AF - 46345. -�
�"� � �1
���
,
�<
Village of Fridley, Minn.
BUILDING PERMIT
` Date: ...'�!��...��..'.� ..................
Owner.......................................
Address......................................
l�° 18U5
� , �y,
� �
� _�
Builder.................. ......................
Address ....o��� 0 v....��� ..............
LOCA'�ION OF BUILDING
No. �a.� .� . e�.. � . Street . . . . . . . . . ?Q(. . .�r. . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . . . .
Lot . . . .�.� . . • • • • Block . . . . .•?,�. . . . . . . . . . Addition or Sub-Division . . . • • •� •'�• • •" � .
D
Corner Lot . . � • • • Inside Lot . . . . . . . . . . . Setback . . Z. s%.• . Sideyard . . . . � � . . . . . . . . . . . . . . . . . .
;�
�
I�
DESCRIPTION OF BUILDING
To be Used as •
� . . . . . ' Front .'�.� . . . Depth '°�'. .��". . . . Height .�, . S . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
�� .� . Front . .�.�. . Depth . �.�.. . Height . � s°�. Sq. Ft. ... .. ... Cu. Ft. . .. .. .. .
?�, � � � To be Com leted
Type of Construction .�!"�l�?:P.�.. .. .. . Est. Cost ... �.. .... .. . .. . p . .. .. . .. .. . ... ....
� X i � �,-��,�,��
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with a11 Pravisions of
ordinances of the village of Fridley.
.....................................................
� � � Cg�V/�
In consideration of the payment of a fee of $.�.�. ...., permit is hereby granted to .� A��"� .•.
. . . . . . . . . . . . . . . . . . . . . . . . . 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 worlmien, in all work
done in, around and upon said building, or any part thereof, `s1ia11 conform in all respects to the ordinances of
F'ridley, Minnesota. regarding location, construction, �teration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revo at any time upon violation of any of the provisions of said
ordinances. ��
.....�.. %� .... ................ Building Inspector
NOTICE:
This pe�mit does not cover the consfruction, installation or alte�ation for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Build(ng Inspector�fo� s�rate Permits for these Items.
�` .a;'- �i«F ��,� . '�s�y`C+°` � ,(l:?° a d> �.:. r r -6r .t ' . '�^a �k � t �• a� r
� '° � . . . � � � � �,; �� j �� ��`� � ��.� , � , i �d ��� :.� �
i, .. . A,' e �*-•.^ '�
c
". �. , ,. 1 . .. . ' :.. • . .. .
"�u+`�.` � �.. . �.� '�; � � � T E �' � r�=�rw� � .s
��� , ; , .vuw �tseRVtr� :i
,.;err�rY i.vn t C�iR�+FD �E1RY�X`QR e.x�s�,
�:�.oro�rur�c �►*MMa ;itso�s� �4k I.�M►� #► s�r� or �sw �v.�utr� > '
:
,�, : � +' .: � ,.
. „-. . , . .I.�R��N� Mt OwbINANCt 0I C/T1f 01 MI�IR1=k10W�. . . . ' _' . . �"..�1 .,..
.. � � , . .. - _ . . , . ..'I
31Q0, �YNf�1�Mi+E'rfk�fE. �. - :•'bhl�?t��"Ol�li 0. Mt1�N: " s . � �
' * P LO�t�T 4370 ,'i
s
• ��r � ` �
<�Y��4R'i ��t�� •
= ,. -
,`��, � 2 �� � �# �,� � .
.. . . , . . . . ' . ' . . � ' .. . � ..h�
. . . . . . ' � � .. " .. ' ,. . . . . � ��
. .� . � . . . - � � . �� � �� . . . -�,`_�.r� . � �. " .. . � ,
'~Gr♦ . ' .����� . . _� � . . .
' � . � . � - � . . . . � . . . ' ' . . ..
.� _-`3� �rs��n
�__.. - + e
..r -�- ',
Q=gz ��'43"4 �
. � � - z�.o t O .
,
_ ; a � -�, -�¢ 2 b.,� �, �
� � _ � .,..
, �._.... :; �
�r 5� � 'z' �:
G�. N w� �
� �� 8• �o , t� , �
' fi,� - , , �
� �ii f �, ' p'`oA�s� .�z5'— �
�1 ml Res,de� e :� �} ,
- :. , „�. . ?.
� .. .� � � � i, . . • . : ' rJ . . . � � . � .
4 Q . � �. }
; ! 1 � _ � :� f �
� Q rf ` �
�� . . . .. � . � . . . 1 � �1�... �++� � . . � � , . . . � . ` . .�;i
. � . . � . . l . . � . � . � . . . ..
