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SUBJECT
City of Fridley PERMIT NO
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i � - - -
� � RECEIPT NO.
� �L ______ COMMUNITY DEVELOPMENT DIV.
r j � PROTECTIVE INSPECTION SEC. /�6 �
� . ,
i
l-_-_ � �����,,� CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE F PRO
s �� 612-571-3450 910-F15
10/21/80 � �
JOB ADDRESS 6221 Carol Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 4 3 Shoreraood Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
3ames Skurich 6221 Carol Drive N.E. 571-3507
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OFi DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
�� Residentia.l
7 CLASS OF WORK
❑ NEW ❑ ADDITION �I ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install class "Bn Chi.mney for forced ai.r gas furnace
9 CHANGE OP USE FROM TO
STiPU LATION S
S EP��q �-E
�lEATatV� �ER�fT� �EQ�r��D
. P�CIAA� J�� ��� �t� FpR �,�I��H
�►S0
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT.
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 OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOiiK WILL BE COMPLIED �`]_OO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $.5O
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
$TRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S7. rJO
PLAN CHECKFEE TOTALFEE
�S` 8. �0
GNATUREOFCONT A TORORAUTHORIZEDAGENT . IDATEI WHEN PROPERLY L DATEO THIS IS YOUR PERMIT
n
� � � �s � — ' �t�' /� �c�
GNATUREOFOWNERiIFOWNEPBUILDERi t ATEI �— BLDG WSP DA E
' • ° •�
CI7Y Of' FRIOLCY -
, kf'�'LIC/1'fI0'� �OiZ !,l:SI[)1:(�lTI/',i_ QUILDIitG f'CR,t�iTTS
���C1�1, Al �erai:ions, /l�iditions, ar Rcnairs)
' ot�t��a: S� V� l c�f
ADORESS: � 2 2 ( �i4,� �- � � � �� !U�
TEL �0: �7(— �So�
0
[3UI LpER : _ �63y-�1 � � .
_-_________
/1DDRCSS: •
TCL i�d0: •
� ���� Consl:ruc�ion Loca�ion °
. sTZU��c rio : &TREET: _ C � +e-o � � � � U � � � _ . .
Lox: C� sLOac: � r�nnzTZO�r: S`
Corner Zot: Insic3e Lot: IC SetbacY.: • Sideyards:
Ap�licant at-tach to this Eorm tcvo Cer�ita.cates of Sux�rey of ].ot and
proposed building �.ocati.on drawn on certificates to scale. _
�
UESCRIPTIOid OF COt�1STRllCTI0P1 -
� i �+ �V ' rront: Depth: Height:
�c�u�e. k'eet: C�ttbic Feet: .
Front: Depth: Heiqht:
Square� Feet: Cubic I'eet:
9 (�� 1t � 9
Type of Co�ls�truction: �v� ( f� C��SS � t��� � Esi:imai.ed Cost: $�� --�
� . G`�l . . �
Zb Be O�r,:pleted: �� — � O 2 .
` . _ Alt. �1 Alt. B
Pro�osed Arive�ray Width If New Openinq is Desired: $' $
. . , SEE �VERSE SIDE OF SiIEET
7.iie undexsiqned hereby ma}:e� applic�tion for a pernlit fcr the t.nrk herei.n specified,
agreeinc� to do .all war3: in s�rzct accordance �•�i.th the Ci4y of �'ridle�� Ordinances and
xulings Qf the Del�zrtme.��t of Blii.ldings, and hei-eby declares that all. the tacts and
zepresent.�ta.ei2� stated :n this applicatian are true azid correct.
