AF - 46014, Village of Fridley, Mimn.
BUILDING PERMIT
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Date -�.�'' : ji � �. . . . ✓ : . .': . . . . . . . . . . .
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Address�����:".i��.:�� �.� 1r.. .. .
�I° i-198
Builder......... ................ ..........
Address............ ..... . ........ ..........
I,G.00ATION OF BUILDING
No. . . l�a.�cr. Street . �',.�Q..cC._�. .. . . ... Part of Lot . ... . . . .
I;ot�� �r:.'.�,�¢.�-. . . Block . � . . . . . . .. . Addition or Sub-Divisionj��"'.�:`�. .��. ;:F �. . . . ` .
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Corner Lot . .�:'`'`.� . . . Inside Lot . . . . . . . . . . . Setbac� � : : . . . . Sideyard : . . . . . . . . . . . . . . . . . . . . . . . . .
DESCRIPTION 'OF BUILDING
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To be tised as: ,r `������'� ,
;, . -: , . . ..P :�: . . � :''�" . . . Front �`' :�� . . Depth �`� '.: :"� Height .�. '�:" Sq. F't. . . . . . . . . Cu. Ft . . . . . .
' ',�"� �
. . . . . , . . . . ��''r . . Froni ��. . . . . Depth GrK '�� . . Height . . . Sq.. Ft. . . . . . Cu. Ft . .
Type of ConsLxuction �%.�:�«�,a.�,; . . . . . . . Est. Costl�'�� +�+. .� . . . . . . . . . . . . To be Completed . . . . . . . . . . . . .
In consideration nf the issuance to me of a permit to construct the building described above, r a�ree to do
the proposed work in accordance with the descriptian above set fortl� and 'm' compliance with all provisions of
ordinances of the village of Eridley. .
... . .�y .. . . a. ......
. . . . . . . . .. � ��r . _ . .. , . . .- . � ' .. . . .
Tn consideratiUn of the payment of a fee of �,�T .".�� ., permit is hereby granted .��.+1�'�,,.
. . . . . . . . . . . . . ,. . . . . . . . . . to consixuct the buildfug or addition as described above. This granted upqn
the express condition that the person to whom it is granted and his ageats, employee,s and worl�nen, in a11 work
done in, around and upon sa3d building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings wIth-
in the village limits and this permit may be revoked at any tune upon violation of any of the provisions of said
ordinances.
.. .. . .,,.,... Bt�il�ling �tispector
v
NOTICE: -
7his permit does not cover the construction, installation or alteration for wi�tng, plumbing, gas heating, '
sewer or water. Ba sure to see �Building �nspector for sepa�ate permits fo��se ttems.
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City of Fridley, Minn.
BUILDING PERMIT
DB�: J'UNE 14, 1966
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��: DR. D. REITH JOT�STON �� D. W. HARSTAD COMPANY, INC.
�� 1306 HILLCREST DRIVE N.E. Ad� 7101 HIGHWAY ��65 N.E.
FRIDLEY, MII�NESOTA 55421 FRIDLEY, NIINNESOTA 55432
LOCATION OF BUILDING
No. 1306 S�t H7ZLCREST DRIVE N.E. p� of Lot _
Lot _ Block Addition or Sub-Divisian
Corner Lot Inaide Lot Setback Sideyard
Sewer Elevation
Foundation IIevation
DESCRIPTION OF BUILDING
To be Used as:
A�. GARAGE �t 13 � DeP� 20' 6" H��t 10 sq. � 162 �� 1, 620
p�� Front Depth fTefght Scl. Fk Cu. F't.
Type of Conatruc°tfon FRAM� F�at. Cost —�1.500 To be Completed
In coasideration oP the iesuaace to me of a permit to construct the build9ng described above I agree to do
th� proposed work in accordance with the d�scrlption above se�j Porth in ce with a'!1 provlsfons of
oniinanoes o! the dty oY FrirIIey. ��' �'e ����-� �., �°"� ;�
�� �
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Ia camafderat[on oP the PaYment of a Pee of � 4.00 � p�t fs hereby granied to D. w. HARSTAD
C111dPA1��Y to conatruct the bu9lding or addit4on es descrlbed above. Thia permft ia granted nP�
the express <son�iition that tt►e n to whom it is graated and his agents, emPloyees and worlQnen, in all work
dane fn, arouad and upon buil�ing, or anypart thereof. shall conforna fn all reapecta to the ordinaace� oP
Fridley, 11�9nnesota g location, conatructfon, atteration, maintenance, repair aad movla� of buildiuga
within the dty limits��this permit maq be revoked at any time up� violatfon oP any of the Pro�►i�tona of sefd
ordlnanCea.
w'R T•?AM H. SANDIIQ Huil�iag inspect�r
NOTIC�
'11ds poimN doa �t eora tia eemleucHoo, � fer �rielno, plum6tno, oa 6�aftno, aw�r or waM�. B� son ro sM
Mn 6nildina lap�oe fer aparafr p�rmtb for !Ma Nuw.
APPLICATIOA FOR BOILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
ow1vER � s �var� /_�� a � ,���� �a���.���-�' su�n�x. �� ��' ,��� � ��.� �'� , ����'.
ann�u.ss ��� ���2� ��s�- � � . ann�ss �e ��! ' �'��� �� � �
LOCATION OF $IIILDING
N0. STREE'� PART OF LOT
LOT BLOCR ADDITION OR St]BDIVISION
CORNER LOT INSIDE LOT SETBACR SIDE YARD
SEWER ELEVATION FOUNDATION ELEVATIQN
Applicant attach to this form Two Certificates of Survey of Lot and propoaed
building location drawa on these Certificatea.
