PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 4303
Date: ..... _-.................. 1-...f ................ J7..!-.... ................. .... ...
Owner: ^�..... Builder
...._............... ..............------..... .._............. ..._......._.
Address -----.............(..._.. Address - ........._..
JXATION
OF BUILDING
No... _. Street - .. ... ....._®�.1......... -- .......
...............
Part of Lot ...------------............._...._.. ..
Lot Addition or Sub -Division ..... _............................. ............................. _.....
1 ,y
Corner Lot .......................... -........ Inside Lot ...................._...... .......... Setback ZZ767.74....74 0......... Sideyard
Sewer Elevation
To be Used as:
/ .................-/.jam..... ----......-----..............
r�.s'Y....✓/moi=... ...................
Type of Construction
Foundation Elevation
DESCRIPTION OF BUILDING
Front 660... Depth 3.ff''._0" Height `Sq. Ft. 4
/' Vt 4
Front /a...-. Depth 97.0'. 7 � eight l...Q. Sq. Ft. 1.....I�i....
Est. Cost ................. ....................................... To be Completed
Cu. Ft. 41 f, 2
cu. Ft. 3...9..W 6
The West 130 feet of the Nast 805 feet of the South 1/2 of the South 1/2
of the South 1/2 of the Northeast 1/4 of the Southwest 1/4 of Section 12,
Township Xs Range 24., Anoka County, Minnesota subject to an easement for
road purposes over the North 30 feet thereof. Also known as a part of Lot 12,
Auditor's Subdivision Number 091, Anoka County, Mimesotao
In consideration of the issuance to me of a permit to constru buil ' es Zd above, I agree to do
the proposed work in accordance with the description a ve ante with all provisions o
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 any of the provisions of said
ordinances. a ��
Building Inspector
NOTICE:
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 items.
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL ALTERATION,
j ADDITION, OR REPAIR BUILDING PERMIT
OWNER'S NAME: M tl 170,6C 4— BUILDER: Pu ,+d f=
ADDRESS : /2 l el A) 77O^% A), f• ADDRESS : T ! 3 � p� t. IV
NO • . / ?_ / 4/ STREET:
,J d Zi- /-LJ /J, C ,
LOT: BLOCK: ADDITION:
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.
DESCRIPTION OF BUILDING
To Be Used As:
Mqvc.'o� Front:
2-)l Depth: � IV Height:
Square Feet: 7 5--(. Cubic Feet: / S� C7
Front-: Depth:
Height:
Square Feet; Cubic Feet:
Type of Construction: 7�E� Estimated Cost:
To Be Completed:
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: SIGNATUREJ40� euii'41_1
(See Reverse Side For Additional Information.)
o �--,r��cc
YAJS I-
6 �- -3 : / 8 '�?
'Aegk
f
Cele- /ill q Z.
R 'YVV SYSE
N . i�
i
Provide approved products of �
Combustion
detector pother than
j t I
heat in all dwelling units as
------ a' — -.r"ed in. sec_ i_ 1413 -of -
� 1973 Uniform But lingo CodenAM a_
Evety steeping r6m shah have at lustoile
i
�\ window with a sill height qt not more thO
48" above the f" aha sftall I rovi#8 00 i
Ion then 5 sq. it. of openible area with to
dlnrerision toss than 22," �
Ire 61/ a ISN
s
�k' I
I
1
t::.; sleeping roo!Ai& rnl(?*-W at least one v j
window with a sill height ut not more thanI wry
ve at te�ast48" above the floor and shall provide not +• i9t�dow �iga Il he ght t no� moje tt+a e
less than 5 sq. It, of openable area witq nets, above {he ifloor nd ft rovtge
dimension fess than 22' IIthnn 6 A. qtr
II' !
kidmi
UMM
OR
V
4 ;red Pr
1
ilt►ie• I � I j
•d I I
II t
Ni MAST
'CH1S per' 1NEQ TSE i I
8E �p1NS ! I i
A CESSIQE LE 0 0� sat.
F' C
,.
01
SUBJECT
IT NO.
City of Fridley3
'//(r
0 719
AT THE TOP OF THE TWINS
BUILDING
PERMIT
`RECEIPT
NO
COMMUNITY DEVELOPMENT DIV.
� PROTECTIVE INSPECTION SEC.
r �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
' 612-571-3450
910415
3/13/00
10B ADDRESS 1214 Norton Avenue NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
Pt 12
Auditor's Subdivision 489
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Cynthia XXM J. Mabel 1214 Norton Avenue NE
574-9497
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
a 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 lj REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (27 Sq) Tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
I 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
$2,360
$1.18
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-
STRUCTION$83.25 OR THE PERFORMANCE OF CONSTRUCTION
F e SC $2.36
PLAN CHECK FEE
TOFEE
$86.79
A
AiUREOFCON'RACTORORAUTHORIZED AGE,T ,OATEN
WHE PROP
L VALIDA D THIS IS_;O�RM=T
B G ,NSP
G (OATE
ATU E OF OWNER„F OWNER BUILDER, ,DATE,
01
NEW []
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: (
Legal Description: i 1
SO
Effective 1/1/2000
(763) 572-3604 Bldg /I�nsp
\(`�\,
9 '!
