AF - 37351� ,�
City of Fridley, Mi�.. �
BUILDIN� PE1�.MIT
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Date: _...___ ....__.._...._..�..�_..._.�:.� _�_._.._....--•--•--•------
Owner:
Address
N° 4308
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LO TION OF BUILDING
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No. ��.�.----- Street ....�ye�'��---_....---•---�--- _ . ..... .........---•----......---------•----. Part o I.ot -----.._.._.._......._....____.._...._�-�• -- -i---/—/�
Lot ...........�� ................... Block ....._...:.�.....---........_................. Addition or Sub-Division .� . ..... .-�.�----.._..I_......._�° �-�!�'1
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Corner Lot .......................__...... Inside Lot .._!�..----...............----�- Setback �.�.^'..�. -------.. Sideyard ...�iJ.---��--�--.........---------�-----...---._._...
Sewer IIevation
To be usea as:
� - - . ....._._....� ---..........
Type of Construction
Foundation Elevation
DESCRIPTIOf+! OF BUILDING
Front'��%....'�sDepth�./..:.e��Height _/.�?.� Sq. Ft. .l_�_��Cu. Ft. ��_���
Front ....._ ............._.. Depth ............._... Height ........�.. Sq. Ft .....- ............... Cu. F�
........................................._..---... Es� C���� �. �J...��. _................ To be Completed ....._.............__....
In cottsideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the descxiption above ,t� #'o�th � i��npliance with all provisions of
ordinances o4 the city of Fridley. (, l( _ �\ 1�
In consideration of the payment of a fee of $..�.�... �.._"� permit is hereby granted to...._ ............._............._.
_._.._..._...._._..........___..---•-------._...._........ to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of bwtldings
within the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. _ �
Building Inspector
NOTICE:
This permit does not cover the eonstruetion, insfallaHon fe� wfring, plumbing, gas healing, sewer or water. Be sure fo see
t6e Building Inspeetor for separate permita for fhese ftems.
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APPLICATION FOR BUILDING PERMIT
CITY OF FRIDLEY, MIlJNESOTA
Owners Neme Builder d°°
�'�1" Pl.��°°� "
�ddre�s Address � / � % £�'"� `°��` . � � `
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. � � -� I�CATIOAI 0�' BUILDING • .
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No. �� �,i Street �`'`�' �"'�`'� . - - Part of Lot :
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Lot �- Block � Addition or Sub.Div. L��'�d'�t�'J �� °���ce`I"�
Corner Lot Inside Lot D,��Set Ba,ck � � 1� Sic�e-Yaxd . '
.�: .
SEWER �EUATION FOUNDATION ELEVATION`�.� � �
lpplicant attach to this form Certifi�a.te of Survey of Lot and proposed�building
loca�Ybn. �
: � �;, : .. .. .. ..
To be used as:
DESCRIPTIOAi�OF BIIILDING •
�v`�, � � �� �/ Y � . . .
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Front Depth Height �
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Sq. Ft. Cu. Ft. . . ''
Front � . =:Depth . :�Height..
Sq. Ft. Cu. Ft.
. ,-..: :. .,... _, ' ,
T3rpe-�xf: ��truction� . ' � Estimated Cost _ _
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To be completed / � v'� � � " � ' '
•; ,,,-�..; � . ,
The underaignec� hereby makes application for a permit for the work�hmrein specifi�l,
agreeing to do all work in strict accordance with�the'City Ordinances and ru].ing of
the Department of Bu3ldings, a.nd.hereb�r declarea that a�l the facts and representa-
tions s.ta��d in this application are true a.nd corpeat. �
. a;: �. . � ( ' �
DATE. ; `,-r � �I �' ° l �� ' .1� I _ SIGNATURE �.. . � a, le it.j° •s.- -
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(A Schedule of Fee costs ca.n be found on �the Reverse Side:��� '� �
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HARVEY A. CARTWRIGHT
ANOKA COYNTY 8URV6Y8
F4ENNEPIN COUNtY BURVHYB
MINNEAPOLIB 8URV6Y8
B�4t0 PALM 9TREET N.�W.
suNeer a-7eaa
OWNER
tNDUBTRIAL — JUDICIA�.
