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— DENUT6S f!T/VfY � !�'�N�{h!G'.tr' .�'AS,E'�IENT �;�
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y/ r� LOCATI . 9F
xal--'�/�..�c staeet ����
I.ot
Lot _ ._. ...-.--- g�°� — ---...._ __�: Additlon or Sub-DivSai� .�.���'
_ �j /
Corner Lot ---- Indde Lot ___� _. Setback .rrT�---- 3idepard
3ewer IIevatlm _a.._.,c � . � ...__ _.....____ Foundatlam Elevattaa . �
r DESCRIPTION OF BUILDING
v
� �� �p� .�.� H�ht ,�..:.. �. �.� �. ��1._2�
—T._ u ...�. __ Dep}.h ��_�—�. H�t _._.� 3q. Ft -----_ Gtit. Ft _.._...._._
7y�pe of Constructton ._._ ' Fak Co1C�:- .�_'_--Ro be Completed —.__._..._....__.�
�UTSIDE APpEARANCE OF THIS BUILDING MUS1' g� �c
B�� D VARIANCE W1TH O7HER BUILDINGS IN Ttil„
��deTBtlon of the lseueace to me of a permit to a
Uu Pl'�POOed work in accoidance witb the descriptlon above
oxLnanaes of the dtv oP Fri�ey.
Ea rnms[deratlaa ot tLe gayment oP a fee ot �,c.�� ., B�t is hezebY Sranted tn
to �romstruet the building or additioa as deecribed above. Thlsp�
t�he express c�ditioa that thepe to whom it fe granted and his aBent+. emPluYees and
doae 14� around and uP� satd �buildin6� or ar1S' Pert thereof, shall mntaam in all
��Y� M�ta reEardfnB lacatiom, conslructlon, ffiteration� maintenance, repau�'�and
wj� dty limits and thia Permit mqy be revoked at any hme uPm viul�on of any d
Pa'ovisione oP
t is �ented upon
�ea, in all work
the ordinances of
'inB of build3nas
Droviaio�ns of sa�d
�_;r,�r.mrs , .�r^.;r,^a
� � NOTICE:
7iM Pr�i das Mt eewr fla wn�uqbn. tn�afl�Hee hr.WrinO. i�G W M�tlY. awx� x wtl�r. B� wn b a�
A� Nildly I�eNr 6r +N�r� P�M+ fer fh�a W�n.
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53-SL-S-915.51
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PLUMBIiVf, PERf1IT APPLICATIOiJ
l�81�-09LG9
p33 AIARQUETTE AVENUE
Res,
. l0.00
-- -- ___ -
— . _� ____ --
Plumbing Fixture Rates: N0. RATE TOTAL
Number Fixtures x $2.00 SL_
Future Fixtures x $1.50
New Fixture-Old Open. x $1.50
Catch Basfn x $3.25
Water Heater-99,000 BTU x$3.00 I
Ground Run Old Sldg
Elec. Water Heater
Gas FittinQ Fees•
lgt 3 Fixtures
Additional Fixtures
x $3.25
x $2.0�
x $2.00
x $ .75
Gas Range-199,000 BTU 1 x$5.00
Reoaira & Alterationa
See
Deacription; Code
State Surcharae ��� .�a �6arg� .61Dd
TOTAL FEE
5.00
.50
g S.So
The underaigned hereby makea application for a permit
for the work herein epecified� agreeing to do all work
in atrict accordance with the City Ordinancea and rulin
of the DepartmenC of Huildi.nge, and hereby declare that
all'the facta and repreaentationa etated in thia
application are true and correct.
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� AT 7HE TOP �OF THE TN/INS A��}1� �t1y ia � 6 9 O$�
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i ' V �� � COMNIUNITY OEVELOP�dEM[�OIV. � � "'' - -� '� � CEIP7 NO�: �
� � � � � • � � PROTEGTIYE fN3PEE710N SEC, � I�
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. ,__ A�^��h•� CITY HALL PRiQCEv , 35632 NUMOEH REV.: UAkE . � GqGE :Of �� APPROVED BY �
,i• .. � 612-57t-3450. _� .. � . � .
. . � 910-F�5 9%2$i��Y,.� � f
�osAaop€ss '767i Baccn Drive N.E.
� 1. LEGAL� .. LOTNO. �. BLOCN �; .� .FRAC70RADDITK)N . �.� . . . �
� DESCR. : � 1(. . � . . � � . SEEA7TAGIi�D �
Meadowm4c�z' Tertace SHEEi
. 2 � PRQPEATVOWNER .�. MA714'6bRHSS � �
I�ave Pa�e 7677 Sacon n�ive N.B. zra vHONe f
.3 CONTRACTOR � 78�3705 . . �
. MAILADOR�$S , ZIP' � PNONE .�UCENSENQ..
Sussel Compaq,y 1850 Caatio Avenue. St. Pau1, i�1 645-0331
���"AqCHLTEC70RdESIONER "' MAILADDRESS � � � � � .
�. � � � � � - Z�P � PHONE � . LICENSE N0. � �
.. . � S� ENGIN§ER � � . � MAR ADORESS � � � � -
� . . - Z�P PNONE LICENSENO:. �
� B UBEOFBUILDING � � � .�
� � �' R281C1@A'tLe1].. , .. . .. � . �
1 - ClAB&AF-WORK � . . . � � � � � � �
. . . . . � NEW ❑�- AQDITION � ❑ AITERATION� ❑ �AEPAIR ❑ � MOVE�� ❑ REMOVE�...
8 'TIESQRIBEWORK � � � . �.
Construct a>24' x Z2' Detached Gara e
9 6MANfiEqFUSEFROM . � . � � TO' � � � . .
� ' $71PULATIONS �. � . � . � � .:' � : . . . � . . � .
P�ovida a har� �urface ci,riveway.
WARlW�G
efae digg'�ng c�li locai uiilifiies
T EPNONE - ELECiRtC - GAS Etc.
EQUIRED BY 'V4W SEPERATE PERMIT5 RE(�UI�t�D fi�fit W.tRI�.
: HEATING. ?iUAA81NG AiVD SI('s�S'i.
�*EPAR%7EPEAMITSARE REONpED FOR ELEC7R�GAl; PLUMBING, HEATING, T�p��F�GONSi. �;pfx ppNCYGROUP :OCCUPANCY LOAD
yENTILATING OR A�A CONDITIpNING. _ � �� �,�� � � . �
T.HIS PERMIT BECqMES NULL AND VOID If yyOqK OR.-0ON&TpUCT70N ZONING ��
AUTHORIZED �S NOYWMMENCED WITHIN 60 DAYS, pq IF COM9tA[ICTION � SQ. FT. CLL FL � �
QA WORK �8 SUSPENDED OH ABANDONED FOR�q.PERlOD OF�12p DqY$ AT 52$ ��
ANV TIME AFTER WORK IS�COMMENCED. � � � SZSO� �
� . . :. . � NO DWIG_.iJN �� OFFSTREET.PARKING �.. �
� t HEHEBV 6ERTtFY THAT I.NqyE READ AND EXAMINED.THIS APP��GATIpN ], STALlS
ANDKMOWiHESAMETOBETRUEANDCORRECT.�ALLPROVISIONSOFI.I�W$ ' � GARAGE5�� � . �
AND�AFDINANCES �GOVERNING TMiS TYPE OF. WOBK WIIL �BE COMP{,fED.. YAIUATfON, � '� .SURTAX �
WITH WHE7WER SPECIFIED HEqEIN OH NOT. TME dAAN71NG QF A PERMIL �. $Q� j89. 'Ca(} -
OOES�N¢T PqESUME TO �ryE'AU'TMORITY TO VtOLATE OR CANCEI TNE� pERMITFEE $Z�49 .
PFOVISIQ� AF ANY OTHER STA{E OR LOCAL�,LAW RE�ULAtING CON. '.. SACCHAqGE � - �
g f -� OA.TME PEt#FQ&MAN�E� OF COM$TptlCT{pry - � $SO.SO . . � - .
-� �� ' -�., � PLAN CNECKFEE TOTALFEE '
Sfpkp {�QpiCON� iQR RI,U�H4RIZEDNQENi . . � ������.. .. �.
, �� 1oATEt NJHEN PqOPERLY Vq�lOAT�D'THIS ISYOUR� PERMIT ��
51 NA 9WNFPllfOWNER�6U�LDER� 1�-, fi�.I-...� �
. . . B �OG IM50 � �
Ohi
. � . ''' ` i: .. � � . . . . . �
� OWNER:
ADDRESS:
CITY OF FRIDLEY .
ARPLICATION FOR� RESIDENTIAL BUILDIP�G PERMTTS
(New, Alterations, Additions, or
� _ BUILDER:
AQDi2ESS:
TEL N0: ( d�� 3] D �T TEL N0:
. Construction Location
STRI�T NO:�� • • STR!EET:
LOT: BIAQC: � ��ADDITIoO��D
Corner Lot: Insiiie Lot: Setback: Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certi£icates to scale.
�q,P�}� DESCRIPTION OF CONSTRUCTION '
Front: _�_ Depth; � ��,� Height:
� ,
Squane.Feet: Wbic Feet:
Front:
Depth:
Height:
Square Feet: Cubic Feet: �/�yq�
. . 7 To/7►-��o �
Type of Construction:l� E�timated Cost: $ OW ��
Rb Be Nmpleted: � �
- Alt. A Alt. B
Proposed Drivewax Width If New Opening Is Desired: $ $
,� .. . � SE� REVERSE SIDE OF SAEET .
R9ie undersigned hereby makes application for a per,nit far the wnrk herein specified,
agreeing to do all work im strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, d hereby declares that 11 tl�e fac and
zepresentations stated in this applica i are true and rrect,
. 3. �/ '
DATE: SIQIATUI� : r
Stipulations • //- [��� D � �/
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¢ � .
. BUILDII�G P�RI+IIT i=[r S'Cf�CDULE
SP•,CT20N 2• The Inspector. ot lluilAing^. shall, befor.e issuing pern�iL•5 for the erecLion
oL any building 4r :;trucCUrc, or for any addi.tion t•o any exi:,ting building or structure,
or for anY alCCraLion or repa:ir.� tp 'a��Y clican�l•gf-'or.1sucligpermiL-ro£tiees t Uthe iamoun�ion
�therefore� require the payment by tiie app ,
herein be.low seL• forth and in the mannen c�rein providcd to-wi.t: .
N)3W CONSTRUCTION: Single PamiJ.y Ilomec and Garages: $4.00/1r000 cubic Leet.
pLAN Cfi1:CY.: 25 percent of buildin9 permit fec. ..
DRIVEI�IAY DEPRis'SSIOt4: (Concxete, �rb Streets Only)
Alternate A: Removal and replaccment of concrete curb and
gutter only; Driveway width plus 6 Leet x Y15.75
A].ter^ natc _g; Removal and replacement of concrete curb and
� guttex and install a 3 foot wide approach with
.� 6 inch depth, Driveway width plus 6 feet x$17.85
;11 1 �I l �1
Pbr the purpose of computing iees ior building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below thc floor line of the basement or the cellar to the
average heights of the upper surface or L-o the average height of the roof suriace
of Yhe �ain gable of a pitched roof.
For repairs or alteratioas to an existing struciure, the fee shall be at the rate
of $3.00 per each five hundred dollars-($500.00) or fraction thereof in the cost
of- all pzoposed work. '
In no case shal.l the fee charged for any pezmit as set- forth in 5ection 2 be less
than $7.50 plus $.50 state surcharge.
, �FRiFICATIOU OF FOUNDA7ION
NOTE: Yermifs :or construction will be issued a miniminn of 24 hours from the time
of app].ication to allow for �roper review of the proposed structure and of the
construction site.
1, Certifzcate oE Survey of the Iot, showing the location of the foundation once it
has been Lonstructed will be reczuired before pr.oceeding with the framing.
('ERTIFICATE OF OCCU'.I�ALC_iL
App2ica�ion ior a Certificate of Occupancy shall be made ten (10) days prior to the
use or accupancy of any structure for wliich a building permit has Ueen issued; and
said stsucture shall not be used or occupied until a CertiEicate of Occupancy has
been issued.
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ADDRESS
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LEGA� QESCRIPTION
LOT:
��s'� �93
o�� o
ADDI T�ON :
LO7 SIZE:
---G�Z� X �v
HOUSE SIZE:
IBy �. FT.
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PLOT PLAN
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SISSEI i��iES .,�,� °:.;K.
NAME
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ADDRESS
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LEGAL DESCRIPTION
LOT:
e�:-�56 ?93
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ADDITION: .
LOT SIZE:
�X /zD
HOUSE SIZE:
/�SQ. FT.
