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; HEAT LOSS CALCULATIONS .DEPARTMENT OF INSPECTION
� Weat6erstrips A.S.H.V.E. Conatruction No.
Guide
�,(/ �� � 13L� �
Windowa Doors Reference Out. WaU Int. Wall Ceiling Roof Floor Kind
Yea—No Yes—No 19_ II
Fl.� /'�, f��,� �', Room Length Width O� Height Fl.� �.�,!� � t9"�` Room 1
Windows and Doora—Crackage aad Are� Windowa and Doors—Cr�
Width Helght No. o� Llneal tt. Area Wldth Helght No.
No. ot Dane o[ Dane IlBhte ot crsek eq. tt. No. o[ Dane ot paae 116'�
�
Infiltration �� � �'
Glaas � ,� �
F�cp. wall ; , ��4
Net e:p. wall , �' ,, �S�'
� I_nt. wall
Ceiling `� t� /�,�
Floor
7atal Btu.
Required sq. ft. E.D.R. or aq. ina. W.A. Leader area
FI.� , r�, a� �± r�oom � Length �'g` VNidth ,// � F;
Windows and D�ors—Crackage and Area
Wldth Helaht No. o[ Lfneal tt. Are�
Na. ot Dane ot pane 116ht� ot cractc sQ. tt. /i.
� J
e % es �c"� i�,,,, � `3 N� ��s� ,
lnfiltratioa � , �,�
C.lau E-A ,�' ,���
E:p. wall ' ,�
Net e:p. wall „ ;' ,;�
Iac. wall
Ceiling � �.i' � �
��
Floor '�> �"� �`-'
Total Btu.
Required sq. Et. E.D.R. or sq. ina. W.A. I.eader area
Fl. �;y°� ���'�: � Room �Length � Width ��
Wiadows and Doora—Crackage and Area
Wldth Helabt No. of Llneai tt. Area p
Na ot Dane ot Dane 116bt� ot crack �Q. iL �
�� � , � ��
E� � !
Y'
1n61tration ( �f"`�
Glass � -'� ��
E�p. wall i',`'��'
Net e:p. wall ��'� _
Int. wa6l
Ceiling � P'� : . ° ��
F loor ; � � �
Total Btu.
Required w• ft. E.D.R. or eq. ias. W.A. Leader area
�
Btu
��
Btu
Btu
����
� ��
n � �;
�
F""�
1VIINd�IEAPOI.IS. NDMV. '
Insulatioa
How Applied
�� VPidth � Height '
and Area ,
nea� tc wre.
'crack aQ.ft. �
�� ��
/
Coef. Btu
In6ltration �d � �' , � � �
Glasa �'�^ �� � � �' �'
Eap. wall ?c�� - � @'i�
Nec eap. wall � e a �` �u'a ��
Int. wal! - - --- - - -,
Ceiling - - ��' � �' � � �� � �
Floor � !��n `� � : �
'fotal Btu. `� "� � '�,
Required sq. ft. E.D.R. or sq. ins. WA. L.ead r area
FI.� Room I Length Widt`�i Height I
Windows and Doors—Crackage and Area �
Wtdth He18ht No. oL Llneal ft. Aree
No. ot ysne ot psne IlBhts ot crack ea. it.
� �� f� ��' acB �� �
In6ltration '"`�'� �� ''�`��� �
,,
Glesa r�,� �ES �'�'G�tF:'�'
Fap. wau �' �' `� �' 9
d " �-
Nee e:p. wall � � � �'�`' �
Int. wall
Ceiling `'"��'�,' G� (:? =� �"� " �
,� �a ,� e ,� �
Floor `�,� "� �
Tocal Btu. ` � ` ` '"9
Required aq. ft. E.D.R. or aq. uis. W.A. L.eader area
�,I q��, � �I,ga, Width Height
Wiadowa and Doors—Crackage and Area
Wldth HefQht No. ot Llneal tt. Area
No. ot nane ot IIans Ilghts o[ cnck w. t4 �
Infiltration
Glaas
Eup. wall
Net eap. wall
Int. wall
Ceiling
Floor
Total Btu.
Required sq. k. E.D.R. or aq. ins. QIA. Leader a�ra
.
Btu
SUBJECT
c�ty of Fr�aley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� �
� • COMMUNITY DEVELOPMENT DIV.
� VL �'�����
r � � PROTECTIVE INSPECTION SEC.
1 . i
�` � ��"t � CITY HALL FRIDLEY 55432 NUMBER
`••-'� � ,'� 612-580-3450
910-F15
JOB ADDRESS
1 LEGAL �OT N0. BLOCK TRACT OR ADDITION
DESCR. 3 [.4 OSTMAN � S
2 PROPERTYOWNER MAILADDRESS
4 ARCHITECTORDESIGNER
5 ENGINEER
8 USE OF BUILDI
MAIL ADDRESS
tERRY, 70!
MAIL ADDRESS
MAIL ADDRESS
REV. 1 DATE
PAGE OF
� �
ZIP PHONE
)T.'�g, MINNESO!'
ZIP PHONE
/
�
PER .
. ° 13093
RECEIPT NO�
// O `�
��
APPROVED BY
SEE ATTACHED
SHEET
LICENSE NO.
LICENSE NO.
ZIP PHONE LICENSE NO.
7 CLASS OF WORK
� NEW ❑ ADDITION O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
CONSTRUCT HOU5E d2 x 25 x 2n �('ARA('F 7G! x 9d sr 1 n
9 CHANGE OF USE FROM TO �, �.,,��e
��`� ._,.a\ � �M_
STIPULATIONS �`��pQ,� R�C'��
Provide Verifying Survey 8e�°4�ONE'F'�"� �`( � ��Lv�
RECONlN�NDaAeT TrURNeAROUND ON DRIVEWAY ��`� Qv`�`� t�� �`
R� G� `
SEWER: � E�f M. 829 `819. 58 Inv. ) ��Q�` S;G�Cj•
TOP OF FOOTING - 834.31 (Minimum) c���'�SG P��
WATER: 10' S. of Sewer Service ,�� Q������
�Q�� ��, Q�-
CJ '��
��P
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT.��� CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R_].
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OFiDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OF NOT. THE GRANTING OF A PERMI$ $35,100 $1% . SS
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE p�RM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCT N OR THE PERFO ANCE OF CONSTRUCTION. tiS`5%.4�. 325.00
PLAN CHECK FEE TOTAL FEE
/ � - 399.96
SIGNATUREOFCONTR RORAUTHORI � AGENT fDATEI /yV�H N P P Y ID D THIS IS YOUR PERMIT
/ /7 _ A ��— -- ' _ ' _ �. _
(DATEI
n. _ . n ° _ ' . �
�
APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER'S NAME: c BUILDER:
ADDRESS :��1�� .3 0� �'e/L;�eZE�,. ADDRESS : � G . /�/�/ �L�v y
/
__ �
N0 : . �E L�� � S TREET : � � 'a�'° � � �o _
LOT: � BLOCK: '�" ADDITION: �i'MnJf�..1�5 �l�1�:eO. �
CORNER LOT: INSIDE LOT:,��_SETBACR: SIDEYARD:
AppliCant attach to this form lfao Certificates of Survey of Lot and propoaed
building location drawa on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As: r ��
� � Front: Depth: ,� � Height: , �_�
Square Feet: � Cubic Feet: � �- ��'��7�i�/
Front: Depth; �e Height:��
Square Feet; �� �Cubic Feet: _ �(�
1�rpe of Coastruati0n: �,(� ��� ��N�(� Estimated Coat: Q�
To Be Completed: /--� --� ��„
�
The uadersigned hereby �kes applicativn for a permit for the work hereia
specified, agreeing to do all work in.sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildiaga, and hereby
declares that all the facts aad repreeentations stated in thie application
are true and correct. �'
,I
� �
DATE : � S '— � � S IGNAT[TRE
(See Reverse Side For Additiona.l Inform
��� � �� � �
�,C. = t� � S�
S o9°� , � i ��`, o��
�►`e��
I.� ,S (I�G2t u�
Q�cc��+�. �o A�
�� '�3t���.��iV
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/
BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings ahall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
building or atructure, or for any alteration or repairs to a.ny 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 pravided to-wit:
UNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thou�aad cubic
feet, or fraction thereof, in such cubical contents. �►pe 3� 5-$1.85 for
e�ch oae 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 line of the basement
or the cellar to the average heights of the upper surface or to the average*
height of the roof aurface of the ma,in gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fractioa thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth ia Section 2 be
less than $5.00.
VLRIFICATION OF FOUNDATION
NOTE: PexYUits 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 coastruction site.
A Certified Survey of the lot,.showing the location of the foundation, once it
has been constructed, will be required before proceedi� with the framing.
CERTIFICATE.OF OCCUPANCY
Applicatioa for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy qf any structure for which a building pemnit has been
issued; aad said structure shall not be used or occup�ed until a Certificate
of Occupancy has been isaued. •
�
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I'hereby certify that the a'bove is a true and correct plat of a survey pf= ��
Lot Three ( 3) , Block Four (4) , OSTMAN' S THIRD ADDITION, Anoka �ouaty, .'��! �
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As surveyed by me this 3Oth. day of March 1959 A. D.
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E3431 UI4�IVERSITI� AV�NUE NE �ch 2, 19�F � FRIDLEY, MINNESO�A 55432
, _ .
, .
Mr.`Be Ee �erry � �
709� H3.c]s��y Dtive N..Eo
FriciZey: Mia�nesota 5543�
Re : FinaL Tnspact3an at 692], East River �oad �T e E e '
Dear N1�o Ser�pa _ ,
, A fi�nai insgection was made aa March ].� ],976 �f �� above address. �.'he iollowing
item� were noted and must be c�ple�ed befor� �a� �onst�ucfiion can be £inaled:
out=
l. Post house ntm�ers oa sttucture on or before iKarch 19, i976.
2. Sad tlie front a�nd side �raxds �n or bsfore �une 1.5, 1976. �
3. InstaZl hard surface driveway, with xeco�mnended turn-axound, on or before
June 15, 1976a
If any problem� ar�se that wi.11 prevent you from comple�.ng these items by the
ap�in�ted dates� please contact use Reinspections will be conducted �o determine
compliance.
Sincerely,
. �
DARREL 'G. CI,ARK �
Coamiunity Development A�ne
DGC/mh
I��Y .!. H�efVS�id 13�07 Sprin� l.oEca �
L�etd Surv��+or ��� � � ���� p�p�s. �9inn. �5�
ANO T@Iepholt� 93&SiYi
Civil En�in+eer
OF PROPER7Y OF Haxland Bszgy
b921 E. River Road, Fr3.dley, Ai:�
LOCATI ON
OESCRIBED AS FOLL01N5 I,pt �. �IO�:{ �a Os±man's ?7'� Ei'�C�'�t30!i
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CER'iI�'I�Ct#TE OF LOCATIOi�1 OF BiJiLHiIY11G
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SUBJECT PERMIT
City of Fridley � n ��
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T � �? A�
r
; � REC
� • COMMUNITY DEVELOPMENT DIV.
' j L'--��`-�
r � � PROTECTIVE INSPECTION SEC � �� �
� �
� � /'��1 � CITY HALL FRIDLE� SS4$2 NUMBER REV OATE PAGE Of APPROVED BV
�----� • •�� 612-571-3450 910-F15 8/29/95 / /
JOB ADDRESS 6921 East River Rd NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 3 4 Ostman's Third Addition SHEET
2 PROPERTV OWNER MAIL ADDRESS ZIP PHONE
Muchtar Sajady 10482 Mississippi Blvd NW, Coon Rapids MN 55433 421-8579
3 CONTRACTOR MAIL ADDRESS Z�F PHONE LICENSE NO
� American Construction M t Inc PO Box 29241, Brookl Park 55429 561-5370
d ARCHITECT OR DESIGNEii MAIL ADOHESS ZIP PHONE LICENSE NO.
7138
5 ENGINEER MAIIADDRESS ZIP PHONE LICENSENO.
6 USE OF BUIIDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION f�l ALTERATION O REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Rebuild a 10' x 20' Deck
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
�������
Before digging caN for
all utility locations
454-0002
REQUIRED BY LAW
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTFUCTION ZONING SQ. FT. CU. FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ], STAL�S GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PpOVISIONS OF �AWS ypLUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WIIL BE COMPLIED
WITH WHETHEFi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 1 714 �. S6
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pEqM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S6.7S Fire SC �1.71
PLAN CHECK FEE T07AL FEE
59.32
� SIGNATUA OFCON�RACypRORAUTN RIZEDAGENT IOATEI WHEN PFiOP LY VA IDATED TNIS IS OUR PERMIT
M1 ��
SiGNATURE OF OWNEA i�F O LDER� ���� AT I - OG �NS �� TE
<
NEW
ADDN
ALTER
C�
[l
[l
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstiuctionAddress: ( %Z I �Q S � ���i�V
Legal Description: �=
Owner Name & Address: /t/�
Effective 8/ 1 /95
;�3 2
� T� i v� �1���r/
,
; ,
Tel. # y/ Z/— aJ 7% 7�d -'�.��%
Contcactor: /O G��� /� � S � 'f � �1`jr� �t v� �� ,� /►Q 1:;� MN LICENSE #
Address: .� Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed consbruction dra.wn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECg ARE�: Length � p Width Z G Hgt/Ground � Sq. Ft. �
C��i�s��1��
Corner Lot [] Inside Lot [] Ft. Yd 5 ack Side Yard Setbacks
Type of Construction: f Fstim�ed Cost: $ T%%"�, `� _
Approx. Completion Date:
(Cost on Baak)
Driveway Curb C�t Width N�ed: Ft. + 6 Ft = Ft x$ _$
DATE: � �Z ��' � _ APPLICANT: � ` ,�a�, Tel. # 7�f '� / �- Z�.�"�/
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� ,
� ,, 5
$ /
$ o
$
$
$
$
$
$
$ �9 �
CITY USE ONLY
Fee Schalule on Reverse Side
.(�1 of Permit Valuation (1/lOth%)
$.50/$1,Oa0 Valuation
$850 per SAC Unit
$5.00 (State Licens� Residential Contractors)
Alt. "A" or Alt. "B° Above
$450.00 Consen►ation Plan Review
Fee Detern�ined bY Engiae�ring
Agreement N�y [ J Not Necessary []
0
BUII.DING PERMIT FEE SCHEDULE
The Chief Build.ing Official shall, before issuing permits for the ere�tion of any building or structurE, or for
any add.ition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment b� the applicant for such permit of fees to the amount
herein below set forth aad in the manner herein provided to-wit: �
TOTAL VALUE
$1 to $5�
$501 to $2,000
$2,W1 to $25,000
$25,�1 to $50,000
$50,�1 to $100,Q00
$100,001 to $500,000
$500,001 to $1,000,000
$1,0�,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $S� plus $2.75 for each additional $100 or
fraction thereof, to and includiag $2,000
$62.25 for first $2,� plus $12.50 for each additional$1,0�
or fraction ther�f, to and including $25,000
$349.75 for first $25,000 plus $9.� for ea,ch additionat $1,(�0
or fraction thereof, to and including $50,000 .
$574.75 for first $50,000 plus $6.25 for each add.itional
$1,� or fraction thereof, to and including $100,000
$887.25 for first $100,0� plus $5.00 for each additional
$1,0� or fraction thereof, to and including $500,000
$2887.25 for the first $5�,(m0 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,� or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Cancrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gut�er only - Driveway width plus 6 feet times $13.�.
Altemate "B" : Removal and replacement of cwb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFiCATION OF FOUNDATION
Petmits for construction will be issued a minimum of 24 houis from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the l�ation of the foundation once it has it has been constructed
will be requir� before proceeding with the frdming.
�20'Y .!. HAf�iS�N
Land Surv�yor
AND
Civi1 En$ineer
� � �"c.� 4�* Z ...
� ._ .
4.
OF PROPERTY OF H3TZdri(� ,�.,f;l:'?"�I
b�21 E. River Rva3, Fx�idley o I:�
LOCATIOv
�ESGRt9ED AS FO�LO`NS T.Ot � �].JC�C r'rA (�s±nan's ?T'�. ii�^.'31'i.10»I
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13�07 Sprin� Lvka Ra�d
Hopkins. F�Inn. ��M13
7elephone 9�8-56T3
CERTIFICATE OF LOCATION OF BUII.DING CERI'T�ICATE OF SURVEY
�
i hcre;;y ce.rtiiy tha� or,__..�� _. _ 19,_,�. I h:reby c�rtiiy lnat on._ 19
1 ......,_ . _.. ._ < < <_ •,��_�.., .
.,..:..� G. i:'.i �u:aiiJii 3i iuc viiiw�ug�� O�i iuC ni�urc a au�veycti �ito property described aoove anri [nat tao aoove piac
::.:.:.: �cd ;.tupeciy snd i� ai tt,r location of sa�d building(�t} is i. a c•arrect representation of said survey,
c�rreccly Shr�wn or. the a1+�?ve plat.
� �
� ROY J. HANSEN, RfGiSTERED SURYEYRR RIO. 6274
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1155
Building Job Report
ADDRESS �s ' � / � �
_ ,
OWNER
BUILDER
DATE PERMIT NO.
DESCRIPTION
� DATE
0 r iNCaFr.rinn� RGr.nan
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sue�etT IT NO.
City of Fridl�y � 2 9 819
AT THE TOP OF TME TWINS g � I L D I N� P E R M I T
r
� �
� ��L _____ COMMUNITY OEVELOPM�NT DIV. / ry
r � � PROTECTIVE INSPECTION SEC. � „�
i_-_-� ��"' �•� CITY NALL FRIDLE� SS132 NuMBEr+ REV D�TE v,►GE Oc �PVaovEO Br
t 612-5��-3abo s�aF�s 7/6/99 / /
J08 AODRESS 6921 East River Road
1 LEGAL �OT NO. BLOCK TpACT OR AODITION SEE ATTACNED
DESCii. 3 4 Ostman's Third Addition SNEET
2 PROPERTY OWNER MAIL AOpR�S$ 21P PMONE
Muchtar Sa ad 21-8
3 CONTRACTOR MAIL ADORESS 21P PFIONE LICENSE NO
Owner
a ARCMITECT OR OESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGiNEER MAIL ADORESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOFiK
O NEW q ADOITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (22 Sq) Tear-off
9 CHAN(iE OF USE FROM TO
STIPULATIONS �
Underlayment must comply with the State Building Code.
TYPE OF CON T. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PEFMITS ARE REQUIRED fOFi ELECTflICAL, PLUMBING, HEATINO,
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AND VOIp IF WORK OR CONSTRUCTION 20NING SO. FT CU FT.
AUTMOR12ED IS NOT COMMENCED V�IITNIN 60 DAYS. OR IF CONSTHUCTION
OF WORK IS SUSPENDED OR ABANOONEO FOR A PERIpD OF 120 pAYS A7
ANV TIME AfTER WOpK IS COMMENCEO. NO OW�G. UNITS OFFSTpEET PARKtNG
I HEREBY CEpTIFV THAT I MAVE READ AND �XAMINED THIS APPLICATION STA��S GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING TMIS TVPE OF WpRK WILI �E COMP�IED
WITH WHETMER SPECIFIEO MEREIN OH NOT. TNE GRANTING OF A pERMIT $1923 $.9G
DOES N07 PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TME pEpMIT FEE SAC CHARGE
PROVISIONS OF ANY OTNER STATE OR LOCAL LAW REGULATING CON-
STRUCTIpN OR TME PERfOflMANCE OF CONSTRUCTION $69.25 Fire SC �1.92
PLAN CMECK FEE TOTA� fEE
$72.13
S�GNATUpEOFCON:F CiOp AAUTMOA� � WM N P PERLY VA IDATED 7MIS S VOUFi PERMIT
S�GN EO� W U�LDEii� iD�TEi BLQG �NS� latE '
�. r
NEW � �
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R 2
BUII,DING PERMIT APPLICATION
Construction Address:
� �� �� �� ��
r�� � c
-�. �- � ��
• � � - . � � - : � � � - // ,.:./► /I � ii •
—
/,i� /�' ' %
, � , ,., f._�. �_.r�_r.�. � � .���%�+'�i� `�
� � � - :%ly�: ��'� /�`� < <��� �'�+���'��
-� � � � .'�. -� � � � I l J- �
� ' -
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
DESCRIPTION OF IlVIPROVEMENT
Width
Width
Width
Height
Height
f
� V �
Construction Type: �'.-�.-1�8� , Estimated Cost: $
�
Sq. Ft.
Sq. Ft.
� Sq. Ft.
/ C./� 1. /l. � V'
f 9 __------- ����
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ $�2
.
` �
DATE: ,� APPLICANT: Tel. # � �"�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPLTLATTONS:
$ q_��
$ . o�
$ �
$
$
$
$
$
$
$ �` /_3
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 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 [ ]
�
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 $2,0(}0
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$1�,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,0�
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,00� 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 $500,000
$3,233.75 for the first $500,�0 plus $4.75 for each additional
$1,0� or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,(�0,0� plus $3.15 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 $15.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow %r 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 co��a�ied will
be required before proceeding with the framing.