AF - 45785City of Fridley, Minn.
BUILDING PERMIT No � �
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Owner: _��-7��=.*�t.-t4..... .. �=-=�-r.t��.. `�
--��---.._..... Builder .............._......_........ . _......._.._....._._......._..____._.._._.......___._.._._........
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Address .....-� ��---- °--'!,� � ._�___. Address ... � ..-----�.,��r±.'r�L____._.._._.._.___..._._._
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No. . .��...- �-� ..'�.�._. Street _ ��--���--�-- _..:. .---_. .._. ...._....:.. : -'�-------.s.._.--- Part f Lot ...._...-------._._----.___...._._...... --•----�..
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Lot ._...�.�.��..�..........._._... Block ....._......---�.-.--...._ ...............:. Addition or Sub-Division .---:.... .._............ --•--:.. ------.-�.�..._...-•------
Corner Lot .... - ...............�- - ....... Inside Lot ._..._..._�' :'.i............ Setback .-�-----��t.� ........ Sideyard --�-------��------•---.......-----.....---� --.._------�
Sewer IIevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: ,
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•A -��.'.e -- Front . � Depth �....��.. Height ..._�.... Sq. F� !:..�.�.� Cu. F't.�{�--"���� G'�
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...................._......................- �-�-- ....... Front .---�---- •--��-� --.. Depth ......... -�� Height ......... ........... Sq. Ft. ....._................. Cu. Ft. .....--�- ........._..
Type of Construction -.�.�.�.. �.!��{:�:�/...._... Est. Cos�.�.�.�"��(��_�."`.��. To be Completed ---------------_..._..........-----...--
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�i�IV ��i �il`��(� ��V��`.�r1� �._ �.r�-���Vl�� ��.�U�)�'�liiV �J i��VL�
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In consideration 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 of the city of Fridley.
In consideration of the payment of a fee oP $�.. .:�.:.'...°_.�.., permit is hereby granted to....._......._....__.._._......_.
_.._ __.._._.�_.._...___._. to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is grantec� and lus 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 of
Friclley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the dty limits and this permit may be revoked at any tim�Qnupon�� 'olation� f any of the provisions of said
ordinances. .�' /',
Inspector
NOTICE:
This parmit does not cove� the wnstruction, installa�ion for wiring, plum6ing, gas heatine, sewer o� wafer. Be surs �o see
1he Buildine Inspeetor for separate permifs for these hema.
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INDUSTRIAL. �
BU&INEB&. '
CITY LOT6 � `
70POORAPNIC MAPPINO
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SCAG � 1 "= �tQ'
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BLOCIr' l, OSTMANS .�RO ADO/T/ON
C. E. COU.LTER
LAND SURVEYOR
REGISTERED UNDER LAWS OF STATE OF MINNESOTA
LICEN6ED BY ORDINANCES OF CITY OF b11NNEAPOLlB
3300 LYNDALE AVE. 50. MINWEAPOLIS 8, MINN.
TAYLOR 4-0370
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�iurbepor'g �ertificate
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PLATTIN6
FARM BURVEYS
LAKE6HORE
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I herebPy certify that the above is a true and cor�ect plat of a survey ofa
Lot Eighteen...(18), Block ONe (1), OSTNlAN'S THIRD ADDITION, Anoka County,
M3nnesota. .
As surveyed by me this 19th day of January ���,7 A. D.
Signed iC,o, G� , �f';•a a�� �
' . A�iiinnpsota Registration No. 2584
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Owners Neme
Address
APPLTCATION FOR BUILD?1dG PERMIT
CITY OF F'ATDLEY, M7NNESOTA
LOCATION OF BiTILDING
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No. � 9 � St�ree� /Y���w �: �.��`; � Part of Lot
Lot _�,�,,,�,_ . Block .�_. Ad.dit3on or Sw.b.Div. �'� �S",�1,> � l� .� ri l� /�OD
_ �-��-
Corner Lot Ineide Lot�5et Back �� !/"e Side-Yard
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SE`WER II,EVATION � �I� � � � 1� F�UNDATION ELEVATIQ�1 � �' � � •
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lpplican� attach to thia form Certifirate of Survey of Lot and proposed building
loca.tion.
DESCRIPT�ON OF BUILDIIJG
To be used as:
� � � � �i �O I � , Front _ s�. 5�.,_ Depth._,��/ Height �' 0','1 ' � � �
Sq. Ft. ,� �__��_,_- Cu. Ft. G°_-L� �/� d� �
�
�°ont Depth Hei�ht
Sq. Ft. Giz. Ft. �
Type of Construction '• ` ��� a�Tst3�ated Cost
..g , o _ f'
To be
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in �trict accordance with the City Ordinances and ruling of
the Department of Bu3ldings, and hereby declares tha.t a11 the facts and repre�enta-
tions sta.ted 3n this applicatian are true ancl correct,
DA�'E _�w � -/�9,L-� SYGI�ATURE '
(A Schedule of Fee coata can be Fowad on the ReversQ Side.)
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BUILDIlVG PERMIT FEE SCi�DULE
Section 2. The Inspeator of Buildings shall, before issuing ang permit
for the erection of e.ny building or atructure, or for any add3t3on to
eny existing build3ng or structure, or for any alterations or repairs
to any existing building or atructure, upon application therefor� requ3re
the payment by the applicant for such permit of fees to the atnount herein
below set forth and in the manner herein provided to-wit:
2.1. For any s�.ch permi� for the erection of any fire-proof building� other
than a�arage, warehouse, factor�► or grain elevator, or for the erection of
e.ny fireproof addition, for similax occupancy, to ar�r existing bui7:d3ng
shall be at the rate of �1.40 for each one thousand cubic feet� or fx'action
thereof, in such cubical contenta.
2.2. For any such permit for the erection of any fireproof garage, ware-
house, factory or grain elevator,�or for the arect.i.on of any fireproof �
addition, for similax occupency, to any existing building shall be at the
rate of �1..25 for each one thousand cubic �eet, classified as "f3x�eproof"
by Section 502 of the Minneapolis Building Code.
H0�
2.3. For an� auch permit for the erection of any non-fireproof building
oth�r than a gara.ge, warehouse, factory or gra3n elevator, or ana► non-
fireproof addition, for simiJ.ar occupauc�, to any existing building.
Permit �7..00 for each one thousand cubic feet.
GARAGES
2.4. For an� such permit for the erection of any non-fireproof garage,
warehouse, factory or grain elevator, or for the erection of any non-
fireproof addition, for similar occupanc�, to arry existing building
for each such bu3lding or add3tion. Ninety Cents for each one tho�d
cubic feet or fraction thereof, 3.n the cub3cal contents thereof with a
minitm�m oF �,�0��
For the purpose of eomputing fees for`building perm3ts the cubical contents
of any build3.ng or addition to a uniform height throughout by multiply3.ng
the grourid ersa covered frem a point six.{6) inches below the floor line of
the ba.sement or cellar to the average height of the upper aurface or to the
aaerage height of the roof surface of the main gable of a pitched roof.
2.5. For repa.irs or alterations to an existing structure, the fee shall be
at the rate of �3.00 for each Five Hundred Dollas'�s (�500.00), or fY�action
thereof in tY�e coat of all proposed work.
2.b. In no case shall the fee cha.rged for any permit ae set forth in
Section 2 be less than �..00.
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sue�ECT PERMIT
City of Fridley � �- 1715 7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
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� `v _ COMMUNITY DEVELOPMENT DIV. � O
r � � PROTECTIVE INSPECTION SEC.
