PRE 2010 DOCSCity of Fridley,Minn.-11-824(!
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: _ December 5, 1972
mer: Vg-rn nnnnay Rea y, Tnc _ Builder Same
Address 7300 - 36t1, Avenije Nnrtb Address sae .
LOCATION OF BUILDING
Naa 1400 Street Osborne Road N.E. Part of Lot
Lot R Block 2 Addition or Sub -Division . Meadowmoor Terrace
Corner Lot Inside Lot X Setback . 35.5 Sideyard _ 10.5
"ek/mievation 893.08 _— I(oMij!W" >4/ 896.08 Minimum
Wye Top of Footing
DESCRIPTION OF BUILDING
To be Used as:
432 &
Dwelling Front32' _
Depth 24' Height. 20'_
Sq. Ft. _ 768
ct, gt, 15,,60
–Garage Front 1�'
Depth 221 Height 10'
Sq, Ft, _ 308'
cu. Ft, _ 3.080'
Type of Construction --Wood Frame
Ft, Cost _$19,319
To beCompleted
6 months .
Stipulations: Provide a verifying survey before capping. Provide a hard surface
driveway that is flared to 16 feet at curb. Abide by agreement isn as on 1st 16 houses.
WATER LOCATION: 8' E. of Sewer Service SEWBR LOCATION: 92.20 ' E. of Manhole.
-(Inv. 892.71)
ISMRIATE PERMil-rt M0101o'b FOft VIi1R1
DATING. PLUMBING AND SIGNS,
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. C�
9.66 State S harge
Rea lty
In consideration of the payment of a fee of *--31. 00 , permit is hereby granted to Vern Donnay MIN
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
1�'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildinJ�
��� city ]units and this permit may be revoked a time upon violation of any of the provisions of said
Building Inspector
DkRfEL CLARK
NOTICE:
Tbjp 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.
0
Lr�rrdPlcnnrn� �+H� � M.�.
LardSwwyy M op�l�sl2,
s0d5 t°y ENGINEERING, INC. 'p
Clw/ b- mlwlx�wl Edda
fnfffWruy -- Engineers Survectors —
certificate of suzvre7 for YUJI P
OSBORNE RD. A
NORTH
75
t
( M
32 161
14
Proposed
v 'tIma AR rte+
1400
rl\j
1 e
110
I LDT 5-
7-5
0&N0TX'S IRON DZN(9rZS UT/L/TY e iWA/NAGC CAs4 rAl Nr
ZoOCk 2AA9ojs1mooR 7/—c�-ReA Com`
CO&NTY .OF 4AVKA
/ A"N w4iry 40 AWs a a bras and m►red tv)"mnkdww a'o su^wy qrAw Jft� qr#r 46rs cl sviA d 4md, moi
Ar4&g vPAW drgldor�s, Avow, adal "! i&e aww"we fs , if 4y. f rn ar &7awd W. As swwyd fy Im Ai -z. dby
9� `�. �•��' 4.0 SU6UR8AAI fNWNEERRV6. INC.
SCALC. - � E►�itte�ers Fr Svr •a
® 1
UEl-F f
5-I
7S -F- CA,) Zf r /LJ
V, c2 o E- 1v
,
zz)t�� El
N.
BOND NO. 200176
S-1583
SUMMIT INSURANCE COMPANY OF NEW YORK
Executive Offices — Delray Beach, Florida
KNOW ALL MEN BY THESE PRESENTS.
That we, Vern Dounap Realty, Inc. , 3030 Harbor Lane, Minneapolis, Minnesota
as Principal, and the SUMMIT INSURANCE COMPANY OF NEW YORK, a corporation organized under the laws of
the State of New York, and authorized to transact the business of surety in the State of Minnesota
as surety, are held and firmly bound unto City -of Fridley. Minnesota
the just and full sum
of Seven Hundred Fifty & No/100-----------------------------Dollars (s 750.00 ),
for which sum, well and truly to be paid, we bind ourselves, our heirs, executors, administrators, successors and
assigns, jointly and severally, firmly by these presents.
Sealed with our seals, and dated this 23rd day of January 1973
THE CONDITION OF THIS OBLIGATION IS SUCH, That, WHEREAS the above bounden Principal
has entered into an agreement witb the City of Fridley, Minnesota, for Driveway
Approaches, Boulevard Sod and a Tree, Lots 8 and 10, Block 2, Fridley, Minnesota.
