AF - 37470"y.
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City of Fridley, Minn.
BUII�DING PERMIT N° 3 7 7 5
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Owner f!.'"�: ! . . . . . . . . . . . . . . . . . . . .�. . . . . . . . . . . Builder !�� : . . . .'�'� . . /. .����?�Z!��. . . �. . .
Address ...................................... Address .............................................
� 8 � ��� LCaCATIO�V OF BUILDING
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No. .���... Street . ... ....... ...1 ................... Part o , t ........... ...................
Lot .....�d..... BYock .... .. �......... Addition or Sub-Dfvision .!����..�...�..�� .............
Coraer Lot ............ Insffde Lot ..�........ Setback ............ 5ideyard ...........................
DESCRIPTION O� BUILD[NG
To be s as: �
_. .
< /� < _. �s
o •, . . . . . Front �� �. . Depth '.�.�. � - � Height /. � : . � Sq. Ft. -3.� � . Gu. Fi.� <. ��
.......... .... Froat ........ ..Depth ........ Hef t� ..... Sq. Ft. ........ C�. Ft. ........
...
Type oP Construction ......... �1
....... F�t. Cost..� ..�............ To be Completed ...................
In consideration of t'he iss�ance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the descrlption above aet forth and in compflance wii� all provis%ns of
ordinancea oP the dty of Fridley.
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In conaideration of the payment of a fee of $. ./. . . �. . .-. . .. permit is hereby gianted to . . . . . . . . . . . . . . . . . . .
..... ...... .. ............ to construct the bwllding or addition as descrlbed above. This perrmit ia granted ugon
the express condition that tb.e person to whom it ie granted and hia agents, employees and worlmzen, in ali work
done in, around and upon said builaing, or any part thereof, shall conform in 'all respects to the ordinances of
Fridley, Minnesota. regarding location, consiruction, alteration, ma3ntenance, repair and moving of buildings with-
in the city limits and thits permit may be revoked at ar�y time upon violation of any of the provisions of said
ordinances.
�� . i. : . . `� . . . . . . . . . Building Inapector
NOTICE: ,
�
This permtt does not cover the �conatrueRion� Installation o� alteration tor wl�inp, plumbing, gaa heating,
sewer o� water. Be sura to see'`the Bulldln8 Inapeotor fo� eaparate permita fo� these Items.
APPLICATION FaR; B�TILDIN� PERMIT
CITY OF' FRIDLEY, MINNESOT�
'�,.
. ; .�. - ; . � � � . �� . . �: � l, .. . _.
Ownera N�me.Brr �� (� ��, � �� 31der f��•i�� � �o•fa� P
�ddress � 3� �.i�� ���� i.a �_ , �cldress .��'r � . �� dL �--��
. �'_"� . . . ..
� LOCATION OF BIIILDING
�
No. ��3treet. � � �art of• Lot _.�_____: ._._ . � �
. . � • . . . � .
Lot _.�.. Block � �cldi�tion o.r 5ub. •Div. ������ � �
Corner Lot I�side Lot � _ Set Ba.ck
_...___
�pplic�ri�,. a�t;ach to this form Certificate of Surv.e3► of L•at and proposed •
buildin� ;1o�a'tion. � . . . � .
� � DF�SCRIPTION OF. BII�LDIlJG ' •
To be used as
� �� � �. �ont f �. Depth� Height �,� .
, _� -
�• �• � �• � �• , �
F�ont _.._....� Depth HAight
Sq. F`t. Cu. F`t. ,,._._._. . .. . . .
Tyrpe of Construction . � . Estima.ted Cost @.��' �
To be completed 6� � � � • � �. . �
The undersi�ed here'bq makea application for a pex�m3.t for . the work
here3.n spec3.fi.ed,;:a�ree3;ng to do all work 3n atrict accordance with the
City Ord3nances and z�u7.ing of the Department of Buildings, and hereby
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declares that all the facts and representations stated in thia applicat3on
are true�and correct. . � . • �
D�.te '�' � "SA i � Signature �—���--'�`�
, � I . ,
�A.Sched.ule of Fee Costs can be fovnd on the Renerse Side) .•�
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BUILDING PERMIT FEE SCHEDULE
5ection 2. TY�s Inspector of Buildings shall, before iasuing an� permit
ior the erect�.on of any building or atructure� or for any addition to
any existing building or structure, or for any alteration� or repai.rs to
any exiatin� building or structure� upon applica.tion therefor, require
the paymerit by the�.�pplican�'�¢r such permit of fees ta the amount
herein below aet forth and in the manner herein provided to-wit: �
201 For any such perr�it for the erection of any fireproof bu3.ldin�' �
other than a garage�•warehouae, factory or grain elevator� or for the
erection of any fireproof addition, for similar occupancy� to any
existing building shall be at the rate of °�1.4fl for e�ch one thousand� •.
cubic feet, or fra ction thereof, in such cubical coritents. ~
202 For any such permit for the'erection of any fireproof gara.ge, ware-
houae, factory or grai.n elevator, or for the erection of any firegroof
addition for similar occupancy, to any�existing building shall be at the
rate of �1.25 for .each one 'thousand cubic feet, classified as "fireproof"
by Section 5d2 of the Mi.nneapolis Building Code. '
HOUSES '
2.3 For ,�.n.y �uch permit for the erecti,on of any non-fireproof buildin�
other than a garage, warehouse, factory or gra.in elevator� or any
non-fireproof addition, for simila.r occupancy, to any existing building.
Permit �1e00 for each one thousand cubic feet. , ,
GARAGF,S •
2.J� For any such permit for the.erection of any non-fireproof garage�
waxehouse, factory.or�gra.in elevator, or for the erectiori of an�y non-
fireproof add.ition, for similar occupancy; to any existing building or
for each such building or addition. Ninetg Cents for'e�,ch one�
thousand cubic feet or fraction.thereof', in the cubical contents there�of
with a minimun .af. �L,:.00 e . . .. y-
For the purpose of computing fees for building permits the cubical
contents of any building or addition to a uriiform hei ht throughout. by
multiplying th�..gr.�a�d �zrea coeered from a point eix �6) inEhes below
the floor line of the baseraent or cellar to the�avera�e height of .the�.
upper surface or to the average height of the roof surface of the main
gable of a pitched roofe , ..� ��
2.5 For repairs or alterationa to an existing structure,'the fe�.shal�.�• �
be at the r�.te of $3,00'`for each Five Hundred I?ollars (�5Q0.00), or
fraction thereof in the cost o� all proposed work. , �
, � •� ,
2.6 In no case shall the fee charged for any permit as set forth in
5ection 2 t�e less th�n �4,00� '
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City of Fridley, inn
BUILDING PERMIT
dune 2, 1965
Date:
� ����
N° '7671
p��; Nick Charchenko �� �. D. Q,, Cl � se ' ce
Ada� �. 632 H3ghway 10� Ad� 6305 Bryan� Ave. So.
�� g ��''�' �'� LOCATION OP BUILDING
No. 632 Street �-�� l� �• �• Part of Lot
Lot 6 _ Bl�k 1 Additfon or Sub-Divfaion ���
Coraer Lot _ Inaide Lot Setback Sideyard
Sewer IIevation .� Foundation IIevat3on
�To be vsed as:
Type of Constructton
DESCRIPTION OF BUILDING
Front DeP� Height Sq. Ft Cu. F't
Front Depth ITeight Sq. F't. Cu. Ft
F�t, Cost �."Z,�a$...3Q. To be Compieted
Storm Dama,ge Repa:i.r
Ia conaideration of the issuance to me of a permit to construct the buildiug deseril�d a�ve, I agree to do
the proposed work in accordance with the d�scrlption above set forth and in compliance with all provlsfons of
ondinanoea oP the dtg► of Fiidley. �"°°� - � �
�� .�� .� ��^ �-�__.. _ P�_�-.�-�...��-�.
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In con�deration of the payment of a fee oP � 10.0� ,�t 3s lieretfy �ranted to P• D. Q. C].aa.m
SeTY1.Ce to coaiatruct the buflding or addition as deacribed above. Thisp��mi t is granted upon
the express condition tt►at the pereoa to whom it is grauted and hfs agents, employees an� worl�en, ffi all work
d�e fn, araund and upon eaid building, or anq thereof, slaall conform ffi all reapects to the ordiaanc� of
FricIIey, Minnesota r�ga�diag loc�l3on, conatru� alteration, maiatenance, repair aad movin� oP buildin�a
wlthin the dtq limits and thia permit may be revoked at any time upon violation of aay oE the proviaions of sa�d
ordinanoes.
ALl.en Jensen B�� �
NOTICEs
1hb peem� das not eo+ra t6s eo�slruetioe, le�alNflm fee rrirteg, plamb�e, eas 6sa�te8, �r� oe wat�r. B� a�es te a�
tla Bufiding I�pseto� for apual� p�emhs for f6�n N�ms.
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�YliMtbil, � ir!'�L'!C�
APPLICATION FOIt B'- �NG ,PERMIT .
CITY OF FR.IDLFY i �N19�SOTA
�
� 7f � _ �!"-�- �(/ ' I
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5 LOC�TIOAT OF Bt�D�i+� .
No, � � � � St��et �art of Lat.
