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Pertxait is here'b�► grant.ed to � � ` � � ,��� . �. '
4 ';"��a ti
, � the btaildiag , �: �}� �, w de�k�ed_ 3n 43ae' almae siatement This p�rm4t" 3�, graated 4' _
. -` "upo� tl,�e espress eonditi�a that tlae pexson to whom i�.is gra,zcied, aad -his ageni�, emPioYees :and �avurknaea, in a11 ' ,_- =
' the v�ork du'ne in, arou�d and t�pon said b�dfn�, or �gr pa�t thereoP,: shait confor�a.:3n .skl respec�s: ta the a�i- -.
_� ' aaiices v� Firfdlle9; B2ign•, reg�x'ding the c?tsnstrutetiYa� 'alt�#�oxi; ,m�.ini�nauce,' repafx :� m,oe3fi� bf ° in�iidiag,s ". -
�ritiiir�; fi3ae cfty �imifi�, aiscl: this permit may '!ie revaked at �z►y ,time iipoa v3ol.�tian of �a� of Ylie prnvisiai�a o� sa,�d =
.�r ' ordinaacea. ' �- = , �
`' �''� '� �'� �� tor oP�F3uuildin�s -
. ; G ; ';- � �;.G`�+ ��]�[�T'.� .�1� S��3RI�T a'�i.�����T'.�' .
_ Itt cos�id�rata��. mf �:he i,�sue ancl d�livery to ai�e bv ih� �'n ;�:��tc�� af �uil.d?�s o� : o'_�'�iclley o�
ihe _ab�ve �errmi.t; Y. hereby, a�ree ta da the �ro���ed.'�vo� as�. �.cc��d�.�:ee �vithwtl��e des��i�iion
=�' above. �et fo�th �d ,a�ordin�'�o tk� y�ro��4n� o� �h� orrlin��e� c�� �dle�, a�cc�z '�i�g���t dui�p `:
•� s�vorn, 7E hereliy �ttate �.nd sa3� �ha.t �he facts �a,��d by ffie ari� ci�nt2.iner� � tL�e ��o�e pei�ait a,�e `;
` ta°us a.� therein s�ated. `, - � , _ -
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� day af� D. ,i9� � ; � ����"� '� `;� _ .
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F r.
suedecr PER�11{i'TNO. �' ,
City of Fridley 13'760 '
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
� � REC --
� ; _���_ COMMUNITY DEVELOPMENT DIV. �-,i����
r �.L ; PROTECTIVE INSPECTION SEC. Q
�� � /�"1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
""� � ,�� 812-560-3450
910-F15 9/16/76 � �
JOB ADDRESS 1325 Hillcrest Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACH ED
DESCR. 17 g Moore I,3�Ce Hl�.1S SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
John iialling 1325 Hillcrest Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
R. J. Ha be Const. 3983 Sunset Drive, Spring Park
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residenti.al
7 CLASS OF WORK
❑ NEW ❑ ADDITION �O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Soffit facia
9 CHANGE OF USE FROM TO
STI PU LATION S
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 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
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�� BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S�-�lOO $`.55
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 DR THE PERFORMANCE OF CONSTRUCTION. � �`9.00
PLAN CHECKFEE TOTALFEE
o v� � - $9.55
SIGNATUREO NTRA Tly O UTFi AGENT (0 EI W EN PRO Y VA TED THIS IS O R PERMIT
�_�� ^ �
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SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI DG iNSP qATE
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APPLICATTON FQR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR QUILDING PERMIT
06�TNNER' S NAME : , ,�,� � BUILDER ° .
Annx�ss : � Annx�ss : . `� ��,� �����r�,G ��.�`,�,,, �Y
D K • ,�� - �r�
/� ���
NO:. %��� STREET: �/l �L C12ES % GJiZ�U�_ A..�� �_
z,o� : �` % Bz.ocx: � ADDITION : ����/062� L�/�c� � � LGS
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this foxm Two Certificates of Survey of Lot azd p�oposed
building lacation drawn on these Certificates,
To Be Used As :
PESCRIPTION OF BUILDING
Front : Depth :` Hei.ght.:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
7.`ype of Construction: �Y �, � �
�'�!l �G�S'�� Estimated Cost: $ �/� �r
To Be Completed: �'r�„ �; '�T l s"�
'T'he undersigned hereby ma.kes applicativn �or a permit for t.he work herein
specified9 agreeing to do all �aork in stx`ict aecordance with the City of
Fridley Q�:dinances and ru.lings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE : �� f � � S IGNATIJRE • � `� I
�'— �
(See Reverse Side For Additional Information.)
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� BUII.DING PERMIT T'L� SCHEllULF;
SECTION 2. The Inspecto"r of Buildings 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 alteratiion 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�:
%TEW CON5TRUC�IOPi: Sa,ng�.e Family Homes and Garages: $4.00/1000 cubic feet
PLAN CH�CK: 25 percent of building permit fee.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contenis
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.r
•height of the roof surface of the ma.in gable of a pitched roof.
For regairs or alterations to an exist.ing structure, the fee,shall.be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction �hereof ixi
the cost of a11 proposed work.
In no case sha11 the fee charged for any pexmit as set forth in Section 2 be
less than $7.50.
VERIFICATION OF FOUNDATION
NOTE: Permits for construetion will be issued a minimum of 24 hours from the
time of applicatiox�, to allow for proper xeview of, the proposed structure and
of the constxuction site.
A Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OP OCCUPANCY
Appli,cation for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued. •
r,�,
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6 t� �'t T`� W��T.� a� �, r�l � Y� I-� 1
WELL OR SORINO LOCATION MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring
Counry Neme
WELL AND BORING SEALING RECORD M; n1esota Unique No. H 12 4 6� 7
��� Mlnnesote Statutes, Chapter f031 or W-series No.
(Leave 6lsnk B �rot Imown)
Tovmshi� Name Tovmshlp No. Renge No. Sectlon No. Fracdon (sm. �i Ig.) Date Sealed Date Well or Boring Constructed
��.���t�� �� �� �°� "Ya�`�Ya�� �� ��� ���� ������a
Numerical Street Address or Flre Number end City of Well or Boring Locatlon
� � � � � �����°�,4�a �� �� Depth Before Sealing � �` �' it Originel Depth � ft.
Show exact locetlon of well or boring Sketch map of we0 or boring AQUIFER(S) STATIC WATER LEVEL
in s�tion grid wifh °X°. � locatlon, showing property Sin le A uifer
lines, roads and bulidinge. 9 4 ❑ Multiaquifer
N WELLBORING �Measured ❑ Estlmated
; ;"� � ; � �ater Supply Weli ❑ Monft Well
'T _ 'T_ '_'F_ ,,,...���°°°
' � ' � ❑ Env. Bore Hole ❑ Other 3�� R �low ❑ above lend surface
� � �
yy -�;- - ;-- -;-- --�-- E CASINO 7YPE(S)
� � � �_ ��
- �-- - �-- -�- -�- I ❑ Plasdc ❑ 7ile ❑ Other
76 e
_ �_ _�__ ' � CASINO
� � -�-- -�--
Diameter Depth Set in overalze hole? Annualar space Initlally grouted?
S ��""
�fi-- tmue� f��r � in. from '� to ��'Z it ❑ Yes [�Ro ❑ Yes ❑ No ❑ Unlmown
_� ,
PROPER7Y OWNER'S NAME in. from to R ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unlmown
� �i _1
Properry owner's meliing eddress H diiterent then we0 tomtlon address U�dlcated ebove. In. from to R. ❑ Yea ❑ No ❑ Yes ❑ No ❑ UNmown
� � � � ��a` �'�� �e�s�'��'rsS� I�'3� SCREEWOPEN HOLE -
����� e � ���' �� Screen from �� � M � c! � it Open Hole trom to iL
OBSTRUCTIO W DEBRIS/FlLL
WELL OWNER'S NAME ❑ Obstrucdon ❑ Debris ❑ FiII � No Obstrucdon
����
Wall awner's me(Iing address if dfftererrt than property owner's eddress irtdicated ebove. Type of ObsWCdon/DebrislFlll
- ObstructionlDebris/FlII remwed7 ❑ Yes ❑ No
PUMP
Type _ � ���.'s s��`��
GEOLOGICAL MATERIAL �p�pp �DNESS OF �OAA TO Removed ❑ Not PreseM ❑ Other
FORMATION
If not Imovm, in�cete estlmeted fortneUon log from nearby well or boring. mETHOD USED TO SEAL ANNULAR SPACE BEIWEEN 2 CASINGS, OR CASIN� AND BORE HOLE:
�o Annular Space Exits
fi �. C� t� � Annuler space grout� wtth tremle pipe
❑ Cesing Perforatlon/Removal
� �� ° in. from tu N. ❑ Pertorated ❑ Removed
ln. hom � ry, ❑ Perforated ❑ Removad
�°a r� � ��� 1 r� Type of per(oretor
Other
�i - �
GROUTIN� 67ATERIAL(S)
�.�i��� i�� �'� lt� ���5 �roudng Material �E�'��'.t�� �m � �+� � ��.i�lE` n. v�ag � � �s�
from to R yerds bags
from to it yards l�ags
from to if. yerds bags
RE�AARKS, SOURCE OF DATA, DIFFlCULTIES IN SEALIN� UNSEALED WELLS AND BORINQS
Other unsealed well or boring on properly? ❑ Yes No -
��'' ���`� �' ��' ��'����� �gL�� LICENSED OR REGISTERED CONTRACTOR CERTIFl ATION
�'��� ��'��"'� ������4 ���� ' �� g Thls well or bodng was seated (n eccordance with Minnesote Ruies, Chapter 4725. The informedon cordained In this repoR Is
�t�� [�,�4'Z`� ����� : � (� -= � � ° � #true to the best of my Imawl�ge.
'�i?�a��4. s�� -- _-____. _,_.
�i� �' ��3�. � , � �� � �' �df !� i'����`a l�v �'t31s � i�'� '� i �? � �a
Co�actor Busfne� Neme l�certse or RegLStraGOn No.
� _ � 'O�rS'�' � _ �,� �J _ - -CF� r r� :.�s.'=� -�'c'°.--•� '�
Aufho�lzeal ReP� � . �9��1e Date
���ardin� �� I�� ����� ����la�ion�:
��ra� ����r��� � � ��c��.��� ����
H ������ Name of Person Sealing Well or Bodng
LOGALCOPY
HE-01434-02 10/85R
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C�myIlVEY AND STACS VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (�) No ()
2, Is free from nist or deterioration Yes () No ()
3, Has no foreign objects lodged within Yes () No ()
4. Is securely supported . Yes () No ()
5. Meets all current Code requirements for size Y� �� No ()
and total BTLJ's connected
6 Has total heating BT[T's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
S. Has combustion air been provided for water heater
Remarks: .
List ALTERATIONS Being,Done:
Yes()No()
Yes ( ) No ( )
HEATING CO:
Signed By:
Date:
��
IRESID
CORNER
December 24, 1998
City of Fridley
6431 University Avenue NE
Fridley, MN 55432
RE: Permit for fireplace
I would like to request a permit refund in the amount of $25.50 for the fireplace.
This permit was issued for a fireplace at 1325 Hillcrest. This fireplace has been
canceled and will not be installed.
Your assistance is greatly appreciated.
Sincerely,
�� �
, ..
Brenda Huston
Scheduling Coordin tor
Encl. �
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BUILDER DIVISION
2700 Fairview Avenue North, Roseville, MN 55113-0�7 Phone (651) 633-2561 Fax (651) 633-8884
3850 West Hlghwray 13, Burnsville, MN 55337 Phone (612) 890-0758 Fa�c (612) 890-5408
MN CONTRACTOR LICENSE It20090911
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Building BUILDING P�lt o.:
Inspections RCi SIDENTIAL APPLICATION Received By: �
763-572-3604
763-502-4977 FAX CITY OF FRIDLEY vate Rec'd� � 1��
EFFECI'IVE 1.1-08
DATE � �� � YOURE-�u-. ADDRESS /�'6�3Fi%� /%�I+� � /i2S� �Nd
srrEa�nn�ss /3aa-� H•GLe/'ES't� �iQ.'d1L�=�/
THIS APPLICANT IS: ❑ OWNER -�CONTRACTOR
PROPERTY OWNER/ x,,�: �,,, �
TENANT ADDRESS: g� �� /71�. �� CITY J f/9G�� STATE��ZIp ��O
PHONE: �� o� ° �O� — �O /�O
NAME: Ce✓avS � G.
CONTRACTOR ADDRESS: ��a/� �Qy�/✓ �/i�/�� CTI'Y�.� STATE�IA�LIP �5�� %
SUBMtT A COPY OF pHONE 6� � 7 0 FAx
YOUR STATE LICENSE STATE i.ICENSE #�,C� ��[!3 �� EXP DATE / 3 O
PROPERTY TYPE � SINGLE FAMII,Y/NEW CONSTRUC'fION SIZE S
❑ TWO FAMII,YJNEW CONSTRUCTIQN STORIES_�
PERMIT TYPE ❑ �DTfION ❑ GARAGF/SHED ❑ WINDOWS
❑ BASEIVIIIQT FINISH � ROOF ❑ DRAIN TII,E
❑ DECK � SIBING ❑ OTHIIL
� SWA�Il4IDVG POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCI'ION ❑ ADDI1'ION
❑ MAINTENANCF/REPAIR ❑ REMODELING
DESCRIBE WORK BIING DONE:. T/ �%R O� ��� �i OCJ�
SIZE OF INIPROVENIENT I.INGTH WIDTH E�IIGHT S Ff
RQOFING ��� ❑ HOUSE ONLY g�� g�ODELING SUBNIlT:
NUMBER OF SQUARES � HOUSE 8c GARAGE
1. Existing Floor Plan
GARAGES ❑ ATTACI�D GARAGE Z. Proposed floor plan
PROPOSID STZE: ❑ DETACHED GARAGE 3. List of strucdual members to be useci
PROPOSED II�IIGHT:
SIDING FOR NEW CONSTRUCTZON INCLUDINC DECKS,
❑ Vinyl ❑�g� ADDTPIOAfS_ 8c PORCHES SUBNIIT:
❑ Aluminum O Trim 1. Site Plao/Su[vey showing the eacisting shuctutes
❑ Other ❑ Fascia a°d pr°�d pr°�ect
2. Two sets of construcaon plaos
WINDOWS 3. Energy Calculations
IN EX[STING OPENINGS OYes QNo L�ATION OF WIN�WS
OR FOA NEW OPININGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED QN VALUATION, INCLUDING TBE COST OF LABOR AND MATERIALS:
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dne
1997 UBC FEE SCHEDULE)
"$ `f �, ��' See Back Page for Fee Schedule
$ � 65% of Building Permit F�
$ .� .001 times the total job valuation
$ �, � .0005 x Permit Valuation Minunum $.50
$ �� j� � $5.00 (State Licensed Residential Contractors)
$ $1825 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreeme�rt necessary ( ) Non Necessary ( )
$ � .� Make checks osvable to: Citv of Fridlev Attac
THIS IS AN APPLICATION FOR A PERNIlT NOT VALID UNTIL PROCESSID
I hereby apply for a building permit and I aclmowledge that the information above is compl�e and accurate; that the work will be in conformance with the ordinanccg and codes
of the City of Fridley and wiffi the Minnesota Consfi�ccbion Codes; that I �mdetsKand ffiis is aot a pe�mit but only an application for a permit and work is aot to stazt without a
permit on site; that the work will be in aocordaace witB the approved plae in �case of all work wlrich requrtes review and approval of plans.
SIGNATURE OF APPLIC � � �'�`� � PRINT NAME�L�>�?/ A�i�ol► S�"t✓ DATE � 4�
APPROVED BY DAT� '