PRE 2010 DOCSJ
w . Ate• ,��
BUILDING PERMIT
Village of Fridley, Minn. No 2763
Date f•�. is. �.........................
Owner... ........ ... . Builder .........................
Address ®.� !L�i!, Address .......................................
LOCATION OF BUILDING
No. ..x".11......... Street .. �.7,gZT.. 4ACA-0.................... Part of Lot .......................
Lot ...... / ........ Block ..... 4......... Addition or Sub -Division
6
Corner Lot ............ Inside Lot ............ Setback t 'X':. Sideyard 1,*...'OV- 1 .............
DESCRIPTION OF BUILDING
T/o�beUsed as:
.... Front
Front. �.. .
Type of Construction ..
Depth 1-4+' ... Iieight 1444 ...
Depth ,p1/�-6r'.. Height M.'.....
Est. Cost . ,/ ,47- �/ �� ........ .
Sq. Ft. jjA% . Cu. Ft. ........
Sq. Ft. 3.t7.'j.. Cu. Ft. ........
To be Completed.�.l�dy .
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 r
ordinances of the village of Fridley.
consideration of the payment of a fee of $. —. , permit is hereby t to ........... .
�to construct the building or addition as described above. This permit is granted upon
e 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. zn /
.... Building Inspector
NOTICE:
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
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City of Fridley, Minn.
MU DING PERMIT
Date: dune 16, 1965
David T. Wade
Address 299 67th Ave. W.E.
N° '7907
Builder G. H. Lindwa l
Address 1120 W. M t haha Pkwy. Mpls . 19
LOCATION OF BUILDING
No. - 29 9 Street 67th Are. X.R. Part of Lot
Lot I Block 4 Addition or Sub -Division Rice Creek Plaza So. Add,
Corner Lot _ Inside Lot — Setback
Sideyard
Sewer Elevation Foundation Elevation
�,'
r -
To be Used as:
DESCRIPTION OF BUILDING
Front Depth Height Sq. Ft.
Front Depth Height Sq. Ft.
Type of Construction Est. Coat 5 �00_ _ To be Completed
Repair Storm Damage
Cu. Ft.
Cu. Ft.
In consideration of the issuance to me of a permit to construct the building described a e I agree to do
the proposed work in accordance with the description above set forth an in pliance a'll provisions of
ordinances of the city of Fridley.
In consideration of the payment of a fee of $ 5•o , permit is hereby granted to QJa MMILU
to construct the building or addition as described above. This permit is granted upon
the e71n,ress condition that the person to whom it is granted and his agents, employees and workmen, in all work
done around and upon said bFridlMinnesota location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and permit may be revoked at any time upon violation of any of the Pmt of said
ordinances.
Allen Jensen Building Inspedw
NOTICE:
Ob pwmb den net dewy the eoesfrud 1W, kMaMoe for vrkb& ph mhbg, gn hogln% awr w water. Be sure to na
the Building hupeftr for separate pwndit for thea it=&
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME David T. Wade BUILDER G. R. Lindwall
ADDRESS 299 - 67th Ave. N. E. ADDRESS 1120 I. X Ihaha Pkw. .11 Mals. 19
LOCATION OF BUILDING
No._ 299 Street 67th Ave. N. E. Part of Lot
LOT BLOCK ADDITION OR SUBDIVISION
Corner LotInsideLOT Setback Side -Yard
SEWER ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To be used as;
DESCRIPTION OF BUILDING
Front Depth Height
Sq. Ft. Cu. Ft.
Front Dept _Height
Sq. Ft. Cu. Ft.
Type of Construction gt0 ® repairs Estimated Cost $500.00
To be completed dune 25, 1965
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 rulings of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
DATE_ Jtane 16. 1965 SIGNATURE
(Schedule of Fee Costs can be found on the Reverse Side.
r
• -
53 city of F718 -10Y
or plu silo
• Dopt. of Bldpx. Phono SW -34.30 . •• •
DESCRIPT10It OF` W Olti I.o;atlors ' 299 67fh -ya NF
Numb, -r. KL -d find LetrAru oi' FIXtszas
•
HO. RATE
TOTAL
�%'�� '^ i✓ �
•
Signed
`"
x 52.0.3. $�
wAvto wra.
nture Fixture Opening
x 51.50 $
..
By 11111 T(jA5(;U
Business Phone Ivo - -
1ew Fixture Old Opening .. o • . •• • a • . �-••-�-�
x $..._ •._
$1.50
�
•
Catch Basins
x $3.75 S
Water Heater 'Up to 99.000 BTU)
x $300 $
few Ground Run Old Bldg.... o ... •
- — x :x.25
E3sr
$2.0 3._____--•--
FINAL, = -
1
'rAS FITTIIG FEES:NO.
RATE
TOTAL
o
Ist3'Fixtures
$2.00 S
Additi�nai Fixtures .........o .. • . •-----------
x S.75 S
1-'
Gas R.— ge to 199.00O BTU ............__
_� x $5.00 5
,
al
g
it
.50 State
Surcharge
P :711133 to ALTERXTIONS--PWar so Code
.i�e:.crl;.aon .'....................... ,.........:....
5.54
.
'
TOTAL F•r. r. ��-----
2 riy
x
3rd
rut"-* Cra:.nir,.
t ?fern Tm!-trv. Old Qp stdngs
cam`
uo•aoz
t;c:rpcol
PARTIAL RATE SCHEDULE
City of nidleyq
The undersigned hereby makes applkation for a permit for the- +rorlc herei
speeifi^d, agreeing to do all Mork in strict accordance with the Citj O:dtraret
and ruling of the Department of Built nZs, and hereby declares Lhat a/I the fad
•
and representations stated in Lh= application are true ar.d correct,
1! —2 —76 19.
Ridley. Minn
Owner li 4ade'
Kind of Building frame
Used as
To be completed about 4-30-76 -
Estimated Cost. S 1® 00
Olde. Building Permit No.
perait Ido. �02 /
TLtMING FIXTiJ?E RATES:
HO. RATE
TOTAL
�%'�� '^ i✓ �
•
Signed
Number Fixtures .... 0 ........... .
x 52.0.3. $�
nture Fixture Opening
x 51.50 $
..
By 11111 T(jA5(;U
Business Phone Ivo - -
1ew Fixture Old Opening .. o • . •• • a • . �-••-�-�
x $..._ •._
$1.50
�
•
Catch Basins
x $3.75 S
Water Heater 'Up to 99.000 BTU)
x $300 $
few Ground Run Old Bldg.... o ... •
- — x :x.25
Elset:J.e W&I.er Heater..
$2.0 3._____--•--
FINAL, = -
'rAS FITTIIG FEES:NO.
RATE
TOTAL
o
Ist3'Fixtures
$2.00 S
Additi�nai Fixtures .........o .. • . •-----------
x S.75 S
Gas R.— ge to 199.00O BTU ............__
_� x $5.00 5
,
5.00
.50 State
Surcharge
P :711133 to ALTERXTIONS--PWar so Code
.i�e:.crl;.aon .'....................... ,.........:....
5.54
.
'
TOTAL F•r. r. ��-----
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8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
TELEPHONE ( 612)571•3450
"NE
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r
OBSTRUCTION':
Lot Block Addition
.L4vlz T W#Dc
Property Owner -:address
RECORD OF COM%FU:,ICATIONS:
2. .
3
4.
S.
G.
7.
3 ®a S-®
CITY OF FRIDLEY
APPLICATION FOR
POWER PLANTS AND HEATING,
COOLING, VENTILATION, REFRIGERATION AND
each acrn. 50,000 BTU
AIR
CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
7.00
$
each addn. 50,000 BTU
6.00
$
OIL BURNER- to 3 gal. per hour
�Tq � 47 A Al E
GRAVITY WARM AIR:
RATE
TOTAL
Job Address a
_..rnace'Shell & Duct Work
$12.00
$
(over 199,999 Biu see Fee Schedule)
Replaca:.e nt of Furnace
7.00
7.00
$
S
Department of Buildings
Repairs s Alteraticns-up to $500.00
4.00
$
City of Fridley
Repairs & Alterations each add. $500.00
$ 1.00
$
Tel. #571-3450
MECH .\ICAL 1iAR>I AIR:
Furnace Shell & Duct Work to 100,000 BTU $12.00 $
each add. 50,000 BTU 4.00 $
Replacement of Furnace 7.00 �
Repairs & Alterations -up to $500.00 7.00 $
Re:airs & Alterations each add. $500.00 4.00 $
STEAM OR FOT ti.ATER SYSiLM:
Boiler & Lines ::p to 100,000 BTU
$12.00
$
each acrn. 50,000 BTU
4.00
$
Boiler only up to 100,000 BTU
7.00
$
each addn. 50,000 BTU
6.00
$
OIL BURNER- to 3 gal. per hour
$10.00
$
each add. 3 gal. per hour
10.00
$
GAS BURNER- from 100,000 BTJ to 199,999 BTU
$10.00
$ iO, rj(a
(over 199,999 Biu see Fee Schedule)
$
GAS FITTING FEES:
ist 3 Fixtures x
$ 3.00
$ 3.0®
Additional Fixtures x
$ 1.00
$
Gas Range to 199,000 BTU x
$10.00
$
AIR CONDITIONING ^i
FAN HEATING SYSTEMS
VENTILATING SYSTEMS
ALTERATIONS $ REPAIRS
ROUGH I\SP.
Date
FINAL I\SP.
Date
;.PPROVAL FOR PER+IIT
See Fee Schedule $
$
State Surcharge $ .50
TOTAL FEE $0,
REINSPECTION FEE
($10.00)
MINDI,UM FEE FOR AV2 1 HEATING PEPUMIT IS $7.50
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 true and correct.
y�
Fridley, Minn. / -(a (/ • 19_�nu
OWNER E MLI—Z A o dUZ j` nl S w P
KIND OF BUILDING C Irv,, co � � k ➢ -P � ` b NQ
II O
USED AS 1A U) N l l A: 0
TO BE COMPLETED ABOUT /vy,2 Si 12 -
ESTIMATED COST
OLD - NEW BUILDING PERMIT NO. PERMIT NO.
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, arm Air • No.
Trade Name Fe dam) Q_ C: ,q Size No. c u & to S
Capacity I&S4e,Q�_ Sq. Ft. EDR BTU f OS�Von HP
Total Connected Load S 4 1116 Kind of Fuel C '�' s
BURNER - Trade Name Size No. e.-)_ f / IDS
Capacity
BTU Ft. EDR BTU ,�5, 11CiZj HP
fejdLacs deh4, 'DIC Company 14aA►dar^j (PleakXQ§
eco eaay .�3� Signed By 7; r9AP2_ �
Tel. No.
SUBJECT
PERMIT
City of Fridley14'7'75
AT THE TOP OF THE TWINS
BUILDING
PERMIT
s
RE
COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
(%J
1
1
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CITY HALL FRIDLEY 55432
`•3
NUMBER
REV.
DATEPAGE
OF
APPROVED BY
---- 612-560-3450
910-F15
I
6/2
I
��78'
JOB ADDRESS 299. 67th Ave. N.E.
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR,
1
4
Rice Creek Plaza South
Addition SHEET
2 PROPERTYOWNER MAIL ADDRESS
ZIP PHONE
E.A. HEbzynski 299 67th Ave N.E.
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO.
Lloyds Hone Improvement Inc. 4911 4th St. N.E.560-4857
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO.
6 USE OF BUILDING
RESEDENTIAL
7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑X REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Apply 2nd roof over orr' inal
9 CHANGE QF USE FROM TO
STIPULATIONS
Builder agrees that this is no more than the seceond roof
Provide pre-formed Val&eys
TYPE OF CONST.
OCCUPANCY GROUP
OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
roof
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
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
800.00
0
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.
S 7.50
L
PLAN CHECK FEE
TOTAL FEE
PROPERLY V*LIPONED THIS IS YOU ERM/I`T
SIGNATURE OF CONTR TOR OR AUTHOR IZ N (DATE)
_Y�01Q
BLDG INSP
DATE
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI
CITY OF FRIDLEY
'
APPLICATION FOR RESMENTIAL BUILDING PERMITS
(NEM, ALTERATIONS,
ADDITIONS.# OR REPAIRS)
'
/ :'
OWNER:
BUILDER: rte l Zp
ir�ii
9
Address:
:
Address: Z,/-
Tel. No.
-7
No.: �-%�
Street:
LOT:
BLOCK:
ADDITION:
^�_
—1`—
CORNER LOT:
INSIDE LOT:
SETBACK: SIDEYARDS:
Applicant attach 'to this form 7Wo Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet: Cubic Feet:
Type of Construction: /)�� -� Estimated Cost:
To Be Completed: ,� %:
£�`-- Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
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 rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
DATE: SIGNATURE:
Stipulations:
ALJ g G�3
�$3
IAy
AGREEMENT
�yAOI kNA R N14S V , owner of the property
13 Ler TW 4uA Etc S k' U=7{,
located at 6 3 KP W.% . , have no objection to the
allowing the construction of a4y, C to be
located at �� L`$ % without the required'
certificate of survey that the City ordinarily requires for all new
construction.
witne
Signature
Address
Date
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
Effective On January 1, 1991
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
PLUMBING FIXTURE RATES:
NO. RATE TOTAL
New Fixtures
$ 7.00 _
Old Opening, New Fixture
$ 4.00 _
Beer Dispenser
$ 5.00 _
Blow Off Basin
$ 7.00 _
Catch Basin
$ 7.00 _
Rain Water Leader
$ 7.00 _
Sump/Receiving Tank
$ 7.00 _
Water Treating Appliance
$10.00 _
Water Heater -Electric
$ 7.00 _
Water Heater - Gas
$10.00 _
Gas Range
$10.00 _
Gas Dryer
$10.00 _
Yes () No
Back Flow Prreventer Required (#
Type/"' Awgk i &zgl +/
$5.00 _
� 7 z® 0 .- tj ,
Reinspection Fee $30.00
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1 % of Value of Fixture or Appliance
_
State Surcharge
TOTAL FEE
$ .50
JOB ADDRESS A
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 Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
Owner
Building Used As Alyll-2_
Estimated Cost
- o2 1 , 1991
w
PERMIT NO. / 6 � _)
PLUMBING COMPANY
SIGNED BY,&�,e
Approved By Rough -In Date
$JSSd PLUS THE $.50 STATE SURCHARGE
TEL NO =L - ®6 ZY
Final Date
IT
SUBJECT
MIT NO.
City of Fridley
29478
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEIPT NO.
`y ______ COMMUNITY DEVELOPMENT DIV.
INSPECTION SEC.
r PROTECTIVE
1
i CITY HALL FRIDLEY 55432
NUMBER
REV
DATE
PAGE OF
APPROVED BY
612-571-3450
910-F15J'%/�
/ /
JOB ADDRESS 299 67 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
4
1 Rice Creek Plaza South SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Emily Hebzynski
571-0628
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Twin Lake Construction 3071 Colbert Ave NW, Buffalo MN 55313 682-4246
4 ARCHITECT OR DESIGNER MAIL ADDRESS
ZIP PHONE LICENSE NO.
20132834
5 ENGINEER MAIL ADDRESS
ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ja REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (20 Sq) Tear -off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
Permit Inspection Cards
Will 13e Mailed
TO Homeowner To Post
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
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
$1,714
$.86
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
PLAN CHECK FEE
TO E
Lic a SSC
5.
7$70.72
SIGNATURE OF CON' RAC TOR OR AUTHOAIZED AGENT IOATEI
H
IS UR P T
07.0
$-GNATURE OF OWNERIF OWNER SUILOERI
LOG -NSF
MAY -11-1999
ivaw t
ADDN [ ]
ALTER [ j
14:54 FROM CITY OF FRIDLEY
TO 6922152 P.01/02
Effective 5/10/99
CITY OF FRWLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: .Z 25 6 %"-
Legal Description:
Owner Name & Address: �r�'-1Y 6¢c-,6zMS1<j' Tel. # 57/ - D(.z.y-
Con ractor: /c„ - 1-,¢.,l MN LICENSE #. 0?o/ 3 8350
Address: 30 �/ Cvl'b 444 1y t�,! v Fa/a /�tN. S53 �3 Tel. # 61?- - 6&2- #2yL
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.
OTB ER: 1%01rv�e, //?, Rw (' .7-0 50.
Construction Type: 140*,5 Tcna &9/j2ezg9yF Estimated Cost: $ - �~v /, 7 /y
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
Ft x $ _ $
DATE: S /Z S' APPLICANT: 7X.4 Tel. # 4A? G 5.2- ya vG
T
63-1-5-
CITY USE ONLY
Permit Fee $ Fee Schedule on Reverse Side
Fire Surcharge $ 411W /,'7/ .001 of Permit Valuation (1/10th%)
State Surcharge $ APOWSP $.50/$1,000 Valuation
SAC Charge $ $1050 per SAC Unit
License Surcharge $ e;. $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Play, Review
Park Fee $
Sewer Main Charge $
TOTAL $--=a %o
STIPULATION '_, /J
Fee Determined by Engineering
Agreement Necessary [ j Not Necessary [ ]
-22-
NEW[']'
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRMLEY
[ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: i? 9 9 - (07 Y-` A t1 if . Al
Legal Description: C
S
Owner Name & Address: 1E/yl /,� 4/ �'� Z y�f $ - Tel. # 6e� =4C ?®- �DWr—
Contractor: /L y AE f NZ MN LICENSE #
Address: 12 IF 7 4o� Fitjpzz W *f A01 Tel. ACI2 ! r 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: Length /42— Width _� Hgt/Ground Sq. Ft.D
OTHER:
oZ
Construction Type: Estimated Cost: $��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $
.010
DATE:� APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$
Tel. #
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 [ ]
SUBJECT
IT NO.
City of Fridley
QJ
018 3
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
�
RECEIPT NO.
"-V ------ COMMUNITY DEVELOPMENT DIV.
� � PROTECTIVE INSPECTION SEC.
r
i
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
612-571-3450
910415
9/8/99
JOB ADDRESS 299 67th Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACT OR ADDITION
SEE ATTACHED
DESCR.
1
4
1 Rice Creek Plaza South SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Emily Hebzynski
571-0628
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
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION )9 ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
B DESCRIBE WORK
Replace 121 x 201 deck
9 CHANGE OF USE FROM
TO
STIPULATIONS
See stipulations on plan:
{ WA1
Before digging call for
all utility locations
454.OWZ
RMQUlREi� BY LAW
SEPARATE PERMITS ARE REOUIRED 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 EW 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
$225.6
$1.13
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE
PERMIT FEE
SAC CH E
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
$83.25
Flr C 2.26
PLAN CHECK F7
TOT L FEE
6.64
S�GN4TURE OFCON"RACTOa OR AUTHORi2E0 AGENT iDATEo
P P V LI A THIS I$�YQUR MIT
Y
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SGN4TUAE O� OWN �6 OW NEA BU TDA i
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NUNDEnENGiNE G
C
ENGINEERS AND SURVEYORS
"140 SOILS TESTIM64'i010
CIVIL i�. MUNICIPAL ENOINEEMINO LAND PLANNINO, ff
G418 -SGT" AVENUE N.
MINNEAPOLIS 27• MINK.
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1• wr+Sr e
KE T- 3637
y S4i `1 4�
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SUr ve
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4-6
Ir �
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4 !
WE HEREBY CERTIFY THAT THIS Ij A TRUE AND CORRECT REPRE5ENTATION OF A SURVEY OF THE BOUNDARIES OF THE
LAND ABOVE DESCRIBED AND OF THE LOCATION OF ALL BUILDINGS, IF WY, THEREON , AND ALL VISIBLE ENCROACHMENTS,
IF ANY, FROM OR ON SND LAND. MINDER ENGINEERING CO., INC.
DATED THIS /" W? OF �A.O.HS'!
ENU11.1¢ER$ ANp SVRV@YOB/S
j�
�yy
Building
MECHANICAL
Permit No.,ePou
Inspections
RESIDENTIAL APPLICATION
Received By:
763-572-3604
CITY OF FRIDLEY
Date Rec'cy0-hIzif
763-502-4977 FAX
EFFECTIVE 1-1-08
7 7-
DATE YOUR E-MAIL ADDRESS e- b Q C,4- i rx Cj GL o CO +�
SITE ADDRESS Z �1 - %� + AlV e- to to e-
THIS APPLICANT IS: ❑ OWNER MCONTRACTOR
PROPERTY
NAME: E rn 1 H e. b z LjYL S k
OWNER/
ADDRESS: -Zq Cl - 10-1 4, t A V e_ v\",t_ CITY C r STATA 14 ZIf- 3Z
TENANT
PHONE: '763 5?1 0 6 y g
CONTRACTOR
COMpANYNAME: ElaSt e_-I4tel 14ec-4-," it
NOTE:
SEPARATE CITY
CONTACT PERSON: ��+ 2 Cho u. vt �+ r c�
STATE LICENSE # 9 3 C1 1r, -7 7 EXP DATE 4 - 2--2- c1
LICENSES ARE
REQUIRED FOR GAS
HVAC.
ADDRESS: 1010 t-1 0 e cl .a! o d �+ (J 4J CITY (aK G 1- / 0- STA N ZIPS,- 0 I
AND
SUBMIT COPY OF BOND
PHONE-7 to 3 14 3 L4 ( t Q o FAX -1 b 3 `i 3 4 LI 2- S 5
AND INSURANCE
PERMIT TYPE
0 SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK:
❑ NEW Z�REPLACEMENT ❑ ALTERATION/REMODEL
DETAILED DESCRIPTION OF WORKe
PER MS 1613.665 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. (This should reflect only the cost of labor )
OR
Labor cost under $300 = $15.00. Labor cost between $300 to $500 = cost of labor x.05 =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW) PbEquipment Installed MFG: CO Vn Pr {gnc ke r MODEL: C M P 6 0-7 5 F t 2C Z SIZE/BTU S,0--o
MFG: MODEL: SIZE/BTU
MFG: MODEL: SIZE/BTU
A/C $25.00 _FIIZEPLACE (GAS) $15.00 RANGE/OVEN $10.00
_GAS
AIR TO AIR EXCHANGEER $15 _FIIZEPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
_BOILER $35.00 1 FURNACE $35.00 UNIT HTR $10.00
_GAS
_CHIMNEY LINER $10.00 _GAS DRYER $10.00 HEATER $35.00
_POOL
_DUCT WORK $10.00 _GAS PIPING $10.00 _VENTILATOR $15.00
PERMIT FEE PROJECTS FOR UNDER $500 PERMIT FEE FOR PROJECTS OVER $500
Permit Fee $ &:5r--.'!pg) Number of fixtures @ $10.00 x $10.00 = $
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ _„!6 OR Number of fixtures @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
MINIMUM $15.50 MINIMIIM $15.50 Total = $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a mechanical 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 esota 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 ' rdan with approved plan in the case of all work whichujres review and approval of plans.
SIGNATURE OF APPLIIC PRINT NAME " a t Y1gy' DATF/Q %
APPROVED BY
—DATI�
PLEASE NOTE: SEP TE PERMITS ARE REQUIRED FOR BUILDING, ELECTRICAL AND MECHANICAL —WoRif
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-502-4977