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�& Village of Fridley, Mum
BUILDING. PERMW
N® 83
Office of INSPEOOR OF RIDINGS
Owne
Architect
Fridley, Minn., 242L,—
Builder
LOCAON OF BUILDING
4111 k' ?
1
No.400
Street
Lot
loek Addition or Sub -Division
DESCRIPTION OF BUU DING
Front- Dep
Height StorieManner of Construction p
To be used as
v .. To be completed Estimated Cosh f s
,4
I
Permit is hereby granted
A
to @:.4*' ...
: described in the above statement. This permit is granted
the buildin"
upon the eq114und
n that the person to whom it is granted, and his agents, employees and workmen, in all
the work
and upon said building, .or any part thereat, shall conform in all rospects to the ordi-
nances of
, regarding the construction, alteration, maintenance, repair and moving of buildings
within the city limit
, and this permit may be revoked -at any time upon violation' of any of the provisions of said
ordinances.
q' %f 6
Iasnector of Buildings.
AGREEMENT AND SWORN STATEMENT
In considers
'on of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above perm
I hereby agree, to do the proposed work in accordance with the description
above set forth
d according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby
to and say that the facts stated by me and contained in the above permit are
true as therein s
ted.
Subscribed an
sworn to before nae at Fridley, Minnesota, thisC77
day o
7,4
'
a
City of ]Fridley, Minn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
Mate: _ nrj-pber 26- 1971
Owner: -- KathleenLanger Builder Same -
,Address __ 4875 - 21 Street N.E. Address Same
LOCATION OF BUILDING
ZTa4875 Street 2i Street N.E. Part of Lot
got _2&29 Block 2 Addition or Sub -Division Plymouth Addition
Corner Lot Inside Lot X Setback ___ — Sideyard
Sewer Elevation
Foundation Elevation
To be Used as: Basement Entry
Front 4 Depth Height 10 1 Sq. Ft. _ _ Ca„ Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Mas n{y ry&Fr McEst. Cost $500,0Q To be completed 1 year
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 3orth and in compliance a all provision–a Of
Ordinances of the city of Fridley.
.In consideration of the payment of a fee of $_1.00 , permit is hereby granted to Kathleen Langer
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
. � city limits and this permit may be revoked at any time upon violation of any of the provisions of said
dinanr
LAREW E RELT T F
NOTICE:
This permit does not cover the construction, installation for wising, plumbing, gas heating, sewer or water. Be sum to sea
the Building Inspector for separate permits for these Items.
.9
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER ° S NAME : �j�//P of Z 1 n r e Y BUILDER:
ADDRESS ® �%7 S SADDRESS:
No: '7,5 STREET:
LOT: BLOCK: ADDITION :M O h
CORNER LOT: INSIDE LOT:�ETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
J34R + V_F7:ont: Depth: L e-"Z:LL4z-wght:
Square Feet: Cubic Feet:
Fronts Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: Estimated Cost: $ 5"06
To Be Completed;
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in sttict 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:' 71 SIGNATURE:
(See Reverse Side For Additional Information.5
i •
s .
LY
City of Fridley
Dept. of Bldgs. Phone 960-3450
DESCRIPTION OF WORK
Number, Iliad and Location of Fixtures Location
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ � x$2.00 $ b ' 6 O
Future Fixture Opening ............ x $1.50 $--
New
_New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater (Up to 89,000 BTU) .... x $3.00 $
New Ground Run Old Bldg........ .
Electric Water Heater ..............
GAS FITTING FEES:
1st 3 Fixtures .
Additional Fixtures . , ............... .
Gas Range to 198,000 BTU.. . ... . . ....
REPAIRS & ALTERATIONS --Refer to Code
x $3.25 $
$2.00 $
NO. RATE TOTAL
x $2.00 $
x $ .75 $
x $5.00 $
Description ......... , .............. , ... , .............. ..$
TOTAL FEE 1�b
(SURCHARGE
City of Fridley:
The .undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that &R the fact
and representations stated in this application are true and correct
Fridley, Minn
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old ew. Building Permit No. Permit No. b�7
Signed
By
Business Phone No �' �� ,Z
ROUGH �v
FINAL /J
Y
�Z
N
i N
WATER MTR.
