AF - 47674-,.4, r .
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BUILDING PERMIT
Village of Fridley, Minn. �� 2 2 3 4
Date ����� ..................:...........
Owner . ...'...�....... Builder ...........................................
Addres �;"`�.f�! . . . . . . .t�. .�„� . . . . Address . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
LOCATION OF BUfLDtNG
No. .�� . . . . . Street : . . . . . . . . . . . . . . . . . Part of Lot . . . . . . . . . . : . . . . . . . . . . . .
Lot . . . . . . . .a':' :". . . B1ock . . �. . . . . . . . . Addition or Sub-Division . . .��„��„��,�� : . , , , , ,
Corner Lot .� ........ Inside Lot ..�/....... Setback .�t� ... Sideyard .�s,,,,.•.�'.'f... .......
DES�RIPTION OF BUILDING
To be Used as:
�
, . F'ront . . �! . . Depth . . ,�,, {,�. Height �„� . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
�r i
. . . . Frox�t �. . . Depth. . IZ o. . . Height . . . . . . . . . Sq. F`t. . . . . . . . . Cu. Ft. . . . . . . . .
....
Type of truction ��� . . Est Cost . ��. .� . . . . .. . To be Completed .�.��.
. ' ' � �,�/�-"'�'�t,r�„�+ � +��r►
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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 forth and in compliance with all provisions of
ordinances of the village of Fridley.
. � .�,rr� ,�a ;.��°' ,�
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- In cons' tio of the psyment of a fee of $. . , pQrmit is hereby ted to ,
.�,�, to construct the bu�ldin�� addition as described above. This�e is gr` ted upon
tTi� exp�� t the person to whom it is granted and his agents, employees and worlanen, u�► all work
done in, around and upon said building, or any part thereof, shalI conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of building�-
in the village limits and this permit may be revoked at any time upon violation of any of the: provisions of d
ordinanc�s. ..+� . , : �,,,,� . ' ,
���
.�r�e::''�Building Inspector
NOTICE:
This permit does not cover the construction, installation or altetation for wiring, plumbing, gas heatln�,
. sewer or water. Be suro to see the Building Inspector for separate psrmits for these iten�s. ,
�_
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City of Fridley, Minn.
BUILDING PERMIT
nate: _.._� 27� 1965
.�_ -�d'.� � %
N° '7595
pR,aer; Hener�r Eggert _._. Buiiaer _M_etro Builders t Ine.
.._ _
Address ..�_Q__._����e.�son _Street. .N.._Et......._.._ Address _2 ..O Nicol.let _.Ave. __So.---._._._.__.___._
.� �__......._._.._._ __.. - - .
LOCATION OF BUILDING
No. ___bi5.4�. street deffe�son Street _ N. E.---.....---------....._...._ Part of Lot •--__.----•--•---._._..---
Lot __.___.�.___...._..__ Block _----�!'•-----.__..._._ .._......----_. Addition or Sub-DivisionCh2"�3tl.e Addition__.._..._.._...__.._.___.�_
Corner Lot .----_..._.._._.._ Inside Lot ----•--._.--•--._.-•---•---•-- Setback .----•------....._-----_--....... Sideyard
Sewer Elevation ..._.._�._�.__..._�.._�..----•-•----------•--- Foundation Elevation ..__..._.._.
To be Used as:
Type of Construction
DESCRIPTION OF BUILDING
Fi�ont ._...___....._. DePth _.---.....__.._ Height -------•--.._.----. Sq. F� .__._._...._ Cu. Ft
Front �__� Depth _.._.---._ Height .-•--•-----__.__ Sq. Ft. _..__.�.__ G�. F't
----•--._._--•----�....._...._.___.. Es� Cost _._...,�1�y.QQQ.QQ------...... To be Completed ....._......._.._........
Storm Damage Bepair
i
In cansideratlon of the issuance to me of a permit to construct buil�g described above, I agree to do
the proposed work in accordance with the description above set fo rand in,,�ompliance with all provisiona of
ordinanoes o! the dty of Fridley. / ,:,f,�;
-- ��,;-'���1���-�'-&'.>�-�
` �.
