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City of Fridley, Minn. �T •° 9000
BUILDING PERMIT
��: � 3BPTffi�BR 69 1966
Oovner: _�• BBTTY SIMCOE Builder TH80. MACIEJNY..� CARPENTER ._..._.._
p� ___.6396 BAKSR ,AVBiQUE N. B. _� A�� �G7ERSTAD & VII�CNGSON � MASONRY
FRIDL�Y, MIftNSSOTA
LOCATION OF BUILDING
No. .._.._6396 3treet ._.._ BAKER AVBNUE N.E. ._..__...___.__.._. Part o! Lot ._�__ R• ''90' of
Iat .._.. $_._.__ Block .._? Adtlition or Sub-Divisian ._._.._MDORS LAKE HIGHLANDS
Coruer Lot ----.__..____ InsiBe Lot ___._?� _._ Setbnck __....__._.__.___._ Sideyard ._._..r..—.� ._
Sewer Ele�vatiau ._._..._w.._.._..__ _._._.. .r..___... Foundatioa� IIevation _._...._ —..�.._._. _____._..._.
DESCRIPTION OF BUILDING
To be Used as: ADDED TO RF.AR
SN(�.OSBD PORCH �.ont _.._.L4__.. Depth ._._...12�.. xe:tght ._._..L. Sq. F't. .._].fi8.._.. Cu. F't 1�,17b
...._ PY�t►t Depth __.__._._.__ I��igt►t _,_._____ Sq. Ft. _.._ Cu, FL __.
Type of Cca�struction __.._ F� _... F�t. Coat ._..__�.800_. 00 _._.___ To be Cocnpleted _.�... _.:_..�.. �
In candderati� oi the issueace to me o! a permit to cos�atruct the buildinQ defcribed abave I agree to do
tha propo�ed wo�k in acxorderice with the d�e�cription above se�t forth and in oompliance with afl p�aviedo�ns t�
o�dinantxs c� the city o! I+'ridky►. � 9/'-'�! � .. ��
In caoddrratton oi the payment o! a!ee o! 4��� ..__._.., pernait is hereby �ranted t� MRS . BETTY
�STM(:�R to ceoastruct the buiidin8 or additiar� ad deecribed above. This, t ia granted uposi
the exp�en oa►diticu that thepe�on to whom it is grsated and his agents, employees �w�rkmen, in ali wozk.
exp en
done in, arotutd aad upan setid buildit�, ar at�y thereoi, shall oonfotm in all rKpects bo the ordir►e�acee a�
ovlt�hin ti�e� b��� p�ermi� t m41�ba ravoiced�at anY time uPar���� �� P�'o�� ��
c�dfnan�ae�.
CLARENCE BELISI.� B� �
NOTI�
7W �N�N i�s �N Nwe fM aeaierdiN, MM�Mi� hr wir1�, �wW�, Nr I�MIy. Nwar N wN�. M�nn N�
fM wWiM �Me t�r � MrrN hr f6w IN�.
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OWNER � S
ADDRESS
APP'LICATTO�i FOR BUILDING PERMIT
CITY OH FRI�.Li, MI1aNESOTAr,r,
LOCA7."ION OF Bt�LDING
Na.43p� ���,�s��r
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�p� LOT BLOCK c� ADDITION OR SUBD'
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CORNER LOT `INSIDE LOT� ''`S�TSACK SIDE-YARD
SEWER ELEVATION FOUNDATiON ELEVATIOft
Applicant attach to this form Two Certificates of Survey of Lot and propo�ed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To be used as: _ � ���,-t � + 0 r' � �' �
. �/�,1, /' _ o S -L � Front��Depth,��,_Height
Sq• I''t• �GI. S. Cu. Ft. �
Front Depth �Height �_
Sq. Ft. Cu. Ft.
Od
Type of Construction__�.i��� Estimated Cos� �QQ ---, �
To be completed
The undersigned hereby makes appl3cation for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley drdinances and z�ulings of.the Department of Bui,ldings, and t�ereby
dec].ares that all the facts and representations stazed in this application
are true and correct.
DATE SIGNATITRE
(Schedule of Fee Costs can be found on the Reverse Side).
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City of Fridley, Minn.
BUILDING PERMIT
Date: _.._. Au�ust 6 .__1968__�_._.__.....___............__
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Owner: _._. Betty Simcoe ..�..__......._.._._..._.__._._ Builder _.._.._._---- �_-------Same
Address ..___. 6396__Baker_St �N. _E. _ _ _ Same
. Address _.._._._.._._.__.._.._._._____.._..._......__..---._.._.__._.._.�...._.._.._r.
LOCATION OF BUILDING
6396 Baker St . N. E -. -.--.-----. Part of Lot .--.--.....__......_...__.._._._.._......._._.__._._.._
No. _.._....--------_._._.._ Street _._..._...-----_._...__.._.._--------...._...._.__.....__..__....._._......---- -- •
� N.,....90'_.�f �1� __._. _2......___._.._______.__________ Addition or Sub-Division .....__Moore.Lake_Hills Hi�hlands_
Corner Lot .____.._._._..__._.. Inside Lot
Sewer Elevati�
Setback .---._......_...._..---_........... Sideyard
.._..._.._ Foundation Elevation ....._...._..._
DESCRIPTION OF BUILDING
To be Used as:
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^Storage ._....__..__ Front $.._..__._.._ Depth _._1_�......._ Height .._._ .............--. Scl. F� __...._.__.__ Cu. FL _...___.__
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__.._.__._.._._..........._._._..__ Front __.___..._._ Depth _...__._...._..__ Height ._..___.._...._.__ Sq. F't. ._.__...__...._. Cu. F'� _.._.__.__
Type of Construction _.. �rame_._...._._...._._.�.. Est. Cast _........----�400..00_........ To be Completed _..._...__...__.__..._..._...._.__
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
th� proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley. /
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In car�sideration of the payment of a fee of $.___ 5.00__.__.� permit is hereby granted to_._.._Betty__Simcoe
to construct the building or addition as described above. Thispe rmit is granted upon
the �express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon safd building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit xnay be revoked a t any time upo� violation of any of the provisians of said
ordinances. i^-�
Official
Buiiding �
ohn Breher
NOTICE:
This p�rmit do�s not eowr tlu construelioo, in�1a1l�tion io� wGtn�. Plumbin�. ��s h�aHny, swwr or wat�r. M wn to a� !
fh� BuiWieo In�p�eMr hr apuah p�neits for fha� ihm�.
-- �,,
APPLICA�:[OI�I �'OR BUII.DING PERMIT
GLTY �OF. �I�t,EY. MIi3Di$SOTA; .
4�+111�A.'.S ��.�<. ` ' ,:,�.. 1�:,�•- �' . $Ui�.DER� f�� _. r�``,.�`��.�
- � : . a----r-- --- , -- .
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. : AD�R,�SS °. .,�•�r`„�.'..� ., ,� �-'. �: .��: �,, °:.' ADDRE�S � ��
y ��f�
. �=. � ..�t�, � �....�:.:..- �.......� ,._._ ___..�.
.. ��... , . , • , .,
' _ ' � I:OCAT�UN -�OI�: B[IIZDtNG �
N0. . STitP:BT . � . , � . ,
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�o����'�° ' `�*�.',�� �" r � � _ �. � . , , n
P�4CK ADDITIE�T OR SUBDIV��N,:. • ��"�
—_..;..., ,-,.--i.'..:_..... . .►,-,..r�-,-....�..-.:--..�.- .. , , _ .
'C4RttER LOT .. �:Ii�SIDE L(� `�.,i.•3ETBA � . . , .
��... G�:�.-..:.�I�Y�kaD - _ _._._-._..._._..
SEWFR EJ�EVATION T4P OF FOOT�NG
A�plictaatC attacb to this �o�m Two: Eerti�ticst�s, af Sntv�ey a€ Lot a.m� ptoposed
b�ildirtg; locati�o�' •�ra�,aii ow tbe�fa' Ci��.�ificates . .. . , -, .
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� ' .1�SC�tI�'T�CA �,�P B�I�G . �
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. . . .. . � � ... : � 'i ..: �.. � . . . � . .. . . . . .
To Be Used Ast � `. .
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`,, ' Sqe,taie` feet '�, ... •: �. : Cub�c ��a�et.
Frant D�pth ��t
. ' � ' , . . _ .:.s .' .�..�....
Square feet Cubic FeeC
,�
Type of ConsCructio� '' Lstimated Cost � GQ� p`�
T'
To Be Campleted
The undersigned hereby makes appiicatioa for a permit for the work herein
specified, agreeing to do all work in stxict accordance with the City of
Fridley Ordinaaces and rulings of the Department of Buildfngs, and hereby
declares thati all the facts and representatiosts stated ia this applicatirns
are true and correct.
DATE SIGNATiIRE �'� _'`"" �'`� °
_ _.� _._...._._____.r�.. ._ ,.x+.-� �—.�-..�.:..�.�i,.+:._.-�°�'.�'.°"' _ ..
(Schedule of Fee Costs can be found on the Reverse Side).
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FRIDLEY
CIVIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
October 24, 1988
Sandra Stone
6396 Baker Avenue N.E.
Fridley, MN 55432
RE: Sign Permit Application
Dear Sandys
Enclosed you will find a sign permit application for your use.
Last week you called requesting sign information for Michael
Servatus Unitarian Church.
Churches which are located in a residential district are regulated
by our General Office, CR-1 district requirements. Residential
districts are only pernaitted area identification signs which would
not identify churches and other uses, therefore, the CR-1 District
regulations are used. The CR-1 district regulations for a free
standing sign are as follows:
1. One siqn per street frontage.
2. A maximum size of 24 square feet in area.
3. A maximum height of six feet above the finished ground grade.
4. A minimum distance of ten feet from any property line of
driveway.
Please return the application to me along with a scaled drawing of
the sign and a plot plan showing its location. On the drawing
please specify the color of the sign and materials used. Once I
receive the application, I will review it in terms of the siqn
ordinance requirements. I will then contact you to inform you of
its status.
If you have any further questions please contact me at 571-3450 x
168. I look forward to hearing from you.
Sincerely,
Kathlyn Castle
Planninq Assistant
KC/dn ` C-88-533
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CHIMI�tEY AND STACB VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes (�. No ()
2. Is firee from rust or deterioration Yes (� No O
3. Has no foreign objects lodged within Yes (� No ()
4. Is securely supported Yes (� No ()
S. 1t�leets all current Code requirements for size
and total BTL"s connected
6' Has total heating BTLT's of ��,{ ���
All other BTIT's "t � , � �
TOTAL BTU's ( d C..Q ��
7. Has a liner been provided:for water heater �
8. Has combustion air been provided for water heater
Remarks: .< n n i i►I 1�.. . _. �
List ALTERATIONS Being Done:
__Y�.s _��, No � �
Yes �) No ( ).
Yes � No ( )
_ . X�.
,t
� $> .
.4. �,
� �
...�: �..
BLJI�lE NTCi. AfC Ei.ECT., INC. �;� '
� #�2G�N7'RAL.AVE. N.E. �"; .
,�
HEATING CO: ANO � MI� �F^"�� , � ;N ; .
,.
Signed By: �'
Date: '��- � ,"I �
6��,�� ~�TING HOUSE HEATING TEST RECORD
AIR CONDITIONING
AND ELECTRIC. INC.
ADDRESS {,� 3�% f0 � a-�Ii�.�� rl'a �T• FLOOR CIT � UBURB
OCCUPANT OWNER �'_� - - -e —
HEAT LOSS �--� DATE HTG. INST. I ri ���� ���
SOLD BY �� ��'^� �`�� INSTALLED BY '` `�
Eleetrical Work By V` `� Gas Lina By
TYPE OF HEAT GA FA HW STEAM_ SPACE HTR._ UNIT HTR._ OTHER
GAS DESIGN
MAKE �'r��v"�"s
Modal � � �
__ _ _ __ -� �,-sr-�t �o s 9
Serial
INPUT �IG�� .o —
CONTROLS
THERMOSTAT �F i�% Heat Plug
Valve
Limit � P�w �
Limit Setting °
Fan SetUng ''
Pilot Type
Pilot Make
Pilot Model Z.f �
Pilot Timing �s� �-
L. W. Cut Off
Pressure � Percent CO= � 3
Input CFH S'� �o Parcant O= 7�
StackTamp. 37�' PercentCO %�✓��
Form 235
CONVERSION
MAKE OF BURNER
Modal __ - -
Max. BTU Rattng
MAKE OF FURNACE
Model
Vant Siza �•
KIND OF LINER ������ SIZE `' NONE
Dnft Hood Regula r
Flltars Sia Number
Chimnay Lxation I�sida ✓ Outside
Chimnay Construction
Smoke Bomb Wi�^9 �
Draft Tast Tag , ��
Door Pressura Ughting Inst. d
Data Tasted
Company Testlng
Nama of Tastar
� y
sue�ttr P NO.
