'��� � ' ��`�
Pilot Make
Pilot Model Smoks Bomb q Wiriny
Pilot Timing Drah �C���h'A'O�� T�st Taq h� �'�
L.W. Cut Off Door Prossure Liphtiny Inst. ,'
�-°,, , r::-�,, I ''; � ! .J " c_=� �� ' '`' —�� .
Prosauro P�roent CO � Dats Tsated ��- y `
��� � � �� Company Testing ' � g � ,�-- E"�-Fi��: � I_° 6 __i, _.�
It�ut CFH , `+ Pere�et 02 _ @` F� _fi �� "-, y _
Stack Temp. �����' Perc�nt CO B�-�� Nams oF Teat�r �� �,r "°'�' ��`-� � �
Fwm 235 - �� . `L� � �
� su6�ECr � � �
c�ty of Fridley
AT THE TOP OF TME TWINS g � I L D i N G P E R M I T
r
� .
� �
COMMUNITY DEVELOPM�NT DIV.
i ty ��'�� , .
r � � PpOTECTIVE INSPECTION SEC.
� _ ,
� �'�'1 � CITY NALL fR10LEV '.i51�2 NuMBER pEV OAT6 vAGE Oi
��"'�" �'' 612-57�-3450 s�aF�s 3/29/99 / /
JOB ADDRESS
6930 Hickor Drive NE
t LEGAL �OT NO. BLOCK TRACT OR AODITION
oescA. 12 4 Ostman's Third Addition
2 PROPERTY OWNER MAIL AOOR�S$
Nadine Warner 6930 Hickory Drive NE
� CONTRACTOH MAILAODRESS
4 ARCHITEC'
5 ENGINEER
Residential
7 CLASS OF WORK
❑ NEW
8 OESCRIBE WORK
Reroof House & Gar
9 CHAN(3E Of USE FROM
STIPULATIONS
MAIL AODRESS
MAIL ADDRESS
ZIP
PER�NO---
29101
l�,
�ROVEO er
SEE ATTACHED
SHEET
PHONE
571-0360
PHONE LICENSE NO
33 566-5225
PMONE LICENSE NO.
2007950
PHONE LICENSE NO
O ADDITION ❑ ALTERATIAN � REPAIR O MOVE O REMOVE
21 Sa) Tear-off
TO
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.
TYP� OF CONST.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, MEATING.
VENTI�ATING Op AIR CONOITIONING
TMIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION 20NING
AUTHOR12ED IS NOT COMMENCED VjIITHIN 80 DAYS. OR IF CONSTiiUCTION
OR WORK IS SUSPENOED OR ABANDONED FOfi A PERIOD OF 120 DAYS A7 '
ANY TIME AF7ER WORK IS COMMENCED NO DWLG. UNITS
I HEfiEBY CERTIFV THAT I MAYE READ AND EXAMIN�D THIS APPLICATION 1
AND KNOW TME SAME TO 8E TAUE ANO CORRECT. ALL PROVISIONS OF LAW$ ypLUATION
AND ORDINANCES GOVERNING TNIS TVPE Of WpRK WILL QE COMPUED
WITH WMETHEF SPECIFIE� NEREIN Op NOT. TME GiiANTING OF A PERMIT �1 � 799
DOES NOT PRESUME TO GIVE AUTMO TO VIOLATE OR CAMCEL TME pEi7MITfEE
PROVISIONS OF ANY OTHER STA CAL LAW REGULATING CON-
STq CT N OR THE FORMA E F ONSTRUCTION S(.7rj
Q, PLAN CNECK FEE
� `'Z� 'l � Li s
S�GNATUAE OF CON"AACTOA Op AUTMOA�ZED AGENT IDAT � EN P
S�GNATUAEO�OWNEAi��OWNEpBWIDEp� �OATE� Bi�f, w5o �
_ � �
OCCUPANCY GROUP OCCUPANCYLOAD
S�.fT CU FT.
