AF - 35437Date
Owner
Address
BIJII.I)ING PERIVIIT
Vi.�lla.ge of �ri�ley, ll�iii�n. �0 2 3 6 8
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. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Address . . . . � � �� � l�,�,,,,�,�,,,. ��
..,�.�.��� .. .... . . ...... .... r
LO�ATION �� BUQ DIN�
No . . . . .. .. . . . . . . . . . '� � �'� � ��.�,�.�
Street . �'`°,"����.� aZ".�i��`. .,�'s �. Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
Lot . . � .`���, . . .. . Block . . . . . . .�. ra'`�.'� Addition or Sub-Division . . . . �` � �+ ,������
•C�• �.�''���� � • ,�
Corner Lot . . . ..�*:"�. . . . Inside Lot . .. . . . . . . . . . Setback . . �:� : �, , , Sideyard . . . . ,����, , � , , , , ,
To be Used as:
�;;J� �,. ,�r -
. �Yrs-��3a�-.*`-,r'1'.� . . .
DES�CRIP'f'IOR� OF' BLJILDlNG
�
Front . . ���. Depth . �; � , fieight . . . . . . . . . Sq. Ft. ��',y�� Cu, Ft. , , , , , , , ,
.................... Front ........ Depth ........ Height ......... Sq. Ft. ........ Cu. Ft. ........
Type of Construction .�'.�..�'.�aar�+ Es~t. Cost ..,�,��� .a��'„�, ,t�� .,, To be Completed . 5�.'��. �G% �''f,�°�"'�,i
�
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
�rdinances of the village of Fridley.
. :f`°�': �� �;J �--�
.�:���. ���.��: � : :�. . . .. .. . . .. .. . . . . . .
,�
In consideration of the payment of a fee of '� ' �,,,,� ���
$. �. �: :�'°,' pernut is hereby granted to . ..
.., to construct the building or addition as described above. This ermit is 'f
� � � p grant� upon
4he �express condition that the person to whom it is granted and his agents, employees and worl�en, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
�ridley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village Limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
�
��� P . 9 ,'�,% .�.:ti,
. ��$ . . �a�;;. ��-f�':��.�:��. . . Building Inspector
NOTICE:
This permit does noi cover the construotion, insiallatiora or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
�"�
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SUBJECT
City of Fridley P �
ATTHETOPOFTHENVINS gUILDING PERMIT - 12555
;�
COMMUNITY DEVELOPMENT DIV. R
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r �. � PROTECTIVE INSPECTION SEC.
l-_-. A �����,.� CITY HALL FRIDLEY 55432 - NUMBER REV. DATE PAGE OF APPROVED BY
L J � 612-560-3450
910-F15 5/24/?4 � /
JOB ADDRESS 626 Bennett Driv e N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. j 5 Christie Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
LeRoy R. Corgard 626 Bennett Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADORESS ZIP PHONE LICENSENO.
6 USE OF BUItDING
Residential
7 CLASS OF WORK
O NEW C� ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Consfruct a 24' x 22' Gaxage Addition
9 CHANGE OF USE FROM � TO
STI PU LATION S
SEPERATE PERI�ITS REQUIRED FOR �i1lRffv�,
HEATII�G, PLUMBING AND S1:�4�S.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R�. SZS
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 5�-►500.00 I.e39
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � �-O.00
PLAN CHECK FEE TOTAL FEE
11.39
-�f �
I;' SIGNA � FCONTRA oRORA R¢EOnGENT (DATEI � WHEN PROPERLY V1LIDATED THIS IS YOUR PERMIT
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SIGNATUREO RUFOWNERBUILD (DATEI BLDG INSP 4A E
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I� ��/���`%�� ,�LaO� owner of the propextp 3.oc�ited
ar �39/ �S�°F��� �
��C�i have no objection to the Ci�y
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allotaing the construction of a�_/'���, a��1�/�jd°� ta be loca�ed at� �
��� _ �L����� ' '�� � .
����� � Fl b � without the requi-red cer.t�iicate �.c
sur.ve3� that the City oxdi.n.axily requires o-r a.l]. ncto cons�ruction.
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Acidress
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Date
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ApPLICATION FOR RESIDENTIAL, ALTERATION,
4R AllllITION BUILDING PERMIT
CITY OF FRI�LEY, MINNESOTA
OWNER' S NAME ;_ �� �6 y � �� �. �a r�UILDER:
,
ADDRES S:_G� ,a f��� v// � I�' 1 v F ADDRES S:
NO :. G� Co STREET :`__.�� �j �g e
�LOT : � . BLQCK : S ADDTTION • ���--� S � � ��
CORNER LOT: � INSIDE LO�: SETBA,CK: SIDEYARD:
Applicant attach to this form �ao Certificates of Su. rvey o� Lot and proposed
building location dxawn on these Cextifica�eso
DESCRIPTION OF BUILDING
� To Be Used As : .
/� � r r►
C� a� � ! Front • � Depth. ���- Height :_�� �
Square Feet: � �"� Cubic Fee�;
e
P�PS��� ��'�e /S Front:- �—�DePth:_ `�- �_ Height: � � �. � r�
---�—�--
Square Feet; �i� � Cubic Feet:
2`ype of Construction: %�°� �„ � Estimated Cost: �__ J' S�'p p�`'
To Be Complet�d: � '
The undersigned hereby makes appJ�icativn fox a permit for the work herein
specified, agreeing to do all work in stxict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares �hat all the•facts and representations stated in this application
are true and correct.
�
DATE : � � a � � � � �'`
SIGNATURE• e
(See Reverse Side For Additiona.Z Information.)
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FRIDLE�
FRIDLEY MUNICIPAL.CENTER •(r}31 UN[VERSITY AVE. N.E. FRIDLEY. MN 55432 •(613) 571-3�50 • FAX (61?) 571-1287
March 19, 1990
Thong Nguyen
626 Bennett Drive N.E.
Fridl�y, MN 55432
RE: First Notice of Noncompliance at 626 Bennett Dride N.E.
Dear Thong Nguyen:
The City of Fridley has established a City Code for the purpose of promoting
a pieasant and attractive suburban environment. A recent inspection of the
above referenced property revealed the following item is not in compliance
with the City Codez
1. Discontinue outside storage of old appliance located along east side of
house.
In additio�, I recently received information suggest�.ng that a repair garage
is being conducted at this residence. In this zoning district, home
occupations are permitted as an accessory use, provided certain criteria are
met. Two of the key requirements (City Code copy enclosed) in defining an
acceptable home occupation are contained in the opening portion of the
definition and are as follows:
l. Must be carried on within the dwelling unit and not in an accessory
building.
2. Must be clearly incidental and secoridary to the principal use of the
premises and shall not change the residential character.
If you are operating a business which is not in full campliance with our home
occupation definition, please discontinue this practice immediately. With
respect to the code violation noted earlier in this letter, a reinspection
will be conducted on.or about April 2, 1990, to determine compliance.
Please feel free to call me at 572-3595 if you have questions or wish to
discuss this further. Thanks for your cooperation!
Sincerely,
Steven Barg
Code Enforcement Officer C-90-102
!.i.
_
C�� �F
FR[DLEY
FR[DLEY MUNICIPAL CENTER - 643 i'UNIVERS[TY AVE: N:�. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (bl2) 571-1287
May 31, 1995
Thang Nguyen
626 Bennett Dr. N.E.
Fridley, MN 55432
RE: First Notice of Noncompliance at 626 Bennett Dr. N.E.
Dear Mr.Nguyen:
The City of k'ridley . has esta}�lished a Gity� Code for. the purpose of �
promoting a �p.leasant; arid at��aetive st�Uiirban : environment. :; . A r�ecen�,-: : � ..� . . _� .
inspection of the property at 626 Bennet Drive N.E�.���revealed that�
not all Code requirements are�presently being met. Listed below
are items which do not comply with the City Code:
1. Discontinue outside storage of numerous materials including a
boat motor, tables, pails, and plastic tarping in the front,
side and rear yards.
2. Vehicles may not be parked continuously on a City street for
more than 24 hours without being moved. I observed a boat
with trailer (Lic. #R72-240} parked in the street for an
extended period.
Your prompt attention in correcting this situation would greatly
assist us in helping make Fridley a better place to live. An
inspection will be conducted on or shortly after June 12, 1995, to
determine compliance.
If you have questions or would like to discuss this, please contact
me at 572-3595. Thank you for your cooperation!
Sincerely,
Rurt Schneider
Code Enforcement Officer
KS:da
CE-95-102
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� �
( i y______ COMMUNITY OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
, ,
L.-__�� �"" �'� CITY HALL FRIDLE� 55d32 NUMBER aEv
i 612-571-3450 910-F15
JOB ADDRESS 626 Bennett Drive NE
1 LEGAL LOT NO. BLOCK TRACT OH ADDITION
oesca. 1 5 Christie Addition
2 PROPERTV OWNER MAIL ADDRESS
Thong Nguyen 626 Bennett Drive NE
3 CONTRACTOR MAIL ADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDHESS
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW
8 DESCRIBE WORK
Reroof House (18
9 CHANGE OF USE FROM
STI PULATIONS
DATE PAGE OF
5J5/97 � �
ERMIT NO.
�����2
RECEIPT NO.
�t�,�
APPROVED BY
SEEATTACHED
SHEET
ZIP PHONE
572-2656
Z�P PHONE LICENSE NO
ZIP PHONE LICENSE NO.
PHONE LICENSE NO.
� ADDITION p ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
Tear-off
TO
Underlayment must comply with the State Building Code. �
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OA 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 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yqLUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED $1�485
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
STRUCTONSORFTHE PE FORMANCE OF CO STRUC ONEGULATING CON- �/+8.SO
CONTRACTOR OR AUTHORIZED AGENT (DATEI
A� IDATEI
� �� �
T
GROUP �OCCUPANCVLOAD
CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
$.74
SAC CHARGE
Fire SC $1.49
OTAL FEE
$50.73
R�Y V LI ATED THIS IS YOUR PERMI
r �• ����
fipTF
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SIlVGLE FAMII,Y AND DLTpLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1 / 1 /97
ConstructionAddress:� �,�� 1�= ��-T 1�
Legal Description:
Owner Name & Address: _�;� ;,; LT. � ��r'r � Tel_ # 5 7:2 � 2 6�;
r � z
Contractor: _ � �� � � ° MN LICENSE # e
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
�n� Width Height Sq. Ft.
�n� Width Height Sq. Ft.
�n� Width Hgt/Ground Sq. Ft.
Driveway Curb Cut Width Needed:
�
�
Fstimated Cost: $ � ��S `=v
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x$ _$
0
„ .
� �
DATE: � � 7 ' � � APPLICANr: ��N �- I� CT-vY'�� Tel. # � 7 `� ' � 6 S �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIOIVS:
$ v. SC�
� �� .
� ��
$
$
$
$
$
$
� �D � �
CITY USE ONLY
Fee Schedule on Reverse Side
.�1 of Permit Valuation (1110th%)
$.50/$1,000 Valuation
$950 per SAC Unit
$5.0� {State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
�$450.Q0 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
� � t°
�. . .�
SUBJECT �f�
City of Fridley 2 � 3 4 3
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
i � �.
� 1 y__�� COMMUNITY DEVELOPMENT DIV.
f � � PROTECTIVE INSPECTION SEC. ��99
� . ,
� � �"'1 � CITY HALL FRIDLEV $j43Z NUMBER REV DATE PAGE OF APPROVED 8Y
�---•� � ,'� 612=5�8' � 910-F15
8/21/98 / /
JOB ADDRESS
626 Bennett Drive NE
1 LEGAL �OT NO. BLOCK TpACT OR ADDITION SEE ATTACHED
DESCR. 1 5 Christie SHEET
2 PFOPEFTY OWNER MAIL ADORESS ZIP PHONE
Thon N u en
3 CONTRACTOR MAIL ADDRESS ZIP PHONE UCENSE NO.
Own.er
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residentia
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
tend roof on a a
steps 5 ft, max. toward street
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Walls can not be extended under new garage eave
or under new entry roof.
SEPARATE PEHMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY CiqOUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONINO SQ. FT. CU. FT.
AUTMORIZED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PHOVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A pERM1T 1150 .S7
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEHM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �FO. ZS Fire SC l. IS
PLAN CHECK FEE T07A EE
r ^ � �
SiGNA OFCO�TRACTOAOAAUTHOAIZEDAGENT IDATEI N P OP ALIDAT D IS I.7X� OUR PEFMIT
�_ V ..� �
/
SiGNATUA FOWNEF7�IFOWNEABU�LDEA1 IDATEI BL �NSP pFTE
N�w � [ ]
ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
� ����
ConstructionAddress: � 2� (� �t.1 Iei�-' > � _ 1�1,� � R l 1� �� ►� 4� ,S � �[- � �'
Legal Description:
Owner Name & Address: 'j µp�(�' 1�'a��J'�/�l� Tel. #°.�7�• �� `���►
Contractor: DI�i� � MN LICENSE #
Address: 5�40� � Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: I.ength Width Height Sq. Ft.
GARAGE AREA: Length ��� Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
5�,.� g c
Construction Type:
Driveway Curb Cut Width Needed:
r�ac �' t'°� e.� (�a�,o-�,�. -ro � x. �-s.�..�J � cr�r /�4�
I.q�t/.� ���►-! rso f ovz� SttQs ,5'r� �.�,..,A�et� St��
�
Estimated Cost: $ � � 5 �
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x$ _$
DA1'E: g �- � � - �l. APPLICANT: Tel. # S? � � � 6 S �
C US ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �D• � 5 Fee Schedule on Reverse Side
$ �./ S� . 001 of Permit Valuation (1 / l Oth %)
$ • S7 $.50/$1,(�0 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 [ ]
$ �
SUBJECT ��Ri`iJIITyNO. _
City of Fridley 2 7 6 0 2
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
' � O.
' COMMUNITY DEVELOPMENT DIV. ���� �
i LL �����_�
r � � PROTECTIVE INSPECTION SEC.
� _ �
� /"'1 � CITY HALL FRIDLEr SS432 NUMBER HEV DATE PAGE OF APPRpVEO BY
�----� • •'� 612-571-3460 9/8/98
910-F15 � �
JOB ADDRESS 626 Bennett Dr
t LEGAL LOT NO. BLOCK TFACT OR ADDITION SEE ATTACNED
DESCR. 1 5 Christie SNEET
2 PROPERTY OWNER MAIL AODHESS 21P PHONE
Thon N u en 626 Bennett Dr 55432 572-2656
3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO.
Owner Same
4 ARCHITECT OR DESIGNER MAIL ADDFiESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRE33 ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION 0 ALTERATION L� REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Replace Siding; 6' x 2' Addition & Sliding Glass Doar
9 CHANCiE aF USE FROM TO
STIPULATIONS
Call for building wrap inspection before covering.
See notations on plan. ������
;Befb� diggtng c�l{ for
all utiPity locations
���� �%���$ R�QUIi'�FQ Fil� 454•00�2
ol�tRi{VG,`HEA�N�16, PLUNBIi�t3 �IPtD 51G� REQUIRED �Y i�AUV
SEPARATE PERMITS ARE REQUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY �ROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN-OR NOT. THE GRANTING OF A PEF;MIT $1,359.00 �.C)S
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ��}rj. ],rj Fire .SC, �1.36
PLAN CHECK FEE T TAL FEE
$47.79
SIGNAT pFCONTRACTORORAUTMORIZEDAGENT IDATEI
r �- H PR E Y VAL A THIS I UR RMy�
� ---�--�_ � - �.
S�G �"R F OW ER BUILDER� �DATEI B OG iNSP Da7E
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ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMII�Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: C�� �, ��J f� j i � 1�
Legal Description:
Effective 1/1/98
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Owner Name & Address: ��p��- N��Y�rJ ��� 1����-ci r�Tel. #�7� ��G S(�
Contractor: MN LICENSE #
Address: c � �. � Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height 5q. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
�.t- s��ac � Si Z.�i r.)�
—�
Construction Type: Estimated Cost: $ I.. 3 S�1
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: l.{ � �' � � � APPLICANT: � - - Tel. # �? � " �C �(�
C US ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS :
$ �
$ �3�
$ .��
$
$
$
$
$
$
$ �` � T
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.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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Building BUILDING Permit No.: , `
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date Rec'd: CU' �
DATE YOUR E-MAII. ADDRESS
STfE ADDRESS � �����d.d ' ,��6'''"�� fl! °�
TFIIS APPLICANT IS: ❑ OWNER NTRACTOR
PROPERTY OWNERJ Nq�: � �� ��
TENANT ADDRESS: CTfY STATE_ZIP
PHONE:
CONTRACTOR N�: � � ° �-
SUBMIT A COPY OF STATE LICENSE # � EXP DATE
YOUR STATE LICENSE ADDRESS: ��� CITY STATE ZIP
WITH APPLICATION pHONE � �� FAX
PROPER'TY Tl'PE � SINGLE FANIILY/NEW CONSTRUCTION SIZE
❑ TWO FAMII,Y/NEW CONSTRUCTION STORIES
PERMIT TYPE � �DTI'ION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH �ROOF ❑ DRAIN TII,E
❑ DECK 0 SIDING ❑ OTI-IER
❑ SWIMNIING POOL
TYPE OF WORK: � ��' ❑ ADDTI'ION
❑ MAIN'I'ENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: /�`P ° �
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S. Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES � ❑ HOUSE & GARAGE BASEMENT REMODELING SUBNIIT:
GARAGES ❑ ATTACHED GAItAGE 1. �xisting Floqr Plan
PROPOSED SIZE: ❑ DETACHED GARAGE Z• Proposed floor plan
PROPOSED HEIGHT: 3. ` List of siruchual members to be used
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCf�S SUBMTf:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing sttuctures
❑ Other ❑ Fascia and pmposed pmject.
WINDOWS 2. Two sets of construction plans
IN EXISTING OPENINGS �Yes �No LOCATION OF WINDOWS 3. Energy Calculations
OR FOR NEW OPENIIQGS-DESCRIBE SIZE OF
OPENING CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUA'1'lUN,1NC:LUllllV(� "1'HL C:US'1' UN LAtiUK A1VD MA"1'L+'KIAL�:
(USIN THE 19 7 U.B.0 FEE SCAEDULE)
TOTAL JOB VALUATION $ �i�Br� �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
$ I 1 1, a S� See Back Page for Fee Schedule
$ 65% of Building Pernrit Fee
$ �{.�a .001 times the total job valuation
$ �. � I .0005 x Permit Valuation Minimum $.50
$ S,� $5.00 (State Licensed Residential Contractors)
$ $1550 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ l a� Make checks pavable to: City of Fridle_y Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII. PROCESSED
I hereby apply for a building permit and I acirnowledge 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 ermit 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 wo iich requ s r vie and approval of plans. � �
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