AF - 46392���1
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City of Fridley, Minn.
BUILDING PERNIIT N° 3 8 0 0
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Owner ....................................... Builder �:'! . .r�.... ..,.�c ....
Addr�s ......... �F��
............................. Addr�s .............................................
LO�ATIO�lV OF BUILDING
No. �a. �.��. . 5treet . . . . ?� . . . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . ,/
Lot ....�...... Brock ..� .............�. Addition or Sub-DivIsi ����:�ryj . . ..•�!� /"�'
°n •�i
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ...........................
DESCRIPTION O� BU[LDING
To be sed as:
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!.'�. . . F`rout . �4� . . . Depth ��.?i .°.� Height .�Q. : � Sq. Ft. ��,�, :�. Cu. Ft °����
.................... I+'roirt ........ Depth ........ Hdght ........ Sq. F� ........ •
/ � (.is. Fk ... ....
Zj►pe of Construction . .. . . .. . . . . .. . . . .. . Est. Cost. ..���. l�q�. �:�. . . To be Completed . .. .. .. . .. . .
In consideration of 'rhe �tss�uance to me og a permit to const�uct tlie building desribed above, I agree to do
the proposed work in accordance wit3i the description above set forth and fn compliance with all pr��� op
ordinances of the dty of Fridley. ,
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In consideration of the payment of a fee of $. ./. ,,�.°�, .a,°, ,, permit 3s hereby granted to ...
................
......................... to construct the bwtlding or addition as described above. This permit 3s granted upon
the express condition that the person to whom it ia gi�,nted and }�is agents, empl�yees and worl�ea, in all work
done in, around and upon said bv3lding, or a�► part thereop, sha11 cbngorm in a11 �p� to the ordinanc;es of
FridleY, Minnesota �segarding location, construction, alteration,�maintenance, repair and moving of buildiugs with-
fn the city limits and this permit may be revoked at a�y time upon violation of any of th� prnvis�tons of said
ordinances.
F�,�ii=�M�i��° � � ° � : . - ..
NOTICE:
Thls permlt does not cover the constructlon, Inatalla#lon o� altaratton fo� wlring, plumbing, gas heating,
eewe� o� watar. Be su�e to see the Bu11dInB Inspeotor for separete permits fo� theso Itema
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Caty of Fridley, �nn
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: _ June 10, 1971
Owaer: ames Bodick g�� The Ppol Center
Address _...S.Q$�..�.HLtgh -�Av -t�yl.�' N.F- ____ Addre3s 770 •�t Rive,- Road N_F_
LOCAYION OF BUILDING
No. 5085____. S�t Hughes Avenue N.E. part of Lot
Lot ._._.._.g Block _....._._�i..�._._...._.._...__ Addition or Sub-Division �7,soz�'s �� Manor South Additic,�
Corner Lot .___ Inside Lot X Setback Sideyard
Sewer Elevatfon _ Foundatton II�va.tion
DESCRIPTION OF BUILDING �
To be Used as: Above Ground
Sw'��,ing. Pool Front Depth Height Sq. Fk Cu. Ft
Front Depth Height Sq. Ft Cu. Ft.
Ty� of Construction _. F�t, Cost .,�2�373.00 To be Completed z weeks
6 foot redwood fence wi11 be put up after digging for pool is completed.
In conaideration of the fssuance to me of a permit to construct the building described ahove I agce� to do
'Ehe proposed work in accordance with the description above set forth and in compliauce with a'll provision� oY
_ Ordinances of the city of Fridley.
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In consideration of the payment of a fee of $ 15. �� , germit is hereby graated to .Tam s R�di k
to construct the building or addition as descxibed above. This permit fs granted u�n
the express condition that the person to whom it is granted and his agents, employees and worl�en, in s11 Work
done in, around attd upon said building, or any part thereoP, shall conform in all respect� •to the ordinanc� oF
Fridley, Niinnesota regarding location, construction, alteration, maintenance, repafr and moving oY bt�il�g8
vYithin the city limits and this permit may be revoked at any time upon violation of any of the provisions of said
o�rdiaancea
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----/'��� — Building 7aspeCtO�
MUHICH
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NOTICE:
79�is permif do� not eover the eonatruetion, installaHon fo� vviring. P���B� 6� b��& �+�� or waier. Be atre to aes
t6s Building Inspeetae for aeparete permits fo� these irems.
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APLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITiON BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
owlv�x � s xa� : _ ���ri'l E s �O � � ��BUILDER : �� 1P�D C� C'�"acJ��
ADDRESS : J`���.�— �%(�C'�{�ES �l.�, nl, �ADDRESS : 77� / .E, 2i J� �
NO : . `J o �" � , S TREET : ,�u �,� � S �v -�
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LOT : � BLOCK : l� ADDITION ;@�9 c�L So� S yy�spitJ p,r� SO .�+ �� �J ,
CORNER LOT: INSIDE LOT:,�, �!_SETBACK: SIDEYARD:
AppliCant attach to this form Ztao Certificates of Survey of Lot and proposed
buildi.ng location drawn on these Certificates.
�o � �-ea � ,� ,c�('� �C�.e" '`'� . G ��
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6��H SCRTPTION OF BUILD NG � �� ���
To e Used As : � ��� ���-e ���� �
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� � � Front: Depth: Height:
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: 5u)� �1 vn ��1� �O L Estimated Cost: ��37 pv
To Be Completed:
The undersigned hereby makea application for a permit for the work herein
specified, agxeeing to do all work in sttict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, aad hereby
declares that all the facts and representations stated ia this application
are true and correct.
�—
DATE : � �o y -� i ' S IGNATITRE : �� �
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(See Reverse Side For Additional Information.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before isauing permits for the
erection of any building or structure, or for any addition to a,ny existing
building or structure, or for aay alteration or repairs to a,ny existing
building or structure, upon application theref�re, require the payment by the
applicant for auch permit of fees to the amount herein below set forth and in
the manner herein prwided to-wit:
iJNIFORM��UILTrING CODE: �►pe 1, 2& 4-$2.15 for each one thousaad cubic
feet, or fractioa thereof, in such cubical contents. Type 3� 5-$1.85 for
each oae thousand cubic feet.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered frrnn a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average.�
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an exiating structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In ao case ahall the �ee charged for any permit as aet forth in Section 2 be
lesa than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for constxuction will be issued a minimum of 24 hours fram the
time of application, to allow for proper review of the propoaed structure aad
of the construction site.
A Certified Survey of the lot, showiag the locatioa of the foundatioa, oace it
hae been constructed, will be required before proceediar� with the framiag.
CERTIFICATE.OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to �he use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been isaued. •
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, . #�01 N:E. STIi 87'Air�T _
COI:UMI�iR HEiGH'1'S $842t 788-8004
_{ l�SI�Y CElITIPY tNAT TNIS SLFRV6Y. PtAN.'dR li6PORT YIN18 PREPARED BY M8 Oti UNQBR MY D114ECT"SItPEW{/IBION
/iNt!'�`i111T 1 AN A O�lLY LAND �JQ 1Jt+FOER T1ig L.AWS OF TNE 8t]►TE OP' MINNF�OTA. ,'-
: ���",�'`" °� F e �"'°-'�'�° . DATE � �•�i i �i� 0
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'�;: M�NN QTA }IEGISTRATiQiV NO. 5332 o=iR�N MONUM�NT�
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FRIDLEY, MINNESOiA 55432
• �hone 7�4-69g0
PR POSAL' SUBMITTED TO� •
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STREET
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GTY, STATE AND ZIP CODE ,
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ARCHITECT DATE OF PLANS
PHONE
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JOB /NAME
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JOB LOCATION
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DATE
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JOB PHONE
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We hereby submit specifications and estimates for: • / ' _, j� � :'
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�p �rD�JitBP hereby to furnish material and labor — complete in accordance with above specifications, for the sum of:
/G���y• �:-- L�tr.� � �� ,��L�::y��er_P-�� :/.��e�-t.!��t.f�, ;�::��-c'1-�- �%G�� dollars ($ =�.��. � � �
Payment to be made as follows: ° .
%3 cL�!�.��:i , .G- �_<<z.-;�nr , ��nt�-�c� C��--�-Y r�-c:_ � �--:� -
All material is guaranteed to be as specified. All work to be compieted in a workmanlike � //
manner aceordfng to standard practices. Any a�teration or deviation from above specifica- Authorized , � y� ��` ��Y��?�/� 1se/j.L �
tions involving extra eosts will be executed only upon written orders, and will become an Signature � '-�' �y�°-�'
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extra charge over and above the estimate. All agreements contingent upon strikes, accidents •
or detays beyond our control. Owner to carry fire, tornado and other necessa insurance. Note: This proposal may be � .� s}
ry withdrawn h us if not acce ted vrithin f�' ��'-' ���'�L'�" days.
Our workers aze (ully covered by Workmen's Compensation Insurance. Y P ,
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,��r,����,p ,[�� ����7�,��$ —The above prices, specifications
and conditions are satisfactory and are hereby accepted. You are authorfzed Signature
to do the work as specified. Payment will be made as outlined above.
�Oat�e "of Acceptance: Signature
►OflM �1BT COPYRIGXT 1980-NEW ENGIANC DU91NES3 SEHVICE. INC.. TOwN9ENO��MA99.
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sue�ecr PERMIT NO.
City of Fridley �' 6 5 9 0
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � ECEIPT NO.
� �y ______ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. �� � �
�
� _ �
`--_-� �����,•� CITY HALL FRIDLEY 55432 NUMBER REV DATE PAGE OF APPROVED BV
i 612-571-3450 910-F15 5/21/82 / /
JOB ADDRESS 5085 Hughes Avenue N. E.
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9 6 Carlson's Su�it Manor 5outh Additi.on SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
James R. H�ick Sr. 5085 HugI�s Avenue N.E. 572-8277
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
$�2
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Resi.denfa.al
7 CLASS OF WORK
O NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK � /
Canstruct a 21' x 14'.and �.5' x�.' Addition to Dwelling
9 CHANC3E OF USE FROM TO
STIPULATIONS
���� ry� �� 1�� ��.i�l T
,
Befae di� p�{ bc�l uttiit�s �� ��$% j� �����EQ �' �
T�,EPMONf • ELECf.'R�C• dA� Et�. . , � A�� S1 � � �'�l (�.
R���REL� BY L�1W
SEPARATE PERMITS AFE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, NPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOCl Fr�
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 WOFiK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 379
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION �. STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �`�.3 %SO (.$%
DOES NOT PRESUME TO GIVE AUTHORITY TO YIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. yS`�.OQc. SO NONE
PLAN CHECKFEE TOTALFEE
2VS� ZJ/�S�
�J SIGN��RnCrOraO UTHOR12EDAGENT IDATEI WHEN PROPE LY VALIOATED THIS IS YOUR PERMIT
�_' c��/ o' �:C.C�CAG �� '°� a�-`
GNATUREOFOWNERiIF NERBUILDER� �DATEI DL�G iNSP f] E
CITY Or FRIDLCY Effective Aug. 1, 1981
APPLICATI��I FO�� RESIDC(�TI/li_ I3U1LQIt�G PL•f�tiITS
(Ne►�, Alterations, AddiLions, or Repairs)
ONJI�ER: �1 � �, •es /i� /� � � r �,�� ���- P I3UI LDER : � •
ADDi�ESS: �S� �s' � � ��� ,,�� �. /j/f � � AODRCSS:
TEL N0: �5 ,� – ,�� � � TEL f�0:
Construction Location
- ST7iI�T NO : � ('� � � STItEET: /�i i� Gi � � � e� + -t� • � ��<
LOTt . �`% BLOQC: � ADAITION: �abLe%'a`i'S �cc��atizr� ��� �
Corner Lot: Insicle Lots � Setbaek: Sideyards:
Ap�licant attach to tl�is form two Certificates af S'�rvey of lot and
pzoposed building locatio� drawn on cextificates to scale.
DESCRIPTIOiv OF COhJSTP.UCTIO«
���� � _ � —
'� cm d e� e� Front: p,a� � c'� Depth: Height:
Square. Feet: �'� Qxbic Feet:
_ Front: Depth: Height:
Squar.e� FePt: Q�bic Teet:
�'�� � t`��'� ��� . '
Rype of Cor,structi�n :
Zb Be Cbr.�pleted:
Estiunated Cost: $ � � � �
Alt. A Alt. 8
Proposed Drive��ay Width If New Openinq Is Des�ured: $� $
_� , . SE� REVERSE SIDE OF SHEET .
�iie unc3ersigned hereb�• maZ:es application for a permit for the work� herein specified,
agreeinq to c� ,all work in strict accordancc with the City of i'ridley Ordinances and
rulii�gs of the Department of Buildings, and hereby declares that all the facts and
representations stated in this �pplication are true and correct.
.P.
D.�T�: SIGNATUF� :
St-ipulations: � � ���,� �P�
n°��` ` „�,�,�� �- .
�P �r���, �� �-� � ��' � � _
n � - � ;��,_�� ��
� � �° �,� w � � �_-- �_ -�' ��
��� %� _ - ➢
�r� � -��1
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BUILDING PERMIT FEE SCHEDULE
The Inspector of buildings sha31, before issuing permits for the
erection of any building oz structure, or for any addition to any
�xisting bu3ldinq or str.ncture, or for any alteration or°repairs
to any existinq building or s tructure, upon application therefore,
zequize the payment by the applicant f or such permit of fees to the
amount herein below set forth and in the m anner herein provided to-wit:
TOTAL VAIdJATI�i
51.00 tc $500.00
$501 to $2,000
52,001 to $25,000
$25,001 to $50,000
FEES
$10.00 Mini�aum Fee $15.00 plus surcharge
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
including 52,000
$32.50 for the first $2,000 plus $6.00 for each
additional $�,000 or fraction thereof, to and
including $25,000
$170.50 for t1�e first S25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000 -
$50,001 to $100,000 $283.00 for the first S50,000 plus $3.00 for
each additional $1,000 oz fraction thereof, to
and including $100,000
$100,001 and up $443.00 for the first 5100,000 plus $2.59 for
each additional $1,000 or fraction thereof
PLAi�T C.HECK: 25 perce�t of building permit fee
DRIV�n1AY DEPRESSION ESQtOW: Concrete Qirb Streets Only
Alternate "A"a Removeal and replacement of curb and gutter only
Driveway width plus 6 feet x$13.50
Alternate "8": Removal and zeplacement of curb and gutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x$15.75
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minim�an of 24 hours from the time o#
application to allow for proper review of the proposed structure and of the
construction site.
A Certificate of Survey of the lot, shvwing the location of the foundation once it
has been constructed will be required before proceedinq with the framinq.
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sua�etr r RMIT NO.°�
c�ty of Fridle� 3 �� �
�
AT THE TOP OF iHE TININS g u 1 L D I N� P E R M I T
; � • RECEIP� NO.
� ` �_' COMMUNITY QEVEIOP�MENT DIV. �������� a _,,D
f � � � PROTECTIVE INSPECTION SEC. ��
� _ �
, /"'1 � CITY MALL FRIOLEV SS��i NUMBEp - pEV OATB VAGE Oi APPROVEO BY �
�"'"� � �'' 612-571-34b0 910-F15 6/4/O1 / /
JOB ADDRESS 5085 Hughes Avenue NE ~~
1 LEGAI L07 NO. 9LOCK TfiACT OR ADDITION SEE ATTACMED
oesca. 9 6 Carlson's Summit Manor South Addition SMEET
2 PROPERTY OWNER MAIL ADpRQS$ �IP PMONE
James Bodick 5085 Hu hes Avenue NE 763-572-8277
3 CONTRACTOR MAIL AODRESS 21P PNONE LICENSE NO
Lloyds Home Improvements Inc 1012 42 1 2 Ave NE Columbia Hei hts MN 55421
4 ARCNITECT OR DESIGNER MAIL ADORESS 21P PHONE LICENSE NO.
763-788-5602 1798
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING `.
Residential
7 CLASS OF WORK
O NEW O ADDITION � ALTERATION � REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Reside House
9 CNANdEOFUSEFROM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Build�ng Code, requires that a weather
resistive barrier be placed over exterior sheathing to protect the interior
wall cove�ing. Exceptions for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states �his in their application guidelines. Call for inspection of wrap
before covering.
TYPE OFCONST. OCCUPANCY GROUP OCCUPANCV�OAO
SEPARATE PERMITS AqE REOUIRED FOR ELECTRICAL, PLUMBING, MEATIN(i,
VENTII.ATING OR AIR CONOITIONING.
7HIS PERMIT BECOMES NULL AND VOIp If WqRK OR CONSTRUCTIOM ZONING SQ. fT CU FT.
AUTHORIZED IS NOT COMMENCED VyITHIN 80 DAYS. OF IF CONSIRUCTiON
OR WOFiK IS SUSPENDED OR ABANDONEO fOii A PER100 OF 12Q pAY$ Ai "
ANY TIME AFTER WORK IS COMMENCED. ' NO OWLG. UNITS OFFSTREE7 PARKING
1 HEREBY CERTIFY THAT I MAVE READ ANp EXAMINED THIS APPLICA710N 1 STAI,LS GARAGES
ANO KNOW TNE SAME TO BE TRUE AND CORRECF. ALL PROVISIQN$ OF LAW$ yALUATION SURTAX
AND ORDINANCES GOVEFlNING TMIS TYPE Of WpRK WILL Q� COMPI,IED
WITH WHETMER SPECIFIED MEREIN Ofi NOT. TNE GRANTING OF A PERMIT �11 fOOO �S.SO
DOES N07 PRESUME TO GIVE AUTMORITV TO VIOLATE Ofi CANCEL TNE pERMIT fEE SAC CMAfiGE
PROVISIONS OF ANY OTMER STATE Oq LOCAL LAW REGUTATING CON-
STRUCTION OR 7ME PERFORMANCE OF CONSTRUCTION $195.25 ire S�.' 11.��
�
, PI,AN CNECK FEE TOTAL F
�9 % 4'-� %
��'' � ���G % �° �/—�' / License 5.0 $ 6.75
$�GN4TUAEO�CON'�7A TOAOpAUTJ RIZEDOGENT IDATEi EN P OP p� IOATED IS VQ PERMI
i ��
S�GNOTUAE O� OWNEA�iF OWNEp BWL�EAi �bAf�i � � BIOG NS� � � E
N� � � Effective 1/1/2000
ADDN [ ] CITY OF FRIDLEY
ALTER [] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 ��63) 572-3604 Bidg Insp
BUILDING PERMIT APPLICATION ���Z �
Construction Address: 5085 HUGHES AVE,� NE
�P �
Legal Description:
Owner Name 8� Address: J�s BonzCx 5085 HUGHES AVE,., NE Tel. # 763-572-8277
Contractor: LLOYDS HOME IMPROVEMENTS, INC,� MN LICENSE # BC 1798
Address: 1012-42 2 AVEa, NE,., CDLUMBIA HEIGHTS, NIN„ 55421 Tel. # �63-788-5602
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LMNG AREA: Length Width Height Sq. Ft
GARAGE AREA: Length Wdth Height Sq. Ft
DECK AREA: Length wdth Hgt/Ground Sq. Ft
OTHER:
- �.
Construction Type: NEW SIDING, HOUSE & GARAGE Estimated Cost: $_ $11,�p00
3/8 FANFOLE, COVER SOFFIT, FASCIA, WINDOWS, DOORS
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �NE 4, 2001 APPLICANT: Tel. #�63-788-5602
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if mailing in application
Permit Fee $ l/�•a��Fee Schedule on Reverse Side
Fire Surcharge $ �-� .001 of Permit Valuation (1/10th%)
State Surcharge $ S �� $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
� $1100 per SAC Uni#
$ - �� $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 PERNIIT. FEE SCHEDULE
The Cluef Building Official shall, before issuing permits for the erection of any building or structure, or for any
addidon 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,(�1 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,Q01 to $500,000
$SQ0,001 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,Ot10 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,(�0 plus $7.00 for each additional
$1,Q00 or fraction thereof, to and including $100,�
$993.75 for first $100,OQfl plus $5.60 for each additional
$1,000 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,OQ0,000 plus $3.15 for �ch 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 $23.25.
VERIFICATION OF FOUNDATION
Permits for constntction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
�
City of Fridley Building Inspections Dept Ph: 763-572-3604 FAX: 763-571-1287
6431 Universit�r Ave NE
Fridley MN 55432
Mechanical Permit # �������
Residential Application
City of Fridley
See Back Side For Required Information
Date a o s Site Address: S�8S il�41n2S A��e Y1, �.
The applicant is: (cirlce one) Owner Contracto
Property Owner: p. � �.e
Address: Ser+�e
City: State: Zip:
Phone: lo - �$ rl Cell: Fax:
Corrtractor Information
Company Name: RIVeI' Cltj/ Sh�et ii�iefal, Ine.
Contact Perso� . 829011Aain St. IV.E. Suite 39
Address: Fridle� 9VIN 55432
C'tty: ��gg
Phone: e : ���) - - -F-ax:
Email: MN Bond# & Exp Date � ��
Type of Work (circle one): New Replacement AlteratioNRemodel
Detailed Description of work:
1 sus w+n.,n ��un.� �- A �c.�
Equipment Installed: MFG:��,_.._v Model:V�(oPK.nR it11�►c�ZSize/BTU: ��Q
MFG: R�w O Model: �►4rNm o�AQ�Z Size/BTU: a zT� n
MFG: Model: Size/BTU: .
Please check all that apply: _Fireplace (gas) $15.00 New Gas Grill $10.00
�A/C $25.00 Fireplace (wood) $35.00 _Gas Unit HTR $10.00
Airto Air exchanger $15.00 �Fumace $35.00 _Pool Heater $35.00
Boiler $35.00 _Gas Dryer $10.00 Ventilator $15.00
Chimney Liner $10.00 _Gas Piping $10.00
Duct Work $10.00 Gas Range/Oven $10.00
Permit Fee $ (o G. 0 0 �otal from above-Minimum fee $35.00)
Surcharge � 0.50
Total Due $ (oo. S� Make check payable to City of Fridley
This is an aaalication for a nermit• not valid until urocessed
I hereby apply for a mechanical permit and I 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
with the Minnesota Constructlon Codes; that I understand this is not a parmit 6ut only an appllcation
for a permit and work is not to start without a permlt; that tha work will be in accordance with the
approved plan in case of all work which requires review and approval of plans.
Signature of Applicant: Date: l b s
Approval Inspector Signature: "'- Date�� rj ��
�
Please Note: Separate permits are required for Building, Plumbing, and Electrical work
Revised 6/14/2005
City of Fridley
6431 University Ave NE
Fridley MN 55432
(763) 572-3602 or Fa�c (763) 502-4977
= -- - ---- --==--Water and Sewer Permit Application
New Connection
xisting
Date: ��
Job Address:
.
� , �� r
❑Utility Line Repair/Relocation
�Water and Sewer Connection
Name of Applicant (Plumber): �� �� 6%�(-�'���Z C, �-��� �� (.:� �
Name of Property Owner: ��"VvG �� �
Existing St.ructure Pemut #
Pernut Type: Sewer Fee: �.�-od
Water Fee:
Meter Fee:
Repair Fee:
Relocation:
Sta.te Surcharge: o �D
SAC Charge:
Special Assessment Fee:
Tota1: $ �o- �
Applicant Signature:
Inspector approval:
Water Meter Repair — Weekend & H�
Water Connections Pemut
Sewer Connections Permit
Tnspection Fee for Water/Se�ver Line
Special Assessments
Cost of Water Meter
SAC Charge
Sta.te Surcharge
Water Tan
04/04/OS
$50
$40
See Engineering
See Utility Billing
$1550
$ .50
See En�ineerin�
City of Fridley
6431 University Ave NE
Fridley MN 55432
(763) 572-3604 or Fax (763) 502-4977
�}�� � �/��
REC'D S E P 5 2007
Water and Sewer Permit Application
❑ New Connection
�Existing
Date: V
Job Address:
�Utility Line ep ' elocation
Water and Se r onnection
Name of Applicant (Plumber): `�����Ts'� ���l�L �
Name of Property Owner: f
Existing Structure Permit #
Permit Type: Sewer Fee: �X ��
Water Fee:
Meter Fee:
Repa.ir Fee:
Relocation:
Sta.te Surcha.rge:
SAC Charge: , ��
Special Assessment Fee:
�P ��. c_e_ b c�� �� �`-' ��%�s-e.�. .�c �_
Total: $�t/��
Applicant Signature;
Inspector approval:
Water Meter Repair - Weekend & H
Water Connections Permit
Sewer Connections Permi
�on Fee for Water/Sewer Line
�ecial Assessments - -
Cost of Water Meter
SAC Chazge
State Surcharge
Water Tan
P I ��
�� �
���-- ���.e��'
�
$125/hour
$50
40
See Finance
See Utili Billin
$1675
$ .50
See En�ineerin