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AF - 46364� City of Fridley, Man.n.. BUILDING PE�T � : ..- - ��- ,��'� " / .�� - �� i � ''� � � /'' • � ��. ,. �- n � 1�T° 308� ��,. Builder . . . . . . . d�'�s��f. .�. . �_ .. . . .. Address ... ...... ... .... . .. .. .� LO�CATIQ�! OF �UI9..D9i'�I� No. . d �/ Street ,�.�. .� . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . Lot . . .�� . . Block . . . . . . . . . . . . .�ditioa or Sub-Division . . . . . . . .4� . . . . . . . . . . . . . . � Corner Lot ............ Inside Lot .... . Setback . '�.�/. �' • Sideyard ..��r� ............. DE�CF�IP1'ION O� �9JILD9�9� To be Used as: i / . s!�� . . . . . . Front � � Depth �°�. . . . Height . . . . . . . . Sq. Ft. �.(�� • . Cu. Ft. . . . . . . . . i�� . . . . . . . . . . . . . . . . . . Fr t . . . . . . . . Depth . . . . ,, H ' . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . . Q�� _,� Type of Construct3on . ........... Es� Cost...Gd�! �!�•. To°be Completed ...:�!�%%�"•�• � �� / f �% �� / . ,_ _ , .. /� � ,, i d � 7 I 9 / , / � � � � �- / In coasideration of the issuance to me of a permit to construct the building desribed above, I agree to do the proposed work in accorda.nce with the description above set forth and in compliance with all provisions oE ordinances of the city of Fridley. ��.� . . . .......... yDO � In consideration of the payment of a fee of $. .�! . �..� permit is hereby granied to . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom ii is granted and his agents, employees and worl�nea, in all work done in, around aad upon said buildiag, 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 city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. _ � /� Inspector NOTICE: Thls permlt does not cove� the constructlon, Installation or alteration far wl�ing, plumbing, gas heating, sewer o� water. Be su�e to see the Building Inspeutor for separa4e permtts fo� the.se itema ��: ��- '�l City of Fridley, Minn. BUII.DING PERMiT .../�l.'.../..� -:��....... �� , .. .� ��`�.�-..°�.� �.�� .:`.: :`f :�-:��a. Acldr�s .:1 � :��•'�� : . .�; .��. : C . ��:`�� .-� No. ��.=�. .. Street Lot . .. e. . ... Biack Coraer Lot ............ � N° 3472 , �, ,� 8,��6:°��... �..��.��.� :�.. . �� ... Addr�s . . . . . � . . . . . . i:`.d� . �� . �. LC}C�ITION OF BUILDINC � � � � . . .�°. . . . .. . . � .�'�� :� . .. . . . Part of Lot�. . . .. . a . . . . . . . . . . . . . . . . . . . . - . . . : . . . . . . . . . . . . Addition or Sub-Division �.��2�'�: i; ., .; �' . :r r�� Ft `a�:� � -�- s .� Inside Lot . . .:� . . . . . . . Setback . ��: r (.-�. . 5ideyard . ��: :` . . . � . �� . . . . . . . . . DESCRIPTION OF' BUILD[NG To be U ed as. � �� ..,,`�.°�..� .:. ... ... � � 4 " � °T 4 ?�R �� Y�:�' From �. 0 `�'nepth . . .�. .�.-. :-�Height ��. � :� sQ. r't. .,.��-��-.�-. .��-. ca. Ft. � . ! . !� ,- , . '� ........ G�. Ft. ........ . . . . . . . . . . . :� . . . . . .�IrrOnt . . . . . . . . Depth . . . . . Height� . . . . . Sq. F't 7j►pe oP Construction .��.�.:.��:� C�.%�,�,��..:�`.-.... To be Completed ................... � ` . ��.C��-�� ` � ✓°� y� ��° l' ��` f`' = �`° � �� '`�� .�-�� '�=� �E ' ,� � O�'� 4� � ,, ;� � ca�?! � �`� j� �� ...t e;.' o-n ��,� �� r � e �� /D'��' .� �� ° In consfderation of ffie issuance to ane oP° a permit to construct the building desribed above� I agree to do the proposed work in accordance with the descrlption above set forth and in compliance with all provislons of ordinances of the dty of Fridley. r o �� r � �` . . .�` ' " . . : : . � :.,�' . .a.� f %� =,' ,� .�! -� : . � �• , Q�� In consfderation of the payment of a fee of $..!'.........� permft 9s hereby gratrted to ................... ......................... to construct the building or addil3on as described above. This permit fs granted up�a the express condition that the person to whom ft fs granted and h1a age�s, employe� and worlm�en, in all work done in, around and upon said bu�Ilding, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, con�lauction, alteration, maintenance, repafr and moving of buildings with- in the city limitg and this permit may be revoked at a�y time upon violation of any of the provisions of said ordinances. � � i�� • �;��/.��°.:..��jf :.�.... Buikiing Inspector NOTICE: Thls parmit do� not cover the conatruotlon, inatallation o� alteration fo� wiring, plumbing, gas heating, sewer o� water. Ba sure to sea the Bullding Inspecto� fo� separate permits fo� the.se Itema ,-� � � �,?� �9� City of Fridley, Minn.. N° '78 �' S BUILDING PERMIT nate: dnne ]1:i., 1965 �: C13fford T�arsoa �� T•�. �'�b �d� _._,545? Horizon Dr. Ad� 101f)S W. Iakevie�r Drive LOCATION OF BUILDING No �t57 St�t HOr'3.ZOII Part of Lot Lot �__ Bl�k 6 Additton or Sub-Divfsion ��-rl Q�� e.�93.-'�-$�37�o�-�R,3.— Coraer Lot — Inaide Lot �etback Sideyard Sewer IIevati� To be Used as: Foimdatton IIeval3on DESCRIPTION OF BUILDING �ont DePth Height Sq. F� Cu. FL Front Depth fTeight Sq. F't. Cu. Ft Type of Construclaton Fast Cost _ 0� To be Completed Rebuild S$orm Damage In cansideration of the 9ssuance to me oP a percn4t to construct the bwllding described a�ve I ag�e to do th� proposed work in accordance with the d�scription above set fo and in ce with proviaions of ordinaac�es of the dty oP FrlaIley. � A In co�sdderat[on oP the payment oY a Pee of ��4"� , permit is hereby granted to `�-� • Cki'�*'�$ to con�truct the building or addition as described abave. Thi� �ermit is granted upon the express condition that the person to whom it is granted and his agents, employees and worl�en, in all work doae fn� around and upon eaid building, or anyp� thereof, ahall conPorm in sII respects to the ordinances oP FridleY� Minnesota regarding la:ation, conatructfon, alteration, mainteaance, s�epair aad mov3ng of buildings wlthin the dLy ]imits aad thfs permit may be revoked at any time upon violation oP aay oY the Provisions of said orodinancea. allen Jensesa �� r I� N01'ICEs 71d� p�rmb dea rto1 eorsr t6s eoeslrueH�, �on fer vrWnO. P�+�9. �� huth�g, sew�e er wNar. B� �un to w tla &rW1in8 In�ta* tor �eparw �rm6s foe th�p t�. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OW1�R`S NAME�11 �� aQ�� BU'II.DER � , �9 ��'� ADDRESS � ," . ADDRESS �i'�'.F--��l� t1 /�P.,��a� LOCATION OF BUII.DING No.__�.��% Street m�+ '�� a Part of Lot ,� LOT BLOCR ADDITION OR SUBDIVISION Corner Lot�Inside LOT SeCback Sicie-4Yard SFWLR ELEVATTON FOUNDATIOR ELEVi�TTON Applicant attach to thia form Two Certificates of Survey of Lot and proposed building location dra�m on these Certificates. To be used as; DESCRiPTTON OF BUIiDING Front DEpth _ Height Sq. Ft. Cu. Ft. Front Depth � Height Sq. Ft. Cu. Ft. �� Type of Coustruction Estimated Cos��•C,�. �� e�� To be cc�mpleeed�� P �� The undersigned hereby makes app.lication for a permit for t�e c�ork herein apecified, agreeing to do all work 3.n sCrict accordance with the City of Fridley Ordiaancea and ruling� af the Department of Buildings, aud herebq declares that a11 the facta aad repres�ntations stated in this application are true and correct. o�� DATE ° �^�� ( c ule of Fee Costs can be found on the Reverse Side). � � � vi � ., , .� � �� .,� - BUII.DING PER1�T FEE SCHEDL1i.B SEy. The Inspectar of Building� sha].i. befora issuing any permit for the erection of any building or etructure, or for any addition to snq existing bu31d- ing or atructur�, or for any alteratioas or repairs to anq ex3sting huildin$ or struc.ture, upon applicatidn therafore, require the paymeat by the�,applicant for such permit of feea to the smount herein below�aet forth�and in the maatrer herein_ pravided to-wit:�, � 2.1. For any auch permit fos the erection of any fire�proof building, other than a g�rage, warehouse' factory or graia elevator; or for the erectioa of any fire-proof additioa� for simi.lar occupancy, to any existing building, shall be aC the.rate of $1.40 for eaah one thousand cubic feet, Qr fraction " thereof, in auch cubical Contents. ' ' 2.2. � For aay auch permit for the erection of any fire�proof garage, Warehouse� factory or.grain elevator, or for the erectian of any fire-proof addition, for similar occupaacy, to any existing buildiag shall be at Che rate of $1.25 for each one Chousand cubic feet, claesified ae "fir�proof" by Section 502 of �he M�tnneapolis Buildin� Code. � SOUSES . 2.3. For any such pes�mit for the erectica of any noa•fireproof building, other than a garage, warehouae, factory or grain e1�vaCor, or any aon-fireproof addition, for aimilar occupancy, to any exiating building - permit $1.00 for each one thousand cubic feet. GARA.GES " �_ °2_ 4. ' For any such germit for the erection of any aoa-fireproof garage, �aarehouse, factorq or graia elevator, or for the erecticn of any non•fireproof addition, for similar occupancy, to any existing i�uilding or for each such buildin� or addition.- ainety cents ($0.90� for each one thousand cubic feet os fr�ction the�eof, in the cubical contents ti►ereof with the miaimum of $4.00. For CFie purpose of camputing fees for building permiCe, the cubical conteats of any buildin� or addition to a uniform h�i�ht throughouC by multiplying the grout�d area covered from"a poiat six (6) 3nches beiow the floor Iiae of the basement or cel}.ar to the average height of the upper surfaae or to the average height of the roof surface of the maia gable of a pitched roof. 2w5; For regairs or alterat3ons to an exa�sting structure, the fee sha11 be at the rate of $3.00 per each Five Hundred Dollar� ("�500.00) or fractioa thereof in the coet of all propoaed work. 2.6. In no case sha11 the fee charged for.anq germit a� eet forth in Se�tion 2-tie le�� thaa $4.00. , ' ,_. � - . :� �1 �'`� '- • � A 3 � � '� s °, � � � � y � �'� p �� A � � � �o�s� � ~ � �: CF �C ��M� �� '�� o �� ,�,�•A � o �.� � �� o �.a.�' o t; `'' � � Q �.� � �.�.� �� r. �o a. ��, ob A � � ��o °, � �; ^ �. °, �: a. � n. m � n� C � ��•� , �.�'� � �. o � � � � o \ R � � � a � R. �. . � o � �• � �� '�A� � �°��. 0 �� a�� •� � � � I �b�� ►++ � ?,� co °.�`0 � �'o,� � �' �. �. � � a�a� b�a.� 0 �� ,��. � bto'�� o �' a' �ti,� �p .Oj y� � r�' � Fy� � � y ��,+ ��a�"�0 � b � � � �., q O � O � � � �o �' a � � � � � I �1 • � � 1 � � I�° I� � . � � � 0 o y o � x � � ; � � � z � � � � �, o R. o co b � � � o a; � � a' � '� � � � a. : � , � � i �; � �R � �1 � Ill ` � � a � � �� ' a, � �• . a. � � � � � � � � � � � .� � �" 7 � N 7Ao y � z � 0 � � A m � A � � ; � � � o; o � �+ C �� . � �� 3 — 3 � � � 0 O � �° o -v � � � � ep °i y � Q :: �: ' � � � � D 0. A� � _ y � � �• "_ :7 � � O � n �B � � �. �r � � A � � �� \ sue�ecr PERM City of Fridley _ 1910 7 AT THE TOP OF THE TWINS g U I L D i N G P E R M I T r � � R EIPT NO. � • COMMUNITY DEVELOPMENT DIV. i LV �'��'� ��-✓/ r � � PROTECTIVE INSPECTION SEC. � _ � � �/"�1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OP APPqOVED BV �'""'� � �� 612-571-3450 910-F15 8/11/87 / / JOB ADDRESS 5457 Hori.zon Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ].t� 6 Caxls.on's 5um�it Manor North Addn. SHEET 2 PROPERTYOWNER MAILADDRESS 21P PHONE Clifford Larson 5457 Horizon Drive N.E. 571-3450 3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO. Home Modernizers Inc. 4153 Minnehaha 1� ls. MN 55406 721-6474 d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING itesi.dential 7 CLASSDFWORK ❑ NEW ❑ ADDITION ❑ ALTERATION �7 REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK RerQOf Dwelling (18 S ares) 9 CHANGE OF USE FROM TO STIPULATIONS Roo� can be the 2nd layex but not the 3rd. Install ridged galvanized val leys . SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 80 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 I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS 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 $9OO S.SO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- TFiUCTION THE PE M CE OF CONSTRUCTION. $�-6. OQ � f'�� PLAN CHECK FEE TOTAL FEE , �'7 % � 1 �� r. ''a •�16. S� SIGNATURE FCONiRACT RAUTHORIZEDAGENT IDATEI WHEN PROPERI.V VA IDATED THIS IS YOUR PERMIT �� ) �j P � r ,��' ° � %'� � � C� SiGNATURE OF OWNEP �IF OWNER BUILDERI IDATEI BLDG iNSP naT N� [] City of Fridleq Effective �/1/86 ADDN. [ ] �R-1 AND R-2 pLTER. [ 7 Building Permit Applieation Construction Address: `��y.�% l/C��'/aD� rY/�=__��/�.�� Legal Description: Owner Name & Address : V 71 T�� '� °` � r-�� Tel . ,� ,,,� 7�'�✓`� /�� Contractor: ('J�I �f �,�%/�i�e ih �'2 Pi'�S � n Tel. � -.�=� � --��%� Address: ��%5 .� //�,%�fi h �e C�� ,,,$ • � CJ �l LIVING AREA: GARAGE AREA: DECH AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPRO�EMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setbaek �� Type of Construction: �,_f'°/�P� � Estimated Cost: $ �%�� Approx. Completion Date: �� Alt. A Alt B Proposed Driveway Width If New Opening Is Desired: $ $ See Baek Page for Explanation DATE: � `��'� �� APPLICANT: Tel. � ��/ '-� �� CITY IISE ONLY Permit Fee $ ��^�� Fee Sehedule on Reverse Side Plan Check $ �� 25� of Building Permit Fee State Surcharge $ � �o $.50/$1,000 Valuation SAC Charge $ � 525 per SAC Unit Park Fee $ Fee Determined by Engineering Sewer Main Charge $ , �� Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPOLATIONS: � � � � �� I,�� . �� /C�,�P� �$,�, � ,�� BIIII.DING PERMIT FEE SCHEDULE The Chiei' Building Official shall, before issuing permits for the erection of any buildin� or structure, or for any addition to any existing building or strueture, or for a�y a��ration or repair to any existing building or structure, upon application therefore, require the payment by the applieant for sueh permit of fees to the amount herein below set forth and in the manner herein provided to-wit: Total 9aluation $1.00 to $500.00 Fees $10.00 (Minimum Fee is $15.00) $501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for eaeh additional $100 or fraction thereof, to and including $2,000. $2,001.00 to $25,000.00 $3�•50 for the first $2,000 plus $6.00 for each additional $1,000 or fraction thereof, to and ineluding $25,000. $25,001.00 to $50,000.00 �170.50 for the first $25,000 plus $�1.50 for eaeh additional $1,000 or fraction thereof, to and ineluding $50,000. $50.001.00 to $100,000.00 �283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and ineluding $100,000. $100�001.00 and up $433.00 for the first $100,000 plus $2.50 for eaeh additional $1,000 or fraction thereof. DRIYEiTAY DEPRESSION ESCROW (Conerete 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 approaeh with 6 inch depth - Driveway width plus 6 feet times $15.75 VERIFICATION OF FOUNDATION Permits for construction taill 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 been construeted will be required before proeeeding with the framing. CITY OF SAINT PAUL Ftc�( a Y/-/�Jf � b��y �J Saint Pau.l, Minnesota �`� ��.j 3�� j�. � j UNIFORM CERTIFICATE OF INSURANCE This certifiFS that the __ 14estern National MutUal Insurance Company, a licensed �9inr.esota Company, has issued the following policy(s) to: � N�MED INSUtt�D LNT Coraoration D/B/A Home Moderni�Prs� Tnc_ ADDRESS 4153 Minnehaha Avenue, Minnea on lisF MN 554(1� TYPE OI' LICEI�ISE ��sn�� VIN # (Serial # of vehicles covered) (YOU HAVE THE OPTION UF FILING CONTINUOUS INSURANCE. IF DESIRID, PLACE °CONTINUOUS" IN THE BfJX MARKED "�OLICY EXPIRATION DATE") POLICY POLICY TYPE OF POLZCY EFFECTIVE EXPIRATION LIABILITY LIMITS INSURANCE NUMBER DATE DATE WUKKER'S COMPENSATION [3P349'i 11-9-84 Continuous Stat��tnr� GENERAL LIABILITY. AUTOMOBILE LIABILITY EXCESS LIABILITY UMBRELI.A FORM 3493 3493 E3P 349 3 11-9-84 11-9-84 11-9-84 Continuous Continuous Cor�tinuous BODILY INJURY PROPERTY DAMAGE BI & PD COMBINED BODILY INJURY (per person) BODILY INJURY (per accident) PROPERTY DAMAGE BI & PD COMBINED EACH OCCURRENCE AGGREGATE $ 500,000 $ 100 , 000 $ ,000 `�--,�--- $ 250 , 000 $ 500 , 000 $ 100 . 000 BODILY INJURY AND PROPERTY UAMAGE COMBINED S 500 , 000 $ 100 , 000 $ ,000 $ ,000 $ ,000 S ,000 000 � $ ,000 $ 1 ,OUO.UUU PLEASE CHECK ONE: � THIS POLTCY CONTAINS NO DEDUCTIBLE AMOUNT. �THE INSURANCE COMPANY SHAI.L PAY THE DEDUCPIBLE AMOUNT AND CnI.LECT THIS AMOUNT FROM THE INSURED (PER SECTION 7.03 UNIEUkM �NDORSE:MENT.) �CHECK THIS BOX If the City of St. Paul, its officers, aqents and employees is an X additional insured as required by, and coverage is provided to the limite specified ir,, the applicable Chapter of the St. Paul Legislative Code perteininq to the iseu- ance of the above mentioned license. This Certificate of Insurance neither affi=matively nor neqatively amends, alters, or extends the coverage afforded by Policy Number above issued by Westerr� tlational Mutual FORM 11PPROVF.D BY � . � Siqned City Attorney's Office PLEASE COMPLETE �iTFiER SIDE OF AGENT 7.03 Uniform I.i�=nse Endorsement ST. PAUL UNIFC�I2M �'IJDORSEMENT "The policy to which this endorsement is attached or incorporated is issued and desig:ied to comply with all of the provisions of the St. Paul Legislative Code, as amended, and it is understood�and agreed that said policy shall provide the coverage for the named assured re- quired by said Legislative Code, as amended. Should anythinq contained in the policy conflict with provisions of said Legislative Code, as amended, then the provisions of said Code, as amended, shall prevail to the extent of coverage of the limits of liability described in said Code. The insurer guarantees payment of all final judgments recovered against such insured, his agents or employees, within the limits herein provided, irrespective of the financial respons- ibility for any acts or omissions of such license holder, his agents or employees. It is understood and agreed that the right of any person to recovery hereunder shall not be affected by any violation of any of the provisions of the policy but all the terms and conditions of the policy shall remain in full force and be binding between the company and the assured. The insurer shall pay any part or all of the deductible amount, if any, to effect settlement of any claim or suit, and upon notification of the action taken the named insured shall promptly reimburse the insLrer for such part of the deductible amount as has been paid by the insurer. The insured further agrees to reimburse the insurer for any and all loss, cost or expense paid or incurred by the insurer which the insurer would not be obligated to pay under provisions of the policy independent of this endorsement. _ It is also agreed that no cancellation at the request of the named insured or the company shall become effective until after the exgiration of 30 days* written notice of such proposed cancellation has been served pursuaat to Chapter 8 of the Legislative Code, as amended." *Only 10 days'� notice is required for lic:ense/permits issued under Chapters 125 (Use of Streets)t 320 (Bituminous Contractor)t 338 (House Sewer Contractor)t and 356 (Sidewalk Contractor) pursuant to the City of St. Paul Department of Public Works Specifications for Street and Sewer Construction as amended Section 1.44. 8.02 INSURANCE TERMINATION. Wheneve�: the insurance company on any insurance policy required by the city to be filed pursuant to the Leqislative Code, elects �o terminate its liability on said policy, such insurance company shall cause a written notice of its intention to terminate its liability to be served upon the insured under said policy, giving said insured at least 30 days in which to secure a new policy, and upon filing proof of such service with the director of the department of finance and manag�ment services, and upon the expiration of the 30-day period, the liability of said insurance company shall terminate, and the license or permit for which such�insurance was given shall automatically be cancelled and annulled unless within said 30-day period the licensee or permitte.e shall have filed a new and acceptable insurance policy. Signed / (Original signature of Licensed Minnesota Agent) Dated 3-14-85 _ LICEPJS� 3► ;�%i�'".".�:�� :•' f'"jCC: 2�3 C�� `;' �i.'-.'--�- ...: . V ,. ., ST. PAUL, P;:l,.�•�c�•• � , �. :,1 � For Western National Mutual Insurance Company Address 7100 Shady Oak Road Eden Prairie Minnesota 55344 Telephone 944-8790 � ,. A SuBJECT City of Fridley � AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �� i � � � � • COMMUNITV DEVELOPMENT OIV. � ; V ��, r � � PROTEC7IVE INSPECTION SEC �� /"'1 � CITY HALL FFiIDLE� SS432 NUMBEF REV DATE PAGE OF APPROVED BV �'"""�� ' 612-571-3450 910-Ft5 3/23/95 / / JOB ADDRESS 5457 Horizon Drive NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. l�i 6 Carlson's Summit Manor North SHEET 2 PROPERTY OWNER MAIL ADORESS ZIP PHONE Cliff Larsen 5457 Horizon Drive NE 572-9602 3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO Minnesota Exteriors Inc 8600 Jefferson Hwy, Osseo, MN 55369-0266 391-5514 2877 4 ARCHITECT OR DESIGNER MAIL ADDHESS tIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDHESS ZIP PHONE IICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WOF;K ❑ NEW 0 ADDITION ❑ ALTERATION �1 REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK Reside dwelling; soffit & fascia 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OP CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT AUTHOFIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS 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 �8,679 ��}.32 DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- S7RUCTION OR THE PERFORMANCE OF CONSTRUCTION. �lOS.00 Fire SC 8.E)S PLAN CHECK FEE TOTAL FEE License SC 5.00 126.00 S�GNATUREOFCON'RACtOAOF1AUTHOA�ZEDAGENT IDATE� WHEN PfiOP lY VALIDATED THIS IS YOU PERMIT / W'I �� V// $�GNATU�7E OF OWNEA ��F OWNEA BU�LDERI IDATEI B OG �NSP r�aiE _ _ .._ 'y„' ` NEW ADDN ALTER [ ] Effe�tive 5126/93 I l CrrY OF FRtn�Y .��Zq [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: �. Legal Description: Oaruer Name & Address: Co�actor: Address: �70//% �� LIVING AREA: Lea�gth GARAGE AREA: Length DECK AREA: Length OTAER: Tel. �7.r - 96oe.7 MN LICENSE ��O Tel. #� — ,f' Attach to this applicafion, a Certificate a►f Survey of the lot, with die proposed c�nstruction drawn on it �o s�ale. DESCRIP'fION OF IMPROVEMENT w�am Wi�fi widtfi Height Sq. Ft Heaght �. Ft. Hgt/Cnoimd Sq. Ft Corner Lot [ j I�nside I�ot [] Ft. Yd Seiback Side Yard Setbacks Type of Construction: t� � ' Estimated Cost: � ��_�� Approx. Co�letion Date: � � ^ (Cost on Back) Drivea►ay Curb Cut Widt6lYeed�: Ft. + 6 Ft = Ft x$ _$ DATE: /7 � APPLICANT: Tel. # �9 -�,S/� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Maia Charge � lJ ! � °e � �g---"— � 3� � $ '� , 6� � $ $ $ C�l. _�i��`�i�Y�i .� )�� Fee Scheiiule on Revers� Side .001 of Permit Valuation (1/1(�th%) $.50/$1,000 Valuation $750 per SAC Unit $5.00 (State Licensed Residential Conh�ctors) Alt. "A" or Alt. "B" Above Conservation Plan Review $4SU.� Fee Determined by Engineering Agreement Necessazy I l Not Nec.essary I l TOTAL $�'�` � " � STIPULATIONS: � '� �� e /.�� `� �l� " �- �-z�p ��' �-��•�^-��; p ,b.., i..�a.�', �' � � ?�—!?'' .°�`��" _�' � o � � �� r:�. �� h.. BUII.DING PERMIT FEE SCHEDULE The Chief Building Official sha11, before issuing permits for the erection of any building or structure, or for any addition to any exisring buildiag or structare, or for any alterdtion or repair to any existing building or structure, u�n application theaefore, require the payment by the applicant for such permit of fees to the amount herein t�low set forth and in the manner herein provided to-wit TOTAL VALUE $1 to $500 $501 to $2,0� $2,001 to $25,000 $25;001 to $50,000 ' $50,001 to $100,� $100,001 to $5�,� $500,001 to $1,000,� $1,UOU,001 and up FEFS $15 (Miaimum Fee is $15 plus surcharge) $15 for first $500 plus $2 for each additional $1Q0 or fraction thereof, to and including $2,000 � $45 for first $2,000 plus $9 for e,ach additional $1,000 or fi�cbion thercaf, to and i�'e��ding $2.5,� $252 for first $25,000 pl�s $6.50 for each additional $1,OOQ or fraction thereof, to and iacluding $50,000 $414.50 for fust $50,000 plus $4.50 for each additional $1,000 or fi�ction thereof, to and including $100,000 �39.50 for first $1(�,000 plus $3.50 for each additional $1,000 or fiaction thereof, to and including $5�,000 $2039.50 for the fi�st $500,000 pins $3 for each additronal $1,000 or fraction ther�f, to aad including $1,000,(l00 $3539.SU for the first $1,000,000 plus $2 for each additional $1,000 or fraction �thereof - DRIVEWAY DEPRESSION ESCROW (�;ortere� Cu� Streets �iy) Alterna.te "A" : Removal aad repla.ceme� of curb and gutter only - Driveway widdi plus 6 feet times $13.50. Alternate "B" : Removal and replacement of curb and gubter 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 const�uction site. A Certificate of Survey vf the lot, showing the tocation of the foundation once it has it has been constructed will be required before proc�ding with the framing. �� -•�:K;:K�:;�h,��... ., . . .,; :.;:;.;.�.;:•c; ;; •:.;.;.;.: q:; .� . . . . . . . . _ .. .. . . .,< ..• . � .-� . . , . .... � . .. ... . . .. .. . ... .. ... . . . . . . . . ....., ........ ....... ......... .... . ....... .............�...........,.. ,.2..... ...... ..,. .. . ....... . . � � � 7 � O � � � Q. 3 0 w ro 7 � o � 3 � Q; �• O m 3 � � � � Q. o � � � � � � �� Q � z � .o ..�'�. rn� �� 0 n C -� Z n -� � �� v zm D � m� --I n � � � D � 0 z O z � m Z � 'C m -�i O Z rn m � � 1 � � Q � C m s � cfl � I�'S'� . : . � O Z � �I � � � < m � a� � � 0 � � � I � v � � m v� � � fl. � � N u� V n� �. m � z "' o � � � � � �a °V . .� � = oo � Z ` � � � � � o � .�v Z � � � � :,,� a � �. �, � � '� ° _ � Y�— �,. � �nJ �� a N t +l 3 � _' z �a a m v � J � N � �, 3 o m �' A � � � � a -�i. C a � � � m A � O 0 � j � � O O j < � c � � � °-� a� �t1A � � D e � m � � O � g� o ._ � N -a Z '• D A 3 � � _ � �� o � � o. � _ �3 � �, � s �; � F j �; � ,; 1��° •j � ��?c� �+ °,. A Ci "�p o � � m � � Q. �n � �r �' 3 aoo = �' o .. m � V � 3 _ � � �''.. \� �� y n v Q m � 1 � � � D � m � f°� A1 � !�A '" �p �n w o � a � � � � n � � � � � � m m (fl n S � Z m � � � � 3 � � I � Q Q' � c � � � � � moo�o � n � �� m. e m m � v ' � n 2 � � � � � c�J� O o 0 0� �-� . • $. � :� .- g c• . �� , � ..�. � � � � � � V� !� o � � � rn � A v � O � V �` ,, `` _ � � rn � � z oR � n 1 m C � Z � c � rn v N p m 2 � � � s m IT1 • � � �1 � �. � p� Q � o,. °W�� _ � Q.. � �� Q � � ;�� o m � � Q a t � �o� �'"s � °—' 3 � �p � � p1 � � s�?om � �\, a a► � � � �,, � Q 3 � �� s � � . � m � �� I ��, ;`'� r;` � � �. � � � '� �. � �- a o �, � � Q 0 � � m � � �Q.�� n 3 � � ��s� � �, o � ,� s : C� :� � m m � � S � +. � \ n `� O N � � j i� � � aN� � m� 3 Q � O W �. � � � �� ;� �1 �� r. �% �:� � Ul �1 � n V '?. � N Q 1 w� c O � � � � zm � T � � N < � � z , Z N m -o rn � _� � v Z m� .� � rna �O Z Z �'1 . �O. z 70 .: 'o � �. n � v� �� Z (�A z� � �� t� _ I�i � ' � � � �n <� mZ �� m z � � z y � � m 0 � �c/r� • / C m. J � � CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefiilly examined Yes () No () 2. Is free from rust or deterioration 3. Has no foreign objects lodged within 4. Is securely supported 5. 1Vleets all cutreni Code requirements for size and total BTU's connected 6 Has total heating BTU's of All other BTU's TOTAL BTU's 7. Has a liner been provided for water h� 8. Has combustion air l�en provided for water heat,er Remarks: � �` ��_. :- i' ��i- HEATING CO: Signed By: Date: Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Yes ( ) No ( ) Y� ( ) No ( ) SUBJECT City of Fridley 2 6�► 5 3� AT THE TOP OF THE TWINS g � I L D i N G P E R M I T � i � �. � `L _ COMMUNITY DEVELOPMENT DIV. �/�� r � � � PROTECTIVE INSPECTION SEC. � i � � /'�'1 � CITY NALL FRIDLE� $S4� NUMBER i1EV OATE PAGE OF AVPROVED 8Y �----�' �'' 612-571-3460 910-F15 7-13-98 � / JOB ADORESS 5457 HORIZON DRIVE t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMED DESCR. I�F 6 Carlson's Summit Manor North SHEET 2 PROPERTV OWNER MAIL ADDRESS ZIP PNONE Anni� Larson 572-9802 3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO. R& B Construction, 1814 214th Ave NE, Cedar 55011, 434-1206, 20072653 a ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO. 5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO. B USE OF BUILDING Residential 7 CLASS OF WORK O NEW � ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Tear-off and reshingle house & garage (18 Sq) 9 CHANOE OF USE FROM TO • STIPULATIONS Underlayment must comply with State Building Code. SEPARATE PERMITS ARE REOUIRED POR ELECTRICAL. PLUMBING, NEATING, �PE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITtONING. TNIS PERMIT BECOMES NULL AND VOIO IF WORK OF CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAVS. OR IF CONSTRUCTION ON WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFiAGES AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS yALUATION SUFTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $ 1 SO � y� ,],rj DOES NOT PRESUME TO GIVE AUTHOFiITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR 7HE PERFORMANCE OF CONSTRUCTION. $S 1. ZS Fire SC $�. SO PLAN CHECK FEE TOT L FEE ��-G"� " v'' -°� ?—i3�� Lic SC .00 58.50 SIGNATUREOFCON'AACTO AAUTNOp�ZEDAGENT IDATEI EN FOP VALIDA THIS IS VOUR PE / / SiGNATUAE OF OWNEA iIF OWNER BU�LDEAI iDATE� - � � iNSD rydTE �w [ ] Effective 1 / 1 /98 ADDN [ ] -� CITY,OF FRIDLEY ALTER [] SINGLE FAMII.Y -AND DUPLEXES R-1 AND R-2 �� - BUII.DING PERNIIT APPLICATION ' �� -. � �� ConstructionAddress: ��L,%� ! N o; , Z v�, pc- " � Legal Description: Owner Name & Address: �,v,v i Z. ,96Z5o� Tel. #.� Z.., `r f o� Contractor: _�� C� C_ n9 �. S� u� �-��t MN LICENSE ��. o O% Z��S'-� Address: I�'I t � Z� "��s�- �r/� Ce d c�,�' w. �. s� f'� i� Tel. ��13�) / Z J� ' � � 6 Attach to this application, a Certificate of Survey of the � lot, with the proposed construcdon drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: 01'HER: . . DESCRIPTION OF IlVIPROVEMENT Length Width Height Sq. Ft. '� Length Width Height Sq. Ft. Length Width �� Hgt/Ground Sq. Ft. ie�.�-o-� �.,,..� �c�s',°�� 4�, L-Id ��. g�� e � Construction Type: Estimated Cost: $ �� •-�� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: �j -- � 3 - � � � APPLICANT: � G' ► ct ,,, /� L � o� o� h L Tel. � G� � �C - / ��U Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ ��. �S� $ . �(� $ �� $ $ e �Cr� $ $ $ $ � $ �,�� CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,OQ0 Valuadon $1000 per SAC Unit . $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering � Agreement Necessary [ J Not Necessary [] �.: � ,�a d , , BUII.DING PERNIIT FEE SCHEDULE The Cluef Building O�cial shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: _ _ _ TOTAL VALUE $1 $501 to $500 FEES $21 (Minimum Fee is $21 plus surcharge) to $2,000 $21 for first $500 plus $2.75 for each additional $100 or fracdon thereof, to and including $2,000 $2,001 to $25,�0 $25,�1 to $50,0� $50,001 to $100,0� $100,001 to $500,000 $500,001 to $1,000,000 $1,OQ0,001 and up $62.25 for first $2,000 plus $12.50 for each addirional $1, 000 or fraction thereof, to and including $25,0(}0 $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 $100,0(� $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,OQ0 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 � 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 lacation of the foundation once it has it has been constructed will be required before proceeding with the framing. �� L�� MINNESOTA DEPARTMENTOF HEALTH Minnesota Well antl Bonng 144876 �� WELL AND BORING SEALING Rf CORD M;��'es ;"a ��;q�e No. H �j Minnesota Statutes, Chapter f031 or W-series ivo. t�ri 0� N (leave Wank d �ro� known) Tow�slip Narne Tornslep No. Range No. Section No. Fraction �sm. -s Ig.) Date Sealed Date Well or Boring Constructe0 rri�le� 3� 24 23 w w� if�-22-�� Numeriral Street Address u Fue Number eM Ciry o� Weil a Boring Loca6on � fl �� {1�1' ��i �i`. ��r i s� i�y Depth Betore Sealing �Y fl. Origmal DePth fl. Shon e�G IocaOOn ot s�e0 � bwmg Sketch map af well or boring A�UIFER(S) STATIC WATER LEVEL � se�m �gid vi�'7r. � location. Shwvi�8 P�hY �Jx6ingle Aquifer ❑ Multiaquder lin�. roads. and build'mgs. �y } WEILBOiiING � Measured ❑ Eslimated � � �+ � �� j Water Suppty Well ❑ Monit Wetl - -i^- -r- �.y ❑ Env. Bore Hole ❑ Other �� (t. �`pelow ❑ ebove lar�d surlace W � T- E � CASINO TYPE(S) -% � �� Steel ❑ Plastic ❑ Tile ❑ Other � u rt�e ".a.c��-"71 i__ � � CASING Diameter Depth Set in oversize hote? q� � inihapy grouted? S � �mvs� u,w...r.r.��. � in. lrom � ro� R. ❑ Yes �No ❑ Yes ❑ No ❑ Unknown �Ty �� in. from �o n. p ves ❑ nw O res p n►o p u� Anni e Lar-�s�� Rap�ry aa�els aaTig addres H�terent Man weu tocava� eddress i�aled above. in. from tb k. ❑ Ves ❑ 1Vo ❑ Yes ❑ No ❑ Unluwwm - SCREEWOPEN HOLE Screen from �� to �� ft. Open Hole from to R OBSTRUCTIONS �� RodslDrop Pipe ❑ Check Veive(s) ❑ Debria ❑ Fdl ❑ No Obstructiaa� Mfd aeda � ad�o B�fere�u emi prcPenY oMrtrer's edtlress iMc� a6ove. Type of Obstrudions iD�c�) �° �°' �•�� i j� t � ObsWcdorisr�noved? �Yes ❑ No Descrme PUYP Type QEOLOOGL IIA7EWAL COLOH ��F FROY TO � Removed (� Not PreseM ❑ Other ��A�N AIETHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINOS. OR CASD�Ki Alm BOAE HOLE: 9 not tro�n. i�6r�b aY'i�rlad tomietion Iop Gom nea�by rre0 or ba0ig. i� No Anmiler Space F�dts ❑ Annular spaee grouted with tr�mie pipe ❑ Cesl� PeAOredoNRemwel In. hom M fl. ❑ Perfore0ad ❑ Removed In. from to R ❑ Pmlmated ❑ R�rowed Type o1 perforetor ❑ Olhet OROUTINO YATERIAL(S) droudng 11Aaterial �� '`��' from � to `� R Yards � begy from to R y� p� hom to R Yards b�s - ' from lo R Yards bags lBW�, �E OF OATA, OFiTCUL7�8IN SEALB�Ifi p7HEp WE1,LS AND BORUIdS Olher wsealed and unused wep or borfig an propeAy? ❑ Yes � No Fbr many/t LICENSED OR RECi13TERED CON7AACTOR CERTIFlCATION This we0 or bori� was seated In eocordance wltli Mlnnesota Rules. Chaptm 4725. The 6dort�tlan oartlatr�ed In 6ib rapat is true ro We best o1 my loiowledpe. 