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PRE 2010 DOCSBUILDING PERMIT Village of Fridley, Minn. N° '2952 2952 Datet'ev. .c ..... �..� ........... Owner :. Builder .............`.. 6 % Address Address'v .®. ®.................... �d4o /LOCATION OF BUILDING No. ...... Street ... '... . �'=�' .......... Part of Lot ....................... e � Lot ............ Block ................ A dition or Sub -Division u!... a444...4 c.... Corner Lot ............ Inside Lot ....`... Setback 3i7....... Sideyard DESCRIPTION OF BUILDING To be Used as: .. Front ... Depth �.... Height Sq. 4 e Cu. Ft. ........ .................... ont ........ Depth ........ Height ......... Sq. Ft......... Cu. Ft........ Type of Construction ?its, Est. Cost,.�.�...... 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 forth ands"in compliance with all provisions of ordinances of the village of Fridley. In consideration of the payment of a fee of $.. , permit is hereby granted to"77WAW490A. . f ...................... . 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 with- in the village limits and this permit may be revoked at any time upon violation any of the provisions of said ordinances. r"n Building Inspector NOTICE: This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate permits for these Items. Y-g9:� City of Fridley, NUnn. N° 7 918 BLUDING PERMIT Date: June 1L 1965 Owner: Ann Cele Builder L., G• Olson Address 331 fey St` N.F. Address 126 Carol Tene w. Saint Paul LOCATION OF BUILDING NO 6311 Street Quincy St' N.V. Part of Lot Lot 10 —Block 8 Addition or Sub -Division Chdstie Add, Corner Lot Inside Lot Setback Sideyard Sewer Elevation ____ Foundation Elevation DESCRIPTION OF BUILDING To be Used as: Front Depth height Sq. Ft Cu. Ft Front Depth Leight Sq. Ft Cu. Ft Type of Construction Est Cosi A 800 _ __ To be Completed Repair Storm Damage In consideration of the issuance to me of a permit to construct,the buildiTdes'bed above I agree to do the proposed work in accordance with the description above set ce with visions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 10• , permit is hereby granted to 00 A.Go OlBD 71 to construct the building or addition as described above. This permit is granted upon the express condition that the peon 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 Emits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. Allen Jensen NOTICE: Ills permB don net cover the sondruaHoe, hutalla = for *fib& phmbhi, gas heatb& sewer or water. Be sure to see the Bumbe hmpestor for separate perm;ts for these Baum APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S LOCATION OF BUILDING. No, Street Part of Lot 1 LOT / d BLOCk ADDITION OR SUBDIVISION I Corner.Lot�_Inside LOT Setback Side -Yard .:SEWER ELEVATION FOUNDATION ELEVATION Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. To be used as: DESCRIPTION OF BUILDING Front Dept Height Sq. Ft. Cu. Ft. Front Depth Height Sq. - Ft: Cu. Ft. Type of ConstructionEstimated 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 bIL SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). 'w y t F 1 1-e --�, A 7- a 2— City of Fridley Building Inspector Minneapolis, Minnesota 55421 Dear Sir: 6311 Quincy Street Northeast Minneapolis, Minnesota 55421 November 15, 1967 This letter is to inform you that on my property at 6311 Quincy Street Northeast I am constructing a temporary shelter of wood and polyethylene materials. This shelter is to be used as protection from the elements while I am building a sailboat to be used for recreation purposes. The size of the shelter is 18 ft. x 28 ft. I plan to dismantle the shelter before summer of 1968. I have discussed this project with 2nd Ward Councilman Ray Sheridan and received his approval. I trust that you will file this letter for future reference. Sine y, Raymond N. Pasch ml APPLICATION FOR BUILDING PEEN CITY OF "J= Y, MINNESOTA- -OWNER'S INNESOTAOWNER'S NOE, �: C!� q UILDER -� _•,._ . APDRE$$„„.6f/ . r. / r ey r v _.jr . -ADDRESS:.; LOCATOIY `OF BUILDING NO./ / STREET :• �/' �,..%r��,+�s��:% :LOT BLOC K,r DITIOPi OR SUBDIUC S CO1U3ER LOT INSIDE LOT_ SETBACK •> : SIDEYARDi SEWIR ELEVATION TOP OF FOOTING Applicant attach to this ,,form .Two Certificates .of . Surveys of Lot . and proposed buildinglocation drawn on ,these Certificgtes.; DFSG,P4,PT,1QN OF BUnMING To Be Used As:jk c ..Daptu Square feet _ .Cubic .Feet Front... Defpt :Height, Square feet Cubic Feet Type of Construction 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 _ •:1�G's' _SIGNATURE (Schedule of Fee Costs can be found on the Reverse Side). P ULAK.GNUh BBL15LB SUBJECT PERM[ ®f Fridley 12313 AT THE TOP OF THE TWINS BUILDING PERMIT I PERM I Ir?City ECEIPT NO. L _--- COMMUNITY DEVELOPMENT DIV. -- INSPECTION ri PROTECTIVE SEC. � i "l CITY' HALL FRIDLEY 55432 NUMBER REV DATEPAGE OF APPROVED BY 612-560-3450 910-F15 9 / 6 / 7 3 JOB ADDRESS6 311 Qui cy Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 8 Christie Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Raymond D. Heselton 6311 Quincy Street N.E. -i-CONTRACTOR MAILADDRESS ZIP PHONE LICENSE NO. 