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�;�'� Villa.ge oi Fridley, Minn.
�r BUILDING PER.MIT ��°• 1? 7 3 .�
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Date: .... ��.�.� .... �:.�. ..��......... �
Owner . . . . . .. . . . ... . .. .... . .. . .. ... .......... Builder . ��: i! .°.�.�. . . .��.r �.d.`% . .
Address ...................................... Address ......�..'Z'.�.�......,�r �i 12 G �.......
LOCAT[ON OF BUILDWG
No. .'�'�..�°..�. Street /. l. � r.'. Z.:°.�7......�i'�:.......... Part of Lot ......... . ..........
Lot . . . . .�. . . . . Block . . . . . .�. . . . . . . . Addition or Sub-Division . . ��R f.".z:�t i. : � .��� y'. a �°. . ! ' �
Corner Lot . . . . �. . Inside Lot . . . . , . . . . Setback � � . � � � Sideyard . .5�. �. � . . . . . . . . . . . . . . . . . . . . .
DESCRIPTION OF BUILDING
To be lised as:
,�/, vr- ei `,r, ��� . . . . . Front . �� . . Depth . .°?: :(. . �Ieight � � .`�. . Sq. Ft. �.� ��. Cu. Ft. . . . . . . . .
..................... Front ........ Depth ........ Height ....... Sq. Ft. ........ Cu. Ft ........
Type of Construction . .!. .�'� !.'? . �. . . . Est. Cost . . d z'. . S� . . . . . To be Completed . . . . . . . . . . . . . . . . . .
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Tn consideration of the issuance to me of a pexznit 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 all provisions of
ordinances of the village of Fridley.
.....................................................
ad '
Tn consideration of the a ent of a fee of ..�� ......... ..
p ym $. �O? ., permit is hereby granted to .�d!� ` � � `� �'2
. . . . . . . .. .. .. . . . . . . . . . . . . to construct the builcling or addi.�4sn as described above. This permit is granted upon
the express condition that the person to whom it is� �d and his agents, employees and worlmien, in all work
done in, around and upon said building, or any �f thereof, shall conform in a11 respects to the ordinances of
Fridley, Minnesota. regarding location, con �1�'tion, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may revoked at any time upon violation of any of the provisions of said
ordinances.
. . . .`.-� � ... . . . . . . .. . . . . . . . . . . . . Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbPng, gas heating,
sewer or water. Be sure to see the Building Inspector for separate Aermits for these items.
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City of Fridley, Minn.
BUILDING PERMIT No s578
Date: �" _ � � C� ���
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OvRner: Builder
Address Adarese
P, J.00ATIO F BUILDING
No. Street �_. ..a P f Lot
I,ot _ Block � Addition or Sub- on ��o
e
Coraer Lot _ y� Inside Lot — �tback � Sideyard
Sewer IIevat4an ____ , F da.tion IIevatfon
DESCRIPTION OF BUILDING
Front _�� Depth � Height L�% ' Sq. F't���[ // J G�. F����
Fro Depth eigh .� Sq. Ft Cu. F't.
Zj►pe of Construct4on � Est, �,�..�� To be C�mpleted
In canaiderat[on oP the iasuance to me of a germft to construct the building described above I agree to do
the proposed work fn acc�rdance with the dr�script�ton above set forth and ia compliance with a'11 proviafons of
ordinances of the dty of Frldley. ����� — ����� � z
In cansideration of the �yment oP a fee oP $�_� , permit fa hereby granted to
to construct the bvildin,g or addit3on as described above. Thia rmit fs granted upon
the express condition that theperson to whom it ia graated and h3s agents, employees an�worlanen, in all work
done in, around and upon said building, or anypa,r� thereof, sk�all conform 3n all reapecta to the ordinanc� of
��Y, �sota rega.r8ing lpcation, constructfon, alteration, maintensnce, repair and mov3ng of buil�ings
o��� dt3' ]�i'Fs and th9a permit may be revoked at any t� u�a�lola�ia�of any of the provi�tons of said
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�'1 NOTICEs
11ds � des� eet cersr t6s com�roetton, f�all�llon I�r wide�. P��+m9. 6n 6e�Iae, sswu or wWr. B� sQrs to �
du Boildiu8 l�or for aparah � �or t6a� h�ns.