GAS ELEC.
`gq
F rA
; u.
�i V
< 3
(9
(�! I
t�
Base
l
1st
2nd
3rd
4th
' -Future Coaaeella Openings Com with
* Sewer
New Fixture, Old Oponings Cesspool ❑
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES: NO. RATE TOTAL
Number Fixtures ................ � x$2.00 $ b ' 6 O
Future Fixture Opening ............ x $1.50 $--
New
_New Fixture Old Opening .......... x $1.50 $
Catch Basin .................... x $3.25 $
Water Heater (Up to 89,000 BTU) .... x $3.00 $
New Ground Run Old Bldg........ .
Electric Water Heater ..............
GAS FITTING FEES:
1st 3 Fixtures .
Additional Fixtures . , ............... .
Gas Range to 198,000 BTU.. . ... . . ....
REPAIRS & ALTERATIONS --Refer to Code
x $3.25 $
$2.00 $
NO. RATE TOTAL
x $2.00 $
x $ .75 $
x $5.00 $
Description ......... , .............. , ... , .............. ..$
TOTAL FEE 1�b
(SURCHARGE
City of Fridley:
The .undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that &R the fact
and representations stated in this application are true and correct
Fridley, Minn
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $
Old ew. Building Permit No. Permit No. b�7
Signed
By
Business Phone No �' �� ,Z
ROUGH �v
FINAL /J
'Lin
SUBJECT
PERM1
City of Fridley
17261
AT THE TOP OF THE TWINS
BUIL DING PERMIT/1,00,
_
r
�
RECEIPT NO.
� •err----- _ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
-"1 CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
.11. 612-571-3450
910-F15
9/23/83
JOB ADDRESS 4875 - 2� Street N. E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
28,29
2 1
1 Plymouth Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Kathleen Langer 4875 - 2j Street N.E. 572-8880
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
13MM 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
Reroof Dwelling
9 CHANGE OF USE FROM TO
S iPULATIONS
Roof can be 2nd layer but not 3rd. Install ridged galvanized
valleys.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
Fiberglass
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
$800
$.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-
$15,00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$15.50
SIG ATU OFC NTRACTORORAU OR EDAGENT (DATE)
WHEN PROPERLY A ID ATE THIS IS YOUR PERMIT
9 -
9
1
SIG TUREOFOWNER OW RBUIL (DATE)
BLDG INSP DAT
'Lin
CITY OF FRIDLEY
. Effective Aug. 1, 1981
APPLICATIO'1 FOR RESIDENTIAL BUILDING PERMITS
(Heir, Alterations, Additions, or Repairs)
OWUER: l&e , L. nel f-1,0�
ADDRESS:�7� ,,n -
TEL
TEL 110: J 7— geg n
BUI LDER : E�--
ADDRESS:
TEL 110:
c~ Construction Location
STRICT NO: 7 0 7 STREET: XQ 2 ;
IDT: -- swrx: AmITION:
Corner Lot: Inside Lot: Setback: Sideyards:
Ap,plicant attach to this form two Certificates of Survey of lot and
f
proposed building location dras,?n on certificates to scale.
DESCRIPTION OF COi;STF:UCTION
�dC Front: Depth:
Square Feet: Cubic Feet:
Height:
Front: Depth: Height:
Square Fent: Cubic Feet: _
Type of Construction � Estimated Cost: S ZOO
7b Be Cbr-pleted:
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE PEVF.R.;-' SIDE OF SHEET .
Mie undersigned hereby makes application for a permit fcr the %..ork herein specified,
agreeing to do.all work in strict accordance with the City of Fridley Ordinances and
rulings of the Departmomt. of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct. _-I?
