PRE 2010 DOCSCity of Fridley, Minn.
BUILDING PERMIT
Date:
Owner:
Address
(:4978
Builder
Address _.._.._....
LOCAT NOF IJII ING
No..... A�?. ... Street _.._ � .......--;WV -4f. Part
..-..__.- Addition Sub -Division or Sub -Din ....._.... w
.........._......-. Block ....._........__._ ......................... _. .,..►�.�......_...�_.
Lot .��.:����.._...__.........__-��t
Corner Lot... ................_...._........ Inside Lot ....._..-gip_.-.... Setback ..1�..._........_..._........ Sideyard .6. ......................
Sewer Elevation ... _..................................... _......._...._......._...._......._...._....._. Foundation Elevation
DESCRIPTION OF BUILDING
To be Used
�,/ �r f�//� C� QQ�`
- fC Sq. Ft. _. �r7 Cu. Ft�i[% c e
-- - ---- ----•-_-.: _ Front _._ ---- f-_ Depth .-- - Height .. .. .--
/ ++�� /
- - .,�+........ Front. Depth .... fighter)../:..._.. Sq. Ft.....�..... Cu. F't..wr�_.0
Type Construction .......wr"�L.... Est. Cos ........44 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 $..09�' '" —, permit is hereby granted to....._......_ ..................... _.......... ...
r�._...._...__.. _ _._�_...._ 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 anyupon violation 6biny of the provisions of said
ordinances. ,d.,A?A ,l
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.
4
Owners E
Address
APPLICATION FOR BUILDING PERNIT
CITY OF FRIDLEY, KMWOTA
LOCATION OF BUILDING
No. f Street1�
, r , � ,P&r t of Lot
Lot '3 BlockAddition or Sub.Div.
Corner Lot= ide Lot Set Back ,� Side -Yard
SEWER ELEVATION „ Fb, FOUNDATION ELEVATION _ j
Applicant attach to this form Certificate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
To be used as:
. Fron � � Depth
Sq. Ft. Ou. Ft.
y� 0
Front Depth Height
Sq, Ft. Cu. Ft.
Type of Construction 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 Ordinances and ruling of
the Department of Buildings, and hereby declares thaA all the facts and representa-
tions stated in this application are true and rrAa
DATZ 16 --pi
O SIGNATURE
(A Schedule of Fee costs can be found on the Reverse Side.)
61f
3 AppReation for Power Plants and Heating, Cooling, Ventilation. Refrigeration and
Air Conditioning Systems and Devices
PARTIAL RATE SCHEDULE Dept. of Bldgs. Phone SII 4-74470
GRAVITY WARM AIR: RATE TOTAL Location 61`(/(7
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 $
MECH. WARM AIR
Furnace Shell & Duct Work to 120,000 BTU ............ 8.00 $ D
each add. 60,000 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. IDA 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 $
OIL BURNER—to 3 gal. per hour ........................ 5.00 $
over 3 gal. per hour --See Fee Schedule
GAS BURNER (up to 400,000 BTU) 5.00 $ ��
GAS FITTING FEES: NO RATE TOTAL
1st 3 Fixtures ...................... x $1.50 $ /,,5_20
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 $T
REMARKS:
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- �--�/"1 6 - 1
Ce �-Ja - i��✓.r�/��
Kind of
Used as
To be completed about
Estimated Cost, $
Old Building Permit No.
DESCRIPTION OF WORK
HEATING or POWERPLANTS—Stearn, Hot Water, Warm Air—No�
Trade Name lett 4"k Size No-%'�
Capacity Sq. Ft. E.D.R ®o BTU H.P.
Total Connected Load 3 ,�,�� Kind of Fuel
BURNER — Trade Name— Size No a
Capacity Sq. Ft. E.D.R BTU H.P.
SUBURBAN HEATING & SHEET METAL
8419 CENTER DRIVE N. E,
Signed MINNEAPOLIS 21, MINk
By
11 POST IM -12-58 Business Phone No $l/ ��
D-56 a 2
HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E. Construction No.
Guide
Windows I Doors Reference Out. Wall Int. Wall Ceiling Roof Floor
e No No 1—
FI_I Rnnm 11.nnof6 /i W;rlltlk /a/ 14nioht C7/ II 1 FII
Windows a�
Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane llghte of crack sq. ft.
Ay/ 3A / /o.L APe
Width Height No. of Lineal ft. Area
No. of Dane of Dane lights of crack sq. ft.
2t ,WL
Exp. wall
Coef. Btu
Infiltration
Infiltration
Coef.1
Btu
Infiltration
O
Net exp. wall !(�
2,Z
Glass
S,
Ceiling
4416 Z
Exp. wall
Int. wall
Net exp. wall
D
A0,6-2,
Int. wall
Ceiling
/p
d
Floor
1 otal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ FI 1.4-.•i 10 --,f-R.,. — I I e..�. MA&L e./
indows and Doors—Crackage and Area
Btu
Width Height No. of Lineal ft. Area
No. of pane of pane llghte of crack sq. ft.
Ay/ 3A / /o.L APe
j yax 0
Exp. wall
Coef. Btu
Infiltration
Infiltration
Glass
.2020
Exp. wall
O
Net exp. wall !(�
2,Z
Int. wall
S,
Ceiling
O p O
Floor
Int. wall
l otal 13tu. 1.21,0754
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
/ FI I laf t --- DL W.J.L -l/ Ll—:—L.&,
Windows
/
Windows and Doors—Crackage and Area
Btu
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack eq. it.
Ay/ 3A / /o.L APe
Glass r
Exp. wall
Coef. Btu
Coef. Btu
Infiltration
p!
.2020
Glass
O
Floor
Exp. wall
Total Btu.
S,
Net exp. wall
O p O
p .p
Int. wall
Ceiling
Floor
Tbtal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Windows and 1
Width H,
NO. Of pane Of,
r I 1
3flpa Z FRIDLEY, MINN.
Insulation
Kind a How Applied
Room I Length ( Width / / Height /
ora—Crackage andArea
ht No. of Lineal fL Area
no lights of crack sq. ft
Coef.
Btu
Infiltration
70
Glass r
Exp. wall
Coef. Btu
Net exp. wall
O
Int. wall
-4415�
Ceiling
O
Floor
p
Total Btu.
S,
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
O p O
/ Fl.l fie®,® Room I Length /3 r Width //J /
Height 92
01 Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane llghte of crack sq. ft.
70
Coef. Btu
Infiltration
O
Glass
-4415�
Exp. wall
Net exp. wall
p
Int. wall
Ceiling
Ej
O p O
Floor
Total Btu.
Required sq. ft. E.D.R. or sq. iris. W.A. Leader area
I El I n___ 1 r __—L / .e i Ql:.raL C/i U—:—L. tZ/
Windows and Doors—Crackage and Area
Width Height No. of Lineal ft. Area
No. of pane of pane lights of crack sq. ft.
70
Coef. Btu
Infiltration rf,
O
Glass
Exp. wall y
Net exp. wall
p
Int, wall
Ceiling
a
Floor
1 otal btu. a
Required sq. ft. E.D.R. or aa. ins. WA. Leader area I /'_
J6�
City of Fridley
Application for Plumbing and Gas Fitting Permit
DESCRIPTION OF WORK
Number, Kind and Location of Fixtures
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE
TOTAL
Number Fixtures ......................
x $1.50
$/o s-0
Future Fixture Opening ................
.2 x 1.20
$
New Fixture Old Opening ..............
x 1.00
$
Catch Basin ...... .....................
x 3.25
�U'
Water Heater (Up to 200,000 BTU) ......
x 2.00
$
y
x 3.25
$
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
z
7u
(Jj
•
F
•
N
WATER HTR.
