PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date: _ _..._---� - ... ...^^....W __..._.._._._... ..........
Owner: ..... ................................... ....................... ....... ....... _..... _............ ..................... Builder
Address....._.............__....._..__......_...._..._.._....Address
No 782
-LOCATION F —WILDING
No..: 71 Street _... •- 4,4_:_part o Lot ...._....� _......_.... � ...._
.
Lot ....... Block .. ...... ................. Addition or Sub -Division +�... �.:. ..._..�
Corner Lot .................................... Inside Lot ........ .... Setback - .: ..._........ Sideyard ........"�.. _:.....,
Sewer Elevation .................... ........ _.... -............. ........ _.... _............. _....................... Foundation Elevation
DESCRIPTION OF BUILDING
To tqn, Used as:
.L .... .- s Front Depth ..,.__ Height ..:. • .: Sq. Ft. Cu Ft.. _.. ,+
x.. � ,r '�_ ..... Front ....1_04 . Depth ....- Height + `.0 Sq. Ft. .,� .: Cu. Ft - " + "
Type Construction... Esta Co +°.:--•--: To be Completed ..... . .......... ..._.................._.._.
_-._. _,t...d, .. .......
� (�T AUTHORIZE W1®LAS -
` is PERMIQ\JEN
T I?:.'E.. =N--�t CA 4 ANS
IONJa
I ,
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.
In consideration of the payment of a fee of $.a:-' W ....... .... ......... ., 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 tine upon violation o�f any of the provisions of said
ordinances.
i`--.. �',���4 ._, g m Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
4
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name Builder
Address Address '40W ._._ _...r
LOCATION OF BUILDING
No. Street Part of Lot
Lot Block „1 Addition or Sub,.Div. ; Q
..
Corner Lot Inside Lot
_Y.Set Back Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and propose4 building
location.
DESCRIPTION OF BUILDING
To be used as:
e
Fr ontDepth L'� Height t? ....._
Sq. Ft.
Cu. Ft.
Front Depth ,73 Height f �
Sq. Ft. Cu. Ft
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 Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representa-
tions stated in this application are true and correct.
DATE SIGNATURE . . e
(A Schedule of Fee costs can be found on the Reverse Side.)
97-8),4.16051 CITY OF FRIDLEY
• APPLICATION FOR PLUMBING AND GAS FITTING hNIT
Job Address 871- Rice Creek Terrace•
Department of Buildings
.City of Fridley
Tel. #571-3450
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 Department of Buildings, .and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. 12-26-78 , 19
OWNER MEVORTER
KIND OF BUILDING frame
USED AS res"
TO BE COMPLETED ABOUT
PARTIAL RATE SCHEDULE
b�
tM
ESTIMATED COST 30.00
v
PLUMBING FIXTURE RATES: NO.
a
TOTAL
Water
QQ
PERMIT NO.-
?timber Fixtures
X
$3.00
$
}
�•
� �� _
Future Fixture Opening
a
$2.00
$
Company
&� •
New Fixture,.Old opening
w
$2.00
$
Heatez
MINNEC,`cr-�
Signed By
H
F3
+
x
$5.00
C �
Water Heater - to 99,000 BTU`
x
•$5.00
$
Tel. No.
100,000 BTU to 199,000 BTU
x
$10.00
$
x
1
$
y
New Ground Run Old Suilding
di
$5.00
$
ROUGH INSP.
'
'
x
$5.00 '�
$
Date
8Bg�
CAS FITTINC FEES:
ou
:2
w
v
FINAL INSP.
QW
Ist 3 fixtures
uwar
$
Date
1
Additional Fixtures
x
as
lec
Gas Range to 199,000 BTU
x
$10.00
$
APPROVAL FOR PERMIT e�
REPAIRS $ ALTERATIONS
,
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUB $.50 STATE kURCHA=
State Surcharge
$ .50
_
• TOTAL FEE
$ 8.00
'.
;anc
e
2nd
3rd
�
(R) - Future Connection Opening
Connected with Sewer
(6) a New Fixture, Old Opening
Water
Job Address 871- Rice Creek Terrace•
Department of Buildings
.City of Fridley
Tel. #571-3450
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 Department of Buildings, .and hereby declares that all
the facts and representations stated in this application are true and correct
Fridley, Mn. 12-26-78 , 19
OWNER MEVORTER
KIND OF BUILDING frame
USED AS res"
TO BE COMPLETED ABOUT
PARTIAL RATE SCHEDULE
ESTIMATED COST 30.00
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL
OLD - NEW BUILDING PERMIT.NO.
QQ
PERMIT NO.-
?timber Fixtures
X
$3.00
$
}
�•
� �� _
Future Fixture Opening
x
$2.00
$
Company
&� •
New Fixture,.Old opening
x
$2.00
$
MINNEC,`cr-�
Signed By
Catch Basin
x
$5.00
$
Water Heater - to 99,000 BTU`
x
•$5.00
$
Tel. No.
100,000 BTU to 199,000 BTU
x
$10.00
$
' Water Softener
x
$7.00
$
'
New Ground Run Old Suilding
x
$5.00
$
ROUGH INSP.
'
Electric Water Heater
x
$5.00 '�
$
Date
CAS FITTINC FEES:
FINAL INSP.
