AF - 47145`,;
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� � Village of Fridley, Mi.n.n.
�'� BUILDING PERMIT �°• 1? 9 6
Date: . ��,/�, ,'� . . �. .�.�.� ..... .. . . �,
Qwner ....................................... Builder .lY�. ,����--e'�rl.. ... . . 4-�i
Address
...................................... Address ....C���........................... "e,
LOC T[ON O ILDING
No. � �!?-: � Street . . . . . . . . . � . . . . . . Part of Lot . . . . . . . : . . . . . . . . w . .
Lot . . . � �. • • • • • Block . . . . . . . � . • • • • Addition or Sub-Division . • • • • • • • • • • •
. �
Corner Lot . .. . .. .. . . . Inside Lot . ..+Y:.. ... . Setback . . °�. °�.�. . Sideyard .. ...��.. . .��.'.�.`%• • • • • • •
DESCRIPT[ON OF BUILDING
To be tised
� . . . .. . � ... .. . Front .��.. . Depth .°�'.°�..j. Height .� � . . Sq. Ft. . . ... .. . Cu. Ft. . .... .. .
..... ..... . Front . .. ..... Depth ........ Height ..... Sq. F't. ........ Cu. F� ........
Type of Construction . %�f.3�t� • • • • • • Est. Cost . . ., .`: . . ��-• • • • To be Completed . . . . . . . . . . . . . . . . . .
�
In consideration of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions of
ordingnces of the village of Fridley.
��
in consideration of the payment of a fee of $. �"�'. .�- Permit is hereby granted to ..�:���.G;��s2
. . . . . . . . . . . . . . . . . . . . . . . . . to construct the building or addition as described above. This permit is �ranted upon
the express condition that the person to whom it is gratated and his agents, employe�s and worlunen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinaaces of
P'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be re ed at any time upon violation of any of the provisions of sa.id
ordinances. :,�
.�: ^ .. . � . . . . . . . . � . . . . . . Building Inspector
IVOTICE:
This permit does not cove� the construction, installation or alteration fo� wi�ing, plumbing, gas heating,
sewer or water. Be sure to see the Building Inspector for separate permits for these (tems.
�
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BUILDING PERMIT �
i
�' N°' 2277
Village of Fridley, Minn.
Date ��� �,�t"�l : . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Owner ri �' t / ............ Builder . ��:1�i.�•
�,�,� � ct'�� ,,�?��'�,�5 r✓•�" ;,:.._ . . . . . . . . . . . . . . . . . . ..
Address r� �'�:� � . . � . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCATION OF BUILDING
No. i�.. ►�.���:. .. . . . Street :,�t���s,J�r, .y,,,��. .�a�ii4�. . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . .. . . .
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Lot ................ Block ................ Addition or Sub-Division .......................................
Corner Lot ............ Inside Lot ...�,,,,....... Setback .��-:,,�_, Sideyard .►�."r'...�-j ................
DES�CRlPT10N OF' BUILDING
To be Used as:
. �`r.�F .,., <at'. . . . . . . Front � . . . . Depth .�, . . . Height �,�'� �r . . . Sq. Ft. . . . . . ; . . Cu. Ft. . . . . . . . .
te'
.................... Front ........ Depth ........ Height ......... Sq. Ft. ........ Cu. Ft. ........
Type of Construction �,f.��}y{;,... Est. Cost ... �•,t�,+ �....... To be Completed �.!7�yt���c..
,,�� ,,��,,�-� t � -�- .
�
In consider�tion of the issuance to me of a permit to construct the building described above, I agree to do
the proposed work in accordance with the descxiption above set forth and in compliance wfth a11 provisions of
ordinances of the village of Fridley.
.
7n considera�ion oP the payment of a fee of $. . �r. . , permit is hereby granted to . .. fMr: :� . .. .. . . . . . . .. .. .
. . . . . . . . . . . . . . . . . . . . . . to construct the building d�° a8 dition as described above. This permit i5 granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work
done in, around and upon said bui�ding, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding locaiion, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at ar�y time upon violation of any of the provisions of said
ordinances. ��,,�`'�.~�-
. . :'trL�':a'!_ .,1. � � ".�: T. s . -litiZ e+�l�s . . Buildin� InsAector
NOTICE:
Thls permit does not cover the construction, installation or atteration for wiring, plumbing, gas heattng,
sewer or water. Be sure to see the Building Inspector for separate permits for these Ytems.
� �,
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BUII.DING PERMIT
( 1
Village of Fridley, Mi.n.n. N� 2 7 7 2
Date /��C�� ..�.� .....................
Oa�ner . . . . .. . ..��-���i�a�� . . . . . . . . .. . . Builde���.. �. . . . . . . . . . . . ..
Address � . %�o� � . . .
Z7'?. . . �.�� Address � � f�.
..�.......
V LOCAT[ON OF BUILDING
No. l7�. �c� � . . . StreeJ���� � : �"(.�'`� . . . . . . . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
L � %%j,,,��� ���
Lot . . . . . �,� . . . . . . . Block . . . . � . . . . . . . . . Addition or Sub-Division .�. . . . . . . . . .L��"�: . . . . . . . . .
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Corner Lot . . . .. . . . . . . . Inside Lot . .. f.l'. . . . . . Set���i�"''.�. �ideyard :�.��.tr . . . .. . . . . . . . . . . .
DES�RIPTION OF BUILDING
To be Used as:
,r.�G�re�. . . . . . . . F'ront � � . . . Depth . �. �: . Height %�. �s. . . . Sq. Ft�. � � . . Cu. F't. . . . . . . . .
. .. . . .. .. . . . . .. . . . . . Front . . . . . . . . Depth . . . . . . . . Height . . . . . . . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
Type of Constructio��'e!:N�. . �st. Cost . ���. . �. . . . . . . . . . . To be Completed �. : !!sl.�' iO�O.�e4l. . . .
�
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In consid�ratian di the i�ssuance to me of a permit to construct the building described above, I agree to do
the proposed work in a�ccordance with the description above �e� ,�orthJ� omp 'ance 'th �,11 provisions of
�rclin�nces of the villa e of Fridley. �� ��
(,� (�
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.�t�..�.�.�' . . ...................
nsideration of the payment of a fee of $.� . . . . , permit is hereby granted to . . . . . . . . . . . .
. �p .......... to construct the building or ad dition as described above. This pernut is granted upon
the ress condition that the person to whom it is granted and his agents, employees and worlrnien, in all work
done in, mround and upon sa.id building, or any part thereof, shall conform in all respects to tUe ordinances of
Fridley, Minnest�t�. regarding loca.tion, construction, alteration, m�intenance, repair and moving of buildings with-
in the village limi4� an�1 this permit may be revoked at any tim�j� pon violation of any of the provisians of sa3d
ordinances. • // � _ �1 il i
. . . .��. . �/. . d�./��✓�":'(e!�.°Building Inspector
NOTICE:
This permit does not cover ihe const�uction, �installatlon or alt�eration for wiring, plumbing, gas heattng,
sewer or water. Be sure to see the Building Inspector for separate permtts for these items.
sue�ecr PER
City of Fridley 125'72
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � REC
� ; y ____ COMMUNITY DEVELOPMENT DIV. �/� /�
r � PROTECTIVE INSPECTION SEC.
� �
� ` �
�' ����1 � CITY HALL FRIDLEV SS4$Z NUMBER REV. DATE PAGE OP APPROVED BY
""� � •`� 812-580-3450
910-F15 5/31/74 � /
JOB ADDRESS 5725 Jackson Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 13 5 Donna 's Lakeview Manor Addts SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
Pie ho L. W. 5725 Jackson Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Giertsen Com an 4
d ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE IICENSENO.
6 USE OF BUILDING �5].C;E.'II't.'1.�
7 CLASS OF WORK
0 NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
���� Repair fire damage to dwelling
9 CHANGE OF USE FROM TO
STIPULATIONS
�EPE�Ai� P�RMITS
HE,ATIIVGp P���g��� a��U�RED FpR �tF?IN� .
� S�G►VS. ,
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, �PE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. �OOd Fr3IRe
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORI2ED I9 NOT COMMENCED WITHIN 80 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 CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIPIED HEREIN OR NOT. THE GRANTING OF A PERMIT $2�000 �.sOO
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 R THE PE/RFORMANCE OF CONSTRUCTION. tii`].Z.00
[J� PLAN CHECK FEE TOTAL FEE�]
i VV � � '��� 7� �ZJe00
�� iIGMATUREOFCONTRACTORORAUTHORIZEDAGENT (DATEI WHEN PROPEFiLY ID TED THI�IS YOUR PERMIT �
� � .
Ce� � 3/"'� � � � .
SIGNATURE OF OWNER IIP OWNER BUILDERI IDATEI BLDG. INSP DAT
E1PPI,ICATION FOR RL•SIllENTIl�L, ALTEIta1'Ii?:V,
OR F1i)lll�'IOA' fiUII�AING pERMIT
C:I'1'�" OF 1-1:1 UL1�� ,'•11 tiN�:S�'�'�
OWN�R � S NAME • � / C �%� � / � • � o BU ILDER • � ��'/L � S C° ,c� �itl .
r---
�nxES s: � 7�' °�//� �,� s o� /� �. ADDRES S: z� �� L�/r @ eaG a, �'7f�y S.,
NO . . `� � � STREET : �/f� kS o Ai %� �
i3O�: �.3 BLOCK: S ADDITION:�dN/Vj4fS �/��r°-P/0� /'?OQ�uo/�
CQRN�R. LQT: INSIpE LOT: SETBACK: SIDEYAFD;
Ap�lican� attach to this i-orm �ao Certificates of Survey of Lot and proposed
bt��.ldi�[g locatiQn drawn on these Certificates.
UESCRIPTIUN OF BUILDING
To Be Used As;
�� � � � � Front: Depth: Height:
Squaxe Feet: Cubic Feet:
Front: Depth: Height:
Square eet; Cubic Feet:
�? � —�
�`yp� o� Constxuction:� � Eatima.ted Cost: $ �OAA
--►
�o Be eomp].eted: � ' /� � 7
The undexsigned hexeby makes applicativn for a permit for the work herein
ep�c:lfied, agreeing to do all work in st7Eict accoXdance with �he City of
Fxidley Ordinances and rulings of the Department of Buildings, and hereby
deelares that �11 th�: facts and representations stated in this applica�ian
��Ce true and ��,,rr.�ct.
s �`- ��/
DATE : � 7 S IC;�AT'URE • ��"
(Se� Revexse Side Fox Additional Tnformation.)
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BUILDING 1'�:IL'�9J'I' 1��:F. SCIII:llUL�:
S�GT�ON �. The Tnspect��r �f Bt�i.ldin�s shall, before issuing permits f.or the
ex�ctfon of any buiiding or strur���rc, ar �o� any addition to .iny exi.sting
bui7.ding ox structure, or for ._tny .�lterat�i.on or r�pairs to any e?:isting
building or structure, i�pon ap�lication ttierelor�, req�;ire the payment by the
�pplicant fox such permit of tec�s tc th�� 3mount hexein below set forth and in
�he manner here.in provided to-���it:
[JN�FORM BUILDING CODE: Type 1, 2& 4-$2.15 for each oiic: thousand cubie
feet� o7C fraction thereof, in such cubical contents. T}'pc� 3& 5- $1.85 for
�aah one �housand cubic feet.
:1DDITIONAI. tvPORh1ATIUIV
�'ax the purpose of computing �ees f��- building permits, the cubical contents
of any buildin� or .�ddition, is determined by multiplying the gxound area
aca���c�d fxom a point six (6) i.nches below the flouX line of the basement
ox ths Ce11a� to tl��� average heights ;>f the upper surface ox to the average �
h�:l�'ht �� tha roof surface of tlie ma.in gable of a pitched roo.£.
Fo� xepaixs ax a�.texations to an existing structure, Ghe fee sha11 be at �he
7Cate o� $�.00 per each five hundred dollars ($500.00) ox fraction thereo� in
the 6os� of all proposed work.
�u rtu case shall the fee charged fox any permit as set forth in Secti.on 2 be
d.e:�a than $5 s OQ •
VERIFICATION OF FOUNDATION
NQi'�i P�xmits tor construction will be issued a minimum of 24 hours from the
tl�e o� application, to allow for proper review of the proposed structure artd
�$ �he constxuction site.
A Certif�ed 5urvey of the lot, showing the location of the foundation, once iC
has been eonstxucted, will be required before proceedin� with the framing.
�'L'RTIFTCATE UF OCCUPANCY
Application fc�r a Certiiicate o� Uccupancy shall be made ten (10) days prior
to the u�e or occupancyo uf any structure for which a building pen�nit has been
�.ssu�d; �nd s,iid structure sha11 not be used or occupied until a Certi�icate
oa Ocaupazicy has been issued.
� ,� . ,�
sua�ecr PER . -
City of Fridley r 16 3 3 7
AT THE TOP OF THE TWINS B U I L D I N G P E R M I T �
r
� � REC .
� • COMMUNITY DEVELOPMENT DIV.
� j L' —
r � � PROTECTIVE tNSPECTION SEC. � 9'9�
1 i �
� /'�"1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�'"'"'� � ,�� 612-571-3450 910-F15 8/11/81
� /
JOB ADDRESS 5725 Jackson Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
oescR. 13 5 Donnay's Iakeview Maimr SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
L. V�. Piepho 5725 Jackson 5treet N.E.
3 CONTRACTOR MAILADDRESS 21P PHONE LICENSENO.
D& L Construction RR #l, North Branch, NIl�i 674-4553
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION C� ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof Dyaelli.ng
9 CHANGE OF USE FROM TO
STIPULATIONS g�of can be 2nd but not 3rd r�of. Install rid ed
g galvanized valleys.
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 SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 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 CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOiiK WILL BE COMPLIED $]_�SOO y�`.%S
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $25.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
J $25. 75
� / ,;�. �
I ATUREOF NiRACTORORAUTNORIZEDAGENT �DnTEi -�� �/yHEN PROPERLY VALIDATED THIS IS YOUR PERMIT
4 ��.,� �� ��� � ��+ +� �`
SiGNATURE OF OWNER�Ii OWNEF BUILDERI IDATEI BLDG INSP Il TE
e
CITY QF FRIDLCY Effective Aug. 1, 1981
APPLIC/1TIOi� FOft RCSIDCi�TIl1� QU1LDIi�G PEfL`�iITS
(��e�•r, Alter.�tians, AddiLions, or Repairs)
011tdER: �,r�'1i,��.,_�%�,
ADDRESS: �''e :� ,� �,�t�,�� /,jl�c,
,�, . �. � - C�.c� t..�,a i� �' c �.i l L� ,+�;y'
I3UI LOER : _ � �'-m-�
ADDRESS: ����, ,/ /�.,, ;�� u _ �
TEL N0: TEL I�dO: � s/'- '�'s �'•
Construction Location
ST�T NO: � ,� "�
�� STItEET: �� �.,�
LOT: � °� BLOQC : �� ADDITION : �, ��� 7�{
��.ti�G��l�— �' 1 �`✓, �� ���t" ��e cJ�✓.,.. ��O.di`,'�✓'�� ���
Corner Lot: Insiiie Lot: SetbacY.: Sideyards:
Ap�licant attach to tliis form two Certificates flf S�rvey of lot and
proposed building location drawn on certificates to scale.
DESCRIPTIOf� OF COF�STRUCTIOPd
�� ��c ti`"� Front: Depth: Height:
Square. �'eet: Qibic Feet:
. Front: Depth: Height:
Square� Feet: Cubic I'eet:
���t���-,i
7j�pe of Construction : �
Rb Be O�r.�pleted: � � �' '7 �_ �s'1_f
�7..
Estimated Cost: $ �,� , �'� �``
Alt. A Alt. B
proposed Drive��ay Width If New Opening Is Desired: $� $
. SE� REVERSE SIDE OF SHEET
T'iie undersigned herebyy ma}:e� application for a permit for the �:vrk� herein specified,
agreeing to do,all work in strict accordance o�ith the City of I'ridley Ordinances �zd
rulings of the Department of Buildings, and hereby declares that all the facts and
representations stated sn this application are true and correct.
.. � .
