AF - 45173Villag� of Fridley, l�r�an.
�UILDING P��.IVIIT
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Date . . �.��;,-:r � ..c .. . . ....
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Owr1�r. � ....... Builder ................:.............................
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Address...................................... Address .............................................
.
;�� L�JCAT[ON OF BL.l�'LD[NG
No. �.�..r�. �/. .�. Street �,.,�: �. . . . .`'. . : . . .': . . . .� :°.•:-: : �,"�`!f'� . : . . Part.of L,ot . . . .. . . . . . . '� .,,�'''. . . . .
. . �:. f rd,�� 2 t , � ° fr......"1 :'.�
Lot . .. . . . . . . . . . . . Blocl� . . . . . . . .. . . . . . . . . . Addition or SuU-Division .: .. . . ....: ... .. � . ..: ...'.
...
,s ' ,,'
Corn�r ; ot ........... Inside Lot ........... Setback ........... Sideyard-���' .............:"..............
DE�CRIPT6�!V O� �U[1LDEl�IG
To be tised as: '
, ........ ... Front ........ Depth .... . �-Ieight . ...... Sq. Ft ......:. Cu. Ft. ........
. . . � . f. : . . . . Front . . . . . . . . Depth . . . . . . . . Height . . . . . . . . Sq. Ft . . . . . . . .:.....d Cu. Ft. . . . . . . . .
Type of ConS�ruction , ;,{ . . � . . . . `"�. �Est. Cost . . . . . . . . . . . . �. : �:`. . . . To be Completed . . . . . . . . . . . . . . . . . .
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. � F"°
i ��Y � _„ �. ��
i: f,� �, , ¢ 1'`" t x.
. . . . . . . � � . 3—. . . �� . . . . . � . . . . . . . . a . . ��: � w.: � ;w ��.� ,;
'� _ _
� d' ✓ .
In r�sideration of the a ment of a fee of $: : ..ax �'� ` ��� �' �� � • • • • •
�rv p y ..., perrLzit is hereby granted to .r .. .. .
�` '" `...,,��. :`� �M-1�. �"'�. to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work
done in, around and upon said building, or any gart thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in tne village limits and this permit may be revoked at any time �on violation of any of the provisions of said
,
ordinances. . ` :: f � �'
��,,.., . . �fi r� �` 1 �� . �
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":�-.... . . . . . .,_; . ,, : . < ��. . . .��ding Inspector
.._ _ � �''''`��" c.��;.. °
NOTiCE:
7his permit does not cover the construction, installaYion or alteration for wiring, piumbing, gas heating,
�ewer or water. Be sure to see the Building inspector for separate narmits for tH��p items.
•
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City of Friclley, Minn.
BUILDING PERMIT
nat�: dw'° ?� 1965 ........._.._
owner: I�i.ke OBannon
Adareas 5296 . F3.I�wre St. N. g.
Builder
Address
�Baxma� �onstr. �o.
�.�� �/
� ���o
LOCATION O� BUILDING
Na �Q.�.._._. Street Fi�2�e Sti•set DI. E. ....._.._.._.�_._._ Part of Lot ...�...._._...
r.ot ?�.,.�.Qs� 81ock _._..._._........�...�..._.._ Additi� or Sub-Division _I'�.������St ��h8tii.CS� 1 l�
Coraer Lot �_.__..._._.._ Inside Lot ...._._.._ �.. Setback ._._.._._..._..._.____. Sideyard __.__..__._..__._.._._.__..._
Sewer F�evatian _____._.._.._..._.._.....�. __.__..._ Fo�mdation IIevation _..._._ __..__.._._.____._.__.____.
DESCRIPTION OE BUILDING
To be vsed aa:
F't+oa►t .�....�...�. Depth Height ..�....._...._. Sq. Ft .�_......._ Cu. F't _.._.._...�..__
________�_..�._.....�._ Froatt .._.._...._..r.. Depth ___. I�eight Sq. F't. ._.___...._.. Cu. Fk
z�yQe or co�,struct�on ___. G�'�..e Es� Cost�.s�•E�0___.___.._ To be CoanPleted _..._.._.._...._.
StOrm dem&ge repair
In cod�dderation of the issusnce to me of a penmit to constru building described abave, I agree to do
th8 P�P� w�ork fn acxordance with the descriptioa above set P in oomPlian with all pravisions of
anliaenoea ot th� dty of Fridley. �Q�Cz��K��
In c�aisideratioti oi fhe payment of a fee oi � 1�-� - ._.., permit fa herebS' Sraated to._..D�r11L�II na -- CO.
to construct the building or addition as described above. Thispe rmit is grantefl upon
ttie expn�ss c�dition that theperson to whom it 3s granted and his agents, employees and workinen, in all work.
do�e in, around and upo�n said buildin8, ��i' P� thereof, shall conf�m ia all reepects to the ordin�ncee a�
��Y, Mianeaota i'e8ardin8 lacat3a�, constivction� alterati�, maintenaiu:e, reF� aad mo�+'in,8 of buildtn�s
wi� Mty limiits and this permit may be revaiced at any time upau vialatiou of any of the ProvfsYo�s of said
ALlea Jsnssn 8��g ��
NOTIC� ;
1Ns p�ertt doM net eowr tlN eon�roeNee, i�apNka for wIrNY� P�W N� �Y. �w�e er wahr. d� wn to sN
fw l�rNdL� hiprewr ie� a�p�eat� p�r�ih fer f� ihies. '
•
•
City of Fridley, Minn.
BUILDING PERMIT
Datc: Se,pt�19, 1967 __
-•�-.� \
N�
,39�.�0
9�60
�
Oa►aer: ___. �e� Bann.�n __._.._._.. Bu3lder ..��Lf....._..---._.__.___._..__...__..._..._.___.._.___._
Adclresa .___5298_Fillmore St�N. E.� p� Same ___��__M,._.,._,.__ ,,,.._..,_._.
LOCATION OF BUILDING
No. _..._..__5298_ Street ._.._.,Fillmore St. 1Q. E.�,,.....__._..__..._.._. Part of Lot ._.._...__._._...��_.._...__.......
Lot .___..�....._.._.__ Block ._....__._._. ��..---._.� Addition or Sub-Diviai� ._M���.on _��.5 ...�5.�....��33..�.
Corner Lot ____.__..__.._ Inatde Lot
Sewer Elevatia�
a
Setback . ..._...�._._.._ Sideyard
Foundation Elevation
DESCRIPTION OF BUILDING
To be vaea ss:
w Garage .__._... F�ont __?�2 � Depth ....24 � xeight . 10' .._. Sq. Ft 288
_.__.._...._..._.______._._...� Front w.._...___ Depth _.___...._.. Height ._.._.._.__.__ Sq. Ft. _.._.....__..
Z`ype of Construction _..�._..._._Frame _.. Esk Co�t —._._.�.1400.._____....._ To be Completed
� � � 2880
Cu. Ft _....
In consideration o! the issuance to me of a permit to ca�struct the building described above I agree to do
the Propoeecl work in acoordauce with the descrlption above eet forth and in compH th a�l proviaiona of
ordinances of the dty of Fridley. �
In cona[deratioa of the payment of a fee o! � 5. 00 _._..� ��{t � h�},�, g�� �__ Mike 0"Bannon
to co�struct the bui�ding or additfon as described above. Thispe rmit is grantefl upo�
the express c�dition that theperaon to whom it is grsated and his agents, employees and workmen, in all wark.
done in, around and upo� eaid baildin8, �' �Y P�rt t6ereof, shall oonform in all reepects to the ordinatices of
FridleY, Minnesota regarding locatfon, constructioa, alteratia�, maintenanoe, repair and moving of buii
Rno�n� dty limiffi and this pertnit may be revodd�ceed at as�Y time uP� violation of any of the Provisians ot�d
�CB BELISLE B�d{�g �
NOTfCE:
iWs p�eek deu aot eowr iM ee�nieNoa, i�u1a11aHen �e� wiet�� PIe�W /u I�tino. s�wr or wN�r. M wn �e �w
!M �uili6p ���p�e1s� for s�p�rN� p�neils fer 1h�a Ihnn.
y � �
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,� a.,•- •,-., t�in nrs•,.—=
_ ]al.�-'�i! 1.r1•:1 !' \.+�Z ;.3j1:.i�D.a.lcli .. _'.��.__.�. �
c�..�° o�i ���:,:�:��:��, rr�r�.��scTn
041�'�fi'S NA2�1E � fit.;f;�i3�R � .
...�.�.�..� — -- ----
ADDP�ESS �?.�����,_...� ��y��� �—��._ A��::ESS - - .
- � LOCAi'�.c� e� BU-jI:�7.:�G
N0. �� l�...._�.A.........�S�t.��T____�,�,�t'�._..R__�._...... PART 0-^• LO'%.....�..�._.:........_._._.
...�........��.�.� ` R�,{ ��
LOT --1- -- _ BL4CK � � M _- - ABJ�TiON Oi SUvD; ViSION �U�'1'1 �,�,����`-"-'' �-� �
CO;P��R LdT � INSi.D� LO'1� -- SEi�ACf:�Cvyw�- l�- SI aYD� � �
S�;WI;R ELEVA�ION � FOtJNDATl�.0:3 ELEV��TION �—
A�piicant attach ta this form Two Certi.ficat2s ot Survey of Lot and proposed
bui7.di.ng Iacatiwn dra�,m ci� these Certificates.
_ . DESCRIPTIC:1 Or^ EUTLDihG
To 8e Used As: � _ , . �
� . . � , �
�
�`ront / _�` Uepth �� Height ��
' Sq. Fr. �� Cu. Ft,� � g��
� Frnnt - Depth _ _ _ H�i.ght
_ Sq. Ft . � Cu. Ft .-- — -- — .�..�....
- ��
�ype of Construction��/���!'i�G- Estimated Cost 1��� __ �
To Be Coa�pletec� �u��� � � / .
The undersigned hereby makes a�plication for a permiC for the work herein specified,
agreeing to do a11 work in strict accordance with the Ci�y of Frid?ey Ordir.ances
and rulings of the Der:�rtment of Bui�dir_gs, and hereby decl�res thut all the facts
and representations sCZted in this app�i�ation are true and correct.
D�?TE � � � / � / SIGtdATURE G�/� \ � O
(Schedule of �ec Costs ea� be found o:3 the Reverse S�.de},
� � � , '� ��,
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�3UZI�DIRTG PF.c^,i�ll2' r?':E SCHEDllL'r',
SECTION 2. The Inspecto�- of Bui_Idi.ngs slial.l, before. issui.n� permits for tl�e
erection of any bui.ldi_n� of structure, or. for any addition to any existitz�
builc?ino. or structure, or for azly alteratioi� or repairs to any existing buil_dinb
or structure, upon appli.cati�n therefor.e, reqtii.re the paym�nt by the applicant
for such perulit of fees to the amount here?..n belo�a s�t £orth and in the manner
herein provided to-��Tit:
Un.iform Buildin�ode: Type 1;2, & 4- $1.75 £or each ozie thousand cubic f2et, or
fraction ther.eo£, in suct� cubical contents. Type 3'& 5-$1.50 for each
one thousand cubic feet.
For the purpose o£ computin� fees ��'or buildi_n� permits, the cubical cont�r�ts of
any building or add�_tion to a uniform heioht thr'ou�hout by multi.pluino the ground
area covered from a point si_x (6) inct�es �ue1o�� the floor line. of the base,��ent or
cellar to the av�rage hei�tit of the upper surface or to the avera�e hei.ght of the
roof surface of the main gablr of a pitched roof. .
For regairs or aiterations to an existing structure, the fee shall be at the
, rate of $3.00 per each Fi:ve �Iundred Dollars ($500,�C) or fraci:ion thereof
in the cost of. aIl proposed work.
In no case shall the fee charged for any pe:mit as set rorth in Section 2 be
less than $S .00. . ' _ .
�p . NSSSD Connection Charges based on location- Area 1 or Z.
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SuB�ECT
City of Fridley
�
AT THE TOP OP THE TWINS g �! L D I N G P E R M 1 T
� i
� ; L ����� COMMUNITY DEVEIOPMENT OIY.
r � � PROTECTIVE INSPECTfON SEC.
� . ,
� � /"'1 � CITY NALL FRIOLEV 55132 NUMBER REV . DATE
�°""'�' �'' 612-571-3a50 s�aF�5
1211/97
10B ADORESS 5298 Fillmore Street NE
1 IEGAI LOT NO. BLOCK TRACT OR AOOITION
DESCR. 1 1 Marion Hil�s lst Addition
2 PROPERTY OWNER MAIL A�ORESS Z�P
3 CONTRACTOR MAIL ADDRESS ZIP
Metro Chimney 148Q8 Portland Ave S, Burnsville MI3 55337
a ARCHITECT OR DEStGNER MAIL AO�RESS Z�P
5 ENGINEER MAILADDRESS Z�P
6 USE OF BUILDING
Residential
7 CLASS OF WORK � NEW
PAGE OF
/ /
PERMIT NO. �
-25705
NO.
��
APPROVEO 9V
SEE ATTACHED
SHEET
PHONE
PHONE UCENSENO.
942-9422 City
PHONE LIGENSE NO.
PHONE UCENSENO
❑ ADDITION O ALTEfiATION �] . REPAIR ❑ MOYE ❑ REMOVE
8 DESCRIBE WORK
Repair top 6 to 8 courses of block on chimney
9 CHANGE OF USE FROM
ISTIPULATIONS
ro
SEPARA7E PERMITS ARE REOUIRE� FOR ELEGTRICAL, PLUMBINCa, HEATI►iG, TYPE OF CONSI
VENTILATING OR AIR CONDITIONING.
7MIS PERM17 BECOMES NULI ANO YOID IF WORK OR CONSTAUCTION ZONING
AUTHORIZEO IS NOT COMMENCED WITMtN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOfi A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG, U�
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINED 7HIS APPLICATION i
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VAIUATION
AN� OROINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED
WITH WHE7HER SPECIFIEO MEREIN OR NOT. THE GRANTING OF A PERMIT �6SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR 7HE PE fOi;MANCE OF CONSTRUCTION. �ZG.SO
PLAN CNECK f I
� a--\ � °�-�
S�GNAIUR FCONiaAC HORAUTNOaiZEDAGENT IOATEI EN
�
�
OCCUPANCYGROUP OCCUPANCY
Sa. fT. CU. FT.
OFFSTREET PARKING
STALIS IGARAGES
$.50
SAC CMARGE
Fire SC $.47
TOT FEE
$27.47
HIS IS YOUii PEFiM1T
1 • � -
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ADDN
ALTER
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Co nst[uctio nAddress :
Legal Description:
' CiTY OF FR[DLEY
S[NGLE FAtV1[LY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT' APPL[CA'I'IOI�i
Effective 1 / l /97
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Owner Name & Address: _ ��.q� �\�„�,� 5� Tel. # � �
Contractor: 'l`'�c� c, C�, ,��e � MN LiCENSE # o-4as-yy�
6� �I"}'>
Address: � ���� '��a�� ��e �r � ��1Q Tel. # cl�-1�._ �i� `�`�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEn7E\T'T
�n� � �'i�� Height
Le�tgth Width HeiQht
Length Width _ _ Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft_
� % �'o �O�,�Ses
Construction Type: �.�. �eT�P�, r Estimated Cost: $ �� Q
(Fee Schedule on Back)
Driveway C�u�b Cut . Width Needed: Ft. + 6 Ft = Ft x$ " _$
DATE: -� � APPLICANT: � Tel. # �4°t- ��� l
Permit Fee
F�ire Surcharge
State Surcharge
SAC Charge
License Surcharge
�riveway Escrow
Erosion Control
Park Fee
�ewer Main Charge
TO"rAL
��rt��ur_n�i�t�,�s:
� a�.sr�
�- �� �a�
$ �
$
$
$
$
$
$
.
�7���
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50!$i,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 Necessani ( )
_ _ ;�
(iUlt,DI��tG !'E;It11Cl' FEE SCHEUC'f,t�.
'l�lie Cliief Building Off�icial shall, bciore issuin� {�ern�its for the erc:ction <�1� any building or ec►uclure, �r fc�r
ai�y addition to any existiilg buildi��g or stcuciure, ot for an}� aiteration or re�air to any cxisting buitding or
stiuccure, upon appiication tilerefore, require the payment by the applicant i�r such permit of fees to the amount
herei.n below set foRh and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $S00
$�01 to $2,000
�2,001 to $2�,000
$25,001 to $50,000
�50, Ot? 1 to � 100, 000
$lOQ,001 to $500,000
$500,00� to $1,OQ0,000
`; ( ,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2_75 for each additionai $100 or
fraction thereof, to and including $2,000
S62_25 for first 52,000 plus $12.50 for each additional � 1.000
or fraction thereof, to and inciuding �25,000
$349_75 for first $25,000 ptus $9.00 for each additional �1,000
or fraction thereof, to and including ��0,000
$574.75 for fu-st $50,000 plus $6.25 for each adaitional
�1,000 or fraction thereof, to and inciuding $100,000
$887.25 for first $100,000pius $5.00. for each aciditional
$1,OOO�or fraction thereof, _to and including $500,000 -
$2887,25 for the::fust :$500,000 pius $4:25 for each .addifional • � ;.i
$1,000 or fraction thereof, to and including $�i,000,000 '-
$5012.25 for the fust $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCRO�'V �
(Concrete C1irb Streets Only) �
�lternate "A"�: Removal and replacemet�t of curb and gutter only - Dri�e�vay width plus G feet times $13:50_
�lternate "B": Removal and replacement of cnrb and gutter and install a 3 foot wide
approach witil b incE� depth - Driveway width pius 6 feet times $15.7�.
VERIFICATION OF F4UNDATION
E'crmits for construction wiil be issued a minimum of 24 hours from the tin�c of application to a11ow ior pro��i-
�cvie�+� ot� ttie pro�oscd stiucture and of ttie constcuction site.
'� �Lcrtilicate of Si�rve�� <�f� tl�c I�i, :SliowinR the location of thc founrlatinn �»ace it }�as it �t�a� ��c�n'cc�nslt-ucii:.{
: t, � r�c�t�ir�.:cl l��t<>r�e i�s����.�:�din„ t��iti� tl�c fr:�miit�.
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« 3
CHIlVINEY AND STACK VERIFICATION �
The undersign�d �ereby verif es, that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rusf or deterioration Yes O No O
3. Has no foreign objects lodged within Yes O No O
4. Is secureiy supported Yes O No O
5. Meets all current Code requirements for size
and total BTU's connected Yes O No O
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes O No O
8. Has combustion air been provided for water heater Yes () No ()
Remarks: .
`, .
List ALTERA,TIONS Being Done:
HEATING CO:
Signed By:
Date: �
sus�6tr P
C�ty of Fridley 3 i 7 5 0
�
AT TNE 10P OF TNE TWINS g �� � p 1�� P E R M i T
� � ��� ��O �y RECEIPT NO.
� ; V ��.��
COMMUNITY DEVEIOPMENT DIV. - `�, CJ� t/ ��
r � �� pROTECTIYE INSOECTION 5@C.
i . .
� � /'�'1 � CITY MAL� fRIDIEr 55132 NUMSER REV OATE PAGE OF APGROVED 8�
��-�'�"� �'' 612-57�-3450 9�aF�s 4/19/O1 � �
!OB ADpRESS 52gg Fillmore Street 13E
1 LEGAI �OT N0. 810CK TRACT OR ADDITION SEE ATTACHEO
oescR. 1 1 Marion Hills lst Addition SMEET
2 PqOPERTY OWNEFi MAIL AODIiES$ ZIP PHONE
Tom Skovran 5298 Fillmore Street NE
3 CONTRACTOR MAIL ADORESS Z�P pMONE LICENSE NO
Tabor & Sons Inc 10547 Terrace Rd, Blaine, M13 55434 612-789-1902
4 ARCNITECT OR OESIGNER MAlL ADORESS ZIP PHONE LICENSE NO.
20014248
5 ENGINEER MAII AODRESS � ZIP PMONE IICENSE NO
6 USE Of BUIIDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR � MOVE � REMOVE
8 DESCRIBE WORK
Reroof flouse & Garage (22 Sq) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE Of CONST. OCCUPANCY GiiOUP OCCUPANCY lOAO
SEPARA7E PERMITS ARE FiE�U�REO FOR EIECTqICAL, PLUMBING, HEATING,
VENTILATING OR AIR CON01710NING
THIS PERM17 BECOMES NULL ANO VOID If WORK Ofi CONSTRUCTtON ZONING SO. fT CU FT.
AUTHORIZED IS NOT COMMENCED V�!ITHIN 60 OAYS. Op IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEa fOR A PERIO� OF 120 DAYS AT
ANV TIME AF7ER WOAK IS COMMENCED. NO OWLG. UNITS OFFSTREET PARKING
I MEREBY CERTIFV THAT I HAVE READ ANO EXAMINEO THIS APP�ICA710N 1 STA��S GARAGES
AND KNOW TME SAME TO BE TRUE aND COiiRECT. ALL PROVISIONS OP IAWS yALUATION SUfITAX
ANO OpDINANCES GOVERNING TMIS 7VPE Of WORK WILI BE COMP�IE�
WITM WME7HER SPEC�FIED MEREIN Op NOT. 7HE GRAN7ING OF A PERMIT �2 s 2SO � 1. 12
DOES NOT PRESUME TQ GiVE AU7HORITY TO VIOIATE OR CANCEI THE PERMIT FEE SAC CNARGE
�ROYISIONS OF ANY OTHER STATE OR I.OGA� LAW REGUTATING CON- @83..25 Fire SC �2.2.5
S UCTION OR TNE PEFfORMANCE Of CONSTqUCT10N •Y
-� � p�� �/ PIAN CHEC Ef TOTA�FEE
�O`'�Z 1 � ��' � ( cens SC $ .0 $91.62
S�GN�TUQEOFCON"N1ICTOAOp�UTNOQ�IEDAGENt �D�TE� EN ERLY A A7ED 7HIS I UR,PERMIT
!
S�GasiUpE O� OWNEQ��F OwNEpBU��DEA� � � iD��E� �DG MS� ' OhfE
�'i
NEW []
ADDN (]
ALTER [ ]
Construction Address:
�����.
�y�Q ��� Effective 1/1/2001
CITY OF FRIDLEY `'' (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
-- � f
Legal Description:
Owner Name & Address: —� S 'V `� Q Te�. #
Contractor: �d�oY a r�c�i. �OrS �� h C • MN LICENSE# aO � I�c�� g
Address: � D S �{ �—�42 � Y� ac� �-c� ��0. + r e_ Tel. #((o t�� �R� � I 90 �}...
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the p�oposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Wdth Height Sq. Ft.
Length Width Height Sq. Ft.
Width Hgt/Ground
�,� S 4 �.�� C
Sq. �t.
� � d ��
Construction Type: oo��� �� Estimated Cost: $ u---�vv .'"��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
� n �� Tel. #��t 2� �? g4 -/ 9a 2_
DATE: �I - r c1- O � APPLICANT: "
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ c�°���5^ Fee Schedule on Reverse Side
$ � � .001 of Permit Valuation (1/10th%)
$ /. /a- $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ e� - ('O $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 [ )
$ a
,-
��
�
BUILDING PERMIT FEE SCHEDULE
The Ctuef Building O�cial 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. SO
$23.50 for first $S00 plus $3.05 for each additional $100 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, 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 iust $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 tunes $15.50.
Alternate "B": Removal and replacement of curb and gutter and 'u�stall 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 Certificate of Survey of the lot, showing the Iocation of the foundation once it has it has been constructed wi11
be required before proceeding with the framing. New Houses Onlv
• r,,.
. , t
sue,,ecT ERMIT NO.
City of Fridley 2 7 0 4 9
/ , AT THE TOP Of THE TWINS g U I L D{ N G P E R M I T NO.
�
,�
COMMUNITV OEVELOPMENT DIV. r � � �
r � L r � PROTECTIVE INSPECTION SEC. ��
� �
l� _ �
-_-_�,�/'�','� CITY HALL FRIOLEY 55432 NUMBER REV DATE PAGE Of APPROVEO BY
i 612-571-3450 9t0-F15 8%7/98 � %
109 ADDRESS 5298 Fillmore ST NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR, 1 1 Marion Hills lst Addn. SHEET
2 PROPER�Y OWNER MA�L ADORESS IIP PHONE
Helen Skooran
3 CONTRACTOfi MAIL AD�RESS Z�P PHONE LICENSE NO.
Twin CIt Exteriors 9060 Zachar Ln N -
♦ AIiCMITECT OR DESIGNER MAIL ADpqESS 21P PHONE IICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PNONE LICENSE NO.
6 USE OF BUIl01NG
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Storm dama e Re air-- west side onl
9 CHANGE OF USE FROM TO
ST1PUlAT10NS
TYPEOFCONST. OCCUPANCVGROUP OCCUPANCYLpAD
SEPARATE VERMITS ARE REOUIRED FOH EIECTRiCAL, PlUMB{IJG, IiEATING,
VENTILATING OR AIR CONDITIONING.
TNIS PERMIT BECOMES NULL AND VOID IF WORK OH CONSTRUCTION 20NING SQ. FT. CU. FT.
AUTHORI2E� IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUGTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UN1TS OFFSTREET PARKING
1 HEREBY CERTIFV THAT I HAVE fiEAD AND EXAMINEO THIS APPUCATION STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVVSiONS OF LAWS VA�UATION SURTAX
ANO ORDINANGES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING Of A PERMIT SOO . SO
DOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OR CAtJCEI THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY O�HER STATE OR LOCAL 4AW HEGULATING CON-
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION. Z1.00 Fire SC .SO
PLAN CHECK FEE TOTAL E
LIcens .
S�GNATUFEOFCON'RACTOpOAAUTHOp�2EDAGENT IDA7E1 N P OPE • LI ATE �S IS UR PERM17
- �_��_
SiGNnTUAEOFOWNEanFOWNEaBU��OER� IDATEI g�� �NgO paTE
NCW
ADDN
ALTER
[l
[l
[J
ConstructionAddress:
Legal Description:
Owner Name & Address:
Contract�
Address:
CITY OF FRIDI,EY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1 / �97
�� �
�'I �1
�
Tel. # ���_S S-� a
ENSE # v���'�~
Tel. # �p� � �7��_
LIVING AREA:
GARAGE AREA:
DECK A,REA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRII'TION OF IlVIPROVEMENT
�ng� Width Height
Length Width Height
Length Wid HgtlGr
_ -� Fs� � ��� �)�.�
Sq. Ft.
Sq. Ft.
Sq. Ft.
/
Construction e: ' �
TyP Fstimated Cost: $ � ���
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ -$
�
DATE: �-_� APPLICANT: Tel. # `7�S � �%3�%
� . CITY USE ONLY
Pemut Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� �l ��
$ ��
$ ��
$
$ S v��
$
$
$
$
I�
/
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuadon
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors}
Alt. "A° or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Deterniined by Engineering
Agreement Necessary f] Not Necessary []
.
-
Building
Inspections
763-572-3604
763-502-4977 FAX
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No.: ,—'��
Re��
�
Date Rec'
DATE ��Z�-�U � YOUR E-MAIL ADDRESS
SITE ADpRESS ,SlZ �/I' ��L� MO�r f T �� ��/ %,L/ � %`�I /N �� f�� l
THIS APPLICANT IS: �OWNER OCONTRACTOR
PROPERTY
OWNER/
TENANT
CONTRACTQR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERMIT TYPE
TYPE OF WORK:
NAME: O`�I S�� U (/%l�/v
ADDRESSSZ �%O F�L< /�%O%1/� fT CITY /C�/�G�'/ STAi'E� �`LIP-���
PHONE: ?� � S� 72 . S Z Z � 6�2 -�'Z - 7/d'S
NAME:
STATE LICENSE # EXP DATE
STATE BOND # EXP DATE
ADDRESS: CITY STATE ZIP
PHONE
❑ SINGLE FAM{LY
❑ NE W
DETAILED DESCRIPTION OF WORK
❑ TWO FAMILY
❑ REPLACEMENT
{/�L v� /Q/
FAX
O TOWNHOUSE
FEES ARE BASED ON S10.Oa PER FIX'fURE, EXCEPT WHERE NOTED. FIXTURES: (IND[CATE TOTAL NUMBER OF EACH BELOW). MINIMUM FEE
$35.50.
BATH SI1dK/LAV FLOOR DRAINS SHOWER
� BATHTUB GAS PIPING (NEED CITY LIC) SWIMMING POOL
� CLOTHES WASHER KITCHEN SINK i WATER CLOSET
`DISHWASHER _ LAUNDRY TRAY WATER HEATER (S35)
WATER METER
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
WATER PIPfNG
_ WATER SOFTNER ($
_ BACKFLOW PREV. $1 )
FOR lRR1GATION
_ OTHER
I hereby apply for a plumbing permit and [ acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance
with the approvedplan in the� f all work which req ' s review and approval of plans.
SIGNATURE OF APPLICANT NT NAME/ �v�� r T '�-.j
--. ��'�.(liP.�%� DATE S�Z �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, NIN 55432
763-572-3604
FAX: 763-502-497?
June �0, i968
Mik�s 0'�annan
� �298 8illmore St. N. E.
Fridleq, Minnesota �5421
i;ear T�1x�. 0'B��an:
I h�ve noticed that you haye a�ot cosapleted Che electrical
al.t�rata+rc�sas you �tarte�t some time a;go.
This must i�e campletec� �n a r�:a�onable lean$th �f t3me. Ii
you have aay quegticm� �.�a regard Co this plea�e co�tact me i�n th� office
la�etaa�e� � �d 14 � . I�i.
LE/bks
�1a�*r� ;.���;� :�:�a�r�,
i,�t}A1a"�$�3 EiGi3NiIi,L��
Electrfcai Iraspectur
City of F'rfdZey