AF - 47737City of Fridley, Minn.
BUILDING PE�IT
N° 5865 �
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Owaer: �–r - :;;t�' � � � Builder �^�� . .._-^�' -�, � _
Address Address �
* �„� t � � �'�LOCATIOI�,!�F BU��IIVG �
No. ���..,� Street l,,'' ' .� ;.� _ . � . � , t- �� Par� c� i.� g
,,�' '' � � �. ? .M���.: �• i ��
Lot �__ Blo� � Addition or Sub-Dfvisia� ��,��..�:._.�_
Coraer Lot � Inside Lot ���`"� Setback �; �„� Sideyard ._ �'
Sewer IIevat3on _____�. Foundatlon IIeval3on
DESCRIPTION OF BUILDING
To , _ •
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��' - �� �'ront � Depth f� Height �',��� Sq. Ft. � j Cu. Ft
, ,�:t� r� ________ Depth � Height _: _� Sq. F� Cu. Ft.
�, . �,� ` �,� "�
Z�pe oP Constructio��"�°� Est, Cost ���— To be Completed
In cons�ideration of the �tsauance to me of a permit to construct the building described abave, I agree to do
the pro�sed work in accordance with the descript3on above set forth and in compliance with all provisiona oY
ordinances of the dty of Fridley,
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In considerat3on of the payment of a fee oP `$�. `'� , permit is hereby granted to
to conslruct the building or addition as described above. This permit is granted up�n
the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work
8one in, arouttd and upon said building, or any part thereoP, shall coffiorm in all respects to the ordinances of
Fridley, Minuesota regarding locatton, construction, alteration, maintenance, repair and moving of buildings
�pvithin the dty limits and this permit may be revoked at any time upon vi,�atioa�f any oP the provisions of said
Ordinances. • .1"� _ �rY:
Building Inspector
NOTIC�
ihts permH does eot eove� ths eonstrueHoe, testallaMon fo� wirtng, plum6ing, eas 6eating. sewer or wate�. Be sun fo as�
ths Balldieg impeetor for separafs peemib fo� these ihma
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APPLICATZON FOR BUILDIRTG PERMiT
C�TY OF FRIDLEY, MINNESaTA
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Addresa Address
ON OF BUILDING
No. ,�� Street Part of Lot
Lot Block di or Subdivisio �. � �/
Coraer Lot Iaside Lot�Setback �� � r Side-Yard
SEWER LI.EVATION FOUNDATIOIV- II.EVATIOAT
Applicant attach to this form Two Certificates of Survey of Lot aad proposed
building location drawn on thess Certificates.
DESCRIPTION OF BUILDING
To be us s:
� Front��Depth�fleight � �
Sq. Ft, � ,� � Cu. Ft. � �� �
Froat Depth Height �
Sq. Ft. Cu. Ft.
�� / ��
Type of Conatructioa Eatimated Goat ��
To be Completed
The uader�igned hereby makes applicat�on for a permit for the work herein
epecified, a�reeing to do all work in etrict accordance with the City of
Fridley Ordinances and ruliags of the Departmeat of Buildinge, and hereby
declares that all the facta and repreaentations stated .in Chis application
are true and correct.
D� �-� � _ � �
(Schedule of Fe� Coets can be fouad on the Reverse 3ide).
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BUILDING PERMTT FEE SCHEDULE
Sect�oa 2. The Inspector o£ Buildinga eha11, before isauing any permft for
the e�ecCioa of any building or structure, or for any addi�ioa to any exist-
iag building or. atructure, or for any alterations ox repairs to any exis�ing
building o�. src�ucture, upon agplication therefor, requi;ze the paymeat by the
applicant for such permit of feea to the amount herein below set forth aad
�n the m�nner-here�n provided to-wit: . _ .
.2.1. �or auy such permit for the erectioa of anq fire-proof building, other
than g Sarage� warehouse, factory or grain elevator, or for the erection oi
any fire-proo£ addition, for similar occupancy, to any existing building
shall be et the rate of $�..40 �or,each oae thousead cubic feet, or fraction
., �hereof, ia such cubical contenta.
