AF - 41645�ne, 13�3�
N_ - - 6 21
� CITY O� FRIDLEY
�
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 lin�. _ n
Address 1_3 � -5 .la���-v7� [�%�
Ovvner �,�5� �–�
Plumber ��./�,.�:��s_. �.�l�l�✓�.�
CHARGES TO BE PAID BEFORE TAP IS MADE — WHERE
ASSESSMENT HAS NOT BEEN LEVIED AGAINST PROPERTY
II) Water & sewer connection permit must be registered before this Tapping
Permit can be issued.
City supplies all material aad 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: Ma.terials Used: $
Street Patch: x . $
TOTAL: $
u
SEWER TAP: Street Patch �����: $ �� � �
III) If this property has not paid a full Lateral Charge for its share of the
water and sewer system, additional chazges 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: $
Sewer Lateral: $
TOTAL ASSESSMENT: $ '—
Clerks Signature � �
Supt. of Public Works
M/P 3/76 White P.W. Canary Finance Ptnk Prop. Owner Goldenrod Plumber
i
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�
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�
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� • COMMUNITY DEVELOPMENT DIV.
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r � � PROTECTIVE INSPECTION SEC.
1 �
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L-___� ��"" �`� CITY HALL FRIDLEY 55432 NUMBER Rev DATE
i 612-571-3450 910-F15 7/3/84
JOB ADDRESS '7325�27 EVP.i't COtlr't N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 3 1 Evert's Additi.on
2 PROPERTYOWNER MAILADDRESS
Star Homes, LTD 7691 Cent�al Avenue N.E., Fridley
3 CONTRACTOR MAILADDRESS
S31lle
4 ARCHITECTORDESIGNER
5 ENGINEER
8 USE OF BUILDING
Residential
7 CLASS OF WORK
MAIL ADDRESS
MAIL ADDRESS
NEW ❑ ADDITION
8 DESCRIBE WORK
Construct a 38' x �14'
9 CHANGE OF USE FROM
PAGE OF
� �
��17593
CEIPT NO.
� t�
/ � 7 ���
APPROVED BY
SEE ATTACHED
SHEET
21P PHONE
�ao-55oo ���r`'°°��
ZIP PHONE LICENSE NO.
21P
t1.� CIiY pE, ��� �
f'i!~� 4�1� IS �p�W�� D�•�
r�f�a'a''; -- '�V�Ri
�+ r�� sr� � �u
❑ ALTERATION ❑ REPAIF
TO
1 � Aet
E LICENSE NO.
�.,�,n,�� ,�ran �i�v�n- ���`
� t� o�rcr �:��:�.
W��MA?ltl�a�
❑ MOVE � REMOVE
STIPULATIONS provide a hard surface driveway. Provide sod in the front and side
yards. Provide City with.copy of verifying survey before capping.
SEWER LOCATION: (Approx. i�l' Deep In Street� Approx. 60' S. of San. M.H.
(�nv. 886.00)
WYE ELEV: 885.76 TOP OF FQOTING: 889.26
WATER LOCATIQN: 52.7' 5.5.E. of 5t. M.H. 46.6' N. of Fence Corner
VVAR�tiHG
Befo�� �i��,�g call local utili►ies �EpERAT� PERMIT5 ftEQUIFtEa FOR WIRING,
TELE�� • ELECTRIC - GAS �tc.
��QI��RED �Y lAV1r �EATtNG. PL�MBING ANi� SIGNS.
... --• --•--�• ---
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ.
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
PANCY GROUP � OCCUPANCY LOAD
I HEREBV CERTIFY THAT-_I HAVE READ AND EXAMINED THIS APPLICATION 2 STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 921900
DOES NOT PRESUME TO G�VE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
T CTION OFi THE PERFORMANCE OF CONSTRUCTION. � S�-2•OO
PLAN CHECK FEE
- $103.00
SIG TUREOFCONTRACTORORAUTNORI2EDAGENT fDATEI WHEN PROPERLY V
�
�- - ,
SfGNATURE OF OWNER tlF OWNER BUILDERi IDATEI 9LOG iNSP
CU.FT.
OFFSTREET PARKING
IGARAGES
RTAX
$46.45
C CHARGE
$850.00
TAL FEE
$1,411.45
'HIS IS YOUR PERMIT -
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- l SUOURd� G i[NIp�O", INC.
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ADDN. [ ]
pLTER. [ 7
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City of Fridley
�R-1 AHD R-2
Building Permit Applicatioa
Effective 4/1/8u
Construction Address: �� ��' � �° `� r �
Legal Desaription. �, � '�' 3 , '�3 L� � t� f � .� �/'�Cr��s ��-- � d � a-- �° o �i
owner Name & Address : � `�1' /�v �`°, 2� , L �- � , ' Tel . # ��o �:,.-� v
Contraetor : s � �, � / /�-c ^-, �� o` �, a-� z. � o �. � �r � 2� � v�-, 1. � � Tel . # _ 1��'�"'J f"-o �
Addresa: 7 ei % l G2Ll �Z,� ���aL �r/'-� �tr��'.
Attach to this application, a Certifieate of Survey of the
. lot, with the proposed construction drawn on it to seale.
� d✓�L�v M�h� ✓ DESCBIPTION OF IMPaOVSMENT
LIVING AREA: Length .�e� width ��/ Height Sq. Ft.
(iARAGE AREA: Length 1.� Width `�' �✓` Height %o Sq. Ft. �� °
DECg AREA: Length � Width �� Hgt/Ground Sq. Ft.
OTHER:
Corner Lot [] Inside Lot [� Ft. Yd. 5etback ��J � Side Yard Setbaek ��
Type of Construetion: %'V'�r�'" � Estimated Cost: $
-:_- �
Approx. Completion Date: � `� �' �� "�'� �� ���� � ����
� Alt. A Alt B
r i
Progosed Driveway Width If New Opening Is Desired: �� � �- " $
See Back Page for Explanation
� -Z`i�''�'� 1_� �^�GC-°►.-� Tel. � ���1J^��oc�
DATE: APPLICANT: , ��
Permit Fee
Plan Cheek
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAL
STIPOLATIONS:
CITY IISE ONLY
� �, � ��
$ I b�•�
$ �'4.�
$ �1�%•oCi
$ 1"'�
$ ,s'�
$ l�
P��4 �'�'�`
Fee Schedule on Reverse Side
25� of Building Permit Fee
$•50/$1,000 Valuation
$�F25 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Neeessary [ ]
�, , e
1►-0
BIIII.DING PERMIT FIs'E SCSBDIILE
The Chief Building Official shall, before issuing permits for the erection of any
building or structure, or for any addition to anq euistiag building or structure, or
for aaq alteration or repair to any existing building or strueture, upoa applicatio n
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 Valuation
�1.00 to $500.00
Feea
$10.00 (Minimum Fee is �15.00)
�
r
�501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional �100 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 each
additional $1,000 or fraetion thereof, to and
including $25,000.
$25,001.00 to $50,000.00
550,001.00 to $100�000.00
$100,001.00 and up
$170.50 for the first
additional $1,000 or
ineluding �50,000.
$283.00 for the first
additional $1 , 000 or
including $100,000.
$25,000 plus $4.50 for each
fraetion thereof� to and
$50,000 plus $3.00 for each
fraetion thereof, to and
$433•00 for the first $100,000 plus $2.50 for each
additional $1�000 or fraction thereof. `
DRIVEfiAY DEPRF.SSION 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 replaeement of curb and gutter and install a 3 foot wide
approaQh With 6 inch depth - DriveWay vidth �plus 6 feet times �15.75
9ERIFICATION OF' FOUNDATION
Permits for construction Will be issued a minimum oP 24 hours from the time of
application to allow for proper revieW of the proposed structure and of the
eonatruction site.
A Certificate of Survey of the lot, shoWing the location of the Poundation onee it
has been eonstrueted Will be required before proceeding with the framing.
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� c EAT LOSS CALCULATION °�EMP. DIFF.. � a
� Cuaom�r Name Typ� Conrt�uctan �
a City Windowt Stam Sath
h OMI�r N�me . yy���� _ ��q.
StrMt . Gilinq Im.
Cit�r .�60 . Fbor ' .
FI.� Room I Length Width Hi t FI.I oom� L h Width FN
Win�iow: and Door:—Crackage and Area Windowr and Ooors—G�dc�ps snd Arn
' No W�dth N�ront No. of LinNl /t Arp NIWtA Iqf�ht `o. p L� I It. p►M
n1 p� ol p�M L M� OI e►Kk p. h. No. �
�- �
Coef. BtU Co�f. 8tu
Inf�ltration � Infiltration
Glass /�p Glm
Exp. wall' -Exp. wali
Net exp. wall Net exp. wall
Int. wall � Int. wall
Ceili� Ceiling �
F loor F loor
Total Btu. Total Btu.
F1.1 ` Room�Langth Width He' t FI.� Room�L h Width � H' t
Windows and Duors—Cradcage x�d Ara Wirxbws and Doors—Gadcpe md Ara
wo w�e�� H.�o�� No. or ��n� n. wn. No. w�arn ��� Ne. m uwr� h. w.«
Of aia o1 l Ot q- 1t• OI M 01 M L b 01 er�elt . h.
Co�f. etu Co�f, 6ty
Inliltration Infiltntion
Glaa Gl�st
Exp. wsll Exp. wall
Net exp. wall Net exp, wdl
Int. wall " Int. wall
Ceilmg Ceiling
F lorn F loor
Teta1 Btu. Total 8tu. �
FI.) T mIL h Width ID ' t FI.� Room�L Width
W�rnk�ws arnf oors—Gackage and ArM Windows and Doaf—Gaek� and ArN
W�dM � H�pAt No. 01 �uwl H. Arp IM�eM Ib1�M No. M �qrN It. A�M
Nr� n/ ta�r n1 Mne l K 01 C►�CM �0- h• No. p� 01 N h
���� �
�
co.�. st� . co.f. ea
Ini�ltrat�on Infik►ation
Guss Glas �
Exp. w�11 Exp. wall
N�t �xp. wsll Nat �xp. wall
Int. wall ' Int. wsll
Ceih^9 0? � � , Ceilirq
Flonr . floor
Total 9tu. _ � � Tonl Btu. � �
G
�
' " � " HEAT LOSS CALCULATION ° �EMP. DiFF.. � � � .
Customw Nsme T1►D� Con�uetan �
City Wir�lows Storm S�t�h
DMI�rName_D�nanAahla Naatin4 AnA Air Cnnrlitio in yj����s _ ��q,
StrMt 2�1� r��_Bapids_8,lv,d.. Gilinp Im.
Cit�r �es.x��a�.irl-s—�i $8�5►33 Floa �
FI.� Room � Length Width o? Hi t FI.� Room � L h WidM i�N
Winfiows and Doors—Craekage and Arss Windows and Doort—Gaekp� and Ara
No W�atH M��qnt No. of LinMl h. A►M wiWl► M�i�M NO. M LIMN It. ArN
! o� p� o� p L nb ot enet No• p� n� O/ rM L a M �0. N.
I �
Glsu
Exp. wall�
Net exp, wall
Int. wall
Ceiling
Floor
Total Btu.
` F1.1 '
Windows
No W'AM
ot ra
�/
Infiltration
Glaa
Exp, wall
Nrt exp. wal�
Int. wall
Ceihng
Flocx
etu �_
Infiltration
G laa
Exp, wsll
Net exp, wsll
�Int. wall
p Ceiling
F loor
� Width H�i ht
and Arp D
wl H. An� �J
eneM �4. h. � � ! /
���
CO!}. BtU
Tetal Btu.
F 1.1 Room I Length Wi
W�ruk�ws anrf Doors—Crackage and A►r
N� W�A�h . H�ptit No. 0/ L�wrl ft. I
�� n..r M �.ne L n oler�at r
Iniiltratwn
G Ia�s
Exp. wa11
N�t txp. wsll
Int. wa11
Ceiling
Florx
Tobl9tu. _
8tu I
I� Total Btu.
FI.� Room�Luqth Width
Windows and Door�—Gackap� md ArM
No. o� M M�M L� b O�h. A h.
Infiltration
Glaa
Ezp. wsll
Net exp, wdl
Int. wall
Ceiling �
Floor
Total 8tu.
FI.I RornnlLwqth WidM
Winduw: n�d Doo►s—Cradu� and An�
Ne. ��et� � ipn Lo. d � N. A M
Inf ihnt�on •
Glas
Exp, wNl
Nat exp. wall
Int. wall
Gilirq
Fbor
Tot�l Btu.
Btu
0[Y
Btu
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L'• f` �' ' 1- � R'
5571 E. BAVARIAN PASS • FRIDLEY, MN 55432
� e
City of Fridley
AT THE TOP OF TME TWINS
r
i �
� `v �����_ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
�
� � .
L_---� ��•" �'� CITY NAII FRIOLEv S,SIJ2
t 612-571-3450
JOB ADDRESS �325 - 7327 Evert C t
1 LEGAL �OTNO. BLOCK TRAC'
oesca. 3 1 Eve
2 PROPERTY OWNER MAIL AOORESS
3 CONTRACTOR MAIL AODRESS
Owner
0 ARCh11TECT OR DESIGNER MAIL ADDRESS
SuB�Eti
�U ILDING PERMIT�
iBEp NEV OATE VAGE OF
s�aF�s 6/7/99 / /
Oii ADDITION
�i. 1.. ll J J
PNONE
PMONE
5 ENGINEER MAIL ADOFiESS ZIP PMONE
8 USE Of BUILOIN(3
Residential
7 CLASS OF WORK
ERMIT NO. �
29631
����
ACPROVEO BY
SEE ATTACNEO
SHEET
LICENSE NO
LICENSE NO
LICENSE NO
O NEW ❑ ADDITION ❑ ALTERATION �X REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (26 Sq) Tear-off; Reside West only; 4 Windows,
Bedrooms meet egress; Remove deck from both units
9 CHAN(3E OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
Call for bui.lding wrap inspection before covering.
Install smoke detectors to meet the State Building Code - in each
sleeping room and on each level of the house.
SEPARA7E PERMITS AiiE RE�UIqEO fOp ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST
VENTILATING Oq AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING
AUTHOR12E0 IS NOT COMMENCED WITHIN 80 OAYS, OR IF CONSTpUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PER100 OF 120 DAYS A7
ANV TIME AFTER WOflK IS COMMENCED NO DWIG. UNI
I MEREBY CERTIFY TMAT I HAVE READ AND EXAMINEO THIS APPLICATION
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PpOVIS10NS OF LAWS yALUATION
AND ORDINANCES GOVERNING TMIS TYPE Of WORK WI�L BE COMPLIED
WITM WHETHEii SPECIFIEO MEREIN OR NOT. TME GRANTING OF A PERMIT �4'Z7Z
DOES N07 PRESUME TO GIVE AUTMOq17Y TO VIOLATE OR CANCEL TNE pEFMIT FEE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGUTATtNG CON-
STRUC710N OF THE PERFORMANCE OF CONSTRUCTION $111.Z�J
$�GNGTUAE OF
A �
T �DaiE�
� ���0�!
OGCUPANCYGROUP OCCUPANCV
SQ. FT CU FT.
OfFS?REET PARKING
STALLS IGARAGES
�z.a9
SAC CM
Fir
TOT FE
4.17
.51
�/ ��'
�t r
ADDN
��
Effective 5/10/99
I l CrrY OF �'RID�Y
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R 2
BUII.,DING PERMIT APPLICATION
� Construction Address:
Lega1 Description:
0
0
�\
�� ��
�- ��
� Owner Name & Address: �� �e�A�- r.� ( �� a 1 � 7 3;� � �� �� ,�. �_ Tel. # �„ j'� ` � ��" 06 �' 6i
X Contractor: MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECB AREA:
� OTI�R:
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPRO`�MENT
�
' Len�th �� �� �� _. Width Height- � e �., �' Sq. Ft. � �'`''° `Na
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
� �--��,�— (P�'�J�� �6 �c � o��n _ �I� � �� - i� �
�
c,�.,� �h
Construction Type:�;�, ;�', y
�`<� �
-�
���� ��c��
Driveway C�rb Cut Width Needed: Ft. + 6 Ft =
� � ��' � � (.@��' �o��- ��p �'��nS
��sti� ��� ���
ma Cost: $ � v��� � _ � f�-
��'-� �- �.-� ... n
Ft x $ _ $ . f `�
�
DATE: _ �° � �% APPLICANT: � Tel. #'
CITY USE ONLY i�' °?� �
� �fll� 1. � �
Fermit Fee $ �� � Fee Schedule on Reverse Side
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS;
$ �+ r r
,
$ . Cg
$
$
$
$
$
$
� llr.
.001 of Permit Valua.tion (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 [ J
l ��
�
- ' �
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 providerl to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,�0
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,0(�
$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,OQ0 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 additional
$1,OOU or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "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 $23.25.
YERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for p�oper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has b�n �o��cg�. vvill
be required before proceeding with the framing.
_ �
- � ' � � SuBJECT � �
City of Fridley
AT THE TOP OF TNE TWINS g � � L D I N G P E R M I T
;,
,�
� ; � __��� COMMUNITY DEVELOPM�NT DIV.
r � � PROTECTIVE INSPECTION SEC.
� . ,
i--_.�� "' �'� CITY FIALL FRIDLE� 'SS' 132 NuMeEA RI
t 612-571-3450 g10-F15
JOB ADORESS �325-27 Evert Court NE
t LEGAI �OT NO. BIOCK TRACT OR AODITION
oescA. 3 1 Evert's Addition
2 PROPERTY OWNER MAIL ADpR�S$
Michael Gile
3 CONTRACTOH MAIL ADDRESS
Owner
A AFCMITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAII ADDRESS
8 USE OF BUILOING
Residential -.Double bim�alow
7 CLASS OF WORK
10/13/99
21P
vAGE Oi
� �
PMONE
PHONE
�0390
o.
�"� ��
�oPAOVEO er
SEE ATTACHED
SNEET
LICENSE NO
LICENSE NO
LICENSE NO
❑ NEW ❑ ADDITION O ALTERATION � REPAIR O MOVE O REMOVE
8 OESCRIBE WOFiK
__ Replace Z windows and 2 slidin� doors (one in each unit of double bi.m�alow
9 CHAN(3E OF USE FROM
TO
STIPULATIONS '
Provide smoke detectors in all sleeping rooms and on all levels of the house.
SEPARATE PERMITS AqE REOUIRED FOR ELECTRICAL, PlUM81NG, HEATING, TYPE OF CpNST.
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL ANO VOIO IF WOF;K OR CONSTRUCTION 20NING
AUTMORIZED IS NOT COMMENCED VyIITHIN 60 DAYS. Op IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AF7ER WOqK IS COMMENCED. NO. DWLG. UNITS
I HEREBV CERTIFY THAT I NAVE READ AND EXAM�N�O TMIS APP�ICA710N
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS Of LAW$ yqLUATtON
ANO ORDINANCES GOVERNING TMIS TYPE OF WpRK WIIL �E COMP�IED
WITH WMETMER SPECIf1ED MEREIN OR NOT. TME GRANTING OF A PERMIT �3000
DOES N07 PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEI THE pEqMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL lAW qEGUTATING CON-
STqUCTION OR TNE PERFORMANCE OF CONSTRUCTION .�53. LS
P�AN CMECK FEE
S�GN4TU�7EOF •RACTOp N TM EQ (�i NT I��TEI EN R(
� o � �� 1
_ S�GNATUAE O� OWNEA ��� OWNEp BU�LOEAi 101ii� � ._ ..� .
F7
STA�LS
ROUP OCCUPANCYLOAD
CU FT.
OfFSTiiEET PAqKING
IGARAGES
$1.50
iAC CMARGE
Fir SC $3.00
'OT FEE
. 75
r TNIS is r ua a�ir
� �
q6�E
� [ ] �T Effective 5/10/99
ADDN [ ] CITY OF FRIDLEY (�O
ALTER [�J SINGLE FAMII�Y AND DUPLEXES R-1 AND R 2 %j
BUII,DING PERNIIT APPLICATION b ' `��
� % � V�
• ( c �Q
Construction Address: � 3�� � e 9�2�`r C`�
Legal Description:
Owner Name & Address: � ; � A e � � ; � -2 Tel. # � )� 7�b'/� � %
Contractor: �j .� � MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECS AREA:
OTHER:
Construcdon Type:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length Width
Length Width
Length Width
��c� g � �..� � �!
Tel. #
Height Sq. Ft.
Height Sq. Ft.
H Ground Sq. Ft.
► a c,e� s.ss _ 1 � 1;cJl �� 1�,�
�� i -
Estimated Cost: $ _ � � r, �, .
c�
Driveway Cbrb Cut Width Needed: Ft. + 6 Ft = Ft x$
_$ �
DATE: 1 � < � APPLICANT: � Tel. #� � d ° 7 �� ��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPLTI,ATIONS:
$ �3,�2 S..
$ � �o
$ l ��
$
$
$
$
$
$
�
$ �
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 $2,000
$2,001 to $25,000
$25,OOlto $50,000
$50,001 to $100,000
$1�,001 to $500,000
$500,001 to $1,000,000
$1,000,�1 and up
FEES
$23.50
$23 .50 for first $500 plus $3 .OS for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,�0 plus $14.Q0 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,Q00 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 ea.ch additional
$1,OOU or fraction thereof, to and including $1,(�0,000
$5,608.75 for the first $1,000,000 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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certifica.te of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing.
_i
� � � � SuB�HCT - ' � .
City of Fridle� 2697
�
AT TME TOP OF THE TWINS g u I L D I N� P E R M I T
; � R T NO.
� ; y _�___ COMMUNITY DEVELOPNIENT DIV. /
r � � PqOTECTIVE INSPECTION SEC. � ( /7
� � , ��
i---. A ��'��,'� CITY MALL FRIOLEV 'Sj132 NUMBEN REV OAT@ PAGE O� APpROVED BY
L " 612-571-3460 910-F15 6/14/02 / /
J08 ADDRESS 7325-7327 Evert Court NE
t IEGAL ��T NO. 9LOCK TRACT Ofi ADOITION SEE ATTACHED
oescR. 3 1 Evert's Addition SHEET
2 PROPERTY OWNEii MAIL AODRQS$ 21P PMONE
Michael Gile 7325 Evert Court NE 763-780-1607
3 CONTRACTOR FAAIL ADDRESS 21P PHONE IICENSE NO
Same
4 ARCMITECT OR DESIGNER MAIL ADDRESS 21P PNONE LICENSE NO.
5 ENGINEER MAII AODfiESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOqK
❑ NEW O ADDITION O ALTERATION �J REPAIR O MOVE ; O REMOVE
8 DESCRIBE WORK
Construct d 41'6" x 10' Deck; two window replacements; two sliding glass doors;
res ng; so an r
9 CHANGE Of USE FiiOM TO
STIPULATIONS See notations on plan.
Provide smoke detectors in all sleeping rooms and on all levels of the dwel�ing
per Sectio�. 310.9.1.2 of the 1997 Uniform Bui�.ding Code.
TYPE OFCONST. OCCUPANCVGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE FiEOUIRED fOR ELECTIi1CAL, PLUMBING, MEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WOiiK Oq CONSTRUCTION ZONING SO. FT CU FT.
AUTHORIZED IS NOT COMMENCEO Y�1ITHIN 60 DAYS. Oii IF CONSiRUCTION
OR WORK IS SUSPENDEO OR ABANQONED FOii A PERIOD OF 120 OAYS A7 '
ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UNITS OFFSTREE7 PARKING
1 HEREBV CERTIfV THAT I MAVE REAO AND EXAIy�1NED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TiiUE AND CORRECT. ALL PROVISIONS Of LAW$ yp�UATION SUFiTAX
AND ORDINANCES GOVERNING TNIS TYPE OF WOFK WILL BE CpMPUED @
WITH WHETMER SPECIFIEO MEpE1N OR NOT. TME GRANTING OF A PERMIT WiZ�934 $6.1F7
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL TME pEqMIT FEE SAC CHARGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGULATING CON- @
STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION y�Z23.2S Fir SC �IL.93
PLAN CMECK FEE TOT ' FEE
42.65
S�GNATU 0� ON'aAC Rn T RIIE GENT IDaTE�
� � EN ROP VALID 7 MIS IS VOUp PER �
t � � � ��
S�GaoTUaEO�OWaEa��FOWNEABUiLOEN� �OATEi � ' BLD �NSo � patE
NEW
ADDN
ALTER
Il
��
�
L�
Construction Address:
Legal Description:
CITY OF FRIDLEY Effective 1/12002
6431 University Ave NE, Fridley, MN 55432 (763) 572�604 Bidg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
" � �
�� }°_ r� •P/' '1' C' cx>rTT ! . � ��v _ J"�a�
OwnerNameBAddress: Ir�;��,�.�cl ��,: �-P,, 73�J���cP-�e-� Tel.#'7��-7 O�I�O`�
Contractor. _�P}� MN UCENSE #
Address: Tel. # �
Attach to this application, a Certificate of Survey of the � `
lot, with the proposed construction drawn on it to scale. ����
?�,c,p� l 1���
DESCRIPTION OF Il�jl_PROVEMENT�(��,���eJ� ��S ���' C>
`� ,.
�.��� ��`�� � �>��� �:���
LNING AREA: Length Width He : t Sq. Ft l�� �
GARAGE AREA: Length eight Sq. Ft -� _
DECK AREA: Length !�'` dth b` HgUGround � Sq. Ft �A��
OTHER: �J � 5 � _ � P � D — --
S� �ti� S��-�.� .�`T'e�� cAi@`'�� - _ —
_,.� ,
Construction Type: Estimated Cost $- � �o� g3�/
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
<
DATE: ' D � °� � APPLICANT: Tel. #�� 3 � % �a" �6 D %
Call (763) 572-3604 for PeRnit Fees if mailing in application or Fax to 763-571-1287 if using credit card a�d we will
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY -
$ o �3, ��
$
$ � - `� �
$
$
$
$
$
$
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1 �000 Valuation
$1200 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 [ ]
TOTAL $ �� 70� ` �%� STIPULATIONS:
BUII.DING 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, 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 $5�
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1Q0,000
$100,�1 to $500,000
$500,001 to $1,000,000
FEES
$23.50
$23.50 for first $5� plus $3.05 for each additional $1(m or
fraction thereof, to and including $2,000
$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,Q00
$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
$1,000,001 and up $5,608.75 for the first $1,0OO,OQO plus $3.15 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet-�imes $17.00.
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 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 constructed will be
required before proceeding with the framing. New Houses Onlv
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