PRE 2010 DOCSCity of Fridley, Mian..
BUILDING PERMIT
Date: May 19, 1970
Owner: E. P . Hag s tr om Bid.
Address 6645 Lucia Lane N.E. Address
Same
Same
k,ec°10- ='�rl 7�
N° 1065
LOCATION OF BUILDING
No. 6645 stmt Lucia Lane N.E. _ _ Part of Lot
Lot 5A __ Block Addition or Sub -Division . 2nd Ray- of A,d- Sub- No_ 21
Corner Lot ---- Inside Lot _ Setback --- Sideyard
Sewer Elevation ___ — Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Garage Front 24' Depth 24' Height 10' Sq. Ft 576' Cu. F•t, 5760'
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction —Frame Est. Cost _$80QQQ_ To be Completed Sept. 1, 1970
Provide Hardsurfaced Driveway
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley. ^
In consideration of the payment of a fee of $ ii -nn _._., permit is hereby granted to_.E
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. !�
41 Building Inspector
r.
NOTICE:
This permit does not cover the construction, Installation for whine, plumbing, gas heating, sewer or water. Be sun to see
the Building Inspector for separate permhs for these hens.
.W
V
APLICATION FOR 'RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
r
CITY OF FRIDLEY, MINNESOTA
OWNER' S. NAME: 4� 7 � a ilk BUILDER: � e
ADDRESS: 4p e ,4L Za u .Q ADDRESS:-
NO:.
DDRESS:NO:. 5- STREET: 4- a G % cL /- 6t N e
LOT: — BLOCK: ADDITION:
CORNER LOT: INSIDE LOT: V"" SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
GaL r a. a e— Front: -2- L Depth: Z4 Height: : /D /
g �l m
Square Feet: s76 C Cubic Feet: .S76 0
Front: Depth: Height:
Square Feet; Cubic Feet:
ez_�
Type of Construction: FT P Estimated Cost: $ �/0'0 �s
To Be Completed: se �
Cie
LIL
The undersigned herebymakes application for a permit for a wor
specified, hRe-rY in�
agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby .
declares that all the facts and representations stated in this application
are true and correct.
DATE: ,/ 7 ® ` 7 SIGNATURE: rr
s
(See Reverse Side For Additional Information.)
o�m
5 7 (6 ',2
�
S0D
r
�I° r •�r't�1�%
G ' o � o a7 L �':, 0
LAND SURVEYOR
REGISTERED UNDER LAWS OP STATE OF MINNESOTA
LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS
3616 EAST 55TH STREET PA. 4-4681
E-)UrbeP0r'!5 s-ertifieate
� l/.3 -5-
I HEREBY CERTIFY THAT THE ABOVE IS A TRUE. AND CORRECT PLAT OF A SURVEY OF
mortsage Survey
Lot 5-h9 2nd Revision of Auditor's Subdivision No. 21<,
Anoka County9Pvlinn.Subject to an easement over the ''des'.
33 feet thereof for road purposes.
AS SURVEYED BY ME THIS--2-Sth—SAY OF---AUg � —A.D.—�-�-�--
SIGNED—
F. C.
MINNESOT EGISTRATION. No. 3600
,1
City of Fridley, Minn.
BUILDING PERMIT
Date: August 4.-1970
Owner: Gene Hagstrom Builder
Russell Scott
Y,154
N 10777
Address 6645 Lucia Lane Address 1050 - 93rd Avenue N.W.
LOCATION OF BUILDING
No. 6645 Street Lucia Lane . _ .____. Part of Lot
Lot 5A Block Addition or Sub -Division Aud . Sub. #21 Rev of
Corner Lot — Inside Lot — X Setback ___ Sideyard
Sewer Elevation
To be Used as:
Foundation Elevation
DESCRIPTION OF BUILDING
Living Addition Front 18 Depth 26' Height 20' Sq, n 468 Cu, Ft 9360
with basement Front Depth Leight Sq. Ft. Cu. Ft.
Type of construction — From Est. 6 000 _ _ To be completed fly 30, 1971
valua on
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
,==
oY the city of Fridley. �
P
In consideration of the payment of a fee of $ 2T . 00 , permit is hereby granted to ott
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
�^ Biding Inspector
HANK MURXCH
NOTICE:
This permit does not cover the construction, hufalhatlon for wiring, plumbing, gas heathgb sewer or water. Be core to see
the Building Inspector for separate permhs for these Mems.
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAM: / L /� BUILDER: /4-
Id
ADDRESS:o �% ADDRESS :)e),5-0 9.3 _!?,4 e_ Ii° 14!
' c/�
NO:.r STREET
LOT: 5–/-f BLOCK: ADDITION: A f ,S,` / �e c
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:.
DESCRIPTION OF BUILDING
Front: —Depth: Height: :�_ o
Square Feet: g Cubic Feet: 9 0
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated &e&t:_$ 0/, 000
To Be Completed: -,L 3" `7/ U@,/vat.^ate
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE:' �' - �e ' 7 O - SIGNATURE:
-,,a L.A—
,,(See Reverse Side For Additional Information.)
a;
10
�® Associates Ino .
Ragstrom++
Okm
LAND SURVEYOR
rI
(rj
.e
REGISTERED UNDER LAWS OF STATE OF MINNESOTA
LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS
3616 EAST 55TH STREET
Ourbepar"!9 Certificate
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a
M2 30-13
I,
PA. 4-4681
f—eOff?C-. ;,r. l
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TRUE AND CORRECT PLAT OF A SURVEY OF ^ !
1 HEREBY CERTIFY THAT THE ABOVE IS A mortgage S et}
aA 2nd Revision of Auditors Subdivision No. 21,
Lot 5 , to'an easement over tie `��" �"
Anoka County, btinn .Sub j road ur oses .
33 feet thereof for ro P p
yh,'t�'h, ;•�,'.:.g:C 'c"�`+'C75zt•",S'.$kS , +t!�C:�:"�r'iGy�'�`';f`�` a;-`='�`zi -''
uavq
o3"73Taaa0 v 173un pe, Soo lo peon eq jou I1eu® aInaa' pt bs ,
uaeq q oe aTutxad $uTP1Tnq v rt,Ttl ao A asn�osuae hue ;O /COuw.naa°
� O a�g�'F3'Fa1aO v
soTsd o�Cap (01) uaa up= eqT.1uKp Aouadn000 3
PERMIT for Power plants and Ideating. Cool-
ing. Ventilation. Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of Pleating Plants to be installed--altered—repaired
Make ,Size ;
Oil fired—, Coal fired—; Gas fired ; Gas Authorization No.
Remarks
Approved by,
Final Inspection Date , 19_
Inspector
,973 (,5-1
Permit N° 4822
Fee 6.0
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn., ldt& o_A-12, 191-0-
Owner
Location(,0666C L&J (AA—LL,
Kind of Building- 4 Q
How Occupied
Work to be Commenced ,19_
To be Completed ,19
Estimated Cost, $
CDjd-gew, Building Permit No.
Permission is hereby granted to! � a L a X LaA" I ( CLA U to install—erect—use the material and devices described in the
above statement. This permit is granted upon the express condition that the person to whom it is granted, and his agents, employees and workmen, in all the work
done and materials used under this permit, and in the operation of the devices herein mentioned shall conform in all respects to the ordinances of the City of Fridley
relating to or governing the work to be done and the operation of the devices herein named, and to the specifica ' ns et forth in the approved application for this
permit on file in the office of the Inspector of Buildings. p � � '
���-p � .?ds✓►ti� _ o1��vi� , Inspector of Buildings
4z 2M 11-67 V
N° 5208
Original Permit for U(VIBING AND GAS I: ING 3�
N.B. When work covered by this permit is ready, the Plumbing Ordinance requires that request for Permit .
inspection shall be phoned in to the plumbing Inspector, 560-3450 giving number of this permit., Fee
DFSCRi MON OF WORK
Number, Siad and Location of Fixtures
City of Fridley Cet&&t4i ,19 n0
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WATER HTR.
GAS
ELEC.
Basement
ist
2nd
3rd
4th
Connected with Sewer -Cesspool Gas Piping for Openings
Permission is hereby granted to do the plumbing and
gas fitting in the building described in the s tement hereto Jacked, upon the express condition that
the person to whom this permit is granted, and his agents, employees and workmen, in the plumbing
or gas fitting of said building shall conform in all respects to ordinances of the City of Fridley, and
this permit may be revoked at any time upon the violation of any of the provisions of said ordinances.
By Order Of The Inspector Of Buildings
Roughing in Inspection Date
Inspector.
Final Inspection Date i ,
Kind of Building ��Q
Used as
To be Completed .19—
Estimated
19_
Estimated Cost
Old- ew. Building Permit No.
Inspector. Inspector of Buildings.
4z tai -6.69-v
SUBJECT
P
City of Fridley
- 17538
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
• COMMUNITY DEVELOPMENT DIV.
`U -'--".
1 PROTECTIVE INSPECTION SEC.
r 1 �
"AS/5
1
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/7/84
/
JOB ADDRESS 6645 Lucia Lane N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
SA
Second Revised Aud. Sub. #21 SHEET
2 PROPERTY OWNER MAILADDRESS ZIP PHONE
Michael K. Richard 6645 Lucia Lane N.E.. Fridley 571-6852
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Remove existing 10' x 24' Porch and Construct a 12' x 24' 3 Season Porch
9 CHANGE OF USE FROM TO
STIPULATIONS
PERMITS REQUIRED FOR WIRING.
S EPERATE
HEATING. PLUMBING AND SIGNS" WARNING
Before digging call local utilities
TELEPHONE - ELECTRIC - GAS Etc.
REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
ZONING
SO. FT.
CU. FT.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
NO. DWLG. UNITS
OFFSTREET PARKING
ANY TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
ISTALLS GARAGES
VALUATION
SURTAX
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
$51000
$2.50
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
PERMIT FEE
SAC CHARGE
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$50.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$12.63
$65.63
SIGNATUR OFC NT CT OR THO ZED ENT (DATE)
WHEN PROP RLY V LI TED THI IS YOUR PERMIT
�-y��
SiGNA RE OF OWNER tlF WNERB ILDERI IDATEI
BLDG WSP q TE
POLO'- L E[-.)q
E'i 1r.;;T N G
Lix q H R C s -r
OVC r-LC:CP —Cf-7
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C, I- y V's Se- � -r-CL,
t ticcf
NEW [ ] City of Fridley Effective 4/1/84
ADDN. [ ] �R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: BALI � �ue� L_c_'`►" '--
Legal Description: 1-o f S- A, 14e00S #oZ
Owner Name & Address: _00oc��� ��''`" Tel. # 'S71 -6ZSaa
Contractor: Tel. #
Address:
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 1.3 Width 41 Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: om00v� /� � �/ ®QC14
r` 4,
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: woo -0 ��-� E__ Estimated Cost: $ Q®0_'
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
L � I Tel.
DATE:�� APPLICANT:
CITY USE ONLY
Permit Fee $ d Fee Schedule on Reverse Side
Plan Check $ Ila 25$ of Building Permit Fee
State Surcharge $ A� $.50/$1,000 Valuation
SAC Charge $ $425 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
STIPULATIONS:
age. Associates Ina • 11230-13
>>lge,ne P . gags trom ,
F. C. JACKSON
• LAND SURVEYOR
REGISTERED UNDER LAWS OF ` TY O E Or NNE POLI
LICENSED dY ORDINANCE MINNESOTA
OF
PA. 4-4681
3616 EAST 55TH STREET
gpUrbcpoC•g gcttificatc
r
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qj
�Adl ;t; ,
7.
F1 R L
TRUE AND CORRECT PLAT OF A SURVEY OF -•� '
I HEREBY CERTIFY THAT THE ABOVE IS A Mortgage Survey
F_=
A 2nd Revision of Auditors Subd.ivisicn t:o• �-•
Lot 5 -Al . an easement oyer t :e
Anoka Countyvyk •Subject to 3
• 33 feet there Of for road
Poses-
• 1 ;Lh •, n.,R
,r b
•penseT uaaq svq fousdnopp 3o
panSS�
.� ,r"rT,iwn w TTnun patdn0oo 10 pasn aq qou TTV118 a=n�onXIS pTaS pus :
CITY OF FRIDLEY
Effective Date May 1. 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
'RESIDENTIAL IRATE
Furnace Shell and Duct Work,
Burner (Also replacement furnace) $ 20.00
Gas Piping $ 10.00
(piping needed with new furnace)
Gas Range $ 1n.00
Gas Dryer $ 10.00
• Air Conditioning (all sizes) $ 10.00
All Others/Repairs and Alterations
li of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
It of Value of Appliance or Work
TOTAL
Job Address
Department of Buildings, 6431 University Ave. N.E., Fridley, NN 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 applicati are true and correct..
Fridley, Minn. �°% , 19
OWNER �%/ ��/�/P- L /ls AI 2O.f
KIND OF BUILDING ljd"'A 1--A— Itn' e_�
USED ASI X)C f'i
$ TO BE COMPLETED ABOUT
J
ESTIMATED COST
State Surcharge $ .50
TOTAL FEE
Reinspection Fee ($15.00) S ��
Rough Insp.
Date Q
Final Insp.
Date
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00
)FLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission from adjoining neighbor.
/d
OLD - NEW BUILDING PERMIT NO. PERMIT NO. ` ® sydr
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name Size No.
Capacity
Total Connected Wad
BURNER - Trade Name
Capacity
Sq. Ft. EDR BTU HP
Kind of Fuel
Size No.
Sq. Ft. EDR BTU HP
Company �2e -efee ed
Signed By ZLAail
Tel. No.
Fill out back side for stack verification on replacement furnaces
CHIM14EY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
I.
Has
been carefully examined
Yes (,)
No ( )
2.
Is
free from rust or deterioration
Yes ( )
No ( )
3.
Has
no foreign objects lodged within
Yes ( )
No ( )
4.
IS
securely supported
Yes ( )
No ( )
5. Meets all current Code requirements for size and
total BTU connected Yes ( ) No ( )
6. Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
Company
Signed By
Date
i� i (.16j*b it -q - ILt ° ° 1 ' Minnesota Well and Boring
WELL OR BORING LOCATION . MINNESOTA DEPA MENT OF HEALTH Sealing No. H 5857
County Name WELL AND BORING SEALING RECORD Minnesota unique No.
Anoka Minnesota Statutes, Chapter 1031 or W -series No.
(Leave blank if rmt known)
Township Name Township No. Range No. Section No. Fraction (sm. - Ig.) Date Sealed Approximate Date Well
F
1. 3/9 4 orBoring Constructed
Numerical Street Address or Fire Number and City of Well or Boring Location
664-5 Lucis Lane. F r #, a l a r Depth Before Sealing 1 7 ft. Original Depth ft.
Show exact location of well or boring Sketch map of well or boring Static Water Level �M Accurate
in section grid with 'X'. location, showing property lines,
N roads, and buildings. ElApproximate
Single Aquifer ❑ Multiaquifer ft. 's below above land surface
-I- - - -I CASING TYPE
W C3,'s1C VA'.N I3. E3.4 1F'i";.•
T ;,± �) Steel El Plastic ❑Tile ❑Other
'
1
S
r mlfe -
Screen from " ' to ft. Open Hole from to it.
OBSTRUCTION/DEBRISMILL
❑ Obstruction ❑ Debris ❑ Fill
Type of debris/obstruction
Obstruction/DebrisfFill removed? ❑ Yes ❑ No
PPTOWf1EFB t _
Mailing Address itdifferent than property address indicated above.
FO II 0 N,531-iPs ER, FINANCE COMPANY
6;45 Ll-tc:is Lance
g' I. 2 d l r~— > M r4r-,_--13'21
PUMP
J! L I. uw: iti. tan -l'-
_ :, e
li! Removed ❑ Not Present ❑ Other
CASING
Diameter Depth Set in oversize hole? Annular space initially grouted?
5` 5 in. fromtl w to 1 " fL ❑ Yes _'C-1 No ❑ Yes ❑ No ❑ Unknown
in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
GEOLOGICAL MATERIAL
COLOR
HARDNESS OF
FORMATION
FROM
TO
It not known, indicate estimated formation log from nearby well or boring.
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE:
Q No Annular Space Exists
❑ Annular space grouted with tremie pipe
❑ Casing Perforation/Removal
in. from to ft. ❑ Perforated ❑ Removed
in. from to fL ❑ Perforated ❑ Removed
Type of perforator
❑ Other
GROUTING MATERIAL
Grouting material j from to ft. yards bags
E tett 6)6'15
from to ft. yards bags
from to ft. yards bags
from to ft. yards bags
REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING
L.'tc'ated withirl ba e. fflent
NG,l,<Si2."ed from tt`Yfx of c.e#fedtl�_` 6'
grade $, t; -e
; -21
PIL+ 1 A -0 0-L'"41 M,
UNSEALED WELLS AND BORINGS
Other unsealed well or boring on property? ❑ Yes QNo
LICENSED OR REGISTERED CONTRACTOR CERTIFICATION
This well or boring was sealed in accordance with Minnesota Rules, Chapter 4725. The information contained in this report is
true to the best of my knowledge.
Contractor Business Name �' a j n or Registration No.
`a� 4 t.t, x s_ :6 '>:: .�`� fes,
Authorized Representative Signature Date
LOCAL COPY
QQC� ((��
H
Name of Person Sealing Well or Boring
HE -01434-01
SuBJECT
PE
City of Fridley
AT THE TOP OF THE TWINS
BUILDING PERMIT
7697
/y
_ COMMUNITY DEVELOPMENT DIV.
rr PROTECTIVE INSPECTION SEC.
r
CITY HALL FRIDLEY 55432
612-571-3450
NUMBER
910-F15
REV
DATE
9/10/98
PAGE OF
APPROVED BY
JOB ADDRESS 6645 Lucia IMEM Lane NE
1 LEGAL
DESCR.
LOT NO.
5A
BLOCK
TRACT OR ADDITION
I Avd. Sub. #21, Rev. of
SEE ATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Kevin Kealy Same
571-4871
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Owner Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW [k ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 16' x 24' Garage Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Install a hard surface driveway.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING. HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
ZONING
SO. FT.
CU. FT.
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
OFFSTREET PARKING
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
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
VALUATION
$7,296.00
SURTAX
$3.64
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
PERMIT FEE
$137.25
SAC CHARGE
Fire SC $7.30
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
x
TOTAL E
$148.19
SI NATUR OF CON ACTOR O AUT IZED AGENT IDATEI
N4PPVYA
DAT I$ I$ Y ERMIT_�/Si
BLD IN
ATUREOFO NEAtiF WNERBUILDERI IDATEI
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
4
ConstructionAddress: (/ z , PS.- wC ! L rt/
Legal Description:
Owner Name & Address:
Contractor:
Address:
Effiel/1/98
Tel. # lv12171 tv8 7/
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft. c�
GARAGE AREA: Lengtl>/ Width 2 y r Height �l r Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type:
Avo-'n G4 v dye
Estimated Cost: $ 9("n
(Fee Schedule on B )
Driveway Curb Cut Width Needed: ---Ft. + 6 Ft = — Ft x $ _ $
DATE: APPLICANT:
e, Tel. # &Z-171-097
USE ONLY
Permit Fee
l nCITY
$ ,�-r Fee Schedule on Reverse Side
Fire Surcharge
$ 30
.001 of Permit Valuation (1/10th%)
State Surcharge
$ Lc
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
Driveway Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$ NCO) ,
. STIPULATIONS:
NEV'J [ ] CITY OF FRIDLEY Effective 4/1/2004
ADDII [ J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 5714287 Fax
BUILDING PERMIT APPLICATION
Construction Address: 6.&�5 Zc7r'/ 6 Z-11�
Legal Description:
Owner Name & Address:
Tel. # 76 -:9--!5-17 /_'/g 7 f
Contractor. ZWIN =) tIOiS/ABC SF*11!SS MN LICENSE # 2535
Address: 9060 ZACHARY LANE N #108 MAPLE GROVE, MLV 55369 Tel.# 763-425-4737
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 Width
Length Width
Height Sq. Ft
Hgt/Ground Sq. Ft
e -5C_-' --
Construction Type:Estimated Cost: $_
Driveway Curb Cut Width Needed: Ft + 6 Ft= Ft x $ _ $
DATE: % APPLICANT: >' Tel. #
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
$_-2'/, as --Fee Schedule on Reverse Side
Plan Review
$
65% of Permit Fee
Fire Surcharge
.001 of Permit Valuation (1/10th%)
State Surcharge
$ 17,3,5'
$.50/$1,000 Valuation
SAC Charge
$
$1350 per SAC Unit
License Surcharge
$5.00 (State Licensed Residential Contractors)
Curb Cut Escrow
$
Alt. "A" or Alt. "B" Above
Erosion Control
$
$450.00 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$
STIPULATIONS:
Building
BUILDING
Permit No.: -
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd:
YOUR E-MAIL ADDRESS
SITE ADDRESS CU
t' t t_ c / W's L N
THIS APPLICANT IS:
OWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: 'E /7-5 Wk+t'
TENANT
ADDRESS: (=G K N L K t I N LN CITY �t
STATE IP
PHONE:? (. 3-1' 71 F V a 71
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
STATE ZIP
WITH APPLICATION
PHONE FAX
PROPERTY TYPE
INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES YZ
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH P<0O17 ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:11
NEW 0 ADDITION
MAINTENANCE/REPAIR 0 REMODELING
DESCRIBE WORK BEING DONE: R�E R-0 ®1P a ,I- r.
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT Sq. Ft.
ROOFING❑ HOUSE ONLY
NUMBER OF SQUARES
MOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑DETACHED GARAGE
2.
3.
Proposed floor plan
List of structural members to be used
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING -TIRE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee $ See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Surcharge $ (.0005) times the total job valuation — Minimum $.50
Fire Surcharge $ .001 x Permit Valuation (1/10%)
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft + 6 ft = ft x $20 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due $ o Make checks payable to: City of Fridley Attach Stipulations
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL 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 which re uires review and approval of plans.
SIGNATURE OF APPLICANT _PRINT NAME eVI 9 DATE ,V10
ram