GAS
ELEC.
y�Z
3
Qi
m
YI
3 h
C LL
LL O
u GO
3
U� G
U�
ii O
Base
1st
2nd
3rd
4th
• Future Connection Openings
Connected with
I
Sewer
New .Fixture, Old Openings
Cesspool �
PARTIAL RATE SCHEDULE
PLUMBING FIXTURE RATES:
NO. RATE
TOTAL
Number Fixtures ......................
x $1.50
$/o s-0
Future Fixture Opening ................
.2 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
$
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 $�
Dept. of Bldgs, hone SII
. - 2-_ YZ/
City of Fridley:
The undersigned hereby makes application for a permit for the work here!
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.
a
,-Fridley , .Minn
Owner 0
Kind of Building
Used as
To be completed about —
Estimated Cost, $
Old New. uilding Permit
//;'62 a- 20 -G
ROUGH , 2 - 9 A - to
FINAL
Business Phone
•
•
City of Fridley, Minn.
BUR DING PERMIT
Date: June 23 ., 1965
Owner: Floyd Johnson Builder
N° 8005
L. W. Samuelson Constr. Co.
Address 861 66 Avenue N. E. Address 7800 E. River Road N. E.
LOCATION OF BUILDING
No. 861 Street 66th Avenue N. E. part of Lot
Lot 3 Block l Addition or Sub-Dtvwon Meadowlandsx Add.
Corner Lot _ Inside Lot setback sideyard
Sewer Elevation Foundation Elevation
To be Used as:
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft. Cu. Ft.
Front Depth Sleight Sq. Ft. Cu. Ft.
Type of Construction Est. Cost $3,475-00 To be Completed
Storm damage repair
X"'
In consideration of the issuance to me of a permit to construct b above to do
the proposed work in accordance with the description above set f ce with provisions of
ordinances of
the city of Fridley.
In consideration of the payment of a fee of 1S 0' . _y permit is hereby granted to 00 L• Samuelson
Qonstr. CO. 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
dome in, around and upon said building, or any part thereof; shall conform in all respects to the ordinances of
Fridley, Minnesotarding 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.
Allen Jensen
NOTICE:
'lids pom* don not emm 16 conshve0ae, kabMw fw wk+bt, pbmmb & on bedk& away w water. Be are to ae
d to BuNft Iesp - hr apwate perm.- IM thea ft"M
APPLICATION"FOR BUILDING PERMIT
CITY OF FRIDLEY; Mn sOTA
OWNER'S NAM,T''?_ycl,.�i �t2I4 BUILDERTy_ ttG �fia`mue ll sari Const.
ADDRESS A67.:F6th Ave- N_P_ ADDRESSj900 E;, `R3er Rd.
LOCATION OF•BUtLDtNG
No.. 861 Street . 66tY Ave.- P4rt' of Lot
I.OT� iloCk ADDITION OR SUBDIVISId t
Corner Lots Inside .L w_'Setback S de=Yht`d
SEWER ELEVATION FOUNDATION SiXV'ATION .:.
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates. -
DESCRIPTION OF B616iNG•'
To be used` as =
Dwelling Front Depth Aeight
Sq. Ft. Cu. Ft.
Front . Depth Heigtit
Sq. Ft. Cu. Ft.
Type of CanetructiPR. f�ne� Estimated Costes 87r2m00
To be completed as so dTn as gosa• b1® �-
T -ho sundersigned 'hereby •makes application for a* peftit-1or the work herein specified,
agreeing to;do all work in strict accordanoe'with'the City •of Fridiey,Ordinances
'~and "rulings of, the Department of Buildings, and hereby declares that all the facts
and representations stated'in this application are a an coir" .`
DATE '
.� SIGNATURE
(Schedule o Fee Costs can be found on the Reverse Side).
