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AF - 36899� �....r.vr � Village of Fridley, Minn. BUILDING PERMIT �°• 1761 -; Dati�: . . . . . . . . . . . . .1. d . . '. . . � 6. . . . � O�n�ner ....................................... Builder .. ..............�..�/-.G�........ Adclress ...................................... Address ....��. 0 d.....�/�!��........... ) �L� C TfON OF BUILDING Ivo. ��.7. .� .I. . Street . . .C/y???i'�'r'.':�. .f�l� . . . . .. . . . . .. . Part of Lot . . .. . . . . . . . . . .. . . .. . . . . .. . . . Lot . . . . G. �. . . . . Block . . . . .'�'�. . . . . . . . . . . . Addition or Sub-Division . � . . . . . . . . . . . . . . .�'.�! . . . . Coi•ncr Lot . ... .. ..... Inside Lot .�. .... Setback .. ��`.... Sideyard .. .. /. d.,.../°!.'..��....... DESCRIPTION OF BUILDING To be lised as• .�./. ,{�.;�'�'.'".':'. . . . . . Front . .��'. Depth Z �. . Height . �. S . Sq. Ft. �/.�. � Cu. Ft. . . . . . . . . � ..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........ o✓ Type of Construction . . �!'�hu . . . . . Est. Cost . . � .`?� 6 �n . . � To be Completed ....... .................. 1: ,'� Tn consideration of the issuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with all provisions of ordinances of the village of Fridley. ..................................................... �= G � Tn consideration of the payment of a fee of $ � !Z: . . . . . , permit is hereby granted to . . . . . . . . . . . . �. . . . . ......................... to construct the building or addition as described above. This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said ordinanc�s. , , , , � r . . . . ; . . . . . . . . . .��'�'�Building Inspector `/�� NOTICE: This permit does not cover the construction, installa,tion or alteration for wiring, plumbing, gas heating, sewer or water. Be sure to see the Building Inspector for separate Aermits for these items. City of Fridley Application for P'lumbing and Gas Fitting Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK 5779 NE Central Number, Kind and Location of Fixtures Location y � � � U' WATER HTR. 01 W 1/� � = N y Z Uj d' Z I Z = ? � � Z a 'j„i" H N Z S in Y vf } Z Q U O �n � C9 Z O < 0 y. ` j � Z < Sa � � = J� l� j<< d �� a F N GAS ELEC. 3 t� � .i F �n 3� o u. u� a o J m< 3 (9 < C9 z(9 O � Base 1st 2nd 3rd 4th _ _ • Fulure Conaectfon Openings * New Fixlure, Old Openiags me PARTIAL RATE SCHEDULE de 3ewer � Cesspool (� PLIIMBING FIXTURE AATES: NO. RATE TOTAL Number Fixtures . . . . . . x $2.00 $ Future Fixture Opening ................ x $1.50 $ New Fixture Old Opening . . . . . . . . . . . . . x $1.50 $ Catch Basin . . . �. . . . x $325 $ Water Heater (Up to 99,000 BTU) . . . . . . x $3.00 $ New Ground Run Old Bldg. . . . . . . . . . x $3.25 $ Electric Water Heater z $2,pp $ GAS FITTING FEE3: NO. RATE TOTAL lst 3 Fixtures .......................... x $2.00 $ Additional Fixtures . . . . . . . . . . . . . . . . . . . . x $ .75 $ Gas Range to 199,000 BTCT . . . . . . . . . . . . . . x $5.00 $ pipeing 3.� REPAIRS & ALTERATIONS—Refer to Code Description .................................... ...........$ TOTAL FEE $ 3. 00 City of Fridley: 879.01 The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the facl and representations stated in this application are true and correct. Fridley, Minn 9 Oct 68 , 1s— Owner Occupant , Kind of Building fr Used as res To be completed about Estimated Cost, $ � Old—ATew. Building Permit N � � N�• ��`� C Signe _ -.._ i$ GM� i,J. By Business Phone No. ROUGH FINAL �/ " � � � � � 42 City of Fridley Application for P'ltrmbing and Gas Fitting Permit Dept. of Bldgs. Phone 560-3450 DESCRIPTION OF WORK Number, Kiad and Lxa3ion of Fixtures Locafion �cj7%9 I�TE' . C@Il'tl"il 3� I`�I � I ZI �I�o 3$Z 57I�=I�QI zl zl •I .I W�TE.� � o m �n 3� o v� LL� m< 3 �� p R N G�5 ELEC. Base lst 2nd 3rd 4th • Fulure Connectfoa Openings * New Fixtuze, Old Openings PARTIAL RATE SCHEDULE Sewer � Cesspool n PLIIMBING FIXTURE RATES: NO. RATE TOTAL Number E`ixtures . . . . . . . . . . . . . . . . . . . . . x $2.00 $ Future Fixture Opening ................ x $1.50 $— New Fixture Old Opening . . . . . . . . . . . . . x $1.50 $ Catch Basin . . . . x $3.25 $ Water Heater (Up to 99,000 BTLJ) . . . . . . x $3.00 $ New Ground Run Old Bldg . . . . . . . . . . . . . x $325 $ Electric Water Heater a $2.00 $ GAS FITTING FEES: NO. RATE TOTAL lst 3 Fixtures . . . . . . . . . . . . . . . . . . . . . . . . . x $2.00 $ 2•� Additional Fixtures . . . . . . . . . . . . . . . . . . . . x $ .75 � Gas Range to 199,000 BTLT ............ .. 1 x$5.00 � �...� REPAIRS & ALTERATIONS—Refer 2o Code Description .... ... ................. ..........$ TOTAL FEE $ 5 • � City of Fridley: The undersigned hereby makes application for a permit for the work herei specified, agreeing to do all work in strict accordance with the City Ordinance and ruling of the Department of Buildings, and hereby declares that all the facl and representations stated in this application are true and correct. Fridley, Minn. �YOV t� 1965 , 19— Owner 1�a730a Gei�er Kind of Building Frp�++� Used as R�lsidenCa To be completed about N OV 2 3 1965 Estimated Cost, $ 5.00 Old�$Tew. Building Permit No. Permit No. �o �� MINNEAPOLIS GAS C0. signe . � By Business Phune No. ROUGH FINAL I �' J v- � D 42 � ryV v . .. SUBJECT City of Fridley � AT TNE TOP OF THE TWINS g U I L D I N G P E R M I T „ � � � • COMMUNI7Y DEVELOPMENT DIV. r � y � PROTECTIVE INSPECTION SEC. 1 � � � �""1 � CITY MALL FRIOIE� 55132 NuMBER AEv �""�� '' 612-571-3450 9/0-F15 JOB ADDRESS 5779 Central Avenue NE t LEGA� LOT NO. BLOCK TRACT OR ADOITION DESCR. 23 4 Parkview Manor 2 PROPERTY OWNEfi MAIL AODRESS Daniel Benson 3 CONTRACTOR MAIL ADORESS Aztec Roofing 11583 Rupp Drive Burnsville � ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER MAII ADDRESS D�iE v�GE Of 10/6/99 / / PERMIT NO. _30355 RECEIPT NO. � �� ►vPnOVEO Br SEEATTACMED SMEET 586-0814 ZIP PHONE IICENSE NO �95-0040 20139140 ZIP PHONE UCENSE NO ZIP PHONE LICENSE NO 6 USE OF BUILDING Residential 7 CIASS OF WORK O NEW O AODITION ❑ ALTERATION �F REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof house (18 Sal Tear-off 9 CHANGE OF USE FROM STIPULATIONS TO Underlayment must comply with the State Building Code. Permit Inspection Cards Wili Be �lailed To Homeo�uner To Post SEPARA7E PERMITS AfiE REOUIRED FOR ELECTFICAL, PLUMBING, NEATING, VENTILATING OR AIR CONDITIONING TMIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING AUTHOFiZED IS NOT COMMENCEO WITHIN 60 DAVS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO fOR A PERIOD OF 120 DAYS AT ANV TIME AFTER WOfiK IS COMMENCED. NO DWIG. UNITS I HEREBY CERTIFY THAT I MAVE REAO AND EXAMINEO TMIS APPLICATION AND KNOW THE SAME TO BE TRUE ANO CORRECi. ALL PFOVISIONS OF LAWS yqLUATION AND ORDINANCES GOVEHNING THIS TVPE OF WORK WII,L BE COMP�IED W17H WHETHER SPECIFIEO HEREIN Oii NOT. TME GRANTING OF A PERMIT $1573 DOES NOT pRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pEqMIT FEE PROVISIONS OF ANV OTHER STATE OR LOCAI LAW REGULATING CON- $TRUCTION OF THE PERFOAMANCE OF CONSTFUCTION �S%.OS PLAN CHECK FEE License S�GNATUQE OF CON'aACTOQ Oa AUTHOA�2ED �GENT IDATE� u D S�GNAIUAE O� OWNEQ �� OwaEp Bw�OEA� iO�iE� OCCUPANCYGROUP IOCCUPANCVLOAO SQ. FT CU fT OFFSTREET PARKING STALLS GARAGES SUATAX $. 79 SAC CMARGE Fire SC 1.57 OTn� FEE 5.00 ' 64. ' ER V IDATED T I IS VOUR PEpMIT �� i r��rt ^ - JUN—c4-1998 V�W l 1 �DDN ( J �LTER ( J �onscnictionAddress :.egal Description: 1?�a8 FROf� CITY OF FRID�EY TO 8959962 "�}lBT�Qa� .�........ . � '�f �,�,/✓ CITY C)F F'RIDLEY SINGLE FAMIiX .�ND DUPLE:�ES R-I AND R-�iTY OF FRIDE.EY BUILDING PEitMIT APPLICATION 643� UNlVERSITY AVE. N.E. �� _�Y�� FRlDLEY, MN 55432-4 �4� ? ? �1 (�P.��c�.Q �v2 N� � _'1,�.,'� Jwner Name & Address: � �� {ytSd✓ 5?%� C�� ! N� Tel. !i (� ( Z S�fQ (l �'i � :oncractor: ,�y�,C `�mB�r�rn� MN LICENSE �0� 3 � / �� ddress: � � �i �S 3 � v OA %�v� . t/�'i?S �i ��, f,�Y>/1/ �3 � � Tel. f1 �O l Z �5�5 `C�C� . Attach to this application, a Cettifcate of Survey of the lot, with [he proposcd construction drawn on it to scale, LIVING A.REA: �AR.AGE AREA: DECK AREA: �THER: DESCRII''TTON OF IMPRO'VEMENT Length Width Hcight Sq. Ft. Length Width Height Sq. �t. Leng[h Widch � HgUGround Sq. Ft. � _ �� :ons�uction Type: �Estimated Cost: $ ,�_, �d`�— � .�� ', _ (Fee Schedule on Back) >riveway G�rb Cut Width Needcd: Ft. + 6 Ft = Ft x$ _$ ),�TE: Q" 2 ' � A.PPLICANT: Tel. !t �q '�j�(�_�f-c� C 'ermit Fee � ire Surcharge ,t2te Surcharge ;AC Charge ,icease Surcharge )riveway Escrow ;rosion ConU'ol 'ark Fce �ewer Main Charge TOTAL �TIP ULA"TI ON S : S � ,�� $.-.1,', -� $ ,�� $ $ ��v_ $ � S S $ $ � �., �i l � CITY USE ONLY Fee Schedule on Rcverse Side .001 of Pennic Valuation (1/IOth%) $. SO/$1.000 Valuation $1000 per SAC Unit $5.00 (Scace Licensed Residential Contractors) Al[. "A" or A1t. "B" Above $450.00 Conservation Plan Revicw Fee Determincd by Engineering Agreement Necessary ( J Not Necessary (] � sue�ecr PERMIT NO. City of Fridley �' 3 3 9 9 4 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r ; ` RECEIPT NO. COMMUNITY OEVELOPMENT DIV. r � � � PROTECTIVE INSPECTION SEC. ' / r 1 � � �"'� � CI?Y MALL FRIOLE� 35132 NuMBEa AEV OATE v�GE OF � ROvEO Br �'""'�"� �'� 763-571-3450 9i0-F�5 10/24/03 / / JOB AODRESS 5779 Central Avenue NE t IEGAI. �OT NO. BIOCK TRACT OF ADOITION SEE ATTACMEO �ESCR. 23 4 Parkview Manor SHEET 2 PROPERTY OWNER MAIL AODRES$ ZIP PMONE Daniel Benson 5779 Central Avenue NE 763-586-0814 J CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Windows America 559 Shoreview Park Rd Shoreview MN 55126 651-20 -0149 20248265 � AACHITECT OR OESIGNER MAIL AODRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PNONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION � ALTERATION X REPAIR O MOVE O REMOVE B DESCR�BE WORK Replace 14 windows within existin o enin s 9 CHANGEOFUSEfROM 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. Caulk and flash all exterior openings. ,Fw,�„s �. :::, r�+ r':'�,�a g�z,:. c 39:�:'`,��.;�ka�i�� 1�'li� �:;��II �� Mailed n�n..F �SI3��M�M�1Y00�iD0 il�/ �� TYPEOFCONST OCCUPANCYGROUP OCCUPANCV�OAO SEPARATE PERMITS ARE REOUIRED FOR ELECTRICA�, P�UMBING, MEATING, VENTILATING OR AIF CONDITIONING TMIS PERMIT BECOMES NUII AND VOIO IF WORK OR CONSTRUCTION 20NING SO fT CU FT AUTHORIZED IS NOT COMMENCED WITMIN 60 DAVS. Ofi IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANOONEO FOFi A PERIOD OF 120 DAYS AT ANV TIME AFTER WOFK IS COMMENCED. NO DWLG. UNITS OFfSTqEET PARKING I HEREBY CERTIFV THAT I MAVE READ AND EXAMINED THIS APPLICATION 1 STAILS GARAGES AND KNOW THE SAME Tp BE TRUE ANO CORRECT. A�L PROVISIONS Of �AWS yALUATION SURTAX AND ORDINANCES GOVERNING TMIS TYPE Of WORK WILL BE COMPLIED WITM WHETHER SPECIFIED HEREIN OR NOT THE GRANT�NG Of A PERMIT �6 � SOO �3 . ZS OOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pERM1T fEE SAC CNARGE PROVISIONS OF ANV OTHER STATE OR LOCAL lAW REGULATING CON- STRUCTION OR THE PERFOfiMANCE OF CONSTRUCT�ON $139.2.5 Fire SC. �6.5� PLAN CHECK FEE TOTAL FEE ' ens SC $5.00 $154.00 SIGN4fUAEO�CON"AACIOQOQAUTMORiZEOOGENT �O�rE� N PROPERL� VALIOATED THIS IS VOU PERM T � � S�GNiTUAE O� OWNEA�� OwtiEp Bu�IDEA� �DATE� BL G�N o' �I� E . �J NEW ADDN ALTER � /V.et! �' �`�,lem��'Gy`- [] CITY OF FRIDLEY Effective 1/1/2003 [] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax BUILDING PERMIT APPUCATION Construction Address: � �7� U� � ��L� Legal Description: Owner Name & Address: �� a�� S UYl �5��`I�1 � G( S o`-�'"�"� Tel. # �i.�� -O� � Contractor: �(�,�1�_�� 1 G%-- MN LICENSE #�-0�- �� Address: �r'I_.�`�lG�'�✓/,t'i�t� �'�K �� f�?�Y'�vilw ��1Z(� Tel.#� ��U3�jl�y�'I_ LIVING AREA: GARAGE AREA: Attach to this application, a CeRificate 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. DECK AREA: Length Width HgUGround Sq. Ft. OTHER: - Gonstruction Type: ��,,e ��/f V//'I �% � Estimated Cost: $��-� _ ,�-�� lGfCel�'c�-!�!� f�l//�2� Drivewa Curb �ut Width Need"ed: Ft. + 6 Ft = Ft x$ _$ Y DATE: � v -3 �� APPLICANT: ��# a� .�U�� 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. �Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge CITY USE ONLY - ,,_� $ �c3� c� Fee Schedule on Reverse Side $ ;,�v .001 of Permit Valuation (1/10th%) � -. $ �_ ,�S $.50/$1,000 Valuation $ � $1275 per SAC Unit $ � , C7C� $�,.00 (State Licensed Residential Contractors) $ Ali� "A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ ` Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] TOTAL .. . _ . $ o-- /�-',yoa r �TIP 1 ATIONS: _ ... . __ . . ... .. BUII.DING PERNIIT 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 t0 $500 $501 to $2,000 $2,041 to $25,000 $25,001 to $50,000 $50,041 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 FEES $23.50 . ._� ... ._ . .. ; .a..., ,�. . .. . . . � � . .".i� ; $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 includir�g $25,U00 $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 $100,000 $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 $1,000,0(}0 $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 CURB CVT ESCROW (Concrete Curb Streets Only) Removal and replacement of curb and gutter only - driveway width plus 6 feet times $17.00. �'ermits 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 foundation will be required before proceeding with the framing. New Houses Onlv . , Building [nspections 763-572=3604 �ATE G BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL iITE ADDRESS _5 l/`7 C`�i �r'1 iHIS APPLICANT IS: � OWNER PROPERTY OWNER/ N,�:� TENANT qDDRESS: S CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICATION PROPERTY TYPE PERMIT TYPE TYPE OF WORK: NAME:� STATE LICENSE # ADDRESS: 7 �2, �Vrvr ll,� 5-�l `T 7/� lC lf7 BINGLE FAMILYlNEW CON37'RUCT7( TWO FAMII.Y/NEW CONSTRUCTION ❑ BASEMENT FIN1SH �-ROOF ❑ DECK ❑ SIDING ❑ SWIMM o n�•rr�rtalac�Pa,tR DESCRIBE WORK BEING - -� � � "� � � SIZE OF IMPROVEMENT xoor uvc; NUMBER OF SQUARES � GARAGES PROPOS£D SIZE: PROPOSED HEIGHT: SIDIIVG ❑ Vinyl ❑ Aluminum ❑ Other . WIl�TDOWS IN EXISTING OPENINGS ❑Yes �No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WINDOW TO BE INSTALLED LENGTH � FAX ,�,I�IOUSE ONLY ❑ HOUSE & GARAGE ❑ A'ITACHED GARAGE O DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LACATION OF WINDOWS Permit No.: `7 - '� 3� Received By: i�'- �a�es�� P 1 9 ��7 CITY �/1 f � � -� � STATE ZIP EXP DATE � �� CITY O �S� � �_STATFi"i'tiZIP_`� �1 I ❑ DRAiN 7ILE ❑ OTHER 'OOL G il c.� P ��/\, c�,�-�, �°� �cSC WIDTH HEIGHT NUMBER OF WINDOWS !'l BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor pian 3. List of structural members to be used Ft. FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIOAIS. & PORCHES SUBMIT: l. Site Plan/Survey showing the existing swctures and proposed project. 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ ��LPJ OCCLIPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Ghazge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Total Due $ C� `�. �� $ $ /�� .y� $ `i ,/.� $ $ $ $ $ _ $ `%'% .�i0 _ See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $1675 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$21=$ $450 Conservation Plan Review Fee Determined by Engineering Agteement necessary ( ) Non Necessary ( ) Make checks pa_yable to: City of Fridley Attach THIS [S AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED s 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 n t to start without a permit; that the work will be in accordance with the approved plan in the case of all work..w.ki�qu" iew and a roval of plans. -� � a� SIGNATURE OF AP�L�ANT < PRINT NAME v �DATE � � Page 2- Building Resi�ential Application BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing permifs 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 �Iie payment by the applicant for such pernut of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and including $2,000 $2,001 to $25,000 $69.25 for ln $2,000 plus $14 for each additional $1,000 or fraction, to and including $$25,000 ' $25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each addirional $1,000 or fraction to and includin $100,000 $100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to and includin $500,000 $500,001 to $1,000,000 $3,233.75 for the 1�' $500,000 plus $4.75 for each addirional $1,000 or fra.ction to and includin $1,000,000 $1,000,001 and up $5,608.75 for the 1� $1,000,000 plus $3.15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to a11aw for proper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the frarning. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 Building Inspections 763-572-3604 763-502-4977 FAX BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-]-09 Permit No Received By: Date Rec'd: s�i —� -� ��t � (,�- °l -�`'1 DATE J iJes (s � � d4J YOUR E-MAIL ADDRESS ___�2WAC-(E�'!C,(Z,—�10PSs (� �' M� L� CQ� N✓\ SITE .ADDRESS � �% 7 °� ��.1'rQ.fc,t— �IZ'�. , THIS APPLICANT IS: ❑ OWNER PROPERTY OWNER/ TENANT CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE I�� ADDRESS: S�% � �6..�'W�_ �iJb. CITY PHONE: 1 ip� -- S�.— o�' 1�"F ATE M�► ZIP STATE LICENSE # Zb(p3 G'12�(o EXP DATE �S 3/ 10 ADDRESS: �'3 Q S I DL� V 6* 5 i• CITY �Q� � i�-- STATE �! ZIP 5 C✓ �� PHONE IOIZ "�63 — Z2U% FAX 763 `�:ZI ��{8r%�i �'SINGLE FAMILY/NEW CONSTRUCTION ❑ TWO FAMILY/NEW CONSTRUCTION PERMIT TYPE Q /�DITION ❑ BASEMENT FINISH ❑ DECK TYPE OF WORK� ❑ NEW HOME CONSTRUCTION ❑ MAINTENANCE/REPAIR DESCRIBE WORK BEING DONE: �GS tQ G I�p�v1 G SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: ID1NG myl Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS ❑Yes ❑No OR FOR NEW OPENINGS-DESCRIBE S[ZE OF OPENING CHANGES & TYPE OF. WINDOW TO BE INSTALLED ❑ ROOF '6YSIDING I'� S�VIMMING POOL ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ADDITION WI S1ZE 1 STORIES 1 ❑ WMDOWS ❑ DRAIN TILE ❑ OTHER HEIGHT FT � ZC�O BASEMENT REMODELING SUBMIT: l. Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION MCLUDING DECKS, ❑Soffit ADDITIONS. & PORCHES SUBMIT: ❑ Trim 1. Site Plan/Survey showing the existing structures ❑ Fascia and proposed project. 2. Two sets of construction plans 3. Energy Calculations LOCATION OF WINDOWS NUMBER OF W[N ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $ �SDD� OCCUPANCY TYPE Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ % r vZ � $ $ ,�J $ $ � $ $ $ $ $ $ v`� . �) See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2000 per SAC Unit (Plans to MWCC for determination) ft+6ft= ftx$22=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( Make checks oavable to: Citv of Fridlev THIS IS AN APPLICATION FOR A PERMIT-NOT VALID LINTIL PROCESSED Attach 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 applicatio r a �t an rk is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of 1 wo c w ich requires review and approval of plans. SIGNATURE OF APPLICANT PRINT NAME � p p� �s hEZA� DATE v t:- O Page 2- Building Residential Application 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: ' 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 proposed structure and of the construction site. 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 City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977