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AF - 46180,.... �= �,�� •-�` Village oi Fridley, Minn. � BTJII.DING PER11iIT � N° 1002 O�ce of ENSPEGTOR OF BIIILDINGS �. -� � _ � r �'�� Owner��.� �� ,r �` � 'i,- - '�� -_:9 r f'°e'b �..M es.s n.'��t.�E---yY.$rV ,s�0, .f'� i.•' �' t �� ' `\ �` � � .. f _ ._ °p _p .� ' ,l'r` � ' Architect � � Fridley� Minn•. '°�° , 19` = Builder � r- LOCATION OF BUII.DING NO. .� '�,�»� � �� 3treet r�`� � _ �-. � -;� .._sy � �t c Part OP Lot � .�' � .. �. � ..,�._r ._.c- _� �' � , ' � �-� �' ' Lot : �-'� Block '� �' � Addition or Sub-Division � '� �' -�'° � '� ,° �` ' _ _ � " � - � DESCRIPTION OF BTJILDING F�ont %�-, � Depth � �-� � Height Storles,.��`�''' �? ,Manner of Constructio�' - �!-� - _ � 4., .. � - _ To be used ��' ��°'>° ��`�-� '9 g=� � To be completed Estimated Co� ' � � - ,i.� �--� ,�-�.F�� -r��.t � ._ _ �.,� � � -•., .r,.,�.x �, _ ., �. a` . � '� � R�%� �, , , _ _ _ _. s _ � � ° � " ,�� , �a�,;, . ,R A . � � `� �,. _ + � � �. d . � ti p .. ..— �� A� .� � � �"[:. Peranit is hereby granted to �� -�°•�,�� ' .. 1-= .�_ = � ;:__�-- - � "� � � _�_ „ r the building �°'�,' .' descrlbed fn the abone statemen� This permit is granted .,�s �r.:. � upon the exprese condition that the person to whom it is granted, aad his agents, employees and worlunen, in a11 the work done in, arouad and upon said 'building, os any part thereoP, shall conform in a11 respects to the ordf- nances oP Frldley, Minn., regardfng the construction, altera.tion, maintenaace, repair and movin� of buildinga within the city llmits, and thie permit may be revoked at any time upon violation of any of the provisione of said ordinaaces. � , � � �4 � � � �� `�_ � r _ ,ineuector oP Buildings. . -.. �: -,-.. -- � - - AGREEMENT AND SWORN STATEMENT In consideration of the issue and delinery to me by the Inspector of �uldinga of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth and according to the provisiona of the ordinances of Fridley, and, being first duly sworn, I hereby state and say that the facts stated by me and contained in the above permit are true as therein stated. Subscribed anci sworn to before me at Frid�ey, day of � �.,;�� = A.D. 1�-^ �. ii �� ,I\ � `� � �fi � Minnesota, �� " �` �,� : �-2- t a. . - _ * �l t�,[ -�C r.,.�'!� rc.:.... L.a._.-s.. � _ �--•s � ,t_ � �..�" 5�.�." ,/�. ��6f �'�_ '�►\ ..•,'`., � � �_ , � y � � � r ��°a : � . 7i : � . � . y : O : o : m o� � . � � � � � � � , N � � � � r y � � W � � a � �� • O ' O � . O . . � . . � � � � � � � �, �N r o O O � cn � � z � r � � � m � � z � � � � � � � � � � � � x � � � �' P4 �:�� d : O � � �a ¢ � '�° � 0 0 : � ° � en p � : � �' : P/� � o ; �� : � � . . . . � . . . . ; � : : : �. x 0 �a i± s: >4 >C �a �„ w n� w r� � r� � c�n °c , e�» °o 0 o y �� t�s tn �n rss f» �» H H � 0 Q x e � i i � i a� • x� a � �i � � 0�, ap � �� {p �p Qi p7� r � � m � � _ � � � v , m � � � m 0 0 � N �' a � � � fD � o n � fb � � o� � � �aa � � � I � 1\�i11_ al�lb�u WATER � URINALS enn+ � e�siNs SINKS was�+ TRAYS DRINK. $FOUNT. SHWRS. 