AF - 46610� Cit of Fridle , Minn•
Y Y
BUILDING PERMI�
N° 414'7
Date : ............ �...^__.. /..�..`..... �.C..�.......... - -....-- ----
Owner: ................- -� - . Builder ...4�'rl.lQt.'��!4....�.... - �-�--..........--�-- �---� �
Address...... ..........._............--�-�--��----......---��---........--�--•-�----•-----•�------••--� -------------.... Address
�o TION F �ui iNc
No. .l-.-l/.....`,�...�p..... Street ...... ... ............ ...... ... -. Part of Lot ....._.
� . .... .. ....... -. ... ....--�- . .. . ......... -- � -� - --------- ....----_....------��-------...
Lot ......�.�.........._. Block ............. ��� ............... .....---.... Addition or Sub-Division .� ��Q
. ......_ .... ........._.. ...._. .- - - - ........._.......--------
t a ( -r
Corner Lot .._ ................_.............. Inside Lot .�........ ..........._ _.... Setback �.._�........... Sideyard ��....._�.._..........._......................
Sewer Elevation
To Used as •
... ......... - . ...__--�-� --- -
Z�pe of Construction
Foundation Elevation
DESCRIPTION OF BUILDING
Front �� d,/ p�� v Height /9'"tQ Sq. Ft.�/Z..Y._.. Cu. Ft. �.....1..!� J
. -...... De th ................. . �..-
Front ...._ - ..._ ...._Depth _ -- - -.. Height - ......._... Sy. Ft. ._....___........... Cu. FG
.............. Est. Cost ..,�J�,.__-!,�/....�'�'�.... To be Completed ...........................
In consideration of the issuance to me of a permit to construct the ' ding described above, I agree to
the prnposed work in accordance with the description above set forth in pliance provisio f
ordinances of the city of Fridley. �.- �
/! R
. a�%
In consideration of the payment of a fee of $_��._.__..._.._., permit is hereb
Y �ted to....... - -... - -- -- -- -- ---- --
.._.._ .................................................................... ta construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted ,and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, sha11 confarm in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time upon violation of�} y of the provisions of said
ordinances. , �" i
Building Inspector
NOTICE:
This permif does nof eover the wnstrudion, insfallafion for wiring, plumbing, gas h�atiw0, s�wer or water. 8e sure fo se�
the Building Inspeetor for separate permits for fhess ifems.
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sue�ecT P
City of Fridley � q. �,� 3
AT THE TOP Of THE TWtNS g U I L D I N G P E R M I T
r
' � RECEIPT NO.
� �` __�� COMMUNITY DEVELOPMENT OIV. , /
r � V � PROTECTIVE INSPECTION SEC �l„(,�/
� �
� �� � -
� � /"'1 � CITV HALI FHIDIE� SS432 NUMBER REV OATE . PAGE Of nPVROVED Bv
�""��� �'' 612-571-3450 9t0-Fi5 6i12/96 / /
JOB ADDRESS 1096 Hackmann Circle NE
1 LEGAL LOT NO. BLOCK TRACT OF ADDITION SEE ATTACHED
DESCR. 1/{ 2 Parkview Heights SHEET
2 PROPERTY OWNER MA�L ADDRESS IIP PMONE
Jim/Thea Langseth 1096 Aackmann Circle NE 571-6431
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Yli.g Viking Home Im rovement Co 4832 2 1 2 Street NE M ls 55421 572-1820 4772
4 ARCHITECT OR DESIGNEH MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION p REPAIR O MOVE ❑ REMOVE
%
8 DESCRIBE WORK
Reroof House (18 S) Tear-off• Soffit, Fascia, Gutters
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
tYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS AFE REOUIRED FOR ELECTRICAL, PLUMBING. HEATING,
VENTILATING OR AIR CON�ITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. fT CU FT
AUTHORIZED IS NOT GOMMENCE� WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OffSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ ANO EXAMINED THIS APPLICATION 1 STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERN�NG THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �3,345 �p1.G7
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT fEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFORMANCE OF CONSTRUCTION �87.25 Fire SC �3.35
PLAN CHECKFEE TOTALFEE
License SC $5.00 $97.27
S�GNATUAEOFCON'AACTOAOAAUTHOR�ZEDAGENT IDATEi HEN PHOPERLY V LI /1�ED HIS IS Y R PERMIT
� S�GNAiUAE Of OWNEp ��� OWNER BU�LDERi �DATE� . BLOG � � qhTE
NEW
ADDN
ALTER
il
Cl
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ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
�- �. � %�1 /t G � `e
Effective 3/1/96
�a��/
Legal Description:
Owner Name & Address: �\ M��/�{e/�- L/�-•v9 ,��%-�- Tel. #�� ! l� 7 3 f
Contractor: c ,,� - e� v -� •yt � � �—MN LICENSE # �
Address: 2� �y .��- Tel. # �` %� �1��
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IIVIPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd Setback 5ide Yard Setbacks
Type of Construction: '' c� �,�� � d,��;t� �i4se �� Estimated Cost: $/�(3 �� ���'
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: — ( - �G APPLICANT: Tel. # ,5r% Z - �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ %, Z�i
� 3, �
$ %
$
$ ��
$
$
$
$ ^
� �� Z7
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 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 [ ]
STIPULATIONS:
__ _ -,� .�
G��
�
�,�2 -°j�
��e � S �`�/ °
James R. Langseth
1a96 Hackmnnn Circk NE
Fridley, MN 55432
�y i4, i�sg
Jon H. Haukaas
Assistant Public Works Director
City of Fridley
6431 University Ave. NE
Fridley, MN 55432
Dear Mr. Haukaas,
This letter concems the elm tree on the boulevard at 1096 Hackmann Cucde_ As we have discussed, we are
concerned that the removal of roots on the street side of the tree could compromise the stability of the tree in a storm.
In view of the extent of root removal by the cornractor in preparation for curb ptacement, in addition to the earlier
disruption due to gas main and gas service replacement, we are very concernai that the tree could be knocked over in
a storm. Therefore, we request that the tree be removed promgtly by the City. We roquest that the stump be removed�
as well.
You may reach me by phone at 832-2731 (work) or 571-6431(home).Thank you for your atterrtion to this matter.
Yours truly,
�'`
James R Langseth
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Building
Inspections
7. 63-572-3604
DATE�,Y,I �l� �'
SITE ADDRESS ,�
TMS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE WITH
APPLICATION
PERNIIT TYPE
TYPE OF WORK:
f•
MECHANICAL
RESIDENTIAL APPLICATIQN
CITY OF FRIDLEY
YOUR E-MA1L ADDRESS
❑ OWNER �CON1'RACfOR
PHONE:G ✓Z � ��JZ-���
NG & AIR CONDITIONING, INC.
cor�nxY xr�:_
CONTACT PERSON:
Permit No.: 'v1�''" r r
Received By�
.� Date Rec'd: (�'' � '�` _
ctz-5r 1^l v\ P��—sr.
STATE LICENSE # EXP DA7'E
Pl��� Yli tq'I..IAP.I �STAT�ZII��
ADDRESS Q�jj �-- CITY
PHONE�Q� �JZJ —I�1� FAX —11�� �JZ�j- IS�'1S
�SINGLE FAMILY ❑ TWO FAMILY
❑ �W �REPLACEMENT
DETAILED DESCRIP1iON OF WORK
O TOWNHOU3E
❑ ,�xnnoN�MOnp..
PER MS 16B.665 the permit fe elacement of aI es den� al fixtuJ'e� xcluding the fixtures� �(Ths Ohou dlreflect only the Tco sof labor )
improvement, uistallation or r p
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor�� x.OS =
FOR PROJECTS WHERE IABOR EXCEEDS 5500, FEES ARE BASED ON 510.00 PFR FIXTURE, EXCEPT WHEKE NOTED• FlXTURES� (IN�ICATE TOTAL
NUMBER OF EACH BELOV� MODEL: ��L� SIZE/BTU Z"N.�
Equipment Installcd . , �G� � SIZE/BTU
Iv1FG: ______ MODEI..: SIZF./BTU
�G: MODII.: GAS RANGFJOVEN SI4.00
,�A/C 525.00 FIREPLACE (GAS) 515.00 _�W G� G�J,L 510.00
_AIR TO AIR EXCHANGEER S 15 _FIREPI-ACE (WOOD) 535.00 _G� �� � S 10.00
BOILER $35.00 _FURNACE S35.00 pppL �p-I-gR S35.00
CI-�MNEY LINER $ I O.OD _GAS DRYER S 10.00 —�,p�TOR S I 5.00
DUCT WORK S10.00 _GAS PIPTNG S10 00 _�������„�,������
- ---- __ _.�. - �.
' ', �� y�nti'._., � ��"',�, ���i�.��IL7Ti3t'7�V,:y�7l7'1+�'s� a';i!;seF v,sY-;.xasrrs-aH��.:+�v-�c ..- . .. ..-....�. ...�.__.._ ...,___..__ . —_
Permit Fee $ Number of fixtures (a3 $10.00 x$10.00 =
Surcharge $ .50 Number of fixtures @ $I5.00 x $15.00 = $
TOTAL DLJE $ Number of fixtures @$25.00 � x$25.00 =$� . c� a
Number of fixtures @ $35.00 x $35.00 = �
State Surcharge = $ .50
Tota] _ $�
THIS IS AN APPLICATION FOR A PERMTf 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 �Construcrion Codes; that I understand this is
not a petmit 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�k whj,ch �eq�ires review and approval of pl � s. ' f.��, ��
SIGNATURE OF APPLICANT
City of Fridley
Building Inspections Department .
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
'' �
Building
Inspeciions
7. 63-572-3604
DATE � � ��
g.ITE ADDRESS �
TfiIS APPLICANT IS;
PROPERTY
OWNER/
TENANT
MECHANICAL
RE5IDENTIAL APPLICATI�N
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
❑ OWI�IER �bN7�RACTOR
PHONE: _1 �3- �7� 1 - �? 43�
Permit No.;
Received By:
Y i_ �-P _C1TY � � L��1 STATE W A.�IP-��
CONTRACT�R COIvIPANY NA2�: � , •
SUBMIT A COPY OF CONTACT PERS�N: U�'
STATE LICENSE # EJ� DA"fE �
YOUR STATE ���, �t�� STATE�_ZIR��
LICENSE VJITH ,anDxESS: �3� '�� ►�� cu �'� —�S� �
A.PPLICATION PHONE ���3Z3- ���, FAX , l�'.�- 3� 3�
PERNIIT TYPE
TYPE OF WORK:
�1dGLE FAMILY ❑ TWD FAMII-Y
❑ �W B'�PLACENIENT
DETAILED DESCRIl'TION OF WORK
� TOWNHOUSE
❑ pyTgRA1'ION/REMODEL
PER MS 168.665 the permit fee is a minimum sidential fioxture� xc{l�uding theSfixt��res� $(Ths Sho ld reflect o y the cost of labor )
improvement, installation or replacement of a re
x.05=
Labor cost under $300 =$15.00. Labor cost between $300 to 5500 = cost of labor I���pTAL
F�R PROJEC'fS Wl�RE LABOR EXCEEDS 5500, FEES ARE BASED ON 510.00 PER FIXTURE> EX�EPT �'`��� N��SIZE�/8��. �
N1JNBER OF EACH BELOW} �G: �,�, ^,�, , MODEL: �m` S��/g.I.0
EquipmentInstalled . , �L�d�— MODEL: •
NIFG: �— MODEL: �_ SIZE/BTU
MFG: `— GAS RANGFJOVEN 510.00
_A/C $25.00 �FIREPLACE �C�A�) $15.00 �W Gpg GRILL $10.00
FIREPLACE (WOOD) S35.00 G,q� �T HTR S10.D0
_AIR TO AIR EXCHANGEER $15 -�F�ACE S35.00 -
_BOII,ER $35.00 _Gqg DRYER 510.00 POOL HE?+TER $35.00
CHIT�Q�IEy LINER SI0.00 VENTII.ATOR SI5.00
DUCT WORK S10.00 GAS PIPING S10.00 — J. s��������
��� - � � � �
-- -
... . ..�
... ' , g, � . _ .
� Permit Fee ~$ Number of fixtures (a3 $10.00 x$10.00 =
Surcharge $ .50 Isumber of fixtures (a3 $15.00 x $15.00 = $
TOTAL DtJE $ Number of fixtures Q$25.00 x$25.00 =$
Number of fixtures @$35.00 i x$35.00 =$?�5 - �0
State Surcharge = $ p
Tota1= $ ''S5 . S
'CHIS IS AN APPLICATIOI3 FOR A PERMIT NOT VALID tJNTII- 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 a1workFslnot o starti�thou a peennit; tha the wor vvoll be ina accordance�with tha
not a permrt but only an application for a permit an
appro�ed plan in the case of all w rk ich r uires review and approval of plans. DA� / v 7
PRINT NAME �� I V��N Cr� --�—t—'
SIGNATURE OF APPL3CANT �
---_._._�...._,�,��__.�._b:..�,fiTa=�-,f'�+�rci .�3��
. . • 1Y19Y �'`•.Tx�..7�" C . . _ .. .,.m,.... � . _ . _ .
City of Frid ey
. Building Inspections Depariment .
� 6431 University Avenue NE, Fridley, MN 55432
� 763-572-3604
� � v. ���z_tn�_4977
�uilding
Inspections
763�572-3�p4
SITR ADDRIs5S „^
'r1115 APPLICANT 15:
PROP�YtTY
OWNER/
'T�NANT
C����O�
SU�MIT A COPY OF
YdUR STATE
L1C��vsr•. wiTH
APpC.ICAT[ON
p��rr �rE
P�,UMBIN�
RES��ENTLA.�, APP�,�CATI4N
�xx� or ��n�.a��'
YOUR
0 OWNER
NAMG:— ,. +- .. C�Q.�
ADDRESS:..�� /�� 1
pHONFi;��,���'+ %
STATR LICENS�
'�'YP� OF WORK: I ❑ N�'�`
Pemut No.:,�7 -
Received By:_
Da�'�aOC
.._STA7'd�/_1'LIP
�
.. -s�rn'��.1'1�crrS�1�/ �
�:..J al !— b Q,a�s�— F,oX �G/�o[" .`,�,C�/"' {���5 .�
RAMiI.Y 0 TWO FAMCLY ❑ TOWNHOUSC
1�RT:ht.ACBMENT
bETA1LF.D D�SCRIP'TION OF WORK
PFR MS 16B.6bS the permit fcc it a tn�Knimum of S�S.00 or 5°/. of tbc total cost up to 5500.00, whichever is grcater, for the
improvcment, install�tion or replac.�ment of a residentis� fixtuz+e, exeluding the fixwrrs. (This shouid reflcct only the cast af labor )
Labor cost under S30U =$ I 5.00. Labor cost between $300 to 5500 = ca�t of labor x.US =
rt)R PROJECTS WHFRF t,ABOR TJtCt6DS 5500, i'CGS ARF. BA.SED ON SI0.00 PEFt FlXTURR, �,7CCEpT WH�RF. NO'I'�D. �tXTURF,S; (R�U]CATF: TOTAL
NUM[iL7t OF EAGH �T.[.OW )
-- UATH SlMK/[.AV _FC.c)OR DRAiNS ,_ SHOWCR _ WAY�x prni1VG
__ RnTHTU1i _ GAS P[PtNG �N..•►,;n tmuc�nsc� _ SW[MMfNG POOL �_ wATER SON I'tdER (t35}
_ CLO'fHFS WASIIGR _ KI'PL'ti�N SINK wATER C1AS6T _ IIACKFLOW PRLV. (S I S)
_, i]ISHWASI(GR ,� LAUNDRY'CRAY �WATER HRq'[�R (S35) FOR IRRICA'!'IUN
_ ^ wA7'F,It M�TER _ OTTi'Bit
Fee
DUE
$ Number of fixuurs c(� SI 0.00 x$] 0_00 ��
.SO Number of fixtur� �u3 S 15.00 x S15A0 =$
a Number of fvct�n+es (a'� $35.00 � x 535.00 = S��Q
Statc Surcharge = ��
Tota1= � S_`
T'HiS TS AN API'LJCA'T70N �OR A PRRMI'I'_NOi VAf,iD UNTiY. PRQCESSGD
1 hcroby appty for a building permic and I acknawlalge that the information above i� complete snd accurato; thxt the work wil] be in
conforn►f►ncc with the ordinances a�d codes of the City pf Fridlty and with thC Minnesota Con.ctruction Ccx3es; that 1 understat�d this is
nat a permit but only an applie:�tion for a ptrmit and work is not to start without a ptrmit; that the wor[c will be in accordancc with the
approveci plan ;n the easc of� wo�ic wh�� roqu;res � and ap�oval of plans.
src;rvn�,RF or•
SE NUTE: SEpARATE PEItMITS
Cxty of Frid�ey
Buildang Inspections �epartment
6431 University Avenue NE, Fridlcy, IvIN 55432
763-572-3b04
�AX: 763-502-497�
1��►1�:
wortx
,._� ..... �.._�....._ ..�_..... ... .._ ......
Wd ES�6Z�6 LOOUOIlOL �a;ea g%Z :a6ed S9Ll LZ9 ZL9 �Wa��
Building
Inspections
763-572-3604
DATE � � � vu► � � v
SITE ADDRESS ��
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No.,
Received By:
Date Rec'd:
YOUR E-MAIL ADDRESS �JSQ��C� ����C OC � CCm'l
.. � _ ( n
0 OWNER OCON7'RACTOR
ADDRESS: � � CITY
PHONE: ��V3 � �� � �y
NAME:
STATE LICENSE #,
ADDRESS:
SINGLE FAMILY/NE�
Renewal By Andersen
1920 County Road "C" West
Roseville, MN 55113
License #20130983
651-264-4777
❑ BASEMENT FINISH ❑ ROOF
❑ DECK � SIDING
DESCRIBE WORK BEING
SIZE OF IMPROVEMEr
ROOF7NC
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O V inyl
O Aluminum
❑ Other
W
ADDITION
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
OSoffit
D Trim
O Fascia
WINDOWS
!N EXISTING OPENINGS �Yes ❑No I,OCATlON OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
❑ WINDOWS
❑ DRAIN TILE
0 OTHER
1ti �St11C c S
ATE ZIP,
ATE ZIP
BASEMFNT RFMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
Ai>DITIONS_ & PORC[-LFS SUBMIT:
1. Site Plan/Survey stawing the existing suucture
and proPo� ProJ�•
2. Two sets of construction plans
3. Energy Calculations
' WINDOW TO BE [NSTALLED NUMBER OF WINDOWS I
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING TI� 1997 U`B.0 FEE SCHEDULE)
OTAL JOB VALUATII
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Cutb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
$ t�'5.�5'
$
$ � .85
$ �.93
$ S.On
$
$
S
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)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21 =$
5450 Cons�vation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payAble to: City of Fridley Attac6
THIS IS AN APPLICATION FOR A PERMIT-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 i�
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 approve<
plan in the case of all work �ch requir ,�Cview and approval of plans. 1
SIGNATURE OF APPLICAN `/ j�j��,�v�.cT�" `�+� pRINT NAME/1 ,Q�tti�,,��,tl�Se If�7 DATE ✓�'" W t/� `�O
Building
Inspections
763-572-3604
DATE � � ��
S1TE ADDRESS ��
THIS APPLiCANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Perinit No..
R����a sy:
. ,- �.;
E-MA[� 9DRESS �i1SC3�,��C��LiDI�C�lC• C.UY�'1—
�
❑ OWNER OCONTRACTOR
ADDRESS: � C�TY
PHONE: t �D � • d'[S � �3 7
NAME:
STATE LICENSE #_
ADDRESS:
SINGLE FAMILY
O BASEMEN7' FINISH
O DECK
TYPE OF WORK: � NEW
❑ MAI1
DESCRIBE WORK BEING DONE:
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O Vinyl
O Aluminum
O Other _
Renewal By Andersen
1920 County Road "C" West
Roseville, MN SS113
License #20130983
651-264-4777
❑ GARAGE/SHED ❑ WINDOWS
❑ ROOF ❑ DRAIN TILE
O SiDING O 07'HER
O SWIMMING POOL
0 ADDITION
� REMODELING
LENGTH
O HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
0 Trim
❑ Fascia
W INDOWS
IN EXTSTING OPEMNGS DYes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES 8c
ATE ZIP,
ATE ZIP,
1 �'
HEIGHT
SASFMENT RFMODELING SUBMIT:
i. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
Ai)DITIONS. � PORCHES SUBMIT:
1. Site Plan/Survry showing the existing structur�
and proposed project.
2. Two seu of construction plans
3. Energy Calculations
' WINDOW TO BE INSTALLED MJMBER OF WINDOWS I
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION $(110� SS OO C�E OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
$ 139. as
$
$ .a
$ I `I
$ . O C7
$
$
$
$
$
$ I 53. (D8
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
55.00 (State Licensed Residential Contractors)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx�21=S
a450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payabk to: City of Fcidley Attac6
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D UNTIL PROCESSED
1 hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that 1 understand this is not
permit but only an application o a permit an work is not to start without a permit; that the work will be in accordance with the approve
plan in the case of all work whi requires re ie and approval of plans. �1
SIGNATUREOF APPLICANT �/p1i�NAME/l ln��. �. v�ce�r�'� �aTF �v I'�I�l�/ Iv