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DESCRIPIZON OF BUiLDI1QG
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To be used as:
, ,i �
Front�Depth �" � Height ,�' �
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Sq. Ft. - Cu. Ft. _ �J'
�
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Constructiont��4�✓,�`Q ,����� �g'e��°�'Estimated Cost /SO� "
To be completed � o
� � e �G�'� d�-�d�� � s—� t�
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The undersigned hereby makea application for a permit for the work herein
specified, agreeing to do al]. work in strict accordance with the City of
Fridley Ordinances and ruliaga of the Department of Buildings, aad hereby
declares that all the facts and representations stated in this applicatian
are true and correct. �
Cr/, ��G�.�� �
DATE G',��'- �� SIGNATiTRE � -- � '�.-�--="�_�' °� .
(Schedule of Fee Costs can be found on the Reverse Side).
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BUILDING PEI�NiIT FEE SCHEDULB
3ECTZON 2. The Inspector of Buildings shall, before iseuing any permit for
the erection of any building or aeructure•, or.for any addition to any existing
building or structure, or for any alterations or sepairs to aay existing
building or structure, upon application therefore, require the payanent by the
applicant for auch permit of fees to �he amount hereia below,set forth and in
the manner herein provided to-wit: .
2.1. For any such permit for the erection of any fire+proof building,
other tha a garage, warehouse, factory pr grain elevator, or for the erection
of any fire-proof addition, for similar occupancy, to any�e$isting building,
ahall be at the rate of $1',�40 for each one thousand cubic �eet, or fraction
thereof, in auch cubical contents.
2.2 For any such permit for the erection of any fire-proof`garage,
warehou e, factof�y or�grain elevator, or for the erection of any f3re�proof
addition,,for similar occup�ncp, to any existing building shall be at'the
rate of $1.25 for each one thousand cubic feet, clasaified as "ffreproof"
by Section 502 of the Minneapo],ie Building Code.
HOIISES
2.3. For any euch permit for the erectioa of any non-fireproof
building, other than a garage, warehouso, factory or grain elevator, or
any non-fireproof addition, for similar occupancy, to any existing buiXding -
permit $1.00 for each one thousand cubic feet.
GARAGES .
2.4. For any such permit for the erection•of aaq non-fireproof garage,
warehouae, factorq or grain elevator, or for the erection of any non-fire•proof
addition, for similar oCcupancy, to any esisting building or far each such
bui.lding or add3tion - ninety centa ($0.90) for each one thous.and cubic feet
or fraction thereof, in the cubical �onte�ts thereof with the minimum af $4.00.
For the purpose of computing feea for bui,ldiag permita, the cubical contenta
of any building or addition to a uaiform height throughout by multiplying the
grouad area covered from a point sis (6)-inchea�below the floor line of the
basement or cellar to the average h�3ght of the upper surface or�to the average
height of the roof �urface of the main gable of a pitched roof.
2,5. For repairs or.alte�ations to an existing atructure, the fee"ahall
be at the rate of $3.00 per each Five°Hundre�i Dollara ($500.00� or frac�lOII
thereof ia the cost of all proposed work. �� � .
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2,_6_ Ia no case sshall the fee charged for any permit as set forth in
Section 2 be less than $4.00.
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STORM REPAIR DAMAGE FEESs .
Resfdential ; Eatimated Coat of work up to S��;�. �0 �- $5 e�?a
Estimated Cost of work over `,::��;.t:. �:;;! ��;, �., �.0
Commercial; Estimatecj-�ost of ��c.��:, ��.;� r;, ��"ria.�;�,Lt,� �, ��r�.c\�
_�_ r-�, Estimated �ost of ���i;� ov��r ��:�i:i".of�yj - $�t._ ,0 . .
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City of Fridlep, Minn.
6431 Univeraity Ave. N. E., Minneagolis, Minn. 55432
BUILDING PERMIT
Date: Ma.y 18, 1971
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p��; D. Kei,th Johnson B�� „ Ercoa Inco�orate
Ad�Iress 1306 Ni 1 1 rrpst .._, Addre38 3231._.�t;enzral �uer��a� �i.�.
LOCATIOiV OF BUILDING
No. —1.34.��. Sfreet — H i 11 � rp s D i ve N: F. PB,rt of LOt
Lot 1_&_Dt. 2 Biock 1 _— Addition or Sub-Division .MoQr.�.Ls.ke.�T� � ��
Corner Lot _.__X Inside Lot Setback 25 � Sideyard 30'
Sewer Elevation
Foundation IIevation -
DESCRIPTION OF BUILDING
To be Used as:
Gara��. _ Front � Depth ?�_ Height �._.. Sq. Ft. Cu. F't
In�erior emodeling�nt Depth Hei�ht Sq. Ft Cu. Ft.
Type of Construction Frame ��, �� .$10, 000 To be Completed Tuly 1� 1 77�
__-�.
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Existing elevations and drainage to remain as they exist. Garage elevation will
actually be lower than Woody Lane. Provide hard suxface drive. No portion of living
area to be less than 10 feet from property line.
In consideration of the issuance to me of a permit to co the building d bed abave I agree to do
� proposed work in accordance with the description abov and ia with a�l. prov3s�ton8 oP
prdinanc�s of the dty of Fridley.
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In consideration of the gayment of a fee of $ 33.00 ���f � hereby granteci to Erco Incor,,po;ated
to construct the building or adclition as described above. This permit ie grantted npon
the express condition that the person to whom it is granted and his agents, employees and worl�en, in sIl WoTk
done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinanc�s oP
I�`ridley, Minnesota. regarding location, constructzon, alteration, maintenance, , repair and moving of bwlltliags
��� city limits and this permit may be revoked at any time upon violattoa oE any oP the provisiona oE 6aid
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���5 ��
HANK MUIiICH
NOTICE:
This permtt does not eove� fhe eonatrue4ion, installation �o� wfring, plumbing, 8aa heatieg, sewar or v►a1er. Be sore io ses
t6s Building inspector for saparate permita for theae items.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
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OWNER' S NAME : i �1�� ! � �^� G�-J�( � v BUILDER : �V �o � e-�--
ADDRES S : _ I �j � (� h�- ( LC.. �-�� �ADDRES S : � `2�7 1 �-�� /y rl �—��
NO : . �� �' � STREET� � � `� C-�i��r t
LOT : � �f'' `L BLOCK : � � ADDITION : Y �' `� r � �- ii�- � I�' Lc- �.�
CORNER LOT: INSIDE LOT:� SETBACK: �Z � SIDEYARD: � a� ±
Applicant attach to thia form Ttao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Uaed As : ������.�� -�
� � Front : °L v' � Depth : Height : � ��
Square Feet: Cubic Feet:
� ��f�Lt� � ��£ : ��"� `V � th ;
p Height:
, ,
Square Feet; Cubic Feet:
Type of Construction: ��- Estimated Cost:_ $�ro ra o c� �—
To Be Completed: � 1 1 1 ' F
,
The undersigned hereby makes application for a permit for the work herein ,d�'�
specified, agreeiag to do all work in stiict accordance with the City of l��'
Fridley Ordinances and ruliugs of the Department of Buildinga, and hereb `�}
declares that all the facts and repreaentatione stated in thia application���''��✓
are true aad correct. � '�
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DATE : � '�r � � "� S IGNA
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(See Reverse Side For Additional Inforniation.) . �,� � ,_ ,
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for aay addition to any existiag
building or structure, or for any alteration or repairs to any exiating
building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth aad in
the mansier herein provided to-wit:
LTNIFORM BUILDING CODE: 1j�pe 1, 2� 4-$2,15 for each one thousand cubic
feet, or fraction thereof, in auch cubical contents. Type 3& 5-$1.85 for
ea.ch one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building pex�3.ts, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the uppez surface or to the average•
height of the roof surface of the main gable of a pitched roof.
For repaira or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fractioa thereof in
the cost of all proposed work.
In no case shall the fee charged for any pemnit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE; 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 coastruction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before aroceeding with the framing.
CERTIFICATE OF OCCUPANCY
Applicatioa for a Certificate of Occupancy shall be made ten (10) days piior
to t,he use or occupancy qf any structure for which a building pexmit has been
iasued; and said structure shall not be used or occup�,ed until a Certificate
of Occupaacy has been isaued. •
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la�d Plonning s�,c���G"(Y�.L�Z 6875 Nighwar No.65 N.E.
Land Surveying �� • • (j� /� Minneopolis�
Soils Tesfing r��z�zyiPe�z�) �-/�L'� Minn. y5432
Civil Engineering Teleplwne 784-6066
Municipal Engit+eering Engineers & Surveyors �►rea Code 612
Mortgage Loan Survey for C���} T��.
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Scale � �—
�01 �.,LLOC1j 1 and },I�a�, � r� �� LOT 2 a�' L�C
N\OOtZE LAI�E H�L�S , I�lin� �c�u�hea���.rly o� E3LAC��
/�Dfi�ITIC�I�I, CouN � � n� �cvor��.
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This is o true and correct representation of a survey y�:7he;boundaries of the lanc� above described and of the
tocotion of all buildings� if any� thereon� and all visible;e+rcroachments� if any� from or on said land. This survey is
made onlr in connection wifh a mortgage loan now baing placed on the properfy and no liobility is assumed
except To the holde► of such morigage or any other interest acquired by the reoson of such mortgage. It is
understood a�d agraed �o monuments hava been ploced for the purpose of establishing lot lines or bovndary
corners. Dated fhis��,day of �prit A. D. 19,]l,. .
SUBURBAN ENGINEERING, INC.
�3Z� Engi�ee I . � � rs
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Lond Planning su��i%L[�Lfin 6875 Flighway No.65 N.E.
Land Surveyi�g ,/ •� p/�� • �j /a Minneapolis�
Soils Tesling �i��//LQC"IlG�, �J%ZCi� Minn. 55432
�ivfl Engieeering Telephane 784-6066
AAuniclpol Engineering Engineers & Surveyors Area Code 812
Mortgage Loan Survey for C�C �'� I� �.
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Thisis o true and correctrepreseetotion of a su►vor of ►he boundariea of the land above described artd olfhe
tocafioo of all buildings� if any� thereon� and all visible encroachmenfs� ii any� from or on said land. This survey is
made onlr in connection wifh a mortgage loan now being piaced on fhe property and no liabilifr i� assumed
exeepf to the holder of such mortgage or c�y othe■ interest acqui�ed by the reoson of sueh morfgage. It is
underatood and agreed oo monumeMs hove been ploced for the p�rpose of establishing lot lirees or boundary
corrters. Dated this +Z4 day oF Ap�.;l A. D. 19�.
Revesesi MA 2S �q�� gUBURBAN ENGINEERINC;, INC.
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sue�ecr PERMIT NO
c�ty of Fridley � ,�s�
AT THE TOP OF THE TININS g U I L D I N G P E R M I T •
� � RECEIP
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COMMUNITY DEVELOPMENT DIV.
� PROTECTIVE INSPECTION SEC. �� O ,/�
� , 7
' i '
�� /��'1 � CITY HALL FRIQLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
""� � ,'� 612-580-3450
910-F15 6/21/78 � �
JOB ADDRESS 1306 Hillcrest Dr.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. j andpart o lot 2 blocic 1 Nloorelake Hills L in S.E. o�E�lac ar dii
2 PROPERTY OWNER MAII ADDRESS ' ZIP PHONE
D. Keith Johnstc�n and Denise M. Johnston�.1306 Hillcrest Dr.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Pool Insta.11ation erts 2231 Cardinal Place St
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USEOFBUILDIN(3
Above round swi�in 1
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 16" x 32` Swi.mming Pool
9 CHANGE QF USE FROM TO .
STIPULATIONS
See stipulations on letter da.ted June 21, 1978 from Envi.ror�ental Officer
'�IIIRNIHG
���r� di�int cail loca! ��ilities
SEPERATE PERMiTS REQUIRED FpR VltiRf�tG, ��������f -fLECT�iiC•G�ASS Ets.
H�ATiNG. PLU1�11BIMG ANU S�GPIS. hE�U1RED BY RAW
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUM8ING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. MC.''��- Fr�le
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAY$, 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 1 STALI.S 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.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $'rJQOO y�`3.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � �`30.00
PLAN CHECK FEE TOTAL FEE
33.00
SIGNATUREOFCONTRACT ORAUTHORIZEDAGENT IDATEI N PROPERLV VALI TED THIS IS YOU PERMIT
� � � �' � .e+-�� ���� � �1! %�
SIGNATUREOFOWNERIIF NERBUILOERI IDATEI � B�.DG �NSP pATE
:ion
�
0
,
c��Y or- r-��IJ)LCY
APF'LIC/1TIOf� i�0(i IZL"SI1)f:rJTIIIL I3UILD1(�1G f'Ct21�1ITS
(�VL"1�1, IILTLR/1T1 U�JS, IIllllI T I 0(J5, .OR REI'AI (ZS )
• . _�-
0
�, �E �t�F �o '�f /� Sro N ' � � -�D O � / �V 5�7'�l � L. #j-°F/ (�'��X �E��S
owli�cR: �,�,.[UdS.t 0►�• 10 �N STO�U T1UILllrR: � — �
d� 3/ Ld �FR��e�'��eAe� .so'P�VZ �s�i�/.
ABdress : �` ���U� ��•l'� e��5� �Adclress : -
, Tel . t�to . '�� — � 9 �'%
1Jo, : ����o Street : �l G c.. G�L�' .Zl�� J'�E �. ,
L�? � �.�oc 1� ( �iry� • TH�t-� 8'��T v� L,oi _� ��t�c K�
LOT: BIdJCY.: ADDITION :/n � 3_E c/� K E �i► /� L 5 � Y, � G
SoCs?/�fER 5 � �RLy o �a4Gti°�/�R
^ SIDL•'�'71RD5: A iJ �T�O�/.
COi2i�TER LOT: IIISJDE �AT: SLTLIICY.: _
Applica'r.t attach �to L-his foi:n T:ao Ceztiticates of. Survey of Lot an� praposed
bui.lding locatian dra�+�n on these Certificates. •
J
3
DESCRI Pi'I0�1 OF BUI LDI P�G
To i3e Us ed As : .�1 � � � � � � �N .� S Ce�1 i �► Ov! I !i/G
iv!
�� . ��� � -
' • Fxonts DLpth: � �'
�' . .
Square Feet: ���' Cub�.c E'eet: _ ^
I'ront: � Depth: � Height:
' Square Feet: Cubic Feet: �
T�,�pe of Canstxuction: �%� �- �A�'11 � Estimated Cost: $� � ,
'1b t3e Completed: �` U AJ �3� �`� B'
Alt. A Alt. B
Prciposed 1)ri��eway �r'idth If New Opening Is Desired $ $ '
(SL•'� R�VERSE SIDE OF SHFET)
The undersigned hereby niakes ap�lication for a pe�mit for trie work herein
specified, agreeing to do all �.ork in stri.ct accordance with tlie City cf
Fridle�� .Oidinaz�ces and rulisigs of the Deoari:ment oi Builc:inc�s, �n�d heie�y �
declares that all �he f�cts and re��resentatiUns stated in .L-his appZication .
�are true and coircct. See xeverse side Car aclditiona3 in�ormation.
�T�; a0� STGI�ATUI'.E:
' �:�*�`
St.ipulatioiis: � •
� �
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n
BUILDING PER��IIT' FE� SC�iEDULE
5ECTION 2. The Inspector of Buildings shall, before issuing pexmits for the erection
oi any building or structure, or for any addition to any existing building or structure,
cir for any alteration or repairs 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:
NEW COhiSTRUCTIdN: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$14.50
Alternate B: Removal and replacement of conc�ete curb and
gutter and install a 3 foo t wide approach with
6 inch depth; Driveway width plus 6 feet x$17.20
� 11 � � � �' � �
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or the cellar to the
average heights of the upper surface or to the average height of the roof surface
of the main yable of a pitched roof.
For renairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 �ier each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
Sn no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
VERIFICATION OF FQUNDATION
NOTE: Permits �or construction will be issued a minimiun of 24 hours from the tirne
of application to allow for proper review of the pro,posed structure and of the
construction site.
A Certificate of Survey af the lot, showing the location or the foundation once it
has been constructed will be required before proceeding with the framing.
CERTIFI.CATE OF 0 _ctiPaNr_y
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occuFancy of any structure for which a building permit has been issued; and
- saa.d structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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6431 UNIVERSITY AVENUE M.E., FRIDLEY, MINNESOTA 5b432
TELEPHONE ( 612)571-3450
June 20, 1978
D. Keith Johnson
1306 Hillcrest Drive
Fridley, NIN 55432
Re: Swimming Pool Construction at 1306 Hillcrest Drive
Dear Sirs:
This letter is to make clear this departments requirements for the
swimming pool construction at the above address.
1. As indicated, 1 skimmer approved by the National Sanitation
Foundation will be provided.
2. As indicated, 2 inle�s of approved design for fresh and/or
repurified water will be provided.
3. The filter and ptunp shall be approved by the N.S.F. and be of
sufficient capacity to provide a minimum turnovex of at least
two (2) times in 24 hours. This department recommends a turnover
rate of 6-8 hours.
4. A deck of at least three (.3) feet wide, measured from the pool
water's edge, shall be provided which_extends completely ar�nnd
all private residential pools. Above ground private xesidential
pools may be provided with decking of a minimum size of 4 feet
by 4 feet at pool entry points and provided that such decking
has the approval of the City.
5. Fencing or other e�fective means including but not limited to
walls or buildings, acceptable to the City, shall be provi.ded
to positively control all access to public and private res.i-
dential swimming pools. Fencing sha.11 meet the following
criteria: �
(a) The fencing shall prevent the entrance of children and
be without hand or foiot holds that would enable a person
to climb over it.
(b) The fencing shall be at least 6 feet high and entrances
shall be equipped with self-clossing and self-latching
gates capable of being locked.
(c) Self-closing and self-latching devices sha11 be placed
at the top of the gate or othexwise inaccessible to small
children.
(d) The opening between the bottom of the fence and the ground
or other surface shall be not more than four inches.
/
\�
�� /
" D. Keith Johnson
�� June 2Q, 1978 Page 2
A
�
6. An automatic chlorinator shouZd be provided with a suitable test
kit.
7. All electrical and plumbing installations shall be inspected
and approved by the City Inspsction Department.
8. All electrical lines must be greater than 10 feet horizonta]1y
from the pool surf ace .
9. The pool will be filled by using a private well.
10. Suitable safety equipment to include but not limited to a ri.ng
buoy and rope that is l�i times the pool diameter, and shepherds
crook pole must be provided and mai.ntained with the pool at all
times.
Furthexmore, these and any other requirements must meet the provi-
sions of the Fridley City Code, Section 115, St��mminq pools. The
building permit is approved conti.ngent on final inspections and
approval by the City.
If any questions or problems arise from this letter, pleas.e .feel
free to wntact me at 571-3450, ext. 170.
Si ncc-±rPlv .
SJO/lw
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Lond Plann:ng
lond Sur�sr:ng
Soils Teffin9
Civi) Enginee�iny
Municipol Enginsi�ing
Mortgage
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Minnaopolis�
(%�11�lj1PPlll'1�, • yll.'� Minn. 354�2
Telephone 784-6066
Engineers 8� Surveyors Area Cod� b�a
Loan Susvey for C�G C�ti I� �. ,
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fJ�t� � /^�'-` }' � i� `= i� � I n 8 L A C 1� /V`�`
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,This is o true and correct represenlation of o survey of the bo�ndorirs of the land above described and of�hn
locofion oI oll build:ngs� if ony� theieon� and nll visible encroochments� if any� from or on soid iond. This survey is
made only in conneeeio� with a moregogn loan �ow being plocad on t{+a property ond no liabili►p is assumad
r�cept fo tF�e holder of such mortgage or ony orher inte�est ocquired by rhe reoson of such morigoga. It is
understood ond agreed no monuments have been placed ior the purpose of establishing 10♦ lines or boundery
corners. Dated ►his rt�i day of i� . A. O. 19,1i,.
SUBURBAM ENGINEERING, 1NC.
L�S? r„ Engigee o ,_� f Y•s •
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sue�ecr PER
City of Fridley 2 0 8 7 3
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 OIV. rQ
r � � PROTECTIVE INSPECTION SEC. �Q �J /�
1 ` �
� /'�'1 � CITY HALL FRIDLE� SS43Z NUMBER REV. DATE PAGE OF APPROVEO BV
�'"°� � ,'� 612-571-3450 9t0-F15 6/12/�1 � �
JOB ADDRESS 1306 Hillcrest Dxive NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1� Pt. 2 1 Moore �IC H111S SHEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE
Dr. Keith Johnston 1306 Hillcrest Drive NE 57 -108
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Minnesota Exteriors 2�5 H 55 Hamel 478-6001
4 ARCHITECTORDESIGNER MAILADDRESS ZiP PNONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION f� REPAIR O MOVE O REMOVE
8 DESCRIBE WOHK
Reside Diaellinc� - So��'it & Fascia
9 CHANGEOFUSEFROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PEHMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATIN(i,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONINd SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 720 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
i HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUHTAX
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $11, 625. $5 . S�.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 13S.00 F'ire SC $ZZ.G3
STRUCTION OR THE PERFORMANCE OF CONSTFiUCT�ON. $
PLAN CHECKFEE TOTALFEE
152 �44
SIGNATUREOfCONTRACTOfiORAUTHORI2EDAGENT IOATEI WHEN ROPERLY A E T S VOUR PERMIT
. -- R�- � �a_��
SiGNATUREOFOWNERUFOWNERBUILDER� IDATE� G $P naTE
Prepaid Plan Q�ac�.k $
Fstimat�d Gbst $ QT![ GQr FRmIEY
Reoeipt # �3, �CIAL ir II�ID08TRII�L
Buildiag Pe�it Applicatiam
o�-tion 1�c3ar��s ��,e� (,P �e,l�.e�r� �- � r _
Effec�tive 1/1/91 �i�� o �F�,c�Le�-�
.� �-
r�e�qal Description
owr,er & ��� I�r, Kc.��. .�D�,►��on �e1. # �7/- /O$�
����� &� li'lil�i��.�� LX�Crivr.S a��'a T��/ �� I�"��/ �1.1r 7�C1Tf��
11i1.711�.G.i�. Q fi�iCa7 ' ��7�
n7gineet & Addl�..s Reg• #
TYPE OF W�RK I l� I � Additiaai � Alteratiori Desc�'ibe��►c�.c, ��e�sk.
S, �;2ti - s�-f� � -�.su�l
Ap�l icant sicp�ature e c 'Z�el #�'l�-(� c� ! Date �-��"1 /
:�� . � . . � ��+ �= • �=
Ie��gth Width iieight Sq. Ft. # of Stories
OFC. AREA: Ielx3th Width Heic�t Sq. Ft.
WfiSE ARFA: Ies�gth Width � Heic�t Sq. Ft.
�m2 ARFA: Ler�gth Width Height Sq. Ft.
l'[:` �,:� M �� � i
sq. Ft. x$ Dost/Sci. F't. = Valuat3an $ )
sq. Ft. x$ Dostlsq. F't. = Valuatiaa�► $ )= S /�, (g�T S_�
Sq. F't. x$ Dost/Sq. Ft. = Valuation $ ) 7�rAL VAIIJE
Bui.l.ding Use �; �.�.� �,Q, �tn�ctiaai 7.YPe �-Y �P
Air G�onditiaa�in4 I] Yes [] No Fire Prat.ec.�t.iaai Prwided [] Yes [] No
PerfoYa�ar�oe Bor�d AmauYt $ See Reverse for �?� e Itec�eived []Yes []No
Permit Fee $ ( 35. ot� � See Fee Sc�edule an Reverse Side
Plan Ct�ecJc $ In F�OOe�-.�s of Pre�aid Amo�uit - See Reverse Side
Fire S��aYge $ � I.�3 .00i x Permit vaivation �i/ioth �)
State �arge $ �$1 $. 50/$l, 000 Valuatian (See SciLed. for >$1 Million)
SAC Q�arge $ $650 per SAC Unit
Park F�ee $ Fee Dete,nm,ined BY II�girreerit�g
5'pec. Ass�es�.G+++p*+*� $ Agre�ner�t NeoessaYY [ ] � ���'Y [ ]
Driveway ��crr�w $ feet x $13.50/foot
'1nT�L $ S�,
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AmITI�iL BTIPIJIATI�1'B �T �E S�
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� � ' � SuB�ECT � � �
City of Fridley 2 8 2 � 2
;`���T��T��F�ME TWINS g u I L D I N� P E R M I T �E�PT
; `v _.��� COMMUNITV OEVELOPMENT OIV. � �
r � � PROTECTIVE INSPECTION SEC.
i = �
� /"'1 � CITY MALL FRIOLE� SS��Z NUMBER REV OATfi PAGE OF APPROVHD 8Y
�"'"�� �'� 612-571-3450 910-F15 10/13/98 � �
10B ADDRESS 1306 Hillcrest Drive NE
t LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACMEO
oesca. 1, Pt. 2 1 Moore Lake Hills SNEET
2 PROPERTY OWNER MAII ADOR�S$ 21P PMONE
Reith Johnston
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO
Advance Alum. Su 1 Inc. 7701 Ma.in
4 ARCNITECT OR DESIGNER MAIL ADOFiESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL AODFESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATIpN � REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and ara e 37 S Tear-off
8 CHANOE OF USE FROM TO
STIPULATIONS �
Underlayment must comply with the State Building Code.
SEPARATE PERMITS AqE REDUIRED FOR ELECTRICAL. PLUMBING, NEATlNG, TYP� OF CONST OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NUIL AND VOID If WORK OR CONSTpUCTION 20NING SC. fT CU fT.
AUTHOR12E0 IS NOT COMMENCED VyITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANQONED fOR A PER100 OF 120 DAY$ AT
ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNITS OFFSTREET PARKtNG
I HEREBY CERTIFV THAT I HAVE READ AND EXAMIN�D THIS APPLICA710N S7ALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND C04iiiECT. ALL PROVISIONS Of LAW$ yqLUATION SURTAX
ANO ORDINANCES GOVERNING TMIS TYPE OF WORK WILL �E COMP�IEO
WITH WME7HER SPECIFIED MEREIN Oii NOT. THE GRANTING OF A PERMIT $3170 �1.SS
OOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CAMCEL TME pERMl7 FEE SAC CMARGE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON-
STqUCTION OR 7HE PERFORMANCE OF CONSTRUCTION �S%.25 Fire SC $3.17
PLAN CMECK FEE TOTA� FEE
License SC 5.00 $97.00
S�GNOTUAE O� CON'AACTOQ OA AUTNOpIZED AGENT � IDAfEi WNEN PROPEpLY - IOAT D TMIS IS VOUR PEpMIT
- IiV O C.�L� ����L U
S�GN4TUAE O� OWNEA��t OwwEp BwtDEa� �DATE� - BL �NS� - q�TE
^- -m .
N�w - [
A�DN [
ALTER [
$ 612 571 2260 RDURNCE ALUMINUM 04
� S 7:�_ 310� �� Tffe�tive i/1/9�
� CITY ON r'RIDL�Y �
] b1NGLE FA1Vtii.'Y AND DUPLExES R-� AND R-a
BUILDING PERMiT APPLICATION �� "� z• � � - �� �
� � �u
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ConstructionAddress: L� E ��� � L��Z+� T
L,egal Descriptinn: ., ��
Owner Name 8c Address: /t� %/ i N �T C N�y s r o�v Tel. lf
Contrdctor: � �,�• �-c f � �.,,� ..-r ��i'`'6 •L�� MN LICEN.SB � 7� ��
Address: � � c Tel. #•,s7i`" 3y'�''C''
Attach [o this applica�ion, a Certificate �f Survey of the
lot, with the proposed construecion drawn on it co scale.
DFSCRIPTION OF IMPROVEMENI'
LNING AREA: Length � Widch � i�Ieight Sq. I�t. �
GARAGE AREA: lxngth Width Height S9• r�• _
DECK AYtEA: l..ength Width Hgt/Ground Sy. Ft. �,_____�
OTHER:
Construc;lion Type:, IE�d ��G 7� _ Estimated Cosl: $ ����
df ' 3
(Fee Schedule on Back)
Driveway Curb Cut Wid�h Needed: Ft. + 6 1't �= Ft x S =$_.
vATT: �a �S APPLICANT: Tel. ll f 7/ "�13'D
�
CITY USE ONY.Y
Permit ree
Fire Sutcharge
State Surcharge
SAC Charge
License Surchar�e
llriveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
�
� 7. �S
$ �• �'1
$� /. �
S
$ � c�c�
$
$
Fee Schedule on Reverse Side
.001 of Permi[ Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licenscd Kesidential Contractors)
Ait. "A" oc Alt. "B" Above
$450.00 Conservation Plan Review
$ Fee Determined by Er�gineering
$ Agreement Necessary [ ] Not Necessary [ �
$ 9�v�
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� FILL IN COMPLETELY FOR REPLACEMENT FUEL BUI�NING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUS710N AIR VERIFICATION
VVhen replacinq an existinA furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterio�ation, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all cuITent codes and m�nufacturer
s�ecifications including sizing, length, number of elbows and terminatidn. Yes ()
The undersigned also verifies that the replacement unit is a listed asset�nbly
and meets the current codes and manufacturer's specifications. This dbes
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the cuRen# codes
and manufacturer's spec�cations.
When required to install a new combustion air, it will be sized and in�talled
to meet the current codes and manufacturer's specifications.
No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
INhen installina a new ventina svstem, the undersigned hereby verif�es that
it is a listed assembly and meets the current codes and manufacturer's�
specifications. This does include AGA-GAMA Category I Central Fum�ce
Venting Tables for fan assisted and natural draft appliances. ; Yes ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
Yes ( ) No ( )
Apaliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Tdal Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS• (Describe)
HEATING CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, NIN 55432
57Z-3bU4 l�'AX:
: 1306 HII.,LCREST DR NE
: 243024210033
: UNAVAII.,ABLE
: LOT BLOCK
: PLUMBING
: RESIDENTIAL
: ADDITION/ALTERATION
571-1287
----�
�
PERMIT O.: 2004-01248
DATE ISSUED: 08/03/2004
VALUATION : $ 300.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A WATER
SOFTENER.
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE
# NEW FIXTURES (EXIST OPENINGS) 0 # GAS WATER HEATERS
# GAS DRYERS
# OF NEW FIXTURES
# WATER TRMT APPLIANCES
APPLICANT
SHII.,OAH WATER CO
7319 166 AVE NW
RAMSEY, MN 55303-
(763)753-9244
� `./�I :
JOHNSTON KEITH D& DEI�TISE M
1306 HIL,LCREST DR NE
FRIDLEY, MN 55432
0
0
1
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 examined this
application and lmow 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
regula ' g construction or the performance of construction.
Applicant � Date
Bldg
�
# GAS RANGES '
VALUE (FOR MIl�TIMUM CALC)
PLBG PERMIT MINIMUM FEE
PLBG FIXTURES (NEW OPENII�TGS)
PLBG FIXTURES (EXIST OPENIrTGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 9987
SEPARATF, PF,RMiTS RF.niTTRF.I� FnR W(�RK c�THF.R THAN nFCrRruFn ARnvF
0
0
0
300
0.00
0.00
0.00
35.00
0.00
0.00
0.00
0.00
0.00
0.50
35.50
.�
.�„
Building
Inspections
763-572-3604
u��: nl..V v
SITE ADDRESS __
TH1S APPLICANT IS:
PROPERTI'
owNEx�
TENANT
CONTRAGTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICA'I'IUN
PER11iIT Tl'PE
Tl'PE OF WORK:
�
PLUMBING
RESIDENTIAL APPLICATION
____ CITY OF FRIDLEY
❑ OWNER
1'GUR E-b1A1L r1UllRL;SS
Perniit No.: � - - - � G`?(�
x�����za �y�: _--_
D����- � -��l
--- - -- --- --- -
- --- ---- ----- - ------------
NAME:- 1 - —_I%I,S d�--- -- ---- -
---.. -------- ---------------- ----- 9
ADDRES . , � O� _ � �`�f.Y�.�'C _y��� _C[TY_ F� j�, �.�----STfITE 1�P�C.1, j�c
PHl.1NE:��� � �.L_-_ ����._ __ ..
-- - -- ----- - - -
�- - — - — _ --- - — --. _— ---- --- -- .
NAh1E:_�V1GTt t c� r+�2�e.<L—. _------ -----
STATE LtCENSE #�g%+��i�Ir�___ E.YP DATE �.3 �� O% �
—� -------- -�1
AllDRES :— ---- -- -- CfTl' S% � F��iv�Uj- -- ---STATEy!�%±�L[F ���
`� —
PHuNE � �� 7,�3- `i�� . _ EAS 11f�� ._7 S3 -_3S(9�-- -- -
L9'SINGLE FAMILY
❑ NEN'
❑'CbVI.� FANIILY p TOWNHCJUSE
DETAILED DE3CRIPTIUN UF WuRI� �•�c.>✓J_��.�t� ��a f�.P��_ ,G.r� ��`
PER 1bIS 16B.665 the pznnit fee is a minimum of S15.OU or S% uf the total cost up to $SOU.00, �vhicl�ever is graater, for the
improvemant, u�stallatioii or replacemeiit of a residetitial tixtiu-C, esclud'u�g the ti�t�ues. t T'liis s}iould reflect only th� cost of labor ►
Labor cost under $3l)0 =$1 S.UO. Labor cost betweeii $3UU to $jln) _= cost of I�bor s.ii5 =
FORPROJECTS WHERE LABGR E�iCEEDS $SUO, FEES ARE BASED C�N $11J.UO PER FI:�'1'URE. E:iCEPT WHERE NGTED. Fi:t'TURES: fINDICATE TOTAL
NUh1BER OF EACH BELOW)
BATH SINK/LAV FLOOR DRAINS SHI�WER IVATER PIPING
BATHTUB c3AS P[PING �xsea c�t�crcrN:sl S�VI1�i�11ING PuOL WATER SvFTNER 1$35�
� _ CLOTHES WASHER KITCHEN SINR R'ATER CLuSET BACKFLuW PREV. ($l5)
_ DISHWASHER _ LAUNDRY TRAY WATER HEATER 1$3g1 � FOR IRRIGAT[l�N
_ WATER &iETER OTHER
Permit Fee $
Surcliarge .50
TOTAL DUE � _
�' /� �
::::::::...::.:::: : : :::
. . .: :::..... . .. .: :.. ...:. ..: .. . . :�L�� �� �i�.�..��.���� �.?�����Qii
Number of Gxtures �$1 QUU �$l ll.Qll =$
Number af �xtures � $1 �.��0 x $I5,00 = $ �—
Nwnber of ti�tures (u $35.Ot� ` s$35.On = g
State Surcharge = $ SCi
Total = $
THIS IS AN APPLICA7'IUN FuR A PER1bllT-NOT \'ALIll UNT[L YROCESSEU
I hereby apply for a buildu�g parniit and I acknowledge diat die u�formatio�i above is cocnplete and accurate; that dia work wili be ui
confortnance with the ordinances and codes of tha City of Fridley aud wid� d�e Muuiesota Construction Codes; that I understand iliis is
not a p�rniit but only a►i application fo percnit ai�d • rk is uot to .tart �ti-itliout a permit; diat the w�rk �vill Ue u� accordat�ce witl� die
approved plai� ui the case of all wor • iich r uiras vizw ai�d apprvval af plaiis.
