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Suite 306 ■ Village North Protessionai Bldg. � 7420 Unity Aver� North • Brooklyn �ark, MN. 55�43 � f612)�fi1-2505
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Ch�rraer 'VVenier � Asso��at�s, Inc.
Registered Professional Land Surveyors
Suite 306 ■ Village North Professional Bldg. ■ 7420 Unity Avenue North ■ Brooklyn Park, MN. 55443 ■(612)561-2505
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Described as follows� �ts 2 and 2A, Blo�k i, 'Phompson's F.iverview
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1 hereby certify that this survey, plan, or report was prepared by me or Scale 1 inch equals�feet
under my direct supervision and that I am a duly Registered Land o Indicates Iron Monument
Surveyor u er the laws of th te of Minnesota � _ Book Page
a _ '"_
' Date '�S��Reg No: _� Job Na 1023�
m
City of Fridley
AT THE TOP OF THE TWINS
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COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
l__N� ��"' �•� CITY HALL FRIDLEY 55432
L 612-�0-3450
JOB ADDRESS
1 LEGAL �OT NO. BL�
DESCH.
:�2 2A
2 PROPERTYOWNER
Donal d Knc� emFz
3 CONTRACTOR
S��1E
4 ARCHITECTORDESIGNER
5 ENGINEER
8 USE OF BUILDING
M
7 CLAS O ORK � NEW
8 DESCRIBE WORK
SUBJECT
BU ILDING PERMIT
NUMBER REV. DATE PAGE OF
910-F15 �j/j (/78 � �
D� X Kimball Street N.E.
TRACT OR ADDITION
1 Thompson°s Riverview Heic
MAIL ADDRESS '
MAIL ADDRESS
ADDRESS
MAIL ADDRESS
-`_----
P 1T NO.
° 14'762
ECEIPT NO.
9�Q� /!�
APPROVED BY
SEE ATTACHED
h'tS SHEET
ZIP PHONE
784-5517
ZIP PHONE LICENSE NO.
ZIP PHONE LICENSE NO.
ZIP PHONE LICENSE NO.
❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
�E��a� ��.R���� ��,� � ���,,.. ..� _
9 CHANGE QF USE FROM Wr���.�i �����'�Q ��D � �� �,� �
C ����
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STIPULATIONS
1. Pravide combustion air to furnace ��v� ��.C�t1,R� �EQ�ACE
2o Provide truss design and verifying survey by July 30, 19� Vp�, wA QQEr
3. Sod front and side yards ���D,�� Y
4. Provide a hard surface driveway �r,t
Needs agreement Driveway Depression Cost 18' x 6° x$14.50=$348.00 ,,�
SEWER No existing Servic� 8" VCP 20' S of North line of Kiinball Stree �
WATER Must be tapped 6" CIP 30' S. of North 1 ine of Kimbal l St �����vt���� ,
n� anr o� �arot�r �� �,a���0 ,GPS
DCES Nd1 cv� � �����g`��tR�� a�
ACCURACY OF U7i1dTY LOCATWNS AND �,E1►A�Gr�.f
THIS DA?A IS 1�OR lNFORMAnON PURPOSES ONi. � 8��� ���E�� �'� �
�soNS uswc rr sHVu�c v��r n�� nvFO�u►�a tE�'� v����
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. '�' wood frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING ��TJS`z CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION Y� ��� ����
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT T X X X
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION � STALLS GARAGES
ANQ KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 'rJ3 OOO �S. �'rJ
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LO AL LAW REGULATING CON- � OG. Z� �iOO.00
TION OR THE PERF RMANC OF CO�S�i CTION. �
`� � ; � —�� PLAN CHECK FEE TOTAL FEE
26.55 898.91
SIGNATU EOfCONTRA ORORA THORIZEDAGENT �onTei, HEN P P RLY VALDATED HIS IS YOUR E IT
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SIGNATURE OF OWNEP IIF OWNER BUILDERI IOATEI e LDG INSP f1ATF
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1. Address � ��,8�(�
' � 2 . Lega 1 . Z . Zr � = � '7�tC�i"" /�.
3. Zoning
4. Lot Wid�h `� � � °'� .
. 5.� Building Width
6., Front Setback
� 7. Total Use .
8. o Lot Coverage •
. 9. Easements .� . . : . .
. � 10. Varianee . ". .
11. Soil .
. 12. Contractor ' � � �
13. Phone • � . .
. �14. Architect
15. Drainage.
16. Energy Ashrae � .
17. Utility Locations •
18. Specials � .
19. Driveway opening .
. 20. Z';uss Design �
21.. Combustion Air •
� 22.. � � � � � . ' .
• 23. .' � . ' -
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Ch�rr�er �in%r & Ass�ci�tes, Inc.
Registered Professional Land Surveyors
Suite 306 ■ Village North Professional Bldg. ■ 7420 Unity Avenue North ■ Brooklyn Park, MN. 55443 ■(612)561-2505
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Property of Da n�:ac i Emba � �-
Described as follows� Lots 2 and 2A, Hlock 1, 'rhampson `s P.iverview
Heiqhts, Ariuka Cot.arlt � , ��i.nn�sota
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I hereby certify that this survey, plan, or report was prepared by me or Scale 1 inch equals�feet
under my direct supervision and that I am a duly Registered Land o Indicates iron Monument
Surveyor u erthe laws of th te of Minnesota" E Book Page�_,
. ` .
,� : Date '� Reg No.� D� Job No. �Z 3�
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"�A-3370 F'ridley : � ... ��'�t��,� ��°-,,.��.."" �" , r ..�, 4�'� :, • A,.'" � t-
,�. : � �t f } �iy a �. y>� .� 'R i' '�._ �?2��i.�'�',r � Y r 1�.�`�i' .T•,j y3 �i,.'.,
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BEFORE THE M[JNICIPAL BOARp.
:- � .h , _ ,s. ; �. �� ,;� �-�' _-.dl-
OF THE STATE OF MINNESOTA
Gerald J..Isaacs
Rabert W. Johnson
Thomas J. Simmons -
Chaixman
Vice Chairlaan
Member -
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IN THF MATTER OF TFIE DETACH.�IENT FROt4 THE ) FILJDIPJGS OF. FACT, .
GITY OF COON �RAPIDS AND THE ANiiEiC�1TION ) COtJCL(1SIONS .OF LAW, . •
TO THE CITY OF FRIDLEY • ) • ANp ORDER � �
On June 12, 1978, the .�li.nnes�ta `2unicipal Board received a resnliation fr►�r.i ths
City of Caon Raaids wnich r�?uested the detachment of certain pronert_• and on Jezn�► 19i:n �
a resolution from the City o£ Fridley which rec.uegted the annexation of tnP sa.-ee.terri-
tor� pursuant to t�inne.sota Statutes 414.061. ����
After review of the resolvt3.ons, the !4innesota E4unicipal Board hPreby �akes a*�d. "� .
files the followina Pin3ings of Fact, ConcLusions of Law and order. �� �� �"� ��
FINDIPJGS OF FACT
1. That a resotution suanorting detac'ruaent �€ certain propArti.Ps was :pcciv:c' fm4
tn� Cit; of Coon Ra�ids and a resolution su�oor�ing annexation of said nr���rty ��as rn-
ceived fron the City of Fridley.
2. The r�solutions contained al� the infarmation re�uir�d b.r st.��ute �n�lu7°r.� a
desCription of the territory proposed for deta�chm�nt/annexation which is as follows:
Lot 24, �tississipni Oaks and the'Easterlj 84.5 feet of T�ot 17,
Auditar's St�Yid?vision Ko. 103 Revised.
- 3. The area proposed for c3etachment is situated within the City of Ccson Ra�ids arsd
abuts the municipal boundary of the City of Fridley.
CONCi�USIOPIS OF L.�1tiI
1. The Minnesota Municipal Board duly acquired and now has jurisdicti�n of the
- within proceeding. ' �. �_ .�
.. � .. -_ : - - __ : _ _: _�- � �-' - �
2. An order should be issued by the idinnesota �•iunicipal Doard concurrently, �
detachinq and annexing the area described herein.
O R D E R
IT IS IiEREFY OFDEREDc That the following-described property be, and the samc here- �
. _ _--�..� _.=- =
. ___ .. . _. . ..
.. . y is, c��tae'zec� fror� the-City of Coon R�pids and-ann�xeci to thP City of Fric3ley,`�t�P
same as if it had originally been made a par� thereof:
Lot 24, F1isSissipF�i Oaks and the Easterly 84.5 feet of Lnt 17,
Auditor's Subdivision No. 103 Revised.
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. � _ � .'""ti��.�y 3�{ �� ��� Txs'tr�i_� � ��j����"s.:.� 7.-"yr '� - �{Yr�[ !' y, _-�.' '�. ��
- a" ti.a-s� �t- 3 �„� -*s- _ . ' e� �'¢€'Sa.+�a-,��1 e,r �a. .xi°.��.��h.e _ �ci-�+.
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IT IS Ft1RTNER ORDERED: That the effecttve date of this order is Ju1g 7, 197g.
. Dated this lZth day of July, 1978.
• MINNESOTA MWICIpAL BOARD
. 165 Metro S3uare Building
� St. Paul, Minnesota 55201
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. P�tricia n. Lcer.dy ' `/ -
Assistar.t F.xecr�tive Director
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/�PP�IC/1TI011 FO{t fZE�Ti�f:NTi/1L BUILU1�dG PE(ZMITS
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��;I2�R: ��d...� � � �- � !1 � G �P ►'�1CJ�
Ac3dress: �4! �'�".�6 �1,�� � _
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Address:
Tel. tdo. ���-°�d �•�
No. Street: ��_� '�(� I I �'�_�� .
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7�OT: � }3TACY.: I 11DDITIQP�: �� ` P�,
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CORN;�R Ij��"z': ITJSIAE IAT: � SLT�I�CY.: �� SIDL•'Y11RDS: /`f ���
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Ap}?licart attach �to L-his i'orm �•�v Certificatc�s of Survey of Lot and proposed !
.
b�i_�.ding locai:ion drawn cn these Cex�titicates. .
. DESCRI PTI01'd OF BUI LDI hG x�� � j�
� . .
Ta RQ Us ed T�s : a , � �
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� � �`ron�: Depth: � �' Height:
Squar� Fe�t: �L '? �' Cubic Feet: r
�p 1'rc�.it: �� Depth: a � Height: 1 �
__ � G��—�---
Square reet: Cubic Feet:
�'ype of Cbnstruction: � Estima�Led Cost: S_sa��
�.b II� Completed: � 1
Alt•. A A_t. B
Praposed Driveway Wirit•h If 11e�ti* Ope.7ing Is Desired � $" $ •
(SLL It�VERSE SIDE OF Siif:FT)
The und��rsign�d hereby makes application for a permit for the work herein
speci:Cied, agrecii:� to do all t.�ork in strict acco�:dance with the City of
Fxa.dle}► Ordinances an� ruli:�gs of the Depar�ment oi BuilditicTs, aiYd ilerel�y
declares that all tlze facts and regresentations stat:�d i�z i:ilis applic�atio:i
a�:e ttue �id corrcct. See revcrse s' � ic�r aclditianal inforniation:,
D11TE: � SIGNATOJ;E: .
Stiyulatioils: � � r��,•'�/
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85 S- 9/
BUILDING PER��IT FEt SCHEDULE
SL'CTION 2. '?'he Inspector of Buildings shall, before issuing pennits for the erection
of any building or structure, or for any additicn t�� any e.Yisting build� ng er_ stnecture,
o*_ for any alteration or repairs to any existing L-uilding or s��z-ucture, upon at�plication
therefore, require the payment by the applic4nt for such permit of �'ees to the amount
herein below set forth and in the manner hereiri provided to-wit:
NEW CONSTRUCTION: Single Family Homes and Garages: $4:Q0/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee. �
DRIV'EWAY DEPRESSION: (Concrete Curb Streets Unly)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$14.50
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approacn wi�t.h
6 inch depth; Driveway width plus 6 feet x$17.20
ADDITIONAL TNFQR^1ATION
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered frcm a
point six (6) inches below the floor line of the basement or the cellar to the
average heights of the upper surface or to the average height of the roo� s�.rface
of the main gable of a pitched roof.
For rep�irs or alterations to an exi�ting structure, the fee shall be at the rate
° of $3.OU ��er each five hu3idred dollars ($500.00) or fraction thereof in the cust
of all proposed work.
In no cu�e shall the fee charged for any permit as set forth in Section 2 be lass
than $7.50 plus $.50 state surcharge.
YERIFICATIO� OF FOUf�DATION
NOTE: Permits for construction will be issued a minimznn of 24 hours from the time
of application to allow for.proper review of the proposed structure and of the
cons'truction site.
A Ceri:ificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
� � � � ':1
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any struci�ure for which a building permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued. ' �
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CONSfRVATION EVA�.U�TION �; �
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• �
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OVERAU. CALCULATED 1'HERAAAL
TRANSMITTANCE VALUES Ue
, � , �; (�,/4.,t (� �►, t l�A,� (�40�,*. . . -
A, �e � �
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. � ��'�
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TO�ALS ����a u : I 2(o p( I�I �.,) 3 O . E
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_ VAPOR BARRIERS ARE REQUIRED , '
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� Ta�l Aeaembly R, Value • . . . . . .
CalC�lated U, . U, =1/R, • . . . . . .
Tatal A� A, . . . . . . . . . .
Aesetably t!, A, - • . . . . . . ,
VAPOR �ARRIERS ARE REQUIRED
-_
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� ��_ � 5 6 9
� CITY OF FRIDLEY �' 3-%
0
PUBLIC WORKS DEPARTMENT
TAPPING APPLICATION AND PERNIIT
FOR INSTALLATION OF WATER & SEWER SERVICE
I) This form to be completed before a tap is made to any esisting water or
sewer line. _ _ .
Address 5 .��"' • �`
Owner
Plumber �
CHARGES TO BE PAID BEFORE T IS MADE — WHERE
ASSESSMENT HAS NOT BEEN LEVIID AGAINST PROPERTY
II) Water & sewer connection permit must be registered before this Tapping
Peraut can be issued.
City supplies all material and labor for 1" or under water tap. Con-
tractor supplies all material and labor for water tap over 1", and all
sewer taps.
WATER TAP: � Materials Used: $ la� �
Street Patch: �: $ / 4'� , o--d
TOTAL: $ �av� �
SEWER TAP: Street Patch: x :$
III) If this property has not paid a full Lateral Charge for its share of the
water and sewer system, additional charges will be placed against it.
This will be in addition to the normal connection and tapping permits,
meter deposits, etc.
Water
ASSESSMENTS TO BE LEVIID: Lateral: $
Sewer Lateral: $
TOTAL ASSESSMENT: $ /�3. 3 eJ
, � v�
Clerks Signature
Supt. of Public Works �
M/P 3/76 White P.W. Canary Finance P nk Prop. Owner Gotdenrod Plumbe►
s o�.ww>i�o�..
8' S•
g
�, ` �',.r
. �
PROJECT: �
REPORT OF:
RESIDENCE
615 KIMBALL �
� , tw�n c�tti+ test�nq
a� e�on,eeru�� �eon,, u,�.
662 CROMWELL AVENUE
� ST. PAUL, MN 55174
PHONE 612/645-3gpf
EXCAVATION OBSERVATION
DATE: July 26, 1978
REPORTED TO: Do y& Sons Inc FURNISHED BY:
620 39th Avenue North 1) City of Fridley
Minneapolis, MN 55421 COPIES To:
Attn: Darrel Clark
Attn: Dan Kociemba
LABORATORY No. 9-1030
INTRODUCTION
This report concerns our recent observations of the soil conditions for the residence at
615 Kimball Street in Fridley, Minnesota. The purpose of aur work was to judge whether the
exposed soils were suitable from which to begin fill or footing placerr�nt. Authorization
for our work was received from Mr Dan Kociemba with Doty & Sons Inc on June 22, 1978.
CONCLUSIONS
Based on our observations on June 22, it is our opinion the exposed natural soil network in
the bottom of the excavation should support the anticipated loads. Any disturbed soils, as
washed in by recent rains subsequent to our observations or created by construction traffic,
should be removed prior to footing construction.
BACKGROUND INFORMATION
Deep soil penetration borings were not placed for this construction, However, according to
our available geological information, the surficial soils of the area consist of primarily
fine to medium-grained coarse alluvial sand. .
We understand the proposed building will be a split entry with overall dimensions of 38' x
54', supported by continuous spread footings. We have not been given the footing loads, but
assume the foundation design was based on an allowable bearing capacity of up to 1500 psf.
The foundation plan was to excavate all surficial topsoil and fill and any soft or loose soils
down to competent natural soil conditions.
OBSERVATION METHODS AND RESULTS
On June 22, wf� observed the excavation work. The exposed soils were visually and manually
classified in accordance with the Unified Soil Classification System, and estimates were
made of their strength properties. A series of shallow hand-auger borings were put down to
further depict the subsurface soil conditions.
At the time of our visit, the building area had been mass �excavated about 2'-3' below the
surrounding grojnd surface. Shallow hand-auger borings in the excavation bottom encountered
up to 1' of silt overlying fine to medium-grained brown and reddish brown coarse alluvial
sands. These soil conditions were judged suitable to support the anticipated loadings.
A8 A MUTUAL PROTECTION TO CLIENT�. TH6 PYBLIC AND OURBELVE9, ALL pEPOiiTB ARE HUBMITTED A8 TNE CONFIDENT�AL PROPERTY OF CLIENTS. AND AUTNOR-
IZATION FOR PUBLIGTION OF BTATEMENTB, CONCLU810N8 OR EXTpACTB FROM OR REGARDING OUR REPORTS 18 REBERVED PENDiN6 OUR WRITTEN APPROVA�,.
�
�''.�""° •.
d �
V� F
�. �
LABORATORY No.
REPORT OF:
9-1030
� tw�n cit� test�nq
� �no �■baraeory,.,c
!82 CROMWELL AVENUE
T" ST PA�JL. MN 55114
•NONE �12/NS�Ot
EXCAVATION OBSERVATION
o�rE: �uly 26, 1978
PAGE: 2
OBSERVATION METHODS AND RESULTS - Cont.
Mr Darrel Clark, with the City of Fridley, has informed us that portions of the excavation
bottom had become disturbed subsequent to our observations on June 22. We understand recent
rains contributed to the saturation and strength loss of the surficial silt. We suggested
totally excavating the disturbed material, followed with our observation of the newly exposed
soils. To date, we have not been requested to observe the corrective work.
Fill will be required to upgrade the garage area to slab elevation. Density tests of the fill
should be performed at 2' vertica1 intervals to document sufficient compaction.
In order to provide frost protection for the exterior footings, at least 3 1/2'-4' of soil
should be maintained above footing elevation around the exterior of the structure. At the
time of our observation, the excavation terminated only 2'-3' below the surrounding grade,
and, therefore, manual placement of soils around the perimeter masonry walls to achieve minimum
frost depth will probably be necessary,
REMARKS
As no deep penetration borings were placed within the building confines, we cannot warrant the
soil conditions below our shallow, hand-auger borings. However, accordi:ng to our available
geological data, the likelihood of encounter9ng inferior soils at depth is quite rerrote.
It must be recognized that Twin City Testing and Engineering Laboratory Inc does not practice
in the -field of surveying. We, therefore, must rely on the staking.performed by others. If
the construction is redesigned or otherwise moved subsequent to our work, we should be informed
so our firm can assess if additional engineering observation is required or suggest sound
engineering alternatives. We cannot be responsible for excavation subsequent to our observation
If we can be of further assistance to you, please contact us.
� ��
3 ° C.r�i� REs�a�o f�.�.o
���' ��:� w�
SMS/TES/jb '
��oc.��
TWIN CITY TESTING AND
ENGINEERING LABORATORY INC
��-� - .
Steven M Sweney, Geological
��r-u�-
Terr`y�wor, C.P.G.S.
A"� naaer, Soils & 6eology Dept �
Af ♦ YYTYAL /ROT[CTION TO CLI[MT�. rws rv�ue ��re ou��vi�. ALL A[MRtt AR[ �Y�YtTT[O U TM[ �M�tO[NTi�L *RO►[IRr 0► CLI[MT/. ANO AVTNOw.
IZATION RpR /Y�LIGTIOM 01 /TAT[M[NT�, GONCLY�IOM� OA tYTAAC{{ �py Ow R(GARDINO OY! K►pRT{ 1� R[{(RytO �►NDING OYR WAITT[N AMwOYAL.
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CITY OF FRIDLEY
A431 UNIVERSITY AVENUE N.E.� FRIDLEY, MINNESOTA 66432
TELEPHONE ( 812)571-3460
Dec�ber 11, 1978
F
Mr. Daniel Kociemba
615 Kisnball Street N.E.
Fridley, l�T 55432
Re: Final Inspection at 615 Kimball Street N.E.
Dear Ntro Kociemba:
A final inspection was made on December 11, 1978 of the above address and
the following items were noted which must be ca�pleted before the structure
can be finaled out;
l. Post house number on structure by Dec�nber 22, 1978.
2.
3.
Provide co�bustion air to furnace area by December 22, 1978.
Pronide sod in the front and side yards by June 1, 1979.
We will expect the above items to be completed by the scheduled dates when
reinspections will be made to deternnine compliencee If you.have any questions
on these it�s, please contact me at 571-3450.
Sincerely,
DARREL G. GLARK
(Ammunity Develo�atent Ac�.
DCC/mh
SUBJECT
c�ty of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
� �
' ' COMMUNITY DEVELOPMENT DIV.
' j L �-���-
r � � PROTECTIVE INSPECTION SEC.
1 � �
� �"'1 � CITY HALL FRIDLEv 55432 NUMBER
�'"�'� � `�� 612-571-3450
910-F15
JOB ADDRES
�1 Kimbail St.
PERMIT NO. \
_ 95884
RECEIPT NO. i
REV. DATE PAGE OF APPROVED BV
8/15/80 / /
1 LEGAL LOT NO. ZAFa2 BLOCK TRACT OR ADDITION
DESCR. ���, �. Thompson's R i ve rvi ew He i ght�
2 PROPERTYOWNER MAILADDRESS 21P PHONE
Daniel Kociemba, 615 Kimball St. , Frid.ley, 55432 780-1508
3 CONTRACTOR MAILADDRESS ZIP PHONE
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE
5 ENGINEER MAILADDRESS
6 USE OF BUILDING
SEEATTACHED
SHEET
LICENSE NO.
LICENSE NO.
PHONE LICENSE NO.
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOHK
Fireplace
9 CHANGEOFUSEFROM
STIPULATIONS
TO
Must be installed accor.ding to manufacturer!s specifications.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUP/
VENTILATING OR AIR CONDITIONING. FI iep�BC@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STA�LS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND OFiDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $�� 200.00.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OF LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 9. QO
SIGNATUREOPCO TWA�, ORAUTMORIZEDSGENT IDATEI WHEN PROPERLY
� { � �� /('� r�',.. F� s_ 'O
/�e ��"6 - —/ �° � ��
dG URE OF OW� ER � OWNER BUiLDEPo IDATE� ai nr, i c
GROUP OCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
GARAGES
SURTAX
.60
SAC CHARGE
TOTALFEE
59.60
ED THIS IS VOUR P�ERMIT,
CITY OF FRIDLEY • •
ARPLICATION FOR RESIDENTIAL QUILDIP�G PERMITS
� (PJew, Alter�tions, Additions, or Repairs)
� 04lfiJER: _
ADURESS:
TEL N0:
�v_�'�.� BUI LDER : , _._ _.