Owner Name & Address: C In Trf I i a- _ M A 6 E L_ Tel. # 5-711-'?'t97-
Contractor:
751-`?`f97.Contractor: S I A'j A A/ aiU D S F,ei,/ MN LICENSE #
Address: Tel. #
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: Leng Width Hgt/Ground °�- Sq. Ft
OTHER: C�C'�% S - / Edzi -d4fi
Construction Type: R0 O F Estimated Cost: $ ?,360
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$
DATE: t7 APPLICANT: Tel. # S `f
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ c3- c2�- Fee Schedule on Reverse Side
$ 3� .001 of Permit Valuation (1/10th%)
$ lr $.50/$1,000 Valuation
$ $1100 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 [ ]
WELL OR BORING LOCATION
MINNESOTA DEPARTMENJOF HEALTF4 Minnesota Well and Boring
WELL AND BORING SEALING RECORD, : MMinln)esotta uniguellWeO No.
Minnesota Statutes, Chapter 1031 or W-series No.
(u,e,s ewixenm wnrnt
H 196906
County Name
—
Township Name Township No.
Range No.
Section No.
Fraction (sm. Ig.)
Date Sealed
Date Well or Boring Constructed
Numerical Street Address or Fire Number and City of Well or Boring Location
R
Depth Before Sealing k.
Original Depth ' k.
Show exact location of well or boring Sketch map of ell or boring
in section grid with 'X*. location, shoving property
lines, roads, and buildings.
N
W
--i-- ---- -�- i- a
- �- - �-- -i-- --i--
B �- �f
r nme#b
I
AGUIFER(S)
5Wingle Aquifer ❑ Multiaquifer
STATIC WATER LEVEL
�..;..s,�
3441-sured Estimated
_ t0. Q5.Wiow ❑ above land surface
WELLISORING
ater Supply Well ❑ Mon@. Well
❑ Env. Bore Hole ❑ Other
CASING TYPES)
SIeel 0 Plastic Tile 0 Other
CASING(S)
Diameter Depth Set in oversize hole? Annular space Initially grouted?
� in. from to k. ❑Yes ',' [�.IQB ❑Yes ❑ No ❑Unknown
„ T
in. from to k. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
in. from to k. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
PROPERTY OWNER'S NAME
Oft
Props owner's mailing address it different than well location address indicated above..
_
SCREEN/OPEN HOLE 4" x
Screen from !21— to 14 it. Open Hole from to k.
OBSTRUCTIONS
❑ Rods/Drop Pipe ❑ Check Valve(s) ❑ Debris ❑ Fill MW Obstruction
Type of Obstructions (Describe)
Obstructions removed? ❑ Yes . ❑, No . Describe
WELL OWNERS NAME
Wap unmans malting address N Menem than property owner's address indicated above.
PUMP
Type
Removed ❑ .Not Presertt ❑ Other
GEOLOGICAL MATERIAL COLOR HARDNESS OF FROM TO
FORMATION
.
It not
11AETH00 USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINt S, OR CASING AND BORE HOLE:
.
Taild%mular Space Exists
❑ Armular space grouted with tr�rde pipe.
❑Casing PerforadoNRemoval
In. from to it. ❑ Perforated ❑ Removed.
In. from to ft. ❑ Perforated ❑ Removed
Type of perforator
❑ Other
X"
GROUTING YATERIAL(S}(One bag cement 94 one bag bentordte 60 Him)
Grouting Materialfrom to k. yards bags
from to i k: yards bags
from to ft. yards bags
from to k. yards bags
REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING
IV!•W w � �+ [� �
{}v.[i i
Z ° f
OTHER W(1LS AND BORINGS &Vj.,& OP8v?
Other unsealed and unused well or boring an property?❑ Yes C) No How many?
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.
t '
r cress License or Registrit n Ab.
s A —lip
re Dab
d it +airy kit win
LOCAL COPY''
00906
Name of Person Sealing WOOor Boring -�
NEW [ ] CITY OF FRIDLEY
ADDN [) 6431 University Ave NE, Fridley, MN 55432
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: / &2
Legal Description:
Owner Name & Address:
Effective 4/1/2004
(763) 572-3604 Bldg Insp
(763) 571-1287 Fax
Tel.# 7Ly-57 `i`'?!1? 7
MN LICENSE #SC 206 `%�'C9 /
ta_t Tel. # 7.6 3-"53 7 2 79
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
10 DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA:
OTHER:
Wirith
Hat/Ground
Sa. Ft
Construction Type: 0 Estimated Cost: $ ?%6 99
Driveway Curb Cut Width Needed:
DATE: 10 —11 `0:5-
+6 Ft= Ftx $ =$,
#3�3 7--i��s
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
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ l� Fee Schedule on Reverse Side
$ 65% of Permit Fee
$_ < 90 .001 of Permit Valuation (1/10th%)
$ d�' $.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 [ ]
$ ® STIPULATIONS: