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BLOCK TRACT OR ADD�TION SEE ATTACHED DESCR. 3G A.S. #92 SHEET 2 PROPERTYOWNER MAILADDRESS ZIP PHONE Rod Johnson 1646 Gardena Lane N.E. 3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO. Darrel Lien Roofing 4802 104th Avenue N.E., Circle Pines 55014 4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING Residential � cu►ss oF woRK ❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE 8 DESCRIBE WORK , Reroof house 9 CHANGE OF USE FROM TO STI PU LATION S TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD $EPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, pitch/Grave VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. , NO. DWLG. UNITS 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 �`2 � OOO �`�..00 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- ].2.00 STRUCTION OR THE PERFORMAN E OF CONSTRUCTION. $ G� PLAN CHECK FEE TOTAL FEE $13.00 IGNATUREOFCONTRACTORORAUTHORI2EDAGENT (DATEI WHEN PROPERLY VALIDATED THIS IS YOUR-PERMIT � - �X�(.J � � ' � - SIGNATUREOFOWNEFi11FOWNERBUILDERI IDATEI BLDG INSP DATE APPLICATION FOR RLSIDL'NTIAL, ALTERATION, OR AllllITION BUILDING P�R1�4IT � CITY OF FRIDLEY, MINNESOTA , ? � � � OWNER' S NAME : � �`i'Cn � -✓�- BUILD�R: �G�i� �-�.�-� AnD�SS : �la �/G .��c,��.__ ��':� I�� nDx�S S : �� °` �� Y �,v.� ��,� � ��' ,� -� � -�`- s`��, � NO :. �(.O �` (D STREET : C� �c./I c2.e� C�. • CCi�,�,� LOT: � � BLOCK : ADDITION : i� � � � 9 �--� CORNER LOT: INSIDE LOT: SETEACK: SIDEYARD: Applicant attach to this form 7.tao Cextificatcs of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be Used As : /�� - ILUU � U,S� Front : Depth: Height• Square Feet: Cubic Feet: Fxont; Depth: Height: . Square Feet• Cubic �eet: � `��`� �� Type of Construction: - Estisnated Cost: _ � . To Be Completed; �'r` �,� �1 The undersigned hereby makes applicativn for a permit for the work herein� specified, agreeing to do all work in stiict accordance with tlie City of Fridley Oxdinances and rulings of the Department of Buildings, and hereby declares that all the facts and repxesentations stated in this application are true and corxecC. _ � f��- � DATE : �� .a � �' � SIGNAT[1RE • � �/ G�.� � �;/�'--' ' (See Reverse Side Eor Additional Infvrmation.) � � �` � U f• �9 � / �" " �� I d t ..--� � � • � �� . K' � BUILDING PERMIT �FEE SC}IEDULE SECTION 2. The Inspector of Buildings shall, before issuing pextnits for the erection of any building ox structure, or for any addition to any existing building or structure, or for any alteration or repairs 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 i.n the manner herein provided to-wit: UNIFORM BUILDING CODE; Type 1, 2& 4-$2.15 for each one thousand cubic feeC, -or fracCion thereof, in such cubical contents. Type 3& 5-$1.85 for each one thousand cubic feet. ' ADDITIONAL INFORMATION For the purp�se of computing fees for building permits, the cubical contents o£ any building or addition, is dete�nined by multiplying the ground area cavered from a point six (6) inches below the floox line of the basement ox the cellar to the average heights of the upper surface or to the avexage� •height of the roof surface of the main gable of a pitched roof. For repairs or alterations to an existing structure, .the fee shall be at the ra.te 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 fee charged for any permit as set foxth in Section 2 be less than $5.00. • VERIFICATION OF FOUNDATION NOTE; Pexmits for construction will be issued a minimum of 24 hours from the time of application, to allow for proper review of the proposed structure and of the construction site. A Cextified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required bei'ore proceeding with the framing. CERTIFICATE OF OCCUPANCY Application for a Certificate of Occupancy shall be made ten (10) days prior to the use or occupancy of any structure for which a building permit has been issued; and said structure shall.not be used or occupied until a Certificate of Occupancy has been issued. � � . . � - �, y. .. . _.. _. � . �^.*„°�i . `�, � �� sue�ecT MIT NO. City of Fridley 2 5� 21 AT THE TOP OF THE TWINS g � I L D I N G P E R M I T r ; � RECEIPT NO. � ; y _ COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. �� ' i ' � /"'1 � CITY HALL FRIDLE� SS43Z NUMBER REV DATE PAGE OF APPROVED BV �""� � �'� 612-571-34b0 9t0-F15 ZI25/98 / / J08 ADDRESS 1646 Gardena Avenue NE t LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. Pt 36 Auditor's Subdivision �i�92 SHEET 2 PROPERTY OWNER MAIL ADDRES$ 21P PHONE Harriet Johnson 1646 Gardena Avenue NE 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Roof Desi n Partner's LLC 4026 7 St NE Columbia Hei hts MN 55421 20004817 4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO. 789-6566 5 fNGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING Residential 7 CLASS OF WOHK ❑ NEW ❑ ADDITION O ALTERATION (� REPAIR O MOVE O REMOVE B DESCRIBE WORK Reroof Garage Flat Roof (Rubberized Membrane) Repair 9 CHANGE OF USE FROM TO STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REOUIRED FOH ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WOFiK IS COMMENCED NO. DWLG. UNITS OFFSTREET PARKING I HEREBY CERTIFV THAT I HAVE fiEAD ANO EXAMINED THIS APPLICATION 1 STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $475 �.SO WITH WHETHER SPECIFIED MEREIN OR NOT. THE GFiANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqM1T FEE SA CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION R THE PERFORMANCE OF CO TRUCTION. �LL.00 rB SC �.�FH PLAN CHECK F O AL FEE , - ns SC $ 00 $26.98 SIGNATUR OFCON'RACTOAO UTNOA� DA ENT � pT � HE P VA ED THIS IS VOUR PERMIT ' � � � d . SiGNATUREOFOWNEFiifOWNERBUILDERi IDATEi �!8 G�NSP �1t�TE NEW ADDN ALTER [] Il �� ConstructionAddress: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION � Effective 1/1/98 Legal Description: Owner Name & Address: j_%� Y r��t .� p�n�c� n Tel. # Contractor: 1�j ��n � ,� ( ,� � n r� �(,� c��l'� �1 ' � � � � . � MN LICENSE #�� l81 ' % Address: L/i� n� �� `% � �� • ��n Tel. # r%8� (r S �� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. LIVING AREA: GARAGE AREA: DECK AREA: OTHER: DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length Width Hgt/Ground Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: �J � ,� (,L�� - (-� � .✓�n � _ �(�"�L Estimated Cost: $ � ' % 'Jr� (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ nA�: a- �� 98 APPLICANT: � nn h 1a � Tel. #�/� 9- �� '�� Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Pazk Fee Sewer Main Charge TOTAL STIPULATIONS: $ �/ o0 $ � (� $ �c`� $ $ �.00 $ $ $ $ $ ��°�8 CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,OQ0 Valuation $1000 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 [ ] . BUILDING PERMIT FEE SCHEDULE The Chief Building O�cial shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 to $500 $501 to $2,0(}0 $2,001 to $25,000 $25,001 to $50,000 $50,�1 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,0(}0 or fraction thereof, to and including $50,000 $574.75 for first $50,0{}0 plus $6.25 for each additional $1,000 or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1,0(10 or fraction thereof, to and including $1,000,000 $5012.25 for the first $1,000,000 plus $2.75 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 $13.50. 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 $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. . _ �, sue�et� MIT NO. City of Fridley 29327 � AT THE TOP Of TNE TW�NS g U i L D I N G P E R M I T „ � � COMMUNITY OEVELOPMENT DIV. ' `� - a�oa f � � PROTECTIVE INSPECTION SEC. 1 � � � � /"'1 � CITY HALL FRIDLE� SS��P NUMBER pEV DATE VAGE Oi APPROVED BY �----� • •,� 612-571-3450 9�0-F15 4/28/99 / / JOB AODRESS 1646 GARDENA AVE NE 1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACNED oesca. PT 36 AUDITOR� S$UB ��'92 SNEET 2 PROPERTV OWNER MAIL AODRES$ ZIP PMONE Harriet Johnson 1646 Gardena Avenue NE 574-0690 3 CONTRACTOR MAIL ADORESS ZIP PMONE LICENSE NO J W Roofing 1227 B T ler St NE, Minnea olis, MN 55413 788-1069 9138 4 ARCHITECT OR DESIGNER MAIL AOORESS ZIP PNONE LICENSE NO. S ENGINEER MAIL AOORESS ZIP PHONE LICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW O AODITION O ALTERATION ❑ REPAIR ❑ MOVE O REMOVE 8 DESCRIBE WOI;K Reroof House (Tar & Gravel) 9 CHANOE OF USE FROM TO STIPULATIONS Install per manufacturer`s specifications. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAp SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR COND�TIONING. TMIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONING SO. FT CU FT. AUTHORIZED IS NOT COMMENCEO WITHIN 80 OAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERI00 Of /20 DAYS AT ANV TIME AF7ER WOqK IS COMMENCED. NO DWLG. UNITS OfFSTREET PARKING I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STA�LS GAflAGES AND KNOW TME SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VAIUATION SURTAIf AND ORDINANCES GOVERNING THIS TYPE OF WORK WII,L BE COMPLIED @ WITM WHETMER SPECIFIEO HEREIN OR NOT. TNE GRANTING OF A PERMIT �C �OOO �p3.00 DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CNARGE@ Pq IONS OF ANY OTHER STATE OR LOCAI LAW REGULATING CON• @ 112. 2S Fire SC �pC) .00 RUC ON OR THE PERfOR NCE STFiUCTION �' PLAN CNECK FEE TOTAL FEE ��-9"� License SC $5.00 $126.25 SiGNatuaEO ON• ACrO Op4UTMOp4E Ear iO��E� WMEN PROPER . VALIOATED 7H1S IS YOUR PERMIT / �!i S�GNATUpEO�OWNEA��FOWNERBU4DERi iOATE� B G�ti5� O�TE -- 1i �� . _- _ � [l [l [] ConstructionAddre, Legal Description: Effective 1/1/99 CITY OF FRIDLEY /\ SINGLE FAMII.Y AND DUPLEXES R-1 AN�D R-2 BUII,DING PERMIT APPLICATION �� `� rL _ � Owner Name & Address: ��. r r r � °°�' � t..,, ��o � Tel. #�� ! — � 6 �' � Contractor: , � � MN LICENSE # � i � � Address: 1 �' L �. � �S ��`Tel. # 7�S� - rd G�' , LIVING AREA: GARAGE AREA: DECB AREA: 01'HER: Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF IlVIPROVEMENT Width Width Width Height Height Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: �� ,��,-�� . '� � J ��' Estimated Cost: $ � �I QO (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: � � Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATION5: $ �/�. ��- $ �,�o $ � 0�0 $ $ � �ad $ $ $ $. $ /��. �.� CITY USE ONLY Fee Schedule on Reverse Side Tel. # - / .001 of Permit Valuaxion (1/lOth%) $.50/$1,000 Valuation $1050 per SAC Unit $5. QO (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] - ' ��- 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 application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE $1 : �; to $500 $501 to $2,�0 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,OW,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge} $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional$1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $SO,OQO $574.75 for first $50,000 plus $6.25 for each additional $1,0� or fraction thereof, to and including $100,000 $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof, to and including $500,000 $2887.25 for the first $500,000 plus $4.25 for each additional $1, 000 or fraction thereof, to and including $1, 000, 000 $5012.25 for the first $1,000,000 plus $2.75 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 Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. �._ _ . °