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WEATHERSTRIPS A�•H•�•E TYPE OF CONSTRUCTION INSULATION Guide �ndor� I Doon Refereneo Ouf. Wall I lat. Wall I Csiling Roof I Floor Ktnd I Ceiling I Well 'ea — No Ye: — No 19 FL I,��, Room I Length ��nWid+h Hsight �� F�. I Room I Length �dth Height 11VINDOWS and DOORS — CRACKAGE end AREA WIIVDOWS end DOORS — CRACKAGE end /LREA Width Heiqht No. of Un�al ff. Area Width HeigM No. of Lineal ft. Area No. of pane of pen� Ilphts of uack tq. H. No. o} paee of pens Ilqht� of ereek iq. ff. 3 �y 3 2 ,s � � 2�' Z `� � ( � � , ,� `��. ,� - � /� Cosf Btu. Coef. Btu. � Inflltra#fon �ndorn v a L Infiltrotion �ndows Doon 2+ D Doors � i Ecp. Wall � 6P. Wall I Glass S,i � 2 �/' Glau N�t 6p. WaU � Nst Exp. Wall i�. Well Int. Wall / S.� � Csilina o� Floor Giling or Floor Teie� Bfil. Rsquired :q. ff. E. D. R. or aq. ina. W. A. Leader sroa I, � I Room I Longth �dth Hsight WINDOWS and DOORS — CRACKAGE �nd /�REA ue_ �Wldih Heiqht No. o Lin�el H. Are� I ef �ane I of pane Ilghh I of aack �q. H. Btu. Infiltration F=o. Well Nat 6cp. Well I�. Wall Ceiltng °� FI°°� Te+al Biv. p, I Room � Length Width Height WINDOWS end DOORS —_CRACKAGE end A�REA � Btu. Infiltretion 6p. WaU Glaa N�t Exp. Wall Int. Wall Ceiling o� Floor � Te9fw1 R+u- — Required :q. i+. E. D. R. or aq. im. W. A. Leader aree RT•500•6-98 . - � Total Blv. Required aq. ft. E D. R. or sq. ins. W. A. Leader erea FI. I Room ( Length Width Height WINDOWS and DOORS — CRACKAGE end AREA I No. IWldth HeigM No. of Lineal ff. Area of pene of pane I Ilghts I of creek :q. tt. I, Coef. Btu. Inflltration �ndorn Doors 6e. Well Glezs Ne+ 6p. Wall lat. Wall ' � Ceiling o� Floor Tofal Btu. Required :q. ff. E. D. R. or sq. ins. W. A. Leader erea Fi. I Room I Length �d+h Height WINDOWS and DOORS —_CRACKAGE and AREA � Infiltration p� 6tp. Wall Glau Nat Exp. Wall Int. Wall Cosf. Btu. I g or Floor I Btu. red aq. fF. 6 D. R. or aq. ins. W. A. Leader erea 6RAND TOTAI�-- Date: Owner: Addre /'�'1 �,� c��y of F�a��y, �. BUILDING PEI�.MIT xo 4 4 3 8 --� -..�-._...�_.�_._. ._.___.._--- �.v��.----•-C.�°•••• -----� _......._--------�-�---- Builder ....._ ............. ..._. .... ... ......._..-----------...._.......___..._—_._ ss ..t--.�.�--�` .... _ . �� _/!' �. Address ........_....------.._.......�.._.. e......---� . s �,. � LOCATI� N �DF UILDiNG No. ..fc��.�---.. Street ._- -- • �.1.�.�=._!�.�...L��.....,�.�..._.��..i--- P of Lot ....----------...--- ----- -�--._.__...... .----.._. .._.._. Lot ........- - -_ _....____.... Block _...---...... � .. ------ .................._...... Addition or Sub-Division ..__ .. .. .�--�,fG_.�.. ..��_._..�� Corner Lot Sewer Elevation Used as: Inside I.ot ...._� .............. Setback ....._............................_..---... Sideyard .....-�------�•------------•--��---�--- �--........----•----- .............. Founda.tion IIevaiion ... -�-•---....... DESCitIPT10N OF BUILDIlVC . _........__- -- ............ - .............. nt .........-------...... Depth _............__.. � ght -� �--- Sq. F� ....._......_..... -. Cu. F� Type of Construction ...._�......__ .........................._-------. Est. Cost _�� .� --C�..`..--� To be Completed _..._......_._--•--._. v f, / A a �� f� .f � . . �� , . ; / ... . a , ." i• , .i � _ _.� . s: . , i. �_i T . � .� , O /r �.. t,, �, . � � � � � _ Ea consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set fo ��compliance with all provisions of ordinances of the dty of FridleY. �/ �°-1 �_ � In consideration of the payment oE a fee of $..:�.....��...., permit is hereby granted ...__.—�—_.._.._..._._. _. --_.... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and workmen, in all work done in, around and upon said building, or any part thereof, shall confoxm in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, rep ' and moving of buildings within tlie dty limits and this permit may be revoked at any tix�,upg� v�,qlationBOf�,ny of the provisio� of said ordinances. ! ) // %� > / Inspector NOTICE: I This permit does nof cove� fhe wnstruction, installaBon fo� wirine, plumbing, gas heafing, sewer or water. Be su�e to see �he Buildine Inspector for separafe parmifs for these hems. 4 �� A N 3 � 0 � � s 0 � � � � � �'� p ��:�� S*��cy0b �o' y � � �. o � � �. �,�� • ��. �� ro' � a� � �' � �t �°'�,�,�•A b ��•A � 0 0 �.�.s �. � � � bd��,� r. �, �. � � � b �.� Q�� ' S a �, o � �,-� . � � ��1.'' c�]' C "' �' � �' ° � �� ."A�� . �„ �. '•��Qs I O iJ N. �o�� •��N �ti �� Q � \ �ti� � � y A `�' �b�� ` ��° �' a" p � � �. �'� � � � ~ � t�� Q R. A �. _ o � �£3� � � O � ~ �'°�� A� �� . ��. � � � �. �, oo�� '"�,� � ~ }� • � a�. � �* � . o r. �� S' y � � � A. o� � � a�+ 0 � ,� � o z � �; p O � o � � � ° � � b R' � °. � � �• b �' . � a � � � � v � � � � b A ` � � � � 1 O � . Z `° � O � a " � � � O � � � y] � R�. O � O o� m � N �S o � � O O co b n � � I� iS. � � Iv • � 0 � x � � � � � � � �� ot� � a I �� . n '� �. � � � � , � � � m � A � � � � � � • O � o � � _. — � 7 � a. � � �p � . � � � � � �' � —1 � �: -�+ � o i � � � � O � � � 3 � '^ � � Q a � � Q rt h :p � Q. A� � � y � � �• � 3 � O o� � �� 0 � 00 � � � � � � suerecr PERMIT City of Fridley � 13028 AT THE TOP OF THE TMIINS g U I L D I N G P E R M I T • � � � RECEIPT NO. � � COMMUNITY DEVELOPMENT DIV. �� ty ��•�� r � � PROTECTIVE INSPECTION SEC. 1 ; � L.--_ � � ��,� CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV ti. J\ 812-580-3450 910-F15 � � 6-17-75 JOB ADDRESS 1355 urr.r.[�uFST DRIVE N.E. F12IDLEY MINNE50TA 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. �j 4 MOORE LARE HILIS ADDITION SHEET 2 PROPERTYOWNER MAILADDRESS 21P PHONE REUBEN E. in4�TIAV, 1355 HILI�CREST DRIVE N.E., FRIDLEY� MINNESOTA 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. CARI, PETERSON 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING RESIDENCE 7 CLASS OF WORK ❑ NEW ❑ ADDITION O ALTERATION � REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK RE—R04FING 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, 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 R 1 ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES ANO 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 $�.��-OO $.r'JO DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � y�`C'�.00 PLAN CHECK FEE TOTAL FEE $6.50 SIGNATUREOFCONTRACTOFORAUTHORIZEDA ENT IDATEI WHEN PROPE V LIDATED T�IS IS YOUR PERMIT a �� .1i/�a i'� . � „ � � �' ' �@ — JITNE 17 , 197 5 �6%%�GNATURE OF OWNERIIF OWNER BUILDEFiI IDATEI BLDG iNSP D?7iPE�, .Lc s `•� � � •APpLICATION FOR R�SIDL'NTTAL., ALTER1iTI0N, � � OR AllllITTON.BUILDING P�RI�ZIT CITY OF �FRIDLEY, hiINNESOTA � , • � � J l� f� BUILV�R:� � �%sl'.� J' e �e t�� r �WNER S NAl�� . c� ��i ADDRESS : �� C� � ��.� ADDRESS : Iv0 0 . /.� s �S' STP.E�T Y ��:�G L�� - �� • � �� LOT • � BLOCI� • ADDITIQI� : � �i-�?, COI2NER LOT t INS IDE LOT : SETBACK t SIDLYAP.D ; br�Iicant attac�� o this forn� Tcao Certificates of Suxvey .af Lot. an� .pxogose ' building location drawn �n these Certificates. � HESCRIPTION OF BUILDING To Be Used As o ' Front : Degth : � Heigh�t : Square Feet: Cubic.Feet: ` Front• Depth• �ieigh�• �Squaxe Feet; Cubic Fee�: Type ot�Construction: e� ��-�s Estimated Cost: $�� To Be Completed: � ' � � • � , . The undersigned hereby ma.kes applicatinn fox a pe�it for the work herein specified, agreeinfi to do all worlc in stiict accordance with the City of �ridley Ordinances and xulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application axe true and correcto � � DATE ; . �% � �� SIGNATUR� : ��%�� /� G i�� / (See $everse Side For Additional Information.)' � � � ' �, U � . � Q G . . �._----- - , � �-� � _ . . . �,�� , ,• �,�U e� � � _ -- . . r �- r= t� .� �) �i 0 � a i- m ... _ �^ ''1 � v � n --- > , , � .. r" . r r - .. �; ` � = a � r - . � J _ _ � -. -'° � ' � � - } L ( r- � � - ---m- .. _ - e R o � „ � ?' c � I ^ � � f. .. v y � r� o• L� n n r- t r !� � B i • 1 1 n� � -� � � n L R f � .. .�, ' ' I � � �1C�C_° .. - .. .-. r �; �t ^� � r -� ' . L 'L - G �+ � G rn ^ = c r � ' ; rt � ' . 1 L .- �. � � � .L _ C - a �. ^� +� _• � _ _ , � I ( i L51r.aia ' � � . r a � y � � .. o � P ; : p r : Z .� r O n � � Y Y T -.N � .r Y r C C� ^ �c O R 7 �c n �- .... a � � -- O L '� n �s � a m�' n n '� . G I -+ ' � L'aLt; Z11�5 � p G � -..- i w T n � n y � p m n ^ ^ �� I 1 I I � , �T' .n .. r''' c � � a C� .o [ m 'p .+ G O n FSa52S29 O J� O n^ N ► G G o p r. -_ r O n o '� o m .- ao '� r I I I ( O �' � n Q G � m � at� m = �. $ 4 O S 1 N_9 � .. Z a � o -• .0 --3 S ~ n t!� H - r O ' [n -i � Cl I I ( I I r c G o o u �, ,_ R Wnsh :Tnys n �- c� � o U „'�� ,.°�3 r - � Luncinc C u I I I I � Fc�unta:n�. � , H �.'� �. . — _ _ _ C�. ___I_- —_ _� _� -_.I _.__-.. _._ N � !.n��vrs� � �T� ---�- - ------- ti -- �- -I I I I F'looz I�7ai �_-, n c� �' • r, � �- I-- �— � � catrn I ' L � f. .��_- � c n , He�in� � �� R � ( I I }. I Auici�r.auc �- i N t/� N V� 0 0 0 0 N tn tn aA � � O o 7 / M M 3 C r � .! r= C C �, r�.� c N H � v ..� U � c w u 0 �•. H � � C � � � R x x x M Y N tn O P' v O O O 0 0 0 N N 4q I I � � G 7 r r r C' �a �-. 5 '+! M f' U. � O 4 C 1 x x x x r. x K x x � M tA <n Y N N tA 1A 6q 11� V� �1 O:1� ln N N W � O O O O � O O O O �-i 0 0 0 0 0 0 0 0 0 � N V! M <N tI� M N N Vl � � a � c [� N N � D e'� G C f V� (l r u ? f C� v` " -� . � � •F'•o i � \ � �� z ftl G) � O r v 1 C; C c H r �-�. L� 7 r .-: � R+ c .y G ' i .l 1 t t�n O H O � � C- O O - C n v, y h � 0 � Ci 7 � � O � N 1 � f � ,O 4 � Washer ~ f / ( I I �n "GSS 'AAU�. � I I � � 1115c_ FiXt � �, I I Gas F.'ange R [4 hn-I I! i I i�� .� � I I I � � N I lG W C � n (n 1-i [�7 2 v `v r•� 3+' O � � '+J C n � �-1 � F--� L, O . � � � � � � � n n or m HI7O - � +p m r m O a. Q �] Y rs ^.l o � • �c w rn ft f- � �t L C � = R �'T [i r r- = v+ . � r r tD � � ,:+ _ � G.%�. Y^� ' ~ i:; o � n rt D tt. A �'S ' W 1- .a a _. a n n. o ., - v, ri ra (^ � O R � r. - '� c o .- � c. � � _ � � C a: r C � co � n �� -- � r U " �� - - r. u ' A •:i G. CT K � n o "- r r ' � � O f � . ic m r; � r. E � � o 0 ri r+ .,. �y s+ �� L 7� ._7 L r m 'O '. c c. r r c G v a `- - r �� _ .- u. v� w 7 �- r. r+ - � n �- � n v r 6 . - m n :� m_ �, � u n• [' c � n '+ - u t� F-' - n o 1 � ~ ;� � %.. � W n n t. r. � o rt =' � � .• o r, n � .- _ a O�' .. r `� � .- •, v r. n c� n i--� T �'1 O 4 n e'� f+ I'� �D - ' i- r ' C � o n � � � n o r+ �* �, � r i 7� � G o T: n fi � � �. C �= y ¢ l, N r. A � n� C.i 0 C' 3 G G N m .� �"J ''d n N � CF d �i I�• C (D � � r n i' --1 O T O � -D C d G� r 0 c� .. > v. Ti � � � �_ 6� "`' v c�,� ��-�� STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD t. LoCATION OF wEU. MINNESOTA UNIOUE WELL N0. counry Nams �10RA (leave blank I} nol known) Townohip N�ne TownWp Number Ranps Number Bsotia� Na. Fraatlon 4. WELL OEPTN (canplMS� Oete rulsd N 8 u� �p of +a FRIDLEY 030N8 24W W 24 imeriat Straet Addreu uM CNy ol W�tl Looatlan or Dl�ne� hmn Road �"�"n°0UO" 1355 HILLCREST DRIVE NE FRIDLEY, MN 55432 8how sxeM Ixatlon of well pn oeCtla� grid wifh'X� N _ -i- -F- -�f- '- E W � � � ..�'. "f.' ..�" � i'. � 1/2 MI, . -�. d , � ' g � 1 mll� 2, PROPERTY OWNER'8 NAMB REUBEN & GLADYS WATLOV 9ket p of well looatlon �� 1 1 �Y t"�r S � __-+-�� _� j-�, I � C irr�m� � i��.�1 Mallinp Addreei N dlMersnt than proporty addrou Indloatod 6b6Vs SAME HARDNE88 Oa 3. FORMATION L0� COLOR FORMATION FROM N rro1 known� Intllaata tmmetlan lop kom new we�l or n¢arby well. 120 n � 11/17/92 e. DRIWNO MffMOD (H known) � O ao�e ��i 1❑ ReveBe 7❑ Ddwn �o p a�o z p Moaow Roe s❑ ar e O eored 1 t p 3 � No�ry 8 0 Jefled B❑ Power AuOer e. OB9TRUCTIONB We�l ob�trueted []�jeo ❑ No OEobuotloni removad ❑�u ❑ No It obtwclionn connot Do rema�d, coMad MOM �f0il uolinp. �, usE 1❑ Oomestk /❑ MonHOrMp B❑ Maat l�op 2❑ Inlpetlon S❑ Pu�tlo 9❑ Indu9try 3❑ TeWY4Wl a❑ �mm�i� �a ❑ commuem 7 ❑ Atr Condltloninp 11 ❑ e. CA.�8a1�N►�0�(8) 1 Ls�seN 1 �Phrsaded 7 ❑ Q❑ oa�v. o O wxa� a o�ianio e 0 s►��iu. st..i _. .. 3 ,�,,, 12 0 �, � u� ro �t 19, REMARK9, EI.EYATION, �URGE OF DATA • CA91Nt#8 REMOVLD, CA9iN�8 P�FiFORA78D, ETC. REMOVED 115' DROP PIPE & JET PACRER FROM WELL... WELL LOCATED IN PIT ON SOUTH SIDE OF BASEMENT... DISTRIBUTION OF COPIES: STATE OF MINNESOTA LOCAL CITY MALENKE WATER SERVICES CUSTOMER COPY CUSTOMER FILE OTHER PID# 24-030-24 12 0060 OFFlCIAL ABANOONED YVELL REf:flRD (Maq bs �uod tar Proparty Trm10t� UIPQRTAJVf• fAF 4i?iN DBED (0279) 0,8CR6€N �8me¢nad wep hom h to �. (If KnoYm) Q Open Hots hom 1L W R. 80 �, �,�„ �,�,,, 11/17/9: lan9 aufaee ste Meaared 11. WELLMBAD COMPLETION 1[] Pitleu Adepter 4[] found 9wled � ❑ BaiertuM otMet 8 ❑ 3 �j(W�p Pit 12, 4ROUTINO INRORMATION � p�Wea� c«nen� z pXea,ron�u a❑ �out meterlN NEAT CE �„ 0 t, 10 �, �,, y�,, _ ENVIRO—GRT 10 120 45 GA] 13. NEAREBT BOlJRCE9 OF CONTAAfiNA710N 12 �� EAST �.,�,,,,,, SEWER�� ,y�, Wen dulnfeolsd befae �edlnp9 Q�� 10. PUMP �emoved ❑ Not Proaent T�' 1❑ SuEmsntble 3 Q 48. Tur�lne 6❑ Redprocetinp a p� a p cemm�,�e� e❑ 16. EXI9TIN0 WELLB (Plea�s akateh l000tloru et �b�ndaied wl aoCv� vrsp� In mm�rb uctlan a on baok.) Ottror unw� wep(q on p►opsnyl ❑ Ya �Qdo ». wnr� weu conm�ncroRe c�n�cnnoN ThI� wsp wa� aatsd unda my �uriMleU� artd QU� nport b Uw to Ms be�t Ot my IalOrNedge Nd OcOM. MALENRE WATER SERVICES #27600 10550 COUNTY ROAD 81 SUITE 20 oa�. o�e � sue�atT PERMIt NO. City of Fridley 2 8 6 91 AT TME TOP OF TME TW�NS g � I L D i N G P E R M I T � �, ��3��° o. � `� __��_ O M NITY DEVELOPMENT DIV. f � � PROTECTIVE INSPECTION SEC. �Q�6� ' �J i ` . � �'��1 � CITY HAL� FRIDLEv sj�32 NUMBEA REV DATE PAGE OF APGHOVED B� �""'� � �'' 612-571-3450 g�aF�s 12/1/98 � � JOB AODRESS 1355 Hillcrest Drive NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACMED oesca. 5 4 Moore Lake Hills SNEET 2 PROPERTYOWNER MAILAODRES$ 21P PHONE Sue Phillips 3 CONTRACTOR MAIL ADDRESS Z�P PFIONE LICENSE NO Gates Roofin 4640 Ximines Ln P1 outh 5 4 a ARCNITECT OR �ESIGNER MAIL ADORESS ZIP PMONE LICENSE NO. 5 ENGINEER MAIL ADORESS ZIP PHONE LIGENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O AODITION O ALTERATION C� REPAIR ❑ MOVE O REMOVE B DESCRIBE WOliK Reroof house and garage (27 S) Tear-off 9 CHANOE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMI7S ARE REOUIHEO fOR ELECTRICAL. PLUMBING, MEATING, TYpE Of CONST. OCCUPANCY aROUP OCCUPANCV LOAD VENTILATING OFi AIR CONOITIONING. THIS PERMIT BECOMES NULI AND VOIO If WORK Oii CONSTRUCTION 20NING SO. FT CU fT AUTMORIZED IS NOT COMMENCED W.ITHIN 80 DAYS. OR IF CONSTFUCTION OR WORK IS SUSPENDED OR ABANDONE� FOF A PERI00 OF 120 DAYS AT ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I MEREBY CERTIFV TFIAT I HAVE READ AND EXAMINED THIS APPIICATION S7AlLS GARAGES ANO KNOW TME SAME TO BE TRUE AND CORREC7. ALL PliOVISIONS OF LAWS yp�UpTION SUR7AX AND ORDINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED WITH WHETHER SPECIfIED MEREIN Oii NOT. THE GRANTING OF A PERMIT 2313 l. 16 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEI TM� pEqM17 FEE SAC CMARGE PROVISIONS OF A OTMER STATE OR LOCAI LAW REGUTATING CON- STRUCTIpN OR E PERF NCE Of CONSTRUCTION F�Y'2 SC 2.31 PLAN CNECK FEE TOTAL FEE S�GN4TUAEO�CON'AACtOpOpAUTMOp�2EDAGENT iDAfE� WMEN PROPER� ALIDA ED TMIS IS VOUR PERMIT � P /� � S�GNOTUAE O� OWNEA�� OWNEABU�LO@Ai �DAIEi B �NSp � f�pTE NEi� " [ ] ADDN [ ] ALTER [ ] CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: ;' �� i �l (`i� ,�'T Legal Description: Owner Name & Address: ,�U� � L L. �,,� � Tel. # ,. . � .� , Contractor: Address: MN LICENSE # LIVING AREA: GARAGE AREA: ECK AREA: C�THER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Effective 1/1/98 �a I �� Tel. # .��-�'� �� Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width HgVGround Sq. Ft. `��ry-� �� v � � � � ss n�� 1nv�c� �.