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Permit No.
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PLUMBIiJf, PERf1IT ,qPPLIC�TI��►d
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1 Plumbing Fixture Rates; Np, ZtATE TOTAL
! Number �ixtures i � x $2.00 ��
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Future Fixtures _T_ x $1.50
' New Fixture-Old Open. x $1.50
� Catch• Bastn x $3.25
+ _._._.—_
' Water Heater-99,000 BTU _� X $3.00 �� ��
1 °-
� Ground Run Old Bldg. x$3.25
— —____..
Elec. Water Heater x $2.00
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Gas Fittin Faes:
�.st 3 Fixtures �_ X $2.00 , �'
Additional Fix tures �_ X $ .7S
Gas Range-199,000 BTU ,__ x 55.00
� � � Repairs &- Alterations I
� I See I
� � Description; Code
� I� State Surchar�e .50
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� i TOTAL FEE . ,S�
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� iThe undersigned hereb}r makea application for a permit
for the work herein specified, agreeing to.do all work
� in strict accordance with the City Ordinancea and ruling
ot Department of Buildings, and hereby declare th�t
a�t e facts and r presentatione atated in thia
pl io are t e and corr ct.
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S ignature ate
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��„�K°�� 5. LOT SURVEYS C4NIPANY � R 4'�"`OD HO AVE.SNH
�COlDEM VALLEY, b41NN. BROOKLYN PARK. MI�d�4.
j���_ q�,, Np, �7�i LA�iD S[1�VE'YOi�S MINN. REG. �d0. bi43
6Efl� 1JP7DER LAW$ O� BT�l:I� OF MINNPBOTA
. �ac�xs� aY aauuw.xc� o� � os nnN�o� INVOICE Ntl. 43 53
5747 W. Broed�ay 533-9922 F,. & NO. �-� 7—� �
iNbiJSTRUL — JUDICIAL . Minrreapolia, Mirtnesota 55428 �� �„ �(�"
�OMMERCl�L — TOP�R�RI'HICAL `
C11Y. LOtS — PLf�TTlNG .__,'��'u��jj�`� �,��'��'�� O -- DENOTES IR�N
,� -; o — Denot es
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Rsv�..�ed tQ show Foundatior� lo��tion 5/I��?�
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We hereby carlify tket `this is e-Yrs�e end eorrect eepresentetion '• - • 'l '
of �a 'susvey of tl+e boundarr�as of the� ebove �iescrrbed fencf e+�d '� � .. �. ` '-
fhe lou#ian of e11 buildings and visiGle encroachmen�s. i# arry, ¢
fr�rm or ori Said iefid. , • ' S ed �' '��`�a ����
s��,,�, �,`��g ��. � d�, of. AFr�t1 ;g 7� � �' � sc�v�s �on���c
sue�ecr PERMIT NO
City of Fridley ,�'�2512 �'
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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� � RECEIPT NO. -
� `L ____ COMMUNITY DEVELOPMENT DIV. /��� .
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i-_N A /'�'1,; CITY HALI FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
� J � � , 612-580-3450
910-F15 4/29/74 � �
10B ADDRESS 5497 Ea.st Danube Road N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 6 1 Inn sbruck North 2nd Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Robert Laugen Homes Inc. 6866 East Fish Lake Road, Maple �rove
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING Residential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK � �� � �� � �� � �
Construct a 27 & 19 6 by 43 6& 27 6 Dwelli.ng and a 22 by 24 Garage
8 CHANGE QP USE FROM TO
STIPULATIONS provide a hard surface driveway. Provide a verifying survey before
capping.
SEWER LOCATION: Stubbed to property line. 4.7' Northeast of Manhole
(Measured along sewer main).
Wye Elev: 951.84 Ma.nhole Inv. 951.91
fi�ATER LOCATION: Located 3' West of sewer on property line.
TOP OF FOOTIN6: 955.0
�C�='E�iATE �ERN�1ITS REQUI�;EQ rvR y'VI�lN�,
HEATING, PLU�IIBING AND. SIG�I,S�
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOCI FY'3IllE
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R—�.