BU91NE88 — TOPOORAPMICAL
CIT1/ LOTS - PLATTIHfi
Lyncla].e atri.laers
s � ti ��r�° �- �
CABTWRtG�T & OLS011T
LAND SURVEYOdtS
REOIS7ERt0 YNDIR LAMid OF BTATH OF MINNCHOTA
LICBNS[O SY ORDINANGi OF GITY OF MINNHAPOLIB
326 PLYMOUTH BUILDING FEDeRA� B-8721
HENNEPIN AT SIXTH • MINNEAPOLIS 3. MINNESOTA
l.�urbepor'g �ettiti�atc
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COMBININ6 TME 17ECORDS OF
.1. E. HI�.L., CIVIL ENGINEBR
eerweusHep �eve
C. F. SANDHOFF
CIVIL EN6INEER
� ESTABU9NED IYOB
JAMES NELSON
SuRVSroR
66TABLIBMED IYBY
METROPOLITAN LAND
SURVEYOR89 EBTABLISNBD �ee�
Invoice 2090�
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I hereby cer�ify tha.t this is a true and correct repr�senta�ion of a survoy of the
botu�daries oi' :
Lo� 2, Block 1, Lyndal� Builders l�th �ddition
As supvey�d by rne dvririg the �onth o� Septomber, 1959.
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City of Fridl.ey, M.inn.
BUILDING 1'E�T N� 5 3 4 3
na�: �� �� _- � �
own�: � � r� .� �-.� ; f�° s,�a� -� � .
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Adalres�s Address
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No. � �; Street �� y��` .� . _..._ Part o t
I.ot �__ Block � � Addition or Sub-Division � '{ � �
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Corner Lot � Inaide Lot ,ia•"°'�° '�Cback Sfdeyerd �.�.�
Sewer IIevation Foundation IIevation
DESCRIRTION OP BUILDING
To b�e'Usaal as: � � �,
�,��!p ``) � � � �. .._�;y9'
r� "� Height Sq. F`t. �- Cu. Ft ��
`�. Front �`' ' DePth �'`�` �
�+'� Fron� Depth " Hefph� ?�� �? Sq. Ft _ Cu. Ft
Type of Constcttction � t' '� Est-C'o�" �' '�`"i�o be Completed
In consideratton of the isauance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance wlth the description above set forth and in compliance with all provIaions of
ordinances of the dty of Frldley.
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In consideration of the payment of a fee oP $�", r��� _, permit is hereby granted io
to construct the building or addition as described above. Thispe rmit is granted upan
the express condition that the person to whom it is grauted and his ageats, employees and worlunen, in all work
done in, around and upon said buflding, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location� construction, alteration, maiutenance, repair and moving of buildinga
Q��� dty limits and this pernait may be revoked at any �,��,��n violati�n of any oP the provisiona of said
,r�`- l
8uilding Inapector
NOTIC�
Thb permh does not eorer the conatructioa, teslaWtioe Po� wUtng, plumbing, gas heaHng, aewe� ee water. Be sure to sae
f6e Buqdieg lespeetae foe eeparate parmifs hr f!►ese Items.
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APPLICATION FOR BIIILDTATG PF.:R�IIT
CITY OF FRIDLEY, MINNESOTI
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No. .�.3 � Sf,reet, -!��<.� �.,�� Part of Lot
Lot �� Block _ � Addition or Subdie3s3on �
Corner Lot.______ Inside Lot Setback Side-Yard �
SEWER ELEVATiON FOUNDATION ELEVATION
�pplicant attach to this form Certificate of Survey of Lot and proposed buildiag
locat3on.
DF�SCftIPTION OF BUSLDING
To be used as:
� � Denth o� �`'
Sq. Ft. �� S� Cu. Ft. .�' ���
Front Depth Height
Sq. Ft� Cu. Ft.
�+�. � .
To be Completed �— / .� - � /�
Cost � 7 �
The undersigned hereby mskes applicatioa for a permit for the.work berein apecif3ed,
agreeing to do all work in atrict accordance with the City ardinances and ruling of
the Depertment of Bu31c13ngs, and hereby declares that a11 the facts and repreaentstioas
atated in this application are true and correct.
DATE � � � — � % SIC�IATURE
(A Schedule of Fee Costs can be found on the Reverse Side.)
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BIIIL�Il�IG 1'ERMIT FEE SCHEDUI� _-- -. _ _.._------..._. �.... ` ��` �.
.. ..: _..... . . _.._ .._..__. __.
Section a.,_=_..�&e_..Inspec#.or �og �a.i-l.c�ing§ eh�r7.1, before 'issuing any permit for the
y�� erect�.on of a� building or structure, or for any addition to a�r exi.sting bu31d-
ing or atructure, or for an�r alteratiane. or repa3rs to an�y exist3ng l�uilding or
structure, upan applicat3.on therefor, require the payment by the applicant for
such perm3.t of fee8 to the emount herein be].ow set forth and� in the 3oana�r hereia
prov3ded to-wit:
2.1. For e.ny such perm3.t for the erection of any fire-proof building, other than
a garage, warehouae, factor� or grain eleeator, or for the erection of an� fire-
proof addition, for s3milar occupancy, to any existing build3ng ahall be at the
rate of �"l.lFO for each one thousand cubic feet, or fraction thereof, in such
cubieal contenta.
2.2. For anyr guch permit for the erection of sny fireproof garage, warehouse,
factory or grain elevator, or for the erection of any fireproof addit3on, for
similar occupancy, to any exiating building shall be at the rate of �7..25 for
each one thousand cub3c feet, classified as '�fireproof'� by Section 502 of the
Minneapolis Building Code.
SOIISE,S
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2.3. For any such perm3.t for the erect3on of an�r non-fireproof bu3lding other
than a garage, warehouse, factory or grain elevator, or any non-fireproof
addition, for simi].ar occupancy, to any exi.sting bu3lding. Permit $1.00 £or
each one thousa.nd cubic feet.
GARAGES
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2./�. For any such permit for the erection of an� nor�-fireproof garage, urarehouse,
factory or grain elevator, or for the erection of an� nor�fireproof addition, for
similar occupane�, to any exiat3ng building or for each such building or addition.
Ninet� Cents for each one thousand cubic feet or fraction thereof, in the cubical
con�ents thereof with a minim�mn of �1�.00. -
For the purpose of computing fees for building permi.ts the cubical contents of any
building or addition to a un3form height throughout by multiplying the ground area
covered from a point aix (6) inches below the floor line of the basement or cellar
to the average height of �he upper surface or to the average height of the roof
sUrface of the main gable of a pitched roof.
2.5. For repa.irs or alterationa �v an exiating atructure, the fee ehall be at:the
rate of �3.00 for each Five Hundred Dollera (�500.00), or fraction theseof in the
cost of a11 propoaed work.
2.6. In no case shall the fee charged for ang permit as set forth in Section 2 be
less than �4.00.
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sua�ecT PERM .
City of Fridley o 2018 7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
COMMUNITY DEVELOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEC. (� 2(�
� 'i ; °i' o� l(�
� /'�'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�'""'� � ,�� 612-571-3450 910-F15 11/1/89 / /
JOB ADDRESS 534 Cheri Circle N.E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 1 Lyndale Builders 4th. Addi.tion SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Don Hansen 534 Cheri Circle N.E.
3 CONTRACTOR MAILADDHESS Z�P PHONE LICENSENO.
Midwest Frauters Inc. 16820 Wren Street N.W,, Andover 753-2711
4 ARCHITECT OR DESIGNER MAIL ADDRES8 21P PHONE LICENSE NO.
5 EN(31NEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING '
Residential
7 CLASSOFWORK � NEW �] ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 21' x 12' Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan, Hand.�ramed rafters must hear onto a 2 x 6
�ootex plate. Use txeated bottom plates.