� Construction Type:�� -�/�� Estimated Cost: $�� J j� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ —$ � / DATE: l� ( � APPLICANT: ' Tel. # f�a `�� x, Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control $ ��'�S_ $ �31 $ /�� $ $ � �a $ $ CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1Q00 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [] Not Necessary [] TOTAL STIPULATIONS: $ c�3- �� - � BUILDING PERMIT FEE SCHEDULE The Chief Building Ofiicial 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 $SO,QO1 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additit�nal $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 �rst $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) Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. r..-.-...._._ __ . . _. Building Inspections 763-572-3604 763-502-4977 FAX DATE �h� SIT� ADDRESS � THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMTT A COPY OF YOUR STATE LICENSE, BOND AND CERTIFICATE OF n�sux�vc�. PERNIIT TYPE TXPE OF WORK: `,` �i TI�:, ,1` ,� � ''.�€ � � :� t ., '�' ;�' . � t ,,; _ .�; , :.; :Fl= �: YOUR E-MAIL ADDRESS ❑ OWNER �CONTRACTOR - � - - ., _, ��_ _ ADDRESS: ��SS �il(r.rP�l— � �l[� crrv �-c PHONE: �10�1� 'rJ �j -� D�"I I STATE LICENSE #. STATE BOND # ADDRESS:�� PHONE �If7J - �SINGLE FAMILY ��i�x:9 DETAILED DESCRIPTTON OF WORK ❑ TWO FAMILY �REPLACEMENT FAX � ❑ TOWNHOUSE Permit No.: Received By:�- � Dai�i�� C � .� ( Lo � A EXP DATE EJCP DA7'E ..._..�..�.•.,�,."" .. .1�,__STATE�ZIp 33�3a PER MS 16B.665 the permit fee is a mmimum of $15.00 or 5% of the total cost np to $500.OD, whichever is greater, for the improvement, instal(ation or replacement of a resideatial fixuue, eac�luding the fixtures. (This should reflect only the cost of labor ) Labor cost undea $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = plus .50 surchazge OR FOR PROJECTS WHERE LABOR EXCEEDS 5500, FEES ARE BASED ON $ I 0.00 PER FIXTURE, EXCEpT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMHER OF EACH BELOVi�. NIINIMUM FEE $15.50. _BATHSINK/LAV _FLOORDRAINS SHOWER WATERPIPING _ BATHTUB GAS PIPING (ATEED CITY LIG7 _ SWIMMING POOL WATER SOFTNER ($35) _CLOTf�S WASHER _KITCHIIY SINK WATERCLOSET BACKFLOW PREV. ($1� _ DISHWASHER _ LAUNDRY'I'R�.Y � I WATER HEATER ($35) FOtt IRRIGATION _ WATER NiEfER OTf�R . .. . .. , ... -:-�—;.-,�-,�.._.....��.H��. ..r_�_v �.. '."'.v Piti41.�aX,'L:GL� Permit Fee $ . Number of fixnu�es @$10.00 x$10 00 =$ Surch e .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ OR Number of fixtiu� @$35.00 � x$35.00 =$ 3 s• � State Surcharge = $ .50 (1v�nvnvtuNt $lssa) : �-�-`----�— - _ _-�, _ -°�---._�---�Ntnvuvrura $is.so� To�t = $ , TIiI3 I3 AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accuraze; that the work will be in conformance with the ordinances and codes of the ity of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a rmit d work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all rk whi requires review and approval of plans. SIGNATURE OF APPLI PR1NT NAME '�L,l GL C,(/��a� DATE I � �1PPROVED BY DAT�� % ` � �ity �f �a�gdle� �uilding �spec�ions �e�ar�ent b�31 TJniversity Avenue �1E, �ridle��. VIN ��;� �63-�'�-.;604 °.�n: ?5�-�OZ--�Q�i' �