SIGNATURE OF APPLICAN _�� _ ___FRINT NAA�1E��������'1Q'� DATE_����s� _
City of Fridley
Building Inspections Depurtment
6�31 tllliversity Avenue NE, Fridlzy, A1N �5432
763-572-3604
F.A1: 7G3-502-4977
JUN-18-2007 MON 09:59AM ID:
PA�aE : 1
Building
Inspections
763-572-3604
DATF. L� — �-J- — ��
SI1'E ADDRESS _L
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
N
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
O OWNER
E-MAIL ADDRESS
CITY �(►U �
CONTRACTOR Co1vtP� 1v�:
SUBMIT A COPY OF CONTACT PERSON: eSSI GC� Q�AJ
YOUR STATE STATE LICENSE # �o�� I�l EXP DATE
LICENSE WITH ADDRESS: { � �_ CITY
APPLICATION pHONE F��
�}-3�Dr� F� �-`�o � -S
PERMIT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: ��W �PLACEMENT 0 ALTERAI'ION/REMODEL
DETAILED DESCRIPTION OF WORK
Permit No.:
Received By:
TE' �LIP.
0
y •
PER MS 16B.665 the permit fee is a minimum 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 WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOVI�
Equipment Installed MFG: MODEL: SIZFJBTU
MFG: MODEL: SIZF/BTU
MFG: MODEL: SIZE/BTU
_A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
_AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 ( gFURNACE $35.00 _GAS UNIT HTR $10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENIILATOR $15.00
Permit Fee
Surcharge
TOTAL DUE
$
� ��
: PERMIT FEE FOR PROJECTS OVER $500
Number of fixtures @$10.00 1 x$10.00 =$�
Ivumber of fixtures @ $15.00 x $15.00 = $
Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 � x $35.00 = $�
State Surcharge = $ 50
Tota1= $ �
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pernut and I acknowledge 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 I understand this is
not a permit 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 of a11 work which re u' �es review and approval of plans.
SIGNATURE OF APPLICAN�,,�,�, C�,rv PRINT NAME ��SV I�_ �����j1�ATE �j ��—D �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building MECHANICAL Permit Ivo.:
Inspections RESIDENTIAL APPLICATION Received By:
763-�72-3604 CITY OF FRIDLEY Date Rec'd: D
763-502-4977 FAX EFFECTIVE 7-1-2010
DATE t� �1 YOUR E-MAIL ADDRESS
SI1'E ADDRESS , I.�ie LA H � I � CV C' S% ��
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY NAME:_ �'�t' i -I-h �ohnS+a.7
��� ADDRESS: I�JOI.c �►,�\cr-e�� �r crrY �r�d l� STATEMNZIP�JS�"i�Z
TENANT
PHONE:
CONTRACTOR COMPANY NAME: �t,ti�arl`1 �(qT1lQ.5 , �-r �c...
SUBMIT A COPY OF CONTACT PERSON: � 1�.Y1 ��'i-��L�
� YOUR STATE STATE LICENSE # EXP DATE
LICENSE WITH ADDRESS: �aJ� � �L�� �} CITY.UlL7p � }pn STATE �1NZIP55�1ZU
APPLICATION pHONE ��,2-�5�1-3�v J FAX ���J 2� $SLI -��7�
PERMIT TYPE I� SINGLE FAMILY ❑ TWO FAMILY � TOWNHOUSE
TYPE OF WORK: ��W Gp �LACEMENT 0 ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK �r^� P j_Ej„c•� ,•nr�, �A,�nci �y Q C, C�; �'ul�,a,�a41,r airl ��(� �
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�
PROVIDE HEAT LOSS CALC'S PER MANUAL J 2006 ASHRAE HANDBOOK
Equipment Installed MFG: ���x MODEL: � 2 SIZFJBTU '�� � v V�
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZF/BTU
�A/C $25.00 FIREPLACE (GAS) $I5.00 _GAS RANGF/OVEN $]0.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 _NEW GAS GRILL $10.00
BOILER $35.00 FURNACE $35.00 GAS UNIT HTR $10.00
CHIMNEY LINER $10.00 GAS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
Number of,fixtures @ $10.00 x $1 Q.00 = $
Number of fixtures @$15.00 x$15 A0 =$
Number of fixtures @ $25:00 x $25.00 = $
_-_
Number of fixtures (c� $35.OQ x $35:00 = $
State Surcharge = $ S.Oii
� ca
FEE $40.00 Tota1= $ �
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge 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 I understand this is
not a permit 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 all work which reyuires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME �r�,�a y- c_� , b DATE � I?�U � 1 U
APPROVAL INSPECTORS SIGNA RE DATE
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR BUILDING, EL�CTRIGAL AND MECHANICAL WORK
� ! i� P,r'� /s i�o �Sf�e
%Yt� G�erniGGK l%G�n.SG
�t ' �f
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977
.�� ���� - �7 a
Z ytfuche� Ocr,� �e, ba��. ���— �-L ��