AF - 40951�
City of Fridley, Minn.
BUILDING PERMIT
Date: June 4, 1968
�r, Clarence H. Olson
Address
Bu3lder
Address
1�T°
y�G o0
9'77 "7
LOCATION OF BUILDING
No. 7501 S�t East River Road ..� � p� of Lot
Lot .�..�_..___ Block Addition or Sub-Division _� �. �. ��7
Corner Lot — Inside Lot ._._ Setback � �._ Sideyard
Sewer IIevation _____ � Foimdatton IIevation
DESCRIPTION OF BUILDING
To be Used as:
Z. R. 9ddition �nt 16 Depth � 2 Height .�.. � 2 Sq. F� ��_ Cu. Ft 2, 204
Front Depth I�eight �. Sq. F't. Cu. F't.
Type of Construction �� Fs� Cost _.._�.�..,...��.�__ To be Coanpleted �1 /68
In consideration oP the issuance to me of a permit to construct the building described above I agree to do
the proposed work in accordance with the description above set forth and in compliance with afl proviaiona oP
or8inancea of the dty of FiYdley.
�'.,�,�. C.� . Cg�.fl.,�-�.e
In consfderation of the payment oP a fee oP $��� , permit is hereby graated to Clarence H.
�.�� to construct the buflding or addition as d�cribed above. Thisp�� t is granted upon
the express condition that the person to whom it is granted and hia agents, employees and worlanen, in all work
doae in, around and u�n said building, or anypar� thereof, shall conform in all reapects to the ordinance� of
FridleY. M3nnesota regarding location, construct�fon, alteration, maintenance, repair and moving of buil�ng�
within the dty ]imits aad this perinit may be revoked at any time upon violation of any oP the provisions of ea�d
ordinanc�s.
�:�:��1;1�I;1
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OffiCi&1
^ NOTICE: �
'flds psnnb does aot sovar t6s coeatrudioe, hataQ�tiee he �rhiee, plumb�e, ea h�atleg, rswu er waMe. B� wn to a�
�6a Buildiea lespsete� fee ssparafe p�rmha Po� fltas iixes.
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APFLI�AT:[QN FOR HUZLD�� P�R1+�IT
cza�r c� FR�Y; ��so� ., ... . . ..
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� :ry .�.y°�i t
. . . . • . . �tt,,1 it � 1 . . � . .
.. ' ����V1Y� ��' $���e . . .. : .
, � �
N0. �� �,� . . ` STREET_Z�f� � ` ,p�„�, ..�' -
d� ����������
LOT d, `f .; BI.QCR •. ADD�TIOP7 .OR SUBD�VI�Id3N rr � c '��
. _���... '��' . . : ._ .. � r , � .�. . .. " -
�CORTIEA LOT INSIDE LOT SETBACK .. � . , : SIDEY �;,;_,_ _,!,___,�,
SEWER ET.�VA�ION TQ� OF FOOT�NG „
,A{�nli��nt aetaeb. to� thi;s3 ;��pa ;�'�ea ,C��tii,i.c�ates, of .Sntv�y. c�lf Lot
btsilding;��oca,tioa ct;�iaa,-pn the�.tC�e�;���i;4ates: • •.:-. :. . ,
. • , , : � . :s� '. ' '�,•'� " � . • _<<
. . . , • , , - . .,UESC#�IFT�OI� �F. B'�D�NG. . . , - �
._ �., •; .:, . -. . �.... ..
To Be Used Ass ..-.;:.; ..
a�ad proposed
� f �. o �7- ��x �`�l� d� � ., .. - Front �� � . Depth � � a'�- Beight . / 2--
. ..�.._ ..a..a_.:.::.. .:._,_:... .�_ �....._
� � s � Square ' feeC,�; -,%� �— Cubi� Feet `� D �
_ -F_ . .Froat •�. �. �.,-.�- D�p�th - - - $eighe.
Square feeC Cubic Feet
Type of Canstruction��_� Estimated� Cost �/� ���
To Be Ccmp
G
The undersigned hereby makea appiicat3on for a p�rmit for tbe work herein
specified, a�greeiag to do all work in etrict accordance with the City of
Fridley Ordiaances and rulings of the Department of Euildings, aad hereby
declares that all the facts and representations_sta�ted in Chis applicatioa
are true and correct.
DATE _�,......71.J_�° ��SIGIJATZ]RE �,4r�� ���"`�''`O _ ..
(C�
(Schedule of Fee Coeta can be found on the Reverse Side�.
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.. ` BUII.DING PERMIT FE� 3��EDULE . . . . -- � .
.
SEH�ON I: fihe Insp�Gtor b� �uildingg shall;, be£ore issuing' pEfinits for
the erec iau df �ny building or structure, or fo� at��► additioii "t`o _any
eaisting• structure •tl�� bui'ldi.ng, , or f�r anq alteratibr�-,-or re�,airg t.o any
:, exist�ng building or etruct�ar�, upon applicetiaa tli���£ore, iequi're ehe
the �aym at by' the� applicgtit..fof sueh:.pe�dnit ,�f. ��qs to the amount hereia
bel�a se f�rth and in� Che Riananner heri�n prov�ided ;�o�-w3.t: .`
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Uniform uildin�g, Code: Tgpe 1, 2, 6c�4- $1.75 for each one Chousand cubic
feet, er f�actioca thereof, in auch cubical contenta. ,.Ty. e 3 b,5- $1.50 for
each,one thoueaad.cubic feet. ._ '
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F�x the �us�ose ef cnmputing fees for building permits, ehe cubical
••eoat@nte ef any builc�i�d'g gr_,addition �� a-uuiform �e3ght throughout bq
�ltiply ng the grouad area covared fiqm a point ein (6) iuches �elow the floo-
lin� �f he basement or the cellar te�the average height of the upper surface
or to th avera�e height of the raof aurface af the maia gable of s
piteh�d � �oof . � � � _ . . . . - . . . . �
.._F�r repa rs� or. alter�tiona:to an esiseiug structure, the fee shall.be at the
. rate of 3..00,per each five hundred do1].ars ($500.00) or�fractioa thereof
. it'n the c �t �£�'all q�r6�osed.� �a�rk.- . . ,
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2n n� c�' ��ha�i 't7h��: fee cha�rged for �a��! permit as set f�rth in Sectian 2 be
' less° th $5 . A0. � � � . • . . . • � .
NSSSD C��nectfa�a Charges based rm locatiea- Area 1 os 2. ��� ��
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HOUSE HEATING TEST RECORD
ADDRESS � � � �p � �i� APT. FLOOR CITY �SUBURB i�,
OCCUPANT � o .� I S 0� OY�MER ��
HEAT LOSS DATE HT I ST. GAS C0. METER BADGE #
SOLD �Y ��� � � INSTALLED BY � �
� Eleetrieal Work By Gas Line By �
TYPE OF HEAT GA FA ��HW STEAM SPACE HTR.
MAKE -��� L�p�.s DESIGN
� MAKE OF BURNER _
Model ��� f 0 d . Model
Serial �� � � � 0 •� �~ � Max. BTU Rating —
INPUT 'I �� z��� MAKE OF FURNACE
Model
__ CONTROLS
THERMOSTAT � � Heat Plug
Valve 7�% �
Limit �`' '� `'�
Limit Seiting � � �
Fan Setting —1 a b'� 1 L. 5
Pilot Type ��'E'Y'� =���
Pilot Make �'°'-� °
UNIT HTR. OTHER
CONVERSION
�T � �
Vent Size
KIND OF LINER � �° � SIZE r�� � NONE
Drah Hood '� � �y-►-� Regularoe
Filters Size!/�i���' k'� Mumber
Chimney Loeation Inside � Outside
Chimney Construction ���
Pilot Model Smoke Bomb
Pilot Timing � � �"� � Draft
L.W. Cut Off
Pressure � � � Pereent COZ —7
Ir►put CFH � Percent 02
Staek Temp. ��� Percant CO Q a��"Pr
Form 235
Door
Data
Wiring �
Test Tag �
v
Pressura_ Lighting Inst.
Tasted � _
Company Testing � �'x �� d
Name of Tester
� �,,°_ . 4 7 8 �
Q
0�' CITY OF FRIDLEY � �i-7�
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PUBLIC WORKS DEPARTMENT
TAPPING APPLICATION AND PERNIIT
FOR INSTALLATION OF WATER & SEWER SERVICE
I) This form to be completed before a tap is made to any esisting water or
sewer line. , ., ., /% �
�
Address �
Owner .�
Plumber
' CHARGES TO BE BEFORE T IS MADE — WHERE
ASSESSMENT HAS NOT BEEN LEVIID AGAINST PROPERTY
II) Water & sewer connection permit must be registered before this Tapping
Permit can be issued.
City supplies all material and labor for 1" or under water tap. Con-
tractor supplies all material and labor for water tap over 1", and all
sewer taps.
WATER TAP:
SEWER TAP:
Materials Used: $ � � � f� O
Street Patch: x . $
TOTAL: $ 8�2�°, �
Street Patch: x . $
III) If this property has not paid a full Lateral Charge for its share of the
water and sewer system, additional charges will be placed against it.
This will be in addition to the normal connection and tapping permits,
meter deposits, etc.
Water
ASSESSMENTS TO BE LEVIID: Lateral: $� �. D��
• / J � �
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� � � _ �. � � � f I ✓ : / ��� ` i e
ai I �� /, / �. / / .VL.s _.z �.i -i / �/
Supt. of Public Works
M/P 3/76 Whtte P.W. Canary Finance Ptnk Prop. Owner Gotdenrotl Plumber
SUBJECT P N O. v
City of Fridley 16 0 8 9
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
i �
� � ,
� �v _ COMMUNITY DEVELOPMENT DIV. ����
r j � PROTECTIVE INSPECTION SEC.
� ` �
� /""1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�.---� • •�� 612-571-3450 910-F15 4/1/81 � �
JOB ADDRESS 7501 East River Road N. E.
LOT NO. BLOCK TRACT OR ADDITION
1 LEGAL SEE ATTACHED
DESCR. I.g AllCl. Sllb. �%% SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
James Pratt 7501 East ltiver lmad N.E. 574-1417
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
5ame
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USEOF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 16' x 16� Room Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
SEPERATE PERMITS REQI�lRED FOR f�i`i�ol� �����H�
HEATtNC�. PLUMBNVG AND SilGrl�CSe Bebie di�g�'in8 �li tocel gt�'��
iELEPNONE • EI�C���"t� �'
REQUIRED BV �.A�
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �- STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURT$i(�pv
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED °°°
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $��95Q � $3.98
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. �`4S• OO
PLAN CHECK FEE TOTAL FEE
$12.00 $63.98
SIGNATUREOFCONTRACTORORAUTHORIZEDAGENT IDnTE� WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
�' � � � M��l /��l � � 1 Q C�Q� �► ��
NATURE OF WNER IF OWNER BUILDERI IDATEI BLDG INSP PTE
�
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� CITY OF FItIQLCY •
I�f'PLIC/1TT0'J FOk (tLSI()LidTllli_ BUIL�It1G PFR�4TTS
(tde�•r, Aller.ations, ltdditio�ts,, or Repairs)
� OI�J�JER: <, � ��� � � 1'..,,����
ADDRESS: _ � �O_( _ �_ �/�r �, P`��
re� no: .5��� 1 `�� �
�_ .: � .:__ _ ��
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�UILD�.R: .—�� �. � � � .
lIODRCSS: • � � � •
TEL t�0: '
" Consi:ruction Location ' � � �
sxrc�T r:o : +%'�Ga � sx�E�: �-' � s -t /�i � � � �o � /� '
LOT: /�� � BLOQC: I�,DDITION: �CX ��� - � � � .
Corner Lot: Insicle Loi:: SetbacY.: Sideyards :
Ap�licant at�ach to this form two Gertificates af Survey. of lot and
proposed�building location drawn on certificates to scale. .
� ' � DESCRIPTIO►d OF COEdSTRUCTIOP�� -� �
,- . � // . � f i
�o� a�., Gt�r.P�t� � a i'ront: �C� � Uepth: / G Height: / l�
Clabic Feet: � (�
Square . 1 eet : � S,� ,
� �r'ront: Depth: � Hea.ght:
Square- I'��t: � CZibic I'eet:
. . . �'i ,95q• oo,
�.`�,�pe of Consicruction :�� cre �� "��� o� �%v c��� i�-� EsL-imai:ed Cost:
: �.b Be Oor,�pleted: _. /- `t ( ( i �( � % , .
� Alt. A Alt. B
Proposed Drive�iay �+]idth If New Openinq Is Desired: $� $_
' _, SE� RGVERSE SIDE OF SHEET .
7.die under. signed hereb}► ma}:e� applicaticn for a permit fcr the �:�ork' here�n specified,
. agrecing to c'� .all wor}; ir� s��rict accordance t•�itl� i.he City of �ridley Ordinances �nd
rulings oi i:he Deplrtment of Bui.ldings, and hereby declares that all�the tacts and
xcpr.c: entati.ons stated an this appliGatian are true and correct.
n.�z�r: LU1Q �� �, Z � � ( SIGNATUF,i::
Sf:i�,�ulations : �
• Z y�,c�0
��,uo
.98
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. ��a�i_r>>r�c ��r_r;��t�r� r-�:��� sc:��r»u�_�� � .
:;l:C'1.':[01•� ?.. � 7.7�Z� 7n�:� ecCar of` lfui.lc?i>>�1 ::;hri71, };cfo�:r, i.r�:;uancJ ��e»nzL:; t�r t:he crr.cLi.an
af` .uiy l�u:i:l_c1:i.ri�J c»: :•i:ruct:uLC, or. �'a�: t�n�� adcli.t:i��n +.:o ��i�y cr.i:;i:i.ai�1 l�ttilclinc,J o�: :;tnicL•ur.e,
. cir. i`c>r �,�iy �il.t.c:rr.�t.i �i or.. r.c�,ai.r.:� 40 •any c.:S.::t.ii��� 1����i.).di.�i�J or sL•�:ucturc, u1�w� ar���li.catzvi�
.tlzr..r.:f.or.c, xcqui.rc �J�� �,��i}►mcr�t: 1�y tlic aj,��].i.c:ar�t: 1:a�- such ��cr.mi.L• or fecs to tl�e ��n�unt
hcz�.in bel.cn�� sc:t f•o .th �incl a.n thc �na»nez hczc�.n �,�:ovidc:ci L•o-�•:it: •
� , •
. . . • -
pol:l•J CON�;`I'I;UC`�IO2�: S�inc�).e Fami).y 1loiae�� and Ga�'�Zqes: ;:4.00/1,U�0 cubxc tec:i:.
l?I,Ts:� C:III:Ct;: 25 Per.�Ce�it: af bu�.lcli_ng }�er.mii: L•c:e. ,
llit]:Vl:�•;nY llEl'P.L•'5SxOt•I: (Cc�ncreL•c, C'�irb �L-rcets Only)
• i AI.L'ern�-�i:e n: Itc�noval and re��l.acentent of conczete curb and �`j3.�
quL-L•er only; l�rivecaay �•�iclth plus 6 i'eet r. _:,
�1L-ernaL-e B: Removal and xcplaccmcnt of concrete curb and
.� gutter ar,d in�t� 11 a 3 i'ooi: c�i.c�e approach c.*ith ''
' ,. ' 6 inch depi:h; llrivc��ay ���idth �plus 6 feet x�° �
. ' ' "�`� ;�'
• . �,�I � l OP�/lL I (�lFOIZ`�1�1�[.I_or� .
� -
ror tlie purl�se of co:nput-i.n� �'ees ior_ building permits,� L-he cuba.ea3. contents af any
buildS.nc� or additi n, is dci:crmi.ned by rnuli:ipl.}�ar�g i.he qround area c�vered trom a
, pc�znt s5.s: (G) inch s beloca ihe iloor ]_�.ne oi i.lze bas�ment or th� cellar io 'thc
average heights oi. the •u�per sur.face or i.o the average heigl-it af the roof. surf:ace
oi- i:he nain gahle c�f a pa.tched roof. �.
• . , .
For re,�ai.rs or a7.t�rations to an ex�sting stnicture, the �ee shall be at the xate
•..o� $3.00 �ier. cach fi_ive hundred dollars °($500.Q0) er fracL-ion Uzereaf i.n fi�ie cost
of all pro�osecl wo$-k. . . '
I
In •no case slia�.l t e fee charyeci idr anx penni.� as set i'ozth �.n 5ect-a.on 2 be less •
�han $7.50 plus $. O state suxcharge. ` � •
• � � . V�RIFIC}�TIO�! �F� F�U��n/11'IOJ�1
. , i , .
NOTE: Pexmits �or construci:ion �vill be issued a minim� oi 2� hours fr.om tlie ti.me
�f a�Z�licatian to �a].].o�a for proper re��ie�� of L-he proposed stxucturc and oi the
construction site-I �
1� Certificate � of urvel of the lot, shoc,�ing the lo�zti.on oi' tiie foundation once S.t
has Ueen coi�s�nic ed �.*ill be required bef.are pr.oceedinq with the iraminq.
�.L�T I F� GpTE OF Q�GUPII(�CY . '
' X►Pp].icat�on �or a Cer�ificate oi' OceuZ�ancy sha1.1 k�e mad;� ten (10) da�►s prior io the
tise ar accuFsncy L an}� sti�c�.ure for �aliich a�.iuilcling permit l.as been xssued; and
s�iid struct:ure slz -1J. iiot l�e used az- occupied uiiti�. a Ceri:S.ticzte of Oceui�zncy has
becn xssucd. �
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City of Fridley 16 39 2
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
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� ' COMMUNITY DEVELOPMENT DIV. • , � Q �
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r � � PRO7ECTIVE INSPECTION SEC. ��
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� /��'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�"""� � �'� 612-571-3450 910-F15 / /
9/16/81
JOB ADDRESS 75O1 E33't R7.VP.1 Road N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ].t� Aud. Sll�. #%7 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
James Pratt 7501 East River Rc�ad N.E. 574-1417
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS Z�P PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION �] ALTERATION ❑ REPAIR � MOVE ❑ REMOVE
8 DESCRIBE WORK
Install a I%arthstar free-standi fireplace (ICBO #2301�
9 CHANGEOFUSEFROM TO
STIPULAT�ONS
�EPERATE PER�4ITS �EQUtRE� ��� �a�a���,,
��4T1��iG, PLU(�IBlNG AIVD S1Giy��
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED 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 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 ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $9OO y�.JrO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS Of ANY OTHER STATE OR LOCAL LAW REGULATING CON- .�''] 6e OO -
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE �
$16.50
SiG ATUREOFCONTRA ORORAUTHORI2EDAGENT �DATEt WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
� �� �; - 9- � � - � � � � , � �
SIGNATU O OWNERtIFOWNERBUILDERI IDATEI BLDG INSP f7 E
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CITY Of� FRIOLCY Effective Aug. 1, 1981
APPLIC/1TIa'J FOl� RCSIDLi�1TIl�� QUILDIt1G PCfU�iITS
(tJe�•r, Alter.�tions, Addii:ions, or Repairs)
OI�tJER: � ��� � �i,-e.,,�
ADDP,ESS: �� v � ��3T �,, P � ��
TEL N0: �7�i — i�%�
QUI LDER : .� �, .� �
ADDRCSS:
TEL I�dO:
Construction Location
- ST7tt�T NO : ��D / STItEET: ��J ,(� � �Q )
LOT: . f � BLOCK : ADAITION : ��� ��,Q y • � rj �
Corner Lot: Insicle Lot: SetbacY.: Sideyards:
Ap�licant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
�� DESCRIPTIOid OF COt�STRUCTIOP�
�h� �c�
Front: Depth : Height:
Square.l'eet: Glibic Feet:
Front: Depth: Height:
Squaze� Feet: Ctibic I'eet:
t�� . F�.� . �� -� �o�- -
Type of Construction : �i v� f� l w c" e Estimated Cost: $ ( ��
Zb Be Oor,�pleted:
Alt. A Alt. B
Proposed Drive��ay Width Tf New Opening Is Desired: $� $
. . SE� REVERSE SIDE OF SiiEET
The undersigned hereby make� application for a perntit for the �:�ork� herein specified,
agreeinq to c?4 .all work i.n strict accordance r�ith the City of I'ridley Ordinances ��d
rulings of tlte Department of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
D.'�TE: �-c'o/°f �> ��� i SIGNATUF.E:
m'
Stipulations:
.
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B�USLDI1�iG PE�RN�IT F�EE SCHEDULE
The Inspector'of buildings shall, before issuing permits for the
erection of a�y building or structure, or for any addition to any
bxisting builc�ing or structure, or for any alteration or repairs
to any existing building or structure, upon application therefore,
require the p�yment by the applicant f or such permit of fees to the
amount herein below set forth and in the manner herein provided to-wit:
TOTAL VALUATIONI
$1.00 to $500.04
$501 t�o $2, 000 �
$2, 001 to $25, 0(�0
I
FEES
$10.00 Minimum Fee $15.00 plus surcharge
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
includinc� $2,000
$32.50 for the first $2,000 plus $6.00 for each
additional $�,000 or fraction thereof, to and
including $25,000
$25,001 to $50,�00 $170.50 for the first $25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000
550,001 to $100,i000 $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 arbd up $443.00 for the first $100, 000 plus $2. 50 for
� each. additional $1,000 or fraction thereof
, PLAN CHEQC: 25 I percent of building persnit fee
0
DRIVF�TAY DEPRES$ION ESCROW: Concrete Curb Streets Only
Alternate "A�': Removeal and replacement of curb and gutter only
Driveway width plus 6 feet x$13.50
Alternate "B1': Renoval and replacement of curb and gutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x$15.75
VERIFICATION OF FOUNIIATI�ON
Permits for con�truction will be issued a minimtua of 24 hours from the time of
application to �llow for proper review of the proposed structure and t�f the
construction si�e.
A Certificate� Suzvey of the lot, showing the location of the founda tion once it
has been cons cted will be required before proceeding with.the framing.
�� �
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sus�ecr PE . ' '�
City of Fridley _ 169
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
i � P .
� ; L _ ___ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � � �.0 �
� i �
� /"'1 � CITY HALL FRIOLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
!""'"� � ��� 612-571-3450 910-F15 3/24/83 � �
JOB ADDRESS
7501 East River Road
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �(4 AUCI. SUb. �77 SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
James R. Pratt 7501 East River Road N.E. 574-1417
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
��D4X SAME
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE IICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
residential
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑�( REMOVE
8 DESCRIBE WORK
Construct a 24 x 32 detached garage remove existing garage 12 x 23
9 CHANGE OP USE FROM TO
STIPULATIONS
r
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood frarr�
VENTILATING OR AIR CONDITIONING.
THIS PEFiMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED I$ 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 OFFSTHEET 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 ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 7�9� O. �iO 3.95
DOES NOT PRESUME TO GIVE AUTHOFiITY 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. G8. �JO
PLAN CHECKFEE TOTALFEE
72.45 _
SIGNATURE OF CON i RACTOR Ofi AUTHORIZED AGENT IDATEI ��PROP RLC' a(AjtJDATE HIS IS O�E IT
1�'�� �;3
GN UREOFOWNER�IFOWNERB ILDERI D T I �r� b�Dc G WSP DATE
0
CITY 0� fRI01CY Effective �u9. 1, 1981
APPLICATI��I fOR RESIOCNTI/l� BUlLOIpG PCRirl1TS
(Nc►,+. Alterations. Additions. or Re�airs)
O�INER: �.n;LCi �� c 0� �"t�e��
ADDP.FSS: ��� _� ��,� 7— � �,�
_ .________. �1�
TEL M0: E_ -�7 �—/ ��,� -
6UILOER: _ ���/In� � •
�
AODRLSS:
TEL N0:
� Construction Location
• STR1rT NOa �� 6TREET: � G�.aJC � t �_e��.. ��51
LOT: / � HIACK a �_`__ �1DDITION s - - � , `��. '� �/ r/
Corner Lot: ________ Znside Lots r Setback: �_ Sideyar!!s:
Ap�l3carrt attach to this form l�ao Certificates ef b1,�zvey of Iot aad
pzoposed buiiclir�g locatian drawn on certificaLes to scale.
OESCRIPT10i+! OF COh�STRUCTIO��
C.�c, ve� Q Front: 2� r Depths _�� r Aefqhts �.� /
� � Square Fc3et: � � � Q�bic Feeta
/�ldl� � _.
X� �� Fronta Depth: Heights
.���'-��°�- Square Fegt: A�bic reet:
' �
�YP� oi Corstzuctfa� a��,� v �,��,, 2.�..�,—
Rb Be Q�r.�pleted: S�� –I– p�j
, �l b>i°-��
Estimated Cost: s –
711t. A A1 t. 8
Proposed Drivc��ay �iiath If New Openinq Is Desited: S� S
-, . . 6EC REVER;E SIDz OF SHEET �
T;�e nndessi ned her maf;e3 a lic�tion for a •
9 �'Y PP permit for the woxk herein specified,
agr�eiag to �b ,all �ork ir, strict accordance With the City of Fridley Ozdinances tnd
zulings of the DePartmc�! of Duilaings, and hereby declares that all the facts and
:eprescv�tatfons state8 in this Application are true a�nd correct.
aasg: .� 2 3 sicr��►zv�:
Stipulations: � �
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BUILDIt�iG P�RMIT FEE SCHEDIILE
Tbe Inspectoz oi buildinqs shall, before issuiaq pezmits ios the
•z�etion of any buildiAg oz structnse, os ior aay additioa to any
�xiatiag bnildiaq or strvetnz�, oz ior any alteration or sepairs
to any �zistinq builainq os stsuctnse� npoa applicatioA thesefore,
=equis• the pay�ent by tbe applieant tor such permit oi �eea to the
asouat Stseia belov set fortb and in tbe �anaes hezeia psovidea to-wit:
. �.
7�OTT71L V1►LUP►TICN �S
:1.00 !rD :500.00
SSO1 to iZ,000
S2•001 tc ;25,000
525,001 to 550.000
i10.00 Minim� Fee 515.00 plus surcharge
;10.00 for Lhe first 550C plus 51.50 for each
a8ditional 5100•or fraction thereof, to aria
inclvdinq 52.000
532.50 foz the firzt 52•000 pius S6.00 for each
additional S1.000 or fraction th�eof, to and
ineluding 525, 000
5170.50 fos the first S25,000 plus 54.50 for
each additional S1,OOO oz fraction thereof, to
and including SS0,000
i50.001 to S1C0,000 ��83.00 ior the first SSO, 000 plus S3.00 for
each additioaal 51,000 oz fraction thezeof, to
and includiriq S100, 000
$100.001 and up 5443.00 foz the first 5100,000 plus 52.50 foz
�ach aaditional 51,000 oz fzaction thereof
PLAN C�ClCs 25 pezc�t of buiiding pe�cmit iee
DRIVt3+TAY DEPRESSIOTt ESQtOW: Cflncrete Q�zb Streets Cnly
111ternate "71": Removeal aria zeplacement cf curb ar�d qutter only ,
Driveway vidth plus 6 feet s 513.50
]1lternate "B"s Renoval ar�d zeplac�ne�►t of curb ar�8 quttez and install a 3 foct
wide approach vith 6 inch dept?�
Drive�.�ay width plva 6 ieet s 515.?S
VERyFICATION OF FOUNDATION
Permits foz constructios► rill be issued a minimuaa of 24 hours fro� the time of
application to allow for proper sevie�r of the propcsed structuze and of the
constru ction site.
11 Certificate of �nrey of the lot, sho��ing the location of the founcietion once 3t
has been oonstructed will be zequired before proceeding wit?� tbe framing.
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CHIMNEY AND_�STACR VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been�carefully examined Yes (+� No ()
2. Is free from rust or deterioration
3. Has no foreign objects lodged within
4. Is securely supported
5. Meets all current Code requirements for _
size and total BTU's connected
6. Has total heating BTU's of ,�';��rre�
Al l other BTU' s �or o 0 0
TOTAL BTU's Jf�
Remarks
Yes (d,J� No ( )
Yes ( ) No ( �
Yes ( d� No ( )
es �� No
Y (I O
List Alterations Beinq Done:
HEATING COMPANY
Signed By
N R Y CENTER =
1d5f15 . 91 �T ev� I�n ���
PLYMOUTH� MN 55�47
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City of Fridley
CONS�R��@PNo�WDi��4Il�JR g � I L D I N G P E R M I
i ,
� �
� `v �_���_ COMMUNITY DEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
�
� _ .
� �"'1 � CITY NALL FRIDLE� 53192 NU�rBER nEV D�TE
�----� • •', 612-571-3450 9t0•F/5 4/22/9
JOB AODRESS 7501 East River Road NE
t IEGAI �OT NO. BLOCK TRACT OR ADDITION
oescA. 14 Revised Aud. Sub. �i�'77
2 PROPERTY OWNER MAIL AODRESS
David Johnson 7501 East River Rd NE
3 CONTRACTOR MAII ADORESS
Loren Wolfe Construction 4110 Valley Industrial,
1 AfiCNITECT OR OESIGNER MAIL AODRESS
5 ENGINEER MAIL ADORESS
8 USE O: BUIl01NG
Residential
7 CLASS OF WOFiK
O NEW
8 DESCRIBE WORK
Reroof House &
9 CHAN(iE OF USE FROM
PAGE O�
� /
29272
�� ��
AVPNOVEO BY
SEE ATTACMED
SMEET
21P PMONE
571-1747
Z�P PNONE LICENSE NO
kopee MN 55379
ZIP PMONE LICENSE NO.
496-1906 4853
ZIP VHONE LICENSE NO
❑ ADDITION O ALTERATION �7 REPAIR
(30 Sq) Tear-off
TO
O MOVE O REMOVE
STIPULATIONS
Underlaym.ent must comply with the State Building Code.
CONSTRUCTION WORR HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TYPE OF CONST
SEPARATE PERMI7SARE REOUIRED FOR ELECTRICAL, PLUMBING, MEATIN(3,
VENTILATING OR Alp CONDITIONING
THIS PERMIT BECOMES NULL ANO VOID If WORK OR CONSTRUCTION 20NIN(3
AUTHOqIZED IS NOT COMMENCED WITHIN 80 DAYS, Ofl IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO FOR A PERIOD Of 120 DAYS AT
ANY TIME AFTER WOFiK IS COMMENCED. NO OWLG. UN
I MEREBY CERTIfV TNAT I NAVE READ ANO EXAMINEO THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS yp�UATION
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIED
WITM WHETNER SPECIFIED HEREIN OFi NOT. THE GflANTING OF A DERMIT �Z�S71
OOES NOT PRESUME TO GIVE AUTMOFIITY TO VIOLATE OR CANCEL THE pEqMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGUTATING CON• 74.75
STRUCTION OR 7NE PERFOFiMANCE OF CONST CTION �
/� / PLAN CNECK FE
X �%+�i /s,�4 �/'�-J Licens�
tUAEO�CON:AACiOp Op1UTN0 � AGENt IDAfE�
iO�TE� � -
SQ. f7
STALLS
$�q�VA
OCCUPANCVLOAD
CU FT.
EET PARKING
GAFAGES
1.29
Fi SC $2.57
'O A FEE
$83.6
I THIS IS � Pf��
`
NEW
ADDN
ALTER
[]
[l
[]
constructionAadress : _
Legal Description:
Owner Name & Address:
Contractor: �-� �
Address: � �� � li+
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
� � / ,� �J ` v-� �/' /�°�/
�i., �, i�� �li Gc S' �` �/ S� G�
Effective 1/1/99
" 1�
�� ��
� 'r}�� -
Tel. # �%% �%� %
MN LICENSE #
Tel.# �� � �r�D �
Attach to this application, � a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: ✓' e�0 �� lr�cc �r S C �-- � c� r� 5 �D `� /� r/
r
CO1LStrl1Ct10II T�: /��/) / ' �� EStllria� COSt: $ � � � �j
(Fee Schedule on Back) .
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$. _$
DATE: ���a ���PLICANT: a Tel. # �`�� — ���G
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park �ee
Sewer Main Charge
TOTAL
S1'IPULATIONS:
$ , ,� �
$ �� �%
$ �� 9
$
$ �-60
$
$
$
$.
�, � �
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 [ ]
r
BUII.DING PERNIIT FEE SCHEDULE
The Cluef 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 $2,000
$2,001 to $25,OU0
$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
FEES
$21 (Minunum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional$1,000
or fractic►n thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fracti��n thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1, 000 o�r fraction thereof, to and including $100, 000
$887.23 for first $100,000 plus $5.00 for each additional
$1,000 ��r fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1, 00�0 or fraction thereof, to and including $1, 000, 000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1, OOt� or fraction thereof
DRIVE�"VAY DEPRESSION ESCROW
(Cpncrete Curb Streets Only)
Alternate °A": Removal aud 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 deptY� - Driveway width plus 6 feet times $23.25.
VERI�'ICATION OF FOUNDATION
Permits for construction will be issued.a nninimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showu��; the �ocation of the foundation once it has it has been constructed
will be required before proceeding with t e framing.
._
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800 f�j 2I�.L002� ,Ll�t3 P��I SSSZ iSS Zi8 %d3 i�i � iT 311Z ZOOZ/SO/Ti
11/05/2002 TUE,11:14 FA% 812 551,2555 �CJ ENT MRROOTER
Nuu-�-�� ��:5�0 ��uM c,i i Y u� �kili� -ra
5512555 P.04✓04� QO7
r. �
THE BELOW Ml� 6E FILLED IN MMEN REPLACING FUEL BURNWC�� APPLIANCES OR THE
APPUCATION WILL 6E RETIJRN��
0
• u,u • � .��.y / � �t•. �I �[• � �, � �• �� _ � •�,, _ � : � �.
When rPQtaaiwo ���a�, the undersiqned hereby verifies th�t the
ve�ing has been e��tnined and is free from n�st,�deteriaration, obstiuucpor�s,
ahd is secur+ely supparted and firestoppesl where �requi�.
The vetttiu�g system is plastiic/PVC and meets all cwrrerlt codes and manuf�acxurer
specifira�ons including siaing, length, number of elbows and termination.
The undel�sigt�ed al�o verifies that the replacemeE�t unit is a listed assembly
and meets t�te c�n�nt codes and manufack�ue�s spea6cations. i'his daes
incJude �GA-GAM� Categary 1 Central Fumare VeMing Tables for fan
assi�ed and natura9 draft appliance.s. .
The e�c%stin�.���e ���� a�� is sized and instelled to meet the cu�rerrt c.odes
and manufacx�i'e�s specific�tiotls,
Wh@n 172QUIiEd �O in_�LI 9 eAw comb ctieh air itw�( be siled 8I1d inst811�d
to meet the curcent �odes and manufactur8rs specificatians.
Yes ( ;► Nc ( )
Yes( ) No( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes( ) No( )
When �� a�w vE►ntinA,�„�m, the undersign�d h�ereby verifles �hat
R is a fisted assemb{y and meets the current crodes and manufac�u�ers
spet�ficatians. T�is does in�lude AGA-GAMA Ca�ory I Cen6al Fumace
Ver�ing �abtes ier fan assiste� and natural dtaft appGances, Yes �) No ()
Is the cammon ve� and vent co�nectors sized atad insta(led carrectly a'�te�
an appliance has b�en remdved fc�om 4he c�mmon vent and vEr�ted
separately as per c�rent codes. Y�s () No ()
��li• . i v.- . - . � • I�- • n r. .�■ _.,� . ■ . - �I . { � - h(• �FC• i�i r i • �
Appfiance #1 Type BTU Input Fah As�isted or Nat
Appliance #2 Type BTU Input Fan As�is°ted or Nat
AppGance #3 Type BTIJ lnput Fan As�isted or Nat
Total AppGance� Total Btu Input
Cflmmon Vent Typv . Vent He�ght Diame�er,,,_,_ inc�es
App�[a�ce #1 Vent �onnect�or Me�ght ft Length ft D°rameter in Type
Appl'iance #!2 Ve.nt Conne�tor He�qhY ft� Leng#h ft Diameter in Type
Appliance �f3 Vent Connector Heigirt�ft Leyngth � Diame,t�er in Type �
� �•�, �. �•
F'IEA`I7NGi CO: •
Si9iled � .. Date :
TOTAL P.64
SuB�EGi �, .
City of Fridley 3391 � \�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� `v _ _ _ COMMUNITY DEVELOPMENT DIV. �� � �
r � � PROTECTIVE INSPECTION SEC.
� _ �
� �'��1 � CITY HALL FRIOLE� SS�3Z NUMBEi1 IIEV OATE PAGE OF AVPROVED BY
�'"""� � �'' 763-571-3450 910-F15 9 / 26 / 03 / /
10B ADDRESS 7501 East River Rd NE
t IEGAI �OT NO. BLOCK TRACT OR AODITION SEE ATTACHED
DESCR. j!} Revised Auditor's Sub. 4�77 SFIEET
2 PiiOPERTY OWNER MAIL ADDRESS ZIP PMONE
David Johnson 7501 East River Rd NE
3 CON7RACTOR MAIL ADDRESS Z�P PMONE LICENSE NO
Heiderscheid Bros. Construction 1532 164 Lane
4 ARCHITECT OR OESIGNER MAIL AOORESS LIP PMONE LICENSE NO.
20060354
5 ENGINEER MAIL AODiiESS 21P PNONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION O REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Remove and re lace 4 s of roofin • i t 1 ven 'ce el
9 CHANf3E OF USE FROM TO
STIPULATIONS Underlayment must c ply w���f�e��ate Building Code.
. P C � � C�G� � � c
� ��
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE fiE�UIRED FOR ELECTRICAI. PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTqUCTION 20NING SO. FT CU iT
AUTHOR12ED IS NOT COMMENCED WITHIN 60 DAYS. Op IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO POR A PER100 OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFfSTREET PARKING
I HEREBY CERTIFY 7HAT I HAVE READ ANO EXAMINEO THIS APPLICATION 1 STAILS GARAGES
ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISI S Of LAWS yp�UATION SUR7AX
AND ORDINANCES GOVERNING TNIS TVPE OF WOiiK WILL E OMPLIEO
WITH WHETMEF SPECIFI D ME F NOT. TME RANT OF PERMIT �LyOOO I.00
DOES NOT PRESUME GI A 7V O LA7E Fi CA CEL TME pEpMIT fEE SAC CHARGE
PROVI NS OF ANV OTM ST CA AW UTATNG CON-
T I OR TRE ERF R NST C 10 a $69.25 Fire aSC �2.��
�J N CNECK FEE TOiAL FEE
cens SC $5.00 $77.25
5 4TUAEOFCON'�7ACTOpO u MOAiZEDaGEtiT iO�7E� - EN PpOPERLY VALIpATED THIS IS YOUR PE MIT
� {.� �
% S�GN4TUAE O� OWNEp��f OWNEpBURDENi �OAIE� 6�NS� p6 E
NEW
ADDN
ALTER
�� CITY OF FRIDLEY Effedive 1/1/2003
[] 6431 University Ave NE� Fridiey, MN 55432 (763) 572-3604 Bldg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: �✓'�l � � � 1
Legai Description:
Owner Name & Address:
T �� � Tel. #
Contractor. � �� � �� ° �� �S ° MN UCENSE # ����s l
e ��ro��• I� � 1)� ��� �1J � � C.ei � � - � Tel. # �,�� �lpo�—��v �J
LIVING AREA:
GARAGE AREA:
Attach to this appiication, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
DECK AREA: Length � Width HgUGro nd Sq. F.
� � � �` ��(�C�J
OTHER: - .
� �� �
Construction Type: � Estimated Cost: $ ,
Driveway Curb Cut Width Needed: Ft. + 6 Ft =
DATE: °��� ��� APPLICANT: _�o�G'�''
Tel. # d- �� "��°��
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763�71-1287 if using credit card and we will
call vou for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Cur�b Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
(� ^
$ %��
$ � ad
$ /-DO
$
$ ��v�
$
$
$
$
$ , �S"
CITY USE ONLY -
� �
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 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 [ ]
--- . ,
�
BUILDING PERI�IIT 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 $2,000
$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
FEES
�23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
�69.25 for first $2,(}00 plus $14.00 for each additional $1,000
or fraction the�eof, 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 $500,000
$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
$5,608.75 for the first $1,000,000 plus $3.15 for each addidonal
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate.
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. �
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
A