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INVOICE FOR LAND SURVEYING SERVICES PERFORMED
OWNER�OCCUPANT
ADDRESS
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LEGAL DESCRI PT I ON Q�"� a, �����a I�, � �
,
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WORR PROJECT DETAILS (ALSO SEE�SRET_ C�ON BACIC OF THIS SHEET)
� LOCATE LOT CORNERS (NUMBER FOUND)
�3ET LOT CORNERS (NUMBER SET) ,
�STARE PROPERTY LINES FOR FENCE (WITH 1�2 INCH WOOD STARES)
�TIE-IN AND SHOW ALL BUILDINGS ON PROPERTY
_SITE SURVEY (STAKE HOUSE AND�OR BLDG. CORNERS WITH ELEVATIONS)
BENCH LEVELS AND/OR TOPOGRAPHY SURVEYS
LOT SPLIT SURVEYS AND/OR TOWNHOUSE SURVEYS
BOUNDARY SURVEYS (METES AND BOUNDS, AUDITOR SUBDIVISIONS...ETC)
ALTA�ACSM (AS-BUII,T) SURVEYS
CERTIFICATE OF SURVEY
�CRESEARCH CITY, COUNTY OR STATE
WRITE LEGAL DESCRIPTIONS
Date a� o� Land Surveyor
The charge for services rendered is: �� 7)� Paid: ash Check
Payment is due upon completion of survey or within ten days.
Make Check out to: Paid in full on � a- �a
Gary L. Backer, Thankyou, GB
6917 - 83rd Ave. No.
Brooklyn Park, Minnesota �,RV �'
55445
Tele: 763-425-6427 REGiSTERED
UND
SURVEYOR
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City of Fridley, Minn.
BUILDING PERMIT NA 71 o s
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/ v,r�/ OCAT ON F BUILDING
NO. ����.(L �,�"'�Qt �.��rCr� //lL�19/ �6 � �n ��; Part of Lot
Lot .—�_ Block �� Addition or Sub-Dfv3sio����°� �
Coraer Lot _ Ine�de Lot —� Setback �—� Sideyard �� � A
Sewer IIevatian —_ � Founda.tioa IIevation
i DESCRIPTION OF BUILDING
To Used • �L���
Front �f Depth � Height � Sq. F't. Cu. Ft�
Front � Depth I%igh,% � Sq. F� Ctt. F�
Z�►pe oP et4on � Fst. ....� ��To be Completed
In consideral3on of the iasuance to me of a permit to construct the bwllding descrlbed abave, I a to do
th� proposed work ffi acc�rdance with the descript3on above set forth and in com ce wi a� one of
ortliaances oP the dtq oP FrirIIey. - 1 �
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In consfderation of the payment of a fee of $_,,L�s._� permit is hereby granted to
to oonstruct the building or addition as d�crlbed above. Thia permit is granted upon
the express condition that thep�o n to whom ft is granted and hia agents, employees and worl�en, in all work
done in, around and upon said building, or any part ther�of, shall conform fn all r�apects t4 the ordinances of
FrYdley, Minnesota regarding lacation, conatruct�on� alteration, ma3ntenance� repair and moving oP buflaings
ordinance.a dty ]imits and this permft may be revoked at any tinae�up�n vio�a�e� of any of the Provisions of said
n i �
Suilding inspector
NOTIC�
'llds permh dea eot cover �hs comlrodi�, �Stall�fm fe� trirtee, plumbtng, en hupne, rewu ee watsr. B� wre to ss�
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HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS
Weatherstrips A.S.H.V.E, Coastruction No.
