AF - 46390BUILDTNG PERMIT
Village of Fridley, 1VIin.n. N° 217 3
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Date �:����'�� �n . . . . . :. . . . . .. . . . . . . .. . . . . . . .
Owner ��'., � � t:�. ��.� �':l.�: }'. . . . . . . . Builder . . ¢ �:�.L'�:�:`� . . . . . . . . . . . . . . . . . . . . . . . . .
Address ��.�i.�..����`,+�-:#� .............. Addness .........................................
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LOCATION OF BUILDING
No. . . . . .''�� .`:��' �� Street . . :����1r� . . . . . . . . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
Lot . . . '� � . . . . . Block . . . �< . . . . . . . . . . Addition or Sub-Division . ��: ���',,,�; �.�;�'d,l".�, ,G�, , ,.���qt�yQ.iPI�
�.... �fi
Corner Lot . . . . . . . . . . . . Inside Lot . . . �"'`�. . . . Setback . . . . . . . . . . . . Sideyard . . �. .�'�. �!'�+�.'*. . , . , , . , , , ,
DES�CR[PTION OF BUILDING
To be Used as:
,,�':'�:G�::''.�;,�'�:...... Froat .,�.�... Depth .''�a`'�... Height �':��+f... Sq. Ft. ........ Cu. Ft. ........
,,�.
. .... .. .. .. .. .. .. .. . Front . .. .. .. . Depth . .. . . . . . Height . . . .. .. .. Sq. Ft. . .. .. .. . Cu. F't, . . . . . .. .
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Type of Construction �. :1:�:'�:t�,,.� Est Cost ... .,��.�''� ....... To be Completed .�.�f.7,�,/?��':�f:.+,��'
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In consideration bf the issuance to me of a perrnit to construct the building described above, I agree to do
the proposed work in aceordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
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cons' eration of the payment of a fee of $. ..d�. .., perniit is hereby granted to .��!.I.�': �L;��. .�. .
�......... to constriict the building Or ad dition as described above. This perxnit i�s granted upon
. e express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, axound and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, NGnnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any tlme upon violation of any of the provisions of said
ordinances, a;
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: •�•�;+�,.�„� Building Inspector
NOTICE:
Thts permit does not cover the constructlon, installatlon or alteration for wiring, plumbing, gas heating,
sawer or water. Be sure to see the Building Inspector for separate perm(ts for these items.
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City of Fridley, Mirm..
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PEI�CNIIT
Date: July 5, 1972
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p��; e bert � Hecke g�� Sy1e-Rite Buildera
,Adaress _ 508/-,� H�hea Avenue Add�.ess 4517 Minnetonka Boulevard
LOCATIOfV OF BUILDING
No. __._.�Q8.4.._.._... Street —�agh,�s A�nLe N.E_ Part of Lot
Lot __...__.8...._�_ Block _.__ 7 __...___ Addition or Sub-Division .�a7Clson's Summit Ma.noa:. South
Corner Lot ...__.._ Inside Lot x Setback Sideyard
Sewer Elevation ,____. .� Fowndation IIevation .—__.
DESCRIPTION OF BUILDING
To be Used as:
ReRi�P N�11Q _ Front Depth Height �. Ft Cu. Ft
�._..__ Front ._ Depth Hei�t Sq. F't. Cu. Ft.
2'ype of Construction A1�in� F�t, Cost .._.�1=250. 0.�_ To be Completed J1a� 211�_.�?.?
Stipulations: Prov�de drip caps over windows and caulk enda of aiding at doors a,nd
windows.
In consideration of the issuance to me of a permit to consiauct the bui2ding Sescr3bed above I agTee to do
'�he proposed work in accordance with the description above set fo and in compliance 'th provYaionB o!
Ord�anc�es of the city of Fridley.
