AF - 35543�,, �
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BUILDING PERMIT
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Village of Fridley, Minn. N� 2� 5�
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s .. �.��....� . ..... (:lols .
Builder ... ... .. ......................
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Address . .a 1. � C,�. . .
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LOCATION �BUILDING
No. .��.�....... Street ..�7 ................... ............. .......................
Part of Lot
Lot . . . . �.� . . . . . .. . Block . . . . . .�. . . . .. . Addition or Sub-Division . . . . . . . . . . . . . . . . . . . . . . . . .
Corner Lot .. ��... Inside Lot ............ Setb ack ............ Sideyard ..........................
DES�RIPTION OF BUILDlNG .
To Used as:
e �
. . . . . . . . . Front . L.� c! . . Depth �.� . . . Iieight ./� Sq. Ft. .��� Cu. Ft. . . . . . . . .
. . . . . . . Front . . � �. . Depth ��. . . . . Height . .r� Sq. Ft. .°� �. Cu. F't. . . . . . . . .
Type of Construction �14�� r... F.st. Cost�.����� �........... To be Completed ... ..
. ��1!�L.s�.p .
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In corlsiderati8n t3f the i�ssuaxice to me of a permit ta ennstruct the building described above, I agree to do
t1�e proposed wor1� in accordance with the clescription above set forth in compliance with all provisions of
ordin�isce� of the village of Fridley.
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�i e e`ide.�ation •of• the payment of a fee of $ �� . . . , permit is hereby granted to . . . . . . . . . . . . .
to construci the building or •ad ditiion as described above. This permit is granted upon
the express conditioYi that the person to whom it is granted a„nfl his agents, employees and worlunen, in all work
done in, arotiit►►d a.t�d upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesot�, regarding loca.tion, construction, altera ' n, ma tenance, repair and moving of buildings with-
in the village limits and this permiti may be revoked at a time u n violatio f any of the provisions of said
ordinances.
.... .... .. . .... ..... ... .. Buildin Ins ector
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NOTICE:
This permit does not cover the construotion, installation or alte�ation 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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EX A. CAF2TilMe�iC1i�T - � �. � T J. E. IrtILL, C�Yt1. ENSi�1Vk� '
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N%ARQLIEi SURY�YF3 � � ` CtVIL EiVQiAi£�R
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S�p��ar 10,, 197§
P. M. Ec�dsl�y Ct��at�y
S0� t�icoli�i 1�Ia�Ii
Minn�apalis, t�ir�m�eso�a a�402
Re: insu�°ar�c� Cl aim
Jo�n Frarac3s Sc��p�ns�i - P�rs�nai Ir�jur,�r
Yi1�'� i F� � L �U. � ���-�
�'tl�� Qi�ii:
T�re attach�d �T ai rn far J�hn Fr�ncf s SGZ�par�s�� a�Q
r�as in3ur�d on Augus� xU, 197� a� approxi�nai�ly
7: � P. ���. ,�� or n� a�r 740 II�r�n��t Dr�i v�, was �i le�d
on t� G9 ty ioday �t appr�xiaaa�'�p i i:��,�F
WouTd yo� pleas� �ak� wh��ever° action is �t�c�ss�r�yy
to prt�ec� �►� C� �y.
'f�tank you.
�@l'� �M!!��/ j/QttY5 s
�t�rvin C. �ru���11
�sst. G� ty i°t�r./�in. Ri r.
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CC: Ri�h81"� Stf��£Ch� PUb��C•idOt'�CS ,�t�C�{?1" 10
Vir�i1 C. �ferri�fc, Cit,y Attorney
PJasim �1. �ureshi, City �•9anager
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STUART L. FINNEY
HOWARD J. KAUFFMAN
AVRON L. GORDON
GORDON KAUFFMAN � FINNEY ja� ?`' t?�;' �;-�r,
' � �� � ��;�' ��`
ATTORNEYS AT LAW "
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525 PEAVEY BUILDYNG �• �.: ;` ", ' T �t � ,' � � � �
73p SECOND AVENUE SOUTH � � � � � ��
MINNEAPOLIS,MINNESOTA 58402 ' • - -�.;� ��i TELEPHONE
September 4, 1975 (sia) 332-6505
City of Fridley
6431 University Avenue N.E.
Fridley, Minnesota 55432
Attent�.on: Mr. Marvin Brunsell, City Clerk
Re: John Francis Sczepanslci - Personal Injury
Our File No. I242-A
Gentlemen:
This law firm represen�s Mr. Frank D. Sczepanski and CharlQtte Sczepanski,
parents and natural gua.rdians of John Francis Sczepanski, all of whom reside
at 740 Bennett Drive, in the City of Fridley� Minnesota.
Notice is hereby given to.you as the governing body of the C3ty of Fridley
that on August 20, 1975 at approximately 7:30 p.m., at or near 74U Bennett
Drive, a public street in the City of Fridley9 Joha Francis Sczepanslci
sustained personal injuries of a serious and permanent nature resulting
from a fall fram his bieycle on sa3.d street. Our preliminary investigatiop.
of this accident indicates that the bicpcle on which John Sczepanski was
riding slid and/vr avertLrned dLe to sand, grave� or other debris on sa�d
street, causing such street to t�e in an unsafe and hazardous condition.
John Sczepanski has undergone surgery for in�uries to his arm and elbow.
The arm in question is in a cast and we are advised that it is too earlp at
this point in time to know the full extent of the injury. Accordingly, we
are not in a posifi�on to specify the amount of compensation or other relief
demanded. However, compensation will be demanded for all amounts incurred
by the Sczepanskis for medical treatment and hospitalization, and for John
Sczepanski's pain and suffering and any permanent injury. Additional
information regard3ng the nature and extent of injuries will be furnished
to you upon request. .
Notice of this claim is also being given to Dunklep Surfacing Co., the
designated contractor in the project known as City of Fridley 1975 - I and 2
Street Improyement Project. -
If you have any questions regarding this claim, please free £ree to call the
undersigned.
ai.c: iW
cc: Dunkley Surfacing Co.
Very truly yours,
N KAUF & FINNEY
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� Avron . Gordon
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SUBJEC7
City of Fridley
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.
r � � PROTECTIVE INSPECTION SEC.
, � ;
� �""1 � CITY HALL FRIDLE� 55432 NUMBER aEV.
�""'� � ,�� 612-571-3450
910-F15
JOB ADDRESS �40 Bennett Drive N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. IFi 8 Christie Ad.ditian
2 PROPERTY OWNER MAIL ADDRESS
Frank Sczepanski 740 Bennett Drive N.E.
3 CONTRACTOR MAILADDRESS
Same .
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDRESS
DATE
4/4/88
ZIP
ZIP
ZIP
PAGE OF
/ /
o/ 1937
��vd /
APPROVED BY
SEE ATTACHED
SHEET
PHONE
572-Q641
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE IICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
C� NEW � ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WORK
Construct a, 10' x 16' Shed in Rear Yard
9 CHAN(iE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE iiEOUIRED FOR ELECTRICAL, PLUMBING, HEATING, � ir� vr �.�rva�.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, 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 OP LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $9D.0
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $ZG. OO
P AN CHECK FEE
SIG= , I R OF CON i RACT(#iTOA" Uj� ORIZE� AGENT � (DATEI � WHEN` PRt
.CA i i1 A /J'i � . t.�/N
vv�rVrAlVliT �jpVUP OCCUPANCY LOAD
SQ. FT. CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
$.50
SAC CHARGE
TOTALFEE
$16.50
N� �l City of Fridley Effective �/1/8 6
ADDN. I] R-1 AND �-2 �
pLTER. [ ] Building Permit Application
Construction
Legal Description: %O�`
Owner Name & Address: �
Contractor
Address: / .9 / -
�
� /�lf�e � -
.
Attach to this application, a Certifieate of Survey of the
lot, with the proposed construetion draWn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #� 7� . d ��J,
Tel . # ��'� ° `%(� `�
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECH AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: ���� cQ /� ` Y 1 / '
�
Corner Lot [+rJ Inside Lot [] Ft. Yd. Setback �' a'�ide Yard Setback.s `
Type of Construction: ��„r_.� �/�ra,�,�,Q�
Approx. Completion Date: 4f ` /� - ��
Estimated Cost: $ `�DD � "
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: � - '' � �1� APPLICANT: Tel. � %�Ll� ° °%�,� %
� r
CITY IISE NLY
Permit Fee $ ,`� d � Fee Schedule on Reverse Side
�
Plan Check $ 25� of Building Permit Fee '.
State Surcharge $ Sa $.50/$1,000 Valuation
SAC Charge $ $��p per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $
TOTAL Agreement Necessary [] Not Necessary []
g _ /�.s
STIPULATIONS:
�
BQII.DING PERMZT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any
building or strueture, or for any addition to any existing building or structure, or
for any alteration or repair to any existing building or structure� upon applicatio n
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 9aluation
�1.00 to �500.00
Fees
$10.00 (Minimum Fee is �15.00)
0
$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
$25,001.00 to $50,000.00
$50,001.00 to $100,000.00
�100,001.00 and up
�32•50 for the first $2,000 plus $6.00 for each
additional �1,000 or fraction thereof, to and
including $25,000.
$170.50 for the first �25,000 plus $4.50 for eaeh
additional �1,000 or fraction thereof, to and
including $50,000.
$283.00 for the first �50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
including $100,000.
#433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEWAY DEPRESSION ESCROii
(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
approaeh With 6 inch depth - Driveway width plus 6 feet times $15.75
YERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 2u hours from the time of
application to allow for proper revieW of the proposed strueture and of the
construction site.
A Certificate of Survey of the lot, shoWing the loeation of the foundation once it
has been eonstructed will be required before proceeding with the framing.
ti..��
SUBJECT � � -r"
City oi Fridley � � .� �� � 6
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
' � RECEIPT NO.
� i v______ COMMUNITY DEVELOPMENT DIV ��� �
r � � PROTECTIVE INSPECTION SEC.
� _ �
� �'��1 � CITY HALL FRIDLEY SS4$P NUMBER REV DATE PAGE OF APPROVED BV
�'"""�" �'� 612-571-3450 910-F15 4/26/96 / /
JOB ADDRESS �40 Bennett Drive NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 16 $ Christie Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Frank Sczepanski 740 Bennett Drive NE 572-0641
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Steven Lee 9465 Irvin Ave, Brookl Park MN 55444 424-1198 5758
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION 1� REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WOHK
Reroof House & Gara e I�BS%% (21 S) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPAqATE PERMITS ARE REQUIRED FOFi ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. 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
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE HEAD ANO EXAMINED THIS APPLICATION 1 STALLS GAiiAGES
AND KNOW THE SAME TO BE TRUE AND CORiiECT. ALL PROVISIONS OF LAWS yAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A pERM1T �1�6HO �.H�F
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PqOVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STR CTION OR THE PERFORMANCE OF CONSTRUCTION. �S�F. OO Fire SC � 1. G8
�o PLAN CHECK FEE TOTAL FEE
ZA License SC $5.00 $61.52
SIGNATUAEOFCON'RACTOAOAAUTHOAIZEDAGENT IDATEI WHEN PqOPE VyALIDATED THIS IS YOUR PERMIT
— Ltd, ,/ -�9
SiGNATUREOFOWNERUFOWNERBUILDEli� iDATEi 8 G�NSP pFTE
NEW
ADDN
ALTER
Il
�)
[l
- - CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/96
�I� 3�
ConstructionAddress: � '�� %3 � �,.. �, .� fi-f-' ,�� � ,
Legal Description:
Owner Name & Address: �y6� 1� �� �e,t� �-� �1�,� , 7 �"/� j��;� `'.ei�" Tel. # -�%�' =- v � `� J
Contractor: � T�-e-� �. � �. � MN LICENSE # � ?-��
Address: � So� � � �,� ,-� !! � Tel. # % % / / % �
Attach to this application, a Certificaxe of Survey of the �
lot, with the progosed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. F�
GARAGE AREA: Length Width Height Sq. Ft. �
DECB AREA: Length Width HgtlGround Sq. Ft.
o�R: �-eo-� �� �. �� ,.� � 1 � V
- �,
Coraer Lot [ ] Inside Lot [ ]
Type of Construction:
Agprox. Completion Date:
Ft. Yd Setback
y'— 02 %�- P �
Side Yard Setbacks
Estimated Cost: $ �.,�°���-- �/�. �s�
- (Cost on Back) �
Driveway C�rb C�t Width Needed: . Ft ,+ 6 Ft = t Ft x$ _$
DATE: "�—oZ l� — �' � APPLICANT: �,� _ . - Tel. # ��. ��-// `�'�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surchaxge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ �(' D� °' Fee Schalule on Reverse Side
$ /� � � .001 of Permit Valuaxion (1llOth%)
$ � _ $.50/$1,0.� Valuatian
$ $900-�r SAC Unit ._ . - .
$ � <��� $5.� (State Licensed Residential Contractors�)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fce Determined by Engineering �
$ Agreement Necessary " [ ] Not Necessary [ )
� / < � -dq
� �
�
`c,
t j
� ;�
�
�� <.
� �, �
_ l�
n
BUII.DING PERMIT FEE SCHEDULE
,
The Chief Building Official shall, l�fore 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 permiC of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $5�
$501 to $2,OQ0
$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
FFFS
$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,Q00
$62.25 for first $2,� plus $12.50 for each additional $1,000
or fraction thereof, to and .including $25,000
$349.75 for first $25,000 plus $9.� for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for �ach additional
$1, 000 or fraction thereof, to and including $100, Ot}0
$887.25 for first $1�,0� plus $5.00 for each additiona.l
$1,000 or fraction thereof, to and including $SOD,000
$2887.25 for the first $SOO,OQO plus $4.25 for each addirional
$1,Ot� or fraction l�ereof, to and including $1,0OO,ODO
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete G�,irb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.�.
Alternaxe "B": Removal and replacement of curb and �gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 f�t times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the faundation once it has it has been constructed
will l� required before proceeding with the framing.
�� � SuB�BCT - - � - �
City of Fridle�
AT TME TOP OF TME TWINS � u I L D 1 1 \� P E R M I T
r �
; `� __ COMMUNITY DEVELQPNIENT DIY.
r j •� PROTECTIVE INSPECTION SEC
� _ �
� �'�'1 � CITY HALL FRIOLE� "432 NuMeeP REv
�"""� � ��� 612-571-3450
s�aF�s
�oe nooaess 740 Bennett Drive NE .
t LEGAL �OT NO. BLOCK TRACt OF ADDITION
oescA. 16 8 Christie Addition
2 PROPERTY OWNER MAIL ADQRQS$
Scott Prebish, 740 Bennett Drive, Fridley, MN 55432
3 CONTRACTOR MAIL AODRESS
Same as above
4 ARCMITECT OR OESIGNER MAIL AODRESS ^
5 ENGINEER MAII ADDFiESS ,
8 USE OF BUIIDING
Dwelling
7 CLASS OF WOHK '
2/22/02 � /
ZIP
oF
/
�RMIT NO.
32434
RE .
� ���
�PPpOVED BY
SEE ATTACHED
SNEET
PHbNE
XXX 763-502-6688
PHONE LICENSE NO
PMONE LICENSE NO.
PHONE LICENSE NO
C� NEW ❑ A4D�TION O ALTERATIpN ❑ REPAIR p MOVE O REMOVE
8 DESCRIBE WOHK
Construct wood deck (20' x 8', detached from house)
9 CHANt3E OF USE FROM
STIPULATIONS
See notations on plans.
TO
SEPARATE PERMITS ARE REDUIREO FOp ELECTRICAL, PLUMBING, MEATINp, TYPE OF CONST.
VENTILATING OR Alq CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WQRK OFi CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED 4j!ITHIN 60 OAYS. OR IF CONStRUCTION
OR WORK IS SUSPENOED OR ABANQONEO FOR A PERIQD OF 12Q DAYS A7 �
ANY TIME AFTER WORK IS COMMENCED. ` NO. DWLG. UNITS
I HEREBY CEFTIFV THA7 I HAYE READ ANO EXAM�N�Q THIS APPI,IGA710N
AND KNOW THE SAME TO BE TpUE AND CORRECT. ALl PqpVISfONS Of LAW$ VALUATION
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL 8� CAMPI,IED
WITH WHETHEf; SPECIFIEO HEREIN OFi NOT. THE GqANTING OF A PERMIT � 1 a 840. OO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OFi CAMCEL THE pEiiMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON•
STqUCTION OF TNE PERFOAMANCE OF CONSTRUCTION $66.2Q
S�GNATS+qE OF_ O9 ai2E0 nGENi �DAiEi
T
STALLS
ROUP OCCUPANCYLOAD
CU. FT.
OfFSTREET PARKING
IGARAGES
$.92
SAC CNARGE
.84
TAL FEE
$68.96
I TED THIS I UR PERMIT
"� ����L/
f�q T E
NtVV [ ]
ADDN [ ] � ,
ALTER [ ]
� � Effective 1/1/2001
CITY OF FRIDLEY .� (763) 572-3604 Bld Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ���
BUILDING PERMIT APPLICATION ���
� �
��c����
Construction Address: �� � � ��"�s`�� �� `�'� ��
Legal Description:
,"_�, •�� �
Owner Name` & Address: �� �°' �������' Tei. #�,�� � � �� ��°�� �
Contractor: _/?i �
MN LICENSE #
Address: Tei. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length �'� Width �' '���'� Hgt/Groun� � Sq. Ft �� �
OTHER:
� ��
Construction Type: �� � ��' Estimated Cost: $ �' ,/ �j �C�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATEf� . .l,S�� APPLICANT: �/�� Tel. #�/�,�' c������
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ , Fee Schedule on Reverse Side
$ .001 of Permit Valuation (1/10th%)
$ A $.50/$1,000 Valuation
$ $1150 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 [ ]
,
$ < r'
�J
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 $5(�
$501 to $2,000
$2,001 to $25,000
$25,001 to _$50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional$1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,�0
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb StreeCs C)nly)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Altemate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
0
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SuB�ECT
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 �
i �
� ; y _._�� COMMUNITY DEVELOPMENT OIV.
r � � PROTEC7IVE INSPECTION SEC.
i.---�� �"' �•� CITY HALL FRIOLEY SS132 NUMBEi� nEv
1 763-571-3450 910-F15
J08 ADDRESS 740 Bennett Dri.ve NE
1 IEGAL �OT NO. BLOCK TRACT OF ADDITION
OATE PAGE OF
10/30/02 / /
DESCR. ].() 8 Christie Addition
2 PROPERTY OWNER MAIL AODRESS ZIP
Scott Prebish 740 Bennett Drive NE
3 CONTRACTOR MAIL ADDRESS 21P
Renewal By Andersen 1920 Co Rd C W, Roseville, Mn 55113
4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP
5 ENGINEER
8 USE OF BUILOING
Residential
7 CLASS OF WORK
MAII ADDRESS
❑ NEW � ADDITION
8 DESCRIBE WORK
Replace patio door within
8 CHANGE OF USE FROM
�
� ALTERATION
TO
33221
APPROVED BY
SEE ATTACNED
SHEET
763-502-6688
PHONE LICENSE NO
651-264-4777
PHONE LICENSE NO.
20130983
PHONE LICENSE NO
O REPAIR O MOVE O REMOVE
STIPULATIONS
Provide smoke detectors in ail sleepi.ng rooms and on all ?eveis of the dwei�ing
per Section 310.9.1.2 of the Z997 Un-�form Buiading Code. Cauik and flash a�.l
e�terior apenings.
P�r�i� 1nsp�cii
�11 I�� on C��'ds
r� �o�� N1�lled
owner TO p�s#
SEPARA7E PERMITS ARE REOUIRED FOF ELECTRICAL, PLUMBING, HEATING, "�c vr a.v�
VEN7ILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCEO WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OF ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AF7ER WORK IS COMMENCED
iPANCY GROUP OCCUPANCYLOAO
T CU FT
NO DWLG. UNI7S
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICA710N 1 I S7ALLS
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION
AND OROINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED @
WITH WMETMER SPECIFIED HERE�N Oii NOT. THE Gi;ANTING OF A PERMIT W2 s 161
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OH CANCEL 7HE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON-
STRUCTIpN OR THE PERFOFMANCE OF CONSTRUCTION �83 . ZS
PIAN CNECI
Lice
S�GN4TUAEOFCON"RACTOQOQ4UTMORiZEDoGENT �OATE� . ..
