AF - 35709N°
Villa�c of Fridley, Minn.
BUYLDING PERI�IIT
171 Office of IIVSPEC'1'OR OF BUILDING4S
y�. "^�! p„`
Owaer S.�- ti .; � �::
i {'� �'�j
Architect � � Frtd!ey, Minn. � . �� r � ^ �+ , 19,.,t ��
Builder . ,� .
Cp� � / LOCATION OF BUII.DIIVG
No� 3treet ���,�cre.+it� � Part op Lot
Lot
To be vaed
Permit is hereby granted
Additioa or Sub-Divieion
DESCRIPTION OP BUII.DING
Stories� NTanaer of Constructio� ��
� i '"' " a� o --��
, To be completed 4� e Estimated Coa
to t�,�'G'� "✓�i.�/'"wC,�
the bvllding deacribed in the above statement. This permit ie granted
upon the eaprese condition that the person to wLom it is graated, and his agents, emp3oyees and worl�en, ia all
the work doae ia, amvnd and upon said building, or any part thereoP;�eLa]] confonm-in all respeete to the ordi-
nancea of P7ldley, Miaa„ regaxding the conatruction, alteratioa, . m43nteasnce, �epair and moving oP buildings
within.the nity limita, and this permit msy be revoked at any time upoa�violatioa�ot any oi�the proviaioas of esid
ordinancea � __ o�. _ � .. � � � . . � .
eator oP- Buildinga.
AGREEEMENT AND SWORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit, I hereby �gree to do the proposed work in accordance with the description
above set forth and according to the provisiona of the ordinances of Fridle,y, and, being &rst duly
sworn, I hereby state and say that the facts stated hy me and contained in the above �ermit are
true as therein stated. ,v°'
��:a�,�.�,�' �° C.� r�
Subscribed and sworn to before me at Fridley,
t
day of�� � D. 19�.
�e t�, t � I S`
..
� � � ��•-` ,,•L,.
. .- �sue�eci:. . . . . P:ERM .
-�' �ity of Fr�d��,�;' , _._ 9 5 8 2 7
` � ATFHETQPOGTHETWIN$ � .�, gU�,E,.DiNG �ERMIT REGEIPTNO.
f Z '
�
� . j �: GOMMUN�i'Y DEVELOPMkNT ON . �. . . . . �
._� y ._..��� ; . .
�-. � � . . ' PROT�QTryE INSRECT7QH $�..� . .. . -
,� , � . : .. . .
i � / �l •�� CYTY NA,�y{�_ �fAIDLEY `��j432 �NUMBER � � REM O�TE � PAGE OF - 4PPROVEDHY �
�••••`�' `•��.. ' %k`3.--57Y�.-.3469 .�� 9t0-P15 � ., 7 5 ;�� . . � � �� � .
�>ao+Sr+ESS � 64 Aehton Y Pl
� 7 LEBAC� ��`� BLOCK TAAGTORADDLflON SEEATTACHED
.� T?�SCxQ;.r �' -� � . SMEET.� � .
, ➢�,3i"6WNEii:.- MXtLA .� R�3S - '. - . �� Z�P PHONE. �. � ..
Ll�c1�8,,.. L�giun3 6k61 8�1'�on Aaeaue N.E. 571-3422
. 9 .CbNTHAC�FF}R - b1A1LAii[lA@$S. � - � I�P � PHONE � LICENSE NO -
� $dffi@ -", . ' " . . i
: 4 AcR�HF CTONDE�fGNER � MAF�.0.�6Rff$5 �� � : Z�P' . � � PNONE LICENSE NO . :
6 "ENGl�1EER ' %1AL4A#]Df�ESS � .. . .21P - PHONE - . UCENSEMO �. .
6"USEOFBW4D/NS'i:=` � � ' - � �� �� .
. R86�IIEldl � ;. : . ' :. . . . � . � �.
7 ClASSQF WddK � � - � . �.
� � �. E3 NHW ❑ AflOFTiON. � � ❑ .� ALTERATION .� ❑ RERAIR : . ❑ � MOVE � ❑ REMOVE _ �
%
, B dESGRIBE W¢AN ,:. . . , � . . . . .. .
� S�C7 DW` ul.. :� ... .. . . . . � . . .
