AF - 40714sue�ecr PERM .
City of Fridley 142'7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T •
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� � ECEIPT NO.
� ` _.__ COMMUNITY DEVELOPMENT DIV. i
f � y ; PROTECTIVE INSPECTION SEC. `�C-!'�, �
� � /"'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE � PAGE OF APPROVED BV
�""� � ,� 612-�0-3450
910-F15 8 5 77 � �
JOB ADDRESS 5557 East Danube Road N.�'i.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 1 Innsbruck Nort,h 2nd Addn. SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
DaVerne Qorporation 1393 - 16th Avenue N.W., NEw Brighton 631-1213
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIONER 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
X
8 OESCRIBE WORK
Construct a 34' x 30' Dwellin and a 24' x 24' Gara e
NG
9 CHANaE OF USE FROM TO
AND SIGNS.
STIPULATIONS provide a hard surface drivev�ay. Provide .sod in the front and side
yards. Provide a verifying survey before capping. Provide City with copy of
truss design before capping.
SEWER L�ATION: (Approx. 13' Deep In Street) 130' S.W. of Manhole (Inv. 946.74)
WYE ELEV: 948.48 TOP OF FOOTING: 951.48 Minimtun
WATER LOCATION: 3' S.W. of Sewer 5ervice
DRIVETnTAY DEPRESSION COST: N/A
1 � �: EI `�.� �'^' �
Tki t�lY Of PRIDIEY DOES NOt Gt►AR�,NTEG n�e �efore dig�ir�g call i�cKi utilities
AGG�IRACT OF UTIl11Y tOCATIONS AND E�iv�,TIONS, TELEPHrOI'aF - ELECTFiC -�a!',� E���,e
THlS OATA t3 FOR 111�ORMATION ►Ue�OSES Oh�LY AND
��s u�rvc rt s�o�nc v��r n� a�o�u►r�t ����.��� �� �`� �,���A
- c� n�+� s�te
'� TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, W� Frame
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION R 1 ]_�]./� + 576 38,104 Total
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 SUFTAX
AND ORDINANCES GOVERNINC3 THIS TYPE OF WORK WILL BE COMPLIED $��215 �•32.11
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ' S1S2.42 $375.00
- . �1_` PLAN CHECK FEE TOTAL FEE
�(,� �l�,�ylA_, ���+L,C�XCJ S 7 $38.11 $597.64
SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT lU rEi WHEN PRO.ERLY VALIDATED THIS IS YOUR PERMIT
� ` � � ` `C-��i� �� '`�'
SIGNATURE OP OWNER IIF OWNER BUILOERI IDATEI BLDG iNSP DATE
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OS�JIZLR:
Addres:::
- l.l I i UI 1 ttlllLLT
APPLIC/1TICi1 FOR RESI))E�lTI/1L Bt11LDING PER��IITS
i�`�LW, /iLTLEZATIU�JS, /�DDITI0�1�, UR ��EP/�IRS)
IIUILDLl2: �(�. (/j��°l�
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Address:
Tel. Na..
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No. : ,�jJ J%��_ Street: � -���•�
LOT: c3 BIACY,: d RDDITIOPJ: ��bf4� �
CORNER LOT: IPJSIDE LOT: Y S,?TBACK: SIDEYARDS:
Applicant attach 'to this form ZWo Eertii'ica�es of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRI PTION OF BUI LDI NG �.
To Bsed As:
_ . • �� �
Front: � � Depth: �� Height:
Square Feet: � 7/� Cubic Feet: .�-�� �`��
�
Front: � � Depth: °� � � Height: ��
Square Feet: ��f� Cubic Feet: ��� �
Type o� Construction: W Estimated Cost: $ P� ���� �
To Be Completed:
Proposed Driveway Width If New Opening Is Desired
Alt. A Alt. B
% � $ �- $
(SE� REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance 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 r ect. See reverse side for additional infozmation.
DATE: v � SIGNATURE:
Stipulations : G��� � ���. ��
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SECTIOt4 ?.. 'rhe Insper,tor oE }3uildit���s shall, Lefoic J.JJUlI�� T�ermit� for thc. cr.cctioti
Uf clfl� �iUJ.�_I�JII:f Ci1" :;t_]'LCf.IlYf•� UY rC�l' �.1)f ilCjr�lt]C�1-t t'C) Z]tl'� ('i'.l.^.tlll�j t�l]11.(�l,l�� C)T" `;i:Yll[:t.�lr�'�
nY 1C)J" �tIi`f i11.1..C1":1i:.1.Ut1 U2- 1_tr}�itll::% i:O c7l�f C'l.J.';Ll.l]�J ���ll.lcllll`j UY ::trucLur�� Uj)UIt �lj�j7�_]�7:tt.]��11
thereiurc, rec�u.�ru LYie ��riyment }�/ tiir_� �����licanC fur ::uch F�cr.ui.it oi iecs to the amuu►,t
hcr.�:ir� },clow seC forth at�d iii thc manncr Yicrc�iii l�r.ovic3ea La-wit:
?;EW C.OtISl'ItUC7'IO;J: :;inglr, r'��mi�.y tiome� and Garages: $4.UU/1,OOU cubic £eet-.
PLJ1td CIILCY.: 25 percent of. t�uildinq E�eizni:t fee.
vRlVrt•7t�Y Df�I�P�L•'SSIGP]: (Concr.ete Curb Streets Only)
Rl.te�'��tite A: 1?�moval. and rei�lacement of concrete curb an�l
yutt�r anly; Driveway width ��lus 6 fcet Y.$11.75
Altc:rnatc A: Iterric�vai and re��la�•ement af cor�crete curb at;cl
guttcr and install a 3 foot wide approach with
6 inch depth; Lriveway width F�lus 6 ieet x$15.��G
�DDI T IOf�/1L I PdFOR��IAT I ON
For the purpose of comput�ng fees for building permii:s, the�cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point sir. (6) inches below ttie floor line of the basement or the cellar to the
average heights of the upper surface or to the average height of the roof surf.ace
of the main gable of a pitched roof.
Eor repairs or alterations to an existing structure, the fee shall be at the rate
of $3.Q0 lier each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 si:ate surcharge.
VERIFICATION OF FOl1NDATIOf�
NOTE: Permits for construction will be issued a minimum of 24 hours from the time
of application to allo�o for proper review of the proposed structure and of the
construci:ion site. ,
A Certificate of Survey of the lot, showing the location of the foundation oiice it
has been constructed �aill be required before proceedir.g with the framing.
Ct2TIFICATE OF OCCUP9NCY
Application for a Certificate of Occupancy shall be made ten (1G) days prior to the
use or occupancy of any sti-ucture for �aiiich a builcling perniit iias been issued; and
said structure shall not be used or occu��ied until a Certificate of Occuganc}• has
been issued.
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CERTIFICATE OF SIJR�/EY
�"o�.•
Da Verne Co.
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�af 3, B/oe�F 1, /NNSBf�U�'!( NORTff Z"'O ADD/T/ON, .4�oko Coa�fy, /Lli�r�esofo-
We hersby certify that fhia ie o frue and corroct ropreeentation of o surver of the
troundariae of tAe above deec►ibad land ond of the locotion of all buildin8s, if ony,
thereon, and all vieible ancroachmenle� it any, from or on eaid land.
E. G. RUO & SONS , INC.
�' S'e � ��
Dated this .�T day of �° t9_' br ,��,. �'�p""'�
Sio%yo.d .f'e,�6vc�.F iervsed' 9•90.77 Minn. Rea. No.
E. G. RUD 8� �OIUS, INC.
LAND SURVEYORS
3847 155th Avenue N. E.
Anoka , Minneso#a 55303
Tei� 434- 5505
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,:3 DA�� eS FOR IP9FpRM,��I�Pg ��pRPOSES O y A��
Pe�SONS USIPIG 1� SMOULD VE1�8�1' TFi� ASdP�B�AATI�PV
ON i�lE SITE
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`�� Before digging call Ie�al utiYities
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1925 Oakcrest Avenue Roseville, Minnesota 55113 (612) 636-7744
220 - 20th Avenue North St. Cloud, Minnesota 56301 (612) 253-3451
REPORT OF DENSITY TESTS
FROJECT:
BLOCK l, LOTS 3, 4, AND 8
EAST DANUBE ROAD
INNSBRUCK NORTH, SECOND ADDITION
FRIDLEY. MINNESOTA .
GEC JOB NO: 1419
REPORTED TO:
DaVERNE CORPORATION
1393 16TH AVENUE NW
NEW BRIGHTON, MINNESt3TA 55112
CC: CITY OF FRIDLEY
BUILDING INSP�CTI�N DEP
ATTN: MR. RON HOLDEN
DATE:
2, 1977
Eight field density tests were conducted at the ref�renced
site on July 29 and August 2, 5, and 12, 1977. The tests
were done using the Density of Soil in Place by the Sand
Cone Method procedure (ASTM D 1556). �
One Standard Proctor Density Test (Moisture-Density Relation of
.�
Soils using a 5.5 lb Rammer and 12 inch Drop, ASTM D 698-70),
previously reported in GEC Job No. ].379 and identified as
Proctor No. l, was used.
Three Modifiecl Proctor Density Tests, numbered 2, 3, and 4
(Moisture-Density Relation of Soils using a l0 lb Rammer and
18 inch Drop ASTM D 1557-70}; were also conducted.
Relative density was then computed by dividing the field density
by the Proctor density, expressed as a percentage.
The results of the field density tests are as follows:
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HYbROLOGY • SOIL AND FOUNDATION ENGINEERING •'FEST BORINGS
MATERIALS TESTING • PERCOLATION TESTING • ENGINEERING GEOLOGY • CONSTRUCTION IPISPEGTION
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GEC #1419 - Page 2
FIELD MOISTURE REI,,ATIVE
I'EST TEST DE.NSI�'Y CONTEL�7T pRpCTOR DENSITY
JOi DATE LOCATION DEPTH cf) % NUMBER. %
1 7/29 Block l, Lot 4. 1/3' below grade 107.7 20.8 4� 90
Rear Frost Footing
2 7/29 Block 1, Lot 4 1/3' below grade 104.3 18.8 4 g�i
Rear Frost Footing
North Side
3 8/2 Block 1�t__3� �' below grade 120.6 4.9 � 1 104
Rear Frost Footing �
4 8/2 Block l, �ot 1/3' below grade 134.8 6.6 2 108�
I3ouse Cen -
5�8/5 Block 1, Lot 8 1/3' below grade 122.6 10.5 2 99
South end � � �
6 8/5 Block 1, Lot 8 1' below grade 125.8 8.9 2 101i
North end
7 8/I2 Block l, Lot 8 1/3' below grade 122.7 8.5 4 L�103
Frost Footing-SE .
8 8/12 Block 1, Lot 8 1/3' below grade 121.1 3.8 3 104
Frost Footing-NE
1
2
3
4
The results of the Proctor tests are as follows:
. , OPTIMUM MOISTURE M1�XIMUM DRY
SOIL�DESCRIPTION CONTENT (%) DENSITY, (pcf)
S�, medium grained, brown (SP) 12.5 116.0 -
SILTY AND SANDY CLAY. brown fCL; 17_R l�d_1
SAND, fine grained, brown (SP)
SAND, fine grained, brown,(plastic�SM)
12.2
13.4
Based on the results of the field density tests, it is our
116.2
119 . 3-�
conclusion the soil was compacted in a suitable manner and will
provide adequate structural support for single family dwellings.
Report Prepared By:
��� , �.�"
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Charles W. Bise]c
• Under �he.Supervision Of:
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R bert E. Pen ergas , P.E.
Minn. Reg. No. 8450 �
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HEAT LOSS GALCULATIANS D��ARTMENT �
Weatherotrips Guide Coa�tructioe I!�
'indow� Doon Refennce Out. Wall Int. Q/all C.eilmg
ee I�o I Y— �0 19_
.� Room Lengch Widch Hei�hc
Window� and Dooro---Crackage and Atea
tVldth Ha1�Al No. ot Lln��l [t. Are�
fe. of Dane o! D�na Ileht• ot craek p. tt.
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tequired sq. k. E.D.R or aq. mi. QIA. Leader area
Room Leagth Width Height
Qlindows aud Doors--Crackage and Area
Wla A He1�At No. o! Llneal tt. Arq
r0. 0[ pans e[ am Iltot� o[ enck p. ft. I
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Room � l.eRgch '3 � 9v�dch ..�
Windowa and Doori—Cratkage and Area
Wldth Hel�at No. et Llaeal tt. Ares
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Total �tu.
R�uir�d w. k. £.D.R. or �q. in�. WA l.eadec arca '(� �
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Windowe `nd Dooes--Craelcage and Area
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Ne. o! pano ot p►n� Ilsets ot craek �v. tt.
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Floor
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Required sq. k. ED.R. or sq. ins. QY.A. L.eader area
Fl.� Room I L.ength W�dth
Windov►n •nd Doon--Crackage aad Ans
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BROOKI�N ►RINTING L ADV. CO
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ty 16r 1978
�ve Ficek
DaVerne Corpprati.on
1393 - 16th Avenue N.W.
New Brighton, Mn. 55112
���� �� �������
8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 55432
Res F'inal Inspection for 5557 East Danube R+�ad N.E.
Dear Mro Ficek:
TELEPHONE ( 612)67'1-3450
A final inspection was made on January 16, 1978 of the above address and
the following it�s were not� w3lich must be completed before the
structure can be finaled out;
1.
2.
3.
4.
5.
6.
7.
Provide sod in the front and side yards by July 15, 1978.
Provide anchor bolt nuts in garage by January 22, 1978.
Insta].� three paxatanent steps in garage by January 22, 1978.
Insulate and fixerock hole in garage firewall by January 22, 1978.
Complete roof flashing by January 22, 1978.
Install garage door closer by January 22, 1978.
Install f�ost footings for deck by July 15, 1978.
We will expect the above items to be completed by the scheduled dates
when reinspections wi11 be made to deteanine compliance. If you have
any questa.ons on these itens, please feel free to conta.ct me at
571-3450.
Sincerely,
ImN HOLDEN
Building Inspector
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NJr. Dave Ficek
'
� Uav�erne eor�oration
� 1393-16th Avenue N.W.
New Brighton, MN 55112
TELEPHOIdE ( 612)5T9-3450
Re: Reinspection For Final at 5557 East Danube R�ad N.E.
Dear Mr. Ficek:
A reinspection was made on July 28, 1978 of the above address and
th.e following items were noted which must be completec3 before the
structure can be finaled out;
�i
2.
3.
4.
5.
6.
7.
Repa.ir closer on gaxage fire door.
Replace broken block.in north. wall of garage.
Inerease deck footings to 42 inches helow grade.
Patch cracks in northwest corner of the basement wall.
Install heavy gua.ge metal strap over cut in top plate
near furnace.
Caulk exterior around all openings.
Install 5/8 inch "plyvaood" box beam tXpe reinforcing above
garage door header where top plate is sagging.
We will eacpect the above items to be completed by August 15, 1978
when a reinspec tion will be made to determine compliance. If you
have any quss tions on the above items, please contact me at 571-3450.
Sincerely,
�N HOLDEN
Building Inspector
RH/mh
CC: Patricia Freeburg
5557 East Danube Road N.E.
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October 5, 1979
CI'�l� O� �FRIDL�Y
8431 UNIYERSITY AVENUE N.E.� FRIDLEV� MINNESQiA 6643�
. TELEPHONE ( 812)571-3450
Ms. Patricia Freeburg
5557 East Danube Road N.E.
Fridley, MN 55432
Rs: Final Reinspection of 5557 East Danube R�ad N.E.
Dear 2�.s . Freeburg:
In response to your r�uest for a written report on our coanpletion check
list sent to your contractor and dated July 31,1978, we list the following
as a re;port; ,
l. Repair closer on garage fire door (complete).
2. Replace broken block in north wall of garage (area ha.s been repa.ired) .
3. Increase deck footings to 42 inches below grade (cor.�plete) .
4. Patch cracks in narthwest corner of the basement wall (unenforceable
by Building Code) .
5. Install heavy guage metal strap over cut in top plate nea.r furnace
(complete) .
6. Caulk exteri.or around all openings (openings visible from grade have
been completed).
7. Install 5/8 inch plywood Yaox beam type reinforcing above garage door
header where top plate is sagging (unenforceable - the Code requirement
of two 2x14'�s as a daor header has been met) .
If you have any questions in regard to these items, please feel free to
call me at 571-3450.
Sincerely,
DARItE G . CZ�ARK
Chief Bu' Official
DGC/mh
CC: DaVerne Corporation
1393 - 16th Avenue IJ.W.
CITY OF FRIC�LEY
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SUBJECT PE .
CitY of Fridle - �-�-�
AT THE TOP OF THE TWINSy g U I L D I N G P E R M I T �����
r
� �
� �• COMMUNITV DEVELOPMENT DIV
' �v _-___-�
r � � PROTECTIVE INSPECTION SEC `�� �
� �
� � /" '1 � CITY HAL� FRIDLE� SS432 NUMBEF pEV DATE PAGE OF APPROVEO Bv
�---'�' �'' 612-571-3450 910-F15 6/5/96 / /
JOB ADDRESS 5557 East Danube Road NE
1 LEGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
oesca. 3 1 Innsbruck North 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Patricia Freeburg 5557 East Danube Road NE 571-6041
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
A 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 O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE � REMOVE
8 DESCRIBE WORK
Reroof House (28 Sq) 2nd layer
9 CHANGE OF USE FROM TO
STIPULATIONS
, Roofing can be the 2nd layer but not the 3rd.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, Ofi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTHEET PARKING
I HEREBY CERTIFY THAT I HAYE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � 1, 736 '1' • 87
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFORMANCE OF CONSTRUCTION. �.56.%.5 Eire .SC �1.73
PLAN CHECK FE O AL FEE
$59.35
SI ATUFlEOFCON'AACTOAOAAUTHOA�ZEOAGENT IDATEI PfiO VALD THIS IS YOUR PERM
f �� ��
I
' • �_� �Q-Q� �,� ,L ,.,
NA UF7E OF OWNEA i�F WNER BU�LUEF7� � ATEi OG INSP �itiTE
r�w
ADDN
ALTER
C]
[l
[l
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R 1 AND R-2
Building Permit Application
Effective 3/1/96
�a� ��
ConstructionAddress: _�" �� j � G �,r-� � � � � � �
Legal Description:
Owner Name & Address: '°� n �! ^ -� 5 T 1. # / (
� U� T i � C i C� , r I��- ��. 1tJ � R�- C .� / L C �-i I
Contractor: _ u-r.u�,��-- MN LICENSE #
Address: � ��_- Tel. # n ��;� �N
LIVING AREAs
GARAGE AREA:
DECS AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction dra.wn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height
Length Width Height
Length Width HgtlGround
Corner Lot [] Inside Lot [] Ft. Yd Setback
Type of Construction:
Approx. Completion Date:
Sq. Ft.
Sq. Ft.
5q. Ft.
Side Ya.rd Setbacks
� / az
Estimated Cost: $ % (�
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: I � �i L APPLICANT: , r - � ��-u;; ' 2_ Tel. # � 7 / — � � =f I
CITY USE ONLY
Permit Fee
Fire Surcharge
Staxe Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
� s�-7�
$ l� �%�
$ � C,� %
$
$
$
$
$
$
^' Fi e � �r�
� � � �
Fe� Schedule on Reverse Side
.QOl of Permit Valuation (1/lOth%)
$.50/$1,�0 Valuation �
$9� per SAC Unit
$5.(� (Sta.te Licensed Residentia.l Contractors)
Alt. "A° or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULAI'IONS: _�
, .-
BUII,DING PERIV�IT FEE SCHEDULE
The Chief Building Official shall, before issuing �rmits for the erecrion of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing builcling 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 $25,0(�
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
�� : .
$21 (Minimum F� is $21 plus surcharge)
$21 for first $5� plus $2.75 for each additional $100 or
fraction ther�f, to and including $2,OQ0
$62.25 for first $2,0(� plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each addi.tional$1,0�
or fi�ction thereof, to and including $50,000
$574.75 for first $50,(�0 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100, 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 $1,0OO,OQ� plus �2.75 for each additional
�1,Qf10 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Ci�,rb 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 - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construcrion will be issued a minimum of 24 hours from the time of application to allow for�proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the lacation of the foundation once it has it has been constructed
will be required before proceeding with the framing.
_ _ `
SUBJECT �: i---�.,,,
City of Fridley 2 6 0 21
' , AT THE TOP OF TME TWINS g � I L D I N G P E R M I T O
�
� �` _���� COMMUNITY DEVELOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEC. �� ��
i �
1 . �
i---. w�'�',.j CITY HALL FRIDLE� SS432 NUMBER REV DATE CAGE OF APPROVED BY
t '� 612-57�-3a6o s�aF�s 5/5/98 / /
JOB ADDRESS 5557 East Danube Road NE
t LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACNEO
DESCF. 3 1 Innsbruck North 2nd Addition SHEET
2 PROPERTY OWNER MAIL ADORES$ 21P PHONE
Pat Freeburg 5557 East Danube Road NE 571-6041
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
Fey's Construction Inc 13270 Jay St NW, Coon Ra.pids, MN 55448 755-4438 1904
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENOINEER MAIL AOORE33 ZIP PMONE LICENSE NO.
8 USE OF BUILDIN(i
Residential
7 ' CLASS OF WORK
� NEW ❑ ADDITION �1 ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Ritchen remodel
9 CHANOE OF USE FROM TO
STIPULATIONS
See notations on plan.
5E�'ARA'1'� PERI�ITS REQUtRED FOf�
V�iRdr��, HEATING, PLUMBIN� A�va �f�NS,
TYPE OF CONST. OCCUPANCY OROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBIN(i, HEATING,
VENTILATING Ofi AIR CONDITIONING.
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCEO WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS OFFSTREET PARKING
I MEREBY CERTIFY TNAT I MAVE REAO AND EXAMINEO THIS APPLICATION 1 STALIS GAHAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS Of LAWS yALUATION SURTAX
AND ORDINANCES GOVERNINCa THIS TYPE OF WORK WILL BE COMPLIE�
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �LO�OOO �LO.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEpMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTI OR THE PERFORMANCE OF CONSTRUCTION. �L8]. LS Fire SC �ZO.00
� PLAN CHECK FEE TOTAI FEE
License SC $5.00 $322.25
SIGNATUREOFCONT ORORAUTMORIZEDAGENT IDATE� WHEN PROPERLY LIDAT D THIS IS YOUR PERMIT
S�GNATURE O% OWNEA ��F pWNER BUILDERi �DATE� BLD iN�r! � p°iE
♦
NEW [ ] Effective 1/1/98 �
ADDN [ ] CITY OF FRIDLEY
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ��� 6
BUILDING PERMIT APPLICATION � �,�
�
ConstructionAddress: _�����,� � �5 � Od�l���� 0�_ . _ _ _
Legal Description:
Owner Name & Address: Pd � ���2P%,�i �� Tel. # �%� ����
Contractor: S �p�� �'ric. MN LICENSE # l��„�
Address: 13� %� ,/�,e..3f. .G!�Gi _ G�h �a�. c1s _ /�� . ��G`�� Tel. # 7�S"�� �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER:
Construction Type:1{.7�ih�l7 �/i��( Estimated Cost: $ �QOl�O
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
_ $
DATE: �'i ���I� APPLICANT: � Gd �.,�c�- Tel. # %�'S'��� �
Permit Fee
Fire 5urcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
$ � �� 2�
$ ' (� `'�
$ �(�� �
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$ $1000 per SAC Unit
$ � `'� $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.Q0 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [] Not Necessary [ J
$ ZZ� Z;�
���� ����
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 buildi�g 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
$2,001 to $25,000
$25,001 to $50,000
$SO,QO1 to $100,000
$100,001 to $500,000
$500,001 to $1,000,0�
$1,000,001 and up
FEES
$21 (M'�inimum Fee is $21.plus surcharge) , .
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,aao
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,OQ0 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 $10.0,D00
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $SOO,OQO plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,0� plus $2.75 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 $13.50.
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 $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 b'e required before proceeding with the framing.
�.
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C;ty of Fridley 3 2 9 4 9
AT THE TOP OF TNE TWINS g � I L D I N G P E R M I T
�
� ` NO.
� ; y ��_�� COIV�MUNITY DEVEIOPMENT DIV. ��� �
r � � PROTECTIVE INSPECTION SEC.
1 i �
� �"'1 � CITY NALL FRIOLE� 35�32 NUMBEa pEV D�TE P�GE Oi •PPROVED Br
�----�" �'' 763-571-3450 9t0-Fts 7/30/02 / /
JOB ADDRESS 5,557 East Danube Road NE
1 LEGAL LOT NO. BLOCK TiiACT OF ADDITION SEE ATTACHED
DESCR. 3 1 Innsbruck North 2nd Addition SNEET
2 PROPERTY OWNER MAIL AOORESS ZIP PHONE
Pat Freeburg 5557 East Danube Road NE 763-571-6041
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Fey`s Construction Inc 13270 Jay St NW, Coon Rapids, MN 55448 763-755-9438
4 ARCHITECT OR OESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
1904
5 ENGINEER MAIL ADDRESS 21P PNONE LICENSE NO
8 USE OF BUILDING
Residential
7 CIASS OF WOFiK
❑ NEW C� ADDITION 0 ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Remove existing deck; Construct a 12' x 14' Deck
9 CHAN(3E OF USE FROM TO
STIPULATIONS See notations on plan.
�1RNIN�
' ��forr� di��►��� ���I f�r
�II utili�[yy I���N�ns
4�4-00�2
�E��►r��� �� L��v
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV IOAD
SEPARATE PEFiMITS ARE fiEOUIRED fOR ELECTfiICAL, PLUMBING, MEATING.
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING SO. FT CU FT
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED POR A PERIOD OF 120 DAYS AT
ANY TIME AfTEF WORK IS COMMENCED. � NO DWLG. UNITS OFFSTREET PARKING
I MEREBY CERTIFY TMAT � HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. AlL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANGES GOVERNING TMIS TVPE Of WORK WILL BE COMPLIED @
WITM WME7MEp SPECIFIED HEREIN OR NOT. TME GRAN7ING OF A PERMIT W1,932 �•97
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OF CANCEL TME pEqMl7 FEE SAC CMARGE
PROVISIONS O: ANY OTH fi STATE OR LOGAL LAW REGUTATING CON-
Tii CTIO TME PERF R E OF CONSTRUCTION �69.25 Fire �J'�,' �1.93
� PLAN CNECK FEE TOTAI PEE
Lice C $5.0 $77.15
5 NATUAE OF CON"AACTOp NOA�2ED AGENt �DATE� HE PROp VALIOAT TMIS I�OUFl PER IT
- -dy
S�GNSTUAE O� OWNEa��� OWNEp BU�LDEp� IDATE� NSo ���TE
a •
NEVV (] CITY OF FRIDLEY Effecctivve 1/12002
ADDN [] 6431 University Ave NE, Fridley, MN 55432 (763) 572�604 Bldg Insp �
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R 2
BUILDING PERMIT APPLICATION : "'��"'��
r �,
Construction Address: ���� ��� � ��/� �� �LG< �
Legal Description:
Owner Name 8 Address: /�l� ��.�c�� Tei. #,7�'3°���° �
�Contractor. S � � MN LICENSE # ����
Address: � 3 � ��� Tel. # ��� �s° i���
�1��- �
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Ce�tficate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length � Width � HgUGround Sq. Ft C�J�
Construction T pe: ,}c, �'- Gi� Estimated Cost: � �� ��
Y
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: �.��ii�`O� APPLICANT: Tel. #%�� �SS' ����
Call (763) 572-3604 for Pertnit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will
call you tor card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ ras
$
$ �
$
$ cC�
$
�
$
$
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. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ � STIPULATIONS:
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 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,OW
$2,001 to $25,�0
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,(?00,001 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.(� 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, 0�
$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 $SOO,Q00
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,0(�,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION.ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.00.
Permits for construction will be issued a minimum of 24 hours from the time of application to �.11ow for proper
review of the proposed structure and of the construction site. �
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the elcisting founda.tion wilY be �equired before
proceeding with the framing. New Houses Onlv
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JUL-22-2082 ,10�37 FROM CITY OF FRIDLEY
���r���aTE � s���Y
For. .
�Da �Verne Co.
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7553?19 P.01/01
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Lof 3, ,9/oc�F �, �N�vs,�i�Uc�k NoRT.y 2�' .�,Od/T/oN.•d�a�v C"oa�,fy, �in��.r�
- . . . �•..
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W� .d�by �erft�y �hot this os a tru� ond ca�rea� reprosenlatioa, o� e sur+►ay ot •tt�e ' E. G, R�D �. �7���'l%'
�esi�a o� +�+ abew dss�tb�d la�d ead �I M+� 100oti0e ef au a�i�at�, tf an�►, L.ANO. 'SUR•Y�'���� �'�' :i:
thanen, ead alt risibla �r��+0►oohe►�+t�, ii ao�r; t�om or a► sn�d {arid. , 384T .!fi6#b ��'►e, 'S�•�;
� � �. s. auc � s�. �o�s. ��ac. ��� ��:.�: �.. `.
��� s � �� . _ . . :���ti ..��� -�:•.
Ostid fbt� .�.� aay +� �'_. � .-19_. • � '�- �► . � • . . . . . T.t�f' .�t��'�: '.c�i�rilt .r:-= �"�.�
...': . •. .. . . . _ �...� TOTRL P.01
�IE1N [ ]
ADDN []
ALTER [ j
Construction Address: :
� I I�€�� p � �. � ' � � �
'� � �— �� ' �
��S ��
CITY O� FRIpLEY
fi431 Universily Ave NE, F�idley, MN 55432
SINGLE FA�AILYAND DUPL�7(�S�R'��AND R-2
BU1LDtNG PERMIT APPl1CATION
�#.2�� ��i,�
(7C3) 572-Si6Q4 Bldg U�sp
(7G3) 571-1287°Fax
�
SS:� � �.��'����,�, ��� ��
Legal Description:
Owner Name & Address: �� ��'� � �� . y � , Tel. #� �"7� ° �° � � —
Contractor: ��` � G`�� i��� t�e.�� �.� ��� �.� MN LICENSE # � `�
Address: �` � � �� �. � � et,� Tel. # �! � . �2� -- �
LMNG AREA:
GARAGE AREA:
Attach to this applicafion, a Certificate of Sun►ey of the
bt, with the proposed cor�truction drawn on it to scale.
DESCRIPTION O� UNPROVEMENT
Length __ Width �_ Height,_,__ SQ. Ft. _
Length � �dth _ Height Sq• Ft
DECK AREA: Lengtl� • wdth _,^ Hgt/Graund Sq. �t ,
QTHER:
Construction Type: Q �-- � � � � _ Estimated Cast: $ � �� �� �
Drivew2y Cur'b Cut Wldth Needed: Ft + 6 Ft = Ft x$ �_$
DATE: �° l� ' �� APRLICANT: Tel. #��.�?- f.2%° �J y�
Call (763) 572-3604 tor Permit �ees if mailing in appliaation. Fax to 7635i1-9287 if us➢ng credit carr! and we will call
you for card number.
CITY US� ONLY -
Permit �Fee
Plan R�view
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
� 3 � o ���'
$
Q L
•r
$ 1���3�/_
$
$ ��
$
$
�
$
Fee Sch�lule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 per S/�C Unit
$5.Q0 (State Licensed Residenfia) Contractors)
Alt. "A" or Ali "B" Above
$450.00 Conserva�don Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary ( ]
$ �,3 e o � STIPULATIiDNS:
S0�Z0 ' d Jl3-1Q I 21� �0 rtl I � Sti : Z ti S00Z-S0-�Idd
BLT�DING PE�iT FEE SCHEDTJLE
The Chief Bui1dffig Official sb�all, before issuiag permits for the e�tion of any buiiding or structure, or foz' any
addition to a�y existixag bu�ding or stzucture, or for any a�teration or repair to any existing buiJ.ding or
structure, upon appUcati.on therefore, require t�e pa�ent by the applicant fox such permit of fees to the amount
biexein below set forth a�td in the manner herean provided. to-�vit '
TOTAL V,E'�LUE
$1 to $500
$501 to $2,�0
$2,�1 to $25,�0
$25,001 to $50,0�
$50,�1 to $10Q,000
$100,001 to $500,0�
$5�,�1 to $1,000,000
��
$23.50
$23.50 fo�c first $500 plus $3.45 for each additiot�al $100 or
fraction thereof, to and Yncluding $�,000
$69.25 for fizst $Z,000 plas $�4.00 for each addiuonal $1,�
or fract�on t�er�f, to and iu�ctudin� $25,000
$391.25 ;fox first $25,�0 Plvs $10.10 for each additio�al $1,�
ox fraction thereaf, to aud including $SO,U00
$643.75 for f�cst $50,� plus 57.00 �o� each additional
$1,0� ox �raction t�reoF, to a�i including $1�,000
$993.75 for first $100,000 plus �5•b0 fox each additio�l
$1,� or fractioa ther�of, to and i�luding $500,000
$3,233.75 for t,��e frrst $500,400 plus $4.75 for each addido�al.
$1,OQ0 or fxaction thereof, to and i�ciuding $1,000,000
$1,000,001 aud up $5,608.75 for the fust $1,�00,000 plus $3.�5 for each additio�
$1,000 or fractioaa thereof
DRIy�WAY DEPRF�5YON ESCROR'
(Concr�te G�irb Stree�.s O�ly)
Removal and replac�ment of curb and guiter only - Driveway vc►idth plus 6 feet tmaes $17.00_
V'EYtIFICATION OF FOUNDATION
Permits for constructaiom will be issued a minio�tum o� ?A hrnus from the time of application to allow for proper
revie�ev of tiae proposed structure a�. of the cox�srinlction site.
A Cera�ficate o� S�rvey of tt�e lot, showing the location of the founda�on once it has it has been consaucted will
be r�ui�t� be�ore pmceeding with the framing. �Tew House.s Onl
S0�£0 • d A3�Q I 21� �0 l�1. I � Sti : Z ti S00Z-S0-?�dH
���� : 16 � 37 C I TY OF FR I DLEY p,�,�p3
City �f Frkiley Buliding lnspections Rept. Ph: 783-572-3604 FAX: 763-571-1287
6439 Univers�y Ave NE
Fridley MN 55432
MeCh�11ic81 Permu o# �'� � � �� ���
Residential Application � J �� �'
City vf Fridley
Sae Back Side Por Re4uired Informa�on
Date �� l 0 C1 f, Site
Owne�
��
City: �<r ,� I ��- _. S�' m�
��
Ga11: - Fax:
MN Bond# & F�cp Date
Type af WorK (cfrcle one): tdew ReWacen�ern fuceranorvKerrpaei _
Oetafled Description ot worlc:
Equipmerd Installed: MFG: nnooe�: �¢er�s, u:
MFG; ' Model: S1ze/BTU:
MFG: Model: Slze/BTU:
Piease check all tnat apply: ,,,_�ireplace (gas) $15.00 New Gas Grill $10.00
�A/C $25.00 ,_Firepiace (wood) $35.00 _G� UnR HTR $10.00
_Airto Air exchanger $15.00 „_Fumace �36.00 Po01 Heater �35.00
Boiler 535.00 Gas Dryer $10.00 _Verrtitator $15.00
_Chimney Uner $10.00 _Gas Piping $10.00
Duct Worlc $10.00 Gas Rande/Oven $90.00 __
Pemtit Fee � �-S �� (Total from abovo-Minimum fee $35.00)
Total D ee $ �s --5� �ake check payable to Ctty Of Fridley
This is an applitxtion for a permit• not valid untq processed
i hereby epply for a meot►ar+led Permit end ��dCnowled90 lh�t th� it�tormatlon above Is eomplete end
mcourate; 8,at the wodc wi11 b� in eonformpnao with the ordinaroes and eodes oi 1he City oi Fridley end
with thw Mlnnesota CoristrueUon Codes; tha[ i tr�ders�d thts Is not e permit but atlY an appGcation
far a permit and work fs no� to start wltfiout a p�rtnit; ihet ths worlc wilt be in aoeordanee with the
�Proved plan in oa� ot e0 work whioh requiros r�iow and approval of p(anc.
Signature of Applfpnt: -��-r " Date: � � '�
Approval Inspeclur Sigr�atu�e: �8��
PiP.AS9 NOt@: Senarate aermits are �eQUired for Building, Plumbing, and Eiectrical work
AUG-03-2a� 16�37 CITY OF FRIDLEY P. ai0'+
REQUIRED INFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLlCA1'!ON HVAC
❑ NEW HOM�SJADDITIONS � EXI5TIId� HOME ❑ MAKE-UP AIR
RE�UIRED FOR NEWIF�CISl'ING HOMES
• r•
1. Corx�bustion Air (See note below) �
a. Oil or solid �el IlMC Chapter 7 with MN Amendmcfnts
b. Natiu�al Gas or Propane/IFGC Chapter 3 with MAT Ameadments
- - - �. ?�Ia�e.-ap-Air�S�cmotehelow) - - -- - - - ----
a. IMC Cl�ter 5 witb� IvII�T Amgndmeats
3. Venting
a Gas appliances I�GC Cbapter 5 with 1VIIV Amenc�me�ts
b. Fuel other than gas fi�IC Chapter 8 with MN Amendme�nts
REQUIR�D FOR NEW HOME9- .
4. �Ieat loss 8t woli.ng load pea� room
� a. Requir�d oa new construction IMC 1346.0312
5. Veutilation
a. Per MN Ene�rgy Code 7670 or 7672
6. Duct Dcsign Per IMC 1346.d603.Z
a. AGCA Maaual D
NOTE: Cente�oint Energy Mechanica! �ode Guidelincs softvvare may �e as� �or
cambushon and make up afr caltulatfions
TOTAL P.03
NEW [ ]
ADDN [ J
ALTER [ J
Constrvction Address:
Legal Description: _
Owner Name ddre
Contractor.
Add�ess:�(��
� � � �'` /
��1 � � �� � � i
CITY OF FRIDLEY Effective 1/1/2003
6431 Universit�l Ave NE, Fridley, MN 55432 (763) 572�604 Bidg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Tel. # ��� ��/ �ca S//
MN UCENSE # � ��
"' el. # l"5� �/S � - Ce �.s°
Attach to this application, a Certificate of Survey of the
lot, with the proposed constn�ction drawn on it to scale.
DESCRIPTION OF IMPROVEMEIVT
LIVING AREA: Length �dth Height _ Sq. Ft.
GARAGE AREA: Length �dth _ Height Sq. Ft.
DECK AREA: Length Width HgUGround Sq. Ft.
OTHER:
Construction
��✓
Estimated Cost: S ���5
Driveway Curb Cut Width Needed: �:--�, Ft = Ft x$ _$
� / �_ ` �
DATE: I °I � �G'�V APPLICAN'I''-:- ' Tei. #
Call (763) 572-3604 for Pertnit Fees if mailing in application ax to 763-571-1287 if using credit card and we wiil
call you for ca�d number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surrharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ /�- ��
$ '� ,`ZZ _
$ ��3�
$ S�C�
$
$
$
$
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th°/a)
�.50/$1,000 Valuation
$1275 per SAC Unit
$5.00 (State Licensed Residential Contrac�ors)
Alt. ��A�� or Alt. ��8�� Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ 3- 3� ,STIPLI ATIONS�
TQO sasnoH nsaN •�unu�� aq� �im 3utpaa�oid
aio�aq pannbai aq �inn uop�puno3 �uqsnca a� 3o uor�raoj a�i �uinno�s `�oi atp 30 �anms �o aa�t ,�a� �►
I�iOI.L�Qi�f l03 301�tOI.L�'�L�I?I�
•a�is uor�naqsao� a� 3o p� am�n�s pasodoid a� 3o nsainal
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'00'LI$ ��l ��3 9 �Id �PTnn �Ensant.ip - �Juo iaun� p� qm� 30 �uatua�da.r puE �nomag
(�IQO ��AS qm� �ia�uo�)
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3oalaql uoq� io pQp ` i$
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000`000` i$�PnI��? P� ol `3oaia� uoq� io p�` I$
TeaoulppE ��a io3 SL'b$ �Id U00`OOS$ lsn� aq� l03 SL'�£Z`£$
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io �I$ I�o?�1ppE q�a l03 SO'£$ �id OOS$ �S�31o; OS'£Z$
OS' £Z$
5333
� P� I(}0`000`I$
000`000`i$ 01 I00`OOS$
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OOS$ � I$
3n�n -�.LOi
:1tn�-o� papino�d uiaia� iauuEm atg m pue t�o3 �as moiaq
maia� aunomE a� ol saa3 �0 1�lad u�ns io3 l�ridde aq� �fq luam�iEd a� annbai `aio�aia� uop�iJdd¢ uodn
`ami�ru4s Io �urp�nq �m3snca �uY ol �dal io uo�Yaa1� �� io� lo `aml�n�s io �utPimq �misrxa �uE oa uou1PPE
I�IIE 10� 10 `am��n�s io �atp�rnq �ue �o not�aia a� io3 s�ttu.iad �mnssr aio;aq `�qs ���p Surp�rng 3a� a�J,I,
�'Il1Q'.��S �3 J,II�1i��d �I�IIQ'IIl1g
3uilding
[nspections
763-572-3604
753-502-4977 FAX
�ATE / — r7 —O
3ITE ADDRESS c� .J `7 / �✓
I'HIS APPLICANT IS: ❑ OWNER
PROPERTY OWNER/
TEAiAl'i`Y'
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-08 _
YOUR E-MAIL ADDRESS
e
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'ATE %�o%LI P��
1VA��lL. � Y• -• � �� �
CONTRACTOR �,DDxESS: '; Z ��1 �e /dlr)P CI� /� �t�9oC9sTArsi�.Zrn v���
SUBMIT A COPY OF pHp� 6�f '�,3R' $— 7� 7' FAX
YOUR STATE LICENSE STATE LICENSE # �� c� �7 3�3 EXP DATE � 7
PROPERTY TYPE
p�SINGLE FAMILYRJEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES_�
PERMIT TYPE � �DITION u ���
❑ BASEMENT FINISH �ROOF
❑ DECK ❑ SIDMG
❑ SWIMM
TYPE OF WORK: �.O NEW HOME CONSTRUCTION
DESCRIBE WORK BEING
OF
R��� 3�
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
� Vinyl
O Aluminum
❑ Other
wnvnows
TN EXISTTNG OPENIAiGS �Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE STZE OF
OPENING CHANGES &
'r'w� nF urmtpOW TO BE WSTALLED
❑ ADDITION
o x�MOn�.
❑ HOUSE ONLY
�1i0USE & GARAGE
f,81 ATTACHED GARAGE
❑ DETACHED GARAGE
O DRAM TILE
❑ OTHER
FT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used,
FOR NEW CONSTRUCTION INCLUDING DECKS,
,ADDITIQNS & PORCHES SUBMIT:
�Soffit I, Site PIan/Survey showing the existing structures
❑ Trim and proposed project
❑ Fascia 2. Two seu of construction plans
3. Energy Calculations
LOCATION OF WINIIOWS
NUMBER OF
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
,.. R1�ING THE 1997 UBC FEE SCiIEDULE)
COTAL JOB VALUATION S
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Swcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due _
$ `�{' � doG'�
$
$
$ ol
$ ��_
$
$
$
$ �
$
$ �0
ANCY TYPE
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the tota.l job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contra.ctors)
$1825 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�able 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 Fridley and with the Minnesota nstruction 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 accord with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME ���ul� ��'��1 DATE /'��7"v �
APPROVED BY
DATE
i�
Page 2- Buildi.ng Residential Application
s , F�, . 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 applicaxion 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 consixuction will be issued a mini.mum 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 found.ation 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
Faz: 763-502-4977
Frcm: City of Fridley� T3: 35� 48�4022 �age: 2!3 D�te: 1' /4/2�8 11:09 25 AM
Bd�ilding ' 1VIECHAlti7I�AL,
Inspections � ��IDENT'I�L Ai'PLICATI�N
763-572-3604 j �'I�l�Y (��� � �I�L�Y
763-502-�97! Ft1X � rrr���-nvr ;-i-ux
ll,� r�__ \ l �� 1'OU1Z �-R1AIL r�;JDR�:SS _--, ^—
Sll'E AUllIt6SS �^ ���.�—���— �----- —
TH1S APPLICaNT IS: ❑ C)N'NEIt Va�'nNT12ACT(�!i
PROPERTY Nm��:_ �o��� G � 0. yZ e e b ��°�.
OWNER/ auuxtss C� Yl l,t '�- �' � C1T1 ��� Ci
TENANT —�------ - /��
PriCiNt: 1'—���_� � �D U—T 1
j Permit No.: �'
� F.eceived By:� I 1'
! D���IOV
� P l.. sr�
P
�
-- —
CONTRr1CTOR l'DMP4N°' NAME�� ��_`��e _ e�� il�--- ----------------.__----
NOTE.: __�� _ `____
---- ��
S�.PAItATE ClT'i' +�ONTAi:T PEIiSON: U� �----� ��.----.-----__------
:.�C'ENStJ �1Kt I �T.4T� :.Il'tV�N ;! EX? ll.a, k�'— �c�t
REQI 1R�ll HtIN. C;A'S ------- -- — -- --- yy� �%i. .. �JJ `�
ARU HVAC. ! AUURtSS: C'ITl s"� ��'� � 1TAT!' � �'
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ANll 1NiUJ2.�N�k:
PERMl7' TYPE I�'��'LL ^�MILY �� rwo r�nsiL�
I�YP�, t)F� «`URl�l I ❑ NEII' ;,YK�PL4C'E.y16NT
DETAILED DES�.RIPT[ON OF' 4VORK
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❑ Tt�WNHt)l.".+E
C .�LT�IiA"fil);r�K�!�tOJEL
_� ��� t?-�1_C�_CSZ. ---------
PF.R'btS 16B.�ifi5 4hc. �crmit fcc i� ,3 minRnum� oT:515.00 or 5% of tlee tot�xl cu�t up t� �500.(1(1, tit•hi�l������� �;rc�3mr. for thc
�r.�rovcriunt, insteli�ti�yn or renl;�cr•n;ent ef a nsidantial fi�ct�irc. ��xcl•adi.n� thC rixYar'.'t,. {TE:i:; shu.zid r.f.ect ��r,t;ti� th� cest �,f 1�'x�r )
OR
L.al.or cust undce $300 = S lSAQ. LaY�or cost bct.va:n :fi+3f�Q iu $�QU – rn�t �f lsbor _________ x.US =_____
F'fJItPKCJI�I��'4'H�lZt_.4kiOR�XCtEUS��00.F'�tSARfEAlcJ(]!N`�lUiIGP�'riL'th7.�12E;'c:i�cPf'�4'He:Lt(h^'Itll I-3\'f'L'It::� �INJI�Ai�'1^1'.:_
NL!11H�R C�F tACH dtLC)1A ) ry��/► l�y - �`^ ' 4� C�D� � �(� 1 C�O�
Equi�nnent Instatied n�r•r: w� ' � --- �i�. , ti1JUEL: __ ^ 51L6r8Tl, ---
Mb'G. ti1t�J�L: S1�::HTU .
, ^ , ;�;'L�,'f3"fl, ._`_'-
11�1F(i. — �lUilEk[ _
A•C $2�:00 � !'1hEN!_SC� 1GA�} S;j �iG ' ----- CiAS 1L4hGE t71�'EN $fu.Ul!
AlR TO .�11R EXCHANG�L•R $]5 I�11tc,PLnC i: i�'� t�.C,Di S�'.��0 `L�V Gr�S f;l'�1LL."b IL�.t��
HOILtiR�35.U0 �NiRhAC,��i35.GU - GhSUNiTHTIt$1�iGU
!(;H@7.'Vtl' LIN�R$l0 GU CA3 URYhk blf!.Q(i PC)1�:._H�.4Trlt i;5.U;1
llUCT 41'OkK $IU.O+� ,, - =liA� PiPllvii SIL.Oi} _VEN71LAPn{:SI S.Gt!
Pcrmit Fcc
Surchargc
T'OTAL DL'E
„ . �..,..
�
'_411N1h1ti11 SiS._SO
OR
. .....
;.,P��4�1 L::�'�� kfiJ:k�t YHE;CJ:J:�4, titi':tiJ<at �ki ��U!#:
htmbcroif�:turc�res;Slf1.OQ x$1UA�)=g.
R'umbcro:'fxt��rc� ra�. $1.5.UG x $15.00 = S
N�:mbcr of fi�:ti�r�� �as S25AU ` x�2g.0i� _$------
Niimbcr c�.' f xturc.� {u�. $35.Ut� x$35.U+1 = 5
� Srdtr Surchargr = �i' .50
!�111�IR9t?AI $15.50 Total = $ __
�.�
THIS 1S Av APPLI(:.�T10N }'ON. A P�RP.�1I-NOT VALIll UNTI! PR�Ck:SSEll
1 here�y n�+iy fnr a nxchanical perrnit and ! acknowledgc that the ���f�an:tlion arn?�e �, �oruple!e ane acc�rcate; ;hat the werS; w�i�l �e in confi�nnan.x with the on'inances
an•J codes ��f the t.ir; '>>' F:id;e} ar,o with the M:r,rms��ta Gonstmction Cc�des. :hai 1 unJeistan�l ��i< is jiet a, ��er.i:i: :•ut unly an ap�^l�ca�io.: for a�:ni�t and •aoek is n:,t [��
.tirt s� ithcn�t.a pcnnit: that tl�e �aora u il� bG in acc:ui�xrn;e with nc� aPprooeu �n� i!� tLe c.:�ac cP.etl itio:� '.s i�h �eiji�ir � rer�iew arnl.ap�sro�el uf la �a. ,
i
_ , _ _. ' �(� _ -�–
S1i1NATURE OF APPUC 4 _ -_,: ��!✓1 .--__PRINT [YAS�'E "�_�� ����� LpATE I (_� 3.l �
APPRO�'�U BY _. . ; . , 1)ATF.
" " Citv ui E'ridlew'
� , Bullding Ins�ecttons Deprartm�,vat
t � G�31 Ur.'i����itv .A��unuc NE; Fridl�y> TViN i�33?.
?b3-�72-3fi0-1. ,F.4.7{; 7c;3,50�-a9;?