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City of Fridley
AT THE TOP OF THE TWINS B u I L D I N C� P E R�II I T
� ��������
i �` ���� COMMUNITY D ELOPMENT OIV.
r � �' � pROTEC7IVE INSPECTION SEC.
� �
� � �""1 � CITY HALL FiiIOLE� 55132 NUMBEP
�•-°� � �'� 612-571-34b0 9t0-F15
JOB ADDRESS
6640 Central Avenue E
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
oescR. pt. of 4F Aud. ub 2'
2 PROPERTYOWNER MAILADOR�,S$
3 CONTRACTOR
Owner
4 AfiCHITECT OR OESIGNER
5 ENGINEER
8 USE OF BUILDING
Residential
7 CIASS OF WORK
❑ NEW
B OESCRIBE WOHK
MAIL ADDRESS
REV OATfi
10/14/98
ZIP
PAGE OF
� �
E
IT NO.
28237
�,
�� ��
APPROVED BV
SEE ATTACHEO
SHEET
LICENSE NO
UCENSENO
LICENSE NO
❑ ADDITION O ALTERATIQN � HEPAIR ❑ MOVE O REMOVE
Reroof house (15,Sq) Tear-off
9 CHAN(3E OF USE F
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
TYP� OFCONST. OCCUPANCV
SEPARATE PERMITS ARE REOUIRED FOH ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULI AND VOID IF WORK OR CONSTRUCTIOM 20NING SQ. FT
AUTHORIZED IS NOT COMMENCED YtIITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANQpNEO FOR A PERIOO OF /2p OAYS A7
ANY TIME AFTER WORK IS COMMENCED. NO OWLG. UNI7S
I HEREBY CERTIFV TMAT I HAVE READ ANO EXAMINEO THIS APPLICA710N STA��S
ANO KNOW TME SAME TO BE TF1UE AND COFiRECT. ALl PROVISIONS OF LAW$ yALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WpRK WILL QE COMPUEO
WITH WMETMEfi SPEC�FIED HEREIN OR NOT. THE GRANTING OF A PERMIT �].285
DOES NOT PRESUME TO GIVE AUTHOR�TY TO VIOLATE OR CAMCEL TME pEqMITfEE
PROVISIONS OF ANY OTHER STATE OFi LOCAL LAW REGULATING GON-
� STR ON OR THE PERFORMANCE OF CONSTRUCTION l}3.00
,.- ��� PLAN CNECK FEE
SiGNATUAE OF CONCNACTOQ Op AUTNOFQED AGENT IDATEi WMEN``'r/ ER ALIDA�
L �
�
S�GNATURE Of OWNEAaf OWNEpBUILDEAt �O�iEi 8 G�NS� ' � _
ROUP OCCUPANCYLOAD
CU FT.
OFFSTFEET PARKING
IGARAGES
$.64
SAC CNARGE
Fire SC $1.28
TOTA�FEE
$44.92
0 THIS IS VOUR PERM�T
��-�f��r�X
f�6tf
e .
NEW [ l
ADDN [ ]
ALTER [�
CITY OF FRIDLEY
SINGLE FAMILY ANB DUPLEXES R-1 AND R-Z
BUILDING PERMIT APPLICATION
ConstructionAddress:
� � �� �� � , � �,�, �li�
Legal Description:
Owner Name & Address:
Effective 1/1/98
� p� �
� � ��� r
��
�, i� �-��Tel. � � %/� �I Y6 �
��°
Contractor: �a�s� �- �' MN LICENSE #.
Address
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width � Hgt/Gr�und
�i_''.
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
� U "
�- -- � � � /���.
Construction Type: L�� f� Estimatcfl C�st: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 1����%� APPLICANT: �JJ�� Tel. #��/�� ���
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �. o v
$ /- �8
$ ��
$
$
$
$
$
$
$ y ,
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 [ ]
BUILDING PERMIT F'EE 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,OU1 to $50,000
$50,001 to $100,000
$100, 001 to $500, 000
$500, 001 to $1,000, 000
$1,OOO,Q01 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25, 000 plus $9.00 for each additional $1, 000
or fraction thereof, to and including $50,000
$574.75 for frst $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 additionaZ
$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 $1,000, 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)
Altemate "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.