PRE 2010 DOCSVillage of Fridley, Minn.
N° 806 Office of INSPE B OF BUII INGS
Owner.
Architect Fridley, Minn., —' 1 el ` " 18 °-
Builder
l LOCATION OF YUILDING
No. Street Part of Lot
Lot Block Addition or Sub -Division
DESCRIPTION OF BUILDING
Front Depth Height Stories Manner of Construction
To bg used as To be completed Estimated Cost
Permit is hereby granted
M
thw! F_ ' �'°�" ° 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 in, around and upon said building, or any part thereof, shall conform in all respects to the ordi-
nances of Fridley, Minn., regarding the 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.
AGREEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit, I hereby agree to do the proposed work in accordance with the description
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby state and say that the facts stated by me and contained in the above permit are
true as therein stated. ,
Subsc 'bed and sworn to before me at Fridley, Minnesota, this er
day of d �c �. ,� .� , A.D. 19
City of Fridley, Minn.
BUILDING PERMIT N® 4387
/
Date: - - -1�-
�._q 1..
. .............................
Owner: ... ....... ..._.................... Builder .........................•----.......-------
Address............. .............. ... -........... - .... - -- -_-._. ... _... _..... .................. Address .............. ....................... -.._......... ....................... _....... .......
LOCA 1 N OF BUILDING
No.....I...... oL_ Streeter.- .. -I........ ............. Part of Lot..........�.Ol......................... _...........
_._
Lot.. ......... .......................... Block ............. .................................... ... Addition or Sub -Division ....................................
Corner Lot ................................ Inside Lot ...................................... Setback ................................... -........ Sideyard
Sewer Elevation ................................................... ............. ....................... _.............. Foundation Elevation ..................
DESCRIPTION OF BUILDING
To be Used as:
H
c `r �/ f / � 4
....................
...._..G Front .:_. Depth ��..7......:. Height ../.... ... Sq. Ft. .Pl- Cu. Fi.
...................................................... Front ....................... .. Depth ............._... _.> Height
/..._............_ .... Sq. Ft......_................. Cu. Ft.
Type of Construction ................................ ........ ..... .._. _. Est. Co l 5 ® /. -. .... To be Completed ..... _............. ......
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 fo h and in compliance with all provisions of
ordinances of the city of Fridley.
�.
In consideration of the payment of a fee of $ ....................... permit is hereby granted to ...... ............................ _............. ........ ...
_.._...._....._..-...... ...-................................. 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 an the provisions of said
ordinances.
Building. Inspector
NOTICE:
r
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these hems. Y°
l
Address' U`6 4 GyW--" -- Address Al
LOCATION OF BUILDING
No. Street E � r .f-�� � ' Part of Lot ;tz
Lot Blocky" `'f Addition or Sub.Div.
Corner Lot Inside,Lot Set Back ,� Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To b used as:
_ � C., -Front Depth e7l height
__.L_
Sq. Ft. Cu. Ft.
Front. Depth: Height
Sq. Ft. Cu. Ft.
Type of Construction".
Typ � �%J``�- �Estimated� Cost
To be completedA,
The undersigned hereby maks application for a -permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true and correct.
DATE % Z /� / / SIGNATURE
(A Schedule of Fee costs can be found on the Reverse Side.)
-
Building Job Report No 2570
ADDRESS ) 6
OWNER // , C Y '
BUILDER
DATE / _ ? / krTYPE
PERMIT NO.
INSPECTION RECORD
DATE • REPORT--------------
"
COMPLETED & APPROVED IN p Cq5 E OR
� C -
DATE
42
- ` CITY OF FRIDLEY Cover Sheets_
INSPECTION. DEPT REPORT Sheets Attached
A S RLDG.
SITE ADDRESS ''%�Q,Z (� AA A I or S 7kZF_
WHAT INSPECTED t,v7,,eF '/3 L DG..
PRINCIPAL USES -DWELL /t kC�
USE ZONE R -Z ���ZDAIED)
LEGAL DESCRIPTION /- 0 Son/' ADD,
OWNER AAe f -Qs %-saws address 46Z— OC. 4j,.j 2_ phone
AGENT address phone
OCCUPANTS
LIENHOLDERS
address phone
address
address
phone
_ _phone
CONSTRUCTION OF BUILDING rRAME e no, of stories / %.
PERMITS ISSUED ON BUILDING
DIMENSIONS OF BUILDING
SETBACKS - front//, p,. rear IV R
building inspection -date
sides All /9.
inspector d, a, 6! s0(3
plumbing inspection -date %� %��C�� inspectoryv /
electrical inspection -date
fire inspection -date
health inspection -date
photos taken -date 7&/ C&8
inspector
inspector
inspector
RECOMMENDATIONS OF THE INSPECTION DEPARTMENT rR b i..k 7? F TT4C-, �p
COSI oP XE:7314IL,D sk6 AE:.AC Enos -.�1v PP*. Es&r1AAA?,:3:v
VALUZ, ®l= Si
Cover Sheet A
DANGEROUS BUILDING REPORT
Address: 4020 Main Street Lot: 4 B1.: 1
Fee Owner: Mr. Robexj; Wilson Contract For Deed:
4020 Main Street N.E..
,
Fridley, Minnesota
Action Summary:
Addn.: Wilson Addition
File Started On:
December 132 1967: At 10:38 A.M. a fire occured that caused structure to be listed as
a hazardous building.
December 18, 1967: Mr. Wilson was granted a trailer permit for a period of one year.
December 264% 1967: Letter to owner from Building Official stating trailer permit
was approved.
December 26, 1967: Electrical Inspector's report on fire damage to wiring.
June 19, 1968: Building Standards -Design Control Subcommittee asked that the house
be inspected and possibly condemned.
June 21, 1968: Letter to owner from Building Official stating a "Dangerous Building"
notice was posted and is to remain until the building is repaired or
demolished.
July 12, 1968: Building Inspector's report on fire damage to structure.
July 15, 1968: Plumbing Inspector's report on fire damage to plumbing.
July 15, 1968: Electrical Inspector's report on fire damage to wiring.
July 24, 1968: Building Standards -Design Control Subcommittee asked what action was
being taken and was informed it was in the hands of the City Attorney.
July 30, 1968: Memo from City Attorney to Building Inspection Department asking for
appraisal of damage.
Appraisal report was; Before fire: $9,240 market value.
After fire: $3,420 market value.
Sept. 1968: Owner applied for variance in lot size for the purpose of obtaining a
lot split to build 2 single family dwellings.
Sept. 9, 1968: Variance approved by Board of Appeals.
Sept. 16, 1968: Council approved variance.
October 21, 1968: Lot split approved by Council. Only 1 house to be built until
property is rezoned to R-1.
January 23, 1969: Memo to City Manager from Health Inspector which in part stated -
"The house has been burned out and there appears to have been
nothing done as yet to repair it."
,r-
4020 Main Street N.E.
Robert Wilson
Page 2
January 27, 1969: Memo to Building Inspection Department from City Manager•asking
for a report on address.
February 3, 1969: Letter to owner from Building Official stating trailer permit
had expired and to remove within 15 days.
March 26, 1969: Memo•to Building Inspection Department from City Engineer asking
for a report on address.
April 10,1969: Memo answered stating Clerk of Court mailed Violation Tag to owner.
If nothing done, further action will be taken.
Sept. 16, 1969: Building permit issued for a double bungalow. Dangerous Building
removed.
Inspection Job Reports:
B#2619 -
12-13-67
E#2686
- 12-21-67
B#2681
- 12-27-67
E#2571
- 1-3•-68
P#2570
- 1-3-68
B#4237
- 6-21-68
B#4271
- 6/25/68
B#5670
- 11/25/68
B#6558
- 4/3/69
B#6565
- 4/7/69
B#9692
- 3/5/70
i
Final Disposition:
Sept. 30, 1969: Hazardous structure
removed.
r
CITY OF FRIDLEY — INSPECTION DEPARTMENT
BUILDING REPORT
DATE INSPECTOR
OWNERS NAME
ADDRESS
INTERIOR PRESENT CONDITIONS CHANGES NECESSARY
BASEMENT
FOUNDATION
WALLS
FLOORS
CEILINGS
j
FIRST FLOOR
WALLS
To
Q c' S
CEILINGS
R/_ P
FLOORS
o r 5 Sat'
ADDITIONAL FLOORS
/ 41 1,A4 o 5 fis ✓ ��
WALLS
FLOORSre
CEILINGS
�S
2f;�C`��
CHIMNEY
DOORS c0
u� G' �/ C/
?IISC o
N CITY OF FRIDLEY - INSPECTION DEPARTMENT
DATE INSPECTOR
OWNER
ADDRESS
EXTERIOR PRESENT CONDITION CHANGES NECESSARY
EXTERIOR WALLS
SILLS
14
DOORS
-A
WINDOWS
ROOF
Ur�yr 2 G
d U e e.1 S
X 3
,A r r
CHIMNEY
a p
�e c
SOFFITS
ACCESSORY
BUILDINGS
8
C, .5 d F7 C-oht JSu—
GENERAL SITE
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C.L
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IC -P ��
MISC.
CITY OF FRIDLEY - INSPECTION DEPARTMENT
ELECTRICAL REPORT • /
DATE t w �G 11- Z INSPECTOR �/ / !2 �'r
OWNERS NAME
ADDRESS D
PRESENT CONUTIONS rVAMRG XF.PRGGARV
SERVICE
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7-kJV
,
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d l/1 t' -t v/,. 7 / `;
I
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BASEMENT
LAUNDRY
FURNACE
ATTIC
a / r_
G jJ /
r�v
of
GARAGE
'pte
L
KITCHEN
BATHS
DINING ROOM
LIVING ROOM
wl, An 7e
Ye
BEDROOMS
STAIRWAYS
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) -e /n/a
7S�vn�rl�
Th �, ; a ,, �✓
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5 l���tss�dI
4-
INSPECTION REPORT
4020 MAIN ST. N. E.
Building Report- Clarence Belisle Inspector
Exterior:
Walls- Stucco was extensively cracked due to the heat and the burned
structural members.
Sills- Burned in some areas.
Doors- Charred and damaged beyond repair.
Windows- All broken
Roof- Burned off in approximately 2/3 of the house.
Soffits- Burned and charred in 2/3 of the area.
Interior:
First floor walls- Wall covering burned off .in 2/3 of the house, balance
was charred, z of studs burned to a dangerous condition.
First floor ceilings- 2/3 burned off.
Second floor walls- Extensively burned and charred.
Second floor ceilings- Burned off in z of the area.
Floors- Burned through in 2/3 of -the area
Doors- Charred and damaged beyond repair.
Electrical Report- Leonard Eichmiller Inspector
Because of the extensive damage due to the fire the entire building
would have to be rewired in compliance with our present codes.
Plumbing Report- William Sandin Inspector
Air tests would have to be made to determine what damage was'done to the
plumbing. The fixtures must be replaced because of the extensive heat
from the fire and the freezing after the fire.
Heating Report- William Sandin Inspector
The heat plant must be replaced because of the damage due to the fire.
INSPECTION REPORT
4020 MAIN ST. N. E.
Building Report- Clarence Belisle Inspector
Exterior:
Walls- Stucco was extensively cracked due to the heat and the burned
structural members.
Sills- Burned in some areas.
Doors- Charred and damaged beyond repair.
Windows- All broken
Roof- Burned off in approximately 2/3 of the house.
Soffits- Burned and charred in 2/3 of the area.
Interior:
First floor walls- Wall covering burned off in 2/3 of the house, balance
was charred, z of studs burned to a dangerous condition.
First floor ceilings- 2/3 burned off.
Second floor walls- Extensively burned and charred.
Second floor ceilings- Burned off in 2 of the area.
Floors- Burned through in 2/3 of -the area
Doors- Charred and damaged beyond repair.
Electrical Report- Leonard Eichmiller Inspector
Because of the extensive damage due to the fire the entire building
would have to be rewired in compliance with our present codes.
Plumbing Report- William Sandin Inspector
Air tests would have to be made to determine what damage was'done to the
plumbin-gg0. The fixtures must be replaced because of the extensive heat
from the fire and the freezing after the fire.
Heating Report- William Sandin Inspector
The heat plant must be replaced because of the damage due to the fire.
REGULAR. MEETING, DECEMBER 18, 1967 �, �j PAGE 9
1
after the storm sewer work, was put toward the new permanent street. He
said this had been pointed out to the people and was one of the reasons
for the lower estimate. He said that another reason had been that there are
more side lots on Rainbow Drive, and the City likes to be conservative on
the estimates. Councilman Liebl said that if this had been pointed out to
the people on Trinity Drive, they would have had a better understanding
instead of comparing prices and being upset. He said that the people will
be willing to go ahead if the cost is a dollar less than the estimate after
everything is added, but will be against the improvement if it is over $9.00.
The City Engineer said that using the existing base could be considered, to
bring the cost down.
Councilman Harris pointed out that there are funds budgeted for sidewalk
that will be available if there is any other street that would qualify.
The City Engineer pointed out that 75th Avenue from Lakeside Road to Stinson
Boulevard had been proposed by Dahlberg Builders, and one gentleman had been
concerned about the 130 feet of storm sewer being put in. The Council
remembered that the gentlemen's assessments had been quite high. The City
Engineer said that this man owned a large lot, and suggested the street be
left in, and after the bids are received, they can see if anyone is in
opposition.
The City Engineer said that this is a large project and the Council is still
considering who should be given some of the work. He said that when the
decision is made, the engineering consultant can be fazed in.
MOTION by Councilman Sheridan to adopt Resolution #207-1967 deleting Gardena
Avenue from Central Avenue to Stinson Boulevard and deleting 3rd Street from
39th Avenue to 53rd Avenue from Street Improvement Project ST. 1968-2 (MSAS)..
Seconded by Councilman Samuelson. Upon a voice vote, there being no nays,
Mayor Kirkham declared the motion carried.
REQUEST FOR TRAILER PERMIT - 4020 MAIN STREET NORTHEAST:
Mayor Kirkham explained that this homeowner had had a fire and his home had
been burned out. It was also pointed out that this permit was requested for
a period of one year.
MOTION by Councilman Harris to grant a trailer permit to Mr. Robert Wilson,
4020 Main Street Northeast, subject to approval by the Building, Plumbing and
Electrical Inspectors, and waive the fee. Seconded by Councilman Samuelson.
Upon a voice vote, there being no nays, Mayor Kirkham declared the motion
carried.
CLAIMS:
MOTION by Councilman Harris to approve for payment General and Public Utilities
Claims #13575 through #13716, and Liquor Claims #1731 through #1792. Seconded
by Councilman Samuelson. Upon a voice vote, there being no nays, Mayor
Kirkham declared the motion carried.
t# __' -'. 77��
_
LCATIONF� r T TO QPARI (999= HOPI: TRAIM _ ..
It is hereby requested that (1) (We) be issued a house trailer permit in
compliance with Chapter 41, City Code of Fridley, Minnesota, 1963 by reason
of the followings.
a. Name and
e of applicant
d , nCA___ 6
A
b. Ownership of trailers. Lz"--ale✓
c. Description of tr9PA'
er - Make and Size:� 5�f` � Tc.�>-
19sx _ y?A //a Ar .
d. Name and address of owner of
located.. IVA !�A ''h' aA,-n.
ler is proposed to be
-� e. Period of tine trailer to be stored or occupieds.
67 10-A -A—
f. Use of trailer:
S. Signatur of adjoini, pr®pert;
ryy�
o a �.
h. Location of trailer on
propertys. �± Q3C
.
i. .Where trailer is to be occupied, (1) What is realtione�hip, if ,
between trailer owner and'land owner? 0 t. ,
(2) Names and age& of all occupants? Ocad—OM441212 L'2
Gv �p
(3) Facili ies for sewage disposal,, water and electricity?
(4) Employment of applicant?
v
(5) Whether applicant is constructing hors in area?
—#W --
The application, when presented to the City Council, shall show the recocen-
dation of the Zoning Administrator and/or Building Inspector.
Please find attached check in the amount of ($5.00 for parking) ($25.00 for
occupying) a house trailer.
Applicant --`
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CITY OF FRIDLEY - INSPECTION DEPARTMENT
BUILDING REPORT
DATE INSPECTOR
OWNERS NAME
ADDRESS 4 oFoci iJLF-y_ XJt Ot t
INTERIOR
BASEMENT
FOUNDATION
WALLS
FLOORS
CEILINGS
FIRST FLOOR
WALLS
CEILINGS
FLOORS
ADDITIONAL FLOORS
WALLS
FLOORS
CEILINGS
CHIMNEY
DOORS
PRESENT CONDITIONS
-'jlT3;5LP W,4LL. z✓ &JV.'>Z2
rZ�olI>Itd J'® }mss >AA Ott!
-poo 2 ! J AID "z.
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cop'tto •Jo) S"o'st All,
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7--V FL. WAIL 5 icIAAS G✓'
791a �ac�. /ti �jf.� i✓:,ii2s0�2 i.cr�Lp
CHANGES NECESSARY
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�,peia-S`" illf�L 'A2r�i1/`cO
/A/S?s4Lrl. yt/�EtJ�o/S i Tv fib'
AP^coi*J - r/MiAJ
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CITY OF FRIDLEY - INSPECTION DEPARTMENT
z
DATE INSPECTOR
ADDRESS 40 -2-0 M A J*.1 S J1 --,r2 / /J L E y x.& 11�4 &� i
EXTERIOR PRESENT CONDITION CHANGES NECESSARY
bai
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rOgd
GA IW I" fi /�VO-44— i��C! /A1
� -P• Gt S T[/ 5 �/d raY d► �a
EXTERIOR WALLSe
Ss!o�41P-.vi STfsIJ
sNfir,,,/.�t icl T '� : ,cry�s : •�
ccm a12 Y{80.. Si.O,
-p®c9Q€p>L�a
�,r� sit•. s Ars A/an�.�.
SILLS
DOORS
Ai Ll. QwJ ! n d e70 4!s
WINDOWS
Do F A; iC IDA^
�� P%sa 1 P� /� Ci C, rr �► ht 49 q j Zcx/ 5 �/A
ROOF
`/ ea �� D?g: nl.
7'1--O;e u ®t✓
/
NS.—J A -t0 -0a11-' 7-1
CHIMNEY
�l o � '%�;7 c.� at i v �be�'.ed.p]r!>� �' it/
�A• 5 � �.&N T w a e ti =o ci as►>• c,cr ��
SOFFITS�'`��
}Vp 5i Di.�Ci a ^4 6400 -A"Sk DC
ACCESSORY
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'y'��""•,,''� 7-,7-*
BUILDINGS
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GENERAL SITE
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CITY OF FRIDLEY - INSPECTION DEPARNENT
PLUMBING REPORT-
DATEINSPECTOR`;_���_
OTTERS NAME
ADDRESS
PRESENT CONDITION CHANGES NECESSARY
SEWER
WATER
WATER PIPING
GAS PIPING
1
WASTE AND VENTS
FLOOR DRAINS
LAUNDRY
WATER HEATER
WATER CLOSETS
SINKS
LAVATORIES
BATH TUB
HEATING FACILITIES
U
KISC.
OWNERS NAME
ADDRESS
CITY OF FRIDLEY - INSPECTION DEPARTMENT
ELECTRICAL REPORT
DATE Ir - (Q _INSPECTOR
PRESENT CONDITIONS CHANGES NECESSARY
SERVICE
BASEMENT
P
LAUNDRY
FURNACE
ATTIC
GARAGE
KITCEEN
~`
BATHS
DINING ROOM
iq oi
LIVING ROOM
BEDROOMS
STAIRWAYS
MISC.
r
M E M O R A N D U M
July 30, 1968
MEMO TO: Building Inspection Department
MEMO FROM: Mr. James D. Gibbs
SUBJECT: 4020 Main Street
As per our conversation, I am waiting for an appraisal of the
property to determine whether or not it is more than 50% destroyed.
Please advise me when you have this appraisal.
44
_3 X12 �
e
N
BUILDING STANDARDS - DESIGN CONTROL MEETING JULY 24, 1968 PAGE 4
-work is not complete at this time, this matter will be referred to the City
Attorney to obtain compliance.
10. HOUSE ON 4020 MAIN STREET, FRIDLEY; WHICH WAS GUTTED BY FIRE.
Committee inquired what action was taken by the building inspector as to the
rebuilding or removal of this house. The Committee was informed that this
matter is now in the hands of the City Attorney.
13 L6111'.11 ki IV 101 ki
The Meeting adjourned at 11:30 P.M.
Respectfully submitted,
John Breher, Building Official
be
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71 ,
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MUNW94LEM
I
City of Fridley, Minn.
BUILDING PERMIT
Date: September 16, 1969
Owner: Forrest Cornelies
Address 201. -40th Avenue N.E.
Builder
Same
Address , Same
4020-4022 .LOCATION OF BUILDING
No. —Street Main Street N . E . --_____. part of Lot
Lot — 4_ --Block 1 -Addition or Sub.Division Wilson Addition
Corner Lot _ Inside Lot ____ X Setback -- Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
4 ffO
N° 10413
To be Used as:
2 f ami ly dwelling Front -10' Depth _3_- 6Height 241 Sq. Ft. 2450 1 Cu. Ft. 58,98 0 f
Front Depth Leight Sq. Ft. Cu. Ft.
Type of Construction Frame Fst. Cost ` $25, 000 To be Completed Aug, 1970
Water and Sewer connected to Columbia Heights lines per letter from
Mr. George F. Brown, City Engineer, Columbia Heights, Minnesota.
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 compli ce with a& provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 85-00 ..permit is hereby granted to Mrs • Cornelia s
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 reg int 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 Oe provisions of said
ordinances.
ARENCE BEL E ,
NOTICE:
Tide permit does not cover the consfruefton, huMMen for wines, phnnbing, gas heaftng, sewer or wafer. Bo aro to see
the Building hapemr for coparafe pennhe for than Items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME S �` /* C9 BIIILDER f P �A e �' S
ADDRESS d /— •c�� ' Aweya ADDRESS lea � of
LOCATION OF BUILDING
NO. STREET
LOT BLOCK / ADDITION OR SUBDIVISION,`
CORNER LOT INSIDE LOT__,V_SETBACK ' osSIDEYARD��
SEWER ELEVATION TOP OF FOOTING
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:
2. —`rU d v Front ,�� —0 Depth 3 ! � G Ir Height
Square feet t� Cubic Feet
Front Depth Height
Square feet Cubic Feet
Type of Construction - ^`, Estimated Cost ® el d
To Be Completed J00y 2.6
The undersigned hereby makes application for a permit for the work
herein specified, agreeing to do all work in strict 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 � t �„ f Irl
SIGNATURE _
e of Fee Costs can be found on the Reverse Side.)
•3cf-v /-� e I (/ (� ')
HARVEY A, CARs-WRIGHT
ANOKA CCUN-C---SUF(VLvS
HENNEPIN CIJUNTY SURVEYS
MINNEAPOLIS SURVEYS
8410 PALM STREET N W.
SUN4,F7 4-7655
OWNER
INDUSTRIAL - JUDICIAL
BUSINESS -
TOPOGRAPHICAL
CITY LOTS
- PLATTING
FLObort
'Allson
LAND SURVEYORS
REGISTERED UNDER LAWS OF STATE OF MINNESOTA
LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS
326 PLYMOUTH BUILDING FEDFRAL B-8721
HENNEPIN AT SIXTH - MINNEAPOLIS 3. MINNESOTA
I 6urbrpor'z terfificatt
Z74
Irv -
N,
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1 har.-by c:. .,_..y tll<�t, this is -- t:%,-)
COMWN;NGT+iE 'RECORLIS rF
J. E. HILL,
CIV.f. ENGINEER
CFTAVLIS�CD 1606
C. F. SANDHLIFF
CIVIL ENdiNzc-t
ESTABLISHED 1108
JAMES NELSON
SURVEYOR
ESTABLISHED 1922
METROPOLITAN LAND
SURVEYORS, ESTABLISHED 1011
�;7
The '103 fect c-7 7..c.',- 2, �U:'.litollls 39., 'ou—,ty,
LL-a,n co t �. , .::ccnt tle �.".or th 93 fect , -'i or„ n r.;:.' r i nr,, of th,,3 at,
tl'p.roo�' -subject- to --n for purl ---)::,--.lc aver ":--c ns` 33 fe—L
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T.
LAND SURVEYORS
REGISTERED UNDER LAWS OF STATE OF MINNESOTA
LICENSED BY ORDINANCE OF CITY OF MINNEAPOLIS
326 PLYMOUTH BUILDING FEDFRAL B-8721
HENNEPIN AT SIXTH - MINNEAPOLIS 3. MINNESOTA
I 6urbrpor'z terfificatt
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N,
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COMWN;NGT+iE 'RECORLIS rF
J. E. HILL,
CIV.f. ENGINEER
CFTAVLIS�CD 1606
C. F. SANDHLIFF
CIVIL ENdiNzc-t
ESTABLISHED 1108
JAMES NELSON
SURVEYOR
ESTABLISHED 1922
METROPOLITAN LAND
SURVEYORS, ESTABLISHED 1011
�;7
The '103 fect c-7 7..c.',- 2, �U:'.litollls 39., 'ou—,ty,
LL-a,n co t �. , .::ccnt tle �.".or th 93 fect , -'i or„ n r.;:.' r i nr,, of th,,3 at,
tl'p.roo�' -subject- to --n for purl ---)::,--.lc aver ":--c ns` 33 fe—L
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City of Fridley
Fridley, Minnesota
Gentlemen:
CITY OF COLUMBIA HEIGHTS
ADMINISTRATIVE OFFICES
• COLUMBIA HEIGHTS, MINNESOTA 55421
Sept. 16, 1969
We understand that Mr. Forrest Cornelius has applied for a building
permit to erect a home at 4020 JWn Street H.E., the site where an
older home owned by Mr. Robert Wilson existed, and has been destroyed
by fire. The former house was connected to Columbia Heights water in
Main Street# and that water line is available for the flew construction.
Mr.Cornelius has made application for a connection to the sanitar7
sever in Main Street, and has paid the proper fee for the private main*
The application will be formally presented to our City Council at its
next meeting on September 22nd.
/n
i
Yours truly,
rgBrosa�
City eeglineer
V
Original
PERMIT for Power Plants and Heating, Cool-
ing. Ventilation, Refrigeration and Air
Conditioning Systems and Devices
DESCRIPTION OF WORK
No. of Heating Plants to be nstalled tered—repaired
Make
Oil fired ; Coal fired ; Gas fired—Z-; Gas Authorization No.
RemarksQi
Approved
Final Inspection
19-
Inspector
65-3 T s'I
Permit N° 4830
Fee $ A9,00
Office of the Inspector of Buildings
City of Fridley
City of Fridley, Minn.,
Owner
6� ��9✓�in 0�1s��
Location
Kind of Building -� Q -✓
How Occupied
Work to be Commenced ,19_
To be CompletedLit_j�Ch� ,1996
Estimated Cost, $ 1400.O6
Old(S)Building Permit No
Permission is hereby granted to to install—erect—use the material and devices described in the
above statement. This permit is granted upon tRe express condition that the p son 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 specifications et forth in the approved application for this
permit on file in the office of the Inspector of Buildings. f JJ
. n
Inspector of Buildings
42 2M11.57V
City of Fridl®y
ApplicuMm for Plate and Gat Pemb
Dept. of BUkPL Phone MD -3490
DESCRIPTION OF WORK �= C
Number, Kind and Location of Fixtures C-
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures............. x $2.00
.. C" Ci
Future Fixture Opening ........... = x $1.50
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater :Up to 99.000 BTU) .... -�2 x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Eloatrtc Water heater .............. x $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
1st3Fixtures .....•••.•••••,
x $200 $ c*
Additional Fixtures .................. x $ .76 $
Gas Range to 199,000 BTU ............. x $5.00 $
REPAIRS B ALTERATIONS—Refer to Code
Description ............................................
TOTAL FEE ��
City of Fridley:
The .undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the Cit, Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct
Fridley, C%'Z
Owner
Kind of Building
Used as Llc-�
6/1/
o -
To be completed about / 71
Estimated Cost, $
Old 7ew.,Building Permit No. Permit No.
Signed
By --- -
Business Phone No
ROUGH
FINAL
�yyGJjH.A
I
NELEC.
NTR.
_FA
Base
,)
1st
'
`/
„Z
2nd
.-;4
e
_
3rd
4th
• Future Connection Openings
# New Fixture. Old Openings
Coaneded with
Sewer ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures............. x $2.00
.. C" Ci
Future Fixture Opening ........... = x $1.50
New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater :Up to 99.000 BTU) .... -�2 x $3.00 $
New Ground Run Old Bldg......... x $3.25 $
Eloatrtc Water heater .............. x $2.00 $
GAS FITTING FEES: NO. RATE TOTAL
1st3Fixtures .....•••.•••••,
x $200 $ c*
Additional Fixtures .................. x $ .76 $
Gas Range to 199,000 BTU ............. x $5.00 $
REPAIRS B ALTERATIONS—Refer to Code
Description ............................................
TOTAL FEE ��
City of Fridley:
The .undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the Cit, Ordinance
and ruling of the Department of Buildings, and hereby declares that all the fact
and representations stated in this application are true and correct
Fridley, C%'Z
Owner
Kind of Building
Used as Llc-�
6/1/
o -
To be completed about / 71
Estimated Cost, $
Old 7ew.,Building Permit No. Permit No.
Signed
By --- -
Business Phone No
ROUGH
FINAL
sua�Ecr
PER
City of Fridley
®1326__0
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
RECEIP
COMMUNITY DEVELOPMENT DIV.
U.
PROTECTIVE INSPECTION
`����
r 1 SEC.
1 �
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
1 = 0-1 CITY HALL FRIDLEY 55432
,'� 612-560-3450
910-F15
10-14-75
JOB ADDRESS
4020 Main Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
4
1
1 Wilson's Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Forrest Cornelius 4020 Main Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
SAME
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEERMAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
7 CLASS OF WORK
❑X NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
9 CHANGE OF USE FROM TO
STIPULATIONS
XK 5' off rea@( yard and 6' off South side of lot
FOR WIRING,
PERMITS REQUIRED
SEPERATE
AND SIGNS.
.MEATING, PLUMBING
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
wood frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT.
CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
320
3,200
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
VALUATION
SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
$20,368.00
1.18
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 CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
6.00
STRUCTIO OR THE PERFOR NCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
' d' 0-7s
$7.18
SIGNATURE OF CONT OR OR AUTHORIZED AGENT (DATE)
HEN P PJALIATED
THIS I U
;PrEIT
SIGNATURE OF OWNER I IF OWNER BUILDERI (DATE)
BLDG INSP 17ATE
APPLICATION FOR RESI'DE'NTIAL., ALTL'RATION,
OR ADDITION -BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME : /� ILDER :
.ADDRESS:
ADDRESS:
NO:. PLCO STREET. M 41 A.)
i.OT : BLOCK: ADDITION: AQ ji@rjdA)—
CORNER LOT: INSIDE LOT: _SETBACK: sIDEYARD: SOrr QCr�n-
• - (.� OFF &, Sat
Applicant attach to this form Two Certificates. -If Survey. .of Lot and.proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
Front • Depth • �G� Height
- J
• Square Feet :1 ,1 Cubic . Feet : 32007
• Front:' Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: ® Estimated Cost: $20%00"tj. 1* 0j -
TO - Be Completed:
The undersigned hereby makes application fora permit for the work herein
specif ied, agreeing- to do all work in strict 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: SIGNATURE:
(See Pleverse ide For Additional Information.)'
CITY OF FRIDLEY INSPECTION DIVISION
•
f Effective On January 1, 1999
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS lib. -2-o 22L4-1-
2L4-tiRATE
RATESCHEDULE
The undersigned hereby makes application for a permit for the work herein
Residential Rate
TOTAL
specified agreeing to do all work in strict accordance with the City Codes and
Furnace Shell and Duct Work, Bumer —
rulings of the Building Division, and hereby declares that all the facts and
Alto Replacement Fumace $ 30.00
$representations
stated in this application are true and correct. I
� /I J /99v
(Side Vent — Fill Out Back)
-
Gas Piping (Needed with new fumace, $10.00
$
a�'U_ . &)
but not replacement)
OWNER
Gas Range $10.00
$
BUILDING USED AS,
Gas Dryer $10.00
$
j
ESTIMATED COST ®G) 0, Ob PERMIT NO. l S�
*Air Conditioning —All Sizes $ 25.00
DESCRIPTION OF FURNACE AND OR BURNER
All Others/Repairs & Afterations (LIST ON BACK)
1 % of Value of Appliance or Work
$
No. of Heating Units Circle One (Steam) (Hot Water arm
Trade Name Size No.
Commercial/Industrial
BTU HP EDI3
1.25% of Value of Appliance or Work
$
Fuel Total Connected Load
State Surcharge
$ .50
Bumer Trade Name Size No.
BTU HP EDR
TOTAL FEE
HEATING COMPANY
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STAT .'SURCHARGE
REINSPECTION FEE $42.00/1 -Ir
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Rough—In Date �— Final
US
CEMMY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (A No ( j
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 Jor size
and total BTU's connected Yes (y4 No ( )
6 Has total heating BTU's of �� , 1006
All other BTU's
TOTAL BTU's VV 0
7. Has a liner been provided for water heater Yes ( ) No (ydj
8. Has combustion air been provided for water heater Yes ( ) No
K, -r" 7 T1/Q
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
4
CEMMY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (A No ( j
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 Jor size
and total BTU's connected Yes (y4 No ( )
6 Has total heating BTU's of �� , 1006
All other BTU's
TOTAL BTU's VV 0
7. Has a liner been provided for water heater Yes ( ) No (ydj
8. Has combustion air been provided for water heater Yes ( ) No
K, -r" 7 T1/Q
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
C,f1YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
March 23, 2001
Occupant
4020 Main Street NE
Fridley, MN 55421
Re: Final Inspection at 4020 Main Street NE
Contractor: Anderson Heating
Dear Sir or Madam:
A mechanical permit was issued on July 29, 1999 for the installation of a furnace and air
conditioner at your address. According to Section 305(a) of the 1991 Uniform
Mechanical Code, a final inspection shall be performed on the mechanical permit. As of
this date no inspection has been called for.
The permit fee that was paid covers the inspector's time to check to make sure the
appliances were installed correctly. We also need to check for the installation of
combustion air, vent and connector sizing.
If you would like the installation inspected, please contact us within 30 days to arrange
the inspection. If we do not hear from you we will expire the permit and note that no
inspection were called for.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
DAVyflENSEN
Bui g Inspector
DJ/mh
SUBJECT
City of Fridley
31878
AT THE TOP OF THE TWINS
BUILDING PERMIT
f
� • _ COMMUNITY DEVELOPMENT DIV.
(�,
572-U0 ®
RECEIPT NO.
r PROTECTIVE INSPECTION SEC.
/6-1
1 �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/5/01
JOB ADDRESS 4020-4022 Main Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
4
1
Wilson Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Evelyn Cornelius 4020 Main Street NE
763-788-6770
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Fridley Roofing & Remodeling 830 West Main St, Anoka, MN 55303
763-780-6210
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO.
20269030
5 ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
6 USE OF BUILDING
Residential Duplex
7 CLASS OF WORK
O NEW O ADDITION 0 ALTERATION Q REPAIR
0 MOVE 0 REMOVE
B DESCRIBE WORK
Reroof Duplex (25 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. '
NO DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION
2 ISTALLS
GARAGES
AND KNOW TME 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
$2,557
$1.28
DOES NOT PRESU E TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS NY,90 R STATE OR LOCAL LAW REGULATING CON-
ON•TRUCTI
TRU 1b ORMANCE OF CONSTRUCTION
$83.25
Fire SC. $2.56
PLAN CHECK FEE
Licens S $5.0
TFEE
OT 92.09
a NA URE OF CONSRAC OR AUTNO 'ZED AGENT iDATE�
N IrOPEjLy'VALIDATFP-THISIS
OUR PERMIT
QLD NSP _
��
fff��� r'ATE
S,GNATURE OF OVVNE 1F OSN11A BU4DER1 iDATEi
NEW [ ] Effective 1/1/2001
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: �U&10 Ll
Legal Description:
Owner Name & Address: C11YAJ C,5,CI LIS
Tel. # 9a WS -4720
Contractor: F-jQ
1- )r
i200*01-
9-407400,
Z/r`e—
MN LICENSE#R�-��
Address:_
A O0oK opt
Tel. � �YQ -6D 10
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: /Lk7je6A — !
Construction Type: Estimated Cost: $�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x
DATE: f APPLICANT: -vJ t Tel.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ Fee Schedule on Reverse Side
$ .001 of Permit Valuation (1/10th%)
$ $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ $5.0.0 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$
11)sC6-L.01i
Building MECHANICAL Permit Nojkr'-77
Inspections RESIDENTIAL APPLICATION Received
763-572-3604 CITY OF FRIDLEY Date Rec'
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS L -i Y V E
THIS APPLICANT IS: 0 OWNER CONTRACTOR
PROPERTY
NAME: C--\/ .-e- k �-, ,—) C', 0 �� ✓12 � L �A S
OWNER/
ADDRESS: 4u Z.CL MUait CITYF-yi i TATI4'WZIP S S`I2r
TENANT
PHONE: -) ln- -1
CONTRACTOR
COMPANY NAME:
-.
