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�NGINEERING
7708 LAKELAND AVENUE
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` GEOTECHNICS LAND SURVEYING
P.O. OSSEO, MINNESOTA PHONE (612) 425-2181
� CERTIFICATE 4F SURVEY . �a�" � � � � r_' � �2a
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I hereby certify that this is o true and correct representation of a survey ot the boundories of the land described
above. It does not purport to show improvements or encroachments, if ony. As surveyed by me this /¢r�4'
doy of , - •.IRN. _ � � , � q 7.4 -.
CASWELL and ASSOCIATES
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File No. �OS 3 Book �.�.� Poge _ 7� �
A �,�-.�. z-��-�� P.�� z-aa-�3 ,Q�k i-zs-�4
by , .�����.� �
Minnesoto Registration No. �03 9
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City of Fridley
r 4r 71N¢ TOP 0+� rnE Tw�MY
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Job Address
ner
Contractor
Kind of Buildin
Comp etion Date
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53-8�—s-915.51
PLUMBI►�r, PERf1IT APPLICATI��d
5780 N. E. Jeiferson Stree�
�m�ra Cane Builders
MIINNEGASCO
Fr�,me
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, �����
S �3� AA�►aQUEYTE AVENUE
se �
Res.
. 1�.00
Plumbing Fix ture Rates: N0. RATE TOTAL
Number Fix turea x $2.00 �_
Future Fixtures x $1.50
---_
New Fixture-Old Open. x $1.50
Catch Basfn x $3.25
Water Heater-49,000 BTU x $3.00
Ground Run Old Bldg. x$3.25
Elec. Water Heater x $2.00
Gas Fittin Fees:
lst 3 Fixtures x $2.00
Additional Fixtures
_____ x $ . 75
Gas Ra,nge-199, 000 BTU 1 x$5.00 5•�
Repeira & Alterationa
^ See
Deacription: Code
S tate Surcharge �lass �'A� �urcharge .50¢ . 50
TOTAL FEE $ 5•50
The undersigned h�reby makea application for a permit
for the work herein specified, agreeing to do all work .I
in atrict accordance w�th the City Qrdinances and rulin�l
of the Department of 8uildinge� and hereby declare that �
a11'the tacte and repr�aentationa stated in this
application are tru@ and correct.
r� /+�k,� p� �h'�
� B ignature �pA� Da te .
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_ __ _ _ � , .� --__.._...--
SUBJECT PE
City of Fridley �`� 12426 �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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� �• COMMUNITY DEVELOPMENT DIV. R ElP'T"1�. ,(
� �y-------� �� � r
r � � PROTECTIVE INSPECTION SEC. /
1 . �
�l ` /"'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
L•"'� � ,�� 612-580-3450
910-F15 1/14/74 � �
JOB ADDRESS
5780 Jefferson Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. t 5, pa t of 1 Adams Street Addition SHEET
2 PROPERTY OW R MAIL ADDRESS ZIP PHONE
O'Meara & Cave, Builders 97 20th Avenue S.W. New Brighton
3 CONTRAC�me MAIL ADDRESS Z�P PHONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILOING
House and garage
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
26 x 36 house 25 x 22 garage
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide verification survey and hard surface drive
Set side yards at right L's from Side Lines
Lot lines have to be marked before footing inspection is made
��p�'�ATE PERI�iTS l�EQUiRED FOR �IRrN�i
�IF�TI�J�P PLU�i�i�G AfVD SIGNSO
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBINO, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. frd.Iile
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIId 60 DAYS, OR IF CONSTRUCTION ��� ].H r'j].2
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OP 120 DAYS AT 9�.O
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS REET PARKI G
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATlON SURTAX
ANO ORDINANCES GOdERNING THIS TYPE OF WORK WILL BE COMPLIED. 21 123.40 ZO. 'rJ6
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC HARGE �
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING cor,- 45.00 �300.00
STRUCT OR THE PE OR AN OF CONSTRUCTI �
/,/_ � PLAN CHECK FEE ZO��: �6
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.t, SIG �A?_'lREOFCONTRACTORORAUTHORIZEDAGENT IDATEI iHEN PROPERLY VALI TED THFS IS YOUR P� IT
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SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI I.OG INSP DATE
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ENGINEERING
7708 LAKELAND AVENUE
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GEOTECHNICS L�ND SURVEYING
P.O. OSSEO, MINNESOTA PHONE (612> 425-2181
CERTIFICATE OF SURV�Y
For o��Ei4RA A�v1� C�4 vE '
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Cl/!A� G�SO �%Q��iO/�O�LD�Q / //Jq SOG��hD�
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I hereby certify thot this is a true and correct representation of c survey of the boundories of the land described
above. It does not purport to show improvements or encroachments, if ony. As surveyed by me this ZZ N�_ .
dcy of �2d___i eLOr� , � q_73 `
� CASWELL and ASSOCIATES
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File No. ��S � b Book I Page �J
A ,�E-v, z-z�-�3 JP�v 2- Z 3-73
1
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Minnesota Registrotion No. ___ 203 9 �
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APPI,TC�TION FOR k1iSIllENTIl�L, ALTERATIiIN,
UR Ai)lll'I'I01�` �UII�DING PERMIT
C 1'1'Y' OF 1=1:1 DL�:�' , 11I ��N�SOT�1
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J�% �,nnxES s: ADDRES S: 9 7 ac� � s w .�
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CORATEA LOT: INSIDE LOT: li SETBACK: 3 S r SIDEYAFD; IG � "S �
Ag�lican� attach to this form �ao Certificatea of Survev of Lot and proposed
build�ltig location drawn on these Certifi.cates. T
�
UESGRIPTIUN OF BUILDING
�
To Bs Ussd As ; _� `� �, � ° � " �� � " � ��
q / � �f _..P t":'1"'�Y
�� �-� Front: � � Depth: Height: � -
i-S� rt '_ _
{ f ���
Square Feet:_ Cubic Feet• -� ' " -�,
_, / � ..
, � r.; �'�� � � � , �Front • _ Depth • •�� Height : A -
Square F'eet; �, ���; � __ Cubic Feet : � - �
Type o� Constxuction; �' '� �-� �-� Eatimated Cost: ��
-�—� �, , �. – ._ ; _
�� � ,.
�o $e Comple�ed: � _ 7 �=- � � �� � � -� _, „ �
The undexsigned hexeby ma.kes applicativn for a permit for the work herein
speeified, agzeeing to do all woxk in st�ic� accordance with the City of
Fxidley Ordinances and rulings o� thc� Uepartment of Buildings, and hereby
deelarea that .�11 the facts and representations stated in this application
ax� true and ���rrt�ct.
d�� �� �,�a
DATE: �� I � j � / �/ S IG�ATURE: �u�. l � `�'�li�-rC
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(See Reverse Side For Additiona.l Tnformation.) _, ,��-`
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BUILDI;�i(: !'�:1Z�T1'I' 1��:E 5C11}:llUI_k:
S�GT�ON 2, The Lnspect��r �rf B�ii.ldin,�s shall, before issui.ng permits fox the
ex�Ction of sny huiiding or stru�•turc�, or �ox an�• addition to any exi.st�ng
bui7.dfng or structure, or i or ..if1y .+ l ti�r�it i.on or r�pairs to any c�isting
huilding or struct.ure, upon application l:herelorc:, r�quirc the payment by the
�.pplicant fox such permit �f fec,s tc r.h� amount herein bclow set forth and in
th� manner herei.n provided to-a�it:
1JNTFORM BUILDIN� CODE: Type 1, 2& 4-$2.15 for each onc: thousand cubic
feet� ox fxaction thex�of, in such cubical contents. T}�pe 3& 5-$1.85 for
�aah one thousand cubic feet.
:�lll)ITIONAL INFORh1ATI0N
Fo� the purpose of computing fees f�,- building permits, the cubical contents
of any buildin� or. .�ddition, is determined by multiplying �he ground area
aOVe�C�+d fxom a point six (6) inches below the floux li�ne of the basement
ox �he+ Ce11ar to tl��� average ilei�lits ��f the upper aurface or to the average -
h�i�ht �f tl�a roof surface of the main gable of a pitched roo�.