Guide
Windows Doors Reference Out. WaU Iat. Wall Ceiling Roof F1oor Kind
Yes—No ( Yes—No 19_
Fl.{ '�-�, Rot�m � Length / Width Height � �'_Fl,� .,�`�s��,�' Room � Length
Windows and Doors—Crackage and Area o�' Windows and Doors—Crackage
�Vidth Hetght No. of Llneal f. Ares ��� Wldth Hatght No. ot LI
No. ot pane of pane lighte oP crack eq. ft. .�� o. ot pane ot pane tlghte � o:
�
� � �'r � � �' A�„� �� 4a..� � '�,� �
��
Coef. Btu
Infiltration � � i 6� `� 1n61tratinn
Glass �^� � �'�
Exp. wall �; ' '
Net exp. wall � - � �� °`' �
�'�
Int. wall
Ceilin� �
Floor �' �° � � "
Total Btu. � '°
Required sq. ft. �.D.R. or sq. ins. W.A. Leader area
� F7.� �� �. Room � Length idth � Hei
Windows and Doors—Crackage and Area
WSdth Height No. of Llneal Lt. Area
No. of pane ot pane llghta ot crack eq. ft.
_�. °�� �°�� �1 ��
- . .._�. _. . _.... �
In6ltration � �
Calass p �1 6
Exp. wall �a�� �"'� � � a;'�
r�
Net esp. wall � �
Int. wall
Ceiling
Floor �' / �;, � �
Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl. �' �, � Room � Length Width
Windows and Doore—Crackage and Area
Wldth Aelght No. ot Llneal ft. Area
No. of yane of Dane Ifghte ot crack sq. ft.
Infiltration
Glass
Exp. wall � � `;
Net exp. wall
Int. wall
Ceiling
Floor
Total Btu.
�_ P
�
Required aq. ft. E.D.R. or sq. ins. W.A, Leader area
�� Glass
F.sp._wall ,��u �' ��`- -
;� Net egp. wall
_ Int. wall
Ceiling
� Floor , �-� ����;,,
� Total Btu.
NQNrIF.APOL.IS. NIIIVN.
Insulation
How
j Width
Area
t. Area
a eq. [t.
Coef. Btu '
� ����� �
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�`�' �,: -- - -- - -
"�� � � � �
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-
Required sq. k. E.D.R. or sq. ins. W.A. Leader area
_ / Fl.l � ,�r,r �'�a,�Room ( Length � � Width r °°"'� Height
Windows and Doora-Crackage and Area
Width Height No. ot Lineal tt. Area
No. of pane of pane llghte ot crack efl• tt.
� :�`°.� .4 �,; r�
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- � _ � . � � . . . �
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�' Net eap. wal� � - � �'� � -
Int. wall
Ceiling
� Floor �. � i1r'- � �;, ",� -
� Total Btu.
Requued sq. ft. E.D.R. or sq. ins. W.A. Leader area
_ Fl.� �,/,� Room I Length Width � Heigt
- Windows and oora—Crackage and Area �'�
No. opa e ot pane Ilghte ot cr ek ar Lt. �.'I
ra +� 0 r +i. e d _ �� �. - � '� .��
Coef.l Btu
Infiltration o` �i ,
� , -.
Glass � ,�
Exp. wall �;' , °� �
Net exp. wall
Int. wall
Ceiling � � �, °°
Floor
7otal Btu.
Required sq. fe. E.D.R. or sq. ins. WA. I.eader area
� . �
:T D•36° � v
HEAT LOSS CALCULATIONS DEPARTMENI' OF BUILDINGS NIINNEAPOLIS. MINI�i.
Weatherstrips A.S.H.V.E. Construction No. Insulation
_ Guide II
Windows Doors Reference Out. Wall Int. Wall C,eiling Roof F1oor Kind How �
Yes—No I Yes—No 19_
.a-Fl.� �`,C'�oom � Length Width `'j Height Fl.� �" �'� Room Lengt6 Width
Windows and Doors—Crackage and Area Windows and Doors—Crackage and Atea
�Vidth Helght No. oP Ltneal ft. Area Wldth Haight No. oE. L1nea1 ft. Ares
No. oP pane of pane llghte ot crack eq. ft. No. ot pane of pane lighte of crack eq. ft.
