AF - 40756,
City of Fridley, Minn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
��; September 12, 1972
OWIIel: �..�V�cxscen� �nc- Builder Same
A�$ _ _ _5901.Bxookl�a Boulevard ___ pd�� � Same
�165
LOCATION OF BUILDING
Na .....5.�1.�-•----._._. Street _._.�.��.._S?.�.L1.3.A:_Sr�.��.._ Part of Lot
Lot ___...b..._.._..____ Block ___...__._.__ 4._.___......___ Addition or Sub-Division .�._.��brttck l�orth 2nd
Corner Lot -•-.-------._..._....__ Inside Lot __._..___..__#�.._.__ Setback _ —..� Sideyard
Sewer Elevation ....__._.__..._._..___...___..._..__.___.__.__�__.__ Foundation` Elevation ......--------
DESCRIPTION OF BUILDING
To be Used as: 1240
.—TSZW.A��u-.�_---.---.-.- Front __ 2 �' �epth —. 31' Height 28' Sq, �•t, 620 �, gt 17 , 360
Garage 20' 22' 10' 440 4400
---------•------....--- Front ._._. Depth .�....._..._�. Height _�__.._._... Sq. Ft. _ Cu. Ft.
Type of Construction �_W�od frame �, �t � 21 417.80 To be C��.� 1-15-73
�
STIPUI.ATIONS :
Owner and contractor to be responsible for ele�ations a�nd for drainage for all
structures and the City shall be held blameless.
Conatructioa must comply with U.B,C. 505 C1-, C2 & C3. See attached sheets - use
figures 5, 9, OR 10.
In consideration of the issuance to me o! a permit Yo construct the building aescribed abo�ve, I agree tQ do
'We proposed work in accordance with the description above #orth aztd ia complianoe with �11 praovtsions al'
ardinances o! the city of Fridley. � � ,
Ia consideration of the payment of a fee of $_ 6Z .50 ,� pex�it is hereby granted tr+ viewcon, Inc .
to construct the building or addition as described above. This permit is granted upo�
the express condition that the person to whom it is granted and his agents, employees and worlunen, 3tt sll WOrk
done in, around and upon said building, or any part thereof, sh�il conform in a11 respects •to the ordin�aCeB oi
l�'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of b
�Yithin the city limits and this permit may be revoked a t any time upoa violation of aay af the provisions�
ordinances. -
� .l��� ���►.0� i sui�a�ns �
DARREL CLARK
NOTICE:
This p�rmit do�s not eover fh� eonMruetion, iashlldfoe foe wirinar plwnbte9, 8as heaKny, s�wN q� w�Hr. B� sun fo s»
fIN buildiny Insp�eto� fo� s�paraN p�rmits for fh�t� items.
s
_� _ ,� � -
.y.—
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITiON BUILDING P,�RMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : �//�i�s.+l'�h► .�irt. BUILDER : .sQ/.. t
ADDRESSs �5'90/ ��oe�i/y� ,Qe.�/isiavd ADDRESS: Sa�e�.
....
NO :.�iS/9 S TREET : L<<JLIS� 06t`� �i �/r c��
-.,..�.
� LOT: lo BLOCK: � ADDITION:I��►�►t�iwt.� /Go��i� .Z� 'a.
CORNER LOT: INSIDE LOT: ✓ SETBACK: SIDEYARD:
---�-,�.�
Applicant attach to this form �ao Certificates of Survey of Lot a�nd proposed
building location drawn on these Certificates. �
�ESCRIPTION OF BUILDING
To Be Used As:
71�sv.a/jlatG Front: 20� Depth; 3/� Height• t8�
IZ40 �
Square Feet: �rZo Cubic Feet: /73G0
C�ItrAq t Front: l0' Dep'th: 22' Height: IO
Square Feet; �40. Cubic Feet: 4'�400
Type of Construction: �%Ied /cI�►In.t Estimated Cost: $..�/�/�; !r0
7 r
To Be Completed: !�/S- 73
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in stiict accordance with the City of
Fridley Ordinances and xulings of the Department of Buildings, and hexeby
declares that all the facts and representations stated in this application
are true and correct.
DATE : �-2 2 -� 7 t S IGNATURE ; � � . ��,�
�'
(See Reverse Side For Additional Infonn�ttion.)
�6 N �• �� -S.Y
ro� so p, e.
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BUILDING PERMIT FE� SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing perniits for the
erection of ariy 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 �h� paym�e�� �� �he
applicant for such permit of fees to the amount herein below set �ogth and i�
the manner herein provided to-wit:
iTNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 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
o� the cellar to the av�ragg heights of the upper surface or to the average
height of the xoof surface of the main gable of � pitched rouf.
For repairs or alteratiuns to an eaisting structure, the iee 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 permit as set forth in Section 2 be
less than $5.00. .
VERIFICATION OF FOUNDAI'ION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
time of application, to allaw 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 constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be ma.de ten (10) days prior
to the use or occupancy of any structure for which a.building pennit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
.
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August 18, 1981
CITY OF FRIDLE�(
6191 UNIVERSITY AVENUE N.E.. FRIDLEY, MINNESOTA 55432
TELEPHONE ( 612)571-9450
Ms. Barbara Lukaszewski .
Innsbruck North Tvwnhouse Assoc. President
1536 South Oberlin Circle N.E.
Fridley, MN 55432
Re: Decks fn Innsbruck Tawnhouse lst and 2nd
Dear Ms. Lukaszewski:
0
In response fn a request by you, we inspected some of the existing decks
in Innsbruck Z+ownhouse lst and 2nd Additions.
We found that many of the decks have joists that are rotting away and
do constitute a safety hazard. This situation must be abated and
correction of the proble�n should be started as soon as possible.
Before the corrections are coiunenced, we will want to review the
correction method to insure a proper and safe procedure is followed.
If you have any questions, please feel free to call me at 571-3450.
Sincerely,
a ___ ``-�'��+�J
naRR� G. CLARK
Chief Buildinq Official
DGC/mh
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sue.,ecr MIT NO.
City of Fridley 2 2 6 9 6
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
� , No.
, �
� ; L _ COMMUIJITY DEVELOPMENT DIV.
r � � PROTECTIVE �NSPECTION SEC. ����
� _ �
� �'��� � CITV HALL FRIDLE� 55432 NUMBER REV. � DATE PAGE OF APPNOVED BV
�""� � ,'� 612-571-3450 9t 0-Ft 5
7/13/94 � �
JOB AODRESS 5519 East Oberlin Circle NE
t IEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. C) 4 Innsbruck North 2nd SHEET
2 PROPERTY OWNER MAIL ADDfiESS 21P PHONE
3 CONTRACTOFi MAIL ADDRESS ZIP PHONE LICENSE NO.
Dicks Fire & Storm 864 19 Ave SE, Minneapolis, MN 55414 781-6170 2481
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION L7X REPAIR ❑ MOVE O REMOVE
6 DESCRIBE WORK
Reroof House & Garage (Tear-off); gutters
9 CHANGE 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 sleeping areas
and in basement.
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOFi ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OH CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCEO WITHIN 60 DAYS, Ofi IF CONSTRUCTION
OH WORK IS SUSPENDED Oii ABANDONED FOR A PERI00 OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY TMAT I HAVE FEAD AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS OF IAWS VALUATION SUfiTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT �p 2� LIH 1. 11
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. �S�F.00 Fire SC 2. ZL .
PIAN CHECK fEE TOTAI FEE
License SC $5.00 $62.33
S�GNA?UAEOFCONTRACTOAOAAUTHOp�ZEDAGENT IDATEI W N iiLY V LIDATED THIS IS vOUF) PE�
� � �l
SiGNATUREOFOWNEF�iFOWNER8U1lDER1 �DATE� BLOG �NSP naTE
� EW ( I Effec;tive 1/ �/94
ADDN ( � CITY OF FRIDLEY
ALTER ( � StNGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application ��o �7'�
Constructi�n Address: 5 519 - E a s t O b e r l i n C i r c l e
Legdl Descripti<m:
Owner Name 8i. Address:
Tel. #
Contr'dctUr: R.J. Williams Gex�eral Contractor MNLICENSE# 2481
Address: 864 - I9th Ave. S.E., Mp1s., Mn. 55414 Tel. # 781-6170
Attach to this appIication, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width HgtlGround Sq. Ft.
Corner Lot (] inside Lot [] Ft. Yd Setback Side Yard Setbacks
Type Of COnStcttCtiOri : h o u s e&. g a x a� e r o o f, Estitnated COSt: $ 2, 218 . 0 0
Approx. Completion Date: g u_t t e r s
(Cost on Backj
Driveway Curb Cnt Width Nceded: Ft. + 6 Ft = Ft x S =$
DATE: 7/13/94 APPLICANT: R.,7. Wi1li.ams Gen. Contractoz Tel. # 781-6170
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$
$
$
$.
$
$
$
$
$
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Fce Schedule on Reverse Side
.00 i of Permit Valuation (1I i0th %)
$.50!$1,000 Valuation
$800 per SAC Unit
$S.OU (State Licensed Residential Contractors)
Att. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [� Noi Necessary [ j
STIPULATIONS:
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/ 9
I3UiLDING PERMIT FEE SCHEDULE
`I'he Chiet Building Ofticial shall, t�efore issuing permits for ttie erc�on of any buitding or structure,
or for any ac�dition to any existing buitding or structure, or for any alteration or repair to any existing
building or structure, upon application therefore, require �e payment by the applicant for such permit
of fec;s to the amount herein bclow sct forth and in the manner herein provicied to-wit
TOTAL VALUC
$1 to $S00
$501 to $2,000
$2,001 to $25,000
$25;001 to $SO,OOU �
$50,001 to $100,000
$100,001 to $500,000
$SOO,OOi to $1,000,000 -
FCES
$15 (Minimum Fee is $15 plus surcharge) - -
$15 for firstV $S0p plus $2 for each additionai $100 or
fraction thereof, to and including $2,000 �
$45 for fiist $2,00p plus $9 for each additional $1;000
or fraction thereof, to and including $25,000
$252 �for first $25,OOp ples $(.SO for each additional $1;000
or fra.ction th�reof, to. and including $SO,U00 -.
$414.50 for first $50,000 plus �4.50 for each additional
$1,000 or fiadion ti�eof, to and including $100,000
$639_SO for f�st -$100,000 pius $3.50 for each additional �
$1,000 or frac�ion thereof, to and including -$SOO,�UO
$2439.50 for the first $SOO,ppp p}us $3 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $3539. i0 for the first $1,Opp;ppp plus $Z for each additional
$1,000 or fractioa �thereof -
DRIVER/AY DEPRESSION ESCROV�
(Concrete C�u�b Streets Only)
Altemate "A": Removal and replacement of curb and gutzer only - Driveway width plus 6 feet times
$13.50_
Alternate "B": Removal and rep(acement of curb and gutter and install a 3 foot wide.
approach with 6 inch depth - Driveway width plus 6 feet times $i5_75.
VCRIFICATION OF FOUNDAT[ON
Permits foc constYUCtion will be issued a minimum of 24 hours from the time of application to atlow
for proper rcview of the pro�sc;d structure and of the construction site_
A Certificate of Survey of the lot, showiag the location of the founciation once it h�s it has been
constructeci will be reyuired before proceeding with th� framing_
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1�i0I.L��L�I?I�A �I�dZS QI�I�' 1��I�II�1IIH�
Su��ECT RM1� N0
,' '{, � City of Fridley � 310 4
' i AT TNE TOP Of TME TWINS g U I L D i N G P E R M i
.� •
� �
� •
� ; y ����� � GO�AMUNITY pEVEIOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
� �
1 ; _ " ,
�"' /'•'1 ! CITY MAIL Fii101E� SS�32 NYM�E� �EV OATE
�.•..� ' `•� 612-571-3450 9t0-F1 S
. 6
JOB AOORESS SS11 � ZS, 3, 27, 31, 35, 39 OBERLIN CIRCLE
t LEGAL �OT NO. 9lOCK TRACT OR AODITION
oESCn. °� � 1-8 4 Innsbruck North 2nd
0o I /
2 P1iOPERTY OWNEN . MAIL AODRES$ z�P
��'Innsbruck Townhome Association
J CONTtiACTOR MAiI ADORES8 ' Z�P
Garlock-French Roofing Corp. 2301 E: 25th St., Mpls., I�Il�1 55406
♦ ARCMITECT OR CESIGNER MAIL AOORESS Z�P
ADORESS
PT NO.
3��9
Of A�/110VE0 S�
/ �
SEE ATTACNED
SNEET
651-224-5482
PHONE LICENSE NO
612-722-.7129
Pt10NE LICENSE N0.
00001423
PMONE LICENSE NO
;_ `Residential
�, ClAS80FWORK
• � � O NEW O AODITION O ALTERATION � REPAIR O MOVE O REMOVE
� a l�e opo��uilding
9 ChANGE OF USE fROM TO
t";r• ,+..".ft";.i,_. r': .
STIPULATIONS
i
a �x�` � " ; _ ��`�-
Underlayment must comply with the State Building Code.
Permtt Inspection Car.ds
�6 ;; : . �- Wili BQ Mall�d�
� �� �� �� � To Nomeowne�`'�'ct post
� ,,
��- :,�... �
,.
SEPARATE'PEi1MITS AqE REOUIREO fOii ELECTRICAL, P�UMBiNG. MEATIN�i, TYPE Of GONST.
VENTIIATING OR AIR CCNqTIONING.
TMI$ PERMIT BECOMES NULI AND VOID IF WORK Oq CONSTRUCTION ZONING
AUTMOf112E0 IS'NOT COMMENCEO WITFIIN d0 OAYS. Ofi If CONSTRUCTION
ON WORK IS SUSPENOEO OR ABANOONEO FOR A PERIOC OF 1T0 DAYS AT
. ANY TIME-AFTER�WORK IS COMMENCEO.. N0. OYVIG. UNITS
1 NEREBV CEflTIfY TMAT I MAVE i1EA0 ANC EXAMINEO TMIS APPUCATION H
ANO KNOW TME SAME TO SE TRUE ANO CORRECT. A�L PqOVIS10NS Of �AW$ yA�UATION
ANO O�i01NANCES �30VERNING TMIS TYPE Of WONK WI�L 9E COMPLIEO
WITN WMETMEIi SPECIFIEO MEpE1N OFi NOT. TME GRANTING OF A PERMIT � ib � ZZ.Z . HS
OOES NOT PRESUME TO GIVE AU7MORITV TO VIOLATE Oii CANCEI TME pEqMIT f EE
PqOVIS10N5 OF ANV OTMER STATE OR LOCAL LAW REGULATING CON•
STRUCTION OR TME PERfORMANCE OF CONSTRUCTION �2%9. ZS
. I E�GN�fypEO�CON•N�C10pOp�UTNOp�2ED�GENt IO�TE�
OCCUPANCYGROUP OCGUPANCY�OAO
SO.FT CU.fT.
OfFSTREET PARKING
STALIS IGARAGES
UqTAX
�8.11
Fire SC $16.22
r r�� ceE
303.58
D TM�S iS�liUp PE;AAiT�
( %f G!
sus�ctr ��
c�ty of Fr�a�ey � 32178
AT TNE TOP Of TME TW�NS g � I L D I N G P E R M I T
�
�� � ��� RECEIPT NO.
� �• COMMUNITV OEVEIOPMENT pIV. � � �v �"�' � �/ /� %�/
� ; V �'��� �� y'
r � �� PROTECTIVE INSPECTION SEC.
� . �
� j �"'1 � CITY NALL iR10LE� SS��2 NUM�EA 11EV O�TE ��GE os �N110vE0 �r
�""� � �'' 612-571-3450 910-F13 9 / 19 /O 1 / /
�oe �ooness 5511, 5515, 5519, 5523, 5527, 5531, 5535, 5539 East Oberlin Circle NE
t IEGAI LOT NO. BIOCK TRACT OR AODITION SEE ATTACMED
oescR. 1_ g 4 Innsbruck North 2nd Addition SNEET
2 PiiOPERTY OWNER MAIL ADORES$ 2�P PHONE
Various
J CONTFACTOR MAIL ADDRE53 ZIP VNONE IICENSE NO
Columbus Exteriors 2131 111 Lane Coon Ra ids MN 55433 763-757-7530
a ARCMITECT OR DESIGNER MAII AOORESS ZIP PMONE LICENSE NO.
S ENGINEER MAtL ADOqESS 21P PNONE IICENSE NO
6 USE OF BUIL0ING
8 Unit Townhouse
7 CLASS OF WORK
O NEW O ADOITION O AITERATION � REPAIR O MOVE O REMOVE
8 OESCfi18E WORK
Reside Building•Soffit
9 CNANGEOfUSEFROM 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 provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyi siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Call €or inspection of wrap
before covering.
SEPARATE PERMITS AiiE RECUIREO FOii ELECTqICAL, PLUMBING. NEATING, TYPE Of CONST. OCCUPANCY aROUP OCCUPANGV �OAO
VENTI�ATING OR AIR CONOI710NING.
TMIS PERMIT BECOMES NULI AND VOIO IF WORK OR GONSTNUCTION ZpNING SC. fT CU FT.
AUTMORIZEO IS NOT COMMENCEO YyITNIN 60 OAYS. OR IF CONSTNUCTION
OR WORK IS SUSPENOED OR ABANDONEO fOp A PERIOD Of 120 OAYS AT
ANY TIME AfTER WORK IS COMMENCEO. NO, DWLG. UNITS OffSTREET PAiiKING
I HEREBY CERTIFY TMAT I MAVE REAO ANO EXAMINE� THIS APPLICATION H STALIS GARAGES
ANO KNOW TME Si�ME TO 8E TiIUE ANp CORRECT. ALl PFiOVIS10N5 OF LAWS yA�UATION SURTAX
ANO OROINANCES GOVERNING TMIS TVPE Of WOqK Wl�l BE COMP�IEO �
WITM WMETMER SPECIFtEO MEREIN OR NOT.• THE GFIANTING OF A PERMIT $59, 637 �29 . HZ
DOES NOT PRESUME TO GIVE AUTMOAITV TO VIOLATE OR CANCEL TME pEpMIT FEE SAC CMARGE
PpOVISIONS OF ANY OTHER..STATE OR IOCA� �AW REGULATING coN• ��13.75 Fire SC $59.C)�F
STRUCTION Op TME PERfORMANCE OF CONSTRUCTION
. PIAN C►IECK fEE TOTAL FEE
� �� -1 -d/ � 3.2i
S�GN�TUpfO�CON'A1CTOpOp�U�«Op�ZEO�GENT �O�rE� qOP l A�IOATED �515 VOUA PEiiMIT
. 9-i9 -oi
S�GN�TUNE O� OWNEp��� OwwEp 8w�0EA� �D�iE� �� ��h�0 � q�tt �
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
57Z-36U4 FAX:
: 5519 E OBERLIN CIR NE
: 243024410072
: INNSBRUCK NO T H 2ND ADD
: LOT 6 BLOCK 4
: BUILDING
: TOWNHOUSES
: WINDOW/DOOR REPL
571-1287
PERMIT NO.: 2004-00168 �" i �
���
DATE ISSUED: 02/OS/2004 b
VALUATION : $ 2,070.00
NOTE: PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF THE DWELLING PER
SECTION 310.9.1.2 OF TF� 1997 LJNIFORM BUILDING CODE WHEN ADDTIONS, ALTERATIONS OR REPAIRS IN EXCESS
OF $1,000 ARE MADE TO RESIDENTIAL DWELLINGS. CAULK AND FLASH ALL EXTERIOR OPENII�TGS.
REPLACE TWO WINDOWS WITHIN EXISTING OPENI1�iGS
APPLICANT
WELLINGTON WINDOW & DOOR CO
3938 MEADOWBROOK RD
ST LOUIS PARK, MN 55426
(952) 933-6300
OWNER
MULLINAX BETH L
5519 E OBERLIN CIR NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a pemut does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulatin construction or the performance of construction.
A icant Date
Bldg
BUILDING PERMIT FEE
FIRE SURCHARGE
STATE SURCHARGE, VALUE
TOTAL
PAID WITH CHECK # 72377
SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
83.25
2.07
1.03
8635
NEW ( j
ADDN (J
ALTER ( j
�C� I 1
Cohstruction Address:
Legal Description:
Owner Name & Address:
Contractor. �ll�et
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/2002 �
(763) 572�604 Bldg Insp
� ���� � o� � ��
�
� �i'�L ` Tel. # /h� �/�'/y�
� � � � MN LICENSE # �
O Tel. #
� . o�� Q� 5 3�
Attach to this_ applica ion, a Certificate o Su�iey of the
lot, with the proposed construction drawn on it to scale.
DESCRlPTION OF IMPROVEMENT
LNING AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length Width HgUGround Sq. Ft
OTHER: .
Constructio� Type: c.�/j'� o � Estimated Cost: � ��� �
w� —S
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: APPLICANT: � Tel. # Z63- 7'��,�C�
Call (763) 572�3604 for Pertnit Fees if mailin application to 763-571-1287 if using ccedit card and we�will
call you for card number. �--�., ,.. .
CITY USE ONLY -
Permit Fee $ g� -�� Fee Schedule on Reverse Side ��
Fire S rchar e ,� .0 . 01 of P rmit Vaivation 1/10th% �--�
u g $ '% 0 e f )
State Surcharge $ $.50/$1,000 Valuation
SAC Charge $ $1200 per SAC Unit
License Sur�harge $ "�' C" $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Erosion Control $ $450.00 Conservation Plan Review
Park Fee $. Fee Determined by �Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL _ $ -- -- -
STIPULATIONS:
� � J
BUII..DING PERNIIT FEE SCAEDULE
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 �erein pr.ovided to-wit: - ;
TOTAL.VALUE
$1 to $SOU
$23.50
FEES
$501 to $2,000 $2�.SO for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,000
$25,001 to $50,000
� $50,001 to $100,000
$100,001 to $500,000
$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 $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 $SQ0,000
$500,001 to $1,000,000 $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
:�11�► !"` ,�r_r;:
$1,000,001 and up _ $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
_ . ___ __ _ - — - ---
(�oncrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.00.
Permits for construction will be issued a minimum of 24 hours from the time of appIication to allow for proper
review of the proposed structure and of the construction site. .
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
> - - .
NOU-16-2��J4
I�tVV L 1
ADDN [j
ALTER { J
��ba5
1��25 CITY OF FRIDLEY ��0� -. Q�S � r�";��_
�.� � � v� � �.��.,�� � �..,......-�--- •
643'1 University Ave,NE, Frldley, MIV 55432 (763) 572�604 Bldq lnsp
S[NGLE FAMlLY AND DUPLEXES R-i AND R-2 (763) 571-1287 Fax
BUILDING P�RMIT APPLICATION
Construction Address:
_ .�.,..��
Legal Descrip�ion: _
Owner Name & Address: � e-}-�, ��e. /�I t�t, I � i Vt a X Tei. # 7 63 -5 �7� -/4 3 6
Contrador, w� � � 1 I� o� "�p �. j/�/ j��W S MN LICENSE #
,, ,�
Te�. #�15'1-� °13 3-6 3 O p
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
p�SCRIPTION OF IMPROVEMENT
tiWN�r-AREIk:--- tengtl�t - _— -- Width-- ---}Ie�t--- _ _ 5�-�- -- _ --
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length Width • Hgt/Ground Sq. Ft.
OTHER:
Construction 7ype: - �'�i�'aG�nre� t Estimated Cost: � 2�7 �•�d
Driveway Curb Cut �dth Needed: Ft + 6 Ft = Ft x$ �$ �
DATE: �-d DS APPLICANT: �i01r�1 Tei. # 733 �% �l ��
Call (763) 572�604 for permit Fees if mailin ia apptication. Fax to 763-571-9287 if using credit card and we wil! ea i�
you for card number.
Permit Fee
Plan Review
i► Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
CiTY USE ONLY -
$ g3 • 25 Fee Schedule on Reverse Side
$ 65% of Permii Fee .
$ � •' .001 of PermitValuetion (1/1�th%)
_ ___
$ /• 3 � $.50I$'1,000 Valuation
$ $1350 per SAC Unit
.$ � $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation P(an Review
$ Fee Determined by Engineering
$ Agreement Necessary [ � Not Necessary [ j
TOTAL $ V I•� Z STIPULATIONS�
NUV-16-2F71�4 10 ��5 C I TY UF FR I DLEY F� ,�-�� ;_i-
� BiI�AING P�xMlr r�� ��n�LUL�
The Cluef Bu�ding OfFiczal shall, before issuing pernuts'for the erection of any building or structure, or for wr�
addition to a�ay existing build'ulg or stntcture, or for any altsrarion or repa�x to any existing buildinR �
structure, upon application therefore, xequire the paync�ent by the applicant for such perrnit of fees �o the amou.-
herein below set forth and in the manne�r herein p�rovided to-wit:
TOTAL VALUE ,
$1 to $S00
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 t�10U,000
���
� lOQ,001 to $500,000
$SOO,OOI: to $1,000,044 `
FEES�
$23.50
$23.50 for�i'�rst $500 plus $3.05 for each:additional $100 or
�'raction thereof, to and i�cluding $2,00�
a
$69.25 for first $2,000 plus $1�.00 £or each additional $1,000
or fraciion chereof, to and including $25,000
$391.25 far. first $25,000 plus $10.10 for each additiona� $1,000
or fraction thereaf, to and in�ciuding �54,000
$643.75 for �irst $50,000 �lus $7.00 for each additional
$1,000 or ixaction thexeof, to and including $1�0,000
th
$993.75 fox first $100,OQ0 plus $S.bO for each addidonal
$i,000 or fractxon tl�ereof, to and includit�g $500,000
$3,233.75 for tt�e first $500,004 Plus $4•7� for each'additiona.l
$1,00() or fraction thereof, to and including $1,000,000
$I,000,001 and up $5,608.75 for the f�rst $1,000,000 Plus �3.15 �or each additional
$3,,000 or fraction thereof
CURS CUT ESCROW
(Concrete Curb Streets Oniy)
Removal and replacement of curb� and gutter only - driveway width plus 6 feet, tino.es the am�.uallY decerm�::�
rate
Perimits for constr�tction will be issued a minixnutn of ?A� hours fro�n the time of application to aliow �or nr,:.,
review of the propflsed structure and of the construction site.
VERIFiCATION OF FOiJNDATION
A Ce�rtificate of Survey af the lot, showit�p the Iocatian of the existing fouadation wil� be xequ'vred be:c�
proceading wiih the framing. New� Houses Orilv �
TiJTHL �' . •.
Building �p Z>
Inspections
763-572-3604
DATE `� � � 'J� ' G 7
SITE ADDRESS 55/
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
���� BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
❑ OWNER
SUBMIT A COPY OF STATE LICENSE #
YOUR STATE LICENSE ADDRESS:�
WITH APPLICATION pHONE �/'�.
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
�
❑ DECK
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
OFSQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDIIVG
❑ Vinyl
O Aluminum
❑ Other
WIINDOWS
IN F,}�ST1NG OPENINGS es ONo
OR FOR NEW OPENINGS CRIBE SIZE OF
OPENING CHANGES 8c
TYPE OF WWDOW TO BE INSTAi.F.Fn
FR�iISH
Permit No.:
Received By:
Ti�k�r�➢wr.h�r n ♦ ry �fAA"1
E-MAIL ADDRESS
� Gle �LrC�' r� �-1 �/ 2 :
,CTOR
% �
� .l Y ct1-x
/�
� .�7�L.C�S
d'/ EXP DATE
r ;1' t�r� � CiTY�
� FAX
RUCTION SIZE
CTION STO
O GARAGF/SHED pp�yg
O RE3AF ❑ DRAIN TILE
❑ SIDING ❑ OTHER
❑ SWIl�IIvIIIVG POOL
❑ ADDITION
0 REMODELING
� � 11!/'�!'�G�°d�t� � �- ��7C�
LENGTH
O HOUSE 8c GARAGE
❑ ATTACI-�D GARAGE
❑ DETACHED GARAGE
OSoffit
D Trim
O Fascia
LOCATJON��FGL-�DOW� �G,�f,�' �
� �f
ALL FEES ARE BASED ON VALUA
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surchazge
SAC Charge
� Curb Cut Escrow
i Erosion Control
;� Park Fee
Sewer Main Charge
Total Due
JOB VALUATION
HEIGHT
'I��P �cS��
BASEMENT RElNOD -i .iwc; C►1Rr �p'r•
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTION RJCLUDING DECKS,
ADDITIONS. 8c PORCHES MIT•
1. Site Plan/Survey showing the existing sdvctures
end proposed project.
2. Two scts of construction plans
3. Energy Calculatirn�s
T, INCLUDING THE COST OF LABOR AND MATERIALS:
' 1997 U.B.0 FEE SCHEDULE)
��� OCCUPANCY TYpE
$ . �
S
� ;3
� J�f��
$
S
$
S
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=�
5450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: Citv of Fridlev Attaeh
THIS [S 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 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; that the work will be in accordance with the approved
plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT �� PRINT NAME �( /il c>UYE�I�L;��Y� DATE ��' l?j ° C�%
Page 2- Building Residential Application
BUILDING 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 �Iie payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
_ •�
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
- _ _ _ City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
FROM :JOE K
FAX N0. :763B565933 Sep. 15 2007 11:33AM P29
r a
C,L O�, �
BL111�1� PY,�UMB�G Permit No.: � `fi
Inspec,rtions RESIDEr�TTIAL APPLICATION �""�.�y=
763-572-3604 CTTy OF FRTDI.EY ��'� F 1 ]
PA1E `11 �� � YOUR �.MA�1. �,�D�tF'.$S _ N � � _
s�nA�s 551�1 ��-o4sC` od�q2�N ��rrL��
'fH18 IhPPL1CAN'f 1S: U UWNE]t (,'7+pR
��� NA1N�: �y �h V`�v r �ShAA.ft'
OWN6�!/ AlUD1RFSS. SS1 � o8r72�rv
'i`�NAN�Y' 1 �CIIY %IL.�"b�tl' STA'IPiy/�xJPSS�.i,
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C'ON'I'RACTOR x,�t�: _ S'lT�� ►.�.�.q��., i,n,C•
SUBbtIT A(3DPY OF STAl'E 'L1Ch`N5E ��_���_ �p pw�
YOURS7'A7E ADDRE.SS: L�tS�o S't�F,,�o�Q CffY ��."7�S' Si'wT� ,�,r,ZIP�S�
UC�1SE wITH � (�—$p3..r�'� F�uc '�63�tqy �1�3��
APP'LiGTl�l
pE��.•�P$ QS�MCI.EFAIb[.Y O'(WpFAl�Qi,Y �B^lb^WNHpUSE
nrrg o� v�osK: o r�-w .
bET.AII.ED DESCRIF"170N OF 11VORK Snrst,,4t�.�-'� �,►�. .,�'7Z i�u�—�6+2
. PE�t MS 16B.665 the pennit fee is a rmmi�un4 oi S1S.00 or SX of twe totd cost �p to SgM,O�, N,iriche.re� is gc�t�, f� �
improvancrt, insdll�tioa or re,plaoament of a raidafRisl fixWrc„ exciu�ng the fixa�ras. ('Ibis shanW �efleet anly the aoa�t af labor )
Labor cosc wrde,r �300 = S 15.00. Iabor oost betwoen 5300 to SSOq = cosc o� labar x_OS =
POR P1tQ1EC73 R►HFR� LAIIUR F.�,�'E�A6 SSOR F�S I►RE liA$F7� Q�1 SI0.00 PIIi F1XT1jit�, E7GCFPf WHbItE N07'1D. F�C7URFS: (INA]ICA7E 71pri'AL
NUA�EIt OF FACEi B6LONN)
_ HA7iI SD�UCMV FIAOR DkAIt+YS SHOVV�7t WA7IR P1P'IIdC
BA't'H7UR ,,,,., GAS P►P1NG �o c�ur.�) n�G_ P_OO�. wAr�a soFrxa� (s�s�
� cW'r�s wnst�at ��rrcxuar suvx � arFae ct.�i � snc�r.c�w e�v. (tt �
� DL4EiWA8[I�R _ LAIJNDRiC TRAY T�R HBA FOR QtRIOA'f[ON
_ WA7FR )iAE']'�iR �yp�
. •w' �'�:
P+arn�is Fee s��• N� of s�es � s a o.00 X ai o_oo = s�
� Nu�nb�roffixh�e�es � 515.0� x S�S.00 ° S
'I�O'Y'AL DUE S_�. S 0 Nuoo�ba of f»mn+es � 535.00 x 535.00 g S
St�e Stu+�e = S_ .50
Tota1= S �
'IHIS 1S AN APi�i1CA710N �R A PF]tldl?�i0? VALID t7N17i. F1EO�ED
I het�eby' apply foc s build'mg pecmit pn� i acknowledge that the informati�oa� above is canptete s�t1d aoairate; that the work wi11 bo in
caafoanance with t!u rndi�noea and otthe City of Fridley and with•the M"u�nesota Consauaian Cod�s; ti�at I �mde�'st'�nd dtis is
not a pamit tnrt ooly an applicati a pexmit aod wak is nat to sbrt without a pccmi� the� d+e wort wil! be in n000�rdance with the
approved Plm� in tbe case of aiI w ' roqui�+es �view and app�+vvsl o�f plaas.
STGNATIJ�SOF APlLICANC — - - - - - PRQIT NAb� �f�' . XQhh�.-,�-Qw DATE __. l �"'�"�
�'s: •: �"`.
City of Fr�idley
Buildin� Inspections �epartment
6431 University Avenue NE, Fridtey, MN 55432
� �63-572-3604
FA7C: 763 SQ2-497�
�°�d p�°����y _lf��u/L,l�� 6875 Highway Ne.65 N.E.
Land Surveying � �� (j Minneapolis�
so�i: re:r��g ��21�'-'�12PP/lZ4'Gl�j � 72C� Minn. SS4J2
Civil Engineering Talephene 784-6066
"w^���pai E^e�^eBf�^e Engineers & Surveyors n.�o Code 61]
Certiiicate of Survey Por DA�12EL �A'�R DEVELOpEMENT CO�p
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I hetaby eertify that this i� a lrue and corraet repre�entaiion of a eurvey ot !h� boundariaa oE khr above de�cribed
land, s� ot t�e locakion of all buildings, tMraon, and ell vleibls encroschoenTa, if a�ry, frae or on �aid land. Aa
•u[v�yW by oe this day o[ (J ��::� r�_A.D. 19,Z=.
5 U B O R B A d S N U I N 6 B A I B G. I N C.
Enqinaera Surveyors
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