OFFSTqEET PARKING
STALLS GARAGES
SURTAX
$.90
SAC CHARGE
Fire S 1.80
10TALFEE
$5.00 $64 4,�
RMIT
Mar 26 99 12:31p
` FE8-10-1999 13:53
� '�a'^ L 1
ADDN [ I
�-T� [ 1
constrnccionAddress: �o �
Kerri 566-7183
�ROM CITY DF FRIDLEY TO
CITY OF FRIDLEY
SINGLE FA1VIILy AND pUPLEXES R i AA1D R Z
$��� PERMIT APPLYCATION
p.2
5667IB3 P.02i92
Effectjve 1/1/99
�\
��1 �
� ��
Le al b \
g escription:
Oamer Name & Addre�s�/� . �'�.--��
Tel. �I �.57/— G>�3lvC�
co�cor: Pir,�/ �, �a� (�� n�r,��.;��. MN LICENSE � a�vo7 �S' O
Address: � �' � . ; L2E �/y��j •
Tel. f! 5�c-;S"' �"
At�ch to this applica�oi►� a C�rtificate of Survey of the
Iot. with We propo� �p��tion drawn on it to scale.
D�;SCRTPTlON QF 11VIpROVE14�NT
LIVIl�TG AREA: � Length �� Width Hei ht �
GARAGE AREA: • g Sq. Ft.
��� _� Width Height Sq Ft.
DECK AREA; Lengtb._i_ Widt� HgbGhowtd 1 Ft. �
OT��RS �` .� �1 � 1 -- - - ��
Coaswcdon Tyge; � Estimated Cosc: $ / �� .
fFee Schedule on Back)
.Driveway Curb Cut Width Need�; Ft, + 6 Ft = F� X$ _$
DATE• 6 APPI.iCANT: �
Tel. # ;� ; 5���" Sr"
Permit Fee
� �ire Surcharge
St�te Sur�harge
SAC Charge
Lic�se Sur�hazge
Driveway Escrow
Faosioa Control
Pazk F�
Sewer Main Charge �
Torar.
ST�ULA'YxONS:
CITY USE Ol1T�y
� �* o�� Fee Schedule on Reverse Side
$ � ' �� .001� of Penriir Vaivation (1/lOth�)
$ c'l l `� $:50!$1,00o Vaination
$ , $lOSQ per SA� Unit
$ .� A`� �"`� $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
� $450.00 Conservavon Plan Review
$ Fee Determjned by Engineering
$ Ag�eement Necessar�► E 1 Not Necessary []�
$ �����
TOTAL p,02
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CITY OF FRIDLEY
6431 ITNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 l+'AX:
: 6930 HICKORY DR NE
: 103024440059
: OST'MANS 3RD ADD
: LOT 12 BLOCK 4
: BUII,DING
: RESIDENTIAL
CONSTRUCTION TYPE : RESIDING
VALUATION : $ 22,000.00
571-1287
PERMIT NO.�:, 2004-00557 >j
�--�_��---�-,°``.
DATE ISSiJED: 04/21/2004
NOTE: PER SECTION 1402, 1997 UNIFORM BUII.,DING CODE, REQUIRES THAT A WEATI�R RESISTIVE BARRIER BE
PLACED OVER EXTERIOR SHEATHING TO PROTECT TI� INTERIOR WALL COVERING. EXCEPTIONS FOR THIS
PROVISION WOULD BE IF SHEATHING IS AN APPROVED WEATI�RPROOF PANEL OR WHEN 'TI� SIDING IS AN
APPROVED WEATHER BARRIER. VINYL SIDING IS NOT A WEATI�RPROOF COVERING UNLESS TI�
MANUFACTURER STATES THIS IN TI�IR APPLICATION GUIDELINES. CALL FOR INSPECTION OF WRAP BEFORE
COVERING OR TAKE PICTURES. RESIDE HOUSE & GARAGE; SOFFIT & FASCIA; REPLACE WINDOWS WITHIN
EXISTING OPENIlVGS.
STATE LICENSED CONTRACTOR
APPLICANT
NORTHWEST EXTERIORS
6500 WALKER STREET
ST LOLTIS PARK, MN 55426-
(612)926-8663
OWNER
WARNER NADINE M
6930 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 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and exa.mined this
application and know 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 no� The
granting of a permit does not presume.to give authority to
violate or cancel the provisions of any other state or local law
regula '�c ction or the performance of construction.
Apulic t Date
Bldg
BUII.,DING PERMIT FEE
FIItE SURCHARGE
STATE SURCHARGE, VALUE
LICENSE SURCHARGE
TOTAL
349.25
22.00
11.00
5.00
387.25
�er�i� �ns�ection �ar�s
Will �e M�il�d
To Home�w�r�r T� Po�#
SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
04/21/2004 13:05 9529265960 NORTHWEST EkTERIORS PAGE 01
RPR�-��4�-2�4 15�82 FR�'i CIIY �F FitJALEY 'T�
� [ ; art�r QF FRi��r
84�1 U�r�+ A� NE. FrYdisy, MN 66�'
A�IER j� SINQLB FAMILY ANQ I�UPLE7t�S R 1 ANa R•2
�UIt,DIN�# PERMIT AF'PLICATION
95292G596fd P.01/�
�Res� 4l912004
�t) e�2�eu� �tdg In��
� y71��389 F1t�c
��� - 40��-�
C�n�udion Addn�as:� � O 1 � I<(� (L- f.'�
I.�sl Deaaiptian.
OWner NtArtre 8� AAt�r�� R! .�1 �D r n► 4�?'1� /�- T�1. # 7 � ^ S ^ 3 O
C�t�01; /1/ o ti 7� 9 v�► E'�S f�', �� � o!LJ' AAN1 UC�N�E # Zt� Z b�% rb
,
Adan�ec .� � � -L S r' Te+. �R �l S �2 S 2 (, - �r_6 �_ 3
ath�J, t� ��ppraatton, . C�cat� 04 �urvey af tt»
tot, v�th tt� propo��e Qor�huc:tlon dr�n pn � to �le.
bESGRIRTI4N OP IUAPROVEMENIT
a��12-�Ig o-Li`11
I�MINt�,ltiR6A: I�t►Om.��. �h� ���----- �Q. F� �
c�,AARAOL AR6A: Ler�t ,� Width � N�ipht �„�. Sq. Pf.
Dk�iC AREA: tA11�tA �,.,.,_._ �M4th �,� H�VOround Sq. Ft
Ol'FI@R:
�2�-S',o� � S� � �
GvnatRtr�n Typ�e:� �_ t -�� � W •�mated Cast: $,�_.,,�d--�,� � ,
Drive�pl L'lulb Cut Wld�t N�ed�k ,_�t. � 8 Fc �,,.,_Ft x� ��. - �.+�-
DAii: APPL1GANil": � C ..c_� �..^�� THI. # �� � i ' �—� �l �i �
C�N ('l8'S) 6°�4 �4r P� F1�tr R mallPn� in appR�9on. I�x to T6�1.�71-1�7 ff usfnp credlt cm�rd �nd we wm aall
you tbr camd numbu.
PeRn�t ��e
Pl�n Rov��v
F� Surr�t�r�e
8ta�9 9w+�hh�rge
SAC Ct��rg�
CfTY U$6 ONI.Y -
� �i��, a��
�
g o � f��
� ll� ��
Fee �ScheduM on �ever� Side
85°Ib of PermR Fe�
.Q01 af Permit V+�tu�tion (1/10th°�b)
$.50/$1,000 Veluatl+an
$1354 per SAC Unit
�.00 (S^�te L.t�naed Re�ider�iat Gor�t�ctors)
Curb Cut �crouv � A�t. "A" or #. ove
�on Canfird g $450,OQ �Conasrvatlan Pl�n �evt�w
Park Fe� $ F�e DetOrmin�d hy Engin�r�n8
Sew� Mt�in Ch��g� $ Agrsement N�c�e�s�ry j] Not N����ry []
' TOTAL � �� I • ���
��
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yl ' .,�� 1 + ,�;: