AF - 45849�"�
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City of Fridley, Minn.
BIJILDING PERMIT N° 3� 5 7
��: ... �.�°:-./. �.:� �C� ............
o�� ....................................... s,�a� ............... .............. ...........
Addre�s ...................................... Address .............................. .. .. ......
LOCAT� OF BU[LDING
a
No. ..�D� � Street .. ... ........ ... y/� ... Part o Lo ............�..... ..
C./�.. ��� .
Lot . . . . .,� Btock . . . . �. . . . . . . . . Addition or Sub-Dfvision . . . �.
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c� �t .'(. . . . . . . . . 7nside Lot . . . . . . . ... .. . s�t� �,�.'". :�� . . s�a�a �� .-.�?. . .. .. .. . . . . . . . . . . .
DESCRFPTION O� BUILDING
To Used • ,
`� — Q'
Frozrt �?�`a� �,Dgppth °�:�: � ryHeight ./�;�Y5q. Ft.�.� ..�1 G�. Ft�O��
� . . . . �� � � t . . �. S . Ft. . J. . � ��`
. . . . . . . . . . . . I+'ront �. !. � �pth �� . �. Hei f � . q � . . (.ii. Fk 7. � . . .
. Cy��
Z`ype of Constru on . .... .. ...... ...... F�t� Cost. ..�� .� /. .:""To lte Completed ....... ..... .......
In consideration of 1�e issuance to me of a permit to con�truct the building desribed above, I agree to do
the proposed work in accordance with the deseriptton above set forth and in compliance with all provislons of
ordinances of the dty of Fridley. �/ _ �, ��
� � 'e.J
In consideration of the payment oE a fee of $.��....., permit is hereby granted to ...................
. . . . . . . . . . . . . . . . . . . . . . . . . to construct the bwilding or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and 3xis agents, employees and worl�en, fn all work
done in, around and upon said building, or auy► part thereof, shall conform in all respects to the ordinances oE
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
fn the city 13mits and this permit may be revoked at a�y time upon viola.tion of� e proviaions of said
ordinances.
•"`.'• •��. • `.'� f/���: .,;,: . . . . Buflcling 7nspector
NOTICE:
Thla permlt do� not covar the construa�tlon� Inatallation o� alteration for wlring, plumbing, gas heating�
sewer o� water. Be au�e to see 4he Bullding Inspaotor fo� separate permits fo� ihese Ibema
APPLI�,ATION FOR BIIILDING PERMIT ;, , - �
. . �CITY �OF, FRID�E�, MINNESOTA : � : , . �
� Qwners � Name �uilder . _ � _
. � 4
6 � � ��� �� �
Address� _; Addr-ess _ , - �
. LOCI�TION OF BUILDING . . � . .
� �- - � , �
No.��S.treet ; � ._. Part of Lat : � _
. :. /�
Lot ;��,�. ;BZock _..,_ � _ .__�iddit;ion or Sub� Div. � � `�
-`�;•Corner Lot_� aide.Lot � Set Ba.ek;:r���
:, � _ .
•�� Apg�ieant � atta-ch to this form Certificate of Survey of• L�t , a�d� Rroposad
bui�rl�:ng �locatiox�. � . - - • •
; - ::_ ,
DESCRIPTION OF BIIILDING ; . -
.����
' �- �To -�� uaed � as � � . . ;iq ii . 'r ' ; :
- , , ._ Fr�,n� . Depth � 1 ` ! Height _
/ - � . � ,. .. ,
_ �s-r% , _ . _.
Sq. Ft. �• .�� _ . _ _ �. ` .
- � F`ront _-. Depth ______�Height . , � . � , �
�Sq. Ft. Cu. ,Ft�. _.:�... � . : � =_,- a u
�, ��_� �
� e of Gonstructi .��;,,,r��.1 � Esti,m,ated .Cost� .�
TyA �.
S� ,
To be completed - _
The -uridersigned �hersby m�ake:s :application for a per.mit, for, . the .work
, � ,._. , _ , . , , .
..: ._ _ . _
herein sge,cified� agreeing to do a].l work i.n strict accordr�.nce with .the
City: ardi+nances and ruling of the I?epaxtment of Buildings, , and hereby .
�:
de�lares, that�all the facta.and repr.es�ntations stated in this application
are�true and correct.' •
c� . �
I�.te � � �� Signature
(1 Schedule of Fee Costs ca.n be found,on the,Reverse Side)�
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BUILDING PERMIT F�E SCHEDULE
��� � Section 2. The Inspector of Buildings shall, before issuing a.n� permit
for the erec�ion of any building or structure, or for a:ri�i�addition to
any existing building or structure, or for ax�y a�t�erations or.repairs to
any existing building or structure, upon.applicatio� th�refor, require
` the payment by the applicant for such permit of fees to the amount
�erein below set forth and in the m�,riner her�in provided to-wit:
2.1 For any such per�it for the erection of any fireproof building,
other-:than a garage, waxehouse, factory or grain elevator, or for the
• erection of any fireproof addition9 for similax occupancy, to any
existing building shall be at the rate of ����.0 for eACh.orte thousand
cubic feet, or fra etion thereof, in such cubical cbntents. ,
2.2 For any such permit for the erection of any fireproof gaxage,. ware-
� house� factory or grain elevator; or for the erection of any fireproof .
addition, for similar occuga,nc�; to any exiating buili�ing shra:7.1 k�e at the
rate �tif �1.25 for each one thousand cubic feet, classified a5 "fireproof"
by Section 502 of the Minneagolis Building Codee -'� .
HOIISES � �
2..�-�F"or any such permit for the erection�of any non-fireproof building
other tlzan a garage, waxehouse,�factory or grain. elevator, or any
non-fireproof addition, for similar occupa.ncy, to any exi�s�ing building.
Permit $1.00 for each one thousand`cubic feet.
GARAGES � �
2.�. For any such permit for the erection of any non-fireproof garage,
warehouse, factory or grain elevator, or for the.erection of any nan-
fireproof addition, far similar occupa.ncy,, to any existing building or
for eac}a such� building or addition. Ninety Cents for each one �
tho�usand cubic feet or fraction thereof, in�the cubica.l contents thereof
with a minimtam of �I��00, , -
For the purpose of computing fees for building per�i.ts the cubical•.
contents of any building or addition_to a uniform hei ht throughout by
muTtiplying the ground area cover�d�iro� a point.eix �6) inEh.es below
the flc*or line of the basenent or cellar to the average height of the
upper surface,or �Go the average height of the roof surface of the �a.in
gable.of a pitched roof..
2.5 For re�airs or alterations to Ftn existing structure, the fee shall
be at the r�:te of �3°00 for each Five Hundred Dollars (�500.00), or
fraction thereof in the cost of t�.7.1 proposed workQ �
2.6 In no case shall the fee chrjsged for any permit as set forth in
Section 2 be lesa than $4�00�
I�
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INOYBTRIAi. C. E. C O U L T E R
EUB�NE68
LAIVD SURVEYOR
CITY LOTB
ToPaot�►rHte pIwPPINO REGI6TERBD UNDER LAWS OF STATE OF MiNNESOTA
LICiN3ED BY ORDINAN� OF CITY OP MINNEAPOLIB
3300 LYNDALE AVE. 50. MINNEAPOLIS 6, bfINN
TAYLOR 4-0370
SURVEY F OR NiR . OSTMA�I
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I hereby certify that the abovc is a true and correct plat of a survey of:
Lot Five (5), Block Two (2), OST(�AN'S THIRD ADDITION, Anoka County� Minnesota
As surveyed by me this 15th day of October 1958 A. D.
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sue���r P NO.
City of Fridley 2 9210 �
, ` AT THE TOP OF THE TWINS g � � L D I N� P E R M I T qE IPT NO.
r
� ; v �_���_ COMMUNITY DEVEIOPMENT OIV. ��'j��/
r � � PROTEC7IVE INSPECTION SEC. 7
' i '
l_---� ��'��,'; CITY MALL FiiIOLE� SS�JP NUMBER pEV DATE PAGE O` APVROVED BY
i 612-571-3450 9to-Ft5 4/14/99 / /
J08 ADDRESS � 7030 Hickory Drive NE
t LEGAL L07 NO. BLOCK TFiACT OR AODITION SEE ATTACHED
oesca. 5 2 Ostman's Third Addition SHEET
2 PROPERTY OWNER MAIL ADOR�S$ 21P PMONE
Alma Olson 7030 Hickory Drive NE
3 CONTRACTOR MAIL ADORESS 21P PHONE LICENSE NO
Richard Hastings Contr. 6331 Riverview Ter NE, Fridle , MN 55432 574-9966
4 ARCMITECT OR DESIGNEF MAIL AODRESS ZIP PHONE LICENSE NO.
4051
5 ENGINEER MAIL ADORESS 21P PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK �
� NEW O ADDITION O ALTERATtON � REPAIR ❑ 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.
CONSTRUCTION WORK HOURS: 7:00 am to 9:OQ pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TYP� OF CONST OCCUPANCY GROUP OCCUPANCY LOAD
SEPARA7E PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING. MEATIN(i,
VENTILATING Oii AIR CONDITIONiNG
THIS PERMIT BECOMES NUII AND VOID IF WORK OR CONSTRUCTION 20NING SQ. FT CU FT,
AUTHORIZEO IS NOT COMMENCED V�11THIN 80 DAYS, OR IF CONSTRUCTION
OF WORK IS SUSPENDED Oq ABANDONED fOR A PERIOD OF 120 OAYS AT
ANY TIME AfTER WORK IS COMMENCED NO OWLG. UNITS OffSTREET PARKING
I MEREBY CERTIFV THAT I HAVE READ AND �XAM�N�D TMIS APPLICA710N ], STA�LS GAHAGES
AND KNOW THE SAME TO BBTRUE AND CORRECT. ALL PROVISIONS OF LAW$ VAIUATION SURTAX
AND ORDINANCES GOVERNING TMIS TVPE OF WpRK WILL �E COMPI,IED
WITH WME7HER SPECIfIEO HEREIN 01i NOT. TME GRANTING OF A PERMIT $2,056 $1.03
OOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OFi CANCEL TME pEqMIT FEE SAC CMARGE
PROVISIONS Of ANY OTMER STATE OR LOCAI LAW REGULATING CON• $7(F.75 Fire S �L.OG
STRUCTION OR TME PERFOfiMANCE OF CONSTRUCTION
� PLAN CMECK FEE TOTA� F
_ %.�s�� � / �' Lice C $5 0 $8 . 4
S�GNATUpE OF CON'FACtOA O uTNOp�2E0 eGENi iDATE� EN OP ALIDATE IS V PE�
/ `
S�GN4TUAEO�OWNEA���OWNEABU�LDEAi �D�TEi ' Bl0 �NSo � pctE
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ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
lG�O l��/ ��,
Effective 1/1/98
����c�
i�
Owner Name & Address: �L �i � � L sQ � Tel. #
Contractor: �� � c 1� ��l`� ,,� g�-� �i u� 6 5 MN LICENSE #�� S �
Address: � .� 3 / c2 b v � 2 � � � � (' t= � ; Tel. # S``f �� - � �'�G
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width HgdGround Sq. Ft.
OTHER:
Z � S�e -
Construction Type: C �� �2 � � � � � � � o � c`� Estimated Cost: $ � D �!(o
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �� APPLICANT: ��� � ��<.�-�- �� Tel. # � 7�' - ��'�,�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� �{ 7S
$ �?_C7�o
$ 1, 03
$
$ �-�o
$
$
$
$
$ oa• ��
,r,.
CITY USE ONLY
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 [ ]
�
�a �
BUII..DING PERMIT FEE 5CHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$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 ea�h additional $1,000
or fraction thereof, to and including $25,0'00
$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 includin,� $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1, 000 or fraction thereof, to and includin,� $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,Q00,000 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 �vidth 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 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.
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� CHIlVINEY 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
3.
4.
5.
b
Has no foreign objects lodged within
Is securely supported
Meets all current Code requirements for_ size
and total BTU's connected
Has total heating BTU's of �
All other BTU's V �
a �
TOTAL BTU's �
7. Has a liner been provided for water heater
8. Has combustion air been provided for water h�ater
Remarks:
�
Yes � No ( )
Yes�No ( )
Yes �No ( )
�`
Yes � No ( )
rf
Yes�No ( )
Xes �No ( )
List ALTERATIONS Bein�Done:
HEATING CO:
Signed By:
Date:
� � l��
SEP-2?-.999 16�39 MI�IEGaSCU SRLES� r�/q�y 6123ci5595 P.04i0�
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TOTAL P.04