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PRE 2010 DOCS0 M-1 City of Fridley, Minn. BUILDING PERMIT N® .7053 Date: Owner:9e�jf:dBuilder Address Address MIN OF UILDING No. �� Street19_ _ Part of Lot Lot _ _ _ _ Block Ad tion or Sub -Di on — Corner Lot Sewer Elevation Inside Lot Setback _ _ Sideyard F dation Elevation DESCRIPTION OF BUILDING To UA14 _ Front Depth 1=,1== Height Sq. Ft. Cu. FL,3120 Front -62 Depth 16K Height _ �� Sq. Ft. Z,6 0 Cu. Ft/—00 Type of Construction Est. �_`9� __ To be Completed In consideration of the issuance to me of a permit to constructbuilding des cri a e I agree do the proposed work in accordance with the description above set fo and in comp a'll pr of ordinances of the city of Fridley. In consideration of the payment of a fee of $•� , permit is hereby granted to the to construct the building or addition as described above. This permit is granted upon 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, shaII conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the dty limits and this permit may be revoked at any tune upon violatio�.gf any of the provisions of said ordinances. NOTICE: ihb pennh does not cover the construction, h=tailaHon for wiring, phrmbin& gas heaiimg, sewer or wafer. Be sun to ses the Building Inspector for separate permits for those hems. City of Fridley, Minn. • BUILDING PERMIT Date: AUGUST 19, 1966 • • Owner: JIM BLAKE Address 5 044 - 3rd St. N. E. Builder rTF= BEN WOLKE tL '35-/ 5-.° N° 8972 251 RICE CREEK TERRACE N.E. Fridley, Minnesota 55421 Fridley, Minnesota 55432 No. 5 044 Street LOCATION OF BUILDING 3rd S t . N. E. part of Lot Lot _ 2 8 _ Block 5 Corner Lot Inside Lot — - Addition or Sub -Division Carlson's Summit Manor, South Add'n. — Setback —_ Sideyard Sewer Elevation —. Foundation Elevation DESCRIPTION OF BUILDING To be Used as: AMUSEMENT ROOM Front _____ - Depth Height Sq. Ft. Cu. Ft. Front Depth Freight Sq. Ft. --_ Cu. Ft. Type of Construction • Frame Est. Cost _ $5 00.00 __ To be Completed In consideration of the issuance to me of a permit to, the buil des i ed ahoy do the proposed work in accordance with the description above orth and in mpliea w f ordinanoas of the city of Fridley. In consideration of the payment of a fee of S 4.00 , permit is hereby granted to BEN WOLKE, 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, emplo s and workmen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances sof Fridley, Minnesota mot may revoked t mon, maintenance, violation n off any of the and provisions of said ngs within the city limits and time ordinances. CLARENCE BELISLE NOTIC& 'lids porm8 does net eoru the andmdion, hwaMtlon for wkbY, plumbing, gn 6aHea, awes or wdor. Be an to ses tbo BviM bg kspsmr for opmft pwmks hr toes. hams. APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME BUILDER ADDRESS �5— //<- �"�71 e ADDRESS LOCATION OF BUILDING Q �o� N0. � C� STREET ;�/[�/ ,PART OF LOT LOT BLOCK ADDITION OR SUBDIVISION �' �� 1�� 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. DESCRIPTION OF BUILDING To be used as; Front Depth Height Sq. Ft. Cu. Ft. Front Depth Height 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 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 / SIGNATURE (Schedule o Fee Costs can be found on the Reverse Side). City of Fridley 52-84-x915.51 Application for Plumbing and Gas Fitting Permit Dept. of Bldgs. Phone 860-3450 DESCRIPTION OF WORK Number, Kind and Location of Fixtures Location 5041 lY E. 3 St - i 3 � �� i i'n S 3� Z O� ya � K Z 8� 6z S� sO 7jm 63 f�9•d (9 �U' Sa 0 Z �O F ♦ N WATER HTR. GA$ ELEC. Base Ist 2nd 3rd 4th • Future Connection Openings New Fixture, Old Openings I Connected with Sewer Cesspool PARTIAL RATE SCHEDULE PLUMBING FIXTURE RATES: NO. RATE TOTAL Number Fixtures ...................... x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening .............. x $1.50 $ Catch Basin ...... .................... x $3.25 $ Water Heater (Up to 99,000 BTU) ...... x $3.00 $ New Ground Run Old Bldg . ............ x $3.25 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... 1 x $2.00 $ 2.00 Additional Fixtures .................... x $ .75 $ Gas Range to 199,000 BTU .............. x $5.00 $ install (1) gas grill 3.00 REPAIRS & ALTERATIONS—Refer to Code Description .................................... ...........$ TOTAL FEE 1 5.00 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 all the fact and representations stated in this application are true and correct. Fridley, Minn_ April 30, 1971 19_ Owner James Blake Kind of Building frame Used as residence To be completed about Maar 5, 1971 Estimated Cost, $ 10.00 OldX -New. Building Pe # t No f Pe i ' o. � i e By.,� Business Phone��— . ROUGH FINAL T _ % SUBJECT PERMIT NO. City of Fridley ®1293'7 AT THE TOP OF THE TWINS BUILDING PERMIT r RECEIPT NO. • ___ COMMUNITY DEVELOPMENT DIV. INSPECTION 663/ PROTECTIVE SEC. 1 � ; CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 15/9175 JOB ADDRESS 5044 3rd Street N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 28 5 1 Carl son's Summit Manor South Addition SHEET 2 PROPERTYOWNER MAIL ADDRESS ZIP PHONE James Blake 5044 3rd Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Potv'n Sales Co 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 C; REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Rprnnf 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. 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $700-00 Fir) DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PE CE IF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE SIGNATUR OF CONTRACTOR OR AUTHORIZED AGENT (DATE)HEN R R A ATED THIS IS YOUR PERMIT oil BLDG OFATE SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE) APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME:— ILDER: ADDRESS: 0 �'r�— 1 --ADDRESS: 3 � NO:. STREET: LOT: BLOCK: ADDITION: CORNER LOT: INSIDE LOT: SETBACK: . SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. i To Be Used As: DESCRIPTION OF BUILDING Front• Depth: Height: Square Feet: Cubic Feet: Front• -.--.Depth: Height: Square Feet; Cubic Feet- Type of Construction: Estimated Cost: To Be Completed: The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are true and correct. DATE: C1 Q SIGNATURE : (See Reverse Side For Additional Information.) City of Fridley SUBJECT PERMIT NO. 4236 AT THE TOP OF THE TWINS PERMIT i ` BUILDING CEIPT N COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. ?�� 1 . � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY 612-560-3450 910-F15 7/25/77 JOB ADDRESS 5044 - 3rd Street N.E. 1 LEGALLOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 2$ 5 Carlson's Summit Manor South Addn. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE James Blake 5044 - 3rd Street N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Custom N=K Pools, Inc. 701 East Excelsior 933-2255 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WORK Ii NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Construct a 16' x 32' In Ground Pool 9 CHANGE QF USE FROM TO STIPULATIONS §wNXKXM See stipulations in letter dated July 21, 1977 from Environmental Officer WUN'NG NeWe digging call local utilities SEPERATE PERMITS REQUIRED FOR WIRING, TELC:PNONE - ELECTRIC. Gas etc. HEATIK PLUMBING AND SIGNS. !� ' P.� �..� � � �� BY LAW 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 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 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 $6,000 $3.00 WITH WHETHER SPE FIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESU , TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE PERMIT FEE SAC CHARGE PROVISIONS OF Y OTHER STAT OR AL LAW REGULATING CON- $36.00 STRUCTION LH PERFORMANC F NSTRUCTION. PLAN CHECK FEE TOTAL FEE $39.00 E.IGNATUREOFCONTR�CTO RAUTHORIZEDAGENT (DATE) WHEN PROP LY VALIDATED THIS IS YOUR PERMIT BLDG )NSP DATE SIGNATURE OF OWNER (IF OWNER BUILDER) (DAR ) L 11 Y U1 I ULL- Y APPLICATION FOR RESIDENTIAL BUILDING PERMITS (ftw, ALTE=RATIONS, ADDITIONS, OR REPAIRS) Address: No.: LOT: Street: BuILDE'R: Address: Tel. No.:-- Street: o. BLOCK: ADDITION: CORNER LOT: INSIDE IAT: SETBACK: SIDEYARDS: 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, A�s: Front: De eight: Square Feet: Cubic Feet: Type of Construct To Be Completed: Proposed Driveway Front: Depth: Height: Square Feet: Cubic Feet: Estimated Cost: $ Alt. A Alt. B d $ $ (SEE REVERSE SIDE OF SHEET) 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 tY all the facts and representations stated in thisa plic _io are true d rrectt. See reverse side for, ditional info a on DATE: / � � �C/ SIGNATURE: Stipula A, --31, � 00 6t o July 21, 1977 1431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432 Custom Pools Inc. 701 Fast Excelsior Avenue .Hopkins, Hn. TELEPHONE ( 612)571-3450 Re: Swimming Pool Construction at 5044 - 3rd Street N.E. Dear Sirs: This letter is to make clear this departments requirements for the swimming pool construction at the above address. -1. As indicated, one (1) skimmer approved by the National Sanitation Foundation will be provided. 2. As indicated, two (2) 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. S. A deck of at least three (3) feet wide, measured from the pool water's 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 childrenandbe 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 bettoeen 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. Custom Pools Inc. July 21, 1977 Page 2 9. All electrical and plumbing installations shall be inspected and approved by the City Inspection Department. 10. All electrical lines must be 10-20 feet or more away from the pool surface. 11. The pool fill spout must be air gapped or protected by a vacuum breaker. 12. Suitable safety equipment to include but not limited to a ring buoy and rope that is 1h 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, ext. 170. Sincerely, "'�o STEVEN J. OLSON Environmental Officer SJO/mh CC: Mr. & Mrs. James Blake 5044 - 3rd Street N.E. CITY OF FRIDLEY Effective Date May 1, 1988 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES RATE SCHEDULE RESIDENTIAL Furnace Shell and Duct Work, Burner (Also replacement furnace) Gas Piping - -- (piping needed with new furnace) Gas Range Gas Dryer RATE $ 20.00 $ 10.00 $ 10.00 $ 10.00 * Air Conditioning (all sizes)�q$ 10.00 All Others/Repairs and Alterations 1% of Value of Appliance or Work COMMERCIAL/INDUSTRIAL 1% of Value of Appliance or Work State Surcharge TOTAL FEE Reinspection Fee ($15.00) Rough Insp. Date Final Insp. Date Approval for Permit MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00, PLUS $.50 STATE SURCHARGE *Air Conditioners can not be placed in side yard without written permission from adjoining neighbor. TOTAL $ Job Address se Department of Buildings, 6431 University Ave. N.E., Fridley, MN 55432 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, Minn. 5r . 19 OWNER�`�(�� KIND OF BUILDING�� USED AS P,-) r TO BE COMPLETED ABOUT ESTIMATED COST(/ OLD - NEW BUILDING PERMIT NO. PERMIT NO. DESCRIPTION OF FURNACE/BURNER HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No. Trade Name �'�i��/�'�,C/( Size No.�/�/�A Capacity 6 c r Sq. Ft. EDR BTU Total Connected Load Kind of Fuel BURNER - Trade Name Size No. Capacity Sq. Ft. EDR 'BTU HP Company /f S i� &' Signed By ,.-LL 2D Tel. No. Fill out back side for stack verification on replacement furnaces CHIMNEY AND STACK VERIFICATION The undersigned hereby verifies that the existing chimney or stack; 1. Has been carefully examined Yes ( No ( ) 2. Is free from rust or deterioration Yes ( No ( ) 3. Has no foreign objects lodged within Yes ( No ( ) 4. Is securely supported Yes ( No ( ) 5. Meets all current Code requirements for size and total BTU connected Yes (J No ( ) 6. Has Total heating BTU's of All other BTU's TOTAL % �•"� Rema rk s Company Signed Bya� 1�• /�/�f� Date�{� �Al SUBJECT PERMIT NO. City of Fridley--`�� AT THE TOP OF THE TWINS � U ILDING PERMIT 22426 PLUG ' • _ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. /"•t CITY HALL FRIDLEY 55432 I'J 612-571-3450 NUMBER 910-F15 REV DATE 4/15/94 PAGE OF APPROVED BY JOB ADDRESS 5044 3 St NE I LEGAL DESCR. LOT NO. 28 BLOCK 5 TRACT OR ADDITION SEE ATTACHED Carlson's Summit Manor South Ad n SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Jim Blake 5044 3 St NE572-8720 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. Berglund Builders 11417 Xenia Ave N bamplin MN 95316 A97_1 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Eproof Dwp1ling 02 Squares) Tear -off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 80 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 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. 141.00 Firp SC $1-80 PLAN CHECK FEE License TOTAL FEE iC�1�-IS-9`/ _ HE ROPE LY IDATED THII&JIS YOUR PERMIT SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE) SIGNATURE OF OWNER IiF OWNER BUILDER) (DATEI DG INSP f)a E �Al NEW ( ] Effective 1/ 1/94 ADDN CITY OF FRIDLEY ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application Construction Address: _ (_ _5�1y --- - --- --- — ---- - Legal Description: Owner Name &Address: Tel. # S -7a a 0 Contractor: MN LICENSE # o(p0QSSa Address: Tel. # Y02 7 - 1,!T60 Attach to this application, a Certificate of Survey of the j6, 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: ' � C C)a F Corner Lot [ ] Inside Lot [ ] FL Yd Setback Side Yard Setbacks Type of Construction: 9, r,2enCr ,, (R Estimated Cost: $ / Approx. Completion Date: / (Cost on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $ Tel. # DATE: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: APPLICANT: CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $800 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 UUMI[XV MN SSdZ? 572-3604 FAX: ADDRESS : 5044 3RD ST NE PIN : 263024230106 LEGAL DESC : CARLSONS SUMMIT MAN SO ADD : LOT 28 BLOCK 5 PERMIT TYPE : WRECKING OR MOVING PROPERTY TYPE : RESIDENTIAL CONSTRUCTION TYPE : POOL VALUATION : $ 500.00 NOTE: REMOVE IN -GROUND SWIMMING POOL APPLICANT FUNDERBURK ROBERT G JR & V L 5044 3RD ST NE FRIDLEY, MN 55421 OWNER FUNDERBURK ROBERT G JR & V L 5044 3RD 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 wort 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 regulat' cos t'�®r erform ce of constru ti p ican-i-Lv�•,pQ�t, I� Date Flo o Bldg Insp6 Date`s 571-1287 PERMIT�2004-00"4 , Z DATE ISSUED: 04/06/2004 BUILDING PERMIT FEE 23.50 STATE SURCHARGE, OTHER 0.50 FIRE SURCHARGE 0.50 TOTAL 24.50 PAID WITH CHECK # 5234 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. e r263 NEW [ ] CITY OF FRIDLEY Effective 4/1/2004 ADDN [ ] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp ALTER SCJ 1 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax 0 BUILDING PERMIT APPLICATION �1& Construction Address: Oqqa. ) T064IN 5S Legal Description: pp // Owner Name & r^ess: /2©6Prf G. � Viyrcrv. Fopor Ck&r, Tel. # '%(03-5 ��- -Alle7 Contractor. �JG-C�I�� 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 GARAGE AREA: Length Width DECK AREA: Length Width OTHER: Height Sq. Ft. Height Sq. Ft Hgt/Ground Sq. Ft. Construction Type: Estimated Cost: $ TU�U U - Driveway Curb Cut Width Needed: Ft. + 6 Ft Ft x" $ _ $ DATE: () APPLICANT: �)-GG�rGI!✓1 1 U 1r e rbtAr4 Tel. # �& 3 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 TOTAL $ -S® $ L-2�7 $ $ $ cq4 S-6 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 [ ] STIPULATIONS: