PRE 2010 DOCSCity of Fridley, Minn. 117 0 8
6431 University Ave. N. E., Mihneapolis, Minn. 55432
BUIMING PERMIT
ate: _.�SCp pmb _ 1972
Ownw: Rarlan Swee Builder Robert Lau&en Homes. Inc.
Address 6824 Tpledo Avenue North Address 6866 East Fish Lake RQad
LOCATION OF BUILDING
Na 1400 street North Innsbruck Drive part of Lot
%t 9 Block 7 Addition or Sub -Division Tnn abn, k North Ist 1stAddition
Corner Lot---2L—Inside Lot Setback 35.5 — Sideyard _
Sewer Elevation Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: 24.5 240
—Dwelling Front 35' 2Per 40.3' &Height _ -28' Sq, Ft 2132 & Cu. Ft 33,6 0
(*aragg Front — —22 Depth 28' Height 10' Sq. Ft - 672 _ Cu. Ft. 6.720
Type of Construction Wood Frame Est Cost $392800 To be Completed Jan. 1973
Stipulations:: Provide a verifying survey before capping. Provide a hard surface
driveway.
SEWER LOCATION: 214' South of Manhole just north of intersection
WATER LOCATION: 224' " it If " if
Wye Elevation: 972.66 Top of Footing Min. 975.66
In consideration of the issuance to me of a permit to construct the build
the proposed work in accordance with the description above setfo d in
ordinances of the city of Fridley.
0
19.92 St a rcharl
described above, I agree to do
apliance with all provisions of
In consideration of the payment of a fee of $ 73 - 02 , permit is hereby granted t, Robert Laugen Homes
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
glcity limits and this permit may be revoked at any time upon -violation of any of the provisions of. said
Ins�iector
CLARENCE BELISL
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sum to No
the Wilding Inspector for separate permits for these items.
J
APPLICATION FOR RESIDENTIAL, ALTERATION, /
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME :__14d r1-? h Is bj e e- BUILDER: T o ir� LWa Wen llotnex C ,
ADDRESS: oa y / s %% 4VC. Wd i ADDRESS: (.066 Coe?r, ,Z
-TaeV /IBJ`„ .
NO:.f go 0 STREET:
9.0'r X -r- l C-
LOT: BLOCK: 7 ADDITION: Zhri,s 41"a n�/x
CORNER LOT: INSIDE LOT: SETBACK: '2i S. �� SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To BeUsedAs:
5j"X-a lj(P- �2rno Front: r Depth: YO.3 A' ZZ,57 eight: 4�-o
1
Y'Q s t�e n /'1 s f' �2 3 D.
Square Feet: _ Cubic Feet: 3 3 (D Q
t, Front: �a Depth: Height: /®
Square Feet; �—pubic Feet:`
Type of Construction: W e®cj r#-2k"e- Estimated Cost: $ _VS- ®-",
To Be Completed:a it 5 19 y / °1
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: �.,_, ?/ SIGNA �o
(See Reverse Side For Additional Inf rmation.) � � � k d
of
t �� 04�
f
300 BRUNSWICK AVE. S. LOT SURVEYS COMPANY 869177 IDAHO AVE. N.
GOLDEN VALLEY, MINN. LAND SURVEYORS BROOKLYN PARK, MINN.
MINN. REG. NO. 4741 MINN. REG. NO. 6743
REGISTERED UNDER LAWS OF STATE OF haNNESOTA
IJOENSED DY ORDINANOE OI• OITY OF MINNEAPOLIS
5747 W. Broadway 533.9922 INVOICE NO.
INDUSTRIAL — JUDICIAL Minneapolis, Minnesota 55428 F.B. NO. 13.7-76
COMMERCIAL — TOPOGRAPHICAL -301
CITY LOTS —PLATTING alk Ar I&eurg QCert��icate sc�'LF 11"
ROBERT LAU""EN HOMES INC. o :denotes Iron
DBPnotes hub for excavation of
Lot 2, Block 7, INNSBRUCK NCIRTff
We hereby certify that this is a true and correct representation
of a survey of -'Me boundaries of the above described land and
the location of ail buildings and visible encroachments, if any,y
from or on said land.
Signed
Surveyed by us this � t11 day of S e ot eMb er 19 72- LOT SURVEYS COMPANY
City of Fridley
AppFaMon for PMmd&g and Gm MCI" PWmit
Dept. of Bldg& Phone 5 W -3M
d' DESCRIPTION OF WORE
Number, Kind and Locaflon of FlxtuYQc tl '
31 x _ • • wAM .
