AF - 46491� �
City of Fridley, Minn.
BUII.DING PERMIT N°• 3 8 9 3
_�
�te: ....... -. �.� ��.......
...........
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Owaer ....................................... Builder .................................. ..........
�� d e,Q�
Address...................................... Address .............................................
LO�CATION OF BUILDING
�o. r.���. . S�t . � ..�D.�.... .. ..... p� ag ........ .. . ......
�t . . . /. . f . . . . B�o�x . . . . . .? . . . . . . . . . aaaroon or su�-n�on . . . . . . . . . . . . . . i� . .�.v. . .�. . . . . .
Corn�er Lut ............ Inside Lot ............ Setback ............ Sideyard ...........................
DESCRIPTION OF BU[LD{NG
� U8. .. ... .
• � N
�t �!a-. � �� ��:�a H� ./.��a `�� �. �. .
. . . . . . . . . . . . . . . . . FrOnt . . . . . . . . Depth . . . . . . . . Height Sq. Ft. . . . ��? �C�. Ft.��� .�i �
T�►pe oi Construction . .. . . .. . . .. .. . . . . . . Est. Co�t�,' t/• •/ •`f. . �:"To be Campleted . . . . . . . . . . . . .. . . . . .
In consideration of f�e is�ance to me oi a permit to conatruct the b g desribed above, I agi+ee to do
ti�e proposed work in acaordance with the dearription above set forth in pliance all proviaiws
oxdinances of the dty of Fridley.
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�
.�. . .. ... . ..... ....
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In consideration of the payment of a fee o! j�� .'-"; �ermit is hereby granted to : . . . . . . . . . . . . . . . . . .
. . . .. . . . . . . . . . . . . . . . . . . to construct the building or addition as described above. This permit is granted upon
� the express condition that the person to whom ft is gisnted snd iris a8ents. emPloYees snd worlmnen, in all work
done ia, around and upon said buiiding, or a�► part thereof, shall o�form in all respects to the ordinances of
Frfdtey, Minnesota regarding lceation, construcf3aai, alteration, maintenance, reP�' and moving of buildings with-
,�_ in the city limits and this permit may be revaked at sny time upon violation of any of the provisions of said
. ordiriancQS. /
.. _' _. . .,. . /� /I � J i
Building Inspector
NOTiCE: r
- _ 7his permit dws not cover the construation, installation o� alteration to� wirin�, plumbiny, yas heatins,
sewe� or water. Be sure to sea the Btlild�irtp Ins�to� for separate perneib for ths�e itsma.
SUBJECT N O.
City of Fridley - 16700
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T
r
; � RECEI .
� `L ___��_ COMMUNITY DEVELOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEG
� �
� � /'�'1 : CITY HALL FRIDLEY SS432 NUMBER REV. DATE PAGE OF APPROVED BY
�""�� `�} 612-571-3450 910-F15 7/2g/g2 / /
JOB ADDRESS 1072 Hackmann Circle N.E.
t LEGA� LOT NO. BLOCK TFACT OR ADDITION SEE ATTACHED
DESCR. ].% 2 Parkview Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Ri.chard Azmstrong 1072 Hacl�►ann Avenue N.E. 572-0927
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO.
Panelcraft 2309 Snelling Avenue 721-6628
4 ARCHITECT OR DESIGNEfi MAIL ADDRESS ZiP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO.
6 USE OF BUILDING
Residential
7 CIASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK �
Reside Dwellin
9 CHANGE Qf USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE FEQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. VlIlI7].
THfS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR �F CONSTRUCTION
OR WORK 1S SUSPENDED OR ABANOONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AfTER WORK"IS COMMENGED: NO. DWLG. UNITS OFFSTREET PARKING
I HEFEBY CERTIFY THAT I HAVE REAQ AND EXAMINED THIS APPIICATION �. STAILS GARAGES
AND KNOW THE SAME TO BE TRUE AND GORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK W�LL BE COMPLIED y�`4�10(� �SZ.OS
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON— �`rjO.SO
TR TION OR THE PERF ANCE OF CONSTRUCTION.
�/ �. PLAN CHECK FEE TOTAL FE
�" $5�2. 55
SIGNATUF FCON� ACT uT � iZEDAGENr. . IDA7Ei WHEN PROPERL AUDATED THIS IS VOUR PERMIT
' �
SiGNATUREOF�OWNEFUFOWNERBUIL�ERb � IDATEI BLDG iNSP � �FT
CITY OF FRIDLCY Effective Aug, l, 1981
A('PLIG/I7I��! FOf� RESIDL'i�TI/li_ [3UILQIitG PLRt�fITS
(Nc�r, Alterations, Additions, or Repairs)
,
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.
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I3UI LOE R :
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TE� r�a:
Construction Location
• STJtITT NO: STItEET:
IAT: . BLOQC: � ADDITION:
�
Corner Lot: Insicie Lot: Setback: Sideyards:
Ap�lieant attach to this fozm two Certificates of S�rvey of lot and
pzoposed builcling location drawn on certificates to scale.
DESCRIPTIOi�! OF COFJSTRUCTION
Front: Depth : Neight:
�
,
Square.Feet: Qibic Feet:
Front: Depth: Height:
Squar.e Feet: Wbic Feet:
+ .� . /� Q�
Rj�pe of Construction: � , Estimated Cost: $ �U�
Zb Be Cbr,�pleted:
Alt. A Alt. B
Proposed Drive�,ray Width If New Openinq Is Desired: $� $
, SE� R�VERSE SIDE OF SHEET .
Tfie undersigned hereby make� application for � pernnit fcr the work herein specified,
agreeinq to co.all work i.n strict accordancc with the City of Fridley Ordinances zaid
ruling� of the Delkirtment of Buildings, and herebv declares that all the fact� and
represcntaticns stated in this applic�
D.'1TL�: � SIGNATUIi�:
Stipulations:
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SUBJECT P
c�ty of Fridley 2 0 3 3 7
AT THE TOP OF THE TWiNS B U I L D I N G P E R M I T
; � RECEIPT NO.
� � COMMUNITY OEVELOPMENT OIV. � � / �/
� •
' iw ' '
r � �: PROTECTIVE INSPECTION SEC.
� . ,
� � �"�1 � CITV HALL fRIDLE� 55432 NUMBER REV. DATE PAGE Oi APPROVED BV
�""� � �'� 612-571--3450 9�0-Ft5 5/4/90 � �
JOB ADDRESS 1072 Hackmann Circle N.E.
t LEGAL LOT NO. BLOCK TRACT OR AOOITION SEE ATTACHEO
DESCR. �% 2 Park�iew Fisights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jerry Sch.aaf 1072 Hackmann Circle N,E, 571--7555
3 CONTRACTOR MAIL ADORESS Z�P PHONE UCENSE NO.
American Handyman Can Inc, 1202 Hatha�ntay Lane N.E,, Fridle 571-2655
4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW �l ADDITION O ALTERATION O REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Cons.truct a 21� x 1Q.� Deck on Front o� L�nrelling
9 CHANGE OF USE FROM TO
STIPULATIONS
See notati,qns on plan
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PEFMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEAT�NCa,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WOFK OR CONSTRUCTION ZONING SQ. 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
ANV 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 yq�UpT10N SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPUED $1 R 550 $ w 78
WITH WHETHER SPECIFIED HERE�N OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROYIStONS Of ANY OTHEf; STATE OR LOCAI LAW REGULATING CON- $37 � aQ
TRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKfEE TOTALFEE
�.r.�-�t �� i/� 1/ p S�-� a s3� , �s
�
S�GNATUfiEOFCONTRACTOAOAAUTHORIZEDAGENT IOATEI�� WHEN PROPERLY V IDATED T IS IS YOUR PERM17
�
SiGNATUAEOFOwNEA��FQWNEPBUiLDEAI IDATEi �p� IN$P °TE
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AL'PER � �
R-1 AND R-2
Building Piermit Application
Effective 1/1/90
Const�uction Address : �C� � oZ f�,qcf�„��µ a! C{� /(�� , /�v' ,�/ r�
I�j31 UeSG7lptlOd'1: il0 f /% i(J /iaN_,� p� �%�rK LI ! 4d� r�,�?c-1��7Z'
�
owner Name & Address: �%� �'v�.X Sc h.aa.r /d 7z h� l��,a.�cu�� A/g ��d �y�el. #-57/- 7 SSS
dontractor: �A'l� �4 t C�4 eJ i�,q ►ti �P.� r✓l �a ,¢ (� GI�C' , 2p1. # S 7/ -a.� SS
AddL�e.S.S: � Qo'Z /'-%4 (�1 x�3J� .� �1. /if �, ('r id ls c/
Attach to this application, a Oextificate of S'urvey of the
lot, with the prq�osed construction drawn am it to scale.
LIVII�IG !�: I�er�gth
C�RAGE AREA: Let�gtti
D�7cx �,R�,: I,er,gth
0'l��R:
��,� �: ��M •., •�� �..i:: ��vr.,i:�,�
Width
Width �
width
Heic�t
Heic�t
�/� � �i
Sq. F't.
Sq. Ft.
sq. r,t. � I 0 �
'Z� � .2 -- � S a �,��
Corner Lat [] Inside Lpt [) Ft. Yd Setback Side Yard SetbacJss
Zj�pe of Constxuction: � c� !�1 d-*i'�J �JM .I1f r Fstimated Cost: $ 4� / S�
Approx. ��letion Date: 5"'- /p _ �d
Proposed Driveway Width If Ne�a Openirig Is Desired: Ft. $ $
Width + 6' See BacJc Page
LX11i'a: 3� /� LfCC1Jl�il1Y1. �SJ %�/^.� �• i1��/ —�� SS
1
P�erntit Fee $ r
State Surchan�e $_ + �
SAC Charge $
Driveway E��craw $
Park Fee $
Sewer Main Charge $
TO►I'AL $
S'!'IRTIAZZOI�S : � �'S '�` ��
�,� _ ��-��_=�.
CITY IISE �II,Y
Fee Sc,hedule on Reverse Side
$.5o/Sl,000 valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" AUc�ve
Fee Determined by D�gineer�r�q
Agreement NeoessaYy [ ] Not Nec2ssary [ )
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3�. r�v
INDUSTRIAL
eusir+ESs
CITY LOTS
TO�OGRArMIG MA►r�N6
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. C. E. COULTER
LAND SURVEYOR
REGISTERED UNDER LAWS OF STATE OF MINNESOTA
LICENSED oY ORDINANCES OF GTV OF MINNEAPOUS �
3300 LYNpALE AVE. SO. MINNEAPOLIS 8. MINN.
TAYLOR 4-0370
SURVEY FOR �-1RV/O �. ���'LSOrY' y'`�- �J�.i IN�.
, �urbepor'g �ertificate
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LAKESHOAE
JUO�GAL
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I hereby certify that the above is a true and correct plat of a survey of:
Lot Seventeen (17), Block Two (2), Parkview Heights Addition, Anoka County,
Minnesota.
As surveyed by me this 20th. day of May 1959 A. D.
�
' s � � e-��.1 �.�
� igned
- --'�� -~ . --.-.. Minnesota Registration No . 2584
.. : �.�.�,�
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sus�ctT MIT NO.
City of Fridley 3 029 8
�
AT TME TOP OF TME TWINS g� � �(� i N G P E R M I T
: : o.
� ; y �___� COMMUNITY OEVELOPM�NT DIV. �
f � � PROTECTIVE INSPECTION SEC.
i . ,
�` �'� � CITY HALL fR10LE� SS1�2 NUY�Ep AEV O�iE v�GE OF �►vROVEO er
L""� � • �.1
612-57�-3450 s�aF�s 9/27/99 / /
108 ADDRE55 1072 Hackmann Circle NE
t LEGAL LOT NO. BLOCK TRACT OR A001TION SEE ATTACMED
DESCR. 1'� 2 Parkview Hei hts SHEET
Y PROPERTY OWNER MAIL ADpR�S$ ZIP PMONE
Jerry Schaaf 571-6076
J CONTRACTOR MAIL ADORESS ZIP PMONE �ICENSE NO
Z-Roofin 1814 r Rd St Cloud - -
� ARCHITECT OR DESIGNER MAIL AOORESS ZIP PNONE UCENSE NO.
5 ENGINEER MAtI ADDiiESS 21P PHONE IICENSE NO
6 USE OF BUILDING
Residential
7 CIASS OF WORK
❑ NEW O ADDITION � ALTERATION �3 REPAIR p MOVE O REMOVE
8 OESCRIBE WORK
Reroof house and garage (18 Sq) Tear-off
9 CHANGE Of USE PROM TO
STIPUlAT10NS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCv IOAD
SEPARA7E PERMITS ARE RE�UIREO FOR EIECTRICA�, P�UM6ING. NEATING,
VENTILATING OA AIR CONOITIONING
THIS PERMIT 9ECOMES NUIL AND VOIO IF WORK OR CONSTFUCTION jONING SO. FT CU FT
AUTHOfiIZEO IS NOT COMMENCEO V�!ITHIN 60 OAYS. OR IF CONSTpUCTION
OR WORK IS SUSPENOEO OR ABANDONEO fO:i A PERIOD Of 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO OWIG. UN175 OFfSTREET PARKING
I MEREBY CERTIiV THAT 1 MAVE REAO ANO ExAMIN�O THIS APP�ICATION STA�LS GAfiAGES
ANO KNOW E SAME TO BE TRUE ANO CORiiECT. AlL PROVISIONS OF LAWS VA�UATION SURTAX
AND NA ES VEqNING THIS TVPE Of WQi;K WILL BE COMP�IEO
WIT WMETM EC IEO MEiiEIN OR NOT TME GRANTING Of A PERMIT $1573 $. %9
DOE NOT UME TO GIVE AUTMORITV TO VIOLATE Ofi CANCEL THE pEqMIT FEE SAC CMARGE
PRO ISIONS AN OTNE�ATE OR LOCAL LAW REGUTATING CON-
STR 10 PERfORMANCE OF CONSTRUCTION �S%.05 Fire SC �1.5%
PLAN GNECK �01 EE
Li e C 5.0 .41
S�G A O�CONCiiACTOQOA�UTNOQ�2ED�GENT iD�iE� M P VAUO E TMIS I UQ PEqMIT
. —
�GN• FE OF pWNEAiif OWNEpBWIDEA� �O�iE� - � OG �NS� ����E
NEV�' [ � �
ADDN
ALTER
Effective 5/10/99
[ � CITY OF FRIDLEY
[) SINGLE FAMILY AND DUPI.EXFS R-1 AND R-2
BUII,DING PERNIIT APPLICATION
Construction Address:
Legal Description�
Owner Name & AddrE
Contractor: � �
Address: � � � �
LIVING AREA:
GARAGE AREA:
DECK AREA:
1
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. , C, Tel. �'!n2 �S7/ � � d 2.�,
, t MN LICENSE #a�00 4�Q /(Q D
v ' Tel. #,�(� ^� S�( � � (/ ��
Attach to this appl�cation, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width Height
Width Height
W�dth Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
�
O�R: y�� t� 1� �S-Q . 1�� � c��
Construction Type: 1'b Y'�p Fstimated Cost: $ � ���
Driveway C�rb C�t Width Needed:
DATE: 1
Pemut Fee
Fire Surcharge
State Sbrcharge
SAC Charge
License Surcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ��. ��
$ 1,
$
$
$ � C�b
$
$
$
$
$ CO� .
0
+ �Ft � Ft x $ _ $
1,. �" '+.
Tel. #
Fee Schedule on Reverse Side
.001 of Permit Valuadon (1/lOth%)
$.50/$1,000 Valuation
$1050 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 [ ]
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COMMON VENT, VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When reqlacing an existina f�u nce, e undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. -- Yes �) No ()
The venting system is piastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No �Jj
The undersigned also verifies that the replacement unit is a listed assembly
and meets the cuRent codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existing combustion air is sized and installed to meet the current codes
and manufacturers specifications.
When required to install a new combustion air, it will be sized and installed
To meet the current codes and manufacturers specifications.
Yes �Qj No ( )
Yes ( ) No �
Yes f�Oj No ( )
When installing a new ventina sYstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturet's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tabfes for fan assisted and naturai draft appliances. Yes � No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes (� No ()
Aqpliance Type and Size/Common Vent and Vent Connector Information
Appliance #1 Type �na.c � BTU Input �D 1�C Fan Assisted or Nat _�
Appliance #2 Type �,ar� .�,. � BTU Input �_ Fan Assisted or Nat �
Appliance #3 Type BTU lnput Fan Assisted or Nat
Total Appliances Z Total Btu Input �,,�,_
Common Vent Type (�qss ,� Vent Height � Diameter J� inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describe) .
