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AF - 45332�— Date � , Owner Addres � BUILDING PERMIT Village of Fridley, Mi.n.n. , , � , � y �`� - .., ' ' � N° 29�6 / �/ , � � i?� Builder . ..........ca P ......... ... ....� F:! Address � `� �.a.�. . �. . �� . I ��s`,�� LO•CATION OF BUILDING � � ` �/ No. �.y�/. . . . 8treet . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . Part of Lot �� . . . ,�-��, ,�, �K.s. � a Lot .......�... Block ...... ....... Addition or Sub-Division .. . . . ............................ �^ / ��/ � /�� °'�'��,��/ Corner Lot . , . . . . . Inside Lot . . . �, Setback . � J . . . . . . Sideyard .� �•.- . � `. � "� To be Used as: . ... . .. . Type of Construction DES�RIPTION OF BUILD(NG / � P y,� ��d�,/� /�/' Front .�Qo � Depth� � . . . . . Height �'��°`.y� Sq. Ft.�� .C✓ ;✓ Cu. Ft. . . . . . . . . / Front �`:.p. Depth �1... Height ... Sq. Ft. ..�� Cu. Ft. ........ ... .�.,�. !�� .°. . . F.st. Co�/O. y . �. � � � e Completed . . . b. . . . . . . . � . ..... (`� � �-° �� In consideration of the i�ssuance to me of a permit to construct the building described above, I agree to do the proposed work in accordance with the description above set forth and in compliance with a11 provisions of ordinances of the village of Fridley. In consideration oP the payment of a fee of $. . . . . , permit is hereby granted to . . U . . . . . . . . . . . . . . �°'°�o . . . . . . . . . . . . . . . . . . . . . . . to construct the building or ad dition as described above. 'This permit is granted upon the express condition that the person to whom it is granted and his agents, employees and worlunen, in all work done 3n, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of �'ridley, Minnesote. regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the village limiis and this permit may be revoked at any time upon violation of any of the provisions of saic] ordinances. � // . /� Inspector NOTICE: This permit does not cover the constructfon, installation or �Iterat(on for wtrPng, plumb•ing, gas heattng, sewer o� wate�. Be sure to see the Butlding Inspector for sepa�a'te permits 4or these items. INDUSTRIAL BUSINH55 CITV LOTS TOPO�RAPNIC MAPP � SC".�1 �f� ' . I ^ K • % �� '•% e —� 0 � '�� , , f �Ol/r � , . ��.'1; r � y:� �°'r"�' ,'`��''�.1��',s� �DCi T�'G.4,�' C. E. COULTER LAND SURVEYOR REGISTERED UNDER LAWS OF STATE OF MINNESOTA LICENBED BY ORDINANGE OF CITY OF MINNEAPOLIS 3300 LYNDALE AVE. SO. MIfVNEAPOLIS 8. MINN. TAYLOR 4-0370 J (J�1 � � ^ ... „ a r'i %� i� l' f C%�!� ,tl�`l'i%� � C. �%✓T�o.�:�:%•�Is' � �J+.�� .i :'✓ c:� �1tC9fP�ttt � fQFYt�fC�fP � `- - -87�- -, - ---- --- 75,_ - ----- - --�.;iL_ - — — 63 _— -- —_ � I o I � I I � I i, � ' I � I � i � __— ---- ----- �.�. s � ------- i I � � Prv�'�s�c. :�f�s:.:��,�<a � I �► /9.67'.s --- � • �n' ZS�� _;- Z5.5' � � I �i e . I.�i � I� --75'- - — — —�-------- _-_87'- - " �°��'— ��-�;��`;��':�'��i.�� ': a �°� PLATTINO FARM SURVEY6 LAKESHORE JUDICIAL � � I I ; I I -� I � � /D� � I � ( .� O I /� � �! � � � 0 I �: \- — �-6�' -- — �-- :� > — � � Q�J�� :� �`�� . e �- � � I hereby certify t•lie�r *:ie ��ovp is a true and c�rrF•ct gl�t of a survPti• cf: All of Lot Five (�) end c:.� �Ye�t '�rPlve (12) feF* of Lct F�ur (t;j� Llock Four (;�1. F.�53:VI1:':d f:��'C-. ��PI"'iI('ri � Ar.��k� Cc,ut ty �: i nnesota. �� urvPyed ��y� n�e tr�i;= �t�z �j��;y of' May 1�,�'S`' ��r. • `' ,yY!F'.!i �:'1�1 � f� � f r4' Q,,.t�,! ��'°��.� ��►_�. _ r . ... �r +_� ��t 4i..:+,2'eti�,n ;`o. �SG1; / 1 n ; , 2„ � �f s •. ' 1�1 �ti SuBJECT City of Fridley � � � � 1 ' ' AT THE TOP OF THE TWINS B U I L D I N G P E R M I T f ; � RECEIPT NO. � • COMMUNITY DEVELOPMENT DIV. � i y �� r � � PROTECTIVE INSPECTION SEC. /'%� � � / � � ��"1 � CITY HALL FRIDLE� 5S4J2 NUMBER REV DATE PAGE OF APPROVED Bv �'"""� � �'' 612-571-3450 9�0-Ft5 4/22/97 / / JOB ADDRESS 5914 Hackmann Avenue NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ,5 4 Parkview Manor SHEET , 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE Carolyn Miller 5914 Hackmann Avenue NE 3 CONTRACTOR MAIL ADDRESS Z�P PMONE LICENSE NO Solomon & Sons 12211 Olive St NW, Coon Ra ids MN 55448 754-5875 20055664 d ARCHITECT OR DESIGNER MAIL ADDAESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PNONE LICENSE NO 6 USE OF BUILDING Residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION p ALTERATION X❑ REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Gara e(27 S) Tear-off 9 CHANGE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTIIATING OR AIH CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENOED 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 1 STALLS GARAGES AND KNOW THE SAME TO BE THUE AND CORREC7. ALl PROVISIONS OF LAWS VALUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED $2 22'�.SO �1.12 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiMITFEE SACCHARGE PROV ONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 74.75 Fire SC �Z.23 ION THE PERFORMANCE OF CONSTRUCTION � PLAN CNECK FEE TOTAL FEE License SC $5.00 $83.10 SiGNATU�7E OF CONiRACTOA OR AUTMOAIZEO AGENT IDATEI WHEN PROPERL A'ID TED THIS IS VOUR PER� � fA' L - � � �e SiGNnTUREO:OWNERiiFOWNER8U4DERi iDATE� --=gL� INSP qarE NEW ADDN ALTER �� [l �� ConstructionAddress: � Legal Deseription: Owner Name & Address: Contractor. � !� �s Address: /��''/ l� LIVING AREA: GARAGE AREA: DECB AREA: OTHER: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERNIIT APPLICATIOAT � � /¢G� .�%�.1�°rtJ .�� /I�C� �e� �- Effective 1/1/97 �� . Tel. # MN LICENSE �# �� `�t�� • !�°� l��D� j�� k�-S ��ff�' Tel. # �Sy/".�� Attach to this app�ication, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPRO`'EMENT Length Width Height Sq. Ft. Length �Vidth Height Sq. Ft, Leng�. Wi�j th HgtlGround Sq. Ft. �/s- /} ,-,�� / /1� � c�. � l',� �� _ �� -%� �J� � Construction Type: ��✓�r�� Estimat�d Cost: $ � �5� (Fee Schedule on Back) Driveway Curb Cut�Width Needed: Ft. + 6 Ft = Ft x$ � _$. DATE: � �� r� � Al Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: � CITY USE OATLY ', �.-� Tel. � . � � % �r� � r $ ,� Fee Schedule on Reverse Side $ '" _� .001 of Pennit Valuation (1/lOth%) $ /, /� $.50/$1,OQ0 Valuation $ $950 per SAC Unit $ � , Q (� $5.� (Sta.te Licensed Residential Contractors) $ Alt. °A" or Alt. "B" Above $ $450.00 Conservation Plan Review $ Fee Determined by Enginc�ring $ Agreement Necessary [ ] Not Necessary [ ] $ � � i c� �, _ �, . BUII,DING PERMIT FEE SCHEDULE The Chief Building O�cial shall, before issuing permits for the erection of any building or strucdue, or for any addition to any e�sting building or siructure, or for any alteration or repair to any e�cisting building or structure, upon application therefore, re�uire the payment by the applicant for such �rmit of f�s to the amount herein below set forth'and in the manner herein provided to-wit: � $1 $501 TOTAL VALUE . : p� _ . , to $500 . : . _.. 1(Minimum Fee is $21 plus surcharge) - to $2,t�0 $21 for first $500 plus $2.75 for each additional $1� or fraction thereof, to and including $2, 000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100, 001 to $500, 000 $SQU,001 to $1;000,000 $1,OD0,001 and up $62.25 for first $2,�0 plus $12.50 for each additional $1,000 or fraction ther+eof, to and including $25,0� $349.75 for first $25,0(}0 plus $9.(}fl for each additional $1,� or fraction thereof, to and including $50,0� $574.75 for first $50,000 plus $6.25 for each additional $1,Q00 or fraction thereof, to and including $1Q0;0�0 $88'�.25 for fust $1�,000 pius $5.00 foi each additioml $1,� or fraction thereof,_to and including.$5�,�. , , . _ � - - � $2887.25 for the first $500,(m0 plus $4 25 for each additional . $1,� or.fract�on;thereof, to and including� -�1 0�:6000 ;` $ , � , , .; �, -�_ : . .: _ _ . .. �__ _ . __ �_ �_ $5012.25 for the first $1,(�0,000 plus $2:75 for each, additioml $1,000 or fraction thereof � DRIVEWAY DEPRESSION-ESCROW = (Concrete C�rb 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 Pemuts for construction will be issued a minimum of 24 hours from the time of application to ailow for proper review of the proposed structure and of the consixuction 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. s -� � A � D � � 7 Q �m a -. � a N � O y � � o � � o a" o � � -p co � -a a o � m a� � N fm � � 1 Q � 0 c .. � m Z � � m n � � Z 'n m m Efl w 0 0 O � 'n D fn 2 m r- � � � � r� o � -_I � � < Q' Z m -�i �- �0° G) mD W O �� c� z v �m � n � o / -. c D 3 � � � c < �° m � � � � v m � � � � W 0 � li � � � . \'°' 0 D r � m m � � � � u�. m � c � � m � � � 0 c� � W � a m z � m 2 � � � z 0 m' � � j � D � o � j — D � �, \ O � 0 � �� ` � O � - O < � m � a� • < a _� a?� r: m� �� . �' O '� � � N � � � 'a _ D m t � � � �° D - D � O m m � � _ N O ` ' � �. O � �� -� O z � 3 � , o � 0 � � � � � o . �D cQ.- �p o �� Qm 5 C' � � oN X � 2 o � n ^' A � �� n � m � � �. � a �� m m � a p o = . � � o � � � : � � � D � G� � � v � � � � � � m � co m � A� � � cQ Z (D CD Q m a � 3 � � c � � 0 m y = N Q � � � � �w n � � � m � � .�-� �. c ° � � � � 0 � W C 3 m � � � � � 0 0 0 0 � � � 0 0 0 � tfl � tfl � tfl p Q � O • � D � � � r m � � � m v n O � O � � -D m � � -i z O � � 00 c r v_ z s�i c � m v �� Z m — � � � � � m�`�mm� � � � � �� nr+�ya � � y � m � co c�'i n ='� m � � � c � a > > cQ � a �a � .� �ocua. � � � � N �D o � ? c°am O � Q � � y� �� N � � � � a o a, � � � � =. � � � o — � m c�i m o � � cu Q, � � � � w a � o �� m ,,,, m ��y3o m �- � co � a � m � n 2 v c r m � � � � � � � rn n V =. � N Q. W � � 1 � `-� � � �°�� -n z� � � ,� v A r m N � � Z Z m� -o m n � 0 Z �o a ° < � � �r �a m� -ai z � � Z � a� Z -fl �O n� �m n� � � Z vz �N on zZ �v _ �� mZ �� Zp v r vz � < nm N Z -i � O m Z � co � m O � � m � c w � � co � CHIMNEY AND STACR oERIFICATION The undersigned hereby verifies that the existing chimney or stack: 1. Has been carefully examined Yes (� No () 2. Is free from rust or deterioration Yes (kj No () 3. Has no foreign objects lodged within Yes �) No () 4. Is securely supported Yes � No () 5. Meets all current Code requirements for size and total BTU's connected 6. Has ta�al heai:ing B`�iJ ° s of t� �� Q v Al1 other BTU' s "7� � � � TOTAL BTU' s I�S ,�� J Remarks S � Yes ;� No ( ) Q�� List Alterations Beinq Done: , • �' ' G►1 � . ' � � !/1 ./.� � .I� . - . : , i1l �. _� �/�'�i�/r�n .. - � J�a�, � �� CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE FRIDLEY, MN 55432 572-36U4 FAX: (763) 571-1287 ADDRESS : 5914 HACKMANN AVE NE. PIN : 243024240079 LEGAL DESC : UNAVAILABLE : LOT 5 BLOCK 4 PERMIT TYPE : BUILDING PROPERTY TYPE : MULTI DWELL CONSTRUCTION TYPE : WINDOW/DOOR REPL VALUATION : $ 2,500.00 NOTE: SEE NOTATIONS ON PLAN. APPLICANT PUBLIC HEATH SOLUTIONS LLC. 5914 HACKMANN NE FRIDLEY, MN 55432 OWNER PUBLIC HEATH SOLUTIONS LLC. 5914 HACKMANN NE FRIDLEY, MN 55432 AGREEMENT AND SWORN STATEMENT This permit becomes null and void if work or construction authorized is not commenced witin 60 days or if construction or work is suspended or abandoned for a period of 120 days at any time after work is commenced. I hereby certify that I have read and examined this application and know the same to be true and correct. All provisions of laws and ordinances governing this type of wor� will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or local law regu 'ng construction or the performance of construction. A licant Date � Bldg PERMIT NO.: 200402332 DATE ISSUED: 12/28/2004 �� • � • : BUILDING PERMIT FEE FIRE SURCHARGE STATE SURCHARGE, VALUE TOTAL PAID WITH CHECK # VISA SEPARATE PERMITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE. 83.25 2.50 1.25 87.00 NEW ADDN ALTER R [) CITY OF FRIDLEY Effective 4/1/2004 [ j 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 � �i ��,c��,� �,�. �►� t� � N,� SS�l3 Z Legal Description: Owner Name 8� Address: �� 1�� l`�� .So(c� f�� s � L c Tel. #�� Z- 3 3/ ��5 �� Contractor. �� LNING AREA: GARAGE AREA: DECK AREA: or�ER: ��U �,.s e�, �/�P % �� ii�er� P ,�; MN LICENSE # Tel.# b�Z 33! ' �� V %rwqP� ��e�'I Mv✓ 1��—�//� Attach to this application, a�ertificate of Survey of the bt, with the proposed construction drawn on it to scale. /� ` DESCRIPTION OF IMPROVEMENT 2��__�, Length Width Length Width Height Sq. Ft Height Sq. Ft Length Wdth Hgt/Ground Sq. Ft �� °� � (� ��e w��- �- l,� t � (Q o�w�. �-c, I�.� e �' p c�hes�� ►^��, �, �Q �-.�e.Q� �" vv Construction Type: � �C'cc��'�� Estimated Cost: � �Y, �� S � � '� Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ =$ DATE: APPLICANT: Tel. # 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. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL � $ �,`� Fee Schedule on Reverse Side $ �� 65% of Permit Fee $ �, �" C� .001 of Permit Valuation (1/10th%) $ /, �7 $.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 [ ] $ :ldC� STIPULATIONS: NEW ADDN ALTER �� Construction Address: CITY OF FRIDLEY 6431 University Ave NE, Fridley, MN 55432 SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Effec6ve 4/1/2004 (763) 572-3604 Bldg Insp (763) 571-1287 Fax � �, Legal Description: - Owner Name & Address: Tel. # Contractqr. MN LICENSE # Address: Tel. # Attach to this application, a Certificate of Survey of the bt, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT LMNG�AREA: Length Width Height Sq. Ft GARAGE AREA: Length Width Height Sq. Ft DECK AREA: Length Width Hgt/Ground Sq. Ft OTHER: - Construction Type: Estimated Cost � Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ DATE: APPLICANT: Tel. # 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. CITY USE ONLY - Permit Fee Plan Review Fire Surcharge State Surcharge SAC Charge License Surcharge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge TOTAL $ 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 [ J $ STIPULATIONS: NEV!/ [ ] ` ADDN [ ] ti.�; - � ALTER [ ] l, Construction Address: .., Legal Description: �- _ ��r � CITY OF FRIDLEY 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 ! l�l ! J La-�:(�,(fy! �i y� k�� Owner Name & Address: � I� S L � c Tel. # 7�'s %�`� 7Y �7 Contractor. y�� c�v�se�� MN LICENSE # Address: 7 � S � 6 %a f%� !L%L I/� �p (4 /1e�,o�/ �� S'-�c ( ,Q Tel. # �, l Z �s�=-� LMNG AREA: GARAGE AREA: DECK AREA: OTHER: Attach to this application, a Cert�cate of Survey of the lot, with the proposed construction drawn on it to scale. Length Length Length DESCRIPTION OF IMPROVEMENT Width Width Width Height Sq. Ft. Height Sq. Ft. Hgt/Ground Sq. Ft �� - ��q� Construction T e: Estimated Cost: $_ �,U C� v uG YP C�c r`a� la�� ^ e�6� Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$ DATE: �" Z. -`�� 5 APPLICANT� G+�l G:��l� Tel. #� 12 3� I -�` �� 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 �.. � � . �� $ 2 �o $ C .00 $ $ $ $ $ $ CITY USE ONLY - Fee Schedule on Reverse Side 65% of Permit Fee .001 of Permit Valuation (1/10th%) $.50/$1,000 Valuation $1450 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 $ l l �] � STIPULATIONS: BUII�DING PERMIT FEE SCHEDULE • rl .e The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any addition to any eusting 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 $Z,O(}0 $2,001 to $25,OQ0 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,0�,000 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 $2,040 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,000 $391.25 for first $25,0(Hl plus $10.10 for each additional $1,000 or fraction thereof, to and including $50,000 $643.75 for first $SO,OOQ plus $7.00 for each additional $1,000 or fraction thereof, to and includi.ng $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $5�,000 plus $4.75 for each additional $1,�0 or fraction thereof, to and including $1,000,000 $1,000,�1 and up $5,608.75 for the first $1,000,000 plus $3.15 for ea.ch additional $1,000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete C�rb Streets Only) Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.0�. 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 foundation once it has it has been constructed will be required before proceeding with the framing. New Houses Onlv ' � .� J� /v�� , � �� s � �. �� N � S� N �� k � � . , ' �` C � sl � � � . � . � r �C ' �� a '�' � C � � � � t• \ ' � � � % � . �. � s �� • � � � � � .� ' �� \, 1 �' i c � � � � � �C' S . s v�` � � ` � � � � �. �. ^ � �� , � , � � �, � . �� ` � � � � � _ °`� � � �\ ! --�`� � �, � � � � �3 1 � � �J �...�` � � � �� -.�.� � � � �• � � �1 � � � � ' � s — � � ^ \. � `' ` v � `�� ,�. �� . � � � �—� , �� J � �� . (� � d � Jn � O � � � G � `� � � � � fi � �. G , r � , . , ', �� ' �� S �. � � � n � ..` x �" V,.'� � � � � cb � � 1 � � C� 1 � � ' . _�'_.._�._._..._______ e-.. -'� . ....... . .._...... .. � ----��--- � � ` G � �� Q � L` '�z �� -J� � i � � S G""_i �Z� � � �t � �S f� � T � NEW ADDN ALTER Il Il � �a��-D�a�� Effective 1/1/2001 CITY OF FRIDLEY (763) 572-3604 Bldg Insp SINGLE FAMILY AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION Construction Address: �%%�- `�l�a+� /�� Legal Description: _ , , �� s Owner Name & Address: Contractor: t� _ LIVING AREA: GARAGE AREA: DECK AREA: OTHER: � Tel. #!�/,� ° MN LICENSE #�� Tel. # ��-.�'��,/-�02/� 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. Construction Type:�i��,�►�s.�. 'T•� Estimated Cost: $�� Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft $ _$ DATE: �" `� � i APPLICANT: Tel. # �� ` �� ' ��Zf/ CITY USE ONLY - Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee �Sewer Main Charge ''TOTAL STIPULf1TIONS: Call (763) 572-3604 for Permit Fees if mailing in application $ Fee Schedule on Reverse Side $ .001 of Permit Valuation (1/10th%) $ $.50/$1,000 Valuation $ $1150 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 Ir� � � � /�� `� � �� i-3 y�,�s 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 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 $2,000 $2,001 to $25,000 $25,001 to $50,000 $SO,QO1 to $100,000 $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,OQ0 $69.25 for first $2,(}00 plus $14.00 for each additional $1,000 or fraction thereof, to and including $25,0(}0 $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 $100,000 $993.75 for first $100,000 plus $5.60 for each additional $1,000 or fraction thereof, to and including $500,0(� $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,Ot?0,000 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. 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 tunes $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. New Houses Onlv Building PI,IT�VIB�TG Permit No.: �� Inspections � ��I��Z`�I, Ap�LICAT'IOl`T Received B :� � 763-572-3604 j1]E� Datb`Y�t°d� CITY OF F� 763-502-4977 FAX E�c�v� 1-,-os DATE O YOUR E-MAIL ADDRESS SIT'E ADD S THIS APPLICANT 1S: O OWNER ONTRACTOR � PROPERTY N�: ` l OWNER/ ADDRESS: CITY S'fATE ZiP TENANT � PHONE: CONTRACTOR xq!„�: SUBNIIT A COPY OF S7'ATE LICENSE # O - EXP DATE YOUR STATE LICENSE. BOND AND STATE BOND # � EXP DATE . CERTIFICATE OF qDDRESS: � � CITY STATE�ti. ZIP.�S 1NSURANCE .PHONE 7 '� ��) � �O� FAX PERMTT TYPE � SINGLE FAMILY ❑ TWO FAMILY 0 TOWNHOUSE �'�^'�� '� . TYPE OF WORK: D NEw �itEPI.ACEMENT DETAILED DESCRIPTION OF WORK L�% PER MS 16B.665 the permit fee is a minimum of �15.00 or 5°/a 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. La.bor cost between $300 to $500 = cost of labor x.OS = plus .50 surcharge OR FOR PROJECI'S WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $]0.00 PER FIXTURE, EXCEPT WHERE NO'tED. FiXTURES: (INDICATE TOTAL NUMBER OF EACH BELOV,�. MINIMUM FEL $ I5.50. BATH SINK/LAV _FLOOR DRAIATS SHOWER WATER PIPING BATHTUB GAS PIPING (NEED CTTY LIC) SWIMMING POOL WATER SOFTNER ($35) CLOTHES WASHER KITCHEN SINK WATER CLOSET _ BACKFLOW PREV. ($15) _ DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($35) - FOR TRRIGATION WATER METER OTHER ;", � � ..ss� zs�,,� �,`�' �` �.'.;•`s ..s.�k _A�`c` �, � �. .�:, �» � Permit Fee $ � �. � � � Number of fixtures @ $10.00 x $10.00 = $ Surchar e .50 Number of fixtures @$15.00 x$15.00 =$ TOTAL DUE $ OR Number of fixtures @$35.00 x$35.00 =$ Sta.te Sulcharge = $ .50 iNIMUM $I5.50 (MINIMUM $15.50 1'ota1= $ THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I he�'eby apply for a plumbing 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 on site; that the work will be in accordance with the approved plan in the of all work which requires review and approval of plans. SIGNATURE OF APPLIC ��/� PRiNT NAME �� Gj' /�� DATE � ��CJ APPROVED BY DATE � . � ` , . :F�' �� Y� - City of Fridley �uilding Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 Building Inspections 763-572-3604 763-502-4977 FAX DATE� SITE ADDRESS _ THIS APPLICANT IS: PROPERTY OWNER/ TENANT ! CONTRACTOR SUBNIIT A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 1-1-09 YOUR E-MAIL ADDRESS "�NTRACTOR NAMr;: •�. STATE LICENSE # Pernut No.:ol�i(1��s� 7U Received By: Date Rec'd•Lo � c. r� L• c Gvi.� EXP DATE ADDRESS: CITY PHONE Gesr PROPERTY TYPE SINGLE FAMILY/NEW CONSTRUCTION O TWO FAMILY/NEW CONSTRUCTION PERMIT TYPE O BASEMENT FINISH � DECK TYPE OF WORK: ❑ NEW HOME CONSTRUCTION 0 MAINTENANCElREPAIR DESCRIBE WORK BEING DONE: r�(,e� q�c. o SIZE OF IMPROVEMENT ROOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED I-�IGHT: SIDING ❑ v�y� ❑ Aluminum ❑ Other wwnows IN EXISTING OPENINGS Yes �No OR FOR NEW OPENIN S-DESCRIBE SIZE Ol OPENING CHANGES & TYPE OF, WDVDOW TO BE INSTALLED ��l�+ ALL FEES ARE BASED ON TOTAL JOB VALUATION Permit Fee Plan Review Fire Surchazge SAC Charge Curb Cut Escrow Erosion Control Park Fee Sewer Main Charge Total Due $ $ $ $ $ $ $ $ ❑ ROOF ❑ SIDING ❑ SWIMMING O ADDITION O HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE osot�c ❑ Trim 0 Fascia SIZE %X�(] STORIES 's LOCATION OF WINDOWS Z� T►''" � I • (��u t� � ��F IC��c� h � � 4�21�' � � ❑ DRAIN TILE ❑ OTHER 'ATEI'VIuV ZIP STATE ZIP, � �. G� � i'+t/'/L�i rNa� r f /,.t HEIGHT _ SO Ff BASEMENT REMODELING SUBMIT• I . Existing Floor Plan 2. Proposed floor plan 3. List of structural members to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORCHES SUBMIT• 1. Site Plan/Survey showing the existing structures and proposed project. 2. Two sets of construction plans 3. Energy Calculations NilMBER OF WINDOWS � VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING THE 1997 U.B.0 FEE SCHEDULE) /'J,.OU OCCUPANCY TYPE See Back Page for Fee Schedule 65% of Building Permit Fee .001 times the total job valuation .0005 x Permit Valuation Minimum $.50 $5.00 (State Licensed Residential Contractors) $2000 per SAC Unit (Plans to MWCC for determination) $+6ft= ftx$22=$ $450 Conservation Plan Review � Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMI'f-NOT VALID 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 1 understand this is not a permit but only an applicatio r a permit and ork is not to start without a permit on site; that the work will be in accordance with the approved plan in the case o.�all ork w' req ues review and approval of p ns. SIGNATURE OF APPLIC� - PRINT NAME C�T� I� �I �^�I �Y� pq'�'� � C � �age 2 - Building Residential Application BUILDING PERNIIT 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 permit of fees to the amount herein below set forth and in the manner herein provided to-wit: TOTAL VALUE FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge) $501 to $2,000 $23,50 for 15` $500 plus $3.05 for each additional $100 or fraction, to and includin $2,000 $2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and includin $$25,000 $25,001 to $50,000 $391.25 for lg` $25,000 plus $10.10 for each additional $1,000 or fraction, to and includin $50,000 $50,001 to $100,000 $643.75 for Ia` $50,000 plus $7 for each additional $1,000 or fraction to and includin $100,000 $100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to and includin $500,000 $500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or fracrion to and including $1,000,000 $1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or fraction VERIFICATION OF FOUNDATION Permits for constntction will be issued a minimum of 24 hours from the time of application to allow for proper review of proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing foundation will be required before proceeding with the framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 Fax: 763-502-4977