� . �. � � .. � � . � ,rA�1. ��_ �._� . � . . __. � Cj�. _ _ . -. . .' ... � .�.. . - .
. . � . . s � . . �. � . - �, - . � . � - .. , . _ .. . .s_ .
� rer+
, ' � , ,
i
� bexe�� a�rti�y that tbe above i� a t�rue an� aorr�at ��.a� a#' a.su�roey. �f s �;
��p� �i.xtee� i2 b} , �:ilo�k Twa E 2 3� CAfiI:�Clti''S SUl�'�:IT A;:�4Nt�t N(�'fi1� ; AD�ITI Cii�'s:. 4ncka. Cc7u�t,�.
l�iixuze:sota,
� s�ieye� by ine thi a�5 t h d a�y oP Febru.etr�r ` 19K 6 A. D. '-tt ,
� � . '. - . . � . .. - � - � � � _ . . . . . . '.'� gf;
.. . - . . � � � . . . � . � � .���i�� '�... ♦ : i�:. � �:� t ��'
. . � � . � . ;. �
itti�a�resa�a Ae�,is�'�r�tt3oa 24c « 7 t-�,
� , - . :.
_ ,, .
, � . . . ... .. ' . . . . . . i , �^4 . + � t
' . . � � . ' � . . . � . - . _� t'.
� . . . � � A " T '::� Y,,�.', )
. .
i -..
.•,, . � ' . � , :. ' ' : , . . . : : : . � -, .. . .. .. , � : . � , . . ,� R �T
, �
� . '.. _ .- '. ... ... . ' � ��:. � . � , . .. '.
. , � . . ..' � ' �' . . * .' . . .. � ' j
� Af':.
� f.
'� . . . . . � '3% t�Y. ` +� t Y � ,� 'S ,
�j �� j Y
����'7�� ]wT �,.� �� V�:� �'�'•_ ' `qe �.� p � _:- .= � ��Y:`,�''�L �' ` ��'�}� t'LA".,. , � � �..AY� 1��8
. ..� . . . . _. . . , _ _, �.a i� '.� -'r ��
?� R"�,�� � _s�',.,�' k�._
SUBJECT
City of Fridley
AT THE TOP Of THE TWINS g � I L D I N G P E R M I T
r
� �
� �
COMMUNITV DEVEIOPMENT DIV.
v PROTECTIVE INSPECTION SEC.
� ` _
. ----
r � ' ;
� _ �"'1 � CITY HALL FRIDLE� 55432 NUMBER
�""� � ,'� 612-571-3450 910-F15
J08 ADDRESS 5324 �iorizon D�i�e N,E,
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR. �.G 2 Carlson ts S'umm
2 PROPERTY OWNER MAII ADDRESS
Buela,h. Ande�sori 5324 f�rizon Dri�ve N,Ee
3 CONTRACTOR MAILADORESS
A,llsta.r Construction 6614 �gle Lake Dri'v
d ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDRESS
20404
3 � y��
REV. DATE PAGE OF APPROVED BY
6/5jg0 / /
SEE ATTACHED
lt M1ri01' NOY"tYl. SHEET
ZIP PHONE
ZIP PHONE LICENSE NO.
e. Ma.ple GroSre. MN 5536� 541-1244
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION
8 DESCRIBE WORK
Tea,� O�� and Rero,c��` D4ze11inc� (�26; �qlaa,res��
9 CHANGE OP USE FROM
STIPULATIONS
TO
ZIP
� REPAIR
On all new roofs or tear-offs and replacement roofs.
State Code requires that 2 iayers of 15 Ib, fett,
mopped together, De .in,stafted fa a point 24 inches
up from exterior wafJ line, ar the �se of ofher
approved underlayment mem6r�n�. �
TYPE OF CON57
SEPARATE PERMITS AHE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. • NO. DWLG. UN
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �-
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1 � 3QO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS Of ANY OTHER STATE OR LOCAL LAW REGULATING CON- y5`3]„eOO
STRUC ION OR THE PERFORMANCE OP CO�TRUCTION.
j/ PLAN CHECK f F
� �����
SIGNATURE OF CO RACTOR OR AUTMORIZED AGENT ioaTEi ,_ t+�HEN
„--
IDATEI
E LICENSE NO.
PHONE LICENSE NO.