�
HEATING CO: �. �G -
Signed By: Date : / �D
FROM,:City oF Fridley
63-os6d'6 �,�
FAX N0. :76�5711287 Jan. 20 2�6 02: 18PI'1 P4 f
�,
Building ������, Permit No.:�
Inspections ��5�����,,�}pp��,�;�TION R�i`'� By: �
763�572-360a CI'� i'���1�`R�Ui,;i''� na� ��d: (� -
nn�re.. 5 D , ,, �YOUrt t+rt�tiu[, nn�s _ ._ -
3Ii'EAADRKSR �T�—/"fQ�'.,�.� o,-� ��..�p Q. ' _ ..
THIS APYLICAI�"I 1S: ❑ OWNER �(1r17RA�L"IOR
�ROPERTY Np��(' �,-y�. �
a'�V1yEn/ AI)fJRTsRB� 0/ %Z
TENAN7' ... . _ , .
�,�,�° c�
. f� . ; � L, �;.
- '�^?..,^'r�.. , . , � .
SU13MI'!� A COPY OF ��''� �`�: �l b 5�-- .'�— .�
Y�l1R STAFE STA'fLIICENSNY : D�DA'[E_... _.
IJCNN'SE W[TH ADDRbS.S, �(D I�_f�'1S2Pn�Po V� � n�C' C17'Y .
APPI .IC:A'1'tON �,�1? U3�,� =��1i_ , - — �r43� ��o L-q�-'�7_.
�P.?2` . ----�,d •�f�' +— � _—
PERMiT TYPE
TYPE OF WQRK:
..,� .
�31t+KiI.H FAMILY 0 TI�Y!��AIA1.Y q TQWNHOUSL'
r . ���'' e� . . , � .
/� . i.'_', .5.,. ..
O NE1�U J�REPLAC�90+T � � Ai.�tX1i0NRtEM0�E1.
r �
ST
ATF.��'LIY��
DETA1LCiUDESC,�tTPTiON OF WORK,_ .C�r�C: /,Jf�: CI�/!/1.t�t' ...� P��S�SL�6��
PER MS 16D.665 the pe�*+►it fcc is a minimum of Si�.AO or S�i q�l�e Np�� aa! up to SS00.00, whichcver is g,reatez, for thc�
itnprovement, instal lation or replacement of a rosidattil� �ttuse„ exCludi�fg dte lixttnea. (Thi� shoutd r�tlect only thc cost of lebor )
Labor cast under $30� = fil S.bO. Labor oo� betV►M� l�D� �3500 = cabCOi�1$bqr . x.05 -
Hb(t YROI['sGTS WFIERC, UBOR Fa7cC.N.EDS 5500, FEFS ARB HA.Ci� t1�1 �Q.O@ PQtFl7tP4iftk� �XCF.PT W}�RE N()TRJ). FIX7't:RES� (WDICATR'I�(7PAL
NUMBERCIF RA(-H BETAVI�
&{aipmcnt r�rW lexi MRC: __ ._ MODI's[.: SI'L�'1'U _..
1►g'G: . MOq81-: SIZfJi�'fCf _._
M�G: , _� ' wton�[.: sur�K�rrr .
,�iuc� szs.00 _�iRE,��.�cc �cas) S�s.00 ..Y _c��.� kaNC�oviav �io:oo
AIR 'I'0 AIR fi7fCIfANQEER $IS I'IRFPLA�(:B (WO�wi 533.00 __ NEV1` QAS� (iRII.T, $tA.AO
BOII.ER 535.00 FL11tNAC� 513.00 GAS UNl'T HTR�10.00
CHIMNEY LIAiGR S1U,00 _OAS D�V$R Zt0.110 ,- � _POOL Ht3A'I'F?k 535.00
lDUG'7' WURK. Si0,11(� CAR P'[P�1Q =LQ.00, � _ _YF�Tf[i.ATOR 515.04
Surchttrgo
TOTAL UU�
s — , -..?��uber of fbanre� �� 10.00 x S 10. W= S
��.. � .SO . Number of Fuctures (a� 515.00 x �15.W = �M
s ��.� Nwa� �r r�u� � �s.00 _�, � szs.rw - � �
Numb�x of fixtur�s r(� �3S_tl0 x$35.00 =�
State Surcharge - S .50
. Total = S- - ... ..----
TE'Q515 AN ANPL(C4Ti'�:�1 �'�t A 1'BRMI'I'-Nt)'[' ��i►LID UN'FIL I'R.00ESSED
1 heneby apply f�r a hailcling permit aad I Acknowlc�tl�qc ti�til�►d �or�4�:iqq,.u�WVa is compiebe and accurntc:; thac the work will be in
c�mformance with the ordinanccs and c�de�' of the City?ofi'Fridloy et�d w�h the Minno�ota Construc�ion Codes; that I understgnd this is
not a permit hu� only an application for a permit and vwcubc is natt,� ss4rk'with�ut a petrnit; that the w�xk will ba in aecordaace with the
app�aved plan in the case u`ail work which requires rovi�.wr and e�prov�l of pia�_
SI(iNA7'IrKF. OP APPLICANT _ . P.RINT:tdAl►(E�Qi)/SP- ��fl"�On DATC D
City of-Frtdley
Bltlidl��IA��C'�1Dt1S� I�CPNTtment
6431;iJmversfty Avc� �iF� �ridtey, MN 55432
!� 7�,3yS72 3C�b4; ..
FAX: 7f:3�50?r4977
Building
Inspections
763-572=3604
DA
BUILDING
RESI�ENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPL{CANT IS: WNER aC�NTRACTOR
PROPERTY OWNER/ Nq�: G-e �/' � j � G Iit q 4
TENANT pDDRESS: /67� �'7 a c(c „�,.�`�q ` r v' CITY,
PHONE: G I�' �(�(nq� –(� r 1�
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNII'P TYPE
TYPE OF WORK:
STATE LICENSE �
��� � � �
ADDRESS: CITY
PHONE FAX
IffSINGLE FAMILY/NEW CONSTRUC110N
❑ TWO FAIvID.Y/NEW CONSTRUC170N
❑ ADDTI"ION ❑ GARAGFISHID ❑ WWDOWS
❑$ASEMENT FINISH ❑ ROOF � DRAIN TILE
�DECK ❑ SIDI13G D OTF�R
❑ SWA�IIvID�G POOL
n
'- •�.�:
. - -. : �i
�. - .
. ����� � �
� . . . 11
A�� -5s�!��
TE ZIP
DESCRIBE WORK BEING DONE: ��,p �a c 1�.� c. C J V v��✓�'� o�� C(L � t �✓' � c. �c
—�" –
SIZE OF IMPROVEMENT LENGTH o� D WID'Tf-i /O HEIGHT / Sq. Ft.�o�'
NUMBER OF SQUARES �
GARAGFS
PROPOSED SIZE:
PROPOSED HEiGHT:
SIDIlVG
❑ Vinyl
❑ Atuminwn '
❑ Othcr .
wn�mows
IN EXTSTING OPEMNGS OYes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENWG CHANGES &
TYPE OF WINDOW TO BE INSTALLED
� HOUSE ONLY
❑ HOUSE dc GARAGE
❑ ATTACI�D GARAGE
❑ DEfACHED GARAGE
❑Soffit
O Trim
❑ Fascia
IACATTON OF WINDOWS
NUMBER OF �WITiI
BASEMENT REIv10DELiNG SUBMIT:
1. Existing Floor Plan
2. Proposed 800r pfan
3. List of strucd�rai members to be uscd
FOR NEW CONSTRU(,'T[ON MCLUDING DECKS,
ADDITIONS. & PORCIffS SUBMIT:
1. Sitc Plan/3urvey stwwing the existing sttuctures
and proposed project.
2. Two sets of construction plans
3. ��y c�a,i�r;«�
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING TIiE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $�(�Z� — OCCUPANCY TYPE
Permit Fee S� 3_ �"Z� See Back Page for Fee Schedule
Plan Review $ 65% of Building Permit Fee
Fire Surcharge $ .001 times the Wta! job valuation
Surcharge S �. �� .0005 x Permit Valuation Minimum 5.50
License Surcharge $ �S.QO (State Licensed Residential Contractors)
SAC Charge $ $1675 per SAC Unit (Plans to MWCC for determinarion)
Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$
Erosion Control $ �450 Conservation Plan Review
Park Fee $ Fee Determined hy Engineering
Sewer Main Charge $ Agreement necessary () Non Necessary ()
Total Due
Make checks aavable to: Citv of Fridlev Attach
'I�iIS IS AN APPLICATION FOR A PERMiT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Friclley and with the Minnesota Construction Codes; that I understand this is not a
pernut 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 work whi requires re iew and approval of plans. �1
SIGNATURE OF APPLICANT 2� Cc� �_PRINT NAME �� V'a ��� �GL� GY a\ DATE 7�? Q/ 6 7
�
Building $jJjj�Djj�jG Permit No.: �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY °��'�U �
UATE B��O/D� � YOUR GMAIL ADDRLSS �����-��GK `�'I�V --��
S1l�E ADDRE-SS /U7Z (7�OLKMA-M C/2C{„�
THIS APPLICANT IS: ❑ OWNER j�ONTRACTOR
PROPERTY OWNER/ NAME: /I.✓� S��
TENANT AUDRESS: I��JZ %�i�cKrN�J� L�j/LC,�i CITY �✓�L� STATE�'��CIP ���?Z
PHONF:�J�I'j, (�(QG1 (F��I3
CONTRACTOR NAME: N C�
SUBMIT A COPY OF STAre i.icErvsE � yDSqSR� r,x►� �n rE � it1�o`�
YOUR STATE LICENSE ADDRESS: �5F ,S��L..�S �+J• CITY INm✓N� STATE�iP S��oS(
WIT}i APPLICATION pHONE (QtZ '102Zz PnS
PROPERTY TYPE � stNC�.F: rnMii.v/Nfw coNSrKUC1ioN siz�
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE O A��irioN ❑ cARacF�sti� o ❑ wiN�ws
❑ BASF.MF:N'I' PINISH ❑ R(x)► ❑ DRAIN TILE
T�DECK ❑ SIDING ❑ OTHER
❑ SWIMMING P(K)L
TYPE OF WORK: ❑ NF-w ❑,�o�n �o�
�4AINTENANCE/RfPA1R ❑ REMODIiLING
DESCRIBE WORK BE(NG DONE: ���CL 4�P Q�_�l�lU/�(o
SIZE OF IMPROVEMENT �{ = LENGTH lD FQ' WIDTH �� HEIGHT % S. Ft.
ROOFING ❑ HOUS[ ONLY
NUMBER OF SQUARES ❑ HOUSE R G:1RAG1: BASEMF.NT REMODELING SUBMIT:
GARAGES ❑ Al "GICHGD GARAGI: I. E�istine Floor Pian
PitOPOSED SIZE: ❑ DET'ACHED GARAGE -'. Proposed Flcwr plan
PROPOSED HEIGHT: 3. Lfst of structural members to be used
SIDING EOR NEW CONSTRUCTION INCLUDING DECKS.
❑ Viny1 ❑Sat7it ADDITIONS. R PORCHES SUBMIT-
❑ Aluminum ❑ Trim 1. Site Plan/Surve� sho��ing the e�isting strucwrc+
❑ Other ❑ Fascia and proposed project.
WINDOWS 2. T�vo sets of construction plans
IN EXISTfNGOPENWGS ❑Yes �No L(x'AIION OP WINtx1W"S � �nerg� Calculations
OR FOR NEW OPENINGS-DESCRIBE SI"I_G OF
OPENING CHANGF.S R
TYPE OF WINI�W TO BE INSTALLLD NUMB[R OF WINDOWS
ALL N C,C,J AtiG tfAJt.0 VIV V ALUA I IUIV� 1tvl:LUU1fVl; 1 fiN; t�UJ l Uh LABUK ANU MA7 �RfALS:
(I�SING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ �% �G� OCCUPANCY TYPE
Permit Fee $ //. 5' See Back Page for Fee Schedule
Plan Review $ � � _ 65% of Building Permit Fee
Fire Surcharge $ �{, $V .001 times the total job valuation
Surcharge $ Z.2S .0005 i Permit Valuation Minimum $.50
License Surcharge $ s:Od $5.00 (State Licensed Residential Contractors)
SAC Charge $ $167� per SAC C!nit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$21 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary �) Non Necessary O
Total Due $ O�/ Make checks payable to: City of Fridley Attach
/
THI. IS AN r�PPI,lCn CtON FOR A PE:RMlI'-NO'1' VA�.tD UNTIL PROCESSED
I hereby apply for a building permit and 1 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 t 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 wo ' j uir s review and approval of plans.
i� u /�
SIGNATURE OF APPLIC T PRINT NAME_ �(i'A��AjI►{/t DATE_ ��.�+�
.�
�
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