NOW, THEREFORE, If the said
Principal shall perform as agreed.
then this obligation to be void; otherwise, to remain in full force and effect.
S-13 PI 6-71
(Principal)
(SEAL)
(SEAL)
(SEAL)
SUMMIT INSURANCE COMP N Nil YOR.
tto ney-I ac[
T. ACKNOWLEDGMENT OF CORPORATE SURETY
STATE OF Minnesota
Hennepin )ss
County of )
On this 23rd day of January 19 73 , before me appeared
Thomas H. Fairfield to me personally known,
who being by me duly sworn, did say that he is the aforesaid officer or attorney in fact of the Summit Insurance Com-
pany of New York, a corporation; that the seal affixed to the foregoing instrument is the corporate seal of said corporation,
and that said instrument was signed and sealed in behalf of said corporation by the aforesaid officer, by authority of its
Board of Directors; and the aforesaid officer acknowledged said instrument to be the,4ee act aq deed of said corporation.
(NOTARIAL SEAL) Notary Public,MARY
My Gomm,sscon Exp;res Jurc 5, 1974,
My Commission Expires
S2
SUMMIT INSURANCE COMPANY OF NEw YORY, , 300 200 7 6
POWER OF ATTORNEY S-1583
KNOW ALL MEN BY THESE PRESENTS, That the SUMMIT INSURANCE COMPANY OF NEW YORK, a corporation of the State of New York, having its
principal offices in the City of Houston, Texas, does make, constitute and appoint: Thomas H. Fairfield
its true and lawful Attorneys) -in -fact, to make, execute, seal and deliver for and on its behalf, as surety, and as its act and deed, any and all bonds, undertakings
and contracts to suretyship, in behalf of: Vern DOnnay Realty. Inc. as Principal
and City of Fridley, Minnesota as Obligee provided that no bond or under-
taking or contract of suretyship executed under this authority shall exceed the amount of : not to exceed =$300,000=
This Power of Attorney is granted and is signed and sealed by facsimile under and by the following Resolution adopted by the Board of Directors of SUMMIT
INSURANCE COMPANY OF NEW YORK at a meeting duly called and held on the 8th day of August, 1972:
"RESOLVED, all bonds of the corporation shall be executed in the corporate name of the company -by the President or Vice president, or by such other officers
as the Board of Directors may authorize. The president or any vice president, secretary or any assistant secretary may appoint attorneys -in -fact or agents who
shall have authority to issue bonds in the name of the company. The corporate seal is not necessary for the validity of any bonds of the corporation."
IN WITNESS WHEREOF, the SUMMIT INSURANCE COMPANY OF NEW YORK has caused these presents to be signed by its officer undersigned and its cor-
porate seal to be hereto affixed duly attested by its secretary this 12th day of September, 1972.
S
SUMMIT INSURANCE COMPANY OF NEW YORK
Attest:( 0hQ�Ojyev
, I -'� . l S��J)1�j 7`
Secretary Pr ident
STATE OF TEXAS )
( ss:
COUNTY OF HARRIS)
On the 12th day of September, 1972, before me personally came Kenneth F. Cooke, to me known, who being by me duly sworn, did depose and say: that he
resides in the County of Harris, State of Texas; that he is the President of SUMMIT INSURANCE COMPANY OF NEW YORK, the corporation described and which
executed the above instrument; that he knows the seal of said corporation, that the seal affixed to said instrument is such corporate seal; that it was so affixed by
order of the Board of Directors of said corporation and that he signed his name thereto by like order.
� Notary Public BARBARA ANNETTE BYRD
Notary Public in and for Harris County Texas
STATE OF TEXAS ) My Commission Expires June 1, 1673
( $a` CERTIFICATE
COUNTY OF HARRIS)
I, the undersigned, duly elected to the office stated below, now the incumbent in SUMMIT INSURANCE COMPANY OF NEW YORK, a New York Corporation,
authorized to make this certificate, DO HEREBY CERTIFY that the foregoing attached Power of Attorney remains in full force and has not been revoked; and
furthermore, that the Resolution of the Board of Directors, set forth in the Power of Attorney is now in force.
Signed and sealed at the City of Houston, Texas. Dated the 12th day of September, 1972.
