AF - 46446��
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City of Fridley, Minn.
BUILDIloTG PERMIT
��:-� s�
N° '7213
Date: "-°° `°
7 p
OvvaeP: � � BufldQr � m �
+�id�reas Addreae
�� L��DC��IN��F�NG
No. st�t � � Part oP �,ot
Lot�_�;;��Hlock - � Addition or Sub-Division
Coraer Lot _ Instde Lot � Setback -�Z-��� Sideyard �� K� B
Sewer Elevation .,- �Q. �� Foundation IIevation � �. `�
�------
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DESCRIPTION OP BUILDING
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t Depth _C;o� FT ght Sq. Fk Cu. F't.
/� � ��
�►�e of Constructi _ � Fast, yC - �'�o be Completed
In cansideration oE the fsauance to me of a permit to construct the building described above I agree to do
the proposed work ffi accc�rdance wlth the drescription above set forth and in coanpliance with a�l provlsfons of
ordinances of the dty of Frldley. _ �
C�'�
In conafderatton of the payment oP a fee of $.�d�. , permit is hereby granted to
to construct the buflding or addition as d�cribed above. This�rmi t is granted upon
the exAr�s condition that the person to whom it ia granted and his agenta, employees an� worl�en, in all work
done in, around and upon said building, or anypar� thereo� ahall eonform in all respects to the orciinance� of
FridleY� Minnesota reg lacatton, conatructfon, alteration, maiatenaace, repaitr and moving of bufldings
within the dt3► 7imits and� permft may be revolsed at any tiaae upon violatio�n of any of the provisiona ot ea�d
ordinanc�s. _ rl
Btiildiag' Inspector
NOTICEs
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� We h�rieby certify that this i� a true and correct �I�i c�`f a sur�reg of ,
Lota 30,,33 nnd 32 �lock A, Piverviev Heights Anoka Couniy, Minnesota e�a
surv�y�d hy me thia Sth day+ c�f A�,�guat,1964.
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sue�ecr PER .
City of Fridley 2 0 3 6 6
' , AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RECEIPT .
r
� �
� ; y ��_��.' COMMUNITY DEVELOPMENT DIV. � � �
r � � PROTECTIVE INSPECTION SEC.
' i '
� �'��1 � CITY HALL FRIDLE� $5432 NUMBER REV DATE PAGE OF APPROVED BY
�""'� � �'� 612-571-3450 910-Fi5 5/18/90 � �
JOB ADDRESS 314 H:ugo �treet N, E. �
i LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oesca. 30 p 31, 32 �, Riverview H21CJI1�S SHEET
2 PROPERTY OWNER MAII ADDRESS ZIP PHONE
Ron Zaczkowski 314 Hugo S,treet N�E, 784-7945
3 COfdTRACTOR MAIL ADORESS Z�P PHONE LICENSE NO.
John Jarvi Construction 240 Long�ellow S�treet N,E.� Fridley 784�7142
4 ARCHITECT OR DESIGNEH MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS Z�P PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK -
❑ NEW � ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Rezoo� Dwelling C16 Squa,res�
9 CHANdE OF USE FROM ° TO
STIPULATIONS
pn aU new raofs or tear-offs and replacemenf roofs,
S�C� Code requires that 2 layers of 15 Ib. felt,
�, together, be installed to a point 24 inches
u� ��t�rior walt line, or the use of other
� �e�laYment membraneo
SEPARATE PERMITS ARE REQUIHED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. �'l�erCj'�-aSS
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO fOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. � NO. DWLG. UNITS OFfSTpEET PARKING
I HEREBY CERTIFY TNAT 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 y5`8OO y�` s rJQ
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 CHAHGE
PROVISIONS OF NY OT STATE OR LOCAL LAW REGULATING CON- y�`2]_ e OO
STRUCTIO R E P FO MANCE OF CONSTRUCTION.