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 8E COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $30, 329 �.5. �.G
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR L CAL LAW REGULATING CON-
STRUCTION OR THE PERFOR CE OF O STRUCTION. � 4 3
PLAN CHECK FEE TOTAL FEE �,
o���� 0 379.16
"� �!' 7
SfGNATUREOFCONTRACTORORAUTHORI ED ENT �DATEI HEN PROPERLY VALIDATED HIS IS YOUR PERMIT
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SIGNkTUREOFOWNERIIFOWNERBUILDERI IDATEI BLDG.INSP pATE � �
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AP.pLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER `S NAME • BUILDER • �a� �,��- ;�.8 1i � n p � s „�.r L. ,
ADDRESS : ADDRESS : � ��oG �,�; � �,� �,,q,r= � ,
_ /�/%��e.E Gi',eo�vE,� �%%iN�✓, .�,�5'.3 � af'
NO : ..5��/ I � STREE� :_ �y�l � P �i4�Y�it�� JLc4A-�
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LOT; �o BLOCK: � , ADDITION:_�n,vs�sQ,,��,� �,2,-,,,� v?''�—°�pp�
CORNER LOT: INSIDE LOT: X SETBACK: SIDEYARD:
,
Applicant attach to this form Two Cextificates of SurveY of Lot and pxoposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As :
% % � � °� �
��NC-��w,o )�s.r.�v�Fron� : � :t °7 � Depth : �.� � Height • � �
Square Feet: �' `7�_Cubic Feet: 3`� �o O
�� �� � Front : �. � Depth : �- Height : ��
Square Feet; ,� Z� Cubic Feet: S 2��
Type of Construction: ��� �STo�ey � n� Esti,ma.ted Cost: $ 5(1 �OO •
, J.;�---�
To Be Completed: /-�c.¢ � . /S � .���_ a ��
The undersigned hereby makes applicativn for a permit for the work hexein
specified, agreeing to do all work in strict accoxdance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares tha� all the facts and representations stated i.n �his application
are true and correct.
DATE : �/ - I Z� 7� S IGNAT[T •�
0
(See Reverse Side For Additional Tnformation.) �A ��.� �•�
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildi.ngs shall, before issuing permits for the
erection of any. building ox structure, or for any additioiz to any existing
building or structure, or for any�alL-eration or 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 be1o� set forth and in
the manner herein provided to-wit:
UIVIFORM BUILDING CODE: �rpe 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction t�ereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet. �
ADDITIONAL INFORMATION
For the purpose of compu�ing fees for building permi�s, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
�bx 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 xoof.
For repairs or alterations to an existing structure, the fee shall be at the
rate 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 fox any permit as s�t forth in Section 2 be
less than $5.00,
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
tiYne of application, to allo� for proper review of the proposed structure and
of the construction site.
a. •
A Certified Survey of the lot, showing the location o� the foundation, once it
has been coristructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structura shall not be used or occup3.ed until a Certificate
of Occupancy has been issued.
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3Q0 BR�NSWICKOAYE S. L�T SURVE�S C�MPANY �YMOD HO qvE�CH
GOLDEN VALLEY, MINN. BROOkLYN PARK, MIN^J.
MIf�tN. REG. NO. 4741 LAND S��EYO� MINN. REC�. tJQ. h743
BEGISTEBED UNDER LAWS OF BTATE OF ffiIAINE90TA t,
LICENSED BY ORDINANtT OF CITY OF MINNEAPOLIS INYOICE NO. �'-� �° i
5747 W. Broadway 533-9912 F. B. NO. �_�+ ir�t+ n_
INpUSTRIAL — JUDICIAL Minneapolis, Minnesota 55428 " (,,t� ��
COMMERCIAL — TOPOGRAPHICAL SCALE I" �
CITY LOTS — PLATTING �urupJnrs �ler�ifu��r O — DENOTES IRON
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Lot b. ,$lock T, IN.NSBRUCK \ , ;��
2ND ADDI"rION,anoka C�unty, `�. ,�'
�'�innesota. ��� J�
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Note: AssuTr��ci n�tti�n ' � ti��,
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We hereby �rtffy tket this is e true end correct representetiun � �
of e surve�v of the bounderias of tMe ebove described lend and �' � �
fhe lo,�afion of ell buitdings and visible encroachments, if any, �
from o� on seid land. �� -''. j�� 9/ ••�-�;, `�� �'�='�`�
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s�,,,,eyad b,, us �,�s 9 de„ of. A Pr� 1 i9 74 5LT�tVEYS GOMPANY
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� �
SUBJECT PE .
City of Fridley 12656
AT THE TOP OF THE TWINS g U I L D I N G P E R M I •
�
� � ECEIPT NO.
� ; L ____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �
' i ' �
�� ����1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
""� � ,'� 812-580-3450
910-F15 %/30/74 � �
JOB ADDRESS 5497 East Danu'he Road N.F+.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ( 1 Innsb,ruck North 2nd Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Robert Laugen Homes, Inc. 6866 East Fish 7,ake Road, Maple Grove
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
S�e
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION �1 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Fi.re damage repais
8 CHANGE QF USE FROM TO
STIPULATIONS Original permit #12,512 issued 4/29/74. Permit fee based on half
the original fee and ha,lf tI� original surcharge.
� �� � SEPERATE PERMIY� REQ4�:fRE,� Ft3R �IIiRING,
FIEATING, P�.UMBING AN0.51faNS.
� y
SEPARATE PERMITS ARE REOUIRED FOR E�ECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. Wppd Fr3IIIe
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION R 1
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 yS`],SiOOO y� %.�j$
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT� PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 32 O
^�' PLAN CHECKFEE TOTALFEE
� �%?'i. � 7-�/- 7�` 58 ,,-
S NATURE OF CON7RAC R OR AUTHORIZED AGENT IDATEI HE ROPERLY VALIDATE THI Y UR ERMIT
e s
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI BLDG INSP �ATE e
AP.pLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER`S NAME:�oB�'RT /tif.'G��'!✓ /`for��"� BUILDER: �o�ERT dc�f10���/1� /-%,��
ADDRES S : �'S� J%� .L� _ / J.9J�/Gl,g'� ADDRES S : �' `r�� % E. ��'�U' L�.�4.�
NO : . � � �I � S TREET : � � .�i9� A1 CC � � �
LOT: � BLOCK: I ADDITION: �AIi��,�fc�Z<C'�f' /�/o .�n,� A�.� -
CORNER LOT: SNSTDE LOT: t/ SETBACK: SIDEYARD:^
Applicant attach �o this form Ztao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As :
E /� Front;
Depth• Height•
Square Feet: Cubic Feet:
Front: Depth: Height:
Squaxe Feet; Cubic Eeet:
Type of Construction: Estima.ted Cost: $/�, DOD . a d
To Be Completed:
The undersigned hereby malces applicativn for a permit for the work herein
specified, agxeeing to do all work in stxict accoxdance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. .
DATE : % - � I - �'� SIGNATtJRE : T/ � d re-Q�L.
�(See Reverse Side For Additional Information.)
e
�- ,
P
. ' �
t
t
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building or structure, or ��or any alteration ox repairs to any existing
build�ng ox 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 ma.nner herein-provided to-wit:
iT1VIFORM BUILDING CODE: �pe 1, Z& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 �or
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered �rom a point six (6) inches Ue1ow the floor line of the basement
ox the cellar to the average heights of the upper'surface or �o the average �
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
Tn no case shall the fee charged for a.ny permit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
time of application, to a11ow for proper 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 been construc�ed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCI'
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
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��:- , HOUSE HEATING TEST RECORD e,�,�;` ',,�•;,
ADDRESS � f t`� APT. FLOOR ��� CITY f SUBURB
OCCUPANT f' '"' ` OWNER
HEAT LO55 DATE HTG. INST. GAS C0. METER BADGE #
�. = - , ,�.,_
SOLD BY '� ` ^' INSTALLED BY
Electrical Work By Gaa Line By
TYPE OF HfAT GA FA •'� HW STEAM SPACE HTR. UNIT HTR. OTHER
•GAS DESIGN CONVERSION
MAKE MAKE OF BURNER
Model Model
Serial . Max. BTU Rating
INPUT r��� MAKE OF FURNACE
Model
-- - — CONTROLS _ _ -- - ---
_ _.
.�
THERMOSTAT ,'" _;- `" Heat Plug Vsnt Size `'� �
Valve '° KIND OF LINER SIZE �'�,_tt10NE
Limit "�'� Drah Hood RegulaTOr
Limit Sefting Filters Size Number
Fan Setting Chfmney Locbtion Inside Y''� Outside
� -
Pilot Type � `'� Chimney Construcfion -
Pilot Make
Pilot Model " Smoke Bomb Wiring
Pilot Timing Draft `���'' Test Tag
L.W. Cut Off Door Pressuro Lighting Inst.
Pressure Pereent CO2 ' Date Tested ,r 3 '#'� �
Input CFH �'" Peresnt 02- � Company Testing '1 " ��
Staek Temp. - Pereent CO v Name of Tester
Form 235
sue�ecT ,,p #At�N�� .
c�ty of Fr�a�ey 2 9 s 27
A7 TME TOP OF TNE TW�NS g � I L D I I� G P E R M I T
r
; � R O
COMMUNITY OEVELOPM�NT OIV.
r � V � PROTECTIVE INSPECTION SEC ���
�
i__-• = ��'��,'� CITY MALL FRIDLEY jS132 NUMBER pEV o.,e��6�99 VAGE OR APPROVED BY
L J\ 612-571-3450 910-F15 ����( / /
JOB AO�RESS 5497 East Danube Road NE
t IEGAL �OT N0. BLOCK TRACT OR ADOITION SEE ATTACHED
oescA. 6 1 Innsbruck North 2nd Addition SNEET
2 PqOPERTY OWNER MAIL AOpR�S$ ZIP PHONE
Rich Schroder 572-2514
3 CONTRACTOR MAILADDRESS ZIP PHONE UCENSENO
Huber Construction PO Box 403 St Michael MN 55376 497-4484 20102687
o ARCHITECT OR DESIGNER MAIL ADORESS ZIP PMONE LICENSE NO
5 ENGINEER MAII ADDfiE$S ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADOITION O ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (31 S) Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS �
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, NEATING, �P� OF CON$T. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING Oii AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING SO. FT CU fT
AUTNORIZED IS NOT COMMENCED V�1ITHIN 80 OAYS, OR IF CONSTRUCTION
OR WOFiK IS SUSPENDED OR ABANDONED FOR A PERIQD OF 120 OAYS A7
ANY TIME AF7ER WOqK IS COMMENCEO. NO. DWLG. UNITS OffSTREET PARKING
I HEFEBV CERTIFY THAT I NAVE REAO ANO EXAM�NED TMIS APPLICA710N STALLS GARAGES
AND KNOW TME SAME TO BE TiiUE AND CORRECT. ALl PROVISIONS OF LAWS 'yp�UATION SURTAX
ANO ORDINANCES GOVERNING TMIS TYPE OF WOpK WILL QE COMP�IED �7
WITH WME7MER SPECIFIED HEREIN Oti NOT. TME GRANTING Of A pERM1T �2lO9 ��,.3�j
DOES NOT PRESUME 70 GIVE AUTHORITY TO VIOIATE OR CANCEL TNE pEqMIT FEE SAC CMARGE
PROVISIONS OF ANV OTMER STATE Oq LOCAL LAW REGULA7ING CON-
T UC7� N R TNE PERfORMANCE OF CONSTFUC710N $83,25 Fire SC Z.71
PLAN CNECK fEE TOTA� FEE
' ense C 5 00 92.31
GN4TUAEO�CON7 OQOA4UiNOpiZEDsGEHT i0a7E� N PR PERLV VA IpATED THIS I VgUR PERMIT
S�GNAIUQE O� OWNEpi�F OWNEpBU40EA� �•rE� BLOG �NS� ' � � r�p1Ed '
d � b
_ ' _ ' " � J
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII�Y AND DUPLEXES R 1 AND R-2
BUII.,DING PERMIT APPLICATION
Construction Address: ..� �/ � � ,��
Legal Description:
��—�
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Owner Name & Address: � 5� �i �orri Tel. #��%=«�S/�
Contractor: e!' K la MN LICENSE # c� �7/,D,� �'��
Address: P. �, g�„� �fJ 3 Sa� �;�►�e� �n!' sS3,�6 Tel. # / %�– �'�
Attach to this applicaxion, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
DESCRIPTION OF IlVIPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Lengt$� Wid Hgt/Ground Sq. Ft.
�f-�'?��� � � �/ _ � � � �s�.�'
_n � v
Construction Type: � Q�oT-7� o�, cf Estimated Cost: $ S�f��--� �%�
�
Driveway C�rb C�t Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: APPLICANT: r Tel. �� -- Y�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ C�. �S
$ ��r
$ S
$
$ ��o
$
$
$
$
$ ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 ger SAC Unit
$5.00 (State Licensed Re.sidential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
. �
BUII.DING 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 application therefore,, require the payment by the applicant for such peraiit 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,Ot�
$2,001 to $25,000
$25,001 to $50,�0
$50,001 to $100,000
$100,001 to $500,000
$SQ0,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.OS for each additional $100 or
fraction thereof, to and including $2,0�
$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 $SO,Q00
$643.75 for first $50,�0 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $1�,000 plus $5.60 for each additional
$1,0� or fraction thereof, to and including $500,000
$3,233.75 for the first $SOO,Q00 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,�0 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 applicat�on 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 �oa�tr�a�t�d �vill
be required before proceeding with the framing.
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CHIMNEY AND STACB VERIFICATION
The undersigned.hereby verifies that the e�tisting chimney or stack:
1. Has been carefiilly examined Yes O No O �
2. Is free from rust or deteriorarion
3. Has no foreign objects lodged within
4. Is securely supported
5. Mee�s all current Code requirements for size
and total BTU's connected
6 Has total heating BTU's of
All other BTU's
Yes ( ) No ( . )
Yes()No()
Yes ( ) No ( )
Yes_( ) No ( )
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ()
8. Has combustion air been provided for water heater Yes () No ()
Remarks:
List ALTERATIONS Being Done:
�
HEATING CO:
Signed By:
Date:
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sue�ecr PERMIT NO.
c�ty of Fridley 3 3 517 �
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
�
; � RECEiPT .
� ; v �__��_ COMMUNITY DEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
1 . �
i---_ A; �"' �.� CITV NAIL FRIOLEV 65132 NUMBEi1 REV DATE oAGE OF APVROVED BY
t �� 763-571-3450 9t0-Ft5 5/15/03 / /
JOB ADDRESS 5497 East Danube Rd NE
1 LEGAL �OT NO. BLOCK TRACT Oii ADDITION
oesca. 6 1 Innsbruck North 2nd Addition SEE ATTACMED
SNEET
2 PfiOPERTY OWNER MAI� ADDRESS IIP PHONE
Richard Schroeder, 5497 East Danube Rd, Fridley, MN 55432 763-572-2514
3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Richard Schroeder (same as above)
4 AHCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
S ENGINEER MAIL ADOIiESS IIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION O REPAIR O MOVE O REMOVE
6 DESCRIBE WORK
Construct deck
9 CHANdE OF USE FROM TO
STIPULATIONS
See notations on plans.
SEPARA7E PERMITS ARE RE�UIRED FOR ELECTR�CAI, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAp
VENTILATING OR AIR CONOITIONING
TNIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION ZpNING SO. FT CU FT
AUTMORIZED IS NOT COMMENCED WITHiN 80 DAYS. Op IF CONSTRUCTION
OR WOfiK IS SUSPENDED OR ABANDONEO FOR A PERI00 OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREE7 PARKING
I HEREBV CERTIFY TNAT I MAVE REAO ANO ExAMINEO THIS APPLICATION STAIIS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED
WITM WHE7MEq SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT �$�9�7.56 �4'.4'6
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CANCEL TME pEAMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR �OCAL LAW i;EGUTATING CON- @ 167 . 2S Fire SC �H . 92
STqUCTION OR TME PERFORMANCE OF CONSTRUCTION W
PLAN CNECK FEE TOTAL FEE
$180.63
S�GNarua OFCON"A TO AAUTMOpIjEDeGENt iO�iE� WMEN PROPEfiLV VALIDATEO TNIS IS Y UR P RMiT
<i � ._ d�i'p� , ��
S�GNGTUAE O� OWNEQ ��� OWNEA BU�LOEp� 1 AiEi BLOG �NS� f� Tt
NEW
ADDN
ALTER
[ ] CITY OF FRIDLEY
[�� 6431 University Ave NE, Fridley, MN 55432
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: y_(1 �
�
� ,�/�d .7i .
Effective 1 /1 /2003
(763) 572-3604 Bldg Insp
(763 571-1287 Fax
�� �, �,�, �.L �
�t �
r� �
�
Legal Description: ,
Owner Name & Address: l��i��� ��S�ta�r� � ��1� Te�. # ��� 5�� .�S %�����
Contractor: ��i�r/? MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
7G� y9� �� ���
lot, with the proposed construction drawn on it to scale.
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft. "
Length �dth Height S . Ft.
Length Width Hgt/Ground_---���. Ft _ �
35� �' � �S� � -�rc�� x
�.
Construction Type: 1��i� L� �%� F�stimated Cost: �
v/l,� p��L �- ��
Driveway Curb Cut �dth Needed: Ft. + 6 Ft = Ft x$ _$ �/,� "S�
f �
DATE: �R�r1 � APPLICANT: �� �� Tel. # 7G .7l" �o ��� l�i
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
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
TOTAL
$ f% o?�
� � � /�
� � ��/�
�
$
$
$
$
$
�L��
� � �
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.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 [ ]
•�
BUILDING 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 applica.tion 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 $SO,Ot}0
$50,001 to $100,0�
$1Q0,001 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 adciitional $1,�
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 $50,000 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 $5�,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,(�0,001 and up $5,608.75 for the first $1,000,0(10 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT FSCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gvtter only - driveway width plus 6 feet times $17. �.
Permits for consfruction 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 e�sting foundation will be required before
proceeding with the framing. New Houses Oniv
6ERALD T. COYNE
300 �RUNSWICK AVE 5.
60LDEN YALIEY, MINN.
MIpIiJ. RE6. NO. 4�41
' INDUSTRI/1L — JUDICIAL
COMMHtCllll — TOPOGRAPHIG1l
CI'IY LOTS — PLATTING
BOB LAUGEN �_
LOT SURVEYS COMPANY R 9'�;'°o HO /1VE SNH
LAND SURVEYORS B M NN YREGANO. 67 ]"
REUI87'�aRR�D UNDEB LAWS OF BTATE OF MINN&90TA
IdCENBED BY ORDINANCB OP CITY O�' MINN6APOLlB (NVOICE NO. 43 53
5747 W. Broedwey 533-9V22 F. B. NO. 1� —� •
Minneapoli�, Minnesote 55428 SCA�E �„ _ ,����
Q — DENOTES IRON
��Li�UplJitrB �pl'�tfirMtP � — Denotes
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5497 East Danu6e Road NE
FrJd/ey, MN 55432
Buildirig BUILDING Permit No.: ��`Z/1�� �
Inspections RESIDENTIAL APPLICATION Received By:1� �`
763-572-3604 CITY OF FRIDLEY vat
763-502-4977 FAX EFFECTIVE 7-1-2010 �� " o
DATE �6 7���QL�� , abf � YOUR E-MAIL ADDRESS �SI,Kt'��t>��2 � FIE,�T(�;�r��'7: C�n'!
srrEa,nn� W 97 ��y� t��l���� �2p.9�� .r� � �-'��� /�/I ,� 5"�-r�
THIS APPLICANT IS: � OWNER OCONTRACTOR
PROPERTY OR'NER/ NAME: ��) S�I'�/��'�6J�%�
TENANT Annx�ss: 5't197 ��.Q�% C��IN.r��-�J,� crrx +�
E��l-/ STATE JZ�%/ ZIP��
PHONE:
CONTRACTOR N,�: /j/
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE LICENSE
AND CER'TIFICATE OF ADDRESS: CITY STATE ZIP
INSURANCE PHONE FAX
PROPERTY TYPE JO`�SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES 1
PERMIT TYPE ❑ �DTI'ION ❑ GARAGE/SHED �WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION ❑ ADDI1'ION
MAINTENANCE/REPAIlt ❑ REMODELING
DESCRIBE WORK BEING DONE: ���LE/rL � �s�) Pl��j
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S Ff
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMTf:
NUMBER OF SQUARES 0 HOUSE & GARAGE 1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED S1ZE: ❑ DETACHED GARAGE 3. List of shvctural membeis to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDIT'IONS. & PORCHES SUBMTC:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing shuctures
❑ Other 0 Fascia �d P�Po� P�Ject
2. Two seis of construction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS �Yes ❑No LOCAT[ON OF WINDOWS FOR WINDOWS — PROVIDE U-VALLTE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPINING CHANGES &
TYPE OF WINDOW TO BE INSTALLID NUMBER OF WINDOWS
�L r�r:a ax�: naar:li u1v v�1.Ua1�1V1v,11v(;LUDll�I(� '1'tl� C:US"1' Ur' LABUK AND MATERIALS:
(USI,NG THE 19�7 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $�?���1r17./, y"3���ifg S�(��� �� occuraivcY �rYrE
Permit Fee
Plan Review
Fire Surchazge
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
.001 times the total job valuation
.0005 x Permit Valuation Minimum $5.00
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pavable to: Citv of Fridlev Attac
THIS IS AN APPLICATION FOR A PERMTI'-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 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 on site; that the work will be in accordance with the
approved plan in the case of�� ' re es review and approval of plans.
SIGNATURE OF APPLICANT �yf'/G�� � PRINT NAME �� j�G�( JGY� DATE O r l�" �P G�/ ��
APPROVAL INSPECTOR SIGNATURE
PLEASE NOTE: SEPARATE PERMITS ARE REQi7IRED FOR PLUMBING, ELECTRICAL AND MECHA1�iI�AL WQRK