AF - 43298sua�ecr PER . `�'-�
City of Fridley 18149
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r �
; � EIPT .
� ' L _____ COMMUNITY DEVELOPMENT DIV. � � � � �
r � � PROTECTIVE INSPECTION SEC.
� � �
l•--- A,�r'�'1,`j CITY HALL FRIDLE� 55432 NUMBER REV. OATE PAGE OF APPROVED BV
i �� 612-571-3450 910-F15 8/5/85 � �
JOB ADDRESS 1400 Creek Park Lane N. E,
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. ]. 3 Creekridge Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
Bob Swanson
3 CONTRACTOR MAIL ADDRESS Z�P PHONE IICENSE NO.
Nedegaard Cons.truction Co. 1814 Northdale Boulevard, Coon Rapids 757-2926
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS �r� R ��?� ►"'`� a�"rK��"n �� 1��1�OD UCENSE Nb.
�� U IZ
,• .
. i •y �i t,:y � �vaY� •.
6 USE OF BUILOING . .
Res i den ti al
7 CLASS OF WORK
� NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOFK
Construct a 45' x 36' Dwelling and a 22' x 22' Garage
9 CHANGE OF USE FROM TO
STIPULATIONS provide a hard surfaced driveway. Provide City with copy of verifying
survey before capping. Provide sod in th.e front and side yards. Paid a
park fee of $1,500.00.
SEWER LOCATION: 115� W. of M.H. (_Inv. 880.09)
WYE ELEV: 880.55 'IOP QF FOOTING: 884.05 Minimum
WATER LOCATION; Tnlest of and in same trench with sewer serv ice.
DRIVEWAY DEFRESSION COST: 48' x$13.50=$648.00
TH£ CITY OF FRIDLEY DOES NO�" �i1A,R,9�iT�f -r}�E r� ������
ACCURACY OF UTILITY LOCA710�11S,��li� ELEy�710NS. �� �f�j.t�,�j �,�� y�f����y�s
7HIS DATA IS FOR INFORti�ATfOI� ;Fl3f�ppSFS ONLY� �����y����_� ���,
AND PERSONS USING TH1S .I.N��T�(y �p{���
VERIFY IT ON THE Sf�,E ,������� ��•
TYPE OF CONST. OCCUPANCY GFiOUP OCCUPANCV IOAD
SEPARATE PERMITS ARE REQUIRED FOF ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC� �r�lle
THIS PERM17 BECOMES NULL AND VOID IF WORK OF 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 OFFSTREET PARKING
I HEfiEBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
W�TH WHETHER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT $g5,550 �47•78
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC E r d..i
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTIO OR THE PERFORMANCE OF CONSTRUCTION. $421.00 $425. OO �� _ s��
�p� p PLAN CHECK FEE TOTAL FEE �� ,et
O '� � 0 S $105. 25 $999.03+PF&DE �c F�-a .
SIGNATUREOFCONTRACT NO EDAGENT IDATEI WHEN PROPER Y VAUDATED THIS IS YOUR PERMIT
1 R ��
v
SIGNATUREOFOWNERi1GOWNEABUILDEA� �DATEI BLDG iNSP FTE
NEW ]
ADDN. [ ]
pLTER. ( ]
City of Fridley
R-1 AKD R-2 f
Building Permit Application
Effective 4/1/84
Construction Address: ���� �� � � � � �� �� '
Legal Description: .�O! �� �LoCi(G � t �r��E/c/Z/DGC-- -
Owner Name & Address : ��' � °�5��/��6/� Tel. #
Contractor :_____ /�.��D E ��.�t2 !� Ca �!S T �-� Tel . # 7S � - �.9 ?�
Address: ��/ `� %%a'L7�c���- �� , �aa� ��%-�-��
Attach to this applicaiion, a Certificate of Survey of the
lot, with the proposed construction dra�n on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft. ��%
GARAGE AREA: Length Width Height Sq. Ft. y8
DECR AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setback
Type of Construction: `";12-c,-�„ ��C�-�-�-�--�°�------� Estimated Cost: � % ""
Approx. Completion Date: "�' S�O.��
Alt. A Alt B
Proposed Drivexay Width If Neu Opening Is Desired: S � '`
See Back Page for Explanation _ , : =� - . �-:,
>� ,
DATE: �� I - �iJ APPLICANT: �i�C �� � Tel . # �-s �"� Z���°
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Set+er Main Charge
CITY
� �a 1.oc�
� l��'.oia
s y�, � �
� �d�,�
� I S�O,ou
� '_�
C� S
STIPULATIONS: �"y �' �� ����
�
OSE ONLY
Fee Schedule on Reverse Side
25x of Building Permit Fee
�.50/�1,000 Valuation
E425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [] Not Necessary [ J
BIIILDING PERMIT FEE SCHEDIILE
m
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 strueture, 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 ihe amount
herein belor+ set forth and in the manner herein provided to-Wit: �
Total 9aluation
=1.00 to �500.00
�501.00 to a2,000.00
�2�001.00 to �25,000.00
�25,001.00 to �50,000.00
E50,001.00 to a100,000.00
�1Q0,001.00 and up
Fees
�10.00 (Minimum Fee is �15.00)
0
E10.00 for the first �500 plus �1.50 for each
additional �100 or fraction thereof� to and including
�2,000.
332•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 �u.50 for,eaeh
additional �1,000 or fraction thereof, to and
including 350,000.
�283.00 for the first �50,000 plus �3.00 for each
additional �1,000 or fraction thereof� to and
including �100�000.
�433.00 for the first �100,000 plus �2.50 for each
additional �1�000 or fraction thereof.
DRIVEWAY DEPRESSION ESCRO'N
(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 - Driveuay xidth plus 6 feet times �15.75
YERIFICATION OF FOUNDATION
Permits for construction xill be issued a minimum of 24 hours from the time of
application to allow for proper r�view of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, shoWing the location of the foundation onee it
has been constructed will be required before proceeding with the framing.
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EXTERtOR E�IVELOPE AVERAGE "U" C(IMPUTATI0t1
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sir� aoaR�ss: �� �
CONTRACTOR: �t`ylc�-��`�� r-, ((�l `,, f f� DATE :
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. � �^�►-�'--�--�------
O�TERMINE 4�ORKI�IC SQUARE f00TAGE OF EACN:
TQTAi, �XPOS�D IJALL �IREA; ... .. . . 2 �� sq f t x "U" •11 �� 1 ,Otp
.�, � . �-
TQTAL ROOF/CEIl.ING AREA,,;.�.�. ,' _� sq ft x"U" •026 c
- � ..d �
70TAl. EXPOSEp I�Af.L AREA CAtCULATiONS:
- Tota l exposed wa l l �� r�
erqa abovs f 1 oor, , , � „ � � `j
sq ft
e) Total wall wtndow area:
qlazed...... �j` �; sq ft x �����
' qlazed:..... � sq ft x '����
b) TQtal door area ,,,,,,�,� 2� sq ft x"U"
c) Total s11dInA qlass d
d)
� a)
f)
9�
, �;'�. * ,130.`�
.
� ��" � � � � �-io
----�;.........._ �.--�--.
, oor area: +� �
� 9lazed...... •� sq ft x ����� �'rj� • ` • 'Z,, t%
• Z
"""'..,' ^,.---� ---�-------'.
. q l a zed ......,------�. sq f t x ���� � � .
� r
r.��
Tota1 fl�eplace wall arca ' sq ft x"U" ���0
� � �t
Total wall fram(ng area /r
iAverage �OXj........... �� � Sy ft x"U'� ��Z. 1`t'. 1(7
.
Totai net wall area above
floo� (insulated)....��� � ��� " S ft x " "
, �
Total rlm Jolst area....., .� �(� sq ft x"U"
Tatal foundatlon C�
area (Exposed).......... ��" 1 sq ft
, 3 . �z.��'
`� � �
� � � f
------ -- - .
t�) Total foundation
Window 8fQ8.�•••����.••� -+• .
sq ft x "U" �� � '—
—
• �) Tot�1 net foundatlon �� a � r ~��
aroa above qrade..,...., . �� � sq pt x����� ���• *!(�. �j l�j
__..
3. , — � Y �
TQTAL a) thru f) • �?�.�
If Item p� 1s the same as. or less than ftem N1� you have met the intent of
S.R.�. Sectlon 600(, (�) y,
" �4. TflTAL EXPQSED aOQF/CE I L I �IG CALCULAT I �tlS :
,. � . . . .
; . . .. .I �
� . . k)
. . i :.
. . ; � li
.. . ' .
�1:
Total exposed �( �"
roof/cellln�l area........ IV � J sq Ft
, r ...—
Total skylloht area....... � sq ft x"I1" ✓ 4
Total �oof/celllnq framin� • /�
area (Averane Ing) . . , , , , � � � sn f t x "U" � � �--'�'. a �� ' l �
+ t t -- .__.. __
. �, ,. . .
Total net Insulated ( �' s ,�. ,,,'
roof/ceillnq area.;�.�.`... `���.._ sq ft x"U" ';�r� b,�?.�'.'l��
�_
TOTAI. j) thru 1,) ��/. j P,
If total of '�h Is the same as. or less than p2� you have met the Intent of
S.q.C. Sectlon (O�E (c) I.
. �
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. ..�
+
ALTERt1ATE BUIL01fIG ENVELOPE �ESIGN
To utlllze the total envelape system Method� the values establlshed by the sum
of items N� and A'4 shall not be greater than the sum of Items pl and �2.
1 • _,,,__� � � � ,�' u + !. • _ � . V � � 2 I �p � � r�
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cEaTiFir,ATior�
� I hereby certify that 1 have calculated the "II'' factors and "R"
values herein and that the bulldin� hpre desc�ibed meets or exceeds the State
... qf hlnnesota Energy Co�servation Act. ( .
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1 I r.ert�r ��IK �ILrn n,F,R
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��►�11L SECTIOt� (INSU�ATED)
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RIM JOIST SECTIAtl:
----(1 Interlor air f11m �,�,R
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'-~---( � E x t e r I o r a I r I 1— m ��'
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POUNOATION SECTION:
"----{1 Interior air fllm �.�,A
"""""'{ 3 11 r j-� „r.� . ' --
----� 4 F>: t e r i c� r a r�I I m ���•
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V�NTED
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f.CILIMf, SEC1'lll�l (IN$ULAfE11): '
I Inr.•, f��r �tlr f1 fri n/,1
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ti Exterlc�r alr Ftlm Stlll�'�± A,/►I
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GEII.INf, FRAMIN1i SECTIAN:
1 Interlor alr ftlm
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3 "`
k Inte�lor alr t m
�+ '�S'�winches so
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TQ Al R �.�- .!
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CEILIaG SEr,Tlor� (I�isuLATED) :
1' Interlor air film �,(,��
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3 ..
ti f.xter or a r i m sti (1.
70TA1 R �� '
,
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u • �/a - . ,,'
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CEILIr�r FRaNIttP SECTIO�I:
l� Interl�r alr,fllm �,(,�
2
3 •- .
4 F.xterlor alr tim st) ! n.
4 �nchess su�c�'+ ; �"""'
' T�7nl R ��"'
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I In�l�in ulr 1'1!n► n./�1
z
i - �
�i Outsl�ie al� r�lm'�"" �
�.____._.
TQTAL R •
......�
II N 1/R .
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� ''''r � EXTERIOR EFIVELOPE AVERAGE "U" COMPUTATIQN
•: �'-i----� � � /�� � ..
pwri�A: � ��'` � Il' ��� � ���F�} �-,����
� SF1E AQpR�SS: % �
CONTRACTOR: � IV1C-�C�'`�^l� ((.�� `:; f f � DATE :(% ��� PHONE :
� , ' +---.-..-----------
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D�TERMlME blORKlN� SQUARE FOOTAGE OF �ACH:
TOTAi, �XPOS�D IIALL �IREA; � , � � � � . � �� Sq ft x "U" ' 11 1 01p
. I LC.�� .
TQTAL ROOF/C�I I.ING AREA� � � , � . � . . � . � sq it x "U" • 026 ' Gf r,,�/f
� � 1 � V �
TOTAI. EXPOSEp IJAIL AREA CALCULAT I ONS :
� Tota1 exposed wali '� � �
arqa abovs f�oor�����.��
_____, s q f t
�� Total wall wtndow areai
— ; ----�. 41 azed, . . . . . ��;
sq ft x "U"
' „_,__,__ qlazed...... . sq ft x �����
b) Tota i door area ......... ` 2.� sq f t x���n
c) Totai slldt�A qlass door areas
d)
e�
• �� * ,� 3a. �'
—�-------- _......__... __
.
� i ��.::_;;�..._, � , �--ca
�:__.__..
,,
. . giazed...... .�� sq ft x ����� � �5 � � '� Z � f%
� ' !VY�� W ��.�_.�.
qlazed...... sq fc x "U'� �
t E r
Tota1 flreplace wa11 area ' sq ft x"U" �"�O
+ . .�
Total wall framing area
�Avel'age 10$) .. ..... . ... � � Z � t `{- , ( (7
� � s q f t x"U' � 4� �. .
f� Total net wali area above
floor (Insulated)..,.��. � � � � s Ft x " "
9� Tatal rlm ,�otst area...... . I� , „U,�
� sq ft x U
Tatal foundation ���
area (Exposed).......... _ F_`� sq ft
' 3 - G� z.��'
• ' ' �'�
h) ?otal foundatlon
r+ilndow afEB..�••��.�..�• _� .
s q f t x"U" ,� . '"—'
• r) Tota1 net foundatton �i�� � � ��
, araa above qrado..,....._.._ �� sq f� x���„ , 08�. , �o. 5�
�� �
TOTAL a) thru I� • � 7��
If Item w� Is the same as. or less thah ttem pl, you have met the Intent of
S.A.�. Section 600fi (�) y,
' 4. TOTA� EXP�SED ROQF/CEILI�IG CALCUlATI011S:
,. , . . . . .
�
� .
. . ; .
4:
�
Total exposed �(¢�"
roof/ceilln� a�ea.:...... �V l� J sq ft
' ��/ 4 �'
�) Total skylipht area....... '' sq ft x"�1" •
k) Total roof/ce111nq Framinc� p • „ 1 �
a�ea (Avera�e l�gi . . . . . . � 0 � s� Ft x "ll'' • � L.2. � � � �
a
�' � � . '�. . .�_.. __
. L „ �
1) Totat net insutated t•'• ��C s ft x"U" �;��� ��� �
roof/celllnq area. ��'" � i � �� ��
.
... q �+ �,_ ,
__.__...__.
. TOTAI. J) th�u I 1 ��•3 ��
If total of ��I Is the same as, or less than p2. you have met the tntent of
S.B.C. Section �OQ6 (c) 1.
' «';',
ALTERIlAiE BUILQlfIG ENVELOPE RESIRN
To uttltze the total envelope system r,ethocl, the values,establlshed by the sum
of Items N3 and A'4 shal! not be �reater than the sum of Items pl and N2.
. .. . . . , s� � f �` • � � 2! � �. Y I " r1
• °��" + a..
. . . � . ; 2 5"z q . -______" ------ -
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, ----- .. _. ._ . -
:
,
cEaTiFIr.ATin�i
, 1 hereby certlfy that I have caiculated the "I/'' factors and "R"
values herein and that the buildin� hPre descrihecl meets or exceeds the State
. Qf N�nnesota Enerqy Conservatfon Act. �
' ' f ' '�
' � .; � 1 c_...
, i�nature �'
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L4T �l�RVEYS COMPANY,--INC.
r.�xn suxvEYORs
REGISTER.ED UNDEft LAWS OF STATE OF- MINNE30TA
` 7601- 73rd Avenue North 660-3093
� NEDEGAARD COdJSTRUGTION
Minneapolis� Minnesota 65428
o Denotes Wood Hub Set
For Fxcavation Only ��'pp�p�� �p�{�{,(� � � .
. �
-•.E-- D�note� Surface Drainage
� Denotes Proposed Elevation
INVOICE N0. 15674
F. B. NO. 9 ' �
SCALE I" 20'
0 – DENOTES I RON
poo,o Denotes Existing Elevation �����I��
Elevation 1)atum Assumed i3efore digging ca11 10ca) utilitie�
F�yp�E.� pOES NOT GUARANTEE
-rH� TEIEPNONE - ELECTa4C - GAS Etc,
, E Cy-t.r 0� ATIONS PUR OSESTONLY, �'�C�t�IRED �Y LAVV
�'H �� ��'ILITY LOC� .�►ON �
� #��G41RA�� ��FORMA p,T1�P1 sHO�LD I �O
� '�'l�1,1� DAT�` �S �0'�. THIS� I�PIFORM
` �� �ERSONS TM� SITE,
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CREE� � PARK LAt�.IE NE.
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AT �
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Lot 1, Block 3, CREEKRIDGE
Ths only eaaementa shown are from plats of record or information provided by
client.
IMe hereby certity that this is a true and correct representation of a survey of the
boundaries of the above desc�ibed land and the location oi all buildings and vis-
Iblb encroachmenta, if any, trom or on aaid land.
Surveyed by us thts 31 st �y of July �� 85
Signed
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UIYOF
FRlDLEY
CIVIC CENTER • 6431 UN�VERSITY AVE N.E.. FRIOLEY. MINNESOTA 55432 • PHONE �6121 571-3450
Novembe r 13 , 198 5
Nedegaard Construction
1814 Northdale Boulevard t1.W.
Coon Rapids, MN 55433
Re: Final Inspec tion at 1400 Creek Park Lane N.E., Fridley
Dear Sirs:
A final inspection was conducted on November 7, 1985 at the above address
and the following items were noted which must be completed before the
structure can be finaled out:
l. Complete all of the siding by November 29, 1985.
2. Install joist hangers on depressed joist in front of fireplace by
November 29, 1985.
We will expect the above it�ns to be completed by the scheduled date when
a reinspection will be conducted to determine compliance. If you have
any questions on these itelns, please feel free to contact me at 571-3450.
Sincerely,
D G. CLARK
Chief Building Official
DGC/mh
; I�I�D�,Ct�1�RD COl�15TR�ICTIOl�I CO., II�IC.
1814 NORTHDALE BLVD. COON RAPIDS,MN. 55433 (6i2) 757�2926
November 15, 1985
Mr. Darrel G. Clark, Chief Building Official
City of Fridley
6431 University Avenue Northeast
Fridley, Minnesota 55432
Re: Final inspection at 1400 Creek Park Lane N.E., Fridley
Dear Mr. Clark:
The two items requiring completion as shown in your letter to us
dated November 13, 1985 pertaining to the above property have now
been completed.
In order to gain access to the house at the time of the reinspection,
please contact me at 757-2926.
Sincerely,
NEDEGAARD CONSTRUCTION COMPANY, INC.
����� ,���� ����' /
Gill V. Gruber
Treasurer
GVG/jz
� CUSTOM HOMES REMODELING LIGHT COMMERCIAL �. MBA.,:
-
_
��
FRlDLEY
CIVIC CENTER • 8431 UNIVERSITY AVE. N.E.. FRIDLEY, MINNESOTA 55432 • PHONE (6121 571-3450
December 5, 1985
Nedegaard Oonstruction
1814 Northdale Boulevard N.W. '
Coon Rapids, MN 55433
Re: Reinspection for Final at 1400 Greek Park Lane N.E., Fridley
Dear Sirs:
A reinspection was conducted on November 20, 1985 to detezmine compliance
with our letter of November 13, 1985. It was noted during this reinspection
that all items have been completed and approved.
The structure is approved for occupancy.
If you have any further questions on this matter, please feel free to
contact me at 571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
DGC/mh
' � � SuB.tEGT _ � � " � �
City of Fridley
AT THE TOP OF THE TWINS ��� L D I� G P E R M I T
r
� .
� � COMMUNiTY OEVE�OFIJiENT DIV.
� •
� i V'�'��� , .
r � � PROTECTIVE INSPECTION SEC.
�
i--_.�,��"' �'� CITY HALI FRIDLEY SS�J2 NUMBEA REv O�TE
i 612-571-3450 9t0-F�5 5/14/02
�oe nooaess 1400 H�.�� Creek Park Lane NE
1 LEGAI LOT NO. BIOCK TfiACT OR ADOITION
oesca. 1 3 Creekridge Addition
2 PROPERTY OWNER MAIL ADOR�S3
Jon/Mary Johnson 1400 Creek Park Lane NE
3 CONTRACTOii MAIL ADORESS
Same
� ARCMITEC7 0R OESIGNER MAIL ADDRESS
ZIP
PAGE Oi
/ /
32592
RECEIPT NO.
oi �00 �
AVPROVED 8Y
SEE A7TACNED
SMEET
PHONE
763-572-7425
PHONE LICENSE NO
PHONE LICENSE NO.
5 ENGINEER MAII ADOi;ESS 21P PHONE IICENSE NO
6 USE OF BUILOING
Residentiai
7 CLASS OF WORK
O NEW � ADDITION O ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Cor.struct a 29' x 23' Deck
9 CHANGE OF USE FROM
STIPULATIONS See notations on plan.
TO
���ti'��
Before digging ca�� for
ail utility locations
45400Q2
����1�RED BY L1#W
TVPE OF CONST.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTHICAL. PLUMBING, MEATING,
VENTI�ATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NUII ANO VOIO IF WORK OR CONS7RUCTION ZONING
AUTMORIZED IS NOT COMMENCEO WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WpRK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 �AYS AJ
ANV TIME AFTER WORK IS COMMENCED ' NO DWLG. UNI7S
I MEREBV CERTifV THAT I HAVE REAO AND E%AMINEO THIS APPLICATION 1
AND KNOW THE SAME TO BE TF1UE AND CORRECi. ALl PROVISIONS OF LAWS VAWATION
AND OROINANCES GOVERNING TMIS TVPE OF WOFK WILL QE COMPUED @
WITH WHETMEA SPECIFIED HEREIN OF NOT. TME GRANTING Of A PERMIT W7 f 67O
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE Oq CANCEL THE pEqMITfEE
PROVISIONS OF ANY OTHEFi STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFOfiMANCE Of CONSTRUCTION $153.ZS
$�GN47Ui7E O� CON'RACTOQ OQ �UTMOAIZED AGENi
4
•iEi
�' � �f a�
,o.
OCCUPANCVLOAD
CU FT
OFfSTREET PARKING
SIALLS GAiiAGES
SURTAX
' $3.84
SAC CHARGE
Fire SC $7.67
OTA� FEE
164.76
ALIOATE THIS I$ VOUR P� fiMj
/ i_ ..f� G �/Ifis
0
NEW [ J CITY OF FRIDLEY Effective 1/1/2002
ADDN [) J 6431 University Ave NE, Fridley, MN 55432 (763) 572�604 Bidg lasp
ALTER ( J � �� SINGLE FAMILY AND DUPLEXES R-1 AND R-2
/ BUILDING PERMIT APPLICATION
Construction Address: �y4� �«� ��,� �'�'iU�'
Legal Description: 1�FL/G
Owner Name & Address: �n���-f��i � //✓S�! /�CY�t!���.��� l.fh��E Tel. # %�3'S�a � ��-S
Contractor. MN LICENSE #
AddreSS: Tel. #
LNING AREA:
GARAGE AREA:
OECK AREA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRlPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
�ength o`�-� ' Wdth �� HgUGround ��� Sq. Ft
OTHER: �
�o�o � x !/. S �
Construction Type: L{iDd,v /�'��� Estimated Cost: $ �% ��O ��� S�
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: `� 3a o2 APPUCANT: avv �/�j Tel. #%�3JS7��9�/�"
Call (763) 572-3604 fo� Pertnit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will
call you fo� card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$ i53. a5
� �7� �0 7
$ ,� �
$
$
$
$
$
$
$ / �7
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. "6" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ J Not Necessary [
STIPULATIONS:
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Lot 1, Block 3, CREEKRIDGE
Ths only eaaementa ahown are from plats of record or !nfortnation provided by
cllent
IMe hereby certtiy that thia la a true and correct represertation of a suney of the
boundarles ot the above descrlbed land and the locatfor� of all bulldings and vis-
ible encroachmenta, if any, from or on aaid land.
Sunrsyed by ua thla._.23t�day ot OctobeT _ 19 85
Signed
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No. 6743
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, LO�' SURVEYS COMPANY, IHC.
I.AND SURVEYORS
ftEGISTERED UNDEH LAWS OF STATE OF MINNESOTA
?601- ?3rd Avenue North 660-3093
Minneapolis� MInnesota 55428
NEDEGAARD CONSTR[JCTION � .
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.
INVOtCE NO. 16i85 L
F. B. NO.'�- � 298-39
SCALE I" 20'
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Building
Inspections
763-572-3604
SITE ADDRESS '� U('J ,
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
t P�t. C�O��! 1[ . ���n-i
� ❑ OWNER �CONTRACTOR
NAME: i�al/lv� S /ua f �U\.
ADDRESS: �YCJU tr�e �a�l� �c��
PHONE: � ��j ' �� ;� �I � a Sr
N,4ME:^ I I �.d� CUwT �'+�C +lY-�
STATE LICENSE # �S � N E}
.e,DDx�ss: u.5 t� a S�e1
PHONE ��(� �' l 7 l� FAX
SINGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
❑ ADDITION � GARAGFJSHED
❑ BASEMENT FINISH �9.ROOF
❑ DECK ❑ SIDING
❑ SWIMMING POOL
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR IS�CREMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyi
� Aluminum �
❑ Other
WINDOWS
IN EXISTiNG OPENINGS ❑Yes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENiNG CHANGES &
TYPE OF WINDOW TO BE INSTALLED
C�TY_ —�1`d 1 f
Permit No.:
Rece}�e�r�y
�t��,
Date Rec'd�
DATE
S L1l 1 t( �� CfTY � l i v` STATE�P
❑ WINDOWS
❑ DRAIN TILE
❑ OTHER
LENGTH WID'TH HEIGHT
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
�Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF V✓INDOWS
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTION MCLUDING DECKS,
ADDITIONS. 8e PORCHES SUBMIT:
I. Site Plan/Survey showing the existing swctures
and proposed pro}ect.
2. Two sets of construction pians
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING TI-IE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $%� 5`C°! .� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
$ �_ 3. a 5
$
$ `7,G1 �
$ 3 -°I `i
$ ,'i�117�
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pa_yable to: City of Fridley Attach
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 accurate; that the work will be in
conformance with the ordinances and codes of the City of Fritlley 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 work which requires review and approval of plans.
SIGNATURE OF APPLICANT f?k� v` U/�-1 1 VV `- PRINT NAME �(. V l �rs�� DATE ` L �`� T