AF - 461014 �
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City of Fridley, Minn.
BUILDING PERMIT
Da�; August 6. 1970
p��; George N. Bacou g�� Sam�? _
�� 1336 Hillcrest Drive Ad� Sa�ne ,
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LOCATION OF BUILDING ,
No. 1336 g�t Hillcrest Drive � Part of Lot
Lot _._..�.._.___ Block 3 Addition or Sub-Division _M�?�P T•a�p Iiil l s
Corner Lot — Inside Lot � Setback �_ Sideyard
Sewer IIevation � — Founda.tion IIevation
DESCRIPTION OF BUILDING
To be Used as:
S�sZ..rag� Bld� . Front �' Depth ��_ Height Z' �t,.�].ds Sq. FL _2.$.$___ C�. Ft _n16
Front Depth FTeight Sq. F't. Cu. FL
Type of Construction Frame �� �_ 450.00 _ To be Completed Sept . 1970
In consideration o4 the isausnce to me of a permft to construct the building described above I agree to do
th� proposed work in accordance with the description above t forth and in compliance with a'11 provisfona of
orr7inanc� oE the dty oP Fridley.
�
In conafderat[on oP the paqment of a fee of $5�9.0— , permit is hereby granted to
to construct the building or addition as descrYbed above. Thia permit ia granted upon
the express condition that the person to whom it is granted and hia agents, employees and worinnen, in all work
done in, around and upon said building, or any►pert thereof, sl�all cronform in all respects to the ordinanc� of
Fridley, Minnesota regarding locat3on, conatructt��on, alteration, maintenaace, repair aad. moving oP buildin�s
witl�in the dty limfts and this permit may be revoked at ex�y time up� violation of aay of the Provisions of seid
ordinances.
����i�e�.1 .�/.G��c.�i,�t�l�u918ina Inspector
HANK. M[THICH e��
NOTICE:
'�6b psemh dws eot eova� t6s �oe�rodioe, testaWNoe ter rhiee, plumbieg, eas heatieg, mv�r or wa�ar. B� sore to a�
tha Bnildie8 I�aetor for mpero» pormtfa fo� t6�s Nsms.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
OWNER' S NAME : ' BUILDER : ��'�'v12._
annx�ss : /� � /v �1L���.� �. annx�ss : ��o
e
No : , 1.�3 � s�T
LOT: �i/ BLOCK: 3 ADDITION:
CORNER LOT: INSIDE LOT:� SETBACK: SIDEYARD:
Applicant attach to this form 7.tao Certificates of Survey of Lot and proposed
building location drawn on theae Certificatea.
DESCRIPTION OF BUILDING
To Be Used As:
!
Front :_ / Z� Depth : Z� Height : 7/�TUI�c
Square Feet: Z� Cubic Feet: �/�
Front; Depth: Height•
Square Feet; Cubic Feet:
Z�pe of Constructioa: �✓y�, Estimated Cost: $ y�0 �
To Be Completed; ��.� � %' %� .
The undersigned hereby makes applicati�n for a permit for the work herein
specified, agreeing to do all work in attict accordance with the City of
Fridley°Ordinances and rulin�s of the Department of Buildings, and hereby
declares that all the facts aad representations stated in this application
are true and correct.
�TE : � S IGNATURE :
(See Reverae Side For Additiona.l Informa.tion.)
��� � � �` _;
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Iaspector 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 paymeat by the
applicant for such permit of fees to the amount herein below set forth and in
the ma.n.ner herein prwided to-wit :
UNIFORM BUILDING CODE: 1�pe 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 perndts, 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 aurface of the main gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each 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
lese than $5.00.
VERIFICATION OF FOUNDATION
NOTE: 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 coastruction site.
A Certified Survey o# the lot, showiag the location of the foundation, once it
has been constructed, will be required before proceedint� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupaacy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building pesznit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued. •
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�`� � OFFICE OF THE CITY MAiVAGER
CITY OF FRIDLEY
MEMORANDUM
FROM THE C I TY f�1ANAGER
T0:
DATE:
PUBLIC WORKS DIRECTOR
NOVEMBER 15, 1974
,
Memo No�� D s- i i s
Respond by: �
v` New Date : �
--�-���- �}_ �� � �� � Jf
SUBJECT: BIG PINE TREE REMOVED BY THE CITY AT WEST END OF
60TH UNDER PROJECT 1972-1. COMPLAIrTT BY GEORGE BACON
TO COUNCILMAN UTTER ��Q���J'i/
�'��� /�i,c�c���� .��� °,���'
George Bacon talked to Councilman_Utter and indicated
he has been talkinq to Darrel Clark about the lose•of
a big pine tree during street construction, and no
action has been taken by the City.
�
Please review the item and take appropriate action.
Thank you for your assistance. -
NMQ/ms
CC: Darrel Clark
November 21, 1974
PCI was contacted and they indicated that they thought the
problem had been taken care of, however, they would meet with
the owner the week of November 25th to see what additional
work might have to be done.
RNS/jm
December 6, 1974
Contact has been made with the property owner regarding the damage
done to the tree. Appropriate replacement waTl be provided and
work to be done in spring.
RNS/jm
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� i PURCHASE REGIUISITION ��-
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REQ'N. DATE IDELIVERY REQUESTED I SPECIAL INSTRUCTIONS a
RECOMMENDED S UPPLIERS
SHIP TO
ADDRE55
SHIP VIA
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FOR WHAT
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DESCRIPTION
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White - purchasing Canary - Acknowledgement Pink - Requisitioner
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From ths d�sk vt
NASIM QURESHI
CITY MANAGER'S OFFICE
DATE: September 24, 1986
SUBJECT:
Call From Don Savelkoul, Attorney
Fridley State Bank regarding
George Bacon Property
MEMORANDUM �R- a2
TO
Jock Robertson
0
Y
ACT10N UPDATE
9/26/86
Mr. Savelkoul called and stated that �is client George Bacon, 1335 Hillcrest Drive,
has been contacted by Mr. Y.och from Concentral Jevelopment Corporation regarding
buying part of his property for development for vacant property south and west of
George Bacon's property.
Mr. Savelkoul's inquire was regarding Mr. Koch's credentials and ability to do what
he was proposing.
Please review this matter and if you have a proposal plan, discuss it with me.
Thank you for your assistance.
NMQ/la
T0: Nasim Qureshi F�QM: Jock Robertson �,TID: Oct�ober 2, 1986
Ni3rk Burch has worked with Mr. Cook (not Koch) on other projects and says he
is reputable. We do not have ariy other information at this time on tY� proposed
project behirrl Mr. Bacon at 1336 (not 1335) Hillcrest Drive. See attaciied map.
JR/ts
Attacl�rnnt
sua�ecr PERMIT NO.
City of Fridley 2000 5
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
; � RECEIPT NO.
� `L � COMMUNITY DEVELOPMENT DIV. �� A��
f � � PROTECTIVE INSPECTION SEC. y
' i '
� /'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. bATE PAGE OF APPROVED BY
�..__11.• •�� 612-571-3450 910-F15 7/17/89 / /
J08 ADDRESS 1336 Hillcrest Drive N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 21 3 Moore Lake Hills SHEET
2 PROPERTYOWNER MAILADORESS ZIP PHONE
George Bacon 1336 Hillcrest Drive N.E.
3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Richar.d Ha$tings Roofing 6331 Riverview Terrace N,E. 574--9�66
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION �l REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof DHtellix�g (32 Squares)
9 CHANf3E OF USE FROM TO
STIPULATIONS
On '�� Iln�� Tnfp /,�l �^�1 n�('.
S:,;t� �';�de �u�tl�i£� :1�3;r ,, �� ����!ar�^�g�t roOfS,
mapp� tQ$eth�r. be inst Iled. to � f 15 I�, felt,
�p frQm exterio�r �a11 fine, or ihe ��� Qf D� hes
approved �u,r,���,�y,��t mem6ra�e
SEPARATE PERMITS ARE REQUIRED 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 ZpNING SO. FT. CU. FT.
AUTHORI2ED 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 WOHK IS COMMENCED. • NO. DWLG. UNITS OFFSTREET PAHKING
I HEREBY CERTIFV 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 $1 � 6OQ. $. SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TNE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 3'].00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
PLAN CHECK FEE TOTAL FEE
y�3%a 80
SIGNATUREOFCON7RACTORORAUTMOHIZEOAGENT �onTEi �/�IHb�V PROPERLY VA IDATED THIS IS YOUR PEFMIT
/
SiGNATUREOFOWNERiIFOWNEFBUILDER� IDATEI BL�G iNSP rypT�
� [ J Effective 5/1/88
� L ] R-1 AND i�2
�� [ J Buildir�g Permit Application
c:onstructian �. �: _ / 3L� �6 �r�C L C �� s°t D �
Isgal Descrip�tioaz:
Owner Naiae & s �: _ � � � R � � � A c � �Y Tel .
- #
Contzactor: � i c_ l, �,� � �{� s f'r',v 6 S' Tel. #�S 7 y-9 �66
s.aa � � �
� �
_ �� 1 �V.���a���,/ %'�,
Attach to this application, a Cettificate of S�vey of the
lot, with the pro�o�ed ow�struction drawn on it to scale.
D�IPiI�i O�F II�VEt�Tl'
I.NII�iG AREA: TpTM� h Width Height Sq. Ft.
Q�iR�GE AREA: I,eT�gth W'ldttl HE1gYlt Sq. F't.
DECK ARETi: Ierx3t-h Width Hgt/Groiu�d Sq. Ft.
O�:
Corner Iat [] Inside L�t [] Ft. Yd Setback Side Yard SetbacJcs
ZYpe of Consttuction: _(Z��aof �I'°'�A��FF Estimated Cost: $ ldao
Approx. c�npletion Date: �lS/�� 3� S-� .
Prop�d Driveway Width If New Openinq Is Desiredz Ft. $ $
Width + 6' See Baalc Page
np,�: 7 c? a� ��c�r: ' / :� z'ei. #_ s� y- ���.G
P�erm.it Fee $ �� �% L1 �
State S�r.hax,ge $ � c�
SAC C�arge $ .
Drive�ray EsGra„i $
Park Fee $
Sewet Main Charge $
• Y•
����5 :
�
� �� �� b
CITY 08E �Y
Fee Sdiedute on Reverse Side
$.50/$l,00o valuation
$575 per SAC Unit
Alt. "A" or Alt. "B" Ai�ove
Fee D�ete�.miried bY Erigineerir�cl
Agreement Neoessaxy [ ] Not NPCe.ssary [ ]
a
• 4 . _ �
�:_�1� � �,. ��+;•��y :�:�- : �.:i:��:��
The Chief Buildirg Official s�all, before issuing peraiits for the erection of any
buildir�q or stn�ure, or for arYy additian to any existiryg build9r�q or structure, or
for ariy alteration or repair to ar�y existir�g building or structure, upon application
therefore, require the payment by the applicant for such permit of fees to the amau�t
herein below set forth arri in the mar�es herein pravided to�-wit:
ZO�rAL VAIIJE
$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
M��a±-?
Sl5 (Minina� �ee is $15 plus s�chaYge)
$15 for fixst $500 plus $2 for each additional $100 or
fract3aa'i thereof, to and includi� $2, 000
$45 foY'first $2,000 plus $9 for each additional $1,000
or fractian ti�ereof, to ar�d including $25, 000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fractia� thereof, to and iricluding $50, 000
$414.50 for first $50,000 plus $4.50 for each additional
$1, 000 oz' fractio�l thereof, to and includirig $100, 000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thex�eof, to and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, t� arid 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 frackion thereof
ffitIVL�It �P�88I�1 ffiC[i�W
(�ete C1irb Streets On1Y)
Alternate ��A�� ; R+emoval ar�d replaoement of curb ar�d gutter only - Driveway width plus
6 feet times $13.50.
Alternate "B" : R�naval and repla�snent of c�cb and gutter ar�d install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
��::�• .� �� .: .�� .��, �� � .�
P�Cl1.tS for C�i1G'�lOI1 W111 be 3SS11g�1 ��ninirnm+ of 24 hO11Y5 fY'C84 �]+L' t],II12 of
agplication t�o allcw for prc�per review of t�e proposed structure ar�d of the
vo�st.l.vctiari site.
A Certificate of Sutvey of tt�e lvt, shc�wirg the location of the fourr3ation onoe it has
it has beeiz vonstruc.�ed will be required befor+e prooeading with the framirig.
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CIIYOF
FR[DLEY
FRIDLEy MLJNICIP�, CENTER • 6431 UNNERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
October 3, 2001 PWO1-059
Qwest
Angel X Meulners, Claim Office
1801 California, Suite 2210
Denver Co 80202
Subject: Notice of Claim (0119372)
1336 Hillcrest Drive
Dear Ms. Meulneers:
I have reviewed your "Notice of Claim" (0119372). I interviewed the City's construction inspector
regarding this matter at 1336 Hillcrest Drive. It is my understanding that the service wire was
buried too shallow in the City's right-of-way. Although the line was marked and potholed, the
wire was damaged during the removal of the 6-inch concrete driveway in the front yard adjacent
to the curb as the wire was only 2-3 inches under the concrete driveway. Prior to beginning
construction we were notified by Qwest that the wires were clear. Qwest was invited to attend our
preconstruction meeting but did not attend. Thus the claim is not valid as the service wire was
too shallow under the driveway.
If you have any questions, please contact me at 763-572-3551.
Sincerely,
Layne Otteson
Assistant Public Works Director
LO:cz
cc: M. Everette/City of Fridley
:,: _�'''
�s•
ridt t�� l��i�t .,.;;:�':
.�'�°
� � �w
1801 California, Suite 2210
Dem+er, Colorado 80202
09/27/2001
NOTICE OF CLAIM
Honorable Mayor of
CTTY OF FRIDLEY
7000 Lf1�IVERSITY AVE NE
FRIDLEY , MN 55432
RE: Our Damage Claim: 0119465
Thic Notice is tendered to alert yon that QWEST sustained damage to communication faciliti�.
Thank you in advance for yonr prompt attention and concern
1. NAME AND ADDRESS OF C.I.AIIVIANT. The name and addreSS of the claimant is QWEST,
Claims Office, 1801 California, Suite 2210, Denver, Colorado 80202.
2. STATEMENf OF BASIS OF CLAIlVL On or about 08/29/2001, in the vicinity of 1340
ur�.i .[ :uFST, in the city of FRIDLEY, and the State of Minnesota; one or more of your
employees or agents acting within the scope of their emplayment damaged a BURIED SERVICE
WIRE owned by the claiman� Your employ� or agents caused said damage during SIGSWAY
STREET EXCVATION.
STATEMENT OF NATLJRE AND EXTENT OF INNRY. As a result of the above descn'bed
damage, the claimant has ���a�ne� financial damage as a result of having to employ its men and
machinery to repair the damage.
4. AMOUNT OF DAMAGE. The amount of monetary damage is $ 9530. Should you have azry
questions or disagree with our assessment of damage.s, please contact the undersigned.
ANGEL X MEULNERS
QWEST
Claims Office
1801 California, Suite 2210
Demer, Colorado 80202
866 864 2255 Ext 3794
City of Fridley Building Inspections Dept. Ph: 763-572-3604 FAX: 763-571-1287
6431 University Ave NE
Fridley MN 55432
�
Mecha-nical Perrr��t# ����° ���5
Residential Application
City of Fridley
See Back Side For Required Information-
Date q-!H -� Site Address: � 3�� /-� �`/�c r�.sr A/L
The ap licant is: (cirlce one) Ov�mer ntra or
Property Owner: Ld �. ar+. ��f � s°4-�
Address: 13 3� �+.11 c i�s�f-- D v�
City: F r'A(� State: �� Zip: �4"Y3z
Phone: iCo3-��y-a°��' Cell: Fax:
Contractor Information
CompanyName: (a��,c �an S��c
Contact Persor�: �-�
Address: d� i L-1 2 t A�;y�ti�•y�.( ¢- Sr n� w
City: C o�� 2g�, ,�s State: �+� Zip: ���5�3 2-
Phone: 7�3 -� SS'-Ce'�f�8 CeIL• f��a-ZS�-�Sq 7 Fax:
Email: MN Bond# & Exp Date
Type of Work (circle one): New eplacement AlteratioNRemodel
Detailed Description of work:
R�move� ►2 e� � �� �� 9c��' Li� '� %�-t �Ir�- �- /-'r�
N e�,.� y
Equipment Installed: MFG: w.s odel: Size/BTU: !.� f' f vJJ ?
MFG: Model: Size/BTU:
MFG: Model: Size/BTU:
Please check all that apply: _Fireplace (gas) $15.00 New Gas Grill-$10.00
A/C $25.00 _Fireplace (wood) $35.00 _Gas Unit HTR $10.00
Airto Air exchanger $15.00 Fumace $35.00 _Pool Heater $35.00
Boiler $35.00 Gas Dryer $10.00 Ventilator $15.00
Chimney Liner $10.00 Gas Piping $10.00
Duct Work $10.00 �Gas Range/Oven $10.00
Permit Fee $ Minimum fee $15 or 5% of cost of improvement
Surcharge � 0.50 whichever is greater + surcharge
Total Due $ Make check ayable to C' of Fridley
This is an application for a permit- not valid until processed
I hereby apply for a mechanical permit and I acknowledge that the informa�on abova is complete and
accurate; that the work will be in conformance with the ordinances and codes of the City of Fridley and
with tha Minnesota Construction Codes; that I understand this is not a permlt but only an application
for a permit and work is not to start without a permi� that the work will be in ac.cordance with the
approved plan in case of all work whfch requires review and approval of plans. �
Signature of
Approval I ns
Date: �� y�
Date: (� C ��
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
Revised 6/14/2005
REQUIRED iNFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HQMESIADD{TIONS ❑ EXISTING HOME ❑ MAKE-UP AIR
REQUIRED FOF� NEW/EXISTING HOMES
1. Combustion Air (See note below)
a. Oil or solid fuel lMC Chapter 7 with MN Amendmen.ts
b. Natural Gas or Propane/IFGC Chapter 3 with MN Amendments
2. Make-up Air (See note below)
a, IMC Chapter 5 with MN .Amendments
3. Venting
a. Gas appliances IFGC Cha.pter 5 with MN Amendments
b. Fuel other tha.n gas 1MC Chapter 8 with MN Amendm.ents
REQU(RED FOR IdEW HOMES
4. Heat loss & cooling load. per room
a. Required on new construction IMC i 346.0312
5. Ventilation
a. Per N1N En.ergy Code 7670 or 7672
6. Duct Design Per IMC 134-6.0603.2
a. ACCA Manual D
NOTE: Centerpoint Energy Mechanicak Code Guidelines software may be used for
combustion and make up air calculations
����-��33�
City of Fridley
6431 University Ave NE
Fridley MN 55432
(763) 572-3604 or Fax (763) 502-4977
Water and Sewer Permit Application
❑ New Connection
�'Existing
„ ��Date• .�,��
Job Address:
Name of App
Name of Prop
Existing Structure Permit #
�Utility Line Repair/Relocation
❑Water and Sewer Connection
Permit Type: Sewer Fee:
ater Fee:
ee:
Repair Fee:
Relocation:
State Surcharge:
SAC Charge:
Special Assessment Fee:
Total: $ �� pC)
Applicant
Inspector approval:
_Water Meter Repair — Weekend & H
Water Connections Perinit
Sewer Connections Permit
Inspection Fee for Water/Sewer Line
�ecial Assessments
Cost of Water Meter
SAC Ch e
Sta.te Surcharge
Water Tan
$40
_ See Engineering
See Utility Billing
$1675
$ .50
See EneineerinF
Building
[nspections
763-572-3604
763-502-4977 F�X
DA7'E t U 51 '(] �
SITE ADDRESS 1,�„
THIS APPLICANI'1S-
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE I-I-0S
Pernut No..
Received By:
Date �
YOUR E-MAIL ADDRESS �'�a�l k 2+'1 (.� �� �% �(nG�l� i,(�'j;,k. .
❑ OWNER �CONTRACTOR
PROPERTY OWNER/ NqME: j,r,t !� .�f-, e�`�,,.�,e� .
TENAN'Y' ApDltESS: �t �z ,
CtTY
PHONE: �76�' � �S� — Zv C� -
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY
PERMTT TYPE
TYPE OF WORK:
DESCRIBE WORK BEIAiG
SIZE OF IMPROVEMENT
ROOFING , J�
NUMBER OF SQUARES `L
GARAGES
PROPOSED SiZE:
PROPOSED HEIGHT:
SIDING
O Vinyl
❑ Aluminum
❑ Other
'ATE ZiP
ADDRESS: �G3% e%��° �v+'. �`� CITY Ci�(uc�.btx' %��(� STA�ZIP �,� 'i�(
PHONE 7�,3 -iC16--L2 rS3� FAX
STATE LICENSE #�60� �-%S% EXP DATE Oe� % O/
�I SMGLE FAMILYMEW CONSTRUCTlON SIZE
❑ TWO FAMILYMEW CONSTRUCTION STORIES
O BAS�MENT FINISH �ROOF � DRAIN TILE
❑ DECK ❑ SmING � O OTHER
❑ SWIMnRA1G POOL
O AiEW HOME CON3TRUC7'ION ❑ ADDTI'IOAf
�I MAWTENANCFJREPAIR ❑ REMODELING
WINDOWS
IA1 EXISTING OPENINGS OYes �No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED
❑ HOUSE ONLY
�Pi HOUSE�AG"E
❑ ATTACHED GARAGE
� DETACHED GARAGE
�Soffit
❑ Trim
� Fascia
LOCATION OF WINDOWS
NUMBER OF
BASEMENT REMODELMG SUBNAT•
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUSMIT:
I. Site Plan/Survey showing the existing struchues
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:
TOTAL JOB VALUATION $ ����`�j�G THE 1997 UBC FEE SCHE OCCUPANCY TYPE
Pertnit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chazge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ c
$ ,�
$ `�L� U
$
$
$
$
$ .
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)
$1825 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined 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; t�jat I 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 th approvfj� �plan in the cese of all work which requires review and approval of lans.
SIGNATURE OF APPLICANT G��� � ,.�� PRINT NAME �dt DATE 1 Q'�'°i(j�
�'
APPROVED BY ��
DATE
page 2- Building Residential Application
BUII�DING PERMIT FEE SCHEDULE
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�3� existing bt;i� or .s]zucture, upon applica.tion therefore, require the payment by the
applicant for such permit of fees to the amount herein below set forth and in the manner herein
grovided to-wit:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the loca.tion of the existing foundation will be
required before proceeding with the framing. New I'iouses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432 '
763-572-3604
Faz: 763-502-4977