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AF - 47539� � • City of Fridley, Minn. BUILDING PERMIT N° 7291 Date: _.,�.�..__.� �"_� —�' �__.� _ � � �`� . Owner: .d�_c�� :t',dP.S.� wlder _.:..::....__ . ..... _ 2..� _L ..__..._. Address_..._.__...._.___.�._.__._._.....�..._._.__......_._..•-•..._...._.._...._.._.._ Address _.__...___.__....._...__._.._.._.._...__.__._.___. LO TIONA BUILDING No. .�,(Q.....J..�..,�Street ._. ..__. _..._ .. ....�.. _. .e!��!�..t..._...1•�r••,h•-•t. P of t ._ ....._.. . ` _�Lot ...__.......oL_....._...._ Bl ._.._._._..__.� .._._......._._ Addition or Sub-Divisi�on . . . . ._.� . Corner Lot ___._._...____ Inside Lot .....�_✓._._..._._.. Setback _�.�•___.._....... Sideyard _._../__� ..� �.._..�._._.. Sewer Elevation .�.�t_.�r..�_� _._._._..___..._._._.._._ FOeiWon IIevation ..._�_..�L..�� _ ��b /C FoeTin )L _ DESCRIPTION OF BUILDING T Used ._ . _ ..._.. _ Front �.�Q Depth �� Height ..,E..-_0 Sq. F� ��? ._ _ . .�..__ Front _1..�_ Depth _. 2 .. Height ._.L.� Sq. F't. ...es.�.d O — � 1�pe of nstruction ��XL�.-• --.. Es� C ,�� ....'......._........ To be ComPleted _:_ Gtt. F't..C�.�:_..� Cu. FL ��.-.Q—� /L�o ��' L L.�J .'%r� rcc� 6 F r- o i— i�L-Rlv s I� S �4 6� U� L, TS /� 2 �r' ��/�' T� c� � �(1 ff-/ L A- !,� C.. � ��i`1��2.� �o� !�, L La uJ c_� p �� ' /"� D � r— � c= 2�� e_.�.1 � n o r� � IH-i �e/ To � p o�" �-o o- ��. �� !� . In consid�eration 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 �/� orth and �� lian with all pravisions of ordinances o! the city of Fridley. p«-^l_r32��8��'' ��_ �� In coa�sfderation of the payment of a fee of ��..._...._._.._.., permit is hereby graated to_ to construct the building or addition as described above. This permit is granted up� the express condition that the person to whom it is granted and his agents, employees and worlQnen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Miiuiesota regarding location, construcUon, alteration, maintenance, repair and moving of buildings within the city ]imits and this permit may be revoked at a�y time upaa violation of any of the provisians of said ordiaances. � Buildin8 Inspecto� NOTICE: 7his p�emh doa nof eowr � eonshv�Noo, �atall�Na� for vrirLp. Plda�b6io. Ya h�afin�, aw�r or wN�r. d� wn to aN th� dvildiag laqneror for ap�rah pwmils for th�a hNas. _... , �,: T 4^[. �. _ APPZICA'PION FOR BUILDING PERM�T . _�- . . , � _ > �. _ �. , .. . . ; . _ CITY OF FItIDLEY, MINNESO'fA, ` ''� ' ' ., - - _- . . . . . . � , . ' .. ' . . ,."'.' . . S '. . •! ' . . « . .:' : - `: � . .. � , . .. ' . .. . � . . .. . . . . i ." . � .. ' . ' ' . . . � ' . ' , . . . . .� . . ...: �.'1`, . _ A --._ O�fl�lS� / S � � AV iLLGA � � � � . . . . . . . . � . , _ . . . . . S :. ... . . . , . . . . . .. .. , . . ,. . . .- :� . -, .. . . . .-., _ .. An }��y� .. .. . ; ..: ...� .. `]:'.:...�� . : �`,�-., M/iri�iJS _ . �' . . ' . . . . �L�ILL�SS� ' . . . . , . . - . LOCATION OF UILDING . . ... . . ;, t -.:, ,. , . : . No. ' �� . . Street ' � rt' bf �b�t� Lot: � Block . Additio or SabdiViaion -' � ' . � _ . ; , ,, . . , .; Corner Lot Inside Lot Setback •• �3ide�Yard`` '�� SEWER ELEVATION P'OUNDATION ELSVATION •• :`-��'-'�.