���!��]��� SEPARATE PERMITS REQUIRED f
�efore digg��g ca11 fcr WeREcSG, �—d�t�T�d�iC, PLUII�'��8�,�� ��i4� R1��
all uiility locatiers
�54-0002
REQUIRED �Y LAV�// On all new roofs or te�r-offs and replacement roofs,
� State Code requires that 2 layers of 15 Ib. felt,
mapped together, be installed to a point 24 inches
up from exferior wall line, or the use of other
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBINO, HEATING, TYPE O ONS . O ROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONIN(i SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OH ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. � NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED $3170Q $1. S�j
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE UTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVI ANY THER ATE OR LOCAL LAW REGULATING coN- $63.00
S RU TION OR HE P RF R ANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
�
4 . 85
SI NATURE CONTR TORORAUTHORIZEDAGENT (DATEI �' 1AIH PROPER V Q� T D S IS YOUR PERMI
/ s
SiGNATURE OF OWNERiIF OWNER BUILDER� IDATEI i SP n4TE
,
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C10�LS�uCt1oJ1 AC�d�^S:
I�'dl D2SCL'l.�l�l:
I�1 AND 1�2
Huilding Permit Appiicatian
r � C�� �
_ ..� 3 �i C i^12�a1' � �i' N , �. .
Effective 5/1/88 :Z
y
�
Owr�e,r Name & Addre�s: �_,�1 I�1 CP �. �
(,1D27ti'dCtOY': � ( n ln lt� S � �C.l I/li, � � � ��J �'' 'l�2.1 • �_ �%S �' � � � �
Aaare�: --1 4� � c,J r e.sJ �,� �
Attach to this applicatia�n, a Oertificate of S�rvey of the
lot, with the prq�osed ao�structian drawn on it to scale.
�IPTICB�i �' II�DOH�TP
R 9�`i� a nl ��1 Width Height Sq. Ft.
AREA: Iength .� Width �
�. � i Z Heic�t ft Sq. Ft. ��
�'h _ Width Hgt/G�aur�d Sq. F't.
C�:
:J?�C � • � � .
Cbrner Iot [� Inside Iat [� Ft. Yd Setback ��_ Side Yard Setbac,Jcs � al
ZYP� of �tn�ion: d�i��� De n911►A-� Estimated Oost: $ -� e'
Approx. Cc�letiaaz Date: i 1 f'� I � R`Q, . �� �
� Dtiveway Width If New � �i�; �, $ $
Width + 6' See Back Page
nATE: r APPLICANr: - Tel. #��J+(C c�' � 4�,/°
P�esmit Fee $ � �j
State S�a�e $ � •�'�
SAC Ct�arge $
Driveway ��,or„i $
park Fee $
sewer Main C�azg�e S
110TAL $ � �
�� � �.�rJ
t�r
slzFtJI.p,TIadZS: . - � — `
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8�1 �7 - �( °7
�cc" ��c� r� e�°
`1 S�'3�- 2 � l I =�
F'ee Sc3�dule aa� Reve=se Side
$.so/$1,Oao valuatian
$575 per SAC Unit
Alt. "A" or Alt. "B" Above
Z''�E �LTI� � �i �+rsri �
� N�Y [ 7 Not Ne�ssaty [ ]
°� x'`� � l(�'� d Q, /�Lc.e 5 S�
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'Ihe Chief Builciing Official shall, befor+e issuir�g permits for the erection of any
buildirg or st�cture, or for any additia�n to any pYl �t 1� building or stru�ture, or
for any alteratic� or re�air to any existinq buildir�c� or �, upcu� applicati�
therefore, require the paya�it by the applicant for suc� penait of fees to the amo�u�t
herei.i� below 8et folth azxi iIl the �T1}1er hereiti prwided to-rwit:
ZU►I'AL V�LIJE
$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
� a.
$15 (Mininaam Fee is $15 plus sur�arge)
$15 for fiYSt $500 plus $2 for eaci� additia�nal $100 or
fractic� th�reof, to ar�d a�r�t�ditx� $2, 000
$45 for first $2,000 plus $9 for each additional $1,000
or fractiaaz t2�reof, to ar�d includir�g $25, 000
$25� for first $25,000 plus $6.50 for each additional $1,000
or fractian thereof, to ani including $50,000
$414.50 for first $50,000 plus $4.50 for eac3� additional
$l, 000 or fracticai the�eof, to azrl inclt�ing $100, 000
$639.50 for fitst $100,000 plus $3.50 for eacfi additional
$1,000 or fraction the,reof, to and includ�ng $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1, 000 oi' fZaCtiar� th+e1-�eof, to and ]ncluding $1, 000, 000
$1,000,001 and up $3539.50 for the fiYSt $1,000,000 plus $2 for each additional
$1, 000 or fractian tiier�eof
�tIVE�IY �SI�T ffi�W
(C�aa�cnete Qirb Streets OnlY)
Alternate ��A�� ; R�roval ani re�la�oent of wrb anl gutter anly - Driveway width plus
6 feet tiioe� $13.50.
Alternate "B" : Raooval ani replaae�etit of c� anl gutter and install a 3 foot wide
�pproaC3i �►ith 6 irrh de�th - Dtivewdy width plus 6 feet times $15.75.
' �Z�' �� •. •�- {�_�i,,��,_� •;�
P�ermits foz' caa�stn�ckiCn will be issued g�nini,�.�n+ of 24 hcxlr5 fZ�o1n t�le time of
applicati� to allcw for proper review of the pro�ed � arid of the
�ticai site.
A Oertificate of �vey of the lot, stlowing the locaticn of the famdaticai aa�oe it has
it has been �ill be z�equired before prooeedir�g with the fiatois�g.
1
' J '�G
f "1s
sue�etT ERMIT NO.
c�ty of F��a�ey 29703
AT THE TOP OF TME TWINS g � I L D I N� P E R M I T
r
; ; T NO.
� i y__���_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEG. y�,J �°�/ �
1 . � T /(�
� � /'�'1 � CITY HALL FRIOLE� SS�JZ NUAIBEII NEV DATE PAGE OF APPqOVED BY
�'""�� �'' 612-571-3450 910-F15
6/17/99 � �
J08 ADDRESS 534 Cheri CTrcl e NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 2 1 Lyndal e Bui 1 ders 4th Addi ti on SNEET
2 PROPERTY OWNER MAIL AODiiFS$ ZIP PMONE
Judie Jeffery 572-2091
3 CONTRACTOH MAIL ADDRESS ZIP PNONE LICENSE NO
Midwest Restoration & Constr. 6319 Hw 65 NE Fridle 5 43 -1
4 ARCNITECT Oi; DESIGNER MAII ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOFiK
❑ NEW ❑ ADDITION O ALTERATIpN � REPAIR O MOVE O REMOVE
B DESCRIBE WOFiK
Reroof house and ara e 1 -
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comp1y with the State Building Code.
Perfiit Inspecffon Cards
To w,ll Be �ajled
Homeowner To Pos4
SEPARATE PERMITS ARE REOUIRED FOR EIECTa1CAL. PLUMBING, MEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCr LOAD
VENTILATING OR AIR CONOITIONING,
THIS PERMIT BECOMES NULL AND VOIO If WORK OR CONSTRUCTION 20NIN(i SO. FT CU FT.
AUTHORIZED IS N07 COMMENCED V!!ITMIN 80 DAYS. OR IF CONSTRUCTION
Of1 WORK IS SUSPENDED OR ABANDONED FOR A PER100 OF 120 DAYS AT
ANV TIME AFTEii WOiiK IS COMMENCED. NO, DYV�G. UNITS OFFSTREET PARK�NG
I HEREBY CERTIFY TMAT I MAVE READ ANO �XAMIN�D TMIS APPLICATION STALLS GARAGES
AND KNOW TME SAME TO BE TRUE ANO CORRECT. A�� PROVISIONS OF LAW$ yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED
WITH WMETHER SPECIFIEO HEREIN Oii NOT. TNE GRANTING OF A PERMIT $1311 $.66
DOES NOT PRESUME TO GIVE AUTMORI7Y TO VIOLATE OR CANCEL TME pEWMl7 FEE SAC CMARGE
PROVISIONS Of ANY OTMER S7ATE OR LOCAL LAW REGULATING CON- q
STRUCTION OR THE PERFORMANCE OF CONSTRUC710N �'rJ0.9'rJ Fi re SCi �1 .31
PI,AN CNECK fEE TOTAL fEE
License SC $5.00 57.92
SiGNGTUpE OF CON'AACTOA Op AUTMOA�ZEO oGENT iDATEi WNEN PqOPE VAUOATED 7H15 �S YOUR PERMIT_
�
S�GNOTUAE 0� OWNEA��� OWNEpBWLDEp� �OAiB� � � �
pG iNS� � Q6tE
NEW �' r ]
��N I l
ALTER [ ]
ConstrucrionAddress: �
Legai Description:
Owner Name & Address:
Contractor: � �
.Address: �i� � 1 � _ iA)��
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
Construction Type:
CITY OF FRIDLEY
SINGLE FAMII,Y AND DUPLEXES R-1 AND R-2
BUILDING PERNIIT APPLICATION
L
,
Effective 1/1/99 �
��
�b� ,��
� ��
� ���
Tel. # ��'�� -�/��j/
MN LICENSE # ��f�'�
Te�. # C�?-.�DZ -ID �%
��z- lOb�/
� Attach to tbis application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
Driveway Curb Cut Width Needed:
DATE: �-1 -�
Permit Fee
Fire Surcharge
5tate Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
DESGRIPTION O� �RU�MENT
Width
Width
Width
�'
Ft. + 6. Ft =
Height
Height
Hgt/Ground
Sq. Ft�
Sq. Ft.
Sq. Ft.
/�.Ss�. ;��3 �/.
Estimated Cost: $
(Fee Schedule on Back)
Ft x $ _ $
CITY USE ONLY
Tel. # �1��-�G��Z
$ :. Fee Schedule on Reverse Side
� . . C�CIl �f �erm,�t ��lua.2.tio�. (1/ lOth °� )
$ �� $.50/$1,000 Valuation
$ $1050 per SAC Unit °
$n �'� $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 $ r � ���, ,�
fivitG S�-�� �' �'���
ST'IPULATIONS: / ���
�q �����/ �O
�.S
� , .
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit: �
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 $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus s�ucharge)
$21 for first $500 plus $2.75 for each adc�itional $100 or
fraction thereof, to and including $2,000
$62.25 f�r first $2, 000 plus $12.50 for each additional $1, 000
or fraction thereof, to and inciuding $25,000
$349.75 for first $25, 000 plus $9.00 for each additional $1, 000
or fracrion thereof, to and including $50,0(?0
$574.75 for first $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 additional
$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 or8fraction thereof, to and including $1,000,000
$5012.25 for the first $1,U00,000 plus $2.75 for each additional
$1, Q00 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6�eet 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 FOUNIDATION
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.
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57"L-36U4 r'AX:
ADDRESS : 534 CHERI CIR NE
PIN : 233024430004
LEGAL DESC : LYNDALE BUII.,DERS 4TH ADD
PERMIT TYPE
PROPERTY TYPE
: LOT 2 BLOCK 1
: HEATING
: RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
571-12if7
— . �_.�
PERMIT N 2004-01566 � '
--�------ .
DATE ISSUED: 09/09/2004 �
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A.
RUN LINE TO DRYER USING 1/2 INCH COPPER.
# A/C LJNITS 0 VALUE OF APPL OR WORK 0
# FURNACES
# GAS RANGES
APPLICANT
CENTERPOINT ENERGY/NIINNEGA5C0
13562 CENTRAL AVE NE
ANOKA, MN 55304-
.1 ./�L_ :_
JEFFERY JUDIE A
534 CHERI CIR NE
FRIDLEY, MN 55421
0 # GAS DRYERS
0 VALLTE (FOR 1�IINIMUM CALC)
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
application and know the same to be true and conect. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a pemut 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.
App ' Date
Bldg Da��f
HEATING PERMIT MII�TIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONII�TG FEE
HEATING REPAIltS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 1017409
0
216
15.00
0.00
0.00
0.00
0.00
0.00
0.50
15.50
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FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacinq an existina furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications inctuding sizing, length, number of elbows and termination. Yes ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances. Yes ()
The existinq combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications.
No ( )
No ( )
Yes ( ) No ( )
Yes ( ) No ( )
�/Vhen installina a new ventina svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
Yes ( ) No ( )
Appliance Tvae and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Bfiu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe)
HEATING CO:
Signed By: Date :
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