AF - 35742SUBJECT
City of Fridley 2 6 2 8 6�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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� `y _����_ COMMUNITV OEVELOPMENT OIV. � �
r � � PROTECTIVE INSPECTION SEC.
� ' �"'1 � CITY HALL FRIOLE� 55�32 NUMBER REV OATE PAGE Of APPROVED BY
�""�' �'' 612-571-3450 9t0-Ft5 6/18/98 / /
�oe nooaess 6445 Able Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHEO
DESCFl. Pt 26 2 Moore Lake Hi Y113ridS SHEET
2 PROPERTY OWNER MAIL ADDRESS tIP PHONE
R�nee Burman 6445 Able Stree.t NE 571-9529
3 CONTRACTOH MAIL ADORESS ZIP PHONE UCENSE NO.
Tim � Exteriors LTD 40677 Hemin wa Ave North Branch MN 55056 574-5932
4 ARCHITECT OR DESIGNER MAIL AODFESS ZIP PNONE UCENSE NO.
20046999
5 ENGINEER MAII ADDRESS ZIP PHONE IICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION p REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
Reside House �
9 CHANGE OF USE FROM TO
STIPULATIONS
Install building wrap and call for inspection of same.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIREO FOR EIECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONOITIONING.
TFIIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED Ofi ABANDONED FOF A PERIOD OF 120 OAYS AT
ANY TIME AFTEFi WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TMAT 1 HAVE READ AND EXAMINED THIS APPUCATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE Of WOfiK WILL BE COMPLIED @
WITH WNETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT W2s7OO �1.35
DOES NOT PRE E TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CMARGE
PROVISIONS OF NY R STATE OR LOCAL LAW REGULATING CON-
STRUCTION OFi HE EfiFO MANCE OF CONSTRUCTION. �7�F.75 Fire S�.' �2.7�
PLAN CHECK FEE TOT FEE
� L1Ce N/A 70.0�
5 NATU OFCONiRACT RORAUTMORIZEOAGEN� IDATE� EN ROP VALI��THIS IS VS%UA PERMIT
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S�GNATUAEOFOWNE uFOWNERBURDERi IDATEI � �NSP �iFTE
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: (p '7��5 ,��L�' S�
Effective 1/1/98
Legal Description:
Owner Name & Address: v-iC� rt-�V Tel. #�? /-�5 a�
Contractor: ,,.., �y �� �k��m,egr�L7'� MN LICENSE # ZcL'�'�/G `�9�
Address: �ct� � 7 ��r,u c �•,�wn-/ C.�P.� . Tel. # ��7�/ : ��3Z
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to Ehis application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
� � �/ ---� / ii% ' / ��- �, "_ .
Sq. Ft.
Sq. Ft.
Sq. Ft.
_ ��
Construction Type:�-���� Estimated Cost: $ c�'7G��
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ��18 °g � APPLICANT: Tel. # � ? y ��% 3 �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� `� , �
$ ��
$ �
$
$
$
$
$
$
����
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 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 [ )
,� , . � �� ,.
.
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL_VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to `$50,000
$50,001 to $100,000
$100,001 to $500,000
$5(10,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
,
$349.75 for first $25,000 plus $9.00 for each additional $1,OOQ
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $1QO,OOU
$887.25 for �rst $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the iirst $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Co�crete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width, plus 6 feet times $13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site. -
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
- _.,