AF - 45452�;
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City of Fridley, Minn.
BUII.DING PERMIT
�
�—„ �� ' �
Date: ... ..................................
N° 3353
-�`�'. .
Owner ......... Builder ......... �'.�t,...:......
....... .:.
Addras.s ...................................... Address .......................................... .
� Q—� � LO�CATI0�1t OF BUILD[NG
No. . =� . Str�et . . ., . . .. . . . : " . .. . . . .. . . . . Part of Lot
..... e ....e ... .. ..
l.Ot .��. .,�. . . . B10CI[ . . . .. . .�'.'�. . . . . . . . OII OP w�IIU-�V�3�OII � .�. /�'..i`.`�. . ����"�S :'ii'iiC'. .�d�!1s;°'��e
Coraer Lot . . . . . . . . . . . . Inside Lot . . �. . . . . . . . ,, ��,�°c� �� -- � . .
. Setback eyard .�.�%...� ................
DESCRIPTION O� BUILDING
To be Ua
� . . . . . . . ��ont . �� . . ne� . �:�. xe�nt . /.� . . sq. Ft. ��. �?. cw. Ft. �.�o � �O
................. I+'ront ........ Depth ...... Hefght ........ Sq. Fk ..
yr� � ...... Cu. Ft. ........
Type of Construction . T . �� � �. . . . �at. . .
���.��...:.'. To be Completed ..........
In cons�tderatlon of Yhe iss�uance to me o! a permit to construct the building desribed above, I agree to do
� P�P�d work in accordance with the descrlptton above set forth and in compliance wi1� all prov3sions of
ordinances of the dty oP Fridley.
.� . . . . . . ..... ....
/� 6�.D
In consideration of the payment of a fee o! . / !. . ""r permit is hereby granted to . . . . . . . . . . . . . . . . . . .
......................... to construci the buildfng or addition as described above. Th�ts er�►it is
P granted upon
the espress condition that th� person to whom it is gi�nted and his agents� employe� and worl�nea, in all work
done in, around and upon said building, or any part thereog, shall rAnporm in all respects to the ordinances of
�idley, Minnesota regarding location, construction, alteraf3on, maintenance, repair and moving oE buildin� with-
o�� limits and this permit ma.y be revoked at any time upon violation of �of the proviaians of said
. e�`: � -�". �. ': :�-: °� .� . . . Building Inspecbor
NOTICE:
Thls pe�mlt does not cover the conatruaRlon, Inatallatlon o� alteratlon fo� wi�ing, pl�iing, gas heating,
sewe� or water. Be su�e to see the Bullding Ir4ppeato[-�fo� sepa�ate pe�mlt� fo� theso Items
INDUBTRIAL C• E• C O U L T E R
BU8INESS
cirv�ors LAND SURVEYOR
TorOOa�wHiC MnvPING REGISTERED UNDER LAWS OF STATE OF MINNE90TA
3 LICENBED 8Y ORDINANCE OF GTY OF MINNEAPOLiB
� 3� � 3300 LYIVDALE AVE. SO. MINNEAPOLIS 8. MINIV.
� TAYLOR 4-0370
' �. .
�I� SURVE�C FOR ARVID E. CARLS4N & SON
� � �u�aegar's �Irrtiffc��
!/i'�'J'FF'1���` q �'�/'�fT� �492N:.F,+P¢
2rew fro'ti
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FARM SUHVEYB
- LAFCE8HOR6
JUDICIAL
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I hereby certify that the abave ia a true end correat plat of a aurvey of:
Lot Thirty-three (33) ��31ock Two (2). PAFiKVIEI� FI�IGHTS ADDITION. Anoka County,
N�innesota..
As surveyed by me tiiis lOth day of September 195Fs A. D,
1� �� � �
Si�ned � ��f � ,,�"�;;�:�;.�.��,�.,�,'. ��-
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y„ Minnesota Re�istration No. 25b1�
.-��� � L� ����� ,��
Date:
Owner
Addr
�
�
City of Fridley, Minn.
BUILDING PERMIT NO 413 9
__�-__.._��.�....... �� �.____....--------..
: ���...��. .._.. - •---..........._..--- Builder -----.... ._: ... .._......_...._.._�.. .__..._._..._...�_._
ess..__....-------._..._..._.�_--------._._...._.. ._...._.._... Address ---...----------._.-•-------..._.._..._---._.......__-------------------- -
L CATION OF BUILDING
No. .���.�..... Street ._. . ------------- -_.... _. ._..---- --��_.I�.s..--•------------•- rt of Lot .....-•-•-----_._..__.__ __.._ .._._
. ��
Lot .��....--�--�--.... Bl�k ..-�---�•�.----�-----�-- ................. dition or Sub-Division ..�---.. .- � ----�-- .... _..._ °�'._..����J .._..._.._.:..
Corner Lot
Sewer IIevation
To be Used as:
���.�. .._ ....... ..... .
- .._...... �-�-� --.....�.�.�.��.
Zj�pe of Construction
Inaide Lot ..� .............................. Setback ..............-•-----....................... Sideyard
..-�---•-�---•---...__.._ .............---•-�----...._......._..----------. Founiiation Elevation _---.............
DESCRIPTION OF BUILDiNG
Front�_.�..�..�..'�� Depth �..'. � Height .._���.._..�� Sq. Ft .��� Cu. Fk ---.�..%1._.���
Front ._ .................... Depth ...................._.. Height ......�'...�..._ Sq. Ft ....._.........-•----. Cu. F�
........................................................ Est. Cost.../���..................... To be Completed ...................._.....
In consideration of the issuance 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 compli with all provisions of
ordinances of the city of Fridley. �� � �S/ `�/ �� /�
In consideration of the payment of a fee of $ 0� ................•--.-.--.., permit is herebY granted to..-•----•-.--_...._....--.-- --
..._.._.__.__-----•-•---•----_....---...._.._........ to construct the building or addition as described above. This rmit is
the express condition that the person to whom it is � �� u�n
granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regerding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time ugon violation of any of the provisions of said
ordinances. � �
Building Inspecfor
NOTICE:
This permh does not cover fhe eonstruetion, ins�allatton for wirtng, plumbing, gas heahag, sewer or water. Be suro fo ae
the Buildfng Inspeetor for seperafe permits for ihese kems.
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City of Fridley _ 15 6 4 6�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
; � R IPT NO.
• COMMUNITY DEVELOPMENT DIV. �� � � n
r � L � PRO7ECTIVE INSPECTION SEC. �j
� _ �
� /�"1 � CITY HALL FRIDLEY 55432 NUMBEF REV. DATE PAGE OF APPROVED BY
�""'� � ,�� 612-571-3450 9t 0-F15 4/7/80 � �
JOB ADDRESS 1001 Hathawa.y Lane N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADD�TION SEE ATTACHED
DESCR. 33 2 Parkviev�r �1CJY1'tS SHEET
2 PROPERTYOWNER MAILADDRESS 21P PHONE
Milo Stenze� 1001 Hathaway Lane N.E. 571-0920
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WOHK
Cons.truct a 10` x 20` Deck onto House
9 CHANGE OF USE FROM TO
STI PU LATION S
�EPERATE PERMtTS REQUIRED F� 1�►����
HEATING, Pt,UNiBIIV(; AND Sr��'�,
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING Sa. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED 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 ]_ STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WIIL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �. QQO .�JO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEpM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. 7e SO
PLAN CHECK FEE TOTAL FEE
8.��
SIGNATUREOFCONTRACTORORA rH RIZE�AGENT iwi`E�. ,. WHEN PROPERLY VALIDATED THIS IS vOUR PERMI7
� ���� � 0. �
�-7-�c�
SIGNATUREOfOWNER�IFOWNERBUILDERi IDATEt BLpG iNSP fJATE
� rITY Of" FItIUI.EY •
AP-f'LTGlI�I'IOi� l�OR ItES1D�P�JTIIIL f3UILUIh�G PER��IITS
� . (WeUr, /lltera�.ions, Addil;ions, or Repairs)
r, o .
ObJ1dER: `'(� r� p ��� 17 7� LUI LUCP, :�c� I� P
� � .� �� � , �
ADDRE5S: tv 7/�� ApDRESS: • '
TEL �l0: � 7 / °- � `% � � TEL t�d0: '
STR1�T NO :, Q� 1 STR�ET:
Construcfiion Location
LOT: BLOC'iC: ADDITION :
Coxner Lot: • Inside Lo�: �� Set;back: Sa.deyards:
Applican� attach to this form twa Certiiicates of Suxvey of lot and '
proposed building location drawn on certificates to scale.
DESCRIPTIO(d OF CO�dSTRUCTION �
�(�(L Front: � (,1 Depth: oZ � Height:
Squa�ee Feet s (�+d Cubic F e�t e
� Front: Depth: Height:
Square� reet: � Cubic I'eet:
Type �f Coilstruction: ' Estimated Costa $ �
�b 73e Cbrnp.leted:
' Alt. A Alt. B
Pro�ased D�ivewa� Width If New Opening Is Desired: $� $
,. S�� REVER.SE SID� OF SHEET �
7�°iie undersigned hezeby makes applicatian for a perma.'t for the work hez:ein specified,
agreeint� to do a].1 work ir� strici: acc�rdance witli i:he City ot �'ridley Ordinances and
rulings of the DeparUuent o� Buildings, and hereby declares t:hat all the facts and
repzesentations stated in i:his application are true and correct.
DAT�: SIGNATUT'� : ' •
Stipulations: �
/• �� . . : i ' .
� v . � ' - � .
� � a �� rA� � .
� _�.
15U1I_1)IIVIU i'1_!il'I1 I I'L't. :,l,ti1_llULI: .
;;T•:C`S7C�)d 2. '1'he 7nr.;1�CCL'()Y of 11ui.lcli.i��J:; :..h17.1., 1�eJ:or.r. i.:;sui�,g }�>enni�s !.'nr. Lhc erccL•ion
vf: ilil�7 ))U].�.(17,11cJ or :;LrucL•utc, or. tar. a»y ���Icl�.t:i.an L-o ai�y e}:a.�t•iii� l�uilcli.i�g or. �Lzuctuxe,
. cir: l.`�r. nny ciltcrc�tiou o�: �:e)�air. ; L•o •cu�y c1:S_:;t.,i«7 l�ui.lcl.i.i��� ur :�L):UCtt1Y.'C� u���n app].S.cat•i.on
'L•hr.r.efc>r.e, r:ec�n.il-e U�c ��aymenL' 1�y t)�e al.���J.i.c��n� fur. s.iich �)er.ma.L of L'ce� to. Llie amount•
hcrcin beloti•� seL• for.th �ii�d iii L•hc manncn c�rei.n nrova.c]ccl t;o--wzL•: � �
1�I:4J COIIS`PRUC7.'TOt•]: Sir�csle 1'a�ni].y 1lomcs �inc1 Ga�'aqes : $Q . 00/l, 000 Cubi.0 �eet�. .
3'L11N C1i1:CY,: 25 �er.cent of I�tii.].din�J� t�e?�niL �ce.
DItTVEi•7RY I)EL�I2LSSXOI��: (Concrci:c, Curb �trecyi:s Only) �' •
' ]1l.Lcrnr�t:e n: Remo�✓al and replacem�nL- of: concrete curb and �
cl�lt•L-er o�ily; Drivew�y widl}i J�lus 6�eeL• a� Y�,5o75
1Lltcrnafi.e 13: Remova]. anc3 rc}�J.aceinc:nt- of. concreL-e cuzb and
• • � gutter_ ancl a.nsta].]. a 3 fooi� wide approach wiU� ''
� .• G S.r�ch :3c��th; Drivc�•ray wiclth }�lus G i'eet x$17.85 �
� � . �nDt-rro��n� Ir�r-or�t•�n�t�.
I'ox the i�urpose of comput�_ng iees ior_ building pex'mi.i:�, tlie cub5.cal coni�eni:s of any
bui�.dxnq or addii:ion, is deL-ermined by rnuli:i.p.lying i.tie ground area cove.red irom a•
, paa.nt si�: (6) iiiches beloca tlze floor J_ine oi the basement or the cellar to the
average lieights at the uPper. surface or to the averaae IieiJYit of t.he roof surface
oi tt�e nain c�ab].e of a pitched roof . �
I'or zepairs or ali:erations to an existing strucL�:re, L-he fee sha1� be a� the rate
oi $3 . QO Per eacii fa.ve hundred dollars -• ($500. 00) or fr.action il�ereoi' in the cost
oi all proposed worke �
�n •no case slxa]1 the �ee charged ior any permit as set forth a.n 5ection 2 be less �
than $7.50 plus $.50 state surcharge. •
_S��RI F I CATIO� 0� FOUP�D�7I0I�
• . . .
