AF - 46829�
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Date:
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City of Fridley, Minn..
BUILDI
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G PERMIT No s s 4�.
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Builder '"�' '°�
�jdaresa ' � Address
LO TION F BUILDING
No. �� street =��'�— p t —
'� a
Lot _.._....�—__ Bl�k � Addition or Sub-Divi�on �'-
Corner Lot — Inaide Lot �� Setback `� � Sideyard �� ����-
Sewer IIevatian � _ Foundation IIevation
DESCRIPTION OF BUILDING
9
To Used � .ry�
- Froat � Depth �� Height ��� Sq. F't �� Cu. F't/��
Front Depth � FTeight � Scl. Ft �_S� Cw. FL� `��
o ct[on _ _ F�t._C,�'�a� _° To be Completed
TYPe /��
In consideration oP the �tsauance to me of a germit to construct the building described above, I agi�ee to do
the proposed work fn acc�rdance with the d�scription above set forth and in compliance with all provisfons of
ordinances oP the dty oP Frldley. ''
� ��� e��
In consfderation oP the payment of a fee of �.�.�'4_� , permit is hereby granted to
to construet the building or addition as desccibed above. This �ermit is granted uPon
the express condition that thepe�on to whom it is granted and his agents, employees and workmen, fn all work
done in, around and upon said building, or anypart theneof, shall conform fn all respects to the ordinanc�es oE
Fridley, Nlinaesota regarding lpcatfon, construct%n, alteration, maiatenance, repair and mov3ng of buildiuge
within the dty lim�tts aad this permit may be revoked at any tiaae upon viol�teip of aay of the P�viaiona oE said
ordinancea. �1, .. � / 1
Buildiag Inspector
NOT1C�
T�s peemN dou eof eewsr ths eo�eHoe, �dm �or �rhieS. P��B. 6a 6adog, awsr ee walsr. B� wro to ss�
!M 8uild6� lesp�etoe for aparaM p�rmHs Por thes huei.
.,,,.., �_ �,
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Lond Plannin9 687'S-Hi�hwoy �6S N.E. �
Cond Surveyii� Minnieopio/s 2I,
S°,,STst»9 �� � x� EN G I NEE RI I� G� I N C. M�nnesofa
Civil b Municip�al - '° SUnsei4-6066
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SUBJECT
City of Fridley � 16 7 6 6
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. ��� �
r � L � PRO7EC71VE INSPECTION SEC.
� . ;
i_-_. A����;'J CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
L J` 612-571-3450 910-F15 9/15/82 � � /
JOB ADDRESS 280 IrontQn St. N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ]. 1 Herwall"s SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Daniel S. Bernt 280 Irontnn St. N.E. Fridley 55432 786-4911
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Oumer
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUIIDING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Insta.11 a wood burnin stove and maso chi.tnne .
8 CHANGE qF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCI' LOAD
VENTILATING OR AIR CONDITIONING. N.Iet31 B�,OC.IC
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R 1
ANY T�ME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STA��S GARAGES
AND KNOW THE SAME TO BE TRUE.AND COFiRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEFiEIN OR NOT. THE GRANTING OF A PERMIT 4SO.00 .'rJO
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 PERFOFiMANCE OF CONSTRUCTION. ].S OO
PLAN CHECK FEE TOTAL FEE
IG TUfiEOFCONTRAC ORORAUTMORI2EDAGENT IDATEI WHEN ROPER Y I A ED IS IS YOUR PERMIT
� - � �i� ;:�za �� � �? lS=��
SIGNATUREOFOWNER�1 VNERBUILDERI IDATEI G iNSP OATE
CITY Of FRIDLCY Effective Auq. 1, 1981
APPLICATI��! FOfi RESIDCWTI/l� BU1LD1rJG PCitt�flTS
�f��►�, A1 terations. Addi tions, or Repa i rs )
�rlNER: _�� h;� J S � ,� ►. ^� � QUiLDER: _ �� h P�- .
ADDRESS: _�Z � D 7�.- �.� i� o� ADDRCSS: S� r�. �
TEL N0: _ '� ��-� f% l 1 � TEL ti0: S a� �
Construction Location
• STJiL�TrT NO s z i� � 6TItEET: �e.� o�.. �� t�
IAT: _ % BLOpC: `_� �pDITION: J� � r w� lI �s
Corner Lot: � insicie I,ota Sctback: � Sideyards:
Ap�licar�t attach to this forn two Certificates of 5lirvey of lot aad
pzoposed buflding locatiaa� ctrawn on certificates to scale.
DESCRIPT10td OF COr•�STRUCTiO��
Zr,. S`�� ��� h� �� �FZ'OTlt:n �..`5 S I�o v� 2 t� o� �p� a�. a�Jr c%��+,�e"� y'Hei ht:
._.__.___ / q
Square Faets Qibic Feet:
, Front: Deptha Neight:
Square Feet: ' Q�bic I�eet:
� G3 i�7/�`�'l�h � •
��_, �c.,V�s g C 1� )un. mfl�.vaha�,� �
Zjtpe of Corsts�"uCtion z Est3mated Costa $ ���
Rb Be Cbr.�pleted:
A lt. A A1 t. B
Proposed Drivc�,�ay kic]th If New Openinq Is Des3sed: $' s
__.--__.____
, . . SE� REVER;E SIDE OF SHEET
9ize undersigned hereby make� application for a permit far the �Ark herein specified,
agreeinq to cb ,all vork ir, strict accor8ance �ith the City of Fridley Orc1i»ances and
rulings of the Delaart�nent of Dufldings, an� hereby declares that all the facts and
re�res�tatiens stated ir� this Applicatior► are true and correct.
aa�: `% /S Z sicxnzvr� <�'��� .��
-�%�-`�_
Stipulationss
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S �v
BUILDING PERMIT FEE SCHEDULE
The Inspectoz cf buildings shall, before issuiaq permits for the
•rection of any building oz structure, oz for any addition to any
•xistiag building or structure, or for aay alteration or sepaiss
to aAy �si�tinq building oz atzucture, npon application thezefore,
requise the payment by the applicant f or �uch pezmit oi �ees to the
a�ouat bereia below set for�b and in the �annez herein provided to-wit:
'POTAL V7ILUATIQd
51.00 ta 5500.00
5501 b� 52.000
52,001 t� 525,000
525.001 to 550,000
lEES
510.00 Mini.mum Fee S15.00 plus surcharge
510.00 for the ffrst S500 plus $1.50 for each
additional 5100 oz fraction thereof, to arid
includinq S2•000
�32.50 for tlie fizst $2,000 pius 56.00 for each
additional �3,000 or fraction th �eof, to and
i.r�cluding 525, 000
5170.50 for the first �25,000 plus S4.50 for
each a�ditional $1,000 or fraction thereof, to
ar�d includiag 550, 000
550,001 tc 5100,000 5283.00 ior the fizst 550,000 plus 53.0� for
each adc73tior►al S1,000 oz fraction thereof, to
ar�8 including 5100, 000
5100,001 and up S443.00 for the first 5100,000 plus S2.50 for
each adaitional 51,000 or fraction thereof
PLAN C�IECK: 25 percent of building permit fee
�Nfl�IAY DEPRESSION ESQtOW: Concrete G1irb Streets �ly
Alternate "A"t Removeal an8 replace�nent of curb and gutter only ,
Driveway width plus 6 feet x$13.50
111terr�ate '8" r Removal and replacemesit of curb ar�d qutter anci install a 3 foot
wide approach with 6 inch aepth
Driveway width plus 6 feet x S15.75 .
VERIFICATION OF FOUNDATION
PermitB for cor�struction will be issued a minimuvn of 24 hours fraan the time of
appliaation to allow foz proper review of the proposed structure and of the
coastru ction site.
A Certificate of Si�zvey of the lot, ehowinq the location of the foundation once it
has beea vonstYVCted will be requized before proceeding with the fzamis�g.
d - �
0
Building
Inspections
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
� � � �� �.�;r�r�'�.'�7t1����ZOTi/sL!
� ): • . . • •
�
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
STATE LICENSE #
�
EXP DATE
Pemut No.:
Received By:
Date Rec'd:
ADDRESS: CITY STATE ZIP
PROPERTY TYPE ❑ SnvGLE
O TWO FA
PERMIT TYPE
O BASEMENT FINISH J�l ROOF ❑ DRAIN TILE
� DECK ❑ SIDING O OTf�R
O SWINIMINGPOOL
TYPE OF WORK:
DESCRIBE WORK BEING DONE:
SIZE OF IMPROVEMENT
ROOFWG �,
NUMBER OF SQUARES ,�
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
O Vinyi
� Aluminum
❑ Other
LENGTH WIDTH HEIGHT
O HOUSE & GARAGE
O ATTACHED GARAGE
❑ DETACHED GARAGE
OSoffit
� Trim
❑ Fascia
WIIVDOWS
IIV EXISTING OPENINGS ❑Yes ONo LOCATION OF WINDOWS
OR FOR NEW OPENINGS-DESCRIBE SiZE OF
OPENING CHANGES &
BASEMENT REMODELING SUBMIT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUCTION �TCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structures
and proposed project
2. Two sets of construction plans
3. Energy Calculations
TYPE OF WINDOW TO BE INSTALLED NUMBER 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 Surchatge
SAC Chazge
Curb Cut Escrow
Erosion Contro)
Park Fee
Sewer Main Chazge
Total Due
$
$ . ✓'I
$
$
$
$
$
$
$�
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)
$I550 per SAC Unit (Plans to MWCC for determination)
$+6ft= ftx$21=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks aavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION 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 worls,will�e�n accordance with the approved
plan in the case of al or which requires rev'ew and approval of plans. `� j��, �f ��� q�/Il
SIGNATURE OF APPLIC PRINT NAME � DATEr� '"/ ��-
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building O�cial 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 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
a11ow for proper review of proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the existing foundation will be
required before proceeding with the framing. New Houses Onlv
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977