"Aw M.
f-I-OrIc to be done:
SIdIngo3oldes
Remove and replace 9 sq*
ft%ontg
Remove and ralQce brick
Put In Vvespy JoInt
aoofing:
Romovo and replace 22 sq,
Jamb and trIm
I
1C'.3,Wbing roof stuck
4 RW,#a sieratched
Remove and replace 5 arninf; mash
-Path:
Sai*x and hardware
Hake r-oldins 1,6#
Peplace firont fuels -*60 LP,
TAvng Room Halls
Patoh-ronall-tape
Paints
lIvIng room
hen
9 back bedroom
kitchen
Oellinge
basement stalro
aepafttt
exterior
block vall,
basement bedr-nom
Recroute basement walls
Replace garage service door
Vas h dirt orf exterior of house
J0,61
Ployd, Jo--inson
FGl WWI Ave* 'T"T.'T,
rridley# TIftneenta
16
�M
SUBJECT
-
City of Fridley
P"�l7 7 81
AT THE TOP OF THE TWINS
BUILDING PERMIT
r
ECEIPT
�
COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
CITY HALL FRIDLEY 55432
NUMBER
REV.
DATE
PAGE OF
APPROVED BY
L 612-571-3450
910-F15
11/2/84
JOB ADDRESS 861 66th AVenue N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION SEE ATTACHED
DESCR.
3
1 1
Meadowlands SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Simon
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Meehan Brothers, Inc. 2838 Stevens Avenue South 870-0234
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 Ek REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
reroof
9 CHANGE OF USE FROM TO
STIPULATIONS
1. Can be second roof, but not third
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
asphalt
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
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
1,300.00
65
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIIFEE
SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
2[.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
TOTAL FEE
22.65
SIGNATURE OFTRACTOR OR AUTHORIZED AGENT (DATE)
PROPERLY VALIDATED THIS IS YOUR PER IT
BLDG INSP DATE
SIGNATURE OF OWNER 0F OWNER BUILDER) (DATE)
�M
NEW
[
]
City of Fridley Effective 4/1/84
ADDN.
[
]
�R-1 AND R-2
ALTER.
[
7
Building Permit Application
Construction Address: �� f� 4"
Legal Description: l c� CG r I(Ulry�00 U,
Owner Name &Address: �'-s ��w� `' �� f Co�? ��' Tel. #
Contractor: `� b"` ��"d c a Tel. #
Address: ,:2, n s- �� .c-,- s e,
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
s
LIVING AREA: Length
Width
Height
Sq.
Ft.
GARAGE AREA: Length
Width
Height
Sq.
Ft.
DE_: Length
Width
Hgt/Ground
Sq.
Ft.
OTHER:
$
$425 per SAC Unit
Park Fee
$
Fee Determined by Engineering
Corner Lot [ ) Inside Lot[ ]
Ft. Yd. Setback
Side Yard
Setback
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
Type of Construction:416&-*
Estimated
Cost: $
Approx. Completion Date: /J"j
'9 (9 �i
1
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
• %!• Z — Y APPLICANT:
Tel. A. ,�U-- 02 2j1
DATE.
STIPULATIONS:
e
CITY
USE ONLY
Permit Fee
$
a v
Fee Schedule on Reverse Side
Plan Check
$
25% of Building Permit Fee
State Surcharge
$
$.50/$1,000 Valuation
SAC Charge
$
$425 per SAC Unit
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement Necessary [ ] Not Necessary [ ]
TOTAL
$
STIPULATIONS:
e
CITY OF FRIDLEY
Effective Date May 1. 1988
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
OOCTnOW".,,TS T
Furnace Shell and Duct Work,
Burner (Also replacement furnace)
Gas Piping
(piping needed with new furnace)
Gas Range
Gas Dryer
• Air Conditioning (all sizes)
All Others/Repairs and Alterations
10 of Value of Appliance or Work
COMMERCIAL/INDUSTRIAL
11 of Value of Appliance or Work
RATE TOTAL
$ 20.00 $-0
10.00 $
$ 10.00 $
$ 10.00 $
$ 10.00 $
State Surcharge
TOTAL !EE
Reinspection Fee ($15.00)
Rough Insp.
Date
Final Insp.
