PRE 2010 DOCSVillage of Fridley, Minn.
BUILDING PERMIT
N? 651 Office of INSPECTOR OF BURMINGS
owner'�
Architect Fridley,
Builder
LOCATION OF BUILDING
No. street.
V —Part of Lot
LotBlock— Addition or Bub -Division
DESCRIPTION OF BUILDING
Front Depth ""^ Height --CL— Stories—1— Manner of Construction
To be used as p To be completed Estimated Cost
Permit is hereby granted to A M
the bu1ld1ng---------,–L� described In the above statement. This permit is granted
upon the express condition that the person to whom It is 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 upon violation of any of the provisions of said
ordinances.
......... 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 Wee to do the proposed work in accordance with the description
above set forth and according to the provisions 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.
Subscribed and sworn to before me at Fridley,
day of L244 A -D. 19
0
Minnesota,
City of Fridley, Minn.. 106-9,
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: June 30 1971
Owner: Harold Beckman Builder Quality Construction Services Company
Address __fik3a East River Road N _ V _ Address . 2001 Ea e t 24th Street, Xp 1 s
LOCATION OF BUILDING
No. _640__.... Street — East River Road N.E. Part of Lot
Lot __ Block Addition or Sub -Division - Aud . Sub . #23
Corner Lot _.__._..__.._ Inside Lot — X Setback
Sewer Elevation
To be Used as:
Sideyard
Foundation Elevation ..........
DESCRIPTION OF BUILDING
Trim House ___ Front Depth Height Sq. Ft. Cu. Ft
Front Depth Height Sq. Ft. Cu. Ft.
Type of Construction _Aluminum Est. Cost . _ $7, 450 _ To be Completed 2 weeks
In consideration of the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with a& provisions of
ordinances of the city of Fridley. Aj
In consideration of the payment of a fee of -1-t.-0.0r_, permit is hereby granted to Qti n I i tai r nn Q t - S erV .
to construct the building or addition as described above. This permit is granted upas
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects -to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
}within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said s
ordinances. QQ �
Building Inspector
HANK MUNICH
9 -
NOTICE:
This permit does not cover the construction, installation for wiring, plumbing, gas heating, sewer or water. Be sure to we
the Building Inspector for separate permits for these items.
APLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: BUILDER: j A—
i
11' I L 2gj 11.
NO:. STREET: � oe�6sp
LOT: a2 Co —BLOCK: ADDITION:
CORNER LOT: INSIDE LOT:_SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
6-7 ront: —Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; `� Cubic Feet:
Type of Construction: /_/, Li z &4 t_ Estimated Cost:_$ /, Vso_�y
To Be Completed: I
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in stfict 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 :� �7 61 171 SIGNATURE •
(See Reverse Side For Additional Information.)
410, f7�
A +
P
11,
SUBJECT
ERMIT NO.
City of Fridley
7197
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
R E C
I `y COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
J
r PROTECTIVE
�
11 CITY CITY HALL FRIDLEY 55432
L
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
----�
612-571-3450
910-F15
6/7/83
JOB ADDRESS 6430 East River Road N.E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1, Block
, Veits 2n
and Lot 26, Aud. Sub. #23 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Oliver Olson 6430 East River Road N.E. 574-9831
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
❑ NEW 7 ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 24' x 301 Garage and a 19' x 8' Porch
9 CHANGEOFUSEFROM TO
STIPULATIONS
Provide a hard surface driveway. Existing garage must be converted
to living - completion to be accomplished >fthmt within 90 days following the
completion of the new garage.
PERMITS REQUIRED FOR WIN(
Le�`w SEPERATE
a\ ° ����'
40 HEATING. PLUMSRNG AND SIGN
ca��N �,P
\c
�1A
SEPARATE PER REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
VENTILATING ORIMA 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
$4.28
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
$8,553
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.
$74.50
PLAN CHECK FEE
TOTALFEE
$78.78
N/ OF CONTRA ORO UTH iF��� DAGENT IDATE1
WHEN PROPERLY ALIDATED To IS IS YOUR PERMIT
w
( v —1 �
BLDG INSP #JATE
TURE OF OW ER F NE UILDERI IDATEI
11,
CITY Of FRIDLEY Effective Aug. 1, 1961
APPLICATIM FOR RESIDENTIAL BUILD1IG PUMITS
(REws Alterations, Additions. or Repairs)
DWIER: BUILDER:
ADDRESS: LY Jo ADDZLSS:
TEL 110: :L7 `/ 4 _ TEL N0:
Construction location
LOT: : ADDITZON: d1
Corner Lot: r,�_ >Insiae Lot: Setback: Sideyards:
-----------
App2lcant attach to this form two Certificates of survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOR OF MNSTRUCTION J®d�
Front: Depth: Height.
squamae nets 'Cubic feet:
Front: z Depth: Height: _
Square Feat: Cubic Peet:
Type of Construction: estimated Cost: : Cgs�-'3_ 0 c-)
Tb be Cbr-pleted:
A it. A Al t. B
Proposed Drive+ay Width If New Opening Is Desired:
SEL PZVERSE SIDE OF SHEET
Mie undersigned hereby makes application for u permit fer the %rork herein specified,
agreeing to do ,all work ii, strict accordance with the City of Fridley Ordinances end
ruling. of the Delvirtment of Buildings, and hereby declares that all the facts and
sepresentatiens stated in this applicatiouLare true and correct.
Stipulations:
t7 y. ,Sr -6
SUBJECT
City of Fridley
WE
19155
AT THE TOP OF THE TWINS
BUILDING
PERMIT
f
� t
___ COMMUNITY DEVELOPMENT DIV.
' L
INSPECTION
`
(P I
r PROTECTIVE SEC.
l /�"1,� CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
....�
L 612-571-3450
910-F15
9/8/87
JOB ADDRESS
6430 East River Road N. E. (-Chane to 140 -
643, Way N. E.
1 LEGALLOT
NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
26•
Aud. Sub. #23
SHEET
2 PROPERTY OWNER MAILADDRESS
ZIP
PHONE
Donna Olson 6430 East River Road N.E.
574-9831
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
Cj NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 10' x 14' Shed
9 CHANGE OF USE FROM TO
STIPULATIONS
Must be anchored to ground
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
SQ. 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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
$15.00
LAN CHECK FEE
TOTAL FEE
$15.50
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHEN PROPERLY VfiWATED
THIS IS YOUR PERMIT
�TE
SIGNATURE OF OWNER IIF OWNER BUILDERI (DATE)
BLDG INSP
NEW [ ] City of Fridley Effective 4/1/86
ADDN. ( ] R-1 AND R-2
ALTER. [ ] Building Permit Application
Construction Address
w"fu N'!�7
o It le , u 2
Legal Description:�rrS4.x. # L3
o
Owner Name &Address: ad /Il /f . 0,4 So "/ Tel. #
Contractor: exl- Tel. #
Address:
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:
Corner Lot [ ] Inside Lot [ ] Ft. Yd. Setback Side Yard Setback
Type of Construction: UJ 0d D e "mac= Estimated Cost: $
Approx. Completion Date: /P-36-97
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: G% 92 APPLICANT: Tel. L_7
CITY USE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Q, C
Fee Schedule on Reverse Side
25$ of Building Permit Fee
$.50/$1,000 Valuation
$ 525 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
SUBJECT
ERM
City of Fridley
19
AT THE TOP OF THE TWINS
BUILDING PERMIT
_
COMMUNITY DEVELOPMENT DIV.
—!/(_J[✓
r � � PROTECTIVE INSPECTION SEC.
1 � i
CITY HALL FRIDLEY 55432
NUMBER
REV,
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15
10/30/87
JOB ADDRESS 140 - 64'h Way N.E.
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
1
1
Oliver Olson Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Oliver/Donna Olson 140 - 6411 Way N.E., Fridley 574--9831
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
❑ NEW 7 ADDITION § ALTERATION 01, REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 10' x 6' Foyer: a 12''x 4' Room Addition: a Covered, open Porch
Aclair-loh -aajacent to foyer
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in existing house (basement and hall to bedrooms)
P a F't MTS rOUIRED
R1 �
�fSj/ (t�A
Foot
YI19�it�tiAkTa .�: T_"NQ.1 ` � �JSlf6L 1NG AND SIGNc�-
��,�s� d���� caia 3��a� ��fi�ii�+��
"E E tO'dE m ELECTRIC v SM Eta'
REQUIRED BY LA
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. 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
$7,200
$3.60
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-
$68.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
$17.13
$89.23
SI TU OF CONTRACTOR OR THORIZEDAGENT DATE)
r
WHEN PROPERLY A DATED THIS IS YOUR PERMIT
a I��
SIGN U OF OWNER IIF OWNER BUILDERI IDATEI
BLDG INSP ATE
.7
NEW [ ] City of Fridley Effective 4/1/86
ADDN. [1 �R-1 AND R -2I
ALTER. [ ] Building Permit Application
p ti D s1 -d Di2c: rs
Construction Address: k -0 6LI2,-N,- U v
Legal Description: %% \
Owner Name & Address: A' -i` -J �'� � �'� ` �J Tel. 5 7 V S f 73
Contractor: Tel. #
Address:(
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
'AREA: Length i() Width Height
Length ��- Width N Height
DECK AREA: Length �Width Hgt/Ground
OTHER:
Sq. Ft.
Sq. Ft.
Sq. Ft.
IM)c &�3 z ff I q q? "3^3 .aG X1.77- e .
Corner Lot [1 Inside Lot [ ] Ft. Yd. Setback Side Yard Setbae
Type of Construction: -lPA8
Approx. Completion Date:
Estimated Cost: $
} Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: ��`°� $ $
See Back Page for Explanation
DATE: 1,12-2=42- 5-:2 APPLICANT: �i�^ f «6.e` Tel. # : z V S f3/
_,pp CITY USE ONLY
Permit Fee $ CC?� Fee Schedule on Reverse Side
Plan Check $ �� `� 25% of Building Permit Fee
State Surcharge $ f $.50/$1,000 Valuation
SAC Charge $ $ 525 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $
STIPULATIONS• -7, 0 0
36,66
s
CI IYOF
FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
October 30, 1987
Mr. Oliver & Mrs. Donna Olson
6430 East River Road N.E.
Fridley, MN 55432
Re: Change of Address CEffective Immediately)
Dear Mr. & Mrs. Olson:
Per your request we are making the following change of address:
FROM: 6430 East River Road N.E., Fridley, MN 55432
TO: 140 - 6411 Way N.E., Fridley, MN 55432
LEGAL: Part of Lot 26, Auditor's Subdivision #23 (also known
as Lot 1, Block 1, Oliver Olson Addition)
NAME: Oliver & Donna Olson
We have notified the following companies of this change and also various
departments in the Civic Center. If you have any questions on this change,
please contact me at 571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
DGC/mh
CC: Minnesota Gas Company Fridley Water Billing Dept.
Northern States Power Co. Fridley Assessing Dept.
Minneapolis Post Office Fridley Police Dept.
Fridley Post Office Branch Fridley Fire Dept.
Northwestern Bell Telephone Co. Anoka County Court House
WELL DRILLING FOR FOUR GENERATIONS
15688_Jarvis Street NX, Elk River, MN 55330
LA010flersons 327-6100
INCORPORATED (612) 427-6100 Fax:. (612) 427-0533
Date: NOVEMBER 28, 1990
MINNESOTA DEPARTMENT OF HEALTH
717 SE DELAWARE STREET
DIVISION OF ENVIRONMENTAL HEALTH
MINNEAPOLIS, MINNESOTA 55440
ATTN: Mr Jim Nye
(612) 623-5339
SUBJECT: WELL ABANDONMENT
RE: NOTIFICATION
Dear Mr Nye,
NORTH
SITE DIAGR.�d
wQ`L.4
This letter is to notify you of a water well in your district that should
be sealed according to the Water Well Construction Code MCAR §4725.2500-2900.
E.H. RENNER & SONS, INC has been notified by the owner of this property or
an interested party and have subsequently submitted to them an estimate for
the sealing of this well under our LICENSE #71015. We have also included
a copy of the current code with our estimate.
In submitting our estimate, the owner may also receive additional estimates
and hire any number of Minnesota licensed water well contractors in the area
to seal this well. However, there is a possibility that this well may not
be properly sealed and thus jeopardize the ground water and Public Health.
E.H. RENNER & SONS, INC. wishes to provide you this information
reference with the abandonmen`t"rport when submitted.
PROPERTY OWNER: DONNA OLSEN PHONE #
ADDRESS: 140-64h WAY
FRIDLEY MN. 55432 DATE 3-5-90
LOCATION: S" --Ii `ROOM OFF SET WELL DIA. 3a
for future
Sincerely Submitted,
Raymond T. Renner,'V-President
E.H. RENNER & SONS, INCORPORATED
STATE LICENSE #71015
CC: CITY OF FRIDLEY
6431 UNIVERSITY AVE. N.E.
FRIDLEY, MN. 55432
ATTN : DARREL CLARK
Equal Opportunity Employer
DEPTH: UK
suedEcr
MIT NO.
City of Fridley
26177
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
1 PROTECTIVE INSPECTION SEC.
3/3 1
r
r'
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
,'�
612-571-3460
910-F15
6/9/98
JOB ADDRESS 140 64 1/2 Way NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
1
Oliver Olson Addition
SHEET
2 PROPERTY OWNER MAIL ADORES$
ZIP
PHONE
Oliver/Donna Olson 140 64 1/2 Way NE
574-9831
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.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION ❑ REPAIR
X
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (20 Sq Tear -off, 20 Sq 2nd Layer)
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building
Code. Roofing can
be the 2nd layer but not the 3rd.
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
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
$2,921
$1.46
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-
$74.75
Fire SC $2.92
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
7TALFEE
$79.13
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDApTEI
VALI DTHIS IS VG R P MIT
1 •"'�.� I ��
SP
kVH'E."�P
�G
•OF
OWN R OF OWNER BUILDERI IDATEI
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress:
Legal Description: Lc F/ . 2 L•
Effective 1/1/98
Owner Name & Address: „�� ,�„� � �� Tel. # wlis s -7 y5',f 3/
Contractor: MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: �r� '�a'q' e 64a
Construction Type:
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
1, d n -/7///? /6(_{
Estimated Cost: $'�) / S
(Fee Schedule on Back)
Ft x $ = $
DATE: - - 9 APPLICANT: /�Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$
Fee Schedule on Reverse Side
$ . �j
.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 [ ]
$ ,l3
SuBjECT
P
Cit of Fridley
5- � THE TWINS
BUILDING
PERMIT
28368
�; COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r 1 PROTECTIVE
��0
CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED By
612-571-3450
910415
10/22/98
JOB ADDRESS 140 64 1/2 Wav NE
1 LEGAL
LOT NO.
BLOCK TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
1 1 1 Oliver Olson Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Oliver Olson 41359
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Panelcraft of MN 3118 Snelling Ave S M is MN 55406
721-6628 2179
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
❑ NEW ❑ ADDITION ❑ ALTERATION Jac REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Sidin ' Fascia and trim
9 CHANGEOFUSEFROM TO
STIPULATIONS
Call for building wrap inspection before covering.
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
SQ. 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
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
2,05
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$99.75Fire
SC 4.10
PLAN CHECK FEE
TOTAL FEE
License SC
5. 0
v10.90
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT (DATE)
WHENO PPROPE VALI ATED THIS IS YOUR PERMIT
�({'G
��-
//�
A-,- e Q
S,GNATURE OF OWNER,IF OWNER BUILDER) IDATEI
BL G INSP
riATE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION 36) 0
0
ConstructionAddress: ��� o'rx
Legal Description:
Owner Name &�kddres�s: 41/ � ��� � �' Tel. #
Contractor:��� lL'i�G�l� MN LICENSE #
Address: kil / 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:
ir
struction Type: /� `�AV� ,Ixx Estimated Cost: $ � -) f160
,
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
APPLICANT: Tel. # o
Park Fee $
Sewer Main Charge $
e /I
OTOTAL
STIPULATIONS:
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 [ ]
PURCHASE ORDER I DATE
BY
THIS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY
F 56796
THIS NUMBER MUST APPEAR
ON ALL CORRESPONDENCE
SENT TO US
® SUPPLIERAo 12CsSO
ADDRESS
li
CITY OF /�I j
Fill D LEY PHONE NO. /a • �/ `f 9
643,1 UNIV. AVE. N.E.
FRIDLEY, MN 55432 4384 CONTACT
612571-3450
t
PRINTED ON RECYCLED PAPER.
PAYMENT VOUCHER
BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE
PAYMENT AND THAT THE GOODS AND SERVICES HAVE BEEN
RECEIVED OR RENDERED AND ALL CITY GUIDELINES HAVE
BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOW
STATED ITEMS.
A D or
PA ENT AU R¢ED BY
ACCOUNT QTY.
UNIT
PLEASE ENTER OUR ORDER FOR THE FOLLOWING UNIT PRICE
AMOUNT
// g�
! 4 o�
ASUEb l
/01- 60M -362.7 -
%
C,?/. O
.. ooeb -.3v.7
/
:40s3 -
TOTAL
THIS AGENCY HAS AGREED NOT TO DISCRIMINATE IN HIRING PRACTICES ON THE BASIS OF RACE, SEX, COLOR, CREED, MARITAL STATUS, RELIGION,
OR NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGES
FIRMS AND OTHER AGENCIES WITH WHOM IT PURCHASES PRODUCTS OR SERVICES TO DO LIKEWISE.
WHITE, VENDOR — YELLOW, PURCHASING — PINK, ACCOUNTING — GOLDEN ROD, DEPT. HD.
SUBJECT
City of Fridley
Z86
9AT
THE TOP OF THE TWINS
BUILDING
PERMITr?
x,572- 6OQ4
f
1.
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC.
�� `
r ;
L6
1
NUMBER
REV
DATEGE
PAOF
APPROVED BY
I CITY HALL FRIDLEY 55432
I.' 612-571-3450
910415
111/23/98
JOB ADDRESS 140 64 1/2 WaV NE
I LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
1
Oliver Olson Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
„` ZIP PHONE
Oliver Olson
612-574-9831
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Panelcraft of MN 3118 Snelling Ave S M is 55406 721-6628
d ARCHITECT OR DESIGNER MAIL ADDRESS Y,:
r
ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential'`
7 CLASS OF WORK \'
❑ NEW ❑ ADDITION ❑ ALTEIATION IR' ,REPAIR, ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
Reside west side of house - aluminum '+
9 CHANGE OF USE FROM TO
STIPULATIONS
iI''
Call for building wrap'inspection before''",;cov rri.ng.
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS AR (/AEOUIRED 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
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$21.00
Fire SC .50
PLAN CHECK FEE
TOTAL FEE
1$27.0
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
HEN ROPER Y LIDATED THIS S YOUR PERMIT
p®
44TU144-L-OWNERa-�V, f% !Q
� G
RE OF F OWNER BUILDER. IDATEI
BL INS -
�lA7E
NEW ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: f Wil) /n U/�/a-tel
Legal Description:. 1�-u azg z„ti
Owner Name & Address:; /��, J��rw Tel. # to/i�Z 5-7,t
Contractor: �vx�e ��� MN LICENSE # X179
Address: 311 cS/4 Al z . 6x- yo G Tel. # -79 / 661 2 -
Attach
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: Len Width Hgt/GroundSq. Ft.
OTHER: _t S / 6-0S i .�/ G 0 / /- G[�C.� 1
Construction Type: 177/,uLz12'7 Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ = $
DATE: / 1423
APPLICANT: 41e-t�� �'�r� Tel. #-J-7 5` f 9
STIPULATIONS:
CITY USE ONLY
Permit Fee
$
J f 60
Fee Schedule on Reverse Side
Fire Surcharge
$
S D
.001 of Permit Valuation (1 / 10th %)
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$1000 per SAC Unit
License Surcharge
$
U
$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:
CITY OF FRIDLEY BUILDING INSPECTION
6431 University Ave NE
Fridley, MN 55432
763-572-3604 FAX 763-5711287
RATE SCHEDULE
Residential
Furnace Shell and. Duct Work, Burner &
also Replacement Furnace
Gas Piping (New Furnace, Fireplace, Insert)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Other Repairs or Alterations (List on Back)
1% of Value of Appliance or Work
Minimum Fee $15.00 for Residential or 5% of cost of
Improvement whichever is greater
Effective 4/1/2004
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION �A
Oq
REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS I -! Q — tpA51'WgLA1
Fee Total
Owner buy-v)
Q in f scwl
$35.00 $� Building Used As
$10.00 $ ESTIMATED COST 322 PERMIT NO
$10.00 $
$10.00 $
$25.00 $
Commercial/Industrial/Institutional
1.25% of Value of Appliance or Work (List on Back)
Minimum Fee $35.00 for Commercial/Industrial/Institutional
State Surcharge
TOTAL FEE
REINSPECTION FEE $50.00/HOUR
# of Heating Units I I Circle One (Steam) Hot Water (Warm Air)
Trade Name .REI M Size No.
BTU %nbo % HP IDR
Fuel NC 0-(ko Total Connected Load
�Oi IPS
Burner Trade Name. Size No.
BTU HP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance withthe City Codes
$ and rulings of the Building. Division, and hereby declares that all the facts
and representations stated in this (application aretrueand correct.
$ HEATING COrJ� C�
5
$ ' -'LJ Signed 41 1 Tel #20
FAX # �D�-'l 0� -1 73? Date c� -I ®
*Air Conditioners can not be placed in side yard without written approval
from adjoining.property owner - copy to City
FILL OUT BACK SIDE FOR STACK VERIFICATION ON REPLACEMENT FURNACE
Approved by Rough -in Date Final Date
l '
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existing furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes �) No( )
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes ()
Noj
//\\
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances. Yes
No ( )
The existing combustion air is sized and installed to meet the current codes
and manufacturer's specifications. Yes ()
No))
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications. Yes
No( )
When installing a new venting system, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Furnace
Venting Tables for fan assisted and natural draft appliances. Yes)�
No( )
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes (
No( )
Appliance Type and Size/Common Vent and Vent Connector Inform/at�i)n
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
s
6wle
HEATING CO:
Signed By: r Date
Building
$ po75-, aa
BUILDING
Plan Review
Permit No.:53
Inspections
Fire Surcharge
RESIDENTIAL APPLICATION
.001 times the total job valuation
Received By: 011
763-572-3604
.0005 x Permit Valuation Minimum $.50
CITY OF FRIDLEY
$ 50
Date Recd:
763-502-49977 FAX
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 = $
EFFECTIVE 1-1-08
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
DATE A ' ®�
YOUR E-MAIL ADDRESS
Agreement necessary ( ) Non Necessary ( )
SITE ADDRESS I °��
y
�'L ' taio ky
Make checks payable to: City of Fridley Attach
THIS APPLICANT IS: ❑ OWNER ,CONTRACTOR
PROPERTY OWNER/
NAME: OfsS�
ADDRESS: 0y® v &-I L 1., -A -y CITY !•0 fir A
� �
STATE � ZIP
TENANT
PHONE. --76-4- 57q- 9 S 3r
NAME: .s
CONTRACTOR
ADDRESS;,23®;/s' A141-1eau... %/ CITY
EV- -I&C. STATE P41P 550't
SUBMIT A COPY OF
PHONE 95;t . %D Y 1'100 FAX S®
Y — 2 `C®�
YOUR STATE LICENSE
STATE LICENSE # 6740-3 17 275' EXP DATE
3-31 _ O
PROPERTY TYPE
klNGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH XiOOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ NEW HOME CONSTRUCTION ❑ ADDITION
PI MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: Teat oG% epA.6 ge -Ayip -�
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING ❑ HOUSE ONLY
BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES
❑ HOUSE & GARAGE
1.
Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2.
Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3.
List of structural member; to be used.
PROPOSED HEIGHT:
SIDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
El Aluminum
❑Trim
1.
Site Plan/Survey showing the existing structures
❑ Other
13 Fascia
and proposed project
2.
Two sets of construction plans
WINDOWS
3.
Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No 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:
TOTAL JOB VALUATION $ Cj BSNG 1997 UBC FEE SCHEDULE)
OCCUPANCY TYPE
Permit Fee
$ po75-, aa
See Back Page for Fee Schedule
Plan Review
$ m
65% of Building Permit Fee
Fire Surcharge
$ S, J<
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ 50
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$1825 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $21 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ Q 0q . OA
Make checks payable to: City of Fridley Attach
THIS 1S 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 Cod5j; that I 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 bccordan with th ed lan in the case of all work which requires review and approval of plans.
11
SIGNATURE OF APPC aef 10PRINT NAME DATE -57-/f -00
APPROVED BY DATE
Building
BUILDING
Permit No.:iz = l
Inspections
RESIDENTIAL APPLICATION
Received By-:
763-572-3604
CITY OF FRIDLEY
DAC
763-502'--4977 FAX
EFFECTIVE 1-1-08
DATE !; j( —o2n—IS
YOUR E-MAIL ADDRESS
SITE ADDRESS
AJ 'L
THIS APPLICANT IS: ❑ OWNER CONTRACTOR
PROPERTY OWNER/
NAME: C "n
TENANT
ADDRESS: L7� l a CITY LJ
STATEYl'I h)ZIP
PHONE: / _ rT
NAME: V
ADDRESS: r CITYtO.�h(U.
STATE 1MAIWP
CONTRACTOR
SUBMIT A COPY OF
PHONE 7 qoc FAX
YOUR STATE LICENSE
STATE LICENSE # SCe51 J!J q -�Z EXP DATE.
9
PROPERTY TYPE
ACSINGLE 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 DONE:
SIZE OF IMPROVEMENT
LENGTH WIDTH HEIGHT SQ FT
ROOFING
❑ HOUSE ONLY
BASEMENT
REMODELING SUBMIT:
NUMBER OF SQUARES
11 HOUSE & GARAGE
1. Existing Floor Plan
GARAGES
❑ ATTACHED GARAGE
2. Proposed floor plan
PROPOSED SIZE:
❑ DETACHED GARAGE
3. List
of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING
V inyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
I . Site
Plan/Survey showing the existing strictures
❑ Aluminum
❑Trim
and proposed project.
❑ Other
❑ Fascia
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No 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 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ Tnc) . 0 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
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors) .
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6 ft= ftx$21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks navable to: Citv 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 anwith 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 on site; that the work ' be in acro ac will the aved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLIC PRINT NAMES S > r� ala ��� DATE
APPROVEDBY �,r%i Q/'��✓ DATF/—
$
$
$
r7CJC
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors) .
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6 ft= ftx$21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks navable to: Citv 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 anwith 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 on site; that the work ' be in acro ac will the aved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLIC PRINT NAMES S > r� ala ��� DATE
APPROVEDBY �,r%i Q/'��✓ DATF/—