' � ` - � � � ` � � � �
Coef. Btu (
Infiltration 'f � � It►filtration / �
Glass � �� t�� � Glass �
E.�p. Wall ` _ j►P __Fsp._�vall `� - � � -
��� � �
�Vet ex#�. yva7l = ---. � � Net egp. wall �;
Int wa11� � ' Int. wall
r �
Ceilii�� -;� .� a� %� � � � Ceiling �o '�" �
Floor Floor
Total Btu. Total Btu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area Required sq. #t. E.D.R. or sq. ias. W.A. Leader area
Fi.�e-;- �� Room � Length ,(� Width �/ Height -�—�__ �.� ��,�e,f f�
Windows and Doors—Crackage and Area Windows and
W1dth Hefght _ No. oY Lineal tt. Area Wldth ]
No. ot pane - o[ pane lighta of crack eq. ft.
,, � 6S � � f r,.� • '- �._No. of D ne a
�� � �•
i �� (� � � r � �k_
� Coef. Bha
Infiltration ` � �
Calass �
Exp. wall �'°
Net esp. wall � �
Int. wall
Ceiling i (r_� 1� / / °�' �
Floor
Total Bfu.
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
Fl• .,,,��°:,-�;? Room � Length � Width Z
Wiadows and Doora—Crackage and Area
Wldth Hefght No. of Llneal ft. Area
No. ot pane of pane Ilghte ot craek eq. ft.
�� C✓ '� � = ' -
� co�
Infiltration ,� �
Glasa � � �
t
Exp. wall °�. _ � �'1�
Net eap. wall � �
Int. wall
C�ilin8 � C°' �,/� C
Floor
'� Tatal Btu. �
' Required sq. ft. E.D.R. or sq. ins. W.A. l.eader area
Glass
Eap. wall � ,
Net exp. wall
Btu
e�R
�-
� � Length� �°°� Width ` � Height ��
-Crackage and Area
No. o! L1nea1 [t. Area
ltghte ot crack eq, ft. �
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� � �:
Coef. Btu
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Int. wall _ "
Ceiling � ;,�,! � � �(� � � �
Floor - _ -_
?otal Btu. "�
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area '
� Fl.� �'P�° - I Length Width `� Heigh
° Windows and Doors—Crackage and Area
Wtdth Helght No. ot Lineal ft. Area
No. af psne ot pane lighte ot crack eQ. tt
B� I I I
� � �`' Infiltration
� � Glass
Eap. wall �° c �'a��
�.�•--
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Int. wall
'� Ceiling � �!'��
Floor
Total Btu. _
Coef.l Btu
Required sq. ft. E.D.R. or sq, ins. W.A. Leader area
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c�ty of Fridl�y
AT TNE TOP OF TME TWINS ��J I L D I N G P E R M i T
r
� .
� �
� `v __��__ COMMUNITY DEVELOPNIENT OIV. ���_�604
1 j � PROTECTIVE INSPECTION SEC.
�
� . ,
l--_-�; �'�' �-� CITY MALL FRIOLE� SS�32 NUNBEN REV O�TE P�GE Oc
L 612-571-3450 910-F15 7/17/O1 � /
J08 ADDRESS 6057 Central Avenue NE .
t LEGAL �OT NO. BLOCK TRACT Oii AODITION
oesca. 2 1 Blacl�an Addition
2 PiiOPERTY OWNER MAIL ADpR�S$ ZIP
Bob Hagetvedt 6057 Centra.l Avenue NE
3 CONTRACTOR MAIL ADDRESS 21P
Westurn Cedar Supply 9700 13 Ave N, Plymouth MN 55441
a ARCHITECT OR DESIGNEp MAII AODRESS ZIP
5 ENGINEER
8 USE OF BUILDING
Residential
7 CLASS OF WOfiK
❑ NEW
ADORESS
"32005
R EI T NO.
�
•VVqOVEO Br
SEE ATTACFIED
SMEET
571-8638
PHONE LICENSE NO
763-541-0304
PMONE LICENSE NO.
20155566
PMONE LICENSE NO
❑ ADDITION O ALTERATION �7 REPAIR O MOVE O REMOVE
8 DESCRIBE WOfiK
Reroof House & Garage (28 Sq) Tear-off
9 CHANGE OF USE FROM
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST
SEPARATE PERMITS ARE fiEOUIqEO FOR EIECTR�CAL, PLUMBING, MEATING.
VEN7I�ATING OR AIR CONDITIONING.
THIS PERMIT 9ECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS N07 COMMENCED Y�!ITHIN 80 DAYS. OR IF CONS7RUCTION �
OR WORK IS SUSPENDED OR ABANQONQO fOR A PERIQD Of 120 DAY$ AT
ANY 71ME AFTER WORK IS COMMENCED. " NO DWLG. UN
I HEREBY CERTIFV TMAT I MAVE iiEAD ANO EXAMINED TNIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS QF LAW$ yqLUATION
AND ORDINANCES GOVERNING THIS TYPE Of WOFiK WILL Q� CpMPF,lEO
WITH WHE7MER SPECIFIED NEREIN OR NOT. TME GRANTING OF A PERMIT �2 f863
DOES N07 PiiESUME TO GIVE AUTMOqITY TO VIOLATE OR CANCEI TME pEfiMITfEE
PROVISIONS OF ANY 07MER STATE OR LOCAL LAW REGULATING CON•
STRUCTION OR TME PERFOFMANCE Of CONSTRUC7ION �83 . ZS
PLAN CMECK FE
„ License
S�GNATUpE OF CON'AACTOp OA vUTMOpi2ED eGENi IDAfE� _ ,u�.
��� OWNEA �URDEN� �DAi6� . � �
SO. fT
STALLS
$5.
V
OCCUPANCVLOAD
CU FT
OFFSTREET PARKING
IGAFAGES
$1.43
SAC CMARGE
Fire SC $2.86
T9�TAL FEE
/ $92.54
)A D TNIS IS YOUR PERMIT
�� � L � �
NEW []
ADDN []
ALTER [ ]
Effective 1 /1 /2001
CITY OF FRIDLEY (763) 572-3604 Bidg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: �0� ! �ev� �i' � l� ��
Legal Description:
Owner Name & Address: _�� �05 � 7��P�77� Tel. # S� f" 86��
Contractor: ��S�F� Cc-�iy� �'��� MN UCENSE#_ �a'/5.���,F;-
Address:_ �>� r3�� f+s - t��o�- � S..s�/�// Tel. # 7� 3-.SY�-a 3o�t
LIVING AREA:
GARAGE AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
DECK AREA: Length
OTHER:
Width �_ Hgt/Ground Sq. Ft.
.._-- v i Q
Construction Type: %������°� Estimated Cost: � l �-s �C���
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: � � �APPLICANT: i��vl �� Tel. #
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
� � 3- a�� Fee Schedule on Reverse Side -
$ �v� .001 of Permit Valuation (1/10th%)
$ / �3 $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ 5� 6�j $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
� �'o�•Sy
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
$2,001 to $25,000
$25,001 to $50,(�0
$50,001 to $100,000
$100,001 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 $25,000
$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 $5(�,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,(�0,000 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
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 Onlv
-�- ,
�
NEIN [
ADDN ] �
ALTER �
s
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-Z
BUILDING PERMIT APPLICATION
,��` 90��
Effective 1/1/2001
(763) 572�604 Bldg Insp
Construction Address: �Pds � � ���``�"' L �-� "�� �`J�`�
Legal Description:
Owner Name 8� Address:
L°�v'
Tel.# J7l ���✓�
Contractor: MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LNING AREA: Length Width Height Sq. Ft
GARAGE /�1REA: Length Wdth Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type: Estimated Cost: $
��ve��vSV Gurb C�t Width Need�d:°2OFt. + 6 F# _��t x�/.�J�U =$ 3• �
���
DATE: D a` ��� APPLICANT:�L7� �������`' Tel. # S 7! �C�;✓ ��
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ Fee Schedule on Reverse Side -- --
Fire Surcharge $ .001 of Permit Valuation (1110th%)
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1150 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [) Not Necessary []
TOTAL
STIPULATIONS:
$
BUII,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building� or structure,
upon applicarion 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
$SO,QO1 to $100,000
$100,001 to $500,000 . �
$500,001 to $i,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $5� plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,(�0
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
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $1�,000
$993.7,5 for first $100,0(?0 plus $5.60 for each additional
$1,000 br fraction t�ier�euf, icranat inciud'mg $St70,G�tl
$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.
