AF - 35432, Minn..
BUILDING PERMIT
�
I�° 1933
Date: r"��''�t"°�r"��y`i'. � _ � ,/�� ,,,.ewr,,..r• �'�� . . . . _
. �•�`•. . . � . -.
Owner ��°�.,� �: • �. .����; ���������i�lder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
�:.;����A,'�.�Ce'.�:..°�.��' Address ....... .... ........ ....... ........
Adclress �"+��• � �
LOCAT[ON OF BUILDING
�i�, �„ �r' ""�F� ��-: ��. .+�: :�+�'�. Part of Lot . . . .. . . . . . . . . . . . . . . . . . . . . . .
No. 9f . 5treei ... .e�i r:� . t.
Lot . ,���. . . . . . 81ock . . . .'�:e�`. . . . . . . . . . Addition or Sub-Division . . . . . . . . ... . . . .... . .. . . . . • .. . .
Corner Lot . . . . .. .. .. . Inside Lot .... ... .. Setba.ck .. ... . Sideyard .. . ................. ....
DESCRIPT[QN OF BU[LDING
T be Used as �
.'�,�.�°� !��.�r'°=: . . . . Front � .y� . Depth . s : :� : . Height f.J�.°. �'`� Sq. F'i. . . . . . . . . Cu. F't. . . . .
� �: .� ��� ,. � .� . . . . Front �'��• . Depth ..�� . . Height�°�. .�f., � Sq. Ft. Cu. Ft. . . . . . . . .
......... � +�
,�� P �� `'�� To be Completed ���,�:��
TYpe of Construction ,�.�. .y:°�`:++`�-.�.�':. .. .. _ Est. Cost �i�': �� . .. .... . . .. .. . .
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In consideration of the issuance to me of a permit to construct the building described above, I agree to flo
the proposed work in accordance with the description above set forth and in compliance with aU. Provisions of
ordinances of the village of Fridiey. ��'
: . , . �+4�✓:' �' ��''""� • . . . . . . . . . . . . . . . . .
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xn consideration of the payment of a fee of $. .,: � . . . . . . , permit is hereby granted to ��. � : �. �: �� � • •
� _.,�: , '
. . . � s. ,� . : . . . . : . . . . . . to construct ihe building or addition as described' abave. This Permit is granf.ed upon
ihe express condition that the person to whom it is granted and his agents, employees and worl�ten, in s11 work
done in, arouiid and upon said builriing, or anY Part thereof, shall conform in all respects to the ordinances of
P'ridley, NLinnesot.a. regarding location, construciion, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any .time upon vialation of any of the grovisio�s of sa.id
ordinances.
�'� .�
.� '' ;r.�� �,�'�,,+ �;�'.���;�:"rr:�. Building Inspector
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NOTICE: �
'ihis permit does not cover ihe construcfion, instaliation or alteration for wtring, plumbing, gas heating.
sewer or water. Be sure to see fihe Buiiding Inspector -for separate permits foM these: items.
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City of Fridley, inn
BUILDING PERMIT
.1:_ �_ a�
oWner: —�eT suilaer pon srandvcld
�IF( IY���Z'�►��.Y��! _ �_4.; 1� i
� -_ r ��X...: •- : Nat= J � : < < ��
N° '7'745
LOCATION OF BUILDING
No. �_ Street BeAiie'�'� DTi'v8 �T. E. Part of Lot
Lot �-g _ Biock 2 Addition or sub-Divisian �'i8tie Add3tioII
Corner Lot _ Inside Lot
Sewer IIevatian
To be Used as:
Setback Sideyard
_._._ Fotmdation IIevaiaton
DESCRIPTION OF BUILDING
Fro� Depth Height Sq. F`t. Cu. Ft
Front , Depth �Teight Sq. Ft (�, Ft,
Type of Conatruction Fs� Cost �-�.a� To be Completed
StOrm dama.ge rep�3.r
In consdderation oP the issuancae to me of a permft to construct the building described above I agree to do
the proposed work in accordance with the d�scription above set forth and in compliance witb� a�l pravisions of
ordinancxs of the dtq of Fridley. --� i'/ iJ -� fl
In camsiderat[on of the payment of a fee oi $�� , permit is hereby granted to Don Br�nrlvnl rI
to construct the buflding or addition as de..acribed above. Thia raiit ia granted upon
t;he exAress condition that the person to whom it is granted and lua agents, employees an�worl�en, in all work
done in, around and upon eaid building, or anypa,r� thereo� ahall conform fn all respecta to the or�inanc� of
Fridley. M9nnesota regardin� loc:ation, constructfon, altera.tion, maiatenance� reFair and nnoving of bufldings
wl�� dtY 7imf'Fs and tius perna�tt may be revoked at ar�y ti�ne upon violation of a�► of the provisians of Ba�d
i�.@tl JBYiSBII �� �
NOTIC�
�'� 'll� pqemtt de�s net aerer t6s ceeatroeHa�, testaWfion tee rrG3aW P�+�B. 9a 6�8. +�r�e er wtlsr. B� wro to �
t6a Butldio8 te�setor tor wPa►+f� � Mr f6a� �ms.
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APP'LICATION FOR BUII.DIATG PERMIT
� CITY OF FRIDLE�i� MINNES6TA
OWNER"S NAME ,� � � � �UILDER ��-
�
�nn�ss_ ���°`�,� � .��a������ Ann�ss_�� ,� . � _._._.
. � . � , . • . . � - • r * p
. . . e , .. . . . . . . � . y ��
• ' . �. • � L�ATiON OF � $UIiDiNG : � r : ;�F'
No. Street "Part o� Lot
�
LOT 1� BL(?CK � ADDITION OR SUBDIOISION C��.���� L�-
,..� . .
�oraer Loty_Ineide L �Setback ' •• Side-Yard�
SEWI�R EbFV�TIQN . . � k`OIINDATTON ELEVATYOAi
Applicant atCach to this form Two Certificates of Survey of Lot and proposed
bui�.d��rg ],ocatfan dr�wn on these Certificates.
. ; ' DESCRSPTION OF ' BUII�DING � "
Ta be used as:
Front Dept � Height
. .. . Sq. Ft' _ Cu. Ft .
- F'ran� � - Hept� � Hei�ht
Type of Ca�truction
Tb be compleCed:
Sq. FC. � Cu. Ft.
:imated Cost �� �
The.undexeigned hereby makes applicaticn for a' permit for th� work•herefrt�specified,
agreeing to do all work in strict accordance with the City o£ Fridley Ordinances
and rulin.�s�of the Depa�tspene of S�ildings, and hereby declaree that aIl the facts
a�d representaeions.stated in this applic�tioa are true a�d correcC.
DATE ��' �a : ST�GNATURE '
(3chedule .of Fee Costs can:be found on the Reve��e"Side).� -.
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BOILDING PERMIT FEE SCHEDULE
SE" G°�ION 2. The Inspector of Buildings shail. before issuiag any permit for the
erection of any building or structure, or for any additioa to any existing build-
ing or strucCure, or fos any aiteratians or repaira to anq exietiag build�n� or
structure, upon application therefore, Yequire the papment by the applic�at far
such permit of feea to the amount herein below aet forth.aad in the manner herein
provided to-wit; `
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2.1. For any such permit for the erection of any fire-proof building,
other than a garage, warehou�e, factory o; �rain elevator, or for the erection
of any fire-proof sddition, for aimilar occupancy, to any existiag buildin�,
shall be at the rate o£ $1.40 for each oae thousand cubic feet, or fractian
thereof, in �uch cubical contents.
.2. Fo� gny such permit ior Che erecCioa of any fire-proof garage,
Warehou�se, fa�tory or grain elevator, or for the erection of any fise•proof
addition, fo� s3milar a�cupancy, to anq existi,ng buildiag �ha21 be at Che rate
of $1.25 for each oae ehoueaad cubic feet, classified as "fireproof" by
Sectioa 502 0£ the Mianeapolis Build3ng Code.
flOIISES
2.3. For aay euch permit for the erectioa of auy non-firepraof building,
other than a garage, wareliouee, factory or grain e].evator, or any aon-fireproof
addition, for similar accupancy, to any existing building - permit $1.D0 for each
one thousand cubic feet.
G�
2 4,^ For any such permit for Che erection of any aon-fireproof g$rage,
ww�rehou�e, factory or grain elevator, or for the erection of aay aoa•fireproof
addition, for similar occupancy, to any existing building or for esch such
bu3ldiag or addition - aiaety cents {$0.9U) for each oue thousand cubic feet
or fraction the�eof, in the cubical contents thereof with t�e minimum of $4.Q0.
For the purpose of camputing fees for building permats, the cubical coaCents
of any build3ng or addition to a uniform height throughout by multiplyin� the
ground area covered froo► a point six (6) inchea below the floor line of the
basement or cellar to the average height of the upper eurface or to the average
height of the roof surface of the main $able of a pitched roof.
2.�. For repairs or alteration� to an existing strucCure, the fee shali
be at the rate of $3.00 per each Five Hundred Dollars �$500.00} or fraction
thereot in the cose af ail proposed work.
2� 6. In no case shail the fee charged for any permit as aet forth in
Section 2 be laes than $4.00.
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SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i `
; `L _ COMMUNITY DEVELOPMENT DfV.
r j � PROTECTIVE INSPECTION SEC.
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�� �"'1 � CITY HALL FRIDLEY 55432 NUnneER aEV.
""� � ,�� 612-560-3450
910-F15
JOB ADDRESS 597 Bennett Drive N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 18 2 Chri.stie Addition
2 PROPERTYOWNER MAILADDRESS
Ken Johnson 597 Bennett Drive N.E.
3 CONTRACTOR MAILADDRESS
_ Geno's Remodeling 4619 Tvler 3treet N
4 ARCHITECT OR DESIONER MAIL ADDRESS
5 ENGINEER MAILADDRESS
8 USE OF BUILDING
Residen
7 CLASS OF WORK
C
8 DESCRIBE WORK
COn5txu�
9 CHANGE OF USE FROM
STIPULATIONS
PER
r° 184
RECEIPT NO. �
DATE PAGE OP APPROVED BY
6/28/77 � �
SEE ATTACHED
SH EET
Z�P PHONE LICENSE NO.
571-8229
ZIP PHONE LICENSE NO.
Z�P PHONE LICENSE NO.
NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
' x 10` Pa
TO
Call for framing inspection. `^���
��t�� 41�i�! catl locat utitities
TELE��If °= EIECTaIC- GAS Etc,
REQUIRE� BY LJ�0111
s��c� ��w�rs a�����o �v��� wr���,
�.EA1�NG, PLUN�BHMG A�iD StGIV�.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINO, '' r� v vv�•V•.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMEPICED WITHIN 60 DAYS, OR IF CONSTRUCTIOIV
019 WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNIT;
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ,I,
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ypLUATION
AND pRDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �`Z�SOO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF AN �OTHER STATE OR LOCAL W REGULATING CON-
STRUCTION O T PERFORMANCE OF CON R TION. � �X$ yS`].
PLAN CHECK FEE
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SIGN TUREOFCONTRACTORORAUTHORI2EDAG �onTet .-� - WHEN PFi
?- �I _ rv 1
1DAT� `
OCCUPANCY GROUP OCCUPANCY LOAD
SQ. FT. CU• FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
�`�. . 25
SAC CHARGE
.00
TOTALFEE
$16.25
ERLY VALIDATED THIS IS Y9UR PERMIT
�a/11„ _ � I _E -,[1 f-.r
CITY OF FRIllLEY
ApPLIC/�TION FOR RESIDENTIAL BUILDING PERMITS
iNEW, ALTERATIONS, ADDITIONS, OR REPAIRS)
owt��r�: �� �
Address:���— �jr����f7�
No.
LOT:
Street:
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;�%fL�.�<� �,'
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BLOCY.: °� ADDITION:
CORN�R LOT: INSIDE .;AT: �_
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S,?TB�,CK: SIDEYARDS:
Applicant attach to this form Ztaa Certificates of Survey of Lot and propased
building location drawn on these Certificates. .
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DESCRIPTION OF BUILDING
To Be Used As:
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Front: �__ Dep�; �� Height:
� � �, �
Square Feet: '�'�°-` Cubic Feet: �
Front: Depth: • � Height:
Square Feet:
Cubic Feet:
�
Type _of Construction: �� Estimated Cost: $ � �'D' �_
To Be Completed: �'
. Alt. A Alt. B
Propose�. Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET�
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance �eith the City of
Fridley Or3inances and rulings of the Depart.-nent of Buildings, and hereby
declares that all the facts and representations stated.in this application
are true arid correct. See reverse side for ddii:ional infoz�ation. �
DATE: 6 d 8 SIGNATURE: ��
Stipulations: '
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BUILDII�G PCR��IIT FEt� SCi.iEDULE
5�CTION,2. mhe Inspector of Buildinqs shall, before i:,suing pezmits �or the erection
of any bui.ldiiiy or �tructure, or for any acldition to •ar,y cxisting building ar. str.ucturc,
or for any alterat-ion or rer�airs Lo any er.i�ting Luilciing or struct;ure, upon api�lication
thcrefore, require t}ie payment by ttie appiicant for such �ermi_t of fces to the amount
herein k�elow set fori:h and in the manner herein provided to-wit:
NEW CUNSTRUCTIOIJ: 5ingle Pamily Homes and Ga'rages: $4•00/1,000 cubic feet..
PLAN CHECK: 25 percent of building permit S'ec.
DRIV�WAY DEPR}:SSIOPd: (Concrete Curb Streets Only)
� T�lternai:e A: Removal and replacemenL- of concrete curb and
gutter only; Dri.vecaay width plus 6 feet x$11.75
Alternate B: Removal and replacement of�concreL-e curb and
� gutter.and install a 3 foot wide ap�roach with
6 i.nch depth; Driveway width plus 6 fect x$15.40
/�DUITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is dete�mined by multiplying the ground area covered from a
point six (6) inches below the �loor line of the basement or th� cellar to �the
average heights of the upper surface or to the average height of the �oof surface
of fihe main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the ra�e
of $3.00 �er each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
In no case shall the fee charged for any pei-mit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
VERIFICATION OF FQUNDATIOf�
NOTE: Permits for construction will be issued a minimum of 24 hours from the ti.me
of application to allaw for proper review of the prop�s�d structure and of the
construction site.
A Certificate of Suzvey of the lot, showing the location of the foundation once it
has been constructed will be required before proceedir.g with the framing.
CtRTIFICATE QF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (1G} days prior to the
use or occupancy of any sti-ucture for which a buildin� permit has been issued; and
said structure shall not be used or occupiec�'until a Certificate of Occupancy has
been issued.
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sus�ecr PER NO.
City of Fridley 18 8 9 0
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
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� i L_____ COMMUNITY DEVELOPMENT DIV. ��� ��
� � PROTECTIVE INSPECTION SEC.
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`._-- J /�'�1'� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
L J\.' ' 612-571-3450 910-F15 4/20/87 / /
JOB ADDRESS 597 gE�ett Drive N. E,
1 LEGAL LOT NO. BLOCK TRACT OH ADDITION SEE ATTACHED
DESCR. �.8 2 Christie Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ken Johnson 597 Bennett Drive N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
�homas Storie Co, 68I3 Humboldt No, #12H, Brooklyn Center 560-8816
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS Z�P PHONE LICENSENO.
8 USE OF BUILDING
ReS.lc�(�il.'t].11.
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Rexoof Dwelli�ng
9 CHANGEQFUSEFROM TO
STIPULATIONS
.�o� c�n be the 2nd layer bait nat the 3x�d, Install ridged galvanized
S%C�,�,J,e�7`S e
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBINCi, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAO
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOHK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $I. ZOQ $ e 6O
DOES NOT Pq SUME TO GIVE AUTHORITY T VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVI NY OTHER STA7E OR LOC LAW REGULATING CON-
ST : TION HE PERFORMANCE OF CON R CTION. �, y5`ZO a SQ
PLAN CHECKFEE TOTALFEE
yS`ZI..1Q
r EOFCONiRACTOR RAUT oa¢ED E r IDATEI WHEN PROPERLYr�DATED TH S IS YOUR PERMIT
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�' SIGNATUREOFOWNERiIFOWNERBUILDERi IDATEI B�DG iNSP
aTE
NEW [] City of Fridley Effeetive 4/1/86
ADDN. I J �R-1 AND R-2
pLTER. [ ] Building Permit Application
Construction Address
�� �`/ �' � �.v �?�- � � t v
Legal Description: �O T ��° , •�Q • a� �l�� tS �� f�-e�aJ �1 +U •
Owner Name & Address : ` '� � °' ° � � `'° �� � Tel . �
Contraetor s � Yl� 6L'��C � �° ��°P � � � x ,� Tel . # ��' � -� � � �
Address:
LIVING AREA:
GARAGE AREA:
DECR AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTIOH OF IMPROYEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setback _,
Type of Construction: ��07� �5����)'� � Estimated Cost: $( 200 0-=
� ' aa �k �
Approx. Completion Date: � �.�5 �i � � U
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
�
DATE: _�*_`_�� APPLICAN : Tel . � s �'O � � �S f �
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Se�aer Main Charge
TOTAL
STIPULATIONS:
CITY
$ r;�, �3
$
$- ��
$
$
�
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,�
`�(�,%b
IISE ONLY
Fee Schedule on Reverse Side
25� of Building Permit Fee
$.50/$1,000 Valuation
$ 525 Per SAC Unit
Fee Determined by Enginep l�8
Agreement Necessary� � Not Necessary [�
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BIIII.DING PERMIT FEE SCHEDIIL$
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 sueh permit of fees to the amount
herein belo� set forth and in the manner herein provided to-wit:
Total Valuation
$1.00 to $500.00
Feea
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00 �32•50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
ineluding $25,000.
$25,001.00 to $50,000.00
$50�001.00 to $100,000.00
$100,001.00 and up
$170.50 for the first
additional $1,OOd or
including $50,000.
$283.00 for the first
additional $1,000 or
including $100�000.
$25,000 plus $�.50 for eaeh
fraction thereof, to and
$50�000 plus $3.00 for each
fraetion thereof, to and
$433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEWAY DEPRESSION ESCROW
(Conerete Curb Streets Onlyi
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 $15.75
VERIFICATION OF FOUNDATION
permits for construction xill be issued a minimum of 2u hours froa� the time of
application to�•allow for proper review of the proposed structus�� and of the
construction sit
A Certificate of Su of the lot, shoxing the location of the foundation onee it
has been constructed be required before proceeding With the framing.
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ISUBJECT
c�ty of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
� �
� `v �_�__ COMMUNITY DEVELOPMENT DIV.
r j � PROTECTIYE INSPECTION SEC.
i.-_.� o�"' �'� CITY HALL FRIDLE� 55432 NuMBEa
i 612-571-3450
910-F15
JOB ADDRESS
t LEGAL LOT NO. BLOCK TRACT OR ADOITION
DESCR. 18
2 PROPERTY OWNER MAIL AODRES$
Ken Johnson
3 CONTRACTOR MAILADDRESS
Daco Inc. 14510 45th St NE Ro�ara ri�v 5'
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
REV I DATE
ZIP
ZIP
PAGE OF
� �
PHONE
PHONE
PHONE
27394
NO.
��� �
APPROVEO BY
SEEATTACHED
SHEET
LICENSE NO.
� 180
LICENSE NO.
LICENSE NO.
❑ NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WOHK
Reroof house and earace f9n G�1 Ta�r_nf�F
9 CHANOE OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF
VENTII.ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED Ofi ABANDONED FOR A PERIOO OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DW
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS yqLUATI
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1668
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T i
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �S6 !1
��� �L2 ��
SIGNATUR F CONiRACTOR OR AUTMOR12ED AGENT IOATEI
S0.
STALLS
OF
IS
OCCUPANCVLOAD
CU. FT.
� PARKING
GARAGES
_ ��������✓�i�:����r��r.�
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ADDN
ALTER
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ConstructionAddress:
Legal Description:
Effective 1/1/98
CITY OF FRIDLEY
SINGLE FANIILY AND DUPLEXES R-1 AND R-2 �� �
BUILDING PERMIT APPLICATION �'� /�
� � �`7
- �' "7 �'S � ✓� 1�_��� )� d' P �'Y' i c%% � .
Owner Name & Address: _ ,1<�e rl � e, h,,, � y, Tel. #
Contractor: � rL e�. MN LICENSE # � r�� �
Address: _ 1 �.5� ! c� �l�5��`'� � T � �'`� �' 7Qo� � Y�� � S; S"� 7 vTel. # �� 9? ^. � � r� c�
' 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:
Length
Length
Length
DESCRIPTION OF Il��IPROVEMENT
. �' -�����--��" �
Construction Type: _
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
Driveway Curb -Cut Width Needed: Ft. + 6 Ft =
Estimated Cost: $_ ���p�, �
(Fee Schedule on Back)
Ft x $ _ $
DA1'E: ��S^ APPLICANT: C� Tel. # C% %?- 3� d c� ,
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ � ` d�
$ l�7
�V r
$
Q ,.-�( /�
�D J �/ V
$
$
$
$
$ •J�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Pemut Valuation (1/lOth%)
$.50/$1,0(?0 Valuation
$1000 per SAC Unit
$5.00 (Sta.te Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
� � �-
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 pemut 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
$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 additiona.l
$1,000 or fraction thereof, to and including $1�,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, 000 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 minunum 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.
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CHIMNEy AND STACK VERI�'ICATION
The undersigned hereby verifies that the existing �himney or stack:
1. Has been carefully examined Yes (�) No O
2. Is free from nist or deterioration
Yes ( ) No ( )
3. Has no foreign objects lodged within Yes () No i)
4. Is securely supported . Yes () No ()
5, Meets all eurrent Code requirements for size Y� �� No ()
and total BTU's connected
6 Has total heating BTU's of
All other BTLT's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ()
8. Has combustion air been provided for water heater Yes () No ()
Remarks: .
List ALTERA'TIONS Being Done:
HEATING CO:
Signed By:
Date:
Building
Inspections
763-572-3604
DA� �IIOI��S
SITE ADDRESS ��
'THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑ OWNER "�PCONTRACTOR
•.�•� l�ldli�iilr /� 11►�117J.'
� � • 'i� I�', ' � - L
. � . � � `7 .
STATE LICENSE #
PHONE
'� SINGL AMILYlNI
❑ TWO FAMILY/NEW
FAX
❑ ADDI1'ION ❑ GARAGE/Sf�D
❑ BASEMENT FIlVISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWI�JG PO(
I L'S MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: �
SIZE OF IMI'ROVEMENT G'I'H
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
EXP DATE
SIZE
❑9RAIN TILE
❑ OTHER
Permit No..
� - - � : ' r u���
•
ro� F. r � � . � � �
�� .I�i' \ :d+ `� � � �,
WIDTH HEIGHT
AT�UZIP�Z
'���
BASEMENT REMODELING SUBMIT:
1. E�risting Floor Plan
2. : Pto�osed floor plan
3. , List of structural members to bg used
Ft.
SIDING FORNEW CONSTRUC7`IO1V INCLUDII�G DECKs'£; "
� V�Y1 ❑Soffit ADDI1'IONS. & PORCHES SUBNIIT•
0 Aluminwn ❑ Trim 1. Site Plan/Survey showing the existing structures
� Ot6er ❑ Fascia and proposed project.
WINDOWS 2. Two sets of construction plans
IN EXISTING OPENINGS �i'es ❑No LOCAITON OF WINDOWS 3. Energy Calcularions
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES & °Z��
TYPE OF WINDOW TO BE INSTALLED !) NUMBER OF WINDOWS
ALL FEES ARE BASED-ON VALUATION, INCLiJDING THE COST OF LABOR AND MATERIA�LS:
(LTSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ P�I DO ('� OCCiJPANC� TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Dne
� ��1' I•�. S See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ �I .001 times the total job valuation
$ .0005 x Peru�it Valuation Minimum $.50
_$ S.(.� C� $5.00 (State Licensed Residential Contractors)
� $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 ( )
$ d�. Make checks payable to: City of Fridley ALtach
THIS IS AN APPLICATION FOR A PERNIIT-NOT VALID IIN'PIL PROCESSED
I hereby apply for a building permit and 1 acknowledge that the information above is complete and accurate; that the wark will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Conslruction 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; tbat the work will be in accordance with the approved
plan in the case of a11 work which requires review d approval of plans.
SIGNATURE OF APPLICANT �� PRINT NAME A� �T1��/�—