AF - 44251��
City of Fridley, Minn.
BUII,DING PERNIIT
Date: . �..... /�. ...� .........
Owner.......................................
Adtlretss......................................
��
N°
3 fi 7'�
_ �
Builder .�'�.;(.�1 . . ............... ..............
Address........................................
�'� 9' L.O�CAT[ � B��ILDINC
No. . . . /Gi
... .. 5treet .. . . .................... Part of I,ot .. ............
...... . .
�;�I.ot� Q : � .�. � . Btack . . . . . . . . . . . . . . . . . Addition or Sub-Division ����i�!� . C%���%�!. . . . . . . . . .
c Q .r
Corner Lot . . . . . . . . . . . . Inside Lot !� . . . . . . . . . Setback��� �. Sideyard /� . . � . . . . . . . . . . . . .
DESCRIPT[ON O� BUILDING
To Used as:
_ p� , e 9 c f ) p�-
. . . � . . Froztt �9. : .0 � Depth �.f�'. `� Height / � .l�. Sq. Ft. � �� Gw. Ft /. P. . � � �
.................... Front ........ Depth . Height . . 5q. F�. ........ Gt�. Fk ........
�►pe of Construction ................... I#at. G�l.��J�4�..� . To be Campleted ...................
In consfderation of tihe is�uance to me oE a permit to construct the building desrib d above, I agree to do
the proposed work in accordance with the description above set forth and fn c�mp , ce with all prov3sions of
ordinancea of the dty of Fridley. '
� .� . ' :C�!� . .��� .. .. .. . . . . .. . . . . . . . .. . .
�. ' ...p
In consideration of the payment of a fee of $. J. . /. �� , permit is hereby granted to . . . . . . . . . . . . . . . . . . .
. . . . . . . . . . . . . . . . . . . . . . . . . to construct the bu9lding or addition as described above. This permit is granted upon
the express condition that the person to whom it ia granted and hia age�, employees and worlmnen, in all work
done in, around and upon said buflding, or any part thereof, shall �nform in all respects to the ordinaaces of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at a�y time upon violation of any of the prnvisions oF sa3d
ordinance.s. 1� �
:....... Building Inspector
R �
NOTICE:
Th(a pa�mlt does not cova� the construotlon, Installation o� alteratton to� wl�ing, plumbing, gas heating,
sewer o� watar. Be sure to sea the Bullding Inspeator fo� se�parate .garmlt� for these itema
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SUBJECT P:RM122�g
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � REC .
� `y _ ____ COMMUNITY DEVELOPMENT DIV. � �� / �
r � � PROTECTIVE INSPECTION SEC.
1 ; �
�` � /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
"'~� � ,'� 612-560-3450
910-F15 $/15/73 � �
JOB ADDRESS 6529 Atthur Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. f� _ ��� � ��.� ���y�� ���,{� SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Bob Dischingex 6529 Arthur Street N.E.
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Sussel Company 1850 Como Avenue, St. Paul
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
�1 NEW � ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK �onstruct 30' x 24' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS gold construction until City has set a garage slab elevation.
S�PERATE PER�IITS REQUIRED FOR �VI�?IN�.
HEATINC, P�,U�qBING AIVD S�GNS.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUM8ING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCl Fi2.lII@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 R-�.
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 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 $3 2( ]. 1.. 63
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- $13. SO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
� ` � �, � � /�vdr d.�=7 $15 .13 s,_
SIGNATUREOfCONTRACTORORAUTH(� I2E AG T IDAT EN PR PE V DA THIS IS YOUR PERMIT �
... `' ���'�6LJ
�- SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI LDG INSP f1ATE
A�PLICATION FOR RESIDENTIAL, ALTERATION,
OR ADDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME:� f�,s � a p�- BiTYLDER: �� s 5� �°a�
annxESS :_ ��"a9 .9a �,�/uv ���" a���ss : �.�'� e�a A� - � f �
NO:. STREET: -
LOT: BLOCK• ADDITION•
CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on theae Certificates.
�ESCRIPTION OF BUILDING
To Be Ueed As; �^��e�� �a.�-�,�
/°
�� Front:_ �g! Depth; Height:
Square Feet: Cubic Feet:
Froat: Depth: Height:
Square Feet; Cubic Feet:
Z�►pe of Construction: �'" /-��.� Estimated Cost; $.�2�2 �-=
To Be Cvmpleted;
y��� ��G�,3G
The undersigned hereby make� application for a permit for the work herein
ap�cified! agreeing to do all work in �tfict accordance with the City of
Fxidley prdinances and ruliags of the Depax�ment of Buildinga, and hereby
declares that all the facts and represent���.ons stated in this application
axe true and cozrect.
.
DATE: v %S -- �.� SIGNAT[JRE •
(See Revezse Side For Additional Information.) •
/ ��r� �� 2 ���'
/� � � �~ � �� �-- �
_ � r 3 ` � �
Sr/
o�� , � . .
BUIL�TNG PER�l1T' �EE SCHED�LE
SECTION 2. The Inspector of Buildings sha11, befoxe issuing perniits fox the
erection of any building o� structure, ox for any addition to any existing
building or stxucture, or for any alteration or repairs to any existing
building or structure, upon application therefoxe, require the payment by the
applicant fox such permit of fees to the axnount herein below set forth and in
the atanner herein provided to-wit:
� UNtFORM BUILDING CODEe Type 1, 2& 4�$2a15 io� each one thousand cubic
feet, or fraction thereof, in such cubical contentse Type 3& 5-$1.85 for
each one thousar.xd cubie feet. .
ADDITIONAL INFORMATION
�
�'oz t�e purpoae of computing fees for building pexmits, the cubical contents
of any building or addition, ia determine� by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or th,e cellar to the �ve�age heights of tthe upp�r �urface or �Q the avera�e
heigt�t ot the roof surface of the main gable o� a pitched roo�E.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost ot al]. proposed work.
Ia no case aha11 the fee charged for any pe�at as set fvrth in Section 2 be
lesa than $5.00.
VBRIFICATION OF FOUNDATION
NOTE: Permits for eonstruction will be issued a minianum of 24 hours from the
time of application, �o all�w for proper rev�ew a£ the proposed structu�e and
of tY�e construction site.
A Certified Survey of the lot, sho�aing the location of t1�e fouadation, once it
ha� laeea constructed, wiZ1 be require� be€ore pxoceedint� with the fr�ing.
CERTIFICATE OF OCCUP�NCY
Applie�tion for a Cextificate of Occupancy shall �e made ten (10) days prior
to the uae ox oacupancy o€ any structa�re for which a building permit has been
i�sued; aAd said stxuC�ure shall not be useci og occup�ed until a Cextificate
of Occupancy ha� bee� issu�d.
' �"' WORK ORDER � ��
��� �����d ��o _
iaso coe�o �v�. sT. �nu� NAME � o� D� S c. t� �►V G� 2 PNOIVE $� %gS� �/�y�
.
,_-� tALL: 645-0331 ,.�
JOBADDRESS�S �9 �2%�iv� �/°� ��°
�Permit byi? ! s =?�' 4-
CI Legal Description BLDG CODE AREA --- -�� �� �- � r
0 Lot ZzX a.'`f �
� Blk SALESMAN ������ CONTRACT DATE /����..�IZE g��'`f pQi�'{
❑ Add'n
.�7, L �` FOR OFFICE USE ONLY
Value
Type Const. CONTRACTOR � �,��`r JOB # � ��"
Slab: ❑ In �y Sussel SUSSEL JOB $� � �� � CONTRACT # � �b � `�Z
❑ By Owner Approx. , �
. i : �
� 2 STARTIN�S POINTS ONLY � ! � -. , , _ . _, ,
.-..
m S.P. L. ' �.. , } � _ y _ ? _ : _. :__ _. � _i �
3 � ` _
, . . F
�. ��-EY. � _ -_ _ _ � i
, - ,. , , ;
S.S.P.L. ' . , _ _�� ,_-� _�� j_;. � ; _ : ;_ : . _.. _ ,
i L ; , .
R.P.L. , � _ _. , ,_ • ,_ .
� Alley �, ' ; __.._i ;
'i ;
House '
- - --_
F. Street � � ' , ; � : _. _. _ -- - .
, � ��
Other (> � ^ .;, ' 1 `. :!::., . ' !. : r'
� _ .
_ _, j
' ' 1 _' ; ' _
!z , ,__,. �. �_.<-.-t .-. _ : _ __. , '
< . ,py � .
�Square With ��io� C L _�_ � ! t� _ . ._ . _
;
„
. _. _ _ . �� �.
..
�'�' , �
r.. , _ .. ._. :.
b4 Mesh �..� � .. -
.
' �1,1 ,�} F" ' ' - - � _. _ r _. - -- - _.
� _ .. . .� _.�.� .� u
.
� Sod Rem. - By _
� ' j.,�,'
, ,
, � , . ' ,z
, _ _ - _ - -
�i , �_,.. _i- I � . , _ ; X A �' y s :. !
�
� �Bag Mix �_ { ., _ -
, �.�P►��' _ � : i , - � �-` j 1 � P _ � � �
�.,. ' _ . _. ` � �. . . ;
� �'
�`- �No Tamping�.sr f_ �
� , � �
1 . .. � � . , , ! ?
�� �A.B.U. : ; �__ > '- _ R _ {. : _,
� Grade Point � _ ,,� ,._ � _ _ . ;. ' -_ � _� - -. �-_:. _ �- - -- --
--_
� �" � � � � � �
, .�_ _ _, _, l-
f� CONDUIT : z. �- - -- _ - � N ? �
C� O.H. Dr. Offset a , , � , � -- ' _ ,
r , ; a � ;�� �
/����� , ' __ �
�S.D. Location � �6 �l _ 30 ' ' C �' �` ; . b ! _ ` ; �
�Blocks ❑ BY Owner _ - t _`_ . _ - - - -
(�y Sussel ' � pJ p
. '} ..y.. � .. �
Windows i �0� �C6� .. _ : .b. ` _ , ;- - , �, _ _ � I
,
_�_. _.
. E�� I -- - �
, , , . � �
, , ; _ ,
. ,_ . _ _.! V_ � _ _
_. _ �„
Existing garage: No � 4" ` � ' �
. I 1 ,i _. ' .�..i � . t . .: : ' .. _" ." � . {
❑ Oetached ❑Attached Yes ❑ I i ' + , � t
Size of existing:— x — ' � __.� � '_ .,_ , , _ 2', -'Jt __1 _ _
Existing garage will be: � ' ' ,. ! . ,
�
� Left as is I ��tCA.vR►ertCa� , ` �. j -_ ��
O Converted to L.S. - BY owner _�_,.a. � �__ . . ' _` • �'�' _ _ . != ' r . � f _
t�1�' �� � � .. �� �6 ' -- ;
O Removed By: Owner ❑ _ 2 2ta ' % x � 6 � i;_ _
, . = �-- ; r -
Sussel � . ; ' ' � _
_ � ; , `r`�: ' .� � _
Junk Must Be Removed By Owner � t a
Z.: ,.�„� ��' „� . . � ; _ ..I �� I C1„ �,► I - - - . , __ � . _ ,
2 S7d� . S ��.5kr., .� _ , 1-. _. , ' ' .;_ I ; . '� -
� S�cify other removals by Sus- ' : ..c�°`'�'S'�-. , � � . ; ... , _ C�a�-r� , . f_ � _s: _ _a._ ,
� � � ' __ _
'� �__.._ __._-_ :_ : _ � _ -.
Sel of oWnel' - trees, bushes, etc ' � ' �`i�` ��` � ' � v` ` "f �`d -'
-d -�
, � 3 2'� ; �t� ; .
'� Show approx. dist. garage to �
house and all prop. lines . . ;2 ; . '. � �:��1 i �_' i ' �.�
y . . � ..'.� . t ":' T ._ "._ . . .. _ ..-.
Stakes visible - ❑ Yes � No "� ' • -' � -�� - E •- z - }
- -- _ : _ _- -�
� �
,
Survey available • C� Yes L� No '� �
, ,
�Special instr ctions from � t ' ' � _ __ _ _. _{
� �
owner ✓SS�� � �� ' ' � � ,..�, . - - _. � ,.___ «.
- - _ _ - -- - - - . _ � --
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. � �, . _- r> �:.. � .�•�:, r _.�, .,. P , �; a5" . er� r - :u• � _ ��' ., ��� �s _ , ° �' . �� .`.:�n ;. j �e.tl, r�� 'k',
SUBJECT P
City of Fridley � 16 6 0 6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i •
� �
� ; v _ COMMUNITY DEVELOPMENT DIV. � � �
r � � PROTECTIVE INSPECTION SEC. ,�j?
1 i �
`--_-� � ���,,� CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
i 612-571-3450 910-F15 6/1/82 � �
JOB ADDRESS
6529 Arthur Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ]_9�S�ZO 4 Oak Grove Addition sHeer
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Robert Di.shi er 6529 Arthur Street N.E. 571-0149
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR 0 MOVE ❑ REMOVE
%
8 DESCRIBE WORK
" B ' F nt
8 CHANGEOFUSEFROM TO
STIPULATIONS
SEPERATE PERMlTS �E�3���3�[� �{��t ����
HEATIIVG. PLU�II�i�i�; A�� S1�;fi�s.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $3OO $. SO
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-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ],S.00 NON.F+
PLAN CHECKFEE TOTALFEE
$IG�I � REOF " NTH TO ORAU HORI�ED T IDATEI �-S� SO
/ � _ WHEN PROPERLY VALIDATED THIS IS VO�JR P RMIT
/
� �� i .�O Z_
SIGNATUR OFOWNERIIFOWNERBUILDERI IDATEIy BLDG INSP n TE
�
CITY Qf FRIDLCY Effective Aug. 1, 1981
APPLIG/ITIffd FO�� RESIDCt�TIAi BU1LQ1f1G PCRiiITS
(f�e►r, Alterations, AddiLions, or Repairs)
OHINFR: I�� ��� / ������/' �,e t3UILDER: .��%�,� .
AODRESS: �.�-2� �%Z%��/Z �/� AODRCSS:
TEL N0: ��/�- D% ��' TEL fi0:
Construction Location
- STItI�T NO: � STI2EET: �� % %�f%/�� �/�� /'1�_..,�_
LOT: . � HLOQC: ADnITION:
Cozner I,ot: Insii3e Lots `-7� Setback: Sideyards:
Ap�Iicant attach to tl�is form two Certificates ef S1�rvey of lot and
proposed building locatian drawn on certificates to scale.
DESCRIPTIOid OF COhJSTP.UCTIOW
�re
�QtGf� Front: Depth: Height:
Square Feet: Qibic Feet:
Front: Deptti: Heiglrt:
� Squar.e� FePt: Cvbic I'eet:
Type of Cor,struction: �%i�� ��0%��"n
Rb Be Obr.�pleted:
Estimated Cost: 9 � ��
Alt. A Alt. B
proposed Drive��ay Width If New Opening Is Desire8: $� $
� , , SE� REVER�E SIDE OF SHEET .
�iie unc3ersigned herebS► ma�:e� application for a permit for the �.vrk� herein specified,
agreeing to do ,all wori: ir, strict accordancc ��ith the City of I'ridley Ordinances �aid
ruling� of the Departm�nt of IIuilc3ings, and hereby declares that all the facts and
repres� tations stated in this �pplica
�.
D.7TE: � �-'� — �S o� SIGNATUI2E: �
Stipulations:
�� � �
/"�, C�d
� •�
� / � , ��
� � . .�
BUILDING PERMIT FEE SCHEDULE
The Inspector of buil8ings sha'11, before issuing permits for the
erecticn of any building or structure, or for any addition to any
bxistinq building or strycture, or for any alteration or'repairs
to any existing buil8ing or structure, upon application therefore,
require the payment by the applicant f oz such permit of iees to the
amount herein below set forth and in the m anner herein provided to-wit:
TOTAL VAI�JATI�T
$1. 00 t� $ 500. 00
$501 to $2,000
$2,001 tc $25,000
$25,001 to $50,000
FEES
&10.00 Minimum Fee $15.00 plus surcharge
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
including 52,000
$32.50 for the first $2,000 plus $6.00 for each
additional $�,000 or fraction thereof, to and
including $25,000
$170.50 for the first $25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000 -
$50,001 to $1Q0,000 $283.00 for the first $50,000 plus $3.00 for
each additional $1.000 or fraction thereof, to
and including $100,000
$100,001 ar�d up $443.00 for the first $100,000 plus 52.50 for
each additional $1,000 or fraction thereof
PLAN CHECK: 25 percent of building permit fee
DRIV�n1AY DEPRESSION ESQtOW: Concrete G1�rb Streets Only
Alternate "A"x Removeal and replace�nent of curb and qutter only
Driveway width plus 6 feet x$13.50
Alternate "B": Ranoval and replacement of curb and qutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x$15.75
VERIFICATION OF FOUNDATION
Permits for constzvction will be issued a minim�m► 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 Suzvey of the lot, shawing the Iocation of the founc]ation once it
has been constructed will be required before proceeding with the framinq.
A � _
sue�ecT pE
c�ty of Fridley 18 6 3 7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� i. R E
� `L _._��_ COMMUNITY DEVELOPMENT DIV.
f � � PqOTECTIVE INSPECTION SEC. � I��
� �
� _ �
' /"'1 � CITY HALL FRIDLE� SS43Z NUMBER REV. DATE PAGE OF APPROVED BY
�'"'"� � ,�� 612-571-3450 9�0-F15 9/10/86 / /
JOB ADDRESS 6529 Arthuz' Street N. E.
t LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ].9 ��20 4 Oak G�'ove Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Robe�t Dischinger 6529 Arthur 5treet N.E. 571-0149
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
$SIIl(.'
A ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Structuace
9 CHAN(iE OF USE FROM TO
STI PU LATION S
lmof can be the.2nd layer but not th.e 3rd, Install ridged
galvanized v�lleys.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $SOO $. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
S�fiUCTION OR THE PERFORMANCE OF CONSTRUCTION. $�.5, OO
LAN CHECK FEE TOT��EE�O
�
SiG CoNianC UTNOAIZE ErvT IDATE� . WHEN PROPERLY ALIDATED THIS IS YOUR PERMIT
� e �°
L / �
SiGNa7U E OF O NER �IF OWNER BUILDERI �DA7Ei B�OG WS ' f)AT
N�,� [] City of Fridley Effective 4/1/86
ADDN. L � �R-1 AKD R-2
pLTER. [ ] Building Permit Application
Construction Addr�
Legal Description: ' - ° � � .
Owner Name & Address: ������ ���c������� Tel. 4 ^�� %
Contractor: � �� � Tel. 4
Address•
LI9ING AREA:
GARAGE AREA:
DECR AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, With the proposed construction dra�an on it to scale.
DESCRIPTIOH OF IMPRO'PEI�NT
Length Width _._ Height Sq. Ft.
Length Width ____..,__ Height Sq. Ft. __
Length Width _ Hgt/Ground Sq. Ft.
f��'S"�/'s��� �'� �DO/~
Corner Lot [] Inside Lot [] Ft. Yd. Setback _ Side Yard Setback _
Type of Construction: Estimated Cost: $ '���
Approx. Completion Date:
Alt. A Alt B
Proposed Drive�ay Width If New Opening Is Desired: See Back Page for Explanation
DATE: � �� S °
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
SeWer Main Char�e�
TOTAI.
STIPULATIONS:
APPLICANT • a 1 Tel . 4 �'�1� "��`�i
CITY IISE ONLY
$ �� � �
$
$ ��
�
$
�
� �-� • ��
Fee Schedule on Reverse Side
25`� of Building Permit Fee
$.50/$1,000 Yaluation
$475 per SAC Unit
Fee Determined by Engineering
Agreemerat �iecessary [ ] Not Necessary [ 7
BIIII.DIAG PERMIT FEE SCAEDIILE
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 strueture, upon applicatio n
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 Valuation
51.00 to �500.00
5501.00 to $2,000.00
$2,001.00 to $25�000.00
$25,001.00 to $50,000.00
$50,00�.0o to 3100,000.00
�100�001.00 and up
Fees
$10.00 (Minimum Fee is �15.00)
$10.00 for the first �500 plus �1.50 for each
additional �100 or fraction thereof� to and including
�2,000.
$32•50 for the first �2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
ineluding �25,000.
�170.50 for the first
additional �1�000 or
including 550,000.
$283.00 for the first
additional $1,000 or
including �100,000.
$25,000 plus a4.50 for each
fraction thereof, to and
�50,000 plus $3.00 for each
fraction thereof, to and
Su33.00 for the first �100,000 plus $2.50 for eaeh
additional �1,000 or fraction thereof.
DRIVEWAY DEPRESSION ESCRON
(Concrete Curb Streets Only}
Alternate "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
approaeh With 6 inch depth - Drivexay xidth plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Permits for construction �.ill be issued a minimum of 24 hours from the time of
application to allow for proper reviex of the propased structure and of the
construction site.
A Certificate of Survey of the lot, showing the loca�tion of the foundation onee it
has been constructed will be reqnired before proceeding taith the framing.
a
NEW
ADDN
ALTER
[)
[l
�l
ConstructionAddress: _
Legal Description:
Owner Name & Address:
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CTI'Y OF FItIDLEY
5INGLE FAMII,Y AND DIJpLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
r �
a 9 .��-
� ���� tS�
z
Effective 1 / 1 /97
Tel. # �l�/'��
MN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlIZPROVEMENT
�n� Width Height Sq. Ft.
�n� Width Height Sq. Ft.
�n� Width Hgt/Ground Sq. Ft.
Construction Type: Estimated Cost: $
� (�'ee Schedule on Back)
Driveway C�rb Cut Width Needed: �Ft. + �Ft = /� Ft;�x $ % ,.�� — $ � ���
DATE: �-- � ' A,pPLICANT:
Permit Fee
Fire Surcha.rge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULAT(ONS:
$
$
$
$
$
$_
$
$
$
$
Tel. #
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 �aluation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450. QO Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
[3U[LDING PER1b1iT FEE SCHEDUi.,E
1'he Chief Building Official shali, before issuing permits for the erection c�f any bui(ding or sttucture, or f<�r
any addition to any existing building or structure, or for any a(teration or repair to any existing buildinv ar
stiucture, 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 $S�
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$1QU,001 to $500,000
$500,001 to $1,OQ0,(?00
$1,000,001 and up
FEES
$21 (Minimum 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 tr.ereof, to and including $25,OOU
$349.75 for first $25,400 plus $9.00 for each additional $1,000
or fraction thereof, to and including $SO,OQO
$574.75- for=f�st;�50;0UU plus $6:25 for each additional
$1,Q00 or fraction thereof, to aad including $1(�,000
$887.25.for first $100,000 plus $5.� for each additional
$l,��or fractian thereo��to and including $S(�,�
$2887:25 for the fust $500,000 plus $4.25 for �ach additional �
$1,000 or fraction thereof, to and including $1;�;000
$5012.25 for the first $1,000,000 plus $2.75 for. each additional
$1,0� 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.>0_
Aiternate "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
Pccmits for construction will be issued a minimum of 24 hours from the time of application to allow foc pm��z�
review of the proposed structure and of the construction site.
A Cei�tificate of Survey of tl�e lot, showing the location of the foundation � 7nce it fias it has heen c��nstruc� _- _'
«�i;! l,� rcyuir�d hcforc ��r��c��din�� urit}i thc fra�nin�*.
Building
Inspections
763-572�3604
�a,rE , %�, c� � ,[ �
SITE ADDRESS __ � �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
TYPE OF WORK:
BiJILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
.-
NAtvtE:
STATE LICENSE
OCONTRACTOR
EXP DATE
Permit N
Received
Date Rec'd:
ADDRESS: CTR' STATE Z�,
PHONE
❑ SINGLE FAMILYME
O TWO FAMII.Y/NEW
❑ BASENID�iT FWISH I�OOF
O DECK ❑ SIDING
❑ SWA�IIvI
u
DESCRIBE WORK BE1NG DONE:
SIZE OF
FAX
❑ REMODELING
� �D�',
ROOFIIVG ❑ HOUSE ONLY
NUMBER OF SQUARE3 � ❑ HOUSE $c GARAGE
GARAGES O A�CHED GARAGE
PROP05ED SlZE:_g� ��� f$'6ETACHID GARAGE
PROPOSED HEIGHT: �
SIDIlVG
❑ Vmyl OSoff t �
� Alim�mmn ' ❑ Trim
❑ Ot�er . • ❑ Fescia
R'WDOWS
IN EXLSTII�IG OPENIl�TGS OYes DAIo Lt�A1TON OF WII�iDOWS
OR FOR NEW OPENINGS-DESCRIBE S�ZE OF
OPIIJIAIG CHANGES &
❑ DRAW 7ILE
❑ OTHER
i+i, I i./` .'
VaIDTH HEIGHT
�ASEM.F�1T R�IODELING SUBMiT:
1. Fatislmg F'foor Plan
2. Proposed floar pfan
3. List of struchual members to be osed
F�
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDI1'iONS. 8c PORCI�S SUBMIT:
1. Site PlanlSurvey showing the eatisting strucU�res
and ProPos�d ProJeci
Z. Two sets vf cor►shv�ion pfans
3. Energy Caiculations
Ai •i • FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND �MATERIALS:
(USING TT3E 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee - --- — - - -
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ �',/, d�
$
$ � .
$
$
$
$
$
S
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the tota] job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTIL PROCESSED
I hereby apply for a building pemut 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 applica.tion permi wo is not to start without a perniit; that the work will be in accordance with the approved
plan in the case of all work w ch r es vie �.pp v of plans.
SIGNATURE OF APPLICANT / AiAME C� . ������ �� O.e2`��
Page 2- Buildin.g Residential Application
BUII..DING PERNIIT FEE SCHEDULE
The Chief Bui.lding Official shall, before issuing permifs for ihe 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 stru.cture, upon applica.tion therefore, require the payment by the
applican.t for such permit of fees to ihe amount herein below set forth and in the manner herein
provided io-wit:
VERIFICATION OF FOUNDATION
Permits for constructinn will be i.ssued a m;,,;T„um of 24 hours firom the time of application to
allow for proper review of proposed structiue and of the construction site.
A Certificate of Survey of the lot, showing the loca.tion of the existing found.a.tion will be
r�uired before proceeding with the framing. New Houses Onlv
City of Fridley
Build.ing Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
Builc�ng
Inspections
763-572-3604
763-502-4977 FAX
DATE � � (��� �
SITE ADDRESS �,�;
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BETNG DC
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-OS
YOUR E-MAIL ADDRESS
❑ OWNER �CONTRACTOR
Pernut No.:
Received By;
Date Rec'd:
CITY���%� /'� �� STA
ADDRESS: CITY STATE ZIP
PHONE
FAX
STATE LICENSE # EXP DATE
O SINGLE FAMILYMEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
O ADDITION ❑ GARAGE/SHED ❑ WINDOWS
� BASEMENT FINISH ❑ ROOF ❑ RAIN TILE
❑ DECK ❑ SIDING �THER
� SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
�MAINTENANCFJREPAIR ❑ REMODELING
WINDOWS
IN EXISTMG OPENINGS OYes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
� C�l� �/-� �fl�°r
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of swctural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Fascia and proposed project
2. Two sets of construction plans
3. Energy Calculations
LOCATION OF WINDOWS
NUMBER OF
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 UBC FEE SCHEDULE)
JOB VALUATION $ . �c�,� ��� OCCUPANCY TYPE
Permit Fee
Pla.n Review
Fire Surchazge
Surcharge
License Surcharge
SAC Chazge
Curb Cut Fscrow
Erosion Control
Pazk Fee
Sewer Main Chazge
Total Due
$
$
$ ��
$
$
$
$
$
$
$ � �
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 rimes the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
T 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 Conswction 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 acc,�a1�¢e��pr�ved pJ�in�e case of all work which requires review and approval of plans.
SIGNATURE OF
. . . . • � : �+i� �� i�� � _: _ '���i �
Page 2- Building Residential Application
BUILDING 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 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:
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 proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Only
City of Fridley
Building Inspections Department
6431 UniversiLy Avenue NE
Fridley, MN 55432 "
763-572-3604
Fax: 763-502-4977
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Building �UILDING Permit No.: � � ° —c� 1 �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY i�ate Rec'd: ��
763–rJ�2-4977 FAX EFFECTIVE 8-19-09
DATE G f ��i �� �O � YOUR E-MA1L ADDRESS O
SITE ADDRESS !i� i a�Z � ir-1 %°��! �— �/ /t[ �
i Sz Ti--'�
THIS APPLICANT IS: �QWNER ❑CONTRACTOR
PROPERTY OWNER/ N�: G r�
TENANT �D�S:�� _ � G� � '{T'h/C�� C�TV STA'1'E�[p� `
PHONE: Z� `'?7 �7 %� 1�—r�' �°
CONTRACTOR NAME:
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE LICENSE
AND CERTIFICATE OF ADDRESS: CITY STATE ZIP
INSURANCE PHONE F�
PROPERTY TYPE 0 SINGLE FAMILY/NEW CONSTRUCTION SIZE
� TWO FANIILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION �GARAGFJSHED ❑ WINDOWS
❑ BASEMENT FINISH ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING � OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCF/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S Ff
�pp�G ��� ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES � L� ❑ HOUSE & GARAGE 1. Existing Floor Plan
GARAGFS ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: O DETACtIED GARAGE 3. List of structutal members to be used
PROPOSED HIIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING p�nniTIONS & PORCHES SUBMIT:
❑ y��y� ❑Soffit 1. Site Plan/Survey showing the existing structures
� Aluminum ❑ Trim and proposed project
❑ p�� ❑ Fascia 2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS �Yes ONo 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 Alu+; 13A,Eli U1V vALU�►11vN, i1��.L.uLiiv�. in� �.wa vr LHDVII [i1�L l�i[11rJiut�i��.
,� SING THE 1997 U.B.0 FEE SCHEDULE)
'OTAL JOB VALUATION $ 1�1 ��- 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 $ .00DS x Permit Valuation Minimum $.50
License Surcharge $ $5.00 (State Licensed Residential Contractors)
SAC Chatge $ $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 $ �� Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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 permit on site; that the work will be in accordance with the
approved plan in the case o k re uire4s rev' and approval of plans.
S
SIGNATURE OF APPLICA ' P NAME O `! / D'/�^��
Page 2- Building Residential Application
BUILDING 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 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1� $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1� $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1� $100,000 plus $5.60 for each additional$1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1� $500,000 plus $4.75 for each additional$1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
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 proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977