AF - 46052.�►
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ViIIsge of Fridley, Minn.
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BUILDING PER11'II'T
N� .. 9 6$ Offi�ce of IN$PEGTO$ OF BIIII.DINQrB
Owner
Architect Fridley, Minn., `���;�• '�j. .� , 19 '� � '�'
Builder �'S� ',#+� ,� � w' �, w� � py ` �.
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LOCATION OF BUII.DING
No. +� °'�e '� � Stseet ,� —� L��P��� � . •. �` ����e. . �--� -c- ` Part of Lot
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Lot fi ��~- Block ���� Additioa or Sub-Dfvision � �' �-;`� � ,,,f � ;'�� �
- �• -
� �` �. � � :�DESCRIPTION OF BUILDING
��}� �� ��
Front -..� Depth� Height Storles ���'� Er= �=:.,...�. Manner oP Construction a'>` �-�� a, -� �'� -_
l_'�_ � �
�b be used as dJ_��..��,_�'_ ��•� t��.� � w,�� To be completed Eatimated Cost
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Permi�t ie hereby granted to- _+ ��'a �:;'�` � `k � '� c: �°� %' - S - "�T'- ��
�- � to��, : �'t �-'� _ r: �,
�e ���' �j�'� � deaerlbed in the above statement. Tl�ie permit is granted
upon the e$presa condition that the person to whom it ia graated, and his agents, employees and worl�en, in a11
the work done 4n, around and apon said building, or any part thereof, ehall conform in a11 respects to the ordi-
nances oP Fridley, Minn., regarding the construction, alteratfon, malntenance, repair and mov7ng of buildings
with9n the city lfmite, and tl�ie permit ma,y be revoked at any time upon violatlon oP anq of the proviefone of said
ordinances. �
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of Bnildings.
AGR,EIII�NT AND .�WORN STATEMENT
In consideration of the issue and delivery to me by the Inspector of Buildings of Fridley of
the above permit, I hereby agree to do the proposed work in accordance witln the deacription
above set forth and according to the provisions of the ordinances of Fridley, and, being first duly
sworn, I hereby state and say that the factas stated by me a.nd conta,ined in the above permit axe
true as therein stat�.
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Subscribed and sworn to before me at Fridl�y, Minnesota, this °�" ,}.
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City of Fridley, Minn.
BUILDIl�TG PERMIT
N° 4630 ��
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Date: _....;�_._..�___._�---•--_____ �.—___._�..— ,
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Owner. .�`.�,.1�'-�..� �,,,,�.r. - .�_f:���s�.:'r Biulder
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• , -----.._...._... —....._...._�.-•--•....._...._....._......
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Address �;� �.,�x�.__.._.q�-°:�.�:: f.�.:.�.�' ,•.�:� � .� �°� :�. �...._..._ ______ ._ _._..._.._......._...._._.__.
_..._.._,.=._...�.. ...._... Address _......_.w�.,�- ``��-.�-� _�.-.�--�� �r
.LOCATION OF BUILDING •
No. ��.�-. _%.--- Street ._.��� '` �--,���c�:;�_ �.._._ .,�:�_..��--1--------_..._ Part of Lot .....-•---�---..._.......__ ,/'
f,�,=.' . ..
Lot .........��_�.__...... Block ..----... ..-`.?'` .. ......................... Addition or Sub-Division .._.��,:�!�l�.;�:::�-'�.._ ....._.� �'�,n_,._%.�.�
Corner Lot ....._...___....---..._........ Inside Lot
Sewer Elevation
5etback .---.--•-•-•-•-.-----....._...._.....--- Sideyard
_____ Foundation Elevai3on _...�.._.._
DESCRIPTION OF BUILDING
To be Us�a as: /�
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`�.-�-�i..�::: �.::==� =�--- Front � --� -- Depth -- - ....._...._.. Height ...�`..�..._.. Sq. F�,�+!�,��...a�.=- Cu. F't. !`...��
_. _.. . . . Y Froni .� ....- ............._.. Depth ..._.......... .._.. �ei�ht�, � Sq. F't. ....._......._..._.. Cu. Fk
Type.of Construction-,�'' �lz�:�-�:�<�.... Est. Cost .............� .�„)'�.. �......... To be Completed ....._...._......_.._.
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the dty of Fridley. y
---.�I......----------__._._.. _._.._ _.____..._._
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In consideration oP the payment of a fee of $.... ......._.........---•--..., permit is herebY granted to...._--••---------..._...._.....---••--.-..--•-.---
_-...._._�_..�.._......._ to construct the building or addition as described above. This pernut is granted upon
the express condition that the person to whom it is granted and his agents, empIoyees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, constxvction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at any time�upon violation of any of the provisions of said
ordinances. _^..� '" ,, `t:
J
-.-�: �'.+�! '� `!� x".,�,rBuilding Inapector
n. �:-
NOTICE:
Thia parmit doea no� cove� the construetion, fnstaliation for wiring, plumbing, gas heating, sewer or waler. Be sure to see
the Building Inspector for separate permifs for these Rems.