2.2. For any such permit for iche erection of anq fire-proof garage, warehouse,
fac�ory or grain elevator,- or for the erection �of any fire-proof addit3on,
for similar accupaacy, to any exiatiag buildiag shall be at the rate o� $1.25
for each one thonsand cubic feet, clasai£ied as °'€ireproof" by Section 502 0£
the Minneapolis Building Coda.
HOUSFS
2,3. For anq auch pesmi.t for ttie erection of any non-fireproof bu3ldiag other
than a garage, warehouse, factorq or graia elevator, or suq non-fireproof
addit3on, for similar occupancy, to eny exi�tiag building - permit $1.00 for
each one thouaend cubic feet.
�.
GA1tAGES � . ..
____.__
2.4. For any such permit for the erection of any non-fireproof garage,
warehouse, fectory or gxaia elevator, or for the erection of aay tton-fireproof
�.ddieion, for similar occupancq, to aaq existing buildiag or for each such
�- building or addi_tion - ninety cents ($0.90) for each one thouaand cubic feet
or f�action thereof, in the cubical contents thereof with a miaimum of $4.00.
For the purpose of campu�ing fees for building permita, the cubical contents
of any building or additioa to a uniform height throughouC by multiplyi�ng the
ground area covered fram a poiat aix (6) inches below the floor line of the
basemeat or cellar to the average hefgh� of the upper surface or Eo the
average hei�ht of the roof surface of th� maia gable of a pitched roof.
� 2.5. For sepaira or alterations to an exis�3ag structure, the fee sha11 be
at �he rate of $3.00 per each Five Hundred Dollars ($500.00) or fraction
thereof in the cost of all proposed work.
2.6. In no c�se ahall the fee charged for anq perm3t as set forth in
Section 2 be lesa than $G.00.
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Date: � 26' 1965
�r: �lande Swart
City of Fradley, Mirm..
BUILDING PERMIT
8��, $obert F. Norberg
Ad�ress 6�2? s�fferson �T. E. Adar� �921,. IItah ��e. No.
� �����
N° 7566
LOCATION OF BUILDING
ivo. �x27 street Jeiferson St. 1V. E. part of Lot
Lot �i Block � Adclition or Sub-Divisian �ce CC�ek '�e2?BCe. P18$ r
Corner Lot �_ Inside Lot � 5etback Sideyard
Sewer IIevation Fo�mdation IIevation
To be Used as:
Type of Construction
DESCRIPTION OF BUILDIIdG
PYont Depth Height Sq. F`t. Cu. Ft
Front Depth I�eight Sq. Ft. G�. F'�
�, � �i.�QQQe� _ To be Completed
Storm Dam�,ge Repa�.r: 1�estore home and gar�ge to origina]. coadition
In c�naideration of the 9ssuance to me of a�rmft to construct the bwlldiug described al�ve I agree to do
the prop�d work ffi accordance with the descriptton above set forth and in compliance with afl praviaffons of
ordinances oP the dty oP FricIIey.
In co�afderat[on of the �yment oP a fee oP ��OAW , permit �s hereby grantea to Rc�bert F. Norberg
to c�nstruct the buil�Ifng or addition as de�cribed above. This �ermft is granted uPon
the express condition that the person to whom it fs granted and hfs agents, employees and worl�uen, in all work
doae in, aro�md and upan eaid bwllding, or anypart thereo� sixall conPorm ffi all respects tfl the ordinances of
Frldley, Mfnnesota g location� conatructfon, alteration, maintenance, r+epair aad movin� of buildiugs
within the dty ]imits�a d�this permft may be revarked at any time up� violation of a�► oE the Provisiona of seid
ordinaao�.
Build9n8 Inspector
NOTIC&
'I61s psrmB doa im! �mrar t6s comm�eNoe, Iestallalton �er wWng. plum6teg, oa 6�tteg, s�wa er wafsr. B� m» to as
tl» Bulldie0 I�paeMe tee qparaia � Mr t6�a Nem�.
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• AFP'LxCATION FOB BUII.DING PERP9IT
'CITY OF FRIDLEY, MINN�SOTA.
