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AF - 43262� � � �� City of �ridley, lltinn. N° 7726 BUILDING PERMIT ��; dune l�, 1965 p�; Don �leictmer �� 3uuer%r �oxicrete Ada�s 172 Cra�m Road N. E. Adaress LOCATION OF BUILDING No. � 3t�eet Cl'oT�tA $O�d N. E• Part oP Lot Lot 15 _ Bl�k 2 Addition or 5ub-Divlsian ��0�� Swo�.i.t �anor� NoPth Corner Lot Inside Lot Setback Sideyard gewer IIevatiam — Foimdaa.tion IIevation D�SCRIPTION OF BUILDING To be Used sa: �. Garage Front Depth He3glnt Sci. Fk c�. F't Front Depth I�efght Sq. F't C�. Ft Type of Construct4on Fr2II� F�t, Cost �924..00 To be Campleted NeW GeTBge In consideratton of the i�uance to me of a permit to conatruct ttse building described a�ve I agree to do th� PrnPo�efl work 9n a�rdance with the d�scription above aet forth and ffi cbmpliance with afl proviaffons oP ordinancea oP the dty of Fridley. In cro�s[deratton oP the payment of a fee of $�.� � P�t ia hereby granted to-Su,.pex3ox Co13CY�e'�e to construct the bufiding or additfon as d�cx'ibed above. Thfs permit is granted upoa the egpre� cAnciitfon that the to whom it fs granted and his agents, e�]nployees and worlQnen, ia all work done i4 around and upoa eai huilding, or anyp� thereof, shall conform in all reapects to the or�linanc�s of FridleY� Minnesota regar+dtng loc�tlon, cwnstruct%n� alteration, ma3ntenance, repair aad mov3ng of buflaiags within the dty ]imiffi and tbis permit may be revoked at aqy time upam violat3oa of aay oE the Provlsions of said ordinan�. 1l en Jensen Buiiding Inspector N01`ICEa 11d� � doa eef eowr t6s tonshnati�. Ie�taQa�ton Me wWeW Pluml+IeB. an 6�atiag, ssrra� or rrder. Bo sans ts a� ' Hn Batl� �or tar qpanf� � ter 16as �. AEPLxCATION FOR BUILDING PERMIT � . �ITY OF FRIDLEY,,MINNESO�A " � o�. OWNER' 3 NAt� ,� �� y BIIILDER . � . � . � ADDRESS � `%� ✓� �_ � ADDRESS - � � � LOCATION OF BUII�DING No. • ,�--�� ' . � � StYeet (�L , Pait of Lot+_,_ LOT BLQCR � ADDITION OR SU�DIV'ISION��i �� Coraer Lot ,Ineide L0� Setback � Side-Yard � � � .r.__ _�.. . S�WEIt ELEVATIOIJ � _ . . � FOUNI)ATIOR . ELEVAZ"ION Applicant attach to this form Tuio Cert�fic�tes of Survey of..�,ot and proposed building location drawu on these Cartificates. . ' � � • • � DESCRtPTION OF SII�DII�TG To be used as: " � ..�. . • � Front Depth��°�--_-fleight /'� . ... Sq. Ft. � Q ,� Cu. Ft. �'��- a � � -- ._ � - � - — . :: Frant � nept _________Heighf . . . " .. �• . Sq. Ft. ' Cu. Ft. Tqpe of Coate��ruction - �- • �Estimated C �o�-� . � To be•compleCed � � The under�igned hereb� malfes $pplication for a permit•for the work �iereiri specified, agreeing to.dc all work in strict accordance with Che City..of Fridley.Ordinances arid rulings,of the DepartmenC of Buildings, and h�reby declares that a11 the facta and representatioris statefl in this applicaCi are true_and orirect.� ` � � �� , � � �� (Schedule of Fee Costa can be found on thd�Revi ^ - _. � ` .. . „ „ ., Side).; l' � �� D 0 BOILDING PERI�IT FEE SC1iEDULE SEG°!''!ON 2. The Inspector of Building� shall, before isauing any parmit for the erection of any building or atructure, or f�or any additioa to any esisting build- ing or atructure, or for any alteratioa� or repairs to any eaistiag building or atructure, upon applfcation therefore, require the payment by the applicant for such permit of fees to the amount herein below aet forth and in the manner herein provided to-wit; 2.1. For any such permit for the erection of any fire-proof building, other than a garage, warehouse, factory or grain elevator, or for the erection of aay fire-proof additiou, for similar occupancy, to any existing building, aha11 be at the rate of $1.40 for each one thousand cubic feeC, or fraction thereof, in such cubical contents. 2:2. For any such permit ior the erection of any fire�groof garage, Warehou8e, factory or grain elevator, or for the erection of anp fire-proof addition, for aimilar occupancy, to any existing building shall be at the �cate of $1.25 for each one thousand cubic feet, clasa3fied a� "fireproof" by 5eceioa 502 of the Minneapolis Builditig Code. HOOSE$ � 2.3� For any such permit for the erection of any non-fireproof building, other than a garage, warehouse, factory or grain elevator, or any non-firepraof addition, for similar occupancy, to any exiating building - permit $1.Q0 for each one thousand cubic feet. GA`RAGES 2.4. For any such permit for the erecCion of auy non-fireproof garage, warehouse, factory or grain elevator, or for the erection of anq non-fireproof addition, far s3milar occupancy, to ar� exietiag building or for each such buildin� or addition - niaetq cents ($0.90) for each one thousand cubic feet or fraction thereof, in the cubical co�etents thereof with the minimum of $4.00. For the purpose of camputing fees for building permits, the cubica! contenta of any building or addition to a uniform height throughout by multiplying the ground area covered fr� a point six (6) inches below the floor liae of the basemeat or cellar to the average heiglit of the upper surface or to the average height of the roof surface of the main gable of a pitched roof. 2.5. For repairs or alteratioss to an ex�.sCing atructure, the fee ehall be a the rate of $3.00 per each Five Iiundred Dollara ($500.00) or fractioa thereof in the coet of all propoaed work. 2.6. In no case shall the fee charged for aay permit as aet forth in Section 2 be less thaa $4.00. � � � � � �- . _. - �. � � City of Fridley AT THE TOP OF TME 7W�NS g � I I� D I N G P E R M I T r � • � � � • COMMUNITY DEVELOPMENT OIV. � VV �"�� r � � P� =�� SE�. � _ , � �"'1 � CtTY MALL FRIDLE� SS132 NUMBER �""�' �'� 612-571-34b0 9t0-F15 10B ADDRESS 172 Crown Rd NE �E I v�GE Oi 9/17/98 � � 1 LEGAL �OT NO. BLOCK TiiACT OR AODITION oescR. 15 2 Carlson's Summit Manor North Addn. 2 PROPERTY OWNEq MAII ADDIiES$ 21P Ross Bleichner 55421 3 CONTRACTOR MAIL ADORESS Owner Same d AFiCHITECTORDESIGNER MAILADORESS 5 ENGINEER MAIL ADDRESS 8 USE OF BUILDING Residential 21P ►,�. ��3 �vEO Br SEE ATTACHEO SMEET PMONE 574-9778 PHONE LICENSE NO PMONE LICENSE NO. PMONE LICENSE NO 7 CIASS OF WORK p NEW O ADDITION O ALTERATION [� REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WORK Reroof house & garage (15SQ) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS AiiE REOUIREO FOR EIECTRICAL, PIUMBING. HEATING. VENTI�ATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONI! AUTHORIZEO IS NOT COMMENCED W.ITHIN 80 OAYS. OR IF CONSTRUCTION OR WORK IS SUSPEN�ED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AfTER WOqK IS COMMENCED. NO I I MEREBY CERTIFY TNAT I MAVE READ ANO EXAMINEO THIS APPLICATION ANO KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS yALU� AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED WITH WHETMER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME pEqM PqOVI510NS OF ANY OTHER STATE OR LOCAL LAW REOULATING CON- STRUCTION OF TME PERFORMANCE OF CONSTFUCTION O�C •p ?OA AUTMOp�2E0OGENt IOATEi � � i )� OWNEp�� ON�NEpBU�IDEAi �D� � ti OCCUPANCY WLG. UNITS STA�LS TION $1,285.00 f FEE $43.00 LOAD CU FT. OFFSTREET PARKING IGARAGES SURTAX $.64 SAC CMARGE Fire SC $1.28 TOTA� F $44.92 T IS IS Y PERMIT� � � r��TE NEw ADDN ALTER [] �� t� ConstructionAddress : CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION 9 F� Effective 1/1/98 �D � �� \� � � Legal Description: Owner Name & Address: �cJ �S 'Q � ��„ �n o ,>- 1 � � C�, � � �C Tel. # � � `� � � 7 � � Contractor: — MN LICENSE # ---- Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Construction Type: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT Length Width Height Length Width Height Length Width HgtlGround sre ,�-�� L.._, ,. � �...C��,., � A �o 0 1 � � Estimated Cost: $ Tel. # Sq. Ft. 5q. Ft. Sq. Ft. ��>.� (Fee Schedule on Back) Driveway Curb G�tt Width Needed: Ft. + 6 F= Ft x$ _$ DATE: �i /`7 `� APPLICANT: � � Tel. # S 7�' I 7 7� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL . STIPULATIONS: CITY USE ONLY $ `�� ' � Fee Schedule on Reverse Side $ /� � j c�1 .001 of Permit Valuation (1 / l Oth %) $ �� / $.50/$1,000 Valuation $ $1000 per SAC Unit $ $5.00 (State Licensed Residential Contractors) $ Alt. "A° or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Engineering $ Agreement Necessary [ ] Not Necessary [ ] $ � 1 .. BUII.DING PERMIT FEE SCHEDULE The Chief Building O�cial 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 $�U1 to $2,000 $2,001 to $25,000 $25 , 001 to $50, (?00 $50,001 to $100,OQ0 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62. 25 for first $2, Q00 plus $12. 50 for each additional $1, 000 or fraction thereof, to and including $25,000 $349.75 for first $25,Q00 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1, 000 or fraction thereof, to and including $100, 000 $887.25 for first $1Q0,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,000,000 � $5012.25 for the first $1,000,000 plus $2.75 for each additional $1,OQ0 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Streets Only) Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50. Altemate "B": Removal and replacement of curb and gutter and install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. . A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. ... _ .. � o�-o��s� Building MECHAlvICAL Inspections RESIDENTIAL APPLICATION 763-s�2-3604 CITY OF FRIDLEY 763-502-4977 FAX FFFG(`TNF 1_111R DATE "j" L SITE ADDRESS _ TEIIS APPLICAN'P IS: OWNER/ TENANT CONTRACTOR NOTE: SEPARATE C1TY LICENSES ARE REQUIRED FOR GAS AND HVAC. JB1bIIT COPY OF BOND_ AND INSURANCE PERMIT TYPE TYPE OF W ORK: ❑ OWNER �JCONTRACfC NAME:� ^ c ADDRFSS: PHONE: // co��r xnME: 11(' rnwtm e nm ucvcni.i. ![�If�3�� '�y f Pernut No. �� Received By: � r Da ��AY � � �� ' STATE ZIP l�tJ � ' ' fj� SII�IC3I.E FAMII.Y O TWO FAMILY r � ❑ NEW �REPLACEMENP DETAILED DESCRIPTION OF WORK O TOaR�HOUSE � ALTERATION/REMODEL PER MS 16B.665 the �rermit fee is a minimum of $1g.00 or �% of �e total cost np to $500.00, whichever is greater, for the improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor ) OR Labor cost under $3Q0 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS = FOR PROJECTS WEIERE LABOR EXCEEDS $SQO, FEES ARE BASED ON $IO.QO PER FIXTURE, EXCEPT WI�RE NOTED. FIXTLJRES: (INDICATE TOTAL NUMBFR OF EACH BELOR� /� Equipment Insfslled MFG: MODII.: �`J ��lY� SIZF/BTU MFG: MODII.: � SIZFJBTU MFG: MODEL: SIZFJBTU �A/C $24.00 AiR TO AIR EXCHANGEER $15 BOILER $35.00 CEIIlIRNEY LINER $10.00 DUCT WORIC $10.00 Permit Fee Surcharge TOTAL DUE FIREPLACE (GAS) $15.OD _GAS RANCiF/OVEN $10.00 �IItEPLACE (WOOD) $33.W NEW GAS CiRII,L $10.00 FURNACE $35.00 GAS UNPI' H1R $10.00 _GAS DRYER $10.00 _POOL HEATER $35.00 GAS PIPING $10.00 VENTII.ATOR $15.00 $ .50 $ . MINIlVILJM 515.50 OR � PERARIT FEE �OR PR(3JECT$ OYER $500 Number of fixtures @ $10.00 � x $10.00 = � Number of fixtures @ $15.00 x $15.00 = $ Number of fixtures @ $25.00 x $25.00 = $ Number of fixtures @ $35.00 % x $35.00 = $� State Surcharge = $ .50 AIINIl1�[JM $15.�0 T � . _ THIS LS AN APPLICATION FOR A PERArIIT-NOT VALID UNTIL PROCESSED I heteby apply for a maohanioal permit and I�kaowledge that the informetioa above is oomplate and aoourate; that the work will ba in oonformanadwith the ordinanoe,s end oodes of the City of Fridley and with the Mume�ote Constnwtion Cad�; Wat I underatand this is not a perniit hut only an applioation for a patmit and work ie aot to atact without a�i the o will ba in rdenoe wit6 the approved plaa in the aase of all work wluah re,quires review and approval of pl�s. � M1nn ��" I `�/,-,� 9/�l �Z�1 C�-1 SIGNATURE OF APP �� `��NT NAME I( V�� t� V'�''' DATE F, • . . � �� APPROVED BY City of F�idley Baildimg InspectYons Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 C•,��L DA