AF - 47440City of Fridley, Minn.
BUILDING PERMIT
N° 55'7i�
Da�: _.__--.-,�'-....�'�.� - �� _._.___.__ _
Oamer: ._.._ _��@.%1'"_.,_:.._..� :,�..._..____._..._.____...__.._._.� Builder ..___.����__....1iT..�.+R_.....______.._.__
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F� •.t��
Address
LO ATION ! ING
No. �.��� Street '- .,----_ ._.... .�.._. _ .__._�'' i���`. _..�...�.l.----- P f Lot �.._ ..___:.._..._...__.._ .._.._.._r...
� __. __ �._..._ .............. Addition or Sub-Divisia� .���"�
Lot .--------. .__ ... ... Blo .---.._..._._...... � . _. �, � ♦
Corner Lot .....----------•.--•---_ Inside Lot ....----.._....._......__..._..... Setback .....�" .�-..__._._ Sideyard --•--.--..__� ----•-•��--------
Sewer Elevati� ....._...._....__----•----._.._..._.._._....__.._...__....._.._.._.._ Foundation Elevation
DESCRIPTION OF BUILDING
To Used as• �
_ Front __.� Depth _�� �ieight _..� Sq. Ft. ��Cu.
. .
_.. .._._ Front _�...__ Depth �..�i,Height _.�� .�... Sq. F� .Z._� Cu.
.. "" .�.�v+"
Z'ype of onstruction .---- ... ..._.. Es� Cost�C.�,�--.���..._.------•..... To be Completed .....__..._.
�
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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 %rth and in compliance with all provisions of
ordix►ances of the city of Fridley. .
�... _. _.. _. _ _. _.. _..
In ca�sideration of the payment of a fee of $:�.�.'~�., permit is hereby granted to....._
_.:._._.._._.._...._.._._........_.._.__�....._. to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minxiesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the city limits and this permit may be revoked at ar�y time upon viola�n of any of the provisions of said
ordinanoes.
Building Inspecta�
NOTICE:
ihis parmit doa not eowr ths eonslruelion, installafion hr wiring, plumbiny, gas hsafing, sewer er waMr. B� sun to �
Mro Buildins In�paefor for separate psrmits for thas� ft�ms.
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APPLICATION FOR BUILDING PERMIT�
� CITY OF FRIDLEY, MINNE50TA '
Owner's Wame_ J�����,� . Bui�.der ,�.�,�,���
Address Addre�e „�� I�, ��.��:� c—
LOCATION OF BUILDSNG
No:. ��`3treet�„/�f/�d��v�Part of Lat
Lot,�,� ,�,_ 81ock ,�_�„ Addit�.on or Subdivis ��
�. .�...�
Corner Lot Inaide Lot f/'� Setbacl���Side-Yard,�'°`�?�
SErr�ER ELEVATION �lC�b FOUIQDATION ELEVATTON
.`
Applicant attach
proposed buil.ding
To be used aso
to this form Certificate of Survey of Zot and
location.
DESCRIPTION OF BUILDING
.�'� Iretg�ht •� . ,
� Sq. Ft. ,�1 .. Cu. Ft. . . �,I T.�� �.
_„_ Front��„�Depth �.3 G Height / O ,__ ,
� Sq. Ft. �� � . Cu. �t. :�_.
Type of Construction ` Estimated Cos����� �----
To be Completed__ % /�`--� Zi-^-
.. ...._._..,.._.
The undersigned hereby makea appli�ation for a permit �cr:-th� work
herein specified, agreeinq to do all work in stric� aceordance wi�is
the City of Fridley Ordinancea and ru]�ing o� the Department of Build-
ings� and hereby declaxes that all the facts and re entatio�s
stated in is app ication are true and corr .
DATE SIGNA�'
�s�neaui� of F�e Costs ean be found on the Reverae Side).