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OWNER' S NAME__ C._"�c�� �t� �i�i.fc+� w�` 7`'_ BOILDER �� L�� � c'°��'
Annx�ss_ ��� ����f'� �� � �nD�ss_ �9� � 1��� ^��
LOCATION OF BU�LDING
.
No._ C� /��� Street ������ Part of Lot _
L0� BLOCR f�ADDI�ION �OR SUBDI�TSIbN�� �� ���� �� �a�
Corner Lot�_Inside L�C_�Setback , Side�Yard ' •
SEWL+R ELEVATION FOUNDATIOA ELEVATIt�N
Applicant attach to chi.s form Two Certificates of Survey of Lot and proposed
building location drawn on these Certific�tes.
DESCRIPTIOAT OF BO�LDII�TG
To be us ed as : /J ���e�� �✓��t �' �~ ��i—� � ��' ��� ` /� �! �°
� � a � � c'q�� `:c�cr . '7'<<0�
P
Front Depth Seight �
�Sq. Ft. .. Cu. Ft.
: Front � � bept �_$eight ,
Sq. FC. Cu. FC.
Type of �oitstruction � Eatimated Cost 6� ��Oa ��
To be compleCed �
The underaigned he�eby.makes agplication for a permit for'the work herein apecified,
agreeing to da all work in strict accarciance with t'h�e City of Fridley Ordinancea
and rul3n�e oi the Department of Buildinga, and hereby de�laree that �ll the facte
and representations etated in this applicati e true and correct.
DATE � " �� � 6 S� SIGNATURE
(Schedule of F'ee Coats can be found on the Reverse Side).
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BIIILDING PERI�IIT FEE SCHEDULE
SECTIOAT 2. The Inspector of Buildings shall. before issuing any ges�mit for the
erection of any buildi.ng or structure, or for ang addition to anq existing build-
ing or structure, or for any alteratibna or r�pa3rs Co anq egisting building or
structure, upon appli�ation therefore, require Che p�qmene by the applicant for
such permit o£ fee� to the amount herein below set forth and in the manner herein
pravided to-wit;
2.1. For any such permit for the erection of any fire-proof building,
other than a garage, warehouse, factary or grain elevator, or for the erection
of any fire-proof addition, for similar occupancy, to any existing building,
aha11 6e at the rate of _$L.40 for each one thousand cubic feet, or fraction .
thereof, in such cubical contents.
2.2. For anq auch permit for the erection of any fire-proof garage,
Warehouae, factory or grain elevator, or for the erectiou of aay fire-proof
add3tion, for similar occupancy, to any existing buildiag shall be at the raee
of $1.25 for each one thausand cubic feet, classified as "fireproof" by
SecCion 502 of the Minneapolia Buildia$ Code.
HOIISES
2= For aay such permft for the erection of any non•£ireproof building,
�ther than a garage, warehause, factory or grain e�evator, or any non•fireproof
addition, Eor aimilax occupancy, to any existiag building - germit $1.Q0 for each
ona thousand cubic feet.
G�GES
2`4. For.any auch permit for ehe erection of anq noa-fireproof garage,
warehouse, factory or grain elevator, or for the erection of any non•fireproof
addition, for simil�r occupancy, to any existing building or for each such
buildiag or addition - niaety cents ($0.90) for each one thousand cubic feet
os fraction the�eof, in the cubical content� t�eseof with the minimum of $4.00.
For the purpose of computing fees for building permits, the cubical contents
of any buildiag or addition to a uniform height throughout by �ltiplying the
graund area covered from a point siac (6) inches below the floor line of the
basement or cellar to the average he3ght of the upper surface or to the average
height of the�roof �urface .of the maia �able of a pitched roof.
2` �� For regairs or alteratioa� to aa existing sCructure, the tee shali
be at the rate of $3.00 per each Five Hundred Dollars ($500.00} or fraction
thereof in the coet of all proposed work.
� 2= In ao case shail the;fee clzarged for any permit as set forth in.
Section 2 be less than�$4.00.
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SuBJECT
City of Fridley
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
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� • COMMUNITY DEVELOPMENT DIV.
L PROTECTIVE INSPECTION SEC.
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l--_-� ��"' �,� CITY HALL FRIDLEv 55432 NUMBER REV. DATE
L 612-571-3450 910-F15 5/21%�0
10B ADDRESS 6727 J`ef�ers.on S"treet
t LEGAL LOT NO. BLOCK TRACT OR ADOITION
DESCR. � 1 Rice Creek. Terrace Plat 5
2 PROPERTY OWNER MAIL ADDRESS Z�P
Bonnie Gaas,land 6727 �'e��erson Street N,E.
3 CONTRACTOR MAIL ADDRESS ZIP
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP
5 ENGINEER MAILADORESS Z�P
8 USE OF BUILDING
Residenti.al
7 CLASS OF WORK
❑ NEW � ADDITION
B DESCRIBE WOHK
Construct a 16 t� 20;.� Deck Adc�ition
9 CHANGEqFUSEFROM
STI PU LATIONS
aee. no.ta,tzons� on �lan a
PAGE OF
/ /
�20375
RECEIPT NO
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APPROVED BY
SEE ATTACHED
SHEET
PHONE
571-7829
PHONE IICENSE NO.
PHONE LICENSE NO.
PHONE LICENSE NO.
O ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
ro
SEPARATE PERMITS ARE REOUIRED POR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOIO IF WORK OR CONSTRUCTION ZONIN(i
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
SQ.
ANY TIME AFTER WORK IS COMMENCEO. NO. DWLG. UNITS
I HEREBY CERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION �- STALLS
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF IAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $2, 350
WITH WHETHER SPECIFIED HEREIN OH 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- $r,4.00
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. ___
ATURE OF CON i R C OR OR AUC� AG�-�- IDATE,;: .. . WHEN PROPERLY
�� �� ,.,.��v .i�(1w6�FR RI111 F17i � � T6�� BLOG �NSP
ip OCCUPANCYLOAD
CU. FT.
STREET PARKING
IGARAGES
iTAX
�lel0
:CMARGE
�AL FEE
$55.18
HIS IS VOUR PERMIT
NEW [ J Effective 1/1/90
ADIX�T �C ] R-1 AND R-2
AL'I'F�Ft [ ] Building Permit Application
cba�structian A�dres.s:
Lagal D�cription:
Owner Na¢oe & Addr�
Contractor:
Addr�.s:
���S�a-� �(
#
Attach to this application, a Certificate of S�ivey of the
lot, with the praposed construction drawn on it to scale.
�CitIPTIO�T OF II�!�O�Vr�TP
LNII�G AREA: Lexigth Width Height Sq. Ft.
(�ARBGE AREA: LEngth Width Height Sq. F't.
�t �: T p�h ' wiclth � C� xgt/Groamd 1� sq. Ft. �
OTl�RI
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Cbrner Ivt [] Inside [�] :`Y�tback Side Yaxd Setbacks
Zjipe of Construction: ���[_ -- c� e��'� Esti.mated Cost: $ 1����'��c-�.
Approx. �letion Date: 2 - � D � �-� S � � �
Proposed Drive�aay Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Page
n�,z�: � �� �sr �c�rtr: -��i�� � � �� �f �e�� �_ �.t. # S� ( -�1 �2 j
P�mit Fee $
State S�haYge $ ,
SAC Ci�arge $
Driveway E.scrow $
Park Fee $
sewer Main ChaYge $
CITY IIBE O1�II,Y
Fee Schedule on Reverse 3ide
$.50/$1,000 Valuation
$600 per SAC Unit
Alt. "A" or Alt. "B" Abave
Fee Determitied bY �J�r�1
Agreen�ent Nec�essary [ ] Not Nec�ssary [ ]
� $ c � ��
s�rix�r.��rs:
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'Eae Chief Buildirig Official shall, before issuing ��; ts for the erection of any
building or structure, or for ariy addition to ariy existing buildinq or structure� or
for ariy alte.ration or repair to ariy existi.rig building or structure, upon apPlication
therefore, r�quirn the paym�nt by the applicant for such permit of fee.s to the an�t
lierein belaw set forth and in the manner herein pravided to-wit:
Zt7I'AL VAIIJE
$1 t.o $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
��
$15 (Minitmnn Fee is $15 plus surcharge)
$15 for first $500 plus $2 for each additior�al $100 or
fraction thereof, to arid including $2,000
$45 for fi.YSt $2,000 plus $9 for each additional $1,000
or fraction thereof, to and including $25,000
$252 for first $25,000 plus $6.50 for each additional $1,000
or fraction thereof, to arid includ,i.ng $50, 000
$414.50 for first $50,000 plus $4.50 for each additional
$1,000 or fraction thereof, t.o atid including $100,000
$639.50 for first $100,000 plus $3.50 for each ac�itional
$1,000 or fraction thereof, t� and including $500,000
$500,001 to $1,000,000 $2039.50 for the first $500,000 plus $3 for each additional
$1,000 or fraction thereof, to ar�d including $1,000,000
$1,000,001 and up $3539.50 for the first $1,000,000 plus $2 for each additional
$1, 000 or fraction thereof
DRIVEf�iY ��P'RESSION ESCi�OiW
(Coricrete Curb Stxeets On1Y)
Alternate ��A�� : Remaval arid replacement of curb and gutter only - Driveway width plus
6 feet time.s $13.50.
A]-texnat� "B": Re�aval and replac�ment of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
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Pexmits for construction will be issued a minirman of 24 haurs frcen the time of
application to allow for proper review of the proposed structure and of the
construction site. �
A C.ertificate of S�rvey of the lot, shcxaing the location of the fwndation or� it has
it has bee.n constructed will be required before proceeding with the fYatn�sig.
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���,�� HEAT'ING HOUSE HEATING TEST RECORD
AIR CONDI'fIONING
AND ELECTRIC, INC.
ADDRESS ��OZ� J�'��YrSOi) gg/�i APT. FLOOR CITY ��d�y SUBURB
OCCUPANT �D � a SLQ� OWNER
HEAT LOSS DATE HTC. INST.
SOLD BY INSTALLED BY
Electrieal Work By Gas Une By
TYPE OF HEAT GA FA � HW STEAM SPACE HTR. UNIT HTR. OTHER
,�/ OA3 DESIGN CONVERSION
MAKE � N 1 MAKE OF BURNER
Model �i G e �� Model
sa�ai q�1,� zS36 Maz. BTU Rating
INPUT S�S� D D 6 MAKE OF FURNACE
f ` Model
conRao�s y,�
THERMOSTAT T$ � Heat Plug Vern Size
Valve W KIND OF LINER g�g ,S'� NONE
Limft i x�� DraftHood �'► Regutator
Umk 3etting L f 7� ^ N� Flitere Size ��%�%1 S X( Number �
Fan Setting ��� Chimney Loeatlon Inside Outaide
Pilot Type aT S�r Chimney Construction
PllolMeke �mdT�e�
Pilo! Modei .Z 7 � Smoke Bomb Wiring
Pilot Timing o Draft Test Tag
L W. Cut Off Door P�essure Lighting Inst.
Pressure s Pereent CO, . S Date Tested
Input CFH Percent O, � Company T�ting
Stack Temp. �00 Pereent CO � Nama of Tester �
Form Z35
s�e��eT PE
City of Fridley 2 917 0
AT THE TOP OF THE TWINS 6 u I L D i N� P E R M I T
:,
,� .
� • COMMUMITY DEVELOPM�NT OIV.
� � �: ----- �
r � � PROTECTIVE INSPECTION SEC.
� � , ���
� _ /"'1 � CITY NALL FRIOLE� SS�32 NUMBEa NEV DATE PAGE OF AvvnOVED 8�
�""� � �'' 612-571-34b0 9t0-Ft5 4/12/99 / /
lOB ADDRESS 6727 Jefferson Street NE
1 LEGAL �OT NO. BLO,CK Ti1ACT OR ADDITION SEE ATTACMED
OESCR. 4 1 Rice Creek Terrace Plat 5 SMEET
2 PiiOPEiiTY OWNER MAIL AOOR�S$ 21P PMONE
Bonnie Gaasland 6727 Jefferson Street NE 571-7829
3 CONTRACTOR MAIL ADDRESS LIP PMONE LICENSE NO
B& B Roofin 6760 Madison. St NE Fridle MN 55432 571-0248 9042
a ARCNI7ECT OR OESIGNER MAIL AODRESS 21P PMONE LICENSE NO.
5 ENGINEER MAII ADDPESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW � ADOITION O ALTERATION Q REPAIR ❑ MOVE O REMOVE
x
8 DESCRIBE WOFiK
Reroof House & Gara e(22 S) Tear-off '
9 CHANOE OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
CONSTRUCTION WORK HOURS: 7:00 am to 9:00 pm, Monday thru Friday; 9:00 am to
g:00 pm on Saturday; No work on Sunday.
SEPARA7E PEiiM17S ARE REGUIRED FOR ELECTRICAL, PLUMBING. HEATINCa, TYP� OF CONST. OCCUPANCV GROUP OCCUPANCY LpAO
VENTI�ATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUGTION 20NING SO. FT CU FT
AUTHORIZED IS NOT COMMENCED V�!ITHIN 60 DAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED fON A PERIOO OF 120 DAYS AT '
ANV TIME AF7ER WORK IS COMMENCED. NO DWLG. UNITS OFFSTFEET PARKtNG
I HEREBY CERTIFV 7HAT I NAYE fiEAD AND QXAA�IN�D THIS APPLICA710N 1 STA�LS GARAGES
AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAW$ yq�UATION SURTAX
AND ORDINANCES GOVERNING TMIS TYPE OF WpRK WILL �E COMPLIEO @
WI7M W Eti SPECIFIED MEREIN OR NOT. THE GRANTING Of A PERMIT W 1 s 8HS �. 9�F
DOES.%iuOT PRESUME TO GIVE AUTMORITY TO VIOLATE Of; CAMCEL TME pEpMI7 fEE SAC CMARGE
PR0�,IIIS10 S Of ANY OTHER TATE OR LO L LAW REGULATING CON•
ST UCTI N Ofi THE PERFO ANCE O C STRUC ION �S9.SO Fi e SC �I.SB
y C� PLAN CFIECK FEE T A� FEE
/ '� �� �/ Licen SC $ 00 $67 . 2
S�GNATUNE F CON'fiACTOQ Op AUTNOAIjEO oGENT iO�TE� ME P � VALI D THIS IS Up EAMI
. � ��
S�GN4TUAE O� OWNEA��F OWNEpBU40Ep� �D�TE� B G�hSo - 0�1f
NEW [ ]
ADDN [ ]
AI.TER [ l
CITY OF FRIDLEY
SINGLE FAMILY- AND DUPLEXES R 1 AND R-2
BUILDING PERMIT APPLICATION
,. .�, ,.:,.. ;�-�
; ,:,;���;�,..� ..s:�: :} ,::
�•,.ConstructionAddress: i��Z
Le al Description• " �C �S
� �� ��
.3�
Effective 1/ 1/99
g • -
Owner Name & Address: ���rL/�� IsAA�S �-�'! D Tel. #� .S %�— �� y
Contractor: �� ��ao r�l�� , MN LICENSE #�� yO�
Address: li %i0 �/�'/i1�17lYI � `S � Tel. # �%/� Da2 `�/�
, �� :, Attach to this application� a Certificate of Survey of the
lot, with the.proposed construction drawn on it to scale.
�; J„,; ,` , ; ; , , , , , ; , , ; , , , DESCRIP'rION OF IlVIPROVEMENT
LIVING AREA: � Length � , Width Height Sq. Ft.
GARAGE AREA:�; `: :. �� Length _ Width ______ Height Sq. Ft.
DECK AREA: � I;ength Width _ HgdGround Sq. Ft.
OTHER:
; 9�t.� � , �; .,�� ' / ��„Q_ �y,�i� .
�.� .� . � �
Construction Type: � Estimated Cost: $ � �S
�i��.,;; (Fee Schedule on Back)
Driveway G�ub Cut� Width Needed: Ft. + 6 Ft = Ft, x.$ _$
DA1'E: ��'r�'�� � �'g' ° , , . APPLICANT: .: : . � Tel. # .S 7�'���
;s., , . �
' i��►?��R � � � ":�: i ", •,>; -
Permit Fee $ � - � �
Fire Surcharge $ �- °
-State Surchazge $
SACyChazge , . $
tw...,',1�;�:�'tls�;<._�:�rt?:.:....4.'��s., ��
License Surchar'ge .
Driveway�Fs�row $ � � ` �
Erosion Control $
Park Fee $
°�SeweraMain�,Charge,;:�.$� �
r TOTAL . $ �J
;j.s�:�P�e.#�;dlz�:�i(.t'.,7: �.���{:: �: . ., . , � .. .
�
• ST'�ULATIONS:
, CITY USE ONLY ,
Fee Schedule on Reverse Side
.001, of Permit Valuadon (1/lOth%)
$.50/$1,000 �Valuation
$1050 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 [ ]
f
�
. -. i �
� � - BUII.DING PERMIT k'EE SCHEDULE �
. , .P, .
The Cluef Building Official shall� before issuing permits for the erecdon of any building .or structure, or for
any addition to any.existing building or structure, or €or any alteration or repair to any existing building or
structure, upon apphcaaon 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-witf
- - TOTAI. VALUE
� . $1 4 to $500
$501 to . $2,000
$2,001 to $25,0�
$25.001 to- $50,000
�_ . _ _.�0,001 to $10U.000
$100,001 to $500,000
,. .. _ : $500,001 to $�,000,000
$1,�0,001 and up
FEES� �' '
$21 (Minimum Fee is $21 plus surcharge) ,
$21 for first, $500 plus $2.75 for each additional $100 or
fracdon thereof, to and including $2,000
$62.25 for fust $2,000 plus $12.50 for each additional $1,000
or fracdon 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 $SO,OOO plus. $6.25 for each additional
$1,000 or fraction thereof, to and including $1�,000
$887.25 for first $100,000 plus $5.� for each addidonal
$1,OQ0 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,�00
$5012.25 for the first $1,000�000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
� . (Concrete Gtiub Streets Only)
. . . /-S • �C
Alternate "A°: Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $�3.50.
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 times $�5:75. �3. ��
VERtFICATION 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 construcdon site.
p Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required �before proceeding with the framing.
0
-� � �
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE '°I ' G`
SITE ADDRESS
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE
LICENSE, BOND AND
CERTIFICATE OF
INSURANCE
PERMIT TYPE
PLUMBING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 2-19-09
YOUR E-MAIL ADDRESS �- 33 e:
����� � e'1 � �f; �.� , 5S�
�OWNER �CONTRACTOR
ADDRESS:
r
STATE LICENSE #
STATE BOND #
Pernut No.:
Received By: �
Date ' , p � `�+ � �
EXP DATE
EXP DATE
'ATE�IP�
ADDRESS: CITY STATE ZIP
PHONE ' F�
�SINGLE FAMILY ❑ TWO FAMILY ❑ TOWNHOUSE
TYPE OF WORK: I � NEW
DETAILED DESCRIPTION OF WORK
REPLACEMENT
FEES ARE BASED ON $10.00 PER FIXTURE, EXCEPT WHERE NOTED. FIXTURES: (INDICATE TOTAL NUMBER• OF EACH BELOW). MIMMUM FEE
$35.50.
_ BATH SINK/LAV FLOOR DRAINS SHOWER . � WATER PIPING
_ BATHTUB _ GAS PIPING (NEED C1TY LIC) SWIMMING POOL WATER SOFTNER ($
_ CLOTHES WASHER KITCHEN SINK WATER CLOSET BACKFLOW PREV. $1 )
_ DISHWASHER _ LAUNDRY TRAY WATER HEATER ($35) FOR iRRIGATION
_ WATER METER OTHER
v�
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a plumbing 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 on site; that the work will 6e in accordance
with the approved plan in the case of all work which requi review and approval of plans.
SIGNATUREOFAPPLICANT \ J���� PRINTNAME V��\����.SIQ�I DATE Z�(�
City of Fridley
Building Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977