AF - 43958SuB�ECT
c�ty of Fridley 29319 �
AT THE TOP OF TME TWINS B U' L D I N G P E R M I T
r
; � RECEIPT NO.
� • COMMUNITY DEVELOPMENT OIV. ���
, � ~ PROTECTIVE INSPECTION SEC.
r , ";
� . ,
� ;
�'��1 � CITY MA�L FRIDIE� SS�32 NUMBER pEV OATE PAGE OF APPROVED BY
�.---�•' �•' 612-571-3450 910-F15 4/28/99 / /
�oe nooRess 6526 Brookview Drive NE
1 LEGAL �OT NO. BIOCK TiiACT OR ADDITION SEE ATTACHED
oesca. pt 1 2 Brookview 2nd Addition SNEET
2 PROPERTY OWNER MAIL ADORESS ZIP PMONE
3 CON7RACTOR MAIL ADDRESS ZIP PMONE LICENSE NO
David Pearson Homes 11960 London St, Blaine, MN 55449 755-1932 20017448
a ARCHITECT OR DESIGNER MAIL AODRESS Z�P PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
� NEW O ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 38'4" x 24' Dwelling; 21'8" x 22'4" Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan. Provide sod in the fronC and side yards. Provide
a verifying survey to the City before capping. Provide a hard surface driveway.
Submit confirmation of recorded easements per � City
Planning Department.
SEWER & WATER LOCATIONS: See City Engineering Dept.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Frida�:J�Sj��
9:00 pm on Saturday; No work on Sunday. ���
8efore digging cai� �or
Paid $1000 Storm Water &$2,622.95 Water & Sewer Lateral charges�� �t11�� �p�tjp�5
454•0002
. �"�� ��rrs �EQura� Foa �EQi�1�RED BY LA
WtR1NG, H�:ATING, PL�9�i(B1� , A�D �,
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCv LOAD
SEPARATE PERMITS ARE REOUIRED fOR ELECTR�CAL, PIUMBING. HEATING,
VENTILATING OR AIR CONOITIONING
THtS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION 20NING S�. fT CU FT
AUTMORIZED IS NOT COMMENCEO WITHIN 60 DAYS. OR If CONSTRUCTION '
OR WORK IS SUSPENDED OR ABANOONED fOA A PERIOD OF 120 OAVS AT
ANV TIME AfTER WOqK IS COMMENCED. NO OWLG. UNITS OFfSTREET PARKING
I HEREBY CERTIFV TNAT I MAVE READ ANO EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME Tp BE TRUE ANO CORRECT. ALl PROVISIONS Of LAWS yq�UATION SURTA%
ANO ORDINANCES GOVERNING THIS TVPE OF WOfiK WILL BE COMPLIED
WITH WHETMER SPECIFIED MEREIN OFi NOT. TNE GRANTING OF A PERMIT �92.,159 �46.0$
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE Ofi CANCEL TME pEqM1T fEE SAC CMARGE @ 1� OSO SAC
PROVISIONS OF ANY OTHEF STATE OR IOCAL LAW REGUTATING coN- �g43.SO Fire SC �y9Z.lE1
STR CTIO PERfORMANCE OF CONSTRUCTION
PLAN CHECK FEE TOTA� FEE
License SC $5.00 $2,786.74 + Lat&SW
N EOFCON�RACTOQOQOUTMOp�ZEDeGENT IDATE� WHEN PROPER VAL�DATED THIS IS YOUii PERMIT
i �. � — � y�G .
U
S�GNATUAE O� OWNEp��� OwNEABU��DEQ� ���TE� BL �h5� ���tf
i+�o �,��%
NEW
ADDN
ALTER
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[]
ConstructionAddress:
Legal Description:
CITY OF FRIDLEY �
� SINGLE FAMILY AND DUPLEXES R-1 AND
BUILDING PERMIT APPLICATION �
�� .5.� � ���
�vv�Y Q/1�Y� �� � � f-r,� l 1L i7 n _ z
Effective 1 / 1 /99
.�
I i�
�l"/,
Owner Name & Address: Tel. #'�����x�-���y v�
�-� v e v
Contractor: /��,�j,/�� � `'�� �,,0 �j�� MN LICENSE # 2-4D�7�1`1 �
Address: �l��l /�'iiL�N s'% ��i�" ,l�l�U� .���� Tel. # 7�"�—1 ��z
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the SG,,.� �� v.
lot, with the proposed construcfion drawn on it to scale. 2�C3 X/�_ �D
/5r �2�,.' = � y ��� �� S� Z
DESCRIPTION OF IMPROVEMENT �
� f,�,� -/,c� y �Z��Z. j �� 3Yf �9
Length :�� �� �� Width � Height _ Sq. Ft. Cirl,S �
Length __��� Width Z�y� Height Sq. Ft. �� �1��
k J�,
Length Width Hgt/Ground Sq. Ft. "�9�3�.
Construction Type: Estimated Cost: $� �� /,S�
(Fee Schedule on Back)
Driveway Curb Cut Width Needed
I�ATE: � - � -�`y'
t
-- Permit Fee
-- Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
, Driveway Escrow
Erosion Control
�Y3, s�
$ -� .
$ � �
$ y�, �k
$ �o��°�
$ .:1" `f�,
$
$
Ft. + 6 Ft = Ft x$ _$
��L�
Tel. # `7�-� - /�'i3z
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Park Fee $ ��`'U �O Fee Determined by Engineering
Sewer Main Charge $ ��� Agreement Necessary [ 1 Not Necessary [ 1
G� - Sv�,�-� Ge�4-���, ,.�
�, �;�1;7. i. -
TOTAL $ � � ' � � �. � L j'7 i �ic�.�LS� ,/�"
�
STIPULATIONS: �
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��
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w. �� �
L �.a� _
C�N�'�
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C�TY OF
FRIDLEY
M
�
SCOTT J. HICKOK
Planning Coordinator
Municipal Center
6431 University Avenue NoAheast
Fridley, MN 55432
BUS. (612) 572-3599
FAX (672) 571-1287
hickoks �ci.(ridley.mn.us
. . :.., ..
� •: . ...,_ .• .. ...... . . .:.. .�....... ..... ... . . .. . . , .
. , - .. . . � , : ,.�,�••��:r :�:. • ..� ........ . . .•_. _ ... . .. . . . . . .. . . : .. . -_ .
. • . `� EXTERIOR '�EHVELOPE� AVERAGE "1J" COMPUTATION �
;»:••. .
. � . . . .
. . .'��1 -� • . � .. .
owNEx . : � � � .� J � �- R�e � . � � � � - . � � . -�
� STTE ADDRESS�� � � . , � ; .
. COI��TRACTOR . �����C/ 1 .�U��, '�DATE �..��,'"F � � � PHOH£ ' .. -
-- . . . , .� ..
� � � � De.termine �_work�ing -square �foo.tage of .each.� � .- �
• � •. . • �: • • .
��1. ~Total.:expose'd�:wall �:area; . . . . � � S . sq. 'ft. -.x� � : #1 = 2 -:
. •-' '. - . •'-: -_'.� .�..: .'� . .. . , � ,
.. �2. •Tota� ;roo�f/ceiling �:�a-rea . ' �" �5 sq. �:f.t _ .x .0�= .
�' - . .. �� � . . . . ::
� '� �3. :Total :rloor/can�.j'=~'a.rea �. . : �-`�J�7 _.. . =Sq.• .ft...-x ;05 = . � ..
. � -. � ---�� ;
. � Total exposed wall �area �above floor ••= . � q-���
� :� a, �.�.Total ���all window area . . . . . . . , •• � S Z, � �
, . b. �.Total door .area . , . . . . - � . � '
. � -c. � Total sliding �glass.�door zrea . . . -, ,�_¢ •
• • . � �d. � � Total •f ireplace . wall �area •a -
• � ' � : e. 'Total wall fran�ing .area (average � 10 0) . .. - -
. ' . � f . �Total net wall area above. floor • �
• � g. •`Total rim ��joist. ..area . . .. . . . . . '
Total •exposed foundation area = .
_ . �5
'. �h: ...To �al :foundation window area _ � d �� � .
_ . •i . .Total .•net ::foundation area �zbove •grade. .—�C • ' • ' � :
� Determin.e "U"�: value of each�'wall segment. � � � ' • . .
a
_ .- .. �.:a . �• -. � S 2 . �. x .�,Uf� � � 3 = • � '�C� .
. . b. .. � —T . � �X t�U« _ _
' . ��C,_ Q� , . X r�U�r _ — - � . .
, d . _s..� __ ' � Z �
. - t7 x T� U,t _
• ' .� •e.�^� l � : X �t�Un. t b _ •/% - '
' f•_ t � i� � x. t�U,T � r .�—
� .. . . :g• . � `x � • X „Ut� �_—�-.? .
. - •h . • � n . X ��U>> � 4" _- �
. . . . : 1 - . �.�• X- nUtt ,�.��_ .. �
._...�, . . .._ . . .�-. � _-. � . .. _SUBTOTAL � _ _. I 5 5_ .
4 . . � � " .. • � . � � , - � ' 10TAL . . ' :_ � _ � .
If •item��4.is the��s�me as, or less :thzn��item Tl, �youu have •met..�'fhe
=;�t�ent :of�'SBC 6006 (c) �2.
� � .. � . .
, � �
r
� . . .
0
�.� � .' . �' . . '_ : .•�.• ''.' : �..� .'�.
��• � . � � . - . . .. . . .
, . � . . . . i � . . . . . . ' : . . . . .
.. • .. ` . ' , . .. .,. : ' '. . ..I .. . i.. .. . . � � . • - ' . . . . � ' � ' .' '. .: . . . . , .• �� . . ' . . .. ..
� � Total exposed roof/ceilin� area � 9� � . � �
- •�j. Total skylight area. ................... �.
:=k. ';'otal flat roof_%ceilin�; ir�min� �area. ... , , .., , . . S
.:1. Total net insulate�i'�flat roof/ceiling area..._. �
•m. .Total vault •roof/ceilin�;�fr�:�i.ng area ..
' �n. Total net�insulated•vault�=oof/ceilin� area.... � �
. . :Determine "u": value =for each.•roof/ceilino•�se�ment •
. . . . � , . - . . _ .
• �-- j - . :�x '•�!.U'�• . _ . � . ,. .
. .{�. - . . : k -- ::,.X ::���„� � . . � � _ 2� . . . '
� � . � 1. � _;X �»t���. ' _ . . . �.
. - . �h 2. 2- 'Z f . . .
� • m - :':x" �� U» . _ — _ .
• . .n. � � . : x »U,� . _ . . �.
5. � . . .�. .. _ : . .� � � _ . �..:. �.� . : . . . . . . . . . . . . . . . . . . . ':Total� _ •'Z- Z.o.
:, . �If �total��of :�5=`_is�:the :same as, or'less•th�n •�2,'� you=have•r�et •the • � -
. . . :intent of :SBC.�6006(�c)1. ..�. • . � �• .• . . . � • .
.. ��• _ • Tot.a1~ �exposed�•:f.loor/•cant. •area .�� '-.... . .
�; _ � ��-•o�. � �-:ota?�`':�floor%cant: �framing �ar.ea (�avera�e��:10 0)� . . . '� � .
. ' ' : , p.�. �� Tot�l :.net �insulatec� :f� oor/c�nt .. area . . .._ . _ . . • - (� —
.� : . � • �,-`•DetE�rrnine � "U" �.value .for �each •,f.loor/cant_._,se�nent:.: _:� '. . '
. ' � • ' � �o. �� . :..X ��U�� �� . _ � � � U` . _. • . - • � .
. ' - . _ . p. .'-�- �y -,�U�� : � _ . _ _ . ' .
• � •�•�6• : �•.--....� ....:.�...�...: ..� ...... . �---....�_.:TOtal = 3 .. .
.:.. �. If �tota? of �6 is the•.'same as,�•.or.'less than �3 ' ou'h�ve met the'
� .. :�.'intent of -SBC 'EJ06(c)3. � � •� .. .'. y . .
•• . .. . . � • . � . • . . : 'ALTF.R�iATE :RU?"LnI?�IG 'Fr?VELOPE �DF.SIGI�i ' : ' ' ' � � ��. . '
•: �'. . ��Toj utilize�=the'��to�tal:.�;envelo� e system. m � '-� �` ' ��'`"�`�"' � ' �
• . P ethod, '.the ;values� established..� ��'. =��
. : �.'�=�by:•the .sum �of���•items��:-=�4_;'����5-and�.�.r6:�sha1�1•�not�'be� �greater,�th�an �the:�sum� �� �
.. . . :of' �i �ens�: �1.� ..�#�2 -and�:•�3 _ - � . � . . . � .. . : _. _.: • � , . : - .. -
. r' ' �: .
.
' • . .• .. �� . . . . .
. . .••::�., .
• � i ��� � 2 2�. . :3 �... . _ •���. ' ' �.
. .. . . � . .
' . 'y _ ' S5 � . :S . . 2 � r6 . . •,j. � _ � [ �� •'
. _ . .� �.. . - . . � ,.
� .;'� � . " . � - . ,� � • ' : , . _ � .
.,;Prepared �'by . ��� • .
�� te
.J� -:� �.
.... .. _
.
. •
= TNRU S�UD Int. Air .68
u� S•�• E SIDING S.R. •9.�
��C,� S t u d 6.� 4-
,�
•,
�.
,
,
. ��i
r
THRU CLG.
; fEMBER
��'}� '�
,. / �
. �
1 ' i .
Shtg.
Siding •�2
Ext. Air ,17
�'otal "R" _ �,U� �
1/R= ��U�� = t p
0
c
Int. Air .s�
S.R- ��� ") • SS
Clg, Mefib. 4.35
�Ins. ( _ ") 2G.33
Still Air .sl
Tota� �=R�� = 3Z.4-Yi
1!R = '�U�� - L�.�.1
,
THRt1 CONC BLOCK Int. Air �sg
c.. 8. c �� ) �. 2y
' 3 l2�' Opt. Ins. �(�. �D --
_ Ext. Air .17
i• . .
' Opt. S.R.
• . .
� %
� .
-- ,-- Opt. Sid.
i• ' .
' %` , , Total "R�'. _ ,) 2,. 63
� � . �� 1/R = ����� _ ��
.
,
Ti�RU INS. WALL Int. Air , 6�
w/ S.R. E SIDIhG S.R: �,ys
(� �� Ins.
- ��q:G�
. . SHTG: � 2,0,�
,
'� Siding • GZ
�,
" � Fxt. Air ,17
-- Total "x" = 23.D•
�
1/R = ��U�� _ .0
THRiJ CLG.
I?�SULATIOPI
THRIJ RIM
JOIST
i�
�
��
��
Int. Air ,6�
s.R. c ����� . sg
Ins. (I3"� �.o�
S.till Air .6I
Total "R" = 4"S. �p
1/R � ��U�� _ �
,p �'
Int. Air :68
. ��� Ins. � �. GG
?'�" 4Jood .1. 8 9
• Sht�. �,US
Siding- .6Z
Fxt. Air .17
,
Opt. Erick
Total' "R" _ �.�-,!-�-�
,. �a= ��u�� _
� •v �
._ ,
CITY OF FRIDLEY INSPECTION DIViSION
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
572-3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
RATE SCHEDULE
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning • All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1% of Value of Appliance or Work
Commercial/Industrial
1.25�'Jo of Value of Appliance or Work
Rate TOTAL
$ 30.00 $ a d • �v
$ io.00 � ��- Uv
$ 10.00 $
$ 10.00 $
�--,
$ 25.00 $
$
$
State Surcharge
TOTAL FEE
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION
REFRIGERATION/AIR CONDITIONING PERMIT IS $25.00
PLUS THE $.50 STATE SURGHARGE
REINSPECTION FEE $47.00lHr
*Air Conditioners can not be placed in a side yard without
written permission from adjoining property owner.
