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AF - 45831� � r, City of Fridley, 1VI�.n.. BLTILDING PE� �°• 3 0 7 3 Date: . . �.. . � � �. /�'. .. .. .... Owner �. .�. . . . Builder ,�� . !.. .. .. . �. . . p � Address .,�5� �.� . . . . .. . ... .. .. . ..... Address . .. ..�. R. ��. . .. .. . . .. . LO�CATIQN OF �UIL.DI�9G No. 7� �r.... Street . ...... Part of Lot . ...... . . .. .. . �............ �'::�� Lot . . .� � . B�ock . . . �.-r. . . . . . �ddition or Sub-DivisiQn . . . . Corner Lot . . . . . . . . . . . Inside Lot . . � !�. . . . Setback . � �./. . . . .Sideyard � �� . . . � � (•�� DE��tIPTI01l1 OF' �LJI�.DIY�I� To be Use as: � � ' . . . . . . . . . Front Depth .R-. f . . . Height . . . . . . . . Sq. Fi. �.�� Cu. F`t. . . . . . . . . . . . . . . . . . . . F nt . . . � . Depth �.°. �� Height . .��, Sq. Fi. T. . �� C�a. Ft. . . . . . e of onstruction . . . . . . :r°�� . . . . Est. Cost. �� `/ To be Completed . �. . . . . . . . . . . . / � �� In consideration oi tlie issuance to me of a permit to construct the building desribed above, I agree to do tlae proposed work in accordance with the descripl3on above se forth a.nd in coimp]iance with all provisions of ordinances of the city ot Fridley. .�.�... . . . .. ... O� In consideration of the payment of a fee of $. .� . . . . . . .� 't is hereby granted to . .. . . . . . . . . . . ... .. .. .. .. .. .. .. ..... ... to construct the building or addition as described above. This permit is grante�upon the express condition that the persoa to whom it is granted and his agents, employees and worl�nea, in all work done in, around and upon said buildiag, or aay part thereof, shall conform in all respects to the ordinances of Fridley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildings with- in the city limits and this permit may be revoked at any time upon viola.tion of any of the provisions of said orclinances. A „ '° ni ding Inspector �� NOYICE: Thts permlt does not cover the construc:tion, installation or alta�atPon for wl�ing, plumbing,-� � sewer or water. Be sure to see the Bullding Inspecto� fo� se�arate permlts for these Itema � �r� �. " � INDUBTRIAL BUBINE69 CITY L0T8 TOPp6RAPHIC MAPPINO s� � � � � � � \ � ( � � __ n � �, -�--. UL UC,`( /, C/.5 �.^riN/i� ��,y✓!c �� ,�1�,�F; : f.`ir C. E. C O U L T E R N P�TT�NO FARM BURVEY6 LAND SURVEYOR LAKEBHORB REGISTERED UNDER LAWS OF STATE OF MINNESOTA JUDICIAL LICENBED BY ORDINANCE OF GITY OF MINNFAPOLIB 3300 LYNDALE AVE. SO. MINNEAPOLIS 8, MINN. TAYLOR 4-0370 5�,� .�'�� r' , � r�� ,. ��i�.;�� '_ � �urar�ur'� fQrrtiftc�e SC�1 L E •' � - .�D I ,� ,_ _ � i ;� -.., i.. �, , i I � o e/ 7�� -� � `r,�. � �;. � � �a �,� �_;� ,,,� I hereby certify tllat the abov� is a tr�ie �n� �orr��;t rlat e�f �;�urvPy of: I.cit Tr��lve (1?), °'•loc�c 0ne (y)• �}'�=��' � '��1�D �DDITIOTv, hnoke C��nty, E•:i11n�WotB. . .4;� .�urveyea by me tl�i s 2nd c� ay of dur.e 19K�, A. L. i�1 f .�Ot�t� w�` .�5�� f ;� .�""' ci��aed /(n ��[�,,�,,�.��.�� Tadinne.�d°atb R��istratic�n l�o. 2��:1� �`, , N (��1 �r � _�� L � . � . � � � v �.y, o �� : o . � : �° : O . � � , � : � � � ' : � � � � � � �A � � `�' � � � � '� � Z �' w 7E 8� 7, 8 � n � �n ~ � ��°�� s � ° a a ° � � � � � , � �p � �d b ' � o y � G . � d � . ;p �. . 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Z � � Z � � 0 � � � c � ..L � � W CHIMNEY AND BTACR �iSRIFICATION 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 (�f No () 5. Meets all current Code requirements for size and total BTU's connected � Yes (� No () 6. Has total heating BTU's of °�j� �O All other BTi7 � s TOTAL BTIT' 5 Remarks 0 List Alterations BeinQ Done: -�5�� 2�� s, �a � �.1 ��,,.�,� �� y �� ,��5� � �,� r C'��►6��►e� 1.�,�. HEATING COMPANY 'eCena- NPG�-1 .� �o I l - Signed By Date _ �,� � %�� SuB�ECi City of Fridley 3 0930 , ` AT THE TOP OF TME TWINS g U I L D I N G P E R M I T qECE1P .` � � `y �� COMMUNITY OEVELOPMENT DIV. �� r � � PFIOTECTIVE INSPECTION SEC. � � j � ' �� CITY FIALL FRIDLEv sj132 NUMBEN NEV DATE VAGE Oi APVROVED BY �'"""� � �'� 612-571-3450 s�aF�S 5/10/00 / / JOB AODRESS 7011 Hickory Drive NE 1 LEGAL ��T NO. BLOCK TRACT OR ADOITION SEE ATTACMED DESCR. 12 1 Ostman's Third Addition SHEET 2 PROPERTY OWNER MAIL AODRESS 21P PMONE Violet Larson 7011 Hickory Drive NE 571-5136 3 CONTRACTOR MAIL ADDRESS 21P PMONE LICENSE NO Midwest Cedar Timberoof 216 N River Ridge Circle, Burnsville, MN 55337 4 ARCHITECT OFl OESIGNEfi MAIL AODRESS ZIP PHONE LICENSE NO. 808-1149 20147336 5 ENGINEER MAIL ADORESS 21P PMONE LICENSE NO 8 USE OF BUILDING Residential 7 CIASS OF WORK O NEW O ADDITION O ALTERATION � REPAIR O MOVE O REMOVE 8 DESCRIBE WORK Reroof House & Garage (24 Sq) Tear-off 9 CHANOE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMI7S ARE REOUIqEO FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCr LOAD VENTILATING OR AIR CONDITIONING TMIS PERMIT BECOMES NUIL AND VOID If WORK OF CONSTRUCTION ZONING SQ. FT CU fT. AUTMORIZED IS N07 COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONEO FOFi A PER100 OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OfFSTREET PARKING I HEREBY CERTIFV 7HAT I HAVE READ AND EXAMINEO TMIS APPLICATION 1 STA�LS GARAGES ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yp�UATION SUR7AX AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMPLIEO @ WITM WMETNER SPECIFIED MEREIN Oii NOT. TME GRANTING OF A PERMIT W2aO9H �1.OS OOES N07 PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL TME pEFMl7 FEE SAC CMARGE ROVISIONS OF ANY OTMEFi STATE OR �OCAL lAW REGULATING CON- S R OR TME PERFORMANCE OF CONSTRUCTION �83.ZS Fire SC �Z.IO PLAN CMECK FEE TO AL FEE °� �'� � Licen SC $5. $91.40 S�GN4TUAE O� CO 'AACTOA AUTNOAl2E04GENT iD� E� M PRO VALIO ED TMIS IS V Up PERMIT .— �=/a -��j S�GN4fUqEO�OWNEAi�FOWNEpBUILDEpi �DATE� ��" DG �NSP pqTE M C�1�3 ' �w � � Effective 5/10/99 ADDN I l CITY OF FRIDLEY AI-TER l� SINGLE FAMII,Y Ai�1D DUPLEXES R-1 AND R-2 �b BUII,DING PERMIT APPLICATION �q� P�� D Construction Address: '� (� I � � j (,kp�u ��Y ,' ��P� � Legal Descripdon: Owner Name & Address: �I[�j�� ,�1 �(�0 I �jC �(`� y �i U� Tel. #_�0�2- �� - � 131� Contractor: iv11'C�1�5� C�L'lV Tjm .rP� MN LICENSE �_2QOy`�j�� Address: _ o� ��p �. �iVe,�' 1�1` C.tP_ Cir 1..� Tel. �# �P 12-8��(-1 �'� Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. D�,S��ION OF' IlVIPROiTEMEN'Y' LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: Construcrion Type:� � p�d Y-r�i-�� Estimated Cost: $�� [� � 5`� (0 , j� Driveway C}urb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: J APPLICA��IT: _ V. .� Q ��.. �G1rW Tel. #_ �p IZ-8�� - ��! crrY � usE orrLY ay � Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ �3 a2� $ 2 . IC� $ IsUS $ $ ;J •� $ $ $ $ Fee Schedule on Reverse Side .f)Ol of Pennit Valuatinn (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 [ ] $ W Io�IO � �e 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 che payment by the applicant for such permit of fees to the amount herein below set forth and in the manner hereia provided tawit: 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 addiuonal $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 $1,000 or fraction thereof, to and including $500,000 $3,233.75 for the first $500,000 plus $4.75 for each additional $1,000 or fraction thereof, to and including $1,(?00,000 $5,608.75 for the first $1,000,000 plus $3.15 for each additional $1, 000 or fraction thereof DRIVEWAY DEPRESSION ESCROW (Concrete C�ub Streets Only) Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50. 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 $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. a t � � Building Inspections 763-572-3604 763-502-4977 FAX c SITE ADDRESS _1 THIS APPLICANT IS: PROPERTY OWNER/ TENANT CONTRACTOR SUBMTf A COPY OF YOUR STATE LICENSE AND CERTIFICATE OF INSURANCE PROPERTY TYPE PERMIT TYPE TYPE OF WORK: DESCRIBE WORK BEING OF OOFING NUMBER OF SQUARES _ GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING ❑ Vinyl ❑ Aluminum ❑ Other BUILDING RESIDENTIAL APPLICATION CITY OF FRIDLEY EFFECTIVE 7-1-2010 Permit No.: Received By: �.�=.,',: ,;i;; � " i �: . . � �, �.,. .N..;�;.•�w:.�� l� ] YOUR E-MAIL ADDRESS `� o S�� S�{ ��/'d7a' �7� C O�( ❑ OWNER � �ONTRACTOR .. � F'�.- s a �r crr�r PHONE: ` �S- � ✓'ce /� z en c� � S %4/'uc �� -� STATE LICENSE # 0 � /�/7.z� ��7_�u �o� EXPDA .�':�� I�� !� e c./U � CITY /� f� e STATE�iI�ZII' S'� I- �'99a- F,ax 76 3-7s'�—�999 �INGLE FAMII.Y/IVEW COI�ISTRUCTION SIZE / � s' �T ❑ TWO FANIILY/NEW CONSTRUCTION STO S ❑ ADDTfION ❑ GARAGE/SHED WINDOWS � BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE 0 DECK O SIDING ❑ OTEIER 0 SWINIMING POOL ❑ NEW HOME CONSTRUCTION ❑ ADDITION MAIIVTENf1NCE/REPAIIt O REMODELING �Q "c�.� e �' %cJ �ar �wy ja S �cz%/e�o il R'INDOWS IN EXISTING OPENINGS �es ONo OR FOR NEW OPENINGS-DESCRIBE SIZE OF OPENING CHANGES & ❑ HOUSE ONLY ❑ HOUSE & GARAGE ❑ ATTACHED GARAGE ❑ DETACHED GARAGE ❑Soffit ❑ Trim ❑ Fascia LOCATION OF WINDOWS TYPE OF WINDOW TO BE INSTALLED U h, I �ce•"�ER OF WINDOWS I v� I ALL FEES ARE BASED TOTAL JOB VALI Permit Fee Plan Review Fire Surcharge Surcharge License Surcharge SAC Charge G�rb Cut Escrow Erosion Control Park Fee Sewer Main Charge � Total Due BASEMENT REMODELING SUBNIIT• 1. Existing Floor Plan 2. Proposed floor plan 3. List of struct�ual memhers to be used FOR NEW CONSTRUCTION INCLUDING DECKS, ADDITIONS. & PORGHES SUBMIT• 1. Site Plan/Survey showing the existing struchues and proposed project 2. Two sets of construction plans 3. Energy Calculations FOR WINDOWS — PROVIDE U-VALUE AND MANUFACTURE STICKER ON WINDOW. l�N VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (USING�THE 1997 U.B.0 FEE SCHEDULE) � Oo OCCUPANCY TYPE $ $ $ $ $ $ $ $ $ . See Back Page for Fee Schedule 65% of Building Pernut Fee .001 times the total job valuarion .0005 x Permit Valua.tion Minnnum $5.00 $5.00 (State Licensed Residential Contractors) $2100 per SAC Unit (Plans to MWCC for determinarion) ft+6ft= ftx$24=$ $450 Conservation Plan Review Fee Determined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED I hereby apply for a building permit and I aclaiowledge that the information above is complete and accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a permit but only an application for a permit and work is not to start without a permit on site; that the work will be in accordance with the approved plan in the case of all w k w i h repuires review and approval of pl / SIGNATURE OF APPLICANT ��, �"✓'�'^ p�T NpME �o�@�/'l �j^p,? 2 C�� DATE �� l6 APPROVAL INSPECTOR SIGNA Page 2- Building Residential Application BUILDING PERNIIT FEE SCHEDULE The Chief Building Official sha11, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any a.iteration 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 FEES $1 to $500 $23.50 (Minimum Fee is $23.50 plus surchazge) $501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and includin $2,000 $2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and includin $$25,000 $25,001 to $50,000 $391.25 for 1� $25,000 plus $10.10 for each additional $1,000 or fraction, to and including $50,000 $50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and includin $100,000 $100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to and includin $500,000 $500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each addirional $1,000 or fraction to and includin $1,000,000 $1,000,001 and up $5,608.75 for the 1�` $1,000,000 plus $3.15 for each additional $1,000 or fraction 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 proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the existing founda.tion will be required before proceeding with the framing. New Houses Onlv City of Fridley Building Inspections Department 6431 University Avenue NE Fridley, MN 55432 763-572-3604 Fax: 763-502-4977