AF - 46931,�
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City of Fridley, Minn.
BUILDING PERMIT
DB�; NOVENIBER 17, 1965
p�er; 8��, CHESTER MACIASZER
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N° 8605
Ad�ress Address 6380 �uincy St. N, E.
Fridley, Minnesota 55421
LOCATION OP BUILDING
No. 5 8� g�t TRONTON STRI3ET N. E. p� of Lot
Lot �9�.� Block G Additfon or Sub-Dfviaion �iverview Heights
Coraer Lot , Inside Lot � x . 3etback -,35' � Sideyard 01 � 14 �
sewer IIevat4on - 1L�� ` � � �on IIevation � °� � "°� ��
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DESCRIPTION OF BUILDING
To be vsed as:
DWELLIIQG �t 26 �p� 40 Height 20 Sq. Ft. 1��'� C�..Ft 20,800
Frant Depth FTeight Sq. Ft Cu, F't
Type og ����� Frame �, �_ 14 000 To be Completed
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In co�ideratlon of the 9ssusnce to me of a perinit to c tb�e bufldiag escribed abave I agree to do
th� proposed work in accardance with the description above se fo in liaa wlth a'll provisfons oP
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or8inances of the dty oP Fridley. ,'� �
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In canaideratlon of t�e payment of a fee of 2$ 1• �� � permft 4e hereby granted to– �STER _
MACIASZER to construct the buildfng or additfon aa described above. Thia permft ia granted u�
tl�e exPr�ss conditlon that the�peraon to whom it ie granted and his agents, emplo�� yees and worlanen, fn all work.
do�e in, around and upon eaid buildiug, or aaypart thereo� ahall conform ia all reapects to the ordinaaces oE
FridleY� Minnesota regardin�g lacatlon, cronatruction, alteration, maintenance� rePair and moving of buflain�a
w1o�� dty Iimits and tbia permit m�► be revoked at any time up� violation of any oE the proviaiona of 88�d
AT•T.F.N G. JENSEN
BUllt3ing IaepeCtOr
NOflC6
'IYs p�emtf doa ue1 eorar �hs coa�tnraHon, �ta�lloe tor �rWe9, plom6tne, 0a h�aHe�, awa or walsr. B� aro to a�
t6� BaiWtoB G�r iar apuaf� p�rmH� 1or tMa h�.
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APP?�ICA7,'IQN FOR BUILDING _PERMIT ., ,: � .
CITY;.OF FR�DLEY, MiNNESOTA-. �
owr�a � s rur� �su�n� L�i�����1' /�� o � � � �.�._
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Ann�ss � . , - .ann�ss � � � d � �` /A� c �/, ���Is�=
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, . . • LO+GATIOH OF BUII.D�NG, , . . . -
No.,_ �s��� . • S�reat 1 %P �/JA �' LD /1A � �.art of Lot �
-Loe ��9 �.'�1J � sio� � � aaair��.on.:�r subaf�ision�oPf�'�.����� �/_=/G�TS
� �� o . . , , .
Corner Lot�Ia�ide Lot - � Setback ���5"� Side Yard�; . /� � /�/ `
S�WER ELEVATION — FOUNDAI`IOA ELEVATION �
_,Applicant� .$te�ch to C,�tis. fosnp Two Certif3cates o% Survey ;of.. Lot -and proposed build-
ing iqcati.on drawa on �these. Certificatea . . . . . _ .� � .
DESCRII�ION OF BUILDING
To be used as:
—�/ile�4���' t� �,�L %. �-� F�COnt _: ,� (� Dep�h . _'�� . - Height � -� d
.. Sq.� Ft, f L% L��: ', '.Cu. Ft.. i� �� � d'� :
• . . . .�:. . . ,
Front Depth Height
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, . • Sq. Ft ._ , �. Cu . .: Ft . �
, ; .
Type of Construction _ /,�'� �d,Q � . ,���e�� Estimated Cost /�D`'G`(� _
. To be Completed ' �/� +p A��-�/� _
The unde=signed hereby makes�application fqs..a permit.for the�wor.k herein•epecified,
a�reeiag to do all work in strict accordaace with the Citq of Fridley Ordinances and
rulings vf the Department of Bu3ldin�s, and bereby declaxes that all the facta and
represeatatione stated in Chis applicativn are true and,coxrect:
DATE
�Schedule of Fee Coats cea be found on the 8everse Side).
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BUILDING PERMIT FEE SCHEDULE
Section 2. The Inspector of Buildin�s shall, before issuing any permit for
the erecCion of anq building or structure, or for any addition eo aaq exist-
ing building or structure, or for any alterations or repaira to anp existing
building or s�ru�ture, upon application therefor, require the payment by the
•appl3cant for such permit of fees ta the amount hereia below set forth and
ia the manner herein provided Co-wiC:
2.1. For any auch permit for the erection o.f any fire-proof building, other
than a garage� warehouse, factory or graia elevator, or for the erectioa.of
aay fire-proof addition, for similar occupaacy, to any existing building
shall be at the rate of $1.40�for each one ehausand cubic feeC, or fraction
thereof, in such cubical contents.
2.2. For any such permit for the erection of any fire-proof garage, wasehause,_
fac'tory or grain elevator, or for the erection of any fire-proof edditiDn,
for similar occupancp, to any exieting buildiag shall-be at the r�ate of $1.25
for each one thousand cubic feet, clasaified as "f3reproof" by Section 502 of
the M�Lnneagolie Building Code. . �
BOUSES
2.3. Fo; �uy such permit for the erection of any non-fireproof buildiag othe=
'- than a garage, warehouse, factory or grain elevator, or anq noa-fireproof
addit�an, for simi3a= occupaacy, to any existiag �iuilding - permit $1.0� for
each one thousand cubic feet. .
GARAGES
2.4. For any such permit for ehe erection of any nen-fireproof garage, .-
warehouse, factory or grain elevator, or for the erec�ioa-of any non-fire}�rouf
acidit3.oa, -€or-�similar occupaucy, to any existing building or for each such
v... �bui].d3ag or addition�- niaety ceats ($0.90) for each oae thou�and cubic feet
or fsa¢tion thereof, in the cubical contents thereof with a minimum of $4.04.-
For ehe purpose of camputiag fees for building.permits, the c�bical coateats
of aaq building or addition to a uniform height Chroughout by multip�ying t�,e
ground area covered from a point si� (6) inchea below the floor line of rhe
bas�ment or cellar to the average height of the upper• surface or to the
average height of the r�of surface of the mai� gable of a p9.tched roof.
2.5. For repairs or alt�erations to an exiatiag structwce, the fee shall be
at the rate of $3.00 per each Five fluadred Dollars ($500.@0) or fractioa
thereof in the cost o� all proposed work. �� �
2.6. In no caee shall the fe�_cliarged for.anq-permit�-a{g seG forth in
Section 2 be less: than $4.00. �
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` 10731 MI.S�SiSSIF�P� B(�ULEVA`RD N. �v:. CO�N RAPtDS,,MINNESOTA Telephone .
421-b340 .
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Certificate oi SurveX: �
Chester �laciaszek � . � - �
1 R�+N TDAf J".T R EEt .
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_ ` ; Lots. 39 ,.and 40, .'Bi a�k �, ;+Ri vervi e�r: Mei gn�ts ,. ; , -
� . Anoka Gounty, tAi nnesata � -
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- t HEREBY CERTIfX TNAT THIS IS A TRU� AND CORR�CT REPRES'EN7ATIOFI OF.A SURVEY 0� 't`t1E80�1NDAR1��
OF, TMFE ABII�E DESCRIBED LA1VD, AND TH@ �OCATION OF ALl BUILDINGS, TNEREON,. AN� ALL Y1:5�gLE'EN .
�1t�TACIiME1�17S, IF /WY, FR�AiY OR ON SAID LANO.
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AS SURVEY�D BY ME TMIS... �T[i........DAY OF.... �ovember ......:........�:.......n.n. ao65 ...... � , °
N. C. ft41UM' AND ASS CI . I _�,AN� SI�RVEY�RS .
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�ity of Fridley, Mi.nn.
BUILDING PERMIT
Da�: Oct, 1,°1968
��=1`� % _
�e 9958
p��.: _ Hoger Benjamim g��. Gusa B1�1g��
Ad� 580 Ironton St. N. E. �,d�� Princeton. Minnes�ta
LOCATION OF BUILDING
No. 5 8� Street Ir ont on S t. N. E. .,.,�, p� oE Lot
� 39 & 40_ glock G Addition or Sub-Division . R�.yg�view Heights
Corner Lot — 7nside Lot
Sewer IIevation
Setback �.�._ Sideyard
___._ Fo�mdation IIevation
DESCRIPTION OF BUILDING
To be Used as:
Garage �t +.22� Depth 24� Height 10' sq, �-t, 528 �, � 5280
Front Depth I%ight Sq. Ft Gtil. Ft
Type of Construcctatton Frame �� �_ 1700,00 __ To be Completed
In consideration of the issuance to me of a germit to construct the building described above I agree to do
the proposed work in accardance with the descript3on above set forth and in compliance with afl provlafons of
ordinances of the dty of Frfdley.
i�L_����� �/��' �ir��t��
In conafderation oP the payment of a fee oP $ 8• �� , permit is hereby granted to Gusa Blders ,
to cronatruct the building or addition as d�cribed above. This �ermit ia granted upon
the express condition that theperaon to whom it is granted and hia agents, employees and worlmnen, in all work
done in, around and u�n said building, or any►part thereof, ahall conform in all respects to the orainances oP
Fridley, Minnesota regarding location, conatruction, alteration, maintenance, repair aad movYng of buildings
within the dty limits aad thia permit may be revoked at any time upon viplation o of the provisiona of eaid
ordinancea
�, °
arence Be1is
NOTICE:
Thb permtt do� eef eeve� t6s eonaweHoe, le�talldlon h� whL�e, plambiee, en 6uNne, sswe� or watsr. B� sun h a�
tiro Butldiae In�or Por ap�rm pannhs M� t6ess Itfm�.
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APPLI�ATION FOR BIIILDINC PERMIT
LITY OI' FEIDLEYy MINNESOTA
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OWNEFi o� NAME � ' B�IIaDEft i���'�� F`'�
ADDRF�SS�D � ADDR�SS � •
LCCATIOIV 0�' BUILDII�?C
I�0 e •J� Fi� STREET � ���
LOT BLOCK A�DITIOIV OR SUBDIVISIO�T
COR_�'�ft LGT INuIDE I,OT SE"rBA�Ir SIDE`_TAR�
SEWEEt ELE`�TATIOPI TOP OF �'OCTI��
Appl icant a�tach -co this ior¢! T�,pa ��rtifi�at�� o? Su�vey oi Lot an�
propoaed build�..g locatiot°z dr�.u�r�. ors �h���� C��tiiicates o
To Be ��Pd A�:
DES�R�F"I' i ON 0�' B17IIaDZI�TG
Fro�t''�Z Dppth � Height � / c� '
�quare ieet Cubic FE�t
Fxont DEpth Height
Squaxe $�et Cubic Fe�t
Type of Con�txuGtion�ij�-�r.ynP Estimated Cost�1,�oQ ��
To Be Completed _
The undersig:n.ed hereby ma.k�s application for a p�rmit for the �aork
he�°e�. specii'icd9 agx°eei�2g to do all work i�a. strict accordance with the
City o� Fridley Ordixaa.nc�s a.nd rula.ngs oi th� Departmez�t o�° Buildangs 9
and he�eby declax es that alI the facts axid rep�e�er..tations stated in
this a�plication are true ara.d correcto
DATE �� 1 — 1y � SiGNA
(Schedule oi F'ee Cost� car be found on �,, e Reve�se Sideo )
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BUII�DING PEftMTT �'EE SCBEDiTT,E
SECTION 2o The In�pector o�f Buildings �hall, �a�iore iss-uing per�it�
for the e�ection oi an.y builditzg o� st�uct�e, r�v° ior a.ny �ddition to any
existing structure or buii�.ing9 or for a.n.y a.lte:�ation or repair� to any
exi�ting building o� �-t�uctu�°e9 upo:� a�pZi�at�o:� thereior�9 �equire the
payment by thE �.ppli��.nt fo� �uch permit oi f�e� to the amount he�ei.ta
belora �et iorth an� in the ma.�n.es° herein provided to�wit:
Unif'o�m Build�. Codeo Type 1y 2, & 4-$1075 ior each one thou�a.nd
cubic feet, or f'raction thereof 9 �.n suer cubical c:�ntert�o Tyloe 3& 5-
$1050 for each one thou�and cubic feeto
For the purpose of comgruting fees for building g�ermits, the cubical
contents of any building or° addition to a u�iform height thz°oughout by
multiplying the grou.nd area eovered from a point six (6) inche� below
the iloor line of the ba�effient or the ceilar to the average height of
the upper aurface or to the average height oi the roof surface of the
main gable oi a pitched roofo
For rep�,irs or alterations to ar� exiating �t�uctu:re, th� iee ahall be
at the �ate o£ $3e00 per each f"i.ve hut2dred dollars ($500a00� or
fraction the�°coi in th� co�t of all �roposed wo�rko
In no ease �ha11 the �ee �haxged f°o� any p�r_°mit as set ?orth in Section
2 be less tha.n $50000
NSSSD �onnection Charges ba�ed on location - Azea 1 or 2e
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NORTHERN STATES POWER COMPANY
September 20, 1g68
Mr. Roger Berganini �
580 Iron-Eon Street N.E. �
Fridley, Minnesota 55�+32 �
Dear Mr, Berganini:
Pursuant to our telephone conversation of this date,
please be advised that we have no objection to the pro-
posed two foot garage encroachment on the five foot
utility easement along the southerly line of the follow-
ing described property:
Lota 39 and �0
Block G
Riverview Heigh�s
Said encroachment w311 not interfere with our existing
facil3.ties occupying this easement.
Yours truly,
� E. P. Robertson �
Dis�ribution Superintendent
- Minneapolis Division
i • By _ �-c. _ --L � C- �>_ �._.. - -L-3
George"G. Lewis
� • Sr. Right of Way Agent
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sue�ecT P IT NO.
City of Fridley 18 814
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 EIPT NO
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r � � PROTECTIVE INSPECTION SEC. ��'7 � �
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l.--_� �'��,,� CITY HALL FRIDLEY 55432 NUMBER REV. OATE PAGE OF APPqOYED BY
i 612-571-3450 910-F15 3/9/87 � �
JOB ADDRESS 580 Trontan Street N. E.
1 LEGAL LOT N0. BLOCK TRACT OR ADDITION SEE ATTACHEO
DESCR. � 39, 40 G Riverview Heights, SHEET
2 PROPERYY OWNER MAIL ADDRESS ZIP PHONE
J'ames Schilling 580 Tront�n Street N.E. 786-1787
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
' S ENGINEER MAIL ADDRESS ZIP PHONE UCENSE NO.
8 USE OP BUILDING
Residential�
7 CLASS OF WORK
O NEW � ADDITION 0 ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroo� Dwelli,ng
9 CHANGEOFUSEFROM TO
STIPULATIONS
Rpo� ca,n be the 2nd layer but not the 3rd. Install ridged,
ga,.l.vanized valleys if necessary.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY (3ROUP OCCUPANCY 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 SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. � NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE 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 TVPE OF WORK WI�L BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT tiS`4OO � $. 5O
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. y�1.S.00
PLAN CHECKFEE TOTALFEE
..� $15. 50
Si TUREOFCONiRACT au Ai ENr tonTE� �HEN PROPERLY DATED HIS IS YOUR PERMIT
1 • �� ' e/
A' URE OF O!'R 1 N UIL RI IDATEI BLDG INSP pT
N� [] City of Fridley Effective 4/1/86
ADDN. I 7 R-1 AND R-2
pLTER. I l Building Permit Application
s �D�a s�- N'� ��i9 D L��
Construction Address: �� �
Legal Description: �v� 3� � yv �i�G� G�������� �P�s�� \
Owner Name & Address: � �--°
�S' ` Tei . � ��� � �
Contraetor : /i�O f' ��/�c� � � Tel . #
Address•
LIVING AREA:
GARAGE AREA:
DECB AREA:
oT�a:
Attach to this applieation, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
Length
Len�th
DESCRIPTION OF IMP80YEMENT
Width Height Sq. Ft.
Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
G�� oP �� �� � s
Corner Lot [] Inside Lot [] Ft. Yd. Setbaek Side Yard Setback
Type of Construction: ����� Estimated Cost: $ ���°��
Approx. Completion Date: ���
Alt. A Alt B
Proposed DriveWay Width If New Opening Is Desired: $ $
See Back Page for Explanation
DATE: � —v APPLIC . � Tel. � ��� �� ��
Permit Fee
Plan Check
State Surcharge
SAC Charge
Park Fee
Sewer Main Charge
TOTAI.
STIPULATIONS:
CITY IISE ON1.Y l '
\J
$ `��--f �- Fee Schedule on Reverse Side
$ 25� of Building Permit Fee
$ $.50/$1,000 Valuatioa
$ $ 525 Per SAC Unit
$ Fee Determined by Engineering
�
,> :
$ -
Agreement Necessary [ ] Not Neeessary [ ]
�-
�
��
BIIII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any
building or strueture, or for any addition to any existing building or strueture, or
for any alteration or repair to any existittg building or structure� upon application
therefore, require the payment by the applieant for sueh permit of fees to the amount
herein below set forth and ia the manner herein provided to-wit:
Total Valuatioa Fees
$1.00 to $500.00 �10.00 (Minimum Fee is $15.00)
$501.00 to $2,000.00 $10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and ineluding
$2,000.
$2,001.00 to $25,000.00 �32•50 for the first $2,000 plus $6.00 for eaeh
additional $1,000 or fraction thereof, to and
including $25,000.
$25,001.00 to $50,000.00 $170.50 for the first $25,000 plus $4.50 for eaah
additional $1,000 or fraation thereof, to and
ineluding $50,000.
$50,001.00 to $100,000.00 $283.00 for the first $50,000 plus $3.00 for each
additional $1,000 or fraction thereof, to and
ineluding $100,000.
$100,001.00 and up $433.00 for the first $100,000 plus $2.50 for eaeh
additional $1�000 or fraction thereof.
DRIVEWAY DEPRESSION ESCROii
(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
approaeh with 6 ineh depth - Driveway width plus 6 feet times $15.75
VERIFICATION OF FOUNDATION
Permits for construetion will be issued a minimum of 2�1 hours from the time of
application to allow for proper review of the proposed structure and of the
construetion site.
A Certificate of Survey of the lot, showing the loeation of the foundation once it
has been eonstructed will be required before proceeding with the framing.
�
sue�ecr p
City of Fridley � 2 6 4 5
AT THE TOP OF THE TWINS g � I L D i N G P E R M I T
�
; � RECEIPT NO.
� i v�_��� COMMUNITY DEVELOPMENT OIV. �D /$
r � � PROTECTIVE INSPECTION SEC. % 0
✓
� S �'�'1 � CITY NALL FRIDLEV $5432 NUMBER REV DATE PAGE OF APPRpVED BY
�'""� � �'' 612-571-3450 9t0-Ft5 7/6/98 / /
JOB ADORESS 581 Ironton Street NE
1 LEGAL �OT NO. BLOCK TRACT OR ADOITION SEE ATTACMED
DESCR. 2] � 2$ F Riverview Heights SFIEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PNONE
Ronald Lundsten 581 Ironton Street NE 785-0358
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADORESS ZIP PMONE IICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
D NEW ❑ ADDITION O ALTERATIO�+i ❑ REPAIR ❑ MOVE ❑ REMOVE
x
8 DESCRIBE WORK
Construct a 12' x 10' Shed in rear ard
9 CHAN(3E OF USE FROM TO
STIPULATIONS
SEPARATE PERMITS ARE REOUIRED FOR E�ECTRICAL. PLUMBING, HEATING, �PE OF CONST. OCCUPANCY (3ROUP OCCUPANCV LOAD
VENTILATING OH AIR CONDITIONING.
TNIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING S�. fT. CU. fT.
AUTHORI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OF ABANDONEO POR A;PERIOD Of 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. OWLG. UNITS OFFSTREET PARKING
1 HEREBY CERTIFV TNAT I MAVE REAO AND EXAMINED THIS APPLICATION ], STALLS GAFAGES
AND KNOW THE SAME TO BE TFUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNIN(i THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED MEREIN OR NOT. THE G(iANTING OF A PERMIT �SOO �.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOIATE OR CANCEL THE pEfiMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF TNE PERFORMANCE OF CONSTRUCTION. $29.25 Fire SC �.SO
PIAN CNECK FEE TOTAL FEE
$30.55
SIGNATUREOFCON: CTOao U�MORIIEDAGENT ionrE� WNEN P'ROp EF PVALa DATED TNIS IS VOUR PERMI7
�° � ' i� �� cr� Qy—�'�
iGNATURE OF pyyNER . OWNE BU40 fi� iDATE� f�.' 'g[D "�NS� �7�pTE
NEW
ADD1�T
ALTER
[l
[l
[l
Effective 1/1/98
CITY OF FRIDLEY
SINGLE FAMII.Y -AND DUPLEXES R-1 AND R-2 � p� �
� BUILDING PERMIT APPLICATION '� �
r�� (�� o�
w _� � I
ConstructionAddress: ��
Legal Description:
Owner Name & Address
�
P
Tel. �# ��s � �.�5'�v�
Contractor: � o�f MN LICENSE #
Address: . Tel. #
� Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
���
�A�-
GARAGE AREA:
DECK AREA:
DESCRIPTION OF IlVIPROVEMENT
. ��
Length �� Width / � Height �
Height
` Hgt/Ground
Length
Length
Width
Width
OTHER: �•
Sq. Ft. �d 6 a `
Sq. Ft.
Sq. Ft.
Construction Type: �� � e% Estimated Cost: $
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
e
DATE: 7°a-�J � APPLICANT: Tel. #i��� ��' s�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�
$ ��IB ZS
$ °
$ � .'�
$
$
$
$
$
$.
$ � '�
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1 / l Oth %)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering �
Agreement Necessary [ J Not Necessary []
._ -
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such permit of fees to the 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 $25,000
$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 each additional $1,000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for °first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,000 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,000 or fracdon thereof, to and including $1,000,000
$5012:25 for the first $1,000,000 plus $2.75 for each additional
$1,(�?0 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.�.
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 minimwn 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 constxucted
will be required before proceeding with the framing.
�
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. FILL IN COMPLETELY FOR REPLACEMENT FUEL BURNING APPLIANCE PERMITS
COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When reulacina an existina furnace, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes () No ()
The venting system is plastic/PVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes () No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
The existina combustion air is sized and installed to meet the current codes
and manufacturer's specifications.
When required to install a new combustion air. it will be sized and installed
to meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When installina a new ventina svstem, the undecsigned hereby verifies that .
it is a listed assembly and meets the current codes and manufacturer's
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft. appliances. Yes ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes.
�i�
Yes( ) No( )
A�pliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #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
Tatal App{iances - --- - -�al-Btu-�n�ut -- - - -
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
ALTERATIONS: (Describel
HEATING CO:
Signed By: Date :
ADDRESS
PIN
LEGAL DESC
PERMIT TYPE
PROPERTY TYPE
CONSTRUCTION TYPE
CITY OF FRIDLEY
6431 UNIVERSITY AVENUE NE
FRIDLEY, MN 55432
�63) 572-3604 FAX: (763) 571-1287
: 580 IRONTON ST NE
: 033024230058
: RIVERVIEW HEIGHTS
: LOT 39 BLOCK G
: PLUMBING
: RESIDENT'IAL
: ADDITION/ALTERATION
— ,
PERM O.: 2004-00868 � �'
DATE ISSUED: 06/09/2004
,�
VALUATION : $ 400.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL GAS WATER
HEATER
# ELEC WATER HEATERS 0 VALUE OF FIXTURE/APPLIANCE 0
# NEW FIXTURES (EXIST OPENIlVGS)
# GAS DRYERS
# OF NEW FIXTURES
APPLICANT
NORBLOM PLUMBING CO
2905 GARFIELD AVE S
NIINNEAPOLIS, MN 55408-2173
(612) 827-4033
OWNER
CHARLESCHACRA
580 IRONTON ST NE
FRIDLEY, MN 55432
AGREEMENT AND SWORN STATEMENT
This permit becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and lmow the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating constr ction or the performance of constntction.
Ap��ie2m�_� _ Date i t
Bldg
0 # GA5 WATER HEATERS
0 # GAS RANGES
0 # WATER TRMT APPLIANCES
PLBG PERMIT MINIMUIVI FEE
PLBG FIXTURES (NEW OPENII�IGS)
PLBG FIXTURES (EXIST OPEI�TINGS)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS
GAS RANGE FEE
GAS DRYER FEE
PLBG REPAIR/ALTERATIONS
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 28399
SEPARATE PERMITS REQUIRED FOR WORK OTI�R THAN DESCRIBED ABOVE.
1
0
0
0.00
0.00
0.00
0.00
0.00
35.00
0.00
0.00
0.00
0.50
35.50
Building
Inspections
763-572-3604
�_3�.�5�
STfE ADDRESS ��
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
BUILDING
�/. � � I Pernut No.
RESIDENTIAL A►PPLICATION
CITY OF FRIDLEY
YOUR E-MAIL ADDRESS
G/L�J7�+ rJ � s� N' "�,
❑ OWNER CL9'�ONTRACTOR
Na,rv�: � ON
nDDRF�SS: � � .L/L �•J �'D� $� �1'('y � P
PHONE: �G• � ��� ° S� �9'
NAME:
STATE LICENSE # � 7'E
ADDRFSS: CI71'_
PHO�TE _ ..
IIJGLE FAMD.Y/NEW CON r SIZE
❑ ADDTI'ION ❑ GARAG
❑ BASEIv�NT FW1SH �'ffOOF
❑ DECK O SIDIl�IG
❑ SWINIM
DESCRIBE WORK BEING
SIZE OF IlViPROVEMENT
nvvca�.v
NUMBER OF SQUARES �
GARAGES
PROPOSID SIZE:
PROPOSID I�IGHT.
SIDIlVG
❑ Vinyl
� Aluminum
❑ Other
WINDOWS
IN EXISTING OPENMGS �Yes ONo
OR FOR NEW OPENINGS-DESCRIBE S1ZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
❑ REMODELD�IG
w+-e � C,�.
LENGTH
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATfACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
❑ Trim
O Fescia
LOCATION OF WINDOWS
NUMBER OF
❑ wnJnows
O DRAIN '�'�i R
� OTI-�R
Received By:
Date Rec' d � -�
HEIGHT
� ��up�
'ATE Z�,
BASEMENT REMODELING SUBNIlT:
1. Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
Ft.
FOR NEW CONSTRUC7'ION INCLUDING DECKS.
ADDITIONS. & PORCHES SUBMIT:
1. Site Plan/Survey showing the existing structur�
and proposed project
2. Two sets 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 $ OCCUPANCY TYPE
Permit Fee $ ��, 2� See Back Page for Fee Schedule "
Plan Review $ 65% of Building Permit Fee
Surcharge $ � (.0005) times the total job valuation — Minimum $.50
Fire Swchazge $ �2.0� .001 x Permit Valuation (1/10%)
License Surchazge $ so� $5.00 (State Licensed Residenrial Contractors)
SAC Chazge $ $1450 per SAC Unit (Plans to MWCC for determination)
Curb Cut Escrow $ ft+ 6 ft= ft x$20 =$
Erosion Control $ $450 Conservation Plan Review
Pazk Fee $ Fee Determined by Engineering
Sewer Main Chazge $ Agreement necessary () Non Necessary ()
Total Due $ �, /, �� Make checks payable to: City of Fridley Attach Stipulations
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 accwate; that the work will be ir
conformance with the ordinances d cod of the City of Fridley and with the Minnesota Construction Codes; that I nnderstand this is not �
permit but only an application a pe t and ork is not to start without a pe it; that th work will be in accordance with the approvec
plan in the case of all work w q' e e i and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME N ����d�"'DpTE � J'� �
Page 2- Building Residential Application
BUILDING PERMIT FEE SCHEDULE
The Chief Buildang 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 xepair
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
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 Fr�rir�y — --
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977