� 9 CHANfa��F#/8&�POM " � � TA.� � . � . . � ..
sa�r�utntiows . :
� -
, �l���� pERAt�I'S �E
� _ ��'rr�. pc�,�� ��o �nR �� � -
� ��
� � �-� �� � � ,Y.�rOF�.CANST ..00CUPANCVGROUP �OCCUPANCYLOAD
�{�{&PEfiM1Y5AFlER��LL��i1'fpREL6CTRIGL.PLUM�FNG,HEATM(i..,� .. � � . ' . �.
Y�'fi{�kY1W6 OR AtR. CONUITIONIN4. � . . . .. � � �
�:. �� PERNIT BECOMES NLILL ANO ?1DIQ If.. WORK OR CQNSTRUCTION 20t�M7(a'-. .: �SO. FL .��- � CU. FT. .
; i�l±kORIZHD 7S NOj S�7MMENC�P ��?Htt; 60�DAVS OR IP f�p5{STflUETIpN �,. . ..
t. i .
,- �019 �WORK�IS SUSPENDEA OR K#yA/i@dt#EO.FOR A PEAIOD Of� iNl DYyi�� 3�::. , '�... ��. . .. .
ANY'TIME RFTER WOAk I& QOMM£NCEO. `! � pW{;G;�'yJyyTB' ,� OfFSTFEET PARKING �
I HEpEBY-�EATIFV THAT I HAVE�I[�AD pN0 E%AMINED THIS: APPUCATION � STALLS �� GARAGES � �
ANONTI�YtTME5ANI.ETOBEtRUEA{J0QQ5itECT.AtiPROVISIONSOF�AW3 yp�(jAT�ON.- � SURTA% � � �
AN6pALNWANGES �OVE(ANINO 7N75 TYOE i}F WQiiK WILL BE COMPLIED'.�� < �
WITY4 WNE3lFER Si?EG�f180 FFER�NJ �OP NOT 7NE� GRANi1NG OF A PERMIT�� � �OO � � �. SO �
. �� DO�S.NQ1'PRESUffi�'LO GIb� qiJ1HORITY TO�VIOUTE OR CANCEL jHE�. pERMITFEE �� SACCHARGE � � ����
. PR(3V7S1QA3 fi1F ANY.DTM�H 37Atp pP EPA%iL��4�W REGWLATINU &QNa� - . . . . . . . . '
STRUCiION,OR i!{E�!ErF'6RMANCEOF�CONSTRUCTION:. � .
.. ; � `:: � � � � �.. � ' -PLAN.CNQCK E � TOTAL FEE . -
�8.�0
, „ E'¢p!$qjT�iAnCi OR� �*NOA¢EOnGEr+T ionTE� ' WHEN FROPER VALIDATED THIS��IS YOUR PERMIT .'
�` � �" �--- -- i' = � � s 8�
�.
_ ../ f�.. FA�IG ... BPBWlOFR� � ° Ef �,BL�G �4 . � � fl<i .
_ . . . . . . es�� �vq� -� -
CITY OF FRIDLEY • •
� ARPLIC/17'IO�J fOR RESIDENTIftI_ 13U1LDiFl6 PERMITS "'
�- (N�w, Alter�ations, Additions, or fiepairs) '
. , . �
.���� . . ,
� 04JfdER: ____„_,__k-�--YC._. f3UILDER:. - _
AQRRESS: ,��{l� .tm.i�n>e c�e_.xyl.f. AUDRCSS: �.�� .
'fEL N0: -s�1F��I- 3 y� YY 7EL fd0: �
� ,
Construction Location .
. �. STRI�T 130: 4 'i� / � STk2EETe �� S�i.i`�.`.�,-�. �t?/��• �'+�• � � . .
I,p�� �' .� BLOCK: �_ ADDITION: ��� .�
Corn�lt Lot; Inside. i,ot: �✓ SetbacY.: Sideyzrds:
Applicant attach to tIiis form Lwo Certificates of Survey o€ lot and '
prop�sed building location drawn on certif.icates to scale. :
dESCRIPTION OF CONSTP.UCTION -
�� Pront: Depth: Height:
. ' �� Squane.I'eetc � Qibic Feet: � . � '
Fror.t.:
—•---
Square• ieet:
�p{�; _ Height:
Cubic Feet: _
Type o£ Construction: rpvb.�) / � �stimated Cost: $"7��
7b Be Qompleted:
Alt. A Alt. 8
Proposed Driveway Width If New Opening Is Desired: $� $'
SEE REVERSE SIDE OF SBEET
Rhe utt�dersigned herel�y makes apglication for a permit ior the worK herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Departanent of Buildings, and hereby declares that all the facts and
regresentatioiis stated in this application are true and cozrect.
. ., �7
DATE:. �� (� i �� SIGNATUI:E:
� Stipulations:
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BUJU)IiJG PCRI�IT fCtc SCfIGDULE �
;L•'C'PION ?.. Ti�e 7n:;pcetor. ot 13�Lildzr�g:s ::lial.Z, bef:or.c iu�uing penniL-� tor lhc erccL•ion
af: any buildi:ng or r�irucCtu-c, or for any addi.ti.on to a��y exi..Linq building or sCructurc,
. or f:or. any altcration or, r.c��air. , Lo •any cr.i.,ting bui.lding or st•r.ucturc, u�,wn application
ther.etor.e, require Uie payment }�y tlie app].i.canL• Lor. :.uch per.mit of tees to. L•l�e �mount
hcrein be.low set f:orth and in thc mannet'hcrcin ProvideQ L•o-v�iL•:
Illiyl CONS�l'P,UC'�IOtJ: Singlc ].'ami].y Ilomes and Gar.aycs: $4.00/1,000 cul�ic Eeet. •
I?I,AN Clil:'I;: ?.5 per.cent of bui.ldincJ permit iee.
D1tIVLY7AY llBY12ESSI0W: {ConcreL-e, Cur.b : trcets Only)
• Altcrnat:e 1�: Removal and replacement of ctrncrete curb and
yutter only; Driveway widtl� plus 6 fee� x$15,75
Rl.ternate II: Removal and replacement of conczete curb and
.'. gutter and i.nstall a 3 foot wide approach with �'
. 6 inch depUi; Drivc�ray widtli plus G ieet x$17,85
�. (�DDI TIONAL I NFOR�IAT I ON -
I�'or the purpose of computing fees Eor buildinq permits, tlie cubical cont-enL-s af any
buildiny or addiL-ion, is determi.ned by multiplying Lhe ground ama covered from a
point sir. (6) inches below the floor line of tlie basement or th� cellar t•o the
average heights of the upper surface or io the average height of the roof surf:ace
oi tlxe ;aain gable o£ a pitched roof.
For. repairs or alterations to an existing structure, the fee shall be at the xate
. o£ $3.00 per each iive hundred dollars-($500.00) or fraction ihereof in the cost
o% aIl proposed work. . �
In�no c.ase shal.l the f�e charged for any permit a� set £orth zn SeCtion 2.be tess
than $7.50 plus $.50 state surcharqe. '
• ,yERTFICATION OF FOUNDATIOf�
NOTF: Permits :or construction will be issued a minimime of 24 hour� fr.om the time
of appli.:;ation to allow for propes review of the proposed structure and of the
const�.uctioii site.
A Certificate of SUZVey of the lot, showing the location of ihe ioundation ance it
7ias been constn�cted will be required befo m proceedin9 with the £raming.
CCRTIFICATE OF OCCUP/�NCY �
' Application for a Certificate oi Occupancy shall be made:t-en (10) days prior to the
use or occup3ncy of any sCructuie ior wlaich a buildinq permit 1ra� been issued; and
said str.ucture shall not be used or occuyied until a.Certificate of Occupancy has
been issued.
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�ity of Fr�d��Y.. : 17989
pT�?HETOPOFTHETVtIN4 g�:.����..�G� p�RM�.IT
r
; � ��. . � � - .. � £GEIPT NO�. ` .
� ��':: � • �. COMMUNITY DEi6El4PMENT �IV. : .,.... . . � . . -*
��. . �'y "� PR0T8CTIVE IN$T&CTION SEQ � � .. .
, �i ,
� �"'1 � C17Y NALL-� FRiDLE� �93�32 NUMBEH� AEV. D�TF � GAOE tli .APiROVED B�
i....Jl.� ••, bt2-571-3a5o 9,aFts ,
5/20L85 I /
iai��oere5s . 64b1 AShtr�n AYernie N.E.
� rn
,, �. f'� �� ,y' � lQ�NO.,, DL� K . ��:� TRACT6RADDITION " � � SEEATTAGHED �
�a; 5, 6 13 Fridley PaYk sHEer
:. R .' � � V' R � � � - MMLA(?ORES$ � . � ZIP �. �.. PNONE .