Fox xep�irs ax al.�erations to an existing �tructuze, the fee shall. be at the
xate o� $�.00 pex eac}� five hundxed dollars ($SOO.Op) ox' fraction thereof in
the Co�t af all proposed worlc. _
Tn na case shall the fee charged for, any permit as set forth in Sect3.on 2 be
18�� than $Se�Q•
VERIFICATION OP FOUNDATION
P1QT�= $�xmits ior construction will be issued a minimum of 24 hours from th�
ti� of application, to allow for proper zeview of the pxoposed structure and
o� �he �oilstXuction site.
A Certified Survey of the lot, showin� the location of the foundation, once it
has� been constru.:ted, will be required before proceeding with the framing.
�� �RT I F I CATE 01' OCCUPANCY
Application for a Certiiicate oi Uccupancy shall be made ten (10) days prior
tp the use or occupancy of any structure for which a building permit has been
�.aeuesd; �nd s.�id structure shall not be used or occupied until a Certi�i.cate
of OcCup�,ncy hae been isaued.
, � ► _
560-3450
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ANOKA COUNTY
6431 UNIVERSITY AVENUE NE December 30, 1974 FRIDLEY, MtNNESOTA 5543i
��., y� �7
Mrs. John Swider
5780 Jefferson Street N.E.
Fridley, Minnesota 55432
Re: Final. Inspection of Your House
Dear Mrs. Swidex:
We would like to make the final btiilding i.nspect�.Qn on your house to make
sure the contractor has completed all the worlt as per the approved plans� This
inspection should anly take about 20 minutes and it can be done anytime between
8:00 A.M. and 5:00 P.M. If this time schedule does not agree with your sahedul�,
we would appreciate your eonta.cting us and another ti.me cauld possibly be worked
out. �
We would like to get this house finaled before the end of January.
Please cantact us at 560-3450, ext. 41, to set up a time when it would be
convenient for you to have the house finaled.
Tha.nk you,
CLARENCE J. BELISLE
Buil.ding Inspector
CJB/mh
560•3450
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ANOKA COUNTY
6431 UNIVERSITY AVENUE ME January 15, 1975 FRIDLEY, MINNESOTA 55432
Mr. Barry O'Meara
O'Meara & Cave Builders
167 Windsor Court
New Brighton, Minnesota 55112
Re: Final Inspection at 5780 Jefferson St.
Dear Mr. O'Meara:
This is to confirm our telephone conversation of January 15, 1975 when it
was brought to your attention that the following items need correction at
5780 Jefferson Street. The Building Inspector noted these items during his
inspection on January 14, 1975. .
l. Provide a door closer on the door leading from the dwe7ling unit
(Group I Occupancy} to the garage (Group J Occupancy) to be completed
on or before Eebruary 3, 1975.
2. Install a products of combustion alarm in the ha.11 leading to the
bedrooms and make sure it is one that has had State approval. This is
to be completed by January 27, 1975.
3. Install a handrail on the stairway leading to the basement. This is
to be completed by January 27, 1975.
4. Repair masonry wall adjacent to door at the bottom of the basement
stairway. To be completed on or before February 3, 1975.
5. Seal cracks around the bathtub. This is to be completed on or before
February 3, 1975. ,
The owner did express some dissatisfaction in the taping job on the
drywalls.� Apparently there is som� nail popping and the seams do show.
Would you please call us when you have completed the five items listed
above so that we can reinspect for Code compliance. Your cooperation in this
matter will be appreciated and if you have any questions, please call me at
560-3450.
CJB/mh
CC: 5780 Jefferson Street
C. �►.�R-n u.+ E�.rr��c� iL 2- 2 i- 9,�".
Sincerely, �
NCE J. BELI E
Building Inspector
560-3450
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� �
ANOKA COUNTY
6431 UNIVERSITY AVENUE NE FRIDLEY, MINNESOTA 55432
February 5, 1975
Mr. Barry 0'Meara
0'Meara & Cave Builders � Ga�- ��- S�''�
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(+Tew Brighton, Mn 55112
Re: Final Inspection at 5780 Jefferson Street N.E.