I = �
� /�"1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�'"""� � ,�� 612-571-3450 910-F15 5% 20/83 / /
�os nooRes�969 Hi Ck01^y C7 rCl e
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �S 1 Ostman`s 3rd Addition SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
Mike Pawlyshyn 6969 Hickory Circle 571-0923 B. 645-9131
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
sar�
4 ARCHITECT OR DESIONER 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
30 ft x ft addition for bedroom and new living room
9 CHANGE OP USE FROM TO
STIPULATIONS
1. Provide outside combustian air to existing furnace.
2. Provide fire alarms on both levels of house.
SEPERATE PERMITS REQUtRED FOR WIRILLG,
�{EAT�t�. �.M�IN.� Aol�-S�1C�S� _w-:�4r=�
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. OOCI 'Fi'�aRI@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING so. FT�540 �U 3LO
AUTHORIZED IS NOT COMMENCED WITHIN 80 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
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED 'Z� s4.00 �0.70
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
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �'�JZ. 'rJO
PLAN CHECKFEE TOTALFEE
38.13 201.33
SiG A UEi,EOFCONT TORO nurHO NT IDA7Et n: -" HEN PiiOPERLY VALIDATED THIS IS YOUR PERMIT
5'�2� �
SIG A UREO OWNERi OW p DERi �DATE� BLDG WSP �ATE
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CITY OF FRIDLCY Effective Aug. 1, 19s1
APPLICIITI��I FOf� RESIDChITI/l� BUlLD11�G PCRi�IITS
(t�c��. Alterations. Additions, or Repairs)
OI�JI�ER: 1''�4
ADQRESS: �,Q� �l,�G.�.�2�'' G�
'r�� No: �'7l- �� 3 �o� �
�c� �� �% Y+��CYQeC
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Construction Location
• STJiITT N0: �� 6TItEET: ��/G�/Q7 �/�G�
LOTs � HLOQC: �Ql�/C 11DDITION: ���J��r iS' %�11/� ���
Corner Lot: Insicle Lota Setback: � Sideyazds:
Ap�l3cant attach to this fo�nn two Certificates of S1�rvey of lot and
proposed building location dzawn on certificetes to scale.
DESCRIPTIOid OF COtJSTRUCTION
. �
Front: ��� Depthr �� Heiqht: � `�
�������� Square Faets �j�a Qibic Feet: �'3�Q
, Front: Dep�ha Height:
Square Feet: Wb3c Teet:
s`{o�3`�,`s�� 2��y�� -
Zype of Corstruction a �,�j� ���h�
4b He Cbr.�pleted: ���' ��
� . � �R ��� ,�.
Estimate8 Costr S �� ,��� �
Alt. A Alt. 8
Proposed Dzivc�►�ay kiath If New Opening Is Desireda � $' $
. . SE� �VERSE SIDE OF SHEET
Ziie undessigned hereby ana3;e� a lication for a •
Pp permit for the work herein specified,
agreeiraq to c4 _all werk fr, strict accordancc �ith the City of Fridle�► Ozdinances and
tul3ngs of the De�rtmc�t of Duildinqs, ana hereby declares that �11 the facts and
representatiens stated 3n this Application are true and correct.
�
D.�TE: �.6.7 f✓� SIGNATUI�r
Stipulationss �
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BUILDING PERMIT FEE SCBEDULE
The Inspector of buildingt shall, before issuinq permits for the
esection of any buil8inq oz atructuze, or for any addition to any
•xistiag building or structure, or for any alteration oz.sepairs
to any �xi�ting buildinq os • tzuctuze, upon appiication therefore,
sequire the payment by Lhe applicant toz cuch permit of �ees to the
a�ouat bereiA below set fortb and in the nanner l�erein prov3cled to-wits
TOTAL V71I�UATIQQ
51.00 tD 5500.00
5501 b� 52.000
S2r001 t� $25.000
525,001 to 550.000
lEES
510.00 Minimum Fee 515.00 plus surcharge
510.00 fot the first 5500 plus S1.50 for each
additional 5100 oz fraction thereo�, to and
inclnding 52,000
532.50 foz the fizst S2.000 plus 56.00 for each
a8ditional $1,000 or fzaction tbereof, to and
3.ncluding 525.000
5170.50 for the first 525,000 plus S4.50 for
each ac]ditional S1,000 oz fraction the�eof, to
arrd including 550, 000
550,001 to 5100,000 �283.00 foz the first 550,000 plus 53.00 for
each adc3itional S1,000 or fraction t2�ereof, to
- aad inclnding 5100,000 . .
