AF - 46347City of Fridley, inn
BUILDING PERI�iIT
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Address �-r�:_..E- .
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N° 5054
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�r suilaer � �` = ----- —
T Address _____ y'"'�i �_._._ _•--:,,�_ ---
:F�� � ��.;� LO�:ATIOIV�F BUILDIIVG
No. �=..��-�,a::_ Street -�..}✓�'--�-��;,,��r'"�,►---%--,_._.�_.___.._._..... Part o� Lot ,n _. �.
-� ��'� `� '� �'�'r=��- �—` �r
Lot ___. .__ Block �___ Addil3on or Sub-Division . � ' "� � f
Coraer Lot _. Inside Lot y�''''�� Setback Sideyard __
Sewer IIevation
Fouadation IIevation ..
DESCRIPTION! OP BUILDING
To ,be Used as � � � ,�,, ,✓�
� = f ' . .':,,;��s'�, � � '"s'� .-, � . � �^� J �,I
r��''��% �—�.�i��ont ie�...��Depth .,�� Height � Sq. Ft w�� Cu. Ft ���'
�' � ' i�� � Depth H'ght � Sq. Ft Gw, Ft
Type of Construction �� --��.:.s,._...�. -'.�_ F�t Cost .��,��.,J! �.—:----.. To be ComPleted.
In consideration of the isauance to me of a germit to constrvci the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordivances of the dty oP Fridley.
fi�
t �„`�' tf t s
Ea consideration of the payanent of a fee oE $� ' ..—..._., permit 3s hereby granted to
to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�en, 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, altera.tion, maiatenance, repair and moving of buildiugi
within the city limits and this permit may be revoked at any time upon violati of any oP the provisiona of said
���� �� �� ��: �.
suilaing Inspector
NOTICE:
ffib permit does not eover fhe �op��oo, a�nen� fo� wirin8. Plumbfag, gas heatieg, sewer o� water. Be are to aee
�he Bulldirt8 Inspeste� for separate permHs for theas hemi.
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APPLIGATION FOR BIIILDING P.ER�iT
CITY OF FRIDI�Y, MINNE,SO`Pi
Owner'a Name ��l`�1�� !a� �,����f�� Bu3Zder ��/�%�
r��Y ■
�dCix'888 �� � 7 /7 � f�� � t9/�i ��% f�� AdC1.re8S
L4CATION OF BIIILDING
No. ��� Street,�l��l�t�� l��l�� Part of Lot
� o�� �/ �Al �7°
Lot Block � Add3tion or Subdiq3sion /1�1 �i�oi� /� O'� �'�
Corner Lot. Ineide S�ot t� Setbaok Side-Yaxd
SEWER ELEVATION FOUNDATION ELEVATION
�pplicant attach 'to this fox°m Gertificate of Survey of Lot and proposed building
location.
�
To be used.as:.
DESCRIi�ION OF BIIZLDING
�- � nAr+h �--
Sq. Ft. Cu. Ft.
Front Depth Hei�ht
Sq. Ft. Cu. Ft.
Type of Conatruction��/�i� Estimated Cost �%� �
To be .Completed
The vndersigned_hereby makes application for a permit for the work herein apec3fied,
agreeing to do all work in atrict accordance with the City,Qrdinances and rul�tng of
the Department of Buildings, and hereby declares tha.t all the facts and representations
stated in this.applica.tion are txue and correct.
/ �
DAZ� � � � ��F L�d O SIGNA'TIJA�
(A Schedule of.Fee Gosts ce.n be found on the Reverse Side.)
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Ga�ti.�n ?_o Z`ha Inspec-`vor of Bu3.ld3ngs ahall, 'before issu3ng aAy permit for the
�rection of e�ny building or structure, or for an�r additioa to eay existin� butld-
i�� or stsuctwce, or fox any al�erationa or repa3rs to aay exieting build3.n� or
s�.�`ucturo, uvon application tharefor, r�qu3re the pa�a►ent by the applicsat for
�u.ch permi.t of fees to the em�unt here3n below aet forth a.nd in the t�aner herein
provided to-w'it:
2 oZ . Fo� any such perait � oM the erection of an�r fire-proof buildirl�� othet' thea
a��rago, warehou�e9 factor� or �r�in e].evator, or for the erection of any fire-
p� oof addit3.a�, for s:�.milsr ocr�:p���, to a.n� existing building shall be at the
ra`�e of �lo/�.0 for each onQ �aousand cub3c fe�t, or fract3on thereof� in sucsh
cubical content�e
2vF � For �o.ny' st:�� pe�'�+tit fcr' �hs �^�!:t�.o� of ars� firep*oof garage, t�ax'ehouse�
�srtory or �^ain elovator, or z';:� tho e�e��_�c�n o�' eny fireproof additioa, for
aini7.� occup��, to €�.n� e:�3.st-? ng b�a�Idin; shall be at the rate of �►1..25 for
each ane thousa�d cu�3c fe�t, cl�.ssi�ied as "fireproof" b� Section 502 0£ t�
N',u.nriealloli�s E�a.a.ldino Code,
R+?:7�
2,3, For �n� such pErm�.t for the
t;�.�.� � �.�raga, war�house, factory
�,:��.ztio�:, f or sir.�lar occu�a�c3r,
ca�:n or�� t,houQand cubic foete
Cd9�t�.�S
erection of a�r noa-f3reproof bui].cling other
or gra�n elevator, or any no�fireproof
to any exist3ng building. Permit $J..00 for
2,/�, i�or ar.�y auc� peran�.t for the erection of any noa-fireproof gerage, warehouse,
fact�r� ar �a� elev�"��, os for the erection o� ang non-fireproof addition, for
simi],ar occupancy, i:o ar.� ex3.stin� 3uilding or for each such building or addition.
P�iuety Cents for each o�e t�.ousand cubic feet or fraction thereof, in the cubical.
co:��ents thereof w� �h a�.nimLm of $J�a00e
For t:�e �Urpu �,�=� ��� conn�.�in; fses for building permits the cub3cai. contente of eny
bu; � di.ri� or addition to a uai �:'�orrra hoight throughout by mult3ply�.ng the ground ares
c�n��ed from a poirit six (6) inches below th� floor 13ne of the �aement or aellar
to the average height o� �h� upper surface or to the average he3ght of the roof
avrface of the m�.in ge.'ale of a pitched roofe
2�5� For repaira or alter�.ti�ns to an exiating structure, the fee sh�17. be at the
?��.�i,e of .�3000 for each Fivo Hundred Dollars (�500�00), or fract3on thereof 3.n the
e��t af all proposod work.
2a6� In no c�.ae shall the fee charged for any permit as set forth in Section 2 be
1F �s t;�an �1�.00,
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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
� � RECEIPT NO. r
� ; y _ COMMUNITV DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. � l� I
� � �"'1 � CITY HALL FRIDLE� 55432 NUMBER pEV Dn7E PAGE oF npvAOVEO er
�'""�" �'' 612-571-3450 910-F15 8/21/95 / �
JOB ADDRESS 5337 Horizon Drive NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. �F 6 Carlson's Summit Manor North SHEET
2 PHOPERTY OWNER MAIL ADDRESS 21P PHONE
Tim Furlong 5337 HOrizon Drive NE 571-5369
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Arthur Theyson Construction 2938 Taylor St NE, Mpls., MN 55418 789-4083 20011251
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW �1 ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WOFiK
Interior alteration to enlarge garage to 16' x 7'
9 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
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 SO. FT CU. FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALIS GAFiAGES
AND KNOW THE SAME TO 8E TRUE ANO CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTtNG OF A PERMIT y�S�HOO �Z.9O
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THF pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTI OR THE PEFiFORMA NSTRUCTION. �].12.25 Fire .S�', �5.8�
PLAN CHECK FEE TOTAL FEE
�'L � License C $5.00 $125.95
SiGNATUAEOFCON� A TOpORAUTHO onGErvr IDATE� HEN P P Y V IDATED THIS IS YOUR PERMI
p � c L/
S�GNATUFIE OF OWNEF UF OWNER BU�IDEAi �DATEi '' -
BLOG i SP ��FTE
NEW Ll
ADDN [-`T
ALTER i )
Construction Address:
Lega1 Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 �►ND R-2
Building Permit Application
C
Effective S/ 1 /95
-����i
Owner Name & Address: �° v►� �^ �/ Tel. #�'"� j' S 3(`� �7
��ontractor: � !� l S d� _ MN LICENSE # o2Q� / j��
Address:��3 � l � / �� e S Tel. # % � �'l� 4�� �.�
LIVING AREA:.
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Surv�ey of the
lot, with the pro�sed construction drawn on it to scale.
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width _
Width _
Width _
,.._ ° i' .
��
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks
Ty� of Construction: �_ S�� y� E�timated Cost: $��0 O�" _
Approx. Completion Date: �� j�- �.�
(Cost on Back)
Height
Height
Hgt/Ground
.� .
Sq. Ft.
Sq. Ft.
Sq. Ft.
i_.--� f7�_
�
Driveway Curb Cut Width Needed: Ft. + 6 Ft — _$
DATE: —%- �'! APPLICANT: Tel. # ��� �.�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
,
� `? �
$ �", ��
$ �� `�U
$
$ ,�o�.
$
$
$
$
, �.i���
- G �.r��
i
r -
CITY USE OATLY
Fee Schalule on Reverse Side
.001 of Permit Valuation (1J10th%)
$.50/$1,000 Valuation
$S50 pe,r SAC Unit
$S.W (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
F� Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: � �
.. ... . ..... . ...::. . . .. _
�iJILDING 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 fe�s to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $5(}0
$501 to $2,Q00
$2,001 to $25,0�
$25,001 to $50,0�
$50,�1 to $100,(�0
$1(�,�1 to $5�,000
$500,�1 to $1,(?00,000
$1,OQ0,�1 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$2I for first $S00 plus $2.75 for each additional $1� or
fraction thereof, to and including $2,000
$62.25 for first $2,OQ0 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for f�rst $25,�0 plus $9.� for each additional $1,000
or fraction thereof, to and including $50,�0
$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 fust $100,� plus $5.00 for each additional
$1,0� or fraction ther�f, to and including $5�,�
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,(�0 or fraction thereof, to and including $1,�,000
$5012.25 for the first $1,O�,OQO plus $2.75 for each additiona.l
$1,IX�0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 fe�t times $13.�.
Alternate "B" : Removal and repla.cement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Drrveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Pernnits 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 tfie foundation once it has it has been conshvcted
will be required before proceeding with the framing.
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----------------------------- �
� BEAM SIZE:1.750 X 16.000 GL2950-2.0 NUMBER OF MEM�ERS = 2
CONNECTION
*** DESIGN ASSUMES COMPONENTS CARRIED ARE APPLIED TO TOP EDGE OF BEAM,
SUCH THAT LOAD IS DISTRIBUTED EQUALLY TO EACH PLY.
*** ATTACH 2 BEAM PLIES WITH 3 ROWS OF 16d COMMON NAILS ON EACH FACE
STAGGERED AT 12.00" C/C.
*** MAKE PROVISIONS TO TRANSFER CONCENTRATED LOADS EQUALLY TO ALL
PLIES.
*** COMPRESSION EDGE BRACING REQUIRED AT 28" O.C. OR LESS.
LOAD LOAD LOAD Wl W2 X1 X2
CASE TYPE SPAN SHAPE (PLF) (PLF) (FTi (FT)
---- ---- ---- ----- ----------- ----------- ---------- ----------
ALL D 1 C 1155.0 LBS 4.0
ALL D 1 U 165.0 0.0 16.0
1 L 1 C 3080.0 LBS 4.p
1 L 1 U 440.0 0.0 16.0
MAXIMUM DESIGN SECTION FORCES (FT-LBS), (LBS):
LOAD CASE MOMENT SHEAR
--------- -------- -------
1 28175 7924
SUPPORT REACTIONS (LBS) :
CASE B E A R I N G N U M B E R
---- --------------------------
1 2
1 8016 5899
CASE BEARING SIZES (IN)
---- ---------------------
1 3.00 3.00
CONCENTRATED LOADS
------------------
LOAD W1
SPAN TYPE (LBS)
1 D 1155.0
1 L 3080.0
X1 MIN
tFT) BRG(IN)
4.0 2.50
4.0 2.50
LOAD CASE LIVE LOAD DEFLC. TOTAL LOAD DEFLC.
NUMBER SPAN ACTUAL ALLOW. L/? ACTUAL ALLOW. L/?
--------- ---- ------ ------ ---- ------ ------ ----
1 1 0.385 0.788 499 0.529 1.050 363
STRESS INDICES:
CASE MSI VSI
, „ ....� - --
u
a .
08/04/95 07:06:26 GL-LP95.1
LOUISIANA-PACIFIC CORPORATION / GANG-LAM DESIGN
REQUEST NO:
STATE: MN
COMPANY: Scherer Brothers Lumber
DESIGN CRITERIA
LIVE LOAD= 40.00 PSF DEAD LOAD= 15.00 PSF
STRESS INCR= 15 % DESIGN CODE= ICBO
ALLOWABLE DEFLECTION: LIVE LOAD= L/240
SPAN CARRIED = 22.00 Ft
STRUCTURAL GEOMETRY
SPANS= 1 CANTS= 0
LENGTH tFT)
SPAN 1 16.000
OVERALL LENGTH= 16.00 FT
SLOPE= 0.000
TOTAL LOAD= L/180
���.�
�l-*-'�`-WARN�NG- DO NOT USE THIS DESIGN AFTER: 1-31-96 �
�-
WARNING- VERIFY YOUR INPUT TO AVOID DESIGN AND FABRICATION MISTAKES.
YOU ARE SOLELY RESPONSIBLE FOR ERRORS RESULTING FROM WRONG INPUT.
THIS PROGRAM IS A DESIGN TOOL AND SHOULD BE USED WITH EXTREME CARE
THAT INPUT UNIFORM AND CONCENTRATED LOAD5 ARE ACCURATE IN MAGNITUDE
AND L�CATION. IF YOU HAVE ANY QUESTIONS OR UNCERTAINTIES, PLEASE
CONTACT LOUISIANA-PACIFIC'S ENGINEERING DEPARTMENT.
. ��
�
______� ��=� _ ;
-----------------------------------
I BEAM SIZE:1.750 X 14.000 GL2950-2.0 NUMBER OF MEMBERS = 3 �
CONNECTION
*** DESIGN AS5UMES COMPONENTS CARRIED ARE APPLIED TO TOP EDGE OF BEAM,
SUCH THAT LOAD IS DISTRIBUTED EQUALLY TO EACH PLY.
*** ATTACH 2 BEAM PLIES WITH 3 ROWS OF 16d COMMON NAILS ON EACH FACE
STAGGERED AT 12.00" C/C.
*** ATTACH ADDITIONAL PLIES TO ALTERNATE FACES OF THE FIRST TWO PLIES,
AS REQUIRED, WITH 3 ROWS OF 16d COMMON NAILS STAGGERED AT
6.00" C/C.
*** COMPRESSION EDGE BRACING REQUIRED AT 27" O.C. OR LESS.
LOAD LOAD LOAD W1 W2 X1 X2
CASE TYPE SPAN SHAPE (PLF) (PLF) (FT) (FT)
---- ---- ---- ----- ----------- ----------- ---------- ----------
ALL D 1 U 105.0 0.0 22.0
1 L 1 U 280.0 0.0 22.0
MAXIMUM DESIGN SECTION FORCES (FT-LBS), (LBS):
LOAD CASE MOMENT SHEAR
--------- -------- -------
1 22766 4187
SUPPORT REACTIONS (LBS) :
CASE B E A R I N G N U M B E R
---- --------------------------
1 2
1 4235 4235
CASE BEARING SIZES (IN)
---- ---------------------
1 3.00 3.00
LOAD CASE LIVE LOAD DEFLC. TOTAL LOAD DEFLC.
NUMBER SPAN ACTUAL ALLOW. L/? ACTUAL ALLOW. L/?
--------- ---- ------ ------ ---- ------ ------ ----
1 1 0.595 0.725 444 0.818 1.087 323
STRESS INDICES:
CASE MSI VSI
1 0.540 0.295
SLENDERNESS RATIO = 2.67
LIMIT = 10.0
1 U.00/ U.OJO
�� S�END��NE5S RATIO = 4.57 LIMIT = 10.0
. . e
08/04/95 07:10:32 GL-LP95.1
LOUISIANA-PACIFIC CORPORATION / GANG-LAM DESIGN
REQUEST NO:
STATE: MN
COMPANY: Scherer Brothers Lumber
DESIGN CRITERIA
---------------
---------------
LIVE LOAD= 40.00 PSF DEAD LOAD= 15.00 P5F SLOPE= 0.000
STRESS INCR= 0% DESIGN CODE= ICBO
ALLOWABLE DEFLECTION: LIVE LOAD= L/360 TOTAL LOAD= L/240
SPAN CARRIED = 14.00 Ft
STRUCTURAL GEOMETRY
-------------------
-------------------
SPANS= 1 CANTS= 0
LENGTH (FT)
SPAN 1 22.000
OVERALL LENGTH= 22.00 FT
_-- ---
I �� ��
I ** WARNING- DO NOT USE THIS DESIGN AFTER: 1-31-96 �
� � _ ___
- ---- - _ ,
__
I WARNING- VERIFY YOUR__INPUT TO AVOID DESIGN AND FABRICATION MISTAKES.
YOU ARE SOLELY RESPONSIBLE FOR ERRORS RESULTING FROM WRONG INPUT.
THIS PROGRAM IS A DESIGN TOOL AND SHOULD BE USED WITH EXTREME CARE
THAT INPUT UNIFORM AND CONCENTRATED LOADS ARE ACCURATE IN MAGNITUDE
AND L�CATION. IF YOU HAVE ANY QUESTIONS OR UNCERTAINTIES, PLEASE
CONTACT LOUISIANA-PACIFIC'S ENGINEERING DEPARTMENT.
_ �'
sue�ecT P IT NO.
City of Fridley 2 716 3
AT THE TOP OF TME TWINS g � I L D i N G P E R M I T
r
� Z RECEIPT NO.
� ; V ��'�� �
COMMUNITY DEYELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �/��
� . ,
i--__ L �'��1'� CITV HALL FRIDLE� SS432 NUMBER REV DATE PAGE Oi APVROVEO BV
ti �� � � 612-571-34b0 910-F15 8/13/98 / /
JOB ADDRESS
5337 Horizon Dr
1 LEGAL LOT NO. � BLOCK TRACT Oq ADDITION SEE ATTACHED
DESCR. 4 6 Carlson's Summit Manor North SHEET
2 PliOPERTY OWNER MAII ADDRESS ZIP PNONE
Denise Furlon 5337 Horizon Dr 571-53 9
3 CONTRACTOR MAIL ADDRESS ZIP � PMONE LICENSE NO.
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PFIONE IICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PMONE LICENSE NO.
8 USE OF BUILDING
7 CLASS OF WORK
❑ NEW ❑ ADDITION O ALTERATION � REPAIR p MOVE O REMOVE
8 DESCRIBE WOFK
—O
9 CHANGE OF USE FROM TO
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REDUIRED FOR ELECTRICAL. PLUMBIN(i, NEATIN(i, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NINO SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAVS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAW3 YALUATION SURTAX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIEO
WITH WHETHER SPECIFIED HEREIN Oii NOT. THE GRANTING OF A PERMIT 1834 .)2
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL TNE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PEFiFORMANCE OF CONSTRUCTION S9. SO Fire SC �1 . S3
PLAN CNECK FEE T07AL FEE
62.25
��5r&NATUpEOFCONTRACTOR RAUTMORIZEDAGENT DATEI HEN PROPERLY V. ATED THIS IS YOUR PEiiM1T
� �' /.� �d' �a �° �"/�—��_
SiGNA7UREOFOWNEHUFOWNER8UILDERi IDATEi _ BLOG � So qFiE
NEW [ ] Effective 1/1/98
ADDN [ ] CITY OF FRIDLEY �
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �
BUILDING PERMIT APPLICATION a�I1� �
ll' � �
ConstructionAddress: ��7 ���Z�j� J..�{�� � �. [ � � y y� � SS'�� /
Legal Description:
Owner Name & Address: ��� /jE � (,l /���„(JG " Tel. #_ � 7/— ,5 � 1� �
Contractor: O �,{�(��, MN LICENSE #
Address:
Atta.ch to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: ��od� /h��.sE v� � �4���E - �� 5� - i E14-��F�'
Construction Type: �j � � (�C� j j �(' Estimated Cost: $ � l �,� �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � / � � J gi � ApPLICANT: � Tel. # � 7/ � �5���
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ s�
$ G`
$ qo�
$
$
$
$
$
$
$ �. ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Pemut 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 [ ]`
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
$25,001 to $50,000
$50,001 to $100,000
$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,Q00
$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 $SOO,OQO
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,�0,�0
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,�0 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Altemate "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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction �vill be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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C�IDVINEY AND STACg VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. . Has been carefully examined Yes (�) No i)
2. Is free from nist or deterioration
�3. Has no foreign objects lodged within
4. Is securely supported .
5. Meets all current Code requirements for size
and total BTiJ's connected
6 Has total heating BTLJ's of
7.
E�
All other BTU's
TOTAL BTU's
Has a liner been provided for water heater
Has combustion air been pmvided for water heater
Remarks: .
List ALTERATIONS Bein�Done:
Yes()No()
Yes()No()
Yes()No(}
Yes ( ) No ( )
Yes()No()
Yes()No()
HEATING CO:
Signed By:
Date:
SuB�EtT - ,-._,_,
c�ty of Frid�ey �2 8 4 �
AT THE TOP OF TME TWINS g � I L D I N G P E R M I T
;,
,� .
COMMUNITY DEVEIOPMENT DIV.
r � y � PROTECTIVE INSPECTION SEC. r%, �U
� :/
1 = �
� /���1 � CITY NA�L f RIDLE� SSI$Z NUMBEp RFV OATE PAGE Oi APPROVED BV
�""� � �'� 612-571-3a50 9taFts
10/30/98 � �
JOB ADDRESS
5337 Horizon Drive NE
t LEGAL ��T NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 4 6 Carlson's Summit Ma.nor North SNEET
2 PROPERTV OWNER MAIL AODRES$ ZIP PNONE
Tim Furlon 571-5369
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Franzen Const. Co. 4250 5 2744
e AfiCHITECT OR DESIGNER MAIL AODRESS ZIP PFIONE LICENSE NO.
S ENGINEER MAII ADORESS 21P PNONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION O REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Room addition - 18' x 14'
9 CHAN(3E pf USE FROM TO
STIPULATIONS
See notations on plan.
�������
Before diggirg call for
��A�. P�RM�S �E�U'� F at► uticity locations
WiR►r�r�, ��Ti�v�, �LU�e�n�G �n� � REQUIRED �BY
srcr�s, �W
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBING, HEATINa, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAO
VENTILATING OR Alq CONDITIONING
THIS PERMIT BECOMES NULL ANO VOIO IF WORK Ofi CONSTRUCTION 20NING S�. FT CU FT.
AUTMORIZED IS NOT COMMENCED WITMIN 80 OAYS. Ofi IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANOONEO FOR A PERI00 OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCEO NO DWLG. UNITS OFFSTREET PARKtNG
I HEREBY CERTIFY TMAT I HAVE READ AND EXAMINEO TMIS APPLICATION STA�LS GARAGES
ANO KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VA�UATION SURTAX
AND OROINANCES GOVERNING THIS TVPE OF WORK WILL BE COMP�IED
WITH WHETHEp SPECIFIEO HEREIN OR NOT. THE GRANTING OF A PERMIT 15 712 %.SC)
OOES NOT PRESUME TO GIVE AUTMOFITY TO VIOIATE OR CANCEL THE pEqM17 FEE SAC CMARGE
P ISIONS OF ANY 07HER STATE OR LOCAI LAW REGULA7ING CON•
TRU ION Op 7HE PERFORMANCE OF CONSTFiUC710N 23 .25 Fire .S�'i �1.5.71
PLAN CMECK FEE TOTAL f EE
� �''� /�r���� 00 265.82
$�GNAT O� CON'RACTOp 4UTMOp�2ED AGENT iO��E� yyNEN PROPERLV LIDATEO THIS IS VOUR PERMIT
- 9 �� /,' /
S�GNnTUAEO�OWNEA���OWNEABWLDERi iOA�E� BLDG N$o p`}E
NEW
ADDN
ALTER
� � �° ' '� �J� �'�
� � �� � C,���,
� CITY OF FRIDLEY / �`- �v �
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION �
ConstructionAddress: 5
,
� � �r
� ��
/98 /�
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,
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Legal Description:
- _ __--_��
Owner Name & Address: �,`( ���ohl �;r 533�7 /-r�aRt�oN l��2 • Tel. #�-I (� S�
Contractor: `�i24N2�A( �dNS�- MNLICENSE# ��7y�
Address: L/2.� �T�1 �� jC�. � Tel. # ``?� �/07/
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length � Width /� Height �_ Sq. Ft. z.�Z X s` ��
GARAGE AREA: Length Width Height Sq. Ft. ___�� Z �
DECK AREA: Length Width Hg t/ Groun d Sq. Ft. �
OTHER:
Constntction Type: (�DpM J� �� �-r� o� Estimated Cost: $ / UD . O� `� �Z �
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: j(�-�(o- j� APPLICANT: Tel. ��� �`1 IZO
CITY USE ONLY
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ z�� z�
$
$ � ��
$
$ 5, �
$
$
Fee Schedule on Reverse Side
.001 of Pemut Valuation (1/lOth%)
$.50/$1,000 Valuation
$10� 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 [ ]
$ �f �; �Z
BUII.,DING PERNIIT FEE SCHEDULE
The Chief Building O�cial 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 $50,000
$50,001 to $100,000
$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 DEPRESSION 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.
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CHIl1ZNEy AND STACS VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2.
3.
4.
5.
6
Is free from nist or deterioradon
Has no foreign objects lodged within
Is securely supported .
Meets all current Code requirements for size
and total BTU's connected
Has total heating BTU's of
All other BTU's
Yes ( ) No ( )
Yes ( ) No ( )
Yes()No()
Yes ( ) No ( )
TOTAL BTU's
7. Has a liner been provided for water heater Yes () No ()
8. Has combustion air been provided for water heater Yes () No ()
Remarks: .
List ALTERATION Bein� Done: /� � �� /Jt� / � �
�� �/�
�� _ O'_ G�i�� ���- -
HEATING CO:
Signed By:
Date:
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SuB�EC�
c�ty of Fr�a�ey
AT TME TOP OF TME TWINS g U I L D I N G P E R M I T
�
� .
� ��
� ; v _�___ COMMUNITV OEVELOPMENT DIV.
r � � PqOTECTIVE INSPECTION SEC.
� . .
i--•-� ��"' �•� CITY NALL fRIDLE� SSIJ2 NUMBEi1
L 763-571-3450 910-F15
JOB ADDRESS 5337 Horizon Drive NE
REV OATE PAGE Of
9/12/03 / /
33879
RECEIPT NO.
�c��/
�VVqOvED Br
t LEGAI ��T NO. BLOCK TRACT OR ADOITION SEE ATTACMED
oESCa. 4 6 Carlson's Summit Manor North SNEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PMONE
Jim Furlong 5337 Horizon Drive NE 612-226-3965
3 CONTRACTOR MAIL ADORESS 21P PHONE LICENSE NO
Above & Beyond Construction 481 206 Ave NE, East Bethel, MN 55011 763-300-6340
4 ARCMITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER
8 USE OF BUILDING
Residential
7 CLASS OF WOpK
MAIL
❑ NEW O ADDITION O ALTERATION
B DESCRIBE WORK
Re�lace two windows within exis
9 CHAN(3E OF USE FFiOM
TO
21P
� REPAIR
PNONE LICENSE NO
O MOVE O REMOVE
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all levels of the dwelliag
per Section 310.9.1.2 of the 1997 Uniform Building Cod.e. Caulk and flash all
exterior openings.
SEPARA7E PERMITS ARE REQUIRED FOR ELECTRICAL, PIUMBING, HEATING, �� � �
VENTI�ATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING
AUTMOR12E0 IS NOT COMMENCEO WITHIN 80 OAYS. OR If CONSTRUCTION
OR WOiiK IS SUSPENDED OR ABANOONED fOR A PERI00 OF 120 DAYS AT
ANV 71ME AF7ER WORK IS COMMENCED. NO OWLG. UNITS
I MEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APP�ICATION ],
AND KNOW THE SAME TO BE TRUE AN� CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIEO
WITM WMETMER SPECIFIED HEREIN Op NOT. TME GRANTING OF A PERMIT �2f8OO
DOES N07 PRESUME TO GIVE AU7MORITV TO VIOLATE OR CANCEL TME pEqM17fEE
PROVISIONS OF A OTMER STA7E OR IOCAL LAW REGUTATING CON-
STRU T R E P RfORMANCE Of CONSTRUCTIO///999N �83 .�GS
�r �� � PLAN CMECK FEE
OCCUPANCYGROUP OCCUPANCVLOAO
SQ.fT CU FT
OFFSTiiEET PARKING
S7ALLS IGARAGES
cen e SC $5.00
AE O� CON'AACTOA Op AUTHOp�ZEO AGENT �o�Te� � HEN PROPER�r vA
�O�TE� �
$1.40
SAC CNARGE
Fire SC $2.80
TOTALFEE
$92.45
�E MIT
� ��
r�� rt
NEW
ADDN
ALTER
�� CITY OF FRIDLEY Effective 1/1/2003
[] 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
Construction Address: �1 ��� C77)�` 4?�.rl 1)�
Legal Description:
Owner Name & Address:
Contractor. � .�� L
Address:��l ` � �" �v � � �- � ��. n� a � � .. �.v .� , .��
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed constnaction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length � Width Hgt/G�ound Sq. Ft.
Construction Type:��� ��`� � ��RPP.� Estimated Cost: $ ��� �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: � Z'� APPLICANT: ��aV�� �„���� Tel. #�nI�Z ��� �' 3� � �
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ .�5�
$ C�
$ �
$
$ ��f��
$
$
$
$
$ 2- ,S-
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th°/a)
$.50/$1,000 Valuation
$1275 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt.. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
_ ..
.
BUILDING 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 manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$SO,QOl to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$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 fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,�0
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $SQ0,000
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate.
Permits for construction will be issued a minunum of 24 hours from the time of application to allow �or proper
review of the proposed structure an.d of the construction site.
� VERIFICATION OF FOUNDATION
A Ce�tificate of Survey of the lat, showing the location of the existing foundation will be required before
proce�ding with the framing. New Houses Onlv
, , _ _
�
3uilding
:nspe�ti�ns
r-
163=572-3604
BUILDING
RESIDEN'I'IAL APPLICATION
CITY OF FRIDLEY
Permit No.:
Received
Date Rec'd: ��f�� �'
)ATE �! l �� � U � YOUR E-MAIL ADDRESS O / � / !/t �2 `� -� c � � � Y- �
;ITE ADDRESS ✓C 3 � % l� o J �` �a � ./' `N C
'HIS APPLICANT IS: �WNER ❑CONTRACTOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
�.o��
ADDRESS: S��? %�/o v ir �vK GD�� � CITY,
PHONE: ��0 3-5 7 �-5 3��{
NAME:
STATE LICENSE #_
EXP DATE
�Y/� SS�/�/
ADDRESS: CITY STATE ZIP,
PHONE
PROPERTY TYPE �INGLE FAMILY/NEW CONSTRUCTI�
❑ TWO FAMII,Y/NEW CONSTRUCTION
PERNIIT TYPE
TYPE OF WORK:
❑ BASEMENT FINISH
❑ DECK
,0 GARAGE/SHED
❑ ROOF
❑ SIDING
❑ SWIMMING PO�
❑ ADDTfION
q1R ❑ REMODELING
❑ WINDOWS
❑ DRAIN TILE
❑ OTHER
DESCRIBE WORK BE1NG DONE:�os �% d ' � /� � G3 � ✓ � S �
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. F� ���C
NLTMBER OF SQUARES
GARAGES
PROPOSED SIZE: a 1� �"6
PROPOSED HEIGHT: J 2 �i�
SIDING
,� Vinyl
E'_''Aluminum
❑ Othet
❑ HOUSE & GARAGE
❑ TTACHFD GARAGE
�ETACHED GARAGE
� offit
f .Trim
i . Fascia
�ASEMENT REMODELING SUBMTf:
1. Existmg Floor Plan
2. Proposed floor plan
3. List of strucwral members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & POItCHES SUBMIT:
1. Site Plan/Survey showing the existing strvctures
and proposed project
2. Two sets of construcbon plans
WIIQDOWS 3. Energy Calculations
IN EXISTING OPENINGS OYes �No IACATION OF WII�TDOWS
OR FOR NEW OPENINGS-DESCRIBE S7ZE OF
OPENING CHANGES &
TYPE OF VJINDOW TO BE INSTALLED NLJMBER OF WIIVDOWS d
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ r� �la ��� OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb G�t Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$ ��'j ,� �' See Back Page for Fee Schedule
$ `@ �j ,�? 9 65% of Building Permit Fee
$ j� _(P / .U01 times the total job valuation
$ R, j� .0005 x Permit Valualion Minimum $.50
$ $5.00 (State Licensed Residenrial Contractors)
$ $1550 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$20=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ y,�`�j Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTII, 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 Consti-uction Codes; thax I understand this is not a
permit but only an application for a permit and work ' n to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w' re ' es revie�j✓ app oval of plans. a �
SIGNATURE OF APPLICANT
Page 2- Building Residential Application
'• �:
�
BUILDING PERMIT FEE 5CHEDULE
The Chief Building Official sha11, before issui.ng 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, reyuire 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 surcharge)
$501 to $2,000 $23,50 for 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 fraction 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 incl ' $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 construction will be issued a minimum of 24 hours from the time of applicaiion to
allow for proper review of proposed shucture and of the construction site.
A Certificate of Survey of the lot, showi.ng the location of the existing foun.dation will be
required before proceed.ing with the framing. New Houses Onlv
City of Fridley
Build.ing rnspections Deparhment
6431 University Avenue NE
Fridley, N!N 55432
763-572-3604
Fax: 763-502-4977
�_pes�gan #49441 � ' ' ° � �/�0/2006
� *
�`-� * Take this sheet to the Building Maferials eounter to purchase your maferials. ***
You s�lected a ara e a►ith these o tions:
, . , 9 9, p
22 UVide X 26 Dee� X 9' High
6able roof �/ 4/12 piteh trusses
2x4 UVall Framing Material
�_ .
� p�, ������;:;�.r� �'r�ss a�s��trs
� � � r"a �A'';`Gi+TS ��n�,L EE S�AADE
2 O.C. �,,.��«��LE �;,� -r�� �o� s�-rE
� �� TI�E �RAP�fit�G I�iSPECTl01�
12" gable/12" �ave overhangs
1/2" OSB {Nail Sheathing
1/2" OS6 Roof Sheathing �;�
Tan Vinyl 4" Doable lap Siding
25 yr. Supreme, Dese�t Tan Shingles �
Almond Aluminam Soffif � faseia �
Almood Aluminum Premiqm Roof Edge f�n..�� ,:
INhite vinyl overhead door jamb
�9 f
;►a- ,
��
"�
--``' ,
Ftor� Visw
;;��);x; �
;� � �
.,�
��`
Baek
Today's cost for materials estimated
'*The 6ase priee inalades: 0° Eeve/0" 6a61e Overhangs, freming Materiela,
7/16 OSB Roof Sheathing, 20 y�. Fi6erglese Clasaie - Onyz Blaak Shingf�,
Plna Fasola, Galvanizad Regule� Roof Edga, 8° Taz�ured Vertioal Herd6oard Slding,
No Serviee Doors, No Overhead Doors, No Windoars, or Any Ofher Options.
; � �.� 3 �t3PY SHAE.�. �E
- �`;�lLABLE ON iHE JOg
; �IT� FOR THE FRAMING
} A�d^u FIf�A►L INSPECTlONS
� - �� � S ��vi
� �
� �— �C�.�,
._ �lV� 6,
r m��G�
�
in this design: $ 3711.63
�`�BASE.priee): $ 2132.12
You mey 6uy atl the materials or any Part at loa► oash and ear�y priees. Beoause oi the wide variable in aodes, Menards cannot guarer�ee that metarlels listed wlll meet your
6uilding eoda requlrements. These plans ere suggested designs and meterief fists onfy. We da not gperar�ee the coropleteness or prfess of these struetares. Tax, (a6or and
def iverq not ineluded.
�J 1 iMA"1'� FOR:
FURLONG
5337 HORIZON DRIVE
Fridley, [+II�T 55421
Estimate From
, ! •
STORE # 3018 FRID PHONE: (763) 571-8689
5351 Central Ave. NE FAX: (763) 571-1932
Fridley, MN 55421
.�
•��
Estimate # 49441 �
Page 1 of 3
Ph: (763) 571-5369 ESTIMATEBY ESTIMATEDATE
BJS O5/10/06
3KU NUMBER DESCRIPTION QTY TO ORDER ADDITIONAL ITEM INFORMATION
.D2-1114 2X4-10' STUD/#2+BTR SPF CONST LUhIDER g ��
TOP PLATE
02-1127 2X4-12' #2+BTR SPF CONST LUMBER B EACH ON SALE THRU OS/14/06
TOP PLATE
02-1130 2X4-14' #2+BTR SPF CONST LUMBER 4 EACH ON SAI,E THRU 05/14/06
GBL FLY RAFTER
02-1130 2X4-14' #2+BTR SPF CONST LUNBER 4 EACH ON SALE THRU OS/14/06
LATERAL BRACIATG
02-1130 2X4-14' #2+HTR SPF CONST LUNIDER 4 EACH ON SALE TFII2U 05/14/06
TOP PLATE
02-1143 2X4-16' #2+BTR SPF CONST LUMBER 4 EACH ON SALE THRU OS/14/06
GBL LADDER RUNQ
02-1305 2X4X104 5/6" SPF CONST STUD 82 EACH ON SALE THRU OS/14/06
�YT`ALL STUDS-
02-1758 2X6X6' STUD/#2+HTR SPF CONSTR LUI�ER 1 EACH
SRV DOOR HEADER
02-1758 2X6X8' STUD/#2+BTR SPF CONSTR LUMBER 2 EACH
WINDOW HEADER
02-1767 �2X6X14' #2+BTR SPF CONSTR LUMBER 4 EACfi ON SALE THRU OS/14/06
SPF FASCIA
02-1790 2X6X16' #Z+HTR SPF CONSTR LUN�ER 4 EACH ON SALE THRU OS/14/06
SPF FASCIA
�2-2197 2X12X18' #2�BTR FIR CONSTLUMBER 2 EACH ON SALE THRU OS/14/06
OH DOOR HEADER
11-0805 2X4-6' AC2 TREATED AG ARSENIC FREE LW 1 EACH
SILL PLATE
11-0621 2X4-10' AC2 TREATED AG ARSENIC FREE LW 1 EACH
SILL PLATE
L1-0634 2X4-12' AC2 TREATED AG ARSfiNIC FREE LW 3 EACH ON SALE THRU OS/14/06
SILL PLATE
L1-0847 2X4-14' AC2 TREATED AG ARSENIC FREE LW 2 EACH ON SALE THRU O5/14/06
SILL PLATE
?3-1085 1/2" (15/32)-4'XB' 32/16 RTD PINE CD BLK 1 EACH
HEADER SPACERS
?4-2809 1/2"-4'R8' ORIENT STRAND BOARD 27 EACH ON SALE TFII2U OS/14/06
ROO�-�° " _
?4-2809 -4'X8' ORIFNf STRAND BOARD 28 EACH ON SALE THRU OS/14/06
WALL SHEATHING
:6-0001 SIDING REMOVAL TOOL 1 gp,�
SDNG REMOVAL TL
:6-0003 SNAPLOCK PUNCH TOOL 1 EpCH
SDNG SPUNCH TL
6-1004 STARTER STRIP 10' (VINYL) g gp�
STARTER STRIP
his is an estimate. It is given only for genecal price informadon. T'his is not an offer and there can be no legally binding contract
:tween the parties based upon this estimate. The prices stated herein are subject w change depend'mg upon the merket conditions.
he prices stated on t6is estimau are not fum for any time period unless specifically wriuen otherwise on this form. T6e availability
' materials is subject to inventory condi6ons. MENARDS IS NOT RESPONSIBLE FOR AIVY LOSS INCURRED BY THE
UEST WHO RELIES ON PRICES S�1' FORTH HEREIN OR ON THE AVAILABILITY OF ANY OF THE MATERIALS
fATED HEREIN. All infom�a6on on this foim, other than price, has been provided by guest and Menazds is not responsible for
ry errors in the infotmation on this estunate, includ'mg but not I�ited co quantity, d'miension and quality. Please examine t6is estimate
�refully. MENARDS MAKES NO REPRESENTATIONS, ORAL, WRITTEN OR OTTiERWISE THAT THE MATERIALS GIJEST COPY
ISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDERED BY THE GUEST. BECAUSEiOF WIDE
ARIA1'IONS IN CODES, THIItE ARE NO REYRESENTATIONS TAAT THE MATERIALS LISTEb HEREIlV MEET PAGE 1 OF 3
OUR CODE REQUIItEMEN1'S.
�
�
ES�'�"IMATE FOR:
FURLONG
5337 HORI20N DRIVE
Fridley, NAT 55421
Estimate From
, ! •
STORE # 3018 FRID
5351 Central Ave. NE
Fridley, MN 55421
PHONE: (763) 571-8689
FAX: (763) 571-1932
Estimate # 49441
Page 2 of 3
Ph: (763) 571-5369 ESTIMATEBY ESTIMAI`EDATE
BJS O5/10/06
SKU NUMBER DESCRIP'TION TY TO ORDER ADDITIONAL ITEM INFORMATION
.46-3798 DOUBLE 4" VINYL SIDING TAN .040 103 EACH
VINYL SIDING ON SALE THRU O5/14/06
.46-4069 OUTSIDE CORNER POST 10' TAN 4 ��
OUTSIDE CORNER
.46-4085 5/B" J-TRIM 12'6" TAN 14 EACH �
J TRIM
.46-4124 12'6" DUAL UNDERSILL TAN Ep� ,*'2
C.��� E ` \, ,
FINISH TRIM ` �
.47-1065 TAN EZ-CORNER B PACK ��
E - ��� �
.51-178 #15 FELT UNDERLAYMENT 3' 144' (4 SQ) � Z gp�
ROOFING FELT
51-1909 ' SHIN STARTER STRIP 7.2"X33'4" ROLL 2 EACH ON SALE THRU OS/19/06
SHINGLES
51-2924 SUPREME FSGLS 25YR DESERT TAN 2g EpCH
SHINGLES
53-1248 1 GAL PLASTIC ROOF CEMENTWET OR DRY USE 7, gp�
ROOF CEN�NT
57-1554 1-1/4"X10' DRIPCAP WHITE WINDOW/DOOR 2 gp,�
DRIP CAP
57-2494 12� ^ADE" ALUM DRIP EDGE S.O. ALMOND 10 EACH ** Special Order **
ROOF EDGE
57-2498 12� PRO FRIEZE ALUMINUM S,p.ALMpND lp EpCH +* Special Order ** ON SALE THItU O5/14/06
FRIEZE RUNNER
57-2506 6°X12�R/S FASCIA.019ALUM S.O.ALMOND 10 EACH *• Special Order ** ON SALE THRU OS/14/06
ALUMINUM FASCIA
57-2512 16°X12' PRO VENTED SOFFITS.O.ALMOND 8 EACH �• Special Order *• ON SALE THRU OS/14/06
ALUMINUM SOFFIT
57-2516 1-1/4" NAIL 1 LB ALUMINUMALMpND 1 EACH ** Special Order **
ALM SOFFIT NAIL
61-1602 3 1/2" X 50' SILL SEALER FOAM 2 ��
SILL SFLT,
87-1267 22'STD 4/12 60# 2'OC 2'OH 12 EACH ON SALE THRU OS/14/06
CONII�lON TRUSS
87-1283 22' STUDDED END FRAME 4/12 PITCH z gp�
END TRUSS
91-7684 HOW TO BUILD -GARAGE PLANG06022 1 E,q�
GARAGE PLAN
21-3918 GEORGIAN ENTRY IQdOB BB FSIVGE0505 1 gp�
SRVDOOR LOCKSET
27-1400 1/2"PLYWD CLIP ALUM 25/BGS56-BMC lOBGS/ 5 gp�
H-CLIPS
27-1442 NAIL JOIST HANGER SLB GALV 1 gp�
5# Tie Nails
Chis is an es6mate. It is given only for general price information. T6is is not an offer and there can be no legally binding contract
>etween the parties based upon this estimate. The prices sfated herein are subject ro change depending upon d�e market conditions.
Che prices stated on this estimate are not finn for any time period unless specifically written othenvise on this fomi.l`he ava�7ability
�f materials is subject to invenWry conditions. MENARDS IS NOT RESPONSIBLE FOR ANY LOSS INCURRED BY 1'HE
;UEST WHO RELIES ON PRICES SET FORTH HEREIN OR ON THE AVAII,ABII,ITy OF ANY OF THE MATERIAI,S
iTATED HEREIN. All informa6on on tLis form, other than price, has been provided by guest and Menards is not responsible for
my errors in the information on this estimate, includ'mg but not limited to quantity, dimension and quality. Please exemine this estimate
arefully MENARDS MAKFS NO REPRESENTATIONS, ORAL, WRITI'EN OR OTHERR'ISE THAT THE MATERIALS GUEST COPY
.ISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDIItED BY TIiE GUEST, gECAUSE OF WIDE
lARIATIONS IN CODFS, THERE pRE NO REPRESENTATIONS THAT THE MATERIAI.S LISTED iiERIIN( MEET PAGE 2 OF 3
fOUR CODE REQUIREMENTS.
ESTIMATE FOR:
FURLONG
5337 HORIZOAT DRIVE
Fridley, MN 55421
Estimate From
, ! !
STORE # 3018 FRID PHONE: (763) 571-8689
5351 Central Ave. NE FAX: (763) 571-1932
Fridley, MN 55421
R�
�+, .
Estimate # 49441'=�
Page 3 of 3
Ph: (763) 571-5369 ESTIMATE BY ESTIMATE DATE
BJS O5/10/06
3KU NUMBER DESCRIPTION QTY TO ORDER ADDITIONAL ITEM INFORMATION
:27-1646 RAFTER TIE U SHAPED IPC RT15 100/ 24 EACH
RAF°fER TIES
!29-3672 1 1/2° VINYL SIDING NAIL 2 LBS 2 EACH
SIDING NAILS
'29-5347 NAIL BD C.C. SINKER 5 LB BOX 5 BOX
SHEATHING NAILS
:29-5363 NAIL 16D C.C. SINKER 5 LB BOX 4 BOX
FRAMING NAILS
:29-5457 NAIL 6D GALVANIZED BOX 1 LB BOX 1 BOX
GALV BOX NAILS
:29-5570 NAIL 16D GALVANIZED BOX 5 LB BOX 1 BOX
FRAMING NAILS
:29-5648 NAIL 16D GALV CASING 1 LB BOX 2 BOX
CASING NAILS
:29-5790 NAIL 1-1/4° GALV ROOFING 5 LB BOX 3 BOX
ROOFING NAILS
:03-2276 36X24 WIiITfi VINYL UTILIT3t WINDOW 2 EACH
WINDOW
:14-1062 CP1 FLUSH STEEL DOOR PH 36X80 RH SB 1 NOSO
SERVICE DOOR
:17-1621 GARAGE DOOR STOP WHITE 7' VINYL 2 EACH
OH DWR STOP
17-1663 GARA(3E DOOR STOP WHITE 16' VINYL 1 EACH
OA DOOR STOP
17-9377 VINYL JAb'1B TRIM WFiITE 7' 11/16X5-13/16 3 EACH
OH DOOR JANB
17-9380 VINYL JANNIB TRIM WHITE 10'll/16X5-13/16 1 EACH
OH DOOR JAMH
17-9720 VINYL BRICK MLD WHITE 8' 1-1/4X2 2 EACH
O}IDR BRICKMOULD
17-9746 VINYL BRICK MLD WHITE 17'1-1/4X2 1 EACH
OiIDR BRICKMOULD
25-1075 KEYED LOCK SET #1024050 1 EACH
OHDOOR LOCKSET
25-1088 REAR TRACK HANGING KIT IDEAL 1 EACH
REAR HANGER KIT
25-4546 WHITE INSUL R/P M4RSF 16X7 EZSET TORS 1 EACFi ON SALE THRU OS/14/06
OVERHEAD DOOR
33-4222 PINE TAPERED SHIMS 12 Cf 3/BX1-1/4X8 " 1 EACH
PACKS OF SHIMS
63-4222 PAINTER'S PREMIUM WHITE WL0037700 100Z 3 EACH
CAULK
This is an estimate. It is given only for general price mformadon. This is not an offer and there can be no legally bmd'mg contract TODAY'S SUB-TOTAL: 3, 711. 6 3
between the parties based upon this estimate. The prices stated herein are subject to change depending upon tl�e market condidons.
The prices stated on this esdmate are not £rm for any 6me period unless specifically written otherwise on this form. The availability REGULAR SUB-TOTAL: 3, 95 9. 9 5
of materials is subject ro invenWry conditions. MENARDS IS NOT RESPONSIBLE FOR ANY LOSS INCURRED BY THE
GUEST WHO RELIES ON PRICES SET FORTH HEREIIV OR ON THE AVAILABII.ITY OF ANY OF THE MATF}tU�S
STATED HEREIN. Al] infom�ation on this form, ather than price, has been pmvided by gu�t and Menards is not mspons�ble for
any errors in the iaformation on this esCvnate, including but not limited to quantity, dimension and quality. Please examine this estimate GUEST COPY
carefully. MENARDS MAKFS NO REPRFSENTATIOIVS, ORAL, WRIITEN OR OTHERWLSE THAT THE MATERU� �
LISTED ARE SUITABLE FOR ANY PURPOSE BEING CONSIDERED BY THE GUEST. BECAUS� OF VVIDE
VARIATiONS IIV CODF�, THERE ARE NO REPRESENTATIONS TAAT THE MATERIAIS LISTED �RFnv MEE1' PAGE 3 OF 3
YOUR CODE REQUIREMENTS.
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