'� :•ivioYd Found 6461 Ashton Avenue N.Er
--!�� 3 C4NFqA['�n'6R� �MAIIADORESS � „�. ' Z�P�.� PHONB UCENSENO. , �
`8iah;a�d Hastings Gant�. 6331 Rine�rievt 9Jatci„ace DI,E. 579-9466
� � N.ECTORD�14NEii .� � '' MAILADDRE53�,. ' ' �- 21P � PoiUNE LICENSENO. � ��
5" EN � R . - � � - � MAlLAD6RESS . . � -� � . ZIV PMONE UCENSf NO. � � ,
�0�.�8UILOFNG� . .. .. . � �
F�i�}eA.ti,al .
`-` ;,� �$ ��R� � ❑ NENQ ❑� ADpITION� C� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE � ��
a nescwaewoaK
��'a Rezoo# t�relling
. . 9 CMAN6EQd��UB$I�NWI..�� . . 70 ' . . . •.
,. �;If[41LA7 N5 ,��, : � . .. . . ... . . � � � � . .
i..: . -. . . . . . � . . . ..
.x
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'� . TVV T. �� OCCUPANCYOflOUP OCCUPANCYLOAO �
l�JaRf.RfiWIfiE6 FOR E�ECTRICAL, PLUMBIN(i, NEATING, �
vEN�'ICr �AORlMp..:. .
� 7HI� BE 4�1iW1 �:YfD„ E�.I WORK OR CONSTRUCTION yONIN }� ' �80. fT. CU�. FL ' �
� AUTHORRE�JS NOT COMMENCEi�,iV1�YM/('�Q+ly�, OR IF CQNSTRUCTION ' � ��
�. OR N(ORK'18 SUSPENDED OR ABANDONED FO�iI.Ay?p.�1�0 OF 170�-0AYS AT � � � �
" ANV"Tlbff,yp.RT�N,A6-COMMENCED. ' HO� OWLG. UNITS� OFFSTREET PARKING �
t -.
111EPEQk��CERTiRA TM%iT 1 Ft4.Y�v�E+±p ANA E%A1dINE0 THIS APPLICATION �� �� STALLS GARAGES �
. � ANRKN0I�THE$R�'n09€ZRfdr`m+k'���•01�iSECT;AILPFOVISIONSOFLAWB.�. y/�tUAT10N;��. . � SURTA% � �
�� ANp Qpp11,JySNGfiS.¢GOVEpMlyfr`7i11$�7`�'!�E'�f-4YpR1{SWILI BE COMPLIED .. . _
7
� WI7!{ y�1FJ�j'}[Eq'�EChFiE4�M�REIN Y,1p NQT THB�6R�NTIN$.DF- q pERMIT ], � ' 5�75� �
��. �KOTiTRE�tiAiE` QI{[E AUTHQR4i,V t0 WIOIXT€ RR GkNCEI THE p -. '- SACCHARGE ' �
16{pµ3 6F A1C�l`,�MEik$TATE�Dp iQ�A�I�LAW PE011lA71N6.00N-� - � � �
.,:. � �UC7ION bR TW€..�EAf6AMANC�@ Qf CONSiRd.CtION ` . `. , . +2S? OQ � � � . :,::
� � TOTALFEE
�� �r� � '���� S�2o - $25.75
SKaNATUREOff;pNiP}C10AORAJt1 R2EDACsENT I�RTE� WHEN PApPER�Y �A��DATE 1HIS IS VOUR PE MIT
� � . � ... � � � .
' ��:SIGNA, UR(OF .�ilf �VINEPBUILOEFJ iOATE� �N � Oa} �
. . .. . _, . � . . . . . . � .�5°. �.. . � , .
N0i [] City of Fridly Effective 0/1/B4
ADDN. I I R-1 l!D !.2
iI.TEA. I 7 Building Perait �pplieatioa
Cor�.struoLlon �ddress: 6 �` / .� <�'I`onr A� 6
I,egel D�scriptioa: L of" S-.L `81 o c� t 3 FP.:�Ce� ,�,q R r /� ��.
Wner Nae i 1Wdress: ��QT .�._ �o..� N� ltl. 1
Contraotors R: c l, e, �[ n „�RS� ��r t S Tel . i S? Sr^g��t
�dans�: 6�3[ R�vE�,�f��,.� �T�'k
LIYING AABA:
QARAQE �l1EA:
DECE �HBA:
4TIiEA:
lttach to tAis application, a Certificate of Survey of the
lot, xitA the propoaed conatructioa draxa on it to scale.
