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City of Fridley, Minn..
BIJII.DING PERMIT
Date: .�.` / /. �...� .....................
Owner.......................................
Addr�s ......................................
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Address.............................................
LO�CATIO�IV OF BU[LDI1�lC
No. . .. . .�. � � Street F.�:�i:�'F: : `:`: �^' :r,�.°...�'. :� :"✓'. :�'��. .�. :� Part Lot . . . . . .. .. . . . . .. . ti . . . . .
.. :` � � � .
Lot . . . . �.�•. . . Btock . . . . .� . . . . . . . �dition or Sub-Dfvision . . ,rt��r: . r : : � �. : F .' � '': . �, � . . . �' �' r r
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Corner I,ot . .. .. . . .. . . . Inside Lot . . . . . .. .. .. . 5etback y � �-�
�� . �% � . . . . . . Side ard . . � . . . �. � � . .
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DESCRIPT[ON O� BUI1LDIll�fa
o Used as: ,.
,� r� v �' � � / } R2
-.:'.���:........ F�ont �,�'.�,.... Depth :'.... � Height .... �.. Sq. Ft. . �.' F..! Cu. Ft �,:�,�'�f�
. . . . . . . . . . . . . . . . . . . . . F'ront . . . . I3epth . . . . . . . . Height . . . . Sq. Ft. . . . . . . . . Cti. Ft . . . . .
? 3 a a2 r� � �'°
Type of Constructioa� 2.. ,`: .r. .,+: : : ; . . . . FF�tt. C�t. �..�. . . �'�. : .�.�. . . . : . . . To be Completed !. . .� r: `, . � . . . . . . . .
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In consideration of the issuance to me of a permit to construct the building desribed above, I agree to do
the proposed work in accordance with the description above set forth and ia compliance with all provisions of
ordiaances of the city of Fridley.
....................................................
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In consideration of the payment of a fee oP $. : . !'. .. �' : . ., peranit is hereby granted to . � . .. . . .. . . . . . -
... .. .... .... ..... .... ... to construct the bwilding or addition as described above. This permit is granted upon
the express coadition that the person to whom it is granted and his agents, employees and worl�nen, ia all work
done in, arouad and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota. regarding location, conatruction, alteration, maintenance, repair and moving of buildings with-
fn the dty limits and this germit ma.y be revoked at a�y time upoa viola.tion of any oE the provisions of sa3d
ordinances.
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NOYICE:
This permlt does not eover the conatruction, installatlon o� alterai(on fo� wlring�mbing, gas heating,
sewe� o� water. Be su�e to see the Bullding Inspe�tor fo� separate permlts for these Itema
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INDUBTRIAL C. E. C O U L T E R�
BUBINE88
cirr �oTS LAND SURVEYOR
TOPOORAPHIC MAPPINO REGISTERED UNDER LAWS OF STATE OF MINNE&OTA
IICENBED BY OIiDINANCE OP CITY OF MINNEAPOLIB
3300 LYNDALE AVE. 50. MINNEAPOLIS 8. MINN.
TAYLOR 4-0370
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FARM BURYEYB
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JUDICIAL
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I hereby certify that the above is a true and correct plat of a survey of:
Lot Twelve (12), B1ock Three (3), PARKVIEVJ HEIGHTS Al)DITIOf1, Anoka County,
Minnesota.
As surveyed by me this 6th day o£ August 1958 A. D.
; .
Approved by Building Ins ector ~ .
P s�.�ea � �
'� Minneso Registration No. 2584
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City of Fridley, Minr�.
BUILDING PERMIT
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N° 6514
TION
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No. � str�eet _
Lot __ Block � A tion or
Corner Lot _ Instde Lot —. /� �ttback
Sewer IIevation ._ Foyddation IIevation
Lot
DESCRIPTION OP BUILDIPIG
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-' �/��/�i,/�1 �� � y � - . � - :I�,��.� � Y,a. � Y�/. 7' ��
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In cansideratfon of the isauance to me of a germft to construct the building descrihed above, I agrce to do
the prnpcsed work in accordance with the description above set forth and in compliance with all provisions of
or�linaa� of the dty of F`ridley. . `_ .,'/ �.r/ � �
In con�fderai3on of the paqmeat of a fee of $� , permft is hereby granted to
to construct the buflding or addit3on as described above. This permit is granted up�
the express c:ondition that the person to whom ft is granted and hia agents, employees and worl�en, in all work
done fn, around and u�n said huilding, or anypart thereo� shall conform fn all reapects to the ordinanc�ea of
Fridley, A2innesota regarrling location, conatruction, alteration, maintenance, repair and moving of builaings
ordinan� dty lfmits aad thia permit may be revoked a t anY /� npon��/ 1P aay of the Pravisiona of �aid
inspector
n Nonc�
'�s psrm@ dea eet eewe ths comhudiee, �an Io� �drteg, pinmbing, ea hating, sar�r er rrater. B� surs w a�
t6s Baildin8 I�or tor sfp�►af� p�rm6s for th�a huw.
