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City of Fridley, Minn.
BUILDING PERMIT
Da�: October 20, 1970
�r: Richard Holien 8�� Ed-Ray Builders
Ad�a A�� 7651 Central Avenue N.E.
LOCATION OF BUILDING
No. 7508 S�t Hayes Street N.E. Part of Lot
Lot - 3 _ Block 3 Addition or Sub-Divisian Don's Sth Addition
Corner Lot _ Inaide Lot ` X Setback .�._ Sideyazd
Sewer Elevation — � Founda.tion IIevation
��3 �°�_
�� �,•n-� ,.
° 10864
DESCRIPTION OF BUILDING
To be Used as:
�a 11 ing Front �' . Depth � Height _21L_. Sq. Ft �.16. �_ Cu. F't .1G.,322 �
Gaxage Front 20' Depth 24' ITeight 10' Sq. Ft. 480' Gy�. F�, 4� 800'
1�pe of Construction Frame �, �, 19 000. oo To be Completed February 1971
SEWER L�ATION: 180' North of Ma.nhole
WATER LOCATION: 190' North of Manhole
Verify Basement Location With Survey. Provide Hard Surface Driveway.
In conaideration of the issuance to me of a permit to construct the building
tha proposed work in accordance with the description above set forth and ia� ca
ordinances oP the dty of Frldley. �„ /� /
I ag�e to do
provIsions of
In consfderat[on of the payment of a Pee oE $.�4.�0 , permit fa hereb�✓g�anted to Fd-Ray RLi 1 clers
to conatruct the buflding or addition as descrfbed above. This �rmit ia granted upon
the express canditaton that the perafln to whom it fs greated and his agents, employees and worlQnen, ffi all work
done in, around and upon satd building, or any part thereof, shall cbnform in all reapecta t� the ordinances oP
FrialleY� Minnesota regarding location� conairuction, alteration, maintenance� repeir and moving of bufldings
within the dty limits and thia permft may be revoked at any time upon violation of any of the provfaions of said
orainanc.es.
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Yhis permh d� aot eovsr t6s eo�lruetion, ImfaU�tloe /e� �rhleg, plum6tne, �a 6e�tteg, ssvn� or w�hr. 8� wro to �
t6a BaiWtus W�soto� fo� apuat� p�rmhs Po� thas it�ms.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
owrrn��s �:�!s le�% J � /, e� BUILDER: �'�- ��y �� � /� 1
ADDRESS : ADDRESS : ^��S l G/�l C�.��� ��.E:
NO:. ' STREET:_ � S O� %1�/��/.�S S7`�-e.3-
LOT : � BLOCK: � ADDITION ;_ _ D�' �' �S � � /.1d�v� � 7`ta �G
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CORNER LOT: INSIDE LOT:� SETBACK: SIDEYARD;
Appli�a,at a�tach to this form Zt�ao Certificates of SurveY of Lot and propoaed
buildiag location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As;
G,�� Front • � `� Depth • .�- Gf Height • � �
Square Feet: �^;-� �� Cubic Feet: � �" , �� � �
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`=,,; .,2�_Front._ �? ,� Depth: �, e. Height• ,� ,-�
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'' Square Feet;_ ��, �!'' t`� Cubic Feet: � �#` ' �
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T�►pe of Construction: G���°� �j�-�✓/ Estimated Cost: $�j�',�d d�-
To Be Completed: _ �� �r j � % / �
The uaderaigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in stfict accordance with the City of
Fridley Qrdinances and ruli�ga of the �par4ment of Buildings, and hereby
declares that all the facts and representations atated in thia application
are true aad correct.
DATE : � � � ' 2�J SIGNATURE • �C�C�� -
(See Reveree Side For Additioaal Iafoxzoation.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings 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 repairs to a.ny exiating
building or structure, upon application therefore, require the payment by the
applica.nt for such permit of fees to the amount herein below set forfh and in
the maa.ner herein pravided to-wit:
tTNIFORM BUILDING CODE: 1�pe 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the averager
height of the roof surface of the ma.in gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work. .
In no case shall the fee charged for any pezmit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Pernnits 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 Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceedin� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupaacy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building pezmit has been
issued; and said structure shall not be used or occup�ed until a Certfficate
of Occupancy has been issued. •
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ANv1�A t C. � �J?y
�l�edy csrfi�y !h� �1us a o frr,� a�d ao►r�cf rrpvrsm�ot+ion o�'o su�y �('f6r ��i'�r a6r�e a(�cr;bmf laid,�d
o�'Nt �arafiar� eJ!'o/I buitd� , fhrean ,�d d/ �ri�kli ax�orlm,ents ,��'ay. {r�n ar r�s�►d laod. As sur� d� e� fir�s -- �
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SUBUQBAN EAJ6/NEER/NG , INC.
S C A L E � N-��j �ipn,eers fr Su�-�ars ,�, �� �,
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CITY OF FRIDLEY
8431 UNIVERSITY AVENUE N.E., FRIDLEY, MINNESOTA 5543Z
> October 21� 1983
Y' S �
TELEPHONE ( 812)571-3450
Nr. Riehard Aoliea
7508 Hayes Street N.E.
Fridley, l�II�i 55432
Re: Siiimming Pool Construction at 7508 Hayes Street N.E.
Dear Nr. Holien: .
This letter is to make clear this department's requirements for the
swimming pool constructioa at the above address.
1. As indicated� one (1) akimmer approved bq the National Sanitation
Foundation Will be provided.
2. As iadicated� one (1) ialet of approved design for fresh and/or
repurified water t+ill be provided.
3. The filter and pump ahall be approved by the N.S.F. and be of
sufficient capacity to provide a minimum turnover of at least t�+o (2)
times ia 24 hours. This department recommends a turnover rate of 6- 8
bours.
4. A deck of at least three (3) feet xide, measured from �he pool Waters
edge� shall be provided Which eztends completely around all private
residential poola. Above ground private residential pools may be
provided With deeking of a minimum size of 4 feet by 4 feet at pool entry
points and provided that such decking has the approval of the City.
5. Fencing or other effective means including but not limited to Walls
or buildings� acceptable to the City, shall be provided to positively
control all access to public and private residential sWimming pools.
Fencing shall meet the following criteria:
(a) The feneing shall prevent the entrance of children and be �ithout
hand or foot holds that would enable a person to climb over it.
(b) The fenciag shall be at least 6 feet high and entrances shall be
equipped With selP-clesing and selP-latehing gates capable of being
locked.
(c) Self-closing and self-latching devices sha11 be plaeed at the top
of the gate or otherr,iise inaccessible to small children.
(d) The opening between the bottom of the fence and the ground or
other surface shall be not more than four inches.
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� Mr. Richard Holien
October 21, 1983
Re: 7508 Hayes Street N.E.
6. An automatic chlorinator should De provided xith a suiLable test kit.
7. All electrical and plumbing installations ahall be inspecLed and
approved Dy the City Inspection Department.
$. Al1 overhead electrical liaes must be a minimum of 10 feet horizontally
trom tbe pool surface� and 18 feet atraight line distance f:rom the Waters
edge. An alternative is to bury said liaes.
9. The pool fill apout must be protected by a vacuu� breaker or air-gapped.
10. Suitable safety equipment to include but not limited to a ring buoy and
rope that ia 1-1/2 times the pool diameter and shepherds crook pole must be
provided and maintained with the pool at all times.
Furthermore, these and any other requirements must meet the provisions of
the Fridley City Code� Section 115� S�+imming Pools. The building permit is
approved contingent on final inspections and approval of the City.
If any questions or problems arise from this letter� please feel free to
contact me at 571-3450.
Sincerely,
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STEVEN JQ�OY,SON� R.S.
Environmental Officer
SJO/mh
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Municipal Enoi�msriny Engineere & Survey�ors Area Cadt 612
Mortgage Lo�n Survey for � v`A2�Ow JUNC-
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This ia o true ond corr�c� repr�sentaeion of o surver eI th• boundo.ies o} �I�e lond above �sc.ibed and oi �ke
loea�ion of oll buildinpy if onr� thereow� end all •isibie oncroachmen�s� i1 onr, from er on �aid lend. Thi� s�rver i�
rnode onlr ia cennectien wifh o morfOage leo� now bain0 ploced on ►he propertr ond no liebililr if oss�n+ed
aacept tp ti�e holder e{ such mortgoge or anr oN+e� inMrest ocquired br fhe reoson ef s�ch rnortyage. H is
unders�ood and ogroed nq T0�1YmB�1f6 have been ploced �or fhe p�rpose o} �s�oblishieg Ipf Nn�s er bo�nderr
cern�►s. Dofed tAis 4.�f7 da�r o{ ►Se nie� r A. p..19�.
+ � l SUdURSAN ENGINEERING, INC.
C`'Q�e :� �RCn t�O / Q.CT — fwgine r� y
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The frame is an infegrated superstrucfure
designed to be dgid and shong while suPP��9
the �il artd Uner. B resists bendi� m saggin9.
even when leaned on In tact. Doughboy uses
shmter top rail secfioru to increase sirengih and
make the top rail shon9er for seafing. SinCe CII
exposed suAaces are smooth, a unique Ifner
ir�llation is P�e �tich helps eHmfr�ate u�h�Y
�NfiN(195.
qnother quality feature Is our massNe toP rail
connector system. B has a smooth, protecfire caP
which hides all screws and forms a clean ap-
Pearar�e.
• Rusf protected wAh Zinc Ciad 9000"'
• Fiot Dipped Galvonized
wd��
The c�m�-dbbing on o DoughboY wa0 adds
fo Rs vertical shength and all�vs slight fle�dbilify
under wave impact. This prevents sudden shess
buildups caused by swimmers' wwe action. En-
gineered fo exacting standards, fhe wall is pro-
cessed with mul�ple heating and protective layer
steps (see sketches tor more detaiq. The fir�l layer
is a clear coaf to protect the decoraHve paltems
thot are ezclusive to Daighboy. These exha steps
er�ue a better loddng. bn8e►lastin9 P� � P��
your family irnesimenf.
• Cprru-►ibbed for flexibilHy and veAical shenglh
• Reversible wall for opflonal color and added
protection
. �ntenacwng sm,c�ure ror stren9+n ond rigidjN
•Hidden screw connector b prevent snogged
suits and scrafches
• Many common PaAs for ease of assembly and
SeMceabilify
• Multiple-layer heafinent and coating on all
frame steel for mmdmum protecfian
• AII smooth surfaces to protect you from cx�is and
Ncks. also to pertnit wrinkle-(ree Ifner installatian
• Ham�onious c�tOr-COOrdinoted P�ems to blend
in with your backyard
• pre-punched skimmer and eyeball retum open-
f�s e�imino}e sharp edges which could cut liner
during inslaliafion
• Slide joinf Connector joins ends oi wall together
for tull structural iMegrity and ease of assembN
Sfeps used In
processlnp DoM sldes
orsree� rrome
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Doughboy Is the only above-8round poot
rtqnufaCturer who is a basic producer of virgin
vinyl lir�rmatedal, modetothe origirml Doughboy
specificcitians. The standard of quality In virryl fs
measured by Hs softness and flexfbilifir. Da�ghboV
Ilrters are mode of a fortnulation designed spe-
cHically to resist uthaviolet ray deterioration and
wr]terheahnent c�emi�is (ihe I�lers of vimA soflr�ess
and fle�dbiBty). In add'dion, all Doughboy liners are
pattem embossed for skid resistance. These
numera�s shapes catch the sun and reflect light,
adding Iffe and sparkie to the water in your poo1.
•�� pp�hbOY virgin vnnA fortrxrla fOr
optimized wear and uihaviolet ray resistance
• Embossed for ezha skid and slip protection
•�C�dable �UfC7fl$x II�1@IS OIIO�N iOf OPhOM%I
cleep swim area or conflnuous deP1h bottom
(cwilable on most pool rtiodels)
Once again Dou9ht�oy has Proved to be Hs
oNY c�mpefitar with ttie retorrTx�lation oi our supe�ior
liner to bring you these additional ber�fits ...
• 100� impravemenf in tear resistance
• 10X greater tensfle s�irenglh
• New embossing for suAace c�sistency and
skid protection
• Additional chemical and ulhrnrialef resistance
F�andable liner models are also avaifable
which peRnit a chofce of eHher continuaus depih
a a groduated slope to a deep swimming area.
The linere�andstofit graduated bottom conlours,
thtu woiding ihe need to precisely pre-fortn the
Bround to fit exact dimensions. fiis clears the way
for an excavated pool wHh a deeper and wider
swimmirig mea than po�ble w�h shaplvPe sY�e�
p. Y ��r(' "
Filtrotion
The P��� of a RRedng svstem is to remowe
suspended particles and circulate water in a
swimming pool. PaA of ihis system includes a fitter
unit itseH, of whiCh fhere are four basiC 1VPes fo be
coruidered: DE (diatamaceaus earth� Hi9h-rate
Sand: Vacuum-Skim artd CaAridge. Each type
fortns a different balance artpng the factors a�
pdce. efliciertay. a�il�iliiy. and c�nuenienc�e.
This filiering system rtwst also be combined wiTh
proper pooi wafer chemishy to ensure a clean,
5patkling. health�' ernUOnmeM!
Your �alet is
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DOUGHBOY RECREATIONAL, INC. - 10959 Jersey Blvd. • Rancho Cucamonga, CA 91730
750'16
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15 Year Llmlted WarrarHy osn � Steel Compw►enb -�_ �. a.� y� � �. , �
Masslv�e 6" flared toP sead • 6" �yi►zad vertical suppoit • FuuAyy atppoAUq verficd te� �es 1cP seat ¢°`' ,
�ockir� • Aq heaW 9a�i9e steel interlodcin8 frame and wa0 sysiarn • Rusf P�tected w�► ZInC Gad 9000n' • �r k �' ,�`��' `" .
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ease and rmer pmtecHon • Conu-�b waa ror nex�il8v a�d �• Eaetiv �sembled sRde Joinfuvan ,: ° -
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1009f, imAr� fn tear � • �0'b gneater ter�e � I�i � tar stn(CtCe i�nG1F . ` ° : " . ,: � � ' �.
and skid resistance • Pedditlond chemicd �d �a-WOlet �ono� 20 til� eopa�ble �net kxop8ond �
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Ic�ty of Fridley S�B�E`T
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� �L __�__ � COMMUNITY DEVELOPMENT DIV.
' i� � PROTECTIVE INSPECTION SEC.
� _ �
�--_�� ��"' �,� CITY HALL FRIDLE� 55432 NUMBER aEV.
612-571-3450 910-F15
JOB ADDRESS 7508 Hayes Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 3 3 Don's 5th Addition
2 PROPEHTY OWNER MAILADDRESS
Richard Holien 75�8 Hayes Street N.E.
3 CONTRACTOR MAILADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
DATE
10/25/83
786-8766
ZIP
ZIP
PAGE OF
/ /
17304
RE NO.
//�/�
APPROVED BV
SEE ATTACHED
SHEET
PHONE
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
8 USE OF BUI�DING
Res idential
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE 0 REMOVE
8 DESCRIBE WORK
Construct a 16' x 32' Above Ground �ool
9 CHANOE QF USE FROM
STI PU LATION S
TO
See letter dated October 21, 1983 for stipulations froaa Environmental
Of f i cer.
VV p����� �,' �, .
ca,� local ut�,,�..
digg�ng GRg �.�;�.
gefore o�E . E1.E��R�C
�EI�E.P1� RE� ��( I.Pe�
�EC�v►
SEPERATE PERMITS REQUt4;E0 FQR ��R�f��4
H�ATING, PLUM�lNG A�If� S6t�NS�
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATfNG OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
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
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ].
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIEO HEREIN OR NOT. THE GRANTING OF A pERMIT S3 � OOO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �S`3$. rjO
�
ATUREOF NTRA R 'qU R12 � GENT IDATEI
_ ..r
SUR�OFOWNERII OW ERBUILDERI IDATEI —
VaGUPANCYGROUP OCCUPANCYl.OAD
SQ. FT. CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
$1.. 50
AL FEE
��Q• 0�
iIS IS YOUR PERMIT
_ �� �(3 �c�
DATE
0l��HER:
ADJRESS:
TEL k0:
CITY OF FItIDLCY
ti('PLICATIa� fOft RCSIDCi�iTIP,� t3U1LQli:G PCfviITS
(I�c�•�. Alterations. Additions. or Rcpairs)
Effective Auq. 1, 1981
_ ° � ,
�'���(,1� ��, �2� �13UI LDER : � Y I �,�I� � � ' � � ��l �L�(
l ��
� c a�- �'o �°� �
� � ��'�.Yl� ADa'tCSS: �� % � � �(
^ �:
TEL I10:
Construction Location
STJtI�T NO: �� �� f� STltEF.T:
L07': � BLOC9C: � ADAITIO:J:
,� ��
Corncr Lot: Insidc Lot: � Setback: Sideyazds: ��
Ap�licv�t attach to tl�is form ts.�o Certificates of Stirvcy of lot and
pzoposed building locatian dz�wn on certificates to scale.
DESCRIPTIO�� OF CO��lSTF�JCTION
� "� Fzont: � Depth: � � Heiqht: lCJ
Squarc Feet: C�ubic Feet:
Front: Depth: Heigl�t:
Square Fent: Cvbic Teet:
'iype of Cor,struction : � �� �- � �
Zb Be Cbr.�pleted: ���i�_
�
. �
Estimated Cost: S � 11'�
Alt. 1� Alt. B
Proposed Dziveway Tiidth Zf New► Opening Zs Desired: $ $
, S�� Ps,VF.iLL' SIDL OF S}IF.ET .
9S�e undersianed hereb}� ma1:�� appliczticn for a per�it fcr the �:ozk he:cin sp�cified,
agzeein3 to cb .all �ork ii, striet accordsnce yith the Ci�y of Tridley Ordi»ances E�id
rulin�� of tl�e Dei�.irtmr��t. of Dui:clir�gs, and heseby declares that all tl�c fact� and
reprecc��ltiens stated sn this applic.�tio are true and cozrect. a
DT.TE: � � � � � — (� � SiGNnTUS� : , ,
Stij�ulations :
�� �Z�
/•��
��.��
�
, _ .�
�
0
, • _ �., - - -
The Cl�ief Building Official ahall, before iasuing permits for the erection
of any building or atructure� or tor any addition to any ezisting building
or atructure or tor any alteratioa or repairs to any existing building or
atructure� upon applicatioa tberefore� reQuire the paymeat by tbe
applicant Por auch permit of fees to Lbe amount berein belov set torth and
in tbe manner berein provided Lo-xit:
'lotal 9aluation
=1.00 to =500.00
Fees
=10.00 (Minimum �15.00)
=501 to =2,000.00 =10.00 for tbe firat �500 plus �1.50
tor each additional =100 or fraction
thereof, to and includiag �2�000
=2�001 to =25.000
=25�001 to =50�000
=50�001 to =100,000
=32•50 for the first �2,000 plus �6.00
for each additional �1,000 or fraction
thereof, to and including �25�000
=170.50 tor the firat =25 � 000 plus
=4•50 for each additional a1,000 or
fraction thereof� to and iacluding
=50,000
=283•0� for the first =50,000 plus
=3..00 for each additional �1,000 or
fraction thereof, to and iacluding
=100�000
=100,001 and up =�133.00 for tbe first �100,000 plus
=2.50 for each additional �1�000 or
. traction thereof
Plan Cbeck: 25 percent of Duildiag permit tee.
Drivevay Depresaion Escrow: Coacrete curb atreets only.
_ Alternate "A": Removal and replacement of curb and gutter only -
Drivevay width plus 6 Peet times �13•50
Alternate "B": Removal and replacement of curb and gutter and
install a 3 Poot Wide approach xith 6 iach depth - Driveway Width
plus 6 feet times =15.75
. . ,.
Pe�ita for construction vill be iaaued a minimum of 24 bours from the
time of application to allow for proper reviev oP �be proposed etructure
aad of tbe aonstruction aite.
� Certificate oP Survey of tbe lot� ahowing the location ct the toundation
oace it bas beea constructed xill De requfred pefore oroceediaR Witb the
framiag.
y, _ - �
sue�ecr PERMIT NO.
City of Fridley 2 0 8 3 3
AT THE TOP OF THE TWINS g U I L D I N G P E R M I `
� � R
� � COMMUNITY DEVELOPMENT DIV.
s �,; _ �0 33 `a-
r � � PROTECTIVE INSPECTION SEC. —
L1 = �
---- A ��"',•, CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
i �� 612-571-3450 910-F15 5/20/91 / /
JOB ADDRESS 7508 Hayes Street NE
LOT N0. BLOCK TRACT OF ADDITION SEE ATTACHED
� ESCFi. 3 3 Don! s 5th. Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE ,
Scott Sannes '7508 Hayes Street NE 784-5001 ��'
3 CONTRACTOR MAIL ADDRESS Z�P PMONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILOING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION �iJ ALTERATION O REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroo�'; reside� and add w,i�dows in kitchsn and bc�th.
9 CHANCiE OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONINO SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 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 WILL BE COMPLIED $2�%OO $1.e�5
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEpMIT FEE SAC CHARGE
PqOVISIONS OF ANY OT R STATE OR LOCAL LAW REGULATING CON- .r�/�, OO � Fire SC $2. %O
STRUCTION OR THE PEg RMANCE OF C NSTRUCTION. $
�` PLAN CHECK FEE TOTAL FEE
� e05
SIGNATUREO � ON'R/� T RORAUT RIZEDAGENT IOATEI WHEN P OPERIY A E T S S YOUR PERMIT
��
I j —2e�— �, ��ls�}/
Si AT � OFOWNERU WN RBUILDER� IDATE� � P qATE
� []
� � L J
AI�'F�2 �
R'-1 AND R'-2
Building Ppxmit Applicatiaa�
Effective 1/1/91
c��� ��: 75'og uaY�s Srr. N� �a.�..�.Y sSy.3z
r�egal nescriptiaaz:
owner xame &�,c�ar+es��: S c.o"� �- �►►��cvQ, 5 Te1. # -SO 0 I
c7o�t,ractor: 7.ie1. #
�: `7 �O � �A�cE.S �'f. �R1vL�,i
Attach to this applicatian, a Qettificate of S�nvey of the
lat, with the propo�ed �ar�tn�t.ion drawn ar► it to scale.
�.:�.•s+• �• •: •)' � �• •.� • � i:�
L1VII�1G AREA: Tp*� h Width Heic�t Sq. Ft.
(�iR�iGE Alt�l: Ier�gth Width Heic�it Sq. Ft.
D�7G�t AR�i: Tp�� Width Hgt/Grotu�d Sq. Ft.
a�: �_�A-� acNE� Su��-r
Corner Iot l[ "]�i��[.a� �t [� Ft. Yd Setback Side YaYd Setbacks
�ype of c�truction: �,o�N� RooF �.stimatea c�t: $ 2. 7ov
Approx. C�q�letion Date: °
Proposed Driveway Width If New � Is ir+ed: Ft. $ $
Width + 6' See Back Page
n�: � 2C� -- `l I ��cArtr: � z�.t. # �7��1� �'C� � /
P+ermit Fee
Fire Surch�ge
state Surcharge
SAC C�arge
Driveway Escrow
Park Fee
SL'OWer' McilTl Ct131'�
. v�
SZ'�[TIATI�TS:
`�
$ \
crr�r v� a�r
Fee Schedule o� R,�verse Side
.001 x P�ermit Valuatia� (1/lOth �)
$.5o/Si,000 vaivatia�
$650 per SAC Unit
Alt. °�j° ar' Alt. nB" AbOV2
Fee DeteYlaitled by �ri n�ri r7
Agre�nent Ne�essaLy [ ] Not Nece.ssazy [ ]
� �v�
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� � �i
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� ► �
�
�`�. U(�
I:���� � �,_ 4�;���4��Y:�.�__i,ti�+i ��i�;�
�lie Chief Buildir�q Official shall, before issuing permits for the erectioai of ariy
building or struc4u�e, ar for ariy additiaaz to ariy existing buildirrg or structure, or
for any alt�satiaaz or repair to any existir�g buildirrg or stn�ure, upan apPlicatio�n
therefore, r�equire the payment by the applicant for such permit of fees to the �mt
hei�in below set forth arld 3ii tl�e mar,r�r � p�� t�o-wit:
Zl7►II�iL VAIIJE
$1 to $500
$5oi to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
��
$15 (Miniman Fee is $15 plus �,�,a„�)
$15 for fitst $500 plus $2 far � additional $l00 or
fraactio� ther�eof, to arr3 ir�cluair�g S2, o00
$45 far' first $2, 000 plus $9 for �ch additiC�2�a1 $l, 000
or' frdctiaa'1 t2�ereof, to and inCludir�g $25, 000
$252 for fiLSt $25,000 plus $6.50 for each additional $1,000
or fractiaaz thereof, to anc� includirig $50, 000
$414.50 for first $50,000 plus $4.50 for each ad+diticnal
$l, 000 or fzactian t$�eY+eof, to arid including $100, 000
$639.50 for fiist $100,000 plus $3.50 for each ac�ditional
$1, 000 or fractian tliereof, to ard includirig $500, 000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each acklitional
$l, 000 or fractioa'1 th+e2�eof, to and iriClt�ding $l, 000, 000
$1, 000, 001 azrl up $3539. 50 for th,e first $1, 000, 000 plus $2 for each ac'�ditional
$1,000 or fractic� t�,ereof
� �tIVE�iY �PRESSI�T E8Qi0�W
(Ca�cr�te Ctirb Streets On1Y)
Alten�ate "A" : Remnoval ar�d replao�nt of curb ar�d gutter anly = Driveway width plus
6 feet times $13.50.
Alternate °g�� : Remdval arYi replao�ent of ca�rb ar�d gutter and install a 3 foot wide
approac�i with 6 iirh depth - D�iveway width plus 6 feet times $15.75.
,.i° :�._�i,i.�,M�•-.T
P+eYmits for oanstructio� will be issu�d a miniinffi of 24 i�s f�en the time of
application to allvw for pYnper review of the pY�oe�ed struc4u�e ard of the
aanstructian site.
A Qertificate of S�nvey of the lot, shawir�g tt�e locatioai of the fa�rrlation oa�ce it has
it has be�n oo� will be required before prooe�dirig with th+e framing.
_ ^�
�
Work To Be Done:
New Shingles/Fascia Board
New Siding-Cedar Lap
New Kitchen Window
2 Glass Block Windows-Bath
New Octagon Window
Total
Cost
$800
$1,400
$350
$110
$35
$2,695
� �
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CHIMNBY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioration Yes () No ()
3. Has no foreign objects lodged within Yes () No ()
4. Is securely supported Yes () No ()
5. Meets all current Code requirements for
size and total BTi7's connected Yes () PTo ()
6. Has total heating BTU's of
Al1 other BTU's
TOTAL BTU's
Remarks
List Alterations Beinq Done:
�
HEATING COMPANY
Signed By
Date
SUBJECT PERMIT NO.
c�ty of Fridley ;�=,� � �--�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
r -
� � RE�EIPT NO'
� • COMMUNITY DEVELOPMENT DIV.
' ��: --___-�
r � � PROTECTIVE INSPECTION SEC. I% ��
i � �
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' � �'��\ � CITV HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVED BY
�'"""� � `'' 612-571-3450 9t 0-Ft 5 5/ 12 /95 � /
JOB ADDRESS 7508 Hayes Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 3 Don's 5 Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Scott Sannes 7508 Hayes Street NE 784-5001
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW �] ADDITION ❑ ALTERATION O REPAIR O MOVE � REMOVE
8 DESCRIBE WORK
Replace existing deck with a 14' x 10' Deck
9 CHANGEOFLSEFROM TO
STIPULATIONS
See notations on plan.
