PRE 2010 DOCSi 0
BUILDING PERMIT
Village of Fridley, Minn.
Date ....�1....................
c
Owner ...... .... ... .... Builder
Address....�.......... Address
N° 2964 /
LOCATION OF BUILDING
No. .... Street v57 ...... ......... Part of Lot ............. ...... .
Lot ...... ....... Block ... ........ Addition or Sub -Division
Corner Lot ............ Inside Lot ... Setback . c7 ........ Sideyard
DESCRIPTION OF BUILDING
To be Used as: _
/ .... Front Depth O C Height Sq. Ft./j ® A.70 Cu. Ft. ........
.................... Front ........
Type of
6a��/oma /7
Depth ......... Height ........
Cost
...1.�'�
.� .........
Sq. Ft.... .. /Cu. Ft. .....
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 all provisions of
ordinances of the village of Fridley.
In consideration of the payment of a fee of $. , permit is hereby granted to ......... .
....................... to construct the building r addition as described above. permit is granted upog
the express condition that the person to whom it is granted and his agents, employ 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 time upon violation of any of the provisions of said
ordinances.
NOTICE:
This permit does not cover the construction, Installation or alteration for wiring, pi
sewer or water. Be sure to see the Building Inspector for separate permits for these tte
heating,
City of Fridley, Minn.
BUILDING PERMIT N° 1]4!561
Date:
Owner: -- .. .. _...._ J... .....•:: Builder .................. _.__._.__
Address Address
LO ON F BUILDING
No. ..... ��, --:.:. Streetger-�............. _ p of t ..__....._...._� .__.._._.. ._.._.__...._._�.,._
Lot .....--- ......._..._-........ Block ....._......... - Addition or Sub -Division .. .... c,r__._.
CornerLot ......................... _........ Inside Lot .......... -........------ •...... Setback ..--•---- ..._:.------............. Sideyard _... -......................... ......... ....... _......
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
D -be ed-
........ ..... Front .. ....._.: Depth s::.. `.._.. Height ..... ! .... Sq. Ft. t Cu. Ft.7
...._..............--............... -............. Frgnt .................. Depth ...................... lie ht ..:,- ............ Sq. Ft......_................. Cu. Ft:. ..... -.................
• d�
Type of Construction ..............
: CA ... Est Cost... .._........�...,�'�.....! �"`�`�o be Completed .............. .... ...............................
-TION
THIS PERMIT DOCrR '��f,! TU HAT ORIZE V10L
ION OF ANY PRIVATE LAND AT
COVENANTS AND
BUILDING RESTS{;CT10NS.
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 all 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 of any of the provisions of said
ordinances. - ^-
Building Inspector
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to see
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name D®"IW /" (L Ili Builder 4 ie" 1-11-e I? --
Address ,0.5`0 S.? tk A W— N ,,-0'E' Address s,4 0- r .
LOCATION OF BUILDING
No. S C Street 7,14A o ; /y.6 Part of Lot
Lot .,, .Block / Addition or Sub,Div*141re ale w if.0-a
Corner Lot Inside Lots t Back 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:
6,4 R,4 G e Front / Depth
Sq. Ft. Cu. Ft. So? 0
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction,%Al a Estimated Cost a o o
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 representa-
tions stated in this application are true and correct.
DATE 3 Z91 0 SIGNATURE �� C
(A Schedule of Fee costs can be found on the Reverse Side.)
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City of Fridley, Minn.
BUILDING PERMIT
Date: Na M 1965
�9�60
N° 7454
owner: Donald Cullen Builder _ _ Q2r1on Cmoiac
Address 65o 57th Ave. N.E. Address 6631 McKin7. St. N.E.
LOCATION OF BUILDING
No. _63S �7th s nne N.E. — Part of Lot
Lot 6 �__ Block 10 _ Addition or Sub.Division DomaY'IS LakeviewManor
Corner Lot — Inside Lot Setback Sideyaid
Sewer Elevation _ _ _ ._ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Height Sq. Ft. t.
Cu. F
Type of Construction Est. Cost _... 500.00 __ To be Completed 521,/65
Restore Property
Storm Damage — Minor Repair
In consideration of the issuance to me e a permit to a set
building described above, I� df
the proposed work in accordance with the description above set fo and in com/plane wi/th/ill of
ordinances of the city of Fridley. �,
In consideration of the payment of a fee of $_3_t0_0 , permit is hereby granted to COrlOn_
r0M-g RrLOtai on GO— 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 anypart 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 andMath permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
NOTICE:
Ibb pemmb does not emu the sondmWon, huhWen for wMh& plumbing, gas hoofing, sewer w water. Be euro to see
the Bulhling Mqm for for separate pormhs for these Nems.
APPLICATION. FOR BUILDING YEP,MIT,.9
CITY OF FRIDLEY, Mib]TTESOTA
OWNER'S NAME Donald Mill en BUILDER Corlon Construction
ADDRESS 650 -57th Ave. N.E. ADDRESS 601 McKinley St.-M.E.
LOCATION OF BUILDING
No. ss Street Part of Lot
Lot Block % Addition or Subdivisio� ` G-CQtt�-��'t,
Corner Lot Inside Lot Setback - Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as: RESTORE PROPERTY
Front iepth Height
Sq. Ft. ,Cu. Ft.
Front Depth Height
Sq. Ft. - Cu. Ft.
Type of Construction MINOR REPAIR .Estimated Cost x;500.00
To be Completed 5/21/65
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.
(Schedule of Fee Costs can be found on the Reverse Side).
0
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36po
City of Fridley, Minn. N9 9057
BUILDING PERMIT
Date: — 17 October 1966
owner: Donald F. Cullen Builder Same
Address 650 57th Ave. NE Address Same
LOCATION OF BUILDING
No. 650 _ Street _ 57th Avenue NE _ — part of Lot
Lot __ 6 _ Block 10 __ Addition or Sub -Division Donna's Bakeview Manor
Corner Lot ---- Inside Lot _.._ X Setback w _ _ Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To Add to Exist Garage 6 22
dt
Front 20 Dept 22 Height 10 Sq. Ft. Cu. Ft.
— Front Depth _ _ Height — Sq. Ft. _ Cu. Ft.
Type of Construction _Erne Est. Cost —$09,94_ _-_ To be Completed 15 November 1966
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 se forth and in compliance with all provisions of
ordinances of the city of Fridley. J
r
In consideration of the payment of a fee of $ 4.00 , permit is hereby granted to Do=ld F.
Cullen 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 of any of the provisions of said
ordinances.
CLARENCE BELISLE Building Inspector
NOTICE:
This permit does not cover the construction, Installation for whing, plumbing, gas heating, sewer or water. Be aura to as
the Building Inspector for separate permits for thea items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA _.
OWNER'S NAME :)J 4 A-/ /'C O t-1 //C- /Y BUILDER 51% &
ADDRESS (r, "! "-o S 7 til 14 o P /t' itP ADDRESS .S
LOCATION OF BUILDING
NO, 66-0 STREET �% � L' �'. ti 6= PART OF LOT
LOT BLOCK ADDITION OR SUBDIVISION iL
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: Add fd yt��
Front 96O Depth Height
Type of Construction2 <z -
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
Estimated Cost � C r
To be completed Zfj� /1-5--
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 r° ��L/ i « SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side).
City of Fridley, Minn.
•
BUILDING PERMIT
Date: July 31, 1969
•
r�L
Owner:
Address
No.
Donald F. Cullen
650 57th Ave. N. E.
Builder
Address
Same
Same
LOCATION OF BUILDING
650Sit 57th Ave, N. E.
Lot 6 ___Block 10 _ Addition or Sub-Divisior
Corner Lot — Inside Lot — Setback
Sewer Elevation
#48255
N° 10354
Part of Lot
Donnay's Lakeview Manor
Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
pnrcch_— Front _L Depth 316"
Type of Construction
Front Depth
Frame Est. Cost
Height 10 ' Sq. Ft.
Height Sq. Ft.
$15 0, 00 _ To be Completed
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 set forth and in compliance with ill provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 5.00 permit is hereby granted to Donald Cullen
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 anypart thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regardinglocation, construction, alteration, maintenance, repair andmoving of bWWI—
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
Clarence Belisle
NOTICE:
This permit doss not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be acre to we
the Building Inspector for separate permits for these items.
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNEE IS NAME4��� -BUILDER
ADDRESS r ADDRESS
LOCATION OF BUILDING
NO • 6-6-0 STREET S-2
LOT (o BLOCK
CORNER LOT
/0 ADDITION OR SUBDIVIS
INSIDE LOT SETBACK SIDEYARD
SEWER ELEVATION TOP OF FOOTING
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 4— Height �0
Square feet Cubic Feet
Type
To Be
Front
Depth Height
Square feet Cubic Feet
of Construction Estimated Cost
Completed
� i y
45-0.0-0
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 1% SIGNATURE C
(Schedule of Fee Costs can be found on the Reverse Side.)
Ile). � �///
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/*
'N r-41 &N'ZZ G1-10dV--3NNWl
'N
ON*IL133NION3
IDNIA'-3Adnc_ ONVI
91d OA, -3 A -d nS Cl. NV S2j -j- -:3
NION3
-��-4nl jr
Applicafia�n for Pewer Phoft and HeathM Cooling. Yengaftn. Rehgermal�ion a®d
Air Co nning SYdem aid Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
MTN TOTAL
Furnace Shell & Duct Work ................
.. $10.00 $
Replacement of Furnace .... . ..... ..
..... 6.00 $
Repairs & Alterations—up to $500.00
600 $
Repairs & Alterations each add. $500.00
3.00 $—_ —
MECH. WARM AIA
Furnace Shell & Duct Work to 120,000 BTU ........
..$10.00
each add. 60,000 BTU ....................
.. 3.00 i
Replacement of Furnace .. .. ..
.... 6.00 $
Repairs & Alterations --up to $500.00
6.00 $
Repairs & Alterations each add. $500.00 ....
3,00 $
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam $10.00 $.
Furnace She]] & Line—to 640 sq. ft. EDR Hot Water 10.00 $_
Each add. 200 sq. ft. EDR Steam 3,00
Each add. 320 sq. ft. EDR Hot Water 3,00 $__
OIL BURNER—to 3 gal. per hour 6.00 $ _
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 199,000 BTU) 5.00 $
over 199,000 BTU See Fee Schedule
GAS FITTING FEES:
NO RATE TOTAL
1st 3 Fixtures
x$ 200
$
Additional Fixtures
x .75
$
Gas Range to 199,000
x$ 5.00
$
AIR CONDITIONING
$
FAN HEATING SYSTEM
Sao Fee Schedulbe
YEIrMATING SYSTEM
$
ALTERATIONS & REPAIRS
TOTAL FEE
ROUGH
FINAL C'4
HCl c a
Dept. of Bldgs. Phone SW -3450
Locate 7
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 Ordinance.
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fridley, Minn 19
Owner
Kind of Building
Used as
To be completed about
Estimated Cost, $_.__. ?_.0_0__.
Building Permit No.
Permit No. '7`
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Sin Ne_
Capacity Sq. FL E.D.R BTU Hp
Total Connected Load Kind of Pue1
BURNER — Trade Narr+e Size No
Capacity Sq. FL E.D.R BTU
ISP.
(REMARKS -OYER)
'.! L
53-84-915.51
Application for Power Plants and Heating, Cooling, Ventilation, ReFrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work .......................... 8.00 $
Replacement of Furnace ............................. 5.00 $
Repairs & Alterations—up to $500.00 .................. 5.00 $
Repairs & Alterations each add. $500.00 ............... 2.50 $
MECIL WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............
8.00
$
each add. 80,000 BTU .......................
2.00
$
Replacement of Furnace .............................
5.00
$
Repairs & Alterations—up to $500.00 .................
5.00
$
Repairs & Alterations each add. $500.00 ..............
2.50
$
STEAM or HOT WATER SYSTEM
Furnace Shell & Lines—to 400 sq. ft. EDR Steam .....
8.00
$
Furnace Shell & Line—to 640 sq. ft. EDR Hot Water ...
8.00
$
Each add. 200 sq. ft. EDR Steam ......................
2.50
$
Each add. 320 sq. ft. EDR Hot Water ..................
2.50
$
s
OIL BURNER—to 3 gal. per hour . ......................
5.00
$
over 3 gal. per hour—See Fee Schedule
t
GAS BURNER (up to 400,000 BTU) .......................
5.00
$
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 $
AIR CONDITIONING $
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM $
ALTERATIONS & REPAIRS TOTAL FEE $ 6.50
ROUGH
FINAL- I--- --
CAM
Mm'surtharge 1-50
Dept. of Bldgs. Phone SU 4-7470
Location 650 N. E. 57th. Ave.
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 true and correct.
Fridley, Minn 12-1-72 19 —
Owner Donald F. Cullen
Kind of Building Frame
Used as
To be completed about 12-8-72
Estimated Cost, $ 10.00
INI New. Building Permit No. Permit No. IS -8C80
DESCRIPTION OF WORK
HEATING or POWER PLANTS—Steam, Hot Water, Warm Air—No
Trade Name Warm Morning Size No V -30-A
Capacity 30 X 000 Sq. Ft. E.D.R BTU 30, 000 H.P.
Total Connected Load Rind of Fuel Gas
BURNER — Trade Name Warm Morning Size No
Capacity.
(REMARKS -OVER)
m 42 4M
Sq. Ft. E.D.R BTU H.P.
Signed '
MINNEGASCO
By
Business Phone No
a
HOUSE'HEATING TEST RECORD
ADDRESSAPT.
FLOOR CITY SUBURB
OCCUPANT
�+
OWNER
.,HEAT LOSS
DATE HTG. INST.
AS CO. METER BADGE #
SOLD BY Minnegagem
INSTALLED BY
' Electrical Work By
Gas Line By
TYPE,OF HEAT
GA FA HW
STEAM SPACE HTR. UNIT HTR. OTHER
r
GAS DESIGN
CONVERSION
MAKE Wam,No
'.I40%'h
MAKE OF BURNER
Model
q
Model
= Serialt
Mai. BTU Rgtin11 g
INPUT
t..°"en 0
MAKE OF FURNACE
Model''
CONTROLS
THERMOSTAT
Heat Plug,
Vent S'nze —
ulve,
KIND OF LINER SIZE NONE
�: Limit
Draft`Hood Regularor
:"Limit Setting
1
Filters Size Number
Fon Setting
Chimney Location Inside Outside `
Pilot Type
'I
Chimney Construction
Pilot Make
Pitot Model
Smoke Bomb Wiring
Pitot Timing
Draft Test Tog
L W. Cut Off
Door Pressure Lighting Inst.
Pressure` '
P reent CO2
Date Tested
InTut CFH
Percent 02
Company Testing
Stack Temp.
Pdrcent CO
Name of `fester
Form 235
i
a
CITY OF FRIDLEY INSPECTION DIV.
Effective On January 1, 1997
6431 University Ave NE
`.
Fridley, MN 55432
APPLICATION FOR PLUMBI
D GAS FITTING PERMIT
572-3604
MARK NUMBER
OF FIXTURES TO BE INS.
WEACH FLOOR
Water;:;
:Batti':>
Wash
:: .
Drtnk...>:.:.,
Gtc
Auto.
Ga ><:>;:> Gas
:Mise">'>
Water e
at Hater
o ies
St r
fcs"
C Urinal
,:.:. .:..
:ub>»
T ...
Shower
S o
,nk:;...
Tray
• iiJ
•::::?.i�:ti
:$i.:•
FoUni:;,
':t3asir�"
Washer
.:..:...
lfippl>:> Range
;F'pct_ ..
Gas Elec
Basement
Floor 1
Floor 2
,,:........:::.
...::.:.:... .
Floor3
<;;,,
.::::::::::::;•.
::.:•:::::
..
.:........:..,:
Floor 4
.: •:::::::
i
::::�
PLUMBING FIXTURE RATES: NO.
RATE
TOTAL JOB
New Fixtures
$7.00
unde
ereby makes application for a permit for the work herein
Old Opening, New Fixture
$ 4.00
s. 1
P:
to do all work in strict accordance with the city codes
Beer Dispenser
$ 5.00
and rulin
Building Division, and hereby declares that all the facts
Blow Off Basin
$ 7.00
and. rept
ons stated in this application are true and correct.
Catch Basin
Rain Water Leader
$ 7.00
$ 7.00
- G / .1998
Sump/Receiving Tank
$ 7.00
wC
Water Treating Appliance
$10.00
Owner
(�
Water Heater —Electric
$ 7.00
Water Heater — Gas**
$10.00
Building
Gas Range"
$10.00
=
4
Gas Dryer**
$10.00
EstimM
OF ANOKAPMUNW. /
Back Flow Preventer Required ( )Yes () No
6
Ave. N. #114
Type
$15.00
PLU
MR. ROOTER OF ANOKA COUNTY
4
6250 Industry Ave.
Reinspection Fee $42.00/Hr
SIGN
Ramse I MN 55?Q3N0.
ALL OTHERS AND/OR REPAIRS AND. ALTERATIONS.':
421-5140 c
1.5% of Value of Fixture or Appliance
421 -6198 -FAX
Approve
R16gh—In Date Final Date
State Surcharge
$ .50
MINIMU
FOR NY PLUMBING GAS PERMIT IS $20.00
TOTAL FEE
$� PLUS-,
0 STATE SURCHARGE
"COMBUSTION AIR SHALL BE PROVIDED
PER UMC SECTION 504(A)
6—A. MINIMUM SIZE 9 SO INCHES.
a
SUBJECT
PE
City of Fridley
2 8 96 6
AT THE TOP OF THE TWINS
BUILDING P C �%
A A I T
�
1 1
L'\'v
1
F
1 •
L _ COMMUNITY DEVELOPMENT DIV.
V -_ __
INSPECTION SEC,
9/
r � PROTECTIVE
,
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
3/2/99
JOB ADDRESS 650 57 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
6
10
1 Donnay 1 s Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
Cullen 650 57 Avenue NE
494-9544
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Master Remodeling Inc 32 10 Ave S, Hopkins, MN 55343
932-9311 20012916
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
PHONE LICENSE NO
S ENGINEER MAIL ADDRESS ZIP
PHONE LICENSE NO
B USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION X] REPAIR
O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (23 Sq) Tear -off; Fascia
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State Building Code.
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 80 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
@
$3, 121
$1.56
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISI OF ANY OTHER STATE OR LOCAL LAW REGULATING CON.
$87.25
Fir,4 SC $3.12
STR I Q OROR ANCE OF CONSTRUCTION
PLAN CHECK FEE
Licen e 5.00
TOT L EE
6.93
7E
GNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
EN OP VALIDAAO THIS I YOUR PER IT
INSpGATE
I fj
S,GNATURE OF OWNER,IF OWNER BUILDERI IDATEI
a
NEW [ ] Effective 1/1/99
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R 1 AND R-2
BUILDING PERMIT APPLICATION ��
ConstructionAddress: A .S O !E;- % )q V
Legal Description:
Owner Name & Address: Lo o s; -t-- C t, ll w Tel. # 9 q 4 9 5 4';
nnMN LICENSE # ao01 A-01 !a
Contractor: �a•0 Qj-a-- I
Address: -3,2-
��"� ✓ 5� �- �DY YY1 a' SS �3 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.
GARAGEFAR.EA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft. �9'71
OTHER' o e Q- r
Construction Type: Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE•
Tel. #
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
o
Fee Schedule on Reverse Side
Fire Surcharge
$
3,42-
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
3AC Charge, ..
$
$1050 per SAC Unit
License Surcharge
$
50b
$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 [ ]
9�
TOTAL
$
l
STIPULATIONS: