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AF - 42020Irp ��1 t � � � G-Z. _.� � � � �� ' 0 � � `{�-f �;� �� #..� ��`�� .ACv�n��i'�I�� -_��i;�r•�� n �•�.. � � _-! �c- ;a� 2825 H{4RRIET AVE. `°' � t�IIdNEAPOLIS. PAINNESOYA �;4l1D. � � 187y � +� �+ ��I ��OQ� €� � �� '��' For ANDY GAWEL - - �7'2 , 5' _ . �, `-6ft Utility apra�nage E'as�men�` ,� .►ron � � �---- t � r �,� �_. � ---' • ` � o cyl m �; a, � � : • ;� 57, 0 � � � �UII.��NC �m N (FOUNDA7'IOA1 ONL`j� m 43.42 . o � I3.55 �,� N � � � , � �ron l � � �� t�i � _� I ---- '72.5 � � � � i �Ir � €;.; ;� i; 000 $Ce 0 C� : 1'� - 3O 1 DESCR9PTtON: Lo� 6, B6ock 1, SHADY OA6C MANOR, /�� ,� � M � o/ � . _ � Founda�oon located this lOfh day a� JuOy, 1973, '�e hereby cerfify that this is a 4rue ae�d correct representa48on ofi a survey oi the boundaries of Yhe Band above described and of the loca�ion of �ii building� if any, fhereon, end all visibl� encroachment�, if any, ¢rom o� on said Isnd, �ated this 304h day of �a� ;��3 . EGAN, ELO & G�i AK , urveyor '' i � f No 5299 Qook No �010 - 12 bY :,�, ,, �/, 2009 - 17 . :� . City of Fridley aT TM� TOP OP rNt TNriNY ---�__, coMwtN�iTr oev��.o�eNT o�v, i MOT�CTIVR Nf�CTIpt� OtK r---` i CITr ►iAI.L iA101.�r �Mt .� N�-sso-s�so aaaress �� .��' �C-�+Q � S� i er � , C� �4 �� L— tractor fl ( �l$d� 1 Lb� d of Building _ �v/N�, L � '�Al+.i1L� p etion Date r�/� s/� -� ��W� + J W C — ;�I� n aoNVal sro •�aavl avo •xi�� i __... i •eaai �'MNIYtl m w 9NISY9 I % H�lv� I i0 � 9Nrvaa ° aoo,.� i� o ;p � I Stl3MON$ �O � I�q '1Nt10d � tl ,� HN�elO IA (� BArlll MSYM I � s�Nre rN�w■I � sani rotva 1YN11111) taso�q �st�M � ` v � II ( i� I � � -- -- � i I I ' �' i ` i � I m �' I I _ ` � i_� i I i ; � � i � j I i ( � I I � -- i I II w ' I I 'a I( � I . , � � I W I � a� I � � � I �� I I � � Y � � � � � PLU�1BIiVr, PERPIIT APPLICATIt�id -� � ��p� ��, � DailR:�:�t��I�7rL�� : � � sa aaress Phone , — �D �i Ps� 7 �'��5� .� .S" se �r:s�ima�ea cosc ---- -- -- ___.... Plumbing Fixture Rates: NO• RATE TOTAL Number Fixtures / x $2.00 /�'.DO Future Fixtures x $1.50 New Fixture-Old Open. x $1.50 . �^— Catch Basfn x $3.25 Water Heater-99,000 BTU / x$3.00 d.0 C Ground Run Old Bldg. x$3.25 E1ec. Water Heater x $2.00 ._......_ Gas Fitting Faes: 1at. 3 Fixtures / x$2.00 �d, c� �.� ��._.� ��..� Additional Fixtures x $ .75 Gas Range-199,000 BTU x $5.00 Repairs � Alterationa See Deacription; Code State Surchar�e �50 I ITOTAL FEE $ o?� � C) !The undereigned hereby makea application for a permit fox �he wo�k herein apecified� agreeing to do all work in atrict acco�dance w ith the City Ordiaances and ruli� of the Depaztment of �uild;ingei and hereby declare that a11'the �acta and xepre�senCatione atated in ie applica ion are true orrect. � 'Signature ate � /�� : �I FJ . City of Fridley r 4T TME TOP OR TME TMiINO , i` . r �-L-------, cwuan+irr oevc�Nr c�v, � '1 � MOTtCTwq ws�cT10N Ot►'r. i p--- � CiTr NALL �IUO�R� �MR �.._�11.� �.� N��sso-a�s0 1573 N. E. Ferndale Street T. Chausen ontractor ind of Building omp etion Date ��;+ I I i MINNEGASC� Frame 10-26-73 1 , � I� �' �� 53-84-879.01 EGT PLUMBI�Vr, PERf1IT APPLICATI�� s aaress p 73� MARQUETTE AVENl1E se Mp�. MINN. Res. ' stimate os one � ��i� � � _ . io, o0 Plumbing Fixture Rates; N0. RATE TOTAL Number Fix tures x $2.00 �_ Future Fixtures x $1.50 New Fixture-Old Open. x $1.50 Catch Bastn x $3.25 Water Heater-99,000 BTU x $3.00 Ground Run Old Bldg. x$3.25 Elec. Water Heater x $2.00 Gas Fittin Fees: lst 3 Fixtures x $2.00 F... : , -„'.�°�— � �I Additiona .' �t , �!�'� ' x $ .75 � � : ��WWlda�— Gas Range-199,000 BTU x $5.00 Repl Range 3.�� Repeirs & Alterations See 3 00 I I I I � � Deacription; Code • I � State Surcharge �fass �'/��' ��rcharge .5�; .50 1 I I I ! II I I I�� TOTAL FEE $� I I I I !The undereigned hereby makes application for a permit Ifor the work herein specified� agreeing to do all work ( in atrict accorda.nce with the City Ordinancea and rulin, of the Depaxtment of Buildinge� and hereby declare that a11�th� facta and repreeentaziona atated in thie application ar��°'� - °—`r J'K.� � c8 � � � � B ignature � Date . i%- e'� � - %f`/i��2'Z� � � sue�ecr PERMIT NO City of Fridley 22 3 AT THE TOP OF THE TWINS g U I L D I N G P E R M i T r ; � R EIPT NO � `L _ _ COMMUNITY DEVELOPMENT DIV. �/ � �G� r � � PROTECTIVE INSPECTION SEC. �v �� ' i ' � /""1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPflOVEO BV �-��'� � ,'� 612-560-3450 910-F15 6/28/73 � � 108 ADDRESS g�g 1573 Ferndale Avenue N.E . 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 6 1 Shady Oak Manor Addition SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Terr. Claseen 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO. Andrew P. Ga.wel 240'7 Washington Street N.E. 4 ARCHITECTORDESIGNER MAILADDRESS 21P PHONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Res idential 7 CLASS OF WORK q( NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBEWORK �onstruct 44' x 24' Dwelling and 14' x 22' Garage 8 CHANGE OF USE FROM TO STIPULATIONS 1. Provide a hard surface driveway. Provide a verifying survey before capping. Grade and clear the drainage easement of eraes.,�at the time of backfilling base�ent. S ��ERATE PERI��IT� REQ'-�'��D ��R VVI�t.l�1�$ ; ��TING, P�-U��ING �ND SIGNSy � TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. OOCl 11IlG THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING Sa. FT. CU. FT. AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION R_1 1056 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 1 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 �19�4'OO 9.70 DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW AEGULATING CON- STRUCT ON OH THE PERFORMANCE OF CONSTRUCTION. � yfi�FC) . OO $27S . OO `, PLAN CHECK FEE TOTAL FEE `�e °� , , ` � ,� y �, r �,� � �� 330.75 SIG�A UREOF ONTRACTOflOR�AUTHONI2EDAGENT ( ATEI � HEN P OP � L AL ATED THIS IS YOUR PERMIT ° l�� -�s°�3 SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI BLOG INSP �ATE � � � �� , --�_.� �� '0 ��, � � �� , v � -�--_ 28Z5 HARRIET AVE. _.-._ �� MINNEAPOLIS. MINNESOTA > ��0�� v � � For A�DY GAWEL . ___ r7,2� S _., , . '6ft Utility �Rra�nage Easememt ��roh, , —. � . .. _---- �i, , • _�. . , , , � . . " ' . -.i " ' � . ., ' . ,' '�� . • •• . m µ s ; .. c�i : �. . M ` � . .,. Sca I e.: , l.0 � 30' `-' ' DESCRIPTtON: Lo4 6 Block 1 ; � . . �, � , , i ' SHADY OAK MANOR. . � �� ron Iror� - '--- � '72.5 —. : / ��' � �� ? /� �� M A V E . : � � : . � � � . � We hereby certify that this is a 4rue and correct representation of a survey of� the boundaries of the land above described and of the locetion of all building� if any, thereon, and all visible encroachments, if any, from or on said lond. Dat=ed�this 30th day of MaY 1973 . EGAN, ELO & N AK , .1 � urveyor / • � F i i e NO 5299 2010 — 12 (jy •`� e_3�� ,c�a.y� , s ��.�. �. 6 �� _ T__,�_ � A�PLICATION FOR RESIDENTIAL, ALTERATION, OR AllDITION BUILDING PERMIT CITY OF FRIDLEY, MINNESOTA ' - i.�". � �jz � OWNER'S NAME: /��°�j � ,C � ��°'�j BUILDER: �1 �� ADDRESS : ADDRESS ��c�� C.�/� ��.�j°� � j��l- �1 1 b NOi• � �� STREETi � � r _�� LOT: l� BLOCK• � ADDITION: � �� CORNER ZOT; INSIDE LOT:�( SETBACK: �� ,E- SIDEYARD:��.� `,- Applicaat attach to thia form Ttao Certificates of Survey of Lot and proposed buildi�g location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Ueed As; �� > .�� ;�; �ront : Depth : � Height : ,�! � � Square Feet • �� _, Cubic Feet : ,� �� „� �� T . �� Froat:�:� Depth: � 2 Height: Square Feet; � ��'� � Cubic Feet: � �� 4�"� Type of Construction: ,%��'�� Eatimated Cost: $ To Be Campleted: � � � � ";��` ��, �' �-� Tha undersigned hereby makes applicativn for a permit for the work here�.x� epecified, a�reeing to do all work in sttict accordance with the City of Fridley prdinaacee and ruliags of the Departmeat of Buildinge, and hereby declares that all the facte aad representationa stated in this a.pplication are true aud cvrrect. ` � . UAT� : _ ��— �� S IGNATURE : � ;�',�� (See Revezee Side For pdditional Information. ) _ �,,% ,� � _ � ��;? !� � � � � � � � _ �, � �, , -�3 am 1, �." "`t ��"a � + � . r � � , � i1 % I.`j � � � T R � �' �f � � "_ � � .«.�-�._ . ��} { � -. ,. � � � "�''� - s' � a.4: � . rl ' � ^ ._. _ 1 O ' _ a � � �� BUIL�TNG PERP�IIT FEE SCHEDULE SECTION 2. The Inspector of Buildings shall, before iasuing pernnits for the erection of any building or structure, or for any addition to any existing building or stxucture, or fox any alteration or repairs to any existing building or structure, upon application therefore, require the payment by the appl3cant for such pe�mit or fees to the amount herein below set forth and in the nqanner herein provisied to-wit: ' UNIFORM BUILDING CODEo Type 1, 2� 4-$2.15 for each one thousand cubic feet, or �xactioa thereo�, in such cubical con�ents. 1�pe 3& 5-$1.85 for each one thousand cubic feet. . ADDITIONAL INFOR�TION . . �or the puxpoae of camputing fees for building permits, the cubical contents of any building or addition, is determined by multiplying the gro�nd area covered from a point six (6) inches below the floor line of the basement or tl�e cellar to t�ne average heights of the upper surface or to the average heigl�t oi the roaf surface of the main gable of a pitched roof. For repaire or a�terations to an existing atructure, the fee ahall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cost of all. propoaed work. Ta no aaee eha.11 the fee charged for any permit as set forth 3.n Section 2 be leas than $5,00, VBRIFICATION OF FOUNDATION ��0 NOTE; Pexmits for eonstruction will be issued a miai�m of 24 hours fram the time of applicatiaa� �o a11o�p for propea xevieta af the propos�d structu�e atid of tYae constacact�oaa ��.ea A Certified Survey of the 1ott, showiaag the loeation af the foundation, once it has laeen constxucted, wi11 be reQuired bef�re roceedia with the fxaming. CERTIFICATE OF OCCiJPANCY Appli,catior� for a Certifi.cate of Occu�ancy shall be n�a,de ten �10) days prior to the uae ax accupancy af any structure for which a buildin� permit has been iasued; and eaid st�ructure shall not %e used or occupied until a Certificate of Occupancy ha� bee�x issu�sd. �s -S 2 _-� � � � a s s > . � i 0 � � � � , t� � i. � r ! t � � � c � � x � � � � � �°ei� O �.r � � � � A � r � � � � � � � ��o �►�� O � `�� i O � � � ,� � � � � -�1 � z � � C r. � y � � b0 �a�� , � W x � � n� � S� � C �� . � � � i Z M °f e�i. o a' N f� $ a 8 � 8 M N �'� 9 � � c r� C" �co�� a � �. � � o �e 7 � � � I 1� � � � � , � � 9�''� � '� 0 � ae � o� �� W �w �m °� � �� a� � O � C � M � � �. � � cxi ; � $ � I � � `� � �� .� IM �� W � � 1 b , �s �e � � � � � �� ° � � � � � � � � � � � � O b �y 0 � � o �� 1 � �. � , b "`b � � � � � � � �� a a � � x 0 0 ° � y �� x�� o s � O � O 4 jj � � q � ii .o i�p '� �1 ,e~+ b L � � oN �� ;aa o 0 g'3�g � � � � I� I I I � I � I� � � j � �. ' n 0 � ��. � ( °5°' � � � j � � i � o � 0 2 0 �, �� I �!' 0 0 � �o �°. B. g � �o � � �' � ' � � � � �a�� m � �a�.� �o�g� A�� 7 � p,+ w � � a � � � � ; O � ; ; � w a� o� cr, o 8 $ 8 8 8 N N R� �: � �, �: 00 ly i a � �� I� n da. - wl ( � � � � w � � � � � � �m� �� a�� ~ � ,��,e �� a,��$ a � � � o. �p �pi op . O o . . 8 . . w o, a o � 8 $ 8 8 e� ri � I � � I � aa� � .�"�� y�. (D � ' r/ � „ .�. '" ~�" � ,��, n c7�.�L°. � d� � � b S �. ��°� � �a�� o � V' M � � �p C� ... � �M�� w � o- :� p��,x A ��p x � �~ ma�m � a�� M .. A �i m�� o � � M�1 M i F � D � r � � T H z T C � � M � �� A I� � � � � � � � � N �� . � 0 w � � v � C�� HOUSE HEATING TEST RECORD ADDRESS ,��-� � o�'P /,!'^�APT. F 00 I S URB/ � i�L� � OCCUPANT OWNER HEAT LOSS DATE HTG. INST. GAS C0. METER B D # SOLD BY INSTALLED BY � Electrical Work By Gaa Line By , TYPE OF HfAT GA FA HW STEAM SPACE HTR. UNIT HTR. OTHER ' _�.�� GAS �SIG� �--- � CONVERSION MAKE '=`'�-� �� e��=MAKE OF BURNER Model � ..��.� �-�J' �� Model Serial ��5�� Max. BTU Rating INPUT ��'�� MAKE OF FURNACE Model ��CONTROLS � THERMOST � � at Plu Vent Size Valve — �'+�/��' KIND OF LINER SIZE NONE Limit � Drah Hood Regularor Limit Sefting Filters Size Number Fan Setting �-�-� " Chimney Loebtion Insida � Outside Pilot Type Chimnay Construction Pilot Make � '� Pilot Model Smoke Bomb Wiring �� Pilot Tlming �� Draft � Test Tag �� L.W. Cut Off � Door Pressure Lighting Inst. Prossure �_�7 Peree t O , � Date Tested �� Input CFH !�� Perc�� '6 �� Company Testing "� Staek Temp. �� Percent CO �°'� Name of Tester '' � Form 235 . City of Fridley � 4T TNE TOP 0' TIIE TN�INO i � . r..-------, GOMMUNITY DEVt1.0�/1ENT OiV, S �{ � 1MOT�criwt ws�scTroN o[►r. i r--- � CIT�► MM.L s1N0��Y iMA �.._.J`.� �.� f�-NO-aN0 Contractor S l�"73 � � ompletion �ate� ^ �� - .__. � � ci �. W � J � 1 W C 3 ` 0 aoNVa SYD 'lddV 'X1� i '�SIN i •eaai I•MNiva m y, 9NIBYB I � H�tv�l i � I ,O � 6Nrvaa aooi� �3 0 ,0 � I saaMa+gl �z.� ��q '1Nf10dl d NNIi/0 b A � SArlIll M�YM BIINISI /NIBYY iYRl 1�111Y i � �� I � ! 00 � ' .� � j � � � � I � i w I .� f� � i C7 � i�N�EGT PLUMB I�If, PERPII T APPLI CAT I Oid � �� :11 ��. ss P one �� ss ,�/q . " / �`�'� P o�e s�� se ��r.s�ima�ea �o�� --... _ _�. _._.__ .�_— Plumbin Fixture Rates: Np, ItATE TOTAL Number Fixtures x $2.00 �_ Future Fixtures x $1.50 New Fixture-01d Open. x $1.50 Catch Bastn x $3.25 -._.._ Water Heater-99,000 BTU x $3.00 Ground Run Old Bldg. x$3.25 Elec. Water Heater x $2.OQ Gas Fittin Fees: lst 3 Fixtures __ X $2,00 Additional Fixtures r^ ,__ x $ , 75 Gas Range-199,000 BTU __ x $5.00 I� � Repeirs & Alterationa � � See Description; Code — a� '__. I� State Surcharge .50 I � I TOTAL FEE $ �� - !The undereigned hereby makea application for a permit for �he work herein specified� agreeing to do all work — i�n atrict acco�da,nce with �he City Ordinances and rulinE f h a,�.M � � I. ° t e DePartment of $uildinge�, and hereby declare that „ a11�th� tacta and representations atated in thia application_are true aad correct. � � � � � ��—�—�,s�� . � / 7 -- Date 1 � � sue�etT P . City of Fridley 2 8 205 ; ` ��T��T��E �'NS g�J ILDING PERMIT RE�E�P . � `� ____� COMMUMITY DEVELOPMLNT DIV. r � � PROTECTIVE INSPECTION SEC. `� l-__- A;��,'� CITY HALI FRIDLE� SS��Z NUMBEP REV OATB PAGE Oi ACPROVED BY t �� 612-571-3450 910-F15 10/13/98 � � JOB ADDRESS 1573 Ferndale A 1 LEGAL �OT NO. 6LOCK TFiACT OR AODITION SEE ATTACHED DESCR. 6 1 Shad SFIEET 2 PROPERTY OWNER MAIL ADOR�S$ ZIP PMONE Terr Clausen 3 CONTRACTOR MAIL ADORESS ZIP PMONE LICENSE NO B & J's Construct 1 _ 4 ARCNITECT OR OESIGNER MAIL ADDRESS ZIP PMONE IICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PNONE LICENSE NO 8 USE OF BUILDING Residential 7 CIASS OF WORK O NEW ❑ ADDITION O ALTERATION �{ REPAIR 0 MOVE • O REMOVE B OESCRIBE WOHK Reroof house and garage (20 S) Tear-off 9 CHAN(3E Of USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYP� OF CONST. pCCUPANCY GROUP OCCUPANCr LOAD SEPARATE PEFiMITS ARE RE�UIREO FOR ELECTRICAL, PLUMBING, HEATING. VENTI�ATING OFi AIR CONDITIONING TMIS PEFMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION 20NING SO. FT CU fT AUTHOR12ED IS NOT COMMENCED VtiIITHIN 80 DAYS, OR IF CONSTpUCT�ON OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT ANY TIME AF7ER WOHK IS COMMENCED ' NO DWLG. UNITS OFfSTREET PARKING I HEREBY CERTIfV THAT I HAYE READ ANO E%AMIN�O TMIS APPLICATION STA�LS GARAGES ANO KNOW THE SAME TO BE TRUE ANO CORREC7. ALL PROVISIONS OF LAWS yALUATION SURTAX AND ORDINANCES GOVERNING TNIS TYPE OF WORK WILL 8E COMP�IEO @ W�TFI WHETME:i SPECIFIED HEREIN OR NOT. TNE GRANTING OF A pERM1T �p1�I1�F �.SC) DOES NOT PRESUME TO GIVE AUTHOqITV TO VIOLATE OR CANCEL THE pEqMtT FEE SAC CNARGE PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGUTATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUC7ION �SC).7S Fire SC �1. %1 P�AN CMECK fEE TOTAL FEE ��%�'�-�� 0� `�� 9� License SC $5. 00 $64. 32 S�GNATUAE O� CON'A (,°TOp Op AUTHOpIjED eGENT �DATEi WMEN PROPEALV V I� ATED TMIS IS YpUp PEpMIT /fI � V s / ' // S�GN4TUAEO�OWNEA��OWNEABW�DEp� �OATE� � BIOG NSD � � �. q6tE � NEW ADDN ALTER � � [l [l ConstructionAddress: Legal Description: CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION l � �1 � f ��n c� �.1 � �-v � _ l� � . Effective 1/1/98 � p �� Owner Name & Address: �;� � r� R�� C ��q-U S�-� Tel. # Contractor: �� 5 �s�-r��.i c�t, MN LICENSE� Address: ► 5 SL, �1 S v� �e if1. ; v� � e S-� .�a.-��k /�I` Tel. # Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Length Length Length DESCRIP'rION OF IlVIPROVEMENT 3`7/-�9�. a ��i �� G �/� • �'�f�3 Width Height Sq. Ft. Width Height Sq. Ft. Width Hgt/Ground Sq. Ft. Constntction Type: Estimated Cost: $ /,�'%%`� �� r (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE:�� " 0-� � 9� APPLICANT: ��-' r�' `�"�1.�,u4.r,�c.u�p.�+- Tel. �{ � �/( .��'� `� � Permit Fee Fire Surcharge State Surcharge SAC Charge License Surchazge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ .�� $ $ $ $ -g� �CJ $ $ $ $ $ � � CI1'Y USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1000 per 5AC Unit $5.00 (Sta.te 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,OQ0 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100, 001 to $500, 000 $SQ0,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum 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 fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,000 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 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 $1,000 or fraction thereof DRIVEWAY DEPIZESSION ESCROW (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 approach with 6 inch depth - Drivewaq width plus 6 feet times $15.75. 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. Buildi�g Irrspections 763-572-3604 DATE STI'E ADDRESS _ THIS APPLICANT IS: BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY YOUR E-MAIL ADDRESS ❑ OWNER OCONTRACTOR Pernut No. Received By: Date Rec'd: PROPERTY OWNER/ NqME: � TENANT ADDRESS:� �-.�.��?/L f�e>�� t�'r? �CTI'Y�, —,��/_ .c� � STATE ,J�' _ ' c./ .%,� eA .�+� � CONTRACTOR SUBMIT A COPY OF YOUR STATE LICENSE WITH APPLICA"iTON STATE LICENSE # �� C G^�f1li EXP DATE �� /��?t�Q G ADDRESS: .� O ✓� , " '7 ✓l�� CITY�sr�o�rlo..��r� STATE�1'I�TP�j�� nuni.r� �� S .� _�e`i 7 7 PROPERTY TYPE I� SINGLE FAMILY/�1EW CONSTRUCTION ❑ TWO FAMII,Y/NEW CONSTRUCTION PERMIT TYPE ❑ BASEMENT FINISH ❑ DECK �rE oF wo�: o �W O MAINTENANCFJREPAIR 0 GARAGE/SI�D ❑ ROOF ❑ SIDING ❑ SWIlVIlvIINTG POOL ❑ ADDITION ❑ REMODELING ❑ WINDOWS ❑ DRA1N T1LE ❑ OTHER DESCRIBE WORK BEING DONE: `�T �,.,.�'..[r.��.�;? �, �'d � 'a�i `��-;�� h cr� /°/ � � �� ,�� e,, �`�' � SIZE OF IlVIPROVEMENT _ LENGTH WIDTH HEIGHT Sa. Ft. n�vruru NUMBER OF SQUARES � GARAGES PROPOSED S1ZE: PROPOSED I-�IGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other WINDOWS IN EXISTING OPENINGS OYes ❑No OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & TYPE OF WII�IDOW TO BE INSTALLED I�°HOUSE ONLY ❑ HOUSE 8c GARAGE O ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia L�ATION OF WINDOWS NUMBER BASEMENT REMODELING SUBMIT: 1. Existing Floor Plan 2. Proposed floor plan 3. List of strucdual members to be used FOR NEW CONSTRUCTTON INCLUDING DECKS, ADDTfIONS. & PORCHES SUBNIIT: 1. Site Plan/Survey showing the existing structures and proposed project 2. Two sets of construction plans 3. Energy Calculations ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION $��,. ��1�� OCCUPANCY TYPE Permit Fee Pian Review Surcharge Fire Surchazge License Surcharge SAC Charge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main Charge Total Due � �1; �,�� See Back Page for Fee Schedule $ 65% of Building Permit Fee $ , � (.0005) times the total job valuation — Minimum $.50 $ , � .001 x Permit Valuation (1/10%) $ � �, �2� $5.00 (State Licensed Residential Contractors) $ $1450 per SAC Unit (Plans to MWCC for determination) $ ft+6ft= ftx$20=$ $ $450 Conservarion Plan Review $ Fee Determined by Engineering $ Agreement necessazy ( ) Non Necessazy ( ) $ � _� Make checks �avable to: Citv of Fridlev Attach THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclmowledge 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 Constcuction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved plan in the case of all work which requires/review and approval of plans. � SIGNATURE OF APPLICANT % "C�� r��i�n PRINT Page 2- Building Residential Application � 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 e�sting building or structure, or for any alteration or repair to any ea�isting building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount hea�ein below set forth and in the manner herein provided to-wit: TOTAL VALUE FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surchazge) $501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and includin $2,000 $2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional$1,000 or fraction, to and including $$25,000 $25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional$1,000 or fraction, to and includin $50,000 $50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional$1,000 or fraction to and includin $100,000 $100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to and includin $500,000 $500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or fraction to and including $1,000,000 $1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or fraction 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 fraxning. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977 � s� r -1��7 -� � b�'o��r� ��'F�..�.� 7� ��5 S��S�L-,��, ��/ °�X y �'" 'l� f // `u�L>l� , ! O� ��;� � i3� �'o� - � � s � %" �`Z�� G z�� - �' , , �� h�� `� ;� � � z��a '� �� ; �