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i0731 Miss. 81vd. W,W.. Coon Rapids, Hiinn. 55433
MARTGAGE LOAN CERTiFlCATE:
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CIVIL EI�INEERS �
LAiVO SURVEYORS
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�445-229�71
�ts 14`, 15. and 16,� '
lak A. RIVERVIEW .HEIGFITS
�oka County,.Minnespt�
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TNUi IS A HJ1T SHOWWG THE BOUNDARIES OP THE LAND ABOVE DE9CRIBED AND OF THE LOCATION Of All SURDWGS, IP ANY, •
��N• � AU. VISI6LE ENCROAGHMENTS, IF ANY, FROM OR ON SAID LAND. NO LIABILITY.IS. ASSUMED EX�EPT TO LME MOlOER �
. O} A MORTGAGE LOAN NOW BBNG PLACED ON THE PROPERTY OR ANY OTHER INiEREST A�QUIRED sY THE REASQp pp ��M
MOlTOAQE. R IS UNAERSTOOD AND AGREED NO MONUMEN75 HAVE BEEN PLI,�ED FOR THE PURPOSE Of ESTABUSNWG LOF LWEB
, •Ot �OUNDARY.CORNlRS.
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� P�. C. HOIUM AND ASSO4A ; INC. o •
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. Minnesota Regi.srrdt�or No. .. �Z�'.'.....:.. _ .� . . .........
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SUBJECT P O.
c�ty of Fridley 15 9 6 0
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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• COMMUNITY DEVELOPMENT DIV.
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' � �'��1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVEO BY
!"""� � ,�� 612-571-3450 910-F15 10/6/80 / /
JOB ADDRESS 358 Hugo Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 14,15,1 A Riverview Heights SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Norton Tucker
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Bjergo Construction 1086 - 132nd Lane N.E. Blaine NflV' S5434 755-2630
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESSEPERRTE PERMfTS RE ZIP PHONE LICENSENO.
8 USEOFBUILDING HEATING, PLUMBiNG AND SIG-N�
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR O MOVE O REMOVE
X
8 DESCRIBE WORK ,
Construct a 26' x 40' Dwelli and an 18' x 24' Tuck-under Gara e
9 CHANGE qF USE FROM TO
'STIPULATIONS provide a hard surface dri.ve�aay. Provide sod in the front and side
yaxds. Provide a verifying survey before capping.
SEWER LOCATrON: Approx. 10' Deep In Street, 85' W. of M.H. (Inv. 839.93)
WYE ELE`�7: 839.66 TOP OF FOOTING: � 843.00 Mi.nunt4n
WATER LOCATION: E. of Sewer Service, 67.8' W. of Hydrant
DRIUEWAY DEPRESSION COST: 6' + 16� = 22' x$15.75 =$346.50
t�� �IiY Gp l4�IB6EY DDES NOi GUARAPeTE�E iP1� •*������
��.:`:.u�:ac�r �iP v1utN WCA'�oNS �� ELEVATIOP�S. 8afote �ggin� cal� 1�ca! atilities
�: ��y DAYA � i�lR MiFO�AAitON f'UQPOSES QNtY ,�ND TElEPHONf� - z�4:��'"!�k�� - G�S Etc.
�,: ;:;Gr+5 4f5�at3 R SMC�UID ME�[FY t�ib INPORA+�iION ��� �1�
:� ���[ s�r�. RE����:.��'
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING. WOOC� FrdIIl@
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING S0. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION lO�O ZO��.60 TO'�d�.
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 HEFEBY 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
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $38,250 ��.9.�-3
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S8O.G4 $42S.00
PLAN CHECK FEE TOTAL FEE
$20.16 $544.93
SIGNATUi7EOFCONiRACTORORAUTMORIZEDAGENT �DATEi WHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
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S�GNATURE OF OWN R IIF OWNER BUILDERI IDATEI is. 'e BLDG INSP �A E
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CITY 0� �RIQLCY •
!�f'PLICA'('IO'J fUft RESI[)f:i��1TIP.�_ QU1LDIf1G P�E'J�fT75 � .
� (tde►•r, A1 �erations, llddii;ions, or Repairs� .
4b•tllER: /��i�T'a� ��r�� [3UILQER: � �� � � c� ���5' T'
ADDP,ESS :
TCL h0: �/ 73- /2 `% 2
/10DRCSS: ���� �- /..� � � ��"
7EL (�0: �� �� Ss�`�� �r
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� Construction Location � °
S�I2L•TT NO: � STREFT: �J"� G v c��'
I,OT: ���`� d I� � BLOC'i'�: y� � 11DDITION: �°�'�2 C) l(� l�`'n , .
Cozner Lot: Insicle Lot: !� . Se't3iacY.: Sideyards:
Ap�licant attach to this form two Certificltes of Survey of lot and
' proposed builcling �ocat�ion dra�an on certiiicates to scale.
// � ��,�[/ o, DESCRIPTIOid OF COPISTF�JCTIOPJ •
(�l��t/-� d�' l 4�'✓�"Z L � ,�16 . .
I�'ront: Depth : Ii eight:
Squa�e. Fee� �D yo � l Ctitbic Ecet:
d„` 5�` c�,,,, ��' �'�C Z`/ � T� e-� -�.,.,�� ('s,q-Gz�-i�
Front� Depth: Height:
Square� Feet: � Glzkiic I'eet: _
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'aj,�pe of Construction : ��'� �(�ih-!Z Estimai:ed Cost: $ �°
Zb ?3e Oor,�plete3: � /, 1 �7 � i
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Propos�:d Drive��ay Width Ii New Opening Is Desired: �j0 �!'Ce'L"1— $� t�b 5V $_
, S�E REVERSL SIDE OF SfIEET ,
7.�ie undersigned lzereby ma}:e� application for a permit fcr the �:�ork� hexein specified,
agr.ec�ing to c?o .all work in s3:Y�ct accorciance �•rith the City of I'ridley Ordiiiances �nd
ruliiigs af i�he Departmeni. of Buildings, and hex.eby dc�clares ihat all tl�e �acts and
rcpresent.ztions stated �� this application rE, tru�d corxect.
A.'�Tis': " ��'" 2 ` � SIGNIITUI'� :
S�iF�ulli:ions : �
P¢�► ir ��tS.6�
6�.e.. 20.1 �
T� �9 .13
,S�e q-tC.00
o�..�+� 3�f �. S °_
B�t I .�13
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ZY sc�b = 9� $
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�;),C'xZ01�� ?..� 7.'1�� 7n�:��cci:c�r. of: 11ui.1da.r��J; ::lu�J.�., bcfa�:c: i.;.;ui.n� ��ennit:; f.�r l:h.c crc:cL•i.on
uf: .�uy 1�ui.J_�1.i�7�j az :,i:�-uct:urc, c�r. �a�: a�Yy ��aa�.t:���n t:o auy er.i:;��.�ic� l�tailcling nr :.txuc�ur.�.,
. ciY. l:c»' �,t�y c�1.t.c�rai:ic,n nr. r.c}��air.:; L•o •�.Zny c::�. .t:in�� 1n�i.l.di.�i�.J oz sL•�ucturc, uJ��n appli.c:atS.on
tlirr�ior.c, r.cqua.zc U�� p�iymc„t� l�y tl�c ar�p].i.c:ant: �or. such ��cr.mi.L• oi tecs to tl�c arnaunL-
hexu.i.n hcl.ovr sr.i: tor.th �uicl i.�i L•he mannet hczein �»:ovi.d!.�cl L•�-t:a.t: •
1�1EI�l COIdS`PI:UC`xION: Sing7:c k'amil.y tlotacs and Gar.ac{es: Y4.00/�.,0�0 cul�ic fec:�. •
l?J.T�:•7 CIIi:C1:: 25 lx:zcc>>t: aL• bu�.lciing j:�er.iriiL- ice.
llitl:l�r�•:11Y llL•'PP1:5SIOi•:: (ConcrcLc, G�irU �trcet� Only} �'
' Al.icrnat:e n: lu:moval and repl.acament of concrete curb and
quLter only; l�riveway �ridth pl.us 6 ieet x�1��75
AI.L•ernai:c B: Removal and replacemcnt of concrete curb and
•� gutter and inst�ll a 3 ioot ��ide approach �aiL-1n �'
' ,• 6 a.nch depth; Driveway width �plus G feet x$17.85 '
• . J�DDI�'I0�/1L INi=0Rf�1/�TIOr� _
rar the puri�se oi' compuL-ing fees for building permits,. L-he cubica� contents of any
build�.nq or. addition, is deter_initicd by rnuli:iptyir�g the ground area coverecl tro:n a
p�i.nt six (G) inches belor� ihc iloor ].ine oi L-he basemenL- or tha cellar to tiie
average' hcights oi thc •upper sur.face or to ihe average heiyP�t of the roof. surf:ace
of tiie raain gable of a pi.tched rooi. �
Fox re�zixs or al.terations to an existang strncture, the fee sha11 be at the xate
. at $3.00 �icx cach �ive hundred dollars °($500.00) er frac�ion tllereaf in the C05t
of aIl proposed wor.Y.. . _ •
In •no case sha�.l thc. ��e cliarqed fcsr any pennit as set %rth S.n Sectivn 2 be iess �
tiian $?.50 plus $.50 state surcliarge. � • '
' _ V�RIFICATIOV OF FOUF�iD/11'IOtd
NOTE: Pexmits : or consi:ruction c�ill be issued a minim� ai 24 hours £rom Uie time
of application to a�.low for proper revieia of ihe proposed structurc and oi the
construction site.
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A Cei tificate � of Snrve;T of the l�t, shoc�=ing the �.ocation oi' i:he founclation once it
has been cons�nicted t.�ill be required L,ef.ore proceeding �aith the tzaming.
.�RTIFtcA� � oF ���uPnr��cv . .
' 1►PPli.catic►n ior a Certificzte of Occ�ipancy shall be mad:� ten (10) days prior t:o the
use or. accur�ncy oi an�► structure for �ti�hich a��uil�ii_ng permit has been issued; and
saic3 struct:ure slial� tiot be used oz- occupied L;i�L-i]. a Ce1:i:i.tic�-�te of Occur:inc5� has
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(Forna Developed by the State of Minnesota Building �ude Di�ision)
TO BE SIIBMITTED �VITH BIII?,UING PER11�T APP�• ; raATION
E%TERIOR ENVE?�UFE AVERAG� "�n CO1I�PITT�i`_s'TOS7
OVYNER :
SI� �D�s : �{UGD S %' �.e.° ��G�t�
CONTRACTOR: ��G d w�ST DATE: ZZ D PHONE ,�,�.�� �,3D
��
Determine working square footage o� �f»h
1. Total Exposed wa].l area........ � �.5�� sq- �:t. x�%� _�i
�
2 • Tota7. roo�/ceil3r�g 8T@S� � � � �. � � • � O �� SQ � :1"j'. • 7C • �� � ��
3•' Total exposed wall area ca]:culations:
3•
Total exposed wa7.l area abave floor = % �
a. Total wall window area.�������������������������• •/
b. Total door area ............................�..... . O
C• TO�'i'dl S�.1C�lI7,b g1.aSS flOOT Ai@8.������������.�cs���• O
d. Total. �ireplace wall area..................fe.... ��
e. Total wall framing area (average 10�fo)......��.... '
f. Total net wall area above �loor............�..... ./
g. Total ri.m joist 8:i'88������������������������re���• �
Total _exposed foundation area =_ Z�D • Q_
rl• TO`t8��. f0U21C18�'t10I1 W:LI1f10W 2L1'88���������������es���• .���i
j.� � �01'i�. aet foundation area above �'8C3.e • � � � � m s � � � • � �
�• Tot�7. door area ............................�..... -����
�
Determine "II" value o� eaoh wall segm�nt
8. yY. 8' g,�„ , S S'
b. �'�. 70 % "U" ......��
�. 3�• OQ x„II,� , s�
fa. --- x ��II�� ` ....— ..
e. /ii�. �/� X ��n
�. 7Z�. 8 / x ,���
g. �b . D� g !iUn
h. ��I. i � g nU�,
i. O� Sd •�� X uIIii
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, pL
. 5'S
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= 4.g3
- •I
_ ..v�
- 2.n•7�f
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a . �
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4. Total exposed roof/ceiling calculations:
Total exposed roof/ceiling area -- � ����
j. Total sl�ylight area ........................- r--
f
...........
li• Total roo�/ceiling framin� c12'Qa. �84@I'8g@ ��jT� � � � � � �.� � � � • •
l. Tota1 net insulated roof/ceilit� area......�c..........._���
Determa.ne "II" va:�..ue for each roof/ceiliT,�; segment
..�.�.-.�..�.
� � R r�IIn
k. ____—/DD. �U x ��►,
1. Yd ?. 2,v g nIIn
4•
. ��
. � oy''
• o� ,�
TOT� L
_ Io•S4.
� _ ��. s,s�
� / 1/
I� total oi #4 is the same as, or less than #2, you have met the intent o�
SBC 6006(c)1. , '
Alternate Building Envelope Desigs��
To utilize the total envelope system method, the val�es established by� •
the sum of items #3 �d #4 shall not be greater thar� the sum o� items #1
and #'2. �
,. l? 4, s� 2- + 2. a��� -� z4. 9�--
3. �� 7. �3 .� 4. S'f• r�- zv/. S`G
C E R T I F I C A T I�0 N
u
Z hereby cert3.�y that I have calculated the "II" fact�r's and'R valueS
herein and that the building here descr3beolmeets or exceede the Sta�e of
M3.nnesota Energy Conser�ration Act.
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TY3'ICAL WALL SECTION
1. Interior Air I'ilm
2. Interior Wallboard
3. Insulation
4. Exterior Sheathing
5. Exterior Siding
6. Exterior Air Film
Total
STUD & HEAD�R AREA
Total Area No. 1.
Less Insulation "R"
Plus 3 2'� Softwood
Total
RIM JOIST AREA
l. Interior Air Film�
2. Insulation
3. 1 Z" Softwood
4. Exterior Sheathing
5. Exterior Siding
6. Exterior Air Film
Total
FOUNDATION WALL AREA
l. Interior Air Film
2. Insulation
3. Insulation (Block)
4. Exterior Air Film
Total
ROOF/CEILING AREA
1. Interior Air Film
2. Interior Wallboard
3. Insulation
4. Exterior Air Film
(Still)
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sue�ecr PER .
City of Fridley 17 3 2 7
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T �
�
� � R .
� ; L _ COMMUNITY DEVELOPMENT DIV. / �
r � � PROTECTIVE INSPECTION SEC. � ��
i � �
� /"'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�----� • •�� 612-571-3450 910-F15 11/9/83 � �
JOB ADDRESS 358 Hugo .S'tY'�'t N.L''.
LOT NO. BLOCK TRACT OR ADDITION
1 LEGAL SEE ATTACHED
�escR. 14,15,1 A Rivervieva Heights SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Ga1en Wax 358 Huga Street NeE. 786-9598
3 CONTRACTOR MAI�ADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Install zero clearance Aspen �i.replace (BC 3642�
9 CHANGE OF USE FROM TO
STIPULATIONS
FoR �IItRliVG.
�EpERATE PERMtTS REQ�� S ^
HEAT4NG• PLUM8ING AND S G
� ,
SEPARATE PERMITS ARE RE�UIRED 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 S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED, NO. DWLG. UNITS OFFSTFEET 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 $2QO �S`.SO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- ]_�j.00
STRUCTION OR THE PEFFORMANCE OF CONSTRUCTION. $
PLAN CHECK FEE TOTAL FEE
$15.50
GNAT E FCO ACTORORq rH ai2EDa EtvT IDATEI WHEN PROPER VALIDATE THIS IS YOUR PERMIT
1 ' � �
SIG ATU OFOWNERIIFOW RBUILDERI I AT BLOG INSP DAT
C1TY OF fItIDLCY
Effective Auq. l, 1981
tiPPLIC/1Tia� f0(t RCSIDL"iiTl/'w I3UlLQ1i:G P�('�iITS
(I�chi, Alterations. Additions, or Rcpairs)
O�;NER: _ �s9-L�� �� �QUILDER: �
ADJRESS: 3� � U!�� S1, /!J� ADa'tCSS:
TEL k0: ?�(� " q�% �" TEL I10:
Construction Location
STJtI�T NO : � STliEF.T: %� �� O � J� /v C
L07': BLOC�C : ADAITZO:i :
Corncr Lot: Insicie L�ts �_ Sctback: Sideyards:
Ap�licant attach to tl�is form L�ao Certificates of Stirvcy of lot and
p:oposed builcling loc�tion dzawn on certificates to scale.
DESCRIPTIO�� OF CO►�STF;�JCT10t�
��I(LG�'�(-_ _Fzont: Depth: Heiqht:
Squarc �'eeL: dbic. Feet:
Front: Depth: Heigl�t:
� � ��� � ���� �� �f ��� �
Square Fc�t: C1�bic Peet: ���`� ��.
i� ? (�� /`! �C � ro �(�. ?PF vt�, C9t.�� ��
'.'S�pe of Cor,structien : Estimated Cost: S� � D� �
Zb Be Cbr.�pleted:
Alt. A Alt. B
Proposed Dziveway tiidth If New Opening Is Desired: $ $
. , S�� PF.VF:R;L' SIDz OF S}IEET .
9iie unc]ersigned hereb:► an�l:c:� appliezticn for a pernit fc= the �:ozk hezein specified,
agzeein3 to cb .all �ork it� strict accordsnce t�ith the Ci�y of I'ridley Ozdi»ances e�id
rulin�� of tl�e Delh�rlment. of IIui2c]ings, and heseby declares that all t)�e iact:. and
reprec����tiens stated 3n this applic.:tion aze true and co:rect.
D.��: - f � -�� ��"3� 5���� : o� ��� � G���;
�tii�ulations :
�
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The Chief Buildiag Otficial aball. Defore issuing permits for tbe erection
of any building or aLructure� or for any addition to any existing building
or atructure or for any alteratioa or repairs Lo any existiag building or
atructure, upon application therefore� require tbe payment Dy the
applicant for auch permit ot fees to tbe amount berein belaw aet fortb and
in tbe manner herein provided to-xit:
Zotal 9aluation
=1.00 to =500.00
=501 to =2�000.00
=2�001 to =25�000
:25,00, to a5o,000
Fee�
=10.00 (Minimum �15.00)
=10.00 !or tbe first =500 plus =1.50
for each additional �100 or fraction
thereof, to and including �2�000
=32•50 for the first a2,000 plus �6.00
Por each additional a1�000 or fraction
t6ereof� Lo aad including a25�000
�170.50 !or tbe fir�t =25,000 plus
=�i•50 for each additional �1 �000 or
Praction thereof, to aad iacluding
=50�000
�50�001 to =100.000 =283.00 for tde first a50, 000 plus
=3.00 for each additional �1�000 cr
fraction tbereof� to and including
�100�000
=100,001 and up
=433.00 for the first �100,000 plus
�2•50 for each additional �1�000 or
fraction thereof
Plan Cbeek: 25 percent of building permit fee.
Driveway Depresaion Escrov: Concrete curb atreets onlq.
Alternate •A": Removal and replacement of curb and gutter only -
DriveWay vidth plus 6 Peet times =13•50
Alternate "B": Removal and replacement of curb and gutter and
�irastall a 3 foot �ide approach rith 6 iach depth - Drive�ay width
plus 6 feet times =15.75
fZT��i���T�.� � _ � . :. . .
Permita for constructioa vill be iasued a minimum of 2� bours from the
time of application to allora for proper reviev of the proposed atructure
s�d of the constructioa aite.•
A CerLificate of Survey of tbe lot, ahoWing t6e location ot the toundation
oace it bas Deen constructed ttill be required �efore �roceedinR with the
framiag. .
�- .
��
sue�etT P _
City of Fridley j '�
AT TME TOP OF TNE 7WINS I N P R I T 3 i 7 6 3
r
�U ILD G E M
; � RE PT NO.
� j V �
COMMUNITY DEVELOPMENT OIV. �a�-360� `�/�ie�
r � � PROTECTIVE INSPECTION SEC. ��� �J
� j .
� �"'1 � CITY MAIL FRIOLE� S.S432 NUMBEP REV DATE PAGE OF APPROVED BY
�----�" �•' 612-571-3ab0 e�aF�S 4/24/O1 / /
lOB ADpRESS 358 Hugo Street NE
t LEGAL LOT N0. BLOCK TRACT OR ADOITION SEE ATTACNED
oescR. 14-16 A Riverview Heights SNEET
2 PROPERTV OWNER MAIL ADORES$ 21P PMONE
Luke Gottwald 358 Hugo Street NE 717-6810
3 CONTRACTOH MAIL ADDRESS 21P PMONE LICENSE NO
Same
a ARCHITECT OR DESIGNER MAIL ADDRESS 21P PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
C� NEW ❑ ADDITION O ALTEFIATION O FiEPAIR O MOVE O REMOVE
6 DESCRIBE WORK
Construct an 18' x 12' Deck
9 CHANOE OF USE FROM TO
STIPULATIONS �
See notations on plan.
,ARNIN�
�efore digging call for
all utility location�
4540002
. RE�UIRED� �� ��1� � .
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARA7E PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING. HEATIN(i,
VENT�LATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AN� VOID IF WORK OR CONSTRUCTION 20NING SC. FT CU iT.
AUTHORIZED IS NOT COMMENCEO V�1ITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS OFFSTpEET PARKING
I MEREBV CERTIFV THAT I MAVE READ AND �XAMINEO THIS APPLICA710N 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PROVISIONS Of LAWS ypLUATION SUR7AX
AND ORDINANCES GOVERNING THIS TVPE OF WORK WILI BE COMPLIED
WITH WHE7MEq SPECIFIEO MEREIN Ofl NOT. TME GRANTING OF A PERMIT �2�.3JF) �I..LO
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL TNE pEpMIT FEE SAC CMARGE
PqOVIS10NS OF ANY OTNER STATE OR IOCAL lAW REGUlA71NG CON•
STRUC710N OR TME PERFORMANCE OF CONSTFUCTION �H3.ZS Fir SC �Z.�FO
PLAN CMEGK FE TOT FEE
86.85
S�GNATUpEO�CON'AACTOAONAUTMOp�ZEDAGENT ID�fQ� N ALIDAT O HIS IS YO A EA T
p�
■/ r
S�GNATUAEO�OWNEA��iOWNEpBU�lDE�1i IDAf�� BLO �NSP � qarE
�
NE1N ( ]
ADDN []
ALTER [ j
Effective 1/1/2001
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Construction Address: � � � �'�"� S� -
Legal Description:
Owner Name & Address:
Tel. # �li - 1�
Contractor. MN LICENSE #
Address: Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LNING AREA: Length Width _ Height Sq. Ft
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length 1�._ Width l o� Hgt/Ground � Sq. Ft a) G�
OTHER:
C�nstructi�n Tyr
e_ Estimated Cost: $ -�'�'�� � � 7�
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: �' �- d f APPUCANT: � �� � ��"�� Tel. # 'Zf � - i�'1 C�
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ ���� Fee Schedule on Reverse Side
$ � � D .001 of Permit Valuation (1/10th%)
$ , i $.50/$1,000 Valuation
$ $1150 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 [ ]
�+ f�� -
., �r �
BUII.DING PERMIT FEE SCHEDULE
The Chief Building OfFcial 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 $SQO
$501 to $2,000
$2,001 to $25,000
$25,001 to $SO,OQO
$50,001 to $100,000
$100,001 to $5�,000
$500,001 to $1,Q00,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional$100 or
fraction thereof, to and including $2,000
$69.25 for first $2,Q00 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,0�
$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 $SOO,OQO plus $4.75 for each additional
$1,OQ0 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 ESCR�QW
(Concrete Curb Streets Only) �'' `° -
Altemate "A" : Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15 .50.
Alternate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $23.25.
VERIFICATION OF FOUNDATION
Pernuts for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site. �
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
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THIS JOB COP'( SHALL 6E 1 1 S1"'���
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AVAILAQL.E ON �R��ING / �� ��
� SITE FOR TNE I� ; �
l�ND FINAL INSPECTIONS �
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� N.C. NOIUM ANO ASSOCI�TES lI�C.
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10731 Miss. Blvd. N.W.. Coon Rapids� Minn. 55433
MOaTGAGE LOAN CERTIFICATE: N G ��Cker
3s8- NuG� ST
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CIVIL ENGINEERS �
LAND SURVEYORS
Telephone
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421-1822
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SC�-11.0 : �.u- �O�
�445-229�71
�ts 14'� 15, and 16,
, � � i _lcck A. RIYERVIEW HEIGHTS
Moka County, Minnesota
' . � � .
. . ; � ? � �� . ,
� . • � _ ----� - ---�- -------- --- � ,
. 75•� - . .
� 11NS R A►UT SHOWWG THE 60UNDARIES OF THE LAND ABOVE DESCRIBED AND Of THE IOCATiON O� All lUIIDWGS, IF ANY, •
iF��LON, /WD AlL VI$�BLE ENCROACHMENTS, IF ANY, FROM OR ON SAID LAND. NO LIABILITY'.IS ASSUMED EXCEPT TO TNE FIOIDER �
. O� A MORTGAGE LOAN NOW BEING PLACED ON THE PROPERTY OR ANY OTMER INTEREST ACOUIRED sY THE REASON OP SUCM
MO�TCiAGE R IS UNDERSTOOD AND AGREED NO MONUMENTS HAVE BEEN PLAGED FOR THE PURPOSE Of ESTABLISMONG LOT UNES
, •O� WUNDARY.COIFNERSv
. '• .1 -OAi� iF/S ,_4tI1. DAY OF .. D@CEI{1bQT' '1�
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'' N, C. HGIU,�w AND A550C]A �, INC. • •
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