Date C
Approval for Permit
MINIMUM FEE FOR ANY HEATING PERMIT IS $15.00
PLUS $.50 STATE SURCHARGE
*Air Conditioners can not be placed in side yard without
written permission free adjoining neighbor.
S
Job Address E61 �� �� � � / Ly t /U
Department of Buildings, 6431 University Ave. N.E., Fridley, NN 55432
City of Fridley
Tel. 1571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are ue and correct.
Fridley, �Minn. � � , 19
OWNER ce-el
KIND OF BUILDING �- 0"zi
USED AS
TO BE COMPLETED ABOUT
ESTIMATED COST 300
/ /J
OLD - NEW BUILDING PERMIT NO. PERMIT NO. D
DESCRIPTION OF FURNACE/BURNER
HEATING r POWER PLANTS, Steam, Mot Water �="
No. o
Trade Name Size No.
Capacity Sq. Ft. EDR BTU RP
Total Connected Load `bulb Z% Kind of Fuel
BURNER - Trade Name
Size No.
Capacity Sq. Ft. EDR B HP
Company 4
Signed By S.5,n AVP.nLip N.
Flalrk, SIN 55443
Tel. No. 4 898
'Fill out back side for stack verification on replacement furnaces
CHIMNEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
I. Has been carefully examined Yes (,—Y --No ( )
2. Is free from rust or deterioration Yes (,,Y -'No ( )
3. Has no foreign objects lodged within
4. Is securely supported
5. Meets all current Code requirements for size and
total BTU connected
6. Has Total heating BTU's of
All other BTU's 0 01
TOTAL � - M
Remarks �C S
Yes ( ) No ( -)����
Yes (,)---"No ( )
Yes(�o()
4 N C -
5t HEATING & COOLING
?0 - 85th Avenue N.
Company Orn;. kj;va Park, MIN 55443
-24-8333
Signed By
Date /)
SUBJECT -
P T NO.
City of Fridley
3 0174
AT THE TOP OF THE TWINS
BUILDING PERMIT
RECEIPT NO.
v ------ COMMUNITY DEVELOPMENT DIV.
r PROTECTIVE INSPECTION SEC.
F
1 �
= ----1 CITY HALL FRIDLEY 55432
NUMBER
REV
PAGE OF
APPROVED BY
.j
L J`� 612-571-3450
910415
[DATE
9/3/99
JOB ADDRESS
861 66th Avenue NE
1 LEGAL
LOT NO.
BLOCKTRACT
OR ADDITION
SEE ATTACHED
DESCR.
3
1
Meadowlands
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP
PHONE
ShirleySimon
3 CONTRACTOR MAIL ADDRESS ZIP
PHONE LICENSE NO
Gates Roofing 4640 Ximines Ln Plymouth
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 MX REPAIR
❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage 24 S 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 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
2098
$1.05
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CHA G
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STR CTION THEPERFORM E OF CONSTRUCTION
$83.25
F� .SC 2.10
I ��
PLAN CHECK F
TOT F E
Lic Sc- $5.
.40
SIGNATURE OF CON'RA R OR AUTHORIZED AGENT IOATEiEN
O A
HIS UR P MIT
M
r
S.GNATURE OF OWNER,iF OWNER BUILDER, I -DAT E,
BlD NSP
TATE
NEW[ Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY
ALTER [) SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: c' P 66 tb , v
Legal Description:
Owner Name & Address:
Contractor: (w, k' S I
Address:
0
Tel. #
MN LIC_ ENSE # 6793
Tel. # ,S50-00 q3
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: (tel / �? I
Gl
Construction Type: Wf) /lei' Estimated Cost: $
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $
DATE: -1 r 5-q_(
APPLICANT: 77GO dfflz Tel. #
Permit Fee
$-�
Fire Surcharge
$
State Surcharge
$
SAC Charge
$
License Surcharge
$
SO
Driveway Escrow
$
Erosion Control
$
Park Fee
$
Sewer Main Charge $
TOTAL $
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1050 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 [ ]