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING garage 7 CLASS OF WORK Cj NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct 22x24 detached garage 9 CHANGE OF USE FROM TO STIPULATIONS 1. Provide a hard surface driveway. SEPERATE PERMITS REQUIRE® FOR MIRING, HEATING, PLUMBING AND SIGIVS.A TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, wood frame 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 528 5,280 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 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING TYPE F WORK WILL BE $ 2 371.84 $1.19 WITH WHETHER SPECIFIED HEREINIOR NOTOTHE GRANTING OF AOPERMIT ! DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMITFEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 10.00 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE $1119 EN PROPER VA ATED THIS IS Pv/E�gRMV SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) Z BLDG INSP DATE S GNATURE OF OWNER IIF OWNER BUILDER) DATE)' ULAK.GNUh BBL15LB p APPLIOATION FOR RLSIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF I -1:I DLLX , M I NNESOTA OWNER'S NAME : "y� D -Da &,1jC QA i BUILDER: ADDRESS : 66 311 QuB51, � A-49, ADDRESS: NO;.63)I --STREET: 0_0'jN e LOT:— I Q BLOCK ; F 7 ADDITION: CH e l sT ► E:_r CORNER LOT: INSIDE LOT: SETBACK: SIDEYAFD: Applicant attach to this form Two Certificates of Survey of Lot and proposed buildiaig location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: !RI F- Front: Ll Depth: Height: Square Feet: :� A ® Cubic Feet: Front: Depth: Height: Square Feet; Cubic Feet: Type of Construction: F�P,(V\ Estimated Cost: To Be Completed: % e/ The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stfict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that .;Il the facts and representations stated in this application are true and co rrvct. DATE: 1AL3- CQ- - ^� (See Reverse Side For Additional Information.) oe.�y z� �g'`n ad �✓Erre �sµ�. k March 23, 1982 CITY OF FRIDLEY 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 TELEPHONE ( 612)571-3450 Custom Pools 601 East Excelsior Avenue Hopkins, MN 55343 Re: Swimming Pool Construction at 6311 Quincy Street N.E., Fridley, MN Dear Sirs: This letter is to make clear this department's requirements for the swimming pool construction at the above address. 1. As indicated, two (2) skimmers approved by the National Sanitation Foundation will be provided. 2. As indicated, four (4) inlets of approved design for fresh and/or repurified water will be provided. 3. As indicated, a main drain of approved construction will be provided. 4. The filter and pump shall be approved by the N.S.F. and be of sufficient capacity to provide a minimum turnover of at least two (2) times in 24 hours. This department recommends a turnover rate of 6 - 8 hours. 5. A deck of at least three (3) feet wide, measured from the pool waters edge, shall be provided which extends completely around all private residential pools. Above ground private residential pools may be provided with decking of a minimum size of 4 feet by 4 feet at pool entry points and provided that such decking has the approval of the City. 6. The diving area will be acceptable provided there is no overhead obstruction. 7. Fencing or other effective means including but not limited to walls or buildings, acceptable to the City, shall be provided to positively control all access to public and private residential swimming pools. Fencing shall meet the following criteria: (a) !he fencing shall prevent the entrance of children and be without hand or foot holds that would enable a person to climb over it. (b) The fencing shall be at least 6 feet high and entrances shall be equipped with self-closing and self -latching gates capable of being locked. (c) Self-closing and self -latching devices shall be placed at the top of the gate or otherwise inaccessible to small children. (d) The opening between the bottom of the fence and the ground or other surface shall be not more than four inches. 8. An automatic chlorinator should be provided with a suitable test kit. 9. All electrical and plumbing installations shall be inspected and approved by the City Inspection Department. a Custom Pools March 23, 1982 Re: 6311 Quincy Street N.E. Page 2 10. All overhead electrical lines must be a minimum of 10 feet horizontally from the pool surface and 18 feet straight line distance from the waters edge. An alternative is to bury said lines. 11. The pool fill spout must be protected by a vacuum breaker or air -gapped. 12. Suitable safety equipment to include but not limited to a ring buoy and rope that is 12 times the. pool diameter, and shepherds crook pole must be provided and maintained with the pool at all times. Furthermore, these and any other requirements must meet the provisions of the -Fridley City Code, Section 115, Swimming Pools. The building permit is approved contingent on final inspections and approval by the City. If any questions or problems arise from this letter, please feel free to contact me at 571-3450. Sincerely, a S VEN J. O ON, R. S. Environme Officer SJO/mh CC: Mr. Ray Heselton 6311 Quincy Street N.E. O. 6505 SUBJECT City of Fridley OER P, AT THE TOP OF THE TWINS BUILDING PERMIT r 1 6 RE COMMUNITY DEVELOPMENT DIV. r � PROTECTIVE INSPECTION SEC. � HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY j 612-571-3450 910-F15' 3/24/82 / / JOB ADDRESS 6311 Quincy Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 8 Christie Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Ray Heselton 6311 Quincy Street N.E. 571-2067 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Custom Pools 601 East Excelsior Avenue., -'Hopkins, MN 55343 933-2255 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 an 18' x 36' Inground Swimming Pool 9 CHANGE OF USE FROM TO STIPULATIONS See stipulations on letter dated March -23, 1982 by Environmental Officer. WARNING SEPERATE PERMITS REQUIRED FOR AfIR G Before digging call local Utilities HEATIM, PLUMBING AND SIGNS. TELEPHONE - ELECTRIC - GAS Etc. REQUIRED BY LAW 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 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 $8,500 $4.25 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- $74.50 NONE STRUCTION OR THE PERF RMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTALFEE ��. $18.63 $97.38 a, SNATURE OFC NT AC O R OR AUTHORIZED AGENT (DATE) . •a. WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT GNATURE OF OWNER IIF OWNER BUILDER) IDATEI BLDG INSP� v DATE O. 6505 CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDENTIAL BUILDING PEFU41TS (New, Alterations, Additions, or Repairs) OWNER: !j1\061 r ADDRESS: TEL NO: -S-7/ - �. BUILDER: ADDRESS: Cn TEL NO: Construction Location - STRIMT NO: �' ?' d STREET: LOT: I BLOCK: c ADDITION: Corner Lot: Inside Lot: Setback.: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION j� Front: Depth: Height: Squame -Feet: Cubic Feet: Front: Depth: Height: Square -Feet: Cubic Feet: Type of Construction: 2--n G rc�jn� �L,? i vlA7 o �c G Estimated Cost: $ 6, C3 'Ib Be Cbmpleted: I ' Alt. A Alt. B Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SIDE OF SHEET Mie undersigned hereby makes application for a permit for the work- herein specified, agreeing to coo ,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 -'dare true an 7 : rect. SIGNATURE: r DATE: ID � P� `�,C"( C C Stipu]ations: arawg March 23, 1982 x Mimi i a i _;q wi 6431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 Custom Pools 601 East Excelsior Avenue Hopkins, MN 55343 TELEPHONE ( 612)571-3450 Re: Swimming Pool Construction at 6311 Quincy Street N.E., Fridley, MN Dear Sirs: This letter is to make clear this department's requirements for the swimming pool construction at the above address. 1. As indicated, two (2) skimmers approved by the National Sanitation Foundation will be provided. 2. As indicated, four (4) inlets of approved design for fresh and/or repurified water will be provided. 3. As indicated, a main drain of approved construction will be provided. 4. The filter and pump shall be approved by the N.S.F. and be of sufficient capacity to provide a minimum turnover of at least two (2) times in 24 hours. This department recommends a turnover rate of 6 - 8 hours. 5. A deck of at least three (3) feet wide, measured from the pool waters edge, shall be provided which extends completely around all private residential pools. Above ground private residential pools may be provided with decking of a minimum size of 4 feet by 4 feet at pool entry points and provided that such decking has the approval of the City. 6. The diving area will be acceptable provided there is no overhead obstruction. 7. Fencing or other effective means including but not limited to walls or buildings, acceptable to the City, shall be provided to positively control all access to public and private residential swimming pools. Fencing shall meet the following criteria: (a) The fencing shall prevent the entrance of children and be without hand or foot holds that would enable a person to climb over it. (b) The fencing shall be at least 6 feet high and entrances shall be equipped with self-closing and self -latching gates capable of being locked. (c) Self-closing and self -latching devices shall be placed at the top of the gate or otherwise inaccessible'to small children. (d) The opening between the bottom of the fence and the ground or other surface shall be not more than four inches. 8. An automatic chlorinator should be provided with a suitable test kit. 9. All electrical and plumbing installations shall be inspected and approved by the City Inspection Department. Custom Pools March 23, 1982 Re: 6311 Quincy Street N.E. Page 2 10. All overhead electrical lines must be a minimum of 10 feet horizontally from the pool surface and 18 feet straight line distance from the waters edge. An alternative is to bury said lines. 11. The pool fill spout must be protected by a vacuum breaker or air -gapped. 12. Suitable safety equipment to include but not limited to a ring buoy and rope that is 11j times the pool diameter, and shepherds crook pole must be provided and maintained with the pool at all times. Furthermore, these and any other requirements must meet the provisions of the -Fridley City Code, Section 115, Swimming Pools. The building permit is approved contingent on final inspections and approval by the City. If any questions or problems arise from this letter, please feel free to contact me at 571-3450. Sincerely, S VEN J. OIS N R.S. Environmental Officer SJO/mh CC: Mr. Ray Heselton 6311 Quincy Street N.E. 01 SUBJECT P City of Fridley 16636 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. COMMUNITY DEVELOPMENT DIV. r 1 PROTECTIVE INSPECTION SEC. fl�� 1 � � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY L 612-571-3450 910-F15 6/14/82 JOB ADDRESS 6311 Quincy Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 8 Christie Addition SHEET 2 PROPERTY OWNER MAILADDRESS ZIP PHONE Ray Hesselton 6311 Quincy Street N.E. 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 x 8 DESCRIBE WORK Constxuct a 121 x 24' Deck 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. Wood, 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 ] 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 $1,600 $•80 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. $26.50 PLAN CHECK FEE TOTAL FEE $27.30 SIGNjkTUREOFCONT A TORORAUTHORIZED AGENT (DATE) WHEN PROPERLY LIDATED THIS IS YOUR PERMIT BLDG INSP DA E SI NA�01 jR fIF OWNER BUILDER) (DATE) 01 CITY OF FRIDLEY Effective Aug. 1, 1981 APPLICATIM FOR RESIDENTIAL BUILDING PE-R14ITS (NEw, Alterations, Additions, or Repairs) OWNER: , � � �d ���� BUILDER: ADDRESS: I�,� ADDRESS: TEL NO: TEL NO: Construction Location • STRIST NO: STREET: 0 LOT: BLOCK: ADDITION: Corner Lot: Inside LotsSetback: Sideyards: Applicant attach to this form two Certificates of Survey of lot and proposed building location drawn on certificates to scale. DESCRIPTION OF CONSTRUCTION Front: Depth: Square Feet: Cubic Feet: Height: Front: Depth: Height: Square -Feet: Cubic Feet: Type of Construction: Estimated Cost: $ ' (® o Rb Be Completed: Alt. A Alt. S Proposed Driveway Width If New Opening Is Desired: $ $ SEE REVERSE SID£ OF SHEET Mie 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: � � 7/ SIGNATURE: Stipulations: 00 SUBJECT ER City of Fridley 2 512 AT THE TOP OF THE TWINS BUILDING PE MIT RECEIP . 1 96_ COMMUNITY DEVELOPMENT DIV. PROTECTIVE INSPECTION SEC. ^ ` L/J 9 r ; CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-571-3450 910-F15 8/24/92 JOB ADDRESS 6311 Quincy Street NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 8 Christie Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ray/Kathy Heselton 6311 Quincy Street 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Pine Ridge Construction 2735 196th. Ave NE CEdar MLV 55011 414-S SR 5126 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 Ej ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Replace living xoom window 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. ZONING SQ. FT. CU. FT. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT NO. DWLG. UNITS OFFSTREET PARKING ANY TIME AFTER WORK IS COMMENCED. I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES VALUATION SURTAX AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,900 $.95 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT PERMIT FEE SAC CHARGE DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $43.00 Fire PLAN CHECK FEE TOTALFEE License SC $5.00 $50.85 SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) WH E P ERY Al ATED THIS IS YYOO)UR7PEERMITT BLDG )NSP DATE SIGNATURE OF OWNER OF OWNER BUILDER) (DATE) NEW [ ] Effective 3/1/92 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: Legal Description: Owner Name & Address: Contractor: -I , u e- P (2 W54� Tel. # MN LICENSE # O O ® Address: 2 93 -5--19 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 GARAGE AREA: Length DECK AREA: Length OTHER: plev jj Comer Lot [ ] Inside Lot j ] Type of Construction: Approx. Completion Date: Driveway Curb Cut Width Needed: Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. Pk Ft. Yd Setback Side Yard Setbacks Estimated Cost: $// 07)UO c Ft. + 6 Ft = Ft x $. (Cost on Back) DATE: y APPLICANT: Tel. # 3 �� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge $ 40p, 00 $ 1, 949 Driveway Escrow $ _, Park Fee $ Sewer Main Charge $ TOTAL STIPULATIONS: CITY USE ONLY Fee Schedule on Reverse Side .001 of .Permit Valuation, (1/10th%) $.50/$1,000 Valuation $700 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ �] CITY OF FRIDLEY INSPECTION DIV. 8431 University Ave NE Fridley, MN 55432 572-3604 Effective On January 1, 1 990f, APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR Stories Urinal . . . . . . . . . . . . . . S ower h $7.00 Wash Tray $ ICOO Floor Drain fi-i"I h`llii ... Auto. Gas . ...... Washer Ranq 1 . . . . . . . Water Heater Uas Elec Basement Rain Water Leader $ 7.00 Sump/Receiving Tank $7.00 Water Treating Appliance $10.00 ....... ........... -1 Water Heater — Gas Floor 1 Gas Range $10.00 Gas Dryer $10.00 Back Flow Preventer'Required )Yes No typeirl"Lo %0_5 45.00 Floor 2 00 3 FI r Floor 4 PLUMBING FIXTURE RATES: NO. RATE TOTAL New Fixtures $7.00 Old Opening, New Fixture $ ICOO Beer Dispenser $5.00 Blow Off Basin $7.00 Catch Basin $7.00 Rain Water Leader $ 7.00 Sump/Receiving Tank $7.00 Water Treating Appliance $10.00 Water Heater —Electric $7.00 Water Heater — Gas $10.00 Gas Range $10.00 Gas Dryer $10.00 Back Flow Preventer'Required )Yes No typeirl"Lo %0_5 45.00 Reinspection Fee $30.00 ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1% of Value of Fixture or Appliance State Surcharge TOTAL FEE JOB ADDRESS 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. Owner Building Used As Estimated Cost PERMIT NO. PLUMBING COMPANY SIGNED B TEL NO. 0 L) Q1 J -z Approved ough—In Date Final Date .50 MINIMUM FEE 'FOR ANY PLUMBING/GAS PERMIT IS $15.00 $ PLUS THE $.50 STATE SURCHARGE 6 2 5 SUBJECT '"PEfrmIT - City of Fridley 2 7 8 89 AT THE TOP OF THE TWINS ?_ BUILDING DLRvIT r 1%GE4PT_N0_ 1 11 -------COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE � O 1 � = CITY HALL FRIDLEY 55432 NUMBER --i-"Ev DATE PAGE OF APPROVED BY 612-571-3450 910-F/5 9/21/98 JOB ADDRESS 6311 Quincy St NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 10 8 Christie Addition SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Mike Zabukovec 55432 574-1147 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO 5 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION :0 REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Reroof house & garage (19SQ) 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 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 $1,628.00 $.81 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. $54.00 Fire SC $1.63 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEETOT FEE $56.44 SIGNAT RE F CON. RACTOR OR AUTHORIZED AGENT IDATEI EN PRO Y VALIOA THIS If�f�UR PERMIT N4Ui �y 722 S�GN4TURE OF OW NE RIIF OW NER BUIIDERI IDATEI BOG INSP Da tE NEW [ ] ADDN [ ] ALTER [ ] ConstructionAddress: Legal Description: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effective 1/1/98 Owner Name & Address: ,— ,C�,� 7� �� � v Tel. # Contractor: 0 (AU MN LICENSE # Address: S' g: - Tel. # --- Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EWPROVEMENT LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Len Width Hgt/Ground Sq. Ft. OTHER: �� r� - l '�;' S-0 U Construction Type: Estimated Cost: $ /4,2<S (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ s DATE: / - APPLICANT: Tel. . STIPULATIONS: CITY USE ONLY Permit Fee $ NW 66 Fee Schedule on Reverse Side Fire Surcharge $ Z, .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 $ s- 7 . STIPULATIONS: 3uilding BUILDING Permit No.