AF - 46696�
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City of Fridley, in�
BUILDING PERMIT
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N° 639?
" LOCAT BUILDING
No. � Stceet � �._.... Part Lot�,
Lot Elock Addition or Sub-Div3si�on� -� -� �-� -==� �
Coraer Lot _ Inaide Lot _._..� Setback __�:_.� � Sideyard � �� yL
Sewer IIevat4on _ Foundation IIevation
DESCRIPTION OF BUILDII�G
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� Front �� Depth �...� Height ��.. Sq. F't �•�� C�. Ft �'�! �:.� �d
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t Deptln � ITefght __�.�� Sq. F� Cu. F'L
Type of Conatruct4 Cost �����'_l�'�� To be Completed
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In cansideratlon of the issuance to me of a permit to construct the building described above, I agree to do
th� proposed work fn acc�rdance with the description above aet forth and ia compliance with all proviaiona of
or�iiaanoes of the dty,oP Fridley.
� �
In conafderatton of the payment of a fee of ���. , peraiit fs hereby granted to
to c�nstruct the building or addition as desc�ibed above. Thiapermi t is granted upon
the expresa condition that theperson to whom it ia granted and kus agents, employees and workmen, in all work
doae in, around ead upon safd building, or anypart thereof, ahall cmnform in all reapects to the orainaacea of
F`n1d1eY, 8�iinn�ota reg la��tion� construct�Ton, alteration, maintenance, repair aad moving of bufldings
�� dty ]imits an� permit may be revoked at any � upon vio�n of aay of the provfsiona of said
s �
Buliding Inspector
^ aonc�
11ds pem� doa eet eorsr �hs coestracHoe, tmhqNion to� vrMae, phrmbing, pa 6eatleg, sewu or rrahr. B� suro to �e
i6� Buiidiq le�tor for apuat� � �or t6as f�na.
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APPLICATION FOR BUILDING PERMtT
CITY OF FRIDLEY, MINNESOTA.
OW1�ER° S PdL�1M�+�j'�"ST�G� �%/�C�/�SL'Fx BUILDER �%l✓I%'.
AiaDItESS �„��F U C,a��t %/l/CY �'�/if C, ADDRESS '�
LOCATIOAi OF BUILDING
No. ���. Street �% ��0 part of Lot
Lot „5"3 �'.� L/ Block ' a�' Addition or Subdivision�/j��'/�'�/'//_= l� �,� 1��/�S
Coraeer Lot Inaide Lot ,� Setback ,�.s ° Side-Yard j� � /%`
SEWER II,EVATION `- FOUNDATION II.EVATION
Appl�.cant attach to Chis form Two Certificates of Survey of Lot and proposed.build-
ing.location drawn on these Certificatea.
DESCRIPTIOAT OF BUILD?.�1G
To be used as:
�/��.E� bt�0=��! �� Froat �� DepCh �� Height 2(�
Sq. Ft. ��� � Cu. Ft. �%. �� v
Front Depth Aeight
Sq. Ft. Cu. Ft.
Type of Conseruction,_ _��jSl/� Eat;Lmated Cost /� P�-�
To be Completed_ _ 9 Q ,��%��
The undersigned hereby makea application for a permit for the work herein specified,
agreeing to do all work in strict accordaaca with the City of,,Fridley Ordinanc,ea and
rulings of the Department of Buildiags, and hereby declares t1�at all the facts and
repre�entations stated in this application are true and correct.
DA�'E ��C%�__ ��/�f �� _SIGNATLtRE .
(sch�duie of Fee Costs can be found on the Reverse Side). ��
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BUIyDSNG I'EI�gIT F8E SCHEDU7,E
� ti� �he InsPector of Buildinga sha.1l
�-hf ere�tion of any bu3ld�ng or etructure, or
$�; b��ldira , be£ore isaui�g aay peam�t for
build�n � or strueture, or for an £Or any addition t� aa
� or structure, �p� $ Y alteratioas err re Y�x3st-
�Pplicant for such p of feesca�ion theref�r P$ixa to any e�����m�
in the e�t to the � require the paymeat b
manner herein provided to-wit; �OUnt hsrein below set � t�e
2.1. forth aad
For any such permit fAr ��e e=ection of �
8 fire$rage, Wgrehouse ry or
, facto Y fire-proof buildfng, othes
shag� be gt�t�egr$tei�• for sim�.],8� occu 8�eyator, or for the erection og
t�ereof $1.40 for each a y' tO anY existing �ui1dixt,�
, in such cubical contenta. °tte th°usand �ubic feet
a oz' f�aGric�x
Za2• For aay such °
�ac�o pe��.t for the erectioa of $n
�or s� �r graitt elevator, or for the Y fire-proof gara e
�milar occupancy, to � erection of any fire- �'�$r�house„
�O�' e�ch one thousand cubic y existing buildi PrO�f �ditic�a,
feet � s�ll be at the r�te o� �1.25
the iKirane� ol$e Buildia � �lasaified as o�
p g �ode� firepxoof" b
gl�'� y Section 502 Qg
?•3� For any such� e �
than a p�� for the erection of an
additio�ar8ge' �ar�hO�Be� f8ctory or y n��-f�repsoof buildiag other
, for s�tm318r oc�upanc �xain elevator, or an
each one thousand � 3�, to any ex�8.ti Y non-fireproof
_-- t3hic--fe�:- - — �-�yildi�g - Permit $1.-00 fo-r- -- - - _
- - ----- --- -- - - - - - --� -- --- — - — - -
- - - �A�RA�E3
2•_ 1Fw For any such e
�'��'ei�ouae p �t for the erecti
addie�.o,�, '�$ctory or grain elevator �°f 8ny nott-firepr�� 8
a for eim3ler , or for the erec�ion g r�8e,
building or add occupa,ncy, to any existin of any non-f�ia-eproog
°�' f�'acti �tion - ninety ceats g buildiag or for each such
on thereof, ia the cubical c$�'90) �or each one �housand �u�ic feet
oatents thereof with a minian� og $4��.
For the purpose of compu�in
°� �ny build3ng or additi g fees for buildin
S�'ound area covered °� tO a uniform heightpth��ghoutebC�b�cal contents
basement or cellar tor� gpoin� six Y�ultipiy�� t�
verage height of c h� u elow the flaor line of ��e
average height of the roof surface of the
PPes aurface or to the
For re a ��n gable of a p�,tched roof.
2'=5' P 3ss or alterations to
a� the rate o�f $3.00 per each ��ia�in
thereof ia the FiVZ Huadred � st�tuse, the fee shall be
cost of all proposed work� Dollars ($,500.00) or frect�ton
2'6' In �O c$8e shall the fee char ed
Section 2 be leas than $y..pp� � fOr gnY Pe�nutt as set
forth in
.
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IAND SURVEYORS
Anoka, AAinnesoto
CERTIEICj4'6E OF SllRiiEY:
CHE3TER �+"AC 1 ASZEK
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�DENOTES
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LOTS �j3 AND �1j.� BLOCK S
RIVERVIEW HEIGHTS
AA10KA COUkVTY� Mltdl�}ESOTA
I HEREBY CERTlFY THAT THiS IS A TRUE AND CORRKT REPRESENTATFON OF A SURVEY OF THE BOUNDARIES OF THE ABOVE
DESCWBED LAND, AND THE LOCATION OF ALL BUILDMGS, 7HEREON, AND All MSIBLE ENCROACHMENTS, IF ANY, FROM OR ON SAID
LAND.
AS SURYEY� BY ME THIS ..,��.,�.TN„ DAY OP ,,,,,,,,,,,,,�ARCH
. . ............................ . A.D. i 9 �
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N. C. HOIUM AND ASSOCI�ES, f C-- LAND SURVEYORS
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LAND SURVEY4RS
Anoka, .Mini:esotp
, CERTIFI:',,'�Tf OF S�RVEY:
CHE57ER �.'A' 1 A:�?CK
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LOTS 5x AND 5�..;� f L�CK S
�{IvERVi�W HCIGNTS
ANOKA COUNTY� b'�Nt�tESOTA
• 1 HEREBY CERTIFY THAT TH�S IS A TRUE AND CORP.ECT REPR�SENT411�:N OF A SUe�vEY OF iHE 80UNDARIES OF THE ABOVE
DESCR�BED LAND, ANO TME IOCATIOtJ OF All BU�IDINGS, THFtiE�N, nND all �/ISiBIE ENCR!`ACN.uE'�TS, IP ANY, FROhI OR ON S�.ID
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AS SURVEYED BY ME THIS ,�� T H„ DAY OF �AR C H p p � p � J.
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N. C. NOtU'� AND ASSCUATES, �� �� = IAND SURVEYORS
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. HEAT LOSS CALCULATI S ARTMENT OF BUILDINGS NQNNEAPOLIS. MINN. I
1 Weatherstrips A.S.H.V.E, Construction No. Insulation �
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof F1oor Kind How Applied
Yes—No Yes—No 19_
�'1 ` ' Room � Length � Width °'' Height .� Room Length �� Width Height 8'
Windows a oors—Crackage and Area Windows and Doors—Crackage and Area
Wldth Helght No. oP Llneal f. Area Wldth Haignt No. oY Lineal ft. Area
No. of pane oP pane lighte of crack eq. Yt. No: oY pane of pane 116hte ot crack eq. tt.
/ �.•'� � � � J / �O Zr O �.�G �.
°r� �i �- � D /�
% ��' � /
e � o ��' /'� _ r_..c n..- Co f Btu
Glass � S'o ? �
Exp. wall ��
Net eap. wall �, � e
Int. wall
Ceiling
Floor °? �
Total Btu. / �
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
��'Fl. � Room � Length /f Width � Height �'
Windows and Doors—Crackage and Area
Wtdth Hetght No. of L1nea1 It. Area
No. o[ pane oY pane Ilghte of crack eq. tt.
/ .1;� / �i �` �� f i
Coef. Btu
In6ltration / 3 O
Glass �
Exp. wall �
Net esp. wall �/ /a �i o
Int. wall
Ceiling
-Floor _ _ �v (� /'.S o
Total Btu. �
Required sq. ft. E.D.R. or sq. ins. W.A. Leader area
�1. Room � Length / ot Width � Height
Windows and Doors—Crackage and Area
Wldth Helght No. of Lineal ft. Area
No. ot pane of pane I1Bhta ot crack eq. ft.
l �- � �� 2 � � � �.
Coef. Btu
II Infiltration �o a.
� Glass :6 �o 0
Exp. wall / -
'� Net exp. wall � o ♦�, �� o
�� Int. wall
i
I Ceiling
� � loor /,�D
i Total Btu.
I Required sq. ft. E.D.R. or sq. ins. W.A. l.eader area
I
/
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e.
Infiltration � � �o ✓/ ?�
Glass / � � O!
Egp. wall � I�
Net eap. wall Bf � a � 2� �
Int. wall
Ceiling
Floor � y � 5 � , o
Total Btu. So s`�a �
equired sq. ft. E.D.R. or sq. ins. W.A. Leader area � I
Fl.� Room ( Length r' a Width Height �'
Windows and Doors—Gackage and Area ��
Wldth Helght No. o! Llneal [t. Area
�. of nane of psne llghte o! crack eq. ft.
Infiltration
Calass
Exp. wall
Net esp. wall
Int. wall
Ceiling
Floor _ -
Total Btu.
C+7
�
Requued sq. ft. E.D.R. or sq. ins. W.A. lxader area ��
F7.� � Room I Length � Width Height �
Windows and Doora—Crackage and Area
Wldth 8elght No. of Llneal Yt. Aiea
No. ot pane of pane lighte ol crack aQ. tt.
3 � �- ` . �c�
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Ceiling
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Total Btu.
��
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APpLICATIQN FOR RESIDENTIAL, AL'TERATION,
OR ADllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
, ` ,:,�? � �%��/- ��/
. � .
OWNER' S NAME : �' � � � .� � �. �,� D� BUILDER : <S �� �
ADDRESS : (�/� ��^ �� � .�,�� ,��°�'. ADDRESS : �S a � 2
NO:�a STREET:
�
LQT : .S'� ��BLOCK : ,S v ADDITION :�,d � � v' �/,� c� t�+ �� ��
CORNER LOT: INSIDE LO'T:�_SETBACK: SIDEYARD:
Applicant attach to this form Two Certificates of Survey of Lot and proposed
building locati.on drawn on these Certificates. r
HESCRIPTION OF BUILDING
To Be Used As:
!
�- '� y� q�, Front : v� O Depth : a� Height : /�
Sqnare Feet: '� ��J � Cubic Feet: �� �'' � �
Front; Depth: Height:
Square Feet; Cubi.c Feet:
�° ��
�pe of Construction: ,�°' � � � � Esti.mated Cos�: $ ,S� �p
To Be Complet�d: ��/" ��
The undersigned hereby makes app�icativn fox a permit for the work herein
specified, agreeing to do all work in stiict accordance with the City of
Fxidley Ordinances and rulings of the Depaxtment of Buildings, and hereby
declares that all the•facts and representations stated iat this application
are true and correct.
��_ %
DATE : v�� �' �°' �� S IGNATURE : �� -�-z�=-�:�..�.� � / �-�
(See Reverse Side For Additional Informa,tion.)
Qen� g , ��
`� � ►� T� � �l �
� ��
,
��,��
�
s
BUILDING PERMIT FEE SC�EDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
_erection of any building or str.�ucture, or for any addition to any existing
building or 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 herein below set forth and in
the manner herein provided to-wit:
UDTIFORM BUILDING CODE: �ype 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
AD�ITIONAL INFORMATION
For the purpose �f computing fees for building pexmits, the cubical contents
of any building or addition, is de�ermined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
ox the.cellar to the average heights of the upper surface or to the average�
height o� 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 a11 proposed work.
Tn no case sha11 the fee charged for any pezcmit as set forth in Section 2 be
less than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits fox construction will be issued a minimum of 24 hours from the
ti.me of application, to a11ow for proper review of the proposed structure and
of the construction site. �
�
A Certified Survey of the loi�, showing the location of the foundation, once it
has been constructed,'wi11 be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificata 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 said structure shall not be used or occup�ed until a Certificate
of Occupancy has been issued.
�is�
N O R T H E R N S T A T E 5 P O W E R C O M P A N Y
4801 BBTH AVENUE NORTH
BROOKLYN CENTER, MINNESOTA 55429
May 21, 1974
Mr Terry Hanlon
610 Hugo Street N E
Fridley, Minnesota
Dear Mr Hanlon
After visiting your home and looking at the set back on your
new garage, it appears you wi I I not infringe on the easement
at your rear property line.
Sincerely
��'//° ���
L M Benson
Customer Service Representative
North Division
LM B/rp
�
.
�
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
;,
� �
� • COMMUNITY DEVELOPMENT DIV.
i ��; ------�
r � � PROTECTIVE INSPECTION SEC.
1 = �
� �"'1 % CITY HALL FRIDLEY 55432 NUMBER
�----� • •'� si2-sso-3a5o 910-F15
JOB ADDRESS
REV. I DATE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR.
2 PROPERTYOWNER MAILADDRESS
T rr n � ii nlon Fil O�CJa Gtrr�c� _ N,F._
3 CONTRACTOR MAILADDRESS
r�i7mF'
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAILADDRESS
6 USE OF BUILDING
Residential
7 CLASS OF WORK � NEW ❑ ADDITION ❑ ALTERATION
8 DESCRIBE WORK �nstruct a 20' x 22' Garage
9 CHANGE OF USE FROM TO
STI PU LATION S
�
ZIP
ZIP
ZIP
IT NO.
12546
RECEIF�#6�
'7/��i
PAGE OF APPROVED BY
� �
SEE ATTACHED
SHEET
PHONE
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
❑ REPAIR ❑ MOVE ❑ REMOVE
�. Provide a haxd surface driveway.
2.':Electric wires be approved by N.S.P. or Electrical
Inspector(�ichmiller) (overhead wires above this garage)
SEPERATE PERMITS RE(�UlRED FOR �IIRING,
HEATlNG, PLUMBING ANO SIGNS.
TYPE OF CONST.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, ��D FRANJE
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
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. UNIT:
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $].�(OO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE
PROVISIONS OF ANY OTHER STATE C}R LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. S. SO
PLAN CHECK FEE
SIsiW7CYURE OF CONTRACTOR OR AUTH 12ED AGENT IDATEI
� °� , �d � ,� =� i� %
/� ---
�SIGNATUREOFOWNERIIFOWNER UILDERI (DATE
OCCUPANCY GROUP OCCUPANCYLOAD
440
STALLS
LY VALIDA
CU.FT.
4400
FSTREET PARKING
IGARAGES
RTAX
1.16
FEE
$9.66 �
OUR�PF�RMIT �"
BU1�Cllrig'` BUILD�(i Permit No.: o(dO� -(�/ �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY r�ate xec'd:
.�
DATE ��_ o S YOUR E-MAIL ADDRESS
SrrE a,DD1�SS Co 1 O /'-/�/S D '"-a �` /✓�.
THIS APPLICANT IS: ❑ OWNER [�CONTRACTOR
PROPERTY OWNER/
TENANT
r
a���,�Z
corrrRacTOR N,�,�: 7WIN CITY NOYE RENODELlNG
SUBMIT A COPY OF STATE LICENSE # Z°S�,�S� � EXP DATE _�" �O- o{O ���iltr'8I AV@.
YOUR STATE LICENSE ADDRESS: CITY Ff�iSI�EG�
WITH APPLICATION pHONE FAX „ PI10 %�%2'ZJ�T
PROPERTY TYPE
PERMIT TYPE
TYrE oF woRx:
❑ TWO FAMII.Y/NEW CONSTRUCTION STORIES
❑ ADDTI'ION ❑ GARAGFJSHED j�WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIlVIlvIII�TG POOL
DESCRIBE WORK BEING DONE:
SIZE OF A�IPROVEMENT
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
� Aluminum
❑ Other
❑ ADDITION
AIIt ❑ REMODELING
f.� .�au1 -2�c�`fS� t
LENGTH WIDTH HEIGHT
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACI-�D GARAGE
�Soffit
❑ Trim
❑ Fascia
WINDOWS
IN EXISTING OPENINGS �ites �No LOCAT�AN OJWINDOWS
OR FOR NEW OPENINGS-DESCRIBE STZE OF �I�wa.T'
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED , NUMBER OF WIIQDOWS
BASENIENT REMODELING SUBNIIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of strucdual members to be ased
Ft.
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing strucwres
and proposed project
2. Two set5 of construction plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ .ri�"� OCCUPANCY TYPE
Permit Fee $ ����" See Back Page for Fee 5chedule
Plan Review $ 65% of Building Permit Fee
Surcharge $ ��'� � (.0005) times the total job valuarion — Minimum $.50
Fire Surcharge $ 2, g� .001 x Permit Valuarion (1/10%)
License Surcharge $ s� �� $5.00 (State Licensed Residential Contractors)
SAC Charge $ $1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ $+ 6 ft= ft x$20 =$
Erosion Control $ $450 Conservation Plan Review
Park Fee $ Fee Determined by Engineering
Sewer Main Chazge $ Ag�eement necessary () Non Necessary ()
Total Due $ %.� Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclai 'wledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances an codes of City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application fo 't work ' not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whi approval of plans.
SIGNATURE OF APPLICANT PRINT NAME i����G% !�' U/�O�i/� DATE s'�!�"�
r
Page 2- Building Residential Application '°
BUILDING PERNIIT FEE 5CHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any e�cisting building or structure, or for any altera.tion or repair
to any e}usting 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:
TQT.Q�;: v . T,�Es.� � FEES
$ � to; $S0� t , , . � $23.50 (Minimum Fee is $23.50 plus surcharge)
�, ,p. M-������'��-��
,-
$501:'Yp $�;� ;(� "u� $23,50 for 1�` $500 plus $3.05 for each addirional $100 or fraction, to and
L � � ° __`^ �� . . .°'�'�' includin $2,000
$2,001 to $25,000 $69.25 for 1�` $2,000 plus $14 for each additional $1,000 or fraction, to and
- _ -- -incl��in �$25,600 — -
$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 $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for ea.ch 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 for the 1�` $1,000,000 plus $3.15 for each additional$1,000 or
fraction
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 proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing founda.tion will be
required before proceeding with the framing. New Houses Onlv
— --- —�ii�c�Fsid�ey ---- -
- — — - -- -- -- -- - Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
s
3uilding BUILDING Permit rTo.: �'� �� �- �4 �
r
:nspections RE5IDENTIAL APPLICATION Received By: C
163-572-3604 CITY OF FRIDLEY Date Rec'd: �� 1�
�p� -� r;- �•' 4• YOUR E-MAII, ADDRFSS
;ITE ADDRESS !s �� ss�u',� � 5f� �tJ � --
'HLS APPLICANT IS: j� OWNER ❑CONTRACTOR
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
TYPE OF WORK:
�
ADDRESS: G/'O �/y�'o 5'�: /Uf CITY �i'��`•?
PHONE: �� � ' �� -� ' 7�� �3
NAME:
STATE LICENSE
EXP DATE
.TT�GP�' � �� a9 �
ADDRESS: CIT'Y STATE ZIP
PHONE F�
�SINGLE FAMILY/IQEW CONSTRUCTION
0 TWO FAMILY/NEW CONSTRUCTION
❑ ADDITION � GARAGE/SHE
❑ BASEMENT FINISH ��F
❑ DECK 0 SIDING
❑ SWIMMING PI
p �w O ADDTTION
o ��x�xc�a,uz � REMODELINC
❑ DRAIN TILE
❑ OTEIER
DESCRIBE 910RK BElATG DONE: �i � h
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT Sq. Ft
— ----- �
n....,a•......
rTiTMBER OF SQUARES �
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
❑ HOUSE & GARAGE
❑ ATTACF�D GARAGE
❑ DETACHED GP.RAGE
❑Soffit
❑ Trim
❑ Fascia
wnvnows
II•T EXISTING OPENINGS OYes ONo LACATION OF WINDOVVS
OR FOR NEW OPENINGS-DESCRIBE S1ZE OF
OPENING CHANGES &
BASBMENT REMODELING SUBMIT:
1. Exist�g Floor Plan
2. Proposed floor plan
3. List of suvctural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS & PORCHES SUBMTI:
I. Site Plan/Survey showing the existing strucwres
and proposed project
2. Two sets of construction plans
3. Energy Calculations
TYPE OF WINDOVi' TO BE INSTALLED NUNfBER OF WIIJDOW3 I
ALL FEES AItE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS•
(USI1�T �THE_ 1��7 U.�,B�.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 'fd � OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
sur�harge
License Surcharge
SAC Charge
Curb C�x Escrow
Erosion Conlrol
Pazk Fee
Sewer Main Chazge
Tntal llne
$ �c� • �`j
$
$ _��
$ � . �-1'�
$
$
$
$
$
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)
$1550 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$20=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMTT-NOT VALID UNTII. PROCESSED
I hereby apply for a building permit and I aclmowledge that the information above is complete and accurate; that the work will be in
conformance with the ordina.nces and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requires r S�'ew and approval of plans.
�- �� -��
SIGNATURE OF APPLICAN�f��>"Z G� P�T N��4 ��� ��� g ��� DATE
�
Page 2- Building Residential Application
BUII,DING PERMIT FEE 5CHEDULE
The Chief Buildi.ng 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 1ffi $500 plus $3.05 for each additional $100 or fra.ction, to and
includin $2,000
$2,001 to $25,000 $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 $1,000 or fraction to and
including $1 D0,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and incl ' $500,000
$500,001 to $1,000,000 $3,233.75 for the 1ffi $500,000 plus $4.75 for each additional $1,000 or
fraclion to and includin $1,000,000
$1,000,001 and up $5,608.75 for the 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 ti.me of application to
a11ow for proper review of proposed shucture and of the constructi.on site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required. before proceeding with the frazni.ng. New Houses Onlv
City of Fridley
Buildin.g Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
Building BUILDING Pernut No.: a �
Inspections RESIDENTIAL APPLICATION Received By:
763-572-3604 CITY OF FRIDLEY Date �� MA 2 5 20 i
DATE 5/16/07 YOURE-MAILADDRESS estherd@probuiltam.com
SITE ADDRESS 6�- 0 Huqo S't NE
THIS APPLICANT IS: � OWNER ❑CONTRACTOR
PROPERTY OWNER/ NAME: David Goschev
TENANT �DRESS: s ame a s s i t e cr[�r STATE_ZIP
PHONE: 7G3) 433-9243
CONTRACTOR NA[v�: ProBuilt America
STATELICENSE# BC-20356847 EXpDATE U.i/Uti
SUBMIT A COPY OF �� 11 11 L ri AV2 � 5 5 ll�
YOUR STATE LICENSE ADDRESS: CITY North Stp STATE_ZIP
WITHAPPLICATION pHONE 651-770-5570 F,vc 651-770-0495
PROPERTY TYPE ❑ SINGLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMILY/NEW CONSTRUCTION STORIES
PERMIT TYPE ❑ �DITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
❑ DECK ❑ SIDING ❑ OTHER
❑ SWIMMING POOL
TYPE OF WORK: � ��' ❑ ADDITION
❑ MAINTENANCFJREPAIR ❑ REMODELING
DESCRIBEWORKBEINGDONE: Replacinq 8 window, not chanqinq sizes
SIZE OF IMPROVEMENT LENGTH WIDTH HEIGHT S. Ft.
ROOFING ❑ HOUSE ONLY
NUMBER OF SQUARES ❑ HOUSE & GARAGE BASEMENT REMODELING SUBMIT:
GARAGES ❑ ATTACHED GARAGE 1� ��g �� p�
PROPOSED SIZE: ❑ DETACHED GARAGE 2• Proposed floor plan
3. List of strucUual members to be used
PROPOSED HEIGHT:
SIDING FOR NEW CONSTRUCTION INCLUDING DECKS,
❑ Vinyl ❑Soffrt ADDITIONS. & PORCHES SUBMIT:
���� ❑ T� 1. Site Plan/Survey showing the existing sttuctures
❑ Other ❑ Fascia and proposed project.
2. Two sets of conshuction plans
WINDOWS 3. Energy Calculations
IN EXISTING OPENINGS ❑Yes �No LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES & 8
TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS
ALL NL:L:J E1K1�. 13A�1�.L U1V VALUA11V1�I� 11Vl,LULilrlr 1tiL� l.V.�l vr i.e�nvicru�y i�u�a��•�+••o.
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ 4101 OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$/f /<�, See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ �/� .001 times the total job valuation
$ .� .0005 x Permit Valuation Minimum $.50
$ 7 � $5.00 (State Licensed Residential Contractors)
$ $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement necessary ( ) Non Necessary ( )
� :�, . Make checks pavable to: City of Fridley Attac
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requ' •�eview aud approval of plans. ,
SIGNATURE OF APPLICANT ` pR� ��E�th�er Dahl DATE 5/ 16 / 0 7
_ _ � � �-
Building
Inspections
763-572-3604
DATE � — Cv � ��
SITE ADDRESS � �
TfiIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
9VITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
� � S � ��
❑ OWNER OCONTRACTOR
. �� �r� l°G s.1� y
Permit No.:
Recei
Date ec :
ADDRESS: �O ifGt 'c� S 7`/U� CITY �r G�����STA1Txyi�IP���
PHONE: �!� 3 — ���' � " 1' �3
NAME:
STATE LICENSE # EXP DATE
ADDRESS: CITY STATE ZIP,
PHONE FAX -- _
z'wo
❑ BASEIv�NT FINISH 0 ROOF
O DECK ❑ SIDING
❑ SWIMM
�rYrE oF woRx: -I � �W
DESCRIBE WORK BEING
SiZE OF
0
;�,�� �- s� ��'�� _
❑ DRAIN TILE
❑ OTI�R
HEIGHT
F�
NUMBER OF SQUARES ❑ HOUSE & GARAGE �ASEMENT REMODELMG SUBNIIT:
GARAGES ❑ ATTACI�D GARAGE 1• Existing Fioor Plan
PROPOSED SIZE: ❑ DETACHED GARAGE 2• �Posed floor plan
3. List of structival members to be used
PROPOSID HEIGHT:
SmIIVG � FOR NEW CONSTRUCTION MCLUDING DFCKS,
V�y� ��t ADDITIONS & PORCHES SUBMIT:
O Alwninum ' �'Trim 1. Site P1arJSurvey showing the existing structures
❑ p�� . � Fascie �d P�P� ProJ�
2. Two sets of conswction plans
WIlVDOWS 3. Energy Calculations
IN EXISTING OPENII�IGS OYes ONo L(�ATION OF WINDOWS �
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WIND09d TO BE WSTALLED NUNBER OF �WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ .� ,� `/� � � _ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Tntal Dne
$
$ � ��-
$
$
$
$
$
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)
$1675 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering ���� I�
Agreement necessary ( ) Non Necessary ( )
Make checks aavable to: City of Fridley Attach St
THIS IS AN APPLICA'�'ION 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 application for a permit and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work which requires review a d approval of plans.
SIGNATURE OF APPLICAl4`T l//'��_ �� PRMT NAM�� � �'� �G' S_ �'`Z �% DATE �—� —G �
Page 2- Building Residential Application
BIJII.,DING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permifs for the erection of any building or
stn,icture, 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
a.pplicant for such permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
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 Certificaxe 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
, Building
Inspections
763-572-3604
763-502-4977 FAX
BUI�DI�TG
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE �� ""6G -` �' YOUR E-MAIL ADDRESS
SITE ADDRESS � �G'� .`�� s'� � � /�'e=
THIS APPLICANT IS: �OWNER ❑CONTRACTOR
Permit Nof�
Received By: �
Date Rec'd: 1 I 1 �
PROPERTY OWNER/ N,�: �� v, �� G�:.- s c=% -
TENANT ,,�DRESS: �/D ��ct5%�� 5 �� CITY %�'� C' �� S STATE��ZIP � i�`/'i�y
PHONE: �G � '%�J'3 � S'-�y".3
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
STATE LICENSE
EXP DATE
ADDRESS: CITY STATE ZIP,
PHONE FAX
❑ SMGLE FAMILYMEW CONSTRUCTION SIZE
❑ TWO FAMILYMEW CONSTRUCTION STORIES
❑ BASEMENT FINISH
❑ DECK
TYPE OF WORK: I❑ NEW HOME CONSTRUC170N
❑ MAINTENANCFJREPAIlt
❑ GARAGE/SHED ❑ WINDOWS
❑ ROOF ❑ DRAIN TILE
❑ SIDING C&I,OTHER
❑ SWIMMING POOL
� ADDITION
❑ REMODELING
DESCRIBE WORK BEING DONE: � y � �
,>': !r P G dr >'�ir'v � 1 , !•° /.i
SIZE OF IMPROVEMENT LENGTH /' �� WIDTH %3 �� HEIGHT ��
ROOFING
NUIvIBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Okher
WINDOWS
IN EXISTING OPENINGS ❑Yes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF, WWDOW TO BE INSTAt,LED
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
� DETACHED GARAGE
BASEMENT REMODELING SUBMIT:
I . Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUC7'ION MCLUDING DECKS,
❑Soffit ADDITIONS & PORCHES SUBMIT:
❑ Trim 1. Site Plan/Survey showing the existing structures
❑ Fascia and proposed projecG
2. Two sets of construction plans
3. Energy Calculations
LOCATION OF WINDOWS
NUMBER OF
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
TOTAL JOB VALUATION $ ����'TH�7 U.B.0 FEE SCHEDULE)
OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surchazge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$
$
$
$
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)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks aavable to: City of Fridle_y Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an application 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 .J���� PRINT NAME,Y��t �c� C9�S��e �r DATE ��y� � S
Page 2- Building Residential Application F '�
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structure, or for any addition to any existing building or structure, or for any alteration or repair
to any 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:
VERIFICATION OF FOUNDATION
Permits for conshuction 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 Departrnent
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
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