�Second Letter
Dear Mr. 0'Meara:
This is to confirm our telephone conversation of February 5, 1975.
Our call to you was prompted by the fact that you had not completed or
corrected the five items brought to your attention in our letter of January
15, 1975.
You stated that you had purchased the items missing in the house, and
just had not taken the time to install them. We agreed tYiat two weeks would
give you sufficient time to complete the necessary work, therefore we will
extend the completion�time to February 21, 1975.
As pointed out to you, we do feel these items are of the type that give
us great concern, and the City would take legal steps to gain compliance, if
necessary.
Your cooperation in completing this project will be appreciated, and if
you have any questions please feel free to call me at 560-3450.
'ncerely,
D L LARK
Community Development Administrator
DC/de
cc: J. W. Swider
5780 Jefferson Street N.E.
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March 5, 1975
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Mr. Barry O'Meara
O'Meara & Cave Builders
97-20th Avenue S.W.
New Brighton, Minnesota 55112
Re: Final Inspection at 5780 Jefferson St.
Dear Mr. O'Meara:
We made a reinspection to check for final compliance of the home you
constructed at 5780 Jeffersan Street on March 4, 1975.
The door closer, fire alarm, handrail on lower steps, and bathtub
caulking were completed. However, the upper level stair railing was loose "
and partly missing and the block repair in the basement is totally
unacceptable. The block work must be repaired with a masonry product.
Covering it up with a piece of wood is not adequate.
These two ma,tters.mus� be corrected by March 14, 1975. Flease call
us again for a reinspection to determine if compliance has been satisfied.
DGC/mh
CC: J. W. Swider
5780 Jefferson Street N.E.
Sincerely,
DARREL G. CI�RK
Community Development Adm.
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Ais�ia . RN�DO�Ii/S CE�i �T W0�
�LiT�i. DO��i PORCii ENCLOSURFS
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?.513 C�tral Aw�nu� 1�. E. •
We propose to do the following
Specifications as follows:
Down P,;yment, If Any
Manner of Payment
HfTCfiEN PZANNIIdG
FAN�LY AOOT�S
HOLIDAY CABBdEPS
��. �-���� ���c����ow� �����P
�neapolis, I�!'inn. 55418 • Phone: ?81-8848
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$ � �-� �_: �:' .�
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ct,'°3„ .l t_ _:. __�-
ra � 4 �� _
Ot the above contract price; no recovery, however, to be in excess of the entire contract price unless extra k i onr� 1'� iS�turttie� "
agroed that in the event of default in any payment or payments, the entire balance at the time of such default shall immediately becomE�
due, that the owner or other contracting agent hereby agrees in event of default to pay reasonable attorney fees and �sts of oollectiors.
You, eho buyer, may cancel this purchase at a�y time prior to midnight of the third business day after the date of this purchase. See
�tasbed-s�otice-of_caacellation form for an explanation_of this right. _-- Q�ia .__ ___ _____
— - --- - ---- -
Signature
��� � . _ _____� � ------------- ----___�_�___-�_
P�R.�,{�PJ; QR COf��r�ARIIES FURI�J�kOtNG LA�-A� AAATE�lA►LS F�R TFfE ll�iPFtQVEMENT QF ��A� PRQPEFtTY MAY EN• __
F�RCE A UEN UPON THE IMPROVED LAND IF TNEY ARE MO? PAID FOR THEIR COIVTRIBUTIONS, EVEN IF-SUCH
PAFiTIES HAVE NO DIRECT CQNTRACTUAI REL�4710NSHIP WITH THE OWNER. MINNESOTA LAW PERMI7S THE OWNER
TO WITHHOLD FROf�i THIS CONTRACTOR SO MUCH OF THE CONTRACT PRICE AS MAY BE NECESSARY TO MEET THE
D�i'�IA,NDS O� ALL OTHER LIEN CLAIMANTS, PAY DIRECTLY SUCH UENS AND DEDUCT THE COST THEREOF FROM.THE �
C�e9TRACT PRICE, OFi I�fITFOHOID AMOUNTS FFtOM HIS CONTRACTOR UNTIL THE EXPIRATION OF 90'DAYS FROM THE
C�Ew7PL�TIOW OF SUCH IMPROVEMENT UNLESS THE CONTRAC70R FURNISHES TO THE OWNER WAIVERS OF CLAIMS
FOF� MECFlANICS LI�IV$ SIGN6D �Y PERSOMS WHO FURNI$�1EO ANY LABOR OR MATERIAL FAR TF�E IMPROVENIENT
AROD IlVHO PROVIDED THE OYVNER WITH TI�IIELY NOTICE.