! 3 litO M GAS [LEC.
Base F
1st
2nd 1
3rd
4th
• Future Comedian Opening �
Sewer
• New Finhue, Old Openings Cesspool
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE BATES:
NO. RATE
TOTAL
Number Fixtures ................
,_LL_ x $2.00
S
g2J
-
V
Future Fixture Opening ...........
x $1.50
=�
New Fixture Old Opening ..........
x $1.50
S
Catch Basin ....................
x $3.25
=
�
Water Heater (Up to 99,000 BTU) • • • •
x $3.00
$—J-00
New Ground !tun Old Bldg. ........
x $3.25
S
Electric Water heater ..............
a $2.00
$
GAS FITTING FEES:
NO. RATE
TOTAL
Iat 3 Fixtures ..... • .. • • • • • • • . • •
_� x $22.00
$
a ` U 0
Additional Fixtures ................
x $ .76
=
Gas Range to 199,000 BTU .. ,.........
x $5.00
$
State Surcharge
$
.50
REPAIRS & ALTERATIONS—Refer to Code
_
Description o . a . ... . .. ... .. .... w...
. ...... . .... ......
TOTAL FEE
'gc�
City of Fridley:
The undersigned hereby makes application for a permit for the work keret
specified, agreeing to do all work in strict accordance with the City 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. M nn I" m , � / , , Ili—
Owner U
Kind of Building
Used as��/
�7
To be completed about
Estimated Cost, $
Old , New. uilding Permit No. Permit No.
ROUGH
FINAL
Signed
B
Busines47e �1� G
MINNEgppUS —AVE. N0.
MINN. 55428
425-4183
9 4/Z10? -f
CITY OF FRIDLEY INSPECTION DIV, Effective On January 1, 1993
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 ®,VOy A10.
RATE SCHEDULE
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, Burner — rulings of the Building Division, and hereby declares that al) the facts and
Also Replacement Furnace $ 20.00 $ representations stated in this application are true and correct.
Gas Piping (Needed with new furnace) $10.00 $
OWNER
Gas Range $ 10.00 $
BUILDING USED AS_�/����
Gas Dryer $ 10.00 $
ESTIMATED COST PERMIT NO. ,•``/S'%�a
*Air Conditioning —All Sizes � r � ��$10,00 's. .06
!O 6
DESCRIPTION OF FURNAQE AND OR BURNER
All Others/Repairs & Alterations (LIST ON BACK)
I% of Value of Appliance or Work $ No, of Heating Units Circle One (Steam) (Hot Water) (Warm Air)
Trade Name Size No.
00%m- ercial/industrial BTU HP EDR
1% of Value of Appliance or Work $ Fuel Total Connected Load
State Surcharge $ .50. Burner Trade Name Size No.
BTU HP EDR
TOTAL FEE s SEDGW CK
HEATING COMPANY HEATING & AIR CONDITIONING CO.
MINIMUM FEE FOR ANY HEATING/COOWNGNENTILATION 8910 WENTWORTH AVE. SO.
REFRIGERATION/AIR CONDITIONING PERMIT IS 15.00 Si ned B MINNEAPOLIS, MN 5�4?�0853
g y oo, onnn a O.
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $30.00 I" .��� 1 Approved By Hough—in Date Final Date7"
Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner. FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
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's connected Yes ( ) No ( )
6. Has total heating BTU's of
All other BTU's
TOTAL BTU's
Remarks
List Alterations Bein4 Done:
HEATING COMPANY
Signed By
Date
Iia 9
CITY Q)F FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATI
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25/0 of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
Effective On January 1, 2000
JOB ADDRESS I LI
OWNER
TOTAL
BUILDING USED AS
ESTIMATED COST PERMIT N0.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units_ Circle One (Steam) (Hot Water) ( a�r)
$ Trade Name A fLl Size No. 33
BTU Fsn HP EDR
$ Fuel tal Connected Load
Burner Trade Name Size No.
$ BTU HP EDR
$ 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 an
$ .50 rulings of the Building Division, and hereby declares that all the facts and
$ b e representations stated in this application are true and correct.
H-thMNS P0, A"P DATE,
490Vg5'r LkKF-ZRs' - —
HEATING CO9f
*Air Conditioners can not be placed in a side yard without C
written permission from adjoining property owner. J S A
-7,S s S�
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes () No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes () No ( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes () No ( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes () No ( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes( ) No ( )
Appliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type
BTU Input
Fan Assisted or Nat
Appliance #2 Type
BTU Input
Fan Assisted or Nat
Appliance #3 Type
BTU Input
Fan Assisted or Nat
Total Appliances
Total Btu Input
Common Vent Type
Vent Height
Diameter inches
Appliance #1 Vent Connector Height
ft Length
ft Diameter in Type
Appliance #2 Vent Connector Height
ft Length
ft Diameter in Type
Appliance #3 Vent Connector Height
ft Length
ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
FEE -03 00 13:56 FROM:STANDARD HEATING CO 6128247554 TO:612 571 1287 PAGE:02
r
20 • d 141.01.
C M N ENT CON CTOR A COMB ON A
R1F1 TON
When re la an ex' tI furance the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and Is securely supped and firestopped where required.
Yes (,t,), No ( )
The venting system is plastirJPVC and meets ami caaRwd codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specMeMons. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
Yes 64 No( )
The iatins� cortmbustion �r is sired and installed to rneet the current codes
and manufacturer's specifications.
Yes(No( )
When required to insnew cam'on air tt
s and mwill be sized and installed
To meet the current codeanufacturer's specifications.
Yes (64 -No ( )
When IM111-1311ing a maw yentingthe undersigned hereby verlFles that
R is a listed assembly and meets the current codes and manufacturers
specificailons. This does include AGA-GAMA Category I Central Fumsoe
Venting Tables for fan assisted and natural draft appliances.
Yes (VIO., No( )
Is the common vent and vent connectors s'¢ed and installed Ovrrectly atter
an appliance has. been removed from the common vent and vented
separately as per current codes.
Y,0844 No( )
AR211angt Tym and mon t and YACt Cannemynfafm
Appliance #1 Type—!EK"
BTU Input $o
Appliance 02 Type _\,�,�• p cam_ Fan Asslst� or Notsd-
Appliance #3 T BTU Input ocb Fan Assisted or Nat
Total Appliance$ BTU
Input _, T Fan Assisted or Not
��_ Total Btu Input 1 �I SM6
Common Vent Type
�-IEL Vent Het ht r
g Diameter inches
Appliance #1 Vent Connector Height--L—ft Len in Type
APPliance #2 Vent Connector Height _ L_ Length
DI®meter
g ^ft Length �ft Dramet®r in Type
Appliance #3 Vent Connector Height ft Length,ft Diameter in Type
—tLt,
HEATING CO; a
Signed By:
Date :
eo/z0 ' d VSSOES 01 Kna I dd d0 A110 WONJ ":9T 0002-82-NUr
GAS WORK ORDER
1072 Payne Ave. STANDARD 410 W. Lake St.
St. Paul, MN 55101 9 Minneapolis, MN 55408
651/772-2449 6 HEATING O 612/824-2656
& AIR CONDITIONING
A Blue Doi: Service Co. EQUIPME-NT INFORMATION
LAST�' Lag 1 �.fl FIRST �►��
ADDRESS I �� ,zN ),,j tm, EQ.. 4-
CITYZIP
,HM PH Lp5 -Q WK PH
TECH DATE A Lau i0o
i
TYPE
MAKE 2 ®4 r/ J
MODEL
SERIAL J J -Sz !'
INPUT
ORSAT TEST RECORD
CO2 %
METERED INPUT S3 S a Cfh
CHIMNEY TYPE
02 %
LIMIT SETTINGS °
FLUE SIZE tg in.
CO 13%
PILOT OUTAGE sec
CONNECTOR SIZE 4 in.
NET STACK TEMP
°
TOTAL CHIMNEY INPUT w btuh
i
WORK PERFORMED:
JOB CODE
PRICE
l
SUBJECT
PERMIT NO.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
3 1 9 7 5
`COMMUNITY DEVELOPMENT DIV.
672-3604
j PROTECTIVE INSPECTION SEC.
#0/ !namd
T�v....._
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
j 612-571-3450
910-FIS
7/10/01
JOB ADDRESS 1400 North Innsbruck Drive NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
7
1 Innsbruck North 1st Addition SHEET
2 PROPERTY OWNER MAIL ADORES$
ZIP PHONE
Ferrier 1400 North Innsbruck Drive NE
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Northern Exposure Ext. LLC 2625 Emerson Ave S, M
ls., MN 55408 612-374-1212
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20173814
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION
fel REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (32 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU 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
OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
1
ISTALLS
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
@@
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
`V3,272
$1.64
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.
$97.25
Fire SC $3.27
TRUCTI N THE PERFORMANCE OF CONSTRUCTION
t
PLAN CHECK
Licen$5.0
FEE
TOTAL F
$ .16
SIGNATURE OFC 'AACTOR OR AUTHRI
OZED AGENT IDATEI
;E�N&OPERs
BL
I$ R PERMIT,///�w/n,
IN SP GATE
S-GNATURE OF OWNERof OWNER BUILDER, IDATEI
l
NEW I l 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: f /00
Legal Description:
Owner Name & Address: Tel. #
Contractor: 4�W 6X u/gre- &-r—, MN LICENSE #
Address: % 2oza
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
DECK AREA: Length 4 / Width
OTHER: IY-P V067VA C
Height Sq. Ft.
Hgt/Ground Sq. Ft.
#G,.f "7&f �fA1 .32Or
Construction Type: /�� Estimated Cost: $ 9'7.)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: O APPLICANT:& eel- Tel. #4 S / 216- 3 o%
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%)
$-1,64 $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ OD $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$
- OF
SUBJECT
PER O.
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
221 17
`KgCEIPT
NO.
`y ______ COMMUNITY DEVELOPMENT DIV.
72®
j PROTECTIVE INSPECTION SEC.
NUMBEN
pEv
OATS
PAGE OF
BY
CITY HALL FRIDLEY 55432
1 J` 612-571-3450
910415
8/28/01
8/28/01
JOB ADDRESS 1400 North Innsbruck Drive
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
7
Innsbruck North 1st Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
David & Donna Ferrier, 1400 N. Innsbruck
Dr, Fridley MN 55432 763-574-9138
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Northern Exposures, 2625 Emerson Ave S, Minneapolis 55408
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 ❑ ADDITION ❑ ALTERATION O REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct 3 -season porch & deck
9 CHANGEOFUSEFROM
TO
STIPULATIONS
See notations on plans.
WARNING
13efore digging call for
all utility locations
454.0002
REQUIRE® BY LAW
SEPARATE PERMITS
REQUIRED FOR:
WIRPLUMBINd
AND SIGNS
SEPARATE PERMITS ARE REQUIRED 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 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
OFFSTREET PARKING
'HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
ISTALLS 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
@
$6,029.00
$3.01
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 F ANY OTHER STATE OR LOCAL LAW REGULATING CON -
$39.25
Fire SC $6.03
STRUCTIO OR THE PERFORMANCE OF CONSTRUCTION
CHECK FEE
TOTAL FEE
Lic se A5.00
$153.29
i N TURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEi
'VVHO PROPERLY VALIDATED THIS IS YOUR ERMIT
SIGNATURE OF OWNER -IF OWNER BUILDER, iDATE.
0ATE
j /
NEW I l Effective 1/1/2001
ADDN [ ] CITY OF FRIDLEY76 )) 5/72-36 Idg n
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �G-G
AlBUILDING PERMIT APPLICATION
Construction Address: /6/00 H 6 c << L
Legal Description: QC --, o Sc -n
Owner Name & Address: h Tel. #
Contractor: MN LICENSE#
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
c
-Ofi
Length !3
DECK AREA: a Length /,;�—
�r:i4�
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height Sq. Ft. /-
Height Sq. Ft.
Hgt/Ground Sq. Ft01
-OF-01C OAF
9�0�
Construction Type: 4 IA4 '11-c /C Estimated Cost: $
%J COW
Driveway Curb Cut Width Needed: Ft + 6 t = Ft x $ _ $ ��>� �. CAJ
DATE: APPLICANT: . Tel. #
T 1 -Z�7
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ /39 ,O?S- Fee Schedule on Reverse Side
Fire Surcharge $ / 06 .001 of Permit Valuation (1/10th%)
State Surcharge $ 3 0 Clio $.50/$1,000 Valuation
SAC Charge $ $1150 per SAC Unit
License Surcharge $ Co $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 $
/J
/ 3
STIPULATIONS:
GIERALD T. COVNE RAYMOND A. PRASCH
300 BRUNSWICK AVE. S. LOT SURVEYS COMPANY BROOI7 IDAHO AVE. N.
KLYN PARK, MINN.
