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SUBJECT PE
City of Fridley 17 7 9 3
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T
r
; � R EIPT NO.
� �,v ______ COMMUNITY DEVELOPMENT DIV. / I,� /
r � � PROTECTIVE INSPECTION SEC. 7
� _ �
� �"'1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�"'"'� � ,�� 612-571-3450 910-F15 11/'13/8� / /
JOB ADDRESS 5139 HQrizfln Drive N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9 6 Ca,rlson�s �'ummi.t Nla,nor South. Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Paul Mosey 513� Hori.zon Dri�re N. E, 574R9087
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USEOF BUIIDING
Residenti.a 1
7 CLASS OF WORK
� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a, 22 ` x 22 t Gztra,ge
9 CHANGE OF USE FROM TO
STIPULATIONS prov�de a hard sur�ace d��.Yewaye
'#�ARHIHG .��PERATE PEI�MITS ,REQt�ED FOR �VI1���-S�:d.
s,
��e�rdigging cail locaJ utilities �{�qTING. PLUMBINii � A� SIC�iNS.
iE�.�PH(}NE - ELECTRlG � ti�4S Etc. T{ ,
REC,�UIRED BY �q� �
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPAHATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIOIdING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. 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 TiYPE OF WORK WILL BE COMPLIED $5�425,64 S2•72
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
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- yS''rj( e SO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
�� $59. 22
GNAT A' C O UrHOa aGENT IDaTE� WHEN PROPERLY V I� A ED THI IS YOUR P RMIT
� � ' I.L��t / � \��J�i �l .� �i
SIGNATUREOfOWNER�IFOWNERBUiLDERi �D E� BLDG iNSP �AT
NEW L �
City of Fridley Effective �/1/84
ADDN. � R-1 AI�D R-2
pI,TER. [ � Building Permit Applieation
Construction Address: �� 3� �� �� � �� � v�
Legal Deseription: �`C.�'�%'� `7 � �� ( �° �'�'�N�� � ��O/✓
Owner Name & Address : ������- � ` ��� �� Tel . # rJ � C��
Contraetor: �"
QUl�iC-[ � L( ��/UC /'�- <[= Te�. # —6906
Address • '.� � � � � �d AJ l /�V� �1/L� � ��-�N L��/V�L� � �vl /lJ
LIVING AREA:
(3ARAGE AREA:
DECB AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to seale.
DESCRIPTI08 OF IMP80YEMENT
Length Width _ Height _
Length �� Width Z �- ( Height �
Length Width Hgt/Ground
Sq. Ft. _—
Sq. Ft. _L—L---
Sq. Ft. �—
�f
Corner Lot [ ] Iaside Lot �
Ft. Yd. Setbaek Side Yard Setbaek
Type of Construction: v`����� Estimated Cost: $ ��`�'
Approx. Completion Date:
/(%�v `l�, �q��_ � �1�� . � y
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: $ $ -
See Back Page for Explanation
. � � ? I�6 APPLICANT: e Tel. � ���� / 0�
DATE: � �
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
SeWer Irlain Charge
TOTAL
STIPULATIONS:
CITY IISE ONLY
� �%.S� Fee Schedule on Reverse Side
$ _ 25'� of Building Permit Fee
$ �•')� $.50/$1,000 Valuation
$ $1�25 per SAC Unit
� _ Fee Determined bq Engineering
$ Agreement Necessary [ ] Not Neoessary [ ]
$ o � �. ��
�
BIIII.DING PERMIT FEE SCHEDIILE
The Chief Building OfPicial shall, before issuing permits for the erection of any
building or strueture, or Por any addition to any exiating building or structure, or
for any alteration or repair to any existing building or strueture, upon applicatio n
therePore, require the payment by the applieant for such permit of fees to the amount
herein beloui set forth and in the manner herein provided to-wit:
Total Valuation
�1.00 to �500.00
�501.00 to �2�000.00
a2,001.00 to $25,000.00
Feea
$10.00 (Minimum Fee is �15.00)
$10.00 for the first $500 plus $1.50 for eaeh
additional �100 or fraction thereof, to and including
�2,000.
$32•50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
including $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25�000 plus $�+.50 for each
additional �1,000 or fraction thereof, to and
including $50,000.
$50,001.00 to $100�000.00
$100,001.00 and up
$283.00 for the first
additional $1 , 000 or
including $100,000.
$50,000 plus $3.00 for each
fraction thereof, to and
$433.00 for the first $100,000 plus $2.50 for eaeh
additional $1,000 or fraction thereof.
DRIVEYAY DEPRSSSION ESCRO�i
(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 replaeement 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 Will be issued a minimum of 24 hours from the time of
appl3cation to allow for proper review of the proposed structure and of the
construction site.
6 CertiPicate of Survey of the lot, showing the location of the foundation once it
has been aonstructed will be required before proceeding with the framing.
ti
�
AGREEMENT
• I, ��pQ� �� 1Qiti��i , owner of the property
located at � , have no objection to the
City allowing the construction of a , to be
located at �/��_,���,1-, [�J h���o d without the required
—�
certificate of survey that the City ordinarily requires for all new
construction.
t�
Wi ess
�.
0
0
0
�
� I i i' � � _ �1.�.�....! � , � ;
s / � % �.if�. �/7��i �.� � ,
_
Address
��r,t� /a , /9 � 5� .
Date
0
%,
0
�
sue�ecT PERMIT
City of Fridley _ 17863
�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
; ',, CEIPT .
� • COMMUNITY DEVELOPMENT DIV. � � �1
r � V � PROTECTIVE INSPECTION SEC. 1
� � � J
� 1 /�"1 � CITY HALL FRIDLEY SS432 NUMBER REV DATE PAGE OF APPROVED BY
�"""� � ,�� 612-571-3450 910-F15 2/26/85 � �
JOB ADDRESS 5139 Horizon DriVe N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 6 9 Carlson' s slll[ILDlt MdIlOY' S011'�l �.CIl't.l.Ori SHEET
2 PROPERTYOWNEH MAILADDRESS ZIP PHONE
Paul E. Mosby 5139 Horizan Drive N.E. 574-9087
3 CONTRACTOH MAIL ADDRESS Z�P PHONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS Z�P PHONE IICENSENO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WOHK
Remodel �� £irst �loor to combine twQ hedxooms into one
9 CHANGE OF USE FROM TO
S'�IPULATIONS
���'A6�d�TE ��!�RlIITS REQ�IIRED FOR
`�`;��+���,��, g���,�� G df'���➢ C���c����i�J� �Ed� �6��'�.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED POR 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 STAL�S GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SUFTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2�500 $�-.25
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 3S. SO
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $
LAN CHECK FEE TOTAL FE
$39.7�5
g C' ACTO o n R GENT ATE� �, yyHF�V PROPERL ALIDATED THIS IS YOUR PE MIT
. 4-(� `� p�i
SiGNATUREOFOWNER��FOWNERBUILDEHI ��AT � BLDG �NSP �ATE
NEW [ ]
ADDN. [ ]
At,T�t. I I
Construction Address
City oP Fridley
R-1 119D R-2
Building Permit Application
Effective 4/1/84
Legal Description: C D� � A�s �-�°l� � �,�Z�N ��t/�If11�i� c/U�%�0�
Ownez Name & Address : ��%� � �� " � � � Tel . �
Contraator: Tel. �
Address:
LIVIpG AREA:
GARAGE AREA:
DECH AAEA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, With the proposed construction draWn on it to scale.
DESCRIPTIOB OF D�lPROYE[�NT
Length
Length _
Length
Width Height Sq. Ft.
Width _ Height Sq. Ft. __
iiidth _ 86t/Ground Sq. Ft. -
Corner Lot [] Iaside Lot [] Ft. Yd. Setback Side Yard Setback _
Type of Construction: .�'`��-��°2 ���" Estimated Cost: � r���
Approx. Completion Date: /�� �� ��� �
Alt. A Alt B
Proposed Drivexay Width If NeW Opening Is Desired: �e Back Page for Explanation
• � � � Tel . # � °� �9�
DATE: � � APPLICANT:
„
CITY OSE O�.Y
Permit Fee ���•�� Fee Schedule on Reverse Side
Plan Check � """�- 25x of Building Permit Fee
State Surcharge � �� �'S �.50/�1,000 Valuation
SRC Charge a � �425 Per SAC Unit
Park Fee � �"'� Fee Determined by Engineeriag
Sever Nain Charge $ �_
� Agreement Necessary [ ] l�ot Necessary [ ]
?OT11L �
STIPULATIONS:
�
BIIII.DII�iG PER!!IT FEE SC�DIILE
The Chief Building Official shall, before isauing permits for the erection of any
building or structure, or for any addition to any exiating Duilding or structure, or
for any alteration or repair to any existing building or structure� upon application
Lherefore, 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
Fees
�10.00 (Minimum Fee is a15.00)
�501.00 to a2�000.00 �10.00 for the first �500 plus �1.50 for each
additional �100 or fraction tbereof� to and including
#2,000.
�2,001.00 to �25,000.00 �32.50 for the first �2,000 plus �6.00 for each
additional �1,000 or fraction thereof, to and
including �25,000.
�25�001.00 to a50�000.00 #170.50 for the first �25�000 plus �4.50 for each
additional �1�000 or fraction thereof, to and
including �50,000.
�50,001.00 to �100,000.00 a283•00 for the firat �50,000 plus a3.00 for each
additional �1�000 or fraction thereof� to and
including �100,000.
�100,001.00 and up
�433•00 for the first �100,000 plus �2.50 for each
additional �1,000 or fraction thereof.
DRIVEWAY DEPRESSIOA ESCROiW
(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 xith 6 inch depth - DriveWay �idth plus 6 feet times �15.75
11ERIFIC6TION OF FOIINDATIOA
Permits for construction �ill be issued a minimum of 2u hours from the time of
application to a11oW for proper reviex of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, shoaing the location of the foundation onee it
has been eoastructed �ill be required before proceeding With the framing.
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SUBJECT P .
City of Fridley 18311
AT THE TOP OF THE TWINS g U i L D I N G P E R M I T
r
; � RECEI .
� • COMMUNITY DEVELOPMENT DIV. �
' LL �����-�
r � � PROTECTIVE INSPECTION SEC.
1 j �
� /'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BV
�'""'� � ,�� 612-571-3450 910-F15 1/8/86 � �
JOB ADDRESS 5139 Horizon Dri�re N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 6 9 Carlson � s ffi Summi.t Manor SOII'tYl ACIC�l'tlO11SHEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE
Paul E. Mosby 5139 Fiorizon Drive N.E. 574-9087
3 CONTRACTOR MAIL ADDRESS Z�P PHON� LICENSE Np:
Same
4 ARCHITECT OR DESItiNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO. �
8 USE OF BUILDING '
Residenti:al
7 CLASS OF WOF;K
❑ NEW � ADDITION O ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a, 17' x 32' �lddition tQ Dwelling
9 CHAN(3E OF USE FROM T�
STIPULATIONS
Be�ore �A������4� �����,�AT� PEP,�!lITS REQtJIRE[� F�R
drgs��g ��II lo�., ,�,;.,e �;, ��qY � � �p ^ E �����"����'
TELEPH�NFd����:�t����:�p,�i;;� „�P `�eA ����, F-1�.�iT6i3�, � L���9�lG�i.-� �.�e� �;�.������..�.
R�����'r'�'a o f'";'�" � ,•`°.". , �
TYPE OF CONST. OCCUPANCY (iROUP OCCUPANCY �OAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING.
VENTILATING OR AIR CONDITIONING. �(1jbQC1 �,''x�Il3CG
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. • NO. OWLG. 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 S24 /�Q�. S�-2a OO.
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW FiEGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �`�.F)4 R SO None
PLAN CHECK FEE TOTAL FEE
� $ 41,13 $217.63
SiG Tu C' Cr0 a oai2ED ENT DaTEi WHEt�t PROPER�Y LIDATED THIS IS YOUR PERMIT
. � (� � d l — ir� /�,(
,
S GNATURE OF OWNER UF OWNER BUILDERI IDA 1 BLDG �NSP OpTE�
NEi�I [ �
, ADDN. [ ]
pLTER . I�1
City of Fridley
� R-1 AND R-2 �
Building Permit Application
Construetion Address: ��3� �l �0'��� �1�� N'
Effeetive u/1/84
Legal Description: �-c�T� �� �L�G�9, �"��S6o�`s �e.c-�h/ia�i %%?A�o2 �- �D�
Owner Name & Address: ��� � • , �'P ��� Tel. � �' �g�
Contractor• �-� � Tel. #
Address• ��
n
2�� � LIVING AREA:
S , � GARAGE AREA:
DECB AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to seale.
DESCRIPTION OF IMPaOYEMENT
� � ���
Length � Width �� Height � a/ Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
���(�C�f �. I �( : �`�, 012 . ( �
Corner Lot [] Inside Lot [J� Ft. Yd. Setback Side Yard Setback
Type of Construction: ��.��V� '�`�'�`�� Estimated Cost: $ ��
P a�(,v�v
Approx. Completion Date: �� �` ��� b
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: ��� $ $
��
See Back Page for Explanation
� � wo�ti �6� -�(� �'% c�
f-
.;� �r�.� �w��: s��t' qo47
DATE: �� / ��� APPLICANT: Tel. �
CITY IISE ONLY .
Permit Fee
Plan Cheek
State Surcharge
SAC Charge
Park Fee
Set�er Main Charge
��
STIPULATIONS:
$ I��1,�
$ �0-��
� �a���
$
$ --
$ - —
��'a�7.��
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 [ ]
.
BIIILDII� PERMIT FEE SCHEDIILE �
.
The Chief Building Official shall, before issuing permits for the ereetion of any
building or structure,•or for any addition to any existing building or strueture, 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-Kit:
Total Valuation
�1.00 to $500.00
�501.00 to $2,000.00
$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
Fees
$10.00 (Minimum Fee is $15.00)
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraetion thereof, to and ineluding
$2,000.
$32.50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
including $25,000.
5170.50 for the first
additional $1,000 or
including $50,000.
$25,000 plus $�.50 for each
fraction thereof, to and
�283.00 for the first $50,000 �p1us�$3.00 for eaeh
additional $1,000 or fraction thereof, to and
ineluding $100,000.
$�►33.00 for the first $100,000 plus $2,50 for eaeh
additional $1�000 or fraction thereof.
DRIVEWAY DEPRESSION ESCROiT
(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
approach with 6 inch depth - Driveway Width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Permits for construction �►ill 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 constructed will be required before proceeding xith the framing.
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SUBJECT
� City of Fridley
� AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� �
� • COMMUNITY DEVELOPMENT DIV.
' j L �"��_,
r � � PROTECTIVE INSPECTION SEC.
� i �"'1 � CITY HALL FRIDLEV 55432 NUMBER REV DATE
�'""'� � �'� 612-571-3450 910-F15 5/6/86
JOB ADDRESS 5139 Horizon Drive N.E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR. ( 9 Carlson`s Su�nit Manor South
2 PROPERTY OWNER MAIL ADDRESS Z�P
Paul E. Mosby 5139 Horizon Drive N.E.
3 CONTRACTOR MAIL ADORESS Z�P
5ame
4 ARCHITECTORDESIGNER MAILADDRESS Z�P
5 ENGINEER MAILADDRESS Z�P
PAGE OF
� �
P� MIT NO.
I°_ 18415
RECE
�D��-�
APPROVED BY
SEE ATTACHED
SHEET
PHONE
574-9087
PHONE LICENSE NO.
PMONE LICENSE NO.
PHONE LICENSE NO.
8 USE OP BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION 0 ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct a 20' x 17' Living Area, Additi.on axid a, 20' x 12' Deck Additi.on
9 CHANOE OF USE FROM TO
STIPULATIONS
Tie new �ooting into existing block wall.
��PARATE PER�IITS REQUIRED ��R
1��`6�aB6VG, h9�A�'IlVG, PLUMBING AND SIGNS.
TYPE OF CONS7
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBINCi, HEATING,
VENTILATING OR AIR CONDITIONING. O Fri
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORIZED 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. U�
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ],
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAIUATION
AND ,ORDINANCES GOVERNING THIS TYPE OF WOHK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $14,750
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE
PROVISIONS OF OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION O THE ERFORMANCE OF CONSTRUCTION. yS].ZO. �JO
PLAN CHECK FI
_ _ A ,� �� // � _ - -- S 27. 63
�/����1'��
�efore di�gi�� c��� �� ��:;��;c�,
TEi.EPN��1� � �����d� � �?�� ����
RE����t�� �� ,�;���>'
S0.
