AF - 45954n
�.
City of Fridley, Minn.
BUILDING PERMIT
.: � - %-
� � � ' - �, 1
� .. � -: � �. � � t' � �- �i.�� _ � s - �z,�.�.� -
�, :
_ , .
N° 6810
. . �� s--o �
,� � CATIO O B�NG
No. st�et _� Part of t
Lot����__ Block �ddition or 3ub- vision .._._ ._
� � L� � ,_,�,• '
Corner I.flt _ Inside Lot Setback ��—_ Sideyard
Sewer IIevation �� � • � � _ a on � C�, �
r
dr�P �a� F����n��
DESCRIPTION OP BUILDING
To Use . ,�
�ont � Depth ��5� Height �� Sq. Ft Cu. Ft����
F`ront .� Depth eight � Sq. Fk � Cu. F't. ��.1—L�
��
Type oE natruct[on F�t. '�'To be Completed
__�� In conaideration oP the issuance to me of a permit to const
` the proposed work in accarrlance with the descrlption above set
� orrlinances oP the dty of Fridley.
Ia consYderation of the payment oP a fee oP
l above, I agree to do
with all provisiona of
permit fs hereby granted to
to conatruct the buflding or additfon as descrYbed above. Thispe rmit is granted upon
fihe express condition that thepe�o n to whom it ia granted aad his agente, employees and worlmnen, in all work
done fn, around and upoa said building, or anypar� thereof, shall conform in all respecte to the ordtnanc� of
wlthin the��liami �and location� construction, alteration, maintenance, repair� �� P�vYsions of�seid
o��� this permit may be r+evoked at tim �/u�pon viol9�ton of
� 1
�� �
NOTIC�
Tlds peemh does �rof eewe t6s eoesMteHoe, i�a�m �or �rlrt�, plum6teg, ea 6uttep, awru� er wdsr. 8� sms te sss
t6o Buildio8 le�tae for aparaf� p�rmifs hr thw h�ms.
f/�°t 7 �G �3
�,:
APPLICATION ''r'�Jzt BtI�'!:?�TNC PERMtT
C yTY OF lt:'.iDI��Y, 2•�tIldL.SOTA�
4d�i`s�s.' S TTAME
�
AI3�t.�5S
>
Loca�ort oF s*�,n�:vc
�
,
�o. � S� �(�� Street �'' ,a� ParC of Lot
�
Lot�'�p B1ock�_ AddiCion or Subdivisioa ��
Coa�er Lot Inside Lot� SeCback � SJ Side-Yard 6- -/��
SEWER ELEVATION F�1'Jl.9DATION BLEVATION
Applicant attach to thig form Two Certificatea of Survey �f. �ot aad proposed build-
ing location drawa on these Certificates.
To be used s�s :
DESCRIPTION OF BUILDING
Front Depth Seight
Sq..Ft. . Cu. Ft.
'FronC
Depth AeighC
Sq. Ft. Cu. Ft.
�ype o€ Con�truct�on Eatimmted CosC
To be Complated
The undexsigned hereby makes application for a permit for the work herein epecified,
agree3ng to do a11 work in atrict aceordance with ehe City of Friclley Ordinances and
rulinga of Che Depaxtment of F�uildiqgs, and hereby dec�aree that all the facte and
repreeentations stFted in this application are Crue and co�crect.
DATE SIGIVATLIR�
(Schedule of Fee Coata can be found on the Reverse Side).
�� - . n �
�
_ e � � ^ _ � 1`'' 3y ♦
� ` •
C
BUII.DZNG PEItMLT �'� SG`HE�ULE
Seation 2. The SnspecCor of Building� sh�.�l, before isstaing, aay per�it fnr
�he erect�on of aay buildiag or structure, or for any addition to any euist-
iag bu�.lding or structure, or for ar►y alterations or repaira to any exia�ing
buibding or s�ructure, upon application therefor, require the payrment by the
applicant for auch permit of fees tv the amouat heraia below set forth and
in the manner herein provided to-wit:
Z.1. For any such germit for ehe erection of atay fire-proof building, other
than a garage+ warehouse, factory or grais elevator, or for the erection of
any fire-proof addition, for aimilar occupancy, to eny existing building
ehall be at the rate of $i.40 for each one thousend cubic feet, or fraction
thereof, in such cubical contents.
2.2. For anq such permit for the ereetion of anq fire-proof garage, warehouse,
faetory or grain elevator, or for the erection of any fire-proof additioa,
for similar occupancy, to aay existing building ahall be at the rate o� $1.25
for each one ehousand cubic feet, cla�aified as °1f3reproof" by SecCion 502 of
the Minrieapolie Building Code.
I30USES
2.3. For any such permit for the erection of any noa-fireproof buiidiug other
than a garage, warehouse, factory or grain elevator, or any non-fireproof
addition, for aimilar occupancy, to any exieting building - permit $1.00 foac
each one thouaand cubic feet.
GARAGES
2.4. For anq such permit for the erection of anq aon-firepraaf garaffie,
warehouae, factory or grain elevator, or for the erection of any aon-fia�e.proaf
add3t�.on, €or similar occupancq, Co any existing building or for each such
�j-id3ng or addition - aiaety centa ($0.90)�for each one thousand cubic feet
or fraction thereof, in Che cubicai contents thereof w3th a minimnm of $4.00.
For the purpose of compue�l..ag fees for building permite, the c�abical coutents
of any buildiag or addition to a uniform height throughout by �Lt9.plying the
ground area covared fram a poine sis (6) inches below the flaor line af the
basement or cellar to the averaga height of the upper surface or to the
average height of the roof surface of the maia gable of a p9Ltched roof.
2.5. For repairs or alterat3ons to an existing structure, the fee shall be
at the rate of $3.00 per each Bive Hundred Dollara ($500.00) or fractioa
Chereof ia the coat of all propoaed work.
2.6. In. no case shell the fep, charg�d fnr anp p�rueit es set forth 3n
Sectiaa 2 be less than $4_O0.
�. ^ � . _ �.
-°.� . _ � � � - _ �
�'�' `•�e� ,..� � . ,� •.e....--�-�-_.-_�.-•�,• _ --�
� _,�_
�,
:�
� ; __- --_
-�-'- ---"_�
Lond P/onnin9
c�su,���y;ny
Soils Testin9
Crvil fr A4unicipal
En�irteerin9
__ -- " _ = � "•� � _ - - , - _ - �- -.� . _ - �
� , -_ - _ _�
_ -- < -
- °-__-��� �-v.- --»� - - ;�_
� 6ers-H�h„� ;cs NE.-`
, Minn�a�olis 31,
ENGINEERING, INC. Minnesofa
SUnset4-6066
— En�ineers � SurvecJo�s --
cests��cate o� sszsve �•:
T
�
% ,.
.
� �
���
I ..�'�Q ( � � .
. :. .�,
. � �
��
� ��` , �
.,
- /` y^ �. , G � d
�`�a `
.a ��
.. � 9 � ��
�y
. `,'1 JY'
_ i '�. � .��`
_ ' �_r �
� �`� a
' y� �
, ��'�
, � � ���
�� �
�
o�
��
� �.�
�.
�
e �
�.�i'�i��z� �. t7���;�;;>`f� $
-J-
�
.�-
\ibn ? . �
� >
, �' �
;r �'�
� �� s �
�y :� ��
b � � ,i�
.�
�.�
: .`�-. �
f... � � \
� ` \ °�
tr' �
..��� _ •'�-�
-.� .
, ,,
�
l��ti `�,
fa
�
g
! oT5 5 ���. ����°� � ��� .
�= �� �� � ��`" �'��R!�
v
Note: As the ori�inal plat of Fridley Park has so many missing dimen-
sions, we used iron monuments found on the ground, lines of occupation and
the platting of Edgew.ater Gardens to establish the corners of this property.
We recommend that the corners of this property be judicially determi.ned.
l/rrreby cerfi�y �lwi lhis is a�nie o.�d m�c� represeniofivn o�'o surretf �'�Iiae bovndor'res �i'!� obe►v �/�d lon4, or�d
o�'!l� locvfinn o�'o// buildin9s ,lhueon , ond d/ ris'ible aw»v�fimarfs ,��'a�y. �n a►` an savd /m�/. As surreyed by n�e 1Ms - doy
• o�—� �• A•� �• SUBURBAN ENG/NE�RlNG , INC.
Fr►9ineers Fr Sta'reyors
/ �/� `"
� � �- :"Q�K�,�.,_��, ( ,��Q , r > �. ��``I 1 �`�� °a� '� _ rr,•,? ,�_ ...
e :,���. -�
,�
4� _
i -� C
' �
�- ��
�
�.._. ,_.�.
;/
t
. , LWnI ��� � . ' :' . . : _ . . .� � _ .p
[���yy��•/��� �
4 :�
;it/'�� / � �
[.(tAf� � ��
� �. �
.�;rskst� � EN_�1����� �'�° �:
. �Cmf b A�i,riiriPvl � _.- , `:.-�.�6 -
�,,, E -
����� , _ , — ,En i�Qers � Surr�e�� �-�-- �� - .
. - . . .� . _
��s����te �►� �L� f �►s C�iQr��S E. ����� v-
. ��% . �- _ 5
�
"1 `
�� ,
��
P �
i `
lZL. L-r
-J� � �� < ��'�.
� �
Z� •
� f i-
�.. , i I
�� �' `°t
.�� �� .
``� �
-� ° .�
s
� ��
�
�j 9
.�� �
�.. �
`�t
vX
�
'T .
;
. '�� oo SF
` ��� y ,
�� �, � .
.�� c�'�
' � �� °�
� �
� , -�.�.
�
.� ,
3�_ ��,�
� �\ '
4 .
�'l .
�
�
� �T� �j �'�'�O, �t..d�.�. �i,
�- �� �� � Y �'����, � �
� � ' ` 4 �� . .. . � . . � . , . � �.r.. - . � . . �h
Note: As the original plat of Frid�ey Park h'as}so,many missing dimen- ��;-�;
sions, we used iron tna�uments found on the ground, lines of ocCUpation and h.�..z
� the platting of £dgeaater Gardens to establish the corners of this property. F
He recommend that the corners of this property be judicially defiermi.ned.
l l�d�sby csrii�'y �vl� 11das is o� and m�r�cf �sentofiian �('a s�rrry �'1I�c irw�dn+�s �'�Mr :+r�6wr /ipu+lyd lend,w�ri
o�'1Yx kco�iiw� ql'al/ bnr�d�s, fArre�n , and sr/ rrgi�rfr a�w+r/x�mfs ,��'ay, � a- nsMid kr�d. /s ,�rir�ed �i �e �...._- t� .
�(' � � ' A.Q /x63. ,' - h
SiJ't3�f��Al�1 E�6l���1l3, '/il�tC. . �:
�' � � � 7� . �j _� _ � � �� � �� �
...� _'! ; Q � = a!i! � _��"t,_.�.��3���.�.,
3 �� . _ _ —� .
_ � �. � _ .��x .
�
M r
b �
� �
'tl �
� r
o M
p �
: N
: °x
: �
. m
. �
• M
; O
: a
. m
0 '
� .
� •
N
�
�• y
�n � w �
� O
� �j �
�0
o � m �
N � .
o •
o �
°o � :
o . .
� : :
� . .
0
�a x aa
N ►�+ �
O O O �
H
y
� �
�
�
�
fZD � W � � z 7i
� M � g � -�r� 4]
� � � � � � �
� � � � � � �
� � O � �
,�y a' p � �
� p � � • M
¢ N : �- � : en
A
bd o � E- � :
Q4 � . � . .
� . . . .
. � � • • �
�o
� � � � � �
CA N W f+ t+ � �
C�1� p C�1� O O O
�
{A {A U9 4R Efl
� O
, �. y
� � � �
O
a
x
�
�
i
�
�"'
m
�
n
_
m
v
�
m
,x, . �a. w � .. p0
hR � p. p, � �
m �
� �
�
� � , �,
O
0~r p �
� � I
� ��
� �
�+ M
� ❑
� � � � �
a� a o.
� � � o �
� � o �
8 a � m
0 f~D G�C.
C3. � R� 0'p9
p�y. � a'
m � I
� I �
.-. _ ,� �
i \ �\ ��.
,�`�, ��'\ ` 1��
' � I� 4 � �, �` \
�
c � P
�� �� � �
� ��
i �� �\;
�`� ��
�\ �� ,
,�,
\
� .
WATER
rios�rs
URINALS
��
�
e/5�1�
SINKS
wnst+
rw�n
DRINK.
FOUNT.
StIWRS.
FLOOR
DRAINS
G7CH
B/�SINS
�uro
w�sr�a
GAS
MPL
GAS
RANGE
��
OPENINGS
� •
2 •
�
� �
F
m �
m
n
a�� A
� �� b
� ��'� �
y � �
p�q�a �
� co �
p �04•p �
��a�� o
�
�' �° � �a
�
�roy �,
m�
b � �' �
� �
o��m c
'p�mo
� � p
], O i„4
O
� y � y
� � � �
�
a� ��
�
a���
���K
A�
. � � �
m `
�O y \
�
fD ].
ro �
3� �
G
� �
� A
�
a ~
R�
� M
p �
��
�, va
� �
� �
�
0•
�
�
C)
�
� -i'
� '�
0. �
m
��
�
�
�
�
S�
�
O.
�-
,
�����
�
�
City of Fridley, Mirm..
BUILDING PERMIT
D$�: June 18 , 1968
�o
Ovvner: .Mr.� Donald Johnson g�d� Custom Pools, Inc.
pd� 6600 Hickory St . N. E. Ad� 909 Excelsior �'lvd .
Hopkins, Minaesota
LOCATION OF BUILDING
No. ._._ 6600 S�t � Hickory St . N. E.� �_ p� of Lot
�� 5& 6__ gl� 6 Addition or Sub-Division ____. Fridley Park Addn,
Coraer Lot — Inside Lot Setback � Sideyard
Sewer IIevatian .T— ._ Foundation IIevation
DESCRIPTION OF BUILDING
To be Used sa:
Poo1 �t 34'x41 �p� 8' Hei�ht Sq. F't Cu. Ft
Front Depth ITeight Sq. Ft Cu. Ft
Type of Construction Steel , Vinyl Li� �� $4, 000'� _ To be Completed
��� ��
9'799
Subject to all requirements outlined in submitted specs. Also submit to the fact
that the City of Fridley is not held liable for anything what so ever.
Ea coneideration of the issuance to me of a germit to constivct the uilding des ve I agree to do
the proposed work fn acc�rdaace with the description abov o in co th a'11 provl�ions
ordinances of the dty of Fridley. G
�
In consideratfon of the payment oP a fee of $ 24.00 ��t fs hereby graated to Custom Pools , Inc .
to construct the buflding or addition as described above. TYiispe rmit ia granted upon
the expresa condition that the person to whom it is graated and hia agents, employees and worl�nen, in all work
dane in, around and upoa said building, or any part thereof, shall conform 3n all reapects to the ordinancee of
FridleY, M3nnesota regarding locatlon, construction, alteration, maintenance, repair and moving of buil�ings
within the dty limita and this permit may be revoked at any t4me upon violation of any of the Provisiona of ea�d
ordinanc�e. �
Official
F-:,r;ir.tr,r,��, ; ;s;<<�y
� NOTICE:
Thb psrmb does rtot eorer the coas�roeHoe, fe�hQ�tien tee �rMne, plumble8, eu hsNtne, sawe� or walsr. B� san 10 as
t6e Buildiee Iesp�e�e� [or pparaM panehs fe� f6as h�ms.
.�
APFLIGA�3t)DT FOA, BUi�DI1QG.,�'ERM�T' .
. .,. .
GITY OF FRIllLEY, MIIiI�SOTI�
r�
., . ^
� ���• . � l o
. • , 6W1�R:B':S NAME•:.�' � ° �I--sr �UILI�E1�' _ ��:� � ,
AbDRESS. ' � ��" .`. �
. • . �� � � ' � :� . ��_ �_.�1DDRESS.�.��''�" �
. . , > ' : � �-. ,. —
. . . . . � : - � � � - � �1od� � ot� � �n'tt'bira0 � � � r. �
��
s��r �
No. . � - - - �.-:.� �,. � � : �
� �_. � � • �
� `_. � . . LOT_ �� .��, '____�' �' BLQCR _ � '� s �' " � ADDITIO�T QR SpBD�VIS TON : � , �
�
CORTIER � SIDE LOT_, SETBACR SIDEHARD _,___�_�
SEWER ELEVATION TaP OF FOOT�� ��
• • ;,tLi . . . •
. ,�re•• � • ; : ' F�, ., ., • :.
. Appiicant atta�h ::ta �th�s �foru� Two C�ttir�i,cates o� Snrveq of LoC' and propoaed
. bui.lding l;ocatiaa drawn on 'these Ceictifi�atea .. . . -
. . . .. � - j . .. •
. � ;;r±. . � �DESCRIPTION OF S�IILDiNG • . � �
To Be Used Ass . .
' . , , Fronr� r � •�D@,pt�,i Height
Square feet �ubic Feet � • � �
/
�`I • :.Y�
� _,,,/ �' Front' '' �� � Depth � Height
i r
, c•� ' Squa� eet ' ' � Cubic Feet
� q . ,-o
Type of Construct3on °�� ��stimated Cost--�L���
` --s�
,
To Be CampleCed
The undersigned hereby makee appiication for a permi.t for the work herein
specified, agreeiag to do all work in strict accordaace with the City of
Fridley Ordinances aad rulinga of the Depastment of Buildings. and herebq
declares that all the facts and representatioas atated in Chia applicatiotn
are t e and correct.
� �.
DATE _ _ ;�j����SIGNATURE _ A
e
�(Schedule of Fee Costs �aa be fouad oa the Beverse Side).
,_ ,
.� �, . 9�
— �` . �
� ,� ;� ��' ' ° � � - �� ' - � �� " -� a
��1�1� 6' �'S� .i Fe. T i � % #$ . ��i�i °''�4 i —.
���v " � � , >�, �r� F'�i � �.�.`f L�
�/���� �./��L� �'02 Awq�y��u� e�:��►; s�g�;
. �' . - • 1` .. . � �Y A
' T. �: � . , a. .. . . . . . . . . .� i .'t
` BUILDING PERMIT�=��E ��CHEDULE:' . .
SECTION 2. The Inspc��.�i =b�f Suildings.,shal]., _,_b�fare i�s�i:��ig. perimits � fo��
. --------,....
�the erection of �ny building or �titwctuxa, or fid�c �lay �ddition to any
existing structure or ,�atii'lding, or. fur, any altera�ion._or, rep.airs to any�'' �
existi.ng buildiag or structure, upoa application therefore, require the
the paymenC by the applicant for sue��peirmiC=�f fees to the amount herein
below set iorth and in the manner heria provided to-�rit:
� ."� :� . .
Uniform IIuildin� :Ccriie:' •-: � � Type 1, �2', �6 4• . $1.75� for eac�i .ane "thousand cub�c
feet, or fractioa thereof, in such cubical cantents. Type 3� 5- $1.50,for
each one theueau.d: ��bic feet . � � a::.:..+ - ;.: `:
.5,. ,. . �•• _ . ' ' ..
. .�'�r �the Puzpose: e£� ct�tput3ng fees fos bail�diag permits;�the �cubical��`� -��
contenta of any buil�ing or addition, �t� '� u�i#dr�� heig�t =thraug�h'oui�` liy •'
multipiying the ground area covered fr�m a point ei.x (6) iaches below the floo:
line •f tl�e base�ent or t&e • c�ll�r te the' �ave�isge� height of the up�er surface
or t� tbe avera�e height of the roof surface of the main gable of a
pitched roof . . . . _ .. :
F�r re�air.a- Qr� alterations to�an enisting. structusa,__�I�e.fee..shall. be aC the
'rate of $3.09 per each five hundred dollare ($500.00) or fractiou Chereof
in the coet •f a11_pr.o�osed work. ,.
Zn no case-:�hali Che fee charged for anq, pernnit a���-��t._�Qrth. in Section 2�be
� less than $S.AD.
. � , ��. .
NSSSU C�nriection Charges�based on locatien- Area 1 or 2.
. .e.. . .. • . ... .__. __ �.- � r.___ .".t . .. ..
. . . . .'•: .. . _. ��!.l' .. ' . _ .. . F , .. . '- � ' � ., ' ' .
. l� , it .. . . 'f . '.. .. . ... • 1' ..'t_; . . . . . � .. . .
. � . .; ' .. .°tit , . , r __r,. .' . .'i ,i�_. .. .:ti: ..,� . . '� :r.
' . ., l , �. . ... . . ? . ... . . . ' ' ..- '7' � .. ' � . .. � ' � , ' . .
L.
....3.. . . •• � �.. . � S . . . 1...
1 ` 4 ' � ^
� 1 � �
. a I'
..�1?
: �• a.. .'•�',
� t •
, • . i
�,� � �
� ' �_/ V�,/ V +►. o.' 6 V oi v � --�
�(JIh�SUiVt!/!!�y .
• �ds�f�t,,,y � � - . • ���0�����t��4 i��s.
� Gvir .r Slurr�r.tv! � �
� �Ef�y���f«.����yT EnSrin�ers � Sur vec�ors
l�iln/k'JfV %S 3 �.
.��,,,�K�f�
su,,,�� � cnc»
. ,� ' - � +
�'9` /f� ,.� ; � � r.,,
� � t. `� � G • d' --� r�.` �i 1��? `L t"! ; � �; . � . l. �1: � ' :l .
4 4
�s t y�.'�`� � °•'•t" � , -� .+� °�.-�',`,�`s v� � �`� .�, � C�'.'y;�:.S� ���� � Si Q-i+ 1� . ,
: �,;. �ny k:� r..�. - a
��
�r�
-'� C�
: =.I r
. �
� � .
. •�.� . .�,
� �. '.
-� . '
i
.> '� � ,
` ' , . �� � . _ L. �� �
'e'. .
/`. .
• � .\ ��% 'f ��1 +� `�'� ,
� • � .�� 'J , :� /� ^
� \` . ' � ' �. r) .
` ��.�1� , j� �i ,�l
�` `� �\ • ' ' � ♦,`�r�� �
� "S% 1 \1 ' . . � /.- �' r\ '1' �,` �,,� . • .
: i s � ', '♦
� '' ' ��R�` � . / . !% ` , . .
