AF - 38674Date:
Owner
Addr�
�
City of Fridley, Min.n.
�UQ..DING PER.l�T
�,
�T° 306�
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. . . . �.�. -�n.7??-�!$!°:L!�'�'� Builder . •. . " s-�'�. �''-
s . � . . �. . � /. . . . .� :�G'?° . . . . . . . . . . . . . . Address . . �P.? � �. . . . . . . . . . . . . ��.
L,OCAT[QN OF' �UILD6�1�
No. �. ��?�.�. . Street . �?*�;��vL� . . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . - . .
. ���. .�.... � �
Lot . . . . ,/. '��. . . . Block . . . . . . . . . . . . . . Addition or Sub-Division . . . . . . . . . . . ,
� .��. .�', p �
Coraer Lot ......... ... Inside Lot ... �.... 5etback ..��. �... Sideyard� �G�� % � ��
DE�RIP'Y'IOi\fl O1F' �LdiP DI6�G
To be Used as: � _/
,�L'NGI� . Frottt �� . . Depth �: � . Height �!�' `/� Sq. Fi. � �. � � Cu. Ft. . . . . . . . .
.�.
. :f.'� Front /. .� r. . Depth °� .��. Height . . . . Sq. F'tR/`�� `Y G�. Ft. . . . . . .
e of Conshvction . . . . . . . . . . . . . . . . . . . Es� C . . �� �. .7�. . . . . . . . To be Completed . . !: . . . . . . . . . . . . .
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In cousfderation of Yhe issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance wif.h all provisions of
ordinances of the city of Fridiey. p
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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 worlunen, 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, consfruction, alteration, maintenance, repair and moving of buildings wi�h-
in the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordi.nances. _ ,�
�
NOTICE:
�►���s� � c,��� . . . - .
This permit does not cover the construcstlon, Installation or alte�ation fo� wlring, plumbing, gas heating,
sewer o� water. Be sure to sea the Bullding Inspector for separate permlts fo� thesa itema
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City of Fradley, Minn..
BUILDING PERMIT
nat�: � 2S, 1Rb5
owner: 3�at�l.e� �laer �� �and Builder � s
Addne�a 6589 Clover P].a�e A�
/����.����
N� '7529
LOCATION OF BUILDING
No. 6589 s�t q.c>ver Place Part of Lot
� 19 �� Adaitton or Sub-Div3sian elo�e�' Lee.f Add.
Coraer Lot In�iide Lot
�wer IIevabian
Setback Sideyard
Foimdation IIevation
DESCRIPTION OF BUILDING
To be Used es:
�nnt Depth Height Sq. Ft
Front Depth I%ight Sq. Ft
Type of Construcl3on F�t, Cost �'? ��� � To be Completed
Qu. Ft
� F'�
Stot�.Damage 8epair Completely xebui.ld
ths proposed work in accordance wi�th the d�scripbton ab ve set fo �and 9n cgbmpliance with afl pro�vIaions of
ordinances oP the dty oP Fridley.
�
In ca�nafderation of the payment oP a fee oP lg 0.00 ,�t �s here� grantea to �IId Builderrs� �
to construct the building or addit3on as descsibed above. This permit is granted upon
the �express crondition that the person to whom it is granted and his agente, employees and worl�en, in all work
done in, around and upon said building, or anypart thereoY, ahall oonform 9n all respects to the ordinauc� of
FridleY� Minnesota regarding location, conatntcl3on, alteration, maintenance, repair and moving of buil�
ordinanc.��. dLy ]imiffi aad this permit may be revoked at ar�y time upon violation of any oE the P�viaiana of sat�d
Bufldfng Inapector
NOTIC�
1bb peredt dea eot eonsr t6s coeatrueNoe, ImtaQatlee he vrteUeg, plumbieg, ea h�atie�, ssw�r er water. B� sas to iss
Na Bufidlug I�etor ior aparat� p�6s tor thw k�s.
A
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APP'LICATION FOR BUILDING PERMIT
CITY OF FRID`LEY, MII4NESOT'A
OWNER' S NAME . �*-'�- � `BIIILDER � ° ""� �"�"`" �'°
�
annx�ss_- C��" ��' ��s-.�--- ��-�� �nn�ss
LOCATION�OF BUILDING
No. St�eet � Part of LoC
��_
LOT �.� . ,BLOC.ff ADDITION OR SUBDp�I5I0N G�i� t�„ �.r � ,� • ,� � ,/�,
Corner Lot_Inside LOT�Setback ' Side-Ya'rd
SEWER,�LEVATION FOUNDA3'IOA ELEVAZ"tON
r. • � . . .
App].icant attach to this .form Two Certificates of"Survey o£ Lot and proposed
building iocation drawn on these Certificates.
• DESCRIPTION dR BOILDING�
�o be .used as : � � �
Front Dept �Height
Sq. Ft. Cu. Ft.
Front Dept �_$eight
� �5q. Ft� Cu. Ft. �
Type of �au�truction Estimated Cos �/�, o�� G��F—'_
To be completed
The undersigned hereby:malces application for a permft for the work herein specified,
agreeing to do all work in strict.accordaace with•the City of Fridley Ordin�nces
and rulings a� the Department of.Buildinga, end kereby declar•es that a11 the facta
and representations stated in thie application are true and correc�.
DATE ���,-1 / /.�" STGNATIIRE �� � ��, ' �
(Schedule of Fee Costs can be•€�und on the Reverse Side).
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BUILDING PERMIT FEE SCHEDULE
SE� ON 2. The Inspector of Buildings ahall� before issuia� aay germit for the
erection of anq buildin$ or structure, or for any addition to any existing build-
ing or- atructure, or for any alterationa or repa3re to any esistiag building or
structure, upon applic�tion therefore, require the paymeat by the applicant far
such permit of fees to the amount herein below eet forth and in the manner herei.n
provided to-wit;
2.1. For any such permit for the erection of any fire-groof buflding,
other than a garage, warehouse, factory or grain elevator, or for the erection
of any fire-proof addit3on, for aimilar occupancy, to any existing building,
shall be at the rate of $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2; 2. For any euch permit for the erection of any fire-proof garage,
Warehouse, faciory or grain elevator, or for the erection of any fire-proof
addition, for similar occupancy, to aay existing buildiag shail be at the rate
of $1.25 for each one thousaad cubic feet, classified as "fireproof" by
Section 502 of the Minneapolia Building Code.
flOIISES
2.3. For any such permit for the erection of any non•fireproof building,
other tbaa s garage, warehouee, factory or grain elevator, or any non-fireprcio�
addition, for aimilar occupancy, to any exiating building • permiC $l.DO for each
one thousand cubic feet•
G�
2` For any► such permit for the erection of anq non-fireproof garage,
warehouse, f�ctory or grain elevator, or for the ereceion of any non-fireproof
addition, for similar occupancq, to any existing building or for each such
buildia� or addition - ninety ceats ($0.90) for each one thousand cubic feet
or fraction theaeof, in the cubical conteats theseof with the minimum of $4.00.
Fos the purpose of computing fees for building permits, the cubical contenCs
of any building or additiou to a uniform height throughout by multiplying the
gsaund area covered from a poiat six (6) inchea below the floor line of the
basemeat or cellar to the average height of the upper surface or to the average
height of th� roaf surface of tbe maiu gable of a pitched roof.
2_,.5; For repaire or alterations to an existing structure, the fee shali
be at the rate of $3.00 per each Five Hundred Do118rs ($500.00) or fract3on
thereof in the coet of all propo9ed work.
2,`.6. In ao case shall
Section 2 be less than $4,00.
the fee charged for any permit as set forth in
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� SUBJECT PE R M1T �di3�- � �
City of Fridley o 19815 :�
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T
r
� � RECEIPT NO: `
� ; ��_�_� COMMUNITY DEVELOPMENT DIV. , R'
r � � PROTECTIVE INSPECTION SEC. / p3 a
� _ , O
`.-_•� �°'1,� CITY HALL FRIDLE� 55432 NUMBER HEV. DATE PAGE OF APP.ROVED BY
L � � � 612-571-3450 910-F15 4/3/89 / /
JOB ADDRESS 6589 Clover Place N. E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 19 C�.OyP.Y' Lead Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Charles Prawalsky 6589 Clover Place N.E. 571-5191
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDINO
Residential
7 CLASS OF WORK C$ REPAIR ❑ MOVE ❑ REMOVE
❑ NEW � ADDITION � ALTERATION
B DESCRIBE WORK
Rer�f Dwelling (20 Squa.res�
9 CHANGEQFUSEFROM TO
STIPULATIONS Roo� can be the 2nd layer but not the 3rd. Install ridged galvanized
valleys.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINO, �PE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PEHIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. • NO. DWLG. UNITS OfFSTREET PApKING
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
WITH WHETHEFi SPECIFIED HEREIN OFi NOT. THE GRANTING OF A PERMIT $l� OOO $. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHAqGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION $ZS.00
LAN CHECK FEE TOTAL FEE
$25.50
SIGNATUREOFCONiRACTORORAUTMOfiIZEDAQENT IDATEI WHEN PROPERL V LIDATED THIS IS YOUR PERMIT
SiGNATURE OF OWNEFiIF OWNER BUILDER� IDATEi LDG �NSP �
�jA T
� [ ] Effective 5/1/88
� [ ] R-1 AND R-2
�� [ ] Buildit�g P+eYmit Ap�lication
Construction Address:
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Addres.s:
Attach to this application, a Certificate of Survey of the
lot, with the propo�-.,ed construction drawn on it to scale.
.;;�_ «- .; .�- � �• -.. � � ��+
LIVIIJG AREA: Ierigth Width Height Sq. Ft.
Q,R�GE AREA: Iength Width Heic�t Sq. Ft.
DECR AREA: Lengtti Width Iigt/Ground Sq. Ft.
o�: o► e c.ce � oc��- � ��,�e S
Corner 7�t [] Inside Iot [] Ft. Yd Setback Side Yard Setbacks
Z'yp� of Construction: ��� �t; $ ���
Approx. Campletion Date:
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
Wi + 6' See Back Page
�: �f�-3�-$� ��: ` ��. # s�� s7�/
P�exmit Fee $ � �, (�
State Surcharge $ ,��
SAC Charge $
Driveway Escraw $
Park Fee $
Se�aer Main criarge $
. �.
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s �5.��1
QTY L�E �II,Y
Fee Schedule on Revexr..,e Side
S.SO/Sl,000 valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Abave
Fee Determined bY �4��9
Agre�rent Necessaty [ ] Not Necessary [ ]
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The Chief Building Official sd�all, before i�s�m �*�its for the erection of ar�y
building or structure, or for any addition to ar►y existing building or structure, or
for ariy alteration or repair to ariy existirig building or structure, upon application
therefore, require the payment by the applicant for such permit of fe�s to the amount
herein belaw set forth and in the mar�*+pr hexein provided to-wit:
Z�0►I'AL 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
�+�.
$15 (Miniiman Fee is $15 plus surcharge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$45 for fixst $2,000 plus $9 for each additional $1,000
or fraction thereof, to ar�d including $25, 000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to and including $50,000
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, to and including $100,000
$639.50 for fizst $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thexe�f, to and includirig $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
�tIV�[ DE�SI�T F5C[�W
(C.oncrete Curb Streets OnlY)
Alternate "A": Removal and repla�nt of curb and gutter only - Driv�way width plus
6 feet times $13.50.
Alternate "B": Removal and replaoe�nent of curb and gutter arid in.stall a 3 foot wide
approach with 6 irich depth - Driveway width plus 6 feet times $15.75.
� �,• .- �� .; . ° �.�u ,. � .
Permits for oonstruction will be issued a m�n;m►�►,� of 24 hours from the time of
application to allow for prc�per review of the proposed structure and of the
c:onstruction site.
A C�rtificate of Survey of the lot, st�wirig the location of the foiu�clation orxre it has
it has bee.n construct:ed will be required before proc�eding with the framing.
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CH�Mr�Er AN� STACK VERIFICATION
The undersigned hereby verifies that the e�cisting chimney or stack;
1. Has been carefully examined Yes (, No ()
2. Is free from rust or deterioration Yes (� ()
3. Has no foreign objects lodged within Yes ( o()
4. Is securely supported Yes ( No ()
5. Meets all current Code requirements for size and
total BTU connected__ Yes ( �o ( )
6. Has Total heating BTU's of
All other BTU's
TOTAL
Rema rk s
�� � � �
,/� ��1
��? , ,/'✓'
na te /�� /, r°%/ .
};
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d� .
HEAT LOSS CAL�CUL�ITIONS DEPARTMENT OF INSPECTION NDMVFApp1d.S. MlI�pV. �. --
Weathentrips A ' I Coastruction No. InnJation
Guide �
Windo D Reference Out. W�ll Int. Wall Ceiliog Roof Floor Kind How Applied
e o es 19.� I .
Room Leoath Width Hei�ht Fl.� Room Lenge6 Widt6 ' t
Windowa and Doon—�Crackage and Ana Windowi aad Doon--Crackage and Arca
�viain H•�se� o. et tae.ai n. wr.. wiaie a•isei t�a et taaw n. a�..
No. er oane et oan� Il��u et enck p. tL Na et oae� M oae� llrAl� W cract p. t4 � o
� �
� �
// 9' Coef. Bcu ' Coef. : &u
1o61tration , In6ltration •
Glas� Glau
Esp. wall , Esp. wall
Net e:p, wall Net esp. wall
lot. wall • Int waU �
Ceiling Ceilrng .
Floor F1oor
Total Btu. T _, Total Btu.
ReQuired �q. ft. E.D.R. or sq. ioi. WA. I.eader area R�a�d w. h. ED.R. or
sq. in�. R►A Lesder area
Fl.� Room LeaQt6 Widch Height . Fl.I Room 1 Lengeh WidtL . Hei�1d
'Wiadowa and Doon--trackage and Area atindews and poon—Crukage and Area
wia�e Ha1sAt xo. ot L�n..� n. wna w�ace a.isee Ho. et �.+n.■� n. w...
Ne. et an• ot p�n� tt��t� oL enek �p. t4 No. ot �n� ef i�a� Ilshb et cneY �p. h.
a p
y l� � 5 ? �o
� �y y � �� ��
In6ltratioa
Glaa
Fsp. wall
Net e:p. wall
lnt. wall
Ceiling
Floor
Total Btu.
Required sy. ft. ED.R or �q. in�. WA L.eader arce
Fl•I Room � Lengd� Widtl:
, Wiadow� and Doori—Crackage and Area
��t
.. �qp�:��:IOD
���f
fsp. wall
Net esp. waU
Int..� ��
Ceiling
Floor /d�t .3
Total Btu.
Required p. ft. ED.R or �q, iaa. WA. Leader uea
�I
In6ltration
Gla�e
Esp. wall
Net e:p. wal)
lat. wall
I Ceiling
�ar
Total Btu.
Rcquired �q. k. EDR or sq. ins. WA Leader area
FI. Room I Lea�th Widtl►
Wiadowi and Doon�--Cneka�e and Area
�viaie •�iee Na �t tan.a� e� �r..
1io. e! pe� �! Oan� U�eu ef enek �p. tt
�
�i:�il0�
GI W
Eap. wall �
Net e:p. wall
In� �rall
Ceiling
Floor
Total &u.
or p. im. Q/A l.eader uea
p[Y `
HO EATING TEST RECORD
� �'j ✓.S''��� C;� 2 �,�� � c
/►.�D(2ES�� �' � APT. FL CITY SUBURB � �c �
OCCUPANT OWNER ��%�'�-��Sf
HEAT LO55 D TE HTG. INST. �
SQLD BY ��� � �� INSTALLED BY �
Electrical Wor By �� � Gas Line By ----'�����1<r�S` ��/���
TYPE OF HEAT GA FA �HW STEAM SPACE HTR. UNiT HTR. � OTHER
�C „, �GAS DESIGN CONVERSION �
��E � �� ��A MAKE OF BURNER
Model � � rs ��Q �� Model ^ e
Serial ��������� Max. BTU Rating � -
INPUT ,,��� MAKE OF FURNACE
Model ° _ _ __
%j,� CONTROLS � �' ��a�'��� �
THERMOS AT -°�° C Heat Plug Vent Size
Valve ��� KIND `OF LINER SIZE y% NONE
Limit � Draft Hood �� egularor �
G /
Limit Setting �� ��� Filters Size umber �
Fan Setting Chimney Loeation insi Outside
Pilot TYPe ��� � Chimney Construction ��G!��� i"'�e .S°
Pilot Make ��� �����r'
Pilot Model ����� � Smoke Bomb `�� Wiring � �+
Pilot Timing � ��� Draft Tost Tea )
L.W. Cut Off or Pressure �� Ligh?ing inst.
Pressure � � �� Pereent COZ % �' ,pote Test�d �( `
InpuY CFH Pereent Q2 os o�Company Testing l�O�
Siaek Temp. Pereent CO �� Name of Tester
Form 235
sue�ecT PERMI
c�ty of Fridley � 4 � ��,,
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEI T NO.
� • COMMUNITY DEVE�OPMENT DIV.
� j V �'���',
r � � PROTECTIVE INSPECTION SEC.
i . �
� , /"'1 � CITY HALL FRIDLEr SS432 NUMBER REV DATE PAGE OF APPROVED BV
�""�' �'' 612-571-3450 910-F15 4/15/97 / /
JOB ADDRESS 6589 Clover Place NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 19 Clover Leaf Addition SHEET
2 PHOPEF;TY OWNER MAIL ADDRESS IIP PHONE
Patrick Zebro 6589 Clover Place NE 572-1217
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAtL ADDRESS ZIP pHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION �❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOHK
Reside House & Gara e Vin 1
9 CHANGE OF USE FROM TO
STIPULATIONS
Install building wrap and have inspection of same unless
manufacturer's specifications state it is not required.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCYLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTIIATING OR AIR CONDITIONING.
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOH A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOqK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STAILS 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � 1 s 4'OO �.%O
DOES NOT PFiESUME TO GIVE AUTHORITV 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 �4'.�7. 75 Fire S�.' � 1.4�
PLAN CHECKFEE TOTALFEE
$47.85
SIG TU EOFC J'AA RORAUTHORI � DAGENT IDATEI HE Pli LV V I TED THIS IS V PERMIT
� ti�� �
S�GNATURE OF OWNEFl iiF OW UILD Ri IDATEI � LDG iN �1tiTE
NEW
ADDN
ALTER
Ll
[]
�l
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BIJILDING PERMIT APPLICATION
Effective 1/1/97
� �
ConstructionAddress: �s� % (,LD t��l� /��4C� FlQI �� y s.sy��
Legai Description: .� 0 7� / i C� o v� � /_ �� F��d, ' f��a �
Owner Name & Address: �d�-T� 1� l� ����� D � 5�9- vt� �: Tel. #� T�- /.� J%
Contractor: . �'�� �' NIN LICENSE #
Address:
LIVING AREA:
Attach to this applica.tion, a Certificate of S�rvey of the
lot, witli the propos� construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length Width
GARAGE AREA: Length
Width
Tel. #
Height Sq. Ft.
Height Sq. Ft.
DECB AR�A: Length Width Hgt/Ground Sq. Ft.
OTHER: _�� S� �D� /�0 vst d- � s9.P�4 � E—
Y.�;� ���. S>�� 1�/'G
Construction Type: � F'stima+P.� Cost: $ ��/Q D°D
(Fee Schedule on Back)
Driveway Curb Cut Width Neede�i: Ft�. + 6 Ft �_. Ft g$ �_$
DATE: -/✓� - � 7 APPLICANT: , Tel. #
CITY USE ONLY
Permit Fee $ L- S•'�S� Fee �chedule on Reverse Side
Fire Surcharge $ �.�� d,QOl of Permit Valuation (1/lOth%)
State Surcharge $ . J� U$.50/$1,000 Valua.tion
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$
$
$950 �r SAC Unit
$5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
�
,�
� �1-�S�
Fee Determined by Engineering
Agreement Necessary [ ] Not Ne�essary [ ]
,_ -
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or sttucture, 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, re�uire the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
.
' TOTAL VALUE ;' . - FEES . : . .
$1 to $SQO �" � $21 (Minimum Fee is $21 plus surcharge)
$501 to $2,000 $21 for first $S(� plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$5�,001 to $1,000,000
$1,000,001 and up
$62.25 for fust $2,� plus $12.50 for e�ach additional$1,000
or fraction thereof, to and including $25,OD0
$349.75 for first $25,000 plus_ $9.� for each additional $1,000
or fiaction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for ea.ch addi6onal
$1,� or fraction thereof, to and including $1p0;�00
$887.25;for fust $100,000 pius $5.00 for each additional
$l,� or. fraction thereof,..to and includmg.$500,000 .; ,;,
, ,;�;�� ��.���� .
. -�
�-$2887.25 for the first $SOO,OQO plus $4.25 for each additional ....
__.. ..� �$1;OQ0 or` fraction: thereof; to and inciud�ng ,$1�,000;000 � s ,
� .�,,
�$5012.25 for the first $1,000,�0 plus $2:75 for each. additional
$1,000 or fraction thereof --
DRIVEWAY DEPRESSION ESCROW "
(Concrete (�rb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway- width plus 6 feet times $13.50.
Altemate "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 wiil be issued a minimum. of 24. hours from the time of application to allow for proper
review of the proposed structure and of the construcfion site. - �
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
wi(1 be required before proceeding with the framing.
SUBJECT
City of Fridley 2 6 2 3.8
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r
; � T NO.
� ' COMMUNITY OEVELOPMENT DIV.�
� j y �����'�
r � � PROTECTIVE INSPECTION SEC. � �� �)
1 . �
( � /�"\ � CITY HALL FRIDLEV $S4$Y NUMBER. REV DATE PAGE OF APVROVED BY
�'""'� � �'' 612-571-3460 910-F15 6/15/98 / /
J08 ADDRESS 6589 Clover Place NE
1 LEGAL LOT NO. BLOCK TRACT OFi ADDITION SEE ATTACMED
DESCR. ].9 Clover Leaf Addition SNEET
2 PROPERTY OWNER MAIL ADORESS 21P PMONE
Pat Zebro 6589 Clover Place NE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Halek Roofing 6258 Eagle Lake Dr, Maple Grove MN 55369 535-8835 5010
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL AODRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION �7 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOFK
Reroof House & Garage (28 Sq) Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SO. FT, CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OFi WORK IS SUSPENDED OR ABANDONEO 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 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �2s335 �1. I.]
DOES NOT PR ME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHAIiGE
PROVISION OF NY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTI OR T E PER fiMANCE OF CONSTRUCTION. �7�F.7.5 Fire S�'i �2.33
PLAN CHECK FEE TO L FEE
Licens $5. $83.25
GNATU E F CON � RACTOp OR AUTMORIZEO AGENT IDATE�
EN FOP VALIDAT TNIS IS Yf,U��
� 6� �
SiGNATUREOFpVyNEpUFOWNERBUILDEii� �DATEi 4 iNSO ��dTE
NEW
ADDN
ALTER
[l
[l
[l
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII,DING PERNIIT APPLICATION
ConstructionAddress: � 5 g 9 C� c� c��l' �� �, � j�3�E
Legal Description:
Effective 1/1/98
�F � �.a,�
�
Owner Name & Address: 'Piq-�' 2c6�'o Tel. #
Contractor: �j w l E �C �oo ��'� � MN LICENSE # S° I o
Address : �o'Z S tf �1�2. C�_ j�, � Tel .# 5� S-- &� 3 S
_
Attach to tlus application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. �
LIVING AREA:
GARAGE AREA:
DECK AREA:
01'HER:
DESCRIPTION OF IlVIPROVEMENT
Length Width Height
Length Width � Height
n Wid Hgt/Ground
� � �a � ��
Sq. Ft.
Sq. Ft.
� Sq. Ft.
� �U�
Construction Type:��u Estunated Cost: $ s`�v�� �-3� �
(Fee Schedule on Back)
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: - �r' � S'' �T p
Perimit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
S'TIPULATIONS:
$ �� ��_
$ �� 3
$ 1. /�
$
$ �� � z�
$
$
$
$
� �3 . ���
Tel. # e7 �.5'- ��'�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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 atiy 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 $5�
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$1(�,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 pius $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 $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Pemuts 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.
�. _