AF - 45428s
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City of Fridley, Minn.
BUILDING PERMIT
Date: - Au�ust 3, 1970
p�r; Tri-Co Builders g,�� Sam.e
Address 756�. Van Buren Street N.E. A� Same
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, ° 1077
;
LOCATION OF BUILDING
NO. �� S�i2e� --.I�� PT[!f)P i1'YPAf N_F_ Part of Lot
� 23, 24 _ gl� H Addition or Sub-Divisian Riverview Heights Addition
Corner Lot _ Inside Lot � X Setback __._ Sideyard ._._
�IIevattan _ 844. 53 _ � � - �1+7-.�a3—��1g��� T—.—
Wye Ton of Footine
DESCRIPTION OF BUILDING
To be Used as:
�ell�.ng� Front 37 � Depth 24 � Height 20 � Sq. Ft, 888' �, F•.t, 17, 760
F'ront Depth I�eight Sq. Ft Cu. Ft
Z�ie of Construcl3on - FraYe Fas� Cost _ 17 _ 0�__ To be Completed
SEWER �OCATION: 99' 1V.E. of Manhole
Verify Location of Basement by Survey.
WATER LOC�TION: 109' N.E. of Manhole
In consideration of the �tssuance to me of a permft to construct the building descrlbed above, I agree to do
th� proposed work in accardance with the descript3on above,�et forth and in compliance with all proviaions of
orrlinances oP the dty of Frfdley. // _^ ,. "
In consideration oP the payment of a Pee of $��92_, perrmit fs hereby granted to �i-Co Builders
to construct tt►e bwild9ng or addition as described above. This rmit is granted upon
the eupress condition that the person to whom ft fs graated and lua agente, employees an�worl�en, ia all work
dane fn, around and upon safd build�ing, or any part thereof, shall c�nform 3n all respecta to the ordineuce� of
Fridley� M3nnesota regarrliuug location, conatruction, alteration, maintenance, repeir and moving oY bufldings
within the dty ]imits and this permit may be revoked at aqy titme upon violation of any of the prov9siona of said
o�dinancea
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NOflCEs
'flds psredi doss not caver ths �oesteuetioe, i�aqdioe Po� wtrlae, plumbte8, en h�aftne, ww�� or wdsr. B� sun ro a�
M� Batldin8 lesp�etoe tar ssparah pormih Po� t6as thnn.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
� �� � ,� �. ����� ��_
OWNER' S NAME :�� `^ � ����. BUILDER:
�nnx��s : �'f / /,�� �� .� annxESS : ���/� e%,�--�� � .
�
NO:. STREET: � � o /1//_
LOT : c�� p�o2 9� BLOCK: � ADDITION •
�
� ��,� /�
CORNER LOT: INSIDE LOT:� SETBACK: SID�ARD;
Applicant attach to thia form Ztao Certificates of Survey of Lot and proposed
buildiag location drawn on these Certificates.
�
HESCRIPTION OF BUILDING
To Be Used As ;�/�•�.-Q���,o� t
(� !
Front • � � DeP�' '� ''� Height • f�t�°
Square Feet: ��° Cubic Feet: j�, �lg �' �
, Front; Depth: Height:
,. Square Feet; � Cubic Feet:
�, Type of Constructioa: �� Estimated Cost: $
,
To Be Completed:
The uadersigned hereby makes applicativn for a permit for the work hereia
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordina.aces and ruliags of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true aad correct.
DATE : �(,t S IGNATURE : . - .��G
(5ee Reverse Side For Additional Infosyna� n.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing penuits for the
erection of any building or structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any exiating
building or structure, upon application therefore, require the paymeat by the
applicaat for such permit of fees to the amount herein below set forth and in
the ma.nner herein prwided to-wit:
iTNIFORM BUILDING CODE: �pe 1, 2� 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. �►pe 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
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 the cellar to the average heights of the upper surface or to the average�
height of the roof aurface 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.
In no case shall the fee charged for any pexmit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours fram the
time of application, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundatioa, once it
has been constructed, will be required before proceedint� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupa,ncy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; aad said structure shall not be uaed or occup�ed until a Certificate
of Occupancy has been issued. •
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5°�9 -
72�-0235
' PHONE: �
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���' DOf�IALD H. DEUiSCH
• �y� 4g55 - 2l�h Avex�uo s outh
LAND SURVEYOR
MINNEApOLIB LICENBEO
MINNEAPpL15, MINNESOTA 55406
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Caty of Fridiep, Minn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PE�MIT
��; Au�ust 25. 1972
Qyq��; — Mr_ �phn Skolt� 8�� _ Same
AddreBS -,�!i„Q G1e�,coe Street l�T.E. Adciress —GAmp
/ ��. `--
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—
No 549 Street
�t 23, 24 ��
LOCA,TIOiV OF BUILDING
Glencoe Street N.E, p� of Lot
H Riverview Hdeights Addition
Addition or Sub-Division _____ _ _
Co�lelr Lot Ivside Loi � Setback Sideyard
�� �na�� Foundation IIevation
DESCRIPTION OF BUILDIIVG
To be vsed as:
CB�d�e Front 16 � Depth 21' H�p�t 10' gq, �, 336' �, �, 3360'
Front Depth Height Sq. FL _ Cu. Ft
� � c���� Wood Frame � � �1522.08 To be Completed _ �� ��°�
�
$tipulation: Provide a hard surface driveway
In considerai3on of the issuance to me oP a perm�3t to construct �the building described above, I agree to do
$he proposed work in. accordance with the deseriptibn above set #orth and ia compli � ce with a]1 provIsions oY
Ordiaances of the dty of Fridley. � ��
,� e
.76 S
In consideration of the payment of a fee o� $ 7_nn , permit is hereby granted to John Sko7,te
to consttrvct the building or addition as described above. This permii is granted ugon
'the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work
done in, around and upon said building, or any part thereof, shall conform in ali respects •to the ordinances oP
I�rYdley, Minnesota. regarding location� construction, alteration, maintenance, repair and moving of liuilc'�ng8
�� dty ]imits and this permit may be revoked at any time upon violation of any of the provisions oP eaid
CE BELISLE
NOTICE:
ThL permlt does hof �ove� the construeFioa, iasfallation fo� wiring, plumbing, eas heatieg� sawer or water. Be suro fo ses
!hs Building Inspecto� far aeparate peemits fo� theae hems.
�
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APPL�CATION FOR RESIDENTIAL, A�T�RATION,
QR Allll��ZON BUILD�NG p��jl�
CITY QF FRIULEY, MINN�SOTA
OWI`T� � S �1AME t � � �� ��� �'7`�� BUILDER : _ -��/�l �
-, .e � �,�...�
ADDRESS E � ��I �-L �!V G� �P �T �x�DRESS :
�o ;�_ .��y� S� • � �- � i� � �- � r �� :
w sss...�.eew..�swr
L�'1� 23 d.� �' BLOCK: f�T ADDITIONs_� 'f SlB� I/�1��,�16y�s
CORNER LOT: INSIDE LOT:_�SETBACR: SIDEXqRpq�
�ppl.icant attach to thia form Zt�o Certificates of Su,�vey of Lot and pxopg�sd
building location drawn an these Certificates.
HESCRIPTION OF BUILDING
To �e Used As:
,���,f��6_ Front: �� Depth: 2J Height: -�`�
Square Feet : 3 .3 � Cubic Feet : �-���- "� °a �_T
�.:� .,,.s �
' Front: Depth: Height;
Square Feet; Cubic Feet:
'�rpe qf Constructioa: �/� �/�I � Estimsted Coet: $ /' ' � ,; , �.�
�o $e Campleted: � ^ � � `7 2-
The undersigaed hereby makes applicatifln for a pes7nit for ti�e .ws��'� ����
t�pec�f�,ed, agreeiag to do all work in attict accordance with ti►e C,�ty► 9��
F��,d�ey O�dinaaces and rulinga of the Department of Buildiags, and '�e�ebT
de�laxes that all the facts aad representationa atated in thie ap��3,����,g�
a�re t�ue aad correct.
�AT� : � �' � � � ? Z SIGNATORE : •,� �
(3e� Reverse Side For Additional Iaformati n.)
� �,
.
T , I;, � x , _ .
. _ , ,_
BUILDING PERMIT FEE SCHEDULE
STC�ON 2. The Inspector of Buildings shall, before issuiag pexmit� fox �he
exection of any building or structure, or for any addition �o any existin�
buildiag, or structure, or for any alteration or repairs ta any e�isting
bui,ldin$ ox structure, upon application therefore, require the payme�� by �li�
applicant for such pesmit of fees to the amouat herein below set fo�tls and in
the manner herein prwided �o-wit:
UNIFORM BUILDING CODE: �►pe 1, 2� 4-$2.15 for each one thousand eubi,c
����, ox fraction thereof, in auch cubical contents. Zj►pe 3� 5-$�.�5 f4r
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpoae of computing fees for building permits, the cubical contenta
of any buildiag or addition, ie determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the aveaage heighte of the upper aurface or to the average�
height of the roof surface of the�main gable of a pitched roof.
�or repairs or alterations to an existing structure, the fee shall be at the
___xate _of�3..00.�er_each fiv_e huadred dollars ($500.00) or fraction thereof ia
_ ____.__ _ ------
the cost of all prop�aed work.
Iu ao ease ahall the fee charged for aay pe:mit as set forth ia Secti�a� � be
lese than $S.Op.
VFRIFICATION OF FOUNDATION
�ijp�; Permits for eonatruction will be issued a mini�um of 24 houss froQ► th�i
�kisAe of applicatioa, to allow for prQper review of the propoeed atructure aud
qf the construction site.
A Ce�tifiad Survey of the lot, ehawiag the locatio� of the fouadat�,p�t�, q��� ��
h� been constsucted, will be required befo�e proceeding with the fxaa�nQ•
CERTIFICATE OF OCCUPANCY
Ap�lication for a Certificate.of Occupancy shall be made ten (10) days g�C1AE'
�p tl�ie use or occup�acy of any structure for which a buildiag pe�mit haQ b��A
iseued; and eaid atructure shall not be used or occup3ed until a Certifi�at�
o� Occupancy hae been issued.
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MINNEAPOLIS UCENSED
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DONALU -}T;.-DEUTS�f-1
LAND SURVEYOR
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MINNEAPpL15, MINNESOTA 554�6
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s�z°�ey uf �'rsa �c��r��� ��� c�i io'e�,. 2� �nd ��.� F�Zrsr� �, I�IV�r� Vi� H�'Ii�H'�ti, .
�.ah�, C�ctia�gr� �°i�n�so'c�� �s su� v�yed by raa .tri� 2�a ���r �f .Ili��C'.t�9 ��C��. _
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NORTHERN STATES POWER COMPANY
�
Au�ust 23� 1972
Mr. John Skolte
549 Glenco Street
Fridley, Minnesota - 55�+32
Dear Mr. Skolte:
4501 68TH AVENUE NORTH
MINNEAPOLIS, MINNESOTA 55429
In response to your question concerning the building of a garage near Northern States
Pt�wer Company's easement at the rear of your home, NSP has no hard and fast rule re-
garding encroac}ament upon its easement. We just ask that you do not hinder our servicing
the line behind your home by building d.irectly under the line.
I suggest you contact the City of Fridley about the build.ino of your garage. They must
have a rvling concerning how close you can. build a structure to your property lines. Is'
the ser�tice wires to your house are too close to the garage roof you may h�,ve to put up
a mast on the �arage that NSP can attach to, but this can be looked at as the garage goes
up.
If there are any further questions, please feel free to call me on 561-7200.
Sincerely,
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Ye;.4 1 t��,..l�^,��.
L. M.� nson
Cv.stomer Service -
Representative
North Division
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City of Fridley � ,� � �_� �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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! �' y__���_ COMMUtJITY OEVELOPMENT DIV. R O.
r � � PROTECTIVE INSPECTION SEC. �� j�
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� 1 �"'1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVED BY
�----� • •�, 612-571-3450 9�0-Ft5 8/8/96 � /
JOB ADDRESS 549 Glencoe Street NE
t LEGAL LOT NO. BLOCK TRACT Op ADDITION SEE ATTACHED
DESCR. 23,24 H Riverview Heights SHEET
2 PROPERTY OWNER MAIL AODRESS ZIP PHONE
Betty/George Rnutson 549 Glencoe Street NE 427-4446
3 CONTRACTOR MAIL ADDRESS 21P PHONE UCENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAllAODRESS ZIP pHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (20 Sq) 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE NEOUIRED FOR ELECTRICAL, PLUMBING. HEATING.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN fi0 DAYS, OR IF CONSTRUCTION �-
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIIVIE AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS ypLUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED
WITH WHETFiER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � 1� 24'O �. 62
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- @
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �p�F3.00 Fire SC �I.Z�F
PLAN CHECKFEE TOTALFEE
$44.86
SIGNATUHEOFCON�RACTOAORAUTNOA�2EDAGENT �DATEi WHEN PfiOPERIV LIDATED THIS IS YOUR PERMIT
r
� S� aTURE �O NE �ic OWNER BUILDERi —�ATE� � � .,,LDG NSP OaTE�
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Appiicaxion
Effective 3/1/96
ConstructionAddress: � � � 1�n p � S�{- �, �,
Lega1 Description:
Owner Name & Address: � �,++ Y � G-eo ('�i � �� �`�Sp �'1 Tel. # �� % - � �i � cp
Contractor: �o� �,S'�k �' �' MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Tel. #
Attach to this applicaxion, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
^ _ l�e -12e�o � C� �A �, c� Sec�Sl
Comer Lot [] Inside Lot � Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimated Cost: $_ -� f�7 (�
Approx. Completion Date: �
fCost on Back) �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ —$
DATE: � ' �D APPLICANT: , Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPiJLATIONS:
� �. oa
$ ���
$ •�
$
$
$
$
$
$
$ � y� ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuaxion (1/lOth%)
$.50/$1,�0 Valuation "
$900 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 [ ]
, a�
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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, require the payment by the applicant for such pernut of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,OQ0
$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
fracrion 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 $50, 000
$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,D00 or fraction thereof, to and including $500,0�
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,�0 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,�0 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.
Altemate "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 Certificaxe of Survey of the lot, showing the location of the foundaxion once it has it has been constructed
will be required before proceeding with the framing. �
"'�" - l
_
_
CI"iYOF
FR[DLE,Y
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
October 24, 2003
TRENT J & KRISTIN LACKIE
549 GLENCOE ST NE
FRIDLEY MN 55432
RE: Illegal duplex at 549 Glencoe Street NE
Dear Mr. & Mrs. Lackie:
It has been brought to the Planning Department's attention that your property at 549 Glencoe
Street NE is being illegally used as a finro-family dwelling.
Your property is located in the R-1 zoning district which allows single family dwellings only. You
have until November 23, 2003, to obtain any necessary building permits and complete the work
necessary to convert the structure back to a single family home.
Code Enforcement and Rental Inspections staff will conduct an inspection on November 24,
2003, to ensure compliance with this request. If the situation is not corrected by the inspection
date, the City will proceed with the necessary legal action.
If you have any questions regarding this letter or the process, please feel free to contact me at
763-572-3599.
Sincerely,
CITY OF FRIDLEY
Paul Bolin
Planning Coordinator
c: Angela Bodene, City of Fridley - Rental Inspections
Ralph Messer, City of Fridley - Fire Marshal
Scott Hickok, City of Fridley - Community Development Director
Fritz Knaak, City of Fridley - Attorney
Address File
CE-03-674
February 1, 2005
Memo to file:
From: Stacy Stromberg
Trent Lackie came into City Hall on 1/27/05 to discuss the use of his property
at 549 Glencoe Street. I explained to him that it can not be used as a duplex,
which is how it's being used today. It is currently an illegal duplex and must
be converted back to a single family home. He is in the process of selling the
home, so I made him aware that he needs to convey this information to the
prospective buyer. I also spoke with the prospective buyer's realtor and it
should be clear that is property can ONLY be used as a single family home.
OCT-28-2005 13�20 CITY OF FRIDLEY
3uila.�a.�
i�a
:nspectians
r63-�72-3604
�
ITE ADDRESS �
7�S APPI.ICANT IS:
&RTY OR'iV�R/
T�NAN'�'
BU�GDI�TG
�S�DE�TTYA.� APP�YCA'TION
��7.'X O� �'�LEY
YOUR E-MAIF, ADDRESS
A .. _
r.� a• � • ., �.
�
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9a c� P. �,�
,
��t �ro.: �,�� ��� ��
Received $y:,
Aa% Rec'd:
, ,,� ��� �,
SU$Iv1YT A GOPY OF S?ATE iJCIIdS& i���l.�� � �p DATB �� � � l��--_._.�
YOUR STATE L.IG`�TS�: ADDRESS:�'/b�! E�Loex�seat�� �a' -�� ��E. I��F QTY���s�cv�rs► STA1���j3
WIT,H Ak'PLICA�'tON PH02� %Sa - � $�-S5 S � FAX /�' S� ,g�C - .SS'S �
�ROPERTY 'iI'PE D sn�t� �atvm.Yn�Ew CANS�RUCrioN sr�
o Bas�m�r �vrsx o xodF
D DSCK O S�IN{p
.�
� ARanV Ta.E
a o�t
�ESCIt�� WORK BEING DONE: �c� �1- ��� � ��c �, �r-� � �
•T^ } AT Ta �e�w A� sYw ws �u V �
R�/�1l'lnl
VLJI�ER OF SQUARES �
� lJ
?ROPOSED SxZ�E:
?ROPOSID i�1ti1�'f�—
sIDlNO
� V;iayi
� Aiuminttm
� Otixa��
� CiARAC3E
❑ ATTACFlED GARAGE
D DsTACf�p GA,RpQb
DSofft
Q Trim
D Fa�cia
N�G OPENDVt}S CYcs WJo LOCATipN OF RrII�TDOWS
JR FOR't�W OPEMNQS-DE$GRISE SiZE OF
�PENII�JG CHANGES &
IYPE OF �W TO 8$ INSTALLID NUfu�IIt OF �►II�OWS
A�.L k�ES ARE BASEb ON'V'Ai,YlATY�N, YTTCLIIDING'iHE COST �F
(USII�G TSE 1997 II.B.0 �E SG�EDULE)
TOTAL JOB VALU�iTION S c.. _ ��1 e-nnnrrn,►,v.�
Pejaoit Fee
Plaa Review
Surcharge
Fire Surcharge
License Sw�g�
SAC Charge
�rb C,itt Escrow
Emsion Coatrot
Park Fee
Sawar Main Charge
�
$
�.� _S �a5�'
$ .�e�o
$ � � ��'
�
�
$
1 Y
BASEMI?nTr A�rpD nsr. ci rra��.
1. �g floar plao
2. P�d floar plaa
3. I.�t 4f gtrsxmusl rn�sbets to be used
FbR NEW GONSTRUCI70N INCLUDING DL�CICS�
ADDIiI - � PORC.F�S SUSI�T•
1. 5�o P1atdSt�evry shovvi�g tbe cx3stiag �uu'es
� 7��co�astrjucd'onplaas
3. F.necgy Celaulati�s
See Badc Page for Fee Schr.dule
6S% of Bufldiag Petmflt Fee
(.00OS� #iaues t�e total job valussian — A2in�mnm $SO
.UQl x pr.rmit Valvatia� (1/1Q%)
�5.00 (Staie Licensed Reside�tial Con�tors)
$1450 per SAC Unit (Plans to MWGC for d�on)
8+68= f�x�20=$
$450 Consa�+atiou PIan Ravfow
Fee Determined by E�g�uee�-ing '
Agreement necessaty' ( ) Non NecessaiY ( )
THtS IS AN Appi„ICArTON FOR A P�FiA�AT NPT VALID UNTII, pROCESSfiD
I hereby apply for a build'mg persait aad I acImowIed�e ti�at the fnfoimation above is eomptete aud aacurate; tbat the work wi11 be i�
coaformaace with the ardinaaees and codes of fhe Gity of Fridl�+ and with the Mismesota Co�trucbien Coctes; that I tmderstand this is not a
permi►t bnt onIy �n applieation for a p�r�mit aad work is not to start without a permit; that t�e work will be in accordance yvith the approved
plan {n the c�se of all work whf aes revie and approval of pIans.
SJt31JA'NREOfiAPPL1CANT' P PWN7'NAIv� �/i��'�fa9l i�ero,-�„-- _ DATr � ° �� '°'� �
I MINNESOTA QEPT. OF LABOR & INDUSTRY
Construction .Codes and Licensing Division
_ , � 443 Lafayette Road N.
� S� Paul, MN 55155-4344
9
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LAKEWOODS REMODELING
9001 E BLQOMINGTON �
, FREEWAY #144
BLOOMINGTON, MN b5420�
; .
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�? ` "° t �#ate of Minnesota
- ' Departmet��tof Labor and lnd�stry
¢ : �� .�� 443 Lafayett� Road N. .
St. Paul, MN 551�3�-�34;4 l-
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Construc�on Codes and L[censing D(vision
Talephone:.(651) 2845065 .
E-mail: addrsss::dlC.cor�traot�C:(�i�ta#e.rr�p:us :'
" i ��bsit� �addr,ess: www.do1C:sfiate.mn:us . ,
Reside�tiat B��ilding Con#ractor L��aense
Legal Name: �q�(�ippDS REMODELING Business Structure: �
DBA: . � - CORPORATION
Address: 9001 E BLOOMINGTON f
`��. FREEIAIAY#�44 - ' �.
BLOQI�IINGTON, MN 5b4�0 ,�
Licarrse Iden�flcatlon I�ur�iber: 204�3066 Qualifying Person: SCOTT H RISE
Ltcense �xpira�ian Dat�: 3/31/2007 Contlnuing Educatlon: 7 h�urs due by 3/31/2007
. . ..-- :: ..,.v .. .
.�___ •e• :�- b•>.,.. � `�.. .� �.--�� a' .�-�� •�.. . . _ _... _
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Building PLUMBING Permit No.� -
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY nate��: '
DATE �—�—� r YOUR E-MAIL ADDRESS P: [3�t' w�."1' j r1.e� e� �1.[a� ��� 1yA_.
SITE ADDRESS _��'� �� lrr�tl ��G dQvr�
THIS APPLICANT IS: ❑ OWNER �CONTRACTOR
PROPERTY NAME:
OWNER/ qpDRESS:S�j/Q ������,�ei� CITY t`;� ��i STATE�ZIP
TENANT
PHONE: •
CONTRACTOR NAME: � � �, ` `
STATE LICENSE # EXP DATE �7_ 31 [S
SUBMIT A COPY OF n, �—
� YOUR STATE ADDRESS: �O7 �L7 t/9� '��n� /.7%/� CITY �,�u ��Y �j STATE�ZIP-�
LICENSE WITH pHONE ����� � ►�� Fp}{ �
APPLICATION
PERMIT TYPE INGLE FAMILY ❑ TWO FAM[LY ❑ TOWNHOUSE
TYPE OF WORK: � NEW fd'REPLACEMENT
DETAILED DESCRIPTION OF WORK ��-o j�_J��� _���%
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL
NUMBER OF EACH BELOW)
BATH S[NK/LAV FLOOR DRAINS SHOWER WATER PIPING
_ BATHTUB GAS PIPING rn�t:i;nrt�ruc•�:NSr•,) SWIMMING POOL WATER SOFI'NER ($35)
_CLOTHES WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($IS)
_ DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($35) FOR IRRIGATION
_ WATER METER OTHER
' S
�.
✓ � .. A .. Y Y � : ��ryq('
�-� � . � ��� ., w � ��� , y .� SF"� � �x ��xY. ; °3. uts 1 �i .r' � �� � '� �.ary" «
.'., �.'+m��,��.c(a, .. ' .. , i. „w .
Permit Fee $ W Number of fixtures @$10.00 x$10.00 =$
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ Number of ftxtures @$35.00 � x$35.00 =$�
State Swcharge = $ .50
Total = $ � . 5°�
TH1S IS AN APPLICATION FOR A PERMIT-NOT VAL[D UNTIL 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 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 w which requires review and approval of plans.
SIGNATURE OF APPLICANT �,r "Y PRINT NAME �d� 11.���� DATE
� � �� ,��,. � , � ,., . .: , . �,� �`�° ,.
Y , ,��, . , � .' �i;�� � . :��. � �`` �� �o
�
City of Fridley
Building Inspections DepartmeQt
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FA�X: 763-502-4977