AF - 35995�u:
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City of Fridley, Minn.
(�..�-�5a 9�
BUILDING PERMIT N� 717g
/y/^, �ocario sui iN�
Na _.1..�(Q;1.� 3treet . . ��_ Y of Lo _......._..___.._.___... .._...-.--
Iqt ___..�c-l.�-_ Black —� .._..--:,. Additlon or Sub-Divlsiaa� _ . .. _. ...._ ,
Corner Lot _`.� _ Ina[de Lot .—_..._ _....--.-- Setback �
�i �+5�'--._._ sia�s��a --._LQ�___�? _.,___..
9ewer IIeva� ._¢_�� �•--------._._...__.._._ �, Elev�tia� _..�_L.�%. ° --.-.--
--' - - " �-
� DaCRIPTION OF BUILDING
; U / /
F�oat'F-..�-. DePth _.�!/ 8ei8ht ..=dz Sq. Ft �.Kl.� Cu. Ft��
-- - �� --�--"- �Pth _ _ iTeight __� 3q. EY. _----.-- G�t. FY. _.._..._._._
Tyge of Conshv _��� �ra�... FF�t. Co�����.y�,
..�r{c/,�._.._.._.... To be Caanpleted _.:_.._...--.-----.—
°l;TSlD� A�PEARANCE Of 7HIS BUILDING MU3T BE Of
,;°F :�;VED VA�IBdCE WITH OTHER BUILDINGS IN TtUS
ut,uC.11.
In canslderatl� of the 9esuance W me of a permit to 0
the Pa�eB work in acxordance with the description above
ordlnanc�ea of tLe dty M FridleY.
7n caodd�ati� of the pqyment of a fem ot $�t� --, 8ermit is herebY Sranted
I agree W do
PmviclOns of
to o�atrvet t6e building or additi� as �scribed above. 77ils permit is granted upaa
the e�cBress canditlaa that thepe W wLom it fs graated and hie agents, employees and worlunen, in all work
done in. aramd and uP� aaid bu� il�ding. or anY Pert thereof, shall oontarm in all respects to the ordinances oP
FridleY� Minnesota regarding locatia4 constructia�, elteration, malatenance. rnpafr and movIng oP buil
wt� etey Iimits ana this aerm�c mqy be revolcea sc anr �pc'�q-vtol�°e anp of the a�vta;a�ns aa�a
Building Inspector
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APPLICATI�i FOB`J91iTt.DI1� P&RTIIT
CITY `OF 1�DL3iSf,' i1iD1N6$OTA . _ �° `
�xPw.�,�� 8�,�,� ���� c�r-r ���� ���
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?R lV� annxsss 3S�f�r �o ��
� LOCATIOp OF BIJ$flYNG' ` '
No.:_. YU'v� ,�' ` `Street ��D/� �` Pa;t of Lot
LOT� �,�.,_BL�K_�_ADDITION OR SUBDIVISION �_ A_'7 v
. . . . - . . . � w. � � . . im` _ �(/�s.
. . . . . . _ . . 1 ' �L°` - '
Carae`r �ot InBide y0T 8etback��Side-Y.aid
SEWSR BLBVATTi7li' . POUAf1A�'Ii�' SLBVATIUdP '
_ �,
Applicant attach to thia form Two Certificates of Survey of Lot and proposed
building location draw on these Certificatea.
DHSCRIPTION Okr BUILDING
�. ,, _
'To be veed �s; :
� C a R BiPaQP Front a0 Depth a a He�ght�
�, Sq.. Ft. S��v Cu. Ft. .� C�O ._ :
. . . . . . � . . . . , . � . . n , .
�.�._..,._, --� � qeight ..
���=
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Tqpe of Conet sEbADA ALUMINUM OF MINNESOTA, INC. :ed Coat /T�v�
.. .� .:��.� Phon�: Minneapoli� 37{-Y550 — Si. Cloud 251.06I2 � . . . .
i�0 �7e �COm(/],@t 725 S�cand Arenw Norfb — Minn�.poli� 6, Minn��of� .. .
.. . � .. . 617 Fir:} 54���t S.E. — ST. Cloud, Minn��oi� ' . . .
