AF - 46423X
BUILDING PERNIIT
Village of Fridley, Minn. N° 2 4 5 9
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Date• ...... . ...................•-
Ownerf�.G:i ..�%'�.f�"���--Gt�%...... Builder ...........................................
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Address `:.'.r% �.."":... /�►:^�'��. .�...'.!........... Address .........................................
LOCATION OF BUILDING
,,�
No. ...�� �...... Street ..... ................................ Part of Lot .......................
Loi ................ Block ................ Addition or Sub-Division .......................................
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard ..........................
DES�RIPTION OF BUILDING
��To e Used as: �
. .. . . . . . Front .'�.x.�. . . Depth . �.~�. . Height . � ��.�. Sq. Ft. �.��. . Cu. Ft. . . . . . . . .
�
.................... Front ......:. Depth ........ Height ......... Sq. Ft. ........ Cu. Ft. .. ..
/�` �"
Type of Construction `��.'� ��. . Est Cost � �� � O. . . . . . . . . . . . To be Completed � . �� �� . . . . . .
Tn consideration of the issuance to me of a permit 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 village of Fridley.
� f � Y � ��'`�^��'
7n Consideration of the payment of a fee of $. .� . . . . , permit is hereby granted to . . . . . . . . . . . . . . . . . . . .. . . .
. . . . . . . . . . . . . . . . . . . . . . . to canstruct the building or ad dition as described above. This permit i5 granted upon
the eicpress eonditiori that the person to whom it is granted and his agents, employees anc� worl�nen, 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, construction, aiteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time u on violati of any of the provisions of said
brdinances. �
i�' �' i
..� . .... .. . .................. Building Inspector
NOTICE:
This permit does not cover the construction, installation or aiteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these Items.
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sus�ecT PERMI �
City of Fridley 13 1�
dT THE TOP OF THE TWINS B U I L D I N G P E R M I T
�
; � RE PT NO,
� `y _ _ COMMUNITY DEVELOPMENT DIV. �� ( ��.�J
r � � PROTECTIVE INSPECTION SEC. �'
I = �
� /'��1 � CITY HALL FRIDLEY rJ$4$2 NUMBER REV. DATE PAGE OF APPROVED BY
������ / ,•� 612'560-3450
910-F15 9/1/76 � �
JOB ADDRESS 5144 Hughes $'�S�"t N.F;.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 13 7 Carlson's Summi.t Manor South SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Androy St. Andrew 5144 Hughes Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
American Builders 4090 West Broadway -
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER • MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Constxuct a 11 x 1� Addition to �� back of dwelling
9 CHANOE OF USE FROM TO
STIPULATIONS Use 1�1� rated insulation in ceiling and R-11 rated insulation in walls.
/���
�TS REptllitE� FOR �tliMt�, � '� ' ;rN �t util�t�es
SEPERAI�E� P'EAM H
T�E�PH E • ECECi� •6AS Etc.
NEATIt�MG, PLt�MBlNt� ��1�. REQUlREO"' 8Y IA�IV
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TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOCI FY'd1Cl@
THIS PERMIT BECOMES NULL AND VOID IF WONK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 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 PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND COFRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $L,� � OOO $Z .00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS O ANY OTHER STATE LOCA LAW REGULATING CON- y�`24.00
STRUCTION O THE PEf�FOR NC F ON RUCTION.
PLAN CHECK FEE TOTAL FEE
$26. 00
Si NA UREOFCONTRACT RORAUTHORI2EDAGENT IDaTEI WHEN PROPERLY VALIDATED THIS IS YOUR PERM�T �
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i�� GNATUFE OF OWNERIIF OWNER BUILDERI IDATEI BLDG INSP �q7 v
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�11 Y ur r�cdu�tr
APPLICATION FUR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
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NO° �� STREET:r �
LOT : BLOCK: ADDITIOII:
COR�'VER LQT: INSIDE LOT: f/ SETBACK: SIDEYARD:
Applicant attach to this foxYn Ztao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used s:
��`� / � Front :��_Depth : % � Height : /
Square Feet: D Cubic Feet:
r
Fxont: Depth: - Height:
Square F et; Cubic Feet:
r �
Type of Construction: �stima.ted Cost:� ,� �-D� �—
To Be Completed: / �1Z�����Z� , e
The undersigned hereby makes applicativn for a p�:rmit for the worlc herein
specified, agreeing to do all work in stxict accoxdance with the City of
Fridley Ordinances and xulings of the Degartment of Buildings, and hereby
declares that all the facts and representations stated in this applicaiion
are txue and correct.
DATE : - �� �— � ,(> S ]:GNA.TURE :
(See Reverse Side For Additional Informa
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13UILDING PLRMIT P�E SCHEllULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any existing
buildi.ng or structure, or for any alteration or repaixs to any existing
building or struc�ure, upon application therefore, require the payment by the
a.pplicant for such permit of fees to the amount herein below set forth and-in
the manner herein provided to-wit:
�iEW CONSTRUC�ION: Sa,ng],e Family Homes and Garages: $4.00/1000 cubic feet
PLAN CHECK: 25 percent of building permit fee.
ADDITIGNAL INFLIRI�4ATION
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 from a point six (6) i.nches below the floor line of the basement
ox the cellax to the average heights of the upper surface or to the average.�
�height of the roof surface of the ma.in gable of a pitched roof.
For repairs or alterations to an existing structure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fractinn thereof in
the cost of all proposed taork. .
In no case shall the fee charged for any permit as set forth in Section 2 be
less than $7.50. _
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 houxs from the
time of application, to allow for proper review of the proposed structure and
of the cons�ntction site.
A Certified Survey of the lot, showing the location oi' the foundation, once it
ha5 been constructed, will be required befoxe proceedin� taith the framing.
CERTIFICATE Or OCCUPANCI'
Application for a Certificate of Occupancy shall be made Cen (10) days pxior
to the use or occupancy of any structure for which a building pexYnit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy lias been issued.
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CHIM�lEY ANJ STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes ()
2. Is free from rust or deterioration '
. Yes ( )
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. Meets all current Code requirements for size and
total BTU ccnnected
6. Ha s To ta 1 hea ti ng BTU ( s of
All other BTU's
TOTAL
No ( )
No ( )
No ( )
No ( )
Ye s i ) No i)
Com pa ny �
- - — - - --- -- - — --Si-gned� —
Date �'�" `5f�
SuBJECT
c�ty of Fridley
AT THE TOP OF TME TWINS g � I L D I N G P E R M I T
�
� �
� ; y __�_� COMMUNITV DEVEIOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
`.---� �"'�'� CITY NALL FRIDLE� SS432 NUMBER AEV DATE
i 612-571-3460 9t0-Fi5 4/27/98
JOB ADORESS 5144 Hughes AVenue
1 LEGAI LOT NO. BLOCK TiiACT OR AODITION
DESCR. 13 7 arlson's Summit Manor South
2 PROPERTY OWNER MAIL ADDRES$ ZIP
Chad Varian, 5144 Hughes Avenue, Fridley 55421
3 CONTRACTOR MAIL ADDRESS Z�P
Panelcraft of MN, 3118 Snelling Ave S., BI�SX�% Mpls. 55406
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
5 ENGINEER
8 USE OF BUILDING
Residential
7 CLASS OF WORK
MAIL ADDRESS
PAGE Of
� �
'25�76
NO.
ao� �
ApPNOVED BY
SEE ATTACHED
SHEET
PHONE
502-9287 .
PHONE LICENSE NO.
721-6623 R-150-461-5 7-432
PHONE LICENSE NO.
ZIP PHONE
O NEW ❑ ADDITION � ALTERATION C� REPAIR
8 DESCRIBE WORK
Siding, gutters, downspouts
9 CHAN(iE OF USE FROM
STIPULATIONS
TO
TYPE OF
SEPARATE PERMITS ARE REOUIRED FOR EIECTRICAL, PLUMBING, MEATIN(3,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WOHK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AF7ER WORK IS COMMENCED. NO. DY1
I FIEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW TNE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUAT
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $3
SQ. FT.
UNITS
STALLS
� vv v
WITH WHETHER SPECIPIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEpMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- �]/{.]S
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
SIGNATURE OF CON'pACTOR OR AUTMOfiIZED AGENT IDATEi
�DATE�
.0�
License �5.00
NO.
❑ MOVE � REMOVE
OCCUPANCYLOAD
CU. FT
f PARKING
GARAGES
$1.50
SAC CHARGE
$3.00 Fire SC
07AL FEE
$84.25
D THIS IS � R PERN
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ADDN
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Conslruction Aciclress:
Lcbal Descri�ii
CI'TY Or FRIDL�Y
SINGLC rAM1LY AND UUPLCX�S R-1 AND R-2
Builclinb Permit Application
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L'►ICCIIVC 1/ 1/ J�
,�'�� �
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Own�r Na�ne & Adclress: � ��_�(.,�Y (, �fL Tel. # ��o��
f'l/ MN L1CCNSC �f � y�'� u�� ��
Contruclor: _��li� ��'_��,� C � f�l _�_----
�Adciress: � / l � sV 1 e i /_ i /7G1 � �D � Tel. # �� 1- �o � 2 c�
LIVING AR�A:
GARAG� ARCA:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction dr.�wn on it to scale.
D�SCRIPTION Or IMPROVEMENT
Length Width Height
Length Width Height
DCCK ARrA: Length
OTHrR:
Widdi HgdGround
sy. rt.
Sy. Pt:
sy. rt.
Corner Lat ( � Insicle Lot ( � Ft. Yd Setback Side Yard Setbacks
, G�i-ter�—
Type oi' Construction: �, d� no� �'F Dc�ns�o�,�t5 Esdmated Cost: $ ,�O•DO
APnrox. ComPleticm Date: � �
(Cost on Back)
Driveway Curb Cul Wiclth Nec;ded: rt. G rC = lit x$ __�
D A T�: �-{ - 2 0-�"! S A P P L I C A N T: Tel. #�� I-�PiU�-�.
Pcrmit ree
rire Surcharge
�i:�te Surcharge
S/1.0 (;hart;e
License Surchacbe
I�riveway �scrc�w
Erosion Contrc�l
Park Fee
Sewcc M�tin Ch;u-�;c
� •r+oTnr
S"i'IPULATIONS
� -� y � s
$ � • S�
��� . c,�c?
$
$_ < - O�
$
$
�
$ - -----
� �� �,�
O�
�ITY I1S� QNLY
� �� ��
-�l O(o 2`?
ree Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$800 per SAC Unit
$5.00 (5ta.te Licensed Rcsiciential Contractors)
Alt. "A" or Alt. "B" Above
$450.Q0 Conservadon Plan Review
Fee Determinetl by Engineering
A�;rcc;mcnl Neccssary I I Nc�l Ncccs1a�y I I
,
, ;
sue�ecr � PE .
City of Fridley 31118
AT THE TOP OF THE 7WINS � � I l D 1 N G P E R M I T
r
; � RE O.
� `L _�_�� COMMUNITY OEVEIOPMENT OIV. � a
r � � PROTECTIVE INSPECTION SEC. ��C.� '�
1 . i �� �
�---- A; r���,,� CITY HALI FRIDLE� SSIJ$ NU49ER pEV OATE PAGE Of ApPROVED B•
�� 612-571-3450 s�aF�S 6/28/00 / /
JOB ADpRESS 5144 Hughes Ave. NE
1 LEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACMEO
oescp. 13 7 Carlson's Summit Manor South SNEET
2 PROPERTY OWNER MAIL AODRES$ 21P PHONE
Chad D. Varian 5144 Hughes Ave. NE 502-9287
J CONTRACTOR MAIL ADORESS YIP PNONE IICENSE NO
Chad D. Varian
4 ARCHITECT OR DESIGNER MAIL AOORE3S ZIP PNONE LICENSE NO.
5 ENGINEER MAII ADDRESS ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION O ALTERATION O� REPAIR O MOVE O REMOVE
8 DESCFIBE WORK
Reroof - Tear Off 12 Squares
9 CHANGEOfUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GFOUP OCCUPANCV lOAO
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATINQ,
VENT�LATING OR AIR CONDITIONING
THIS PERMIT 9ECOMES NULL AND VOID IF WORK Oii CpNSTpUCT10N ZONING SC. F7 CU FT.
AUTMOR12ED IS NOT COMMENCED V111TNIN 80 DAYS. OFi IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANOONEO FOR �► PERIOD OF Ipp OAYS AT
ANY TIME AFTEp WORK IS COMMENCEO. NO DWIG. UNITS OffSTREET PARKING
I MEREBY CERTIFY TMAT I HAVE REAO AND EXAMINED THIS APPLICA710N ], STALLS GARAGES
ANO KNOW TNE SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS yq�UATION SUq7AX
AND OFiDINANCES GOVERNING THIS TYPE OF WORK WIL�. BE COMP�IED �
WITH WHETHER SPECIFIEO MEREIN OR NOT. THE GRANTING OF A PERMIT 1 049.00 .�.SZ
DOES N07 PRESUME TO GIVE AUTMOpITY TO VIOIATE OR CANCEL TME pEqMIT fEE SAC CMARGE
PROVISIONS OF ANY OTHER S7ATE OR LOCAI LAW REGULATING CON-
STRUCTION OF TH� PERfORMANCE OF CONSTRUCTION 4],.HO FlY� SC .$�..OS
PLAN CHECK FE TOTA FEE
.�� � �o
S�GNA�F�CTOaOaauTNOaiZEDnGENi � i�tE� � EN O E ALIOA ED s3�s37ua IT
� �j �/�
S�GNOTUAE O� OWNEp��� OWNEpBURDEp� iDATE� Bl �NSD � pp�i
NEV1l [ ]
ADDN []
ALTER [ ]
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/2000
(763) 572-3604 Bldg Insp
Construction Address: � l �/ y j-lv � e� S ,Q�/>i �/. � � �'�/�! (
Legal Description:
Owner Name & Address:
Tel. #
�'� �������
Contractor: s e� MN LICENSE #
Address: �� y�f ��v� � e 5 �[�� � � S3�-/� � Tel. # ��� — � � ��
,
LMNG AREA:
GARAGE AREA:
DECK AREA:
Attach to this application, a Certficate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length Width Height Sq. Ft
Length Width HgUGround Sq. Ft
OTHER:
�� / �_�
Construction Type: / ��� Estimated Cost: S
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
// �
DATE: 6��/do APPLICANT: �� G° �--� Tel. #/ 02
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ ,� Fee Schedule on Reverse Side
$ /, D.r .001 of Permit Valuation (1/10th%)
$ • ,SZ $.50/$1,000 Valuation
$ $1100 per SAC Unit
$ $5.00 (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Consenration Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
$
BUII.,DING PERMIT' FEE SCHCDULE
The Cluef Building Official shall, before issuing permits for the erection of any building or siructure, or for any
addition to any existing building or structure, or for any alteration or repair to any existing building or structute,
upon application therefore, require the payment by the applicant for such �rmit 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 $25,0�
$25,001 to $SO,OOQ
$50,001 to $100,000
$100,�1 to $500,000
$500,001 to $1,000,000
$1,OU0,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $100 or
fraction thereof, to and including $2,OQ0
$69.25 for first $2,000 plus $14.00 for each additional $1,0�
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,000
or fracdon thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,Q00 or fraction thereof, to and including $100,OQ0
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,0{�
$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 $1,000,000 plus $3.15 for each additional
$1,000 or fracdon 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 S�uvey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding witli the framing. New Houses Onlv
, —�. _
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 Q� , D��� �/ �
_ � .,
�� �
� Construction Address: �
Legal Description:
�( Owner Name 8� Address:
Contractor. �% �Z
� a.
LMNG �AREA:
GARAGE AREA:
DECK AREA:
�rt�
�
i � %L
Tel. #
MN LICENSE # 2�3�
Tel. # %��� • ��c/��
Attach to this application, a Certificate of Survey of the
bt, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft
Length _ Nlidth Height Sq. F�
Length Width HgUGround Sq. Ft
QTHER:
L.�° '"'� � � �� '� ,�' ' � ���
�Construction Type: y � ��"' Estimated Cost: $
��
�Driveway Curb Cut Width Needed: �Ft + 6 Ft = Ft x$� � _$
DATE: — , APPLICANT: Tel. # %6.'3- 7��� ���
Cail (763) 572-3604 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
$ 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 [ ]
TOTAL $ STIPULATIONS:
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erecdon 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 pemvt of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $SOQ
$501 to $2,0�
$2,001 to $25,000
$25,001 to $50,000
$50,�1 to $100,000
$100,001 to $500,000
$500,001 to $1,Q00,000
$1,000,�1 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 fracdon thereof, to and including $25,�0
$391.25 for first $25,000 plus $10.10 for each addidonal $1,000
or fraction thereof, to and including $50,�0
$643.75 for first $SO,OQO plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $1�,0� plus $5.60 for each addidonal
$1,�0 or fraction thereof, to and including $500,000
$3,233.75 for the fust $500,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,Q00,000
$5,608.75 for the first $1,000,000 plus $3.15 for each addidonal
$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 � 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 location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
NEW []
ADDN [ ]
ALTER [ ]
Construction Address: � a L
Legal Description:
Ou±mer Name & Address: �
����--a����
CITY OF FRIDLEY
6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bidg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
1
� ,_ �Il��i
Contractor. ' � MNLICENSE #
Address: Tel. #
Attach to this application, a Cert�cate of Survey of the
lot, wath the proposed construction drawn on it to'scale.
DESCRIPTION OF IMPROVEMENT
LMNG AREA: Length Width Height
GARAGE AREA:
DECK AREA:
OTHER:
Length Width Height
Sq. Ft
Sq. Ft % - Ud
Length Width Hgt/Ground Sq. Ft
_� �
Construction Type: Estimated Cost: $ U�� d��
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
, � J1(�
DATE: APPLICANT. � Tel. #� � � v"
Call (763) 572-3604 for Permit Fees if mailing in applica . Fax to 763-571-1287 if using credit card and wre 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
$ ���.
�
$ o
$ , �"^C)
$
$
$
$
$
$
Fee Schedule on Reverse Side
65% of Permit Fee
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1450 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 [ ]
TOTAL $ � � �� STIPULATIONS:
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 e�sting 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,�0
$25,(�1 to $50,000
$50,001 to $100,0�
$1�,Q01 to $500,000
$500,(�1 to $1,000,�
FEES
$23.50
$23.50 for first $5t� plus $3.05 for ea.ch additional $100 or
fraction thereof, to and including $2,0�
$69.25 for first $2, 000 plus $14. 00 for each ad.ditional $1, 0�
or fraction thereof, to and including $25,000
$391.25 for first $25,000 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 ad.ditional
$1,(�0 or fraction thereof, to and including $1(�,000
$993.75 for first $1�,� plus $5.60 for ea.ch additional
$1,000 or fraction thereof, to and including $500,000
$3,233.75 for the first $5�,000 plus $4.75 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$1,0�,001 and up $5,608.75 for the first $1,�,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet times $20.00.
VERIFICATION OF FOLJNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the propos� stntcture and of the construction site.
A Certifica.te of Survey of the lot, showing the location of the existing foundaxion will be required before
proc,e�iing with the framing. New Houses `Only `