AF - 356284 r2
SuBJECT
City of Fridley
AT THE TOP OF THE TVYINS g U I L D I N G P E R M I T
i �
� �
; �L __�_�_ COMMUNITY DEVELOPMENT DIV.
r j � PROTEC7IVE INSPECTION SEC.
1 . �
`� _ �"'1 � CITY HALL FRIDLE� SSIJ2 NUMBER
L___.� � `.�
612-571-3450 gt0-F15
lOB ADDRESS g330 Broad Avenue NE
REV DATE
11/16/99
1 LEGAL ��T NO. BLOCK TRACT OR ADDITION
DESCR. 22 Q. Ati.ssissippi Oaks
2 PROPERTY OWNER MAIL ADDRES$
Steven Brown
3 CONTRACTOR MAIL ADDRESS
Tabor F� Sons Inc. 10547 Terrace Rd. Blain
4 ARCHITECT OR DESIGNER MAIL AODRESS
5 ENGINEER MAII ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
PAGE OF
� �
PMONE
�-190
PMONE
PMONE
l�RMIT NO.
3=�-
RECEIPT NO.
i � ��
�PnROVEO BV
SEE ATTACHED
SHEET
LICENSE NO
;0014248
IICENSE NO.
LICENSE NO
� NEW O AODITION O ALTERATION � REPAIR ❑ MOVE O fiEMOVE
8 OESCRIBE WORK
_ Reroof house (17 Sq] Tear-off
9 CHAN(3E OF USE FROM
TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARA7E PERMITS ARE RE�UIREO FOR ELECTRICAL, PLUMBING. MEATING, TYPE OF CONST
VENTILATING OR AIR CONDITIONING.
7HIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION IONING
AUTHOfi12ED IS NOT COMMENCED WITHIN 80 DAYS. OR If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PEi;IOD OF 12p OAYS AT
ANY T�ME AFTER WORK IS COMMENCEO. NO. DW4G. UNITS
I HEREBV CEi;TIfV 7HAT 1 HAVE READ AND EXAMINED THIS APPLICA710N
AND KNOW TME SAME TO BE TRUE AND CORRECT. A�L PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WOqK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT 1486
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERfORMANCE Of CONSTRUCTION 54.00
�� A/;' s /� � e� � PLAN CNECK FEE
��s�� '�
S�GN4TUiiEO�CON•QACTOAORAUTMOp�2EDAGEN� IOATE� 1 HE PR
S�GN4TUFE O� OWNEA ii� OWNEp BU40EAi IDAiE� n, _,..en
S7ALLS
OF
TOT
OCCUPANCYLOAO
CU FT.
T PARKING
IGaaAGES
�
rrEw � � �
ADDN [ l
ALTER [ ]
Construction Address:
Lega1 Description: _
���Q1f� ���� � �
Effective 5/10/99
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ��� ��
BUII,DING PERMIT APPLICATION � �
) � a e� ��Lt c�
��r � � aa?. i �
{��
,�
� S�SS 1��� ��
Owner Name & Address: _ ���e v�N d�,�0�'� Tel. # %�f> "��g %
Contractor: . � oi €' �iti5� �,� MN LICENSE #
Address: L'� � y 7 �f.�� � Tel. #�%�'9 /s� z
Attach to this application, a Certificate of Survey of the
lot, with the proposed construcrion drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construcrion Type: /�� of � �, � �p���� ���� �t�� Cost: $ l � 55�� ��� �
Driveway Curb Cut Width Needed: Ft, + 6 Ft = Ft x$ _$
DATE: ��� -SS APPLICANT: �,e� ��i Tel. # 7 g�����
Permit Fee
Fire Surcharge
Staxe Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �� 7. ��
� I`
$
$
�� o�
$
$
$
$
� l-�,3
CITY USE ONLY
Fee Schedule on Reverse Side
.�1 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservarion Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
r ' ' �
BUII.DING PERNIIT 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 alt�ration 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 $2,0(�
$2,001 to $25,(�0
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$SOO,Q01 to $1,000,000
$1,�0,001 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 $25,0� plus $10.10 for each additional $1,�0
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 $5�,000
$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 Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
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 $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 frami.ng.