� I � ADDRESS: -
TEL NQ: '
� C nstruction Location
STRSS�'sT NO: �/� STREET: `� �/ ��
0
LOT: ��� p� BLOCK: ADDITIOIJ: _ ��� �CJ
Corner Lot: Insicle Lot: Sef:back: Sideyards:
ApPlicant attach to thi� form two Certiticates of Survey of lot and
proposed bui.lding locat'on drawn on certificates to scale.
Front:
Scruane. Feet:
Front:
Square� Feet:
IPTIO(J OF CONSTRUCTION
Depth : Heiqht:
C�ibic Feet: �
DePth: Height:
Cubic Feet:
Type of Construction: �-P � � Estimated Cost: $�(/. �
7b Be Cbmpleted: �l/� �C� " .. �
_ . Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $' $
. . SEE REVERSE SIDE OF SHEET
The undersigned hezeby makes application for a permit for the work'hexeirn specified,
agreeing to do all work in strict accordance with the Ci�y of Fridley Ordiiiances and
rulings of the Department of Buildings, and hereby decJ_ares that all the facts and
representations stated in this � �
DATE: SIGN.
Stipulations:
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,�. �
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`�t� .�'�i�Jt1(,t��l Lru �t�Z:'s s �c� �e� C'�i iorl��
�� � �.',-
BU1LDItJG PERt�I1T FEr SCHCDULE� .
5�CTION 2. Tiie In:.;�,�ccl:or o.t 13uilQiru�v sha).]., bcfoLC issuing pc�niLs for. the crecL-ion
oi any bui�.diny or �truct:ure, or for any additi.ori to any er.i..ting buildiny or s�xucL-urc,
ox ior any altcration or repaa.r.s ta •any .exi.�ting }�ui1dS.»g or. S1:i:lACtUZ'C� UpG11 a�plication
fihereioxc, requir_e t}ie paymen� by tlie a},���licant Lor such pex.mii:� of fces to, the amount
}ierein bel.ow set forth and in tlie manncn c�:rein providec� to--wit: �
-V'-N�I�� L'ONS'TRUCTION: Singlc: Fami].y IJomes aiid Garages: $�.00/].,000 cubic teet.
PI,I�N CtiLCK: 25 percenti o� 1�ui.lding perrni_t fe�e. . .
llRIVL'tJAY DEPRI:SSXOI,1: (Concrete, Curb StYeei:s Only) �
• � AlL-ernai:e A: Removal and replacGment of concrete cuxb and
� guti:er only; Driveway width plus 6 feet x�1�,75
Alternat-e B: Removal and replacement of concrete curb and •
' . 4 gutter and instalJ. a 3 foot wide apprc�ach wi�
' . 6 inch depth; Drive��ay width plus G feet x$17.8S
�I3DITTOP�AL INFOR�1l�TION
�or the purpose of computing fees for building �rmits, the cubical contents of any
buildinc� or add.ition, is determined by multi.ply9ng i-he c�round area covered from a
point sis: (6) inches below the. i'loor line of the basement or th� ceilar to� the
average heights o�' the upper surface or to the average height of the roof suriace
of the raaia� gabl.e of a pitched root. •
For repairs or alterations i.o an existing st-ruciure, the fee shal7. be at the rate
of $3.00 Per each five hundred dollars-($500.00) or fraction thereof in the cost
of all proposed work. � •
In •no case shal.l f:he iee charged for any permit as set forth in Section 2 be less.
tha. $7.50 plus $.5i� state surchargeo ' �
jCERIFICATIO� OF FOUNDATIO(J
NOTE: Perrtiis �or construction �vill be issued a minimiun of 24 hours from the time
of application to allow for proper review of the proposed structwre and of the
ce�nstruction site.
� Certi�Eicate of Survey of the lot, showing the locatien caf �..he foundai.ion once .i.t
has b�en construc�ed wi11 be required before proceeding with the frami.ng.
CE�°i I F I CATE QF OCGtIPANCY
Applicat?on for a Certiiica�e. of Ocet�pa��cy sha1�. be made ten (10) days prior to the
usc or occupancy of any st-xia.cture fo.� which a builr�i.ng pexmit has been 3.ssued; an�i
said stsucture shall not be used or occup:ied unta.l. a Certiiicate of Occupancy has
bcen issued.
