AF - 35421- - -
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� � `� � � � � BUIL�IIiTG .�PE�MIT ���� �
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: • , , : N° 2i11
3 . . � .. . . . .
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; Yillage oi Fr�dley, Mlnn.
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i ov�er ,/�� `` ',' � ,d`;� B,.�aep . . . .
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� Address ,�y'� O. . a„�,�., .�.1 � , ,�, , ,�,� . . .'�. .l�'J Address
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' ,�� LOGATiOIV C)F -BUILDING � _
No. . �{.,� . Streef . . �€.';% Part of Lot . . . .
'�� . .1� . . Block ° . !��; . . Addition or Sub-Divislon • ��'����,�-�. . . . .
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" Corner Lot ... Insfde Lot ... .. _ `
' . .. . . . . . . lr�. . . .`. Satback � � . .�%1 �ideyard �Q. r�^' �
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- ,. _
�E�RIPTtON 4F BUILDING
yTo be Used `as: ,,
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`. . . . . . , Front c� �: . . : De ` ;'
. ,. . . . . . . . . . . . pth �'�. . . Heig�t l.�'?!,', . , Sq. Ft. , . . . . . . . Cu. Fi, . . . . . . .
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�t. ao�-�.
��• . . . . . . . Front� Zr. . . . . I7epth : ,2. �. . : Height . . � . . . Sq. Ft. . . . . . . . , � �. . � ;.
�
ki'yp�:of Constzlzzet�tos,��fiiG.`:z`:�p Es�. Cost .�� �� �� .�, �.-�,�,� `
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� t . , . . . . . . . . . . . . . . . . To b,e �Gompleted
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` Ir, cons�td�ra.ti�n o� the issuanG� t.� me' of a permit iu consfxuct fihe bu�ding described a�ov�, I agree to do
�he proposed wark in. accordance with the deseription above set forth and in compIiance with all presvisions of'
�irdinances . of the village of Frldley,:
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.�������+�� t�e AaYment oF a fee of $ �`Z� . , Aern�it- is lierebY granted . . . . . . . . . . . . �
' ._ .. .. � .
e�1o: . to eanstruct the building or ad dition as deserithed a�ve. This perxn�it is t�eci 'upoa �; : '
.e ;
�Fhe ex�,sress condition that the person to whom it is gi�anted ati8 F�is agents, empioyees `and worlunen, m all wark
c�one in, around and u�n said building, or t�ny Part iher eo�, shall eanform in ali respects ta :'the ordina.naes af �
e n ,s .
�`ridley, Minnesata regarding IoCatioa, constxtiction, alterai34n, maini@narice, rePair and moving of buildings with- .�.'
3n the village limits and this Permit may be revoked at ariy time upon violatio , �► of_ the, gravisions of said
4Pd�t1822C@8. _ .
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, ' • • ••> • • .. .'` BUfl�llg 7t18pCCtOP > ,
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, NOTIG�• : I
� '!'hia permtt does not ,ctiver fihe constructi6n,.Ustaliaiion or aii�ra#ion for wiring,- pfnmtttng, pas heattAg, �
� sewar or vvater. Be sure to see tt�a Bullding inspe�tor €ar sepacate perrntts for lhese iiems. � ��
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CC%.ty of Fradley, Min.n..
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nate: �'a]-� 6 � 19b5
p�; Roman Chock
Addre�a �t617 �ler St. BT. E.
, �
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N° 8125
Buflder - - rS'tPQriC@� B].dTS! � IAC •
Ad�s 3020 Sileer Lake Road
LOCATION OF BUILDING
No. 5�_ Street BBAxlett �1.oe N. E. Part of Lot
� � Block � Addition or Sub-Div�sion . Ch�'3.9t].e
Coraer Lot Inaide Lot _ Setba.ck ___. Sideyard
3ewer IIevation Foundation IIevation
DESCRIPTION OF BUILDING
To be Used as:
Front Depth Height Sq. Ft (�u, F't
�Yont Depth �Teight Sq. Fk Cu. Ft
Type of Construction Eoc� Cost ����•(� _ To be Completed
�torm Dam�.�e,: Bebuild on or3.ginal fcrc�datioa
In c�deratlott oP the isattance to me of a germft to et the building bed above, I�� � to �
� P�Posed work in accordance with the drescript�on above t f rth in
ordlnaaoes of the dLy of Fi3dley.
�
Ea c�nafderati� of the P$3'm�t oP a fee of l$ 0•��., Permit fa herebY granted to doe S$POnCek
to c�nstruct the buflding or addition as described above. This permit is granted upon
the enpre�s condition that the person to whom ft fs granted aad his agents, employees and worl�en, in all work.
done in, asound and upon said building, or any part thereo� shall �nform in all respects to the ordinances oP
FrYdley� Mfnnesota lacation, construction, alteration, �aiateaaace, repair and mov3n� of bufldinga
wi�� dtr ]imits�� perm�it may be revokea at any time upon violation of any of the provisions op•said
.�.�.eII J8�96� Building Inapector
NOTICEr
'lldt pum(! dws erof wwr H�s �oeshv�i�, hutaQalten hr trMag, Ph�mb6�p, 6u 6�aHa9. ssww er waha B� sme to ss�
tln Butiding I�ae for pparaf� parmhs Por tha� hann.
owrt�x's
ADDRESS
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APFLICATIOIV FOR BVtLDING PERMIT -
� CXTY OF F'RIDLEY, MINNESOTA . ' .
i'�!aser�. . . �,
LOGATIOAT OF BDILI}ING
N0._ �,�d_�� SZ'REET,��.�./,�e�,� �/� rs'�— �AItT OF LOT
L� � BLOCR � � ADDITION OR SDBDiVISION_1`d_� ` �
CORNER LOT iNSibE LOT SETBACR SIDE-YARD -
SEWf;R ELEVATIOR___ FOUNDATIQN ELEVATTQft
Applicant attach to this form Two Certific�tes o��S�i�e�i o� Lot and propased
building locat�ton draC�a on these �er�ificates.
To be used as;
DESCRIPTION OF BUILDi1�G
Front�_Depth Height
Sq. Ft. Cu, �t.
FronC ., Dept ,�geight
Sq, Ft.� � �; Cu. Ft..
Type of Construct3on Estimated Coat „� ����
To be completed
The undersigned hereby makea app],ication for a permit �for the work herein
specified, agreeing to do all work in strict accordance with the City o£
Fridley Ordinances and r�lings of the Department of Bu�Idings,�and hereby
declares that all the facts and repreaentations stated in this application
are true and correct. �
DATE_ ''�°— � �°� ��� SIGNATOR
(Schedule of Fee Costs can be found
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$UYY.DING PERM�T FEE SCAEDtTLB
gTCTIOP 2. The Inspector of Buiidings �hall, before iasuing any permit for
the erece3on of any building or stsucture, or Eair any addition to any existin�
building or structure, or for any altaraCions or repairs to any existing
bu3lding or etructure, upon application therefore, require the payment by the
applicant.ior:such prermie of-fees to the s.mount herein below set forth and in
the manner herein psovided to�wiCs
2.1. For any auch permit for the erection of.any fire-proof building,
other than a gara�e, warehouse, faa�orq or grain elevator, or for the erection
of anq fire-proof addition, for similar occupancy, to any erti9ting building,
shall be at the rate of $1.40 for e�c�i one �housand cubic feet, or fraction
thereof, in such cubical contents.
2. .2 For any such permi:t for the erectioa o£ any fi�Ce-proof �arage,
warehouse, factory-or grain elevator, or for the erection of any fire-proof
addition, for eimilar o�cupancy;�to any egistiag building ahall be �t the
rate of $1.25 for each one thousaad cubic feet, class�fied as "£ireproof"
by Section.502 of the Minneapolie Building Code.
HOIISES
2.3. Fos any auch permi� for`the erection of any aon-fireproof
buildiug, other than a garage, wnrehousos factory•or grain elevator, or
any non-fireproof addition�, for similar occupancy, to aay existing bui�.ding -
perm�.t $1.00 fos each oae thousand cubic feet. .. ..-.
GARAGES
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2,4. For anq such permit for the erection of any non-£freproof garage,
warehouse,.factory or graia elevator� or for the erectian of any non-fire-proof
addition, for s�.milar oecupency, to at►y e$istiag building or for each such
building or addition - n3nety cents `($0.90) for each one thousand cubic feet
or fraction thereof, in the cubizal contenCs thereof with the minimum of $4,00.
For the purpose ot c�►puting fees for building permits, the cubical contenCs
of any building or addition to a uaiform height throughout by mulCiplying the
groun.d area cover�d�fram a point six (6� inches below the floor line o£ the
basement or cellar to the average �ieight of the upger surface or ta the average
height of the roof �urface of the main gab3e o£ a pitched roof. ..... •-
2,5. For repa3xs or alterat3ons Co aa existing aCructure, the fe� shall
be at the xate of $3.00 per eac1� F�ve Sundred Dollars ($500.00� or fr�ction
thereof in the cost of all proposed work.
2.6. In no case eha11 the fee charged For any permit as aet foreh in
Sectio 2n be less Chan $4.00... �
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STORM REPAIR DAMAGE FEES:
Resideatial, Estim�.ted Cost of woxk up to,$500,00 -.$5.00
Estimated Cost of work�over $5�00.00 - $L0.00
Co�nerciaY; Estimated �t of work up to $504.00 -$10.�
8s timated t� ., C of work over $500. 00 -, :�20. ►.
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City of Fridley �°�`y' t
AT THE TOP OF THE TWINS � U I L D i N G P E R M I T
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� ` COMMUNITY OEVELOPMENT DIV.
l j y ' PROTECTIVE INSPECTION SEC. �0�����
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( � �"'1 � CITY NALL FRIDLE� SS��i NUM�ER NEV OATE PAGE OF
������� ��� 612-571-3450
91Q-F15 3/28/O1 � �
JOB ADpRESS 513 Bennett Drive NE
t LEGAL �OT NO. BLOCK TRACT OR AODITION
DESCR. 11 2 Christie Addition
2 PROPERTY OWNER MAIL AODRES$ ZIP PHO!
Jenny Chock 513 Bennett Drive NE
3 CONTRACTOR MAIL ADDRESS
3i708
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SEE ATTACNED
SFIEET
Z�P PHONE IICENSE NO
Midwest Siding & Roofing 7385 Mark St, Greenfield, MN 55357 763-416-4804
4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
2�01�277
5 ENGINEER MAIL AODRESS , ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION � ALTERATION C� REPAIR O MOVE O fiEMOVE
8 DESCRIBE WORK
Reroo= House & Garage (25 Sq) Tear-off
8 CHAN(iE OF USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
SEPARATE PERMI7S ARE REOUIREO FOR ELECTFICAL, PLUMBING, HEATIN(i, � �rc vr �,u
VEN7�LATING OR AIR CONOITIONING
7HIS PEFMIT BECOMES NULL AND VOIO IF WORK Oq CpNSTFiUCTION 20NING
AUTHORI2ED IS NOT COMMENCED V�!ITHIN 80 OAY$, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOO OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DW�G.
1 HEfiEBY CERTIFV THAT I HAVE READ AND �XAMINEO THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS Of LAWS VALUATION
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMP�IED 2 557
WITH WHETHER SPECIFIED MEREIN Oii NOT. THE GRANTING OF A PERMIT ��
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME pEqMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- @
STR CTION F THE PERFORMA E Of CONSTRUCTION y�83 . ZS
� �� PLic NEs
S�GNATUpEOFCON'aACTOpOR/.UTNOA�2EOAGENT IDA1'E� ...d
� IpATEI
PANCY
SQ.FT
II7S
STA�LS
cE
SC $5 00
P LY VAi
OCCUPANCYlOAO
CU FT.
OFFSTREET PARKING
GARAGES
SURTAX
$1.28
SAC HARGE
F e SC $2.56
T TAL FEE
$92.09
iA D 7H�5 IS VOU PERM
Prepaid Plan Check $ ,�.� '
;�� ���(� Effective 1/1/2001
Estimated Cost $ CITY OF FRIDY,EY � vrJ
�;���,�A�L°" (763) 572-3604
Receipt # R-3, COl�lERCIAL & INDIISTR
BIIILDING PERMIT APPLICATION
Construction Address �r � . �v► ✓l� � �r t �
Legal
Zoning
Owner & Address �v� �. /�t.,�9G�C Tel# ( ) vs d ����%�
corrrx�cTOR � x�Dx�ss /P/1 ���5� �CG�ivz� �f � �g Tei# c (03� �—YB'� `�/
!3 �3 � � S� l �� �' c C � � �r �v .�s- 3 �
Architect
TYPE OF WORK [] New
��ct r� B'j/f
Reg.# Engineer geg,#
BIIILDING CONSTRUCTION
[] Addition �lteration -Describe
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OFC. AREA: Length Width Height Sq. Ft.
WHSE AREA: Length Width Height Sq. Ft.
OTHER AREA: Length Width Height Sq. Ft.
APPLICANT ��.-r% �i � �2.r(�J Tal # �P�Z���IP `�E'�,��Date �-Z �`� �
VALUATION � ����
Sq. Ft. x$ Cost/Sq. Ft. = Valuation $ �� ) 6�
Sq. Ft. x$ Cost/Sq. Ft. = Valuation $ )_$_ �
Sq. Ft. x$ Cost/Sq. Ft. = Valuation $ ) TOTAL VALUE
Building Use Construction Type Occupancy Group
Air Conditioning [] Yes [] No Fire Protection Provided [] Yes [] No
Performance Bond Amount $ See Reverse for Schedule Received []Yes []No
Permit Fee $ �_�
Plan Check $ `--"
Fire Surcharge $ �e �
State Surcharge $ % � �
�� LritiJS� c� e $ •
$ Sd�o
Park Fee �
Spec. Assessments $
Driveway Escrow $
TOTAL $ •
PERMIT FEES
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.001 x Permit Valuation (1/loth �)
$.50/$1,000 Valuation (See Sched. for > $1 Million}
$1150 per SAC Unit (Plans to MWCC for determination)
$450.00 Conservation Plan Review
Fee Determined By Engineering
Agreement Necessary [] Not Necessary []
feet x $15.50/foot
ATTACH STIPULATIONS
$1 to $500
$501 to $2,�0
$2,Q01 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$5�,001 to $1,000,000
$1,000,001 and up
BUILDING PERMIT FEE SCHEDULE
$23.50 (Minimum Fee is $23.50 plus surcharge)
$23.50 for lst $500 plus $3.05 for each addn'1 $100 or
fraction, to and including $2,000
$69.25 for lst $2,0(l0 plus $14.00 for each addn'1 $1,0«? or
fraction, to and including $25,000
$391.25 for lst $25,000 plus $10.10 for each addn'1 $1,000 or
fraction, to and including $50,000
$643.75 for lst $50,000 plus $7.00 for each addn'1 $1,�0 or
fraction, to and including $100,000
$993 .75 for 1 st $100,000 plus $5 .60 for each addn' 1$1,000 or
fraction, to and including $500,000
$3,233.75 for the lst $500,000 plus $4.75 for each addn'1
$1,000 or fraction, to and including $1,000,000
$5,608.75 for the lst $1,000,0(}0 plus $3.15 for each addn'1
$1,000 or fraction
PREPAID PLAN CHECK FEE SCHEDULE
Per Minnesota Building Code - 65 % of building permit fee.
PERFORMANCE BOND POLICIES
When a building pernut is issued for a commercial, industrial or a multiple dwelling
residential project which requires outside improvements, a Performance Bond or a Letter of
Credit shall be submitted to the City. The bond will cover all outside improvements, including
but not limited to landscaping, irrigation, curbing, blacktopping, sc��ening fences, lighting,
water & sanitary sewer services, and storm drainage systems.
Calculation of bond amounts will be determined by the building permit values. The
bond amount will be 3% of the building pernut value up to a 2 million dollar project or a
$60,000 bond. Actual amounts will be rounded to the nearest $1(}0. The City reserves the right
to require greater or lesser bond amounts based on unusual circumstances. Projects with no
outside improvements, generally will not require a bond.
Bonds must remain open until the project is fully completed. Reproducible "as-built"
drawings of all exterior underground utilities must be submitted to the City Engineering Dept
before the project is considered complete and the bond released. All bonds will be held over
one winter and through the next growing season to insure the survival of all landscape
installations. The City will then inspect these properties in August of the year following the
initial planting. Bonds may then be released in October of that year if all improvements are
satisfactorily completed.
Building PLUMBING Permit No.: �
Inspections RESIDENTIAL APPLICATION Received sy: �
763-572-3604 CjTY OF FRIDLEY Date Rec'd:
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS C'� � � � �ed�%N � -
THIS APPLICANT IS: � OWNER pe'�iNT�A1�i CTOR
PROPERTY Np�: '
OWNER/ pDDRESS: � CITY STAT ZII'
TENANT
PHONE:_� r � V �
CONTRACTOR N�:
SUBMIT A COPY OF STATE LICENSE #_ ��� / J C� EXP DATE l
YOUR STATE ADDRESS: �%J � CITY STATF/"Wci ZIP t�� .�3
LICENSE WITH pHONE ����1�' �_ FAX
APPLICATION
PERMTT TYPE GLE FAMILY ❑ TWO FAMILY � TOWNHOUSE
TYPE OF WORK: � NEW FF3-R�PLACEMENT
DETAILED DESCRIPTION OF WORK �,�,�� ���� �,�
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (T'his should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =�/��
FOR PROJECTS Wf�RE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOVt�
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
_BATHTUB GAS PIPING pv�ctrruc�) SWIMMING POOL � WATER SOFINER ($35)
CL01'HES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
WATER METER OTHER
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Permit Fee $ _� � Number of fixtures @ $10.00 x $10.00 = $
Surchaz e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ L�. Number of fixtures @$35.00 x$35.00 =$
State Surcharge = $ .50
Tota1= $
THIS IS AN APPLICATION 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
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 w� c whic quires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME DATE �/
�.' �d`"r a�. �. ` .�: � T $� ,
_ .b. .k-.. C �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977