PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N® 4 0 21
Date: ...._-- � °..... 6..� - _...__._._..
Jq
Owner: ......... Builder �
Ad .. .. .. r ,,.p q....._... Address
.................. -............................ _...-._.--------...----__..._......._.._..__._
LOCATION OF BUILDING
No. .... /6��... Street _......................................... Part of Lot
Lot ....................................... Block ..... _....... .... ................................ Addition or Sub -Division ....._...-_---...._.----
Corner Lot .................................... Inside Lot... ............ .............. Setback ....._............................ -........ Sideyard
Sewer Elevation ..... _....... _.... .............. __..............................._..._..................._........ Foundation Elevation .....................
DESCRIPTION OF BUILDING
To be Used as:
pp // el 7
�__.Front ..`...4® Depth <�...:." Height ... -� Sq. Ft. 14Cu. Ft.
..... .............. .......................... -............ Front ........................ Depth ...................... Height ........................ Sq. Ft. ......... ........... .. Cu. Ft.
Type of Construction............................................................ Est. Cost..G��y......�....... 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 and in o ' ce th all provisions of
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.
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, pas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
YI ` 4
APPLICATION FOR BUILDING PERNBT
CITY OF FRIDLEY, MINNESOTA
Address
LOCATION OF BUILDING
No. _ 00/0 Z Street C;� 1;1� (�.��'. Part of Lot
Lot Block Addition or Subdivision
Corner Lot Inside Lot Setback Side -Yard
SEWER. ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location. P iia
DESCRIPTION OF BUILDING
To be used as:
Front I k Death ;Q 6 Hpisht Z o
Sq. Ft. 'Cu. Ft.
Front Depth Height
Sq. Ft.
Cu. Ft.
Type of Construction ^2 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 Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representations
stated in this application are true and correct.
r-:1
(A Schedule of Fee Costs can be found on the Reverse Side.)
4
City ofFridley,Minn.
BUILDING PERMIT
t:, (6174
f
Date:'
Owner � cc Builder .,� _
Address
►�`�: tip"'
LtTI P"l1 ING
No. Street ,. .:°; "-�a�- Part of Lot
Lot _ _ -�-- Bleck Aidition or Sab-1 piv, ton .
Corner Lot wY Inside Lot tftbackSideyard
—1�` .
Sewer Elevation _ _ _ FoZdation Elevation
DESCRIPTION OF, BUILDING
To Used
o ` � Front Z Depth Height pe Sq. Ft Cu. Ft
_ . From, Depth Height�_ Sq. Ft. Cu. Ft.
Type of Construction=:,. Est. ----" `' - 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 and in compliance with all provisions of
ordinances of the city of Fridley.
x
0,01
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. _ - 1 -
Building Inspector
NOTICE:
"k pemdt do" not sever the coastreetion, hista"oe hr vrhhg, phmhinp, gat headag, sewer or waMr. Bo sere to we
the BWdh* hupsetor" for separate perm8s for these items.
Owner's
Address
APPLICATION FOR BUILDING PERMIT "
CITY OF RRTDLEY_ MINkSOTA
LOCATION OF BUILDING
No. /� G Street'. art Lot
Lot BlockAddition or Subdivision _
Corner Lot Inside LotSetback 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.
DESCRIPTION OF BUILDING
To be uaed��
Depth Height
Sq. Ft, \6— Pie Cu. Ft. Z6
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cosh y
To be Completed
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work fn 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.
�7
DATE ��6 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
1040 FROM:
RICHARD N. SOBIECH
Public Works Director MEMO N0. DC 126 REPORT BY: 9/28/76
DATE 9/14/76
SUBJECT: Retainine Wall at 1540 Rice Creek •R
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(Mrs. Theilmann)
D MAARKS °
See attached °
Mrs. Theilmann called and indicated that Ed
Dropps is constructing a -retaining wall on hei
east property line. She said the construction
Lj Review & take appro- is bad and the location is improper.
priate action
Could you please review -this & comment if
F1 Review & comment any City action is required. You may want
to work with Tom.
