AF - 46303SUBJECT � PER�A,IF�A
City of Fridley �. 1465
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO.
� 1 v___��_ COMMUNITY DEVELOPMENT DIV.
r � PROTECTIVE INSPECTION SEC.
i i
1 1 �
l•--_ � �/'��,,� CITY HALL FRIDLEY 55432 NUMBER REV. OATE PAGE OF APPROVED BY
L � \ 812-580-3450
910-F15 4/27/78 � �
JOB ADDRESS 5129 Horizon Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �j 9 Carlson's Su�it Manor South SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Warren Nelson 5129 Horizon Drive N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Reliable Roofing 3504 - 18th Avenue 5outh, Mpls. 721-3025
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house
9 CHANGE QF USE FROM TO
SrtIPULATIONS
Insta.11 ri,dged galwanized valleys.. New roof can be second but not
third roof .
SEPARATE PERMITS ARE REOUTAED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. AS Y13�.'t
THIS PEFMIT 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 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 CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT y�S4O y�` . r'JO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORM NCE OF CONSTRUCTION. � $%. 'rJO
PLAN CHECK FEE TOTAL FEE
� $8. ��
Si ATUHEOFCONTRACTORORAUTNORIZEDAGENT �Dn E� WHEN PROPEfiLY VALIDATED THIS IS YOUR PERMIT
— ��iL\el-- d�.==L.�l�%? � Y , ��;/1e�V -'�s
SIGNATURE OF OWNER IIF OWNER BUILDERI (DATEI ' EjIDG. INSP pATE
__ .. . �
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0
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CiTY ►►(- f=f� � 1)i_��' ,
�i�'{'LIC/�,7I UI� (=()R I,t:S Ill(:(JTIl�i_ �111 �I;I I�G f'r_[�Mi 7� .
(�'�LW, IIL�I��R�7I U(!�, �I?UIT I Ufv s, ��Z REP/1I RS)
06•;���r�: �/�� cY��"/`�% � � 1�/�LS'o�i nuir u�.��z: e_� ��� � 60
� _
Addl:ess: S I '7-. � ��i�s'�,^-�� ��/l )1c�clre�s: � 7"J�( " � �- � -�
Tc 1. No a : % '�. j •- '3 � �-� � '
tso e
LOT:
COR:dER LJT:
Street:
fiI,OCY.:
ItaSID� I'JT�
ADDITIOP� :
S,?,TF?I� CY:: SII�L•'�'11RDS :
Applicar�. attach to L-his fonn 7�:a� Cc.r+:.i�icate� of Si:i:vey of Lot ar:d pro�sed
• buildir,g location dra���n on these C�rL-ificates. .
DESCRIPTIOPJ OF T�UILDTI�G
7�'0 }3e Used 1�s:
� .r''�. 1.(/�YOI1t7 ��ptll: '
Sgu�re Feet:. Cubic Feet:
Pront:
Dept�h :
Hei.ght;
Height:
Square Feet: Cubic �`eet: '
Type of Construction: ��Ib �. S��'��.��; ��Estimated Cost: $ �g �p �
Zb �e Campleted: y q-F,
Alt. A Alt. B
Proposed Drive�vay �ti`idth If 11ew Opening Is Desireci $ $
(S�� I2�VEP.SE SIDE OE SHEET)
The undersigned here��y makes application for a permit for the work herein
specificd, agreeing to do all �cork in strict accordance wii.h the City ot
Fx'idlcy Ordinances and ruliiigs o� the Departraent oi Laiildings, and hereby
declares L•hat all the facts and re��resentatioi�s �tated in L-his applica�ion
are true anc� eorreet. See reverse side for. aclditic�t�al iizionnation.
v
DAT�:
Stipulations:
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Sf'�..`�'TO:J ti. 'I'he Tns�?�cror rf L'�<i.1.:lir:c?s �t;=:11, hef��r.'e i,c,suin�l Z>,_:r:m�_t_, fv!- t,1ic. �r.�_:cLioi�
!'ii �i.7�7 b��il.d�_n�� C�Y' StiLi.��T.L7i"?� Cl!` 1"•:�" ci°�.'�� ;:��<�'t.'._�21 tU _it21 PaCi.:,�J.:?�; k):2:�..�_4`.lti:J Gi: ;t?'L1C't?ll"!`r
f» fCl3" F1I'1�/ c1�.1:c'Z'cLi:lOIl G1" Yt=�J�1.YS �C! r1i\'j t]:ti]SL'7.ii;� i:rli.l.ZCjlilg OI S1':Y'UCt.il..°f�6 1�i�:J7i <3�aj):. iC`i2�1�1T1
�hcrefore. �-c�c{uire the pa}r7ne:�t Y�;� r�'i� ;tt•�-�lic::rii; :a�- ::;uc:Yi gez�ti.t c.i= fc:��:: ±�o tlie arnount
I7r�2"F 1 T] ,�-�lcE�� sryt farth �r,�.:� i�n ti�e .^,� �r,�,�st her��zr� pro���deLt to-�vit_ e
T:i:w' COPvS^RUCZ'ION: Sir>.,�.e H�a.i1y iir;anc.,_ �..�3 G�r_ages. $4�.OfJ/I.Cti��. ctz�,i;.� f:..�.
�I,�#N CNE�::K: �5 �c�r�� �r�t: �� 'h�.il di_nc; p,..z�i,.it ff,r�.
�?itIV�WAY 1"�E2FTS:�I�Jz:: ((:c�ncr�te Cugb :���e:ets !J::ly)
Alternate A: �:-mav:±1 arc'. replace:�er�t of conerete c�.�h a.izd
vu�?�F�r onI1T; f�+'iveway �ai:�th plus 6 ieet x$14.50
Alternate E: i:2i:lJVdl ci�l�:i :C::��I.dCCfi�7] G Gi concrete curb dll�
-- yu�ter _^._�r�. .i_?:���.11 a 3 faot �•7ide aP1�roach vaith
6 in,:i� ::cp��:-�; r��ivEaay �Ni�ltl;. glus 6 fF��t .. �i•�-<'�
.�D� {';� 1; 'rtF ��r ,T +V
_� � T.� �_ �f�-_.-_,-,. _(ir;:_;.;=-- �!' --
For the purpose of computin� fees for building permi�s, the cubical contents of ar.y
building or addition, is determi.zed by multiplyir:g �-�}:e ground area covered. fronl a
t?oint sia (6) inches below the f1oo�- .'..ine of �c71e ba�u�ent or the cellar to the
average heights of the upper surface �r to the average height of the roof surface
oi the main gable of.a pitahed roofo
E'or re7airs or alterations to an er.istir�g stru.��urE, the fee shall be at th� rate
of $3 . 00 ,� er each five hundred doll.�rs ($5U0. ;:0; or fraction thereof in the cost
of all proposed work. '
In na cas� shall the fee charged for ai:� permit as set forth in Section 2 b: 1 ea_:
t:ian $7.50 plus $.50 state surchargee
VERTFICATIOV OF FOUNPATION
NOTE: Permits for construction will be issized a minim�.� o� 24 hours from the time
o� upplication to allow. for proger re�Tie�a of the proposec! struc�ure a.nd of_ the
construction site.
A Certific«te of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before or:.c� ed?r.g with the frami.ng.
C�� i�? v�i��� �?�.� �.i' A N CY _
Ap�lication for a C�rtifica�e of Occupancy shall be made ten (10) duys prior -to the
use or occupancy of any struc�ure for which a building permit has been issued.; and
said st�ticture shall not be used or occupied uritil a Certificate of Occupancy has
beeri issued. , °
6
� � �. .�-�-
--�----�.r
sue�ecr PERMIT .
City of Fridley _ 1804
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
i � O.
COMMUNITY DEVELOPMENT DIV.
r � y � PROTECTIVE INSPECTION SEC. f/ � /
� c�a
� ` �
, /"'1 � CITY HALL FRIDLEY 55432 NUMBER fiEV. DATE PAGE OF APPROVED BY
�.._.� • •�� 612-571-34b0 910-Ft5 6/6/85 / /
JOB ADDRESS 5129 Horizon Drive N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE AttACHED
DESCR. 5 9 Caxlsozl' S 5uffinit Manor South Addition SHEET
2 PROPERTY OWNER MAIL ADDRES$ 21P PHONE
Warren Nelson 5129 Horizon Dr.ive N.E. 572-9535
3 CONTHACTOR MAIL AD4RESS ZIP PHONE LICENSE NO.
Don Schuett Builders 8431 Terrace Ro�d N.E., Mpls.. 55432 784-8041
4 ARCHITECT OR DESIGNEH MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
�J NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 26F x 22' Deta,checl Garage
9 CHANGE OF USE FROM TO
STIPULATIONS
PXOVide a haxd su��ace d:�ivetn?ay. �,,gxeement s%gned by neighbor to
south.
SE6°ARATE PEf��IITS REQUIRED FOR
�a��,��� WIRING, H��1Tf�;G, PLL1Y1B11�G /�lyD SJG��
Before digging call local utilitia�
TEIEPHONE - ELECTPIC � �p� �t�,
���l1iPEp �'f' ���
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT 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 PERI00 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 CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES (iOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $6,972s6S y�3.4g
DOES NOT PRESUME TO GIVE AUTHORITY TO. IOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LO LAW REGULATING CON-
UCTION OR T PERFORMANCE F C RUCT N. $F)Z. SO
/ �� /�� PLANICHECK FEE ro$��e99
_�r�,- ��
SIGNATUREOFCONTR Cr �anur OR12EDAGENT IDAT&) a � WHEN PROPERL VALIDATED THIS IS YOUR PERMIT
( la �,.��
SiGNATURE OF OWNERiIF OWNER BUI�DERi �DATEi BLDG �NSP ATE
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AGREEMENT
. I, �� ., owner of the property
located at %.S :�i� .2 /� ", have no objection to the
City allowing the construction of a ������ to be
located at ,Z � � without the required
certificate of survey that the City ordinarily requires for all new
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construction.
itness
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ignature
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Address
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Date
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NEW [] City of Fridley Effective �/1/8�
ADDN. [ ] R-1 AI�D R-2
pLTER. [ ] Building Permit Application
Construction Address: s ` �� �0��� `�0.� • �� � 1 e -
Legal Description: �-o \ � �� o C � Ql �cA ��S4t�7 ,S �� �il `�j� �C4'n� n d� � t� ,
Owner Name & Address :��o� � e�� e�S o�• s��.q \� o c ��'L-. o tJ �'(�, Tel . 4 s� �. �9 S� 5
Contractor: � � � �� v.P� � �.\ \ � a'�S Tel . � � " �
Address: c���� ��r�Q �`� 'l�c,� �(1•� • �p� S-
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:,
GARAGE AREA:
DECH AREA:
OTHER:
Corner Lot [ ]
DESCRIPTIOp OF IMPROYEMENT
Length Width Height Sq. Ft.
-� �7� 115 .
Length a ln Width ��. Height � Sq. Ft. S' �--
$tTe� •
Length Width Hgt/Ground Sq. Ft.
-- _y ���.
Inside Lot �' Ft. Yd. Setbaek � D� Side Yard Setbaek �
Type of Construetion: °�O�iC�eZe '�- �c�c� �_
Approx. Completion Date: , � - `� - � 5�
Proposed Driveway Width If New Opening Is Desired:
DATE: Io - S�' � 5__ APPLICANT:
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
SeWer Main Charge
TOTAI.
STIPULATIONS•
CITY IISE ONLY
$ � � oS.�C
$
$ �-'`f�
$
�
�
� �� 9�
�S
/c�. q�
Estimated Cost: $ �07� �O � (9�0
�,9�� ��
Alt. A Alt B
$ $
See Baek Page for Explanation
Tel . � �� T--d �� /
Fee Schedule on Reverse Side
25� of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�� � ��� �� �
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BIIILDING PERMIT FEE SCi�DIILE
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 strueture, upon applic.atio n
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 Valuation
�1.00 to �500.00
Feea
$10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional �100 or fraetion thereof, to and including
$2,000.
$2�001.00 to $25,000.00
$25,001.00 to $50,000.00
$50,001.00 to $100,000.00
$100,001.00 and up
$32•50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
ineluding $25,000.
$170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraetion thereof, to and
ineluding $50,000.
$283.00 for the first $50,000 plus $3.00 for each
additional $1�000 or fraetion thereof, to and
including $100,000.
$433.00 for the first $100,000 plus $2.50 for eaeh
additional $1,000 or fraction th�reof.
DRIVEWAY DEPRESSION ESCROii
(Conerete 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
approaeh with 6 ineh depth - DriveWay width plus 6 feet times $15.75
YERIFICATION OF FOONDATION
Permits for construetion 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 onee it
has been aonstructed will be required before proceeding With the framing.
p ' . i
sue�ecr PE
City of Fridley 19403
AT THE TOP OF THE TWINS g U i L D I N G P E R M I T
r
� � REC
� `L ___�� COMMUNITY DEVELOPMENT DIV. �
r � � PROTECTIVE INSPECTION SEC. h����
� i � ��
' �'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVEU BV
�""'� � ,�� 612-571-3450 910-F15
4/21/88 � �
J08 ADDRESS 5129 Horizon Drive N. E.
t LEGA� �OT NO. BLOCK THACT OFi ADDITION
DESCR. 5 9 Carlson � s Si11IIIDl't Nl3LlOr South Addn. SEE ATTACHED
SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Warren Nelson 5129 Horizon Drive N.E. 572-9535
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Milton L. Johnson Co. 2513 Central Avenue N.E., Mpls. 55418 781-9548
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZtP PHONE LICENSE N0.
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO.
8 USE OF BUILDING �
Residentia7,
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION �7 REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install aluminum siding, soffit & trim
8 CHANCiE OF USE FROM TO
STIPULATIONS
SEPARATE PEHMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 OFFSTREET PARKING
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF �AWS VALUATION SURTAX
AND OROINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIfIED HEREIN OR NOT. THE GRANTING OF A PERMIT S4�O�O S2.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
�UCTION OR THE PERFO ANCE, OF CONSTRUCTION. , �44. SO
� ' �J PLA CHECKFEE TOTALFEE
/ . / %' /%f —�� T ` _" $46• r'J�
SIGNA UREOFCONT ACT RORAUTHORI2EDAGENT (DATEI WHEN PROPERLY VAL TED THIS I YOUF PERMIT
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r y � � C�Ce.`
9
SiGNATUREOFOWNEFiIFOWNER8UILDERi 1DATE1 BLDG iNSP ATE
NE6d L ]
ADDN. [ ]
AI,TER. � l
City of Fridley
�____.
R-9 AND R-2
Bu3lding Permit Application
EPfeetive 4/1/86
Construetion Address: 'J �`'� � � �� � �e�� `" �� -
Legal Desaription:
Owner Name & Address : v "��� t "s � ' `' �L 5 c+ �� Tel . � °��''� — y`� �`��
Contraetor : � � � d'' %� � � (� �' � ° `� �� , Tel . � � �� ;�5� �
i�i .
Address: °�; / 3 � �,°v� r� �- � /L��� f''%��g .� �/� � S �/ �
LIVING AREA:
GARAGE AREA:
DECR AREA:
OTHEa:
Attaah to this applioation, a Certifieate of Survey of the
lot, with the proposed aonstruotion drawn on it to seale.
DE3CRIPTION OF IMPROYEMENT -
Length Width Hei�ht Sq. Ft.
Len�th Width Height Sq. Ft.
Length _ Width H�t/Ground Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setbaek �
� °i
Type of Construetion: %� �° � �' � "v �.� ° � �' � °� T�"` �� Estimated Cost: $ �- � �� �
Approx. Completion Date:
Alt. A Alt B
Proposed Driveway Width If New Openin� Is Desired: $ $
See Back Page for Explanation
DATE: �" �� "� �
Permit Fee
Plaa Check
State Surchar�e
S�iC Char�e
Park Fee
Sewer Main Char�e
TOTAL
STIPULATIONS:
APPLICANT: I � • R°� Tel. � "� ��-��� � �
CITY USE ONLY
$ 6{ �. �� Fee Sehedule on Reverse Side
$ � 25� oF Building Permit Fee
� � � � $.50/$1,000 Valuation
$ $ �,�� per SAC Unit
$ Fee Determined by Engineering
$
� �•�� Agreement Necessary [ ] Not Neaessary [ ]
.�1�
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�I', 000
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BUII.DING PEIiMIT°`FEE SCHIDULE
The Chief Building Official shall, before issuin� permits for the erection of any
building or structure, or for any addition to any existing buildirl� or structure, or
for any alteration or repair to any existing buildin� or structure, upon application
therefore, require the payment by the applioant for sueh permit oF fees to the amount
herein below set forth and in the manner herein provided to-wit:
lotal Valuat3on
$1.00 to �500.00
Fees
$70.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the f3rst $500 plus $1.50 for each
additional $100 or fraction thereof, to and ineluding
$2,000.
$2,001.00 to $25,000.00 $32•50 fbr the first $2,000 plus $6.00 for eaeh
additional $9,000 or fraetion thereof, to and
ineludin� $25,000.
$25,001.00 to $50,000.00 $170.50 for the f3rst $25,000 plus $�4.50 for each
additional $1,000 or fraction thereof, to and
ineluding $50,000.
�50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for eaeh
addi�tional $1,000 or fraetion thereof� to and
including $100,000.
$100,001.00 and up
��33•00 for the first $100,000 plus $2.50 for eaeh
additional $1,000 or fraetion thereof.
DRI�EHAY DEPRE3SION ESCRO�I
(Conerete 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
approaeh with 6 ineh depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Permits for construetion w311 be issued a ffiinimum of 2�4 hours from the time of
application to allow for proper rev3ew of the proposed strueture and of the
construetion site.
A Certificate of Survey of the lot, showing the location of the foundation onee it
has been construeted will be required before proceeding with the framing.
. 4�
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sue��tT � MIT NO. ;,
City of Fridley 2 8 313
AT THE TOP OF THE TWINS � u I L D i N G P E R M I T
r
; � RECEIPT NO.
� `v ____� COMMUMITY DEVELOPMENT OIY.
f � � PiIOTECTIVE INSPECTION SEC. ��� g
i = �
� �'�'1 � CITY HALL FRIOLE� SS13Z NUMBEN NEV DATE PAGE OF APPROVEO BY
�----�' ,'� 612-571-346Q 910-F15
l0/20/98 � �
J08 ADDRESS 5129 Horizon Drive NE
1 LEGAI L07 NO. BLOCK TRACT OR ADDITION SEE ATTACMED
DESCR. 5 9 Carlson's Summit Manor South SMEET
2 PFOPEiiTY OWNER MAIL AOpR�S$ 21P PMONE
Warren Nelson 572-9535
J CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Milton Johnson Co. 525 Lowr Ave NE M ls
4 ARCHITECT OR pESIGNER MAIL ADORE35 IIP PHONE LICENSE NO.
5 ENGINEER kAA1L ADORESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK '
❑ NEW ❑ ADDITION � ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WOHK
Reroof house and garage �(25 S) Tear-off
9 CHANdE OF USE FROM TO
STIPULATIONS �
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE FiEOU�pEO FOR ELECTRICAL, PLUMBING. MEATINa, TYP� OF COIJST. pCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONOITIONING.
TMIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION 20NING Sa. FT CU F7.
AUTHOR12ED IS NOT COMMENCED V111THIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED Ofi ABANQONE� FOR A PERI00 OF 120 DAYS A7 '
ANY TIME AF7ER WORK IS COMMENCED. ' NO. DWLG. UNITS OFFSTREET PARKING
I HEREBV CERTIFY 7HA7 I MAVE READ ANO EXAMIN�D TMIS APPLICATION STAILS GARAGES
AND KNOW THE SAME TO BE TF]UE AND CORRECT. ALL PROVISIONS OF LAW$ VALUATION SUR7AX
AND ORDINANCES GOVERNING TMIS TYPE OF WpqK WILI QE CpMPLIED
WITH WHE7MER SPECIfIEO MEREIN OR NOT. TNE GRANTING Of A PERMIT 2],/{Z 1.07
DOES NOT PRESUME TO GIYE AUTMORITY TO VIOLA7E OF GAMCEL TME pEqMIT FEE SAC CMARGE
PROVISIONS OF ANY OTMER STATE OR �OCAL LAW FEGULATING CON-
STRUCTION OR THE PEpFORMANCE OF CONSTRUC710N ]/{. ]S Fire SC 2. I�F
� P�AN CHECK FEE TOTA EE
„ � �` � � _ ..�a �z -Pr �i-�,F� Lice 2 96
-.�SiGNGTUNE OF CON'A4CTOp ON AUTMOA�ZED AGEN� IDATE� N FOP VALIOAT � S IS D P�$� � �
� �r
V��
$�GN41UAE O� OWNEp��� OWNEp BWLDENi �DAT�i ' Bl �NS� � � f��Tt
N l;�v � [x I �
ADDN ( �
ALTLR � )
' CITY OE FRIDLEI'
SINGLL+' FAM[LY AND DUPLEJ�ES R-1 AND R-2
BUILDING PERMIT APPL[C}�TION
[:ffecti��e 1 / 1 /97
. 1�
�� ��
ConstructionAddress: 5129 Horizon D�ive � � �o
Legal Description:
Owner Name & Addcess: Warren Nelson (sa�e) Tel. 1l
_ 572-9535
COntractor: �j �,ton Johnson Company MN LICENSEf� 2083
Addcess: 525 Lowry Ave. N.E. M ls. 55418
Tel. // _ �Ri _9548
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEAZEN'T
LIVING AREA: � LenB'� � Width Height � Sq. Ft.
GARAGE AREA: Length Width Height
Sq. Ft.
DECK AREA; Length Width Hgt/Ground Sq. Ft.
OTHER: . -
�
Tear off house/ re-roof
Construction Type: house & garage �25 Sq, �� � F�ti�a� Cost: $� � � J �
..� .
�Fee Schedule on Bac c)
Driveway Cwrb Cut .Width Needed: Ft. + 6 Ft = Ft x$ �.. _� . �
DATE: , � = / � -�' � A►PPLICAN'T: � . ` 0 .
• � Tel. # 781-9548
...� -.
Permit Fee
�ire Surcharge
�tate Surcharge
�AC Charge
.icense Surcharge
)riveway Escrow
irosion Control
'ark Fee
ewer Main Cliargc
TOTAL
['[!'U(,A"l'(ONS:
$ 7 �� °Z�'
$ �
$ 1 � �1►-
$
$ : t� t�
$
$
$
$
� cj�-�I io
CITY USE ONLY
Fe� Schedule on Reverse Side �
:001 of Permit Valuation (1/lOth%) �
$.SO/$1,000 Valuation �
$950 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 IVecessary [ ] Not 1Vecessary [ ]
0
�
0
c
�
�
t- • •�
au�i.��i�vc; ��c�i�irc rcc sc�{cuc.��,��.
'L�I1C CI1ICi L3UlIdIR� OfIICIdI SI1dII. l�efore issuing pern�its for the eroction c�l' a�y building or scructure, ar 1<�r
any addition to any existinb building or stcuciure, or for any alteration or repair to any cxisting building or
stiticture, upon application dierefore, require ihe payment by the applicant i'or such permit of fees to the amount
lierein below set forth and in the, manner herein provid� to-wit: '
TOTAL VALUE
$1 to $S00
$501 to $2,000
$?,OU1 to $25,000
$25,001 to $50,000
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for fust $S00 plus $2.75 for each additiona! $100 or
fraction thereof, to and including $2,000
S62.25 for first 52,000 plus $12.50 for each additional $1,000
or fcaction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additiona! �1,OQ0
or fraction thereof, to and including $50,000
$SO,OOI�to $100,000 . . • $574.75 for�first $50,000 plus $6.25 Cor each additional
. �1,000 or fraction thereof, to and including $1p0,000 •
$100,001 to $500,000
$SOO,OOI.to $1,000,0� •
$1,000,001 and�up
.$887:25� for 5r� $100,000 plus $5.00. foF e.ach additional
$1,000 or fradion thereof,.to and �including $500,�0
$2887.25 for die fust �500,000 pius $4:25� for eacli .additional . . . . � .
$1,Q00 or fraction thereof, to a�i including $1,000,000 '� �
$5012.25 for the fust $1,0�,000 plus $2.75 for each additional
$1,OD0 or fraction thereof
DRIVEWAY DEPRESSION ESCRO�V
(Con�rete C�irb Streets On1Y)
�Iternate "A"�: Removal and replacement of curb and gutt,er only'-�Driveway width plus 6�feet times $1�:�.
I ternate "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 $15.75.
VERIFICATION OF FOUNDATION
. .,�
.:rniits for constcuction will be issued a minimum of 24 hours from the time of applir.�tion to atio�u for propec
:��ie�+� of the pr��Posec] suvcture and of die constcuction site.
.{.;crtit ic:�ice of Surve�� of thc loc. showin, the location of tlie foundation c�nce it has it ha.n c�;�:n con�trtictcc!
.= t*. rc��uir��1 t��1i�r� t�ru:.�:��din�_ ���ith th� fr.tmin�_
,. -,
aun�e�� . r IVV. -
City of Fridley 3 2 715
AT THE TOP OF TNE TWINS B u I L D i N G P E R M I T
r
! �, V�_��� COMMU�IITY OE�ELORMENT DIV. NO.
f � � PROTECTIVE INSPECTION SEC. � �
� . ,
� � /'�'1 � CITY MALL FFIOLE� SS��2 NU4BEN pEV OATE PAGE O� APPAOVEO 8�
�'""'� � �'� 612-571-34b0 910-Ft5 6/20/02
� /
JOB ADDRESS 5129 Horizon Drive NE
t IEGAI LOT NO. BIOCK TRACT OR ADDITION SEE ATTACNED
�ESCR. S 9 Carlson' S. Summit Manor South Addn SHEET
2 PROPERTY OWNER MAIL ADORES$ 21P PMONE
Mark Gorzychi 5129 Horizon Drive NE 763-586-0099
J CONTRACTOR MAIL ADORESS ZIP PFIONE IICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL AOOFiESS ZIP PMONE LICENSE NO.
5 ENGINEER
8 USE OF BUIIDING
Residential
7 CIASS Of WORK
❑ NEW
AODFESS
ZIP PMONE LICENSE NO
O ADDITION �7 ALTERATION ❑ REPAIR ❑ MOVE �❑ REMOVE
8 DESCRI9E WORK
Instal3 two basement egress windows
9 CHAN(3E OF USE FROM
TO
STIPULATI�NS
Windows to meet the State Egress Code.
SEPARATE PEFMITS AqE REOUIRED FOR ELECTRICAL, PLUMBtNG, NEATINO, TYPE OF CONST. OCCUPI
VENTI�ATING OR AIR CONDITIONING.
TNIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION 20NtNG SO. FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 OAYS, Oq If CONSTRUCTION
OR WORK IS SUSPENDED OR ABANQONED FOR A PER100 OF 1Y0 DAYS A7 '
ANY TIME Af7ER WORK IS COMMENCED ' NO pWLG. UNITS
1 HEFiEBY CERTIFY THAT I HAVE READ AND EXAM�N�p THIS APPLICAiION 1 STALLS
AND KNOW TME SAME TO BE TqUE AND COARECT. ALL PROVISIONS OF LAW$ yp�UATION
AND ORDINANCES GOVERNING TNIS TVPE OF WOpK WILL 9E C(�MPUEO 1�000
WITM WHETMER SPECIFIEO MEREIN OR NOT. THE GRANTING OF A pERMIT �
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOlA7E OR CAMCEL TNE pERMIT FEE
PROVISIONS OF ANY OTHEfl STA7E OR LOCAL LAW REGUTATING CON-
STRUCTION OR 7HE PERfORMANCE OF CONSTFUCTION �3�.75
TUAE OF CON'RACTOgrOR AUTwOai2ED AGENT 10ATEi
�
NCV LOAD
CU fT_
OFFSTREET PARKING
IGARAGES
$.50
SAC CMARGE
Fire SC $1.00
TOTA�FEE
$J�J0.25
VALIDATE MIS IS YOUR PERMIT
� � ����� �
r�a1F
NEVN ( J CITY OF FRIOLEY Effective 1/1/2002
ADDN [ j 6431 University Ave NE, Fridley, MN 55432 (763) 572�604 Bldg insp
ALTER (] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Cohstrucaon Address: �f �% l�o2lZ� At� � 2j�/�
Legal Description:
Owner Name 8 Address: _/�2c-�Go�-zy�� Tel. #�(3� -s��-DO �' 9
Contractor. MN LICENSE #
Address: Tel. #
LMNG 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 Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
Constn�ction Type: � ���� ��y� ��� Estimated Cost: $ �����'
�fr�l 8
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: � 4�— APPLICANT: dL. Tel.# �°o� � P��-��Pf
Call (763) 572-3604 for Pertnit Fees if mailing in application or 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
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ � � �a
$ � �'�
$ ,��
$
$
$
$
�
$
$ .��
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan �eview
Fee Determined by �Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS:
BUII.DING PERNIIT 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 ma.nner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,(�0
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1(m,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 $2,0� plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,� 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 $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,(�0
$1,000,001 and up $5,608.75 for the iust $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.00.
Permits for construction will be issued. a minimum of 24 hours from the time of application to allow fot 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 e�sting foundation will be required before
proceeding with the framing. New Houses Onlv
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_� T�i� BELOW MUST BE FILLED IN WHEN REPLACING FUEL BUWVING APPLIA(VCES OR THE
APPUCATiON WILL BE RETURNED
•t���•► / ► / ► •►► �: '►r •u: 1•► � : / : ! Ii1
�� "e �-�^p a^�p ����p, .the u�dersigned hereby verifies that the
venting has been examinec� and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where require.d. Yes�j('� No ()
The venting system is plastiGPVC and meets all current codes and manufacturer
speafications including sizing, length, number of eibows and termination. Yes (► No ()
The wndersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifirations. This does
indude AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The P7��Q cemhuc+ien A�r is sized and installed to meet the cuRent codes
and manufacturers specifications.
VI/�1611 f@qtijl2d tp ine+all a n w_emh��ctien air ���� pe si�ed and installed
to meet the current codes and manufacture�'s speafications.
Yes � No ( )
Yes �,No ( )
Yes �No ( )
VVh8t1 in_StallinQ a new v�r�tin'�Y� m, the undersigned hereby verifies that
it is a Gsted assembly and meets the current codes and manufacturers
spsaf'' tcations. This does indude AGA�GAMA Category 1 Central Fumace
Veriting Tables for fan assisted and natural draft appliances. Yes () No ()
Is �e common vent and vent connectors sized and instaUed correctly after
an appliance has been removed from the cammon vent and vented
se�rately as per cuRent cades. Yes (} No ()
�.. .. - ..- .�. .����.. -� .�. -� ..�,-«. � ..�,. .�
App�iance #1 Type BTU Input � Fan Assisted or Nat
APRUance #2 Type 1 r BTU Input c�0a Fan Assisted or Nat
Appliance �Ki Type BTU Input Fan Assisted or Nat
Tot,�l Appliareces Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Conner.tor Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Cannector Height ft Length ft Diameter in Type Y
��i� 1�� �,- ..-
��. •
HEATING CO: � /� �_
Signed By: - Date : L �� l0� .
Building
Inspections
763-572=3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit Na � ' '� - Oo32
Received By:
Date Rec'd: i3 c��
DATE ���� 0� YOUR E-MAIL ADDRESS
SITE ADDRESS ,S�e2 9 �O P/ Zd YV ��• /� �
THIS APPLICANT IS: ❑ OWNER �20NTRACTOR
PROPERTY OWNER/ Nq�: BELR�SE
TENANT ,r�DRESS: /3G 7O l�4�/�' T�N W CITY /�'W�-S� STA
��P.�S3o3
PHONE:_? � 3 • %�O — 62� p
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICEMSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
o F �N�r
STATE LICENSE #�iOn'2 �9d 3 O EXP DATE
ADDRESS: / �07 O �'�'IQw/�'% < T- n /I�L�
3-7�0-l�10
O TWO FAMIL
❑ BASENIENT FINISH
❑ DECK
�ROOF
O SID1NG
❑ SW�vIMING POOL
❑ ADDITION
O REMODELING
� DRAW 1'ILE
O OTI�R
A�S.S.3��
DESCRIBE WORK BEING DONE:�ODF/r✓�+- ' GA �'Od �X G F ��e�S t/�+/ � F
SIZE OF IMPROVEMENT.
Kuur�uv�
MJMBER OF SQUARES o� �
GARAGES
PROPOSED S1ZE:
PROPOSED HEIGHT:
SIDIIVG
❑ Vinyl
❑ Aluminum
O Other .
wn�mows
IN EXISTIIdG OPENINGS ❑Y� ONo
OR FOR NEW OPENWGS-DESCRIBE SIZE OF
OPENIlVG CHANGES &
TYPE OF_WIIVDOW TO BE INSTALLED _
LENGTH
❑ HOUSE ONLY
❑ HOUSE 8c GARAGE
❑ ATTACI-�D GARAGE
O DETACHED GARAGE
OSoffit
� Trim
❑ Fascia
LOCATION OF WIN�WS
NUMBER OF WINT.
HEIGHT
BASEIvI�Nf REMODELING SUBIVIIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members W be used
Ft.
FOR NEW CONSTRUCTION INCLUDIlVG DECKS,
ADDITIONS. & PORCI-!ES SUBNIIT:
1. Site Plan/Survey showing the existing structures
and proposed project
2. Two sets of construction plans
3. Ener�y Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
� � 7j \ "i � � `j (USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ , v OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Charge
Gurb Cut Escrow
$rosion Control
Park Fee
Sewer Main Charge
Total Due
� �l� , J�; See Back Page for Fee Schedule
$ �— 65% of Building Permit Fee
$ �� .001 times the total job valuatiofn
$ � � �� .0005 x Permit Valuation Minimum $.50
$ S: cX� $5.00 (State Licensed Residential Contractors)
$ $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21 =$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ ,%` Make checks payable to: City of Fridlev Attac
THIS IS AN APPLICAT(ON FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applicarion for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whic ' s review and approval of plans.
SIGNATURE OF APPLICANT pRIIVT T1pMEJob►N �� �v/✓ fy Dp.�.g 3 J 3 O 7
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official sha11, 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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus swcharge)
$501 to $2,000 $23,50 £or 1�` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $25,000 $69.25 for 1$2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fracrion to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 1�` $1;000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for consixuction will be issued a minimum of 24 hours from the time of application to
a11ow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing founda.tion will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977