AF - 46017City of Fridley, Minn..
BUILDING PERMIT
nat�: _�`...�..�-- .C__-�� -- =�'.....�� ___.
.� �-
Owner: -- ' -._- : .�-. , --: ��.. ... �C.'-:r'� s_: ;, � .. ..� . . Builder
.. -.��"'�' ,�_. � -° �'�:.�:_��
.
Address -_--••-_•--.�____—...---.�._.. . Address
,
N° :'� 963
,
.�`� �
s ,.3'�
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,�`�d�����`'-� , .�.�-:f� • , ���'�
---���~��.-. ' . ` , �
��� ��CATION 0,,� BUILDING •
No. ..l-..: _..-- - --... Street ....�,..`�` : �--.- .:�-r'�.�_... �� ��1.....��t�==�- P of Lot ._.----_.._...__..__ _......_. ... .. ��r
� � �, �'� ' .
Lot ....._......._...�....._.. Block ....._....� ................_......._...._.. Addition or Sub-Division .....�� �E„��?'��._,,,r.���aC�� ���G�
_ ,r, � ,.. i �/
Corner Lot ....._ ...................--....... Inside Lot .....�-�':'.............._. Setback .�:..�;�.----...._...._........ Sideyard ._��i.-__---.``�',����'�jC�►
Sewer IIevaiaon ----.---------•-•-•---•-_.----•---•--•--•------•_----•--------••-•---_..-----.....----_.. Foundation IIevalaon
DESCRIPTION OF BUILDING
To Used : � �
�9 ��,�� � '' r ,�s � / . '{' �✓�'� ���` � •i
_...,�..r..�.�....--.. x:y�.%!=� Front �.---�.- Depth �-�. Height ..._,��'.. Sq. F��-�!�---.- Cu. Ft .r..^���
...................._.._..---..._.........-�.-�-- Fro -- --........----.. Depth ....._...�_... eight ........�..,�_... Sq. F� ....._........_....... Cu. Ft ....._......._..----
° i'� � .�,r.� .....�,..
�'S . .� : , f
Type of Construction ...._ :.�.._:___�...�t..�......... Est. Cos ......,ka`"�.�_`��,r`�`_:�f:�!......._._..... To be Completed _......--.--•----------------•---.
In conaideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed wark in accordance with the description above set forth and in compliance with all provisions of
ordinances of the city of Fridley. �_
!�-► ,,�f �"�
In consideration of the Payment of a fee of $,� "-�-------_--.---.. Permit is herebY granted to...._...------:------------------....__......_..
_� _.__._._....—_..._.._._._ to construct the building or additlon as described above. This permit is granted upon
the express condition that the person to whom it ia granted and tus agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all r�spects to the ordinances oP
Fridley, Minnesota regarding location, construction, alteration, maintenance, repa3r and moving of buildings
within the city ]i�nits and this permit may be revoked at any time upon violation`� any of the provisions of said
ordinances. j � � /
r,
._ ....�=:!,�-�-:� ��'-�:..����ding Inspector
__. _- ,�
NOTICE:
This permif does no1 cove� the wnsteuction, instellallon for wiring, plumbing, gas heaHng, sewer or waier. Be sure to see
the Building InspeNor fo� separate permits for fhese ifema.
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-- ,�; ." - �t. � - � ,e" �... .�.�i �,�'
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o�9T$ � � ���o a � �� A .�a L �%`t'
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lddress ' `��� �=� " .._:___
APPLIGATIDN FOR BIIILDIldG P�RI�IIT
' CITY OF FRTDLEY, M�ESOTA
, �: ' (
;,:-� �'�y"�,.,
r�ocaTZON oF suu,n�xG
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e""i�T � '�'' `� o- �
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n - ._ . �
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No. �' `�� stree� `��� =�.%�''_ ��°�-`� Pert of Lot - _.
