AF - 45665�
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City of Fridley, Min.n.
BUILDING PERIid]�T
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Builder . . ..... .. ................
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Address . . � �'.� . � .l:Y..�r. . . . .-r.�r� .�°.�. .e.� . . . . . .
O�CATI4IV OF BUI�..DI1�G ���!� J , < �
No. � .l. .�/l. � . Street� . ` .. . . �]'�': .70�! :: :.: . . .. .. . . . Part o Lot ��.. � � �
Lot . . � (. . . . . . Block . . . . �. . . . . . . . Addition or Sub-Division ��a . . . . . . .
Corner Lot . . . . . . . . . . . . Inside Lot . . `. �. . . . . . Setback . . . .��. . Sideyard vZ �a �� � � ' 3 � �fa.�.f
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To be Us d as: ..
Typ of Construction
DE��RIR'iION O� �LJ�LDI�IG
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Froni��. Depth°�C:!�% Height`'��'�����q. Fi.r/...3,! F't. ........
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Froat�. . .�R . Depth a. � . Height . .� . . Sq. Ft. . .�.°.Z:. . Gta. Ft. . . . . . . .
. . . . . . . . . . . . . Est. Co���. � � �%. . . . . . . To be Completed . . . 4? . . . . . . . . . . . .
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In consideration of t`he issuance to me o4 a permit to construct the building desribed above, Y agree to do
the proposed work in accordance with the description above set forth aad in compliance with all provisions of
ordinances of the city of Fridley. �
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In consideration of the payment of a fee of $. . ��.�rmit is hereby granted to . ��.�e�'L�"-. . . ._. . . . . . . . .
..... .. .. .. ...... ..... ... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is graated and tiis agents, employees aad worl�nen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota. regarding location, coastruction, alteration, maintenance, repair and moving of buildings with-
in the city limits and this permit may be revoked at any time upon violation of any of the provisioas of sa.id
ordinances. A � -_ T _ - -�� ---- -
NOTICE:
This permlt does not cover tha construction, Installatlon or alteration fo� wl
sewer o� water. Ba sure to see the Bullding Inspectgc �.�arate perm(ts for
-g < -
� DYll�g
Items.
gas heating,
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INDUSTRIAL
BU81NE88
CITY LOTS
TOP06RAPHIC MAPPINCd
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" C. E. COULTER �
LAND SURVEYOR
REGISTERED UNDHR LAWS OF STATE OF MiNNE&OTA
LICEIVSED BY ORDINANCH OF CITY OF MlNNEAPOLIB
3300 LYNDALE AVE. 50. MINfVEAPOLIS 8. MIryN.
TAYLOR 4-0370
SURV�Y FOR iPOBERT FAiReN%�o
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PLAITINO
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LAKESHORE
JUDICIAL
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T hereby certii�� that ttie abave is � tr�ie and correct, glat �f fs �Z�rvPy �-:
All Of Lot �1� ='1CCk 1, C+��!'h':At�'�,`ir.IRL- �1TJDITIOi:� gnd tY:�t ��aT't us LQt ;, �i�- -,. ;. _.
Subdivi�� oii 1°0.23 � An��a County� � inr_PQot�. de�crit�e�� 3. fc? l.cw� : �'.� ._ . . '.`
E�s+erZf �:orner of' s�i�? L�t jI. thpr�e r1?nnin� � 89oI.�'�i°�ti e.1on�, + . v> >, ��,< .;�..
Lot '�1, �0 fPet to +.he i3ortl;e��t corner of Lot 1. �1c�ck 2. C�:�IT'r°:' _'. ---- --'- ,`' •=�'
runriint �,rj4°26'29° E, 11�.17 feet more or leQs to t�e shore? ine c�' °,'
t•unnir.� Ivortilea5terly alc�n� said sliorel�_ne to its ir.tere�eti�n � '- -�x'= `'` "'�
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P�Qm the �otnt Qi' beQi:ininGs ther.ce runnin�; �T30�1�9��9"ti��� �?��� �eet --
pQint of beginning. For the �UT^05,P, oi this description tY�e :�outh a �. _ � �-. �=
consid�red to �e e line �innin� s89°1£''.;1"L�. :,�, •� �:
As aarvPyed by n�e this 1Gth day of I�sy 19K8 �D. � f . '
y v�.E,'°:lP� / <<,� � i, � _�s'�_ _�._�_� n � _�. _ � bo.�...-�
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� City of Fridley, Mi�nn.
BUILDING PE '� IT
nate: ._..�"W' _�.�_ """
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Owner:
Address
�Address ...�'^...r�' j..r',,1..__'
N° � - 767�
� L CATIOI� OF IL INt�� �`
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No. .- --��- �- i��� ' , ._.._.. . /.._ .. .. __..__.__._......�---._..__.._.
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Lot ._.... �_....__..._. Block -------_�.._.. .__.- -. --. Addition or Sub-Division .�I�.._.. ::_ .._...._..._ . ... � ... '� � ,�
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Corner Lot ......:.._.._.._._...._..---... Inside Lot ....._............_.......__...... Setback .....-------......_. .. il_... Sideyard ..--•-��-�-------- �-- ............._..._.. -------___..
SewerIIevation .-----........._-------..__.___..........._.....__.----� ................----....._........ Foundation Elev��aton ...._.....---..._.._.._..__-----._._....._........---..........-----......_...._..
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DESCRIPTION OF BUILDI
To be.Usea as;,n � !� �e .
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�'�-:_:��...a_.:....:_.._. Front .,�.,�-�----. Depth .--.��....f�--- Height
-� ---.___......_ ............._......._............_. F�o ,•--.._............._.. epth ...._........._.._.. Heigh�
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Type oP Construction ._---�I`�.,�"` . ....... . Est. Cost..,.��' .��....
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Sq. Ft. _� �� Cu. Ft ��� �
Sq. F� -•---- ............._.. Cu. F�
To be Completed .....-•-----......_..._
�°��'�.�-�6���P��
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THIS PE�=i!�'�r;il" C��ES iJU7 AUTY icl�tl�E VIOL,�T-
ION OF A('+VY I�R!VATE LAftiD C�VEfJANT� AfVL�
� BUILL d�Ju II���TRICTIONSo
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In consideration of the iasuance to me of a permit to construct the building descrit�d above, I agree to do
the propased work in accordance with the description above set forth a.njti in compliance with all provisions of
ordinances of the dty of Frldley. � �
In considerat3on oY the payment oE a fee of $.�`_-• -'�.----.._:..-.---, Permit is kiereby granted to...___...._..._....._...._...---.----------
_... to construct the building or addition as descri � above. This permit is granted upon
the express condition that the person to whom it is granted and his agen �i , employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall confo in all resPects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, mainten ce, repair and moving of buildings
within the city limits and this permit may be revoked at any time u�po 'ol�ia�ox► of any of the provisions of sa.id
ordinances. �"°� e ,, �� ; ,�
NOTICE:
This permit doea not cover the wnslruNioe, installation for wiring, plumbine.
fhe Building Inepeetor for separafe permHs for these hems.
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Building Ins�etor
6ealing, sewe� or wafea Be sure fo see
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SUBJECT
City of Fridley
AT THE TOP OF TNE TWINS g U I L D I N G P E R M I T
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� �` .��_ COMMUNITY OEVELOPMENT DIV.
r � v � PROTECTIVE INSPECTION SEC.
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� S �"'� � CITY HALL FRIDLE� 55432 NuMBER
�""� � �'� 612-571-3450 910-F15
JOB ADORESS 6901 Hicko Drive NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
oescR. 31 1 Ostma.n's Th�
2 PROPERTY OWNER MAIL ADDRESS
REV
27288 �
3 /5'
OATE PAGE OF AGPROVEO B�
�/19/98 / /
SEEATTACHED
SNEET
Lorraine Hanson 571-7037
3 CONTRACTOR MAIL ADDRESS Z�P PMONE LICENSE NO.
J I Build�rs Inc PO Box 667 o ect L ke MN 55n75 b��_�,�.n4 ���R
4 ARCHITECT OR DESIGNER MAII ADORESS ZIP PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDtTION ❑ ALTERATION � REPAIR O MOVE O REMOVE
e DESCRIBE WOFK
Reroof house and �arage (28 S� Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOfiK OR CONSTRUCTION 201
AUTHORIZED IS NOT COMMENCEO WITHIN 80 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OFi ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOfiK IS COMMENCED. NO
1 HEREBY CERTIFV THAT I HAVE REAO AND EXAMINED THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yAl
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT 2
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pE�
PROVISIONS OF ANY OTHER STATE R LOCAL LAW REGULATING CON-
STRUCTION OR THE ERFOR ANC O CONSTRUCTION. �7
PL
Li
SIG A CON OiiORAUTHOAIZEDAGENT IDATEi
/
c�r.ueriiAC nc nwNOa �iG OwNER BURDER� �DATE�
STA�LS
OCCUPANCVLOAD
CU. FT.
f PARKING
GARAGES
e SC
L FEE
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f16TE
NEw �
ADDN
ALTER
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ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
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Effective 1/1/98
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Owner Name & Address: �;�� �� . _ , _ _ _ � � Tel. # S 7/ — �0 3 �
Contractor: � � , L�:����� � MN LICENSE # � �� �
Address: P d . � /�7 �—¢-e� ��(�`y� � �oa S� _ Tel. # �� 3 ° ��a u
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:
OTHER:
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width
Width
� ��� �
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
� , / �.�'�' _ O�%
�
Construction Type: Estimated Cost: $ � �� �� �
(Fee Schedule on Back)
Driveway G�rb Cut Width Needed: Ft. + 6 Ft = Ft x$
3�
DATE: � 9 APPLICANT: Tel. # r�� � — �F� � �
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ , �S
$ �e3�
$ � / (o
$
� �� ���
$
$
$
$
$ ��_ �
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.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 [ ]
. --.,
BUII.DING PERMIT FEE SCAEDULE
The Chief Building Off'icial 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,OOlto $50,000
$50,001 to $100,000
$100, QO 1 to $500, 0(�
$500,001 to $1,000,000
$1,Q00,001 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 each 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 $1 Q0, 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)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for propei
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 const�cted
will be required before proceeding with the framing.
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE "f / O� '
SITE ADDRFSS �i
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACI'OR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING DC
SIZE OF IMPROVEMENT�
�QOFRVG
NUMBER OF SQUARES _
GARAGES
PROFOSID SIZE:
PROPOSED HQGHT:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS �
Fl�i cko� y �. N�
❑ OWNER �CONTRACTOR
Nan�: LO 2 N
�D�ss:67o1 �ck E ,
PHO�: �b 3- s �1- 703?
xa�: vi (d�n� on �nt CcY'r�eis , fn c,
STATE LI� �.O Z�i�i 19 S
ADDRESS: l� Q Z��%iI �"�O/%~4 1� 0�
PHONE %�is3' yliY'' ZS�I B
�SINGLE FAMQ.Y/NEW COIVSTRUCTION
❑ TWO FAMII.Y/NEW COIdSTRUCTION
ADDITION ❑ G GFJSHEb
❑ BASIIvffidT FINISH O ROOF
❑ DECK ❑ SIDING
❑ NEW HOME CONSTRUCTION
❑ ADDTI'IOAT
O REMODII.ING
0 HOUSE ONLY
� HOUSE & GARAGE
❑ ATTACFIED GARAGE
❑ DETACHID GARAGE
E??CP DATE
❑ DRAIN TII,E
��� N�W
Permit N
R����a By:.
Date Rec'
Ft�
�ASEMEPi'C REMODELING SUBMi7':
1. Existing Floor Plan
2. Proposed floor plen
3. LisY of structwal members to be used
�IDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ V'uryl pSoffit ,AADITIO�iS. & PORCHES SLJBMTf:
❑��� ❑�.� 1. Site Plan/Survey showing tlre existit►g strucpues
❑ Other C1 Fascia �d PI'aPo� P%1�
2. Two se� of canstruction plans
INw � TING OPININGS OYes ONo LOCATION OF WINDOWS 3' �°�' ���ons
OR FOR NEW OPII3INGS-DESCRIBE SIZE OF
OPINING CHANGES 8c
TYPE OF WINDOW TO BE INSTALI.ED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERiALS:
'OTAL dOB VALUATION $ �3 �e� � � 1� U.B.0 FEE SC ���� �E
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
� '��, nl �� See Back Page for Fee Scheduie
$, O 65% of Building Permit Fee
$ � � Sb .001 titnes the total job valuation
$ .0005 x Permit Valuation Nrnimum $.50
$ $5.00 (State Licensed Residential Contractors)
$ $2000 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Date�mined bY Engineering
$ � Agreement necessary ( ) Non Necessaay ( )
$ Make checks payable to: City of Fridlev Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII, PROCESSID
I hereby apply for a building pernut and I aclmowledge that the informarion al�ve is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to st�rt without a permit on site; that ttie work will be in accordaace with the
approved plan in the case of all work w'c requires review and approval of plans.
SIGNATURE OF APPLICANT� ��f PRIlVT NAME� �•lG�tbGlC. DATE �/2 %/O I
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHArTICAL WORK