D.'�T�: / SIGN1�TUitE :
Stipulations: �
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BUII,DII3G PERMIT FEE SCHEDULE
The Inspector of buildings shall, before issuing permits for the
erection of any building or structure, or for any addition to any
bxisting building or structure, or for any alteration or repairs
to any existing building or structure, upon application therefore,
require the payment by the applicant f or such permit of fees to the
amount herein below set forth and in the manner herein psovided to-wit:
TO�AL VALUATION
$1.00 t�o $500.00
$501 t�o $2, 000
$2,001 to $25,000
$25,001 to $50,000
FEES
$10.00 Minimum Fee $15.00 plus surcharge
$10.00 for the first $500 plus $1.50 for each
additional $100 or fraction thereof, to and
including $2,000
$32.50 for the first $2,000 plus $6.00 for each
additional $�,000 or fraction thereof, to and
including $25,000
$170.50 for the first $25,000 plus $4.50 for
each additional $1,000 or fraction thereof, to
and including $50,000
$50,001 to 5100,000 $283.00 for the first $50,000 plus
each additional $1,000 or fraction
and including $100,000
$100, 001 arbd up $443.00 ior the first $100, 000 plus
each additional $1,000 or fraction
PLAN Ci�CR: 25 percent of building permit fee
$3. 00 %r
thereof, to
$2. 50 for
thereof
DRIVEWAY DEPRESSION ESCROW: Concrete Curb Streets Only
Alternate "A": Removeal and replacement of curb and gutter only
Driveway width plus 6 feet x$13.50
Alternate "B": R�oval and replacement of curb and gutter and install a 3 foot
wide approach with 6 inch depth
Driveway width plus 6 feet x$15.75
VERIFICATION OF FOUNDATI�ON
Permits for constsuction will be issued a minimina of 24 hours from the ti.me of
application to allow for proper review of the proposed structure and qf the
construction site.
A Certificate of Suzvey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with. the fr�ning.
- . �
sue�ecT PE .
City of Fridley `
AT THE TOP OF TME TWINS 3 3 3 6�'
� BU ILDING PERMIT
; � RECEIPT NO.
� �v _____ COMMUNITY OEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
� j �
� �'�'1 � CITY HALL FRIOLEV Sj13i NUMBER REV OATE PAGE Of APPROVEO BY
�'"""� � ��� 763-571-3450 910-F 15 3/ 13 / 03 � �
JOB ADDRESS 5725 Jackson Street NE
t LEGAI �OT NO. BIOCK TRACT OR ADOITION SEE ATTACMEO
oescR. 13 5 Donnay's Lakeview Manor SNEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PMONE
Neil Twitchell/Teresa Stockman 5725 Jackson Street NE 763-571-7097
3 CONTRACTOF MAIL ADDRESS ZIP PMONE LICENSE NO
Custom Remodelers Inc 474 Apollo Drive, Lino Lakes, MN 55014 651-784-2646 1748
a ARCNITECT OR OESIGNER MAII AODRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDFiES3 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WOFiK
O NEW 0 ADDITION 0 ALTERATION �J fiEPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Replace 13 windows within existing open�ngs
9 CHAN(iE OF USE FROM TO
STIPULATIONS
Provide smoke detectors in all sleeping rooms and on all leveis of the dwelling
per Section 310.9.1.2 of the 1997 Uniform Building Code. Caulk and flash ali
exterior openings.
a~ ��;�����n ��rd�
�e� ������: .
��� �� ��� �led
�� oo�������� �� Post
SEPARATE PERMITS ARE fiE�UIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV �OAO
VENTILATING Op AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WOFiK OR CONSTRUCTION 20NING SO. fT CU FT
AUTHORIZED IS NOT COMMENCED WITMIN 80 DAYS. OR IF CONSTHUCTtON
Of1 WORK IS SUSPENDEO OR ABANDONEO FOFi A PERIOD OF 120 DAYS AT
ANY TIME AFTER WOpK IS COMMENCED. NO DWLG. UNITS OFFSTqEET PARKING
I HEREBY CERTIFY THAT I HAVE READ ANO EXAMINEO TMIS APPLICA710N 1 S7ALLS GARAGES
AND KNOW TNE SAME TO BE TRUE AND CORREC7. ALl PROVISIONS OF LAWS yALUATION SURTAX
ANO OROINANCES GOVEpNING THIS TYPE OF WOFK WI�L BE COMPLIED
WITM WHE7MEq SPECIFIEO HEREIN Oli NOT. THE GRANTING OF A PERMIT �I.C,13b �8.07
DOES N07 PRESUME TO GIVE AUTMORITV TO VIOLATE OR CANCEL TME pEqM17 fEE SAC CMAqGE
PROVISIONS OF ANV OTMEFi STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFOFMANCE OF CONSTRUCTION �Z]9,2rj Fir SC, �16.1�}
PLAN CNECK FE TpTA FEE
Lic se 5 0 08.46
S�GNGTUAEO�CON'AACTOpOpOUTrIOp�ZED4GENT �OATE� MEN PF .P VALIDA E 7HIS IS VOUR P RMIT
- �,�, � l� �.�
S�GNOTURE O� OWNEA�iF OWNEABU4DEA� �DATEi BL G�NS� p`1
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R 1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/99
constructionAadress: J� 7 �- 5 �� � �" � � � .
Legal Description: . . . . . , . _.
Owner Name & Address:�� ��1.1��n��� ��i�c�9, �Z�e�vmriov�.�� Te1. #'6 3 �J`%� �%04_ �
Contractor: MN LICENSE # � % ��
Address• �'F. U f Tel. # �J��$���
Attach to this application, a Certificate of Survey of the ,
lot, with the proposed construction drawn on it to scale.
LIVING AREA: Length
DESCRIPTION OF IMPROVEMENT
Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: ._ _. Length ._ Width � HgdGround Sq. Ft.
OTHER: �
�
Construction Type: � timated Cost: $_ � � � � � 6,� � �
� (Fee Schedule on Back1
Driveway Curb Cut Width Needed: �� Ft. + 6 Ft =� � Ft x$ _$
�
DATE: � � � `'0.� APPLICAl�]'r: Tel. � �('� � �" 1� � 1�
� CITY USE ONLY �
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
$ �7 �
� �ol
� �'� r��
$
$ ��, o �
$
$
$
Sewer Main Charge $
TOTAL .
STIPULATIONS:
,� r
�
Fee Schedule on Reverse Side
.001 of Pertnit Valuation (1/lOth%)
$.50/$1,OQ0 Valuation
$1050 per SAC Unit
$5.00 (5tate Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
- � �.
81111filllg
Inspections
763-57�-36�4
BUILDIN�
RE�IDENTIAL APPLICATION
�ITY UT TRIDLEY
Permit
Receive�l By:
Date R�c'd: (
DA'fE YOUR E-MAII. ADDRE3S
SP!'E ADDRE33 ��� � �c 1 �� ' _ — - — — — -
?HIS APPLICANT GS: 0 OWNER �NfRACf08
ERTY OWNER/
TENAAIT
SUBMIT A (�AY OF
YOUR STATE LICEIBSE
WITH APPLICAT[ON
TYPE UI�
ADDRESS: ClT1r SFtiT@ ziP;
YHON&:
l _ly?��7a
i ; :,,ia �i
■ ► «•
DESCRTSE WORK BEINC� [fONE:
x
� . • � :1a� r•
-.•. a� i:a�..
O��
0 A�m
O Oei�
IN H�5'�tAT QPBNaVG$ �IY�s mVo
OR FOR NEW OPF.NtN(iS-bH$(9�E SIZE OF
dPFNIl�TG CHANGET 8t
I�f !�
P�rnit Fee
�'Ian Rewiew
Fae Surcharge
Surcl�arge
License S�ucharge
SAC Chsrge
Curb Cut Escrow
Faosion Cont`o]
Park Fee
Sewer Main Charge
!►RL� BA.SED ON V
SIDIIJG
�
o xa� � on�►cE
O A7TACHED (iARAGE
� DETACHED OARAtiE
��ff�
O Tmn
O Fescia
LOCATIOAI UF �NAdDOWS
P.XP DATE
IIY�6UDINC TBE C(�T OF
�.0 FEE SCHEDUL�y
� DRAIhT TII.B
OOTHER
�
r---
s��r►' x�an�et.nvG stran�r:
�. ��r�►
Z. PropaaedAoorplen
3. [.istofstr�natmembenwbe used
FORNEW CONS?RUCTLQN 1NCLUDING DE(nGS,
ADDTlIQ1VS_&PORc�ursC c� ta►unr;
1. SiLe Plao/Sw�xy a�vi� the ea�ting �
����
2. Taro sate of� p�na
3. E+xrgyCalculat�
�� �1 ' �e Back Page for Fee �le
$ a e 65% of Buiiding, Pernrit Fee
$ .00I times the taaat job valuation
$ .0005 x Perarit Valt�ati� A4iai�mim $.50
$ � �a . , $5.00 (State Lic� Resictential Cont�actors)
$ _ S I550 per SAC Umt (PEans to MWCC for det,eamination)
$ R+Bfta Rx$21�$
$ $450 Conse�vatioe Plan Review
$ Fce �netl bY Fa�Sm�rmg
$ Ageen�ent n�+ ( } Non N� ( )
S �1 o Mage c6ecics �arable ib: �v of FrldleY A�
�t�s �sa�v agr�.m�►nox FoRa ��srr-rrorva�n uNrn.pxocr��
I he�ebY a�1Y fer a baildiflg prcnrit end I�irnowl�ge ti�at the infortt�tion above is �leta and ae�agate; t�at the work witl be in
confantmnce with the cu�s of the City of Frldley and with the Mnmes� Constru�ion Code� �t I�nd this is nat a
penrrit but only an appli ' a wa�ic is not to start without a per�rri� that the w�k wll be in accordance witb the approved
plan in the case of sll w ew and s r�val ��' lena �_ �
« � . � ���� .%�l►'�.�/ l�./� • , ,_ ���.���,/ � � �
Building
Inspections
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
DATE �"��d � YOUR E MAIL ADDRESS
SrrE anDRESS � � � `� � � C' iG �r,�'� �T .
THIS APPLICANT IS: D OWNER C�CONfRACI'OR
ERTY OWNER/
TENANT
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLiCAT[ON
PROPERTY TYPE
FERMIT 'FYPE
TYPE OF WORK:
Pennit No.:
Date
nnutt�.ss: cro srn�_z�,
PHONE:
STA?B LICENS� �.
DATE
ADDRESS: CTfY STATH ZIP
Cl HASEMRVT FINISH ❑ ROOF
[I DECK °�,S[D1NG
� SWQvlMING P�L
� NEW ❑ ADDITI013
�iMApvTENANCFJREpAIR C] RF.MODELING
DESCRIBE WORK BEING
SIZE OF IMPROVEMENT_
SQUARES
GARAGF.S
PROPOSED SIZE:
PROPOSED HEIGHT:
p HOUSE �t OARAGE
O ATTACHEQ GARA(iE
Q DETACI�D QARACiE
❑ DRAA1 TILE
0 or�at
BASEMENT REMODELINCi SUBMIT•
I. F.xistingFloorPlan
2. Proposed floor plan
3. List of strucdual membets to be wed
FOR NEW CON37RUCTION RVCLUDING DECKS,
0� p��t ADD11'IONS 8c PURCHES SUBMIT•
O AI►an'vmm O Trim 1. Sioe Plae/Siuvey showing the existing struchueq
0 Other ❑ Fe� � PmP�� ProJ�
2. Two seta of comtruatioo plans
IN�t} QPIIJINGS �Yea fllVo 1.00ATION OF W WD09VS 3� �� �����
OR FOR NEW OPFNINGS-DESG'R�E S1ZE OF
OPENING CHANGES &
TYPE OF WIIJDOW TO BE RVSTALI,ED NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, AYCLUDING THE COST OF LABOR AND MATERIALS:
(USING THnE,1 �97 U.B.0 FEE SCHEDULL7
TOTAL JOB VALUATION $�i�1X�� OCCUPANCY TYPE
Pernrit Fee
Plan Iteview
Fire Surcharge
Swcharge
License Surchar$e
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fe.e
Sewer Main Gharge
Total Dae
$�e'�� p� S See Back Page for Fee Schedule
$ 65% of Building Pennit Fee
$ �', � .00I times t1�e total job valuation
$ ,(l. � .0005 x Pernzit Valuation Minimum $.50
$ �j.� 55.00 (State Licensed Residential Contractors)
$ � �1550 per SAC Unit (Plans to MWCC for determination)
$ ft+6t}= ftx$21=$
$ $450 Conservatian Plan Review
$ Fee Determined by Engineering
$ _...�. _.� �►8reement necessarY � ) Non N�ry ( }
THIS IS AN APPLICATION FOR A PERMCI'-NOT VALlD UNTIL PROCESSED
I hereby apply for a building pemiit and [ aclmowledge that the information above is complete and accivate; that the work will be in
cnnformance with the ordi �md � of e City of Fridley and with the Minnesota Consuuction Code� that I wtderstand this is aot a
permit but only an applic�ition `a �mtit an ork is not to start,AVithout a permit; that the work will be in accordance with the approved
plan in the case of al] w rk , ich es of �lans. _�
�� � �_l_
SIGNATURE OF APPLIC ,' f� r NAME ` � `DATE ��