AF - 46375. - r"� �
� BUII�DING PERMIT
Village of Fridley, Mina. No
l
Date
Owner
Addre
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Builder
Address
2935
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L.00�N OF BUILDWG
No. .��/ �.... Street ... .............................. Part of Lot .......................
. `
Lot . . . � . . . . . . . . . Block . . . �. . . . . . . . . . . Addition o r Sub-Division . C�'�r�'��, ��+° ,�, , �?=�;��G�����
✓- '
Corner Lot ............ Inside Lot ............ Setback .�....... Sideyard ...� .....................
DES�CRIPTION OF BU(LDING
To be Use as:
�. . . . . . . c . . . . . Front . � Depth . . . .�. .�. Heigh�. � Sq. Ft. L. � �. Cu. Ft. . . . . . . . .
�
.................... Front ........ Depth ........ Height ......... Sq. Ft. ........ Cu. Ft.
1'ype of Construction .6� . Est Cost . �. � . �� � . . . . . Td be Completed . . . ���'°�'�
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In consideration of the i�ssuanee to me of a pernut to construct 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
ordinances of the villa�e of Fridley.
. .............. ....... ............. : ..
Tn consideration of the payment of a fee of $�� ��rmft is hereby granted to .... r'• •.��G�
. ... .
� .. to construct the building or ad dition as described above. Thia permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work
done in, axound and upon said building, or any part tlzereof, shall conform in all respects to the ordinances of
Fridley, 1Vlinnesot� regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limif� and this permit may be revoked at any time upon violation of of the provisions of said
ordinattces. �.
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- - _ � '�uilding InsPector
NOTICE:
This permit does not cover the const�uction, installatlon or atteration fo� wiring, plum6ing, gas heattng,
sewer o� water. Be sure to see the Buildtng Inspector for separa4e pe�mtts for these Items.
City of Fridley, Minn.
BUILDING PERMIT
-�a-��
N° 6185
Date: "�..'' ""*'' „H "`r�
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Ocvaer: .s.�:/��. ,, j �.�� �- `. . �. �v. Builder ,c=�,. �. "��`.,±�.�'°��
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Address Addrese
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L TIG�OP � ING
No. �' �;' � street 4 '` V*�'�'�= rr_�' Part or Lot
Lot � � -- Block S�_ Addil3on or Sub-piviy�ion ___._ `� � ^ � . ���'�'�
Corner Lot — 7naide Lot �"�"� Srisback �'�'P� ideyard _.,,�
Sewer IIevatian — Fo dation IIevation
DESCRIPTION OF BUILDING
T v�a �:
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Front � Depth .�:_.,+��► Height .,��_ Sq. F`k (�. Ft.����4+�
� � f � ,�Wr�
—�Fro� —:.,�— Depth `�eight �t,_.. Sq. Ft. Cu. FtI�'
1j� Of ConstructiOn ��°''�� .' '"' Es��{ 'f'�".�.�'w� To be Com leted
�°�`—K � —,�--�---�------ n
In con�deration of the issuaace to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with tYie description above set forth and in compiiance with all provlsions of
ordinances oP the dty oP Fridley. �
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In consfderatfon of the payment of a fee of $ �°'� , permit is hereby granted to
to conatruct the buflding or addition as described above. Thia permit is granted upon
the express condition that the person to whom it ia granted and his agent�, employees and workmen, in all work
done in, around and upon said building, or anypart thereo� shall conform in all reapects to the ordinances oE
Frldley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within 'the dty limits and this perniit may be revoked at any tirne upon violation of aay of the proviaiona oi said
ordinanca. � .. �..�,,
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��, �.' ,' g. ",� r �=`�/ swuaing rnapector
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NOTICE:
16b permh dws no� eevsr ths coostrueHoe, tmtallatioe 1or rrietsy, �lum6teo, �n h�aitey, saw� o� rralrr. 8� sun to ss�
th� BuOdiee Insp�etoe fer ppuaM p�rmtfs Po� 16a� It�ms.
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APPLTCATIdN FOR BUILD�RTG FERMCT
CITY OF FRIDI.�.Y, Mt�i1vESOTA C� ��-���`�
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Owner's N �� Builder ��V �� 7;.3 0�_ � o
Address � � / .� -- 'L�`� Addreas
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LOCATION OF�BUILDING
Na. �� f_� Street � Part of Lot
Lot Block Addition or Subdivision
� S /
Corner Lot�Tnside Lot��stback Side-Yard .j
�EWBR ELEVAT�ON FOITNI3ATION ELEVATION
Applicant attach to this form Two Certificates of Susveq of Loti and proposed
building location drawn on these Certificatea.
DESCRIPTION OF BUTLDING
To used ast
Froat Depth � �eight ��
Sq. Ft. .� Q c� , Cu. Ft. �L� t� [�
c��� Front , G� bepth �. �HeighC
�- .
Sq. Ft. Cu. Ft.
�
Type of Con�tructi �cio��t � Eatimgted Cost ���
To be Compl�ted �
The undersigned hereby makes application for a permit for the work herein
specified, �greeing to do all c�ork in strict accordance c�rl.th the City of
Fridley Ordinances and ruliags of the Departmeat of Buildin�s, and hereby
declarea that all the facts and repreaentatione atated in this application
are true and correct. � �
DATE_ �� � �--- � � SIGNATURE �,�C��%V�+-r ,�(/
(Schedule of Fee Coats can be found on th� Reverse 9i�e).
— ct.�-` � G� / � - � �t'�' �4�'` - f7
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BUILDI�TG PERMIT FEE SCHEDULE
Section 2. The Inepector of Buildinga shall, before issuiag any permft for
the erection of any building or atructure,, or for any addition to aaq ex3et-
iag building or stsucture,..or for any. alterations or repaire to �.ny existing
buildin��or s�ructure, upon application•therefor, require the payment by the
applicant for auch permit of feee to the amount herein below aet forth and
in �he maaner herein provided to-wit: " ""
2.1. For any such pesmi.t for the erectioa of any fire-proof building, other
than a gara�e� warehouse, factory or grain elevator� or for the erecticn of
aay fire-proof addition, for sim�.lar occupancy, to any existing building
atiall be at the ra�e of $1.40 £or each one thou�and cubic feet, or fracCion
�hereof, in such cubical conCenta.
2.2. For aay such permit for �he erection of any fire-proof gerage, warehouse,
Factory o� grain elevator, or for the erection of any fire-proof addition,
for similar occupancy, to any existing building sh�ll be afi,the rate of $1.25
for each oae thousand cubic feet, classified as °1fireproof19 by Section 502 of
the Minneapolie Building Code.
FdQUSES
2,3. For any such permit for the erection of any non-Eireprooi building other
Chan a garage, warehouse, factory or graia elevator, or any aan-£ireprcof �
addition, for similar occupancy, to any existiag building - permit $1.OU for
each one thousarit� cubic •feet. ••
GARAGES �
2.4. For any such permit £or the erecCioa of any non-fireproof gara�e,
warehouae,.factory or grain elevatar, or for the erection of any non-firepra►af
additioa, for sim3lar occupancy, Co any existiag buildiag or for esch such
building or add3tion - niaety cenCs ($0.90) for each oae thoueand.cubie feet
ar �ract3on ther�of, in the cubical contents thereof with a minimv� of $4,00.
For Che purpose of computing fees for building permits, the cubical coatent�
of any.building or,additioa to a uniform hei�ht throughout by multiplying the
grouad area-covered fram a point six (6) �.nchea below the £laor liae of the
basement or cellar to the average he3ght af the upper surface or to the
aeexage height of the roof surface of the main gable of a pitched root.
2.5. For repairs or alterations to a� exietiag structuse, the fee aha11 be
aC the rate of $3.00 per each Five flundred Dollars ($500.00) or frection
thereof �.n the cost of all proposed work.
2_.6. Za no case shall the fee chargrad for eny permit as �et Forth ia
Section 2 be less than $4.00.
��� i�
. . �
August 31, 1962
TO THE BUILDING BOARD:
This is a request by Curtis Peterson to move a single
car garage, two years old, from 3618 - 3rd Street North to
5013 Sughes Avenue.
The garage conforms to all codes and ordinances.
Yours very truly,
'�
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ALLEN G. EN
Building spector
AGJ:cks
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City of Fridley, inn
BUILDIl\TG PERMIT
DB�; 3une 11, 1965
�r: Curtis S. P�tersoa �� S�
�a� 5013 Hughes Avenue N'. E. �,d�8
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N� '7�61
LOCATION OF BUILDING
N� 5013 S�t Hughes St. N. E. Part of Lot _
Lot _ Bl�k Addition or 5ub-Divisfon __._
Coraer Lot Inside Lot Setback Sideyard
Sewer IIevat4an
Foimdation IIevation
DESCRIPTION OP BUILDING
To be Used as:
FYont Depth Height Sq. F'L
Front Depth fTeight Sq. Ft
Type oP Conatruetion �, � 6 00. 00 To be Completed
Cu. FL
C�1. Fk
Rebuild Detached Garage
In consideration oP the isauanc:s to me of a perrmit to construct the building described atmve I agree to do
tha proposed work in acc�rdance with the d�scription above set forth and in comp�ce with afl provIsions of
ordinaaces oP the dLy of Frldley. �
� � ✓°, � � �
In co�afderation, of the paqment oP a fee of $ 5. 00 � p�t 9s hereby graated to
to construct the buflding or addition as de.acrlbed above. This �errmit 9s granted upon
the exPresa c�nditian that theperson to whom ft fs graated aad his agettts, employees and worlQnen, fn all work
done in, around and upon safd building, ��Ypar� thereo� shall conform in all respects to the ordinaaces oP
FridleY. B�finn�ota regarding location� construct[on, alteration, maintenance, repair aad moviag oE buildings
wio��� dty limiffi and thia permit may be revoked at any time upon violal3on of any of the provisions of eaitd '
Bufldin8 Inspector
n Nonc�
'llds psem(t doa eet eoru t6s eoestweHoe, lo�tatNlton hr �rUiee, P��+�9. 0� 6*+�8� sswu or rrmr. B� son �o sss
��9 �r to� apartl� �hs for fhas N�ms.
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APPLICATION FOR BUII.DING PERMIT
CSTY OF FRIDLEY, MINNESOTA
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LOCATION OF BUILDING
Na. Street l�art of LoC
�
L�T BL4CR ,ADDITION OI� SUBb�VISZON
Corner Lot�Inside LaT Setback Side�Yard
SEWER ELEVATI�N FOUNDATION ELEVi4�I0N �
Applicant attach to ti�is form Two Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTIOAT OF BiTT�DING
To be ed as:
�.��� ���_ .
Front 'o�o � � Dept ` geight
-- � �
Sq. Ft. Cu, Ft.
I�'ont _ Depth T_Height
� Sq. Ft . Cu. Ft . . �
Type of Coastructioa Estimated Cos (� �� d�
a
To be completed
The undersigaed ltereby makes agplication for a permie for Che work herein apecifierl,
agreeiag to do all work in strict accordance with the City of Fridley Ordinances
and rulings of the DegarCmene o£ Buildings, and herebq declares that all the facts
and representations stated in this application are true and correct.
, ^�����
(Schedule of Fee Costs can be found on the Reverse Side).
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BLIILDING PERNaT FEE SQ�ED�LE
SEGTIpP 2. The Inepec$or of Buildings shall, before isauing any germit for the
ereceion of anq buildiug or etructure, or for any addition to any esisting build-
ing or structure, or far any alterations or repairs to any ex3sting building or
atructure, ugon applicaCion therefore, require the payment bq the applicanC for
sucb permit of iees to Cbe amount hereia below set foreh and in the manaer l�erein
pravided to-�it;
2.1. For any such peranit for the erection of any fire�proof buflding,
other th�n a garage; warehouse, factory or grain elevatori or for the erection
of any fire-proof addiCiou, faa aimilar occupancy, to any existing building,
shall be at the rate of $1.40 for each on� thousaad cubic feet, or fraction
thereof, in auch cubical contenta.
2.2. For any euch permit for the erection of anq fire�proof garage,
Warehouae, factory or grain elevator, or for the erectioa of anq fire-proof
addit3on, for aimilar occupaYtcy, to any existing building shall be at th� rate
o£ $1.25 for each oae thaueand cubic feet, claseified as "fireproof" by
Section 502 of.the Minneapotia Building Code.
HOUSES
2.3. Ror any �such permit for the erection of any non•firepraof buildimg,
other than a gasage, warehouse, factosq or graiu elevator, or any non-fireproof
additian, for.similar accupancy, to anq existing build�ng - germit $1.00 fo= each
one thousand cubic feet.
GARAGES
2 4. For any auch permit for the erection of anq non-fireproof garage,
warehouse, factory or grain elevator, or for Che erection of anp non-fireproof
addition, for similar occupancy, Co any exiating building or far eac h suc h
building or addiCion - ainetq cents ($0.90) for each one thousand cubic feet
or fraction Chezeof, �.a the cubical contenta thereof with the minimum of $4.00.
For the purpose.ot computing.fees for building permite, Che cubical contents
of any building or addition to a uniform height throughout bq multiplying the
ground area covered from a point six (b) inches below the floor line of the
basemeat or cellar to the average height of the upper eurface or to the average
height of the. roof .surface of the main gable of a pitched roof.
2.5. For repairs or alteratione to an ex3stiag structure, the fee shall
be at the rate.of $3.00 per each Five Sundred Dollars ($500.00) or fractioa
thereof ia the cost of ail proposed work.
2.6. Ia aa case shall.the fee charged for any permit ae set forth in
Section 2 be less than $4.00.
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suerecr �ERMIT NO.
City of Fridley 2 � 4 7 �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I
�
i � � .
� ; L �.___ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �' 3
1 .1 �
� 1 /"'1 � CITY NALL FRIDLEv $$03Z NUMBER REV DATE PAGE Of APPROVED BY
�----� • •�� 612-571-3450 910-F15 / /
8 31 98
10B ADDRESS
5013 Hu he e
1 LEGAL LOT NO. BLOCK TRACT OR ADDiTION SEE ATTACHED
DESCR. 3 � SHEET
2 PROPERTY OWNER MAIL ADDRES$ 21P pHONE
Marl s Peterson 2-8216
3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO.
Tabor & Sons Inc. 3716 St Franci
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII ADDRESS IIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR O MOVE ❑ fiEMOVE
8 DESCRIBE WORK
Reroot house 15 S Tear-off
9 CHANOEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
�
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBINO, HEATIN(i, �PE OF CONST. OCCUPANCY (3ROUP OCCUPANCV LOAD
VENTIIATING Oi; Alp CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKtNG
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILI BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GpANTING Of A PERMIT 1251 .(2
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR IOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �}3. OO Fire SC L. ZS
PLAN CHECK FEE TOT FEE
����`�'� �i'-� -�� i e 5 9. 87
SIGNATUR OFCONTPACTORO AUTMORIZEDAGENT IDATE� EN FOP VALID E TNIS I�UR PER I_T
r
SiGNATURE OF OWNER�iF QWNER BUILDER� IOATEi B G�NSP r�aiE
NEW "
ADDN
ALTER
[' ]
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CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
������
ConstructionAddress: �p � , � �
Legal Description:
Owner Name & Address: �� �, � �.�,�`�� Tel. # ��'%,� - �� /�
Contractor: � � �, ,���� „� ,� MN LICENSE# �Q�f �� ��
Address: �°/ � � � , 5bt Tel. # '? � �J� / � o �.
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.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: �c-Q.�� � �S
Construction Type: � Estunated Cost: $ ��� %
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �.�i-9' APPLICANT: ' v'�° %��i-� Tel. # 1'� Gi— /�S a�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ��> d�
$ /. �S
$ . ��
$
$ .C��
$
$
$
$
$ �f - �° %
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 [ ]
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 pemut 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,QO1 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 $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location� of the foundation once it has it has been constructed
will be required before proceeding with the framing.
sue�eer PERM �O.
City of Fridley �
AT THE TOP OF THE TYVINS g � i L D I N� P E R M I T 2 9113
;,
.� .
COMMUNITY DEVELOPM�NT DIV. �
r � y � � PROTECTIVE INSPECTION SEC. I/,� G
� , � ���
� _ ,
� /�"1 � CITY HALL FRIOIE� SS13i NUMBEN pEV O�TE PAGE OR APPROVED BY
�""'� � �'� 612-571-3450 910-F15 3/31/99 / /
J08 ADDRESS 5013 Hughes Avenue NE
t LEGAL LOT N0. BLOCK TRACT Oii AODITION SEE ATTACMED
DESCfi. 3 6 Carlson's Summit Ma.nor South Addn SNEET
2 PROPERTY OWNER MAIL ADOR�S$ ZIP PMONE
Marlys Peterson 5013 Hu hes Ave NE 572-8216
3 CONTRACTOR MAIL ADORESS 21P PHONE LICENSE NO
Lloyds Home Im rovement Inc 1012 42 1/2 Ave NE Columbia Hei hts, MN 55421
s AHCMITECT OR DESIGNEF MAIL ADDRESS ZIP PMONE LICENSE NO.
788-5602 1798
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOiiK �
❑ NEW O ADDITION O ALTERATION l� REPAIR � MOVE O REMOVE
B DESCRIBE WORK
Replace fascia (west side); Cover 7 windows
9 CHANGE OF USE FROM TO
STIPULATIONS �
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.
TYPH OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARA7E PERMITS ARE RECLIRED fOR ELECTRICAL, PLUMBING, MEATIN(i,
VENTILATING Oii AIR CONDITIONING
THIS PERMIT BECOMES NULL ANO VOID IF WORK Oi; CONSTRUCTION 20NING SO. fT CU FT.
AUTHORIZED IS NOT COMMENCED V11ITHIN 80 DAYS, OR IF CONS7RUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF tIp DAYS A7
ANY TIME AFTEF WORK IS COMMENCED NO. DWLG. UNITS OfFSTWEET PARKING
1 HEREBY CERTIFV TMAT I HAYE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALl PROVISIONS OF LAWS VALUATION SUR7AX
ANO ORDINANCES GOVERNING THIS TVPE OF WORK WILL QE COMPLIEO
WITH WHE7MEii SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT �700 �. SO
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE Oq CANCEI TME pEqMIT fEE SAC CMARGE
PHOVISIONS OF ANY OTNER S7ATE OR LOCAL lAW REGULATING CON-
STRUCTION OR THE PERfO�fiMANCE OF CONSTRUCTION ,�.�� �26.,50 Fire � C�.%O
�'% PLAN CHECKFEE TOTAL E
�-����✓�-� ,�� 3 3/ !� Lic n S$5. 32. 70
S�GN4TUAEOFCON'AACTOAOpAUTiy �ZEOAGENT ID�E� EN P PE LI ATE 7 IS IS VOUR PERMIT
3- �'
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S�GNATU�7EO�OWNEp���OWNEpBU�LDEp� �D�fE� BLDG N5� r�ptE
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AL,TER
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ConstructionAddress:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R 1 AND R-2
BUILDING PERMIT APPLICATION
�.� �� 13
� ., -, �
Owner Name & A,ddress: �
�° � �
COIIti1CtOI: d'�� ^%� ..i � '�—
Address: i C� ��- — Ll �- '/
LIVING AREA:
GARAGE AREA:
DECS AREA:
OTHER:
�'�`��i� .-'�G'�°� !, � �
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,�, �
� ��7 J�,/"�/�/�,i�" P °�
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, , �. � ,�,; � ��
. �a _
1��: .
Effective 1/1/99
� �
� \�0
Tel.# � ��-� 7��—��t�
MN LICENSE # ��/ r' "� � ,�
Te1. # � � �� - �� � � � o �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
Length Width Height
Length Width Height
Length Width Hgt/Ground
-� ✓ ,
Sq. Ft.
Sq. Ft.
Sq. Ft.
„? ,
C,��-v�-�-�z � w�-�--�-�� e.�,z� �/' �
�
Construction Type: Estimated Cost: $ �� _
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
- � `' � �
DATE: 'S ° 3 / - `j � APPLICANT: � a%��--�-�� P -�� ��; �� �� � Tel. � � �''���a�si
�, L
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surchazge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ ��-S?�
$ r %O
$ . Sb
$
$ � UO
$
$
$
$
$ 02 '1 D
CT!'Y USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation ,
$1050 per SAC Unit
$5.00 (State Licensed Residential Contractors) , ,
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
Building
Insp�ctXons
763-572-36(}4
763-502-4977 FA�
�r�-�-fa
SI7'F. ApA�SS ��'+� !r
'�IIS APk'�CANT IS:
PRU�ERTY QWNER/
TENA�iT
SU�11�IIT A, C�PY OF
xvuR s�r,�a� Lic�sE
�vU c�r�c,�� d�
II�6SU�1'3CE
PR,UkER'rll 7,`7CP�
'�'YPE
T�k.fiCRIBE WORK B�TG
From: 6516331549 Page: 2/5 Date: 3/1 7/201 0 4:47:10 PM
�,j�jT,p�(� Pe�nitNo.��
RESID�+ N�'X,A►L t�,FFL�CA�.TI(J�MT 1�e�eived By:.
CITY OF FRIDLE�X '��,
xouR�.�a.aa,nnz�ss +^nho•�tloe C��r►���•����tufi'�s.
L7 OvVi�TER C04V'�ACffOR
N.AME' c e ('1 rt �Ir� �(��SC. �
ann�tsss:.,�{,� i�-,�.��� s A�
r�toN�:� �to 3 �Saat �.�'�'�v
��.�, Pr � c��' nc.r3 u,� o(
S�',A,� LICSNS� N .��G %a � 3 � �
n,np�ss. �'�r � s-k-.s..� ��
PHOM `~I ta `� ' - � � b��
"II+3GLE �,A1vm.Y/N�W CONSxRUCTfON
o,�wo Fa�nz.xn�w corrs'rRVC-r�c>rr
O ADA�ON ❑ GA�tAG
O �t?.SEI�N"�' k1A1iSH O ROOF
p pk�CK � SIDING
❑ SWIi�N
C1Nk.'W EIOb��NLSTRUCT14N
�
NCihts� OF 3QUARE?S
pROPOSrr.�D S�:
PROPOSEA HOGf�:
�
o v�a
O Aiumin�
O Qthor
IN�G OPEt3IDtG$rAYes DAIo
Olt FOR NEW OPEI�tiNG3-DE3C,F,�E 31Z� OF
o�vnva cz�►t��a � E1_, f�
A�LL 1+'ETS AR� BASED
�TAL JOS V,�I.U,
�esmit �e,e
Pl�ua �teview
�ire Surcharge
gutcharge
License Surcb��rge
S,AC G"taarge
4btb Cut Es�row
F,xosion Cantral
Ferk �ee
Sewer 11Qain G'I��ge
�
CjTY�nic�.t�"i $TATE�NZIP SSYe'� I
� L,4
��A�, �- �.�� � r
Cx'�Yf�`'i���►�'° n 5�'A,"�E��ZIR S5q �-
F (�� (� !0'3 '3 �- l 5 �`� , —
3xZE
saa�s
�ar�ws
CI DRAQd TII.E
O O�.
o An�noN
p R66A1�ODEL$�C�r
� � r � !Ll's�'
fl Ii0U5� ONLX
0 HOUSk.� QA�GE
0 A'�°k'ACFIED GARAGTs
❑ DETACF�D GA�AGE
r.i r� � d��Al�� lr�s���1-� �
o � a��.*�' R�tw[�bELING SLn3Mrr•
1. Exisd�u8 Flaar �1�
2. Pcaposod Aoor plan
3. Li� of structtusl man►bors to be �sed
FORN�W CONS11t.UGT[QN INCI.UT)II�TG A�CRS,
AD13I7'ft)NR � PbR S[3BIv➢;I:
OSafftt 1. Site PlafllS�avaS'showipg� �i� sttuahues
� Triu� � l�� PT�i�
� Fascta 2. '�wo �s �f aonsauctiau plsns
/�,�,�, 3. �esBY Calculatl+�o�e
�.00ATlO1�OFWIlVA�DW8�lA1�^lu�w^� FURWAVi�(�+�5-�tOVID�UVALi7�AAff)
��t�i1+'bd`'N� MAT1[�ACTUA.� 5T[CK,&�t ON WAVAOW.
�4 � N�B�R ��W9
�L `�'�ON, A�iCLUD�NG �E COST Ok' 1�AB�U� AND MA'�'ERI�►LS:
9ING TH� 1997 U.B.0 k� SG�DULE) ,�. _ P%r� �
g ���� See Hac� Page �or Fee Sch�We '
$ �5% oY Buildisg �'e�mit �•�
$ .001 times tbe tota� �ob va�uation
$ � .d405 x Pemai�t Vafu�tion Minitnuna $.50
$ -�'°� S5.4U (State I.ice�fsed �xdential Coatrsctars)
� 5�:�00 �er SAC tJnit (P1a�s to Iu�WCC �or deternninat�on)
$ �t+6�=� �tx$24°�
$ $4S0 Co�setvs�io�a Plaa� Zteview
$ Fce Acterm�fed by �a$iueerin�
$ Ageement mecessa.r�+ ( ) �ion Necessary ( )
� � � M�lu+ ehe�r.ka nav�ble t0: CI�tS* Oi Fll7ld10j' ��
I�i1S I9 AT� APP'LICATION kOR A PFRMIT �TC7T V.A3-ID UN'�L PRC�ks.9E1P
I her�bY a��Y for a buiiding permrt and x aekttow�edge that tbto infoz�ation ebove is wmplcte and s�ccurate; kb�t the wrnrk wi11 be iun
confa,�aance with tb�e orciina�aces and c�dcs o� tho Ciiiiyy of F�icIley snd wit� the Micu�ota Canstru�tion Codes; tb�at I umd�stamd this �s aat a
permit but anly �n e�lic�uion far a pe�mit eaad work xs not to start without a p�nodt ou s�te; that the work wla be iia a�or�ce wi.th the
a�,Pi°"'ed plsn in �e case o£ all waz�c whicb� rec�uires �nv �ad appmva� of plams.
sitr'l�tA.7rURB ok' APPi,xc � PR�7' AiAMO�]'Y1Cd i s+•'�.�� �`�- nA,'1l� �-���' �a
Building
Inspections
763-572-3604
763-502-4977 FAX
i � ,Z .
SITE ADDRESS ��i'
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERITFICATE OF
INSURANCE
PERNIIT TYPE
TYPE OF WORK:
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 7-1-2010
� OWNER
STATE LICENSE
STATE BOND #
YOUR E-MAIL ADDRESS
OCONTRACTOR
Pernut No�10 ° � \� °�
Received By: ��
Date Rec'd: � 3 `i�
EXP DATE
EXP DATE
ADDRESS: CITY STATE ZIP
PHONE
�1 SINGLE FAMILY
❑ NEw
DETAILED DESCRIPTION OF WORK
0 TWO FAMILY
�REPLACEMENT
FAX
❑ TOWNHOUSE
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER OF EACH BELOVI�. MINIMUM FEE
$35.50.
_ BATH SIIVK/LAV FL�R DRAINS SHOWER �WATER PIPING
_B�►7'fiTUB GAS PIPING (NEED CITY LIC) _ SWIMMING POOL _ Wp.TERSOFTNER ($35)
_ CLOTf�S WASHER _ KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15}
—1����� _ LAUNDRY TRAY _WATER HEATER ($35) FOR IltRIGATION
_ WATER METER OTHER
THIS IS AN APPLICATION FOR A PERMIT NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing permit and I acknowledge that the information above is complete and accurate; that the work will be in
conforniance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an applicaxion for a permit and work is not to start without a pemut on site; that the work will be in accordance
with the approved plan in e ca�se 9f work which requires review and ap r al of lans. o ' /-�
SIGNATURE OF APPLICANT� e,l p e�,.,,,,n �/� PRINT NAME���.�1���DATE �� I� � I V
APPROVALINSPECTORSSI A
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604 �
FAX: 763-502-4977