D.'�TF: D 2� �� SxGNATUI'�;;
S�iz�ulations :
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S).:C'rr01�� 2. �'3.'1�L 7n�.cJ�ccic�r.' oL• lzui.lc?in�t :::hri).)., ticfv�:r. i.r, .ui�u� ��c�init� tor t:hc c.rc:cLi.on�
uf .���y l�u�.l.rl.i.r��! ar :,i_�•uct:ure, w- fc»: any .idQi.i:S��n +�r� ai�y cr,i::L•a.»g l�uildincj or ::LYUCLur_e,
, ci�- !`a�� a�iy a1.1:c�rt�t:ic-�ti or. r.cl�air.:� L•o •any c;:i. .1.i.n�� hai.t.di.�i�� oz sL�.�uc:ttirc, u���ri ar����.i.c:ati�n
'i:lir..r.�for.c, r.cqui�:c tJi� pa}�mc��L ?�y t1�c ���;,p].i.c:arzl: f:o�' ��ucl� per.mi.L• ol.� fec.^, fia Llic mnount-
hcz�in bcJ.c�t•� sr.0 for.th aiicl �.�i i:1ic manric�: hcrei.n p�:ovxdaci ��-�•::i.C: •
I;l.t•7 COIdS`I7:UC'xIOtJ: Si�ig7.e ]?amil.y Ilotaes anci Gax��t{es: Y9.00/7_,0�0 cul�ic £'ec:�.
I?L1�F•2 C113:C1:: 25 l�cr.ccl�t: oL- bu�.�cli�lg }�er.�niL iee. ,
U1t1:VI:l•'11Y llL•'1'P1:SSX01•:: (CancreL•c_ Cuxb �trceL-� Only) �
• R).tern�li:e R: lu:�noval �I1C3 Y'Cj)�.itC:�ment of conczete cuxb and
gutL•er only; l�rivea�ay �•ridt}i p]_us 6 feeL• Y�:�..�',.75
111.L�ernatc II: Removal and zeplacemcnt of concrete curb and ..
, guL-ter and iiist� 11 a 3 £oot ��ic3e approach ���it:h
' . 6 a.nc}i depth; Dri��evray �aidth �plus G£'eet x$17.85 �
. . AI�pI i 1ON/1L_ IP�FOR[�"�l�TIOP!
I'or the purl�se oi co�npui:�_ng �ees far. building permits, L-he cubi.ca]. contents of any
buil.di.ng or addition, is deicr.mi.ned by rnultipzyisig ':he ground area covered from a
p�i.nt si.s: (6) inches belof� the �loor J.9ne oi L-he basemeni: or tha cellar ta thc
averaqe heights oi L-hc �upper surface or to ihe average iieight of the roof surf_ace
oi tlie raain gahle of a pi.tched roof. �.
For. ze�airs or al.teratians to an exista.ng stZ-ucture, f.he fee shal7: be at the xate
..of $3.00 rer. each five hundred do�lars °($500.00) er fraction L-hereof i.ri the cost
ai' all proposecZ wor.Y. . . �
In •no case sha3.l �he fee cliargeci fc�z any pp�nnit zxs set ior�h. �n Sectian 2 be less �
than $7._ 5_ 0 pl.us $.50^state surcharge. � '
� � � V�R1'FIC,�TIO�! OF FOU�tiD111"IOfd
0
' N�'IE: Permits .�ar construcL-ion wrill be isstted a minimt� ai 24 hours �rom ihe tim�
nf ��Plication to al.lo�o for proper revieca of i:he proposed structurc and vi the .
construction site.
, A Ceri:ificate � of Survey of the l�t, sho<<�ing the location of the foundation once S.t
( has been cons�nicted �eill be required before pr.oceeding �•rith the �rami.nq.
� TL-�FI�LLT� OF O�.GUPA(�Cti' . .
' 71PpZication f:or a Certificate oi' Occupaz�cy shall be mad�� ten (10) days prior L-o the
u::e or OCCL1r�IlCj� ot any st;ruciure for �rhich �i ��illl.t�l_11C3 k?CLIiIl� }:as been issued; and
stiicl struct:ure shal� �iot l�e used or. occuyied L:nL•il a Cez:i;�.ticlte Q� OCCUj�ill'iC�► has
becn issued.
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�
SUBJEC7
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
;,
,�
; �L _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
L� S �
._--� ��"' �`� CITY HALL FRIDLEY 55432 NUMBER REV. DATE
L 612-571-3450
910-F15 7/7/86
JOB ADDRESS 6221 Carol Drive N. E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 4 3 Shore�rood Addition
PAGE OF
� �
BPER NO.
11� 18527
RECEIPT NO.
�/�! �
APPROVED BY
SEE ATTACHEO
SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Slsirch 571-3507
3 CONTRACTOR MAILAUDRESS ZIP PHONE UCENSENO.
T. C. Construction Co. 7685 Wedgwood Court, MAELE GROVE 55369�. 420-3334
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW
� ADDITION ❑ ALTERATION ❑ REPAIR p MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 20` x 20' Addition to Re�r of D�elling
9 CHANGEQFUSEFROM TO
STIPULATIONS .
Install fire alarm
SEPAR�4TE �'�R�ItiTS ����REa ���
wiRO��i, ��►�ii�i�, ��.c����.�. ��� ����s.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBIN(3, HEATING, �PE OF CONST.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK 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. DWLG. UNITS
I HEREBY 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 yS`Z].. %rjO
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
TRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
� AN CF
���-.�, �. �-�-p;�
SIGNATURE OF CONTRACTOP OR AUTHORIZED AGENT IDATEI
SIGNATUREOFOWNERiIFOWNERBUIL�ERi IDATEI ` �
152.
.13
���d�� ����/
1"E��'jrHpd���ih,� �� ��
R� ��. �����i� �� ���,�;��
Q���,�� � �� �.��
� �� �
OCCUPANCY OROUP
SQ. FT.
OFFS'
STALLS
OCCUPANCYLOAD
CU. FT.
REET PARKING
IGARAGES
1X
$1.�. $8
AL FEE
� 201. 51
iIS aS
NEW
ADDN.
ALTER.
� �
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City of Fridley
R-1 AAD R-2
Building Permit Application
Construction Address: �°% �� � ��� �� ���
�
Effective 4/1/86
Legal Description:
Owner Name & Address:
� • �- � .���� Tel. � S�7/ - .��d�
Contractor: �� �• �� � �° � Tel. � `�v� �S 35�
Address: ���� w-r�� N� ��� ��Q ,�� � ���� r
LIYING AREA:
GARAGE AREA:
DECH AREA:
OTHER:
Corner Lot [ ]
Attaeh to this applieation, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to seale.
DESCRIPTIOA OF II�IPa09EI�+�NT
' P �
Length a b �lidth o� � Height � Sq. Ft. ����
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
6 � .��r = �D. � � Za � °° � � 7—
Inside Lot [f] Ft. Yd. Setbaek Side Yard Setback �
Type of Construction: �/�" ��z�
s� � s�.
Approx. Completion Date:
,
Estimated Cost: $ ��
�? I, 7�. C�ee
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: C� � 3� � P �° APPLICANT : 1 �• �� � � � Tel . � �� � �S 3'�"
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
CITY IISE ONLY
$ .� �� Fee Schedule on Reverse Side
$ ��5.�� 25� of Building Permit Fee
$ ��•� � $.50/��,000 Valuation
$ � $�}75 per SAC Unit
$ " Fee Determined by Engineering
SeWer Main Charge $
�� �-� Agreement Neeessary [ ] Not Necessary [ ]
TOTAL $ "�
STIPULATIONS : �� %j , � � �C7 Cj C/'� � � � �SI(� ,J
�
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��� �
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f � �
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BIIII.DING PERMIT FEE SCSEDIILE
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 strueture, 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 smount
herein below set forth and in the manner herein provided to-Wit:
Total Valuation
$1.00 to �500.00
$501.00 to $2,000.00
Fees
$10.00 (Minimum Fee is $15.00)
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraetion thereof, to and
including $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $�.50 for each
additional $1,000 or fraction thereof, to and
including $50,000.
�50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1�000 or fraetion thereof, to and
ineluding $100,000.
$100,00"I.00 and up
$433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEWAY DEPRESSION ESCROiI
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13.50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approaeh with 6 ineh depth - Driveway �idth plus 6 feet times $15.75
VERIFICATION OF FOIINDATIOA
Permits for construction �till be issued a minimum of 24 hours from the time of
application to allow for proper review of the proposed structure and of the
construetion site.
A Certificate of Survey of the lot, showing the location of the foundation onee it
has been eonstructed will be required before proceeding with the framing.
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Su8JEC7
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.
r j L � PROTECTIVE INSPECTION SEC.
l, _ ,
•-__� ��"" ��� CITY HALL FRIDLE� 55432 NUMBER
L 612-571-3450
910-F15
J08 ADDRESS 6221 Carol Drive N. E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. t,� 3 Shorewood
2 PROPERTYOWNER MAILADDRESS
Jim 5kurich 6221 Ca,ro1 Drive N E
4
REY I DATE
['7
TRACTOR MAIL ADDRESS Z�p
T.C. Construction Co. 7685 Wedgwood Court, Maple Grove
HITECT OR DESIGNER MAIL ADDRESS Z�p
PAGE OF
� �
_18540
�.�3��
APPROVED BV
SEE ATTACHED
SHEET
�HONE
571-3 50 7
�HONE LICENSE NO.
420-3934
�HONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE ' UCENSENO.
8 USE OF BUILDINC3 .
RG'S].CZE11'kla]. ` "
7 CLASS OF WORK
_p NEW ❑ ADDITION ❑ ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WOHK
Construct a, 24� x 24' Detached Ga,rage and reduce attached garage width by 6 feet
to obta:i.n more room to lot line.
9 CHANOEOFUSEFROM TO
STI PU LATIONS
Provide a hard surface driveway tA new garage, three feet off froan lot
line unless written permission to go closer is obtained frc� the neighbor.
Convert paxt of ex%sting, remaining garage to living area by ti.me new gaxage is
finished.
SEPARATE PERMITS RE�U�RED Fp
-w���N�,. HEATING, PLUA�IB�N� ANp �
���r�sv
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONS"i
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK 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 AFTEF WORK IS COMMENCED. • N0. DWLG. U�
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED THIS APPLICATION 1
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 +�7 tQ67
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. yS`68.SO
TURE OF CONTi}pCT(qR OR AUTHOR,EZED AGENT IDATEI
� tl dl v G/
R BUILDERI IDATEI I,��-BLpG i
8efarc ; ' ���� �
TE(EpyO���g �,�� ���` �
IQFQv� Eb �t �'cf�,� eA airr;�s
REp � r SErE
[q �,,
• OCCUPANCY(iROUP OCCUPANCYLOAD
SQ. FT. CU. FT.
OFFSTREET PARKIN(
STALLS GARAGES
SURTAX
$3 . 53
SAC CHARGE
TOTALFEE
$72.03
RLY V�DATED THIS IS YOUR PER
NEW [ City of Fridley Effeetive 4/1/86
ADDN. ] R-1 AND R-2
ALTER. [ ] Building Permit Applioation
Construction Address:� � 2� �- �.V`o f !f f^ 11O ��
Legal Desoription: �i 6� � 4Odc� b�lv�l� 5� �'1�S i
owner Name & Address : �� M� � �(� � L G %�- ,/�(v �- �� C` Q /� f o � ��' Tel . � s�' ? �- � 5°D�7
Contraetor: � c �A �1 � ]� [�'c�c� I o {1 Tel . �
Address:
Attach to this application, a Certifieate of Survey of the
lot, with the proposed construetion drawn on it to scale.
LI9ING AREA:
� �_,�� GARAGE AREA:
DECR AREA:
' OTHER: � R�
d ���
Corner Lot [ ]
DESCRIPTIOA OF IMPaOYEMENT
Length iiidth Height Sq. Ft.
Len�th �'.� �' Width `�.. �4 P Height 1�._ Sq. Ft. �7
Length
� �y � i a°r�•
Inside Lot �]
Type of Construction: ��'� r�l�
Approx. Completion Date:
Width Hgt/Ground Sq. Ft.
� �� � � � � d -tl� b � � � � �F� �`o ��1� 1 t�,��
�
Ft. Yd. Setbaek �
r
Side Yard Setbaek �
Estimated Cost: $ � 1�.`1ie�
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
BATE:
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
APPLICAIJT: Tel. �
CITY IISE ONLY
,
$ �.�'t�
$
$ ��
�
$
$
$ � .0 3
Fee Sehedule on Reverse Side
25� of Building Permit Fee
$.50/$1,000 Valuation
$�175 per SAC Unit
Fee Determined by Engineer3ng
Agre�ent Neeessary [ ] Not Necessary [ ]
STIPULATIONS:
� ` � U i i l iL �C �� `L '�.o�t ct l��A9 .E' /i � y �ao�I I+l � 01 � �t °►�C � .
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p,�c ��
9 t�� 1��` ����. �, �`Or a4P�u.��-c��,c� % P��►os��l 2
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Cal'� C+dQ(V��{� s
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BIIII.DING PERMIT FEE SCAEDIILE
The Chief Building Official shall, before issuing permits for the ereetion of any
building or structure, or for any addition to any existing building or strueture, 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 Valuation
$1.00 to $500.00
Fees
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
ineluding $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $�4.50 for eaeh
additional $1,000 or fraction thereof, to and
ineluding $50,000.
�50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraetion thereof, to and
including $100,000.
$100,001.00 and up
$433.00 for the first $100,000 plus $2.50 for eaeh
additional $1,000 or fraction thereof.
DRIVEiTAY DEPRESSION ESCROW
(Conerete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13•50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach Kith 6 ineh depth - Driveway width plus 6 feet times $15.75
9ERIFICATION OF FOIINDATION ' s•'
Permits for construction Will be issued a minimum of 2u hours from the time of
application to,allow for proper review of the proposed strueture and of the
construction site. �
A Certificate of Survey of the lot, sktowing the location of the foundation onee it
has been eonstructed will be required before'proeeeding with the framing.
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Certilic�te ot Survey tor "�M ��K�t "
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SUBJECT
c�ty of Fridley PER
�
AT THE TOP OF TME TWINS g u � L D I I� G P E R M I T 2 8 � 4 4
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; `V _ COMMUNITY DEVEIOPMENT OIV.
r j � PROTEC7IVE INSPECTION SEC.
l--__����"' �'� CITY MALL FRIDLE� 55132 NUMBER
i 612-571-3450
910-F15
J08 ADDRESS
6221 Caro1 Drive NE
1 LEGAL LOT NO. BLOCK TfiACT OR ADOITION
DESCR. [�, 3 Shorewood Ac
2 PROPERTY OWNER MAIL ADDRES$ �
Jim Skurich
3 CONTRACTOR MAIL ADORESS
Steven R Lee Contr. 9465 Irvin� Ave Broa
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIIADDRE$S
B USE OF BUILDING
Residential
7 CLASS OF WORK
nEV pATfi
_ 12/14/98
ZIP
��3��
PAGE OF APPROVEO BY
� /
SEE ATTACHED
SHEET
PHONE
571-3507
PHONE LICENSE NO
575R
PHONE LICENSE NO.
PHONE LICENSE NO
❑ NEW O ADDITION ❑ ALTERATIpN � REPAIR ❑ MOVE ❑ REMOVE
8 OESCRIBE WORK
Reroof house and garage (31 Sq) Tear-off (�arage onlv 2nd laver�
9 CHANGE OF USE fROM
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIREO FOR ELECTiiICAL, PLUMBING, HEATING, TYP� OF CONST
VENTILATING OR Alq CONDITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED VyITH�N 80 OAYS. OR IF CONSTRUCTION
OR WORK tS SUSPENDEO OR ABANOONED FOR A PERIOD OF 120 DAYS A7
ANY 71ME AFTEfi WORK IS COMMENCED. NO DWLG. UN17S
� HEREBV CEHTIFV 7HAT I HAVE READ ANO EXAMIN�D THIS APPLICATION
AND KNOW THE SAME TO BE 7RUE AND CORRECT. ALL PROVISIONS OF LAWS ypLUATION
ANO ORDINANCES GOVERNING THIS TYPE OF WORK WILI QE COMPLIEO
WITH WHETHEii SPEC�FIED HEREIN OR NOT. THE GRANTING Of A PERMIT $2656
DOES NOT PFESUME TO GIVE AUTMOiiITY TO VIOLA7E OR CAMCEL THE pERMIT FEE
PROVISIONS Of ANY OTHER S7ATE OR �OCAL LAW REGULATING CON-
STqUCTION OF THE PERFORMANCE OF CONSTRUCTION $7(�,.�5
� PIAN CMECK FEE
���� �� � Lice
S�GNA qE OF CON"RACTOA OR 4UTMOAl2E0 AGENT �DAiE� EN P C
S�GN4TUAE O� OWNEQ��� OWNEA BU40EFii IOATE� e� nn ...ce
SO.
STALLS
NG� GFiOUP OCCUPANCY LOAD
CU FT.
OFFSTREE7 PAqKING
GAiiAGES
SUR7AJ(
$1.33
SAC CHARGE
Fire C $2.66
/ TOTAL F E
� 8 .74
IDATE T IS IS VO R PERMIT
/ ,
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NEW
ADDN
ALTER
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ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R_Z
BUILDING PERMIT APPLICATION
� � �
Etfective 1/1/98
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Owner Name & Address: , �� "� c�lc�,,,,� , � � �� � ��� � j�� Tel. # �7 �— �.� �
Contractor: ���� 12. � MN LICENSE #� 7��
Address: `�° `zo !o ,Y" �'Yv� ,�.a s�� %��.�/�—��� Tel. # �/.�Z �-- // °l�
� �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: e
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
�n8� Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq� t. �
�31 �'�,� �-<-�L b� �- Y..�v �'
'�– � �-v� � .s�h.r g � r.o y� �
�.—
Q h �'Q/". o vt i�/
Construction Type: � � � '�p Estimated Cost: $ �� �°- � � � (o S(o
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
_$
DATE: IOZ- l Y i J' ApPLICANT: �� Tel. 1# %v�. �— // g�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charg�
TOTAL
STIPULATIONS:
$ �l'ti� %.s�
$ o� � (o b
$ l, .3�
$
$ S� � o
$
$
CITY USE ONLY
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 [ ]
$ �3��'�/
m
BUILDING PERMIT FEE SCHEDULE
A
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
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
����I.y
$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 �rst $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,Ot10,000
$5012.25 for the first $1,000,000 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 $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
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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Building PLUMBING Pernut No.: '
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Da�'d�GT = 200
DATE I�`� —o � YOUR E-MA[L ADDRESS
SITE ADDRESS �n '� 2� �� /i�� p%� o N E
THIS APPLICANT IS: ,� OWNER ❑CONTRACTOR
PROPERTY � NAME: �% n
- 1 � ADDRESS: �Q � '�. � C�' � l�. C�L (.! �� � v �Y � .2 STATF��ZIP,��3
TENANT pHONE: % fe �i -- '
�71���v7
CONTRACTOR NAME:
��T£-61�EAIS£ # - . _ --- EXR DA3'E _ _ -- -
SUBIVIIT A COPYOF - — -- --- -
YOUR STATE ADDRESS: CITY STATE ZIP
LICENSE WITH pHONE FAX
APPLICATION
PERMIT TYPE /�'��NGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW �-REPLACEMENT
DETAILED DE CRIP ION OF WORK J2 �`�=� O C VQ S U d '
� �Q � ��
PER MS 16B.665 the petmit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.Q0 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (IlVDICATE TOTAL
NUMBER OF EACH BELOW)
BATH S(NK/LAV FLOOR DRAINS SHOWER WATER PIPMG
BATHTUB GAS PIPING �Ntta� c7iTl.lt7:NSF:) SWIMMING POOL WATER SOFTNER ($35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
_ WATER METER ,_,� OTHER
' i . �� <; .� , �:������� �; � `� � � � �� <
_ �- � �* ,x , � �. � � � � � a� +
� . � � '�� . � �' €. .:��: , .„� . :� s� . �� ��� • � < �.
Permit Fee $ � _ _ _ � z Number of�fixtures (a� $10.00 x $10.00 = $
Surchar e- .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ Number of fixtures @$35.00 x$35.00 =$
� State Surcharge = $ .50
Tota1= $
THtS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL P�tOCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all work which re ui�es review a d approval of plans.
SIGNATURE OF APPLICANT � PRINT NAME ATE f�,- �-0�7
:����r��. �': �H,�����,'�'�� `:��` S���r i �'+ , � r �€
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977