AF - 47742BUILDING PERMIT
Village of Fridley, Mi.nn. N° 2 3 3 7
Date °•�,�'.+� •'�,�.`�� . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Owner �:� .°! , ,�',�: -� ;�,'�``'�, . i'. G. .� ? ,'; �r'iT ,��*�'.�' Builder . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Address .'�'�..''�?'��i!• ,�,�� �:1�- � �2. ��7�. ��t�Address . . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
s LOCAT[ON OF �UILDlNG
No. . . . �. � .''��. �. . . . . Street �'�: f . . . .��''. . . :�':�. ��. .p� . . . . . . . . . . . . . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
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Lot . . . .. .. .. �.. .. . Block . . . a►. . . .. . . . . .. . Addition or Sub-Division ��i�:".�. � �'�.��. .� . . . . . . . . . . . . .
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Corner Lot . .. .. .. .. . . . Inside Lot . :�'� . .. . . . Setback .�:''�. . t"��� . Sideyard � � .':���`.�.` . .. . . . . . . .. .. .
DES�CRIPTION OF BUlLDtNG
To bQ Used as:
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""''��. .�.�. .'��. . . . . Front . .��. . Depth ,".�.` �' �. . Height '�. c�" . . . . Sq. Ft. . �t� `� ��' Cu. Ft, . . . . . . . .
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�'. .'�� ��".. . . .. . Front . � .a�'. .. . Depth �.�.� . Height !r« ""�'�. .. .. Sq. Ft. . .-.�.° cl�i�? Cu. F't. . . . .. .
�:.
Type of Construction . . . . . . . . . . . . . . Est Co �./.' �!�� �. . . . . . . . . . . To be Completed � ��+�.�.j�.��. .
Iti consideratian 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.
In considez� tion� the payment of a fee of $.!'�.�^.°. �. , permit is hereby granted to c::�°'�"�'?'�: .. .... .. .
�'�z :?.��.. . :���r-- . :�. .
. to construct the building or ad dition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�nen, in all work
c�one in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota. regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village limits and this permit may be revoked at any time �on viola of any of the provisions of said
ordinancea. e�'` ,+�'.•. r" �;
:�"Fd:. Building Inspector
NOTICE:
This permi# does rtot cove� the construc4ion, installation or alteration for wiring, plumbing, gas heatPng,
sewer or water. Be sura to see the Building Inspector for separate permPts for these items.
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City of Fridley, Mina.
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. BUII,DING PER1VlIT N° 3 2 4 0
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Date: ....................... ............
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Addze�ss _ •,,� . ..... � � �..�'�:.�- Address .............................................
, � �� LO�CATI�V OF BU[LDINC�
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No. . �..� � 5treet ,./ -r ,, � .: . ..... ... .. .. .. . . . P 1„�ot . .. . . .. . .. . . . . . .. . . . .
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Lot Btock . . . . . . Addition or Sub-Division r'�r . . . :a-� . . .� �'-�:.,
.........�.. .... . ...� ... . . .
Coraer Lot ............ 7ns�tde Lot ......�.�..... Setback ............ Sideyard ...........................
DESCRIPTION O�' BUILDING
To be Used as:
.................... Fro� ........ I�pth ........ Height Sq. Ft. ........ Gw. F't. ........
........
. .. .. .. .. .. .. .. .. .. . Front . . . .. .. . . •Depth ....�. . �HeiEht� .'� . . . . Sq. Ft. . .. .. .. . Gti. Ft. . .. .. .. .
Type of Construcl3on . . . . . . . . . . . . . . . . �st. Cost. . . �.�': "�. . . . . . . . . . To Be Completed . ¢� �. B . . . . . . . .
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In consideration of t�e is�uance to me of a permit to construct the bwilding desribed above, I agree to do
the praposed work in accordance with the descrlpt[on above set forth and in co pliance with a11 prqvisions o!
ordinancea of the dty of Fridley. �
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In consideration of the payment of a fee of $. �, n�. ..``. .� permit is hereby granied to .�. .�; .
..... .. .. .. .. .. .. ........ to construct the bwllciing or addition as described above. This permit is granted upon
the egpress condil3on that the person to whom it is granted and his agents� employees and worl�en, fn all work
done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of
Fridley, Minnesota regarding location, construction, alteration, maintenance, repa3r and moving oP buildings with-
in the dty limits and thfs peraiit may be revoked at eny time upon violation of any of the provisioi�s of said
ordinances.
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�:::'�,,,v.�::r .`:�.. :�.,..� �''��:.s•r�lBuiitling 7uspector
NOTICE:
This permit doas not covar tha construation, inatallatlon o� alteration fo� wl�ing, plumbing, gaa heating,
sewe� or watar. Be su�e to see the Bulldlnp Inepeotor for separate pe�mits fo� these Items.
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City of Fridley, Minn.
BUILDING PERMIT
nate: Jul� 6, 1965
Owner: 3. C. Hendrich B�, 8. C. Hendrich
Ada�s 6�36 Jeffersoa Street N. E. Ada�ss
N° 8117
LOCATION OF BUILDING
N� 6736 S�t Jeffer�an StreOt N. E.. p� oP L�t
Lot �.��_ Block 1 Addition or Sub-Divteian ��e CTe Te�'8C8� Plat !�
Coraer Lot Inside Lot Setback Sideyard
Sewer IIevation — Foimmdal3on IIevation
DESCRIPTION OF BUILDING �
To be Used as:
Dwelli.n� Front --J�.1.�— nepth ___��_ xeight 20 sq. c;u. Ft
Att. Gara�e �nt _22— Depth �8 i�Teight �- Sq. Ft cw.
7�do� o�ci�onm F.i'e�e Fst. Cost — 16 0• To be Completed
Rebnild: �eq�.est earianee on Froat
Rec�,uest v�.riaace on Sid�
In consideratton oP the fssuence to me f a
th� ProPcsed work in accardance with the
oralinaac�s of the dty of Fridley.
from
to�construct the
bo set forth a
33t
8t
room.
l above I agree to do
vvith afl provisions of
In cro�afderation oP the payment oP a fee of $ 1� , permit is hereby granted to R• C. I�ei1dl'3..Gh
to construct the bufldiag or addit%n as de�cribed abave. T,hispermi t ia granted upon
the express c:onditiam that thepe�on to whom it is granted aad his agente, employees anc� worl�aen, ffi all work
doae fq arouad and upon eaid building, or anypart thereof, shall oonform in all respects to the ordinances of
Frld1eR Minnesota loc�tion, construction, alteration, maintenance, repa3r and moving of buildfuga
wio��� dty limits��aad�� permit may be revoked at any time upon violatton of aay of the P�vis�lona of said
�LLl.en Jensen �� �
,
' NOTIC&
iYa pqemit d� ee! eevse ths coedwcH�, t�hlWlen }er �rie�g, pinm6le9, 6a heaNng, taru� or �rNa�. B� atn to a�
t6o BoUdieB 1�«te� to► aP�►tl+ Pamits for t6�a h�ms,
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OW1�R' S NAME
APP'LTCATIOR FOB BUiLDING PERMLT
CITY'OF FRIDLEF� MINNESOTA
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ADDRESS_ ADDRESS
LOCATION OF
�.��._-____,��� � � s��et e
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of Lo �
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Coraer Lot`_Inside LaT Setb�ck_�5 „�, Side-�Yard �
SEOdER �LEVATIDN . Fb�iDA1'i0N ELEVA"Z'tOl��.r:�. �
Applicant attach to this form Two CerCificates of Survey of Lot and proposed
bu3lding locatioa drawn on these Certif�cates.�
� +�
� � ) DESCRIPTIO , 0 HIIS.DIIVG ; _��
To b ,used as ; i I / j � � °�. �"'� --�� /
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�Y""*�'•'•
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Sq. Ft. Cu. Ft.
�qnt � DepCh�$eight � �
_ " r Sq. Ft. Cu. Ft.
of CoaetrucCi �`� ���� � Estimated CosC 1� �
/
To be completed •
�'he undersigned hereby makes application for a permit for the work hereia apec3iied,
agreeing to do all work in strict accordance with the Citq of Fridiey Ordinances
aad rulings of the Department of�Buildings, and hereby deciarea that all tha facts
aad repres�ntat3ons stated ia this applicatio�t are true and correct.
�� �.
DA� vs, --- � � " �, dj� aIGNATURE � � i �
(9chedule of Fee Coata can be found on the Reverse Side),
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BOYi.�II1YG PER�T F_'� _.$C�.E
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SE�. The Inspector of Buildinge shall. before issuiag any �rmit for the
ereceion of any building or.atructure, or for any addition to any egieting build-
ing or structure, or for any alteraCions or repairs to any exiating bailding or
structure, upon application therefore, require the payment bq the applicant for
such permit of�fees to t&e aflnouat herein below set foreh and in the.maaaer herei�..
pravided to-wit; .
2.1. For anq such permit for the erection of any�fire-proof building,
other than a garage, warehouse, factory or graia elevator, or for the erection
of any fire-proof addition, for aimilar occupaacq, to any existing building,
ahall be at the rate of $1.40 for each one thouaand cubic feet, or fraction
thereof, in auch cubical contents. •.
2.2. For any auch permit for the erection of any fire-proof �arage,
werehouse, fantory or gra�.a elevator, or for the erection of a�nq fi�e-proof
addition, for similar occupancy, to`anq existing building sha11 be at ttae rate
of $1.25 for each one.thousand aub3c feet, classified as "fireproQf" by
, Section SQ2 of the Minneapolia Building Cod�.�
fl00SES
2_ For aay such germit for the erection of any non-fireproaf building,
other thaa a garage, warehouse, factory or gra3n elevator, or aaq aoa-fireproof
addition, for aimilar oc�cupancy, to any exiating bu3lding - permit $1.00 for each
one thousaad cubic feet.
GARAGES
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2`4. For any auch permit for the erection of anq aon-fireproof garage,
warehou�e, factory or grain elevator, or for the ere�tion of any non•£ireproof
addition, for similar occupancg, Co any existing build"ing or for each euch
buildiag ar addition - ainexy cents ($0.90) for.each one thousand cubic feet
or fraction theueof, in the cubical conteats t&ereof with the mini.mum of $4.00.
For the purpose of campu�ing fees for build3ng permita,.the cubical conte�ts
of any building or addition to�a uniform beight throughout by multiplying the
grouad area covered from a point aix (6) inchea below the floor liae of the
basement or celiar to the avera$e height of.the upper surface or to the average
height of the rooE su,rface of the main gable of a pitchad roof.
2` 9. For regaira or alterationa to an existing structure, th� fee shall
be at the rate of $3.00 per each Five Hundred Dollars ($500.00) or frectioa
thereof in the coet of all proposed work.
2` 6. In no case shall the fee charged for any permit as aet forth in
Section 2 be less than $4.00.
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City of Fridley, Minu..
BUILDING PERMIT
nate: �ub'ust 11, 1965
��: Russell Hendrick B�� Rober�G F. DTorberg
Ad�re� 6736 Jeifers� St. �. �. A� 392�. U�ah A,ae. No.
3a���
N° 8350
LOCATION OF BUILDING
No. � st�et JF�r�'El.�SOTT STRE�1 N. �. Part of Iut
Iat Block Addition or Sub-Div�sfon
Coraer Lot Inside Lot Setback Sideyard
�� II�1�� Foimda.tion IIeval3on
To be Uaed as:
Zj►pe of Construction
DESCRIPTION OF BUILDING
Front Depth Height Sq. FG C�. FL
F'ramt Depth fTeight 5q. F't. C�. Ft,
Fas� Cost _y�.��0.00 _ To be Completed
Rabu3ld — Stox� Damage (IF THERE IS FENCING Cfl� �OSTS l�ROUND TH� CAPP OF THIS
HOUSE PL�S Ra itOVE �ND 1�TUi�N TO THL CITY t�' Ft�DLEY. )
In canffideration of the iesueac�e to me oP a germft to c e ding described above I agree to do
th� proposed work in acc�ordance with the drescription above t Porth an in com ce with afl provlsfons of
ordinances oP the dLy oP Fri�IIey � /�/j /
In c��sideration oP the payment oP a fee of � 10•� , permit �ts hereby �ranted to ROB�RT F. NORB�G
to construct the buflding or addition as descrlbed above. Thispermi t is granted upon
the exP� c�ndition � said b to whom ft ia granted and his agents, emplo�yees anc� worl�nen, in all work
done fq around and uilding, or eaYpar� thereo� ahall conform in all respects tfl the ordinance� of
Fridley, Minnesota regardiag location, conatruction, alteration, maintenance, repair and moving of buildfngs
wi� dty limits and tbia permft may be revoked at any time upon violation of a� of the provfaians of said
�°t�'F�j G. JENSEN g�S �
NOTIC&
ilds peemU doa eot �r ths coasnuati�, lastal�loa �or Mrte9. P«m9. a+� 6�9, ssn�r er wdsa B� wre to ss�
tin BaIldlog le�e�o� ior aW►+b �mhs Ior t6a� hams.
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APPLICATIOR FOR BOTLDING PERMIT
CITY OF FRI�LEY, MINNESOTA
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OWNER' S NAME f! �-� �' ° BUILDER r
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ADDRESS l� %'� C� vs' ��ii-i � 7 ADDRESS ��� �Td �a2 i�
LOCATION OF BUTLDING
N0. STREET PART .OF LOT
LOT BLOCR � ADDITIOLV OR SIIBDIVISION
CORNER LdT INSIbE LOT�_SETBACK SIDE-YARD �
SEWER ELEVATION FODNDATION ELEVATIDP � �
Applicant attach to this form Two Ce'rtificates of Survey of Lot and�proposed
building location drawn on these Certificates.
To be used as;
DESCRIPZTON OF BUILDTPG
Front Depth Iieight
Sq. Ft. Cu. Ft.
Front Depth Height
Sq. Ft. Cu..Ft.
� � � � �
Type of Construction � ������ Estimated Cost ��� ���9g �
�'"-.�°��°
To be completed
The undersigned hereby makea application for a permit for the work herein
specified, agreeing to do a11 work in strict accordance with the City of
Fridley Ordinances and rulinga of the Department of BuildiCngs., and hexeby '
declares that a11 the facts and representations stated in this app�,ication
are true snd correct.
DATE �` � ���5� SIGNATURE �a;?� �
(Schedule of Fee Costa caa be foun�sl on the Reverse Side)�
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BIIILDING PE� FEE SC`SEDOLB
SECTIOP 2. The Inspector of Buildinga shall, before iseuing any permit for
the erect�.on of any building or s�ructure, or for any addition to aay esiating
building or structure, or for any alteratiotts or repairs to any existing
building or etructure, upon application therefore, require the payment by the
appl3cant for such.permit of fees ta the amount he�ein below set foreh and in
the manner hereia provided ta-wit;
,. . . .� .
2.1. �For auq such peimit'`for 'the�erection of any fire-proof bullding,
othe= than a garage, warehouee, factorg or grain elevator, or for the erection
of any fire-proof addition, for similar occupancy, to any exieting buflding,
shall be at the rate of $1.�+0 for each•one thousand cubic feet, or fractioa,
thereof, in such cubical contents.
2 2 For any such p.ermit for �he erectioa of any fire-proof garage,
warehouse, factory.or grain elevator, or for the erection of anq fire-proof
addition,�for similar occupancy, to any esiating building��ehall be at tl�e
rate o£ $1.25 for �ach one thousand" cubic feet, classified as "fireproof"
by Section 502.0£ the Minneapo],is Building Code. -. �
HOIISES • ..,.' `
2.3. For any such permit:for.�l�e erecti,on.of aay aoa-fireproof
building, other than a gsrage, warehouso, factory or �rain elevator, o� .
anq non-fireproof addition, fo�r similar occupancy, to aay esieting building .-
permit $1.00 for each one thousand cubic feet. '
GARAGES .. �. . .
-2.4. For any such permit for tha erection of aay non-fireproof garage,
warehouse,,factory or gra�ta elevator, or for the erection of any non-fire-proof
addition, for aimilar occupancy, to aay egtsting buildiag or for each such ��
building or addition - ninetq centa ($0.90)�Par each one thoue.and cubic fe�t
or fractioa thereof, ia the cubical cantents the'reof with the miaimum of $4.00.
For the purgose of ca�p�tiag fees for buildiug permit8, the cubical contents
of any buildi�g or addition to a uniform height throughout by multiplying Che
ground area covered €ram a poit�t six (6j iaches below the flaor line of the
basemenC or cellar to t�ie average h��ght of the upger�aurface or to the average
height of the roof�aurface of�the maia gab�.e of a pitched roof. .
2.5. For repairs or alterations to an existing structure, the fee shall
__
be at the rate df $3.00`par each Five Hundred Dolla.xs ($SQ0.00) or�fraction
thereof in�the cost of a31 prc�p6sed work.
2.6. In no case sha11 the.fee charged for ariq,permit as �et forth in
Section 2 be less thaa $4.40.
STORM REPATR DAMAGE FEESa
• stimated Coat of work u,� to '$500.00 -$5.00
�� ; imuted Coat of work over.,�S�500.00� -$1fl.00 0 �
. •. �
p ��t,�r'� mate�'��oat o,f wogk up to $SO�.OQ -$1Q'�0
�% matea ,ost of work over $500.00 -$21.. ,�
��,
i
_� � —
SUBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� .
� �
� `v _____ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
�
� j �
� �"'1 � CITY HALL FRIDLE� SS432 NUMBER
�'"'"� � �'' 612-571-3450 giaF�5
JOB ADDRESS
6736 Jefferson Street
1 LEGAL LOT NO. BLOCK TRACT OR ADDiTION
DESCR. S 1 Rice Creek T
2 PROPERTY OWNER MAIL AODRES$
4 ARCHITECT OR DI
5 ENGtNEER
6 USE OF BUILDING
Residentia7
7 CLASS OF WORK
8 DESCRIBE WORK
Reroof hou:
9 CHAN(3E OF USE FROM
STIPULATIONS
MAII. ADDRESS
Service 6760 Madi
ER MAIL ADDRESS
MAIL ADORES3
REV OATE PAGE OF
8/25/98 / /
ae+n � Ul �t /
21P
21P
27379
�'�T��
APPROVED BY
SEE ATTACHED
SMEET
PHONE LICENSE NO.
Q..OSE2
PNONE LICENSE NO.
PMONE LICENSE NO.
❑ NEW O ADOITION O ALTERATION � REPAIR O MOVE O REMOVE
e (31
TO
Underlayment must comply with the State Building Code.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING. HEATINCi, ��re vr ��rvs�.
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID If WORK OR CONSTRUCTtON
AUTHORIZED IS NOT COMMENCEO WITHIN 80 OAYS, OR IF CONSTRUCT �
OR WOF;K IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. N0. DWLG. UNITS
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION
AND KNOW TNE SAME TO 8E TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION
AND ORDINANCES (30VERNING THIS TYPE OF WOqK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A pERM1T 8
DOES N PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL TFiE pERMIT FEE
PROVI O OF ANY OTHER ATE OR LOCAL LAW REGULATING CON-
STR TI OR THE PERFO ANCE OF C STRUCTION.
/� � PLAN CHECK FEE
v
SIGNATUR FCO 7RACT017ORAUTMOfiIZ AGENT IDATE� N P �
SiGNATUFE OF pyyNEF i�P OWNEfi BUILDER� iDATE� oi nr. reo
STALLS
ROUP OCCUPANCVLOAD
CU. FT.
OFFSTREET PARKING
IGARAGES
NEw .�
ADDN
ALTER
�]
[]
[l
ConstructionAddress:
Legal Description:
CTTY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
�� �_�
/
�
�
Effective 1/1/98
��
.1� '�
� r��
�
Owner Nazne & A dress: � U SS ��1%%��/�C Tel. # S%� ����
Contractor:,� (� D/� S MN LICENSE # 90 � Z
Address: � %OC� ,/���Q/J7/1/% � � Tel. # � �l oa y�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECB AREA:
OTHER:
Length
Length
Length
DESCRIPTION OF IMPROVEMENT
Width
Width
Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type��� /��l��� Estnnated Cost: $ �� L�S
(Fee Schedule on Back)
Driveway G�rb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: ��.5 APPLICANT: Tel. # �.S � �c� %
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
�
$ ` S
$ �_ � �)
$ /. o� �/
$
$ •� C�C)
$
$
$
$
$ �3-��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Pernait 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 [ ]
L -
BLTII.DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, 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 $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,OQ0
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$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 $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $S.QO 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
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Altemate "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 times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
c�ty of Fridley
AT THE TOP OF THE TWINS g u I L D I N� P E R M I T
;,
� �
' � �: ------�
COMMUN�Tr DEVELQPM�NT DIV.
r � � PROTECTIVE INSPECTION SEC.
i--_.� �'�','� CITY MALL FRIDLEV bS132 NUMBER
i 612-571-3450 9t0-F15
J08 ADDRESS
6736 Jefferson Street NE
1 LEGAL �OT NO. BLOCK TfiACT OR ADOITION
oesca. 5 1 Rice Creek TE
2 AROPERTY OWNER MAIL ADORES$
Rus Hendricks
3 CONT ACTOR MAIL ADORESS
Gladstone's Window & Door 1870 English St
A ARCHITECT OR OESIGNER MAIL ADDRESS
5 ENGINEER qIAIL ADDRESS
B USE OF BUILDING
Residential
7 CLASS OF WOFiK
REV DATE PAGE OF
9/29/98 / /
�a _ P1 at 6
ZIP
10
21P
ZIP
PMONE
�8455
PMONE
PHONE
��\
28027
ECEIPT NQi
AVVqOVEO BY
SEE ATTACMEO
Sh1EET
LICENSE NO
2110
LICENSE NO.
LICENSE NO
� NEW ❑ ADDITION � ALTEFIATION � f1EPAIR O MOVE O REMOVE
B DESCRIBE WORK
Replace windows
9 CHAN(3E OF USE fROM
STIPULATIONS
TO
Install smoke detectors to meet the State Building Code - in each sleeping
room and on each level of house.
SEPARATE PERMITS ARE REOUIRED FOR ELECTfi1CAL, PLUMBING, MEATIN(3, ��rc vr �,�na�.
VENTI�ATING OR AIR CONOITIONING.
THIS PEFMIT BECOMES NULL ANO VOIO IF WORK Ofi CONSTRUCTtON IONING
AUTHOR12E0 IS NOT COMMENCED VyITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANQONEO FOR A PERIOD OF 120 OAYS A7 `
ANY TIME AFTER WORK IS COMMENCED. ' NO DWLG. UN17S
I HEREBY CERTIFV 7HAT I MAVE READ AND EXAMIN�O THIS APP�ICATION
ANO KNOW 1ME SAME TO BE T(�UE AND COFRECT. ALl PROVISIONS OF LAW$ VA�UATION
AND ORDINANCES GOVERNING THIS TVPE OF WpRK WI�L QE CpMPIIED
WITH WME7MER SPECIFIED MEREIN OF NOT. TME GRANTING OF A PERMIT �1�}�OOO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOIATE OR CAMCEL THE pEpMIT FEE
PROVISIONS OF ANY OTHER STA7E OR LOCAI LAW iiEGULATING CON-
STRUC�IiI'�(V OR� TME PERf�CE Of CONSjRUCT10N $2],2.25
NGTUpEOFCON'AACTOAOpAUTM IZE GENT �iE�
v
i4�U�7E O� OWNEp��� OWNEA BUq0EF1� IDATE� '
FT
STALLS
fiOUP OCCUPANCV �OAD
CU f T.
OFFSTREET PARKING
IGARAGES
SURTAX
�7.�0
SAC CMARGE
Fire SC $14.00
r0 a� FEE
' 38.25
D THIS ISfR�JR�n IT �)�
+ /(/ [�f
r�� T
�
rrEw
ADDN
ALTER
�
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L]
[J
CITY OF FRIDLEY
SINGLE FANIILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
Effective 1/1/98
� ��e ��
ConstructionAddress: � � 3� �� � ��2 � c � � i _ I� , � .
Legal Description:
Owner Name & Address: I��. S I-�-� t,/�L � c\LS Tel. # 5% i- 3 7�3�
Contractor: G� r..� �-�,�(rz S W t.� � o,,.�►' 4� o� �-to�-L MN LICENSE # 21 ) U
Address: f$ 7� F�.r�-c,s}t S'► , M�4p��o�o vv�� �.� J oi Tel. # C��)-�`7'-/-8� �
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
DESCRIP'TION OF IMPROVEMENT
Length W idth
Length Width
Length Width
Height
Height
Hgt/Ground
Sq. Ft.
Sq. Ft.
Sq. Ft.
Construction Type: �\��� ���` � Estimated Cost: $ � L% ooca �
� o E..t i,�+GS
(Fee Schedule on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
DATE: -Z�(-°j3 APPLICANT: Tel. # l�S►�'l'7�1� �y,`'�
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
$ «�-S�
.p v `^�
$ 7.- G�
$
$ ��r�
$
$
$
$
$�, ��
CITY USE ONLY
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$1(?00 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 [ ]
BUII..DING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or structure, or for
any addition to any existing building or structure, or for any alteration or repair to any existing building or
structure, 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 $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$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 $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $50,000 plus $6.25 for each additional
$1, 000 or fraction thereof, to and including $100, 000
$887.25 for first $100,000 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
$5012.25 for the first $1,000,000 plus $2.75 for each additional
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
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 times $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 location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNING APPLIANCES OR THE
APPLICATION WILL BE RETURNED
C'C)MMC�N VEN� NT C`ONNF TC�R AND .nMR ISTInN AIR V RIFICATInN
When ry In acing an pxic ing f��rance, the undersigned hereby verifies that the
venting has been examined and is free from nast, deterioration, obstructions,
and is securely supported and firestopped where required. Yes (�o ()
The venting system is plasticlPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (✓}'�No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
include AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
�4
The px��inp cemhustien air is sized and installed to meet the current codes
and manufacturers specfications.
When �equl�ed t0 inctall a new r_embustien air;,it will be sized and installed
to meet the cuRent codes and manufacturers specifications.
WI'1@I1 inc alli a new vpnfin8 e�e m, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
specifications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances.
Is the common vent and vent connectors sized and installed coRectly after
an appliance has been removed from the common vent and vented
separately as per current codes.
Yes (�No ( )
Yes ( �No ( )
Yes (�o ( )
Yes ( �–IVo ( )
Yes ( -�o ( )
�nliance T���nP and Si� _/ .emmon V_n and V_n �_enn _ctor Infermatien
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
Appliance #3 Type BTU Input Fan Assisted or Nat
Total AppKanc�� — --- Total �tu inpat
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type
�1i��7r�Li ► � - .:Ta
// !f/� � '/ �_ �
HEATING
Signed By:
����� S.� Y � v
Date � ;/�—� �
Building
Inspections
763-572-3604
DATE_ �' I �.L' `
S1TE ADDRESS (��
THIS APPLICANT IS:
PROPERTY
OWNER/
TENANT
CONTRACTOR
PLUMBING
RESIDEI�TTIAL APPLICATION
CITY OF FRIDLEY
YOLJR &MAII. ADDRESS
O OWNER '�ONTRACTOR
ADDRESS: C1TY
pHO�: �b3� 7 �- 735 �
Permit No.
Received By
���N
SUBMIT A COPY OF STATE LICENSE # # B'� %%�-PM EXP DATE I�%'� ( C7
YoUR STATE annxESS: 651-365-1340 crrY s�ra� z�.
�CIN� �i P$ONE ° FAX '
APPLICATION s
PERMIT TYPE
TYPE OF WORB:
�SINGLE FAMII,Y
o xEw
DETAII..ID DESCRIPTION OF WORK
O TWO FAMII Y O TOWNHOUSE
�
�xErLacE�rrr
PIIt MS 16B.665 the �mut fee is a mmimnm of S15 00 or 5% of the total cast np to $500.00, wlrichever is greater, for t�
im}rroveme�, installation or replacement of a nesidential fixmre, excluding the fixmres. (T his should reflect only the cost of
Labor cost under $300 =$15.00. I.abor cast between $300 to $500 = cost of lalmr x.OS =
FOR PROJECT3 WHERE I�ABOR EXCEEDS $500. FEES ARE BA3ED ON $10.00 PER FD�TURE, EXCEPT WHERE NOTED. FDtTURES: (IlVDI
NUMBER OF EACH BELOV� ,
BATH S1NB/LAV ' F7AOR DRAIN3 S$OWER � WATER PIPING
BATHTUB GAS PIPIIVG (� cazr�) SWIIVII+�IDVG POOL WATER SOFTTV]
CLOTI�S WASHER I{1TCFIENN SINK WATER CLOSET BACKFLOW PR
_ DISHWASHER _ LAUNDRY TRAY �WATER HEATER ($3S� FOR IRRIQATT!
WATER METER OTf�R
Pemut Fee
1���7;`�1i�J�
FOR iJNDER
��i �
� ' Number of fixmres @ $10.00 x $10.00 =
.50 Number of fi�ures @ $15.00 x $15.00 =
�g N�ber of fixtures @ $35.00 x $35.00 =
Sta�e Surcharge =
Tntal — '
THIS IS AN APPLICATiON FOR A PERMIT NOT VALID UNTTL PRQCESSED
�
TOTAL
(S35)
. ($15)
I heneby apply for a building pe�it and I acknowledge that the i�fonnation above is complete and ac�ntate; thai the wo will be in
conformance with ttie ordin�ances and codes of the Ciiy of Fridley and with the Nlinnesota Construction Codes; that I this is
not a permit but oniq an application for a pe�mit and work is not to start without a permi� tliat the wo� will be in acco with the
appmvai plan inthe case of all work w' ' and approval of glaens.
�.� _...m..�w�°^ F .� �. _ .. P / � A A .. _ . .— 1 � � °7 I / �.
SIGNATCTRE OF APPLICANT
PLEASE
�OR
City of Fridley
� � Bnilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
� � v. �c� cn� nn��
.
I