$ .50
� �d. S�
Effective On May 10, 1999
� �
JOB ADDRESS ��r� �' �
OWNER / �
' S � ✓�}? � 8 �'Y1 �
BUILDING USED AS �� �����,� C�
o, c� '7 �. . �7;
ESTIMATED COST o� � � 8 PERMIT N0. -E ���
DESCRIPTION OF FURNACE AND OR BURNER
No. of Heatin Units Circle One (Steam) (Hot Water) Warm Air
Trade Name��i�,dr�/ �?—J�2�� Size No. ✓IfTC..� 75—
BTU 7�r bOC� HP EDR
Fuel /1�l�7� Total Connected Load
Burner Trade Name Size No.
BTU HP EDR
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
HEATING CO � 1/ S S✓��v^ I'� �
Signed ,�°"Y' Y� �c DATE � � f 7 — / �
�
Approved By �� /� Rough•In Date Final Date
CITY OF FRIDLEY INSPECTION DIV.
6431 University Ave NE
Fridley, MN 55432
572-3604
APPLICATION FOR PLUMBING AND GAS FITTING PERMIT
MARK NUMBER OF FIXTURES TO BE INSTALLED ON EACH FLOOR
Effective On May 10, 1999
G�
PLUMBING FIXTURE RATES:
New Fixtures
Old Opening, New Fixture
Beer Dispenser
Blow Off Basin
Catch Basin
Rain Water Leader
Sump/Receiving Tank
Water Treating Appliance
Water Heater -Electric
NO. RATE TOTAL JOB
��r
Water Heater - Gas*" �
Gas Range** /
Gas Dryer** _�
Back Flow Preventer Required ()Yes () No
Type
$ 7.00
$ 4.00
$ 5.00
$ 7.00
$ 7.00
$ �.00
$ 7.00
$10.00
$ 7.00
$10.00
$10.00
$10.00
$15.00
Reinspection Fee $47.00/Hr
ALL OTHERS AND/OR REPAIRS AND ALTERATIONS
1.5% of Value of Fixture or Appliance
State Surcharge
TOTAL FEE
��o,C�
D< o0
io vc�
1 D,c�
��
$ 8�-s�
S�
o�v�� ,� �
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the city codes
and rulings of the Building Division, and hereby declares that all the facts
and representations stated in this application are true and correct.
CD -- �`�
Owner
Building Used As Y� ¢u��-�z�'�,��+'
" � �
Estimated Cost� � �}� PERMIT NO. - -
1999
PLUMBING COMPANY � � � �
SIGNED BY 6/�����2_-� -� TEL N0. 7S� �� I �
Approved By Rough-In Date Final Date �� C�
' -- � _ ► ■ 1 : _ _
**COMBUSTION AlR SHALL BE PROVtDED PER UMC SECTION 504(A) AND TABLE 6-A. MINIMUM SIZE 9 SQ INCHES.
�
_
_
CITYOF
FRiDLEY
FRIDLEY MUMCIPAL CENTER • 6431 UNNERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
August 10, 1999
David Pearson Masonry & Construction Inc
11960 London St �
Blaine, MN 55449
Re: Final Inspection at 6526 Brookview Drive NE, Fridley, MN 55432
Dear Sirs:
A final inspection was conducted on August 10, 1999 for the above noted address and the
following items were noted which must be completed before the structure can be finaled;
1. Finish the final grading and provide sod in the front and side yards by October 1, 1999.
2. Provide a hard surface driveway by October 1, 1999.
We will expect the above items to be completed by the scheduled date and a reinspecdon called
for. The structure is approved for occupancy before completion of the above items.
If you have any questions on this matter, please feel free to contact me at 572-3602.
Sincerely, /: 1 / /
RON JUL V
Building ici
RJ/mh
-
_
crnr oF
FRiDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 5'71-3450 • FAX (612) 571-1287
August 11, 1999
PW99-106
To Whom it May Concern:
Subject: 6526 Brookview Drive
The developer of the property at 6526 Brookview Drive had requested the City install a curb cut for the
home so that a driveway could be placed.
Due to the weather and other priorities, the curb cut was not installed until August 10, 1999. Accordingly,
the driveway surface has not been placed. It is expected that this work will be completed once the concrete
has cured and a schedule established.
Sincerely,
��'��
John G. Flora
Director of Public Works
JGF:cz
NEW [ ]
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY �
[] SINGLE FAMII,Y AND DUPLEXES R-1 AND R-2 ���
BUII,DING PERMIT APPLICATION �,�/ �
_ %%�]" "
Construction Address: G ,5�, ,��,��� �/i �Z�. ��2
Legal Description: ��- o.e,r��.�� i���m��— C���c��-n� N�v ��� �
Owner Name & Address: ,Q�IIi�� ����Lso.� Tel. # L lZ- ?SS'193Z
Contractor: S/a-r��- MN LICENSE # ?�'x�/7yY,�
Address: ll °%� Gc�wDr�/ S; Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Lei�gth
Length
DESCRIPTION OF IlVIPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Construction Type: Estimated Cost: $
��
Driveway C�rb Cut Width Needed: �Ft. + 6 Ft =�2 Ft x$ /���
DATE:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$
$
$
$
$
$
$
$
$
$
APPLICANT:
CITY USE ONLY
Sq. Ft.
Sq. Ft.
Sq. Ft.
_$ .3�1 �
Tel. #
Fee Schedule on Reverse Side
.001 of Pernut Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
Building
Inspections
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE '"1 ' a0 � O'7 YOUR E-MAIL ADDRESS
SITE ADDRESS �O S�o? �v L� RbaKV I�Lc� L� 2.
THIS APPLICANT IS: ❑ OWNER
PROPERTY OWNER/ Nq�:��
TENANT pDDRESS: �o �
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
�
Permit No.:
Received By: I
Da�'�Q�a+� PR 2 4 20�i
A7'B'NnIZIP,
NAME: /�� O �
STATE i,ICENSE #�7b� Jk`!i ��P EXP DATE �— v�
ADDRESS:_�b �5 �1.� �1 L K- �A , CITY S � � STATE(1�ZIP � 50 �c)
PHONE % '7 �� � � yaa -g � � s FAX � 3o�d � 3 S� — y � 3 �
❑ SINGLE AMILY EW CONSTRUCTION SIZE
D TWO FAMILY/NEW CONSTRUCTION STORIES
❑ BASEMENT FINISH
O DECK
O MAINTENANCE/REPAIR
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
xvvr uru
NUMBER OF SQUARES �_�
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O Vinyl
❑ Aluminum
❑ Other .
" 0 SIDING
O SWIMMING POOL
O ADDITION
�$EMODELING
D�t� {�00 F
LENGTH
❑ HOUSE ONLY
❑ HOIJSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
OSoffit
❑ Trim
❑ Fascia
WINDOWS
M EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENRJG CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF�
0 DRAIN TILE
❑ OTHER
WIDTH HEIGHT
BASEMENT REMODELING SUBIvDT:
1. Existing Floor Plan
2. Proposed floor ptan
3. List of swctural members to be used
Ft.
FOR NEW CONSTRUCTION fNCLUDMG DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Siu Plan/Survey showing the exisdng swctures
and proposed project.
2. Two sets of construction pians
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
��� TOTAL JOB VALUATION $�,I'�(�1�97 U.B.0 FEE O CUPANCY TYPE
Permit Fee
PIan Review
Fire Surcharge
Swcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$5���� .
$
$ � `iC'i
$ % - ,?�S
$ S•C�O
$
$
$
$
$
See Back Page for Fee Schedule
65% of Buitding 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+6R= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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 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 work ich rev' and approval of plans.
SIGNATURE OF APPLICANT 7 PRINT NAME DAV lt� �/-/�9stil�'i-DATE �/ '� U' U%