Ist 3 fixtures
x"
'$3.00
$
Date
1
Additional Fixtures
x
$1.00
$
Gas Range to 199,000 BTU
x
$10.00
$
APPROVAL FOR PERMIT e�
REPAIRS $ ALTERATIONS
,
First $100.00
$5.00
$
each add. $100.00 or fraction
$2.00
$
MINIMUM FEE FOR ANY PLUMBING PERMIT IS $7.50 pLUB $.50 STATE kURCHA=
State Surcharge
$ .50
_
• TOTAL FEE
$ 8.00
'.
REINSPECTION FFR
SUBJECT
City of Fridley
18315
AT THE TOP OF THE TWINS
BUILDING PERMIT
REC
11 `y COMMUNITY DEVELOPMENT DIV.
INSPECTION
r PROTECTIVE SEC.
1 . �
i 1`� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
.1/22/86
JOB ADDRESS 871 Rice Creek Terrace N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
]
Brookview Terrace 3rd SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Fredrick Mewhorter 871 Rice Creek Terrace N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Du-A11 Service 636 - 39th Avenue N.E. 788-9411
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
RM=:K1mx Fire Damage Repair
9 CHANGE OF USE FROM TO
STIPULATIONS
o f PERMITS S REQUIRED FOR
,vii°;
Ale AND SIGNS.
"��il'4�a—, ? ��
® HIE � ���II��
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
Q. 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
$1,00.0
$.50
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-
$17.50
T CTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
FEE
TO$18.00
U11141AT/E.
ONTRA RORAUTHORI2EDAGENT (DATEIWHEN
.PROPERLY ALIDATED THIS IS YOUR PERMIT
T
BLDG )NSP E
SIGNATURE OF OWNER IIF OWNER BUILDER) (DATE)
NEW [ ] City of Fridley Effective 4/1/84
ADDN.[ ] R-1 AND R-2
ALTER. [f Building Permit Application
Construction Address: �;/
Legal Description:
Owner Name & Address: y �" 3= �a�c� Ct Yi C.� � � e4l X C."P y Tel. 0
Contractor: def G L �'�OY ez 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
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Corner Lot [ ] Inside Lot Ft. Yd. Setback
Type of Construction: i;- P P/I �-w 4 P -
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired:
Side Yard Setback
Estimated Cost: $
Alt. A Alt B
$ $
See Back Page for Explanation
DATE: / ---4' APPLICANT: /r�c-�.e1� Tel. #
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Chs
�t�-M
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
25% of Building Permit Fee
$•50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
CITY OF FRIDLEY
APPLICATION FOR HEATING REPLACEMENT
CHIMNEY AND STACK VERIFICATION
THIS FORM MUST ACCOMPANY STANDARD APPLICATION FOR HEATING PERMIT FORM.
LOCATION A, �\__�L boot in -n DATE
OWNER`��, ADDRESS��
The undersigned hereby verifies that the existing chimney :or stack:
1. Has been carefully examined
2. Is `Tree from rust or deterioration
3: No foreign objects are lodged within
4.. That it is securely supported
5. That it meets all current Code requirements
for size and total BTU connected
6. Total Heating BTU
All Other BTU
TOTAL
REMARKS
SIGNED Ica X
Licensee
by
Address
TelephoneA16
HEATING PERMIT #
Fridley City License
• ..
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS
BUILDING
PERMIT
f("--27997./
RE
• COMMUNITY DEVELOPMENT DIV.
_
r - PROTECTIVE INSPECTION SEC.
46
li✓
NUMBER
REV
DATE
PAGE OF
APPROVED BY
1 = ""'1 CITY HALL FRIDLEY 554$2
I''
612-571-3450
910-F15
92998
JOB ADDRESS 871 Rice Creek Terrace NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
1
Brookview Terrace 3rd
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Lorraine Mewhorter
571-4607
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Seal Guard Systems Inc. 9199 Central Ave EBlaine
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO,
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW 4 ADDITION ❑ ALTERATION :Ek REPAIR ❑ MOVE - ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (23 Sq) tear -off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF, CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. `
NO. DWLG. UNITS
OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
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
1971
.98
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
$62.25
Fira SC $1.97
PLAN CHECK FEE
TOT FEE
Lic ns 5.
20
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGE N T (DATES
EN ROPE ALID THISI$ UR PERMIT
BL I 4SP or
6
ATE
$,GNATURE OF OWNEROF OWNER BUILOERi tDATE) `
a
.r L J r.�ecave 1[If_
ADDN [ ] _ CITE;OF FRIDLEY
ALTER [ ] SINGLE FAMMY AND DimLEM R-1 AND R-2
�
BUILDING PERMIT APPLICATION
ConstructionAddress: I �16 cQQ �� ��
Legal Description:
Owner Name & Address: L- V-a:k
Contractor:
Address:
-gyral
AD 1 OftY hr WON t ) Tel. # 9,5-71-Ll(p® 7
5 m S mNq LICENSE # :280 3&
F BI a -i nom, 15514 3`7 Tel. # 91 r7 - 0 r%w
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction T v-
ype: �%� � Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: qjZ�) C APPLICANT: iLLE��— Tel. #
01
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ 6,.6'D
a
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1000 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 [ ]