AF - 45019BUILDING PERMIT
Village of Fridley, Minn.
Date �. � �; �? .�. � % . . . . . . . . . . . . . . . . . . .
Owner �.��.'!....�t".'?*:�..���.
j% .
Address . ��. �.� . . . �r:'3r� . . �'1,�:%�� . .
N°
2533
Builder ,t''��I�,'',`Y7! .....'.�.�" ................
Address . . ,.r?'!"'!.1'r'��� . . . . . . . . . . . . . . . . . . . . .
LOCATfON OF BUILDWG
No. . �,�'�? . . . . . Street �. .�:". �. �-:_'.'�`��. .'"�!� . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . .
,�rJ� ► �/�
Lot ......� ....... Block ../!.......... Addition or Sub-Division .'�.!!:�.'��..�.�... ..........
Corner Lot ............ Inside Lot .... ... Setback ............ .`Sideyard ..........................
DESCRIPTION OP BUILDaNG
To be Used as:
�:��"���a""" . . . . Front ..�id � . Depth ti�. .�. .'� Heig.'�k'"^�!���."� Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
�
.................... Front ........ Depth ...... Height ..... Sq. Ft. ........ Cu. Ft. ........
/►�! �►;�
Type of Construction�'7�:�*`:�... Est. Cost �.�'�.��.... ....... To be Completed !�,1��/.����'�:i","'....
_...._�,
. ,. � � r O+^IG � #�4ii �1�' LV' '� i.F � � �
�-� � t� �Li; l•o ''��"�� � �' � 1 �
�,,
In consideration of 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 all provisions of
ordinances of the village of Fridley.
� . '�°�.��.�,,.���.�.ui • i • . .
In consideratio of the payment of a fee of $ : ..�...r-. , permit is hereby gran ' . . . . . . . . . . . . . : . . . . .
"�-•�yR.�✓ ...��, to construct the building or additioz� as described above. This p rmit is granted upon
`'�he express condition that the person to w�om it is granted and his agents, employees and workmen, in ail work
�.t
°°-�;r°rlane in, around and°upon-said building, or any part thereof, shall conform in all respects to the ordinances of
F'ridiey, Minnesot� regarding location, construction, alteration, maintenance, repair and moving of buildings witn=
in the village limfts and this permit may be revoked at any time on 'olation of any of the provisians of said
ordinances. � %� � �����
�� �
• •�• • ��'fi �.��. .—.,(;� . . �„l��r�":`:'�:":"` �'•': Buiiding Inspector
..�_
#
NOTICE: y,
This permit does not cover fhe construCtion, installation or alteration;for wiring, plumbing, gas heating,
se�nter or water. Be sure to see the Bui{ding inspector for separate permits for these items. • ,
SUBJECT .-.
City of Fridley 25 35 9
AT THE TOP OF THE TWINS g U i L D I N G P E R M I T
r �
� � O.
� • COMMUNITY OEVELOPMENT DIV. /
r �~ � PHOTECTIVE INSPECTION SEC. j a��
� . �
� � /"'1 � CITY HALL FRIOLE� 55432 NUMBEF REV. OATE PAGE OF APPROVED BY
�----� • •'' 612-571-3450 9t0-Ft5 8/12/97 � �
JOB ADORESS 5200 Fillmore Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. 7 1 Marion Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Pat McHugo 5200 Fillmore Street NE 572-1873
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Crosby Construction Inc 3247 Vincent Ave N, Mpls., MN 55412 799-2213 20021017
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS Of WORK
O NEW O ADDITION ❑ ALTERATION C� REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Tear-off and install rolled roofing (19" Selvedge) 18 Sq
8 CHANGEOFUSEFROM TO
STIPULATIONS Install per manufacturer's specifications.
TVPE OFCONST. OCCUPANCY GROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NIIJG 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
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. Ut�11TS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STAILS GAiiAGES
ANO KNOW THE SAME TO BE TRUE AND CORRECT. A�� PROVISIONS QF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE Of WORK WI�L BE COMPLIED $1,501 �.%S
WITH ETHER SPECIFIED MEREIN OR NOT. THE GRANTING Of A PERMIT
DOE NOT ESUME TO GIVE AUTHORITY TO VIOIATE QH CANCEL THE pEqM1T FEE SAC CHARGE
PROVISIONS O ANY OTHER STATE OR LOCAL LAW REGULATING CON- �SI.ZS Fire SC �I.SO
STRUCTION OR E PERFO CE OF CO STRUCTION.
� �� ^ PLAN CNECK FEE TOTAL FEE
y License SC $5.00 $58.50
S�GNAIUAE OF CON7RAGTOA OR AUTM D AGENT onrEi . WMEN PROPERLY IDATED THIS 1S YO R PERMIT
� � �Z.�,�
S�GNnTUREOFOWNERi60WNERBU�lOEfii �O�TE� � _..�_�r.BIDG NSp qaTE
NEW
ADDN
ALTER
L)
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Ll
ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUI DING PERMIT APPLICATION
�'�.� �GC.;Y� S E� � �
Effective 1/1/97
�Pas�S
Owner Name & Address: /��fT �1��'zl�, � Tei. #_,�`�2 %�7 �
Contractor: (�'�ieo,S'. � ('p,�� C`�`� ��° MN LICENSE #°� ��Z�°�'
Address: �. L Tel. # r-^ �j�
_ � S� li/ c'f�,�,��li: �/;—�� �' �� ��9 z2 /�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale. � b�� ��ry��
LIVING AREA:
GARAGE AREA:
DECK AREA:
DESCRIPTION OF IlVIPROVEMENT
�ng� Width Height
�ng� Width Height
Length Width Hgt/Ground
Sq. F . � �
Sq. Ft.
Sq. Ft.
OTHER:
/�' "
c �- .��-� 9 �� S'�/�.���e � � ,1� F �c> 1 �-- -�
�nstructi�n Typc: ��Q �/= � Estiinated Cost: $ s�s-j l Q � �{�� (J S� ���d
� —�
(�'ee Schedul e on Ba ck) ;,� �"(j J 2 U
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft_�x $ =$
DATE: � �/ % APPLICAN'T: / �` �Q.S' � Tel. # �'�- �%�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
'COTA L
S"I'iPULi1TIONS:
�_ 'J �, 2�
$ ��
$
$
$ , cl�
$
$
$
$
$� � �'C�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (i/lOth%)
$.50/$1,000 Valuation
$950 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
Inspections
763-572-3604
DATE
SITE ADDRESS _
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑O R ❑
NAME: �
ADDRESS �
PHONE:
NAME: D iyj
STATE LICENSE # �
PHONE�GS — `J / Ja 7S
❑ SINGLE FAMILYlNEW CONSTRUCTIc
❑ TWO FAMILY/NEW CONSTRUCTION
ii A TTTTTlIT.i n r. e c
❑ BASEMENT FINISH
❑ DECK
TYPE OF WORK: I❑ NEW
❑ MAIA
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
ROOFING �/y .
!/
' - .n ��c:'�
Received By:
Date Rec'd:
EXP DATE
CITY
F� ce , 6�e�- 3c��--� �'
SIZE
❑ ROOF
❑ SIDING
❑ SWIMMING POOL
O ADDITION
AIR ❑ REMODELING
/7�l�/ �
❑ DRAIN TILE
❑ OTHER
LENGTH WIDTH
❑ HOUSE ONLY
HEIGHT
ATE ZIP
STATE_ZIP,
NUMBER OF SQUARES OUSE & GARAGE BASEMENT REMODELING SUBMIT:
GARAGES ATTACHED GARAGE 1. Existing Floor Plan
PROPOSED SIZE: ❑ DETACHED GARAGE Z• Proposed floor plan
3. List of structura] members to be used
PROPOSED HEIGHT:
SIDING FORNEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Aluminum ❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Other ❑ Fascia and proposed project.
2. Two sets of conshvction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes ❑No IACATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING T U.B.0 F'EE SCHEDULE)
TOTAL JOB VALUATION $���� OCCUPANCY TYPE
Ft.
Pemiit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$<�j3 ,a- S See Back Page for Fee Schedule
$ –r— 65% of Building Pernut Fee
$ , .001 times the total job valuation
$ �� �Z.� .0005 x Permit Valuarion Minimum $.50
$�� 6 v $5.00 (State Licensed Residential Contractors)
$ $1550 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ ,/� Make checks payable to: City of Fridley Attach
THIS IS AN �PLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
pernut but only an applicatio r 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 w hi re uires review and approval of plans.
SIGNATURE OF APPLIC T�r _________ PRINT NAME �^� " O� DATE
�UI�C�l�g
Inspeet�ons
763-572-�iU4
Tiw��. ti.ur u� rteuwy �u raa-ww ra}/c. �.r a..�w. w...w.... v.-r �.,. ��u.,
i����� ���:�� Pennit N�
RES�DEIITTIAL APFLICATIt�N � R��"'�
CIT�' OF FRIDL�Y � n$re R�•a:
DATk� `� � �YQUR �-M�AjL AL�RE3S _ .......
SiTE AUDRE33 . � _ _ . _.. _ �I��,�_ ` �l� n �� _.
THJS AF+pI.tGANT IS' D OWN$I�L Q�UNTRACPOR
,� _ ._ _. . . - --- --------�—
PSt�PERTY rra[�:
OV4rl�f FR/ � � �- —
TF.NANT ADDRESB 1'� TT't'_
....,.....1 ,. ► �1 _^r�'1 _ 4
CONTRACTQR CuI�ANI�?�rAME:. . _ ��
SUBMIT A COAY OF eQ�����`
YOUIZ STq'E'� 3TATE L[C13N3is �I_ � P DATE
LlC.Ft�FSE WTrH ADD![ESS�.�� . ..._.___
APFLICATION
P1i4Nt�-_^�L� FAX ______.
_��I � - ��A��ai��Z
_��
P�:RMIT TYPE �snzc� r�r.r o� Fn�au.r o rowr�ciavst
7'YYE oF woRK: � � m�w �x�r�.nc��a�xr
DETAILSI3 I)�SC'RIPTION dF WORK
❑ �u.�nriow�MOr��.
PER MS IfsB 665 the permit f� ia a minieqnin of 515.00 or SS9� d'the total coat a� b SSUO.OQ, whichavmr is �,rtater, far the
improvemetit, instatlati�i or raplaccmern of a residmitial fucture, exclud'm� the frxtures. {Thia should rofleat ouly tha coat af labor )
I.abor cast u�clar $300 =$15.00. Labor cost batween $34U to �SQO = cost of lebor x.45 =
FORFROlEGTB WH6RE LAilOREXCEIDS 3500,FEE8 ARS 8A98D OTi SI0.04 PIIt F[XT[l�C. �XCL�P'7 WHERE I3d1ED. FIX'1'[JRE9_ (Q+�ICA�E TQTM.
NfJA�ER OF F�4c:H �EW�'V}
Gquipmrnt Lnst8llcd MGG. MUDII._ .— _ .. _ . _� _ SlZts/[ITU ._— -- —
VAJC �25_U9
�A[Ft TO AlR F7iCHANGFl3lt Sl S
SOILER 335.00
__GitIM?+1EY I1NER S10.0[i
MFC b[4D6[.�
MFCi MOBf'[s .:
� � �FI[tF�LAGE (GAS} Si S.On
TFl[t�PLACE (WOOD) i3S.01f
i/i�URNAC6 535.00
�C�„4s Dit1'6R S 10.00
4AS PiPINQ i10_QQ
� �: . , . ... ': 1�l�11�3.F��J�:t��.J�K.�l�kCC3�$C.3�f��.#�:�{#.4f
Number of fixtxtres (r� $ t�.00 _ x$t Q.OQ r$
Number of fixturas (a� $I 5.00 x SI 5.00 =� _
Number of fixtur�s (ct� $25.00 _ __ x �25.00 = $` - - -
Num6er of fixtures (a� $35.U0 _,� x $35.00 = $ --
Statc Swcharge = � .50
Total = $
Sl:Gki7b1'U
517�lST11 _.. __�
GAS RAtdGC�/OVEAt 514.UQ
�NEVY GAS GRi1.L St 0_OQ
�GAS UNIT HTii t10.40
POOL !{EATER 335.00
�VENTILA't'dR SI5A0
Perm it Fee $ � ,Ql �U �
Surc.hargo $ ��y �
TOTAL �UE $ �QI�_ •� v
'CHTS IS A,'N AYDI.ICAiI�[ FOR A PHRl1[CC.DI�P V1L[D YINTIi. P1YDL_'6S36D
I hereby appiy far a bulc�ir� petmit and � acknowled�e th� the information above ia campletc and aca�rato; that the wark will ba in
confwmanee with the ordin a�d codes of tt� Cety oF Fridley and wiih the MinnesQta Conswetion Gfldas; that I undarsEand this is
not a pmmit but c�ly aa app ' for a�cimit work i� not to st,art without a pamit; tl�t fhe �ork wii! ba in accosdas�ce wiEh the
approv�d pleri ui Ehe cese a!1 whicli requ a �proval of
310ENATt1ItE OF APPLfCA PRINT Ttl1ME�� DA?E����,�,_
Cily of Fcidiey
$uil�uig Inspectioas Deparhnent
643 � University Avenue NE, Fridley, MN 55�13Z
?63-592-3d0�
£AX: 7b3-�02-4977