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PRE 2010 DOCS• • 0 City of Fridley, Minn.. BUILDING PERMIT Date: SEPTEMBER 3, 1965 Owner: ELIZABETH C. MADSEN Builder Address 30 West Read Address Circle Pines, Minnesota SAME �OCATION OF BUILDING No. S 49 0 Street Pl DPart of Lot Lot 1 __ Block 1 Addition or Sub -Division HOLIDAY HILLS Corner Lot _ Inside Lot Setback — 51 �— Sideyard 12' Sewer Elevation Foundation Mevation To be Used as: HOUSE DESCRIPTION OF BUILDING N° 8431 Front 40 Depth 28 Height 20 Sq, Ft. 1, 034 Ca. Ft 20;680 ALL . GARAGE Front 24 Depth 24 Height 10 Sq. Ft. 5 76 Cu. Ft. —2j 76 0 Type of Construction FRAME. Est. Cost 81 000=00To 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 and in compliance with 21 provisions of ordinances of the city of Fridley. In consideration of the payment of a fee of $ 27.00 , permit is hereby granted to EL•T •ARF.TR C MADSEN 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 anypart thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinances. ALLEN G. JENSEN NOTICE: Tbb pe mh den aot cam the construeHon, hutdLtien for wiring, phmbing, gn hesdng, awu or wafer. Be sons to as tin &riidiag lnpnter for apmte pwmhs for thea hmm APPLICATION FOR BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA OWNER'S NAMEeL Z ✓-1 (3c T r/ L"• r� O 5 c- BUILDER Q} M ADDRESS 3cce,�s i Pc'y e. C��.� c << Tiw r9 S ADDRESS 54 7W 6 LOCAAON OF BUILDING N0. L/ �� STREET 4 Ag PART OF LOT. LOT _JBLOCK ADDITION OR SUBDIVISION /'�,e / D.4 ,i A41 e < s CORNER LOT INSIDE LOT SETBACK 3 6- SIDE -YARD SEWER ELEVATION FOUNDATION ELEVATION i LAB g,,,,� 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: 01A) , Z C ,0 w e x- .v c-, - /;'✓? o /-e'n Front v o ' Depth z,/ez f� Height 17 4& ' f0 6'07 Sq. Ft.- /,0 :55Z Cu. Ft. /f XAac' A. T 7:4Front Depth 2 `/ Height Sq. Ft. 5' 7CQ Cu. Ft. -1-31" Type of Construction_ �'/dAaEstimated Cost6 To be completed ,Vo 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 S 15.1-7-, 34 / %G !— SIGNATURE (Schedule of Fee Costs can be found on the everse Side). SUBJECT PERMIT N City of Fridley 252 1 2 AT THE TOP OF THE TWINS BUILDING PERMIT r _ReNO. ` _ COMMUNITY DEVELOPMENT DIV v------ PROTECTIVE INSPECTION SEC �� r NUMBER REV DATE P PAGE OF APPROVED By CITY HALL FRIDLEY 55432 612-571-3450 910-F15___[ 6/24/97 JOB ADDRESS 490 - 69th Avenue 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 1 Holiday Hills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Roger Nelson, 490 - 69th Avenue, Fridley, MN 55432 574-1485 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Roger Nelson 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 CY REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK Re -roof (tear -off) 20 Sq 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCYLOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT_ CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS I 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 $1,650.00 $.83 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- $54.00 double fee Fire SC $1.65 STRUCTION OR THE PERFORMANCE OF CONSTRUCTION ItE PLA E EE TOTALFEE $110.48 SIGNATURE TRACTOR OR AUTHORIZED ARGENT WHEN PROPERLY ALIDATED THIS IS YO�1R PERMIT s�(DDATEI ZER,IF BLD INSP DATE iGNA,OWNER BUILDERI IDATEi NEW ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION ConstructionAddress: Li f c;o - 6 Legal Description: Effective 1/l/97 --0=-3-)-S7 Owner Name & Address: IVE4 ,5 5;' /L/ Tel. # Contractor: MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF EVIPROVEMENT Length Width Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. RJ7 %c hLR 0170 o ,S'cS 22- f ri Driveway Curb Cut Width Needed: Ft. + 6 Ft DATE: � -9-4 - �1� APPLICANT: Estimated Cost: $ (Fee Schedule on Back) Ft x $ = $ Tel. # STIPULATIONS: cV 2�C CITY USE ONLY Permit Fee$ `� l�. Fee Schedule on Reverse Side Fire Surcharge $ .001 of Permit Valuation (1/10th%) State Surcharge $ $.50/$1,000 Valuation SAC Charge $ $950 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ -$450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer. Main Charge $ Agreement Necessary [ ] Not Necessary [ J TOTAL 7 $ A-1 STIPULATIONS: CINOF FRIDLEY FRIDLEY MUNICIPAL CENTER - 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 - (612) 571-3450 - FAX (612) 571-1287 LICENSE AGREEMENT The undersigned Roger Nelson and Sandra Nelson , being the fee owners of certain property located in Fridley, Minnesota, at 490 69th Ave Fridley MN 55432 . and legally described as: 14-30-24-12-0001 hereby grant to the City of Fridley, Minnesota, and that the City's employees, a license for the purpose of gaining access across the above-described property to a retaining wall and other structures adjacent to Rice Creek. This license is only for the purpose of allowing the aforementioned persons access for maintenance purposes. This license is intended to last ten (10) years from the date of its execution, and is not transferable or useable by any persons other than those designated herein. By accepting and using this license, licensee hereby agrees to repair any and all damage caused by the City or its employees while using this license on the above-described parcel. Signed: Roger Nelson J_AaZa, Y110 J&/VJA_ Sandra Nelso Subscribed and sworn to before me this ay of IVA ��-saxVNf"64( i W Notary• VICKI L. HANSEN WTNry puallC-Mu+ MTA woe EqM .w. M 31M 0 ANA• ROWN=1-1 SUBJECT E NO. City of Fridley 29585 AT THE TOP OF THE TWINS BUILDING PERMIT r `v ------COMMUNITY DEVELOPMENT DIV. INSPECTION SEC. r PROTECTIVE 6i�C i A ,'; CITY HALL FRIDLEV 55432 L J` NUMBER REV DATE 1� 9 9 /1/99 PAGE Of APPROVED BY _•__ 612-571-3450 910415 �( JOB ADDRESS 490 69th Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DES CR. 1 1 lHolidayHills SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Roger Nelsen 574-1485 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Owner A 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 ADDITION O NEW O ALTERATION REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reside West & North sides of home - Redwood 9 CHANGE OF USE FROM TO STIPULATIONS Call for building wrap inspection before covering. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST OCCUPANCY GROUP OCCUPANCYLOAD 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 $10,000 $5.00 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 TOTAL FEE / $196.25 SIGNATU OF CON'RACTOR OR AUTHORIZED AGENT IDATEI WHEN PROPER VALIDATED THIS IS Y UR PERMIT BLD INSo MATE SIGNATURE OFOW NEA IIi OWNER BUILDER, IDATEI NEW[ ]� Effective 5/10/99 ADDN [ ] CITY OF FRIDLEY ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: A V'C- Legal Description: Lo< / gi, l b C4_S Owner Name & Addr s: F �,� Tel. # ,! 7zl— 4/,? -og Contractor: Z 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 A Hgt/Ground Sq. Ft. OTHER:L Construction Type: -D i) Estimated Cost: $ Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x $ _ $ DATE: cp APPLICANT: k2&.d�T�L� Tel. # 5 '14f -11$ STIPULATIONS: USE ONLY Permit Fee /CITY $ l f . o�s Fee Schedule on Reverse Side Fire Surcharge $ /Q • 00 .001 of Permit Valuation (1/10th%) State Surcharge $ 00 $.50/$1,000 Valuation SAC Charge $ $1050 per SAC Unit License Surcharge $ $5.00 (State Licensed Residential Contractors) Driveway Escrow $ Alt. "A" or Alt. "B" Above Erosion Control $ $450.00 Conservation Plan Review Park Fee $ Fee Determined by Engineering Sewer Main Charge $ Agreement Necessary [ ] Not Necessary [ ] TOTAL $ STIPULATIONS: CI Y OF FRIDLEY INSPECTION DIV. 6431 University Ave NE Fridley, MN 55432 (763) 572-3604, FAX (763) 571-1287 APPLICATION FOR PLUMBING AND GAS FITTING PERMIT MARK NI IMRFR OF FIXTURES TO BE INSTALLED ON EACH FLOOR Ettective un Jan 1, 2-UO3 COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE q7O ` 6 7 fi- F E PLUMBING FIXTURE RATES: NO. RATE TOTAL JOB ADDRESS New Fixtures $ 7.00 The undersigned hereby makes application for a permit for the work herein Old Opening, New Fixture $ 4.00 specified agreeing to do all work in strict accordance with the city codes Beer Dispenser $ 5.00 and rulings of the Building Division, and hereby declares that all the facts Blow Off Basin $ 7.00 and representations stated in this application are true and correct. Catch Basin $ 7.00 o r 20 �� Rain Water Leader $ 7.00 Sump/Receiving Tank $ 7.00 Water Treating Appliance $10.00 Owner Water Heater -Electric $ 7.00 Water Heater - Gas" $10.00 Building Used As Gas Range" $10.00 Estimated Cost2lry ' o� PERMIT NO. Gas Dryer"' $10.00 Back Flow Preventer Required (v,#es () No Type $15.00 PLUMBING COMPANY _s' SL '7W3 /��TEL Reinspection Fee $47.00/Hr SIGNED BY N0. ALL OTHERS AND/OR REPAIRS AND ALTERATIONS 1.5% of Value of Fixture or Appliance Approved By Rough -In Date Final Date State Surcharge $ .50 MINIMUM FEE FOR ANY PLUMBING/GAS PERMIT IS $20.00 TOTAL FEE $ -P, S' PLUS THE $.50 STATE SURCHARGE COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. COMMON VENT INFO ON BACK SIDE THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE APPLICATION WILL BE RETURNED C`C)MIhnN VENT- VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When replar-enn an exicting furanrp, 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 () No ( ) 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 gYi�p cemhiistien air is sized and installed to meet the current codes and manufacturers specifications. Yes( ) No( ) When required to in -+all a new comhustion air; it will be sized and installed to meet the current codes and manufacturer's specifications. Yes () No ( ) When inc allinn a new venting system, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturers 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 Si7 JCommon Vent and Vent Connector Information 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 HEATING CO: Signed By. Date : CITY OF FRIDLEY PERMIT NO.: 2004-01519 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 DATE ISSUED: 09/01/2004 572-3604 YAX: (763) 571-1287 ADDRESS : 490 69 AVE NE PIN : 143024120001 LEGAL DESC : HOLIDAY HILLS : LOT 1 BLOCK 1 PERMIT TYPE : ELECTRICAL PROPERTY TYPE RESIDENTIAL CONSTRUCTION TYPE ADDITION/ALTERATION VALUATION NOTE: ELECTRICAL PERMIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL SAVERS SWITCH. # INSPECTIONS 1 APPLICANT HUNT ELECTRIC CORPORATION 2300 TERRITORIAL RD ST PAUL, MN 55114 - OWNER NELSEN ROGER L & SANDRA J 490 69TH AVE NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of worl will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regulating construction or the performance of construction. Applicant Date Bldg Ins p Date ELEC PERMIT FEE - MIN (RESI) 20.00 STATE SURCHARGE, ELEC FLAT 0.50 TOTAL 20.50 PAID WITH CHECK # 117431 SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. Building Inspections 763-572-3604 763-502-4977 FAX DATE_ i 0 - d SITE ADDRESS ' THIS APPLICANT IS: PLUMBING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 2-19-09 c, ; /:,I- I(QWNER YOUR E-MAIL ADDRESS OCONTRACTOR Permit NO.Z ( h`-01 S10 Received ByJ-41: Da PrT 09 2 PROPERTY NAME: k Z:5 OWNER/ ADDRESS: _ rN TENANT !�� /° LlCITYSTATE AY -41P 6 932 PHONE: L j ` 6,-7-Z. ' l L CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE, BOND AND CERTIFICATE OF INSURANCE STATE LICENSE #, STATE BOND # EXP DATE EXP DATE ADDRESS: CITY STATE ZIP PHONE FAX PERMIT TYPE GLE FAMILY O TWO FAMILY O TOWNHOUSE TYPE OF WORK: O NEW REPLACEMENT DETAILED DESCRIPTION OF WORK Ri;i�L A C E_ FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. $35.50. _ BATH SINK/LAV _FLOOR DRAINS -BATHTUB -GAS PIPING (NEED CITY LIC) CLOTHES WASHER _ KITCHEN SINK _ DISHWASHER _ LAUNDRY TRAY FIXTURES: (INDICATE TOTAL NUMBER- OF EACH BELOW). MINIMUM FEE _ SHOWER -SWIMMING POOL WATER CLOSET _WATER HEATER ($35) WATER METER THIS IS AN APPLICATION FOR A PERMIT -NOT VALID UNTIL PROCESSED _ WATER PIPING _ WATER SOFTNER ($31) _BACKFLOW PREV.$l FOR IRRIGATION OTHER I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans. SIGNATURE OF APPLICANT J PRINT NAME I ` 2f 1� 4 � lKL:K DATE City of Fridley Building Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977