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City of Fridley
App�ication for P`lumbing and Gas Fitting Pernrit
Dept. of Bldgs. Phone SU 4-7
DESCRIPTION OF WORK
Number, Kind and Loca3iot� of FixYures
V! � � W w ?
� �
� �n � S �^ Z = > Z Z � � < IV- Z � � a Z w
3ti � o� � ? 3� o� � $o S� <3 � °d �Sn �o
Base
lst
2nd
3rc3
4�_L_ i I I { L
• Futuse Connectioa Openings
* New Fixture, Old Openings
PARTIAL RATE SCHEDULE
WATER HTR.
• ♦
F N GAS ELEC.
Sewer �
Cesspool n
PLUMBING FIXTURE RATES: NO. RATE TOTAL �
Number Fixtures . . . . . . . . . . . . . . . . . . . . . . � x $1.50 $ � -J
Future E'ixture Opening . . . . . . . . . . . . . . . . � x 1.20 $ °? � �
New Fixture Old Opening . . . . . . . . . . . . . . x 1.00 $
Catch Basin ............................ x 3.25 $
Water Heater (Up to 200,000 BTIJ) . . . . . .—� x 2.00 $ � � J
New Ground Run Old Bldg . . . . . . . . . . . . . x 3.25 $
GAS FITTING FEES: NO. RATE TOTAL �
lst 3 Fixtures ..........................--.,L x $1.50 $�t �
Additional Fixtures .................... x .50 $
Gas Range to 200,000 BTU .............. x 2.00 �
REPAIRS 8t ALTERATIONS—Refer 3o Code
Description ................................................$
TOTAL FEE �__ �,�i� Q
City of Fiidley:
The undersigned hereby makes application for a permit for the work herei
specified, agreeing to do all work in strict accordance with the City Ordinance
and ruling of the Department of Buildings, and hereby declares that ail the faci
and representations stated in this application are true and correct.
Fridley, Minn. `r K-+ , 19�
Owner �� �r%
Kind of Building
i
Used as
To be completed about
0
Estimated Cost, $
�
Old 1Vew. uilding Permit No. \�S / P rmit o.
Signe
By
Business Phone No. '
ROUGH �� � / ���
FINAL
4 e 'jp1
Application for Power PlaMs and Heafing, Cooling. Yentitation, Re�friger�tion and
Air Conditioning Systems ond Devices
PARTIAL RATE SCHEDULE
GRAVITY WARM AIR: RATE TOTAL
Furnace Shell & Duct Work . . . . . . . . . . . . . . . .. . . . . . . . . . . 8.00 �
Replacement of Furnace ............................. 5.00 �
Repairs & Alterations—up ta $500.00 . . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alterations each add. �500.00 . . . . . .. . . . . . . . . 2.50 $
I�ECH. WARM AIR
Furnace 5he11 & Duct Work to 1?A,000 BTU . . . . . . . . . . . . 8.00 $ <�'�
each add. 60,000 BTU .......... .. . ..... .... . 2.00 ;
Replacement o4 Furnace . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alterations—up to $500.00 . . . . . . . . . . . . . . . . . 5.00 $
Repairs & Alterations each add. $500.00 . . . . . . . . . . . . . . 2.50 $
STEAM or HOT WATER SYSTEM
�rnace 5he11 & Lines—to 400 sq. ft. EDR Steam .... . 8.00 $
� Fumace Shell & Line--to 640 sq. ft. EDR Hot Water ... 8.00 $
� Each add. 200 sq. ft. EDR Steam . . . . . . . . . . . . . . . . . . : . . . 2.50 $
�
� Each add. 320 sq. ft. EDR Hot Water . . . . . . . . . . . . . . . . . . 2.50 $
OIL BURI3ER—to 3 gal. per hour . . . . . . . . . . . . . . . . . . . . . . . . 5.00 $
over 3 gal. per hour—See Fee Schedule
GAS BURNER (up to 400,000 BTU> . . . . . . . . . . . . . . . . . . . . . . . 5.00 $ � �'�
GAS FITTING FEES: NO RATE TOTAL
lst 3 Fixtures ...................... —� x $1.50 $ /��
Additional Fixtures ................. x .50 $
Gas Range to 200,000 BTU . . . . . . . . . . , x 2.00 $
AIR CONDITIONING a
FAN HEATING SYSTEM See Fee Schedule
VENTILATING SYSTEM a
ALTERATIONS 8t REPAIRS TOTAL FEE $ d�v
ROUGH
FINAL
Depi. of Sldgs. Photie SU 4-7470
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City of EYidley:
The undersigned hereby makes application for a permit for the work herein
specified, agreeing to do all work in strict accordance with the City Ordinances
and ruling of the Department of Buildings, and hereby declares that all the facts
and representations stated in this application are true and correct.