Length
Lehgt6
Le�gth
Corner Lot [-j Inaide Lot [ )
0
YSdth
rsacti
Nidth
Ft. Td. SetDacic
Type of Conmtruction: �F�T o�F �1- '�F�oo�
Approx. Complttion Date: %��5�8 S
Height
Beight
N6t/Ground _
M t
Sq. Ft.
Sq. Ft.
Sq. Ft.
Side Yard Setback
Estimated Cost : t /So o. o a
Alt. A Alt H
Propoaed Drive�ay Width If New Opening Ia Desirod: = f _
See Bsek Page for Explanatlon
DATE: S2o d' S APPLICANT: �.`� /^�+-�-.�.� Tel.
Permit Fee
Plap-Cheok
State Surcharge
SAC Cearss
Park Tee
Sswr Main Charge
tor�.
STIPOLkTIONS:
CIiI �SE ONL!
_ ��- OU Fee Schedule on Reverse Side
_
_ ��
i
�
_
= a S �S
25f of Suilding Permit .Fee
i•50/=1,000 Yaluation
=425 per SAC pnit
Fee Determined by Engineering
5��� Py'6,�'
Agreement Neceaaary [� No= Neeeaaary t]
s'+s ..--
��.DING PHRMI! !8E SC86DIIL8
The Ch4ef Huilding Official shall. Eefore iaauiag permits for the erection of any
Duilding or structure, or for a�,y addition to any e:iating building or structure, or
for �ny alteration or repair Co any e:iatiag bulldSng or atrueture, upon application
tAsretore� reQuirc t6e paymeat by tAe applicant'for such permit o! feas to tAe �mount
Eerein Delow set forth aad Sa tpe �an�r herein prorrided to-wit: �
Sotal taluation
�1.00 to �500.00
=501.00 to �2,000.00
=2,001.00 to =25,000.00
=25,001.00 to ;50,000.00
=50,001.00 to �t00,000.D0
110D,001.00 and up
: Plfq
=10.00 (!lini�um Fee ia =15.00)
=70.00 ior tAe firat =500 Dlus =7.50 for each
�dditional =100 or fraction tdereof, to and including
=2r 000.
=32•50 for thc firat :2,000 plua =6.00 for each
aaditional =1,000 or frsetion thereof, to and
iacluding =25,000.
=170.50 for the firmt
addltioasl =1,OQ0 or
including i50,000.
=25,000 ylua =b.50 for each
fractioa tdereof, to and
�283•� for tre firet =50,000 plua =3.00 for each
additional =1,000 or fraction Yhereof, to and
ipoi�i� =�oo,000. ,.
=�33.00 for the firat =100,000 plua =2.SD for each
additional =1,000 or fraction t6ereof.
DRIYE'8Af DEPRESSION SSC80Y,
(Conerete CurD Streets Only)
Alternate "A": Removal and replacement of curD and gutter only - Drivevay width plus
6 feet times =13•50
Alternate "8": Aemoval and replaeement of curb and gutier and inetall � 3 foot xide
approach With 6 inch depth - Driveway xidtD plua 6 feei timea =15.75
YSRIPIClTION OF FODNDATION
Permits for construction will be"iseued a■inimum of 2A houra from the time of
application to allow for yrop�r r�viex of the propoaed atrueture and of the
construction aite.
4 Certificate of Survey of the lbt, showing Lhe location of the foundation once it
has psea ooaatructed vill be nQuired Defore proceeding with the framing.
.
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. � � � wuclr` � � � � � � � P£R
City of Fridley � d 8 9
.� •T.METO°o`."E��"5 gUIIDING pERMIT
� RECEIPT NO.
` a667
� ; y � �OMMUNITY O@V�IOPM@NT OIV. . .
/ � ����� VFOTECTIVE INSGECTIQN SEC.
�
� � � /'�'1 . CITY MA�L FRIl3LE� SS�77 NWOEP �FV (NTF ��GE 0� �M1qYE0 �Y
t'""� � �'' 612-571-3460 gtU-P�S 5./2/00 / /
�oe �opqess 6461 Ashton Avenue NE
1 IEGAL �OTNO. BLOCK � � TqACTORAbD1TION SEEAT7ACMED
oescn. 5,6 13 Fridley Park s�eer
2 PFOBENTYOWNEA MAtIADDRES$ �P �MONE
Effie/Lloyd Pound 6461 Ashton avenue NE 571-3422
3 CONTRACTOR � MAIL ADWIESS Z�P PNONE IICENSE NO
R Miller Construction Inc 5316 Matterhorn Dr, Fridley, Mn 55421 571-3514 6354
� ARC111TECTORDESI6NER MM��ADbRESB � Zt0 VNONE LICENSENO.
5 EHGINEEF MAILADGAESS , Z�P PMpNfi UCENSENO
8� USE OF BNIDING � - �
Residential
1 CIASSQF�WORK
O NEW O ADDITION ❑ ALTERATION � fiEPA1R ❑ MOVE O REMOVE
8 GESCN�BE WONN
Reside House
9 CMANGEOFUSEFROM TO �
STIPUlAT10NS .
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed.over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved:weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their applicatlon guidelines. Call for inspection of wrap
before covering.
TYP OCCON T. OCCUPANCYGpOUP OCCUPANCYLOAD
SEPAqATE PERMITSARE REOU�RED FOR ELECTA�CA�, G�UMBiNCt, MEATING.
VENTI�ATING OR A!F OpNDITIONING. - � � �
TMIS PERMIT BECOMES NUIL ANO VOIO If WORK OH CONSiRUCT10N zONING 50. FT CU FT.
AUTMORIZED IS NOT COMMENCED V�(ITMIN 60 DAY9, Op �� CONSTPUCTION .
OR WORN IS SUSpEN0E0 ON �BANDONEO fOA A�iERlO� OF 17p DAYS AT
ANY TIME AFTER WORK 16 COMMENCEO. NO. OWLG. I1NIT5 OFFSTFEET PAPNING
I HENEBV CERTI:Y TNAT I NAVE NEAD AND EXAMINED TNIS APPIICATION 1 STA4lS GARAGES
AHDKNOWTNESAMET08ETNUEANOCORNECT.ALLPFOVISIONSOFLAW3 yq�UA 101+ � SUIiY x
ANO ORDINANCES GOVERN�N(3 THIS TYGE OF WQRN WI�� BE COMP4�ED @ r. @
.WITM WMETMEN SPECIFIED MEAEIN OR NOT. TME GRANTING OF � PERMIT w2sOOO q1.00
DOES NOT VPESUME TQ GIVE AUTM ITY TO VIOUTE OR CANCEI TNfi pEPMITFEE � � SAC CHARGE
7ROVISIONS �F ANY OTMEp 5T A Wl UW REGUUTING CON� $69.ZS � . � j.IO SC �Z.00
TA CTiON ON PERFp. OHSTNUCTION
. i�I�NCMECK� � £ T •LFEE
Lice e' C $77.25
— S�GH�ruAFO�CO �. urw0a�2fi0�GEN�� �O�iE� •Y VA ID . TMIS I$ yppP PERMIT
��
S�GN� UAEO OwnEa���OWNFABUnDEM�' � �tE� � `��/
ib50 L!f
�; ~
NE1N [ ]
ADDN []
ALTER [ ]
Constructian Address:
Legal Description: _
CtTY OF FRIDLEY
SINGLE FAMILY AND DUBLEXES R-1 AND R-2
Effeetive 1/1/2000
(763J 5723604 Bidg Insp
'� 1
Owner Name & Address: � .�� � /� �t � t�0 cT /cl.D Tel. # `� i%��/� �
Contractor. �� /%��(��✓ �+,�„n.�1— ��/ MNLICENSE# �,�5��
Address:� I L �G ffL'.!/ �,n✓'v� � � • Tel. # % ��� % �
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIP710N OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width
Length Width
Heght Sq. Ft.
HgUGround Sq. Ft
L E � Y�I.� L S' i:J �)e
� ` �
Construction Type: (-cS �f�d+�h �-/� �.. Estimated Cost: $ 2� 60C�
Driveway Curb Cut Width Needed: _Ft + 6 Ft =_Ft x$ _
/F�y1�� ��,��
DATE:�� I ' WAPPUCANT: ��/ /��G%// Tel.
�----T,,.