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APPLICATYON FOR BUILDING PLRMI�
CI�Y OF FRIDLEY, MII�ES.OTA
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LOCATiON OF
No. ��� SCreeC�
Lot�,,, - B1ock�_ Adaitipa or
Cor�er Lot�Iaside Lo�
SEWLF. EI.EVA3.'IOAT
�Side �ard �,
, ���
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E'LEVATION
Applicant attacb to this form Two Gertificates of Survey of Lot �nd proposed build-
ing iocaeion drawn on these Cestificaees.
DESCRIFTION OF BOILDING
�o be �s,ed as :
Front�� � - Depth��1 Eeight� �
/ Sq. Ft. / � Cu. Ft. �L��
Front �Depth � iieight ��
�
Sq. Et. Cu. Ft. �
Ty�s� of Construction Estimated Cost ���� '—�
ao be Completed
The �sndexsigned hexeby makes application for a permit for tbe work herein apecified,
ffigreeing to do all work in atrict accordaace with the City of Fridley Ordinances a�se�
rulings of the Department of Buildings, and here'by declares that all Che facte and
repre�eatations etated in this applicatian are true and correcC.
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DA� �' � SIGNATURE
('�cheda�le of Fee Costs can be found on tihe Beverae Side).
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BUILDING PEIi1wQT FEE S(�IEDULE
Sec�io� 2. The Inspector of Buildings's�i�11�,'before iseuing 8nq permit fos
�he erec��oa of any building or atructure, or for any addition to any ex3et-
iag building or structure, or for'any alterations or repairs Co any exia�ing
building or s�ructure, u�on application therefor, require the payment by �he
appl3cant for such permit of feea te the amount hereia below set forth Pnd
in the manner herein provid.ed to-wit:
2.1. For any such permit for the �:reation o,f any fir.e-proof building, other
-tlaan a.garagei warehouse, factory or graia elevator, or for the erectioa'of-
�:an3►°fire-prooE addition, for sianilar occupancy, to any exieting build3ag
ahall be at the rate of $i.40 £or each one thousand cubic feet, os fractio�a
thereof, in such cubical conte�ts. �' "
2,2. For any such permit for the erectioa of �ny fire-praof g�rage, urasehau'se,
factory or graia elevator, or for the erectiou of any fire-proaf additiom,
for similar occu�pan�y, to aay exisCing building shail be at�the rate of $1.25
for each oae thousand cubic feet, claeaified as t1firepraof" bq Section 502 of
- t�e Minneagolie� Buildireg 'Code. _ -� . ,
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1�OUSES � �
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2.3.- For anp such permit'for the erection o€ any hoa-Eireproof b�ild3ng�other
than a garage, warehouee, factory or �rain elevator, or anq non-fireproof
- -- -
addition, �o"r simiY�r occup�aey,-to`aiiy -eaci��ng �uilding - permi.t �'t.O6 ��
each one thousand cubic fe��. -�
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GAL�AGES
2.��, For aay auch permit for the erection of any aon-fireproof gasa�e,
w�rehouse, factory ar grain elevator, or for Ehe"erectiot� of any non-fire�x�
�dditi�a, fos s3milar occugancy, to aaq ex3stiag build9.ng or for each auch
�iidia� ox_addition - aiae�y cen�s ($�.90) for each one thousand cul�ic feet
or fract3on thereof, in the cubical conteata thereof with a minimum of $4.�.
For the purpose of co�mpu�iag fees #or building permits, the cub3cal caateatB
of aay building or eddieiaa eo � uniform height throughout by �Ltiplying the
ground area covered from a poiat sin (6) inches below the floos line of the
hasement or- callar to Che average he3gh� of the upper surface or to the
average height of the roof eurface of the main gable of a pitched roof.
Z.S. For repairs or alterations to a�a exiaeing atructure, the fee ahall be
at the rate of $3.00 per each F3.ve �uadred Dul.lars ($500_QO) or fraction
thereof 3n the coet of a11 proposed work. „
2•6 . Iu att, .C8Q0 8h811 the fAp. chargad fc>'r anp peruii fi ae ee� forth in �
8ectiaa 2�e le�A than C4_t10: - '
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sua�ecr PERMIT
City of Fridley � 1209
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T •
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� � `ii.ECEIPT NO.
� `� _ COMMUNITY DEVELOPMENT DIV. ''--�, / �
r � � PROTECTIVE INSPECTION SEC. � �'
1 � �
� /'��1 � CITY HALL FRIDLEY $5432 NUMBER REV. DATE PAGE OF APPROVED BY
�---�� � �'� si2-58o-aa5o 910-F15 4/13/�3 � �
JOB ADDRESS
80 t an
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],2 3 Parkview Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Gerald J. Hults 980 Hathawa Lane
3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
7 CLASS OF WORK
O NEW � ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construction a f il oom between the house r e
9 CHANGEOFUSEFROM TO
STI PU LATIONS
Drawings to be returned to this department when building is completed.
TYPE OF CONST. OCCUPANCY GROUP OCGUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. OOC�. �i$IIte
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPEWDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. 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
WITH WH THER SP CIF EDNHEREINIOR NOTOTHE GRANTING OF AOPERMIT �2� �-13.4'3 `�, 1.06
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- $1,2.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �
PLAN CHECK FEE TOTAL FEE
$13.06 `t
Si ATUREOFCONTRA RoRAUrHORIZ DAGENT IDATEi �HEN PROPERLY VAL` ATE HIS S YOUR PERMIT
, 4/13/73 /73�`��
SIGN TUREOFOWNERI OW B ILDERI IDATEI DATE
�P.P�����IQN ��� ���IAENT���� �LT��ATI�N,
OA ADA�T�O� ��I�DT�G P�RNlIT
��Tx pF ��iA��Y, M��N�soT�
t�W�t�'s � : l2� � � e� � � 1 � � �, -r° � �ut� s �,.����. ,� � ,�I � � �° S
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�D1AkRE9 S s ,��'�� ��',�T a ��ES S : S.4•va� � �,-.� � , , �
y� � s �'�.a'°,,�i��r��1/' „���
?��� .. ��q 4..e^� �s ` te r/ �e i� � n i�� o■ q/ e � � i � e
4E^��w'�' / � {7L\/\/�$ � as6sCl�0.�+���•��^�"�+���� ���w� ■! 1
�lU� L(n: �� LOT: � S�TBACI�� SIDEY�RD:�
.L���,� ��ad� �o ����„a Certificates of SuxvBY of Lc�� at�d }�rop�p��d
�t%�.��$ ��ati,� d� �a t#�se �ertif�.�tes,
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�������TItJN OF �UIL�9I�iG
-�a � ii�� i�a :
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`�' /� ��� �` ���� % � De�+th: �� $�$@,�t: �D
�1� 2 �, r a i� ,
Sq��Te �'+����.,, � Cubi� ��3 %� � ,�
• e s
�''TQAt : ���1 j �@�$tit ;
$t�y�a� ��et; Cubic Feett
�►� o� �o�t.x�tc�ki�s �/���� Esti,�ated CosC: $ ,���e�s `'
.a � �
�� � �����3 � � � % / 3 � `�
��e�#�a�d hereby �,�s a�l�catio� �or, a pe�aatt €�r tlae w�►xk b�reiu
�e���i�d# a�ee�a$ t.+a cto al� [�� in stt�at accordaxice with ths G�.�3► �f
�L�d�.�' (f�r+��+c�s �si �t►� �r� �he De�art�en�t Af Bu��di�a, � �eteby
d��� i� al1 �h� �E�cts �d ��reseats�3.o�s �tated � t�ia a�►3�,catiaa
a�► � �d cvrrec�.. .
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�r �+�v�e s�.� �or �ta�t��. �n�o,r�ci�.� � � a �v / �� 5 7`� � -�
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--BUT��ING P�ItMIT F�� ��H�AU�E
����QN 2. Th� I�epec�a� pf �ui,ldiags sk�a11., befaxe i.esuing �ermit� far the
�����ion o� a�,y bu�.lding o� �tructure, ox fo� any addition to any �eist��g
�a��,�d�� ox stx�G�ure, or fQ�t any altera,tion or repairs to ar�.y exi�ting
�;������.n.� ox stxu.c�uxe, upon �pp] i��ation the�ef�xea requi.xe the paym��� by Ciis
�.�p�.i��t fp� such P��i�� p� �ees �o the axaonnt herein below set far�h �d 1�
��a� ��sr ��r��.n p�c�rided��o�,,i�s
UN7CFQRM BtJ�LDTNG CODEs Tj�Pe �.s 2&�+ -$2.�.5 for each �e tlzous$ad cubic
�e�fi� 6��' f�actioa th�7cea�. in �at�clt cubical co�,tet�ts. Type �& 5-$�..$� �o�
�cb �s �oasand �ub$c �eeC. �
�1�D � T�UI�iAi� I NFO�tMAT I ON
FA� �� �u�gp�e of Ca�ugu�3.u� �ees for building per[aits, the cubical contents
oi a�y building or addition, i� det�txmined by mul��.ply$.n� the �ound area
gaqe�� ��a a poi�� �:P�s (f ) in�ies below Che f].00r line o� the basement
��be �+��la� �o tt�e average heights of the upper surface or to the avera���-
�� �� �e �oc�� ��face ok the main �ab�� p# a pitched xoo�,
��irs o� al���at�.ot�s � aa existin� s�tu�re4 �ae f�e shall, be �� �,h�
;��� o� $3,� �ex' �+�i� fi�ve hµ�dsed dollaxs ($30QoQ0) � £���.ion �h��e�o� �n
!�� c+a�t o� all p�Qg�►sed wo�k�a
%� ca�e s�ail ��ie ��s fo�c ar�y pe�i� as set �o� �n Se���Qm 2 b�
�.�a t�a�n $5. t�ti.
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V�R�����ATiQN OF �t��1NUATION
�TQ�� ��its ��ar �c�st.�ue��ton wi�� be i�$ued a �iA�C�m o� �4 %c}urs ��am the
� o� �applicat�a�►, �a a��c�v �ox Pra�r review of �e p�apo�ad s�su��kutre and
��? �►e �st�uGtion �ixe.
� ���1�%$ Suu�v�y v� � 1��, �a� � �.c�catf.� v� �th� �awadati�, ox�� ��
�� �� �st�iit+�d� wiil � g�jui.s�d befa�e �ror.eeding w��hh � fr�i�g,
,
C�RiT����i� QF o����N��
�Pl�.c����a�a �� a Caxki�3.�ake o� Oaeu{�aacy �hal� bs made Cea (iQ) �a�� pziox
�o �h� �t�se c��' r�c�upa�ey o� �g �c�tre foz which � bu�.ldin$ pex�i� hae baen
Lsat�a,c�; ��$�.d stsuc� �hai�, �at ba uses� a� occup�ed unt�.l a Ce'��ificate
Qf 0c���epaa�cy � bee� �saosa�.
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CHIM�JEY AN� STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (�
,
2. Is free from rust or deterioration Yes �)
3. Has no foreign objects lodged within Yes (�
4. Is securely supported Yes �
5. Me�ts �11 cur�ent code requirQ��nt� ��r ci�P �n�
total BTU connected Yes (�
6. Has Total heating BTU's of �_pp�
All other BTU's
TOTAL
Rema rk s
No ( )
No ( )
No ( )
No ( )
No ( )
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TOTAL P.01
sue.i�cT ' i PERMI
c�ty of Fridle� � 3 i 9 5 `�
�
A T T M E T O P O F T M E T 1 N I N S �� J � L D I N� P E R M I T
; � ' R EIPT NO.
� • COMMUNITY QEVELOPNlENT DIV.
f � L �'� PROTECTIVE INSPECTION SEC. ���m��o� �/�
�
� .1 ,
( 1 �"'1 � CITY HALL FRIOLE� SSI3P NUMBEp - pEV OATf PAGE Oi AVVNOVED B•
�""�" �'' 612-571-34, 50 910-F15 7/3/O1 / /
JOB ADDRESS gg0 Hathaway Lane NE �
t LEGAL L.07 NO. BLOCK TRACT OR ADOITION SEE ATTACHED
oescR. 12 3 Parkview Hei hts Addition SHEET
2 PROPERTY OWNEfi MAIL ADDR�S,$ ZIP PMONE
Sue Terry 980 Hathawa Lane NE 763-571-8094
3 CONTRACTOR MAIL ADDRESS Z�P PFIONE LICENSE NO
Same
d AFCNITECT OR OESIGNER MAIL AODRESS ZIP PMONE LICENSE NO
5 ENGINEER k1AIL ADDRE$S Z�P PMONE IICENSE NO
8 USE OF BUILDING 5
Residential
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATIpN � REPAIR ❑ MOVE • O FiEMOVE
B DESCRIBE WORK
Reroof House & Garage (24 S) Tear-off
9 CHAN(iE OF USE FROM TO
STiPULATIONS
Underlayment must comp3.y with the State Building Code.
tYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS AqE REOUIRED FOR ELECTRICAL, PLUMBING, MEATINCi,
VENTI�ATING OR AIR CONDITIONING.
TMIS PEpM1T 9ECOMES NULI ANO VOIO IF WQRK QR Cp14STRUCTIOM ZONING SO. fT CLL FT
AUTHORIZED IS NOT COMMENCED V�1ITNIN 80 DAYS. OR IF CONSTpUCT10N
OR WORK IS SUSPENDED OR ABANQONEO FOR A PER100 OF 1i0 DAYS AT `
ANY TIME AFTER WOiiK IS COMMENCED. ' NO. DWI�G. UNITS OFFSTREET PARKING
I MEREBY CERTIfV THAT I HAVE AEAD ANp EXAMIN�D THIS APPLICA710N 1 STA��S GAFAGES
ANO KNOW TNE SAME ?O BE TRUE AND CORRECT. ALl PROVISIONS Of LAWS VAlUAT10N SURTAII
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL 9� CpMPUEO @2�454 $1.Z3
WITM WME7HEfi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT W
OOES NOT PRESUME TO GIVE AUTHOqITV TO VIOLATE OR CANCEL THE pEqM1T FEE SAC CNARGE
PROVISIONS OF ANY OTHER STATE OR IOCAL LAW REGULATING CON• $8�.25 Fire SC �Z.�LS
STRUCTION Ofi 7ME PERFORMANCE OF CONSTpUC710N
Pt,AN CNECK FEE TOTAI FEE
� $86.93
S�GNGTUpE OF CON"AACTOA OA 4UTMOp�ZED sGENi iDAfEi HE PR �V VALIO ED THIS IS VOUR PERMIT
. I
� '
GNAT E NEA��fO NE�IBUIL Ep� ��OATE� � �� G��NS ��Q���
�
N� I l Effective 1/1/2001
ADDN [ j '. CITY OF FRIDLEY (763) 572-3604 Bidg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
� —
Legal Description:
Owner Name & Address:
Contractor:
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
_ ii�_,
r����
,.
MN LICENSE #
Tel. # � —
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Wdth Height Sq. Ft
Length
Length
Width
Width
Height Sq. Ft.
Hgt/Ground Sq. Ft.
i
Construction Type: f��'�► i� Estimated Cost: $ T_ S�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ v��J��
DATE: APPLICANT: Tel. #
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ ���� Fee Schedule on Reverse Side
$ � , �f S' .001 of Permit Valuation (1/10th%)
$ , ' $.50/$1,000 Valuation
$ $1150 per SAC Unit
$ (� $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
•
� ,�_
.,, r•
BUII,DING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$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
$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 additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,Q00 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 $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minunum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
-.._ � ...
From: 6128277351 Page: 2/3 Date: 5I21/2009 8:08:22 AM
13uildirlg BUxLDING P'ermi�No •
Insp�ctions RJ±,SIDF�I\T�'IAL A�'PLICA�'ION �t�ceived � -
7�►3-572-3b04 CITY' OF FR.YDLEY Date Rec' •
76:�-502�4977 FAX EFl�ecrivs,-�-oy �-
t IA ! I•_� .�' � 4� �],. .._ YOUR F..-MAII. ADORFSS A � N• !,d E$� � n�� C�f.�' • Ld ^'
srri. n�aiaiti:ya „__ £'� 0 _.. �''�- cc �.J � �y h �. y1J L�' .�_.. - •----. . .
'ff It5 At�l'I.IC'AN'1' IS: Q UWN�'R �NTRAC'1'dR !_ _
PROPER-�•v owNr� -
TFNANT
� C`.()N7'RAG"I"OR
�t �t�iwc�r,� r��rv c�r�
YOl.ili S'CA'I'►: i.ic:r•:�!;r;
n�u c�i:ie�i��►�►c.arr or
INSURANCIi
PItOPERTI�' TYPE
PERMf7"I'l�'P1:
TYPE UM' WO�tK:
Ilf .'+I.'lillili 41'f)Rli IiI:IN('i f)t
S['/.li c)I� IMPlttIVIiMF:4�I'1'
YI
ti�rn'I'Iti LICIiNS�
AUI)ItESS: �S
O 51N(iLE FAMfI.Y/NL'W GONSTRIJC IIUN S
❑'lwt7 �AMILY/NE'W ('UNSTRUCt'ION ti
O RA.ti1?MLN'I' I�INISH � RCC�F
� UIiCK �".SIDINCi
❑ Nr'W HOM� GOhaSi'�uC'i70N
4 MArN�i7cNaNCEIREPA�R
iinc�r� ivc
Ni IMlilik Oh ti�11�lARliS _ .. .�.
(:.�R:1[:Fti
l'I:c'tl'f)tilil)til%li: , ,_
ri:nw�,r;u i�Fac�irr:
ti1Df1t:
�nvi
I' :11um�num
� (1lhCl' _..._. __.._.
wiNlan ��.�
(N I'X1S111\(i OPItNINtia ��� �Np
('qt t��)IZ NI:W t)1'IiNINii:i-f)1'SCRII3� S1�L� (3F
f)I'IiNINC.+ C'I IANfiI:S K
A1�1� F'EESARE 6AS�D
I'()'1',7L. Ji)S VA[.11ATION ;
�I'crn7h l�ec
!'f�n ltcvicw
l�irc Surc:hsir�e
Surchar�e
I.iccnsc Surchs�r�e
SAi' t'harD,e
C'w�b C'ut �scmw
firusion Cbnlrol �
�� � nu.���, �
tiewer Main Cht�rse
'1'otal Due
❑ liOUSF. (INLY
❑ HUUS�, & CiARACif;
O ATTACHL"•U CARACE
� uL•"1'ACI•ICDOARAt;�
�n��
�'I'rim
�asaia
I.00'ATCUN Ur W1NDOwS
aDDITiON
s���A•����d'it� .����, J�.�a�-
--.... ,- - -• .
ExP r�a•rr': 03��-= � _
t�� %'�li n n�srn�i,���v�'•�"r9.�
� ��Y �a-1 . � � ri
�+it��uaws
O DRA1N TIL�
O OTHER
�
13ASIi ETIT RFEMpUI?I.IN(i�511NM1'I;:
I. Ctlsting hlaar Plun
2. propt,�l flmr plan
3. I.isl oFsvuceurul mambcra in hc uu:J
FOR NF.W CC1NS'I'RUC°17ON INCt�UnIN(i I)l:CNS.
A.Dnl7'f()PiS. � P�RC'FIF:ti Sl.IIiMJT
I. Sitc Plan/Survcy showinG �hc �ri��ia�+�nirtun�s
and pra�cd pruloct.
2. '1'�vo uLa �f con�tniCliptl pluns
3. !s"nergy Calcul�.�litmn
VALUA'f1+pN, iNCLU�IIVG TNE COST OF LA130R AND MA'1`�'RI�►LS:
(USING 7"I�fE 1997 U.�.0 F'EE SCHEI�ULE)
l•Z
TYPL�
$ �.7 ��� See Back Page fnr Fee 5eheduie
$ 65%ofBuilding Permit Pee
$ .OQ 1 times the totral job v�luation
$ � � 0005 x permit Valuati�n Minimum $.50
� ,� $5.00 (Stat� Licensed Residential Contraacors)
$ $3000 prr SAC Unit (Plans m MWGC For determinrati��n)
$ ft+6ft= ftx$31 °$
$ $4S0 Conservat�on Plan Rcview
$. _ �, �� Fee L�etermined by Engine�ring
$ Agreement necr.�ssry ( ) Non Necessary ( }
�� � %„ ,. Make ehecks n�vAble to: Citv of k'ridlev Attaeh
TI•I15 I� AN APPl.ICAl7C�N FUR A PERMi'I'•NOT VA1 •lA UN'17L PROCFSSLU
I I�erLby �p�ly fur a building permh and 1 aeknowled�e that the informstion abovE is complete and acc:ur�te; that the werk will be in
c�m1'orm��cc with the ordinan�s ond cc�des of thc City of Fridley and with thd Minnesots Constwction Cocles; that I undei5land this ia not a
permit but nnly an application for a permit and work is nat to start without � permit on site; thet the wurk will bc in accordanCe with thc
o�proved plwy in the c�c o4'a! work which uiros review �nd approva) of plans.
Clc i�A'PUKIi (N� APl'LICAN'C���a��G�r PRlNTNaMF, t` ,)nn�v�. DA'I'I:_,�3� �„ ..__.