9 :� �
�,ot '�� Block . ,�.�' Addition or Sub.Div.����--� =�'- � �'���.- �`��� � � ' _
�_,Se� Back ='� � � S3de-Yard �1 % � . ,__.. �
ri01`ll@T �A't�„12]8j.f�8 I+Ot► / , -
SE`f�R ELEVATION r.__ FaUNDATION ELEYATION --
Applic�t attach to �his form Cer'tificate of Surwey of Lot and propos� building
location.
DESCRIPTION OF BUII�DING
To be used as:
�' � .���� ���r���� Froat � L' e D�
` b
/
. Ft.� �A-�� Cu. Ft.
— �--
r
Front Depth Hei.ght
Sq. Ft. Cu. Ft.
Type Q.f
To be
`�,�'� y d� �_ � i/ ° l'<-' � ..i � #� 4- .�'.'.
Cost,,,,,,,_,_
> `
�
. �
The uadersigned hereby makee application for a permit for th� work herein specified,
agreeing to do al],taork in �trie� accordance w3th the City Ordina,aces and ruling of
the Department of B�ildin8s, and hereby declares that a11 the facte and representa-
in thi p7:9.cation sre true and carrect. ,---
0
tions stated s e,p � _
,, � ��
a .-� � �� � �" � % SIGNATURE � � =-�.,'��'��� i� ����' � �s���� a �.�
DATE� �� � � � � �.� �a _ ,�—
•_ ; � � =�..s�-� � �-��.1
�'LC: ,r.;� e"=�z �_
(� Schedule of Fee costs c�n be found on the Reverse Side.) ;!�
��'�
.
'"1
���° � '�
�
BDILDTRIG PERMIT FEE SCF�DIILE
Seot3on 2,,, The Inspector of Buildin�s eha].}, before isauing any per�it
for the erect3on of any bu3lding or atructure, or Por any addition to
. any_existing building or structure, or for any alterations or repa3rs
to.any e�dating build3ng or structure, upon applicatiori therefor, requix°e
�he paymsat by the applicant for.such permit of feea to the amount herein
t�3ow set forth and in the manner herei.n proeided to-wit:
2.1. For any such permit for the_erec�ion oY any �ire-p�roof�buildi�g�.other
the.n a gar��e, warehouse, fac�tory or grain elevator, or for the erection oi
any fireproaf add3.tion, for simi�ar occiupanag, to s�r�q exist3ng bui.ldi.ng
sYraZ3. be at the re.'t.e of $1.,1,�,A for each one thousand cubic feet, or f`ractiab
tls�reof, in such cubical c�nteats. -
2.2. For any �ch pes�i.t for the erection of any f3reproof garage, ware-
housQ,.faetory or grain elevator; or for the erection of e.ny fireproof �
sddition for aimilar occup�ncy, t,o a� existing bui].d3n� ahall be at tbe �.
raf.e of �7..25 for each one thousa.nd cubic feet, cla.ssified as "fireproof" .
by Ssct�.on 502 of the I�ixineapolis Builcl�.n� Code.
0� IISFS
2.3. For ang such �ermit for the erection of an�r non-f3reproof building
other than a garage, warehouse, factorg or grain elevator, ar any aon-
f:lsseproof addition, for simi].ar occupanc:y, to any exist3.ng buiidin�.
Permit �.t.00 for each one thousa,nd cubic feet.
�
2.1�. For �ny su.ch pern�i.t for the erectaon of any nor��ireproof garage,
warehouae, fac'tory o� gra3n eleee,tor, or for the erection of an� noa�
fireproof addition, for s3milas occupan�►, to any e�d.st3n� building lir
�or each auch bu37.d3ng or add3t3on. Ninety Genta for each one thou�a.tid
cubic feet or frsction thereoE, in the cubical contenta thereof �aith a
min3.mum of �l;..00. � �
For the pnrpose of computing fees for building permi.ts the cu�ical contents
of a.ny building or a.d.dition to a uniform he3.ght throughcut by multiply3n�
the ground asea covered from a point six.(6) inches below the floor lin� af
the basement or cellar to the average height of the upper surface or ta the
average height of the roof surface af the main gable oP a pitched roof. �
�
2.5. For repairs or elterat3ons to an �xisting atructure, the fee shall`be
at the rate oFm�3.00 for each Five Hundred Do11� ($500.00)� or fr�ction
thereof in the eost of aZl proposed work.
2.b. In no-ca8e
Sect3��" bs l�ss
- ...fi.-r�.,.
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sha].1 the fee charged for ang pes�m3.t as set forth in
than �4.Q0.
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D�16 .._ .,az '
HEAT LOSS CALCULATIONS DEPARTMENT I
Weatherstrips A.S.H.V.E. Construction Nc
Guide
Windows Doors Reference Out. Wall Int. Wall C,eiling
No % —No 1 ° b -v —�
Fl.� Room � Length / Width c�!/ Heigh ��
Windows nd Doors—Crackage and Area
Wldth He1Bht No. ol Llneal Lt. Area
No. o[ pane o[ Dane IfBhta ot crack nq. ft.
� p
— s�
�i `�' zz< <
/�/ l ,� ,.O Coef. Btu
� In6ltration ' ,
Calass �,
Exp. wall
Net exp. wall p �� p
Int. wall
Ceiling p O �
Floor
'I'otal Btu. p ��
Required sq. ft. E.D.R. or aq. ins. W.A. L.eader area ,3 y
Fl. '„�.' oom ( Length �Z/ Width /Z� Height9/��
.
Windows and Doora—Crackage and Area
Wldth Helght No. ot Lfneal Lt. Area
No. ot pane ot pane llshts ot crack �q. tt.
<O ��
Z / �O ��
� / . .3.
Z/� °�� /� , e �J COtf. BtU
In6ltration Q, ' D �
Glaaa ,
Esp. wall $y� .
Net exp. wall ,
Int. wall
Ceiling o`�o �
Floor
Total Btu.
Required sq. ft. E.D.R. or aq. ins. W.A. Leader area
Fl. , Room � Length c,!/ Width,/Z/
Windows and Doors—Crac�age and Area
Wldth HelBht No. ot L(neal tt. Area
No. of Dgne ot pane Ilghts ot cnck ep. tt.
a v .� y / �� �
lnhltration � �2( ;
` Glaa� �
Exp. wall
' Net exp. wall
int. wall
Ceiling �
' Floor
I Tetal Btu.
Required sq. ft. 6.D.R. or aq. ins. RI.A. L.eader area
;i �
/ I
%�/o ��� �
�F BUILDINGS �loi�ff� FRIDLEY, MINN.
r. Insuladon
Roof Floor Kind How Applied
�
Fl.� Room Lengt6 / Width Zi Height /''
Windows and Doors—Crackage and Area '
Wldth Heisbt No. ot Llneal it Ares
No. of pane ot Dane Ifghte o! crack sQ. tt
Z v � �
Coef. Btu
Infiltratioa ,Z� � �
c�� � � i.
�
Esp. wall �o � I
Net eap. wall , (� �
Int. wap
Ceiling �' � 4S � � %
Floor
Total Btu.
Required aq. ft. E.D.R. or aq. ins. W.A. Leader area
F7.I Room I t�ength „� � wiarh y/ Heighc ��,
Windows and Doora—Crackage and Area �I
Width Aelght No. ot Lineal ft. Area
No. ot pane ot Dene Ilshts ot crack eQ. it
� Y .� � < � �
Infiltration
Glaas
Eap. wall
Net ezp. wall
iD�. Wau
Ceiling
Floor
'fotal Btu.
�r�
-��
Requued sq. f� E.D.R. or aq. ins. W.A. Leader area
�. t�m ��pS�h � � w�a� / Hei�hc
Windowa and Doora—Cracl�age aad Area
Wtdth He1g6t No. o! Lineal tt. Area
No. ot Oane ot pane tlBbte ot craok �p. tt
I ?� /.� �i ii % �/� .�'i O
Bc�
� In6ltration
;� � Glass
Eip. wall
� Nec eap. wall
Int. wall
�� Ceiling
Floor
I?otal Btu
��
�f.l Bc�
� �
��
�,s y
sq. k. E.D.R. or sq. ins. WA. L,eader area
SUBJECT � P N O.
c�ty of Fridley � 13481
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ECEI .
r
COMMUNITY DEVELOPMENT DIV. �� �
r� � v � PROTECTIVE INSPECTION SEC.
, ,
� � ,
1l /"i � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
L•�_�•1 `•I ,•� 612-560'3450
910-F15 4 28 76 � �
J08 ADDRESS 1310 Fii.11crest Drive N. �';.
1 LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 3t,� 3 Moore Lake Hi11s Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Paul Tinnons 1310 Hillcrest Drive N.E.
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
D. F. Vizecky Construction 2659 Du,pont Avenue South
4 ARCHITECTOR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDINO
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION X ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside Dwellin
8 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTIIATING OR AIR CONDITIONING. �-UIR1I111ID
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION R 1
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 1 HAVE READ AND EXAMINED THIS APPLICATION �' STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �S`2 � SOO �.. ZS
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER TATE OR LOCAL LAW REGULATING CON-
STRUCTIO�OR THE PERFOR A CE OF CONSTRUCTION. $�.S.00
a� PLAN CHECK FEE TOTAL FEE
�� $16. 25
�
SIGNATUREOFCONTRACT �� ORAUTHORI2EDAGENT IDATE) WHEN PR PERLY VALIDATED THIS IS YOUR PERMIT
� �, � � � �-�� -`�, :"
� SIGNATURE OF OWNERIIF OWNEH BUILDERI IOATEI BLDG INSP DA7E
AP.pLICATION FOR RESIDENTIAL, ALTERATION,
OR AllDITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
J� .
OWNER' S NAME • % t'„A, �L �v�-��- BUILDER : �l_,J ~ .- �'j�-�-c� �i�=� �
aDn�ss : I �i �,.�-��.�.t.�- �-►-�:,,� annxESS : � � � � �.-�-�� �.-�• .�-�
No:. /�/a � s�ET: hl�c e�� i°� �� � c1s�
LOT : � � BLOCK • � ADDITION : �d�� �' �� /'p- !Cm ��� ��DO � `� .
CORNER LOT: INSIDE�LOT:_�SETBACK: SIDEYARD:
Applicant attac� to this form �ao Certificates o£ Su,rv� of Lot and proposed
building location drawn on these Certificates.
�
HESCRIPTION OF BUILDING
To Be Used As:
���l�T��� Front: Depth: Height:
( �� Di n�Fr�
Squaxe Feet; Cubic Feet:
Fxont: Depth; Height:
Square F et; 'Cubic Feet:
Type� of Construction: '° "F -�°� Estima.ted Cost: $� 51� `��
To Be Completed: --��i� �''�r � � 7 %
/
The undersigned hereby ma.kes applicati�on for a permit for the work herein �
specified, agreeing to do all work in stxict accordance with the City of �
Fridley Ordinances and ru2ings of the Depart�cnent of Buildings, and hereby �
declares that all the facts and representations stated in this application �
are txue and correct. �
� G�Z,.r�%�%i
nA�: �'� � � � �1 Z SicNa�: �
,
(See Reverse Side For Additiona.l Information.)
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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
bu3lding 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 ma.nner herein provided to-wit:
*
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�
,;,
UDTIFORM BUILDING CODE: Type l, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, i.n 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 ma.in gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall.be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereot in
the cast of all proposed work.
Tn no case shall the fee charged for any permit as set forth 3aa Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for eonstruction 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 Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before uroceeding with the fram3ng.
CERTIFICATE OF OCCUPANCY
Application for a,Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building pern►it has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
.
sua�ect ERNjif NO. ;
City of Fridley 3 3 5 3 3
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� ; L __��� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. ����
� _ �
( ����1 � CITY MALL FRIOLEr SS�3Z NUMBER REV OATE PAGE OF APPROVED BY
�""'� � ��� 763-571-3450 s�aF�s 5/20/03 / /
10B ADDRESS 1310 Hi3.lcrest Drive NE
t LEGAL ��T NO. BIOCK TRACT OR ADDITION SEE ATTACMED
oescR. 34 3 Nloore Lake Hills SHEET
2 PROPERTY OWNER MAIL ADDRESS 2�P PMONE
Charlie Pearson 1310 Hillcrest Drive NE 763-571-5948
3 CONTpACTOR MAII ADORESS Z�P PMONE LICENSE NO
BAC Construction Services 6015 Lyndale Ave S, Minaeapolis, MN 55419 612-721-5500
d ARCNITECT OR DESIGNER MAIL ADDRESS ZIP PMONE IICENSE NO.
zoi4zo62
5 ENGINEER MAtI AODRESS 21P PHONE IICENSE NO
B USE OF BUILOING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION k REPAIR O MOVE O REMOVE
8 DESCRIBE WOfiK
Reroof House (20 Sq) Tear-off• Rebuild chimne
8 CHANGE OF USE FROM TO
STIPULATIONS
UAderlayment must comply with the Sta�te Building Code.
Provide smoke detectors in aZi s�.eeping rooms a�d on al� �evels of the dwei�ir.g
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all
exterior openings.
Pe� a� �ns����aon ����
ill � ailed
�o ���eowr��r �°� ����
TVPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAI. PLUMBING, HEATING.
VENTIIATING Oii AIR CONOITIONING.
TMIS PERMIT BECOMES NULI AND VOIO IF WORK OR CONSTRUCTION 20NING SQ. FT CU FT.
AUTHORIZED IS NOT COMMENCED WITMIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTFEET PARKING
1 NEREBY CERTIFV THAT I HAVE READ ANO El(AMINEO 1HIS APPLICA710N 1 57A��S GARAGES
ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING TMIS TVPE Of WOFK WILI BE COMPLIED
WITH WHE7HER SPECIf1ED HEREIN Oq NOT. THE GRANTiNG OF A PERMIT �4' f 8�S �2 .4'1
DOES NOT PRESUME TO GIVE AUTHORI7Y TO VIOLATE OF CANCEL TNE pEfiMIT FEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL lAW REGULATING CON-
STRUCTION OR TME PERFOfiMANCE OF CONSTRUCTION $111.ZS F�.iG' SC ��F.SL
PIAN CMECK fEE TOTA� FEE
ic nse SC $5.00 $123.47
S�GNOTUpE OF CON��7ACTOp Op AU�HOp�ZED 4GENT �O�TE� NEN PROPERI`/ VALIDATED TMIS IS YOU PER IT
S�GN4TUQE O� OWNEA��� OWNEp BUI�DEAi 10ATEi BIOG �N$� �
r _ _-
NEW
ADDN
ALTER
��5�3�,
[] � I-� q,-� CITY OF FRIDLEY
[] 6431 University Ave NE, Fridley, MN 55432
[] SINGLE FAMILY AND OUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: � � � �' � ���-���" �'�� � � �
Effedive 1/1/2003
(763) 572�604 Bldg Insp
(783)571-1287 Fax
Legal Description: ,
Owner Name & Address: �"�C� �, P-�.orY��4 Te�. #�1�3--�` ���
Contractor. , BAC Constr. Services MN LICENSE #�C����C'��� —
Address:_ 6015 Lyndale Ave S Tel. #�l���a �' ���
�innPanolis MN 55�419
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRlPTION OF IMPROVEMENT
� .
LNING AREA: Length wdth Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Wdth Hgt/Ground Sq. Ft.
OTHER:
Construction
��•� ���a1.�.� ���' � ���e� ��V� � �
�
aC> �, �r�_r� � Estimated Cost: $ � �1� � �
Driveway Curb Cut Widtfi Needed: �t.°+ 6 Ft = Ft x$ = S
DATE: �°� '��� APPLICANT: , � f� � � �"�L� Tel. # �f�� �'�% 0� ��
Call (763) 572-3604 for Pertnit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee $ 1� 1 a��
Fire Surcharge $ �-I � `�S1
State Surcharge $ � � �I l
SAC Charge $
License Surcharge $ � • ('°�
Curb Cut Escrow $
- - �rosion �ontrol - - -$ - - � -
Park Fee $
Sewer Main Charge $
TOTAL $ ��� s ��
B
Fee Schedule on Reverse Side C�
.001 of Permit Valuation (1/10th%)
�$.50�$1,0001.'slu�tion
$1275 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$45�.�O�onservafion-P1an eview - -
Fee Determined by Engineering
Agreement Necessary [ J_ Not Necessary []
. _ _ .
_ •.
BUII.DING PERMIT FEE SC�DULE
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 stru�ture,
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
�SOI _ _� �Z,OOQ - - - —
$2,001 to $25,OOQ
�25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
►, �� �� � �, i�� ���
$1,000,001 and up
FEF„S
$23.50
a. ... .. ..-.. .u.. P ... ...........,._ .w .:. ... . _. �o,. .., ._ _ .. .. , .. ..'_
. w�t
.... P°`''. . '. ` � . ..
$23.50 for �us� $500 plus $'3.D5 for each addi�ional $1�0 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereuf, ta and includir,b $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 includ' $500,0�
$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
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction ther�f
cux� cu�r Escxow
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet times $17.00.
Permits for const�uction 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.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
��MMAN VENT� VFNT C�NN _TC)R �4ND _pMB ISTI�I� AIR ��RIFI ATlnl�
V1/hen � �n acin0 an�etlr�p �ra� _, the undersigned hereby verifies that the
venting has been examined and is free from rust, deteriorataon, obstructions,
and is securely supported and firestopped where required. Yes (�No ()
The venting system is plasticlPVC and meets all current codes and manufacturer
speafications inGuding sizing, length, number of elbows and termination. Yes (�o ()
The undersigned also verifles that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
� ng��H� _nmRnietien � js SI'l�t� aild ifisi�ii�3i� �� (if��t t�°i@ CUfPeil� CL'd8S
and manufacturers specifications. � -
Wh@n nBQUlred to ���11 a n�w _emh ,_�e� a���,� ��� be sized and installed
to meet the current codes and manufacturers specfications.
Yes (�' No ( )
Yes (�No ( )
Yes (�' No ( )
WI1@11 jpSi�IljpO a n�w ver�iin�,c�vc m� the undersigned hereby verifies that
it is�a Ifsted assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I C�ntral Fumace
Venting Tables for fan assisted and natural draft appliances. Yes (e�No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes (�Vo ()
B�nliance T�ne and S'�p/[`emmen V n and V n onn ter Inferrn tien
•�li �1 �6✓�%Z.L-
�Appliance #1 Type �, a �,. �c� BTU Input �a � Fan Assisted or Nat �
Appliance #2 Type 1��. l��� BTU Input oo Fan Assisted or Nat _ i✓� ?
APP��ar�ce #3 TYPe BTU Input Fan Assisted or Nat
Total Appliances ___ Total Btu Input
Common Vent Type C��s b Vent Height l= Diameter �� inches
i( AppGance #1 Vent Connector Height _�ft Length .r ft Diameter �•• in Type S Gval�
Appqance #2 Vent Connector Height ft Length ft Diameter in Type'��
Appliance #;i Vent Connector Height �_ft Length ft Diameter in Type �
>j
HEATIN� CO: � � -� ����t Py �--
Signed By: ' s� �� z
. , Date : � - �?���
Building - '
Inspections
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE 6,�4�at� �, o10bS YOURE-MAII,ADDRESS p K`le� �'Ieta»;��t, °c12'f'
SITE ADDRESS 13 1 l� I-� ���C+�eS} D � N E, �',dley , M N SS'�13�
THIS APPLICANT IS: � OWNER �CONfRACTOR
Permit No.
Received By:
Date Rec'd:
PROPERTY OWNERI N�: � eAs��� 1�-�,� I�.le
TENANT pDDRESS: �3 �� 1-) � ��Crect 1�- N F CITY �a-� STATE�ZIP r�33-
PHONE: � �03" S � 1— otg(o0
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
1�I
STATE LICENSE
EXP DATE
ADDRESS: C1TT'
PHONE FAX
O SINGLE FAMII.Y/NEW CONSTRUCTION SIZE
❑ TWO FAMILYlNEW CONSTRUCTION STORIES
�BASEMENT FINISH
❑ DECK
TYPE OF WORK: I �
❑
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT
ROOFING
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED I�IGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES 8c
TYPE OF WIl�IBOW TO BE INSTALLED
.
;.,, a,:
❑ GARAGE/SHED ❑ WINDOWS
❑ ROOF ❑ DRAIN TILE
O SIDING � OTEIER
❑ SWIl�M�ID�1G P�L
� ADDITION
� REMODELING
'�-a� G�o�t "cv �ou.-a-r Cwo.l�k-o,,�c•
LENGTH WIDTH HEIGHT
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
� Fascia
LQCATION OF WINDOWS
ATE ZIP
Ft.
BASEMENT REMODELIl�TG SUBNIIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of shvctural members to be used
FOR NEW CONSTRUCTION WCLUDING DECKS,
ADDTTIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the exisdng slructures
and proposed project
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(LJSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ��� �- 0� OCCUPANCY TYPE
Permit Fee
Plan Review
Surchazge
Fire Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Gontrol
Park Fee
Sewer Main Charge
Total Due
$
$
$
$
$
$
$
See Back Page for Fee Schedule
65% of Building Pernut Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Pla.ns to MWCC for determination)
ft+6ii= ftx$20=$
$450 Conservation Plan Review
Fee Deternuned 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 acknowledge 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 pemut and work is not to stazt without a permit; that the work will be in accordance with the approved
plan in the case of all work which requires review and approval of plans.
SIGNATUREOFAPPLICANT ��%-�`�'�'° '"�^"'�°f"`�—'PRINTNAME �f e�''`�'� �a`"^ � ���R DATE A�gG�4� 3j�Q�
,
Page 2- Building Residential Application
BUII.,DING PERMIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erection of any building or
structure, or for any addition to any eausting building or structure, or for any altera.tion 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 surcharge)
$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 includin $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 additional $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
allow 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
F�: 763-502-4977
Building
Inspections
763-572=3604 �`
763-502-4977 FAX
BUILDING
RESIDENTIA.L APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-09
DATE ;� � ✓'u � YOUR E-MAIL ADDRESS
SITE ADDRESS l,� � Ci �'� ���Si`—
TfIIS APPLICANT IS: ❑ OWNER �CONTRACTOR
��- , .�:"i+%� ��-`
Received By:�
Date Rec'd: '�' � "�
PROPERTY OWNER/ NAME: H��L6'N i�J�9 �fJ•t7 %.f"
TENANT ADDRESS: / 3�d %�� L ci7�s T CITY �`je���� � j�' STATE �jA.�ZIP S3P�1.� ^2
PHONE: ��y�.� � — � a� G? �
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CER'f�ICATE OF
II�iSURANCE
%G
STATE LICENSE #�� v� EXP DATE °���� ol�� ��
ADDRESS: �� I ��cr� �'�t���C' J/7�a'/'� CITY %'J�l1%��'Y STATEf�•P> ZIP�-��
PHONE /`� J� '� 'J % j� — ��'L3.� FAX
PROPERTY TYPE I�f SINGLE FAMILYMEW CONSTRUCTION
❑ TWO FAMILYMEW CONSTRUCTION
PERMIT TYPE
TYPE OF WORK:
❑ BASEMENT FINISH ❑ ROOF
�,DECK 0 SIDING
❑ NEW HOME CONSTRUCTION ❑ ADDITION
p MpINTENpNCE/REppIR � REMODELING
❑ DRAIN TILE
❑ OTHER
k S' �'i�l'r�-'7�
DESCRIBE WORK BEWG DONE: ����e/`% �J1 � % � �� ` � � S��
SIZE OF IMPROVENIENT LENGTH % F� WIDTH � HEIGHT S FT
ROOFING ❑ HOUSE ONLY BASEMENT REMODELING SUBMIT:
N[JMBER OF SQUARES ❑ HOUSE & GARAGE l. Existing Floor Plan
GARAGES � ATTACHED GARAGE 2. Proposed floor plan
PROPOSED SIZE: ❑ DETACF�D GARAGE 3. List of structural members to be used
PROPOSED HEIGHT: FOR NEW CONSTRUCTION [NCLUDING DECKS,
'SIDING ADDITIONS & PORCHES SUBMIT:
� V�Y� OSofftt 1. Site Plan/Survey showing the existing structures
������ 0 Trim and proposed projecG
� Other ❑ Fascia 2. Two sets of construction plans
WIIVDOWS 3. Energy Calculations
IN EXISTING OPENINGS �Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENIIVG CHANGES &
TYPE OF.WWDOW TO BE INSTALLED NUMBER OF WMDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
SING'�'u� �oo� rt R r� FFF. C[''NF.DULEI
TOTAL JOB VALUATION
Permit Fee
Plan Review
Fire Surchazge
Surchazge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due _
'� �; ac�c�
$ � o � S'
$ , ��
$ .3
$ � 'l
�D l 4
$
$
$
$
$
$ � � _
ANCY
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
TEIIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge 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 1 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 1 wor�C hich requires review and approval of plans.
� r'JAv� � IrJ ! C j� �Z DATE �� v�3 c; �
SIGNATURE OF APPLICANT �r�t.6� ��" i'i PRINT NAME �
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Building Officia.l 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 shucture, 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:
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 proposed stntcture and of the conshuction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE �
Fridley, NIN 55432
763-572-3604
Fax: 763-502-4977
�
_ p � � �� l� ��� �,��s� i28�2�09
. . ..�
3
Design #.8549 �,.������:�, �� �
*** Take this sheet to the Building Materials desk to purchase your materials.
You selected a 1 le�el deck with: Below is a section of the d forg ourldeck.
Pressure Treated Framing Material options you have selecte y
4 x 4 Framing Posts
1-118" x 5-3116° „ 4� dee �"���'�� �"4``"=� os
Poured Footings 8 Tube p �� ��
t�" �C�'�°�'�t'�'��=' �
Natural Ultradeck Screws °� a� ���' y ��
Galvanized Framing Fasteners �� ^� �„ F� :,,z_
� :ua�'i.3, .. .
End Caps �; - � ,, � � Q
**
Handrail selections: '`Ys��~°.'`:�'
` .. �,
36" Horizontal Handrail Railing ��.
2"x�'x36" Pressure Treated Sq. E fe ed�Ra lin Posts
4"x4"x48" Pressure Treate��CRam 9
�� �� T ted H
�
Spindle placement is approx. 4" apart depending on sty�e
2 x4 Pressure rea
f the wide variable in codes,
.�
�
�
,
�
You may buy all the materials or any part at low cash and carry pnces. Because o
enards cannot guarantee that materials listed wdl meesuouec��o aedesigns and matenal lis s only �Some�emsn t ncluaed.
M ermit. These plans are gg .
for plan compliance and building p
from those pictured. We do not guarar�ee the completeness or pnces of these structures. Tax, labor and de ivery
O'� .. h�, � IJ �C , !D `T Gl:
e �� �_. � �X O�
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