AF - 42802��:
. .. „
�
Ci#y of Fridley, Minn.
���
� � �r3333
BLTIi.DING PERiVIIT N° 3_4 4 0
,
..../..� .-... 3 -. ��....... �"
r�..-.�
�;� � � .��. .��. . . .� . . - Bu�� . . . . . . . . . �. . . . .-�. . . . .
l� :z! .°'C. �..�?.... . ...... Address ..�.�..�.�....�.�.! ........ ............
LOCAT(ON OF BU[LDING
rj �
No. �� � .`•.'�. . Stre�t . . . . . . . . . . .. .. . . .s.! ./.�. . . . . . Part Lot . . . . . . . . . . . . .. . . . . . . . . . . . . . .
Iat . . /. �.. .. . Biock . .. .. . .. .. .. . . .. . Addition or Sub-Divisiat . .. . .. .. . . . . .�is�y,�!��
Co�er L�t I�side Lot x �etback . �•?�. . . . . Sideyard . �Q. : �. y . . . . . . . . . . . . .
............ ............
DESCRI�PT[ON OF BUILD[NG
To be �7nea as: �
%.�!': :�r:-�., . . . . � ..� q - o e n�, .°"�. .s� :'.d H�t �a : ,�►. `' s�. i�c. 5��.!� . c�. �. ���
.................... P'i"�t ........ Dep�th ..../...�. Heiglst ........ Sq. F't. ........ G1lt F'k
Z�+pe oi Construckton . . �!7 ��. r�. . . . . . iet. C.osl�. . �'S+ '� " To be . . . . . . . .
,�9 .... .......... ��......:............
���r�,�.+� �G ,'� �'� �' ay "D � .3c�.a.: ,�,�
i� / � � �I�I!��(/� '�/" r .
d�G�`r` Oa�' t y ;
. .y�,a,,� � .•� � /�'��i��
C'���
Ia oondderation o! me iseuanoe to me o� a permit to construct buildin6 deuibed above. I� to do
tire prapo�ed work in acoordance with the d�ercrlptSa� above set f and fn 000apHance all �io�o� oi
ordinaaces o! the dty oi Fridley. . �
.�. ���1�'�f�C. .. . . J . .. . .. . .. .. .
x ....
�
In c�deration of the payment of a fee oi ��j�!....... permit ia hereby Qratrted to ...................
. . . .. .. .. .. . . . . .. . .. .. .. . to c�nstnict the buildina or adrlition as deacribed a�ove. This permit is granted �
the expresc condittoa� ti�at the person #o wham it is �ranted aad �is agents, emiiloYees sad worinn�, in a11 wo�k
da�e fn, around and upoa said building, or aqq Part �ereoi, shall aoa�form in all r�pects to the ord#naaces of
FridleY, M1tit�eaota regar�l}ng Iocatiaai, cons�n�ttoa, ait�ation, maintenance, repair nnd moyiag o! buildiags with-
in the dty limits and tbis permit may be revdced at any time upon Mulation of u�y, oi the pravlsfarrs o! ssid
ordinances. /
...... Buildini It�ec�bOr
MOTICE:
Th� ps�mtt does not oover th� ootat�otion, ImtallatJon o� �bratiar� for wl�inp, plumbi�, pas heatinpr
ssvvar or wabr. B� wro to �as ths Buiidin� 1� for separate permtb for th� ib'mt.
, � � �
� � �; �, �
�
� r�bv
. � �; b �
p•.�r.
s U +� v
y Cr v� Ii
N 4� N �
�� N .0 .-vi N
p ♦ � U I'J
y� ..� G
: �o r.
`\ ` u o
.� u >.•.�
.Y � �� � ��
� N t: �J �! 1 .
U O N U
n� v �u ••�
` �uron
►, uaro
W � y N
U„ ..� . .
o � c� [ ;
.�. �,
�, .� .:� r.
U L� � .i �
r1 '.i y U .�j �
1 a, c� „ v
`\ +
raj� � i ua i� 11
O O N 4�
� N 'f
U � N
xr+r. r.
J n ,-� u o
1 � '� j '�+ �
� � a 1�
J. c1 A j fj j� .
:� c�-. i o u ei
•.-1 U J� Q �i
'O ,C U
.� rn � s,
•,, � � . x. n. �
� u •�+ +� u
q >. :� N
uo ;i+ �w
W .-r L� •a �i O 'U
o v � s a
a •.r cn �a � w ro
sc�, "w� �°c. u•[ +-��
T1 E: �:� �'1 � '.i .-i U
^�J` � O �� �� � N W
r: >. .i: U
� ,q : , t� '-t "r� �� '� Cl
h .'JIUH ci rlil
U
1� C7 .-�
u �
�
'.ny' -. �
.4�1{i�
abutia.sE�
�XT� 'JST(��
. "[CiGt SS?J
__— `{ r `i•;
�t�c�c:o� ny
suisru
�. `�'� �_�
ctrx� zooj.�
S]. ::Gi15
�utc.junod
f�ttl �(ltT.i{]
s�(ray tis�Ft
ti�UT$
SUl^,(yT
S��U. �i�t'fi
r.ti•uj��
ttaJ::o(J
voFao�.1S
�
. �
� �
� ��
� � �,I
1 � �
o. v ; �j�
� C' �
E' `i r 1
� � � .
w ',�/� ni
a
J ` \
I c� 1 �
O
F
!i
E� W
� a
O
� � z
7 Cl A
H w c� a
Q E+ N H
a w o a
I �
r v �
n, "r.
t= tr .i
U t� F�
H l U 07 •
q � C� 3 ul
C•r v! U H G� � H
R: � �` W } 1 .T,
7 Z U w H A a
� �+ �n o m a o
o x a H w o a
s, �
U
3 +�
c� �
m ;?
,r,
�
3
.d
v
��
U
N
C1
U
b�
r. tn
..� [
r. �-+
_ � �„
�. ,�
u �.,
— �>
_ p q;
+� O.
U
�
l� b
— — �. ��
V i;
?:
�1 .��
_- — f� I��
ji ;�
a n
i� a1 a/ 1 �• �
�t r, i� ,1 �
� r� M .� i
�
t�
A
�
C
F �
O
F-�
. N N V? N t? N N VT 4?
u
t� E�
o s
�
L7
a
o:
NO
M �.^
� O
C:
z a
w �
N N v?
O
N
�
H
N
H
N
a
a
t9
ii
p3
:�
a
a
N
�
a
0
W
t:.
J
f%
r
r
O ��•
��
V? tn V? l?
w o 0 0 0 0 0 o c� o 0 0 0 0 0
� a o 0 0 o c o 0 0 0 0 0 0 0
� M CV N l�1 trl O 1� 1.'1 Ul rl .� O u1 t�
C7 V} N V? N.-� t? Vf N l�> N �! tn G?
- � N
iC `/, h X a �: X X k % X !C
� O I I I I I
1
�� i I
Z
C.�
�
W
1—
aC
� � r.
� � O
� E� � �
¢ , , at o c.
._, cn ° u
rn a o %�
2 F+ O� i U C� i f N �
oq � u�
� � •.i Gl T� tt) U O � f�
� N
�� U � o v ro ' u o F� �
nW'. ti v u♦, p � cn �� . �� o
L1,. O
•� Ul -1 �] (�� �� O� /a
E-�>G f Q' O 1 lA v �� u u �1 i" c�
. � u• i o 0
. .> >� � • n. � � �, u, o -� � , �
�-� �1 IJ U C CI Cl U J (.� '1 J� •f, N
i=.� Y 11 �.1 !1 /) Il r�) .. •• Jl 1 h
•� • � '1 41 N �, v� . �, .. ..
U. (�� f�� +� 1 U .() 3 U ~ � N C1 . y? C�
X ol :C o ul O .�+ �_• w O in i i/
% i a•.� o �� �� t� •.� � � i� ro
H � �1 I�� .!: l/ r-I l/ U 11 �-1 /•� �1
U (L. •1
n� j 1� �t �l � � ;t Cl �� 4I V� � 11 (1
`� ;i f � ;: ii � . .. ai c� � •�� �� � . � ,
;a • .� t9 �i a. u
a �
U
�
N
�
r.
.lVi 41
.7 [:l
V1 k�
v :�lJ
J� O
v� E �
W �t
4� 1
C) �
r� q
O O
�� U
7 N
ii v
c�
�.
. _ � �----�o� �� _ ��
3 `
o,.�-� o*:z 43 � -�� � a�x�s �.. + 10�2 9 3.�i
�--�-- — _
THE JOHN .1. RYAN CO. �
30 160Y�iELOY AVk'�1VUE, sT. Pwu� as�oa �e�NON��� sas-asae
sas•aa�s
SCALE: 1 INCN pEET 742 BUILpERY EXCHANGE BLDG.. MINNEAPOLIi SE402 �
�PLAT OF' �URVEY
, �
OF PROPERTY OF--.----�iZ�i�R $. `�1� - _
i �
� �
�
'
� '
DESCRIBED AS
1
�t z�;��� �. se
��..irC � �
����
��. �t w�r soata� �aatt�.w�
........-----, _ _� __ _ _ _ _ � _ _
-�'' .
I
m� �
�
�
: . -� ___.______� -..-._._ �:- _
. ��
`� , 53 � �lb9=��" j s ? �-'
1
Z�` ;, �
� �
• W.
r-r=.� s � � � J.� � �.. r' �� J <�
. iT+ Z' ��Y O N , � � "-'�:
�j�� o p f, N
�, u�� � � 2e,i oi r .
N l 5� � � � � 4 �
CL1 •
. o � � � V
�' ` c
it
—i-
( + .
�
- - �.� . —._
L •
4
i .
l
I
� •
CEftTIFICATE OF LOCATION OF BUILDING CERTIFICATE OF $UiiVEY
I herehy �Qrtify t�,at oe. __�..�,.�_ ��_�s.� _ -3-��shy 4a'.Y�:sj% c2s�t oy� -- tg
I made a sur�vey of the location of the buildin�(e) oa the I surveyed the property described above and that the above
above described property and that the location oP said •
buiiding�) is correctly,a,hown on the above plat. P1at is a correct representation of said survey. •
�Y . " J s.. , �l �� 4 :^f. � �t .
—__7'
,f' ./� HN J. RYAN. REGISTERED SURVEYOR. No. 448Y
Form Na l37 2N McClein•Hedman•Schuidf Co.
��
�� �
SUBJECT P
City of Fridley 17843
AT THE TOP OF THE TWINS gU I L D I N G P E R M I T
r
� � RECEIPT .
� i y_____ COMMUNITY DEVELOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEC.
� . ,
�
l---. A �����;,� CITY HALL FRIDLEv 55432 NUMBER REV. DATE PAGE OF APPROVED BV
i �� 612-571-3450 910-Ft5 1/23/85 / /
108 ADDRESS 5212 Capitol Street N. E.
1 LEGAI LOT NO. BLOCK TRACT Ofi ADDITION SEE ATTACHED
DESCR. 17 % Cd�1.SOri � S Su�mnit Manor S011�l �CI1t1011 SHEET
2 PROPERTY OWNER MAIL ADORESS ZIP PHONE
Glen Harstad 5212 Capitol 5treet N.E. 571-7024
3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDHESS IIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP pHONE LICENSENO.
B USE OF BUIIDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION � ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Install wuod burning stove in garage
9 CHANGE OF USE FROM TO
STIPULATIONS
Call be�oxe installing �or clearance to canbus:tibles.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUM8ING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTII.ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWIG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE FEAD AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S4OO $. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO V�OLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR IOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. yfi�.S.00
PLAN CHECKFEE TOTALFEE
�
$15. 50
� SIGNA R F NTRACT uTHO NT iDnrE� WHEN PROPER� LIDATED THIS IS YOUR PERMIT
i TURE OF OWN IIF O NER BU�LD I A 1 �� ' �
BLDG INSP �1P E
pgw � � City of Fridley
ADDN. I 7 �R-1 AIiD R-2
pLTER. [ 7 Building Permit Application
�
Construction Address: �; !
Legal Description
/
� �G
Effeetive u/1/84
Owner Name & Address : - `�Tel . # ��� � ��� �
Contraator: 1 ��-� P Tel. #
Address:
LIVII�IG ARBA:
GARAGE AItEA:
DECI� ARBA :
------
OTHER:
Attach to this application, a Certificate oF Survey of the
lot, with the proposed construction draWn on it to scale.
DB3CRIPTIOA OF INPB09ffi�1T
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Nidth Hgt/Ground Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setbaek
Type of Construction• � �� �O��s imated Cost: ��7 ��, �v
• � _ /1 P. �
Approx. Completion Date: �
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: � �
See Back Page or Explanation
DATE: � � APPLICANT: Tel. # J �/ ���/
Permit Fee
Plan Check
State Surcharge
3AC Charge
Park Fee
SeWer 1�lain Charge
TOTAL
STIPULATIONS:
CITY IISE 01�1LY
� /S . O C�
�
� ��
�
�
�
�, �`�.5�
Fee Schedule on Reverse Side
25x of Building Permit Fee
�.50/�1,000 Yaluation
�425 per SAC Unit
Fee Determined by Engineering
Agreement Neeessary [] Not Neeessary [ 7
0
.� , � � • .
1+7�' ��� � � •-��:'' � � j' � ■.
� �i� � , � � � � � / � ` � +••
-s��
�
BOII.DIIiG PERMIT FSE SCHBDIILB
The Chief Building Official shall, before isauing permits Por the erection of any
building or structure, or Por 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 Porth and in the manner herein provided to-Wit:
Total Yaluation
Fees
=1.00 to ;500.00 �10.00 (Minimum Fee is �15.00)
�501.00 to a2,000.00 #10.00 for the first �500 plus $1.50 for each
additional �100 or fraction thereoF, to and ineluding
�2,000. � -
a2,001.00 to a25,000.00 �32•50 for the first $2,000 plus $6.00 for each
ad'ditional �1,000 or Praetion thereof, to and
including a25,000.
:.Q , , _
a25,001.00 to a50,000.00 �170.50 for the first �25,000 p1us��4.50 for each
_ � ', � additional� �1,000 or fraetion thereof, to and
, ' ineluding $50,000.
�54,001.00 to �100,000.00 a283•00 for the first �50,000 plus �3.00 for each
additional �1,000 or fraetion thereof, to and
including �100,000.
a100,001.00 and up #�33•00 for the first �100,000 plus �2.50 for each
additional �1,000 or Praction thereof.
DRIVBfiAY DBPR�SION BSCROii
(Concrete Curb Streets Only)
. Alternate "A": Removal and replacement of curb and gutter only - Drive�ay width plus
6 feet times �13.50
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 $15.75
VBRIFICATION OF FOUNDATION
Permits Por construetion �ill be issued a minimum of 24 hours from the time of
application to allow Por proper review of the proposed structure and of the
coastruetion sfte.
A Certificate oF Survey of the lot, showing the location of the foundation onee it
haa been oonstrueted will be required before proceeding With the Praming.
a.
!= "� .a a
sue�ecr PER O.
City of Fridley 18838
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� � REC .
� `v _.���_ COMMUNITY DEVELOPMENT DIV. �� ���
r � � PROTECTIVE INSPECTION SEC.
Y . ,
1
L-•-• � �����;,� CITY HALI FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
i �� 612-571-3450 910-F15 3/25/87 � �
JOB ADDRESS CJ212 �dpltcl.l StY'2e't N.E.
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 1,% % CcLY'].SpI1�S SUIRiIlt M3i1lOr Sall'�1 AL�C�1't.t011 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Glen Harstad same 571-7024
3 CONTRACTOR MAII ADDRESS 21P PHONE UCENSE NO.
S�.
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
RE5ld2rit1c11.
7 CLASS OF WORK
❑ NEW C1X ADDITION ❑ ALTERATION O REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WOF;K
24' x 20' garage addition - total with addition will be 960 sq, ft.
9 CHANGEQFUSEFROM TO
STIPULATIONS
1
SEPARATE PERMITS ARE RE�UIRED fOR ELECTRICAL, PLUMBING, HEATING, TVPE OF CONST. OCCUPANCY (iROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. f
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OFi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEU FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. • NO. DWLG. UNITS OFFSTREET PARKING
I NEREBY CERTIFY TNAT I HAVE READ AND EXAMINED THIS APP�ICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF IAWS VALUATION SUHTAX
AND ,OROINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6 892.H0 y�3.�i'rJ
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEiiM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OFi THE PERFORMANCE OF CONSTRUCTION. 62.rjO
PLAN CHECKfEE TOTALFEE
� $65.95
Si OFC I CTORORA MOAIZEDAGENT DnTE� WHEN PROPERLY VAUpATED THIS IS YOUR PERMIT
, 4 � Z�z������
SiGNATURE OF OWNER�IF OWNER BU�LDERI ATEI BLDG INSP
�FTE
r�r L l
ADDN. �
u,TEx. I J
Construetion Addr�
Legal Description
Owner Name & Addri
Contractor : � �/J� C Tel . #
Address: 5���'
City of Fridley Effective 4/1/86
R-1 AND R-2
Building Permit Applieation
LIVING AR$A:
GARAGE AREA:
DECS ARBA:
OTHER:
Attach to this application, a Certifieate of Survey of the
lot, with the proposed construetion drawn on it to scale.
DESCRIPTIO�I OF IMPROY�MBNT
Length Width Height
Length �z y Width � Height O
Length width Hgt/Ground
Sq. Ft. �_
Sq. Ft�,�
Sq. Ft. ___-____,
��j�-�— c,u ��� c����-� �e� � `7� � t� � �
Corner Lot [ 7 Inside Lot � Ft. Yd. Setback Side Yard Setback �F
Type of Construction: � orc�r � � o d %•� e Estimated Cost •�:�;�- -
�`� a ga
Approx. Completion Date: � � ��� `
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: � �
See Back Page Por Explanation
DATE:
Permit Fee
Plan Check
State Surcharge
3AC Charge
Park_Fee
SeWer 1�'Iain Charge
ToTei. /
STIPULATIONS:
O
APPLICANT: Tel. #
CITY IISB O1�LT
a �o�i � �� Fee Schedule on Reverse Side
� 25x of Building Permit Fee
$ 3�� #.50/�1,00o valuation
� � 525 Per SAC Unit
� �-- -----.,, Fee Determined by Eagineering
�
$ ����' �
Agreement Necessary [ ] Not Neoess�ry [ ]
i � y-^I"
BUII.DING PBRMI? FEE SCHBDULB
The Chief Building Official shall, bePore issuing permits for the erection of aay
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
therePore, require the payment by the applicant for such permit of fees to the amount
herein belox set forth and ia the manner herein provided to-Wit:
�:; .
Total Valuation
�1.00 to �500.00
Feea
$10.00 (Minimum Fee is �15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional �100 or fraction thereof, to and ineluding
�2,000.
�2,001.00 to $25,000.00 �32•50 for the first a2,000 plus $6.00 for each
additional �1,000 or fraction thereoP, to and
including $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each
additional �1,000 or fraetion thereoP, to and
including $50,000.
�50,001.00 to $100,000.00 a283•00 for the first �50,000 plus �3.00 for each
additional �1,000 or fraction thereof, to and
including �100,000.
�100,001.00 and up
�433.00 Por the first �100,000 plus $2.50 for each
additional �1,000 or fraction thereof.
DRIYLHAY DEPRESSION ESCROfi
(Conerete 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
approach with 6 ineh depth - Driveway �idth plus 6 feet times �15.75
98RIFICATIOp OF FOUNDATION
Permits for construetion will be issued a minimum of 24 hours from the time of
application to allow for proper review of the proposed strueture and of the
construetion site.
A Certificate of Survey of the lot, showing the location of the foundation onee it
has been construeted will be required before proceeding With the Praming.
aaner:
�ddress
City/Zi
R1e].. No
CIT'Y OF FRITLFY
IT APPLICAT�I
EEfective: J�e 1, 1986
� � �� �
s�cN �: -s��e
A�.1RF5S:
QTY/ZIP:
�3.. I�:
,
aaaress: ---���
�
Iot: Slock: Addi�`ion:
Zoning.
.
�sc ;i�tion Of Siy�
l. () Wall Lenc,�th o�f Wall Max. Allvwahle 9q. Ft:
Si� Length: Width: �j. Ft.;
2. () Pylon Distanoe Fr. Prop. Line: Distance Fr. Inter/Dwy:
Sicy� Length; Width: Height: 9�. Ft.:
3. () Roof Roof Sic� in Lieu of Pylon Si�
Sic� Length: Width: 8q. F't.:
4. ( ) CamPaic�
*5. � Tenporary (&w�ers �brta-F�nel Penr�ants, etc)
*r,��aovm �ux io nAYS a�.Y _ � /� - �� ,�= �2s'-��'
Date Erected Date Zb Be Renwed
Constructed Of: Estimated Value S Zb Be �ocnpleted
Illuainated: Yes ( j No (� I�' YES; Electrical Permit is Neoessary Fbr Wiring Sic,�
SIGN !�'.SSAGE:
�e �ndersic,�ed hereby makes application for a permit for the work here.in specified,
�greeing to cb all work in strict aco�rdanoe with the City of Fridley ordinanoes and
rulings of the Building Inspection Department and hereby declares that 1 the facts and
regresentations stated in this application are true ,pn�7 p�rr�C. �
nATE: b ^�.� �cp
Please Print
Permit Fees
' 0 to 40 square feet: $24.00 plus $.50 surchazge if not lit.
41 square feet or m4re: $60.00 plus $.50 surcharge � not lit.
iblitical Siqis: $15.00 deposit, ref�6ed when sic�s renaved
Tanporaiy Sic�s (porta panels, baiv�ers, etc. ): NO FEE
StiDUlations �
Revolving beaoons, zip flashers and similar devices including any �ouroe c�f light whic-. .
c�anges in intensity are pco�hibited. �
i .., _�_•� ;e;
Date
�
�
�
T
�
�
�
�
L �
>
U
:J
y
� \
�
;I O N
Q W �
� � �
Z �
Q
� Q d
� Z
Za
H
V W w
N Lr
C'3 N �
2 � Q
¢ ? m
O
Z
=0
� �
Q Z
v� O
Z�
d'
aq
c
W Z
�a
z
-Q°, o
�Q
o�
Z�
O�
Q W
V �
�
a
z a
o a
�n
>
�
Z
O
F-
U
W w
�
� Z �
z N N
>-�CM I
�' rr
J � � � n
p � � t�p '�1
� M
� Z �-.
� • � � N M
O � �� n
� ,� a� .� "
E-- m :a `D �
1� U l�0 Li � Frr
W
J
�
�
W
_
V
N
W
F-
Q
C.'
�
Z
O
0
�
W
�
�
C�
Z
�
J
�
m
.�
O
Z
H.
�
W
�
�
�
�
U
0
w
F-
¢
�
�
w
J
O ��
F-
b4 69
.°.? o 0
� o 0
m °
64 69
�
¢
�
cv
�
a>
� �
�
o �
� � �
� � � o Z w
� (� � N
� � �
v V
� �
C C
C� p
� U
� �
U p a'
� F- _
I
� �
c �
� Z
c u�
� � �
= Z ~
w' a� a�
� � � � i �
Z f`-m�i a�Om
�} 64 Ef} 69
0 0 0
0 0 �n
� '-�+ N
69 69 y}
i 4j
� U
c �
� c
� � r.
+•
Y .� c
i V �
o � m � a��i
� m � � ca
� � � 3 a�i
� �y — � i
-p �"' � 41 O
c � ' � C
� � +r N
C � �-'
� V � z �
� cv a� d0 N
"+. � � � 'C 0�0
a
C�i cVC �' �-' d. �
O
.a a. tn N
fA � N fa fa
��Q C7 U
a�
�
Q
N
ca
�
�
a�
N
c�
Q
h0
C
C
O
'�
c
O
U
Q
Y
U
m
z
0
F-
(J)
N o
c �
o ,,,
� o
c�a �
a; v
c
Q .ca
d1 Q
N ¢
'� �
Q O
� �
�
� j
a� �
L p
,..
0 �
— .-1
¢
� c
_ R
.� N �
� y c
sa �
Y U �
i U
3 � '�
U �
� .
,��, � '''' U
_ _ �
i. � � L
° ,� ` C(�'
i=' 3 .� � .�
� � � � �
�
�'a � �' � ---�
c� �
� � U i
° ° a a�
O � � � W
�
� . C'1 � Q Q
U +,L., L a-'
fII
.Q N � ,V
Q .� C
c° �c �O a
s 3 p �
� _ N L
�v �' �
� Q 0 •C
G) � � �
� O G �
� ���
�
C N
� �N m C
on � = o
i � a"' R
� � O �
� "' 00 N
a� y � �
� a 3 �
H y i i
� � �)
� �
s
0
�
O
a�
v
C
ca
� d
N �
� O
� �
C �
� ?
N
�i O
� � .
� N
U ~
�
i0
m
� W
i W
cn �`
°� F¢-
�
� o
O
U
C3
Z
Q
w
_
O�
�
d'
O
I
N
�
�
�
m
�o
�
�
J
W
I--�
� �
%� 1�
c -� .�
�
N
m
�
�
c
�
.�
�
N,
�
L!l
�
m
�
�
C �
0o X
N �
2
�
O
O
�
d'
�
W
W
L�
Z
�
U
W
�
C/)
Z
W
�
�
(Q
0
L
Cf0
3
A
�
m
�
m
>
O
a
a
Q
�
0
t
�
�3
i
'� U�
(p C
>+ 3
� o
� �
� �,
�c a
� O
��
a> �
U C
fB .
Q .�
0
� �
+, �
c �
� O
U �
� .O
� N
C N
O �
� �
Q
Ua�i
a.. +�+
Q •3 �.
.::,_. ►
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
•��u•► ► ► •►► i: �►� •�i:. •► � ` . �►
When rspla.�ino a� Px��,�0 f►ir` ny� the undersigned hereby verifies that the
venting has tieen examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes`(� No ()
The venting system is plasticJPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes O No O
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The '' ' ' is sized and installed to meet the cuRent codes
and manufacturers specifications.
Whet1 �eqUl�ed t0 install a np�•� rc�mhustinn �ir it v,iill be sized and installed
to meet the cuRent codes and manufacturer's specifications.
When installina a np�•� .�Pntin�,�y tPm, th� undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does inctude AGA-GAMA Category I Central Fumace
Ven�ng Tables for fan assisted and natural draft appliances.
Yes� Na (
Yes�No ( )
Yes ( ) No ( )
Yes() No()
!s the common vent and vent connectors size.d and. install�d correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ()
An�lianrp Tvru� ancl Si�p/C'emmon ��ent nd �/�ant (''��••��.,. �N*.,.».
Appliance #1 Type BTU Input —1 UQUO Fan Assisted or Nat
Appliance #2 Type . BTU Input –_Z�(%L Fan Assisted or Nat
Appliance #3 Type BTU Input � Fan Assisted or Nat
Totat Appliances � Total Btu Input _�, i� c�
� ...- �r
Common Vent Type _ �_.' �(,�,Q� � Vent Height ��_ Diamete� �_ inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Apptiance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter Tin Type
HEATING CO: har Ht & Ac =.
Si�ned By: ' /,�. Date : r�`
L��
V �°--,
i� � � CITY OF FRIDLEY
,DDN [] 6431 University Ave NE, Fridiey, MN 55432
�LTER [] SINGLE FAMIILY AND DUPLEXES R-1 AND R-2
BUILDING PERM(T APPLICATION
c�a �`��
(763) 572-3604 Bidg Insp
(763) 571-1287 Fax
Construction Address � °� - - ' � ��' � �t � S`j�l2�- l �� �
Legal Description:
Owner Name & Address: f� (�. i�he� CF.Li-o �� � Tel. # i 6 3�� l �l ��5�
Contractor: �� MN LICENSE #
Address Tel. #
LMNG AREA:
GARAGE AREA:
DECK AREA:
Attach to this appiication, a Cert�cate of Survey of the
bt, with the proposed construction drawn on it to'scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Sq. Ft
Sq. Ft
Length Width Hgt/Ground Sq. Ft
OTHER:
Construction T e: � � C� Estimated Cost: $����� ��
yr �
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x� _$
DATE: APPLICANT: Tel. #
Call (763) 572-3604 for Permi� Fees if mailing in appiication. Fax to 763-571-1287 if using credit card and we will cail
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
� .�^
$
$ 04 i(1o�
� �� 31
$
�
$
$
$
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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 $ � STIPULATIONS:
BUII.DING PERMIT FEE SCHEDULE
The Cluef Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing buildi.ng or structure, or for any alteration or repair to any existi.ng 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
$1,000,001 and up
FEF.�S
$23.50
$23 .50 for first $500 plus $3 .OS 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 includ.ing $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 first $1,000,000 plus $3.15 for each additional
$1,000 or fraetion thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet times $20.00.
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 S�rvey of the lot, showing the locadon of the existing foundation will be required before
proceeding with the framing. New Houses Only