City of F�idley 2 8 6 2
AT THE TOP OF TNE TWINS g� �� p 1�� P E R M I T
� � 5?'�-3604
RECEIPT NO.
i � `V������ COMMUMITY OEVELOPMENT pIV. �j
r � � PROTECTIVE INSPECTION SEC. i9b/
1 �
� � �"'1 � CITY NALL fR10LEY 55132 NUMlEN RHV O�T� v�GE O: APVROVEO OY
�'"'"��� ,�� 612-571-3450 9t0-F15
11/20/98 � �
�oe Aooaess �
6396 Baker Avenue NE
� IEGA� �OT NO. 9LOCK TRACT OR 11DDITION SEE ATTACMED
OESCR. Pt. $ 2 Moore Lake Hi�hlands SMEET
2 PROPERTY OWNER MA�L AODR�S$ ZIP PHONE
GreQory J. LeGeault 574-0679
3 CON7RACTOF MAIL AOORESS ZIP PHONE LICENSE NO
Owner
a AFiCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADORE$S ZIP PHONE IICENSE NO
B USE OF BUILOING
Residential
7 CIASS Of WORK
O NEW O AOOITION � ALTERATIQN ❑ REPAIR O MOVE • O REMOVE
e DESCRIBE WORK
Finish basement
9 CHANGE OF USE FROM
STIPULATIONS
See notations on plan.
Install smoke detectors to meet the State Building Code - in each sleeping
room and on each level of house.
SEPARATE PERMITS ARE REOUIqED FOF EIECTRICAL, PLUMBING, MEATINQ�, T�P OF
VENTILATING OR AIF CONDITIONING '
THIS PERMIT BECOMES NUIL AND VOID IF WORK OF CpNSTRUCT10N �ONING
AUTMORIZED IS NOT COMMENCEO WITHIN 60 DAYS. OR IF CONSTRUCTION
OF WORK IS SUSPENDED OR ABANQONE� fOR A PERIOD OF 120 OAYS A7 �
ANY TIME AfTER WOFK IS COMMENCED. ' NO DW
I MEREBY CERTIfV THAT I HAVE READ ANO EXAMIN�O THIS APP�ICATION
ANO KNOW THE SAME TO BE TRUE AN� CORRECT. ALL PROVISIONS OF lAW$ VALUATI
ANp ORDINANCES GOVEFNING TMIS TVPE OF WpAK WILI BE GpMP!)ED
WIThi WMETMEfi SPECIFIED MEREIN Ofi NOT. TME GRANTING OF A PERMIT ].00�
DOES NOT PRESUME TO GIVE AUTMOiiITY 70 VIOLATE Oii CAMCEL 1HE pEqMIT 1
PROVISIONS OF ANY OTHER STATE OF LOCAI lAW REGULATING CON-
STRUCTION OR TNE PERFORMANCE OF CONSTqUCTION '
PLAN CM
� SiGN�tUpE O " A(;T�OQOA�UTHOR�ZEO�GENT �D�TEi
� � � -�5 '`� �%
�
U
G TUAE O� OwaEA iii OWNEp BUILOEAi � � i AiEI .. � ' �� �
SO.F7
.G. UN175 OfFST
STA�LS
)N SUFTA
.50
EE SAC C1
F'
ECK FEE T �
�ME PR � V VAU AiE MIS
OCCUPANCVLOAO
CU FT.
f PARKING
GARAGES
I$ Vp�p� MI
/� .
