AF - 38525�
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� Village of Fridley, N1inn. �
� BUILDING PERMIT �°• 18 3 6
� �,
Date: . . . . .. . . . . ���. . :'ss�. . . . . .. . . . .
Qwner .................................
...... Builder .. .. . .. .... � �/�??��?,c!�l..........
Address...................................... Address ...� a�:� 4�.....��..............
LOCATION OF ILDING
No. .��.�p�... 5treet .. ..... ... ..... .....E%�.... Part of t .......... ..............
, , , , � . . . . . . . . . Addition or Sub-Division . . . •�����
Lot .... �...••••• Block ••
� � d
Corner Lot . . . !� . • Inside Lot . . . . . . . . . . . Setback . �.:s . - • • • Sideyard . . � . �. • • • • • • • • • - • • • • • • • •
DESCRIPTION OF BUILDING
To be Used a /
�'�, ... . . .. . Front . .:�. .'Z' Depth .!Z. � . Height . (. .-:-� Sq. Ft. ..... .. . Cu. Ft. . .......
..�„
..................... Front ........ Depth ........ Height ........ Sq. Ft. ........ Cu. F� ........
Type of Construction . . . �/:'�').°f'.� • • Est. Cost . . �' J . • :�G � � • • • • • To be Completed . . . . . . . . . . . . . . . . . .
Tn consideration 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 description above set forth and in compliance with all provisions of
or,�inances of the village of Fridley.
;
g�f�` ...� ..................................................
�'` ' . (o!`�+t��� �/���'��
� Tn consideration of the payment of a fee of $. �. r� °�. .�. ., Pe�t is hereby granted to
, , , , , , , , , , , , , , , , , , , , , , , , , to construct the building or addition as described abwe. This permit is granted upon
the express candition that the person to whom it is granted and his agents, em.ploye� and worlmzen, in a11 work
done in, around and upon said building, or any part thereof, shall conform in all resPects 't° the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
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'�H• � �r • Building InsPector
� .. ..... ................
NOTIGE:
Thia permit does not cover the construciion, (nstallation or aiteration for wi�ing, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these ftems.
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City of Fridley, Minn.
BUILDING PERMIT No 4 3 2 2
Date: _. _� �.__.`._.. � ...�.._. _._� ._!__._...._..._.__.._.
.
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Owner: .....-- --�--•---C�°.��---'��----._-••--�----- Builder ..---��---. _: -- --_......_._.__..._....._.----._ ..........._.__ _....
Address_------.___._..�_._.._.._----.�• _._...�._ Address ........---....-------...__....__._........._....-----��----------------------- ----- ----
LOCATIO(V OF BUILDING
• �_
No. ��� Street _..._����... .. .- ••.- -�--•-�------•-„dG��-...-•-----...------�--. Part of Lot ....._ . .._....._.... _._...._..���_.�/
� .. Block ....------.. .................... ...... Addition or Sub-Division ... � I�/
Lot .......... ..............
........: �-- .... . ... . - ----�a��-.._.. w�inc:��f
Corner Lot .........................._........ Inside Lot
Sewer Elevation
Setba.ck ....._ ............._.................-•---- Sideyard
........... Foundation Elevation ........_........
DESCRIPTION OF BUILDING
To be Used as:
��__.. ..../�.�_."_.� ...------- ---. .... Front c�-Q---� Depth �7...'. i� Height I...� _� � " sq. �. _�� �. cu. �. ..�._�_.��
......................_���.... Front ....._............._.. Depth ____�-� _. Height ....._---._......_.. Sq. Ft. ....._.._........._.. Cu. FL ....._............._..
Type of Construction ......��......... Est. Cogt. �..l...�.�.�.....-••�._........ To be Completed ...__ ............._............._.....__....---
�n-.-......._........
In considera.tion of the issuance to me of a permit to construct the building des above, I agree to do
the proposed work in accordance with the description above set fort,�t�j and in com a�ce wi all provisions of
ordinances of the dty of Fridley. _ (� (� R/�
In consideration of the payment of a fee of $'� ...............----.---., Permit is hereby granted to...-----_.--._---._...-------_.--- --
_.__ .__.._._..__..�...�._._. to constauct the building or addition as described above. This �rmit is granted upon
ihe 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, repa.ir and moving of buildings
within the dty limit� and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. _ � i `
Building Inspector
NOTICE:
This permit doea not eover �he eonstruetioe, insfalletion Por wiring, plumbing, gas heating, sewer or water. Be sure �o aee
1he Building Inapeetor for separete permits for fhese Mema.
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Address
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APPLICATION FOft BUILDIldG PERNlIT
CITY OF FRIDLEY, MINNESOT@ ,_
. L4CATION OF BUILDING ' � � � ' '
� . .. f . �4 . . . . . . . , , ..
No. �',� �� Street � ���`' ; Paxt of Lot
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Lot glock Y Add3tion or Su:ti:Div.��.�.�a� , --
Corner Lot �neide.� Lot� t Ba.ck - Side-Yard
� • . . �;
SEbTER ELEVATION � � FOONDATION ELEVATI�N � � • ` �
Applicant attach to this form Certifica.te of Survey of Lot and �proposed bu�:Id3:ng
loca.tion.
.. . � DESCRIPTION OF BUILDING ._-.._...._.._
To be used �s: �-� :. � ..•
� ��_ . � � , .. ��. � ;r
; Front � Depth ��. . . Height : ��
Sq. Ft. `�� �� Gu. Ft. � �` � ._._� .-_ _ _..
� Frant Depth . ,,;.. �eightl� _
Sq. Ft. � Cu. Ft. � - ---
� � ..
�rpe of Cons
ted Cos��,. ��P'G?
To be completed
The undereigned hereby makes application for a p.erm3.t _ for the . wor.k .kierein spe��.fied,
agreeing to do all work in strict accordance with �tha City Ordina.nces . end. i�u7.i�ig of
the Department of Bui].dings, and hereby declares that ell tha �:�acts -atad �ep.re.senta-
tions stated: in this application are true and co / et. . � -
C% /.� � SIGNATURE
DATE : ' � � 7
(A Schedule of Fee costa can be found on the Reverse Side..) .
,.... .
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BIIILDING PERMIT FEE SCHIDULE
Section 2. The Inspector:of,Bui�d3ngs sha�l� before issuing any permit
-£or �he erection of an�r btiilding or structure, or for an�r addition to �
any existing building or structure, or for any alterations or repairs .
to.any existing building or str�ct�re, upon,applic�,tion .there£or,�requ3:re� �� �
..___ t,h�a�me��� by- •�he-app13:C�n� � fbr such permit of fees to the amount herein
below set forth and in the mann�r,.;herein proyided to-wit:_ ....... _.- ...- '`�
r� 2.1. For any such permit for the erection of .a�,y fire-proof building, other
than a gaxage, warehouse, factorj►��or�grain elevator, or for the erection of
any fireproof addition, for similar occupancy, to an� existing.building ..._ .
sha11 be at the rate of ��I.40._,far. .each �one ��housand cubic feet, 'or fraction
-Y��-�'t�ie��eof, in �such cubica,l contents. .
---���:2. For �a:ny such peradt for the erection of .any fireproof. garage, ware= •: . _
house, factory .or gr�.3:n eleyat�r,. or . f.or the erect�:on �of any fireproof
•-�•'���a�Yciition, for similar occupancy, to any existing building shall be �at the ".�
rate� of �1.25 for eacl� orae _ thousa�d Eubic • feet, � cl�ssified 'as "-�ireprooi" .
° � - �b� u�ct�ion 50� of �� the Minneapolis Building Cpde. _ ; • � . ..
I�tl. USES : ; .. .. . _ _ , , .. .. . . .
2.3. For any such permit for�the erection of any non-fireproof building _.
other tha.n a garage, waxehouse, factory or grain elevator, or any non= � �
fireproof addition, for similax occupancy, to any existing building.
Permit. $1.00 for each one thousand cubic feet. . ��-�-----��-�
r •GARAGES~ �
2.4. For any �u�h permit for t2}e,.erection of any non-firepr:oo.f ga:��ge,
._.warehause,.•factory or grain �e�evator;� or for the erection of any non-
fireproof addition, for aimilar occupancy, to any exiating.building or " �
for each sv.ch bui].ding or addition. Ninety Cents for each one thousand
cubic feet or fraction, thereof,.,.:�.n the cubical contents thereof with a �
--..�-m�.mum of ��:.00... . - �--- -• . �
, For.t�ie piu`pose of comput3ng fees for building permits the cubicel contents
of any buildi.ng or e.ddition to . a, uniform hei.ght throughout by 'multiplying �, "
�tfie ground•a.'rea covered from a point six (6) inches below the floor line of '
' the; °basement o� �cellar to� � the avera�e height � of the upper_ surface� or to the ' �
-�.verage •Y�ei�ht oP the �roof surface.of the main gable of a�pitched roof. �� �
_ . 2 • 5. For repaira or alterations to an exi$ti:ng :structure, .the .f.ee .aha�l - be-• -� ' �� ` .
at the r�,�s. _af._�3...4� -for- -each Five Huridred Dollars (��QO .00 ), or fraction
thereof in the cost of al;l proposed.�rork.: .. . . -
2.6. In no case shall the fee chaxged for any permit as set forth in
Section 2 be l.ess tha,n �/�.00.
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City of Fridley, Minn..
BUILDING PERIV�IT
`����
N° 6351
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LOCATIONf OF UILDING
No. 8tr+eet _ .—... P P Lot _�
Lot _ Block Addition or Sub-Divfsion i� ��
Coraer Lot
Sewer IIevation
Inside Lot �.�. Setback .._.__._.._ Sideyard
_ Foundation IIevation
S IPTION OF BUILDING
T v ���% � �
t� Depth �.�._ Height _�� Sq. Ft. C�. Ft ���..��
Fro t Depth � eight , _ Sq. F� Gw. F't.
Typ� of Construction P��.�. Fdst. Cost � _�- To be Completed
In �deration oP the 9ssuance to me of a germit to construct the building described above I agree to do
the proposed work in accorrlance with the description above set forth and in compliance with a�l provisions oP
ordinances of the dty of FrYdley.