:rote & discus_. :�.ith me
Thanks.
l,iork with i om
Rush, immedi-m-_ action
desired
f
Make reports, w//oar .ground
i material as compl e 7 as poss-
iible. Make interi- report if
necessary.
cl�'
O
o�, Action completed, no
' further review needed
0
Further action necessary
E] See attached letter
Interim report
►Clm 000Lt:, kion
COMMENTS:
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DATE: r r $ SIGNATURE �
� � -�
SUBJECT
P .r
City of Fridley
o 610 6
AT THE TOP OF THE TWINS
BUILDING PERMIT,
r
RECEIPT NO.
I • COMMUNITY DEVELOPMENT DIV.
W
PROTECTIVE INSPECTION SEC.
1 �
.--, CITY HALL FRIDLEY 55432
{l
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
----�
L 612-571-3450
910-F15
14/6/81
JOB ADDRESS 1540 Rice Creek Road N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
9
Ands Sub. #22 SHEET
2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE
Theo. B. Theilmann 1540 Rice. Creek Road N.E. 571-5508
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
Install window replacements
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATf PERMITS REQUIRED FOR '�+IR;� ($,*
�IE.ATING, PLUMBING AND SIGNS.
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
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
$1s0Q0
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$.50
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-
$7.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTALFEE
$8.00
si EOFCONTRA A oRlz AGENT IRATE
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
BLDG INSP DATE T-
- S' NAT E OF OWNER i I iDATF.
CITY OF FRIDLEY
APPLICATION FOR RE:SIDMTIAL BUILDING PEW41TS
(New, Alterations, Additions, or Repairs)
4 OW14ER: s ", � . GUILDER: .
ADDRESS: ADDRESS:
/�{'p
1
TEL NO: �57 71 TEL NO:
Construction Location
STREET NO:
STREET: Sid:
LOT: BLOC:: 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
• �i�3,,�- Front: Depth: Height:
Square. Feet: Cubic Feet:
Front: Depth: Height:
•
Square - Feet: Cubic Feet:
Type of Construction: Estimated Cost: $ /M0. no
Tb Be Completed:
Alt. A Al.t. B
Proposed Driveway Width If New Opening Is Desired: $ ' $
SEB REVERSE SIDE OF SKEET
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 appli,
MTE: SIGNATURE
Stipulations:
Community Development Department
PLANNING DIVISION
City of Fridley
DATE: May 5, 1994
TO: Walter Cole, Accounting/Data Processing Clerk
FROM: Michele McPherson, Planning Assistant
SUBJECT: Special Assessment Search
Please complete a special assessment search on the following PIN:
13-30-24-44-0005
We have a resident who is interested in subdividing this parcel.
into eight single family lots, and I am interested in any pending
special assessments for the property. Please forward this
information tome as soon as possible.
MM/dn
M-94-248
w
Community Development Department
PLANNING DIVISION
City of Fridley
DATE: May 5, 1994
TO: Scott Erickson, Assistant Public Works Director
FROM: /Michele McPherson, Planning Assistant
SUBJECT: Cost Estimates for Potential Single Family
Subdivision
A resident is interested in subdividing the property indicated on
the attached map. The resident is interested in connecting the
two sections of Woodside Court as indicated. Please provide
preliminary cost estimates for road and utility construction.
Also provide information as to whether or not sewer and water
stubs are available in Briardale and Rice Creek Roads for lots
fronting those two streets. I appreciate your help with this.
Please forward this information to me as soon as possible, and I
will inform the resident.
MM/dn
M-94-249
3o T. 30t R. 24
R/DL EY
EM
----.,\\ 43 RpLAND W. ANDERSON
COUNTY SURVEYOR
! �y_� fnnoKn ccwnr. .unnrsor�
THIS 15 A COMPILATION OF RECORDS AS
THEY APPEAR IN THE ANOY.A COUNTY
OFFICES AFFECTING THE AREA SHOWN.
THIS DRAWING IS TO BE USED ONLY FOR
REFERENCE PURPOSES AND THE COUN-
TY IS NOT RESPONSIBLE FCR ANY IN-
ACCURACIES HEREIN CONTAINED.
41
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El
539/3
15
i C;P 1C.Z
FRIDLEY MUNICIPAL CENTER . 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (612) 571-3450 • FAX (612) 571-1287
May 24, 1994
Ted Theilmann
P.O. Box 238
Carpinteria, CA 93014-0238
Dear Mr. Theilmann:
I have compiled the information you requested at our meeting in
early May regarding the subdivision of the property at 1540 Rice
Creek Road N.E., Fridley, Minnesota.
I have enclosed for you a copy of the as -built information
regarding the proposed subdivision. It appears that there is
only one set of sewer and water services along Rice Creek Road.
An additional water and sewer service would need to be installed
for a second lot fronting on Rice Creek Road. There are,
however, two sets of water and sanitary sewer services for the
proposed lots which would front on Briardale Road. The four
interior lots proposed by you would be serviced off of new
utilities installed as part of the extension of Woodside Court.
The Engineering Department has estimated that the minimum cost to
install the extension would be approximately $50,000. This cost
could increase based on the soil types and the topography located
in the general area of the extension.
I have also enclosed a copy of the special assessments levied
against the property. The assessment list shows the date and the
improvement assessed against the property. The current balance
is $1,022.18.
If I can be of further assistance to you regarding this issue,
please contact me at (612) 572-3593.
sincerely,
Michele McPherson, BLA
Planning Assistant
MM/dn
C-94-140
F
3
Community Development Department
PLANNING DIVISION
City of Fridley
DATE: May 5, 1994
TO: v-Qalter Cole, Accounting/Data Processing Clerk
FROM: Michele McPherson, Planning Assistant
SUBJECT: Special Assessment Search
Please complete a special assessment search on the following PIN:
13-30-24-44-0005
We have a resident who is interested in subdividing this parcel
into eight single family lots, and I am interested in any pending
special assessments for the property. Please forward this
information to me as soon as possible.
MM/dn
M-94-248
CITY OF r*RIDLEY
PLANNING DIVISION
RE: PIN# -
Address -
Legal -
13-30-24-44-0005
1540 RICE CREEK RD
9 AUD SUB NO 22
MAY 10, 1994
CITY OF FRIDLEY
6431 University Ave, N.E.
Fridley, Minnesota 55432
(612) 571-3450
--------------------------------------------------------------------------------
Assessed
Date
Int. Number
Original 1994 Tax
Current
Improvement
Assessed
Rate of Yrs
Amount Amount
Balance
--------------------------
Water/Sewer
12/31/60
15
918.40 ------
Paid
Mains
Water
10/01/62
20
575.31 ------
Paid
Laterals
Service
Sewer
10/01/62
20
1231.58 ------
Paid
Laterals
Service
Storm Sewer
08/14/72
20
2323.00 ------
Paid
Mains
Laterals
Storm Sewer
08/14/72
20
269.00 ------
Paid
Mains
Laterals
Streets
09/10/73
10
152.30 ------
Paid
Surfacing
Curb/Gutter
Storm Sewer
03/17/75
20
1135.26 ------
Paid
Mains
Laterals
Water/Sewer
04/12/76
20
5144.42 ------
Paid
Laterals
Storm Sewer
04/12/76
20
56.24 ------
Paid
Mains
Laterals
Streets
04/19/76
10
2251.80 ------
Paid
Surfacing
Curb/Gutter
Streets
10/18/93
6.50 10
1135.75 202.29
1022.18
Curb/Gutter.
Pending Improvement Cost Estimate Escrow Paid
----------------------------------------------------------------------------
* NONE *
-------------------------------------
Misc. Fees Due Amount Due
-------------------------------------
* NONE *
Continued on next page . . .
-------------------------------------
Paid'Misc. Fees Amount
* NONE *
CITY OF FRIDLEY SPECIAL ASSESSMENT SEARCH Wage Z
do
RE: PIN# 13-30-24-44-0005
The current balance of the water and sewer bill is $
The balance of $1022.18 is payable through November 15, 1994. This balance
does NOT include the 1994 tax statement amount of $202.29.
This search was made by the undersigned as a public service on request. The
undersigned certifies -the search is believed to be accurate, however, the under-
signed or the City of Fridley does not insure the accuracy of the above state-
ments and does not assume liability for errors and ommissions.
By:
SPECIAL ASSESSMENT CLERK
NOTE: There is a $15.00 charge for each search.
Q Community Development Department
Q PLANNING DIVISION
City of Fridley
DATE: May 5, 1994
TO: V Scott Erickson, Assistant Public Works Director
FROM: Michele McPherson, Planning Assistant
SUBJECT: Cost Estimates for Potential Single Family
Subdivision
A resident is interested in subdividing the property indicated on
the attached map. The resident is interested in connecting the
two sections of Woodside Court as indicated. Please provide
preliminary cost estimates for road and utility construction.
Also provide information as to whether or not sewer and water
stubs are available in Briardale and Rice Creek Roads for lots
fronting those two streets. I appreciate your help with this.
Please forward this information to me as soon as possible, and I
will inform the resident.
MM/dn
M-94-249
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�� ROLAND W. ANDERSON
COUNTY SURVEYOR
�A ANOKA COUNTY. MINNFSOrA
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THIS IS A COMPILATION OF RECORDS AS
THEY APPEAR IN THE ANOKA COUNTY
OFFICES AFFECTING THE AREA SHOWN.
THIS DRAWING IS TO BE USED ONLY FOR
REFERENCE PURPOSES AND THE COUN-
TY IS NOT RESPONSIBLE FOR ANY IN-
ACCURACIES HEREIN CONTAINED.
539/3
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CITY OF FRIDLEY INSPECTION DIViSION Effective On January 1, 2000
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572.3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS �S . , C.e_ CcZex'k -, .
RATE SCHEDULE '�—
V.,D � L YY1 � tJ
Residential Rate TOTAL OWNER
Furnace Shell and Duct Work, Burner - BUILDING USED
Also Replacement Furnace $ 30.00 $ D. 00
(Side Vent - Fill Out Back) ESTIMATED COST PERMIT NO.
Gas Piping (Needed with new furnace, $ 10.00 $
Gas Range
but not replacement) $ 10.00 $ DESCRIPTION OF FURNACE AND OR BURNER
Gas Dryer No. of Heating Units_ Circle One (Steam) (Hot Wate Warm Air)
Y $ 10.00 $ Trade Name CA R -A i e- 9--:e Size No.__ k'O 0
BTU _ Res'. ei o b HP EDR
*Air Conditioning - All Sizes $ 25.00 $ Fuel n'a :� CA Y, Total Connected Load
All Others/Repairs & Alterations (LIST ON BACK) Burner Trade Name Size No.
1% of Value of Appliance or Work $ BTU 4 HP EDR
Commercial/Industrial
1.25% of Value of Appliance or Work $ The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
State Surcharge $ .50 rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
TOTAL FEE $ ®• 0 River City Sheet metal, ITE a o0
9928 Bluebird St. N.W.
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION HEATING 060®T6 Rapids, MN 55433
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00 Si neck(11312) 754-2199 Fax (612) 754.2%#
PLUS THE $.50 STATE SURCHARGE g
REINSPECTION FEE $47.00/Hr 0'40/ *Air Conditioners can not be placed in a side yard without Approved By Rough -In Date Final Date
written permission from adjoining property owner.
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furance, the undersigned hereby -verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes {1Q No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes) No( )
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes ( No( )
The existinq combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes ¢ No( )
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturer's specifications. Yes No ( )
When installing a new ventina system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes W No( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented G L
separately as per current codes. y �&���� Yes No( }
Appliance Type and Size/Common Vent d Vent Connector Information
Appliance #1 Type AA r, e BTU Input ffPCOO_ Fan Assisted or Nat Zoe , N
Appliance #2 Type BTU Input 44vocP Fan Assisted or Nat off'
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances -- Total Btu Input
Common Vent Type-ALVA Vent Height X10 ! Diameter inches /7 �
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
G7YOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 • (763) 571-3450 • FAX (763) 571-1287
May 25, 2001
Ms. Audrey Thielmann
1540 Rice Creek Road NE
Fridley, MN 55432
Re: Final Inspection at 1540 Rice Creek Road NE
Contractor: River City Sheet Metal Inc
Dear Ms. Thielmann:
A mechanical permit was issued on February 11, 2000 to install a furnace at your address.
According to section 305 (a) of the 1991 Uniform Mechanical Code, a final inspection shall be
conducted on the mechanical work authorized by this permit. As of this date, no inspection has
been called for.
