AF - 45922City of Fridley, Minn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
BLTILDING PE�.MIT
•_:_ _ � _ j��
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pwner; �Wi.11ia�_Buelow g�� Derksen RLilder �_ T_n�
Addx�ess _..._.._..__._...._.__..�.__.._._._. . .
.___� Address �.�._�v�,]•and S treet N_ E_
788-1139
LOCATION OF BUlLDING
No. ....._7092---...._._ S�t _.----Hickor.y_Drive N.E. Part of Lot
Lot .—.....L._.._�__ Block ------_.2.._.---•---------...--- Addition ar Sub-Division Llstma.n � G �rd AdditiRn
Corner Lot .....--•---.__..------ Inside Lot ___._._.X._... _ 5e�back 35 �—. Sideyard S'
Sewer Elevation ..__.._:....�_---._.___._.._._..._.._._�_.__.._.___.__...� Foundation IIevation _.-.--.----•
DESCRIPTION OF BUILDING
To be Used as:
_.$et.e.l,l..in$..-----------..__ Front .�42 � _ Depth �4 � ._.. Height ___2II �_ Sq. Fk .-12ZD � Cu...Ft ._2�yL,L10 �
.ara��.__.._.._..._....._....._ Front __�_ Depth ....2.�k � �. Height .�..�.Q.� .. Sq. F't. __.__528 � Cu. F't ,_.Sy1.(JO �
Type of Construction �.�ame ��, �t � 26�80D To be Completed �Ge.gt..?� �97�
SEWER LOCATION: 37' N.W. of Manhole Wye Elev.: 852.69 Top of Hi Footing: 855.69(Approx.
WATER LOCATION: Approx. Ties 56.7' S.W. of Manhole 10' N.W. of Sewer Service
Provide verification survey before framing. Provide a hard surface drive.
In conaideration of the issuance to me of a permit �o construct the building described abave, I agree
the proposed work in accordance with the description above set rth and in with all pravisi ot
Ordinanc�es of the city of Fridley. '
In conssideration of the payment of a fee of $_. 57 .00 �_� �,�� � hereby granted to �rksen Builders, Inc.
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worinnen, in atl work
done in, around and upon said building, or any part thereof, shall conform in all respects •to the ordin�tnces Of
Fridley, Minnesota regarding lceation, construction, alteration, maintenance, repair and moving of
Within the city limits and this permit may be revoked a t any time upon violation of any of the provSsions o� f� S�d
o�cdinances.
� . BinS Inspecto�
CLARENCE BELISLE
NOTICE:
This p�rmit do�s not eove� fl�� eonsfruefion, installafion fo� wiriny, plumbing, yas heafing, s�w�� or wN�r. D� sur� to aN
f6� Building Inspeefar for s�panf� p�rmib for fh�» itsms.
r
.+�
,
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAML : CU/� �.lA-r11 �l,�E.(�c-i BUILDEIt �`���-�CS'E71/ �GL�,�,Q 5�5�-�/c .
ADDRESS : !dE ADDRESS :�T��%�.,�Fr�.�� / JT, �(/�.
7�l� /i3�
xo : . a sTREET • ��� �o.�� /.e<vE /v, � .
i �
LOT : / BLOCK: oZ ADDITION :�s�'-'��,y' Q�,e,p JT�,p !T!D �
CORNER LOT: INSIDE LOT:� SETBACK: � J � SIDEYARD: .� �
Appli�ant attach to this form Ztao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
HESCRIPTION OF BUILDING
To Be Used As : �, — /7 � X � /
f 6
L �✓ Front • �, Depth ; � ' Height : �p �
� f r . ,. ,�
S�uare Feet: � Cubic P'eet. , t, �' ��
if'� � Front : �-� Depth : � � Height : /D
Square Feet; � �
�� �` Cubic Feet :_ �, � � Ej
Type of Construction: a j2,�-N) � Estimated Cost:_� o°rlo, �pp
7
To Be Completed: ��o T - �— ����_
The undersigaed hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordinances and ruliags of the Department of Buildings, and hereby
declares that all the facte at�d repreaentationa stated in this applicatioa
are true and correct.
DiATE : � /3 S IGNATURE :
(See Rev ree ide For Additional Infoa�nation.)
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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 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 prwided to-wit:
t1NIFORM BUILDING CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fxaction 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 average.�
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.0!0 per eacli five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $5.00. -
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimaum of 24 hours fram 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 nroceedinr� with the framing.
CERTIFICATE OF OCCUPANCY
Applicatioa for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy qf any structure for which a building pennit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued. •
` � - _ _
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300 BRUNSWIC�K AVE. S. ��� i��r � ����R� ;
"� � �
GOIDEN VALIEY, MINN. �.�� �Ry��r� . �"'`�
MiNN. REG. NO. 4741 �\ � :,
aaa� � �1� V il�M'� 0�' �M�R ;, . < � � . �
LIQ�11i� s! A�IX�W a! Ol�! Ot � `� .- �' '
�T�7 W. B�y � {�� � ,� �;:
INDUSTR1Al — JUDICIAL Minns�potis. MinnaatE 66+l�1B �.��; , �
f�AIIAEliC1AL — TOPOliRMFtlCAL .f � .f
GTY LOTS — PLA7TIMIti ��� � �
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w. n.r.bvi ce►cNy tM.c ehim a a�u..ea eornN �ia+ `
of � surwy of tM boundKhs of U�s alia� dNdribd tand and � `�
the location of �11 lwildit►p and wri�ibis l�e►tt. if aq�. • .
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from or on aid land. � �� � � � Y
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OERALD T.COYNE
300 BRUNSWICK AVE. S.
GOLDEN VALLEY, MINN.
MINN. REG. NO. 4741
INDUSTRIAL — JUDICIAL
COMMERCIAL — TOPOGRAPHICAL
CITY LOTS — PLATTING
, H
LOT SURVEYS COMPANY R 91MO�ND AO.�PRESNH
LAND SURVEYORS BROOKLYN PARK, MINN.
MINN. FiEG. NO. 6743
=aOI�TE�,SD V1�DBS LAi►S OF OSA?S OP YINNEROTA
I.ICEI/8ED DY OtDIXA1fCS OF CITY OF l[INNBAlOLIS
5747 W. Broadway 533-9922 INVOICE NO. 3�� �
Minneapolis, Minnesota 55428 F.B. NO. �?4 `�%
�iurbcpor� Q�ertii[cate SCALE 1" = 3`'
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Nt� Mnby aarti�r that thit it a true and cwrect repre�entation
of s survay of the boundsrfes of the above deacribed land and
the location of all buildinyc and v.islble �ncroechments, if any,
from or on aaid land.
'3urv�y�by us thb��i}i�y of Ma� 19�1.
o Denotes Iron
° Denotes wood
hub set for
A� L� r_ • _ S,- � BXCciVc3tl0
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Lot 1, Block 2,
OSTMAN'S THIRD �DDITION
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LOT SURVEYS COMPANY
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sue�ecT PERMIT NO.
City of Fridley 20257
AT THE TOP OF THE TWINS g U i L D I N G P E R M I T
;,
,� .
� ; L _.���_ COMMUNITY DEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC. �
� ; , ?5 y3s
� � /'�'\ � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPHOVED BV
�'""� � ,�' 612-571-3450 9�0-F15 3/20/90
� �
JOB ADDRESS �p92 Hi.ckory Drive N. E.
1 LEGAL �OT N0. BLOCK TRACT OR ADDITION
SEE ATTACHED
DESCR. 1 2 C?stman's 3rd Addition SHEfT
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Don k'oreman 7032 HickQry Dri�e N.E.
3 CONTRACTOR MAIL AODRESS ZIP PHONE LICENSE NO.
i�Tes:tern Remadelers 2520 West Larpenteur, St. Paul 645--1411
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION �1 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOFK
Resi:de Dwelling
9 CHANGE QF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAD
VENTI�ATING OR AIF CONDITIONING. Stee]_
THIS PERMIT BECOMES NULL AND VO�D IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED 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 CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION �' STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS yALUATION SURTAX
AND OROINANCES (30VERNING THIS TYPE OF WORK WIIL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S7 �QOO yS3 . SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEFiMfT FEE SAC CHARGE
PROVISIONS OF ANY OTHER TE OR LOCAL LAW REGULATING CON-
TRUCTION OR THE PEFFO A CE OF CONSTRUCTION. $90.00
PLAN CHECK fEE TOTAL FEE
$93.50
S�GNATUREOFC N?RAC OAAUT�� RqEDA ENT IDATE �.�y�H PR PE AL A D THIS IS YOUR PERMIT
SiGNATUREOFOWNERUfOWNERBUILDERi IOATE� � �NSp � � nFTE/��
� []
Iw�t1 ( �
AI��R � �
o�c�Q, �: `7 �J
CITY OF FRIDLEY
i�l AND R-2
Building Pesmit Applicatian
�_ 1��G/�oi�% TJ
EffeCtive 1/1/90
,
�� �riptia►: L-. 07' �� Q� z/� � O S�n'I�� l� �' 3�i� ��� _
owner xamne & Adaress: �rJ ,�o.� C-r►� �/v �, �
cb�tza�to�: _ �ll� � S� ��1 h� %� � I�'J �J�`�� �,�J �e].. # 6 � S—/ � /�
N �
s�Y�L�Ti• � _/ � � �
�U � .S �
Attach to this application, a Oertificate of Slirvey of the
lvt, with t.t� proposed oor�stnic,-tiaci drawn an it to scale.
E� � _�+. ��M • . •i- ���:: ��'i:..,i�,�4
LIVII�s �it'E�1: IEl'gth Wldttl H21c�lt SQ. F't.
C�ii�GEE 11RE�l: Iength Width Height Sq. Ft.
D�QC ]�tEA: Lenc�th Width Iigt/Grau�d Sq. Ft.
o►�: - .s� /�i �
Corner Lot [) Inside Iat [] Ft. Yd Setback Side Yard Setbacks
Zype of Constniction: 5���6� S/,�j/�//� Estimated C�ost: $ 7c% c> �
Appr�x. oc�letio� Date: _`f - j o- 9 �
�.�_
Prapo�ed Driveway Width If New Openir�g Is Desired: Ft. $ S
Width + 6' See gack paqe
LIATE: 3 � � AP�'LICANI': Z�e1. #1��5���/
�'PY USE �II,Y
P�ermit Fee $ , �, � 0
State Slurharge S 3. �U
SAC Q�arge $
Driveway E,scr,ow $
Park Fee $
Sewer Main QLarge S
To►r�, $ ��_ S�
s�R.rr.AZZa1s:
Fee Sci�edule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Above
Fee DeteYmined by f�ginee.rin9
Aqree�ne.nt N�essa�Y [] Not rteoessaiY I]
:�1 � � � f ' i�'� � " :,� _ •:I:r� 1 '
�he �ief Buildi:x� Offici.al shall, before issuing permits for the erecticn of ar�y
building or stnictur+e, or for ar�y additicn to ar�y eacisting buildirx,� or stxvcture, or
for any alteratio� or zEpair to any existinq building or stnx:ture� upaz aPPlication
therefore, require the payment by the applicant for ax3� �+�+; t of fees to the amount
herein belvw set foYth and in the maru�er i�er�ein prwided t�wit:
'I�I'AL VAI�JE
$1 to $500
$501 tfl $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
�ia.�
$15 (MininRm� Fee is $15 plus stlrc�3tge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000
$45 for first $2,000 plus $9 for each additioa�al $1,000
or fraction thex�eof, to arid iricludirg S25, 000
$252 for fizst $25,000 plus $6.50 for each additior�al $1,000
or fractioa� thereof, to and includiryg $50, 000
$414.50 for first $50,000 plus $4.50 for each additioTal
$1,000 or fraction thereof, to and including $100,000
$639.50 for fiYSt $100,000 plus $3.50 for each additicnal
$1,000 or fraction thexeof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additio�al
$1,000 or fraction ther+eof, to and including $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction ther+eo�
D[tIVEi�PiY �PRE8SI�1 SSC�W
(Concrete c� Streets Only)
Alt.eirate "A" : Removal ar�d replaoe�nent of curb arid gutter o�nly - Driveway width plus
6 feet times $13.50.
Alternate "B" : Regnoval arid replao�merit of c�irb and gutter ar�d install a 3 foat wide
approach with 6 iix� depth - Driveway width plus 6 feet times $15.75.
�rs �� v;-y� • ��- :���Ii;ii�.�+Y��]
P�ermitr for oonstniction will be issued a minim�m� of 24 hcurs fran the time of
application to allaa for proper review of the prq�ed stYVatur+e arid of the
vanstrvetioaz site.
A Oertificate of S�vey of the lot, showing the location of the faurlation anoe it has
it has been oonstzucted will be raquir+ed before prooeedirg with the fraati�.
1
, ��
sue.,ecr PER
City of Fridley 0 4 9
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
� � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
� �,; ------ d�/Q'
r � � PROTECTIVE INSPECTION SEC.
1 . �
� � �"'1 � CITV HALL FRIOLE� SS13Y NUMBER REV OATE PAGE Of APPROVED BY
1----�• •'' 612-571-3450 9t0-F15 5/13/98 / /
10B ADDRESS 7092 Hickory Drive NE
1 LEGAL �OT NO. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. 1 2 Ostman's 3rd Addition SNEET
2 PROPERTY OWNER MAII ADORES$ IIP PMONE
Don Foreman 7092 Hickory Drive NE 572-0259
3 CONTRACTOR MAII ADOFESS ZIP PMONE UCENSE NO.
Dan Netko Exteriors 7118 Riverdale Rd, M ls., MN 55430 566-3731 20060494
l ARCHITECT OR DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAiL AODFESS ZIP PMONE LICENSE NO.
6 USE OF BUILOING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION a REPAIR ❑ MOVE O REMOVE
%
8 DESCRIBE WORK
Reroof House & Gara e(25 S) Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV l.OAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, MEATING,
VENTIIATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUIL ANO VOID IF WORK Op CQNSTRUCTIQN ZONING Sa. FT. CU. fT.
AU7MORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR If CONSTRUCTION
OR WORK IS SUSPENDED OF ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARK�NG
I HEREBY CERTIFV THAT I HAVE REAO AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF �AWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIEO �2 OHS �L.O�F
WITH WHETHER SPECIf1ED FIEREIN OR NOT. THE GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL TNE pEFMIT fEE SAC CHARGE
PROVISIONS OF ANY OTNER STATE OR LOCAL LAW REGULATING CON- $74.75 Fire SC �Z.OS
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CMECK FEE TO FEE
Licens SC $5. 0 82.87
S�GNATUAE OF CON'AACTOA OFI MUTNOAIZED AGEN� IDATEI E Pq0 VALI T THIS IS `VOUR PER T
? ✓ '
SiGNATUqEOFpWNEA���OWNEABU40E1ii 1DATE1 p(� �pSD qiTE
NEW
ADDN
ALTER
[l
[l
[]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building ,Permit Application
ConstructionAddress: ���'2 /���,�d '�_%
Legal Description:
Owner Name & A
Contractor:
Address:
Effective 3/1/96
o�q���
�� �
ldr ,�d'/" �i,�� Tel. � ✓�7 a2 s,��
_ _ _. _.___ _ _ _ MN LICENSE �
� Attac�' �i�i �pplication, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Lengih
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Width Height
Length Width Height
Length Width Hgt/Ground
Corner Lot [ J Inside Lot [] Ft. Yd Setback
Type of Gonstruction: � D.���,�OO,�'
Approx. Completion Date: J� �� 9�
(Cost on
Tel. � ,����3 z,�l
Sq. Ft.
Sq. Ft.
Sq. Ft.
Side Yard Setbacks
Estimated Cost: $
���
Back)
Driveway Curb Cut Width Needed: Ft. + t= t x =$
DATE: � � APPLICANT: Tel. # _
CITY USE ONLY
Permit Fee �� /S $ , Fee Schedale an Reverse Side
Fire Surcharg� �$ .001 of Permit Valuation (1/lOth%)
State Surcharge�'� $ ,,.,� -' $.50/$1,000 Valuation
SAC Charge $ $900 per SAC Unit ,�
License Surcha g� $5.00 (State Licensed Residential Contractors)
Driveway Escro� w $ Alt. "A" or Alt. "B" Above
Erosion Control
Park Fee
Sewer Main Ct
��'
TOTAL
$
$
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary ( ]
STIPULATIONS:
BUILDING PERMIT FEE SCHEDULE
T'he Chief Building Official shall, before issuing permits for the erection of any building or stcucture, 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
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional �$I00 or
fraction thereof, to and including $2,000
��' �$62.25 for first $2,000 plus $12.50 for each additional $1,000
J'��� or fraction thereo�, tQ anci 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
$500,001 to $1,000,000
$1,000,001 and up
$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 Streefs Only)" "� �"�� '
Alternate "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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site:
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
- - �..,. ,,�-
sus�eci
c�ty of F��a�,�� 3 2 6
AT TME TOP OF TME TWINS g� � L D I N G P E R M I T
r
� � RECEIPT NO.
' ' COMMUMITY OE�EIOpMENT OIV.
i ; V •'��� , -� . � � '
f � � PROTEGTIVE INSPECTION SEC.
i . .
`_-_.�; �'�' �•� CITV FIALL FRIDLEV Sj1a2 NUMBEi1 NEV O�TE v�GE OF AvnqpvEO Sv
� 612-57�-3a50 9�aF�s 5/30/02 � �
J09 ADDRESS 7092 Hickory Dr�ive NE
1 LEGAL LOT NO. BLOCK TRACT Oii ADOITION SEE ATTACMED
oescR. 1 2 Ostman's 3rd Addition SMEET
2 PFOPEfiTY OWNEFi MAIL ADDRQS$ 21P PMONE
Don Foreman 7092 Hickory Drive NE 763-572-0259
3 CONTRACTOR MAIL ADORESS ZIP PMONE LICENSE NO
Same
1 ARCMITECT OR OESIGNER MAIL AODRESS YIP PNONE IICENSE NO.
5 ENGINEER MAIL ApORESS ZIP PHONE LICENSE NO
6 USE OF BUILGING
Residential
7 CLASS OF WORK
❑ NEW C� ADDITION O ALTERATION O REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 16' x 22' Dwelling Addition
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
WARNING
Before diggin9 calt for
SEPARATE PERMITS a�� ��nY �ocations
R�EQl1�IRED FOR: �000z
�tuMBt H��NS REQUIRED BY LAW
N� AND SI6�IIS
SEPARATE PERMITS ApE FiEOUIRED fOii EIECTRICAL. PIUMBING. HEAT�NG, tYP Of CO ST. OCCUPANCY GROUP OCCUPANCV LOAO
VENTI�ATING OR AIR CONDITIONING
TMtS PERMIT BECOMES NULI ANO VOID IF WQRK OR CONSTRUCTION ZONING SO. FT CU fT.
