AF - 43097�
City of Fridley, Minn.
BUILDING PERMIT
n
�
N° 3072
. C� './,� �' � �
Date: .. ....�V...... ..
Owner �. � . uilde .� . , . . . !. �,.a2i��.�!�-�
. . . . . . . /; • +� • Q
Addre�ss ..��%.�!.. . .............. Address ....�0 �. ....... .................
LO�CA IaN OF BUILD[NG
No. ac! �v .. Street ... ................................ Part of Lot ...... ...... . ...
LoY„Q_ ./�. � .�Block . . . . Q. . . . . . . . . . . �ddition or Sub-Di 'sion . . . . ' .� `�`��. � . . .
Corner Lot . . . . . . . . . . . . Inside Lot . . . r . . . . Setback � � . . . . . Side rd . . � � . �. . . . . . .'. . . . . . .
D C [PT[ON
T b tJ as•
. . , . . . � . . ront .aS�� . . Depth � / . . .
Type of Construction
........ Depth ......
'!:L1 .... Est. Cost.��
��,��� �'� � ��
OF BUILDLNC
Height���JG��
Height ...�
�.�a�......
Sq. Ft. �! .�1. . Cu. Ft. . . . . . . . .
Sq. Ft. ........ Cu. Ft. ........
To be Completed . .� �. .. ... ..
In consideration of t7ie issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
� . . . . . . . . . . . � . �C,'1�I�!:r�. . .
In consideration of the payment of a fee of $. .��! O�rmit is hereb ranted t
P Y g ................
... .. .. .. .. .. .. .. ... .. ... to construct the building or addition as described above. This perxnit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in ali work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of ap3j of the provisions of said
ordinances. / %% i //
NOTICE:
This permit does ,not cover the construction, installation or alteration for wirtng, plumb,ifig, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
'�,
- �
'`�
� � PUBLIC WORKS
� ANCE
F�RI�DL,�EY
DATE September 3, 1986
FROM �n Carrigan, Water Foreman
SUBJECT
500 Dover Street N.E.
MEMORANDUM
TO
The sewer and water have been inspected at 500 Dover Street and the water meter
is hooked up. Everything is ok.
� a-x� �
Don Carrigan, ti9ater For n
INFO
�
_
Ct1YOF
FRtDLEY
CNIC CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MINNESOTA 55432 • PHONE (6l2) 571-3450
September 5, 1986
TO WHOM IT MAY CONCERN:
Re: 500 Dover Street N.Et, Fridley, MN
Dear Sirss
0
This is to inform you that thE sewex and water lines�for ths ahove add�ess
were installed in 1962 and the sewer has been billed since that time.,
The water meter was taken out in 1978 bu� the water was just connected to
the dwelling in Septeznber, 1986.
The water departsnen t has made their inspections on this connectibn �nd they
have approved the connectibn.
If you have any questinns on this matter, please feel free to contact me �t
571-3450.
Sincerely,
DONALD CARRIGAN
Water Foreman
DC/mh
SUBJECT
City of Fridley 2 O 5 O 7
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
i • RECEIPT NO.
� �• COMMUNITY DEVELOPMENT DIV.
r � L � PROTECTIVE INSPECTION SEC. 3 7��Q
� �
� �
� � /"'1 � CITY HALL FRIDLEV 55432 NUMBER REV. OATE PAGE Of APPROVED BV
�_'__�; �.' bi2-571-3450 910-F15 8/8/90 � /
JOB ADDRESS 500 Dover Street N.E.
t LEGAI LOT NO. BLOCK TRACT OFi ADDITION SEE ATTACHED
SHEET
oesca. 1, 2, 3 8 Spring Brook Park
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
John Lewis 500 Dover Street N.E.
3 CONTRACTOR MAII ADDRESS Z�P PHONE IICENSE NO.
Shep's Construction 2177 Shad wood Road [ni� zata MN 55391 471- 0
4 AFCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGtNEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CIASS OF WORK
❑ NEW C� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
��3�i Constxuct a 25' x 11� Deck.Additian� Remove window and add patio door
9 CHANGE QF USE FROM TO
STIPULATIONS
See notatians �� on �lan.
W�Rt�1HG
�efore diggrng ca11 fot
all uii�i�i loc�tiort�
�A-0002
R�QUIRED 8Y i,A�V
TYPE OF CONST. OCCUPANCY GfiOUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITNIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOFK IS COMMENCED. NO. DWLG. UNITS OfFSTREET PARKING
I HEfiEBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION �' STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLtED $3�SQO $]-.']S
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OF CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $63, OO.
STRUCTION OR THE PERFORMANCE OF_ ONS7RUCTION.
� � �7 PLAN CHECKFEE TOTALFEE
�> <�� �. $64. 75
- S�GNATURE OF CONiaAC OR AUTHOR12ED AGENT IDATEi HEN PROPEFi Y V IDATED THIS IS YOUR PEFMIT
a ` ' �����
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SiGNATUAE OF OWNEFliiF OWNEFl BU�LDERI iDATE� BIDG �NSP �A �
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MARK SHEPHARD ,� '. j �� !! I
2177 SHADYWOOD ROAD ' � '
� WAYZATA, MN 55391
� � 471-7006 � � ' �
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NEW [ ] Effective 1/1/90
ADDN [}� R-1 AND R-2
P�L'I'EEt [ ] Building P�ermit Application
construction �s.s: � � � a�o V�►2 �S.,i -
Legal Description:
owner r�ame & Address: �f C� c-f rv �. `.w l s Z�e.t. #
c'ontractor: c5C-�c=t� ,S G� c�S� Te1. #� ZI �7C�0�
�: 2t-�� �st�����vc�� �t� iN�'�' �� �"� r�r� ����39 �
Attach to this application, a Certificate of SuYVey of the
lot, with the proposed construction drawn on it to scale.
., «• ., . � r •.. a� ia�
LNII�1G AREA: Iength Width Height Sq. Ft.
C�R�GE AREA: Lenc�th Width Height Sq. Ft.
DF�R AREA: Lerigth �� -�a Width (�� � Hgt/Graund o� o Sq. Ft. Z�4 d Zr55to►
,
OTi�R: REr-�c:`i` �...�fiV �' f��r� t'�A <<C� c..1("'�(? 8
25� �C �?. � ���?. � a -4 4du ^.
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yan3 Setbacks
'Ij�pe of Construction: wo�� �=r�Ar�-r �. Estimated Cost: $ 3�[`>C� ,�
Approx. Oca�letion Date: SE� ; ���r--�
Proposed Driveway Width If N�a Opening Is Desired: Ft. $ $
' th + 6' See Back Page
L�ATE: �- Y���j APPLIC�IV'r: �'"�� Tel. #,4 7J � TOC�,
CITY USE ONLY
.
Permit Fee $ �p 3, C�(:��y: `���� Fee" Schedule on Reverse Side
-� �: ;�.
state surcr�arge S 1; �'�r ;_�,�'�.'... $:�d/Sl, o0o valuation
SAC Chazge $ ���°'��'n� '�";,�600 per SAC Unit
,,, "'� `� ,
I1Y'1V@4Tdy ESCY'C1W $ .� r, �n .�•t: ��A�� OY' Alt. °B�� AbC3V2
Park Fee $ � � , , ' ` �Fee Determined bY �J�r�J
Sewer Main Charge $ Agreemexit Neoessary [ l Nat NeoessaiY []
�mrp,L S % �Q
s�z�zzorrs �ls
3� ,c�c�
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ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
s�2-36u4 r�aa�:
: 500 DOVER ST NE
: 033024310084
: LTNAVAILABLE
: LOT BLOCK
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
571-1ZIi7
2 3�v
PERMIT NO.: 2004-00135 �
DATE ISSUED: Ol/28/2004
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER. COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
REPLACE FURNACE (WARM AIR, TRANE, 80,000 BTU)
VALUE OF APPL OR WORK 0 # FURNACES 1
# GAS DRYERS
APPLICANT
PRIDE HEATING & AIR COND INC
22713 BUCHANAN ST NE
EAST BETHEL, MN 55005-
OWNER
HATCHNER TIMOTHY P
500 DOVER ST NE
FRIDLEY, MN 55432
0 # GAS RANGES
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 governing this type of worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give autharity to
violate or cancel the provisions of any other state or local law
regulating construction ar the performance of construction.
Applicant Date
Bldg Insp
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 3870
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0.00
30.00
0.00
0.00
0.00
0.50
30.50
`i
1
\
CITY OF FRIDLEY INSPECTION DIViSION � Effective On January 1, 2002
6431 University Ave NE
Fridley, MN 55432 APPLICATION FOR POWER PLANTS AND HEATING, COOLING, VENTILATION,
(763) 572•3604 REFRIGERATION AND AIR CONDITIONING SYSTEMS AND DEVICES
JOB ADDRESS__,� t XJ��� ��:%��J
RATE SCHEDULE 1:_i��a `
OWNER�C�' L�t�l C_'il� Y�'1.C�il '
Residential
Furnace Shell and Duct Work, Burner -
Also Replacement Furnace
(Side Vent - Fill Out Back)
Gas Piping (Needed with new furnace,
but not replacement)
Gas Range
Gas Dryer
*Air Conditioning - All Sizes
All Others/Repairs & Alterations (LIST ON BACK)
1°Jo of Value of Appliance or Work
Commercial/Industrial
1.25�"/0 of Value of Appliance or Work
Rate
$ 30.00
$ 10.00
$ 10.00
$ 10.00
$ 25.00
State Surcharge
TOTALFEE
TOTAL
$Z- '
$
BUILDING USED AS_�C S �� �iil��' /
e ► ..-
ESTIMATED COST �Y`, %SC� � PERMIT N0: �' , 'C� �l�J
DESCRIPTION OF FURNACE AND OR BURNER
$
No. of Heating Units � Circle One (Steam) (Hot Water (Warm Air) �
$ Trade Name '�Yc.�-Y.�.. Size No. � C�
BTU �SU;C� HP EDR
$ Fuel i��'[,wC`.�.J1 L-��� Total Connected Load
Burner Trade Name�c � i No. � 7�
$ BTU F�(�, OC�!'� HP EDR 1�iA�' 1�'
�
$ .50
� ��
$
/�
MINIMUM FEE FOR ANY HEATING/COOLING/VENTILATION � G� �' •�Z�
REFRIGERATION/AIR CONDITIONING PERMIT 15 ffi25 00
PLUS THE $.50 STATE SURCHARGE
REINSPECTION FEE $47.00/Hr
*Air Conditioners can not be placed in a side yard without
written permission from atljoining property owner.
The undersigned hereby makes application for a permit for the work herein
specified agreeing to do all work in strict accordance with the City Codes an
rulings of the Building Division, and hereby declares that all the facts and
representations stated in this application are true and correct.
�7_ �� �r3 .� '
DATE I I � � �(j �
TEL # `TC � ��� DBC�
THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
•uu•► ► ► •►► •: �►� •��: •► e - � •►
When re In acing an _xis in� f iran __, the undersigned hereby verifies that the -�
venting has been examined and is free from rust, deterioration, obstnactions, ��
and is securely supported and firestopped where required.
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination.
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The Pxis+in� comb ��tien air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to in�tan a n_w came ,� ien air�it will be sized and installed
to meet the current codes and manufacturers specifications.
When ins allina a new ventinq cyctpm, the undersigned hereby verifies that
it 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.
Is the common vent and vent connectors sized and installed corre�tly after
an appliance has been removed from the common vent and vented
separately as per current codes.
Yes(�No( )
Yes (1�} No (
Yes ( ) No ( )
Yes �o ( )
Yes�No (
Yes(�o( )
! • • . � ' � ' . � • ' • 11 11 • / ' � - � • " � • � � ' M • / • �11 . • �
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 Input $�Q � J
Common Vent Type �(� Vent Height �� Diameter _`� inches
Appliance #1 Vent Connector Height ft Length ft Diameter in ?ype
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
� :� •► �- ..- r � . � � ,.
- - i, ' .
—
HEATING CO:
Signed By:
.�
Building
In�pect'rons
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�U --""
Received By:
Date Rec'd:
DATE � G� �� �'� YOUR E-MAIL ADDRESS
SITE ADDRESS J�O� ��� � S�
THIS APPLICANT IS: ❑ OWNER �ONTRACTOR
PROPERTY OWNER/ N,yT,�: S�4N t�V �_.j, Y� � 1
TENANT �Dx�SS: �'b0 �O11 ��12._ S'T C1TY '�21 1� STA'rE_zrn
PHONE: ��v� � S�%�' — 2'�S3
CONTRACTOR
SUBMIT A COPY OF STATE LICENSE a
YOUR STATE LICENSE ADDRESS:��
WITH APPLICATION pHONE (1TS( �
PROPERTY TYPE
PERMIT TYPE
�XP DATE ��
�1 (,jv CITY.
F.�x cp -.��'- l• co � 3.
�+SWGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
0 ADDITION �GAR.AGE/SHED
� BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIMMING PO�
TYPE OF WORK: I �E�' �
� MAINTENANCE/REPAIR ❑
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:� C�Z�
PROPOSED HETGHT: �_
SIDING
❑ Vinyl
❑ Aluminum
�other G£M��JT �(�E�
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED__
LENGTH
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
❑ Fascia
IACATION OF WINDOWS
NUMBER OF
SIZE
❑ DRAIN TILE
O OTf�R
HEIGHT
AT91�1�P�_(
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
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:
(USING TH� 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ p�� SII -��P OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
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 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 APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I 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 es of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicatio for permit d work is not to start without a permit; that the work witl be in accordance with the approved
plan in the case of all work i requires evi w and approval of plans.
SIGNATURE OF APPLICANT �Y_� PRINT NAME % Y' �F�-If� i G�IIJ���-L�DATE=_T ��i � S
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163-572-3604
)ATE s r ��
�ITE ADDRESS �
'HIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH A.PPLICATION
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑ OWNER
Permit No.: �
Received By:
Date Rec'd:!
1,�, G �,fi�
ADDRESS: .�Z'D //�!'4/"' �� CITY ��"''�l STA'
PHONE:
�•
�04- - c�o G=�7
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STATE LICENSE # . EXP DA d3�s `1 Zy,� J� 3 6�'
nnDxESS• �3�3 3 �`f � r I" � N CITY /��� ���`= STATE_ZIP
PHONE iG !2J �23 ��S".� F� 17�6 3� 4� �- 4 7 s�
PROPERTY TYPE � ❑ SINGLE FAMILY/NEW
❑ TWO FAMILY/NEW CC
PERMIT TYPE ❑ ADDITION U �iAKACir✓st
❑ BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
❑ SWIMMING
TYPE OF WORK:
❑ NEW
� MAINTENANCE/REPAIR
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
i2s... � �
WII�DOWS
IN EXISTING OPENINGS OYes �No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 2SZ�0 OCCUPANCY TYPE
D TILE
�' \ R
— :hs-f:l��-, Z c�.�r
'�i WIDT'�i
o xousE orrt,Y
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
O Fascia
IACATION OF WINDOWS
HEIGHT
Ft.
BASEMENT REMODELING SUBMIT:
1. Existing Fioor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existin� structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
$ �� �j. Z�
$ •
$ 2� °5
$ � . Z�
$ �; � U G'
$
$
$
$
$ �
$ 'i Z-�,� C'T? �,
See Back Page for Fee Schedule
65% of Building Pernzit Fee
.001 rimes the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (Sta.te Licensed Residenrial Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
�+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
TION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pemrit 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 Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a pe 't and w rk is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work 'ch req es evie and approval of plans. qC
SIGNATURE OF APPLICAN PRINT NAME ��c�a.1 eV ��-- DATE � b'" G
�C/
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Building
Inspections
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No
Received By/��
Date Rec'd: �L
> / /
DATE �Z � YOUR E-MAIL ADDRESS ll�+'+Q �l1� /Z S/`L1» ��+ v �4 i'�'�Yt�
SITE ADDRESS �� P� UE-'� S NLC.�7
TH1S APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY OWNER/ � NAME:_
TENANT ADDRESS:
CONTRACTOR
SUSMIT A COPY OF
YOUR STATE LICENSE
WITH A.PPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
�
STATE LICENSE # ZO S I�T �o � E}
�DxESS: � 3 � � 3 � - �
PHONE / Z Z `" �3�� FAX �
INGLE FAMILY/NEW CONSTRUCTION
❑ WO FAMILY/NEW CONSTRUCTION
❑ ADDITION ❑ GARAGE/SHED
❑ BASEMENT FINISH � ROOF
❑ DECK ❑ SIDING
❑ SWIMMING POOL
❑ NEW ❑ ADDITION
❑ MAINTENANCE/REPAIR �@'REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUP.RES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT: _
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
OSoffit
❑ Trim
❑ Fascia
_ ,�?� ( STATE�!�LIP ✓ �.3 �Z
/.�1
DATE 3107 ��
CITY s� iA/i' STATE_ZIP '�-36 9
:� 1 �2� - 97s`�
WINDOWS
IN EXISTING OPENINGS ❑Yes ,`Io LACATION OF �yI� IDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF S7 y K a�o
OPENING CHANGES & �� e� 2
TvPE c�F WINDOW TO BE INSTALLED �'1 NUMBER OF WINDOWS
SIZE
STORIES
�❑ D IN TILE
T�HER /KT��2/pQ. �Nl.s ¢f
�t
WIDTH HEIGHT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
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:
(USING THE 1997 U.B.0 FEE SCfIEDULE) �_ 3 T a
TOTAL JOB VALUATION � 70 P� D OCCUPANCY TYPE SL '
Perxnit Fee $ 1 9,� S See Back Page for Fee Schedule
Plan Review $ . S I 65% of Building Permit Fee
Fire Surcharge $ �,Q[� .001 times the total job valuation
Surcharge $ 3� �U .0005 x Pernut Valuation Minimum $.50
License Surcharge $ ,5 , c� $5.00 (State Licensed Residential Contractors)
! SAC Charge $ $1550 per SAC Unit (Plans to MWCC for deternrination)
Curb Cut Escrow $ ft + 6 ft = ft x$20 =$
Erosion Con�ol $ $450 Conservation Plan Review
Park Fee $ Fee Deternrined by Engineering
Sewer Main Charge $ Agreement necessary () Non Necessary ()
Total Due $ a'� S v� Make checks payable to: City of Fridley Attach Stipulations _
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pernut and I aclmowledge 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 worlc is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w re ' s review an approval of plans. �/
SIGNATURE OF APPLICANT � PRINT NAME '�'"� �/�J� DATE T�Z� C� 6
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
struchzre, 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:
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, showing the location of the existing foundation 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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