AF - 46315Date:
Owner:
Ad
City of
Fridley, "'��----
BUILDING P:
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Builder
Address
-..� OF BUILDING
����,� CAPTIO ,
,
No. .--- -_. .. ._ .... Street .�_!-��• ��... ° .. s._...._�y�.�.!......... Part gf I.ot ------....--------_... �..----_..;..__--- ............._..�........._....
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Lot . .. . Block .. ._. . . . Addition or Sub-Division _. °� -;�:� � �'�,�s�yt.•���
..._._��._. _ ...... - - -- �.._.... ..� � ._.� ::�„� � �-#..:�l.��:_------ � �
Corner Lot ---_-- ............._...__........ Inside Lot .._.......:........_. � �
.- ._..... Seiback �----_v�-�.__---._........ Sideyard ....---�..-•-------._ .............----�-.....----�--....
Sewer Elevation
Foundation IIevation
DESCRIPTION OF BUILDING
To be Used as:
;
• ---��l:�� �--�---'�.�,��---- Front �- ------�---- Depth --. �.._�-: Height ._.. �....�'. .j_-- Scl. F� ....;�.�.�...`1. Cu. F� ,�!�gi._�
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--.._...-- �----..._ .. .....:.........•----...-----... Front ....--��--- �---....... Depth ....._.......---..._.. Heighi .... - .. Sq. Ft .--�--............._.. Cu. F't. _...._.......--� -..
Type of Construction ...... .�.....�-...��°��.�.... Est: Cost..:...�:.�
�
� ..................... To be Completed �- ._........•_---............._.....----....._.
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and itt compHance with all provisions of
ordinances of the dty of Fridley. ],,�
....�T....--•-------.__-----_.�.._ ._._.___.�.�.._...__....
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In consideration of the payment of a fee of $..._y,..... �`:'......__..., permit is hereby granted to....._......._...._......_.
_�.J..__�.___...__�....__... to construct the building or addition as described above. This �rmit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the dty limits and this permit may be revoked at any time upo violatioa` any of the provisions of said
ordinances. .�3, d1� �
Building Inspector
NOTICE:
This permit does no� cove� �he wnstruction, installation for wiring, plumbing, gaa heating, sewer o� water. Be sure 10 see
fhe Building Inspeefor fo� separeta permifa for these ifems.
�rr-� ir 1 �V 1"r
�, '� 4 T�''��ERIVII7' DOES NOT AUTypR1�E V10LAT-
:i;:�— �� IAN OF ANY PRlVATE LAIVD �O�N,4N�S .,��yp
', DUIL�1lVG RESTRIf;TinN�
APPLIC�TION FaR BIIILD�IiTG P�T
CITY OF FRIDLEY, A'IINNF�SOTA
Ownera I�me � � � l�' � f � �'"� �' �,� Bui7-de.r /�l � L. � � �� 1�0�' %'
Address ��% �% ��� � � ��3 �%�e t� dress � � `�7' /%' ��"1°�-�' � �
LOCATION OF BIIILDING
No.�,���_, Stree'� 1�%�'/Z�� �� �� �'t of Lot
� ��
Ioot Blocls . � ' �ddition or Sub.Div. �� �'Q= �.�-� -- , �
�_.
Corner Lot,� side I�t 4� Set Back Side-Yard ��
SEW�R ELEOlTION FOUNDATION ELEVATION
Applicant attach to this fai"m Cer�3ficate of Survey of Lot and proposed building
location.
DESCRIPTION OF BUILDING
o be used as«- -
``` / �/4 i� /� ��� Frout � � Depth � � Iieight
� � �.....�.�..�....�.......�...�..�..� ����. �-...�.
Sq♦ Ft. � � � Cu. Ft. � / •��
. -
Front Depth He�.ght
Sq. Ft. Gtii. Ft.
��
Type of Construction� / „6� /T l� �� Esti�ted Gost �. � � � �
To be completed �� / °�� � � � � ''
7.`he underaigned hereby makes application for a permit for the work herein specified,
agreein� to do all work in atrict accordance with the City ardinances and ru].ing oP
the Department oP Bu3ldings, and hereby decleres that all the facts and representa-
tiona stated �n this application are truc� and c��� ,��
DATE �" � � � � SIGNAT�AiE
�_
(g Schedule of Fee costs can be found on the Reverse Side.)
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HIIILDING PERMIT gEE SCAEDULE
S�etion 2. The InspBCtor of Build3nga sha11, before issuing an� permit
for the ereation of any builaing or structure, or for an� addition to
any e�isting buildin� or atructure, or �'or any alterations or repeirs .
to any existing building or structure, upon application therefor, requi.re
the payment by the applicant for such permit of fees to the amount herein
below set forth and 3n the manner herein provided to-wit:
2.1. .,For any such permit �'or the erection of any ffre-proof buildin��.other.
tk�an a garage, warehouse, factory or grain elevator, or for the erection oF '
an� fireproof addition, for similar occupa,ncy, ta e,ny existing building
sha11 be at the r�.te of .�1.�.0 for each one thousancl cubic feet, or fraction
thereof, in such cubical contents.
2.2. For any sueh perm3t for the erection of any fireproof �arage� were-
housp, factory or grain elevator; or for the erection of any fireproof
addition, for similar occup�ncy, to any existing building sha11 be at the
rate of �1.25 for each one thousand cubic feet, classified as "f3reproof'�
b,y 3ectioa 502 of the Minneapolia Building Code.
HOUSES
2.3. �or any such permit for the erection of an
other tha,n a garage, warehouse, factory or �rain
fireproof addition, for aimi.lar occupancy, to an
Perm3t �]..00 for each one thousand c°ubic feet.
GARAGES
y non-fireproof building
elevator, or any non-
yr existing building.
2.4. For an� such perinit for the erection o£ any non-fi.reproof garage,
warehouse, fac'tory or grain elevator, or for the erection of any non-
fireproof addition, for si.milax occupanc�r, �o ar�y existing buildiag
for each such building or addition. Ninety Cents for each one thou�d
cubic feet or f.raction thereof, in the cubical contents thereof Ta3.th a
mir�3.mum of �1,..00. �
For the purpose of computing fees for building permits the cubic�l, contents
of any building or addit3on to a uniform height throughout by mu].tip�.ying
the ground area covered f`rom a point six. (6) inches below the f'loor �irie of
the basement or cellar to the average height of the upper aurface or to the
average h�ight of the roof suxface of the main ge,ble o�-a p3tched roof.
2.5. For repairs or alterations to an existing structure, the fee shal]. be
at the rate of �3.00 for each Five Hundred Dollar'�s (�500.00), or fraction
tbereof in the coat of all propoaed work.
2.6. In no case shall the fee charged for �ny permit as set forth in
Section-2�be lese than �4.00.
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• TNE ORIG INATORS OF EASIER TO ASSEM BLE PRECISION CUT HOM ES, GARAGES 8e CABINS
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City of �'ridley, Minn.
BUILDING PERMIT
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N° , 6�'71
LQCATIO OF BUILDING
No. ��Td%�� Street .�� ' �, ► � � Part oP Lot
Lot _.... _ Slock Addition or Su an .�_._.._
g �
Corner Lot _ Inside Lot �..d.� S'�back - �Sideyard �,2�.�
Sewer IIevatian Founda.tion IIevation
DESCRIPTION OF BUILDING
To es: �//�
Front B� Depth �� Height �� Sq. Ft. �? �-(r� Cu. Ft �� ��
Front Depth ITei t._._._� Sc1. Ft Cu. F't.
Zj►pe of Construction _���i �??�� F�� CCosst _�� To be Completed
In c�ns[deration of the issuance to me of a perrnit to construct the building described above I agree to do
the proposed work in accordance wlth the d�scrlption above set forth and in compliance with afl provieions of
ordinaaces oP the dty of FY3d1eY• /e 11 /.� ��� G�' �
In consfderation oP the payment of a fee oP $_(�.�� � permit is hereby granted to
to construct the buflding or addition as described above. This t is granted upon
the eupress condition that the persfln to whom it fe granted and h3a agents, employees an workmen, in s11 work
done fn, around and upon satd build9ng, or anypart thereof, st�all conform in all respects to the ordinancea of
Fridley� Minnesota regardiig location, construct�on, alteration, maintensace, repafr and moviug of bufldinb�s
within the dty ]im�tts and thia permft may be revoked at any time upon violation of any oE the Provisions of said
or3inaacea. /1 m ,,, �.•�
Bt�ldiag Inapector
Nonc�
'llils penei� doa aot eorsr Na construcHoe, I�aWftoe hr trLdnB. P���9. 6a 6fadng, sswe� e� walsr. B� suns !e me
t6a Buildieg les�e�o� for ap�rat� p�rm6s /oe thas Me�.
�i
OW1�CR ° S
ADDRESS
APPLICATION FOR BU�DING PERMiT
CIT'Y OF FRIDLEY, MINIQESOTA
LOCATIOAT OF BUILDII�G
No.��� �� Street . Part of Lot
Lot Block Addition or S diviaion
Corner Lot Inside Lot Setback Side Yard�
SEWLR ELEVATION FOUNDATION ELEVATION
Applicant attach to this form Two Certit3cates of Survey oi Lot and proposed build-
ing location drawn on these Certifi:cates. �
DESCRIFTION OF BUILDI1dG
To be ed s;
� / Front Depth Height e �
Sq. F't. Cu. Ft.
Front Depth Aeight
Sq. Ft. Cu. Ft.
Type of Construction � � Estimated Cost
To be Completed
The undersigned hereby makes application for a permit for ehe work herein specified,
agreeing to do all work in strict accordaace with the City of Fridley Ordinances and
rulings of the Department of Buildings, and hereby declares t&a� all Che facts and
representationa atated in this application are true and correct.
DATE �-- "" �� S IGNATLiRE
(Sehedule of Fee Costs can be found on Che Reverse Side).
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BUILD7STG PEItMIT FEE SCHEDULE
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SeGtion 2. ahe Inspector of Buildings shall, befora iasuiatg any permit far
Lhe erection of any buildia,g or structure, or for any addi�ion to any exis�-
3.n� bu�lding or struct�a�, or fcr any alterations or repairs to any e�isting
building or st�ructure, upon application there€or, require the payment by the
applicant for such permit of feea to the amount hereia below set forth �nd
in the manner herein provided to-w3C:
2.1. For any such permit for �he,erection o.f any fire-proof building, other
than a.garage� warehouse, factory or graia elevator, or for the erection of
aa� �'�:�e-proof adsiition, for similar occupancy, to any existing build�ng
shall be at the rate of $1.40 for each one thousand cubic feet, or frac�ion
thereof, in such cubical coatenta. '
2.2. For aay such permit for �he erection of any fire-proof ggrage,•warehouse,
factory or grain elevator, or for the erection of any fire-proof edditiaa,
�or similar occupancy, to any existing buildfag shall be at the rate of $1.25
for each one thousand cubic feet, classified as °1fireproof" by Section 502 of
t:�e Minneapolis Building Code. �
aa�usrs
2.3. Fox� any such permit for the erection of any non-fireproof buiZdiag other
than a garage, warehouse, factorq or grain elevator, or any aon-fireproof
addition, for similar occupancy, to any existiag building - permit $1.00 for
each one thousand cubic feet.
GARAGES
2.t�. For any such permit for the erectioa of.any non-fireproof gagage,
warehouse, factory or grain eleva�or, or for the erection of any non-fi.seproof
�ddit�on, €or s3milar occupancy, to anq existing building or for each such
bvilding or addition - niaety cents ($0.90) for each one thousand cuk�ic feet
os fracCion thereof, in the cubical coatents thereof with a miniaQUm of $4.00�
For the purpose of comgu�3.ag fees for building permits, the cubical contents
of any building or addition to a uniform height throughout by multiplying tfie
ga�ound area covered fr�n a poin� six (6� iaches below the floor line of the
basement or celiar. ta the a�erage height`of the upper aurface or to the
av�rage height of the roof surface of the main gable of a pitched roof.
2.5. For repairs or alterations to an existing structure, the fee ahall be
at the rate of $3.00 per each Fiv� Hundred Dollars ($500.00) or fraction
thereof in the cost of all proposed work.
2.6. In, no.,CB�e- shs:ll the' feQ chargad f.or any p�rmit as set� forth in
Section 2 be less than $4_00.
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sue�ecr PER
City of Fridley 18820
AT THE TOP OF THE TWINS g U I L D i N G P E R M I T
r
� � ECEIPT NO.
� `y �_�___ COMMUNITY DEVELOPMENT DIV. ��
r � � PROTECTIVE INSPECTION SEC.
i .1 � .
' 1 /"'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVEO BY
�""'� � ,�� 612-571-3450 910-F15 3/16/87 / /
JOB ADDRESS 5183 H�rizon Drive N. E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 11 9 Caxlson's SllI�lt Mdi10r South Addition SHEET
2 PROPEFiTYOWNER MAILADDRESS ZIP PHONE
Kendall Chri.sten 5189 Horizon Drive N.E. 780-6095
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
S 3tq@
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS Z�P PHONE LICENSENO.
8 USE OF BUILDINC3
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR � MOVE � REMOVE
8 DESCRIBE WORK
Reside Dwelling
9 CHANGEOFUSEFROM T�
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING. V].II�71.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S0. 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 1. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. AlL PROVISIONS OF LAWS VALUATION SURTAX
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPUED
WITH 1NHETHEfi SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $�-i2OO �C$�X�� $. F)O
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHAFGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $ZO. SO
PLAN CHECKFEE TOTALFEE
.SZ�s1�
� Si nr a �.nC R AUTH0:�12EDAGENT �onTE� WHEN PROPER VALIDATED THIS IS YOUR PERMIT
J� '�S? �- I(� �3
SiGNATU O N R11 W ERBUILDERI IDATEI BLDG iNSP �qT
N� [] City of Fridley Effeetive �/1/86
ADDN. � �R-1 AND R-2
pLTER. I 7 Building Permit Applieation
Construetion Address
'L�r; r �/v
Legal Deseription: l-b� � /5 %�ac � � C� v �,$�� ��' � 4���; _� S�.
Owner ATame & Address s ����? ��I f r� r�S ��v' Tel .#��U'G'p `lS'
Contraetor:` � �� Tel. �
Address:
LIVING AREA:
GARAGE AREA:
DECB AitEA :
OTHER:
Attaeh to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to scale.
Length
Length
Length
DESCRIPTIOH OF IMPROVEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Width Hgt/Ground Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd. Setback Side Yard Setback
Type of Construetion: V�� �c. Estimated Cost: $ l•� �r% ��
Approx: Colmpletion Date: �`/��° � � � �� �
Alt. A Alt B
1� �
Proposed Driveway Width If New Opening Is Desired: $ $
See Back Page for Explanation
c�� r
f
DATE: � -�G d % APPLICANT: Tel. �
CITY IISE ONLY
Permit Fee $ 2d�� Fee Sehedule on Reverse Side
Plan Check $ � 25� of Building Permit Fee
State Surcharge $ �� $.50/$1,000 Yaluation
SAC Charge $ $ 525 per SAC Unit
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ � --
,' n Agreement Necessary [] Not Necessary []
TOTAL $ V
STIPULATIONS:
�
�Zav
rc�o • Ita.Oc�
�1C�� ��`S�
Z�.� a
BIIII.DIAG PERMIT FEE SCHEDIILE
The Chief Building Official shall, before issuing permits for the erection of anq
building or strueture, or for any addition to any existing building or structure, or
for any alteration or repair to aay existing building or structure, upon applicatio n
therefore, require the payment by the applieant for sueb permit of fees to the amount
herein below set forth and in the manner hereia provided to-wit: •
Total 9aluation
Feee
$1.00 to $500.00 $10.00 (Minimum Fee is $15.00)
$501.00 to $2�000.00 $10.00 for the first $500 plus $1.50 for each
add3tional $100 or fraetion thereof, to and ineluding
$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 fraetion thereof, to and
ineluding $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for each
additional $1,000 or fraetion 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
additional $1,000 or fraetion thereof, to and
ineluding $100,000.
$100,001.00 and up 3433.00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof. "
DRIVEKAY DEPRESSION ESCRO�i
(Conerete Curb Streets Only)
Alternate "A": Removal and replaeement of curb and gutter only - Driveway width plus
6 feet times $13.50
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of
application to allow for proper revieW of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation onee it
has been eonstructed will be required before proeeeding with the fraaning.
° SUBJECT � MIT K .
c��y of Fridley 2 6 3 3 4
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
�
i •
� � iP�Tl�b.
� ' COMMUNITY DEVELOPMENT DIV.
' j L �'���'�
r � � PROTECTIVE INSPECTION SEC. . / / '�
� s , � �,� �
L-.--� ��'��,'� CITY HALL FRIDLE� $5432 NUMBER REV OATE PAGE OF APPROVED BY
L 612-571-34b0 910-F15 6/24/98 / /
JOB ADDRESS 5189 Horizon Drive NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 11 9 Carlson's Summit Manor South Addition SNEET
2 PROPEFTY OWNER MAIL AOOFiES$ 21P PHONE
Rim Imholte 5189 Horizon Drive NE 572-8039
3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUIIDINCa
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIFt O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House 17 S Tear-off
9 CHANGE OF USE FROM TO
STIPULATIONS Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATIN(3, TYPE OF CONST. OCCUPANCY (iROUP OCCUPAtVCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTMORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTqUCTION
OR WORK IS SUSPENDED OR ABANDONEO POR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GAFAGES
AND KNOW THE SAME TO BE TFUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SU1iTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A pERM1T �1,417 �.7I.
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVI IONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRU T N OR THE ERFO NCE OF CONSTRUCTION. ��F8..50 Fire .S�', �1.42
� %n� �� PLAN CNECK FEE TOTA E
ll $ 0:63
SIGNA URE ONTRACTOR OR AUTNORIZED AGENT IDATE� N P OPE ALIDA E IS IS VO R PERMIT
e: ,r /
SiGNATUREOFOWNEA�iFOWNERBUIL�ERi IOATE� �'-BL �NSP ��q E
NEW
ADDN
ALTER
[l
[l
ConstructionAddress:
Legal Description:
Effective 1/1/98
CITY OF FRIDLEY
SINGLE FAIVIILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION ����� r; ���
Owner Name & Address: �C� �i1�f U�l Tel. # � fo� �
Contractor: �G�_� MN LICENSE # �'�
Address: , �'"' Tel. # "—'
' � 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:
DESCRIPTION OF IlVIPROVEMENT
Length Width Height
Length Width Height
Length Width � HgtlGround
5q. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: � � Estimated Cost: $_� `�' � - l � �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
APPLICANT:
�� 5'��
� e
$ . �I
$ � 9 `7/
—�
$
$
$
$
$
�
$ S'�� , � �3
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 [ ]
_ _ ._ �
BLIILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,0(}0
$50,001 to $100,0(�
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for °first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100, 000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012:25 for the first $1,000,000 plus $2.75 for each additional
$1, 000 or fraction thereof
DRIVEWAY DEPRES5ION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
,.-.� �-�
�.
' �� � SUBJHCT - " . .
City of Fridley r 27994
AT TME TOP OF TME TWINS ��J I L D I N G P E R M I T
r
; � PT NO.
� `v _____ COMMUNITY OEVELOPMENT OIV. � �� �
r � � PiiOTECTIVE INSPECTION SEC.
� i �
� /'�'1 � CITY HALL FRIDLE� SS13$ NUMBEN pEV OATE PAGE OF APPROVED 8Y
�""'� � �'' 612-571-34b0 9�aF�5 9/29/98 / /
J08 AODRESS
5189 Horizon Drive �
1 IEGAL LOT NO. BLOCK TfiACT OR ADDITION SEE ATTACMED
oesca. 11 9 Carlson's i SNEET
2 PROPERTY OWNEFi MAIL AOpR�S$ IIP PNONE
Kim & John Imholte
3 CONTRACTOR MAIL ADORESS 21P PMONE LICENSE NO
Mon-Ra. Inc. 8224 Ols -
4 ARCHITECT OR DESIGNER MAIL AODRESS 21P PMONE LICENSE NO.
S ENGINEER MAILADORE$S ZIP PNONE LICENSENO
8 USE OF BUIIDING
Residential
7 CLASS OF WOFiK ,
O NEW ❑ ADDITION ❑ ALTERATION � REPAIR p MOVE �❑ REMOVE
B DESCRIBE WORK
Re lace atio door
9 CHAN(3E OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling.
` TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO
SEPARATE PERMI7S AqE REOUIREO FOR ELECTRICAL, PIUMBING, MEATING,
VENTILATING OR AIR CONDITIONING.
7HIS PERMIT BECOMES NULL ANO VOID IF WORK OR CONSTFiUCTION iONING SO. FT CU FT
AUTHOR12E0 IS NOT COMMENCED VyITHIN 80 OAYS. OR If CONSTRUCTION
OR WORK IS SUSPENDED OA ABANQONEO FOii A PERIOD OF 120 OAYS AT "
ANY TIME AF7ER WOiiK IS COMMENCED. ' NO DWLG. UNI7S OffSTREET PARKING
I HEREBY CERTIFV THAT I MAVE iiEAD ANO EXAMINED THIS APPLICA710N 57ALlS GARAGES
ANO KNOW THE SAME TO BE TF1UE ANO COFiRECT. ALL PROVISIONS OF LAW$ VAIUATION SUqTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETMER SPECIFIED MEREIN Oii NOT. THE GRANTING Oi A PERMIT ZOOO Z.00
DOES NOT PRESUME TO GIVE AUTNORITY TO VIOlA7E OR GAMCEL TNE pEqMIT FEE SAC CNARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON-
STqUCT10N OF TME PERfORMANCE OF CONSTRUC7�ON 62.25 F re SC Z.00
PLAN CNECK FEE T TA� FEE
Licen C 5 0 70.25
S�GNGTUpE OF CON'FACTQA 0�7 AUIMOQ�2E0 OGENT IDATEi ME PR �Y VA A ED TNIS IS R P I7
I
� r
S�GNGTUAEO�OWNEp���QWNEABU40ER� �DAiEi . ' B G �NS ��6f(
J
rrcw
AD�N
ALTER
REMODEL'
>
II
(I
(X f
C�nstruction Address
C[TY OF FRIDLEY
SINGLE FAMILY �ND DUPLEXES R-1 AND R-2
Builciing Permit Application
5189 HORIZON DRIVE
Cffective 8/1/95
��� d�
�� ��
L.egal Description: —
KIM & JOHN IMHOLTE � Tel. # ���_�n�A
Owner Name & Address: �1A9 HOR 7�N �RTVF �Rtn�FY
Contractor: �N�=RAY INC _ MN LICENSE # 0005111
Address: 8224 Olson Memorial Hw��C�1�1Pn Vallev} MAT 55427 Tel. #����5�
Attach to this a.pplication, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IMPROVEMENT
Length Width Height
�ngth Width Height
Length Width HgtlGround
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lat [] Ft. Yd Setback Side Yard Setbacks
Type of Construction: REPL'ACE (1) PATIO DOOR ��� C��= $ �Y nn nn _
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. 6 Ft — F $ _$ �
DATE: A.PPLICANT: — Tel. # J — _
('ITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
-6rosion �on�ol
Park Fee
Sewer Main Charge
TOTAL
$ 62.25 Fee Schedule on Reverse Side
$ 2.00 .001 of Permit Valuation {1/lOth%)
$ 1.00 $.50/$1;Oa0 Valuation
$ $S50 per SAC Unit
$ 5.00 $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
-$ -- -- - �50.00 Conservation�Ias-1�eview —
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
�
$ �a � C;��-'
� �S� �
�' � �-`e���� �'� �!�"`� ��°�'��
STIP TIONS: i����/f � � ���%�
/ c����9�� �•v �� ��v�'G� �lJ ��� �1����'��
� �
�UILDING PERMIT FEE SCHEDULE
�
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or fcjr
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,�1 to $1(10,U00
$10�,001 to $5�,000
$500,001 to $1,000,000
$1,OQ0,�?1 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $S00 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for ea.ch additional $1,000
or fraction thereof, �to and including $25,�U
$349.75 for first $25,000 plus $9.0{} for each additional $1,000
or fra.ction thereof, to and inciuding $50,QQ0
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fra.ction thereof, to and including $100,000
$887.25 for fust $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,0�
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or. fraction thereof
DRIVEWAY DEPRESSION ESCROW
�Coacrete Curb Streets Only)
Alternaxe "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the l�ation of the foundation once it has it has been constructed
will be required before proceeding with the framing.
SuB�ECi
c�ty of Fridley
AT TME TOP OF TNE TWINS g � I L D I N G P E R M I T
r
� �
� ; V __��� COMMUNITY DEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
�
1 . ,
i-•_-� ��"' �'� CITY HALL ffi101EV SS1�2 NUMBEF
L 612-571-3460 910-F15
JOB ADDRESS
5189 Horizon Drive NE
1 LEGAL �OT NO. BLOCK TRACT OFi AODITION
DESCR. 1� g Carlson's S�
Z PiiOPERTY OWNER MAIL AODRES$
Kim Imholte
4 AFiCNITECT OR DESIGNER MAIL ADORESS
5 ENGINEER MAIL ADDRESS
8 USE OF BUILDIN(i
7 CLASS OF WORK
❑ NEW
8 DESCRIBE WOpK
Replace bedroom window
9 CHANGE OF USE FROM
11EV DATE
5/14/99
ZIP
IIP
PAGE Oi
� /
29468
� �
RECEIPT NO.
����
AVP110VE0 Br
SEE ATTACMED
SFIEET
PMONE LICENSE NO
PHONE LICENSE NO.
LICENSE NO
� ADDITION L� ALTERATION O REPAIR p MOVE O REMOVE
TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelling
per Section 310.9.1.2 of the 1994 Uniform Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
9:00 pm on Saturday; No work on Sunday.
SEPARATE PERMITS AqE REOUIRED FOR ELECTRICAL, P�UM8ING, HEATINO, ''r` vr vv•V•
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK Oq CONSTRUCTION 20NING
AUTHORIZEO IS NOT COMMENCED WITHIN 80 OAYS. Oli IF CONSTRUCTION
OR WORK IS SUSPENDED Oq ABANDONEO FOii A PERI00 OF 1� DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIfV TNAT I MAVE fiEAD ANO EXAMINED THIS APPLICA710N
AND KNOW TME SAME TO BE TRUE AND COHREC7. ALL PROVISIONS Of LAWS yALUATION
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILI 8E COMPLIED
WITM WME7MER SPECIFIED MEREIN OR NOT. TNE GRANTING OF A pERMIT �lOOO
DOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OF CANCEL THE pERMIT FEE
PROVISIONS Of ANV OTMER STATE OR LOCAL LAW REGUTATING CON-
STR C ION OR T PERFOiiMANCE OF CONSTFUCTION $3S.7S
/� / PIAN CNECK FEE
y'
SiGNATU OF CON:NACTOA OA AUTMOA�ZED 4GENT IOATE� � e►� e i
� �o�re� �` �
P �OCCUPANCVLOAO
FT
OFFSTFEET PARKiNG
STALLS GAqAGES
SUFTAX
� ..50
r SC $1.00
F25
IS IS ypJJR PER�
V �
�tTE
�w [ ]
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII,Y AND DUPLEXES R 1 AND R 2
BUII,DING PERNIIT APPLICATION
G
Construction Address:
� �j D
�� � ��
�
Lega1 Description: "
Owner Name & Address: Tel. # �J�-$(�.3�/'
Contract�
Address:
LNING AREA:
GARAGE AREA:
DECK AREA:
OTI�R:
NIN LICENSE #
Tel, # ��2-���%
he
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length � Width
Length Width
Length Width
Height'
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
5q. Ft.
. ,
Construction Type:� �P �� W �c ,P Estimated Cost: $ / ��" �
Driveway C�rb Cut Width Needed: Ft. + 6 Ft = t x$ =$ �
DATE: APPLICANT: Tel. # �� 2 � ,
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License 5urcharge
Driveway Fscrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
�TTPULATIONS:
CITY USE ONLY
� 7� ��
$ g Fee Schedule on Reverse Side ���
$ /, � .001 of Permit Valuation (1/lOth%) !�� S �
$ , � $.50/$1,000 Valuation C� � �i:�--
$ $1050 per SAC Unit . �" �/1 (� 5
$ $5.00 (State Licensed Residential Contractors) 1 � ��
$ Alt. "A° or Alt. "B" Above ��
���
$
$.
$
$ �, ��
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agxeement Necessary [ J Not Necessary []
� 3 � r
����
y ��
�j��
BUII.,DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structure,
upon application therefore, require the payment by the applicant for such permit of fees to the amount herein
below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to- $25,000
$25,Q01 to $50,000
$50,001 to $100,0(}0
$100,001 to $500,000
$500,001 to $1,�0,000
$1,000,001 and up
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 fracdon thereof, to and including $25,000
$391.25 for first $25,Q00 plus $10.10 for each additional $1,0�
or fraction thereof, to and including $50,000
$643.75 for first $SO,Q00 plus $7.00 for each additional
$1,0� or fraction thereof, to and including $1�,000
$993.75 for first $100,000 plus $5.60 for each addirional
$1,000 or fraction thereof, to and including $5�,000
$3,233.75 for the first $5�,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
DRIVEWAY DEPRESSION ESCROW
(Concrete C�rb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times �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 minnnum of 24 hours from the time of application to allo�✓ Por p���r
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has ��n ������ w�
be required before proceeding with the framing.
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