PRE 2010 DOCSDate:
June 7, 1965
Kerr Ackerman
j
N? '7'748
-_- Builder Carlson Ia Fine, Inc.
Address 6,370 Washington N. E. Addre� 2851 Colnmbmbia, Ave, So.
LOCATION OF BUILDING
No 6370 street 'Washington Street N. EsPart of Lot
,at 2 Block 3 Addition or Sub -Division Christie Add.
Corner Lot _ Inside Lot Setback Sideyard
Sewer Elevation ____ Foundation Elevation
To be Used as:
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft
Front Depth Height Sq. Ft
Type of Construction Est Cost 102000000 _ To be Completed
Storm damage repair
Cu. Ft
Cu. Ft
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, forth and in compliance with all provisions of
ordinances of the city of Fridley. % e
In consideration of the payment of a fee of $ 10.00 , permit is hereby granted to Carlson Lavine, Inc.
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 location, construction, alteration, maintenance, repair and moving of buildings
within the city limits
permit may be revoked at any time upon violation of any of the provisions of said
ordinances
Allen Jensen
NOTICE
'ibis pwu* doss not cover the coasrvefim, iaataiiatiee for whug, phmi+ing, pas heaNns, sewer or water. Be ane to we
the BuMiag kspeeter for sopor to permth for thea items,
APPLICATION FOR BUILDING PERMIT
CITY. OF FRIDLEY, MINNESOTA
OWNER S. NAME /
'. I(✓. � C��� �_..�
BUILDER
ear `• s5',4,PV.
ZZ el
ADDRESS_ j %
W4,SA, /� t✓
ADDRESS
s2q '�4C ;
LOCATION OF BUILDING
No. Street Part of Lot
LOT BLOCK ADDITION OR SUBDIVISIONe� .a�•�
Cotner.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 Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq, Ft. Cu. Ft.
Type of Construction ' F timated Cost jjQ o o®'—
To.be completed
The undersigned.heieby makes application for a permit for the work herein specified,
agreeing to do a1.1"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 – d,C
_SIGNATURE f ��r i -� F
TF.
(Sch'dule of Fee Costs can be found on the Reverse Side).
1 j I a
"..ID
d
SUBJECT
P
City of Fridley
2 1 4 3 9
AT THE TOP OF THE TWINS
BUILDING PERMIT"
r
CEIPT NO.
_ COMMUNITY DEVELOPMENT DIV.
�0 PROTECTIVE INSPECTION SEC.
o ,
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
= CITY HALL FRIDLEY 55432
612-571-3450
910415
7/13/92
JOB ADDRESS 6370 Washington Street NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
2
3
Christie Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ken Ackermann 6370 Washington Street NE 571--1677
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
D & D Home Improvement Inc. 7401 Central Avenue NE, Fridley 784-7543 4840
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 ❑ ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK ,
Reroof Fuse (18 Squares) 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd lager but not the 3rd.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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 I 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
$954
$.50
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-
$25.00
Fire SC $.95
STRU ON R THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
License SC $5,00
$31.45
S URE OF CONT R U ORIZEDAGENT (DATEi
WH E PR PE L VA DATED THIS IS YOUR PERMIT
7BLD5 ,NSP 2ATE
SIGNATURE OF OWNER IIF OWNER BUILDER, 1DATEI
NEW [ l
ADDN [ ]
ALTER [ ]
Construction Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/92
<<.
Legal Description: ) � -3f rSi7 L.
Owner Name & Address: `� /�� �� Tel. #_ Z -7
Contractor: D & D Home Improvement, Inc. MN LICENSE # 4840
Address: 7401 Central Avenue N.E., Fridley, MN 55432 Tel. # 784-7543
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd . Setback Side Yard Setbacks
Type of Construction:9 A4oalgq 01��2_ Estimated Cost: $
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Park Fee
Sewer Main Charge $
TOTAL
STIPULATIONS:
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.501$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 [ )
SUBJECT
City of Fridley51
AT THE TOP OF THE TWINS
?
BUILDING
PERMIT
:
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
P
r PROTECTIVE INSPECTION SEC.
/
l
NUMBER
REV
DATE
PAGE OF
APPROVED BV
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
7-8-98
JOB ADDRESS 6370 Washin tonSt.
1 LEGAL
LOT NO.
BLOCK
TR ACT OR ADDITION
SEE ATTACHED
DESCR.
2
3
Christie
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Ken Ackerman
571-1677 Lisc # 201387
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Four Seasons Roofing & Remodeling, 7930 University Ave,
Fridley, 55432 795-9410
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
Remove & Replace roof (23 Sq) -tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
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
1 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
$1,918
$.96
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 THER STATE OR LOCAL LAW REGULATING CON -
U TI O PERFORMANCE OF CONSTRUCTION.
$62.25
Fire SC $1.92
PLAN CHECK FEE
TOTAL F
License
$5.
$6 5
111NATL RYUFCONT TOR 09 AUTHORIZED AGENT IDATEI
6-1
PPE
v BLDG SP
LIDAT S I$ Y R PERMIT
s
MATE
SIGNATURE OF OWNER OF OWNER BUILDERI IOATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY.,OF FRIDLEY
ALTER [ ] SINGLE FAMILY -AND DUPLEXES R-1 AND R-2 Z l�
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description:
Owner Name & Address: KeAn L—ker- ma'ti'1
Contractor: po u LO- MN LICENSE # 0138780
Address: �� 1.� ��t� a ���� il/®� 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 Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: �P�VV1®�! @._d 3 Sq 6 -f `5h d r\ ei- le -'s
Y
Construction Type:®o-F _Estimated Cost: $
(Fee Schedule on Back),
Driveway Curb Cut Width Needed: Ft." + 6 Ft = Ft x $ _ $
I I / % � . � �r�.► � � �����.. ter, - ( ,ti
l
CITY USE ONLY
TOTAL $ 2.6-12
STIPULATIONS:
t
Permit Fee
$
��-�S�
Fee Schedule on Reverse Side
Fire Surcharge
$
4 9
'-.001 of Permit.Valuation (1/10th%)
State Surcharge
$
$:50/$100 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 $ 2.6-12
STIPULATIONS:
-SUBJECT
c
P
City of Fridley
2989 0
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
F ,
O
1 L
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
r
6
1 ;
CITY HALL FRIDLEY 5532
NUMBER
11EV
DYE
GE Of
APPROVED By
612-571-3450
910-F15
7/19/99
JOB ADDRESS 6370 Washington
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
2
3
Christie
SHEET
2 PROPERTY OWNER MAIL ADDRES$
ZIP PHONE
Ken Ackerman
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Premium Roofing 6680 Lucia Ln Fridley
55432 571-3973
a ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
Q USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION XM REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof house and garage (22 S Tear -off
9 CHANGEOFUSEFROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
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
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
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
$1923
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$.96
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHA G
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$69.25
$1.92
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
Fire
PLAN CHECK 50nTOTA
F E
.�
Li ce e S
5 .X11
177. 3
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI
EN RO
VA ID T is IS
pie,'
BL INS
OF
2�fT�ATE
S.GNATURE OF OWNERJF OWNER BUILDERI 'DATE,
NEW[ ]
ADDN [ ]
ALTER [ ]
Construction Addm
Legal Description:
Effective 5/10/99
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ,pp
BUILDING PERMIT APPLICATION QED
Owner Name & Address: Ley /A'-- Tel. #
Contractor: MN LICENSE #�'�/$`�
Address: fiUi 110 1- r l& G,y Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: AaySE z �2�f/ _ 0 -?r!5/ Estimated Cost: $ f 90
Driveway Curb Cut Width Needed:
Ft. + 6 Ft = Ft x $
DATE: 7—Z'I- 72/ APPLICANT: Z"4c ' Tel. # 2 Y%26 ?�
Permit Fee $ 69
07 ��
Fire Surcharge
$
State Surcharge
$ 9L
SAC Charge
$
License Surcharge
$ Soo
Driveway Escrow
$
Erosion Control
$
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
$1050 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 [ ]
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
F63) 572-3604 FAX: (763) 571-1287
ADDRESS 6370 WASHINGTON ST NE
PIN 143024420030
LEGAL DESC CHRISTIE ADDITION
LOT 2 BLOCK 3
PERMIT TYPE HEATING
PROPERTY TYPE RESIDENTIAL
CONSTRUCTION TYPE ADDITION/ALTERATION
PERMIT NO.: 2004-00251
DATE ISSUED: 02/23/2004
VALUATION
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
REPLACE FURNACE (WARM AIR, RHEEM, 75,000 BTU'S) AND AIR CONDITIONER
# A/C UNITS 1 VALUE OF APPL OR WORK
#FURNACES
# GAS RANGES
APPLICANT
RICCAR CORP
2387 STATION PARKWAY
ANDOVER, MN 55304
(763)754-4000
OWNER
ACKERMAN KENNETH W & MARY M
6370 WASHINGTON ST NE
FRIDLEY, MN 55432
1 # GAS DRYERS
0 ENTER VALUATION
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regula ' onstruction or the performance of construction.
Dlicant Date .
Bldg Insp
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS PIPING FEE
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONING FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 50219
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
5000
0.00
30.00
10.00
0.00
0.00
25.00
0.00
0.50
65.50
;ITY OF FRI E -Y fNSPBI TION IV'iSIO
431 U.nivergitY AX0 ��"; .. .
ridley.,.MN ° 3, ! w ARPLICATIOM FOR POWER PLANTS At P:HEATING, CQOLING, VENTILATION,
'63-572-36"R JGERAT101�i A if A>II Cd"q!T!"�NJh1G SYSTEMS AND DEVICES
' y JOBADDRESS
iESS la
R 1 1 16
x H RULE
Resldepial';
Furs a SI I� and Ou Work,134rn r
Also Replarriar�ku►ace.
ide op ¢ Fill D E3acl `
Gas Piping -'Ne -,ed ;rjlh°new furnace,
but rift r+�})acement) , .
Gas H nge
Gas pryer
*Air Conditioning - All sizes
All 0 &,Alterations (LIST ON BACK)
1%Q Qf Value pf Appliance or Work`
CoMrll rciai/lrldustri i ,
1.25QJo of Yp l ie of Appliance or Work
:Rate
$ X00
$ 10.00
$101.. 00
$ 10:00
$ 25.00
State Surcharge
TOTAL FEE
r
MINKMEE HING/VENTILATION R
REFRIGERATION/Alti:�6.IiNbiTIONING PERMIT IS $25.00
PLUS THE $.503TAU `S `JRCHARGE
REINSPECTION :FEE'$47.00/Hr.
*Air Conditioners :can -not bei,placed in a side yard without
written permission from adjoining property owner.
Effective On January 1., 2001
t
BUILDING USED qS
ESTIMATED COST PERMIT.NO.
DESCRIPT19,tOF FUR ACS ANP OR BURNER
No. of Heating Units Circle One (Steam) {Hot Water)
Trade Rema inn Size No.
BTt! '`lam �® HP s EDR _
Fuel Total `Connected Load
Burner"Tradia Name Size No.
BTU HP EDR
Th6 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
rulings of the Buildipg Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
DATE-c:;>1+dd
HEATING
Approved By
TEL #103 '-1 91 'Y
Rough -In Date Final Date
BACK SIDE MUST BE FILLED IN ON VENT SIZE, VENT CUNNEGIUKS
AND COMBUSTION AIR VERIFICATION _
02/23/2004 08:25 7637540132
FEB -20-2004 11:20 FROM CITY OF FRIDLEY
RICCAR HEATING
TO
hf
. . . . . . . . . . . . .
been w
T��,Qw-s gym[ on.
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unu
TtjjwdeTslVM-d, iiw does
Rdj. 0-- Mbdu
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.--r(teeu CLA
TOM
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areoe
in&W.A -GAMA C-a%M-
,ond nowd drait 9004nm-
UaOsd to MW ft
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I CftW F*w
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and �gtw* dra# a*.='- CBS
vqnlVMn'94,.,- Wstrlan
ventand, V&A and �M�, -cavic4y
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ht 0. b MM, a** d*
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ieper current =ds"s...
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pl
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vent Type Went Haig M.
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Goed By.
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PAGE 03
P.03/03
I
TOTAL P.03
Building
BUILDING
Permit No.: bib 41,
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date
763-50�2/-4977 FAX
EFFECTIVE 1-1-2010
DATE �-/ — 6 — /®
YOUR E-MAIL ADDRESS
SITE ADD/1 6 — d j 104Z
THIS APPLICANT IS:
'010'WNER ❑CONTRACTOR
PROPERTY OWNER/
NAME: —
TENANT
ADDRESS: 5 ��� 6?I T ��fCITY Z!; , � 4 STATE
PHONE:
CONTRACTOR
NAME:
SUBMIT A COPY OF
YOUR STATE LICENSE
STATE LICENSE # EXP DATE
AND CERTIFICATE OF
ADDRESS: CITY STATE ZIP
INSURANCE
PHONE FAX
PROPERTY TYPE
W -SINGLE FAMILYNEW CONSTRUCTION SIZE
❑ TWO FAMILYINEW CONSTRUCTION STO
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED OWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
&OAUn'ENANCE/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 -
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List of structural members to be used
PROPOSED HEIGHT:
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
2. Two sets of construction plans
WINDOWS//
3. Energy Calculations
IN EXISTING OPENINGS DY/,
ON, LOCATION OF WINDOWS
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
�®
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
COTAL JOB VALUATION $tel 1-- OCCUPANCY TYPE
Permit Fee
a 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
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
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 on site; that the work will be in accordance with the
approved plan in the case of all work whi h requires review and approval of plans. �/
SIGNATURE OF APPLICANT PRINT NAMEA6! �C-�/O, DATE !!y <
NA -02792-07
MINNESOTA CLIMATOLOGICAL NETWORK
VMinnesota Board r Water and Son Resources �am
Soil and Water Conservation Districts m 2 FT3 2 4
-
Name
Ken Ackerman
Tear
mmm Vo time
i ownsrup Menge Section
County
name Anoka
Address
6370
Washin ton Street NE.
Fridley,
MN.55432
Township
name
Oman
Telephone No. (7 63 ) 5 71-16 77
24-HbUR AMOUrM
gain, snow snow
Milted On $. & on
tic {Ins. Tenth) Ground
a 14dth} {Inches)
REMARKS:
Gime times and commentscAnder
about events.
(Temperature and Phenology!
items are very useful}.
Ga u
e Woe Chet* One):
Gatch *Wt"9 �neler/slze (omes)
ma)d mum oatdu depth (inches} / I
]' `—
boatd1ruler t� for snow
IpaSt �Yeg
gDoIngbucket
test tube weighIn
me a Other
.32
01
02
.5
4
0
a '
04
05
06
07
08
09
10
12
�dZ
13
14
16
/3
17
.73
18
Ls19
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r
Z2
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20
21
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22
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24
12 A
25
26
27
28
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30
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TOTAL$ State Climatology Office, 439 Borlaug Hall, 1991 Upper Buford Circle, St. Paul, MN 55108-6028