AF - 46419r
�
Village of Friclley, Minn.
BUILDING PERMIT
Date: ��: �.� ��.��.. �.� .. ...
t���,�„�. .
Owner�i��o: .... ...�„ ..... .
�t � �
Address�!�� 4�� " �°?. . . . . . . , . . . . . .
N° 1570
Builder ,l�P��s"5;,, .' :�r�:,.�"';�,.•. . . . . .. . . . . .
Address... .......... .. ........ .....
L ATI�N OF BUiLD[NG
No. . :".��. .� � .��. Street . . : . ,r. '`-'� � . � �:��. . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . .
Lot . . . . . . . . . . . . . . Block . . . . .,r. . . . . . . . . Addition or Sub-Division . ��,,. �. . . . .. . . . . . .
Corner Lot . . . . . . . Inside .Lot .� .r . . . Setba.cl��h.�'.� .�`�id�ard ��. . �� � : . . .
DESCRIPTION OF BUiLD[NG
To Used as: f
,,,�` ,� „
�,�c _.�.-�e - �' ` ..: . Front . . d.�.�`'. Depth .4:"'� : . Height . . . �
....... :�.. Front ........ Depth . Height . .....
. � .. �.
Type of Construction �i�:�'!'.?�: c.;ti.•. . . . Esf. Cost . ! . .�`'�. ,�.. .. . . . . . . . .
� , �
Sq. F't. ..... Cu. Ft. .....
Sq. Ft. ........ Cu. F� . ..
To be Completed �� ! �': ���.
In considexation of the issuance 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 alF prov3sions of
ordinanees of the village of Frldley.
:.
7n consideration of the payment of a fee of ��::.. ., permit is hereby granteti_ ' ��""`'��
: .... ... �
. . : . . . . . . . . . . . . . . . . . . . . . . to construct the huilding or addition as described above. Thia permit is granted t�n
the e�ress condition that the person to whom it fs granted and his agents, employees and wurl�uen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota. regarding location, conslxuctian, altera.tion, maintenance,: repair and moving of buildings with-
in the village ]imits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
� � ��
• �..�• i !,t"�.,.. .r� � _�' . . . . . . . . . . B1lildi�7g' InBpector
NOTIC�:
This permPt does nat cover ti�cons£ruction, installation- or alteration for wi�j�, plumbing, gas heating,
sewe� ar water. Be sure to see 1�,�uiiding (nspector for separ.ate Aermits for � se items. '
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SuB�ECT
c;ty of Fridley
AT TNE TOP OF TME TWINS g � I L D I N G P E R M I T
i �
� �
� ; � __��� COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
� i .
� �"'f � CITY HALL FRIDLEV SS132 NUMBEN
�----�" �•� 612-571-34b0 s�aF�s
J08 ADDRESS 5120 Hu hes Avenue NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION
DESCR. ]_1 7 Carlson's Sw
2 PROPERTY OWNER MAIL AODRES$
John Gacek
3 CONTRACTOR MAII ADDRESS
Owner
4 ARCNITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAII ADDRESS
8 USE OF BUILDING
Residential
7 CLASS OF WORK
rE PAGE oc
9/1/99 / /
30149
RECEIPT NO
3
•vvnOVEO Br
SEE ATTACMED
Ad�.R. SNEET
ZIP PMONE
574-0481
ZIP PMONE LICENSE NO
ZIP PMONE IICENSE NO.
21P PMONE LICENSE NO
❑ NEW O ADDITION � ALTERATION 7Q� REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House and Garage (22 Sal Tear-off
9 CHAN(3E OF USE FROM
STIPULATIONS
TO
Underlayment mu.st comply with the State Building Code.
TYPE OF CONST
SEPARATE PERMITS ARE REQUIqED FOR EIECTRICAL, PLUMBING, NEATINO.
VENTILATING OR AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTFiUCTION 20NING
AUTHOfiIZED IS NOT COMMENCED WITNIN 80 DAYS. OR IF CONSTiiUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PERIOO OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCEO. NO DW�G. UN
I MEfiEBY CEpTIFV THAT I HAVE READ ANO EXAMINEO THIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW$ yp�VATION
AND ORDINANCES GOVERNING TMIS TVPE Of WOFK WILI BE COMPLIED �1g23
WITH WHETHER SPECIFIEO MEREIN OR NOT. TNE GRANTING OF A pERM1T
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL TME pEqM17fEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULA7ING coN• �69. ZS
STqUCTION OFi THE PERFOfiMANCE OF CONSTRUCTION
•uTMOAi2E0 a T � � A�
� �
>
BURDERi iDI�1Ei
SO. f T
S7Al,LS
GROUP OCCUPANCVLOAD
CU FT-
OffSTREET PARKING
IGARAGES
$.96
iAC CNARGE
Fire SC $1.92
OTAL FE
�7�1J
IT
NE� [ } � _, Effecdve 5/10/99
ADDN � I l CITY OF FRIDLEY �
ALTER �]. SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII,DING PERNIIT APPLICATION ` �
J� � � �1
Construction Address: ��dZ� �° / i ��/�%� S � �% �(� s � . , J
Legal Description:
Owner Name & Address: J 0 /�.V ('� ('� (1'"K � ��',/n g'O (,t/,,� ��� Tel. #�%� .� � �/D �� (
Contractor: _ il�C9✓Y)� � c,�,.cJ �� MN LICENSE #
Address:
LIVING AREA:
GAItAGE AREA:
DEC$ AREA:
OTHER:
Attach to this application� a Certificate �of 'Survey of the
lot, with the proposed construction. d��wn on it to scale. .
DESCRIPTION OF IlVIPROVEMENT
Length Width
Length Width
�
�
Tel. �#
Height Sq. Ft.
FIeight Sq. Ft. .
Hgt/Ground Sq. Ft.
���) l�"A�'�
� v
Construction Type: ���i Q� Estimated Cost: $
l�'a�
Driveway Curb C�t Width Needed: Ft. + 6 Ft = Ft x$ _$ .
DATE: � � � APPLICANT: � Tel. #
Permit Fee
Fire Siircharge
State Surcharge
SAC Charge
License Surchargs
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Cha.rge
TOTAL
STIPULATIONS:
$ � , a��
$ i, � a
$ (o
$
-$
$
$
$
$
� � �3
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,(�00 Valuation
$1050 per SAC Unit
$5.00 (State Licensed Resid�ntial �Contrac+_ors)
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 siructure, 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 �ayment 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 $5�
$501 to $2,(�0
$2,001 to $25,000
$25,OOlto $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.SU
$23 .50 for first $5.00 plus $3 .OS for each additional $100 or
fracdon.thereof, to and including $2,000
$69.25 for first $2,000 plus $1A�.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,(�0 plus $10.10 for each additional $1,000
or fracrion thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fracrion thereof, to and including $100,(�l0
$993.75 for first $100,000 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 $1,0(}0,0� plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Ciirb Streets Only)
Alternate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Alternate "B": Removal and repiacement af curb anrl gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet tunes $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 S�uvey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing.
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
►631572-3604 FAX: (763) 571-1287
: 5120 HUGHES AVE NE
: 263024220078
: CARLSONS SUNIlVIIT MAN SO ADD
: LOT 11 BLOCK 7
: BUII.,DING
: RESIDENTIAL
: ADDITION/ALTERATION
� �,
PERMIT O.: 2004-01399 �
� _ e. _______
DATE ISSUED: 08/23/2004
VALUATION : $ 1,600.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTILITY LOCATIONS.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER R317 OF TI�
2000 INTERNATIONAL RESIDENTIAL CODE. REPAIR BASEMENT BLOCK WALL PER IRC CODE REQUIREMENTS.
APPLICANT
QUALITY CONCRETE
8520 BASS LAKE RD
NEW HOPE, MN 55428
OWNER
GACEK JOHN ALAN
5120 HLJGHES AVE NE
FRIDLEY, MN 55421
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violat c el the provisions of y other tate or local law
re ating cons criQ�6 /, e pe �an�� construcrion.
Ann irant �l�l � �/,1 � ii� � Date /
Bldg Insp
BUII.,DING PERMIT FEE
FIRE SURCHARGE
STATESURCHARGE,VALUE
TOTAL
SEPARATE PERMITS R�QUIItE� FOR WORK OTf�R THAN DESCRIBED ABOVE.
57.05
1.60
0.80
59.45
NEW
ADDN
ALTER
[] CITY OF FRIDLEY ��� �� Effective 4/1/2004
[� 6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bldg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
��o�����`�9�
Construction Address: �'/� o �� 4�is �
Legal Description:
Owner Name 8 Address: �� n r� ,�z �� Tel. # 7�� 5'�� o�3�`r
Contractor.
LMNG AREA:
GARAGE AREA:
DECK AREA:
OTHER:
MN LICENSE #
Tei. # -7 6 � �'�"�-���'—
Attach to this application, a Ce�t�cate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length _ w�d� Height Sq. Ft
Length Width Height Sq. Ft
Length Width Hgt/Ground Sq. Ft
� ^'-a�"T `A'A�.S� �
� " � Estimated Cost: $
Construction Type: r�� -� " ° -
�----,
Driveway Curb C �Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: � APPUC T: .� Tel. # > �������
Call (763) 72-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will call
you for card number.
CITY USE ONLY -
Permit Fee
Plan Review
Fire Surcharge
State Surcharge
SAC .Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
� f,
� ��, ���
$ �
$ � D
$ �O
$
.$
$
�
� ��,
$ —
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1350 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 [ ]
s"q ��°
$ �
_ �3� (�-� �,��
� y ��
�,'�L �v��� ^ � �
A
STIPULATIONS:
��'�
�
BUII.DING PERMIT FEE SCHEDUI.E
The Chief Building O�cial shall, before issuing permits for the erection of any building or structure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the appl;cant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,Q01 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fracdon thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each addidonal $1,000
or fraction thereof, to and including $25,�
$391.25 for first $25,OQ0 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
$1,0(}0 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $500,000 plus $4.75 for each addidonal
$1,000 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,OOO,IX}0 plus $3.15 for each additional
$1,000 or fraction thereof
CURB CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate
Permits for construction will •be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the locadon of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
_�
Building
Inspections
763-572-34
DATE ✓ ��
SITE ADDRESS _
TH1S APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMTI' A COPY OF
YOUR STATE
LICENSE WITH
APPLICATIOTT
PERNIIT TYPE
TYrE oF woiuc:
MECHANICAL
RESIDENTIAL APPLICATION
CIT�' OF FRIDLEY
❑ OWNER
E-MAIL
�
CoMr� ru�;
CONTACT PERS( y��� ;,�,*� 4 � O WEST L
STATE LICENSE i{_
ADDRESS:
PHOI�IE
�SINGLE FAMILY
❑ r�w �f
DETAILED DESCRIPTION OF WORK
�J�}�, MN 55408
2-824 �—
FAX
❑ TWO FAMILY ❑ TOWNHOUSE
FMF.N'I' ❑ pLTERATION/REMODEL
Pern7it No
Received By:�
�'��,AY 2
ATE ZIP
PER MS 16B.665 the permit fee is a miuimnm of $15.00 or 5% of the total cost ap to $500.00, whichever is greater, for the
unprovement, installation or replacement of a residential fixtu=e, excluding tlae f�hires. (This should reflect only.the cost of labor )
Labor cost under $300 = $15.00. Latior cost between $300 to $5� ° cost oflabor _ . x .OS - , .
FOR PROJECTS �RE LABOR EXCEEDS $500, B�ASED ON $10.00 PER FD�I'URE, E7fCEP'I' R�RE NOTI=D. FIXTI�RFS,: (II4DICATE TOTAL
NUMBER OF EACH BELOW) . (�� SIZElBTU °� rCJv�
Equipment Installed , MFG MODEL: [ -�
MFG: MODEL.• � SIZ,FJB'PU �
MFG: MODEL..�TC I�'l S�T�
.%� A/C $25.00 FIREPLACE (Gf4�S) �15.� � GAS RANGFJOVEN $10.00
AIR TO AIIt EXCHANGEER $15 FIItEPLACE (WOOD) $35.00 NEW GAS (iRII.L 510.04
BOILER $35.00 FURIQ�.CE $35.00 GAS UNTT NfR $10.00
CHIMNEY LINER $10.00 �AS DRYER $10.00 POOL HEATER $35.00
DUCT WORK $10.00 GAS PIPINCi $10.� VENTII.ATOR $15.00
.� a � ��:, , -: . � _ _._.._.._
Pemiit Fee $ Number of fu�tures . x ._ - -
��.ge $ � ,Sp Number of fix�ures a(� $15.00 x $15.00 = $
TOTAL DLTE $ Number of Sxtures @ $25.00 ,� x $25.00 = $Z . �
Number of fixtures @ $35.00 � x $35.00 = $�s,�
State Surcharge = $ 50
Total ° 9��Q
TI�SS IS AN APPLICATION FOR A PERr9T NOT VALID UNTIL PROCESSID
I hereby apply for a building permit and I owledge that �e information above is complete and accurate; that the work will be in
conformance with the ordinances and of City of Fridley and with the Nfinnesota �onstzuction Codes; t3�at �i underst,and this is
not a permit but only p fo d work is not to start without a permit; that the work w�l be m acc°rd ce with the
approved plan in the of o ' r. review and approvaJ of
TURE OF APPL '' PRWT �lYi ATE
SIGNA
City of Fridle�
Building Inspections Department
6431 �Jniversity Avenue NE, Fridley, MN 55432
. 763-572 3604
FAX: 763-502�F977
REQUIRED tNFORMATION NEEDED TO PROCESS PERMIT
RESIDENTIAL PERMIT APPLICATION HVAC
❑ NEW HOMESIADDITIONS EXISTfI�G HOME ❑ MAKE-UP AIR
R.EQUIRED F�R NEW/EXISTIN:��H(3�yIE:S .:..:,:. _. . .
_it;. _ :i,� _ fi..t,t: 1.
..� e .1� ..P�
1. Combustion Air (See note belo�j� : �,, r ' ' � . '
;:.3 .-, `� -. ..
a. Oil or solid fuel IMC Chapter 7 with MN Amendments
b. Natural Gas or Propane/IFGC Chapter 3 with 1wIN Amendments
2. Make-up Ai.r (See note below)
a. IIvIC Chapter 5 with MN Amendments
3. Ven.tin.g
a. Gas applianc.�s IFGC Chapter 5 with MN Amendments
b. Fuel other than gas 1MC Chapter 8 with MN Amendments
REQUIRED FOR NEW H�MES
4. Heat loss & cooling load. per room
a. Required on new construction IlVIC 1346.0312
5. Ventilation
a. Per MN Energy Code 7670 or 7672
6. Duct Desiga Per IlVIC ];346�0603:2 � �� -�
a. ACCA Manual D
NOTE: Centerpoivat Energy Mechanical Code Guidelines software may be nsed for
combustion and make up air calculations