AF - 47218�-,�
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City of Fridley, Min.n.
BUILDING PERMIT
Da�; A,pril 23 � 1969
p�; Tri-Co Builders B�� Same
Address ffi 7561 Van Bureu St. N. E. �,d�� Same
�������
N° 10198
LOCATION OF BUILDING
No. 7310 s�t Jackson St. N. E. p� of Lot
Lot 23 _ Biock �' Addition or Sub-Division Melody Manor 3rd Addn.
Coraer Lot _ Inside Lot X Setback 35' _ gq�y� 13 � 6"
Sewer IIevation — 869.69 _ 872.69
Top of Footiag
DESCRIPTION OF BUILDING
To be Used as:
Dwe� 1 ix� F'ront 46 ' Depth 26 � Height 20' gq, �, 1196 �, Fy; 23 , 9 2 0
a''�f� Front 22' Depth 22' ITeight 10' gq, �, 484 �, r-t, 4840
Type of Construction Frame �� �_$20, 000 To be Completed
SEWER LOCABION - 140' North of Man.hole
WATER LOCATION - 150' ftorth of Ma.nhole
In consideration oP the issuance to me of a permit to construct the buildiug described above, I agree to do
the proposed work in accordance with the deacrlption above set forth and ia compliance with all provisfons of
ordinances of the dty of Fridley. �;i�?�i^ L f
Connection Char
In consfderation oP the payaient of a fee of $ 43 .00 � p��t fs hereby granted to Tri-Co Blders .
to coastruct the building or addition as descrYbed above. This �rmit 9s granted upon
the egpress conclition that the person to whom it is granted and h3s agente, employees and worl�en� fn all work
done in, around and upon said building, or anypsrt thereof, shall cbnform in all reapecta tfl the ordinances of
Fridley� Minnesota regardtng lacation, construction, alteration, maiatenaace, repair and moviug of buildinga
within the dty ]imita and thia permit may be revoked at any time upon violal3on of aay of the provi�lona of said
nnr7innwnne
NOTIC�
Tids psrmit d+� uof eovse ths coestrndioe, installaMon }e� wietag, phrmbtne, ea haHeg, sswa or watsr. B� arro te ss
t6a Bnildio8 Inspeetor for aparaf� pormtls Por thess (tfms.
_- - -.
APP�,ICATZON FOR BIIILDING PERM2T
CITY OF FRIDLEY, MINNESOTg
OWNEL3'S NA�+ �i�� � � ���'�- ��P BIIILDER
�
AUDR.�S 'jS,fo/ lO,�i �•Z � Jv�'` . AUDRESS i�
LOCATION OF S[TILDING
NO . ��l � STREET
,
�
LOT o7� B�,QCK� ADDITION OR SIIBDIVISIONr��'� �✓^�� 3�¢�
CORNII3 I,OT INSIDE LOT � SETBACK c� s SIDEYARU / 3`G `�
,r._,..��
SEWER EJ�EVAT�ON TOP OF FOOTING
.Ap�la.ca.r�.t at-�ach to this form Two Certificatea of Suxvey of Zot and
propoaed bu�lding location drawn on �hese Certifica�es.
DESCRIPTION OF BUILDING
�'o Be IIsed As: .���� ��"'�'`� ��"��
� � Front '1��v Depth Height � �
Squaxe feet /> 9� Cubic Feet � 3 P�� d
� Fxont �'�— Depth a� Height f d
Squaxe feet Cubic Feet y$�d
,
�
Type of Construction �°��-�.C' Estimated Cost �. �-�
,
To Be Completed �� / � � � �
v� ��� ��►s� '� b'�G �
The undersi�ned hereby makes application for a permit for the work
herein speci�ied, a.g�eeing to do all work in etrict accordance with the
City of Frid.�.ey Ordinances and rulings of the Department of Buildinge,
and her�by declarea that all the facts a.nd representationa stated in
thia application axe �true a:nd correcte .� ��r,�, ���� c�
D�TE �`�� � � � SiGN9TUR� � st.., ����-�
.($oh�dule of Fee Costs can be fouzid on the Reveree Sideo)
� � , �,
/ $�° _� � �
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BiTILDING PEftMIT � FEE SCH�DUI,E
S�CTION 2, The Iri.spector of Buildinga sha.11, before issuit� permits
for the erection of any building or �tru.cture, o� for any additio�. to any
c��i�ting �tructure or building9 or.for aiay alteration or repairs �o any'
existing buildixa.g o� st�uctu:�e 9 upox� application therefore, requixe the
pa,yment by the applieant for such permit oi fees to the amount herein
below set forth and i.n the manner herein provided to-wit:
Uniform Building Code: Type 1, 2, & 4-$1075 for each one thousand
eubic feet, or fraction thereoi, i:n such cubical c.nntents. Type 3& 5-
$1050 for each one thousand cubic feeto
For the purpose of computing fees for building permits, the cubical
' c`t�x�tenta of any'b�.iidir�°add:itio�.� '�o°`a uni�orm liei�t�th�u�hau.t =%y `° '
multiplying the ground area covered from a point six (6) i.nches below
the floor li.ne of the basement or the cellar to the avera.ge height of
the upper surface or to the avera,ge height of the roof sur�ace of the
main gable of a pitched roof.
For repairs or alterationa to an existing atructure, the fee sha,ll be
at the rate o� $3.00 per each iive hundred dollars (�500.00) or
iraction. thereof irb the cost of all proposed worka
In no cas� shall the fee charged for a�y permit as aet £orth in Section
2 be less thexi $5v00o
NSSSD Cox�.ection.Chax ges ba�ed on lo�ation - Area 1 or 2.
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SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T
r
� �
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� • COMMUNITY DEVELOPMENT DIV.
� i V �����
r i � PROTECTIVE INSPECTION SEC.
1 . �
� � /"'1 � CITY HALL FRIDLEY S$432 NUMBER REV. DATE PAGE OF
�"'"'� � �'' 612-571-3450 9� 0-F15 5/20/83 / /
JOB ADDRESS �310 Jackson Stxeet N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR, 23 4 Melody Ma.nor 3rc1
2 PROPERTYOWNER MAILADDRESS
Keith Bellefeui.11e 7310 Jackson Street N.E.
3 CONTRACTOR MAIL ADDRESS
4
5 ENGINEER
Same
OR DESIGNEH MAIL ADDRESS
MAIL ADDRESS
ZIP
ZIP
ZIP
PER .
_ 17154
RECEI .
9s ��
APPROVED BY
SEE ATTACHED
SHEET
PHONE
� �so-ai3s
PHONE LICENSE NO.
LICENSE NO.
PHONE LICENSE NO.
8 USE OF BUILDING
RES].C12rit:],.�1
7 CLASS OF WORK
❑ NEW g ADDITION ❑ ALTERATION 0 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 20' x 12' Poreh Addition
9 CHANGEQFUSEFROM
STIPULATIONS
� ���r�iG utili�ies
Befare diBb+�� ��� �ocal
T�I.EPHBNE -����TRtC - GAS Etc.
REC��!IREp B'� �►W
TO
SEPERATE PERMt7S—�fQl11RE0 F4R W1Rt�G�
HEATIN�, PLUMBt�NG ANQ SIG{�"5.
i
TYPE OF CONST.
SEPARATE PERMITS AFE REDUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCZ Fr�t.'
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I FiEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED $2 �%SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $38. SO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
$9. 63
O� AC R OR AUTHOR12ED AG NT IDATEI ,
�' -dS ��J�
.�.., �eo,�env,ruoowiwnca� IDATEI
OCCUPANCY GROUP ` I OCCUPANCY LOAD
CU. FT.
24o I
OFFSTREET PARKING
STALLS GARAGES
SURTAX
$1.38
SAC CHARGE
NONE
TOTALFEE
$49. 51
:RLXIVALIDATED THIS IS YOUR PERMIT
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CITY OF FRIDLCY Effective �ug. 1, 1981
APt'L�CAT1Qi FOk R[SIDCNTIII� 6UlLDlP1G PIRt9lTS
(Nc,,r. Alterattons. Additions. or Rep�irs)
OW��R: � il�- �e � � u � `� BUILOER: ' .
ADDA.ESS: �3 !� o(� e I�S e u S�7 � ADDRLSS:
—
TEl A0: ' ��� Z i 3 3 ' TEl N0:
. _
��� ��� � � I � �
strvction Location
• iTRTST NOa �,� / l� 6TREET: J/� � iC f' t7 n. S 7 ��c
Lo'r: � 3 �i.00c: ,�� acnir�: �/'.p � �� ,�/� r��c- � ,� .� 2 ,�
Cozner Lot: � sn�ta� Let: `�( ictbacka ________ Sideyazds:
�-�---
J1p�]icar�t attach to t)�is lozm L+o Certificates of S1�zvey of Iot aru!
pzoposzd buil�]ing loeataan drawn on eertificstes to seale.
. -
OE SCR I PT IO�t OF t;01•�STP.UCT 10��
f�Q.��� � �R� Fror�t: � � Oept?�s Height:
6quare Feets 2� � _ Oubic Feet: j� D
�
, Ftont: Deptl�: Bef�ht:
Square Fest: p�bfc Peet: .
��U� ��oc�Q � ��� � a��°'� • � ���%
�►pe oi Cbrstzuetion: �2A�� Esti�ated Coste : �` UJ
-_� �
7b Se Onnplctee: Gj - / ' �-?
—
f11t. �► !�l t. B
proposed, Drivc�+ay I:iath Ii Nev Opening Ie Desireds =' ��`
. , . 6E� Ri.VER;E SIDE OF bHF�T �
7i�e undercigned T�ereby mal:e� app2ic�►tion for a per�it icz the �,ork f�ereirs apecifi�d, .
egreein9 to �b ,all vork L, striec eccozdsnce with the City of Fridle�• Ordi»ances �nd
:vli»�s of the Del�►�str►c�t of Duiidingt, and hereby declazes th�+t ail �ie facts and
represe�G+�tfens stated in t]�is appiication are true and correct.
narE: _ � ; !�� � � sicN�►zv�:
6tipulations: r� �
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P � �. ��
�1 J � �
�5 �
� � � "�_
sUILDING PERMIT ?EE SCHEDOLE
The Inspector os eviiein�s •?�all, betoze issuaag pesmits ioz the
•s�cticn oi any builaanq oz •tructure, oz toz any aeditioa to ar,y
•:i�tiAq DuilaiAg or struetur�, os ior any altezation os z�paiss
to �r►y •sistinq bvildinq oz strnctuze. npoa application t?�esetoze,
s�quist t�e paysent Dy tAe applie�nt toz sue?� pezmit pi te�s to the
��oaat L�sein Delov s�t toztA and in the sannez rereiA pzovided to-vita
!'0?11I. VJ1I�[)ATI�1
�l. oo ea i Soo. o0
SSOi �D ;2�000
i2.001 !c t25,000
f25,001 to �50.000
I
lEES
i10. �0 �lini�� Fee 515. 00 plus surcMrge
:10.00 toz the iirst i500 plus Sl.SO for each
•dditional =100 oz fzaction theieof, to ar�d
ir�cluding :2,000
i32.S0 ioz th e fizst 52,000 p2us 56.00 for each
additional 51.000 or izaction thes eof, ta and
inclvding i25,000
i170. SO for the iirat S�S, 000 plus Sa. SO for
each additional s1,000 oz tzsction th�eoi, to
ar�e including iSO, 000
i50,001 tc i1C0,000 :263.00 foz the fisst =50,00� plus S3.OD for
eech •dditional i1,000 oz fraction theze�f, to
and incluair�g 5100, 000
i100,001 ar�d vp t4a3.00 ior the firat 5100,000 plus 52.50 icz
�ach •dditionsl 51,000 or izaction thezeof
pI.�W O�C7C: ZS percv�t of pui lding pe�rmit fee
DRivfl,TA� DEPRESSION ESQt�i�T: Conczetc Q�rb 5tseeta �ly
111teznate 'J►•: Renov�al and zeplace�oer�t of cvrb and�guttez oaly ,
Orivevay vidth plus 6 feet ::13. SO '
111ternate •B': Reaoval ar�d rep2scw.�ent ot cvrb ar�d gutter ana install a 3 ioot
vide �ppzosch vith 6 iruh depth
Drive�ay vidth plus 6 teet s:15.75
VERIFICATION OF FOUNDATION
Permits toz cor�tsuctian viil De issued • �einiir+�n of ?4 hcurs fzom the time of
applieation to allcw tor propez sevie.r ot the pzoposed ctzvcture and of the
const� ction site.
11 Gertilicate of �rvey of the lot, showing the loeation of the foundation once it
?�as Deen vonstsvcted vill De zequized before proceed_ ir� vith the fzami�Q.
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r�ds,.�y,� ,a�����.
��s��� ENGINEERING, INC. �°�
nn� i t��ool , slhir� e�
� — En9ineers F Surveyors —
cett���cate o� sszsve�r �•: �1'Y� DFV�I.O�m�.n'i �
NOR'�N
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�fF1�►T LOSS CALC`�JL.ATIONS �EPAIt7�MF,'oiT ut� IhrSF3t�C1�lO:e' I�I . Af�tIV.
Weat�erstrips � �� • Coaetruction Na. � � ` lnseillation
' o�va I ea Fteference Out. WaU Int. Wall C.eiling Roof Floor Kind How App
e No es o 19_
FL� � Room ([.ength - Width Height Fl.� oo� L.eDgth Width f�ieeiyqht �
Win�ow� an ro—Cracka o and Area v1 Wis�dows and rs--Cracica and Ana ///��� -/
K'�dth HelgAt No ot gLlneal (t. Are► � v � Wld Helsh o. gLloul ft. Araa � ./
No. ot pane o! pane 116ht• o[ k . tt. � L � �� N. n ot a • ot aek aQ. t. �/
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lefilteation �' In�iltration - �
Gla,e
E�. wall
Net e:p. wall
lnt. w
Ceiling
Floor
To tu.
or �o. ins. W.A. Leader area
� �id►h � tie►gnc r
Area
„ n at tt. Area � �
ot crsot cp. tt. �
1�
Inbitration
G1a�
E:p. wall
Net e:p. wall � '� '
Iat. wall
Ce�lmg
Floor .-'
To n.
Requir D.R. or eq. iee. WA. r ar�a '•
FI. Roa� � Leey�eh edth ' eight
�li�ows aeirl �OOn--�Crackaee aud Area /^^�
IdIA •I�bt Ne. Of Lln�al !t. AreO �
N�. ot pan� ot a• 11 pi� ot c k eQ. t
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d:laas
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Cciling
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E.D.D R or �. iea, W.A. l�ader acea
�
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Esp. wall
Z Nec eap. wall C�
Int. wall
�, Ceiling
Floor /
�_ �ota tu.
��� Requir ft. E.D . or eq. ias. W.A. l.eader area
F7.1 m I Lengch �►idth
' Windows and Doore—Cracka�e ad Area
Wte[n H�ISht No, ot l.�neal lc. Ans
No, ot D�ne o(,�yle LsTab ot cr4c4 �. ft.
�
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In6ltration
Glass
F.�cp. wal)
Net eap. wall
Int. wnll
Ceiling
�Fioor
Tot tu.
ED.R. or sq. in�. W.A. Leoder sre� � y
m I I.et�th Width --plei�he
aed rackage and Ares
H�I�ht AYa ot Llneal tR ♦n� /�i
� o aae ►/�ht� o! e .!t-
/� /� /
lnfiltrstion
Cala�
• Esp. wsU .,
� Nst e:p. well
Iat. w
Ceiling
,_Floor
Tot u.
ea�. � i,�er anea
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• _ ` ��� CAL�°�°I ,' ,rc '��, ;�� _ ' -�; ,. , ,�y ,�
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• Weatherstr�pa ��:���.H.�.E.:� "—`'�
Cwde Conattuction 1�Ju, ' ��
----�. __ _ -- - --,- _ --
Yes �g e, Refuence ;' Ou �all Int. Wall Ceilsn� Roof �'�I — lnsulaeiod. �'
" o --
Y� 1q_ � Floor I Kind f-(ow App e� `
Fl i Length ,�-�lyidth
� Windows and Door e'? H�;�he � �_
q - rackage and Area {�� �°Om �48� C�Vidth _--f-��;�ht
Wldth He1gryP Nn. of �p'4� �'YUI and D
� No. ot pane of Linoal Pe. nre¢
� u�n�e „r ��.�k oors—Crackage and Atea
'°�- 'a � �� wiain He1BAt o. oc Lineai rc. wraa
/ � � No. D e ot p 1• ot cr4ck �. tt.
lC
� j .--- . � �,s
/ II A � .� ��� / 1
1n61tretion
—_
�aae
E:ap.�--- �i�..,
Net e—__
lat. wa11 •
Ceiling
Floor i- �
ro u.