CROSS STREETS:
AND
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PLOT PLAN
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S�AICE � 91 S
SeS��iuufs •�„�,�
.�«.�..,,�
i— 7" x 8" Ridgeboard
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k s„
— — RditQ�S
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-- -- 2„X6.,
Cross Ties
1"x 6" W-Bracing
when applicable
per Minn. State Code
NOTE:
1)
21
3)
4)
I 51
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ROOF: GABLE REVERSEGABLE HIP
IL/ t
EAVE OVERHANG �
RAKE OVERHANG:
SEAL DOWN SHINGLES WITH PLYWOOD OR ASPENITE
ROOF SHEATHING AND 15 L6. FELT
Roof Sheathing
Seal Down Shingles
3/8" Plywood
G uss�ets
2" x 4" Double
Top Plate
Roof approved by Minn. State Building Dept. as meeting Minn.
State Code Requirements of 30# snow load. Refer to State
Building Code Letfer Number 35.
7russes set 48" O.C. (Gusset - 3/8" Plywood).
Intermediate rafters are 2" x 6" 's braced with 2" x 6" collar ties.
On 18' and narrower garages, eliminate the W-bracing and collar
ties. ,
Hip roofs consist of 2" x 6" rafters, 2" x 6" cross ties 48" O.C.,
2" x 8" hip rafters and no plywood gussets are used. i
RAFTERS: -2".x 6" 24" O.0
STUDS '. 2', x 4" 16" O.C. 24" O.C.
WALL SHEATHI _ � �� �
SIDING: _ lL '�' �,p
OVERHEAD DOOR HEADER: Dou •• �::,
uelam beam_ X _,
Slab on grade construction approved per Minnesota State Code. Refer .
to State Building Code Letter Number 11.
e
SLAB: 4" WITH MESH 6" x 6" #10 Gauae
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as° L�
, , , g I 4„
3/4" Cove
Trim
Fascia
1"x4"Sub
Fascia
Soffit
2" x 4" Studs
Siding
'h'" x 7" Anchor Bolt
per U.B.G.
2" x 4" Treated Bottom Plat�
Grade Line
, � %�/�/�//
l��LV�1• H�S'�
SIIHVEVING e fNG�NEEAirvG CO.
81241
12 30 ?4
THE SUSSEL COh1PANY
Lat 16, Bloch 1,
MEADOW Af00R TERR/iC�
� �S°° 2
JOB NUMBER
SEC/TWPlRN
CLIENT
LEGAL
DESCRIPTION
10/2/91 DATE SURVEYED
10/7/81 DATE DRAFTE�
Z� SCALEIN FEET PERINCH
PROPOSEO ELEYATIONS: NONE
m.
'�� -i.�.....
FIRST FLOOfl
TOP OF FOUNDATION
GARAGEFLOOR
LOWEST FLOOR
SANITARY SEWER
6ENCHMARK ELEVATION
BENCHMARK
DESCRIPTION
5300 HIGHWAY 101 SoUTN
MINNFTONXA,MINN£SpTA 553f3
STANDARD SYMBOLS
"p' Denotes 1!2" ID pipe with plastic plug
bearing StaYe Registratlon No. 9235, aet.
"O' Denotes iron monument found,
"*" Denotes cross chiseled in concrete surtace.
"982x5" Denotes exlsting spot elevation measured
at the point marked by "x", io Mis ca>e,
982.5 feet above mean sea level.
"982x5" Denotes proposed gpot elevatlon at the
point marked by "x".
"—�" Oenotes proposed direction of storm wa¢er
runoff.
CERTIFICATION
i hereby certify that this plan, survey, report
or specification was Dreparetl by me and that f
am a duly Registered Land Surveyor and Profes�
sional Engineer uoderthe Laws oflhe State oi /
Minnesota. � 1 �. .
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H. Farker, PAinn. Reg. No. 9Y,i5
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9G�7 �
fa�a.EY, ta,v.
City of Fridley SUeJFC
ATTHE70POFTMETWINS gUILDIN� PERMIT
.
, ,
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' COMMUNITY DEVELOPMENT DIV.
�v"
r j PROTELTIVE INSPECTION SEC.
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l-._-� �'���'� CITY NALL FRIOIE� 55032 Nue�eER
t 612-571-3450
910-F15
lOB ADORESS '
7677 Bacon Drive NE
1 LEGAL �OTNO. BLOCK TRACTONAOOITION
DESCR. i c , __ _
1 ARCNITEC�ORDESIGNER
e USEOFeUIL01NG
Residential
7 CLASSOFWORK
❑ NEW
B DESCRIBE WORK
Te
MAII ADDRESS
�
MAII ADORESS
❑ ADDITION O ALTERATION
2/i6/96 I / /
21P
ZIP
�CHMIT NO. '
?39'i8
$EEATTACHED
SNEE7
PMONE
784-3705
PNONE UCENSENO.
9-3150 2004063
PHONE LICENSE NO.
PMONE LICENSE NO
REPAIH ❑ MOVE O REMOVE
9 CMANGE OF USE FROM Tp
STIPULATIONS
XXBXXRX% Bedroom replacement windows must meet the State Egress
Code. Install smoke detectors as per State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, P�UMBING. HEATING, T�PE OF CONST. OCCUPO
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VpID IF WORK OR CONSTRUCTION ZONING SQ.FT.
AUTHOFIZED IS NOT LOMMENCED WITNIN 80 DAYS, OR IF CONSTRUCiION
OR WpqK IS SUSPENOEO OR ABANOONED FOH A PERIOD OF 12D DAYS AT
ANV TIME AFTER WORK IS COMMENCED. .
� N0. DWLG. UNITS
1 MEPEBY CERTIFV THAT I HAVE READ ANO E%AMINED THIS APP�ICA710N 1 STAlLS
ANDKNOWTHESAMETOBETRUEANDCOflRECT.ALLVpOVIS10N50F�AWS yq�UAiION
WN H WRHENHE(i SPECIF EDN EREIN'OR NOTOTHE GRANTING OF AOPERMIDT WS�SOO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TNE pERMITFEE
�ROVISIONS Oi ANV OTNER STATE Ofl LOCAL LAW REGl1LATING CON- @
STRUCTI OF TME FE FOflMANCE OF CONSTRUCTION. pI12.ZS
PLAN CNECN FEE
° � License SC $5.00
Sqp�TUEE � ON� CiONOR1U1NpR1ZEDaGEN1 IDATEi
. . �.f /r , lN?,�EN"R PER VAL
F T.
$1.38
>AC CHAPGE
Fire SC $5.50
OTALFEE
$124.13
NEW
ADDN
ALTER
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ConstructionAddress:
Legal Description:
OwnerName & Address:
Contractor:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Bui(ding Permit Application
`�fih �iU . �/l� _
' Mh �
Effective 8/1l95
i
s �
i
Tel. ;7 7$ <�-370�_
MN LICENSE # Zo o�(p (�3 U
� Tel. � �3W -SfJ�
Attach to this application, a Certificate of Survey of the
lot, with the Proposed consfruction drawn on it to scale.
DESCRIPI'ION OF IMPROVEMENT
LIVING AREA: Length Widfh HeiBht Sq. Ft.
GARAGE AREA: LeaB� Width Height Sq, Ft.
DECK AREA: Lengtt► Width
OTHER: HBbGround _ Sq. Ft.
�J i vl ilov.> uC�w�en S- k Y' e w i �� �02 v�e�u
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Fstimated Cost: S J�SU c7
Approx. Complefion Date: —
(Cost on Back)
IJriveway C�rb C�t Width Needed: _Ft. + 6 Ft = Ft x$ –$
DAT'E: _'^� / �(p � q(� qpPLICANT: �k�ov�q�y$ /�. , JtK ,L �_ Tel. # Zi�-� Ci5 Z`�
��� �
Permit Fee
Fire SurcLarge
State Surcha�ge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
�.
$ ���� � Fee Scheciule on Reverse Side
��" .001 of Permit Va[uation (1/lOth%)
$ .�,3�° $.50/51,000 Valuation /• 5����
$ _ $�50 per SAC Unit
$ S. �d $5.00 (state Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$
Sewer Main Chazge $
TOTAL
STIPULATIONS:
s /�y. �.3
$450:00 Conservatioa Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
� �.:
�
i
BUILDING PERMIT 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 buiiding or structw'e, or for any alteration or repair to any e�stinS building or
structure, upon application therefore, require the payment by the applicant for such permit of fces to the amount
herein below set forth and in the manner herein Provided to-wit:'
TOTAL VALUE
$i to $500
$501 to $2,U00
$2,001 to $25,000
s2s,00i c� sso,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,0OO,ODO
$1,000,001 and up
FEFS
$21 (Minimum Fee is $21 plus surcharge)
S21 for first $500 plus $2-75 for each additionai 5100 or
fraction thereof, to and including $2>000
562,25 for flrst $2,000 plus S12.50 for each additional $1,000
or fraction ther�f, to and including $25,000
$349.75 for first S25,OOU Plus 59.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 far first $50,000 plus $625 for each additionai
$1,OOQ or fraction ther�f, to and including $100,000
$887.25 for first 5100,000 plus $5.00 for each additioual
$1,000 or fraction thereof, to and including $500,000
$28H7.ZS forthe first $SOO,OOO plus $4.25 for each additional
$1,000 or fraction thereof,to and inciuding $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$i,(100 or fi�action thereaf
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Sueets Oniy)
Altemate "A": Removal and reptacement of curb and guder only - Driveway width plus 6 feet times $13.50.
Aitemate "B": Removal and re,placem�t of curb and gntber a� install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feex times $15.75.
VER�FICATION OF FOUNDATION
permits for construction will be issued a minimum of 24 hours from t1� time of appiication to allow for proper '
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, shoariag the location of the foundation oace it has it has been consin►cted
wili be required before proceetting with the framing.
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JOB ADDRESS
1 LEGAL �
City of Fridley
AT THE TOP OF TNE TWINS
GOMMUNITY DEVELOPMENT DIV.
PROTECTWE INSPECTION SEC.
� CItV NALL FRIDLEV 55132
' 612-571-3460
7677 Bacon Drive NE
SU6JECT
BUILDING PERMIT
�BER REV D�TE v�GE OF
aiaFie 2/12/98 � �
oesca. 16 I 1 I Meadowmoor Terrace
2 PROiERTYOWNER MAILADDRESS
Dan/Kim $ickle 7677 Bacon Drive NE
a
5
8
i
e
Same
MAIL
MAIL
25800
(� /a -�
SEEATTRCMED
SHEE7
PHONE
783-9704
NO
PNONE LICENSE NO.
Residential
oF wonK
❑ NEW ❑ ADDITION �7 ALTERATION O REPAiR ❑ MOVE ❑ REMOVE
BE WOHK
Install a basement egress window; finish basement
CHANGEOf
STIPULqTIONS
rr�ur.�
See notations on plan.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, P�UMBING. HEATING.
VENTIlq71NG OR qIR CONDITIONING.
THIS PEHMIT BECAMES NULL AND VOID IF WORK OR CON3TRUCTION
AUTHORIZE� IS NOT COMMENCED WITMIN 60 DAYS. OR IF CONSTRUCTIpN
OR WppK IS SUSPENDED OR ABANDONED FOR A PERIOD OF tZp DAVS AT
ANY TIME AFTEF WOPN IS COMMENCE�.
I HEREBV CEfiTIFV THAT I HAVE FEAD AND EXAMINEO TNIS ACP�ICATION
ANONNOWTMESRMETOBETRUEANDCORqECT.ALLpqOVISIONSOFI,AW$
AND OqDINANCES GOYERNING TMIS TYPE OF WOFK WILL BE COMP�IED
WITH WHE7MEH SPECIFIEO MEREIN Ofi NOT, THE GRANTING OF A pERMIT
DOES NpT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME
PROVISIONS OF ANV OTHER STATE OR LOCAI LAW REGULATING CON-
STRUCTIpN OF THE PERFOfiMANCE OF CONSTRl1CTION.
o�
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G.�..d�i.'��� �
/� �.r�,,�.�.�,t a .sPo 0
, ..._... �(f. .
l�o �%�l � l.ril. %%G. .
�,�,�c�.�� -�) City of Fridley
l�,r.'�'^' REPRIN7
OPER: 11A�S � � DIWIER: �
DNTE: 12/29/98 00 IECEIPT: 0008975
OESCRSDTI�l1 QTY f1pOlPR TP TM
PENIItS-BUIiDIN6 1 f53,75 gp IX
FIAE �1Rf�q�E F i f2.50 FS CK
DWIUKIM H�q�
1�@ITi�I. �5 �! BP�80
7677 BRC�M lIRIVE tE
T�IEi Ydsidr96
TOFAL LIECR _ ��
.....,._ n _ . .
_. _..._�_.,. ...�..� _
1 ISTALlS
JATIpN
$$0Q $3,000
dIT FEE
�zztee ��a. �s ,
,
�GARAGES
1RTA%
$/$0 $1.50
iC CNARGE
i SC ,��$¢ $3.00
FEE
�zz100 ��9.zs
NEW
ADDN
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Il
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstrucdonAddress: ��c, 7 7
Legal Description:
Owner Name & Address:
Contractor:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
���z
0
Effecdve 1/i/98
�ha �}D
Te�.� � 7$'3 — �' 70 �/
MN LICENSE #
Te1.11
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPI'ION OF IMPROVEMENT
�n8� �3 Width ( a Height � Sq. Ft. ��p
�n8� �'Vidth Height Sq. Ft.
I.enStt►�_ Width Hgt/Ground _ Sq. Ft.
Construction Type: Estimated Cost: $ ��J ��
(Fee Schedule on Back)
Driveway C�rb Cut Width Needed: _Ft. + 6 Ft =_Ft x$ _$
DATE:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
APPLICANT:
CI1'Y USE ONLY
Tel. #
$ �� Fee Schedule on Reverse Side
$ f � .001 of Permit Valuation (1/lOth%)
$ . 1'U $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ 22�
��
��
BUILDING PERMIT 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
$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
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof,to and inciuding $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 fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $S.00 for each additional
$i,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2887•25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5012.25 for the first $1,000,000 plus $2.'75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Giub Sueets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 Feet times $13.50.
plternate "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 suucture and of the construction site.
A Certificate of Survey of the lot, showing the locauon of the foundarion once it has it has been consuucted
will be required before proceeding with the framing.
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Building
[nspections
763-572-3604
763-502-4977 FAX
iITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMI7' A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEMG IX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
E-MAIL
■. u;
STA'1'E LICENSE
❑ SMGLE FAMILYMEW CONSTRUCTION
❑ TWO PAMILYMEW CONSTRUCTION
❑ BASEMENT FIN[SH ❑ ROOF
❑ DECK ❑ SmING
❑ NEW HOME CON57RUCTION
❑ MAMTENANCEIREPAIR
ROOFWG � � /Q �
NUMBER OF SQUARFS /
GARAGFS
PROPOSED SIZE:
PROPOSED HEIGHT: �
FAX
S12E
STORIES
❑ ADDITION
❑ REMODELRJG
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ AITACHED GARAGE
❑ DECACHED GARAGE
Permit N
Received By.�M�R �
Date Rec'd: 5_p�_�
r
DATE D�j" �j— Z� �
0
❑ DRAIN TILE
❑ OTHER
4ASEMENT REMODELMG SUBMIT
I. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used,
SIDING FOR NEW CON57RUCIION RJCLUDMG DECKS,
❑ Vinyl OSoffit � . ADDITIONS. & PORCHES SUBMIT'
❑ Aluminum , ❑ 7��m I. Site Plan/Survey showing the existing sVUCtures
� �u ❑ Fascia � and proposed projcct �
2. Two sefs of construction plans
WINDOWS � 3. EnergyCalcuiazions �
M EXISTMG OPENINGS OYa �No LOCATION OF WINDOWS
OR FOR NEW OPENMGS-DESCRIBE SIZE OF
OPENRJG CHANGES &. �
TYPE OF WINDOW TO BE MSTALLED NUMBEROF WINDOWS
ALL FEFS ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
n SING THE 1997 UBC FEE SCHEDULE)
'OTAL JOB VALUATION S dS� _ OCCUPANCY TYPE
Plan Review
Fire Surcharge
Surchazge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosioo Conh�ol
Park Fee
Sewer Main Chazge
Total Due
. �i1„
. j►�
��Ir'
See Back Page for Fee Schedule
65°/a of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
55.00 (State Licensed Residential Contractors)
51825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
5450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
checks
TH[S IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PAOCESSED
Attach
7 liereby epply for a building pem�i[ and I acknowledge that the informatlon above is complete and ace�ua[e; that thc work wili be in confo`mance with the ordinances and codes
of the City of Fridley and with ihe Min�rcso[a Cunstrucdon Codes; that I understand this is not a prnni[ but only an appiication Por a permi[ and work is no[ to start without a
pertni[ on site; Nat the wo�be in accor �ith�p��n the cate of all work which requires review and approval of plans.. �
SIGNATURE OF
APPROVED BY
DATE
r^ _
Page 2- Building Residential Application
BUILDING PERMIT FEE 5CHEDULE
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 shucture, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment by the -
applicant for such peRnit 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 Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fas: 763-502-4977