AF - 35425BUILI�ING PERMIT
Village of Fridley, Minn. No 2 �� 2
Date . . . . �`�J� � .,Ir��. :�r . . . . . . . . . . . . . . . . . . . . . . .
Owner . �� Builder . . . . . . . ,� . . . . . . . . . .
*�.����r,,.iC.,.-. ..,� `� +�"'�•;���*,� ,�,,�^`^'�+'�`�-< ............
Address .. .� . Address ....... ,,,
������OCAT(ON OF BUlLDING
No. . ..: �.?'. /. .. . . . Street . . � � . . . . Part of Lot . . . .. . . . . . . . . . . . . . . . . . .
r
Loi . . . .. . ��. . . . . . Block . . . . . . . . . . . Addition or Sub . . . . . . . . .
•�• -Division ��: ��,�, ,�". .�a�.
��
Corner Lot . . . . . . . . . . . . Inside Lot . . . �,,t . . . . . Setback ,�t. . Sideyard � „�e , , , , , , , , , , , , , ,
���f �►�''i,� � � d�,;v�
To be Used as:
'�si�����j ..
.............:I,,...
DES�CRIPTION OF' BUILDWG
Front ��. . Depth . � � . Height �'��� Sq. Ft. . . . . . . . . Cu. Ft. . . . . . .
Front . . . . . . . . Depth . .. . . . . . Height . . . . . . . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
Type"of Construction .e' ., . Est Cost , . �p. . To be Completed . � � .�, � � �
���,"p"`,� *l�''�.��%+� • ' !� ' ,
In consideration of the issuance to me of a permit to construct the building descxibed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of �ridley.
�
In consideration of the payment of a fee of $. permit is he by antedito �
` to Construct the buildin�o� dition as described above. Thi� an�upon
�1�+��ti�!!�dition that the person to whom it is granted anc� his agents, employees and wor •.en, in all work
done in, around and upon sa3d building, or any part thereof, shall conform in all respects to the ordinances of
�'ridley, Minnesotg regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this germit may be revoked at any time upon violation of any of the provisions of said
ordinances.
— - • •,+''�� .
NOTICE:
Inspector
This permit does not cover the construction, installation or alteration for wiring, plumbing, gas heating,
sewer o.r water. Be sure to see the Building Inspector for separate permits for these items.
�
-�,
p ra:. .
•��►.
�,:
�,
i
�
/
BUI[.DING PERMIT
Vill.age oi Frid.ley, Mi_n.n.
N° 2535
�
Date .��� �"��. :�. �. .. . .... . . .. .. . .. .. . . .
.. . �����.4'' .� BuiIder �:�'�`r� �
Owner _ .�+°�' ��.�'. . .�'.� . . . � . . . . . . . . . . . . . . . . . . . . . . . . . .
�
�
Address �� � • . : "'�'. . � .�'. . . . . . . . e .�a � Address . . . . . . . . . . , . . . . . . . . . . . . . . . .
� LOCATIDN OF �UILDING
s
' No. ��'�'........ Street .��i':'.`i�:�''..��. ..��";��:�.. ...... Part of Lot .....................
Lot .... . . . ..
. t ....s.s
a%� . . . . .. . Block . . . .�!. . . . . . . . . Addiiion or Sub-Division : , , �`
��"�'��'�.�-. i�. . .. �:�i�'. .. . .. .. . ..
• � � fi �►
Corner Lot . Inside Lot ..:�:'°:..... Setback �.� ..��"!: Sideyard��...����{' ..: .............
' DES�RIPTION OF BUILDING
To be Used as:
�, 9�
.�i�� .�''��. .�� . . . ,€�.'"� . . . ,
Front �":.. Depth ,��... Height ,�£•��fi• Sq. F��,d���:+-. Cu. Ft,
� ���
• �� a��... Front � �.... Depth .�� . Height ..... ... Sq. Ft. . Cu. Ft ....... .
Type of Construction �.-,� � F.st. Cos� � � .�.�!�, �� . . . . . T � � � • . �° , �,�$ .
•� ""q' ,�a+ . o be Completed �:'.%��'",��.i . . .'°' .�"`. . .
In consid�ratien of the issuance to me of a permiti to con$iruct the btti�ding described above, 2 agree to do
the proposeci work in accordance with the description above set forth a.nd in compliance with all provisions of
brdinances of the village of �`ridley.
,�r i.�ion of the payment of a fee of $. �°,��,'�? permit is hereby granted .to .. :���;-�_
_ �`� � �y .� to construct the building or a@dition as described above. This permrt �is gra� upon
f,he express condition thai the person to whom it is granted and his agents, employees and worl�nen, in all work
done in, around and upon said building, or any part thereof, shall conform in a11 respects to the ordinances of
�'ridley, Minnesot�, regarding loca,tion, construction, alteration, maintenance, repair and moving of btu'ldings with-
in the village lim�ttis and this permit may be revoked at any time upon violation of any af the provisions of said
Ordin&tices. r�' - � �
�
���
• • . 8uilding Irispector
NOTICE:
This pe�mit does not cover the constructton, instaitation or alte�atian fqr vdiring, plumbing, gas heaftn�,
' sewer or water. Be sure ta s�e the Building Inspeoior for separate permlts for these �iems. -_. �
r� `
:�� i _
;�,."�
�
:��, �
��,
�
�
City of Fridley, Minn-
BUILDING PERMIT
Date: Jvne 9, 1965
N° 7�09
Owner: fTQhn_Anrles�son �� Don Br�udeold Const. Co.
Aeareas 544 Ber�net� IIrive N. E. Adaress .�i2l�ent Ave. Ito.
���o �
LOCATION OF B�ILDING
No. �_�...9 Street BeAAe'�'� DT'iv� 1�. E. Part of Lot
Lot —�-�-.__ Block 2 Addition or Sub-Division ChT3�$$e Add.
��� � — In�ttde Lot Setbaek __._ Sideyard
Sewer IIevatian
Fo�mdatton IIeval3on
DESCRIPTION OF BUILDING
To be Used es:
F�ont Depth Height Sq. Ft. C�u. F't
I�'ront Depth I�eight Sq. F� Cu. F't.
7.'Ype ot Construct[on F�t. Cost ��s5��� To be Completed
Storm damage repair: Rebuild honse.
Ea consideratlon of the issuaacx to me of a per�nit to et the building d�cri bove, I do
the Proposed work ffi acc�ordance with the d�scription above orth and ffi ' c+e with all
e�diaancea of tbe dty of Fridley.
Ia camsiderati� of the payment of a fee oP 1$ ��� . permit is herel�Y granted to IjoII Bz'alid4old
Cc>IIS'�i'• Co• to c�nstruct the build3ng or addition as described above. Thia �t is granted upon
�he exAress s�ondil3on that theperaon to whom it is granted and hfs agents, employees an workmen, �1n a11 work
dcne in, around and upon seid building, or any part thereo8, si�all conform in all respects to the ordinan� of
��Y� M3nnesota g lacation, constructCon, alteratlon, matntenance, repair and moving of builclings
within the dty liaoits��an�this perrmit may be revoked at aqy time upon violation of any of the provYaiona of said
ordinances.
- -=� _ �.--. ,- �
Nonc�
tl� pqrme aua ew eowr Nro ceesho�, tn.t.pNton �er vr6�eg. pluml+tee. ap 6aNaa �u' or wner. e. an. to is.
� ��8 �+ � +�Pu+� � foe th�a hs�.
.. .1 _ �
��'��,
APP'LICATION FOR BUILDIATG P�RPiIT
CITY UF FRIDLEY' MINNESOTA
�.�r�� �. ��� ���c ��a �
1�� i_�t%. a�: r• � • i m
ADDRESS 5�,.9 Be+�nett �_ ADDRESS---- �+� ��, Bz�t Ave- I�TO-
" LOGA`�IOI�t OF BUILDING
Na.�_��/ % �Street ' � �� ��
Part of LoC �
.�.�...._
L�T � B��K � ADDITION OR SUBDIVISION �� - ����o�---�--�
Corner Lot�_Inside La � Setback Sicie-�Yard
SEidER �ZEVATZON FOUftDATZOR ELEVA�ION
�..��..,..,�
Applicant attach to t%is form Two CerCificates of Survey of Lot and proposed
building location drawn on these CerCificates.
DESCRiPTiON �F BUILDING
To be used as:
.�.,.� , Front Dept �,���eight
Sq. Ft. Cu. F�.
Frant Depth _T�geight
Sq. Et. Cu. Ft.
Type of Coztstruction Re�,i,id ho�r� E�timated Cost r�nn nn
. �L�r•---•-
To be campleted
Tha unders3gaed hereby makes appiication for a permit for the work herain sgecified,
agreeing to do all work in strict accordance with the Cfty of Fridley Or@inances
and rul3ngs of the Department o€ Bu3ldings, and hereby declares thaC all the facts
and representa�ions stated in �his application are true and correct.
� �
DATE f , � �"� � � SIGNATt1RE ,
- � .�--
(Schedule of Fee Costs can be found on the Reverse Side).
�
�
BOII.DING PERMIT FEE S('�IEDpLE
SECTION 2. The �aspector of Buildiags ahall, before isau.ing aay permit for the
ere� cCion of any building or structure, or for any additian to anq exiating build-
ing nr stiw.cture, or far any alterations or repairs to any es3stiag buildin� or
structure, upon application therefore, require the payment by the applicane for
such'permit t�f fees to the amouat here�n below ae� forth and in the manner t,erein
provided to-wit:
2.1. For anq auch permit for the erection of.any fire�+praof building,
other han a garage, warehouse, factory.or grain.elevator, or for the erection
of any fire-proof additibn, for aimilar occupancy, to any existing building,
shall be at the �ate �of $1.40 for each one thousand cubic feeC, or fraction
thereof, in auch cubical coritents�:
2.2. For aay euch permit for the erectiion Qf any fire-proof garage,
Warehouae, factory or g�sia elevator, or for the erection of.any f3re-proof
addition, for similar occupancy, to any existing building shall be �t Che_rate
of $1.25 for each one thoueand cubic feet, classified as "fireproof" by
Section 502- of the Minneapolis Building Code.
HOtTSES .
�_
2.3. For aay such permit for the erecti.oa of any non-fireproof buildim�,
othex than a garage, warehouee, factorq or grain elevator, or aaq non-fireproof
addition, for similar occupaacy, to any eacisting building - permit $1.00 for each
oae thousaad cubic feet.
GARAGES .
�_
2.4. For any such perm3t ior the erecCion of anq non-fireproof garage,
wareha e, factorq or grain elevator, or for the ereceion of any non-fireproof
addition, for similar ocrupancy, to anq existing building or for each�such
building or addition - ainety cents ($0.90) for each oae thousand cubic €eet
or fractioa thexeof, in the cubical contents thereof with the minimum of $4.00.
For the purpose of computing fees for�building permits, the cubical contents
of aay buildin� or addition to a uniform height throu�hout by multiplying the
ground area covered fr� a point six (6) inches below the floor line of the
basemeat or cellar to the average height of the upper surface or to the average
height of,tbe roof surface of the main gable of a pitched roof.
2�5., �For rapa3rs o= alterations to an�eaiating structure, the fee ehall
be at the rate of $3,Q0 per each Five.Hundred Dollars. ($SQ0.00) o� frac'tioa �
thereof in the coat o£ a11 proposed work.
2.6. In no.,case ahali the fae charged for any germit as aet farth in
Sectioa 2 be leas t�ian $4:fl0. � .
�� ��,
±5 -�. .o . .r w,
sue�ecT - P R
City of Fridley 18902
AT THE 70P OF THE TWINS g U I L D I N G P E R M I T
r
� ` R
� �y _ COMMUNITY DEVELOPMENT DIV. •
r j � PROTECTIVE INSPECTION SEC. ���/��
� ` ' O
l.._-� �����,,� CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPqOVED BV
i 612-571-3450
910-F15 4/23/87 / �
JOB ADDRESS 749 Bennett Dx1yE
1 LEGAL LOT NO. BLOCK TRACT OA ADDITION
DESCR. 8 1 Christie Addition SEEATTACHED
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Fred Bosak 74�.. �ennett Dx-iye N,E,
3 CONTRACTOR MAILADDRESS ZIP PHONE UCENSENO.
Applied Roo�ing �ystems 4575 �st 77th Street #161� l�pls. 55435 937�-2529.
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER
8 USE OF BUILDING
�Zesi,dential
7 CLASS OF WORK
MAIL ADDRESS
Z�P PHONE LICENSE NO.
❑ NEW ❑ ADDITION � ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Tea,r of� a,nd Re,1;oo� iiouse C2�4 Sc,�ua,xes�
9 CHANGE OF USE FROM
STI PU LATION S
TO
Clean site o� all tarn of� xoofing,
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. • NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �.
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPUED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $4 �2�Q
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEFMIT FEE
PROVISIONS OF ANY OTHER ST OR LOCAL LAW REGULATING CON-
S RU N OR THE PE FORMA E OF"CONSTRUCTION. �S`rJ�e rJO
PLAN CHECK FEE
� URE FCONTRACT ORAUTHOR12EDAGENT IDATEI tr a°-- � yyHEN PR(
SIGNATURE OF OWNER�IF OWNER BUILDER� �pq7E� o� �� �� �o "
:�
GROUP �OCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
$2 ,7,�
SAC CHARGE
TOTALFE�
$52 4 6.0
RLY V�ATED THIS IS YOUR �ERMIT
t�w [ l
ADDN. [ �
ALTER. [ ]
Construetion Address:
Legal Description:_
Owner Name & Address:
Contraetor: l�
Address:�
City of Fridley Effective 4/1/8b
R-1 AND R-2
Building Permit Applicatioa
Tel. �
#
Attach to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to scale.
' DESCRIPTIOA OF IMPaOVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA:
DECg AREA:
OTHER:
Length Width Hei�ht
Length
Sq. Ft.
Sq. F�.
Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setback
Type of Construetion: �'�r� � d Estimated Cost: $ ��o� �•m
Approx. Completion Date: � � o
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Baek Page for Explanation
�
DATE: � APPLICANT: � ° Tel. � I��r�2 (
CITY IISE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Se�er Main Charge
TOTAL
STIPOLATIONS:
$ ���.�.�
$
$ �,/�_
$
$
�
� .�02• �c Q
�
�i-�l�
Fee Schedule on Reverse Side
25� of Building Permit Fee
$.50/$1,000 Valuation
$ 525 Per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Idecessary [ ]
BUII.DIAG PERMIT FEE SCHEDIILE
The ChieP Building Offieial shall, before issuing permits for the erection of any
building or structure, or for any addition to any existing buildin� or structure, or
for any alteration or repair to any existiag building or structure, upon applicatio n
therefore, require the payment by the applicant for sueh permit of feea to the amouat
herein below set forth and in the manner herein provided to-wit:
Total Valuation
$1.00 to $500.00
" Fees
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for eaeh
add3tional $100 or fraction thereof, to and ineluding
$2,000.
$2,001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
ineluding $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraction thereof, to and
ineluding $50,000.
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional �1,000 or fraetion thereof, to and
including $100,OOQ.
$100,001.00 and up
$�33.00 for the first $100,000 plus $2.50 for eaeh
additional $1�000 or fraction thereof.
DRIYEiIAY DEPRESSION ESCR�T
(Conerete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13.50 '
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approaeh With 6 inch depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOIINDATION
Permits for construction Kill be issued a minimum of 24 hours from the time of
applicatioa to allow Por proper review of the proposed structure and oP the
construetion site.
A Certificate of Survey of the lot, showing the location of the foundation onee it
has been construeted will be required before proeeeding with the framing.
: ��
♦
�a
� O
��
� c.
3 �
O
N (p
o �,
��
o �
3 �
G. �
O N�
5�
� �
� n
0
� m
�y
f �
� �
a
�
�`s
0
c
r.
� '�1
�r
0
n�
-�
m>
��
��
co
z r" '
DO
n�
m
�
a
-- �,;
�,
, mi
�
C�
--1
0
z
O
Z
�
m
Z
�
�
n
�
z
�
m
m
w
O
C
0
'O
'o
m� �
a
o�o
�
�
�
0
c
�
�
�
�
�
�
m
�
�
�
v
�
�
�
�
tA 2
m
Q. �
_ . Z
m
z
0
�
�
c�
�
�
�
�
�
0
0
-5
v
s'
�
c
�
�
�
n
O
a
r
�
m
m
�
w
�
�
�
�
m
�
c
�
�
�
�
��
C �
�
m
1
a
m
z
�
�
x
�O
�
m
z
0
m�
v
�
j O
��
0
-�i. m
� A
c �
m �
�' c
a�
� �
m
O
0
�
.a. ua�w.an •.•.. ._ .a�.., cwauocx:flu:bo:xx,:�,�w..a.n,_a.sw.��u.�v.,i..uc.u.��+...,�.0 �c.u.>�.,.,.,.v .>.>.�w ,.�.
,� v_
\ Q
0
o, ?
m
c �
��
�, pi
D t�n
�a
� �
�L*
o �
��
� r
�
0
z
a
n
3
� �
�
0
� -��1 � O
� C p,
cn �,
�z ._
�"3 �%
� �
�
C
�
��
�
-fi �
0
�
s `_''
� � � n
��
o ��
s� .� �
n
� �
m �
m �
fl. fn �
� m � �
Q.00�,
ap • 2
0
� �
�.
�m
��
�
�
�
a
v
�
c�
�
�
Z
O
�
�
�
z
n
m
Z
0
O
�
W
C
�
z
m
�
•
v
n
0
�
0
�
S
�
v
N
N
�ii
y
v
�
�
N
�
�
m
m
� � �
� j j
0 0 0
°o °a o°
� � �
N
-_I
D
�
m
v
c�
�
N
0
�
�
�
m
�
�
-i
Z
O
��..
�
�^
�N
W
C
r-
v
z
�
c
�
m
v
�
m
�
�
m
�
�
m
�
�
�
�
�
m
-s
�
m
�
�
�
v
�
�
Z
m
m
�
a
� �.
7
�
c
�
a
v
�
0
0
0
�
�
�
0
a���
o � a
a m �� N
p 3
� �
m �
�a
c �
� �C
mc
O
�
W
c
3
m
�
�
o ap
�
o° i
�
�
N �
.� a
.� r
0
"' ? t7 ? --�
� .�+ `'� � m
3�'�>>
n r. � u, n
n � y � W
o ,�, � � cr,
c�c'inm�
�' � c � a
a�cm�
� o m �
a ���
N�DO�
� W � m
0
� Q � y
- -Q -� --�
N � � -g
���w
Q o N 3
� � �
� � � o
N 3 A m
-�a m o 3
�.
�ci � � �
�� Q � o
� o � c° -
�� � � �
�
N y �* O
� 1
� �
�
�
...►
�
m
N
c�
2
�
I11
L
�
'v
v
cii � o� n
�. -j
N O, W .[
�
�� 3 �
.P Z � �-._
y �
�� v
r
N < �
m
zZ
m�
'0
n
-i
Z
v
m� �
� r
�a
m�
-vi z
zp
a�
z�
vp
am
��
�i .o
O�
vZ
-� �
Oy
Z Z
� �.
2
-N-1 Z
� �
�n
z�
v
vZ
�c
nm
mz
��
--- �
Z
� - --
m
�
m
�
�
�
c
�
�
m
co
j
�
CHIM�Y AND STACR VERIFIC�TION
The undersigned hereby verifies that the existing chimney or stack:
l. Has been carefully examined � Yes () No ()
2. Is free from rust or deterioration Yes ) No ()
3. Has no foreign objects lodged within Yes () o(
4. Is securely supported Yes ) No ()
5. Meets all current Code requirements for
size and total BTU's connected Yes ) No ()
6. Has total heating BTU�s of �� ���
,
All other BTiT's ,� � a�
TOTAL BTU' s � � �i �� �
a
Remarks
List Alterations seinq Done:
� - �
HEATING COMPANY �� '� � � � �`�
S igned By / ' �� - --- �'�—
Date �/ �� � � � � � � ��
w. s o ,�. e
��°' �� f``r F .
ADDRESS - " � I�. _� <. � a``
OCNPANT `�' ° aF � �`= �-
HEAT LOS� D T@E H
S�� gY.. ���v�`'"8� Bi.fi p_�6'- e-_
El.ct►ieol wwk 9q , `3 -
--� te? .
T7PE OF HEAT GA RA.
HOUSE� HEATING TEST RECORD
,.� � f
£ � ,, .. .
- �''�� ' ° �IPT. FLOOR CITY SUdURB � � �'_�._.�' °`�,_, �'� �'__
� �" OMMER �
��' :,,� .� ��' '°,
;�- � « _ „�,
�°r INS?ALLED BY �-`'��"P'`�'�---�--
Gos Lin� Br
�i�► STEAM SPACE MTR. UHIT NTit. OTHER
GAS DEa9GW COkVERSION
MIRKE +'�:!„ ��������� �r�e�`'-���'�,'°-� dAAKE OF BIJRNER � -
Mod�l - � - "�� �r� � � k �' �'V ° �' ��.., Mod�I _,,r_,.�� --r _
S�rial � �' � �`� � ,
t°-- i--��' ,..u'�' �-' ,L. A{sY. BTLI Rorinq --
,, .._
1NPUT ��;� �+F" �' R a' � � 9 � � MAK�E OF FURNACE• �`'�
} 1�Asd.l '
�-.� _ _� CONTROLS �°'� , �% � o
— TH�Ri�tQST�\� �--�T� -Hsar-Pi�q- _-- ---- " r__�.
-- -- - � � ,
Valv ' � � n' "''�:
L i mi t- ``o ��`..� 4�' 6�, �_
fi r:,�� �,
Limit S�M�ny i
Fan SMina "�'� f �r 41: ih, _�,Y.��
s
Pilof Typ� '�-�'p � r�-
Pitat Aiol�� 'rn r R�> �;°'� �'
q:
P1�04 �{O�� ,�P'__� 6:"'� `�-'� +�s �F'4c�
Pilot Timiny � `"n`°°°'
KIND OR LINER SIZE�NONE �
Oroh Hood °;� a�' " m'���� Rpularor
Filr�►s Si=• "� '�°`F � °m ►�i�iwi�� �
aimn� Lotatio� Insid� Outsid�
dsimn�r Consttvction
Spillage ��;�
smok. Bomb - - w;�;na '�"
D►aft ' T�st Taq
L.YI. Cut Off Dow Pr�saw• �
l.iqhlin9 In�r.
�'' "``,r � � m.
Pr��sw� P�ro�n� CO2 + Dot� T�st�d 6;� ,�� , ,;'` __� - , �
�' °'' s� �r�. �+. a'�'_ t'✓^ Fv. � J �' .F4 s' . ¢
Input CFH � PKe�nt OZ +� Company T��tinq� ��� , z'lr r r�t �,=^`�t� r,���� �?1� ��,
Sr�rek 1'��np. ��`^ P�te�nt CO 't� Nan� oi T�aeK �' ,��-�= � � =A °� •. _ ���L'�'
Certificate. of Compehtency_ #-`"-'�� , �, �= �
d �s -
' ' ° � SuBJECT�. . . � , � . -
City of Fridley � ��
AT THE TOP OF THE TWINS 6 u I� D I N� P E R M I T 2 8 5 8 5
r � ���°���� RE .
� ; y __�__ COMMUNITY DEVELOPM�NT OIV.
r � � PROTECTIVE INSPECTtON SEC. � ���
I = �
� /���1 � CITY HAL� FRIDLE� SS�a2 NUMBEP REV DATE PAGE OF APPROVED 8Y
�----� • •,, 612-571-3abp s�aF�s / /
11 16 98
J08 ADDRESS
549 Bennett Drive
t LEGAL LOT NO. 9LOCK TRACT OFi ADDITION SEE ATTACMED
oescR. 14 2 Christie Addition SNEET
2 PROPERTY OWNER MAtL AOpR�S� ZIP PHONE
Chester Re'man
3 CONTRACTOH MAIL ADDRESS ZIP PHONE LICENSE NO
Premium Roofin 6680 L
4 ARCMITECT OR OESIGNER MAIL AODRESS ZIP PHONE UCENSE NO
5 ENGINEER MAIL ADDRE$S ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK �
❑ NEW � ADDITION 0 ALTERATIQN � REPAIR O MOVE : 0 REMOVE
8 DESCRIBE WORK
Reroof house and garage (26 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS �
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, MEATING, TYP OF CONST. OCCUPANCV (3ROUP OCCUPANCV LOAD
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTIOM 20NING S�. fT CU FT
AUTNORIZED IS NOT COMMENCEO V�ITHIN 80 DAYS, OR IF CONSTRUCTION
Of1 WORK IS SUSPENDED OR ABANDONED FOR A PERIOO OF 120 DAYS A7 �
ANY TIME AFTER WORK IS COMMENCED. ' NO. DWLG. UNITS OfFSTREET PARKING
I MEFiEBY CERTIFV TNAT I HAVE READ ANO EXAMIN�O THIS APP�.ICA710N STALLS GARAGES
AND KNOW TME SAME TO BE TRUE ANO CO�ipECT. ALL PROVISIONS OF LAWS yp�UATION SURTAX
AND ORDINANCES GOVEqNING THIS TYPE OF WpRK WILL QE CQMP41E0
WITM WHETHER SPECIFIEO HEREIN OF NOT. THE GRANTING OF A PERMIT 2228 1. il
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OR CAMCEL TNE pEqMIT iEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION ]/{. ]S Fire SC 2. 23
PLAN CNECK FEE TOTAL FEE
�S�GNATUAE OF CQN7_��MOAQED OGENT �� /�pTE�� License Jl� S• � OJ • 07
WHEN PROPERLY VALIOATED THIS IS YOUR PERMIT
S�GNATU�7EOFQyyNEp��:OWNEpBUilOEA� � �b�iE� � ' � B�OG �a5�' � r�arE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY �
ALTER [� SINGLE FAMILY AND DUPLEXES R-1 AND R-2 p
BUILDING PERMIT APPLICATION A� D �'°
� � a%t-��� �,D ���'
ConstructionAddress:�� _�� �jp[(��
Legal Description: �p�/�
Owner Nazne & Address: �%r���j� ���M�� Tel. # .S7/� %3.��
Contractor: ���j/�,r,� �pF�� MN LICENSE � �Z��'�� �'�
Address: �p��� � ��;1� L. .t� Tel. # S %f- ,3 %' ��
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�ER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length w�a�n Height Sq. Ft.
Ixngth Width Height Sq. Ft.
Length Width HgdGround Sq. Ft.
�s�/
Construction Type: / � ���-��rp�� Estimated Cost: $�' _ `� ��� j
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
_$
¢ Tel. �#� �0 -.� ��
DATE: APPLICANT: ��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Chazge
TOTAL
STIPULATIONS:
$
$ �023
$ / ll
$
$
$,
$
$.
$
�• l� D
$ �j U.
CITY USE ONLY
Fee Schedule on Reverse Side
.QO1 of Permit Valuation (1/lOth%)
$.50/$1,0(�l 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 [ ]
¢ a f
BUII.,DING 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,OU1 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
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $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 $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,0(� or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site. �
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
�
�
JAF�1-16-2002
� b m
�T 1 z
� O �
� 'v
ro -°: c�'i
�` = _-I
�• � O
N
N �; Z
O N -r�
� � rn
-.. m m
o � �
� O �
,,,� V
O
o� o
� �? 2
� o' �
� �
� a
� �
� at
fD y
�C fl-
C �D
� m
�
1 r:.
{
�
�
0
�
b
�
�
O
�
�
�
�
�
0
�
aa
�
0
a�
�
0H�31 FROM
� �
�
. -�i
m
r
�
1'1
�
C1
0 r
d �fTD _ 1
� \
�
a ��
2
�
Z
�
c�
O
�
j
�.�v'si.
���
� ��
��
..�� � �
�:,�Pi
�;�m
�� �
C I TY OF FR I DLE`�
►� o
� �
� A
< °'
= �
m a
� �
y
va a±
��
�
A
cfl
0
�
�
0
�
O �
al
D �
r �
m =
rn �
�
�
�
�
� �
C�11
� �
� � y �
'��•��
A
[yD y CD =
Q.
� O p.�p
.�-.� � � N
o���'
y W�,c�o
_. � Q.
�. aa �
� � o `'�'
Q °a n- r
� po�c
<' � �
�' y �y
NO�^Ex"
�• � � y
� � � �
� ���
°: �. � �.
? � ���
0
m �G� n �
c�'a � o 0
_ " a m
� � m
�
7 �
cp
� y t�p �
Q � � �
A � -• rr
O �+ �.
-t
� p� � O
� S � ?
T
� � <
d `C O
� O �
N
d � fD
� �
L1 N cD
� j.
a
D
p`� Q
o �-
< tD
d N
�
c
te �
� �
a -�'
a N
n�' n
f� CD
`° m
O '+;
� O
�
O.�
� r
CA
�
�
Z
W
A
c�
v
n
n
�
0
7
��
OC
�
N
�
H
T�
L�
II�
N
v
�
c�
� •.
75^r5^r01
G� G� D '*► io
N N N '� N
:t7 �0 � � m �
� � cn m � ��.
� � � � � � �
c Z � � � �
..«� �� � D'
'o °- ' � a. �
� a' �1 � v (!f
n
v � O �` c�i =
r+ � � r+ R1
°; ? .-� °; � iv
cfl � po cc a C
� � A X PR
� C v p
v �t
� !t
� c'
- '� '��.� '� � '�
� � � � � �
0 0 0 o r� a+
0 0 0 0 0 �
� c� � t�► � �
i� --i
� o
D
� r
GJ W
-i c
C �
�
tD
�
�
�
m
n.
c�
Z
a�
. m
_
�
v_�
N
�
�
0
0 •
�
� W --� Z
c�c -� �' o
— C � o
� �
3 °f
c� �
ca
C
?
N
_
o � n
� �.
c� �
o p
� �
� �
m
� ..
� �
fl. � o
f N �
�°► mZ3
a � � ^
_
O
�
0>
.-r
(D
U
O�i
�
�'
v
m
�
�
�
--1
1�7
0
n
O
N
-i
-�
V
G
�
��
rn
�
�
Z
�
�
J�
�
�,�
�
C
r
�
Z
�
C
�
m
�
O
z
fT'f
`
O
W
�
�
�
�
P.0_�2?
Q1Qw=.i
� � � �
V� � O
�v � ,�• �
W Z .CD,� T!
� � H �
� �� m
N '� �
fD z
Z �
m�
m
n
�
O
Z
a
�
D �
-p Z
�
r
'� —Di
I� O
Y� �
� �
� O
a�
�
-�
z � U�
� m �
v� �
D D 1
� Z
O N
z 7,
vz
-i a
o=
Z �
Z �
� Z
N �
ii �
-� o
m
3�
N Z
a�
vm
vz
�
C "y
n �
m
a
N O
z
rn
�
r
G
�
�
7
t�
�
�
C
d
�G
N
N
O
O
N
c0'd �101
: a}ep :�CB pau6ig
�O� �JNIl`d�H
. . . •�t � � - :
— ad�(1 u► .►a�aweip � t�36ua� � �46!aH �o}�auuo� }uan �# a�u�i�dd�
adl(1 w� �a;au�e�p }� y�6ua� �} �y6iaH �o3�auuo� �uan Z# a�ue��ddy
adl�� w �a�awe�Q � y�6ua� � �y6ieH �o�euuo� }uan 6# a�uei(ddd
say�ui �a�aweiQ � lU�!aH ��an ed�Cl �ua� uowwo�
_�ndu-l-��L-��1_ __- -- -- ��u �e tdr�d � t
— -- - - --- �e� �o pa�s�ssy ue� —�ndui f118 ad/(1 �# 2�uE�(ddy
�eN �o pa�ssy ue,� —�ndul �8 adl(1 Z# �uei�ddy
}�N �o pa}sissy ue� —lndu� (u,g ed�Cl {,� a�uei�ddd
�
.. =...... .»_.�.- .. ..- .. ..��.�. ..• _. .• ..-
() oN �) Sa� °sapo� �ua�rr� 3ad se IC�a�e�edas
pa�uan pue;uan uowwo� ay� wa� panowai uaaq s�y a�uei�dda ue
�a}}e l��a.uo� pa�(e}su� pue pazis s�o}�auuo� �uan pue �uan uouiwo� at� s�
() oN () sa,� �sa�ueqdde }}er+p �e�nlEU pu� pa}s�ss� ue� �a� sa�qel 6uguan
� a�ewn,� {��ua� � ICio6a�e� yW��-t/�d apn�ui saop styl �suo����r�ads
s�tam���nuew pue sapc� �ua.urr� a�,�} s�aaw pue 1�1q:z3asse pa}sr� e si ��
}ey� sayuan Rqa�ay pau6�s�apun at.� ' . � ua�
( ) �N �( ) S�1.
( ) o� ( ) sa�
•suoqe�yi�ads s�a�n}�e�nuew pu� sapoo �ua��m a� laaw o�
Pafl�sur pue paz�s aq I!!M 3! . . . o� pa�inba� ua�
� � •suoge��}pads s,�a�n}�e�nuew pue
sapo� �ua.um ay� }aaw o} pa��e�su► pue paz�s si , . .. ayl
- -- - --- - -- --- -
----_ _
--- - -
' ' ( ) oN ( ) se� �sa�uei�dde }�e�p �em�eu pue pa�s�ssE
�- ue� �o� sa�qel 6ugvan a�ewn� le�ua� � IGo6a��J ylNyJ-dJd aP���!
saop siyl �suor}e��}qads s�a�npe�nusw pus sapo� }ua1�n� ayi s�aaw pu�
�(�qwasse palsi� e si �iun 3uawa�eJda� ay� �ey� sa�uan os�e pau6�s,rapun ay1,
() oN �� sa� �uo�}eun.wa� pue snnoq�a �o laqwnu `y�6ua� '6urzts 6tnpn�ui suoge�►�t�ads
Jam�e�nuew pue sapo� �ua�rp ��e s�aaw pue �nd/�i�se�d si wa;s�Cs 6u�uan ayl
() oN t) saJ� 'pa��nba� a�a� paddo�sa�� pue pa}�oddns �t���rr�as si pue
`suo�rv�sqo 'uot��oue�ap '�sru wo�� aa�� st pue pauiwexa uaaq sey 6ur�uan
at{l le� seyuan �Cqa�ay pau6,s�epun ay� ' .. . Ue�
o3N2if113a �8 "1�1M NOI�.b�Ilddt/
3H1-2�0 S3�N'dllddtl rJN1N2�f1813f1� �JNl�tfld32� (V3HM NI 03��1� 381Sf1W M0139 3H1
c�iZO'd T6LSLSL
Gl
�.��a i a� .�o �l t � wo�� zi : eo �eoz-`�T-t��t�!'
Building
���
Inspections
7. 63-572-3604
DA'{'E d — �
SITE ADDRESS �
THIS APPLICANT IS:
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YQUR STATE
LIGEI�TSE WIT�I
APPLICATTON
11�ECI3ANICAL
Permit No.:
1ZESIDENTIAL APPLICATION R�i°ec�,By. �� �
CITY UF FR�DLEY Date Rec d.
h YOUR E-MAIL ADDRESS
STATE ZIP
• �. i , _ ... s :.
.. ¢,'�
� " `� � s �' � `� ��s c s�
M• � • . __.__�-- . -.-'°°-^---_,... . _.�...�.�,r-.,....
7��. ,,..,
� �-;��., b_
-�. � ��: - , � � s x , -
� � , ry, ���
"s !•,
� % � . �1
PERA9�1T TYPE '�'Di'"GL.E FAMILY 0 TWO FANN.Y
TYPE OF WORK: � � �j''`'�
DETAII.ED DFSCRIE�I7�N OF WC?RK
o row►�t�v�E - - - ��
■ . �• . . .. �
PER MS 16B.665 the permit fee is a minimnm oi �15.00 or 5•/s of the totai cost ap to SSOD.OQ whichever is greater, f� the
improveament, in�aliation or replacement of a residential fixbue, ex,cluding the fi�ci�u�s. (This should reflect only the cost of labor )
Labor ct>si under $300 s$15.00. Lahor co5t between $300 to $S(� = cast af labor x.OS �
FOR PROIECf5 WIi�RE IA80R, IXCEEDS $5 , A1tE BASED ON S10.f� PER FIX7`URE, EXCEPT 9dHERE NUTID. EQCi'URES: iA`IDICATE TOTAL
NUNBF.R OF FAQi BELOI�
F�uipmsa►t In�aUad . MFG: MC?DEL: � SIZEBI`Ci
pr�(',; MODEL: SIZFJB'N
MFQ• MODEL: SIT.E/BTU
A/C S15.00 FIREPLACE (tiAS) 515.� GAS RANCiEl01+A�i $10.�
AIR TO AIR EXCHANGEER $15 FIREPI.ACE (�VaQD) $35.� I3EW (3AS QRILL $10.�
BpILER �iS.00 �F(,TRAtACE S35.OQ GAS UNIT H1R $10.�
c�m�v �x sto.au oAS nx�x sia.� �t. t�a� s3s.ao
DLiC7' WORK 510:� (3A3 PIP1N0 $10.� -- VEIJ1'II.ATOR $13.�
_
Pern►it Fee $�. � Numlrer of fixtures @$lO.OQ x$I O.QQ =$
Surcharge $ .50 Number of fuctures �$15.OQ x$15.W ffi$
TOTAL DUE $ l�,�,.� Numher of fixt�u�es (a� �25.40 x$25.�1= $
Number of fixt�ues cQ $35.00 x$35.40 =$
State Surcharge = $�
Tota1= $
THIS IS AN APPLICATION FOR A PERN11T�lOT VALID UNTTL PRqCESSFA
I hereby apply for a bui}ding �rmit and I ackaowledge that the u�formation above is coffiplete and accurate; that the work vvill tx in
confoimance with the ordinances and co�ies of the Ciry of Fridley and wit� the Minnesota �Const�vction Codes; that I understand this is
not a permit but only an appli 'on €or a permit and is not to start wifhaut a permit; that the work will be in accordance with the
approved ptan in the c�se of ork whi CS F V[CW d apgroval of plans.
._./�
SIGTIATURE OF APP�.ICANT PRRQT NAME � DA1E. "
Ciiy of Fr�dley
�uilding Inspechons Departme�t
b431 University Avenue NE, Fridley, ARN 55432
7F.Z_S7�_��na
f�
Building
Inspections
763-572-3604
STIB ADDRESS �
—.,�
THIS APPLICANT IS:
ERTY OWNER/
TENANT
CKIT�M M� - 7Tij �1�;7
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
'1 ` 1�;�-��
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
[J OWNER
PHONE:%�=� � 2j�
STATE LICENSE #�(
ADDRESS:�
PHONE
�SINGL FAMILYlNE
❑ TWO FAMILY/NEW
❑ ApDITION
C] BASEMENT FINISH
❑ DECK
L7 RCmF
O SIDING
.�
EXP DATE
i
❑ DRAIN TILE
❑ O'IT�R
Perm�it
'- -� : �',�.y
_.,�
� .�';�: � � l ; '� '1 �-� I 1 �t
A'FE�IP��2
Alry•u°��IP�J
DESCRIBE WORK BEING DONE: �'-P r�1 t.L� f f'i� � el ����1 /l6�'-1 �
SIZE OF IlVIPROVEMENT � LENGTH W1DTH _ HEIGHT Sa. Ft.
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
S�DING
� V'vryl
❑ Aluminum
❑ Other
S
IN EXISTING OPENINGS �Yes DNo
OR FORNEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES & �1
TYPE OF WINDOW TO BE INSTALLED T� T l
ALL FEES ARE BASED ON y
TOTAL
Permit Fee
PIan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dae
C] HOUSE & GARAGE
0 ATTACHED GARAGE
❑ DETACHED C3ARAGE
OSoffit
❑ Trim
❑ Fascia
• • � • � �•
�' ♦ ' y i ;�"►,�
AASEMENT REMODELING SUBNIIT•
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
�UDITiONS 8c PORCHE,� iBMTf•
1. Site PIan/Survey showing the existing structures
and ProPoged Pro.l�.
2. Two sets of construction plans
3. Energy Calculations
ALUATION, INCLUDING THE �OST 4F LABOR AND MATERIALS:
USIl�G THE 1997 U.B.0 FEE SCHEDULE)
� �? �},, �`.� See Back Fage for Fee Schedule
$ 65% of Building Permit Fee
S � v�^� .001 times the total job valuation
$ � . �ii� .0005 x Permit Valuation .Minimum $.50
$ � �� $5.00 (State Licens�i Residential Contractors)
S $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ �°� � 1� Make ehecks aavable to: Cftv of Fridlev Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge tbat the informarion 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 rec}uires review�nd approval of plans.
.,
. . � . .. . �.1i. �.i �� -' i�.l�� .. � � i J[II //`/ ,_, __-_/� • � ��i '
Building
Ii1S�eCt10riS
763-572-3604
763-502-4977 FAX
DATE L� '`'�
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERMIT TYPE
•rYrE oF woRx:
I'LiTN�i��TG
�SII9�NT'� A�'PLI�A�.'ION
CI'TY ()� F LEY
EFFECTIVE 2-14-09
YOUR E-MAIL ADDRESS
❑ OWNER
Permit No.:
Received By:
Date :.,
ADDRESS: SA�/L� v CITY STATE ZIP,
PHONE: �� %% > I 3 S �
STATE LICENSE
STATE BOND #
PHONE %�3 Z� S y-�-! LIl' . FAX
❑ SINGLE FAMILY
❑ NEW
DETAILED DES.CRIPTION OF WORK
❑ TWO FAMILY
�REPLACEMENT
Q
0 TOWNHOUSE
_ EXP DATE
EXP DATE
.-//
'A'
FEES AR.E BASED,ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER•OF EACH BELOW). MRVIMUM FEE
$35.50.
BATH SINKlLAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL WATER SOFTNER ($
_CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. $1 �
_ DISHWASHER _ LAUNDRY TRAY _TCyVATER HEATER ($35) FOR 1RRIGAI'ION
WATER METER OTHER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNT1L PROCESSED
I hereby apply for a plumbing 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 on site; that the work will be in accordance
with the approved pian in the case of all wor which requires review and approval of plans.
SIGNATL2E OF APPLICANT PRINTNAME /v i� ��S�DATE (�O ��%"�
�aty of �'�idlley
�uilcliag �nspec�ions �epartment
6431 University Avenue NE, Fridley, MN 55432
763-5"2-3604
FAX: 763-502-4977
.�uilding
rnspections
%�3-572-3604
�..�� q 3
�TE ADDRESS '
i-IIS APPLICANT IS:
'R�t ERTY OWNER!
TENANT
CONTRACTOR
SUBMTT A COPY OF
I'OUR STATE LICENSE
WITH APPLICATION
PROFERTY TYPJ�
PERMIT TYPE
- �rYrE oF woxx:
l �
YR
BUILDIi`TG
RESIDENTIAL APPLICATION
CITY OF FRIIl�LE�
Pernut No.:
Received By:6/
Dat��3: � �
Em-MAIL ADDRESS � � cY� 's co.c td� �� o n� s. � � m
[/�`/ l! [_
❑ OWNER. .�CONTRACTOR
Y2 rnn� f
7�3 7�R- 30
N,�: fHD At- Home Services, Inc.
sTA� Ltc 2690 Cumberland Pkwy, Ste 300
,,,DD�ss Cumberla.nd Office Park
PHONE Atlanta, GA 30339-3913
❑ sING� Lic# 20268257 Ph. 763/542-8826
� TWO FA •
QADDTfION ❑ GARAGEISHID
❑ BASEMEI�IT FINISH ❑ ROOF
� DECK ❑ SIDING
❑ SWARMIIJG POOL
:-ESCRIBE WORK BEING
, IZE OF
UMBER OF SQUARES _
ARAGES
-� OPOSED SIZE:
;OPQSED HEIGHT:
Gst
❑ REMODELWG
o t.s ie D C? Lt
LENGTH
❑ HOUSE ONLY
D HOUSE & GARAGE
� ATTACF�D GARAGE
❑ DETACHED GARAGE
�rn�c
0
STA'TE_ZIP S� y 3 %
.,oa� a c�a�r �onc5
i QSa t3Y5- (.oy7
CITY STATE ZII'
❑ DRAIN TTLE
❑ OTf�R
S I� �Crr st��/1� .r�i ��
TH HEIGHT S . Ft
BASENNIENNT REMODELING'SUBMTf:
1. Existing Floor Plan
2. Proposed floor plan
3. List of struchiral members to be used
�)ING FOR NEW CONSTRUCTION TNCLUDING DECKS,
-. �Tinyl OSoi�"it ADDITIONS_ & PORCHES SUBMIT:
='-���� � T� 1. Site Plan/Survey showing the existing sirucivres
:: Other ❑ Fascia and proposed project.
[f1DOWS 2. Two sets of canstructiort plens
EXISTIIQG OPENINGS I�es �No LOCATION OF WS 3. Energ� Calculations
-: FOR I�IEW OP�NINGS-DESCRIBE SIZE OF b��/ u,�, lq n�h. � l v��1 �• A�A
_�EN]NG CHANGES & q• s!"� d. rs ��- O/�f s I• i4 w n, n�j �
:PE OF WII�IDOW TO BE INSTALLED �- D P NUMBER OF W II� ID OWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MA,TERiALS:
TOTAL JOB VALUATION ING g �9�U.B.0 FEE SOC CE PD�� �PE
'ermit Fee
'lan Review
'urcharge
re Surcha.rge
,'cense Surcharge
.-�C Charge
arb Cut Escrow
:rosion Control
:sk Fee
� wer Main Charge
�tal Due
� / G 7, ,'i 5 See Back Page for Fee Schedule
� '� . q � 65% of Building Permit Fee
$ N. y S (.0005) times the toial job valuation — Minimum $.50
� .001 x Permit Valuaxion (1/10%)
$ $• 0 v $5.00 (State Licensed Residential Contra.ctors)
$ $1450 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ , Le O Make checks payable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOit A PERMIT-NOT VALID UNTIL PROCESSED
nereby apply for a building permit and I aclaiowle�ge that the information above is complete and accurate; that the work will be in
- nformance with the ordinances and codes of the City of Fridley and with the Minnesota. Construction Codes; that I understand this is not a
-mit but only an application for a permit and wo ' not to start without a permit; that the work wiIl be in accordance with the approved
:n in the case of all work which require evigw d pproval o€plans.
-JNATURE OF APPLICANT � PRINT NAME 7�'i S e h��,�' DATE l C�( ��
Page 2- Building Residential Application
BiJ�DING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any buildang or
.stru.cture, or for any ad�.ition to any e�i.sting building or structure, or for -amcy a1��raiion or repaar
to any existing building or structure, upon application fiherefore, require the payment by the
applicant for sv.ch perm.it of fees to the amount herein. below set forth and in the manner herein
provided to-wit:
VERIFICATION OF FOUNDATION
Pernv.ts far constru.ction will be issued a mi.n.imum of 24 hours from the time of application to
allow for proper review of proposed s�fructure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required. before proceedi.n.g with the fram.ing. New Hou.ses Onlv
City of Fridley
Buildi.ng Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977