The permit fee that was paid covers the inspections to make sure the work was completed
according to the Mechanical Code. We will keep your permit open for another 30 days and if we
do not hear from you within this time to set up the inspection, we will expire the permit and no
further action will be taken.
To set up the inspection or to have any questions answered, please contact the Building
Inspection Division at (763) 572-3604.
Sincerely,
DJ/mh
U
SUBJECT
P
City of Fridley
WRECKING
r. }
3 4 0 C
2-C,
AT THE TOP OF THE TWINS
AT
PERMIT
G
f
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
NUMBER
REV
DATE
PAGE OF
APPROVED BY
i : CITY HALL FRIDLEY 55432
��"',•�
--_-
L j\ 763-571-3450
910-F15
11/17/03
JOB ADDRESS 1540 Rice Creek Road NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DIE
Pt 9
Auditor's Subdivision #22
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Meadowview Homes 14621 Aberdeen St NE, Ham Lake, MN 55304
763-421-7919
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Sauter & Sons Inc 6651 141 Ave NW, Ramsey, MN 55303
763-421-7919
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 O ADDITION O ALTERATION O REPAIR
O MOVE iJ REMOVE
8 DESCRIBE WORK
Wreck House (60' x 22') and Garage (24' x 24')
9 CHANGEOFUSEFROM TO
STIPULATIONS
All demolition debris, including foundation and slab, shall be
removed from site.
Sewer and water lines to be disconnected at property line and
inspections called
for to inspect capping method.
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 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
$
N/A
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORIT TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE FOCAL LAW REGULATING CON.
ON
$41.25
N/A
TRUCTION OR THE PERFORMA F
P AN CHECK FEE
TOTALFEE
7 A
$41.25
SIGNATUREOF(CON-RA)OR OR AUTHORIZED AGENT [DATE
WHEIN11PROPERLY VALIDATED THIS IS YO R PEMIIITT��
0 C15
S,GNATURE OF OYVNER,1F OWNER BUILDERi iDATE,
Lp i SP
rjArE
U
Effective 1/1/03
CITY OF FRIDLEY MOVING [ ] WRECKING [ ] PERMIT APPLICATION
6431 University Ave NEj
Fridley MN 55432
(763) 572-3604 FAX (763) 571-1287
Job Address: /. q Q �-
Legal Description: n?S :2
Owner & Address : Al rt to -D U i F.�! �'°� I'�` ( iS Tel
�Tei.. #
Contractor. �.�='tL-.C.- � .S Tel. # o
State License 43
Address:
DESCRIPTION OF BUILDING
y
HOUSE: Length Width DL Height ad' Sq. Ft. Cu. Ft.
GARAGE: Length Width Height Sq. Ft. Cu. Ft. S 7�
OTHER: Length Width Height Sq. Ft. Cu. Ft.
Estimated Cost $ Approx. Completion Date
CALL GOPHER STATE ONE AT 001-404-vvvc-
UTILITIES FOR DISCONNECTS BEFORE WRECKING/MOVING STRUCTURE.
Water Bill Paid: Yes [ ] or Collect [$ 7 Signature 9Q' 1-63
Moving Route:
The undersigned hereby makes application for a permit to wreck/move the building described above, agreeing to
do all work in strict accordance with the City Ordinances and rulings of the Building Division, and the State Code
which requires any water well on the property to be sealed by a State licensed water well driller, and hereby
declares that all facts and representations stated in this application are true and correct. ALL DEMOLITON
DEBRIS INCLUDING FOUNDATION & SLABs SHALL BE REMOVED FROM SITE.
r®I_-)y Cc? E���
Date Signature
Moving
Principle building into Fridley .... $300.00
Accessory building into Fridley ... $ 42.00
Through or within the City ...... $ 20.00
Move a building out of City ...... $ 20.00
P� V /_ -)- � MINIMUM $20.00
Wrecking 3.2 ) e
For each 1,000 cubic feet or fraction ...... $1.25
For structures which would be impractical to
cube, the fee shall be based on the total cost
of wrecking at the rate of $6.00 for each $500.00
or fraction.
STIPULATIONS: