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City of Fridley, Minn.
BUILDING PERMIT
,;
.
� � � / � �/
. , / ._�
�.� .? 5.2 95�
N° 71'7'7
LOCAT N F BUILDING
Na ���� . 3treot ���� ���! _._ Part o4 L.ot��..-__.�..._._._.—_._—...
Lot _._3...G____ Blor�C �._..�_ Additian or Sub-Divls[on _�����.��i,�_
Corq� Lot _ 7ndde Lot �_.'`�._..__ Sztback .C� �._.__ S �
.� _... �a�r�a-,�.cS=_�2_�—_�..
3ewer IIevatloa �._$.�.�t_l'a._.__.-.---....._..--° Foundat[am Elevat{aa .—_—.._.�Q z_ 5 .__—
� DESCRIPTION OF BUILD{NG
To v.ed
Fratt �� DePth ��.�— Height .:,�.t._ 84. FG j� Cu. Ft�,,.�'!/
._._. -. _ t .._�.... Deptlt � t _.��Sq. Ft. _..__._._. Cu. Fk _....___
Type oi Caas4uctiw ���Pjk ����.�._.._.... To be Completed -•--•--.----�---
^UTSI�J� APPEARANCE OF THIS BUILDING MUST BE C�
:.FP;:�'tVE�. VARIANCE WITH OTHER BUILDINGS IN THi i
►.IuCK.
In mosldaration M the iaeuance W me of a permit to c
the� ProPOred work in acoordance with the descriptioa abwe
aadlmnea of the dty of Frldley.
Ea caodderaliai ot the payment of a fee of
�scribed abov , agree W do
apllance wit6 provsaione of
permit 1s 6ereb3' B+'�ted to_�
to construM the building or additi� aa descrlbed above. Thispemu t ia granted uyon
Lhe exPl'eas o�diti� that theperwn to whom ft is S='anted and�tua agents, �nPloyees and worlrmen� in all work
�d�e i4� amund and uPoxi eald bulldin6. or any �art thernof, shall oontaam in all reapects w the ordinences of
��r, �ta reeara�ns iocat�. construcaon, a�teranon, mainrena�e. reresr ana mwus of buildings
aa��� dty limib a� this P�'m►t may be revaked at aqy time upom vlo�ion of aqv of the PTO��s of said
HufldlnB Inepectar
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,�c�r �.c�,� �nLCU�.a�roNS DEpAFtTMF.NT OF BUILDINC�S
_�� �� ns.w.v.-e: - _ -- -- �� —
Wcatheesteepas j� � � � Cooatcuc¢ion No.
--__..�-.._----- �uidz —�� _-- � -
wa � ri Reference ��Jue.lVall 1nt.Wa11 Ceiling Roof Roor @Cmd
ra No Yea�-No O�s �� —+ � � �-� �^� _ -
� F7.� � (yy (�,f Room � Lcngt6 y° Wid¢h .`% `' eight _�_ �'�I � � : y ' 4ioc�9
Windows and �ors—Crackage and /irez p! � �.�uE;+ *w �w 1 a: 3-Cr
R �dtL flalgnl No. [ L�nea! Ic wrm 3 �� f '� — Y. 1� _:♦ o
NO. ant u�f� 1i6h1 crs' � eq Pt ]� / I.. N � e !.,ye. .%
�a� r — ja + jP1 � i / i 'P` � �'l I � <_
•� r .
� ���----1-� ¢ '�`"� � ��i �- 1-- � _ . _
ln5ltrafion
_Glsa
Exp. wa11
Net exp. wall
1n2, wall �
Ce��mg
Floor
To tu.
Window� and
wm�n �
t+o. c n.n. �
IFsp. wall il �;
� f�1ee esa. wrll
or sq. ina. W.A. Leader area
m�Length Width
--Crackaie s d Arca
Et. .D.R. or aq. in�. W.A. ad
Room � Len`th .�-W
a� Doorr--Cneka¢e and Area
�II�1��f�ilOR
Glus
�xp. waU --
Nee e:p. wall
Tne. ewall
area
Btu
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_ I� Infiltration
� ... . ------ ---
�' �I Glass -_
__. !i Ezp. wall —�r . —�
��II Nee e:p. wall
i., -----__ _
_ ' Int. wall
i
i ------t---..___. �..____..__._
T _ i��ei�mg
�-�� �—_T
�. I; Tot Btu. �
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I�t3i\l\CJICVW3e IT16d�14.
Inaulation
� 11ow Applied
Rrca
�.._
E. R. or sq. in�. W.A_�
oam i L,ength r _
and Doors---Crackage and Area
Infif[ration
Gla»
Esp. walJ
Net ezp, wall
Int. wall
—c--
are►
�JJ
------ ___ _ _----------- -
k D.R. or sq, �ns. ��.A. ader ares
�(i_�tuom 1 Length --Width He�{he a
and Doozr-Crecicage nnd Area � �
Heirht No, of Llneal (t. wtt� �-
� an� Iif�t• oS crc �Q- ft.
l f J!
_ 3.'__ —'
Glasa
E:p. wall
Nec e:p. wall
Int. wall
CeJm
Flonr
�p �.R° �.u.ec. or p. �ns. W.A. S.eaeler ore� �!'1,�� � II Req�ired p. h. EA.R. or p, im, WJl. l.ea&r �rea
<.:_r..�_ � �
+ .:.:�. �.
- ' s
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4
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1V�n�iowa zr�d riab a�. r — i ' -` -_ ° . - - . �
- � n-�"�i .y - � �c R� 1 � i V6�indows an�i DG c♦ d rac�agw �nd A:ea
No ��:: � r .� Y�:. ii Yn �nle n �.a �i� �s e ��..-- m" S e 1 fi.� e j..
a I
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lnfiltra�ion y_. `�-� �i- - ���- r�� � — _`__ _ * Corf� __$tu__
. r� , � /�; — . _ -_ __
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F.sp. well
Net exp. �
lne. wali
Requirrd sq. fi. E.p.R. or aq. ina. W.A, L,eader arra
` -' —�.�. ___.�. - --
�- --- . __.--_ _ - --
.-.___ .._..
__ �• Room) Lengt6 Width
_ Windowy and Uoor�--C:ratkttge and Aren
- _.
__ ` wD ie x�anc'—(' N'. oe �,ineai re. n:�e
Na. of ana of dne 1 I{ hta of rrack p. 1�
inbjtrateon
I �F'sp. wall____.____�_
Net eap. wa11
Cnt. wall �
Floor
� Ne.
_.__--. .._...
..._....._ ___..
a. ft. E.i),R. or aq. ins W.A. ieader aren
Room �Length Width
e and Doon-�Crackagt and Area �
�.n xNrnt No. of LIn�.� rt.r wrea
n1 o[y�n� Ilrhb oicrtek I w ff '
�II�i�«illOi! � —
' Glau �
�Fap. w�U
Net e:p. wnll
Int. wdl
Ceiimg ��
1�loor �
Toul &u.
___its�6red sq. te. E.b.62. mr
s -.s,__t_ .z,a�. in6ltration ' �
,. ,. � _._— —_. _ ._._ . _.� . __.__..
.�. j __
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---- __.__ ._j ,_._
- . -jcri! Ex�s wall _ _ _ .
— ----- - _._ --- -
_
� �-7 i� Net exp. Nall
. . . .. . .. _ i _j. .._
.._..� ' f� (ni w�al� ;
Cael. � Btu
�O[f
arc�
._.__ ___ . _.__._ _�__--b-
i��i Tatal Biu �
i___ _._ ... ._.,_ - -- _ _—_
-, . Reyuired y�L i�..U.R. or eq. �n� W A. l.sadet nrta
__
___ _.__ _ _ _. _ _._. _
___ ---- --__
_ �� F! : Ra,m I.e:Igi{e VJ�dtt�
if Wmdows and F7ooca (ratkage znd Acra vT
�'. _ �.,_niii5 rr�.!�;�i r� --r A. ._' A g...�
,_ __L }(' e � t! qlne � IIR�-a (., r , f.
I_ . .__ -l-___'
f� _..__ ... __.. ..__.'�
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- _ � __� ---$
In6ltration �
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i� _ (,la�s
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F�ep wail e f �� t j--
- � - __ _ �
Net np. wall " .
i - --- -
�
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li Flaor � 1 1 2^'�_t _. _
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. T'at af Btu. / � f
; ... ___ ._ __... __ .._._. �
�i Hequ�red sq k E.[7.R o��, ms I�.A. Leader area
_ —_
n- --- _. - ---
�' �'1.� Room i Length Widt}i �u
-- !i - _. � -- - - ----`r-
� W�rtdowi and Doors Cra.kage aod Arxa
wiain t�e� ne � n. �r T�L� e-�--� T� rs.;.n �
�. _ No�pene ..ofDan� 1 qtne� 1 [•:vck . t�
B(Il j
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---. � .___..
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�. �. II fsp. wa{[ �--
_ �� __..--------�.
; NeY exp. wall
_____-- i ----- ------..
InEe wa��
- _ . V �I Cr�6ng
. ._�� � : �Ioor �
_._... _ _. �I ._��
` I� Total Btu.
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't Required w. fr.
or rq. ins, R7A. E.ea&r arra
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City of Fridley, Minn.
BUILDING PERNIIT
��; _OCTOBB& 4, 1966
�o
�-`�,�s-a�s-
90351
Owner; ALLAIQ F. KAUPPI _ Builder _ SUSSEI.. COMPANY._..._.....—.._....—.__._._. _
p� 76I3 BACON_DRIVE N,E, `___ _ A� 1850 COMO AVENUE
------.._.._--.__ _--�---•—�--
FRIDLESC� MINNESOTA 55432 ST, PAUL, MINNESOTA
LOCATION OF BUILDING
Na 7613 3treet __. BACAA DRIVS N..._L' �_._..----- Part of Lot .___-----.--.----.—
Iat —_ 11 -- Blcek --....— 1.----. Addition or SubDivis[oa ._._._MEADOWi�DOR TSRRACE ------
Coiaer Lot ------ Inside Lot _..?�_._ Setback --.--...-- Sideyard —.---- --
3ewer IIevatlon
Famdattoa IIevation
DESCRIPTION OF BUILDING
To ee v.�a e.:
__ D, GARAGS ,�nat __ 16_ Depm _22 Hdght 10_. Sq. Ft 352
Cu. Fi 3�,520
"— �nat -- neDtb --.— tTe��trt ------ �i. F't _._— cw. Ft
1)'Pe of C�struction __._ �_._ F�k Cost $975 .00 ---...... To be� C�pleted ---
LOCATED OA HOUSS SiTRYfi'SC
In onodderallon of t6e iseuance to me of a peraitt to construct },� pu��g � y� above, I W do
the Proyored work in accoidetice wIth the deeceiption above�� � With al P �._... �.
wdimnoea M the dty of Frfdley. �
_..�.
Ia crondd�atim o[ the payment of a fee oi; 4.00 � permit is herebY 8rasted to__.. SUSSffi.
COMPAPY u c�atruct the building or addition as descMbed above. This t�ermit is gi'anted upon
dome in, airound and up� said buildin8� or a� Pert thexeof, shall �a�m inpall respects to the Ordinences oR
��3'� Minnesota regaidtn� locaUam, ca�sh�urtion. alteratlaai, maintemnee, rePalr aud mwing of building�
wi�� dty limite and th�s Pa'm[t may be revoked at e*O' time nPon violati� of eny of the Pa'ovlaims of eaid
CLARBftCS BS[.ISLE Buiidins �up�t�
NOTICE:
7W w� dw �w eewr �M eeMneNe., i+r.IMNen f« �deig, plu�isa a� .
1M luYdYy 4yMw br a�ya�h W� fa 1iw krr. �d"Y. awwe er wNa. M wn ro w�
R �
\
OWNER'S
APPLICATI�P FOR BIIILD� p$�p
CITY OF PRZD;,gp, MII�i&gpTA
LOCATIODT OF BUII.DING
N0._ � lo ��STRSET _ 0. O ���F PART OF LOT
�T— f � BLOCK�`pDplTYpp OR SIIBDIVISION�� p-y�„�,,M �--o Y
CORNER LQT INSIDE LOT l� SBTBACK SIDE YARA
SEWSR ELEVATION FOONDATION'ELBVATIOft
Applicant attach to this form �o Certificates of Survey of Lot and propoaed
building location drawn on these Certiffcates.
DSSCRIPTIOft OF BUTLDIftG
To be used as;
T C- • Front �(n Depth zZ, Height� U
�
S9. Ft.__ 3�� Cu. Ft. j 2 C
Front Depth geight
Sq. Ft. Cu. Ft,
Type of Gonatruction J rQ � (� �� D��
— � Batimated Cost
To be comoleted
The undereigned hereby makea application for a permit far the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulinga of the Department of Buildinga, and hereby
daclares that all the facta and repreaentationa etated in this application
are true and correct,
_ _, _
(Schedule of Fee Costs can be found on the Reverse Sfdej,
�� �
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`;: ' ; BUILD�G. PERMIT FEE SCHEDOLB
ds
SBCTTOI�_2., .The Inepector of'$u�li�dinga.ehall, before ieauing any permit for
the erection of any buiiding 4,r etructnra, or for any add�tion to anp exiating
building_or �.tructure, or Por'enq'8ltexationa or repaire to any eacisting
bui].ding or atructure, upon application therefora, require the payment by the
applicant,foX_auch_petmit of.faea to ehe aawant herein_be1Qw set.forth arid in
ehe manner herain provided to�wik;
2._1. Fornany such permit for the erection of any fire-proof building,
othei than a gara8e, warehouae, factory or grain eievator, or for the erection
of sny fire-proof addition, for eimilar occupanc�+, to any exiating building,
ehall be at the rate of $1.40 for each one Ehousand.oubic faet, or fraction
thereof, in such cubical conteata.
2�2 gor any such permi�..fnr the erectian of any fire-proof garage�
warehouae; factvey or'°'grain elevator, or for'the erection of any fire-proof
additiott, for aimilar oacuparicq, Xo:any exiatfng building ahall be at,the..
rate of .$1.25 far each one thoueand cubic feet, clsasified as ^Hreproof°
by Section 502 0£ the,Minaeap.oi,ie Building Code. _
HOIISES
2.3. For any such permit...fon.:the erection of any non-fireproof
building, other than a garage, warehouse, factory or grain elevator, or
any non-fireproof addition, for aimilar occupancy, to any esiating building -
permit $1.00 for each one thaueand oubic feet,
GARAGLS. _ . _
2.4, For any auch pex�it for the erection of any non-fireproof garage,
warehouae, factory or grain elevator, or for the erection of any non-fire-proof
additfoa, for simiiar occupaacy, to any esisting building or for each auah
building or additian - ninetg cente ($0.90) for each one thousand cubic feet
or fraation thereof, in the cubtcaY contenta thereof with the minimum of $4.00.
For the purpose of-compating feea far bulldtag permite; the cubical contenta
of any buiiding or addition to a uniform height throughout by multiplying the
grouad area coverad from a point six (b) inchea belosr the floar'line bf the
basemeat or cellar to the average hEfght of the uppex surface or to the average
height of the roof syrface.Qf the main gable of a pitched roo.f.
2.5. pox repaira or alterations to an exiating atructure, the £ee ehsll
be at the rate of $3.00 per each Piva Hundred Doliera ($50�.�i or fractxca
thereof in the cost of 911 ptopoeed work.
2.6. . in no case ehall the fee charged for any pexmit aa set forth in
Section 2 be lesa than $4.00. : _.
STORM REPAIR DAMAGE FEE9t'
Residential; Eetimated Coat of work up to $SQn,!!� - SS.�'J
Ar� '�:♦ �...� t.'� � (.
Eatimated Coat of work over ;. � :••- - � v-'� � -� _
t: - -
Y?. ��;.; tc "`?�ii<:3:.1 r „r
Coamercia2; Estimated �t of wo - ��--�
Batimated t of s�orl< ov=r v-+:�.'•UU ^;<i%•
`� . .
� �<. /
112
LOT
� � �OLOGIC�� �
ME.
�'LI.A kJ
oRESS
_78to'- 4to48
91ZE
��s.t� PP ► I�o x '�2
. - � VALUE � . . .
'itesr 3 SACON : ��2... h.f . E. . �TS �—�'"
" FOD'N. . . � - AREA�� " .. � � � TVPE .
