AF - 45863�
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Date:
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City of Fridley, Minn.
BUILDING PERMIT
N°
��..�-�.� _
[� ����� �-��-�.�ti Bu9lder
Adt]ress _____�._ Address
� ���
?0'74
� OCATIO OFl BUI D G
No. �e�1a° .�� Street art of t
Lot ._._� � .�— Addition or Sub-Divisi�n � � a �
Corner Lot � Ineide Lot ._._ S.etback _.s�...�..—_._._ Sideyard �— �Ce �
Sewer IIevatian ��.s� � F n IIevatfon 1LO��f i�._--
,��. oF �r�oT/l�C� �
DESCRIPTION OF BUILDING
T Used �
Front �.�.. Depth .s� Height .�%� Sc!• Ft ����-.c Cu. Ft �������
t Depth fTeight � Scl. F't. Cti. Ft
1j►pe of Conatruction � F�t.�C'osL� ��C __.. To be Completed
In considerat[on oE the issuance to me of a permit to construct the bwllding descril�d above I agree to do
th� proposed work in accc�rdance with the descripfion above set forth and in compliance with afl ons oP
ordinances of the dty oP Fridley. � � Q
� s
In conafderatiQn of the payment of a fee of $� , pera►it ia hereby graated to
to vonatruct the buflding or addition as descrYbed abave. Thiapermi t is gi�anted nPon
the exPress condition that the P�'sfln to whom it is granted aad his agent�, employees anc� worl�ien, ffi all work
done in, around and u�n said building, or anypart thereof, shall conform in all respects to the or8inance� of
FrirIIey, Minnesota regardiig locatton, conatruction, alteration, maintenaace, repair and moving of bufldiugs
within the dty ]imits and this perm�tt may be revaked at aqy time upon violation of any of the provi�lons oE said
ordiaaacea _ �
Bt�9ldinS Inapector
NOTICEa
Tbb psnetf dea as1 eersr f6s coestencHon, 6utallallee fo� rr63e& P�6+9. 6u 6saHe�, sew�� er wahr. 8� sun fe ss�
Hw BaiWiaB le�etor far aparab p�rmNi for fh�a huns.
3 ,�"
� • �•, a:
, ; , ,; �; � .. . , APP�ICATiQN FOR :BUILDING; .PERM�T �:.,`�' . : �w. R - ,;
. . . ' � . .... .� .. ., . . � ' ..._ .. . _ ��I .. el-_Y�?... ._ ^ .�e...
: _ . . , _. CI1`Y: OF FRIDLEii, MINNESOTA . �;�, ,� } ; : �:- �:
. ,. __ � °_.. . . . . , . ,� . . ; .,� ._.
.. . f. , .. . . . .. . �. ' . � ... � . . � . �. !'r.... .. . ..� . _
�W1�R� S NAM�' BUnD'�g ..: , ,����/�+.L.�m7 ..'.���.�
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ADD�ESS I � . ADDRESS C�� � � : � �
� , _ ;
. .. : . ;, .
. � -- LOCATIOPI OF BUILDING; `; � -: : , _ . _
. .. .
No: ,�,~'�G?. � � � � . , _• , Stree, `�� . , ..� .. $art.� of, :Lot
: Lot /� � Sloc�C. � �.., � Additioa, pr Subdivis.io,n ,�� ���-�����'
, . , �,.. • . �,. • . S. ., �� .� �-�,.�,. .. ....,. ..n.�^ �'.�.:.
Corner Lot � � .zeside� Lc ` etback �3+5.• , S�.de Yard���; � . � -4�
SEWER ELEVATION FOUNDATION ELEVATION �
Appli�ant attach, to �hi.�, form 1�►►o Cer�ificates of, Survey , of Lot. aad . proposed build-
ing locat�ion drawa on,•,�hese Ce�tific�tee.
� • � .. �. �..� , . � . _ - � _ .
. . . ". ( . s �..�� , f 1 .. . .
• . DESCRII�'i0A1 OF BUILDING
To be used as;
' ,,., � _ _._
�� . �_Froat ;, ,�Depth• 1.�°�,_�ieight -,:. .
_ • � . :. .
. �. ;., � . Sq. FC.� /.�3.�-- .Cu. FC'.; � 'f
� . . . . , .; 1: .: . _ .
.. � , . � . . . F�ront Depth Height
', s M1 , ` , . , . : -
. , ��q. F� . .. Cu . Ft . �� r
� _ . . , : . , ,, � ��
:T�pe��f:Eoastruction, � � � . Est�mated Cvst -
`� � - - .. ,
�To : b� � Ccmpie.�ed - -- - -
. • . � _ . � �_� .. ., . ; �.: � � . , . :
, :; . , . , , , . ,
Thea.umdersignec� hereby� makes application. for a pe,rmit far the work herein� specified,
ag�r�eing to do all�work ia �trict accordanca wit� the City of Fridley Ordinances and
rulings ,of the Departmeat.,�of, Buildiags,. anrl�: hereby dec]�ares that .aI1: t�e facta and
representations s�tated in this applicatioa are true and �orrect�. � •
b
DATE � S
�Schedule of Fee Costs can be found on the Reverse Side). ��
_ ...
7 - _ ,"� - � �1
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BUILDIIdG PERMIT FEE SCHEDULE
Section 2. The Inspector of Buildings shall, before issuing anq perr�it for
the erection of any building or atructure, or for any addition to aay exist-
ing building or etructure, or for any alter�tioas ar repaire Co auy existiag
building or seructure, upon application therefor, requira the paymeat by the
applicaat for such permit of fees to the amount hereia below aet forth and
3n the manner here3n provided to-wit:
2.1. For aaq such permit for the erecCion o.f any fire-proof building, other
than a garage� warehouse, fac�ory or graia elevator, or for the erection of
aay fire-proof addition, for s�imilar cccupaacy, to any �acistiag building
ahall be at the rate of $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2. For any such permit for ehe erectioa oi any fire-pr.00f garage, warehouse,_
factory or graia elevator, or for the erectioa of any fire-proat eddit3on,
for similar occupancy, Co aay existf�ag bu3ldiag shall be at the rate of $1.25
for each one thouaffi►d cubic feet, clmsaified as t1fireproof" by Section 502 of
�.the_Minneapolis Huilding Code. �
HOr... USES
2.3. For anq such permit fvr the erection of any nen-fireproof buildiag othex
than a garage, waxehouse, factory or graia elevator, or aay aon-fireproof
addition, for similar occupancy, to �ny existiag bu�i.].ding - permit $1.04 for
each one thousand cubic feet.
GARAGES
?.4_ For aay such perm�Lt for the erection of any aon-firepraof garage, .
warehause, factory or,graiu elevator, or for the erection of any non-fire�pro�a�f
additioa, €or--similar occupaucy, to anq exiating build3.ng or for each such
. building or addition - aiaety.cents ($0.90) for each oae thou�and cubic feet
or fra�t3an thereof, in the cubical contents thereof with a minimum of $4.00..-
Fer the purpose of computing fees for building permaLts, the c�abical contents
of any buildiag or additioa eo a uniform hei�he throughout bq mult3plying the
ground area covered from a point si� (6) inches below the floor line of the
baseanent or cellar to the average height of_the upper surface or to the �
average height of the r�of surface of the tnaim gable of a p3tched roof.
2.5. For repairs or alteratioas to an exiating structuace, the fee shall be
at the rate of $3.00 per each l�ive Hundred Dollars ($500.00), or fractioa
thereof ia the cost of all progased work. �
Z.b. In no case shall the fee�:cliarged_for..aay permit -a� set fortb in
8ection 2 be lesa.thaa $4.Dp� .
^ � � Y /�1 '� _
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r; E3�oc�c Z C� STMAN {S THtRD �t�UiTl4ir►
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'"°"'T"u` ` �. E. C O-U L T E R ''"'n'"°
eun�rs � ��r suavnrs
cmrtass � LAND SLJRVEYOR u►xseHORe
TO�OWIPNIC YA�INa REGISTERED UNDLR LAWB OF STAT6 OF MINNEBOTA �uDtCtAL
LIC6N8ED �Y ORDINANCB OP CITY OP 1tINN6APOLi6
• 3300 LYPiDAL� AVE. SO. MINNEAPOLIB 9, tNINN.
TAYLOR 4-09T0
�rurgpr'B (�Mtit�t�tp
! V NICKORY DRIVE
St4��E I" =40' _ IRoN^� ,�,
iRaN . 53 - �� Qq�4�'o
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I hereby cetfify that the above is a true and correct plat of a survey of:
Lot 4, Bloek 2, OSTMAN'S THIRD ADDITION, Anoka Cot�nty, Minnesota.
As surveyed by me this 19th day of January 1957 A.D.
S igned �
Minnesota.REgistration No. 258��
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City of Fridley, inn
BUILDING PERMIT
���j /�
N° '7235
� , .
•: _ % .,:.."y/ 3� ':
• �.� .:..�'..I(� � ! ,� �. � i , � � � .. . I�/'�
� /,/.� ; f , i'il.�.� � �� .x..i�./ ��i
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• � � -
` L CATIO F BUILDING
No. � 5tr+eet _.�. �— Part Lot
Lot ._._�_ Bl�k �� Addition or Sub- on � -..��
��
Coraer Lot ._ �� 7naide Lot � Setback Sideyard �
Sewer IIevati� — Fo dation IIevation
DESCRIPTION OP BUILDING
T as: s
F'ront � Depth -:�� Height ....� � 9c1• Ft°�.y� Cu. Ft ��
Front Depth I�eight .�.�— S9. Ft G�t. F't.
Type of Constructtoa __� Est C,ogE �./��= � To be Completed
Ea con�deratfon oE the issuaace to me of a perm4t to construct the buildfug des�tbed above I agree to do
th� proposed work in acc�rdance with the drescription above set forth and in c�mpliance wIth af1 ons of
ordinances of the dty oP Fridley.
- o
f?� /!'J
In con�deration of the payment of a fee oP $��� , P�rmit fs hereby granted to
to conatruct the building or addition as descrYbed above. Thfs �ermit is granted upon
the express c�ndition that the n to whom it is grented and hfe ager►ta, emPloyees and worl�en, fn all work
8one in, around end upon sai building, or anypart thereo$ shall conPorm in all respecta to the or8inaace� of
Fridley, Minnesota lacation, conatruction, alteration, maintenance, repair and mov7n� of buildinga
o�rdinano�es. dty ]imits� perinit may be revoked at time �� vi,�on of aay oE the Provisions of eaid
� /
��S �
NOTICEs
TW p�rmit doa eet �we tUs eenatrucHon, IushllaHoa Mr wirieg� pinmbteg, eu 6aNeg, aw�� er w�Mr. B� son ts as
Nn Buildlog leqaefoe for aparab p�rmiis hr t6�a ilwa.
� C �—w i�
1�PPLICATTON FOx .BUILDING. PERMIT ... , �,,
� � � ' CYTY OF FRIDLEY, MINNESOTA .
r.. . . _ �''.: .
• �� .
OWNER' 5 NAi�� � � � � .�_ �,�;>_ � _ � . :��, BUILDER 6 � �������.� �� , � , : �
f � .T � �r ' If "�r"�1 '�'T�� � ��� ru��
�,un�ss .� � � �����.� ,�����> � annx�ss � � : � �� �i�.,����`+.,��, —
� , . . LOCATIOAI OF BUILDING
. . �
No. ,�� � � � Street � " �� � � �Fart of Lot�_
Lot_ Pl� . - . Black • :, �Addition or l Sub$ivis�.on . �
--� .
Corne�' Zot `�.,�'_Inside Lot,Setback � g , :'_ � ; Side-Yard _.-- „�,�"`
� ��--
SEWER ELEVATION FOUNDATION ELE9ATION
Applieant.attach to this �orm Two Certfficates of Survey-o� i,ot.and p�roposed� build-
ing locati.Q�n drawa. on these Gertificatea. .
. -r � _ _ ,. .� .
. 1 ..i , . , .. . .. . ..
DESCRIPTION OF BUII.DIIQG
To be ueed as:
,
. . , �° r����.a�'� Front , �.� pth _ 'fleight . .
. . �
_ , Sq, Ft. Cu,. Ft:
' • � • '�
� Front' Depth�� Aeight
" . � Sq. Ft .�.. - Cu;, . Ft . ,
� . , . ,,
Type of Constructfon � .,��,,,,�►_�.._ Estimated Co�t • __
To be Completed . . _ _.
. . .- .
Th��uiiriersi�aed hereby makea spplication for a peimit Eor the work herein apecified,
a�i�e�ing to do all work ia atrict accordance with�the City of Fridleq Ordinances and
rulings of Che Department of Bu3ldiaa,zgs, and hereby declares that s],l the facte and
representations stated in ttiis applicatioa are true and correct.
DATE .�..���° � �
�Schedule of Fee Costs can be found on th� Reverae Side).
,� - t � - n
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BUILDING PEP.MIT FEE S(�IEDULE
4
Section 2. The Inspector of Buildings shall, before iasuiag any perid►i.t for
the ezection af any,building or strucCure, or for any addition to any exist-
ing building or structure, or for any alterations or repaiTa to any existiag
building or aeructure, upon application therefor, require the payment by the
applicant for such permit of fees tv the �mount hereia below set forth and
in the manner hereia prw�tded to-wit:
2.1. For any auch permit for �he erection o.f .any fire-proof build3ng, other
than a garage, warehouse, factory or grain elevator, or for the erectioa`of
any fire-proof addition, for similar occupaacy, to any existing build3ng
ehall be �t the rate of $1.40 for each one.thousand cubic feeC, or fraction
thereof, in such cubical contents.
2.2. For aay such_permit far the erection of any fire-proof garage, warehousa,_
factory or grain elevator, or for tbe erection of any fire-proaf addit34n,
for aim3lar occupancy, to any exieting building shall be at�the rate of $1.25
for each one thousand cubic feet, clae�ified as "fireproof" bq Sect4on 502 of
the Minneapolis 8uilding Code. ,
HOUSES
. 2.3. For �uy�such perm�it for the erection of eny non-Hreproof buildiag other
than a garage, warehouse, factorq or grain�elevator, or any aoti-firegroof
additimn, for aimilar occupancy, to aay existing buildiag - permit $1.00 for
each one thousand cubic feet.
GARAGES
?.4._ For any such permit for the erectioa of any non-fireproof garage,
warehouse, factory or grain elevator, or for the erection o� any naa-fireps�oo�f
gd���r-�-similar oc.cupancy, to aay existing buildin� or for each such
�,_--..-bvilding or addition - ninety cents (�0.90) for each one ehouaand cubic feet
or fraction thereof, in the cubical conteats thereof with a minimum of $4.0�.-
Far the purpose of camputiag fees for building permits, the cubical coatests
of anp buildiag or addition Co a uni�orm height throu�hout by multipZying the
grouad area covered fram a point ei� (6) iachea below the flaor line of the
basement or cellar to the average height of the upger surface or to the �
average height of the rQOf surface of the mais� gable of a pitched roaf.
2.5. For repairs or alterations to aa esistiag structuace, the fee aha11 be
at the rate of $3.00 per each �'ive Huadred pollars ($500.00) or fractioa
thereof fn the cost `of all progoaed work.
a.6 . In no case ahall the fee__c,harged, ,fo=..�,ny_p�;� ,� Bet forth in
Se tc oni 2 be leg a. thaa $4..D0. �
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City of Fridley 9102
AT TME TOP OF THE TWINS �
r
�U ILDING �ERMIT
� � COMMUNITY DEVEIOPM�NT OIV. RECEIPT NO.
; :� - - 1���
f � � PROTECTIVE INSPECTION SEC.
� _ �
� �"'1 � CITY NALL FRIDLE� SS1� NUMBER pEV OATfi PAGE OF APPROVED BY
�°���" �'' 612-571-3ab0 s�aF�s 3/29/99 / /
IOB ADDRESS
7068 Hickor Drive NE
1 IEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACMEO
DESCR. (�, 2 Ostman's Third Addition SMEET
2 PROPERTY OWNER MAIL AOOp�S$ ZIP PHONE
Jim McGuire 7068 Hickor Drive NE 5 1-5763
3 CONTRACTOR MAIL ADDRESS Z�P PNONE LICENSE NO
New Haven Constructi 8 -
4 AHCFIITECT OR DESIGNER MAIL ADDRESS ZIP PMONE IICENSE NO.
2 7 950
5 ENGINEER MAII ADDRESS ZIP PMONE IICENSE NO
8 USE OF BUILDING
Residential ,
7 CLASS OF WORK
❑ NEW O ADDITION O ALTERATION O� REPAIR p MOVE O REMOVE
8 OESCRIBE WORK
Reroof House & Gara e 24 S Tear-off
9 CHANQEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
TYP�OFCONST. OCCUPANCV GROUP OCCUPANCVLOAO
SEPARATE PERMITS ARE REOUIRED fOR ELECTFICAL. PLUMBING. FIEATING,
VENTILATING Op AIF CONDITIONING
THIS PEiiMIT BECOMES NULL ANO VOIO IF WORK OR CONSTRUCTION 20NING SO. FT CU fT
AUTHORIZED IS NOT COMMENCED Vj!ITHIN 80 DAYS, OR If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED fOR A PERIOD OF 120 DAYS A7 '
ANY TIME AFTER WORK IS COMMENCED. NO OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIfY TNAT I MAVE READ ANO EXAMINED THIS APP�ICA710N 1 STALLS GAAAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS yq�VATION SUR7AX
AN� ORDINANCES GOVEqNING THIS TVPE OF WQRK WILL QE COMPUED @ @
WITM WHETMER SPECIFIED MEREIN OR NOT. TNE GRANTING OF A PERMIT W2,056 y�1:O3
DOES NOT PHESUME TO GIVE AUTMORITY TO VIOLATE OR CAMCEL TNE pEqMIT FEE S�►C CMARG
PROV�SIONS OF ANV OTHER STATE OR CAL LAW REGUTATING CON- @74.75 Fire �L.O6
STRU O OR TME ERFOiiMAN OF C NSTRUCTION •P
�I PLAN CNECK FEE TOTAL f E
� �'�l z � L $ $ . 84
S�GNarupE CON'AACTOpOAAUTMOA�ZEDOGEN� �O�iE� EN O ALIDATED I YQUp PEiiMIT
� �
S�GN4iUAE O� OWNEQ��F OWNEA BU�LOEi1� ���TE� BL �NS� - f��
n�
.w a = �-
Mar 26 99 10:57a
:: �� � �
. ADDN [ l
�►I-TER t ]
Kerri
566-7183
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R 2
BUTLDING PERMTT APPLICATION
p.l
Effective 1/I/99
��
�1
� 1
constructionAddress: �%lo � Q�,"lj�,o'Z't-1 l�.r ��ic_.?�
Legal De�ription: �
Owner Name & Address: e � Tel. #�-�% j— S7(p �
��
Contractor: �� :�Y MN LICENSE #�7 79S C�
Address:_5'�c� ��� .��7�LP�JZ /l/C/�'�� � Tel. # �ZD� " ��d' _'�`
,
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: �
OTI�R
DESCRIPCION OF IlV�'ROVEMENT
Length Width Height Sq. Ft.
Length Width � Height Sq. Ft,
Length Width Hgt/Ground Sq. Ft.
� ��
Construction Type: G�-!� ��� ' DC"��T� � Estimated Cost: $ (���
(Fee Schedule on Baak)
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ =$
DATE:��%lP -- -�j `^�
Permit Pee
Fire Sur�harge.
State Stiucharge
SAC Charge
License Surcharge
Driv�way Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPUIfA1`IONS:
$ � ,�S_
$
$ 3
S
� �o�
$
$
$
$
•
i_ .
CITY USE ONLY
Tel. � �S�'� S��'.�
Fee Schedule on Reverse Side
.�1 of Permit Valuation (1/lOth°!o)
$.50!$1,000 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. ;"B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�
.�
` �.
�
� �
/��
�
sue�ecr ERMIT NO.
c�ty of Fridley 33300
AT THE TOP OF TNE TWINS g � I L D I N G P E R M I T
�
; � RECEIPT NO.
� ; y � COMMUNITY OEVELOPMENT DIV.
r � •� PqOTECTIVE INSPECTION SEC. ���
� _ �
( /'��1 � CITY NALL FRIDLE� SS132 NUMBER REV OATE PAGE OF AVPROVEO BY�
�'""'� � ��� 763-571-3450 910-F15 12/18/02 / /
JOB ADDRESS �068 Hickory Dr NE
t LEGAL ��T NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. (} 2 Ostman's Third Addition SNEET
2 PROPERTY OWNER MAIL ADDRES$ 21P PMONE
Jim McGuire, 7068 Hickory Dr NE, Fridley, MN 55432 763-571-5763
3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Minnesota Exteriors Inc, 8600 Jefferson H, Box 266, Osseo, MN 55369 763-391-5514
1 ARCFIITECT OR OESIGNER MAII ADDRESS ZIP PNONE LICENSE NO.
28��
S ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO
B USE OF BUILDING
Residential
7 CIASS OF WORK
❑ NEW O ADDITION O ALTERATION O REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WORK
New vinyl siding
9 CHANtiE OF USE FROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code requi�res that a weather-
resistive barrier be placed over exterior sheathing to protect the interior
wall covering. Exceptions to this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved wea�her
barrier. Vinyl siding is not a weatherproof cove�ing unless the
manufacturer states this an the appl.ication guidelines.
Call for inspection of wxap before covering.
��rm�� �n�p�ction Card�
ill � Mailed
�� Norneo�n�rT� Post
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REOUIRED FOR EIECTfi1CAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NIN(i SC. FT CU iT.
AUTHOR12ED IS NOT COMMENCEO WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT •
ANY TIME AfTER WORK IS COMMENCED. NO DWLG. UNI7S OFFSTREET PARKING
I MEREBY CERTIFY THAT I HAVE READ AND EXAMINEO TMIS APPLICATION STALLS GARAGES
ANO KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PFOVISIONS OF LAWS VA�UATION SURTAX
ANO ORDINANCES GOVERNING TNIS TVPE OF WORK WILL BE COMPLIE� $9,460.00 �4.73
WITM WMETMEii SPECIFIED HEREIN Oii NOT. TNE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TNE pEqMIT FEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON• @ 181 . 2S Fire SC �9 .�FC)
STRUCTION OA TME PERFOfiMANCE OF CONSTRUCTION ��
PLAN CMECK FEE TOTA� FEE
Licen $5.00 $ 0.44
S�GN4TUpE0FLON'AACTQAOAAU�MOAl2EOoGENT iO�iE� ME PRO Y VALIOAT THIS IS VOUR P MIT
!.` y/ ,d" �'
S�GNeTUQE O� OWNEA��i OWNEA BUi�DEAi IOA�E� INSD f1�
NEW
ADDN
ALTER
[] CiTY OF FRIDLEY Effective 1/1/2002
[] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
[ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address:
Legai Description:
Owner Name 8� Address:
Contracto� tia
Tel. # ���' S%%-57��
MN LICENSE # S�� `� 7 7
�'J'�� 9 ' Tet. # 7�3 39/�-S.l�/ �
Attach to this application, a Certficate of Survey of the
lot, vvith the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LMNG AREA: Length Width Height - Sq. Ft '
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length Width HgUGround Sq. Ft
OTHER:
�
. . ���� r �
Construction Type: l� �� �/��� Estimated Cost $
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: � i�' C� APPUCANT: �/Ly� i'� �� Tel. #/�� �i�°'�f/
Call (763) 572-3604 for Permft Fees if mailir�g in application or Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
/
$ . �
$ C�
$ � �
$
$ � t�
$
$
�
$
$ � - `f'
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ ]
STIPULATIONS:
�
�uzlaln��
lns�e�zions
l�:-.' i.�-.i`JC�L
� �� -� ��_-=� �� ;� r_a �i
SITLADDRE55 -'����t"
THIS ,�.PPI.TC.�.i�lT iS: � L� OWNEP.
PROP�.'� :T
a�mt�t/
T.�N��TT
CDN'i32EiCTOR
SUBMIT A COPY OF
YOUR. ST`ATE
LICF�(SE, BOND ATiD
CERTgTCATE OF
IATSZJR.P.�3�TC�
M:���►� i r�i�:i�+
TYPE OF �ORS:
�� ��i� � � �:
�-�:.' 'T"���.�r�-�a ? � '��� � � � �T
�. �....�u�iJ 1 � ��'_.�.� _`�.� .� 'r'...�.l1�..�� i ��� � �1
�'TT'T1 � � j ��,.j�',�.j'�, T3..�. "r �{ '�'
'�+ � 1 1 1�.'� _:i' �'Ta�� u ��
i i .. JIL:! �i
;-� ��
`lOiJP� �-��IAIL .aDDREyS
NAML•: J�/,'Y1fJj� ,}wx� ov�r c. ,�,t r�
ADDR.G�s: �'0 t� X�, .I�pr v ��v ►..I �� crrr
PHONE: �'1EJ'�—S�'I"�i�,�
perrn.iL �lo.:`s�
�.�C�l�/e� �
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STATE LICL-TfSE � `° � DATE
STATE BOND � ��
.�1DDRESS:�
PHONE �4
Q SINCLE FAMII.Y
iv
� NEW
DETAII+ID DESCRII'TION OF WORI�
0 TWO FAMILY
► • a• «�I� ia
�.
�
_crrY Vi �
_ FA:{ ! 3—
❑ TOWNHOUSE
SS
. � . .� . .
PER MS 168.665 the pemtit fea is a m�nm of �15.U0 or 5a/o of the total cost np to S5a0.00, whiche�rer is �eat�s, for t6.e
improvemeat„installation or replacemeat of a resideaiial fix�re, exclu�ag the �. �(This should reflect oniq the cost of labar )
Labar cost undar $300 =$15,00. Labor cost betweea � 00 to �500 = cast of Iabor x.OS = ' pins 50 surchar�e
� OR ��
Fa'RPR07ECT5 WF�RRE LABOREXCEEDS 5500, b�ES ARE BASID ON �10.00 PERFTXTUAE, F�CEPT W�RE NDTID. FIXTLTRES: (IIdDICATE TO�AL
NUMBIIt QF' EACH BEL�R�. MIIVIM[JM FEE �ISSO. .
_BATfi SII�TK/LAV ' FLOORDRAINS SHflWER WATERPIPING ;
_BATHTCTB GASPIPIIdG(1VBEDQTYLIG7 5'WID�iI1�TGPOOL WATERSOFTNER($3�
_ QAT�5 WA9HER _ K1TCi�iY SINK WATER CL09ET _SACIiFLOW PREY, ($1�
_ DI3SWASI�R _ LAUNDRY TRAY �r �VYATER �'ATER (535� FOI� IRRIGATION
' � ' _ WATER METER ,_ OTF�R
Permit Fee $ Number of fixtures ��10.00 x 510.00 =$
9urchar�a .50 Number of fixtures (c� � 15.00 x$15.00 =�
TOTAL DLTE S OR Number af fi.�stnre.s �a �35.00 �:c �35.00 =$ , i'''
' � ' . 9tate Surafiargs = $ 50
vlUM �15.�0) ' � • � (MINiNCUM �15.50) Total = S ` . 5�
THIS IS r�,N APPI.1CeiTION FOR A PERMITy�(OT VALID UNTII. PROCESSED
�[ liereby appiy for a p lumbin� permit and 1 acicnowledge that the information above is complete and acevrare; that the woric will be in ��
confomzance �vith the ordinances and codes ofthe Ciry ofFridle�� and �,vitl� the Nfinnesota Cunstruction Codes: ehat ! underssand chis is '; -_
not a permit but only an applicarion �or a permit and woric is not ta �tatt �Nithout a permit on siie: that the �vorlt �,vill l�e in accordance `'_
�,vith the anproved plan in the case of all �,varlc �:vhich requires revietiv and approval of plans.
i
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