.75 State Surcharge
. r
In consideration of the payment oP a fee of ��...Q.I� , permit is hereby granted to $tvle-Ri�e Buildara
to constrvet the building or addition as described above. This permit 3s granted upon
the express coadition that the person to whom it is granted and his agents, employees and worl�en, �1n, all work
done ui, around and upon said building, or any part thereof, shall conform in all respects •to the ort7inanCes oP
l�'ridley, Minnesota regarding loca.tion, construction, alteration, maintenance, regair and moving of buildingB
vyithin the city limits and this permit may be revoked at any time upon viola.tion of any of the provis�ttans oi said
o7rdinances. -
`E���� Bt�t1�73ng Ins�ctor
CLARENCE BELISLE
NOTICE: -
,,,�.� 7his permft doas aot �ove� fhe eoaafrueHon, inatallation fo� wirine, plumbine. gas heatiu8, sewer or wafer. Be sure 40 �s
f6e Bufldfng Inspeetar for aeparate permits for fheae items.
�
APPLICATION FOR �ESIDENTIA�, ALTE�.ATI�N,
OR AllllITiON BUILD�NG P��NjIT
CI�Y OF FRIDLEY, MINN�SOTA
aw�t�'s �:�� ���T �i�,� l�e � ��E BUILDER: ���� - D�� �'� �L ��.s
s � �.�. ,
e.� rfS/ � r��-�-r� ,� z �l�
�,n��ss : �� �'�� �f � s e� nn�s :
r�o: , �"� ° � / s�: ��° �/�`-�s �° �'
LO'1': BLOCK: � ADDITIONs C�Q �6�'� S�%'hM,'% S o
..,�., �
CORNER LaT: INSIDE LOT: C� SETBACR: SIDEX�RDt
�
Applicant attach to this form 1�o Certificatea of Survey of Lot and pxo�r��e,d
buildiag location drawn oa these Certificates.
HESCRIPTION OF BUILDING
To Be IIsed As:
/� ,
U� �s� �� Front : Depth : Height •
Square Feet: Cubic Feet:
' Front: Depth• Height:
Square Feet; Cubic Feet:
�pe of Construction: /�'LLV�, si��'�,-� Estimated Coet:_$ f 2-�°� °v
i r ��� sel9laa
To Be Campleted: c�vC`/ Zv %�� Z
The uadereigaed herebq makes applicatioa fos a pes�it for ti�e .wQ�c1� ��c��
specif�ed, agreeiag to do all work in attict accordance witb the G�L�i g�
F�'�,d�ey O�dinances and sulings of the Depar4ment of Buildinge, and b�e�e�r
de+claxes that all the facte and representatione atated in thie app�l,����,�
a�e true and correct.
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• ��� ;tr" �, �+° :� � .,�, � :�.,. „ �
(Se� Aever�e Side For Add tioaal Iafosmation.j ��-, ,
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$UILDING PERMIT FEE SCHEDULE
S�C�ION 2. The InspecCor of Buildings shall, before issuing permita fox the
exection of any building or structure, or for aay addition �o any ex�st�n�
building or structure, or for any alteration or repairs to any existing
bu�lding ox structure, upon application therefore, require the payme�� b� t,h�
applicaat for such permit of fees to the amouat herein below set forth �id in
the m�aaner herein prwided to-wit:
UN�'ORM BUILDING CODE: Type 1, 2 bc 4-$2.15 for each one thousand cubi.c
�p��, ox fraction thereof, in such cubical conteats. Type 3� 5-$�.$5 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
F'ar the purpose of computiag fees for building permite, the cubical contents
o£ aay buildi�g or additian, ia determined by multiplying the ground area
covered from a.point six �6) inches below the floor line of the basement
or the cellar to the �vessge heights of the upper aurface or to the average�
height of the roof surface of the main gable of a pitched roof.
�'or repaira or alterations to an exieting structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
tlie cost of all proposed work.
T.�►, no ease shall the fee charged for any pesmit as aet forth ia Sectip� 2 be
lese than $5.00.
VFRIFICATION OF FOUNDATION
�TpT�; Permits for eonstruction will be isaued a mini�um of 24 hours fxa�p �Y►�
�i,me of applicatioa, to allow for proper review of the proposed etructuxe and
o� the conatruction site.
A Ce'�tified Survey of the lot, ahowiag the location of the foundat�,A�� A��� ��
1�a� been constructed, will be required befo�e proceedinpt with the f�ca�,.tng.
CERTIFICATE OF OCCUPANCY
Applieatioa for a Certificate.of Occupaacy shall be made tea (10) days �►�CiAL
t(� the uae or occupancy of any structure for which a buildiag permit �a� k��
issued; and said structure shall not be used or oceupied until a Certifi���
o� Occupancy has been isaued.
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SUBJECT P
City oi Fridley � :� � �� �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
� � RECEIPT NO.
� ; y _.____ COMMUNITY DEVELOPMENT OIV �
r � � PROTECTIVE INSPECTION SEC. ��
I �
i
t � ����1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPROVED BY
�"""�" ,'' 612-571-3450 9�0-Ft5 2/12/96 / /
JOB ADDRESS
5084 Hu hes Avenue NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 8 7 Carlson� s Summit Manor South Addn SHEET
2 PROPEHTY OWNER MAIL ADDRESS 21P PHONE
Duwa e Sheila Petterson 5084 Hu hes Avenue NE 572-0523
3 CON7RACTOR MAILADDRESS 21P PHONE UCENSE NO.
Master Remodelin 32 A e 932-9311 20012916
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE LICENSE NO
5 ENGINEER MAILADDRESS ZiP PHONE LICENSENO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION p� ALTERATION ❑ REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Install windows• re lace atio door
9 CHANGEOFUSEfROM TO
STIPULATIONS
Replacement windows in bedrooms must meet the State Egress Code.
Install smoke detectors as per the State Building Code.
SEPARATE PERMiTS ARE REOUIRED FOR EIECTRICAL. 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 Of; ABANDONED FOR A PERIOD OF 120 �AYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEHEBY CERTIFV THAT I HAVE FiEAD AND EXAMINED THIS APPLICATION 1 STAILS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATFON SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIfIED HEREIN OR NOT. THE GRANTING OF A PERMIT �4'fOOO �Z.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OT R STATE OR LOCAL LAW REGULATING CON- $87 � 2S Fire SC ��F . OO
ST U T E ORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTAIFEE
License SC $5.00 $98.25
SiGrv uaE F N'RACTOAORAUTHOR12EDAGENT iDnTE� WHEN PNOP LY VA�IDATED THIS IS YOUR PERMIT
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S NATUR OWNEF1uFOWNERBUILDEFii IDATEi DG INSP qaTE
P
NEW
ADDN
ALTER
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Construcdon Address: �
Legal Description:
Owner Name & Address:
Contra,ctor:
Address: � � / � i �
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
J� ` ,�
C� �`y .� /�-/L %,
Effecdve 8/1/95
���a
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Tel. # � 7Z �'Z �
MN LICENSE # �°� � � 5/-�
Tel. # �� �j/
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width
Length Width
Length Width
/ � s�-_ ����� ' � � �.��
,1'�f���C�e�C�Gn �,U,�,��)�c-�s
Coraer Lot [] Inside Lot [] Ft. Yd Setback
Type of Construction:
Approx. Completion Date:
Driveway Curb Cut Width NeeciPrt�
DATE: /�
Peimit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�
Height Sq. Ft.
Height Sq. Ft.
Hgt/Ground Sq. Ft.
�
�
Side Yard Setbacks
Estima.ted cosc: $ ��c�
, —
(Cost on Back) .
Ft + h Ft = Ft Y� �
_$
Tel. #--`,�'��"�
$ e`_`'%. .� S Fee Schedule on Reverse Side
$ �/ C► � .(l01 of Permit Valuation (1/lOth%)
$ ~ . C1c'� $.501$1,000 Valuadon
$ $850 per SAC Unit
$ �� �� �' $5.00 (State Licensed Residential Coatra.ctors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Review
$ Fee Determined by Emgineering
$ Agreement Necessary [ ] Not Necessary [ ]
�
$ i �� �?S
: 2. _
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sue�eer PERMIT
City of Fridley
AT THE TOP OF TME TWINS g � f L D I N G P E R M I T ����
' � RE .
� ; L ___�� COMMUNITY OEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC �� !3
1 . ,
i.-__ A �'��,•� CITY HALL FRIOLEY SS�3P NUMBER NEV DAT6 VAGE Oi APPIIOVED 8Y
L �� 612-571-3460 910-F15 2/2/99 � �
JOB ADORESS 5084 Hughes Avenue NE
1 LEGAL �OT NO. BLOCK TRACT Ofi ADDITION SEE ATTACMED
oesca. 8 7 Carlson's Summit Manor South Addn SNEET
2 PROPERTY OWNER MAIL ADpR�S$ ZIP PNONE
Kenneth Petterson 5084 Hughes Avenue NE 572-0523
3 CONTRACTOR MAII ADORESS ZIP PNONE LICENSE NO
Ma.ster Remodeling Inc 32 10 Ave S, Hopkins, MN 55343 932-9311 20012916
4 ARCMITECT OR DESIGNER MA1L AODRESS ZIP PHONE UCENSE NO,
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW p ADDITION O ALTERATION C� REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (20 Sq) Tear-off; Reside
9 CHANGE OF USE FiiOM TO
STIPULATIONS '
Underlayment must comply with the State Building Code. Call for building
wrap inspection before covering.
SEPARA7E PEFiMITS ARE REOUIRED FOFi ELECTRICAL, PLUMBING, HEATING, TYPH OF CONST. pCCUPANCY GROUP OCCUPANCY LOAD
VENTI�ATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK Oi; CONSTRUCTION IONING Sa. fT CU fT.
AUTHORI2ED IS NOT COMMENCED Vj!ITMIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PER100 OF 120 DAYS A7
ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OffSTpEET PARKING
I MEFEBY CERTIFY THAT I MAVE REAO ANO EXAMINEO TMIS APPLICA710N I. STAL�S GARAGES
AND KNOW THE SAME TO BE THUE AND CORFiECT. ALl PRQVISIONS Of LAWS VAI.UATION SURTAX
AND ORDINANCES GOVERNING TMIS TYPE OF WQRK WILL QE COMPUED
WITH WHE7HER SPEC�FIED HEiiEIN OR NOT. THE GRAN7ING OF A PERMIT �C'), 914 $3. �FS
DOES NOT PRESUME TO GIVE AUTMOFI7Y TO VIOLATE OR CANCEL TME pEqMIT fEE SAC CMARGE
PqOVIS10NS OF ANV OTHER STATE OR LOCAI LAW REGULATING CON-
STRUCTION OF THE PERfOqMANCE Of CONSTRUC710N �12�►.]rj Fir .SCi �6.91
P�AN CMECK FEE TOTA EE
Lic C $5, 40.11
-_ SiGNATUAEOFCON'RACTOAOAAUTMOA�IEDAGENT 1DAT�t NEN R V VALIO D I� IS VO=�ERMIT �
I
S�GNOTUAE O� OWNEA��F pWNEA BWlOEA� ib�rE� B G�NS� � � qpTE
NEW
ADDN
ALTER
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Effective 1/1/97
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUII,DING PERNIIT APPLICATION
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ConstructionAddress: �O � � �u /� � �l/'E /✓ � � �
Legal Description:
Owner Name & Address: en� �' � S° � Sr�s�e a-s c��ove Tel. �i v�% — 0,��, '�
Contractor: _ ��A�t� Sou�h MN I.ICENSE �t
Address:
Attach to t�is appTic�i�'o�,���CCertificate of Survey of the
lot, with the proposed const�uction drawn on it to scale.
DESCRIPTION OF Il�ZPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE �REA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: _ � _ � ,,,, _
. �s , � a�� �o ,.� �,� ���
� ���� �� �
Construction Type: e,,/ , ��a.�-� o0 0� Estimated Cost: $
S�'vi� �ie�/�o4f= ��� �' !OZw �'�Fee Schedule on Back)
Driveway Curb C�t Width Needed: Ft. + 6 Ft =_� Ft x$ =$ .
DATE: f �6 �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATION .
$ 1 � TJr
$ � 9/
$ �
$
$ ,� l�d
$
$
$
$
$
/�./�
CITY USE O�TLY
Fee Schedule on Reverse Side
.001 of Permat Valuation (1/lOth%)
Tel. # ��� ���'
$.50/$1,000 Valuation
$950 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineeriag
Agreement Necessary [ ]. Not Necessary [ ]
-._�
� SuBJEtT .. . � . � PE
City of Fridley 31117
AT THE TOP OF THE TWINS � � I L D i N G P E R M i T �
� � o.
� ; y__��__ COMMUNITY DEVEIOPMENT OIV. o���
r � � PROTECTIVE INSPECTION SEC. a T
i.---� �"'�,� CITY NALL fFiIOIEV 95�32 NuuBER pEV D�TE PAGE of �vvROvED Br
L 612-571-3450 gt0-Ft5 6/28/00 / /
�oe nopaess ,084 Hu hes Avenue NE �
t IEGAI LOT NO. BLOCK TRACT OR ADOITION SEE ATTACMEO
oescR. g � Carlson's Sumtnit Manor South Addition SHEET
2 PROPERTY OWNER MAIL ADORES$ ZIP PHONE
LuWa e 0. $ Sheila A. Petterson 5084 Hu hes Ave. NE Fridle , MN 55432 572-0523
3 CONTRACTOR MAIL ADORESS YIP PMONE LICENSE NO
L�Wayne 0. Petterson
d AFiCHITECT OR DESIGNER MAIL AODi;ESS ZIP PHONE LICENSE NO.
5 ENGINEER MAiI ADDRESS ZIP PMONE LICENSE NO
e USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION �l ALTERATION � REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
12' x 14 Wood Deck
9 CHANGEOFUSEFROM TO
STIPULATIONS
For stipulations, see attached plans.
TYPEOFCONST. OCCUPANCYGROUP OCCUPANCVLOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMB�NG. HEAT�NG.
VENTILATING Ofi AIR CONDITIONING-
TMIS PEFMIT BECOMES NULL AND VOID IF WORK Oq CONSTRUCTION 20NING SC. fT CU FT.
AUTHORIZED IS NOT COMMENCED Y�1ITHIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONEO FOR A PERIOO OF 120 OAYS AT
ANV 71ME AFTER WORK IS COMMENCED. NO. OWIG. UNITS OfFSTREET PARKING
I MEREBY CERTIFV 7MAT I MAVE READ AND EXAMINEO THIS APPLICATION ,' S7AlLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PqOVISIONS OR LAWS VALUATION SURTAX
AND OROINANCES GOVERNING THIS TYPE OF WOFK WILL BE COMPLIED $1,579.ZO �.%H
WITM WHETHEA SPECIFIED MEREIN OF NOT. THE GRANTING OF A pERM1T
DOES NOT PRESUME TO GIVE AUTMORI7Y TO VIOLATE Ofi CANCEL TNE pERM17 FEE SAC CNARGE
PROVISIONS OF ANY OTNER STATE OR �OCAL LAW REGULAIING CON• �S%.OS 1T@ SC ��..5%
STRUC ON OR TME PERFOi;MANCE OF CONSTFUCTION
PLAN CMECK FEE TOTAL FEE
Lf Lc) � $59.40
S�GN4tu OF CON'AACTOA Op AUTMOp�ZEO AGENT �OATE� EN PqOPE LIDAT THIS IS Y UR PEAMIT
f ���_ • F_
$�GNATUAE O� OWNEp��F pWNEp BU4DEA� �D iE� BL �NSP � f��TE
N� Il
ADDN [ ]
ALTER [ j
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�P � ,r�7
Effective 1/1/2000
(763) 572-3604 Bldg Insp
Construction Address: _ J� � �'� ��% �' /��S � (J� • �'
Legal Description: L°+ 8 %� �� u� 7 -�gR � s o,nJ s�',� n-� /yj ,'� �Q .
Owner Name & Address: �-.1..� t.e�.� yl�i E �'/�EiL� ,q 1��; T 7�0�1. #���-�5� 3
Contractor. "� MN UCENSE #
Address: " Tel. # —
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq
Length � `� '
� z HgUGround ��� "
� lC�� �a
�
�/ '�
�U � �
• �.h�/��-)" � � � �� � �� � � ,
Construction Type. � � Estimated Cost: $ �°
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$_ _$
DATE: APPLICANT: Tel. #
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in applicatlon
Permit Fee $ �7, �s Fee Schedule on Reverse Side
Fire Surcharge $ /� S7 .001 of Permit Valuation (1/10th%)
State Surcharge $ a � $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
� $1100 per SAC Unit
� ,%$5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation Plan Reviev�
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$ _ 9, ��
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STIPULATIONS:
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BUII.,DING PERNIIT FEE SCHEDULE
The Chief Building Official shall, lxfore 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 tawit:
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,�1 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEEB
$23.50
$23.50 for first $500 plus $3 .OS for each additional $100 or
&action thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,0(?0
or fraction thereof, to and including $25,000
$391.25 for first $25,Q00 plus $10.10 for each additional $1,000
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,�0
$993.75 for first $100,000 plus $5.60 for each additional
$1,0� or fraction thereof, to and including $500,000
$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 $1,000,0(� plus $3.15 for each additional
$1,000 or fraction thereof .
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a 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. New Houses Onlv
JUN-26-2000 10:59 AM WINGER
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The Home Depot #2802, 5650 MAIN ST, NE, FRIDLEY, N�T 55432, (612
Sat Jun 17 17:36:02 2000
File saved as: f:�dn\decks�6090D261.DEK
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The Home Depot #2802, 5650 MAIN ST, NE, FRIDLEY, N�T 55432, (612
$at Jun 17 17:36:02 2000
The materials in this deck will cost $1274.52
File saved as: f:�dn�decks\6090D261.DEK
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THE BELAW MUST BE FlLLED IN fN!°IEN I�E�'l.AC1NG FUEL �URiUlPa� ARRLfA�UCES Q►R THE
APPLICATIQN WILL, B� FtETURNED
iCOMMON VEN7��R�' CCII�m� CTAR AR� [`„pMBL1�T1[]R ��IR ��IFIGATitI�
When , the undersign�d hereb�r verifi�s t[�at t�
venting h�s b�n exemin�c! and is fre� fram n,st, a1e��ot�tian, ob�tructPons,
�nd Is s��ly support�d �etd fiirestopped where r�qulred. Yes (} IVo ()
The v�rrt�ng �tem is plastldPl/C and meets all curront codes �nci mana��chs��r
�ecfications 1ncludPng sizin�, len�th� number �f elbow� arrd term(nstlan. Yes () No ()
The �nclerslgned also verfie� that th� ce�pE�r.�m�nfi wtiit i� a li�ted �ssembly
and m�et� �he cur�ent cades snd man�fac�urer�� spec�ic�ons. Tf'ii� doe�
include AGA-OAMA C�g�ry I C�nntr�i Fum�ca Ve�nting Tabl�s �or fen
assi�#ed �nd natura! drsft a�ppan�a.
The is sized and in�ttatlRed t� m+s�t th� c�un�,nt c.�des
�nd man�facturer'� sp�c�ications.
WFtBn fB�UU'Bd 'td insi�fl a n�w Qemh�.�1en 9ir it 1M71 be s�ed etld �PI�Qi!@d
to meet the aur�nfi cod�s and manuPadurer�s specifications.
Whk�n � ine � n�w v�nt�np�,�t�m, � U11d8�ip�ted hereby V�i'11�� th�E
it i� a li�trad as�embty and me�t� iile c�ent codes �nd m�n�ctur�r's
sp��i�#iot�s. This does include AGA Q�►MA �'�gory I Cer�tr�! F�unace
V�nting Tab[es for fan as�isted �nd natue�l dr�it a�opli�nc�,
i� the camman v�nt �nd ver� conn�r� siz�d and ins�ll�d carr�ctl� a�er
an appli�nce h�s been remove�i from fih� camman v�nt � v�nted
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A�plte�nce #3 Verrt Cortt��t[ir Height f! L�rigth ft Di�met�r,_,in Typ� �
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Building
Inspections
763-572-3604
� I =��-o4t--
SITE ADDRESS �� � �
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
❑ OWNER
�8
STATE LICENSE #
CITY OF FRIDLEY
__YO_LJR E-MAIi, ADDRESS
�� �
f�CONTRACTOR
eo— 't.�'e/LPj
`� �-Cv�h �� �'G. crrY �
°7,°� - m5~a,�
RY H�YE REYODELfNt3� INC.
IT�O �AIw� � n� EXP DATE
PHONE
INGLE FAMII.,Y/NE
❑ TWO FAIviILY/NEW
❑ BASEMENT FINISH
❑ DECK
DESCRIBE WORK BEING
SIZE OF IlVIPROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPOSED S1ZE:
PROPOSED I�IGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS � �
IN EXISTAVG OPENINGS �'Yes ❑No
OR FOR NEW OPENING3-DESCRIBE SIZE OF
OPENING CHANGES &
FAX
O GARAGE/SHED
❑ ROOF
❑ SIDING
❑ SWA�IlVIDVG P(�OL
❑ ADDITION
❑ REMODELING
LENGTH
o xousE ornY
❑ HOUSE & GARAGE
❑ ATTACI�D GARAGE
❑ DETACHED GARAGE
�Soffit
❑ Trim
❑ Fascia
LOCA I�V��WS
NUMBER OF WINl
■ � 7\I�. i/I
■•
�� f�
Pernut No.:
Received By: /'�:
Date Rec'd: �` �o � �
HEIGHT
.�.��� r
ATE ZIP,
BASEMENT REMODELWG SUBMff:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMTf:
1. Site P1an/Survey showing the ezisting structures
and proposed project
2. Two sets of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCAEDULE)
TOTAL JOB VALUATION $��d� OCCUPANCY TYPE
Permit Fee
Plan Review
Surcharge
Fire Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ %. �.S
$ �.sc�
$ <S �G'�
$
$
$
$
See Back Page for Fee Schedule
65% of Building Permit Fee
(.0005) times the total job valuation — Minimum $.50
.001 x Permit Valuation (1/10%)
$5.00 (State Licensed Residential Contractors)
$1450 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plaa Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building pertnit and I aclaiowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and cod of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application f a pe t and ork is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work w' e e4�evi and approval of plans.
SIGNATURE OF APPLICANT G�' PRINT NAME �`d��'^��'✓��w�ATE �/''�y�
.�
Page 2- Building Residential Application
BUII..DING PERNIIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or siructure, or for any alteration or repair
to any existing building or structure, upon application therefore, require the payinent by the
applicar�t for such pernut of fees to the amount herein below set forth and in the manner herein
provided to-wit:
VERIFICATION OF FOUNDATION
Pemuts for construction will be issued a minimum of 24 hours from the time of application to
a11ow 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
Fax: 763-502-4977
Building
° Inspections
763-572-3604
BUILDING ��6 --
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE v^ '�'— � S° YOUR E-MAIL ADDRESS
SITE ADDRESS SD 7� �/ `(�c� �(�e5 � � /`� �
TH1S APPLICANT IS: ❑ OWNER P�CONTRACTOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STA'I'E LICENSE
WITH APPLICATTON
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
NAME:
0"'`%
,,
Received By: `-
_�
��,"��- - ��
Date Rec',�: ;;/' , - � _
ADDRESS: S��cp�I �'���1L'S �C CITY � %���'� STATE/'!�LIP�_�3
PHONE: %C9 � S % �- ^D $ OZ 3 —
STATE LICENSE �_ � � I �� �� ���TE
ADDRESS:
��
PHONE rn� � �_ ww�.
WGLE FAMILY/NEW CON S�
� TWO FAMILY/NEW CONS7RUCTION ST�
� ADDTTION O GARAGE/SHED
BASEMENT FINISH O ROOF
p ", ❑ SIDING
�,IYj1 %Bt!/y�/y O SWIMMING POOL
O NEW � ADDITION
p MADJTENANCE/REPAIR �i REMODELING
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
NUMBER OF SQUARES
GARAGES
PROPOSED SIZE:
PROPOSED HE]GH7':
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
�
��'INDOVI'S
IN EXIS'TING OPENINGS �Yes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENRJG CHANGES &
TYPE OF WINDOW TO BE 1NSTALLED
�
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ A'ITACHED GARAGE
O DE'fACHED GARAGE
�Soffit
❑ Trim
❑ Fascia
LOCATION OF WINDOWS
NUMBER OF
CITY STATE_ZIP
❑ WINDOWS iq�/t.e,�. ��(,��. Np-�ci
O DRAIN TILE " �� �
❑ OTHER
HEIGHT
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2, Proposed floor plen
3. List of swctural members to be used
Ft.
FORNEW CONSTRUCTION INCLUDING DECK:
ADDITIONS. & PORCHES SUBMIT:
1. Site Plar✓Survey showing the ezisting stn
and proposed project.
2. ?wo seu of conswction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ I I, O m� OCCUPANCY TYPE
Permit Fee $ � �S See Back Page for Fee Schedule
Plan Review $ /� �.. / 65% of Building Permit Fee
Swcharge $ �,$"'o (.0005) times the total job valuation — Minimum $.50
Fire Swcharge $ /� p� .001 x Permit Valuation (1/10%)
License Surcharge $ �ac, $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
Cwb Cut Escrow $ ft+ 6 ft= ft x$20 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement necessary () Non Necessary ()
Total Due $ � �.� Make checks payable to: City of Fridley A[tach Stipulations
THIS IS AN APPLICATION FOR A PERMJT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will
conformance with the ordinances codes the City of Frid]ey and with the Minnesota Construction Codes; that I understand this is
Uermit but only an application r rmi d work is not to start without a permit; that the work will be in accordance with•the app�
plan in the case of all ���ork w ir pproval of plans. /� /%'v����(/� �� �/"d�o
SIGNA7'URE OF APPLICANT PWNT NAME ��� ATE
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Building PLUMBING Permit No.: � -��C,�F� _
�
Inspections R�SIDEN�IAL �PLICAT][ON Received By: �
763-572-3604 Date Rec'd: � � �a �
CITY OF FRIDLEY
DATE �' � c� YOUR E-MAIL ADDRESS
SITE ADDRESS �
THIS APPLICAI�T1' IS: 0 WNER �CONTRACTOR
PROPERTY Np,ME: - �5 ,�
OWNER/ twnxFSS: r��� °�'�'yL- u%�-� ' 1/�i crrSr ��/��� � STATi�, z����'�
TENANT -°� �
PHONE: ��' � ° � � �' Zl �� e�
CONTRACTOR NAtti[E; .�C % ,�%�,A-. �CC�fI ��' G
STATE LICENSE # `7�c7 / I J'��i EXP DAT'E � 2-��
SUBMIT A COPY OF T- '
YOUR STATE aDDRESS: � h` i � fi��.✓✓a� (� �� CTfY /e/Q/✓c L.L�/4: �'� STA IP�,n ,�c��}
LICENSE WTI'H PHONE %�:? �/ 12 `l�"'� s; FAX •
APPLICATION �-
PERNIIT TYPE �GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: �w ❑ �P�'��
DETAILED DESCRIPTION OF WORK �� � v o8 rh � S� � �" �s�L�'� �LY C��
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to 5500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (Thi.s should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost beiween $300 to $500 = cost of labor , �i' G' x.QS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT Wi�RE NOTED. FlXT[JRES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
i0'� BATH SINK/LAV / FLOOR DRAWS I SHOWER WATER PIPING
BATHTUB GAS PIPING �:o crrrLrc�rvs� SWIlv1M1NG POOL WATER SOFTNER ($35)
_ CLOTf�S WASHER KITCHEN SINK � WATER CLOSET BACKFLOW PREV. ($15)
_ DISHWASHER ,� LAUNDRY TRAY _WATER HEATER ($35) FOR IRRIGATION
_ WATER METER _ OTI�R
, . . ..
��,
...'[.1 ,
1'S`= ..,.�,, ��. ,.. . ,. _�:._,.� „���.,. < t�n.�..',� ...,,. � � :. . . .. . ... . 4 � �.,. ''b �A�, u«`�?�:� ;�''�z i��,w.s, +t,.;�,., ��,� .�^� �� t :. 4 .. '= i, r �#
Permit Fee $ �'�. �G� Number of fixtures @ $10.00� x $10.00 = $
Surch e Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ . � �� Number of fixtures @ $35.00 x $35.00 = $
- State Surchazge = $ .50
Tota1= $
- THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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 Consiruction Codes; that I understand this is
not a permit but only an applicatio for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all rk whi h requir s review and approval of plans.
SIGNATURE OF APPLICANT //►+J=�[r' � PRINT N !- ,/�/�r�/��I �%� DATE� J�'v �'�
:_�� �r. r''' ,: t � . ` `.. �' �� � a° ,.� � �;;� � , , .
�� � � � � �
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
�.