AF - 47192� • -- a-- ------- -- _ �_�s
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City of Fridley, Minn.
BUILDING PERMIT
Date: ..`���.. �.�. . °�..J, .............
Owaer.......................................
Addre� ......................................
N° 3543
Builder � . . . . �-��l.Q.f�Y.� . . . . . . . . . . . . . . . .
Address ...�e��� .................................
LCaCATIC?�Vo�, QF BUILDING
No. �.�.�� . 5treet . .. .. . .. �'..�. .. .. .. . Part oP Lot .. .. .. .. . . . . . . . . . . .
... .......
Lot . . . . . . . . . . . Block . . . . . � . . . . . Additfon or Sub-DfvIsion . ��"'�J'�i . �
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ........................
DESCRIPTION O� BUILDING
To be Used as:
. . . . Fr�t '��: y.,� Depth�;� .—.-:�a Height .l.%. t� � sq. Ft. %�,�''�'c�. F't. � � �7.f `
.................... F'ront ........ Depth ........ Height ........ Sq. F't. ........ Cu. Ft.
Type oP Construction . .. . .. �st. Cost.��� �,�.(B. �.� . ... . . . .
....... ...... ..... To be Completed ..........
In cronsidera.tion of ffie isstiance to me of a permit to
the proposed work fn accordance with the descsiption ab
ordinances of the dty of Fridley.
desribed above, I agree to do
�mPliance with all provisions of
......................................
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In consfderation of the payment of a Pee of $.� /. . . . . . ., permit fa hereby gran�ted to . . . . . . . . . . . . . . . . . . .
•. to construct the bwllding or addition as described above. This permit is granted upon
the express condition that the person to whom it is gre,nted and hta agents, employees and worlmien, in a11 work
' done in, around and upon said building, or any part thereog, shall cbnform in all respects to the ordinanc�s of
�!, Fridley, Minnesota regarding loca.tion, construction, alteration, maintena.nce, repair and moving of buildiugs with-
in the city limits and this permit ma,y be revoked at auy time ugon viola.tfon of aziy of the provisions of said
ordinances.
: .�/� . . .., . Building Inspector
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NOTICE:
This permlt does not cover the construa�tion, Inetallaiton o� alte�atlon to� wiring, plumbing, gas heating�
sewer o� water. Be sure io see the Buildlne Inspeato� fo� eeparate permita fo� theso (tema
MINDERENGINEERING CO.,INC.
� ENGI NEERS AND SURVEYORS
LAND euRVEY�NO � 801L' TESTIN�
CIVIL Au MVNIGIPAL ENOINEERINCi LANO PLANNINO
6418-Sr'oT" AVENUE N.
��� ?! IJIINNEAPOUS 2i, MIP1N.
����� KE 7-3637
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WE HERE6Y CERT�FY THRT TF115 IS A TRUE AN� CORREGT REPRESENTATION OF A SURVEY OF THE BOUNUARIES OF TME
LAND ABOYE OESGRIBED ANO OF TNE LOGA710N OF ALL BUtLDlNGS, iF Pa�Y, TKEREON , AND aLL vi518LE ENCRoACHMENTS,
IF ANY� FROM ORON SAI� LAND. MINDER ENGINEERING CO., INC.
OATED TM�S DwY oF �"t° b� r �0• ��5 •;.-
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City of Fridley, Minn.
BUILDING PERMIT o ; � f � �
N. �' 4'7'72 _� .
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Date: _ _� `" _�._�� "'"r +�.'?..� _._.__.._._._..._ �
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Owner: . - -:'',=-�' �-.�'�._.� :. ;_ �.� �Y�� � :� �:'?�'.._ Builder _.____
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Address .. .;:.---����� • :��.:° � ��3�__.. Address .�.. _'�`� _� ��.�.��L.:�--•--_____._.__�__
� � LO, TION Q!-�a UILDING
No. �--. �.�...�.._�:.�''._ Street ._ .: '� '` ����1 --- "� ��.,�
� r �� E,.> ;�--�" -- -.,�`-.. ._I..... � Part� Lot ---.._.......__.._.._..._...___._�.._..__.__._ .___..___.
�' � Y � x
Lot .__._.�.. .... .._........ Bl�.,... :..__,�.... _ ......... ...... Addition or Sub-Div�sias .�*' �� � � �-• -+,-* �-
---.... ,�+ .r,,�' --- � "'. � � '5,.�- �
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Corner Lot ............._�....... Inside Lot ...__ ..: . ..---.. _ ..... �back =� :t,�1'�%...�_�Sideyard ---._ .....,�. .�........----....--..--------
SewerIIevation ---�---�--._._...._......._....__....._..-•---•-�-----��--�--...__..._._..-----�--.......... Fou�]ation Elevation ..--�-••---•-......_ .............---...._------.............__..._.-•---•---�--...---
DESCRIPTION OF BUILDING
To be Us
.
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� °. ='i. � �� ... `�? .::�'�: _ _ . �'"�``°� -- r.-'� �� '
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.,g:.�. :x.._ ..�_..r'.1..... Front ....�.�� ,/. �d` f ,� - f �
Depth .�„e � Height ..�f.� -----. Sq Ft. -� -{� -�- Cu. F� -.,i�. �
-- _. . ....._�__- ...... ..._.... F'�ont _...---�- �------... Depth ... ... ._ �-� Hc�ight �-- 39. F� ---.._ ..___....--- Cu. F� ....._..... __......
.
; � �r„� �..�«�,,,, �.�'.:�
Type of Construction .._:�� .�:'r.;�: � r a.:...... Est. Cost ...�� ��,, ...�,� . ............. To be Completed ....._....-•••_---••-------.---.. ..----.....
��"���`�"���1
THiS PER�P;! f f�"�r.�� I'vUf .qtJTHORlZE VIOLAT-
ION 0� A�JY N,,: . f11 E LA�VD COVENANTS AND
BUILDIi1JG RES"PRICTIONS.
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 wlth all provisions of
ordinances of the city of Fridley.
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_....�.�._...___...___. _ __..
. �_ � .- -
In consideration of the payment of a fee of ;�.....�'.`_"':"'�. , '
$ --- pernut is herebY granted 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 granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Nlinnesota regarding location, construction, alteration, maintenance�-r��air and moving of buildings
within the city limit� and this permit may be revoked at any time u violationjof any of the provisions of said
ordinances. ,.��` ' ` � � ,�� � ��
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_.. ��....<_<...._.:..._..._-�.�:.�,..�_:..�..�:__.. suilding Inspector
PIOTICE:
This permif does not aover the eonsfruetlon, insfallation for wiring, plumbine, ges heafing, sewe� or water. Be sure to see
the Building Inspeefor for separate permffs for these ifems.
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APPLTCATION F0� BIIILDIldG PERMTT
� CITY OF FRIDLEY, �0�'A
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Ownera Name �� . ��' ��� -�.�,,_.�! Builder,
Addresa �� ���� � �� � Address
LOCATION OF BIIILDING
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No. � � �� . Stree� ' � _,_, pert of Lot
Block . Addition or S�ib,Div. �-����: ��'�����
Lot ,,. . `
Corner Lot! aide Lot,___,Set
3Ei�t ELEVATION FOUNDATIf�N ELEVATIOAI_,__ -. .�,�.,.,,,,.,..
lpplic�nt attach to th3s form Certificate of Sux�vey of Lot and propos�l building
locatioa.
DESCRIPTION OF BUILDING
To be uaed as:
> >
� � � F`ront �•�� st° � Depth �� Hs3ght � „�,_
Sq. Ft. .- Cu. Ft. �,��
-
F'ront Dapth Height
4�
Sq. Ft. Cu. Ft,
Type of Construction��s���-� Estimated Cost
_.,,�
To be completed . _
The undersigned hereby m�kes application for a pe.rnoi.t For the work here3an specified,
agreeing to do all work in strict acCorda.nce with the Cit�► Ordina.nces and ruling of
the Departament of Buildings, and 1lereby declares that all the facts and r�presenta-
tions stated 3n this applicat3an are true and correct. � ,
. ��
,��. � � �� SIGN11TtA�E ° m � �-�� . `�
DAT� (,�,����,�_„_,
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(A Schedule of Fee costs ce.n � found on the Reverse .
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HOILDING PERMIT FEE SCAEDIILE
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Sect3on 2. The Inspector of Buildinga sha11, before issuing any permit
for,the erect3on df any builcling or structure, or for any addition ta
any existing bui].ding or structure, or for ang alterations or repairs
to.any exiating building or structure, upon application therefor, requ3se
the ps�ment by the applica.nt for such permit of fees to the amount herein
be3ow set forth and in the manner herein provided to-wit:
_ � 2.1. For any such perm3t for the erection of any fire-proof building,.other
th�n a garage, warehouse, factorg or grain elevator, or for the erection of
any f3xeproof addi�ion, for sim3lar occupancy, to any existing building
shall be at the rate of $1.L�0 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2. For any such permit for the erection of any fireproof garage� were-
housQ� factory or grain elevator; or for the erection of eny fireproof
addiiion for sim�lar occupancg, to any existing building sha1Z 'be at the
rate of �1.25 for ea.ch one thousand cubic feet, clasaified as "P3reproofn
b�► �ction 502 of the Minneapolis Builcl�xig Code.
Oi�USES
2.3. For any suah permit for the erection of any non-fireproof building
other than a garage, warehouse, factory or grain elevator, or a.ng non-
fireproof add3tion, for aimilar occupancy, to any exist�.ng build3n�,
Permit �]..00 for each one thousand cubic feet.
G� ..
2.4. For any such peria3.t for the ereation of ar� non-fireproof �arage,
warehouse� factory or grain elevator, or for the erection of an�r non-
fireproof addit3on, for similar occupanc�, to any ex3.sting building
for ee.ch such buil.ding or add3tion. Ninety Cents for each one thous�d
cubic feet or f`raction thereof, in the cubical contents ihereof with a
m�n�um af $4.00. � .
For the purpose of comput�.ng fees for building permits the cubical contents
of eng�building or addit3on to a uniform height throughaut by multiplying
the �round area covered f`rom e. goint si�c.(6) inches below the floor line of
the basement or cellar to the average haight of the upper aurface or i.o the
average height of the roof surface of the main gable of a pitched roof.
� -
2.5. For repaira ar alterations to an existing structure, the fee shail be
at the rate of �3.00 for each Five Hundred DoYla,� (�500.00), or fraction
thereof 3.n the cost of all propoaed work.
2.6. In no case sha11 the fee charged for any permit as set forth 3.n
Secti�-2� be less thsn �L,..00.
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6431 UNIVERSI7Y AVENUE N.E., FRIDLEY, M4NIUESOTA 55432
TELEPHONE ( 612}5T1-3450
October 20, 1980
Western �nsurance Company
- �630 Plymouth Building
12 South Sixth Street
Minneapolis, Minnesota 55402
Attention: John Allbright
Supervisor, Claims Department
9
Reference: Sewer Backup at 6740 Jackson Street, Fridley
D/I: October 7, 1980
Claim of Mr. and Mrs. Stanley J. Wozny
City C1aim No. PL-10/80
Dear Mr. Allbright:
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Attached is the claim of Mr. and Mrs. Wozny in this matter which �ve
discussed with you by telephone this morning. This sewer backup
also involved 6730 Jackson Street (City Claim PL-8/80 which a�as -
submitted to you last week).
Both parties on Jackson Street have requested that an adjuster�
be sent as soon as possible so they can know the determination of
the insurance company at the earliest possible date: , ,
Note the report by Chester Swanson attached to the claim is the
same report attached to our PL-8-80.
Again, please. keep us advised and copy us on all correspondence
regardi�g this incident. Thank you.
Yours truly,
Nasim M. Qureshi
City Manager and
Acting Finance Direct r
cc w/attachments:
cc:�ohn Flora
Ralph Volkman
City Attorney
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Dale Hadtrath, Transcontinental Brokers
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6431 UNIVERSITY AVEPIUE N.E.� FRIDLEY� RAINNESOTA 55432
TELEF�HONE .( 612)571-3450
October 20, 1980
:ir. Dale V. ci�:dtrath
Transcontiner_t�l Broker�
��0 Plymoi:�h B�aildir,cj � �
12 South Sixth Stireet
Minneapalis, Minnesota 5S4I.2
Re: Plorkers' Compensation Polir_y No. iy'C 239 �29
Employee rra.�ne: Chester C. Swanson
City Depart�nent: Public Works
Date of Incident: October 7, 1980
City claim No. 38-1980
Dear Mr. Had�rath:
Attached is a first repoyt of w�rkers' �ompensation item
for the above-capt�onQd emFloyee. Please process this
claaxa. Thanky ouu. .
Yaurs truly, � �
Nasim M. Qureshi
City Manager �n@ � •
Acting Fizia.�ce Directar
Attach: Original and 2 copies of claim
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10/20/80
To John Flora
From Jean Christianson
Re: Sewer Backup Claims against City
I passed on your questions to Dale Hadtrath, our insurance agent, and
he advises the following:
1. Re the Public Works people helping the homeowners who have suffered
a sewer backup: yes, this could be construed as an acceptance of
liability.
2. The best thing to do in the case of a sewer backup is to notify
the insurance company as soon as possible so they can get an adjuster
to the site immediately*
3. The insurance company criteria for City liability are standard. It
is not up to the City to determine liability; it is up to the insurance
company. Any change the City might have in philosophy toward such
incidents would have no effect on the insurance procedure; no insurance
company would consider it.
4. As in other areas of insurance that we carry, the monies that are paid
out on claims has an effect on our future insurance rates. There is
no way to predict what that effect will be without actual figures.
*This backs up what we were discussing this morning. I think there is a
misunderstanding in the Public Works Department about�his. For instance,
if a City vehicle is damaged, I do get after the department for estimates
and often the claim is submitted with the estimates rather than beforehand
and we haven't been getting after people about that. But maybe we should.
My understanding of insurance claims in general is that general policy
should be to get a claim submitted as soon as is possible after an incident
occurs, no matter what type of claim it is. In the case of the sewer
backup homeowners, it can be a simple claim wherein they state that they
do not yet have any estimated value to the damage. Any claim will get
the insurance company involved and the process started.
Rusty and the others are not incorrect in advising people to make/get
estimates and keep track of things. They are however in error in telling
people that they should hold off submi�ting a claim until they have all
pertinent information. When people are interested in making a claim
against the City, they should be told to put their claim in writing and
deliver it to us, or they should be told to call me for information.
Thanks.
�� �.
�,�������
MEMORANDUM TO THE FILE: PL-8/80 and PL-10/80
October 22, 1980
cc: Nasim Qureshi
John Flora
I talked this morning with John Allbright of Western, Mr. Steies and
Mrs. Wozny.
The adjuster met Mr. and Mrs. Steies at their home about 3 p.m. yesterday
and took pictures. The adjuster told them to get someone in to make
estimates re the floor. Mr. Steies said he thinks they can clean off the
wall and is hoping that there is not a serious wall problem that will mean
ripping them apart. Mr. Steies' attitude was much different today and
he thanks all people at City Hall for getting the adjuster out there. He
said the adjuster told him he had to leave in a hurry as he had to be
in the City offices before closing time.
Mrs. Wozny said the adjuster didn't know about their backup problem, that
the adjuster had stopped by because of what he had been told by Mr. and
Mrs. Steies. The adjuster took pictures so they can start more cleanup
and made an appointment to get back to them on Friday. Mrs. Wozny said
they will have their list of estimated expenses by Friday and will try to
get a copy to us as well as the adjuster.
GAB Business Services tnc
�- � 4510 West 77th Street Suite 248
C • Minneapolis Minnesota 55435
Telephone (612) 831-8444 '
Bra�ch Offica
November 5�h. 1980
Stanlev J. Wozny .
�740 Jackson Street .N.E.
Fridley. P4innesota
Our File Plo.: 5h527-93307
Our Insured: City of Fridley
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�-�� �;�, 4�ar Mr. Woznv:
After careful consideration af yaur �laim a4ainst the City of
fridley. Fridley. P+innesota. the insurance comnany cioes not
believe that the incident was caused by the fault of their
insured or their employees, ah� there��re will be una6le to.-
make settlement ofi your claim. �
EAW�d�fb
Very truly yours.
Ed 4larner��, /
Ad j uster t�'J
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ORDER TO
TABOR CONSTRUCTION, INC. � GE.Pi�Oii�L COH�RACTOR
1800 Central Anenue N.E., Minneapolis, M19inn. 5��118 'i 88-919;1 i88-1G28
License No. 1407 �k Bonded �k L�sured
Sold to: - y�
Date �[� 3,}L 19 ��_
We propose t do the following work at 7�O �2l.�t�x .�f !7 .� _ _—
Specifications es follows:
/
.�-. ---'
v -
Total Price $ � �/ �o~
Down Payment, If My $
Manner of Payment
Of the above eontractp►ice; IM fF.CCYtlf'�, f104YBVCf� to be in exeess of the entire contract price unless extre work isdone. It isfurther
agreed that in the event of default in :��n/ nayment or payments, the entire balance at the time of such default shall immediately become
due, that the owner w other contractir.� agent hereby agrees in event of default to pay reasonable attor�ey fees and costs of collection.
You, the buyer, may eancel thn purehase at any time prior to midnight of the third business day after the date of this purchme. See
attached m_�tiee of caneelletion fnrm ��r an nrrlanntinn at this ►i4ht. . Date
Signature
PERSONS OR COMPANIES FURNISHING IABOR OR MATERIALS FOR THE IMPROVEMENTOF REALPROPERTY MAY EN-
FORCE A LIEN UPON THE IMPROVED LANO IF 7HGY ARE NOT PAID FOR THEIH CONTRIBUTIONS, EVEN IF SUCH
PARTIES HAVE NO DIHECT CONTRACTUAL RELATIOfdSHIP WITH THE OYIINER. MINNESOTA LAW PERMITS THE OWlVER
TO W�THHOLD FROM THIS CONTRACTOR SO MUCH OF THE CANTRACT PRICE AS MAY BE NECESSARY TO MEET THE
DEMANDS OF ALL OTHER LIEN CLAIMANTS, PAY DIRECTLY SUCH LIENS AND DEDUCT THE COST 7HEREOF FROM THE
CONTRACT PRICE, OR WITHHOLD AMOUNTS FROM HIS CONTRACTOR UNTIL THE EXPIRA'f1UN OF 90 DAYS FRUM THE
COMPLETION OF SUCH IMPROVEMENT UNLESS THE CONTRAGTOq FURNISHES TO THE OWNER 4VAIVEFlS Of CLAIMS
FOR MECHANICS LIENS SIGNED BY PEHSONS WHO FURNISHED ANV LABOR OR MATERIAL FOR THE IMPROVEMENT
AND WHO PROVIDED THE OWNER WITH TIMELY NOTICE.
Rep w Tebor Constru tion, Inc.
( -9�l � �
s
Date l�fA � � 19�
Cantrect Aceepted
1 ha�e read the /oregoh�g order, erd egree te psy the amourM therNn
Buyer Signature
BU�/C! $i91181Uf8
Address
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JOHN'S APPLIANCE, REfRIGERA COR
& A1R COIVDITIONtNG SERVICE
YYhlrlpool • Mayrtag- Fedders - Litton • Tappan
Kenmore • Speed Queen • Sharpe
4128 E. 35 St. - Minneapol�s 55406 Ph.: 722-0151
Commeru Bldg • St. Paul 55101 Ph.: 8441875'
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TIME ON 10B
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See reverse side tcr G+ueranty '
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Ef431 UNIVERSITY AViEIVUE N:E., FRIDLEY.. �RIRINESOTA 55432
TELEPHOPIE ( 812)571-3450
November 6, 1980
Mike Goblirsch, Esq.
l�destern Insurance Company
, 630 Plymouth Building
12 South Six�h Street
� ��Rinneapolis, Minnesota 55402
Re: Western Policy No. CM 944 519
C]aimant: Kenneth J. and Delores Steies
D/I: October 7, 1980
Dear Mr. Goblirsch:
Attached is the estimate of damages subr�itted by Mr. and Mrs. Steies
in connection with the above-captioned incident. The estimate totals
to $5,129.85 including cost of repair �;o Lowry organ, or �8,729.85
including replacement of Lowry organ.
We would appreciate your earliest atter�tion to this matter. Please,w
feel �frr� to cor�tact us if you i�avr a►�;� questions. Thank you.
Yours truly,
Nasim M. Qureshi
City Manager and
Acting Finance Director
cc: Dale Hadtrath, Transcontinental Brokers
Virgil C. Herrick, City Attorney
�}6hn Flora, Dir./Public 4Jorks
1 . �
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GG70�::�R 31, 1930
ESTIPLi�L' QI' DI3INIG�:;; — CITY GF �1dIDL�Y ��::�R II/;C?;UP �- i'Ui::;D�iY UCTUF3kR 7� 1980.
SUIIt�:I"i'1:,:I) �`is Ki:;�i;�iH �'. AilI) I1�I,Uici::S STEIES� 67'�0 Ji��f:�(�.y :iT. P1.E.' FIZIDLEY� �.�.
ITCt� : �
C'���SPLL•"TL TIL� FLOOR' ( i;EPL';CE1.S}r;Tf (,OST �STI1P,t1TE; ) 1�577.00
�3 5�. YAI;�S ( D'a:.TPOY::D )�� 3.95 per yard 90.F35
BOX Sc'�RIidG t:i�D �.'�TTR�SS ( Di�T�OY�U ) 1 yr. ald replacement cost 289.00
TAPL� (T?6f>'T^OY; �) l� � -��.�15 97.30
3 ::9.�5 79.60
3 �:�12.95 38.F35
P.EGO^�S (D�aTl'.OYEI)} 7b G08.00
L�.1TIiL-}, fiUtdTI�iC ;��TS 2 i�AIR i;E:'1
STERII� SPE&�K�.:� ; ��.i:1 2
L�-1TH��: LUG�AG� 2 P�ECs.S DESTIdOYED
C%OaIiI:�iG (ULST,.O� �^'} '
RE.'L.? C'��t.i,:a �T CAST
b'd�'iTi3it Dl'�P.SI'�GL �0 LO'.J%iY O�Gf.IJ P�I't1liz �Gl°!���
REPLACEI:IEIti"f 3' 9dL ,.00
Q SL�:�F�::r, B�GS (DTi`f GZ��"u��)
3 G7.`1TS L�F�1':OYiii�
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TOYS9 Ga.::4�5g �. STUF�ED ��IP9ALS DfiSTR01'�
2� T.O�',�S OF LAU;�?^Y' o'd��H �. I��'Y (�;UTLTS r� 3i...::t�.��'�)
S�r�I2yG Si3PP� ir�,-�a �r��IC� Y�+��, PATTEFt?dS ALL ��'L'iJ �=ULb'TF:UYi�7j
CL�^JIIaG L�1�0� 15.'. ri�UF;S �. �;:%3.75
CLE�1It+G £IIPPI.IE5
70.00
2F,0.00
150.Q0
200.00
300.Ofl
32.0�
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80.00
a�.00
25.00�
250.00
566.25
30.00
_ _ _., ._. ... �:�,��.�-�.�_. - -- _-
�. . � , ....,.. _-
� � ... . _ .
_ . . . _.� ,:
..
ro " John Flora
cc: Nasim
�l�"
Date
11/3/80 �� ����
reshi
From Jean °����f '����
Subject �ozny/Steies sewer backup
This morning Wozn� ca11 P� to ask �aw �e-e� ����a '� -
answer from insurance company; he'll call back this afternoon.
John Allbright of Western told me we can tell Wozny he should
� ' o is wee or at latest, Monday of
next week. I will tell Wozny that when he calls back_
For our information• This item hac hc�Pn ���, .,,�o� +�p���_
Goblisch of Western. He is an attorney on Western's staff. From
ri01,v c�r� rn�r f171PC'��A�i�J ��01�+ +�ra-�c "�----„ '_`_Qii�eCLe
Mr. Goblisch. He will be returning to the office tomorrow.
Wllson Jonea Company 87B Signed
aRAYLINE FORM Ad-899 7�PART
Q 1971 � PRINTEU IN U.S.A
, _ , � __�_ �� :.� _ :
/o�, �
� ��
MEMORANDUM TO FILE - Wozny sewer back-up
cc: John Flora
Na:sim Qureshi
Attached is a copy of the list of damages which jUozny gave to Ed
Warner, the independent adjuster hired by Western InsurancE Co.
This includes service calls for the freezer and dryer, and includes
an estimate from Tabor Construction Inc. The total amount is
somewhere in the neighborhood of $10,000 according to Wozny.
Wozny and his wife have scrubbed walls and floors three times.
The contracfor told him that cleaning will not remove the smell:
that the water seeped between floor tiles into the porous material
below and through the walls to settle into the fiberglas insulation.
That the only way to get rid of the smell is to pull up the floc�r
and tear down the walls and pull t:�e smelly material out. Wazny
also gave the insurance adjuster 12 snapshots of the damagE. The
only items located.in the family room now are couch and chairs
which have to be thrown away due to smell. The rest of the damaged
items are stored in the garage in case anyone wants to vie�► them.
Wozny and his wife had no complaint about the behavior of the adjuster
when he visited their home. However, yesterday Wozny telephaned
the adjuster to see how things were coming along. The adjuster told
Wozny that he was acting pushy and in general was insultin�. (I
,passed that complaint along to our Western contact.) The.adjuster
'told Wozny that his report wws completed and that he r:c-�?a be
forwarding it to the insurance company.
Wozny said the adjuster told him now it would be up to the City of
Fridley and idestern to decide and the adjuster acted negative about
the outcome. This upset Wozny because he interpreted that �amment
to mean that the City could direct the insurance compary's decision.
I told him that as far as I know, the insurance company's ciecisions
are made independently and I thought he misunderstood what the agent
was saying.
Wozny had already talked to Mayor Nee who told him t;�at if the insuran
company doesn't accept the claim, that the Council is already aware
of the situation and would then consider the possibility of help from
the City for Mr. $ Mrs. Wozny. idozny said the Mayor's comments
initially made him feel better; then he considered that this is an
election year and taonders if that was a political speech.
Wozny asked how City Hall is run and what is the relationship to
City Hall of the Council and the City Manager. I told him that the
City Council is the decision-making entity c�f L'ity Hall and a
role of the City Dianager is that of liaison bztween the City Council
and City Hall staff. I suggested if he would like more inforMation
about City Hall that he should contact the City hianager's office and
told him Mary Lu's name.
Wozny said he has been feeling upset at the way things are progressing
since it's beginning to appear that he might have to se�k legal advice
which he doesn't want to do. He is going to call next week to see if
the report has been received and what is happening. I called Asr.
Allbright at Western to ask him to get back to us re Wozny as soon as
ossible after he has received the adjLSter's report.
,� �-
, p� � GRB Busin�ssS�dl'JIC?S�+►n�
�-1 ti"'�� 45?0 bVest 77th Street Suite 248
�j! • �Minneapolis PAinnesofa 55435
` Telep,ioria •(612) 031-8444
Branch Qriic2
November 5�h. 1A80
Stanlev J. 4lozny _
b740 Jacksan S�treet lJ.E.
Friciley. P4inneso�ta -
Our File Plo.: 5�527-933Q7
Our Insured: Ci�Y of Fri�ley
�l�L: 10-'?-Rn - .
r`"f�t �:5 rs ;°� .
'' aear Mr. 4Joznv:
'�� � : . ..: i:;7
A#ter careful consideration o-f your �laim aaainsfi �he City of
Fridtey. Fridley► P1innesota. •the insurance comnanv c!ofls not
be l i e�re that �he �i nci den� t�as caused by �he fau l� of thei r
i nsured or thei r er��loyees ► anc� there-Fore wi l L be unab le �o
make settlern�n�t o•f your claim. �
�
EA4�1/dfb
P
Very truly your�s.
Ed t•!arner,�,� /
Adiuster(;U
1
` .
`. _ _ :._ � _ _ ' ..... r_.�.... . .. "" '"_".�_"."" " -"_ "_ "._"_ '__"" " _'„__'._' _'_"_.. ..,.._ �_ _.�_.._ ..�..� _ ��_.
m
t
�'
y
TME CITY OF
Fql LEY
DATE
FROM 'D.P.W,
SUBJECT
DIAECTORATE
OF
PUBLIC WORKS
7, 1980
Sewer Backup - October 7, 198Q
e /� � (.R
l�y '�
}.«,� S . ; :g�"�'6...+'
. �rk �. �
;� .
�
. •
.•.
;
�" � `- i � 1 ?J
o) 9 , -1 ."-�f 1� � �P�
,��` ; �I MEMORANDUM
� '
TO
ACTIONI INFO.
On October 7, 1980, two residences on Jackson Street (6730 and 6740) suffered
a sanitary sewer backup in their basements. 6740 experienced approximately
nine inches of water, while 6730 appeared not to receive water throughout the
entire basement,
The Public Works Sewer Section assisted both parties in carrying out wet items
from the basements the day of the Backup, and followed up with laundering
clothes and hauling heavy items from 6740--plus vacuuming, sanitizing and deo-
darizing both basements the next daye
Both damage claims were submitted to the City's insurance company, Western
Insurance Company, upon receipt. We were informed today that both claims were
disapproved because the incident was not caused by the fault of the Citye
I have discussed this matter with Mr. Mike Gablirsch, the attorney for Western
Insurance Company, and he advised that the City remain out of any discussions
on this issue. The Company will respond to any future claims or suits per-
taining to this evento He further advised that if the City became involved,
we would be setting � a precedent that would have long standing detrimental
effects, plus would negate the purpose of maintaining Western Insurance Com-
pany's services.
We will continue to review this particular sanitary sewer line in conjunction
with the other lines in the City for possible improvement. If any positive
actions to reduce the volume of flow or diversions is possible and practicable,
we will incorporate these actions in next spring's contract or in-house work.
JGF:ik
�=; - �` . � . � �
b
a
DATE
2/28/65
3/ 1/65
3/1/65
3/1/65
3/1/65
3/1/65
3/19/65
5/10/65
6/1/65
6/ 1/65
6/10/65
1/27/66
68
68
9/17/69
70
70
2/26/70
3/20/70
SEWER BACKUPS
CLAIMANT
& ApDRESS CLAIM
Margaret Zuber $ 3,000.00
278 - 57th Place
Robert Byrne 150.00
6020 - 4th Street
James L. Campbell 581.75
6102 Star Lane
David W. Olson 129.04
6072 - 4th Street
Glen Wilkes 100.00
290 - 61st Avenue
Richard Wood 702.50
6054 - 4th.Street
Max Hopka 25.00
281 - 57th Place
LeRoy A. Bushey 86.00
6899 Channel Road
LeRoy:A. Bushey 86.00
6899 Channel Road
Dennie Eckholm 415.07
1081 Rice Creek Terrace
Harold Dawson 15.00
6817 Hickory Street
1170 - 52nd Avenue
Richard J. & Bernadine Stawski
588 - 53 2 Avenue
Jane Wojciak
6031 - 2nd Street
Bruce Hoch 112.75
7815 Apex Lane
Darrel A. Klein
851 Mississippi Street
R.L. Newman
�,501 Rice Creek Road
Ellsworth Hinz ],43.3$
384 - 66th Avenue
Brian W. Porter 200.00
6870 Channel Road
AMpUNT PAID BY
INS. C0. CITY
$ $
112.75
143.38
Page two
, SEWER BACKUPS
� CLAIMANT
� DATE & AppRESS
9/16/70 Steven Mast
6034 - 4th Street
2/24/71 A1 Johnson
6745 Channel Road
4/14/71 Oliver Erickson
605b Woody Lane
5/1/71 Max Hopka
281 - 57�h Place
9/27/71 Bill Hlavinka
5923 Main Street
10/6/71 Frank Sarazin
5017 Clearview Street
72 Kenneth E. Gill
4638 - 3rd Street
7/23/72 Donald B. Moldenhauer
5380 - 6th Street
7/23/72 Richard Stawski
588 - 53 2 Avenue
9/26/72 Mrs. Bruce Estenson
581 Buffalo Street
10/26/72 Bruce Estenson
581 Buffalo Str�et
12/9/72 Dr. James Gilbertson
6801 Channel Road
4/6/73 Carl E. Gabriel
401 - 76th Avenue
5/9/73 Mervin Christensen
5239 Greenfield Avenue
1�/2/73 Elsie Schleiman
5700 Hackmann Avenue
11/22/73 Roland Morin
650 Hugo Street
11/22/73 Gunter Zinkermann
640 Hugo Street
3/6/74 Richard Haugen
1080 Hathaway Lane
CL.AIM
$ 38.18
106.70
178.00
250.00
30.00
207.78
51.11
6,OQ0.00
243.00
141.97
AMOUNT PAID BY
I . ' . TY
$ $ 60.00
Page three
' SEWER BACKUPS
CLAIMANT
� DATE & ADDRESS
4/6/74 Judith Wilson
1050 - 52nd Avenue (#4)
4/7/74 Douglas K. Johnson
1050 - 52nd Avenue
(& Wm. Bergstedt)
5/2/74 Richard J. Hatcher
1608 Berne Circle
5/2/74 Ronald Finley
1604 Berne Circle
6/6/74 Richard Clobes
5908 Anna Avenue
7/16/74 Beverly Wilson
1319 - 75th Avenue
8/6/74 Richard S. Silverstein
6675 East River Road
12/1/74 John Leschisin, Jr.
840 - 66th Avenue
5/13/75 Peter Schenk
576 Rice Creek Terrace
5/13/75 James Gibbs
577 Rice Greek Terrace
5/31/75 Rober� J. Vandenberg
609 Rice Creek Terrace
6f 19/75 Byron B. Davis
170 - 62nd Way
6/20/75 Thomas W. McGraw
605 Rice Creek Terrace
6/26/75 Kazimierz Gazda
627 Cheryl Street
6/26/75 H.C. Hudyma
641 Cheryl Street
6/26/75 Blair V. Berg
6809 Hickory Stree�
7/1/75 Leroy Tovsen
1356 - 64th Avenue
7/i/75 Walter Ce Egler
1456 - 64th Avenue
CLAIM
$ 3,831.00
2,500.00
575.39
30.00
700.00
11.70
34.OQ
5,235.00
40.00
645.20
250.00
81.62
193.45
485.00
1,009.00
AMOUNT PAID BY
INS.�C . CTTY
$ $
2 ,1,52. 00
9a9.79
34.00
34.00
40.00
230.20
�
395.00
Page four
� SEWER BACKUPS
_�
� CLAIMANT
e DATE & ApDR�SS
7/],/75 Donald C. Anderson
3319 Belden Drive
7/1/75 Ken Hoilister
1466 - 64th Avenue
7/1/75 Marvin Nevala
1476 - 64th Avenue
11/16/76 Mrs. E. Walski
1631 Rice Creek Road
3/17/77 T.W. Hanson
610 Hugo Street
3/26/77 Richard S. Silverstein
6675 East River Road
12/11/77 Hjalmer Anderson
1491 Rice Creek Road
5/8/78 Newton Larson
1361 Mississippi S�reet
l,/15/80 Ellsworth Hinz
384 - 66th Avenue (see 1970)
4/5/80 Harlen Hanscom
60p0 Stinson Boulevard
11/7/80
CtAIM
$ 1,482.60
495.46
501.45
150.00
200.00
20.00
685.00
170.95
973.38
200.00
65.00
AMOUNT PAID BY
INS. C0. CITY
$ $1,482.60
20.00
154.95
973.38
2Q0.00
32.50 32.50
FIRE DEPARTME�T MEMO
� ✓
T0: �SUILDING INSPECTION
ASSESSING
SUBJECT: �FIRE DAMAGED STRUCTURE
FTRE .HAS OCCURRED AT g�a� t�ozny
6740 NE Jackson St.,
Feb. A4 � 19� �
Feb. 6, 19�7
DATE:
DATE F FIRE
i/� �c..as� ..�'°�`�''�-:�`i'i
�,,.
n F
FPB-6
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
;,
� �
� ; L ____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 . ,
� i �"'1 � CITY HALL FHIDLEY 55432 NUMBER REV. DATE
�'""'� � ,�� 612-571-3450 910-F15
4/3
JOB ADDRESS 6740 Jacks�on Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. % 5 Srookvi.e�r Terrace
2 PROPERTYOWNER MAILADDRESS
Stan inTo�y 6740 Jackson �treet N.E.
3 CONTRACTOR MAILADDRESS
Tabor Construction 1800 Central Avenue
4 ARCHITECTORDESIGNER MAILADDRESS
5 ENGINEER
8 USE OF BUILDING
R2S lC� E:Sl'�.l..A�..
7 CLASS OF WORK
❑ NEW
MAIL ADDRESS
ZIP
ZIP
ZIP
ZIP
O ADDITION ❑ ALTERATION �] REPAIR
8 OESCRIBE WORK
� Repair �ire damage to main level of house
9 CHANGE OF USE FROM TO
STIPULATIONS
PAGE OP
� �
°_( 16142
RECEIPT NO.
�` � � �
APPROVED BV
SEE ATTACHED
SHEET
PHONE
PHONE LICENSE NO.
788-9193
PHONE LICENSE NO.
PHONE LICENSE NO.
❑ MOVE ❑ REMOVE
SEPE�t�E PERMITS REQUIRER �OR V+�1�1�8�
HEAT1Rl�. PLUMBt�iG ANO StGNS.
SEPARATE PERMITS ARE RE�UIFiED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OH IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED POR A PERIOD OF 120 DAYS AT
ANY TIME AFTEF WORK IS COMMENCED.
NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �'
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UAT�ON
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIfIED HEREIN OR NOT. THE GRANTiNG OF A PERMIT S261000
DOES NOT PRESUME TO GIVE AUTH RITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS F ANY O HER A OR LOCAL LAW REGULATING CON-
STRUCTI E F E OF CONSTRUCTION. $�-56.00
PLAN CHECK FEE
-�' - � - - �� � r
SIGNATU F O RACTORORAUTMORIZEDAGENT . (DAT WHEN PR(
^ ��
SIGNATUREOFOWNERiIFOWNERBUILDERi IDATEI HL�G WSP
SQ.
STALLS
Y
NCY GROUP OCCUPANCYLOAD
CU. FT.
OFFSTFiEET PARKING
GARAGES
SURTAX
$�. �0
SAC CHARGE
TOTALFEE
$169.00
IDATED THIS IS YOUR PERMIT
�C .Ii� �
Ot.T
�
CITY OF F(tIDLCY •
APPLICII'('IO.�J FOR RL"SI[)Ei•dTIAi_ QUILDIt�G PG�t�ITTS � �
� (idet�r, Al ter•�Lions, ACICI1t1011S� or Rcpairs) .
� 04JtdER: S�i9�/ �4�.vc./ � [3UILDER: ��o� �, a-vt�����'�v� .
11DORESS: ��Y4 ���s�� �'>`�,%�� ADDRCSS:��a-o �`''._,,,��
TCL N0: 3'�.�5 =.s' ��� 7EL td0: ��,�� f�;�
_____
" Construction Location ' . �
• STI�T NO : l�� �-I C� STREET: ��U�,.,�,6 /� � 1��P /v - � ° .
Lom: . � sLOac: � r�nnzTioN: � �i� 1 ��2i�C°.�
Corner Lot: Insiiie Lot: SetbacY.: Sideyards:
Ap�licant attach to i:his form two Certificates oP S�trvey of lot and
proposed builcting location drawn on certi.ficates to scale. .
DESCRIPTIOtd OF COFaSTRUCTIOPd •
� //�'e ,' Front: � Depth: Height:
Square. �'eetM Qzbic Feet:
.�%/�/.i'✓ � e d e�. Front: Depth: � Heiglit:
. Square• Feet: � Cubic I'eet:
' .
.
Type of Construction : Estimai.ed Cost: �$,��, �D (� f�
. • . �a._��__._
Zb Be Cbr,�pleted:
' � Alt. A Alt. B
Proposed Drive�iay Width If New Opening Is Desired: $' $
� . ., SE� Rc,VERSE SIDE OF SiIEET ,
Zqie undexsigned hereby make� application for a permit for the �•,ork� he.rein specified,
agreeing to �w ,all work ir� strict accardance �•rith tite City of I'ridley Ordinances and
rulings of i:he Depzrtment of Buildings, and hereby dec res th� all the iacts and
represen tati.ons stated :n this applicatian a tr d t.
D.�TF;: �Q �%v SIGNATUF�: � � �
17""",
• " r
SL•iF�ulations : � , . /� �
� � (� e C�� .: ��.
��� �- .
. � � � _ �� y
I
1 G �0�1
s
s
e �:� .
�
• •. � �
• BUJLT)Ir�c ���r_�r,r�i=r r-e�_ sr.��r:nu�_�� � .
51:;C',CIOI•� 2. �'1'1�L 7n�.c��ectc�r. nf• 13u�.1c?in�J:; ::liri].1., befor,c: i. ��.ui.i�c� penniL•� for the crr.ct•�.on
uf• �x»y l�u�.l.�l.i.i7�� Ux :;t:�-uct:urc, �r. �oi any adcli.i:9��n +�o aitiy cr.i:;L].11� ��ll].I.C�7.11(J nr ::i:zucL•ur.e,
. cir. i:a�� c,�,.y �i1,t�c•r�-�Lir,» �r. r.cl,air.:; Lo •�7ny c;:�:::Li�i�,� ln�i.l.di.�i�1 oz st�:ucturc, u���n ar��,�li.c:at.i.o»
�ther.�for.c, r.cc;ui.�-e t�J�� ��a}►mer�L• }�y tlic a�;,p].i.car�t: far. s;uch ��er.mi.L• 01.� fecs to tl�c a�n�unt
hrr�in bcl.o�•r sc:l• tar.th �ui4 i.�i tlic �nanricz hcrci.n proviclecl L•o-a::it: •
. • .
IJl.l�l COId�:'I'I;UCTIOiJ; SingJ.e 1'amil.y IIOIIiC:� and G�r.actes: Y4.00/7_,000 CUU].0 �cat..
P7.A.�t CII1:G;: 25 rexcet,t: oi' bu3.lcling }��e�7nit ic:e.
Ult]:VEI•'11Y DL•'L'P1:5SIOt•J: (Concretc, Curb SL-reets Only) '
• Al.ternai:e A: Itc:moval atid re��lac�ment oi concxe�e curb and
qutL•er only; nriveway �•ridth plus 6 fee� x$13. �0
1�].L-ernate II: Removal and re�,�3.acement of concrete curb and
• gut•ter and in�k�ll a 3 foo�� e�icie approach t.�ith ''
' ,� 6 ineh clepth; Driveway a�ic:th �p1.us 6 feet x 51.5, 75
• . �DDITIO�!1lL I(�li=0Rf�111TI0P!
I'or the purl�se oi co�nputi_ng �ees for building permits,. i:he cubical. contents of any
bui.Idxng or adc3ition, i.s deL-cr:ni.ned by mult-ip].ying the ground arel covered Lroa► a
poi.nt �ix (6) inches below the iloor ].ine oi L-lie basement or th� cellar to the
average heights of the •upper surface or to the average height of the roof surf:�ce
of the r►ain gable oi a pitched roof-. • �.
Foz xe�aixs or a].t�rations to an existing stnicture, the fee shal'1� be at the xate
.. of $3 . QO Per. each �ive hundred dollars °($500. 00 ) or fracL-ion rhereof in the cost
of all proposed wor.k. . , '
In •no case �ha�.l the fee cliargeci fc�r any pPxmit as set iorth i.n Secti�n 2 be less �
than $?.50 plus $.50 sta�e surcharge. � � ' �
' � . 1[�R�FICATI0�1 OF F(1UF�D�11I0f�
NOTEx' Pexmits �or construcL-ion will be issued a mznimum of 24 hours from Uie time
ni applicatipn to a].l.ow for proper review of i}�e proposed st_ructure and oi ihe
construction site. �
; �
A Certificate � of Survey of the lot, sho�,�ing the location of tiie foundation once it
has been cons�nicted �.*ill Y�e required before proceec2ing �•�ith the �raming.
.�j-�T,I FI G�TE QF ��CUPAt�'Cl' � '
� 1►Pp�.ication �or a Certificate oi Oceupancy shal], be mad� �en {lpj days prio� to the
us� or occu�ncy oi an}► stzucture for �ahich a��uilcli.iig pe=mit i2as been issued; and
s�3a.c1 structuxe : Z131.�. iiot be used or. occupied L:iitil a Ceri:i.iicate of Occul�ancy has
bcen issu4d.
�
�
� - '� ,
�.,
I
�
a '
i,a��
�;
< t`rOl^�L 5�1G'@'t
, :;tan ti�►ozny
I 6'��0 Jacks on St . N.E .
�� �'ridley, Mn.
i
� rront Bedroom:
i Re�ove and replace Gheetrock on ��alls an� ceiling. �
S eal and paint �valle . •
i Te�t�re spray ceiling..
_ Remove and replace eaxpet wi-�h pad. �
- Remove and re�lace 35' base. � . .��
Finish 2"10' t��n. . - _ - -
'' Remove and �replace 2-d.ouble htai�.g windov�s with tri�.t, si�l and hard�aare,.
��' -:: Clean 2 aluminam storms. ` -- '
Remove a�.�. repla,ce: door with trim and hardvaare and jamb. -
= Finish door. - _ .
. � - . _
��j C�.oset= _ __ -
-�emove : and repla.ce sh�etrock on ceilin.g and �walls . _- .
-- Seal and �airit walls . ` � ' _ - -
_ ' Seal _ an.c� :pa�:nt :ilceiling_. .,- , � _
, Remove and�_re�lace g* bases ° - _ - - - - - - �
_ _ __ ,_ ,
. _ . Finis h, :110" triin°. . , _ _ - . _. _ ,
Ins-�all l ��te1f an� pole with brack�ets . - `- �
-�� Remove and replace 1 set sliding doors: - - _
I �inish sliding door._ - `
': � ..: - �._ _ � . _ ,
..1 , .. _ ... _ . . _. . _
, i . . .. . . .. . _ - , __
�._., ��ar _Bedro.oms ; _ _ _
, , . _ - - -�
� Remove -and r��Iae�e sheetrock on, yvalls� and, cei3ixig. - _
- - � - = -
.. _
- S�a3. a.nd-. �aa� _ �.�3.s� . , - _ . - , - . -
� � " - �, ��t�re ; `��� aei��g. � --_ y - _
;� RemovQ ."an.d �p�e �?I` yds . carpet��wi�1�. pad�: _ --
{.� � J --:Remove : arid. =re�X�c-e "���-¢_ Abas� :� � _ . � � .. - _
_ .- . ,� . , . , - -
��.� . �inish 2 6_ t��.�n:- ; . _ : �:_t: - -_ - �
�'
- �Remove 'ar�d replace l :door with �trim, jamb and-�Y�a�dwa.�e. - - . ,
_ Finish 1 door. _ = .-_ -. - - � ^
_„ �emove and�-:replace 2 double h�.n.g. vvindovas with tr�r sil1-_ancl _hardware. _
� � Cle�n � 2 �.lumintam combirration :.v�ind���rs_: , - - _
-, . _ .. _ . ._
Clos:et a " _ _ - - _ _
-� . Remove and replace sheetrock .from: vaa�.ls aris�` ceilirig: ..
' �: S eal and paint �valls . _ . �
Seal and paint ceiling. _ , '
Remove and replace 12° base.
+ Finish 128' tri.m. �
; Remove-and rePlace 1 set sliding doors.
Finish door. _ .
- Ins�all 1 shelf and poYe �vi �h brackets . ,
In.s tall 1 cioor mirror�. .
� -
��=�; -- �� • - _ ; - . - � -
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� � � . -� _ . - - Page � , _ � �
�� - ._ ,. .*' A � :
�'' `E�terior: ,- . - �
��m�e and replace 16 ft. soffit-and fascia.
�irist�l:ate sidevrall with 3�" #rictian �'iberglass.
�e�ver. exterior walls wit1� 6 mill_palye:thylene.
I-t7.3 tb d t �1 •
i
ns a new u:an s oot �.n bathroom.
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City of Fridley
AT TME TOP OF TME TWINS
i �
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� ; v _����_ COMMUNITY DEVELOPMENT DIY.
r � � PROTECTIVE INSPECTION SEC.
ii = �
-� �"'1'� CITY NALL FRIDLE� SS132 NUMBEF
L % �
�U ILDING PERMIT
°' 612-57 �-3a50 s� o-F� 5
JOB ADORESS 6740 Jackson Street NE
t IEGAL �OT NO. BLOCK TiiACT OR AODITION
DESCR. % S Brookview Te:
2 PROPERTY OWNER MAIL AODRQS$
Stanley Wozny
3 CONTRACTOR MAIL ADDRESS
Dave Berry Const. Inc. 20625 Co Rd 30
A ARCHITECT OR DESIGNER MAIL AODRESS
S ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
REV DATE
9/30/99
ZIP
21P
�
30316
RECEIPT NO.
�! � �
OF APVROVED BY
/
SEE ATTACMEO
SHEET
�-��+�
PMONE
•8628
PMONE
PNONE
LICENSE NO
9204
LICENSE NO
LICENSE NO
O NEW O ADDITION O ALTERATION x� R�PAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reroof house and �arage (25 Sal Tear-off
9 CHANGE OF USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Bui.lding Code.
SEPARATE PERMITS ARE REOUIREO FOR ELECTflICAL, PIUMBING, MEATIN(3, "rc vr a���o�. Vi+t.Uri
VENTILATING OR AIF CONDITIONING
TMIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION zONING SO. fT
AUTHOR�ZEO IS NOT COMMENCE� V�!ITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOEO OR ABANOONEO fOR A PERIOD OF 120 DAYS A7
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
1 HEREBY CERTIfV TNAT I MAVE READ ANO EXAMINED THIS APPLICATION STALL$
AND KNOW TME SAME TO BE TRUE ANO CORRECT. A�� PROVISIONS Oi LAWS VALUATION
AND ORDINANCES GOVEFiNING THIS TYPE OF WORK WILL BE COMP�IED
WITH WME7MER SPECIFIEO HEREIN OF NOT. TME GRANTING OF A PERMIT a�2�.HS
DOES NOT PpESUME TO GIVE AUTMORI7Y TO VIOLA7E OR CANCEL TME pEWMITFEE
PROVISIONS OF ANV OTMER STATE OR LOCAL lAW REGULATING CON-
ST CT O\N OF T E PERFORMANCE Of CONSTRUCTION .�83. 2S
��y� � PLAN CMECK fE
v, Lice SC 5.a
$�GNATUAEO�CON'F4CTOpOA• OpiZEDeGENt IOATE� N OP A
S�GNeTUAE O� OWNEA ��c OwNEp 9WlDER� �O�fE� m n�_ ...en
ROUP OCCUPANCY�OAO
CU FT.
OFFSTREET PARKING
IGARAGES
SUR7AX
$1.09
SAC CMAq
Fire � �2.19
�'�
��
� -=
rrEw � �
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMILY AND DUPLEXES R-1 AND R 2
BUII.DING PERNIIT APPLICATION
`�
0� ��
� �
Construction Address:
�7�� ���N � N�. �
I.egal Description:
Owner Name & Address: �°�q-���, �� Tel. #;5 7C' 3`�(� �
Contractor: � ���y ��- 7�. NIN LICENSE # � �C1
Address:_ °�.� o°� � C.d � �U �Qe�'-�eoS it/ � S°� i'� Tel. #_�! Z�f�el fi'� 2�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECB AREA:
01'HER:
Length
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width Height
Width Height
Wid+L�l/,y HgtlGround
v tiL'jl ���
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: R"C�f T�4�P.t� Estimated Cost: ��' '� �/gs _
Driveway Curb Cut Width Needed:
DATE: - � '�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Ft. + 6 Ft = Ft x$
—$
$ ,� : �
$ �. ��
$ /,a9
$
� ���
$
$
$
$
$ �•3
CITY USE ONLY
Tel. #(�l�l?������
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 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 [ ]
�
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 b.uilding or structure,
upon applicarion 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 $50,0�
$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 $1� or
fraction thereof, to and including $2,OQ0
$69.25 for first $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 $50,000 plus $7.� for each addirional
$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 $500,0�
$3,233.75 for the first $5(�,000 plus $4.75 for each additional
$1,(�0 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 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 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 realacina an existins� 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 () 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 Furnace Venting Tables for fan
assisted and natural draft appliances.
The existing combustion air is sized and installed to meet the current codes
__ an�ma�ufaciurers �gecificatior�s _ -- -_ _- _- - _ –
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
YesO No�)
Yes ( ) No ( )
When installina a_new ventinst svstem, the undersigned hereby verifies that
it 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 natu�al 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 current codes.
Yes ( ) No ( ) ,
Aaaliance Type and Size/Common Vent 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 1Lent T�Cp� -—__ 1/�nt Height__ _� Di�mQter inches
Appliance #1 Vent Cannector 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• (Describel
>� , .
HEATING Cb: ' .
Signed By: Date :
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