AF - 46206"",
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City of Fridley, Minn.
BUILDING PERMIT N° 4 2 6 5
Date: ---..___�'..__.. �•... �... _._..�� .��...�....�.---�...._..
Owner: .....- •--�---.........--•--�----...._......-•---..__..... ----------._...._.�..__.._......._.----_.... Builder
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Address
Addre�
LOCATI ,OF UILDING
No. ----!•�.._.�..-•---. Street _�._---..._. �. _i... .... - ----.......� .......... ..._...--�---�------_..._ Part of Lot
�-�I�a�/ -- - -
Lot.................................
Corner Lot .............
Sewer IIevation
Block
Inside Lot
Addition or Sub-Division
Setback ....._ .............--............_........ Sideyard
.......... Foundation Elevation - ................
DESCRIPTION OF BUILDING
To be Used as:
�' •��ati�� Front .l �.. ^.C� �Depth�.�.........��..`� Height ��.....�f Sq. F�� .(....%'._.
. _ ..........................................• --..... Front _...._......-� -.. Depth ............... Height ........................ �9. F� ....._.................
Type oP Construction ........................... ................................ Est. C ... .. .... ..... ........ .... -- ....... pleted
.. �
r� �� . . �......... To be Com
Cu. F� �--��&? �
Cu. F� .............._........
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 se�rth�d �n�co�pr�iance with all proviaions of
ordinances of the city of Frldley. �
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In consideration of the payment of a fee of $..�� Permit is hereby granted to------�..........._ .............-•----_--•-.-----....._..
.....__..___._..._....._..--.------- .............—••---. to constrvct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, canstruction, alteration, ma3ntenance, repair and moving of bwildings
within the city limits and this permit may be revoked at any ti�ne upon violation of ar�y of the provisions of said
ordinanc�. i �
Building Inspector
�
NOTICE:
This permit does not eover fhe wnstrudion, inslallaHon for wiring, plumbing, gas healing, sewer or water. B� wre fo tes
the Building Inspeetor for separ�te permhs for these hems.
4
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City of Fridley, inn
BUILDING PERMIT
Date: OG°POBER 22, 7.965
�/Q Sa
N� 8556
�: GEORGE BAR�H �� DWIGHT SWANSON REALTY & CONSTRIICTTON'
Ad��ss �,� 3710 Nort��,.enith
Mianeapolis, Minnesota
LOCATION OF BUILDING
No. 10� 5treet HORIZON CIRCLE 1V E Part of Lot
Lot ti _ 81oek 4 Addition or Sub-Divisfon C..A�.SpN' � g S'Q1�'T MAIQOR � NO$TH ADD.
Coraer Lot _ g Inside Lot Setback � Sideyard
Sewer IIevation
Fo�mdatioa IIevation
DESCRIPTION OF BUILDING
To be Used as:
STORM REBIIILD �t 40 De� 26 H��t 18 �. �-.t, 1, 040 �, � 18, 720
F`t�ont Depth �Teight Sq. Ft. Ca. F't.
Type of Constructfon Fr� FF�t. Cost _ 14 000, 00 To be Completed
In con�deration oP the 9esuaaoe to me of a permit to construct the building described above I agree to do
ths ProPosed work in accordance with the descrlption above set forth and ffi pliance with a'll provlsfons oP
ordinances oP the dty of Fr1�IIey.
/% �- ��. _
In camsfderat[on of the Payment of a Pee of � 10.00 , P�t fa hereby granted to ffi DWIGHT SWANSON
RFAT•TY & CONST. CO to construct the building or additfon es described at�ove. Thfs rmit is granted upon
the express condition that thepe�on to whom it is gi�anted and hfs agente, employees an�worlQnen, 9n all work
dome in, around and upon eaid buildiug, or aaypart thereof, shall conform in all respecte to the ordinanc�ee oP
Fridley, Minnesota regarding location, conatruction, alteration, maintenance, rspafr and moving of bufldings
within the dty limits and tbfs permft may be revoked at any time upon vlolatlon of any oE the P�visions of said
ordinance�.
ALL�N G. J"E1�SEN �� ��
NOflC�
ih�s p��mk dea eo! co�nr �la eoe�euaHoe, t�atl.ttee �� wt.tna �mt+t�a oa b..�na .�r.r m waa.. e� son ro a�
fla bulldl� leqn�o� for ap�rab pumif� ht fka� Nu�.
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APPLICATION FOR BUTLDING PERMIT
CIfiY OF FRIDLL�Y, MI1�IESOTA
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OWNER' S NAME��3C���� G�%��°L`�� BUILDER ,C��' 4�����o.�'i.e�Q�'�j; �'° E�� �.
ADDRESS ADDRESS �`1�� `N� ����
I.00ATTON OF BUTLDING
N0, % l— STREET ���c-�-� ���� ��i PART OF LOT �
LOT BLOCR ADDITION OR STJBDIVISION � �--�� � i" /,�%������
CORNER LOT � INSIDE LOT SETBACR SIDE�YARD
SEWER E�,E'VATION_ FODNbA7`'IO1V ���VAZ`IQN ,
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BIIILDIIQG
To be used as ; � ��,����
Front�Depth �,� Height � o
Sq. Ft. � ��% Cu. Ft. �'' �, t�
Front Depth Seight
Sq. F�. Cu. Ft.
Type of Construction Estimated Cos�f�.B�,�..�
To be completed
The undersigned herebq makes application �or a permit for the work herein
specified, agreeing to do a11 work in strict accordaace with the C3ty of
Fridley Ordinances and �ulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true snd correct�,
(Schedule of Fee Costs
� _ _
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found oa the Reverse Sidej:�
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BIIILDIlIIG PERMIT FEE, SCHEDIIL$
SECTIOP 2.. The Inapect.or of Buildiaga shall, before iBSUing any permit for
the erect3on of any building or seructure, or for any addition to any existing
building or structure, or for any alterations or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for aucb p�tmit of fees'to the amount.hereia below set forth and in
the mauner herein provided to-wit;
2.1. For auy such permit for the erection of any fire-proof building,
othei tha a garage, warehouae, factory or grain elevator, or for the erection
of any fire-proof addition, for similar occupancy, to any esiating building,
ahall be at tha �ate of $1,40 for each one thousand cubic feet, or fraction
thereof, in such cubical contente.
2.2 For any such permit for the erection of any fize -proof;garage,
warehouse, factorq or graia �levator, or for the erection of any fire»proof
addition, for similar occugancq, to any exiating building sha11 be at the
rate of $1.�5 for each one thousand cubic feet, classified as "fireproof"
by Section 502 of the Minneapolis Buildiag Code.
flOIISES
2.3. For any such permit fot Che`e�ection of any non-fireproof
building, other than a garage, wareho�tse, factory or grain elevator, or
anq non-fireproof addition, for eim3lar occupancy, to any existing building -:;
permit $1.00 for each one thousand cubic feet.
GARAGES
2.4. For anq auch p�rmft for the erection of any non-fireproof garage,
warehouse, factory or grain elevatoz, or for the erection of any non-fire-proof
addition, for aimilar� occupancy, to any egisCing buildin� o� fo� each su�h "'
building or addition - ninety centa ($0.90).for each one thous.and cubic feet
or fraction ti�ereof, in the cubical contents thereof with the minimum of $4.00.
For the-purpoae of computing fees for building permi.ts, the cubical contents
of any building or addition to a uniform height throughout by multiplying the
grouad area covered from a point six (6) inches below the floor line of the
basement or cellar to the average he�ght of the upper surface or to the average
height of the roof surface of the main gable of a pitched roofo �
2.5. For repaire or alterations to an existing structure, the fee�shall
be at the rate of $3.00 per each Five Huadred Dollars ($500.00} or fr�ct�on
thereof in Che cost of a11 � proposed �aork.
2.6. In no case shall the fee charged for any permit as set forth in
Sectio 2n be less than $4.00.
STt1RM REPAIR DAMAGE FEES:
Residential; Estimated Coat of �ork up t� �zG�.L�O -$5.00
Estimated Cost of �a�r� ez�e� Y:��_o�.;���;J -$;.G,�►0
C�S_�o,,e�ciat; Est�?*R�.Led �t o� c�r���°lc u; �t�,�;;,�:!:�: ti0 -$��,�
Estimate3 � at of wurlc o�rer $SG�i.U� -$�0..
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8A31 UWIVERSI7Y Al/ENUE N.E., FRIDLEY, /AINNES�TA 55432
, TELEPHONE ( 612)5T1•3450
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OBSTRUCTION:
l, ��a°��t
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Lot
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H����
Block Addition
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Properfiy Octirer-.;ddress
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RECORD OF C���1[1;�IC.r�TI�.�N5:
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3.
4.
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6.
7.
NE� �� City of Fridley Effective L/1/8i
ADD:; . I 7 R-1 AND A-2 (
pL7'ER. I 7 Building Permit Application
Construction Address:
Legal Description:_
Owner Name i Address:
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Contractor: �� '�Q� �
Addresa:
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Attach to Lhis application, a Certificate of Survey of the
' lot� xith the proposed construction draWn on it to scale.
DESCRIPTIOp OF INPROQEMlEb'T
Width Height Sq. Ft.
LIVING AREA: Length -
iiidth Height Sq. Ft.
CARACE AREA: Length __ -
Nidth Hgt/Ground Sq. Ft. _—
DECR AREA: Le(s8th ' • �/ i ��
�l�G,�}�I � 6 � =' : .,�*..�_
OTHER : 3 i� �"-';
� 6� g, +� 3�Q6, �c-�- C t��. x �.-� � ��s•� � y �rll.y6 -
Corner Lot [ �
� Insi'de�bt [] Ft. Yd. Setback _ Side Yard Setback
� Estimated Cost: � � � —
Type of Construction: t°'�'��� — � �
Approx. Completion Date: /���� � � -- �L- �'� � V
Alt. A Alt P
Is Desired: � �
Proposec Drivexa�• k'idth If t�ex Opening SeelBack Page for Explanaticn
DRTE : �� ' � �O- ��
Percit Fee
Plan Check
State Surcharge
SAC Cbarge
Park Fee
Sever Naia Charge
?OTAL
.
STIPUL6TI02:S : ��
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APPLICAJiT: I�"�c �~"' ``��
CITY OSE ONLY
` �� Fee Schedule on Reverse Side
� . 25'i of Building Perait Fee
� ����_ �.50/�1,000 Yaluation
� �u 75 per SA C U ni t
e Fee Determined by Engineering
�
� j 1 Agreemeni Necessary [] Not Necessary [ �
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BDII.DING PERNIT FEE SCHEDIILE
?he Chief Building Official shall� before laauing permits for the erection of ar.y
Duilding or structure, or for any addition to any existiag Duilding or structure, or
for any alteration or repair to any existing buildir� or structure� upon application
tt.erefore, require the payment Dy the applicant for such permit of fees to the amount
herein below set forth and in Lhe manner Aerein provided to-xit: '
Total 9aluation
�1.00 to �500.00
�501.00 to �2�000.00
Fees
�10.00 (Minimu� Fee is �1$.00)
�10.00 for the first �500 plus �1.50 for each
additional �100 or fraction thereof� to and includinE
�2.000.
t2�001.00 to 525�000.00 �32•50 for the first �2�000 plus �6.00 for each
additional �1,000 or fractior thereof, to and
including �25,000.
t2;�001.00 to 550,000.00 �170.50 for the first �25�000 plus �4.50 for each
additional �1,000 or fraction thereof, to and
inclucing �50,000.
�5G�001.00 to 5100�000.00 �263.00 for the first �50�OD0 plus �3.00 for each
additional �1�000 or fraction thereof� to ar.d
includinE �100,000.
1100,001.00 and up
�433•00 for the first �100,000 plus �2.50 for each
additional s1,000 or fraction thereof.
DRIVEiiAY DEPRESSION ESCROIi
(Concrete CurD Streets Only)
Alternate "�": Aecoval and replacement of curD and gutter only - Driver�ay uidth plu�
6 feet time� �t3•SO
�lternate "E": Re�ov21 and reFlacecer.t of curb and gutter and in�tall a 3 foot r�i�e
aFFroaci: uith 6 inch derLh - Driveua} Width plus 6 feet times 515.75
YERIFICA?ION OF FOUNDATION
Fercits fo^ construction �ill be issued a�ir.idu� o.° 24 hours froc the time c.°
aFFlication to allou for proper review of the propose� structure and of trc
construction site.
A Certificate of Surrey o:' the lot, shoWing L�e loceticr.� of tt:e foundation once it
has Deen constructed xill De require� Defore proceed:r,E �it� tt,e framing.
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�,TER. I 7
Construction Address:
Legal Description:_
Ovner Name i Address:
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City of Fridley
�R-1 IUiD R-2 i
Building Permit Application
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Contractor. a �,
Addreaa: �</� � �� �� �'� �� �
Attach to this application, a Certificate of Survey of the
' lot� With Lhe proposed construction draWn on it to scale.
DESCRIPTIOA OF IMPROFElSEh'T
LIVING AREA: Length
Width Height __ S4• Ft.
iiidth Height _____ Sq. Ft.
GAAAGE AREA: Length -
Width Hgt/Ground Sq. Ft.
DEC_ R AREA: Le�Bth � �� • � � / � �
, .,�'.-.y� � _���s''�i^ ..;�An._
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OTHER: `';•lQ�I��C�I7.i��.� � 7�•� ` y�II•76
�`� ���•�� Ft. Yd. Setback Side Yard SetDack
Corner Lot [ l Insi e t[ l
�' Estimated Cost: � _ �
Type of Construction: f'✓'���-- � -1
ppprox. Completion Date:
/V D f� � � �� � � � ��
Alt. A Alt P
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Proposed DriveWay k'idth If Ne�. Opening Is Desired� SeelBack Page for Explanaticn
D�TE: �� ' � �- ��
Per�it Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sever Nai� Charge
TCrIIL
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STIPULRTIO2iS:�,�(�
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APFLICAt�T: � �-f �^ �� Tel . � ,, �
CITY OSE ONLY
� �� Fee Schedule on Reverse Side
� • 25x of Building Perbit Fee
� _�,�,d �.50/�1,000 Valuation
� �u75 per SAC Unit
�� Fee Determ�ned by Engineering
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j 1 Agreemeni Necessary [] Not Necessary [�
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SuBJEC7
City of Fridley 2 213 9
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
� � R
� � •
� ' COMMUNITY DEVELOPMENT DIV.
' j V �'���'�
r � � PROTEC7IVE INSPECTION SEC. � ��
1 ` �
� /""1 � CITY HALL FRIDLE� 55432 NUAABER REV. DATE PAGE OF APPROVED BV
�'""� � ,'� 612-571-3450 910-F15 9/28/93 / /
JOB ADDRESS 101 Iiorizon Circle NE
t LEGAI LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 6 4 Carlson�s. Siaumit Manor North SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Don/Sonja Knutson 101 Horizon �i�f� Circle NE 572-1010
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
VIP Siding & Roofirig 1014 Stout St, Menomonie TniT 54751 (_715) 235-0083 PENDI
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
%
8 OESCRIBE WORK
Reroof House (18 Squares) Tear-o�f
9 CHANGEqFUSEFROM TO
STIPULATIONS
Underla�rtent must comply� �vith. th.e State B;uilding Code, Provide adequate
attic ventilation. �rovide s�ke detectors as pex UBC 1210 adjacent to all sleeping
areas and in basement.
�4��.�i'�`TC �
� �
�
�2�� �
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCC NCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONINO 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. DWLG. UNITS OFFSTfiEET PARKING
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 IS TYPE OF WORK WILL BE COMPLIED $2 � 300 y�`�. e�-S
WITH WHETHER SPECIFIED HE OR NOT. THE GRANTING OF A PERMIT
DOES NOT RESUME TO GIV UTH RITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIO S OF ANY OTHE S AT R LOCAL LAW REGULATING coN- $5.4 � OO Fire SC $2. 3O
ST UCT N R THE P, M F CONSTRUCTION.
PLAN CHECK FEE TOTA� FEE
' �e� /� �� License SC $5, Q0 $62, 45
SIGNATUREOFCONiHACT � OfiAUTMORIZEDAGEN? � IDATEi WHEN PR LV ATED THIS IS YOUR PERMIT
// - � � ��
SiGNATUREOFOWNER�i OWNERBUILDER� IDATE� 'i �$P DaTE
NEW
ADDN
�.�
[]
[l
i�
Conslxuction Address:
Legal D�ccription:
CITY OF FRtDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Pezmit Application
Effe�tive 5126/93
���(6,�
Oaner Name & Address: /t� Tel. #,�7Z - f 0/ O
Co�ractor: 4' S c�- � ���� `� MN LICENSE #
Address: d l (� - �i -� S Tel. #(? S_2��6�3
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPI`ION OF II4IPROVEMENT
LIVING AREA: Length Rtidth Height Sq. Ft.
GARAGE AREA: Length Width Heaght �. Ft.
DECR AREA: Length Widtii Hgt/Grouad �. Ft.
OTHER: ���%�- D�-� -- ,�� v �
Corner Lot [ J Iaside I.ot [] Ft. Yd Seiback Side Yard Setb�cks
Type of Con�oa: Estima%d Cost: $ � D C c�
Approx. Completion Date: `
Driveway Curb Cut Width Ne�d�:
DATE: �S ,� APPLICANT:
Permit Fee
Fire Satcharge
State Surcharge
SAC Chazge
License Surcharge
Driveway Escrow
Erosian Control
Park Fee
Sewer Main Charge
TUTAL
S �"� �C�
$ �-3Q
$ /, /��
$
$ �� � G�
$
$
$
$
$ :,y?_ � �
(Cast a�n Back)
�� �.. � �t — �t Y e
Fee Schedule on Reverse Side
.U01 of Permit Valuation (lllt�h�)
$.50/$1,0� Valuation
$750 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Al� °A" or Alt. "B° Above
Conservation Plan Review $45U.(IO
Fee Determined by Engineering
Agreeme�t Necessary [ ] Not Necessary [ ]
STIPULATIONS:
_�
Tel. � %�-Z,�Sr'C�?�8��
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the ere�tion of any building or structure,
or for any add.ition to any existing building or structure, or for azry alte�ration or repair to any existing
building or stiucture, upon applica.tion tti�refore, require the pay3nent by the applicant for such permit
of fees to the amount herein below se� forth and in the manner herein provided to-wi�
TOTAL VALUE
$1 to . $500
$501 to $2,(m0
f���•`�
$15 (Minimum Fee is $15 plus surcharge)
$15 for first $500 pins $2 for e,ach additional $100 or
fraction thereof, to and including $2,000
$2,001 to $25,� $45 for first $2,000 plus $9 for each additionai $1;000
. ar fracti.on thereof, to and including $25,000
$25;001 t,o $50,000 � $252 �for first� $25,(I00 p1�s $6.50 for each additional $�1,000
� or fraction thereof, to and inclading $50,000
$50,001 to $100,�
$100,001 to $500,000
$500,001 to �1,OQ0,000
$1,000,001 and up
$414.50 for first $50,OOU plus $4.50 for each additional
$1,000 or fracdion thereof, to and including $100,000
$639.50 for first �1�,OU0 plus $3.50 for each additional
$1,000 or fiaction thereof, to and including $500,000
$2039.50 for the first $500,000 plus $3 for each additional
$1,0� or fradion thereof, to and iacluding $1,(�0,000
$3539.SQ for the first �1,000,000 plus $2 for each additional
$1,000 or fraction �thereof �
DRIVEWAY DEPRESSION ESCROW
(Concrete G�ufi Sixeets Only)
Alternate "A" : Removal and repla.cement 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 const�uction site.
A Certificate of Survey of the lot, showing the l�on of the foundation once it has it has been
constructed wiil be required before proceed.ing with the framing.
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CHIlVINEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1.
2.
�3.
4.
5.
6
7.
Q
Has been carefiilly examined
Is free from rust or deterioration
Has no foreign objects lodged within
Is securely supported
Meets all current Code requirements for size
and total BTU's connected
Has total heating BTU's of ��, �C`��
All other BTU's � 2. }� � �
TOTAL BTU's 1 �Z , � � Q
Has a liner been pmvided for water heater �
Has combustion air been provided for water heater
List ALTERATIONS Bein�Done:
Yes � No ( )
Yes � No ( )
Yes � No ( )
Yes � No ( )
Yes � No ( )
Yes�No()
Yes� No ( )
HEATING CO:
Signed By:
Date:
�� �t '- �b
JIM A. KORDIAK
Counry Commissioner
DisMct #4
Mr. Jeff Plaster
101 Horizon Circle
Fridley, MN 55421
Dear Jeff:
��� C��
�
COUNTY OF ANOKA
Office of the County Board of Commissioners
GOVERNMENT CENTER
2100 3rd Avenue • Anoka, Minnesota 55303-2265
(612) 323-5700
February 2, 1999
Thank you for contacting me regarding traffic control problems on Main Street. While I was
pleased to assist in a major upgrade of the roadway, I recognize that this now wider and smoother
street may encourage traffic moving at a higher rate of speed. Your concerns included speed and
enforcement and, further, you thought that a stop sign may help to solve the problem. As I have
indicated, you must contact the Fridley police chief to consider enforcement activities. You had
indicated that you have called the Fridley Police Department before; however, should you choose
to call again, feel free to contact Fridley Police Chief Dave Sallman at 572-3629.
Regarding the proposed stop sign, you will need to contact John Flora, the Director of Public
Works, at the Fridley Municipal Center, 6431 Universiry Avenue NE, Fridley 55432. I would
suggest that you put your request in writing to initiate the examination. I rather expect .that this
issue has arisen before; however, I am certain that John will consider this proposal carefully and
communicate a response to you.
Thank you again for contacting me.
Sincerely,
f
Jim Kordiak
Anoka County Commissioner
JK:pd
cc: �Da�v Sallman
ld�6hn Flora
FAX: 323-5682 Affirmative Action / Equal Opportunity Employer TDD�TTY: 323-5289
�
sue�ecr p
City of Fridley 3 3 3 5 0`�
AT THE TOP OF TME TWINS B U I L D I N G P E R M I T
r
; � RECEIPT NO.
� `v � COMMUNITY DEVELOPMENT OIV. �� �
r � � PROTEC7IVE INSPECTION SEC
� � /"'1 � CITY HALL FRIDLE� SS�3Z NUMBER REV DATE PAGE OF AVVqOVEO BY
�"""� � ��' 763-571-3450 910-F15 2/25/03 � �
108 ADORESS 101 Horizon Circle NE
t LEGAL �O7 NO. BLOCK TRACT OR ADDITION SEE ATTACMEO
DESCR. () 4 Carlson's Summit Manor North Addition SMEET
2 PROPERTY OWNER MAIL ADDiiESS 21P PNONE
Jeff Plaster 101 Horizon Circle NE 763-574-0769
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO
RMA Home Services Inc 3200 Co1ob Galleria Pkwy STE 200, Atlanta, GA 30339
4 AFiCMITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
763-542-8826 20268257
5 ENGINEER MAII ADDRESS 21P PMONE IICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOAK
O NEW � ADDITION � ALTERATION C� REPAIR � MOVE O fiEMOVE
8 DESCRIBE WORK
Replace 14 windows within existing openings
9 CHANdE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms an.d on all levels of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash all
exterior openings.
P � �� ������t�on ard�
�I� �� atled
�'� ���������r�o Post
SEPARATE PERMITS ARE REOUIREO FOii EIECTRICAL, PLUMBING, MEATING, TYPE OF CONST. OCCUPANCV GROUP OCCUPANC� IOAD
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOIO IF WORK Ofi CONSTRUCTION 20NING SO. fT CU FT
AUTHORIZED IS NOT COMMENCED WITMIN 80 DAYS. Ofi IF CONSTRUCTION
ON WORK IS SUSPENDEO OR ABANDONED FOR A PERI00 OF 120 DAYS AT
ANY 71ME AF7ER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TMA7 I HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES
AND KNOW TME SAME TO BE TRUE ANO COflRECT. ALL PROVISIONS Of LAWS yqLUATION SUR7AX
AND OROINANCES GOVERNING TMIS TVPE OF WORK WILL BE COMPLIEO
WITM WME7MER SPECIFIEO MEREIN OR NOT. THE GRANTING OF A pERMIT �13,294 �E).6S
DOES N07 pRESUME TO GIVE AUTMORI7Y TO VIOIATE OR CANCEL TME pEFiMIT FEE SAC CMARGE
PROVISIONS OF ANY OTMEFi STATE OR LOCAL LAW REGULATING CON- @ @
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION y�237.25 Fire .5�.' y�13.29
PLAN CMECKFEE TOTA�FEE
cens SC $5.00 $262.19
S�GNATUpE OF �ON'AAC10p Op MUTMOA�2ED sGENT �pAiEi EN PqOPEF1LV VA�IpATED TMIS IS VO ii PEAMI
� � �
S�GNAtU�7E O� OWNEp��� OWNEA BU�lOEp� IDA1E� Bl� �N f�6fE
/.
N� [ ]
ADDN
AI.TER
Effective 5/10/99
( ] CITY OF �'RIDLEY �
[, SINGLE FAIVIII�Y AND DUPLEX�S R i AND R 2
BiJILDING PERMIT APPLICATION
Construction Address: � I�I 1�<;�n C•.cc.k.. n�.S�. �.� ..
Legal Deseription: '
Owner Name & Address: �,� �14„4}ur � Tel. # �o3•S�y •0�l�1
CoIItCdCtOI:; � RMA HOME SERVICES INC. �j j�j�ENSE #-
Home Depot Installed Sales
Address: 3200 Cobb Galleria Pkwy., ste. #20o Tel. #
Atlanta, GA 30339
A 763-542-8826 u�vey: of t�e �
1cBC-20268257 --- -_�___�.,� ......... ,�n..it to scale.
• -�r--r- .
� DES.C�.fl1+J UF ��D�EM�NT �. . � '
LIVING AREA:
GA►RAGE AREA:
DECB AREA: �
01'��R:
Construction Type:
I.ength Wi3th Height � Sq. Ft.
Length Width Height Sq. Ft.
Length � Widtti �� Hgt/Ground Sq. Ft.
�.�dc� 14 w � ctdows �u � �in,,� •c.rx< <
Esrmared cosc: � 13, a9y °=
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = Ft ic $
_$ -
DATE: �- .� . 03 APPLICANT: �c�,O��,m�,c,� Tel. � 95 0l •3LJ5 • (oCH �
�.
Permit Fee
Fir� St:rc�iazge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ a3�-�
� 13 ��
$ �o �
$
$ ��
$
$
$
$
CITY USE �NLY
Fee Schedule on Reverse Side
.�1 �f Perinit Valuati�n (1/lOt�t n)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.00 (State L�cens,�d Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.� Conservation Plan Review
Fee Determined by Engineering
Agreement Necess��ry [] Not Necessary [ J
�_ cc,
� �� ���'� % s( J c.. _
,� �.�, �� �.l a�
�
sue�ecr p - .
City of Fridley 3 3 3 61
AT THE TOP OF TME TWINS g � I L D I N G P E R M I T
�
; � RECEIPT NO.
� ; y ��___ COMMUNITY DEVELOPMENT DIV. .
r � � PROTECTIVE INSPECTION SEC. /� 7Cs/
1 i � �
t �'�'� � CITY NALL FRIDLE� SS13P NUMBER pEV OATE VAGE Oi AVPNOVEO BY�
�'""'� � ��' 763-571-3450 9/0-F/5 3 / 11 /03 / /
JOB ADDRESS 101 Horizon Circle NE
t LEGAI LOT NO. BLOCK TiiACT OR AODITION SEE ATTACHED
oescR. 6 4 Carlson's Summit Manor North Addition SHEET
2 PROPERTY OWNER MAIL AODRESS 21P PNONE
Jeff Plaster 101 Horizon Circle NE 763-574-0769
J CONTRACTOR MAIL ADDRESS 21P PNONE LICENSE NO
Installed Products USA LLC 207 Kelse Ln, Tam a FL 33569 620-782-1321 20318345
4 AiiCNITECT OR DESIGNER MAIL ADORESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADORESS ZIP PNONE LICENSE NO
8 USE OF BUILOING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADOITION O ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOHK
Reroof House (21 Sq) Tear-off
9 CHANCiE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYPE Of CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTI�ATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU FT
AUTHOR12ED IS NOT COMMENCED WITHIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY 7�ME AF7ER WpqK IS COMMENCED. NO DWLG. UNI7S OffSTREET PARKING
I MEREBY CERTIFV THAT I HAVE READ ANO EXAMINEO TMIS APPLICATION 1 S7ALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORiiECT. ALL PROVISIONS OF LAWS yp�UATION SURTAX
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WI�L BE COMPLIED
WITH WHE7MER SPECIFIED HEREIN OF NOT. TME GRANTING OF A PERMIT �2 s 431 �L . ZL
DOES NOT PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEI TME pEqMIT FEE SAC CNAqGE
PROVISIONS OF ANY OTMER S7ATE OR LOCAL LAW REGULATING CON- @
S RUCTION O THE PERfORM CE Of CONSTRUCTION y�83.25 Fire SC �Z.�F3
PLAN CMECKFEE TOTALFEE
/l � Lice e SC $5 0 $91.90
NOTUAEO "AACTOAO i2E0aGENT iD�iEi ►� N PR LY VALIO ED TMIS IS VOUR PERMIT
— � l/�3
S�GN4TU�7EO�OWNEA���OWNEpBU�lOEA� IDATEI DG �NS� f�6/t
NEW
ADDN
ALTER
[] CITY OF F'�IDLEY Effective 1/1/2003
[] 6431 University Ave N�, Fridley, MN 55432 (763) 572-3604 Bldg Insp
[] SINGLE FAMILY AND Dl1PLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: �O i �f��?-.� �� �l� .� �-
Legal Description: _ � /2� �'� /� �.�-<- d� > �,
Owner Name & Address: .���'�' r� l�,s f�.�-- Tel. #`�G 3-.5- ��-- �"�� %
Contractor: _�s �x--l/`� � 6 vff'�. L �
�.s �✓S a� �-L � MN LICENSE # � � �c� �%S �
Address v o �7 ��. /s -e � L�, v >�.,� a � ,�.3��0% Tel. # l�o - ��� — �3a I
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
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 �dth Height Sq. Ft.
Hgt/Ground Sq. Ft.
`� ���3 /
Construction Type: Estimated Cost: $�� '
Driveway Curb Cut Wdth Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ���� �� APPLICANT: �--� L=—�_ Tel. #�`�� ���'�/ 7�
Call (763) 572-3604 for PeRnit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
Permit Fee
Fire Surcharge
State Su�charge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ 03, ��
$ �•
$ i, a�
$
$ �,0�
$
$
$
$
$ 1/.�z�
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$�1,000 Valuation -
$1275 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engine�ring
Agreement Necessary [ ] �lot Necessary [ ]
_ • :;_ .
� JI__� I� ' �I; u1Y�DI•Y :I�il�l�!
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 $2,000
$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
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 $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,0�
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 $1(�,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,000,001 and up $5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
cuRS ccrr Escxow
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet times $17.00.
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.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the loca.tion of the existing foundaxion will be required before
proceeding with the framing. New Houses Onlv
- r-