AF - 34939��
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City of Fridley, Minn.
BUTLDING PERNIIT N° 3 fi 9 0
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o� .�,l.�. /.�...��'� ............... swuaer .�..J.�/►��,Q....���"..r�-�.......
Addr� ...................................... Addr�s ....�................. ... ... ..........
LGCATt�N OF BUILD[NC
No. ���7.. Sfr�et .. . ..Y.�.f�O............ Part P Lot ..... .. .....
.. . .. .. . . .
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Lot . . . .�. . . . . . Btoek . . . . . . ��. . . . . . . . . . . Addit[an or Sub-Di�vision . . . . . . . . . . . . . . . . . . . . . .
Cor�ner I.ot ............ Inside Lot �........ Setback ............ Sideyard ...........................
DESCRIPTION Of' BUILDING
To be Used as:
.....:.............. F'ra�t ..... Depth ........ 8eight ........ Sq. Irt. ........ G�. Fk ........
.................... P'r0nt ........ Depth ........ i%ight ........ Sq. Ft. ........ Ct�. I�'k ........
�►pe of Gonstruction ................... H�t Co�t..................... To be Completed ..............:....
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In consideration of ihe i�ance to. me oP a permit to coasfruct the building desMbed above, I agree to do
t� pr�sed work in accardanc� w3th the descriptton above aet forth and in c�nnpiiance wit9� all prov3sions oP
oTdinances of the dLy of Fridley.
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In consideratton of the payment of a fee of $, .�.. .. . .., permit 4s her+eby granted to . .. .. .. ... . .. .. .. . .
. . . . . . . . . . . . . . . . . . . . . . . . . to construct the builcling or addil3on as descrlbed above. Tl�is permft is grantecl upon
the �press condif3on that the person �o wh� it is S�ted and his a�ents� emPloq� and worl�en� in all work
done in, around and upon said buffding� cr auy Part 'there�f. shall csoz►form in all respects to the ordinanoes of
Frfdley, Minnesoia xegarding location, con�trueiton� alberai3on, maintenance� rePair and moving of buildings with
in the dty limits and this permit may be revolted at a�y �me upon violation of aay of thE provlsions of sa�d
or8inanc�. �-
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���Y �� '� I 1� ? 11� �
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N�TICE:
Thia pern�it doea not cove� ihe construatton, leatallatton or alteration fo� wlr��plumbing, gaa heating,
�we� o� wate� B� su�e to �e the Bulldlrtg Irtspeoto� fo� saparate perrr►i!s tor these Itema.
� �
1PPLIC&TION FOR BUIL�IlVG:P�T
, CITY OF FRIDLEY, M�1NF�OT�
Owners �Tame � Suilder' _ � � .�
.. � '� :� �� . ��� �
Lddresa , .._.._.._. �Cldreaa =. .
�� 3 � �. � � LOCATIOAT OF BiT3LDING = � . ` ..
No. ___._,� Street ��'__..�....= �rt .oP Lot �.., '
I�ot � 87.ock � Lddi��.on or Snb., Div. � .
Coraer Lot ' . �*+aide Lot � ' � 3et Hack' � � _
Applic�}t attach to- thi� �orm Cert�.ficata of Survey of Lot artd pr.oposed
build#�g• �.ocatiot�. _ � ' . . �
..., ...,_. : . . . • . ' DFSCRIPTIOAT OF BUILDIlJG � .' ' . '
To ueed ��-� " " ��
, „�,- _
�_. Front .,�_ Depth_,,,_._.r�Height � • ' ,
• �• . . . Cu.� �`t: . .. ' . . ' . . • ... � .
- ----- --- - - - ' �p.th -�pp,�_ �- `_ _
_ �ront __-__._.... ---.-- _ _
Sq. Ft.. �u. Ft. _.._.�.� . �. ...
of.�Construct3oa � . ' ' � . Esti�'ted Cost- �� .
� .
To be ComPleted; � �� � � �.-
�
The undersigaed hereby makea applicstion for.a �ermit for the work
herein �spec�3fied,� -agreein� tc do' all raork i.n . s�ict accordaace .w3th the �
C3.ty Ordi�naes a�d :ru�-ing� p� the Department of � Bu�ldin�s.� and hereby ,
declares that all tiie facts and representa.tions stated ia this' ap�ilicatioi� '�
are fi,�us and ct. • .
• s���i"' .. �-� '-'/ / S ture. . '
D�.te �
(A..Schedu3.e .of Fee..Co�t� cea be' fouad on the Reve�s� S�d�}� .. . ,
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BIITLDING �� 1� SCi�UI,E �
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Section 2. The Inspect,or of Bui:l.dings�: aha13:, �before issv3ng aag: per�ni.t
for the ere��-ion• of �r builditag or s�t,�r-���ure � or for any add�:��;;�n • to
ar�r existing building or s�tructu�re, ���or� � i'�:�r . aug, �1-��.r�tions a�� re,�.ix•s;,::to .
an�r existing bu�ldin� or �tructure� upon e:p}�13ca.iion ther�for� r:�q,uire .
the ��merrt �y �he appl3:ce:nt far � �ac�i:��aermi� of . feea ' to t�s �.m4'ui�� � " :. _ - .
hereiaa belo�i..•set � for�h and in � the manr� here�a,:,���i�sc�.:'t�-t�t.�, ;-y� -
_ �3 . fi., r� .
. t:. '
�.'�.. . . . _, .. _` . .
2.�. For any auch perr,�i.t for the erect,�on of any fireproof buil.d-�ng,
other than a garage, warehouae,`facto�''or grain elevatort or €or the ,.
erection of ang fireproof addition, 'fo�r similar occupancy, t.o a.tY�
existin� buil�lin� si�a�:l be at � the rate"; of °�',I.l.�O �f'or . each ,.one. thoti�sand .
cubic f eet, or fra ction thereof, in s�ich :cia.bical cbntent�,
2.2 For a.ny,' ssuch permit for the erec��on of any fireproof garage!, ware-
houae� �acto'ry or grain eleva.�or, or fo" r the erect3on of arry_.fi�r�proo� .
addition for similar occupancy, to ang existing building aha7,7. �'e a� t�e:
rate of �1.25 for each one tho�xsand cu'�3�c feet, classified as "fi;reproof"
by Section 502 of the Minneapolis' Bui]:d3ng Cocle.
HOIISES _` -` � .... � � '"
2.3 For"any such permit for the erect�on of any non: fire�aof •bui:Lc�in� s�
other thari"a g�rage, iaarehouse, �acto : or grain el:evator, c�ir an�r ,: ,_._
non-fireproof addition, for similar oc�upancy, to any..e�.st�xig bu3.lding.
Permit $1a00 for each one thousand cub�.c•fee�. p �-. __=
.
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r. -¢ - - - - � � --=� -�- - - - - - � - - - - __. �..�,"_
; ��
- = —+� -.-� _� �;;�--�,__--� _ . -,- ���:-<--------
2.1� Fbr any 'such permit for the 'erection of any non-fireproof gara.�e� '•
werehouae�..factory or grain elenator, or for the�ereation.oi-a.ny non-
f3reproof addition; for aimi.�.ar occupa.ncy, to any.existing building or �-
for each �such ` build3ng or addition. Ni.netg Cer�ts for each one
thousand cubic feet or f"ractiori thereof� in the cubical contents thereof
with a m3nimum of �4.00e
For the purpose of computing �aes for building perm3.ts the cubicaZ
contents ' of a�n�► building or a�ddition to a uniParm height throughczut by -�
multipl�ing �the. ground Fzrea cove"red from a point siu (6) in�hes below
the floo� '1�e, of � the �basenent ��r cellar to th� average height af� the
upper sur�'ace or `�o'the'sverage height of the roof surface of the �in
gable,oP a pitched roofp
2.5 �Eor rep(airs or alteratioria to an existing s#xucture, the fee shall
be.at the ra�te of $3.00 for-each Five Hundred �ollars (�500.00), or � .
fract3on thereof�3.n the eost of all proposed work.
2.6 In no case ahal"7. the fee chrjrged for an�r permit as set forth in
Section 2 be less than `$�,.00 e -�
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Caty of Fridlep, Minn..
6431 iTni�versity Ave. N. E., Mmneapolis, Minn: 55432
BUILDIl�'G PERMIT
��; _ November 5,, ],�71
O�s �Iie*�.+-t C. ErLr Suilder Same
�_ 534��j] tura Road ]� _ E_ �g� S�
� � /
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LOCATIOtd OF BUILDING
N� 53�+7 S�t Altura Road N.E. P� �p �ti
iAfi S B%ck 7 �dc7ition or Sub-Divlsion �
Cao� Lot Insicie Lot Setback Sideyard
�wer E�evatia�t Foundal3art IIevation
DESCRIRTION OF BUILDING
To be Us�i as:
, rara�a Froat. �_. DePth � Height ._.7.Q� ._ -.5q. Fk -?�A � Cq. Ft. ..�$.Q$!
Front Depth Height S�l. Ft Cu. Ft.
Tylae of Camatructton �rame �, � 52.000.00 To be Completed .7une_ 1�.�72
.�.
CS3.416.40)
Stipulations: Set Slab 12" above exiating slab in rear yard. Provide a hard �t����/
aurface drive. Existi�fig garage to be rem�ved by February 1, 1972.
I, the underaigned, aha11 hold the City blameleas because of any water damage due to
the fact the garaga is below 'street grade.
In consideraiion-oP the fssuance to me of a permii to const
�1@ �OpOHC� WOPit 3II SC(,OTI�SIIC@ W��1 �lB �jY�OII BbOV@ S@�
�&IIC� O� $Il@ C�i:j► Of �C3►. _
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In c�&iderati� of the paYment of a� #ee ot $�.�A�--- ,�t is hereby granted to Mr. Eddy
to canstruct the building or addition as described above. Thispe rmit is granted upott
tl�e �zspre� oondition that thep�sson to whom 3t 9s granted and I�is ageni�, employees and worlrnnen, in all work
8one 9n, around and upon said building, or anY Part thereo� shall conform in all respects •to the orc3in�nc� oF
1'ridleY, Minnesota regardiag location, construction, alteration, maintenance, repair and moving of bt�il
y�t� dty ]9mits and this permit may be revoked at any time upon violal3on of any of the Pmvi�ons of
t
CLAItENCE BELISLE '
NOTIC�
'ihis para�tt does . not cover t6e sonairueHoe, tastapallon for wirine, pluaibine, gas 6eaNeg, sewer or waier. Be wre to ws
16m Bnild6�g lespeeto� fo� separate parmits for tkoae items.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAi�;_ �rbert C.�,d,�y BUILDER: Se7-f
�,nn�E�s : 53�7 Altura Rr1. �. E. Annx�ss :
No :. 53�? � sTREET :�1ta�ra 1id. � E.
Lt�: 5 BLOCK: 7 ADDITION:Carlson•s �i.t Manor
CORNER LOT: INSIDE LOT: � SETBACK: SIDEYARD:
�-
Applicaat attach to this form Z�wo Certificates of Survey of Lot and proposed
building location drawa oa these Certificates. �
.� � � �r � � . ,, �? ,�; � r+�/� ,�, F,/; �� ��j � �' �. � �- ! ��
_� , �� � '� � �z ��� / � � � � �- �
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� HESCRIPTION OF BUILDING � � � -f' °°� � ' �� �' �''� ;� � �
. \ �,�, � _ �� 1 �-,� ,
To Be Used As:.
Garage Fx�t; 30 ft. Depth; 26 ft. Height:
�
Square Feet: ?'80 Cubic Feet: appox. ���-� p
� Froat: Depth: Height:
Square Feet; Cubic Feet: ,�
�"
Tqpe of Construct : f�e Estimated Cost: $$2000.40
�-�e � J _�.!
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To Be Completed: / �/�Cu� * � �
, �7��Z �� �� C/
The undersigaed hereby niakes applicativn for a permit for the work hereia
specified, agzeeing to do a11 work in stt'ict accordance with the Citq of
Fridlsy Ordinaaces aad rulings of the Department of Buildings, and hereby
declares that all the facts and representationa stated ia this application
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are true aad correct. � �r��.�,�
DATE:� / SIGNATIJRE '`i
(See Severee Side For Additional Iafoxmation. ) � �� !� �+ � � '' �� ,� �'; �
�,P y yyl � / �P A '� � � c� � °'-9 � � `�' r� �, f'".;a : �' �L°
p -�Ce �1 � > � 'x.� .�� .� ��. � ,.
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, vr for any addition to any exiatiag
buildiag or structure, or for any alteraticm or repairs to auy 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 prwided to-wit:
UNI�'ORM BUILDING CODE: �pe 1, 2� 4-$2.15 for each one thousaad cubic
feet, ox fraction thereof, in such cubical �ante�ts. Type 3& 5-$1.85 for
— each � -thousas�d -cub i�_ �e�t .
ADDITIONAL INFORMATION
For the purpose of computing fees for building permita, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average.•
height of the roof eurface of the main gable of a pitched roof.
For repairs or alteratioas to an existin� structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of_all proposed workt .
In no case aha1T the fee charged for any permit as aet forth ia Section 2 be
lesa than $5.00.
V�RIFICATION OF FOUNDATION,_
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-- — -__ - -� -- —
- � - _��� _�,_ _ — � _ —
--. z - .. j--�— .�_._ __ _ _ _ - __- -- -_ - -
NOTE: Pernits for conatruction will be issued a minimum of 24 hours from the
time of application, to a11ow for proper review of the proposed structure aad
of the construction eite.
A Certified Survey of the lot,.ehowiag the location of the foundation, once it
haa beea crnnstructed, will be required before �ro�_� wi� �8 ����
CERTIFICATE..OF OCCUP.ANCY
Application for a Certiticate of Occupaacy shall be made ten (10) days pxior
to the use or occupancy qf aa y etructure for w h ic h a building permit has beea
iasued; aad said atructure shall not be used or occup3ed until a Certificate
of Ocaupan�y hae been issued. •
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, SUBJECT A-ERMiT�70,'
City of Fridley 2 6 4 7
AT TNE TOP Oi THE TWINS g U I L D I N G P E R M I T f
�
; � RECEIPT NO.
� ; y ������� COMMUNITY DEVELOPMENT OIV. ����
r � � PROTECTIVE INSPECTION SEC.
1 � �
� ` �"'1 � CITY MALL FRIOLE� SS432 NUMBER REV DATE PAGE Oi APPROVED BY
�'."_.� � �•� 612-571-3460 910-F15 �
7/7/98 / /
� JOB ADORESS 5347 Altura Road NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMED
DESCR. ',S 7 Carlson's Stmnmit Manor North Additon SMEET
2 PROPERTY OWNER MAIL ADORES$ 21P PHONE
Robert Commers 5347 Altura Road NE 572-2102
3 CONTRACTOR MAIL AODRES8 ZIP PHONE LICENSE NO.
4 ARCNITECT OR DESI(iNER AAAIL ADOiiE88 21P PHONE LICENSE NO.
5 EN(iINEER MAILADDRES8 ZIP PMONE LICENSENO.
8 USE OF BWLDINO
Residential
7 CLASS OF WORK
O NEW ❑ ADD4TION O ALTERATION l� REPAIR � MOVE O REMOVE
8 DESCRIBE WOFiK
Reroof Garage (10 Sq) Tear-off
9 CHAN(iE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIREO FOFi ELECTRICAL, PLUMBINCi, HEATINti, TMPE OF CONST. ' OCCUPANCY (iROUP OCCUPANCY LOAD
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NIN(i SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AfTEli WORK IS COMMENCED. NO. OWL(i. UNITS OFfSTREET PARKING
I HEREBY CERTIfY TNAT 1 HAVE READ AND EXAMINE� THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIEO FIEREIN OR NOT. TNE GRANTING OF A PEiiM1T $834 �.SO
OOES NOT PFESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATIN(i CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �32.00 Fire SC �.83
PLAN CHECK FEE TOTAL FE
$ .33
ATURE Oi CONTRACTOR Op AUTMOR12ED AGENT tOATE� N OPE IDATED �S IS YO � P� IT��
C����'�`�v\ �
SiGNATURE OF OWNER Ui OWNER BUILOER� �DATEi p qaiE
TTEW
ADDN
ALTER
[l
[]
Ll
CITY OF FRIDLEY
SINGLE FAMII.Y �AND DUPLEXES R-1 AND R 2
BUILDING PERMIT APPLICATION
co���o�a�s: S'3 � �
Legal Description:
G
Effective 1/1/98
��� �
a'�0 Q �
�
0
Owner Name & Address: ���j-CG � ('dl� �-e��' Tel. # S ?�iZ '�-Z/�
Contractor: /� Gc//!i°� MN LICENSE �#
Address: . Tel. #
� Attach to this application, a Certificate of Survey of the
lot, with the proposed construcdon drawn on it to scale.
zr9.v.,�
� DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: I,sngth Width Height Sq. Ft.
DECS AREA: Leagth Width � Hgt/Ground Sq. Ft.
ar�R: �� ,�ad�� � �-�� Q-� !U s�'�
�'--e a�a� d��
Consrivcdon Type: Estimated Cost: $ �� ''°' � .
. . (Fee Schedule, on Back)
Driveway Curb Cut Width Ne,eded: Ft. + 6 Ft = Ft x$ _$
DATE: S� APPLICANT: �� ������ Tel. � ��'� �4Z�a�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �o�_O�
$ �
$ ��
$
$
$
$
$
$
$ ,��.3 3
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 [ ]
�� �- M
BUII.DING PERMIT FEE SCHEDULE
The Cluef Building Official shall, before issuing permits for the erection of dny building or struct�re, 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 �rnut of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,0�
$2,001 to $25,000
$25,001 to $50,�0
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,�,000
$1,0OO,OQ1 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$Zl for fust $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,0�
$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.� for each additional $1,0�
or fraction thereof, to and including $50,�
$574.75 forrfirst $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,�0
$2887.25 for the first $5�,� plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012:25 for the first $1,000,�0 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only) �
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Altemate "B": RemQVal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for const�uction will be issued a minimum of 24 hours from the time of application to allow for pmper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the l�ation of the foundation once it has it has been const�ucted
will t� required before proceeding with the framing.
-_ _ .�.�
Building
�ilSpeCtlOriS
763-572-3604
763-502-4977 FAX
DATE � ^ 7/7 " �O
STfE ADDRESS �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR •��-
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY
PERNIIT TYPE
�rE oF woRx:
DESCRIBE WORK BEING
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
ADDRESS
❑ OWNER . �ONTRACTOR
Pernut Na � �,C'� � f� `� �
Received By:
Date Rec'd: �l� '
NAME:_ T1n� � w G � T� /�fv 7�'1 {s` ulfl R-� -C
STATE LICENSE # ZOO 4/ S� ?�/ '�—
ADDRESS:_ _( � / ( � " Z�ea 1 4✓! `'
PHOATE P% fo 3 7�(� 0�C(, d
EXP DATE � �? l C �
��
��
�SWGLE FAMII.Y/NEW CONSTRUCfION SIZE
❑ TWO FANIILY/NEW CONSTRUCTION STORIES
❑ ADDTITON O GARAGFJSHED ❑ WIATDOWS
❑ BASEMENT FWISH �F ❑ DRAIN TILE
❑ DECK ❑ SIDING 0 OTHER
❑ SW[NINIING P�L
❑ NEW HOME CONSTRUCTION ❑ ADDTfION
�MAII�TENANCE/REPAI$ '� REMODELING
xi00F1NG
NUMBER OF SQUARES �
GARAGES
PROPOSID SIZE:
PROPOSED HEIGHT:
SIDING .
