PRE 2010 DOCSVillage of Fridley, Minn.
BUILDING PERMIT
Date: "....6'�® .....................
Owner.......................................
Address......................................
1817
Builder .. 00c! ..... .. �- .. ......... .
Address.............................................
LOC TIAN OF BUILDING
No. .. .. !.... Street ....... ................... Part of Lot ............. ..
Lot ..... 7 ...... Block ...... d......... Addition or Sub -Division . 4021 ... �y
Corner Lot ........... Inside Lot ...�... Setback ..3 . .. Sideyard ..... .....................
DESCRIPTION OF BUILDING
To be Used as:
... �1 .. ... ........ ........
Front ."T. � . Depth !'�: �! � Height j.`r Sq. Ft. Cu. Ft.
................... Front ........ Depth .... Height ........ Sq. Ft. ........ Cu. Ft. ........
Type of Construction ...... Est. Cost f .��. �....... 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.
®v
In consideration of the payment of a fee of permit is hereby granted to orro . .
......................... 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 village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
..... V ``�! ....... Building Inspector
NOTICE:
This permit does n cover th onstruction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be surto se a Building Inspector for separate permits for these items.
SUBJECT
PERMIT
City of Fridley
12;9 6 6�
AT THE TOP OF THE TWINS
BUILDING PERMIT
T
RECEIPT
• ___ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 �
� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
,J 612-560-3450
910-F15
JOB ADDRESS
621 - 58th Avenue N.E., Fridley, Minnesota.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
7
8
Donnay t s SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Thomas R. Corbett,. 621 - 58th Avenue N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Robert Hammes, 3908 Edgewood Avenue North, Minneapolis, Minnesota
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residence
7 CLASS OF WORK
❑ NEW N ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Family Room - 16 x 22
Garage - 2116" x 24' Estimated Cost $5,800.00
9 CHANGEOFUSEFROM TO
STIPULATIONS
WARNING
Provide Hard Surface Driveway.
Blf"I digging cap local
Utilities
TELEPHONE
- ELECTRIC-. CAS Etc.
REQUIRED By LAW
WERATE P-MTS R-Q,w- REV F -aft WIRING,
WIATMI, PLUMM +ai-No' :stG14'S:.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
Frame
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION
ZONING
SO. FT. 352
CU. FT. 4,224
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
R-1
516
5,160
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
$5,800.00
$5.88
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.
$37.30
PLAN CHECK FEE
TOTALFEE
$43.18
SIGN OF CONTRACTOR OR AUTHORIZED T (DATE)
WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
—/ �'l 7f
�� 5-2%-7S
BLDG INSP DATE
SIGNATURE OF OWNER IIF OWNER BUILDERI I ATEI
Es
APPLICATION FOR RESIDENTIAL., ALTERATION,
OR ADDITION.BUILDI•NG PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: / �Gdl�ir �1 ��',B$�"% BUILDER: tfQ&�7-- lay/leS
ADDRESS: % - 70 �� eV ADDRESS: ��®r
NO:. STREET •
LOT: "% BLOCK: ADDITION: -
CORNER LOT: INSIDE LOT: ✓ SETBACK:SIDEYARD:
Applicant attach to.this.f.orm Two Certificates of Survey of Lot and.proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
TooBe Used As:
4F 14u Front : -W Depth: 2 Z Height: ee-,
Square Feet: s _ Cubic.Feet:
Front: /° G Depth:
Square Feet; (o Cubic Feet: 51 (00
Type of Construction: / /fG�l�-�_ —Estimated Cost: $ 5X'3CD
To Be Completed: �(%s
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stxict 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: V12L, S- SIGNATURE:
&,��
(See Reverse Side For Additional Information.)'
ADO.
9. V
1X ,� ��� �c 3`0 S. fig
1,90
71y ��
V 4 Y
Land Planning sfkf,�,tlwjo 4875 Highway No. 65 N. E.
Land Surveying • • ��/1f Minneftpolis,
Soils Testing `' ����1�1�7�7��J��) l • I Minn. 55432
Civil Engineering (/ Telephone 784-6066
Municipal EngineeringEngineers & Surveyors Area Code 612
r-
r-- s� T't � '� `` •-
t-07 7, /J.
This is a true and correct representation of a survey of the boundaries of the land above described and of the
location of all buildings, if any, thereon, and all visible encrouchm.,nts, if any, from or on said land. This survey is
mode only in connection with a mortgage loan now being placed on the property and no liability is assumed
except to the holder of such mortgage or uny other interest acquired by the reason of such mor tguge �t is
understood and agreed n4 ptonuments have been placed for the purpose of establishing lot lines or boundary
corners. Dated this.duy of A' , . A. D. 19
SUBURBAN ENGINEERING, INC.
Engineers Surveyors
by.
. . . a
El
I ort�ag!e Loan Survey fog %! �ril l
�.: TT t o_6j4 3
S` -42"&d P1 67"f'4> a-
p� -/C.. X 2215 '
/�� �C-rJ�C �EiR� (3-2�$x�df�
— -;l�,X• i�-1.:1f�i.� r'f=r�;-cr
rt
CrG, ]DO Vi Ed'A
I�rPP%s�ooFs 2�Soy/ IG'i�C��F,42 C'E,G✓�%J4%JjS
J 6�,�
i6•Cct17�,�s wlr� z�CG .174e.,)
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t-07 7, /J.
This is a true and correct representation of a survey of the boundaries of the land above described and of the
location of all buildings, if any, thereon, and all visible encrouchm.,nts, if any, from or on said land. This survey is
mode only in connection with a mortgage loan now being placed on the property and no liability is assumed
except to the holder of such mortgage or uny other interest acquired by the reason of such mor tguge �t is
understood and agreed n4 ptonuments have been placed for the purpose of establishing lot lines or boundary
corners. Dated this.duy of A' , . A. D. 19
SUBURBAN ENGINEERING, INC.
Engineers Surveyors
by.
. . . a
El
01,
SUBJECT
•.
'26
City of Fridley
2 6 412
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
`
RECEIPT NO.
I COMMUNITY DEVELOPMENT DIV./
_
v PROTECTIVE INSPECTION SEC.
1 ,
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
6/30/98
JOB ADDRESS 621 58th Avenue
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
7
8
Donnay's Lakeview Manor
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
XXXX xx Ty Grainger, 621 58th Ave, Fridley 55432
571-8731
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Warrpn Fidler, 3800 48th A -venue S. Minneapolis
722-9203 20007396
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO -
Roofing Specialist
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION CK REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof (tear -off)
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must meet 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 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
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
$2,335.20
1.17
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-
STRUC ON OR THE PERFORMANCE OF CONSTRUCTION.
$74.75
ire SC $2.34
�
PLAN CHECK FEE
TOT FEE
I
License 00
$83.26
SIGNATURE OFC TRACTOR R AUTHORIZED AGENT I EI
O
odroo
- -BLV INSP.
VALIDA THIS IS YOUR PER
r
OW OA q
SIGNATURE OF OWNER IIF OWNER BUILOERI IDATEI
01,
NEW [ l
ADDN [ l
ALTER [ ]
ConstructionAddress :
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
Owner Name & Address: If �{ KS �j ('-R�� Tel. # 5 �% - ��3
Contractor: ilkm MN LICENSE
Address: �& 46711 Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF E%IPROVEMENT
LIVING AREA:
Length
Width Height
Sq. Ft.
GARAGE AREA:
Length
Width Height
Sq. Ft.
DECK AREA:
Length
Width Hgt/Ground
Sq. Ft.
OTHER: 1_
%fig- orF
Construction Type: ����� o� Estimated Cost: $ `7 7d
(Fee Schedule. on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
DATE: U fi 2 1l APPLICANT: Tel.
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
Fee Schedule on Reverse Side
Fire Surcharge
$ , 3
.001 of Permit Valuation (1/10th%)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$ 6-1
$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
$ 3.
STIPULATIONS:
Building #
BUILDING
$ e
Permit No.: RW
Inspections '7--V
RESIDENTIAL APPLICATION
$ -(0
Received By:
763-572-3604
$5.00 (State Licensed Residential Contractors)
CITY OF FRIDLEY
$1550 per SAC Unit (Plans to MWCC for determination)
$
QQ
0
$
DATE ®. /Dp .
YOUR E-MAIL ADDRESS
Fee Determined by Engineering
SITE ADDRESS 162.1 —
p
S8 � /1 L7
$ /
THIS APPLICANT IS:
❑ OWNER ACONTRACTOR
PROPERTY OWNER/
NAME:
TENANT
ADDRESS: Z ' S CITY
S _ IP
PHONE: 7J )C7,5/
j
CONTRACTOR
NAME:
STATE LICENSE # EXP DATE
SUBMIT A COPY OF
YOUR STATE LICENSE
ADDRESS: CITY
//��
ITA_2`
WITH APPLICATION
PHONE q254 FAX
PROPERTY TYPE
❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHEDDOWS
IJBASEMENT FINISH ❑ ROOF ❑ RAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: l%
SIZE OF IMPROVEMENT LENGTH WIDTH
HEIGHT S. Ft.
OR OFING
13HOUSE ONLY
NUMBER OF SQUARES
❑ HOUSE & GARAGE
BASEMENT REMODELING SUBMIT:
GARAGES
❑ ATTACHED GARAGE
1.
Existing Floor Plan
PROPOSED SIZE:
❑ DETACHED GARAGE
2.
Proposed floor plan
PROPOSED HEIGHT:
3.
List of structural members to be used
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
WINDOWS
2.
Two sets of construction plans
IN EXISTING OPENING es
ONo LOCATION OF WINDOWS
3.
Energy Calculations
OR FOR NEW OPENINGS -D
CRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ru.a. Jvr ZO eucr, DAM,u vIN vA1.uA11v1N, UNULUll11NU THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0SCHEDULE)
TOTAL JOB VALUATION $ f 3 aO - P OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ Id- 5., -
See Back Page for Fee Schedule
$ e
65% of Building Permit Fee
$`'
.001 times the total job valuation
$ -(0
.0005 x Permit Valuation Minimum $.50
$
$5.00 (State Licensed Residential Contractors)
$
$1550 per SAC Unit (Plans to MWCC for determination)
$
ft+6ft= ftx$21=$
$
$450 Conservation Plan Review
$
Fee Determined by Engineering
$
Agreement necessary ( ) Non Necessary ( )
$ /
Make checks payable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requires rev .ew and ap roval of plans.
SIGNATURE OF APPLICANT T NAME DATE—
DATE