� �=2�2 _
Lot ✓�_Biock_� _ Addit.io�rr or ubd�visian '� _� '
Corn�s Lot Inside Lot _.,,��e��s�k Side Yard
SEWEIZ E�E�1A7.'IP�1 FODNDATION EL��'tTON
Apgli�ant ateach to thi� form,Two.Certificates of .Survey of Lot� and proposed build-
ing location d��.w�a ort these (;��'tificates .
' DESCRIFT�ON OF B�TII.DING
To be used 8s; ,
� d
�ronC Depth Seight
9q. Ft. Cu. Ft. .
„ Front Depth Aeight
aq. Ft. Gu. Ft.
. . . �
� 7j�pe of Construc�Cion . �':�, ,,_, ����� ' Estimated Cost �� j . 3� �
� -
� �
.._Tb-.be �amp]..eted
The undersigned heraby makes application for a pe�mit for the work herein specified,
agreei�rg �d c�o a�.l work i� atrict accardance wi.th the City of Fridley Ordinances and
rulings b� ttae Departmeat� of Buildings, and hereby dec�.ares Ehat all the £�cts aad
repres.entations stated in this application are true and correct.
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�Schedule of Fee Costs caa be fouad on the Reverse Side).
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BIIII�DIN� PERMI� FEE $��
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� Seotfon 2. The Inapector of Buildings �shal�, be�ors isadu,i� sny perii.t for
, the erecCioa of any building or stru�t_ure, s�i for aap adcl�Lti� ts any e�ist-
. ing building or structure, or for� �� ��,terat��r�r�':repat� t� any esisting .
huildix1g or structure, upon applicat��t �er,e£or, �eQurire tbe pa�eat bq �he
applicant for auch permit of feee �b �tiie amouat °�er�i�a��below sst �fortl�...a�d
� � fn the manae� herein g�ovided to-�r�C:• '..
� _ . . , . - - - __ _. . - � . -►� ._.
••- --.2.1. F�r an� �uch permit £or the t���e�,tiori-a�' aa� fire��pr�f bu�l,dipg� cather �.
. �_
'•.��,�.�a .a gar�ge�, .�ar•ehous�, fact�ry ox� g�a�i�t' ��e��p�c;.- .� -f�r. the et�t� ef :'",
,' aay fire-�z�rof addi�ioa. fa�'. aia�}9,�;ar°°o��ip�a�yt �a a�,y �xis�t,i�►g bu�1d� ' �.. - - . �.
shall be at the rate �rf $Z.44 for, �aat��.pn� thousr�ad �et�bie feet, or� fras�tci.�a
.��- .. :thereof, i.a such cubical contgn�s. ., ':� ` '` . . , . ` .
_ �. �
�.
�'` 2�2. ...For. aay suc6 -permit fact-..t�e- erectioa o�' any firerproo� g,�rr�e�.: �QA^�� •
�ory sr graia elevator, or f� fihe �ection �,f e�� ���noo� �•.c
. f�r .s�m�i,l�r accu anc to an _.eicist• '�`.
y fn� �a�ldi�pig -s6a11� �be �t .t�ie .
. ,.�.,:fo�"�e�h one .thousand�cubic .feet;�.,c�l.aea+i�ied .ae�!'fixep�roo��" 'b4� S�
the •A�IiaaeaP��.._B�s�.3.�iiag Cotl�:.:a���� ' ' - . . .
.,�.:4 HOUSLS
p
� 2.3'�. Fcsr a.nq �uch p�rmt� fo= the ereation o# any noo-f�repro�f �Wildiag cat
`�r'��, n a�ar�ge, warehouae facto or, ,�';
, ry grain elevator, dr aiiy i�o�-firep=�►f `°
additivn, gor �imf�,d� ocCup�qq� to an� e�isti�g��iuildia,� - pexmit $2,.�00 fo� .�
each �oae thou�ain21 c�bi�, fe�6.. .
GARAGES , .. . . ���
2_*,4_, For any auch permi,t f�r the erectioa of any aoa-fireproof g$aa�e, .
warehouse, factory�or graia elevator, o� for the erec'tiotii-of any nou-f���
�ditioa. -f�s,tmilar•' occupancq, t� anX enistiag building ds for esc� such •'
.__�,, �.�.�i].ding or addit3on - ninety ceats ($0.9�j for each one thousand cvbic feet
°r fr�tiaa thereof. in tbe cubical�contents thereof with a minimum�of �4.OQ..�
�
Fo't the purpoee o� camputiag feea for building permits, th�. cubical cottt.e�r ��
of any bufldiag or ac�dition to a uai�orm height throug'fioi�t �'�y muLtip�ying t�.__"'
gro�tnd asea covered .fsom a point siu (6) 3mche� b�la�r� the �Ioor lin� ttf �the_ „� f,.
ba�ement or cellar to ttie average height of the upper su�face or to t6�
average height of the rQOf surface of the mai� gable of a,�iitched rovt. . �
2 5_•. l�or repairs or a�,terations to an exiat ��
� at the rate of 3.00 �$�'�t�. �'� �ee ai�].1 .b�•.�°'''°1: .
.. $ per each Five Iivadred. Do11ar..s .($50b':� os� �Factioa�'
;. therebf i� �he cos� 'of •�11, propcaed work. . . � � `
, � . ��• . . . _ �s' .
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2, +� . In � no case si�ell ��be .:.for-aa�- permi� .a,� se� fess'th in �� '
' � Sectiau _2 be i,ea�„�han...$�,,:pp; . � . . . ,;�
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6431 UNIVERSI7Y AVENU[ NE September 2, 1975 FRIDLEY, MINN�SOTA 55�►3�
piinneapol�is Post Of�i_ce Dapartment
Superintendent of Delivexy
lst & Aizxquette tivcnue
Aiinneapo7�is, Mzn-�esoL'a 55402
'� � Re: Change oi Addxess - Effective Oct. 1, 1975
. c��y ar- rx�ax�y . �
c�����n: � � �.
� jde are listing the follot��in� change of addxess in the City of Fridley;
NATlG: Mr. Nick.Charchenko .
FROM: 632 Highway #100 N.E'. � .
'. • �p; 589 Cheri Lahe N.E. , ' '�
L�GL�L" D�SCItIPTION •�t 6, Block 1, Murdix Park ,
We liat�e noti.{ied tlie occupanC of .this change �3.11C1 we �aould appxeciate
� .a.t very much if you t�ou].d cha.nge youx xecaxds accordingly.
. ' Si.ncexely,
� • D�ilt�.�L G . CLt�.K
� . . Con�nunity Deuelopment Adm. �
DGC /mh . . . ' : '
. GC : Ci;L-y Watcr 13illinb DepC . . •,
C3.ty Assessin�; Depax�_ment • • '` „ ,
.. rii.nnc�polis Gas Company - I3xoolclyn Paxk O�ii:ce .
� • IJo�:thcxii S�taLcs I'o�acx Com��.Zny ' ,. � .
, . Noxl•liwesL•ern 13c11 Tcic�hone -
. .City Votexs ]:egistration ,
liomco�anex . -
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' � . . ' ' . . ' ' S60•3450
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�� ��-' 6431 UNIYERSITY AYENUE NE' September 2, 1975 FRIDLEY, MINNESOTA 55421
. ' f � M ' • . , • '
. 4-� .
�; . , -
� �� . .. . . .
' Mr. Nick Charchenko . •
� 632 Highway #100 N.E. � '
� . Fric�ley, r:rl. .5542].. . . ,
� ; _ Re: Change of House Numbers �
• Effective October 1, 1975 •
' • •- Dear Mr• Charchenko: . � ' �' - _
��.• It has been necessary for this of�ice to change the address
of y.our house . .'
•' ' FROM 632 Hi�hway #100 N.E. TO 589 Cheri Lane N.E. '
' LEGAL D�SCR7PTION Lot 6, Block'1, Murdix Park '
� . �4e have notified the•Po�t Office Departanent, Minneapolis Gas
' . '�"Company, Northern St�tes Power CoMpany, Northwestern Bell Telephone
, Company and various departments in City hall of L-his change. .
� � � ' • - . Sii�cerely,
� .. . .. ._. . . _ .
. . . . DAFtR�L G. CL�1Rl: � . ,
� � . ' . Coramunity Development Adm. � � �
' DGC/mh ' � , �
� •- . .
sue�ecT PERM
City of Fridley _ 19126
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � R O.
� `L _ COMMUNITY DEVELOPMENT DIV. �� � ��
r � � PROTECTIVE INSPECTION SEC.
`� _ ,
.--_� /'�'1,� CITY HALL FRIDLE� SS43Z NUMBER REV. DATE PAGE OF APPqOVED BV
t � , 612-571-3450 910-F15 8/21/87 / /
JOB ADDRESS 589 (�eri Iane N. E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR. 6 1 Murdix Qark SHEETTACHED
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Pauline Ch.archenko 58� Cheri Lane N.E. 572-9274
3 CONTFiACTOR MAILADDRESS ZIP PHONE LICENSENO.
Milton L. Johnson Co. 2513 Centa�al Avenue N.E., Mpls. 55418 781-9548
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING •
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Rsroo�.Dwelling (tear-of£2
9 CHANaE OF USE FROM TO
STI PU LATION S
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY OROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZOIdING S0. FT. CU. FT.
AUTHOFiIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITN WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S2 �OOO $�..95
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHE STATE OR LOCAL LAW REGUTATING CON-
ST UCTION OR THE PERF R ANC OF CON TRUCTION �`32. rJO
PLAN CHECKFEE TOTALFEE
� o � �� 7 $34.45
SIGNATUREOFCONTRAC ORAUTHOFiIZEDAGENT IDATEI �, ��/�,y{EN PROPERLY VALIDATED THIS IS YOUR PERMIT
SiGNATURE OF OWNER IIF OWNER BUILDERI IDATEI BL�G iNSD �ATE
NEW [] City of Fridley Effective u/1/8G
ADDtr. [ J R-1 AKD R-2 j
ALTER. [ j Building Permit Application
Construction Address: `� �� � ����/ /�"� � � ��-
Legal Description
�t�G� /i /�� C�� �%�% �c'�i ��rf% s�� --' c�
Owner Name & Address: Tel. � � � %7
Contractor : S �-`r e� oJ � . �e� �%.� s c.' J �� � � e Tel . 4 ��'°���� ^ � �'
�
Address: �S ' .3 ��!i ��- ���
LIVING AREA:
GARAGE AREA:
DECR AAEA:
OTHER:
Attach to this application� a Certificate of Survey of the
lot, With the proposed construction draran on it to scale.
DESCRIPTION OF IMPROYEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
m
Corner Lot [) Inside Lot [ J Ft. Yd. Setback Side Yard Setback
Type of Construction: �C�f�/L- o�� v� ILD �,`l r Estimated Cost: $ �, �$-D _J
Approx, Completion Date: � �'' �C c��
Alt. A Alt B
Proposed DriveWay Width If New Opening Is Desired: $ $ +
See Back Page for Explanation
DATE: � Zf d
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sexer Main Charge
TOTAI.
STIPULATIONS:
APPLICAh'T: � Tel . �I � � / ' S_� d
CITY QSE ONLY
$ � z"�� Fee Schedule on Reverse Side
g 25� of Building Permit Fee
� '° �% � $.50/$1,000 Valuation
$ a475 per SAC Unit
� Fee Determined by Engineering
�
� � Agreement Necessary [ ] Not Necessery [ ]
$
.�. � _ ._
BDII.DING PERMIT FEE SCHEDIILE
The Chief Building Official shall, before issuing permits for the erection of any
building or structure, or for 2ny addition to any existing building or structure, or
for any alteration or repair to any existing buildins or structure, upon applicatio n
therefore, require the pay►�ent by the applicant for such permit of fees to the amount
herein beloW set forth and in the manner herein provided to-Wit:
Total Valuation
31.00 to �500.00
�501.0o to 32,000.00
$2,001.00 to $25�000.00
$25�001.00 to $50,000.00
Fees
�10.00 (Minimum Fee is �15.00)
$10.00 for the first �500 plus $1.50 for each
additional �100 or fraction thereof� to and including
52�000.
S32•50 for the first �2�000 plus $6.00 for each
additional �1,000 or fraction thereof, to and
including �25,000.
$170.50 for the first $25�000 plus $�.50 for each
additional �1,000 or fraction thereof, to and
including $50�000.
$50�001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.`b0 for each
additional �1,000 or fraction thereof� to and
including $100,000.
�100,001.00 and up
�u33•00 for the first �100,000 plus
additional �1,000 or fraction thereof.
DRIVENAY DEPRESSION ESCROY
(Concrete Curb Streets Only)
$2•50 for each
Alternate "A": Removal and replacement of curb and gutter only - DriveWay width plus
6 feet times $13.50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach xith 6 inch depth - DriveWay rridth plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Peraits for construction �:ill be issued a minimu� 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, sho�aing the location of tre foundation once it
has been constructed Will be required before proceeding with the framing.
. _ �
sue�ecr PER
City of Fridley � 19 4
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r °
i � '
� • COMMUNITY DEVELOPMENT DIV.
i j V ����� ,
r � � PROTECTIVE INSPECTION SEC. ��
i� ` �
---- w �/'�';,� CITY HALL FIiIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV
i �� 612-571-3450 910-F15 6/30/93 / /
JOB ADDRESS 589 Cheri Lane NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. Fi 1 Murdix �ark SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
Pauline Charchenko 589 (5zeri Lane NE 572-9274
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
D& D Home Imp�ovement 7401 CentraZ .�ve NE Fridle 55432 784--7543
4 ARCHITECT OR DESIONER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDFiESS 21P PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW � ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Reside Garac�e
9 CHAN(iE OP USE FROM TO
STIPULATIONS
Install smoke detectoxs as �r UBC 1210, adjacent to all sleeping areas
and in basement.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTFICAL, PLUMBING, HEATINf3,
VENTIIATING OR AIFi CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTHUCTION ZONINO SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 OAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTfiEET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GAFiAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFiTAX
AND ORDINANCES GOYERNING THIS TYPE OF WORK WILL BE COMPLIED $�87 $� 5Q
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CHARGE
PROVIS NS ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUC ON OR HE PERFORMANCE OF CONSTRUCTION. $25• QQ F�lY'@ SC $. �9
PLAN CHECK FEE TOTAL FEE
� � �,� Li.cense SC $5,OQ $31�49
SIGNATUREOFC iRA RO AUTHORIZEDAGENT IDATEI V�1H PER ALIDATED THIS IS YOUR PERMIT
.�- ��v-��
SiGNATUREOFOWNEfi��FOWNERBUIIDEiiI �OATEi �'�"�
BL �NSP �ATE
ATEW j ] Effe�ctive 5126/93
ADDN [ ] CITY OF �RYDLEY
ALTER [] SINGLE FAMILY AND �DUPLEXES R-1 AND R-2 �� g�
Building Petmit Applicattion
Construction Address: ��� �/1� ��t��
Legal I�scription:
Owner Name 8c Address:
Tel. #�� ���'�
Co�rttactor: D& D Home Improvements Inc MN LICENSE # 4840
Addte.cs: 7401 Central Avenue N. E. , Fri dl ey, MN 55432 Tel. # 784-7543
Attach to this application, a C�r�ficate of Swvey of the
lot, with the propa►sed cat�vction drawn on it to s�ale.
DESCRIPTION OF IIHII�ROVEA�ENT
LIVING ARFA: Length Width Height Sq. F�
GARAGE AR�A: Leng�th Wic�h Height �. Ft.
DECK AREA: � Width Hgt/Grc�uad �. Ft.
OTHER:
Coruer Lot [] Insic� i.ot [] Fi. Yd Setb�ck Side Yard Setbacks
Type of Conslruction: ����� ������_ Estimat� �t: $ ��.��
Approx. Co�letion l3at�: 9��
{Cusi � Back)
Driveway Curb Cut Width Need�: F+ 6 Ft = Ft x$ _$
DATE: �4 APPLICANT: T�. �
�. 11. ' ! �1_ _
Permit Fee � �S. ��'c� Fee Schalute on Reverse Side
Fire Surcharge $ � 9� .001 of Permit Valuation (111(?th�)
State Surcharge $ � ��� $.50/$1,0� Valuation
SAC Charge � $750 per SAC Unit
License Surcharge $ �� - �%' �% $5.00 (State Licensed Residential Conti�ctors)
Driveway Escrow
Erosion Control
Park Fee
Sewa Main Charge
TOTAL
$
Al� "A" or Alt. "B° Abo�►e
$ Conservation Plan Revi+ew $450.�
$ Fee Determined by Engineering
�
� � �, ���
Agreem�ent Nec�ssary [ l Not N�ry [ l
STIPUI.ATIONS:
�
BUII,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permit� for the erection of any building or structure,
or for any addition to any existing bnilding or struct�re, or for any alteration or repair to any existing
building or st�ucture, upon application therefore, require �e payinent by the applicant for such permit
of fees to the amount herein t�low set forth and in die manner herein provided to-wit:
TOTAL VALUE
$1 to $S00
$501 to $2,000
$2,001 to $25,000
$?.5;001 to $50,000 � .
$50,001 to $1(ro,000
$100,001 to $500,000
$5�,001 to $1,000,0� .
$1�,(100,001 and up
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $S00 pins $2 for �ch additional $100 or
fraction thereof, to and including $2,000
$45 for first $2,000 plus $9 for each add.itional $1,000
or fraction thereof, to and including $25,000
$252 �for first $25,U00 pl�s $6.50 for each additional $�1,000
or fraction ther�f, to and including $50,000
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to aad including $100,000
$639.50 for Srst $100,000 plus $3.SO.for each addidonal
$1,000 or fraction th�eof, to aad including $500,(�0
$2039.50 for the first $500,000 plus $3 for each additional
�$1,0� or ftacbion ther�f, to aad including $1,(�?0,000
$3539.50 for the first $1,�,000 plus $2 for �ch additional
$1,000 or fraction �thereof -
DRIVEWAY DEPRESSiON ESCROW
(Concrete Curb S1re�ts Only)
Alternate "A" : Removal and repla.cemem of curb and gutt�er only - Driveway width plus 6 feet times
$13.50.
Alterna.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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applica.tion 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 proceeciing with the framing.
-_
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CITY OF FRIDLEY �
��� �
[] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: � �A e� � � � �� L- 4 � �.
Legal Description:
,3 -�'� � �-/7��
�^ � C
Owner Name 8� Address: � i `-- � �,���ce-2 � � �,� •_-�— TeL # ��c
Contractor: .� �- %' r MN LICENSE #
Address: Tel. #
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 Width Height Sq. Ft
Length � Width Hgt/Ground Sq. Ft
- O`, �r 6 �
Construction T pe: Estimated Cost: $�
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
�C�.S"`— ��-� .� ,
DATE: � � �' �^ APPLICANT: �---� � ---��'°� � Tel. #
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
��.��5�
$
�
$
$
� ��
$ �P�—°
$
$
$
$
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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 [ ]
TOTAL $ ���U � STIPULATIONS:
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,�
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,�,000
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional$100 or
fraction thereof, to and includi.ng $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 $25,0� 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 addidonal
$1,Q00 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5,608.75 for the first $1,0�,000 plus $3.15 for each additional
$1,Q00 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.00.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applica.tion to allow for proper
review of the proposed structure and of the construction site.
A Certifica.te of Survey of the lot, showing the lacation of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv '
�uilding
Inspections
763-572-3604
DATE �j " I / — d .S
SITE ADDRESS J I
THIS APPLICANT IS:
PROPERTY OR'NER/
TENANT
CONTRACTOR
SUBMTT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
�E oF woRx:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
,I'i �a-nL
OCONTRACTOR
Pernut No.:
Received. By:
Date Rec'd:
NAME: ��°-�-
ADDRESS: CITY STATE ZIP
PHONE:
ueiurF• �� ��
STATE LICENSE # £XP DATE
PHO _ blZ"CaG j'_�f��
GLE FANID.YINEW CONSTRUCTION
❑ TWO FAMII.Y/NEW CONSTRUCTION
❑ ADDITION O GARAG
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
DESCRIBE VJORK BEING DONE:
SIZE OF IMPROVEMENT
ROOFING �"
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOR'S
IN EXISTII�TG OPENINGS ❑Yes �No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPEMNG CHANGES &
TYPE OF WINDOW TO BE INSTALLED
ATE Z1P
❑ WIIQDOWS
❑ DRAIN TII.E
❑ OTf�R
O REMQU�ELIriG N�+'`� ..? dl �` [� X l�
LENGTH
❑ HOUSE ONLY
❑ HOUSE 8c GARAGE
❑ ATTACHED GARAGE
❑ DETACI�D GARAGE
�Soffit
❑ Trim
❑ Fascia
LOCATION OF 9JINDOWS
HEIGHT
Ft.
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. ProposaQ floor plan
3. List of strucrival members W be used
FOR NEW CONSTRLICTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing struct�res
and proposed project
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997�.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �l�C� OCCUPANCY TYPE
Pertnit Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ — �'s�
$ � . ��:�
$ ';> r ` �;..�
$
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks oavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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; thax I understand this is not a
percnit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requires revie and a�,proval of plans.
SIGNATURE OF APPLICANT / f'/.�� PRiNT N ��''` �� �� � g�� �DATE � � � r �� �S �
Page 2- Building Residential Application V
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 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 aznount 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 1�` $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 1�` $50,000 plus $7 for each additional$1,000 or fra.ction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fnction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1� $500,000 plus $4.75 for each additional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 foi the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Pemuts for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showin.g the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Build.ing Inspections Departrnent
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
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FROM :City of Fridley
`� Build.i.ng
Inspeciions
. 763-572-3604
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s1Tr nn�R�ss _,_, _.,
7'HtS aPPLIC;nNT IS:
FAX N0. :7635711287 Mar. 27 2006 12:34PM P2
�UILDING �
R�SIDEN�T�AL APP�rCATION�
C:ITY� OF FR1D i�EY
G] UWN�R
�1iOPERTY OW.Pi,F�2/ N�t�tE:
TENANT a�URHtiti:...,.�
CONTT2.4CTOR
$i]HMJT A COPY OF
iYOUR STAiT�' LICENSL�
VV1TH APPLICAT1nN
PROPER'tY 'lY:l'�+
��RNIIT 'Ci�P�:
��o��. �� ss__.. .
`�CO OR.
�
1'eXmit No.: ��� �- �
Rcceived 1'iy:.
Date Rec'd: - � ` l � -�
�w
�''���STA�F,��i��:,��'a/
YHONG: rJ/�f � /�G % �,�,�[/_� SF
...._ ... -
—.._. .... ���'IiVC� & t�EMc�DELIPat3. it��'
NAME; _ .. .. - - •.. ... _.
�7�'EX�ELSiOR BLVD. � nAi�__, , � ' `
STATE LIGF,IVSt�' ��,.�,� �i � ,
ADDRESS: ., .,. ' . _ ... • -- GITY� . . . _.. .. STATE T.rn�. . . ._
rr�n�ra uo x'
L�7
❑ BASC:IvfLNf CII�TI.SIi
❑ DP.C:K
TYPE U� WO1tY�: I❑ r��
Q MA
DESCJtT.RE WORK BE]NG
❑ SV1�1MA�ITNG POOL
� ❑ .4UU11'ION
❑ RPMpDF,L,lNG , ,
�S .
o wtrmriv;wti-
0 DRAW l'ff.F
❑ OTT�R
SI�E OF IMl'KUV�MLNT LENG'TI-i Wi.I�TH
„�,.r._ _-
�pOFIN(. Cl HC.)IJSRUNLY �
NUM�iL1i OP SQUA1tES ❑ HvU6C � CAItAO�
GAR�IG�S ❑ A'I'TAC:TILU CATtAGE
P�tUI'c)$Rn SIZE: _„__ O lS�TAGHLb GA1tAGE
PTtOT'OSEP HEIGHT:
SIDING
❑ vinyl ❑Sofiit
�A.luminue, � Trfm
❑ oa,� ❑ r�4�:�
WINUpWS �
1N EXISTING C�PRN]NGS �Yce �No IAC:ATf.ON OF VdiNllt)WS
ORPQRNEW QPF1VINtiS-DFSCkl$L SIZE Oi _,_, ,
c)PE?N IN'G CHANGT�S & 1.��
TYl'G OP WJNJ)�W Tn RF INS7'ALi..�ll % L. Z 7Z �i1MRRR ()F W1NI�UWS
ALT. FEES ARL 13ASL� ON ALUATTnN, 'fNCLUDllV(� 1']�l+j C4ST pR T•A�
(USINC THE 1997 U.B.0 T�I� SCHFLDL7LE)
�'OTAI� dCaB VALLJATION S � OrCUPANCY
II�IGHT
m
b'l.
��JT�tLNT 1iLM(�DELING 3L1BMTf:
1, Exlssing rincn Pian
Z. Prop�e�d IIcwr plau
3. List of suucmral ni�mbcra to bo usa9
Fc,)R N�:w CnN�Tl2UCTION INCLUL�ING nF.4KS,
,�DnTfl,p.n9 ,�. roRr_.Hns suaMrr:
I. Site Plun/Survey shoWing the c�:lsting structures
and prU[mscd �Nnject.
2. TWo sct4 of conetruclicm plxnb
�, Lni�gy CalculaUons
�Ult ANll MA'Y''�TtIAL,S: _. _ ..
TYPE
r�mrit Fee $ ��� �� S�e Back Page for Fee Sclicdule
Plan Iicview $ � � � GS% �.►f Au�lding }'c7mit :�ee
Fire Surchargc ��R� y�"� �% .001 Limes l:he r.otal joU valuation
Surcl�ar�c $ �" ( OU05 x Pe�ni6 Val'uation. Minimum $.50
LicanseSurcl3arge �,$_ �'-�-`��a��� ������� $5,00(StatcTiccnscdResidentiaiCJont.ra�t.�,rs)
SAC Cl�arga � pT .$1550 per SAC Unit (]'lans to MWCG' for dztaanina.�ion)
Guzb Cut Escxow $' i't + 6 ft = ft x S20 =$_,. .„�„ ,,,
�P.OS10n Control $ $450 Conservatlon Plan Re.►iew
Park l�ae � $ �� � Fee l�eiarmin�d by Eagineering .
Sewer Main C;hargc �Y$ �1grECmtn1 nccessary () Nom Neccssary (} �
Tutal Dt�F ' __ � ��� ���� Makc c1�eGks pa,Ysble to: City of Fridley Attoch Stipuiations .
' THJS IS AN APPI.�ca•r�aN r•ox a. pr,r�nrr-xoT vnz,m r_nvrn. PRU(;HtiSEU
i hercby apply for � builclin� perrt�l a.ad I ackuowledge tlzat die information above is cotxl�l.ete a,t�d aecurate; that thc work will Ue ia
cuuforcllanca w.i.tJ� rJae ord�.�ance.s and cod�s of tho City of rridloy auc] wit.� ti�e Minnesota Constn�ction Codos; th�� i undzrstand rhis �s not r�
pannit l�ut only an applicatian for a permir An.d work is not f.� c�rt withciut a permit; t1L�t the wrn-k will bc in accordance wit� thc approved
plmt� i.4 �Tie cace of, al,j work which r� ro� cvir�w p�rovsl vt'�lA.t.���� � n���� /� C�'
SIGNATCTR.E OI' APT'LTCANT _ ��,. ;, � PitIlVT N �.r/ � , (�'���� f •