PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT N° (5:9:83)
Date: _ J'.""" /�,
If
Owner: Builder -- --
n
Address _ _ Address
WqATIO OF BUILDING
No. _ e –i Street t Part go Lot
Lot _ _ __ Block Addition .or Sub -Division
Corner Lot Inside Lot Setback -_ _ _ S - oo
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
�,,�,�
Front � Depth Height � Sq. Ft. / - Cu. Ft .r
Fro
Depth Height _ 5q. Ft Cu. Ft
Type of Construction Est.. 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 city of Fridley.
In consideration of the payment of a fee of -$ V , 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. .00-1 ./f /t <¢-
Building Inspector
NOTICE
This permit does not cover the construction, installation for wiring, plumbing, Baa 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
Owner's Name Builder
Address �7�J o ��� ��' e �r Address
LOCATION OF BUILDING
No. W/ �� ' Street ,.�z - Part of Lot
Lot Block Addition or Subdivision�,�5
Corner Lot Inside Lot `/ Setback_j__LSide-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:
kAtJ r4190A FrontA/�/ Depth Height
Sq. Ft. P Cu. Ft.
FrontDepth height
Sq. Ft. Cu. Ft.
'�p' !>
Type of Construction �%e�J�i 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 ruling of the Department of Build-
ings, 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).
City of Fridley
l "� AT THE TOP OF THE TWINS
v------INTER-DEPARTMENT REQUEST
I j PUBLIC WORKS DIVISION
jI
�--.� CITY HALL FRIDLEY 55432
612-560-3450
SUBJECT
SEWER STOPPAGE
NUMBER
REV.
DATE
PAGE OF
APPROVED BT
ADDRESS 670 - 59th Ave.
CALL RECEIVED BY Jim Saefke,
CREW LOCATION WHEN NOTIFIED
EQUIPMENT TAKEN TO SITE
SEWER STOPPAGE
DATE 11=24-89
then called Robert Small AT 1:00 Pm (AM)(2H)
Home
Truck
CAUSE OF STOPPAGE City line ok
- in homeowner's own service
TIME STOPPAGE RELIEVED
DESCRIBE DAMAGE (IF ANY)
NOTE ANY STATEMENTS MADE BY CREW
OR HOMEOWNER REGARDING DAMAGE OR POSSIBLE CLAIM
i
CREW AND HOURS Robert Small -
2 hour callout
i
i
_ J
SUBJEC
AVONIT NOS --'-
city of Fridley
26647
AT THE TOP OF THE TWINS
BUILDING
P E R M I T
r
`
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
i
1 v PROTECTIVE INSPECTION SEC.
�[l "/
yq
r
NUMBER
REV DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910-F15
1/16/98
JOB ADDRESS 670 59th Ave NE
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
5
3
IDonnay's Lakeview
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Jill Johnson
571-0848
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Midwest Siding and Roofing
-4804
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP P NE LICENSE NO.
20010277
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION M REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House and garage 26 S Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with 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 WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$2168
$1.08
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 -
ON OR THE PERFORMANCE OF CONSTRUCTION.
$74.75
Fire SC $2.17
`
PLAN CHECK FEE
TEE
Licensr 5.0068t.00
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
NP OPE ALIDA HIS IS YOUR PERMIT
BLD NSP
i
MATE
SIGNATURE OF OWNER OF OWNER BUILDERI IDATEI
NEW [ ] Effective 1/1/98
ADDN [ ] CITY. OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (�c� O`
BUILDING PERMIT APPLICATION
ConstructionAddress: & 70 � `� � V�� �� 4"
Legal Description:
Owner Name & Address: 3'j /` �' W 57Q�✓ Tel.
Contractor:oj[r-de-5� r J;1 & a 6 �1 MN LICENSE #,,t Oc) 10222
Address:. 19'iP 7 9 C� /c �Ps���e %3�� 1� � Tel. # (//G -,Ve®
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF EMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: 7 -
Construction
Construction Type: al S i —L,<, y / a Estimated Cost: $ ,
(Fee Schedule, on Back)
Driveway Curb Cut Width Needed:
DATE: 7-16 j i
Ft. + 6 Ft = Ft x $ = $
Tel. # 6116 - c1f �--)Y
TOTAL $
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
J
?
Fee Schedule on Reverse Side
Fire Surcharge
$
.001 of Permit Valuation (1/10th%)
State Surcharge
$
- ® ;
$.50/$1,000 Valuation
SAC Charge
$
$1000 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 $
STIPULATIONS:
Building MECHANICAL
Inspections RESIDENTIAL APPLICATION
7.63-572-3604 CITY OF FRIDLEY
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS - q
THIS APPLICANT IS: 0 OWNER NTRACTOR
PROPERTY NAME!
OWNER/ ADDRESS: c ` CITY
TENANT .. `IJ 07, - Lf t-{ -a - ✓✓V
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
COMPANY NAME:_
CONTACT PERSON:
Permit No.Dili
Received By:
Date Rec'd:
ATE ZIP
STATE LICENSE #-
ADDRESS: CITY STATE ZiP
PHONE -1Z "�`ar" ' FAX
TYPE OF WORK: I 0 NEW
FAMILY 0 TWO FAMILY
)tEPLACEMENT
DETAII,ED DESCRIPTION OF WORK
0 TOWNHOUSE
0 ALTERATION/REMODEL
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (Tris should reflect only the cost of labor )
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $ 00, FEES ARE BASED ON SIO -00 PERr-,V,37_Q-7C:)
EXWHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) MOD SIZEBTUEquipmentinstalled MFG. S1ZF1B1V
MFG: MODEL:
MFG: MODEL: SIZFJBTU
A/C $25.00 FIREPLACE (GAS) $15.00 GAS RANGEIOVEN 110.00
R TO A1R EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
FURNACE $35.00 GAS UNTr HTR $10.00
CHIMNEY BOILER LINER $10.00 —GAS DRYER $10.00 POOL HEATER 15.0$35.00
DUCT WORK $1Q00 GAS PIPING $10.00 VENTILATOR $15.00
Permit Fee $ Number of fixtures @ $10.00 x s
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ Number of ftxtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $__0
Total = $
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 appli . forafreqq'
t ork is t to start without a permit; that the work will be in accord an with the
approved plan in the of b& whiu review and ppmval of plans.
SIGNATURE OF APPLICANT _ RINT NAME TE
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
'74z_Ccv')_'Ar.na