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V "� = '" o � � m � C 3 ? �. �A V �° \\ � VO � � � 6 SUBJECT PE O. City of Fridley °' 13419 � AT THE TOP OF THE TWINS g U I L D I N G P E R M I T • � � � RECEIPT NO. � ; L__�� COMMUNITY DEVELOPMENT DIV. � I � PROTECTIVE INSPECTION SEC. � � ' 's ' �� "'1 � CITY HALL FRIDLEV S$432 NUMBER REV. DATE PAGE OF APPROVED BV ""� � �'� 812-580-3450 910-F15 /29/76 � � JOB ADDRESS 1331 Hillcrest Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ].9 4 Moore L3�C@ �7.�.1. � S SHEET 2 PROPERTYOWNEH MAILADORESS 21P PHONE Donna Murphy 1331 Hillcrest Drive 3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO. 4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENGINEER MAIL ADDRESS ZIP PHONE �LICENSE NO. 6 USE OF BUILDING �� residential 7 CLASS OF WORK ❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE X 8 DESCRIBE WORK reroof garage 9 CHANGE OF USE FROM TO • STIPULATIONS SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. �� fY'3�C.' THIS PERMIT BECOMES NULL AND VOID IF WpRK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED 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 1 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. WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $'4OO . 5O DOES NOT PRESUME TO CaIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � S.00 PLAN CHECK FEE TOTAL FEE 5.50 1 NATUREOFCONTRACT RAUTHORIZEDAGENT �DarEl H.EN PROPERLY V LI ATED THIS IS YOUR P RMIT � � �� -�� `,��'• ,��/ . SIGNATUREOF OWNERIIF OWN R BUILD I IDATEI BLDG INSP p 7E - � ' ' '. • •A�'PLICATION rOR RESI'DL'�UTIAL., ALTL'RATION, � � � • . � OR AllllITI0N.I3UILDI\G P�RI�IIT � . • ' � CITY OF FRIDL�Y, r1INNESOTA . � • • • . • . . ,, ' '• .r �� ' ' � . • .• � • OjrTNEIt S NAI�i� . !� BUILD�R . - � , ' ADDRESS : �°��i��%2�i'E�� ADDR�SS : � • . , . . NO:. � � STREET• � . . ` - i0i: BLOCl�: � �ADDiTI011; ��o / . CORh�'R LOT: INSIDE LOT: � SETBACK: SID�Y�IP.D: . --.---,�--�— • • � Applicant attacl�. �o this for� �.t�o Certificates. �f.Survey.of Lbt an3.groposed . . building loeation di•swn on these Certific�tes. . - . . • e .. . � � •HESCRIPTION�OF BUILDING � � : . a - - e Ta Be Used As: . . � . . � : . . . . •. Front: Depth- . Height: •° • . . .�Square Feet: � Cubic.Feet: � ' . ° • �' � • - . � Front : _ ` Deptli : • � Height : •� . . � Square Feet; Cubi,c Feet:_ � � � -. . � �tpe of �Construction: . � ' Estimated Cost: $ �� To�Be Campleted: • � � � . - . . • . . •e • • � . . � . . . . . The undersisned hexeby makes applicati�n•for a permit for the work herein � 1 speciiie�, agreeing to do all work in st=ict�accordance xaith the City af - � Fxidley Ordinances an�_rulings ot the D�paxtment of Buildings, and her�by � � declares �that all the facts and representations stated in tliis application 8re true and correct. � - ' . � �/ � ' ' - • Di.4TE: � �° �- SIGNATUItE - . (See l�everse Side For Additi�nal Infornation.)' , ' '. , . ��° '• � . - , ' ' . . . . . . ��'i��c��.`R---� _ . . � , . . �;� . . . . � � � . . • . : � � • . e • . . ' ' - . r. . . . .. • • ' • ' ' � � • . .. �, , , • • l3UiLll1NV L'.L'1N�I11 !•tI.L• �Lt�Lliui.c � ' � � . . ' . � '. i ' • ; • , . � . i i � S�CTION 2. Tlie Inspector oi Buildings shall, bcf•.ore issuing permits for �the ; execCion of any buildin� or structurc, or L•or any addition to any existing . •' bui.ldin� or stxuctuxe, or tor any altcration or rcpairs to any existing , building or strucCurc, upon app�ication thcretore, xcquixe tt�e payment by the ; applicanC •foic such pennit of fees to Ehe a�rount hcxein bclow set iortia� and in the mannen c�rein providcd to-wit: � .., . j . � . , . • ' . UPi�TOI'Si BUILDInG COD�: Zjipe 1, 2& 4-$2.15 fox each one thousand cubic . feet, or txaction thereo�, in such cubical �ontentso �pe 3& 5-$1.85 foz •' • ' each�one thousand cubic feet. � • •• ! ' . � . ADDITIONAI, iNFOItI�iATION � •� ? , . . - . � . , ' . • : .For the purpose of ::omputing fees for building permi.ts, the cubical contents �• vf any buildin� or addition, is determined by multiplying•the gxound area . cove�ed from a point siY (6) inches i�elow the floor line oi the basement • _� or the c�el}.ar ta the average heights of the upper surface or to the avexage�r . height of th�•roof surface of the main gable of a pitched roofe � ' . . s . � • Fox �cepairs.o� alCexations to+an existing structure� the fee shall be a� the ' ra�e of $3.00 per each five hundred�dollars ($500.00) or fraction thereof in . . the cos� of a1J. Proposed work. ° . . � �� in no case shall �he fee aharged for any, permit as set forth in Section 2 be • ' less thaxt �5:00, • - � � o ° ` � � � �, ,VERIFICATION DF' FOUI�DATION � � � . . . . �. I�O�a 1?e,rmits for construction �aill be fssued.a minimum of 24 hours fxom the ��u�: os: ap��.�..aei�..,��.low for pxoper review. of the proposed structure aad, � • o� �he consCaruction sit�e; . . � .. . . , � . , � • � �--��_ __-- � ' � A Cextified Suxvey of�the 1ot, shoi�ing the loca�ion of the foundation, once i� � has been cons�tructed, will be required before proceedin� �aa.�h the framirig. ! . � . , � CERTYrICATE OF�OCCUF�NCY . ,� Applica�tion for a Certificate of Occupancy shall be made ten (10) days pxior to the usc or occnpancy of any structure fox which a building permit has beea ��ssued; �nd said structure shall noC be used or occupied until a Certificate � •• vf Occu�ancy has becn issucd.. . . '' • � • . . �ti � � o � 1 . ' . ' ' . . - . �. • 9 � \ . . • • � . • � . . • � • .. . • � - • . . . � • . ' � � ' • . . • • • s • . . � • • . • e Z r.�.�.� T ------- SUBJECT P O. c�ty of Fridley � 136'73 � i, ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RECEIPT N � � • COMMUNITY DEVELOPMENT DIV. , �y ------, ��3�% r � � PROTECTIVE INSPECTION SEC. 1 i � � /"'1 � CITY HALL FRIDLE� 55432 NUMBER flEV. DATE PAGE OF APPROVED BY �� ,•� 612-580-3450 910-F15 7 30 76 � � JOB ADDRESS �n Backstrom 1331 Hillcrest Drive N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. ],9 4 Moore �.� ��.�.5 SHEET 2 PROPERTYOWNER MAILADORESS 21P PHONE Ron. Ba.ckstrom 1331 Hillcrest Drive N.E. 3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO. S�' 4 ARCHITECT OH DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO. 8 USE OF BUILDING residential 7 CLASS OF WOHK ❑ NEW ❑ ADDITION ❑ ALTERATION g REPAIR O MOVE ❑ REMOVE 8 DESCRIBE WORK re-roof 9 CHANGEOFUSEFROM TO STI PU LATION S SEPARATE PERMITS ARE HEQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWIG. UNITS OFFSTNEET PARK�NG I HEREBY CERTIFY THAT I 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 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 STATE OR LOCAL LAW REGULATING CON- ]� SO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � PI.AN CHECK FEE TOTAL FEE $.�� N �u !OF N C RORAU ORI DAGENT ( TEI EN PRO ER� LIDATED THIS IS YOUR ERMIT �I r ' `' ` - d -� 1�l'� � �, � _ ,� /� � u;/ � SIGNATURE OWNERIIFOWNE BUILDERI ID EI BLDG INSP �ATE �.. CITY OF FRIDLEY APPLICATION FOR RESIDENTIAL ALTERATION, ADDITION, OR REPAIR BUILOING PERMIT � � OWNER' S NAME :D��OJ_ /� S�� BU ILDER :�/�'/ � ADDRESS : ��, /ff�/C�l°�� ADDRESS : ��a-r�., -�p . NO :�� STREET : /'Y /�/ L��°� LOT : BLOCK: � ADDITION : �/�°OD/'c° 1�`i � . %�� CORNER LOT: INSIDE LOT: SETBACK: SIDEYARD: Applicant attach to this form Two Certificates of Survey of Lot and proposed building location drawn on these Certificates. DESCRIPTION OF BUILDING To Be TJsed As : , Front: Depth: Height: Square Feet: Cubic Feet: Front�: Depth: Height: Square Feet; Cubic Feet: 2`ype of Construction: Esti.mated Cost: , d To Be Completed; .�� The undersigned hereby makes applicativn for a permit for the work herein specified, agreeing to do all work in strict accordance �aith the City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts and representations stated in this application are? t�rtiP anci enrrPeY _ DATE: 3O � SIGNATURE: (See Reverse Side For Additional Informa � � � . �� o. � � � � a A . BUILDING PI;ItMI1" FLI: SCHL'llli1,L' SECTIOY� Z. The Inspector of Buildi.ngs shall, before erection of any building or structure, or fox any add building or structure, or fror any alteration or repai building ox structure, upon applicatian there£ore, re applicant for such permit of fees to the amount herei the ma.nner herein provided to-wit: NEW CONSTRUC�ION: Si.ng�,e Family Homes and Garages: $4. PLAN CHECK: 25 percent of building permit fee. ADDITIONAL INFORMATI�ON ssuing permits for the tion to any existing s to any existing uire the payment by the below set forth and in 000 cubic feet For �he ur ose of com utin fees for buildin P P P g g permits, the cubical contents of any building or addition, is determined by multipl ing the ground area covered �rom a point six (6} inches tielow the floor 1'ne of the basement or the cellar to the average heights of the.�:ppex.�sur ace or to the average.�- height of the roof surface of the main gable of a pit hed roof. For repairs or alterations to an existing strt�cture, t e fee shall be at the rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in the cos� of all proposed work. Tn no case shall the fee chaxged for any permit as set'�forth in Section 2 be less than $7.50. ° 'i VERIFICATION OF FOUNDATION s NOTE; Permits for eonstruction will be issued a mini m of 24 hours from the tiane of application, to allow for proper review of the proposed structure and of the construction site. A Cert�ified Survey of the lot, showing the location of the foundation, once it has been constructed, will be required before proceedi�� with the framing. CERTIFICATE OF OCCUPANCY Application fox a Certificate of �ccupancy shall be ma to the use or occupancy of any structure for which a b issued; and said structure shall not be used or occup3 of Occupancy has been issued. ' z e ten (10) days prior ilding permit has been d until a Certificate . 0 ,, � � SuBJECT City of Fridley AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � � � � COMMUNITY DEVELOPMENT DIV � � �: ------� r � � PROTECTIVE INSPECTION SEC `-_--� ��"' �'� CITY HALL FRIDLE� 55432 NUMBER t+Ev i 612-571-3450 9t0-F15 JOB ADDRESS 1331 Hillcrest Drive NE 1 LEGAI LOT NO. BLOCK TRACT OR ADDITION DESCR. 19 4 Moore Lake Hills � 2 PROPERTY OWNER MAIL ADDRESS ' EDwin Serum 1331 Hillcrest Drive NE 3 CONTRACTOR MAILADDRESS Same I ARCHITECT OR DESIGNER MAIL ADDRESS 5 ENGINEER MAILADDRESS 6 USE OF BUILDING Residetttial 7 CLASS OF WORK ❑ NEW B DESCRIBE WORK Reroof House & Gar 9 CHANGE OF USE FROM STIPULATIONS DATE PAGE OF 9/16/96 / / PERMIT N ��.��3 �� APPROVED BV SEE ATTACHED SHEET 571-0232 ZIP PHONE LICENSE NO. ZIP PHONE LICENSE NO. ZIP O ADDITtON ❑ ALTERATION n REPAIR x 20 Sq) Tear-off TO PHONE LICENSE NO. O MOVE O REMOVE Underlayment must comply with the State Building Code. TYPE OF CONST. SEPARATE PERMITS ARE REOUIRED FOF ELECTRICAL. PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANDONED FOFi A PERI00 OF 120 DAYS AT ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS ypLUATION AND ORDINANCES GpVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPE�IFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,650 DOES NOT PRESUME,TO GIVE AUTHORITV TO VIOLATE OH CANCEL THE pERMITFEE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �S�F.00 PLAN CHECK FE� � SIGNATURE OF CO�N•'RACTOqA AUTMOA�ZED AGENT (DATEI l, A l C/A • A .. _ i �OATE� OCCU FT STA�LS OCCUPANCVLOAD CU.FT f PARKING GARAGES $.83 AC CHARGE Fire SC $1.65 AL FEE $56.48 THIS IS Y i��Ml 1 NEW ADDN ALTER �l [l Ll ConstructionAddress: � CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application `ff I� G • Effective 3/1/96 Legal Description: L-pt' � � v1� `OG �C � �i �D/� L,�4-�'�° �f �`S Owner Name & Address: �� i�� J 3� f t�� c 1Z � Tel. # S %-�(��3 , Contractor: �� (� MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECB AREA: OTHER: Tel. # Attach to this applica.tion, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT Length Widtli -Height Sq. Ft. Length Width Height Sq. Ft. Length Width Hgt/Ground Sq. Ft. nr ,o � /��—� ,.�� „ /_' am a�,o �.-,c•�. .�, �s� � Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks Type of Consiruction: Fstimated Cost: $ �� C� Approx. Compledon Date: � ,,,>;,, iCost on Back) - Driveway G�rb Cut Width Needed: Ft. + 6 F�= x$ _$ DATE: APPLICANT: Tel. #�l--Q o�t � a Permit Fee Fire Surcharge state surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPU'LATIONS: � �� l, ��r $ � c�3 $ $ $ $ $ $ � ��- � � CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $9� �r 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 [ ] � . -� 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 existing building or structure, or for aay alteration or repair to any existing building or struchxre, upon application therefore, require the payment by the applicant for such pernut 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 $25,0� $25,(�1 to $50,000 $50,001 to $100,000 $1�,001 to $500,�0 $500,001 to $1,�,000 $1,000,00�. and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,OQ0 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and including $25,000 $349.75 for first $25,000 plus $9.00 for each additional $1,000 or fraction thereof, to and including $50,0� $574.75 for first_ $50,000 plus $b.25 for each additional $1,000 or fraction thereof, to and including $1(}0,0� $887.25 for first $100,000 plus $5.00 for each additional $1,000 or fraction thereof,.to.and including $5(�,000 $2887.25 for the first $5�,000 plus $4.25 for each additional $1,000 or fraction thereof, to and including $1,OQ0,000 $5012.25 for the first $1,000,000 plus $2_75 for each. additional $1,000 or fraction tl�ereof ' DRIVEWAY DEPRESSION ESCROW (Concrete C�rb Streets 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 aad install a 3 foot wide approach with 6 inch depth - Driveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be required before proceeding with the framing. s w n O � � � � O 2 � � � _ � r � m v � O < v v � m � � � n � m n � O z � 0 D D Z v a 00 r m rn I D � z � C � � N m �o � O z n _ m � O -y� i � m m � m � c � s w � � � � •'� in � � d D � � r m r y � O -� � O = � m � � C � m D � 0 0 w � � A � � N � �D m ° O � ? D � v � v � Z � v � D r m � O Z � �o � � � ct � c w w � � � m � cwi N 71 m m m 3� o�`�° °' f v o 70 -, -. -, v � � �-r� � °' � y m � � � m � m m � � � � O v � c � s m°'. m°», m'' ' m 1D � tD > > '�D • � � � � z. � N y t0 N < � � � (O 0. � Z c�n y � �. � � � (�D � � � � C � � � c m a m N -D C � � Z � � X C � m D -i � �� ° I I I I I I I I I I I I� ° � ��n�� (71 O O O v O V V V�l (J1 A�I m °o o° o° °o o° °o °o °o °o °o °o °o °o ,�, o c � � � ; � � � y � � C ? 'o G� C - -' � � Z 3 a v� o m � �, � m _ � c. � Z a C m � �ao -c n o � u► rt7 O � °� �' m ) � N O ,n J D -�i � � � --� N � 0 c tC s 1 � v � m � � w z � m � � � z O ��^S° '�' V � � � � � � co � � � O � D � 0 � m � � f� � � i�- � � r.. � ti � � .� sus�etr RMI . City of Fridley ,,� 8 � AT TNE TOP OF TME TWINS g� � L D i N� P E R M I T � r ��! V�� ; � � NO. MITY OEVELOPM�NT DIV. r � v � PROTECTIVE INSPECTION SEC. � j /� / � , �� i--_-�� '�' �•� CITY HALL FRIDLE� SSIa2 NuMeER pEV o�Te v�GE oi �vPnOVED er L 612-571-3450 910-F15 12/4/9$ � � 10B ADDRESS 1331 Hillcrest Drive t LEGAL ��T NO. BLOCK TRACT OF ADOITION SEE ATTACMED DESCR. 19 4 Moore SMEET 2 PROPERTY OWNER MAII AOpRES$ ZIP PMONE Sara Schreiner & Patrick 3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO Castle Bld & Rem Inc a AiiCHITECT OR OESIGNER MAIL ADDRESS ZIP PHONE UCENSE NO. 5 ENGINEER MAII AODRESS ZIP PNONE IICENSE NO 8 USE OF BUILDING Residential 7 CLASS OF WOFiK ❑ NEW O AODITION [� ALTERATION ❑ REPAIR ❑ MOVE . O REMOVE B DESCRIBE WOfiK Remove and re lace ara e• Inter r remodel new windows kitchen bath 9 CHANCiE Of USE FROM TO STIPULATIONS � See notations on plan. ��z�� ,. Before ��g�;�� 1 for ��i Ut►O!ty !nC��90RS 4s4-�o�z R�4�ulR�D �� L�� SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATIN(i, TYP� OF CON T. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID If WORK OF CONSTiiUGTIOM ZONING SO. fT CU FT. AUTMOfiIZED IS NOT COMMENCED V�ITHIN BO OAYS. OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANQONEO fOR A PERIOD OF tpp pAVS A7 ' ANY TIME AF7ER WOFK IS COMMENCED. ' NO OWLG. UNITS OffSTREET PAqKING I HEREBY CERTIFV TMAT I MAYE READ ANO EXAMIN�O THIS APPLICA710N STALIS GAFAGES AND KNOW TME SAME TO BE TF]UE ANO CO�1:�ECT. ALL PROVISIONS Oi LAWS ypLUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE Of WQRK WI�L BE COMPIIED WITN WHETHER SPECIFIEO MEREIN Op NOT. THE GRANTING OF A PERMIT $65 000 32.SO DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CAMCEL TME pEi�M1T FEE SAC CMARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STqUCTION OF TNE PERfOFMANCE OF CONSTRUC710N ($].2,rj Fire SL' h6.5.�� PLAN CMECKFEE TOTALFEE License SC 5.00 789.75 S�GN4TUAE 0� CON7FACTOA OA AUTMOAl2E0 AGENT �O�7Ei WHEN PROPERIY � OATED TMIS IS YOUR PERMIT S�GNOTUpEO�OWNEA��OwNEpBW�DEA� �OATE� . � B�OG NS�� T 4�i� � � NEW [ ] ADDN [�(j �� ConstructionAddress: CITY OF FRIDLEY SINGLE FAMII�Y AND DUPLEXES R-1 AND R-2 � BUILDING PERMIT APPLICATION � �� 4� ��I��ST �t�u�` a Effective 1/1/98 ° ��.f� � � �� C � �� P��f�� Legal Description: �cr�- !°L ,� I.t�K �► i� DoP2 C L-AKE �t �y.S /� �D � 7t on( � A'11�o1� �• Owner Name & Address: �/a� ��F�ElN��2 ��A�' R l�� /ES�I v Tel. # S S�-� l�i°� Contractor: ��A�,TI,i= �%Utc.D JNG ��E'MaDEI,�N��MN LICENSE# o00 57�- Address: 3�2�j A►ZTHvtL ST(2�ET' F�o�2�E{-E/�T' Tel.# ��5�-8So9 Attach to this application, a Certificate of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMENT LIVING AREA: Length Z<v� �(o�zr Width �- Height �' Sq. Ft. g( GARAGE AREA: Length z8 � JD%" Width Zi `- /� " Height ��( u Sq. Ft. lDa� DECK AREA: OTHER: Construction Type: Driveway Curb Cut Width Needed: Width Hgt/Ground Sq. Ft. �c �-� �� z �t ��C�� ,%�L�al°��l�'= � ,��YI'1��G�L. j /%�� r,�E,a��;�°.1 � � � � �`� � �' Estimated Cost: $ ��%�'j} . � (Fee Schedule on Back) Ft. + 6 Ft = Ft x$ _$ Q DATE: 12. • o �•�� APPLICANT: CJ�. Tel. # 78 `�^ 8 5`� j-�1 nn,� scH-� r�r�e., c�z 7or8 79� c��.L CITY USE ONLY 5Z� -g3G� � P Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL S1'IPULATIONS: $ % �� $ �SQ3 $ ;�.�,� •.rf% $ � $ . T>6 $ $ $ $ $ 9 7� Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,000 Valuation $1000 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] / / .- BUII..DING PERNIIT FEE SCHEDULE The Chief Building O�cial shall, before issuing permits for the erection of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner h�rein provided to-wit: TOTAL VALUE $1 , to $500 $501 to $2,000 $2,001 to $25,000 $25,001 to $50,000 $50,001 to $100,000 $100,001 to $500,000 $500,001 to $1,000,000 $1,000,001 and up FEES $21 (Minimum Fee is $21 plus surcharge) $21 for first $500 plus $2.75 for each additional $100 or fraction thereof, to and including $2,000 $62.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction thereof, to and 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 $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 DEPItESSYON ESCROW � (Concrete Curb Streets Only) Altemate "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. � � * � D � o � a i�i m � � ��' � � � Q o o m � � (Q A "� Q O j m � � N O m � � m Q � S O � 0 � a c� � � v m Ci • . � r � rn Z � m � O Z m � 3 � a � < m � � 0 c c� � t � v � m � � v � m C $ m � �. • „ . .� � .■ •> • ►: �� . 1' 1 ��, � ►y � �; � . � n N � � 3 �� m � m a °. � �� m 0 O � � � r � � rn � . c� m � D \ � °. m� < m � °. � �� m m � o �'*• -C, o G N 7�' � � O Z � n 3 � ts� tfl ts C � � � �D � a � z � .� 2, v, � � Z 0 m v � � � � o � Q � �o z= � � ��m� cn C � � N � — _ o � n � n n � o � � � �i � � '. � �3 � � v a�o�. O m � ' � � D O � o. � S cQ i D � � v � � � N i C71 O 8 O v� � m � � v n 0 � m � � --1 Z O �� o Q.j'0 � 6 � c � v � e a��i � D � �i ai p � a � � av m � m cc m � � � �� r. � o � � �. 'n. � a ?! � p m c$�i s � � �. �� 3 m �� v � m � _ � � � � O O O � O C S � tfl t� rfl � � �1 O C � � � � � m 2 �' � �� y � Q � o �. � �s�� _ /� o m �° cQ s ��.�m / s.� n �a � � ��°� � °p� � a�'i °' 3 N o — ^ a� ? o m � a � �. v, 'a � � a'�v � o � � � � m � ? �' '< cQ'i � z m °- o 0 � � � m m N g�� • A � � � � � N�� b,' m � � ��o N�� - � =- a �, m 1�q � � � fl' � N n 2 m v C � V Q � � � C O � � �- �t Z � � � � � � � �D z Z � m � n � O Z � '�O � .� Z C m� � O fll Z � � Z � Z � v� �� 8� Z� v_ v z� �- z -� v�° � z g � c� 8 O � N C z v� � v� — � � � � � O ^ Z � V� � t�i V � ,� O , � � � � z �i� � �� 1 � � I� � :a��Q :�g pau�ts �O� JI�II.L�'3H :auoQ maS 5i�iOLLd2I�s'Id �sI'I :sxn�ag () oN () sa� .I2�82Lj .I2�L'M 103 p2pIAO.I(I IIA2Q IIE IIOi;SilQLIIO� SL'j� • g () oN () sa� ia�Eaq .�a��nn io� papinoid uaaq iauti ��H ' L S �ll.Lg 'I�dsOS ' , S�lLLg ia�o Iid � � ' 3o s.I1.Lg ��I I�� H - 9 i) 011 () sa� pa��auao� s�fLLS i�a� P�' azis io3 s�uauiannbai apo� �ua.r.m� � s�aay� • S ( ) oN ( ) sa� _ pauoddns �iam�as sI •� () oH () sa� . utq�inn pa�poi s��aCqo u�ia�o� ou s�H '£ () oN () sa� uor��oua�ap �o �sn.z uzoz� aa� sI • Z ( ) o�i ( ) sa� . � pauim�xa �iin�a.re� uaaq s�g � j :��s io �aumiq� �uqsnca aql �� sa�uan �qaia� pau�isiapun aq,L I�iOLL��I3RI�A S��'ZS Ql�i�' 1��1�iL1IIH� � 0 � � m m � � � � c � � � � � in a° °, � C � -�i. C � 0 a v 'Q �i � � � � � N , ` �' b �� ' D : � C < _ � ; a . � n '< n . � � , . . � � � � �� . , : � � � � � � � � , � T I � � i �v 1 N I I I �, � ^J �a � � a m � � � `� c � � °-° c�o � m� 7 "-1 n Vl N m► wi m► ••�► � 11 y � T �� c� m m.� ��, O v� � � � � � �m � � w � m �, o�o � �. c � v•* m m� z. r- � a, � m y N � � � ��G � p1 7 � Z (p (Q Q (fl "' W � '�p � � � N � * � � j 'Tl o � � � � _ = c m � � a � � m � I�I I I I I I I I I I I I� � � � � � � � � � � � � � (J1 O O O V p�I V V V(Jt A�I 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0 � � y � O � C � -� � � v 0° �' c� � � 0o Z n- c � � n y O y � a � a � � N ; D �, � Z � a � � � � �g c� 6 ' � �, �� Z � 0 � � � � 1' � � � \ .A � � � -o r C � m z � � � � m � � 6'r � � m � O � � � O 00 a v v � � � , w � _ � � � � � � . V � A � N �. W � � � � O ,°p � < -n Z N � ��'v A� ,.r,., N C �•� � Z Z m -�v n � 0 z v < � � � m O � L N 7 C ¢1 � J J � � � Building Inspections 763-572-3604 DATE 2 3 srrE nnnt�ss �� 77{IS APPLICANT IS: �O S 31 � PROPERTY OWNERJ TENANT CONTRACTOR BUILDING RESIDENTLA.L APPLICATION CITY OF FRIDLEY �. � �� (�T�� Received By: Date Rec'd: YOUR E-MA1L ADDRESS V�SL► b Sc-� �-e Fke ►r V� �►� � c��^�t r. J�OWNER OCOMRACTOR [•� ADDRESS: 13 3/ f{i��G r�,St Q� ►� PHONE: �o /� - a39 — �g 3� SUBMIT A COPY OF STATE LICENSE N YOUR STATE WCENSE ADDRESS: WITH APPLICATION pHONE ❑� CONS7RUCTION n:i EXP DATE PERMIT TYPE O ADD1770N O GARAGE/SHED u W11vuUw� 0 BASEMENT FM1SH �ROOF O DRAM TILE O DECK ❑ S[DING O OTHER ❑ SW(MM1N� M?OL � TYPE OF WORK: O REMODELiNG � S-5"5�3� STA'fE_Z1P DESCRIBE WORK BEIl�iG DONE: �e.�(ac� ro� Sdz� �-�. ��?a e SIZE OF IIvIPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft. sQva�s 3� GARAGES PROPOSED SIZE: PROPOSED HEIGHT: SIDING O Vinyl O Aluminum O Otha _ 1�7NDOWS [N EXIS7'INCi OPFNMGS OYes ONo OR FOR NEW OPENMGS-DESCRIBE S1ZE OF OPENING CHANGES & TYPE OF WMDOW TO BE MSTALLED O HOUSE & GARAGE O ATI'ACHED GARAGE ❑ DETACHED G � � �C. � OSo�t � O ?rim O Faccia LACATION OF WINDOWS NUMBER OF BASEMENT REMODELIId(3 SU$M1T: l. Existing Floor Plan - 2. Proposed floor plan 3. List of swcwral manbers W be used FOR NEW CONSTRUCTION MCLUDING DECKS, �DDITIONS. & PORCHES SUBMIT: 1. Siu Plan/Survey ahowing tho wcisting structures and P�� P%1� 2. Two sets of consWcRion plans 3. Epergy Calculations - ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS: (LISING THE 1997 U.B.0 FEE SCHEDULE) TOTAL JOB VALUATION S OCCUPANCY TYI'E Permit Fee Plan Review Surcharge Fire Surcharge License Surcharge SAC Chazge Curb Cut Escrow Erosion Control Pazk Fee Sewer Main CharQ� $ ��`� $ $ �.1� $ $ $ $ $ $ See Back Page for Fee Schedule 65% of Building Permit 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 (Plans to MWCC for detennination) ft+6ft= ftx$20=$ $450 Conservation Plan Review Fee Dctermined by Engineering Agreement necessary ( ) Non Necessary ( ) Make checks payable to: City of Fridley Attach THIS IS AN APPLICATfON FOR A PERMIT-NOT VALID UNTIL PROCESSED lations (�ier�h�r-a-b�uiTding permit and I acknowledge that thc information abovc is complcte 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 applicaGon for a permit and work is not to start without a permit; lhat tl�e work will be in accordance with the approved plan in the case of all work whi h req ' es review and approval of plans. SIGNATURE OF APPLICAIV7' �� PR1NT NAME P� � G��. UP^S �-f l3 DATE � I 12-3 /� � Page 2- Building Rcsidcntial Applicatioii -�•` . BUILDING PERMIT FEE SCHEDULE The Chief Building Official shall, before issuing pernuts far the erecdon of any building or structure, or for any addition to any existing building or structure, or for any alteration or repair to any existing building or structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount herein below set forth and in the manner herein provided toTwit: 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 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 10I2212009 06:20 95280B16BB TWIN CITIES SEWER & PAGE 01�05 From: City oE Fridf�y To: 952808i888 Page: 41d Date:10�'1'?l2�J 3:17:42 PM v� � 'EngiIIeeiing ��►'�'�r � �� + �i �. Permit Nv.: 763-572-355� � PERPVIIT ,�#��LICATIOI� ��v� sy: 7G3-571-12$7 .fax C�TY +�F FRIDLEY I�a,te Rec'a: ��' Z� d� +A,PPT.jGTATIONDAi'E:...,��B�Z.�Q� 'YOURE-MAII.ADbRE35� _ T�IIS,��1.ir,n.lv'r rs ❑ owlvEt:. �cc�'1v�ritncroa roR nnD�: J.�3,L N i 11 �t�ST' A iL �,�_ - NEbVCOTis'fRUCfI0ATP8RMTft�(�APPLICABLE}: _ _—_ ��RTX NAM6: owrr�w nnn�ss: f 331 H� tt � t'� !I�R.. — c�a.�.r �� l�.�I STATE�1l�LIP �� — PHONE; ,,,,,_, ..,.,.. ,.....,... ....n Nt1A�ki;� SUB1f�.�A. COI'YQF ,tbDRffiS:L YdtIR S.T+�� —I LI�ENSE �1 TA PHONE _ d PDIJf'd 77/hi1P STATE LIC # � � �"•=—•-- STATE�ZIP GELL PIIONTs:H� z—� � � �71 �, STATE HOND: � B3� 1. Narrative/a�ritten d�criptioa: ��l C�Z.�JE.' i` l►� �G�i` �1 2. Please attsch sltetch shn�ving eurb line, o'�hllit3+ IiQe? building, etc. wrt6 distancacs ou bgek po�e. 3. Sti�al�ion�. FF.RA�QT TYPE ❑ SEWER CONN�CT��N F�R�1dTf ❑ wATER CdNNFC1TORT PSRM�' ❑ WAT]?R I.INR REPAIEt ,� 9EWBR. LINFs �F�'ATR ❑ ADD STATE SURCHA�tG� D 9.AC CHARGE {� $201m ^ $5� $50 $40 S4� ��.1 - 5.�0 --- � �� ---� - TOTA,L S 4 { �°� `,`-�, OTFJF.�t CHQiBGES (II�' APPLICABLE� PA.7i '�O UTILITY BILLING NEW WATSR METSR CO3�' — Si?fi UTILTfY BILLINCx SPECL4L A35BS:iMENTS � SEE FIlVANC.Ig WATER TAF — SEE ENC•]NEBRNCi '�TOTfi: WATER METER 1�EPAYR., .LhT3P �R SHUTAFF / WEEI�NDS �]�UT.m.aYS $125/H4UR-$IL.L�U 'C.FIIS LS AN APPIICAT[ON FOR A PERM.tT•N4T VAT�I] iJN°TIL PROCE$5ED I hereby apply far a wat�r ox ac+�eer (new c�neztioa ar repairj permi.t s�A Y ackr►owled�e that the ffi£o�zo.s�tio� �bone fs complete a=;d acc�at�; that Chc work wi11 be m conformance+ with thC ofditlattees �r►d codes of the City of Fxi[tley. Z understaud this is not a permit b��t anly ai�. �pplie�tion far a p�nit and work ia rlot ta gtext without a permit. SIG^Ti ATURfi OF APPLICAi� APPROVED SY: _ i ..CC1PY G�.IrT'1 � � �� PRINT N�: ��g,�� DATE: ��' � —� � �= -- �- DATE: � � Z � L� ❑"Ci"TILITY BII.LING (ouly if nea meter) � FUB�LIC WORI�S 0.F,�1'G G Caty af Fridley ° � - Engpteering I�epariment 6431 University Ave�nue NE, �ridley, MN 55432 763-57�-3ssz FAX� 7fi3�571-1287 10J2212009 06:20 9528081688 TWIN CITIES SEWER & PAGE 02/05 From: City � FrEdley To: 9528Ct89�8 Page:'�4 Dane: 1012?J2009 3'17:41 PM Farm State of N�"w►esota SP:C1 Lice�nse Ap��ic�tt �forma#ion Under Niinne�ta taw (M.S_ 2?0.72� #be agency issuing you tbis license i� requir+� to �provide the Minn�sota Comm,xssioner af Revenu� your Mitmesota business tax id�atificatian �.�nber and the Social Se,curity nur�.her of each ].�c.anse appl.icant. U�+der the 11l�ittnesata (�ovetnment ]�aRa Pr�et�ces Act and the Fedetgl. �riva,cy A.et of 1974, we must advi se yr�u that: • Tk�.is infarmation may be used ta deny the issuance, renewa.l or transfer of. your licen.se if you vwe the Mi��.ne�ota Department o.f Revenue dalinc�uent taxes, �ena�ties, or interesr, • Tb�e Licensin.g agency �ll sapply rt only to tbe Minncsota Department of REVemie. However, under the FetSeral Fxchange o� %formatian Act, tlae Depas�tmeat of Revenue is allowed to supply th� xnformation to �e Itatem�3 Revcn�ue Sernice; • Failing to suppiy tlus i.nfcmua�io�n. mav,jex�p�ndize or deJay th� issu�ce of your license or prc�cessir�g yaur renewal a�►plic�t�an. P1�ase f�Il in the �ollowing iu��orma�ion �nd retu.rn ti�s foxan �l�ng w�th yowc applic�tfofi to the agenc� i�uing the license. Do r�ot re'�un t�ais form to tlae Deparbment of Revenue. Person�ll i�n�£orn�ati+on: Praof +�� Wort��rs �ampensation� �nsurance Cave�rage N�ii�xu►esota Statut�e SeGt�an 1?6.1�� requires avfi:rry state and locai l.�oensis�� ag�cy to wi'thh renewal of a Iicense or p�mit to operate a business or engage iit aa� activity i�. Mirmesota presen.ts accegtable evidence of carnpliance with t�e watk�rs" compensatian insurance cov� MSS Chapt� X76. The informatio� r�uircd is: The na�oae of the in�rance cam�ny, t�ie 1 date.s af coverage or the ge�mi�t ta s��f insure. �iis inf�smat�on will be c�1le�tecl b the l�c t�taisied in tlteir files. 'This xs�formation is requi�d by law, �nd licens�s and pernaits to ope�,-ate a bus.'tness m; renew�d if it is �not �rovided and/or is �s.lsely tepc�.rt�d. Furtbe�mare, if. this infor�otation is a fa�sely repcsrted, it may result ua a$2,U40 pe��alty a�ssessed aga.i�st the applic.�nt by the C� �}e�arlme�nt of Labor. and I�dusiry. ProVide the inform�.ion specifi.e.d above i� �e spac� provided. or ce�kify the prec�ise � is dxeluded itorn cornpliance witit t�e insur�ee coverage �equlreme�at for wox'kers' eom�ns� ❑ I am not required to hav� workers' oon�7�ls�.tio�a ltability coverag� be.c�use: 'F� I have �o emp�ay�s eove.red i�y the �aw. a z � S�if�� {��i� ��t t� �� 7 ❑ i l�ave na emp�oyees who are cover�d by th� workers° co�.pens�tion ��w (tYtesc Par�nt's, C1�ildren �d effita,in f�r�m employecs) namc First aama ?S i %�a I �.+5 S � -z g��ra y G� -� �! i�It 1�.) th� i ssu�nce o.r il the appiic�n't requir�ent of cy number, and �n.pt be issued or provide.d aticUat oa�ssianer o� the your business Spouss, �l� i ru G� -t �G x 5 t�! �r a� a �,.,+ a4��t �' C c.t _ s,,.a��.� � Srr� w� � � zip coa� Busiesss addre� G'ti]+ � 10/22/2009 06:20 9528081688 TWIN CITIES SEWER & P�GE 63/05 �t // �I�'��