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AF - 47761�, � City of Fridley, Minn. BUII.DING PER.MIT N° 3 6 8 4 � . °� - � � �-/y !�� Date. ..f?� .............�.J. �.............. � Owaer ....................................... Builder .. ..� �.. .... . . . .. ................... Adclrc�s ...................................... Address ............................................. �CAT[Q�V OF BU[LDING No. �. �� / . . 5treet . . . . . . . . . . . . . . . . . . Part of t . . . . . . . . . . . . . Lot . . � . . . . . . . Brock . . /. . . . Addition or Sub-Df�vision . �i�'� �! `�!�. �.�/. t�?�: � . . ��`�' _ � . . . . . . . . . . . . . . Setback ��.� �. Sidesard . �Q .—c�. � . . . . . . . . . . . . . . . . Corner Lot ............ Inside I.ot ..� DESCRIPTION OF BUILDING To be Used t !,� " ' ' f � �om . �:'� :� � ne�t� �.� O x�t % .—� sQ. �. �� . cw. r-�. �'� ¢ � 2� �� ' � �P � . . y �a �v . C�PIt �:!1. ... F'rPnt /� DePth �7"°� H t� .:�. Sq. Fk��.. Gtt. Fk�� "'� 0 ........ .. . Type of Construcl3on . .. � � �' omp ................ �st . . � . ............ To be C leted ..............:.... In consideration oE i�e iss�uuance to me of a permit to construct the building desribed above, I agree to do �1ie proposed work in accordance with the descriptton above set forth and in compliance with all provisfons of ordinances of the dty of Fridley. �� ................................. �_ ___.. �� In consideration oP the payment of a fee of $.��...... permit its hereby granied to ................... . . . .. . . .. .. .. .. .. . . . . . .. . to construct the builaing or addition es described above. This permit is granted upon the express condition that the �rson to whom ft 9a granted and trSs agents, employees and worl�nen, in all work done in, around and upon said building, or any part thereof, shall conform in all respects to the ordinances of FridleY. Min�esota regarding location, construction, alteration, maintenance. repair and moving oP buildings with- in the city limit� and this permit may be revoked at any time upon violation oP any of the provisions of said ordinances. / . .- �t. ..•�•. JBuilding Inspector ��:� f ,. � /� / NOTICE: Thta permlt does not cover the construaUon, Inatallation or alteration for wiring, plu�ina, gas heating, sewer or water. Be su�e to see the Bullding Inspeator fo� sepa�ate permits ior th�se Itema . � MINDER ENGINEERING CO.,INC. ENGI NEERS AND S�'VEYORS LAND 8UQI/EYINO GIVIL 8�. MUNIGIPAL ENOINEERINO 6418-56T" AVENVE N. MiNNEAPOLIS 2T,MlNN. KE T- 3('037 � 2 � �'i U � Y �C �� i �� 1� [F �i IN �'� �! `' � � �� , _ ',�. `�.�,1 J�i� . �� •� �`�� e� - 1� ` �� , � � �. �. ��/ '�i''� � ., � ; -�. � � �� W f � r`� 801�,9 TESTINO LANO P�.ANNINB �, . _ . . ' C '•-� ��' F u � 1` _w t � , �� _.�. � �.� _.� _�. .-- � � �- -_ _,_ � �_ � ,Y., � --- -�. �'¢ � �+-�"_'� �° � `.z,..�� f � '� a � � I` _ r v_ �� M,� �' '. � � .. � �� '� � f � _ ! f� � � � �'. x s-� \ \ �/ } ' r �� r '' � "�. �� ,- � y ''� �r � 1� ��_ ,� � e •,�� ' • � .- . `1~ � � � °----_._._ - � � t,-o, .! � � `° �� .� " ,� � � - . -- � ._ . xu.s_ ..��n�s , 0 �9� 2 � � � j _ � �� c � � e f �- s , ,�. W� -� �..� �� .--� ,--�.. . 1, �'.1:: � � � � � �� T�� -� ��..�°�.� �: WE HE0.E6Y tERT�FY THAT TNIS IS A TRUE. ANO CORRER REPRESENTATIOI�f OF A SURVEY OF THE BOUNpAR1E5 OF THE LAND ABOYE DESGRiDED AND OF THE LOCAT�ON OF AU. f3UlLDINGS, IF A1JY, TNEREON , AND AI.L VISlBLE ENCROACHMENTS, �F �w,r, FaoM ORON s�o �NV. MINDER ENGINEERING CO., INC. OATED TMIS OI►YOF y`, °� �' �•�•��5, EA1G`j��E,� . AND �URVEYORS �� ' � �rn F4,� ° �� f� ^ � � � G,�Z f' ` � � c�.� of F�.a�ey, M�.. �UILD�TG 1'ERMIT DB�: AIIGIIST 27, 1965 ��: JOHN F. GWIAZDON' ,34 3 3� N° 8410 Builder QUALITY FtOMES, INC, Adaress 6801 JeffersE�n St. N'. E. ,,�d� 3701 Fremont Avenue North Fridley 32, Minnesota Minnea�olis, Minnesota LOCATION OF BUILDING No. 6801 S�t JEFFERSON ST. N.E. Part of Lot Lot �— – Block Coraer Lot _ In�tde Lot Sewer IIevation Addition or Sub-Divisian Rice Creak Terrace,_ P1at ��5 Setback —_ Sideyard Fo�mdation IIevation To be Used as: DESCRIPTION OF BUILDING Front Depth Height Sq. Ft Cu. Ft Front Depth ITe3ght Sq. Ft. Cu. Ft Type of Construction F�t, Cost _ 14 320. 00 � To be Completed REpAIR AND REPLACE HOME FROM CAP UP � STORM DAMAGE In c�slderatton oP the fsauance to me of a permft to canatruct the bwllding descrlb¢d a�ve I agree to do the P�P� work ffi accoraance with the d�scription above s�forth and ffi c�omplje�ce �i,th afl provisions of ordinances oY the dtq oP FrirIIey. / �� / � Ia camafderat4on of the payment oP a fee of $ 10. 00 � p��t � hereby gra,nted to Q�ALIZ'Y HOMES, ��,?�� to vonatruct the buflding or addition as descrlt�ed above. This t is grantc� upon the exPress condition that the P�n to whom it fs granted and hfe agents, eYnPloyees worlcmen. in all work doae fn, arotmd and upon eaid building, or anypart thereof, ahall conform fn all respects tfl the ordinance� of Fridley� Minnesota location, construction, alteration, maintenance, repair and moving of builc7inge withiu the dty limfts� per�nft may be revoked at any Lizne upon violation of any of the prov9sions oE seid ordinanc�. ALLEN G. JENSEN g�� NOTIC� � 'Ihb peee�it doa net eovse �6s coestroeti�, fealal�loe fer �rirteo, pluabieg, �n haNea, mru or w�tsr. B� wn te ss� - t6s Buildfu0 I�eto� ior pparat� p�rmhs for f6�a NNm. __ „ Y � APP'LICATION FOR Bt1ILDING PERMIT CITY OF FRIDLEY, MINNESOTA i� �,- OW1�R' S NA1►II3 �0�[+1 F. Gtn�IAZDDN BtTILDER � QUALI`PY HOMES . INC � ADDRESS 6801 defferson N.E. ADDRESS 3701 �'remont Ave. No. LOCATION 0�' BUILDING No. 3treet Part of LoC � LOT 1 BLOCR 1 ADDITION OR SUBDIVISION Rice Creek Terrae�e #5 Corner Lot Inside LOT Setb�ck Side�Yard. _�_. SEWER ELEVATION FOUNDATION ELE'��ON Applicant attach to ti�is form Two Cereificates of Survey of LoC and proposed building 1oca�ion drawn on these Certificates. , DESCRIPTION OF BUILDING To be used as; TORNADO DAMAGE gEP�IRS Front Dept� Height Sq. Ft. Cu. Ft. Front Dapth �_Height Sq. Ft. Cu. Ft. Type of Coaetruction Estimated Cost $lit,320.00 To be completed ' The undersigned hereby makes application for a permit for the wark herein specified, agreeing to do all work in strict accordance with the City of Fridley Ordinances and rul3.ngs of the Department of Buildings, and herebq declares that all the facta and representaCions stated in Chis application are true and correct. DATE SIGNAT[TRE (Schadule of Fee Coats can be found on the Reverse Side). Replace home from cap � _ „ ,. _.� � � ,,,, . r a Bort.DiNG PERt�T FEE SCHEnvzL SECTION 2. The Inspector of Buildings ehall� before isauiug any parmit for the erecCion of any building or strucCure, or for any addition to anq esisting build- ing os etructure, or for any alterations or repaire to any eaietin� building or atructure, upon application therefore, require the paymeat by the applicant for euch pesmit of fees to the a�onnt.herein belQw eet forth and.°in ehe manner.herein provided to-wit: o 2.1. For any such permit for the erection of any fire �proof building, other than a garage, warehouse, factory or grain elevator, or for the erection of any fire•proof additiou, for similaF occupancy, to any existing building, ghall be at the rate of $1.40 for each one thousand cubic feet, or fraction thereof, in euch cubical'content�. - 2..2• For aay �uch permit for the erection of any fire-proof garage, Ware-hou�e; faat�rq ar-gra�n- aievator, or €or--��e �recti�n-af-�y fi�� nrng�_ _ addition, for'similar occuparicy; to anq existing building sha�ll i�e at the rate of $1.25 for each oae thousand cubic feet, classified as "fireproof" by Section 5U2 of the Minneapolis Buildiri� Code. , HOUSES 2.3. For any such permi,t for the erection of any non-fireproof building, other thaa a garage, warehouee,'factorq or grain el�vator, or any aon-fireproof addition, for eimilar occupancy, to any exieting building - permit $1.00 for each one thousand cubic feet. . GARAGES �_ 2 4,: For any auch perm�tt for the erection of anq noa-fireproof garage, warehouse, factory or gr8in elevator, or for the erection of any non•fireproofc addition, far aimilar occupancy, to any exiating building or for each auch building or addition - ainety cents ($0.90) gor each one thousend cubic feet or fraction thezeof, in the'�cubical conteats ehereof with the minimum of $4.00. For the�purpose of camputing fees for building permits, the cubical contenta of any buildiag or addition to a uniform height throughout by multiply�.ng the ground asea cuvered from a point aix (6) inches below the floor line of ths. -�a�eane� or-celrar to �be average he3g�t �f tl�e u�per surfaca ort�-tir� �verage- height of the roof sur€ace of the maia gable of a pitched roof. 2.5. For repairs or �1Cerations to an exiat9.ng �tructure, the fee sha11 be at the sate of $3.00 per �each Five Huadred Dollars ($500.00) or :Eractioa. : thereof ia the coat of all propoaed work. 2 6. In no case ahall the fee charged for any permiC as aet forth in Section 2 be l�ss tha�► $4.OQ. .. . 4�.