WARHI��
Before di�ging caU for
all utiiity lacations
454•ODa2
REQUIRED BY LAW
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL. PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION ]. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAJ(
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �1� L1F1 �.57
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �ZB.JO Fire SC �1.I�F
PLAN CHECKFEE TpTAL'FEE
$30.61
SIGNATUAEOFCON�RACTOAOAAUTHORIZEDAGENT IOATE� WHEN PqOPE Y VALIDATED THIS IS YOUR PERM�T
P J {.,X��' ' �9 I,'�
SiGNATURE OF OWNEA UF OWNER BURDEA� �DAT6 � DG �NSP q fE
NEW
ADDI�i
ALTER
il
(1
L1
Construction Address:
C[TY OF FR[DLEY
S[IVG1,E F�MILY AND D�IPLEXES R-1 ANI3 R-2
Building Permit Application
o� u���, s
Effective 1 / 1 /95
�°l7�1
Legal Description:
Owner Name � Address: �c.o 1'f �A�+� Tel. #����- �� �
Contractor: � �" MN LICENSE #
Address: �5 G��, � � . _Tel. ,# _
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawa on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: Length Width Height
GARAGE AREA: Length Width Height
DECK AREA: Length /� ' Width � Hgt/Ground �
OTHER:
Sq. Ft. _
Sq. Ft.
Sq. Ft. L/(�
i
Coraer Lot [] Inside Lot `(� Ft. Yd Setback �� , Side Yard Setbacks ��
Type of Construction: �r� nn .e.. ��� �= $ ���
Approx. Completion Date: �J\.� ( , l �� ���%�� �
,
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: q IU �� APPLICANT: Sc�� 1 SArlN� Tel. #%� 5�� _
Permit Fee
Fire Surcharge
Staxe Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
v-Z�, 70
$
$ 1� �% --
$ ,'�I
$
$
$
$
$
$
$ �V ��l
('iTY USE ONLY
F� Sch�e on Reverse Side
.�1 of Pennit Valuation (1/1(rth%)
$.50/$1,000 Valuation
$850 per SAC Unit
$5.� (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$4.50.00 Conservation Plan Review
Fee Determined by Engineering
Agreeme� Necessary [ ] Not Necessary [ ]
a
��ui�.»>rvG 1'I:KMCt' FEi? SCHEDCJLr
I�lu� (;hi�f l3ui(ciin�; U�ticial shall, tx;iocc itisuing permits for the ercctic>n of any huilding or stn�cturc,
�,r ti>r any a�iciitivn lu any cxistin�; huildiiy; c�r structurc, or for any allcraiion or rcpair to any cxistin�
l�uilciing ��r s�rucwrc, u�n a���lication thcrcfore, rcx�uirc thc paymcnt by d�c a��piicant for such �crmit
c�f� ti:c;ti t<� thc; <i�nvunt t�crcin t�cli�w sct forih :�nd in thc manner hercin proviclul tt�-�yit:
"I'O"I'AL VALU(?
� 1 to $500
$501 to $2,000
�2,001 io $25,000
$25;001 to �50,000 -
�50,001 to $100,000
$i00,001 to �500,000
$500,001 to SI,000,000
$1,000,001 and up
Ft�i;S
$IS (Minimum Foe is $1S plus surcharge)
$15 for first $S00 ptus �2 for each addiaonal $100 or
fracbion thereof, to and including $2,000 -
$45 for fust $2,000 pius $9 for each additional $1;000
or fraction �eroof, to and incl��dmg $25,000 ' -
$252 �for first $25,000 pl�s $6_SO far each additional $1;000
or firaction theareof, to. and including $S{),000
$414_50 for first $50,000 pius $4S0 for each additional
.$1,000 or fraction thereof, to and including $lIX},0(}0
$63950 for €ust -$100,000 pta�- $3.50 for each additional-
$i,Q00 or fraction tit�eof, to aad inclucii,ag -$500,000
$2039.50 for die 5rst $�?0,000 pins $3 for each additional
$1,000 or fraction diereof, to and inc(uding $1,000,000
$3539.50 for the first $1,OU0,000 plus $2 for each additional
$1,0(}0 or fraction thereof -
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
Alternate "A": Removal aad replacement of carb and gut�er only - Driveway wid� plus 6 feet times
� 13.50_
Alternate "F3": Removal and replaceraent of curb and gutter and install a 3 foot �vide
approach with 6 inch depth - Dr�veway width plus 6 feet times $1S_75.
VL•RIFICA"f10N OF FOUNDAT[OP(
!'ermits fur co�ist�uction will be issued a minimum of 24 hours from the time of �plication to altow
for �roper rcview of the propt�sul structure and of thc cor�struction site. -
A Ccrtit;�::ite of Sucvcy of tlie lot, showing the IocaUon of die founciation once it hac it has hcen
constructe�i tivill t�e re;yuiru! t�etore proceeding with the framing_
4
9 )
0
Lond Plnnning
lond Surveying
Soils Testing
Civil Engfneering
Municipfs7 Engineering
5
Mortgage
�S'ulu��lan. � , ,
�'n���ae��i�z�, �.�nc.
, Engineers &`��; Surveyors
Loan Survey for / V \A�I.�.W
1
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Minneapolis,
Minn. 55432
Telephone 784-6066
Area�Gode 612
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This is a trve and corrae� represeMafion of a survey of 'the bouadarie's of,the land•abo�� deserlbed a�xt of the •
Iocatlon of all buHdings� if aay� therow+� aHd al1 �isible encrodchments� if any� froni,o� oe �aid lond.'This iurver it
made only ie conneetion wifh a mortyage loan now being placed oe tha propbrtr on�d ne Ila6i17fy f• aseumed
ezcapf fo the holder of such mortgage or any ofhe� Infarost acquirod by, tho. ceasiln of such mortyage. . H is
. understood and ogreed _�,��nonuments have betn placed for ftie purpose of .dtobliah�pa:,lof ,lines oi boundary
cornera. Dated fhis_,,'=doy ef,�,A,D.�19�, � � ` ' �
n - SUBURBAN ENGINEERINa, INC. �
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Deaiq� Works (R), Knox Lumber, �220 Coon Rapids
WeFd� Map 03 19 :17 :18 19 9 51��
Drawing: Plan View
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De�ign Works (R), Knox Lumber, #220 Coon Rapids
We� -M�y° 03 19:17:18 1995�;`
Drawing: Post Layout View �
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$ItE ADDRESS�
EXTERIOR ENVELOpE AVERAOE "U" COMPUTATION
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COMTRACTOR � DATE t �'I �_ � � �PHONE t � ' _ � .
DETERMINE HORKINt3 BQUARE FOOTAQE OF EACHi �
1. TOTAL EXPOSED WALL AREAt ��u" �r sq. ft. x"U" _',� . l l�, �%
P. TOTAL ROOF/CEILINO AREAe � sq, ft. x"U" _.026 ■��. �� `
3. TOTAL EXROSED MALL AREA CALCULATIONBt
Tot�l exposed Mall
aree above floor ��� ,�� tiq. it.
a) Total Mall MindoM �reae
Insulated tilass gl�=ed ' . � �q. tt. z "U" _ . gi . '����
LoM E Oless glated sq. ft. x"U" .`3_ ■�r
b) Total door area �� • '� sq. tt. x"U" _' 1= : ��
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e) Total sliding glass door ersa: -
Insul�tfd Olass gi�zed sq. tt. x"U" _. i •
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LoM E Olass �laz�ed sq. tt. x"U" -�31„ � °�
d) Totsl Fireplace Mall are�t�� sq� {t. x"U" _.09 : �
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e) To�al Yall Fra�ing area
(Average lOx) � , � �� sq, tt. x "U" . 091 � . � �_�
t) Total Met Wall area above
f loor � insulated) �� �� aq. tt. x"U" 104�3 •�� ��i�i
�) Total R1� joist area � �✓� • � • sq. tt. 7t "U" ,�,,,� � �� �—
Total Foundation are� .
, �exposed) � sq. tt.
h) Total Foundation
MindoM area sq. tt. x"U" �.`��
i) Total Net Foundation .
�rea above 9rade sq. tt. x"U" �_��
' TOTAL aI thru i I �'� ���'S
If ite�s M3 is the saMe �s, or less th�n ite� Ai, rou hays wet �•
�hs intent ot S.B.C. Section 6006 �c) 2:
4. TOTAL EXPOSED ROOF/CEILING CALCULATIONS:
,
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- . : � ��-�-. . _. �: �':
Total exposed -
roof/ceiling area � .� sq ft - _'� � �;�_�; ,
j) Total skylight area sq ft x"U" _
-
k) Total roof/ceiling framin � v�
area taverage 10X) s O sq ft x"U" .025 __
1) Total net insulated � -� 3 �
roof/ceiing area ��.� sq ft x"U" .022 _
TOTAL j) thru 1) _ �. S � ��
If total of #4 is the same as, or.less than #2, you have met
the intent of S.H.C.•Section 600f� (c) i.
ALTERNATE BUILDING ENVELOF'E DESIGN
To utilize the total envelope system method, the values
established by the sum of items #3 and #4 shall not be greater
than the su�a of items #1 and #2.
1. 1 14 - �� +z. �� � � - 1 �� •SS
3. 0 C7� . �-S +4. �S ' I �O = - I �S. �1
C E R T I F I C A T I 0 N
I hereby certify that I have calculated the "U" factors and "R"
values herein and that the building here described meets or
exceeds the State of Minnesota Energy Conservation Act.
tDate)
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SUBJECT .
City of Fridley 2 � 6 2 9
' , AT THE TOP OF TFIE TWINS g U I L D I N G P E R M I T T No.
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� � COMMUNITY OEVELOPMENT DIV,
v PROTECTIVE INSPECTtON SEC. �S( �
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� �"'1 � CITY HALL FRIDLEY $:{43Y NUMBER f1EV DATE PAGE OF APPROYED BY
�_._.�' �-� 612-571-3450 910-F15 9/9/98 � �
J08 AODRESS 7508 Hayes St NE
1 LEGAL ��T N0. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3 3 Don's 5th Addition SHEET
2 PROPEf;TY OWNER MAIL ADDRES$
Jan Larson 7508 Hayes St NE 55432 PH�785-6418
3 CONTRACTOR MAIL ADDRESS Z�P PHONE IICENSE NO.
Owner Same
< ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII AODRESS 2�P PNONE LICENSE NO �
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW C� ADDITION ❑ ALTERATION ❑ REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WOFK
Addition - Living area (680SQ) / Garage area (200SQ)
9 CHAN(3E OF USE FROM TO
STIPULATIONS
See notations on plan.
�VA����G
Before digging cail for
all utility locations
S'EPARATE PERMITS REQUIR'ED FOR 454-0002
w,A;..�,� �,T-��T+.�.:c. ^�_�.l�SBING ANa� SIGNS. R��UIR,ED BY LA1N
TYPE OF CONST. OCCUPANCY OROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBtN(3, NEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONINCi SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO FOR A PERIOO OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OPFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STAILS 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 COMP�IED �/{/{, 865.00 �L2. �F3
WITN WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR IOCAL LAW REGULATING CON- �529.75 Fi SC �4�F.HG
STRUCTION OR THE PERFORMANCE Of CONSTRUCTION.
PLAN CNECK FEE TO AL FEE
$597.04
f 51GNAT REOFC iRACT ORAUTMORIZEDAGENT IDATEI EN R P V LID D TI'lIS IS R P MIT
����- �- �- y M — -
5� A'URE OF O EA F OWNER BURDER� iDATEi 8L �NSP pqTE
� - -
NEw
ADDN
ALTER
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ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
� 5oS
/���
� �
Legal Description: � � �� � 9�G ' 6' y73
Owner Name & Address: �� [�i1 � Sph Tel. 785' � 7��
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
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
�� i
Length 3� Width � � Height � Sq. Ft. !��
Length � Width �_ Height Sq. Ft. pt�
Length Width Hgt/Ground Sq. Ft.
01'HER:
.
Construction Type: Estimated Cost: $
��.r/�', �9 36r�"�°
(Fee Schedule on Back .-
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
I
p� � �
DATE: �� 2� � /o APPLICANT: � Tel. #
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
��ilt�►:��1
STIPULATIONS:
$ .7
$
$ �• 3
$
$
$
$
$
$
$ ?�
Fee Schedule on Reverse Side �� �� ��
�
. 001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1000 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 [ ]
;
. ��
BUILDING 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 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,OO1 to $50,000
$50,001 to $100,0(?0
$100,001 to $500,,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for eacM additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 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 $13.50.
Altemate "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
Permits for construction will be issued a minimum of 24 hours from the time of application to a11ow 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.
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Building
Inspections
763-572-3604
DATE �J v� G —
srrE a�D�ss Z
THIS APPLICANT IS:
BUI'LDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
sy— YOUR E-MAIL A
7 �¢' Ze aS i" � 7'� r �'1n
❑ OWNER �ONTRACTOR
PROPERTY OWNER/ NqME: �6 �� �°�0
TENANT .qnDxFSS: °� �o /�{9 Zc r��e '� CrrY
c
PHONE: �
CONTRACTOR
SUBMIT A COPY OF STATE LICENSE
YOUR STATE LICENSE ADDRESS:�
WITH APPLICATION pHONE G�. ��
PROPERTY TYPE ❑ SINGLE FAMII�'
❑ TWO FAMILY/f
PERMIT TYPE
�rE oF woRx:
❑ BASEMII�iT FINISH
0 DECK
u
DESCRIBE WORK BEING
SIZE OF IIVIPROVEMENT ;
� d � � SyO � EXP DATE
� 5��� �GY/'� GZ /Y. 6✓,
� �—'�S F.�X
iW CONSTRUCTION S1ZE
CONSTRUCTION STO
❑ GARAGE/Sf�D
❑ ROOF
❑ SIDING
0 SWIlvIlvIDJG POOL
O ADDTfION
'AIIt ❑ REM DELING
C� Gtr �� h ��.. .. fn/ ���
ROOFING — O HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GAR.AGE
GARAGES TTACHED GARAGE
PROPOSED S1ZE: ACHED GARAGE
PROPOSED HEIGHT:
SIDING
❑ Vinyl ❑Soffit
� Aluminum ❑ Trim
❑ �� O Fascia
vvnvnows
IN EXISTING OPENINGS {�Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF' c.
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBE F WtNi]
Pernut No.: o(l�l�S °' D� L
Received By:
Date Rec'd: � �G �.
i
i
,- sTa,�i,�i�_,���?-2
A��' ,-
'i1l —'V �n
CITY s�G/ ��^i� Il�q, STATF�LGIPSS//oC
❑ DRAIIV TTLE
❑ OTHER
°•. .f A �'t rZ
ViTIDTH HEIGHT
�ASEMENT REMODELING SUBNIIT•
1. Existing Floor Plan
2. Proposed floor plan
3. List of siructural members to be used
Ft.
FOR NEW CONSTRUCTION INCLUDWG DECKS,
ADDTTIONS. & PORCHES SUBNIIT•
1. Site PlanlSurvey showing the existing structures
and proposed project.
:� 2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, IN UDING THE COST OF LABOR AND MATERIALS:
(LTSIN 9 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $� . OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surchazge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Chazge
'Total Due
$ See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ . (.0005) times the total job valuation — Minimum $.50
$ r �}� .001 x Permit Valuation (1/10%)
$ �' �/�y $5.00 (State Licensed Residential Contractors)
$ $1450 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ �greement necessary ( ) Non Necessary ( )
$ a Make checks pa_yable to: City of Fridlev Attacb
THIS IS AN APPLICATION FOR A PERMTf-NOT VALID UNTII. PROCESSED
r 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 Construcrion 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 approved
plan in the case of all work w h requires rev' w and approval of plans.
S IGNATURE OF APPLICAI� � PR1NT NAME G h Qi �I �" /`'d DATE `' ��� (/ �
� ,
�,���.}� � �p � ��
�
Page 2- Building Residential Application
BUILDING 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 existin.g buildi.ng 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:
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 proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, NiN 55432
763-572-3604
Fax: 763-502-4977
— ./
s�L� 8 ---�f�1�ES � T�e E E � ___� � _ _ ---
�Secue r : /�D �_�ar t�i a,� M� fi � � _ %5 �'� � �a
-���--1�_� /I,�r�� _s�t,��_�_—_�___��t� d `�'ay 5