_/ � .�� � '� '
•� 1 . - � � • � ,�' ,/
. �� � `�1 _i1 J%. ' --
. ; � . .L- '.
ry .= y � — . ��l _ i �t� i_
:�• ' ;�� - � `�/� �7 / �y�' ' .••
' .?. � . � r � i Z� , ,1 ./. ' . 1,I ;;•� ��
`�i. � ' � , � 1 l
� /- �+ '..c
�r �J. . � � l �, �Q .v� � ' ' ` r i
�r /.:.• .�1�t I . . \ \� ��.� - ``1 . .
!i _ � � . S ' '/� A..` , ,
� �I� ^'• " /�� �
r` / _- 1 _ �,, N
. :� .
_- :�, . �
1
�_.^ jJ
: .�
. ' /'. . . . .
. ` �� � .
• - . . s� ;`��� � . , � . . .
" . .� . .� r' f'� . .
,.1 - - . � . , � � , _ . —� -- - ^ • - •, •
� +�+� . r.� ^'. . . .
•'� -' i� - ' _ _ �- ' , .'ti \..�
. , . . � - . . . ' .
. . �"
' i.
.
� � fdote: rs t�e ori£ inal plat oL �ridlE•y ?-�rk ��ic so ma;�•: �,:.iss�.^.c. :ii^e::=
sior:s, ��e �sed iror. m�c,nu�ents found on ttiP �roun::, �i�es of occun�*:�;� anc
�� the pl��ttin� e` Ec:i.exater Gar�Jen� tc establi�h t:�e corners or *_�:is ��ro;�e-ty. .
We recomr•end th�3; the corners o� tnis property i�e ;u�iciallv dete:�miri�•c.
/hereby :erfr�i� f,`rof,'i�rs is o h-ue oird correcf �eP�esenfofinn o�'a sLrvey �'flie�l�,�dor�es ,�'�'e o5ar� c4�criltrd 'n.n4,ar,�
�'f�� lccvfr.n o�'vlr hu.�/din�f , f.5ere�n , onc,o/l risrb/e �;u-ooc.�imcafs ,!r�ry, f�n or arrsoid /or,d. As surveyed brf. me ,ffri5 - do5f
a� � _ �i. . A.� �9_`' . SUBU(�B�kN ENGlNEE21NG ; INC.
En9mcerS E Surreyors
.ti�' _. _ ; ?_ ` -�1�� . �. �,j,j_'� f �"1 � '�r . . .
; `ry. � _ J::� � _ - r �
.,__
I. .
�
� *
� n
� �
��
�
�. o
�
3 �
��
o �
3 �
a �'
`o �
��
� A
� Q
� �
� �
��
��
�
� �'
a
�
?
O
.C+
��
� O
��
mn
��
C �
�v
Z �
D �
n0
m�
�
D
�
�
�
n
O
z
Z
�o
m
z
�
�
n
-�
O
Z
�
m
�
�
D
"a
'Q
<
�
a
�
�
)
�
�
�
_
�
�
v
�
�
�
v
�
�
,
�
�
"W
�
cn a
N �
� z
� �
�
zI0
'�n0
�
�V
�
�
�
�
�
b
� Q
0 3
°. � .
m
� �
�
�• �
� C
'� .��r
� �'
0
�
O
�
O �
-i �-►
� �
N
c
� �
rmn �-
m
�
m
�► �
�Q
�. �
<
c �
� �
�. m
.p �
� f�
� �
�
0 0
� �
tA
O�
� �
--I
Z
W
n
•• 3
� �
�
�
I`� �
� W
�
�
�
�
�
Q
m
Z
�
m
_
�
�
m
z
O
rn
v
� .
c Q o
-- � �
`� D ��
�
_
-�
� y�
� �
�o O
� m
� �
� �a.
� � 3
n' � a =
0
��
��
�.�i
� m
�
�D
�
�
�
�
�
�
�
�
�
1
�
�
m
w
�
v
m
�
�
m
�
�
�
cfl
�
a
�
a
�
�
�
L�'t�
7
A
�
���
o � �
� � �
� N r:
� � �
� �
.. cs
c �
m �
`� �
x
W
C
7
fD
1
� � t� � tfl
J ..l �.► J N
O O O O p �
O O O O O �
�
i-A EA f� b9 ffl
� �
o �
I�
m oa
� C
� a
�z
�
v c
n �
o rn
v
�� m
� �
Ol �
� �
�
�
-� �
m �
�
�
O
�
�
J��
�
Z
m
�
�
� � � �
tD tQ n' _
m N � �
� o � m
3���.
N � � (�
y �. � Li
s Q- � �'.
�� o �
3 � O �C
3v��,'�' 3�
� o � ,�
su � o m
�m��
��Q�-�
w����
0
� � �...
����
;�o�'
a
� � � m
� � � �
a ,., m
o � � �
s -*
�pt .,,�, o
� � � �
� �
� `� O
� ���
� �
����
� �
.r.^a Q.
�
�
�
�
�
v
v
�
m
�
�
�
�
��
�
0
°� \
B�
9 •
CHIMNBY AND STACR VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (�f No {)
2. Is free from rust or deterioration � Yes �j No ()
3. Has no foreign objects lodged within Yes (� No ()
4. Is securely supported Yes � No ()
5. Meets all current Code reguirements for
size and total BTU's connected � Yes (� No ()
6. Has total heating BTU's of �� �
_ All other BTiJ' s � � /�� � �
TOTAL BTU's ��� J�
Remarks
List Alterations BeinQ Done:
HEATING COMPANY ����
S igned By - ,����
Date / � � ��� � �
sue�ecr � P IT NO.
City of Fridley 2 8 210
, , �72�����F T�E �'"S gU ILDING PERMIT
,� .
� `v _���� COMMUNITY OEVELOPM�NT DIV. 9 ���
r � � PAOTECTIVE INSPECTION SEC. �i
1 = ,
� �"'1 � CITY HALI FRIDLE� SS�,i NUMBER REV DAT@ PAGE Oi APPHOVED BY
�""�� ��' ' 612-571-3450 9�aFi5
10/13/98 � �
�oe AooRess
t LEGAL �OT NO. BLOCK TRACT OF ADDITION SEE ATTACHED
oescR. 5, 6 6 FRidle Park SNEET
2 PROPERTY OWNER MAIL AODR�,S$ ZIP PMONE
Johnson 574-7559
J CONTRACTOR MAIL ADDRESS ZIP PMONE IICENSE NO
John Hale 4�'1 Roofer 3150 Lakes o
a ARCHITECT OR OESIGNER MAIL ADORESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ApDRE$S ZIP PFIONE IICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION � REPAIR ❑ MOVE • O REMOVE
8 DESCRIBE WORK
Reroof house and ara e 35 S Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS �
Underlayment must comply with the State Building Code.
SEPARA7E PEIiMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. pCCUPANCV GROUP OCCUPANCV LOAO
VENTILATING OR AIq CONOITIONING
THIS PERMIT BECOMES NULL AND VOID IF WQRK OR CONSTRUCTION ZONING SQ. FT CU FT
AUTHORIZED IS NOT COMMENCED V'IITHIN 80 OAYS. Op IF CONSTqUCTION
OR WORK IS SUSPENDEO OR ABANQONE� FOFi A PERIO� OF 120 DAYS A7
ANY 71ME Af7ER WORK IS COMMENCEO. ' NO DWLG. UNITS OFFSTqEET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICA710N STALLS GARAGES
AND KNOW TME SAME TO BE T E ANO CORRECT. ALL PROVISIONS OF LAW$ yqLUATION SURTAX
AND OROINANCES GOVERNI TMIS T Of WORK WILL �E COMPLIEO
WITH WHET ER S IED EREIN O NO . TNE GRANTING OF A PERMIT 29 L. SO
DOES NOT R ME O VE AU OFiIT TO VIOIATE O:i CAMCEL TME pEi�MIT FEE SAC CMARGE
PROVISIONS F ANY OTM R ST E O IOCAL LAW REGUTATING CON-
TRUCTION 7HE ERF R A CE O CONSTRUCTION �]/{. ],rj Fire .SC. �3. ��
PLAN CMECK FEE TOTAL FEE
���� � License SC 5.00 $84.25
5 u E OF CON��7ACTO RAUTM NT �D�TE� WHEN PqOPERIV IOAT D THIS IS VOUR PERMIT
S�GNAfUAEO�OWNEp��FpyVNEABU40EA� �DAIE� Bl G�NSp �' ' � p`}E
NEW [ ]
EwDN L l
�.�R [ l
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERNIIT APPLICATION
ConstructionAddress: �IO � � [�l l C
Legal Description:
Effective 1/1/98
1b
�� ��
� �s
Owner Name & Address: ���,�%j�l Tel. # �%� �2�J
Contractor: �� �T�7(�% � —' MN LICENSE #�d ���c�c�
Address: � �S� � K� �i � �L( ) D C�t� y Zdfi�'p �.�3 Z / Tel. # _ �D�/�% �,(
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. '
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Length
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width
Width
Width
- ��°'�.9 .
�
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
. � v �,
Construction Type: ���}f�D�� � � Fstimated Cost: $ � ���j4
� (Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + t= F $ _$ �
DATE: �� �a� APPLICANT: Tel. # �
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Chazge
TOTAL
STIPULATIONS:
�
$ ,%s Fee Schedule on Reverse Side
$ , U O .001 of Permit Valuation (1/lOth%)
$ �, S. � $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ �. D d$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 [ ]
$ � o?�'
BUII.DING PERMIT FEE SCHEDULE
The Cluef 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 $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,Q00 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
$1,000 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 minirnum 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 constructed
will be required before proceeding with the framing.
J u�.--r�., cr.,r�ti ir.r • reo r R.uri � � t t ur r t[ t uLC t
� �
o �
� � 1
�s �
� Q g
A �, �:
C"7 :� cu
� �
Ul a A
� � �
O o �
� � m
� ��
n o �
� �
fT� � N
A
� � �
A d_
� - Q --
� �
� �
m �
� 3
C�? a
m a
3„ o
rn �
�
�
� ,
�
�
�
-- �
0
Q
�
V
�
�
�
�
�
�
�
�
�
d
��
�
�
z
�
m
�
�
�
�
0
O
�
0
�
--- �
�
�
0
�
�
\
�
� I
d "'
A �
r �
C
� s
�
�
1-'
�' y
3 ae
c� �
m
w °�
$ �°
s
o ai
a
o R
� o
rn �
��
a �
a -+
m �
C� N
� �
�
c
�
m
� � � �
n z.Q �
�'3d`�
� � � �
~ � � �.
����
c�� � ~
g��
� � a ,T
� � � fD
l�t' � p �
� �.�°�,
su n o
���'c
9 � g
�C p �
�
� � d
�p �
CN p -
y A
0
m �
� �
�
g
�
IU
� N � H
�o � �
� �
a � �
C � �
� �
o� +�
� E
� �
� �
� �
�
n�p+
�9
�
�4�.Slld1 t'. b�/105
� G
� � a
A � �
C6 d
� �
.-- a
��
� c
� " R�9
m �
� �
�
� �
tro
� s� � � �
,tNi1 O O G C7 It�
� � g3 6
0
� � � � � � � � �
�� s �
� �� �
!`�D
�
��
\
' \
�
�
�
�
�
�
�
���
n �
� �. �3
� � n
y N �
�. �. �
� a m �.
: � � p
� �
i � � 0
_ Q �p N
. � �
1 �' �
_�� T
� �'
� � T
F � p �.
p1 3 �
l Q � Cj
� �
�
� N Q �
. � �+ �
fD @ €,
=l N 3
S°' �
�
� ��
� �
N �N A
� fn
N
�-�
�
�
�
�
Z
�
�
V
U3
n:
W
� ¢
_����
� ��
z �
m �
t9 Ota
��.
�a
A
� �
� v=� O
1 v �
7
f=D C!1
� �
�
r �
�
a o
� N �
�A �
o "'
�
ffi
�
9
�:.
�
�
n
v
�
0
�
-i
�
1�C
C
�
�
�
O
J
�
ti
W
�
�.- �
a �
�
� � s �?
in � ti �
� c
^a z ?. O
<
A � y �
��� �
� � �
� �
� � iri
4 m �
� �
v �
� �Fi
� �
v �
�
�
�
�
m �
� �
�7 p
� �
� �
��
��
��
��
�- � �
�
� � �
0 v
� � �
O �
�
�� Z �
6 � �
✓ � �
� m ��{
� � �✓
� � �
� Q �
�
-�- � �
> � �
� _ � � �
��� �
�
�
�
�
A
f�D
\
�
O
�
�
d
�
�
�
�
S�
��
�
V'
�
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 iJNIVERSITY AVENUE NE
FRIDLEY, NIN 55432
572-36U4 l� AX:
: 6600 HICKORY ST NE
: 153024130031
: UNAVAII,ABLE
: LOT BLOCK
: HEATING
: RESIDENTIAL
: ADDITION/ALT'ERATION
571-1287
�.� r;_�
PERMIT N .: 2004-01233 �
��
DATE ISSUED: 08/02/2004
VALUATION : $ 2,417.00
NOTE: AIlZ CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL AN AIR CONDITIONER.
# A/C LJNITS 1 # FURNACES 0
# GAS DRYERS
APPLICANT
FLARE HEATING & AIR CONDITIOI�TING
9303 PLYMOUTH AVE N
GOLDEN VALLEY, MN 55427-
(763) 542-1166
OWNER
JOHNSON DONALD E & SHIlZLEY
6600 HICKORY ST NE
FRIDLEY, MN 55432
0 # GAS RANGES
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONII�TG FEE
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 45328
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or conslruction
authorized is not commenced witin 60 days or if construction
or work is suspended or aba.ndoned 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 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 not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating constructi�n or the performance of construction.
a
Bldg Insp_
_�
SEPARATE PERNIITS RE�UIRED FOR WORK O'TI�R THAN DESCRIBED ABOVE.
0
0.00
0.00
0.00
25.00
0.50
25.50
BiU1lCllrig �C�C�, Permit No.:�
Inspections RESIDENTIAL APPLICATION Received By: °`2
763-572-3604 CITY OF FRIDIaE� Daie Rec'd: ?o D
DATE -' � E" Q YOUR E MAII. ADDRESS
SITE ADDRESS
THIS APPLICANT IS: ❑ O �CONTRACTOA
PROPERTY NpME: ' J �
, EN�AN,T� ADDRESS: �C / S. � CITY STATE�ZIP
PHONE• 7� 3— s ' 7� ,
CONTRACTOR CoMpANY N,a.1v�: � �
SUBMIT A COPY OF CONTACT PERSON: Jm I C
YOUR STATE STATE LICENSE # SS` I� I % EXP DATE �� �� ���
LICENSE W1TH pDD�g; �T � CITy ' STATE ZIP
APPLICATION pHONE - FAX
PERNIIT TYPE �SINGLE FAIVIILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � �' ����E�T � �TIOwREtv�oDEL
DETAILED DESCRIPTION OF WORK � � �
PER MS 16B.665 the permit fee is a minimnm of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS Wf1ERE LABOR EXCEEDS $500, ARE BASED ON $10.00 PER FD�7'URE, EXCEPT Wi�RE NOTED. FlXTURES: (II�IDICATE TOTAL
NUMBER OF EACH BELOV� �pn
EquipmentInstalled . MFG: ��� MODEL: VU'f�ITp7 ���� SIZE/BTLJ 7�
MFG: MODEL: SIZFJBTU
MFG: MODII,: SIZE/BTU
A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGFJOVEN $10.00
AIR TO AIIt EXCHANGEER $15 FIREPLACE (W�D) $35.00 NEW (3AS GRII.L $10.00
BOILER $35.00 �FURNACE $35.00 GAS UNIT HTR $10.00
CEiIIvWEY LWER $10.00 _GAS DRYER $10.00 P�L HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTII.ATOR $15.00
_
� y. � x f.. ..�' . a q.� a,��.�:r�+-�.� '$�, tH����k t' ��� I�ir'kr :�r" '#.3���,`,�;� rM^``� �;� t � q
,s9, �:r�i,ici_. .'.l. v�, 'i'...
Permit Fee $ � Number of fixtures @ 520.00� x$10.00�= $
Surcharge $ .50 Number of fixhues @ $15.00 x $15.00 = $
TOTAL DLTE $ Number of fixtures @$25.00 x$25.00 =$
� Number of fixtures @ $35.OU ,� x $35.00 = $�
Sta.te Surcharge = $ .50
� Tota1= $ 3�5. 3 �
Tf�IIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSID
I hereby apply for a building permit and I aclaiowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota •Construction Codes; that 3 understand this is
not a pemait but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case o work w re ' es revie d approval of p .� .
` ��'► � D. ��in�seA/ nA� l - • Q
SIGNATURE OF APPLICANT PRINT NANIE
ai �` - g ; t " i �� '
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572 3604
FAX: 763-502-4977
REQUIRED 1NFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT �4PPLICATION HVAC
❑ NEW HOMESIADDI�IONS EXISTlAIG HOME ❑ MAKE-UP AIR
REQUIRED FOR NEW/EXISTING HOMES
1. Combustion Air (See note below) .
a. Oil or soTid fuel IMC Chapter 7 with MN Amendments•
b. Nafi�ral. �as or.P�opane/]FGC Chapter 3 with NIld Amendments
2. Make-up Air (See note below) .
a. IMC Chapter 5 with MN Amendments
3. Ventin.g
a. Gas appliances IFGC Chapter 5 with MN Amendments
b. Fuel other than gas IMC Chapter 8 witli MN Amendments
REQUIRED FOR NEW HOMES
4. Heat loss & cooling load per room
a. Requir�d on new constru.ction IMC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Design Per IMC 1346.0603.2
a. ACCA Manual D
N01'E: Centerpoivat Energy Mechanical Code Guidelines software may be used for
combusiion and make up air calcul.ations
0
From: 952 854 4909 Page: 2/5 Date: 3/24/201012:05:02 PM
rrom:tLUtFi JUNtS 1NL; Jb� ii�b4 4tI1Jii U:i/��/�UIU IJti:lif �roa r.UU�iULA
Building r � BIJILDING �e�i� No.:���o °�
Irisp�tions �+ ��EN��AL APP�ICATIO�T Iteceive�. �y: �
763-�72�3604 (�,-+Y'� (�F �i ��,�t Y' Date Rec'd � C� � 1�
763-502-4977 FAX �r.rtv6 i-i-2oro
DATE 3r I 2� �} O YOUR E-MA1L ADDRBSS j'+j �!'W S �_ 2�'i r mY1�.S. CbVY1
SITE aDriRESS
THLS APPLICANT 19: O R iCONTRACTaR '
PROPERTY OWNERI Np�:
���x ADDR$SS: GiTY '�i1d�81 STATE,b�ZIY �.�,3Z
Pk�ONE:
CONTRACTOR �1�� �t- ome Services, Inc.
3UBMIT A COPY dF NA ZGHO C11�����d �'k'Wj�� S�P ��4
YOUR STATE LICENSE 5Te �berlanc� Clffice Park ��'9'�
AND CERTIFIGATE OF .°►� A��� ��, 30339-3913 C� STATB ZIP
INSURANCE FqX .
]�]►��►]�EItTY TYPE a s�� 20268257 Ph. 763/542-88xb S�e
� TMcrrs�unn.:�lV6W (,'UIVS'FR'(JCfION STORI65
P�g� '�(p� . � ADPI970N � GARACpJSHED ❑ wIIVDOVI'S ,
O BASBMFNP FINiSH ❑ ROOF ❑ DRAriV TII.E
0 DECCC I� SII3ING ■ pTHER
� SWIMMI1�Ta L
TYPE OF WORK: 0 NE'QV HOME CONSTF[UCTION � ADDITIdN
� MA3NTENANCPJREPAIIt � FIEMODE.LING
DSSCRISE WORK BHWG DONE: Sd �r��- l'�.� �'�
S]'!.E OF DvlPROVEMET�'I' LENOTH WIDTH HEIQHT 5 FT
O HOUS6 ONL'!'' �tA,ggMENT g,gMODELIIVG SVSMIT:
T1U� pF SQUARS5 tl IiDUSE & QARACiB 3. Exis�� Floor Plen
� sR„��� O ATTACHSD �ARAQE 2. Piopose9 fl00r p1�n
PROP6SEA S[ZE: O DETACFA:D GARAGE 3. I.+st of e�uat�uel m�6ere to be uaed
PROPOSED HEIGHT:
�� • FOR NEW CONSTRUC770N iNCL[lDING DEGKS,
O Vitryl *gp�pt AQDIT[ONS. & POitCI�S_Sj,JBM1T:
� Al�imaa• 0'IYim 1. 5ite P1au/Slavry ShowiC,g d� exist�n8 s�wrna
0 o�e� o xeso�� �a �asea �roj�t
2. Two eeta of�ronei�uadon pl�s
W[NDOW6 3. Energy Caladatioas
INEXI5TYNQOPENIl�Tt3S OYes 17No LOCATTONOF'WINDUWS � FOR'WDdDOWS-PR�VIDEU-VALUEAND
OR FOR N6W OPENIl�TGS-DESCRIHB SIZG OF MANUFACTURE STlCKfiR QN W i1VDOW. .
OPPJ�IIVG CHANCE6 &
TYP� OF WriVDOW TO HB INSTALLED NUMBBR OF WINAOWS
Ai,r, �,�,9 ARE $ASED ON VALUATTON, INCLUAX�dG T�, COST OF LABOR AND MA�RIAI•S:
I!_�C�l� �►:`� 1�+ 7I
Plaa �t.eview
Fire Surcharge
Surch�rge
Liccnsc Surcharge
SAC C6argc
41trb Cut �scrow
Erosion �ontrol
Park Fce
Sewer Main Ch�rge
Toffi1 Y3ue
1997 U.S.0 FEE SCHEDtJL�j
$ � I d 7� Scc Bavk Pege for Fea 3ch�edule
$�� 65% of Building Pennit Pee
$ � �° . .OQI �imes the total job valusdrni
� ,�, A�i � .0005 x �'e�rnnit Valualion Mmimurrr $.50
$ �l� i� $SAO {State Licez►sed Re.sideatial Contraotors)
$ � $210Q per SAC Unit (�at�s tp MWCC for deEorminat3on)
$ � tt+6ft= ftx$24�$
$ $4$0 Consesvation Plsn Rtview
$ Fee Determined by Engin�ring
S Agreement nece.ssary () Non Ncccssary ()
$ �- _ s Make checks �a'va6�e to: City of Frldlev Attas
THIS xS AN APPI:ICATION FOR A PERMTT•NOT VALID UNTII. PRdCE'SSED
I hereby apply for a buildiag pernlit and I aclrnowlcdge that tEie infrnmation above is completc and aeew�ate; that the wo�k will be in
eonfOrnlst�oe with the ordinanccs and codcs of tho City of F�ri,dley and with tho Minncsots ConstruCtion CodeS; that I understand this is not �
ge�mit but only an applicstion for a permit and work is not to stact without a perniit on site; that the work will be in aeeordamee with the
approvcd p[an in the ease v�k whic revicw and approval of plans.