• Inspections RESIDENTIAL APPLICATION Received By 763-572-3604 CITY OF FRIDLEY Date Rec'd: --� 45?1 )ATE©b ,ITE ADD SS G'? .HIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: YOUR E-MAIL ADDRESS ❑CONTRACTOR STATE LICENSE EXP DATE TEMZIP �iSY3Z ADDRESS: CITY STATE ZIP PHONE D SINGLE FAMILY/NI ❑ TWO FAMILY/NEW D ADDITION D BASEMENT FINISH D DECK D NEW D MALT DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT! ROOFING NUMBER OF SQUARES L GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING D Vinyl D Aluminum D Other WINDOWS IN EXISTING OPENINGS ❑Yes ONo OR FOR NEW OPENINGS -DESCRIBE SIZE OF OPENING CHANGES & TvaF. nF WINDOW TO BE INSTALLED FAX N CONSTRUCTION :ONSTRUCTION D GARAGE/SHE KROOF D SIDING D SWIMMING P( D ADDITION AIR D REMODELINC LENGTH D HOUSE ONLY KHOUSE & GARAGE D ATTACHED GARAGE )?f DETACHED GARAGE ❑Soffit D Trim D Fascia LOCATION OF WINDOWS NUMBER OF SIZE STORIES D WINDOWS D DRAIN TILE D OTHER WIDTH HEIGHT Ft. BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS & PORCHES SUBMIT: I. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING 199 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ See Back Page for Fee Schedule $ _ 4�� 65% of Building Permit Fee $ .001 times the total job valuation $ �,�.0005 x Permit Valuation Minimum $.50 $ $5.00 (State Licensed Residential Contractors) $ $1550 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$20=$ $ $450 Conservation Plan Review $ Fee Determined by Engineering $ Agreement necessary ( ) Non Necessary( ) $ _ Make checks payable to: City of Fridley Attach Stipulat 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 all work which requires eview and approval of plans. SIGNATURE OF APPLICANT_ i _�„ PRINT NAME SLAM � t �-S DATE FROM :City of Fridley FIX NO. :7635711287 May. tab 2106 03: 45PM P3 $uiixi BUILDING Permit No. g Inspections RESIDENTIAL APPLICATION Rc��ivt;(1$y: , — 7f 3-572-3604C:'ITY OF I+'Rll]LEY Date RCC'd: L)A 1'L YOUR F, MML ADI)RFSs SITF AL)t)RESs _... 'I'w,li APPLICANT 15: 0 OWNER 000NTRAC7(.)R IyROPER'PY t7WNER/_> NAMY'...../� TENANT ADURE5S: q l h T'IIONft: 1 CONTRACTOR NAM F:: ^ � e k' SUBMIT CC1F1' U1 STATF I.IC;ENS 11 EXP DAM. _._ ._. R!'V" tP YOUR S'I'n1T LICI?NS.F, ADDRf (.I"r^Y I STAT. _ . WITH APPLICATION rlloNl� - Y.Z. iAx PROPERTY TYPE SING A ILYRNEW CONSTRICTION © Two FAMILY(NtIW CONSTRUCTION PERMff TYPE 0 ADDITION ❑ GARACiAISHED 0 WINrx)WS I;1 RAREMENT FINaSH n ROOF 0 TRAIN TILE O J)1?&K bMIDnNG 0 OTIi" ja swiMMING, POOL TYPE OF WORK: 3VFw C) A.nnFi ON OMA INTRNANCLIRErAIR -MODFIaN+I -- DESCRIBE WORK 13FTNCi DUNF:- S )` SlF1PPCVLPNT HFCHT 1't•_1)HC_ $ C. 0 Hilo: I ONLY NTTMBER QF SUI)AitHS „_ 0 HOUSE & GARAGE3t�ASY'.MENT ISi1V3U!?F..] ING 3LMMIT: 1. Existing F'lonr Plan GARAGM Q A't't'ACIiIM GAR.AC:41i �. Frn anti floor plan PROPOSED S17F..: 0 Lti1~TA.CII'. T) OAl2AGE 3. 'List of structural -embers to be user! rROPOSi,a)IimGI3T: 91IIb1N POR NEW C't)NSTRUCTION INCLUDING DE(_KS, D Vinyl 'r:' AJ)1)1'no NS c .Pl?RCHAS SUB IT El VinylMuni um��, % Trim I. site FlsaofSurvey showing the existing structilrea Other T/uC�l Na 'ia andpriposeclrr�ject. �-- % 2. Two sets of construction plans WINDOWS 3. FncrgyCalculutions IN 1 xlSl'INC; OPENINGS 13Yes ONO LOCATION OF WINDOWS OR FOR NE. W OPEN)ws-DrSCROE S)ZF, OF OPENING CHANMS & TYPE OF WINDOW TO BE MI'ALLM, NUMNhR OF WINDOWS ALTFEES ARE BASER► ON VALUADO N, INCLUDING 't"T1E COS'!' t)b''LABOR AND .MA"TERIA.T S: (USING'; THE 1997 U.BI.0 FEE SC:H.FIDULE) TOTAL JOB VALUATIONS Permit Fee $ ,S:_ r' See Bank Page for Fee Schedule Plan. 65% of Building Permit Fee, Fire Surcharge; $ �l. Ca .O()1 times the total job valuation Surcharge $r,�". "� .0005 x PcmYit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractor-.) SAC. Charge $ $1550 per SAC: Unit (Plans to MWCC for detem-Anation CuFb Cut Escrow $_ft + 6 ft — -...._ ft x $20 G $ lirosion Control $ T.. $450 Conservation Plats Review Park Fee $ Fcc Determined by Engineerixig Sewer Main Charge $ � Agreement necessary ( ) Nor Necessary Total Due T $ � � _ � Make checks payable to: Cid of Fricllcy Attach- Stipulations 4')41'§ IS AN APPI.IC'A'M N POR A PRRMiT-NO I• VALID 1JT Ml. PROCESSED I hereby apply for a building perroit and I acknowledge that the infortn4tioll above is complete and accurate; that the work will be in conformance with the, ordinance-, and codes of the ttity of Fridley and with the MirnneSota (,onstruc-tion Curies; that t understand this is not a pcmit but only an application r 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 all. work wl 'ch rcquirrs )' v' w d approval of flans. P'RIlNT NAMH STGNATT IRE OF AFPLILANT _.^ –. MAY 09,2006 18:18 CITY OF FRIDLEY 7635711287 Page 3 FROM :City of Fridley FAX NO. :7635711287 May. 09 2006 03:45PM P1 CITY OF FRIDLEY WSPECTIONS DIVISION 6431 University Avenue NE, Fridley, MN 55432 CONTRACTOR LICENSE (763) 572-3604/ Fax 763-502-4977 T.TCI' 3NSETERM: May 1, 2006 to April 3i1, 2007 U Blacktopping 0 plastezing; T-1 Chimney Sweep U livj%.k-; 0 Roofing 11 Excavating 13Masonry U Sign Frector 0 Gas Services 0 0i1 Services El Wrecking R.E,CUSTRATULN F—ORSTA TT' Lff,:ENSEDQ. !Q NjRACT0R,5—N0ffF 0 rJectrical C7 Mobile Rome Installer 0 Plumbing &"Aesiden:tial ContnicLor 0 Moving 0 Well Driver TO THE HONORABLE CITY COUNCTL: I herewith submit an application for license to perform construction within the City of Fndley in accordance with the City Code of said City regulating the same. I am over twenty-one years of age. Submitted herewith is a Certificate of Insurance evidencing the holding of Public Liability Insurance in the limits of $50,000 per person, $100,000 per accident for bodily injury and $25,000 for property damage, and Wonders Compensation as required by Minnesota Statute 176.182. ATTACHED ARE COPIES OF CERTIFICATES OF INSITRANCE FOR LIABILT.TY AND WORKERS COM.VFNSATION — S tarnn Name - of Liability Insurance Con-qmny T&_KV_iQ 19 I_q Liability - J_ Insurance Policy Number 13106 PulicyTimn Nome of Workers Conip, Tnsurance ConVany Address of Cornpavy . A0494A5 le5sG'44.0,-6— Name hf Company to be Licensed/Regisiercd A Name of Contract Person (First/Last Name) WC PoFi�_jNuinbcr Fo—ficy Term * Minnesota Licenqc * ATTACH COPY OF STATE JTCFNSR 1�afti a - -? - �Vl AL , �71ty/.State/Zip + 4 digifs LfW4' JzC(—vq-6 Bus* ass Telephone/Bus' --is Fax FILL IN REVERSE SIDE OF FORM For .qtffic,, Use Qnl Receipt # License# Council Approval Date MAY 09,2006 18:17 CITY OF FRIDLEY 7635711287 Page 1 FROM : State Farm Insurance FAX NO. : 7637555554 May. 09 2006 04:43PM P2 CERTIFICATE OF INSURANCE This Certifies stet ® STATE FARM FIRE AND CASUALTY COMPANY. Bloomirtpion, iiflnois (� STATE FARM GENERAL INSURANCE COMPANY, Bloomington, lliinois insures the following policyholder for the coverages indicated below: Name of policyholder TROY A. MILES DBA: AQUE®US SEAMLESS GUTTERS Address of policyholder 2613 MER.IDIAN DR R-OBDINSDALE, 55122-3718 Location of operatlons Description of operations CONTRACTOR The policies Gamed below have been issued to the policyholder for the policy periods shaven. The insurances described in these poticlee r uhleef fn Al the farrm OwAtisx mm and rnndrtinnn of thneo nnrinic— Tf— 111—H. .,f lift%''Wk.�L.oc— ... ., t....,.. ti,....... - a......a "....... —5.1 POUCY NUMBER TYPE OF INSURANCE POUCY " O Aato UMITS OF UABiUTY Effective Date Expiration at nrift of Policy Comprehensive BODILY INJURY AND 93—KV-1991-4 Business Uabli 08/13/u. D8/13/0 6 PROPERTY DAMAGE This insurance includes: ® Products - Completed Operations ® Contractual Liability, ® Underground Hazard Coverage Each Occurrence $1,000,000 Personal Injury Advertising Injury General Aggregate $2,000,000 ❑ Explosion Hazard Coverage Products - Completed ❑ Collapse Hazard Coverage Operations Aggregate $2,000,000 (� denerai Aggregate Limit applies to each project EXCESS LIABILITY POLICY PERIOD BODIL INJURY AND PROPERTY DAMAGE Eftetive Doto Expiration Date (Combined Single Limit) ❑ Umbrella Each Occurrence $ Omer Aggregate Part 1 STATUTORY Part 2 BODILY INJURY WorkeW Compensation and Employers Uabriity Each Accident $ Disease Each Employee $ Dl - Polo Limit $ POLICY NUMBER TYPE OF INSURANCE CY PERIOD Effective Oats Expiration Date LI S P LIr4BiLITY at beginning of policy pmrwd) Name and Address of GeMcate Holter CITY OF FRIDLEY DEPT: BUILDING & INSPECTIONS 6431 UNIVERSITY AVE NE FRIDLEY, MN 55432 5W994 a 2-80 Pdrftd In U.SA a any or tyre aesonnea ponc ies are cartmea velure 8.5 a*rabon date. State Farm will try to mail a written notice to the; cOMfiCeft holder 10 days before aanaeliation. If, hcv}ever, we fail to malt such notice, no obligation or liability will! be Iniposed on ate Farm or Its agerits or MAY 09,2006 18:26 NORDQUIST DAVID 7637555554 Page 2 FROM :City of Fridley FAX NO. :7635711287 May. 09 2006 03:45PM P2 State of Minnesota SP:C1 License Applicant Information Under Minnesota law (M.S. 270.72), the agency issuing you this license is required to provide the Minnesota Cornmissioner of Revenue your Minnesota business tax identification nuinber and the Social Security number, of each license applicant, Under the Minnesota 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 Department of Revenue delinquent taxes, penalties, or interest; • The Licensing agency will supply it only to the Minnt�sota Department of Revenue. However, tinder the Federal Exchange of Information Act, the Department of Revenue is allowed to supply the infon-nation to the hiternal Revenue Service,; • Failing to supply this information may jeopardize or delay the issuance of your license or processing your renewal application. Please fill in thefiollowirig information and return this form along with your application to the agency issuing the lieemu. Do not return this form to the Department ol'Revenue. Personal information; Proof of Workers Compensation Insurance Coverage Minnesota Statute Section 176.182 requires every state aod. 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, 'the b-. formation required is: The name of the insurance company, the policy number, and dates of coverage or the permit to self -insure. 'Phis information w 11 be collected by the licensing agency and retained in their lilts. This information is required by law, and licenses and pen -nits to operate a business may not he issued or renewed if it is not provided and/or is falsely reported. Furthermore, if this information is not provided and/or falsely reported, it may result in a $2,000 penalty assessed against the applicant by the Commissioner of the Department of Labor acid Industry. Provide the inforniation specified above in the spaced provided, or certify the precise reason your business is excluded from compliance with the insurance coverage requirement for workers' compensation. I am not required to have workers' compensation liability coverage because: I have no employees covered by the law. 0 T am self insured (biclu& permit to self -insure) 0 1 have no employees -Arlio are covered by the workers' compensation law (these include: Spouse, Parents, Children and certain farm employees) es T-rN Aa—/MA MOO VJ-9?-(,;SS2 's last name f-'init rime Middle name 1)ata Cfh,,Ttf, so6al SCcU-Ifty uufiiml -ZI�FIS Aec�JigA Rusinossaddresb (".y State Zip C(Ae Minnesnta trk identification n k federal Lax iduritiritulion number Signat3TRIJ 1� 147� MAY 09,2006 18:17 CITY OF FRIDLEY 7635711287 Page 2 Building $ BUILDING See Back Page for Fee Schedule Permit No.: �' c Inspections RESIDENTIAL APPLICATION Fire Surcharge Received By: 763-572-3604 .001 times the total job valuation CITY OF FRIDLEY $ Date Rec'd: DATE YOUR E-MAIL ADDRESS $ SITE ADDRESS 0 311 &6"' 5+I A( $5.00 (State Licensed Residential Contractors) THIS APPLICANT IS: OWNER ❑CONTRACTOR PROPERTY OWNER/ NAME: IS, IrIAv I.�S(a®v JIc $ TENANT ADDRESS: b`' 1i %+.'net ST- CITY re- STATEPi&LIP ,�?' $ PHONE:_ $450 Conservation Plan Review CONTRACTOR NAME: STATE LICENSE # EXP DATE Sewer Main Charge SUBMIT A COPY OF YOUR STATE LICENSE ADDRESS: CITY STATE—ZIP WITH APPLICATION PHONE FAX Make checks uavable to: Citv of Fridlev Attach Stiaulations PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE ❑ TWO FAMILY/NEW CONSTRUCTION STORIES PERMIT TYPE ❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS ❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE ❑ DECK ❑ SIDING ❑ OTHER ❑ SWIMMING POOL TYPE OF WORK: ❑ NEW ❑ ADDITION ❑ MAINTENANCE/REPAIR ❑ REMODELING DESCRIBE WORK BEING DONE: SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. ROOFING ❑ HOUSE ONLY NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT: GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan PROPOSED SIZE: ❑ DETACHED GARAGE 2• Proposed floor plan PROPOSED HEIGHT: 3. List of structural members to be used SIDING FOR NEW CONSTRUCTION INCLUDING DECKS, ❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Other ❑ Fascia and proposed project. WINDOWS 2. Two sets of construction plans IN EXISTING OPENINGS I Yes ❑No LOC4TION OF WINDOWS ll- 3. Energy Calculations OR FOR NEW OPENINGS- T jESCRIBE SIZE OF S OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS o2' ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ 100& 00 OCCUPANCY TYPE Permit Fee $ �R.`7 S' See Back Page for Fee Schedule Plan Review $ 65% of Building Permit Fee Fire Surcharge $ 1.00 .001 times the total job valuation Surcharge $ . SCS .0005 x Permit Valuation Minimum $.50 License Surcharge $ $5.00 (State Licensed Residential Contractors) SAC Charge $ $1550 per SAC Unit (Plans to MWCC for determination) Curb Cut Escrow $ ft + 6 ft = ft x $21= $ Erosion Control $ $450 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement necessary ( ) Non Necessary { ) Total Due $ q®. a<— Make checks uavable to: Citv of Fridlev Attach Stiaulations 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 all work which requ a review and approval of plans. SIGNATURE OF APPLICANT NAME ��t �w SlbF� DATE