NEW '
ADDN
ALTER
i �
[l
��
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�bx.Q r �s ��.�
ConstructionAddress: � ,5 1 b
f1
Effective 1/1/98
��'��� � 7
Legal Description: �
Owner Name & Address: ;�rre csr �e e�, ��� Tel. #�� -v6 7°�
Contractor: - MN LICENSE �#
Address: 6 3 � (� � �Qke� %�1� Tel. �#
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
� �,
I.ength 3� Width 2 3 Height 7" a
Length Width Height
Length Width Hgt/Ground _
Sq. Ft.
Sq. Ft.
Sq. Ft.
r
Construction Type: � N� S� bq �2-mQ,,,�� Estimated Cost: $��� (�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
A Q
DATE: I�' I' I APPLICANT: Tel. �i ��! - Obr%°i
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ y��
$ /, �'
$ ��
$
$
$
$
$
$
$ o, 2�
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.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 [ ]
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CgINiNEy AND STACK VERIFICATION ,
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes O No O
2. Is free from rust or deterioration
Yes ( ) No ( )
3, Has no foreign objects lodged within
YesONoO
4. Is securely supported .
Yes ( ) No ( )
5, Meets all current Code requirements for size YeS �� No ()
and total BTU's connected
( Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
Yes()No()
g. Has combustion air been provided for water heater Yes () No ()
Remarks: .
List ALTERATIONS Bein� Done:
HEATING CO:
Signed By:
Date:
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COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When realacina an existing furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the cuRent codes
and manufacturers specifications.
When required to install a new combustion air. it will be sized and installed
To meet the current codes and manufacturers specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installina a newventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the cuRent codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ()
Appliance Tvae and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3.Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS• (Describel -
HEATING CO:
Signed By: Date :
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c�ty of Fr�a�ey .. . _ _ �
AT TNE TOP OF TME TWINS g � I L D i N� P E R M I T 3 0 � 9 6
r
� ' NO.
� �
� `y ����� COMMUNITV OEVEIOPMENT DIY. ����
r � � PROTECTIVE INSPECTION SEC.
l.-_-�; �'��;'� CITY MA�L FRIOLE� SS1,�j NUMBEA pEV DATE VAGE OF AbPROVED BY
i 613-571-3450 9t0-Ft5 4/6/00 / /
�oe Aooaess 6396 Baker Avenue
t LEGAL ��T NO. BLOCK TqACT OR ADDITION SEE ATTACHED
oescR. Pt 8 2 Moore Lake Highlands SNEET
2 PROPERTY OWNER MAIL AQDRES$ Z�P PHONE
Greg LeGeault 6396 Baker Avenue NE 574-0679
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
a AFiCHITECT OR DESIGNER MAII AODRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAII AODFiESS ZIP PHONE LICENSE NO
6 USE OF BUIIDING
Residential
7 CIASS OF WORK
❑ NEW O ADDITION �] ALTERATION O REPAIR ❑ MOVE O REMQVE
8 DESCRIBE WORK
Install basement shower
9 CHANGE OF USE FROM TO
STIPULATIONS
Extension of building permit ��28627 issued 11/20/98. See notations on plan.
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code.
TYPE OF CONST OCCUPANCV GROUP OCCUPANCv IOAD
SEPARATE PERMITS ARE REOUIRED FOF ELECTFiICAI, PLUMBING, MEATING.
VENTIIATING OR AIR CONOITIONING
THIS PERMIT BECOMES NUIL ANO VOIO IF WORK OR CONSTRUCTION 2pNING SO. fT CU FT.
