AF - 40752City of Fridley, Minn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
��: September 12, 1972
��16�6
p�; _ $SiZ Viewcon, Inc. �� Same � � ��
� 5901 Brooklyn Blvd. �� �N_ __ S�e__.__..:_.._.._.__....._..�
Address .
LOCATION OF BUILDING
Na 5511 S�t East Oberlin Circle __��� Part of Lot
y� _ R g�� 4 Addition or Sub-Div3sion Iu�sbruck North 2nd
Casmer Lot Inside Lot X Setback � ._._.�.. SiBeyard ___
$eWer Ele�va13aa1 _ Foundation Elevation
DESCRIPTION OF BUILDING
To be Used as: 1496
Front r..24_'_. Depth ,3L'._ Height ..2.$ �� Sq. F� _.�4.�._ Cu. F� 2Qs832
Front 2�� Depth 22 � Hei�ht 10' �. �`440 �� 4, 400
Type of Ca�struction W�od Frame ��, �t „ 25,416.96 _ To be Completed 1_15-73
Stipulatious:
Owner and coatractor to be responsible for elevations an�d for drainage fora all
structures and the City shall be held blameless.
Constructio�s must comply with U.B.C. 505 C1, C2 & C 3. See attached sheets - a use
figures 5, 9, or 10.
In consideral3on of the issuance to me of a permit to co�struct the building described above, I a�ee to do
't�e P�I�d work in accordance with the d�crlptioa abovg�et forth and in compliance vvtth�11 provisions at
�nancea o� the city o! FridleY• /' 1 .� __U
In c�sideration of the payment of a fee of „�. 7 0.5 0 � pexmit is hereby granted to
to construct the building or addition as described above, This permit is granted upozi
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
do�e in, around and upon said building, or any part thereof, shall conform in all respects •to the ordinances oi
15ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of building�
Wi'�.th�n' � city limits and this permit may be revoked at any tame upon violation of any of the provisions oP said
Buildin8 InsPecta�
DARREL CLARK
NOTICE:
This p�rmif do�s aof eove� tha eonstruefion, insfaliation for wiring. plumbeng, gas heating, s�w�r or wat�r. B� sun M aw
t6� Buildiny Inap�ctor fo� ssparat� psrmits for th�se ihms.
� .r —=
�_
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING P.�RMIT
CITY OR FRIDLEY, MINNESOTA
OWNER' S NAME : U/rsd�fq 1 c. BUILDER: .SQA�r�.
— .�_...�.
ADDRESS t_.T90/ ,B/y�/,�/yy ,�/vj� ADDRESS : .SQ�tt
NO:. �SS// STREET: E�t� D�tI�I�s �%K/t
� LOT : � BLOCK: '� ADDITION : .I'��GrNE.ii IiIO�� .Z "d . � 1
CORNER LOT: INSIDE LOT: `� SETBACK: SIDEYARD:
"'._"'"T^
Applicant attach to this form ltao Certificates of Survey of Lot and propoaed
building location drawn on these Certificates. '
�ESCRIPTION UF BUILDING
To Be Used As:
�AAr,v�s ,�l�«tG Front : ,Z4 � Depth : ��� Height : Z B �
/��G .,
Square Feet: 74� Cubic Feet: Z O!l�
VAr�4t Front: 20' Depth: ZL' Height: �O �
Square Feet; -�'�O Cubic Feet: ��OD
Type of Construction: �jOd �I�Iwa� Estimated Cost:_,� Za�'��_��i
�
To Be Completed: �" /.t�' 7.,�
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinaaces and rulings of the Department of Buildings, and hexeby
declares that all the facts and representations stated in this applicativn
are true and correct.
DATE :' 8"L L-� 7 L S IGNATURE : �. �
(See Reverse Side For Additional Information.)
,� �1 �, 04
I�2•�/ S-T,
� �3 . S� P. C.,.
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BUILDING PERMIT FE� 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 for any alteration or repairs to any existing
building or structure, upon application therefore, require the payme�� b� the
applicant for such permit of fees to the amount herein below set fogth and i�
the manner herein provided to-wit:
LTNIIFORM BUILDING CODE: 1�pe 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. 1�rpe 3& 5-$1.85 for
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 from a point six (6) inches below the floor linC of the basement
ox the cellar to the average heights of the upper surface or to the average
height of the roof surface of the main gable of � pitched roof.
For repairs or alteratiuns to an exicting structure, �he 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 for any pennit 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 allow 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
haa been constructed, will be required before proceedint� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (YO) daya 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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sue�ecr MIT NO. `'
City of Fridley 2 2 6 9 8
AT THE TOP OF THE TWtNS g � I L D I N G P E R M I T
i � RECEIPT NO.
� �
COMMUNITY DEVELOPMENT DIV.
' j ~ ' �
r � � PROTECTIVE INSPECTION SEC. � r' �
l---. A �/'��;,� CITY HAIL FRIDLE� 55032 NUMBER REV. DATE PAGE OF APPROVED BV
i �� 612-571-3450 910-F15 7/13/94 � �
JOB ADDRESS 5511 East Oberlin Circle NE
1 LEGAL LOT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. 8 4 Innsbruck North 2nd SHEET
2 PROPERTY OWNER MAIL ADDRESS 21P PHONE
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Dicks Fire & Storm 864 19 Ave SE, Minneapolis, MN 55414 781-6170 2481
4 ARCHITECT OR DESIGNER MAIL ADDFiESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO.
6 USE OF BUtLDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (Tear-off); gutters
9 CHANCaE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State Building Code. Inform owners to
install smoke detectors as per State Building Code, adjacent to all sleepiag areas
and in basement.
TYPE OP CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATIN(3,
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING Sa. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFEET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALIS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WOfiK Wl�l. BE COMPLIED
WITH WHETHER SPECIFIED HEFEIN OR NOT. THE GRANT�NG OF A PERMIT � Z�LiH 1. 11
OOES NOT PRESUME TO GIVE AUTHOR�TY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFORMANCE OF CONSTRUCTION. �S�i.00 Fire SC �2.2�
PLAN CHECKFEE TOTALFEE
License SC $5.00 $62.33
S�GNATURE OF CONTRACTOR OR AUTNORIZED AGENT IDATEI ERLY V IDATED THIS IS VOUR PEAMIT
_. �-l�-�z�
SiGNATUREOFOWNEA��FOWNERBUILDEAI IDATEI ."BLDG IN v na7E
.r>
NEW
ADDN
ALTER
Il
��
il
Construction Address:
Legal Descrigtion:
Owner Name 8i Address:
CiTY OF FRIDLEY
SiNGLE FAMILY AND DLJPLEXES R-1 AND R-2
Building Permit Application
511 - East Oberlin Circle, Fridley, Mn.
Tel. #
Effective 1 / l /94
�����
ContractUr: R.J. Williams General Contractor MNLICENSE# 2481
AddiCSS: 804 - 19tri Ave. S.E., Mpls., Mn. 55414 Tel. # 781-6170
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this apptication, a Certificate of Survey of the
lot, with the proposed coasiruction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height Sq. Ft.
Height Sq. Ft.
HgtlGcound Sq. Ft.
Corner Lot [] inside Lot (] Ft. Yd Setback Side Yard Setbacks
Type of ConSttuCdoti: h o u s e & g a r a g e r o o f, Estitttated Cost: s 2, 218 . 0 0
Approx. Completion Date: g u t t e r s
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ =$
DATE: 7/13/94 APPLICANT: R.J. Williams Gen. Contractor Tel. # 781-6170
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ Fee Schedute an Reverse Side
$ .001 of Permit Valuation (1 / lOth %)
$ $.50!$1,000 Valuation
$ $800 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Pian Review
$ Fee Deiermined by Engineering
$ Agreement Necessary ( ] Not Neces.�ary [ ]
$
I3UILDING PERMIT FEE SCHEDULE
1'he Chief I3ui(ding Ofticial shall, before issuing permits for ihe 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
buiiding or structure, upon application therefore, reyuire tfie payment by the applicant for such permit
<�f fces to the amounE� herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $S00
$501 to $2,000
$2,001 to $25,000
$25;001 to $50,000 • �
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000� �
$1,00�,00I and up
FEES
$15 (Minimum Fee is $ IS pius surcharge) ��
$15 for ficst $Spp p(us $2 for each additional $100 or
fraction thereof, to and including $2,000 �
$45 for first $2,ppp plus $9 for each additional $1;000
or fraction thereof, to and including $25,000
$252 for f�st� $2S,ppp pi�s $6.50 far each additional $1,000
or fraction thcxeof, to. and including $50,000
$414.50 for first $Sp,ppp plus $q,.5p for each additional
$1,000 or frac6toa t�'eof, to aad including $100,000
$639_SO for f�rst -$10p,ppp plus �$3.50 for each additional
$1,000 or fraction thereof, to and inciudiug -$500,000
$2039.50 for ti�e first $SOp,ppp plas $3 for each additional
$1,000 or fraction thereof, to and inciuding $1,000,000
$3539_SD for the fYrst $i,ppp,ppp plus $2 for each additionai
$1,000 or fraction �thereof .
DRIVEWAY DEPRESSION ESCROW
(Concrete C�u-b Streets pnly)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times
$I3_SO_
Alternate "B": Removal and reptacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6�feet times $15.75.
VERIF[CATION OF FOUNDAT[ON
Permits for construction will b� issued a minimum oF 24 hours from the time of application to a(low
for proper review of tfie pro�seci stnucture and of the construction site_
A Certificate of Survey of the lot, showiag the location of the foundation once it has it has been
constructeci witl t�e reyuirecl before Proceeding with the framing_
u
�
sue�ecT IT NO. �
City of Fridley 310 4
AT THE TOP Of TME TWINS B U I L D I N G P E R M I
f
; � IPT NO.
� `v _ COMMUNITY DEVEIOPMENT DIV. ��� �
r � � PROTECTIVE INSPECTION SEC.
i = ,
� •• w�"' `'; CITY MALL FRIOIE� SS�32 NUMBEN ' REV O�TE v�GE Os �►PROVEO Sr
�� 612-571-3450 9t0-Ft5 6/8/00 � �
�oe �ooRess�� 15,19, 23, 27, 31, 35, 39 OBERLIN CIRCLE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
oesca. 1-8 4 Innsbruck North 2nd SNEET
2 PROPERTY OWNER MAIL AOOfiESS 21P PMONE
Innsbruck Townhome Association 651-224-5482
3 CONTqACTOR MAIL ADQRESS IIP PMONE UCENSE NO
Garlock-French Roofing Corp. 2301 E: 25th St., Mpls., MN 55406 612-722-7129
l ARCMITECT OR DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
00001423
5 ENGINEER MAII AODFESS ZIP PMONE UCENSE NO
6 USE OF BUIIDING
Residential
� c��ss oF woAK
O NEW O AODITION O ALTERATION X] REPAIR O MOVE O REMOVE
8 ESCRIB WQN((
l�eroo Building
9 CHANf3E Of USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
Permit Inspection Cards
Will �o Nlali
To Homeowne� � �ost
! �i,
SEPARATE PERMITS ARE REQUIRED fOR ELECTRICAL. PIUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
VENTILATING OR AIR CON�ITIONING.
TMIS PERMIT BECOMES NULL ANO VOIO If WORK OR CONSTRUCTION 20NING SO. fT CU FT
AUTMORIZED IS NOT COMMENCED WITMIN 60 DAYS. OR If CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO FOR A PERIO� OF /20 DAYS A7
ANY TIME AF7ER WORK IS COMMENCED. NO DWLG. UNI75 OFFSTAEEI PARKING
1 MEREBV CERTIFV TMAT I MAVE REAO AND EXAMINEO THIS APPLICATION $ STALLS GARAGES
AND KNOW THE SAME TO BE 7RUE AND CORFECT. ALL PFOVISIONS Of �AWS VALUATION SURTAX
ANO OROINANCES GOVERNING TMIS TVPE OF WORK WILL BE COMP�IEO
WITH WMETMER SPECIf1E0 MEpEIN Oii NOT. TME GRANTING OF A PERMIT �16�22.2.85 .�H. �.1
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqMIT fEE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TNE �ERFORMANCE Of CONSTRUCTION �2%9. ZS Fire SC $Z6.22
PLAN CNECK fEE T TA� FEE
303.58
S�GNATUpEO�CON'A�CTOpOp�U1MOA�2ED�GENT �OAiE� yyH PRO V VALIDA O TMIS IS OUp PE:MIT�
(� '
� %
S�GN�TUAEO�OWNEA���OwNEpBUi�DEpi �OATE� :� 91 �NSp qcfE
NEV11 [ J . Effective 1/1/2000
ADON [ j CITY OF FRIDLEY 612-5►?2 3604 Bldg It�sp
ALTER [ j SINGLE FAMILY AND DUPLEXES R-1 AND R 2
� � BUILDING PERMIT APPLICATION � -( O D
. �/�,(p 6�
Construction Address: S� � I�i 3 2� 3 3 5� � h. �� J �
Legal Description:
Owner Name & Address:
Contractor: ( C-
Address: a�3D l �s
LNING AREA:
GARAGE AREA:
#lo5i-aau-SN��
Mrv ucENSE # �boi �a►3
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Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Fi
Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER:
Construction Type: R Estimated Cost: $ �� �a �•��
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: � 2 APPLICANT: ��- �1 �� .�P.f'� Tsi. # t, � a-� a a-� l a�'i
CITY USE ONLY - Call (612) 572-3604 for Permit Fees tf mailing in application
Permit Fee $�17���s Fee Schedule on Reverse Side
Fire Surcharge $ 1�.1- y.001 of Permit Valuation (1/10th%)
State Surcharge $ .�/ $.50/$1,000 Valuation
SAC Charge $ � $1100 per SAC Unit
License Surcharge $_ $5.00 (State Licensed Residentiai Contractors)
Driveway Escrow
Erosion Controi
Park Fee
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ J Not Necessary []
TOTAL
�� 3-.�c�
STIPULATIONS:
�
BIJILDING 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 stcvcture, or for any alteration or repair to any e�cisting building or sttvcuu+e,
upon application therefore, require the payment by the applicant for such permit of fees to the �ount herein
below set forth and ia the mann�er herein provided to-wit: . . �.. .
TOTAL VALUE
$i , to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1W,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEFS
$23.50
$23.50 for first $500 plus $3.05 for each addidonal $100 or
fracdon thereof, to and including $2,000
$69.25 for first $2,000 pius $14.00 for each additional $1,000
or fracdon 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 aad including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fracdon thereof, to and i�luding $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRES,SION ESCROW
(Concrete Ctub Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Altemate "B": Removal and replacement of curb an�d gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of applicadon to allow for proper
review of the proposed structure and of the construction site.
A Certifiicate of Survey of the lot, showing the location of the fou�ation once it has it has been constructod will
be required before proceeding with the framing. New Houses Only
�
� Sul�EtT . � � � . . •;\
c;ty of Fridley 32178
.
AT THE TOP OF THE TW�NS g � I L D I N G P E R M i T
� � R� / �
COMMUNITY OEVEIOPMENT DIY. �j������� ^
r �~ � � PROTECTIVE INSPECTION SEC. � U
i.--- A;�"' �'� CITY HALL FRIDLE� SS�32 NUMOEA pEV O�TE vAGE O� �i►novEO sr
� �� 612-571-3450 910-F15 9/19/O1 / /
J08ADpRESS 5511, 5515, 5519, 5523, 5527, 5531, 5535, 5539 East Oberlin Circle NE
t LEGAI �OT NO. BLOCK TRACT OR AOOITION SEE ATTACMED
DESCR. j- 8 4 Innsbruck North 2nd Addition SNEET
2 PROPERTV OWNEF MAIL AOCRES$ 21P PMONE
Various
3 CONTRACTOR MAIL ADDRESS iIP PHONE LICENSE NO
Columbus Exteriors 2131 111 Lane, Coon Ra ids MN 55433 763-757-7530
4 ARCMITECT OR OESIGNER MAII AODRESS ZIP PMONE UCENSE NO.
5 ENGINEER MAII ADOFiESS Z�P PNONE IICENSE NO
8 USE OF BUILDING
8 Unit Townhouse
7 CIASS Of WORK
O NEW O AOOITION O ALTERATION fR'1 REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reside Building•Soffit F
9 CHANGE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code, requires that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions for this pro�ision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Viny1 siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Ca11 for inspection of wrap
before covering.
TYPEOFG NST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE FEOUIRED FOR ELECTRICAL, PLUMBING. MEATING.
VENTILATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL ANO VOIO If WOAK OR CQNSTRUCTION 20NING SO. fT CU FT.
AUTMORIZED IS NOT COMMENGEO VyITNIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO fOR A PERIOD OF 120 OAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO OWLG. UNITS OFFSTREET PARKING
1 MEREBY CEfiTIFV THAT 1 NAVE READ ANO EXAMINEO TMIS APPLICATION H STA��S GAAAGES
ANO KNOW TME SAME Tp BE TRUE AND CORRECT. ALL PROVISIONS Oi LAWS VA�UA710N SURTAX
ANO OR�INANCES GOVERNING TMIS TVPE Of WORK WI�L 8E COMP�IEO
WITM WHETNER SPECIFIEO MEREIN OA NOT. THE GRANTING OF A PERMIT �59,637 $29•82
OOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pEpM17 fEE SAC CMARGE
PROVISIONS OF ANY OTHEF STATE OR LOCAL LAW iiEGULATING CON•
STRUCTION OR TME PERfORMANCE OF CONSTFUCTION �%13.75 Fire .S�'i �59.6�i
, P�AN CMECK fEE TOTAL FEE
� 1� 9 l� dl � 3.21
S�GN�TUpEOFCON'AACTOpOpAUTMOp�ZEO�GEN1 IOATE� ROP L ALIOATED . �S IS VOUR PEpMIT
�'�9'd�
$�GN��UAE O� OWNEp��� OWNEA BWLDEAi � ��E� Bl -�N �' �i�tE
Prepaid Plan Check $
Estimated Cost $
Receipt #
CITY OF FRIDLLY
R-3, COI�ILRCIAL & INDUSTRIAL
BUILDING PERMIT APPLICATION
Effective 1/1/2001
(763)572-3604
��� .� ���'
Construction Address ���� '� ��3 � �' ��'�����.. �r��.r Zor�ing
Legal i �AS ��`'E-�� • 1 �r��
Owner & Address � r� � v 9! `' ��` � Tel# (��) a y^ `� y! Z
CONTRACTOR & ADDRESS �- � � ~' 6 �� �i� � Tel# (%� � ) �S� � ' � S�j �
�/�� /%� ?� .L� G�� ��p•d
Architect
TYPE OF WORK [] New
Reg.# Engineer
Reg.#
BUILDING CONSTRUCTION
[] Addition �' Alteration -Describe � = � � µ,Y _ S �O " � � �
�/�' C �' !a. vtJ . '� � � t�t� � Il �� ,
oFC. AREA: Length Width Height Sq. Ft.
WHSE AREA: Length Width Height Sq. Ft.
OTHER AREA: Length Width Height Sq. Ft.
APPLICAN'P �� ��_ Tel # �l v ^ �C+ 3 � ? ��te
Sq. Ft.
Sq. Ft.
Sq. Ft.
VALUATION
x $ Cost/Sq, Ft. = Valuation $ )
x $ Cost/Sq. Ft. = Valuation $ )
x $ Cost/Sq. Ft. = Valuation $ )
%rl�-G/
= S ��- G 3 � `'�
TOTAL VALUE
Building Use Construction Type Occupancy Group
Air Conditioning []Yes [JNo Fire Protection Provided []Yes []No.
Performance Bond Amount $ See Reverse for Schedule Received []Yes []No
Permit Fee $ r ! � > /��
Plan Check $ ���
Fire Surcharge $ � . �
State Surcharge $ , a
SAC Charge $
Erosion Control $
Park Fee $
Spec. Assessments $
Driveway Escrow $
TOTAL $ O .��
PERMIT FEES
See Fee Schedule on Reverse Side
In Excess of Prepaid Amount - See Reverse Side
.001 x Permit Valuation (1/lOth �)
$.50/$1,000 Valuation (See Sched. for > $1 Million)
$1150 per SAC Unit (Plans to MWCC for determination)
$450.00 Conservation Plan Review
Fee Determined By Engineering
Agreement Necessary [] 1�7ot Necessary [J
feet x $15.50/foot
ATTACH STIPULATIONS
$1 to $500
$501 to $2,000
$2,001 to $25,000
$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
BUILDING PERMIT FEE SCHEDULE
$23.50 (Minimum Fee is $23.50 plus surcharge)
$23.50 for lst $500 plus $3.05 for each addn'1 $100 or
fraction, to and including $2,000
$69.25 foi lst $2,000 plus $14.00 for each addn'1 $1,000 or
fraction, to and including $25,000
$391.25 for lst $25,000 plus $10.10 for each addn'1 $1,000 or
fraction, to and including $50,000
$643.75 for lst $50,000 plus $7.00 for each addn'1 $1,000 or
fraction, to and including $100,000
$993.75 for lst $100,000 plus $5.60 for each addn'1 $1,000 or
fraction, to and including $500,000
$3,233.75 for the lst $500,000 plus $4.75 for each addn'1
$1,000 or fraction, to and including $1,000,000
$5,608.75 for the lst $1,000,000 plus $3.15 for each addn'1
$1,000 or fraction
PREPAID PLAN CHECK FEE SCHEDULE
Per Minnesota Building Code - 65 % of building permit fee.
PERFORMANCE BOND POLICIES
When a building permit �is issued for a commercial, industrial or a multiple dwelling
residential project which requires outside improvements, a Performance Bond or a Letter of
Credit shall be submitted to the City. The bond will cover all outside improvements, including
but not limited to landscaping, inigation, curbing, blacktopping, screening fences, lighting,
water & sanitary sewer services, and storm drainage systems.
Calculation of bond amounts will be determined by the building pernut values. The
bond amount will be 3% of the building permit value up to a 2 million dollar project or a
$60,000 bond. Actual amounts will be rounded to the nearest $100. The City reserves the right
to require greater or lesser bond amounts based on unusual circumstances. Projects with no
outside improvements, generally will not require a bond.
Bonds must remain open until the project is fully completed. Reproducible "as-built"
drawings of all exterior underground utilities must be submitted to the City Engineering Dept
before the project is considered complete and the bond released. All bonds will be held over
one winter and through the next growing season to insure the survival of all landscape
installations. The City will then inspect these properties in August of the year following the
initial planting. Bonds may then be released in October of that year if all improvements are
satisfactorily completed.
.. .._
�
Building
Inspections
763-572-3604
�
DATE
SITE ADDRESS ��
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
���
❑ OWNER
Permit No.
Received By;
Date RL�'1d�
YOUR E-MAIL ADDRESS �SO��aC�1 � C���[ C• C.C�iY'\
,� r�-�
OCONTRACTOR
ADDRESSl:_ � CITY STATE ZIP
PHONE: T"��— ���' f
NAME:
STATE LICENSE #_
ADDRESS:
SINGLE F
Renewal By Andersen
1920 County Road "C" West
Roseville, MN 551 l3
License #20130983
651-264-4777
❑ ADDITION ❑ GARAGE/SHED
O BASEMENT FINISH O ROOF
0 DECK ❑ SIDING
❑ SWIMMING POI
TYPE OF WORK: I O NEW
O MAI1
DESCRIBE WORK BEING
SIZE OF IMPROVEMEr
ROOFING
NUMBER OF SQUARES _
c.►te. c
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O Vinyl
❑ Aluminum
❑ Other
ADDITiON
�
LENGTH
0 HOUSE ONLY
❑ HOUSE 8c GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
OSoffit
O Trim
❑ Fascia
WINDOWS
IN EXISTING OPENINGS �Yes ❑No LOCATION OF W[NDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPEN[NG CHANGES &
TYPE OF WINDOW TO BE [NSTAI.I.En rn iuewco nc a
r STATE ZIP.
O DRAIN TILE
0 OTHER
WIDTH
HEIGHT
BASEMENT RFMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor pian
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
A9DITIONS_ & PORCHES SLIBMIT:
1. Site Plan/Survry showing the existing structure
and proposed project.
2. Two sets of construction pians
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
_ (USIN('j,TI� 1997 U.B.0 FEE SCHEDULE)
JOB V.
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ -
$
$
$
TYPE
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
THIS IS AN APPLICATION FOR A PERM[T-NOT VALID UNTIL PROCESSED
I heteby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be i�
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not :
permit but only an applicati for a permit ork is not to start without a permit; that the work will be in accordance with the appmvec
plan in the case of all work ' h uires r' and ap val o lans. �
SIGNATURE OF APPLICANT P T NAME�Q�R . v�Gn v� DA7� (./�
l°nd pl°nniog s�,L'GY�u/L.C�n 6875 Highway No.65 N.E.
Lnnd Surveyin9 (/ Minneapeli��
son: Testing �42��/�2P6��L'YG�j 72C. m��„. ssaas
Civil Engineering Telephena 784-6066
Municipal Enginaaring . Eng1I1@CTS & Surveyors A�ea �ode 612
Certificate of survey for DA�12EL �AI212 aEVELOpEMENT CO�p
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I hairby certiry tM[ ihi• le a true and corract reprawniation of a aurvey of the boundariae oF tha above daecribed
land, snd of the location of all buildinqa, therwn, and all vieible wneroachueM�, if any, from or on �eid land. Ae
suzvayad by ea tA1� day oE �({�, ;;,�-T L A.D. 19ZZ.=.
S U B U R B!1 N 6 N O I N E 6 R I A 6� I 9 C,
E'gineare Sucvayora
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