A ��� OWNEA BU�LDERi 1OATEi
�
��
r��
T PARKING
IGARAGES
$i.08
e SC $2.16
4� FEE
91.49
iIS IS YOUR P RMIT
G d/ �fd/
r�w � �
ADDN
ALTER
[l
Il
Effective 5/10/99
CITY OF I'RIDLEY
SINGLE FAMII,Y AND DUPLEXES R i AND R 2
BLJII.DING PERM�f APPLICATION
ionstruction Address: � �-�{b �r�,°� �( o�.Q�
Legal Description: '
Owner Name & Address: ��_� �(„�'p �S� � ' Tel. � �� j. �o"� . (p(p $�
Contractor.; (����a\ '%u Q�a �cS.e, � MN L,IiCENSE # oi01�j09�
Address: 1921� C.ot.��n�M�ao►d C. W�e, ��'�,c�s�c.v�t1�� �1c1�1 S�SII� Tel. #(a`�l•a11�4�y�"i'�'
Attach� to this app�cation, a� �ertificate of Survey of--t�e �
lot, with ttie �rogosed �constc�ction dravvn �n it to scale.
,
DES.C�'i.#�N OF ��!��1VI,ENT .
LIVING AREA: Length Width. Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft:
DECK AREA: � L.ength VVidtti H�t/Ground Sb. Ft.
� •i �
Construction Type:
Estimated Cost: $_ p� i� l(� ���
Driveway C1�rb C�t Width Needed: Ft. + 6 Ft = Ft x$
_$
DATE:a!�•�•�a' APPLIeANT: � Tel. # 95a •3�°i.S•(o0�i�-
Permit Fee
Fire Surcbarge
State Surcharge
SAC Charge
Lic�nse Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
� a�
,---
$_ � �
$ /�
$
� ��:
$
$
$
$
$
9�`��
CITY USE OrT�,Y
Fee Schedule on Reverse Side
.001 of Psrmit Valuadon (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State L�cens�ed Residential Co�actors)
Alt. "A" or Alt. "B" Above
$450.0{) Conservation Plan Review
Fee Determ.ined by Engineering
Agreement Necessary [ ] Not N�essazy [ ]
STIl'ULATIONS: �p �v 1,,�--
.
ADDRESS
PIN
LEGAL DESC
PERMTT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY PERNIIT NO.: 2004-00893 �� �
6431 iJNIVERSITY AVENUE NE �
FRIDLEY, MN 55432 DATE ISSUED: 06/11/2004
�63) 572-3604 FAX: (763) 571-1287
: 740 BENNET"T DR NE
: 143024410046
: CHRISTIE ADDITION
: LOT 16 BLOCK 8
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
VALUATION ,
NOTE: ELECTRICAL PERNIIT BECOMES VOID 12 MONTHS AFTER PERNIIT ISSUE DATE. WIRE DETACHED GARAGE.
# INSPECTIONS 2
APPLICANT
SCOTT PREBISH
740 BENNETT DR NE
FRIDLEY, MN 55432
OWNER
SCOTT PREBISH
740 BENNETT DR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances goveming this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or locallaw
regulating construction or the performance of construction.
Applicant Date
Bldg Insp.
ELEC PERNIIT FEE - MIN (RESI)
ELECTRIC FORM FEE
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 3114
SEPARATE PERMITS REQUIltED FOR WORK OTI�R THAN DESCRIBED ABOVE.
40.00
1.00
0.50
41.50
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�63) 572-3604 FAX: (763) 571-1287
: 740 BENNETT DR NE
: 143024410046
: CHRISTIE ADDITION
: LOT 16 BLOCK 8
: BUII,DING
: RESIDENTIAL
: GARAGE,DETACHED
� � °�a
PERMIT O.: 2004-00927 ''
DATE ISSUED: 06/17/2004
VALUATION : $ 15,736.00
NOTE: CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS. PROVIDE HARD SURFACE DRNEWAY.
SEE NOTATIONS ON PLAN. CONSTRUCT A 24' X 24' DETACHED GARAGE. CONVERT EXISTIlVG GARAGE DOOR INTO
WINDOW. REPLACE TWO WINDOWS WITHIN EXISTING OPENII�TGS.
STATE LICENSED CONTRACTOR 1
APPLICANT
GD CAR CONSTRUCTION (20192414)
8045 SUNNYSIDE RD
MOLJNDS VIEW, MN 55112
OWNER
SCOTT PREBISH
740 BENNETT DR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or constntction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified here' or not. The
granting of a permit does not presume to g' e authority to
violate or canc 1 the provisions y o er state or local law
regulati�ig,�on�truc�tlyqp ce of construchon�o
Bldg
BUII,DING PERNIIT FEE
PLAN CHECK FEE
FIRE SURCHARGE
STATE 5URCHARGE, VALUE
LICENSE SURCHARGE
TOTAL
PAID WITH CHECK # 7283
SEPARATE PERMITS�EQUIR�D FOR WORK OTI�R THAN DESCRIBED ABOVE.
265.25
172.41
15.74
7.87
5.00
466.27
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,ARVEY A. CHRTWRIGHT J. E. HILL, Crvl� ENGINEEfi
%ANOKA COUN'iY SURVEYS ESTABL18H6D tB98
�HENNEPIN COUNTY SURVEY9 LAND � UI� VEYC1 RS
titINNEAPOLIS 9URVEY3 C. F. SAfdDHOFF
8.310 PALM 5TFlEET nE618T�RHD UNDEk LAWS UF STACE QF MINNESOTA CIVIL CNCiINEER
$UN3L'T B-OOiH ESTA3LI�HtD 1908
IICfiNSEU BY ORDINANCE OF CITY UR aiINNEaPOU�• JAMGS NELSOIV
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345 PI.YMOUTH BUILDING FEDERAL 8-872T SURVEYUR
INDU87RIAL — JUDICIAL
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I hereby certi� that this is a true �nd correct plat of a survey of
Lot 16, Block 8, Christie Addition, Anoka County, Minnesot�, as surveyed
by me this 8th day of January, 195g.
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The Home Depot # 2828
4550 PHEASANT RIDGE DR, BLAINE, MN 55449
(763) 717-0316
Wed Jun 16 20:20:18 2004
GARY ANDREN
7/1 GARAGE 24X24
55453
The materials in this garage will cost $3451.19
This Price does not include any Special Order Items.
Drawing: 3-Dimensional View
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The Home Depot # 2828
4550 PHEASANT RIDGE DR, BLAINE, MN 55449
(763) 717-0316
Sat Jun 05 08:59:07 2004
GARY ANDREN
7/1 GARAGE 24X24
55453
Drawing: Plan View
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The Home Depot # 2828
4550 PHEASANT RIDGE DR, BLAINE, MN 55449
(763) 717-0316
Wed Jun 16 20:20:18 2004
GARY ANDREN
7/1 GARAGE 24X24
55453
Front Side
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The Home Depot # 2828
4550 PHEASANT RIDGE DR, BLAINE, MN 55449
(763) 717-0316
Sat Jun 05 08:59:07 2004
GARY ANDREN
7/1 GARAGE 24X24
55453
Back Side
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The Home Depot # 2828
4550 PHEASANT RIDGE DR, BLAINE, MN 55449
(763) 717-0316
Sat Jun 05 0$:59:07 2004
GARY ANDREN
7/1 GARAGE 24X24
55453
Front Side
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The Home Depot # 2828
4550 PHEASANT RIDGE DR, BLAINE, MN 55449
(763) 717-0316
Sat Jun 05 08:59:07 2004
GARY ANDREN
7/1 GARAGE 24X24
55453
Right Side
The Home Depot # 2828
4550 PHEASANT RIDGE DR, BLAINE, MN 55449
(763) 7�7-0316
Sat Jun 05 08:59:07 2004
GARY ANDREN
7/1 GARAGE 24X24
55453
Left Side
The Home Depot # 2828
4550 PHEASANT RIDGE
(763) 717-0316
6/5/2004
GARY ANDREN
7/1 GARAGE 24X24
55453
Qty UOM SKU
DR, BLAINE, MN 55449
Use
Description
4
1
3
4
10
1
4
27
1
1
71
8
16
1
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
EA
5 EA
1 EA
4 BX
1 BX
1
16 LF
1
1
1
33 LF
2 EA
1 EA
2 EA
1
1
33 LF
2 EA
1 EA
2 EA
1
168161
124380
167929
569062
569062
161713
662496
161861
161713
161926
161896
832150
161772
161667
569062
161713
Base/Bottom Plate
Base/Bottom Plate
Base/Bottom Plate
Cripple Stud
Door Framing
Door Header
Door Header
Rafter
Rafter
Ridge Board
Ridge Board
Stud
Sub Fascia
Top Plate
Window Framing
Window Header
984590 Caulk
454141 Door Mnting Nails
944327 Framing Nail-51bs
456004 Window Mnting Nails
828133 Windows
252677 Brick Mould Wood
828005 Doors
460395 Entry Set #1
door8x7 Doors
252677 Brick Mould Wood
161721 Door Track Backing
161713 Jamb Frame-Head
161713 Jamb Frame-Sides
120706 Jamb SealHead/Sides
door8x7 Doors
252677 Brick Mould Wood
161721 Door Track Backing
161713 Jamb Frame-Head
161713 Jamb Frame-Sides
120706 Jamb SealHead/Sides
29 BD 143585
3 RL 258830
12 EA 561967
2 BG 668932
2 BX 418463
29 EA 787792
3 BX 944319
25 EA
15 EA
1 EA
9 EA
3 EA
3 BX
25 EA
19 EA
� 10 EA
Roofing
15# Felt
Drip Edge Wht
PlywoodH-Clips1/2"
Roofing Nails 51bs
RoofSheathingOS6 1/2
RoofSheathNail5#
178424 Siding
500555 Frieze Trim-Cedar
454141 O/S Corner Nails
500555 O/S Corner1 x4/Cedar
454087 Siding Nails 51bs
944319 WaIlSheathNail5#
386081 WaIlSheathOSB 7/16
401226 Soffits
401242 AlumFascia-6" White
2X4-12FT. N0.2 PRIME ACQ-C PT SYP
2X4-10 NO 2 PRIME PT ACQ/CA
2X4-8FT. N0.2 PRIME ACQ-C PT SYP
2X4-92 5/8 KD W1N STUD
2X4-92 5/8 KD WW STUD
2X6-8FT. #2/BTR KD-HT SPF
�'T2-10FT. #2/BTR KD-HT SPF
-8 �T. #2/BTR KD-HT SPF
2X6-8FT. #2/BTR KD-HT SPF
2X8-12FT. #2/BTR KD-HT SPF
2X8-10FT. #2/BTR KD-HT SPF
2X4-104 5/8 KD W1N STUD GRADE/CONTR
2X6-14FT. #2/BTR KD-HT SPF
2X4-12FT. STD/BTR KD-HT SPF
2X4-92 5/8 KD WW STUD
2X6-8FT. #2/BTR KD-HT SPF
ALEX PLUS WHITE 10.1 OZ.
16D 3-1/2" HOT GALV BOX 5 LB
16D 3-1/4" COATED SINKER 5 LB
6D 2" ELECTRO GALV. ROOFING 1 LB
2800 SLDR 4/0 3/0 WHT LOE/ARGON W/SC
180 BRICKMOULD PRIMED 1-1/4X2
36X80 RH PREM 6-PANEL PH IS BM 2-3/4
TYLO KEYED ENTRY - PB
8x7 S/O Garage Door
180 BRICKMOULD PRIMED 1-1/4X2
2X6-10FT. #2/BTR KD-HT SPF
2X6-8FT. #2/BTR KD-HT SPF
2X6-8FT. #2/BTR KD-HT SPF
GARAGE DOOR STOP WHITE 9'
8x7 S/O Garage Door
180 BRICKMOULD PRIMED 1-1/4X2
2X6-10FT. #2/BTR KD-HT SPF
2X6-8FT. #2/BTR KD-HT SPF
2X6-8FT. #2/BTR KD-HT SPF
GARAGE DOOR STOP WHITE 9'
TIMBERLINE 30 BURNT SIENNA
NO. 15 FELT-432 SQ.FT
F4-1/2 WHT ALUM DRIP EDGE
1/21N PLYWOOD CLIP 50/BAG
4D 1-1/2" ELECTRO GALV.ROOFING 5 LB
1/2 4X8 OSB
8D 2-3/8" COATED SINKER 5 LB
11/32 4X8 1.60C PINE PLYBEAD CLASSIC
7/8X4X8 KD STK CEDAR BOARDS
16D 3-1/2" HOT GALV BOX 5 LB
7/8X4X8 KD STK CEDAR BOARDS
8D 2-1/2" HOT GALV BOX 5 LB
8D 2-3/8" COATED SINKER 5 LB
7/16 4X8 OSB
VENT SOFFIT PERF WHT AL 121NX12FT
FASCIA TRIM WHT AL 61NX12FT
3 EA 378031
19 EA 669997
1 Spec. Order 1
FasciaNail-Whit
Sof F-ChanelEavWht
Trusses
1-1/4" ALUM. TRIM NAIL WHITE 40Z
12FT WHT-FASCIA RUNNER
1 set special order trusses for hip roof (See
Note Below)
The total cost of in stock materials is $3579.41 plus tax.
This Price does not include any Special Order Items.
This estimate was created on 6/5/2004 and is valid for 3 business days.
Your Hip Roof Trusses must be constructed for: 6/12 pitch; 24' span
for 24" spacing (o. c.); 24-inch overhang
40 psf live load, 7 psf dead load
Parameters from UBC.cod parameter file.
Parameters used: 24' by 24' by 9' high,
Eave overhang of 24 inches, Gable overhang of 0 inches,
with a foundation size of 8" wide by 0" high.
WARNING:
THIS IS NOT A FINAL DESIGN PLAN. VARIATIONS IN BUILDING CODES, SPECIFIC ARCHITECTURAL
CONSIDERATIONS, OR SITE CONDITIONS MAY REQUIRE CHANGES TO THIS DESIGN. YOU ARE RESPONSIBLE
FOR THE FINAL STRUCTURE, CODE VERIFICATION, MATERIAL USAGE, AND STRUCTURAL SAFETY OF THIS
DESIGN. BE SURE TO CHECK AND VERIFY THE DESIGN WITH YOUR LOCAL ARCHITECT AND BUILDING
INSPECTOR.
THE COMPANY ASSUMES ABSOLUTELY NO RESPONSIBILITY FOR THE CORRECT USE OF THIS PROGRAM.
ALL OUTPUT SHOULD BE EXAMINED BY A QUALIFIED PROFESSIONAL TO DETERMINE IF THEY ARE
REASONABLE AND ACCURATE.
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
I VALUATION
LINEAR FOOT
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s iz-36U4 N'AX:
: 740 BENNETT DR NE
: 143024410046
: CHRI5TIE ADDITION
: LOT 16 BLOCK 8
: DRIVEWAY CURB CUT
: RESIDENTIAL
: DRIVEWAY CURB CUT
A
APPLICANT
SCOTT PREBISH
740 BENNETT DR NE
FRIDLEY, MN 55432
OWNER
SCOTT PREBISH
740 BENNETT DR NE
FRIDLEY, MN 55432
12
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or constnzction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction ar the performance of construction.
Applicant Date
Bldg Insp.
Date
s�l-iz��
DRIVEWAY CURB CUT
PERMIT NO.: 2004-01395
DATE ISSUED: 08/20/2004
TOTAL
PAID WITH CHECK # 7348
�r,rtinH i� r�nivu 1� tcn� u ltc�11 r ViC W Vlcis V 1 ri�1( 1 riAN 1Jr:�1;K113r;1J AIiU V�.
240.00
240.00
N� �� CITY OF FRIDLEY Effective 4/1/2004
ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
���%���f � ��- i
Construction Address: ��� � �� � �r
Legal Description:
Owner Name 8� Address: � `� �'�'s� Tel. #
Contractor. ��� ��� ✓� ' ��!�� MN UCENSE # ��� ���"�
Address: � �i= ��- � � � �--
� 5 �/`Z� Tel. # �� �i ^ �� ��� �
Attach to this application, a Certificate of Survey of the � ,�'
bt, with the proposed construction drawn on it to scale. ��
�� � C� � � .
DESCRIPTION OF IMPROVEMENT � �� �� �
�
LMNG.AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length �--�" Width ,�_ Hgt/Ground . Ft
t C,C_ � � - �l-��� � � -
OTHER: � - S it �� L�� � � � �
f c� /
Construction Type: a �d�u��Estimated Cost: $
o�
Driveway Curb Cut Width Needed: �F� + 6 Ft = �Ft x $ � � _ $ � �
DATE: APPLICANT: Tel. #
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$
$
$
$
$
.$
� 2�4 �
$
$
$
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
STIPULATIONS:
BUII.DING PERMIT FEE SCHEDUI.E
The Chief Building O�cial 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
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,400,(�1 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,�
or fracdon thereof, to and including $25,�0
$391.25 for first $25,� plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,OW
$993.75 for first $100,000 plus $5.60 for each additional
$1,�0 or fraction thereof, to and including $500,0(}0
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,�0
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,0� or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
Pemuts 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.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
�uilding
Inspections
763-572-3604
DATE - ' '�
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑ OWNER
STATE LICENSE #
�
PHONE
O BASEN�NT FWISH ❑ ROOF
❑ DECK ❑ SIDWG
❑ SWIIvIM
DESCRIBE WORK BE1NG
SIZE OF IMPROVEMENT
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSID HEIGHT:
SIDIlVG
O dinyt
❑ Aluminum '
❑ Ottter .
w�avnows
1N E3QS17NG OPENWGS OYes �Ido
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENIlJG CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED
0 REMODELING
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DEfACHED GARAGE
OSoffit
� Trim
❑ Fascia
I.�ATION OF WINDOWS
NUWIBER OF
Permit No.;
Received By:�'
Dat���.:MAY
E3� DATE �J "'(%
� crrxs'-�l�l<eGr�
7��–�14°7— � f�s`�f
SIZE
STORIES
❑ WII�iDOWS
❑ DRAIN TILE
�17�ER
)L
�
G�Gt'/'�!LlG�— � � S i'OG�
OJIDTH HEIGHT
�
.�,�cz� �371
— �t�1�,0 C�c �l �vi
BASEMENT REMODELING SUBARIT:
1. Existing Fl�r Plan
2. Prop�sed fl�r plan
3. List of swct�ual members to be used
Ft
FOR NEW CONSTRUCTION 1NGLUDWG DECKS,
,ADDITIONS. & PORCHES SUBMIT:
1. Site PlanlSurvey showing the existing strucUues
and proposed proj�t.
2. Two sets of construction plans
3. Energy Calculazionc
- - - — -- - --- --- - ----
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LA.BOR AND MATERIALS:
(USING 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ rS��� �° OCCUPANCY T�PE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
$ �3.��
$
$. ���
$ ,��DD
$
$
$
$
$
$ �ai .GY�
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Detemuned by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks nava6le to: Citv of Fridlev Attach
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 Friiiley and with the Minnesota Construction Cndes; that I understand this is not a
pemut 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 apgroved
plan in the case of all work v� requires rey.i�w an� approval of plans.
SIGNATURE OF APPLICANT �eJ I��L2� ��%Ii(�/i�itGZ��/ PR1NT NAME C/.�6�//LO �_/ G1.UlilC1'�11 DATE c� ��%—G� �
��.
Page 2- Building Resid.ential Application
BTJILDING PERNIIT FEE SCHEDULE
� �,� � d
The Chief Building Official shall, before issuing permifs for the erection of any bui.lding or
shvcture, or for any ad.dition to any existing buildin.g or sh-ucture, or for any alteration ar repair
to any existang building or structure, upon applica.tion therefore, require the payment by the
applicant for such permit of fees to the amoun.t herein below set forth and in the manner herein
provided tawit: '
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
including $2,000
$2;001 to $25,000 $69.25 for 1� $2,000 plus $14 for each additional $I,000 or fracfaon, to and
including $$25,000
$25,001 to $50,000 $39125 for l�` $25�000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1� $50,000 plus $7 for each additional $1,000 ar fra.ction to and
includmg $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additianal $I,000 or fra,ction to
and includi.n $500,000
$SOQ,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up $5,608.75 forthe 1� $1,000,000 plus $3.15 for each additional $1,000 or
fraction
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 proposed structure and of the construction site.
A Certificate of Survey of t�e lot, showing the location of the existing foundation will be
required before proceeda.ng with the framing. New Houses Onlv
Ciiy of Fridley
Buildi.ng I.nspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977