SUBMIT A COPY OF
Wentworth ve.
CONTACT PERSON:
IviffiriuE
004/-u
YOUR STATE
Nil
STATE LICENSE #
LICENSE WITH
ADDRESS: STATE ZIP
APPLICATION
PHONE FAX
PERMIT TYPE
;a'SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK.
11 NEW REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK (2-e 421ci V /16k C1�- , JA C�
PER MS 1613.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor X.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
Equipment Installed MFG: LLY1 ✓) C"r MODELC-t Ire 0 U 4 3 6A6-7 0 SIZE/BTU Z 0 G 6 C a -N&
MFG: 1 a_snYl GX MODEL: SIZE/BTU Z-M;Nd
MFG: MODEL: SIZE/BTU
A/C $25.00 _FIREPLACE (GAS) $15.00 _GAS RANGE/OVEN $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_
_BOILER $35.00 FURNACE $35.00 _GAS UNIT HTR $10.00
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00
_DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00
PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500
Permit Fee $ Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ _' Number of fixtures @ $25.00 1 x $25.00 = $ Z-5. ob
i
Number of fixtures @ $35.00 1 x $35.00 = $ SS . c 0
State Surcharge = $ .50
Total = $ bo • SD
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 al k which uir s eview approval of plans.
c
SIGNATURE OF APPLICANT �� lam` RINT NAME U f1/lQ �� lC TE 1 Z %
PLEASE NOTE: SEPARATE PERMITS ARtREQUIRED FOR BUILDING ELECTRICAL AND MECHANICAL WORT
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
1 194
Building
Inspections
763-572-3G
DATE_ 11
SITE ADDRESS
THIS APPLICANT IS:
From: 535 6473 Page: 1/2 Date: 11/24/2008 2:09:49 PM
BUILDING
RESIDENTIAL "PLICATION
CITY OF FR.IDLEY
❑ OWNER
Permit
Received By; �yM `'F �9
I7at t1 V 2 2008
YOUR E-MAIL ADDRESS
J=-a:,r4+
TENANT nv NAME :: �-I Lr 5
ADDRESS: A49 2&3 MI-? IT► ST /v'15
CITY
PHONE: 763 19R 0770 STATE/I?nL�IP C3 .
NTRACTOR .,.... . —. _
SUBMIT' A COPY OF STATE LICENSE # Q � EXP DATE .
YOUR STATE LICENSE ADDRESS:��,2� ryDN/�nr47
S; n I.�' CITY F IOL STATE "ZiP
W1'I FI AFP[.ICATION FIIiONE '7&T. r,� 4s�. _ 11–_
PERMIT
❑ BASEMENT FINISH
q DECK ❑
TYPE
DESCRIBE WORK BEING DONE: V 2 S
SIZE OF IMPROVEMENT - -- --
NUMMER OF SQUARES u "Vus>~ VNLY
-_ ❑ HOUSE & GARAGE
13 ATTACHED GARAGE
PROPOSED
PROPOSED SIZE. HEIGHT: —' O DETACHED GARAGE
^SING
Vinyl ❑SofLit
Q Aluminum Otl ❑Trim
Ll 13 Fuscia,�
OW
IN =STING OPENINGS ❑Xcs Mo LOCATION OF WINDOWS
OR FOR Nr3W OPENINGS-DESCRILiE SIZE OF
OPEMG CHANGES &
TYPE OF WINDOW TO SE AISTAL LED NUME1rR OF•WLNtpOWS
ALL FEES ARE BASED ON VALUATION, WCLUDING THE COST OF
(USING THE I9U.B.0 FEE SCHEDULE)
TQTAL JOB VALUATION $ l n _ ^df 4 1vrn A wig
❑ I)RAI14 TILE
❑ OTHER
EASEMENT REhj0DE1jN),GT•
1. Existing Floor Plan
2. Ptoposcd floor plan
3. List of structural membMs to be used
FOR NEV CONSTRUCTION INCLUDING DECKS.
�L��& PdRC�rFc SiJ13IHrr
Site P1antSutvey showing the odsong StnCjures
and Proposed project,
2. Two sets of tronstruetion plans
3. Energy Calculations
P,++/M0. Fee
Plan Review
$
YLa.VA rWq!f-A I Irlb
See Back Page for Fee Schedule
Fire Surcharge
S
$
65% of Building Permit Fee
16
Surcharge
$
,001 tithes the total job valuation
License Surchtwge
$
�� _0005 x hermit Valuation Minitnuln $.50
SAC (;barge
$
$5.00 (State Licensed Residential Contractors)
Curb Cut Escrow
$
$1675 per SAC Unit (Plans to MWCC for determination)
Erosion Cool
$
$450 Conservation Plan Review
Park Fee
Sewer Main Charge
$
$
Fee Determined by Engineering
Total Due
't
Agreement necessary ( ) Non Necessary ( )
�H -
THIS IS AN APPLICATION FOR A PM(Mrr-NOT vALID UNTIL, PROCESSED
I herby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
permit but
o with the arl codes oftlae City of Fridley and with the Minnesota Carrstntction Codes; that I understand this is not a
permit but only plication for a pe 'and work is not to start without a permit, that the work will be in accordance with the approved
plan in the case of I woaa -nio iequ s t iew, wand approval of plans.
SIGNATURE OF APPLI��` �""`',.. • i ,' PRINT NAME�JN,q /r� ��O �• DAT