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PRE 2010 DOCSVillage of Fridley, Minn. Ii BUSING PERMIT N0 2 1: Office of INSPECTOR OF BUELDINGS �I Owner_r'�' r�N-� Architect - v Fridley, Minn., 18 I; Builder S Ok OF B DIN No. Street Part of Lot Lot Block Addition or Sub -Division DESCRIPTION OF BUILDING Front 3 0 Depjth{ 4 Height __/ � Storied� Manner of Construction To be used asI "� To be completed A 0 Estimated Cost! -0- I ILr .. d s ON Permit is hereby the building s "�`�x "" a�' % ndescribe in the above statement. This permit is granted upon the express condition th4 the person to vK om it - granted, and his agents, employees and workmen, in all the work done in, !around and upon said building, or any part thereof, shall conform in all respects to the ordi- nances of Fridley, ',;Minn., regarding the construction, alteration, maintenance, repair and moving of buildings within the city limits, and this permit may be revoked at any time upoviolati� of any of the provisions of said ordinances. `,' .. C1 1 li '-1 ' it 4 A \ 1..0`i,NJ Ae3 _Inspector of Buildings. AGREEMENT AND SWORN STATEMENT In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of the above permit, I hereby agree to do the proposed work in accordance with the description above set forth ;and according to theprovisions of the ordinances of Fridley, and, being first duly sworn, I hereby',', state and say that the facts stated by me and contained in the above permit are true as therein 'stated. i Subscribed and sworn to before me at Fridley, Minnesota, tai) a .� day of A.D. 10-19 0 1 City of Fridley Application for Plumbing and Gas Fitting Pennit a - Y,,)- u% 0"*"l Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK % Number, Kind and Location of Fixtures Location �i" r" +� rn 3�� RATE TOTAL Number Fixtures .... ................ ?� $1.50 c� Future Fixture Opening ................ Z ua Z S w <3 �d w BSc Z �0 F N WATER HTR. GAS ELEC. Base x 2.00 $ New Ground Run Old Bldg. ....... .... x 3.25 $ S GAS FITTING FEES: NO. RATE TOTAL 1st 3 Fixtures .......................... x $1.50 $ Additional Fixtures .................... x .50 $ 1st x 2.00 $ 2nd 3rd 4th • Future Connection OpeningsI %,onnecren W'm Sewer � * New Fixture, Old Openings Cesspool 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 Heater (Up to 200,000 BTU) ...... x 2.00 $ New Ground Run Old Bldg. ....... .... x 3.25 $ S 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 herei 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 fact and representations stated in this application are true and correct. Fridley, Minn - 1 -1 ) - innpis .1, - Owner Kind of Building –/ Used as � � To be completed about Estimated Cost, $ Old ew. Building Permit No Permit No. Signe B u� Business Phone No. ROUGH FINAL % 6 ' B ^ & 6 d2 a' SUBJECT PERMIT N City of Fridley 13212 AT THE TOP OF THE TWINS BUILDING PERMIT r ` RE T NO. `y •_____ COMMUNITY DEVELOPMENT DIV. r PROTECTIVE INSPECTION SEC. 1 � 1 ••'1 CITY HALL FRIDLEY 55432 �•-•- �'� NUMBER REV. DATE PAGE OF APPROVED BY 612-NO-3450 910-F15 X9/17/75 JOB ADDRESS 121 64 1/2 Way N. E. 1 LEGALLOT NO. 12 BLOCK TRACT qR ApPITION SEE ATTACHED HU(I1 for S Sub. #23 DESCR. SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Ed Sakry 121 64 1/2 Way N.E. 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 k NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK 16 x 20 garage 9 CHANGE OF USE FROM TO STIPULATIONS 1. Provide a hard surface drive. 2. R,RXXX Owner agrees never to attach this house to the new garage. PERMITS REQUIRED FOR WIRING1. SEP RATE PLUMBING AND SIGNS. HEATING, SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. wood frame OCCUPANCY GROUP OCCUPANCY LOAD 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 320 3,200 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 ISTALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORECT. 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 $2,868 1.18 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. 6.00 PLAN CHECK FEE TOTAL FEE 7.18 SIGNATURE OF CON TO R OR AUTHORIZED AGENT (DATE) - WHEN PR PER Y VALIDATED HIS IS YOUR PERMIT , 9✓ �1 C� 3 BLDG INSP D T RE OF NERpF NER BUI D - (DATEI a' APPLICATION FOR RESIDENTIAL, ALTERATION, OR ADDITION BUILDING -PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAME: BUILDER ADDRESS: �� �- 7 Xj" GUA cf NADDRESS: NO • . STREET • r �l LOT: i ADDITION: S 3 CORNER LOT: INSIDE LOT: L-"' SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposrd building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As: do o Front: Depth: 02 Cv Height: Square Feet: Cubic Feet: Front: Depth: Hei.ght Square Feet; Cubic Feet: type of Construction: klOa(, rie4m w- Estimated Cost: $ � To Be Completed: / '% , The undersigned hereby makes application for a permit for the work herein specified, agreeing to do all work in stzict accordance with the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and -representations sta in thisap�����il� are true and correct. DATE: `��^ 7 SIGNATURE: (See Reverse Side For Additional Information.) AGREEMENT owner of the Property located at JG/ /- � /2 �� have no objection to the City allowing C the construction of a `� �L to be located at /,2 1 • without the required certificate of survey that the i . City ordinarily requires for all new. construction. { Address f / 7 Dae Wi ness ZZ, STATE OF MINNESOTA DEPARTMENT OF HEALTH ABANDONED WELL RECORD 1. LOCATION OF WILL County Name Anoka Township Name Township Number Range Number SectioTxoFracttoa EyotFridley 30 ;r 23 pr 15W SE S Numerical Street Address and City of Well Location or Distance from Road Intersection 121 642 Way, Fridley Show exact location of well (in section grid with 'X') Sketch map of well location W W MENU ME ENNIN ENNE E T 1 J P-1 -i L ---+ 2. PROPERTY OWNER'S NAME Mailing Address if different than June Sakry P7501/101boone'`l ted Apt 506 New Hope, MN 55428 HARDNESS OF 3. FORMATION LOG COLOR FORMATION FROM TO If not known, indicate formation log from new well or nearby well. . ELEVATION. SOURCE OF DATA - CASINGS REMOVED, CASINGS PERFORATED. M. t IFFICIAL ABANDONED WELL RECORD (May be used for Property Transfer) ZXP=rANrt PILE NZ?B D= MINNESOTA UNIQUE WELL NO. ABANDONMENT (leave blank if not known) 4. WELL DEPTH (completed)' Date sealed 31 rt. 1 3-14-90 BILLING METHOD (if known) 10 Cable tool 40 Reverse 70 Driven 100 Dug 20 Hollow Rod 50Air. C Bored 110 30 Rotary 60 Jetted g0 Power Auger 6. OBSTRUCTIONS Yell obstructed 0 Yes ® No Obstructions moved C3 Yes 0 No If obstructions cannot be removed. contact ON before sealing. 7. USE IKkOomestic 40 Monitoring BO Neat Loop 20 Irrigation 50 Public go Industry 30 Test Well 60 Municipal IC Commercial 70 Air Conditioning 110 B. CASING(S) In Black 4R3 Threaded 70 20 Gal v. SO Welded 30 Plastic 60 Stainless Steel 2 tn. to 27 ft. in. to ft. ® Screened wall from 2Z ft. to -31 ft. (If known) 0 Open Role fm _ ft. to _ ft. 10. STATIC WATER LEVEL 29 t.)a below 0 above land surface Date Measured 3-14-90 11. WELLHEAD COMPLETION 10 Pitless Adapter 40 Found Buried Basement offset C3 30 Well Pit 12. GROUTINGINFORMATION Neat Cement 20 Bentonite 30 Grout material Nt . cemenrom L_to_U ft. cu. yds_L 17. -r- bu—t3 of GW—min-lux cast iron sewer feet East directi type Well disinfected before sealing? Yes 14. PUMP 0 Removed Ja Not Present Type: 1[1 Submersible 30 L.S. Turbine SO Reciprocating 20 Jet . 40 Centrifugal Go 15. EXISTING YELLS (Please sketch locations of abandoned and active wells in remarks section or on back.) Other unused nwells) on property? 0 Yes G No W Abandoned: Permanent 0•Temporary 0 Not sealed 17. WATER WELL CONTRACTORS CERTIFICATION This well was sealed under my jurisdiction and this report is true to the best of my knowledge and belief. Mork Well Co., Inc. 02133 licensee Business Name License No. - SUBJECT - City of Fridley Tim AT THE TOP OF THE TWINS BUILDING PERMIT 281 r x`57. 3dW10Y DIV. DEVELOPMENT r PROTECTIVE INSPECTION SEC. �/. ( �f�.� ) NUMBER REV DATE PAGE OF APPROVED BY ' "'1 CITY HALL FRIDLEY 55432 � ��� 612-571-3450 910415 10/9/98 JOB aooREss 121 64 1/2 Wav NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 Auditor's Sub. #23 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Eldred Keehn 502-0125 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner 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 Edx REPAIR ❑ MOVE ❑ REMOVE B DESCRIBE WORK Reroof house (13 Sq) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS Underlayment must comply with the State Building Code. 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 OWLG. UNITS OFFSTREET PARKING 1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1114 .56 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 $40.25 Fires 1.11 PLAN CHECK FEE TOTAL F E 41 92 SIGNATURE OF CONTRACTOR ONT (DATE. "11AJC EN P OP LDATE IS YOUR PE(/p/y����T S�GNA OWNER BUILDER. (DATE. .NSP MATE 01 ~ R NEW [ ] Effective 1/1/98 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 e� BUILDING PERMIT APPLICATION V ConstructionAddress: Legal Description: Owner Name & Address: � � 1 �- ` `�'g_VA, N, C Tel. # 5e X Contractor: 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: Lengthiddi Hgt/Ground Sq. Ft. OTHER: % .� S Z& �p ,Cly Construction Type: Driveway Curb Cut Width Needed: Ft. + 6 Ft = V / Estimated Cost: $ l l (Fee Schedule on Back) Ft x $ = $ DATE: ©` 1 ' ) 6 APPLICANT:C2"S �� � Tel. # Permit Fee Fire Surcharge $ State Surcharge $ .S(O SAC Charge $ License Surcharge $ Driveway Escrow $ Erosion Control $ Park Fee $ Sewer Main Charge $ TOTAL $ �� 20 11' I = M•0 CITY USE ONLY 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 [ ] �� suBjEcr City of Fridley 3 3 6 9 7 AT THE TOP OF THE TWINS BUILDING PERMIT • V _ COMMUNITY DEVELOPMENT DIV. � PROTECTIVE INSPECTION SEC. r � �sgJ 6� ^� NUMBER REv DATE PAGE OF APPROVED BY j CITY HALL FRIDLEY 55432 763-571-3450 910415 7/14/03 JOB ADDRESS 121 64 1/2 Way NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 12 Auditor's Subdivision 423 SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Eldred Keehn 121 64 1/2 Way NE 763-502-0125 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 8 USE OF BUILDING Residential 7 CLASS OF WORK O NEW O ADDITION O ALTERATION Q REPAIR X O MOVE O REMOVE 8 DESCRIBE WORK Reroof Garage (5 Sq) Tear -off 9 CHANGEOFUSEFROM TO STIPULATIONS 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 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 $579 $ WITH WHETHER SPECIFIED HEREIN OR NOT, THE GRANTING OF A PERMIT .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- $26.55 Fire SC $.58 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION PLAN CHECK FEE TOTALFEE $27.63 SIGNATURE Of CONTRACTOR OR A`UUTM'OAIZED�A/AGENT IDATEI VIIEN PROPERLY VALIDATED THIS IS YO R PER IT BUG INSP SIGNATURE OF OWNERIIF OWNER BUILDERI IDATE, �� NEW [ ] CITY OF FRIDLEY Effective 1/1/2003 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: Legal Description: Owner Name & Address: L Q LD I� �L i -t IV Tel. # 76 3 Contractor. 6 W 146 R ' 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: G L Construction Type: Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft— Ft x $ _ $ DATE: '7-1q-6-3 APPLICANT: (� . I` r Tel. it � 63- 5"' �2' 121 �- 5 - Call 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. CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ ;, , Fee Schedule on Reverse Side .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1275 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 [ ]