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APPLICATION FUR R�SIDENTIAL, ALT�RATION,
OR AllllITION BUII.DING PERMIT
CITY OF FRIDLEY, AIINNESOTA
OWNER'S NAMC:__ S�2 G ��U fl Se BUILDER: /,J 0� � G/( /� E'� �`JZ,Q/� -s
ADDRESS: ADDRESS: ����5' �8N j1/JO%� ��
NO:.� STREET: C�M EG �7`
LOT: �3 BLOCK: � ADDITION:���/f/� G�j.'C ��Tif% ES
CORNER LOT: INSIDE LOT: � SETBACK: � S SIllEYARD: `�
Applicant attach to this form T\ao Certificates �f Su?-vev of Lot and proposed
building location drawn on these Certificates.
➢ESCRIPTION OF BUILDING
To Be Used As:
�E��'� � Eront : �% � De th : v2 .3i �
P .� Height • o� 6
Square Feet: /��0 �ubic Feet: �fQ p�wi 8
Yr''�i4�CE. �'-�-
Fxont: 02 � Depth• 1 2. lieight:` / �
Square Eeet; Jr� � Cubic Feet: ,�p2 80
1j�pe of Construction: �GE,QI'l1 � Estiznated Cost:�_
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To Be Completed: �b U��/S � �6 �� �p�
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The undersigned hereby ciakes applicatinn for a permit for the work herein
specified, agreeixig to do all work in stiict accordance with the City of
Fridley Ordinances and rulings of the Department of. Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE: I r �%"� b SIGNATURE:_��i6%�� �n'%�Z'4%�(�/��
(See Reverse Side For Additional Information.)
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BUILDING PEI2MIT FEE SC}IEllULE
SECTION 2. The Inspector of Buildings shall, befoxe 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 repairs to any exisentgb the
building or structure, upon application therefore, require the paym y
applicant for such permit of fees to the amount herein below set forth and in
the manner herein prwided to-wit:
UNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet� or iraction thereof, in such cubical contents. Type 3& 5-$1.85 fox
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined ty multiplying the ground area
covered from a point six (6) inches Uelow the floor line of the basement
or the cellar to the average heights of the upper surface or to the average.��
height of the roof surface of the main gable of a pitched roof.
For repzirs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case sha11 the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction wi11 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 Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occup3ed until a Certificate
of Occupancy has been issued.
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� City of Fridley
"T'"E'°`°°'"ETW'"5 gUILDING PERMIT
r �
� •
� � ____ COMMUNITY DEVEIOPMENT OW.
% � y PROTECTIVE INSPECTION SEL.
i '
i
i_---� �"'1�,; CITY HALL fRIDLE� SSC3t NUMBER nFv
i 612-571-3460
910-F15
ioe aoor+ess 1661 Camelot Lane NE
t LEGAI �07 NO. BLOCK TRACT ON ADDITION
DESCR. Z3 2 Harris Lake Estates
2 PROPERTYOWNEfi � MAILADORESS
Les Johnson
3 CONTRACTOR MAILAODRESS
D& D Home Imurovement Inc 7401 Central Ave N'
a ARCHITECTORDESIGNER MRILA�oacac
24651
RECEIPT NO.
✓/�4E Oi I qpPROVEO BY
10/11/9 / �
SEEATTACMED
SMEET
ZIP PMONE
Z�P PHONE LICENSE NO
ridlev MN 55432 784-7543 �
ZIP
IICENSE NO.
7 CLASSOFWORN
❑ NEW ❑ ADDITION O ALTERATION ❑ REPAIR O MOVE �❑ REMOVE
R
8 DESCRIBE WORK
Reroof House & GaraQe (24 Sq) Tear-off
9 CMANGE pF USE FqOM TQ
STIPULATIONS �
Underlayment must comply with the State Building Code.
SEPARATE PERMrtS ARE REQUIRED iOR ELEC7RICAL, VLUM8ING, MEATING, Tv�
VENTILATING OR AIR CONDITIONING. �
iHIS PERMIT BECOMES NULL AND VOID IF WORK OH CONSTRUCTION ZOI
AUTHpRIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUC710N
OR WONK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTEF WpRK IS COMMENCED.
NO
I HEFEBY CERTIFV TMAT I HAVE READ AND E%AMINEO THIS APP�ICATION
ANOKNOWTMESAMET08ETRUEANDCORHECT.A��GROVISIONSOFLAWS yq
AND ORpNANCES GOVERNING TNIS TVPE OF WORK WILL BE COMPLIED
WITH WNETHER SPECIFIED NEHEIN OR NOT. TNE GRANTING OF A PERMIT
DOES NOT PRESUME i0 GIVE AUTNORITV TO VIOLATE OR CANCEL TME pE
PROVI510 OF ANY OTHER STATE OH LOCAI LAW REGULATING CON-
STqUC N O THE 7ERF ANCE OF CONSTRUCTION. �
51 AipREOFCONiRPCiOROR1UiNOA4E01GENl �I/ I �� P`
1 STA�LS
LUATION
$1,980
PMIT FEE
$62.25
AN CMECK FEE ��
License SC $5.0(
HEN PNOOERIY V
� Pi/, .�
CU fT.
GARAGES
$.99
iACCMARGE
Fire SC $1.98
OTALFEE
$70.22
NEVv
ADDN
AI.TER
�l
[I
Il
ConstcuctionAddress:
L.eSal Description:
Owner Name & Address:
CiTY OF FRIDLEY
SINGLE FAMII,Y AND DUPLE7�,S R-1 AND R-2
Building Permit Application
Effective 3/1/96
���93�
._ Tel. # v�7� g �
Coatractor: D& D Home imnrovement Inc MNLICENSElf apan
Addt+ess: 7401 Central Ave NE Fridley, MN 55432 Tel.# 7g4=7 43
Attach to Uris application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVIIVG AREA:
GARAGE AREA:
DECB AREA;
OTAER:
�S�
I.ength
I.ength
DESCRIPTION OF II1SP'ROVEMENT
Width Height
Width Height
Width Hgt/Ground _
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [ j Inside Lot [] Ft. Yd Setback Side Yazd Setbacks
� of co��o�n:� �� ��a co�c: $ /9�30 `
Approx. Complet� Date: -g - Qy ' f�'dl,s�,c.ls�q,t,� a,4(�u.�i[c�
.(Coat on Back)
Driveway Curb Cut Width Needed: Ft. Ft — Ft x$ _$
DATE: APPLICANT: /�. �� Tel. # /���3
� Permit Fee
Fire Surcharge
sc�c� s�t�e
SAC Charge
License Succharge
Driveway Escrow
Erosion Contcol
I Park Fee
� Sewer Main Charge
TOTAL
� STTPULATIONS:
$ a5
$ /.9c�
$ ,9�
$
$ S-OD
$
$
S
$
$ D-�a
CITY USE ONLY
Fee Sc6edule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.sor$1,000 vatuation
$900 per 3AC Unit
$5.00 (State Licensed Residential Cotmactors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Nxassary [ ]
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CHIII�IIVEY AND STACB VERIFICATION
The undersigned hereby verifies thaC the ex� chmnneY or slack:
t
, i. Has. ti6en cazefnllY e� a-' Yes O No <)
;Y �
2. is fi�from rust.or d�eriadation _" Yes O: No O
3, Has no foreign objects lodged withm „ _ Y�s i, ) No O
4 Is securely suPPorted Yes O No O
5. Mcets all eurrent Code requiremeffis for size
-and total B'FU's!conn� Yes ( ) No ( )
6 Has total heating"BTU's of -
�kl other BTiJ's .
TOTAL BTL7's
7. Has a liner been provided for water heat� `' Xes O` No O
" •" - — �_::.,,..� �,_ n.a.o. �� Yes ( ) No ( ) . .
. . s "F... 3 . .;` ., ,
a. ,..., , .... .
r
{ '' � :.
Remarks: w; � }�;e ��,> _�
�
�
�
HEATING COr
Signed By:
Date_
�r
� ; �a �� �; : , � . tn �r :
. �; °
t
� j
� f
� � �
� � ��� �
f,; _
m�� I3one: `
:,:
� y; � � ,: �; ,,
.. . �~L.. 1 S ... 1 :Y .
8 ' �
� f .
!. . . � u.. . .
. ..�. �� '. . '� ' �� . '
, .. . . i .:... . ,. : . <i: � �.�� . . � .
n
C
' c�ty of Fr�a�,��
AT TNE TOP OF TME TWINS
,`
: �� ty������� CQMMUN�TY �DEVEl49��%�NI DIY.
� PROTECTIYE INSPECTION �6EC:
� �
� ` �"'� � CITY MALI FRIDI.EY �N�i
t.".�' '•� 612-571-3460
JOB ADOPESS 1661 Camelot I.ane NE
t �EGAI LOTNO. LOC1t . ..� TRMC1
oescn. 23 z
I OROOEWiY.OWNEN MAllA0W1@$�.
Les/Janet Johnson 1661 Camel
] CONTAACiOR MAILAODRE33�
Brunn Remodeling 1209 O1d Hwy $,
v �NCwnFr.rnwKeinuoa u�n �nneea .
6 USE Oi BUILDING
Residential
� � O NEW �1 AODITION
�8 DESCRIBEWpRK . . . . .
Construct a 31' x 8` House Additi
OF USE
�ueCi `� . . _ .. . . � � .
BUllpll�l� PERMIT
�72-3604
��EM � IIEV C1T4 I�GE O�
eiaF�s � 7/9/O1 / /
Harris Lake Estates
ot Lane NE
New Briehton, MN
i 96;
IPT NO.
SEEATTACMED
SMEEi
4016
O ALTERATION. ❑�� qEPA1R O MOVE � O REMOVE
an 8' x 8' Garage Addition; Replace windows
See notations on plan.
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform,Building Code. Caulk
and flash all exterior openings.
SEPARATE PERMRS
REQUIRED FOR:
PUIMB� NG6� AND SI6
WARNING
Before digg��9 call for
all utility locations
asa�0002
REQUIRED BY LAW
SEPARATE PERMIt3 ARE REOUIRED fOR ELECTFICA�, PWMB�NG. HEATIN6, � Tre �r uvns�. VccVP�
�� VENTIUTING OR AIR (70NqTWNIN�. � ' � ' � � � �
TNIS GEFMIT BECOMfS NULL AND VOID IP WQRK ON COHSTpUC�Tl0�1 20NIN6 � SO. FT
•UTMORIZED IS NOT COMMENCED WITHIN BO DAVS. OR li CON�TRUCTION �
OM WORK IS SUSPENpEO OF ABANQpNEO FON A PE91Q0 OF tYq OAYS Ai � �
ANY TIME AFTER WppN IS COMMENCED. ' NO: DWIG. UNITS
1 HEREBY CERTIfV TMAT I MAVE AEAD ANO E%AM�NED i1715 APPiIQA710N 1� $iA��S
ANO NNOW TNE SAME TO BE TAUE �NDCOPRECF. 1Ll PRpV191CNSOF �AW$ VALWTION � � �
�NO OROIN4NCE5 GOYENNING TNIS TYPE OF WOAK WI�E BE CpMG�IED
WITM WMETMER SVECIiIED MEaEIN OR NOT. TME GRANIING OF A VERMIT �4S�OOO
DOES N07 PRESUn�E TO GIVE �U7HONITV Tq viOL�TE Oa CAMCEL�TMk pERMi7FEE�. �
PAOVI$IONS Oi ANY 07MER $TATE ON LOWL L�W REGULATING CON- .
STRUCTION OR TNE PERFOpMANCE Of CONSTRUCTION $593.�.5 ��� �
� . . vt�NCw uc. � E .
. �_
y.22.S0
. SACCHppGE
F're SC $45.00
T �FEE
$665.75
1 D TNIS 1 VOUA PEAMIT
. � � �.
NEW '
ADDN
AITER
[1
�
Construction Address:
Legai Description: �
Effective 1/1/2001
CITY OF FRIDLEY (763) 5723604 Bldg Insp ��
SlNGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION � �
� �
� �. T G.¢.�L. �
i o7� E
L�
Owner Name & Address: �E 5¢��'�,.. �r iwso „� Tel. #
Contractor. j�'�Z:ati,,�� '��r,.,�,�ri,„ � MN UCENSE # yo/�
Address:/2o9 o/lJ/i.,.Y 8.c/rw.`$�5y,ro--��bn,c/ SS//� Tel_#�S/-/33—Szfs-8
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.
DESCRIPTION OF IMPROVEMENT
Length 3/ Width� Height�_ Sq. Ft. �y8
Length �_ Width 8� Height �9 c,�' Sq. Ft. G y
Length Width HgVGround Sq. Ft
�lL.v17o.✓ �r 7IWGYmr T / Sh` L Si2�� .