O Vinyl
❑ Aluminutn
� Other
�a 4�>
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACi�D GARAGE
OSofftt
❑ Trim
� Fascia
wnvnows
IN EXISTIlVG OPENINGS OY� ONo LOCATION OF WINDOWS
OR FOR NEW OPENIIJGS-DESCRIBE SIZE OF
OPENING CHANGES &
�� .M
BASEMENT REMODELING SUBMIT•
1. Existing Floor Plan
2. Proposed fl�r plan
3. List of strucwral members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
,ADDITIONS. & PORCHES SUBAATf:
1. Site Plan/Survey showing the existing strucUues
and proposed projed.
2. Two sets of construdian plans
3. Energy Calculations
FOR WINDOWS — PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WMDOW.
TYPE OF WINDOW TO BE 1NSTALLED NUMBER OF WINDOWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ bCCUpANCY �rvpF
Petxnit Fee
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
park Fee
Sewer Main Charge
Total Dae
$
$ e
$ � . 1�
$
$
$
$
$ _ . _ s
See Back Page for Fee Schedule
65% of Building Permit Fee
.U01 times the total job va}uation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6tt= ftx$24=$
$450 Conservation Plan Review
Fee Deter�►ined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERA�IIT NOT VALm UNTIL PROCESSED
I hereby apply for a building permit a�d 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 pemut on site; that the work will be in accordance with the
approved plan in the case of a11 work which requires review and approval of plans.
SIGNATURE OF APPLICANT �v�� _ PRINT N ����� L v1V �'�Vl p'�� �'7�� /O
Page 2- Building Residential Application
BUII..DING PERNIIT 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 altera.tion or repa.ir
to any existing building or structure, upon applica.tion 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:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applica.tion to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing founda.tion will be.
required before proceeding with the framing. New Houses Onlv
i
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
y�
From: +763 428 6779 Page: 111 Date: 3/25/2010 8:38:57 AM
xwrt-co-w iu ur:ocniw 1'RU141�PC11 uiaruan� artv rio�-aco-oiid i-c4u r.uuiiuui r-aco
Building LCi�ll�1 LITYIIT Permit No. ��
Ynspecfiions M�p�'ICATX�N APpLICATYl7N R�cei�ed ay:
��s-s7z-36a4 R �
cY� c��� ���� ��.
763-502�4977 fax e�,��:i,vE,-,-oa
APPLICATlpN DATE:
ar�
'PHIS AP'PLICANT 1S: '�AUL�R O PROPERTY Ovl1d ER
PROPER'C'Y OWNERt
JOB ADDRESS: �7 '�" ���u J�`� ��
MATF.RIAL TQ BE HAULID:
MAT'ERIAL �EING HAULED SY:
DRTES TO BE MAULED (UP TO 3 DAYS):
YOUR E-MAIL ADDRES ' `�+ ���'°'���'� �
�
THIS PERM�f IS i$SUED TO ALLOW AN 1NCI�tE,ASE OF A7�C�,E wEIGHT FR�M FOUR (4} TONS PER
AXEL Td �NE (S) TONS PER AXEL OVER THE FO�LORTING DE9IGNATED ROUTE:
l � � Rc� ��:.�:� s s�..������
NOTICE: T'l�is permit is valid only for vehicles enroute to consvucdon addresg during the hours of $:00 am w
S:OQ pm. See ResolutIan #Q1-20Q4 and Stats Sratute Sec�ion 169.87
PE�IVIYT MUST BE IN VEI3ICi�E'�'NI�.�.E H'AULINC ON ESTABLISI�'ED ROUT�.
F��T FFE: SZSAO
�rruS �S nN nPPLICnTiON FflA �. ��rr-NOT VnLID UNTtL PROCES.SEn
I hereby appiy for a load limit ntodlfioatlon p�mit and I acEnawlodge ihat the information ebove ls complete and aceurate; that the
work will be m aanforraance wtth the ordinanccs eud tx�der of the City of Fridloy. I understand this is not a permit bot rnily an
application fior a perns fi a hsuling on res�icte� roads 9s t�ot W srtart wili�out a permit.
