AF - 36854�
sue�ecr RMIT NO.
City of Fridley � 13'783 '
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
, � ECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
r i L � PROTEC7IVE INSPECTION SEC. �� � ��
I �
�` � /'��1 � CITY HALL FRIDLEV SS432 NUMBER REV. DATE PAGE OF APPROVED BY
""•'�' ,'� 612-560-3450
910-F15 9/28/76 � �
JOB ADDRESS 16.41 Camelot Lane N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 21 2 Harris Lake Estates SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Brickner Builders, Inc. 6245 Ben More Drive N.E., Fridley 574-9871
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK RNIAt
Construct a 52' x 26' Dwelling and a 22' x 24' Garage
�ng cali focaf util
SL�pERATE PERMITS REQUIRED ` F.�t WtRiNG, tELEPHO;�F - Et r AS
9 CHANGE OF USE FROM �.n� p��Mg�NG AN� t� REQU�RED B
STIPULATIONS provide truss design. Soil borings and compaction tests will be
required. Provide a hard surface driveway. Provide a verifying survey
before capping. Provide sod in the front and side yards.
SEWER LOCATION (Approx. 9' Deep) 38' West of Manhole (Inv. 879.00)
WYE ELEV: 878.85
TOP OF FOOTING: 882.35 Minimum
WATER LOCATION: 11' East of Sewer Service
� � Q� � � � �,�,� � --IMPORTANT—
ACCtlRAtY OF U'TILI11f LOCATICNS AND FLEYATtC �. NOTIFY THE FRIDLEY ENG ,
T;i►5 DATA IS FOR INFORMATION PUF.POSES O�lr.l•r•. • OIVI510N REGARDING CUR
�ERSt�NS USING R SNOUlO VEtiifY jME kIFORMATION REMOVAL AND REPLACEME T
ON 1ME 51te AT DRIVGWAY OP6NINGS,
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCl FYc1Iil@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 DAYS AT R-1 1352 +�JZH 29, 728 Total
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF L.AWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPEC�FIED HEREIN OR NOT. THE GRANTING OF A PERMIT $54, 355 S27 •18
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE LOCAL LAW REGULATING CON-
STRUCTION O ERFORMANC OF ,ONSTRUCTION. $�.�.H.91 $350.00
PLAN CHECKFEE TOTALFEE
� ���`� ,�W2� . �
�, �' `. �� $29.73 $525.82
GNATUREOFCONTRACTOFlORAUTHORI2EDAGEN7 IDATEI WHEN PR PEFLY VALILIATED THIS IS YpUR PERMIT
6 � 1 c�� 9 �� -7l0
SiGNATUREOFOWNEfi11FOWNER8UIl0ER1 IDATEI BLDG iNSP ��ATE �
ities
Et�.
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APPLTCATIQP! F��R RESl.ULN�fIAL ALTERATION,
A�GITIOf�, Of: F<Ei'/1Tk F3l.lIi_CI�;G �'Ei:MIT
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NO : . /�� �I _ S T3t�ET : �r � /)1 ��G� ! � 1-i ��'��c�. .. /v � � = —_
�'�' l�° �
LOT : �. f BLGCK.: �' ADDITIOP� : �?`,�F����T +'" "'` ��"�.
CORNEl: LOT : T_NS 1DF LOT : '� SETrA�K : f � S'� DEYARL : � � � � �
Applicant att.ach to tl�is f.orni 'i�re Cer.tificat�s of Suz��eY of Lot and proposec�
building locatzon drawn on tl-�ese.�C�.rtificates. ^
vESCRIPTION OF BUILDI\G
T� e Used As:
,� - - a �� �
_____� _�._�___.Front.��_�� Depth:�_ � � � Heigl�t:__�_.____._
Sqtiare F�et ; ��.�Z- C��bic Feet :�?.�y�
� -�-- --
Fror;.t ;_ � �° �Depi.h :���_�Height :___ � v
Squaxe Feet ;_��-'- � _ Cubic ii eet :��� �'' � ____
T}*pe of Construction: ��0 �.Estimated Cost:�����7`�'_�-� ,,"�
To Be Completed: ��
T.he underszgn.ed hereby makes applica*inn for a pei�nti* for the �vork herein
specified, agreeing to do al.l �oorlc in stxict accordanc.e �•aii.li t��e City of
�'ridley Ordinances and rulings of t11e P,e}>aitmeni: ot L'riilciinL;s, and here�y
decla.rc.s that all ihe facts and repxesertat.iaas stat:ed i1.i tl�is applic��ti.on
a.re L-zue and coxruct. �,
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pA:iI� : � � � _ S It,NA'i'[JRr : .��' � '�-':d� � � �7�'` .�''��...,�.-��_`'�--'
(See 3:evers� Si<le r'or Additional Information. )
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BIIILI)ING I'ERMIT PE� �C!IEllULI;
SECTION 2. The InsPecLor of Buildings shall, before issuing permits for the
erection of any building or structure, dx for any uddi_tion to any existinb
Uuilding or structure, or far any alteration or. repairs to any existing
building or structure, upon application there�ore, rec�uir� the payment by the
applicant for ,such permit ot fees to the amount herein below set forth and in
the manner herein provided to-���it :
NEW CONSTRUC�,'ION: Sa,n.g�,e Fanlil.y Homes and Garages: $4.00/1000 cubic feet
PLAN CHECK: 25 percent of building permit fee.
ADDITIONAL INFORTIATION
Fox the purpose of computing fees for building permits, the cubical contents
of_ any bu�lding or addition, is determined Uy multi.plying the ground area
covel_ed ixom a point six (6) inch.es i�elow the f_loor line of the basement
ox the cellar to the a��erage heights of the upper surface or to the average
iieigr�t of the roof surface of the main gable of a pitched roof.
I'or repai.rs or alterations to an existing structure, the fee shall be at the
rai.e of $3.U0 per each five hundred doilars (Y500.OG) or fraction thereof in
the cost o�` all propos�;d worlc. .
T.n no c�.se shall tlze fae chalged for. any permit as set forth in Sectzon 2 be
less than $�.50.
V�RIFICATION OF FOU\'DATIOV
NOTE; Permits for construction will be issued a mininium of 24 hours from the
time oi applicati.on, to allow for proper review of the proposed structure and
of the construct.ion site.
A Certified Survey of the lot, showing the location of the foundation, once it
has Ueen. co�zstructed, �oill be requixed betore proceeding witll tiie framing.
CEP.TII�IC�1'TE OI' OCCUPAI�'C1'
Applic�ition for a Certiiicate of Occupancy shall be mucle ten (10) days prior
to th.e use or occupancy of any structure :Eor which a building permit has been
issued; a.nd sai.d s*rtictt.tre shall not be used or occupied unti]. a Certi.ficate.
oi Occupancy has Uecn issued.
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EXTERIOR Et1VELOPE AV�RAGE "U" COMPUTATION
Page 1 of 4
OWNER: DATE / �' �� � L
S ITE ADDRES S : ����`�� f :�� ,,,e,� �:d, s� � ��s�:,�2..-0`���� . � ! ". ` :. c... PHONE : � ��.< � �i_ i l
CONTRACTOR: �<>: �.,�,,�..�� ,� u,.,� '� � � ' �,, y'" -�t'�, - ` � .
Determine working square footage of each
�,/� �� �
1. Total exposed wall area...... +� � 2• sq. ft. x .17 = �' ,
2. Toal roof/ceiling area ...... �� sq. ft. x
Total exposed wall area above floor =
.OS = ��''G
a. Total wall window area ...............................:�
b. To�al door area .....................................
c. Tota� sliding glass door area .........................
d. Total fireplace wall area .............................
e. Total wall framing area {average 10�) ..................
f. Total rim joist area ..................................
g. wall area above floor ..........................
h. wall area above floor ..........................
i. wall area above floor ..........................
j, wall area above floor ..........................
� Total exposed foundation area = � � �
___._. _, .._...._. . �
— -�,
�I•3✓ - r
[/
, a.
_.�._�
`�7• I"?
k. Total foundation window area ........................... �
1. Total net foundation area above grade .................
Determine "iJ" value of each wall segment
(e.g. window, door, each separate wall section)
a. ��/.. 3 ti X��U�� ', f S' = 0 3. 1,1/
b. � � � b X ��U�� � • s � _ ��-,��`. a�
c. ` �, i' `` g ��U�� / ' .S� �'� _ S� • ti �
d. �� X nUn �� 1" � = Q� v
� � . 1 � _ `� . 3 �
e. � ��i' g ��U�� _ � 3 �
;
'
f . �-3 � x „�,. . ��a �, _ � . � ;
,—; � t
� 7 ( �/
g• � �. 4 �°� . _
�. �.. X ��U�� ,
i�
X "�JJ" _
i. X "U" _
� . X ��U�� _
`� � �� �
k. X "U" • _
� l. � X �,U,� • � � _
r —
3 . .............................�Total =
� �.v
3��y�"
3 � - s��
�
r
If item #3 is the same as,
or less than item #l, you
have met the intent of
SBC 6006 (c) 2. -
�Scterior Envelope Average "U" Computation
Total exposed roof/ceiling area = �� L` �r
Page 2 of 4
m. Total skylight area ............................
n. Total roof/ceiling framing area (average 10$)...
oe Total net insulated roof/ceiling area........... `
Determine "U" value for each roof/ceiling segment �
m. X "U" _
n. X "U" _
"�
o. � � � � x ��U�� , � L = � � • � �
4....� .. . . . . . . .. . . ... ... .. . .. Total = �% • q �''� �.
;
If total of #4 is the same as, or less than #2, you have met the intent of
SBC 6006 (c) 1.
Alternate Building Envelope Design
To utilize the total er_velope slstem method, the values established by the sum of
items #3 and #� shal.l not be greater than tne suin o� items #1 a��d �2.
1. . ./ � �J • � + 2. � Z� , _� �`r� r � ta
.. 3 : ,3 6 � . 3 % + 4 . �� ' 7r' Z— _ _ �� , [� S �--,�
• WALL SECTIONS
NOTE: Use 10� of opaque wall area for
' frame construction
�1G. #3
_..__ 1 � ~ .O ` � L.�...,_,_
. ' � d, - • . ` , cs- '
• • �
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Page 3 of 4
Construction R-Value
1. Interior air film 0.68
� 2. Yv �.
3. � �''v S f✓b � 3g'
4 . �'L�" /�l�<i i��'d `t �c. I � � � —
5 . '',/� � �,;�, � rt N °Z.. � � ° 7
6. Extermr air film 0.17
Total .,_�` •��
1, Interior air film 0.68
2 . ,���: � �.� �, .,: � _
3 . '�, � ;� -. � l�/ �, :.r L,�� /9
4 . `.'-� ° ' N � ! �„ r'�� s -� �
s . 'I/e t � I�''�°.�� r'`� "' �- �a � �
6. Exterior air film 0.17
Total / I,I �� � , b�
1, Interior air film 0.68
'' ' r� s�-� c,�. . � r
2 . � 1.
3 . ► ;, � � �� 1i►,� 1 �- � q
� . ��L � !� 1� -�- l � 1 `�
s. ��f ,, r: � r <� � �� r-.�. �?- � 1
6. Exterior air f ilm 0.17
Total � S , _, , b �
1. Interior air film 0.68
2.
3 . ^' `� �� � � ��� � �•'L �
4.
5.
6. Exterior air film 0.17 .��
Zbtal �„.r3"
� � � • � `• � ' a
S�R= �T'-F� X . •; , '� _ . 6 — ; � t,
Il � �-= , , . ' � .
/� � V . � • � / —,
( b . / � � �
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-- /(/
FIG. �4 = ' � ' ` :. i�r
�. / ( ( t� � ' � C> �
. �} ` �iii�
r •
� �ci ' x x � �(/
• Il ( _ !r r _ r�r r -
NOT1s: Indicate type, "R" value, depth and
placeMent of insiilation. '
r��
��
• V"�ITT
Vented
ROOF/CEILING
� ��r--��� I►
v '
/? �i I ►
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:.� � -------r
: ���
�:,,��" z �- �
i3eat flow
up .
FIG. #;5 �
?ta��l;s.• �u-_%�e�_'�_^��;:i_>>'�'<'_ ��sc.l^.�-G��G1
- - - -- �
`�J `�.l `��� `�lJ �
� Heat floc•� up . , •�ventede
. . :
- -FIr,. #6 � . .. . . � . - . :
• i v ---- — �{ : � i v
1�
' rcu.�:—vi:tr•l�u
• � • � �{eilt ` �. ' ,
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Page 4 of 4
Construction R-Value
1. Interior air film 0.61
�� i2 . ��y s - 2- . `i
3. i D'' � iJ S V L %'�� 1�. t�' �L'L'''
4. Exterior air film (still) 0.61
' Total �� y, ; �p�
1: Interior air film
2.
3.
4. Exterior air film (still)
To tal
1. Inside air film
3.
4.
5. Outside air film
0.61
0.61
0.61
0.17
Total
Note: Use additional sheets if more space is
needed for details and calculations
0
�f�
� uBURBaN
�j� NQINEERIN�
�� � Nc.
� � Civil, Municipal & Environmental Engineering
� Land Surueying • Land Planning • Soil Testing
/iu6erl hliiidvr, l�cg. Enq.
Wrn. E. -Jenserz. /leg. F'ng.
Mr. Dave Harris
6279 University Avenue NE
Fridley, Minnesota 55432
Re: Lot 21 Block 2
Harris Lake Estates
Dear Dave:
V
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Main Office 571•6066
6875 Highway No. 65 N. E.
Minneapolis, Minnesota 55432
South Office 890-6510
1101 Cliff Road
Burnsville, Minnesota 55337
October 15, 1976
/(G � / �� .
I �r ,�
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At the request of Jerry Belair, on October 5, 1976,
we examined the excavation on the above subject lot. Several
hand auger probes, to a depth of 3 feet, indicated all peat
and muck had been removed and the lot could be backfilled.
After backfilling on October 11, 1976, we ran two density
tests at footing grade. The tes.ts passed at 1.04�.and 106%
of modified Proctor density with 90� being the minimum acceptable.
Based on the above, it is our opinion that the foundation
material is satisfactory to support a typical single family
framed dwelling.
If you should have any questions, please call at your
convenience.
PJM/jp
cc: City of Fridley (Darrel Clark)
Jerry Belair
E. A. Rath6un. Reg. Suru.
Wm. K. Meyer, Xeg. Eng.
Sincerely,
SUBURBAN ENGINEERING, INC.
"e� i��✓ /��.-��
Peter J. Molinaro
Project Engineer
Wm. E. Price, Reg. Eng.
f[. WilLiam [togere, lieg. Saru.
Cary �{, i(arrta, Reg. Suru.