Secretary
;A
State of Minnesota
County of Hennepin
On this 29th day of January, 1973, before me, a notary
public within and for said County, personally appeared
L. A. Donnay to me personally known, who being duly
sworn did say that he is the President of the Corporation
named in the foregoing instrument, and that the seal
affixed to said instrument is the Corporate seal of said
corporation, and that said instrument was signed and sealed
in behalf of said corporation by authority of its Board
of Directors and said L. A. Donnay acknowledged said
Instrument to be the free act and deed of said corporation.
A!? S
PAR-1AL 2 T «
MAIM TFARM 0 MATE TOTAL
Yawasce Shell & Duct Work ... ... 410.00 �
Replacement of Furnace ... .... &Go �
Repairs & Alterations—up to 9500.00 6.00 �-- - —
Repairs & Alteratiorns each ate. WDOM 3.00 aL---_-- _--
WAM AM
vurnace Shen & DuctWait to 120,GN ZTU ..
.. ..
each add. 691000 r ............ .... �1S®..Wiu q$�
H
Replacement
Of Furnace 6.00
Repairs & Alterations --up to SM.00 0.00
Repairs & Alterations each add. $M.00 3.00
;,"' e+ M4 or HOT WATER BTBIMM
rurnace Shell &Trines—to 400 sq. ft. MDR Steam
$10.00
$
Mcnace Shell & Trine—to 640 sq. ft. EDR Hot Rater
10.00
3_
Each add. 2W sq. ft. EDR Steers
too
Each add. 320 sq. ft. EDR Hot Fater
3.00
>�—
OIL SUNMR—to 3 gal. per hour
6.00
$ —
over 3 gal. per hour—,%e Fee Schedule
GAS N (up to SkODD BTU)
Loo
over 199,000 VM See Fra Sdmbduk
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures
x$ zoo
Additional IMNrtures
x ,7
$
Gas Range to 199.00
x$ M
f
AMR C----ITICXMG
FAP NZATING STSTM
VEEN?J<LATING BTBTlZM
ALTERATION8 & REPAM
ROUGH
see see
vehodah
TOTAi. M$
�y=
fit. of
City of rd( lay:
The undersigned hereby makes application for a pemit for tyle Work hemig
specified, agreeing to do all work in strict-viEcordance, with fae City Ordftanewr
aaad ruling of the Department of Buildings, and hereby declares that all Me fn-�L
and representations stated in this application are true =2 =,tet.
% dley. Minn./ ' I7d
Owner
Kind of Building ..
Used! as
To be completed about __— --- rJ
C) c>
Estimated Cost.
`Building ftrmit No. permit No.
HEAiZNG PID Hot Water. Nat
Tirade
Capacity-- Sq. )r. ED R %0 41,, D D
Total Connected Load ��� `� 2 1 of 1Fue �
BURNER — Tirade Name size Ne
Capacity 3q. Ft. EAR- BTU SP
(ASMAf is -oval
By
-Btuinm Ptraae 1H.
e;/v/- C/.�- —'--e" 60.ze 2u
VIA., g � A�19
HEAT LOSS CALCULA ONS DEPARTMENT OF INSPECTION V 4NEAPOL6. MINN.,
E
H
S. ...
Weatherstrips A.Construction No. Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yes—No I . Yes—No 1 19—
F1.1 j, 1-w Room l Length Width ,S'Height Fl.� Room Length Q Width Height
Windows d Doors—Crackage and Area Windows and Doors—Crackage an ea
Width Height I No. of Lineal A. Area Width Height No. of Llneal ft. Ates
No. off panne of pane li/ghh of c/rack rsq. ft. No. of pane of pane lights of crack sq. ft.
Z
Coef.Btu Coef. Btu
Infiltration Infiltration ZVi 7211 92 2k,
-
Glass 0 Glass /4-1, O 0
Exp. wall'
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
/ Fl.l l(l,-ki Room I Lenath /!Z Width PO' Height
Windows and Doors—Crackage and Area
m I Length
P
Width Height No. of Lineal ft. .Area
No. of pane of pane ilghto of crack sq. ft.
44Coef.1
nelgnf d --
Windows and Doors—frac age and Area
Width Height I No. of ` Lineal ft. Area
No. of pane of pane llghts of crack sq ft.
Coef.
Btu
Btu
Infiltration
2—,Y
3k
491 Z,
Glass
206
/
Z Z
QQ
Exp. wall
;a /14
Net exp. wall
1�1
s -V
a % 0 0
Net exp. wall
Int. wall
Int. wall
y
d
O
Ceiling
L
to
1-L00
�
O
Floor
I '
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area *
m I RM,.. I t ...A. /,i Lq�1;A,b'' /�: 1"l ►
ftirI l'
Windows and Doors—Crackage and -Area
m I Length
P
Width Height I No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Z
nelgnf d --
Windows and Doors—frac age and Area
Width Height I No. of ` Lineal ft. Area
No. of pane of pane llghts of crack sq ft.
Coef.
Btu
Infiltration
Glass
Btu
Infiltration
206
Exp. wall
Z Z
3 v
Glass
Net exp. wall
s -V
a % 0 0
Exp. wall
Int. wall
Net exp. wall
Int. wall
I2
to
1-L00
�
O
Ceiling
I '
Ceiling
Floor
Total Btu.
ft. E.D.R. or sq. ins. W.A. Leader area
Exp. wall
Net exp. wall
Ceiling Us /Z 12,4 /d 26
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
F1.1 Room I Length Width Height
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
Coef. Btu
Infiltration
Glass
Exp. wall
Net exp. wall /+®' 6 joee
Int. wall
Ceiling d /V !l DT -
Floor
Total Btu.
Required sq. ft. EDABL or sq. ins. W.A. Leader area
,44 FI.I
m I Length
P
11d,a
nelgnf d --
Windows and Doors—frac age and Area
Width Height I No. of ` Lineal ft. Area
No. of pane of pane llghts of crack sq ft.
3 _;2
36 b t3
Coef.1
Btu
Infiltration
910
3 P'
3 v
Glass
s -V
a % 0 0
Exp. wall
Net exp. wall
Int. wall
TY
A)
S
�
O
Ceiling
I '
Floor
1713
1-7
Total Btu.
ft. E.D.R. or sq. ins.. W.A. Leader area
S9WOF�+-� r•9118
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SUPERINTENDENT OF INSURANCE OF THE STATE OF NEW YORK AS REHADILITOR OF
AMMA amine 0C.0firsam of ftu; York
P.O. Box 52516
Houston, Texas 77052
CONTRACT STATUS INQUIRY
City of Fridley, Minnesota
City Hall
Fridley, Minnesota
For the completion of our records in connection with Bond No. 200176 issued
on behalf of Vern Donnay Realty, Inc., 3030 Harbor Lane, Minneapolis, Minnesota 55441
as Pr'ncipal covering contract dated on or about Januray 23, 1973 in the amount of
c 750.00 Driveway approaches Blvd., Sod and a Tree for Lots 8 & 10,
Y
Block 2, Fridley, Minnesota.
Project No. kindly furnish the information requested below.
James W. Dowling
Special Deputy Superintendent of Insurance
BY:
1. Has the contract been fully completed?
S e�
If so,
(1) What was date of completion and acceptance? tJ•C) % in w
(2) What was the total contract price?
If not,
(1) When is it expected that work will be finished?
(2) Has work completed been satisfactory?
2. Amount of work completed to date
3. Total amount paid to this contractor to date
4. Amount of retained percentage
5. Have any liens or claims for unpaid labor and material bi!ls been filed by anyone other than our contractor?
6. REMARKS:
t'j
t� Lct� 1u
Dated:
SICONY-371
(Rev. 2/75)
v
(Sig ature)
(Address)
01
SUBJECT
P R 0.
City of Fridley
o 19110
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RE IPTNO.
`L _____ COMMUNITY DEVELOPMENT DIV.
ppAA ®
r PROTECTIVE INSPECTION SEC.
OC�Io
1 . �
CITY HALL FRIDLEY 55432
NUMBER
REV,
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
8/11/87
JOB ADDRESS 1400 Osborne Road N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
8
2
Meadowmoor Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ed Blaido 1400 Osborne Road N.E.
784-0454
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
8 DESCRIBE WORK
Construct a 14' x 221 Garage Addition; Reroof & Reside
Dwelling; Add Windows
9 CHANGE OF USE FROM TO
STIPULATIONS
"WARNING
-SAA Q002 call local PERMITS R FOR
NICTRIC •CAS ate, SEPARATE
MBING AND SIGNS.
PLU
TING,
WIRING, HEAD
REQUtED BY LAW
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
SQ. 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 I HAVE READ AND EXAMINED THIS APPLICATION
1
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
$6, OOO
$3.00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFOR NCE OF CONSTRUCTION.