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Ca.ty of Fridley, Minn.
BUILDING PERMIT
��: Juae 29, 1965 ,
N° 8068
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p�r; _ Melvin Bolin g�� H. J. �lomstr�n R. �ensTInC.
Addr�s �460 Horizcn Dr3�e N. E. A� 1220 A,rcade Street St. Paul, Minn.
Fridle_v. Minn. , .
LOCATION OF BUILDING
No. � Str�eet FiOri�On i3r3_ve N_ F. � Part of Lot
IAt � Bl�k 5 Adeitton or Sub-Divlsion Stmtmi_f Mancfl"� �!)r�l
Coraer Lot Ineide Lot Setback Sideyard
Sewer �evation - Fo�mdation IIevation
To be vsed as:
DESCRIPTION OF BUILDING
Front DeP� Hefght Scl. F'L Cu. F't
Front DeP� Hefght Sq. Fk Cw. Ft
Type of Constructton F�t. Cost�.�����0 To be Completed
Storm Damage Repair
In c�sideratton of the 9ssuanc,� to me of a permit to conatruct the building described above, I agree to do
tha PrnPosed work in accordance with the dr�scription above set forth aad ffi cbmpliance with all provisiona oP
cmiinaaces of the dty oP FrlcIIey. �� lj
�l��., n�w � > 4 !_��.�.� �� �`sz�
Ia ca�ideration oP the paymeat oP a Pee of 1�� ,�t fe liereby+ granted to �.ehard Blomstrand
$tid Son.S, Inc.. to conatruct the buflaing or addition as d�crlbed above. Thi�p�mi t ia granted upon
the espress conditlan that the person to whom it is granted aad h9s agenta, emplo anc� worlunen. 9n a11 work
espres
dane in, around end 1� eafd building, or any�rt the�of, shall cflnPorm in r�pects to the ordinanc� oP
FridleY, Minn�ota r+agardiag �t �ca�ctto�al t � � ���.���� ��onba�or �id
wi� dty limits and tb9a
Al].en Jensea �� �
NOTIC� �
TI� p�rmB dea eo� eswr ths comtracNee, tmlalHtlen ior rr6�, P�om1+�9. Oas 6afie�, a�ru er �r. B� sun te a�
dn BoiWioe In�etor tor apardM� pum6s tor t6w �a.
APPT,ICATION.FOR BUILDING PLRMIT �
. � . CITY , OF FRIDI,EY, MINNE50TA-
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OWNER' S NAML Melvin Bolin BUILDER H. J. Blomstra.nd & Sons Inc.
ADDRESS 5460 Horizon �D,� r.�, F,�ridlev ADDRESS 1.220 Arcade St, St. Paul.
� LOCATION OF BUILDING
No.� _6�60 Streat Horizon Drive parC of, Lot.
. . ) .
Loe� . Bloal� V Addition or : Subdivision ; ` �,,'T�� ' '��1 �, � ,
Corner Lot Inside Lot� Setback Side-Yard � �'
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SEWER ELEVATION FOiJNDATION ELEVATION
Appli�ant attach.to.,Ghis foraa Two Certificates of Survey of:Lot and propoaed buiid-
�ing lo�atioa drawa ot► these Certific�tes . ..
DESCRII�IZON OF BUILDING
To be used as:
Front ,Depth Seight.. '
. . Sq.:FC. Cu. Ft.
Front Depth Height
Sq. Ft . Cu . . Ft .
Type of �Coastruction repair of tornado d�,m.age Estimated Cos.t .$4, 000. 00 ___
� ..