❑ MOVE ❑ REMOVE
OCCUPANCY GROUP OCCUPANCY LOAD
SO. fT. CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
�e65
SAC CHARGE
TOTALFEE
$31.65
�LO V LI A E � IS ISfYOU�, PE���
f(�
� [ ] Effective 1/1/90
�N [ ] R-1 AND R-2
�T� [ ] Building Permit Application
co�nstYU�tion Adaress: S3 Z
I�gal Description:
r
i � , .t�_ , a
�
%¢itlG �
ow,zer r�ame & Adar�ss: 1�t1Z,d . ��.�;F%�-�t �C',t �. # /'�'1 �� r�
_ ,
co��r• ��5�ft- �_e'�. s a-fiZ z�a.. ��l /2�
.
.
Aaa�: ��� l� �
�
Attach to this application, a Certificate of SuYVey of the
lot, with the proposed construction drawn on it to scal.e.
DE'.SCRIPTIdQJ OF
LIYIIJG AREA: Lexig'th Width Height Sq. Ft.
� AREA: I,erigth Width Height Sq. Ft. ��?���
D�CR ARE�,: Length Width Hgt/GrcAU�d Sq. Ft.
ar��t: � Cr- �� �, C 7�r ;-���,,, r
�orner L�t [] Inside Iot [] Ft. Yd Setback Side Ya�l Setb cks
Zype of Construction: Fstimated Cbst: $�j � -
Approx. Coanpletion Date: �
Pro�osed Driveway Width If New Opening Is Desired: Ft. $ $
������/n�dth + 6� See Back Page
/ � - !T_
DATE: (t � APPLICAIV'I': L��7 Tel. # ( / �
CITY 03E �Y
PPxmit Fee $ � � 0 c'�
State S�rchaYge $ (�;-
SAC C�arge $
Driveway Escrow $
Park Fee $
Sewer Main Ct�arge $
ZOIrAI, $ ��- in S
�' -
;,-
��
S'I'IP[JIATIONS :
-- —
_ _�- ��� ��-
Fee Sch�dule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee Determined bY ���1
Agre�nt Nec�'�.sazY [] Not Neoe.ssar'Y I]
..�- _.
:?1 � � � "�1'i � ' 3i" . M:171��1� �,
Zhe Qzief Building Official shall, before issuirg �*�++;ts for the er�ec.�tion of ar�y
building or structur�, or for ariy addition to ar�y existirig i�ilding or structurn or
for any alteration or repair t� ariy existing building or structur�, upon a�lication
therefore, require the payment by the applicant for such �*�++; t of fees to the amo�mt
herein belaw set forth ar�d in the ma�v�x herein provided to-wit:
TO►1'AL VALI7E
$1 to $500
$501 to $2,000
$2,001 t.o $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
I,_�I �
$15 (Minim�mt Fee is $15 plus suYrharge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to arid incl� $2,000
$45 for fi.rst $2,000 plus $9 for each additional $1,000
or fraction thereof, to and includirig $25,000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to ar�d iricludirig $50, 000
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,000
$639.50 for fizst $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and includirig $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to and ir�luding $1,000,000
$1,000,001 arid up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DdtIVEW�,Y DEPRESSION ESCimW
(Concrete Curb Str�ets On1Y)
Alternate "A" : Resnaval arid replacement of curb and gutter only - Driver�,ray width plus
6 feet time.s $13.50.
Alternate "B": Remwal ar�d replacement of curb and gutter and in.stall a 3 foot wide
a�roach with 6 inch depth - Drive�ay width plus 6 feet times $15.75.
OF F1DIA�IDATI�J
Piermi.ts for oorLStruction will be issued a mininnrm of 24 houYS f�cen the time of
application to allaw for proper review of the proposed st,ructure and of the
oonstruction site.
A Ce�rtificate of S�YVey of the lot, showing the location of the foundation once it has
it has bee.n constructed will be required before proceeding with the fiaming.
.� _
� Y
Building
Inspections
763-�72-3604
DATt �' J/ L
SITc ADDRESS �
7'Fi1S APPLICAN'I' IS
�r•
� M.ECI-�A,NICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLE�
YOUR E-MAIL ADDRESS
❑ OWNER �ONTRACT�R
Permit N
Received By:
Date Rec'd:
PROPERTY N,�g: JD /��
OWNER/ ADDRESS:�� V1 ���.�Qn �/l ��^ GITY
TENANT PHONE'� G��-� I �
CONTRACTOR COMPANY NAME:
CONTACT PERSON: �"� '�_ �derson Heating and Air-Conditionmg
;uB��T A coPY oF � 4347 Central Ave N.E.
