AF - 45246,
City of Fridley, Minn.
' �`' "''
.� _�.�._._.� �___._.
Date: --�
�i 1/� I
OWne -'f ,..,' " "=,1 .�!�f�t'.,G" .•^�_��1
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PEl�.�'iIT
N° 5559
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Address
Address .�..._._..___.__..___.._.._
�L C TtON O F �
� . _... .�.._. art of Lot ....._.......__.._.__.___._.._...._.-•---_..__----
Na ,���� .. Street .�-,� --• •• .:._ .. - •
. ` Block __..._......_..:.�..----__--.__.._---•• Addition or Sub:Divisian ._._.__�._..._____...._....___._._._.._.._.._----------__..—..—_
Lot..._........_.__. __--- .. .
Inside Lot ....._..._�----........_....._... Setback ._._.._.Y._.._._�..�_ Sideyard ..._........_..__.....___---_.._._.._..___. _. _._._
Corner Lot ___._...._._.__ _......___.._..�.._.
. • ....__._........_.__._..___..
. . ......_.__.— Foundat�on Elevation _____.._........._..
Sewer IIevatton _________._.._.._�----------.--...._... _..
DESCRlPTION OF BUILDING
To be Used as:
�ype of Constxuction
� �
�,�
�
Height .....�:_._..:.._.. Sq. Ft. _�.._..___. Cu. Ft _.._..._...._.._.. �(
Front ____....._.._. DePth --=-__�._.
eight __� �1. F� _._.....______
Cu. F� _..._..____.._.. ,
Front _.._.._..__..._ Depth _.._._� � I
��.�}/'} ... To be Completed ...___......_.._....._...__.._...._..__ ,
... ._._..__ Es� Cost ' ...1� ��-�••-__�__--- 1
.._....... ,
_.._.._...._.._.... �� ��
�s
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In consideration of thrdancenwith the descriP on above et forth and 'm eompliancedwithVallIP o� � of
{h� proposed work m ac o
ordivances of the cit7' of Fridley.
� ___._._---�---�------
�r.�
rmit is hereby S�� to_.�___.�---.._...—.....----
�n consideration of the payment of a fee of $.� •--�•-- �
In rmit is granted upon
_.,__ to construct the building or addition as described above. This Pe
the express condition that the person to w��o�y p� �ereof�shall Coxiform in lall respects to the o�o�b dings
done in, arowid and upon said building, repair and moving
Fridley, Minnesota regarchng location, construction, aiteration, maintenance, of � of the pro��ons oE said
wlthin the city limits and t.his Permit may be revoked at any time upon viola '
ordinances.
,�"%�=� Buil.din8 InsPecto�r
NOTICE: lumbin a: heating, sewer or wate*• ee wre to sss
This pe�mit does not eover fhe construetion, fnstallation for wirin9, P 9� 9
th� BuiWia9 taspeetor for separah parmits for fhese items.
4 �
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APP'�IC�ATION FOR M,OVIN:G pERMIT
No.
_ .. Fridley, Minn., l 19�,
. �
Insp�ector of Bu�idings, a - � �� .
6431 Univ. Ave. N.E.
The undersigned hereby makes application for permit to move building as herein specified, agreeing ta do a11
wark in strict accordance with the C'ity Ordinances and rulings of the �Depa,rtment of Buildings, and hereby de-
clares that all the facts and representations stated in this application are true and correc�.
Lot Block Additian
Present I.acation :
�3 �d � `�e:.�Q �.�-rl • � , ' � � , �
To maved to:
_
<����` ..-� ��� �- �!- �,
� , ,
Routing : _ ��� 11e�-�-�i ^
_%% .
Distance moved it.To be completed about �• `� 19�
�
Taxes paid? Estimated cost — Foundation and alteration permit numbers
Certification as to cast:
I hereby certify that the above designated building is worth at least sixty (60) pRr cent of the cost of a simi-
lar new building. �� � f h( �
Approved by:
Utilities Notified:
(Title)
(Title)
,� � —
�
Owner os
Water & Sewer Depa,rtment
Gas Co. (date
lVarthern States Power Co. (date
orthwestern Bell Telephone Co. (date)
Signed
� �censed Mover � -
(See reverse side for iasiructions)
Engineer
�� �
In the event that the moving germit is ta be apglied far by the owner or by any other person than the��icena�d
Mover, the following letter must be campleted antl signed by said mover:
Inspecto�'z of Buildings, Aate 1g_
6431 University Ave. N.E. , • ,
'� ` .r
Fridley, Minnesota `
�
Please issue the bearer of .this a.pplication, Mr
a permit to move building fram:
ta : to which I hereby authorize him to sign my name.
. Signed
Lice�sed Mover
GENERAL INSTR,UCTTONS
The following must be secured before maving permit will be issued:
1. A building permttt for new location of building to be moved. To obtain this building perrnit, the following is
required : ' .
(a) The building to be moved must be inspected for structural soundness by the building inapector. Phone this
office for inspection. SUnset 4-7470.
(b) A survey of lot to which building is to be moved. This survey must be rnade by a Iicensed surveyor.
(c) Tlte building and moving permit must be obtained at the same time.
2. Tax receipt ahowing that all real estate taxes due have been paid. Duplicate receipts may be obtained at Anoka
County Auditor.
3. Approval from, the Fridley Watex and Sewer Department showing that bills chargeable againat the property to
be moved have been pa,id and water connections have been discontinued at the curb line or at the main. (See
reverse aide of form,)
4. Approval frorn Fridley Director of Public Warks office approving routing.
5. Natification io, and signature of utility campanies. (See reverse side of form.)
(a) Minneapolis Gas Co., 739 Marquette Ave., Engineering Depaxtment, Fourth F1oor.
(b) Northern States Power Co., 15 South 5th Street, Application and Extension Department.
(c) Northwestern Bell Telephone Co., 224 South 5th Street, Business Office, First Floar.
11 2sa�ss � � • _, _ �
t. _
City of Fridley, Minn.
BUILDING PERMIT
„�,�..�,
N° 5565
�' . - /�
Date: _. ...;�� _�� � `_�! � _.__ � 1
t . �� �
._. ----.._... ..--�---- ____. �
Owner: . � w = :_._..� uilder ....__.. .._..___..._..__.__ ..
Address_._.__._.._._.._......_.._._...._..._....�.._..w..____-------_.._._� Address _...��_..._._._._.._.._:....�_�_:..---------•--------------__---._�._._..
,, �'L� ATION OF ING
No.�..� .F..�., Street _.._..�-w"���.�'?�'�'-.'���.s'� �-.:...•.• Part of Lot
Lot ..�...______.�.
Corner Lot _.___.
Sewer Elevation
Block
Inside Lot
Addition or Sub-Division
Setback _�______.__....__ Sideyard
..__..� Foundation Elevation ....._......._.
DESCRIPTION OF BUILDING
To ���nt +�� Depth ��' ,� Height � Sq. Ft. �� Cu. FL ����
�_�,
_. ......_..._._ Fro _____ pth Height �.—. Sq. Ft. _._...�_ Cu. Ft
.,..
1'ype of Construction _._.. � .._ Est, Cost .. i��w .. To be Comgleted _.—.�..___....
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 city of Fridley.
�...�._.�
In consideration of the payment of a fee of
permit is hereby granted
to construct the building or addition as described above. This permit is granted upon
the express coadition that the person to w�iom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, xnaintenance, re and moving of buildings
within the city limits and this permit may be revoked at any time upox �violat� o of the provisions of said
ordinances. r^, !?f i ,f ����
Inspector
NOTICE:
This p�rmit doa not eover ths construction, inshllation for wiring, plumbing. gas'�heating, sewer or water. Bs wrs to sa
th� Buildfny Inspeetor for separaro parmib for th�a� it�ms.
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cn���;�d ��„a <<�,�:
l<,�.
hlerlyn Ski.t� I
lnokt� Caunty, P
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APPLICATION FOR BUZLDTNG PERMTT
CITY OF FRIDLEX', MSNI3�StnA
Owner `s N�nc►e Builder
Address Address
LOCATION OF BUILDSNG
No. Street Part of Lot
Lot Block Addition or Subdiv3sion____,___
Corner Lot Inside Lot Setback____�,rSicle-Yard
SEVaER ELEVRTI�}N FOUNDATIOI�T ELEVATION
Applicant attach to thi� form Certif�.cate°of Survey of Zot and
propoaecl bui].cling ].ocation.
To be uaed as:
DESCRIPTI!?N OF BUILD�NG
Front� epth Height
Sq. Ft. Cu. Ft.
Front_,�__�___ Dep�th Height
Sq. Ft. Cu. Ft.
�
Type.of Construction Estimated Cos�
To be Completed
The ur�.der;signed hereby makes application for a permit �or the work
hereiri specitied, agreeing to do all work in strict accordance with
the City of Fridley Ordinances and ruling of the Department of Hui1d-
� ings, and hereby declares that all the facfis d representations
stated in this application are true and co �r��''ec� �
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(Schedule of F�e Co�ts can be faund oa the Reverse Sidej'��,c
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BUILDING PERMiT FEE SCHEDULE
� �. _ . � .
Section 2. Z'he �nspector of Buildings shall, before issuing any
permifi �or the erec�ion of any building or strueture, or for any
addition to any existing building or structure; or for any a].terations
or repairs to any e�isting building or structure, upon �tpplication
therefor, require the payment by the appiicant fcor such permit of
fees to the amount here,i.ri belvw set �orth and iri the m�nner herein
provided to wito ,
2,,,�. For any such permii ior the erection o� any fire-proo� building,
other than a garage, warehause, factory or grain elevator. or for the
erectian of any fire-proof_addition, for similar occupancy, to any
existing building shall be at the ra�e of $1.40 £or each one thousand
cubic fceet, or fraction thereoE, in such cubical contents.
2.2. For any aueh permit for the erection of any fire-proof garage,
ta�rehouse, facto�y or c�rain elevator, or for the erection�� o€ a�,y fire-
proof addition, for simi�.ar occup�ncy, to any existing'building shall
be at the rate ofc $1.25 �or each one thoua�and cubic f�et, classi�ied
as "�ireproo�" by Section 502 of the Minneapol3� Bui].ding Code.
HOUSES
2.3. For any such permit for the erection o£ any non-fireproof bu31d-
inq other than a garage, warehouse, factory or grain elevator, or any
non-fireproof addition, for similar occupancy, to any existing building
Permit $1.00 for each one thousand cu'bic feet.
GARAGES
2.4. For any such permit for the erection o� any non-fireproof
garage, warehouse, �actozy or grain elevator, or for the erection of
any non-fireproof addition, �'or simi�.ar occupancy, to any existiag
-bui�ding or for each such building or additian. Ninety Cents for each
one thousand cubic feet or �raction thereof, ir� th� cubical conter�ts
ti�ereof with a mi�iimum o� �4.Q0.
For thg purpose of camputing fees for building permits the cub3cal con-
tents of any building or'addition ta a uniform height throughout by
multipl�ing the ground area covared from a point six (6j inches belo�w
the floor line of'the bas�nt or cellar to the average height of the
upper surface or to t�e average height ofc the°roof surface o� the main
galble o� a pitched roof.
�?� Far repairs or alterations to an exist�ng structure, the fee
shall be at the rate o� $3.04 per each Fi�e Hundred Dollars 4$500,OOj
or �raction thereo� 3n the cost of all proposed work.
2� In no case ehali the fee charged gor any pesmit as set forth in
Sect3un � k�,�s less � $4.00. � .__., x �__
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Date:
a.33�.
`City of Fridley, Minn. ':
6431 University Ave N E Minneapolis Minn. 55432
. . ., ,
BUILDING PERMIT
August 4, 1972
Owner: .__.__Roger Frank � � B�d�, Same
___
Address 5512 Fillmore N.B. �,d�� Same
LOCATION OF BUILDfNG
No. _..._..5512.____ Street _._.___ Fillmore_St . N.E. Part of Lot
Pt 7& g -----• Addition or Sub-Divisian .__..��2�.�..4.�._`.�....�..�.�.�.�,..V�.�QR�2�
Lot .............._...._..._____ Slock _----....__:_:._._._..._.....--.--_.---.--•
Corner Lot X._..._....._.._...___ Inside Lot ....._.._._..---.___._..._._ Setback _.._._ Sideyard
Sewer Elevation ..._.__.��__.__.__.........:__:..r.._..._..._._. _.__ Foundation IIevation _�_r____._..__.._._..
DE5CRIPTiON OF BUILDING
Ta be v�a �:
. K/%F���-.-�.Garage ...___._ Frant __._.._2�'' . ne�tt� 24 � Height �0' � �. � 624 Cu. �^�. 6 , 240
_.._._...�--•-------�._..._.._.._...._.. Front ..__...__.�.� Depth ._ Height _.. Sq. F� ...,.+ Cu. Ft.
Frame Au ust 1973
Type of Construction �_._........__..._...____ ..........:...._ Est, Cost �._..�.s-�7�a�..._..___ To be Completed ____ .8
For Eagineering approval on public access to dedication.
Provide a hard surface driveway
Tn conaideration of the issuance to zne of a permit to constryct the building described above, I agree to do
#he proposed work in accordance with the description above set/;orth and in compliance �yith all pravisions �
q�dtnances of the city of FridleY• � I/ A
In consideration of the payment of a fee of �_23 .00 Roger Frank
$ __r_._.., permit is hereby granted ta
.�..... .___..._ ............._......__ to construct the building or addition as described above, This perrnit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all Wox'k
done in, around and upon said building, or any part thereof, shall conform in all respects •to the orclin�llCes pf
�'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of built7i21gu
}yithin the city ]imits and this permit may be revoked at any time upon violation of any o� the provisiona of Said
a�rdinances.
�
ding InspeCtOr
CLAR8NC8 BSLISLS
NOTICE:
This psrmit doas not eove� th� wnstruetion, instattdion for wiring, plumbing, pas h�atiay, a�wee or water. B� sun to s»
fhs Buiidinp Mspacta� for saparata p�rmits for th�t� it�ms.
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APP�ICATION POR RESIDENTIAL, A���ItATION,
QR AlllliTION �UILD�NG ��R�IT
CITY OF FRIALEY, MINN�SOTA
OWN� � S NAME : a � � �: f .2�i� 1�., BUiLDER • ���' � c =�- �'� /� �U %
, . � „�
�,,nrn�ss �, S � / Z- �; � �s►-, ��e � an�ss : S5 1 � �, L � .-�, �rc �:;
,. .
� � � .....� � .� ��.. �,,
�va .,s � 5 / Z. fi��T 1 � �- � � o �e � .
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�,OT ; 7�� BLOC K: ADDITION s h` �-^ Y S�� ��
CORNER LOT: � INSIDE LOT: SETBACK: SIDEXAR�?;�,,,,,,.,,�„^
,A,pp�icant attach to this forin Z�o Certificates of Survey of Lot and pxo�ose+d
buildiag location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Uaed As:
��� �
) ��� `�` �'" � ;� :� �` �,.� �- Front : ,i� �� Depth : � �i Height : % �
r—
Square Feet: Cubic Feet:
t
' Front • � Depth • �- �, Height : 1 �',
Square Feet; Cubic Feet:
',[�►pe of Construction: Estimated Coat: � " �' �j'
�o �e Campleted:
The undersigned hereby makes application for a perpuit for tt�e w��ck ���'��,�!
specified, agreeing to do all work in ettict accoxdaace with the C�ty p�
Ffi�.d�,e� Osdinancea and rulings of the Department of Buildings, and he�eby
d�claxee that a11 the facts and representations stated in this app�.�����on,
afie true and correct.
'
�AT�: �-�L���/ ff � 2., SIGNATITRE: �
, � � A� /
(See Raverae Side For qd,,diti � 1 Information.) ���� r� �
�` � � ��
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$UILDING PERMIT FEE SCHEVULE
��CT�ON 2. The Tnspector of Buildings shall, before issuing penuit� foz fih�
erection of any building or structure, or for any addition Co any existing
building or structure, or for any alteration or repairs to any e�isting
building or structure, upon application therefore, require the payme�t b� �he
app���ant for such permit of fees to the amount herein below �et faxth and i�
the snanner herein pravided to-wit:
TJNIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubi,c
�s�t, o� fraction thereof, in such cubical contents. Type 3� 5-�51..$� fo�'
each one thousand cubic feet.
ADDITIONAL INFORMATION
Far the purpose of camputing fees for building permits, the cubical contents
of aay building or addition, ie determined by multiplying the ground area
covered from a point six (6) inches below the floor lina of the basea►ent
or the cellar to the average heights of the upper surface or to the average�
height of the roof surface of the main gable of a pitched roof.
�or repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed wnrk.
r
Ir� no case shall the fee charged for any permit as set forth in Sectia� � be�
less than $5.00.
VBRIFICATION OF FOUNDATION
NpT�; Permits for eonstruction will be issued a minimum of 24 hours fro�t �'h�
�ime of application, to allow for proper review of the proposed structuxe a�d
qf the construction site.
A Ce�rtified Susvey of the lot, showing the location of the foundati4t�� c?#�c�+� ��
hss been constructed, will be required befo�e proceedin� with the fraat�tt��
CERTIFICATE OF OCCUPANCY
Appllcation for a Certificate.of 4ccupaacy shall be made ten (10) daqs p�C�,o�
��t the use or occupancy of any structure for which a building petinit has ����
issued; and said structure ahall not be used or occupied until a Certifiaa��
a� Occupancy has been issued.
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� � SUBJECT � .
City of Fridley
AT TME TOP OP THE TWINS BU I L D�� G P E R I� 1 I T
'��i �
� �
� ; L _�__� COMMUNITY OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 �
`..••� ��"' �,� CITY HALL FRIDLE� 55432 NUMBER aflv
i 612-571-3450 9t 0-Fi 5
�os Ao�Aess 5512 Fillmore 5treet N.E.
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
oesca. p� �� 7 g Aud. Sub. #25
2 PHOPERTY OWNER MAIL ADDRESS
R�ger Frank 5512 Fillmore 5treet N,E.
3 CONTqACTOR MAIL AODRESS
Same
4 ApCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
TE PAGE Of
.1�a9ta4 / /
�MIT NO.
� 17821
f s-� �%
APPRQVED BY
SEE ATTACHED
SHEET
ZIP PHONE
574-0356
ZIP PHONE UCENSE NO.
ZIP PHONE L�CENSE NO.
ZIP PHONE LICENSE NO.
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ AL7ERATION Q REPAIR � MOVE ❑ REMOVE
X
8 DESCRIBE WORK
ConStruct a 3Qt x 26` Detached Garaae
9 CHAN[iE QF USE FROM
TO
STIPULATfONS pxovide a h�ard s�ur�ace driveway. Convert existing gaxage to living
area upon completion o� new garage or obtain Special Use Permit � retain
existing garage.
�A�`��N�
��f °� '�t�'��ng caN locat utilitf�S
i���E�'i��NE - �CECtRlC .
��t�t1)RED BY cas �tc.
�A W
SEPERATE ����,,It� �
�EAitNG. PLU�Blt�� ����1����t� � �;:�w ��;4r -�,:.
� a�1J� Si,�{�,�
SEPARATE PERMITS ARE REQU�RED FOR ELECTRICA�, PLUMBING, HEATING, TYPE OF CONST.
YENTiLATING OR AIR CONDITIONING. iATOOC� FY'dlCl.�
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTHUCTION 20NING
AUTHORiZEO IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK �S SUSPENDED OR ABAN,OONEO FOR A PERIOD dF 120 DAYS,l4T
ANY TIME AfTER WORK IS COMMfNCED. N0. OWtG. UNITS
I HEREBY CER7IFY THAT I HAVE READ AND EXAMINED THIS APPIICATION ],
AND KNOW THE SAME TO BE TRUE AND CORREGT. ALL PROVISIONS OF LAWS VA�UATION
AND OFDINANCES GOVERNING THIS 7YPE OF WORK WILL BE COMPl1E0
WiTH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $8 743
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CAtJCEL THE pERMITFEE
PROVISIONS OF ANY OTHEF4 STATE OR I.00AL LAW REGULATING CON-
STRUCTION OR THE PERFOHMANCE OF CONSTRUCTION. $74, SO
OF CON7RACTOR R AUTNO ED AGENT IDA7E1
�� � .
�
1
OCCUPANCYGROUP OCCUPANCYLOAD
SO. FT. CU. F7.
OFFSTREE7 PARKING
STA��S GARAGES
SURTAX
$4.38
SAC CFiARGE
TOTALFEE
y�%$�g8
R VALfDATED THIS IS YOy R PERy11T
.��r~',r �1 � l � /���'i �f�c 1
K�w L ]
ADDN. [ ]
pLTER. [ ]
Construction Address:
Legal Deaaription:�
Owner Name & Address:
Contractor:_____
Address:�
LIQI�G ARBAs
(iARA6E 'AREA :
D8C1C AAEA :
OTHSR:
City oP Fridley
�R-1 J►ND R-2
Building Permit Appliaation
S.� l 2... ,� �
* c�.. � r�'t � �- ��
C. ��..
�-t
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t�
�
Attach to this applieation, a Certificate of Survey of the
lot, with the proposed construction drar�n on it to seale.
DBSCRIPTI�H OF IMPROYEMENT
Length Width Height _______r
Length �._ Width Z � Height �
Length Width Hgt/Ground
Effeetive 4/1/8u
� 7 —���
Tel.
Tel. # -
Sq. Ft.
Sq. Ft. ��
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd. Setback __ Side Yard Setbaek
�'M`� � Estimated Cost: $ �7 43 �$�
Type of Construction: --
Approx. Completion Date: „� ''�'' 2�
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: Baek Pa e for Explanation
See 6
q — .s�
DATE: .��f� (f�� APPLICANT: "~ Tel. � �
Permit Fee
Plan Cheek
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
?OTAL
CITY IISE OI�ILY
s ___ `�_�?. �O
� �r,..,
� �,3?3
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Fee Schedule on Reverse Side
25x of Building Permit Fee
�•50I�1,000 Valuation
�425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Nat Necessary [ ]
STIPULATIONS: .�
C~ll C��tc��.ruc- �o��Twr� �,e�n�2 � �.����ic� t3Por.�
EE,y rL �,u �.c� C� s�R-Ide rt.. Qr` (� ,'fi'�J �e,� vi-�.. C�s�
�u R �� i�� �,��,•? � G �an�
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Ct�PLft,� �
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BIIII.DING PSRMIT F8E SCHSDIILE
The Chief $uilding 4fficial sha11, before issuing permits for the erection of any
building or strueture, or for any„�addition to any existing building or strueture, or
for any alteration or repair to any'existing building or structure, upon application
therefore, require the payment by the applicant for such permit 4f fees to the amount
herein below set forth and in the manner herein provided to-wit:
Total Yaluation
Fees
=1.00 to �500.00 �10.00 {Minimum Fee is �15.00)
�50i.00 to �2,OOO.dO $10.00 for the first �500 plus �1.50 for each
additional �1QQ or fraction thereof, to and including
�2,040.
�2,001.00 to �25,000.00 $32•50 for the first $2,000 plus $6.00 for eaeh
additional �1,000 or fraction thereof, to and
ineluding $25,000.
�25,001.00 to �50,000.00 �170.50 for the first $25,000 plus $4.50 for each
additional �1,000 or fraction thereof, to and
including $50,000.
�50,001.00 to $100,000.00 �283.00 for the first $50,000 plus a3.00 for each
additional �1,000 or fraetion thereof, to and
ineluding $140,000.
�100,001.00 and up ��33.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIYEiiAY DEPRSSSION ESCROii
(Conerete Curb Streets Only)
. Alternate "A"s Removal and replacement of curb and gutter only - Driveway width plus
b feet times $13•50 �
Alternate "B": Removal and replaeement of curb and gutter and install a 3 foot wide
approaeh With 6 ineh depth - DriveWay Width plus 6 feet times $15.75
YERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of
applieation to allow for proper revie� of the proposed structure and of the
construetion site.
A CertiPicate of Survey of the lot, showing the location of the foundation once it
has been construeted Will be required'before proceeding with the framing.
� � .�
� . SUBJECT P NO. .
City of Fridley o 18624
AT THE TOP Of THE TWINS B U I L D I I w� P E R I- I I T
r
; ;, RECEIPT NO.�
� • COMMUtJ1TY DEVELOPMENT DIV.
' 1 � L,„ --�
� � PROTECTIVE INSPECTiON SEC.
1 � �
� � ���'1 � CITY HALL FRIDLE� SS432 NUMBEq REV. DATE �PAGE OF . APPROVEO BY
�..__.Jl: '•� 612-57t--3450 970-F15 9/2/86 / / ,
10B ADDRESS
5512 Fillmore Street N.E.
t LEGAL �-07 N0. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. p�, 'J�$ Aud. $ilj�. #25 SHEET
2 PROPERTY.OWNER MAILADDRESS ZIP PHONE
Sherily Frank 5512 Fillmore Street N.E.
3 GONTRACTOR MAIL ADDpESS ZIP PHONE UCENSE NO.
Hince Roofing 2071 Oakwood Drive, Moun"3s View, MN 55112 786-0526
4 AFlCHITECT OR OESIGNER MAIL ADDRESS tIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING .
esidenti�l
7 CLASS OF WORK
� NEW ❑ ADDITION C� ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dwelling - Tear off and replace
9 CHANOE OF USE FROM TO
STIPUTATIONS
Use 3 foot starter roll - 50 ox 907.1a test
1
i
SEPARATE PERMITS ARE NEQU�REO FOR EIECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPAIVCY GROUP OCCUPANCV LOAD
VENTII.AT{Nfa OR AIR CONDITIONfNG.
THIS PERMIT BECOMES NUII AND VOID If WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. µ0. DWLG. UNiTS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPUCATION STALLS GAPAGES
AND KNOW THE SAME TO BE rRUE ANO CORRECT. ALL PROVISIONS OF �AWS VALUATION SURTAX
ANO OfiDINANCES GOVERNING THIS TYPE OF WORK WILI BE CQMP�IED
WITN WHETHER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT $�. ZOO �. 6O
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON-
STRUGSION OR THE PERFO ANCE O ONST tiS`ZO. rJO
� PLAN CHECK FEE TOTAI. FEE
� g' � �6 sZ�.. io
S�GNAT EoFCONTRACTORO nurHOaiZEDn IDATEI �� - � WHEN PROPERLY UDATED THIS IS YOUR PERMIT
�C.G
~— SiGNATURE OF OWNEFI�F OWNER BU�L0EFi1 tDATE1 BIOG �NS �1aT
N� I ]
ADDh. [ �
qLTER. � �
Ccnstruction Address:
Legal Deacription:�
Owner Name 6 Addre s:
Contractor:--�����
Address: c�% �
G
City of Fridley
�R-1 AND R-2 �
Building Permit Application
t� ��/ /
i'
, #�`.�_� .
Attach to this applieation, a Certificate of 5urvey of the
lot, vith the proposed construction draWn on it to scale.
DESCRIPTIOA OF INPROYEMEI3T
Effective 4/1/8t�
Tel. �
Tel. � �Z��=�S'°�
LIVING AAEA: Length Kidth _ Height _____.__ Sq. Ft. _ _
GARAGE AREA: Length __ Width _ Height Sq. Ft. �
DECR AAEA: Length iiidth __ Hgt/Ground Sq. Ft.
___-__._..._.
OTHER:
Corner Lot [) Inside Lot [] Ft. Yd. Setback _________ Side Yard Setback _
,(%6' -�'� ��� Estimated Cost: � /°260. �c
Type of Construction: �.���—
Approx. Completion Date: 9^ �� 2�
Alt. A Alt B
Proposed Ariver�a�• width If NeW Qpening Is Desired: � �
See Back Page for Explanation
vZ " SG APPLICAhT: � Tel. � 7�'� ��0��
D�TE: ,�r
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Strrer !'iain Charge
TOTJIL
STIPULATIOt3S :
CITY OSE ONLY
� �C� . S O Fee Schedule on Reverse Side
$ 25i of Suilding Permit Fee
a � U �.50/�1,000 Valuation
� �475 per SAC Unit
� Fee Determined by Engineering
�
` �/.1U
�S
��-�b
Agreement Necessary j� Not Hecessary (]
_� a s T
BUII.DING PERI�SIT FEE SCHEDtTLE
The Chief $uilding Officia2 aha12, before iaauing permits for the erection of ar.y
buflding or structure, or for any addition to any existing building or structure, or
!'or any alteration or repair to any existing buildin� or strueture, upon applicatio n
therefore, require the paymenL by the applicant for such permit pf fees to the amount
herein below set forth and in the manner herein provided ta-xit: '
Total YaluaLion
=1.00 to �50Q.00
�501.00 to �2,000.00
Feea
�10.00 (Minimum Fee is �15.00)
�10.00 for the first �500 plus ��.50 for each
additional �t00 or fraction thereof, to and including
�2,000.
�2,Q01.00 to 525�000.00 332.50 for the first �2,000 plus �6.00 for each
additiona2 �1,000 or fraction thereof, to and
inc2uding �25,000.
t2;�d01.00 Lo �50,000.00 �170.5Q for the first �25,400 plus �4.50 for eaeh
additional �1,000 or fraction thereof, to and
including �50,000.
�50,001.00 Lo 5100,000.00 �283.00 for the first �50,000 plus �3,00 for each
additional �1,000 or fraction thereof, to and
SncludinE �100,400.
�100�001.00 and up
�433•00 for the first E1Q0,000 plus �2,50 for each
additional �1,000 or fraction thereof.
DRIDEIiAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
A2ternate "A": Removal and replacement of curb and gutter only - Driveuay Width plus
6 feet times $73•50
Alternate "B": Re�oval and replacement of curb and gutter and in�tall a 3 foot wide
approacr wfth 6 inch depth - Drivexa3� xidth plus 6 feet times 515.?5
VERIFICATION -0F FOUNDATI4N
Percits for construction will be issued a�ir.imua of 24 hours fro� the time of
aF•plication to allow for proper revieW of the pro�,osed structure and of the
construction site.
A Certificate of Survey of the lot, shoxing Lhe loc�tion of the foundation onee it
has been constructed Wfll be required before proceeding Wfth Lhe framing.
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:�fi�►�+���� � `�I`�+�f=Z�����=� :���
� -_,�
sue�cer PE
City of Fridley 3 0 005
AT THE TOP Of TNE TWINS g � l L D! N G P E R M I T
r
� .
� � '7 ! Q T
� ; y �. .. COMMUNI7Y DEVELOPMENT OIV.
f � � � PpOTECTIVE INSPECTION SEC.
� i .
� /'�'1 � C17Y MA�L fRIpLE� SS�32 NUMBEN pEV OATE PAGE O� APGqOVEO 8Y
����'�' �'' 612-5� �-3a5o 910-F15 8/4J99 / /
108 ADORESS 5512 Fillmore Street NE
t IEGA� LO7 NO. Pt � p IOCK TRACT OR AOOITION SEE ATTACHED
OESCR. O,tS 7 t SNEET
2 PROPER7YOWNER MAl1.ADORESS 21P PHONE
57 -0356
3 CONTpACTOR MAIL ADORESS 21P PHONE LICENSE NO
Owner
Y ARCHITECT OR �ESiGNER MAII, AODRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII A�DRESS ZIP PHONE IICENSE NO
8 USE Of BUIl01NG
Residential
7 CLASS OF WORK
O NEW O ADDITION � ALTERATION ❑ REPAIR ❑ MOVE O REMOYE
8 �ESCRIBE WORK
Frame wall in existing garage door o enin
9 CNANGE OF USE fROM TO
STIPULATIONS
Complete by 11%1/99 per Planning Commission - See Missy
TYPEOfCONST. OCCUPANCYGROUP OCCUPANCYLOAO
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PIUMBING, MEATING.
VENTI�A7ING OR AIR COND1710NING.
TMIS PERM17 BECOMES NULL ANp VOIO IF WORK Ofi CONSTRUCTION ZONING SO. fT CU fT.
AUTHOR12E0 IS N07 COMMENCED WITH�N 60 DAYS. OR IF CONSTRUCTION
OF WORK IS SUSPENOED OR ABANOONE� fOii A PERI00 OF 1p0 pAYS A7
ANV TIME AFTER WORK IS COMMENCED. NO. DWI.G. UNITS OFiSTREET PARKING
I HEREBY CERTIfV THAT I MAVE READ ANO EXAMINEO THIS APPUCATION � STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PqOVISIONS Of �AWS VAI,UATION SURTAX
ANO OFDINANCES GOVERNING THIS TVPE Of WOqK WILL BE COMP��ED
WITM WHE7MER SPECIFIED MEREIN OR N07. THE GRANTING OF A CERMIT ,�SOO . SO
DOES N07 PqESUME TO GIVE AU7HORITY 70 VIOLA7E OR CANCEL TNE pERM1T FEE SAC CMARGE
�ROVtSIONS OF ANY 07MEp STATE OR LOCAL LAW REGULATING CON•
STpUCTI OR TME �EpFpRMANCE OF CONSTRUCTION 23.5� Fire .SC . r'J�
PIAN CMEGK f EE �OTA� EE
N�TUAEOFCON7FACT0 Op�U�� QEOaGENr �O�TE� '�N OP AUOAiE HIS $O PER I
� ` ��
S�GN�IUAEOfOWN M OWNEABU�lOEAi �OAfE� g� � g qp
�
NEV�[ -}- _.
ADDN
ALTER
Effective 5110/99
I l C� OF �tID�Y
[] SINGLE FAMII�Y AND DUPLEXES R-1 AND R-2
M
BUILDING PERMIT APPLICATION
0�
� ba
�
�� ��
Construetian Address: � � �'2- � c..�rc o�z � � �
Legal Description:
Owner Name & Address:
Contractor:
Address:
LNING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
Tel. # � � ��' O �S�'.�,
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPR4VEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
Tel. # S `7f� �3 S.G
Sq. Ft.
Sq. Ft.
Sq. Ft.
�
Construction Type: _ ��,� �✓ l�,�C.� Estimated Cost: $ .�� � ��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: r' — APPLICANT: �� ,L_____. Tel. # � %� "� � ;�'�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
$�3,SD
$
Q r
�D s .��
$
$
$
$
$
$
_ � j,
.
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$lOSQ per SAC Unit
$5.00 (State Licensed Residential Cantractors)
Alt. "A" or Alt. "B" Above .
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: ����v����� � ��— f �. �9
Y
G��� ���SI�� � ���'
��"
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E
1
Sue�EC� PER .
City of Fridley 2 9 0 8
AT THE TOP OF TNE TWINS g� { L D I N G P E R M I T
�
� �
RECEIP NO.
� `v _ _ _ COMMUNITY OEVELOPMENT O�V. �O �
r � � �� PqOTECTIVE INSPECTION SEC.
� . �
i.--.�� �"'�'� CI7Y MALL fRIDIE� SS�32 NV►�BFa nEV O�TE v�GE OF �vnROVEO 8r
1 763-571-3450 s�aF�s 7j19/02 � �
J08 ADDRESS 5512 Fillmore Street NE
1 LEGAL ��T NO. BLOCK TRACT Oii AODtTION SEE ATTACMEO
DESCR. Pt ]�8 Auditor's Subdivision ��25 SMEET
2 PROPERTY OWNER MAIL AODRESS ZIP PMONE
Mary Jirek 5512 Fillmore Street NE 762-572-0737
3 CONTRACTOR MAIL ADORESS ZIP PHONE UCENSE NO
Nidwest Roofing 7385 Mark St Greenfield MN 55357 763-416-4804
1 ARCHI7ECT OR DESIGNER MAIL AOORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII AD�qESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 GIASS Of WORK
O NEW O ADDITION � ALTERATIQN � REPAIR 0 MOVE O REMOVE
8 OESCRIBE WORK
Reroof House & Garage (18 Sq) Tear-off
9 CNANGEOFUSEfROM T�
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTR�CA�, PLUMBING, HEATING.
VENTI�ATlNG OR AIR CONDIT{ONING
TMIS PERMIT BECOMES NUII ANO V�Ip IF WORK OR CONSTRUCTION ZONING SO. fT CU FT
AUTMORIZEO IS NOT COMMENCEO WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WOi;K IS SUSPENOEO OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCEO NO DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAV£ READ ANO EXAMINEO TMIS APP�ICATION 1 STAILS GAFAGES
ANO KNOW THE SAME TO 8E TRUE ANO CORRECT. A�� PROVISIONS Of LAWS VALUATION SUFTAX
ANO ORDINANCES GOVERNING 7HIS 7VP� OF WORK WI�L 9E COMPLIEO
WITM WMETHER SPECIFIED HEREIN Op NOT. TME GRANTING OF A PERMIT � 1� 929 �. 96
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATQ OR CANCEI THE pEqM11 FEE SAC CHAfiGE
�ROVISIONS OF ANV OTMER STATE OR LOCAL LAW REGUTATING coN- �69.ZS Fire SC �1.93
STRUCTION OR TME PERfORMANCE OF CONSTRUCTION
PLAN CHECK fEE �OTAL fEE
I,icens 5.00 $77.14
S�GN�TUAEOfCON7i111(;TOaOpAUT�+OA�2EDOGENT iD�TE� � N PR PERL IOATEQ�T S IS V UQ PEf�MIT
lJ i ���..
$�GNeTUQE O� OWNEA��� OWHEpBUi�DEp� �DATE� g�p( � V �Lit
we�cts
City of Fridley RM1T
AT T11E TOP OF TF1E TW�NS B�� L D I N G � E
� �
� �� ���� COMMUNiTY DEVELOPMENT DIV. ' -'�
� �' � PROTECTIVE INSPECTtON SEC.
r , ,
� . �
� t �"•1 � C�TY NALL fR10LEr SS�J2 NYM�Ep
�----�"� �'� 612-571-3450 9t0-F/S
lOB ADORESS 5512 Fillmore St NE
� �E6A� LOi NO. BLOCK TNACT OR AOOITION
oescr+. pt Lots 7, Auditor's Sul
2 PAOPERTY OWNER MAIL AOOpES$
Mary Jarak, 5512 Fillmore St NE, Fridley
3 CONTRACTOR MAII ADORESS
Midwest Roo:fing, 7385 Mark St, Greenfiel�
1 ARCHITECT OR OESIGNER MAIL AOORESS
S ENGINEER MAII A�ONESS
6 USE OF 6UIl��NG
Residential
7 CIASSOf WOiiK N� ❑ ADDITION C] ALTERATION ❑ REPAIR O MOVE O REMOYE
�
IIEV DATE ��
7I19/02 /
division ��25
ZIP
MN 55432 7E
21P
, MN 55357 76_
ZIP
i���
q O
,�/d �
pr ANIIOvEO sr
l
SEE ATTACMEO
SMEET
-572-0737
PNONE LICENSE NO
410-4804
PHONE IICENSE N0.
20010277
PHONE LICENSE NO
8 DESCRIBE WORK
Reroof (tear-off) - 18 squares
9 CHANGE OF USE FIiOM
STIPULATIONS
TO
Underlayment must comply with State Building Code.
TYPE OF CONST.
SEPARATE PERM{TS ARE REOUIRED FOR ELECTRICAI, P�UMBING. HEATING.
VENTIUTING Op Alp CONDITIONING
THIS PERMIT BECOMES NULL ANO VOID If WORK Op CONSTRUCTION ZONING
AUTHpR12ED IS NOT COMMENCEO W17MIN BO OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOfO OR ABANOflNEO fOR A PERIOD Of 120 OAYS AT
ANY TIM£ AF?Ep WORK IS COMMENCEO. N0. OWLG. UNITS
1 HEREBY CERTIiY TMAT I MAVE REAO ANO EXAMINEO THIS APPIICATlON
ANO KNOW TME SAME TO BE �RUE ANO CORRECT. ALl PROVIS►ONS Of �AWS yA�UATION
AND OApINANGES GOVERNING TNIS TVPE OF WOpK Wlll 9E COMPLIEO � j, 929 . OO
WITN WMETNEp SPECIf1EQ MEpE1N OA NOT. TME GRANTING Of A VERMIT
OOE$ NOT PqESUME TO GIVE AUTMOp�YY TO VIOIATE OR CANCEI TME pEqMIT fEE
pROV1510NS OF ANY OTHEf1 STATE OR IOCAL lAW AEGU�ATING coN• $69 . ZS
STpUCT OR TME PE MANCE NSTRUCTION
PLJ►N CMECK fEE
�CCUPANCYaROUP OCCUPANCYlOAO
SO. FT CU iT
OFFSTREET PARKING
STAIIS
License 5.00
S� U EO�CON" G pOp�u�MOp�ZED�GEN� ���rE� HEN FiOP
J
�O�TE� .
+ a
$.96
SAC CNAFlGE
Fire SC $1.93
�OTAIPEE
$j7.14
�"�"�...�...
Ali
a�
NEW (] CITY OF FRIDLEY Eifec6ve 1!1/2002
ADON [ j 6431 University Ave NE, Fridiey, MN 55432 (763) 572-3604 Bidg insp
ALTER [ J SINGI.E FAMILY AND DUPLEXES R-1 AND R 2
BU4LDING PERMIT APPUCATION
Construction Actd�ess: Jr s% a �i � � t'''�0 �� `� !
Legai Description:
Owner Name & Address: �+� G�a l� Tei. # � 6�-� �7� - C�7� !
Contractor. MN LICENSE # ��� �a�l
Address: ��a`�s ��� �l , ��;re�,�;"I�J ,�1itn� 5535�_7e�. # �63 -�-t Ib��l�d�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Ce�tificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRlPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length V�idth Height Sq. Fk
Length Vlfidth Hgt/Ground Sq. Ft
Construction Type: ��� ���`� Estimated Cost: $ rs'��U `� �
l, 9� °.�
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
OATE:
APPLICANT: Tel. #
Cal! (763) 5T2-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we wilt
cal! you fo� carrd number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ !- 2S
$ � 3
$ �9�
$
$ � h-n
$
$
$
$
$ �� 1�
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of PeRnit Valuation (1/10th%)
$.50/$1,OQ0 Valuation
$1200 per SAC Unit
$5.00 (State Licensed Residentiaf Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS:
�:r'.r�." .��
SUBJECT P IT NO. .
City of Fridley 3 3 8 3 4
AT TNE TOP OF THE TWINS g �� L D I N G P E R M I T
r
RECEIPT NO.
� . �
� � COMMUNITY DEVEIOPMENT DIV. : J/ �—
� �
� � L •+�+ � PFOTECTIYE INSPECTION SEC. ���,
� � �'�'1 � CITY NALL FRIDIE� SS�32 NUMBER REV DI�TE PAGE OF APPAOVEO 8Y
�""�'�� �'' 763-571-3450 910-Ft5 8/27/03 / /
JOB ADDRESS 5512 Fillmore Street NE
1 LEGAL �OT NO. BLOCK TiiACT OR AODITION SEE ATTACHED
oescA. Pt Lots 7, Auditor's Sub. ��25 SHEET
� PROPERTY OWNER MAIL ADORESS ZIP PHONE
Donna Henderson 5512 Fillmore Street NE 763-502-9551
3 CONTRACTOR MAIL AODRESS 21P PHONE UCENSE Np
Windows America 559 Shoreview Park Rd, Shoreview, MN 55126 651-203-0149
4 ARCHITECT OR OESIGNER MAIL AD�FESS ZiP PHONE UCENSE NO.
20248265
5 ENGINEER MAIL ADDRESS IIP PNONE LICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WOfiK
O NEW O AODITION 0 AI,TERATION � REPAIR p MOVE CJ REMOVE
8 DESCRIBE WORK
Replace three window5 within existing openings
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all
exterior openings.
Permit insp�ction Cards
Wiil �e Maifed
To Nomeowner i'o Post
7YPE OF CONST. OCCUPANCY GROUP OCCUPANCr lpAO
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING. HEATING,
VENTILATING OR AIR CONDI110NING
THIS PERMIT BECOMES NULI ANO VOIO IF WORK OR CONSTRUCTION ZONING 5�. FT CU FT
AUTHORI2ED IS N07 COMMENCEO WITMIN 60 OAYS. OF IF CONSTRUCTION
OR WOqK IS SUSPENOED OR ABANDONE� FOR A PER100 Of 120 pAYS AT
ANY TIME AFTEFi WONK IS COMMENCED. NO OWLG. UNITS OFFSTFEE? PARKING
I NEAEBY CEiiTIfY THAT I HAVE REAO AND EXAMINEO THIS APPIICATION I STAILS GARAGES
ANO KNOW THE SAME TO BE TRUE AND CORAECT. ALL PROViSIONS OF �AWS yALUATION SURTAX
ANO ORDINANCES GOVEiiNING THIS TVPE Of WORK WILI BE COMPLIED
WITH WHETHEA SPECIf1E0 HEREIN OA NOT TNE GRANTING OF A PERMIT �19000 �.SO
DOES NOT pRESUME 70 GIVE AUTNOAITY TO VIOIATE OR CANCEI THE pERM17 FEE SAC CHAFGE
PROVISIONS OF ANY OTHER STATE OR IOCAI, LAW REGUTATING CON-
STRUCTION OF TNE PERFOfiMANCE Of CONSTiiUCTION �38.,5,5 Fire SC �1.��
Vl,AN CHE K FEE TOTAL FEE
Lice e SC $5.00 $45.05
S�GN�IUAEO�CONTR��TQROp�UTMOQ�2EOAGENT io�rE, � EN PROPEaIY VAUOATED THIS IS YO PERMI
�
$�GN4IUQEO�OWNEA���OWNEpBU�LOEp� �04TE� - lOG i �Sp ����t
NEW
ADDN
ALTER
[}
tl �
il
Construction Address: �
Legal Description:
Owner Name 8� Address:
Contractor: ��
Address:J�J'r_9 �a__�?
L{V1NG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CiTY OF FRiDLEY
6431 University Ave NE, Fridiey, MN 55432
SINGLE FAMILY AND DUPIEXES R-1 AND R-2
BU{LDING PERMIY APPLICAT{ON
0
Effective 1/1/2003
(763) 572-3604 Bldg lnsp
(763) 571-iZ87 Fax
T��. # ��� -�� -4s5 i
MN LICENSE #� aoa�ga�S'
`o Tel. # IoSI ao� -0��9
Attach to this application, a Certificate of Su�vey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROV�MENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width HgUGround Sq. Ft.
Constnaction Type:� /1 ��-C Uu'l�l.t) U`�07,c_lS Estimated Cost: $��C'
Driveway Curb Cut Widtt► Need"ed: Ft: + 6 Ft = Ft x$ _$
. _ �G:Sr�
DATE: � APPLICANT: �• # ��� ���
Ca{I {T63) 572-3604 for Permit Fees if mailing in application. ax to 763-571-1287 if using credit ca�d and we will
call you for card number.
Permit Fee
Fire Surcharge �
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
CI'lY USE ONLY - �
o�� ��
$ �g�� Fee Schedule on Reverse Side ��'Y` ��
$ �� DO .001 of Permit Valuation (1I10th%) � �
$ � 5?� $.50/$1,000 Vafuation �- �
$ $1275 per SAC Unit
$ �=Od $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 ... .._...... $ . . 'Jr..V_ J __ _ . . _. gT1PULATIONS�- .. ..._
NEW
ADDN
AlTER
aoo� � d���/
�� C17Y 0� FKIDLEY Efiecdve 4/1/200d
t j 6431 University Ave NE, Fridley, MN 55432 (763) 572-360A Bldg Insp
�� SING�� EAMlLY AND DUPLEXES R-7 AND R-2 (763) 57i-1287 Fax
BUfLDfNG PERMIT APPIICATIUN
Consttuction Address:
�
Lega! Descripfion:
Owner Name & Address: `� o � v� c� � er� c� ��-s - Te�. # - a-�i 55 1
cont�ac�or. ' MN LICENSE #��- c�� J�� Y 7'
addnr±ss• oZ �.. (�— i �� J�J e, E' . 1�l ,�J� �C �. SS %d �I _TeL #�� �'�'% O� S�O
UVING AREA:
GARAGE Al�FA:
DECK ARFA:
OTHER:
Attach to this application, a Certificate of Svrvey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPftOVEMENT
�es�gt� Width Height � Sq. Ft.
Length Widih Height � Sq. Ft
Width
C�'�5 � L��
HgUGround Sq. FG
�E,r i �i/r � �1 �C r'Y1� S� �i'
Consiruction Typ�: �� sl ��►'1 �i A� Estimated Cost: � 9 c�-C� � d�
�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ =$ _
DATE: � < 7 .APP�.ICANT• ��Q��t•rl✓ Tel. # � �� %%G'- „J�,f �%G
Call (763) 5T2-3604 for Pe�mit Fees if maiting in appiication. F'atx to 763-57'l-428T ii nsing credit card and we wiil cati
you for aard number.
CiTY USE ONLY -
Permit Fee
Plan Review
Fire Surctaarge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
�rosion Contt'ol
Park Fee
Sewe� Main Charge
TOTAL
Ea�ze•d
$ * Z Fee Schedule on Reverse Side
$ 65°Io of Permii Fee
$ Z.00'I a€ Pem�it Valuatior� (1 i'i Oth°lo} .
iti I
$ $.50/$'I,000 Valuation
$ $1350 per SAC Unit
.$ _ � $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ � $450.00 Conservation Plan Review
$ � E=ee Determined by Engineering
$ A�reement Necessary (] Not Necessary [ j
$ ` sY�pu�-rroNS:
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