To be Completed � � - `f
The undersigned hereby makea application for a permit for the work herein specified,
agreeit�g to do all work in etrict accordanca with the Citq of Fr3dley Ordinaaces and
rulin�s cf tl�e Departmeat,of Buildis�ga, and.hereby declares that all the facts and
repreaeutatione stated in this appliaation are true aad correct. .
June 25, 1965
�(Schedule of Fes Costs can be found on the Reverae Side).
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BUII.DING PER�YIT FEE SCHEDULE
Section 2. The Inspector of Buildings shall, before isauiag anp permit for
, the erectioa of eay building or structure, or for any additicn to any ex3st-
fag building or structure, or for any alt�ratioas or repai�a Co any existing
buildia� or eeructure, upoa application therefor, require the payment by the
appl3caz►t for auch permit of fees to the amount hereia below aet forth and
in the manner herein provided eo-wit:
. . _ �_ � � . , � .
2.1. For aay such permit for the erection of any fire-proof building, other
th� a.$ara�ge�, �arehouse,- factory �oi grain elevator; orA for'the �rectioa of
anq fire-proof addition, for s�tmilar occupaacy, to anq existing building
shall be �,C the rate of $1.40 for each one thousaad cubic feet, or fraction
thereof, in such cubical coatents.
2.2. For any auch. pern►�t for the-�recCion of any fire-groof garage,\ werehouse,_
factory or grain elevator, or for the erection of any fire-proaf eddition,
for simflar occupaacy, to anq exieting buildia� ahall be at the ra�e of $1.25
for each one thousand cubic feet, clasaified as "fireproof" by Section 502 of
the Minneapal.is Buildiag Code. � '
SOUSES
2.3. For any such permit for the erection of any non-ftreproof buildiatg other
than a garage, warehouse, factory or grain elevator, or any noa-fireprouf
addition, for s�imilar occupancy, to any existing bnilding - permit $1.00 for
each oae thousand cubic feet.
GARAGES
2.4. For anq such permit for the erection of any non-fiseprocf gara�e, -
warehouse, factory or grain elevator, or for the erection of any non-f.ireproof
addit3.oa,-€or--similar occupancy, to s.ny existing building or for each such
_,_ building or addition - niaety centa ($0.90) for each oae thousand cubic feet
or fraetion thereof, in the cubical coatents thereof c�ith a minimum of $4.00.-
For the purpose of camnputiag feea for building permita, the cubical centents
of anq building or additiom Co`a uaiform height throu�haut by multiplying the
ground area covered from a point si� (6) iaches be],ow the floor line of r.he
baaement or cellar to the averag�- height 'of tli�'ugp�r `aurface or to the
�verage height of the rQOf surface of the mai� gable of a pitched root.
2.5. For repairs or alteratfons to an existing structwce, the fee shall be
at the rate of $3.00 per each Five Suadred Dollars ($500.00) or fractioa
thereof in the cost of all progoaed work. ' •
2.6. In no case shall the fee_.charged .for-aay-perm,i�.ara set forth in
Section 2 be lese. than $4.Di�.
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City of Fridley, Minn.
BUILDING PERMIT
Date: _�D'�QII1bLr :�„� -° 1�965
p�r; Melv3n Bolin g��. Own.er
Address 54.Fi0 H�*'i �on. nri vG 11T.1? . AddTC98
No 8445 _
LOCATION OF BUILDING
�o, 5460 S�t Horizon Drive N.E. p� og �t
Lot ._.�_ Block 5 Addition or Sub-Diviaion Su�i-t Man.or North
Coraer Lot — Inside Lot Setback Sideyard
Sewer IIevat3an
Foundation IIevation
DESCRIPTION OF BUILDING
To be Vsed ea:
-_Garage Fnont Depth Height Sq. F't. Cu. Ft
Front Depth fTefght 5q. Ft Cu. FG
Type of Construct�ton Fx�� F�t, Cost �7., 000�00 To be Completed
In conffideration oP the issuancs to me of a perrnft to conatruct the building described above, I agiee to do
the proposed work fn accordance with the d�scription above aet forth and ia compliance with all provlaioas of
orclinancea oE the dtq of FrlrIIey.
., ia��� � � �8
In conafderation oP ti►e paqment of a fee of $ 4.00 , permft is hereby granted to M�1vin Bo1in
to cronatruct the buflaing or addition as described above. Thisp ermit is granted upon
the express condition that theperson to whom it fe granted aad his agents, employees and worl�en� in 811 work
caone in, around ead upon said building, or anypa� thereo� shall conform in all reapects to ffie ordinanc� of
F'ridley, Mianesota regarding location, conatruction, alteratton, maintenance, repafr aad moving of bufldings
within the dty ]imits and tbia perrmft may be revoked at any 13me upon violation of aay of the P�vi�itona oi said
or3innnc�.
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NOTIC&
T6b � doas � eovar fhs con�frucdoe, tmlall�lee to� wlrL�g. plumbieg, �as 6f�tina, ss�r�� or wNsr. B� mn to as
tM eoiidtng le�o� for aRarala p��Ib Por flua ihmi.
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APPLICATION FOR BUTLDING P&RMtT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME�i ,°� � � a `sv � �3 �t /I e�p BUILDER
ADDRESS -�� d9 � �� �,� l� ' "' �a ,�__�„� ADDRESS
IACATION OF�SUILDI
�° ,
N0. ,.� �� � (� STREET � , � - �� � PART OF LOT
LOT BLOCR ADDITION OR SUBDIVYSiON
CORNER LOT INSIDE LbT SET$ACK SIDE-YARD
SEWER ELEVATION _ FOUNDATIOR ELEVATION
i.
ApplicanC attach to th�ts form Two Certificates of Survey of Lot and propoaed
building locatioa drawn on these Certificates.
To be
DESCRIPTION
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=a ,_� �f — ���'
Depth Height
y-� � � �q. Ft. . Cu. Ft.
�� ���
Front Depth Height
Sq. Ft. Cu. Ft. , '
Type of Construction - - � _� � Eatimated .Cos ��- �� �
To be completed
The undersigned hereby makea application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildi�gs, and hereby
declares that all the facts and representations etated in this application
are true and correct.
� .
DATE '� m' � SIGNATIIRE ��-°"���° �'"--"�.a��<�p �, ��� .
(Schedule of Fee Costs can be found on the Reversa Side�.
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1s � �
BIIILDIl�TG PERMIT FSE SC'HEDOLE
SECTIOR 2. The Inspector of Buildings shall, before issuing any permit for
the erection of any building or structure, or for any addition to any esiating
building or structuze, or for any alterations or repairs to aay e.�cisting
building or structure, upon application therefore, require the payment by the
applicant for such permit of feea to the amount herein below eet forth and 3.n
the manner herein provided to-wit;
2� 1. For any euch permit for tbe erectictn of any fire-proof building,
other than a gara�e, warehouae, facCory o� grain elevator, or £or the erectioa
of any fire-proof addition, for similar occupaacy, to any esiating building,
shall be at the rate of $1.40 for each�one thousand cubic feet,_or fraction
thereof, in auch cubical contenta,
2.2 For any such permit.for the erection of any fi7re-proof garage,.
warehouse, faetory or grain elevator, or for the erection of any fire•proof
addition, for ai�nilar occupancy, to any esistiag building shall be at the
rate of $1.25 for each one thousand cubic feet, classified as "firepraof"
by Section 502 of the Minneapoli� Building Code. .
HOUSES
2.3. For any such permit for the .erection of any non-fireproof
building, other than a garage, warehouso, factory or grain�elev�tar, or
any non-fireproof addition, for �imilar occupancy, to any esisting bui�.ding -
permit $1.00 for each one thousand cubic feet.
GARAGES
�.4. For any such permit for the erection of anq non-fireproof garage,
warehouse, factorq or graia elevator, or for the erection of any non-fire-proof
addition, for similar occupancy, to any esisting buildiag or for ea�h snch
building or addition - ninety cents ($0.90) for each oae thous.and cubic feet
or fraction thereof, in the cubical contenta the�eof with Che minimum of $4.00.