�
In conafderation of the payment of a fee oP
permft fs hereby granted to
to construct the bufld'ing or addition as described above. This permit is granted upon
the express condition that theperson to whom it is grented and his agents, employees and worl�en, 9n all work
� done in, around and u�n safd building, or any part thereof, stxall conform itt all respecta to the ordinances oE
FridleY, Minnesota location, conatruction, alteration, maintenance, and moving of bufldings
�� dty ]imfts and permit may be revoked at any t3aa�von viola on o aay of the provlaions of said
/ J� /i
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�"'�, NOTIC�
TW psneb doa eot sevsr ths eonstweHoe, hutaWHee fe� vrUirtg, plvm6teg, �n haHeg, aw�� er wafer. B� wre to ss�
1ha &rildiee leqa�tar for apnab p�rmits fee th�a I�nu. .
� � .. _
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OWNER' S PI�2E
ADDRESS
APPLICATION �'OR �UILDING PERMIT
CIZ`Y OF FRIDLEY, MINNESOTA
LOCATIOAI OF BUILDING
No. 5� �' 0 Street ^
-A.�-�-� Part of Lot
Lot Block Addition or Subdivieion
Corner Lot�_Inaide Lot geCback Side-Ya_,rd_=_ �_ -_- "
-- �`"� . ` - - -
SEWER L�LEVATION � — _ �'O�li�bATION ELEVATTON �
App�iEa�nt �ttach to this form Two Certificates of Susvey of Lot and proposed build-
ing location drawn on tl�ese Certificates.
Sq.
I,DING
%
th ' Height �
Ft ._.�,�� � Cu . Ft . q _
Front Depth Aeight,:
Sq. Ft. Cu. Ft.
Type of Construction Estimated Cos ���
To-�e �ompleted
The undersigned hereby makea application for a pernTft-fc�r-.�h� work herein specified,
agreeing to do all work in strict accordance with the City of Frid�ey �caA�,ps and
rulings of the Department of Buildings,.and here declares th all Che facts and
representations stated in this appl3cation are e and cor ct.
� �� �
DATE '-- � - -- -- _ S tGNATI�RE % � Qp�'„ % G�4 s� /l � �
(s�h�dule of Fee Gost� ca.n be found on the
. - - *� �`"�
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Side)� �
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BUILD7NG PEIiMIT F'S�E SCHEDU]LE �
Se�tioA 2. The Inspec�or of Buildin�s sha11, before issuing any permit for
ehe erecC3on of aay buildiag or structure, or for any addition to any exis�-
in� b�=.�lding or structure, or for any alteratioas or repaira to any esci��ing
- - ---=�3���r _ at�ructure, upoa applicaeion therefor, require the paymen� by tiiae
apglicant for such permi"C`�- fe�s---��amo+�nt� herain. below set forth and
in the maaner herein proeided to-wit: -� —----_- __ _
2.1. For any auch permit for �he erection o� any fire-proof building, othes
th�n__a garage� warehouse, factory or grain elevator, or for the erection of
.. anq fire-proof addi�ion, for similar occupancy, to any existing build�in.g
shall be at the rate of $1.40 for each one thousand cubic feet, ox fract�Qa�
��±ereof, in such cubical contents.
2.2. For any such permit for the erection of any fire-proof garage� warehoanse,
�actoxy or grain elevator, or for the erection of any fire-proof ecditiQa�,
for similar occupancy, to any existiag bu3lding shall be at the rate oi-$1_.25
for each one thousand cubic feet, classified as °1fireproofj' bq Sectioa 302 0�
--�. �n�ae �polie Buildinffi Code.
-�- .���-
��3USES '.� �' .- =- =--� - �-
2.3, For any such permft for the erection of aay non-f�r�psoof buildiag ot�ier
than a garage,;war�house, factory or �rain elevator, or any nora-fireproof
addition, for =similar occupancy, to any exis�ing building - permit $1.00 for
each one thous�.nd cubic feet.
�ARACES
2.[t, For any such permit for the erectirns o£ sa�y non-fireproof garage,
w�rehouse, factory or grain elevator, or for the erection of any aon-f�egroo�
-- - - --- a�it-�-e�- �- s���- �as+c3r,�-ta-ang exist�ag�ni3��:ug-�r�or_eac�- suck- � - _ _
��ilding or �.ddition - niaety:cents (^�0.90) for each one thousat►d cubic feet
or fraction thereof, in the cubical canteats thereof with a minimuffi of $4.00.
�or the purpose of computting fees for building permits, the cubical contents
of.aay building or additioa to a uniform height throughout by multiplying tt�.e
ground area covered from a point six (6) inches below the floor line of ftbe
b�sement or cellar to the average heigtit' of the upper surface or to the
av�rage height of the roof surface of the main gable of a p�.tched roof.
2.5. For repairs or aleerations to an exis�in_g_struet�e; the fee shall be
at the rate o£ $3.00 per each, �'i�ze �sttred" Dollara ($500.U0) or frsction
thereof in the cos�-aY=aI�I proposed work.