�`_� �, � Applieant attach. Co Chia form 1'wo Certificates of Sur�y of Lot aad pt%;�pc�=build- _ . „ �, , x .. .. . ing location drawn_on theae Certtficatea. '' ' " :l:. �:4:,... , ,�_, .. _ ' DESCRIPTION OF aUILD�DiG . , ss�;k<�r��'� To be used as: - c� . , . : , , ,. ,. �. .. , � . ... _ Front Depth � � . 8ei�ht�'.;.. x � �� , � . . : Sq. Ft. ' Cu. 'Ft. �. � : , . � Front � Dspth Height`.... � r .. ,.,�_, .. , .. . .. � � � Sq.�;Ft. : Ctii. i�t. .- . �., . Type of ConsCructiao EstimaCed�CdsC, `- �`� .,—.}.W ..r ..... �.. To be Completed , � . , . ., �� . �� The undersigned hereby makes application for a permft 'for the work he�!'etid �'s'pecified, agreeing to do all work in strict accordance with the City of Fridley OtdinanGas and rulings of the Depar.tmen�t,:Af Build3ngs, and hereby declares'thaC`�Yl;th� �;and • . ,�^��.a�� .; representations stated in this application ar true and c rr� �, � �� / . �Schedule of Fee Costs can be found on the Reverae Side). . . � ` • - . .. t� �� QESIDEL�iTIAL CITY OF FRIDLEY APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING $YSTE�4S AND DEVICES RATE SCHEDULE RATE TO'PAL Furnace Shell and Duct Work, BurneT (Also replacement furnace) Gas Piping (piping needed with new furnace) Gas Range Gas Dryer * Air Conditioning (all sizes) All Others/Repairs and Alterations 1� of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 18 of Value of Appliance or Work $ 20.00 $ $ 10.00 $�� $ 10.00 $ $ 10.00 $ $ 10.00 $ $ $ State Surcharge TOTAL FEE Reinspection Fee ($15.00) Rough Insp. Date Final Insp. �l",7`��D � Date Approval for Permit !� MINIMUM FEE FOR ANY HEATING PERMIT IS $10.00 PLUS $.50 STATE SURCHARGE Effective Aug. 1, 1981 Job Address � 7 7 .��/'� �C� p/� � Tf Department of Buildings, 6431 University Ave, N.E., Fridley, MN 55432 City of Fridley Tel. #571-3450 The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. Fridley, Minn. %� d (f , � 3 , 19 � � OWNER l�� /V N� T/� �. �7 6� % S S� KIND OF BUILDING � � � �% � USED AS ��i r ��. 1_�✓ G---- TO BE COMPLETED ABOUT ESTIMATED CO5T $ .50 � OLD NEW BUELDING PERMIT NO. PERMIT NO. _ $ S ! d /.`�� DESCRIPTION OF �'URNACE/SURNER Attach stack verification fonu with replacanent furnace pexmits � . >, _,. .� ; _,,..� . . • *�;:� ' . . . ... . . .. :;Y u�"L .. Y .. . . re 5k .. . HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name �� s ��,Q /�j ),�� Size No. Capacity Z T . Ft. EDR BTU � U��Q HP .�j- Total Connected Load Kind of Fuel �I/f}T G�g- S BURNER - Trade Name , Size I�. Capacity Sq. Ft. EDR BTU HP Company r` Signed By Tel. No. .� }( � ^ � Z (,� � CITY OF FRIDLEY iNSPECTION DIV, 6431 University Ave NE Fridley, MN 55432 572-3604 ;� I_ • � APPLICATION FOR POWER PLANTS ANp HEAtING, COOLING, VENTILA710N, REFRIGERATION AND AIR CONDITIONING SYSTEMS ANp DEVICES � Residential Fumace Shell ar�d Duct Work, Bumer - Also Rep{acement Fumace Gas Piping (Needed with new furnacej Gas Range Gas Dryer *Air Conditioning - All Sizes All Others/Repairs & Afteratlons (LIST ON BACIq 1 of Valu f Appliance or�+llork C�.�� c��.