AF - 46474BUILDING PERMIT
V�illage of Fridley, Minn. N� 2 3 9 �
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Date... ....... .........� ................
�"�'�c'=: L�"°.�,...���lk� ``�', .%,`,�' Builder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Owner ........ �.� ... '
Address c,� �� . . . � °.`� .�.�°:_.� . . . . . . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCATION OF BU(LDING
No. . . . w� �l . . . . . . Street �': ��.�.�. "`.'. � . . . . . . . . . . . . . . . . . . Part of L�ot . . . . . . . . . . . . . . . . . . . . . . .
Lot ................ Block ................ Addition or Sub-Division .......................................
y,� �
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Corner Lot ............ Inside Lot . .... ....... Setbac � ideyard ... .4�..�. . �lr".':�.......
DES�CRIPT[ON OF BUILD(NG
To be Used as:
�
,,,.����' °� �. . . . . Front ,��� . . . Depth r�,�;,'a . . . Height %r s� A�?+�. . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
. .... .. .. .. .. .. .. .. . Front . .. . . . . . Depth . .. . . .. . Height . .. .. .. .. Sq. F't. . . . .. . . . Cu. Ft. . . . . . .. .
� � �
Type of Construction ; .��j.':��v+F-rt:�/? . . Est Cost . �.�``:� . .. .. .... .. .. . . . To be Completed .�.�.g. ��.".� . . .. .
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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 all provisions of
ordinances of the village of Fridley. � .
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�n consideratio of the payment of a fee of $..�. . . . . , permit is hereby granted to r. :�G.`i :� i�;s.-I�s�. . . . . .. . . .
�,�'�d��r�'. �,,R:... to construct the building or addition as described above. This permii i�s granted upon
Yhe express c�dition that the person to whom it is granted and his agents, employees and worlunen, in all work
done in, around and upon said building, 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 village limits and this permit may be revoked at any time upon violation of any of the provisians of said
ordinances. ��- � ,.�`�
�,,L:� ,�'.� �;e:��f"Zr: . . . . . Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wlring, plumbing, gas heatPng,
sewer or water. Be sure to see the Bultding Inspector for separate permits for these items.
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City of Fridley, Minn.
. BUILDING PERMIT No ,° [ 5 o s`�
)
Date: _._���� �--�--'�' � -------
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Owner: ,����:. :.�..�-�'�.�r"�_ :... _...,;;¢� Builder •---._........-•---- ,�---._._..�._..__._....--- _.__...___._.__......�__..
. �
Address .---- :.��..��.._..•_ -- � � � �
Address ..._ . . _.._... . .. ---_ ...._..._._..� _.__.._----------._.__.
� LOCATIC��F BUILDING
No. ....;�„�`.-,�`i.-•.�.--- Street .-- f -_-- --.`:::, a .._.,c_. .. .... Part of Lot
Lot .....- ......................-�--... Block ...---............_...........-�------............ Addition or Sub-Division ....---•--.................
Corner Lot .................................... Inside I.ot
Sewer IIevation _-----.-----.-.--•.---....._...
To be Used as:
...., .............._......---...._..--�•----•-�--... Front
....- � ��-�--- ................... ........_..... Front
Type of Construction ....................
Setback ...-----•-•---....._ ............._....._.. Sideyard
._...__. Foundation IIevation ._..._........_.
DESCRIPTION OF BUILDING
Depth .....- ............._.. Height ...
Depth ...._ .........:..._.: Height ....
- ... Est. Cost. ��'.�...—_c�......
Sq. F`t . ................�--- Cu. F�
Sq. F� . ...................... Cu. Ft
To be Completed ....._ ............._.....
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°i� (,✓ � �'
Ir�� J GF r,!�' i` ''�' � 13 � t`Lr1�V� Ct�'v"Cf'J �i��TS 11ND
6iJl��Jfi'�dG fit� {"r;IC I IUfVS.
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 all provisions of
ordinances of the ciLy oP Fridley.
- -- --- - - .. ._._____�_____
In consideration of the payment of a fee of $.. �.. , permit is hereb
�-----� Y �ted to._._....-------��------------�---------._..
_.._ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is grauted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, sha11 conform in all respects to the ordinances of
Fridley, Nlinnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upo violatiotrof any of the provisions of said
ordinances. � ,:
-- -• ----.:_:._...�.._..� ._._ ..__. Building Inspector
NOTICE:
Thia permit does not cover the tanelrue�ion, inatallafion for wiring, plumbing, gas heatieg, aewer or watar. Be aure to see
ihe Building InspeHor for separafe permhs for fhese hema.
._/''�'� �.� 4 /�� r>^ . a a r
Owners Name �
� ���:
�dclresa �� ,
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No. _ _4 � � �
�PPLICATTON FOR BUI]',�DZNG PERMIT
GITY OF FR.TDLEY', M�Il�NF;SOTA
- -=�-- _ �- -
LOCATION OF BUILDING
of Lot
Lot "� Block Addit3.on or S't�b.D3v,
����A
Corner Lot_____Inside I�ot_�Set Back Side-Yard
, SEWE�t ELEVITION FOUNDATION ELEVATION
lpplicant attach to�this form Certificate of Survey of Lot and praposed_bvilding __
loca.tion. '
DESCRIPTION OF BUIL�ING
To be uaed as:
/ �
��j�� ; , Front l� Depth Height �"
Sq. Ft. Cu. F't.
Front Depth Height
Sq. Ft. G�Z. Ft.
Type of Conatruction d� �,� �-��- Estimated Cost
To be c4mpleted- - - � -
3'he underaigned hereby makes application for a permit for the work hsrein specified,
agreeing to do all work in gtrict accordance with the City Ord3nances and ruling of
the Depastment of Buildings, and hereby declares that a11 the facts and representa-
tions atated 3n this applica.tion are true and correct. P.� -,
,I y//'jJ/���*T��{1�7'p'� A �� �
' ~��6� .1f€f i F" � �.l.Vl9�i'�J.1JL1�C1 � / � �
DATE � '' "
...___.___
(A Schedule of Fee costs can be found on the Reverse Side.)
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Sect3oa 2. The Inspector of Buildinga shall, before issuing any permit
for the erection of any building or structure, or for any addition to
any existing building or structure, or for any alterations or repairs
to any existing building or structure, upon application therefor� require
the payment by the applicant for such permit of fees to the amount herein
below set forth and iri �he"mann�r herein proeided to-wit:
2.1. For any such permit for the erection of any fire-proof bu3lding, other.
than a gaxage, warehouse, factory or grain e�evator, or for the erection of
a.ny fireproof addition, for similar occupancy, to any existing buildin�
shall be at the rate of �1.40 for each one thousand cubic feet, or f'r�.ction:
thereof, in such cn.bical contents.
2.2. gor an�r such permit for the erection of any firepraof garage, wax�e-
house, factory or grain elenator,�or for the erection of any fireproof
addition for similar occupe.ncy, to any existing build3ng sha].1 Ue at the
rate of �7..25 for each one thousand cubic feet, classified as "P3reproof'�
bg Section 502 of the Minneapolis Building Code.
H0,_ USE3
f`- _ --- - �.�Y �or a�g--s�=-��mi� ��r�f�as�� - �t#�.sti�g_- _ _ - --
other tP�an a garage� warehouse, factory or grain elevator, or any non- ,
fireproof add3tion, for s3mil,ar occupancy, to any exist3ng build3ng�
Permit $1.00 for each one thousand cubic feet.
GARAGES
2.4. For any such permit for the erection o£ any non-fireproof garage,
warehouae, factory or grain elevator, or for the erection of any� non-
fireproof addition, for similar occupancg' to any exi.sting building
for each such building or addition. Ninety Cents for ea,ch one tho�d
cubic feet or fraetion thereof, in the cub3cal contents thereof with a
mininmm oP �.00.
For the purpose of computing £ees for building permits the cubicel contents
_ __ of.ar�,building_or ad�:ition to a uniform height throughout by multiplying
- --
- -- —
-- th:e__gr9wz�i,_� (E�l i�she�- �e�:s�r the f'loor line of
_
-- _ -tkse - �a�ei�en� � c� �- �.� �� � � �i� ' h� �� -t�en�P�''�€�ee--sr to the
average height of the roof surfaee of the main gable of a pitched roof,
2.5. For repairs or alterations to an ex�.ating structure, the fee shall be
at the rate of �3.00; for each Five Hundred Do]1a,�,s (�5oa.00), or f�action
thereof in the cost of all propoaed work.
2.6. In no case shall the fee chasged for any permit as set forth in
Section 2 be less tha.n �1�.00.
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Date:
C��.'='rL�
Addres;
City of Fridley, Minn.
BUILDING PERMIT
Builder
G���3':�!
N° ; " 4738�",
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............. .. .._. .... _......_ �
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} � �' LOCA'��0�1 � BUILDING
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No. ..._�-.��.----C- �Street �� .:� _�:.�.��!--�f p�,�----.._..._----. Part gf �pt ._----•--._.---•--a---__._.:.._<.: __. __�.
Lot ��. .�.,�. �.��d Block ....._ .. . ..........-----._....... Addition or Su -Divi on �,,.��,,.:, --�-•y-- - �-��::_"'�'......+.-•---
,�-°' ,.�'
� - -..
Corner Lot .....--- ................._........ Inside Lot .....__�'"............--�fback�:. .. .---..: .: Sideyard ....._.....�---
Sewer IIevation -�-----�-----_...--�---...._..----------•---•------------� .................-------. Fo� tion IIevation .....-•--�--------._...-�----•-�--•-----.._...--•�---•-•--..__---._...._..._..
DESCRIPTION OF BUILDING
To ;b�e iJ �s..� i
;' ,, � _ .�r,
>.._� _.� �.---. Front .�.,�._.. Depth �;;_.. Height .._��-._.. Sq. Ft y,,�.�-,p�;,: Cu. F't. �,��.�
..__....._...._ -- ---......-----� -- -- Front ....._ ............._.. Depth .... - --. . eight .�........ q F� ....._......---�--.. Cu. Ft. -----.............._.
Z�pe of Construction ..._��+�.. .. . Est. Co�'��� To be Com
�-��"� ._ ..� . . .. . .. _ .:�- ------ Pleted ......_............----------- -- -
�.�� ������
THI:; PER?:^;�f i�0.F.5 �;�-; ��UTF�itJRIZE VIOLAT-
ION (�F Ai�lY' r'i�;�,F,'i E L�,i�D COVEN�,NTSAE'^��3
�UlLD1I`J�; F«:;"i „I�TIONS.
In consideration of the issuance to me of a pexxnit 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 city oP Fridley.
•.i�--------._.._.._..._.__.__._..._._._._..__.._.._..._..__._._...._._._.___
In consideration of the payment of a fee of '"'r'
$..- ----.--...._.----_....., permit is herebY grante�i
__.. to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is gran,ted and his agents, employees and worl�nen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordfnances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, regair and• moving of buildings
within the dty li�nits and this permit may be revoked at any time upon violation of t�ny of the provisions of said
ordinances. ;.-�, � ,�! �
Building Inspector
NOTICE:
T6is permh does not cover the eonatrucHon, installatioe fo� wirine, plumbtng, gas heafing, sewer or water. Be sure to see
�he Building Inspeetor for separate permits fo� these hema.
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�C�i'@88
APPLICATI�Ai FOR BUfI�DIldG PERMIT
CTTY OF FRIDLEY, �OTA
• LOCATION OF BIIILDING
:: .� � �, � � ; .� . �fl, , ,�!�:
No. St�ree� �t��t -- -- -- - � _ .
,� e � '--...
Lot � ffiock. � 8ddition or Sub.Di , 9
. -�-.
Corner I�ot_,Inside Lot� t Ba.ck Side-Y�rd �'
3EWF� ELE�lATION F'aONDATION ELEVATION
Applic�nt attach to thia form Cer�ificate of Survey of Lflt and proposed building
loeation.
DESGRIPTION OF BUtLDIlJG
To be used as: �
o �„F`ront ,__>�;,_„� epth Z 2� I%ight �_
Sq. Ft. � S� 'Z Cu. Ft.
Frant Depth He3ght
Sq. Ft. Cu. Ft. �
� �1 .--
Type of Construct3on ���,�-- Tstimated Cost U
To be completed_____�_„ / � =.� � . .. _
The undersigaed herebg makes application for a permit for the work here3n specified,
agree9.ng to do all work in striat accordance with the City Ordinances and ru].ing of
the Departanent of Bvildi.ngs, and hereby dec,].:ares the.t all the facts and represen#,a-
tions atated in thia appl3cation are trug and co ct.
y ___
DAT� `� � / � - � � SIGNATIIRE
, � �
(A Schedule of Fee coats can be found on the Reverse Side.)
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�c�,ti.or} 2. The Insp�c�or of Buildings elna].7., bePore i�suing ar�' permd.�
Po� the ereotion of any building or structure, or for anq addit3on to
any existing build3ng or atructure, or for aay alterat3on� or repairs
�►o .a.ny exiating buildin� or struature, upan application th�refor� reqwise
t►i�e payment by the e,pglicant for such permit of fees � the amount hereia
ioeiow aet fortY► and an the manner het�eiz� provided to-wit: �
• 2.1. For aar�y such perm9.t for the ereat3on of ang fire-praof bu3ldittg�. other
than a garage, warehouee, factox�r or grain eleee.tor, or fo� the ereatior► of
a,ny f3reproaF addi�ion, for simi].ar oacuPanaY, to any eu3a�3.ng laiia.ding
shal7. be at the rate o£ .�]..1�0 for each one thouaand cubic feet, or fraction �
thereaf, in suaia oubica,l c�ntants.
2.2. For eny euch permit . for the erection of e.r�► i'ireprooF gare.ge, �aare-
hous�, fsetory or grain elev�tor; or for the ereation of aay.fireproof
addition for simtlax� occupancy, to.any exieting bui3ding ehall be at tb�
rete of �1..2� for each one thousand cubic feet, elassified ea "fireproofn
by 3ection 502 of the Mtnnes,poli9 Builcl�.ng Code. �
0� IISES
2.3. Far e.ny �uoh permit for the eraction of any non-fireproof building
other then a garage, warehouse� Pactory or grain elevatar, or any non-
fireproof e.ddition, for aimilar occupanoy� to any exist�ig building.
Permit �7..� for each one thvusand cubic feet.
GARAGES
2.4. For any such perini.t £or the ereot�.on of a�y non-firaproof �ara�e,
warehouse, fao'tory or grain elevator, or for the erect3cn of any noa-
fireproof addit�.on, for �imilar occupancy, to arr� exi��ir� building �r
for each euch bui].ding or addition. Ninety Gents for eac�a one thousand
cubic feet or fraction thereo�, in the cubicel contents t}ssreof w3th a
m�ni�mnn Of �.00. •
�� For the pvrpose of computing fees for bu3.ldin� perm3.ta the cubic�l contents
of any 'building or e.ddition to a uniform hei�ht throughout b� mu�.tipl��..ng
the ground area covered from a point six.(6) �.nches below the f'loor line a�
the basement or cellar to the average haight of the upper surface or to the
� e,vera�e height of the roof aurface of the ma3n gable of a p3tched roof.
� .:
2.5. For repa3rs or alterations to an exiating atructure9 the fee shall be
at the re.te of �3.00 Par each Five Hundred Dollacs (�5�.00), or t'raction
thereoi' in the coat of all proposed work.
2.6. In no-cese �hall the fee char�ed for any perm3t as set �orth in
Sect3�-�2 be less than ��..�.
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MEMO T0: CITY ENGINEER
FROM: CITY MANAGER
DATE: MAY 14, 1970
MEMO: N0. 50-514-70
Councilman Breider indicates he received a call
from Mr. Schepher (?), 381 Hugo Street. Mr. Schepher
was concerned about a defective curb - too far back or
something. Resident indicated that someone from
Engineer Department told him a mistake was ma.de, but
it would be too expensive to correct.
I need information for reply to Mr. Breider. He
would like to know status, what was the mistake? How
much it would cost to correct? Was it a fault of the
contractor, can we require contractor to replace and
just how the error occured.
Please give me info on which to base reply.
HRA�mis
CC: Councilma.n Breider
��� � �
HOMER R. ANKRUM
i�� ° � ;
P, :.:,-
x� _ . ,. .
ATTENTION � , � ...,�
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SUBJECT � i` ' � •• DATE► �� , • ��'d
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DATE � +�� �,�� SIGNA7l1RE
RETURN THIS COPY TO ORIGINATOR
f_�.,� .
NTION'OF.: , ` _ , ?�'�:-.� ;- '
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DATE �`°�-- � � � �
DATE ,��""'E- � l � �� , SiGNATURE
//
RETURN THIS COPY 1t0 ORIGINATOR
:
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• y ORIGINATOR — Extract PINK copy and Forward WHITE and YELLOW copies.
Y
REPLIER — Return YELLOW copy and retain WHITE copy.
FORM G-1. MANUFACTURED BY HOLDEN BUSINESS FORMS, 807 WASHINGTON AVE. NO., MINNEAPOLIS, MINNEBOTA • FEDERAL 9-0241
ATTENTION OF:
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SIGNATURE
REPLY:
DATE SIGNATURE
REPLIEE:'S COPY— RE7'AIPd F04i YOi10 FiLES
,
�
�
sue�ecT PERMIT
City of Fridley ° 16 5 2 2
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
' � RECE
; `L ____�_ COMMUNITY DEVELOPMENT DIV.
r j � PROTECTIVE INSPECTION SEC. � J�9 /
1 � ' O !m
i '
l-_-_ � �����;,� CITY HALL FRIDLEY ,55432 NUMBER REV DATE PAGE OF APPROVED BY
i �� 612-571-3450 910-F15 / /
4/13 i�,
10B ADDRESS 381 Hugo St. N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. %3�7Jr A Ri.verview Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Ryan Falk 381 Hugo St. N.E. Fridley 55432 786-3626
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Owner
4 ARCHITECTORDESIGNER MAILADDRESS 21P PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Resid�ential
7 CLASS OF WORK
❑ NEW � ADDITION xCJ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Finish basement and pravide cant3leaver over exterior daors
9 CHANGE OF USE FROM TO
STIPULATIONS
Any bedroom built intro the basement must have an approved esca.pe window.
SEP�RATE PERh1BiS 6�EQ9J1R� �'�R �1#tt1��:
HFn�9lS'�� �.'-� �s'•,''s:�� .'^, .;a,lr ;`—'nlC
S �.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOCZ FP3�
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORIZED 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. N0. 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 WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1� �300.00 $`� 75
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $ZS.��
PLAN CHECK FEE TOTAL FEE
$25. 75
SIGNATUREOFC CTORORAUTHORIZE a E IDATEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
�1 ° 1� � � � -��'t.._ ��%/r� �� ��-��,
SIGNAT Oi OWNER�Ii OWNER BU LDERI IDATEI BLDG INSP f1ATE
CITY OF FRIDLCY Effective Aug. 1, 1981
APPLICATI�J FO(� RCSIDCi�TIl1i_ I3U1LDIf�G PCI2i�iITS
(t�c�r, Alterations, Additions, or Repairs)
ONJI�ER: � � � r� � - I �:
ADDRESS: � S' l �°�-v Cs� � S� �
TEL N0: � �ls' � C� ��
t3UI LDER : G�� �
ADDRCSS:
TEL f�0:
Construction Location
• STItiTT NO : � � STItEET: � C� C� �� '
LoT: . �73 �`1 � BLOac: _�_
ADAITION : � �t <S �T� l.9 �� L�� i�'l �� ��
Corner Lot: Insii3e Lot: SetbacY.: _ Sideyards:
Ap�licant attach to tliis form two Certificates of S�rvey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOfd OF COhJSTP.UCTIOP�
. \
���Sh �5��`� Front:
�` S are . Feet:
C�.n`F"9L.C,A.� E� °"� �
��'� � Front:
Square� Feet:
�ype of Cor,struction :
'Ib Be Oor,�pleted: � t 1 � 1 D�
Depth: Height:
Glibic Feet:
Depth: Height:
Wbic I'eet:
Estimated Cost: $ ' � � ��
Alt. A Alt. B
Proposed Drive��ay Width If New Openinq Is Desired: $� $
. . SE� REVER�E SIDE OF SHEET
Ti�e undersigned hereby ma3:e� application for a permit for the �.vrk� herein specified,
agreeinq to do ,all work in strict accordance r�ith the City of Fridley� Ordinances �aid
ruling� of the Department of IIuilc3Sngs, and hereby declares that all the fact� and
representations stated in this appli " -
Dt�T�: � " � � r � 2 SIGNATUI2E
Stipulations:
� 2�.c�
� �? �
�
� �.7j
BiTILDING PERMIT FEE SCHEDULE
The Inspector of buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any
bxisting buildinq or structure, or for any alteration or`repairs
to any existing buildinq or structure, upon application therefore,
require the payment by the applicant f oz such permit of fees to the
amount herein below set forth and in the manner herein provided to-wit:
TOTAL VAIdJATION
$1.00 t� $500.00
5501 to $2,000
S2, 001 to $25, 000
$25,001 to $50,000
FEES
$10.00 Minimum Fee $15.00 plus surcharge
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
including $2,000
$32.50 for the first $2,000 plus $6.00 for each
additional $�,000 or fraction 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 includinq $50,000
S50,001 to $100,000 $283.00 for the first $50,000 plus $3.00 for
each additional $1,000 or fraction thereof, to
and including $100,000
$100,001 and up $443.00 for the first $100,000 plus $2.50 for
each additional $1,000 or fraction thereof
PLAN CHECK: 25 percent of building pezmit fee
DRZV�WAY DEPRESSION ESCROW: Concrete Glirb Streets Only
Alternate "A": Removeal and replacement of curb and gutter only
Driveway width plus 6 feet x$13.50
Alternate "B": Removal and replacement of curb and qutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x$15.75
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minuatan of 24 hours from the time of
application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of SuYVey of the lot, shawing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
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SuBJECT P ,
City of Fridley 2 6 9 5 0
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� � NO.
� `v _����_ COMMUNITY DEVELOPMENT DIV. �� fl�
r � � PROTECTIVE INSPECTION. SEC. �y
i . �
� �� �"'1 � CITY HALL FRIOLE� SS43P NUMBEF REV DATE PAGE OF AVPROVEO BY
�"""'� � �'� 612-571-3450 910-F15 / /
7/31/98
JOB ADDRESS
381 Hu o St NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
oesca. 73 74 75 A Riverview Hei. hts SFIEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PNONE
Joe Behr
3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
e
4 ARCHITECT OH DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP pHONE LICENSE NO.
8 USE OF BUILDING
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION L� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
— r o se
8 CHANOE pF USE FR6M TO
STIPULATIONS
Install smoke detectors to meet the State Building Code — in each
sleeping room and on each level of house.
Provide vapor barrier over insulation.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING, MEATING, �PE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
VENTILATING OR Alii CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION zONING SO. FT. CU. FT
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WOHK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWIG. UNITS OFFSTHEET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORFECT. ALl PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVEI;NING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED NEREIN OR NOT. THE GRANTING OF A PEFMIT �ISOO �.75
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �({8. rjQ Fire .SC �1..5�
PLAN CHECKFEE T07AL E
0.75
NATURE OF CON � RACT A IIED AGENT DATE� N OP ALIDAT IS IS UR PERMI
� r
Si NA UFiE OF O NEii Ui OWNEfi BUILDER� ID 1 + iNSP q�TE
1VEVV
ADDN
ALTER
[l
Il
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ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII,DING PERNIIT APPLICATION
��
Effective 1/1/98
�� ��
�� ��
Legal Description:
Owner Name & Address: �O � �,�,�, r" Tel. # °1 � °�' � S� ({�
Contractor: �� MN LICENSE �
Address: 3 �s l �1 ��o C� . N � � . Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. ��
LIVING AREA:
GARAGE AREA:
DECB AREA:
�OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width
�n� w�acn
Width
Height
Height
Hgtl Ground
a
c.�S ► n lr�c
Sq. Ft.
Sq. Ft.
Sq. Ft.
C� S�'i triNL �1 'Z�- -° /�f���./'�C�C; �-�'�l "���� — �"��;7���
Construction Type: Estimated Cost: $ ' ����-
� (Fee Schedule on Back) ,��
Driveway Curb Cut Width Needed:
DATE: � I �l �d
Permit Fee ��; `��� $ .
Fire Surcharge ���,� �
State Surcharge e d�.��$ -�
SAC Charge $
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
$
$
$
Ft. + 6 Ft = Ft
$
CITY USE ONLY
Fee Schedule on Reverse Side
_$
Tei. # % � 7—/ S�/�(p
� l V'(�I ��ti�� �� G�`�
�-��;��C� ���,���� ��
�L �9 �_SS' ��� � s�� �
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above �
$450.� Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
�� � �,�, , �
TOTAL $ � -
�
STIPULATIONS: l� I/1�7� �� _�'T�.�• �'� /�'(�. ��i��'
G�,%ti'� ,sg•'.i� �.cr .l1LL - ��''-�� _-�'i � .�D�-4f�'
i�ylD� �/r�`7z- Y'�2 �"�CsGll � r=��
�
!
BUII.,DING PERMIT 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 to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000 .
$50,001 to $100,000
$100,001 to $500,�
$500,001 to $1,000,000
$1,Q00,001 and up
:
FEES
$21 (Muumum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,0� ��
$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,OQ0 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 first $100,0U0 plus $5.00 for each addirional
$1,000 or fraction thereof, to and including $SOO,Ot�
$2887.25 for the first $5(?0,000 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) � -
Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Altemate "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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
�
e
. ..._ r � .
�
�
SuB�ECT
c�ty of Fr�a�ey
AT TNE TOP OF TME TWINS g U I L D I N G P E R M I T
i �
� �
� i y_���� COMMUNI7Y DEVELOPMENT DiV.
% � � PROTECTIVE INSPECTION SEC.
i----� �"' �•� CITY NALL FRIDLEv SS132 NUMBEp
� 612-57 �-3ab0 s � a F � s
JOB ADDRESS 381 Hugo STreet NE
t LEGAL LOT NO. BIOCK TRACT OR ADDITION
oescR. X 73, 74, 75 A Riverview Heigh
2 PROPERTY OWNER MAIL AODRES$
Mike Coyer, 381 Hugo St, Fridley, MN 55432
3 CONTRACTOR MAIL ADDRESS
Mike Coyer, 381 Hugo St., Fridley, MN 55432
d ARCMITECT OR DESIGNER MAIL AOORESS
NEV DATE PAGE OF
11/29/00 � �
3 i 5�0-��
�� � /
•vvaOVEO er
SEE ATTACNEO
tS SHEET
21P PMONE
786-7218
ZIP PNONE LICENSE NO
21P PNONE LICENSE NO.
8 ENGINEER MAII ADDiiESS ZIP PMONE LICENSE NO
8 USE OF BUIIOING
Dwelling
7 CLASS OF WORK
L� NEW O ADOITION O ALTERATION � REPAIR D MOVE O REMOVE
8 DESCRIBE WORK
6' x 8' vestibule and re-rooi Ga
9 CNANOE OF USE FROM
(6 Sq) Tear-off
TO
STIPULATIONS
See stipulations on plans.
Underlayment must comply with State Building Code.
1n/ARIVIIVG
�efore digging call foR
all utility locations
454-0002
REQUII�ED �Y LAW
SE���►�� � ����r"t�iC r �
REQUIRED FOR:
HVIRING, HEA77NG,
PLUi'������ ��,N� �I�NS
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, IiEATING. ��rc vr �,arna� . ��.t,Ur�
VENTI�ATING OA AIR CONOITIONING.
THIS PEFMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NINfi SO. fT
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO POR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFV THAT I HAVE F1EAD AND EXAMINEO THIS APPLICATION 1 STALLS
AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW$ yp UATION
ANO ORDINANCES GOVERNING TMIS TYPE OF WOqK WILL BE COMPLIED ��, 460 . H�F
WITN WMETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHOFITY TO VIOIATE OR CANCEL THE pEqMl7 fEE
PROVISIONS Of ANY OTMER STATE OR LOCAL lAW REGULATING CON- ��j8.3S
STRUCTION OR 7NE PERFORMANCE OF CONSTRUCTION ,
0� CON'aA QA pp q�TMOp12E0 eGENT IDATE�
� • %Zy-�
1� OWNE OWNEp BWlDEf1� IDAtEi
F � '�!
P �OCCUPANCVLOAD
OfFSTREET PARKINC
IGARAGES
���
Fire SC $1.46
�p Al FEE
70.54
� TNIS ISIV��ERMl7,
/ �� /�+
i �
NEV1l [ J
ADDN []
ALTER [ ]
Effective 1/1/2000
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: � U � �`f �-�� �� � � �.
Legal Description:
Owner Name & Address: �1�� �o (/ e o" Tel. # ��� %Z/� �
Contractor.
�
MN LICENSE #
Tel. # �%�°� -��� 7
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LNING AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Width Height Sq. F� ��
DECK AREA: Length Width Hgt/Gr nd Sq. Ft.
OTHER: � � � /
� 3. � � �y�80
�r� � � � ��� � � �, � �' , 7�j1� �a�' L/. /y sy ��,a�5
� � �
Construction Type: Estimated Cost: $_ =-�tt7'o �� �✓l00,$ /�
J
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
�'i�,
DATE: � 02 . F�� APPLICANT• Tel. #, °���
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ G. 3� Fee Schedule on Reverse Side
Fire Surcharge $ % �%(o .001 of Permit Valuation (1/10th%)
State Surcharge $ � 73 $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contra�ctors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$,
$.
$ � � 7`a'`. S�J'f
� �- - —
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
a
BUII.,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pernuts 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 $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
$1,000,001 and up
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 addirional $1,000
or fraction thereof, to and including $25,000
$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 $7.00 for each additional
$1, 000 or fraction thereof, to and including $100, �0
$993.75 for first $100,000 plus $5.60 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
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,0�00,000 plus $3.15 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 $15.50.
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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proger
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
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, ` AT TME TOP OF TME 7WINS ��� L D I N� P E R M I T RErC
r
� `y _____ COMMUNITY DEVELOPNIENT DIV. ���_��0� ����
r � � PROTECTIVE INSPECTION SEC.
� _ �
� �"'1 � CITY MALL fF10lE� 331�2 nuMBEA REV D�TE PAGE Os �PVROVED Br
�.---�: �.� 612-571-3¢b0 910-F15 6/ 5/�1 / /
10B ADORESS 381 Hugo Street NE �
1 LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
oescR. 73, 74, 75 A Riverview Heights SHEET
2 PiiOPERTY OWNER MAIL AODRQS$ Z�P PMONE
Mike Coyer 381 Hugo Street NE 612-919-5017
3 CONTRACTOR MAIL AODRESS Z�P PMONE LICENSE NO
Same
4 ApCHITECT OR OESIGNEIi MAIL AODRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS 21P PHONE IICENSE NO
8 USE OF BUILDINCi '
Residential
7 CLASS OF WORK
C� NEW O ADDITION � ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 16' x 12' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
� ����
��fore di � �
99�ng call fo�
all utility loc�tion�
4�DQ02
�EQ�'RED g� LAw
" TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV IOAD
SEPARA7E PERMITS ARE FiEOUIRED FOfi EIECTFICAL, PLUMBING. HEATIN(i,
VENTI�ATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOIp IF WQRK Oii CONSTRUGTIOM ,�ONING SO. FT CU FT
AUTMORIZEO IS NOT COMMENCEO NrITHIN BO DAVS, OR IF CON$tpUCTION
OR WORK IS SUSPENDED OR ABANQONEO FOR A PERI00 OF 120 DAYS A7 "
ANV TIME AFTER WORK IS COMMENCED. ' NQ DWLG. UNITS OFFSTREET PARKING
I MEREBY CERTIFY TNAT I MAVE REAO ANp EXAMINED TMIS APPLICAT�ON ], STALLS GARAGES
AND KNOW TME SAME TO BE TFiUE AND CORRECT. ALL PAOVISIQN$ Of LdW$ yALUATION SURTAX
ANO OROINANCES GOVEflNING THIS TYPE OF WpRK WI�L 8� CpMP�.lEO @
WITH WHETMER SPECIFIED MEREIN Oli NOT. TME GRANTING OF A pERM1T WZsi12 �1.OS
DOES NOT PHESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEL THE pEi7MIT fEE SAC CNARGE
PROVISIONS Of ANY OTMER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION OF TNE PERfORMANCE OF CONSTRUCTION �S�.ZS Fire SC �Z.lO
P�AN CMECK FEE TOTA FEE
6.40
S�G 'AACTOpOpOUT r+�IEDaGENt iO�iE� NEN RO ALIOATE TMIS IS VOUA PERMIT
P_ ��—� �' 'L/ ` ��� �:
S�GN UAEO� Ep���O U40Ei1� iDAfE� � Bt0 �hSP � O��E
. A.
K '
NEW []
ADDN [] ,
ALTER [ ]
Construction Address: �
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�
Effective 1/1/2001
(763) 572-3604 Bldg Insp
Owner Name & Address: iNl.�. %'� �u �,�.� Tel. #_�'/�,.. n 9��- ,S`o/ � C
Contractor. .S �� MN LICENSE #
Address � � o� .�,. Tel. # '7�°G ^° �� / �' �
LNING AREA:
GARAGE AREA:
DECK AREA:
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. Ft.
Length Width Height Sq. Ft
Length � Width %� Hgt/Ground �� Sq. F�
OTHER:
Construction Type: �f h�t �.� 'y°,� Estimated Cost: $ 2� ��
Driveway Curb Cut Wdth Needed: Ft + 6 Ft = Ft x$ _$
�
DATE�"' �'"3'� G � APPLICANT: ` Tel. #
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$-�P �� Fee Schedule on Reverse Side
$ �Z � /� .001 of Permit Valuation (1/10th%)
$ / . �� $.50/$1,000 Valuation
$ $1150 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 [ ]
�, r �
BUII.,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any e�cisting 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
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
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 iust $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,�0
$643.75 for first $50,(}00 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 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
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
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 $23.25.
VERIFICATION OF FOUNDATION
Pernuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Only
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sun�ccr �
c�ty of Fridley
AT THE TOP OF TME 7WINS g�J I L D I�l G P E R M I T
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� • COMMUNITY DEVELOP�IIENT OIV.
� �V ����� �
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� �"'1 � CITY HALI FRIDLEV 53�32 NuMBER pEv
�'""� � ,'� 612-571-34b0 914-F/5
JOB ADDRESS 381 HugO St NE �
t IEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR. 73, 74, 75 A Riverview Heights
2 PFOPEiiTY OWNER MAIL AOqRES$
Mike Coyer, 381 Hugo St, Fridley, MN 55432
3 CONTRACTOR MAIL ADDRESS
XXX Gjertsen Company, 2010 E Center Circle, Ply
4 ARCMITECT OR OESIGNER MAIL ADOFiESS
5 ENGINEER MAII
Dwelling
7 CIASS OF WOFiK
O NEW
8 DESCpIBE WOHK
Rebuild roof (house)
9 CHANGE OF USE FROM
STIPULATIONS
O ADDITION O ALTERATION
TO
See notations on pian.
Underlayment must comply with State Building Code.
DATE
12/27/O1
21P
OX REPAIR
.��.,�...,..��.
SEPARATE PERMITS ARE REQUIREO FOR ELECTRICAL, PLUMBING, MEATING.
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR COf�STRUCT10M �ONING
AUTHORIZEO IS NOT COMMENCED W.ITHIN 80 DAYS. OR IF CONSTRUCTION Y
OR WORK IS SUSPENOED OR ABANQONEO FOR A PEFiIOD OF 12Q DAYS A7
ANY TIME AFTER WORK IS COMMENCED. ' NO OWLG. UNI
1 HEfiEBY CERTIfV TMAT I NAVE READ ANO EXAMINEO THIS APPUCATION
AND KNOW THE SAME TO BE TFIUE ANO CORRECT. ALL PROVISIONS Qf LAW$ VAWATION
AND ORDINANCES GOVERNING TNIS TYPE OF WOpK WILL B� CpMP�IED
W17H WHE7HER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT �],2 8]S.
DOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CAMCEL THE pEPMIT FEE
PROVISIONS OF ANY OTMER STATE OR �OCAL LAW REGULATING CON• $223.25
STqU ION OR 7ME PERf RMANCE OF CONSTRUCTION
�( PI,AN CNECK f �
/\ Q-!� � � �" � % � � $5 . 0
$�GN4TUAE OF �QN • AGCTOA Op AUTMOp�2E0 ENT IOATE� �ue � e
iO�iE�
� � :
SO.
STA�LS
vAGE Oi
� �
PERMIT NO.
32368
RECEIPT NO.
.-�
G � ��
�vvqovEO er
SEE ATTACNED
SMEET
PMONE LICENSE NO
9-546-1300 179R
PMONE LICENSE NO.
LICENSE NO
O MOVE O REMOVE
OCCUPANCYLOAD
CU FT.
OfFSTREET PARKIN(
IGARAGES
,12.87 Fire SC
OTAL PEE
$247.55
fED TMIS IS VOUFi P RMIT
. /_: — -
IIEC-12-2001 ��28 FRQM CITY OF FRIIILEY TO 5460623 P.04/�
NEW ( ] ' E�r...a �,. o...._ .
ADDN I J . CITY OP FRtDLEY �,s�� e�,(- �r
ALTER ( j SlNGLE FAA�LY AND DUPLEXES R 1 ANd R x ��p,(�.
BUlLDING PERMITAPPUCAT10N
m
Constntction Address:
Legal Oescription:
Owner Narne � Address:
Contractor: ' r�
Addr�- � 1 O � �
LMNG ARFA:
GARAGE ARFA:
DECK AREA:
oni�:
Construc�ion
�81
S�- Gl/�
� �� � .�S
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1 Y`V V l 1�
Tel. � � � • oc i7
twN uc�vsE � / 7 �f
��/ T�. # 7d�-sS�/(r/��
Attach to #�ts applica�on, a Certific�ate oi Survey of the
lot, with the prvposeci canstn�an drarnm on it to scale.
DESCRIPTION OF I�f1PROVEMENT
1 P 1 �fw� _..
Lengtt� � Width __�c� Height !% � ` 'Sq. Ft ,
Lengttt Widtb ,
Lengih Width ,
L n �1 �._
Hetght 5�. F�
�1
�ca�s�. $ ��.5�
Driveway Curb Cu# Wtdth Ne+�ded: Ft + 6 Ft = Ft x$ =�
DA'f�: �-�„ APPLICANT: .e`A7�,h� �/1'1,�,� Tel. # i��-�.Sry�-��c�0
� �
CI'CY USE ONI.X - Caf1(763) 672�60d��� ���ees ff mailing in applicallon
Pennit Fee $�� «�� Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valua�on (1/10th%)
State Surcherge $ $.50/$1,040 Val�ia�on
S�►C Ch�rge $ �1150 per SAC Unit
Ltcense Surcharge $ �. Qd �5.00 (Siate Ucensed Residential Contractors)
Driveway Escrow $ Alt "A" ar Alt "8" Above
Erosion Conttol $ $450.00 Conserva�on plan Review
Paric Fee $ Fee Det�rmined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary � j
TOTAL $ � � ' �`SA
STIPULATlONS:
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COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all cuRent codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes O No O
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 existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combGStion air, it will be sized and insta[led
to meet the cuRent codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installing a• new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the cuRent codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
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 cuRent codes. Yes () No ()
Appliance Tvqe and Size/Common yent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 �/ent C�n�ector Height ft Le^.rth `t DiGm�¢�r i� Typ�
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :