AF - 34944n
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City of Fridley, Minn.
BUILDING PERIVIIT
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N° 1032i �
p�; Rusae7,l Daley g�d� Miles Co.x�struct�n
� 5358�1�a A� 4500 L� le gv�nue North
LOCATION OF BUILDIWG
No. -�,3�8 Sfiseet �ltu�a Part oP Lot
Lot �8 B�ock 6 Addition or Sub-Divlsio� Ca�lac�n' A$'ILTM�T��'t...M9.Tlnr Nnr#h ,�ddu.
co� rmt rnatae Lot � s�t�a�x 3�' siaey�a
sewer nevation Fo,maation IIevai3on
DESCRIPTION OF BUILDING
To be vsed sa:
G�e Front ��pth ?� xeight 10i gg. F't. � c:u. FL 33�
Ftnnt Depth fTei�ht Sq. Ft. Cu. FL
� og ��� Frame � � _ $ � , 2g3 . 00 To � �p� Se'�t . 1,� 1969
Blacktopped Driveway
In c�sider8tlon of the issuaace to me of a permit to consh�uct the bwtld
oidinancea�oY the d� of�F'ridl�ey. with the de�ntpt�on above set fo�,rth � ia
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In cronsdderatta� of the �yment of a fee oP �Q. �, permit fa herebY granted to Miles C�nstruction
to ca�atruct the building or addition as d�crlbed above. This �ermit is granted upon
t�he exPre� conditian that theperson to whom it is granted and his agents, emPloye� and wor�ten, ia ell Work
doae fn� araand end upon said building, or a�►�,r� thereo� shaIl coffiorm in all r�pects to the ordinant�s of
Fridley, Minn�sota loc�tion, camstruction, alteral3on, matatensnc� rePair aad m�n� of bt�ldi�t�s
wi� dty ]imits�a� permit may be revoked at a�► time upon violatton of a�► a� the 8��� of Said
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aonc�
tW ps�mh does ��rer �6s w�, � tor r►Wes. p�. e+� �. sa�ra� or wtla. e. am. to ss.
da Buqdtng Intp�tor hr se�rd� �/or Nro�s H�.
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@:FPLICATION FOR BUILDING_PERMIT
. CIZ'Y' OF FBIDLE7 y �OTA
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OWNEFt'S. N9ME � s s P�/ ,�.��� .BIIII,DER ,t,ri��.��` d� ° f�/�`�v.%
�DDR.E�S � d'�l �?� i�o�� �DDRESS L!r'oo :v ;,��,e��..`'�-�i
LOCITION OF BIIILDING
NO . STRTET . �s'-s �� �� �E� . �- _ .
LOT � �,r $I,OCg /�' AU�ITION OR SIIBDN2SION L�i�.�s� Soa�r�,�.�•�.o-r y GOd �
CORNER LOT zNSLUE LOT ,X SE°I'B9.CK 3 c� SIDEYARD��,
SEWF� ELEYITION TOP OF I'UOTING �
Applic�.ut att�.oh to this form Two Certificates of 5usvey of Lot sazd
proposed b�u�.�.dit'� . looatian draw.n. on these CertifiQates .
]�F�C�tIPTTON OF BIIILDI�TG
�o Be ITs�ed. _�a: _ �'ti �� Y-e . �., , , .e_
� _ Front � `/ Depth � y Hei�ht � , ��
, Squax� feet 33 �_,Cubic Feet � 3 r-�
Front Depth Hei�ht �
Square feet Cubic Feet
Type of Construotion �,..�� ,r Estime.ted Cost i a,�,3 �,
To Be Comp],eted a% s S�a�.•i o e� � Gl L� -
The underaigned hereby makes application.for a permit for the work
h8reir� �specsified, a�reein� te do all work in atrict acc4rd,ance w3.th �he
City of Fridley Ordina.nces and rulin�'s of the Department of Buildin�s,
and hereby decls,rea that all the facts and representationa etated iln
thie application axe true and correcto
D.A.TE SiGNATDRE �
.(Schedule of Fee Costs can be fouYid on the Reverse Sideo)
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BIIILDING PERMIT�FEE SCHEDULE
SECTIOIV 2, The In�pector of Buildin�s sha,ll, b�fore i�suin..� pex�nit�
for the erect�on of any building or �tructurey ox €or any addition to aaiy
�xiati.n� structure or buildin�, or .for any e,lteration or xsp�e.ixs �o a,�;y
egietin� buildiu� or etructure, upon �,pp13c�;tion therefo�e, requi�e the
payment by ._the applicant ior sucsh permit of fees to the amount hex�%a.
below aet forth and in the ma.nner herein provided to-wits
IIniform Bu�,l� diz� Code o Type 1, 2,& 4-$1 0 75 �'or each oxle thous�cl.
cubic feet, or fraction thereof, ita such cubical c.rzn.tenta: T� 3 8a 5-
$�1 e 50 for each or�e thousand cubic �,feet o
For the purpose of computi�.feea for building permits, the cubica,l
� con�tents of a�y `b�i].ding'3�`�additi4iii to a uniiorm hei��"�h�bughout "by '�
multiplyiug the ground area couere�`�from a point six (6) inGhes belaw - �
the floor line of the basemen.t or the c�ellar to the a�erage h�i(�ht of
the upper aurface or to the avera�e hei�ht of the roof sur�.ace of the
main. gable of a pitched roof.
For repairs or alterationa to an existin.� struC�ure, the fee sha11 be
at the rate of $3.00 per each five hut�dred dollars (�500.00) or
fraction thexeof in the cost of all.p�oposed work.
In no caee shall the fee charged for any permit as aet forth ixi SeCtion
2 be 1e8s tnan �5.000 "
NSSSD Corinection Cha.r�es based on locatian - Area 1 or 2.
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City of Fridley, 1Vlinn.
BUILDING PERMIT
nate: _A ro il ls 1971
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N 0968
LOCATION OF BUILDING
No. . 5� sts�et ���--Rata.d_N_ F. Part or I.ot
� 28 $IOCiS �S'T AdBftion or Sub-Division �'i.'8r1 aon ��S`v�mmi i- Manr�r Nnri-'h Ad�.
co�r Lot � �t x ��k siae�a
Seover Elevatian Foundation IIevation
DESCRIPTION OF BUILDING
To be vsed as:
Fi *'p� A-e Front �pth Height Scl. F't. Cu. F't
�'rant �pth I�eight Sq. Fk Cu. Ft
Type of Construction Brick �, �_„�1�,200.00 To be Completed 7� mnnth
Located on Permit �10�321
In conslderation oP the isauanoe to me of a permit to camstruct buflding d�crlbed above I a�ee to do
th� proposed work ffi acc�ordance with the d�scrlption above sei Po and ia cwm with afl p�ovistona of
�inanc�s of the dty of Fridley.
In camsdderat[on of the_payment oY a fee oP $ 9.00 � permit fa hereby �ranf�ed �T•9-ke? �d Rri�'k & Stone
t0 c�nstrnCt th� building' OT 8dd3tiGII A8 desCTlbed 8bOV6. ThiB �e1�7it f8 �8nt� up�
the exAre� cronditioa that the P�n to whom it is granted aad his agents, employe� and workmen� in all work.
doas fn, aro�md and upon said building� or anq thereo$ shall conforra in all r�pecFs tfl the o�inanc� of
Fri�IIey, Minn�sota loca'tfon, c�s�uc� alteration, maiatenanc� rePa9r and. movi� oE buil�in�
wl�� dty limits�an�� Permft maY be revoked at anY time upo� vlolation oP an3+ of the P�� of sa�d
A
�
CLARENCE BELISLE
NOTIC�
7bb peemi! deas eo! eora t6s condeo�, h�n �or �rMne, P�e, B�+ �, � a� rrahr. B� wrs to �ee
�a BQUd� I�eto� for �Rnats permtb for tin� �s.
n n
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,� ��
�`
APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
� � ����L �,p�,Ld-P..�r.o( ��,r ,ft��. �
OWNER S NAME._ �'DcC BUILDER2
ADDRI'aSS : $3 S �c�f �i L Tv�?ISt �,Q , '!?. �r ADDRESS : ��7 C�•V.�� �vs�.y. �i � 1' ,
NO:,��.�5 {�^ STREET: �` ,� T(J!? /;Z ��. �i � �
LOT• BLOCK: ADDITION:
CORNER LOT: INSIDE LOT:,� SETBACK: SIDEYARD:
Applicant attach to this form ltao Certificates of SurveY of Lot and propoaed
buildiag location drawn on these Certificates.
To Be Used As:
DESCRIPTION OF BUILDING
Front: Depth• Height•
Square Feet: Cubic Feet:
� Front; Depth; Height•
Square Feet; Cubic Feet:
1j�pe of Construction: �`2���r�. c-� Estimated Cost: $ /°��� ��
To Be Campleted: `�'
The undersigaed hereby makes applicativn for a permit for the work herein
specified, ag�ceein� to do all work ia sttict accordance with the City of
Fridley Ordinances and ruliags of the Department of Buildiage, and hereby
declares that all the facts and represeatations stated in this application
are true and corxect. .
o ! �v:
DATE : � e���'e � �� � � SIGNATtTRE : �
,�_
(See Reveree Side For Additional Infosmation.)
� . � � c e � � -P � �' r/ P -� � N� c %�
�a � �
,.� �
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, ���
K
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Iaspector of Buildings shall, before iasuing pezmits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteratioa or repairs to any existing
buildiag or structure, upon application therefore, require the paqment by the
applicaat for such permit of feea to the amouat herein below set forth and in
the manner herein provided to-wit:
U1�TIFORM BUILDING CODE: �pe 1, 2� 4-$2.15 far each one thousand cubic
feet, or fraction thereof, in such cubical conteats. �pe 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical conteats
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 avarage heights of the upper surface or to the average.*
height of the roof surface of the main gable of a pitched roof.
For repaira or alterations to au existing atructure, 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 work.
I� no case sha11 the fee charged for any permit as set forth in Section 2 be
lesa than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours fram the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey af the lot,.showiag the location of the foundation, once it
has been constructed, will be required before �ro�e�d� with the framing.
CERTIFICATE,.OF OCCUPANCY
Application for a Certificate of Occupaacy shall be made teu (10) days prior
to the use ox occupaacq qf aay structure for which a building permit has beea
issued; and said structure shall not be uaed or occupied until a Certificate
of Occupaa�y has been issued. -
�' , � �1 � =. ,.m,.
.
�.. '
sus�ecT PERMIT
City of Fridley 17 01
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��
i �
� �
� `L � COMMUNITY DEVELOPMENT DIV. � �
r � � PROTECTIVE INSPECTION SEC.
i' i '
-__-� ��"��;,� CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVEO BY
i 612-571-3450 810-F15 6/24/83 � �
JOB ADDRESS 5� r�g �,,.4yra Road N. E.
1 LEGAL LOT NO. BLOCK THACT OR ADDITION . SEE ATTACHED
DESCR. 28 6 Carlson's SiZI�I.'t Md.IlOr North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Russell Daly 5358 Altura Road N.E. 572-1584
3 CONTRACTOR MA1L ADDRESS Z�P PHONE LICENSE NO.
Kilgore Siding Co. 460 Mi�issippi 5txe�t N.E. 574-0575
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDINO
Residential
7 CLASS OF WORK
O NEW � ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
S DESCRIBE WORK
Reside Dwellin , sof�it & Facia
9 CHANOE QF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LORD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBINti, HEATINO,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. 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. D�ULG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STAI.LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORHECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED. y�`3 �OOO ��.• SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTINO 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 RE(3ULATING CON- $38� �
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
� ` PLAN CHECK FEE TOT�FEE OO
4 U.
SIGNATUREOFCONTRACTORORAUTHORI AGENT (DATEI �^� WHEN PROPER VALIDATED THfS IS YOUR PERMIT
�
a• "
SIGNATUREOFOWNERIIFOWNERBUILOERI IOATEI BLOG INSP - �
CIiY Of fRIDLCY
. Effective Aug. 1, 1981
APPLICATI�1 FO�; RESIDCi�TI/ti. BU1LQIitG PL•iL�iITS
(I�c�l, Alterafiions, Additions, or Repairs)
.
p��NER: S-�e � � BUILD�R:
ADJRESS �`33� �� �� ''� �ADOftCS�
)
�
TEL �50: CS ��i �It ��L 110:
Construction Location
STRITT NO : ��� ST1iEF.T:
��
!
c�J/ / /1��
, � $ e
�
..S
�`I �/.-e
LO7': BLppC: ADAITION : o
Corner I.at: _,_ Znsiiie Lotz � Setback: Sideyards:
��
`V
Ap�licant attach to this form two Certificates of Slirvey of lot ,anci �
p=op�sed building location dr�wn on certificates t scale.
' �EN]8D� S�/N�l�� �o •'�/�
DESCRIPTIO�� OF COi�lSTF�JCTIOt��s�� c'ac, e� Sa�'�`��� �
' • ,D�°�G�i�✓�1.a� ��=1c�.—�r�, ��/r��.�i��
�� $1 �I /�.i � Front: Depth: Height:
__.___.—__.�— .
Squarc �'eet: G�bic Feet:
Front: Depth: Height:
• Squar.e Fe�t: Cvbic Feet: _
�
Rype of Construction : +Si� D�°� . E timated Cost: S� d��
• � �.-.l �t..-e C.��� �� ly'c¢�.
7.b Be O�r.�pleted: �l� /� � �
. Alt. A Alt. B
Proposed Driveiaay tridth If New Openinq Is Desired: S! S
SE� �VF.R: E SIDr. OF SHEET ,
9iie undersigned hereby mai:cs applicatien for a percait fcr the �erk herein specified,
agreein�3 to do .all kork ir, strict accordanee with the City of Fridley Ordii�ances �nd
rul�a��� of the Dei�.�rtmcnt of Duilc3ings, and hereby declares that all tlic facts and
re res�t.itions stated in this applicatien ar ye and corr ct. � �
p �/� mit- � �� c�� 9'
D�TE: - _ � SIGNATUi� : ����P�-��L� /,� � C3�-���
SLipulaCions: � �
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Tbe Chief Building OPficial shall� bePore issuing permits for the erection
of aay building or structure� or for any addition to any existing building
or atruoture or for any alteration or repairs to any ezistiing build�ng or
aLruoture, upon applicaLion therePore, require tbe payment by the
applioant for such permit of fees to the amount herein belo�r set forth and
in tbe manaer bersin provided to-xit:
�ot.al 9aluation
�1.00 to �500.00
� � _�;
:10.00 (l�inimnm �15.00)
�501 to �2.000.00 =10.00 Por tbe first �500 plus �1.50
for each additional �100 or fraction
tbereoP� to and including a2,000
�2�001 to��25,000
�32•50 Por the Pirst �2�000 plus �6.00
for each additional �1,000 or Praction
thereof, to and including a25,000
�25,001 to �50�000 �170.50 for ibe fir�t a25, 000 plus
�4.50 for each additional a1,000 or
fraction thereof, to and including
�50,000
�50,001 to �100�000
�100,001 and np
�283.00 for the first �50,000 plum '
�3.00 for each additional a1,000 or '°
fractioA thereoP, to and ineluding
a100,000
���3.00 for the first �100�000 plus
a2.50 Por each additional a1,000 or
fraction tbereof
Plaa Gheok: 25 percent of build3ng permit Pee.
Drive�ray Depresaion Sscrov: Concrete aurb streets only.
Alternate RA*:� Removal and replaoement of curb and gutter only -
Drivevay rridth plus 6 feet timea �13•50 �
Alteraate aB": Removal and replacement of curb and gutter and
� install a 3 foot vide approaoh With 6 inoh depth - Driveway vidth
plus 6 feet timea �15.75
_ ., • ,. .�
Permitis Por eonstruetion �rill be issued a minimum of 2� hours from the
time of appliaation to allo�r Por proper reviex of tbe propo$ed structure
and of the oonstructioa site.
A Certifioate of Survey of the lot, shoving the loaation of the foundation
oaee iL has been �nstrueted �till be required before �roeeedina xith the
framing.
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�_i 1! �,_i�,L' �._��� 1 .�. _;.. �:. � �..�.�. � Y����
T�C i�� .��► Y�CS ��� C�Bj► � S�SC�C:
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All �r BTU's �� Q��
TOTAL BTU's � ��0��'
Y�S(�NO��
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7. Has a lin�r b�en p�ovid� for � heat�r Yes () No i)
$. Has a�vn air � p�!�d f� wa�r he�ter Yes () No ()
::,::
Re�ks: �!'/�4��� �"�� �u02YU�9-�.`'
� � � � � -
. .�._. . .. _,._., _ . ! .. .•_����� .!.�r��
HEA►TTAiG CO:
Signed By:
Date:
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City of Fridley 2 6 6 91
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T
r
� � RE���t"y
� • COMMUNITY DEVELOPMENT DIV.
f � v �. PROTECTIVE INSPECTION SEC.
1 . �
� ` /�'�1 � CITY HALL FRIDLE� SS432 NUMBER REV DATE ' PA6E OF APPROVED BY
�..__.11.� '•� 612-571-3450 9�aF�s 7/20/98 / /
JOB ADDRESS 5358 Altura Rd
t LEGAL �OT NO. BLOCK TRACT OR ADDITION . SEE ATTACMED
DESCR. 28 6 Carlson's Summit Manor North Addition $NEET
2 PROPERTY OWNER MAIL ADORES$ IIP PMONE
Russel Dale 572-1084
3 CONTRACTOR MAIL AOORE8S �P PHONE LICENSE NO.
U To 2737 lllth Ave NW Coon Ra. ids MN 5 433 2- 85 1
d ARCNITECT OR OESIGNER MAIL ADORE88 ZIP PMONE LICENSE NO.
5 EN(iINEER MAILADDRE38 ZIP PHONE LICENSENO.
8 USE OF BUILDIN(i
Residential
7 CLASS OF WORK
❑ NEW 0 ADDITION � ALTERATION �] REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and ara e 19 S Tea -off
9 CHANdE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State building code.
SEPARATE PERMITS ARE REOUIRED fOR ELECTRICAL, PLUMBINCi. HEATING, �PE OF CONST. OCCUPANCY (3ROUP OCCUPANCV lOAO
VENTILATING OR AIR CONDITIONINO.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONINd SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWL(i. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY TNAT I HAVE READ AND EXAMINED TMIS APPLICATION ], STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PFiOVIS10NS OF LAWS yALUATION SURTAX
ANO ORDINANCES GOVERNINti THIS TYPE OF WORK WlLL BE COMPLIED
WITH WHET IED NERE OR NOT. TNE (3RANTING OF A PERMIT 1584 .�%9
DOES NO RESU G AUT ORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISI S OF Y T STA R A AW RE(3ULATIN(i CON-
STRUCT N O HE FO' M UCTION. ,rj]..25 Fire Si'i 1.58
PLAN CNECK FEE TOTAL FEE
� °�� • �� License SC 5.00 58.62
SiG A� �aa TO oaaurHO 2EOA6ENT IDATEI WFIEN PROPEiiLY A IDATED TNIS IS YOUR PERMIT
v
� �
�TQIdATURE Of OWNER �iF OWNER BUILDER� �DATE� �pg �iaTE
rtEw
ADDN
AL1'F.R
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Il
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R 1 AN� R 2
BUII.DING PERMIT APPLICATION
constructionAadress: a�3S'� ��.,�� ,
Legal Description:
Owner Name & Address: /,�
Contractor:
Address:
LIVING AREA:
GARAGE: AREA:
DECK A,REA:
�� . � .
. �
���
Effective 1/1/98
�� �
��,��/
Tel. � � 70? - O��
MN LICEI�TSE # % 7/�
���DdSa Tel. # �/,�a - �7��
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRII''rION OF IlVIPROVEMENT
Length Width Height Sq. Ft.
- �n� w�acn Height Sq. Ft.
Le Width / Hgt/Ground Sq. Ft.
A
. � �-- v - . - .
Construction Type: Fstimated Cost: $ �`'-� , f�� �
�- : �� �(Fee Schedule on Back)
Driveway Curb Cut Width Needed:
DA�'E: � •,�� , y� APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
:
$ �1,�5
$ -�
$
$
$ ��: � O
$
$
$
$
$ ��- ��-
$ .
