AF - 45584! \
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City of Fridley, Minn.
BU.[I.DIliTG PERMIT
��: June 23s 1965
N° '7997
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p�; G. A. Gandersan ��r G. �. Gunderson
�� Route s, Aaoka, Minnesota p� Route 5, Anoka,� Minnesota
LOCATIOId OF BUILDING
No. 7�78 street ga�res N. E. Part or Lot
Lat � Bl�k 1 Addition or Sub-Divid� �d�x SQn `i'erx�a.e
Coraer Lot In�de Lot g Setback Sideyard
3ewer IIevatfon � Fouadation IIevati�
DESCRIPTION OF BUILDIIdG
To be Used as:
�elling F'ront nepth xeight sq. Ft Cu. Ft
1tt. Garage �nt Depth ITeight Sq. Fk c:u. FL
7�+pe of Constructton �r�m.e F�t. Cost -�� 6 i�� •CILL_ To be Completed
Dwelling, Att. Garage
In c�deration oP the �esuance to me of a permit to conatruct the buflding described abcve I agree to do
th� ProPosed work in ac.c��rdance wlth the d�scrip�ton above set and in camplianc� with a�l provlsions of
�inencea of the dty oP Fridley. �
�-
In �deration oP fhe �qmeat of a fee oP $�Q��2�. permit is her��by �ranted to G. A. firandersc�n
to construct the bufld9ng or additiam as descrlbed above. This��mi t ia grantsd upon
the exp�2ss condition that the person to whom it is gra.nted and his agenta, employees an�3 worl�uuen, in all work
dame 3n, around and upon said build�►g, or anypart thereof� shall �onPorm fn aII respects to the ordinanc� of
Fridley, Minnesota rel�ardtig �t ma� � revaked�at aqq time upoa�o a�tion o�P � the prov9eions of�said
wltt�in the dty limits and tbi8
ordinances.
A]].en Jensen g��g �r
NOTICEs
11ds pseedf do�s �t �er �6s coa�lra�e, ��er vrbieY. P�+�e. Ilp �, Wwu or wmr. B� sQ» io ass
tM BQild[n8 tm�sr ier apm� p�e�(is for fh�a Bum.
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APPLICATION FOR B IIJG PERM[T
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CITY OF FkTDI,�Y� , NN�SbTA
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LOCC�kZ"i0N OF ���NG
No. � � 7 �'�, St��et _ . ��t o� Lot .
Lot � Biock � _ Addit.3opr or Subd�.visian ..�c•T�1�2.?.-t�..���',';�c�.�
• . � _�__.-�— �-
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Coraer Lot Ins ide %ot l-��_�e�#sa�k ,� �Side Yard� �;- ���
• •.
SL�JER E�E'�iATI¢N FdUNDATION EL�V�fiION
Appli�ant azeach to ehi� farm,�"wo Certificatea ,of,Survey of Lot and proposed.huild-�
ing location d��,wn ot� the�e ���tificates. �
DESC$IFTiON OF B�DING
To be used �s: p/ �
. ' . d f /� �'e •
� . c�v
_ �' --����-�..,� � �-� d� �rvnC �� Depth �. (, � �eigirt � �' �
�
� 9q Ft � � � Cu . ,Ft . � L � �
. . � .
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����_> �� . r� Frone '� :.L- DepCh ���Aeight % ���
� � Sq'. Ft . � � �. Cu . Ft ;� �,. � ,��
. '� �
� Type of Construction �(�c�: � � ' •�+ Estimated Coat '��� � , �� -
_.�o..be �amp].eted
The undersigned hereby makes application for a pe;rmit for the work herein specified,
agreeisg �o c�o si�l �aork ii� strict accordance urith the City of Fridley Ordinaaces and
rulings p� tbe Department'�of Buildiags, and h�reby declaresrtha� all.the f�'acts and
repres.entatioas stated in this application are true and correct:
" che�ule of Fee Costs caa be found on the Reverse S3de).
