AF - 45333sue�etr MIT NO.
City of Fridley �' 29758
�
AT THE TOP OF TME TWINS g� I L D 1 N� P E R M I T
� � RECEIPT NO.
� `v _____ COMMUNITY OEVELOPM�NT DIV. ��/
r � � PROTECTIVE INSPECTION SEC. �
`_--- A,��'��,'; CITY MALL FIiIOLEv �j13Z NUMBEP IiEV OATE PAGE OF APPROVED BY
t '� 612-571-3a50 91aF15 6/23/99 / /
JOB ADDRESS
5917 Hackmann Avenue NE
t LEGAL LOT NO. BLOCK � TRACT OR AODITION SEE ATTACMED
OESCR. /,�, 2 Parkview Manor SFiEET
2 PROPERTY OWNEq MAIL ADOR�S$ 21P PMONE
Dou Audette 571-2066
3 CONTRACTOR MAIL ADORESS 21P PMONE LICENSE NO
Advance Home Products 3770 W. oa 22 2- 211 2332
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADORESS ZIP PHONE LICENSE NO
8 USE OF BUILOING
Residential
7 CLASS OF WOFiK
❑ NEW O ADDITION � ALTERATION p� REPAIR O MOVE ❑ REMOVE
8 OESCRIBE WORK
Reroof house (20 Sq) Tear-off
9 CHANf3E OF USE FROM TO
STIPULATIONS �
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, FIEATING, TYPE OF CON T. pCCUPANCV GROUP OCCUPANCY LOAO
VENTILATING Oii AIR CONOITIONING
TMIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION jONING SO. FT CU FT.
AUTHORIZED IS NOT COMMENCEO V�1ITHIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED fOR A PERI00 OF 120 OAYS A7
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TMAT I MAVE READ ANO EXAMIN�O THIS APPLICA710N STA�LS GAFAGES
ANO KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW$ yp�UATION SURTAX
ANO OROINANCES GOYERNING THIS TYPE OF WpRK WILL QE COMP�IEO
WITH WMETMEii SPECIFIEO MEREIN OR NOT. THE GflANTING OF A PERMIT �].]�F8 �.S]
DOES NOT PRESUME TO GIV UTHORI7Y O V�OLATE OR CANCEL TNE pEqMIT FEE SAC CNARGE
PROVISION OF ANY OTME S TE OR AW REGULATING CON-
Tq C OR 1 E PERFO M CE OF STRU TION �(73 .].,rj Fire SC �1 .%5
� � � PLAN CMECKFEE TOTALFEE
License SC $5.00 $70.77
S�G TUAEO�CON:AACTOpONaUTHpqIjEDAGENT �D�TE� WMEN PROPE VALIDA7ED THIS iS Y R ERMIT
f �
S�GNnTUAE O� OWNEA��f OWNEp BU4DEiii IDATE� Bl G� 5� ' pitE
� j S
T
NEW [ ] Effective 1 / 1 /99 '
ADDN I l CITY OF FRIDLEY
ALTER �].' SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION , ,�fj�
`A� � �-���
ConstructionAddress: _ �j °%/ 7 - 7�7��� l�`�h � i'v � �
P L.°�al Descripiion: S�.ti.-� � - - . - - _ _
Owner Name & Address:
Contractor: ���
Address: � % 7i'1 � G
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
������� �.
� _ _ - iQ1lr'�ir � ��
��. �.� :,, � _ .
�- �.
,
Attach to this application, a Certificate of �u*vey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF �ItOVE11�1�T
Length Width Height Sq. Ft:
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Construction Type: {�m� °t' - T �rh - e2 � Estimated Cost: $ �, % `�� � � � s�,
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: - �3- � APPLICANT: Tel. # �� ����
Permit Fee
Fire �urcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ �3�l�'
� �p ��
`V v�7
$
$ S.�o
$
$
$
$
$ C�
CITY USE ONLY
Fee Schedule on Reverse Side
.OL'1 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.� Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�.-
BUII,DING PERMIT FEE 5CHEDULE
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 appl'ication 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
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minirnum Fee is $21 plus surcharge)
$21 for first $S00 plus $2.75 for each additional $lU0 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 $50,000
$574.75 for first $50,000 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
$1,000 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 $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 Cert�cate 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.
, Building
Inspections
75�'=572-3604
�` 763-502-4977 FAX
DATE �p '� �
SI1'E .ADDRESS � ?
THIS APPLICANT IS:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-09
Permit No.: ' ��a
Received By: ` �
D�(����-�!� . 2009
YOURE-MAILADDRESS ��i�D �G,�r�'GF%�'C�' .�/e,�L'%� s [�O'v+�
❑ ow�R �CONTRACTOR �t ll �� � C � �� - (o `� ' 3 �0 3 - ��a %
PROPERTY OWNER/ NpME:-- �►�R.�'Q F�4� �OL
TENANT ,�Dx�ss: ,-9/ 7�,��6t��4 ^� CITY �/�/OGJ'Z Y STATE�Z[P_ssy3 Z2
PHONE: _'�103 � ��� -,�9a 9
CONTRACTOR NAME: L.i�%'� �a,.��� �T f' � ���o.�,e y � � � e �
SUBMIT A COPY OF STATE LICENSE # 3,5�� � EXP DATE
YOUR STATE LICENSE
AND CERTIFICATE OF ADDRESS: %/�% — l� z/¢ fOl ,�l/, L. CITY /'?P� �• STATFJ�i.v, ZIPSS /
nvsu�tcE rxox� _CP f a- 7�'' i- S�/ `7 / FAx ll�� � 7&'� - a 3/ 3
PROPERTY TYPE I�SWGLE FAMILYMEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE 0 �DITION
❑ BASEMENT FINISH
❑ DECK
TYPE OF WORK: ❑ NEW HOME CONSTRUCTION
DESCRIBE WORK BEING
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
£/-�u�- c
❑ GARAGE/SHED ❑ WMDOWS
❑ ROOF ❑ DRAIN TILE
❑ SIDING �OTHER
❑ SWIMMING POOL
0 ADDITION
❑ REMODEL[NG
= �2 a.JT ST £pS �GA �� scs¢Pt' �
0 HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
O Fascia
WINDOWS
IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINBOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF V
�'i/�GJ' �}�r s7`r�.r
SQ FT
BASEMENT REMODELING SUBMIT:
1. 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 strucwres
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION $�o�-� �NG THE 1997 U.B.0 FEE SCHOC UPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Chazge
Total Due
$ �
$ a u
$ • �
$ ��t�
$
$
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)
ft+6ft= ftx$22=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary (
$ . Make checks aavable to: Citv of Fridlev
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
Attach
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 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 case of all work which requi es review and approval of plans.
SIGNATURE OF APPLICANT i���• PRINT NAME_{'�lCl�fjrT�L. "%lf�'/I�'S DATE_�g °� �o - O%
Page 2- Building Residential Application
� ; BUILDING 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:
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 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
763-572-3604
Fax: 763-502-4977
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Building
Inspections
763�572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-09
DATE �- �j - O� YOUR E-MAIL ADDRESS
srrE,annxESS SI'/� �-1ac��ANa�/ A�. �v,E .
THIS APPLICANT [S: ❑ OWNER �CONTRACTOR
Permit
Received By:
PROPERTY OWNER/ I NpME: ��r}�,r Q ��-/gF'(Z
TENANT ,�D�ss: SI/ 7/��C��v�i A�� A�I,F:N�� CITY F2! 0 L�L ;' STATE�ZIP
PHONE:
CONTRACTOR N�: j�yMF..�zF/ CB�cr�-�TC ���sotiRr, /�C,
SUBMIT A COPY OF STATE LICENSE #.35� � � EXP DATE /'?ft2�1 .�/ � oZ �� �
YOUR STATE LICENSE
AND CER'I'IFICATE OF ADDRESS: `7/y - I�' z A� ✓f. �. F� CITY MO��- S• STATEMN ZIP SS�f�
n�suxEwcE PHONE �� a- 7�' 9- fI ��7 i FAx ��� - 7�� - o.� � 3
PROPERTY TYPE �(SINGLE FAMILYMEW CONSTRUCTION SiZE
� TWO FAMILYMEW CONSTRUCTION STORiES
PERMIT TYPE
❑ ADDI1'ION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ RQOF ❑ DRAIN TILE
❑ DECK ❑ SIDING � OTHER
TYPE OF WORK: O NEW HOME CONSTRUCTION ❑ ADDITION
,�MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BEING DONE: �^�.S 7�LF LL �� j LA-/ � L o¢.✓-O SC� [�2 L�%lj / nJ /..� (� e.i�} LL
SIZE OF IMPROVEMENT LENGTH `f � WIDTH /� HEIGHT y T� (o ! S Ff
ROOFIlVG ❑ HOUSE ONLY gpSEMENT REMODELING SUBMIT:
NUMBER OF SQUARES 0 HOUSE & GARAGE 1. Existing Floor Plan
GARAGES ❑ ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACHED GARAGE 3. List of structural members to be used
PROPOSED HEIGHT:
SIDING — --- - - ---
❑ Vinyl ❑Soffit
❑ Aluminum ❑ Trim
❑ Other ❑ Fascia
WINDOWS
IN EXISTIIdG OPENINGS OYes ONo LOCATION OF WINBOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCI-IES SUBIv[IT:
1. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construcdon plans
3. Energy Calculations
� TYP_E_OF. WINIIOW TO BE INSTALLED NUMBER OF WINDOWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION $��OCgO G THE 1997 U.B.0 FEE SCHOCCUPANCY TYPE
Permit Fee
Plan Review
F've Surchazge
Surcharge
License Surcharge
SAC Chazge
Cwb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 rimes 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 uavable to: Citv of Fridlev
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
Attach
I hereby apply for a building permit and I aclmowledge 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 applicarion 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 case of all work which re uires review and approval of plans. �E� -(o/a - 3(03- e/o�b7
SIGNATURE OF APPLICANT ��G�-t�v�[ �oi�.-i� c PRINT NAME/?'1/C/f'f�.� L/Q, T�/�:�•l DATE 7- �o ' ��
Page 2- Building Residential Application
BUILDING 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 � $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
including $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 1�` $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 1�` $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 addirional $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
fraction to and includin $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 construction will be issued a minimum of 24 hours from the time of application to
a11ow 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
763-572-3604
Fax: 763-502-4977
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STRUCTURAL �NCiINEER ��� ���'�=�' � � `_�'���� �,
STROH ENGINEERING � � ,. '
.. 1128 SIBLEY HIGHWAY � f Z,.I�ENSE�i �� �
' f MENDOTA HEIOHTS� MN 55148 ; E�'�-?ar�� ?w�J�r��p�_� a.
� p: g51-454-9455 f: 651 �54-5086° Ed� C c h: F�� � `
I E-mail: �strohr�nainsers[3�comcasi.-n�t `'.` `' � �
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CERTIFICATION -?-: , ` ;���.° .
I hereby ceRKy that this plan, specificatitfn,, �� �t�����:�; ��
or report was prepared by me or under thy� ���, p�� e
direct supervialon and that I am a duly .
• licensed Professional Enginesr under the
I�ws ftb tat of Min sota. . , �, `
(� � � y 3
Bemie Stroh, P W
� Minnesota U e: 14289 2 •
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'1128�SIBLEY HIGHWAY �,�-�',�°"� - '-�•.o�� ;
ME�VDCJ'TA HEIGHT8, MN 55118 �,�,�° `'},.�..� '�
p: �b1-464-5�455� f: 851�-4b4-5088 LI��i�J� ��, �s ''' '
E-maiL• $t[ohertafneersf�comcaat net � :� �'l��JFF�c;Si��h��9r��. � �
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i hereby certify that this plan, spealfication ,�";>:4 14;�6� �',�'� ..-:�
or report was prepar�d by me or under my "� '�T :'••4.,..�,t_=�r' �'� `
dire�t supgrviaion and that I am a dufy �� �F C�F ����5��` ti •
� lice�s�d�Professionai Et�gtr►eer under the � q� �� 6,: ���.
� I� , nf S,�ate of Minnesota. �
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Bemie St�oh : .
Minnesota L nae: 14269
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TYPiCAL 8ECTION
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DESICN TABLE S
%.�r 12" FREt DRAINII� AGGREGATE I �
. 1
••� �l ' 2nd. La er '
GE�SYNTHETIC REINFOR�EMEMi' � Xn
L �
j r DR/UN TILE isi L er �' xz
�"— d ALL B,45E X1
— �— _
GRANLLAR 6ASE FACTED
LEVEL BACKFILL
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�ES1GN PARAMETERS:
y�e�hodology — AICMA SRW Deaiqn 4anuol
Geosynlheiic Reinio�cement — LT]5 = 670 Ibs/it (rriB►;
Factor oi Sefety for Maeer�al Uneerta►nty — 1.5
ppT6. ProteaslMOf e++9�^eering m�st be consldered Fo• proper desiqn onG reinforcemen! piceement.