For the purpose of camputing fees for buildiag permits, the cubical contenta
of any building or addition Co a uniform height throughout by multiplying the,
ground area covered fram a point sis (6)� inches bel�w the floor line ot tlze
basement or cellar to the ayerage h�stght of the upper surface or to the average
height of the roof aurface of the main gable of a pitched roof.
2.5. For repairs or alteratians to an existing atru�tb�re, the fee ahall
be at the rate of $3.00 per each Five Hun�r�d Dollara ($5:1�,.GJ) or fraction
thereof in the cost of all proposed wo��c. �
2.6. In no case sh�11 the fee charged for any permit as aet forth in
Section, 2 be� less than $4.1;0.
STORM REPAIR DAMAGE ??r�S;
Residential;
Commercial;
Eati�na�r_ed Cost of work up to $50�.00 -$5.40
E�tinaced..Coat,, of wo�k over. �3 Jc7; �0 -$i.0o 00
Estis.�ted �t of woxk up ts� �:�,�:��m00 -$10.T,�
Estimated �.,at of work over $50a.00 -$�0.�_
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HEAT LOSS—
SOLD BY
Electrical Work
TYPE OF HEAT
c9 A
HOIISE HEATING TEST tB�CORD �� ��� � -%
FLOO�_ CITY SUBU
DATE HT . INST � � GAS CO. METER BADGE # �
� � ' INSTALLED �Y
�' e Gas Line By
_ F�_ HW STEAM— SPACE HTR UNIT HTR. OTHER
GAS DESIGN
OF BURNER
CONVERSION
5erial ��7 ,7�'/�/ � �/ �- PAax. BTU Rating
INPUT��T M�1KE OF FURN�.CE
Model
CONTROLS
THERAAOST � � S� ��
��Hea# Plug �' g Vent Size
Valve KIND OF LINE �� SIZ -�" NONE
Limit IJLI � o nraft Hood RegulatQr -�
Limit Setting ��� Filters Siz � Number
Fan Setting �° �� Chimney location Inside �� Outside
Pilot Typ Chimney Constructio� ��'
Pilot Make
Pilot Model �2X ��� y Smoke Bomb � Wiring �' �
Pilot Timing �' �-� ` �� fj �-�� Draft � � Test Tag �r
L.W. Cut Off Door Pressure �- lighting Inst.- ��
Pressure �� � Percent CO2 7� � Date Tested °
Input CFH—��- � Percent 02 Company T�stina—L
Stack Temp. �=� Percent CO Name of fester
0
SUBJECT pE�-pfi
City of Fridley 18703�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � CEIPT NO.
� `L _.�_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. ,�- � �
� _ �
� �'��1 � CITY HALL �FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�""""� � ,�� 612-571-3450 910-F15 10/16/86 � �
JOB ADDRESS 5460 Horizc�n Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. L� �j (;�],$pn� S SlIliHILlt MaI1C3Y NO�Yl SHEET
2 PROPERTY OVI(I�ER MAIL ADDRESS ZIP PHONE
BO�_l.Yl S�IYl2
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Netko Bros. 3446 Russell 529-7397
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
7 CLASS OF WORK
❑ NEW O AODITION �1 ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof duzelling
9 CHANC3E QF USE FROM TO
STIPULATIONS
Roof can 1� 2nd layer but not third. Install ri.�ged galvani.zed valleys.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULC 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 AFTEH WORK IS COMMENCED. NO. DWLG. UNITS OFfSTREET PARKING
I 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�L BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OF; NOT. THE GRANTING OF A PERMIT ��-i8OO �.90
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OFi LOCAL LAW REGULATING CON- $Z9 �5O
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
$ 30 . 40
SLGNATUREOFCON7RACTORORAUTHORIZEDAGENT IDATEI ,�F-a/yH N PR P Y V UDATED THIS IS YOUR PERMIT
�' se-
SiGNATURE OF pWNER�IF OWNER BUILDERi IOATE� ��V���
DG iNSP ppiE
NE� �� City of Fridley Effective 4/1/8c
ADDt:. [] R-1 A1�1D R-2 � .