2.6. In no case°shal'1`the fee. charged f.or anp permit as set forth in
Section 2 be less than $4.00.
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��,s � .� �' A
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sue�ecr PER �
City of Fridley 9 6 812
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � REC IRT NO.
� ; L ____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 � �
' �"'1 � CITY HALL FRIDLEV 55432 NUMBER REV DATE PAGE OF APPROVED BV
�----� • •�� 612-571-3450 910-F15
10/8/82 � �
JOB ADDRESS SOOO C�.EdYVl@W
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ]_ 6 Carlson's Sutnmit Manor South SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Dean Custer 5000 Clearvianr 572-8215
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP pHONE LICENSENO.
B USE OF BUILDINC3
R@S].CI@I1t7.3�.
7 CLASS OF WORK
❑ NEW � ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOYE
%
8 DESCRIBE WORK
Construct a brick chixnne
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERN!(TS RE�Q��RE� �F�� 1+��#ff��
�FATI�NG. Pk.t�R�9�IP�� At�i� ��aC��.
VV�RN�G
Setore diggir�� c�!! lc�a� utili'�i��
TELEPHONE - C�EC t �€�� - � E�CB
REC�'IJi�E� �� ��
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. Br1C�C
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
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFS7REET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 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 $7r,O �`.5O
WITH WHETHER SPECIFIED HEREIN Oli NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $1rJ.OQ
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
� PLAN CHECK FEE TOTAL FEE
$15. 50
S AT�UREOFCONTRACT O AUTHORI T t ATE� WHEN PROP LY VALIDATED THIS IS YOUR PERMIT
� g�- � ��� /��' c�
SIGNATUREOFOWNEfi I NEPBUIl0ER1 IDATEI BLDG INSP �ATE
e
CITY �F FRIDLCY Effective Auq. 1, 1981
APPLICATIO�� FOR RESIDCWTI/1� BUILD1i�G PCRi�1TS
(N�►�, A1 terations. Addi Lions, or Repa i rs )
OtJNER:
ADDRESS:
�� No: • ,��� --�'�l� -
Co
13UILO�R: � •
110D1tCSS:
TEL ti0:
Location
�
�
• STRITT NO: � ST7tEET:
LOTa � BLOtX: li1DAITION:
Corner Lot: l�/ Insiile Lota � Setback: � Sideyards:
11p�licarit attach to tl�is fo�cm two Certificates of Slirvey of lot and
pzoposed building location drawn on certificates to scale.
DESCRiPTJOts OF COUSTRUCTiOr�
Front: Depth: Heiqht:
6quare Fcetr Qibic Feet:
.
. Front: _ �� Deptha /�? � Height: �G�-�.�
Square Feet: A�bic Teet:
�
4ype of Corstruction s
Rb Be O�r.�pleted:
Esti.mated Costa S ;�
Alt. A Alt. B
Proposed Drive�►vay wiclth If New Opening Is Desired: $' $
. . SE� Rr^,VER�E SIDz OF SHEET
Tiie undessi ned here ma);es application for a •
9 by permit for the �•�ork hereir► specified,
agreeing to cb .all work ir, strict accord3nce �ith the City of Fridley Ordinances and
ruli»g� of the De��rtment of Duilaings, anc] hereby declares that all the facts and
repres�tations stated � is applic�tion e true and _o�rect.
� � C�
D.'1TE: S IGNATUI� :
Stipulationsr
�
13.Ov
•3�
/�'•�'�r
e
__.,
BUILDING PERMIT FEE SCHEDULE
The Inspector of buiidings shall, before issuinq permits ior the
esectioa of any buildinq oz structure, or for any addition to any
•xistiaq bnildiag or structure, oz for any altezation or repairs
to ar►y s�ci�ting building or st=ucture, npon application therefoze,
requize the payment by the applicant f oi �uch permit of �ees to the
a�ount bezein below set iorth and ia the a�anner bere3a prov3ded to-wit:
TOTAL V1ILTJATIQd
51.00 m 5500.00
5501 t� 52►000
52.001 b� $25,000
525,001 to 550,000
550,001 ta $100,000
lEES
510.00 Minia�um Fee S15.00 plus surcharge
510.00 for the first 5500 plus S1.50 for each
additional 5100 oz fraction thereof, to arid
includirig S2•000
532.50 for the fi��� $2,000 plus $6.00 for each
additional 51,000 or fraction th ereof, to and
i.riclndirrq $25, 000
5170.50 for the first 525,000 plus S4.50 for
each ac7ditional $1,000 or fzaction thezeof, to
and including SSO,G00
5283.00 %r the first $50, 000 plus S3. 00 for
each adc]itional $1,000 or fraction thereof, to
an8 includiriq 5100, 000
5100,0�1 ar�d up 5443.00 for the first $100,000 plus S2.50 foz
each additional $1,000 or fraction thezeof
PLAN Ct3EQC: 25 pezcer�t of building pezmit fee
DRIVF�AY DEPRESSION ESQtOW: Concrete Airb Str eets O�ly
Alternate "A"s Removeal and zeplacement of curb and gutter only ,
Driveway widtb plus 6 feet s�13.50
Alternate "8": Renoval anc] replacement of curb ar�d gutter and install a 3 foot
wide approach with 6 inch deptli
Driveway width plus 6 feet Y 515.75
VERIFICATION OF FOUNDATION
Pez�its for construction will be issued a minisnwn of 24 hours froan the time of
application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of S�rvey of the lot, shawinq the locatfon of the founc7aticn once it
has been oonstxucted will be requfred before proceeding with the frami.ag.
�
SUBJECT PE .�
City of Fridley �
' , AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RECEIPT .
r
� �
� • COMMUNITY DEVELOPMENT DIV.
' j y �����'�
r � � PROTECTIVE INSPECTION SEC. � �
i = �
� /"'1 � CITY HALL f RIDLEY 55432 NUMBER REV. OATE PAGE OF APPROVED BV
�""� � ,'� 612-571-3450 910-F15 4/8/94 i �
J08 ADDRESS 5000 Clearview St NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. j 6 Carlson's Summit Manor South Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Dale/Laurie Plante 5000 Clearview St NE 571-0125
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
� Bud Bloomin n -
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
7 CLASS OF WOHK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE � REMOVE
B DESCRIBE WORK
9 CHANGE OF USE FROM TO
STIPULATIONS
Inform homeowners that smoke detectors are required adjacent to all
sleeping areas and in the basement.
TYPE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 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 OFFSTHEET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �6, 391 $3. ZO
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 CONSTRUCTION. �90. �� Fire SC �6.39
PLAN CHECK FEE TOTAL FEE
License SC $5.00 $144.59
SIGNATUREOFCONiRACTORORAUTHORI2EDAGENT IDATEI WHE Y V IDATED THIS IS YOUR PERMIT
C�.� ' �
SiGNATUREOFOWNER�IFOWNERBUILDERI IDATEi BLDG �NS fjATE
NEW [ l �J-1 l� 3�-E S�1
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Construction Address: � C7 O� G��,V� l Q.� e� f" °
Effective 3/1192
-�7"( a �
/
Legal D�scription:
Owner Name & Address: P - Tel. #•��� �-- 0) 2--`j
Contractor: � - MN LICENSE #�� (o (�
� TeL # � c� � �, (� ( �i
Address: �
Aitach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: I.eugth
GARAGE AREA: Length
DECK AREA: Length
OTHER:
DESCRIPTION OF IMPROVEMENT
Width Height
Width Height
Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [ J Ft. Yd Setback Side Yard Setbacks
Type of Construction: y(��z��� ,S ��, �� C.�Q� Estimat� Cost: $(o�va �°`�
Approx. Completion Date:
Driveway Curb Cut Width Ne�ed:
DATE:
APPLICANT:
Per�aat Fee $ �► � • �
Fire Surcharge $ �, • 3 �i
State Surcharge $ 3 . LC�
SAC Charge $
License Surcharge $ �j . ��
Driveway Escrow $
Park Fee $
Sewer Main Charge $
TOTAL $ ( l'1�.� e(
(Cost on Back}
Ft. + b Ft = Ft x$ _$
TeI. #�
CITY USE ONLY
Fe� Schedule ora Reverse Side
.�1 of Permit Valuation (1/lOth%)
$.501$1,000 Valuation
$7� per SAC Unit
$5.� (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: �/`
�� �.�' � j�°'�'`�',�e�`�
` . _
�f��'���'..�'i->'�,� �� �a ,��'°� ��;� �'� � ���`g�''����3�.
_ � r � 6�
r
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or sbructure,
or for any addition to any existing building or structure, or for any alteration or repair to any existing
building or structure, upon applic�xion therefore, r�uire the payment by the applicant for such permit
of fees to the amount herein below set forth and in the manner herein provid� to-wit: .
$1
TOTAL VALUE
to $500
$501 to $Z,000
$2,�1 to $25,000
$25,�1 to $50,000
$50,(�1 to $1(�,000
$lOt},001 to $5(10,(�0
$500,�1 to $1,000,�
$1,�,001 and up
FEES
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $5� plus $2 for each additional $1� or
fraction thereof, to and including $2,000
$45 for first $2,000 plus $9 for each additional $1,000
�r fraction thereof, to and including -$25,(�0
$252 for first $25,000 ptus $6.50 for each additional $1,000
or fraction thereof, to and including $50,0�
$414.50 for first $50,0� plus $4.50 for each additional
$1,� or fraction thereof, to and including $100,000
$639.50 for first $1�,� plus $3.50 for each additional
$1,�0 or fraction thereof, to aad including $SOQ,�
$2039.50 for the first $500,� plus $3 for each a.dditional
$1,OW or fraction thereof, to and including $1,OQ0,000
$3539.SU for the first $1,�,000 plus $2 for each additional
$1,� or fraction thereof
DRIVEWAY DEPRESSION ESCRO�V
— - - (Concrete _Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times
$i3.50.
Alterna.te "B": Removal and replacement of curb and gutter and in.�tall a 3 foot wide
approach with 6 iach depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for cons�niction will be issued a minimum af 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.
sue�ecr PERMIT NO.
c�ty of Fridley 2 710 s
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 � � PqOTECTIVE INSPECTION SEC.
i i �
� /"'1 � CITY HALL FRIDLEv $$432 NUMBER REV DATE PAGE OF APPROVED BY
�'""'� � �'' 612-571-3460 910-F15 8/11/98 � /
JOB ADDRESS
5000 Clearview St
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCFi. 1 6 Summit Ma.nor- South SNEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE
Dale Plante 5000 Clearview St
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Qwner
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PFIONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDtTION ❑ ALTERATION � REPAIR ❑ MOVE � REMOVE
8 DESCRIBE WORK
Reroof house and ara e 18 T
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
Roofing can be 2nd layer but not 3rd.
i
i�
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, NEATINO, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WONK OR CONSTRUCTION 20NING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE REAO AND EXAMINEO TMIS APPLICATION STAL�S GAqAGES
AND KNOW THE SAME TO 8E TRUE AND CORREC7. ALl PROVISIONS Of LAWS yAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T fEE SAC CHARGE
PROVISIONS OF ANY OTHEFi STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION (+ e
PIAN CHECK FEE TOT L FEE
' NAiU O CONi AC O AUTNO 2EDAGENT IDATEI N OP VALID TE HIS IS V UR PERM17/'ylf
a� p %'
ATURE OF OW �IF OWNER BUILDERI IDATEI � INSP f�qTE
� s a �
NEw
ADDN
ALTER
[]
[l
L]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: (��, � b � � �e �, ,�' V ; � ��
Legal Description:
Owner Name & Address: J� �-� �� � N � t
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Effective 1/1/98
�� b�
�` �
�
Tel. #� 7�. �/ 2S^
MN LICENSE #
Tel. #
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.
f� -� �S —�— � ' —� b ��
��� T-e �, � o�, / z S�r C� � r3 --- o� e� L��S ��11C� f-frc
Construction T e: �
YP /U -� � c�� �_ Estimated Cost: $� o '�� i
(Fee Schedule on Back�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � I � �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surchazge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
! J � l -�-- l e �� ��
CITY USE ONLY
Tel. #
$ ��%� Fee Schedule on Reverse Side
$ ���7 .001 of Permit Valuation (1/lOth%)
$ f„� $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ � � ��
R -
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $5�,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for 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 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,OQ0,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
„
SuB�ECi
City of Fridley �
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
� .
� �
� `v _ _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 � �
� _ �"'1 � CITY HALL FRIOLE� SS132 NUMBER pEV O�TE P�GE OF
�'""'�� ��� 763-571-3450 910-Ft5 10/15/02 / /
�oe aooaess 5000 C�earview Street NE
1 LEGAL �OT NO. BLOCK TRACT OR AODITION
oesca. 1 6 Carlsor.'s Summit Manor South Addn
2 PiiOPERTY OWNER MAIL ADDRESS ZIp PMOf
33171
RE�I���
AvnqovED er
SEE ATTACMED
SNEET
�,aurie Thompson 5000 Clearview Street NE 763-571-0125
3 CONTRACTOp MAIL ADDRESS Z�P PNONE LICENSE NO
Same
e ARCMITECT OR OESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
5 ENGINEER
8 USE OF BUILDING
Resident�al
7 CLASS OF WORK
MAII ADDRESS
❑ NEW �l ADDITION
PHONE LICENSE NO
O ALTERATION ❑ REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Construct a 14' x 18' Addition to Dwell
9 CHANGE OF USE fROM
STIPULATIONS
See notations on pian.
�'� '`�i L`" .� .���:�
�,
�■ � „ � �� ,� _
. �
i �. ` � l�' �
SEPAfiATE PEIiMITS AqE REQUIHED FOR ELECTFICAL, PLUMBING. HEATING.
VENTILA7ING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL ANO VOID IF WORK Oii CONSTRUCTION
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAVS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED.
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION
AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF IAWS
AND ORDINANCES GOVERNING THIS TVPE Of WORK WILL BE COMPLIED
WITM WHETMER SPECIFIED MEREIN Ofi NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME 70 GIVE AU7MORITV TO VIOLATE Oii CANCEL THE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STqUCTION OR THE PERFORMANCE OF CONSTRUCTION
TUAEOFCONCAA,TOpOAAUTHOp�ZEDaGENT IDA7Ei
�- 1 bs��-D�.
UAE 0� OWNEp��f OWNEpB LDEpi �DATE�
TO
�.,; ,� . . � � ;. ..
� �:.
�.�': ;.�':�� s. A.
�, • � . �. ; a� � �
` '.( i �` � �
•� lII'
-;, � ,•, .
��. •� �
NO OWLG. UNITS
1
VALUATION
$14,303
PERMI7 FEE
$251.25
�'e'� , � /
OCCUPANCY GROUP OCCUPANCV LOAD
SO.f7 CU FT
OFfSTREE7 PARKING
STALLS GARAGES
SUR7AX
$7.15
SAC CMARGE
Fire SC $14.30
�2.70
s �5 rouA a �T
/� �s-i
NEW [) CITY OF FRIDLEY Effective 1/1/2002
AODN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572�604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Cohstruction Asic�ress: ���� Cf�a f J•e� 5f /�%� .
Legal D�sc�iption:
8rnrner Name & Address: � L�P%c T����as�� $�� ��r�v e� 5t_eUL�TeI. #�wi 6 2��3yo 8s6i
Contractor. ��o�
N� GI $� ' 43�P -�i2 3� MN LICENSE #
Address: (�) �6�2 - ��`l -36`-�7 Tei. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
,���T
� � �l
LI101BdG AREA: /� Length /� �dth � 4,�� Height 8 Sq. Ft,�-�� o��pc
GARAGE AREA: Length Wdth Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Fk
OTHER: '
. 7 L,- 1
Construction Type• � L� �,�! Estimated Cost: $ , � �3 � �'
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
I,c91e �12-3 �°' `�b°7
DATE: l('� '`- a`eL APPLICANT: �/ 1� � Tel. # i(�a3 -S� I-� t2�S
Call (763) 5T2�604 for Pertnit Fees if mailing ln application o� Fax to 763-571-1287 if using credit card and we will
call you tor card number.
Perm� Fee
Fire Surcharge
State Surcharge
S�lC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
�__���
$�� '�D
$ -] , i 5
$ �
$ �
$
$
$
$
� j �'
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ ]
,,
�
STIPULATIONS:
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon 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 $100,0�
$1�,001 to $500,000
$500,�1 to $1,(�0,0�
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,(�l0 plus $10.10 for each additional $1,(�0
or fraction thereof, to and including $50,000
$643.75 for first $50,0� plus $7.00 for each additional
$1,0(� or fraction thereof, to and including $1�,000
$993.75 for first $100,Q00 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $5(}0,0� plus $4.75 for each additional
$1, 000 or fraction thereof, to and including $1,OOO,a?0
$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 times $17.00.
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.
VERIFICATION OF FOUNDATION
A Certifica.te of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
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� "' �� TITLE: Dining Room
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`"`'CONSTRUCTION TYPE: Single ]
DATE: 09/30/02
DATE OF PLANS: 9-22-02
PROJECT INFORMATION:
5000 Clearview St NE
Fridley, NiN 55421
.��,k� � :ig
tl �� �, { p Y I', i '7 p I �� h i ff 1: I
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COMPLIANCE: Passes
' 1Vlaximum UA = 65 ` ` �`"�'� �''' �" � �e :1,+� l �. � ,
Yoiur Home = 58 �'�:�
1�8% Better -T�aII Code t,.��; �. c:
� �. ;it, , , � .�,.: �: �: i .;r_ �. . . , : � �,'��i�i �w�i, cl�.',.Jit}i�u,; ;�c;a.�t ��� �,�; � i - Glazing
Area or` Cavity Cont or porn,'
- _ , Perimeter R Value R Value U Factor UA
Ceiling 1: Flat Ceiling or Scissor Truss 269 38A 0.0 8
Wall 1: Wood �rame, 16" o.c. 160 19A 0.0 9
Window 1: Above Grade, eVood Frame, Double Pane with Low E 5 Q.330
2 �
�Viindow 2: Above Grade, Wood Fram�; �ouble Pane with Low E 5 0.330
2
Wall 2: Wood Frame, 16" o.c. - 130 19.0 0.0 6
Window 3: Abave Grade, Wood Frame, Double Pane with Low-E 12 0.330
4
Window 4: Above Grade, Wood Frame, Double Pane with Low-E 12 0.330
4
�Va113: Wood Frame, 16" o.c. 144 19.0 0.0 7
Door 1: Glass 21 0.330 7
Floor 1: All-Wood Joist/Truss, Over Outside Air 266 30.0 0.0 9
Air Conditioner 1: Electric Central Air, 10 SEER
Furnace 1: Forced Hot Air, 80 AFi7E
Proposed and Ma�mum U-Factor Averages �
, � ; proposed , Maximum
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Abave-Grade Windows and Glass Doors
Includes Foundation Windows > 5.6 fi2
Average U Factor Allowed U Factor
0.330 0.370
COMPLIANCE STATEMENT: The proposed building design descn'bed here is consistent with the building
Plans, sp�ific�tions, and other calculations submitted with the permit applir,�Uion. The proposed building has
been designed to meet the Z000 Minnesota Energy Code requirements in MECcheck Version;3.3 Release lc and to
' comply with the mandatory requirements list�. in the MECcheck Inspection Checklisk
Builder/Designer �Q�'�-�? c%'G���l Date % �� � l�Z
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LAND SURVEYOR ��������
�NIC M�I�INO � qffG19TER6D UNDER LAW6 OF 6TATE OR MINNESOTA J,YOICIi6
LICRN6lo �Y ORqINANCC OR CiT� O} MINNtA�OLiI
3300 LYNDALE AVE, SO. MINNEAPOl.IS 8� M(NN.
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Lot One (1). Hlock Six (6). CA}�L,ON'S �DhIT h1,pNOR �OUTH ADpITZON, Anoka�Couaty�
Minnesata.
As surveyed by me this 2nd day ot' April 1956 a. D.
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIAIVCES OR THE
APPLICATION WILL BE RETURNED
•ii�i•► I ► l ► •►► •: �►� ��i= �•► � I : � � 1•►
When � IarinQan eYi_c±in0 �ran _, 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 plastidPVC and meets all cuirent codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (► No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specfications. This does
indude AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
�jQ pY1G+1 ,seme���en air is sized and installed to meet the current codes
and manufacturers speafications.
Wh@f1 feCjUl�2d t0 ���±all a new _emb �ctien air' it will be si�ed and installed
to meet the current codes and manufacturers specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
�g� jp�jp0 a n_w v_ntin�y��, the undersigned hereby verifies that
it is a listed assembly and meets the cuRent codes and manufacturers
speafications. This does inGude AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
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. Yes () No ()
�.. .� - - ..��._._.__-. .�. -. .��-«. � ..��. .�
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 Btu Input
Cammon 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 Connedor Height ft Length ft Diameter in Type _
� r -� r•► •�- .•-
HEATING CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
___V______,
CITY OF FRIDLEY rEx�v� o.: 200400579
6431 UNIVER5ITY AVENUE NE
FRIDLEY, MN 55432 DATE ISSUED: 04/23/2004
�631572-3604 FAX: (7631571-1287
: 5000 CLEARVIEW ST NE
: 263024230107
: CARLSONS SUNIlVIIT MAN SO ADD
: LOT 1 BLOCK 6
: BUII.,DING
: RESIDENTIAL
: GARAGE,DETACHED
VALUATION : $ 4,245.00
NOTE: CALL GOPHER STATE ONE AT 651-454-0002 FOR UTII,ITY LOCATIONS.
PROVIDE HARD SURFACE DRNEWAY.
SEE NOTATIONS ON PLAN.
CONSTRUCT A 16' X 12' ADDITION TO GARAGE
APPLICANT
ERIC & LAURIE, ANDERSON
5000 CLEARVIEW ST NE
FRIDLEY, MN 55421
OWNER
ERIC & LAURIE, ANDERSON
5000 CLEARVIEW ST NE
FRIDLEY, MN 55421
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 correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel . e provisi ns of any other state or local law
regulating �fruc ' o• e perf ance of construc on.
Applicant //I�� Date � �3"�
�
Bldg
BUII.,DING PERMIT FEE
PLAN CHECK FEE
FIRE SURCHARGE
STATESURCHARGE,VALUE
TOTAL
PAID WITH CHECK # 4249
SEPARATE PERNIITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
111.25
72.31
4.25
2.12
189.93
��.����
NEW [] CITY OF FRIDLEY Effective 4/1/2004
ADDN (�Q 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
�v�o G ��. 'P � �T �l �DO� � �s�9
Construction Address: �'� e
Legal Description:
Owner Name 8�Address: ��`� '� ��r�f�t ��erso� .5v-�e Tel. #%�'.S7/- DI� S
Contractor. ri�/�1 P1� MN LICENSE#
Address: Tel. #
LMNG AREA:
GARAGE AREA:
Attach to this application, a Cert�cate of Survey of the
bt, writh the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft. '�.
Length I(� Width �a � Height _� Sq. Ft % g�
DECK AREA: Length
OTHER:
Width Hgt/Ground Sq. Ft
Construction T � � � �� 6 �
ype: Estimated Cost: $ .3 � �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �j"�3 "� �� APPLICANT: ��� �����sD� Tel.# 763��7�'�l�S
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
� 1l l. ��
$ ��.� �
$ '�1���
$_�,1 �
$
$
$
$
$
�
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 $ ��C� � � STIPULATIONS:
BiJILDING PERNIIT 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 provid� to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,�1 to $25,0�
$25,001 to $50,000
$50,001 to $100,000
$100,W1 to $5�,�
$500,001 to $1,000,000
$1,0�,001 and up
FEES
$23.50
$23.50 for first $5� plus $3.05 for each additional $1� or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,�0
$391.25 for first $25,000 plus $10.10 for each additional $1,�0
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.� for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $1�,�0 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $SOO,OQO
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,0� or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,(�0,� plus $3.15 for each additional
$1,� or fraction thereof
CURB CUT ESCROW
(Concrete Ctiarb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
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.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
procesding with the framing. New Houses Onlv
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.)UMMIT �VIAIJOA ;�i0U7H ADD. L'l,Y, i
� C. E. 1:0U �.TER •`••""°
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U!!d� SURVEYOR �����Ne��
/NIC M�►IINO � pEG10TEFt6D UNOER LAW6 OF tTATE OF MINNESOTA ��e�����
LIC[NKO �r OIIqiNANC[ OR CITt O/ MINNlA►OLU
• 3300 LYNDIILE AVE. SO. MINNEAPOLIS t, MINN.
LOGUST 0370
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I hereby oertiPy thet the above f� a true end correct plet of a surv�y ofi
Lot One (1). Block 31x (6). C�FtL,ON'S �A��IT h1AN0A �OUTH pDDiTION, Anoko�County�
Minaeaote,
`a surveyed by me thie 2nd day of April 19,�6 A. D,
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MinnE;HOta Re�i3tration No. z,584
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