AF - 46210� 1
� �� illage of Fridley, Mi.n.n.
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�°�- BUII.DING PERMIT
_
Date: . . . . � � .�. . . .o,�. . � . . � J �v . . . . . . . .
Owner.......................... �...........
Address...........................I...........
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�1T° 1768
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Builder . .�y!�'.. .. . �. .. .. . . .� ` � !?. ... .
Address . . . . . . . � .'Z . �. �. . . . � c� h G G . . . . . . . . . .
� LOCATION OF �UILDING
No. . .� ,/� . . Street . � ' : c �? :�. . . .4� �. !°. �: �r. . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . . . . . .
Lot . . . . � . . . . . Bldck . . . . . �. . . . . . . . Addition or Sub-Division . �1.�+.!�?. �l'.!�. �� . : •� � �!`� • • � • � • • • • •
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Corner Lot ........... Inside Lot .��... Setback ..'�:� . Sideyard ....% � .....................
D SCRIPTION OF BUILDING
To be Used�as:
�, E�! L/ t?`.'/.... . Front . 7� Depth .�.:�.. Height ..�. s. Sq. Ft. .�C� �� Cu. Ft. ........
{/
..................... Front ..... Depth ........ Height ........ Sq. Ft. ........ Cu. Ft. ........
z ,3'� �
Type of Construction . �� � � : � . • Est. Cost . . l . . . . . . . . . . . . . . . To be Completed . . . . . . . . . . . . . . . . . .
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In consideration of the issuance me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
fI � i/11 • � �%r J .� S i� f' c� � 9 � � �/ v �a � . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
In consideration of the payment o a fee of $ �P. �.�'�.��'9,�epermit is hereby granted to . . . . . . . . . . . . . . . . . . . . .
V
, . . . . . . . . . . . . . . . . . . . . . to constru the building or addition as described above. This pernut is granted upon
the express condition that the person o whom it is granted and his agents, employ�s and worlmien, in all work
done in, around and upon said buildin , or any part thereof, shall conform in all respects to the ordinances of
F'ridley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the vfflage limits and this permit m. y`�ie revoked at any time upon violation of any of the provisions of said
ordinances. �� 1
% � . . . �,�. . . `�� �".'�:`°� . . . . . . . . . . Building Inspector
NOTICE: I
This pe�mit does not cover the construction, installation or aiteration for wiring, plumbing, gas heating,
sewer o� water. Be sure to see the IBuilding Inspector for separate Aermits for these items.
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Z herebe ca�rtify that Lhe abo. is a trus and correat plat of a surre�y at:
Lot Bi�rs i5�. B�.ock Faur i4). aRI.SCN�S SUI�MT i�A�ANGR NOATH ADDITIiN. A1�ck+�,Ge�u�►. lrtin�aa�s .;' �,,�
Ae� eurfeyec3„ by me thie 10�h o�' 7�:tary 1956 A. A.
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Mixwesota Re�e�r�tio�a :lt+�� ' , . t `� .'�.
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City of Fridley, Mirm.
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B�JILDING PERMIT No 416 9
Date: _.._� � �. �__.... '�._.� _......_.._.__......_.
' -- � --- Builder -----� - �� a�c�.s�'��, .__._..
Owner: -----••---__.--•---.._.._.. ._._... ..�/�� ._. �.�=-=�_._..._—____�..._ —
Address.-----....._..___..__._.__._..._.._.___._.. � ._ Address _..------.----------.._..._...._.._._.__._. _._..__..____.__...A......
� LOCATION OF BUILDING
No. .....�_./...ti.:J._._........ Str�eet ..�,�fi� . _ c _...�4�..���.....--------......._..... P of Lot ...._......_...__._._..__._...._..._..._..._...._.__.�.
Lot .__........_............_......_ Block ....._..-----'��... Addition or Sub-DivIsion ....._........ .._ ............._....:�!v'.:_.-.`� ��---a�1 ��"
CoraerLot .....--� ........................... 7nside Lot ....�........----.............. Setback ....._............._...---•------..._... Sideyard ..--•-----------..._......._..._..-----••-•---......._.._.._.._..
