PRE 2010 DOCS0
City of Fridley, Minn.
•
BUR DING PERMIT N® 3827
Date: ... y ....... ,a ."'1-� ...........
Owner ....................................... Budder .���i%.tsioii ............................
Address ...................................... Address .............................................
ATI OF 8RjWLDING
No.. f/: !. J../.. Street .... Part of t .. .
...
.... ...... ..........
Lot jell ... Block ......1......... Addition or Sub -Division .. ... RG .................. .
Corner Lot ......... 4.......... Setback 3'.� v ide l .......................
... Inside Lot .... ... yard
DESCRIPTION OF BUILDING
To Used
�/ G70 4
.. ..... Front �� Depth ��.,40 ' Height IFSq. Ft. .�Vi. O Cu. Ft. %0PIF1�I)
.................... Front ........ Depth ........ eighu. t ........ Sq. Ft. ........ CFt. ........
Type of Construction ................... Est Cost.. l��.�®.7 .. To be Completed ...................
In consideration of the issuance to me of a permit to construct the building esribed above, I agree to do
the proposed work in accordance with the description above set forth and pliance with all provisio of
ordinances of the city of Fridley.
..x.....40
.....
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 with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. _
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, plumbing; gas heating,
sewer or water. Be sure to see the Building Inspectowfvr separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name: Builder
Address' , Address
OCATION OF BUILDING
No.Street '_''' Part of Lot1 019
Lot Block Addition or.Sub..Divi,
Corner Lot Inside Lot Set Back
Applicant attach to this form Certificate of Survey of Lot and proposed
building••location.
DESCRIPTION OF BUILDING
To be ed -as
Front L� Depth Height
Sq. Ft. Cu. Ft.
Front Depth ight
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 representations stated in this application
are true and correc
DateSignature - -
(A Schedule of Fee Costs can be found on the Reverse Side)
City of Fridley
Application fc Plumbing and Gas Fitttt ng Perndt
Dept. of Bldgs. Phone SII 4-7470
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
1
�
�'�Zxyy,Zc
Number Fixtures ......................
x
$1.50
u'
Future Fixture Opening ................
pril
1.20
N
WATER HTR.
GAS
ELEGopp
Base
$
Catch Basin ............................
x
3.25
$
Water Beater (Up to 200,000 BTI)
......
x
2.00
$
New Ground Run Old Bldg. ............
x
3.25
1st
t
NO.
t
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
Additional Fixtures ....................
x
.50
$
2nd
x
2.00
$
3rd
4th
' Future Connection Openings I
Fixture, Old Openings
Connected with
Sewer
E]
Cesspool 0
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO.
RATE TOTAL
Number Fixtures ......................
x
$1.50
$�
Future Fixture Opening ................
x
1.20
$
New Fixture Old Opening ..............
x
1.00
$
Catch Basin ............................
x
3.25
$
Water Beater (Up to 200,000 BTI)
......
x
2.00
$
New Ground Run Old Bldg. ............
x
3.25
$
GAS FITTING FEES:
NO.
RATE TOTAL
1st 3 Fixtures ..........................
x
$1.50
Additional Fixtures ....................
x
.50
$
Gas Range to 200,000 BTU ..............
x
2.00
$
REPAIRS & ALTERATIONS—Refer to Code
Description ................................................$
TOTAL FEE $
City of Fridley:
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
�tru�e and correct. q
Fridley ATinn- � a19�
e
9
Owner19—
Kind of Building -' 19_
o e n
Used as
To be completed about �z
Estimated Cost, $ � d `_
Old—New. Building Permit No
Sign Z,4 r, ' ` - .,
Ey o4L"-0��l cax!A& )
Business Phone No
JUN 3 1959 R ou��
it POST 1M-12-58
0
•
•
City of Fridley, Minn.
BUILDING PERMIT
No '7036
Date: 'j
Owner: Builder —
Address Address
LON F B ILDING
No. Al Street T�_ Part f Lot
Lot _ _ Block L Addition or Sub -Di n
Corner Lot _ Inside Lot _ _� Setback ideyard a�
Sewer Elevation___ _ Fo dation Elevation
DESCRIPTION OF BUILDING
T
' FrontM Depth Height Sq. Ft. Cu. Ft.
Fro t Depth HVIght __ Sq. Ft. Cu. Ft.
Type of Construction r -e Est. Cost __ 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 ah provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $-X=—, 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 reg location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and is permit may be revoked at any time upon violation of any of the provisions 701a
ordinance.
Building Inspector
NOTICE:
Ole permit does not corer the construction, hwtatlafion for wiring, plumbing, gee heating, sewer or water. Be sure to ace
the Building ingmfor for soparate permits for these (team
APPLICATION FOR BUILDING TERMIT
.. CITY.:OF FRIDLEY, MINNESOTA;,
..BUILDER /-/" C t� -
ADDRESS 1p f'� i. -�—.: ADDRESS - 2�
LOCATION OF BUILDING
No. - (_/ 71 /1/ -6, Street part, sof Lot
Lot` 'd -L— Block Addition "or +Subdivision
Corner Lot____�_Inside Lot 9, Setback Side
SEWER ELEVATION FOUNDATION ELEVATION
Applicant, attach to this;.form.T-wo,Certificates of Survey, .-of, Lot and proposed build-
ing location drawn on these Certificates.:.
DESCRIPTION OF BUILDING
To be used as- J
Front Z Depthf. . Z 2 Height 7 Q
Sq. Ft. Ft.. _
Front Dmpth Height
Sq. Ft. r Cu.. Ft.
Type of Construction7 /" w � Estimated "Cost.
To be Completed �yn
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:Departmeut,of Buildings,, and hereby de CI that all the facts and.
representations stated in this application are true and,correct.
s
DATE 6
jSchedule of Fee Costs can be found on the Reverse Side).
r
•
City of Fridley, Minn. W? , 7527
BUILDING PERMIT
Date: May 252 1965
per; Hasley Ralanchard Builder Erstperty?mgraveme>at Co.
Adm 6171 6th Street N. E. Address ?353 Jansen Ave. White Bei Inc. ,101m.
LOCATION OF BUILDING
No.6171 Street 6th Street N. E. Parc of Lot
Lot 12 Block 1 Addition or Sub -Division U131 and, Second Adds
Corner Lot _ Inside Lot Setback — Sideyard
Sewer Elevation Foundation Elevation
To be Used as:
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction Est, cost $1.,873 -00 To be Completed
• Storm Damage Repair
L�
In consideration of the issuance to me of a permit to construct -,the building described above I agree to do
the proposed work in accordance with the description above set fo�fh in con ante with 21 ons f
ordinances of the city of Fridley. ��
In consideration of the payment of a fee of l$ 0•00 , permit is hereby granted to Fr' I
CMpar 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 pert thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buiIM—
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
NCMC&
Ibis permit doss riot cover the eombudlon,, lestatlalten for wkb& plumbloW gn has&& ewer or wale,. Be sure to we
the Building hfgmbr for aparale permits for the» Hann.
C. L,IA5.. C01 ID LW5,
f' 4r" �, a
��i.sR �: LLP Y N O� W �`'
<:5 -TP a a e-, F_ -
Eu t po o elw r"Vks c
7119-. 'Doe P_
2J>J
;ATION FOR BUILDING PERMIT
7 OF FRIDLEY, MINNESOTA
BUILDER - _ P - A n s
ADDRESS Af� F.B
:ATION OF BUILDING
.Street to is Part of Lot
IITION OR SUBDIVISION
,ck Side -Yard
FOUNDATION -ELEVATION
rtificates of Survey of Lot and proposed
tificates.
tIPTION. OF BUMPING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft.'' Cu. Ft.
Type of Cons truction_Fuu-, Estimated Cost rl 1.5. 0-0
To be c
The'undersigned.hereby makes application for a.permit for the work herein specified,
agreeing Eo ddlali ,Oork in strict accordance with the City of Fridley Ordinances
andrulings of the Department of Buildings, and hereby declares that all the facts
and rep esentatioizs stated in this application are true and correct.
DATE- - II►Px1 �I 1- ct�.
(Schedule of Fee Costs can be
found on the Reverse Side).
ti
SUBJECT
City of Fridley
19318
AT THE TOP OF THE TWINS
BUILDING
PERMIT
R
' '
`y ....... COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
LK
r PROTECTIVE
1 ; �
l 1� /'�'1.� CITY HALL FRIDLEY 55432
,
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L •--.
612-571-3450
910-F15
1/27/88
JOB ADDRESS 6171 - 6th Street N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
12
1
Upland 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Hurley/Mary Blanchard 6171'- 6th Street N.E.
571-3234
3 CONTRACTOR MAIL ADDRESS
ZIP PHON LICENSE NO.
183-9094
Corner Stone.Masonry Inc. 684 N. Birch, Shoreview, MN
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 X❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Construct a masonry fireplace
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke alarms on both. levels of dwelling..
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
ISTALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS
VALUATION
SURTAX
AND,ORDINANCES GOVERNING TYPE OF WORK WILL BE MPLIED
$4,500
$2.25
WITH WHETHER SPECIFIED HEREINS NOT. THE GRANTING OF AOPERMIT
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-
$50.50
STRU,;TION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
7 /9'9
-'-
1 $52.75
SIGNATURE OF CON"RACTOR OR AUTHORIZED AGENT I TE)
WHEN PROPERLY
BLDG INSP
VALIDATED THIS IS YOUR PERMIT
DATE
SiGNATURE OF OWNER IIF OWNER BUILDER) IDATEI
ti
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [ ] �R-1 AND R2I
ALTER. LjC`] Building PermitC Application
Construction Address: ����
Legal Description:
Owner Name & Address:
Contractor
Address
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application,, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Tel. # S -,7/-3.;L3 V
Tel. #
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction:Estimated Cost: $ `
Approx. Completion Date:
Proposed Driveway Width If New Opening Is Desired:
Alt. A Alt B
$ $
See Back Page for Explanation
-�' APPLICANT Tel.
DATE.. # (�/
CITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Plan Check $ 25% of Building Permit Fee
State Surcharge $ CIO $.50/$1,000 Valuation
SAC Charge $ $0 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
® Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS: kfb C, 'L) 0 455®
61.570
3 ,� � l'8
��rYr'
HOUSE HEATING TEST RECORD
o
ADDRESS
APT. -FLOOR �CITY SUBURB
OCCUPANT
OWNERa.�r
HEAT LOSS DATE HTG. INST.
SOLD BY . We
INSTALLED BY ga se 4K 1X&12i!At
Electrical Work Bly,
Gas Line By
TYPE OF HEAT GA FA HW
STEAM SPACE HTR. UIAT HTR. OTHER
GAS DESIGN
CONVERSION
MAKE _ ���
___MAKE OF BURNER
Model %GIi� D®�
_._ _. Model
Serial EZ)
_—_ Max. BTU Rating
INPUT c> a
MAKE OF FURNACE Neap® 18' IVI
Model _ �' 825-6867
CONTROLS
THERMOSTAT A40V-9i Heat Plug
Vent Size
Volvo Q� '
• KIND OF LINER & 11-- 5 SIZE 5 NONE
Limit , �dC�
Draft Hood Regulatore
Limit Setting _' o
Filters Size 14495= Number. -
Fan Setting
Chimney Location Inside Alm Outside
Pilot Type
Chimney Construction 11jeSAeV —
Pilot Make
Pilot Model '""-
Smoke Bomb Wiring - --
Pilot Timing __,Zee
Draft Test Tag
L.W. Cut Off
Door Pressure Lighting Inst. __ y
Pressure 2 S- «? C- - Percent CO2 Date Tested
Input CFH %,70 crkf Percent 02
Company Testing ` -. ZA e •-
Stock Temp. AhC Percent CO ==A?
'- Name of Tester - - .-._.--. -- --- -
Form 235
CITY OF FRIDLEY
Effective Date May 1, 1.988
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
' Air Conditioning (all sizes)
RATE
$ 20.00
All Others/Repairs and Alterations
18 of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
1% of Value of Appliance or Work
$ 10.00
$ 10.00
$ 10.00
$ 10.00
State Surcharge
TOTAL FEE
Reinspection Fee ($15.00)
Rough Insp.
Date
,l
Final Insp. /0 / ^ /
Date
Approval for Permit .�0
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 6171 - �p rff
$ 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. X
$ idley,Miinn.. V/4 . 19�l/
OWNER f��/���� l?i/� !/ :JLI#A& hl oof / �7
$ .50
KIND OF
USED AS
Ta BE COMPLETED A%BODUT
ESTIMATED COST
OLD NEW BUILDING PERMIT NO. PERMIT NO.
QV < `�
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air No. //1
Trade Name A2 &Z Size No. ;rk 00 y ��
Capacity Sq. Ft. EDR BTU HP
Total Connected Load 0JX&5J
` ) AiCa' 6htind of 4F..1
BURNER - Trade Name --�_ Size No.®�®
Capacity Sq. Ft. EDR BTU HP
company
SignedQ ®® Q�/
Tel. No. � — 4 O /
Fill out back side for stack verification on replacement furnaces
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
Signed B
Da to
1.
