AF - 46427�UII..DING PERMIT
Vil.lage of Fri�ley, 1Vlinn. _N° 2 4 2 4
Date ,�j�:'•"'"• �� ,�" . tij .�' : . . . . . . . . . . . . . . . . . . . . . . .
Owner ��`�,�;:: � "�Ec°'"�:�:��:�'e�,�:}: . . . . . . . . . Builder ��'���`' . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address �`� � � . .� ;�� �. . .e*�. ;Let."r�$. . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
. � ,� ,� LOCATION OF' BLI[LDIN�
No. . .a,�� . . . . . Street . . �.�'�.�"�'�: �' �t��'. . e�:��.s�' . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
�
Lot . . . .�`„��".". . . . . . . Block . . . �': . . . . . . . . . . Addition or Sub-Division .�t-'-.���:-:-T�:�:�. ��,��';r+� � ;''� , , , , ,
Corner Lot ............ Inside Lot ............ 5etback ... ...... Sideyard ..........................
To be Used as:
/��'����+:x� . ...
DESCRIPTIOIV OF BUdLDONG
Front . ,�f ,,ti'. . Depth .�',s�' . . Height �1.�.� 4. ..
.................... Front ........ Depth ........ Height .........
Type of Construction � � ,�a•a��. . . Est Cos���`�l#i�: . :��:� . . . . . . . . .
0
Sq. F't. �! �� : . Cu. Ft. . . . . . . . .
Sq. Ft. ........ Cu. Ft. ........
To be Completed �k" :�:'f��'`:t�...
In consideration of the fssuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordinances of the village of Fridley.
Tn considera�io$ of the payment of a fee of $. ��,... , permit is hereby granted to ,�.p�,;�'�.�,,,��!�f ,,��, ,....
-��-�+::�z�. ...... to construct the building or ad dition as described above. This permit is granted upon
the express conclition that the person to whom it is granted and his agents, employees and worlanen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
�'ridley, Ntinnesota. regarding location, consiruciion, alteration, maintenance, repair and moving of buildings with-
in ihe village limfts and this permit may be revoked at any time upon violation of any of the provisions of sairl
ordinances. �
F �«�
. � . '"� ���;�,:���,��,���...... Building Inspector
WOTICE:
This permit does not cover the construction, installatton or alteration for wi�ing, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate perml4s for these items.
�- -� �-.
� �,
SUBJECT P
City of Fridley 49'7�
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T •
�
COMMUNITY DEVELOPMENT DIV. RECEIPT NO.
� �
� �ti.-------�
r � � PROTECTIVE INSPECTION SEC.
�
� � �
�� /'�'1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
•'-•� � ,•� 612-560-3450
910-F15 10/25/78 � �
JOB ADDRESS 5157 Hughes
1 LEGAL LOT NO. BLOCK TRACT OR ADDI710N SEE ATTACHED
DESCR. �.5 6 Carlson's Sl]IDIDlt MdriOr SOli'�1 SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Archie Shrewsbury 5157 Hughes
3 CONTRACTOR MAII ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION � ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Construct ma�nry chimney and brick front
9 CHANGE QF USE FROM TO •
STIPULATIONS
SEPERATE PERMITS REQUORED FOR 1�1lRlffifGe
H�ATING, PLUMBtNG AND SIGIVS�
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S0. 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 �' 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. $`2�QOO y��..00
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � $ZZ.00
� PLAN CHECK FEE TOTAL FEE
$l3. OQ
I U C C70RORAU7H RII�EDAGEtuT �DA7E1 WHEN PROPER ALIDATED THIS IS YOUFi PERMIT
� I/S� G� �� � � �� oU.
�SGNA R FOWNERIFOW ER �ERI IDATEI ��'- � BL�G INSP p E
0
.
CITY or-
r-itiv�cY .
• APPLi C/1TI 0t� rOft RL'S I llf_NT I/1L BU l LD I NG PE(2t�1I TS .
' (�1�L"W, �LTL"R/1TI0(�dS, �L�llIT101JS, OR �EPAIRS)
.,
. :
OWt1�R: rC d�� }3UILD�R: ''' .
�aax�ss : ��7 ,�f` C4 � � naar�ss : .
• Tel . 2Jo . :
1Jo.:�� /��_ Street: /,j ���— •
LOT : ^�� BLOCY.: _� ADDITION : ��I � / ��;�1/ � �[.4� l � a � � O
C012NER LrJT: I2JSIDE IAT: �' 5LTBACY.: SID�YARDS:
Ap�licarat attach to L-his form 7�ao Certiiicates of Survey of Lot and proposed
• building locaL-ion drawn on these Certiticates. •
DESCRI PTI OPJ OF BUI LDI NG
0
� To Be Used 11s: � � ,
� Front: � Depth: � Nei.ght:
Square Feet: � Cubic Feet: �
, e � Fronts � Depth: � Heiqht:
�f�'�` �'� � Square I`eet: CUbic Feet: '
�pe ot Construction: . _ �� _ _ ._ EstimaLed Cost: $ , �"�d
7.b Be Completed: �% �,ct �( `�, Alt. A Alt. B
Proposed Drive��ay Width If 11ew Opening Is Desired $ $
(SE� R�VERSE SIDE OF SHEET)
The undersigned hereb�� makes application for a permit for the work lierein
specified, agreeing to do all work in stLict accordance �aith the City of
Fxa.dley Ordinances and rulings of the Department of Suildings, and hereby
declares L-hat all tlie facts and re�resentations stated in this application
are true and correct. See reverse s
DAT�: � � � _ STGNATUF�E:
Stipulationso
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BUILDItJG PER��IIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the erection
of any buildinq or structure, or for any addition to any existing building ar structure,
or for any alteration or repairs to any existing building or structure, upon application
therefore, require the payment by the'applicant for such permit of fees to the amount
herei:n below set forth and in the manner herein provided to-wit:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee.
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$14.50
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with
6 itzch depth; Driveway width plus 6 feet x$17.20
�11 � �_ ► 1' : �l
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) 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 existing 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�no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge. ° �
' + � � � 1 � : ��
NOTE: Permits for construction will be issued a mini.minn of 24 hours from the time
of application to allow for proper review of the proposed structure and of the
aonstruction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceedi.ng with the framing.
i : � • ':A
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building permit has been issued; and
saa.d structure shall not be used or occupied until a Certificate of Occupancy has
been issued. �
�._� �
,�
%
SUBJECT _ � 5� 5 81- �
c�ty of Fr�aley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � ECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
� j Y----- � ��/ //
r � � PROTECTIVE INSPECTION SEC.
� . ,
�
� � /"'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�----� • •�� 612-571-3450 910-F15
12/12/79 / /
JOB ADDRESS 5157 Hughes Avenue N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. lrj 6 Carlson's .S11IDIILl.t �dri01 5011't11 AC1CIt1. SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Archie Skr.ewsbury 5157 Hu hes Avenue N.E. 566-8609
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Sussel Com an 1850 Como Avenue St Paul
4 ARCHITECT OH DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
Residenti_al
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
�
9 CHANGE QF USE FROM TO
STI PU LATIONS
SEPERATE �E���i�� ���uau�r� F�� �I�I�t�
�-ICATlIV(;, P��tJM��t�� A�,ip SI��VSe
������
Before digging c�ll local util�es
TFLEPHGI�E - F�EC7�l� _ �qS Etc.
EtE�i����� ��' i.,�1�r'
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOGl Frd�G
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT 22t�
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 CORRECT. AI.L 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 S%OO Z.BS
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PR VISIONS OF ANY OTHER STATE O LOCAL LAW REGULATING CON-
ST UCTION OR THE PERFO ANCE O ONSTFiUCTION. 3Fi.00 NONE
'� PLAN CHECK FEE TOTAL FEE
. 1.•12 •7 j
SIGNATUREOFCONTRA RORAUTN RIZEDAGENT (DATEI � WH N PRO ER V DA D THIS IS YOUR PERMIT
�
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SIGNATURE OF OWNER�IF OWNER BUILDEP� IDATEI BLDG iNSP � ATE
S
�
CITY OF FRIDLEY •
��,p�
M�F�'
�ii
Af'-PLICf�TION FOR RESTDENTIAL EUILDTP�G PERMITS �
� (fdew, Ali;erations, Additions, or� Repairs)
OWPdER:�'��� � / BUI LDER : - `-�
�1DDRESS:��S C�— AQDRESS: � �� ��
TEL N0: �CO�°�6 B% TEL N�: �v �S ����
Construetion Location
s�xr�� t�o : �� � 7 STI2EET: ��—e ���
LO�: �� BLOQC: �j � ADDITION:I�'e'%/`v'�
Corner Lot: Inside Lot: Se�tback:
Sideyards;
Applicant attach to this form two Certificates of Survey of lot and
proposed building location drawn on certificates to scale.
� r,� p c�, � DESCRIPTIO�� OF CONSTRUCTION �
� ,�' / P
� Front: � Depth: v Height: ��
Squa�e. Feets 2 Cubic Feet;
Front: Depths Height:
Square� Feet: Cubic Feet:
. . S� oo. �u
�.�� . ,
Type of Construction: Estimated Cost: $
�b Be Cbmpleted: � Ir (� �
' Alt. A Alt. B
Pro,posed Driveway Width If New Opening Is Desired: $� $
, SEE REVERSE SIDE OF SHEET .
The undessigned hereby makes application for a permit far the work herein specified,
agreeing to do all work in strict accordance �aith the City of Fridley Ordinances and
rulings of the Depariment of Buildings, and hereby declares that all the facts and
representatiens stated in this applicati n are true and correct.
% / % /�� �J��,�
DATE : l� 1� r' /� S IGriATU RE : w (�-Z� '
. � �� ,�
Stipula�ions: ` � ��
IyXI� � z2�X 2�.�5 t SiOG
4 �o ` �
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S:?. xr s
3�, ov �tiw► t�°
9 . oo P. �°
Z.es '�v
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IIUl LUII�G P�R1�1IT I FC� SCf�CDUI_E� .
SrCTI0I1 2. �`lie Jn����cel:or oL L�uilcla�ng , sh��].�., }�eforc: i�suing L�ennit•s for the erecLion
oL any bui].dil�c� or si:ruct:urc, or for any addi4�i.on Lo any eri::t_ing Uuildi.ng or strucL-uxe,
, or io�' any alteration or rei�airs to •any cr,i�Ling buS.Ic2a.ity or sL-zucture, UjJG21 applica�ion
�L•hcreforc, rec�uirc the paymenL• Uy t}ie ap�l.icanL- �vr. sucla permi.t o� fees to. Lhe amounti
herein below set forth aiid in tiie manner herein �ro�,ia�a to--wiL: . �
N�W CONSTRUCTION: Single rami].y Ilomes and Garages: $4.00/1,000 cubic feet. '
PL11N CIiL•'CY.: 25 percent of bui.lding permit fee.
bRIV�t?AY D�PRL5SIOI1: (ConcreLe, C1arb Streets Only) �
• AliernaL-e A: I2emoval and rep].acement o£ concrete curb and
yuL-�er only; Driveway width plus 6 feet x Y�S,75
�,lternaL-e B: Remova7. and replacement of cancrete curb and
.� • gutter and install a 3 foat wide approach with �'
' . 6 inch depth; Driveway width plus G feet y$17.85
�DDITIOhAL I FOR�I/ITION
For the purpose of computing £ees for building permits, the cubical contents of any
build9.ng or addition, is determined by rnultiplyang the ground area covered irom a
paa.nt six (6) inches below ih� 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 raain gable of a pitched rooi'.
For repairs or alterations to an existing structure, the fee shall be at the rate
of $3.00 �ier each five hundred dollars�($500.00) or fraction thereof �.n the cost
of all proposed work. . . '
Tn •no case shal.l the fee charged for any pexmit as set �Eorth a.n Section 2 be less �
than $7.50 plus $.50 state surcharge. '
VERIF�CATION OF FO�JNDATION
NOTE: Permits �or construction wi.11 be issued a minimiun 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 5urvey of the lot, showing the location of the faundation once it
has been constructed will be required before proceeding with the framing.
CERTIFIC�TE OF OCCUPANCY
App].ica�ion for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy o� any structure for wliich a building permit has been i.ssued; and
said structure shall not be used or occupied until a Certificate of Occupancy has
been issued.
0
L,�; L�:� _ �: �;1�'�I_L�i'l ,�1�� �.�w�_ •�.i�' ; u�;�'u. �'ll 10t! �' d�
�
> OWN�P � �.. $ �R,u�• _ _���._ 7�! S �'I��Iw1s ��T
� T
�. SITE 11DDR!:SS _ ���� � 111��� -�t'--I-�-� ,�IWV1� ��
� a
co�TrncTO�: �i u_�'.�_._s...�l�. �>,��ri: _--��l�� t>norar _�9'.�"�331
DL''TEP.^1I\i: ivOI:hINi; SQU.11:1: i�OU'I'�1i11: 0� EACIi
1. Total exposed cr;�ll ar�:a . . . . o . . � �. ���� :;q. Ft. x .185 - g
2. 'I'otal roof / ccilin� ar�;t ....... ���� ;,cl, Ft. x ,04 = ��
.
b.
c.
d.
e.
f,
�•
h.
i.
-.._._..____� __._
TUT!1L I•:XPOSI:I� �•!ALL :^,ItI:� �1i;0��1; 1�I.c,Olt = _ � ,
1�LTP:R�!I�;I, "U„ �rAl.Ul: clI� I:�1Cli ':1:.LL ;'EGMENT
S,.j � �iU�i
Total c�:all winc:ow area •• ............. �g��g �' _ �
Total �oor ar�� � . . . . . . . . . . . . . .. . . . . . . �� � . . .��. _ . . � .
Total slidir.}� �la�� door ar�r;i , , , , , , , , � }{ . _ ---"--
�. �..�r. ,
Total fireplace �,r�ll area . . , . , , , , , , ��� X e� _ ���
Total wall f�-amin�; area (a����z•�ge 10;�) X =
Total net wall arca abuvc f:��or ,,.,,, ! (o X _ °
Total r�m joist area ................ X 6 ='/�
TOTnL LXI���Sr:i� :�(�Utdl)ATIOV A1tG�l = �o��� �
Total foLndat iun ldL:1cIOW ar�•;� , , , , , , , , , .�� X „� _ �� '
Total net foundation arca c_'�� �c �;ra�c X �_ ���
.
3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . T�TAT.� �9.91
If item 4�3 is tiie sane as., or less tl�an itcr.� ��1, y,,u have met the intent of
S13C 6006 (C) 2.
T(1T,1L E:{POSED Rc�(?F / CI:II.INc; AItF.:1,= ��_
I� :TI:�:;•fInli "U" 1',`,LUIi .'01� 'L�\C11 I�OGI� / CL LINC SGG�iENT.
Total skyli�l�t area ,,,,,,,,,,,, , S9• "U"
J • . . . . . . . . . . . . ,�_ 7C �� _ .��
�c. Total roof/ceiling framin�; area (;:v��ru,;e 10%) }{ _ w0� _
l. Total net 1I15i11;1CC3 roof/ceilitr� ar��a ..... .
. • • X --�,� _
4 .......... ...............................................................TOTAL �.�'�
If total of �f�4 is tt1r� ;,a�7e a5, or lc:;s tlt;in ;'�2, you t�av� met the intent of
SBC 6006 (C) 1. �
e1LTF.ItPIATL'' BUlI,UIi�t: 1�::IV1'1.OP1? llL''SI1�G
To utilize the total envel,,pc system n�cthocl, the ��;�1ues estahlished by the su�
of items �-3 and �d'+ sha] 1 r•.�t be ,�rcat��l' Ill.ill �lic ;:�nn uf itc��;:s !�1 and- ��2.
1 � • _ � � • �_ - � �� _ • ����`/
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sue�ecT PERMIT .
City of Fridley 4� 18 4 8 3 -
' ` AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RECEIP .
�
� ; v _ COMMUNITY DEVELOPMENT DIV.
f � � PROTECTIVE INSPECTION SEC. �� �� y
1 i �
l.-__� ��"��,,� CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
L 612-571-3450 910-F15 6/9/86 / /
J08 ADDRESS 5157 Hughes Avenue N,E,
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ],rj 6 Carlson's Summit Manor South Addition SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Archie Shrewsbury same 572-8609
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
D& D Home Improvement Inc, 784-7543
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE IICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDINfi
7 CLASS OF WORK
O NEW ❑ ADDITION �I ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reshingle dwelling
9 CHANOE OF USE FROM TO
STIPULATIONS
1. Shingles can be second layet^ 6ut not third,
SEPARATE PERMITS ARE FiE�UIRED FOR ELECTRICAL. PLUMBING, HEATING, NPE OF CONST. OCCUPANCY GHOUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S0. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OH 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 STALLS GARAGES
AND KNOW THE SAME TO BE TFiUE AND CORRECT. ALL PROVISIONS OF LAWS ypLUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $1,350 �sC7
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
P OVISIO S OF ANY OTHEfl STATE OR LOCAL LAW REGULATING CON- $23 e�jO
TRUCTI N OR THE PERFORMANCE OF CONSTRUCTION.
� � PLAN CHECKFEE TOTALFEE
l�L��� � 24 .1 %
SIGNATUREOFCONTRACTORORAUTHORI2EDAGENT OATEI WHEN PR ER V LIDATED T IS I YOU PE
- - � ,���2� ��-z.l�. � ��
SiGNATURE OF OWNEF�IIF OWNER BUILDERI IDATEI BLDG INSP �l+TE
NEW [] City of Fridley Effective 4/1/84
ADDN. [] R-1 AAD R-2 j
pLTER. �7 Building Permit Application
Construction Address:
Le�al Deseription:
Owner Name & Address: -����%L-° ����P�S,��/a(AJ ••�+Or `�• "' TeZ. � �%Z°��
Contractor : � 94-v ri'�//✓'!I� �.�,�Pe��'r�,�.rJ7�. ....�'•�/�C_ Tel . � ���-��
Address: ��� ��/1�1��i� .�� �'�
LIVING AREA:
GARAGE AREA:
DECH AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construetion drawn on it to scale.
DESCRIPTION OF IMPROYEMENT
Length Width Height _
Length Width Height _
Length Width Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setback
� s
Type of Construction: ���%��'/� Estimated Cost: $ ,�'��
Approx. Completion Date: ..� � E � �
Alt. A Alt B
Proposed Dr3veWay Width If New Opening Is Desired: $ $
See Baek Page for Explanation
DATE: L�� APPLICANT: ����'2 _ Tel .���� �=� L�
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
��
STIPULATIONS:
$ ���0
$ �_
$ ���
$
�
�
$ '1 1
CITY QSE ONLY
Fee Schedule on Reverse Side
25� of Building Permit Fee
$.50/$1,000 Valuation
$425 per SAC Unit
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
_ =� `
��
j 3 �v
�oU - l�i.u�
t�`�% . S'u t, � �'c�
��
�
�
I� �.
4I I
.� �t
�
�
BIIILDING 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 strueture, upon applicatio n
therefore, require the payment by the applieant for sueh permit of fees to the amount
herein beloW set forth•and in the manner herein provided to-wit:
Total Yaluation
#1.00 to $500.00
�501.00 to $2,000.00
Fees
$10.00 (Minimum Fee is $15.00)
$10.00 for the first $500 plus $1.50 for each
additional �100 or fraction thereof, to and including
$2,000.
$2�001.00 to $25,000.00 $32•50 for the first $2,000 plus $6.00 for each
additional $1,000 or fraction thereof, to and
including $25,000.
$25,001.00 to $50,000.00
$170.50 for the first
additional $1,000 or
including $50,000.
$25,000 plus $4.50 for eaeh
fraetion thereof, to and
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1�000 or fraction thereof, to and
including $100,000.
$100,001.00 and up
$433•00 for the first $100,000 plus $2.50 for each
additional $1,000 or fraction thereof.
DRIVEMTAY DEPRESSION ESCRO�TT
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus
6 feet times $13.50
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 $15.75
VERIFICATION OF FOIINDATION
Permits for construction Will be issued a minimum of 24 hours from the time of
application to allow for proper review of the propos�d structure and of the
construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been construeted will be required before proceeding with the framing.
_
� o-
sue�ett P
c�ty of Fr�a�ey 3 i 4�4
A T T M E T O P O F T N E T W I N S � � � L D I N G P E R M I T
� � �.
� ; y �_���_ COMMUNITY DEVEIOPMENT OIY. `
r � � PROTEC7IVE INSPECTION SEC. /�'f �
1 . � (V
l---.� ��"' �•� CITY HALL FRIOLEV 85132 NUMBEN pEV DATE PAGE OF A6PROVED BY
t 612-571-34b0 s�aF�s 10/6/00 / /
JOB AODRESS 5157 Hughes Avenue NE
1 IEGAL �OT NO. BLOCK TqACT Oii ADDITION SEE ATTACHEO
DESCR. 1S 6 Carlson's Summit Manor South Addn SFIEET
2 PROPERTY OWNER MAIL ADDRES$ 21P PHONE
Archie/Kim Shrewsbury 5157 Hu hes Avenue NE 572-8609
3 CONTRACTOR MAIL ADORESS 21P PMONE LICENSE NO
Dave Wiger Construction 901 Rice Creek Terrace NE Fridle MN 2
d ARCNITECT OR DESIGNEii MAII AODRESS ZIP PMONE LICENSE NO.
763-572-8403 8392
5 ENGINEER MAIL ADORESS ZIP PHONE LICENSE NO
B USE OF BUIl01NG
Residential
7 CLASS OF WORK
O NEW ❑ ADOITION ❑ ALTERATION C� REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Replace 9 windows within existing openings
9 CHANOE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms atad on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code.
SEPARATE PERMI7S ARE REOUIqEO FOR ELECTRICAI, PLUMBING. HEATIN(i, TYPE OF CON T. OCCUPANCY GROUP OCCUPANCV LOAD
VENTI�A7ING OF AIR CONOITIONING
THIS PEFMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO. FT CU FT
AUTMORI2ED IS NOT COMMENCED Vj�ITHIN 80 DAYS. Oii IF CONSTqUCTION
OR WORK IS SUSPENDED OR ABANDONED FOii A PERIOD OF 120 DAYS AT
ANV TIME AFTEFi WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PAqKING
I MEREBY CERTIfY THAT I MAVE READ ANO EXAMINED THIS APP�ICATION 1 STALIS GAFAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS ypLUATION SURTAX
ANO ORDINANCES GOVERNING TMIS TYPE OF WOqK WILI BE COMPGIED @
WITH WHETMER SPECIFIED HEREIN OR NOT. TME GRANTING OF A PERMIT `I'2sOOO ` $1.00
DOES NOT PpESUME TO GIVE AUTMORI7V TO VIOLATE OF CANCEL TME pEqMtT FEE SAC CNARGE
PROVISIO Of ANY OTHER S7ATE OR �OCAL LAW REGULATING coN• �69.ZS Fire aSC �Z.00
STqUCTlO R TM PE fOAMANCE OF CONSTFUCTION
��� PLAN CNECK FEE TOT FEE
Licen C $5 7.25
S�GN4TUpE O� LON'NAC OA 4UT110p�IED 4GENT �•iEi E P OP VALIDATEO MIS IS VOUR PERM17
.- /O - -�j
S�GN4TUREO�OWNEA��FOWNEABWLD@tii iOATEi �NSp' ' piiE
4 '�
NEW [ ]
ADDN []
ALTER [ ]
Effe�tive 1/1/2000
CIIY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: 'S �� � �u ���� � f%
Legal Description:
Owner Name & Address: I�IZC°lf/�����.y� c5'fflZ��S,�ceh'� �'el. # � �o� — �� � �
Contractor: D f� �� / �s
� ��� MN LICENSE #_ CJ � % r�
Address: 9� / /Z�C� C����' I�f�/� Tel. #✓�7� ^��a3
Attach to this application, a Cert�cate 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 Width Height Sq. Ft.
DECK AREA: Len th Width Hgt/Ground Sq. Ft.
OTHER: ( L� � � j'd�f b%e /S�ca�? 47� !� o c� c7 �.S'�9�%%� �T'�Z�
Construction Type: Estimated Cost: $� D�Q
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
� c�(Q �.DOCJ %) � /�
DATE: , APPLICANT: �z/ Tel. #� T�� �/ a' 3
CITY USE ONLY - Call (763) 572-3604 for Permit Fees if malling in application
Permit Fee $ (��% �� Fee Schedule on Reverse Side
Fire Surcharge $ �- �� G .001 of Permit Valuation (1/10th%)
State Surcharge $ l , �C� $.50/$1,000 Valuation
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$.
$1100 per SAC Unit
$ � C� C� $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 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 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,OOO,Q01 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 $25,000 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $SO,Q00 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $1(�,0(}0
$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 $1,000,000 plus $3.15 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Altemate "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 minunum of 24 hours from the time of application to allow for proger
review of the proposed structure and of the construction site.
A Certificate of S�rvey 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
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CHIlVINEY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioration
3. � Has no foreign objects lodged within
4. Is securely supported
5. Meets all current Code requirements for size
and total BTU's connected
6 Has total heating BTU's of
All other BTU's
TOTAL BTU's
7. Has a liner been provided for water heater
8. Has combustion air been provided for water heater
Remarks:
List ALTERATIONS Being Done:
HEATING CO:
Signed By:
Date:
Yes()No()
Yes ( ) No ( )
Yes ( ) No ( )
Yes()No()
Yes ( ) No ( )
Yes ( ) No ( )
SuB�Etr N M L�N'CT"
City of Fridley 3 3 9 6 7
AT TME TOP OF TME TWINS g � I L D i N G P E R M I T
�
; � CEIPT NO.
� ; y _____ COMMUNITY DEVEIOPMENT OIV. �
r � � PROTEC7IVE INSPECTION SEC.
1 ; �
i__--�; �'�' �'� CITY HALL FRIDLEr SS�S2 NUMBEp i1EV O�TE vAGE OF •VOqOVEO B�
L 763-571-3450 et0-Ft5 10/13/03 / /
JOB AODRESS 5157 Hughes Avenue NE
t LEGAL �OT NO. BLOCK TiiACT OR ADDITION SEE ATTACMEO
oescA. 15 6 Carlson's Summit Manor South Addition SNEET
2 PROPERTY OWNER MAIL ADDRESS 21P PMONE
Sam Shrewsbury 5157 Hughes Avenue NE 763-572-8609
3 CONTRACTOR MAIL ADDRESS 21P PHONE �ICENSE NO
Same
d ARCHITECT Oq DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER
8 USE OF BUILDING
Residential
7 CLASS OF WORK
MAIL ADORESS
ZIP PMONE LICENSE NO
O NEW O ADDITION O ALTERATION �7 REPAIR O MOVE O REMOVE
8 DESCRIBE WOFK
Reroof house & garage (22 Sq) Tear-off
9 CHANGE Of USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Building Code.
TYPE OF CO
SEPARATE PERMITS ARE fiE�UIRED FOR EIECTRtCAL, PLUMBING. HEATING,
VENTI�ATING OR AIR CONOITIONING
TMIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTION ZONING
AUTHORIZEO IS NOT COMMENCED WITMIN 80 DAYS, Op IF CONSTRUCTION
OF1 WORK IS SUSPENDED OR ABANDONED FOFi A PERI00 OF 120 OAYS AT
ANY TIME AfTER WOpK IS COMMENCED. NO DWLG.
I MEREBY CERTIFV 7HAT I MAVE REAO AND EXAMINEO THIS APPLICA710N 1
AND KNOW TME SAME TO BE TRUE ANO CORREC7. ALL PROVISIONS OF LAWS VALUATION
AND OFIDINANCES GOVERNING THIS TYPE OF WORK WI�L BE COMPLIED @
WITM WHE7HER SPECIFIEO MEiiEIN Ofl NOT. TME GRANTING OF A pERMIT �P2,547
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TNE pEqMITfEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGUTATING CON• @83.25
STRUCTION OF TME PERFORMANCE OF CONSTRUCTION .�a
S�GNOTUpEO�CON'AACTOpOpAUTHOp�2EDeGENT ID1TEi
i� �_� �� ._ J% .,.�. ��-)Z_��Z
.��
SO.
STA�LS
GROUP OCCUPANCVLOAD
CU FT.
OfFSTREET PARKING
IGARAGES
$1.27
SAC CMARGE
Fire SC $2.55
TOTALFEE
�8%.�%
Y VALIOATED TMIS IS VO A PEii
NEW [ ]
ADDN a [ ]
ALTER [ ]
CITY OF FRIDLEY Effective 1/1/2003
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
Construction Address: J� J� 6
Legal Description:
�,�
Owner Name & Address: O�c ��1vv� SZ-i � A�5 � u Y�/ Tel. #��� .S ��� c��o�"j
Contractor: �� �7�� MN UCENSE #
Address: Tel. #
LIVING 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. Ft.
Length Width HgUGround Sq. Ft.
�� �
�—'�C.1f, Y' C7 1� � � ►�.� ��YJ � 14 G � � �� - -
Construction Type: Estimated Cost: $ � �
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: APPLICANT: �b� �Sl4-...�. .5 ���, � Tel. #7�3 5 7a ���°�
Call (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.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
CITY USE ONLY -
$ c�.� - �s�'
$ �
$ % � '%
$
$
$
$
$
$
$ ��-t��
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 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 [ ]
�
•►
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 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
$2,001 to $25,000
$25,Q01 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEE5
$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 $25,000 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
$1,000 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 $1,000,000 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 af Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
e.�
Buildinag
In�pections
763-572-3604
763-502-4977 FAX
DA
SITE ADDRESS _
THIS APPLICANI' IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
��
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�cnvE i-�-zo�o
❑ OWIGER
NAME:�,��
ADDRESS:_�
PHONE:�
NAME:�
STATE LICENSE
YO � E- L ADDRESS
�
OCONTRACTOR
�-�/�� � �-iJi'��° %�i Z,
``7 I'f ll Cs� 1-� t�`�
° �i ' A. % °� �' �i �% �I �
.� rii sa .>
�°SINGLE FAMILY/NEW CONSTRUCTION
I� TWO FAMILY/NEW CONSTRUCTION
O BASEMENT FRVISH ❑ ROOF
O DECK �SIDING
SIZE
❑ SWIMMING POOL
TYPE OF WORK: O NEW HOME CONSTRUCTION ❑ ADDI110N
❑ MAINTENANCE/REPAIR ❑ REMODELING
DESCRIBE WORK BIING DONE:
SIZE OF IMPROVEMENT LENGTH WIDTH
ROOFING O HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE Bt GARAGE
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
Vim+l
O Al�nninum
❑ Other
❑ ATTACHED GARAGE
O DETACHED GARAGE
Permit No.:�
Received By:
Date Rec'd: (
��; �� � STATE�ZIP S Z
EXP DATE
O DRAIN TILE
� OTHER
�a��vzrP��
FT
BASEMENT REMODELING SUBMIT�
1. Existing Floor Plan
2., Proposedfloorplan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
�Soffit ADDI1'IONS. & PORCHES SUBMIT•
�I Trim 1• Site Plan/Survey showing the existing structures
fp1'Fascia and proposed project.
2. Two sets of construction plans
R'INAOWS 3. Energy Calculations
IN EXISTING OPININGS OYes ONo LOCATION OF WINDOWS FOR WINBOWS — PROV[DE U-VAL(JE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF MANUFACTURE STICKER ON WINDOW.
OPENING CHANGES &
TYPE OF WIldDOW TO BE INSTALLED � NUMBER OF WINDOWS
ALL FEES ARE BASED ON i�ALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $,�< �dat� „�'" OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
.v .r � mc
$ �
$ i �
$ B
$
$
$
$
$
$
$ , o �'
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridlev Attac
THIS IS AN APPLICATTON 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 Construction Codes; that I understand this is not a
permit but only an applicarion for a permit and work is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT �A����a�_PRINT NAME� r�j�� ��� y DATE � ZOI '� .?i2 e%'�
i �- �
Page 2- Building Residential Application
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 FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
includin $2,000
$2,001 to $Z5,000 $69.25 for 1� $2,000 plus $14 for each additional $1,000 or fraction, to and
includin $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1� $50,000 plus $7 for each additional $I,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1" $100,000 plus $5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for the 1� $500,000 plus $4.75 for each additional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 forthe 1� $1,000,000 plus $3.15 for each additional $1,000 or
fraction
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 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
�
�
._
{
�...
� Sf
'# � �
BUILDING PERMIT APPLICANT: PROPERTY OWNER
I� , understand that the Staxe of Minnesota. requires
that all residential building contractors, remodelers and roofers obtain a sta.te license
unless they qualify for a specific exemption from the licensing requirements. This license
requirement applies to owners of residential real estate who build or improve such
property for purposes of speculation or resale.
By signing this document, I attest to the fact that I am improving this house for my own
use and am not building or improving this house for the purpose of reselling it. I hereby
claim to be exempt from the state licensing requirements because I am not in the business
of building or remodeling on speculation or for resale and that the house for which I am
applying for this permit, located at � �
is the only residential structure I have built or improved in the past 24 months. I also
acknowledge that because I do not have a state license, I forfeit any mechanic's lien
rights to which I may otherwise have been entitled under Minn. Sta.t. §514.01.
Furthermore, I acknowledge that I may be hiring independent contractors to perform
certain aspects of the construction or improvement of this house and I understand that
some of these contractors may be required to be licensed by the Sta.te of Minnesota.. I
understand that unlicensed residential contracting, remodeling, andlor roofing activity is a
misdemeanor under Minn. Sta.t. §326B.082, subd. 16 and can also result in a fine of up to
$10,000. I further state that I understand that the filing of a false sta.tement with
The Citv of Fridlev may also result in criminal prosecution andlor civil penalties
to applicable city ordinances andlor state statutes.
I have also been informed and acknowledge that by listing myself as the contractor for
this project, I alone will be responsible to The Citv of Fridlev for compliance will
all applicable building codes a.nd city ordinances with the work being preformed on this
property.
, >�z
Signature of Prope , ner
�Gr/il��7Zol �
V�
' Date
For yuestions or information on contractor ticensing, or to check the licensing status and enforcement
history of a particular contra.ctor, call the Minnesota Department of Labor and Industry, Construction
Codes and Licensing Division, at (651) 284-5069. T'he web site is: httn://www.dli.mn.�ov/Ccld asa