��,�� Commercialltndustrial 1% of Value oi Appliance or Work Rate TOTAL $ 20.00 $��-- $ 10.00 $ $ 10.00 $ $ 10.00 $ $10,00 $/a � State Surcharge TOTAL FEE Effective On January 1; 1993 JOB ADDRESS �O � The undersigned hereby makes application for a permit for the work herein specified agreeing to do all work in strict accordance with the City Codes and rulings of the Buitding Division, and hereby declares that all the facts and representations stated in this application are true and correct. � �� ,1993 OWNER ,� �.�,� BUILDtNG USED AS ' ESTiMATED COST-� S� �•� PERMIT NO. ��< < � : • � i►' : � •: 1i� i $.J� G'� No, of Heating Un Circle One (Steam) (Hot Water) Air Trade N me Size No. � - o BTU o� �� HP EDR $ Fuel /f/�� Totai Cont�ected �oad $ .50 Burner Trade Name Size No. � �-�� BTU HP EDR REFRtQERATIONlAIR CONOITtQNlNG PERMIT tS �15.00 PLUS �tE E.50 STATE SURCHARG,� s REINSPECTION FEE $30.00 *Air Conditione�s can not be piaced in a side yard without written permission from adjoining properry owner. HEATING COMPANY �/ r � Signed By �� Tel fdo. ��--/�1`0 . Approved By t�C Raugh-fn Date Final Date ..��--�j P1LL OUT BACK SIDE FOR STACK VER(FICAl'ION ON REPI�ICEMENT FURNACE CHIMNEY AND STACK VBRIFICATION The undersigned hereby verifies that the existing chimney or stack: l. Has been carefully examined Yes �) No O 2. Is free from rust or deterioration Yes (�._ No () 3. Has no foreign objects lodged within Yes (�) No O 4. Is securely supported Yes (�) No {) 5. Meets all current Code requirements for size and total BTU's connected . Yes j�(j No () 6. Has total heating BTU's of ��,� LSZ�D , All other BTII�s � � lS?S� � � TOTAL BTU's � �� Remarks / i��P �� Tu�s a � ,. List Alterations Beinq Done: e � c HEATING COMPANY d—� �.� ,, S igned By /� _ f"�%_�� Date :��d. �� / lo �� /�y'� � • sue�ecr P City of Fridley �� C; 7 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r ' ` RE � � �` COMMUNITY DEVEIOPMENT DIV. r � L � PFOTECTIVE INSPECTION SEC. ,�� i � � ' /'��1 � CITV HALL fRIDLEV 55432 NUMBER REV OATE PAGE Uf APPROVED BY �_.__11.• ••� 612-571-3450 910-F15 8/28/96 � � J08 ADDRESS 7677 JACKSON ST NE 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO DESCF. 2 1 Melody Manor 4 Addition s"EET 2 PROPERTY OWNER MAIL ADDRESS Z�P PHONE Ken Brisse 7677 Jackson Street NE 780-1248 3 CONTRACTOR MAIL ADDRESS 2�P PHONE IICENSE NO Midwest Siding & Roofing 3533 Perry Ave N, Crystal MN 55422 421-3652 d ARCHITECT OR DESIGNER MAIL ADDRESS Z�P PHONE LICENSE NO. 2��1�2%� 5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION ❑ ALTERATION f� REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof House & Garage (22 Sq) Tear-off 9 CHANGE pF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIREO FOR EIECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITtONING. THIS PERMIT BECOMES NULL AND VOID IF WORK Oq CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 OAYS, OR lF CONSTRUCTION OR WORK IS SUSPENDED Oi± ABANDONED FOR A PERIOD OF 120 DAVS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STAIIS GAFiAGES AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVIS�ONS OF LAWS VAIUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WI�L BE COMPLIED @ WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT Wis81S �.91 DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- TRUCTION R THE PER ORMANCE OF CONSTRUCTION. �S9.SO Fire SC �I.HZ PLAN GHECK FEE T L FEE � � Y � License $5. $67.23 SIGNATU OFCON�RACTOAO AUTHORiZEDAGENT ionTEi AOP VA D D THIS IS YOUR PERMIT • - � `��c�_.�� S�GNATU�7E OF pWNEP i1i OWNER BU�LDE�7i �DATEi ' �D �NS ��FTE NEW � ] Effective 3/1/96 ADDN [ ] CITY OF FRIDLEY ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application _ - .��,� ConstructionAddress: `�_ I�_� ��c a_ �-� _ Legal Description: Owner Name & Address: �C,�„ .�►'rTr Tel. # �� o-'/�,1 ti� Contractor: yy, ,�,�,�, Yr-f ,S, �,'„�,.F R�'GO �';. MN LICENSE# �d �/Q� 7 7 Address: ��3� ,{��e r - � � /L � �� ' S" � � Tel. # S�� / - .�G �-� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: Length GARAGE AREA: DESCRIPTION OF.IlVIPROVEMENT Width Length Width Height Sq. Ft. Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: � �� Corner Lot [] inside Lot [] Ft. Yd Setback Side Yard Setbacks Type of Construction: 'T a r o �� }- ��- �'"�� -� Estimated Cost: $ �_ ��-6�.P • /�✓S�' Approx. Completion Date: � � /�( (Cos t on Ba ck) Driveway C�rb Cut Width Needed: Ft. + 6 Ft = x$ =$ DATE: � � `v r (, APpLICANT: ' Tel. # Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: � �1�� CI1'Y USE ONLY Fee Schedule on Reverse Side $ l °� .001 of Permit Valuation (1/lOth%) � � 1/ $.50/$i,000 valuation $ $900 per SAC Unit $ � . �� r $5.00 (State Licensed Residential Contractors) $ $ $ $ � � � �? Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] , w sue�etr c�ty of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r i . � � � ` ____ COMMUNITY DEVELOPMENT OIV. � � � PROTEC7IVE INSPECTION SEC. r , , � , � 1 �"'1 � CITY NA�� Ffi101E� 55�32 NUMBEp �'""�� '' 612-571-3450 910-F15 J08 ADDRESS 7677 Jackson Stre 1 LEGAL LOT N0. BLOCK TfiACT OF ADOITION oescR. 2 1 Mel 2 PROPERTY OWNER MAIL AOORES$ I AiiCHITECT OR DES�GNEfi 5 ENGINEER 6 USE OF BUILDING Residentia 7 CIASS OF WORK 8 OESCRIBE WORK 9 CHANGE pf USE FROM STIPULATIONS MAIL ADORESS 2937 1741 MAII AOORESS MAII ADDRESS REV OATE 1OJ21/98 P�GE Oi i i PNONE PHONE PNONE ,$E'RM I T N O. 28341 �� RECEIPT NO. 74�� APPROVED 9� SEE ATTACMED SMEET IICENSE NO �n��n�� LICENSE NO. LICENSE NO O NEW O ADDITION O ALTERATION � REPAIfi O MOVE O REMOVE TO Underlayment must comply with the State Building Code. TYPf OF CONST. SEPARATE PERMITS ARE REOUIREO fOR EIECTRICAL, PLUMBING. MEATING. VENTI�ATING OR AIH CONOITIONING. THIS PERMIT BECOMES NUIL ANO VOIO If WOFK Op CONSTRUCTION 20NING AUTMORIZED IS NOT COMMENCEO WITHIN 60 DAVS. OF If CONSTRUCTION OR WORK IS SUSPENDEO OR ABANDONED POR A PER100 OF 120 pAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWIG. UNITS 1 MEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF �AWS yq�UAT10N ANO OROINANCES GOVERNING THIS TVPE OF WOiiK WI�L BE COMPLIED WITH WHETME:i SPECIFIEO HEREIN OR NOT. THE GRAN7ING OF A PERMIT 21�}2 DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEL THE pEqMIT FEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCitON OA TNE PERfORMANCE Of'�ONSTRUCTION ]L}. ]S PLAN CMECK FEE � � pY Licens NATUQE F�ON'PACiOQOA�UTNOA�2ED�GENT ATE N ( :I7 STA��S ROUP OCCUPANCY�OAD CU FT. OffSTREET PARKING IGARAGES y�1.Q7 SAC CMARGE Fire SC $2.14 TOTA EE 8 .96 � HIS IS VOUA PERMIT ,�0� i r��,fE NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ J SINGLE FANIILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION q�-�� ` � � �u � ConstructionAddress: / (� 7 � ��G�S � �� Legal Description: Owner Name & Address: ��1 r3�-r � s�-� Te1. # 7�0� jZ`r�p Contractor: ��e �x� �� • MN LICENSE # �-ao � � �� Address: oo�`� 3 7 1%�� L� Tel. #`7 S3 �-�`/!� � Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LIVING AREA: Length Width Height GARAGE AREA: Length Width Height DECK AREA: Length Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. OTHER: � �� Construction Type: � `� .� Estimated Cost: $ ��°� �o�-�� (Fee Schedul e on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: C� il g� APPLICANT: Tel. ��3'` -% �� CITY USE ONLY Permit Fee $ �%� Fee Schedule on Reverse Side Fire Surcharge $ a• l .001 of Permit Valuation (1/lOth°!o) State Surcharge $ �, d � $.50/$1,000 Valuation SAC Charge $ $1000 per SAC Unit License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ 5 . (�(j $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 [ ] $ �• � SuB�EtT P City of Fridley 29005 AT THE TOP OF TME TWINS g U i L D I N G P E R M i T r � � � � COMMUNITY OEVELOPMENT DIV. � � f � � � PR07ECTIVE INSPECTION SEC. �� , �"'1 � CITY NALI FFIDIE� SS132 NUMBEt1 pEV O�TE P�GE OF �PVROVEO Br �""�" �'' 612-571-3450 910-F/5 3/10/99 / / J09 ADDRESS 7677 Jackson Street NE 1 LEGAL ��T NO. BLOCK TRACT OR AODITION SEE ATTACMED DESCR. 2 1 Melody Manor 4th Addition SMEET 2 PROPER7Y OWNEii MAIL ADDRESS ZIP PMONE Kenneth Brisse 7677 Jackson Street NE 780-1248 3 CONTRACTOR MAIL A�DRESS ZIP PMONE LICENSE NO Same � ARCHITECT OR OESIGNER MAtL AD�RESS IIP PMONE LICENSE NO. 5 ENGINEER MAI� ADOfiESS ZIP PNONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WOiiK O NEW ❑ ADDITION O ALTERATION G� REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Replace windows 9 CHANGE OF USE FROM TO STIPULATIONS TVPE Of CONST. OCCUPANCY GROUP OCCUPANCv IOAD SEPARATE PEiiMITS ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING, VENTI�ATING Ofi AIR CONOITIONING. THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTpUCTION 20NING SO. fT CU FT. AUTMORIZED IS NOT COMMENCEO WITHIN 60 DAYS. Oii IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO fOR A PERI00 OF 120 DAYS A7 ANV TIME AFTER WOiiK IS COMMENCED. NO DWIG. UNI7S OfFSTREET PARKING I MEREBV CER7IFV THAT I MAVE REAO ANO EXAMINEO TMIS APP�ICA710N 1 STALIS GARAGES ANO KNOW TME SAME TO BE TRUE AND COFiiiECT. ALL PROYISIONS Of LAWS VALUATION SUfiTA% ANO OROINANCES GOVERNING TNIS TYPE Of WORK WILL 8E COMPLIED @ WtTN WHETMER SPECIFIEO HEREIN Oii NOT. TME GRANTING Of A PERMIT �$3,409 4'1.70 OOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OF CANCEL TME pEiiMtT FEE SAC CNARGE PROVISIONS OF ANV OTHEH STATE Oii LOCAL LAW REGUTATING CON- STRUCTION OR THE PERFOiiMANCE Of CONST{iUCTION $8].Z,rj Fire �3.�F1 PI.AN CNECK FEE TOiA E $ .36 S�GN11TUpE OF CON'FA(;iOQ OA AUTMOQ�2E0 AGENT iD�iE� N RO ALIOAT IS I UFi PERMIT . � ��1�- y'� �� .�,,P �L , �-- . Si • F pyyNE �� O N R BU+IDEp� ° �DATE� Bl �h p �i�tE r NEW ADDN ALTER [l [l �� CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/ 1 /99 � ConstructionAddress: ��7 �� G l�' S D.I/ S?' � Legal Description: Owner Name & Address: - �) �� , ,�� s s -- _ Tel. # %8'D �l2 `�� Contractor: MN LICENSE # Address: Tel. # LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Sq. Ft. Length Length Width Height Hgt/Ground Sq. Ft. Sq. Ft. Construction Type: Estimated Cost: $ � y� �� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$�3 �� - O� DATE: � 4 `� APPLICANT: . ,�j2A�P Tel. # 7�'O - / Z �f � Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ �7� Z� $ $ � $ $ $ � CITY USE ONLY 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 [ ] $ �, 3G _.�- sue�ecr p .� City of Fridley 2 9479 AT THE TOP OF TME TWINS g U I L D I N G P E R M I T r ; � RECEIPT NO. ' • COMMUNITY OEVELOPMENT DIV. /� f � y • � PROTECTIVE INSPECTION SEC. �� y� � i 1 � � i----�; �'—' �'� CITY MALL fR10LE� 55132 NUMBER pEV OATE v�GE OF �PnROVED Br i 612-571-3450 gt0-F�5 5/17/99 / / JOB ADDRESS 7677 Jackson Street NE 1 LEGA� LOT NO. BLOCK TRACT OR ADOITION SEE ATTACMEO oesca. 2 1 Melody Manor 4th Addition SNEET 2 PROPERTY OWNER MAII ADORESS ZIP PHONE Ken Brisse 7677 Jackson Street NE 78 - 2 3 CONTRACTOR MAIL ADORESS IIP PMONE UCENSE NO Twin City Exteriors Co 9060 Zachar L 4 ARCMITECT OR DESIGNER MAIL ADOaESS ZIP PHONE LICENSE NO. 425-4737 2595 5 ENGINEER MAIL ADORESS 21P PMONE LICENSE NO B USE OF BUILDING Residential 7 CIASS OF WORK O NEW O AOOITION O ALTERATION X REPAIR D MOVE O REMOVE 8 �ESCRIBE WORK Reside House 9 CHANGEOFUSEfROM TO STIPULATIONS Call for building wrap inspection before covering. CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to 9:00 pm on Saturday; No work on Sunday. Permit Inspection Cards To W�� Be Mailed Nomeowner To Post TVPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO SEPARATE PERMITS ARE RE�UIqED FOR ELECTRICAL, PLUMBING, MEATING. VEN7ILATING OR AIR CONOITIONING TMIS PERMIT BECOMES NUII AND VOID IF WOFK OR CONSTRUCTION 20NING SO. FT CU fT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONE� fOR A PER100 OF 120 OAYS AT ANV 71ME AFTEfi WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING I MEfiEBY CERTIFV TNAT I MAVE READ AND EXAMINEO TMIS APPLICA710N 1 STA�LS GAFAGES ANO KNOW THE SAME TO 9E TRUE ANO CORPiECT. ALl PROVISIONS Of LAWS VA�UATION SURTAX AND ORDINANCES GOVERNING THIS TVPE Of WORK WILL 8E COMPLIEO �S OOO �Z.SO WITH WHETHEii SPECIFIEO MEpEIN Oii NOT. TME GRANTING OF A PERMIT � DOES NOT VRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEI TME pERMIT FEE SAC CMARGE PROVISIONS OF ANY OTMER STA7E OR LOCAI lAW REGULATING CON- STRUCTION OR THE PERfORMANCE OF CONSTRUCTION �99.75 Fire C�5.0� PLAN GMECKfEE TOTAL E Licens $5.00 2.25 S�GNATUpE OF CON'�7A(;TOA Op AUTMOA�ZED AGENT �OATE� EN OP A� I� I�U� MI r � S�GNATUAEO�OWNEQ��OWNEi18UilOEp� �OATEi Bl �NSD f�cfE �rEW �� ADDN ALTER [] �l �l ConstructionAddress: � L`egal Description: Owner Name & Address: Contractor: Address: 9/'�/.� T� � LIVING AREA: GARA,GE A,REA: DECK AREA: OTHER: CITY OF FRIDLEY SINGLE FAMILY AND DUPL�XES R-1 AND R-2 BUILDING PERMIT APPLICATION � EPfective 1/1/97 �` ��` n�a�� " Tel. # `j��'j -�� MN LICENSE # p?S��J�r �Tel. # �/a� ��?., - y7 � �% Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground Sq. Ft. Sq. Ft. : Sq. Ft. +-�— Construction Type• �,� � �� Estimated Cost: $ .��j (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: - - % APPLICANT: � . Tel. # �/oZ -`�d S `i73 % CITY USE ONLY Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ �q, ��Fee Schedule on Reverse Side $_��/» � .001 of Permit Valuation (1/lOth%) $ �� $.50/$1,000 Valu�tion $ $950 per SAC Unit $ � Da $3.00 (State Licensed Residential Contractors) $ Alt. "A" or Alt. "B" Above $ � $450.00 Conservadon Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] _ $ .. STIPULATI S: � � �l � � ADDRESS PIN LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE VALUATION 1;1 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 57"L-36U4 l+'AX: : 7677 JACKSON ST NE : 113024110008 : MELODY MANOR 4TH ADD : LOT 2 BLOCK 1 : ELECTRICAL : RESIDENTIAL : ADDITION/ALTERATION d APPLICANT BRISSE KENNETH A& GAIL L 7677 JACKSON ST NE FRIDLEY, MN 55432 OWNER BRISSE KENNETH A& GAIL L 7677 JACKSON ST NE FRIDLEY, MN 55432 AGREEMENT AND SWORN S'TATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl� will be complied with whether specified herein or not. T'he grantirig of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Insp Date 571-1"lif7 # 0-100 AMP CIRCUITS PERMIT NO.: 2004-01027 DATE ISSUED: 07/02/2004 ELEC AMP SERVICE FEE ELEC CIRCUIT FEE (0-100 AMPS) ELECTRIC FORM FEE STATE SURCHARGE, ELEC FLAT TOTAL SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABUV�. 8 30.00 48.00 1.00 0.50 79.50 Building Inspections 763-572=3604 � BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY Permit No.: Received By: Date R�k=�':D M A '"r ZO -- �/ -- -- DATE �— 2 'r� � YOUR E-MAIL ADDRESS �� i � /JJ�/i` i �/��i SITE ADDRESS `J�7 7�{� -�i D �/ `Z% - THIS APPLICANT IS: �OWNER ❑CONTRACTOR PROPERTY OWNER/ N,�: K�/ F Tf-�- �R j�S E __ TENANT pDDRESS:''%G� ? 7 3'"�/:K Sd,�L S� CITY �"'�Zl �� STAT'6�P r�� PHONE: '� ��I Z � � CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION NAME: STATE LICENSE # EXP DATE ADDRESS: CITY STATE ZIP PHONE FAX PROPERTY TYPE ❑ PERMIT TYPE � ❑ ❑ GARAGE/SI�D ❑ WWDOWS FINISH ❑ ROOF ❑ DRAtN TILE O SIDING ❑ OTHER ❑ SWDvIMWG 1'OOL TYPE OF WORK: ❑ �w ❑ MAIN7'ENANCE/REPAIR DESCRIBE WORK BEING SIZE OF IlVIPROVEMENT ROO NUMBER OF SQUARES GARAGES PROPOSED SfZE: PROPOSID HEIGHT: ❑ HOUSE ONLY � HOUSE Bt GARAGE ❑ ATfACI�D GARAGE 0 DETACHED GARAGE HEIGHT BASEMENT REMODELIDIG SUBIvIIT: I. Existing Flo� Plan 2. . Proposed floor plan 3. List of structural members to be used F� SIDIIV FOR NEW CONSTRUC770N MCLUDIIJG DECKS, O Vinyl OSoffit AAD1110NS. & PORCHFS SUBMIT: ❑ Aluminum ' O 7'rim � 1. Site Plan/Survey showing the acisting structurcs ❑ Other . O Fascia snd proposed project. WINDOWS 2. Two sets of conshvctia� plans IN E3QSTWG OPENII�TGS OYes ONo IACATION OF WMDOWS 3. Encrgy Calculationt OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENIlVG CHANGES 8c TYPE OF WINDOW TO BE INSTALLED NUMBER OF�WWDOWS ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S .�'� 'i �Y� OCCUPANCY TYPE Permit Fee Plan Review Fire Surchazge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Total Due $ $ � $ ,�� S $ $ $ $ $ $ See Back Fage for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a pertnit but only an application for a permit and work is not to start without a permit; that the work wili be in accordance with the approved plan in the case of alt work w ich re uires review and approval of plans. SIGNATURE OF APPLICANT ��,� �� jf,(Q PRMT NAME��/i( ��,� /�'S7� ATE J'�� 7"'D � , � � ._. . syf`C� �5 S'� � � C.f ''`y F:t �.,� 5 , �'i`Qfi %�at � �� .n ' -�-�� r•. � � I � • � L �� .�� ' ".-�... � •`• '' � �t ,�. K s _ L ,� �. (� � ., .� � � � � � � ��-� � � N, � � Ly ,� c� � � � !.) +-�` _.. . � 4 : . ' .. : � 1 . � _ t . . � . � . . � � � ��' � � �� . � s � � � ' � � °� � - �. � `�j'� Q , � �, .� p : ., � � � ,g c�C a � , a f--�-I I� _- \ �' '� � � .�i - � `.! � "3 � �� o . a/i/ � -E i� (.,1� .. � �p Z� ` ` F � s . _.. ... . _..._..,_ , W � � �� ,� _ :? � 0 '�SQ .��.'� ` ,�',� �} ` � � ; ; W a � C� , IW � � Z '`' � l.l fl % � , ... Q , — � � C m � �'11 c�� ` __ _�_� , � / r � � �� L � y _ , , � ` ;7 _ f � j � � 1 . �.._�. _. . . .._._ . � ' , i i i � _ �� . _ r �..�, � c� c� � � � � � � , : c7-}� � � . � _., -� == o f t � � F ' � � . . � ° _ : .� ___. _ '`� �w�r 1 __ _ ��U i _Q � ,..M < � _ . � .� k c� � , , �� s �' x � � � � ;� .� -Z , � � � � � � � �, � \� � ;�= _ ,r.. �_ � � 4 � i.�.� � �� N�� E _ _ z cn -� � • _ ..� �a�z j ,� ,,,�, U � !-- � (y � .�� ''�-,. m Qt p � 1 � � o a �.�. E � �. -� .� �i _ � �q�-� (� � ,�`��,a ' � � � . � + � , � ..��.� . ! � . _� = . N � ; � ' ?S � N r �- - I �� I� �� t-�° VI ' � - �. 3- ,;� �' S � °� �I ol � ��; . �-- �,2; � � a � z 3 � �.) � �� . � , � . . 1 � . � ,� � =�� .,� _ Q 1/' � � � � � u1 � � �� -� � .� �v_ �� z � � �w-�-�-�-- � ,_,� ; I � �� -1 REC'D �AY � 3 2007 �;�c�r�t� � �� -3--�`� �� 3� � May 23, zoo� City of F�idley 6431 University Ave NE Fridley MN 55432 To whom it may concem: Ptease be advised that the basement remode�nish project we antfcipated doing this summer has be,en put on hold indef+nitely sinae my father (Ken Brisse) is currentiy hospitalized. We would appreciate the cancellation of permit number 2007-00713 and a refund of the building permit fee and applicable surcharges to the fullest amount possible. If you have any questions, please contact me. Thank you! Sineerel ' Mary M. risse Fridley MN 55432 763-780-1248 C�� , � ��4 ` + ti�� . hN{� t s�� f , t �:ia� n '' . .. , r v'y` � _; ; � �"�a , � � �.,, �.':,,.; �� : ^� �`, . . , . . .. . , �.,.+�,va�.s_.�G.aw�:i�. '—x �� PURCHASf ORDER °ATE �-�- � _ p�PA�� ''�` `� ��o. av . ^� _ �_:� a � 4 � ,zt,�z,� 4,.. � ` *`.a:�N •,� �_.�; . � . , ,- , „ �.:, THtS DOCIlMENT GOOD' �OR PURCHASES; UNQ�R $�lfl�p �D Q�C�'��;,,,5,� M�:: �".; .. �. V�fi�YtTS � � :� � �k ,. �.�. - �� _ �� SUPPWER �r��, �� R q` �� ;�' .�. ��- ' BY�SI�� ADDRESS � . � � ' ,� �.. P,A1�M�i�4'� t� � � � �, � "'�' f�GHl1�� B��N FOLI:01�A i� � � kj �ITYCJF ` �� STAT�D �CT��i1� ` " Fi�[DL� PHONE N0. � 6431 UNlV. AVE. N.E. "� FRIQLEY, MN 55432•4384 � - ,r 763-571-3450 GONTACT x � "� ', F�AINTED QN RECYCLED FAPER, � PAYMENT A Eflr9„Y 'y RGCO1tNT pTY. UNIT PLEASE ENTER �UR i�RDER FOR THEF,piIOWtNG l3All,? PRIGE µ��;`t., � �;.,t � �^ � �^ �� ' ` � � � �.� �:.�. � � , �� r � . �, , ; �, �� "' � `+�. : � ..�.....�' ,.-' �" '>, s!"' ,{, � ,�,,�,w�r �`� ,;, 1NHITE, VENDOR -- YELLOW, `PURCHASING -°.PtI�K, AGG'