Cartstruction Type: ��h,rsq[_ Estimated Cost: $ y
��o�o, °=
Driveway Curb Cut Width Needed: _Ft + s Ft =_Ft x$ -
DATE: Sez3 o APPLICANT: jN�i G,Ly,n �S .}`� p4,,,,, , Tel. # Gs/ -G 3 3- Sycs'g
G�, � �_
CITY USE ONLY - Cail (763) 572-3604 for Pertnit Fees if mailing in application
Permit Fee
Fire Surcharge
5tate Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1150 per SAC Unit
$5.00 (State Licensed Residentiai Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Pian Review
$ Fee Determined by Engineering
$ Agreement Necessary ( J Mot Necessary [ j
$_�1a�15
BUII.DING PERMPr FEE SCHEDULE
The Chief Building Official shall, before issuing pernuts for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alterarion 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,OOlto $50,000
$50,001 to $100,000
$100,001to $SQ0,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each addidonal $100 or
fraction ihereof, to and including $2,000
$69.25 for first $2,000 pius $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 &action 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 addirional
$1,000 or fraction thereof, to and it�luding $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fracuon 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 fracuon thereof _
DRIVEWAYDEPRESSION ESCROW
(Concrete C�rb 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 instali a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet tunes $23.25.
VERIFICATION OF FOUNDATION
Pernuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed strucnue 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
,
.
_— ---- -- ,
lewd 11ano:ny �j,�'�, L"�I —"
LMN FrwruM Vs I• �� (
i�U� LNiw� \ I I ���������1 �f ���� •%�f �
Ciril �w�1n��einq Y
��`�~�.�"�""••'"9 Engineerr &
Surveyora
Mortgage Loan
6!)S Miyhwoy Ne.63 N.(,
Minn�rp�li� �
M.nn l3�31
I�I�y1qn• )�1.6W6
•r�a Csde 671
$urvey tor BQ�GKNEQ Bui�o��g
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NOI1V�Idia3A 211V NOI1Sf18W0� aNV 2101�3NN0� 1N3A 1N3/� NOWWO�
. . _:�� . -:� �� suucti... � , . ... . P
� City of Fridley /��) //A 3 2 0 8 6
ATTNEfOPOFTNETIH�NS��� �u�Ll./I�'1yR�PERMIT
� •
� � 572-3604 �/pao
� � �QMMUPI�TY� OEYELORIII(NT DIY.
� � � �� Gi1pTECTIVE�INSPECTIQN SEC.
� � �
�
� � �'�9 . CITY MALL FRIDLE� SS��i MYY�ER �FV O�Ti � v�C.E 0� �IVPOVEO �Y �
�.._.� � '•' 612-57�-3450 a�aF�a 8/16/01 / /
lOB ADORESS 1661 Camelot Lane: NE � - �
1 LEGAL �OT NO. � � BLOCK ��� tRAC OR ADDITION � SEE ATTALNED
oescn. 23 2 Harris Lake Estates s�EE*
t PROPERTYOWNEM MM��QDpES� � 21P 7MONE
Lea Johnson 1661 Camelot L'ane NE
] CONTNACTOR MAIL ADORES$ LP PNONE LICENSE NO
Brunn Remodeling 1209 Old Hwy 8, New Bri hton, MN 55112 651-633-5819
� ARCNRECT OR DESIGNER � MAIL ADDRES - ' Z�P � PMONE LICENSE NO.
4016
5 ENGINEER MAIIADORES9 � 21P PNONE LICENSENO
6 USEOFBUIlDIN4 - �
Residential
7 CIASSO:WORK � � ` � �
O NEW O ADDITIGN ❑ AL7ERATIQN � � f�l � REPAIR ❑ MOVE �� � REMOVE
8� OESCR18E WONK � , . � . . .
Reside House & Garage
:, ''# sCNANOE OF USE FROM � T�
STIPULATIONS .
Per Section 1402, 1997 Unifoxm Building Code, requirea that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. ninyl siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Call for inspection of wrap
before covering.
� - � � � � - T1IP ��O CO T. OCCUPANCYGRWP OCCUPANCV LOAD
SEPAHATE PEFMITS APE HEOU�NED FpR EIECTRICAL, PIUMBING. NEATIN6.
VENTI�ATING ON Alp OONDITIONING. ' � �
THIS PERMIT BECOMES NULI �Np VOIO IF WONK OH CONSiPUGT10N pONIN6 � SO. FT CU FT.
AUTHORIjED IS NOT COMMENCEO Y�!ITMIN 80 OAVS. OF IF CONSiRUCTION �+� .
OR WORK IS SUSPENDED OR ABAN�ONQD FOp A VERIQG �F 1iQ OAYS A7 -
�NY TIME AFTEN WORN IS COMMENCEO. ' � NO. OW�G. UNITS OFF57REET GAqNING
I MEREB� CERTIFY TMAT I NA4E REAO AND EXAM�NED TJ/15 AOP�,ICA7ION 1� ST�lLS GARAGES
ANO KNOW TNE SAME TO BE iAUE ANO COPpEC7. ALl PROVISIQN$ OF LMWS �yA�UATION � � � SURTAX
ANp OADINANCES GOVERNING TMIS TYVE QF WORK WQL Q� CpMG�iED @ @
WITH WMETMER SPEC�fIED NEREIN ON NOT. TME 6RANTLNG OF 11 PEAMIT W9�OOO � '� y��F�.SO
DOES NOT PRESUME TO GtVE AUTMORITY TO VIO��TE ON CANCEI 7Hf pEpMITFEE� S�CCM�RGE
PAOVISIONS OF I,NY OTMEA StATE OR LOC�L LAW qQGUI�TING CON- @ @
STR{JpTION OP TNE VEAFppMANCE OF CONSTAtlCT10N W167.?S .�� �ElY' C y�9.00
G�ANCMECKfE£ � TOT FEE
� "� � � G o / License $5.00 185.75
Si � EO CON'PICTOAOa�U*�OA�ZED�GEN� •�L N yq�lp TMI$ I�l��'I��
$rGN�TpqEOiOWNEP�6QWMfPBU1tQER� i 11f� � �450'. ' . . � pLif
NEW (�
ADDN []
ALTER [ ]
Construction Addre
Legal Description:
Owner Name & Adaress: i r� Tok,,,�e," Tel.
Contractor.
Effecdve 1l1/2001
• CITY OF FRIDLEY (763) 572�B04 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
LNING AREA:
GARAGE kREA:
DECK AREA:
OTHER:
MN LICENSE # No/ (o
# �S�- 633^ J�,rS8
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length �_ Width HgUGround Sq. Ft.
Construction Type: �'t.+l:.lL Estimated Cost: $ 9, snc
Driveway Curb Cut Width Needed: _Ft. + 6 Ft =_Ft x$ -
DATE: � L• APPLICANT: � � Tel. #_ G/2 -3G6 ^ S8J 9
CITY USE ONLY - Call (763) 572-3604 for Pertnit Fees if mailing in application
Permit Fee $ �S Fee Schedule on Reverse Side
Fire Surcharge $ -Ob .001 of Permit Valuation (1/10th%)
State Surcharge $_ y S O $.50/$1,000 Valuation
SAC Charge $ $1150 per SAC Unit
License Surcharge $ �• 0 0 $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ AR. "A" or Aft. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary [ J
TOTAL
STIPULATIONS:
$��S`
BUII.DING PERMIT FEE
The Chief Building Official shall, before issuing permits for the erecdon of any building or stcucture, or for any
addifion to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon applicarion therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein pmvided to;wit •�-""'A' •
$1
$501
TOTAL VALUE
FEES . . . . .
to $500: . , $23.50 ..
. .. . �; .
. , . ; ". .
. to $2,000 $23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000
$25,OOlto $50,000
$69.25 for first $2,000 plus $14.00 for each additionai $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,Q00 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000 $643.75 for first $50,000 plus $7.00 for e2ct19dditional
$1,000 or fraction thereof, to and including $100,000
m
$100,001 to $500,000
, ,+ a� . ', e�� e��
$1,000,001 and up
$993.75 for first $100,000 plus $5.60 for each addiuonal
$1,000 or fraction thereof, to and inciuding $500>000
$3,233.75 for the fust $500;0130.-plus $4.75 for each additionai �`'
$1,000 or fraction thereof, td and including $1,000,000 �
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fracuon thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "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 $23.25.
VERIFICATION OF FOUNDATION
Pemuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
c...�
���. �.. . ..
c;ty of Fr,at�y
AT TME TOP OF iME TWiXS �
;�
; � COMMUNITY OEVE�OPMENT OW.
/ - j y ������ PAOTECTIVE �INSPECTIqN SEC..
i �
l.- .� �""�., GTV NALI FNIOIEY �SS�32
i 612-571-3450
JOB ADORESS 1661 Camelot Lane NE
1 LEGAL LOTNO. . BLOCK � TRAC1
BUILDi�� ��E�v11T
_
�OF� �EV 0�1R ' V�GE OF
9to-fts 4/28/O1 / /
�S�p 23 2 Aarris Lake Estates
t GROpERtYpWNEN MAILAqpRES$�
Les/Janet 3ohnaon 1661 Camelot Lane NE
Same
i ct11350f WORK �
� 8 �� DESGRIBE WORN�
MN'OE pF USE
32205
NO.
SEEATTACMEO
8NEE7
763-574-9287
NO
O NEW �7 ADDITION O ALTERATION ❑� REPAIR ❑ MOVE O REMOVE
a 28' x 25' Deck
See notations on plan.
SEPARATE PERMITS
REQUlRED FOR;
P MBI� �D �
WARNING
$eforo digging ca�� for
all udiity locations
454-OQ02
REQUIRED BY Lqyy
SEPARpTE PEflM1T5 ApE REOUIRED fpq EIECTRICAL, PLUMB�NCw, MEATING. �pEOF CQN T
VENTILATING OR AIR CONqT10NING. � ' . � �
iMIS AERA4lT� -BECOMES NUII 4N0 VOID IF WQNN OA CQN$TRUCTiON 20NING
AUTHORIZEQ�d$ NOT COMMENCED Yt(ITMIN.80 DAY9. OR IF CONSTqUCTION �
OR WOaK 15 SUSPENOEO OR ABANDONEO FOR A PEAIOD �f 12p DAVS AT ��
ANY TiME AFT�R WpRK IS COMMENCED. � NO. � OWLG. UNI
� NEREBV CERTIFV� iNAT I MAVE NEAD ANO EXAM�NEO TM16� APP�ICATION 1
•NOKNQWTMfiSAME�OBETRUEANDCOFRECT.4��PqpWS�ONSpF�►W$ yA�UATION
AND ONDINANCES GOVEPNING iN15 TYPE OF WqpK WILL� BE COMiUED @
WITM WMETNER SPECIFIEO NEREIN OR NOT. TNE GRANTIN6 OF A PERMIT Y'4, 246 �
OOES NOT CqESUME TO GIVE AUTMORITY TO V10lATE OR CANCEL TME PEAMI�iEE �
GROVISIONS OF ANY OTMEP ST�TE OA LOCAI L4W FECUUTIN6 CON�
STpVCT�pN OF;TNE VERFOFMANCf OF CONSTRUCTION . �1I.1.2S ,�
��
•GENr ��D�fE�
d
STAL�S
` $2.12
SACCM�R E
Fire SC $4.25
TO7 FEE
�17.62
IOAD
NtW
ADDN
ALTER
I1
I1
I�1'
Construction Address:
Legal Description: _
CITY OF FRIDLEY E���e ��1n001
SINGLE FAMILY AND DUPLEXEg R.1 qND R-2 ���� �Z�g� B�dg �nsP
BU�LDING PERMITAPPLICATION
Owrter Name & Address: �(Ec �- J�Gr �,k,vs�u� j/,({e�a�r /L.f A
Te�. #�(, 3- S 7Y- 92 �P' �
Contractor. _ ('� iJ � MN LICENSE #
Address:
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.
, DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft.
Length '2 8� Width � HgUGround %� Sq. Ft. _�$6
�
Construction Type: TE�_ Estimated Cost: $
�nrr,sr � �ECk ��vG—
Driveway CurB Cut Width Needed: _Ft. + 6 Ft =_Ft x$ -
DATE: ��L2' /Q j APPLICANT: _ � E'S � CJ�JN,itl,S �N Tel. # 7(�3 �J 77 `/ �7
_%'�
CITY USE ONLY - Call (763) 5723604 for Pertnit Fees 'rf mailing in application
Permit Fee $ //� ,� Fee Schedule on Reverse Side
Fire Surcharge $� .� ,001 of Permit Valuation (1/10th°/a)
StateSurcharge $_ �,/Y $.50/$1,000Valuation
SAC Charge $ $1150 er SAC Unit
License Surcharge $ � p
�$5.00 (State Licensed Residential Contractors}
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ j Not Necessary [ j
TOTAL
STIPULATIONS:
$ //?• GY
BUII.DING PERNIIT FEE SCHEDULE
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 alteradon or repair to any existing building or structure,
upon applicarion therefore, require the payment by the applicant for such pernut 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
$SO,OOIto $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 pius $3.05 for each additional $100 or
fracrion 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 $500,000
$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 fust $1,000,000 plus $3
$1,000 or fraction thereof
DRNEWAY DEPRESSION FSCROV4�"
(Concrete Ctiu�b Streets Only)
15 for each additional
Aiternate "A": Removai and replacement of curb and gutter only -Drivevoag wi�th 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 FOUNDA7'ION
Pernuts for construction will be issued a minnnum of 24 hours from the time of applica6on to allow for proper
review of the proposed structure and of the construction site. '
A Certificate of Survey of the lot, showing the locaaon of the foundadon once it has it has been constructed wIll
be required before proceeding with the framing. New Houses Onlv
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Building
Ins�p�cfions
763-572=3604
0
S1TE ADDR£SS �
rx�s nrrucaaar �s:
PROPERTY OWNER/
TENANT
BUILDING
RESIDENTIAL APPLICATI4N
■ • � ,
3—
SUBMTf A COPY OF STnTE
YOUR STATE LICENSE ADDRI
WiTH APPLfCATlON n„�,.R
❑ BASEMQJ'f FINISH
❑ DECK
DESCAIBE WORKBEING
[.yr�x.�a
a.
•�•�w
•.a•a:ydc i
StQaIG
o v��
o Alwnimun -
O qha .
OF FRIDLEY
YOUR E-MAIL ADDRESS
Received By:,
Date Rec
��"7 EXPDATE J"�// �ZC/�/d
� � �✓ c�rv �clbve.�
FAX
'�7RU(,'110N SIZB �
.UCf10N STORIES
OGARAGFJSHED OWINDOWS
❑ ROOF 0 DRAIN TILE �
0 S[DING O4h�R
❑ SWIMA4P]G POOL
❑ ADDITION
❑ REMODELQJG � _/ _
) Coc,�GS f3� ,�fjC�l4��'lL 1�GlGY�°/r?�"�
I.RNGTH WIDTH HEIGHT
O HOUSE k GARAGE
❑ ATCACF�D GARAGE
❑ DECACHED GARAGE
os�rc
O Trim
O Faacia
wwnows
1N EXIS7'ING OPENINGS OYa ONo LOCA170N OF R7NDOWS
OR FOR NEW OPENQda&DESCRIBE SIZE OF
OPENAIG CHAN(iES Be
BASEMENT REMODELING StIBA9T:
l. Existing Floor Plan
2. Propased �ow pian
3. List of strucwral manbers ro be used
Ft.
FOR NEW CONSIRUCTtON INCLUDRJG D�,CKS,
ADDI7YONS. & PORCHES SUBMIT:
I. Siu PladSurvty sirowing ihe acisting structures
and proposed project
2. Txro uu of conshuaion plans
3. �gy c�wi�o� ,
Ai•i. FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License S�ucherge
SAC Charge
C�ub Cut Escrow
Erosion Control
Park Fce
Sewer Main Charge
Totsl Due
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
S1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftxS21=$
5450 Conservazion Plan Review
Fee Detennined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attac
TH[S 4S AN APPLICATION FOR A PERMIT-NOT VAL[D UNTIL PROCESSED
I heceby appiy for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
�nformance with the ord'mances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understaod this is not a
permit 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 approved
plan in the casc of a1( work which r�qu'ves roview and approval of plans. c
SIGNATUREOFAPPLICANT �%'"""'���~— PRMTNAME�/�� J�"'•�h DATE � /���
Page 2- Building Residential Application
BUII.DING PERMIT FEE SCHEDULE
The Chief Btrilding Official shall, before issuing pemufs for the erection of any building or
structure, or for any addition to any existing building or strvcture, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payment by the
applicant for such pernut of fees to the amount herein below set forth and in the manner herein
provided to-wit:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
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
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
/
r
: ~ �� �� �° � � ✓
s �
��8���,� Proposal
_ Specifications and Estimaze
4179 - 149Eh Ave. N.W. • Andover, MN 55304 • Phone: 763-42T-3332
Les 8c Jan Johnson
1661 Ca�elot Lane NE
Fridtey, MN 55432
Mu+ch 19, 2007
(fi) 763-574-9287
We hereby propose to fumish
materials and labor necessary to: R�p�e �t p,� �� 6� of b�ickwork; remove
linei; rebuild 5 courses of lxick (best mateh), i�ll and ins�ilate Ve�inox stainless steel lwer (U.L.�'Lsrod with tile
manufacturar's lifetime limited warrantY), F,rovide concreoe crown with overheng and drip ledge as outlined in article
•�Tops to Lart a L�time" by Jack Pixley.
Incledes:
✓ Home imterior, Sroimd 8c raof protoction
✓ Scaffold setup & removat
✓ Equipmant setup
'� Conorde wash, brick 8c tile brealcout
✓ qccess iuW chimney
`� Csay debris to �siler
✓ In.�tall stainless stcel liner 8c insulate
� Gi�t & rado �v to chimney
'� Rebrick top of chimney
� Concreto crown at top
✓ C���Pment Dear-down & removal
P
✓ Landfill, h�avel, unlosd
✓ Remove fotms
✓ Tax
✓ Buildin8 P�mit & inspection
TOTAL: S 6,039.�0
Optwn' Reuove brkkwork fros rootliee rP. reMild hoe roof ap aod pov crowe ... additio�al S1,90Q00.
Plase note: At oompk4ioo ot job, dedaet tre ST9 servtoe ca0 S'oo tbie propoapl, dscic P�ky 3woeps Ina job invoke
#516�0.
PLEASE NOTE: /f du'ing breakout, we find ¢ code violation ... we reserve the option to stop the job; show owner and/or consult with tke building
inspector. The extrn repairs necessary may result in an odtled price for the job. �
INE PROPO�E hereby to furnish material and labor - comptete in accordance with above specification,
for the sum of:
dollars ($_
pAY�'r'ro eE Mana ns Fo�,r.ows: lORb at acceptance and remainder at completion of job
a� mi� Is —
ro��W �bheacE� .aNakto6ecpnpMMONawla6�YYYaWmila�mierazcwtliip � �
DN D�.Ny0lMOtionarEeWtlonfiama0alespedfi�nsiWaMnpe�roa ��
am wu he mmam0 onN uoan wpbn atlers. aM wx Orme en m� anrye orermtl ahwe tle �tMnue. NI
a0�swntlnpn�uO�slriWS.aml7mbaEMrysAeYpqaxmmalOwerNanY�0.bmt0o.atloMw �
�neryN�w�uwro.0uwdueueNAY��a�eOMWabnenBCa�peneauonlmmanra. �
ACCEPTpNCE OF PROPOSAL '[he elwve prices, specificationy and
cwdirions aze satisfactay aod are heneby accepted. You aie authorized to do
the work as spe,ci6ed. Payment will be made as wtlined sbove. siqmvexre
DauafAttepm�xe: �} / � � /� � �
���
�t ae�bl wIbIIR
�, � :. / /
Building
Inspections
763-572-3604
S1TE ADDRESS _�
TH[S APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOURSTATE
LICENSE WITH
APPLICATION
PERMIT TYPE
TYPE OF WORK:
PLUMBING
RESIDENTIAL APPLICATION
_ CITY OF FRIDLEY
YOUR
�OWNER �CON7'RAC7'OR
Received By:
S7ATELICENSB# EXP DATE
ADDRESS: CITY STATE ZIP
PHONE _ gp}� �
OYSINGLE FAMQ,Y
❑ NEW
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY � i] TOWNHOUSE
6{REPLACEMENT �� �
168.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to 5500.00, whichever is greater, for [he
ient, installation or replacement of a residential fixture, eaccluding the fixtures. (This should reflect only the cos[ of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON 510.00 PER FIXTURE, EXCEM WIiERE NOTED. FIXTURES: (A1D[CATE TOTAL
NUMBER OF EACH BELO� � �
_ BATH SINK/LAV � FLOOR DRAINS ...�-�- - SHOWER WA'CER PIPING
—gATHTUB GASPIPING/rve5ucmucE,vse) . . —SWQvIMINGPOOL WATERSOPI'NER($35)
_CLOTHESWASHER KTTCHENSINK �IVATER�CLOSE7 BACKFLOWPREV.($IS)
_ DISHWASHER _ LAUNDRY 1RAy WpTER HEATER ($35) FOR IRRIGATION
_ WATER biETER OPHER
Fee
Number of fixtures @ $10.00 x $10.00 = $
Number of fixtures @ $15.00 x $15.00 = $
"Dlumber of fixtures @ $35.00 x $35.00 = $
; � State Surchazge = $ .50
THIS IS AN APPLICATION FOR A PBRMIT-NO'1' VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclaowledge that the� iqformation above is wmplete and accurate; that the work will be in
conforniance 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 pemtit and work is not �to start without�� apermit; that the work will be in accordance with the
approved plan in the case of all work w�ch rec�,�uire�eview and approval� Of plans.
N
SIGNATORE OF APPLICANT
�
City of Fridley `'-
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-49771
7