P - 43690Building
Inspections
763-572-�6�4 .
763-502-4977 FAX
DATE �.�
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2011
YOUR E-MAIL ADDRESS
�
❑ OWNER ❑CONTRACTOR
Permit N
Received
Date Rec'd:
NAME: L / .
ADDRESS: �S�/ 7�� V�T J��_CITY__ �/�.�L�!_G f, STATE�ZIP�
PHONE: %�,.��- — !� �7Z — B �i.� �
NAME: c7G ��
STATE LICENSE # LEAD CERT NUMBER
ADDRESS: � C►TY STATE ZIP
P ONE FAX
SINGLE FAMILY/NEW CONSTRUCTION SIZE ' �
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIMM
TYPE OF WORK: _O NEW HOME CONSTRUCTION
DESCRIBE WORK BEING
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
S DING
❑ Virtyl
❑ Aluminum
❑ Other
❑ ADDITION
❑ REMODELING
J�I-IOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
� Trim
❑ Fascia
WINDOWS
IN EXISTING OPEI�INGS ❑Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
❑�DRAIN TILE
'�OTHER
-� �'rtS. �C!a,p.a+ S
BASEMENT RFMODELING SUBMIT•
1. Existing Floor Plan �+j
2. Proposed floor plan !�
3. List of swctural members to be used !/"
FOR NEW CONSTRUCTION MCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing swctures
and proposed project.
2. Two sets of construction pians
3. Energy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
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 U.B.0 FEE SCHEDULE)
COTAL JOB VALUATION $ �7�--- OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chazge
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 $5.00
$5.00 (State Licensed Residential Contractors)
$2230 per SAC Unit (Plans to MWCC for determination)
$+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the Ciry of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plaps.
SIGNATURE OF APPLICANT 5�,,�, �� ^ � PRINT NAME S Ir� �` �-1 ce'� �. . ,rL�[ / DATE d� ° ��� . ��
APPROVAL INSPECTOR SIGNATURE ^�—
�
' !�
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I, ..��� � r,�_� c�s ��, understand that the State of Minnesota requires
that all residential building contractors, remodelers and roofers obtain a state license
unless they qualify for a specific exemption from the licensing requirements. This license
requirement applies to owners of residential real estate who build or improve such
property for purposes of speculation or resale.
By signing this document, I attest to the fact that I am improving this house for my own
use and am not building or improving this house for the purpose of reselling it. I hereby
claim to be exempt from the state licensing requirements because I am not in the business
of building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, located at �$ �-� ��,� �" 5t �� ,�,� `� .� �
is the only residential structure I have built or improved in the past 24 months. I also
acknowledge that because I do not have a state license, I forfeit any mechanic's lien
rights to which I may otherwise have been entitled under Minn. Stat. §514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certa.in aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is a
misdemeanor under Minn. Stat. §326B.082, subd. 16 and can also result in a fine of up to
$10,000. I further state that I understand that the filing of a false statement with
The Citv of Fridlev may also result in criminal prosecution and/or civil penalties
to applicable city ordinances and/or state statutes.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to The Citv of Fridlev for compliance will
all applicable building codes and city ordinances with the work being preformed on this
property.
Signa�e of Prope Owner
' Date
For questions or information on contractor licensing, or to check the licensing status and enforcement
history of a particular contractor, call the Minnesota Department of Labor and Industry, Construction
Codes and Licensing Division, at (651) 284-5069. The web site is: http://www.dli.mn.�ov/Ccld.as�
� !. 1
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Existin Conditions
The dip in the floor is caused by the vertical
load from the roof carried by the column
between the cioset door and the double entry
to the tiving r�m. The existing fkwr
construction does not ofFer proper structuraf
support with original construction.
Additionafty, the entry i9oor jaists were
modified to 6-34" to accommodate ceramic fite.
NQT TO SCALE
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Pr000sed c�h�ur�s
Sister (3) addit�nal 2 X`s to existir� joist.
Ext�nd 15" be�rond each side of the bearing
cotumn. Suppart the additionaf structurai
members w[th a 2x4 consUucted wall wli�ch
indudes a 4'-0" doubte 2x8 header with 2
trimmers and k'� stuci on the existing 4 inch
concrete siab.
��t/ cO�vil�C%
. .�.
.�.
Bridging had bee��rtoved forthe
duct work i two s
.�—.--.
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/��;�� Joi�t
` �,,,�y'Tn•�
n�i�"
r
Stabilize Joists with 2 X's to carrect
as replac.�emeM for bri�ing.
New �A/ail and Bearing B�am
.�
�sa�. �"'sa�c ww
Fridley, MN 55432
753-572,8439
Column Bears Roof Load
Existing Conditions
Not to Sca le
Proposed Corrections
Not to Scale
Closet
Basemen#
Entry
Basement
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68417�' Sts�et NW
Fridley, MN 55432
763-572-8439
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6&417tl' Stree�t NW
Fridley, MN 55432
Vaulted Ceiling
Wal1 Beyorul
Balcony
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Assurr�cd Pra�in�t
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4-�x6-8 Fassage Dbor
Eartr► Residenoe
68417�" Street NW
fridiey, MW 55432
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