Ci1Y �!f" f-K11'LC��'..
aPPLICATION FOR PUJ'��•I�G A;JD �AS FITTI�G °�N�"IT
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::�te: So`t_r.er x $7. �0
.._•.+ G:o::= c?_:: O�Z B::ilding x 55.0�
__ectric ,.�_�� !:cater r :5.00
G.�S : IT-:::v . _�S:
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---�_ '_G�.C� S5.00
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APP20'vRL :OR ?BR'?IT _1%�
1`iI:�IN.;.;:^. FEE ?OR l.�Y PLL':!OI::v 1°?�:�T SS 57.SJ
CITY OF FRIDLEY
APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION, REFRIGERATION AND
.AIR CONDITIONING SYSTEMS AND DEVICES
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR:
Ftirnace Shell & Duct Work
Replacement of Ft�rnace
Repairs & Alterations-up to $500.00
Repairs & Alterations each add. $500.00
MECHANICAL WARA1 AIR:
RP.TE TO'PAL
$1z.00 S �
7.00 $
'7.00 $
�1.00 $
Elirnace Shell & Duct Work to 100.000 BTU $12.00 S'�"`�
each add. 50,000 BTU �1.00 $
Replacement of Furnace 7.00 $
Repairs & Alterations-up to $500.00 7•00 $
Repairs & Alterations each add. $500.00 �•00 $
STFAM OR HOT WATER SYSTEDI:
Boiler & Lines up to 100,000 BTU
each addn. SO,U00 BTU
Boiler only up to 100,000 BTU
each addn. 50,000 BTU
OIL BURNF:R- to 3 gal. per hour
each add. 3 qal. per hour
GAS BURNER- from 1U0,000 BTU to 199,999 BTU
(over 199,999 BTU see Fee Schedule)
GAS FITTING FEES:
lst 3 Fixtures
Additional Fix tures
Gas Range to 199,000 BTU
AIR CONDITIONIVG —'1
FAN HEATING SYSTEMS � See Fee Schedule
VENTILATING SYSTEMS
ALTERATIONS $ REPAIRS
$1'l.. 00 $
4.00 $
'7.00 $
6.00 $
$1t).00 $
10.00 $
$10.00 $ ��: ���
$
x S s.00
x $ ]..00
x $10.00
.: �,;: ��%
- State Surcharge
, h t � � � ,'„ ' TOTAL FEE
RpUGH ZNSP.
Date
FINAL INSP. ,j - / `/ - � �
Da te
APPROVAL FOR PERMIT i�(J
REINSPECTION FEE
(.$10.00)
S
$
$
$ � ��—
S
S
$ .50
S_�-;�=
MINIMUM FEE FOR ANY HEATING PERMIT IS $7.50 PLDS $.SO STATE SURCHARGE
� � � /��
JobAddress �/�'l�,%J�;'!-fC1�
Department of Buildings
City of Fridley
Tel. #571-3450
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance wfth the City Codes �-
and rulings of the Department of Buildings, and hereby declares that all the
facts and representations stated in this application are true and correct.
Fridley, Minn. , 19_
OWNER ' . < � ; �� .�,� �
, �
KIND OF BUILDING �� i � '
USED AS _ �� / � �� .�.���
TO BE COMPLETED ABOUT �' � �� ,/
ESTIMATED COST �
OLD - NEW BUILDING PERMIT NO.
� _ • .
PERMIT NO. �
DESCRIPTION OF FURNACE/BURNER
HEATING or POWER PLANTS, Steam, Hot Water, Warm Air- No.
Trade Name =���" %T yy�� ' I Size No. ;', , ... �, % �',; , C_
Capacity � c�;��_ Sq. Pt. EDR BTU HP _
�_�.
Total Connected Load Kind of Fuel f� '� �^
BURNER - Trade Name Size No. �
Capacity Sq. Ft. EDR BTU HP
, ` `,'
Company , c <' �-% -� ic"< �tii� .� <_. ,%_
J
,, j .
Signed By �k�",. _ � �r �.�1„�.-� _ �
Tel. PIo. r � � - ��� �/ �
sue�ecr P ,
City of Fridley _; :; �; ;� 9
AT THE TOP OF THE TWINS g U i L D I N G P E R M I T
� � RECEIPT NO.
� � COMMUNITY DEVELOPMENT DIV. ��j� �
r � � � PROTECTIVE INSPECTION SEC �
� �
� � �
' � ����1 � CITV HALL FRIDLE� 55432 NUMBER REV OATE P/GE OF qPVROVED B�
�""'�'� �'' 612-571-3450 9�0-F15 6/10/97 � �
JOB ADDRESS 1641 Camelot Lane NE
1 LEGAL LOT NO. BLOCK TRAC1 OR ADOITION SEE ATTACHED
DESCR. 21 2 Harris Lake Estates SHEET
2 PROPERTY OWNER MAII ADDRESS 21P PHONE
Nancy Boynton 1641 Camelot Lane NE 571-5351
3 CONTRACTOR MAIL ADDRESS ZIP PMONE LICENSE NO
D& D Home Improvement Inc 11773 Magnolia St NW, Coon Rapids MN 55448 757-7780
d ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO
4840
5 ENGtNEER MAILADDRESS ZIP PHONE LICENSENO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION p ALTERATION C� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOfiK
Reroof House & Garage (26 Sq) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PIUMBING, HEATING,
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 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTtNG OF A PERMIT �2�145 W1.O7
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISI F ANY OTHER STATE OR LOCAL LAW REGULATING CON- $74•75 Fire SC �2.14
STRUC ION O THE PERFOR CE OF CONSTRUCTION
PLAN CHECK FEE TOTAL FEE
� License SC $5.00 $82.96
s�crvntuaEOFCON'c�ACtoaoRnUTHOR� OncENt �oA E� WHEN PfiOPER�V V I Q.I�D TNIS IS V UR PERMIT
� /"�
SiGNA7UREO�OWNEF�iFOWNERBUILDER� iDATEi V"- '�BLDG NSP ���TE
NEW
ADDN
ALTER
[�
��
il
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-I AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress_ �(Q
Legal Description:
Owner Name & Address:
Effective 1/1/97
�
�
� � �
TeF. #_ ����35�
� �
Contractor: �4� Hnma TmrirnvAmant ��� MN LICENSE# 484
Address: 11773 Maq.�oZ 1� ��rp�t Nw r�n�n � z a� ��aa� _ Tel. # 75�_����
�
Attach to this application, a Certificate of Survey of the
lot, with the proposed canstruction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
QTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type:_�QQ� l ��� Estimated Cost: $ -� �` I�
�� r�uy�E� (Fee Schedule on Back)
Driveway Curb Cut Width Needed:� « Ft. + 6 Ft = Ft x� _�
DATE: �' APPLICANT: Tel. #�%�7� L�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ � --� � �� � �
$_ � „( -
� � - ��
$
� �; ' ,�
$
$
$
$
$ \ -; � �
; .,�; ''/'�-
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Vaivation {1/10th%)
$.SQ/$1,000 Valuation
$9S0 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Ahove
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
%
/ -
NEW ( ]
ADDN [ ]
ALTER [ ]
Construction Address:
Legal Description:
Owner Name & Address:
Contractor: ��
Address:SJ'r7 :�.l�1,��
�D� � — �71 �
CITY OF FRIDLEY Effective 1/1/2003
6431 University Ave NE, Fridley, MN 55432 {763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
-re�. # % - 5?�-535/
� MN LICENSE # �a'7`0 �� � _
� IV re�. # 7 5 I- a�3 -of �9
ss/ a�
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 HgUGround Sq. Ft.
OTHER:
Construction Type: �--� -� u Estimated Cost: $�3 ��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � l0 APPUCANT: Q Tel. #�S1-�3-0� �/�
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
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ aa3. �.s
$ /3, DO
$ e� �
$
$ 5, oD
$
$
$
$ -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 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 [ ]
_. .TOTAL _ _-- . $ a � 7 STIPLIt ATIONS� . ._ .. .. . . .. .._ ....