PLAN CHECK FEE TOTAL FEE
e�L Q%l�"�Z� $21a50
/SIGNATUHEOFCO �RACTOHORAUTNORIZEDAGENT IDATE� EN PROPERIY V IDATED TNIS IS YOUR PERMIT
L �., F.
a � � hh ���- �� —
SiGNATURE OF OWNER iIF OWNER BUILOERI IDATEI BLDG �NS� f1A
� []
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AI��t � �
,,
1 Effective 1/1/90
R-1 AND R-2 �
Building P�ermit Application `
cor�struction Ac�dres.s: �i''� �% (J�,' c� s � ou. �'• �v'�/�f� �j�
Legal Desc,7iption: /
Owner Name & Ac�ress : _�� /� � /� C' � �f� t.�.��^ r� f �el . # � �' Gis
Contractor: l% CJ f� � ( % -%�/Q 1�� �l'1 ��-�` � Z�e1. # �`� 7� `i�.
p,ddres.s: �'�iQ � �'� �` �i�'� L o� J S%' /l1 �•
Attach to this application, a Certificate of Survey of the
lot, with the propos�i construction drawn on it to scale.
D�ESCiZIPPIO�T OF I��I'
LIVIIJG AREA: Iength Width Height Sq. Ft.
t�R�GE ARE�: Lexigth Width Height Sq. Ft.
DDCR ARF.�i: IL7K, j�1'1 Width Hgt/Ground Sq. Ft.
�• 1
.
� ���5 S
Corner 7nt [] Inside Lat [] �. Yd Se ck Side Yard Setbacks
Zj�pe of Construction: acJ ,� l S Fstimated Cbst: $,�7�d�
Approx. C�letion Date: �v 1. y'
C� .. OC)
Proposed Driveway Width If New Opening Is Desired: Ft. $ $
,` e�� Width + 6' See Bac]t Page
OATE; S�� � APPLICANI': G Te1. # %�h�'� 7/ ��
Permit Fee $ �� CTo
state su�rchazge $ �
SAC Charge $
Driveway Escrow $
Park Fee $
s�wer Main charge $
. ��
srzzxn�ZZONS :
$ °�/, SZ�
�-
.� � - S�
CITY USE �Y
Fee Schedule on Reverse Side
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Abave
Fee Determined by F�gis�eeruxl
Agree�[�eazt Nec;assaYy [ ] Not Nece.s,sary [ ]
i:+� � . � • :�•, � � �+- :-.�:i�+. �
Zhe Qu.ef Buildi.rig Official shall, before is�»*+� p�rmits for the erection of any
�; i dir�g or struciure, or for ar�y addition t� ariy existing 2�ilding or structurn, or
for ariy alteration or repair to any existing building or structure, upan application
therefore, require the payment by the applicant for such permit of fees to the an�nt
herein belcxa set forth and in the manner herein pravided to-wit:
. TO►I'AL �TALUE
$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
i,_� �
$15 (Mininarm Fee is $15 plus su�ge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to arid including $2,000
$45 for first $2,000 plus $9 for each additional $1,000
or fraction thereof, to and including $25,000
$252 for first $25,000 plus $6.50 for each aclditional $1,000
or fraction thereof, to ar�d including $50,000
$414.50 for first $50,000 plus $4.50 for each additional
$1, 000 or fraction thereof, to and i.r�cl�xlirig $100, 000
$639.50 for first $100,000 plus $3.50 for each additional
$1,000 or fraction thereof, to and includirr� $500,000
$500,001 to $1,000,000 $2039.50 for the fiYSt $500,000 plus $3 for each additional
$1,000 or fraction thereof, to arid including $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1,000 or fraction thereof
DRIVE�iY DEPRE`.SSIORJ ^EaC�W
(�nctete Ctirb Streets On1Y)
Alternate "A": Remaval and replacement of curb arid gutter only - Driv�way width plus
6 feet time.s $13.50.
Alternate "B" : Resnoval ar�d replace�nent of curb and gutter ar�d i.nstall a 3 foat wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
. � �.11�..=_ �_ .;
Pezmi.ts for oonstruction will be issued a mininnan of 24 hoaars frcBn the time of
ap�lication t.o allow for prop�x review of the praposed structure and of the
wnstruction site.
A Certificate of Sutvey of the lot, shawing the location of the fotuxlation once it has
it has been con.structed will be required before proceeding with the framing.
a _ .�
sue�ect PERMIT NO.
City of Fridley ,� .��'� 1
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ' ------ —
r
� � RECEIPT NO.
� ; y ����� COMMUNITY DEVELOPMENT OIV
r � � PROTECTIVE INSPECTION SEC � � c(
1 . �
� � /'�'1 � CITY HALL FRIDLE� SS432 NUMBER AEV OATE PAGE OF APPROVE� BY
�'""'� � ��' 612-571-3450 9t0-F15 5/7/96 / /
10B AODRESS
314 Hu o Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 29-32 A Riverview Hei hts SHEET
2 PROPERTY OWNER MAIL ADORESS ZIP PHONE
Ronald Zaczkowski 314 Hu o Street NE 784-7945
3 CONTRACTOH MAIL ADDRESS 21P PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADORESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
g NEW O ADDITION O ALTERATION ❑ REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 36' x 22' Gara e
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide a hard surface driveway.
SEPARATE PERMITS ARE REQUIREO FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCV GHOUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT CU. FT
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOFi A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CEHTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PfiOVISIONS 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 W14,034 �7.02
DOES NOT PRESUME TO GIVE AUTHO Y TO VI ATE OR CANCEL THE pERMIT FEE SAC CHARGE
PRO 1 NS O Y OTHER STATE 'LOCA L W REGULATING CON-
ST UCT N EF�F�RMANC O CONS TION. �224.7.5 Fire S�.' �I�F.03
6 a r PLAN CHECKFEE T07ALFEE
� '°� �� $245.80
SIGNAT PEOF Q�y �RACTO RAUTHOf712EDAGENT IOATEi WHEN PfiOPE � ATED THIS IS VOUR PER �/
�' � '�=0 -- �
SiGNATUFiE OF OWNEA UF OWNER BU�LDERI iDATEi r, 8 G �NSP paTE
NEW
AI�I�N
ALTER
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ConstructionAddre;
Legal Description:
Owner Name & Ad
Contractor:
Address: � �L�
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Effective 3/1/96
� �, � �
�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Tel. # 7� —7�'�,j
DESCRIPTION OF IlVIPROYEMENT
Length Width Height Sq. Ft.
Length �h � Width � Height � Sq. Ft. % 9�X l7. 7 Z
Length Width Hgt/Groun Sq. Ft. =%y�o�'�,�'�
�!Q
Corner Lot � Inside Lot [] Ft. Yd Setb ck � ���- B Side Yard Setbacks ` Q� �
Type of Construction: D �2 t�� Estimated Cost: $ , QQ y�� �,2 �
Approx. Completion Date: /(� -3 ( �(o
(Cost on Back)
Driveway Curb Cut Width Needed:
DATE: APPLICANT:
Permit Fee
Fire Surcharge
Staxe Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STTPULATIONS:
$ ���. �.S
$ /y, 0,3
$ 7 ��
$
$
$
$
$
$
� ;/
Ft. + 6 Ft = Ft x$
CITY USE ONLY
Fee Schedule on Reverse Side
_�
Tel. #
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$900 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 �
a
A
BUII,DING PERMIT �'EE SCHEDULE
The Chief Building Official sha11, 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 %r 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,Q01 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 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 ea.ch additional$1, 000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,(�UO
or fraction thereof, to and including $50,000
$574.75 for first $SO,OQO plus $6.25 for each additional
$1,(}00 or fraction thereof, to and including $1(�,000
$887.25 for first $100,000 plus $5.00 for each additional
$1;000 or fraction thereof, to and iacluding $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, 0�,000 plus $2. 75 for each additional
$1,OOU 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.
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 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.
�
�-..��
HARVEY A. CARTWRIGHT
ANOiGA COUNTY iURVt.Y3'
N[NNEPIN COUNTY SURVEYS
MtNNEAPOLIi $URV[YS
ed10 PALM STREET N.W.
9UN![T 4-7033
OWN(R
INDUfTq1Al. - JUOICIAL
HU�INE65 - TOrOGRArNIGAL
CITT 1073 - rLATTING ,
:u�e Sk:anL:es
�
CARTWRIGHT & OZ.SON
LAND SUR�`EYORS
N[GISTt1l[D UNO[1� LAWS OF 1TAT[ OF MINN[90TA
L/Cf'tNYtO •Y OROlNAMC[ OF CITT Of MINNIAPOLI`
328 PLYMOUTH BU�LDING FEoeww� 8-8721
HENNEPIN AT SIXTH • MINNEAPOLIS 3. MINNESOTA
.��rbcpor'g �rriiftcatc
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COMBINING TME qECORDS OF
J. E. HILL. CrviL EN61Nt[R
c�rA�LUN[o �aN
C. F. SANDHOFR
GlVIL ENQINEER
[lTA�IIfNtO 1/O�
JAMES NELSON
SURVtYOR
asr��uaNCO ��a=
METROPOLITAN l.ANO
SURVEYOR3, [aTw�6�sN[o ��e�j
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lond Plan�ing /� /� e875 Mighway No.6S N.E.
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land Surv�ying � ��1 • • ( Minn�apolis�
�, so�is re.�;,,9 ((jlQ�t/lPRltjl.�%!� r`�l('• Mion. S34]2
. Civil Enaine�ring ♦ � U C/ T�I�phon� 784-606e
Municipal Enginee�ing ' Engin@eTS & Surveyors Ar�a Qod� ell
Mortgage Loan Survey Por �R�' �� BV��OGR�
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
S`pII�ILnpl� t/�I`T� t/�I`T [`�I�(�EGT�R AA!D .(�MBl1ST1�N AIR VERIFICATI�N
�Qn �p�, acin0 9fl QYICt111Q ,ran __, the undersigned hereby verifies that the
venting has been examined and is free from nast, deterioration, obstructions,
and is securely supported and firestopped where required. Yes (:► No ()
The venting system is plastic/PVC and meets all curr.ent codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes ( 1 No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
indude AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
�e pYi� r_emb ���en air is sized and installed to meet the current codes
and manufacturers specfications.
Whe11 requi�ed t0 ���'all a new cemb�ic±ien air� it will be si�ed and installed
to meet the current codes and manufacturer's specifications.
�e� jp��jjp� ne�•� �er�tin0„�e_tem, 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
Veriting Tables for fan assisted and natural draft appliances.
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 cuRent codes.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
! • • . 1 ►(' . ��' . 1 � - • 11 11 • / ' / . � • ' � � 1 � ' M • � • �11 . � • �
AppGance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
AppGancs #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 N
� -_ �•► �- ..�-
HEATING CO:
Signed By: Date :
m
sue�ecT p
c�ty of Fridley 3 3 2 7 9�
AT THE TOP OF TNE TWINS g � I L D i N G P E R M I T
�
; � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV. o
f � V � PROTECTIVE INSPECTION SEC /���
� _ , Fc?
( /'�'1 � CITY MALL FRIOLE� SS��Z NUMBEII 11EV OATE PAGE Oi APPROVED BV�
�'"""� � ��' 763-571-3450 s�aF�s il/26/02 � �
JOB ADDRESS 314 Hugo Stree� NE
t IEGAL LOT NO. BLOCK TRACT OR AOOITION SEE ATTACMED
oesca. 30,31,32 A Riverview Heights SMEET
p PiiOPERTY OWNER MAIL AODRES$ 21P PMONE
Ronald & Jan�t Zaczkowski 314 Hugo Street NE 763-784-7945
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAII AODiiESS ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CIASS OF WORK
O NEW O ADDITION � ALTERATION ❑ REPAIR p MOVE O REMOVE
9 DESCRIBE WORK
Interior aZterations to the kitchen/bedroom
9 CHAN(3E OF USE PROM TO
STIPULATIONS
See notations on plan.
Provide smoke detectors in al�. sleeping rooms and on all levels of the dwe�.�ing
per Sect�.on 310.9.1,2 of the 1997 Uniform BuiZding Code. Caulk and f�ash all
exterior openings.
SEPARATE PERMfTS
REQUIREp �OR:
PL!lwMBi�� AIVD 5�16
��
. SEPARATE PERMI7S ARE REOUIRED FOR ELECTiiICAL, PIUMBING, MEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY �OAD
VENTILATING OR AIR CONOITIONING.
THIS PERMIT BECOMES NUIL AND VOID If WORK OR CONSTRUCTION ZONING SO. fT CU FT
AUTHORIZEO IS NOT COMMENCED WITHIN 80 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT '
ANY TIME AFTER WOqK IS COMMENCED. NO DWLG. UNITS OFFSTqEET PARKING
I HEREBY CERTIFY THAT I HAVE REAO ANO EXAMINEO THIS APPLICA710N 1 STALIS GARAGES
ANO KNOW TME SAME TO BE TRUE ANO CORREC7. ALL PROVISIONS Of LAWS yALUATION SUR7AX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED @
WITH WHETMER SPECIFIED MEREIN OR NOT. TME GRANTING OF A PERMIT 'P8OO.O0 �.SO
DOES NOT PRESUME 70 GIVE AUTNOfiITY TO VIOLA7E OR CANCEL 7ME pERMIT FEE SAC CMARGE
PROVISIONS OF ANY OTHER STATE OR LOCAI LAW REGUTATING CON-
STqUCT10N OR THE PEpFORMANCE OF CONSTNUCTION �32 . 65 FlY'� .S(,' �.$0
PLAN CMECK FEE TOTAL FEE
$33.95
GNarun C .an,r pAUTH EOaG IOATE� MEN PROPEiiLY VALIOATED TMIS IS VpUR PE MIT
3 ���� o �� � �� �
S�GNATU�7E O OWNE i�� WNE ui�DEp� iD�iE� B G�NS� f16 f
NEW
ADDN
ALTER
(] CITY OF FRIDLEY Effective 1/1/2002
� J 6431 University Ave NE, Fridley, MN 55432 (763� 572�604 Bldg Insp
f�J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Cohstruction Address:
Legai Oescription:
Owner Name 8 Address: o a � v� e� S� Tel. #%�3-��� �i�,�
Contractor. �atM P MN LICENSE #
e
Address: Tel. #
LNING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Ce�ificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width �� Height � Sq. Ft
Length Width Height Sq. Ft
Length Width Hgt/G�ound Sq. Ft
Construction T e: �
yp �P Nlo�e I��pS/ Ph f� a/ Estimated Cast: � ��f��
-� t
Driveway Curb Cut Width Needed: F�� Ft �Ft x$ a�
DATE: r `'� APPLICANT:
Tel. # %`�� %�� r��
Call (763) 572�3604 tor Pertnit Fees if mailing in appOcation �r Fax to 763•571-1287 if using credit card and we will
call you for card number.
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ . .J
$ .$�
$ � SO
$
$
$
$
$
�
$ 3� � �
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1200 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 [ ]
STIPULATIONS:
.�
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 die payment by die applicant for such permit of fees to tlie 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 $25,00�
s
$25,001 to $50,000
$50,001 to $100,�
$100,001 to $500,000
$5�,001 to $1,000,000
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. IO for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,�0 or fraction thereof, to and including $100,000
$993.75 for first $1�,(�0 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,�
$1,000,�1 and up $5,608.75 for the iirst $1,000,000 plus $3.15 for each additional
$1, 000 or fraction thereof .
DRIVEWAY DEPRESSION ESCR�OW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $17.00.
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv -��
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Note: This drawing is an artistic
interpretation of the general
appearance of the floor plan. It is
not meant to be an exact rendition.
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