GOLDEN VALLEY, MINN. LAND SURVEYORS MINN. REG. NO. 6743
MINN. REG. NO. 4741
REOISlERED tJNDEB LAWS OF STATE OF iQNNESOTw
LICENSED BY ORDINANCE OF CITY OF 1 UNNEAFOLIS
5747 W. Broadway 5339922 INVOICE NO.
76
INDUSTRIAL —JUDICIAL
Minneapolis, Minnesota 55428 F.B. NO. 17' r
COMMERCIAL — TOPOGRAPHICAL SCALE V fl 3O
CITY LOTSv- PLATTING our beporg aerttitcate
IZO13ERT LAUGEN HOMES INC. o Denotes :Iron
DDenotes hub for excavation of
0�'ti `T1 �1`1�SaQuc _�i12-1V E
. - - — ---- _ _._...___ __ _- -� - V •_—� I
2
Il
14100 i4I �tilirtsbru���
970•,
Lot 2, Block NORTH
Amendea to' show foundation to/9/ 2
Jl
We hereby Certify that this is a true and correct representation %
of a survey of the boundaries of the above described land and �/ s
the location of all buildings and visible encroachments, if any,
from or on said land. _
�-
SurvNyed by us this �* h day of �T tg— Signed LOT Si'_1RVEYS COMPANY
NOV-16-2004 10:25 CITY OF FR I DLEY P. 0= :
NtvV t j lN! I %.."
.. ..__. . -
ADDN {) 54-'�- 6431 University Ave, NE, Fridley; MN 55432 (763) 572-3604 Bldg lnsp
ALTER { 3 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION VC6
01
Construction Address: 14 e o 1 V• e h h S b r w G 1- la- e.
Legal Description:
Owner Name & Address: —David D h a Fe t -r % e 1^ Tel. # 7 � 5 _S 74 — 119 d
Contractor, IV e 111 P%-// I DWS MN LICENSE # u�fQ
Address: �J
W YDO Tel. # S2 — 300
U IS
Pk—
Altach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LMNG AREA:
Length
Width Height
Sq. Ft.
GARAGE AREA:
Length
Width Height
Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground
Sq. Ft.
OTHER:
repl�ce���t a� .
Construction Type: n Estimated Cost: $ 3300 0
T"
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: z/ 0 S APPLICANT: B Tel. # �5�' %� �✓ "-d 3
Call (763) 572,3604 for Permit Fees if mailing in application. Fax to 763-5714287 if using credit card and we will call
you for card number.
Permit Fee
Plan Rear --__
Fire Surge_=--
State urcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$ 7 • �5 Fee Schedule on Reverse Side
$ Q 65% of Permit Fee
$ > .001 of Permit Valuation (1/10th%)
$ (_ �S $.50/$1,000 Valuation
$ $1350'per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A", or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
S 6 ' 2� STIPULATIONS:
Building
MECHANICAL
Permit No. .o -� 3
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'd: 4-
763-502-4977 FAX
I
EFFECTIVE 2-19-09
DATE .- O
YOUR E-MAIL ADDRESS
/
SITE ADDRESS ��✓(Jb Znn s Lr -=A- Dr. do
THIS APPLICANT IS: ❑ OWNER JICONTRACTOR
PROPERTY
NAME: 1Dad'J, IFg& 1-,c j e r -
ADDRESS: /5/v -D S..n� �o�.�,�G o1/e STATE Y! ZIP
Dr No. CITY ��;
OWNER/
TENANT
r
PHONE:
CONTRACTOR
COMPANY NAME:
ome Ti&qj&5jW I=
SUBMIT A COPY OF
CONTACT PERSON: dha FireTele uon.rti bOme
YOUR STATE
STATE LICENSE # Licerise 20512080 EXP DATE
2700
LICENSE WITH
ADDRESS: Roseville MN 5511'vu3 CITY STATE ZIP
APPLICATION
651 -2561
PHONE FAX
'PERMIT TYPE
SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
XNEW ❑ REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORK i n S i �� s_r e 14 4- r
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOW)
Equipment Installed MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZEBTU
A/C $25.00 FIREPLACE (GAS) $15.00 _GAS RANGEIOVEN $10.00
AIR TO AIR EXCHANGEER $15 _FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
$35.00 _FURNACE $35.00 ,GAS UNIT HTR $10.00
_BOILER
CHIMNEY LINER $10.00 GAS DRYER $10.00 ,+ POOL HEATER $35.00
_
DUCT WORK $10.00 GAS PIPING $10.00 VENTILATOR $15.00
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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; thati the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT --� PRINT NAME K>o�Lj n �l'j,5 6; 'f DATE �)o
n
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977