AUTHOAIZED IS NOT COMMENCED Vy1TMIN 80 OAYS. OR IF CONSTqUCT10N �
OR WOFK IS SUSPENOEO OR ABANQONEO FOR A PER100 Of 120 DAY$ A7
ANV TIME AFTER WORK IS COMMENCED. ` N0 DWLG. UNITS OfFSTREET PARKING
I MEREBY CERTIfV THAT 1 MA4E fiEAO AND ExAM�NEO THIS APP�ICAtIQN 1 r S7A��S GARAGES
ANO KNOW TME SAME TO BE TqUE AN0 CORRECT. ALL PROVISIONS Of LAW$ VAWATION SURTAX
AND ORDINANCES GOVERNING TNIS TYPE OF WQRK WIIL �E CAMF�IEO
WITM WHETMER SPECIFIE� MEREIN Ofi NOT. TME GRANTING OF A PERMIT �7 a�OO �3.60
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CAMCEI TME pEqMt7 FfE SAC CMAAGE
PROVISIONS OF ANY OTMER STATE OR LOCAI LAW REGUTATING coN• � 153 . 25 Fire SC �% .�O
STRUCTION OR TME PERFOFiMANCE Of CONSTRUCTION
PLAN CN�CK F TOiA� FEE
64.05
GN ruAEO� N AOpAUTMOA�ZEO�GENT i0�►E� E p Y VA TED THIS 15 YOUR PERMIT
_ �..,...� �DM��r vz �.� _.��'��
S�GN�TUAE O� OWNE ��� O�NNEp BU�IOEp� � A � e� �NSp ' - �1L1E
i
NEV1! [ ]
ADDN [ ]
ALTER [ ]
Construction Address:
,��
,� Y
CITY OF FRIDLEY � E 002
6431 Universiiy Ave NE, Fridley, MN 55432 (763) B g Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �
BUILDING PERMIT APPLICATION
'09� �1��,ko�y D� N �
Legal Description:
Owner Name & Address: �aN -�o ��l�N ��9 2 t�<�k�Y Tel. #�� 57� O2 S9
Contractor. %NNf�� y cTDl+,uSd � MN UCENSE #
Address: Tel. #
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot. with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT �
3 Z
Length '� �o Width z-2— Height �� Sq. Ft � S Z
length VYdth Height Sq. Ft
Length � VVdth HgUGround Sq. Ft
3.S"� X•%�• ¢7 �
Construction Type: �2f�M E Estimated Cost: $�, c� ���� •�
tidNF
Driveway Curb Cut Vlfidth Needed: Ft + 6 Ft = Ft x$ _$
DATE: Z� �A-y �� `L APPLICANT: �aN �2e�,�ir�ni Tel. # 763 J"72 02�$'g
Call (763) 572-3604 for PeRnit Fees if mailing in application or Fax to T63-571-1287 if using credit card and we will
call you for card number.
Pemnit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
$�.�..?.�
� 7. 1�
$ 3. G�
$
$ �-"
$
$
$.
$
CITY USE ONLY -
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 [ ]
TOTAL $ D� STIPULATIONS:
BUII.DING PERNIIT FEE SCHEDULE
The Chief Building� Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any �xisting buil�iing 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
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 additional $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;�700 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 $1,000,000
$1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRFSSION ESCROW .
(Concrete Curb Streets Only) , �
Removal and replacement of curb and gutter only - Driveway width plus 6 f�et-�imes $17.00.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be
required before proceeding with the framing. New Houses Onlv
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(iERALD T. COYNE
300 BRUNSWICK AVE. S.
GOLDEN VALLEY, MINN.
MINN. REG. NO. 4741
INOUSTRIAL — JUDICIAL
COMMERCIAL — TOPOGRAPHICAL
CITY LOTS — PLATTING
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LOT SURVEYS COMPANY R�;�'°�A a A�'�"
LAND SURVEYORS BROOKLYN pARK, MINN.
MINN. REG. NO. 8743 .
�EOIt17sBD vxnss znws O! flAts O! ][IItl1�/O'!w
�osxsaa sY osnix�xos or oirr or �uxxa�or�s
5747 W. Broadway b33-9822 INVOICE NO. 3257
Minne�polis, Minnaota 6b42$ F.B. NO. 134' -35 .
SCA�E 1 �
�iurbcporg� �Certiiicate o Denotes Iron
� Denotea wood
%��� hub set for:
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We heroby csrtity that thii it a tnN snd aornCt r�pr�wntation
qf s surwy ot th� boundpHa of tM abov� d�stxibsd la�d arxl
t�he loation of ali buildinp� and vid�N �npo�chrr»nts, if sny,
from or on aid taod. �
*Surwyed by w this..��y of Mg� 19�
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Lot 1� Block 2,
OSTMAN'S THIRD ADDITION
� amended to �how loca�iori of
� foundation May 2%th, 1971
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LOT SURVEYB COI�P�NY
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