AF - 43620City of Fridley, Minn..
.�UILDING PERIiiIT N° 5 5 3 2�
Date: "`-��"'
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Owaer: Builder ���.�����_____
Address Address -
. � ��►TI�N O� F�DInIG � .�
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No. Street �� ._..�:_ Par� of �°'4'� ��.'
�,�'
Lot Block ..�_ _._.. Adc]ition or Sub-Division ��
Coraer Lot � Inaide Lot Setback '� # Sideyard �.����I
Sewer IIeva.tion ________ _ �oimdation IIevation
� DESCRIPTION'° OF BUILDING
T 3 Used
Froni � Depth � Heiglnt � Sq. F� +� ��Cu.. F't. �����+�
- nt _rL_.— Depth � Height y� .�r+ Sq. Ft. Cu. F�k y���
Type Constructtoa � Esi. �' �. To be Completed
In considerai3on of the issuance to me of a perazit to construct fihe building described above, I agree to do
the proposed work in accordance with the descript3on above set Porth and in compliance with all proviaions of
ordinanc� of the dty of Fridley.
�
In consideratioa oY the payment oP a fee of $.�� , permit is hereby granted to
to construct the buildiag or a.dditioa as described above. This permit is granted upon
the egpress condition that the person to whom it is gramted and lus agents, employees and worl�en, in all work
done in, around and upon said building, or any gart thereof, shall conform 3n all respects to the ordinances of
Fridley, Minaesoffi regarding location, construchon, altera.tion, maintenance, repair and moving o4 buildings
ordinances. dty limits and this permiit may be revoked �t anY�po� vi�latito�e�f any of the provisiona of said
�"�sl .� �
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NOflCE:
Ti�b permh does nof eove� the eeestrueHoe, testallatton fo� wirie�, plumbtne, pas heatieg, sswer e� water. Be wre 10 �
the Buildles lespeetor fo� separate permiii for thase items.
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APPLICATION �'OR BUII►DTNG PERMIT
C�TY OF L'RIDZEY, 1�1l�E30TA
4wner's Nam�.� Mr p �� �, ��--���-�:���-� Builder �-'�� °� �� ���,�`�
..=,..�,_ _- ._
114�.f. e �7 � i��r���'� � � l � � ii�1�0 i7 �7 F`�. �4 . �.�� �� 1�.!%'14./ ��" ' � r
f �
LOCATION OF HUI.�DI�Tt3
NO._ �` ,�„Streat ,.�!�,��_�,('"s��.�2 1�%-� P3rt Of LOt
� ����,F�
Lot . /� Block�,�_ Adc11t3oa or Subdivis�.on �4�_�-r-�, ��°'
Co�aer Lot Tnside Lo�t Setback -�L9 � S3.de-Yard -��
�EWER ELEVATSOIV FOUNDATION ELEVATiON
Applicant attach to thi� rorm Certi�icate of Survey o� Lot and
proposea building location. �
To b� used aso
l�l �� l
DE�CAIPTION OF SUILDING
�� Heiaht ��
� �� �
�' Sq . Ft . f'� ��__._. Cu . Ft .__._� ��
Front�,7�,�_De,p��h ' eight ,� �
S Ft . Cu . Ft . ���
4�
Type of Construc�ion Est�.mated Cos��
To be Completed
The undersigned here�y makes application for a permit �or t13e wo�k
herein specified, ac�reeing to do all work in strict accordance with
the City of Fridley Ordinar�ces and ruling o� the Depar�acneat of Huilcl-
ings, and hereby declares that al]. the facts and represeni:a�tions
stated 3n this ap�l�cation are true and correct.
�°'� .�-/ e�.
D�TE ��'� -� SIC�TURE��-- ?� w ./� `� /c�. �
F
(Schedule of Fee Costs ca�n be found on the Reverse Side).
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�UILD�LVG PERi�iIT FEE �CHEDULE
Sec�ion 2. The Inspector of Suildings shall� before issuing any
per�i� �or the erec•�ion of any building or structure, or �Eo�c any
addi�3on to any c��si:3ng �uilding or s�cructure, or for any alterations
or repa�.rs �to any �xisic�.ng bu�.lding or struci:ure, upon applica�tion
�here�or, require t'l1e payment by the apPlicant fo� such permit of
�ees �o the amount herein below set forth and in the manner herein
p�covided to wito
2.1. For any such pe�tnit for the erection of any fire-proo:� building,
o�er than a garaqe, warehouse, factory o�c grain elevator, or �or the
erection of any �3se-p�oo� addition, for similar occupancy, to any
exis�t�g buildin� shall be at the rate of $1.40 for each one thousand
cu�ic :�eet, or �rac�tion thereof, in such cubical contents.
2 a�. �or a.riy such perm��t for �the erecitioa of any �ire-proof garage,
warehouse, �acfio:�cy or grain eleva�o�c, or �or the erection or ar�y zire�
proo� ad�i�tion, �`ox si�nilaTC occupancy, �o any ex3sting building shall
be at the ra�te o� $]..25 for each one thousand cubic �Eeet, classiaEied
as "Zireprooi" by Sec�ion 502 o�.the Miz�neapolis Building Code.
fIOUSE�
2.3. For any such perm�.t for the erection o£ any non-f3repzoo� build-
i�g o�,her than a garage, warehouse, fac�ory or gra�.n eleva�or, or any
non-r�.gep�coo� addiiion, for similar occupancy, to any exisi:ing building
Permi�t $I. 000 for each one thousand cubic feet. �
c�GES � � /�
�
2sa. For any such perm3t for fihe erectio� oi any non�fireproo�f �.
ga�age, warehouse, �actory or ��a�.n eaeva�o�c, or for the erection of
any non-fi�eproo� add�ti.on, :�or similar occu�ancy, to any exist3ng
building or ror each such building o� adcl�Ltione Nin�ty Cen�ts £or each
one �housand cubic feet or fcraction �chereor, 3n th� cubical contents
thereof wi�h a minin►wn o� $9�v00.
For the purpose o� compu�cing fees for building permits the cubical con-
ten�s o� any builc��ng or addition to a unisorm height�throughout by
mult�.plying �the g�cound area covered irom a point six ( 6) inches belaw
�he floor line os �the basement or ce11a:� to the average height o�E the
upper surgace or to che average heigh� of the roof surface o� fhe ma�.n
gable of a pitched �coor.
2.5. For repa3..rs or alterations to an existing structure, the fee
shall be at `he rate of $3.00 per each Five Hundred Doilars ($500.00)
or �raction �thereor in �the cos�t o� all proposecl wo=k.
2.6 e �n no case sha11 the �ee charged ror any pesmit as s�t �orcth in
Se�t3on�2 be less th� $4.00. ^
_ � -
HARVEY A. CARTWRIGHT
ANOKA COUNTY SURVHYS
MENNfiPIN COUNTY SURVEYB
MINNEJ►POLIS SURVEYS
8410 PALM STREET N.W.
�UNBET 4-7BS$
OWNER
INDUSTRIAL — JUDICIAL
BUSlNE88 — TQP06RAPHICAL
•GITY LOTS — PLATTIN6
P�s. �.1e..�,nder
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CAR�G�T & OLS011T
LAND SURVEYORS
RE61aT6R&D UND6R LAWO OF BTAT6 OR MINNE80TA
LICENSED BY ORDINANCB OF CITr OF MINNEAPOLIB
326 PLYMOUTH BUILDING FEDERAI 8-8721
HENNEPIN AT 51XTH • MINNEAPOLIS 3. MINNESOTA
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COMBINING TME RECORDS OF
J. E. HILL, C�vi� ENGINEER
EBTABLlBNED IB96
C. F. SANDHOFF
CIVIL ENOINEER
E9TABLIBMED 1808
JAMES NELSON
SURVEYOR
ESTABLIBMED fY22
METROPOLITAN LAND
SURVEYORB. esTweusr+eo �ae�
Ir?v.;;�?2199
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HEAT LOSS CALCULATIONS DEPARTMENT OF BUILDINGS , MINN.I
Weatheratrips A.S.H.V.E. Construction No. Insulation
Guide
Windows I Doors Reference Out. Wall IInt. Wall I Ceiling I Roof I Floor Kind How Applied
Yes—No . Yes--No 19_
1 Fl• � L �y- Room � Length �Width ,�G'�° Height � I jj F1. ��,`�,' �� Room � Length �'.��. Width �� Height
Windows and Doors—Crackage and Area � Windows and Doors—Crackage and Area � ��
W9dth Height No. of Lineal ft. Area Width Height No. of Lineal ft. Area �
No, of paae of pane llghte of craek eq, fk � NO• of pane of pane lighrta of craek sq. ft.
/ � �°s � F��� �m , � ,`�?- � �� � � � e�f� �
� �9 � � � ��� �� ��� ���
� �.� � � �� �� ��
Coef Btu Coef Btu
Infi�ltration �� ��' „y�++ , "� � Infi�ltration � � �; �" �� •� �
Glass � � �`� � �i�"+�� Glass ,� ,��P� ��_
�p. .,,�ii � 9 � �° ,� � , �p. ,,,�i �� � � /' � .
Net ezp. wall ��' � � � � f�., �' Net esp. wall � � ,tJ � �! �' ° I
.I�'aJll �e � � A�^��,��, , � �'�' � Int. wall
Ceiling . �; � �' . - /�'� � � � � Ceiling . :+. �'�: - C��`�� /��� `� � C.� C�
F1oor F1oor
Total Btu. �'��3 ,� ; „� Total 'Btu. �'� �
Required aq. ft. E.D.R. or aq, ina. W.A. Leader area Re uired e. ft. E.D.R. or aq, ina. W.A. Leader srea I
Fl. (��+�/.�� ,,� Room � Length ��,, Width �9 `� Height � FI. ��;'� �� Room � Length ��i" Width A� Height �
Windows and Doors—Crackage and Area Windows and Doors—Crackage and Area
Width Height :30. of Lineal ft. Area Width Height No. oF Lineal ft. Area
No. of paae of pana lighta of crack eq. ft. � NO• oF pane of pane lighte of ctack aq. ft ��
�' I � s I � g I �'�. I S � I �$ ��'� ��-!� _ �'t� L - �— `��' ��.� �
�
Infi�ltration
Glass.
Egp. wall �� � �
Net ezp. wall
Int. wall
Ceiling r� �r�
��`: �
F1oor
Total Btu.
���� �
�ef Btu Coef Btu
,�' � �°�'� Infiltration ,y � � �� � � � �
�'� r? �'� � Glass � < � � ,� � � �
F.sp. wall � � �� �' � �. �''
� _ � 'jyf° Net esp. wall � � �
Int. wall
� c� �, � �+ Ceiling ! j �' /� � / . ��`
Floor
_ �/� �, Total Btu.
Required eq. ft. E.D.R. or eq. ina. W.A. Leader area Required e. ft. E.D.R. or aq. ina. W.A. Leader area
Fl. � /� �'�' Room � Length � Width ,D� Height � Fl. � B�/��`� Room � Length ,� Width ,f�
Windows and Doors—Crackage and Area Windows and Doors--Crackage and Area
No. �idth Height No. of Lineal ft. Area ,(�� � Vl�idth Height No. of Lineal ft. Area
of pane of gane lighta of crack eq, f!. `� NO• of pane of pane lighte of crack eq. f!.
�_ ,��" �- � � f � ���p�, -�--=�--�- �% °� `1
� r '
Coefl Btu
In<ration �!� ,: `� �
Glass
E%p. Wall ,�`�° �
Net egp. wal
Int. wall
Ceiling �_ R�
F1oor
Total Btu.
���' I��
ft E.D.R. or sa. ins. W.A. Leader area
� �l� �O
-.�z�—�
Height �`
� �'
���
� � Infiltration � ��' � �'
� � Glass � �'`�
Esp. wall � „ �°�'; _
�,;,� Net egp. wall e� �
—�—
Int. wall
r� � Ceiling ���? �' � � f�
F1oor �`
� � Total Btu.
Reauired ea. ft. E.D.R. or sq. ina. W.A. Leadar area
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sue�etT � PERMI
c�ty of Fr�a�ey 3116
AT THE TOP OF TNE TWINS g � I L D I N G P E R M I T
r
; � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV. / �
r ��' � PROTECTIVE INSPECTION SEC. T�� �
i = �
� /'��'1 � CITY HALL FRIDLE� SS13Z NUMBER REV DATE PAGE OF APiROVED B�
�"""'� � �'� 612-571-3450 910-F15
7/12/00 � �
J08 ADpRESS 128i Gardena Avenue NE
t LEGAL ��T NO. BLOCK TRACT OR AODITION SEE ATTACHED
DESCR. ],O 1 Gardena Meloland Gardens SHEET
2 PROPERTY OWNER MAIL AQORES$ 21P PMONE
Richard Alexander 1281 Gardena Av�ue NE Fridley, NIlV 55432 571-0899
3 CONTRACTOR MAIL ADDRESS Z�P PMONE LICENSE NO
Owner
a ARCMITECT OR OESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAII ADDRESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOFK
O NEW � ADDITION O ALTERATION pa( REPAIR O MOVE O fiEMOVE
8 OESCRIBE WOfiK
Reroof House and garage - Tear Off 22 sq
9 CHANdEOfUSE:ROM TO
STIPULATIONS
Underlayment,must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GiiOUP OCCUPANCV �OAD
SEPARATE PEIiMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION 20NING SO. PT CU FT.
AUTHORIZED IS NOT COMMENCED VtIITHIN 80 OAVS, Oii If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOii A PERIOD OF 120 pAYS AT
ANV TIME AF7ER WORK IS COMMENCED. NO DW4G. UNITS OFfSTpEET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GAiiAGES
AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PAOVISIpNS Of LAW$ yA�UATION SURTAX
ANO ORDINANCES GOVERNING TMIS TYPE OF WORK WILI BE COMPLIED
WITH WHETMER SPECIFIED HEREIN Ofl NOT. TME GRANTING OF A PERMIT $1,923.00 �.96
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEFM1T fEE SAC CMARGE
PROVISIONS Of ANV OTHEp S7ATE OR LOCAL LAW REGULATING CON-
STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION $69 • ZS Fire SC .��.. 92
PLAN GMECK FEE OTAI. FEE
$72e13
nru O�CON' ACTQROpAUTMOp�2E0 T iD�TE� W N P fiLV V 1 ATED 7M15 YOUR P RM��
� � '/� /
i NATUpEOCOWNEAiiFO EpBU�IDEp� �•rE� � �� y Ih �1GIE
N� I � Effecctivve 1/1/2000
ADDN [] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 � f`
BUILDING PERMITAPPLICATION Ir„ ��1.�
I lJ
Construction Address: _ �d1- (� � � R � q�p� Q � y.e— �l �i
Legal Description: �
c
Owner Name & Address: f%�� ,
Contractor. l�Jd,
Address: /��
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
�
Tel.# 5�7�—��`'r9
MN LICENSE #
�
Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
� �P d �-�� � � �� 4� �Cl�Gt R-c� o�� Sf.- �O �
-���- o �.� - , .
Construction Type: Estimated Cost: $ /, 9�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: P 4'D APPUCANT: � Tel. # ,�7 % � ^ � ��
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Call (763) 572-3604 for Permit Fees if mailing in application
$ 02�� Fee Schedule on Reverse Side
$ %. �� .001 of Permit Valuation (1/10th%)
$ �� $.50/$1,000 Valuation
$ $1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$
$450.00 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
$ ,/
.1
� -
BUII,DING PERMIT FEE SCH�;DULE
The Cluef Building Official shall, before issuing germits for the erection of any building or stiucture, 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 tawit:
TOTAL VALUE
$1 to $5(�
$501 to $2,000
$2,001 to $25,0�
$25,Q01 to $50,000
$50,�1 to $1�,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 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, tm 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,(�0 or fraction thereof, to and including $100,Ofl0
$993.75 for first $100,000 plus $5.60 for each additional
$1,� 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 first $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 times $15.50.
Alternate "B": Removal and replacement of curb and gutter and install 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 S�rvey of the lot, showing the location of the foundation once it has it has been constructed vvill
be required before proceeding with the framing. New Houses Onlv �