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7y!ype af: Canstru�oa T+;°�r �`� . Est, C�st Tn 3�_�►pleted..
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� `: " �n t�nsider�i��zn oi tk�e, i�u�nc� ;�o � ai a A�t io cbnstrt�cr� f�e; builciing d�bed alaove. : I agr�e t� do _ �
�.�ie pr�iPosed worl� in `a,�r�axic� avi�# ttze dsscrfAtion, above � foi� s�nd 3n co����4� at3fi�x ali provisions c>f
= Ordihances oi fihe viilllage oi k`rfdl�'. '�
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;�. „.,', ln consid�ra.�icsn iri #Tne payinent t�f.a fee ot $�_�.�.:°:�, �� �s �er�y'� to :.. ��tr+�::� ��� �:
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,' `. . . . . . . . . . . . . . : . . . . to cr�struct . th� bui't�rig o�r �idclit�ion as d��bed a�ove. �h3s: per.imit is 8�t'ted u�n ,` �
�,� ; .�� express� conci3tit�n �t t� P�rsam t+� ovhoa�it �.granted and his a�e�n't�> emp�oye�" &�d �.'kme�►► in all work = �,�
� �ame in, . arQtartd and. itpon �it� buiIc'tia�. ox, �nY �t •'k.��xe�vi. sb$li con��n i�i e11 � to .� arti9uatic�es o� +.
�'� .:�'ridle�, M#n�nesota re�a.rding lac�i�oa,' construc�ion, alier�ti't%n,. main'�n�ine�, �e�r aad; m+�ig af bwtldir�s wi'Fh � �
+ � :, �x �ke �*I1Tage ximifis �asl- f,his permit' ma�r be x�vs��eri . at �ny 't�ne _u�n vialatian � aiiy crg the Prdvi�tans o� �d = :
ke im rrni � �
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y� � -T�is perrnit cTO� not.'cAver 8��nstructt0n, idstatlatfort or aitet��ion fax riJ, i?tumbT►�g, �as [�e�aiing,
� ° - sewer oc wa#e+�. �� sura ta se�nitt�tRg ►rr�pects►r fcr sepa�+aie .�arni4�is f, i�ern�a.
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CIlY OF �RIDLCY •
a
Af?d'L�C11'iI�Ji1 FOR 1tESIDL.PdTI11L f31J1(_ilTh�G PCRI'�9TTS
. ((dc�ti�e, Alter�ations, l�ddii:zoi�s, or Re�}airs)
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Ot�lt�Et�: �c�r-e � �' -e � �oo+.�'fo�es G'UIL[)ER: ,�-����
ADDRCSS: �'��/✓J�' a'��� l,._._�re% ADDRESSo • .
Tr l. �� : "� � % �/ - / � e�� TEl. i�d4: �
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LOT: �
Construc�iotz Location
ST12L�T: � � �n -�
BLOC"i�.: �
Corner Lot a Ins 5.c1e Lat a
�DAITION : � `� , �-' i���l'-��i� / 7 �,�I �^
Sei:back: Sideyards :
� Xapplicant attach to this �orm �e�o Certiiicates ot Suxvey of lo�.and
prnposed builci5.nq locat.ian dralan on ceztificates to scale.
,/� D,g� � r� �, DESCR�CPTTO�� OF CONSTR�JCTIG(V -
j�T
�" � Front: i L ! Dep"tiz a` /(� � F�aighi: q
� .
� :�quta�le �•ect���� � Qibi.c I'eetr �`�'�
Fzan�:
Depth: Heiglzt:
�� �
Square� I'eete ' Cubic Feet:
�� ��
rl',��pe. of Construction : ^ A %� r�� ^_..,�'-" �' � � ..R EstimatEd Costs $ �' -- g--
�.0 L e C7c�r�iple�Led: � v it/ F l°S /'�/ �� .
' Alt� A A? �o B
I��cn�s�d Drivcway Wi.d�th If New Qpening Is Des.ixed: ,$ � t
,. . SE� RE'VEi2.S� SIDE Ok' SH�.ET .
�ie w;dersigned hc�rrby' raakes ap�licat�.un fas- a pe�:mi�t ��.r -thc work hc:z'ein sp�:r.i�ied,
agreei.a�g to do al.l w�rk in s�crict � ccord�zce wi�kh the City of ��:idley Ordinances a�id
xu.'�iiigs o� �iie Uc;pa.r'auent oi Buildu7qs, a�id hereby dec].ares t-hat al.l �Elze facts and
re�xe�r.ntations s�a�ed in �.hi� ap,��licat.ion arc true arid correc�.Q
DATE ; S IGi�I11'.CU I� s
�ti�u'lai:ions :
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� L'tJ11_1)lfv�����.i�r��> > ►-�:�� :,�:���_��u��� .
�J:C'P7.01�� 2. �'l�e :1:�y�.,�3ectc�r ot )sexi.].cli.>>�jr� .,1�,,3.]., l�ef.a�:c: 5.:.:��ui�srt ��ca�nit:s !.'o�: �he crc:c�inn
oi any l�u�.J.rl:i.»c� oz :.;tsucCtarc, or. i:r>r. a»� acl:l�.t:�.c,n t:c� ai�y ;-�xa.::L•i�uj Uuilcli.ncJ or. strucLure,
. ci1: fr�x r�ny ;il.t`erciti��t� ol:• �=el.���a.r. ; t.a •any c�.;.i.,i;�i�c� l�ui.lcl.i.��y or sL-�:ucturc, u��c�n ar�>>].].C:�1:).G�l
�L)�r_y:c.tcfr�, �cc�ui.l-c� t:l1e }���yrnciit )�y il�c �ZY�I�J.i.r:ant: i��r- ;ticli per.ina.L• of !.`ee, to ti�e amounL-
lic�rein b�^1o4� seL• forL•h �i��d i�i i�hc n�annen c�re9.n �i:oviclec3 L-a�-�•��.L•: � �
I�3:67 CC�.d..�'RUC'.�'IOP�1: S.i.riglc I.'r,�ni7.�� llomes and Gar.ar,cy: $4.00/1,000 cubi.c iec�. .
J'I,1�ta C1I1:CY: 25 ��ca°cent of l�ui.�cliru� },erjnii� fcee
llltl'VL•'ldnX lll�i'I2L•'SSXOi�l: (Concrctc, C'�ia_b �Lr.ceLa Oi��lyj � '
' 7�ltcrnrite 71: I:emoval and re��J_ricemen� o£ conr.rete curb and
giiL-tc� or11y; J��ive4�ay wicltli plus 6 fecL- x y:�,�,7�
7L1_ternat:e I3: }:emova�. and i-cp.l.�ZCrmenL' of. concreLe cuzb ��.nd �
• � ' Y gu�i:er and i.tlsta].J. a 3 �ooL- wide a�proacli �aiU1 ''
� ,� 6�.nch cl���t:li; Dr.ive�•�ay width }�lus G feet Y�17.85 '
. • . LLI��I T I O f� l� [�I ��L�_4 R'. ,�� /'� IT � N
0
I'ox the purpose of computi.ng fees for 131ii1d5.ng permit.;, tlle cubi_cal. conteni:s af any
l�ua.�.dinq ar addiL-ion, i.s deLermined by mult:;.p]_yany i.lie c�round area covered from a
poa�lt si}. (6) inclies bclo�r. i;he floor Iine o.� i;l�e basernenL or tJ�� cellar to the
�verage heighL-s ai the upner surface ar to the avezage height ai the r_oof suriace
af t2�e raain gabte of a pitch�d roof o �
rox rep�i.r_s or alterations io an existing sLructure, the fee shall be a� the rate
o� $3.00 Z�er cacii five hundzed dollars -�($500.00) or fraction t;.hereo� in t:he cast
a�' �.11 proposed �•,ork. . , '
Tn -no r.ase sl�al.l f;he fee cliaryed ior any permit as �et fcri�li in Sectian 2 be l.ess �
�han $7.50 plus $.50 state surchargeo � �
_ VERT F I CATIO�! OF FOl1;�D/IT I01�1
N�frr: Perma.L-� �or construcL-ion wi1]. be issued a rninimum of ?.4 hours frozn the �a.me
o� �,�plica;:iou i.o allow for pxoper xevie�•r of the pro,�osed sf�ructure �d o� ihe .
COi2S�xL1Ct:.lOI1 S].t.G.
21 Ccrti.��.cate o� Surve�� o� the lof:, showa.ng the location o� the foundation onc� a.t
has beer� eoils�zZicted wi11 be rec�uired before p�-oceed�nc� tvi.-t1i �.he framing.
Ct�RT I F I C.n�rr: o��� UP�CI'
' App'!i.catian fo.r, a Certificate ot Occu}��-�nct� shal�. he made ten (10) da�rs prior� �o the
use ox- occupancy of aiiy :.•t•ructure for r,aiiiri� a L,t�il.c?i_i�g ;�ern�it lias bc�en �.ssued� and
saic� �:i-ructurG shall uot be used o�: arcupied UI71�1.� �-� Ce�ti�i.ca�e o� Uccupancy has
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CHIlVIlITEY AND STACB VERIFZCATION
The undersigned hereby verifies that the -existing chimney or stack: ' ,
1. . Has been cazefully e� - Y( No O
2.. Is free &om n�st or de�terioration Yes ) No (�
3. Has no foreign objects lodged within � Yes',(y ) No O
4: Is securel rted Yes �/) No O
Y �PP�
5. Meets all current Code requirements for size
and to.*�1 BTLJ's connected Yes (� No ()
6 Has total heating BTU's of
All other BTLT's
TOTAL BTIJ's
7. Has a liner been rovided.for water heater ° es Na�S�) �����
P ( ) �.
8. Has combustion air be�n rovided for water heater Yes No � e'� J�
P ) �)
�T ��f` ��(� � c�S � ��-- ���� � C `� �'�.J .1V� � �.1
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1(1 b �115� `��J� �
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
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SuBJECT
c�ty oi Fridley
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T
�
� �
� �
� • COMMUNITY OEVELOPMENT DIV.
r � � � PROTECTIVE INSPECTION SEC.
� �
� � �"'1 � CITY HALL FRIDLE� 55432 NUMBER aEv
�""� � �'' 612-571-3450 910-F15
J08 ADDRESS 6218 Carol Drive NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
oesca. 3 2 Shorewood
2 PROPERTY OWNER MAIL ADDRESS
Susan Maile 62I8 Carol Drive NE
3 CONTRACTOR MAIL ADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW
OATE PAGE OF
6/10/97 � �
21P
ZIP
ZIP
❑ ADDITION ❑ ALTERATION �7 REPAIR
8 DESCRIBE WORK
Reroof House & Garage (27 Sq) Tear-off
9 CHANGE OF USE FROM
STIPULATIONS
TO
PE
�a��
RECEIPT NO.
����
APPROVED BV
SEE ATTACHED
SHEET
PHONE
572-1684
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
❑ MOVE O REMOVE
Underlayment must comply with the State Building Code.
TYPE OF CONST.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOFK OR CONSTRUCTION ZONING
AUTHORIZED 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. OWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPL�CATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOYERNING THIS TYPE OF WORK WILL BE COMPLIED �2�227
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �]/�,.75
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
SIGNATUAE OF CON � RACTOR OA AUTFIOA�ZED AGENT
��.:��.�L_ �' �"`°
NPu
IDATEi
����� � �
iDATEi
OCCUPANCV GROUP IOCCUPANCVLOAD
SQ.FT. CU.FT
OFFSTREET PARKING
STALLS GARAGES
SURTAX
�1.11
SAC CHARGE
Fire SC $2.23
T AL FEE
$78.09
VALID T THIS IS y�OUR PERMIT
� J .
qpTE
NEW
ADDN
ALTER
[]
[l
�-
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLiCATION
Effective 1/1/97
� �b I
�
ConstructionAddress: �r�l $ Co�—.o� �,1-c� �
Legal Description: _ ��'r-r��.. � "`"f t'�--4s�- �C-�P�- C.Q_
Owner Name & Address: S- � S GL�—,. 1�l\, J`I`a�.� e Tel. # S��_ �{o$�-
Contractor: �-i MN LICENSE #
Address:
LIVING AREA:
GA►RAGE AREA:
DECK A,REA:
OTI�R:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIP''rION OF IMPROVEMENT
Length Width Height Sq_ Ft.
Length . Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
. 8.�.s�k a� = �aa��.
Construction Type: _� � ` TT� ��1� Estimated Cost: $ ;_ � — - -- �.,
� (Fee Schedule on Back)
Drivevvay C�rb Cut Width Ne�ded: Ft. + b Ft = Ft x$ _$
DATE: �o—t �O --OS —j APPLICANr: �'�' �S.a�f—J�/i 1�J�,a.t.:� t Tel. # S Z�. � lo g�
�,�1 �� -
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 Valuation (1/lOth%)
$.50/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential �ontractors)
Alt. "A" or Alt. "B" Above
� $450.00 Conservation Pian Review
Fee Determined by Engineering
Agreement Neeessary [ ] Not Necessary [ ]
r--
$ � lC°�.D�
IiU(LDI�ti't� PE[tM(T' FEE SCHEDL�L[:
`I'lic Chief Building Official shall, before issuing permits for the erection of any building or structure, or tc>r
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 paymeirt by the applicaqt. fRr such permit of fees to the amount
herein below set forth and in the manner herein pcovided ta-wit:
TOTAL VALUE
$1 to $500
$501 to $2,OQ0
$2,001 to $25,000
$25,001 to $SO,OQO
$50,001 to $100,000
$100, 001 to $500,000
$500,001 to $1,0OO,OQO
$1,000,001 and up.
FEES �,
$21 {Minimum Fee is $21 plus surcharge)
$21 for first $5� plus $2_75 for each additional $1fl0 or
fraction thereof, to and including $2,000
$62.25 for first $2,� plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,OQ0
$349.75 for fust $25,0(}0 plus $9.(�D for each additional $1,000
or fraction thereof, to and including $$0,0�0
$574:75 for fii�st $50,000 plus $6.25 for eac�t additionai
$�1, 000 or fraction thereof, to and including $1 QO;OOU
$887.25 for first $1�0,000 plus $5.00 for each additionai
$1,000 or fraction thereof,_to and inciuding $5�,000
$2887.�5 for the first $500,� plus $4:25 for each additional
$1,0{}0 or fraction thereof, to and including $1,000,000 '.
$5012.25 for the first $1,(�00,000 pius $2.75 for each additional
$1,0� or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C1urb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - DriveLVay width plus 6 feet times $13:�0_
Alrernate "B": Removal and replacement of curb and gutter and instail a 3 foot wide
approach with 6 inch depth - Driveuray width plus 6 feet times $15.75.
VERiFICATION OF FOUI\TDATIOti
i'ci-niits for construction wi(1 be issued a mirumum of 24 hours from the time of application to. ailo� �or pro.�?er
'evietiv of the proposed structure and of the construction site.
'� Certif icate of Survey of the lot, shawia� the (ocation of the foundation r,ilce it has it has been construc� _• _f
��;�1 h�� rcquired h�f�re j�i-c�ce;edin�� �vith tl�e framin<�:
sue�ecr R�RMIT NO.
City of Fridley � 2 5 7 9 3
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��—^ -
r
; � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
i i V �������
r � � PROTECTIVE INSPECTION SEC. �� �
� j �
� ���'1 � CITY HALL FRIDLE� rJSd$P NUMBER REV DATE PAGE OF APPROVED BV
�"""�"� �`' 612-571-3450 9�0-F15
2/6/98 / /
JOB ADDRESS 6218 Carol Drive NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 2 Shorewood SHEET
2 PROPERTY OWNER MAIL ADDHESS 2�P PHONE
Susan Maile 6218 Carol Drive NE 572-1684
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNEFi MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIIADDRESS ZIP PMONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION �] ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 OESCRIBE WOiiK
Basement alterations to finish room; add closet
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
SEpA�a� �����RS ��
WtRO(��, N��"i��t�, i'�.ii��i"r3tlN���q ��
�� S��N�
SEPARATE PERMITS ARE REOUIRED 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 SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTqUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PEF;IOD 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 ]. STAILS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT �Z�OOO y�I..00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE Of CONSTRUCTION �CZ.ZS Fire SC �Z..00
PLAN CHECK FEE T07AL FEE
$65.25
SIGNATUREOFCON'RACTORORAUTNOFl12EDAGENT IDATEI WHEN PROPERI �I,IDATED THIS IS VO R PERMIT
�C,c��-7'�?��S-i. 2 b --Rg �y� �'�L�
SiGNATURE OF OWNEA i�F OWNER BUILDERi IOATEI s�� ip5p paTE
NEW
ADDN
ALTER
[]
[]
�
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
,�����3 �
L � ✓
ConstructionAddress: ��-� S C �° � �`�` � �� � �'�"y
Legal Description: �- 5� �-�—� �
Owner Name & Address: ����.-��� �� �°� �"r Tel. # J��= 1�'��°f
Contractor: � MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER: ��
�-� Y� ^
Construction Type:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length �1 � Width �'`�` g 9� Height �� Sq. Ft.
Length Width Height Sq. Ft.
�ng� Width Hgt/Ground Sq. Ft. �
�.� t s���e a � r� ;�-s.�.\�t•` a�-- �- e��-nn�r.�-� cl w=�-��--�
�r � _ i .� '- -
Driveway Curb Cut Width Needed:
DATE: � �� g
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
5'TIPULATIONS:
APPLICANT:
$ 2 ��
$ ��
� �� �
$
$
$
$
$
$ _
� ��2�
�
Estimated Cost: $ �"���
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x$ _$
� - - - ��--•��
.—_ - - —
0
CITY U5E ONLY
��
Tel. # �?�.°" 51°��-
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 [ ]
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
$501 to $2,Q00
$2,001 to $25,000
$25,(�1 to $50,000
$50,001 to $10U,000
$100,�1 to $SQO,Q00
$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
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each a��ditior
$1,000 or fraction thereof, to and including $1 ,000
$887.25 for first $100,000 plus $5.00 for each a ditic
$1,000 or fraction thereof, to and including $500 000
$2887.25 for the firs�$500,000 plus $4.25 for ea�ch additional
$1, 000 or fraction thereof, to and including $1, 0(�0, 000
$5012.25 for the iust $1,OU0,000 plus $2.75 for each additional
$1,000 or fraction thereof �
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.SQ.
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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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City of Fridley 3 0 8 � 2
, AT THE TOP OF TNE TWINS g � �� D I N� P E R M I T
r
; � RECEIPT .
� ; � __��� COMMUNITY DEVEIOPMENT D1V.
r � � PROTECTIVE INSPECTION SEC. C���.d�!
I = �
� r"'1 � CITY HALL FFiiOLE� SS:3P NU41Q@A pEV DATE PAGE Oi A�iROVED BY
�----�: �.� 612-571-3450 9tQ-F15 4/28/00 � �
JOB ADDRESS 6218 Carol Drive NE
t LEGAL �07 NO. BLOCK TfiACT OR ADOITION SEE ATTACHED
OESCR. � 2 Shorewood SHEET
2 PROPERTY OWNER MAIL AODRES$ ZIP PHONE
Susan Maile 6218 Carol Drive NE 763-592-1684
3 CONTRACTOR MAIL AODRESS 21P PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNEii IWAIL ADDRE3S ZIP PHONE UCENSE NO
5 ENGINEER MAII ADDRESS � 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ AODITION C1X ALTERATION 0 REPAIR � MOVE ❑ REMOVE
8 OESCRIBE WORK
Bathroom finish
9 CHANOE OF USE FiiOM TO
STIPULATIONS
See notations on plan.
SEPARATE PERMITS
REQUIRE6 FOR:
��u��eN�� aNDnsi���
TYPE OF CONST. OCCUPANCV GFOUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAI, PLUMBING, MEATING,
VENTILATING OR AIR CONDITIONING.
TMIS PERM�T BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING SQ. FT CLL FT
AUTHOR�IEO IS NOT COMMENCED V�!ITHIN 80 DAYS, OR IF CONSTRUCTION
Ofi WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DW�G. UNITS OFFSTREET PARK�NG
I HEREBY CERTIFV TNAT I HAVE READ ANO EXAMINEO TNIS APPLICA710N 1 STALLS GAfiAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND OROINANCES GOVEqNING THIS TYPE OF WORK WILL BE COMP�IEO �S �SOO ' �2. %S
WITH WHETNER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHOfiITY TO VIOLATE OF CANCEL THE pEFMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR IOCAL LAW REGUTATING CON-
STRUCTION OF THE PERfORMANCE Of CONSTFiUC710N $125.25 Fire SC �.5.5�
PLAN CHECK F TOT FEE
$ 33.50
S�GNATUAE OF CON'NACTOp OA AUTMOAIZED AGENT IDATEi EN PE Y ALID TE 7HIS IS VO P RMIT
� '-l-��'�� ��
$�GNeTUQE O� OWNEQ��� OWNEpBU�LDEF1� iD�TE� -�� ' ipgo qpfE
NEVN [ J
ADDN []
ALTER [ ]
Construction Address:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
e� �a � � �' �c ( `�--
Effective 1/1/200
(763) 572-3604 Bld�
��� � �
I� � ���
Legal Description:
Owner Name 8� Address: �t� SS °� � 1'�1 � k c P � Tel. # � ��� �S �,,2 � ���'�%
Contractor. �� c� S �c. c.� INi %� � e F� �p MN UCENSE #
Address:__ � �- / � c.. cc. � n ( � � r � f �e �p 9 �c� �� y Tel. # ��3 - S �� � l � ��
_ ,
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
Construction T �
ype: ��c� �� V� oo �t �,� P9,S � Estimated Cost: $ ��
Driveway Curb Cut Width Needed: Ft. + 6 F��_Ft x$ �P --�
DATE: a� APPLICANT: G��.2 Tel. #�F�3 `�7�v2 � I�� i
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $��,�, �� Fee Schedule on Reverse Side
Fire Surcharge $ � o��,� .001 of Permit Valuation (1/10th%)
State Surcharge $ � � °7� $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ $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
$ Agreement Necessary [ ] Not Necessary [ ]
� �� s �
`�3, .�
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
$501 to $2,0�
$2,001 to $25,�0
$25,�1 to $50,000
$50,001 to $100,0(�
$1�,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23 .50 for first $500 plus $3.05 for each 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 $50,0� 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 $SOO,OW
$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 fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete G�urb Streets Only)
Alternate "A": Removal and. replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and 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 to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Oniv
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacing an existina furance, the undersigned hereby verifies that the
venting has been examined and is free from nast, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastiGPVC and meets all current codes and manufacturer
spec�cations 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 Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
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To meet the current codes and manufacturers specifications.
Yes ( ) No ( )
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Yes ( ) No ( )
When installina a new ventina system, the undersigned hereby verifies that
it is a listed assembly and meets the cuRent codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ( �
Aapliance Tvae and Size/Common Vent and Vent Connector Infiormation
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
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: (Describel
HEATING CO:
Signed By: Date :
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NOIl�/�I�Ia3A 211V NOI1Sf19W0� aNb� a01�3NN0� 1N3A 1N3A NOWWO�
sue�ecr PERMIT NO.
c�ty of Fridley 323 � 4
AT TME TOP OF THE TWINS � u I L D I N G P E R nll I T
r
; � RECEIPT NO.
� • COMMUNITY DEYELOPI�I�NT OIV.
� �v � PfiOTECTIVE INSPECTION SEC. ��° ��
r ; ,
� .1 ,
� 1 �""1 � CITY MALL FRIOLEV SS13Z NUMBER pEV OATfi PAGE OF ACPROVED 8Y
�'"""�� �'' 612-571-3450 910-F15 11 / 13 / O 1 / /
JOB ADDRESS 6218 Carol Circle NE �
t LEGAL ��T NO. 9LOCK TFlACT OR ADDITION SEE ATTACHED
DESCR. 3 2 Shorewood SHEET
2 PROPERTY OWNER MAIL ADORES$ 21P PMONE
Susan & Emil Ra.smussen, 621� Carol Circle, Fridley, MN 763-572-1684
3 CONTFiACTOF MAIL ADORESS ZIP PHONE UCENSE NO
Norwa Construction Co., 3414 43rd Ave S, M ls, MN 55406 612-721-0332 20245619
4 ARCHITECT OR DESIGNEFi MAIL AOORESS ZIP PHONE IICENSE NO.
5 ENGINEER MAIL ADDFiESS ZIP PHONE LICENSE NO
8 USE OF BUIIDING
dwelling
7 CLASS OF WORK
Q7 NEW � ADDITION 0 ALTERATIQN ❑ REPAIR ❑ MOVE �❑ REMOVE
8 DESCRIBE WORK
Replace 7 windows
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulking & flashing
for all exterior openings.
SEPARA7E PERMITS ARE HEOUIRED FOR ELECTRICAL, PLUMBING, HEATING. �PE OF CONST. OCCUPANCY GROUP OCCUPANCr LOAD
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUGTION yONING SO. fT CU FT
AUTHORIZED IS NOT COMMENCED VYITHIN 80 DAYS, OR IF CONStRUCTION
OR WORK IS SUSPENDED OR ABANQONEO FOR A PERIUD OP 12p DAY$ A7 �
ANY TIME AFTER WORK IS COMMENCED. ° NO. DWLG. UNITS OiFSTREET PARKING
I HEREBY CERTIfY THAT I HAVE READ ANO EXAM�N�O THIS APPLICATION STA�LS GARAGES
AND KNOW THE SAME TO BE TAUE AND CO�i�ECT. AlL PROVISION$ OF LAW$ VA�UATION SURTAX
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL �E Cf�MPUEO �S � HOO . OO �B� L. 9O
WITH WHETMER SPECIFIED HEREIN OFi NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMOiiITY TO VIOLATE Ofi CANCEI THE pEFM17FEE SACCHARGE
PROVISIONS OP ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �],ZS . ZS re SC �S . SO
PLAN CNECK FEE TA� FEE
Lice e 5. $138.95
5 Tut�E N'AACTOAOp4UTHOp�ZEOAGENT ioArEi HE Pfl LV VA ID TED TH�S IS YOUR PERMIT
� w ll ���
S�GN4TURE O� OWNEA��F OWNEp BU4D.EAi � �OATEi . �� G� �N$ QctE
N� [ J Effective 1/1/2001
ADDN [ J , CITY OF FRIDLEY ,(763) 572-3604 Bldg Insp
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: �A�4� ���t ����- �� �� S�-`� �
Legal Description:
Owner Name & Address:
Contractor: N�
„ ��____. 3�\�-
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
b
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, with
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1.�tJ SS�
` �,°e. Tel. # `Z �3-57Z-1 �8 �-
MN UCENSE # �'�`�--�Sl�i°�
Tel. # %� 2 -� �7'�t ��°3 �
plication, a Certificate of Survey of the
osed construction drawn on it to scale.
OESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width
Sq. FG
Sq. Ft
Sq. Ft.
1��
Construction Type: �/�! ' ate Cost: $�/��% �
Driveway Curb Cut Wdth Needed: Ft. + 6 Ft = Ft x� _�
C
DATE: � � APPUCANT• v�s��� Tel. # ��3°�`7�'���t"
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$���a-� Fee Schedule on Reverse Side
$ ��G .001 of Permit Valuation (1/10th%)
$ o% �l� $.50/$1,OQ0 Valuation
$ / $1150 per SAC Unit
$ `��p $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 [ J
, �
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BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pemuts 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 amvunt herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $5�0
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,OG1 to $500,000
$500,001 to $1,OOO,Q00
$1,000,001 and up
FEES
$23.50
$23.50 for first $S00 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,OOQ
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
$6�3.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Pernuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed 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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City of Fridley 3 014
�
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
� � COMMUNITY DEVELOPMENT DIV. RECE PT
� •
� � �: ----- �
r � � PROTECTIVE INSPECTION SEC
1 r
l---- A ��'��,'j CITY HALL FRIDLEY 35432 NUMBER NEV DATE VAGE OF AVPR ED BY
L J` 763-571-3450 910-F15 8/23/02 / /
108 ADDRESS 6218 Carol Drive NE
1 LEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACHED
DESCfi. 3 2 Shorewood SHEET
2 PROPERTY OWNER MAIL AOORESS IIP PHONE
Emil & Susan Rasmussen 6218 Carol Drive NE 763-572-1684
3 CONTRACTOR MAIL AODRESS ZIP PMONE LICENSE NO
Same
4 ARCMITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZiP pHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION �J REPAIR O MOVE O REMOVE
8 OESCRIBE WORK
Reside original house & garage
9 CHANGE OF USE FROM T�
STIPULATIONS
Per Section i402, 1997 Uniform Building Code, requires that a weather resistive
barrier be pl2ced over exterior sheathing to protect the interior wail covering.
Exceptions for this provision would be if sheathing is an approved weatherp�coo�
panel or when the siding is an approved weather barrier. Vinyl siding is not �.
weatherproof covering unless the �ma.nufacturer states �his in their dpplication
guidelines. Ga11 for inspection of wrap before covering. Caulk and flash alI
exterior openings.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARA7E PERMITS ARE REQUIHED FOR ELECTRICAI, PLUMBING, HEATING.
VENTILATING OR AIR CONDI710NING
TMIS PERM�T BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING S0. FT CU FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS. Op IF CONSTRUCTION
OR WOiiK IS SUSPENDED Oii ABANOONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AF7ER WOiiK IS COMMENCED. NO DWLG. UNITS OPFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICA710N 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS yq�UATION SUiiTAx
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED
WITM WMETHER SPEC�FIED MEiiEIN OR NOT. TME GRANTING OF A PERMIT �SOO �.SO
DOES NOT PFiESUME TO GIVE AUTMORITV TO VIOLATE OF CANCEL TME pERMIT FEE SAC CHARGE
PROVISIONS Of ANY OTHEF; STATE Oii LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFOFiMANCE OF CONSTRUCTION �23.SO Fire SC �.SO
PLAN CNECK fEE TOTAL FEE
$24.50
SiGN4TUAE OF CONCRACTOA Op AUTMOp�2E0 oGENT �DarE� HE PR LV VALIDA D THIS IS YOUR PERMiT
� `�'-?�{��- • 8 _.Z� -D�-
.
S�GN4TUAE Oa OWNEQ��� OWNEA BU�LDEA� �DATE� Bl G�NSP ncTE
�
NEW
ADDN
ALTER
[� CITY OF FRIDLEY Effective 1i1/2002
(� 6431 University Ave NE, Fridley, MN 55432 (763) 572,3604 Bidg Insp
( J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
Construction Address: � � S�S �"�, �� �=
Legal Description:
Owner Name 8 Address: �-M-` �� S�*s���`-5�- Tel. #%�3 `S��"-�,4���
Contractor. ���'-� MN LICENSE#
Address: Tel. #
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width HgUGround S�. Ft
�G'� �� � P� 4�� �. �- ���- '� . °�� � ,
Construction Type: �� �"'� ' � Estimated Cost: $ ��
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: $'� � �� APPLICANT: Tel. #��� -���-��°.�'�
Cail (763) 572�604 fo� Pertnit Fees if mailing in appiication or 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
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ ��
$ . S�
$ �
�
$
$
$
�
$
$ L-�c�
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:
��
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
$2,001 to $25,000
$25,(�1 to $50,000
$50,001 to $100,000
$100,�1 to $500,000
$500,001 to $1,000,000
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $1(� or
fraction thereof, to and including $2,000
$69.25 for first $2,0� plus $14.00 for each additional $1,0�
or fraction thereof, to and including $25,0(?0
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $SO,OQO
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,(�0
$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,OQ0 or fraction thereof, to and including $1,�0,000
$1,Q00,001 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 times $17.00.
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.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing
proceeding with the framing. New Houses Onlv �
�
foundation will be required before
sue�ecr PE NO.
City of Fridley 3 7 5 6
AT TNE TOP OF THE TWINS g � I L D I N G P E R M I T
i � RECEIPT NO.
� �` ���� COMMUNITY OEVELOPMENT DIV
r � ~ � PqOTECTIVE INSPECTION SEC �/��
i �
i-_-- A �/'�',,, CITY NALL fRIDLE� SS��Z NUMBER REV DATE PAGE OF APPROVED BY�
1 '� 763-571-3450 910-F15 8/1/03 � /
lOB ADDRESS 6218 Carol Drive NE
1 LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 3 2 Shorewood Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Susan & Emil Ra.smussen, 6218 Carol Drive, Fridle , MN 55432 763-572-1684
3 CONTRACTOR MAIL ADDRESS 21P PNONE LICENSE NO
Same as above
4 AfiCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO
5 ENGINEER MAII ADORESS 2�P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION p ALTERATION O REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
Replace patio door with entr door• remove ara e bum -out.
9 CHAN(iE OF USE FROM TO
STIPULATIONS
See notations on plan.
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code.
Caulking and flashing for all exterior openings.
SEPARATE PERMITS ARE REOUIREO FOF EIECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID If WORK OF CONSTRUCTION ZONING SQ. FT CU FT.
AUTHOR12E0 IS NOT COMMENCEO WITHIN 60 DAYS, Ofi IF CONSTRUCTION
OF WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED NO DWLG. UNITS OfFSTFEET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND E%AMINEO THIS APPLICATION STALLS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS yALUATION @SURTAX
ANO OROINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED $1 200.00 y�.GO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT �
OOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEpMITfEE SACCMARGE
PROVISIONS OF OT R STATE OR LOCAL LAW REGULATING cor,. �44.85 Fire S L. ZO
STR ONQOR RMANCE OF CONSTRUCTION
PLAN CMECK F TOTAL F E
$46 6
S�GNGTUpE OF CON'AACTOp Op 4UTHOp�ZEO AGENT IO�TEi �1�1 E PAO Y VALIOATE S I V PE M T
S�GN4TURE0%OWNEA���OwNEABui�DEAi �D�rE� B OG �NS� �� E
NEW
ADDN
ALTER
�� 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 Fa�c
BUILDING PERMIT APPLICATION
Construction Address:
� � � � � `P � � � � � � � �-
Legal Description: •
Owner Name & Address: ��✓S�ti�''� `� �'�`'t � ` �.`Ls � e0� � � Tei. # �� �5 1�� - � � ��
Contractor. �� �� C�c.eJJ 12 e� MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certificate of Sun�ey of the
lot, v�ith the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length �dth Hgt/Ground Sq. Ft.
OTHER: -�
,p P' .� °d �- � �.� �. ��� ennv� ����y-� �r�j'•-vv
�,.� �1 � � �e a � �o �° OG
Construction Type: Estimated Cost: $ �� � V
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
s�� DATE: � � �� APPLICANT: Tel. #
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
TOTAL
; i ,,,
,� -
,�; ; : �
�
;
�-
•,��" ,',
.; �.
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 per SAC Unit
$5.00 (State Licensed Residential Contractor�)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
•►�
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
$501 to $2,000
$Z,001 to $25,�0
$25,�1 to $50,000
$50,001 to $100,000
$1(�,001 to $500,000
$5�,001 to $1,0�,000
$1,(�0,001 and up
FEES
$23.50
$23.50 for first $500 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 $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $SO,Q00
$643.75 for first $50,000 plus $7.00 for each additional
$1,Ot� or fraction thereof, to and including $100,(�00
$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 $500,0� plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,�0,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,�0 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate.
Permits for construction will be issued a minimum of 24 hours from the tune of application to allow for proper
review of the. proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
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