5[GNATURE O�' APPLICANT �' PRINT NAME 7ivvt �'�.rl� DATE ��'�'�'1 �b
���s�;,r:v..7�►i�xr a�.7�:�_r:aaeo��a:a� �a��.�ra�:�:�:�a�uu7a6�3�1@I1J M�u.�:��o�cax�awtr,uaa_�w_�oE���� ��e�:r�v�`uer���r�����c�r��
From: 952 854 4909 Page: 3/5 Date: 3l24/201012:05:03 PM
trom:tLUtFi JUNtS 1N1; �� ii54 4�LI�J U�Ii�41�U1U Uii:lii
• i:1,i/ 1`_IJ'LI71 b '14: 4t( f b:.i� 41t1'l'L r NLIMt J1tJ'U I
03/19JPaiQ I3:4R 76364282a7 HOp9E DEPD�' ' P�[� �1�96
�i�8 � �C �t�sB�,C7C • � �
, �.
S�hs.tawnbinoa,�d �1ted by:
�h lie� M1�at�pvum [um y►`� � . 'i'RD Nr�iwa� 9n'eawx. Rrc.
d�bla � ti� i7�w; A�Honw 3ar�i�
'' t+�r Me�d+iie�J►n a•ti. �a�+6. �id�at ys�tvy, l� ,eaar
$�c�, Nna�bc�r: a7 . 'Ibll r-� [8[+�7 �ie.�CAZ; E�[ (76�] �.�►
g�laeMl lO 1179.� �N Lbe. Y�e�21' 7
' WI L1a � ss0�+69.11v6�lA4J' : NA �.ea. ID 2Bl�: aA 1-+0. � C'b ETZ� ,
t�1� Add*��i: .1�.°L�"'' �C GF+7�►t � N �' �^": �+C�a . 1.+-� '��+`i�- .
7u�as . �SaD
.-�—
j�°°a° AQds�9° ��, 9aur � �i'
fIY�� &vtn�e►allaean Add+„�)
�I A�!'�4F ISO �' r[ �.�GC Wl1i�LH0IC0CitllYf Blld �OR16 IICQO� 4D��I� �-
! DO i'Q�S �h tP �� �S' �`'�B em�1S ftom'� 1�10the Do�+Yt ,
�,��Undue�ig�ue��C���. �� 6ia u,w�.cA ac �* a�+s tasnutrtlen aodra�+, s�nv�s ta bny.
��'k1V amm leev. iaa. Aome bepel a tti fi�r++1.�. drtyN� [ver msd mias� 7�+►� �I ����� �Is
s!f mu�i�s daqaiM1ed oa !Ra be�mv 9e10 oA n+e nPseaeed Apac �fieat(a7. n11 vf•e+hkh a�
�fbemcF d7ong wttb aoY �FPli�tbJ� ��a �lems�t aqd Pa.vmrnt 3u�Ginary �o� lueee+a�•�d �y �m� ikJ�ar�a i����7.
•Cno4natL"?: .
�hRe m�a.,.rt�r� aclr �
�
mo� w� o�+ �%
� � �+ �% QCwqyl'a / Cvwr6 �SndrY 1�t+va � ��
1�flnde*a Aaiatla�
p��au�. ic,�a ar�o� C�., _ .
p�attas � cv� �++�'y b�r•
� idlna +m �
Otdwwr. r Swera ❑��ry r,�m
� ����
M1+A�Imam ?,39b Dqrall! e1 Cad�net mavo�. . �Nami Ceatr+ed,�ot � e,� � gy�. .
rin� oA� a+«�M e►T �1B cm�aCl
�mer up�ocul rttrr. f0'�pmdlYWly up� 44Mplemes7 nP ihe wR+� Fer em�t Pra�dtDel. Ga�ennr.r wift• t'AOCUGe H C9mnlC�lam G�4�G�9�
(onq WT Caeh Prad�l +P dnpMCd by An leptalduaf upe�: OFlCGiJ Rnd lmy �p 1�1anw dwQ. �R appHe�1�, cs�h C�oma �mdwr thin
['.aae�m u�Ad�1 io be,Ioll+�p an4 �►elly 9bll�tltltl u+d Itabla hv�un�a�.
7'hv Huma Doppf ►o�ar+� t�+a ri�ftt 10 ireuo'a fi�san�o [kdvr "r mai�rinmta lhia Crmt+.wR ar ,mnp 'vdw�dapl ProOU�f.� l�loded hersilL et
ta diewduw,� it7ho HemC Awv9� �r ia u+,9�+K1sa�J r��• vrovlde a�s�tlinu u,at Ic ean� p�+ne �0i abtigstloas dvo w a,bweural
{�o6�am wlat uye ttbnus, +�vf�+lvnanwl lw�rd� 8�+d+.n �eo+m. asawea+ vrdesd pdhd. otl,¢ aa�tj e�r�. tR'Iqi� �ao as b��
am'A.Fqo'Aa1 {a ran�P4tl�P�t++J�4 w�e+kk4nr��4�in'pu C6aos� .
e��c s�s�r � pa,�,�+� �. �r. 3� S�� i�� _'iru4�dod os pmt d 4de Cea�e6 aqb RirtB t� �snl
ConbacC sti10u0� OtrM �Sfy�laP 1'Z4vfmd 4n' 1}w da�V�iSe R�d ��� paYTna�+►r'1� P�� t� aG4��md1�-
NO'�[ .-� 7'v �sJ'9'I�ir�
xeu �u'e mtltled•to n �Iled�►+�p� ot eht �m+trwct at �i+a �4rile �on Do oat e1�n u c��ds c�!'Qac�te 0�
�e !� aee t�,�platou��urte ►a� ex�c` p tkaat Preau�t es aen,wa !�r s+ufi,�aat sp�ee ed�aabl bet� +►� �n � e.oaa�c
is �m�pYl�1.
�x1 l�e lYCli: 4� ��E11 �lr WIR COi1�A�, CViii7rnR�' �a T�6 HI�.Cp,� �' � Of il�fi.R'�°�'+ 1�A��, �
�n� .��e�c lar�w"��n a� Ar��c o�oWVdAuQa �a�p�� mF.�'l'�B�H+�A�����aJ�'rsA��wntZ�eQf.'b AM�fA�9
L� f�' 'I'� i�0i��6�F*� �� I4�Eil�. ,IF�.�p RSAF.CO�Y �� A'M �LA� MA`�9i' '9VTk��W
1���g � C±{d �� �0.` a+� �dey�t�p14+� �ild �R. A�o�f. i6 � s�eJes ag�oamw+l bol�9 Cu�W�
711 B CJ�qIC .UlifOi a'� l� itl SnC u� ratd Innto?�ndoe :�vica� I��d ;�fhdC� WI pAOC d10Cltp10� a�d a�em�44 �9�r
OF+I 9► u►IO�ea�, ralaQ�ut to �s T�uducts• mnd Jr�t:�ldhan, Tlun A�,s��+ ► ameW ��R*;&� w��d exc�l iry u�1ilM� sd�nad
bP Cueiome� �nd ihel-Zoms IIqwu C�L� asicnwwicdyp.a And ��r,rew• Bmt C�..mmcr Ita� r�d u�ldafaa�d.i. n�ea+lartiy acapM ihc
mettli o� enK fa� rooeiw.d a eapy oi tl+ls A�ro�men6 �
f.U�ta r f 51 u I]s���
te
Y
p»tfprtl� F SIELD8RICC �1A�C
� N�.�T.o�r� �IJS'Ct)3t1S81 M�AY CA1'�C1;T, su�
,p►�xt,�ax.�x wrrnitivY r,s�wwxx o�t oaLZGn�
$Y uYS4TMB�TiY[i wFi71�'L�N 1'10�AiCE SO 1� S�'�
D� �t7t 1�P�Gfit' ON TF� 7�ifl SU9I1V5i`8�9
7W.Y AF7'�!t 91G1� '� A�GF�'�'• i1�
�'1',A1� 5C�PPL�h18P11' 1177Yl�� HER3� [Q
'CO]�AINS A FU�M 7'd USE IF 41� R�
�p�FICq�/.d.Y YRBS[�EP SY LAS� �
CU9TOHlPR'S 3'CA7[�
m��Q w��� ��v
Y (�p� �
{�. �a. [ �S1,K�i�°/ /�, � �!.�
Tela�iswee Nn. � '=� � � c� ��"' �
swlcv Cansul� Lb��e PPo.