In ca�sideratfon oP the payment of a fee oi �1,l,i.D�L..----_-__-•-, permit is hereby granted to._AI�.'�TQ�l7,l.$�8. �
._._�iiC.........�._._�_.—.._...._._ to construct the buflding 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
Frldley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings
within the dty ]imits and this permit may be revoked a t any time upon violation of any of the provisions of said
ordinaaaes. �
Building Inspector
NOTICE:
7Ws p�rmtt do�s aot eowr tl� eeas�eucNoa. IeqallNien for �. Plwabtno, yas huNn�, srww or wN�r. d� sun ro sM
th� duildiao latp�elor for �paaM p�rn�its for fh�a if�ns.
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A.P^T�IC?TT�N FOR BU�LDI'v^ FFF.MXT
CITY 0� �,"'.�IDLEY, Mi;�i•��;�TA
OWNER' S NAME�,� � L G ��- �-� BL'�:LDE�Z ��.���-�,�''��L�GC ,�-GG-i_ J�,� _
ADDRESS ._j.�' ` � � ADT�P.ESS �JC-' S' � ' `� �� —
LOCATION OF BUi.L�JiNG
No. �,�j ('��i Street _� Part of Lot
Lot �� Block� Addition or Subdivision !^� '� � � � � -{ � �:�.�-� -
Corner Lot Inside Lot Setback S�de-Yard
SEWER ELEVATIO:V FOUNL��'1TION ELF.�'ATION
Applicant att:cti to this form Two Certificates of Survey of Lot and proposed build-
ing location drawn on these Certificates.
To be used as:
DESCRIPTION 0�' BUILDI*��
�'ront i�pch i.Pight
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu. Ft.
T e of Construction �st�m:ted Cost ��� f�� ��
YP 4 ��;;Z�GE=t-�1" ,-I� '�� �C�DI c
�_
To be Completed u,.,e y�� ��
�, ..
The undersigned hereby makes application for a permit for the work herein specified,
agreeing to do all work in strict accordanc2 with the City of Fridley Ordinances and
rulings of the Depart�ent of Buildings, and hereby declares that all the facts and
representations stated in this application are true and correct.
1
�
DATE � - � I"� �.� SIGNATURE ��1�-7=lG%' � ' �-CG - ,�-l`Z'`�
(Schedule of Fee Costs can be found on the Reverse Side).
�-. - � �
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BUILDING PE�2asT FEE SC;iEBUL,E
Section 2. The Inspector of Buildings sh�ll, b�fore issui�g any pel-mit for
the erection of any tis.i:i�ding or structure, or for any addiCion to any e:�ist-
ir_g building or etrLicture, or for any alterations or repzir� to any �xist3.ng
building or structure, upon application therefor, require the paS�cent by the
applicant for such permit of fees to the amount herein below set �O'i'tI1 ac:3
in the manner herein provided to-wit;
2.1. For aay such permit for the erection of any fire-proof build;n�, oitier
than a gara�e� warehouse, factory or grain elevator, or for the erecti.ot� of
any fire-p:oof- addition, for similar occupancy, to any existing buitd�r.�g
shall be at the rate of $1.40 for each one thousand cubic feet, or fraction
thereof, in such cubical contents.
2.2. For any s�ch�permit for the erection of any fire-proof garage, war�house,..
factory or grain elevator, or for the erection of any fire-proof a�ldit3.or.,
for similar occupancy, to any existing buildiag shall be at the rate o� $1.25
for each one thousand cubic feet, classified as "fireproof" by Section 5�2 of
the Minneapolis Building Code.
HOUSES
2.3. For any such permit for the erection of any aon-fireproof buildin.� c!`.I�er
than a garage, warehouse, factory or grain elevator, or any non-fire^��-:�f
addition, for similar occupancy, to any existing building - permit $�.CC� for
each one thousand cubic feet.
GA�tAGES
2.4. For any such permit for the erecr��� �' �r�,� n�n-fi:.?��oof gara�e,
warehouse, factory or grain elevator, ��: �:. -,� ,.:zE: ��:<,; gia� o� any non-s�re�roof
additioa, for similar occupancy, to �.~;-� �--�:i.;;�ing L-;�:.�ding or for esch sLCh
. building or addition - ninety r�n; ,� r;,: ,c,;�.r Fcr e�;ca one thousand cubic feet `
or fraction thereof, ia the cut i�G:,j. G��r�4�A !.: thareei with a minimum of y4.00.- :
For the purpose af camputing fees f�r bc�';.ciing permi�•s, the cubical conten.ts
of any building or addition to a unifer:a izeight throughout by multiplyin$ the
ground area covered from a point six (6) inches below the floor line of �he
basement or cellar to the average height of t�� ,.v�>per surface or to the
average height of the roof surface of the main gable of a pitched roof.
2.5. For repairs or alterations to an existing structure, the fee ahall be
at the rate of $3.00 per each Fivz Hundred Dollara ($500.00j or fraction
thereof in the cost of all proposed work.
2.6. In no case shall the fee.charged for any permit a� set forth in
Section 2 be leas than $4.00.
�..., _ . . .. ,..�
sua�ecr
City of Fridley
AT THE TOP OF THE TWINS g U I L D i N G P E R M I
r
� �
� �
� • COMMUNITY DEVELOPMENT DIV.
� i L'�"��',
r � � PROTECTIVE INSPECTION SEC.
1 �
� A' �""1 � CITY HALL FRIDLE� 55432 NuMaea aev
: �___J \�/ �.J
612-571-3450 910-F15
JOB ADDRESS 6350 Jefferson Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. �J 4 Christie Addition
2 PROPERTY OWNER MAIL ADDRESS
Henry A. Eggert 6350 Jefferson 5treet N.E.
3 CONTRACTOR MAIL ADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
6 USE OF BUILOING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION C� ALTERATION
8 DESCRIBE WORK
Reroof Dwelling
9 CHANGE QF USE FROM TO
DATE PAGE OF
8/18/81 / /
3MIT NO.
63
y�9�
APPROVED BV
SEEATTACHED
SHEET
ZIP PHONE
574-1510
ZIP PHONE LICENSE NO.
ZIP PHONE LICENSE NO.
ZIP PHONE LICENSE NO.
❑ REPAIR ❑ MOVE ❑ REMOVE
STIPULATIONS
Roof can be 2nd but not third roof. Install ridged galvanized valleys.
TYPE OF CONST.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING, ASpYld�.t
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
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 WOFK IS COMMENCED. NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION �-
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $(OO
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $11.50
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECK FEE
Si LREOFCOnI7RnCTOR UTH i EDAGEN7 �Dn7Ei WHEN PR
/L / > _
SIGNnTUREOFOW R�IFOW EPB ER iDATEI BLDG irvSP
)CCUPANCY GROUP OCGJPANC`r LOAD
iQ. FT. CU. FT.
OFFSTREET PARKING
iTALLS GARAGES
SURTAX
$.50
SAC CHARGE
TOTALFEE
�12•��
RLY��LIDATED THIS IS YOUR PERMIT
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�` OF7E
CITY OF FRIDLCY Effective Aug. 1, 1981
kf'PLICIITI�:d FOR R�SIULi�TIR� QUILDIi1G PCfL'�ITS
((Je�•r, Alter.�tions, Additions, or Repairs)
_ - , � ��
O1dIdER: �� ��� �- � -- c'G=��;��-- �UILDER: :s�}j'� ��
._ �--- .
ADDRESS: � � S �' ,,,� � �!--�-%C� � /t-� lIODRESS:
TCL h0: T_ f � S/� TEL (d0:
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Construction Location
STRI:ET NO : ��- i � � STFtEET: �� �;._�� ,� � -.f,' � C` ��-
�
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L07': - � BLOCK: � ADDITION : ����C -S r� ��,� �*,�1)� ��
Corner Lot: Insic3e Lot: SetbacY.: Sideyards:
Ap�licant attach to t}iis form two Certificates of S�rvey of lot and
proposed building location drawn on certificates to scale.
-.- DESCRIPTIOid OF COP�STPJJCTIOPd
,� � —
`�� -r��1 }- I'ront: Depth: Height:
� - _
; �
.,Y��,C � Square Feets C�ibic Feet:
Front:
�P� =
Squar.e Fe�t: Cubic I'eet:
Height:
e of Construction : �. EstimaL-ed Cost: $ ;`�ti� �
�'P ___-,._�1 �'� ���"�".' � '
Zb Be Oor,�pleted:
Alt. A Alt. B
Proposed Drive�•�ay Width If New Opening Is Des:ised: $ $
S�� Rr�VERSE SIDE OF SHEET
�►ie undersigned hereby ma}:es application for a permit fcr the t:�ork herein specified,
agreeing to do .all work ir� strict accordance with the City of Pridley Ordiiiances �11C1
ruliiigs of tlle Department of Buildi.ngs, and hereby declares that all the facts and
representatiens stated ;n this application are true and correct.
D; T�: (� ' ��j '� �; SIGNI1TUItF. :
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Stipulations:
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SUBJEC7
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� �
i �• COMMUNITY DEVELOPMENT DIV.
' �a.-_"._ ,
r � � PROTECTIVE INSPECTION SEC.
� �
� � i-"1 � CITY HALL FRIDLEv 55432 NUMBER aEv
�---"�'� ,'' 612-571-3450 910-F15
JOB ADDRESS 6350 Jefferson Street NE
1 LEGAL LOT NO. BIOCK TRACT OR ADDITION
DESCR. S 4 Christie Addition
2 PROPERTV OWNER MAIL ADDRESS
Henry Eggert 6350 Jefferson Street NE
3 CONTRACTOR MAILADDRESS
Builders & Remodelers Inc. 3517 Hennepin Aye S,
4 ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEEfi MAIL ADDRESS
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION G� ALTERATION
8 DESCRIBE WOFK
Soff it/Fascia
9 CHANGE OF USE FROM
STIPULATIONS
TO
DATE
3/10/92
ZIP
21P
>ls
ZIP
ZIP
PAGE OF
� �
PERMIT _ �
: 2�.�27
RECEIPT NO, -�
-,
'�� �' ,� �
APPROVED BV
SEE ATTACHED
SHEET
PHONE
574-1510
PHONE LICENSE NO.
827-5481 1100
PHONE LICENSE NO.
PHONE LICENSE NO
❑ REPAIR ❑ MOVE ❑ REMOVE
TYPE OF CONS7.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENOED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCE0. NO. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2,195
WITH WHETHER SPECIFIED HEREIN OFi NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHOAITV TO VIOLATE OR CANCEL THE pERMIT FEE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING coN- $54.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION
SIGNATURE OF CONTRACTOf7 OR AUTHOAIZED AGENT
S�GNaTURE OF OWNER UF OWNER BUiLDER�
SO.FT
STALLS
PLAN CHECK FEE
e SC $5.
ionrE� I WHE PROPERLY
�DATE� �NSP
CYGROUP OCCUPANCYLOAD
CU. FT.
OFFSTREET PARKING
IGARAGES
SURTAX
$l,l�
SAC CHARGE
Fire SC $2.09
TOTA�FEE
� $62.19
�p HIS IS YOUR PERMIT
/ 4-- �� i� ( —
qaiE
NEW ( ]
ADDN ( ] CITY OF FRIDLEY
ALTER SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit AppliCation
Eft'ective 3/ 1192
Construcdon Address: �, 5� D Je�F'��;ow s7. w�% ,
Legal Descripdon: S�F �a-r�� �.d-
Owner Name & Address: %{�,r�.�k� �C6 �/'� Tel. #,���"�Slo
Contractor: ��w ; � �,� , � �Qe�%�e � Pa (� 5 -�- � � MN LICENSE # j,t� � /l d �
Address: '�S-l7 �-e�K-�-� `�. �w s Tel. # �'3 �—�l�"/
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LIVING AREA: I.ength Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECK AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: � ��t � Cr�� � r
Corner Lot [ ] Inside Lot ( ]
Type of Construction:
Approx. Completion Date:
Ft. Yd Setback Side Yard Setbacks
,r
ESt1ITla� COSt: $ �� �`�
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
r
DATE: � �� y APPLICANT: ,U� Tel. # ���— 5���
('ITY USE ONLY
Permit Fee $ �' '`� �''� Fe� Schedule on Reverse Side
, ��,
Fire Surcharge $_ �• �.6('�1 of Permit Valuation (1/lOth%)
State Surcharge $ / - i � $.50/$1,000 Valuation
SAC Charge $ $700 per SAC Unit
License Surcharge $ ��J $5.00 (State Licensed Residential Contractors)
Driveway Escrow $ Alt. "A" or Alt. "B" Above
Park Fee $ Fee Determined by Engineering
Sewer Main Charge $ Agreement Necessary [ J Not Necessary []
TOTAL
STIPULATIONS:
$ -'�=� �-�. r��
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sue�ecT PERMIT NO.
City of Fridley 2 8 26 0
AT THE TOP OF TME TWINS g� I L D I N G P E R M I T -�
i � ' AECEIPfi NO.
� �
i ; V'�'��� ,
COMMUNITV OEVELOPMENT OIV. ; � I
r � � PqOTECTIVE INSPECTION SEC �/ ", f",'�
i �
i_-_. A,��"';,� CITY MALI FRIOLEV SS�J2 NUMBEA REV D�TE P�GE O� •vPROvEO Br
Z '� 612-571-3450 910-f15 10/15/98 � �
JOB ADDRESS 6350 Jefferson Street NE
1 LEGAL �OT N0. 9lOCK TRACT Ofi ADDITION SEE ATTACMED
DESCR. 5 4 Christie SHEET
2 PfiOPERTY OWNER MAIL ADDRESS ZIP PMONE
Henry Eggert -
3 CONTRACTOR MAIL ADORESS ZIP PHONE LICENSE NO
Wm Woods Const Co Inc 7728 Knollwood Dr M -
4 ARCHITECT OR DESIGNER MAII ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAII AOORESS ZIP PHONE UCENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Reroof house and garage (22 S) Tear-off
9 CHANGEOFUSEFROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TVPE Of CONST OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE RE�UIqED FOR ELECTRICAL, PLUMBING. HEATING,
VENTI�ATING OR AIR CONDITIONING.
TMIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING SO FT CU FT
AUTHORiZEO IS NOT GOMMENCED WITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED NO DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV TMAT I HAVE REAO ANO EXAMINEO THIS APPlICA710N STALLS GARAGES
AND KNOW TME SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVEFNING THIS TVPE OF WORK WILL BE COMP�IED -
WITM WMETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT 1885 .94
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STFUCTiON OR THE PERfORMANCE OF CONSTRUCT�ON 59. O 1T2 SC
� _, / PI.AN CHECK FEE TpTA� f EE
� , � � �,� J_
S�GN4TU%�E O� CON"AAC Q OR AUTi+OQ�ZED �GEtiT �D�iE� EN ROPE V ALIOATED TH IS VOUR PERMIT
/ G
S�Gan7uFEO�OwNEQ��[pWNEQBU�IDEAi �D�iE� B G �wSo r��tt
NEW
ADDN
ALTER
��
[]
��
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: �'� ,� .°��
Legal Description:
� G� s1i.
Effective 1 / 1 /98
� ,
Owner Name & Address: "' � , �' %1 '� � � -� , i �? �, Tel. # 5�� �� � -� �' C�
� � �, �, f
Contractor: ", ✓� (l <<� , ,�'.� �� � ��' MN LICENSE # � ,/ � /
Address: � ,�� ��� r�l'��'f/t'�''��'/ ��"/�i Tel. # r c�'�� � �� ��„�
�
Attach to this application, a Certiiicate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIPTION OF I��IPROVEMENT
Length Width Height Sq. Ft.
Length Width Height Sq. Ft.
Length Width Hgt/Ground Sq. Ft.
�, ',' - - � �s '
t
Construction Type:� 0�',�j;; �,� `� �.!���j�-(; Estimated Cost: $ '� -
//%��� � r ��, ���,�� �7/� �� /',�%�i ��,�G�f%`/ (Fee Schedule on BackJ
Driveway Curb Cut Width Needed: �Ft. + 6 Ft = Ft x$ _$
� � i
DATE: j fl%'� �� APPLICANT: � �� �� �'� � Tel. # � c;'� � %,�`,'
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$
$
$
$
$
$
$
$
$
s.�
$ i ' � �r
CTTY 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 Plan Review
Fee Determined by Engineering
Agreement Necessary [] Not Necessary [ J
Building PLUMBING Pe�it rro.: �
� Inspections R E+ SIDEi�TTIAL APPLICATION Received By: ,d`
763-572-3604 CITY OF FR�DLEY Date Rec'd: �`�� •`- -
DATE � �� YOUR E-MAIL ADDRESS
SITE ADDRESS �� `i� O � � �
THIS APPLIC.ANT IS: ❑ OWNER 9�ONTRACTOR
PROPERTY N�: ar ' � �
OWNER/ qDDRESS: Lo.�U� ���i°-j"'5�7� CI7Y ' N� STATE�n%ZIP,���
TENANT
PHONE:�y� ,��7i
.-,—•
CONTR.ACTOR NqME:
SUBMIT A COPY OF STATE LICENSE #i �,r.�G EXP DATE �i^
YUUR STATE ADDRESS: 7� l9 ����P�t�P_-ICJGt� _ CITY v''e S7'ATS �`�U ZI��
LICENSE WITH pHp� � �r'{—Cj7 �c pp3(
APPLICATION
PERMIT TYPE GLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: � ��'' PLACEMENT
DETAILED DESCRIPTION OF WORK �-psC°��(,�1� S �
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, whichever is greater, for the
improvement, installation or replacement of a residential fixture, excluding the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cASt between $300 to $500 = cost of labor x.OS =
FCR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $1 D.00 PER FIXTURE, EXCEPT WHERE NOTED. FIX1'URES: (INDICATE TOTAL
NUMBER OF EACH BELOV�
BATH SINK/LAV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (x�crrrtrc��j SWIMMING POOL � WATER SOFTNER (S35)
CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. ($15)
DISHWASHER LAUNDRY TRAY WATER HEATER ($35) FOR IRRIGATION
— WATER METER OTHER
; P��� �E�'��JE�;'�"� �"fl� ,,.'t7�������`�� .� fr � �'�r���`. ,�, � y � ��3��� �; �"� ��,��. ,w;����"�'ER��`�:����" ��`
� ..:! �i�R'�RflT����:,(�;�''E�-��9..,,.
Permit Fee $ Number of fixtures @$10.00 x$10.00 =$
Surchar e .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ Number of fixtures @$35.00 x$35.00 =$
State Surcharge = $ .50
Tota1= $
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work will be in
conformance with the ordinances and codes of the City of Fridley and with the Minnesota Construction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of all w rk whic .q,uires review and approval of plans.
SIGNATURE OF APPLICANT PRINI' NAME�� DATE� " C%�
�'� ��,���s�%r�� �: �.,.��'����,�u w ` ��.t. �Q��I�,�'-��`���`��.����'��'��� ,����c�3.�.��r��g'u���`��'���;'
City of Fridley
Building Inspections Department
6431 Ur�iversity Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
Building
Inspections
763-572-3604
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
Permit No.:
Received By:� �-- _
Dat����� P 1 � 2��9
DATE_ � �IC� �Oci YOURE-MAILADDRESS S}��'6�SOnQ,C4�GY►aQlonl'tqc�of't,��{jr,eC.�WM'�
SITE ADDRESS �p3Sd ��'�Q(�v� C,�� N ��
THIS APPLICANT IS: ❑ OWNER CxCONTRACTOR
PROPERTY OWNER/ I N,�:�
TENANT
ADDRESS:
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
WIT'H APPLICATION
PROPERTY TYPE
PERNIIT TYPE
TYPE OF WORK:
r �-
���� s�t�
CITY_�, ��.Q � STATE� P��'Z,
NAME: � h Ori l� u�.CJt.a.� CO -
STATE LICENSE # ZOy� (p'j'� EXP DATE _ � 3 ( d
. . �.
IN FAM Y/NEW C
TW /NEW CON
❑ ADDITION
❑ BASEMENT FII�IISH
❑ DECK
I�
DESCRIBE WORK BEING I
SIZE OF IMPROVEMENT
NUMBER OF SQUARES
GARAGES
PROPOS£D SIZE:
PROPOSED HEIGHT:
❑ ROOF
❑ SIDING
❑ SWIMMING POOL
w��s�w
LENGTH
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
CITY �W�j'j,Q STAT�rLtP��
_-�n��.�
❑ DRAIN TILE
❑ OTHER
�i�.^�5 an �
WIDTH __ HEIGHT
BASEMENT REMODELING S BMIT•
1. Existing Floor Plan
2. Proposed floor plan
3. List of swctural members to be used
Ft.
SIDIIVG
❑ Vinyi ❑Soffit FOR NEW CONSTRUCTION RJCLUDING DECKS,
� Aluminum ADDITIONS & PORCHES SI Ig�T•
� Trim
❑ Other � F���a 1. Site Plan/Survey showing the existing swctures
and proposed project.
WINDOWS 2. Two sets of consVuction plans
M EXISTING OPENINGS �Yes pNo LOCATION O,� WINDOWS 3. Energy Calculations
OR FOR NEW OPENINGS-DESCRTBE SIZE OF Lt �1tti1,t � w�
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED D. • NUMBER OF WINDOWS
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ I OCCUPANCY TYPE
Permit Fee —
Plan Review
Fire Surcharge
Swcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due _
$ •r
$
$
$ h
$ �
$
$
$
$
$
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 detetmination)
ft+6ft= f}x$21 =$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pa able to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
ulations
I hereby apply for a building permit and I acknowledge that the information above is complete and accurate; that the work wil] 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 o a per ' and work is not to start without a permit; that the work will be in accordance with the approved
plan in the case of all work whi requir s eview and approval of plans.
SIGNATURE OF APPLICANT PRINT NAME�� �' Q.�,3C)�� DATE � O C