AF - 46425BUILDING PERMIT
Vi.11.age of Fridley, Minn. N� 2 � 7 y
Date . . . . .�:�'. .�. �. . . .�C'� . . . . . . . . . . . . . . . .
Owner . ����� � � . .�.'�. . j�����v�"?'yu-^, Builder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
s
Address ..y�.�'�j,l��.......�� ��:...... Address ........................................
LOCATION OF BUILDING
No. . . . s.� �/. � �,r. . . Street . . ���LG:''�. . . . . . �� . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
Lot ........... ... Block ................ Addition or Sub-Division .......................................
Corner Lot .... ..... Inside Lot ............ Setback .........,.. Side ......
yard ....................
DESCRIPTION OF BUILDING
To be Used as:
�ti���. . . . Front . ,,�,�. . DeptP� . �.�. . HeigIit �� Sq. F't. . . . . . . . . Cu. Ft. . . . . . . . .
. .. . . . . . . . . .. .. . . . . . Front . . . . . . . . Depth . . . . . . . . Height . . . .. . . .. Sq. Ft. . . . . . . . . Cu. F't. . . . . . . . .
Type of Construction .�;��:�y�;�.,,� Est. Cost . .. . ��,�(�, .� , , , To be Completed .�,�-�.�.�. . NI..":. � �'
t� a ,%�o v� �,,r��+' � 9��%�J
In considera.tion 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��c�sideration of the payment of a fee of $.... , permit is hereby granted to "' ��r'.,�`,��.�.... .......
���• •..... to construct the building � ad dition as described above. Thi�permit is granted upon
e express condition that the person to whom it is granted and his agents, employees and worlunen, in all work
done in, arownd and upon said building, or any part thereof, shall conform in all respects to the ordinances of
F'ridley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances.
.� �° d .�,..�...—
`�:-73,, Building Inspector
NOTICE:
This permit does. no4 cover the construction, instaliation or alteration for wiring, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these items.
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CHIMt�EY AN�J STACK VERIFICATION
The undersigned hereby verifies that the existing chimney o� stack;
1. Has been carefully examined Yes (,)
2. Is free from rust or deterioration Yes ()
3.` Has no foreign objects lodged within Yes O
4. Is securely supported Yes ()
5.--ii�ee�s ��fi-current Cvae requiremenLs for size and
total BTU connected
6�. Has Total heating BTU�s of
All other BTU's
TOTAL
Rema rk s
No ( )
No ( )
No ( )
No ( )
. Yes ( ) No ( )
Cam pa ny
Signed �y
Da te
SuBJEGi
' �
City of Fridley 2 5 9 3 2
AT THE TOP OF TME TWINS g U I L D I N G P E R M I
r
� � NO.
� 1 L�_�__ COMMUNITY DEVEIOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC. l e���
1 � �
L---_ � �r�",•, CITY HAIL FRIDLE� SS43Z NUMBER REV DATE PAGE OF APPROVEO BV
� '� 612-571-3450 9�aF�5
4/14/98 � �
J08 ADDRESS 5156 Hughes Avenue NE
t LEGAL LOT NO. BLOCK TRACT OR AODITION SEE ATTACNED
DESCR. ],(} 7 Carlson's Summit Manor South SNEET
2 PqOPEFTY OWNER MAIL ADDRES$ ZIP PHONE
Elmer/Marlysee Lee 5156 Hu hes Avenue NE 574- 25
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL AODRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW C,� ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
X
8 DESCRIBE WOHK
Construct a 20' x 20' & 6` x 36' Deck .
9 CHANOE OF USE FROM TO
STIPULATIONS
See notations on plan.
��
8e��e ��
all 4iBglp �
Q� u1��, � �' r�l/ for
IT ��/� �D2 h0ns
�o ey .
��
SEPARATE PERMITS ARE REOUIRED FOR ELECTRiCAL. PLUMBING, HEATINO, �PE OF CONST. OCCUPANCV f3ROUP OCCUPANCV LOAD
VENTILATING OR Alii CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. fT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STAIIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS yAIUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT � W6sOOO �3.00
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEiiMIT FEE SAC CHARGE
PROVISIONS OF AN OTHER TATE OR LOCAL LAW REGULATING CON-
STRUCTIO T PERFO NCE OF CONSTRUCTION � 112. ZS Fi e SC �E) . OO
PLAN CHECK FEE T07 EE
�- � � f 121. 25
GNATUREOFCONT ACTORORAUTNOiiIZEDAGENT iD Ei EN ROP VALID T THIS IS O PERMIT
__ • � _/V �
!
SiGNATURE OF OWNERpF OWNER BUILDERi IDATEi 84D �NSP qATE
NEW
ADDN
ALTER
[l
[l
�]
ConstructionAddress:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
� �� � �r�� � ��s ���
Effective 1/1/98
,�
�r
�
Legal Description: `-
Owner Name & Address: � � i�1� � c� � a a� � N�'� ��- e� ' Tel. # �.�% `� 7� ��-�
Contractor: � C �� MN LICENSE #
Address: � C� �M � Tel. # o`� 7`l� ���-�
� Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF IlVIPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground � FTSq. Ft. ����d %7
� n /-� x � nl � f � ,� �c �. � � � � A-b ave dc-?
v � v -
Construction Type: (,l' C�� Estimated Cost: $ � C� Z? ��� 'S�� '��
(Fee Schedule on Back) �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: �( '1`��1 APPLICANT: �cc._ Tel. # � � `� 7�-��
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
. STIPULATIONS:
$ F �
$ �t'
$ ��
$
$
$
$
$
$
$ �/, ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
. ��� .
0
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the amount
herein below set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 tq $500
$501 to $2,0(�
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,�1 to $500,000
$500,001• to $1,0�,000
$1,000,001 and up
FEES .
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,Q00,000 plus $2.75 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 tunes $13.50.
Alternate B: Removal and replacement of curb and gutter and install a 3 foot wide
11 n approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site. .
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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City of Fridley 3 0401
AT THE TOP OF THE TWINS � � � L D i N G P E R M I T
r
; � RECEIPT NO.
� `� _��� COMMUNITY OEVELOPM€NT DIV.
r � � PROTECTIVE INSPECTION SEC. % ���
' K�
i_--- A�'��,', CITY MALL FRIDLE� �a2 NUMBEA REV DATE PAGE Of AVVROVED BY
i �� 612-571-34b0 9t0-F15
10/13/99 � �
�oe nooRess
5156 Hu hes Avenue N
t LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. 14 7 Carlso � S SNEET
2 PROPERTY OWNER MAIL ADDR�S$ ZIP PNONE
Elmer F� Ma.rl se Lee
3 CONTRACTOR MAIL ADORESS 21P PMONE LICENSE NO
Owner
4 AiiCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDFE$S 21P PFIONE LICENSE NO
8 USE Of BUILDING
Residential
� anss oF woaK
❑ NEW �c ADDITION O ALTERATIpN ❑ REPAIR O MOVE O REMOVE
B DESCRIBE WORK
Construction of a 2' '
8 CHANGEOFUSEFROM TO
STIPULATIONS
See stipulations on plan
P�ovide anchor bolts or tie downs for 80 mph wind load.
Provide roof load for 5Q lbs snow load.
SEPARATE PERMITS ARE REOUIRED FOR ELECTFICAL, PLUMBING. HEATING, �PE OF CONST OCCUPANCY GROUP OCCUPANCY LOAO
VENTILATING Op AIR CONDITIONING
THIS PEFMIT BECOMES NULI AND VOIO IF WORK Oq CONSTRUCTION 20NING SO. FT CU fT.
AUTHORIZED IS NOT COMMENCED V�11THIN 80 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS A7
ANY TIME AF7ER WORK IS COMMENCED. NO DWLG. UNITS OfFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ ANO EXAMIN�D THIS APPLICATION STALLS GARAGES
AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALL PROVISIONS OF LAWS yp�UATION SUR7AX
AND OROINANCES GOVERNING TNIS TYPE OF WpRK WILL BE COMPLIED
WITH WHETHER SPECIFIEO HEREIN Ofi NOT. TNE GRANTING Oi A PERMIT ].00O
DOES NOT PfiESUME TO GIVE AUTMOFiITV TO VIOIATE OR CANCEL TME pEqMIT FEE SAC MARGE
PHOVISIONS OF ANY OTMER STATE OR LOCAL lAW REGUTATING CON-
STRUCTION Oii T P RF ANCE OF CONSTRUCTION 3 e�
PLAN CMECK TAL FEE
' l� /�
40.25
S�GNATUAE O� CON OCTOp OA AUTNOp4E0 AGENT IOAT � P V VA � TMI$ 1$�R P RMI
_� � ^ � ' �
S�GNnTUAE O� OWNEA i�� OWNEA BU40EAi �OATE� DG �h5 q tt
F
rrEw � � =
ADDN
ALTER
Effective 5/10/99
[ ] CITY OF FRIDLEY
[] SINGLE FAMII.Y AND DUPLEXES R-1 AND R 2
BUII.DING PERMIT APPLICATION
Construction Address:
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Legal Description:
Owner Name & Address: �-) Ur� � (L � �� � �.�� ��� Tel. � ��� 7�.�.�
Contractor: MN LICENSE #
Address:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AItEA: Length Width Hgt/Ground Sq. Ft.
OTHER: ��i'�� � e ��► �d t 2- � 1�
Construction Type: � � oci
Driveway Curb Cut Widt�i Needed:
Estimated Cost: $
Ft. + 6 Ft = Ft x$
.��
—$ .
DATE: _ � �� d'2-�^z �' APPLICANT: Tel. �# ��� �2 �.`�
Permit Fee
Fire Surcharge
State Siu�charge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
� � � ,°7.�
$ , ��
$ . �f�
$
$
$
$
$
$
$ � C7. ��
STIPULATIONS: — �our (��
�o ��o�r
' ��a� ��r�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1050 per SAC Unit
$5.(� (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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BUII.DING PERNIIT 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 to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,OW
$25,001 to $50,000
$50,�1 to $100,000
$100,001 to $500,000
$500,001 to $1,(�0,000
$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 $2,0� plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,(100 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, 000
$993.75 for first $100,000 plus $5.60 for each additional
$1,OU0 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 $1,000,000 plus $3.15 for each additional
$1,0� or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alterna.te "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 lacation of the foundation once it has it has been constructed will
be required before proceeding with the framing.
��� �6�. ��� ��1 $n.�t�`Tl�,�.i�;i�r xE�`3$ �ri�r � "��l �
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. rt �(Sx1��, �.� � R, �} A��iiG A4 7 £ S�` F..'�` � '�e'p f i'!
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� ,� � WITN�SS BY:�/ PORCHES
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'RAISAL,CARD ;:: GARAGE -''CARP 5 '' cu�ss � �
c�s CLASS YEAR BUILT ��/�.�
YEAR BUILT / SIDE BACK C
��.T FRONT �
qTTACHED ��' SCREENED GLAZED ,
EFFECT�VE AGE FLOOR OPEN
FOUNDATION FLOOR
NO. STORIES fOUNDATION +� +��~y
EXTERIOR .� �•f t " �r' EXTERIOR
h
BY BY �. �
p 2 3 . ROOF ROOF !tZ ,
INTERIOR INTERIOR �y
O.H. DOORS �/ 9p ! '
ELECTRICITY � ` �
► i
YARD i ROVEMENTS ;; - � � ,, ,
� ,�� .,�, �.,8����.EWAY . ;: � _ �
CLASS DRIVEWAY T% �
YEAR BUILT a q � �w
FLOOR �. � "
FOUNDATION "'
EXTERIOR Q� t^ c
ROOF .I ��. "�,�,., 'P , � � u I V/
INTERIOR � �, f p • '� . r . � I
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' DIMENSIONS ; : ' I :
=' . X = � II\
.� � _ �� . �0 �— X _ = N
X O X �
� `�°� x = X _ ' • �
�� �� = s,�'� x = X� v- �4
X � X = � 4
... _
X - _ X _ �
X_ X_
x = -
x = X = �.
x
x = X t
�.. 1 �g�
NO. , 19 � lq 19 ` � 19 ' � � ° _. /1(EW �i'/7t//CI�
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RANGE-OVEN , - d� ' ��"'" �
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HOOD-FAN � n ✓ � ' �S/�1 T '
GARBAGE DISP
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:ERAMIC TILE _
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AIR CONDI
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, BY, DATE ��� G�v� 1 S x( � �
, , : 1AlITNESS � � , � ,
; n��►�►
. ' � � � _ ._^...� .-... . , . �r11lTC , 1 4 -, ��.\ r
~ Permit No.. G a � �a
Building MECHANICAL
Inspections RESIDENTIAL APPLIC�TION Received By: ��
t�
763-572-3604 CITY OF FRIDLEY Date Rec'd: e �
DATE � — � 1 YOUR E-MPJL ADDRESS
SJTE ADDRESS .SI S �o �' W
TH1S APPLICANT IS: 0 OWNER 1�'AN!'RACTOR
PROPERTY �y,y�„�;
�ENNA1 � ADDRESS: � �� CI1Y � j,�_�k.� ST� ZI �
PHONE:� �� � -� �
CONTRACTOR COMPAriY NnN�: .
CONTACT PERSON: P"�� Anderson Heating and Air-Conditioning
SUBMIT A COPY OF °�
YOUR STATE STATE LICENSE � N/a 4347 Central Ave N.E. —
LICENSE WITH qDD�g; * r STATE ZIP
APPLICATION PHONE �%�'%�I- (0-s// CO�. HtS� lvi11 SJ4Z1
,
PERNIIT TYPE ��GLE FAIvIILY ❑ TWO FAMILY O TOWNHOUSE
TYPE OF WORK: ���'�' ���CEMErrT O ALTERATION/REMODEL •
DETAILED DESCRIPTION OF WORK � � �
� �
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WF�RE LABOR EXCEEDS $500, FEFS ARE BASED ON $10.00 PER FIXTURE, EXCHPT' WHERE NOTED. FDCTURES: (AIDICATE TOTAL
NUNBER OF EACH BELOV� � `l
Equipment Instalicd . MFG: MODEL: 1� S1ZE/BTU �0
MFG: MODEL: � SIZE/B
MFG: MODEL: SIZFJBTU
�A/C 525.00 _FIREPLACE (GAS) 515.00 _GAS RANGFJOVEIJ $10.00
AIR TO AIR EXCHANGEER $15 FIREPLACE (WOOD) $35.00 NEW GAS GRILL $10.00
BOILER S35.Q0 � �QFURI�ACE 535.00 _GAS UNTf HTR $10.00
CHIMNEY LINER $10.00 _GAS DRYER $10.00 _POOL HEAT'ER $35.00
DUC'T WORK 510.00 (3AS PIPING S10.00 VEIJ7'[LA7'OR 515.00
"�E ' ,�R�.��.�RO . F,(aA �D�: n0 ' � r ���R.�'�
, .. ; � .�' ;:.� � SQ�;-.
Permit Fee $ a� " Number of fixtures @$10.00 x$10.00 =$
Surcharge $ .50 Number of fixtures @ $15.00 x $15.00 = $
TOTAL DUE $ �.� Number of fixtures @ $25.00 • z $25:00 = $
. Number of fixtures @ $35.00 . x $35.00 = $
St�te Sw..c�i�ge = $ .50
Tota1= $
' 7'l�IIS IS AN APPLICATION FOR A PERMIT NOT VALN UNTIL PROCESSED �
I hereby apply for a building 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 •Construction Codes; that I um�erstand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plaf� in the case of all work which requires review and approval of plans.
SIGNATURE OF APPL1CANf L. GV��2,u�(,�i'1Li./�1 � • PRINT NAMEC. •!�Nli ��Bfl��YGj U'' DATE 'O°'o'i�I �i
_. }� �}���
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City of Fridley ��
Suilding Inspections Department .
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977