Us �a��mbka
RRT[Qp+�lmRmPfA4'� A1� WnD[i70Q1S i1�1C �iA77QJhN TFQ` R� qIDA RT�V ARE 41�RR OF'�R6 W�•T
1�1�06e�r�9-0gG$C WI�-Bt,mhF¢P 1'.II�+-GOM�4► r41M-aUYCm�Oalu�d
� rtia r. u�� uu�
YAL�t 1'G!1!
rrom: tLUtli JUMtS 1N1;
°� • VA7 1J! LV1V lY. YO
� 03/19J2918 13:48
From: 952 854 4909 Page: 4/5 Date: 3/24/201012:05:03 PM
�m� 1it14 4iiU�l U:i! �4/ �Ul U Uti � 1 J �f f btl F'. UU4! UU�
t 4�+�JYG4LG f
96354ZB227
I M7'I{� YLI 4+ I
HCME AEP�T
�ne� o�c�: t$ � ""�� � � w��` �
e�+n T ��
�,' r �, �-o�ris�
����
��r.�wn n� �O'�� —. C G.r4�� �"�� /1{�� .
—�'r' `�, : Y�L^: s 3�
� Rpa� m p
Cro�l �
L�n G7
�
1N9� �
� � m./�- a.Ir i�
�A�GE 02/ �S
��� 3�
r�w 1,3)'��'77
.�.�.� .��� �� 7�S°j ..
��b , , ,
S�C D�va Lvva�`�
If�W��l�`���tl�°w° Ya�+. �
R�� �Fi�.0 ���
��het t+etl�u11�' �� 6 �'�
b�t e"'°�` � a��
ee�m � � �II°
w� ^� � � ��
'O!4 �
�r
i�P;�._ 'Oe�- — �
yNlA� �w
pr6r.h � mo�MfRwr � i�is
�yn� uue.r 90.tm.�n � CRn�
�b�R'MMII�
30� ead!
'eWry�0a9`
u
cvnteuhrlm�'I�vAFVkv�i:PVCT�CaY19�U'�4p°T �t
•
a�qqn�tovi. N u `
A��nlwm�ea,sr w v _--•
pp�a 6u� �r: M v ��
Rw'V6�rl
' 0/� �IA
�I�., y d 6 �
Mn16qt6�: O�e+' R
. N� ur8v
Inaa�e� �s�a rtw�hl .�aF'
NnbE
� �
�.w�awP'q'lNw�9��AT
-;.:�r:.:.,�,,.qo�
t��...
i�r
7MIqW�►�
�1�01lU471
� m�w,�oave.'myt.+►u�s+�r
pys�na�ar.as�r�w
���rt M �
r
�C11R �M17 M v �
�aa o�ur. w y
M� eonld: !1 V •
TUn K
��� H
�
�
�
,., �
r �.bL011�—
�����
�, � s�ar r�n u��
� � ' �I_—I
W��
Yn.. !lBi6% ��
��
7�
�et 'CC�C�'
�d7�7 A�'� ��-^.
N M1/ aPPwr
S0.Py' .
� �
t r.w �1e� aad a� wt� tlie J�� apft,'na�Be... sa��ca nnwo or••dt an q+e 6a�+al 7tns.
and �on� t1a�Cl oe Fao.svc*�:a8v ot'!bo Sel�ow �°•e�wcrl e�p7' w�0�i� GPc�l�•�d�
heot�sdwnPl+wiR'm��P+��IOVIeC1�eNk9w4 "�•spyrmTR� mro DIai1 �I�itlnt�6���-SCeL�'tP �
,��.� � � p �� � �, �..-r 9 _ rQ
_ � _ . �..�.
��m;�.�
r.,��-��� �°
�,.�, _��� .
From: 952 854 4909 Pa e: 5/5 Date: 3/24/201012:05:04 PM
rrom:tLUtli JUntS 1N1; am� �a�4 4au� U�/��iI�UIU Uii:1J �r�a r. UU5/UUb
e °
° � �r.r� .�..�! e..uiV iw� wu ru.a.s�i•!ic f nt1�� /.�r� V 1 • ' iM�7G i°1/.L7
B3/1�/2010 13:49 7'635a2B227 •'. Nr�NIE f�EFl7T F�t� 05/0b �
� _ _ .., c� ��,�,,,�, � � �9,Y S �'�'
, M�'�:�E`�iT��.leWUn�u�4�'� t ":�e►yu,xar:—_-•-.._.��j_.. � .e..,. _-� �._.
;+�..r�tik�°-�t�tel&'�.�4^i i i /1 \ !�'�! .�,a: 3���L_,.._
� ,:.,� L�Y�a,rl Y — —�
_,�,�., �,._:� ,�_�.._.:�,,....,_.,.� -_�._- - -- �
�., ,�_...,, ��� e.�.., ..��..�.�. . ..�
� ____. ----.�.�� ` -- --'I
n I 'wa9Ll 9 3� W�.. _. ..� rw...��Z �+=� . ' ��,+y�� i.,m�� �� � � �'��'�� "�,,;,r�� ...�i 'M nqy2"
�' � ln• pF • • �� .�'rr�.�L�.++^^. M1 49
�" •n „ � � � 4�`_ � � �—a �
���� �
� ��w
�■��� �+��i■�
����������
r�������
� ��i��r�■�r��rr�
■���r�■r■r■��w����w
�������� �w
�r�a■ ��r�■■■r■wr�■���■■■�
�■��� �����■■■r
��■■r���� �■■�s��
����������
�r■.��■r����■�■�r�
e��tr�■� �■w����■■���■■■w�
■rr�r■�a�������r��
��ar���w■�r��■■r�
�■■����■�r■■��r►ir�■rw■w■�
�r��■���wrr���■w�s�
������ r�a��rr�■O�
i
�
. .�,.�
9q�e ha+ (B�Maht t s7
Wbtw�1 hr L=rp� �IMI�
xruu �w.wFen
�b61 l�OVOII �C. � / �M�
•LAn� os�7q�lOdYMYV1�
�......�.� � w+r.i.�ro.
��� � r1lu�tt� �eGMI��R+�Y• "aNv'Mn
r.rMlehvn��..r�w?s
��„r-�•,�+. .n Ao.�.�.r.�
.n�w� Rr.t+9M� n n11m-�ayP•wn�e m+�wtP+1-�
' .p�y�i��M�/O��IM�
� � D e�m �
if�/1� 4 i¢ RI� V� ��i1bl16DtlON
201R ��isEL s rtl��.r►� . AOn+�h�l imnalPSf M W�I ls