PRE 2010 DOCS*---a .4 4".. -.1.6 0
BUILDING PERMIT
Village of Fridley, Minn. N?' 2783
Date /
/� . /0 \?
.........
Owner ......... A_w�� ,,azli*�. Builder .......................
Address..................................0...... Address .........................................
LOCATION OF BUILDING
No. ...... Street .15. .................... Part of Lot .......................
Lot .../,I ......... Block ... I q........ Addition or Sub -Division UZA . .
s
Corner Lot ............ Inside Lot .. `....... Setback J Sideyard JV..lftf ......... ... .
DESCRIPTION OF BUILDING
To be Used as:
J".. ... Front 14Q... Depth 2C�rleight �.�.... .
.................... Front ........ Depth ........ Height .........
Type of Construction... Est. CosI���f 0�% ..........
Sq. Ft. /d. !�V Cu. Ft. ........
Sq. Ft......... Cu. Ft. ........
To be Completed
In consideration of the issuance to we 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 village of Fridley.
In conratihe payment of a fee of $,/V , permit is hereby granted to .�&
Z= to construct the building or addition as described above. This permit is gralrlted 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 village limits and this permit may be revoked at any tim�upon violatio 1k�rf any of the provisions of said
ordinances.
1%nAV: / aY . Building Inspector
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 Inspector for separate permits for these Items.
City of Fridley, Minn.
BUILIDING PERMIT N? 5212
Date: - V.
Owner: Builder -.----_
Address Address
..
ON VT
ILDING
No. �r ��r/�r Street --, �- i Part 91 Lot
Lot Block _ Addition or Sub- �n.4t�
l'
Corner Lot Inside Lot S= back Sideyard
Sewer Elevation ____ _ Fo dation Elevation
DESCRIPTION OF BUILDING
Tofie
" Front Depth , Height s ,+,, � Sq. Ft. Cu. Ft.+C,�
Fr t Depth eight Sq. Ft. Cu. Ft.
Type of Construction �y, w 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 a'il provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $. permit is hereby granted to
to construct the building or addition as described above. This permit is "granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation -o any of the provisions of said
ordinances. _ _
Building Inspector
NOTICE:
This permit does not cover the construction, Installation for wiring, plumbing, gas beating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owner's Name Nr G h ® 4 a s & eirBuilder ,,., � t.J • 44a -e- r
Address ge® —7 , Aue. fv.F. Address S.d1y1�
LOCATION OF BUILDING
No. Street Part of Lot
Lot li Block i d Addition or Subdivision D n h a v Aleeuiyw
Corner Lot Inside Lot Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
r
�9 RA Front % � / Depth 2 Z Height
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Ou. Ft.
Type of ConstructionRA Estimated Cost
To be Completed
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Buildings, and hereby declares that all the facts and representations
stated in this application are true and correct.
DATE 1-11 -4lSIGNATURE � •
(A Schedule of Fee Costs can be found on the Reverse Side.)
0 11 . a a
City of Fridley
AT THE TOP OF THE TWIN$
r'L-------COMITY CEVELOPMENT MV,
�i PROTECTIVE wsfECT*M 09FT.
CITY HALL :LUOLRY OME
53-8b -879.01
$UD ECT
PLUMBING PERMIT APPLICATION
1
Jon Aaaress
580 N. E. 57th. Ave.
Owner Address Phone
S. Coffen
Contractor Address Phone
Kind of Building lUse
Frame
etion Date
1-11-74
`b
Class'12'Am Surcharge .50¢
TOTAL FEE $ 3.50
undersigned hereby makes application for a permit
the work herein specified, agreeing to do all work
trict accordance with the,City Ordinances and Tulin
he Department of Buildings, and hereby declare that
the facts and representations stated in this
i tine -,o reee true and and correct.
gnature Date
Res.
Estimated os
10.00
Plumbing Fixture Rates: NO.
RATE TOTAL
Number Fixtures
x
$2.00 $
Future Fixtures
x
$1.50
New Fixture -Old Open.
x
$1.50
Catch Basin
x
$3.25
Water Heater -99,000 BTU
x
$3.00
Ground Run Old Bldg.
x
$3.25
Elec. Water Heater
x
$2.00
Gas Fitting Fees:
1st 3 Fixtures
x
$2.00
Additional Fixtures
x
$ .75
Gas Range -199,000 T[1
Y
.00
....:...
Re airs & Alteratio���
e
Description: Replace Range
Code 3.00
State Surcharge
.50
Class'12'Am Surcharge .50¢
TOTAL FEE $ 3.50
undersigned hereby makes application for a permit
the work herein specified, agreeing to do all work
trict accordance with the,City Ordinances and Tulin
he Department of Buildings, and hereby declare that
the facts and representations stated in this
i tine -,o reee true and and correct.
gnature Date
SUBJECT
PE
City of Fridley
1717�4�
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
'ftCITIrrN
• COMMUNITY DEVELOPMENT DIV.
-_____
r � � PROTECTIVE IN SEC.
1
i HALL FRIDLEY 55432
NUMBER
REV.
DATEPAGE
OF
APPROVED BY
L 612-571-3450
910-F15
5/27/83
�
JOB ADDRESS 580 - 57th Avenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION SEE ATTACHED
DESCR.
13
10
Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Linda Cassem 580 - 57th Avenue N.E. 571-7218
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
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
❑ NEW ❑ ADDITION] ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
6 DESCRIBE WORK
Reroof Dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
Roof can be 2nd layer but not 3rd. =Kli TTXK ffi L1VxK*y
Install ridged galvanized valleys.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
Fiberglass
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 THIS TYPE OF WORK WILL BE COMPLIED
$600
$.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
TOTALFEE
$15.50
SIGNAT EOFCONTRACTO RAUTHORIZEDAGENT (DATE)
WHEN PROP RLY YAILIDATED THIS IS YOUR PERMIT
' BLDG INSP D f
SIGNA URE OF OWNER tlF OWNER BUILDER) (DATE)
CITY OF FRIDLEY
Effective Aug. 1, 1981
APPLICATIO:d FOR RESIDENTIhL BUILDING PER141TS
(New, Alterations, Additions, or Repairs)
OtiNER: L BUILDER:
J SSI
ADDRESS: 6-007 Aj ADDRESS: C
TEL n0: TEL NO:
Construction Location
STRUT NO: 500 STREET: 5 / Pq 1!e %V t=
LOT: 13 BLOCK: t3. %� ADDITION: bON ,A1 r
Corner Lot: Inside Lot: Setback.: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
-4=�0� Front:
DESCRIPTION OF CONSTRUCTION
Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet: _
�j o�
Type of Construction: e 6 e r ^�iaSS Estimated Cost: $ �000
Zb Be Completed: _ � Ltyle 30, rg�3
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired: $ $
SEE MVERSE SIDE OF SHEET .
1lie 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 Delwirtment of Buildings, and hereby declares that all the facts and
represenUitions stated in this application are true and correct.
DATE: 7 O SIGNATUIE :
Stipulations:
S°
I , S"U
M
SUBJECT
City of Fridley
2 7 71 1
AT THE TOP OF THE TWINS
BUILDING PERMIT
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
______
I ~ PROTECTIVE INSPECTION SEC.
I . �
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
j
1 J` 612-571-3450
910-F15
9/11/98
O
JOB ADDRESS 580 57th Ave NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
13
10
Donna 's Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Brian Balthazer Same 55432
571-4510
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Owner 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
B DESCRIBE WORK
Reroof house 20S 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
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 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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
59.32
E OF CONTT OR iHORIZED AGENT (DATEEEj
SIGN URI
EN OP
DATED IS Y PER IT
A
/e�r_
BLOGFINSP
PATE
S,GNATURE OF OWNER OF O R BUILDER( - (DATEI
M
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
xConstructionAddress: 5yo 571A Av e
Legal Description:
Owner Name & Address: 61,1 ZVI 9. Z o w Tel. #
Contractor: vn e. MN LICENSE #
/I Address: Tel. #
LIVING AREA:
DECK AREA:
YOTHER:
Construction Type:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
R a Ir+ov Q. H d +VS4 0 O F1(- P
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Effective 1/1/98
571 - L(510
Sq. Ft.
Sq. Ft.
Sq. Ft.
Estimated Cost: $ / /)/ v
(Fee Schedule on Back)
Ft x $ = $
OS
JI-6ATE: 9 -(i" TF APPLICANT: ;0 Tel. # (9
CITY USE ONLY
Permit Fee $ J % - /75
Fire Surcharge
$ /, ? /
State Surcharge
$ y
SAC Charge
$
License Surcharge
$
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $
STIPULATIONS:
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 [ ]
CITY OF FRIDLEY INSPECTION DIVISION
6431 University Ave NE
Fridley, MN 55432
572-3604
RATE SCHEDULE
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
Residential Rate TOTAL
Furnace Shell and Duct Work, Burner —
Also Replacement Furnace $ 30.00 $
(Side Vent — Fill Out Back)
Gas Piping (Needed with new furnace) $10.00 $
Gas Range $10.00 $
Gas Dryer $10.00 $
*Air Conditioning — All Sizes $ 25.00 $�
All Otherrs/Repairs $ Alterations (LIST ON BACK
1% of Value of Appliance or Work $
Commerciale ndustrial
1.25% of Value of Appliance or Work $
State Surcharge $ .50
TOTAL FEEc .�
MINIMUM FEE FOR ANY HEATING/COOUNGM NTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00Mr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Effective On January 1, 1998
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 Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
,1998
OWNER S �ca n �o-2 r
BUILDING USED AS___P
ESTIMATED COST./� t,�, CZ PERMIT NO. Z31=29V
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units
Trade Name
Circle One (Steam) (Hot Water) (Warm Air)
Size No.
BTU HP EDR,
Fuel
Burner Trade Name,
BTU
Total Connected Load
HP
Size No.
ar -
HEATING . 1
r• J ' �` .�
Signed
A
Approved By Rough—in Date Final v
4�8c
FILL OUT BACK SIDE FOR STACK VERIFICATION ON
REPLACEMENT FURNACE
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
Has been carefully examined
Yes {)
No
( )
y1,
2.
Isere from rust or deterioration
Yes
O
No
{ )
3.
Hisno foreign objects Iodged within
Yes
(
)
No
( )
4.
Is'securely supported
Yes ()
No
{ )
S.
Meeets all current Code requirements for size
ind total BTU's connected
Yes ()
No
( )
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Bein&DDone:
HEATING CO:
Signed By:.,,
Date:
I
SUBJECT
.�
City of Fridley
11474
AT THE TOP OF THE TWINS
BUILDING
PERM
'
� rr
NO.
• �����_, COMMUNITY DEVELOPMENT DIV.
fr
INSPECTION SEC.
r � � PROTECTIVE
1
1 i �"•I CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/12/00
JOB ADDRESS 580 57 Avenue NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
13
10
1 Donray's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Brian Balthazer 580 57 Avenue NE
571-4510
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Sams
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
J NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE JG REMOVE
5 DESCRIBE WORK
Remove existing 18' x 22' Garage;Construct a 30' x 22' Garage
9 CHANGE OF USE FROM
TO
STIPULATIONS
See notations on plan. Provide a hard surface driveway.
'WA1?jqjjqG
80'011G
.digging call fOr
all utility locations
4`4-0002
REQUIRE® y
A
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT
CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 50 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
$ 14,935
$7.46
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-
$251.25
F e SC $14.93
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK
TetALFEE
$273.64
S-GNATUREOFt:py'RACTOR OR AUTHORIZED AGENT MATES
14)- ra
[A-S-GNATURE
yy p Y VA 10 ED THIS IS YOUR PERMIT
C`///)�
OF OW R,,F OWNER BUILOERI ,DATE,
B ,N$ MATE
I
NEW [ l Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 5 ? d 97-(A /+ ve
Legal Description: 1-10+ 13 131 o c- k 10 19 o vi n a y'rs L e- We V <%V h op
Owner Name&Address: igHgot 4t -Z,1,4 ,SQch,a Tel.#
Contractor: SA ti• 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 301 Width s Height Sq. Ft. 6 6D
DECK AREA:L Width Hgt/Ground Sq. F
OTHER: 7jn o v EA-j G lA
Construction Type: Estimated Cost: $ a 0-. 0
If
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ =$
DATE: 110-1,Q-00 `
APPLICANT: �-^^ Tel. # 5-71—V910
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ , or Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
$ $1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
Sewer Main Charge $
TOTAL $ 7.T. (D
STIPULATIONS:
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
The Home Depot #2805, 400 W 79TH ST, BLOOMINGTON, MN 55420, (61
Thu Sep 28 13:52:39 2000 3432•°0
The materials in this garage will cost $2589.43
This
Price Trvss t 3 Y3.00
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ENGINEERS AND SURVEYORS
LANO SURVEYING SOILS TESTING
CIVIL A.. MUNICIPAL ENGINEERING LANG PLANNING
6418 -SETH AVENUE N.
MINNEAPOLIS 22.MIIJN.
OR T- 4014
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�,�JR -MINNESOTA REOISTRAT10tJ NO. 3'795.
SUBJECT
PERMIT
City of Fridley
3180 0
AT THE TOP OF THE TWINS
BUILDING
PERMIT
06
RECEIPT NO.
• _____ COMMUNITY DEVELOPMENT DIV.
572-3604
r � � PROTECTIVE INSPECTION SEC.
1 . i
I = 1 CITY HALL FRIDLEY 55432
�''
NUMBER
REV
DATE
F;GE OF
APPROVED Br
612-571-3450
910-F15
5/4/01
/
JOB ADDRESS 580 57 avenue NE
1 LEGAL
L07 NO.
BLOCK
—7
TRACT OR ADDITION
SEE ATTACHED
DEscR.
13
10
Donnay' s
Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Brian Balthazer 580 57 Avenue NE
763-571-4510
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
T CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION] REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Replace soffit
9 CHANGE OF USE FROM
TO
STIPULATIONS
Install soffit ventilation to meet the State Building Code.
SEPARATE PERMITS ARE REOUIRED 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
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
$500
$.50
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
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$23.50
Fire SC
PLAN CHECK FEE
TOTAL FEE
$24.50
TORE OF CON' ,TO NORiZEDAGENT iDATE.
WH N Pq LY VALIDA ED THIS IS YOUR PERMIT
5- Y°- �f
X
&-' , 5-- z O I
S-GNATURE O. OWNER WNER BWLDE Ri IDATE,
LOG �N 0AIE
NEW [) Effective 1/1/2001
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 5%0 5-71,`` (1 v -e-
Legal
Legal Description:
Owner Name & Address: 13" io•w f Tel. # W 3 671-11,5(,0
Contractor. Sa*`-.-
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. Ft. _
DECK AREA: Length Width Hgt/Ground Sq. Ft. _
OTHER:
Construction Type:9 � 1 i„c e, So Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: APPLICANT: Tel. #
CITY USE ONLY - Call (763) 572-3604 for Permit Fees If mailing In application
Permit Fee $ 43, Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/10th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1150 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 [ j
TOTAL $ C� V, S U
STIPULATIONS:
a
SUBJECT I
P -
City of Fridley
31867
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
�• COMMUNITY DEVELOPMENT DIV.
�: •--••-
r PROTECTIVE INSPECTION SEC.
®
O
�� '/TL
1
Vq72.36®4
1
'-•-1 CITY HALL FRIDLEY 55432
�'"'-A
NUMBER
REV
DATE
PAGE OF
APPROVED BY
, j 612-571-3450
910-F15
6/1/01
JOB ADDRESS 580 57 Avenue NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
13
10
1 Donnay's Lakeview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Brian Balthazer 580 57 Avenue NE 763-571-4510
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
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
C3 NEW 0 ADDITION 0 ALTERATION REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reside front of house
9 CHANGE OF USE FROM TO
STIPULATIONS
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.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING. HEATING.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCYLOAD
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
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$1,600
$.80
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 ANCE OF CONSTRUCTION
PLAN CHECK FEE
TOTAL FEE
4- 1` 0I
$59.45
SIGNATURE OF CO ACTOR OR AUTI ORIZEO AGENT IDATEI
61
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
BLDG INSP - OA TI
S.GNATURE OF Ow NEROF OWNER BUILDERI IDATE, a
a
NEW [ ] Effective 1/1/2001
ADDN [ ] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 510 mac 7+y A U e.
Legal Description:
Owner Name & Address: zo.- Tel. #
Contractor: S 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. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: (fie �`r�� -Pi v ,+ fl'F hous¢.
Construction Type: Estimated Cost: $ 1,6 010
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ —=$
DATE:
APPLICANT: Tel. #
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee Fee Schedule on Reverse Side
Fire Surcharge $ O .001 of Permit Valuation (1/10th%)
State Surcharge $ 90 $.50/$1,000 Valuation
SAC Charge $ $1150 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 $ :5 /° q5
STIPULATIONS:
DESCRIBE WORK BEING
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
H
Faii
BASEMENT REMODELING SUBMIT:
I . Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes 17No 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:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 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 $ $2000 per SAC Unit (Plans to MWCC for determination) �1 -
Curb Cut Escrow $ Upyot Aft=�� ft x $22 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due $ Make checks payable to: City of Fridley Attach Stipulations
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 1 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 which requires review and approval of plans.
_�' 0 - PRINT NAME
SIGNATURE OF APPLICANT T� SC' P In DATE `� GI
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BUILDING
Permit No.:1
Building
Inspections
RESIDENTIAL APPLICATION
Received By:N
763-572-3604
CITY OF FRIDLEY
Date MAY
763-502-4977 FAX
EFFECTIVE 1-1-09
DATE -09
YOUR E-MAIL ADDRESS
SITE ADDRESS 5W / l h �t'e Nie
THIS APPLICANT IS:
1LOWNER ❑CONTRACTOR
PROPERTY OWNER/
NAME:__m le 7 To 5e P tA
9s4 jZ
TENANT
ADDRESS: 51 t j, A.e Nt', CITY E r.`� Pe -1
STATE-1�/ ZIP
PHONE: 763` )_Z9 -WS;,"
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
ADDRESS: CITY
STATE ZIP
INSURANCE
PHONE FAX
PROPERTY TYPE
SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
H
Faii
BASEMENT REMODELING SUBMIT:
I . Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes 17No 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:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 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 $ $2000 per SAC Unit (Plans to MWCC for determination) �1 -
Curb Cut Escrow $ Upyot Aft=�� ft x $22 = $
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary ( ) Non Necessary ( )
Total Due $ Make checks payable to: City of Fridley Attach Stipulations
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 1 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 which requires review and approval of plans.
_�' 0 - PRINT NAME
SIGNATURE OF APPLICANT T� SC' P In DATE `� GI
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