AUTMpRIZED IS NOT COMMENCED 1�!ITH�N 60 OAYS. OR IF CONSTiiUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOp A PERIOD OF 12Q DAVS AT
ANV TIME AFTER WORK IS COMMENCEO. NO DWLG. UNI75 OfFSTFEET PARKING
I HEAEBY CERTIfV THAT I MAVE REAO ANO EXAMINEO THIS APPLICA71pN 1 STA�LS GAAAGES
AN� KNOW TME SAME TO BE TRUE ANO COpRECT. ALl PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMP�IED �SZO �.SO
WITH WHETMER SPECIftED HEREIN Op NOT. TME GRANTING OF A PERMIT
DOES NOT PRESUME TQ GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqM1T fEE SAC CMARGE
PqOVISIONS Of ANY OTMER STATE OR LOCAL LAW REGULATING CON- �26.55 Fire SC �.SZ
STRUCTION OF THE PERFOFiMANCE OF CONSTRUCTION
PLAN CNECK FEE TOTA� FEE
$27.57
S�GN�TUQEOFCON'AA(;TQqQp1UTMOp�IED�GENT � IOATE� WM � PROPER�Y VA�IOATED THIS IS VOU PERM
S�GN4TUaEO�OWNEQ��FOwNEpBU�IDEii� � •TE� ��DG �ti$� � /�rE
NEW []
ADDN [)
ALTER ( ]
Construction Address: '
Legai Description: �
Owner Name & Address:
Contractor: ��,. n
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Effective 1/1/2000
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �/�
BUILDING PERMITAPPLICATION ��
��� �
�� ��- qv� �
, � ' � , t ���'�-�tJ�S�
�P�e�,Jl� Tel.# .-��`���D�*%q
MN LICENSE #
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type: �r-�,� e�'N Sh Dw e;r Estimated Cost: $� ��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ' �G v APPLICANT: Tel. # �1 /'�7-� ���
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ ,J� Fee Schedule on Reverse Side
$ �S'� .001 of Permit Valuation (1/10th%)
$_;�,� $.50/$1,000 Valuation
$ $1100 per SAG Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Consenration Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ °� 7 �
� (S � !� �-�1� �C �'-� �� i ��� %
� �� �d
�/-ae� - 9 - S� �� �� ��o�s a� _.`��-�-a'
/ 8
�__-
jss���
BUII,DING PERMIT. FEE SCHEDULE
The Chief Building Official shall, before issuing pernuts 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
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fracdon thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$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 fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$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 fraction thereof .
DRIVEWAY DEPRESSION ESC.ROV�
(Concrete C�rb Streets Only) '
Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Altemate "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 $23.25.
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 construction site.
A Certificate of Survey of the lot, showing the location of the foundatipn ance it' has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
Building
Inspections
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
E-MAIL ADDRESS
SITE ADDRESS (�i�"l y /.�H.l�-�-'
THIS APPLICANT IS: ❑ OWNER
PROPERTY OWNER/ NAME:�
TENANT pDDRESS:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
a-���-
Permit No.:
Received By:
Date Rec'd:
STATE LICENSE # �T 0 3 6 v EXP DATE s� 3l �0 7
ADDRESS: �6 ( J C�.�'+-o�� /�'�c /`f0 CITY J ��+
P ONE 76 i- �"6 �- G �r/ FAX
SINGLE FAMILYMEW CONSTRUCTION SIZE
❑ O FAMILYMEW CONSTRUCTION STORIES
O BASEMENT FINISH
❑ DECK
L'
ROOF ❑ DRAIN TILE
❑ IDING ❑ OTHER
❑ SWIMMING POOL
O ADDITION
AIR ❑ REMODELING
DESCRIBE WORK BEING DONE: �Jr� q4� �- r�/'o�1F
�
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES �_
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
LENGTH WIDTH HEIGHT
❑ HOUSE ONLY
I,�HOUSE & GARAGE
❑ ATTACHED GARAGE
� DETACI-�D GARAGE
'ATFj1�IP rni�Z
ATE�.�ZIP rf Y�
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum 0 Trim 1. Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia and proposed project.
WINDOWS 2. Two sets of construction plans
1N EXISTING OPENINGS ❑Yes ❑No LOCATION OF WINDOWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ;� � 7 9.— OCCUPANCY TYPE ___
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ a . S�S'
$ �.a9
$ S,dC�
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=5
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks �ayable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMTf-NOT VAL[D UNT[L 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
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; 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 � 1 Z PRINT NAME �� /�f�` DATE �6 3��0�
Page 2- Building Residential Application
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:
VERIFICATION OF FOUNDATION
Pernuts 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
Faac: 763-502-4977