AF - 35693_ T _. - S __ --_ .___... ...
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City of Fridley, Minn.
BUII.DING PERMIT
Date: . . . �.�. . . � / . . `. .�� . . . . . . . . .
Owner .......................................
Addre� ......................................
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N° 3880
Builder ����.. .............
Address .........................��.......
LQC�4TIOdV OF BUILDING
No. . � ��. � StrEet . �� . . . . .. . . �. �f� Part of I,ot . .. . . .. . . . . . . . . . . . . .
. .. .......
Lot .�le�. .. ... BYock ... .� ...... .. ... Addition or Sub-Division /¢.���e�Ft�s..+:!.. °����T. .....
Corner Lot . . . . . . . . . . . . Inside Lot .1�. . . . . . . . .. Setback :� ��. : �.ep. Sideyazd . �LS g % . . . . . . . . . . . . . .
DESCRIPTION OF BUILD[NG
�T be Us as: /�r / r• �, Cy ti 9
s . . . . . Front . �� � �� �[d' � Hei.ght �(. .�� 5q. F't./�� � Gtix. F'��.-J.�.'� � �
.................... Front ........ Deptb, ...:.... Height ........ 5q. Ft.�........ Cu. F`k ........
Type of Construction ................... Foat. Cost..................... To be Completed ...................
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In consideration of Yhe issuance to me of a pernoit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set and in compliance pro ons of
or�linances of the dty of Fridley. �
. ..��' . .. ........... .���.. .....
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In consideration of the payment of a fee oP $. �l"�� germit is hereby granted to . : . . . . . . . . . . . . . . .
. . . .. . . .. . . . . . ... . . . .. .. . to construct the bwilding or addil3on as described above. This permit is �anted upon
the express condition that the person to whom it is granted and lnis agents, employec� and worlmlen, in a11 work
done in, around and upon said building, or any part #hereof, shall conform in all respects to the ordinanc�s of
Fridley, Minnesota regarding location, construction, alteration, maintenanee, repair and moving of buildings with-
in the city limits and ihis permit may be revoked at any time upon viola.tion of any of the provisions oF said
ordinances. .,� � . �
.... Buildi�g 7nspec�or
NOTICE:
Thls permlt does not cover the construotlon, Installatlon or altaration fo� wlring, plumbing, gas heating,
sewe� or water. Be sure to see the Bulidtng Inspeoto� fo� sepa�ate permits fo� thess Itema
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;. .. .. .
_ _ . .. .. . . . APPLIC�1TIOiJ FOR -BUILAING PERMIT '
..V � � , CITY OF FRIDLEY,�MINNESOT� . �
. . ,.
_
.
...,. % , . � -
Chmers Nam�e�� ui� Builder /Y� Q' ."'
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Address �.�1 � .L�,�'���CJ,� , Address � �G`lil�CJ�
. . LOCATION OF BLTILDTNG � � - ..
NoY � . � Str.set �������' • f% Part o� Lot - . ` .
Lot ��. �Block �'"' � �ddition or 5ub. D3.v.. ��l6fi . �� d�� �
�- �o'r'rier Lat � . � . � Inside Lot �' � Set Ba.ck � +.
;,:, , . .
•�^~ Ap�Y3��,nt at�ta,cYi to this form Certificate of Survey of Lot and _proposed
< bui]:;ding ].oeation.. - - . � , ,
.. . . � DE5CRIPTION AF BUILDING - '-�
�To be uaed as /�FSs/?[�/rJ eCr'- - � � � . ... F �
. � �
�1; . .
, -Front, �� Depth - � Z Height. � �
Sq .. F t. �� Cu. Ft ��:.�.GL-�C�.
_ . .� . ' Front . DeptYi ' Height ' ,
Sq� �. . Cu, �:. . , . . . . �
Type of Gonstr.u.ction ��!%J''-�� _..... Estimated Cost�
�' ,
To' be completed � �/� ����
TI7e� undersigned. �hsreb� r�kes application for a:permit ior the, work
h�rein speaified, ag�eeing to do �11 urork in strict accoxdanGe w�.th_the
Cit�r Ordin�.ncea �.nd xuling of the Departr.ient of Httildings., and herr�by
declar�s tYiat all the f�cts and-representations s°tated in this application
are tru,e. and corrsc�G, .
l�te � � � Signatur
(A 3chedule of Fee Gosts can be found.
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., _ .. __ .._ Bi�ILDING PERMIT F'EE S�HEDITLE � - ..
Section 2, The Inspector of Buildings shall, before issuing any permit
for the erection of any building or structure, or for any addition to
any existing bu.ilding or structure, or ior any'alterati.ons.,or repairs to
an�r existing building or structure, upon application therefor, require
�t,�.e :.pa�rrment by t�i.e: 'applicar�t `for such per�na.t -o£ �ees -to #.he e,raount
herein below aet forth and in the manner herein provided ta-wit:
2.1 For any such pernit for the erection of any fireproof building�
�� other�tharr a. gax�ge, warehouse, factory or grain el.eva�br, or��for the.
erection of any fireproof addition, for similar occupari�y, to any
exis�ing building sha11 be �:t the rate of �1.,4Q �or each one thousand
cv.bic feet, or fra ction �thereof, in such cubical contents.
2.2 For any such permit for the erec�tion of any fireproof ga�age, ware-
house, �actory or grain elevator, or`fo-r the erection of an�r fireproof
__.ad.ditiort � for. similar occupancy, to ari� existing building sla�l.l be at the
rate of' �1.25 for each one thousand cubic feet, classified as "fireproof"
by 5ection 502 of the Minneapol�s $uile�king Godae- ,• •'`�
.. . ,
�. . k HOUSES .. _.. ._. .. .. : . _ -..
2.3_ For any such per�.i� ior the erec-�ior� of any non-fireproof building
other than a'garage, warehause, factory o�:grain elevator�, or ar�y
non-fireproof addition, for similar occupancy, to any exi�ting building.
, _ .
_,
-.. P�rmit �1.Q0 for each one--thousand cub3c feet. -
GARAGES .. .
2.1� For any such permit for the erection of ang non-fireproof garage�
wa.rehouse, f�.ctory or grain elevator, or for the e�eetion of axiy non-
fireproQf addition9 for si.milar occupancy,.�o any existing buildi.�g or
� `' for"'each� �such� building or addition, � Nin'�ty�' Cents fbr each one
thousand cubic feet or fraction ther;eof, in the cubical contents thereof
; � witli a minimiva of��4aoQ, ' __ ` .
... For tYie purpose of computing fees for building permits the ctibical
contents of any building or addition to a uniform height throughout b�
multiplying the ground. are�.'covered from a�pnin� six (6) 3nEhes below
the fl�or line af the bASer�en� or ce?_lar to the average height of the
.-... . u�pex..-surface or; -�o -�he .averaoe height, - of -�he- roo� sur#'ace of the main
gable of a pitched ro6��
2.5 For repai.rs or �.l�erations to an existing structure, the fee shall
be at the rate''af �3�00 for each F_,'_ve Hundred Dollars (�500.00), or
fraction ther.eof in tY�e cost of a7.1 proposed work, `
2.6 In no case shall the ien ch�.rged fo'_ any permit as set forth in
Section 2 be less than �1��00�
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sus�ecr PER
City of Fridley 17856
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO
� `L ___._. COMMUNITY DEVELOPMEN7 DIV.
r � � PROTECTIVE INSPECTION SEC.
� � I ��_�
1 i �
� /"'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�'""� � ��� 612-571-3450 � 910-F15 2/19/85 / /
JOB ADDRESS 5851 Central Ayenue N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 32 � Pd:CISV].C'.W Ma.riO� SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James Pineault 5851 Central Avenue N.E.
3 CONTRACTOR MAILADDRESS 21P PHONE LICENSENO.
Panelcraft Inc. 2309 5nelling South, Mpls, , NIDT 55404 721-6628
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS 21P PHONE LICENSENO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION C� ALTERATION ❑ REPAIR � Mi�VE ❑ REMOVE
8 DESCRIBE WORK
Reside and add alumix�.ua� txim to dwelling �
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED 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 ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OH 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 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $4 �500 y�2.2rJ
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- yS`�jO. rJO
STRUCTION OR THE P f0 ANC OF CONSTRUCTION.
, PLAN CHECK FEE Tpy�T512FE�S
IG TUREOFC N'RACTORORAUTHORIZEDAGENT 1DATEI WHE PROPER V A TH�S IS YOUR PERMIT
� �
SiGNnTURE OF OWNER iIF OWNER BUILOERi �DATEi BLDG INSP � pA7
NEW [ l City of Fridleq Effective 4/1/84
ADDN. [ ] �R-1 AND R-2
pLTER.� Building Permit Applieation
Construction Address: ���� l P� ti'�l� .1���,
Legal Description:
Owner Name & A ess : ��jv%°S �t°�rr�/� ��.�` �io�i� � a� 1 Tel . # �
r.,�*wnnter � �G/s'lP� 1�oC� �� � � Tel . # _%� ��r��
Addresa• ���D� —s�re��
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
� �._ ��
Attach to this application, a Certifieate of Survey of the
lot, with the proposed eonstruction drawn on it to seale.
Length
DESCRIPTIOH OF Il�IP�OYEMENT
Width Height Sq. Ft.
Length �Tidth Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard�etbaek
A' �
Type of Construction: �i� ���-�/� ��� Estimated Cost: $.����
Approx. Completion Date: ��-��/�--�
Alt. A Alt B
Proposed Driveway Width If NeW Opening Is Desired: $ $
See Baek Page for Explanation
DATE: 1/ �' APPLICANT• Tel. ���5 ��'`�
�'�L�
C OSE ONLY
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Se�,rer Main Charge
TOTAL
STIPULATIONS:
$ ��.��
$
$ �� ��
�
� `�
$
$ �� c� �
Fee Schedule on Reverse Side
2596 of Building Permit Fee
$.50/$1,000 Yaluation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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BITII.DIAG PERMIT FEE SCHEDIILE
The Chief Building Official shall, before issuing permits for the erection of any
building or strueture, or Por 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 sueh germit of fees to the amount
herein beloW set Porth and in the manner herein provided to-wit:
Total Yaluation
�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 fraetion 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 fraction thereof, to and
including $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 eaeh
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 each
additional $1,000 or fraction thereof.
DRIVEWAY DEPR&SSION ESCR0I�T
(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 ineh depth - Driveway Kidth plus 6 feet times $75.75
VERIFICATION OF FOIINDATION
Permit� for construction Will be issued a minimum of 24 hours from the time of
application to allow for proper review of the proposed strueture and of the
construetion site.
A CertiPicate of Survey of the lot, showing the location of the foundation once it
has been eonstrueted will be required before proceeding With the fraaning.
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CHIM�JEY ANJ STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (,)
,
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
No ( )
No ( )
No ( )
No ( �
5. Meets all current Code requirements for size and
total BTU connected Yes () No ()
6. Has Total hea ting BTU's of
All other BTU's
TOTAL
Rema rk s
Com pa ny
Signed By
Da te
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szuawaa�nbaa apo� �uaaan� l�e s�aaw ��. �eyl
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:���s ao Rauw�y� 6u��s�xa ay� �ey� sa}}�.�an �tqaaay pau�tsaapun ayl
. ���� SS321aQ11 �r'�'� � �2'i�� ��J� 2i3NM0
� ��i -� �--� 31�0 �,�/ � �� �� ���„�d� ��„�.� NOI111�O1
'WbO� lIWa3d 9NI1�N bOj NOI.Ld�Ilddb a�boNy1S AP1dd�d0��1d 1StiW 4�i0� SIHl
NOI11i�I,�I2i3A �I�d1S UNt! A3NWIH�
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�i
sue�ecr PER
City of Fridley ��. 3 7 9
, , AT THE TOP OF THE TWINS g U I L D I N G P E R M I C
r
� � COMMUNITY DEVELOPMENT DIV.
i LV ������ ��� /
d � � PROTECTIVE INSPECTION SEC.
� _ �
� ���'1 � CITY HALL FRIDLE� SS43P NUMBER REV. DATE �AGE OF APPROVED BY
�'""� � ��� 612-571-3450 910-F15 6/5/92 / /
JOB ADDRESS 5851 Central Avenue NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 32 4 Parkvi.ew Manor SHEET
2 PROPERTYOWNER MAILADDRES$ ZIP PHONE
Jim P�neault 5851 Centxal Avenue NE 574-0349
3 CONTHACTOR MAILADDRESS Z�P PHONE LICENSENO.
Panelcxa�t 3118 Snelling �ve S, Mpls.., MN 721--6628 2179
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
k�es�dential
7 CLASS OF WORK
❑ NEW �7 AODITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Const�uct a 14� x 20'•� 'rhxee �eason �oxch.inT/Wxndows; a 19� x 10' Deck
9 CHANGEpFUSEFROM TO
STIPULATIONS See notations an plan, �'�ovide smoke detectvrs in existing home.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINCi,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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 f HAVE READ AND EXAMINED THIS APPLICATION 1' STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $ S� 776 $4, 39
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
R VISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $1Q]..00 k'ire SC $8. %8
T UCTION OR THE PERFORMANCE OF CONSTFiUCTION.
/y PLAN CHECK FEE TOTAL FEE
r� /l�CP/t ��J°//`'�� 0 �r/ L7.C'.ei1.4e SL' �rJeQ� ��.�.9•1%
SIGNATURE OF CON i RA OR OR AUTHORIZED AGENT (OATEI WH PR RL V LI TED THIS IS YOUR PERM�T
� � V � � � G�/
SiGNATUREOFpWNER�IFOWNERBUILDERI �DATEI BLDG iNSP �aTE
NEW [ ] Effective 3/ 1192
ADDN [ ] CiTY OF FRIDLEY
ALTER [ j SINGLE FAMILY AND DUPLEXES R 1 AND R-2
Building Permit Applicadon
con�ction Addres.s: 5 8�l � n� r� f��.I� �
Legat nescription: 1-o t 3 0� � 1 i' � .
o�_� �-� czr �c �� � P�.� a� 01^
�
Owner Name & Address: _�Y� �( 1�.P, cc u,l �' Tel. # S7 ��}.� � 9
Contractor: �Ly� P l L ra �°}- MN LICENSE #�� ,�.17 9
Address: 31 1'� S� e� 1 i n 9 ,� V� s� rn� 1 S, Tel. ��a 1�� o� �
Attach �fo this application, a Certific.ate of Suivey of the
lot, with the proposed construction drawn on it to scaie.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: LeFtgth Width Height Sq. Ft.
GARAGE AREA: Length Width � Hei,ght Sq, Ft.
DECK AREA: Length I�`' . wicith 7�� Hgticnound �3" sq. Ft. / p�
oTHER: 1�'x ao' 3 seq ��r� t'�rch �i �-� ��c��r,�s ��`�
Corner Lot [] Inside I.flt [] Ft. Yd Sexback Side Yazd Setbacks
Type of Construction: Estimated Cost: $
Approx. Completion Date: � r%r%� �
(Cost on Back)
Driveway Curb Cut Width Ne�ed: Ft. + b Ft = Ft x$ _$
DATE: �°' l- q oZ APPLICANT: �a�✓-�r� x/- �� TeI. # 7� l Z�s�2-�
Petmit Fee $ . �� ,%o � �
Fire Surcharge $ 8 , `1 �
State Surcharge $ r �
SAC Charge $ —�
License Surcharge $ ,.5� O �
Driveway Escrow $
Park Fee $
Sewer Main Charge $ �-
TOTAL $ I �
� ��
F� Sch�ule on Reverse Side
.�1 of Permit Valuation (UlOth%)
$.SQI$1,000 Valuation
$7� per SAC Unit
$5.00 (State Licensed Residential Contractors�
Alt. "A" or Alt. "B" Above
Fee Determined by Engin�ring
Agreement N�:essary [ J Not Necessary []
STIPULATI4NS: �` ;� ` c �>"�� �2�
� � � ,
��. `� � � 1�YV .
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure,
or for any addifion to any existing building or stivcture, or for any alteration or repair to any existing
building or structure, upon applicatioa therefore, r�uire the payment by the appli�ant far such permit
of €e.e.s to the amouat herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $50Q
$501 to $2,(�0
�
$2;001 to $25,000
$25,001 ato $50,000
. � �
$50,�1 to $1�,�
$10(?,001 to $5�,(�l0
$5�,001 to �1,000,�
$1,OOQ,001 and up
FEES
$15 {Minimum Fee is $15 plus surcharge)
$15 for first $SQ(} plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$45 for first $2,000 plus $9 for each additior�at $i,000
or frdction thereof, to and including $ZS,Q00
$252 for first $25,� p�us $6.50 for each additional $1,000
or fra,ction therebf, to and iacluding $50,000
$414.50 for first $50,� plus $4.50 for each addidonal
$1,�0 or fraction thereof, to and including $100,000
$639.50 for first $i�,�U plus $3.50 for �ch additional
$1,t�10 or frac�ion thereof, to and including $500,000
$2039.50 for the first $500,0� plus $3 for each additional
$1,IX10 or fraction thereof, to and including $1,(m0,000
$3539.50 for the first $1,(mQ,000 plus $2 for e�ach additional
$1,000 or fiaction �thereof
DRIVEWAY DEPRESSION ESCROW
, (Concrete Curb Streexs Only)
Altemate "Aa: Removal and replacemem of curb and gut�er only - Driveway width plus 6 feet times
$13.50.
Altemate "B" : Removal and replacement of curb and gutter and instail a 3 foot wide
appraach 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 prop�sed structure and of the constiuction site.
A Certificate af Survey of the lot, showing the location of the foundarion once it has it has been
consavcted will be required before pr�ing with the framing.
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sue�ecr PERM
City of Fridley ,� ;a �
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T ~�� �e '� �
.
„
' � R PT NO.
� ; y _�_�__ COMMUNITY DEVELOPMENT DIV. ����
r � � PROTECTIVE INSPECTION SEC.
� _ �
�.---� �r���;-� CITY HALL FRIDLE� SS4.3Z NUMBER REV DATE PAGE OF APPROVED BY
612-571-3450 910-F15 7/15/9 � �
JOB ADDRESS 5851 Central Avenue NE
1 LEGAL LOT NO. BLOCK TfiACT OR ADDITION SEE ATTACHED
DESCR. 3Z 4 Parkview Manor SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James Pineault 5851 Central Avenue NE 574-0349
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Woods Construction Co 7728 Knollwood Dr, Mounds View MN 55112 786-2321 8737
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION CJ ALTERATION � REPAIR � MOVE 0 REMOVE
8 DESCRIBE WORK
Reroof House & Garage (20 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED 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 ZONING SQ. FT CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yqLUATION SURTAX
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �1,668 �,8/{
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- $54. OO Fire SC � 1. C)7
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
�/ � PLAN CHECKFEE TOTALFEE
��! � �� License SC $5.00 $61.51
SIGNATUREOFCON'RAC RORAUTHORIZEDA ENr iD� Ei WHEN PNOPERLY LIDAT D THIS IS YOUR PERMIT
- " �°���-
��
SiGNATURE OF OWNEA UF OWNER BUIL�ERi IDATEI BLO �NSP pp E
NEW
ADDN
ALTER
f�
[]
Il
ConstructionAddress:
Legal Description:
, CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT A,PPLICATION
Effective 1/1/97
i yv
Owner Name & Address: _ �Y�?���� ��� ������� Tel. #
�� � ��J � � �
Contractor: _ �� ,�j ���j � MN LICENSE # % � %
Address:_ ' % `� � ��,g����� �i� �
�,���� �,�tL/ �5 5J�/�` Tel. # 7 �'� o�,°��—.
Attach to this applica.tion, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA: .
DECK AREA:
OTHER: �9�1,�. �
✓Yoj� �
��
DESCRIPTION OF IlVIPROVEMENT
I.ength '
Length
Length
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
�/� , �J n'� ) /J
�/� �/�i.0�// � / V/////.�%!n /D�/(/// .� 9.{ w i A. � �//er
1 � � / �f/ � U
Construction Type: �,,C ' Estimated Cost: $ `3 �--- / � � �
f�ee Scl2edule on Back)
Driveway C�rb Cut Width Needed: Ft. + 6 Ft ,— Ft?x $ _�
� 1 , ' �� � � '% , .
%, � 'l /, i' 1% � � i �
� � � �
/ ' �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee .
Sewer Main Charge
TOTAL
STIPULA"I'IONS:
CI'TY USE ONLY
� �`�D� Fee Schedule on Reverse Side
�— � � �% .�i of Permit Valuation (1/lOth%)
� v $.SO/$1,000 Valuation
� $950 per SAC Unit
� -� �%�� $S.t}0 (State Licensed Residential Contractors)
� Alt. "A" or Alt. "B" Above
� $450.00 Conservatio� Plan Review
$ Fee Determined by Engineering
� Agreement Necessary [ ) Not Necessary [ ]
�� , �S /
E3U[LDING PERMIT FEE SCHED[,TLE
"I'he Chief I3uilding Official shall, before issuing permits for the erection of any building or structure, or fc�r
any addition to any e�isting building or structure, or for any alteration or repair to any existing buildina or
stiucture, 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: �
TOTA�L VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$i00,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
�
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000 •'
$349.75 for first $25,� plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,0�
$574.75. for� fiist �$54,00(} �lus $G 25 for each ad�iitional
$1,000 or fraction thereaf, to and including $1�,000
� ��
$887.25 for fust $1q0,0i?0 plus $5.00 for each additional
$1,40D or fraction thereo���.�o and including $500,000
$2887.25 for the fiist $500,000 plus $4 25 for each additional
$1,� or fraction thereof, to and including $1,�;000
$5012.25 for the fiist $1,(}00,000 plus $2.75 for. each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCRO�V
{Concrete G�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter oniy - Driveway width plus 6 feet times $13.�0.
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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction witl be issued a minimum of 24 hours from the time of applicarion to allow �or pron�r
review of the proposed structure and of the construction site.
A Certificate of Survey �f the lot, showing the iocation of the foundation �mce it has it has heen c�nstruc-_•�:
���i'1 h� reyuired hefc�re ��r�,c:�edin�� «�itla the fra�nin�i.
�
sue�etr PE
c�ty of F��a��� 32567 �
�
AT THE TOP OF THE TWINS Q u I L D I N� P E R nll I T
� � RECEIPT NO.
; `L __�__ COMMUMITY DEVELQPM�NT DIY. ���
r j � PROTECTIVE INSPECTION SEC.
�
� . ,
l--_. A �����,,� CITY MALL FRIDLE� SS��M12 NUMBER REV OAT6 PAGE OF APPROVEO BY
L �� 612-571-3460 9iapi5 5/7/02 � �
,
10B ADDRESS 5851 Centrai Avenue NE
1 LEGAL LOT NO. BLOCK � TRACT OR ADDiTION SEE ATTACHED
oescR. 32 4 Parkview Mano� SHEET
2 PROPERTY OWNER MAIL ADpR�S$ Z►P PMONE
James Pineault 5851 Central Avenue NE 763-574-0349
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO
Renewal By Andersen 1920 Co Rd C W, Roseville, MN 55113 651-264-4777
4 AFCHITECT OR OESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
20130983
5 ENGINEER pIAIL ApDfiE$S , ZIP PNONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION � ALTERATIQN � REPAIR p MOVE - O REMOVE
8 DESCRIBE WOi;K
Replace 9 windows within existing openings
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code.
��rimit InspeC�'on Car
Will Be Iyai d�
�Q Ho�n�n���� �ed
� ����
SEPARA7E PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATINCa, tYPE` OF CO ST. OCCUPANCV GROUP OCCUPANCV LOAD
VENTI�ATING OH Alq CONOITIONING.
THIS PERMIT BECOMES NULL ANO VOIO IF WQiiK OR CONSTRUCTIOM IONING SO. FT CU. FT
AUTHORIZED IS NOT COMMENCED Y`IITHIN 60 OAYS. OR IF CON$TRUCTION
OR WORK IS SUSPENDED OR ABANQONED FOR A PERIOD OF 120 DAYS A7 ¢
ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNI7S OFFSTREET PARKING
I NEREBY CERTIFY THAT I NAYE REAO AND EXAM�N�O THIS APP�.ICAiION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TFlUE AND CO�iRECT. ALL PROVISIONS �F LAW$ yAIUATION SURTAX
ANO O:iDINANCES GOVERNING THIS TYPE OF WORK WILL QE CpMPl�ED
WITH WHETHER SPECIFIED HEREIN Ofi NOT. THE GRANTING OP A PERMIT $6,000 $3oOO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR GAMCEL THE pEqMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION Oii 7HE PERFORMANCE Of CONSTRUCTION �IZS.ZS Fire SC �C.00
PLAN CH�CK FE TOTA� FEE
iicen S $5.00 139.25
-- S�GNATUfiEOFCON'RACTOQOpAUTMOAQEDAGENT IOAfE� [-.H pOP ALID� THIS I�OUR�RMIT
� �� �`\
S�GNATUREO�OWNEAi��OWNENBWIDEA� �OAf�� . ' 8 G iNSP' ' p�tE
�[ ]
ADDN
ALTER
� � Effective 5/10/99
CITY UF FRIDLEY
[] SINGLE FAMII,,Y AND DUpLEXES R-i AND R 2
BiJILDING PERMIT ApPLICATION
�onstruction Address:
Legal Description: •
�UU..a... i�; �. .
Owner Name & Address: ;� "� � n.e��, . J'�' }4 3�i q
Tel. # ��o3•S • 6
Contractor:;�__ww\ �u A�a�e,rs�e,� MN LICENSE # o'i013098"�
Address:�9 ao C.Ot,��n'�M 1c � C. l,�?,�, �.'� • t 1Y � Y1�1� S�S ll�, Tel. #� . �.
Attach� to� .this aPP�cation, a`Certificate� of Su�vey. �of-t�e �
lot, with t#�e:�roposeci�cvnstt�iction. dravv�i` on.it to scale.
. ,
. I2ES.C�.i#3N UF �P-��D�Mi�;NT �. . � �
LIVING AREA: Ixngth Width Height Sq. Ft.
GARAGE ABE�j; Length Width Hei
DECB AREA; - � Sq. Ft.
Length � Widt�i � Hgt/Ground Sq. Ft.
OTHER: �kZo n 4.et.r o .
l�J1 � i�C, C,�,j1�(.�.�_ ^^ �i ^:.i'S� i'��. mA �i A� .
COILStii1Ct10II Tj�:
Driveway C�irb C�t Width Needed:
ESt1II1St� COSt: $ I..QI��
Ft. + 6 Ft = _ Ft x $_ _ � _
DATE: �_ . 0 APPLICANT: Tel. �`_ 9Cj o'� •3�i,S • 10�0�{ �-
Permit Fee
Fire Surcliarge �
State Surcharge
SAC Charge
Licanse S�rcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ � '�v •a5
$ �o•C)O
$_ � . OQ
$
� �- O.O
$
$
$
$
� I 39.'o�S
CITY USE UN�.Y
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State L�cens�d Residential.Cou�ractors)
Alt. "A" or Alt. "B" Above
$450.OU Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�� ��
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE
STfE � DRESS �
THIS APPLICANT IS
0
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-I-09_
YOUR E-MAIL ADDRESS
❑ OWNER �CONTRACTOR
, ! � a� ��'°
STATE LICENSE # � �
wrv� �..� r � �
INGLE FAMILY/IVEW CONSTRUCTION
TWO FAMILY/1VEW CONSTRUCTION
EXP
r
Permit No.: ° C� 7 S=
Received By: �
Date Rec'd: 7< /�� �
STA
�L=��g��G
SIZE
❑ ADDITION ❑ GARAGEISHED ❑ WINDOWS
❑ BASEMENT FINISH �'ROOF ❑ DRAIN TILE
❑ DECK 0 SIDING ❑ OTHER
❑ SWIMMING POOL
ROOFING ��7
NUMBER OF SQUARES �' �
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING— --
❑ Vinyl
❑ Aluminum
❑ Other
HOME CONSTRUCTION ❑ ADDITION
fTENANCE/REPAIR ❑ REMODELING
� HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
� Fascia
HEIGHT
A
�
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of siructural members to be used
_ FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBIvIIT:
1. Site Plan/Survey showing the existing strucwres
and proposed project.
2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS OYes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF, WWDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 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
$ y`7. ��"
$ .�
$ �, a t-�
$ �, �� `
$ ���
$
$
$
$
$ ..
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 rimes 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 Aa_yable to: Cityo uf Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acl�owledge 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 a ' n for a permit d work is not to start without a permit on site; that the work will be in accordance with the
approved plan in case of all ork quires review and approval of plans.
SIGNATIJRE OF APPLICANT� PRINT NAME DATE
��7� �
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official sha11, 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for IS` $500 plus $3.05 for each additional $100 or fraction, to and
including $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$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 includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
. including $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 additional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1 S` $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
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 fraxning. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977