, Rep.: �YlJTON�,yJOHN
�
��
_—_ --,
Contract Accepted
I have read the foregoing order, ard agree to pay the amourtt thersin
�er Signature —
Buyer Signature �
Address
� � I 7ate = 197 �~` ;�-�el�.J.Vo. ' �
,, � - -- --�_ - � :
FoaM � WE CARR1' Y'UBLIC LIABII.ITY INSURAIYCE AND WORKMAN'S GM �N � i
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City of Fridley
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Job Address
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PLUMBI�r, PERP9IT APPLICATI���J
aaaress -- p�
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use
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stimate ost
_-�-��- -°-.� _ -
Plumbin Fixture Ratea: Np, RATE TOTAL
Number Fixtures � X$2 , 00 /$ �. v t
Future Fixtures -� x $1.50 �
New Fixture-Old Open. x $1.50
Catch Bastn _'
x $3.25
—__
Water Heater-99,000 BTU _� X$3.00 �-O U
Ground Run Old Bldg. x$3.25
Elec. Water Heater x $2.00
Gas Fittin Fees:
lat 3 Fixtures _� X$2.00 0?. cSC�
Additional Fixtures --^
_,_ 7{ � • % 5
Gas Range-199,000 BTU __ x $5.00
Repeirs & Alterationa
See �Deacription: Code
State Surchari�e _ �50
TOTAL FEE $ �_ � C) 6
The undereigned hereby makes application for a permit
for the wo�k herein specified� agreeing to do all work .
in atrict acco�da.nce with the City Ordinances and rulin
of the Department of Buildinge, and hereby declare that
a1l�the tacts and repxesentatione stated in this
application are true and correct.
�CJ�ti� �f
/-30-'7�'
B ignature Date ,
.
�
_ _ .�
c�ty o� F��a�ey _
AT TFIE TOP OF TME TWINS g � I L D i N G P E R M i T
r��o� / C-36�A�
� `L __��� COMMUNITY OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
i.-_.�� "' �•� CITY FIALL FRIDLEv �IJ2 NUMBER
t 612-571-3a50 s�aF�s
JOB ADORESS
5780 Jefferson Street NE
t IEGAI �OT NO. BLOCK TRACT OR AODITION
DESCR. Pt. 4� 5
Pt Adams Stree
2 PiiOPERTY OWNER MAIL ADDRES$
Lauretta Swider
3 CONTRACTOR MAIL ADDRESS
Advance Alum. Supplv Inc. 7701 Main St NE
a ARCHITECT OR DESIGNER MAIL ADORESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILOING
Residential
7 CIASS OF WOFiK
REV OATE PAGE O�
10/23/98 � �
ZIP
PNONE
�'28393
RECEIPT .
7�� �
APPROVEO BY
SEE ATTACNED
SMEET
LICENSE NO
7983
LICENSE NO
LICENSE NO
❑ NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 OESCRIBE WOfiK
Reroof house attd Qarase (23 Sa) Tear-off (Haill
9 CHANGE OF USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
SEPARA7E PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, FIEATINO, TYPE OF
VEN71�A71NG OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANOONED FOR A PER100 OF 120 OAYS AT
ANY TIME AF7ER WOpK IS COMMENCED. NO DW
I HEREBV CERTIfV TNAT I HAVE READ AND EXAMINEO THIS APPLICATION
AND KNOW TME SAME TO BE TRUE ANO COHiiECT. ALL PROVISIONS Of LAWS yALUATI
AND ORDINANCES GOVEpNING TMIS TVPE Of WOFK WILL BE COMPLIED
WITM WMETMER SPECIFIED MEREIN Ofi NOT. TME GRANTING OF A pERMIT 197
DOES NOT PRESUME TO GIVE AUTMOii1TY TO VIOLA7E OR CANCEL TNE pEqMIT I
PiiOVIS10NS OF ANY OTHER STATE Ofi LOCAL LAW REGUTATING CON-
STqUCTION OF TME PERFOFiMANCE OF CONSTRUCTION ¢�7
S�GN4TUpEO�CON'FACTOpOp4UTMOA�ZEOOGENT IDATE�
� �DAfE�
su. r r CU f T
UNITS OFFSTFEET PARKIN(
STA�LS IGARAGES
>r FEE
7M15 IS V4UR PERMIT
=//"/ r e
V
r��rE
lOAO
$ 612 571 2260 RDURNCE RLUMINUM 01
. ° �
TTEW [ ] �fPective 1/1/98
ADDN [ ] C1TY OF FRInLEY
ALTER [ J SINGLE FAMIY.'Y AND DUP�EXES R-1 AND R-2 �r ����`�,.��
BUILDING P£RMIT APPLICATION �� ��C� �
�� ��,�
ConstructionAddress: �� �l � ���'����d� .��' � 1
Lcgal Description: �
Owner Name & Address: ��C,�G7�'rJ� ���$.E.�' '1'el. �!
y
Contractor: I���l�'r�k+G� AL G���� �z�t��+ �� �+r'�i�I f•tc.- --._._MN LICFNSE ��� �� _
Addre.�.s: � %0 % I�'1 �/ ti y'�- ra..Q _ �/L /� �,� y Tel. # S %� �'y�1 �
Attzch to this application, a Certiticate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVni 1G AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF riti1PROVEMENT
L,englh W idth lleight
I.ength Width Height
Length Width Hgt/Ground
Sq. F�.
Sq. Fc.
Sq. Ft.
�.�vvC 'v
Construction Type: � � � ���G Estimated C�sl: $ ��� � .
(FQe Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
�ATI�: APPLICANT: ; � � Tel. �' S�/' �%�
Cx'1�'X USE ONLY
Permit Fee $ CP�° ��v Fee Schedule on Reverse Side
Fire Surcharge $ �, .001 of Permit Valuacion (1/lOth�)
Scaoe Surcharge $ _� $,50/$1,000 Valuation
SAC Charge $ $10a0 per SAC Unit
License Surchazge $ �,�D $5.00 (St�ate Licensed Residential Contraccors)
llriveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Cantrol $ $450.00 Conservation Plan Keview
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary t] Not Necessary ()
TOTAL
ST�PULATIONS :
$ C�-� D
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saop siy1, �suoi�eo�ads s�a�nloe�nuew pue sapo� �ua�no ay� s�aaw pue
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(x) sa,� �uoi��uiw�a� pue sn+wq�a �o �aqwnu 'y�6ua� `6uiz�s 6uipnnui suoi��t,�.oads
aaanl�e}r�uew pue sapoo �ua��m ��e s�aaw pue ��/��}se�d si wa�sl�s 6ui;uan ayl
(} oN (�) sa� 'pa�mba� ala�{nn paddo}sa�� pu� pa�oddns ��a�noas si pue
'suai�aru}sqo 'uo���oua;ap `�sru wa� aa�} si pue pauiwexa uaaq sey 6u��uan
ay� 3�u� sa��an �(qaaay pau6isaapun ay� `a�ewn� ui;sixa ue u�oei a� uayM
N01111�Idi?13A 2llb� NC111Sf19W0� aNff ?J01,�3N(d0� 1N3A 1N3A NOWWO�
S11WZI3d 3�Ndl�dd�1 JNINbnB �3f1� .LN3W3�d'Id3a 2�0� A�3131dW0� NI �"11d
TOTAL P.02
��- _-
� CITY OF FRIDLEY PERMIT N 200401846 a
6431 ITNIVERSITY AVENUE NE � — ---f.``-
FRIDLEY, MN 55432 DATE ISSUED: 10/i i/2004 -.
r, �
ADDRESS
PIN
LEGAL DESC
PERNIIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
572-36U4 FAX:
: 5780 JEFFERSON ST NE
: 233024130003
: UNAVAII.,ABLE
: LOT BLOCK
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
571-1287
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERNIISSION FROM
ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL A FURNACE (WARM AIIt, RWD, 70,000 BTUS)
# A/C UI�IITS 0 VALUE OF APPL OR WORK 0
#FURNACES
# GAS RANGES
APPLICANT
CENTERPOINT ENERGY/NIINNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
OWNER
SWIDER LAURETTA E
5780 JEFFERSON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
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 exarnined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regul�g constru,ction or the performance of construction.
Bldg
1 # GAS DRYERS
0 VALUE (FOR MINIMUM CALC)
HEATING PERNIIT NIINIMUIVI FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONII�TG FEE
HEATING REPAIItS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 6106
SF.PARATF. PF.RMiT� RF.nTm2RT� F[1R vV(1RK nTUFR TuAN nFCrRmFr� eunvF
0
2400
0.00
35.00
0.00
0.00
0.00
0.00
0.50
35.50
• ^�w
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GI�I�
Minnegasco
ADDRESS S�7S� �c-f-�c►�soN ��
OCCUPANT�.• � ��
HEAT LOSS Yes DATE HTG. INST.f0-7-o�
SOLD BY CenterPoint Energy Minneaasco
Electrical Work By C� ^} r � Po :�r
TYPE OF HEAT FA � SPACE HTR.
GAS DESIGN
MAKE � v ci�
Modei � C� Pe� m7 F'A "� E 2
_�e� Fcost�3�2F3ic�4m� ti7�
NPUT � �oo
CONTFIOLS
THERMOSTAT 'f�CaAnr�'F HeatPlug
Value� WC�/
�imit
Limit Settlna / 9'D° F
Fan Settin
Pilot Type s
Pilot Make
Pilot Model
Pilot Timina ��°"��
Pressure y. S� ��►• 4 Pereent COZ .�Bla
nput CFH � S o e o Percent OZ °�6
Stack Temp. � a6 ° F Percent CO � 7 t Po"►
� ,i { ` ���.:
APT. FLOOR CITY `r� ti �" ��
OMINER � w � � (
lfdST41LLED BY____G�n4erPoin4 En�rqy AAinne�asco
Gas Line By _C«`'�r� Po �^�fi
UNIT FiTR. OTHER
� ., , , -; . ;. ,:
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Filters Size _�6 �C Z�L Number j
Chimney Location Inside � Outside
Chimney Construction �—V � �'�'
Viliring � Gc��F « po :,•• 7�
T�s4 Tag —i�-
LighYing Inst.
Date Tested _ lD i'—O �
Company Testing CenterPoint Energ M� inneQasco
Rd�me of Tester �n �.. / o� rs a^�
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 iTNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 r'AX:
: 5780 JEFFERSON ST NE
: 233024130003
: UNAVAII,ABLE
: LOT BLOCK
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
571-1287
PERNIIT NO.: 2004-01847
DATE ISSUED: 10/11/2004
VALUATION .
NOTE: ELECTRICAL PERNIIT BECOMES VOID 12 MONTHS AFTER PERNIIT ISSUE DATE. WIRE FURNACE.
# INSPECTIONS 1
APPLICANT
CENTERPOINT ENERGYMIINNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
OWNER
SWIDER LAURETTA E
5780 JEFFERSON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
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 wor�
will be complied with whether specified herein or not. The
granting 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
ELEC PERNIIT FEE - MI1�T (RESn
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 6106
Jr,r.�1cH 1� r�luvu l J x�l� u ucr,u r Vx w uxlt u l t1�x 1 t1A1v 1)�5t;xl�3�ll AtiUV�.
20.00
0.50
20.50
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE �� /'��
SITE ADDRESS S
THIS APPLICANT IS:
PROPERTY OWNER/
TENAATT
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2010
YOUR E-MAIL ADDRESS
�OWNER OCONTRACTOR
Permit No.: �{������2� L��
Received By: _ ��'� � .
D�����AR 19 2010
AnDxESS: ,i 7� �T��e..c�a�c� , �{E crrY�-;�� STATE�ZIP 5�15�
PHONE:�plo��r✓�,']_—Zi��iv C •�Q�.I�r� (G � �'�`'f' " ��'�`�
CONTRACTOR NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE STATE LICENSE #
AND CERTIFICATE OF ADDRESS:
INSURANCE PHONE
PROPERTY TYPE
PERMTI' TYPE
�SINGLE FAMII.YMEW CONSTRUCTION
❑ TWO FAMII,Y/NEW CONSTRUCTION
❑ BASEMENT FWISH
J�,DECK
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION
❑ MAIlVTENANCE/REPAIIi
DESCRIBE WORK BEWG
SIZE OF IlvIPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
0 Vinyl
❑ Aluminum
❑ Other
❑ ROOF
❑ SIDING
❑ SWIMMIIVG POOL
■ - �.�y �.
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
EXP DATE
C�' STATE ZIP
❑ wn•tnows
0 DRAIN TTLE
❑ OTHER
F'I'
s � � BASEMENT REMODELING SUBMIT•
l. Existin Flaor Plan
,7 2. Proposed floor plan
� 3. List of structival members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
OSoffit ADDITIONS. & PORCHES SUBMIT•
p T� 1. Site Plan/Survey showing the existing strucdues
❑ Fascia and ProPosed project
2 Two sets of construction 1
P�
WIlVDOR'S 3. Energy Calculations
IN EXISTING OPENINGS OYes �No LOCATION OF WINDOWS FOR WINDOWS – PROVIDE U-VALUE ANp
OR FOR NEW OPENIIVGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING TI� COST OF LABOR AND MATERIALS:
(LTSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Charge
Curb Cut �sow
Erosion eontrol
Pazk Fee
Sewer Main Chazge
Total Due
$
$
$
$
$
$
Q
$
OCCUPANCY V � S TYPE
See Back Page 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)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24=$ .
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridlev Attach
THIS IS A'AT 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 Constntction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of work which r ' es review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME � y�Q�� l,i � �/ DATE �' �� � ��
=� ,�_ . �� ^��� K.:.. .,
., ;��:� n �....�:,� .�r... �._ ,. a _ .. . _. _
Page 2- Building Residential Application
BUII..DING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1� $2,000 plus $14 for each additional $1,000 or fracrion, to and
includin $$25,000
$25,001 to $50,000 $39125 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each addirional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
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 proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Departrnent
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
� �
�-:;
� '
� ` � ��'
������ �
BUILDING PERMIT APPLICANT: PROPERTY OWNER
i� ��4 , understand that the Sta.te of Minnesota. requires
that a11 residential b lding con actors, remodelers and roofers obtain a sta.te license
unless they qualify for a specific exemption from the licensing requirements. This license
requirement applies to owners of residential real estate who build or improve such
property for purposes of speculation or resa.le.
By signing this document, I attest to the fact that I am improving this house for my own
use and am not building or improving this house for the purpose of reselling it. I hereby
claim to be exempt from the state licensing requirements because I am not in the business
of building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, located at _�%j�L3 � �'�� � ��-, � , r � �
is the only residential structure I have built or improved in the past 24 months. I so
acknowledge tha.t because I do not have a state license, I forfeit any mechanic's lien
rights to wluch I may otherwise have been entitled under Minn. Sta.t. §514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the Sta.te of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activiry is a
misdemeanor under Minn. Stat. §326B.082, subd. 16 and can also result in a fine of up to
$10,000. I further state that I understand that the filing of a false sta.tement with
The Citv of Fridlev may also result in criminal prosecution andlor civil penalties
to applicable city ordinances and/or sta.te statutes.
I have also been informed and acknowledge that by listing myself as the contractor for
tlus project, I alone will be responsible to The Citv of Fridlev for compliance will
all applicable building codes and city ordinance 'th the wor ing preformed on this
property.
Signature of P o erty Ow e
� 9-
' Date
For questions or information on contractor licensing, or to check the licensing status and enforcement
history of a particular contractor, call the Minnesota Depariment of Labor and Industry, Construction
Codes and Licensing Division, at (651) 284-5069. T'he web site is: httn://www.dli.mn.�ov/Ccld as�
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