�� � � �� � STORM DOORS • �JALOUSIES��M W�N N SS • EXTRUSION
The underaigq s� the work heretn apecified,
ag*aeing to d'`�� I q of Fridley Otdinances
aad rnlinga c N �clares that a31'the facta
and represeitC � e �
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naxs� `�
(Schedule of
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, SUILD7.NG PBRffiT FYB SCHEDULB
ggCM�i 2, The Inspector o#.Bufldings st�ll, before issuing any permit for ehe
erectioa of any building or structure, or far any addition to any egiating build-
ing or atructure, or for any alterationa or repaire to any esiating building or
structure, upon apPiicati.an tUerefore, require the payment by the applicaat for
auch parmtt of feaas to the amount herein beiow set.farth aad in the manner herein
pravided to-wit:,
2,2, For any such permit for the erection of any fire-proof building,
other ehan a garage, warehouae, £actory or grain elevator, or for tHe erection
of any fire-proof addition, for eimilar occupancy, to any existing building,
shall-be at the rate of $1.40 for each one thousastd cubic feet, br fraction
thereof, in euch tubicai contenta:
2.2. For any such permit for the erection of any fire-proof garage,
Warehouae� factary or grain elevator, or for the erection of aay fire-proof
addition, for aimilar occupancq, to say existing building shall be at the rate
of $1.25 for each one tboaeaad cubic feet, claseified a� "fireprooi" by
- 3ection 502 of the Minneapolie 8uilding Code.
HOITSBS
2.3. Por any such pe;mit for tha erection of any non•fireproof building,
other than a garage, warehouae, factory or grain elevator, or aay naa-fireproof
addition, for aimilar occupancy, to any existing building - permit $1.00 for each
one thousand cubic feet.
GARA�BS _
2,4, For any such permft for the erection of anq non-fireproof garage,
warehouse, factory or grain elevstor, or for the erection of any noa-fireproof
addition, for similar occupancy, to any eaiating building or far each euch
building or additioa - ninety cente ($0.90) tor each one thousand cubic feet
or fractfon thereof, in the c�tbical cantents thereof with the mini�m of $4.00.
For the purpase of computing fees for building permtts� the cubical contents
of any building or addition to a uniform height throughout by multiplying the
ground area covered From a point six (6) inchea below the floor line of the
basement or cellar to the average height of the upper surface or to the average
haight of tha roof eurface of the maia gable of a pitched roof.
2,5. For �epairs or slterationa to aa exiatiag structure, the fee ehall
be at the rate-of $3.00 per each Fi.re Hundred Dollars ($500.00) ar fraction
thereof in the coet of all propoaed work.
2.6. In no case ahall the fee charged for any permit as aet forth in
Sectiun 2 be lese than $4.00:
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City of Fridley, Minn.
BUILDING PE�i.MIT
��; Jan . 7 , 3f� 1969
y�sssa'
N° 10076
p�yer; P. Healy g��r McCall Co.____._.__..�_._.__
p��� _ 7�Sjl Bacon Dri.ye N. E. _._ p�s 1618 West�ake St_ _�
LOCATION OF BUILDING
Na � �l � 8heet —._Bacon Drive N. E._...._----- Yark M I.ot _ .
I,,� 10 __ gl�g ___ ___, 1_��� �. g���� ___Meadowmoor Terrace
1_. ._- - Crnper Lot _�_ Ineide Lot —_. Setback ---.— SideYard
_ -- _ __
3ewer Elevatlm -----.----------..__._..__ Fo�mdatim IIevation __...—..—..– ----
DESCRIPTION OF BUILQING
xo te u.ea as:
Re airs after Fire
P Frmt —_ nepth Heisht .--- &t. �. --- c�. P't.
--.�_._....___ Front Depth Heig6t ..—, Sq. E't _.__.—.._ Cu. F4 _.�.�
TYP@ Of CaothvMlaa __._.Eramo FB' k Cost --�2�.5..QQ..D9_._.. To be CamPleted —._—..�.�
In �rati� ot the iaeuance to �� a.permtt to canshuet the building deecribed above I agree W ao
t� pcoporeA wosk in accoidance with tt� descrlpUan al�we aet forth sad in co�pliance with a�l provtsions ot
_aril�tancee oP the c1RY o! i+'�ky. . �^�,
� .. __ _" i Q . �f^`-i -� - t��_�/ L D
m�e►a�aa� �r c� �t � a� or a is . oo _., a�c �, �r e�s�a ta. rtocaii co .
co c�.scucc we b�l�ns �' eaathm ee aa�ibea 8bove. rnsep�rmi c is srsntea ,ipon
the e� mnditiva� that thepere� � to whom it is ganted � and his a�ents, �ploy�s and wrMrnxn. In all work.
�u in. around md i+P� eaid buildln& or e4v P�'t thereof. shall c�qrm in a!1 nspects. W the ordineacee d
��Y� Minnaota regeidinT locattaG, conshvctton, alteratlan. maintmaace. reP�' awl mwini of buU��
ovlthiD the dty 11ffits and thLB B�'nM1it may be revaked at ar�y time opwe vlolati� oP a� at UM D� o[ seld
�►,��.�.. i��,
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iw vwi dw .a es... �h. e�heeqe�, wfJMtee t« w�r�.a v�a w�Y. �ww x�ra... e. .w. e. ...
fl� l�Y�Y �pqr� ter a�prN� PnsiM fae 1M� (b�n.
'� ;`i�? . . � �,r-
APPLICATION FOR BIIILDING PI$tMIT
CITY OF FBIDI.EY, MINNffiOTA
��8 �p,. N E,� � k �� rr r e �� � L���,
.n�ss 7� o�- r---� ' �s � 6 i ss -�,1. � t f- 1 i3 k F
Locemiox oF suiLnrxG
xo. 7�� �- smx.�r I3 fl C o ly ,D 1� �' L� N, F,
LOT I D BLOG$ t ADDITIOIP OE SIIADIVISION � E,�: p Q y/MOD� ��/3
COR.17�i LOT INSIDE LOT SII'BACIC SIDPYARD
Si�YlIIt SL�PATION TOP OF FOCTIHG
Applioant sttach to thie form T`,..o CertiYicate6 oY 3urvey of Lot and
proposed building locatian drawn ott thea� Certifioatee.
D�CRI.PTION OF H[JILDING
ToBeIIaedAe: f{�/"f�1"RS liE7'�/i ��'RF
,
Front Depth Height
�quare feet Cubic Feet
Front Depth Height
Square feet Cubic Feet
Type of Conetructio.n &etimeted Coet ',� ��'p Q, � jj
To Be Gompleted
The undereigned hereby makes application for a permit for the work
he7rein epeoified, agreeing to do all work in atrict accordance with the
City of Fridley Ordinances and rulings of the Depsrtment of Buildinge,
and hereby dea]sree that all the facts and L��;reaer.tations stated in
thie appliaation are true and correct. p� � e� y 1�! eur
DATE SiG�i#TUR�r G'! . ✓'�-�-� � C� ��P /
(Sahedule of Fee Coeta can be found on t� Renerse Side.
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BiTII,DING PF�?MIT FEE SCHF�tTLE
SECTION 2. The Inepector of Buildinge ehall, before iaeuing peraite
for the erection of any building or etructure, or for p.ny ad.dition to any
exiating etructure or buildi.ng, or for any alteration or repsire to �uy
eaisting buildiug or etructure, upon application therefore, require the
payment by the appliosnt for euch permit of feea to the amount herein
below set forth and in the manner herein provided to-wit:
IIniform BuildinA Code: Type 1, 2, & 4-�1.75 for e�ch one thouaaad
aubia feet, or fraction thereo£, in euch oubical oAntente. Type 3� 5-
�i.50 for each one thouesnd cubia feet.
For the purpose of computing fees for building permita, the cubicsl
aoz3temte of any building or addition to a uniform height throughout by
multiplying the ground area covered from a point eix (6) inches below
the floor line of the baeement or the cellar to the average hei.g3�t of
the upper aurface or to the average height o£ the roof surface o£ the
main gable of a pitched roof.
For repaire or alteratione to an exiating etructure, the fee ahall be
at the rate of �3.00 per each iive hundred dollare (=500.00) or
fraotion thereof in the coet o£ all propoeed work.
In no case shall the :ee aharged for any permit aa eet forth in 3ection
2 be leas tt�.r, �5.000
NSSSD Connection Charges baeed on location .- Area 1 or 2.
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5u8JECT
;� City of Fridley
ATtHETOPOFTNETWINS gUiIDING PERMIT
. �
� � ��� COMMUNITY DEVELOGMENT DIV.
% � y � iRpTECTIVE INSPECTION SEC.
, �
l-.--� f"' �� CITY NALL FRIDLE� � 55�32 MuuBER REV �
� 612-571-3460 910-Ft5
ios nooness 7601 Bacon Drive NE
1 LEGAL �OTNO. . BLOCN � TRACTORA�OITION
DESCR. lO 1 Meadowmoor Terrace
2 PROPERTYOWNEN MAILADORES¢
Ellwyn Healy 7601 Bacon Drive NE
3 CONTRACTOii � MAIL ADDRESS
Same
6 USE OF BUIIDING
Residential
7 CLASSOFWORK
�iE C�GE OF
fi/17/98 / /
26272
,3�/0
SEEATTACNED
SHEET
PHONE
786-1685
PNONE LICEN6E NO.
PNONE LICENSENO.
NO.
O�; NEW ❑ ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE ❑ REMOVE
Reroof House &
9 CHAN6E OF
S71PUlATIONS
Tear-off
IL•7
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED fOR ELECTRICAL, PLUMBING. HEATING. TYPE OF CON
VENTILATING OR AIR CONDITIONING. � -
TMIS PENMIT BECOMES NUIL AND VOID IF WORK OR CONSTNl1CTIDN ZONING
AUTHORIZE� IS NOT COMMENCED WITXIN BO OAVS, OR IF CONSipUCTION
OR WORN IS SUSPENDED OR ABANDONED FOq A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. - NO. DWIG.
I HEREBY CERTIFV iXAT I XAVE READ AND E%AMINED THIS APPLICATION 1
ANDKNOW TNE SAME TO BE TRUE ANO COFNECT. ALL PROVISIONS OF LAWS yAIUATION
AND ORGNAN6E5 GOVERNING iNIS TVPE OF WORI( WILI BE COMPLIED
WITH WMETMER SPECIFIED XEREIN OH NOT. TXE GRANTING OF A PERMIT �2>OOL
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL TNE pEFMtTFEE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATIN� CON-
STRUCTION OR THE VERFORMANCE OF CONSTHUCTION. *iBY�H
OR
t0�i6
STA��S
�1.Q�
SACCNARGE
$74.75 Fire SC $2.00
LOAD
NEW
ADDN
ALTER
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ConsmutionAddress:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
7� d � .� .a.. c o � �%� , N � �r
Effective i/1/98
��� �fl
3
Legal Description:
Owner Name & Address: � l('it/,%ltf f� � K�-�4_4Y Tel. fi ��6 -�� �-3
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTi�R:
Construcdon Type:
MN LICENSE
Attach to tl�is application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF Ilb1PROVEMENT
�n�n �
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w�a�n ,2 y /
.��_—.
Width � o�
TeL �i
Height
Height �
Sq. Ft.
Sq. Ft.
Fsrimated Cost: $ �� Q �
(Fee Schedule on Back)
Driveway C�rb C�t Width Needed: _Ft. + fi Ft = Ft x$ _$
�DATE: � - ( 7- � � APPLICANT� . Tel. #_ 7�6 � //v ��
Permit Fee
Fire Sureharge
State Surcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIOiVS:
$ / � S^
$ Ut5
$ �� U �
$
$
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Pernrit Valuation (1/lOth�)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5. W (State Licensed Residendal Contractors)
Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ � Not Necessary [ ]
i
$ � �
�»,�. �.�
BUII.DING PERMTT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erecuon of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any exisring building or
suucture, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$SOO,OOl to $1,000>000
$1,000,001 and up
FEES
$21 (iviinunum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and 'u�luding $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fracdon thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additionai
$1,000 or fraction thereof, to and including $100,000
$887.25 far first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the frst $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 glus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW , .
(Concrete Curb Streets Only)
Aitemate "A": Removal and replacement of curb and gutter only - Driveway width pius 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the consuuction site.
A Certificate of Survey of the lot, showing the location of the foundarion once it has it has been constructed
will be required before proceeding with the framing.
��/ "��/
� SuMECT � . � .. - : �
City af Eridley
;� "TT"E,o°°FT"E�,"S gUiIDiNG PERMIT
..
;� �� ____ COMNUNITY D(YELOPNQNT DIV. . �
% � � � PNOTECTIVE INSPEC71qN SEC. �
`...-� �''�.J CITY NAIL FRIOLEv . yyap7 ww�Ea eEV WTE ..
L . 61$-571-3450 9/Q-F13 SIzI00
J08 kOpRE55 7601 Bacon Drive� NE � � �
7 IEGAI L07N0. BLOCK � TPACTORADqT10N �
oescn. 10 1 Meadowmoor Terrace
t. PXOVERTYOWNEN MA{lA0ORE5$� 1
Ellwyn Healy 7601 Bacon Drive NE
3 CONTRACTOR � MAILADORESS - i
Same
MAII
� �
,..
•�
a� 65'
i novE�o Br
SEEATTACMED
SMEEi
MONE
786-1685
HONE IICENSE NO
Residential
7 CLASSOFWONK � � � � � � ' � '� � � � � �
. Gk NEW O ADDITION O ALTERATION ❑� pEpA1R O MOVE ❑ REMOVE
B DESCRIBE WOi1K� � � .
Construct a 12' x 12' Deck
TO
STIPt1LATIONS
See notations on plan.
WARNING
Bsfore di99�ng call for
all utility focations
454-0002
REQUIRED BY LAW
�� S�PARATE PERMITS ARE REOUIRED:OR ELECTRICAL, PLUMBING, NEATIN6, TMPE �F C
VEN7I�ATING�OR AIN GONDITIONING. � � � �
� TNIS PERMIT!BECOMES NULL ANO VOID IF WORIf OH CONSTRUCTION =ONIN6
•UTNpqIZE� I$ NOT COMMENCED V�(ITNIN 60 DAY9. OR Ii CONSTRUCTION
OF��WOAK IS SUSPENOEO OR A9ANpON[D FpN A PER100 OF ttq OAYS �T �
ANY TINE AFT�q WQBN IS COMMENCED. NO. - DW4G.
i NEREBrCEH7�FV�A�7 � qAyE READ AND Ex�MMED iMiS APVUC�riON 1
ANDKNOWTNESAFI�+j.''¢�E7AUE�NOLORRECT.A���PqOV1510NSOF�AW$ yALW ION
AND ORqtMM�ES G�6QptU1/a� TMIS TYPE O: WQNK Wlll B� COMP4IED @
WIiN WM{�TNEP SOECIFJEnXERE1N ON NOT. TME GRANTING OF A PERMIT `Y1,353
DOES N�T PR�$UME T0�61Vg�AUTMORITV 70 ��OLA7E OA CANCEL TNk VERMIifEE
PROVIS�ON$ OF. ANY OTXER�,STATf OR LOCAI LAW RE6UUTING CON-
S�RUCTLON ON�TME PERfORM�NCE OF CONSTRUCTION �SQ.IS
S�GNarUAfO�CONSN�C.IpaOF�Ytrrpp�jEO�GEMi iD�1E�
k t
STA��S
FT
$.67
CHnRGE
r SC $1.35
FEE
.97
NE1N [ ]
ADDN []
ALTER [ ]
Construction Address: % � a
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLFJCES R-7 AND R-2
BUILDfNG PERMIT APPLICATION
Effective 1/1l2000
(763) 572360���dg InsP
�,
M A/, �C'� �-�
Owner Name & Address: �/�!�01� - ?G e f ,t4.ctCo,� !3� �11, � Tel. # 7 �� — ( 6 ��
Contractor: �'cl�u. MN LICENSE#
Address: Tel. #
INING AREA:
Attach to this application, a Certficate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
GARAGE AREA: Length
DECK AREA:
OTHER:
Construction
n�. ,
HeigM Sq. Ft _
�._.'.._____ . n / .. �.
Estimated Cost: $ �/ 3$�,�
Driveway Curb Cut Width Needed: _Ft. + 6 Ft =_Ft x$ -
DATE: � —Od APPLICANT: _� OBu�-U_. � i,,���;P Tel. #__�J',�� -/���`
��� �.
CITY USE ONLY - Call (763) 5723604 for Pertnit Fees if mailing in application
Pe►mit Fee $_�z( Fee Schedule on Reverse Side
Fire Surcharge $ ��' .001 of Permit Valuation (1/10th%)
State Surcharge $ , � $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
$ $1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Aft. "A" or Att. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
==c� `""
BUII.DING PERMIT FEE SCHEDULE
The Chief Building O€ficial shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or strvcture, or for any alteration or repair ta any e�dsting building or structure,
upon application therefore, require ihe 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
$502 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,OOito $100,000
$100,001to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each addidonal $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and i�luding $25,000
$391.25 for fust $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$(43.7� for first,$50,000 plus'$7.00 for each additional
.$1,U00 or fraction thereof, to and i�luding $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each addidonal
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fracrion thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Ctiub Sueets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and repiacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus b feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construcdon will be issued a minimum of 24 hours &om 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 locadon of the foundation oace it has it has been constructed will
be required before proc�ding with the framing. New Houses Onlv
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Building
Inspections
763-572-3604
DATE �! - c�
SITE ADDRESS _
THIS APPLICANT [S:
OWNER/
TENANT
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
— � / voux e-nv.iL n�oa�ss
�/O/ �A� �!Z •
�OWNER OCONTRACTOR
NAME:
ADDRESS:
...,,,,,�. 7� t— 9i 7_ n/' �f
SUBMIT A COPY OF
YOURSTATE
LICENSE W1TH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
STATE LICENSE
EXP DATE
Permit No.:
Received
Date Rec
ADDRESS: CITY STATE_ZtP.
PHONE F�
��SAIGLE FAMILY
❑ NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY ❑ TOWNHOUSE
�REPLACEMENT
PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of the Wtal cost up to $500.00, whichever is greater, for the
improvement, installation or replacement oE a residential fixture, exduding the 5xtures, (This should reflect only the cost of labor )
Labor cost under $300 =$I5.00. Labor cost between 5300 to $500 = cost of tabor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS 5500, FEES ARE BASED ON 510.00 PER FIXTURE, EXCEPT WIiERE NOTED. FIXTURES: (PIDICATE TOTAL
NUMBER OF EACH BELON�
HATH SINK/LAV _FLOOR DRAINS SHOWER _ WATER PIPING
BATHTUB .GAS PIPING M�'ncmucEVSS) SWIMMING POOL _ WATER SOFTNER (S35) �
CIATHES WASHER KITCHEN SINK WATER CIASET _BACKFLOW PREV. (SIS)
DISHWASHER LAUNDRY TRAY WATER HEATER (S35) FOR IRRIGATION
— — WATERMETER _�T�R
�
�
Number of fixtures
Number of fixtures
Number of fixtures
X 3IU.W =
$�$.�� X$1$.00=�
535.00 _ x $35.00 = $
State Surcharge = $ .50
Tota1= $ is' �
THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the infortnation above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the Ciry 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 witk�out a permit; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT��� �, fb� PRA1T NAME �I�W�Mi /' ' /'� �� DATE � -S � � 7 .
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4477
Building
Inspections
763-572-3604
SI7'E ADDRESS '
THIS APPLICANT IS:
PROPERTY OWNERi
TENANT
SUBMI'1' A COPY OF
YOUR STATE L[CENSE
WITH APPLICATtON
�r��:�
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
OWNER
YOUR E-MAIL ADDRESS
... i_�x-�
Permit
Received
STATE LICENSE N EXP DATE � -
ADDRESS: CftY STATE ZIP
� BASEA�N'f FQJISH
0 DECK
DESCRIBE WORK BEING
.1
n
& GARRGE
Ge�G�' . ❑ ATTACFIED GARAGE
PROPOSED SlZE: O DEI'ACHED GARAGE
PROPOSm HEfGHT:
--- --..__-�_.---�---___.—_._. , ._
❑� -.—_ _� ..__ . _ _ . pSoffit ' .
❑ Aimnimun ' ❑ Trim
❑OtlKr . � ❑.F�cia
WQiDOWS
INEXIS7IIdGOPENWGS �Ya ONo LOCA7YONOFWQJDOWS
OR FOR NEW OPFNRdGS-DESCRIBE SIZE OF �
OPEIJING CHANGES &
_r�
O DRAIN 7'ILE
❑ 07ilER
�
Ft.
&ASEMFNi REMODFd.WG SUBtAT:
1. ExistingFloorPlan
2. Pmposed floor pinn
3. L.ist of swcNial manbers to be usW
�Z
_.
FUR F1�W C'bNSTRUCTION MCLUDING DECRS, �
ADDITIONS. � PORC}�S SUBbff[':
l. Sife PImJSurvry showing tlu ezisting struuures
� P�W� P�1�
2. Two uts of construaion plans
3. Energy Calculationa
: FEES ARE BASED ON VALUATION, DVCLUDING THE COST OF LABOR AND
([TSING 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S��`J�_. 00 . OGCUPANCY TYP
Plan Review
Fire Surchazge
Surchargc
License Stvchazge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times t6e total job valuation
.0005 x Pumit Valuation Minimum 5.50
55.00 (State Licensed Residential Contractors)
51675 per SAC Unit (Plans W MWCC for de[ermination)
ft+6ft= , ftxS21=$
5450 Conservation Plan Review
Fee Deurmined by Engineering
kgreement necessary ( ) Non Necessary ( )
Make checks oavabie to: Citv of Fridlev Attac
7}[IS iS AN APPLICA710N FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I admowledge that the information above is complete and accurate; that the work will be in
confo�mance with the ordinances and codes of the City of Fridley and witf� the Minnesota Construction Codes; that 1 understand this is not a
pennit but onfy an application for a permit and work is not to start without a permit; that the work will be i� accordance with the approved
plan in the case of all work wMch requires review and approval of plans.
SIGNATCIRE OF APPLICANT
Page 2- Building Residential Application
` BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permi4s for the erection of any building or
structure, or #'or any addition to any existing building or structure, or for any alteration or repair
to any existing building or structure; upoa application therefore, require tlie payment by the
applicant for such permit of fees to the amount herein below set forth and in tbe manner herein
providsd to-wit: ,
VERIFICATION OF FOUNDATION
Permits for cons�uction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed sh-uct�ae and of the construction site.
A Cerlificate 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 Depaztment
6431 University Avenue NE .
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
Buildi�tge
[nspections
763-572=3604
iITE ADDRESS
I'HIS APPLICANT IS:
TENANT
SUBMIT A COPY OF
YOUR S[AT£ LICENSE
W1TH APPLICA.7TON
'FYPE
�:�
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAO. ADDAESS
OCANTRACCOR
SfATE LICENSE
DATE
Received By:_
A7'E_ZIP
ADDRFSS: CITY STATE ZIP
❑ aas�m�rr r�n�nsx
o �c�c
DESCRIBE WORK BEING
SIZE OF IIvIPROVEW�NT
NUAffiEA OF SQUARFS _
GARAGFS
PROPOSED SIZE:
PROPOSED FfEIGHT: _
❑ HOUSE R GARAGE
❑ A77ACF�A GARAGE
❑ DEI'ACHED GARAGE
❑ nxaw rn.e
O OTHER
�
BASEMEN'f REMODII.WG SUBbllT�
1. Existiug Floa Pian
2. Aopoud 800r ptan
3. List of swcwral manbers to be used
,�—
S FOR NEW CONS7RUC170N INCLUDING DECKS,
t/�� ��Sog'rt - ADDITIONS. &. PORCk�S SUBbUT:
.❑ p���� ' Trim i. Site PlsdSurvey showing tlx aisting sWCturcs
❑ q� . � ❑ Fascie �d P�� P�J�-
WAIDOws � 2. Txro sds of canstruc6wi plans
IN E7QSTQJG OPF111NGS DYea ONo IACATION OF R'INDOWS 3• ��' Calculations
OR FORNEW OPE7JA1G5-UFSCRIBE SIZE OF
OPII9WGCtiANG£5 k .
TYPE pF WINDOW TO BE INSTALLED NUMBER OF WQJDOWS
Ai•i" FEES ARE BASED ON VALUATIUN, INCLUDING THE COST OF LABOR AND MATERIALS: �
TOTAL JOB VALUATION SGSI, I 5Q U.B.0 FEE OCCUPANCY TYPE
Permit Fce
Plan Review
Fue Sw�chsrge
Surchazge
License Sinchatge
SAC Q�arge
Gtiub Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Sce Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the toml job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (Stau Licensed Residentiat Contractors)
$1675 per SAC Unit (Plans to MWCC for determinazion)
ft+6ft= ftx$21=5
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Mske c6ecics pavabie to: City of Fridiey Attac
THIS IS AN APPLICAT[ON FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
confotmance with the ordin5nces and codes of the City of Fridley and with the Minnesota ConsWction Codes; that I understand Uvs is not a
pem�ibbut on(y an application for e permit and work is not to start without a permit; that the work will be in acwrdance with the approved
plsn in the case of all vrork which requires �revie aud proval of plans. ---�'�J 7� `
SIGNATURE OF APPLI � �s'�T t �� PRRJT NAME�-1`�fR'� T DATE ✓ � O
�
Page 2- Building Residential Appiicarion
BUILDING PERMIT FEE SCHEDULE
The Cluef Building Official shall, before issuing permifs for the erection of any building or
shvcture, or for any addition to any existing building or structure, or for any alteration or repair
to any exisfing building or structure, upon application therefore, require the paytnent by the
applicant for such pemut of fees to the amouat herein below set forth and in the manner herein
pmvided to-wit:
VERIFICATION OF ROUNDATION
Peimits for construction will be issued a*n;n;mum 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 &aming. New Houses Onlv
City of Fridley
Building fnspections Depaztrnent
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
A- GENERAL POWER OF ATTORNEY
..
Notice: This is an importaot document. Before signing this document, you should know these important fac[s. By signing this docu-
ment, you am not giving up any powers or rig6ls to control your fnances and property yourselG In addition ro your own powers and
righis, you may be�ving another person, your attorney-in-fact, bmad powers to handle ywr finances and pcoperty. This generai power
. of attorney may give the person whom you designate (yoar "attomey-in-faM") broad powers to handle your finances and property,
which may include powers to encumber, setl or otherwise diapose of any reat or personal properly wi[M1out advance notice to you or
approval by yoa The powers will not exist aRer you become disabled, or incapacitated. This document does not authorize anyone to
make medicet or other health care decisions for you. If you own complex or special assets suc6 as a 6usiness, or if there is anything about
this form that you do not understaod, you should ask a lawyer to erzplain this form to you before you sign it. [f you wish to change your
general power ot attorney, you must comptete a new document and revoke thfs one. You may revoke this document at any 6me by
destroying it, by directing another person to destroy it in your presence or by signing a written and daled statement expressing your
intent W revoke tltis dxument. If you revoke this document, you should notify your attorneyin-fact and any other person to whom you
have given a copy of the torm. You also should notlfy all parties having custody of your assets. These parties have no responsibility to
you unless you actually notify t6em of the revocation. If your attomey-in-fact is your spouse and your marriage is annulted, or you are
divorced after slgning this document, this document is invalid. Since some 3rd parties or some transactions may not permit use of this
docament, it is adviseble to check in advance, if possible, for any special requirements tha[ may be imposed. You should sign [his form
only i[ the attorney-in-fact you name is retiable, trustworthy and competent to manage your affairs.
I,�l7G1%t//'1 !TI 11�-Gi�ti./ .of��� f��� l7t�C J, ���JlJ,City
A^ e �/
of /` I/ i'l�'l CA � j/ i , State of /' C 1�'1 ✓1 �,� , as principal, do hereby
appoint � 1 Gt �C 9r� 9�l 7 . /"Te� , of ���� �+'� --- �//^. ,
p ���
City of �Qy1(/l Le i� , State of ��- %�i"l A , my attomey-in-fact to
act in my name, place and stead in any way which I myself could do, if t were personally present, with respect ro the following matters ro the
extent that I am pern�itted by law to act through an agent:
_ (a) real esta[e vansactions;
_ (b) goods and services v,aesactians;
(c) bond, share and commodity transactions;
(d) banking transactions;
_ (e) business operaung transactions;
_ (� insurance transactions;
_ (g) estate vansactions;
_ (h) claims and litigation; �
_ (i) personal relationships and affairs;
_ (j) benefits from military service:
_ (k) records, mports and statements;
_ (I) retilement benefi[ transxtions; �
_(m) making gifts to my spouse, children and more iemote descendants, and parenu;
(n) tax matters;
./� (o) all other matters; .
_(p) full and unquelified auttwrity to my attomey-in-fact to delegate any or all of the forzgoing powers to any person or persons whom
my attorney-in-fact ahall selech,
_(cil unlimited power and authority to act in all of the above simations (a) through. (p) ��
If tpe attomey-in-f�t n� ed above is unable or unwilling to serve, I appoint �/, / , of
� � . . . �� . City of , State of
to be my attomey-in-fact far all purposes hereunder.