AF - 40848��—
SuBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� �
� • COMMUNITY DEVEIOPMENT �IV.
L PROTECTIVE INSPECTION SEC.
� .'__
r ; �i
� _ �"'1 � CITY HALL FRIDLE� 55432 NuMSER
�""� � �'� 612-571-3450 910-F15
JOB ADDRESS 6601 East Ri ver Ro�d
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
oescR. 35 & 36 5 Fridley Park
2 PROPERTYOWNER MAILADDRESS
Charles A. Sparks
3 CONTRACTOR MAIL ADDHESS
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDRESS
8 USE OF BUILDING
REV. DA7E
4/17/84
ZIP
PAGE OF
� �
PHONE
PHONE
PHONE
PERMIT N .
_ 97463
RECEI .
�a� �-S
APPROVED BV
SEE ATTACHED
SHEET
LICENSE NO.
LICENSE NO.
LICENSE NO.
� residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION �l REPAIR ❑ MOVE ❑ REMOV
8 DESCRIBE WORK
re-roof, other roofs removed
9 CHANGE OF USE FROM
STIPULATIONS
TO
TYPE OF CONST. OCCUPANCY
SEPARATE PERM�TS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, i bregl ass
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT.
AUTHORIZED IS NOT COMMENCED 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. NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK Wlll BE COMPLIED ��X��I � HOO. OO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OH CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 29• 5O ^"'
OR AUTMOR D AGENT 1DATE1
e `� �
.� o c�ui nca� IDAT 1
aOUP OCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
IGARAGES
SURTAX
.90
SAC CHARGE
TOTALFEE
30.40
:D THIS IS YO� R PE IT
� �// � ��
NEw L l
City of Fridley Effective �/1/8u
ADDN. [ ] R-1 AND R-2
pLTER. � 7 Building Permit Application
r
Construction Address
Legal Description: s �� � � '`�'�o`�"
5-7a - cc�/3 /-/
Property OWner%Adcir��sz ��l .�r'��S ����� �%� - Tel. � ���- ��o� c�
- Tel. �
Contractor:
Address•
Attaeh to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to scale.
DESCRIPTIOA OF Il�IPROVEMENT
LIVING AREA: Length Width _ Height , Sq. Ft.
GARAGE AREA: Length _ Width _ Height Sq. Ft. -
DECR AREA: Length _ Width _ Hgt/Ground Sq. Ft. ,—
OTHER:
Inside Lot [] Ft. Yd. Setback _ Side Yard Setbaek _
Corner Lot [ ] �;,,
Type of Construction: ���y�Y�� �'���'yla�s S�r``y�°S Estimated Cost: $����
Approx. Completion Date: /�%�c �
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: - $ $
See Back Page for Explanation
DATE: I7 � APPLICANT:
� Tel. �
CITY IISE ONLY
Permit Fee $ L��• °�v Fee Schedule on Reverse Side
Plan Cheek $ 25� of Building Permit Fee
State Surcharge $ y0 $.50/$1,000 Valuation
SAC Charge $ $�425 per SAC Unit
Park Fee $ Fee Determined by Engineering
SeWer Main Charge $
� Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ _�`��� `� --
STIPULATIONS:
� , "
BIIII.DING PERMIT FEE SC�DIILE
The Chief Building Official shall, before issuing permits for the erection of any
building or strueture, or for any addition to any existing building or strueture� or
for any alteration or repair to any existing building or structure, upon applicatio n
therefore, require the payment by the applieant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-xit:
Total Valuation
�1.00 to �500.00
$501.00 to $2�000.00
Fees
$10.00 (Minimum Fee is $15.00)
$10.00 for the first $500 plus $1.50 for each
additional a100 or fraction thereof, to and including
$2,000.
$2�001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
including $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $u.50 for each
additional $1,000 or fraction thereof, to and
including $50,000.
$50�001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
ineluding $100,000.
$100,001.00 and up
$u33.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIYEWAY DEPRESSION ESCROiI
(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
approaeh with 6 ineh depth - Driveway Width plus 6 feet times $15.75
VERIFICATION OF FOIINDATION
Permits for construction Will be issued a minimum of 24 hours from the time of
application to allow for proper revieW of the proposed strueture and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been eonstructed Will be required before proeeeding with the framing.
e_
� 4
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� �
� �
� i y_____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
`--_•� ��"' �'� CITY HALL FRIDLE� 55432 NUMBER
� 612-571-3450 910-Ft 5
JOB ADDRESS �'
REY. I OATE
� � ���— � �
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR, � ��, � -- � � iQ Lr'�,
2 PROPERTY OWNER MAIL ADDRESS
� (��-SKr Y ��G.� � ��s; z�
3 CONTRACTOR MAILADDRESS
5PA-2�S �l����-
4 ARCHITECT OR DESIGNER MAIL ADDRESS
.-�
5 ENGINEER MAILADDRESS
8 USE OF BUILDING
� �S�
7 CLASS OF WORK
❑ NEW
8 DESCRIBE WORK
��.v�U��� �
0
PAGE OF
� �
�18784
� ��1
APPROVED BY
SEE ATTACHED
2 ��, SHEET
ZIP PHONE
� mpc.� ���� `��-���
ZIP PHONE LICENSE NO.
�`��-'��P�
ZIP PHONE LICENSE NO.
ZIP PHONE LICENSE NO.
O ADDITION �, . ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
9 CHANQE OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATINO, ���
VENTILATING OR AIR CONDITIONIN(3. ��� ���
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. PT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT � -�
ANV TIME AFTER WORK IS COMMENCED. � NO. DWIG. UNITS OFFS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION "�� STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURI
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
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 i
PROVISIONS F ANY OTHER STATE OR LOCAL LAW REGULATING CON- P,� p,��
ST TION R THE PERFORMANCE OF CONSTRUCTION. '"� ���
OCCUPANCYLOAD
�
CU. FT.
�-.
T PARKING
GARAGES
'� � o
PLAN CHECKFEE TOTALFEE
'! � J � 2 Z — ,� � �-- � e04��
SIGNATUREOFCONTRACTORORAUT RIZEDAGENT �DnTEi _ EN PRO ER Y A ID D THIS IS YOUR PERMIT
_ 1 r�2'0 /
e:r.raenioc nc flwniFF iIF OWNER BU�LDEAI IDATEI BCDG INSP DATE _
N� [] City of Fridley Effective 4/1/86
ADDN. [ ] R-1 AND R-2
pLTER. �7 Building Permit Application
��
Construction Address: � � U � /1� � ' ��-1 S j �r � �' � 1� 1���
Legal Desaription:
Owner Name & Address : e ��/� /�� L-' S S /' �1- � /�,S• Tel . � ��� ° �'G �/-�'
Contractor • 1�/�'�� 5/t � y � 5 o ni s ��n � s i - Tel .� 7� �- �10 �%
. a G � v �a /�/��/ /� s l - f�/ �' . NI��L s - � � �//�
Address•
Attach to this applieation, a Certificate of Survey of the
lot, with the proposed construction drawn on it to seale.
DESCRIPTION OF IMPR09EMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width _ Height Sq. Ft. __________
DECH AREA: Length Width Hgt/Ground Sq. Ft.
OTHER : '� �/`/1 v 1� C- L 13 �� � 1'� •
Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setback
Type of Construction: � � � � � � � � �L` Estimated Cost : $ °�!0 � a " � o
Approx. Completion Date: �� � � S
Alt. A Alt B
T---- � $ �_
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: J' �-Z' - O�
Permit Fee
Plan Check
State Sureharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAI.
STIPULATIONS: � �S
APPLICANT: � ��� Tel. �,
CITY IISE ONLY
� `7 "[ ��� Fee Sehedule on Reverse Side
$ '-- 25`� of Building Permit Fee
$ �c� v $.50/$1,000 Valuation
� $�75 per SAC Unit
$ —' Fee Determined by Engineering
7 1�-1a7 �
� -- Agreement Necessary [ ] Not Necessary [ ]
$ �� ���
`�j��� U C� C���j �
�O p� OG G — �a���
�
I � ��� �ti
y����
�, . .
BIIII.DING PERMIT FEE SCHEDtTLE
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 applicatio n
therefore, require the payment by the applicant for such permit of fees to the amount
herein belo� set forth and in the manner herein provided to-wit:
Total Valuation
$1.00 to $500.00
$501.00 to $2,000.00
$2,001.00 to $25,000.00
Fees
$10.00 (Minimum Fee is $15.00)
$10.00 for the first $500 plus $1.50 for eaeh
additional $100 or fraetion thereof, to and including
$2,000.
$32•50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraetion thereof, to and
including $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraetion thereof, to and
ineluding $50,000.
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
including $100,000.
$100,001.00 and up
�433•00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEWAY DEPRESSION ESCR�i
(Conerete 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 Kith 6 inch depth - Driveway width plus 6 feet times $15•75
VERIFICATION OF FOIINDATION
Permits for construction will be issued a minimum of 2u hours from the time of
application to allow for proper review of the proposed strueture and of the
construction site.
A Certifieate of Survey of the lot, showing the location of the foundation onee it
has been eonstructed will be required before proceeding with the framing.
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WEU OR BORtNG LOCATION MINNESOTA DEPARTMENT OF HEALTH Sealing No. H
County Name WELL AND BORING SEALING RECORD Mi��esoca umq�e No.
���� � Minnesota Statutes. Chapter f031 or W-senes No.
(Leave blenk il �rot knoaml
Townsh�p Name Townsh�p No. Hange No. Seclion No. Fract�on (sm. • Ig.) Dale Seated Approxvnate Date Well
6- i�� !J 1�y! �6� G.7 S� �/4 �la �i4 ���`�1° or Bonng ConStrucled
Numencal Slreel Address or Fue Number and C0y of Well or Bormg Localion °�
�� p� j� �CJ � � � ��5�+ ��g� � ��'� � � ��/ Depth Belore SeaGng �+ fl. Original Depth �� R.
Show exad bcalwn ol weU rn bormg Sketch map of well or boring Static Water level Acwrate
m seclion grid wilh -X'. location. showin9 P��MY lines.
roads, ar�d buildings. ❑ Approximate
W i i i i E
� i i � �
-r -�- -r- -r
� � � � •e mile
_I 1 I I_ �
� - �- -� - -�
N--- f mile -�
PROPERTY OWNEq'S NAME
C�rav�19� S��rks
Madmg Address d differeN than propeAy address mdicated above.
�jf��4a
GEOLOGICAL MATERIAL COLOR HARDNESS OF ��� TO
FORlAATION
If not known. indicate eslimated fortnation log trom nearbq well or bonng.
�_.�a 0 2
m Single Aqui(er ❑ MultiaquHer I �� R. x' be�arr ebwe land
CASING TYPE
w� Steel ❑ Plashc ❑ Tile ❑ Other
�
Screen irom �� ro � fl. Open Hole from
OBSTRU CTIO WDEBRIS/FlLL
� Obstruclion ❑ Debns ❑ Fill
C�'�ii�i �
Type oi deDris/abstruction
ObslructionlDebris/Fill removed? �,Yes ❑ No
PUMP
❑ Removed [� Not Present ❑ Other
CASING
ro
�iameter Depih Set in avers¢e hole? Mnular space inAialty grouled?