D.M.: — U. :3 SIGNATU -, :
Stipulations:
CITY OF FRIDLEY PERMtISSUEDt:4
00510
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432 DATE 2004
(763) 572-3604 FAX: (763) 571-1287
ADDRESS : 4875 2 1/2 ST NE
PIN : 263024320027
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMIT TYPE : BUILDING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : RESIDING
VALUATION : $ 4,000.00
NOTE: PER SECTION 1402, 1997 UNIFORM BUILDING CODE, REQUIRES THAT A WEATHER RESISTIVE BARRIER BE
PLACED OVER EXTERIOR SHEATHING TO PROTECT THE INTERIOR WALL COVERING. EXCEPTIONS FOR THIS
PROVISION WOULD BE IF SHEATHING IS AN APPROVED WEATHERPROOF PANEL OR WHEN THE SIDING IS AN
APPROVED WEATHER BARRIER. VINYL SIDING IS NOT A WEATHERPROOF COVERING UNLESS THE
MANUFACTURER STATES THIS IN THEIR APPLICATION GUIDELINES. CALL FOR INSPECTION OF WRAP BEFORE
COVERING OR TAKE PICTURES. RESIDE HOUSE & GARAGE. REPLACE SOFFIT & FASCIA.
APPLICANT BUILDING PERMIT FEE 97.25
BULTENA SCOTT FIRE SURCHARGE 4.00
4875 2 1/2 ST NE STATE SURCHARGE, VALUE 2.00
FRIDLEY, MN 55421 TOTAL 103.25
OWNER
BULTENA SCOTT
4875 2 1/2 ST NE
FRIDLEY, MN 55421
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 work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or c cel the provisions of any other state or local law
regulating co truct' no e performance of construction.
Applic s Date
Bldg In Dat
SEPARATE PERMITS REOUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
e ao.,-9-o
NEW [ ] CITY OF FRIDLEY Effective 411/2004
ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: y 7S1�
Legal Description:
Owner Name & A gess:Tel. #
Contractor. MN LICENSE #
Address: 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. FL
DECK AREA: Lengthy Width �/ Hgt/Ground Sq. Ft.
Construction Type: - Estimated Cost: $�0�� o `�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$
DATE: - l -o APPLICANT: S C o� -v`. \Azs � Tel. # 3 -S q -77S&/
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
TOTAL $ ®�-�� STIPULATIONS:
Building
$
BUILDING
Plan Review
Permit No.: 2
Inspections
Fire Surcharge
RESIDENTIAL APPLICATION
Received By:
763-572-3604
$
CITY OF FRIDLEY
License Surcharge
M
DateM: NOV 2 4 20011
763-502-p4977 FAX
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
EFFECTIVE 1-1-08
Erosion Control
$
DATE B ' e�- �. (26, YOUR E-MAIL ADDRESS
Park Fee
SITE ADDRESS
Fee Determined by Engineering
Sewer Main Charge
THIS APPLICANT IS: ❑ OWNER .CONTRACTOR
Agreement necessary ( ) Non Necessary ( )
PROPERTY OWNER/
NAME: -T
TENANT
ADDRESS: CITY ('
. I V STATEN_ZIP
PHONE: I 3
NAME: 9
ADDRESS: Lt Wq 01(f4 do l'_i(% CITY CR(d1n ()__STA% ZIP 316
CONTRACTOR
SUBMIT A COPY OF
PHONE 1 r,- 2-6 FAX
��
YOUR STATE LICENSE
STATE LICENSE # %} EXP DATE �Z ,a 4711
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH )d ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR V REMODELING
DESCRIBE WORK BEING DONE: 1 m d f
SIZE OF IMPROVEMENT
LENGTH WIDTH
HEIGHT SQ FT
ROOFING ❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
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:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
ADDITIONS & PORCHES SUBMIT:
❑ Vinyl
❑Soffit
I. Site Plan/Survey showing the existing structures
❑ Aluminum
❑Trim
and proposed project.
13 Other
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
SING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ ( �(D OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 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
$ V :4 T)
Make checks payable to: City of Fridley Attach Sti ulations
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 acco0ance with the apgroved plan ip the case of all work which requires review and approval of plans.
SIGNATURE WXR�NT „� PRINT NAME -Fr ac(Il' 60I�oe I I DATE 1 I
APPROVED BY t 1WJrN DATE