_ KtqUlild b(j. �i. E.D.R. OP �. lfdf. W.A. LtedPP lY7�a
Fl.� � en�th VVidth
Window� and u�.,-�,,o,;�� aad Are�
W� e e1�At No. o[ Llneal [t. Are�
No. ot o[ pane 11 hl� o[ crnek
t �p. tt.
�
le�ltiation �f• 8tu
Glara
Eap. wa1)
Net e:p. wa�)
Int. wali
C In��e g
Ftoor
Total �tu.
REquired sq. h, E,p.it. or u�. in�. P1/,A, (,ea�r area
--� Fl. Room � LenBCh Width
Wiadowe aad Doo �s8hi
n---Gackage �nd Area
waen KN�ee xo. o[ Lrre.a� te. wrea
�a o! pane o[ pane IISBt� ol enck e
a. tt.
Is6hr�tio� �f' �
�;lau 1 ,
Esp. wall i
Es
N� ssp. wall � � ��
Int. wall ��
Ceeling
Floor
Total �tu.
�irmd oq. Fa. E.DJZ. � �. �i+.A. l�adc� ar�a
`��ma,r�re„�.
_ _ �•..,
- a.. c..::::Y;w...�. — -
dn6ltratioa
Glaaa �
F.xp. wall
Net ezp. wall �
Int. wall
Ceiling
�oor �^ __
Tot tu_
sq. ft. E.D.R. or tq, ins. �I.A, j,,eader arre
r�.� Room I l..engch Q/;d�,
Windows and D�rs--Creckage end Area
Wldth Hel��t No. ol Llnsel [t. Area
No. ot pane ot pan� ll�ht� ot craek
W. ft.
In6ltration
Cilasa
Eup. well
Net e:p, wall
Int. wall
Cei�ing
Floor
Total Btu.
Requiced �q. ft. E.D.R. or aq. iaa. �V.A. Leadee area
FI.� Roo� I Lsagtb Width
��d°� °pd ��d--Craeleage and Area
WIdeA He1sAt No. ot Llneal ft. p�y
No. ot pan• ot pane IIQAt� ot er�cie .e a
1n6ltration
----_
Glese
-------
Eap. waA
--____
IVet ezp. w�ll
J��, waA
Ceiling
E' loor
7'otal �tu.
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7
CtTYOF
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E.. FRIDLEY, MINNESOTA 55432 • PHONE 16121 571-3450
April 9� 1984
Mr. Reith F. Bellefeuille
7310 Jackson Street N.E.
Fridley, IrW 55432
Re: Concrete Obstruction In The Gutter
Dear Mr. Bellefeuille:
It has been confirmed by recent inspections that you have placed concrete in
the gutter immediately in front of your driveway. This practice obstructs the
Water flox in the gutter and can cause damage to City vehicles When clearing
snow from the streets.
Therefore the City must require that any material be removed from the gutter.
To insure that all the concrete is removed and that there is no damage to the
curb� a City street maintenance cre�► will be removing the concrete.
Any initial costs Will be absorbed by the City, but if at a later date, it is
found that a neW obstruction exists, any new removal expenses Will be the
property oxner's responsibility.
If you feel that a problem exists When trying to enter your driveWay from the
street� please contact the City Engineering Department about acceptable
solutions, e.g. constructing a neW driveWay depression. T* �ho��d be noted
Work•
The City is confident in your cooperation on this matter and again, if any
questions or problems arise, please feel free to call on me at 571-3450.
Sincerely,
.o`�
STEVEN J. OLSON, R. S.
Environmental Officer
SJ 0/mh
CC: Mr. Ralph Voll�aa
Supt . of Public iiorks
�$�� '� :.r�=��� CITY O� FRIDLEY
� J+�-�.:'�� d�31 UNIVERSITY AVENUE N.E.. FRIDLEY. MINNESOTA 6S�3Z
TELEPHONE ( 612?571-3�50
- '"� o , '-
_�". � �,
�`�' .%'� October 26 � 1983 -
..�,�;,"� ���- —
��:, ,. � — <:.� -
� • ..;�� �,z.
.;,-
.A��,x��;
�,.�,�;
-_���� Nr. Reith F. Bellefeuille
.#� 7310 Jackson Street N.E.
�' Fridley� !�1 55432
Re: Concrete Obstruction Zn The Gutter
Dear Iriir: Bellefeuille:
_ It has been cont'irmed by recent iaspectioas that you have placed concrete
in the gutter immediately in front of your drivexay. This practice
obstructs the vater flow in the gutter and can cause damage to City
vehicles �rhen clearing snow from the atreeta.
Therefore the City must require that any material be removed from the
gutter. To insure that all Lhe concrete is removed and that there is ao
damage to the curb, a City street maintenance crew will be removing the
concrete -.
Any initial costs Will be absorbed by the City, but iP at a later date,
it is found that a new obstruction exists� any aew removal expenses will
be the property owner's responsibility.
If you feel that a problem exists when trying to enter your driveWay from
the sLreet� please contact the City Engineering Department about
acceptable solutions, e.g. constructing a aev driveway depressio n. j�.
should be noted that only the Citv or its �u*�^^��°'� ^nntrae�OP C8fl do
s±�rb and a�tter cement rrork.
The City is confident ia your cooperation on this matter and again, if
any questions or problems arise, please feel free to call on me at
571-3�►50.
Sincerely�
STEVEN J. 4i.SON � R. S.
Environmental Officer
SJO/mh
�%_ K�i� ��c^��P- /rY�-,.�.
NEW
ADDN
AL1'ER
[ l E 've 5J26/93 ��
L I Crr�t OF FRtnr.�Y Q�, �� � U
[ J SINGLE FAMII.Y AND DUPL�XES R-1 AND R `L�' �
Building Perrnit Application
XConstntction Address: %� /C� �/�9c�sd � �� � � �
� Legal Description: •
�Owner Name & Addtess'.���E2 ��c� j� �� �J,��!,�� S7- Tel. #��a "��
���ar; MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lc�, with �d�e preposed �ca�ucd:on drawn on it to s�a1e.
LIVING ARSA: Length
Q�ARAGE AREA: Length
DECK AREA: Lengtt�►
OTHER:
DESCRIPTION OF IlVIPROVEMENT
Width
Vl�idth
Rlidth
Corner Lot [ j I�nside I,ot [] Ft� Yd Seiback .
TyQe of Coastcuctian:
Agprox. Con�letion �aate:
Height
Height
HgtlGround
Sq. F�
�. Ft.
�. Ft.
Side Yard Setbacks
Eslimated Cost: $
(Cost � Back)
�Driveway Cnrb Cut Wi� Ne�d�: l�o Ft. + 6 Ft = A2� Ft x$ I 3.��i =� oZ 9' 4��
DATE:
Permit F�
Fire Surcharge
St�ate Surcharge
5AC Charge
License Svrcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Maia Charge
S
$
$
$
$
S
$
$
$
APPLICANT:
�. _�. _ ' ! �L
F� �t�lule on Reverse Side
.001 of Permit Valuation (1I1(#th°b)
$.50/$1,OOU Valuation
$750 per SAC Unit
$5.00 (State Licensed Residentiai Contiractors)
Alt. "A" Or Alt. "B° AbWe
Conservation Plan Review $450.�
Fee Determinal by Engineering
Agreemem Aie�essa�y I l Not Ne�cassar�► [ l
TOTAL $ STIPULATIONS:
Tel. #
BUII,DING PERMIT FEE SCHEDULE
�'I'he 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 applica.tion therefore, require the pay�ent by the applicant for such permit
of fees to the amount herein below s� forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,0�
$2,001 to $25,OW
$2.5,001 to $50,000 . .
$50,001 to $100,0�
$10(},001 to $5(10,000
$500,001 to $1,000,(�0 .
$I,OOt},001 and up
FEFS
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $500 pins $2 for each additional $100 or
fraction ther�f, to and including $2,000
$45 for first $2,00p plus $9 for �ch additional $1;000
or fraction thereof, to and including $25,000
$252 for fYrst� $25,000 p��s $(.50 fur each additional $1,000
or fraction thereof, to and including $50,000
$414.50 for first $50,0� plus $4.50 for each additional
$1,000 or fraction thereof, to .and including $100,000
$639.50 for first $1�,OOU plus $3.50 for each additional
$1,IX10 or fraction thereof, to and inclu+ding $500,000
$2039.50 for the first $500,000 plus $3 for each additional
$1,UQ0 or fraction thereof, to and including $1,000,000
$3539.SU for the first $1,OOO,Q00 plus $2 for each additional
$1,000 or fraction �thereof �
DRIYEWAY DEPRESSION ESCROW
(Concrete Ctirb Streets OnIY)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times
$13.50.
Alternaxe "B" : Removal and replacement of curb and gutter and install a 3 foot wide .
approach with 6 inch depth - Driveway width plas 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 structare and of the coastruction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been
consbructed will be required before pr�ing with the framing. �
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,� ADDN
' ` ALTER
��� � ���
��� �
[ ] CITY OF FRIDLEY —�� � [ �
[] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bidg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
- — —
Construction Address: �� % C..�' ���.�c%�C1 ,`�% �-
Legal Description:
Owner Name 8� Address: P�Y���Z A� �4u� � O�/ Tel. #%C�3 -%�� -�2y9
Contractor: .��-d c�—.� � �--5 �G �tJ L`�2 5 MN LICENSE #�� Z
Address: �% 7`�L� �2'�� �- � C. l2-ol31���15 D�4-� �- Tel. #?.63 -S 33 - t� 3 s�
LMNG AREA:
GARAGE AREA:
Attach to this application, a Cert�cate of Survey of the
lot, with the proposed construction drawn on it to scale. i''�,�
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER: L`��✓%/1UG, � 5��d � 1�DJQ-c f-� 7'� �I � c.7'9��3� �l�l .
ev
Construction Type: - �L L— Estimated Cost: $ Z C�v�
Driveway Curb Cut Width Needed: _��± 6 Ft �_Ft x$ _�
DATE: J � Z S " �S
Call (763) 572-3604 for Permit Fees if
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
� �11f.�S
� ` `�s� °.
$ �7, �' �
� `3���
$
$ a ��
$
$
$
$
Tel.# l /2- 22/- `�3s �/
in application. Fax to 763-571-1287 if using credit carrl and we will call
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [
TOTAL $ !�`f . �f STIPULATIONS:
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 buildi.ng or siructure, 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 $SOQ
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
FEES
$23.50
$23.50 for first $5� 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 ea.ch additional $1,000
or fraction thereof, to and including $25,Q00
$391.25 for first $25,0(JO plus $10.10 for ea.ch additional $1,000
or fraction thereof, to and including $50,�
$643.75 for first $50,0� plus $7.00 for each additional
$1,000 or fra.ction thereof, to and including $1�,(�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 ea.ch additional
$1,000 or fraction thereof, to and including $1,Q00,000
$1,000,001 and up $5,608.75 for the first $1,0�,000 plus $3.15 for each additional
$1, Q00 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.00.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed. structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv �
s� St�te of Minnesota
oep�rtrn�nt ot commerce
85 - 7tft Plat�e East. 5uite �
<;,� •. �-a� : St PaUI MN 55101-3165
�;� �����
. �.�. � .. . .<>:
DBA. .
Address: 4��,4�� AVE N ` _
ROBBFNSDALE, MN 55422
Ucer�e IdentH'ication Numi�r. BC• ��$Z
ticense Ex�rtratian oate: 3l37l2005
�
Department of Canmerce Licensing D'nrision
Tetephorre: (651) 2�-6319
�rnail address: Ik;ettsMg.cornmerc�state:mn.us
Webs�e addr�s: crommer�.state.mn.us
. >.. .. _
. .< ,:
A'�. � ....r......�..�-... �■:.Y..:.. .._.:' ..;.,
quaitfying Pefson: DMVID P DAHL
cor�thwir�g �ducation: 7 HI^s C� due by 3/39/2Q05
CITY OF ERIDLEY INSPECTION DN.
6431 Uninersity Anenue NE CONTRACTOR LICENSE
Fridley, NNm11 55432
(763) 572-3604/572-3602/572-3603 EXPIRES : April 30, 20(�'
APPLICATION FOR FRIDLEY LICENSE
535.00 EACH - Mark only one license per application form
[ ] Blacktopping
[ ] Chimney Sweep
[ ] Excavating
[ ] Gas Services
[ ] Commercial or Specialty [ ] Plastering
[ ] Heating [ ] Roofing
[ ] Masonry [ ) Sign Erector
[ ] Oil Services [ ] Wrecking
REGISTRATION FOR STATE LICENSED CONTRACTORS
NO FEE For the following registrations
[ ] Electrical
[�]. Residential Contractor
[ ] Mobile Home Installer
TO THE HONORABLE CITY COUNCIL:
[ ] Moning
[ ] Plumbing
[ ] Well Driller
I herewith submit an application for a license to perform construction within the
City of Fridley, in accordance with the ordinances of said City regulating the same.
I am over twenty-one years of age.
Submitted herewith is a Certificate of Insurance evidencing the holding•of Public
Liability Insurance in the limits of $50,000 per person, $100,000 per accident for
bodily injury and $25,000 for property damage, and Workers Compensation as required
by State Statute Section 176.182.
Attach Copy of
CERTIFICATES OF INSURANCE
Public Liab.
Expiration Date
Worker's Comp.
Expiration Date
*MINNESOTA LICENSE # 2--3'� �
*ATTACH COPY OF STATE LICENSE
FILL IN REVERSE SIDE OF FORM
FOR OFFICE USE ONLY
��-c�b7 �c .�c5/Gti��l�
Name of Company to be Licensed/Registered
�1� N� C� �.� �G��I�
Name of Individual to Contact
�/i�/v �/2 N`—� d.r Jr- _ � ) , —
Address of Com �����°
� C����` �
�D13C3�� 5 lJ�-� ���j� �
City , � VI ,/�-1 �° �
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763 -5 33 -v3.� (��� � � �
Tel # of Busine
Receipt # License # Counci
WORKER' COMPENSATION INSURANCE COVERAGE
�
Minnesota Statute Section 176.182 requires every state and local licensing agency fio
withhold the is�uance or renewal of a license or permit to operate a business in Minnesota
until the applicant presents acceptable evidence of compliance with the worker' compensation
insurance coverage requirement of Section 176.181, Subd. 2. Provide the information
requested in the spaces provided, or certify the precise reason your business is excluded
from compliance with the insurance coverage requirement for worker' compensation:
I am not required to have worker' compensation liability coverage because:
[] I have no employees covered by the law.
[ ] Other (specify)
[] Insurance certificate provided to City.
MINNESOTA TAX IDENTIFICATION NUMBER
Laws of Minnesota, 1984 Chapter 502, Article 8, Section 2(270.72) (Tax Clearance; Issuance of Licenses),
the licensing authority is required to provide to the Minnesota Commissioner of Revenue your Minnesota
business tax ident�cation number and the social security number of each license applicant. Under the
Minnesota Govemment Data Practices Act and the Federal Privacy Act of 1974, we are required to advise you
of the following regarding the use of this information: (1) This information may be used to deny the issuance or
renewal of your license in the event you owe� Minnesota sales, employer's withholding or motor vehicle taxes;
(2) Upon receiving this information, the licensing authority will supply it only to the Minnesota Department of
Revenue. However under the Federal Exchange of Information Agreement the Department of Revenue may
supply this information to the Intemal Revenue Service; (3) FAILURE TO SUPPLY THIS INFORMATION MAY
JEOPARDIZE OR DELAY THE PROCESSING OF YOUR LICENSE ISSUANCE OR RENEWAL
APPLICATION.
Minnesota Tax ID Number
Applicant's Last Name First Name Middle Initial
Applicant's Address
Applicant's Soc. Sec. # Position with Company
Business Name and Business Address
I have read and understand my rights and obligations with regards to business licenses, permits and
worker' compensation coverage and I certify that the information provided is true and correct.
Date Signature
MECcheck Compliance Report
2000 Minnesota Energy Code
MECcheck Soflware Version 3.2 Release lb
COUNTY: Anoka
STATE: Minnesota
ZOATE: 2
CONSTRUCTION TYPE: Single Family
DATE: Ol/27/OS
DATE OF PLANS: 12/20/04
PROJECT INFORMATIOAT:
NAWROCKI
7310 Jackson St NE
COMPANY INFORMATION:
Sawhorse
COMPLIANCE: Passes
�`�` f_� _
�ta�mum UA = 49
Your Home = 49 j
1T.$°/u�etter Th811 Code = ,-:-
� ��
Permit Number
Cha k� By/Date
Crross Glazing
Area or Cavity Con� or poor
Perimeter R_value R_Value U-Factor iJA
Ceiling 1: Cathedral Ceiling (no attic) 240 38.0
Wall 1: Wood Frame, 16" o.c. 396 21.0
Window 1: Above Grade, Wood Frame, Double Pane with Low� 64
20
I�or 1: Glass 20
Proposed and Ma�mum U-Factor Averages
Proposed
Average U Factor
Above-Grade Windows and Glass Doors
Includes Foundation Windows > 5.6 ft2
COMPLIANCE STATEMENT: The
Plans, specifications, and other cul
been designeci to meeL�e�20�D���ilinp�
5.7 6
1.3 17
0.310
0310 6
Maximum
Allowed U Factor
0.310 0.370
lding design descrt'bed here is consistent with the building
terl with the permit applicatioa The proposed building has
Code requirements in MECcheck Version 3.2 Release lb.
Date l -' 2,�^0�'
�
CERTIFICATE OF SURVEY
FoR: SAWHORSE DESIGNERS & BUILDERS
LEGAL DESCRIPTION: Loi 23, Block 4, MELODY MANOR
SITE ADDRESS: 7310 JACKSON ST. N.E. FRIDI,EY, MN
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Adjocenk H�use I
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o Denotes iron monumenf
• Denotes found monument
x Denotes large spike
x 000.0 Denotes existing elev.
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1 hereby certify that this survey, p/an or report was prepared by me or under File No.
DEMARS—GABRIEL my direct supervision artd thot I om o duly Registered Lond Surveyor under the 12718
LAND SURVEYORS� jNG'. �aws of tne State of Minnesoto. Book-Page
3030 Harbor Lane No. fts surve e; by me tn1; — <otn day of �ecembar 2o a4 428_9
Plymouth, MN 55447 Scale
Phone:(763) 559-0908 • ���
David F. Crook Minn. Rrrj Nn. ,7q14 �"-30�
12/22/04 11:07 DEMARS—GABRIEL i 7635332668
�
CERTIFICATE OF SURVEY
FoR: SAWHORSE D.ESIGNERS & BUILDERS
LEGAL DESCRIPTION; �ot 23, Block 4, ME,LODY MANOR
S7'TE ADDRESS: 731 p dACKSON 5T. N,E, FRIDLEY, MN
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��°� �j` rr e�°4¢'ls" wy e 112 00
�++�I��11 Fenc. o.fs ovor lina �8�,6 •
AdjUCln( iIpU.9p .
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o Dsnotes iron monumeni
• Denotes lound monument
x Derrotes �ar9e spike
Y 000.o Denoies exisling elev.
�—......, c :\i'v'���nw� i � � t � ::wG
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I ne�eDy c�rlily thot thi9 survey, p/an or report wos prepored Gy me or under File N0.
my direct supervision ond lhat / am a duly Registered Lpnd Survoyor undei tAe � 2718
Laws of tbd Stota ol Minnes�to,
Book-?oge
a� aurve ed by me tni� ?��� dQy of Dee�mbvr — '
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_____ a-�,�.... Scc�e 1
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DEMARS— GABRIEL
LAND SURVEYORS, INC.
3030 Horbor I_pne No.
Plyrriouth, MN �5�t4•7
Phone:(763) 559—Q9U$
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SAWHORSE
D�SIGNERS & BUILDERS
Roger and Gwen Nawrocki
73 i 0 Jackson Street North F.ast
Fridley, MN 55432
Job # 1800
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1.
SCOPE OF PROJECT: Porch conversion
Date: 12l20/04
Rev: 1l11/OS per
CPR & C/O
Walls to be removed shown as "sha.ded" on e�sting plan. New wa11s constructed are
shown as "cross ha.tched" on proposed plan.
WINDOWS-
Pella Proline 2953 aluminwn clad casement window (qty. 2)
Rough openi.ng: 2' S 3/4" x 4' 6 1/8" (includes 3/8" @ sill)
Glass size: approx. 24" x 48"
Glazing: Low "E", Argon gas filled
Exterior finish: Clad; aluminum-white
Interior finish: Unfinished wood
Jamb size: 6 3�4��� due to new 2x6 stud. walls
Sash to open as per plan, w/ "champagne" latch, rotos and screen
No grids, blinds or shades included in this contract
Trim: Oak ranch casing, stained by owner
2. Pella Proline 2953-2W aluminum clad casement window (qty. 2)
Rough opening: 4' i 0 3/a" x 4' 6 1/8" (includes 3/8" @ sill)
Glass size: 24" x 48"
*remaining specifications simiiar to window #1 above*
3. Pella Proline direct set trapezoid window (qty. 2) (above window #Z)
Rough openi.ng: 4' 10 3/4" x varies
*remaini.ng specifications similar to window #1 above*
�
�
EXTERIOR DOORS-
Pella Proline 3781 French door
Rough openi.ng: 3' 1'/4" x 6' 8 5/8"
Jamb size: 4 3/4", due to mfg., door will not open past 90°
Glazing: Low "E", Argon gas filled
Exterior finish: Clad.-white
Interior finish: Unfinished wood
No grids or bli.nds included in this contract
Hazdware: Mfg. Brass lever with three point lock
Trim: Oak ranch casing, stained by owner
MECHAIVICAL/HEATING per contrac� Reloca.te one existing wall register (living
room).
SPEC'S Page 2 of 3
[J ELECTRIC per contract;
• ALL FIXTLTRES (UL listed), if on job site at electrical fuush, aze furnished by
owner, installed by SAWHORSE.
• Switch and outlets to be "IVORY" color.
CABLE TV, SECURITY and/ or PHONE rough ins aze by owner.
SAWHORSE will advise owner when to call for installation of the above items.
• ALL electrical openings in exterior walls require an "air-tight" rough-in box.
• No DOOR BELL BUTTON relocation is included in this con�act
The following aze electrical items included in your contract:
6 - removals/relocations in existing area
1 - circuits added as needed for addition/remodeling
1 - hardwired smoke detectors with battery backup
3 - battery powered smoke detectors
4 - standard receptacles (wall duplex outlets)
1 - weatherproof ground fault interrupter (GFn receptacles
2 - standard switches
1 - ceiling fan/light openings with two switahes
1 - electric junction for owner's gas fireplace
Any changes to the above quantitiea will be charged or credited accordingly.
°�Indica.te any special receptacles needed for computers, entertainment centers or any special
height wanted.
[] INSULATION-
• Wall insulation shall be R-21 friction fit fiberglass.
• Floor and ceiling insulatioa shall be 3/4" thick rigid insulation (R-5) with 5" t�ick
polyurethane "foaan-in-place" (R.-35) insulation in ceiling and R-30 insulation in
floor.
Four mil poly vapor barrier over studs and joists.
[] DRYWALL —
• %2" gypsum board over wall studs w/ taping process, sanded smooth for ovv�er's
prime, spackle, and painted finishes.
• 5/8" gypsum board for all ceiling applications w/ taping process and "medium"
texture finishes.
[] FIREPLACE- By owner. Install new 42" Country Stoves Cha.teau 42DV (R.O.: 43" x 35
%2" x 20 3/4") with stone facing, raised hearth (15" high x 19" deep), and an unfinished
wood mantel ($500 allowance). Stone facing, gas piping, and fireplace provided and
installed by owner. (Facing- Hamilton Blend 56120-3 Boulder Creek).
[] GENERAL NOTES
[] CAUTION:
Do NOT remove, t.�ar dawn, or dig up anything before buildi'.ng permit is on job site.
SPEC' S Page 3 of 3
�
[] OWNER to protect or move all personal property from in or around consttvctioa area,
bath interior and exterior. Please review area before construction start-up and remove
necessary items.
[] OWNER DIRECT "Not Inclnded in Contract" ITEMS:
SAWHORSE to assist in schedule coordination
• All painting, staining and decora.ting by OWNER.
• Fireplace, stone facing, and gas piping
• LIGHT FIXTLJRES
• FLOOR FINISHES
• Modifications to public utilities
• ABATEN�ENTS (lead or asbestos)
• Corrections of existing substandard conditions (structural or mechanical)
Owne�r is responsible for all N.I.C. obligations:
Selectioas, schedule costs, liabilities and warranty issnes.
Q Clean up of building debris at job completion by SAWHORSE.
Dumpster may be left on job site for building debris.
(No tires, appliances or neighbor's matt�ess).
[] Any yard damage REPAIR including ttees, shrubs and all landscaping by OWNER.
Communication is essential for a successful projec�
Project Manager: John Westgaard cell (612) 221-4354
Construction Administrator: Tracy Wright (763-533-0352 ext. 241)
Weekend EMERGENCY Pager: 612-527-a590
'� �,�,�L/ � � �
�D65
ORDER FOR PAYMENT NO. -
�- - _>�,�. ; - �'�-,�i' a�€R F�
Installer of Wiring `/ �� � ` `�' � �"` ` � �
h/ t� k� i� ��c �c i Job r�/`��� `I
Owner/Occupant _
. �:� - ;'iz<<��
Property Address �`-��� � ������ Z�p �
Date �_� .S '� �` t� Permit No, ��:� 7�� " t y � Date Filed �
O Additional rough-in inspection was required.
❑ No access - scheduled inspection.
[a'Fee shortage - see computation.
O Reinspection fee.
Fee Computation:
� ` / �`' S� � �c'+ � . �
/ � �� r_ ..�-
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c� � � � � �, z, 1l�
�� �7 j [ -i ,�r � � � iz,, t`��� �c�� ,nl, �'
�= iz, �f �r � �"1!I H , .S S"Y-f:� --�/3 �3� 5�
Please retum this order with your check in the amount of ��`- �� `—� payable to the city/ �
township by (date) 5 �— � � � �'�S
inspector �'�'�`�' `J—' _ Telephone �'��— �� 7 7 � �`�
RETURNTHIS ORDER WITH PAYMENTTOTHE CITY/TOWNSHIP WHERETHE JOB IS LOCATED. RC-02