' NOTE: Per_mits far construct.ion wil� be issued a minzmum of ?_4 iiours from the time
of apnlication �o a?low �or proper review of the propo�ed structuxe and of the
constz-uction siLe, '
11 Certificate oi Survey oi the lo�� sl�owa.ng the locai:ion of the �ounda�ion once a,�
has been construci:ed wi11 be xequired befare nr-oceedinq wit11 the �raming.
r I�TCATE Q�= ��CUP�, ��Cl, ' .
�lpplica�ion for a Certificafi.e of Occupancy shall be made i:c�n (10) days prior ta the
u�e or occupancy of any sL•ructure ior �•rliicli a build�i�g ��crn�it has becn �.ssued; and
said sisucture sl�all not be used or occupied uiii�il a Ceri�i�icate of Occupa�icy has
been xssued.
. � , -�,
� '
�°: �
' ��^-
9
SuBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� .
� �
COMMUNITY DEVELOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEC.
i �
L1 = �
.-_.� �"' �•� CITY HALL FRIDLE� SS432 NUMBER REV DATE PAGE OF
ti 612-571-3450 910-F15 8/27/97 / /
J08 ADDRESS 1001 Hathaway Lane NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION �`
oescR. 33 2 Parkview fleights Addition
MGf1T NO.
5436
RECEIPT NO.
�J J��
APGROVED BY
SEE ATTACFIED
SHEET
2 PROPERTY OWNER MAIL AUUNtS� ��r rnv�c
Pat Michael 1001 Hathaway Lane NE 572-2638
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
Sela Roofing 4100 Excelsior Blvd, St Louis Park mN 55416 823-8046 1050
d ARCHITECT OR DESIGNER MAIL ADORESS ZIP PNONE LICENSE NO.
5 ENGINEER
8 USE OF BUILDINC3
Residential
7 CLASS OF WORK
❑ NEW
MAIL ADDRESS
ZIP PHONE LICENSE NO
❑ ADDITION ❑ ALTERATION j�] REPAIR ❑ MOVE O REMOVE
e DESCRIBE WORK
Reroof Garage (6 Sq) Tear-off
9 CHAN(iE OF USE FROM
STIPULATIONS
TO
SEPARATE PERMITS ARE RE�UIRED FOR ELECTHICAL, PLUMBING, HEATIN(i, CONST. I OCCUPANCY OROUP I OCCUPANCV LOAD
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTpUCT10N
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. l
I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED MEREIN OF NOT. THE GRANTING OF A PERMIT �SOO
OOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEfiM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE RF RMANCE OF CONSTRUCTION. � �Zl.00
^ PLAN CHECK
r
�� �, ��,�' '�� �f �-.� - Li s
S�GNATUAE OF CON � RACTOR OR A 7M RQE AGENT ��ATEI E
�
SiGNATLIRE OF OWNEP �li OWNER BUILOERI . IDATEI : p1 f1f.1
SO. FT. CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
�.J��
SAC CHARGE
Fi e SC $.50
TO A FEE
$5. 0 27.00
VALID E THIS IS �'OU�I
v-
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ADDN
ALTER
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ConstructionAddress :
Legal Description:
CI1'Y OF FRIDLEY
SINGLE FAMILY AND DUPLEXE5 R-1 AND R-2
Building Permit Application
Effective 3/1/9b
���/ �-�
Owner Name & Address: �� J� /�%r�c� �t�� Tel. # ���'"�� ��
Contractor: �� /�g �� �> � ��� C MN LICENSE # /tS.S-c��
Address: �/�d G���E/s,�c� �%vQ� �t` �e�G�.£� P,�-�_ Tel. # :1��' ��y�
LIVING AREA:
GARAGE AREA:
DECS AREA:
01'HER:
Attach to this application, a Certifica�e��of��urdey of�e
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
�
Width - Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground 5c�, Ft.
� �C�
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
a �� �t�
Type of Construction: �,�2,�� C���G � Estimated Cost: $ _ �
Approx. Completion Date:.
Driveway C�irb Cut Width Needed:
DATE: �'` � 7--� � APPLICA
Permit Fee
Fire . Surcharge
State Surcharge �
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
(Coat on Back)
+ 6 Ft = _ Ft x $
CITY USE ONLX
_$
_ Tel. # �oZ-``'�-- �C'�¢'6
$ ���� Fee Schedule on Reverse Side
$ � � .(�1 of Permit Valuation (1/lOth%)
$ �� $.50/$1,(�0 Valuation
$ $900 per SAC Unit
$ . C��� $5.00 (Staxe Licensed Residential Contractors)
$ Alt. "A" or Alt. "B° Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ �����
STIPULATIONS:
� z
BUII.DING PERMIT FEE SCHEDULE
The Chief Building O�cial 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 acnount
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,(�1 to $100,�
$100,001 to $500,000
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $5� plus $2.75 for each additional $100 or
fraction thereof, to and including $2,OU0
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,�
$349.75 for first $25,OQ0 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,0� plus $6.25 for each additional
$1,000 or fraction thereof, to and including $1�,000
$887.25 for first $1�,0� plus $5.00 for each additional�
$1,D� o� fractionthereof,..to.and including.$500,000
- �,:.�
.,_ . :J , �.. ,�;,,
;
_
$500,�1 to $1,000,000 $2887:25 for the first $500,�0 plus $4.25 for each additional
$1,IX10 or fraction thereof, to and including $1,0�,0�
$1,QQ0,001 and up
'$5012.25 for-the first $] ,Oi�,000 pius $2,75 for ea�h. additional
$1,�0 or fraction thereof � �
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb 5treets Only)
Alternate "A": Removal and replacement of cnrb 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
Pemuts 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 const�ucdon 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. �
sue�ecr P L�
City of Fridley 3 90 �
AT THE TOP OF TME TWINS g � I L D I N G P E R M I T
�
RECEIP NO.
� �• COMMUNITY DEVELOPMENT DIV. � ��
v PROTECTIVE INSPECTION SEC.
, ."'-
r ; ;
, _ ,
� /"'1 � CITY FIALL FRIDLE� SS�SP NUMBER REV DATE PAGE OF APPROVED B�
�""� � ��' 763-571-3450 ei0-F15 7/18/02 / /
JOB ADDRESS 1001 Hathaway Lane NE
1 LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 33 2 Parkview Heights Addition SNEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Linda Peterson 1001 Hathaway Lane NE 763-571-1929
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
Standard Water Control 5337 Lakeland Ave N, Crystal, MN 55429 763-537-4849 1522
4 ARCNITECT OR DESIGNER MAIL ADORESS ZIP PMONE LICENSE NO.
S ENGINEER MAIL ADDFiESS Z�P PHONE LICENSE NO
8 USE OF BUILDING
Residen.tial
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Install draintile
9 CHANOE OF USE FROM TO
STIPULATIONS
Extension cords cannot be used to hook-up pump.
TVPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO
SEPARATE PEiiMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, MEATING,
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZpNING SO. fT CU FT.
AUTHORIZED IS NOT COMMENCEO WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OA ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTNEET PARKING
I NEREBY CERTIFV THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STAILS GARAGES
AND KNOW TNE SAME TO BE TRUE ANO COiiRECT. ALL PROVISIONS OF LAWS VA�UATION SURTAX
AND OROINANCES GOVERNING TMIS TVPE Of WORK WILL BE COMP�IED �3 600 �I .8O
WITH WHE7MEF SPECIFIEO HEREIN OR NOT. TME GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE Ofi CANCEL TME pEqMIT FEE SAC CHARGE
PiiOVIS10NS Of ANY OTHER STATE Oii LOCAL LAW REGULATING CON- 97 � 2S Fire SC �3 . C7O
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION �
PLAN CMECK FEE TOTAL FEE
License $5.00 $ 7.65
S�GNOTUpE 0% CON'AACTOA OA AUTHOA�ZEO AGENT iDATE� EN . ROP VALIDATE THIS IS V sR PE ���
!� W�
S�GNnTUQE O� OWNEp ��� OWNEp BU�LOEAi IDATE� �N$� f�6lt
w
� �
NEW [J
ADDN []
ALTER [ ]
Construction Address:
Legal Description:
Owner Name & Address:
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY Effective 1/1/2002
6431 University Ave NE, Fridley, MN 55432 (763) 572,3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
������� � �
�it � ��� � Tel. #��e.� -�7/ /�� �
G� � � /! MN LICENSE #
�t (�Q �1.� ��- Tel. # �lro� ��� Li��i
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
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
� / ,e,,�
Construction Type: ��I !�l c e Estimated Cost: $��l� Q�i U(0 .-
�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � �� APPUCANT: ,i��%% � � ���•U�� Tel. # 7�o�2i7P 4��i�
Call (763) 572-3604 for Permit Fees if mailing in application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
I�i��
� q����
� 3a�d
$ t ���
$
$ �� c� t�
$
$
$
$
$� � �
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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:
.,_ - �+
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official sha11, 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
$SO1 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $5�,0�
$5�,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 $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additionnl $1,Q00
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 $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,OOO,t}00
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1, 000 or fracrion 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.
