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�ie�u expres�s condiixon that th� person �o whom !t is gxanted and �is �ni�, :�aYee,s `and� �rorlaaea, in all �orl� ,
do�;E �, aronnd ariH i�oa saxd Biuild��, ar'a� Pe,rt thereof, sh�i� cbniarn�. -fn �11 :r� xa i� or�aCes o� - �� ',
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rep�tr aud miov3�ig a�.buiidi� a!it�
3a the village Iim�i#a at�ci �ikhis p�z�it. mia� tie revaked at anY 1�e .upo� violaf.�or� a� � o� txte pra'visians of ��td `��
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. ... . . . � . . . . " , ... . ., ... .: . . 8t�lt7�g Insp��r
� 4�It7TICE� _
;.... � This percnii ctaes nof �qve e ccnstrr�at�on, Insta#iatt�n �sr� at#eraRion fbr . iitq, piumbfng,�gas iiesitn�, �: `
sewer or.wafier. Be s�t�e to �e��iiild€ng Inspec2ar #or _separate� Aermlts,F��e ttems. ''r
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City of Fridley, Mi.nn.
BUTLDIlvG I�E�iMIT N° 5 5 7 3
Da�: � �..,� ..;. � �
o��: ����. �� �, � ¢�a swua� � .
F ,. .
Address � � Address ._
� � LO�AT N O� B� D,lNG -
No. ��� Street "� .�� � �._..�! ' � , part t
Loi �__ Block �__.._ Addition or Sub-Di;�' ton ._._. ��--���
Corner Lot , Inside Lot � �—� r
�tback . ��` Sideyard _ +V,�" �"""�---•-=�-�a �'
Sewer IIevation .�...... �. Foundat3on IIevation ____
DESCRIPTION OF BUILDING �
To as: ��� � �
�,,,�r� f � r� '� '�+'
J °f r'""'�'ront .�� Depth I+"� �'�y p,�a-_ Height � Sq. F't. Cu. F'�
� � �A� '�%ight Sq. F� � Cu. Fi.
�,y...a �, �'
Type of Construction ��5� ��� � Cost _.... � �_ �' ��' '�� To lie Completed ._..
In consideration of the iasuance to me of a permit to consixuct the building described above, I agree to do
the proposed work fn accordance with the description above set forth and in compliance with e,ll prayqsions of
ordina,nces oP the dty of Fridley.
�
In consfderation of the pa,yment oP a fee of "`� F� , permit 3s herebY gra.nted to
��-. �
to construct the building or addition as described above. This permit fs granted upon
the express conditioa that the person to whom it is granted and his agents, employees and worl�nen, itt all work
done in, around and upon said building, or any art thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, constru�on, alteration, maintena.nce� repair and moving of buildiags
within the alty limits and thia perrmit may be revoked at any time upaa violatio _ f any of the provisions of seid
OrdinaIICeB. �� � ,,.
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°-, '"''�' _. . � � �r. �'_> . , Building 7napect�
NOTICE:
ffib pem�it does aof eover the eonstrueNon, iestapatfon for wiring, Pl�+�+g, gas heafiag, sewer or watea Be aure to sas
tiro Building Inspeetor for separate permtls fo� these hems,
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APPLICP,T�ON �'OR BUSI►D�1�iG PERMIT
CST3t 0� k'ItID�EY', i'�i.T�SOTA
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L�TION OF SU ING
No,_[� �� ��Stree�t Parfi o� Lot
Lo�t Block ddition or ubdivision '
""'_7�'_
Co�ner Z,ot �nsi�e Lot �tback de-Yard
SEWEFt ET,EVAT
ELEVATiO1�T
Applicant at�ach to �his �arm Certi�icate o� survey of Lot and
proposea building location.
lo � used ass
nESC�az�Tao�v o� �znc�z�r�
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/
1
�„T�e3�ht
So� e Ft . Cu . Ft .
F�ont________L�ep� t�eight
S . Ft. Cua Ft,
s �
Type of Construction �stiraated Cos� -�
To be Comp].eted
'�he undersigned he�eby ma]ces applicati.on for a permit �or �he work
hescein speci�ied, agreeing �o do all work in strict accordance with
the City of Fridley Ord�.nances and ru].ing o� the .Depar�nent of Build-
�.ngs, and hereby declares that a11 the facts and �epresenta�ions
stated in this ap�l3,catioa ase true and corrac�.
� �.,,.�"�° ,� ,� "� � SIGiVA� URE - ���
(Schedule of Fee Cosfis ca� be �ound on the Reverse �Side).
�"� r-'�
= ��
.-4 ��.°�
BUILD�N'G PE�iNiST FEE �GHEDULE
Sec�ion 2. The Tnspector o� Bu3ldin�s shall, before issuing any
per���: �or the erec�ion o� any build�.ng or structure, or for any
adc�i�ion to any ox�s�jng muilding or s�c:�ucture, or for any alterations
or repa�rs .:to, any �xist�ng build�.ng ��c atructu�e, _ upon applica�tion
�here�or, require �he pay�nent by �he a�plicant �or such per�nit of
iees to the amount herein below set forth _and in the rnanaer herein
prov�.ded to-wito
2.1. For any such pe�m3t for the erect3on og any iire-proo� building,
o�lner than a garago, warehouae, �actory or grain elevator,,, or iEor the
erec�ion of any �C��e-p�oo� addition� for sa�ailar oc�upancy, to any
exis�ing b�ailding shall be at the rate of $1.40 for each on� thousand
cu�ic ceet, or �rac�tion thereof, in such cubical �ontents.
2�.2. &'or any such pormit �`or �he erec�tion of ar�y fire-proof garage,
warehouse, �actory or gra�.n eleva�or, or fo� the erect�.an � oi axiy sire-
� praa� addit�.on, fox simila�c occupancy, to any 'exist.ing buildinc� sha3.l
be at the ra�te o� $1.25 cor each one thousand cub3.c �Eeet� classi�ied
as "�ireprooi" by Sect�.o� 502 0� the Minneapol�s Building Code.
FiOUSE S
2.3. For any such permit for the erecti.on of any non-gi.reproo� build-
�ng other than a garage, warehouse, fac�ory or g�cain elevator, or any
non-r�.xep�oo� addi•��on, for s3milar occupancy, to any exis�ing bu31d3.ng
Pe�mit $1.00 for eaeh one thousand cubic feet.
G�1GES .
2.4. �or any such �ermi�c for �he erection o:� any non-fireproo�
gaxage, warehouse, �:actoxy or grain e7.eva�or, or for the erection of
any non-f3reproox add3.t�on, ior similar occupancy, to any existing
build3.ng or for �ach such building or adclitione N3noty Cents �or each
one �thousand cubic ieet or �raction �chereof, in the cubical contents
thereof wi�ch a min�num o� $�„00.
�or'the purpose o� compu�ing fee� �Eor bu3lding permite the cubical coa-
tents o� any building� or addition� to a uniform height throughouic by
multi�ly3.ng the g�ouacad aTCea covesed Lrom a point six ( 6) inches below
�the rloor line o� �the baseinent or cellaac to the average height of the
upper surface or to 'che average heigh� of the roof surfcace ox the main
gable of a pitched roof. �
2�� For repairs or alterations to an existing structure,� tlle �ee
shall be at the rate of $3.00 per each Five Hundred Dolla�cs ($500.00)
or iractio� thereoc in �the cos� o� ail proposed worko
2.6. in no case+ shall the fee chargad for any pesmit ag set forth in
Section 2 be less tl�^n $4.00. �
�,�,
,,,._ -
-�� -
.�
i c�ty of Fridley S�B�E°T
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i `
; ; � ______ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
� _ ,
`+_--� ��"'"�,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE
L 612-560-3450
910-F15 8/29/73
JOB ADDRESS
6212 Carol Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 6 2 Shorewood Addition
2 PROPERTY OWNER MAIL ADDRESS
Claxence I. Larson 6212 Carol Drive N.E.
3 CONTRACTOR MAILADDRESS
Erickson-Bronson
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDRESS
6 USE OF BUILDING
7 CLASS OF WORK
ZIP
ZIP
ZIP
PAGE OF
� �
PERMI
12300
R P .
� 7�'�33a.
APPROVED BY
SEE ATTACHED
SHEET
PHONE
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
❑ NEW � ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
re-shingle roof
9 CHANGEQFUSEFROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HER.EBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �SOO.
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �S.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �
ei �
OF CONTRACTOR OR AUTHORIZED AGENT
SQ.FT
STALLS
PERLY V
NCY GROUP OCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
GARAGES
SURTAX
.50
SAC CHARGE
TOTAL FEE
$5:50
IDATEC� IS Y{JUR PERMIT
�1PPI,T��TION FOR RLSIDENTII�L, ALTERaTIt�!N,
0 R F1ll U 1"I' I OI�` f3 (1 I I� U I N G p E RNI I T
CI�I'Y' nF F1:1llL�:Y, �1INNESO'.C�1
�1'W1�TFR � S NAME : ��� /{j �,�J (° ,� �' �� 6�jILDER :- �� l C/�°SG /if � �J�e /�b Se ! u
��nxxES s : � � 1 � Ca,�s►.� G � C' /JQCL � ADDRES S :
NB:. T STREET:
�Q�: BLQCK• ADDITION•
CQRNER LOT: INS�pE I,OT:�_�SETBACK: SIDEY.�,itD;
Ag�7.ican� attach Co tttis Lorm �ao Certificates of Survey of Lot and proposed
bu�.ld�.ri� ]�vcation drawn on these Certificates. �
UESGRIPTI�N OF BUILDING
To Be Ussd As;
,,) � °�
�%� �`-� �Fxont • Depth ° Heigh� •
Squaxe Feet; Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet•
�`y�p� of Ct�nstxuction; Estimated Cost:�� O���
�o ae completea: � ,3
Th� u�,clexsigned he7ceby ma.kes applicativn fox a pexmit for the work herei.�
specified, agreeing to do all work in stfict accoxdance with the City �f
�'xi.dley Ordinances and rulings of thc>_ Uepartment of Buildings, and hereby
dselaxea �hafi �ill the facts and xepresentations stated in this application
a�� true and c;,rrt-c t.
DATE: 02 / � 3 SIC;NATLJRE:�� � ' �
s�.s,.`.�..�- �-�.A-�s�-c_.
iSe� Reve Side For Additiona.l Tnforma,tion.)
�r��
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.
!
BUILDING 1'k:1�L�T1'I' 1��E 5CtI1:llULk:
S�GTIQN �. The InspectuX �r B�ti.ld�n,�s sha11, bef�re issuing permits fox the
exeCtion of any buiiding ox' strur;:ttr��, or Eox an�• addition to any exi.sting
6uildfng a� structure, or for -.Lny .�1Cera.ti.on or r�:pairs to any c::isting
building ar sL-ructuxe, iipon application t.herelnrc:, r�q�,ire the payment by the
appliGant fox such permit of fees to kh�� amount herein below set f�rCh and in
�h€� manner herein provided to-�•�it:
I,TN��qRM BU�LDING CODE: Type 1, 2& 4-� $2.15 fox each onc: thousand cubic
feet, o7r fxaction the.rc:of, in such cubical contents. T}�p� 3& 5- $1.85 for
each Qne thousancl cubic �eet.
:�DIlITIONAL 1NFORAtATIUN
�'ox the pur�osc� Qf computing fees f�: building permits, the cubical contents
p� �ny buildin� or .zddition, is determined by multiplying �he ground area
epv�x�d fx'vm a point six (6) inches below khe floux l�ne of the basement
,px ��� �e11ar to tl��� average 11eiKtits ,>f the upper surface or to the aver�ge •
h�i�n� o:E ths xoof surface of tlie main gable of a pitched roo�.
FOx xepaix� ox a.l.te7:ations to an existing structure, the fee shall be at �he
x�te o� ,��.00 pex eac}� fi,ve hundred dollars ($500.Op) ox fraction thereof i.n
the �ost of all proposed work. ,
Ta �no a�.se sha11 the fee chaxged for any permit as set forth in Sect�on 2 be
1��s than $S,OQ.
VERIFICATION OF FOUNDATION
NQT$t P�xmits ior canstruction will be issued a minimum of 24 hours from th�
�� o� application, to allow for proper review of the proposed structur� and
c�i Ghs �o;nstxuction site.
E1 Gertif�ed Survey of the lot, showing Che location of the foundation, once �.t
has been eonstxucted, will be xequired before proceeding with the framing.
�'L'RTIFICATE OF OCCUPANCY
Application for a Certiiicate o� Uccupancy shall be made ten (10) days prior
tv �he u�e or occupaney of a.ny structure for which a building permit has been
$.�6tt�sd; �nd s,�id structure shall not be used or occupied until a Certificate
of Uaeupancy has been issued.
` \ <.b
SUBJECT PE ...
City of Fridley 2 2114
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i �
' � O.
COMMUNITY DEVELOPMENT DIV.
r � y � PROTECTIVE INSPECTION SEC. �� ��
i �
� i �
l.--- A /���1`J CITY HALL FRIDLEv 55432 NUMBER REV. DATE PAGE OF APPROVEO BV
i �� � , 612-571-3450 910-F15 9/17/93 / /
JOB ADDRESS 6212 Ca.rol Drive NE
1 LE�AL LOT NO. BLOCK TRAC7 OR ADDITION SEE ATTACHED
DESCR. 6 2 Shorewood SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Tim Johnson 6212 Carol Drive NE 574-0397
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Panelcraft 3118 Snelling Aye S, Minneapolis 721--6628 2179
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 EN�INEER MAILADDRESS ZIP PHONE IICENSENO.
8 USE OF BUILDING
Res identi.al.
7 CLAISS OF WORK
❑ NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
R�s.ide Durellinc�
9 CHAN(iE OP USE FROM TO
STIPULATIONS
��cavide smoke detectors, as �r UB:C 1210 adjacent to all sleeping areas �
and �n basement.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF COIdST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTH06i12ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIINE AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. 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 $7/QQO $3. �JO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEHM1T FEE SAC CHARGE
PROVISOONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE P RFORMANC OF CONSTRUCTION. $9O.QQ Fire SC $%.00
PLAN CHECK FEE TOTAL FEE
- s � �� � License SC $5.0 $105.50
SiGNA7 CONii;ACTORORAU M 12EDAGENT IDA E� yy�/pA6fxyq LI D THIS IS YOUR PERMIT
���-.
SiGNATUREOFOWNERIIFOWNENBUILDERI IDATEI m �BLDG WSP fjpTE
�
ADDN
ALTER
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Conshuction Address:
Legal D�riPtion:
Effecbive 5126/93
CITY OF FRIDLEY
SINGLE PAMII.Y AND DUPLEXES R-i AND R-2
Building Permit A�li�n
�212e �� � �� �-- y � � /U . i�
Owner Name & Address: � I/� � c`� j�( ('J �
���,«�
Add�ress:
�-�(�
�l���e� G�
�
� S.
�
�-���
- Tel. # �� 1�?J��
MN LICENSE # � � � �
T�i. � ��/�� '�
AUach to this application, a Ce�tificate of Survey of the
lot, vvith th€ propased coastructaon drawn on it to scale.
DESCRIPTIUN OF �MPROVEMEN'I'
LIYING AREA: Ixatgth Width Height Sq. F�
GARAGIE AREA: i.ength WYChh Height �. Ft.
DECK AREA: I.ength Width HgtlGrtwad �. Ft.
OTHER: � ,-��� I.1,.� �
Cornea Lot [ j Insic� Lot [] Ft. Yd Seiback �ide Yard Setbacks
Type of Cmnst�vct'ton: Estimated Cas�: �� 00(�
Approx. L;ompletion �aate: �
(Cast on Back)
Driveway �irb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$.
DATE: � APPLICANT: � i(G � ,�-- W ��.iL.��� Tel. # � l r � <�
Per�nit Fe�
Fire Surch�rge
State Surcivarge
SAC Charge
License Su�charge
Driveway Escrow
Er�ion C�atrol
Park Fe�e
Sewer Main Charge
TUTAL
�+��fM'�I� ' t .�1--
� �� 0� �'ee Schedule on Reve�se Side
$-- �4.� -Otll of Permit Valuation (1l10�h9�)
$ , . �� $.SU/$I,UOU Valuation
� $750 per SAC Unit
$ � � � $5.00 (State Licensed Residemiai Contractors)
$ Ait. "A" or Alt. "B" Abawe
$ Conservaticm Plan Review $450.00
$ Fee Determined by Engiaeexing
� Agreement Necessa�Y [ 1 Not Necessary [)
� ��� ' �� STIPULATIONS:
�. � . `
- -- - - -. --__ � �
BUII.DIN(i PERI4IIT FEE SCHEDULE
The Chief Building Official shall, Uefore issuiag Permits for the erection of any buiiding or structure,
or for arry addition to any existing bnilding or strucd�re, or for auy alt�ation or repair to any existing
building or structure, u�n application therefore, require the pay�ne� by the applicant for such permit
of fees to the amount herein l�low 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 $SO,U00
$50,001 to $100,0�
$100,001 to $5U0,000
$500,001 to $1,000,�
$1,OOU,001 and up
FEES
$15 (Minimum Fee is $15 plus sarcharge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereaf, to and including $2,OOU
$45 for fust $2,000 plus $9 for each additional $1;000
or fraction thereof, to and including $25,(}00
$252 for first $25,000 plas $6.50 far each add.itioual $1,OOQ
or fradion thereof, to. and including $50,000 -
$414.50 for first $50,0� plus $4.50 for each additional
$1,000 or fraction thereof, to aad including $100,000
�39.50 for first $i00,00Q plus $3.50 for each additional
$1,000 or fraction thereof, to and inclnding $500,000
$203g.50 for the fir� $500,000 Plns $3 for each additional
$1,(lOQ or fra.ction thereof, to and including $1,(m0,0IX1
$3539.50 for the first $1,0(�,000 plus $2 for each additional
$1,000 or fraction �thereof -
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacemem of c�rb and gutrer only - Driveway width plus 6 feet times
$13.50. � �
Altemate "B" : Removal and replacement of curb and gutt�r and install a 3 foot wide .
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for constructioa 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 coasttuction site.
A Certifica�te of Survey of the lot,� showing the location of the foundativn once it has it has been
constructed will be required before proc,eeding with the framing.
y- t �
SuBJECT n 4.�
City of Fridley PE��p'�" ����
,
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T 9 �����
r
i � - _._ -
� �
' ' COMMUNITY DEVELOPMENT DIV. RECEIPT NO.
� �L'_
r � � PROTECTIVE INSPECTION SEC. �� I
i ,
i
l_e_- �; r���,.j CITY HALL FRIDLE� 55432 NUMBER HEV DATE PAGE OF APPROVED BY
L �� 612-571-3450 910-F15 4/20/95 / /
JOB JIDDRESS
6212 Carol Drive NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 6 2 Shorewood SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Tim Johnson 6212 Carol Drive NE 574-0397
3 CQNTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 EN�GINEER MAIL ADDRESS ZIP PHONE UCENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW X ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
B DESCRIBE WORK
Construct an 8' x 8' Detached Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
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 SUSPENDED OR ABANDONEO FOR A PERIOO OF 120 DAYS AT
ANV TIAAE 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 LAWS VALUATION SUHTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �522 �p.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTI�N OR THE PERFORMANCE OF CONSTRUCTION. �I.7.00 Fire SC �.SZ
PLAN CHECK FEE TOTAI FEE
$18.02
� SIGNAT^ OFC N7RACT RA ORIZEDAGENT IDATE� WHEN PAOPERLY LIDATED THIS IS YOUR PERMIT
�_ � � / �
SiGNATUREOFOWN RUF W EF7BU�LDER1 1 ATEI Lp INSP pqT
NEiN
ADDN
AL'I'ER
dl
(I
11
Construcdon Address:
CITY O� FR[DLEY
SilifGl.E F�MILY AIYD DUPLEXES R-1 ANI) R-2
Building Permit APplication
�.I'� �.�.�0 � �.' �-
Lega1 De�cription: � (� �Ibc,l,c_ �'
� �riC�,
Effective 1 / 1 /95
�-I �r �
r� �5`L{ 3 a--�
Owner Name 8r. Address: _�(�M J O�v�SD�� Tel. #�� y�- �3 �`�
Contractou�: � MN LICENSE #
Address:
LIVING .AREA:
GARAG� AREA:
DECK AREA:
OTHER:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the pro�sed const�uction drawa on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length �_ Width � Hgt/Ground Sq. Ft. �
Corner Lot [] Inside Lot .�Cf Ft. Yd Setback Side Yazd Setbacks
Ty� of Construction: ___.�� Estimated Cost: � �7 S,� L. G�
Approx. Completion Date: � 3� 9 S �
(Cost on Back)
Driveway Curb Cu Width Ne�led: Ft. + 6 Ft = t $ _$
DATE: `l` �� q� APPLICANT: ,,,�,.. � Tel. # �7��03��
Permit Fe�
Fire Swcharge
State Surch�rrge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main� Charge
TOTAL
STIPULAT'ffONS:
� �� � ��
$ ���
$ ���
$
$
$
$
$
$
� f� �a
CITY USE ONLY
Fe,e Schedule an Reverse Side
.�1 of Permit Valuatioa (1/lOth%)
$.50/$1,0� Valuation
$850 per SAC Unit
$5.(� (State Licensed Residential Costractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation P1an Review
Fee Determined by Engine��img
Agreement Necessary [ ] ATot Necessar�+ [ ]
��,1 �.,-��`°��- �� ���
liUll.l)ING 1'1:KMCI' PE1's SCtiEDU1.E
I�h�: C:h��t 13uildin�; Ufl7cial st�all, (x:iorc issuinfi permits for thc ercction of arry tniilclinF or stn�ciurc,
cir tc�r any a�lcliticm [u �ny cxititing bui(dina, or structurc, or fot any altcraUOn or rcj�air to ar�y cxistin�;
l>viliii��g <�r s�ructure, u�n a�j�lication thereiore, requice [fie payment by tl�c a��plicant for such �ermit
c�f f��cs tc> lhc; anu�unt hcrcin t�clinv tic:t forih a�d in the ivanner hercin �rovidcxl to-wit:
"I'O"I'AL VALi)E
� 1 to $500
$501 to $2,000
$2,001 t4 �25,000
�25;001 to �50,000 -
$50,001 to $100,000
$100,401 to $500,000
$500,001 to $1,000,000� -
$ i , 00�,001 and up
rr� ;S
$IS (Minimum Fce is $15 plus s+urcharge)
$15 for first $S00 plus $2 for each additional $100 or
fraction thereof, to and including $2,000 -
$45 far firs� $Z,000 pius $9 for each additional $1;OOQ
or fraction t�ec-eof, to and iucluding $25,000 ' -
$252 for first $25,000 pl�s $6_SO for each addirional $1;000
or fractiou thereof, �o. and inclading �50,000
$414_50 for first $SO,OOU plus �450 for each additional
$1,IX10 or fraction tiiereof, to and including $100,000
$63950 for €ust �$100,00Q plus� $3S0 for each additional�
$1,000 or fradion thereof, to and inctudiug -$SIX3,000
$2039.50 for the 5rst $500,000 plus $3 for each additivnal
$1,000 or fraction thereof, to and including $1,000,000
$3539_50 for the first $1,IX)O,IX}0 plus $2 for each additioua.l
$1,000 or fradion �thereof -
DRIVE'WAY DEPRESSIOId ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gut�ter only - Dctveway width plus 6 feet timies
� 13.50_
Alternate "Q": Removal and replacement of curb and gubta- and install a 3 foot wide
approach with 6 inch depth - Driveway width plas 6 feet times $15 _75.
VL'RtFICA"I'(ON OF FOUNDAT[ON
Permits for corut�uction wili i�e issued a minimum of 24 hours from the time of application to allow
for praper revicw of tt►e �roposed structure and of the co�struction site_
A<:ertitic::ite of Sucvey of d�e lot, showing the locaUon of thc founciation once it ha.e it f�as heen
constructeci will fx: reyuiru! i�efc�re proceeding with lt�e framing_
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Timothy P. Johnson �
6212 Carol Circle N.E.
Fridley, MN 55432
�.
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� S�+oUJ —rrY� S���so�1 AT �af� c�Ro� � N� �'Itis e�oB�RT�i `ts eN c iTY w����. �'�►
N-u _
WEU. oR soRWa LoCATiON MINNESOTA DEPARTMENT OF HEALTH Minnesota Well and Boring H�� 4 6� �. �
WELL AND BORING SEALING RECORD Sealing No.
County Name Minnesota Unique No.
��� Minnesoffi Statutes, Chapter 1031 or W-series No.
(Leave bienk tl nM Imown)
T , Township No. Renge No. Sectlon No. Fractlon (sm. � Ig.) Date Sealed Date Well or Boring Constructed
_ ��'+ �� 1� ��� �� :��� 1��� ���"�
Numerical Street Address or Flre Number end Cfty of Well or Boring Locatlon �
���� ����� ���� Depth Before Sealing �� ft. Original Depth it
Show euact IocaHon of well or boring `� Sketch map of well or boring A UIFER(S) STATIC WATER LEVEL
in sectlon grid with °X°. � ��� loca8on, showing ro rty �Single Aquifer ❑ MulUaquffer
,-J Ines, roads� u di gs. ,,,...yyy��������� ❑ Esdmated
fd tl" WELL/BORINO Ly Measured
�
; ' ; � � [�lNater Supply Well ❑ Monft Well � �
--�r- --�-- --r- ---�--
� � ❑ Env. Bore Hole ❑ Other fL [�elow ❑ above land surface
--i-- --'r- --i-- -i-- f �
yy � � i � E CASIN0IYPE(S)
� � � �_ �
`'r- - �-- -;-- --;- �Steel ❑ Plastic ❑ Tlle � Othar
mlle
- �- -�- -- j-- --� � CASINO
Diart,�e�� � Depth �� Set in wersize FroIe7 Mnualar space initlally grouted?
L' S -I� ,!,
pk— i mne—�ype in. from �to ft ❑ Yes [�No ❑ Yes ❑ No ❑ Unlmown
I I
P����V1![yE�'S.�P�� in. from to ft ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unlmown
�3E
Properly ownePs mailing address B c9ffereM than we0 locatlon address inmceted above. In. trom to ft. ❑ Yes ❑ No ❑ Yes ❑ Na ❑ Unlmown
�r � �. � �,�°�a,i�;�„��,s C�� ��'�t�"�'a SCREEWOPEN HOLE
�'�.'�'�3���e ���.�� �� �� �
Screen from to ft. Open Hole from to ft.
OB&TRUCTIO W DEBRIS/FlLL
��JER'S NAME ❑ Obstruction ❑ Debris ❑ FII [�No Obstructlon
a
Well ownePs mall(r�g addrese H differerrt than property owner's address Indlceted above. Type of Obstruction/DebrisJFfll
Obstrucdon/Debrls/FlII removed7 ❑ Yes ❑ No
PUMP
,__ T� - . "a3���&'�� e:��
GEOLOGICAL MATERIAL COLOR HARDNESS OF �o� TQ ❑ Removed Not Preserd ❑ Other
FORMATION
If riQt Imown, indicate esllmeted fomiatlon Iog from nearby well or boring. ��OD USED TO SEAL ANNULAR SPQ,CE BETWEEN 2 CASINGS, OR CASINO AND 80RE HOLE:
s��. �`�� �� `��4� � - � � � No Mnular Space Exits
❑ Annular space grouted with tremle plpe
��..�5� ����� ��� t:�� ❑ CasingPertaraUoNRemoval
��'�� ��.�� ��� r� �� i�.rrom to n ❑ aano�caa ❑ Removed
'��y���°�E� �3��� �_<y b� in.from to ft ❑ Pertorated ❑ Removed
Type of perforator
❑ other
OROU'fIN� MATEWIAL(S)
��1� � '� �+� ����" i.
Gmutlng MateAal _ from to `— {t, yards bags
from to R ye�g y8gg
from to ft. y� �98
from to ft. yards bags
REMARKS, SOURCE OF DATA, DIFFlCULTIES IN SEALINQ UNSEALED WELLS AND BORINGS
�;*� ,��� ��� 4 ���� ��r� ��� Other ur�led well or boiing on Property? ❑ Yes o
UCENSED OR RE�ISTERED CONTRdCTOR CERTIFlCATION
�,��� �.:�..'���I.s �� ��1�� $+��"'��: ��'
�-��� ���a�� �� ���� " �� g�, �"�'This well or boring was sealed in accordance wtth Minnesoffi Rules, Chepter 4725. The informa8on cordeined in thts report is
__ _____ _� �_ _ ` e to the best af my Imowledge. `
���
� . �-e 6 � '� �� :����� � �°� . 7' 1��. F�
`'� .-i� � Contracta- —r -Buslne�s Nam� - _ _ _ > IJcense or Regts6atlon No.
�- �� s�,���y���
��cordin� t� �� ��a�e �e�u����ns AuthoNzedReP " °'_ �eS19���e ' Date
' � � �������� �����
H �� ���a �� Name of Person Seallrtg Well or Bodng
LOCAL COPY �y
10/95R
��
sue��tr pE �fQtT'�^-
City of Fridley 2 8 2 3 5
AT THE TOP OF THE TWINS g u I L D I N G P E R M I T
� � ��2�36��
; `V ___�� COMMUNITY OEVELOPMENT DIV.
r j � PROTEC7IVE INSPECTION SEC.
�
� i �
� �"'1 � CITY HALL FRIDLE� SS132 NUMBEp
�""'"� � ��� 612-571-34b0
s�aF�s
JOB ADDRESS 6212 Carol Drive NE
t IEGAI �OT NO. 9LOCK TFiACT OR AODITION
OESCR. 6 2 �Y Shorewood
2 PROPERTY OWNER MAIL ADOR�S$ �
Kelley J. Frain
3 CONTRACTOR MAIL AOORESS
Ridge Rockers Roofing 13615 Poppy St Andov
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILOING
Residential
7 CIASS OF WORK °
REV OATfi
10/14/98
ZIP
ZIP
�
�� 7�
OF APPqQVED BV
�
SEE ATTACHEO
SHEET
�MONE
571-5971
�HONE LICENSE NO
20136188
�HONE LICENSE NO.
'HONE IICENSE NO
❑ NEW O ADDITION O ALTERATION � REPAIR � MOVE O REMOVE
8 DESCRIBE WORK
Reroof house, �ara�e and shed (21 Sol Tear—nff
9 CHANGE Of USE FROM
STIPULATIONS
Underlayment must comply with the State B uilding Code.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTqICAL, PLUMBING, HEATING, TYP� OF I
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NUIL AND VOIO IF WORK OF CONSTRUCTION 20NING
AUTMOii12ED IS NOT COMMENCED VR!ITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK tS SUSPENDED OR ABANOONED FOR A PER100 OF 12p OAYS A7
ANY TIME AFTEH WORK IS COMMENCED ' NO. OWL
I HEREBY CERTIFY THAT I HAYE READ ANO EXAMINED THIS APPLICA710N
AND KNOW TME SAME TO BE Ti�UE AND CO�iRECT. ALL PROVISIONS Of LAWS yp�UATIC
AND OiiDINANCES GOVERNING THIS TYPE OF WORK WI�L QE COMPUEO
WITM WHETMER SPECIFIEO HEREIN Oii NOT. TME GRANTING OF A PERMIT $1799
DOES NOT PRESUME TO GIVE AUTMOR�TY TO VIOLATE OR CAMCEL THE pEfiMIT FI
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
S�RUCTION OR TME PERFORMANCE OF CONSTRUCTION �Sl, 7
SiGNATUAE OF C0�'QnCTOA OR nU�MOp12ED 4GENT IDATE�
/J
- �/ � 1�����,��
���
��GN4TU O�OWNEA� OWNEpBWLDERi � ►TE�
UNITS
T
S7A�LS
0
qOUP OCCUPANCYLOAD
CU FT.
OfFSTREET PARKING
IGARAGES
$.90
SAC CMARGE
Fire SC $1.80
TOTA�FEE
5 YOUR PE�pQMITpE'
�� A / V
�
�
NEw [ ]
�DN I l
ALTER [ ]
ConstructionAddress: _
Legal Description:
Owner Name & Address:
Contractor: �, � a
Address: A��! S P��ar S'
CITY OF FRIDLEY
SINGLE FAMII,Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
A ��c� ������ i��
Effective 1/1/98
. h
g,. � � �.� ��
� �� �
�
Tel. # �,f�� � '� ��`
MN LICENSE # �/.��/��
Tel. # �—���
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 VVidth Height Sq. Ft.
DECK AREA: Length Width HgVGround Sq. Ft.
OTHER: �erdd� e� u S.e, t�� 4���'��r_� ^�1 S'Q,u� -� % ear�
Construction Type:
Driveway Curb Cut Width Needed:
Estimated Cost: $_ � ��
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x$_ _$
T1ATE: d APPLICANT: Tel. � �il-����
a CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ��.�s�
� �80
$ d.
$
$ .�`f�0
$
$
$
$
$ ���s."
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 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 PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration 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,Q01 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
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000, 000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRE5SION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
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 $15.75.
VERIFICATION OF FOUNDATION
�
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
SuBJEC7
City of Fridley
;�
AT THE TOP OF TME �,INS g U I L D I N G P E R M I T
� �v __��_ COMMUNITY DEVELOPMENT DIV.
I j � PROTEC7IVE INSPECTION SEC.
l��_�� ��"' �•� CITY HALL FRIDLEY SS132 NUMBEp
L 612-571-3450
910-F15
JOB ADDRESS 6212 Carol Drive NE
1 IEGAL �OT NO. BLOCK TRACT OR AOOITION
oesca. 6 2 Shorewood
2 PROPEqTY OWNER MAIL ADDRES$
Kelley Frain 6212 Carol Drive NE
3 CONTRACTOR MAIL AOORESS
Same
a ARCMITECT OR DESIGNER MAIL AODRESS
5 ENGINEER MAII AODRESS
8 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW �J ADOITION
6 DESCRIBE WORK
Construct an 18' x 10' Deck
9 CHANOE OF USE FROM
STIPULATIONS
See notations on plan.
SEPARATE PERMOTS
REQUIRED �OR:
�LUMRR�lNG� ANDnSIGfNS
REV
5/19/00
ZIP
ZIP
PAGE OF
� /
30954
�/ ! �
�vnqOVEO Br
SEE ATTACHED
SNEET
PMONE
571-5971
PHONE LICENSE NO
PHONE LICENSE NO.
PHONE IICENSE NO
❑ ALTERATION O REPAIR O MOVE O REMOVE
TO
� -�
�efore digging eall fc��
als �tiiity location�
4540002
��Q����� �Y �:�a���'
SEPARATE PE1iMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATING OFi AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO FOR A PERIOD OF 1� DAYS AT
ANY TIME AFTER WORK IS COMMENCED.
NO. DWLG. UNITS
I HEREBY CERTIFV 7HAT I HAVE READ ANO EXAMINEO THIS APPLICA710N 1
AND KNOW THE SAME TO BE TRUE ANO CORREC7. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMP�IEO
WITH WNETMER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �1,692
DOES N07 PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME pEpMIT FEE
PROVISIONS OF ANY OTMER STA7E OR LOCAL LAW REGULATING CON-
STRUCTION OF TME PERfORMANCE OF CONSTRUCTION �C7O.IO
S�GNATUr+E OfjCO�v'aACTOa OA sUTNOAIjED nGENT
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c
OCCUPANCV GROUP
s�. r r I CU. FT.
OFFSTREET PARKING
S7A�LS GARAGES
SURTAX
$.84
SAC CNARGE
Fire C $1.69
TOTAL EE
$6 .63
R LIDATE�7 IS IS VOLLR PE9J�
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LOAp
.i%
N� � � Effective 1/1/2000
ADDN [] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
�-T�R I � SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION � �
Constnaction Rddress: ��.��., C�1 C'_� rclt, N� �� `�
Legal Description:
..-- --
Owner Name & Address:
Tel. # �( a.- S7�' SQ17 �
Contractor: ���ll"' MN UCENSE #
Address: �p � Tel. # ,SA�2i�,
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Suniey of the.
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length � Wdth Height Sq. Ft
Length ($ F.I- Width L Q 1�?- Hgt/Ground a. �1' Sq. Ft
�f � l
Constnaction Type:_ ((�A. Estimated Cost: � ��� 1 C� /02
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _�
DATE: S �9 OG APPLICANT: Tel. #��'S?j'�7%
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ (pC�,1 D Fee Schedule on Reverse Side
Fire Surcharge $ �� �q .001 of Permit Valuation (1/10th%)
State Surcharge $ �y $.50/$1,000 Valuation
SAC Charge $
License Surcharge $,
Driveway Escrow $
Erosion Control $
Park Fee $
$1100 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not IV�ecessary []
TOTAL
STIPULATIONS:
$ �. �o
BUII..DING PERNIIT 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 building or smicture, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment-�y 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,�
$2,001 to $25,(�0
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$SQO,(�1 to $L,0�,000
$1,000,�1 and up
FEES
$23.50
$23.50 for first $5(� plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,(�0
$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,OQ0
$993.75 for first $10U,000 plus $5.60 for each additional
$1,0(}0 or fraction thereof, to and including $S�,OIX}
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fra.ction thereof, to and including $1,000,000
$5,608.75 for the first $1,0OO,OW plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete "Curb 5treets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application Y.o allo�r for proper
review of the proposed structure and of the construction site.
A Certifica.te of S�rvey of the lot, showing the location of the foundation once it has it has been �o t�l �
be required before proceeding with the framing. New Hauses Onlv
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Beam layout for Your Deck
The Saale io 1/4" :1'
Design#:68278
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Joist la out for Your Deak
The �aale i� 1/4" :1'
De�ign#:68278
bark length Desaription Usage
A 1'10-1/2° Zx8 Stafned and T�eated Rim joist
6 7'10-1/2° ?x8 Stained and Tre�ted Joist
C 9'9° ?x8 Sta(ned and Tre�ted Ladger
D 9i0-1/2° ?x8 Stained and Treated Joist
E 10' 2x8 Stained ond Treated Rim joist
F 16' 2x8 Stained ond Tre�ted Rim joist
Joi�t� to be on 16° aentsr�.
Joists to ba hung from the ledger with Joi:t hangers.
Joi:ts to be toe-nAiled to be�ms with 2-1/2° (8d) galvani2ed nails.
Rim joists io be f4ae-nailed to joists $ ledger� with 3-1/2° (16d) galvanized nails.
Blocki�g 4nd b�idging is not shown, but may be required by your local code.
Illustration may depict options.not included.
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�esi n#:68278
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Ple�sebdn ��rp�ns�o 1�9n 6,6n 1'9"
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�- Denotes railing posts and are placed at a 48" maximum post sPacing.
Iilustration may depict options not included.
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��� Take this sheet to the Building Materials desk to purchase your materials,
You have selected a 18' x 10' deck 2' off the ground. -------- -
Green Treated Framing Material Below is a section of the railing style and
Horizontal Decking options you have selected for your deck.
S/4" x 6" Green Treated Deck 6oards
36" Spindle Railing
2" x 2" x 42" Green Treated Spindles, 6eveled 1 End
4" x 4" x 48" Green Treated Utop Notched Railing Posts
Privacy 6reen Treated Lattice
Concrete and a Post Footings
Premium Phillips Drive Screws
2" x 8" ,loists
2": x 8" 6eams
..�:.::::::
40 PSF deck load ..:�:::.�:�"::::�::::::`:::�::�:�:`��:
lepict oQtions not included
chosen railing style with options.)
For 6uilding Material's use only :
Selection Code : 21612002401020406030003020000500000001
Today's cost for materials estimated in this design with options: $981.02
'The b�se price may Include: 40 PSF deck load, horizontal decking, 2x6 green treated deck I�ards, green treated ir�ming matenal, no stairs,
36' 2x4 railing, green tre�ted railing �� and galvanised I�x nails. *�gpSE price): $6�%.�4
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COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When reqlacina an existins� furance, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstru�tions, Yes () No ()
and is securely supported and firestopped where required.
The venting;,system is plastic/PVC and meets all current codes and manufacturer
specifications .including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the cuRent codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan Yes () No ()
assisted and naturai draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufa�turer's sp�ci_fications. _ _ _ _
When required to install a new combustion a�it wiil be sized and installed
To meet the current codes and manufacture�'s specifications.
Yes ( ) No ( )
Yes ( ) No ( )
When installin� a new ventinst svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace Yes () No ()
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and instailed correctly after
an appliance�has been removed from the common vent and vented Yes O No O
separately as;per current codes.
A liance T e and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat __,_.____
Appliance #3 Type BTU Input Fan Assisted or Nat
Totai Appliances _ Total Btu Input _
Common Vent Type Vent Height _ Diameter inches
Appliance #1 Vent Connector Height ,_ ft Length ft Diameter _in Type
Appliance #2 Vent Connector Height ft Length ft Diameter _in Type _______.
Appliance #3 Vent Connector Height ft Length ft Diameter ______in Type __,___
ALTERATIONS: Describe
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HEATING CO: .
Signed By: Date :
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►-•
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
b When realacing an existing furance, the undersigned hereby verifies that the
venting-has been examined and is free from rust, deterioration, obstructions, Yes (�O) No ()
and is securely supported and firestopped where required.
The venting system is plastiGPVC and meets all cuRent codes and manufacturer
specifications inciuding sizing, length, number of elbows and termination. Yes () No (ya
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 Yes (y,) No ()
assisted and natural draft appliances.
The existing combustion air is sized and installed to meet the cuRent codes
and manufacturer's specifications.
When required to install a new combustion ai�, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( ) No (�j
Yes (�1 No ( )
When installing a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace Yes (y) No ()
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented Yes (�) No ()
separately as per cuRent codes.
A liance T e and Size/Common Ver�t and Vent Connector Infortnation
Appliance #1 Type�_ ' BTU Input �._,_ �� Fan Ass" d or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances � Total Btu Input
Common Vent Type Vent Height Diameter _ inches
Appliance #1 Vent Connector Height ft Length ft Diameter _in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type _,.
ALTERATIONS: Desc�ibe
> n _a / _ .. .,//.�., ... _ � //n l��i� n,� /ii , L�il��
HEATING CO:
Signed By:
,.p-...,, / _ .. _ : .
���Il�$!�
H __ ������ � x,ti .
�,,._..�
��� „ � �
. s,�
_ -f�,� < - %�� '
�'�-; �."�� � '} - �-,,�`� at.",
� ' TEST RECORD �' s � H`�=��--
-4;,s�,;,«r <�''" �'_`� ,.���° � ., '
H EAT IN� sue►�RB
� ;, HOUS�E �oatR ---c�rr -----'
+ ,� ,�, � y, • pp T. �- � �, �: �'
�' � ��? � ,� p� ��� � �' ,�'�-_ . pWNER
� � �n� �r�= � � ��
r: , rr
! ALIDRE55 . , iNST ���j�,� � �NSTALLE� B <.�e ��.;'�
; �C�PANT �_ DAT � HT�• �x` �� ; �'— g , � . pTHER
L�� '��� , F,'%°�� P J_�' Gas Line Y UNIT H�• ��
`�. HE�►T , ,�,a �. �.� � s.� ' - SPACE HTR. �'
4 50LD BY�� HW �_STEAM �— CONYERSI�N �—
' Eleetrica�,Work BY FA �
,, 7YPE OF HEAT GA �—
�
Gp,S DESIGN �pKE OF BURNER
k � �+�✓i q�� �v r-, � �H Mode�
�� MAKE q��� ;';�? a.�£r�Y �' � Max. BTU Roti�9 GE .�
, M1°d°� ' �ati° `. �" �� `� � � MAKE OF FURNA _
Ssriol ModO� "'' - _ �: � �„
; � � �, . . -
��'-; � ^� � � � z�ONE-=—�—`
� ��NPUT � SIZE
p ' CONTR�LS �/anrSizs �' . �, ' "`
p OF LINE� r � >.
.i' � 0 Re9ulator
t �HEI2M,a,ST�A�T'
' '�olva -�*s' �
4 I�imit �
�` Limit SsHin9 -
�c,>,Fad Settin9 —
�; pil'ot 7yi� —
!; Pilot Moke —
`'� pilot Mod°� -
'� Q�fot Timi�9
', L.W, Cut Of�
: °
1 � �-Ieat P�vB
���
'InPvt CFH--
`<Sta�►c TemP�
' F �n, .435
E
'- ,
c' '
� , -- �
S
pefeent COZ
pe�csnt C0
KIN ��, - r
praft Hood � � K�� � � �y _.Numbsr D�tside�
Filtsrs SjzO�,� ����de a `�
Chimney Location � ,.yg,,7�,.
Chim�eY CO�structioA / ��"
�s.
� �.�` Wiring ��
Smoke Bomb , Test T�9 r�"
_ proft E�
Lightiny Inst.
_ Door Prossure , �
�'�- � > P � ��n . _ ii� ��? �
: �'" �- �
Date 7eatsd ,,^`! �, . :� ,-' ,'p, .
� fi° n ',� . 9 B'. � r`7 �
j GomP°�Y Tsatin9 - d'f,'� El
� Nlome of Tester �:
SuB�ECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
' ' COMMUNITY DEVELOPMENT DIV.
� �v __._�-�
r j � PROTECTIVE INSPECTION SEC.
l-_--�� �'�' �'� CITY HA�L FRIOLE� 55�32 NUMBER NEv
L 763-571-3450 910-F15
J08 ADDRESS 6212 Carol Circle NE
1 LEGAL L07 NO. BLOCK TRACT OR ADDITION
DESCR. ( 2 Shorewood
2 PROPERTY OWNER MAIL ADOfiESS
Fred Hughes 6212 Carol Circle NE
3 CONTRACTOf; MAIL ADDRESS
Merten Builders 19486 Vernon St N6d, Elk River,
4 ARCHITECT OR DESIGNER MAIL AODRESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
DATE
8/12/OZ
IIP
PAGE Oi
/ /
32974
�- �---�
RECEIPT NO.
0
APPqQVED 8Y
SEE ATTACHED
SMEET
PHONE
763-502-1334
PHONE LICENSE NO
763-286-0139
PMONE LICENSE NO.
203388Z7
PHONE LICENSE NO
O NEW � ADDITION 0 ALTERATION ❑ REPAIR O MOVE O REMOVE
X
8 DESCRIBE WORK
Replace header for overhead garage door (enlarge door from 8' to 10')
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
SEPARATE PERMITS ARE REOUIRED FOF EIECTRICAL, P�UMBING, HEATING, � Tre Ur Wi
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WOiiK OR CONSTRUCTION 20NING
AUTHORIZEO IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO FOR A PER100 OF 120 OAYS A7
ANY TIME AFTER WORK IS COMMENCED. NO DWLG.
I HEREBY CERTIfY TNAT I HAVE FEAD ANO EXAMINEO THIS APPLICATION 1
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILI BE COMPLIED
WITH WHE7MEq SPECIFIED MEREIN OFi NOT. TME GRANTING Of A PERMIT �I.�OOO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME pEiiMIT FEE
PROVISIONS OF AN MER ST E OR LOCAL LAW REGULATING CON-
STRUCT H PE F CONSTRUCTION $3H .�IS
LAN CNEC!
icen
S�GNJ TUAE OF CON'RACTOA OA nUTNOAl2E0 oGENT iDATE� �
S�GNU7UAE O� OWNEQ��� OWNEp8UIL0EAi iDA1Ei
UN�TS
T
STALLS
SC $5.00
PROP
GROUP �OCCUPANCVLOAD
CU f T
OFFSTREET PARKtNG
IGARAGES
SUR7AX
$.50
SAC CHARGE
Fire SC $1.00
TOTALFEE
$45.25
D TH1S IS VO R PERM�T
° 2 �
/i�Ti
NEW
ADDN
ALTER
� , CITY OF �RIDIEY
� l 6431 Universiiy Ave NE, Frtdley. MN 55432
I l SINGLE FAMILY AND DUPLEXES R-1 AND R 2
BUILOING PERMIT APPUCATION
Ccnstruction Address: _
Legal Description:
Efl'ec6ve 1/12002
r163j 572�SQ4 Bidg Ina�
�,
�, �� ,,.
� �_��
�
1' Y �, �
`F
�1
Owner Name & Add�ess: Te1. # ZCQ 3- Sa2 �/,3��
Contractor. Ift.e.�X� � � � MN LICENSE #__ �o �3�� 2 �7
Address: /�9� � 2ri'�10� �� �IJP,J �f ,� ,�;,�.�� ,�,�� Tei. # 7C�3� � � � p/39
IMNG AREA:
GARAGE AREA:
OECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the p�oposed consVuction drawn on it to scale.
DESCRlPTION OF IMPROYEMENT
Length Width - Height Sq. Ft
Length `�� � Width ` Height �� Sq. Ft 2�U
Length Width HgtlGround
`J
Sq. Ft
Q �
`� ° � o� � �� � ti. �� D U►�'c.� � � % 0 1 � �
Construction Type: � Estimated Cost: $ (,O c� �.- a c�
� �
Driveway Curb Cut Width Needed: t+ 6 Ft = Ft x$ _$
DATE: �� � z APPLICANT: Tel. #?Ca3 - 2�-�2�7
Call (763j 572-36Q4 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will
call you tor card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
�
$ ��- �s
$ /, l� �
$ S~�
$
$ - C7
$
$
$�
$
$ S �S�
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ ]
STIPULATIONS:
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration 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
��01 to $2,0�
�2,001 to_ $25,000
$�,OQl to $50,000
�SO,OQ 1 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
�69.2� for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $ZS,Q00 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 $SOQ,000 plus $4.75 for each additional
�$1,000 or fraction thereof, to and including $1,000,000
�1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet�imes $17.00.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for prop8r
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
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