AF - 42305SUBJECT ,
City of Fridley 15 413
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T' -
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� `L ______ COMMUNITY DEVELOPMENT DIV. /� ! _ �+ ��
r j � PROTECTIVE INSPECTION SEC. `-! dC �'
� _ ; CQ �' _
i--_-� ��'���,'� CITY HALL FRIDLE� SS4$2 NUMBER REV. DATE PAGE OF APPROVED BY
i 612-577-3450 910-F15 / /
82479
JOB ADDRESS 1350 Fi.reside Drive N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 6 1 Flannery's �31{�.dIld �C�i.'L't1011 �S� $'H'Tf]�� SHEET
2 PROPERTY N • 0 A S i • • ZIP PHONE
Harold Johnson 1441 - 73rc1 Avenue N.Eo 784-6660
3 CONTRACTOR MAILADDRESS ZIP PHONE �ICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
s
5 ENGINEER MAILADDRESS ������� � R���� pHp�E LICENSENO.
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8 USE OF BUILDING ' � , , �,�+ '
Residential � �'�
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
x
S DESCRIBE WORK
Construct a 48' x 26' Draelling ar�d a 30` x 24' Garage
9 CHANGEOFUSEFROM TO
STIPULATIONS provide a hard surface drivernray. Provide sod in the front and side
yards. Provi,de City with copy of veri£ying survey.
SEWER LOCATION: �Approx. 9.5' Deep In Street) 83' W. of M.H. (Inve 885.36)
WYE E.LEV: 884.89 T�P OF FOOTIlVG: 888.00 Mini:mtun
WATER LOCATION: 10.3 � E. of SeFrer Service
DRIY�WAY DEPRESSION C�5T: � 18' + 6' x$15.75 =$378.00
LECAL DESCRIPTION: Also Kno4m As Part of Lot 15, Aud. Sub. #129
� .°n .o� ,� �,� ,�� �,� WARNIHG-
���'�'� ��; NI'rf�,.�� �� �� 8efo�e ��f18 u� lut�t atili#ies
� �1$A !� !p� � �� � �A�iG r �. iELEFMONE • EIEC�RIC - GAS Etc.
Y�Own'tby pvr�� Q�tr .r�� °�
oN ����O� �r n+� wFO�+nnoH REQUiRED �Y 1A1�
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILA�'ING OR AIFi CONDITIONING. WOOCI Fid�@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 124H �- %ZO 32,868 7.bta
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UN�TS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. 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 y�`4 %.� OOO y�23. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. yS`].3],e L.�% yS`425. OO
� PLAN CHECK FEE TOTAL FEE
� 32.87 612.84
SiGNATUREOF T ORO UT ORIZEDAGENT tDa7E� WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
�'S =��1-'�i �?; �l ' � ,�
SI TUREOFOWNERIFOWNER IL 1 IDATEI BLDG INSP �A
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CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL QUILDING PERMITS
(New, Alterations, Additions, or Repairs)
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OWNER: ___�-�,�(�i� ��� c�'°,�.�, BUILDER: �I21�oL� �10l�,�,�.�,�
ADDRESS: ��LLI,I ���� ��a� 1��1,� ADDRESS: ��I. �3�'� /�,�� [�, ,
TEL N0: ��Ir Cp� � C� ' TEL N0: ��� ��� (.�
. Construction Location
ST�T NO: � STREET: �� �� �' �.� � � (� 1�_
�'' LOT: � �p BLOCK: �� ADDITIOIQ: �� �A.t �f�°�4� ��t�L�RtD �O'{��`i1ON
� � [0 � � e!
Corner Lot: Inside Lot: _� Setback: � C� Sideyaxds: ���� 7
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOtd OF CONSTRUCTI0�1 _
���� Front: � Depth: � Height: �
Squa�e. Feet s �%r, �� Cubic Feet: ��, L� A y
. —�.
��,� � Front: � � Depth: � � Height: � �
5quare Feet: ��� Cubic Feet: � �� �
Type of Construction: ��t� �,���
7.b Be �mpleted: � c `�` \�'��
. ��
Estimated Cost: $ -
Alt. A Alt. B
l �O
Pro,pos ed>- Dra.ve�ra1 Wid_th �f I�ew Open ing Is Ues� red. , _ _ – . - - $ - �" $
SEE REVERSE SIDE OF SHEET'
The undersigned her.eby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares that ali the facts and
representations stated in this application are true,and corre�t.� '
DRTE: ��� ° � SIGNATURE:
Stipulations : USrL ��SC� ����'v �'S S>�'QLv�.J �� QF �_� C_� dd �
,�}+o .-r,�� r+csa l�tiaw A5. Pg-�� �r�
���* G et,oc�t� f- �. r}�►�, r� w.t �S ��A�. � 9�+0 �4
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P. � 3,'t,g��
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• BUILDIt�G PERt�1IT FEt SCHEDULE `��' ��
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SECTION 2. The Inspector ot }3uih.��ings shall, before issuing pexmits for the erection
of any building or structure, orqfo'r any�addition to any existing building or structure,
oz for any alteration or repairs to any existing building or structure, upon application
therefore, require the payment by the applicant for such permit af fees to the amount
herein below set forth and in the manner herein provided to-wit: �
� NEW CONSTRUCTION: Single F�nily Homes and Garages: $4.00/1,000 cubic L-eet. •
�X PLAN CHECK: 25 percent of buil,�ding permit fee.
DRIVEWAY D�PRESSION: (Concrete Curb Streets Only) '
• Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x�15.75
Alternate B: Removal and replacement of concrete curb and
. � gutter and instalZ a 3£oot wide approach with
` 6 inch depth; Driveway width plus 6 feet x$17.85
�� ��:�
:,, , :. , .� : .,
For the purpose of computing fees for building permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or th� cellar to the
averaqe heights of the upper surface or to the average height of tha roof surface
of the main gable of a pitched roof.
For 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 work.
Tn�no case shall the �ee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state suxcharge. �
� � � � �.►�' �1
NOTE: Permits for cons:truction will be issued a minimim► of 24 hours from the time
of application to allow for proper review of the pro,posed structure and of the
construction site.
A Certificate of Suxvey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framang.
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Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure £or which a building permit has been issuad; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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EXTERIGR ENVEL�JPE AVEI2P,GE "U" COMPUTATION
047NER �1 y^� , _ r--� � C....� �] ca �" \, ip`+ ."� <9 r ,
SITE ADDR�SS
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CONTRl�CTOR �_ r .y , � : _ . }. +. a l � .a , � ..-, I?ATE Lo ' I 2 -�l ( PHONE . '- `+ •.`,
S .�.� 4 �+:.> >-'y �
� Determine working square footage of each. .
l. Total exposed wall area . . . . . . ? ?. 4:�: � sq. ft. X �/ ���;
, I �'1 —._
2. Total roof/ceiling area ..... —� � � _
1 � �� sq. ft. X �C�=� � r'� t
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Total er.posed wall area wbcve floor - � �'
A. Total wall window area� .. . . . . . . . . . . . o . . . . . . . . . . . �_j �5;� %
B. Total door area ................e...........e... �-�
C. Totai_ sliding glass door area ................e. �}
D. Total fireplace wall area.......e..o........... �
E. Total wall framing ar�a (average 10�a)...........�'�l �_
r. Total net wall area �bove floor ..............., 1�^ y �
G. Total rim joist area ................e.....e.... e� �
Total exrose;l fou.7dation �rea - � �_�`
ii. Total foundation window area ................... �
I. Total net foundation �.re�: a�ove grade..........._ 1�� �
Determine "U" value of each wa1Z se<nnent.
, cl. � [�' i }( t�Ut� , a/�J _
---�-�.1.� _____ � I � �'�
b.�_"°' }► oUn � �..J <� _ �- !
C. 4 C,'� }( nUn -- /_ C} _ 2�
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d. �� y, ��Un �.� _ �`s
e o Z I _ x,�u,� �•� _ � 1
._____ _� _._� � 1
1• 1.�i �� X tti7ll -- jK... ,� '� _...�_� I'.�^"'-..4-�
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� h, C' X ��U�� '' _ C1
1. �.. 7 X����e L� �P — l�
� __L. ,..._____.. ^ .— -- — —
3 ..................................eTotal -- �` Z ���rt
_ _ . �--:;
If i�em #3 is t'�e sam� a5, ar less than ��_em #;1, you have met the inten�: of
SBC 6006(cj2.
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Total exposed roof/ceiling area = ��� V
j. Total skylight area ..............aaoa.ao�e.e...s.. �-°�
k. Total roof/ceiling framing area (average 10$)...... l�:_ :���
1. Total net insulated roof/ceilinq area .............. �I Z�
Determine "U" value for each roof/ceiling segment.
� . �_ X ��U„ ._.1 _ --�
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k. � �. � X ��t��e ,,,., .` ..J ._ � � � , � �
1. I i �. � X "U" � ., ` f �.. = cI "% , I �
4. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Tot�3]. _ -.-, �U • J Co� .
If total of #4 is the same as, or less �than #Z, you have met the intent of
SBC 6006(c?1. '
Alternate Buildin� Envelone Design
To utilxze the total enve?ope system method, the values established by the
sum of items #3 and tt� shall noi: be greater than the sum of items #1 and #2.
1. '���.� + 2. � � = Y g .�
3 . �'"'' � �. e �� -F � . �.,.� �.. c� _ _ � �.G' � � �
I hereby cerri��; that th:s pi;in, sn.�cir�c��i�
ar rc�crr ��,-as p;r•parrci I,y me u� un�!rr iny
,
direct �, -• i�;, n:����, rL.i� i:�in :z �'�.::y l�c��is-
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EAT LOSS CALCULATIONS
- ���,Q��n Jo`��5� - �
Nners Address
I
I� F I. ,� ��. R m. Lgth �,�� Wdth (p Hgt�
Windows and Doors — Cracka e and Area
� Desig. Wtdth Height INO. L�ttek. ArfY
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ilass (Desig. 1
;i �lass (Desig. 1
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' let Exp. Wall in�� 2 J
j let Exp. Wall �
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' 'otal Btu � 13 Z t$
, iequired sq. ft. E.D.R. or sq. ins. W.A. Leader Area
F I. 5 R m. Lgth. / fj Wdth. s H9 •
� Windows and Doors — Crackage and Area
�I Deslg. Wtdth Helght No. Lin. ft. Area
of ane of ane I hts crack s. ft.
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ADVANCED
HEATING & AIR CONDITIONING, INC.
7805 Beech Street N. E. Minneapolis, Mn. 55432
coaf btu
Infiltration (Desig. 1 A � ,� � � �
� Infiltration (Desig. !
Infiltration (Desig. 1
Glass (Desig. 1 �
Glass �Desig. )
Glass (Desig. 1
' Exp. Wall /C� � °j �'%o
Net Exp. Wall $ : �•3
Net Exp. Wall
Ceiling � �/� 3•�
Floor
`Total Btu �
Required sq. ft. E.D.R. or sq. ins. W.A. Leader Area
/�
Page of.
Phone: 786-4881
Builder
Job Name
Location
FI. t:p Rm. Lgth.'Z Wdth. �
Windows and Doors — Crackage and Area
�y19. Width Height No. Lin. ft. Area
of ane of ane I hts crack i
� a/�1� �/-o '�''- v 2 2� ! Co
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Infiltration (Desig. 1 2V `` � �
Infiltration (Desig. 1
Infiltration (Desig. 1
Glass (Desig. ) /CP ` �� �
Glass (Desig. 1
Glass (Desig. 1
Exp. Wal 13+ 1S. 5� x°l
� Net Exp. Wall
IVet Exp. Wall
Ceiling
Floor
� Total Btu
0
1���
1_--
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1_�—
� FI. co � R m. Lgth. J� Wdth. /C�, � Hgt
Windows and Doors — Crackage and Area
Deslg. Width Helght No. Ltn, ft. Area
pf ane t n� I hts crack i
� �e �, � -O ` -C� Z `LC� � LO
Infiltration (Desig. 1 � d
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Net Exp. Wall
Ceiling �` 7 �� � `� �
Floor � � '�•� ! � l /�
T..r�l R+�� V �O V
, � Page -� of
�� ADVANCED
�� HEATING & AIR CONDITIONING, INC.
,-f LOSS CALCULATIONS 7805 Beech Street N. E. Minneapolis, Mn. 55432 Phone: 786-4881
� �wners Address Builder
' a Job Name
i
; i � Location
j,j FI. �r� Z Rm. Lgth. 1�. S� Wdth./O. S Hgt� FI. v��Rm�. th. L�Vlldth. Hgt.
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�� , 30�3 0 3-c� 3—o a I J �i
coef btu coei btu
i � nfiltration Desi , a `/`` � Infiltration (Desig. ► `` SO`i
; �nfiltratio� (Desig. ) Infiltration (Desig. ►
nfiltration (Desig. 1
� � �lass (Desig. ) (� �c�
'� � �lass (Desig. 1
! ' �lass (Desig. )
� ! -
; ; :xp. Wall ��
f � det Exp. Wall (p.3
� � Jet Exp. Wall
i'�,
; ; ;eiling Z 3.�
� ° =1oor 1 Cv G •3
" { -otal Btu �
�a
'� iequired sq, ft. E,D.R. or sq. ins. W.A. Leader Area
` � FI. � % Rm. Lgth. Wdth.
Windows and Doors — Crackage and Area
Deslg. W�dth Height No. Lin. ft. Area
of ane of ane I hts crack s. ft.
��
Infiltration (Desig. ►
Glass (Desig. )
Glass (Desig. 1
Glass (Desig. 1
Exp. Wall U� la 1 x 5�= CooS - 8� S z Gv.3 � 30 (
r� Net Exp. WallU�$cOc x � r� � ,�
Net Exp. Wall� c, g��� /n3� 'Z .3Z.
(p C� Ceiling
� v� Floor c13 Z � b� _
;'J Cn 3 Total Btu 202�
+ , coef btu
infiltration (Desig. ) s �
'' Infiltration �Desig. 1
��
j Infiltration (Desig. 1
� j 31ass (Desig. 1 �— °
� Glass (Desig. 1
I 31ass (Desig. 1
�xp. Wall
�Net Exp. Wall �- �
{ Net Exp. Wall
p �ei�ing ' ` d� ,,�'} Z � 7
� nFloor
; Total Btu a '� Z �
" Req 'ireu d sq. ft. E.D.R. or sq, ins. W.A. Leader Area
;,
�. ,
Required sq. ft. E.D.R. or sq. ins. W.A. Leader Area
� FI. �g, Rm. Lgth. / Wdth. 7 Hgt,
Windows and Doors — Crackage and Area
Desig. Width Hatght No. Lln.4t. Area
of ne f n I s crack . it
�,Z 3-0 -o ab z
Infiltration (Desig.
Infiltration (Desig.
Infiltration (Desig.
Glass (Desig.
�QQ�
�_-
�
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� Glass (Desig. 1
Exp. Wall 7+/2f�� X/ o
� Net Exp. Wall
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�� Total Btu
C.�
�
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coef btu
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ired sq. ft. E.D.R. or sq. ins. W.A. Leader Area
.3 � ;SZ°l
� ',�"'
'� e,T LOSS CALCULATIONS
�9 fwners Address
�►DVANCED
HEATING & AIR CONDITIONING, IIVC.
7805 Beech Street N. E. Minneapolis, Mn. 55432
FI. Rm. Lgth. Wdth:
Windows and Doors — Crackage and Area
Desig. W�dth Height No. Lin. ft. Area
. n1 nann nf nano Inh4e rrar4 en f}
� ����
�
��
coef � btu
filtration (Desig. )
� filtration (Desig. �
� iass (Desig. )
� !ass (Desig. ►
ji �ass (Desig. ►
�<p. Wa I I �� L e�,
: �t Exp. Wall
> >t Exp. Wall ,� -
�iling •
� oor
� �tal Btu
s
�quired sq. ft. E.D.R, or sq. ins. W.A. Leader Area
FI. Rm. Lgth. Wdth
� Windows and Doors — Crackage and Area
+ Wldth Hei9ht No. Lin. it. Area
g D¢Si9. nf oane nf eanw lahtc rrarlc cn H
filtration (Desig. )
filtration (Desig. )
filtration (Desig. )
ass (Desig. )
ass (Desig. ►
ass (Desig. )
p. Wall
�t Exp. Wall
t Exp. Wall
iling
�or
+tal Btu
��quired�s q. ft. E.D.R. or sq. ins. W.A. Leader Area
Page of
Phone: 786-4881
- Builder
_ Job Name
_ Location
gt. FI. Rm. Lgth. Wdth.
Windows and Doors — Crackage and Area �
�5�9. Width Height No. Lin. it. Area
n9 nann M nann �..i.�� ...�..i. ... �a
coef I btu
Infiltration (Desig. )
(nfiltration (Desig. ►
Infiltration (Desig. )
Glass (Desig. ►
Glass (Desig. ►
Glass (Desig. )
— � S Exp. Wall
Net Exp. Wall
� Net Exp. Wall
Ceiling
Floor
j `��Z Total Btu
Required sq. ft. E.D.R. or sq. ins. W.A. Leader Area
Flgt. FI. Rm. Lgth. Wdth.
Windows and Doors — Crackage and Area
Deslg. Wtdth Hetght No. Lln, ft. Area
nf nano nf nanu InM4c ��ei-li �n 1!
coef I btu
coef f btu
Infiltration (Desig. )
Infiltration (Desig. ►
Infiltration (Desig. ) .
Glass (Desig. 1
Glass (Desig. ►
Glass (Desig. )
Exp. Wall �
Net Exp. Wall
Net Exp. Wall
Ceiling
F loor
Total Btu
Required sq. ft. E.D.R. or sq. ins. W.A. Leader Area
Hgt.
Hgt.
• r �F
. � . 4'','�-
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8431 UNIVEftSlTY AVEidIJE M.E., PRIDLEY, MIWIdESOTA 68432
17, 1979
.,.'� Mr. Harold Johnson
;�-- I.350 Fireside Drive tJ. E.
'.;;� Fridley, MN 55432
TELE�@10NE ( 812j671-3450
Re: Final Inspection at 1350 Fireside Drive NoE.
Deax Mr. Johnson:
A final inspection was made on December 14, 1979 of the above address
and the following items were noted which must be completed beiore the
structure can be finaled ouic=
1. Provide sod in the front and side yards by June 15, 1980.
2. Provide a hard surface driveway by June 15, 198d.
3. Post address n�mtbers on structure by January 1, 1980.
We will expect the above items to be completed by the scheduled dates
when reinspections will be made to determine c�npliance._ If you have
any questions on these itPms, please contact me at 571-3450.
Sincerely,
DARREL G. CLARK
Chief Building Official
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CHIMNEY AND STACK VERIFICATION
The wndersigned hereby verifies that tke existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioration Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4: Is securely supportsd Yes () No ()
3.� M�7s all cutrent Code requirementfi for size - �
and total BTU's conn� �es () No ()
6 Has total heating BTU's of
All other BTU's � . . . . � � .
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ()
8. Has combustion air i�en provided for water heater Yes () No ()
Remarks:
:,L ,. � .�: ,'_� �s, �E; i,��1
HEATING CO:
Signed By:
Date:
3uilding
nspections
763-572-3604
�
)ATE � � — � � �
iITE ADDRESS � -°'�a
i7-IIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATI�N
PROPERTY TYPE
PERMIT TYPE
�r�rnE oF wo�c:
BUILDING � ������
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
�°OWNER ❑COAITRACTOR
Permit No.:
R���ea By: s
Date Rec'd��
,�wnxESS: � a�� �����' �r �� �� � crrY��.� � ��°� sTA�'i►r�� � � �':°�
PHONE:�� � -'- � � �°i— Kt'v Ce2 �➢
STATE LICENSE il EXP DATE
ADDRESS: CITY STATE ZiP
PHONE
SINGLE FAMILY/NEW CI
TD✓O FAMILYMEW CON.
O ADDITION
0 BASEN�NT FMISH
��
� NEW
o n�un�vawc�,�
DESCRIBE WORK BEING
SIZE OF IlvIPROVEMENT
NUNBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminwn
❑ Ofher
FAX
ftUCT10N
CTION
❑ GARAGE/SHED
0 ROOF
❑ SIDING
0 SWDv�VID�1G POOL
O ADDTfION
O REMODELING
��� `��
�.r��rv a"'� I �f�
O HOUSE & GARAGE
❑ ATfACHED GARAGE
❑ DETACI�D GARAGE
OSoffit
O Trim
O Fescia
W WDOWS
IN E3�STMG OPENIl�TGS �Yes ONo LACATION OF WINDOWS
OR FOR NEW OPEMNGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIId�W TO BE INSTALLED NUNBER OF �
O DRA1N TILE
� OTf�R
� �Y' S4. Ft
BASEMENT REMODELING SUBNIIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of swctural members to be used
FOR NEW CONSTRUCTION INCLUDII�TG DECKS,
ADDITIONS. & PORCI�S SUBNIIT:
1. Site Plan/Survey showing the exisling struc4ues
and proposed pmject
2. Two sets of �ronstruction pians
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING TI� 1 97 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ a,S�,�FOCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surchatge
SAC Charge
Curb Cut Fserow
Emsion Control
Park Fee
Sewer Main Charge
Total Due
$ � e-� . t I
��
$ /.��
$
$
$
$
$
$
$ l�(1. 1 �
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: _C ytt of Fridley Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acl�owledge that ihe 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; that the work will be in accordance with the approved
plan in the case of all wo�l� which �ec}�r�i�re�qw and approval of plans. � �
SIGNATURE OF APPLICtuv i►����r_„_. PRIIdT AfAME I'��i�'�t;a� -��� rY��a� DATE ��
Page 2- Building Residential Applica.tion
BUILDING PERMIT FEE 5CHEDULE
The Chief Builda.ng 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 existi.ng buildin.g or structure, upon applica.tion 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 tawit:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the ti.me of application to
allow for proper review of pro�sed s�tructure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceedi.ng with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
.
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Building BUILDING Permit No.: aoo� -
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY �e �
DATE�� 2 I O� YOUR E-MAIL ADDRESS
srt�nnn�ss ,�3�� �1RCS�gE �i�
THIS APPLICANT IS: � OWNER OCONTRACTOR
PROPERTYOWNER/ N�: �y�p �
TENANT nnnxESS:_t350 ��2'CS1�.if� �2 CrrY �'�10�'{ STAT�NFLIP���
PHONE: ��'`�'� � '�s l°I — lP l��
CONTRACTOR N�:
SUBMIT A COPY OF STATE LICENSE # EXP DATE
YOUR STATE LICENSE ADDRESS: CTI'Y STATE ZIP
WITH APPLICATION pHONE FAX
PROPERTY TYPE INGLE FAMILY/NEW CONSTRUCTION SIZE
TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE � �DTI'ION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH �OOF ❑ DRAIN TII.E
❑ DECK ❑ SIDING ❑ OTHER
❑ SWINIMING POOL
�rE oF wox�: o� 0 ADDITION
MAINTENANCFJREPAIIt ❑ REMODELING
DESCRIBE WORK BEING DONE:�r�,,��o, r���,� �� (Z�p � 1�/s�
SIZE OF IlVIPROVEMENT LENGTH WIDTH HEIGHT S. Ft
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES � ,�iOUSE & GARAGE BASENIENT REMODELING SUBNIIT:
GARAGES ❑ ATTACHED GARAGE 1. Existing Floor Plan
PROPOSED SIZE: ❑ DETACHED GARAGE 2• �oPosed floor plaa
PROPOSED HEIGHT: 3. List of structural members w be used
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑�1Dyl O��t ADDTI'IONS 8c PORCHES SUBMIT•
�'v�� � T� 1. Site Plan/Survey showing the exisfing structures
❑ Other ❑ Fascia
and ProPosed Pro.lect
�pUK,g 2. Two sets of construction plaas
IN EXISTING OPENINGS DYes ONo LOCAT'ION OF WIlVDOWS 3• EII�SY ��°�aho°S
OR FOR NEW OPININGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
.�u.i. rr.�� Euc� ntiar.0 viv v[�.Un��V1V� 11Vl;LUlillV(i "lril�,' C:U,'1' UN' LABUR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $�, I 9� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
Total Due
$
$ 3, � 9
$ /. CQG
$
$
$
$
$
$
$ �1�,� .
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuarion
.0005 x Permit Valuation Minimum $.50 - "
$5.00 (State Licensed Residential Coniractors)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks paysble to: City of Fridley Attach 5tinul
TFIIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII. 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 Construcrion Codes; that I understand this is not a
pernut but only an appli tion for a rmit d work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all wo� , which u' rev and approval of plans.
SIGNATURE OF APPLICANT , PRINT NAME,�{�120L.i) V� ►��gp,�' DATE I Z � G
Page 2- Building Residential Application
BUILDING 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$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
includin $$25 000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fracrion,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or &action to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,�0 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 inciudin $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 framing. New Houses Onlv
City of Fridley
Building Inspections Department
, 6431 University Avenue N�.
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977