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r„r, � ��`t
BUILDING PERMIT
Village of Fridley, Mi.nn• N�
Date
�r' :�,T�7
Addr
. �� ... � � /..� .. .����. .. .. .
��
. . ����? . .�.°./���: . ?� ,p. . . . . . . .
ess . /. � .� . . b�.�.�.'u:'�°. . � . /. . . . . . . . .
2933
� �,� �
.� : �: .�. �. . C g, ,
Builder :............... ......
��"� ,
Address ..�.� ........................�:`�i
LOCATION O BUILDWG
� � Part of Lot
No. .. / � �..... Street . .�. .... .. .... ............... .......................
,. . . .
Loic ...J...�°./........ Block ...��....... Addition or Sub-Division .�'��.°,,�'��L`�.... . �
���� Ge:�
�''� y � � '� . . . . � �
'� . �l�.
��� �t ....... ..... Inside Lot ..... ....... Setback . ..�....... Side ard .� . . ...
DES�RIPTION OF BUILDING
To be Used as:
�
. �4�1��': ." � � . . . . . Front . �. . Depth . ��Height . �. . . Sq. Ft. �� � Cu. Ft. . . . . . . . .
V �
. .. . . .. . . . . .. .. .. . . . Front . . . . . . . . Depth . . . . . . . . Height . .. .. . . .. Sq. Ft. . . . . . . . . Cu. Ft. . � �
, ,��' . �� � To be Com leted � `��:����
Type of Construction .............. Est Cost . � .......... p ...
y-
T i " -'� >
� �_
r �
In cohsideration of the i�susnce to me oE a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
oPdinances of the village of �rridley.
. . ?� , iw��ii�
_ �✓ _ I % (
In consideration oE the payment of a fee of $. . . . . . . , permit is hereby granted t . . . . . . ' �
. . . . . . . . . . . . . . . . . tb construct the building or ad dition as described above. This permit •i5 granted upon
the express cOnditibn that the person to whom it is granted and his agents, employees and worl�aen, in ali work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesot�. regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at arny time upon violation of any of the provisions of said
ordinances. �� /�
� �
c�`,• + � �
�,�..�; . .�,�:�Z��=..��1..� �uilding Inspector
-- — -f� =
NOTICE:
This pe�mit does not cover ihe construction, lnstallatton or alteration for wtring, plumbing, gas heating,
sewer or water. Be sure to see the Bullding Inspe�tor for separate permits for thesa (tems.
��
�
City of Fridley, Minn.
BUILDING PERMIT N� 4132
-�_ _ � .�
Date: _...__.__.._._..��........_.._.�,..�_--� ,..�---_�_��
� ._...�.. Builder ....._.._. ,... ._.., �----......___..._�_._.._...__.__._�.... ...._._..__....
Owner: _. . �-_......_... � .��!.�./_
_ �
Address..._......_.._..._._________._..__.�__ __............_ Address ...-----••-----..-----...---..__.__._..___.�....._._.�.._.__..._.._._.._._.......
LO TION OF BUILDING
No . .... j...... .....�'_........ Sheet ..._.la.-'_'�-F�7..�:✓_.Y.1-�-----����-----......__.............---....-----_.............. Part of Lot ---�--.._..._...._.._.. _..__.._._.�_.._..._.
t� �,�°A
Lot .......�.�..._...._:....... Block -----.......�...._----.........._....... Addition or Sub-Divlsion ..���ae.�A...�/����__i��°J'.�c"°7 �
..- �---•-- Sideyard .---._ .............---•�-•-----•_....--�--------.....-•-----_.._.
Corner I.ot ....._ ..................._........ Inside Lot .... ............................... Setback ....._........-------......_. _.
Sewer IIevation
Foundation IIevation
DESCRIPTION OF BUILDING
To be Used as:
/�"� d er a s m t ,`
�l'%.�� ���2�e�.... Front "�_�'.�... �' Depth ..��.._ ..�.�....'..�`' Height -��--�� Sq. F� •_ -7...�� Cu. F't. ��. ��
f� •_'_-°
--��- .............._......................_.............. Front ....._...-• ---...._.. Depth ............ � � -.. Height ....................... Scl. F� -------..._.....------ Cu. Fk •---._......._...._--
�r / G�-��
Type of Construction ....1.�..-�� ................... Est. Cost.....L�_�..�......................... To be Completed .--�--.......------........---�---......_........
In consideration of the issuance to me of a�rmit to construct the building described above, I agree to do
the prnposed work in accordance with the description above set forth and in compliance �� all provisions of
ordinances of the city of Frldley. ��� � � , _ � _ _ �
�
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 workmen, in all work
done in, around and upon said buflding, or any part thereof, sha11 conform in a11 resPec� to the ordinances of
Fridley, Minnesota regarding loca.tion, construction, alteration, maintenance, repair and moving of buildings
within the dty limits and this permii may be revoked at any time upon violation of any of the provisions of said
ordinances.
����._ �!�_e ....��,�K'�� _ Building InsPector
NOTICE:
Thls permh does not cover the eonatruetion, installatton for wiring, plumbing, ges heaKng, sewe� or water. Be sure to se.s
�he Building Inspecior for saparate permits fo� fheae ilems. -
�
4 '►
�PPLICATION FOR BUILDIIdG PERMIT
CITY OF FRIDLEY, MINNESOTA
Owners Name _ c�v��'Ph' V✓� L��yG�9� Builder �o��Pd� �N 8�� 2,G��.
$ddreas ��� � �� � �/ oc � Address /�G � � a ceJ.y �D,
LOCATION OF BIIILDING
No. Str�et /� ��� o� fv �D Part of Lot
' �a� ap�r i�'1����
Lot � Block � .. Addition or Sub.Div. �� ��� € �a•v �a �!�?'.
��
r:..�.
Corner Lot�� s3de Lot ��� �S�et Back -• � - Side-Yard �
. . , , :,;iT� _ -- .
SEWER ELEV�TION �• � ... � _< � .'.. � FOURIDATION E�l`ATION ; - •
- r .._-.-„-r-
Applicant attach to ��3s n form �Certifieate _ of Survey ' of Ltit .azid proposed biail,ding �
location. `" - • •
`'::ij : . � DESCRiPTION QF BUILDING
- � , ,, .
To be used as: � � �-_ : � . . _., . . . . '
"��_�.;�.;�i��fED•. . � . �.. .� ::.� .� �•
��c r� .� G � ° _F'ront � � - Depth � �. � , Height : � , ��
.. �._. z c � � ,.
�,� �T, - _ C:u. Ft. � �--��
Sq. Ft. ��: . .
�
Front � � � Depth Heigh't
Sq. Ft. Cu. Ft. . � . . : .
Type of Cons�ruction�-C „��� � Estima.ted Cost l��� e�
To be completed � ��� i� . .
The undersigned hereby makes application fdr a permit for �he work herein apecifi�d�
agreeing to do a11 work in strict accordance with the City Ordinances and rul3ng:of
the Department of Buildings, and hereby declaxes tha.t all the facts and representa-
tions stated.in this application are t�ue and correct..
DATE � °./ � ° �% SIGNAT.U�tE __
- � �
(A Schedule of Fee costs cari be'found�on the Reverse Side.)
,"" '�; �_?�.�.....
: �iJ' ..
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.. �>_%�r�:: `,:;.r.. _
___. ..._.. _.__._ ._. .. _. ..___BUILDIlVG PERMIT FEE SCHEDULE
Se��3.can_�. The Inspector of Buildings sha11, before is,�,uin�, any permit
for the erection oi any� buildir� or. �;�ru�ture, or for an�r additiori°�to--••---� ����f' '=�:.-:::.�,,
any existing building or structure, or fbr �,ny alterati.�ns_or repaire to
� any e�ti'st�ng build�ng or structure,.,��on. �p�lication therefor' require~---------�.-. �������:���,�'.
the pa�nent by the applicant for such perniit� of fees;-:�,q the amount
here� °b�i�-� s�t...f.��th-�:�.nd� i�a ,;�he ma.nner herein provid.ed to-wit:
._._.
�:i"�'or any-�uc.}�..perr�.it fqr, ,�h� . erection of any fii�eproaf -k�ia.3:ldi:�ig;�.,.. y� �NS.F +: �;T
other than a garage, waxehouse,�factorg'or�grain elevator, or for the "�- �
erec�it�n -of� a:ny fireprt�o�^addition, for s�milar occupg�tcy, to aiiy � _.
.�..__.. .. ._._.... ' :1: i
exist3.ng building shall be�� a�- th��-ra�e .o%.�]:�t�0.� for; each one thousand �
cu'�iic'�e�t�-�oar fra.. �tio�i.the�eof, ,in. �uch cubical cori��nts. �° � � ._.__._ _ -;,. f...,.,�`
. .;,. ;_
2.2 �� For �.ri.y `such per�nit f.or the ,erec�ion of any fireproo� •g�age.,,..�r�e.� : ;r,�.; ;r •=: :�::-_��,
house, factory or grain elevator," or �t�r the er�ction qf ,ar�y firegroof
addition for similar occupanc�, to any existing building shFL7.1 b� �.�t ��b�.�: ;-;_;,: ;: :: {^;
rate of �1,25 for each one -t�Y�o�.�and c�bio -feq;�.a,; classified as "firepr�of" ,:;.; :,-.,..
. .:.. ,_�:�ry�:
by Section 502 of the Minneapolis Building CocTea
� t�
--�E��IJ.5ES..... _.�. _ . _ . ; . z . •
2.3 For any such �p�r�� �a�.t�,�<.�erection of any non-fireproof buildiri�� `'�='�`�T .�,• �R'
,
..._.-
other than a garage, warehouse, factory or�'gr�r.in-e�evator�t or any
non-fireproof addition, for siLnilar_ occupancy, to an�r existing ��iiififid�g�. �•��.......__„_ �
--�.eam�..:�_.�1,00 for :�ach one thousand cubic'���et: ��--��-•' t' �°•��
.�_..._ .
.. .. ... ..___.._.._..___�__
,,
.� _.... . , r ... . ..
_......_. _ .
GARAGES ' ...._._..... _.. .,•;;
2s4 For any such permit for the erection of any non-fireproo��g�a.ge-� --� ... ._,___
•-- -�rarahouse�._factory or .grain elevator,��or �far t�e erectiiii�_of any non-
fireproof ad�.i��o�ri, ��for simil�.r .occupancy, to any existing builcT�Tg-o�•----�-� •='ti .;::
�--� �ar..e�.ch such bailding or additione �Nin�ty--Gents fo�._each_one:.,,..,...r._,. .
thousand cubic ��e�t crr• � f�act�.o.n thereof, in the cubical contents tfier�of �' �' � r+ Y�T�:,.`
. .
, ... , .. . .
l�w��� '� ...__
�, . � � e . ^ � .... . . _ .. _ .. _
min. ' •�a„f_ 4 00
. -• �. ��,:�. .,,.. , ... . � � --.___ - .
• � ... • . ' • . _._.__t:: . ... :�7;-:� .;tfi
'' `�or� =ti�e� pu7c�osq, o�` �com�u�ing fees �for bu�lding pe�Zn.h.ts :�the .cubical . .
contents of any bu.ilC�ing �or �a;c�dit,i:on to . a_ uniforrii °Yieign� throughqut b�'� �•' �'��' ��� �!
multiply�ing th2 �rot��d �.»ea��c�vered from..a point��s�x.�(6)��.�nE�ies�,below �°�'���'''°_�.
-�-• �..th�.. fl�or line oi -;.ne base�en.�c or cellar to the a`vgr�,g�; he�.ght ;of the �'�'`�'`��` ::`��
upper s�urf`ace oY�°� ;,o -�.�--�.T:er�.�.e�height of the . roof surface of the main -' �� �� •_�� .'
gable of a pitched r.00i .. ��
, _.. .
. _.._...._
. ..�.__........
. , _ . , .�, � _ .. ..._..__ .__... .... :._ ._.... . "t:.C�
2 0 5 For repairs or e,l ��ration� to ar� existing s`t'r`'u�t��, .:��te •..f,ee. , shall .
be at the rate of �3,C0 for each Five Hundred Dollars (�5�.00�, �or ���J ='�?
fraction thereof i:� t�.e co�t of �11 proposed work,
2.6 In no case sh�ll the fe� ch._irge� for any permit as set forth in
Section 2 be less thaa.l �/�.00.,
�
� ~ b • ' � n �u ��
su9�¢tt , P .
City of Fridley 3 0 7 2 2
AT THE TOP OF TNE TW�NS � � I L D I N G P E R M I T
�
� ` RECEIPT NO.
� ; L __��� COMMUNITY OEVELOPMENT DIV. ��� .
r � � PROTECTIVE INSPECTION SEC.
i . �
� � /�"1 � CITY FIALL FRIDLE� SS�3i NUM�E11 REV OATE oAGE Of AI4VitOVEO BY
������' �'' 612-571-34b0 s�aF�S 3/13/00 � /
�oe ao�aess 136 Crown Road NE
t LEGAL �OT NO. BLOCK TRACT OR AbDiTION SEE ATTACNED
�ESCR. j.2 2 Carlson's Summit Manor North Addn SMEET
2 PROPERTV OWNEq MAIL AOD:iES$ 21P PMONE
Nick Pietig 136 Crown Road NE 586-9201
3 CONTRACTOR MAIL ADORESS 21P PNONE IICENSE NO
Same
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO
8 USE OF BUIIDING
Residential
7 CIASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION [� REPAIR O MOVE O REMOVE
8 DESCRIBE WOfiK
Reroof House, Garage, Shed (24 Sq) Tear-off
9 CHANGEOFUSEPROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CCNST OCCUPANCY GROUP OCCUPANCv LOAD
SEPARATE PEiiMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING. MEATING,
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTi;UCTION 20NING SQ. FT CU FT.
AUTMORIZED IS NOT COMMENCED Vji1THIN 80 OAYS. OR tF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO fOR A PERI00 OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV 7HAT I HAVE READ ANO EXAMINEO TMIS APPLICATION ]. STAILS GARAGES
ANO KNOW THE SAME TO BE TRUE ANO COFiRECT. ALL PROVISIONS OF �AWS VALUATION SURTAX
ANO OROINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIEO
WITM WMETMER SPECIfIED MEREIN Oii NOT. TME GRANTING Of A PERMIT �2a098 �1.OS
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqM1T FEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL lAW REGULATING CON• $83 � 25 F+'ir SC �2. LO
STRUCTION OR TNE PERFOFiMANCE OF CONSTFUCTION
P�AN GMECK fE TOT EE
$,6.40
S�GNATUFlE OF CON"AACTOp Op oUTNOA�2E0 aGENT IDATEi EN RO ALIO MIS I�UA P
� � �;� - .�
�GNATU�7 OWNEA OWNEpBU�LOEA� ATE� Bl �NS� �� TE
NEVV [ j
ADDN []
ALTER [ J
Construction Address:
Legal Description: _
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/2000
(763) 572-3604 Bldg Insp
� /- ��
Owner Name & Address: � �� i Tel. # 6/� ��-�i
Contractor: � � MN LICENSE #
Address: Tel. #
LMNG AREA:
GARAGE AREA:
DECK AREA:
OiI�iER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width HgUGround Sq. Ft
� ������/ � s��� �o!d�, �
Construction Type: ���i/-� Estimated Cost: $ ,-�Y' �t��.�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: APPLICANT: � Tel. # �/,,.� -`%�%�/�
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
$�.3.�.� Fee Schedule on Reverse Side
$ o,%, �� .001 of Permit Valuation (1/10th%)
$ % �3 S� $.50/$1,000 Valuation
$ _$1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
,,: I
�
BUII.DING PERMIT FEE SCAEDULE
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 e�sting 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,OQ0
$25,001 to $50,000
$50,001 to $100,Q00
$100,Q01 to $500,000
$500,(�1 to $1,Q00,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $1(m or
fraction thereof, to and including $2,000
$69.25 for first $2,OQ0 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $85,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1, 000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,0{� or fraction thereof, to and including $5�,000
$3,233.75 for the farst $SQ0,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,OU0,000
$5,608.75 for the iust $1,(m0,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
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 $23.25.
VERIFICATION OF FOUNDATION
Permits for conslruction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site. �
A Certificate of Survey of the lot, showing the locatiQn of the foundatian once ��t `has it has been constructed will
be required before proceeding with the framing. New Hotises Onlv
sue�etT PE
c�ty of Fr�a�ey 3 0 897
AT TME TOP OF TNE 71NINS g � i L D i N G P E R M I T
r
; � REC IPT NO.
� ; v _�___ � COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � � ��
i� i �
---. w ��'��,'� CITY NALL FRIOLE� SS1J� NUMQEp pEV DATE PAGE Oi APPROVEO BY
t �� 612-571-3450 9ta-F15 5/2/00 / /
JOB ADpRESS 136 Crown Road NE
t LEGAL ��T NO. BLOCK TfiACT OR ADDITION SEE ATTACHED
oescR. 12 2 Carlson� s Summit Manor North Addition SHEET
2 PROPERTYOWNER MAILADDRES$ 21P PMONE
Nick Pietig 136 Crown Road NE (763) 586-9201
3 CON7RACTOii MAIL ADDRESS YIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION {�] REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WOfiK
Replace front steps; concrete patio with foundatiott
9 CHANdEOfUSEFROM TO
STIPULATIONS
See notations on plan.
TYPEOFCONSL OCCUPANCY(3RpUP OCCUPANCYIOAD
SEPARATE PERMITS ARE RE�UIRED FOF ELECTRICAL, PLUMBING, HEATING,
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. fT CU FT.
AUTMOR12ED IS NOT COMMENCED VYITHIN 80 OAYS, OR IF CONSTIiUCTION
OR WORK IS SUSPENDED OR ABANDONEO fOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WOiiK IS COMMENCED. NO. DW�G. UNITS OfFSTREET PAFK�NG
I HEREBY CERTIFY THAT I HAVE READ ANO �XAMINEO THIS APPLICATION 1 STA�LS GARAGES
AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAW$ yqLUATION SUfiTAX
AND OROINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITM WMETMER SPECIFIEO MEREIN Ofi NOT. TME GRANTING OF A PERMIT �2fOOO �I..00
DOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CANCEL TNE pERMIT fEE SAC CMARGE
PAOVISIONS OF ANV OTMER STATE OR LOCAL LAW REGUTATING GON• @�9.25 F�Y' C�Z.00
STqUCT10N Oii TME PERFOiiMANCE Of CONSTRUCTION y�
„ PLAN CMECK F 70iA E,
e a,
�� .2.5
S�GNATUAEO� CON"AACTOA p4UTMOA�ZEDOGENT iD�iEi MEN ROPE ALIDAT D IS V R P RMIT
r 1�
S�GNaivaEOFpwHEA��iOWNEi1BUILDEiii iO�TE� Bt �NS� - 06TE
NEVV [ ]
ADDN []
ALTER [ ]
Construction Address:
Legal Description: �
Owner Name & Addre
Contractor. ��-.
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
0
Effective 1/1/2000
(763) 572-3604 Bldg Insp
�q7
�' ���
�
_ �� � � � �
MN LICENSE #
Address: �,ti�, A�-- Tel. #
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Sq. Ft
• ,
�
Construction Type: ��,,�,��; ��� Estimated Cost: $ �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: APPLICANT: Tel. #
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ •-0�5` Fee Schedule on Reverse Side
Fire Surcharge $_ �, bb .001 of Permit Valuation (1/10th%)
State Surcharge $ /, Ol� $.50/$1,000 Valuation
SAC Charge $ $1100 per SAC Unit
License Surcharge $ $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ 7�• o?J�
�
BUII.DING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,�1 to $25,000
$25,(�Ol to $50,000
$50,001 to $100,000
$100,(�1 to $500,000
$500,�1 to $1,000,000
$1,0�,001 and up
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 $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,(�0 plus $7.00 for each additional
$1,0(� or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,� or fraction thereof, to and including $500,000
$3,233.75 for the fi�st $500,000 plus $4.75 for each additional
$1,0{� or fraction thereof, to and including $1,000,000
$5,608.75 for the fia�st $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the constntction 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. New Houses Onlv
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Building
Inspections
763-572-3604
DATE � ��DP� ��
SITE ADDRESS 131�
THIS APPLICANT [S:
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
Pernut No.: ��� -D��f�y
Received By:
�� �'�: ° � Z00%
E-MAIL ADDRESS W�.c� � r�o I�c Dc CD P1�1
❑ OWNER �ONTRACTOR
ADDRESS: ^ C�y
PHONE: �I S � �
NAME:
STATE LICENSE #_
ADDRESS:
PHONE
❑ SINGLE FAMILY/NE�
❑ TWO FAMILY/NEW [
Renewal By Andersen
1920 County Road "C" West
Roseville, MN 55113
License #20130983
651-264-4777
❑ BASEMENT FINISH ❑ ROOF
O DECK O SIDING
_ ❑ SWIMM
NE W
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
ROOF7NG
NUMBER OF SQUARES
G.�AwG�S
PROPOSED SIZE:
PROPOSED HEIGHT:
ADD[TION
0
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
O DETACHED GARAGE
ATE ZIP,
r STATE ZIP,
❑ DRAIN TILE
� OTHER
BASE NT FMQD� ING TBMIT•
l. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
�IDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ,ApDITIONS & PORCHFS S BMIT•
0���� ❑ Trim 1. Site Plan/Survey showing the existing svuctur
O Fascia
and proposed project,
WIN�WS 2. Two sets ofconstruction plans
IN EXISTING OPEMNGS OYes �No LOCATION OF WINDOWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USIN T 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ��, �/� � OCCi7PANC'V �rwF
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$
$ S (�O -
$
$
$
$
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 ResidenNal Contra.ctors)
$1550 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 payable to: City of Fridlev Att9�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNfIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not
permit but only an applicarion for a permit work is not to start without a permit; that the work will be in accordance with the approve
plan in the case of all work whi requires r v' and approval of plans.
SIGNATURE OF APPLICAM' P NAME �('/), r/1 ��lri DATE