Fr� ► fl�._�.Y F rL.�.nn e.
d
F �'�' � 3'
"t�c.--��szv�._ C'�z��-±��.--Psa���
�$E - VJ tT �,4 _ _ l--:QUSE _ ,..
�35i�.1. G.�i�i PLl.►T
� �,��T2l.t��... �
_t�.�l... 5t0E.W�.�,.tL 1?.s 5�-tCiWN
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c�ty of F'ridley
AT THE TOP OF THE TWINS
;,
.
' � _�� COMMUNITV DEVELOPMENi OIV.
r � ~ � PROTECTIVE INSPECTION SEC.
,
i_-._� �"' �•� pTY HALL FRIDLE� 55132
i 612-571-3450
JOBADDRESS 7613 Bacon Drive NE
t LEGAL �OTNO. BIOCK TqACI
SuB�ER
BUILDIN� PERMIT
NUNBER NEV O�TE aeGE O�
910-F15 8/31/94 / . /
oesca. 11 1 Meadowmoor Terrace
2 PqOPEPTV OWNEH � MAIL AODRESS .
Deann Sharp 7613 Bacon Drive NE
7 .CONTqACTOR MAIL ADDFESS
Same
d APCHITECTOROESIGNER MAILADORESS
2 G Q �1 �
O.
33b3
APPROVEO B�
SEEATTACMED -
SHEE7
786-3255
Z�P PMONE LICENSE NO
ZtP PMONE UCENSE NO.
ZIV PMONE UCENSE NO.
�fi USE OF BUILDING - � - - � �
Resideatial
7 CLASSOFWONK
❑ NEW #7 A�DITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
e �DESCNBE WOFK �
Construct a 20' x 20' Garage Addition
9. CNANGEOFUSEFROM TO
STIPULATIONS '
Provide a hard surface driveway. See notations on plan.
SEPAPATE PERMITS nFE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING. �T�e �� W
VENTI�ATING OR AIR CONOITIONWG.
THIS PERMIT BEGOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONIN6
AUTHORIZE� 15 NOT CQMMENCED WITHIN 80 OAVS, OR IF CONSTRUCTION
OR WOFK IS SVSPENOED OF� ABANDONEO FOR A PERIOD OF 120 pAYS AT
ANY TIME AFTER WQRK IS COMMENCED. NO. DWLG.
1 HEAEBV CERTIFV THAT 1 HAVE READ AN� EXAMINED THIS APVLICATION 1
AND KNOW TME SA�1E T0 BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS yq�UATION
WN M WHETNEii SPECIF ED NEREIN'OR NOTOTHE GRANiING OF A�pERMR �6, 74k
DOES NOT PRESUME 70 GIVE AUTHORITV TO VIOLATE OR CANCEL TME pERMITFEE
PROVISIONS OF:ANV OTNER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �90.00
STALLS
$3.37
'�ACCHARGE
Fire SC $6.74
� $100.11
merei � t ..,..�.. ...,� .. .....----- -..._ _ __
LOAO
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit ApplicaUon
ConchvctionAddress: 7� f� Bac on �+�2 ��
I.egal Description:
Effective 1/1/94
-�� 3.b3
Owner Name & Address: Deu„� J,�,, � Tel. # �86-3as s
C���O1= �e � � MN LICENSE #
Address: `7(0/3 6ac oh 1��� o� Tel. #
Attach to this appGcation, a Cerfificate of Survey of the
lot, wifl► the pmlwsed consdvction drawn on it to scale.
DESCRIPI'ION OF IMPROV&MBNT
LIVINti AitEA: Length Width Height
GARAGE AREA: I.ength ��7� O" WidYh � n'_o "" Height �'-v„
DECg AREA: Lertgth Widih Hgi/Ground _
or�R:
��[l �dei..octl
Type of ConcErnction:
Approx. Completion Dabe: —
Ft. Yd Setback Side Yard SetbaCks
Fstimated C�t: $
Sq. Ft.
Sq. Ft �/od
Sq. Ft.
(COSt on Back)
Driveway Gufi Cut Width IVceded: Ft. + 6 Ft = _Ft x = $ � � � � . � �
DATE: �` — PI.ICANT: e��%% �J Tel. # 7r��� 3�5�
�� d �� s/ 0:3
rermic Fee
Fu+e Surchaige
State Surcharge
SAC Ci�arge
License Surchatge
Dtiveway Escrow
Erosion Conffol
Pazk Fee
Sewer Main C6arge
��
s �20,C�
$ b� l�(
a � � .3�
$
S
S
$
s1��
� M_I! o � , _
Fee Schedule on Rev�se Side
_001 of P�mit Valuation (1110th96)
a.soisi,000 v���
$800 pa' SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B' Above
5450.00 Conservation Plan Review
Fee Dete�mined by EnBineering
Agrecment Ne�sai3' I l Not Necessazy [ i
STIPULATIONS:
, ,
I3UILllING PGRMIT FEE SCHEDULE
Chc ChieC I3uilding Ofiicial sfial(, i�efore issuing permits for the erection of any Uuilding or sUucture,
or Co� any addition to any existing building or swcture, or for any altccation or rcpair to any existing
buildirig or structurc, u�n apnlication U�ercfore, require the payment by thc applicant for such permit
of fe:c,e to Uic amount hercin I�c[ow set forih and in the manner herein provided to-wit
"1'OTAL VALUE
$t to $500
$501 to $2,000
$2,001 to $25,000
$25;001 to $50,000 '
$50,001 to $iQ0,000
$i00,001 to $500,000 .
$500,001 to $1,000,000"
$1,000,001 and up
FGES
$15 (Mininmm Fee is $i5 plas surchatge)
$13 for first $S0p p(us S,2 for each additiona[ $100 or
Crdction thereof, to and i�luding $2,000
$45 for first SZ,000 plus $9 for each additiona( $1;000
or Cractioa thereof, to aud ineIuaiag $25,000
$252 for first $25,000 plus $6.50 for each addifionat $1;000
a� fracxion thaeof, to. and including $50,000 ..
$414.50 for fust $50,000 plas 54.50 for each additional
$1,000 or fixcti� U�f, to and including $i00,000
$63950 #or f�rst $100,000 piac S3_SQ for each addifional.
$1,000 or fracfion thereof, to and including �$500,000
$7.039.5(1 fior the 5rst $S(10,000 pins $3 for each addiffona!
$1,000 or fiacflon thereof, to and mc(uding $i,000,000
$3539.SQ for the 5rst $1,000,000 plus $2 for each addiflonal
$1,0(l0 or fraction �thereof -
DRIVEWAY DEPRESS[ON ESCROW
(Concrete (�ub Streets OniY)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times
$t3_SO_
Alternate "F3": Remova( and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch deptli - Driveway width pius 6 feet times $15.75.
VERIF[CATION OF FOUNDATIQN
PecmiLS for construcuon wi(1 be issued a minimum of 24 Iwurs from tfie time of application to allow
For proper rcvicw of Ihe proposed structure and of the coastn�ction site_
A Certificate of Survey of the Iot, showing the location of the foundation once it hae it has hecn
constiucteei will be re;yuirecl before proceP,di�g with the (raming_
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From: 651 784 6648 Page: 2J5 Date: 8l28/2008 2:57:25 PM
From. Cicy of Fridiey To: &51-789$648 Page. 4!5 Date: 828l200B 2:05:08 PM
ttuitdmg I' BUILDiNG
Inspactions I RESIDENTIAL APPLlCATION
��-sn-3�a � CITY OF FRIDLEY
on�. . _..._ d/.
SfCE ADDR643 �
TI�S APPLICAM IS:
PROPFRTY OW
TFdVANT
SU8MI7'A C,'OP!' OF"
YOIISt STATF. I.IC@t<.4F.
WI'CH APPLICA7'ION
PROPERTY TYYE
V � YOUR E-MA'�
T �_,._ ,aA�
❑OWN6R MCOMRACTOR
Nnme: �'4�yX�/ �
AUllRfi.45....��7�e/_/� f7i�1CDi I
PFi07vG- /�Y.�' n�1i `%�v.,.1
ODECK
DESCRIB& WORK BEINC D019L+:
Rec:eivecl t3y:�
�ateRec'd: �'
___. _..... . _. _ . .. ........ .. ... ....... ----�--
r.irr_ �f.v� STATT:�IP JrS�'F3.:1
—_ � __— —
`61f_ _ .. O.� D'�.... ... . . . BXP DATE . _... .S/.Y/t
�d'7 ,¢:.�✓,l:..�.�'�..bd. <ar5'S.1
7- %-6'�`-G�l` Fnx s,�`�;•z ... .. . _
9LY(N61V CON3TRUCf10N ._. � ����'�'� Sf2E ' ` . " ..
Y(N6ri CUNSTRUCTfUN $TORt6S
--_ —.... --iSGARAGP/SHED ...._.... _ _._ � WINOUWS
f]\ISli EROOF � � ❑DRA1�TlI.E
OSIDING ❑OTl16R
—' _...___�SWAfMINOP00L
� O AOIB't1UN . . .... .. .............__........_..._..
�CERkY.t7R �REMODSL11:Cr
� NUMBEItUF3QIJARG3_ci�-t�_.. /HO(f3EQE1ARAOG
�_�o�r.ve ❑ A7TA(][EU OARAOE
RROROSBD512ti: . ._ .. fDRT.tC.ff1�AGARAC.k
,....
� PAOPOSL•A FIL•IGIIT ..... ... _
G
I O Viiryl �
i ��� OTmo
I � �"�__ . 7 Fmr:ia
WINDOWS
, INEXI517YCOPEXJINGS OYes QYO LOCAT'.QNOFW["N614S
i ORFORNEWOPGMNGS-0L•SCR18L•$YLEOF ___ ,.. ...
IAP6NIN(iCHANGF:3.! ' -:. _:_:::::.:--___ —_"—_�
;TYPEOFWRJDOA'.i'OBL,�,ASTALI.ID � - NU:NdEROFWINWW3
ALL FEES 9RE B9SED bN VALUA'F�ON, INCI.UDIIVG THS C�OF
----- --- -- _ - (USING�;�'}�E.Ip97U.B.CFEESCHEDULE)
Permit Fee
Plan Review
Fin Surcharge
Sw cha[qe
License Surchnrgc
SAC C'harge
Cl1rb CLt Eseruw
Erosion Ccmtro{
Yark Fee
Sewar Mem Chatge
�
S�. Ft.. _ . �..
IiA$fiMtsJT RF.MOUEI.INIl SURNIT�
1. E%islinj FIaM Pha
2. vmpoxalbarphn
3. L'al of svuqural mombus b bc uscd
F4R NEW CONS7'RUCTfOY INCL[JDINC DC•CR$
ADDITH1hB. R PORCH55 SI18.btIT:
1. SAePhd55weyshowi�theewstingshucturtt
anAMaMoxaPrel�a.
2. 9Mro Feu otcon.5l.mcuqn plans
J- BmrgyGekulitfom
AIYD MATERIALS:
.. S .. . G� � ), c� _L.--- See Back Page for F¢e Schedule _ .. _ _. _._-
S 65% of Buitding Permit Fee
_ S __ 'f�j� .001 timca 1hc total job valuation
3�`(p .0005 x Permit Valuation Mmiinum 5.50
a -
---'=Qi.�.._._... _ SS.00 (S4ste l.icensed Reaidential CoMmetoro)
�� _ El 550 pa� SAC Unit (Plana tu MWCC for demrmmation)
S _ft+6R =...,. _ __Ax821 =S
.'------..'-------- �
. ?. ... _ ... _ . _ _ 5450 Consarva[ion Plao Reciew �
$ .. ......._. Fee Determined by Engineering
3 ------ AgeemeM necessnrY () Non Neccesary ( 7
. . THIS IS AN 0.1'PllCA2lON F'OR A PfiR.N1T•NU'P YALIU UN'171 PROC.'E55EU .
1 heroby epply fw a building parmit end F ackmyviodgo thpt tho information abovc ie aomglato and aoaumts; 1lmt �hc wrnk xrill be in
conformance with the qrclmnncw and caleg ofShe C.ily of h'ri�3ley anci with fhe Mmnesora Crni:truci.i�m (;ndes; thaz I unclentand this is ru�t a
- . .,.-- � -- - -" ' -.. _..__.. . _ ....... _. .
permit but only nn appiication for a pamit end work is not W start without a pennit; that the work will be in accordance with the approved
plmi in the cnae oC all work�/ uves review and eppmval of plans. n �
SIf4?1dTURF.OiA%'I.IC�'2'c4�C�����i6l� PAIV'I`NAMF.t'��/.-iA/,y/` .�rt.,,r� �/.��/n/_
��
Building MECHANICAL P�t No.:
�6�5�2 "3604 RESIDENTIAL APPLICATION R�'°� ���
CITY OF FRIDLEY Dffi��.
DATE S-( S� D� YOUR E-MAIL ADDRESS p� � h � � d@ a o�, CO �
SPtE,wnRESS -% (o I 3 M3c�co n �r�JC A1 F
7FIIS AH'GICANTIS:
�WNER/
TENANT
SUBMIT A COPY OF
YOIJR STATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
• � � .
CONCACI' PI.?RSON:
- ,A1..�1' : Mt� :
-�bzl�
r L:'� O 4. i/10. f
STA7E LiCENSE H E7�p pp7E
nnnxESS: � Ro4o Doo�woa a S�- N vJ Q�—�Qr�G,-a �
�oa� � b3 �{ 3�{ l l 9 0 Feix -i b3 �{ 3�{ �{ Z SS
iSINGLEFAI�IILY QTWOFAMILY OTOWNHOUSE
❑�w ��,nc�ur o.v.rexatmi+rxen�wnra.
DETAILID DESCRIPITON OF WORK
ra
S7ATE�ZIP 5 `-� 0 { �
I PER MS 16B.665 the pemiit fee is a m inimum of S15.00 or 5% of t6e tohl cost ap ta SSqyi.09, w}uchevcr is greater, for the
�' improvemeni, instailalion or replacement of a residenfial fixturc, excluding the fixp�ms. ('�7�is shouTd ceflect oniy the cost of labor )
Lab� cost under $300 =$15.00. Iabor cost betwew 5300 to 5500 = cost of labor x.OS =
FOR PRO7EC7'S WNptE LABOR EXCEEDS 5500, FEF.S ARE BASED ON S10.OD PER I•7X'FIJRE, fi7{C'Epp qR.gRg N07ED. FIXTURES: (INDICATE TOTAI,
NUMBER OF EACH BII,OW)
Fquipmmtlnsmtld n.�c:ComFofi-p�41'Lf �a:CqMp0o�5F�ic� Sr�s�ru'IS,000
MFG: MODEI,: g�Z�g��
MFG: MODII.: SIZFfB'lV
A/C 525.00 FIILEPI.ACE (GAS) SI5.00 GAS RANGFIOVEN SI0.00
AIIt TO AiR EXC7iANGEPR S15 FIREPI.ACE (R'OOD) 535.00 NEW GAS GRII.L 510.00
HOIIFRS33.00 X NTRtNACES35.00 GASIJNIi'f3TRSID.00
X CFF1IIvv1NEY LINER S10.OQ GAS DRYER SI0.00 _POp�HF?ATER SiS.OD
DUCT WORK_510.00 GAS PBIAi(: S10A0 .,...,...� ....
Permit Fee
Smcharge
TOTAL DUE
° ° N�ber of t"ixaves !ra $10.00 x $10.00 = $
—� Number of fietiaes (ai $1 i.00 x SI5.00 =$
5 o Number of fu-liaes (t(ta 525.00 x S25.00 =$
Nwnber of 1'n:tutes (2 535.00 r$35.00 =$
State Sureharge = $ .50
Total = g
TFIIS IS AN APPLICATTON FOit A PERhff7-NpT VAI�DIINI7L PROCES3F�
I hereby apply for a building permit mul I acknowledge that the infoimaAion above is comp[ete and acetttate; that the work will be in
confonnance with ihe ordinanees and codes of tl� City oF Fridley m�d with the Minne�fs Conatruction Codes; �t6aE I tmdersta� this is
not a pertnit but only an application for a pczmi[ and work is not to staA withWt e pe�mlt; that the �worb will be in �rdaxe with thc
SPProved plan in Uu case of all worlc wtrich ieauves aeview a� ao�ovel nf ���.k
SIGNAIURE OF APPI,ICANi
fC�'LD�..,nard DATE�'�S-O
City of Fridley
Building Inspections Department
643I Unive�sity Avenue NE, Fredtey, MN 55432
763-572-3604
FAX: 763-502-4977