Sewer Elevation
To be usea as:
/t±� ` �,°'B �
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Type of Construction
Foundation IIevation
DESCRIPTION OF BUILDING
Front �...l..`..� 1•Depth ��'.� Height ��.�.-._�.� 89• F� ���.�Cu. F't. �r,���'
Front....._ ................. Depth .........:.........._.. Height ........................ Sq. Ft ....._............._.. Cu. F't.
a�
Est. Cost....��� .T ........................... To be Completed
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In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed womk in accordance with the description above set forth and in compliance with all provIsions of
ordinances of the dty of Fridley. �' �Qf% � r'� °������
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In consideration of the payment oE a fee of $��...'—.._�.__�.=....., permit is hereby granted
_.._.__......�__...______.._.._------...... to construct the building or addition as described above. This permit is gra.nted upon
the express condition that the person to whom it is granted and his agents, employ�s and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
withiu the city limits and this permit may be revoked at any tune upon violation of any of the provisions of said
ordinaaces. .. ,, , ��°�
Building Inspector
NOTICE:
This permit does not cover the eoastruetion, installaNen fo� wiring, plumbing, gae heating, eewer or wa�er. Be aure �e �e
the Building Inspeefor for separate permhs for �hese kema.
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APP3.ICATION FOR BUILDING PERPIIT
CI�t OF FRIDLEY, MINNESOTA
OWNER' S NAME � ��,�/1C�� �'��,�%�/�OILDER, j��,,� /4� �� �� �l .� T%�
ann�ss ,�� �,� 2� ,,�����,.��� ann�ss , .��e��' �
LOCATION OF BOiLDIDTG
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NO � � � � , STREET ! ,��� . �PART OF LOT
LOT �� BLOCR ADDI1`ION OR SiTBDIVISION `—< �� �� ° �'-,�—�- �--�� �
CORIVER LOT ` INSIDE LOT_�SETBACR SIDE-YARD �
SEWER ELEVATION � FOONDATION ELEVATION �
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building location draFan on these Certificates.
To be used as ;
DESGRIP7.ZON OF BIIILDIIQG
Froat r�� . Depth�He3ght �'� /��,�� c$' / � ��
Sq. Ft . �Q �,� Cu. Ft .
Front Dept _ Height
Sq. Ft. Cu. Ft.
Type of Construction ,%—�/�� �� , Estimated Coat �,� � � �• �
��
To be completed �� d"� ,� / S� ,
The undersigned hereby makea application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and ruliags of the Department of Buildings, and hereby
declares that a11 the facts and repreaentations stated in this application
are true snd correct.
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(Schedule of Fee Costs can be found on the Reverse Side).
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BII�DIIQG PERMIT FEE SC�iEDULE
SECTION 2. The Inspector of Buildings shall, before iesuing any permit for
the erection of any building or structure' or for any addition to any existing
buildin� or etructure, or for any alterations or repaira to any existing
building or structure, upon application therefore, require the payment by the
applicant for such parmit of fees to the gmount_herein�below eet forth and�in
the manner herein provided to��vit;
2.1. For any such permit for the erection of any Eire•proof building,
other thaz a garage, warehouae, factorq or grain elevator, or for the erection
of any fire-proof addition, for similat occupancy, to any esieting buildin�,
shall be at the rate of $1.40 for.each one thousand cubic ieet, or fraction
thereof, in auch cubical contents. �
2.2 For any such,permit for the erection af any fire-proof garage,
warehouse, factory or grain elevator, or for the erection of any fire»proof'
addition, for similar occuparicy,_to any eaisting building shall be at the .
rate of $1.25 for each one thousand cubic feet, elasaified as "fireproof"
by Seation 502 of the Minneapo�.is Building Code.
80IIS�S
2_ For any auch permit for.the erection of any aon-fireproof
building, other than a.garage, warehouso, f�ctotq or grain elevator, or
any non-fireproof addition, for eimilar occupaacy, to any exiat3ng buildiag -
permit $1.Q0 for each one thousand cubic feet.
GARAGES
2.4. For any such permit-for the erection of aay non-fireproof garage,
warehouae, factory or gra�tn elevator, or for the erection of any noa-fire-proof
addition, for eimilar occupancq; to aay existing buildiag or for each such �
buildin� or addition - ninety centa ($0.90) for each one thous.and cubic feet
or fraction thereof, in the cubical contents thereof with the minimum of $4.00.
For the purpose of computi,ng fees for building�permits;,the cubical conteats
of anq building or addition to a uniform height throughout by multiplying the,
ground area covered-from � point six (6) inehes below the floor line of the �
basement or cellar to the average hr��ght of the upper surface or to the average
height of the roof surface of the main gable,of a p3tched roofc.
2.5. For repairs or alterations to an existing st�u�ture, the fee ehail
be at the r,ate of $3,00 per each Five H+ln�red Do2lars ($Sf1t7.GJ) or fraction
Chereof in the cost of a11 proposed work. �
2.6. In no case sh�ll the fee char�ed for any permit as.aet forth in
Sectio 2n be less than $4.00.. '
STORM REPAIR DAMAGE rrFS;
Residential; Esti�ated CosC of work up to. $5��.00 •$5.40
Estina.�ed Cost of w��k over ,�`sfi�7a�� -$;.uo00
Commercial; Estim.ated-�oat of wo�k��.�g ,,tt� y�a�7a�0 -$1Q�°�
'� ��i Estimated ,,ost of work over $5Gt1.00 - $��_ .0
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City of Fridley, inn
BUILDING PERMIT
Date: � Oct. 15, 1968
��� ��
N� 998�
pwner. _ Herman Tatley g�� Same
�,d� 115 Horizon Circle Ad� Same _
LOCATION OF BUILDING
No. 115 g�t � Horizon Circle � � p� af Lot
Lot ._._.. 5 __ Block 4 Addition or Sub-Division .�_Carlson�s Summit Ma.nor N. Addn.
Coraer Lot _ Ins3de Lot —. Setback —_ Sideyard
Sewer IIevation �� ._ Foimdation IIevation
DESCRIPTION OF BUILDING
To be Used as:
Ga�� Front _.._� Depth � Height .�..Q..� Sq. FL � Cu. Ft �Q
Front Deptla ITeight _._.. Sq. Fk � Cu. FL
7.jme of Construction .._..^..E%� Fst Cost ._ $.g.4� .9SL..__ To be Compieted
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 aet forth and in compliance with all provia�tona of
ordinances of the dty of Fridley. ,�., .� i ./ °1–tA
In camsfderation of the payment of a fee of $___.�00 , permit is hereby granted to �ermau Tatlev
to construct the buflding or addition as described above. This permit ia granted upon
the express condition that the person to whom it is granted and his agenta, employees and worl�en, ia all work
done in, around and upon said buflding, or any part thereof, shall conform in all reapects to the ordinancea of
Frldley, B�fnnesota regarding location, conatruction, alteration, maintenance, repair aad moving of bufldings
within the dty limits and tbia permit may be revoked at aqy time upon violation oP any of the proviaiona of said
ordinancea a
�
arence Belisle
NOTICE:
Thk psrmh d�s eot eovsr ths eoestrueHoe, lestallaMoe tor wWeg, plumbleg, ea huNng, �rs� er watu. B� a►n to sss
16a BuUdieB Iespsetor for aparats parmiis Poe thas inms.
� . : �
gPPLICATION FOR BUII,DINC PERMIT
�TTY OP FRIDLEY9 MINNESOTA
owr� p s N.� �,�i�/�7AiU �i4T� E�BUZ�� S E L�
ADDRESS //5 f/D,C�/X p/U (�/�'�;L���x�ss SA//�IIE
IdCCATIOIV OF BTJII,DIATC
No e / s�� � o,� iz o �v ci�'c�,�
LOT 5 BLOCK � A.�DITION OR SLTBDIVISIO�T���,i0 .fI7�%7�� /�/��
� �
COR�'II� I,OT II�T�II3E LOT,� SETBA(:F:. SI�E`_TARD
SEGTER ELE�ATIOPl TOP OF T'OCTI�Ca
Applicart a-ctach to this iorm. Tv�7o �e�tifi�ate� of Su�vey oi Lot at�.d
propo�ed buildi:�.g locatior drar�m. o.r� -che�•� �e�tificateso
DES JR��'I' i ON OF BL�IIaDING
To Be �TsP�. A� :
'�/�l� c ,E Front„���Depth a � Height
0 /
�quare �°eet �.S % � �ubzc FE�t ��� 4 _
Fz°ont Depth Height
Squ�,re yeet Cubzc Feet
Type oi Con�truction�/�� T� E�timated Cost � 90�
To Be Completed �/V /V� F%li��/�°
The unde�signed hereby makes application for a permit for the work
hex°ein ape�ii°i�d, agxeeing to do all raork i� strict accordance with the
�'ity oi Fridley Ordinar,.ce� a.nd rulings oi th� Department o� Build�gs 9
and he�eby declares that alI the �'acts arid. rep�eae.r..tations �tat�d �.n
this application a.re true a.��d correeto
DATE �'��l �� # I i�� � �GNA'I�ORE %�� �('•�/ae1"��"I � �/
(Schedule of Fee Cost� ca�. be foutzd on the R�ve��e Sideo}
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SECTION 2o The In�pecto� o� Buildings shall, �eiore issu�ng per�it�
for the e�ection oi any builcling o�° st�u.eture, o�° ior aaa.y addition to any
exista.ng structure o� bU11C11.Y�,gy or for a�.y a.lte�:�.tion or repairs to a,ra.y
exi�t�ng buildi.�.g or� str�u�tu��9 upon �,pplica-tion th�reiore9 �equ�.re the
payffient by the �.ppli��,.nt fo?� auch perm.it Qi fee� to the affiour�t he�ea�.
below set iorth an� in the ma.�ner he�eix�. provided to�wit:
Unifo�m Buildi�.g Code e Typ� 1 9 2 9& 4-$i o 75 f or each one thous�,-nd
cubic feet, o?� fractio:n thereof e i:r� auch eubical c�ntent� o Type 3& 5-
$1050 for each one thousa.na eubic ieeto
Fo�° the pu:r°°pose oi computing fees f'or buildi.ng permits, the cubical
contents of any building or addition to a u�.iform height thz°oughout by
multiplying the ground area covered from a poirt six (6� inches below
the floor line of the basement or the ceilar to the average height of
the upper suxiace or to the average height oi the roof' �urface of the
ma,�.n gable of a pitched roof o
For repairs or �,lteration� to an existing struciure9 the iee �hall be
at the �ate of $3,00 per each f"ive hundred dollars ($500000� or
fraction ther�of i:� the cost of all p�oposed worko
In no case shall the �ee �harged io� any permit as set iorth i�. Seetion
2 bE less tha.n �u5o00o
NSSSD Connection Charges based on location - A.rea 1 ox° 20
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SUBJECT
City of Fridley
AT THE TOP OF THE TININS g U i L D I N G P E R M I T
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� ; y _._._ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
1 . �
( � /�"1 � CITY HALL FHIDLE� S$432 NUMBER REV. DATE PAGE OP
�----� • •'� 612-580-3450 910-F15 � �
7�18�7�
JOB ADDRESS 115 Sorizon Circle
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. S 4 Carlson Summit Manor North
2 PROPERTY OWNER MAIL ADDRESS
Aerma.n L. Tatley same
3 CoNTRACT�R MAILADDRESS
4 ARCHITECTORDESIGNER
5 ENGINEER
8 USE OF BUILDING
Addition to garage
7 CLASS OF WORK
❑ NEW
8 DESCRIBE WORK
Addition to garage
9 CHANGE OP USE FROM
�'-
STIPULATIONS
MAIL ADDRESS
MAIL A�DRESS
ZIP
ZIP
ZIP
�° 1480�
CEIPT NO.
9a3y3
APPROVED BY
SEE ATTACHED
SHEET
PHONE
560-3771
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
� ADDITION 0 ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
TO
1. Provide 2" x 6" rafters where full span
2. Tie rear footing iato floor with reinforcing bars - 4'o.c.
3. Fire stop S.W. corner of garage ceiling with 5/8" sheet rock.
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TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, Wood Frame
VENTILATING OR AIR CONDITIONING.
THIS PEflMIT BECOMES NULL AND VOID IF WORK 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 384 3840
ANY TIME AFTER WORK IS COMMENCED. NO- DWLG. UNITS OFFSTREET 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 THIS TYPE OF WORK WILL BE COMPLIED. o� �1•39
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PEFMIT p�
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � �15.36
PLAN CHECKFEE TOTALFEE
SIGNATURE OF CONTRACTOR OR AUTHORIZED AGENT IOATEI
�.� 1 0�� �-/�-%�"
1 oc nc nWr.icn rIF f1WNFR RLiP ERI IDATEI �
16.75
Y VALIDATED THIS IS YOUR�PER
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APPLIC�"fI01'� f=OR RESIlll:NTI/1L LUII_DING f'ER1�IITS
���C1�, �LTGR/1TIOPJ5, %�DDITIO�dS, OR REPAIIZS)
OWiJ�R: i�'tC�� �. �� 13UILD�R: 6-f,�.ci'��1 '
. �
Address : /� �,� �1� , , nddress : �
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Tel. Ido. 5(�0 —�3 � ?/. •�
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No. : %�✓ Street: �> �J C �G � fi�o� _
LOT: �J� BTACY.: � A'DDITiON: _ ����.1�'��! �x�r? ��""���9/.t�✓,� / �i�'Z�
C0�2IQER LOT: INSID� LOT: SLTBACY.: SID�YAItDS:
App�.ica'r�t attach to this fonn �Wo Certiiicates of Survey of Lot and proposed
bu9.lding location drawn on these Cextificates. .
DESCRIPTIOPd OF BUILDII�G
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To Be Us ed As : � ✓ � ,e� o ' �� � •
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�{,�� ' 2� ,�j �,����ront: /d� � Depth: �`� / Height o �C� f '
Square Feet: ---�?� Cubic Feet: ��U
Fx'on t: Depth : He ig ht :
� Square Feet: Cubic Feet:
, � �C�!'J2�_—
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Type of Construction: _ �r�- �, . ---� F �� Estimated Cost: $ � %��
7.b �e Completed: � �-' �'t,�
Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired ,��� $ $
(SE� 1tCVERSE SIDE OF SiiEET)
The undersigned hereby makes application for a permit for the �uork herein
specifa.�d, agreeing to do all �vork in strict accardance toitli the Cit}l of
Fridley Ordinances ai�d ruli.nc�s of the Denartment o� B111I.C�ilJ1QS� and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side far additioiial information.
D.�1TE: �- I�� �� STGNATUF.E: � ���� c�" � '�
5tipulations: � �` i�
f ��°r,e_�,��-� -� �C � � T���
� � ��P R , . G� Ff �� � � L � s.�i�n�
� ( � . � ��� �� ��� `.✓�a
n � . � � cdt� t 1`�� � � � � ��°�[
) � � � �� �y — "� � °`� ' .
�' S�• Cs�+-- - �
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BUILDING PER��IIT FEt SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issui.ng permits for the erection
of any building or structure, or for any addition to any existing building or structure,
oX for any alteration or repairs 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:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$14.50
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 inch depth; Driveway width plus 6 feet x$17.20
' 11 � : ► �' � �
For the purpose of computing fees for building permits, the cubical content5 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 th� cellar to the
average heights of the upper surface or to the average height of the roof surface
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 �er 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 less
than $7.50 plus $.50 sta.te surcharge.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of SuYVey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
��RTIFICATE OF �7CCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
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� C. E. COU LTER �
LAND SURVEYOR
REG{$TERED UNDER LAWS OR STATE OP MINIVESOTA
LICfiN06D BY OROtNANC6 OI CITI OP MINNCAIOLI�
3300 LYNDALE AYE. SO. MINNEAPOLIS 8. MINN.
LOCUST 0370
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I hereby certi.fy that the a��ove is a true and correct plat of a survQy o� ;
Let I�zve (5�. I�lock Four (!�), C;uiL,g�;'� �[;i,;..T.'� I--=,i��CR T•IC�.z?'I'H :�ODITICa.. �lnoka.CQUnty, i-iinaesota.
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� P:i�ue�cta Re�istrati�n No. 2�E�.
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AGREEMENT '
I • _�� � ��%� � �a//��� . owner of the property
located at %�� ��/z�,� �J,� �� , have na objec�ion �to the
Cit} allowing the constcuction oi a�� l? �p�/ � 9., eq�� to be
located at ��� D,� /���/ �`,� ��� without the required
certi.ficate of survey that the City ordinarily requires for a1Z new
co:nstruction.
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Address
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SuB�Etr
Cit of Fridley
5 � ��E �„NS gU ILDING PERMIT
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r � � PROTECTIVE INSPECTION SEC.
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l---.�� �"' �'� CITV NALL FRIOLE� 53132 NUM8Ei1
ti 612-571-345p 910-F15
J08 ADDRESS 115 Horizon Circle NE '
t IEGAL LOT NO. 9LOCK TRACT OR AODITION
DESCR. S 4 Carlson's Su
2 PROPERTY OWNER MAIL ADDRES$
Linda Tatley
3 CONTRACTOR MAIL ADDRESS
Oume r
d ARCHITECT OR DESIGNER MAIL ADDRES6
5 ENGINEER WIAII ADOpESS
8 USE OF BUILDING
� Residential
11EV OATE
10/9/98
21P
ZIP
P�GE O:
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J/L—
PMONE
PMONE
PERM
28185
ECEIPT .
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APVi10VE0 BY
SEE ATTACNEO
SFIEET
LICENSE NO
LICENSE NO.
LICENSE NO
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION � REPAIR O MOVE • O REMOVE
B DESCRIBE WORK
Reroof house and �araf?e (26 Sa) Tear-off: Partial
9 CHANOE OF USE FROM
STIPULATIONS
Underlayment must comply with the State Building Code.
Call for building wrap inspection before covering.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, NEATING, 'r� v� Vv•�•
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION 20NING
AUTHORIZED IS NOT COMMENCED Yji1THIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANQONEO FOR A PERI00 OF 120 OAYS AT 5
ANY TIME AF7ER WORK IS COMMENCED. ' NO DWLG. UNITS
I HEREBY CERTIFY THAT I MAVE READ ANO EXAMINED THIS APPLICA710N
AND KNOW TME SAME TO BE TRUE AND C04iRECT. ALL PROVISIONS OF LAW$ yp�UATION
AND ORDINANCES GOVEiiNING THIS TYPE OF WpRK WILI �E CpMP1,lE0
WITH WMETHEFi SPECIFIEO MEREIN OR NOT. TME GRANTING OF A PERMIT 2328
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE Oii CAMCEL TME pEqMITfEE
PROVISIONS OF ANV OTNER S7A7E OR LOCAI LAW REGULA7ING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION P7G _ 7 S
r
T
STALLS
CMA
re
A� F�
OCCUPANCVLOAD
CU fT
T PARNING
IGARAGES
tURE OF CON'AACTOA OA 4UTNQAIjEO AGENT �OATEi EN FOP - AU ATE T v I$�� P I1
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NEW L l
ADDN [ ]
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Effective 1/1/98
BUILDING PERMIT APPLICATION �
N �
ConstructionAddress: � i �� � rC l , �' , � �� �
Legal Description:
Owner Name & Address: �, i y� d� T f/e. �1 � lyav��zb� �'� r. Tel. # �% -/D//
Contractor:
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Construction Type:
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Length
Length
Driveway Curb Cut Width Needed:
DESCRIPTION OF I�i IPROVEMENT
Width
' Width
Width
0
Ft. + 6 Ft =
Height
Height
Hgt/Ground
Tel. #
Sq. Ft.
Sq. Ft.
Sq. Ft.
�-_,.. ��.-
Estimated Cost: $ �� �
(Fee Schedule on Back)
Ft x $ _ $
DATE: 0 Q APPLICANT: , Tel. # .� °r� � �l //
Permit �ee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ °7�% �'
$ �. .33
$ /. / �
$
$
$
$
$
$
$ U-�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/l0th%)
$.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 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 $2,000
$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 DEPRESSION ESCROW
(Concrete Curb 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 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.