Tel. �# ��,?.� -cF"i�S°
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.SO/$1,000 Valuation
$1000 per SAC Unit � �
$5.� (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above� �
$450.� Conservadon Plan Review
Fe� Determined by Engineering
Agreement Necessary [] Not Necessary j]
2_�y L zI'
�
e
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 smicture, 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 tawit:
TOTAL VALUE
$1 to $500
$501 to $2,�
$2,001 to $25,000
$25,001 to $50,�0 _
$50,001 to $1�,000
$100,001 to $500,000
$500,001 to $1,�,000
$1,�,001 and up
FEES
$21 (Minimwm Fee is $21 plus surcharge) .
$21 for first $500 plus $2.75 for each additional $1� 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 $25,0�
$349.75 for first $ZS,� plus $9.00 for each additional $1,�
or fraction thereof, to and including $50,�0
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,�
$887.25 for first $1�,000 plus $5.� for each additional
$1,000 or fraction thereof, to and including $500,0�
$2887.25 for the first. $500,000 plus $4.25 for each additional
$1,� or fraction thereof, to and including $1,�,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSI4N 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": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway widih plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundadon once it has it has been constructed
will be required before proceeding with the framing.
�-.. �,,�
0�/02/2004 FRI 13:21 FA%
NEW [)
ADDN [ j
�-T� II
-�;i ELDER JONE9
�
. L�"
CIN OF FRIDLEY Effective 4/1/2004
6431 University Ave NE, Frtdley. MN 55432 .(7S3) 5i2-3SO4 Bldg Insp
91N�I�E FA�MRY AND DUPL�3 R 4 AND R 2 (763) b7'I-728� Fax
BUILDING PERMITARPLICATIQN
l�j 001/001
�o� IS ' �• . .. .. ' - -• .. •-
Construction Address: �'3�� ���Y�,'�„ • � �
Le0a1 Description: .
Qwner Name � Address: �i, v �st�1 �at1,a, TeL � �' l03 • � • S�� - l�$y
Cc�ntractor. � _ �N WCENS� #�O ��JO9�3
Address: RENEWAL BY AND �ERSEN Tel. #�p�J I' o���' ����
—�- 1920 COUNTY ROAD C WEST
ROSEVII.LE, MN 55113 icate of Survey of the
a drawn on it to sca(e.
LMN� AREA;
GARAGE AREA:
DECK AREA:
o-n�toz:
DESCRIPTIt?M Of IMPROVENI�1�'f'
Length � Wtd� � Height, Sq. Ft .
Leng� ,__ �dth ___ Height,__ Sq. Fi
L.engfih Wfdtl� r__-___,__—
Sq. Ft
/ po
Constructton Type: Estlmated CosC $ `0, ��� �"'
Driveway Gurb Cut Width N�pdad: Ft, + 6 Ft = Ft x$ _$
DATE: `e d�'f1�S APPlICANT: _ �Q/V`�� Tel. # QS� • ��1a�• ���{ �
Call (�63) 6'72-36Q4 for Pem�it Fees if ma0ing in applicafion. F� to 763-S17-�i287 if u�in� credit c� �nd we wifl call
you for card numbe�.
Permit Fee
Plan Review
Fire Surcharge �
State Surcharge
SAC Charge
Licx3nse Surcherge
Cw�b Cut Escrow
Erosion Corrtrol
Park Fee
Sewer'Main Charge
� I�q. as
$
$ L� .3�a
$__ 3, t�
S
$ S.Od
$
$
$
$
CR1f USE ONLY -
Fee Sch�u{e on Revers� Side
65% of Perrnit Fee
.001 of Pennit Valuation (1/10ih%)
$.50/$1,000 Valuation � �
$1350 per SAC Unit
$5.00 (State uc�nsed Resider�tial Contractors)
Alt "A" or Alt. "B" Above
$450.00 Conseniation Plan Review
Fee Determined by Engineerfng
Agreement Necessary [ ] Not Necessary [ ]
Tor,v. $ 1`�3 • �'�' s-riPUU�-r�a�s:
