AF - 46682City of Fridley, Minn.
BUILDING PERMIT
nate: �Y lU, 1y66
° 8817
Owaer: CLAiRENCL GRAVEa Builder RTE�tARfl .T.�u u,�S
Adaress 413 Pa�aoraa�a Avenua N. E. Ad� 8`5 � Mo�rc�e :; t LT1 �
Frid],ey, Mi�esota 55421 Mi�ne,aaolie. �13.�ne�ot,s 55�32---
� . CA �O�,V OF BUILDING
No. —1.�� Street _._.. E..._�.� Part oP Lot
Lot ._._._�..___ Blocic Additfon or Sub-Div�sfon . S��L�/�Ai �f�RBS
Corner Lot — Insfde Lot � Setback �� � Sideyard Lo �� ��
8ewer IIevatian � �� �--.� IIevation � � �
/
DESCRIPTION OF BUILDING
To be Used ae:
7'�LL,�DiG Front �.... Depth .._�._ Height .._`�Cl.� Sq. FL 1�.:kiu1 Cu. Ft �p
GARl�GS Front 2 Q Depth 24 iTefght _.._.� Sq. F� �.�$.Q Cu. Ft. _.�,.$DO
Type of Conetruction �"�. Es� Coat _._..�: .Li.,.Gl�9�..�.--.- To be Completed
� �--' � - . � 7 . , .. _ _ - � _ �:: ���<-�
t
.� �.i_ .�. n P �qli� � r,��- � _ r'. '_ _ � _ - _;�'-_
.�� - -., `_ r �Ca�; � y... •�.^. .af� � ��i�_^_ M _, ^� ... �.�. .`:�s��%'as`��4w` _ ",�'��s'_.`�.
��s �.�. _.•z.< .,�� �� , . ���. .$;_., � F � �:. � 6
Ia consideratlon oP the iseusace to me oP a permit to conatruct the buflding descrlbed above I a�ree to do
the P�P�Ed work fn accordance with the d�ecripi3on above set forth aad ia compliance wlth efl provisinns of
onifnanoea oP the dty oP Fri�IIey.
Ia camaideratton oP the payment oP a fee o! ��3� � Permit ie hereby �ranted to Rz aA� M'n'.i.'RR
v � to Constrllct the building or 8ddition ae descPlbed above. Th1s rmlt 1s grant�d upoII
the exgress conditton that theperson to whom it is granted and hfs a�ente, employees an�worl�nen� ffi sll work.
done in, around and upon eaid building, or anypart thereoP, st►all c�onPorm in all respecte to the orrlinances of
Fridley, Minnesota regardia�g locatlon, conatruct�on, alteratton, �aintenaace. repeir and movl:►8 oP build1nge
witUin the dty limite and ti�is permit may 6e revoked at aqy tisne upon violatlon of aay oE the provieions oi eatd
ordiaaacxs.
ALL:�3 �. ..'EI+T:;�P� HullaiaBlnePector
NOTIC6a
'Ihb p�emtf da� eot cew� �h� eeedruaHoe, fn�taUaHee Io� wMao, phrmbtno, Oa halhfa, aw�r e� waM�. d� wn to a�
�6� Bulldieo Insps�fo� }or aparai� p�emif� Mt f6a� ii�mt.
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APPLICATIOIV FOR� BUTLDIIQG PERMIT� ;'
CITY OF FRIBLEY, MI1�1ES0'tA
OWNER' S NAINE___�� BUILDER ! 1�
ADDRESS � I 3 � ADDRESS � Z 6
LOCATIOAI 4F BIIILDI��' � � ` �
r ,�
N0. :� � � �, STREET �� 1;� ^rL-��� �.g � '' . PART OF LOT �
� � �
LOT BLOCK �— AADIZT � OR . SUBDIVISION ✓' ��°'�-/1-��
CORNER LOT INSIDE LOT X SE�.`BACR ' ��/ SIDE-YARD �� �' � S-
_� .
SEWER ELEVATION FOUPDATION �LEVATI014
Applicant attach to this form Two Certific�tes of Survey of.Lot and proposed
building location drawn on theae Certificates.
D�SCRIPTION OF BUILDING
To be used as;
_ . ,��'�ds` Front � Depth� eight � �
Sq. Ft. � � � Cu. Ft. � ��
Front Depth"���Height � f�
Sq: Ft. Cu. Ft. � ��
Type of Construction ��s� . � Estimated Cost � � �� �
To be completed_ ��-ta� � _ � � � .
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work ia strict accordance with� the City of
Fridley Ordinances and rulings of the Departmeat af Buildings, and hereby
. declares that a11 the facts and representations stated in this application
are true and correct.
DATE 7'�- �� G G SIGNAT[TRE
�
(Schedule of Fee Costs can be found on the Reverse Side). �
��
�
�`\ /"�
R -s � 7
�If � a �
BIIILDING PERMIT FEE S�EDIII.E
SECZZOR 2_ The Inapector of Buildings shall, before isauing any permit for
the erection o£ anq building or structure, or fos any addition to any euisting
building or etructure, or for any alterationa or repairs to anq existing
building or �tructure, upon application therefore, require the payment by the
applicant for euch permit of fees to the amount hereia below set forth.and in
the manner herein provided to-wit;
2.1. For any such permit for the erection of any fire-proof building,
other t a a garage, warehouse, factory or grain elevator, or for the erection
of any fire-proof addition, for aimilar occupancy, to any esiating building,
shall be at the rate of $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2 For any such perm�it for the erection of any fire-proof garage,
warehouse, fectory or grain elevaCor, or for the erection of any fire»proof
addition, for aimilar occupancy, to any e$isting building ahall be at the
rate of $1.25 for each one thoueand cubic feet, clasaified as "fireproof"
by Section 502 of the Minneapolis Buildiag Code.
HOIISES
2.3. For any such permit for ehe erection of any noa-fireproof
building, other than a garage, warehouse, factorq or �rain elevator, or
any non-fireproof addition, for �imilar occupancy, to any euisting building r
permit $1.00 for each one thousand cubic feet.
GARAGES
2.4. For any such permit fo� ti�e erection of aay non-fireproof garage,
warehouse, factory or graia elevator, or for the erection of any non-fire-proof
addition, for similar'occupancy, to any egisting buildiag or for each such
building ar add3tion - ninety cents ($0.90) for each one thousand cubic feet
or fzaction thereof, in the cubical contents thereof with the miaimum of $4.00.
For the purpose of computing feea for buildiag permite, the cubical contente
of any building or addition to a uaiform height throughout by multiplying the
grouad area covered fram a point sf.x (6) inchee below the floor line of the
basemeat or cellar Co the average h0��ht of tha upper auriace or to the average
height of the roof surface of the main gable of a pitcbed roof.
2.5. For repairs or alterations to an existing atructure, the fee s?�a11
be at the rate of $3.00 per each Five Aundred Dollars ($500.00) or frac�i�n
thereof in the cost of all proposed work.
2.6. In no case 8ha11 the fee charged for any permi� as aet forth in
Sectio 2n be less than $4.00. �
STORM REPAIR DAlY1AGE EEES :
Reaidential; Estimated Cost of work up to SSr�.�?� - 55.�?0
Estimated Coat of work ove� ~:•;�;:;:.A:a! ��;�.;,,'�;0
Co�ercial; � Estimated �st of wo�'�. •��:-� ° ,, ':� _�':; Lt>> r ;^,.� r• �r�
- " Estimated ��st of W+JL�s ov�r y::�i;Z�,fJt1 - y�iJ,;„,
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HEAT LOSS CALCULATIO � R TM E N T O F 1 N SP EC TION MINNEAPO(.t.S. NIINN.
Weather�trips A� Guide � Conatruction 1Vo. Insulation
Windows Doore Reference Out. Wall Int. Wall Ceiling Roof Floor Kind How Applied
Yee-- o I Ye� 19_
F1.�,L► �- Room Length Q.Width /¢.Height Fl.� cc�iP , Room Length Width Height
Win�ws a Doon—Crackage and Area Windows and Doors—Crackage and Area
Wldth Heiebt No. o[ Llneal tt. Area Wldth Height No. ot Llaeal tt. Area
NO. ot psne ot pane Ilghts ot crack e tt. ��� No. ot Dane ot Dane IlBhte � ot crack W [t•
O � �J � ^' � �, � ¢
� � � y ) ��
Coef. Btu Coef. Btn
In6ltratioa s' Infiltration �
Cilats c� � Glaaa . �..., .
f�tp. wall � � Exp. wall � y.•
Net eYp, wall .� Nec eap. watl �' S� 1
�at. wall Int. wall
Ceiling • /G .� �.-- D Ceilins ...� fr - ♦/ L :�' �.Z �'
Floor l .Z
Total Btu.
Rcquired �q. ft. E.D.R. or aq. ins. W.A. l.eader area
F7. ' Room ( Leagth Widthj )— _Height '
Windowa and Doors--Crackage and Area
Idth Hel�ht No. o� Llaenl ft. Are�
Na ot pane ot pane Ilght� ot onck sp. tt.
� �� !
e '
Q
Coef. Btu
1�51tratroe � $ � •
-� _ -__ - - ------ _ 5a-• o �G��•
M� �
Akt etp. well
In� wal)
��_
Ceila�
f loor
__�
T�el Bcu.
Reqaire� aq. k. ED.R. or aq. ina. W.A. Leader area ��
FI. • Room � Length � Width p Hei
�'� and Doon—Crackage and Area
th He1�At Na of Linea{ tt. Area
llp, ot w o( psee II�AI� ol erack �Q. ft.
• A� � _ rLJ . � � i �
L .d �-
���
Floor
Total Btu.
�uired sq. ft. E.D.R. or sq. ina. WA. Leader area
Fl•� ? Room � Length / Width
Windows and Doore—Crackage and Area
Wtatn Hatght No. of Llneal ft. Aree
No. o[ pane o[ yans 1166t� ot crack ea. [t.
� �
� / �
f
Inbltration
Cslaaa
�p. Weu �
Net c:p. wall
Int. wall
Ceiling � � y,
Floor
Total Btu.
Required aq. ft. E.D.R. or nq. ins. Q/.A. L.eader arw
� Fl•I /rl �. Room I LeaB�h 5,,� Width
/r
Windows nad Doors--Crackage aad Ana
R'idth He1�ht NO. o[ Lineal tt. Are�
No. ot pane ot Daes 11[hts ot crack p. tt
2 �/J � ` � �U'�� I �t•
B� I I
�L, A Infiltration
.� � v . Glasa
Eup. wall Z � �
5 �!v . Net ezp. waU
1nc, wall
^� — .
��i �. '
A. E.D.R. or . ie�. W.A. L.eader area /
ICeilin
Floor
0
� :„
I r11��
��
��
1 /lJlf�
_ Tocal etu. _
Required sq. ft. E.D.R. or sq. ina. WA. l.eader area
y �.. �
v
b!6 e � e
HfAT L�SS CALCUI.ATIONS UEPARTMEN'T OF (tiSPEC"�ION MINNEAPOLLS. NIINN.
Weatherstripa A'S' ' Conetruction No. lnsulation
Guide � - ---- --
`tVindowe I Doore Reference Out. Wall Int. Wall Ceiling T Roof F1oor kind How A
Yt� e— o- Y- ee—�Vo 19_ -
F1.� �-� Room Length •„> Width Height ,•• �I Fl.) Room l.cngth Width
Windows and Doora—Crackage and Area W�ndows and Doora--Crackage and Area
�Vldth He1gAt No. ot Llneal It Area I` VVldth He�ght No. ot Llneal tt. Area
N0. ot Dane of Dane Ilghte ot crack ea. tt. No. ef DB�e ot pane Iighte ot crack ea. tt.
� � �'� �� ------ - - - —
Coef. Btu � -� ^ — _ C
In6ltration "'�� � - � Infiltration
�a!! � y �:.• r Cilass - - -----
EYp. wall 7! ;� :: Exp. wall`---��----
I�let e=p. wall <� Net exp. wall _ __ ____
lnt. wall Int. wall
Ceiling / 4� � �' c= Ceilins --
Floor % �" � v • Floor
Total $tu. � ,�r L� ' Total Btu.
Required sq. k. E.D.R. or eq. iae. W.A. Leader area 1 Required sq. ft. E.D.R. or sq. ins. WA• Ltader area
FI.� Room Length = ,Width /. Height ( Fl,I Room I Length VVidth
'I�liedows and Doore—Crackage aed Area Windows and Doors—Ctachage and Area
Idth HelgAt No. oI Linenl tt. Are� 1 R'Wth Helg�t No. ot Lineel lt. Area
NO. ot pane ot pane Il�ht• ot erack tt. j� / No. ol Dane ot pane IIB�te ot cr6ck eq. tt.
f � �
! �' / • ��t � J� v �
� � ��
Coef. Btu
Ynfilartion '� o
GI��. --
�'r►� �a '�.-
;VN e�p. wall
let. wall �. �/ ' /}-
Ceiliag /b
F'lor►r
Tot�l �.
�
! ' ii
��
��
� ,� �
�0
��
—
ft. E.D.R. or eq. ina. WA. l.eader area
Room � Length Width
and Doort--Craekage snd Area
er �q. ine. W.A. Leadee �rea
�„ . ,
n
�. I
8cu
�
Infiltration
Glaea
Eup. wall
� Net e:p. wall
Iac. wall
Ceiling
Floor
Total Btu.
Requued eq. ft. E.D.R. or eq. ine. W.A. Leader area
Fl. Roam I Lxngth Width
Windows snd Doort--Crackage and Ana
RTidth Helafit o. ot Llneal ft. wra�
No. ot Mne ot D�os Il�hts ot crack W tt.
Btu
Coaf. Btu
In6ltratioa
Glaes
Esp. wall
Net eap. wall
Int, waU
Ceiling
Flaor
Total Btu.
Required sq. ft. E.D.R. or sq. in�. WA. Leadet area
- ---_
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City of Fridley
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53-81�-sz915.51 � - - -
i��ECT
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PLUMBI�r, PERPIIT APPLICATI���d
1 7 � V�
ob Address
1323 N. F. Hill ��rind Road
wner
Cl�r�nce J. �rabes
Contractor
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?88-1�35
ss �3� �pkQUETTE AVE e
?�es.
. 10.00
Plumbing Fixture Rates; N0. RATE TOTAL
Number Fixturea x $2.00 �_
Future Fixtures x $1.50
New Fixture-Old Open. x $1.50
Catch Bastn x $3.25
Water Heater-99,000 BTU x $3.00
Ground Run Old Bldg. x$3.25
Elec. Water Heater x $2.00
� Gas Fitting Fees:
lst 3 Fixtures x $2.00
I -
' Additional Fixtures x $ .75
�
IGas Range-199,000 BTU x$5.00
� Regairs & Alterations
See
Description: Space Heater Code 5.00
Siegler S�,�-32-2
State Surchart�e .50
� Class��'�A� Surcharge .50�
iTOTAL FEE $ s.50
�The undersigned hereby makes application for a permit
f�r the work herain specified, agreeing to do all work
in atrict accorda.nce w ith the City Ordinances and rulin
of the Depaxtment of Buildinga� and hereby declare that
a11�th� tacta and repxesentatione etated in thia
application are true and correct.
�$.� ��$*�� a� • j��►�
'Signature �ip��q�� Date
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HOUSE HEATING TEST RECORD
ADDR�SS���; ���1 tnTinrl �oa.d Fridle r�aPT. FLOOR CITY SUBURB
OCCUPANT �%larpnce Graves OWNER
H�AT LOSS DATE HTG. INST. GAS C0. METER BADGE �
SOLD BY Minne�asCO INSTALLED BY
Etectrical Work By
Gas Line By
T?TPE OF HEAT GA FA HW STEAM SPACE HTR. x UNIT HTR. OTHER
' GAS DESIGN CONVERSION
MAKE � MAKE OF BURNER
Model sW'�' 2�2 Model
Serial _� � Max. BTU Rating
INPUT MAKE OF FURNACE
Model
CONTROLS
THERAAO�TA� Heat Plug Vent Size
Valve �a�0 �'� ��� `I o-�� KIND OF LINER SIZE NONE
Limit `�- Droh Hood Regularor
Limit Sefting �^ Filters Size Number
Fan Setting Chimney Loeation Inside Outside
Pilot Type Chimney Construdion
Pilot Make — B�� 1°' g?�j
Pilot Model Smoke Bomb Wiring
Pilot Timing �� �� `� Draft Test Tag
L�:W. Cut Off Door Pressuro Lighting Inst.
Pressure �� �� PereentCO Date Tested /�' ��` � I ,,�'l � �
• 2 v'�D�d �?s ��
'�i�put CFH �� Pereent OZ Company Testing
Staek Temp. Percent CO Name of Taster �-(r���Q �� d�
Form 235
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CHIMtJEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (,)
,
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. Meets all current Code requirements for size and
fi8��}--�Ti) �v^Tm�c".�cu - -- --- --
6. Has To tal hea ting BTU's of
All other BTU's
TOTAL
Rema rk s
No ( )
No ( )
No ( )
No ( )
Yes ( ) No ( )
Com pa ny
Signed By
i3a �e
c�ty of Fridl��
AT TNE TOP OF THE TWINS
i�
� �
� ; y ����� COMMUNITY DEVELOP�MENT OIV.
f � � PROTECTIVE INSPECTION SEC.
i = .
� �"'1 � CITY HALL FRIDLE� '35��2
�----�" �•� 612-571-3450
�IT NO.
�UILDIN� PERMIT 255
NUMBER
s�aF�s
RECEIPT NO.
�� ��
OAT@ VAGE Oi APOROVED 8�
4/30/02 / /
JOB ADDRESS 1323 Hillwix�d Road NE
t IEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR. �F Sheridan Acres
2 PFOPERTY OWNER MAIL ADOR�S$ Z�P
Dex�nis Doege 1323 Hillwind Road NE
3 CONTRACTOR MAIL ADDRESS Z�P
Pheasant Run Construction LLC 1109 141 Lane NE, Ham Lk, MN
a ARCNITECT OR DESIGNER MAIL ADDRESS Z�P
5
8 USE OF BUILDING
Residential
7 CLASS Of WOFiK
ADDRESS
❑ NEW � ADDITION O ALTERATION
8 DESCRIBE WORK
Revlace wir,dows within exi.st
9 CHANdE OF USE FROM
TO
21P
�7 REPAIR
SEE ATTACNED
SNEET
763-571-1954
PMONE IICENSE NO
55304 763-862-2106
PMONE LICENSE NO.
20193061
PMONE LICENSE NO
O MOVE ❑ REMOVE
STIPU�ATIONS
Provide smoke d�tectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1997 U�aiform Bui�ding Code.
--- — - ---
SEPARATE PEIiMITS ARE REOUIRED FOR ELECTFICAL, PLUMBING, MEATING,
VENTILAT�NG OR Alfi CONOITIONING
THIS PERMIT BECOMES NULI AND VOID IF WQRK OR CONSTRUCTION 20NING SO. fT
AUTMORIZED IS NOT COMMENCED V4!ITHIN 60 DAYS. OF1 IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANQONEO fOR A PERIOD OF 120 OAY$ A7 '
ANY TIME AF7ER WORK IS COMMENCED. ` NO DWLG. UNITS
I MEREBY CERTIfV THAT I HAVE READ AND EXAMINEO TNIS APPLICA710N 1 S7ALLS
AND KNOW THE SAME TO BE TF1UE AND CORRECT. ALL PROVISIONS OF LAW$ VALUATION
AND ORDINANCES GOVERNING TNIS TVPE OF WORK WILL �E COMP6IED @
WI7M WHE7MER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT y�9�000
DOES NOT PRESUME TO GIVE AUTMOqITV TO VIOLATE OR CANCEL TME pEAMl7 FEE
PROVISIONS O ANY OTHEfi STATE OR IOCAL LAW REGULATING GON-
STRUCTION O NE PERFORMANCE OF CONSTRUCTION $167.ZS
PLAN CMECK FEE
� o ^� Lice C $5 .
�GN4TUAEOfCON•NAC RIUTMOp�ZEDOGENi IOATE� E PROP VA
� �o�,e� � �-�—
� v ,a
.1..
NC� GROUP IOCCUPANCV�OAO
CU FT.
OFFSTREET PARKING
IGARAGES
$4.50
iAC CMARGE
Fire SC $9.00
'OTAL FEE
�i185 . 75
) THIS IS VO�1R P�RMI� '
�s'/�� v
NEVV [ ]
ADDN ( j
�..�R I l
Construction Address:
Legal Description:
CITY OF FRIDLEY Eifective 1/1R002
6431 University Ave NE, Fridiey, MN 55432 (763) 572�604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Owner Name & Address: `7�.��'e� 1� �� �� Te�. #�%(03 ) Si�—lyS�/
Contractor. ��tG SG.�,1' �� ��� � /� � _ MN LICENSE # C� " !o
Address: 1 /D9 /�/ � L� /l/G � La�G2 �(1+A/ �3c7�Te1. # -
LMNG AREA:
GARAGE AREA:
DECK AREA:
Attach 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 HgUGround Sq. Ft
OTHER:
�`
Construction T W� ��� �� �e � Estimated Cost: $
YPe� °
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: %'.3 v APPUCANT: Tel. # l0/� la`�(o�
Call (763) 572-3604 for Permit Fees if mailing in applica n or Fax to 763-571-1287 if usl�g credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ ;'�. ��.
$ �.�`?�
$ a ��
$
$ � �.
���, ��;
$
$
�:
$
$��,/�6G ��
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 per SAC Unit _ _.
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by�Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS:
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 any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,Q00
$2,001 to $25,000
$25,001 to $50,0�
$50, 001 to $100,000
$100,�1 to $500,000
$S�,OQ1 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,�0
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional$1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 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 including $500,000
$3,233.75 for the first $5�,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,0OO,OQO
$5,608.75 for the first $1,0�,000 plus $3.15 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet �times $17.00.
VERIFICATION OF FOUNDATION
Pernuts for construction will be issued a minimum of 24 hours from the time of application to allow for proger
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will be
required before proceeding with the framing. New Houses Onlv
`° - . w
BUI.IC�.lrig BU�D�(i Permit No. -� D� `%%
[nspectior�s RESIDENTIAL APPLICATIOl�T Received By:
763-572-3604 CITY OF FRIDLEY vate xec'd°' .�''�
�A'CE _/ l� �� YOUR E-MAIL ADDRESS GV L�� IVl ��°Z � COY'�"��ST. N��
iITE ADDRESS �' Zl 7i � ��, l�.�N ��� �
I'HIS APPLICANT IS: ❑ OVJNER
PROPERTY OR'NER/ NqME: �� � �j.���
TENANT twDx�ss: �3 � 3 L-�L�tnSi� � � crrY �D�� STA7'B'Ki�
PHOAIE: i��'� 7I � l� j�
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
QVITH APPLICATION
STATE UCENSE #'L� I?j � S EXP DATE
anDt�ss: i 1��l — 1-1�1 � i.nS (�
��
PROPERTY TYPE SINGLE FANIII.Y/�ii
TWO FAMII,Y/NEW
PERNIIT TYPE 0 �DTTION
❑ BASEMENT FIMSH
�DECK
TYPE OF' VVORK: � NEVJ
�t 0 Q
� I��i STATEIIW�Z[P��
I�� FAX 7`.�J �`B Io L—�s�G�
R�ieN SizE
CT10N STORIES
❑ GARAGFJSI�D � WIIdDOWS
❑ ROOF ❑ DRAW TILE
❑ SIDING O OTf�R
O SWII�RVIAIG POOL
DESCRIBE WORK BEING DONE: �%'�-� D� �� 5 �–1 O 1�� � c�SS -�jQDr�- � dl� �r� t,-�-
SIZE OF IIV�ROVEMENT
NUNBER OF SQUARES _
GA1tAGFS
PROP05ED SIZE:
PROPOSED HEIGHT:
SIDIIVG
❑ Vinyi
0 Aluminum '
❑ Other .
WINDOR'S
IN E)QSTII+iG OPENWGS OYes ONo
OR FOR NEOV OPENII�iGS-DESCRIBE SIZE OF
OPENING CHANGES & ,
LENGTH__
❑ HOUSE ON1.Y
❑ HOUSE & GARAGE
❑ ATTACI�D GARAGE � (I4"1 V �.
❑ DEfA ARA. E
�� �L �� r�'�
l0
OSoffit
❑ Trim
❑ Fascia
L�ATION OF
°C ��
�R.� , � �1�° 7,
ALL FEaES/E/`$' ��i �(U UATION, INCLUDING T
�p � SING THE 1997 U.B.0 FEE
TOTAL JOB VALUATION $ � =`"�-� i-�T— /
Permit Fee
Plan Review
Fire Surcharge
s���
License Svrcharge
SAC Gharge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
� ��
$ , .�
$
$ 3. �y
$ S",, �
$
$
$
$
$
ANCY
HEIGHT
BASEMENT REMODELING SUBMIT:
1. Existing Floar Plan
� 2. Proposed floor plan
3. List of structurat memb�ers to be used
FOR NEW CANSTRUCT[ON MCLUDIIJG DECKS,
ADDITIOATS. & PORCI�S SUBMIT:
1. Sitc Plen/Swvey showing fhe acisting strucUues
and proposed proj�t.
7. Two sets of conshuction plans
3. Energy Calculaoions � � ��
// � �. �
AND MA'
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuarion Minimum $.50
$5.00 (State Licensed Residential Contractors)
�1675 per SAC Unit (Plans to MWCC for determination)
ft+68= ftx$21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary (
Make checks payable to: Citv of Fridlev
THIS IS AN APPLICATION FOR A PERMiT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit
conformance with the ardinances an
peranit but only an application for
plan in the case of a11 worj�hich
Attach
;a�owledge that the information above is complete and accurate; that the work will be in
he City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
work is not to start without a permit; that the work will be in accordance with the approved
�v and approval of plans.
SIGNATURE OF APPLICANT\ `��i:� —t _ PRMT NANlE C�'� ���s � DATE /I I"'J I�
Page 2- Buildi.ng Residential Applicatian
�
BUILDING PERMIT FEE SCHEDULE '- •
The Chief Building Official shall, before issuing perniifs for the erection of any building or
siructlire, or for any ad.dition to any existing buildin.g or structure, or for any alteration or repair
to any existing bui.lding 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 tawit:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a min.imum of 24 hours from the time of application to
allaw for proper review of proposed structure and of the construction site.
A Cerlificate of Survey of t�e lot, showing the location of the existing foundation will be
required before proceeding with ihe fram.ing. New Houses Onlv
City of Fridley
Buildi.ng Inspections Depariment
6431 University Avenue NE
Fridley, N1N 55432
763-572-3604
Fax: 763-502-4977
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