AF - 46367City of Fridley, Minn_
BUILDING PE�NIIT
N° 5966
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;�.00�►TION F L !3
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No. � � s�t + � o�,ot
Lot ��.__ Block _._..� � Addition or Sub-Di on ��� �r �1�
�� �
Coraer Lot — Inaide Lot �� Setback Sideyard _�— �
Sewer IIevation
Fotmdation IIevation
DESCRIPTtON OF BUILDING �
To ,� e as: Front „�. Depth .��"--� Height � Sq. Ft 4.���Cu. Ft. ��'�
Fr Depth �3eig�b �.�, Sq. Ft Cu. F't.
�r�� Fast. Cost �lj�-+���To be Completed
Type of Construcl3on .�...
In consideration of the fssuance io me of a permit to construct the building described above, I agre� to do
the proposed work in accordance with the description above aet forth and in compliance with all provisiona of
ordinances of the dty of Fridley.
.,�'
In consideration of the payment of a fee of
permit is hereby granted to
to construct the building or additioa 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 builduig, or any part thereof, shall conform in all respecfis to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildfuga
within the dty limits and this permit may be revoked at any�s, upoa viola of aay oP the pmvisions of said
ordinancea .+'� � ,�/� .��
Buflding Inapector
NOTICE:
'Ihia permh doei not eover 1he eoeshveHoe, lesta�atton fo� wiring, plumbtn8, 8as heaHog, se�wer or water. Be arce to �e
f6a Buildieg Inspeetor tor aeparate permits Por these hsme. �
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APPLICATIO�T FOR SUI7�D�T�TG PERMIT
CiTY OF FRIDLEY. MTL�7ESOTA
Owne�'a Name �srs�� �1��N � �p+p•� Suilder_ �e�`�'�� ���.�� _
.
Adc�ress 5���' �aa�,s ��.., .��-��� 1�,ddress �i�`�� �or��_ � �<
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Lo�t /�� Block � Addition or
Lot ��P s
subd ivia ion��e� -.
ra_.t�__-�� .
Corner Lot ins3de Lot Set]�ack ___�__Sic�e-Yard
SEWEI3 ELEVATION FOUNDATIOL�T ELEVATY0I�T
Applicant a�t�ach to �th3s form Certi�icate og �urveg of Zot and
propose� building location.
To be used aso
�a/
DESCAIPTYON OF BUILDING
� De»th � �'
aS.�s F�.• ��-C7 .�s ��.•
Front� ep•�h _Height
SQ• F�s VYo i'�i. .
3'ype o� Construction ��'� Est�xaated Cos�
lo be Completed _ __
... .
�'b,e undersigned here�Oy makes appli.cation for a permit �or the work
here�in specified, ac�ree�.ng �o do all woick in strict accordance with
the C�.ty of Fridley Ord�.nancea and ruling o� the Deparf�nent of Huild-
ings, and hereby decla�es that all the facfis and �epresen'ra�tions
s�ated in this ap�l�.catian are true and corr�ct.
DATE � � �� � � � � S
(Schedule oi Fee Coats can ne �couna on tne x�evvrse �iae�.
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- �IIYLDa1VG PERMIT FEE SC�EDULE
�
sec�ion 2. The Tnspector o� 8uiidin�s shall, before iseuing any
pe�m�.�: fo� the erec��ioa o� any lbuil�ing Or struCtura, Or fOr any
addit�.on to any oxis�ing building or struc�wce, or for aay alterations
or repa�.rs �ko any oxistin� bu3lding or si�ucture, upon application
�ho�efor, require the payatent by the applicant for auch permit of
fees to the amount here3.n below set �orth and in the mannex here�.n
pro�ided to-�ito
2.1. For any such pormit for the erection og any fire-proo� buiiding,
o�her than a garaga, wascehouse, faetory or grain alevator, or for the
erec�t�.on of any fi�.�a-p�oof addition, . for ��nilar occupancy, to any
exis�ing building shall. be at th� rate o� $1.40 for each ono thousand
cutoic feet, or fraction thereo�E, in such cubical contents.
2� For any such pormi�t �or the erectcion o� any fire-proo;� garage,
wa�cehouse, �ac�co�cy or grain elevator, or for fi�e erection oi any fire-
psoo� addition, �or si�n9.la� occupan�y, �to any existing bu �ild�.ng shall
be at the rate o� $1.25 �or �ach one thousarid cubic feet, classi�ied
as "�ireproo�" by �eci:ion 502 0� th� M,�.rir�eapolis Building Codle.
HO. USE,
2_ 3. For any esuch perm�.t for th� erec�ion of any non-�ireproof build-
�.ng otch�s �han a garac�e, warehousse, factory or grain aZevator, or any
non-rireproo�E addattion, �or s�ilar occupaacy, to any exisging building
Permit $1.00 gor each one thousand cubic feet.
G�AR�P►G�E3
2,_.�. �or any auch permi� for the erection oi any non-fireproof
qarage, warehouse, �actory or ggain eleva�or, or �or the erection of
a.�y non-fcireproo�c adc9ition, �or sim�.lar occuparicy, to any exiating
building or for each such building or adclitalon. Ninoty Cen�s for each
one �ousand cubie �:eet or fraction �hereof, ia the cubical contents
thereo�' wi�h a mini.murn o� $4,.00 e
For the purpose oc computing fees for bu3lding permit� the cubical con-
ten�s ofc ariy building or additio�n to a ur�ifo�n height throughoutc by
multiplying the ground a;rea covered irom a point six (6) inches below
�he rloor line o� the basement or cellar to the average heigh� o� the
upper surface or i:o 'che average heigh� of the roof surfac� of the mai,n
gable o€ a pitched roof.
2� For rapairs or alte�atione to an existing etructure, the �ee
shall be at �he rate o� $3.00 per each Five Hundred Dollars ($500.00)
or �raction �hereor in �the cos� o� all proposed work.
2_,.,6. Yn no cas� shall the fee chasged for any pesmit as aet forth in
S��t.3.o� 2 be less �-.Y,-� $4.00. ,�,
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Ci.ty of Fridley, Minn. 1�`° '7588
BUILDING PERMIT
nate: M� �s 1965
p��; Mr. Keuneth S�.00m �� Ala� Construction Inc.
Ad�s 54b9 �orizon Dr3ve 11T. E. A�� �,�j0 �ach� L�.ne No,
LOCATION OF BUILDING
No. �&b2.— stc�et Hor3.zon Drive �T. E• Part oP Lot
Lot �'S Bl�k 6 Addition or Sub-Divisian CBTlso11 t s�uuun�.� �nor NC. Add.
Coraer Lot Inafde Lot Setback Sideyard
Sewer IIevation Foundation IIevation
DESCRIPTION OF BUILDING
To be vsed as:
F'ront Depth Height Sq. F't. Cu. FL
Front Depth I�eight Sq. Ft Cu. FL
�►pe of Conatruction F.st, Coat -��k-200.4Q To be Completed
�� Storm Damage 8ep�i�
�
In cons[deration oP the f�uaace to me of a permit to construct the building descrit�d above I agiee to do
the proposed work ffi accordance with the d�scrlption above set Porth and �complience with a'11 provisfons oP
orrlinsnoea oP the dty oP Frldley. ��� �� ��s��2� � �
���
In camsfderatian oP the paqment of a fee ot �.1Q.SIQ,. , p�rmit ia hereby granted to�-a-^- �ona�.-S�= Ii1C.
to coastruct the building or addition aa d�crlbed above. Thiape rmit fs granted u�n
the exPress conditlon that the peraon to whom it 9s grented and hia agents, employees and worlanen, fn all work
done in, around and upon said building, or anypart thereof, shall caonPorm fn sII respects to the ordinance� of
Fridley, Minnesota rega�iag laca'tion, construct�on, altera.tion, maintenaacx� repafr and moving of buildiugs
wlthin the dty limits and th9s perazit may be sevoked at ar�y time up� violation of any of the provi�lons of said
o�*d9neaa�.
�� �
NOTIC�
'llils p�emlt dea eof �ru t6s eomtrasdoe, �sta�oe �or �rhie8. P��e. 0a hattn8, aru er warsr. B� ams ts ss�
Nn BuiWinB In�eto� tor ap�rtl� �s Por thea h�ms.
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APPLICATION FOIt B ING PERMCT
,�
CI.TY OF, FRII3�',�'Yf N1�SQTA
O�R'S NAME Mr Kennetii: Bloom g�� Alar� Oonstru�tion Ir►�.
,AD�RESS 5�69 Horizon; Drive. AUDRI3S3 �850 �acln�ry 1.�n� �'a.
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LOG�TTOA1 OF ��Il� � � �
No. `a � ��" � St%�et 0��' a "�'a ,P��' ��"�'� ° Part ofr`I.ot .
�
Lot Block ��_ Addit.ioa' or Subd��'�visian ���,F'1 �a. � � . � . ,� �a� � �`d�
_ _ � �' ���_ .A � �' } _ ' �� �
� .. • �Lr�i4" �L � EJ'�.��( I
Corner Lot Inside �ot _,,.,�e�isa�k �ide-Yard " "`
SBWER EbE'VATIQN FOUNDA�.`ION EL�VA°1''tON
Applicant .ateach to th.i� form, �'wo Certificates of. Survey of Lot �aud �Srapased huild-
ing location .di��wa ot► these (;�Y'tificates . �
DESC�IPTiOPT OF B�JII.DING
To be used �s: , �
�'ronC Depth Height
9q. Ft. Cu. Ft. �
Frout Dmpth Height
' St�. Ft . � Cu . Ft .
�
Type af ConsCruction ' E�timated Cos �; �� t�' ��°-° ;
_.,T.o---be _S,omp].ete+d
The undersigned hereby makes application for a permit for the work herein specified,
agreei�g tm c�o a�,l taork ii� str�c� accordance wi.th the City of Fridley Ordinances and
rulings o� ttae Department' of Buildiags, and hereby declares tfiat all the facts and
repzes.entations stated in this application are true and correct.
Map. 26 , 19�5. ��� t�lar� Pe �ers on
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�Sc�.1.e" of Fee Costa can be found oa the Reverse Side) .
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� Seetion 2. The Inspector o�' Buildi�t�s �s1��2•�,' �be�orQ isau,i�g �aq permit for
„ tt� erection of anq buildiag or.stru��,nre, �or for a4y add�.ti�, te any euiet-
, ing building or sCructure, or for,' r�ay a�terat�4.�,s�+�.os''.�epair� to an�r es3sEing .
huildi� or structure� upon applicatioa� �er>efor, �er��isa tbe payme� by �he
applicant for such perm3t of feee �D �iie amount �her�in��below eet �forth..ecrd
: �in the mannei herein provided to-w�t: �` ..
: -. - . _. .. . . ' � . � �
-..r .-- ��.1. F�r aay �uch permit #or tbe gs+��.�iari •c��` any fire�-`pr��.. bu�ld�pg. o�i�er
�•.�'�t�ssa a g�a.r�ge� war-ehous�, factory ox: ��iu' �'��ev�t�#c'p :� fmr. _the e�tion of ..�
•' any fire-�r�of addi�ioa, fox' siu�];ar°�oic��p�acy� �� a�,y �xis�t�i�g bu�.ld��g ��•;.� . �.
shali be at the ra�e �f $1.4Q for a�e,sh�,p�o titausa� �t�bie feet, or�fr�i�on
ar� .. thereaf, i�a such cubical cont�n�s.� . �� '� � ' . , , . � . � �
h. '
. ���. 2.,,:�2. _ P'or any such permit. fat..,,��e erettion o# .any f3rerprooi gi�rae�.. �o�^•.--:,..r
factorq sr grain elevator, or f��the �rectio�: � a�►g �p�?o�of '�. ��.s
. f�r aim�ilar occupancy, to any eXise�ing ���Idi�g sh�ll� �be �t .t�ie .; ';
, , .._��fo�'�aeh one .thousead cubic .fee�;�.,c�lassi�ied �8e.!'firep.ra►o�'� :bq .Sz . � . .
the �'iinreeap�i,is�-8u�3di�q�g Cod4..:p?�ee.>:• . . � � . -
� SOUSES ' � � .' , , � - � . . .
. .: 2_,� For e.uy such permi� for. the er.eattoin of �ny non-Hre�o+�f '$Wild3� cat ..
.-.thaa a gar�ge, warehouse, factorq or, grain elevator, Or auq non-fitepr�f ��';.�:
additi�n, gor simfd,�r ��up�yy to an� e�i�ti�g�Tiuildin� - peXmit $E.�� fbr
each •oae thou�a¢e� .e�bl.�, fe��.. . , '
GARAGES , . ., • '. ��
Z,,,,:4_, For any such perc�it f�dr the e=ection of aay aon-�fireproof gaa-age,, �
warehouae, factory or grain elevator, o= for the erection of anq non-f3repr�a�f'�
���'�*;^", -€er--s3milar occupaacq, to anX exiating building br for eecb� euch ��
--_��..; '��tn8 or addition - aiaety cents ($0.90j for each oae thouaand ce�bic Seet
or fraCtion thereof, in the cubical coatenta thereof with a minimum of $4.OQ.-
For the purpose of computing fees for building permite, th� cubical c�mte�C� ��
of any buflding or addition to a uni�crm height thrau�hoi�t�bq multigiying ��f2.-'
�ro�nd areg tovered .fsam a�poiat si$ (6� iach�� b�ld�r� tbe �loor 13ne c�f _the ,✓,_`
baeemeat or cellar to the sverage height of the uppe� su�face or to tt�e
average height of the rQOf �urface of the maim gable of a.�titched roof. , •
. 2,_,5_•. For repairs or aXterations to an exiati �� �r�"
, at the rate of 3 00 �$ t� tu�. �g �ee sI�a11 be .••-' �, .
$. per each Fine Fivadred Doilar.,a .($50b':�Q� or, �rectia�
,y� therebf . in t�h�� cos-t 'ofw �11 ^ proposacl work, . ' � � , � � '
. . . . . _ s' .
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2.6.` In ao case shali Ehe fe8,.,.charge�;far.aa3' P�rmi� a{� BeE f�t'th in � ��� °.
' Sectia�a _2 be .lea�i-.�haa. �.$�..00: . � . . . • � ,,;
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WE SPECIALIZE IN NEW HOMES
533-2600
533-7988
iii����i�.._: �iii��►►������.
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-- � � —o_,._.:
ALAN CO�TSTRUCTION COMPANY
4a50 Zachary Lane No.
MINNEAPOLIS, MINNESOTA 55428
TSTIMATE. BID.
Storm dam�ge estimate�
Mr. K��ae�h Bloom.
5469 Horizon Drive.
�Y. 2�. 1963.
We will rsmo�� and r�plaoe roofing at the said addre�s.
i�.� ti►^�'� �"`F I �'°
Alan Constr�ction Inc.
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CHIM��EY AN�J �TACK VERIFICATION '
The undersigned hereby verifies that the axisting chimney or stack;
1. Has been carefully examined Yes (;�
2. Is free fram rust or deterioration � Yes ��j
3. Nas no foreign objects todged within Yes (�
4. Is securely supported � Yes (�
5.
6.
Meets all current Code requirements for size and
total BTU connected
Hds Totai heating BTU's af �S >���'
Al l o ther BTU' s
�l�u��L�
TOTAL ��
e
A
tvo()
No ( )
rro ( )
Na ( )
Ye s (1� No ( )
Company
5igned �
pa te
�
sue�etr PERMIT .
c�ty of Fridley 7835
AT TNE TOP OF THE 7WINS g � I L D I N G P E R M I T
r
� � RE NO.
� `� __��_ COMMUNITY DEVELOPMENT DIV.
� � TI ION SEC. % _ /��
r '; � ������ �O �
( r"'1 � CITY MALL FRIOLE� SSI,$ NUMBEN NEV DATE PAGE Oi AVORpVED 8•
�----�" �•' 612-571-3460 910-F15 9/16/98 / /
JOB ADDRESS 5469 Horizon Dr NE
t LEGAL �OT NO. BLOCK TpACT OR AODITION SEE ATTACHED
DESCR. ZS 6 Carlson's Summit Manor, North .Addition SNEET
2 PROPERTY OWNER MAIL AODiiES$ 21P PNONE
Gordon Rasmussen
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO
Panelcraft 3118 Snelling Ave Minneapolis 55406 721-6628 2179
d ARCHITECT OR DESIGNER MAIL ADDRESS 21P PMONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PNONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW � ADDITION O ALTERATION �7 REPAIR p MOVE O REMOVE
B DESCRIBE WOfiK
Reroof house & garage (25SQ) Tear-off; Siding; Soffit/Fascia
9 CHAN(iE OF USE fROM TO
STIPULATIONS
Reroof - Underlayment must comply with the State Building Code.
Reside - Call for building wrap inspection before covering.
Soffit/Fascia - Install soffit ventilation to meet the State Building Code.
TVPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE fiEOUIRED FOR ELECTRICAL. PLUMBING. MEATING.
VENTILATING Op AIF CONOITIONING
THIS PERMIT BECOMES NULL AND VOID IF WOiiK OR CONSTRUCTION 20NING SO. FT CU FT.
AUTMOR12ED IS NOT COMMENCED W.ITHIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO fOR A PERI00 OF 120 DAYS AT
ANY 71ME AFTEH WORK IS COMMENCED. NO DWIG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY TNAT I HAVE READ ANO EXAMINEO TMIS APPLICATION S7ALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VA�UATION SURTAX
ANO OfiDINANCES GOVEFNING THIS TVPE OF WORK WI�L 8E COMPLIED
WITM WHETHER SPECIFIEO HEREIN Ofi NOT. THE GRAN7ING OF A PERMIT �6��FSI.00 �3.24
DOES NOT PRESUME TO GIVE AUTMORI7V TO VIOLATE OR CANCEL TME pEqMIT fEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REOULATING CON-
STRUCTION OR THE PERfORMANCE OF CONSTRUCTION �].Z�1. %S Fire C�E7. �S
PLAN CNECKFEE TOTALf
Lice S $5. $139.47
ATUpE O� CON'WACTOp Op AUi aGEhT iDaiE� t� p p ALIO TED S IS R P R IT ��1
`' �
S�GNOTU�7E O� OWNEAi�� OWNEQBU�LD@fii iO�TE� BL �NSo � ff`1E + ,
�' �
�
NEW [ ]
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FA.'VIILY AND DUPLEXES R-1 AND R-2
n BUILDING PERMIT APPLICATION
ConstructionAddress: .� i"/,, � ���/'��� �� �
Effective 1 / 1 /98
��� �
��j ���
�
Legal Description:
Owner Name & Address: %� /) . � Tel. #
Contractor: � ��' MN LICENSE # � �-�%
Address: ,�" ��i.P �/�7. � _/' � f% Tel. # �� ����'
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Af�ach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Ixngth Width Height Sq. Ft. �
I.ength Width Height Sq. Ft.
I.ength Width Hgt/Ground Sq. Ft.
a �' � �, , �1��.
.
„�onstruction Ty e: �/�/.� �i? i � Estimated Cost: $���, " � ��g
� �
� ��� j��, � ` _ , chedule on Back) ,c���
�
Driveway Curb Cut Width I�3eeded: Ft. + 6 Ft = Ft x$ _$
DATE:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
�� TOTAL
STIPULATIONS:
APPLICANT:
f
� � -
$ �e��
$ �
$
$ � ���
$
$
$
$ .
$-, .
� 3�� ��%
Tel. # ��'ll'/� �i �
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
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [] Not Necessary [ J
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a �8o3g$�88888
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CIIYOF
FRIDLEY
FRIDLEY MiJ1VICIPAL CENTER • 6431 UrTIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
October 9, 2000
W. Rasmussen
5469 Horizon Drive NE
Fridley, MN 55421
Re: Final Inspection at 5469 Horizon Drive NE
Contractor: R A Johnson and Son
Dear Mr. Rasmussen:
A plumbing permit was issued on May 24, 1999, for the above noted address,
to install a gas water heater. According to section 4715.2800 of the State
Plumbing Code, a final inspection shall be conducted on the plumbing authorized
by this permit. As of this date no inspection has been called for.
You will be given thirty (30) days from receipt of this notice to respond. If we do
not hear from you, we will expire the permit and any inspections on this
installation will require a new permit.
Any questions can be addressed to myself at (763) 572-3603.
Sincerely,
DAVEJENSEN
Building Inspector
t
a
Building
Insp�ectio�s
763-572-3604
763-502-4977 FAX
DATE �� (O— Q� _
SITE ADDRESS sy6 �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
PROPERTY TYPE
PERMTT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-I-08
YOUR E-MAIL ADDRESS
�f OWNER OCONTRACTOR
NAME: �J�.,'� ���
ADDRESS: y O�
PHONE: ! 3 � '�
NAME:
ADDRESS:
PHONE
STATE LICENSE #
�
Pemut No. • ,
Received By: !�
Date Rec'd: f��
� C[TY�R��=� STATEIti%N ZIP,
�SINGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILYMEW CONSTRUCTION
❑ BASEMENT FINISH
❑ DECK
❑ NEW HOME CONSTRUCTION
❑ MAINTENANCE/REPAIR
DESCRIBE WORK BEING DONE: S
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
� Aluminum
❑ Other
WINDOWS
M EXISTING OPENINGS ❑Yes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
FAX
' STATE ZIP
EXP DATE
❑ GARAGE/SHED ❑ W1NDOw5
❑ ROOF ❑ DRAIN TILE
❑ SIDING ❑ OTHER
❑ SWIMMING POOL
❑ ADDITION
❑ REMODELR�IG
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
F'I'
BASEMENT REMODELING SUBMIT:
l. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION IAICLUDING DECKS,
❑Soffit ADDITIONS & PORCHES SUBMIT:
❑ Trim 1• Site Plan/Survey showing the existing structures
❑ Fascia and proposed project.
2. Two sets of construction plans
3. Energy Calculations
LOCATION OF WINDOWS
NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
S�N lG THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ 2 a�Ov, OG OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Chazge
Curb Cut Escrow
' Erosion Control
Park Fee
Sewer Main Charge
Total Due
�-
$ �'� , s See Back Page for Fee Schedule
$ �/�, � i 65% of Building Permit Fee
$ ��� .001 times the total job valuation
$ �, �� .0005 x Permit Valuation Minimum $.50
$ $5.00 (State Licensed Residential Contractors)
$ $1825 per 5AC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Detertnined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
$ // a a Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMTI'-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and 1 acknowledge 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 ' the Minnesota Constr�ctio ; that 1 understand this is not a permit but only an application for a permit and work is not to start without a
permit on site; that the work will e in a w' ap � ved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLIC NT PRINT NAME ,� � Nt%G u� u DATE -�� 8.
, . � . • , I;,� %, ,�,t�a����'�i�=��lr , .
Page 2- Building Residential Application
BUILDING 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 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 l�` $25,000 plus $ I 0. I 0 for each additional $1,000 or fra.ction,
to and including $50,000
$50,001 to $100,000 $643.75 for ls` $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 includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 15` $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
Pernuts for construction will be issued a minimum of 24 hours from the time of application to
allow for proper review 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
Faz: 763-502-4977
y
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