CITY USE ONLY -' Call (763) 572�3604 for Pertnk Fees if mailing in application
Permit Fee $ (� ,o?S^ Fee Schedule on Reverse Side
Fire Surcharge $ o�- C)O .001 of Permit Valuation (1/10th%)
State Surcharge $ /. O CJ $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Corrtrol
Park Fee
$ $1100 per SAC Unit
$ � C)U $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
g , a5�
•>- - •
� � y
BUII,DING PERMIT FEE
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 applicani for such permit of fees to the aznount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $Sa0
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$SO,OOIto $100,000
$f00,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for fust $500 plus $3.05 for each additional $100 or
fraction thereof, to and i�luding $2,000
$69.25 for first $2,000 plus $14.00 for each addi6onal$1,000
or fracdon thereof, to and including $25,000
$391.25 far first $25,000 plus $10.10 for each addidonal $1,000
or fraction thereof, to and i�luding $50,000
$643.75 for first $50,000 plus $7.00 for each addidonal
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fracdon thereof, to and including $500,000
$3,233.75 for the first $SQ0,000 plus $4.75 for each additional
$1,000 or fraction thereof, to a� including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Co�rete Giub Streets Only)
Alternate "A": Removal and replacement of curb and gutt�+�ly - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal a� replacement of curb and gu�� install a 3 foot wide
approach with 6 inch depth - Driveway wid'th plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours &om �he 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 loca6on of the foundatian once it has it has been constructed will
be required before proceeding with the framing. New Houses Only
��g��
Building
Inspections
763-572-3604
srrE annnESS �yt
7'H13 APPLICANf i3:
PROPERTY
OWNER!
TENANT
CON17'RACTOR
SUBMIT A COPY OF
YOUR SfATE
LICENSE W1TA
APPLICATION
PERMiT TYPE
r�rE oF wotuc:
DETAII.ED DESCRII
Y�n � �59SQ
MECHANICAL
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWNER
CONTACTPERSON:
Pem�it No.: �
Received By:
���QEC 1 2!
� �, rta arti-l� � r.
EBWGLE FAMILY ❑ 1W0 FAMILY ❑ TOWNHOUSE -
❑ NEW
OF
43.�r'LACEMENT ❑ ALTFRAITONJRP.MODfiL
PER MS 16B.665 the permit fce is a minimam of 515.00 or 5•� of the total coat ap to SS00.00, whichever is gieatey for the
imprOVement, installation or replacement of a residential fixwre, excluding tlre S�ctures. (This should reflect ooty the cost of labor )
Labor cost �mdet $300 =$15.00. Labor cost between $3pp to 5500 = cost of labor x AS =
FOR PROJECTS WEII+RE LABOR EXCECDS $SOD, FEES ARE BASED ON SIO.OD PER FIXTURE, EXCEPT WHERE NOT&D. FIXTURES: (IND[CATE TOTAL
1d[7MBBR OF FaICH BHLOV�
F mi�..wnt Gm.u.,�
A/C 525.00
AIIt 2Y1 Allt EXCHANGEIIL SIS
LINERS10.00
Surcharge
TOTAL DUE
t"�G� MODEL:
MF� MODEL:
MFG: MODEL:
FIREPLACE (GAS) SI5.00
�FDtBPLACE (WOOD) t35.00
SiZFJBTU
SIZF/BN
SiZFBTU
I7NIT F177t
..u�uuw u■ iunaes a� aiu.w x alU.W =
Number of fixtures �$15.00 x SI5.00 =
Number of fixtures (o) 525.00 x$25.00 =
Number of Sxtures (a3 $35.00 � x $35.00 =
State Surcharge = ;
Tota1=
THIS 1S AA1 APPLICATIOP! FOR A PERAff1'-NOT VALID UNTQ, pROCESSED
I lurebY apP13' for a building permit and I aclmowledge that tl�e information above is complete aod accurete; that the work will be in
°°°f°rme°�e with the ordinanoes and codes of the City of Fridley and with the Minnesota Construc[ion Codes; that I understand this is
�t a permit but onty an appGcation for a pamit and work is not ro start wiq�out a permi� thaz the work will be in accordance with the
approved pian in �e case 1 work which(�/,Q �uire^s re�v,ie'w Land approval of plansp.
SIGNATUREOFAPPLICAN�/Y Y1� /A1U Ml Y1 M� ................ .4��V�/�� � 1�\I/`�� ��� �osl�ci
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977