6'�� 1 � �t�1� • Y�� CoriLeeL�rBt� Nanre Licerese ar ReyyiLs�G's0(on Rb. _ Autladzed Re�nteQve 3J8nafure QaEs Ron D�ni�ls�n 1Q-2?-3� L�,�� H �44�76 ��,P��W��,� f�01�34Ri ' ?JB7 R sue�eer E . City of Fridle� 3 2% 16 . AT TME TOP OF TME TWINS g u I L D I N G P E R M i T � � RECEIPT NO. � `v �_�� COMMUNITY DEVELpRMENT DIV. r � � PiiOTECTIVE INSPECTION SEC. `� �� _ . l--_•� �"'�'� CITY MALL FRIOLE� SS132 NUMeEp pEV OATE PAGE OR AvPROVED BY ` 612-571-3450 s�aF�S 6/20/02 / / J08 ADDRESS 5457 Horizon Drive NE 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACNED DESCR. j!} 6 Carlson's Summit Maaor North Addition SNEET 2 PROPERTY OWNEFi MAIL ADORES$ ZIP PMONE S�even Ahca� 5457 Horizon Drive NE 763-571-7224 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Same e AiiCHITECT Oii OESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO S ENGI 8 USE OF BUILDING Residential 7 CLASS OF WOFiK A 21P VHONE LICENSE NO O NEW � ADDITION O ALTERATION ❑ REPAIR O MOVE O REMOVE B DESCRIBE WORK Construct a 21' x 12° Deck 9 CHAN(iE OF USE FROM TO STIPULATIONS See notations on plan. W�IRNING Before digging call foP all udlity locations 454D002 ��RED BX LAVU SEPARATE PERMITS ARE FiEOUIRED FOp EIECTFICAL, PLUMBING. MEATING, "r� vr vv� VENTILATING OR AIR CONOITIONING. TMIS PERMIT BECOMES NULL AND VOIO IF WORK 01i CONSTRUCTION 20NING AUTHORIZED IS NOT COMMENCED V�!ITMIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANpONEO FOR A PERIOD OF 120 DAYS A7 � ANY 71ME AFTER WORK IS COMMENCED. ` NO. DWLG. 1 HEFEBY CEflTIFV TMAT I NAVE REAO ANO EXAMINEO TNIS APPLICATION 1 AND KNOW TME SAME TO BE TF1UE AND CORRECT. ALL PROVISIONS Of LAW$ VALUATION AND OFDINANCES GOVERNING TMIS TYPE OF WpqK WI�L qE CpMPLIEO @ WITH WHETNER SPECIFIED MEREIN Ofl NOT. THE GRANTING OF A PERMIT W2�89S DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLA7E OR CANCEL TNE pERMIT FEE PROVISIONS OF ANY OTHER STA7E OR LOCAL LAW REGUTATING CON- STRUCTION OR 7ME PERFORMANCE Of CONSTRUCTION �S3 . ZS $�GNATU CONCRAC AUTnOp�IEDOGEN� IDAfE� .�ol�i� �'�L� o`�O-0� ��GN UAE O� OWN �i� OWNEp BUROEN� IDATE� m OCCUPANCYGROUP IOCCUPANCVLOAD SO.FT CU fT STALLS GAflAGES $1.45 AC CMARGE Fire SC $2.90 OiA� FEE $�7.60 )UR PERMI ��, � NEIIV ( ] ADDN (] a�r�R Il Construction Address: y�7 7 Legal Description: / CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 (763) SINGLE FAMILY AND DUPLEXES R-1 AND R 2 BUILDING PERMIT APPUCATION %� ar:'�oh pr /�lr • Etfective 1/1/20 572�6 BI 91 �Q� Q ;� � �. Owner Name 8� Address: S �i�Cl�l �`i�C'Q�y Tel. # 71o3�Si/- 7 �/ Contractor. � GV r1 � MN LICENSE # Address: ' Tel. # 7 .113 �7f- �y LNING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Fk Length Width Height Sq. Fk _ ti Length �_ Width /.�- HgUGround ,� Sq. Ft � s 7 Constn�ction Type:�a/e c.� �/1a k�_ C'C c%.� Estimated Cost $ I 5 �U �� Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ DATE: - - O� APPLICANT: �C /.�iltG�. Tel. # 7G • ,�/- %�f I Call (763) 572�604 for PeRnit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will call you for card number. Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge � �� t o�?� � • �� $ �� $ $ $ $ $� $ CITY USE ONLY - Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1200 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by �Engineering Agreement Necessary [ ] Not Necessary [ ] TOTAL $ � 1 ° C�� STIPULATIONS: BUII.DING PERNIIT FEE SCHEDULE The Chief Building Official 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 tawit: TOTAL VALUE $1 to $5(� $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 FEES $23.50 $23.50 for first $500 plus $3.05 for each additional $100 or fraction thereof, to and including $2,000 $69.25 for first $2,000 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,Q� $391.25 for first $25,000 plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $50,000 plus $7.� for each additional $1,OQ0 or fraction thereof, to and including $100,000 $993.75 for first $100,(�0 plus $5. � for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,�0 or fraction thereof, to and including $1,000,000 $1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1, 000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.00. 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. New Houses Onlv � I - i I - ' -- i -- � -- i . � i j - •----. ..--- -� -- -- - - � . . i i - - ' . ._ _ � . . _ . , .. . ; . � ' � �^--- -... .� -_.. � �' - � � � , , _ � -! .--� . � � I _ i � � i ''- '— -- : ' �; - � � � ' _._. � - � , , -�-- - - - , � � � i �, �. 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