AI,TER. I 7 Building Permit Applicatioa
Construction Address: ��� �� � _ � 1
� �� " -� r� ��y by`� � �.,
Legal Description: •
Ownez Name i Address: �� �'� � Tel. �
Contractor: ������ ��GOS Tel. f�`� < 7�C 7
�L� •������
Address• �`� , �
LIVING AREA:
GARACE AREA:
DECR AREA:
OTHER:
Attach Lo this application, a Certificate of Survey of the
lot, With Lhe proposed construction draWn on it to scale.
DESCRIPTIOA OF IMPROQE!'IEI�'T
Length Width Height Sq. Ft.
Length Hidth .=_ Height Sq. Ft. .__
Length Width __ Hgt/Ground Sq. Ft. __
Corner Lot [� Inside Lot [] FL. Yd. Setback _______ Side Yard SetDack
�, � ov
Type of Construction: � �" ''r �� F � � Estimated Cost: � ��
Approx. Completion Date: � � �
Alt. A Alt P
Proposed Drivexa�� kidth If New Opening Is Desired: � �
See Back Page for Explanation
D�TE: �%
Percit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sever Nain Charge
TOTdL
STIPUi�TIOl:S:
i
APPLICAAT: �✓�%i Tel. 0 ����
CISY OSE ONLY
` �` �- � U
�
� �a
�
�
�
� ���_ �( U
��
� ��� �
.. �� , ���
u '� � �
Fee Schedule on Reverse Side
25i of Building Permit Fee
�.50/�1,000 Valuation
�u75 per SAC Unit
�ee �termined by Engineering
Aga�eement Necessar� [] Not Necessary I 7
0
1` i V �
C
P
�� �`�'_ ��' � �/'�`�t�-�`
�
�
SD�.DING PERHIT FEE SCBEDIILE
The Chief Building Official ahall, Defore iasuing permita for Lhe erection of ar.y
Duilding or structure� or for any addition to any existing Duilding or structure� or
for any alteration or repair to any existing building or structure, upon application
tt.erefore, require the payment Dy the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-vit: '
Total 9aluation
=1.00 to �500.00
�501.00 to �2,000.00
s2.00�.00 to S25,000.00
�2:�001.00 to �50�000.00
�SO.00t.00 to 5100,000.00
Z100�001.00 and up
Fees
�10.00 (Hinimue Fee is �15.00)
�10.00 for the first �500 plus �1.50 for each
additional �100 or fraction thereof. to and includin�
�2,000.
�32•50 for the first �2,000 plus �6.00 for each
additional �1�000 or fractior thereof� to and
including �25,000.
�170.50 for the first �25,000 plus �4.50 for each
additional �1,000 or fraction thereof, to and
includfng �50�000.
�263.00 for the first 550�000 plus �3.00 for each
additional �1,000 or fraciion thereof, to ar.d
includinE �100.000.
�u33•00 for the first �100,000 plus �2.50 for each
additional 51,000 or fraction thereof.
DRIVEHAY DEPRESSION ESCRW
(Concrete CurD Streets Only)
Alternate "6": Recovsl and replacement oT curb an� gutter only - DriveWay vidth plus
6 feet time. �13.50
�lternate "E": Recoval and replacecer.t of curb and gutter and in�tall a 3 foot Wi�e
aFproacr with 6 inch depth - Driveuay xidth plus 6 feet times �1�.75
YERIFICATION OF FOUNDATION
Percits fo^ construction uill be issued a¢ir.idu� o!' 24 hours fro� the time c!'
aFFlication to allou for proper revieu of Lhe proposed structure and of tre
construction site.
A Certificate of Surrey o!' the lot, sboWing Lhe loc2tio^ of tre foundatior, once it
has Deen constructed xill be required before proceed:r,E xitt th� framing.
0
'� � s �
SUBJECT P .
City of Fridley 2 6 3 0 5
AT THE TOP OF TNE TWINS g � I L D I N G P E R M t T
r
; � RECEIPT NO.
� ' L � COMMUNITY DEVEIOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEC. ���
1 = �
� �'�'1 � CITY HALL FRIDLEV 55432 NUMBER REV DATE PAGE OF APPROVED BY
�°"� � �'' 612-571-3450 s�aF�s 6/22/98 / /
JOB ADDRESS 5460 florizon Drive NE
1 LEGAI �OT NO. BLOCK TRACT OR ADDITION SEE ATTAChIEO
DESCR. /� 5 Carlson's Summit Ma.nor North Addition SHEET
2 PROPERTV OWNER MAIL AODRESS 21P PHONE
Melvin Bolin 5960 Horizon Drive NE 472-9630
3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO
R& B Construction Inc 1814 214 Ave NE Cedar MN 55011 434-1206 20072653
4 ARCHITECT OR DESIGNER MAIL AOORESS ZIP PMONE UCENSE NO.
5 ENGINEER MAIL ADDFiESS 21P PNONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION Q REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
Reroof House & Gara e(18 S) 2nd La er
9 CHANOE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, NEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTftUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 OAVS AT
ANV TIME AFTEFi WOfiK IS COMMENCED. NO. DWLG. UNITS OFfSTREET PARKING
I HEREBY CERTIFY TFIAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STAIIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORFEC7. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO @ @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 'P1 s 127 �p.56
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TNE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PEfiFORMANCE OF CONSTRUCTION, �4�.25 Fire .5�,' �1.13
e PLAN CHECK FEE TOT FEE
� •���► � License $5.0 $46.94
SIGNATUAEOFCON7RAC OAOR�UTMOAIZEDAGENT IOATEI . N P OP ALIDATE THIS IS YOUR PERMIT
, � • �` � ��
SiGNATURE OF OWNER iii OWNER BUILDER� �DATEi BLD !NS� �16TE
.M i �.
��
NEW
ADDN
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
ConstructionAddress: .�a el �CC"� N�, c� ; S c� h t� t� c;d: l� �-, �-• s' ��� ��
�> ��365�
Legal Description:
Owner Name & Address: yh.-c, l v i h �c� (,'+-. Tel. # y7Z � 5[, e�U
�
Contractor: R� f� E v+ v�„;f 1����'i i c9 �, -��.. � MN LICENSE # 2�o CJ � 2(� �S3
Address: . t�1 �I '? t`l 1-�✓� �✓C [� �.d�. �-�.�, �. �S S 8 1� Tel. #�! 3 el ��2,v�
' � Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
DESCRII'TION OF IlVIPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width � Hgt/Ground Sq. Ft.
_ _ _ .__ `�„�n
� � ����� � ��
Construcdon Type: Estimated Cost: $ �� � `
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �- z 2- - g 8� APPLICANT: �%' �,�.�i�., �4-u�,���/! Tel. #�J,3e/ - I 2-0 6
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
CITY USE ONLY
$ h`G� •�� Fee Schedule on Reverse Side
$ j�� .001 of Permit Valuation (1 / l Oth %)
$ . � _ $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ � � d $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 [ ]
$ ��. �1
.:, _
BUII.DING PERMIT FEE SCHEDULE
The Cluef 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 to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,(}O1 to $50,000
$50,001 to $100,00�
l ., j . � <°sl , �
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minunum Fee is $21 plus surchazge)
$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 additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,0(}0
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 first $1�00,000 plus $5.00 for each additional
$1,000 or fraction thereof, to �nd 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 $1,0OO,�J00 plus $2.75 for each additional
$1,U00 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Orily) -
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 imstall 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 fro�n 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.
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacinq an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from n.ist, deterioration, obstructions,
and is securely supported and firestopped where required.