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4.�t' -rr4' �.-_v ..
BPPLICATION FOR HUILDIldG PERMIT.
CITY OF FRIDLEY, MIINNESOZ'A
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LOCATION OF BUILDING
No.1 � � � _street„�'/_ �C. ����r-e-��" �`-'' � Pert of Lot
Lot / S � � Block_ � _ Addition or Sw.b.Div. `�ii � �� i� _V
Corner Lot Inside Lot Set Bac1s Side-Y�rd
� ..
3EWER ELEVATION FOUIVDATION ELEVATION
Applicant attach to this form Certifica.te o� Survey of Lot and propased building
locat3on. � �
DESGRIPTION OF BUII�DING
To be used as:
� � Front D�
Sci. F�t. Cu. Ft..
Front Depth Height
Sq. Ft. Cu. Ft.
Tgpe of Construotion Est�rnated. Cost
To be completed
�
�`Ya.e undereignefl hereby makes appl3ca.tion for a permit for the work lserein specified,
agreeing to do all work in strict accordance with the City Ordinances and ruling of
the Department of Bu3ldinga, and hereby decleres that all the facts.and representa-
tions atated 3.n this application are true and correct.
DATE �I'l.. � � S' . 1 cs � o SIGNATURE ,�1Le�r►�-
,—� 7T ,�..s ._.._� �_.�..._
(A Schedule of Fee costa can be i'ound on the Reverse 5ide.)
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BIIILDING PERMIT FEE SCHEDULE
Sectioa 2_ The Inspector of Buildinga shall, befora,issuing any,pet�mit
for the erection of any bu3lding or atructure, or for eny add3tion to
ar� existin� building or structure, or for any alterations or repairs
to ar�y existing building or atructure, upon appl3cation therefor, require
the pa3►meat by the applicant for such permit of fees to the amount herein
below set forth affi1 in the manner herein provided to-wit:
2.1. For any such permit for the erection of any fire-proof bu3lding, other
than a garage; warehouse, faatory or gra3n e1ee�.:tor, or for the erection of
any firepraof addition, for s3milar occupancy, to any ex3sting bota,itding
aha11 be at the rate of �1./�A for each one thou�and cubic feet, or fraction
thereof, in such cubical contents.
2.2. For aqg such pexYmit for the erection o£ any f'iregrcof garage, ware-
hous�, factorar or grain elevator, or for the erection of ar�y i'ireproof
additian for, e3milar occupancy, to a,n� exist3ng bui].ding ah�ll 1� at the
rate of �1.25 for each one thousand cubic feet, classiiYed as "fireproof"
by Section 502 of the M�nneapolis Building Code.
HOIISES
2.3. For ar� suc�h pex�mit for the erection of a.ny non-firegroof build3ng
other than a garage, warehouse, factory or grain eleeator, or any non-
fireproof additi.on, for similar occupancy, to any exist3.ng building.
Permit �]..00 for each one thcuasnd cubic feet.
GARAGES
2.1�. For a�► such permit for the erection of an3r non-fireproof garage,
warehouse� factory or grai.n elevator, or for the erection of e.ny non-
fireproof addition, for similar occugancy, to arrry exiatin� buiZding or
for each such bu3lding or addition. Ninety Gents for each one thousand
c:ubic feet or fraction thereo£� 3n the cu.bical contents thereof with a
minimum of �l�..00. �
For the purpose of computing fees for building permits the cubical eontenta
of any build3ng or addit3on to a unifor�n he3ght throughout by multiply3.ng
the groUnd erea covered from a point six (6) inches below the floor line oP
the ba.sement or cellar to the average height of the upper sur£ace or to the
average height of the roof surface of the main gable of a pitched roof.
2.5. For repaira or alterations to an existing structure� the fee aha7.]. be
at the rate of $�.QQ %r each Five Hundred Dol].ars (�500.0�), or f'raction
thereof in the cost of all propoaed work.
2.6. In no case eha.�1 the fee charged for any permit as set forth 3n
Section 2 be less tban �..00.
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sua�ecr p
c�ty of Fridley d 18 4 2 6
AT THE TOP OP THE TWINS g U I L D I N G P E R M I T
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� � COMMUNITY DEVELOPMENT DIV. CEIF�T NO.
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r j � PROTECTIVE INSPECTION SEC.
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l__-_� ��'��,.� CITY HALL FRIDLEY 55432 NUMBER FEV. DATE PAGE OF APPROVEO BY
i 612-571-3450 9t0-F15 5/13/86 � /
JOB ADDRESS 1321. Hillc�est Drive N, E.
t LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ].5 4 Moore Iicl�{(.' H].Z�.S SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
H�nson 1321 Hillcrest Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Mr. Sidi.rig Inc, 10800 Xavis Street NPt, Coon Ra.pids, N�i 55433 421-8200
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDINCi �
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
A,I.uminum so��it & Fascia
8 CHANGE OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE RE�UIqED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WOFiK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STA��S 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $I.�OOO $.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
R CTION OR THE PERFOHMA E OF CONSTRUCTION. �S`�.%.00
PLAN CHECK FEE TOTAL FEE
� $17.50
S nTU FCONiRACTOROR UTHORIZEDAGENT iDnTEi WHEN PROPERLY V I ATED THIS IS YOUR PERMIT
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SiGNATUREOfOWNERiIFOWNERBU�IDEHI IDATE� BLDG �NSP nA E
NEw L J
ADDN. [ ]
pLTER. [ 7
Construction Addre
Legal Description:
City of Fridley
�R-1 AND R-2
Building Permit Application
Effective �/1/86
Owner Name & Address : ��'L y a� Tel .�
Contraetor: /L! 5 i� ��� «e _ _ -, Tel . 4
Address: ,/� Svo X.�vi��'t_? 7, ��o�*- /�/l'P/o5 s� ��� �S�3�i
LI9ING AREA:
GARAGE AREA:
DECR AREA:
OTHER:
Attaeh to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width
Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd. Setback
Type of Construction: �Ll��i�v�vsyr SD,�t�r.�..-a f��cis�
Approx. Completion Date: /Li�9�►�_.3__�- � l S S�
Side Yard Setback
Estimated Cost; $ /�j6� Bo
Alt. A Alt B
Proposed DriveWay Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: /86 APPLICANT: /L11�P S/.DO'?'� �°` t, Tel. # Ll��-� �ov
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
F����
STIPULATIONS:
CITY IISE ONLY
� /%�S� Fee Schedule on Reverse Side
$ � 25$ of Building Permit Fee
$ �� $.50/$1,000 Valuation
$ $475 per SAC Unit
$ Fee Determined by Engineering
�
Agreement Necessary [ ] Not Necessary [ ]
$ /�. (� �
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BIIII.DING PERMIT FEE SCHEDOLE
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, ugon applicatio n
therefore, require the payment by the applieant for such permit of fees to the amount
herein beloW set forth and in the manner herein provided to-Wit:
Total Valuation
$1.00 to $500.00
Fees
$10.00 (Minimum Fee is $15.00)
�501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and including
$2�000. �
$2,001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
ineluding $25,000.
$25,001.00 to $50,000.00
$50,001.00 to $100,000.00
$100,001.00 and up
$170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraction thereof, to and
ineluding $50,000.
�283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
including $100,000.
��33.00 for the first $100,000 plus $2.50 for eaeh
additional $1,000 or fraction thereof.
DRIVEiIAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Drivexay width plus
6 feet times $13.50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approaeh with 6 inch depth - DriveWay Width plus 6 feet times $15.75
VERIFICATION OF FOIINDATION
Permits for construction will be issuQd 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 been constructed will be required before proceeding with the framing.
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Building
Inspections
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE � � 6 G YOUR E-MAIL ADDRESS
si� a,D Ess /�� i /-� ;//� he s� D r, !l/. E�
THIS APPLICANT IS: �irNER �CONTRACTOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
2
STATE LICENSE #
�
EXP DATE
Pernut No.:
Received By:�
Date Rec'd: �� ° � -'�.�
A�rc��i rn 5 s�� � �
ADDRESS: CITY STATE ZIP.
PHONE FAX
❑ TWO FAMILYMEW CONSTRUCTION
❑ BASEMENT FINISH �OOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWINIMD�TGPOOL
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
ROOFING
MJMBER OF SQUARES i �
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDIlVG
O Vinyl
0 Aluminum
❑ Other
❑ HOUSE ONLY
�OUSE & GARAGE
O ATTACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
O Fascia
WINDOWS
IN EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SiZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED NUMBER OF �
WIDTH HEIGHT
AASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of strucwral members to be used
Ft.
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBNIIT:
1. Site Plan/Survey showing the existing strucd�res
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:
(USING 9 7 U. .0 FEE SCHEDULE)
TOTAL JOB VALUATION $ J -� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ 'l , a�' See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ '3_ (0^j .001 times the total job valuarion
$ �� .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residenrial Contractors)
$ $1550 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering -
$ � Agreement necessary ( ) Non Necessary ( )
$ i O'� _ R Make c6ecks aavable to: City of Fridley Attach
� THIS IS AN APPLICATION FOR A PERMTf-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 permit and work is not to start 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.
SIGNATURE OF APPLICANT �Fi`7'+-C� _• �� e� PRINT NAME � C.' f9 h c�t C fffL l'/ S o 3�,DATE a 6- a% � a o lo
Page 2- Building Residential Application
BIJILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
stxucture, 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: �
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 Certifica.te 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, MN 55432
763-572-3604
Fax: 763-502-4977