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City of Fridley, Minn. �° 8840
BUILDING PERMIT
Date: M�y 19, 1966
Owaer: PAUL W. CARLSON �� SAME
AdBreas 1643 Gardena Avenue 1Q. E. Address
�ridley, Minnesota 55421
,�,���� LOCATION OF BUILDING
No. _,�", Street GARDENA AV.ENUE N'.E.� P� op �t E. 80' o� the South 150'
Lot 2� __ Hlock Addition or 8ub-Div�sion No..;92„ ex. the S. 30' of said Lot
Inslde Lot � �
�� �— g Setback ��.� Sideyard 10 an.d 22
3ewer IIevatioa _ 961. 00 IIevation -- �.��-. AO
TOP OF FOOTING �
DESCRIPTION OF BUILDING
To be Vsed ea:
DWELLING �t 48' �p� 26' g��t 20' gq. � 1 24.g �, � 24, 960
F�nt Depth Hefght _______ Sq. F't. Ca. F't.
Type oP Conetructton —� �, �_ 13 000 To be Completed e
SEWER LOCATION - 36' West of Maahole
WATER LOCATION - NO WATER SERVICE
In con�deratlon oP the issuaace to me of a permit to conatruct the buildin� described above I agree to do
the proposed work 9a aceordsace wlth the d�acription ebove set Porth and in complience wlth afl provlsfone oE
ordiaanc� of the aity oP Fridley.
Ia comaideratlon of the payment oP e, Pee o! � 25 . OU , permit 9e hereby graated to PAiTL W.
to conatruct the bu9ldir�g or additton ae described above. Thispe rmit is �raated upon
the exPrese aon�]ition thst theperson to whom it is graated and hfs a�ente� emplo�yees and worlmien, fn all w�k
doae in, around ead upon eaid building, or anypart thereo� shell conPorm in all respecte to the o�dinaaces of
Fr1d1eY� Mianesota ar�fn� lacatlon, conatruct[on� alteration, maintenance� repafr and movlag oE buildia�s
wt�� dty ]imits3aad th�s Permit may be revoked at ar�y tlme upon vlolatton oP aay of the provlsiana of said
��S �
!� NOTIC6r
Thb p�neU dea eof coru t6� aoeateuaHoe, te�taqnlon Ier vrirleo, P�uml+lnW Yp b�HnY. aw�� or wahr. � sun to a�
th� BotWl� le�o� io� apnara p�rmN� hr t6a� li�t.
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APFLICATION FOR BUTLDING PERMIT
CITY OF FRIDLEY, MINNESOTA
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a:.s F� _-..�<,.:� �.�?�.�� -._�
� LQCATION OF.BUTLDING
N0,_ /��. � STREET_ �r,���� PART OF LOT
LOT BLOCR ADDIT`ION OR SUBDIVISION
CORNER LOT INSIDE LOT�SET�ACR 'j�� / SIDE YARD / O� ,�� �
SEWER LLEVATION FOUIQDATIOIV �EVATTON
Applicant attach to this form Two CertificaCes of Survey of Lot aad propoaed
building location drawn on these Certificates.
DESCRIPTIb1Q OF BUiLDING
To be used as;
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%S/ �7?�-P Front_ �� Depth �� Height � � �
_ �
Sq. Ft. �o2'�d' . Cu. Ft.-3�y�°� � �'�' �' �k
Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction_�� Estimated Coat_ f�, �/%��
To be completed�_ f � � � —
The unders3gned hereby makes application for a permit for the work hereia
specified, agree3ng to do all work in strict accordance with the City of
Fridley Ordiaances and rulings of the Department of Buildiaga, and hereby
declare� that all the facts and representatione stated in this application
are true and correct.
DA'TE % �SIGNATORE �� .
(Schedule of Fee Costs can be found on the Reverse Side).
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BIIILDING PERMTT FEE S�'HEDULE
SECTTOft 2. The Inspector of Bt�ild,�.ngs sha11, before iasuing any permit for
. . �.:� .. .
the erection of'any building or atrueture, or for any addition to eny esisting
building or structure, or for any alterationa or repairs to any existing
buildiug or�structure, upon applicat�ion �therefore, require ehe payment by the
applicant for such permit of fees to.the amouat herein below.�et forth and in
the manner herein provided to•wit; ���
��.1. �T�'or any such pexcnit for th� nrection of any fire•proof building,
othei than a garage, warehouse, factory or graia eleva�or, or for the erection
of any fire-p`roof addition, for eimilar occupancy, to auy eais�ing building,
ahall be at the rate ,of $1.40 for each one thoueand cubic feet, or-fraction
thereof, in such�cubical contents.
2.2 For any such permit for tihe erection of anq fire-�proof garage,
warehouse, factory�or grain elevator, or for the erection of anq fire»proof
addition, for similar occupancy, to any exfsting building shall be at the
raCe of $1.25 for each one thousand cubic feet, classified as "fireproof"
by Section 502 of the Minneapolis Buildiag Code. �
BOIISES
2.3. For any such permit for the erection of any non-fireproof
building., other than a garage, wa�ehousa, factory or grain elevator, or
any non-fireproof addition, for aimilar occupancy, to any existing building - ,
permit $1.00 for each oae thousand cubic feet.
GARAGES
2.4. For� any auch permit for ehe erection of any non-fireproof garage,
warehouse, factory or grain. elevator, or for the erection of any non-fire-proof
addition, for s3milar occupancy, to any egisting buildimg or for each such
building or addition - niaety ceats ($0.90� for each one thous.and cubic feet
or f�racCion thereof, in the cubtcal contents thereof with the minimum of $4.00.
For the purpose of computing feea for building permit�, the cubical contenta
of any building or addition to a uniform height throughout by mult3plying the
ground area�covered from a point six -(6) inchee belor� the floor line of the
basement or cellar to the average h��ght of tha upper aurface or to the average
height of the �oof surface of the main gable of a pitched roof. .
2_5. For repa3re or alterat3ons to an existing structure, the fee shall
be at the rate of $3.00 per each Five Sundred Dollars ($500.00) ar fract3.on
thereof 3n the cost of.a11 proposed work.
2.6. In no case ahall the fee charged for any pernnit as seC torth in
Section 2 be less than $4.00.
STORM REPAIR DAMAGE FEES:
Residential; Estimated Cost of �»rk up to �5�0�00 - 55.�0
Estimated Coat of �avC1S o�e� ;:,:'=�.1.��J - $::L,�O
Co�ercial; Estima�c�Cost �f w��k u�_to ic�,;�=t�0 _ p,�'�0
1 _ ♦ •. r J
`� Eeti�t�,�. Cost of wu�k oier $�OC�.i3U -$�.,.G�
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1'a� Sct�u�e fr►z
R.qia...a und�r �a.r. of stor. o� M�u� .
- 1tOUTE N�. 4• ANOKA, MINN.
PNONE hAQR150N 1-1854
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C.ERTIFICAT� 0-F SUR-VEY
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l.EGAL DESCRIPTI4N
� THE E�ST 80 FEET QF' THE S4UTH 15tJ FEET OF L4T 24, AUDtTOt�`S
SUBDlVISIQN N0.82 tN ANOKA C4Uf�TY, MiNNESQTA, EXCEPT THE 30UTHERL.Y ��
30.fEET OF TH�tT PART OF ,SAtD L�T: 24 - � h�86y:c�rt�fy t1,ar o�, .y.,_t9�
A.�OVE b��CRiBED. : I surveyed the o` d scribed above ond thot the
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above plot -is a conect representaticn.of sai� survey:
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`-
NEW
ADDN
ALTER `
����� � �'�'�`�`�
[] CITY OF FRIDLEY Effective 4/1/2004
[] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
-`[ ] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fau
BUILDING PERMIT APPLICATION
Construction Address: l�D J.� (�'l�-�''�'tCh., f%/`{,d�.t�� /l/�'. __- --- j
Legal Description:
Owmer Name 8� Address: � -2� �,VL �d ('�.c�f- �5�1� a,r . Tel. # 7l�3°57l - Sq5 �-
Contractor. l'Vl� COYtS"fYu c�BVr MN LICENSE# 02�� 3�g78
Address: �b-7 I}2 rz.h�.�o.v'� �,; ��a�Le,`i 1�'�� 5��32 Tel. # 7(v� 785- 8�5/
LMNG AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Cert�cate of Sunrey of the
lot, writh the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length �(o , Width � 2� Hgt/Ground_� Sq. Ft �.
OTHER:
� -
Construction Type: ��%���- Estimated Cost: $ �� � J� a
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
�/�� � � Iv�e�+��
DATE: � � � -� 5 APPLICANT: �J'_V_� Tel. # ��P �J-7gS- � g c' l
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
� C����.�
$ �� I \
$ ,�,`i�
� I . ��
$
$ ����
$
$
$
$
CITY USE ONLY -
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
TOTAL $ � O � STIPULATIONS:
BUII..DING PERMIT FEE SCHEDULE
The Cluef 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 applicaxion 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 $2,0(�
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$1Q0,001 to $5�,�
$500,�1 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,OD0
$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,�
$643.75 for first $50,�0 plus $7.00 for ea.ch additional
$1,0(� or fraction thereof, to and including $100,Q00
$993.75 for first $1�,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,� plus $4.75 for each additional
$1,000 or fracdon thereof, to and including $1,000,000
$5,608.75 for the first $1,OOD,� plus $3.15 for ea.ch additional
$1,�0 or fraction thereof
CURB CUT ESCROW
(Concrete C�rb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
Permits for construction will be issued a minimum of 24 hours from the time of applicadon to allow for proper
review of the propcised stntcture and of the construction site.
\
> VERIFICATION OF FOUNDATION
A Certificate of ,�+iirvey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
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W
FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When reulacins� an existinct furnace, the undersigned hereby verifies that the
venting has �en examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes ( No ()
The venting system is plastic/PVC and meets all curren� codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existin� combustion air is sized and installed to meet the cuRent codes
and manufacturer's specificafions.
When required to install a new combustion air, it will be sized and installed
to meet the current code� and manufacturer's specifications.
Yes ( � No ( )
Yes (f.y� No ( }
Yes ( ) No ( )
When in��alli�t a tt��► �rentin�a svst,�m, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
s�ecifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes ()
Is the common vent and vent connectors sized and installed coRectly after
an appliance has been removed from the common vent and vented
separately as per current codes.
No ( )
Yes (� No ( )
Appliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type �- � BTU Input ld�e Fan Assisted or Nat ��
Appliance #2 Type �`C"'� \'�"lf BTU Input � �� Fan Assisted or Nat �
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances �--- Tdal Btu Inpu\' ��
Common Vent Type v�T Vent Height � S� Diamet �D inches
Appliance #1 Vent Connector Height � ft Length � ft Diameter in Type-� V� �
Appliance #2 Vent Connector Height � ft Length 3 ft Diameter in Type �T
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe) �l�a-� v � � �'C �
HEATING CO: ���� �� �� '� ��
Signed By: Date : � �- � � � ��