__...__
LAN CHECK FEE
TOTAL FEE
$59.50
CO.R OR OR AUT [ZED AGENT IDATEI
WHEN PROPERLY LI DATED THIS IS YOUR PERMIT
PERMIT
;S1VTF
O
BLDG INSP
V I l)
BATE
SiG TURE CM OWNER IIF OWNER BUILDERI IDATEI
01
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address: -We9 -1/ '
Legal Description: L --C) �l® �1E D�cx�ovt�or
Owner Name & Address: � Zaz (d-42 Tel. #
Contractor: 0LAD yk- Q-� Tel. #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
GARAGE AREA:
Length ILA
Width
Height Sq. Ft.
DECK AREA:
Length -----------
Width
Hgt/Ground Sq. Ft.
OTHER:
SL- S 10 C
d► Q. 0 Qr AL i�
10 Q?
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
ooh vv
Type of Construction: Estimated Cost.
Approx. Completion Date: ' 1 S QA
Alt. A OOozAlt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: V ' - I APPLICANT: � 1 --� Tei. #, 715?
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
0 KRQ
CITY USE ONLY
$ 4CM So Fee Schedule on Reverse Side
$ 25% of Building Permit Fee
$IQia $.50/$1,000 Valuation
$ $ 525 per SAC Unit
$ e Determined by Engineering
we -,1 reement Necessary [ ] Not Necessary [ ]
6 o®t
3011
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j
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yy d
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L �.
TES ACC
I.� Ani. kAthis is o 'Istow and'co�roti 4prese"Oulion Ol 0 wi.ey .414 the 1►oenduries of the land above dest,illed and of the
latetien-of all ►oildintr, i1 adli, tAere,ow, and all risibleeq"Ocitba,lents, if'any,
from of on *aid Fond. lhis s111rvey is
nlede only to �onr+eailion,r.+'th 0 nsorttpejjir loon' nowltp,grly, *he#ed de,*e palepersy and no Uabilisy ib osoelwee
eYtepl is tlsevA+ld�rr of:;idr< �N+grs o�e,4t ! is+h,�sr'rt'rta'Ft s�sslrr4`tnel;4F f"l� ,ewseo of Oath,ntorlel�. 1►, is
pritderstolgi oe� oltrred igJJ�4wwws+ 1 � �r ,dm�eNi ' i � I I w.R w1 is+►Ni�po i►19 ollp ellsbonp lot O"es 40 boundery
l SIIt . ' it+1 � N ��N� INC. I'�,jpYi
{E { t1 • d'M�'1 Sei �.OWOrtY; I' i , i Jt
,
., v: , � rr!'Jli�° Yi ,,. �,; ,aj t 11x1 �t, � I �I + ,;� ' t l �t'" 'Y. r° o l> i'. I ,, •ti I I , r , : n{; �If �;,
ten^ �h
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tl
SUBJECT
PERMIT NO: -_
City of Fridley
2 '6202
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
._
�iiEG`E1PTN0
_ COMMUNITY DEVELOPMENT DIV.
~ PROTECTIVE INSPECTION SEC.
,1
3 7"
I
NUMBER
REV
DATEPAGE
OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/9/98
JOB ADDRESS 1400 Osborne Road NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
$
2
Meadowmoor Terrace
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Ed Blando 1400 Osborne Road NE
784-0454
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO.
Tabor & Sons Inc 3716 St Francis Blvd, Anoka, MN 55303
789-1902 20014248
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
O NEW ❑ ADDITION ❑ ALTERATION JD REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (23 Sq) Tear -off
9 CHANGE OF USE FROM 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
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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,918
$.96
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-
Fire SC $1.92
T CTION OR THE PERFORMANCE OF CONSTRUCTION.
$62.25
x
PLAN CHECK FEE
TOTAL FEE
anl_,� �4�
License SC $5.00
$70.13
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
WHEN PROPER VALIDATED
c
BL INSP
THIS IS YOUP PERMIT
®r
r�ATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: IYoo 05-60/n '0 a 7 -
Legal
Legal Description: --
Owner
Owner Name & Address: d - J� L41 LD Tel. # % 3 Y
Contractor:/ � 5 e> �' _5 a, -z, s , C MN LICENSE # 60
Address: ?/ L 57 Fe;, o, s fy/c,n n, -Ale- Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF D4PROVEMENT
LIVING AREA:
Length
Width Height Sq. Ft.
GARAGE AREA:
Length
Width Height Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground Sq. Ft.
OTHER:-
THER:Construction
ConstructionType:
Estimated Cost: $ f 00
(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $ _ $
DATE: & -/0 '9 g
APPLICANT:
aJ-7� � Tel. #
CITY USE ONLY
�� �S
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ [ , 02-
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.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
$
STIPULATIONS:
NEW [ ] CITY OF FRIDLEY
ADDIS! [ J 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldglin
ALTER [v]' SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION 61A I l 5j
Construction Address: /-Od
Legal Description:
Owner Name & Address: tt ��✓ �a�t-� Tel. #_14. a - ?jr*- 45'4
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. ALDESCRIPTION OF IMPROVEMENT PAo
(A F-
LMNG AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length /cP- Width Hgt/Ground kj(t. Sq. Ft
OTHER: ,/ �S
o�
Construction Type: Estimated Cost: $ �v
/,gj
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x $ _ $
DATE: 6 ?A0 'r APPLICANT: v Tel. # �6 3 1-78T eYd
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.
op
Permit Fee 6 % 7 $
Plan Review $
Fire Surcharge ? $
State Surcharge -/q4 - -�
SAC Charge $
License Surcharge $
Curb Cut Escrow $
Erosion Control $
Park Fee $
Sewer Main Charge $
TOTAL $
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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:
, .,,,..,....,, , 4zj-, " , , ,.,
Building
PLUMBING
Permit No.: 200
Inspections
RESIDENTIAL APPLICATION
R e' ed
t-
763-572-3604
CITY OF FRIDLEY
�c d: 0
763-502-4977 FAX
P.F5XC WE 1-1-M
T)ATR I YOUR E-MAIL ADDRESS
SrrH ADDRESS I- e.
TIRS APPLICANT IS: 0 OWNER )(CONTRACTOR
PROPERTY
NAME: C7
OWNER/
AnT)RF.SS: l�t 0, OP 01 /\Je;7 CITY ^T STATI�'l_�1.IP
TENANT
PFTONK_�Q/ � " U%C/" !2ez 7 --
CONTRACTOR
NAME: 1 '
'
SUBMIT' A COPY QF
YOUR STATE
STATE LICENSE # BXP DATE
LICENSE, BUND AND
STATE 801%)#(P50-70.0--3 EXP DATE ' f
CERTIFICATE OF
AODRESSS: !E CIT J STATEN z k
INSURANCE
. _56-M-1
RIONISY 4. " FAX 4?!5&
PERMIT TYPE
XTNGLE FAMILY O TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
C NLW REPLACEMENT
OETA1LED DESCRIPTION OF WORK
PER MS 168.665 the permit fee is a minimum of $1,5.00 or $% of the total cost up to S500.60, 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 = .26.+ plus .50 surcharge
OR
FOR PROJECTS WHERE LABOR EXCL•'EDS $500, FFF4 ARE EASED ON $10.00 PER PIXTURL'•, EXCEPT WI IERE NOTED, FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW), MINIMUM FEE $15.50.
BATH STNKII.AV _FLOOR DPA1NS SHOWER _ WATER Pipmo '
_
BATHTUB _ GAS PIPTNO (NF.RD CITY LIC) _ SWIMMING POOL WATER SOFTNER ($35)
!
CLQ7'HI:S WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. (SIS)
—DISHWASHER _ LAUNURY'1'ItAY WATER HEATER (S35) FORIRRIGATION
—WATER METER OTHER
PERMIT FEE PROJECTS FOR UNDER $500
PERMIT FEE FOR PROJEO'fSYP.R $500
Permit Fee $
Number of fixtures Q $10.00 x $10.00 = $
Surcharge
Number of fixtures ® $15.00 _ x $15.00 - $
OR Number of fixtures @ $35.00 x $35.00 - $ _
TOTAL DUE $
State Surcharge -
MINIMUM $15.50 �
MINIMUM $15.50 Total =S
THIS IS AN APPLICATION FOR A PERMIT -NUT VAL10 UNTIL PROCESSED
I hereby apply for a plumbing 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 Fridlcy 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 on site; that the work will be in -accordance
with the approved plan ' e�1LSe o=work requires review and approval ofplan`s.
' _
SIIINA CURE L7F APP _ PRINT NAME . 1% IGEN 1 �L.�•U 1 j'Jl DATE' _41'7/00k_
APPROVED RY DATE
PLEASE NOT EPARAT ERMITS ARE RE UIRED, FOR BUILDINt1 ELECTRICAL AND MECHANICAL ORK
�City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
011
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