14 in. from � to �� N. ❑ Yes �No ❑ Yes ❑ No ❑ Unkno
in. hom to fl. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unkna
in. from to k. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknc
METHOD USED TO SEAL ANNULAR SPACE BETWEEN 2 CASINGS, OR CASING AND BORE HOLE:
�lo Mnular Space F�cists
❑ Mnular space grouted with tremie pipe
❑ Casing Perforatlon/Removal
in. trom to ft. ❑ Perforated ❑ Remwed
in. from ta
Type of perforator
❑ Other
GROUTING INATERIAL
�� ���
Groufing material
n. ❑ PeAorated ❑ Removed
trom � to 2a n. yards I/�
hom to H. yards
RENARKS, SOURCE OF DATA, DIFFlCULTIES IN SEALING
Pi��e's7i����� �� i���0�� ��J��� �+V����1 :»i+ from to fl. yards bags
�et las� 1Gr' �� c��i�g au�. %��.�a����d
p��'�1Cit� �+i CeiS701 j t�le�� ��i�� ��lT���i��t�' r�om �a e. ya� bags
c����S� f��A'LJ� � Y��0� 1 Cf�J i�g �I�I� �I'�fl� EJ�i:FC UNSEALED WELLS AND BORINGS
��� .�v �� 1 � � � �1 ��� �� � ����� `�� �� �� O[her unsealed well or horing on propeRy? ❑ Yes ��90
�` �� ����� � ��`,.� .��,��� � � � „��y � UCENSED OR REGISTERED CONTRACTOR CERTIFlCATION
This well or boring was sealed in accordance with Minrresota Rules, Chapter 4725. The inlortnation contained in this repoA is
true to the best of my knowledge.
t���k E��11 Cfl., T�c, � E�2133
;�_�� =t .
��;��� �.�;�� H � , ��. � ;
Authorized Representatrve Srgrtature �°�°
�06� ��P1���50�1
Name ol Person Sealing Weli or Boring
From: 763 444 8925 Page: 6/6 Date: 11/13/2009 9:09:53 AM `�
�..,. �...... �..,�.... � ......��.�.....���y..��....�� ..... � � ..., r....
Building N�ECI-iANICAL ��"t No.: ,
Inspection.s RESIDENTIAL APPLICATION R��ved By:
763-572-3604 �Y �F FRIDI,Ey Dat���l: I
763-502-4977 FAX �crivEZ-�s-a4
__..... 1 l_ t:-, �(�� vouw��int�. n�D�ss � jrj, n Q' ..
SLTE ADDRESS �
TH45 APPLICAN'f IS:
OWI�TER/
TENANT
CO�fTRACTOR
suBMrr a cor�r or
YOUR S'fATE
L[CFNSE V►�i1 H
APPL[CATION
PERViIT TYPE
■ • � d�
IdAME�
ADDRESS, CI"fl, STATE ZlP
COMPANY NAME:_
CONTACiPERSON:
�SINGLE FAMILY ❑ TWOFAMiLY O TCJWNHOUSE
TYPE OF WORK: I � �'' �i�Lac�'['
DETAIi,ED DESCRIPTION OF WORK
O ALTERATIC7NIRF�VlOIlEI-
�
u�° � uq�-�"
�.�i��
���GO �R�E SO�IB7U FLO�V
FE�S ARE BASED O\ SIU.00 PER FU�TU C T WHERE PIOTED. FIXTURES'
MODEI.: �j
�quiPmentlnslalled �C`' y,�, a��-Vr` SlZF1B7'U o`' �
IV1FG: MODII.:� '�� .J� .
���: �_ S[ZFJB7U �_
M�G= �— GASRANGFJOVEN$10.00
�A/C S25.U0 FIREPLACE (GAS) $ IS.OQ NgW GA5 GR111. S10.00
AIRTO AlR EXCHANGHER $15 FIREPLACE (WOOb) $35.00 GAS U1�IT HTR St0.a0
Ba1LER 535.00 �FCRNACL; $35.� POOL HFA'fER 535_OD
(�I1MNEy LINQi310.00 GAS DRYExt $10.00 yp�'y'[LATOR 51 S.�
— -------.. _......, r,as PtPiNG StO.�
Nttmtser of fixdues {a3 $10.00 x� 10.00 =�
Number of fixtwes @ $15.00 x $15.00 = $
Number af fixtures @ SZ�AO ` x$25.00 ° S ��
Number of fixtur�s (a3 $35.00 � x $35.Od = $ ��
State Snrcharge ° $ .50
...�,�,u.r„u cL+s cae efll Tn1a1 =.ti' VC
•.aaa....�.."� -- �--- - . . .
TH[S IS AN APPI.ICATIaN FOR A PERMIT NOT VA1 ID UNTIL PRO�ESSED
I hereby apply faa' a bu�ding permit and I acknowledge that the information above is coraplete and accurate; that the wark will be in
conformaace with the ordinances and codes of the City of �ridley and witi� the Minnesota Con�pruction Cod�; that 1 urnlerstand this is
not a per►nit but an�y an aPplication for a pern►it and work is not to sfart withaut a permit; #hat the work will be in acxordartce �vi�t the
appcoved plan in d�e case of a�l work whi requires revi�►v and approval of plans. i/l.��y j 1' I� � O
�� PKINTTiAME 1!„ AI'E +
SIGNA7'UREOF APPWCAN7',,_ , _ - - -- • - �......�
cny o� F�ai�y
�uilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 FAX: 763-SQ2-4977
�
Buildirlg BUILDING Permit No �� ����
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date�c�: F E� 0 2 201 ,
763-502-4977 FAX EFFECTIVE 1-1-2010
DATE �1' �'- ,Ti YOUR E-MAIL ADDRESS y�S T►41�"�flAIZI�, rN L�'/C!il�o0 CC� +��`
srrE,4nnxFSS �6 � \ �r�sT ���.i2 �
THIS APPLICANT IS: ❑ OWNER �NTRACTOR
PROPERTY OWNER/ NA1�1E: ��V l�J tNoo ���7 �
TENANT pDDRESS: 6�o O 1 �, �� � e,,C, (Z L� CITY -E-�I� l f� � �° y STATE�ZIP
PHONE: 6 � a.. �i% E� . �� 9�T
CONTRACTOR NpME: � �j �`d�}�Q ���� �'�JC.
SUBMIT A COPY OF STATE LICENSE # � 0 J� .�o ��-i a EXP DATE +� ' 3/'" l�
YOUR STATE LICENSE
AND CERTIFICA�'E OF ADDRESS: LI �� �l ��d� W����� .�� CITY �MMP / S STATE�IP_e�
INSURANCE PHONE �� - 6 FAX 7 6 /� 7 � S/8 S'
PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTIOId SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ ADDITION ❑ GARAGFJSHED DOWS
❑ BASIIvIEN'1' FIIVISH 0 ROOF ❑ DRAIN TILE
❑ DECK � SIDING ❑ OTHER.
❑ SWINIMING POOL
TYPE OF WORK: 0 NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCF/REPAIR �MODELING
DESCRIBE WORK BEING DONE: 9�'}�� �El. W(1r �tl�D u�S ��{n �7 �'�- `�' T"A-�T'�� DC7 c)
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S FT
ROOFIIVG ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
NUMBER OF SQUARES O HOUSE & GARAGE �. �i�ng Floor Plan
GAIiAGES O ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: O DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING ADDITIONS. & PORCHES SUBMIT:
❑ V�ny,� ❑Soffit 1. Site Plan/Survey showing the existing structures
O Aluminum ❑ Trim and proposed project.
O Other � F��a 2. Two sets of construction plans
�Op,s 3. Energy Calculations
IN EXISTING OPENINGS �c ❑No LOCATION OF WINDOWS FOR WINDOWS - PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WIIdDOW.
OPENING CHANGES 8c
TYI'E OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
. c_
ALL NL�'1�',, AKL�' 1fA>L�:U V1V VALUAIivi�� ii�a.a..uLai�v inr� �.voi vi` a�t�iava� ru�a� 1�LA1L' 1`lALI)•
(USING 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ � � C�Z� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Chazge
Total Due
$
$
$
$ -
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)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary (
Make checks payable to: City of Fridley
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
Attach
I hereby apply for a building permit and I aclrnowledge that the informarion 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 p an work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all wo w' uires review and approval of plans.
SIGNATURE OF APPLICANT NAME �A-i� (�N.Y i�'F� �O� DATE t�`"t7�� r V
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 the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
. 763-572-3604
Fax: 763-502-4977
Building BUILDING Permit No.: ��� L�� ��° ��'
Inspections RESIDENTIAL APPLICATION Received By:
�,
'�63-s�2-3604 CITY OF FRIDLEY D�°��w�+� � � �� �
763-502-4977 FAX �FECTTVE i-�-zo�o
DATE 3—� ° I� YOUR E-MAIL ADDRESS
srrE annxESS b b d1 ��s-r '��� � vZ �fl
THIS APPLICANT IS: ❑ OWNER �QNTRACTOR
PROPERTY OWNER/ NAME:� .�j \� �o �c%`����c
TENANT �D�S: ��� � ��� �`� � � , ct7�r �R`��V STATE`�ZIP�
rxorrE: (r� 1 a. �l ? a. I$°l 7
CONTRACTOR NpME: �, g��g� pq.�� �/l� G
SUBNIIT A COPY OF STATE LICENSE # �� C> � b� ti o� EXP DATE 3-31 - �b
YOUR STATE LICENSE
AND CERTIFICATE OF ADDRESS: `( I�°� H I�A.W �+'T��A. ���.. 'S � CITY y S STATE�ZIP SSy-IO%
INSURANCE PHONE % l 02 ��':• �� o2oi FAX 7. �S
PROPERTY TYPE �INGLE FAMILY/NEW CONSTRUCTION SIZE
❑ T�VO FAMILY/NEW CONSTRUCTION STORIES
PERMTT TYPE O ADDTi'ION GARAGF/SHED ❑ WINDOW3
❑ BASEMENT FINISH ❑ OOF 0 DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER.
❑ SWIMMING POOL
TYPE OF WORK: O NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCFJREPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: F� `�T�1'�N� G-RR�4� o P��' �^"t ��� ��� ��� °��"��'4
SIZE OF IMPROVEMENT LENCTH _ WIDTH HEIGHT S FT
�pp�G O HOUSE ONLY BAS&MENT REMODELING SUBMIT:
NUMBER OF SQUARES ❑ HOUSE & GARAGE 1. Euisting Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of struchual members to be used
PROPOSED HIIGHT:
FOR NEW CONSTRUCTION INCLUDING DECKS,
SIDING ADDITIONS_ & PORCHES SUBMIT:
p y;ny� �Soffit 1. Site Plan/Survey showing the existing structures
O Aluminum ❑ Trim and proposed project.
❑ Other ❑ Fascia 2. Two sets of construction plans
WINDOWS 3. Energy Calculations
IN EXISTWG OPENINGS OYes ONo LOCATION OF WINDOWS FOR WIIVDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STiCKER ON WINDOW.
OPENING CHANGES &
TYPE OF WINBOW TO BE INSTALLED N[JMBER OF WINDOWS
AT ♦ ATT 1�R � TTi7 � i C��
ALL r��1�;J AKC:IfAIL�L Vlr VALUAliv1�� ii�a..aJa�Lii�v aur. a.vva vr ,...�.......-...,. ,..�.=..s_..,......
�1 SING THE 1997 U.B.0 FEE SCHEDULE)
JOB VALUATION $ .�7`•_ � � OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Swcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks uavable to: City of Fridley __ Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and 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 ' and work is not to start wjthout a permit on site; that the work will be in accordance with the
approved plan in the case of all rk tequires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME �a41Y/ L f/!?/ur T£�� DATE �� �-��
Page 2- Building Residential Application
7
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 application therefore, reyuire the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minirnum of 24 hours from the time of application to
allow for proper review of proposed structure a.nd of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
reyuired before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridl�y, MN 55432
. 763-572-3604
Fax: 763-502-4977
.-
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