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BTJILDIN� FEBMI�T FES SCH�`j�kli��
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� . Seetion 2. The Inspector of Buil�dings •shal�, 'iie�or� � issu,i�lg aa�r permit for
,�the erection of anq building or stru�t�,ure, �oi for any ad,d$ti� te auy euist-
. in� buildin� or structure, or• for. any a��erat�ctri;�,��ir'_repai�m ta� an� existing �.
buildi�g or s�ructure, upon applicatii�i �}et,efor, ��geaire tbe paymeQk by �he
applicant fos such permit of fee� •�b �tiie amount •�ergiia��below set �forth•.a�d
• � in the manae= herein provided to-w�.t:� �` � �� ��
• � _
.�.. . . . t• . . . •
°•�••r ---,�.1. R�r aay guch permit for the r�a�a�,tiori-��`aay fire+�p�f bu�ldLpg. o�her
' •.•';--r�an.�.�ar�ge, .wazehouse, factQry Ox :&�ii�` ��eva�;..� %r.-�he e�t,3oa of . , �
.-. any fire-�r�of addi�ion� fvX sip�$];ar°°oic��►►p��: �a a�ty &sis�t�i�g bu�.id�ig � a�:.� ...
�ha1T be Bt the sate �i $a,.4Q for �aa,�l�. ou� thats�d ��bi ¢ feer, or � fra��ion
� r� .. thereof, in such cubical c�orit�n�s , • . • � �" � '� . . , :. � � � � . � �
_Y M1. ' ,
�'� 2.. ., ..For any such permit.f�..:��e._erect�oa o� �.njr fire-praoE g�ra�ee..���^�---�:,x'
fastory �r grain eievator, or i��the �ection �t aa�n ����?oof '�. •.�
. f�r .a3m�.la� oscupanc to. an �eicist•in r��
� � ��ldi�g s6aY1• �be �t .tbe �
eic
. . ..:�.�fo'L`'��eh one .th�uaend�cubic .feet;�.,c�1a,$aiiied ,se�"fixep.raia#" by .S�
the_ trs�tn�p�L��-su�3.atng Cot3�.. ;:����:�� ' ' � � '
� HOUSES . _ _ : : . � . . . .
. � � 2 ��.. . F�r =any such permi� fbr. �he ' er�ation of •any non-Hrep�o�f �build3ag �
`"; .+�th�a a arg e warehrnuse facto ��
� 8, . ry or, grain elevator, dr a�y �oa-firep'r�6►f ,�°,
additi�n, for siini.��r ocCupauqYr to an� e�i�ti�g�fi�iidi� - pesmit $�.�00 foac
each aae thou�aia�l �e�ibi�. fe�t.. . � '
GARAGES . . .. , � ' . �,
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2,_,,;_4_, For any such peralit f�r the ezection of anq non-firepraaf gara�e�, .
warehousa, factorq :or grain elevator, or for the erecti�on� ai aay non•fi.repraoFf`� .
additiois. -€o�r-s-imila�" occupaacy, to ariX existing building dr for eec� such ��
.��ding or addition.- niaety centa ($0.90j for �ach oae thous�aAd ce�bic ieet
`�� or fiactiou thereof, in the cubical coateata thereof with a minimum �of ,�4.OQ,-
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For the purpose of c�gut3ag fees for building permits, thg. cubical c�ttt,ear.a� ��
of saq bufiding or additioa tc a uai,�orm height througlioia[t •'by multip�yin� t�..- '
gro�nd area eovered .fiom e point siu (6) iach�� bel�c� the �loar li.ue tsf.�.he ,,., f,�
basement or �cellar to the avesage height-_o# the �upper sus�fa�e or to tlie � �
average height of the rpof $urface of the �aaia gable of a.�t�,tched roof. ..� '
�=•. For repairs or� alteratioae to aa existiri$ aCsuctu�.y �ti £ee s�$11 be •--�`p; �•
,• at the rate of $3.00 per each Fi�re I�undred DoLiar,.a ,($3Qb':�� pr, �recti.a� .
..� the;ebf in t�he cos�t 'of,� �il.; �rapoaed work. � . . . • � .
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2 6.,� In no case ahall the � fe�. p p�rmi � a�; BeE fc��h in ' �,
. c�h�ed . £or ,eia ' .
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��w ��g �,�t�� � �c��p%�8 ��i�I� ��+� �a��� 3��It� i�r�s.
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City of Fridley 3 0121
AT THE TOP OF TME TWINS � � I L D 1 N G P E R M I T
r
; � IPT NO.
COMMUNiTY OEVELOPMENT DIV.
r � V � PROTECTIVE INSPECTION SEC. ���
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� � r���1 � CITY NALL FRIDLE� SS�3i NUMBEN REV DATE PAGE Oi AVPROVED 8Y
�.---�: �., 612-571-3450 910-F15 8/25/99 / /
JOB pDORESS �478 Ha es Street NE
t LEGAL LOT NO. BLOCK TRACT ON ADDITION SEE ATTACMED
oescR. 2 1 Gunderson Terrace SNEET
2 PiiOPERTY OWNER MAIL AODRQS$ 21P PMONE
Chad � Kim Lennox 784-8121
3 CONTRACTOR MAIL ADORESS ZIP PMONE LICENSE NO
C W Johnson Const. Co. ik� 15740 Rockford Rd P1 o th 55 46 9-
4 ARCNITECT OR DESIGNER MAII AOOFESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATIpN C�X REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reside house and garage - Vi.nyl
9 CHAN(iE Of USE FROM TO
STIPULATIONS
Call for bui.lding wrap inspection before �� covering.
SEPARATE PERMITS ARE REGUIRED FOR EIECTRICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VEN7ILATING OR AIR CONOITIONING,
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CpNSTRUCTION 20NING SO. FT CU FT.
AUTHOR12ED IS NOT COMMENCED 1NITHIN 80 DAYS. OFi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 pAVS AT
ANY TIME AFTER WOiiN IS COMMENCED. NO DWLG. UNI7S OfFSTREET PARKING
I HEREBY CERTIFV TNAT I MAVE READ AND EXAMINEO THIS APPLICA710N STA��S GAHAGES
ANO KNOW TME SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS OF LAWS VA�UATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WpRK WILL BE COMPLIEO
WITM WHETMEq SPECIFIEO HEREIN Ofi NOT. TME GRANTING OF A PERMIT $8307 4. �.S
DOES NOT PRESUME TO GIVE AUTMORITY 70 VIOLATE OR CANCEL TM� pEiiMIT FEE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR LOCAI LAW REGUlA71NG CON-
TRUC N O TH fOFMANCE Of CONSTRUCT�ON ].6%.25 Fire C 8. J70
I � PLAN CMECKFEE TOTAL E
i � .%�
$�GN4TU OFCON'AGCTOAOAAUINON�IEOOGENT � AiE� EN O LIDAT I$ I R P li
t G
S�GNOIUAE OF pWNEAi�i OWNEp8U0.DEai iDATE� Bl0 �NSP � / q�Tt
�� -�
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII,Y AND DUPLEXES R 1 AND R 2
BUII.DING PERNIIT APPLICATION
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Construction Address: %f � �t(�yr�'� �'. ��r �,�y /►�/I� ���
Legal Description: ' �o,v ye. �, �on/G
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Owner Name & Address: ��� (� P f C� M �, �iv At�� Tel. �t ���'�Z O
Contractor: � � � ��/ �S�-. � � MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
Attach to this applicadon, a Certificate of Survey of the
lot, with the.proposed canstruction drawn on it to scale.
Length
Length
Length
DESCRIPTIOIeT OF IMPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: �`�+� �jr90 �G Estimated Cost: $ �6`3�0°% �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ -
[��
DATE: '� �5 �1°!' APPLICANT: T"el. � 6� '`9��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
Licemse Siircharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
CITY USE ONLY
�
$ � ,�S Fee Schedule on Reverse Side
$ .�� .001 of Permit Valuation (1/lOth%)
$ . /S~ $.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 Necessazy [ ]
TOTAL $ � �
��.
STIPULATIONS: �� �t ?�
_ � �
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant far 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,�1 to $50,000
$50,�1 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,(?O1 and up
FEES
$23.50
$23.50 for first $�00 plus $3.05 for each addidonal $100 or
fraction thereo�, to and including. $2,0{�
$69.25 for first $2,000 plus $14_.(� for each addidoa�al $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,(�0 plus $10.10 for each additional $1,000
or fraction thereof, to and including $SO,ODO
$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 $100,0� plus $5.60 for each additional
$1,000 or fraction tfiereof, to and ineludiaig $500,000
$3,233.75 for the first $5�,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,�0 plus $3.15 for each additional
$1,004 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 aad replacement of curb and:gutter and install a 3 foot �ide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the locadon of the foundation once it has it has been constructed will
be required before proceeding with the framing.
r . _
City of Fridley
AT THE TOP OF TME TW�NS � � I L D 1 I� � P E R M I T
i�
� �
� • COMMUNITY DEVELOPMENT OIV.
i ; V �'���
r � � PfiOTECTIVE INSPECTION SEC.
1 . �
i--_-� �"' �.; CITY MALL FRIOLE� SSIJ2 NUMBEF
L 61�-571-3460 91Q-F15
JOB ADDRESS �478 Ha es Street NE
t LEGAL �OT NO. BLOCK TRACT OR ADDITION
REV
DESCEi. 2 1 Gim.derson Terrace
2 PROPERTY OWNER MAIL ADDIi�S$
Chad $ Kim Lennox
3 CONTRACTOR MAIL ADORESS
Owner
4 ARCMITECT OF OESIGNER MAIL ADDRESS
5 ENGINEER MAII ADDiiES3
8 USE OF BUILDING
Residential
7 CLASS OF WORK
OATE
10/4/99
tIP
VAGE Of
� �
-8121
PHONE
PMONE
PMONE
310_�
RECEIPT NO.
�Q0�3D�
►PPROVED BY
SEE ATTACHED
SNEET
LICENSE NO
LICENSE NO.
LICENSE NO
O NEW ❑ ADDITION ❑ ALTERATIpN XI�J REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reraof house and �ara�e (24 Sal Tear-off
9 CHANOE OF USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REGUIRE� FOFi EIECTRICAL, PLUMBING. MEATING, '' r� v� vv•�•
VENTILATING Ofi AIR CONOITIONING.
THIS PERMIT BECOMES NULL ANO VOIp If WORK OR CpNSTRUCTION ZONING
AUTMORIZED IS NOT COMMENCED V�!ITHIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONEO FOR A PER100 OF 120 DAYS AT
ANY TIME AfTEF WORK IS COMMENCEO NO OWLG. UNITS
I MEREBY CERTIFV 7MAT I MAVE READ AND ExAMINED TNIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yq�UATION
AND ORDINANCES GOVEqNING TMIS TVPE Of WpRK WI�L BE COMP�IED
WITM WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT ��O9H
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OF CANCEI TNE pEqMl7 FEE
PROVISIONS OF ANV OTMER STATE OR LOCAL LAW REGULATING CON•
STqUCT10N OF THE PERFORMANCE OF CONSTFUC710N .�H3. ZS
S�G
�
TOp Op
�0 AGE iOAfEi
� �/O � 7 � /
S7A�LS
CU fT.
f PARKING
GARAGES
` $1.05
SAC CMARGE
' Fir SC $2.10
TOT FEE
6.40
?A 7H15 IS YOUR PERM
/ //�1 �
� i� r�
naiE
LOAD
r�w � � `
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAIVIILY AND DUPLEXES R-1 AND R 2
BUII.,DING PERMIT APPLICATION
�C����
�� �R
�� ���7
Construction Address: ? y 7� �i¢y�S S J- !U ��
Lega1 Description:
Owner Name & Address: �j q ��, `�-,� � e� h p� sa,,�+e�. Tel. # 78 �i ' 81 Z 1
Contractor: �� � MN LICENSE �
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
01'HER:
DESCRIPTION OF IlVIPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
�
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: Estimated Cost: $ �"1� � �' � � ��
�_i
Driveway G�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ .
DATE: �- � � APPLICANT: � Tel. #
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�� .�� �� -�
$ c �_ � ,�. �
$ �����C�
$ %` �� �
$
$
$
$
$
$
��
$ �-' �' ° yG'
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
t ° -.^'
BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erecrion 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,�1 to $50,0(}0
$50,001 to $100,000.
$100,�1 to $500,000
$500,001 to $1,000,000
$1,0�,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,�0
or fracrion thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fracrion thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,0� or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,0� 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,OQ0,� plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb 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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the 1ot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing.
c�ty of Fridley
AT THE TOP OF TME TWINS � � I L D 1 N G P E R M I T
;,
.�
� ; v _�__� COMMUNITY DEVELOPMENT DIV.
f � � PROTECTIVE INSPECTION SEC.
i--_-� ��"';'� CITY NALL FRIDLEr SS�32 NUMQEP pEV
L 612-571-3450 910-F15
J08 AODRESS 7478 Hayes Street NE
t LEGAL ��T NO. 9LOCK TRACT OR ADDITION
oescR. Z 1 Gunderson Terrace
2 PROPEfiTY OWNER MAIL ADDR�S$
Kim Lennox 7478 Hayes Street NE
3 CONTRACTOR MAIL ADORESS
Same
4 AqCNITECT OR DESIGNER MAIL AODRESS
5 ENGINEER MAII ADDRESS
1/4/O1
ZIP
21P
PAGE OF
� �
PERMIT NO.
i6�0
����
'ROVEC Br
SEE ATTACNED
SHEET
PMONE
763-784-8121
PHONE LICENSE NO
PFIONE UCENSE NO
PNONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION L� ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WOFK
Finish basement bathroom and egress window
9 CHANdEOFUSEFROM TO
STIPULATIONS �
Provide smoke detectors in all sleep.ing rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code. See notatioras
on plan.
SEPARATE PERMITS ARE FiEOUIqED FOR EIECTRICAL, PLUMBING, HEATING, ' rrc a,r wna�.
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL ANO VOIO IF WORK OR CpNSTRUCTION 20NING
AUTHOR12ED IS NOT COMMENCED V�1ITMIN 80 DAYS. OR IF CONSTqUCTION
OR WORK IS SUSPENDED OR ABANOONEO fOFi A PERI00 OF 1� OAYS AT
ANY TIME AfTER WORK IS COMMENCEO. NO OWLG. UNITS
I MEREBY CERTIFV THAT I MAVE FEAD AND EXAMINED THIS APPLICATION 1
ANO KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWB VALUATION
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMP�IED � 1� OOO
WITM WMETHER SPECIFIED MEREIN OR NOT. TME GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AU7MORI7Y TO VIOLATE OR CANCEI TME pEWMl7 FEE
PROVISIONS OF ANY OTHER STA7E OR IOCAL lAW REGULA7ING CON• $38.75
STqUCTION OR THE PERFORMANCE Of CONSTRUC7ION
S�GNAT E O� CON'aACTOp OR nUTMOAiZEO AGENi 1DAfE�
r 1 . . �f /
�owrEi
OCCUPANCYGROUP OCCUPANCYLOAD
SG.FT CU FT
OfFSTREET PARKtNG
STA�LS GARAGES
SURTAX
$.50
SAC CHAiiGE
Fire C $1.00
TOTAL F E
$40 25
IPER CIDATE TM IS YOU PEpMIT
� �v =�
perE
N� [ l Effecfive 1/1/2000
ADDN [] CITY OF FRIDLEY (763) 572-3604 Bldg Insp
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: � �
�,
�.�
f� ���/ �'�"
Legal Description: �-'
Owner Name & Address t ��l n C�-� C;,�vl2,C� C�L �- Tel. #��-� �u z� 1�i
Contractor: MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certficate 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 Sq. Ft.
Length Wdth Hgt/Ground Sq. Ft
Constnaction Type;�'�+",;;�c-, �C�UI�;e��v� ` Estimated Cost: $ I C� uC7. ��
�
�'UZ`.�S l-v�r(�v�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: 1'�1 G l APPLICANT: 5'�Li�l+`L I�-�Y� �. Tel. #�� 3'���-%"��I 3"I
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in appllcation
Permit Fee $ J� Fee Schedule on Reverse Side
Fire Surcharge $ �� B� .001 of Permit Valuation (1/10th%)
State Surcharge $ ,S� $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
$ $1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [] Not Necessary []
TOTAL
STIPULATIONS:
$ � ���
..� .
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pernvts for the erection of any building or structure, or for any
addition to any e�sting 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,OOlto $50,000
$50,001 to $100,000
$100,Q01 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $5� 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 addidonal
$1,000 or fraction thereof, to and including $1�,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $5(�,000
$3,233.75 for the first $500,000 plus $4.75 for each addirional
$1,Q00 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
0
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb 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 minimum 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 �
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