5100,001 and np S443.00 for the first 5100,000 plus S�.50 for
each additional $1,000 or fraction thereof
PI.�1N C�IECRr 25 percesit of building pe�cmit fee
DRIV�WAY DEPRESSION ESQtOWz Concrete Wrb Streets Only
Alternate "A"a Removeal arid zeplece�ent of curb ar�d gutter only ,
Driveway width plus 6 feet x 513.50
Alternate "B": Renoval and replac�ent of curb and qutter and 3nsta1l a 3 foot
wide approach with 6 inch depth
Drivewag* width plus 6 feet �c �15.75 � .
VERIFICATION OF FOUNDATION
Pera►its for construction will be issue8 a minimiae of 24 hours frcaa the time of
application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, ehowinq the location of the foundation once it
has been constructed Will be required before �roceedinq with t1�e framing.
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C. E. COULTER
LAND SURVEYOR .
REGISTERED UNDER LAWS OF STATE OF MINNE60TA '
LICtNiED �r OIIDINANC[f Oi CITY OF YINM[A►OLIi
3300 LYNDALE AVE. SO. MINNEAPOLIS 8. MINN.
TAYLOR 4-0370
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I hereby certify that the above is a true and correct plat of a survey of:
Lot Eiqhteen.(18), Block ONe (1), OSTMAN'S TIiIRD ADDITION, Anoka County,
Minnesota. -
As aurveyed by tne this 19th day of January �957 A. D. �
" . Signed_ � �C,o , / , .Cs a,��
� '� . Minnesota Registration No. 2584
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--'- ..,-..-,.,r.. ii.c•t .
sue�ecT RMIT NO.
City of Fridley ` 2 � � 21
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� `y _ COMMUNITY OEVELOPMENT OIV. ���
f � � RfiOTECTIVE INSPECTION SEC.
� . �
( � r"'1 � CITY HALL FRIDLE� SS432 NUAABER REV DATE PAGE OF APPROVEO BY
�----� � �•' 612-571-3450 910-F15 8/11/98 / /
JOB ADORESS
6969 Hickor Cir
1 LEGAL �OT NO. BIOCK TRACT OR ADDITION SEE ATTACHED
oescR. 18 1 Ostman's 3rd Addition SHEET
2 PqOPERTY OWNER MAIL ADDRES$ 21P PHONE
Mike Pawl sh n and Barbara 6969 Hickor Cir
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Owner
a ARCHITECT OR DESIGNER MAIL ADOfiESS 21P PNONE LICENSE NO.
5 ENGINEER MAIL ADDRE33 ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION � ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house west side Storm dam e
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY G1i0UP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOH A PER100 OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTFiEET PARKING
1 HEREBY CERTIFV TNAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TFiUE ANO CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX
AND Of;DINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIPIED MEREIN OFi NOT. THE GRANTING OF A PERMIT SOO . SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OFi CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION 2]..00 Fire SC .SO
PLAN CHECKFEE TOTALFEE
NATURE�FCON7RACTOROR UT OR12 iaGE T IDATEI
�r � � �y `/ /��� WMEN PROPERIV VALIDATED THIS IS YOUR PERMIT
� ri.'l/c'� GLlt
TUREOFOWNER�iFOWNERBUILDERi / � ATE� BLDG �NSP ��qTE
4�
NEW
ADDN
ALTER
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ConstructionAddress: �G
Legal Description:
Owner Name & Address:
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
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Effective 1/1/98
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Tel. # Jr�%-D%z.�
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Driveway Curb Cut Width Needed:
DATE: � I/ � APPLICANT:
/
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Width
Width
�f
Height
Height
Hgt/Ground
�d c�Se�-
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
Estimated Cost: $ � 5b � , fi°
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x�$ _ _$
Tel. # S% � � � -2�
CITY USE ONLY
$ �� C?C� Fee Schedule on Reverse Side
$ �C� .001 of Permit Valuation (1/lOth%)
$ �� $.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 [ ]
$ ��_ C�C�
!I
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official 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 su�h 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 $100 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,(}00
$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
$1,000 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 $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.
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 constxucted
will be required before proceeding with the framing.
;. - . �.