AF - 37962��
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City of Fridley, Minn.
BUILDING PERNIIT
DB�; A,.pril 30� 1968
� �
�To �'702
�����
p��.; Robert C. 6�Thite g�� Clemron.� Inc .
�,d�r�s p,d� 701 Columbia Blvd .
LOCATION OF BUILDING
No. 73� Street Concerto Curve ,�,.. p� of Lot
Lot ._._3 _ Block 3 Addition or Sub-Division _._.._..�.Melody Maaor �rd
Corner Lot _ Inside Lot X Setback 35 �__._ Sideyard 10 �& 5�
Sewer IIevatfon —.._�.. $69.90 ^ 872.90
Top of Footing
To be Used as:
Dwelling �t 25'
DESCRIPTION OF BUILDING
Depth �' � Height _ 20 � �. � 1396 � � 27, 920
�a��� � Front 20' Depti� 21' �Teight 10 Sq. Ft, 420 ��•t, 4200
Type of Construction Frame ��, ���25�660 ___ To be Completed 6 Months
SEWER LOCATION - 31' North of Manhole
TaATER LOC�TIOft - 47' North of Manhole
In consideration oP the issuance to me of a permit to cons
the proposed work in acc�rdance with the descriptton above ��
ordinances of the dty of Fridley.
�i``
� building descrlbed a i�� to do
and in co� nrovlsiona oP
In considerat4on oP the payment oP a fee of $ 48 . 00 , permit fs hereby grauted to Clemron, In.c .
to construct the buflding or addition as described above. Thispe rmit ia granted upon
the expr�s condition that the peraon to whom it fs granted and his agente, employees and worl�en, in all work
dane in, around and u�n said building, or any �art thereof, shall conform in all reapecta to the orainaac� oE
Fridley, Minnesota regardi�g location, construchon, alteration, maintenance, repair and movin� oP bufldin�s
wlthin the dty limits and thia permit may be revol�ed at any time upon violal3on of any o the provis�lona of said
ordinancea. '
,
Jan Gasterland, Building Official
NOTIC�
'�s psrmit dea no� eevar ths wamodioe, ie�aQaNen te� whWe, plumbin8, ea 6eaNng, sewer er �rmr. B� ame fe se�
f6e Butldia8 lesp�etor for aparats p�rmNs Mr 1h� Nfnn.
APPLICAI'IOR FOR BtT�DING PERMIT
CITX OF
OWNER' S
, M�NATESOTA
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N0. �.��� . STREET . � �` PART OF LOT
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LOT �� � BLOCR ��� ADDITION OR StIBDIVISION, ��GQ���,���
J
CORNER LOT .INSIDE LOT SETBACR SI�E-Y S G'� �/la �.
SEWER ELEVATION ,�Io � ' FOUNDATION ELEtI'ATION p_��
���r ���� � �'� `
Applicant attac t t s rm Two CeYtificates'of Surveq of Lot and p�'opo�ed
buflding location drawn on theae Certi icatee.
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DESCRIPTIOA OF BUII.DIIQG
To ed as: �
/
Front °'�� ,� � Depth_�i,��'�fleight , �
Sq. Ft. � :�; , Cu. Ft. � 0 2"� �-�`„
/, ,L�� . � f �� ^
. V�'�% i i . '
Froat , ,�� ,_ Depth�/� Height �-1
Type of Conatruction
To be completed
�S�. Ft. � ���l� � Cu. �Ft. � �� ,.�_3,,,.�� �-� .
�� . _. � ,
%/��.�'/l��/; , Estimated Coat a?,5���� } �� _
��_'_
The undersigned hereliy makes application for a permit for tihe work herein"
specified, agreeing to do all work�in�strict accordance,with the Citq of
Fridley prdinances and,ruZiags�o� the Departmant of Buildiags, sud hereby
declares that all the facts and representations stated in t�iis application
are true and correct. �� //�,
(Schedule of Fes Coste caa be found on the Reverse Side).
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BIIILDING PERMIT FEE SCxEDULE
SECTION 2. The Inspector of Buildings shall, before isauing any permit for
the erection of any building or structure, or for any. addition to an.y existing
building or �tructure, or for any alterationa or repairs to any exiseing
building or sCructure, upon application therefore, require the paymeat by the
applicant for such permit of fees.to the amount herein below set £orth and in
the manner herein provided to-wit;
2�.1,._ For any such permit for the erection of any fire-proof building,
othei than s gar�ge, warehouse, factory or grain.elevator, or for the erection
of any fire-proof addition, for similar occupancy, to any exiating buildin�,
shall be at the rate of $1.40 for each oae thousand cubic feet,-or fraction
thereof, in such cubical conteats.
2.2 For any such permit for the erection of any fire-proof �arage,
warehouse, factory or grain elevator, or for the erection of aay fire»proof
additfon, for similar occu�ancy, to any existing building shall be at the
rate of $1.25 for �ach one thousand cubic €eet, classified as "fireproof"
by Sectioa 502 of- the Minneapolis Buildiag Code.
flOIISES
2.3. For any such permit for the erection of any aon-fireproof
building, other than a garage, warehouse, factoxy or �rain elevator, or
any non-fireproof addition, for �imilar occupancy, to any existing�building �
permit $1.00 for each one thousand cubic feet.
GARAGES
2;4. For any such permit for the erection of aaq non•fireproof garage,
warehouse, factory or grain elevator, or for the erection of any non-fire-proof
addition; for similar occupancq, to any e$isting building or for each such
building or addition - n�nety cents ($0.90) for each one thous.and cubic feet
or fraction thereof, in the cubical contents thereof with the minimum of $4.00.
For the purpose of computing fees for building pexmita, the cubical contenta
of any buildiag or addition to a uniform height throughout by multiplying the
ground area covered from a point six (6) inches balow,the.floor line of the
basement or cellar to the average he�ght of the upper aurface or to the average
height of the roof surface of the main gable of a pitched roof.
2.5. For repairs or altexations to an existing atructure, Che fee s?�P11.
be at the rate of $3.00 per each Five Hundred Dollara ($500.00) or fractivn
thereof in the cost of all pxopoaed work.
2.6. . In no case shall the fee charged for any permit as set forth in
Sectioa 2 be less than $4.00.
STORM REPAIR DANIAGE FEES:
Residential;
Commercial;
Estimated Cost of work up to $500.�J� - S5e!?0
Estimated Cost of work over $5�:::.+:'� ��;;:;,., ��fl
Estimate�`'�ost of wo�k L�- s: _ ' `; _, , ;.•` •� ' .�'"�'�
Y �
Es�imatea-_.:ost �f WOZa:'ii-,�i�.:ci Y?i;s,�oUL° — 4:::�..•_�t7
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EN G I NEE R I N G, I N C. ��'�nx�'°
�Unscf �l-h0(oe
— En ineers � Surveyors ---
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ces�ti,�iczte o�
Su,z•oe Fo�' - E� M DEYELOPI�iF.�IT CO
� NOTE�- �
1. Eleva�ions 56own ar¢ P�epo�¢.d �
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„` Q. Fi�s+ �1eor sl. 2.9 i�. a6eva c�r�uetd
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EMEIJT
o �ENoTE.S IRON DENOTES DRAir11'►�E � UTILITY EAS
LOT � BL�OCK 3� MELODY MAI�10R 2'�D ADDITI4N
��noka Coun� — Mie1n¢�o-,-w�
/ hrrrby urfi�'y � lhis is o frue mjd oarrtcf rrp�resenfaflon o�'a survet, �'1lee darn►eariies �'�r aibe�e oFsrr:bsd la�d ��
o�'�k /cco�iOii a�'al/ bwldrrr9s ,�eain , ad d/ ris�fiJi o�mo�rfs , r!'ay ,%n ar in �sid /mad. As surveyed 6r� mr f�s
�� Av r i I A.O h�. SUB URBAN ENG/N�ERJNG , INC.
L-n�n s �fr Sur're rs
SCALE. I"= 30' � � �i'� t�--` ��`'.�z1r_
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HOUSE HEATING TEST RECORD
ADDR ESS � � �� `� -�� �
-� �—�'►-' APT. F 0 R CI� �UBUR �
OCCUPANT OWNER �-- �, v
HEAT LOSS DATE HTG. INST. ^AS C0. METER BADG
SOLD BY INSTALLED BY --� `� - �
Eleetrica) Work By Gaa Lins By
TYPE OF HEAT GA FA � STEAM SPACE HTR. UNIT HTR. OTHER
GA ES�f N �. CONVERSION
MAKE ��G�-�+���► -�° ��` A'' MAKE OF BURNER
Model Model
Seria l — � �/�� � '� .�-�. � Max. BTU Rating
INPUT ��t�Z'�I MAKE OF FURNACE
Model
CONTROLS ��
THERMOSTAT e�°,t Plug Vent Size
Valve � �" KIND OF �lNER_ _ �' � J NnuF
�—.._.._
Limit � Draft Hood •!'l��•� Regularor
Limit Sstting -�'� Filters Size Numbsr
Fan Setting `-a��� -�`+' Chfmney Loeation Inside �� Outaide
Pilot Ty� Chimney Conatruetion
Pilot Make ��
Pilot Model Smoke Bomb Wiring
rilot Timing �ti'°�� Draft ��— Teat Tag ��
L.W. Cut Off Do r Preasure Lighting InsL �
� � r-- � � �-S� �� � �- �
Proasuro / Pe�rce�nt C�O Date Tssted
Input CFH ,/�-� PeiE6n`i' -O"`- �'�� ���$ompany Testing 4
2
Stack Temp. -� Pereent CO �¢-�' Name of Tsstar
Form 235
SUBJECT IT N O.
City of Fridley 12610
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
; � RECEIPT NO.
� `y __.__ COMMUNITY DEVELOPMENT DIV. �1���
r � � PROTECTIVE INSPECTION SEC. �
I . �
� � /"'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�----� � �'� si2-5so-aa5o 910-F15 / /
6 27 74
JOB ADDRESS
%3$ CO C O
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 � SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
C
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO.
8 USE OF BUILDING Residential
7 CLASS OF WORK � NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK �onstruct a 16' x 34' Pool
9 CHANGE OF USE FROM TO
STIPULATIONS
See letter dated June 25, 1974 signed by Environmental Officer
.;o.,
:�
SEPERAT� PER�AITS REQ�JtREp FOR WIRtNG,
F��ATING, PLUNlBtlVG AND StGNS.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATINO,
VENTILATING OR AIR CONDITIONINO. Stee�'
THIS PERMIT BECOMES NULL AND VOID IF WOFiK 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 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.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTIN(3 OF A PERMIT 3 OOO �. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL_,LAW REGULATING CON-
STRUCTION �?ERF �CE OF �fiUCTION. � $�.8. OO
L���'" i"�� �--� �" PLAN CHECK FEE TOTAL FEE
�C $19.50 „
SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT IDATEI WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
. e��� �'��.1�J a ! w.
SIGPiATURE OF OWNER IIF OWNER BUILDERI IDATEI BLDG INSP DAT
560-345Q
�L � O ��'� ���
� �
ANOKA COUNTY
6431 UNIVERSITY AYENUE NE June 25, 1974 FRIDLEY, MINNESOTA 55421
Mr. Mike Shepherd
Aqualand Pool Company
34Q0 Dakota Avenue South
St. Louis Park, Minn. 55416
Re: Swimming Pool at 7380 Concerto Curve
Dear Mr. Shepherd:
This letter is to reiterate our phone conversation of June 25, 1974 and
to make clea� this departments requirements for the swimming pool construction
at the above address: �
1. As discussed, two (2) skimmers approved by the National Sanitation
Foundation will be provided.
2. As discussed, three (3) inlets of approved design for fresh and/or
repurified water will be provided,
3. As discussed, a main drain of approved construction.will be provided.
4e The filter and pump should be approved by the N.S.F. anc� be of
sufficient capacity to provide a minimum �turnover of at least four (4)
times in 24 hours.
5. A deck, a minimum of 3 feet wide and sloped away from the pool, must
be provided around the en�ire perimeter of the pool.
6. The diving area will be acceptable provided there is no overhead
obstruction.
7. A fence or other suitable barrier, a minimum of four (4) feet high,
that affords no external hand or foot holds and which is impenetrable
by toddlers, must be provided around the entire perimeter of the pool;
All gates and other accesses shall be equipped with self-closing and
Iatching devices which are capable of being locked.
8. An automatic chlorinator should be provided with a suitable test kit.
9e All electrical and plumbing installations shall be inspected and
approved by the City Inspection Department. .
10. Al1 electrical lines must be 1.0 - 2Q feet or more away from the pool
surface.
11. The pool fill spout must be air gapped or protected by a vacumn
breaker.
t
w
0
Mr. Mike Shepherd
7380 Concerto Curve
Qage 2
12. Suitable safety equipment to include but not limited to a ring buoy
and rope that is l� times the pool diameter, shepards crook pole,
must be provided and maintained with the �ool at all times.
Furthermore, these and any other requirements must meet the provisions of
the Fridley City Code, Section 115, Swimming Pools. The building permit is
approved contingent on final inspections and approval by the City.
If any questions or problems arise from this letter, please feel free to
contact me at 560-3450, ext. 41.
Sincerely,
STEVEN"J. O SON
Environmen 1 O ficer
SJO/mh
CC: Mr. Robert C. White
7380 Concerto Curve N.E.
Fridley, Minnesota 55432
�
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AP,pLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER ` S NAME : � 0 ��� � C���"� BUILDER : � _ .
W� � f�
ADDRESS : '7 3 �C� C�e- ADDRESS :� �Y(�� � �:.��c.� `�, �
NO • ./ ,3 � S TREET • � C� � .
LOT• 3 BLOCK• � ADDTTION: V"l�-�'��
CORNER I.OT: INSIDE LOT:_ ?�. __SETBACK: 3 S� SIDEYARD; .%� �� S.�
Applicant attach to this form �.Yao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As : �" � ` � /� � 3 �,
Front: Depth: Height:
Squaxe Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Eeet:
Type of Construction: s'�ee � Estimated Cost: $�� 0�(7, CT�
To Be Completed:
The undexsigned hereby ma.kes applicativn for a permit fc�r the work herein
specified, agxeeing to do all work in stsict accordance �ith the City of
Fridley Ordinances and ru.lings of the Department of Buildings, and hereby
declares that all the facts and representations stated i.n this application
are true aiid correct. .
DATE:
� — a `7 --- / / SIGNATURE - �j ����� �
�(See Revexse Side For Additional Tnformat n.)
�
-��— `' G- `� � / � 1�����_.�- �._ .�-
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'BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing perm3.ts for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration o� repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in
the manner herein provided to-wit:
UNCFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or ad�.ition, is determined by multiplying the ground area
cover.ed from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper'surface or to the average�
height of the roof surface of the main gable of a pitched roof.
For repairs or alteraiions to an existing structure, the fee shall be at the
xate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOU�VDATION
NOTE: Permits for coizstruction will be issued a minimum of 24 hours from the
time of application, to allota for pxoper review of the proposed structure and
of the construction site. .
A Certified Survey of the lot, showing the location of the foundation, once it
has Ueen constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be ma.de ten (10) days pxiox
to the use or occupancy of any structure for which a building permit has been
issued; and said st1-uc�cure shall not be used or occup3.ed until a Certificate
of Occupa�cy has been issued.
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O D£NOTES IRoN TUE�3oTE5 DRAINAGE �- UTILITY EA5EM�NT
�.0°r' � �LO��. 3 I��.��Y � 0� 2�� �.��Ii'I���
_ �Anoksa Co�n�� -- Minn�ao-{-a�
/ btnlay ca�fi�'ef tha¢ ihis a a h-rxx �d mn�cf rrpresenfofran e�'o sc�-vec� �'fht �dor ies �'�+r eboly desrribed �, �
nf�/!x /ora�z�n a/'vl/ t�r'1�;n9s , tlxreoer�, m��l �,sib/e axrnahmrn/s , rl'�, �n a� �soid /and. As wrr�cJed �� h�'s _ abt�
,�(' A a r i 1 , A.D.19�. .
SU� flRBAN �l'+1G/I1IF�2/�1G , ll+lE. - _
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a _. � S C A L. E 1 " = 3 O' ` � ' ,l [.c_--aa � _ » ' .
, -t -w��
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p+ _v.cw
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m �rl�i/��
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h o w R o o m: T�le. �20-�244
DAKOTA AT WEST LA�E STREET °���1°��
�11NNEAPOLIS, MI��ESOTA 55416 ��'�'�vTE
Since 1961
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City
Phone
Su�i
EIQUIPN[ENT S�CIF°ICATIONS
DATE /9Ir/P/�C /.5f� '�
POOL DATA:
Pool Sis� 1� �X�'�f �,`S�C'i���l.dL Turnover Rate � Hour�
Surfa�@ Az�ea e5 °�/y sq• Ft• Fi.lt�r Rat@ �� GPM/sq• Ft.
Capacity /B.P�,��Gallons Rste of Flow G�� G�
Perimeter O[�C� Lia�. F't. 'i'�'Y�ae of Pool �PARp� �.�F'�. !�`�L b'yfu y�c.
PIPING DATA:
Smetioa l �'� ��l���`r �G�.C,�/ °�'i 1��� -
R�tur�s ° / ii ^g''- � ,e, �► G
1Kanif ol�l �✓.� �� .� -✓A.� WE' r�f��5 —
FILTER � -l��( � -/ , " ° G _r' P :A ° /ySf
PUMP dc MOTOR s� •COdtJ Q'' • C�' •` GvoTN / �L eFtkt TL�
�CIMMERS '� 1�'��lol�i�P. � .SO/GRd/ �G'�J�/�[' /�vo[�/�/�T/C
�y�g G° � t7�t ' DIR. FLOM FTGS. ��,-f��i�l-�/i'IiPG� C'Yl'�.C,9�
�+hKIN DRAIN ° �l/• REISFF YALYE -
CHIARINATOR ���-C� [� .91J�"v/yRT/G THERI�IOMET�R � - �,v9g TiC'_
)I5CHA�GP HOS$ . � �
FILL SPOiFr _ B�R -
POOL HEATER /,? SC�l� �-//� Ot?L� �Tr� /ll�i Cx.9S' �9i�� - � �i1`�?U�� -
e�IVIPTC BOARD �D �%�5.cs�� �1>` L)11>� �75�°3-�r� �-�-r S�r'7 ft
sLIDF � -� - -.. �a cY�'�'���c• %f'�i9.LZ5
LADDERS ,� �sA '� J'�'� Si"�P ,S��Ji/L°.�L�a.S'S �1',��.[,
GRAB RAIL AATCHOR CUPS
STEP5
POOL LIGHTS DECK BOX
VACUUM KIT � � L` i.,aJ,'� d5 "l� ,lf � �'�
I�AINTENANCE KIT / ' -.0 F _ ' � ` 7"'� ` � D �' "
1�AT8R TEST KIT '/��i' G°L � C! .�. SAF'ETY KIT /��"'I' �FCP% �F �`F�O.��
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LIECTRICAL ° ' �' y '�'� '
GAS LINE '�'' r - �- /2"/!�
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DATE:
From The Desk Of
RICHARD N. SOBIECH
RUBLIC WORKS DIRECTOR
SUBJEC7: ��a9e Pnob�2em a,t Cwcb Li.�.e
7380 Cance�ia C te.
, �. Wh.L�2, .-�;el`'-1 -- � � 5 � —
MEMORANDUM
M�M� �VZ 26
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,�Q�
sue�ecr PERMIT
City of Fridley 19 3 8 9
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
i � RECEIPT �10
� `L __�__ COMMUNI7Y DEVELOPMENT DIV. ��
r � � PROTECTIVE INSPECTION SEC.
i i �
, /"'1 � CITY HALL FRIDLE� $S4$2 NUMBER REV. DATE PAGE OP APPROVE� BY
�.__.Jl.' '•� 612-571-3450 910-F15 4/12/88 � �
JOB ADDRESS '7380 Concerto Curve N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 5 Melody Manor 3rd P,ddition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP pHONE
Robert White 7380 Concerto Curve N. E, 784-1355
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO.
Normandale Services Route #1, Isanti, MN 338--1511
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PFIONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE UCENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WOFiK
Reroof Dwelling
9 CHANGE OF USE FfiOM TO
STIPULATIONS Roof can be the 2nd layer but not the 3�d. Install �idged galvanized
v al leys
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT 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 ABANDONED FOfi 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 1. STALIS 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 $1.,250 $,63
WITH WHETHER SPECIFIED HEHEIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS F ANY OTHER ATE OR LOCAL LAW REGUL TING CON- $22 � QQ
St�iUCTION fi THE PE ORM NC F�CONSTRUCTION.
S\ � PLAN CHECK FEE TOTAL FEE
[ � � $22..63
S� ATUREOFCO ta CT AUTHO EDAGENT I�nT � WHEN PROPERLY A D TED THIS IS YOUR PErRMIT
/9 P
� �t�%
SiGNATUFiEO:OWNERUFOWNERBUIL0ER1 �DATEi BLDG �NSP qaTE
NEw I ]
ADDN. [ ]
pLTER. [ ]
Construction Address:
Legal Description:_
Owner Name & Add�ess:
Contractor:
Address:
LIIIING AREA:
GARAGE AREA:
DECR AREA:
OTHER:
�
� �
City of Fridley
R-1 AND R-2 �
Building Permit Applieation
�1.3��l ���1�e�C��
" � � �J ° �`
�/t G �l P � li � C
�S�n ✓� . //V 1 ��
Effective u/1/86
�� n�1 � Tel . # �� �/� � � S �
� S Tel . +� '3 � $ � PS" l (
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
Length i�idth Height
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd. Setback � � Side Yard Setback
� ,SOU S ca v � .�
Type of Construction: ,��e �c� e� �- ��` y U `✓e `� __ Estimated Cost : $ ��;�
Approx. Completion Date:
`p � ^ /�2�Z�. OG
Alt. A Alt B
Proposed Drivexay Width If New Opening Is Desired: $ $
See Back Page for Explanation
�
DATE: 0 APPLICANT: � Tel . # .�3 g� � �� (
Permit Fee
Plan Cheek
State Surcharge
SAC Charge
Park Fee
SeWer Main Charge
TOTAI.
STIPULATIONS•
CITY IISE ONLY
$ a�a- OC�
$
$ In �
$
$
�
$ ��- � ?
Fee Schedule on Reverse Side
25$ of Building Permit Fee
$.50/$1,000 Valuation •
$ �,SQ per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�
BIIILDING 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 applicatio n
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 9aluation
�1.00 to �500.00
$501.00 to $2,000.00
�2,001.00 to $25,000.00
�25,001.00 to $50,000.00
$50,001".00 to $100,000.00
�100,001.00 and up
Fees
$10.00 (Minimum Fee is �15.00)
$10.00 for the first �500 plus �1.50 for eaeh
additional �100 or fraction thereof, to and ineluding
�2,000.
�32•50 for the first a2,000 plus $6.00 for each
additional �1,000 or fraction thereof, to and
including �25,000.
�170.50 for the first �25,000 plus $4.50 for each
additional �1,000 or fraction thereof, to and
ineluding �50�000.
$283.00 for the first �50,000 plus $3.00 for each
additional �1,000 or fraction thereof, to and
including �100,000.
��33.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEiiAY DEPRESSION ESCR�N
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway �ridth plus
6 feet times $13.50 ,
Alternate "B": Removal and replaeement of curb and gutter and install a 3 foot wide
approaeh With 6 inch depth - Driveuay Width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Permits for construction t�ill be issued a minimum of 24 hours from the time of
application to allow for proper reviex of the proposed structure and of the
construetion site.
A Certificate of Survey of the lot, sho�ing the location of the foundation onee it
has been constructed will be required before proceeding with the framing.
.---�5
sue�ecr
City of Fridley
AT THE TOP OF TNE TWINS g � I L D I N G P E R M I T
�
� �
� �
� ; v _�___ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
i � ,
L_-_-�; �"' �'� CITY HALL FRIOLE� SS�32 NUMBEp pEV D�TE
L 763-571-3450 9/0-F 15 4/ 15 / 03
JOB ADDRESS 7380 Concerto Curve NE
t LEGAL �OT NO. BLOCK TRACT OR ADOITION
oesca. 3 3 Melody Manor 3rd Addition
2 PROPERTY OWNER MAIL ADDRES$
Nancy Formosa 7380 Concerto Curve NE
3 CONTRACTOR MAIL ADORESS
Budget Exteriors Inc 8017 Nicollet Ave S, Blo
e ARCNITECT OR DESIGNER MAIL AODRESS
5 ENGINEER
8 USE OF BUILDING
Residential
7 CLASS OF WORK
MAIL ADDRESS
� NEW O ADDITION
8 DESCRIBE WORK
Install egress window
9 CHANOE OF USE FqOM
�] ALTERATION
TO
P�GE O�
/ /
33430
RE .
�� �
•�qOVED Br
SEE ATTACHED
SNEET
763-783-1155
21P PHONE LICENSE NO
, MN 55420 952-887-1613
ZIP PNONE LICENSE NO
6564
ZIP PMpNE LICENSE NO
❑ REPAIR O MOVE O REMOVE
STIPULATIONS Window to meet the State Egress Code.
Provide smoke detectors in all sleeping rooms and on alZ levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all
exterior openings.
�: �
� I s� f, � � a r,{*r
:� �,
��f ' `� � : ;1�.
`�' � ;I;s,�f ;
TYPE OF CONST.
SEPARATE PERMITS ARE REOUIRED FOR ELECTFICAL. PIUMBING. HEATING,
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONE� FOR A PER100 OF 1pp DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS
1 HEfiEBY CEfiTIFV THAT I MAVE READ ANO EXAMINEO TMIS APPLICATION g
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS yALUATION
AND OROINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIEO
WITM WHETMER SPECIfIED HEREIN OR NOT. TME GRANTING OF A PERMIT �2 � 7OO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OF CANCEL TMF pEqMIT FEE
PROVISIONS Of ANY OTHER STATE Oii LOCAL LAW REGULATING CON- @
STRUCTION OF TNE PERFOiiMANCE OF CONSTRUCTION y�83 .^LS
Lic
S�GNATUpE OF CON'AACTOA OA AUTMOp�2ED OGENT IDATE�
S�GNOTUAE O� OWNEQ��� OWNEpBUILDEA� �DATE� I��
t
OCCUPANCY GROUP IOCCUPANCVLOAD
CU
OFFSTREET PARKING
STALLS IGARAGES
SURTAX
$1.35
SAC CMARGE
Fire SC $2.70
E TOTAIFEE
SC $5.00 $92.30
PROPEpLY VA�IOATED TNIS IS YOUR PERp117
,
NEW
ADDN
ALTER
��
�� �%
[] CITY OF FRIDLEY ��,ti Effeative 1/112003
[ J 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: �3� �n C et �2] e.t�ur v e N E
Legal Description: �
Owner Name & Address: t�Qt1CU Fofm�SGY Tel. #?[e3 • 7R3 • t[55
Contractor. t�.t�P� �'cFft�lit��s� n[nc . MN LICENSE # C,�„SLe ��
Address:�Of7 /1r'col�P� � �Sn �loomc'n�`1z.t"1 ��I2� Tel.# �ZS2-887•/(0['�_
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Cerkificate 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.
�..��!:,�s, ,,� � � • �1��, ,� . o
.� .
Construction Type: SFI� Estimated Cost: $_�'IOC� `�'
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �I'II'O3
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
ToTa�
$ �•2�
$ �•� D
$ 4 •35 �
$
$ S.OD
$
$
$
$
$ �92. �0
CITY USE ONLY -
Tei. #
-1287 if using credit card and we will
Fee Schedule on Reverse Side ��T����
.001 of Permit Valuation (1/10th°/a)
$.50/$1,000 Valuation
$1275 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 [ ]
..
:��� � a ��d
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: � � i � � � i � - �: i_�_� �,
The Chief Building Official shall, before issuing permits for the erecrion of any building or structure, or for any
addition to any exisring building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,�0
$500,001 to $1,000,000
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 $2,000 plus $14.00 for each additional $1,QQO
or iiaction thereof, w and including $25,IX}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 $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1, 000 or fraction thereof, to and including $1,000, 000
$1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
- - - - -- C�JR� Ci]'� �SCR4�K - -- - - -
(Cuncrete Lurb Streets On13� j
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 Certificate of 5urvey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 l+'AX:
ADDRESS : 7380 CONCERTO CRV NE
PIN : 113024130027
LEGAL DESC : MELODY MANOR 2ND ADD
: LOT 3 BLOCK 3
571-1287
PERMIT NO.: 2004-0011 �� � 1
�
DATE ISSUED: Ol/23/2004
PERMTT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CON5TRUCTION TYPE : ADDITION/ALTERATION
VALUATION .
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
INSTALL GAS WATER HEATER
# ELEC WATER HEATERS
# NEW FIXTURES (EXIST OPENINGS)
# GAS DRYERS
# OF NEW FIXTURES
APPLICANT
NORTHWOODS MECHANICAL
BOX 1085
FOREST LAKE, MN 55025-
(651)257-4951
OWNER
NESS GREGORY S& CANDY C
7380 CONCERTO CRV NE
FRIDLEY, MN 55432
0 VALUE OF FIXTURE/APPLIANCE
0 # GAS WATER HEATERS
0 # GAS RANGES
0 # WATER TRMT APPLIANCES
PLBG PERMIT NIINIMUM FEE
PLBG FIXTURES (NEW OPENII�IGS)
PLBG FIXTURES (EXIST OPEATINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
5TATE SURCHARGE, PLBG FLAT
TOTAL
PAID WIT'H CHECK # 6072
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 atter 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 worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other sta.te or local law
regulating construction or the performance of construction.
Bldg
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Date<
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURIVED
�MeA�N VFNT VFI�T C`C�RI�F[`TnR �1A!n (711�t�� ISTIC�I� pIR ��RIFIC`ATInR
When reo_ i,.. a��r,0 an_ pY,� ���a fi,�„�Q� the undersigned hereby verifies that the
venting has been examined and is free from nast, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastiGPVC and meets all current codes and manufacturer
specifications inGuding sizing, length, number of elbows and termina�on. Yes () No ()
The undersigned aiso verifies that the replacement unit is a listed assembly
and meets the current codes and manufacture�s specifications. This does
include AGA-GAMA Category I Central Fumace Venang Tables for fan
assisted and natural draft appliances.
The pxictinA_combuctien ��r is sized and installed to meet the current codes
and manufacturers specifications.
When required to inctai� a npw _emh ic+ien a� it will be sized and installed
to meet the current codes and manufacturers specifications.
When installin� a npw ventin�,�,ct,,,�, we undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does inGude AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances.
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 ( )
Yes( ) No( )
Yes( ) No( )
Yes( ) No( )
Yes( )No( )
� • • . � - • ' . � • • 11 11 • � " • • � • ' � • � � ' M • / • /1� • • •
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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 (nput
Common Vent Type Vent Height Diameter inches
�
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
� : � •► .- ..-
HEATING CO:
Signed By: Date :
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FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacina an existina furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
spec�cations 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 cuRent codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air, it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventinq svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specfications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
Yes ( ) No ( )
Aapliance Tvae and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances T�al Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
���.
ALTERATIONS• (Describe)
HEATING CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�631572-3604 FAX: (7631571-1287
: 7380 CONCERTO CRV NE
: 113024130027
: MELODY MANOR 2ND ADD
: LOT 3 BLOCK 3
: PLUMBING
: RESIDENTIAL
: ADDITION/ALTERATION
�� �
»�
PERMIT O.: 2004-01007 `�
DATE ISSUED: 06/28/2004 •
VALUATION : $ 0.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A INSTALL AN IRRIGATION
BACK FLOW PREVENTER (WII.,KINS 720A, 1 INCI�
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENII�IGS)
# GAS DRYERS
# OF NEVJ FIXTURES
APPLICANT
NANCY FORMOSA
7380 CONCERTO CRV NE
FRIDLEY, MN 55432
OWNER
NANCY FORMOSA
7380 CONCERTO CRV NE
FRIDLEY, MN 55432
0 # GAS WATER HEATERS
0 # GAS RANGES
1 # WATER TRMT APPLIANCES
PLBG PERMIT MINIMUM FEE
PLBG FIXTURES (NEW OPE1�iINGS)
PLBG FIXTLTRES (EXIST OPENINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 7969
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 goveming 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 the provisions of any other state or local law
regulating constru�ion or the performance of construction.
Bldg Insp
Date
ARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
�
�
0
15.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.00
0.50
15.50
Building
Inspections
763-572-3604
DATE 1���5 '
SITE ADDRESS n:�
THIS APPLICANT IS:
PROPERTY O�VNER/
TENANT
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
— _ .-� .
OCONTRACTOR
PHONE: '%/o �- ��3 %I s"S
CONTRACTOR I Nq�g:
SUBMIT A COPY OF STATE LICENSE #
YOUR STATE LICENSE ADDRESS:
WITH APPLICATION pHONE.�—
PROPERTY TYPE
PERMIT TYPE � �DTfION
❑ BASEMENT FINISH
❑ DECK
�E oF wo�:
DESCRIBE WORK BE1NG
SIZE OF IlVIPROVEMENT
£XP DATE
Pernut No.:
Received By:
Date Rec'd:
3�
� �� ���
CITY STATE ZIP,
�ROOF 0 DRAIN TII E
O SIDING O OTI�R
❑ SWIlvIlvID�iG POOL
❑ ADDTfION
❑ REMODELING
ROOFING ❑ HOU3E ONLY
NUMBER OF SQUARES }&`HOUSE & GARAGE
GARAGES � �^ � ❑ A'ITACI�D GARAGE
PROPOSED SIZE: � ❑ DETACI�D GAR.AGE S
PROPOSED HEIG T: �.l ��
SIDIlVG � (�J
❑ Vinyl OSoffrt
❑ Aluminum ❑ T�
❑ p�� O Fascia
WINDOR'S
IN EXISTWG OPENINGS OY� �I�To
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WII�IDOW TO BE WSTALLED
IACATION OF WII�IDOWS
I: ���s�1
Ft
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plen
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the atisting structures
and proposed pmjecL
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING TI� 1997 U.B.0 FEE SCAEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Percnit Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ ��,��� Se,� Back Page for Fee Schedule
$ � 65% of Building Permit Fee
$ �� (.0005) tames the total job valuation — Minimum $.50
$ �_ � � .001 x Permit Valuation (1/10%)
$ $5.00 (Staxe 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 payable to: City of Fridley Attach
THIS IS AN APPLICATTON FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acla�owledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a 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 wo which requires revier�r and approval of plans.
SIGNATUREOFAPPLICANT I � �-- PRINTNAME�L�j � f�/�� DATE /� /� o�'
Page 2- Building Residential Applicataon
BUILDING PERMIT FEE SCHEDULE
The Chief Building O�cia1 shall, before issuing permits for the erection of any building or
structure, or for any addition to any e�sting building or structure, or for any alteration or repair
to any existing building or structure, upon application therefore, requue the payment by the
applicant for such perm.it of fees to the amount herein below set forth and in the manner herein
provided to-wit:
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 fo� each additional $100 or fracrion, 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
includin $$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 ea.ch additional $1,000 or fraction 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 fraction 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 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or
fra.ction
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 proposed structure and of the constructioa site.
A Certificate of Survey of the lot, showing the location of the existing founda.tion will be
required before proceeding with the frazning. New Houses Onlv
City of Fridley
Building Inspections Deparixnent
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
Building
Inspections
763-572-3604
DATE «
STCE ADDRESS �
THIS APPLICAM IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
gUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
�..
- MECHANICAL
RESIDENTI�.L APPLICATION
. CITY OF FRIDLEY
YOUR MAJL ADDRESS
�� �n .N D r�ic� ��� A�
0 OWNER �'ONTRACTOR
� cint
5:
7 _-�? � 11 �"
COIvIPANY NAME:_
CONTACT PERSON:
srn� �ac�sE �_
ADDRESS�
(�INGLE FAMILY ❑ TWO FAMILY
(
p ��y �PLACEMENT
�
DETAILED DESCRIPTION OF WORK _
FAX
Permit No.:
Received By:_
Date Rec'd:_�
A
.�
rl��'.!'' ►i' :� ,�; �:
O TOWN}�OUSE
❑ ALTERA7'ION/REMODEL
PER MS 16B.665 the permit fee is a minimum of 515.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixtwe, excluding the fixtures: (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor
x.05=
FOR PROJECTS WHERE LABOR EXCEEDS $5 , EES ARE B ED ON $10.00 PER FIXTLIRE, EXCEPT v''FiERE NOTED. FDtTURES: (INDICATE TOTAL
T•ii,TNIBER OF EACH BELOVI� M��S D 31ZEBTU ��5�
Equipment Instailed i`'�G� SIZE/BTU
MFG: ,_— MODEL: SIZElBTU
�G: MODEL: _�—.
FIREPLACE (GAS) $15.00 _GAS RANGEJOVEN $10.00
_PJC 525.00 =��pLpCE (WOOD) $35.00 ]JEW GAS GRII.L $10.00
_AIR TO AIR EXCHANGEER $IS , F�ACE $35.00 GAS UN1T HTR $10.d0
BOILER 535.00 '—Gpg DRYER $10.00 POOL HEATER $35.00
_CHIMAIgy LINER $10.00 — _VEN7ILATOR $I5.00
DUC'f WORK SI0.00 _GAS PIPING $10.00
_.„ _ .
_ __.,.,�..-��w,�„�r m��, �. ���s��,���cr��t��Fa���#?��;�'S�'���':�5.{l
�
�,,���!l�.� ',�i�J�'ti�..4���K �.i�ll.9d'i1Crt�..�V V'4�tih::. aiN �£R:�;,r..� is u�.-w,�. „n a..,. -. �..,p.�...w .—. __. ,.... _ . .
Permit Fee $�� � Number of fixtures @$10.00 x$10.00 =
Surcharge $ .50 Numbec of fixtures @ $15.00 x $15.00 = $
TOTAL DLJE $ _�` �•� Number of fixttues @ $25.00 x $25.00 = $
Number of fixtures @ $35.00 x $35.00 = $
State Swcharge = $ .50
Tota1= $
' THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accura.te; that the work will be in
conformance with the ordinances and codes of the Ci of Fridley and with the Minnesota �Construction Coc}es; that I understand this is
not a permit but onl applicarion for a p it and wor � ot to start without a permit; that the work will be in accordance with the
approved plan in fh e of all wor hich ' s eview and a roval of ans.
.. � � N� a
SIGNATURE OF LI
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridl'ey, MN 55432
763-572-3604
FAX: 763-502-4977
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Building
Inspections
763-572-3604
�iTE ADDRESS
�IIS APPLICANT IS:
�ROPERTY OWNER/
TENANT
CONTRACTOR
SUBMTT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMTT TYPE
TYPE OF WORK:
BUILDI�TG
RESIDENTIAL APPLICATI4N
CITY OF FRIDLEY
i`=�
■• .
ADDRESS:
YOUR E-MAIL ADDRESS
�CONTRACTOR
N�:_ RENEWAL BY ANDERSEN
STATE LICE 1920 COUNTY RD. ��C�� w�+ ST
anD�ss:_ ROSEVII.LE, MN 55113
PHONE 651-264-4777
❑ s�rGr� F LICENSE #20130983
❑ TWO FAI�.
Q ADDITION ❑ GARAGEISHED
O BASEMENT FINISH ❑ ROOF
� DECK ❑ SmING
❑ SWIIvIIvIITIG POOL
❑ MAII•TTEAIANCE/REPAIR 'i�REMODELING
DESCRIBE WORK BEING DONE:
;IZE OF IlvIPROVEMENT
NUMBER OF SQUARES _
GARAGES
?ROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
D Vinyl
rJ Aluminum
❑ Other
'J��INDOWS
IN EXISTING OPENINGS �Yes �No
OR FOR NEW OP£N1NGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WWDOW TO BE INSTALLED_
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GAR.AGE
❑ AT'TACHED GARAGE
0 DETACHED GARAGE
�Soffit
❑ Trim
❑ Fascia
Permit No.: ��p `% — C�0
�
Received By: �
Date Rec'd: �" �J" `
�2 i� �.oa1¢ S . C o�
�_sTATH -! �II' S�S' y 3 a
(45� 3k S- L 0 y�
CITY STATE ZIP.
❑ DRAW TILE
� OTI�R
ATION OF WINDOWS
tva�n h3 � ��cA��, d�n �nM �l �p��p
_t. l
OF
HEIGHT
BASEMENT REMODELIIVG SUBNIIT:
1. Exisiing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft
FOR NEW CONSTRUCTTON INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site PlanlSurvey showing the ea�isting sWctures
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:
(LTSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ I i2 ,� te � OCCUPANCY TYPE
? ermit Fee $ p`� a� p� :j _
Plan Review $
Surcharge $ , 3 �
r ire Surcharge $ / � , --t (�
License Surcharge $ S, p u
SAC Charge $
Curb Cut Escrow $
r,rosion Control $
Park Fee $
Sewer Main Charge $
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 Residentia] 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 ( )
Tota! Due $ '1�� 2� Make checks payable to: City of Fridley Attach
Oj
THIS IS AN a,r�rL���. �.�N FOR A PERMIT-NOT VALID UNTIL PROCESSED
f 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; that I understand this is not a
permit but only an application for a perm' d 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 �qu' es iew and approvai of plans.
� ^
SIGNATURE OF APPLICANT �1�� PRINT NAMEfi�� 5��� DATE �� pi L V,
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erection of any buildang' or
.structure, or for any adriition to any existing buildi�g or structure, or for �amy alt�ration or repau
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 i.n the manner herein
provided to-wit:
ToT� v�.uE �Es
$1 to $500 $23.50 (Minimum Fee is $23.5.0 glus surchazge)-
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional$100 or fractian, to and
including $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,U00 or fra.ction, to and
including $$25,000
$25,001 to $50,000 $39125 for 1�` $25,000 plus $10.10 for each additional $1,000 or fi�action,
to and including $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction 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 fraction to
and including $SOO,OOU
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
fraciion to and includi.n $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional$1,000 or
fi-action
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 proposed structure and of the construction site.
A Certificate of Survey of the lot, showin.g the location of the e�.sting fbnndation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
, .
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