From: 9528914250 Page: 2/2 Date: 10l27/200812:31:53 PM
$li�,�C��.�� �'r�(J��.��(� Permi� 1Vo.: �
Ins�►�c1.�ians :�iES�]► +'�TTIA,�, ,A��.'PL�C,�4TION tt$ceiv�d t�y: �
�6�-s��,3�u� C�'Y C�F �+'�DLE� r.�t
763-Sp2-4977 F� �cT►vE,-,�a o �
[SATF r-�="�.�r O QC YqiJR S-MAI L ADA. FS3 ►�b �<rC. �J,��'d�G �t.�i GlJt. �Gd"Y�
Srr�.AUn�ESS ��30 �3noe,d �4.+� N�' �r`r.� �c..v
tNIS APFLIGANT ig; � OvdNER �TT'RAC7 C1R
!'�Ol'�RTX 4'W�Irlt! raaME_.� �•�, ��Ca�.�eJ'A
'��'i' NA�'I' AI]�RR,S9 _�,_�J x'� ttC� �:v� IV ^� A CITY � ��i,�qTA7'@, '�2iI! .�'
PH�NE�,�,� 6 - "Y �CCt° ,��
Nn�re: C�,.!�w�s�—wJ.�e�.�..� d�. _ • ,y....,,c,.cs J," ,�,
CON'X'�tAC'�'p'R AdDRr?gs; f �,I L'� ia �t,n �.a a� _ CTTY�,.j�%;1���9TA7"Fi�Ai ZlP�
SIJI3Mf'I' A COPY �F pH�NF. �„�'�/C�1 FAX _ t?,$�T �$" y r Y_� (,. I
YO;1R STAT$ L1C.ENSF, 4TAT� LIGT:hi9F N 2..' e�b �_G °'�7 ^ 1:3tP UATE? �....31�� �
P.RQI'�RTY TYp'E NGT.E FAMILY/pTNW �pNS7itUGTLON SIZ� 6at! S%�'"�
d Twc1 FAMILY/NFSw CONSTkUCt'ION ST�R�S
PETiMi7' 7'YPE ❑ AI�DiTfON t7 GARAG6JSH.CD WIND4WS
0 IIASRMENT FiMSi•T � RO�P 0 BRAtN'f�L1?
t)1713CTG � � Si�TNCi C] p'1'1iP.R
C1 SWTMMiNGPOOL
TYFE OT+' WORK: ❑ NEVV b1UM� C,t�N9TRUC7'ION ❑ A�DmON
� MAIN7�N�NC�REPAII2 ,s�-ETfiT�11�ioUGL1Nt3
�7E.^+GRTRfiWC)RT{ ARTNG dO1VF,: i�tJ-�L� ,F�G�L�Gte.s.-w�..�� ..
Si7.F.OF TMi+ROVEML'N'i LENGT.FI WJUT74 HEIGHT $(j FI'
A.,�* C7 H(n,►Sr� pM.Y DAS�,N,iE�LT R�Mt]D$LiN�, 5UBMfT:
NUMBER OF 8Q[IARR.S O Hf3lll5L 8c CiAlLiGE j. ��ybng Pltu�r Pian
� D AT7'ACFILD GARA[3E 7.. Pmrmaed floor plan
FROP03Eb SIZ�: � D�TACI,,1TyT} (iARACR 3. List oPstrtlCfurol memlmr� to bc u�i
1'ItOROSGD biripllT: �. ,^
smrn�r TC1R jd,Ts9V C(}MSTR(7C17pN INCLUDfIVti bECKS,
n v;�v� c�so�c ADD1TtONS�oRC��zss sugn�rr:
Cl Aluminum � Trim 1. 3ito P1aNStm�y shawmg t�e exiating atractmes
❑ �thCr ,_ � Fnxcia and proposed �xnjecc
•------ 2. Two Set9 of ct�mtructian pisns
�nQWS 3, F,ncrgy CaicttlAtibns
IN S3CI.�,i11VG OPCNtNGS ,J�ca ❑No Lc�, TIUN t7F WINDnWS
c�R Fc�li NCW OPGNfNC.i3-PFgcRt�� Sr7B c�r �rt,a1�- �erfi rLe�1 �.�e.�
UFENiNQ CNANt',rF3 &
TY.PF 9F VY1nTDQW Ttl BL INSTN.i,ED wvn�eBrs. or• W WDOWS �
Aid, i�r:�S AR� BASEn oN VAI LrA�rr�N, nvc��mtivG rflE CUST pr rJa�oR anm MA�i"ER1AL3:
Plan heview
Fitc Sutcltat�
Surcharge
Liccnsc Suroh�e
SAC Charge
Curb Cue Escrow
Erasian Cafri,rol
Park F'ee
Sewer Main (.:tiarge
1�TJf3i.; � � E BC.i�DIJ�.T.)
� See Back P9gc fat Fee Schedule
� 6S°/n �f Building Pcrmit ree
$ .047 timcs Ihe tot�l job va3uation
$ _OQOS x Pemttit V�lu�tion Minitnum $.5(?
_ $ $5.00 (9tate Licensed Residetttiial Cottt-racCOrs)
� �1825 per 3AC Unit ('Alans ta M WC(: fvr determinaCion)
$ {�+6tt= ftx$21 C$
$ $450 Conservsition hl� Review ��
$ _ Fee Uetetmincd by Engineering
� ,�„_ _ , A.greemerrt necessary t ) ]Von N�cesst�ry (. )
'f1iIS T$ qN APPLICATfQN FOR A PL�hMiT-IVO'f VA1.�1T3 LTNTfI.. PRQCB.94ED
I hereby apply Ibc � bttiTd�ng �rmit nnd I acicnowl�dqc dmt 4hc irrFmnmhbn abave Is complete and accw�ate; thac thc warlr will l� in conformance wi8h du ordinm�s ond cor�
oP the City of Fridl •ry an�i wit4 the Minnes�r� C,�rn.atructian Cades; that I undoistand this is not a pamrit but only m� nppltcntlon Cor a permit n�M work is not to start withouC a
permil on sft� th;�t the werk wiN hc in acxordnncx wich t �r plan {n the case oFail wnrk which requir�.w rcviaw and appmvai of pin s.
9TGNATURE OF APPLI�ANT PRiNT NAM� �%Iiltt ,���_DATE /r0r�)�et
APPROV�D BY tiA'TE