AF - 46300sue�ecr PERMIT NO.
City of Fridley 15 4 0 9
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��
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; � R IPT NO.
� `L __���_ COMMUNITY DEVELOPMENT DIV. � P ���
r � � PROTECTIVE INSPECTION SEC. (A
1 � �
� � /"�'1 � CITY HALL FRIDLEY 55432 Nt1M8ER REV. DATE PAGE OF APPROVED BY
�'"'"� � ,�� 612-571-3450 910-F15 8/23/79 � �
JOB ADDRESS 5115 Iiorizon Drive N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. L� 9 (,'�,L'].30I1 � S $'llID1Rl't NIdIlOr South Addn. SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
R. W. Brandt 5115 Horizon Drive N.E. 560-5269
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Resi.dential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
X
8 DESCRIBE WORK
Reroof S.tructure
9 CHANGE OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. AS I7�7.�.'t
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OA IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
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 �ORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL 8E COMPLIED
WITH WHETHER SPECIFIEO HEfiEIN OR NOT. THE GRANTING OF A PERMIT $SOO �. SO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OF CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $%. SO
PLAN CHECK FEE TOTAL FEE
� �4: �O� V�
` SIGNATURE,O�FC9 NiR TORORAUTHOR12EDAGENT IDATEI Q WHEN PROPERLY IDATED THIS IS YOUR PERMIT
�h��,o j1�//{' Q1?.2�C�. ����v' � �.i �
SiGNATURE OF OWNER�IF OWNER BUILDERI IDATEt BLDG INSP �A E
CITY OF FRIDLEY •
ARPLICATION FOR RESIDENTIAL BUILDIPJG PERMITS
(Pdew, Alterations, Additions, or Repairs)-.
. � �,�` � < ���
OWP�ER: ,
ARDR
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1'EL�lO: �(�U � S�' %
BUI LDER : - ��� �-
ADDRESS: -
TEL N0: '
0
f'nnctruCtion LOCd'�lOtl
STREET NO: �� � �� 5TREET: ��d�--
LO�: BLOQC: �,
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ADDITION: � �
Corner Lot: Inside Lot: Setback: __ Sideyards:
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certif icates to scale.
� DESCRIPTIOtd OF CONSTRUCTION �
• ���pb� Front: Depi:h: _ Height:
�, I�,� c� Sguare Feet: _ Cubic Feet: '
r����
Front: Depth: H eight:
Square• Feet: Cubic Feet:
. ���� ��' � ��� �
Type of Construction: - Estimated Cost: $
7.b Be Cbmpleted: � � � � ��
Prop�sed Driveway Width If New Opening Is Desasede
SEE REVERSE SIDE OF SHEET ,
Alt. A A7-t• B
$ ---__�____ $
The undersigned hereby makes application for a permit for the work herein specified, s
agreeing to da all work in strict accordance with the City of k'ridley Ordinances and
rulings of the Department of i3uildings, and hereby declares that all the f acts and
representations stated in thi.s applicat'on are true and correct.
� ,� n . � � f�) ,v :�,,�L !�
DATE:
��- �r` � � � � szcNATU� : f - � � �' fi � u-=' ,,����
Stipulations:
i� , �
,
�� �
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BUILDI(JG PCR��IIT FCr SCiiEDULE� .
S�CTION 2. The ins1�ecL•oz ot l3uilclings shall, l�cf.ore i�suing j�ennits for the erection
ot any bui].ding ar sCructure, or Lor any addita.oii to at�y exi�ting building or structure,
or for any alteration or rel�airs L-o•any existing building or �tructure, upon application
therefor.a, require the paymenL• by the applicant for such pex�mit of fees to. tlie amount
hercin below se� forth and in the manner herein provided to-wit: ��
N�PJ CONSTRUCTION: Single �amily iIomes and Garages: $4.00/1,000 cubic L-eet.
PLAN CIILCY.: 25 percent of building permit fee.
DRIVE4IAY D�PRESSION: (Concrete,Curb Streets Only) �
• Alternate A: Femoval and replacemenL- of concrete curb and
gutter only; Driveway width plus 6 feet x y1�.75
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$17.85 �
:I/ 1 :, ► �' ` �►
ror the purpose of computing fees ior building permits, the cubical contents of any
building or addition, is determined by multiplying ihe ground area covered from a
point six (6) inches below the floor line of the basement or th� cellar to the
average heights of'i:he upper surface or to the average height of the roof suriace
of tlie nain gable of a pitched roof.
For repairs or al.terations to an exist3ng.structure, the fee shall be at the rate
of $3.00 per each five hundred dollars-($500.00) or fraction thereof a.n -the cost
of all pxoposed work. '
In •no case shall t,he fee charged for any permit as set forth in Section� 2 be less �
than $7.50 plus $.50 state surcharge. '
' � � � � ►1� �
NOTE: Permits for construction will be issued a minimum of 24 hours from the time
ai application to allow for proper review of the proposed structure and of the
aonsi:ruction si•te.
A Certificate of Survey of the lot, showing the location o£ the foundation once it
has been constructed will be required before proceeding with the framing.
L C � . � '"►
Application for a Cer�ifica�.e of Oceupancy shall be made ten (10) days prior to the �
use or occupancy of any structure for �ahich a building permit has been issued; and
said structure shall not be used or occupied un�xl a CerL-iia.cate of Occupancy has
been issued.
. �r
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sue�Eh
c�ty o�' Fridley 2 8 5 7 4
,`�7�0���� THE TW�NS g u I L D I N G P E R M I T
r
� ; v _���� COMMUNITY DEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC. ��� f
� _ �
� �"'1 � CITY HA�L FiiIDLE� SS1�2 NUMB@N REV O�TE n�GE Oc �PVqOVED Br
�"""'� � �'' 612-571-3450 s�aFiS / /
11 13 98
JOB ADDRESS
5115 Horizon Drive NE
t LEGAL ��T NO. BLOCK TRACT OR ADDITION SEE ATTACMEO
DESCR. (�, g Carlson's Summit Ma.nor South Addn. SMEET
2 PFOPERTY OWNER MAII ADORESS ZIP PMONE
Ma.r Brandt
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
Vikin Hm.Im rov.Co. 4832 2 t - 772
4 ARCNITECT OR DESIGNER MAIL AOORESS ZIP PNONE LICENSE NO.
5 ENGtNEER MAII ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION � REPAIR ❑ MOVE O REMOVE
8 OESCRIBE WOiiK
Reroof house and ara e 15 S Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE fiE0U1RED fOR ELECTRICAL, PIUMBING, HEATIN(i, TYPE OP CONST. OCCUPANCV GROUP OCCUPANCr LOAO
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT CU FT_
AUTHORIIED IS NOT COMMENCED W.ITNIN 80 DAYS. OR IF CONSTRUCTION
OR WOfiK IS SUSPENDE� OR ABANDONED FOR A PERI00 OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED NO DWIG. UNITS OFFSTfiEET PARKING
1 HEREBY CERTIfY TNAT I MAVE READ AND E)(AM�NED THIS APPLICA710N STA�LS GARAGES
AND KNOW TME SAME TO BE TRUE AND COiiflECT. ALl PROVISIONS OF LAWS yp�UATION SUR7AX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILI BE COMPLIED
WITM WHE7HER SPECIFIED MEREIN Ofi NOT. TME GRANTING OF A PERMIT ],285 .6�}
DOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CANCEL TNE pEqMIT fEE SAC CMAPGE
PROVISIONS OF ANY OTM R STATE OR LOCAI LAW REGULATING CON-
ST C OF THE PER O OF CONSTR C710N Fire SC 1.28
PLAN CHECK fEE TOTA FEE
4 .92
S�NAT RE O� CON'AACTO ON AUTMOA�2ED OG NT IDATE� EN F P VALIOAT MIS IS V i V�=T �
1
S�GN4TUAE O� OWNEA��� OWNENBUILD@Ri �OAfE� BLO �NS� ' f�6ft
NEW 3 [ ]
ADDN [ l
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�
ConstructionAddress: ;� �,� �
Legal Description:
Owner Name & Address: �
Contractor: I/ � l�� 2
Address: � � � 2--
LIVING AREA:
GARAGE AREA:
DECK AREA:
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Effective 1/1/98
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Tel. #
MN LICENSE # C�� � Z—
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Tel. # �� � — �/ �
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
Length Width Height
I.ength W idth Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
OTHER:
� /
Construction Type: �-P �'/L � � c� Es ' ated C.ost: $ ! ���
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: % � 3-- dAPPLICANT•
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPUI,ATIONS:
$ ��. �o
$ � � �v
$
$
$ ��o
$
$
$
$
$ '�% ✓ a
, Tel. #
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.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 [ ]
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CHININEY _ANI? STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioratioII Yes O No O
3. Has no foreign objects lodged with:n Yes () No ()
4. Is securely :supported Yes O No O
5. Meets all current Gode requirements for size
and total BTU's connected Yes () No ()
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ()
8. Has combustion air �een provided f�r water heater Yes () I�10 ()
Remarks:
List ALTERATIONS Bein� Done:
HEATING CO:
Signed By:
Date: