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AF - 46373� � � City of Fridley, Minn. BUILDING PERMIT � �� N° '7416 nate: - � `— ,�� ' a' �� VWfiil: �E<�� '„�� / a� Z'�/LL BWi� / °•<TG � -"��i �� . , �iL� , A{i{�J:� � �' LO�►TIQ��OF I�UJLD�VG No.�_� �� .ff��^ - �'"� Street , �� "�� Part o� Lot 1 Lot r_L____�_ Block �� Addition or Sub- � an ./"/�,�� '�'�. r' � Coraer Lot _� Inaide Lot � S.etback s� �� -� Sideyard �—'`�� : Sewer IIevation � _ Fo 13on IIevation DESCRIPTION OF BUILDING � � �, T �,'� Front -� Depth �� • Height �� Scl. Ft ��'� Cu. F'.t��l � , �� t Depth - - efght Sq. Ft Cu. Ft > �/' ` Type of Construction �±% �i�.� F�� /��..�i�� _ To be Completed In consideratlon of the �tesuance to me of a perinft to construct the buildiug des�Ibed above I agree to do th� proposed work in accordance with the description above aet o and afl provis%ns oP ordinances of the dty of Fridley. F � In consfderation of the PaY��t oP a Pee of !$�_��permft fs herebY granted to to construct the buflding or additfon as described above. Thispe rmit is granted upon fihe express cbnditlon that thepe�o n to whom it ia granted and his agenta, employees and workmen, in sll work done in, around aad upon said building, or anypart thereof, shall oonform in all reapects to the orrlinaa� of Fridley� llRinnesota regarcliag location, construction, alteration, maiatenance� repeir and mo�+'ing of buildings within the dty ]imfts and thia permit may be revoked at aqy time upon violation of any of the provisions of said ordiaanc�. i;% � �, Buildin8' Inspector NOTICEs '11ds psrmlt doa eat eorsr ths �onshaelt�, �on toe �hieY� P��+m9. 6a M�ttna, s�wa or wtlar. B� wn fo ss� tM Buildiu� le�fer te� ap�raM p�emhs hr 16�a H�ms. _ 4 :+.R � � APPLICATION FOR BUILDING F°a,1�ITT CITY OF FRIDLEY, MIYd�ESO�TA o�R � s��a �� T., IJC �s v cJ sUrLnEx AIIDRESS eJ�� I'1 �( 61i � /� U � . �� . ADDRESS . LOGATZON OF BUILDING. No. Street �art of Lot Lqt Block Addition or Subdivision �, �• _ 1�� t�c� Corner Lot In�ide Lot Setback Side Yard SEWER ELEVATION FOUNDATION E�EVATION Applicant att�ch to this form Two Certif�icates of Surr�eq of Lot aad proposed bLild- ing location drawn on.the9e Certificates. DESC1tIPTION bF BUILDING To be � 1 � a I flR�CfG Front ��Lh � � Height � Sq. Ft. �� Cu. Ft. �� —�- Front Depth Height S9. Ft. Cu. Ft. Type of Conseruct3on Estimated Cost �r/ �%a � v To be Completed �v� ; 1. ��'{ (o �, __ The undersigned hereby makes appiication for a permit for the work herein specified, agreeing to do all work.in sCrict accordance with tlne City of Fridley Ordinances and rulings of the Department of Buildings, and hereby declares that all the facts snd representations stated in this appl3cation are true and co�crect. DATE_ � P R 1 I., �, C� f� SIGNATURE . �(Schedule of Fee Gosts caa be found on the Reverse Side). ,�_ �, t.y� �--� � , , � � .,R., ,. � a BUILDING PE�T FEE S�IEDULE Section 2. The Inspector of �uildingd shall, before issuiag any pea�ni.t for the erection of eny b��ilding or strucCure, or for any addition to aay e:�iBt- ing building or atructure, or foa any alteraeioas or repalra to any exis�ing bu3lding or s�ructure, upon applicat3on therefor, require the pay�enC bq the applicant for such permit of fesa to the amouat herein below aet forti� and in the manner hereia:provided to-wie: 2.1. For any such permit for the�erection a,f any fire-proof,building, �ther than-a garage, warehouae, factorq or grain el�vator,- or for the erection of any fire-psoo� addition, for similar occupancy, to any enisting buildin.� shall be gt the rate of $1.,40 for each one thousand cubic feet. or iracti�+a thereof, in such cubical cantenta. 2.2. For eay such.permit for the erectiou of aay fire-praof �srage,�warehause,_ f�ctory or grain eleeator, or for the erection of say fire-proaf edd3tioc, , for aimilar ocoupancy, to anq existing bu3lding shall be at the rate of $1.25 for each one thousand cubic feet, claseified as °1fireproof" by Section 5G2 of. Che Minneapolis Buildiag Code. - . HOUSES 2.3. For aay such permit for the erection of any non-fireproof buildire�; e�:Lea than a garage, warehouse, factory or grain elevator, or any aoa-firapre��f. addition, for s�tmilar occupency, to eay exiatiag building - permit $�.�0 £or � each one thoueand cubic feet. GARAGES ?.4_ For aay such permit for the erec�:i�� r' �;�; n�a_fiappa-ao� gara�e, warehous.e, factory or graia elevator, �°� ''c� 4►.ti�: �:�E:,:�::ion of any non-Sc�.remoof additioa, �or-�similar occupancy, to �-;� ,�ti:�s�in� tia�;.:d�ng or for each such . �. build3ng or addition - niaety CP..*.�`�� A�e+��s?d F�� e€.f�a one ehousand cubic feet or fraetion thereof, ia ehe cu��c�l �:��, �� .therc,os with a minimtmn of $4.0�-.- For the purpose of cem�puting feea far bu-�;.ding permi�s, the cubical contents of aaq building or addition to a unifcrau taei�ht throtighout by multiplying the ground area covered from a point sis (6) inches bel�w the floor line of ��e basemeat or cellar to tfie average height of tha-��per surface or to the avere.ge heighC of the roof surface of the main gable of a pitched roof.. 2.5. For repa$zs or alCeratione to aa eaciat3ng structure, the fas aha11 be at Che rate,of $3.00 per each Five Suadred Dollara ($SOO.00j or fraction. thereof 3,n the coee of all proposed work. 2.6. Tn no case shall the fee,_charged #cr-any permit ag set forth ia �; .Section 2 be 1ess. Chaa $4.00,� . - , ! /`1 ,�, . , � ,� �-�: �« �`•° ` � sus�ecT PERMIT NO. City of Fridley -16 3 5 7 AT THE TOP OF THE TWINS B U I L D I N G P E R M I T i � � � • � • COMMUNITY DEVELOPMENT DIV. �/ �� : ------ r � � PROTECTIVE INSPECTION SEC. i � i i_--. � ��,'� CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV i' � � 612-571-3450 910-F15 / / 8 25 $1 10B ADDRESS 5p00 Hughes. Avenue N.E. 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 7 Carlson's Summit Manor $011'�1 �iC�CZA• SHEET 2 PROPERTYOWNER MAILADDRESS 21P PHONE Howard Cudvagen 5000 Hughes Avenue N.E. 3 CONTRACTOR MAILADDRESS Z�P PHONE LICENSENO. Nedegaard Construction Co., Inc. 3903 Fo�s Road 560-0070 4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO. 5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO. 8 USE OF BUILDING RES 1CZGri'�].�,�. 7 CLASS OF WORK ❑ NEW ❑ ADDITION a ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE R 8 DESCRIBE WORK Rc�n�el Ki.tchen and add �ek 9 CHANGE OF USE FROM TO � STIPULATIONS TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. 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 l. STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VAI.UATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5,500 yfi2.%S DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $SG. SO NONE PLAN CHECKFEE TOTALFEE NONE $59.25 SIGNATUREOFCONiRACTORORAUTHORIZEDAGENT IDATEI WHEN PROPERL VALIDATED THIS IS YOUR PERMIT SIGNATUREOFOWNER�IFOWNERBUILDERI IDATEI ^ BLDG iNSP � �A E� A CITY OF FRIDLCY Effective Aug. 1, 1981 APPLIC/ITIOiJ FOft RCSIQEi�TIl1L [3UILDIf�G PEf2�jITS (tJe�r, Alter�tions, AddiLions, or Repairs) OIJf�ER: h1owA�e� �vovA��v [3UILD�R: �e�o� G'R�RJ� �r�sr. � 1 � ADDRESS: S000 f�vcH�r ADDRESS: �9a3 /��ss �vAD TEL N0: TEL (d0: ,�60 - oo7p Construction Location • STRI�T NO : $O o O STItEET: j�u G�� ,g LOT: � BLOQC: __�_ ADDITION : �R R�soN � ��rv,.r► � -r- �dv rN Corner Lot: _�_ Insic2e Lot: SetbacY.: Sideyards: Ap�licant attach to this form two Certificates of S�rvey of lot and proposed building location drawn on certificates to scale. pESCRIPTI01d OF COt�STRUCTIO�J Front: Depth : Height: Square.Feet: C�ibic Feet: Front: Depth: Height: Square� Feet: Cubic I'eet: _ Type of Construction: � rnosD�c ��rak�rr � l�Fw ��CK�'� Estimated Cost: $$�SoO •�� Zb Be Ot�r,�pleted: /p �RyS Alt. A Alt. B Proposed Drive�Jay Width If New Opening Is Desired: $� $ � , , SE� Rr^�VERSE SIDE OF SHEET . T'Iie undessigned hereby ma}:e� application for a permit for the t:vrk� herein specified, agreeing to do.all work in strict accordance v�ith the City of I'ridley Ordinances �Zd rulings of t11e Delkzrtm�nt of Duildings, and hereby declares that all the facts and repres�r►tatiQns stated in this application are true and correct. � D.3T�: ��2,5'�F( SIGNATUF�: Stipulations: � � . �"�, :� o �a' � �7= 3, s ��:�`� .. � SUI7�DING PE�RNlIT FE�E SCHEDI�LE The Inspector of buildings shall, before issuing permits for the erection of any building or structure, or for any addition to any bxisting buildin,g or structure, or for any alteration or repairs' �o any`existing building or structure, upon application therefore, require the pay.,ment by-the applicant f or such permit of fees to the amount`herein below set forth and in the manner herein provided to-wit: TOTAL VALUATION $1.00 tc $500.00 $501 to $2,000 �2, 001 to $25, 000 $25,001 to $50,000 $50,001 to $100,000 $100,001 and up F�S $10.00 Minimum Fee $15.00 plus surcharge $10.00 for the first $500 plus $1.50 for each additional $100 or fraction thereof, to and including• $2',000 � '' $32.50 for the first $2,000 plus $6.00 for each additional $�,000 or fraction thereof, to and including $25,000 $170.50 for the first $25,000 plus $4.50 for each additional $1,000 or fraction thereof, to and including $50,000 $283.00 for the first $50,000 plus $3.00 for each additional $1,000 or fraction thereof, to and including $100,000 $443.00 for the first $100, 000 plus $2.50 for each additional $1,000 or fraction thereof PLAN CHEQC: 25 percent of building pezmit fee DRIVFS�TAY DEPRESSION ESQtOW: Concrete Curb Streets Only Alternate "A": Removeal and replacement of curb and gutter only _ Driveway width plus 6 feet x$13.50 , Alternate °B": Renoval and replaceineri� of curb and gutter and install a 3 foot wide approach with 6 inch depth Driveway width plus 6 feet x$15.75. , VERIFICATION OF F4UNDATI�ON Permits for constsuction will be issued a minimum of 24 hours from the time of application to allow for proper review of the proposed structure and e�f the c�nstruction site. A Certificate of Suxvey of the lot, shawing the location of the foundation once it has been constructed will be required before proceeding with_ the framing. �so� i z .�-- 3 ��- / 32, S� t�. o� S-d. � o __ _ _ _z � D m � � � 0 � a 3 0 w � � � � A o � 3 � a �' c m� 3� � m � � 'a � m m � Q �� m � � �a � 0 :.� � m Z � � m � O Z � m m � N � � � � � � � 0 � m -�-� ° � rn D •m ' -Zi 7�C �' � c N W �o ° z r" � n� m . _ tn � � c � � � � � � v �� o � � Z 0 z T � v Q« � 1 � N � o � �' A c � 1D a °, c � � � � � m 0 0 � O � � m � in � m s � • cQ . � , .. . . v� _ m a � W Z � � O � o � -D l � � � � J � \° Q 0 °, � < `D �� . � �� o ? �� 0 xN -� Z- � c� 3 � i� 0 � � � 0 � � � � D � m � � � � � � � � v �o � -� o 'm � � � � Q m � rt � .� ��m Z � m S m fD .�► 3 � a � „��,� a a ?� � v �� m ao � o � � R . �� m e m m -� v ' � � j � � . °o .•� � � � aQ u�o � oo '-� Z � � o C�� —�C� °� � � � � � m 3 c � m � 2 � � � � � A m ci o � � � m 0 tn �• � N � � � Q- !A ID a a°� � 3 m� 'Q'oo i O � O � � m � 3 � 3 a m � � .. -�i m v � � � � � rn � � � Z O C � � : m � Z � c � m O � � � 2 C � � . �r, � � . • V o � •• �� o . ...� - . • �;, . . • • , . .m . . � � � 0 � � 0 � �2�� m � � � � � � � � � ��.� rn — � � � Q- � s ��°�` � �o� �� w` o s»? o� -. � A Q � � ! � 3 � �� 0 � � a�� `�o� � n O � ��G � � � � � a ,,.. � �•,� � �� . -., � � o� � 3 � � fD n �`� �' O � :� ::: m �. �- � a w m � � a � � O � v T n N Q. � � � � � rn � � Q �zm � ,�v D � N � � Z Z rny m � .O . z v � �� m -n -� � � ma �o � Z � '• Z,� , Z�� .. v �� . �o �� z -o . vs �Z Z y Z y �Z �v �n = -� • � � �• - Z �� O r rnZ N � < m � � Z � m O � G tti C W. j c�o � . � CHIMNEY AND STACK VERIFICATIUN The undersigned hereby verifie.s that the existing chimney or stack: 1. Has been carefiilly examined Yes () No () 2. Is free from rust or deterioration Yes () No () 3. Has no foreign obje� lodged within Yes () No () __ 4. Is securely supported Yes () No () 5. Meets all cuireSt Code requirements for . size � . — - � � �I's c�aanerx�- - — -- �- - - - - - y� � � �Ia- (__ � __ . 6 Has total heating BTU's of All other BTU's • � � ' � : � � � . � � . - . TOTAL BTU's 7. Has a liner b�n provided for water heater Yes i) Na i) 8. Has combustion air been provided for water heater Yes () No () Remarks: . � � Y _:_ ' � • :• i� ��• HEATING CO: Signed By: Date: i ,y� �s I � : ' sua�ecr PERMIT NO. City of Fridley � � 7 °�7 AT THE TOP OF THE TWINS g U I L D I N G P E R M I T r � . ' � H IPT NO. � ; � _____ COMMUNITY DEVELOPMENT DIV. �� r � � PROTEC7IVE INSPECTION SEC. � , i l---- � ��;'j CITY HALL FRIDLE� 55432 NUMBER AEV DATE PAGE OF naPROVED Br i� �� 612-571-3450 910-F15 / � JOB ADDRESS 5000 HUGI3ES AVE NE 1 LEGAL LOT NO BLOCK TRACT Oq ADDITION SEE ATTACHED DESCR. 1 7 CARLSONS SUNIMIT MANOR SOUTI3 ADDITION SHEET 2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE CHESTER GUDVANGEN 5000 HUGHES AVE NE FRIDLEY MN 55432 21 3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO SAME A ARCHITECT OR DESIGNER MAIL ADORESS ZIP PHONE IICENSE NO. 5 ENGINEER MAtL ADDRESS ZIP PHONE LICENSE NO. 6 USE OF BUILDING RESIDENTIAL 7 CLASS OF WORK O NEW 0 ADDITION O ALTERATION O REPAIR O MOVE O REMOVE 8 DESCRIBE WORK 9 CHANGE OF USE FROM TO STIPULATIONS SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD VENTILATING OR AIR CONDITIONING THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHOR�ZED �S 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 CERTIFV THAT I HAVE FEAD AND EXAMINEO THIS APPLICATION STALLS GARAGES AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS ypLUATION SURTAX AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIEO 3�000.00 I..SO WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A pERM1T DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- 74. �5 FIRE SC .3. OO STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. PLAN CHECK FEE TOTAL FEE 79.25 siG U�7EOFCON7R�a ORiZEDAGENT IDATEI WHEN PNOPERLV V DATED THIS IS VOUR PERMIT �'``� G�',� ' �'�� ° C(O, � �'�� $�GNATU:iEOfOWNEFl�iFOWNERBU�LDERI �nA7Fi _.__ . __ � � N�Y� ADDN ALTER (l [l [l ConstructionAddress: Legal Description: Owner Name & Contractor: ( - Address: CITY OF FRIDLEY SINGLE FAMILY AND DUPLEXES R-1 AND R-2 Building Permit Application �o�a , � �" C-�,� it1 � Effecdy�� F� �� `� J �� Tel. # 5 7� °�� MN LICENSE # Attach to this application, a Certificate of Survey of the lot, with the propased construction drawn on it to scale. DESCRIPTION OF IMPROYEMENT Tel. � LIVING AREA: Length Width Height Sq. Ft. GARAGE AREA: Length Width Height Sq. Ft. �ECg AREA: Length Width Hgt/Ground Sq. Ft. �-. OTHER: ��.,�',�t�C� � �-eJ �� '��'�- _ Corner Lot Inside Lot [] Ft. Yd Setback Side Yard Setbacks Type of c�ion: F�stimated Cost; $, 5� o�� Approx. Completion Date: � - � � — g � (Cost on BackJ Driveway Curb Cut Width Ne�ied: Ft. + Ft = Ft x$ _$ DATE: -/� �� S- APPLICANT: �-�-� Tel. # 5�� °-�2 � � Permit Fee Fire 5urcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: CITY USE ONLY $ � � Fee Schalule on Reverse Side $ 3� � c� .(�1 of Permit Valuation (1/lOth%) S I .5 �� $.50/$1,000 Valuation $ _ $850 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 [ ] $ � 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 e�sting building or structure, upon application therefore, require the payment by the applicant for such permit of f�s to the amount hereiu below set forth and in the manner herein provided to-wit: � TOTAL VALUE $1 to $5� $501 to $2,000 $2,�1 to $25,IX10 $25,001 to $50,000 $50,001 to $1�,Q00 $100,001 to $500,000 $500,001 to $1,000,� $1,000,�1 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 includiag $2,000 $52.25 for first $2,000 plus $12.50 for each additional $1,000 or fraction ther�f, to and including $25,a10 $349.75 for first $25,0� plus $9.00 for each additionat $1,000 or fraction theaeof, to and including $50,OQ0 $574.75 for first $50,000 plus $6.25 for each additional $1,000 or fiaction thereof, to and including $100,000 $887.25 for first $100,� plus $5.00 for each additionai $1,000 or fraction ther�f, to and including $5�,000 $2887.25 for the first $5�,{l00 plus $4.25 for each additional $1,(�0 or fraction thereof, to and including $1,000,0� $5012.25 for the first $1,0�,(�0 plus $2.75 for each additional $1,(�0 or fia.ction thereof DRIVEWAY DEPRESSION ESCROW (Concrete Curb Stre�ts 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 - I7riveway width plus 6 feet times $15.75. VERIFICATION OF FOUNDATION Permits for construction will � issued a minimum of ?� houis 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 be�n constivcted will be required before pro�ding with the fiaming. � � SuBJEC� PERM City of Fridley 27 2 7 9 AT THE TOP OF TME TWINS g � I L D I N G P E R M I T � ; � CEIPT NO. � ; L __�� COMMUNITY DEVELOPMENT DIV. r � � PROTECTIVE INSPECTION SEC. �'j �� i � `/ � � �'�'1 � CITV HALL FRIDLEV 85432 NUMBER i1EV OATE PAGE OF APPROVED BY �----� • •,, 612-571-3450 910-F15 8/19/98 / / JOB ADDRESS 5000 Hughes Avenue NE i LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED DESCR. 1 7 Carlsons Summit Ma.nor South Addn. SHEET 2 PROPERTYOWNER MAILAODRESS ZIP PNONE Chester Gudvangen 572-8221 3 CONTRACTOR MAIL ADDRESS ZIP PHONE IICENSE NO. Owner 4 ARCHITECT OR OESIGNER MAIL ADORESS 21P PNONE LICENSE NO. 5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO, 8 USE OF BUILDING Residential 7 CLASS OF WORK � NEW ❑ ADDITION D ALTERATION l� FIEPAIR ❑ MOVE O REMOVE B DESCRIBE WORK Reroof house and ara e(20 S) Tear-off 9 CHANOE OF USE FROM TO STIPULATIONS Underlayment must comply with the State Building Code. SEPARATE PERMITS ARE HEOUIRED FOR ELECTRICAL, PLUMBING, HEATIN(i, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT. AUTHORIZED IS NOT COMMENCED WITHIN 60 DAVS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OR ABANOONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS OFFSTiiEET PARKING I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINEO THIS APPLICATION STALLS GARAGES AND KNOW THE $AME 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 $1668 ,83 DOES NOT PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHAFGE PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �,rj�{.QQ Fire .S�'. 1.66 PLAN CHECK FEE TOTAL FEE 56.49 �siG UfiEO�CON'AA TOA R U�H ZEDnGENT IDATEi WHEN PROPERL ALIDATEO THIS IS VOUR PERMIT ✓ �1/ � �"v r�V / ! � SiGNATUREOFpyyNEAiIFOWNERBU�LDEfi� IOATEI BLD �NSp f�pTE �w "` [ ] �DN I l ALTER [ ] ConstructionAddress: CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION C!' Effective 1/1/98 �� ,��-,,�� Legal Description: Owner Name & Address: �,y�si� ,� �� f(� Tel. # S %� - � � �, Contractor: Address: MN LICENSE # 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 5q. Ft. GARAGE AREA: Length Width Height Sq. Ft. DECK AREA: Length Width Hgt/Ground Sq. Ft. OTHER: %�%� ��C o o�' .v o c�S,� s� v�2 O 5 Q� %�.� ��_� Construction Type: Driveway Curb C�t Width Needed: Estimated Cost: $ ��(��` � (Fee Schedule on Back) Ft. + 6 Ft = Ft x$ _$ DATE: �/�' 9'� APPLICANT: ,�n Tel. # S"�' 7a -�? �/ Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL S'TIPULATIONS: $ .�� 0 O � 1.�� $ c�3 $ $ $ $ $ $ � ��- y`� 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 [ ] � _� 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 amc�unt 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 $100,0� $100,001 to $500,000 $500,001 to $1,000,000 $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,Q00 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,�0 $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 $1,000,000 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 times $13.50. 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 $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 con��uc�ed will be required before proceeding with the framing. w ADDRESS PIN CITY OF FRIDLEY 6431 UNIVERSITY AVENUE NE " FRIDLEY, MN 55432 (7631572-3604 FAX: (7631571-1287 LEGAL DESC PERMIT TYPE PROPERTY TYPE CONSTRUCTION TYPE : 5000 HUGHES AVE NE : 263024230117 : CARLSONS SUNIlVIIT MAN SO ADD : LOT 1 BLOCK 7 : HEATING : RESIDENTIAL : ADDITION/ALTERATION PERMIT NO.: 2004-02105 DATE ISSUED: 11/17/2004 VALUATION . NOTE: AIlt CONDITIONERS CAN NOT BE PLACED IN A SIDE YARD WITHOUT WRITTEN PERNIISSION FROM ADJOINING PROPERTY OWNER COMBUSTION AIR SHALL BE PROVIDED PER UMC SECTION 504(A) AND TABLE 6-A. # A/C LJNITS 0 VALUE OF APPL OR WORK 0 #FURNACES # GAS RANGES APPLICANT RESIDENTIAL HEATING & AIlt, INC 1815 EAST 41 ST STREET SUITE A NIlNNEAPOLIS, NIN 55415 (612)724-1899 � .d s GUDVANGEN CHESTER H& D A 5000 HLJGHES AVE NE FRIDLEY, MN 55421 1 # GAS DRYERS 0 VALUE (FOR MIl�TIMUM CALC) 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 l�ow the same to be true and correct. All provisions of laws and ordinances governing this type of wor� will be complied with whether specified herein or not. The granting of a permit does not presume to give authority to violate or cancel the provisions of any other state or locallaw regulating construction or the p rmance of construction. Applicant /I � > Date , : �. � � �� . , HEATING PERMIT DRINIMUM FEE FURNACE SHELL/DUCT WORK GAS RANGE FEE GAS DRYER FEE AIR CONDITIONING FEE HEATING REPAIRS/ALTERATIONS STATE SURCHARGE, MECH FLAT TOTAL PAID WITH CHECK # 16625 SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE. 0 300 0.00 35.00 0.00 0.00 0.00 0.00 0.50 35.50 � -� � g m a � � a � � � v v m � � Ol v � m � T 3 � �; o Q< � `o; i W � : � S n � < � o � N � i rn m 3' - O g � � � i � Z D � 's o� � � s m ° i � � � n s -Di � z � o ; z � m � � ! � ; (') i m ? 3 � z '• -i -n c z z � m � m z � � n � O z -n m m � � 0 0 � _ O � � � � � � � � 0 �1 �� IV � � � �o � y � c m � °� D O -�p o j � � � O � �• � v � � O � Q �, � � C O r �, � � � m i °1 0 � �� m � 0 � � � � G�S� ' � � � � �� a� ►� r� � � x � Z L7 � i a m m �� i 2 �i � � Q a m i N p�a N i � � � t�' •a i � � � W o � i �: o � � � °—� 3 �o ' <: o � r N. � > "$ � — i � � ' Q .� « � � � r 'aoo �QQ ��' ; n n � � �m � � �' y � � � i 3 � � j rt N S e � (7 � �— �3'�0 � o �' yy (D � 3 � o � � _ ° o 0 3 °, � `m � � c� m -n � m � cCDU o � 3- t�' a v, �; ,cn � o m � oi D � o � � N � o °: N p. O y �� °—' o o � � � o v °� 0 � °� � � 0 a O ? � � n N � � N v m -. N N � o 0 0 � � � W � � W � � � � �CQ°, `� � � z � � � � m a � Z � � � � � � � �� u � a _ � � -o �? = o o � 3 m � � � � �, � � � � r cn ° _ � Q- o � o � � `2 � • � � (�D O v � N D � c� N z v � m c� N � � a � ma z � � � m � fD a � � 5 N N � � � z o � �n � � � n: a � � � � � � � d m � � a = v � c � mv � 0 � W � � m Re � � n m v � r OO UWi � 0 0 o f� � � � � � � I� � � � � m v 0 � � � C, � m � � � Z 0 W � a � aa � m a � � � o W � o v � � � I � �� G � -,� ° � 3 � � C C ��,, � � . Y L � r L � r � � 1 � \� �, a w � cn ,� N N � ? O w z � "n O Cfi t�n, TI .p �� N � o z �rn w W � C � � �' v N 00 � � � � m � O z � D m � � r �a m � � z Z O a� z -o vo a� � m c� � � vz � � O D Z zv c� _ � � '""� Z m � t3n � C� Z O v= vz �� . m r" � Z � � O Z � .�_-r m � N O O �A FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMI�S COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION When reqlacinu an existina furnace, the undersigned hereby verifies that the venting has been examined and is free from rust, deterioration, obstructions, and is securely supported and firestopped where required. Yes (� No () The venting system is plastic/PVC and meets all current codes and manufacturer specifications including sizing, length, number of elbows and termination. Yes (� No () The undersigned also verifies that the replacement unit is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes () No () The existina combustion airis sized an� instaped to rrreet th� currerrt codes - and manufacturer's specifications. Yes () No () When required to install a new combustion air, it will be sized and installed to meet the current codes and manufacturer's specific�tions. Yes ( V/ No () When installina a new ventina svstem, the undersigned hereby verifies that it is a listed assembly and meets the current codes and manufacturer's specifications. This does include AGA-GAMA Category I Central Fumace Venting Tables for fan assisted and natural draft appliances. Yes (� No () Is the common vent and vent connectors sized and installed correctly after an appliance has been removed from the common vent and vented separately as per current codes. Yes (�' No ( ) Apaliance Tvae and Size/Common Vent and Vent Connector Information Appliance #1 Type �.��.� ��- BTU Input b� �' Fan Assisted o Nat�) Appliance #2 Type BTU Input Fan Assisted or Appliance #3 Type BTU Input Fan Assisted or Nat Total Appliances _� Tdal Btu Input —�,�— Common Vent Type Vent Height Diameter inches Appliance #1 Vent Connector Height ft Length ft Diameter in Type Appliance #2 Vent Connector Height ft Length ft Diameter in Type Appliance #3 Vent Connector Height ft Length ft Diameter in Type ALTERATIONS• (Describe) HEATING CQ: `� Signed By: Date : � f ;i f , Building Inspections 763-572-3604 DATE ' � " l `] �. SITE ADDRESS _ � THIS APPLICANT IS: PROPERTY OWNER/ TENANT PLUMBING RESIDENTIAL A.PPLICATION CITY OF FRiDY�]EY YOUR E-MAIL ADDRESS � ADDRESST- �_ J CITY PHONE: 'J% (�2.. C_,�— �i Permit No.: Received Date CONTRACTOR HAtv�: , � •., - c� - STATE LICENSE # �hamp1fln EXP DATE t�= �i SUBMIT A COPY OF CTTy STATE 7IP, YOUR STATE �D�S: , . LICENSE MITH PHONE ' � PERNII'I' 'I'YPE TYPE OF WORK: I � �w F�Y � .I.w� FANIII,y 0 TOWNHOUSE DETAILED DESCRIP"CION OF WORK �REPLACEMENT PER MS 16B.665 the permit fee is a min of °1es d ntial �fixture� xcluding the�sfixtur so �Thissh uld reflect only the c st of labor ) unprovement, installation or replacement x.05= La bor co s t u n d e r $ 3 0 0 =$ 1 5. 0 0. Labor cost between $300 to $500 = cost of labor j�� TOTAL FOR PROJEGTS W� �OR EXCEEDS $SOQ FEES ARE BASED ON $10.00 PER FIXTURE. EXCEPT WI�12E NOTED. F1�CCURES: (LND t•I[JMBER OF EACH BELOVi� SHOWER _ WATER PIPING BATH SINK/LAV FL�R DRAINS — S�G POOL _ WATER SOFTNER ($35) BATHTUB ,_,GAS PIPING fr�vCm't�c�n's� — WA.� �,OSET _BACKFLOW PREV. ($15) CLOTHES WASHER —�TC� S� WATER HEATER ($35) FOR IRRIGATION DISHWASHER _, LAUNDRY TRAY = WATER MEfER _ OTHER _ — � _. $ Permit Fee Surcharge TOTAL DUE � � �. .r ,�u;`r�� ,- , ;w. ,� � � � ,. .� �•: � � : . ..�, ... .�... �... � Number of fixtures @ $10.00 x $10.00 = $ .50 Number of fixtures @ $15.00 x $15.00 = $ — � Number of fixtures @ $35.00State Surcharge = $�� Tota1= $ _ THIS IS AN APPLtCATION FOR A PERA�IIT-NOT VALID UNfII- PROCESSED I hereby apply for a building permit and I aclrnowledge that tlie informaxion above is complete and accurate; that the work will be in conformance with the ordinances and codes of tl�e�Ci W�okFzs not to start1withoutM permit; thax the w°rk W 11 b m� �°r��' �l�e not a permit but only an application for a permrt approved plan in the case of all wark which r ires r uiew and approval of I /► �� %/}_ � � .... —w h�/i mAn �i /°� /�I.Yf/�� 1�ATF SIGNATURE OF APPLICANT � :� City of Fridley 16uilding Inspections Department 6431 University Avenue NE, Fridley, MN 55432 763-572-3604 FAX: 763-502-4977 37�� ' � ��