AF - 45184�
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City of Fridley, Minn.
BUILDING PERMIT
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Address Address
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N° '7090
� � � LO TION UIL�,I,NG
No. st�t ._. � _� —� - ��� ,,��� o t
Lot ��__ Block � Add3tion or Sub-Division
Corner Lot � Ine3de Lot 4� Cptback �-e Sideyard �� aSp- �� �
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Sewer IIevat4on .— � � � G�� � _�e�sIIev�iion �-� °� R �� ��
�, DESCRIPTION UF gU1LDING "
T Used
Front -�. Depth .�� Height � ���q. Ft � Cu. F't
Front � Depth I�eight `- Sq. Ft. ��� Cu. Ft " �
—�� ��.�—"�
Type of ction Fst, ,� � be Completed
Ea consideration of the fsauance to me of a germit to construct the building d cribed above I agree to do
tha proposed work in accrordance with the d�scrlptioa above set forth�r]d^ in com�ce wj��h af 1 provla�tons of
ordinaaoea oY the dty oE Fridley. �� //
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In consfderat[on of the paymeat of a fee of $�_ , permit is hereby granted to
to construct the building or addition as described above. This �ermit is granted upon
the egpress condition that thep�ao n to whom it fs granted and hia agents, employees and worl�en, in all arork
done in, azound and upon said huilding, or a�►part thereo� shall �nform in all reapects to the ordinQnc� of
Fridley, Minaesota regardfag 1� � y be revoked�at � time upc��� �of aay�of �viaiona of said
within the dty ]im�its and tbia
orciinaacea /1 n/I
Bulldtng' InspectQr
n NOTICCCa
'IYs p��mft do� not eowr ths eoeafrudioe, �SlalHfien tee �rGtae, plumbiee, en hadeg, aw�r er wder. B� wn to a�
iln Baildieg ImpKfoe tor pp�raM pwmHs for fh�a kuin.
HARVEY A. CARTWRIGHT
ANOKA GOYNTY 8�1RVBT6
NiNNEPIN COUNTY SURVEYS
MINN�APOL18 BURVEYS
6410 PALM STREET N.W.
SUweE7 478SS
4WNER
INDUST6t1AL — JUDICIAL
BUSINSBS — TOPOGRAPHICAL
CITY LOTS — PLATTtNG
S+ 1,., rF1....,....'7 : ...
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C�BTW�IGST & OLS011T
�AND SUR �'EYORS
RH�ISTERED UND6R LA1M0 OF BTATE OP MINNE90TA
LICBNYlD SY ORQiNANCi OI CITY OF MINNEApOLIB
326 PLYMOUTH BUILDfNG FEoERa� 8-6721
HENNEPiht AT StXTH • MINN6AP01.15 3. MINNESOTA
�9b�trbepor'g �ettiftcatc
71i
COMBINING THB RECORD6 OF
J. E. HILL, Gvl� EMGIN66R
¢BTABl18ME6 IsD!
C. F. SANDHOFF �
CIVIL EN6INEER
ESTABLISMBD tY06
JAMES N�LSON
3URVEYOR
EBTABLIBMED 102II
METROPOLITAIV LANkD
SURYErORS, EaTweusMeo �en�
r'—__� _ _ nr.A�!
_ I • '
I hereby c�rta�."y th•ut tl�.is is a true ancl car°r�c� rc�presenta�i�n oi a��ey ofs
Lot 7, �31ock 1' G�.rden� T•�ielol�.nd G�rdens
�s �vr�t'e�d b� m� -�his 9th. day of �lavember' 1962.
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APPLICATION FOR BUILDING PERMIT •
. CI7.'Y OF FRIDiEY,, . MINNESOTA . �
O�R'S NAi� BUILDER
ADDRESS • . . ♦ ADDRESS �
� � LOCATION OF SUILDING •
No. Stre�t .�^ , ._ P,art of Lot
Lot ' � Block . Addi,t3,op or Subdivision •
Coraer Lot Iaside Lot _SeCback , Side:Yard
SL+'WER ELEVATiON FOUNDATION ELEVATION • �
Applies.nt atCach to ei�is form Twa Certificate� of Survey of Lot and proposed build-
ing location draw,n oA tliese Certificatea .
To be used as;
DESCRIPTION OF BUiLDING
' � � F�ont Depth Height
Sq. gt. Cu. Ft.
� � � F'ront � Depth Height
. . .. . ,Sq., Ft. Cu, Ft.
Type of Constructiion � � Est3mated Coat• __
To be Completed ' �
The undereigned here6y makea application for a permit £or the wark,herein specified,
agreeing to do all work in atrict accordance with the City of Fridley Ordinances and
ruliags vf the Depaxtment ,of Buildings, and hereby declares that a11 the facts and
represeatationa aeated in �this application are_true �nd c rreat..- .
DA� ��-� I r� �- �� S�� v '
� Schedule of Fee Costs can be found on the lteverse Sid�).
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BUILDING PEP.�lIT EEE SCHEDULE
Section 2. The Inspector of Buildin�s shall, before iseuing any permit for
the erection of any building or structure, or for any addition to any exist-
ing bu3lding or structure, or for any alterations or repai=s to any esistiag
building or s�ructure, upon application therefor, require the payment by the
applicant for such permiC of fees to the amount herein below set forth and
in the manaer hereia provided eo-wit:
2.1. For any auch permit for the erection o.f anq fire-proof building,_other
than a garage� warehouae, factory or grain Elevator, or for the erectioa of
any fire-prooi addition, foz aimilar occupancy, to ang existing buildiag
sha11 be at the rate of $1.40 for each oae thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2�. For aay such permit for the erectioa of any fire-proof garage, wareliouse,_
factory or grain elevator, or for the erection of aay fire-proof addition,
for aimilar occupancy, to any existin� building shall be at the rate of $1.25
for each one thousand cubic feet, cla�aified as 11fireproof" bq Sectioa 502 of
the Minneapolis Building Code.
HOUSES � ��
2.3. For �ny such permit for the erection of anq aoa-fireproof buildiag other
than a garage, warehouse, factory or grain elevator, or anq noa-fireproof
additian, for similar occupancy, to aay exietiag buiiding - permit $1.00 for
each one thoueand cubic feet.
GARAGES
2„4_, For any such permit for the er�ctioa of aay aon-fixeproof garage, �
warehouse, factorq or grain elevator, or for the erectioa of aay noa-fireps�oo�f�
gdcUtt3.oa, �€or---similar occupaucy, to any esisting building or for each auch
_.�_-.--buildiag or addition - aineCy cents ($0.90) for each one thousand cubic feet
or fraetion thereof, ia the cubical contents thereof with a minimum of $4.OQ.•
For the purpose of cflmnputiag fees for building permits, the cub3cal conter�ts
of any building or additioa to a uniform hei�t�t throughout by multip�yin� the
ground area covered from a poiat si� (6) iaches below the floor line of.ihe
basement or ce118r to th� average he3ghC of the upper surface or to the
average height of the r�of surface of the maim gable of a pitched roof.
Z.S. For regairs or alterations to an existing structu�e, the fee shall be
at the rate of $3.00 per each Five fluadred Dollars ($500.a0) or fraction
theieof in tbe cost'of all proposed work. �
2.6 . In no ' case shall the fe�.char�ed; �or __a.np_ p�rm.{� .� Bet forth in
Section 2 be lese. thaa $4.00,
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CHI�i f�YEY AND STACK VERIFICATION
The undersigned �reby verifies that the existing chimney or stack:
1.
2.
3.
4.
5.
Has been �arefully examined
Is free fio�n rust or. deteriaration
Has no fortei�n obJects lodged within
Is securelyi supported
Meets all �urrent Code requirements for size
and total BTU's connected
6 Has total heating BTU's of �� ,�Q
All other $TU's ��', OQ �
TOTAL B�'U's 1 O�1. � O O
7.
E�
Has a line: been provided for water heater '
Has comb�tstion air been provided for water heater
_ �'�'�!� C_� t�' U iZ N�4C, �
_ � K 1 � ( 1�L� �� 'MP�L�S� l� �i�'�
List ALTERATIO�TS Being Done•
Yes � No ( )
Yes � Na ( )
Yes`�Cjl No ( )
Yes � No ( )
Yes�) No ( )
Yes �) No { )
Yes� No � )
HEATING CO:
Signed By:
Date:
0
sue�ECr P .
City of Fridley 3 3 5 3 5
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
�
; � RECEIPT NO.
� ; y _ __ COMMUNITY DEVELOPMENT OIV. ,� �� ^
r � • � PROTECTIVE INSPECTION SEC. ��i ��
1 . �
� � ��"1 � CITV HALL FFitOLE� SS��Z NUMBER pEV OATE PAGE Oi APVROVED B�
�"'"�� ��' 763-571-3450 910-F15 5/21/03 / /
108 ADORESS 6001 Gardena Lane NE
t LEGAL ��T NO. BLOCK TRACT OR AODITION SEE ATTACMED
oescA. 7 1 Gardena Meloland Gardens SFIEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PNONE
Don Lewis 6001 Gardena Lane NE
3 CONTRACTOH MAIL ADDRESS 21P PMONE LICENSE NO
D& B Home Im rovements 4901 105 Lane NE Circle Pines MN 55014 763-784-0922
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO
8 USE OF BUILOING
Residential
7 CLASS OF WOHK
O NEW O ADDITION O ALTERATION �] REPAIR ❑ MOVE O REMOVE
8 OESCRIBE WORK
Reroof H.ouse & Garage (25 Sq) Tear-off
8 CHANGE OF USE FqOM TO
STIPULATIONS
Underlayme�.t must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOii EIECTRICAL. PLUMBING, MEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT CU FT
AUTMOR12ED IS NOT COMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WOiiK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OfF$TREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION ], STA�LS GAFAGES
AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS yALUATION SUqTAX
AND ORDINANCES GOVERNING TMIS TVPE OF WORK WILL BE COMPLIED @
WITM WMETMER SPECIFIED MEREIN OR NOT. TNE GRANTING OF A PERMIT �Zy894 �yl e�FS
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL 7HE pEqM17 FEE SAC CMARGE
PqOVIS10NS OF ANY OTHER STA E OR LOCAL W REGULATING CON•
9�R TI N R T E�iFOFM9�1 E OF CON R CTION �83 . 25 Fire SC �Z .89
`f � PLAN CFIECK FEE TOTAL FEE '
i nse SC $5.00 $92.59
S�GNAT C • A T AOp M ii A NT 1 ATEi WMEN PROPEfiLV VALIDATED TMIS IS YO R PE IT
S�GN4TUQEO�OWNEA���OWNEpBU�LDEAi �D�fEi �g� i o �i E
NEW
ADDN
ALTER
[] CITY OF FRIDLEY Effective 1/1/2003
[] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address:
Legal Description: _
Owner Name 8� Add
Contra�tor.
LNING AREA:
GARAGE AREA:
�
Tel. #
MN LICENSE # . �
�Tel. # � � '
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
DECK AREA: Length
Hgt/Ground Sq. Ft.
• 1ZI�i.1lJ - ���rr�,��ii��s�l�� -
, /�.❑ i ! /
. . .-
�/ � ' ( I� j - . . � 17� � � —
Driveway Curb Cut �dth Needed: Ft. + 6 Ft = Ft x$ $
� � r
DATE: � I ` APPLICANT: - Tel. # �c � `�
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763�71-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ �3.��'
$
$ .
$
$ �� d �
$ �
$
$
$
$ �. �
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 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 [ ]
�iII��L�I���i
BUII.DING 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, irequire 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 $SQO
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEFS
$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.� for each additional $1,�0
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 $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,Q00
$993.75 for first $100,000 plus $5.60 for each additional
$1,IX?0 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additionai
$1,000 or fraction thereof, to and including $1,0�,0�
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
cuxB cu�r �,scxow
(Concrete Curb Streets Only)
Removal and replacement of curb and gutt�r only - driveway width plus 6 feet times $17.00.
Permits for constivction will be issued� a minimum of 24 hours from the time of application to allow for proper
review of the proposed struature and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the l�ation of the existing foundation will be required before
proceeding with the framin�. New Houses Onlv
