PRE 2010 DOCSSUBJECT
PER
City of Fridley
o 18172
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
r
RECEIPT O.
COMMUNITY DEVELOPMENT DIV.
S
r PROTECTIVE INSPECTION SEC.
3
1 ` �
1 /---1 CITY HALL FRIDLEY 55432
j
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
8/22/85
JOB ADDRESS 1564 Osborne Road N. E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR:
3
1
Blomberg Estates SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Garjac Inc. 481 - 206th Avenue N.E., Cedar, MN 55011 434-7096
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
J NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ ' REMOVE
B DESCRIBE WORK
Construct a 241 x 381 NNX Dwelling and at 22' x 201 Garage with an 81 x 10' Deck
SEPARATE PERMITS REQUIRED FOR
9 CHANGE OF USE FROM WIRING,' PLUMBING AND SIGNS.
STIPULATIONS Provide a hard surface driveway. Provide sod in the front and side yards.
Provide City with.copy of the verifying survey before capping.
SEWER LOCATION: (Approx. 11' Deep in Street) Service extended 30 feet south of
manhole (Inv. 893.88) WYE ELEVATION: 893.86 TOP OF FOOTING: 897.86 Minimum
WATER LOCATION: 103.7 feet east of water service serving property on west side
of this property.
DRIVEWAY DEPRESSION: N/A
,�lE
r� A I G
THE CITY OF FRIDLEY DOES NOT GUARA'h i tTHE
ACCURACY OF UTILITY LOCATIONS ANIS ELEVATIONS. Before digging call local utiliti
THIS DATA IS FOR INFORMATION PURPOSES ONLY, TELEPHONE - ELECTRIC - GAS Etc
AND PERSONS USING THIS INFORMAMN SHOULD,
REQUIRED BY LA
VERIFY IT ON THE SITE.
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
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
$59,150
$29.58
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
8.25
$845.83
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
W N P QP A ID ED THIS IS YOUR PERMIT
DG INSP riA7E
SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE)
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✓. r 'I '
NEW City of Fridley Effective 4/1/84
ADDN. [ ] �R-1 AND R-2 j
ALTER. [ ] Building Permit Application
Construction Address:'Ovc
/�7�
Legal Description: LU/ 614, /
Owner Name & Address: Tel. #
Contractor:_ �e�/e-fl C /'N C- Tel. # 5�3 t/-- %°�•�
Address • 02 0 6 /-� /? `Js2 N� f Q��R a. _ S-ro
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width_ Height 8
Length a2 Width 20 . Height
Length Width / 0 Hgt/Ground
Sq. Ft. 1040
Sq. Ft. W4'D
Sq. Ft.
Corner Lot [ ] Inside Lot P6 Ft. Yd. Setback _ Side Yard Setback 30
Type of Construction: eT4(I _ Estimated Cost: $ �.
Approx. Completion Date: (�C l �/ 5q , Go
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: 0Lj A $ $
See Back Page for Explanation
DATE: APPLICANT:
Tel. #
CITY USE ONLY
Permit Fee $ 0c) Fee Schedule on Reverse Side
Plan Check $ r) 01 25% of Building Permit Fee
State Surcharge $ c) q $.50/$1,000 Valuation
SAC Charge $ �Zo $425 per SAC Unit
Park Fee- $ Fee Determined by Engineering
Sewer Main Charge $
TOTAL $
y 3 Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS:
.A
on
Surveyor's Certificate
COMSTOCK & DAVIS, INC. Consulting Engineers and Land Surveyors
1446 County Road J, Minneapolis, MN 55432, (612) 784-9346
SURVEY FOR:
B & G Investments
961 Hillwind Road
Fridley, Minnesota 55432
GUARANTEE THE ��� d1"30tl' 0111
OF FRIDLEY DOES NOT SSP,
THE E�CI MOPLE e ELIC 1M ,
ADM RACY OF UTILITY LOCATIONS pURp�SESTONLY, r `� F, �� ; •-, _
,��Q�(+TION SHOULD ,n
TWS DATA IS FOR INFORMATION_ _ lV I y �� UIR ` D
AND PERSONS USING T
VERIFY IT ON THE SITE. Q�Q
27.74'
N 84* 4T' 0+ n W -
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69
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DESCRIPTION 1
Lot 3, Block 1, Blomberg Estates, City of Fridley, Anoka County, Minnesota.
SCALE: 1" = 40
.0 Denotes 1/2'.' diameter iron pipe monument set and capped No. 10832.
I hereby certify that this survey, plan or report was prepared by me or under my direct
supervision and that I am a duly Registered Land Surveyor under the laws of the State
of Minnesota.
10812 Nov. 17, 1980 4273 9
Reg. No. Date Job No. Book No.
11Ar -T-I
/Of
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G,.) 6d&;�7- S�� IF
,pl,ld Pye,�5�-510 ,L,/
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CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On January 1, 1999
PLUMBING FIXTURE RATES
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater —Electric
Water Heater — Gas**
Gas Range**
NO. RATE TOTAL
Gas Dryer** _
Back Flow Preventer Required ( )Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ 7.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $42.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge $ .50
TOTAL FEE
JOB ADDRESS � 1� OS�)eljlNE
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
CJ , 1999
Building Used As
Estimated Cost PERMIT NO.
PLUMBINGCOMPANY
SIGNED BY TEL NO.
Approved By 1(r 1Z Rough—In Date
M
Final DatA
**COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6—A. MINIMUM SIZE 9 SO INCHES.
11
FROM :CITY OF FRIDLEY FAX NO. :7635711287 Oct. '09 2008 10:56AM P5
Building MECHANICAL Permit 2_D
Insp9Gtions RESIDENTIAL APPLICATION Rei ,' Vpy�..
7b3 -572-3b04 CITY OF FRIDLEY �
763-502-4977 FA EFFECTIVE w -os
DATkI K. I, CJ� YOUR F MAIL ADDRESS v2 %lei S 1pf Jr�b It
SITE ADDRESS /Q4 6 � titr .. _
THIS APPLICANT 1$; ❑ OWNER OLCONTRAM.)K
PROPERTY
O��� DRESS; ,. CITY __.. _ $T TF_ _ _"LIP
NOP
SEPARATEE CITY
LICENSEFOR S wti ARE
RL+(JIIANDHYAG,G�
SUBMIT COPY OF BOND
ANDINSURANCE
CONTACT PERSON: ,. ...... _. .._
SATE LICENSE _ EXP DATE_ y ,_.a _ STATFI ZIP �
DRCSS:�t°l�'�� u! —*�
P TONE _ FAX_„_,.
PERMIT TYPE
111 S[NGLE FAMILY D TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORD:
ClNEW )(REPLACEMENT O ALTERATIONIREMODEL
DETAILED DESCRIPTION OF WORK ray} t iN A Ci&T
PER MS 1613.665 the port rdt fee Is a minimum of $15.00 or S% of the total Cost vp to $500.00, whichever Is ,greater, fdr the
improvement, installation r replacement of a residential fixture, excluding the fixtures, (This should reflect only the cost of labor)
Strata Surcharge = $��Q
OR
Labor cost under $300 = . 15.00. Labor cost between $300 to $500 - cost of labor _ „ X'05 = _
FOR PROJECTS WHSItF I.AB R EXCELDS S500. FEB$ ARE BASER ON $10.00 PER FIXTURE, EXCEPT W14ERENOWA), FIXTURES: (INDICATE TOTAL
NUMBER OF EACII BELOW)
Equipment installod MFC3 r:.z, .(c� ,.... MODEL: .._ . wrLE/BTU i5,��'J _
I hereby apply for a maAaniciti permit and 1 ocknowledaa that the infomtation above is compleru end ammtc; that the work will be in confimnewc with the ordinenow
MFCi; MOD9L: ., SWBTU
and with the Mirtoesofa Conatructim Codes: that I undetsnes,d this is not a permit but only on application for a permit and work Is nm to
MPO: MODEL: _ .... sizMTU _.
A/C $25.00
,�.-v�
FIREPLACE (GAS) $15.00 OAS RA OFJOVEN $10.00
OAS GRILL S10.00
_AIR TO AM EXCHANO
FOILER 533.00
$15 FIREPLACE (WOOD) $35.00 NEW
X_FURNACE 535.00 GAS UNIT HTR SI0.00
X( CHIMNEY LINER $10.00OAS DRYER $10.00 POOL HEAWR S35.00
1111 Ur wQRK slo.M
OAS PIPING 510,00 VE fI1..ATOR $15.00
Permit Fee
$ Number of fixtures $10.00 x .W =
Surcharge.
50 Number of fixtures Qa $15.00 x $15.00
TOTAL DUE
$ � OR Number or fixtures @ $25.00 x $25.00 - $ _
_�
Number of fixtures @ $35.00 _ x $35.00 - $�
Strata Surcharge = $��Q
NIM MUM 513.50 MINIMUM $15.50 Tata!
TIUS [SAN APPLICATION FOR A PERMIT -NOT VALID UNTIL PR(WESSED
I hereby apply for a maAaniciti permit and 1 ocknowledaa that the infomtation above is compleru end ammtc; that the work will be in confimnewc with the ordinenow
and wiles of the City of Fridley
and with the Mirtoesofa Conatructim Codes: that I undetsnes,d this is not a permit but only on application for a permit and work Is nm to
start without s permit; that the v
ork will be in accordance with the approved plan in the was of all work which requires review and approval or plans.
SIGNATURE OF APPLI
ANT �-- PRIN'r NAME• 1�^^�_nA'1,'C it3
APPROVED BY
DATE., _
City of Fridley
Building bspections Department
6431 University Avenue NU, Fridley, MN 55432
763-572-3604 FAX. 763-502-4977
10-09-2008 09:53 2 GUYS PLUMBING AND HEAT 7634988380 PAGES
FROM :CITY OF FRIDLEY
FAX NO. :7635711287 Oct. 09 2008 10:56RM P3
Form State of Minnesota
'SP: 1 License Applicant Information
Under Minnesota 1 (M.S. 270.72), the agency issuing you this license is required to provide the Minnesota
Commissioner of kwenue your Minnesota business tax identification number and the Social Security number
of each license apph mt.
Under the Minru sota, Government Data Practices Act and the Federal Privacy Act of 1974, we must advise
you that:
• This information may be used to deny the issuance, renewal or transfer of your license if you owe the
Minnesota ant of Revenue delinquent takes, penalties, or interest;
• The Licensing ency will supply it only to the Minnesota Department or Revenue. However, under the
Federal Exchan a of Information Act, the Department of Revenue is allowed to supply the information to
the Internal Rev us Service;
• Failing to suppl thiis information may jeopardize or delay the issuance of your license or processing your
renewal applicat on.
Please fill in the following information and return this form along with your; application to the agency
issuing the license. Do not return this form to the Department of Revenue.
Personal information:
10-09-2008 09:52 2 GUYS PLUMBING AND HEAT 7634988380 PAGE3
Proof of Workers Compensation Insurance Coverage
Minnesota Statute Section 176.182 requires ovary state and local licensing agency to withhold the issuance or
renewal of a license
or permit to operate a business or engage in an activity in Minnesota until the applicant
presents acceptable evidence
of compliance with the workers' compensation insurance coverage requirement of
MSS Chapter 176.
a information required is: The name of the insurance company, the policy number, and
dates of coverage or
the permit to self -insure. TW�ii f=ation will be colJSgtgd by the licensing aaen wW
retained in tb* files
This information
is required by law, and licenses. and permits to operate a business may not be issued or
renewed if it is not
rov.ded and/or is falsely reported. Furthermore, if this information is not provided and/or
falsely reported, it
y result in a $2,000 penalty assessed against the applicant by the Commissioner of the
Department of Labo
and Industry.
Provide the in . 'on specified above in the spaced provided, or cer iify the precise reason your business
is excluded from co
pliance with the insurance coverage requirement for workers' compensation.
17 I am not reqt tired to have workers' compensation liability coverage bocause:
❑ I have no em
ployees covered by the law.
❑ I am self insi
Lred (include permit to self -insure)
❑ I have no ex
iployees, who are covered by the workers' compensation law (these include: Spouse,
Parents, Childrei
i and certain farm employees)
j
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Tide Date
10-09-2008 09:52 2 GUYS PLUMBING AND HEAT 7634988380 PAGE3