AF-R - 37176sue�ecr PE .
c�ty of Fr�aiey 14890
AT THE TOP OF THE TWINS � g U I L D I N G P E R M I T
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� • COMMUNITY DEVELOPMENT DIV.
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r � � PROTECTIVE INSPECTION SEC.
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' 1 ����1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�----� • ••� si a-sso-saso
910-F15 9/1/78 � �
108 ADDRESS 140-42 Charles Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. pdrt Of �. 2 Eiayes River LO'tS (Parcel A) SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Stan Caxlsten Genaral Contractor 6528 University Avenue N.E., Fridley
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same 571-7575
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE IICENSE NO.
5 ENGINEER SEPERATE PERMtTS REQIStREQ f�R WIRI�i� �ICENSE NO.
8 USEOFBUILDING �EA71NG, PLUM8ING AND
Residential
7 CLASS OF WORK
C� NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ OVE
8 DESCRIBE WORK
Construct a 26' x 42' Duplex and a 38' x 24' Garage 8ef� diggiAg �a� 1oea� utiriies
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9 CHANGE qF USE FROM TO
STIPULATIONS ProVi� ���tyon air to the furnace. Provide truss design and certificat
of veri.fying s.urvey by 5eptember 3Q, 1978. Install attic access (22" x 30") in
hallway. Expose 6 inches of block around perimeter of structure. Provide
a hard surface driveway. Provide sod in ��cfr�c tlie front and side yarc3s.
NO EXI5TING Ti�TER/SE�1ER SERVICE.S TO PARCEL A, 8" Sani.tary sewer is 33 feet
north of north property line. 6" CIP W3'F��a�T� is 23 feet north of north
property line.
DRIVEWAY DEPRESSION OO5T: N/A Existi.ng bitumi.num curbing.
n� ant o� �n� ao�s wot ova� n,e
ACGVAACY O� VMY tOGTF� JWD �►A�}ON�.
'FNtS DAtA li !pR N�pAMATION PUP.PCSf.S 0►iLi� r1t�
���OM:+ ti�ING R SMOtriD rlp�pY 1H� �
TYP OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. ��Od Frd�e
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
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT �.�.40'�"'$4C 31, 260 Total
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 2 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINAtdCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT y�` �iI.�O�.O �ZO.SO
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-
STRUCTION OR THE PERFORMANCE OF C NSTRUCTION. �S`].25.04 �`SOO.00
9 / PLAN CHECKFEE TOTALFEE
.26 976.80
SIGNATUREOFCO RACTO ORAUTHORIZEDAGENT 1 i HEN PROP RLY VALIDATEO THIS IS YOUR PERMIT �
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SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI BLOG INSP f1ATE
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CITY or- r-�z�v�cY
• A!'PLIE/1TI01�� �FOR f2L'SIllf:NTIAL BUILDI�IG PE(2(�IITS , � '���
��; �
tid�:wt �1LTLR/1TIOfJS, �DllITIOIJS, OR REPAIRS)
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OWti�R: -�',- �'A � 13UZLUER: -'' '� � -�7�0 �
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Actdress : � ��, � �-� r� �s✓ ���._ Address : . �� t ��- �
. . Tel. No. : � �/b m��` .� � .
No. � � -� � 5tr`e�et • � �'�i,�0�, ��� � .
��c.�. � o .�
LOT:� BIACY.: �_ ADDITIOPJ :�
C012NER LOT: INSIDE IAT: im' S3TB11CJ:: SID�YARDS:
Applicant attach 't-o t•his form Zt�o Certiiicates of Survey of Lot and proposed
building locatian drawn on these Certificates. •
� ,
DESCRI PTIDrd OF BUI LDI I�G ,,
'1b Be Used As : � � . '� � -
��, Front s Depth : � Height : ��
, Square F�et: �t�Q Cubic Feet: �`�� ��%�
'�.�� �F'ront: �� � Depth: ��/' . � �. .
Hei ht: �
������ ���
Square Feet: '. �.ubic Feet: ��' �
Type of Construction: ��� � � • Estimated Cost: $ ;��' - -
�'� d0o-�
e Com leted: p �" � � A1'�: A A2t. B
�.b B p
Proposed Driveway �4idth If IZew Opening Is Desired � $ $ '
• � (SE� it�VERSE SIDE OF SHEET)
Tha undersigned hereby makes agplication for a pexmit for the work llerein
specified, agreeing to do all �aark i.n strict accordance with the Gity af
Fridley Ordinanees and rulings of tlie Department oi Suildings, and hereby
declares that all tha facts and representations s�ated in this ap�lication
� are true and correct. �See rever�e side f r additianal informa�ion. .
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Stipulations: � � �
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BUILDI�JG PERt�IT FEt SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection
of any building or st�ucture, or for any addition to any exi.sting building or structure,
or for any alteration or repairs 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:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.Q0/1,000 cubic fee�.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete�Curb Streets Only)
Alternate A: R�emoval and xeplacement of.concrete curb and
gutter only; Driveway width plus 6 feet x$14.50
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x$17.20
� 11 � : 1 �' : �l
For the purpose of c�mputing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the baseraent or th� cellar to the
average heights of the upper surface or to the average height of the roof surface
of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 gier.each five hundred dollars-($500.00) or fraction thereof in the cost
of all proposed work.
In�no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plu's $.50 state surcharge.
�� � � � � 1 1;� � l
NOTE: Permits For construction will be issued a miniminn of 2� 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 been constructed will be required before proceeding with the framing.
_► ' � � ':►
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which.a build:ing permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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,Surveyors C'ertific�te
COM3TOCK & DAVIS, INC. Consulting Engineers and Land Surveyors
1446 County Road J,11�Ipls., Minn. 55432, 784-9346
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i hereby certify that this survey, plan or report was prepared by me or under my direct
supervision and thai I am a duly Registered Land Surveyor under the laws of the State
of Minnesota. �
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1446 County Road J, Mpls., Minn. 55432, 784-9346
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I hereby certify that this survey, plan or report was prepared by me or under my d'uect
supervision and that I am a duly Registered Land Surveyor under the laws of the State
of Minnesota.
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� CITY OF FRIDLEY � -�'
0
PUBLIC WORKS DEPARTMENT
TAPPING APPLICATION AND PERNIIT
FOR INSTALLATION OF WATER & SEWER SERVICE
I) This form to b��mplete ��re a tap is mad to any esisting water or
sewer lin . . �z�
Lo � � loc ddition
Address � �
Owner ct�v
Plumber
CHARGES TO E PAID BEFORE AP IS MADE — WHERE
ASSESSMENT HAS NOT BEEN LEVIID AGAINST PROPERTY
II) Water & sewer connection permit must be registered before this Tapping
Permit can be issued.
City supplies all material and labor for 1" or under water tap. Con-
tractor supplies all material and labor for water tap over 1", and all
sewer taps.
WATER TAP: Materials Used: $ / � � �
/ �
Street Patch: �: $/ 4� P O-�
TOTAL: $ � a�� �
SEWER TAP: Street Patch: x :$
III) If this property has not paid a full Lateral Charge for its share of the
water and sewer system, additional charges will be placed against it.
This will be in addition to the normal connection and tapping permits,
meter deposits, etc.
Water
ASSESSMENTS TO BE LEVIED: Lateral: $�'�
Clerks
Supt. o
Sewer Lateral: $
TOTAL ASSESSMENT: $ �% �
M/P 3/76 White P.W. Canary Finance Plnk Prop. Owner Goldenrod Plumber
�. �nK�� Ja ��.�ks �*''4." .
�, .��h �� i�t� �
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4 �e�j ,,��,{y ' ��.
,'�� 'i�u� $ �"'°t�,2 �`.
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� f` i , $��, ��
£ � .'4 9 t J�} pd %.i �� W, 'c,�
R � 9
6431 UNIVERSITY AVENUE PI.E., FRIDLEY, MINNESOTA 55432
' F ruary 13, 1979
,_.,
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TELEPHONE ( 612)5T1-3450
✓�
�/��
�
Re: Final Inspection at 140-142 Charles 5treet td.E.
Dear Mr. Carlsten:
A final inspection was made on February 13, 1979 of the above address
and the follawing items were noted which must be completed before the
structure can be finaled out;
l. Post house niunbers on structure by February 20, 1979.
2. Provide a hard surface driveway by June 15, 1979.
3. Provide sod in the front and side yards by,June 15, 1979.
4. Provide permanent post and footings for the deck by June 15, 1979.
5. Reduce spacing on deck railing to 9 inches or less by June 15, 1979.
We will expect the above items to be completed by the scheduled dates
when reinspections will be made to determine compliance. If you have
any questions on these items, plea.se feel free to contact me at 57Z-3450.
Sincerely,
D G. CLARK
Chief Building Official
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8439 U�d.IVEt9SITY AVENUE PI.E., FRIDLE•Y, W11tdNESOTA 55432
YEL�PHOIVE ( 812)571-3A50
October 17, 1980
Mr. Dick Anderson
140 Charles Street N.E.
Fridley, MN 55432
Dear Mr. Anderson:
RE: 1980-81 License Application for the Residential Rental
Property located at 140-42 Charles Street N.E:, Fridley, MN
At the end of July, 1980 you were mailed an application to
license your residential rental property. As of the date of
this letter, the City has not received ihe application and
appropriate fee:
The��efore, we are again mailing out the enclosPd application
which must be completed, signed and returned with the license
fee plus the 50% late penalty no later than 11-3-80.
Your prompt attention to this matter 7s appreciated.
SJO/kw
Enc 1 osure (1)
�
0069A/0807A
Very truly yours,
STEVEN J. OLSQN, R.S.
Environmental Officer
� � '� ' SUBJBCT . -
City of Fridley 3 2 0�i 4
�
AT TME TOP OF TME TWINS g u I L D I N� P E R M i T
; � ' REC IPT NO.
� ; y �_��� COMMUNITY DEVELQPAMENT OIV. ������0 �y � �
r � � PROTECTIVE INSPECTION SEC.
f�,
� 1 �'�'1 � CITY NAIL FRIDLEV j�13P NUMBEF pEV OAT@ PAGE OF APGROVEO BY
�----�: `.� 612-571-3460 910-Ft5 $���01 / /
JOB ADORESS 140 Charles Street �
t IEGAL ��T NO. BLOCK TRACT OR AODITION SEE ATTACMEO
oesca. t. of 1, Parcel A, lock 2, Hayes River Lots SNEET
2 PROPERTY OWNER MAII ADORQS$ 21P PMONE
Shane Nazar, 140 Charles St., Fridley, MN 55432 612-810-8437
3 CONTqACTOR MAIL ADDRESS ZIP PMONE LICENSE NO
Shane Nazar
d ARCHITECT OR DESIGNER MAIL ADDRES5 ZIP PMONE LICENSE NO
5 ENGINEER MIAII ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
$j NEW O ApDITIpN O ALTERATIpN � REPAIR O MOVE � 0 REMOVE
8 DESCRIBE WOHK
Replacement windows
9 CHAN(3E OF USE FROM T�
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code.
Caulking & flashing for all exterior openings.
" ' TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY IOAD
SEPARATE PERMITS ARE REQUIREO FOR EIECTRICAL, PLUMBING, MEATING.
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULI AND VOID IF WORK Ofi CQNSTRUCTION 20NlNCi SQ. FT CU fT.
AUTHORIZED IS NOT COMMENCED V�IITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANQONQO FOii A PERIOD OF 120 OAY$ A7 �
ANY TIME AfTER WOFiK IS COMMENCED. ' NO DWLG. UNITS OiFSTREET PARKING
I HEREBY CERTIFY TMAT I MAVE READ ANO EXAMIN�O THIS APPLICA710N STA�LS GAFAGES
AND KNOW TME SAME TO 8E TRUE AND CORRECT. A�L PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL fl� CIDMPI,IEO � 1� HOO .00 �. 9O
W17H WMETMER SPECIFIED HEpE1N OR NOT. TME GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME pEqMIT f EE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGUTATING coN• $63.ZS Fire SC �Z.SO
STiiUCTION OR 7HE PERfORMANCE OF CONSTRUCTION
PLAN CHECK FE TOT FEE
$65.85
GNATUpE OF CON'�7ACTOp OA AUTMOp�ZED AGENT � �O�tE� EN OPE LIOA THIS IS �JR V FM1�
� �� l�/� �
��
AEO�OWNEQ��iQWNEABU40EA� �6�rE� BLDG NSP � ��Fft
N� � � Effective 1/1/2001
ADDN [ ] , CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 572-3604 Bldg Insp
BUILDING PERMITAPPLICATION
Construction Address:
l� s �
Legal Description: �
Owner Name & Address: �� L� �Gt.� c�.y Te�. # 6`� _ gl4 --�c��%
� �
Contractor:
_ MN LICENSE #
Address: Tet. #
LIVING AREA:
GARAGE A-REA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed consfruction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. F�
Length
Length
Width
Width
Height Sq. Ft
HgUGround Sq. Ft
°'✓t c1' 0 � �
Constnaction Type: Estimated Cost: $ �g Q� �
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
a} 1 /
DATE: ( � ! APPLICANT: Tel. # ���- ��� o -� �3�
CITY USE ONLY -
Permit Fee - --
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
Call (763) 572-3604 for Permit Fees if mailing in application
$ Cv.�• �-� Fee Schedule on Reverse Side
$ /.86 .001 of Permit Valuation (1/10th%)
$ . 9G $.50/$1,000 Valuation
$ $1150 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 [ ]
$ ���s.
STIPULATIONS: ��r��l/'�b�i � -���'�"�'��,� �2�ja �/,
� �
/i' 1 � � �•�. L��tL�i'�'� �r' �!!�j'�./.�-1�- ��L.
��7�"a�lr�/L- J�i°�".�/-���
9. �
BIJII.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 e�sting 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,OOO,Q00
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $1(� or
fraction thereof, to and including $2,000
$69.25 for first $2,0(� 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, 0�
$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) � �
Altemate "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 timme of application to allow for proper
review of the proposed structure and of the construction site. "
A Gertificate of Survey of the lot, showing �the location of ihe foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
' ' ' � SuB�EtT �� - � �
c�ty of Fr�a��� 3 2 4 9 0
AT TME TOP OF TME TWINS g u I L D I N G P E R M I T
r
� � RECEIPT NO.
COMMUNITY OEVELOPMENT OIV.
r � � � PFOTECTIVE INSPECTION SEC /e `7
.�
� ; i G i
� � /�'9 � CITY h1ALL FRIDLEV SS�3Z NU4BEN 11EV OATB PAGE OF APPROVED BY
�----� • •', 612-571-3450 s�aF�s 4/2/02 / /
JOB ADDRESS 140-142 CHARLES STREET NE
1 LEGAL �OT NO. BLOCK TRACT OR ADOtTION SEE ATTACMED
oescA. PT 1 2 Hayes River Lots SHEET
2 PROPERTY OWNER MAIL ADORQ$$ ZIP PMONE
Shane Nazar 661 Quixote Ave, Lakeland, MN 612-810-8370
3 CONTRACTOH MAILADDRESS ZIP PMONE LICENSENO
S& D Exteriors 14210 43 Ave N, Plymouth, MN 55446 612-327-4238 City
4 AqCHITECT OR DESIGNEFi MAIL ADDRESS ZIP PMONE UCENSE NO
5 ENGINEER MAIL ADORESS 21P PMONE LICENSE NO
8 USE OF BUILDING
Duplex
7 CLASS OF WOqK
❑ NEW O ADOITION ❑ ALTERATIQN � REPAIR O MOVE - O REMOVE
8 DESCRIBE WORK
Reside Duplex; Install Soffit & Fascia
9 CHAN(iE OF USE FROM TO
STIPULATIONS
Per Sec�ion 1402, 1997 Uniform Buildi�ag Code, requires that a weather resistive
b2rrier be placed over exterior,sheathing to protect the interior wail covering.
Exceptions�for �his provision would be if' sh2athing �s an approved weatherproof
panel or when the siding is an approved weather barrier. Vi�yl siding is not a
weatherproof covering unless the maau£a.cturer states this in their appl�cation
guidelines. Call for inspeCtion of wrap before covering. Caulk ar,d flash aIl
exterior openings. Install so,ffit ventilation to meet the State Building Code.
° TYP�OiCONST. OCCUPANCY GROUP OCCUPANCV�OAD
SEPARATE PEfiMITS ARE REQUIRED FOR ELECTRICAL, PIUMBING, HEATIN(i,
VENTILATING Op AIR CONOITIONING
THIS PEFMIT BECOMES NULL AND VOID IF WORK OFi CONSTRUCTIOM 20NING SO. FT CU FT
AUTHORI2ED IS NOT COMMENCED V�IITHIN 80 OAVS. OR IF CONSTRUCTION
OF WORK IS SUSPENDED OR ABANQONED fOR A PERIOD Of 120 OAVS A7 ''
ANY TIME AFTER WOpK IS COMMENCED. ` NO DWLCa. UNITS OFFSTREET PARKING
I HEREBY CEiiTIFV THAT I HAYE READ ANO ExAMIN�O TNIS APPLICATIQN 1 STA�(,S GAiiAGES
ANO KNOW TME SAME TO BE TRUE AND CORREC7. ALl PROVISIONS �f LAWS yqLUATION SURTAX
AND ORDINANCES GOVEHNING THIS TVPE Of WQRK WILL �E C�MPlIEO $9 � OOO ��F . SO
WITM WHETMER SPECIf1ED HEREIN Ofi NOT. THE GRANTING Of A PERMIT
DOES NOT PpESUME TO GIVE AUTMORITY TO VIOIATE Oii CAMCEI THE pERMIT FEE SAC CMARGE
PROVISIONS OF ANY OTNEFi STATE OR LOCAL LAW REGULATING coN• �167.LS Fire SC �9.00
TRUCTIO O TN ERFORMA E OF CONSTRUCTION
��� �` ���� PLAN GHECK fEE OTA� FE
` License "City" $18 .75
$�GN4TUAEO�CON'FACTOpOpOUTNOA�ZEOAGENT �O�rE� N P PER� OATED TH IS VOU PERMiT
/ �� �
S�GN4TUAEO�OWNEA���OWNEpBURDEp� iO�TE� � BLOG N50 � f�6tE
NEVV [ J CITY OF FRIDLEY Effectivve 1/1/2002
ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572�604 Bidg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: � ���� � � l � � 1 d i - �� �� '� � a � °��� � � �
Legai Description:
Owner Name 8� �Address: _� l�h��-� � � � �_ e� -i �' r-r ,( � �� r „r � �� ._ << � �� � t� � 7 � � d Tel. # � C��-o �� �� �� � °, - �
Contractor. �� � � � � `- ��� " � � l� � � .�' �� � ��: � •� �MN LICENSE #
'� c-' c Q_�;�
Address: � % �%1l �° �-�_� o �.�✓ , � � ( �. � ,. �� ��:�. 1,_. �� l -� � �- -, , Tel. # G: � f,<�� � �� �� ,-" ��,�� : - S
LMNG 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 Sq. Ft
Length Vlfidth Height Sq. Ft
Length Width HgUGround Sq. Ft
� �' -� � � p '�`� `� �� �'� `�stimated Cost: $ r� � � � � � ; _ � - �
Construction Type: /�� _ � , d ��r _ �
Driveway Curb Cut Width Needed: Ft + 6 Ft =�Ft x$ _$
F �
.: �' �
�
DATE• i � ` ` �
`r = ' APPUCANT• �� G �.J �_ ;� -� � Tel. # � , � -��'� � .�, _:- �v_ �
w
Call (763) 572-3604 for Pertnit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
� I �-�'� / �°��=
$ �
$ �/, ���
$
�_�����—
$
$
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 per 8AC 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 [ ]
TOTAL $ ���'C' - �� STIPULATIONS:
� � � ` ��'�� ��c � � ,�- e-� �. _
� � �" ���~
BUII.DING PERMIT FEE SCHEDULE
The Chief Building O�cia1 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 $2,0�
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,�1 to $5�,�0
$500,001 to $1,000,0�
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,Q00 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 $1,0�
or fraction thereof, to and including $50,0�
$643.75 for first $50,0(� plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,(�0
$993.75 for first $100,0(m plus $5.60 for each additional
$1,OQ0 or ftaction 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
$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 -
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet-�imes $17.00.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the rime of applicarion 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 proceed.ing with the framing. New Houses Onlv
Inspectxons
763-592=3d04
DarE S= /�c
SITE ADriRESg ,�
Tki1S APPLICANT IS:
TENAN7'
BUILDING P�xmit No.:_.� � ;
�SY'DElYTI.�,L A.PP�IC.ATION Received By; /�
C.YT� O� 1� IZYDLE+'Y' Da.t� Re�'d�' ,
� � YOU�i E-MAII. qpDP.�SS •
A A _
�i�11
0 ow�vEre
PHQNE: �""
SUBMTT A COPY OF STA7'� LIC�NSE fi � 2�.a."�p� �� �� w
YOUR STATE i.ICENSE A,DDRESS: I S� 1 Z . � DATH �� p� .
DVI�I APT'LICATION �� '�b - `l� . C17'X
•PFIOAiE �.P.IZ- i¢��'S'� 3 7'X
PY20PE1;T'Y' TYPE I� Sfi1GL� F.4Ivm.Y/NEW CONSTRi1CTlON FA7C �l IG' ���f 3''�'°Qi� Z. .
❑ TWO FA�TLY/N$Vy CpNSTRU�ON' s�
PERl1i1T �'YPE ' • O AUDITiON L7 GARA�GE/SI� 5TO1tIES: '
❑ B.a S�1vIDV�' FII�'!SH O ROOF 0�DOWS
I� DSCK •- ❑ DR.4ZN TTC.E
❑ S11�II�lG
TYPE OF WORK: � NE'W • ❑ SW�'iMD�G POOL �� � �.��,� ��
a�rrEr,,�vc�,�,,R ���arrcaN . .
�REMOD�l,D�1G
DESCR�� woRx B�rtvG norr�: f�..-�Y 3Q� �f .��q A
Q1'7� �c. n. .�.,.....' .._' -- -- • � ^'�� �� R �u h �mi1 ��- c . K . ..�
N uNIp3ER OF SQUARB$ �_
GAkAG�F �
P1tOPO,�ED S1Z�;
P1tOPQSED T�GHT: �i
SID NG
O Vinyl
L7 Alumims,n '
O Oth�r
—��_
WS
IN EXIS171V(� OPEPT�GS pYes pNp
OR FOIt NE W OPLNIIVGS-DESCR.[BE SuE OF
OPh1VING CHqNGES &
Ar.L
Perniit Fe�
P�an Review
Fire Surch�rge
Surcharg�
Liceese Surchargo
�AC Charge
:urb Cut Escrovy
:rosion Coutrol
'ark 1�'c3e
�e'wer Maiw Charge
O HOTISE b� Crq,l�p�g
C] ATfACFi�D GAR.AGE
Q bEfACiaEb GAK,q,G�
OSoff'it
C7 Trifi
0 Fascia
1,QGATlOId OF'VVIIWOWS
��
aTe�wz� �5.3�
� s�.�. ,�,=b
i�•,
�SEMFNT1�en�UnPL1N SI M1T.
l. Exiscing Floor Plaa
2. ProposGd fl0cr pl�
3. =� °1'strucduui rnCmbers to bC t�ed
FOtt NEW (.pNS�`�U�70N INCLUD�NG D�CKS,
A DIT N. d� RC. $
1. Sito P1r�nMe�rvey showen6 tl�e.nxiseing srrucour.ss
arid propascd projp�,
2'. Two se�s of coastruction plens
3. �ne�rgy C�olculations
�ASED 4N VALUATXON, IIVCLYIA�TG THE COST O�` Y,A,SO�!
(U'SIIVG T� 19g7 U.g,C FEE SCTiEAUL�)
YAT.,UATroN � � -► �o �c o�
a / s�� /1 6S% of B -- --- ..........u.�
� . ., uilding Perrnit Fee
$ .001 times W� tora! job vatuation ,
� � �� .00QS x Parn►it Valrtation Minimum $,�p
.$ ` U`Ze � $5.00 (Sta�e Licens�d �esidenti&1 Contractors)
,$ �1675 per SAC Unit (Plans to MWCC for datern�2r�ahon)
_,��$ + 6 fit = r
� �„ftx$21-g
� �450 Conservation p]ars Reyiew
$ �c�e b�termincd by Engine:ering
$ / •4grenmEnt necessary ( ) N'on Necessary ( )
Make cbec[ts a able to: City of Fr;dley
TH1S LS AA1 APP1,rCAifOT1 FOR A p$RMIT_NOT YAr,ID 71NTlL pRpC�S�D ��C� S� ��f1on5
her�by apply for a buildin A
L� Fermit and I actc�owledgG that the informati�n above is coraplet� and accw�ata•
�nformance with the ordinanccs and eod�s oi th� Ciry og Friiiley and with che Mir�nesota Constn�cHon Codes• thnt 1
%rtuit but oe! an 1' .� fhe work will be rg
�' aPP �cation for $ pex�mit and w,ark is not to start v�rithaut a permit; that the work will be in aceordance vy�p.� �� rQ
a� in Che case of all wark w i � t undtlrsr�and t,his is not a
'�s revievv d approval of ptans. apA ved
3NA'I'URE OF APPLIC P,R1N'I' NAME ��, % .
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59/90 3�Gd tt 8�EbZL5�9L 8Z�59 L60Z/0Z/50
City of Fridley
6431 University Ave NE
Fridley MN 55432
(763) 572-3604 or Fax (763) 502-4977
� �� ����
Water and Sewer Permit Application
❑ New Connection
❑ Eacisting
tility Line Repair/Relocation
Water and Sewer Connection
Date: S Z, C5 �
Job Address: � �'t. (�) �� cr� ��e S S�"
Name of Applicant (Plumber): � �� �`� �p o
Name of Property Owner: ���' �,2 U"�.' �� 5�
Existing Structure Permit #
Permit Type: Sewer Fee:
Water Fee:
Meter Fee:
Repair Fee: �°f � �
Relocation:
Sta.te Surchazge:
SAC Charge:
Special Assessment Fee:
Tota.l: $ �f ��
Applicant Signature: �
Inspector approval:
Water Meter Repair — Weekend &
Water Connections Permit
Sewer Connections Permit
Inspection Fee for Water/Sewer Line
Special Assessments
Cost of Water Meter
SAC Cha.rge
State Surcharge
Water Tan
$125/hour
$50
$50
$40
See Engineering
See Utility Billing
$1675
$ .50
See En�ineerine
Building PLUMBING Permit No.: � �d
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Da��' 'd�AY 2 4 200
DATE YOUR E-MAIL ADDRESS
SITE ADDRESS �-' `Z � � �
THIS APPLICANT IS: ❑ OWNER ONTRACTOR
PROPERTY N�:
OWNER/ pDDRESS: CITY STATE ZIP
TENANT
PHONE:
CONTRACTOR N,e,�,�: ' � �
ti
SUBMIT A COPY OF STATE LICENSE # DATE
YOUR STATE ADDRESS• �'I�'�3���,��1--� C�' � CTCY �� �.td STATF�Id/ ZIP sS�1 �
LICENSE WITH pHONE +co �•'�i-�,� � 9S8lj FAX
APPLICATION
PERMTT TYPE SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � NEW �REPLACEMENT
DETAILED DESCRIPTION OF WORK��S��I AiC. �_�� �;�7�' � L E�IJ
PER MS 16B.665 the permit 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 $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
� BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
1 BATHTUB GAS PIPING pve�o cirrwc�sE) SWIMMING POOL WATER SOFfNER ($35)
CLOTI-IES WASHER KITCHEN S1NK 1 WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
WATER METER OTI-IER
as.T.x }� . . _ , �2 w
£�1 .;'x. ���,j;�� � . . �:.._ ���N�� � , x .. � « , � �. ��� � 'q,�., . � � � �"�;, ��^'� n .. �w¢e �. �<3 . �. :3 �� �:. � �-<� �.���.
3
Permit Fee $ � > .� �Number of fixtures @ $10.00 � x $10.00 = $
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ �C�a � Number of fixtures @ $35.00 x $35.00 = $
State Surcharge = $ .50
C� Tota1= $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building petmit and I aclrnowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances d codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applicatio for 't and work is not to start without a ermit; that the work will be in accordance with the
approved plan in the case of a11 w r ich r quires review and approval of plans
�2 �
SIGNATURE OF APPLICANT PRINT NAME `� DATE �v�'� ��
.y 1 :. ��y �� q4.�. _ ��.� .. � 4 : ,' `S �'9� �� � ..�� �^i`.
_
'_°�`.'. 4 . . n ��i ��
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
�uilding
Inspections
763-572-3604
763-502-4977 FAX
��o
SITE ADDRESS � "\V [: V��
THIS APPLICANT IS: ❑ OWNER
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-OS
Permit No.: � � �'
Received �
Date Rec'd: � �
YOUR E-MA1L ADDRESS /�I�� a-� iS 5�� ►�l0 a. l: ��'v�
PROPERTY OWNER/ NAN►E: �Y��V�P /V�a�o►Y °�
TENANT p�DRESS: / 37 C� tLPiJI-WYI CITY �.QI�,t.Ell/i� STATE V�N/ZIP-��-�—..�-a-
PHONE: iUiCi�- `61 b "��3�
,.,..,�. o �.-. n
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
� . ���C�l�l�
STATE LICENSE # d'U ;� � Ip 7 Y
❑,�IN�iLE FAMiLYMEW CONSTRUCTION
`I�'�'WO FAMILYMEW CONSTRUCTION
❑ BASEMENT FINISH ❑ ROOF
�j�g ❑ SIDING
❑ NEW HOME CONSTRUCI'ION
DESCRBE WORK BEING DONE:
SIZE OF
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes DI�]o
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIN�W TO BE INSTALLED
CITY
FAX
SIZE
NG POOL
❑ ADDITION
❑ REMODELING
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
ATEJ�IP rU�
EXP DATE �^ � 1 "' d �
❑ DRAM TILE
❑ OTHER
HEfGHT
�
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
���t �DDITIONS & PORCHES SUBMIT:
❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Fascia and proposed project.
2. Two sets of conswction plans
3. Energy Calculations
LOCATION OF WINDOWS
OF
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING 199 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $°�e�" ��� �� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
E���i'�r�
�'�' �
m � ���,
�. � � �.
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 (Sta.te Licensed Residential Contractors)
$1825 per SAC Unit (Plans to NIWCC for determination)
ft+6ft= fix$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMTf-NOT VAL[D UNTIL PROCESSED
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 pertnit and work is not to start without a
pem►it on site; that tlie worly'vJi�l be in accordance with the proved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF '�IC�ANT ��i�.JC �.� PRINT NAME /�� � I ���JI-P� DATE �'7— (7 Oy
APPROVED BY �,-���;Y' � DATE��, L�?
.._ , _ .�
�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 1�` $500 plus $3.05 for each additional $100 or fraction, to and
including $2,000
$2,001 to $25,000 $69.25 for 15` $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 includin $50,000
$50,001 to $100,000 $643.75 for I�` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for ls` $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�` $SOO,U00 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�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for conshuction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing fou.ndation will be
required before proceeding with the framing. New Houses Oniv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432 �
763-572-3604
Faz: 763-502-4977
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