AF - 47463��
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C,ity of Fridley, Minn.
BUILDING PERMIT N� 73s1
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L CATION BUILDING
No. ��;L�Street � , ;�����'�- P oP Lot
Iat _�,��__ 81 Addition or Sub-Divisian ��
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Coraer Lot � 7ns�de Lot �� Setback _��___� Sideyard .y ..�---�°��
Sewer IIevation �� � ..s�'� IIevatfon � �� � i
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Ea conaideration of the issuance to me of a permit to construct the building descrlbed above I agree to do
the P�P� work ffi accordance with the description above set forth and in compliance wlth af1 provlaiona oP
ordinan� of the dty of Fridley. /%- � � �� O
Ia consfderattan of the payment of a fee of $�—°� , Permit fa hereby graated to
to conatruct the buflciing or addition as descrlbed above. Thia �ermit fs granted upon
the enpress condition that the persfln to whom ft ia granted and hia agenta, employees and worl�en, fn all work
done in, around and upon said building, or anypart thereof, ahall conform fn all r�spects to the or�iinaz►ce� of
Fridley, B�innesota g location, conatruction, alteration, maintenance, repair sad moving of buildinga
�� dty lfmits��� thia permit may be revoked at any� �upon �t,ion of any of the provisions of ss�d
��S �
NOTIC�
'11� parmH deas nof eevse t6s �edroeNoe, les�allaltoe fe� �rWn9. P�+�9. 6a 6adng, awu er wtle�. 8� wn to s»
tin Bnildiee lesp�etor for aparaf� p�rmtis Po� th�a �n.
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ADDRESS
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APPLIGATTON FOR BUILDING FL�,�IIT
CITY OF FRIDLEY, MINNESOTA
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LOCATIOPT 0 BUILDING
No. ��"� Street . �art of Loe
Lot Block Addit n or Subd3.visian
Corn.er Lot Iaside I,ot � SeCbaCk Side Yard
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SEWER ELEVATION FOUNDAT�ON ELEVATION
Applicant attach to this form T�ao CexCi�icates af Survey of Lot and proposed bLiZd-
ing location drawn on these Certificates. �
1
DE3CRIPTION 0�' BUILDING
To be used as;
l�i,�'� ' Front � ���sLh 1:#eiglit
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Sq. F�. I��� Cu. Ft.
G����� ' Front '��_Depth � �_Aeight ��
Sq. �t. Cu. Ft.
Type of CQnstruction
To be Completed
Estimated Cost % � _
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�
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accosdance with the Citq of Fridley Ordinances and
rulings of the Department of Bui�diags, and hereby declares that all the facte �nd
representations atated in this application are true and correct.
DATE � �� SIGNATURE. / �
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�(Schedule of Fee Gosts caa be found on Che Reverse Side . ✓/L%��'
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BtJILDING PL�RA�T gF�� SC9EDULE
Section 2. The Iaspector of Buifdin�a slrall, before iesuia,g anq per.coi.t for
the erecti4n of any building os atriicture, or for any addition to aay e�iat-
ing buildinffi or structure, or for a�y alterations or repaira to any exis��.ng
buildin� or s�ructure, upoa application therefor, require the pay�ent l�y tb�e
appl3caat for such permit of feee to the amount hereia below set fortlz and_
ia the manner her�ia provided to-wit; .
2.1. For any such permit for the erection o.f anq iire-proof building, other
thea a garage� warEhouse, factory or grain elevatar, or for the ereetion of
aay fire-psoof addition. for aimilar occupaacq, Co aay exieting build3r.g
ahall be at the rate of $1.40 for each ome thousand cubic feet, or fractioa
thereof� in such cubical caatente. '
2.2. For any such perm3t ior the esection of any fire-proof garage, warehouse�
f�ctory or graia elevator, or for the erection of any fiie-proaf eddiCio�,
for similer.occupancy, to anq exist3.ag'bu3lding�ahalZ be at the rate of 51.25
for each one thousand cubic feet, classified as °'f3reproof" by Sectian 5C2 of.
�he Minneapolis Building Code.
HOUSES -. _
2.3. For any such perm3,C for t�e ��rection of �a�iy non-fireprvo! build�n.� ot�rea
than a garage, warehoase, factory or gretn�elevator;.or anq aon-firegsc�>� ��
acldition, for similar occupancy, to aay exietin� building - permit $�,t30 �or
each oae tbousand cubic feet.
GARAGES .
2,_.4. For any such permit for the erecr.��, �t �r;; ��y�_f�LP�xsog gara�e,
warehouea; factory or grain elevator, n4• rc��: �:'3„ �:c:;:�:to�a o� 2r�y s�on-��r.;�raog
�dditioa. f�c-�s3milar occupeacy, to r=:;�, ����:ts _��r.�, lasy:, :4A�n� or for each auch
__- � buiLdiag or .addit3on - aiaety cend.; g:1;; ;�;?; ;��� e:.�.:a oae Cho�asaad cubis feet
or fraction thereof, in rhe cuF��e��.1 r.C?T.lt :n�:� the���� with a minimum of $4.04.-
For the purpose of comput�tag fees fcr �a:.::�.�ing pera�i�s, the cub3cal con�tertts
of any building or additioa to a uaifc�.� �ei��t thro�ghout by mu],.tiplying ths
ground area covered from a point sis (6) iuehes be�.�wdthe floor liae of.s�h�
basement or.callar to the average he3ght of t�� �`:�er surfaCe or to t e -
average hei�ht of the roof surf�ce of the main gable of a p�ttched roo�.
2.5. For repairs or alteraCiaua to an exis�ia,� etructure, the fee ahall be
at the rate of $3.00 per each Five Hupdred.Do].lars ($500.Q0) or fr.actiou
thereof 3n the coat of all progoeed work. . • .�
2.6. In no case ahall the �fee_.charged far.any permit ae .aet forth.in �'
Section 2 be less. thaa $4.Otl.. '
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City of Friciley
At THE TOP OF THE TWINS
INTER-OEPARTMENT REQUEST
PUB(.IC NtORK4 DIVISION
CITY HALL FRIOLCY dS432
al2-6s0' �4D0
' SEINER STOPPAGE
SEWER STOPPAGE
AUDRESS 7529 Jackson DATE 1-13-90
CALL RECEIVED BY Greg Kottsick
CREW LOCATION WHEN NOTIFIEO Home
EQUIPMEWT TAKEN TO SITE Jetter
AT 1:00 pm �q���p�
CAUSE OF STOPPAGE After backup was relieved, 10-12 steel wods (from 1-1/2 to 3 feet
in length) were removed from manhole where setup took place - 75tii & dacksvn.
TIh1E STOPPAGE RELIEVED 1:15 pm
DESCRIBE DAMAGE (IF ANY) Cement floor was wet, water was all clear water, had nc
yet backed up from street. No damage.
E ANY STATEMEPITS MADE BY CREW OR NOMEOWNER REGARDING DAMAGE OR POSSIBLE CLAIM
seen his neiQhbor's boy several times dropping objects through
manhole cover.
it
REW AP�D HOURS 1 man - 2 hours {
. �1
0
, City of Fridley
4T THE TOP Of THE TWINS
�V.������� INTER�OEPARTMEHT REOUEST
� j PUBLIC WORKS DIVISION
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� CITY HA�1, fRIOLEY 66432
j` ��-__��j a12-860-3430
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' SE�[ER STOPPAGE
SEWER STOPPAGE
AUDRESS 7529 Jackson DATE
1-15-90
CALL RECEIVED BY Greg Kottsick qT 2:00 pm (qM)(p�)I
CREW LOCATION WHEN NOTIFIED
EQUIPMEWT TAKEN TO SITE Jetter
CAUSE OF STOPPAGE Several more steel.rods were removed from same manhole as 2 days
___previously, probably still lying in line from previous backup. ;
TIME STOPPAGE RELIEVED 2:20 pm
DESCRIBE DAMAGE (IF ANY) None, no water escaped from floor drain.
E ANY STATEMEPlTS MADE BY CREW OR HOMEOWNER REGARDING DAMAGE OR POSSIBLE CLAIM
REW AP�D HOURS 1 man - 2 hours �
. _r1
sue�ecr MIT NO.
c�ty of Fr�aley 27 054
AT THE TOP OF TME TWINS g � I L D I N G�P E R M I T
� CEIPT NO.
� �
COMMUNITY DEVELOPMENT DIV.
r � V � PROTECTIVE INSPECTION SEC. �g�/
� �
1 . �
� _ �'�'1 � CITY FIAIL FRIDLE� SS432 NUMBER REV DATE PAGE Of AVPROVEO B�
�"""� � �'� 612-571-3460 910-F15 8/7/98 � �
JOB ADDRESS ���9 Jackson St
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. SHEET
2 PROPERTY OWNER MAIL AOORESS 21P PHONE
Kim Mortenson 784-4244
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO.
Seal Guard S stems 9199 Central Ave NE B 717-0700
4 ARCHITECT OR DESIGNER MAIL ADORESS ZIP PMONE LICENSE NO.
20093688
5 ENGiNEER MAIL ADDIiESS ZIP PNONE IICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION ❑ ALTERATION � REPAIR O MOVE ❑ REMOVE
8 DESCRIBE WORK
Reroof house and garage (28 Sq) Tear-off
9 CHANOE OF USE FROM TO
E�
STIPULATIONS
Underlayment must comply with State Building Code.
SEPARATE PERMITS ARE REOUIFiEO FOH ELECTRICAL. PLUMBING, HEATING, �PE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. 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 CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION STALIS GAHAGES
AND KNOW THE SAME TO BE TRUE AND CORpECT. ALL PROVISIONS OF LAWS ypLUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOfiK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN Oii NOT. THE GRANTING OF A PERMIT 2335 1. ZJ
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOIATE OR CANCEL THE pEqMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFORMANCE OF CONS?RUCTION 7L�.. ]S Fire SC 2.34
PLAN CMECK FEE TOTAL FEE
Li ense SC 5 0 83.26
SIGNATUAEOFCONiRACTORORAUTMOii�ZEDAGENT IDATEI WHEN PROPE ALIDATED TNIS IS Y UR� PJERMIT
t_ �s^ / e� !/
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SiGNATUREOFOWNERiiiOWNERBUILDERi IDATE� B G�NSP qpTE
NEW
ADDN
AL'TER
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constructionAfldress:
CITY OF FRIDLEY
SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2
BUII.DING PERNIIT APPLICATION -
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Effective 1/1/98
��
10 ,�q,�
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Legal Description:
Owner Name & Address: 1�� �,�li�.� .1_� � �� �� ��cac�� S°� Tel. # �$ � � L/ a-�/ ��
Contractor. (� ����.Q�{� MN LICENSE # _� �°13 �� �
Address: _ �I �� ���-�'�� �v � �I�i°l� ����% Tel. # `�����% �
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LIVING AREA:
GARAGE AREA:
DECK AREA:
01'HER:
Construction Type:
Attach to this application, a Certificate of Survey of the
lot, with the proposed constcuction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
- Length Width Height - - -
Length Width Height �
Length Width Hgt/Ground
I
Driveway Curb Cut Width Needed:
DATE: � S —CI
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Sq. Ft.
Sq. Ft.
Sq. Ft. �
oti � � -
`��� �^ ���� �
�� �- TVd,� il i°Estimated Cost: $ .
(Fee Schedule on Back)
Ft. + 6 Ft = Ft x $ _ $ " �
� � � �� �
$ �•
$ e �
$
$ �� �
$
$
$
$
$ ���
Tel. # � `'U %U v
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1000 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plaa Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
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BUII.DING PERNIIT FEE SCHEDULE
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The Cluef Building Official shall, b�fore issuing p�rmits for the erection of any building or s�tructure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structuie, 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,Q00
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,�0,000
FEFS
$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,Q(30 �
$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,�0 plus $y.(�il rur each additional $1,�0
or fraction thereof, to and including $50,000
$574.75 for first $50,� plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,0�
$887.25 for first $100,� 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 fraction thereof, to and including $1,000,000
$1,000,001 and up $5012.25 for the first $1,OQ0,000 plus $2.75 for each additional
$1, 000 or fraction thereof .
DRIVEWAY DEPRESSION ESCROW .
(Concrgte Curb �treets Un�y� - - - --
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
approach with 6 inch depth - Driveway width plus 6 feet tunes $15.75.
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 the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the l�ation of the foundation once it has it has been. constructed
will be required before proceeding with the framing. �
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