YOUR STATE STA'FE LICENSE � NI A'
L]CENSE WITH pDDRESS: �
.APPLICATION PHONE 7Lo�'�/- ��S// .�rZ� COl, HtS, Mn 5�421
PERNIIT TYPE
TYPE OF WORK:
i�.SINGLE FAMILY O TWO FAMILY
�
❑ �W �REPLACEMENT
DE7'AILED DESCRIPTION OF WORK
O TOWNHOUSE
O ALTERt+TION/REMODEL
�
ATE,(1�iJZIP,
STATE ZIP
�--
PER MS 168.665 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 fixtw'es. (This should reflect only the cost of labor )
Labor cost under $30U =�15.00. Labor cost between $300 to $500 = cost of ]abor x.OS =
FGR PROJEC7'S W}�RE LABOR EXCEEDS 5500, FEES ARE BASED ON $]0.00 PER FA'TURE, EXCEPT WHERB NOTED. FIXTURES: (lNDICATE TOTAL
NUIJIBER OF EACH BEL0�1� � MODEL�__I'��LLL'� SIZEBTU �
cquipment Installed �G� I�'��� SIZEBTU
�G: MODEL:
MFG: MODEL: SIZEIBTU
A/C 525.00 _FIREPLACE (GAS) $15.00 GAS RANGE/OVEN 510.00
AIR TO AIR EXCHANGEER S15 FIREPLACE (WOOD) $35.00 _NEW GAS GWLL $10.00
BOILER $35.00 faFURNACE $35.00 _GAS iJNIi' NTR $10.00
CHIMNEY LINER $] 0.00 GAS DR�'ER $10.00 POOL HEATER $35.00
— _GAS PIPING $10.00 _VENTII-ATOR $15.00
DUCTWORK$10.00 _._. �._._�_,...�_. ,,.a._.a:....����t,��z�x.�.,;,�::.,�.�,+r;,rh:�-�,,:�n �;,stiiari5r�t?e�n'I77:�R':`CSf1
11�; 3'�1.''YK 'V,J'�l':i J: i':Vi� :vi��✓i:n:vavw c�n e. ..:,...:.N ,.,, ;,.. _� ...: .. _�n-e-__.__ -. ___ _
Permit Fee $ .,� Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number af fixtures @$ I 5.00 x$15.00 =$
TOTAL DLJE $ �.,�. Number of fixtures @ $25,00 x $25 �0 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .5fl
Total = $
� 7'H1S IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the infarmation 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
approve� plan in the case of all work which requires review and approval of plans. �
SIGNATURE OF APPLICANT (._• G�{i�Z�� �—PWNT NAMEC �!�'l i T�elip�r�j L/�' D1ATE,,�^�i" "�
., . .. _ _ _
City of Fridley `
Building Inspections Department
6431 University Avenue NE, Fridley, MN 5�432
763-572-3604
FAX: 763-502-4977
�-
�
@�
._. _
0
0
suoR�in�t�� �E dn axEtu puE uopsnquzo�
.�o� pasn aq ��uz aaEn�os sauriaprn� apo� Y��tu��q�ay� �.zaB� �mod�a�ua� :�,Y,p�
Q i��T�i ����I •E
— - - -- ----------- - - - - -----�-�go�n'oi,sT -)T�t iaa u�1saQ ��nQ •9
� ZL9L 1O OL9L aPo'J �jaII'31�II�1t Iad -e
' � IIo�ETqIIa� �S
ZI £0'91�£I �WI IIoA��� bau uo parmbag -�
Luoo.� iad p�eoj �ar�oo� �g ssoj zeaH '�,
s3woH nn3N ao� a��in�3�
�s�uatapuac� I�U�I �?� 8 ia���I� �L�II �� � i��o jan3 •q
� s�IIampIIautd i�t �?� S ia�dE� �J�I sa�uE�ddE se J-e
��rqIIan ' £
s�uamPIIa�' l�i �?� S Ia�� �L�II `�
(mojaq a�oa aaS) � dn-a�ey� 'Z
- ` - - ��ampaam�' l�ILK �� £ ��� �J�u�edo� io serJ Te.�I�I 'q
s.�c�amPuau�' 1�U�I �:� L�� �L�II ian3 P�Ios io �p �e
�, (n�otaq a�ou aas) .rry ttot�snqLao� ' I
� S3WOH JNIlSIX3/N1�N 2i0� a32�If1D�21
?31d dfl-3�/W ❑ 3WOH JNIISIX3 � SNOIlIa�tl1S3WOH M3N ❑
�t/AH NOIl�d�lldc�d 11W2�3d lf/ilN3QIS321
11W2�I�d SS��Oad Ol Q3033N N011t/W2tO�N1 432�If1�3?�
' ....