Altema.te "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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Cert�cate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
c�ty of Fridle�
AT TME TOP OF TME TW�NS
�
i �
� • COMMUNITY DE�ELQPNIENT DIV.
i ; V �'��� , . . .
f � � PfiOTEC7IVE INSPECTION SEC.
� i .
� �"'1 � CITY HALL FfiIDLE� SS�32
�'.---� • •,, 612-571-3460
�U ILDING PERMIT
NUMBEF REV OATH vAGE Of
910-F15 12/3/O1 / /
108 ADDFESS 6057 Central Ave NE �
t LEGAL ��T NO. BLOCK TFiACt OR AODITION
oescA. 2 1 Blactcman Addition
2 PiiOPERTY OWNER MAIL ADDRES$
Robert HObelvedt, 6057 Central Ave, Fridley, MN 55432
3 CON7RACTOH MAILADORESS
Lloyd's Home Improvement, 1012 42 1/2 Ave, Columbia He
e ARCMITECT OR OESIGNER MAIL ADDRESS
5 ENGINEER
8 USE OF BUILDING
Dwelling
7 CLASS OF WORK
8 DESCRIBE WORK
Deck
9 CHANaE OF USE FROM
STIPUlAT10NS
ADDRE$S
PERMIT NO.
32344
RECEIPT NO.
�� ��„
AVpROVED 8r
SEE ATTACMED
SHEET
763-571-8638
ZIP PHONE LICENSE NO
ts, MN 55421 763-788-56C
ZIP PMONE LICENSE NO.
LICENSE NO
C� NEW ❑ ADDITION O ALTERATIpN O REPAIR O MOVE O REMOVE
See notations on plans.
TO
�������
�efore diggin� cala for
all �tility IQ�ation�
45Q�0002
REQ!l�RE� �Y LA1�/
SEPARA7E PERMITS ARE REOUIRED POR ELECTRICAL, PLUMBING, FIEATINCi, ''r� vr �••�'•
VENTILATING OR AIF CONDITION�NG
THIS PERMIT BECOMES NUII AND VOID IF WORK OR CQNSTRUCTIOM zONING
AUTHORIZED IS N07 COMMENCED VyITHIN 80 DAYS. OR If CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANQONEO FOii A PERIOO OF 120 DAV$ A7 `
ANV TIME AFTER WORK IS COMMENCED. ' NO. DWLG. UNITS
I HEREBY CERTIfY TNAT I HAVE flEAO AND EXAMIN�D THIS APPLICATIQN
AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS Oi LAW$ yALUATION
ANO ORDINANCES GOVERNING TMIS TYPE Of WpRK WILL QE CpMPUED
WITM WHETMER SPECIFIED MEREIN Oii NOT. TME GRANTING OF A PERMIT $3,450
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqMtT FEE
PROVISIONS OF ANY 07HER STATE OR LOCAL LAW REGULA7ING CON-
ST UCTION OR TME PERFORMANCE OF CONSTRUCTION $9].2S
- PLAN CNECK FEE
� -� ( � Licen '
SiGN4 RE OF CON'RACTOp Oii 4U1N 2E0 eGENT �O�iEr ueu ai
�o.,e�
FT
S7A�LS
ROUP OCCUPANCYLOA
CU f T
DffSTREET PARKING
IGARAGES
SURTAX
$1.73
SAC CHARGE
Fir�ISC $3.45
TO�F E E
107.43
THIS IS VOUR PERMIT
:• /�` -3 -a/
NEW [ J Effective 1/1/2001
ADDN [ J , CITY OF FRIDLEY ,(763) 572-3604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: �� �� � U � ���z-����, �`��- �/ � I
Legal Description:
Owner Name 8 Address: �`�' �'��i` �( G Tel. # ,� .3� � � I �� �3 �
Contractor. `��(:� 1� C�-�: c'� ��v`u�' 1 MN LICENSE #� U� l`� y�
Address: r � � d `� d �� �.� - � � � E%^�:'�-�.�..[:� ��=� Tel. # � `� 7 g� � � ��
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the p�oposed construction drawn on it to scale.
-� DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. F�
Length Width Height Sq. Ft.
Length 3� Width i �� Hgt/Ground b Sq. Fk
Construction Type: � o��, ���..-�� Estimated Cost: $ �`7``� �
Driveway Curb Cut Wdth Needed: Ft. + 6 Ft = Ft x� _$,
r � � /�,
DATE: � APPUCANT: rJ���°e�C� ���. i'F' Tel. # % � j � 8 � `5 C � �
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
$ �o�� Fee Schedule on Reverse Side
$ - 5 .001 of Permit Valuation (1/10th%)
$ /. z�_ $.50!$1,000 Valuation
$ $1150 per SAC Unit
$ �0� $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 [ ]
� G� . ,..3
BUII.DING PERMIT FEE SCHEDULE
The Chief Building OfFcial shall, before issuing pernuts 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 $1�,000
$100,001 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 $25,000
$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 $1,000,000
$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.
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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
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ry
� sue�aci � RMIT NO.
City of F�ridl�� 3 24 9 9
�
AT TNE TOP OF TNE TWINS g u I L D I N� P E R M I T
; � RECEI O.
� • COMMUMITY DEVEIOPAMENT DIV. ��� ,
� j V �'���
l � � PROTECTIVE INSPECTION SEC
� j �"'1 � CITY HALL FRIOIE� 53132 NUMBER pEV O�iE o�GE O� �PVROVED Br
�"'"'�� �'' 612-571-3450 910-F15 4/11/02 / �
JOB ADORESS 6057 Central Avenue NE �
t LEGAL �OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. 2 1 Blackman Addition SHEET
2 PpOPERTY OWNER MAIL ADpRES$ Z�P PMONE
Robbie Hagetvedt 6057 Central Avenue NE 763-571-8698
3 CONTRACTOR MAILAODRESS , Z�P PHONE LICENSENO
Standard Water Control 53.37 Lakeland Ave N, Crystal, MN 55429 763-537-4849 1522
4 ARCNITECT OR DESIGNER MAIL AOOqESS ZIP PMONE LICENSE NO
S ENGINEER MAII AODRESS 21P PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOFiK
❑ NEW O ADDITION �] ALTERATION O REPAIR O MOVE - O REMOVE
8 DESCRIBE WOHK
Install drain tiie
9 CHAN(iE OF USE FROM TO
STIPULATIONS
��rmif �nspection �
IlV�ll �� �rds
1'o Hor�co Ma�led
wner To Po��
SEPARATE PERMITS ARE REOUIqEO FOii ELECTRICAL, PLUMBING. HEATINa, TYp� GF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OFi AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WQRK OR CONSTRUCTION tONING SO. fT CU fT
AUTHORIZED IS NOT COMMENCED Vy1THIN 80 DAYS. OR IF CONSTRUCTION ;
Oli WORK IS SUSPENDED OR ABANqONEO FOR A PERI00 OF 120 DAY$ A7 ''
ANY TIME AFTER WORK IS COMMENCEO. ' NO DWLG. UNITS OFFSTFEET PARKING
I HEREBV CERTIFV THAT I MAVE REAO ANO ExAMINED TMIS APPLICA710N ]. STALLS GARAGES
AND KNOW TME SAME TO BE TFIUE ANO CORRECF. A�L PflOVISIQNS OF LAWS yALUATION SURTAX
AND OROINANCES GOVEFiNING THIS TVPE Of WORK WILL B� CpMPIIED @
WITM WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT W3s8SO �1.9Z
DOES NOT PRESUME TO GIVE AUTHOFiITV TO VIOLATE OR CANCEL TNE pEqMl7 FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW qEGULATING CON- @
STqUC710N OR TME PERFORMANCE Of CONSTRUCTION y��7.25 F re SC �3.SS
PI,AN CHECK FEE T � FEE
Lice C . U $108.02
S�GN4TUAEO�CON7RACTOpON4UTMOp�2E0oGENT IDAT6 HE PFO � VALI D TMIS IS VOU PERMIT
_ (� � , I
S�GNATUaE O� OWNEp��F OWNEp8U4DEAi IOATE� ' , B ��NSp ' � � qc1E
FROM : FAX N0. : 7635371882 Apr. 10 2002 12:27PM P1
�a-�t° Fax Note 767'2
To �
�„ I�� ��.,�s,�. ���:
,:1.:; ��,.��{ a
From
�
I��� ���%l�� i�m�,
f�� �� � I
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� ��
'Fait� . Ta�er�se ... �� T_� / �
:� .. ... . Q]' �
. . � . . ... . ... ��y9
� .�
:.... . . . .. .. .. _.. .. �� ��
.. .._. _. .. . . �.
:_.._..� _._ .... __. _. _ . ... _ . ... ��
�� . � a �
. ....
; P��. C�o..� .►� .. .��:. co� .,�,,�,x, b�on..�.. _ ... . .. . . . . . .... . .. _.
�._ - �... �'' ... .__..__ ..
NEw t1
ADDN (�
ALTER ( ]
Construction Addrass:
Legal Description:
Owner Name 8 Address:
Contractor: _,j �GC�"�
cmr oF FRio��r �c;�e �i�rzaoz
6431 University qve NE, Fridiey, MN 55432 (763) 5723604 Bldg Insp
SINGLE FAMILY ANO OUPLEXES R-1 AND R-2
BUILDING PERM(TAPPUCATION �� �l°3'-5 �l /°�?
�
Tel. � � _ � /- i
MN UCENSE� a�,
Tel. � �.lo. � �%�- � �/
Atfiach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF 1MPROVEMENT
LNING AREA: l�gth Width Hei9ht r Sq. Ft � '�
GARAGE ARFA: Length Width Height Sq. Ft
DECK AREA: Length Width HgtlGround Sq. Ft
OTHER:
Construction Type�rOl+ r`,�� �-2 Estimated Cos� $ 3 d, �
Driveway Curb Cut Width Needed: �FL + 6 Ft =_Ft x$ = g
DATE: APPLICA�IT; Tel. �%!�/.3 , 7�y 9
. /
Ca(I (763} b72-3604 for Pemtit Fees if mailIng in application or Fa�c ta 763-67l-1287 if using c►edit �ard and we wiil
call you for card number.
CITY USE ONLY -
Permit Fee $���,?,� Fee Schedule on Reverse Side
Fire Surcharge $ .001 of Permit Valuation (1/lath%)
State Surcharge $ �-- $.50/$1,000 Valuation
SAC Charge $ � $1200 per SAC Unit
License Surcharge $,�`av $5.00 (State Licensed Residenfial Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee � Fee Determined by Engineering
Sewer Main Charge � Agreement Necessary j j Not Necessary j]
TOTAL 5 O' ��'� STIPULATIONS:
��� �d'�� J��I � 3��
D�i ��~
t� •
ADDRESS
PIN
LEGAL DESC
PERNIIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, NIN 55432
s�i-36u4 r��:
: 6057 CENTRAL AVE NE
: 243024210010
: BLACKMAR ADD
: LOT 2 BLOCK 1
: ELECTRICAL
: RESIDENTIAL
: ADDITION/ALTERATION
571-1287
PERNIIT NO.: 2004-01792 �� ! 1
DATE ISSUED: 10/OS/2004
VALUATION .
NOTE: ELECTRICAL PERNIIT BECOMES VOID 12 MONTHS AFTER PERMIT ISSUE DATE. INSTALL A SAVERS
SWITCH.
# INSPECTIONS 1
APPLICANT
HUNT ELECTRIC CORPORATION
2300 TERRITORIAL RD
ST PAiTL, MN 55114-
� dL:
HOGETVEDT ROBBIE J
6057 CENTRAL AVE NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
applicarion and lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the performance of construction.
Applicant Date
Bldg Insp Date
�
c��n � n � mc nr. n w wTmcv T T!!1T TiT Tr ,-.
ELEC PERMIT FEE - MIl�T (RESI)
STATE SURCHARGE, ELEC FLAT
TOTAL
PAID WITH CHECK # 118132
��� � �... _ � �. �......aa a u iW � V i1�LiL 1' Vl\ rv v1� v 1 i1Gri 1 I1ti1V L�Jl.1CLI3L" 1J iyJ,s V V L" .
20.00
0.50
20.50