Has been carefully examined
Yes
(4
No ( )
2.
Is free from rust or deterioration
Yes
(✓f
No ( )
3.
Has no foreign objects lodged
within
Yes
(vf
No ( )
4.
Is securely supported
Yes
(V�
No ( )
5.
Meets all current Code requirements for size and
total BTU connected
Yes
(✓f
No ( )
6.
Has Total heating BTU's of
aU
All other BTU's
®�
TOTAL
Rema rk s
Signed B
Da to
City of Fridley
sueJEcr
PERMIT NO.
�
24521
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
• COMMUNITY DEVELOPMENT DIV
______
r v PROTECTIVE INSPECTION SEC
.y
(03
NUMBER
REV
DATE
PAGE OF
APPROVED By
CITY HALL FRIDLEY 55432
1'j
612-571-3450
910-F15
9/3/96
JOB ADDRESS 6171 6 Street NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
12
1
Uplands 2nd Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jason Arth 6171 6 Street NE
572-3841
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Renslow's Decks & Gazebros 1746 E Co Rd B Maplewood MN 55109 773-9707 8209
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 X ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 12' x 11' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
WARNING
DOM digging call for
all utility locations
454.0002
-REQUIRED BY LAW
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
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
$.59
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,165
DOES NOT PRESU E TO G VE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHARGE
PROVISIONS OF NY OT R STAT OR LOCAL LAW REGULATING CON-
$54.00
Fire SC $1.17
STR CTIO O HE PE RMAN OF CONSTRUCTION
PLAN CHECK F
OTAL FEE
�Z_
Lice e C
5.0
$60.76
NATURE 6F CONTRACTOR OR AUTN EDA NT IDATEI
EN7P�RLY
ATED--THIS IS YOUR PERMIT
1,
4rkDG i P
f
DATE
S,GNATURE OF OWNER OF OWNER BUILDERi (DATEi
0
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress:
Legal Description:
Owner Name &
Contract
Address:
Effective 3/1/96
Tel. # ,5%� •� ���
MN LICENSE
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EWPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length /,,2/ Width Z1 , Hgt/Ground
OTHER:
Comer Lot [ ] Inside Lot [ ]
Type of Construction:
Approx. Completion Date:
Ft. Yd Setback
Sq. Ft.
Sq. Ft.
Sq. Ft. __Z
Side Yard Setbacks
Estimated Cost: $ / /� .f, �yIf
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. Ft = $ _ $
DATE: P —1.9 - 9 APPLICANT: Tel. # `/ %9 Q;26 %
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ G�C�
$ a f9
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$900 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 [ ]
NUNDEnEwGINERPING C0,49INco
ENGINEERS AND SURVEYORS
L^No BUaVVYING SOILS TESTING
CIVIL & MUNICIPAL ENGINEEQINC3 LANA PLANNING
6418-SGTK AVENUE N.
MINNEAPOLIS 2T, MINN.
KE 7- BG37
Hca t ip of !� 1� ��►t!
T'or;
NoRTHERAI ZA/VO le DEAL TY CO,
/33. /if — rte,,,
A/y
n�
_IZZI
Z— D f 1Z — 0 L r' — &�,/,4,Av,�%� 2 NL APp T1 DN
WE HEREBY CERTIFY THgT THIS 15 A TRUE AND CORRECT REPRESENTATIOAI OF A SURVEY OF THE BOUNDARIES OF THE
LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF ANY, TIAE.REON, ANO ALL VISIBLE ENCROACHMENTS,
IF ANY, FQOM oRON SAID LAND. v M;NDER ENGINEERING CO., INC.
GATED THIS OAYOF EN61NEER5 wNIP, SURVEYORS
by
5"715'S
773-970
Flat top sin le ballaster casad
TXT
NEW [ ] CITY OF FRIDLEY Effective 4/1/2004
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: (0( -
Legal Description: 2
Owner Name & Address: % e 11 y %�, Teel.# 709
Contractor. TWIN PTY HOME REMODEUNG MN LICENSE # Z O S/ 5"F rR
Address- FrIfty_ MN 55dg9 - Tel. #
W 70-U 2577
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. X��
OTHER: �-+ - galls , 'PV i
'
NOW jLG*tf'j-e J,"' V �� �.
Z0Construction Type: /�°ir%� 5-� f /Zo Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + Ft = t x $ _ $
DATE: -7— ( 1- 0'5- APPLICANT: Tel. #
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: