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City ®f Fridley, Minn.
BUILDING PERMIT
Date: September 23, 1965
Owner: Vernon E. Godeen Builder owner
Address 375, - 76th Avenue N.E. Address
LOCATION OF BUILDING
N4 8483
No. - 3 75 Street 76th Avenue N.E. --- ....._.... Part of Lot
Lot 2 _ Block 2 Addition or Sub -Division . Osborne Addition
Corner Lot _ X — Inside Lot — Setback — Sideyard
Sewer Elevation
Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as:
Det. Garage Front 22' Depth 24' height 10' Ft 528 c:u. Ft. 5,2$0
Front Depth _ _ Height -- Sq. Ft. Cu. Ft.
Type of Construction Wood Est.Cost $1s,000 -0D---- To 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 ;h provisions of
ordinances oY the city of Fridley. /
In consideration of the payment of a fee of $-5-0--, permit is hereby granted to 'uwrn nn G _ Gnrl p an
to construct
person to whom it or addition as described above. This permit is granted upon
the express condition that
-done in, around and u d y part thereof, � � agents, employees and workmen, in all work
Fridley, Minnesota regarding location construction, alteration, n, mmaiinnteenance, in ap�s � m `theme ooffinbuilddisugofa
within the city limits and this permit may be revoked at any time upon violation of any of the provisions oY sald
ordinances.
ALLEN G. JENSEN Big Inspector
NOTICE:
This permit does sof eewsr the eondruedw, huk&Mon for airing, phunbing, gn hoaft, sewer or water. Be sure to soo
the Budding IespKtor for aparafo pormhs for thea items.
- - I
APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S DER
ADDRESO �� % 2a,,e- 2l (E� ADDRESS
LOCATION OF BUILDING
Street _� Part of Lot
i(YT K ADDITION OR SUBDIVISION 6A-"
Corner Lot_Z_Ittside LOT___,,_Setbaci,, Side -Yard
.,SEWER ELEVATWX iib 9DATIOIt ELE�AfitOId
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
fight Ir5
Sq. Ft. � - Cu. Ft.
Front Depth _Height
Sq, Ft. Cu. Ft.
Type of Construction '�Jo�.z� I r
Estimated Cost f r '�
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 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.
(Schedule of Fee Costs can be found on the Reverse Side).
0
0
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L: A
SUBJECT
P
City of Fridley
9
AT THE TOP OF THE TWINS
BUILDING
PERMIT
r
RECEI
COMMUNITY DEVELOPMENT DIV.
PROTECTIVE INSPECTION SEC
-71-
T
NUMBER
REV
DATE
PAGE OF
APPROVED BY
CITY HALL FRIDLEY 55432
J 612-571-3450
910-F15
8/15/96
JOB ADDRESS 375 76 Avenue NE
1 LEGAL
LOT NO.
BLOCK
TRACTOR ADDITION
SEE ATTACHED
DESCR.
2
2
Osborne Manor Addition
SHEET
2 PROPERTY OWNER MAIL ADDRESS
ZIP PHONE
Vern Godeen 375 76 Avenue NE
784-5033
3 CONTRACTOR MAIL ADDRESS
ZIP PHONE LICENSE NO
Quality Contracting 11412 West River Road, Champlin MN 55316 427-7733 7035
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 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (11 Sq) & 7 Sq - Tear -off and 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
1 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
@
$1,341
$.67
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-
$45.75
Fire SC $1.34
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
PLAN CHECK FEE
FEE
Lice e 511$
5.00 /7TAL
$52.76
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IDATEI
NP
LDG IN0fP
RLY a
WED THIS IS OUR_ P§jF'1Al �
_ 4
/c J __F4
QATE
_
S,GNATUREOFOWNER IIFOWNER BUILDER) IDATEI
L: A
WILIMA
ADDN [ ] CITY OF FRIDLEY
ALTER [ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: ��5 7 6 -r�- Aj -e
Legal Description: /. b `l''
/®e 2,
Effective 3/1/96
Owner Name & Address: vee w c ® Tel. #-7'3-f
S�® �
Contractor: r c�' - %- ® —�\,Aa®`�
Q MN LICENSE # -7
Address: ((`f (2- Ono) Tel. # c ^ 7
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:
Comer Lot Inside Lot [ ] Ft. Yd Setback Side Yard Setbacks
Type of Construction: _Tfiv- 0 4' It (2,- V'0 ® Estimated Cost: $ CV 7 � e moo !�
Approx. Completion Date: r Lls q , o-6
(Cost on Back) 341 . cb
Driveway Curb Cut Width Needed: _
DATE: APPLICANT:
Ft. + 6 Ft = Ft x $.
M9
Tel. #
CITY USE ONLY
Permit Fee $ q-5-15 Fee Schedule on Reverse Side
Fire Surcharge $1,5q .001 of Permit Valuation (1/10th%)
State Surcharge $ A $.50/$1,000 Valuation
SAC Charge $ $900 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:
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential Rate
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace $ 30.00
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace) $10.00
Gas Range $ 10.00
Gas Dryer $ 10.00
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1 % of Value of Appliance or Work
Commercial/industrial
1.25% of Value of Appliance or Work
TOTAL
$ 25.00 $
Effective On August 1, 1995
JOB ADDRESS 3>S' 7G " eZW_ IV E,
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.
S-20 ,1996
OWNER_
BUILDING USED AS ��✓
ESTIMATED COST
�P'yD , 67t7
PERMIT NO.
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heating Units
Trade Name
Circle One (Steam) (Hot Water) (Warm Air)
BTU HP
$ Fuel Total Connected Load
Size No.
EDR
State Surcharge .50
.017
TOTAL FEE V c 4
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $42.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
Burner Trade Name Size No.
BTU HP E�
$Tr?:D"•.RD HEATING AND AIR CUNU1110 IN
41 o V, -.'T LAKE STREET
F.41NINEA-1 55409-2998
HEATING COMPANY 612 ^4-�e5s
Signed By GvN-�,� ! �2 Tel No. V - 2 (a ,t"(,,
Approved ByRough-In Date Final Date
1
FILL OUT BACK SIDE R STACK VERIFICATION ON
REPLACEMENT FURN E
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Being_ Done -
"D A11lCONDVT ONINGCUA•
LAKE SSREET
41o\!: MN 55408-2998
�pcpJ �^4.2056
61�•�>
HEATING CO:
signed By. ; •. ,��� . • ��`�,��/.. -
Date: A —
CHIMNEY AND STACK VERIFICATION
The
undersigned hereby verifies that the existing chimney
or stack:
1.
Has been carefully examined
Yes ()
No ( )
2.
Is free from rust or deterioration
Yes ()
No ( )
3.
Has no foreign objects lodged within
Yes ()
No ( )
4.
Is securely supported
Yes ()
No ( )
5.
Meets all current Code requirements for size
and total BTU's connected
Yes ()
No ( )
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ( )
8. Has combustion air been provided for water heater Yes () No ( )
Remarks:
List ALTERATIONS Being_ Done -
"D A11lCONDVT ONINGCUA•
LAKE SSREET
41o\!: MN 55408-2998
�pcpJ �^4.2056
61�•�>
HEATING CO:
signed By. ; •. ,��� . • ��`�,��/.. -
Date: A —
Building
BUILDING
Permit No.: t 3
Inspections
RESIDENTIAL APPLICATION Received By:. -
763-572-3604
Plan Review
SEP 1420
65% of Building Permit Fee
CITY OF FRIDLEY
Date RED
763-502-4977 FAX
Surcharge
$
EFFECTIVE 8-19-09
License Surcharge
DATE
YOUR E-MAIL ADDRESS
SAC Charge
SITE ADDRESS
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
THIS APPLICANT IS:
❑ OWNER ❑CONTRACTOR
Erosion Control
PROPERTY OWNER/
NAME: oti
Park Fee
TENANT
ADDRESS: �/ .C�
STATE ZIP
$
/A�`CITY
PHONE:
Total Due
CONTRACTOR
SUBMIT A COPY OF
//
STATE LICENSE #_ 6,6 3 6_2 EXP DA^- f�-'!�
YOUR STATE LICENSE
rfie �f4y ,
CERTIFICATE OF
ADDRESS4
ADDRESS -/,2;2&
CITY L G STATE ZIP
INSURANCE
PHONE — 'qcy FAX
PROPERTY TYPE
❑ SINGL FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH �1tOOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK:
❑ EW HOME CONSTRUCTION ❑ ADDITION
AlXrENANCEREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: Z;
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 members to be used
PROPOSED HEIGHT:
IDING
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl
❑Soffit
ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum
❑ Trim
1. Site Plan/Survey showing the existing structures
❑ Other
❑ Fascia
and proposed project.
2. Two sets of construction plans
WINDOWS
3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS
FOR WINDOWS — PROVIDE U -VALUE AND
OR FOR NEW OPENINGS -DESCRIBE SIZE OF
MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
e) -oh (USING THE 1997 U.B.0 FEE SCHEDULE)
1'
TOTAL JOB VALUATION $
Of JLP
OCCUPANCY TYPE
Permit Fee
$
See Back Page for Fee Schedule
Plan Review
$
65% of Building Permit Fee
Fire Surcharge
$
.001 times the total job valuation
Surcharge
$
.0005 x Permit Valuation Minimum $.50
License Surcharge
$ SCt
$5.00 (State Licensed Residential Contractors)
SAC Charge
$
$2000 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow
$
ft + 6 ft = ft x $22 = $
Erosion Control
$
$450 Conservation Plan Review
Park Fee
$
Fee Determined by Engineering
Sewer Main Charge
$
Agreement necessary ( ) Non Necessary ( )
Total Due
$ a
Make checks Davable to: Citv of Fridlev Attach Stiaulations
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 and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicat' 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 cas alwork which requires review and approval of s. �J %41
SIGNATURE OF APPLIC PRINT NAME /tCCCa"�- L��% `L DATE ! — [ / r�f