Yes Q� No ( )
�
The venting system is plastiGPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No (�
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air it will be sized and installed
To meet the current codes and manufacturer's specifications.
When installing a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
Yes�ql No ( )
Yes ( ) No (�
Yes ��Q No ( )
Yes �(j No ( )
/
Yes (� No ( )
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type �+��✓q�.� BTU Input � 0 0� Fan Assisted or Nat �
Appliance #2 Type �r��— BTU Input ��e�� Fan Assisted or Nat �'�
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances � Total Btu Input /O/� poc� •
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe) �� ��/f-t�lu�`(� �A-�?
�JP�OR4'0�4L�0�, i.ti��.
812142�AVENUE N0.
H EATI N G CO: CR1(�Ti�ll� MN G54�
Signed By: e� Date :. 1—/� ��
���. a���y
Building
TIlSp8Ct1dri4
763-572-3604
7G3-502-4977 FAX
�oi�a� �d
Sf]E AI3DRESg
TfflS APPLiC4lYT !S:
1'ROPERTY
OWNER/
TENANT
SUBMlT A COI+Y OF
YOUR 5'fATE
LICENSE, BOND AtdD
CEitTIFICATE OF
INSURANCE
PERMtT TYPE
�nrrE oF wo�c:
PLUMBING
RES�DENTIAL APPLICATIQN
CITIT (?F FRIDLEY
YQUR E-MA[L pppRE,qg
� ��
❑ OWNE[!
Permit No.:
Receiv�d
pxoxE: '> 6 3 _ � a _ g � -•- - - _... � sTn�azn► •�� r��.
N.�: � l3d.E elr,� LBG !� c,
STATE � TrF;uS� � _
37'ATE 602VD p EXP DATE
F� DATE
AnnxFSS: '0 2 � � �. , ,..� S �- crnr_ .Awi �� ,� sTnz� YhN � S � ia3
�UNE % G 3•- S7 2-�� FAX ~% G�7 � S � Z-� Q
�INGLE FAMILY
a n�EU►
DETAILED DESCR[pT[ON OF WORK
O 7'WO FAMILY p Tp�{�gfi
�i tt�c.�►c�rrr
FEEB ARE BAS$D ON $10.00 PER FIX7'URE, fiXCEPT WHERE NOTED. FtX1VRES: (INDICATE TpTAL N1,nyggg qp �q� BaQ�r M
$33.50. � �M[fM FF�
, SATH SINK/LAV FLOOR DRAIATS _ SHOLYER
_ BATHTUB _, GAS PIPING {NEED CI7Y L[C) � S W1MM[N(3 F�pL -- WATIIi PlPING
_CWTHF� WA5HER � KIT'CHEN S1NK _ WA'fEK CLOSEf � WA7ER SOETIVQL(S33)
_,DISHWASHFR _,LAUNDRYTRAY _WAT6RHEA7ER($3S� ' FURIRRIGApN���1�
._ �u. . -_ ._ . _ B
_ . .. � � s _.,,,, .. .. , _ .. . :.�, ,.. :.�,..��. m ,... WATER M6TER �.�.�
THI3 IS AN APPLICAT[ON FOR A pERAg1T_HOT VALID UN77L PROCESSED
1 hereb3+ aPPEY for a piumbing permit aad I aeknowledge that the information abave is comptete ead accurete; �at the work will be in
c�nf+�rmance with d�e ordtnamces and codes of the City oFFridiey anc! wich tf�e Minnesota CoAStruction Codes: tbai I uaderstand thta is
noi a permit but onty an appli�on for a permft and watk is nat to ste�t without a pennit on site; thea the woric wiil be in scco�aace
with �e approv�i plen in the ca4c of aIl work which requires review and approval of uians.
SIGNATURE pF'qppLICANT
NAME����1„� ��QiddJf.DATE ���i���%f
City Of Fridley
Bui�ding InspECtiuns Dep�ment
b431 Utiversity Avenue NE, Fridley, MAj 55432
• 763-572-3644
FAX: 763-502-4477
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