Fiidley, Minn. �.���- , ., 1��
Owner ���.� � -
Kind of Building
Used as
To be completed about �J �
Estimated Cost, $ �S 2-�
Old-y-�:�'�j Building Permit No. V'`� Permit No.
DESCRIPTION OF WORK
HEATING or POWER PI.ANTS--Steam, Hot Water, Warm Air ,—No.�
Trade Name Size No.���/o�
Capacity q. F't. E.D.ft. � BTU H.P.
Total Connected Load 3�� �0 6 Kind o! Fuel %i ��
BURNER — Trade Name Size No. ,r "�� C�
Capacity Sq. Ft. E.D.R. ,��� �� BTiJ H.P.
SUBURBAN NEATING & SHEET METq�
8�419 CENTER DRiV� N. t.
Signea MINNEAPOLIS 21, ININN,
gy_ � / /
�� < z sM Business Phone No. SG �--� Q'o
(REMARKS-OVER)
�3/i �f�°
ase , .._. - 4Z '� - • -
HEAT LOSS CALCULATIONS DEPARTMENt OF BUILDINGS FRIDLEY, MINN.
Weatherstrips A.S.H.V.E. Construction No. Insulation
Guide
Windows Doors Reference Out. Wall Int. Wall Ceiling Roof F7oor Kind ow A lied
—No —No 1 Q�. /v-- � .�
Fl.� Room � Length 9� Width 1/ Height�/ Fl.� Room Length /� idtl�/2/ Heig
Windows an Doors—Crackage and Area Windows and Doors—Cratkage and Area
�Vldth Helght No. ot Lineal tt. Area Width Helg6t No. ot Lineal ft. A1'ea
No. ot pane ot yane lighte ot crack ea. [t. No. of pane ot pane lights ot crack sV. tt.
� � 2a z- 2�,
Z— 2 1�V
3'0' �� .v
Coef. Btu Coef.
In6ltration , .� /,3 Infiltratioa , �a �
Glass p � � o Glass 1.3i S 2
Exp. wall Exp. wall 9
Net exp. waA .,S'� O Net ezp. wall � �'
Int. wall Int, wall
Ceiling Z /� Z2�"� Ceiling p� <
Floor Floor
Total Btu. �"S/ Z'otai Btu. `
Required sq. ft. E,D.R. or sq. ins. W.A. Leader area� Required aq. ft. E.D.R. or aq. iaa. W.A. Leader area
Fl. � Room � Length�/� Width/� � Height / �.� Room I Length/Z� Width � Heigi
Windows and Doors—Crackage and Area Wmdows and Doors—Crackagt and Area
Wldth Helght No. oI Lineal tt. Area Wldth Hetght No. ot Lineal tt. Ares
No. ot Dane o[ pane Ilghte o[ crack �Q. tt. No. ot yane ot psne llihts ot crack sQ. ft.
3 y- � a , ,
z- 6,� ,
. � �,��� vi ,�r �.�. � i,e�
In6ltration s'3, o
Glasa 1, Z .�v
Exp. wall
Net exp, wall � Z
Int. wall
Ceiling � �
Floor
7'otal Btu. �y
Requir�d sq. ft. E.D.R. or aq. ins. W.A. Leader area eZ,o
Ft. Room �Length f3' Width Z� Height �
Windows and Doors—Crac�age and Area
W)dth Helght No. ot Llneal ft. Area
No. of Dane ot pane IlgAts ot crack � sq. tt.
2– Zd'' �n � z7, ,(�,
Cocf. Btu
Infiltration Z � S`
Gfaaa
Exp. wall ' p
Net exp. wall � �
Int. wall
Ceiling �� ���
F loor
Tbtal Btu.
Required sq. ft. E.D.R. or sq. ins. W.A, Leader area
Infiltration
Glaaa
Exp. wall
i Net exp. wall
Int, wall
Ceiling
Floor
Total Btu.
Requirea sq. k. E.D.R. or aq. uis. W.A. l.eader area
Fl.� Room I L.ength ' Width /
Windowa and Doorr—Crackage and Ana
Width Hel�ht No. ot Ltneal tt. Aret
No. ot pane ot Daoe light� of crack p. tt.
l �o Z- % •7 .�;
Infiltration
Glass
Exp. wall
Net exp, wall
Int, wall
Ceiling
Floor
Total Btu.
Btu
�zv
�
�/
���
Coef.I Btu
sq. ft. E.D.R. or aq, ins. WA. l.eader arra
!�i f���
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City of Fridley, Minn.
BUILDING PERMIT
� ����
N° 7258
Date: � `"'"_._.�_.��-.- �— � _.__.._ ..___..�_
l % .
dwner: .. .__. .. . _ .. __._._._..___ Bu3lder _. ._.. _ ... .. .._..._...._...__...._..._._.._........._.._.._.
Ad&�e�s .._._._._...._._._�._...._._.__._....,..._....._......_..__...._...._.._.___..._..... Address ..._.___.___....._..___._..___....____.__.._.._..._.._......__ _...._.
LO TION OF ILDING
No. �._l._�� Street ._._ _._ ._..._._ _ _.. ......#..___._. Part of Lot _.__.._._ __._..._.._.__.�._... _._._
Lot ._.._.....�..._._..._ Block __._....�........_.._......_ ciition or Sub-D � • • �'�'"�'�J
i
Corner I.at .___..._"....___ Inside Lot •...._._.__.._._.._..._.._. Setback . _ . ideyard _........y�...� _.M_.�.._.__�_.
Sewer Elevation _.__..______._.._.�___...._._..�,.._.._.. �. ..____..__ Fo tion Elevation _..._..__....._._.._...._._..____._
DESCRIPTION OF BUILDING
T sed as:
_,�!✓,��M_ Frant �� Depth _..�..� f%ight .._.�_:L�! Sq. F� ��� Cu. FL��.�'�
_..__...._._..._........_..._.._.__ �� t_.._�...___ Depth _.___._..._ eight _._._ Sq. F't. ...�_.._._.._.. Cu. F't.
� ��
. ...__ To 'be C�si eted _.._..._._._...:
Type of Constructi __......_.._ _.._... _. �.... Est. Coat ._. _. _ .....�._._. _. Pl
Ea consideration oP the issuance to me of a permft to cons ct building described a I agree to do
the proposed work in accordance with the description above set fo and in compliance wi provisions of
ordinances of the city of Fridley. -
�
In c�sideration of the payment of a fee of ��'� _._..._._., permit is hereby granted to._._..
to constxuct the building or addition as deseribed above. This permit is Srauted upo�►
the express condition that the person to whom ft is granted and his agents, employees and workmen, in all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinsnoes o�
Fridley, Minnesota regarding location, construction, alteration, maintenance pair attd moving of buildings
within the city limits and this permit may be revoked at any ti� upon vi tio of any of the provisions of said
ordinances. /' l . A
Buildin8' Inspector
NOTICE:
ihis p�rmi� doa net eowr tlw eondrocNoe, teqdi�Nee fe� vririnW PWmbin9. Yas b��Nn�, swvK � wN�r. M wn fo tN
tM buNdieg In�p�ewr for apaaM p�nehs for th�a iMms.
^-d . �
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APPLICATION FOR BUILDING PEP.MIT
CITY �0�' 1�RIDLEY, MINNESaTA . . .
OWNER' S NAI� �il I�. j o r�} �. �� ►"i� � BiTILDER � 7'1 r^� r .
� ��ss � � o i -',lA �Ks o �J - � ;� � . �J � r Ann�ss .
.. ,
S�o-.�3�.�' � . . .. ,
LOCATION OF BU'iLDII� � � •
No. Street Part�,of Lot�_,
Lot � Block � Addition or Subdivisiot�2 �.�q0o�,�.ANps AOo�noa
Corner Lot�_Inside Lot Setback Side:Yard�. �
SEWER E'LEVATION FOUNDATION ELEVATION "
Applicant att�ch to this form Two Certificates of Survey of Lot.and proposed build-
ing location drawn`on Chese Certi�icatee. .
DLSCRIPTION OF BUI7.DING , .
To be used as:
� �
gOfllilon3 �0 lio�S� <Inb �Front �� i��th � o� fle�:ght
, _ Sq. Ft. ' Cu. F•t,.. ..
Fxont Depth Height :
: Sq. Ft . � Cu . Ft.,
Type of Constructiou � Estimated� Cost
To be Completed 19 � � .
The undersigned hereby makes gpplication for a�permit.for the work hereia specified,
agreeiug to do all work in strict accordance with the CiCy of Fridley Ordivances and
rulings of the Department of Buildings, and hereby declares that all the facta and
representatioas stated in this applicati.c�a arg-=t�ue and correcC.
DATE � � I _ � � �'' � t� S IGNATURB �.�,��.4�-� �
�Schedule of Fee Coste cau be fouad oa the Reverae Side).
� • � , �.
•• • 'A � . -
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City of Fridley, Minn.
BLTILDING PERMIT
na�: ..._..�??.� 19b5 _._._.
� ��� ��
N� '7556
Owner• �.�0]1 Re�.'�8II B�ulder �� TAC•
. _.____._.. _.... _._.
_.._...__.._ _..__._._.._---....�._........_....�._.
b701 �ackson Street 1�. $•_._...._.._ aaa�$ ._.. 3z31 C�ntral Avet �,_�,._^____,_
Address_.__..._..._.._..._..._
LOCATION OF BUILDING
No. ._ b"�Ol �.-• St�eet .___dSCksOn St. _ 1�.,_. E�_....---.____.�..._..__._ Part og Lot _
Lot � g__._..._..__ Block _�...� _._....__.._.__.__. Additi� or 5ub-Divisi� .__.______.___
Corner Lot _.__.__..�.._ Inside Lot _.___._.. Setback ._.___._..._....�__._ Sideyard
Sewer IIevatiaai
Foundationn Elevation
To be vsed as:
.w...._____ ti...._ Front
�......_.._._._..._........ �+ont
Type of Construction _____._._
DESCRIPTION OF BUILDING
Depth _____ Height ._.__.._.._.. Sq. F't
Depth _._.._.._.._ I�eight __....._____ Sq. Ft _�..........
........ Es� Cost �i�...�.2���rOQ_...__...._. To be Completed
Cu. F't
G�. F't.
StOrm Dam,ag@ xepair
In conaideration of the issuance to me of a permit to constru the ' g c]escribed abave, I agree to do
the propoaed work in acc�ordance with the d�scription above compllsuce with all pravisfons of
ordinancea oi the city oi Fridley.
In caa�sideratfaai of the payment of a fee of �0•� _�._._, permit is hereby granted to �'�,1 �G.
to c�struct the building or addition as described above. This permit is granted upoa�
the express condition that the person to whom it is granted and his agents, employees and worinnen, in all wark
done in, around and upon said building, or any part thereof, shall oonform in all respecffi to the ordinances of
Fridley, Minnesota reganiing location, construchon, alteration, maintenance, repair and moving of buildings
within the dty limits and this permit may be revoked at any time upo� violation of any of the provisions of said
ordfnance�a.
Buildin8 Inspecto�
NOTICE:
'Ihb p�ndf doa nof cewr fh� eonshuefioe, �uh1l�Noa hr wielno, phmbino, �u hMNn�, aw�r er waNr. N aun to sw
Ih� 6uiWino la�elor fer a�p��afr p�neils for fh�a Ibms.
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OWN�R' S NAME /L%
ADDRESS _ �[o `I D 1 �
ti
G
:�
:5
A.PPLICATION FOR PBRMIT
CITY OF FRID�i�,� +��F1�SOTA
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a
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C> %� �� ��'
�m.�Frr
»� s� 3 � �-�--�
, LOC�TION 4F Bi�JING
No�_ fo ;� � I St�.�et,��� �r.' � : �srt •�iE Lo�,,...._,_
Lot �_B�ock � � Addit.ionr,ar Subd�.vi��,oq '
Coraer Lot Inside "� -
i.ot _ ,:Se�b�k 3fc�e-Yarc� _ Z
�+..�....r.� �r. ��.�.rr ■
SBWER EbEVATIQN FOUHIl�41ZON BL��AiT��..,..w..�.._... ,.' :
APPli�ai�t atta�h to thi� fo.rn� Two Cert:if�,cates af Survey of Lo# aa�d� p�rop�s�ct b�idw�
ing locatian� d��wn ot► these C�`tificat .- . ,
- '
�.. �0-7-�.�j�c,G�� , ' 3 �� '�-`fo1
��h�O-rn� °v� IPTION OP B�JILDING
__ _ " � ..,c A
Tb e us s: �",it%L,c-y-,� 3T /"�"�'�'yi.�o�
,�zoreC _ De}�th 4
� 9q. F.t. Cu. P`t..
� w .
.. , ` � oat Dspth Height
�� �t�. Ft . .; Cu . Ft•. �
.._y.._: ..`.
sype of coast�ucti`ioa 4� Esttmacea ce.c � _�
� . r.:�.�....ri w • . .
�
..�.���. .� ' . . .. . . , . . , . . . .. . . - _
The undersigned hereby makes application for a permit for the work�herei��t sp�ci�i�; `
agreeing Co cio a3,1 work ii� s,trict accordance with the City of Fridley Ord�itaances and
rulings if the Departm�a� of Buildin�gs, and hereby declares ttiat aZi-�the f�cts�and
regresea�atioas stated in this applicaticn�e,/l�rue and coracect. '
`►�
�'�Sche�duie .oi F�ee Co�ts caa be found on the Reverse Side) .
� � r �-� � � ^ � � .. �
SuBJECT
c�ty of Fridley
AT THE TOP OF THE TWINS g � I L D i N G P E R M I T
r
� �
� �
.
COMMUNITV DEVEIOPMENT DIV.
r � v � � PROTECTIVE INSPECTION SEC.
� ,
i•--_�� �"' �,� CVTY HALL fRIOLEv 55432 NUMBER REV DntE
i 612-571-3450 910-F15 a/20/91
J08 ADORESS 6701 Jackson �treet NE
t IEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. $ 3 Meadowlands. 2nd Addition
2 PRQPERTY OWNER MAII AOORESS
Milton Reiten 6701 Jackson Street NE
3 CONTRACTOR MAIL ADDRESS -
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAII ADDRESS
6 USE OF BUILDING
Residential
ZIP
ZtP
PAGf OF
� %
21017
�/ y/s�
APPROVED BY
SEE ATTACHED
SHEET
PHONE
571-5i33
PHONE LICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof House & Garage (25 �quares.� 2nd lay er
9 CHANGE OF USE FROM 70
STIPULATlONS
Roofing can be the 2nd layer but not the 3rd.
SEPARATE PERMITS ARE REQUIREO FOR ELEC?RICAL. PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NUIL AND VOID IF WORK OR CONSTFlUCTION ZONING
AUTHORIZEO IS NOT GOMMENCED WITHIN 60 DAYS, OR IF CONSTRUCT{ON
OR WOAK IS SUSPENDED OH ABANDONEO FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UN
1 HEREBY CERT{FY TFiAT I HAVE READ AND EXAMtNE� THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE Of WORK WIIL BE COMPLIED
WITH WHETHER SPECIFIEO HEREIN OR NOT. THE Gi±ANTING OF A PERMIT 51-�300
DOES NOT PRESUME TO GIVE AUTHORiTY TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS QF ANY OTHER STATE OR IOCAI LAW REGUTATINCa COtJ-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. $31.00
UAE Of CONT
AGENT IDATEi 1
�
��
iDATEI
OCCUPANCY GROUP OCCUPANCYLOAD
SO. FT. CU. FT.
OFFSTREET PAqKING
STAILS GARAGES
SURTAX
$.65
SAC CHARGE
Fire SC $1.30
TOTAIFEE
32.95
=R 1 AT H IS YOUFi PERMIT
I�+1 [ ] Effective ],/1/91
AD[N [ ] l�l PiND i�2
ALT�t [ ] Building Penait �Ipplicatian
�Qonstnyctian acidress: tv 70 /-�/-} � K�S� � S� �t1. C- .
t� .
Des�c,riptian: �. o?' � I�,�. o C ic 3 �- '`�' /Yt �A �-b c..� t.. A �v Ds _ A 0 R i•
owner xam,e ��s.s; 11'1 ��.�o nl �k��7Eni �701- �.I� ���.s o�l 5?. �1 � E se1. � 5 7/- 5/ 3 3
�: �/� rn C Tel. #
Addx+e�ss • . .
.
3+IiiII+1G ATtE�:
� �1
� j��.
7 '
�f '
Pittacii to this applic�.+tian, a�fic;�te of bluvey of the
lot, with the p�c��osed �ian drawn an it to �cale.
LB9�TI�i G� II�Tr
Ler�gth Width Heic�t Sq. F't.
_ �/-_ ��Y• -�'-!_� �� �• �•
/ •
� c��' l-Eo�3C L��G.4�2AG� ( ���d,�o�.t�� �+`�1 ��,
�er Lot [] Ir�' Iot ] Ft. Yd Sicie Ys�d SetbacJts
�pe of Da�ion: � /t (. ` Estimated Oost: $ ��� �
Approx. ocmpletirn Didte: .
Prqx�sed D�iveway Width If New Op�aning Is Desired: Ft. S S
, � + 6' See BaCk P�ge
nt�: A v G �.o.r��i � �c�xr: � �. �
T
P�mit Fee $ � � ��'
Fire S�rcharge $ /, � p
State Surri�arc3e $ . � S
�� $
D�iv�eway F�sctvw $
Perk FeE $
sew+er Main triarqe S
�•1 �;
:>I'IH1IA'I'IC%15:
�
S .��� gS
�aY� � :r. • �i
F�ee Sd�ule an Aeverse Side
.001 x F�it Valuatian (l,/lOth $)
$.50/$1,000 Valuatian
$650 per SAC Unit
l,lt. "A" ar Alt. �'B" Above
F�'E I�T1�9C1 b� �i r�sri rrl
�
��tYll ��zYI]
•„ - -
Building
�nspeciions
763-572-3604
�ATE � ' J I �
�ITE ADDRESS
IT-IIS APPLICANT IS:
%
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WITH APPLICATION
PROPERTY TYPE
PERNIIT TYPE
TYPE OF WORK:
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
�
❑ OWNER
PHOTIE:
YOUR E-MAIL ADDRESS
x,v�: (�.c,..�. lc J. 4�Omb� a,S �w.t
STATE LICENSE #�T ('j � g(a,�t�_ EXP DATE
ADDRESS:
jONE 1bJ' `t'1J
6II�iGLE FAMILYRJi
TWO FAMILY/NEW
❑ BASEMENT F[NiSH
❑ DECK
❑ MAWTENANCE/REPAIR
DESCRIBE VJORK BEING
SIZE OF IlvIPROVEMENT
OF SQUARES ��
GARAGFS
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aleunintun '
❑ Oti�er .
wnvnows
IN EXLSTING OPENINGS OYes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENIIJG CHANGES 8c
TYPE OF WINDOW TO BE INSTALLED
FAX 7�0 � ^
K�' 1
LENGTH
❑ HOUSE ONLY
�HOUSE & GAR.AGE
❑ ATfACHED GARAGE
❑ DETACHED GARAGE
❑Soffit
O Trim
❑ Fascia
IACATION OF WINDOWS
NUMBER OF �WIN[
❑ wixn�ws
❑ DRAIN 7'TLE
❑ OTHER
Permit No.: 4(�!'7 - G! 5`13
Received By:
D���°�
WIDTH HEIGHT
a.�re�z� S-S Y3 2
STATE Z�
BASEMENT REMODELING SUBtvIIT:
1. Existing Floor Plan
2. Proposod tloor plan
3. i.ist of structural mcmbas to be uscd
FL
FOR NEW CONSTRUCTION lNCLUDING DECKS,
ADDITIONS_ & PORCHES SUBMIT:
1. Site Plan/Servey showing tlte existing suvc0�res
� P�� P�'o1�
7. Two sar of conswaion plans
3. Encrgy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(LTSING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION S OCCUPANCY TYPE
Permit Fee
Plan Review
Fire 3urcharge
S�rchazge
License Swcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
$
$ 3.i�
$ /• (,� D
$ .�,�
$
$
$
$
$
$ l� �, l}�f
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
Agreement necessary ( ) Non Necessary ( )
Make checks aavabte 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 fo a permit and work is not to start without a permit; that the work wiil be in accordance with the approved
plan in the case of all work wh�y�ui iew�d approval of plans.
SIGNATURE OF APPLICANT ,,��_���!��/ PRINT NAME �'�°� DATE 0'�(' ��%
Page 2- Building Residential Application
SUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing pemnifs for the erection of any buildi.ng or
structure, or for any addition to any existing building or structure, or for any alteration or repa.ir
to any existing building or structure, upon application therefore, require the payment by the
applicant for such pennit of fees to the amount herei.n below set forth and in the manner herein
provided to-wit: .
TOTAL VALUE FEES
S1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 f�r each additional $100 or fraction, to and
includin $2,000
$2,001 to �25,400 $69.25 for 1�` $2,000 plus $14 for each ad.ditional$1,QQ0 or fraction, to and
inc�udin $$25,000 '
$25,�1 to $50,000 $391.25 for 1�` $25,000 ptus $10.10 for each additional $1,000 or fraction,
to and includin 550,000
$SO,d01 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additionat 51,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus �5.60 for each additional $1,000 or fraction to
and includin $500,000
$500,001 to $1,000,000 $3,233.75 for ti�e lp $500,000 plus $4.75 for each additional $1,000 or
fraction to and inctudin $1,000,000
�1,000,001 and up $5,608.75 for the 1� $1,000,000 plus $3.15 far each additional $1,000 or
fraction °
VERIFICATION OF FOUNDATION
Permits for constructi�n will be issued a rr►in;n,um of 24 hours from the time of application to
allow for proper review of proposed structure and of the construction site.
A Certifica.te of Survey of t�e lot, showing the location of the existing foundation will be
required before proceedin.g 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