CU. FT.
OFFSTREET PARKING
STALLS GARAGES
SURTAX
$7.38
SAC CHARGE
None
TOTALFEE
S 145. 51
,� WHEN PROPERLY ALIDATED THIS IS YOUR PERD
N � ' '' "' /'� n
� / S Gi �. �/ R a B 0 ( 'Ora .� l� , ���
LOAD
N� [] City of Fridley Effective 4/1/86
ADDN. � R-1 AND R-2
AL,TER: [ ] Building Permit Appl3cation
Construction Address: �� �a � ��t0�c l� aN ��/ to� ,�a �
Legal Description: .
Owner Name & Address : ���- �• �"' ��� �� � Tel. � 5�y-9o$�
,.
Contraetor: ���'"�� Tel. �
Address•
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER•
Attach to this applieation, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROYEMENT
Length �O � Width � Height O/ Sq. Ft. �`��
Length Width Height Sq. Ft.
Length �0 � Width %� � Hgt/Ground 2� Sq. Ft. Zy�—
3yv�- e°L—'�
Corner Lot [ ] Inside Lot [ ]
��
� ���
"�G �'�,3'i � 1�,�-�`�-�� 1 ��o � G,'�v � � � � S�
. Yd. Setback Side Yard Setbaek � �
�,�J�.p� �ief►-iM� Estimated Cost: $ �° � ����
Type of Construetion: '
Approx. Completion Date: �l"V� r l 8�
Alt. A Alt B
Proposed Driveway Width If New Opening Is Desired: See Back Page for Explanation
DATE: ��!%� �, I�g% APPLICANT: ��L ��C��� Tel. ��7�� � 7
CITY IISE ONLY
Permit Fee $ � � Fee Schedule on Reverse Side
Plan Check $_� r� �-� 25� of Building Permit �ee
State Surcharge $ •���- $.50/$1,000 Valuation ',
SAC Charge� $ "'" $475 per SAC Unit
Park Fee $ '� Fee DeLermined by Engineering
Sewer Main Charge � "
,� � Agreement Necessary [ ] Not Necessary [ ]
TOTAL � � �� � ' �-� �
STIPULATIONS:
/`��, �' i "�
�+ , ,.
� � _ ;� � '� � J t �
�
, .,
,_ ,
l �; a ,1�
�
BIIII.DING PERMIT FEE SCHEDULE
�
The Chief Building Official shall, before issuing permits for the erection of a�iy
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 applieant 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
$501.00 to $2,000.00
Fees
$10.00 (Minimum Fee is $15.00)
$10.00 for the first $500 plus $1.50 for eaeh
additional $100 or fraction thereof, to and including
$2,000.
$2,001.00 to $25,000.00 $32.50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
including $25,000.
$25,001.00 to $50,000.00
$50,001.00 to $100,000.00
$100,001.00 and up
$170.50 for the first
additional $1,000 or
ineluding $50,000.
$283.00 for the first
additional $1,000 or
ineluding $100,000.
$25,000 plus $�.50 for eaeh
fraction thereof, to and
$50,000 plus $3.00 for each
fraction thereof, to and
5433•00 for the first $100,000 plus $2.50 for eaeh
additional $1�000 or fraction thereof.
DRIVEWAY DEPRESSION ESCRON
(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 $15.75
VERIFICATION OF FOONDATION
Permits for construction will be issued a minimum of 2�# hours from the time of
application to allow�for proper review of the proposed structure and of the
construetion site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
0 �, `7 S� .
�t� e, � 3� �
�� �'� �$ e�� .- � .
I 0 O• yQi � �r '
m
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ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 iTNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�631572-3604 FAX: (763) 571-1287
: 5139 HORiZON DR NE
: 263024220102
: CARLSONS SUMMIT MAN SO ADD
: LOT 6 BLOCK 9
: HEATING
: RESIDENTIAL
: ADDITION/ALTERATION
PERMIT NO.: 2004-00192 /���
DATE ISSUED: 02/11/2004
VALUATION .
NOTE: AIR CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERMISSION FROM
ADJOINING PROPERTY OWNER.
COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A
REPLACE FURNACE (WARM AIlt, LENNOX, 70,000 BTLT)
# A/C iJNITS 0 VALUE OF APPL OR WORK
#FURNACES
# GAS RANGES
APPLICANT
DAVES APPLIANCE HEATING & AIIZ INC
1601 37 AVE NE
COLUMBIA HEIGHTS, MN 55421
(763) 781-6901
,� .I�I :
CORNEJO, VALERIA
5139 HORIZON DR NE
FRIDLEY, MN 55421
1 # GAS DRYERS
0 ENTER VALUATION
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and laiow the same to be true and correct. All
provisions of laws and ordinances governing this type of work
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating construction or the pe�'formanc�, of construction.
Bldg
HEATING PERMIT MINIMUM FEE
FURNACE SHELL/DUCT WORK
GAS RANGE FEE
GAS DRYER FEE
AIR CONDITIONII�TG FEE
HEATING REPAIRS/ALTERATIONS
STATE SURCHARGE, MECH FLAT
TOTAL
PAID WITH CHECK # 33841
SEPARATE PERNIITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
,
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0
0.00
30.00
0.00
0.00
0.00
0.00
0.50
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Tt� BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
qppUCAT10N WILL BE RETURIVE�
�,
�� , fhe undersigned hereby verifies that the
ventinng has been examined and is ftee from ru�t, deteriaration, obstruc�ons, .. -Yes ��� No O
and is securely supported and firestopped wt►ere required.
The venting system is plasdc/PVC and meets all current codes and manufacturer
s�cations including slzing, Iength, number of elbows and termination. Yes {� No �
The undersigned also verfies �at #he replacement unit is a listed assembiy
and meets the c�Rent ccdes and manufacharer's specdtt��ca�ons. This daes
include AGA-GAMA Category I Centrai Fumace Ven�ng Ta�les for fan Yes � Na ()
assisted and natural draft appiiances. �
The �Yis�np �r�±e �•�'y �an 9e* is sized and ins#alled to mePt the current codes
and manufadurer's speci�t�#ions•
�@� ��� �o it will be sized and insta0ed
to meei the current codes and manufacturers speciftcations.
Yes �) No { )
Yes ( j No �
Wtten I�stalliap.� �� � v�r�"gi,"�, the under�gned hereby veri'fi�es that
� ls a�isted assembly and meets the cutrent cc�des and manufacturer"s
�specificatians. This does include AGA-GAMA Category l Central Fumace Yes No
Ventlng Tables for ian assisted and natural draft appliances. {} �
!s the common vent and vent connectors sized and insta{led carrec�y after
an appliance has been removed from the common vent and vented Yss �No ()
sepatately as per current codes.
± s • c 1 h� �.� . 1 • I : • 11 11 � � � �1 : � � " f � f � �sH � � � �Il ; M s /
App�iartce #1 Type ���w�.� BTU Input �'',�_ Fan Assfsted a' Na# ��,�._
AppUance #2 Type �'° ��� BTU fnput � Fan Assisted or Nat �� �
Appliance #3 Type 8TU Input � Fan Assisted or Nat ______,�
Total �4ppiiances � Totat Btu Input p���?��
V c�� Ve�t Hei ht � p Diameter mches
Common Vent Type ��'- 9 �.— �
AppUlance #1 Vent Conne�tor Heigh# � ft Length � ft Diameter _�_in Type �
qppUance #2 Vent Connedor Height �ft Length �, ft Diameter __,�� _in Type �
qpp�ance #3 Vent Connector Height ft Length ft Diamete� in Type �
,-o
4 'TPRA'fY�NS. (� a �i +�►� � ►�4 ��i'�. �sr.w �l, /;; �', r� ti �._i��:�,� � � ` , _
%"`\ . � „ '
,��:� • ( . � �p .� �
HEATING CO:
Signed By. - :�� °y� Date : � � �' ° �a �
. �
Building
Inspect�ns.
76�7'-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE ��v, I Ip ���G YOUR E-MAIL ADDRESS
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMTT TYPE
TYPE OF WORK:
'"� OWNER ❑CONTRACTOR
rr.an�: j -► as-i o �'�'�E'-�c?
ADDRESS: �� � � {Z9 Z-O q�L �
pxoi•rE: 7G 3 5 71 Z 1��
Pernut No.:
Received By:��
Date Rec'd: "�'�°'
� Z �
STATE LICENSE # EXP DATE
ADDRESS: CITY STATE ZIP
PF,iONE _ _ FAX
� SINGLE FANIILY/NEW
O TWO FAMILY/NEW CC
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDIATG `�'OTI-IER
❑ SWIMIvIDVG POOL
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED I�IGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS OYes ONo
OR FOR NEW OPEMNGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIIVDOW TO BE INSTALLED�,p�F
�' W �.f r�`
LENGTH
❑ HOUSE & GARAGE
O ATTACHED GARAGE
0 DETACI�D GARAGE
OSoffrt
❑ Trim
❑ Fascia
IACATION OF WINDOWS�� u1 f_
T I'/
� �. cess
HEIGHT �f I �r
BASEMENT REMODELING SUBMIT:
1. Existing Floor Pian
2. Proposed floor plan
3. List of struct�ual members to be used
Ft.
FOR NEW CONSTRUCfION INCLUDING DECKS,
,ADDITIONS. & PORCHES SUBMIT:
1. Site P1an/Survey showing the existing structures
and proposed projec�
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON'�VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USIN 19��[ .B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ���C! --- OCCUPANCY TYPE
_ -- -- -
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
Total Due
$ �'l .��' See Back Page for Fee Schedule
$ �O �.� I 65% of Building Permit Fee
$ �, �� .001 times the total job valuation
$ �,� _ � .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residenrial Contractors)
$ $1550 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ L(A e,,,_ �_� Make checks payable to: City of Fridley Attac6
THTS IS AN APPLICATION FOR A PERMIT-NOT VALID UN'fIL PROCESSED
I hereby apply for a buildittg permi d I aclaiow e that the information above is complete and accurate; that the work will be in
conformance with the ordinances an codes of the,, rty f Fridl�nd with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for permit and work�'s not t� statt without a permit; that the work will be in accordance with the approved
plan in the case of all work whicl�°'r quires revi��v a�td appro�val f plans. � �
SIGNATURE OF APPLICANT �„ �r�-.� ' `� PRINT NAME �T� a��%�� �(7 DATE
}.' '
, �
�
�
i
Page 2- Building Residential Application
• ��.
BUII..DING PERMIT FEE SCHEDULE ' e
The Chief Building Official sha11, before issuing pernuts for the erection of any building or
sttucture, or for any addition to any existing building or structure, or for any alteration or repair
to any exis�ing 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:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to
a11ow for proper reyiew of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation 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
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CIIYOF
FR[DLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(763) 571-3450 • FAX (763) 571-1287
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I, ��rl ���i'�1 �-I � , understand that the State of Minnesota
m
requires that all residential building contractors, remodelers and roofers obtain a state
license unless they qualify for a specific exemption from the licensing requirements. As
the owner of the property at SL 34 ��iGt?.�aJ 1�ti'd- �Vt= , Fridley, I
am exempt from the state licensing requirement only if I am not building or improving
this property for purposes of resale. By signing this document, I attest to the fact that I
am improving this house for my own use and do not intend to sell it. I hereby claim to
be exempt from the state licensing requirements because I am not in the business of
building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, isl the first residential structure I have built or improved in the
past 24 months. I also acknowledge that because I do not have a state license, I forfeit
any mechanic's lien rights to which I may otherwise have been entitled under Minn.
Stat. 514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perForm
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the State of Minnesota. I
understand that unlicensed residential contracting, remodeling, and/or roofing activity is
a misdemeanor under Minnesota law, and that I would forFeit my rights to
reimbursement from the Contractor's Recovery Fund in the event that any contractors I
hire are unlicensed.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to the City of Fridley for compliance with all
applicable building codes and city ordinances in
perFormed on this property.
Nami
Date � v v �