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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunum of 24 hours from the tune 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 Oniv
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FILL IN COMPLETEL'Y FOR REPLAC�M�fT FUEL. BURNIHi3 �►PPLIANCE PERMITS __
.L. ' • � - L�.- _ •
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VVF�an �nlacln� an �t�tina�fi�,m�e� the �mderaigned hereby ve�lfies that kh+a
ventinng has been exami�d and is tr�ee from rust, deteriat�n� obstrudlvr�s, Yfls (a�� �p t)
end i� set�uely �upported ar� firestopp� wher� r�equir�l•
The vac�tirtg sYste+�'� is PlasticlPVC and m�ts all curne� c�d� altd ment�tdturer N� ()
s�edfic�tfon� induding si�ng. �angth, rnunbe� af elbavas ar�d t�m�ation. Yes E�j
The undersigned a�so verif�es that the replacemerit ur�t i� a tisted assembty
attid meets �te cur�rtt ood� attd martufac�ime�s apet�c�tint�s. Thls does
include AGA-GAMA Catpory 1 Cer�rat Fumace Ver�ting Ts�es f�r ien v� �� No I)
asslst� �nd r�turei draft appi'ianr.es. .
�,j dYi��r;n �;plTllt�18�O�1 �IP is �iz� artd inSt0lled t+D m�t tite c�ure�t t�88 Y� �� P1p ()
and rnanufas�ure�8 speciflc�tior�•
When r�quired to ir�tall a n�v c�nix�s�an ai_r it wNl be sfzed and ir�tatted Yes (� �� t a
#o m�t the curr�rit �d� and manufacturet`� spectficetions.
When ino-�ill ventllna s�� ���ned hereby veri�es th�t
it i� � li�d �s�n�yr $nd m�ts the c�rrent � snci manuFacturer's
Ve�This daes indude AGA�AMA CategorY t Cet�tret Fwna�oe Rlo I)
for fan assisted and naturai c�raft app�ances• Y� �
Is the � ��mov�d frame the �mm�mon v ���d y�er
an apptia�ce Y�.s (� NQ i)
s�,�rat��y as �er c�n�r�er�t c�.
q � T d SL�I m Ye a t Co r
Appliane� #1 Typ�e � V do 8TU lnpvt
� � �an qss[sted ar Nat `�"
p►P�isnce #� Type ce�- BTU Input � F�n A�siated or idst .�^
AppC�ance #3 Type BTU In�ut �_ %ri /1�sf�ted or Nai
Tots� �� �-.— iotal8tu tnput .lr�
r
Camman Ver3t Ty� Ver�t Height ,^.. �� � D����r ���
�
q p P�� � 1 Vertt Connecta' liei$ht �ft Le�gth �.� Dlam�ter �in Type �
R Olameter _�.+.tn Ty�pe �..-
qPp{�nce #� Vent Conned� He�ht �ft t�ength � Diameter 9n Type ___.�--
Annlitanl� �Ci VArlt CQ11TtA +t"ti0r H�ght _.._
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- - �.� -
Building PLUMBING Permit No.: `�
Inspections RESIDEN�II�L APPI�ICATION Received By:
763-572-3604 CITY OF FRIDLEY nat��aAPR 12 20
DATE �/ � I`� % YOUR E-MAII, ADDRESS
srrE aDDx�ss av c� e �d r� r� �4 �..� � ��' ,�J E
THIS APPLICANT IS: ❑ OWNER J�CONTRACTOR
PROPERTY N,q�: L � �/ �,q P� i� 2 S o�
OwNERi aDnxESS: e v� v �O�PN A u1 �► �+ � a/ crrsr �R � t� ��"„�STATE�°✓ZIP .S s��y
TENANT rxor�: � � 3 _ 5 � � - � 9 a �
CONTRACTOR N�; Terry Overacker Plbg Inc
SUBMIT A COPY OF STATE LICENSE # /`1 `$ �,�'i 1628 County Hwy 10 _
YOUR STATE nDDxESS: Spring Lake Park, MN 55432 �.� ur _
LICENSE WITH pgp� (763) 572-8880 -
APPLICATION
PERNIIT TYPE �SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � ��''' �P�CEMENT
DETAILED DESCRIPTION OF WORK �.e-/�r,�� � �t-r/ G�--�✓ —���d
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installaxion or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cASt between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WI�RE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WI�RE NOTED. FD�TURES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
BATH SINK/LAV FL�R DRAINS SHOWER _ WATER PII'ING
— gqTH'['UB GAS PIPING fn�o ctrt'uc�vs� SWIlvMIING POOL WATER SOFTNER ($35)
CLOTI�S WASHER KTfCHEN SINK WATER CLOSET _BACKFLOW PREV. ($15)
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
— WATER MEfER _ OTi�R
v}�?� ._. _., `���T.�..,.. ����. � ..�..,.�w _ ..'�� ��"��� � �3� ����'� `� r .�N � b � f°iixtur �., � 1 $10 00 �
F�,,. ,. .� .. �
� =
;. F. �. : --�, ,. �., �,. ,� . ,;. . .. � . , ��'�� . , . ' `
Permit Fee $ um er o es @$ 0.00 x . _$
Surch e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ Number of fixtures @$35.00 _[_ x$35.00 =$ 3 s. � J
State Surchazge = $ 50
Tota1= $ �
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSID
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 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; thax the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME �%/t C• K �� A� !L J.J £ DATE y/ 9�`� 7
4Y�� �-:��.. ���,s,�iY,i,��?�J:iJ� ��..�.n.. ��'. .. R'� 's��'. ��� K- .��...�. ��-.e3�.� ����.a ���.... ��������i
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City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
Inspections
763-57Z=3604
DATE
SITE ADDRESS I
'I'HIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMTT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
�E oF wo�:
BTJIIIDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
E-MAIL ADDRESS
❑ OWNER �CONTRACTOR
STATE
❑ ADDTfION
❑ BASEMENT FINISH
❑ DECK
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
ROOFING �
NUMBER OF SQUARES �
GARAGES
PROPO�ED SIZE:
PROPOSED f�IGHT:
SIDING
❑ Vinyl
O Aluminum '
❑ Other .
EXP DATE
FAX
❑ SIDING
❑ SWIMMING POOL
"sPAIlt ❑ REMODELING
LENGTH
HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACF�D GARAGE
❑ DETACHED GARAGE
❑Soffit '
O Trim
❑ Fascia
wrnnows
IN EXISTIlVG OPENIlJGS DYes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF ��
❑ DRAIN 1'ILE
❑ OTI-IER
Permit
�
� - - -. : - ��
�►;'��� ;:-�y� �� �
1
HEIGHT
.,� 5 +-5 IcA
BASEMENT REMODELING SUBMIT:
I. Existing Floor Plan
2. Proposed floor p(an
3. List of structural members to be ased
Ft.
FOR NEW CONSTRUCTION INCLUDII�IG DF�CKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site PlanlSurvey showing the existing structures
and proposed project
2. Two sets of construction plans
3. Energy Calculations ,
ALL FEES ARE B.�SED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(US 'G � 97 �I,���E SCHEDULE)
TOTAL JOB VALUATION LL �s OCCUPANCY TYPE __
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ �_G'�/
$ f. (�'�f-
$ ,o^�j •CJZ�
$
$
$ �
$
$
$ l,�R'- --
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)
$1675 per SAC Unit (Plans to MWCC for detemzination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks navable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERNIIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclaiowledge 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
pertnit 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 which requir review approval o lans.
SIGNATURE OF APPLICANT M�M./� 1��+ NAME M�1� DATE �� u���