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CITY OF FRIDLEY
6431 i7NIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 N'AX:
ADDRESS : 615 KIlVIBALL ST NE
PIN : 033024220131
LEGAL DESC : RIVERVIEW HEIGHTS
: LOT 2 BLOCK 1
571-1287
�x
PERMIT NO.: 2004-01134 y `�f`` ♦+�
��
DATE ISSUED: 07/19/2004
PERNIIT TYPE : ELECTRICAL
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: ELECTRICAL PERNIIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL AN AIK
CONDITIONER.
# INSPECTIONS 1
APPLICANT
CENTERPOINT ENERGY/NIlNNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
OWNER
REKUCHA NATALIE
615 KIlVIBALL 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
applicarion 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 pemut 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.
[�TT � T � T�"� i� ,
ELEC PERNIIT FEE - MIN (RESn
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 5844
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() oN (� sa� •suo����ads s,�a�n��.ndew pu� sapa� 3ua.un� ay} }aaw o}
palle�su! pue pazis eQ II!nn � ��e uo�snqwo� nnau e Il�su� o} pa�mbaa uayM
� ) oN � ) sa� •suoi�e��oads s,ta.m���.nuew pue
sapo� }ua�no ay� �aaw o� p2(�e�sui pu� pazis si �ie uoi}snqwo� ui�sixa ayl
() oN �) sa� �s�ueiJdde }}e�p �e�n}eu pue palsisse
u� �o� sa�q�e16w�uan 2o�wn� �e��ua�J I tio6a3�J yWb'J-`dJb aP�loui
s�op siyl �suoi���ads s,�a�n�e�nuew pu�e sapo� �ua�no ay� s�aaw pue
�t�qway-s� pa}si� e si �,iun �uawa�e�da� ay� 3ey} sa�uan os�e pau6is�2pun ayl
� � oN (�) sa,� -uoi�euiw�a� pue snnoq�a �o .�aqwnu 'y�6ua� `6uiz�s 6uipn�ui suoi���►�ads
aaan�oe}nuew pu� sapa� ;uaurr� ��e s3aaw pue �nd/�!�s�ld si wa�s�(s 6ui�uan ayl
O oN �) sa� 'pa�mba� a�a�{nn paddo}sa�� pue pa�,oddns l��a�n�as si pue
'su�i�an.�}sqo 'uoi}�oua}ap `�sru wa� aa�} si pue pauiwexa uaaq sey 6w�uan
ay� 3���� sa��an �tqalay pau6is.iapun ay� 'aaewn; ui�s�xa ue uioe� a� uayM
NO11b�l�la3A al�d NC►IlSf19W0� aN�! 2lO.L�3NN0� 1N3A 1N3A NOWWO�
S11W213d 3�NV�11dd�1 JNINZlf18 "13f1� 1N3W3�d'ld3�l 2i0� A'13131dW0� NI �11d
TOTAL P.02
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY PE� No.: 200401133 � a
6431 iTNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 07/19/2004 ,
572-36U4 FAX:
: 615 KIlVIBALL ST NE
: 033024220131
: RIVERVIEW HEIGHTS
: LOT 2 BLOCK 1
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
571-1287
VALUATION .
NOTE: AIlZ CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
INSTALL AN AIlZ CONDITIONER
# 0-100 AMP CIRCUITS 0 # A/C LJNITS 1
#FURNACES
# GAS RANGES
APPLICANT
CENTERPOINT ENERGY/NIINNEGASCO
13562 CENTRAL AVE NE
ANOKA, MN 55304-
OWNER
REKUCHA NATALIE
615 KIlVIBALL 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 laiow 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 cons rion or the performance of cons �� }ctia .
Applicant ''� . � Date 1 �
Bldg Insp (� ���,��'- ' �� Date
0 # GAS DRYERS
0 VALUE (FOR 1��NIMUM CALC)
HEATING PERNIIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIOI�TING FEE
STATE SURCHARGE, MECH FLAT
ATHI,ETIC FIELD 0-100 AMP CIRCUITS
TOTAL
PAID WITH CHECK # 5844
SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
0
2400
0.00
0.00
0.00
0.00
25.00
0.50
0.00
25.50
3uildiag
rnspections
763-572-3604
�ATE �
iITE ADDRESS '
i HIS APPLICANT IS:
�
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
� PROPERTY TYPE
PERMIT TYPE
�E oF woRx:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
� OWNER
STATE UCENSE
❑ TVdO FAMILYMEW
O ADDITION
O BASEMENT FINISH
❑ DECK
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
OF SQUARBS �
GARA.GES
PROPOSID SIZE:
PROPOSED HEIGHT:
SIDING
❑ Viayl
O Aluminum
❑ Other
YOUR E-MAIL
Pernut No.:
Received By: � ��
Date Rec'd• ��� ° � `����
� C EXP DATE � O "
�r. � ( CITY �b
�f Fax �� � � 6 y °rO
JSTRUCTION ' SIZE
IRUCI'ION STORIES
❑ GARAGE/SHED ❑ WIN�WS
/0 ROOF O DRAIN TILE
❑ SIDING ❑ OTHER
❑ SWllvIIvlWG POOL
❑ ADDITION
❑ ODELWG
�_
LENGTH WIDTH HEIGHT
o HOUSE ONLY
0 HOUSE & GARAGE
❑ ATTACHED GARAGE
O DETACE�D GARAGE
OSoffit
O Trim
❑ Fascia
WINDOWS
IN E3�ST7NG OPENINGS ❑Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIDE STZE OF
OPENING CHANGES &
TYPE OF WIIJDOW TO BE INSTALLED NIJMBER OF �
��
Tr�°t��-v r �
BASENIEN� REMODELING StBIvIIT•
1. Existing Floor Plan
2. Propctsed floor plan
3. List of structural members to be used
Ft
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBNIIT•
1. Site Pian/Survey showing the existing sWc4ues
and proposed project,
2. Two set5 of construction plans
3. Energy Calculations •
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING �HE 1997 U.B.0 FEE SCHEDULE)
TOT.
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
VALUA'
Q
$
$ I.�
$ S• �
$
$
$
$
$
0
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 Residenrial Contractors)
$1550 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: Ciri of Fridlev AttA�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UIdTIL PROCESSED
I hereby apply for a building permit and I aclmowledge 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
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requ' review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME Di✓� �21 �i DATE_ �// /I G
.r` ��
Page 2- Build.ing Residential Application
BUILDING 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 altera.tion 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
pmvided to-wit:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunum 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 Oniv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
J Building
Inspections
763-572-3604
DATE i�.� - �a - a,�
SI'1'E ADDRESS �IS
'fI11S APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
►,,
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
iT_/�/� �
O OWNER �'ONl'RACTOR
::—� a � � � e� t/�
ess: ra 1 S' !('.' m b�.. g-� /li�
E: �% 7J' "� %iii� -r �24x'qy
STATE LICENSE
0
❑ BASEMENT FINISH
❑ NEW
❑ MAIr
l.��i7
Permit Nc�
Received By:
Date Rec'd: I
r�,�z�r.S�S �
� nr! HO,�h E �h�t'ir D� 5
�y5�oa�c� EXP DATE '3 ' 3� � a('Xj �
s�,� f5?�� 3F . .�,;�fe a�a crrsr � res� L�.ke STATFItI�i ZIP SSvo'2,$'
�- Do�3� a FA.Y G�S/ � YGy� - e�Dp �� d , �
� 9a ��PI ���1C� u��f l�
W CONSTRUCTION SIZE
:ONSTRUCTION STORIES � ��bFa�.� �ji�.+�� �
� _
DESCRIBE WORK BEING DONE: �ti _ o7D�� n
❑ ROOF ❑ DRAIN TILE
� SIDIN(3 ❑ OTHER
❑ SWIMMING POOL
�
e,� �
SIZE OF IMPROVEMENT LENGTH io� � WIDTH )o? � HEIGHT ��( �� S. Ft. I�/y
QOFING ❑ HOUSE ONLY
NUMBER OF SQUARES � HOUSE & GARAGE BASEMENT REMODELINC3 SUBMIT•
GARAGES ❑ ATTACHED DARAGE 1. Ezisting Floor Plan
PROPOSED SiZE: ❑ DETACHED GARAGCi� 2. Proposed floorplan
PROPOSED HEIGHT: 3. List of structural members to be used
SIUING '�C____.�
❑ Vinyl i"` ^ FOR NEW CONSTRUCTION INCLUDINd DECKS,
❑SotTt ADDITIONS. & PORCHES SUBMIT•
❑ Aluminum ❑ Trim f�i
❑ Other � F�� / CJ �� y� I. Site Plan/5urvey showing tha ezisting structures
and proposed project.
WI llOWS 2. Two sets of construction plans
IN EXISTINC3 OPENINC3S ❑Yes ❑No LOCATION OF WINDdWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPG OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USI1�G THE 1�7 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $� (j OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ " 6 65% of Building Permit Fee
Fire Surcharge $ ' (� .001 times the total job valuation
Surcharge $ .� .0005 x Permit Valuation Minimum $.50
License Surcharge $ S_r�� $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary () Non Necessary ()
Total Due $ �/`' d� Make checks payable to City of Fridley Attach SHnulationc
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT[L PROCESSED
I hereby apply for a building permit and I acknowledge 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
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work ic r quires vie and approval of plans.
Sl(iNATURE UF APPLICANT ' ,6 PRINT NAME ��� �Q✓t K S DATE I o� ' Io� ' O�j
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