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Village of Fridley, Mi.n.n.
BUI�.DING PERMIT
Date: ..... . . .....�.� �. ��.......
Owner.......................................
Address......................................
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I�° 1835
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�. .��-�0��'E�-�e
Builder................... ... ......
Address . . .S.Z. � � . . �� . . . . . . . . . . . . . . . . .
LOCATI OF UILDING
No. . . � �. . � . . . Street . . /. ��. . . . � . . . . . . . . . . Part of t . . . . . . . . . . . . . . . . . . . . . . . . . .
�
Lot . . . . . . � . . . . . . Block . . . . . � . . . . . . . . . Addition or Sub-Division . . . . . e!�a?rYi t�. . . . . . . •
e �' �
Corner Lot . . . �� . . Inside Lot . . . . . . . . . . . Setback .��. . . . . . Sideyaxd . . .�-�. . � . . .�. . �. . . . . . . . . . .
To be Used as:
P.Fl•. ..... ......
C�z��-. . .. . . . . . . .
Type of Construction
DESCRIPTION OF BUILDING
Front . �.�.�. . Depth . �: �°. . Height . �. � `S Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
Front �: � . . . Depth .�: .`Z . Height J' �. . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
.��m�...... Est. Cost .��..��-.°:.... To be Completed ..................
� �� � ��
In consideration of the issuance ta 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
I ordinances of the village of Fridley.
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Tn consideration of the payment of a fee of $. �.� .°�, permit is hereby granted to
0
. . . . . . . . . . . . . . . . . . . . . . to construct the building or addition as described ahwe. This permit is granted upon
the.express condition that the person to whom it is granted and his agents, employees and worlmien, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordiaances of
�'ridley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
- ..� ... ........�.....
. B111Id1Ilg Ii1Sj]ECtOP
NOTICE: �'°
This permit d'oes not cover the const�uction, installatlon or alteratton for wi�ing, plumbing, gas heating,
sewer or wa4er. Be sure to see the Building Inspector for separate Aermits for these items.
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City of Fridley, Minn..
BUILDING PERMIT
Date: _ Oct . 1, 1968
p�r; Peter L. Bo�.eateel g��r �am,�.
Ad�re� � Horizon Circle A�.�
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�0 995'7
LOCATION OF BUILDING
No. 169 Street HcZ�� �o:�. C�rc� Part of Lot
Lot _..__._..L..._.__ Block ______..¢ Addition or Sub-Div3sion . �,,,�+*�,; t–l��^a� �Ts��k�
Coraer Lot _ Inaide Lot � Setback —_ Sideyard �
Sewer IIevation �� _ Foundation IIevation
DESCRIPTION OF BUILDING
To be Used as:
�eauty 5�,.9� . Front _.._. Depth Height � Sq. FL ..�2.f1.� C�. F't
Front Depth _.._ I�eight Sq. F� (.31. F't.
Type of Construction Frame ��, ��_�1QQ�QQ,,,_.,._ To be Completed
In consideration of the isausnce to me of a percnit to construct the building descrlbed above I a�ree to do
the proposed work ffi accordance with the deacription above set forth and in compliance wlth afl pravisfons oP
ordinanc�es oP the dty of FrTdley. �)
/
In consfderation of the payment of a fee oP $—_�.�� , pera►it 3s hereby granted to ..r T, .
�4.���.���- to conatruct the buflding or addition as described above. Thiap�� t is granted upon
the express conditfon that theperaon to whom it is granted and his agents, employees an� worl�en, fn all work
done in, around end upon said buildi�►g, or anypart thereof, shall coffiorm in all respects to the ordinanc� of
Fridley, Minnesota regarding location, conatruction, alteration, maintenance, repair and moving of buildinp
within the dty limits and thia permit may be revoked at ar�y time upon violation of any of the provlaiona of said
ordinanc�s.
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NOTIC�
This peimh dea nm eover ths eoes�ruetioe, 6ntaUaHoe tor widne, Plumbteg, gu 6eaHaa, �wu er waMr. 8� sun to sN
the Buildiu8 lasp�eta► Por uiipareta p�rmif� Por thas itNm.
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APPZICATION FOR B�II,DINC PERMIT
CITY OF FRIDIaEYy MINNESOTA
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OW�TEFi °$ N ��U � �GrY,�a,,��1' l� BiTII�DER ��
A�DRESS / li� 9 ��.tffl�z. ("�f'_,�2.���' ..�1��.�a'sr.� ,�--JiLleva'lJi�
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LCCATION OF BUII�DI�TC
1V0 , S'I'RE�°I'
LOT BLOCK�� �DITION OR S�BDIVISION���O /� �%�
COF��'�ER. LOT I1�T�IDE I,OT SEt'I'BAC� SIDE`TAR.D
SEWER ELEV'ATIOPi TOP 0�' �OCTII�'�
Applicant attach to thi� ior�. T�o !°z�tiiicat�� o? Su�vey of' Lot a.n3
propo�ed buildir.tg loca.tio:�� c1rQt�. or� -chea•� Cer°ti�ie�,t�s o
�ESCR.��'T i ON 0�' BIIIZD�NC
To Be ��P�. As :
��� ��Gz..� � Froz�t 7�epth Hezght
�quare �°eet Cubic Fe�t
Fr°ont De�pth Height
Squaxe ��et %a� ���°�-�ubic Feet
Type of Construction ���'�-� Estimated Cost ��G � a �'
To Be Completed � � � - � �
Th2 underaigxJ.ed herEby mak�� application for a permit ior the vaork
herein specifi�d9 agx°eei�ag to do all work in strict accordance with -thP
�ity of° F'ridley Ordina.rzces and rulings of' th� Department o�° Buildings,
and hexeby declar�a that alI the iacts ard rep�E3er�tations stated in
this application are true a..n.d correcto
DATE � �� .- /— (° � S�G�N9.TiTR.E �' � ( Z'`�=�
.
(Schedule of Fee Cost� car� be fourid on the Reverse Sideo�
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BUII,DING PERMIT �'EE SCF3ED�ULE
SECTION 2o The In�pector of Buildings shall, beiore issuing per�it�
for the erection oi any building o� �truct-u�°e, o� ior a:ny addition to any
existing �tructure or buii�ing9 ox ior a.ny a.lte�atio�. or repair� to any
existing buildi.ng or �t.cuctu.�e 9 upoa2 a�pli;:at�on therefore � �equi.re the
payment by the �,ppli��nt fo?^ Such perm.it oi fee� to th� amount he�ce�..�'�
below �et iorth anc3 in the ma,.:�n.�r herein provid.ed to�wit:
IIniiorm Buildir�g Co�.e o Type 1 y 2,& 4-$1 0 75 for eaeh o:rie thou�a.nd
cubic feet, or iraction thereof9 ir sueh cubical c:onte�t�a Type 3 8� 5-
$1 0 50 for each one thousa.i�d cubic i'eet o
For the purpo�e oi com�rutirig ieea ior buiZding permit�, the �ubical
contents of any buildi.ng or addition to a ut�iform height tY�xoughout by
multiplyi.ng the ground area covered from a point six (6) inches below
the f'loox° line of the basement or the cellar to the average height of
the upper surface or to the average height o� the roof �ur°iace of the
main ga,ble of a pitched roofo
For repairs or alteratio:�s to an eacistl..ng �tructure, th� fee shall be
at the bate oi $3000 per each iive hundred dollars (�500e0Q� or.
�raction thereof i�. the co�t of all �roposed worko
In no case shall -the ��e �h�.rged ior any p��mit as set ?orth �.:� Section
2 b� less than $50000
NSSSD �onnectio�. Charges based on location -.Area 1 or 2e
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sue�ecr PERMIT NO.
c�ty of Fridley � � � �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �1 y______ COMMUNITY DEVELOPMENT OIV. NO.
r � � PROTECTIVE INSPECTION SEC. �I�� �
1 i
cs
' , ����1 � CITY HALL FRIDLE� 55A32 NUMBER REV DATE VAGE Of APPROVEO BY
�----� • •'� 612-571-3450 910-F15 8/22/95 � �
JOB ADDRESS 169 Horizon Circle NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. 1 �+ Carlson's Summit Manor North SHEET
2 PROPERTY OWNER MAIL AODRESS ZIP PHONE
Peter/Ma.ry Bonesteel 169 Horizon Circle NE 572-1009
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Same
4 ARCHITECTORDESIGNER MAILADORESS ZIP PHONE LICENSENO.
5 ENGINEER MAllAODRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOFiK
Reroof House (19 Sq) 2nd Layer
9 CHANGE OF USE FROM TO
STIPULATIONS
Roofittg ean be the 2nd layer but not the 3rd.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOH ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED Oi; ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 S?ALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �L�I�FO �.57
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANV OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $�FO.LS F 0 SC �1.I.4
PLAN CHECK E TOT L FEE
1.96
S�GNATUREOFCON�RACTORORAUT IZEDAGENT TEi PAO ER V ATED T IS IS YOUR PERMIT
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SiGNATU E OF OW R iIF O NE BUILDENi �OATE� L D pbTE
. . ..w �T.G ..w. f.� � �.�.�.... • . ... < . .s. . .. . ...v . �.. . ... .• . . . . . .. .n.. ...�......� ..... .,..� .w .an .. . c ...r. . .. . �...�.�.�. �.� v»s.�n.� i.�.�.� �.�.�.�.�.� i �.i.i.�.�.� s.�.....wi.-rt.-�.-..n....ww-w .,...... .�. ... . .��YC'n �....2�.�.::)::�
....... . . .. . . . . . . . ....... .......... .. � ♦� i
NEW [ ]
ADDN [ l
ALTER []
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 8/ 1 /95
��� �
CoastructionAddress: �
/� 9 .� ��� �°�,e�/� _
Legal Description:
Owner Name & Address: �iG r2 �
Contractor: CJ C�� ac/ ��C ' _ MN
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed constivction drawn on it to scale.
DESCRIPTION OF II1�ROVEMENT
# �%2._/00
iE #
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECg A1tEA: Length Width Hgt/Ground Sq. Ft. �
OTHER: � ��� �� ���—�.��,,
� � �� .
Corner Lot �] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
Type of Construction: Estimat�d Cost: $ //�Q
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ �
DATE: — o� �_% S— APPLICANT: Tel. �� 7� — o o� 9
Permit Fe�
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� �o. ��
$ %. /
$ , � `7
$
$
$
$
$
$
$ �,
CITY USE QNLY`
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,0� Valuation
$850 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Cons�vation Plan Review
Fee Determiaed by Engineering
Agreement Necessary [ ] Not Necessary [ ]
BUILDING 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, W 1 to $50,000
$50,(y01 to $100,�0
$100,001 to $500,000
$500,�1 to $1,OQ0,�
$1,0�,001 and up
I��.�
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $SW plus $2.75 for each additional $100 or
fraction thereof, to and including $2,�
$62.25 for first $2,� plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,OQ0
$349.75'for first $25,(�)0 plus $9.00 for each additionat $1,(�0
or fraction thereof, to and including $50,000 .
$574.75 for first $50,000 plus $6.25 for each additional
$1,� or fra.ction ther�f, to and inclading $100,000
$887.25 for first $100,000 plus $5.00 for each additionai
$1,�0 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,�0 or fraction thereof, to and including $1,000,�0
$5012.25 for the first $1,000,� plus $2.75 for each additional
$1,� 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.�.
Alternate "B" : Removal and replacement of curb and gutCer and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet tim� $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 1A� hours from the time of application to allow for pro�r
review of the proposed structure and of the construction site.
A Certifica.te of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing. �
B��
sue�etT .
City of Fridley � 29978
AT TME TOP OF THE TWINS �� I L D I N G P E R M I
;,
,� .
� ; y _____ COMMUNITY DEVELOPMENT DIV. ����
r � � PROTECTIVE INSPECTION SEC.
� . ,
i-_-• i�'��,,; CITY HAIL FRIDLE� SS��2 NUMBEII REV OATE VAGE OF APVROVED 6�
L J\ 612-571-3460 9t0-Ft5 8/3/99 � /
10B ADDRESS �
169 Horizon Circle NE
1 LEGAL �OT N0. BLOCK TRACT OR ADOITION SEE ATTACHED
DESCR. 1 4 Carlson's Summit o orth SMEET
2 PROPERTY OWNER MAIL ADpRQS$ 21P PMONE
Ma.r Bonesteel
3 CONTRACTOR MAIL ADORESS 21P PNONE LICENSE NO
L J Roofin 10151 Fole B vd. -
4 ARCHITECT OR OESIGNER MAIL ADORESS ZIP PNONE LICENSE NO.
5 ENGINEER MAII AODRESS ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOFiK
O NEW � ADDITION 0 ALTERATION �C R�PAIR O MOVE O REMOVE
B DESCRIBE WORK
Reroof house and garage (26 S) Tear-off
9 CHANf3E OF USE FROM TO
STIPULATIONS
Underlayment must comply with �d� the State Building Code.
SEPARA7E PEIiMITS ARE REOUIRED FOR ELECTflICAL, PLUMBING. HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTI�ATING OR AIR CONDITIONING
7MIS PEfiM1T BECOMES NULL ANO VOID IF WOfiK OR CONSTRUCTION ZONING SO. FT CU FT
AUTHORI2ED IS NOT COMMENCED WITHIN 80 OAYS. OR If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIpD OF 1�0 pAYS A7
ANY TIME AF7ER WORK IS COMMENCED. NO DWLG. UNITS OFFSTFEET PARKING
I HEREBY CERTIFV 7HAT I MAVE READ AND EXAMINED TMIS APPLICATION STA�LS GARAGES
AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS Oi LAWS VA�UATION SUR7A7f
ANO OROINANCES GOVEpNING THIS TYPE OF WpiiK WILL BE COMPUED
WITM WMETHER SPECIFIED NEREIN OF NOT. TME GRANTING OF A PERMIT �22%2 ��.. �.4
DOES NOT PRESUME TO GIVE AUTMOFITV TO VIOIATE OR CANCEL TME pEWMIT FEE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR LOCAL LAW REGUTATING CON-
STRUCTION OR TME PERFOFiMANCE Of CONSTRUCTION �HJ�.25 Fire SC Z.Z%
PLAN CMECK FEE TAl FEE
_ �� � Q License S .00 91.
S�G�TUpE ON'AACTOQOpaUTMOA�ZEDAGENT IO�T � W N PR ERl � ATED T IS V UA �IT
�
S�GNAtUAE 0� OWNEA i�F OWNEA BWLDEp� �DATE� � BIOG So � qaiE
� �
�l J
ADDN
ALTER
Effective 5/10/99
[ l CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R=1 AND R-2
BUII.,DING PERMIT APPLICATION
Construction Address:
Legal Description:
Owner Nam
<
#
!�
�� i
�� � ��
Contractor: __ �,T �L o��� MN LICENSE # �'�3%
Address: � o l�! �-e,l e� I� 1 u� Tel. # ?(� 7-/J°�%
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
Length
Length
Length
DESCRIPTION OF IlVIPROVEMENT
Width
Width
LY
Height
Height
HgtlGround
Sq. Ft.
Sq. Ft.
Sq. Ft.
v �
Construction Type: �C�r c� ¢' �e se vi Estimated Cost: $ . �� %�-
�
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$.
DATE: �� APPLICANT: � 2'" Tel. # 7h 7'����
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
CITY USE ONLY
$ �_ �,� � Fee Schedule on Reverse Side
$ '7 .001 of Permit Valuation (1/lOth%)
$ /, � `� $.50/$1,000 Valuation
$ $1050 per SAC Unit
$ .� - O U $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Nece�s�ry [ )
I.
.
�
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
a�idition to any existing building or structure, or for any alteration or repair to any e�sting 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
$SQ;001 to $100,000
$100,001 to $500,000
$500,001 to $1,Q00,000
$1,Q00,001 and up
FEES
$23.50
$23 , 50 for first $500 plus $3 .OS 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 $1,000
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 $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,�0,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRI�Ei�VAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet tunes � 15.50.
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 $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to a.11ow for proper
review of the proposed structure and of the consiruction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it h� ��n �����t�d wil�
be required before proceeding with the framing.
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C. E. COU LTER
LAND SURVEYOR
REdIBTERED UNDER LAWB OR BTAT[ OR MINNESOTA
LIC[N/CD �r ORDINANG[ O! CIT� O► MINN[A►OU�
3800 LYNDALE AVE. SO. MINNEAPOLIS e, MINN.
LOCU3T 0370
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I 1�reby certify t�t the abave is a true and correat pl.at of e au�rvey of:
Lot One (1), Block Four (4).� CAi�ISIN'S SUI+�►4IT MANOR NORTfi ADDIZ'1�1� Anoka Cot,tnty. Minnesota,
A� surv�yed,by me this 29th day of Maroh 19,'"j6 A. D.
' ed — �5.� . �.f",.� �'� . .
Si gn
I�iinnesota Registration No. 2s81�
ARV�D E. CAR�So
�, �
o �� �
HEATING HOUSE HEATING TEST RECORD ��� %
���1�� AIR CONDITIONING
D ELECTRIC. INC.
ADDRESS I�,�,. �� I Zt�v� �' ✓ APT. --� FLOOR CITY �r SUBURB
OCCUPANT ^ OWN�p I��:'�a C�
HEAT LOSS DATE HTG. INST. '
SOLD BY Gt t� INSTALLED BY
Electrical Work BY _ (�_. �,Q Qae Llne By
TYPE OF HEAT GA FA� HW STEAM� SPACE HTR._ UNR HTR._ OTHER
GAS DESIGN CONVERSION
MAKE � � MAKE OF BURNER
--- _
- Nbdel - - Mo7a1 — -- -----
Serial a � AAex. BTU Rating
INPUT f� 1� �� MAKE OF FURNd►CE
_'
Model
^•-° CONTROL3 �' �
THERMOSTAT Heat Plug Vant Siza
Valve KIND OF UNER g�g NONE
LImR ° C.f� Draft Hood / e.e.o Raguiator
Ltmit Setting � Fllten Siu ✓+��Sh Number �
Fan Seriing ^�� Chimney Location Inslde Outsi�
Pilot Type G� Chlmney Conatruetion
Pilot Make
P(lot Model Smotca Bomb Wiring ./
Pilot TlminB � , Drak Test Tag ✓
L. W. Cut Oft Door Pre�ure u0��9 ��•
Prossure Pereant CO, , Data Tasted �• 2. ��
Input CFH d Pereent O� � Company Tasttng
Staek Temp. ��° Pe►eeM CO Name of Tester
Form Z3S
sue�ec* RMIT NO: �
c�ty of Fridley 33602
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
; � REC O.
• COMMUNITY OEVELOPMENT DIV. � � ��
� � V �
r � � PROTECTIVE INSPECTION SEC.
i .' �
`----� ��'��,•� CITY MALL FRIDLE� SS�3Z NUMBER REV DATE PAGE OF ACVROVED BY
L 763-571-3450 910-F 15 6/ 12 / 03 / /
JOB ADDRESS 169 Horizon Circle NE
t LEGAL �OT NO. BLOCK TRACT Ofi ADOITION SEE ATTACHED
DESCR. 1 4 Carlson' S Summit Manor North Addition SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Peter & Mary Bonesteel 169 Horizon Circle NE 763-572-1009
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
a ARCMITECT OR DESIGNER MAIL ADDFESS ZIP PMONE LICENSE NO.
5 ENGINEER MAILAODfiESS ZIP pNONE LICENSENO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW �J ADDITION O ALTERATION O REPAIR ❑ MOVE O REMOVE
B DESCRIBE WORK
Construct a 10' x 8' & 2' x 6' & 3' x 6' Decks (detached from house)
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
SEPARATE PERMITS ARE RE�UIRED FOR ELECTiiICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIF CONDITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK Op CONSTRUCTION 20NING SQ. FT CU FT
AUTMORIZED IS NOT COMMENCEp WITHIN 60 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AF7ER WORK IS COMMENCE� NO DWLG. UNI7S OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED 7NIS APPLICATION 1 STALLS GARAGES
AND KNOW TME SAME TO BE TRUE ANO CORi;ECT. ALL PROVISIONS OF LAWS VALUATION SUR7AX
AND OROINANCES GOVERNING THIS T.VPE OF WORK WILL BE COMPLIED ��g93
WITM WME7HEfi SPECIFIED HEREIN Ofi NOT. THE GRANTING OF A PERMIT �.SO
DOES NOT PRESUME TO GIVE AUTHOfiITV TO VIOIATE OF CANCEL TME pERMIT FEE SAC CMARGE
PROVISIONS OF ANY OTMER STA7E OA LOCA� LAW REGULATING CON• $3H.%S Fire SC �.99
STRUCTION OR TME PERFORMANCE OF CONSTqUCTION
PLAN CNECKFEE TOTALFEE
$40.24
L�JS�GN4TUAEOF�pN'AACT AUTHOAIj OsGENT iD�iE� ME PROPERIV VALIDATED THIS IS YO R PE M17
�� '1 _
. ' t ` �i � -/� -o � ; 1� 2��
S�GN4TU O�OwHEa�i:O NEQBUiLOEtii iOATE� B�OG �NS� qat
NEW [ ]
ADDN [ ]
ALTER [ ]
Construction Address:
Legal Description:
r
/
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�J ��l�� l-
Effective 1 /1 /2003
(763) 572-3604 Bldg Insp
(763) 571-1287 Fax
� �� � � q)
� a� �� 0�
Owner Name & Address: ��7��� ���,_� N��/✓��el. #���-� 7�-�dog
Contractor. i�`f:� N�'%� � MN LICENSE #
Cs
Address: Tel. #
LIVING 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.
0
Length Width Height Sq. Ft.
Length �dth HgUGround � 5 Sq. Ft. �
,
� �, � �- i �i (1 �"�;;.. � �' �' 4 , l�X � � o��C � � �'
1
�
Construction Type: � d �� � �� � � r� Estimated Cost: $ � �� 9 Z � � 7 � �
�,\��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �-- �-� �� APPLICANT: � � Tei. # ��-3-�%� /°e%
Call (763) 572-3604 for Permit 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 Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
� � ��
$ � qq
$ m ��
$
$
$
$
�
$
$ �9�• ��
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 Engineering
Agreement Necessary [ ] Not Necessary [ ]
•�
c�
��`
�a
BUII.DING PERMIT FEE 5CHEDULE
The Cluef 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 pemnit 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,OQ0
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
$25,001 to $50,000 $391.25 for first $25,000 plus $10.10 for eaah additional $1,000
or fraction thereof, to and including $50,000
$50,001 to $100,000
', 11 11 � ', 11 11'1
$500,001 to $1,000,000
$1,�,001 and up
$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 $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CUltB CUT ESCROW
(Concrete (:urb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate.
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 location of the existing foundation will be required before
praceeding with the franung. New Houses Onlv
f ��
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