SIGNA'r'CJRE OF
APPROVED BY
NAME•S%�'�� � I�A'L_�.. DA'
��i�
COPIES G1VLN T0: /� POLICE ❑ EP7uINEERING
Cif�y �f Fridley
Bufldfng Yns��cHons Department
�r431 Universiry Ati�enue NE, Fridley, MN 554�2
763-572�3604
FA7£; 763-502-497? '
From: 8888627403 Page: 2/4 Date: 3/25/2010 8:58:17 AM
Bu�ld�ing MECHA�ITICAL
�ng
In,spectioas R�g���IAL ApPLICATION
�63-s�2-3� �ITY ()F FRIDLEY
763-542-497'7 FAX ��..�.�... . , ,,,,.�
DATB�7 �
Sl'!'F, ADDRESS s�
TldIS APPLICAMTIS:
PROPERTY
OWNERJ
1TNANT
CANTRACI'OR
SUBMIT A COPY OF
YOUR STAT�
LI�SE 1V]TH
APPLiCA7TON
&MAiL ADDRESS
OOWhER �LCONTRACfOR
�
�ot��:�p3 � �SZ7o7 — l 3e�.'�
con�axx xnt,+�:�,
CONTACTPERSON:
STATC LIC�NSE ki ;
PHONE
PERiVIIT TSf�E SINGLE FAMII.Y CI 'I'V1'Q FAM[LY
TYPE UF W4RK: o NEw ,�Kr:.�i,nCN�nharr
}�,TA[LED D�SCRCt�'7'fON OF WORIE .J."r',l�y�. �
� nar� �l 3'c� —
C �` CITY�
FAX ��O�g�Lf'� - �
G TOWNHOUSE
a ai: r�rta•rwwR�ansi.
P�it N
Received
Date
FEESARE BhSED 41V 510.00 PBR FIXT[)RC. �[CEPT VI�F.AE 1YOTED. FIXTURLS: (IlVAiCATE TOTAL TVUMBER OF EAGH BEWV1�
i'ROYIDE iiEAT f,098 CALC'Si PER MANUAL J 2ab6 A3FIRAE IiAND1300R �
�qmpmant tavtaltod MFG: MQDF1.: 317..F.113'R:
,;�A
MODII.:
SIZPJB7'C:
MFG: MODEL: SIZFJ.�!'[:
AiiC SZ5.00 FIREPLACE (GASj $15.00 OAS RANCiFF/OVBN $10.�
�A1R TQ Ailt E7CCHANGEEIt SlS FIREALACE (WOOD) $35.00 iVSW GAS Gl2ILL b1Q.Q0
BOILER $35.00 FURNACE S35A0 GAS CI.VYT N'IR $10.00
CHFl1+INEY L1NER $10.00 GAS DRYER $10.� POQL HFAIER 335.�0
IWCC WORK $10.0U GAS PlP1NQ $]Q.�O �'NTILATbR S15.OQ
N„�n� o��es C� �i :'°�`�° X s�a oo =$ `�°' .°
Numberoffixbur�s (a3 $IS.00 x�$15.00 = S '
Nu.mb�oifxhues {a3 �25.00 x $25.00 = $
Number of fix#ures @$35.00 x$35.80 a$
sr� s�e=� sa �, \
r�n+ttm.un� �E �sso� ro� S � � �CJ
THIS 18 AN APPLi(;ATIDIIV FOR A PBRNllT-NOT VAL� liM1'T1L PR�ES3ED ` ,
I he�eby a�ply for a building permlt and I acknowledge that the information above is completa and accurate; that the wark wiq !� in
oanfomffince with the ocdsnances and cx�des of the City of Fridley and with the M�rnesota Canstructian Codes; t6at I unde�stand this is
not a pc�rnit but onty an ap�tlicabian for a permit and work is not to start without a permi� that the work wiil be in accondeace with the
ap�oved plan in the c�se of a�work witie�requi�li�evieuN and ap�aval af plans. ,
StGNATURE OF
APPROYAL
� c;�y of�,�a��y
�u�itd�ing Inspections Departmeat
6431 University Avenue NE, Fridley, N�T 55432
7d3-572-3604 P,AX: 763-502-4977
�
1I