-� _ n � r o 8` -!, ' .9 +r R � � d � � � � �y °p L�+lI : y : x : � . m . y ; O . � . m rJ . � : � • � O� • O N � � � � � a � � p � � � � � z n � W � � � y � r� � � :� � p�, � � � � � � � 6d � •+ �► � �. � � m � a " ' `° � � � � � � � b a ,� � � �. : ��o: ��: � �: : � m . � � . . � � • � , . . . � . . . . : : : : � : : : '. 0 0 � x oa " x oe x x �e �a � � t�.� ;y � � � � r�+ r ,t�.� `� g� g� S � g�' g o�� r� � va sfl tn �n �» ts� � � y H O y O � � O � o � x \ 1 w 0 � D � r � m � 2 m C r m * • �J p. � w � � w � � Storles m � 8 W�� a `i°sErs �f uatwas � e�n+ rues � p s�s�rg � � I SINICS � � � W�, TRAn DRINK. FOUNT. • SF1WR5. FLOOR C'F' DRAINS UTCH (� R�. BASINS b � AUTO .d wws�e GAS APPL ��s I �..� RANGE GAS � OPENINGS a • I I z • � �dm � � V p $ h � � �❑ � I n o � o y � � � �. � � � � � ° g a � od � n ro � � � � w � �. a a �� g � h � �� ' � h bd �e y � I w � � � �aa� � � � �: �, � �� o ��,�a � °p � o�n. °t� m ��o�. � � � ��oy � � o � ��`� � � � � � � bd�' b �� t-+ � � �s � ° q �� p �' �' o � � � p � � � � y � y � � � w tis a � o�� r �, � � � ��o � �' � � i M, c7D 3 `� � � ° � � � � �, �� I � Ii a A � � M M � � � '6 � 3�i � � n � {0 � � � , � O_ b � o � � � � � � � DD ]'d,, 0 � m � �� K �n d c�o � �o • F-�-� 0 � SUBJECT City of Fridley AT THE TOP OF THE TWINS g � I L D I N G P E R M I T � � � i �• COMMUNITY DEVELOPMENT DIV. r � �' � PROTECTIVE INSPECTION SEC. � '_ ��•'1 � CITY HALL FRIDLE� 55432 NUMBER �""� � �'� 612-571-3450 910-F15 JOB ADDRESS 68Q1 Jefferson Street NE t LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCH. 1 1 Rice Creek 2 PROPERTY OWNER MAIL ADDRESS Bob Severs.on 6801 Je��erson �treet NE 3 CONTRACTOR MAIL ADDRESS D& D Home Improvement 7401 Central AvE A ARCHITECTORDESIGNER MAILADORESS 5 ENGINEER MAIL ADDRESS pEV IDATE 10/7/91 ZIP ZIP 8 USE OF BUILDING Res, ident ial 7 CLASSOFWORK � NEW ❑ ADDITION � ALTERATION � REPAIR 8 DESCRIBE WORK Reroo�' House (19 Squares) 2nd Layer 9 CHANGE OF USE FROM TO STIPULATIONS Roo�ing can be 2nd layex but not 3rd, SEPARATE PERMITS ARE REQUIHED FOR ELECTHICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING 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 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 WOFK WIL� BE COMPLIED $g88 WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE PROVISION - F ANY OTHER STATE OR LOCAL LAW REGULATING CON- $2S.00 STRUCTIO O THE PERF RMANCE OF CONSTRUCTION. PLAN CHECK FEE � � SIG ATURE OF CON i RACTOR OR AUTMORI2ED AGENT IDATEI � yy}�EN PR � �DATEi SQ. �.��` �9�y VAGE OF APCROVED BY � � SEE ATTACHED SHEET PHONE PHONE LICENSE NO. 784-7543 PHONE LICENSE NO. PHONE LICENSE NO. ❑ MOVE O REMOVE GROUP CU OFFSTHEET PARKING STALLS GARAGES SURTAX $.50 SAC CHARGE Fire SC $.98 TOTALFEE $26.48 :FiL V NIS IS YOUR PERN LOAD � I] � I J �� [ ] �l Pl[�ID I�2 Buildinq Pe�mit l,pplfcat�tan Effective 1,/],/91 � Co�tructian �res.s: � �C�l ��d�:�� %� ,�� Lec�al De�iP�tian' . Owt�er I�Ta�e i Address: ��e:f�/� Tel. #��%� �••'�i•s K .� .., - , �� L z+e.t. # ��`�S� Att3d� to fihis applicatian, a Qextificate ot' Stitvey of tiye lvt, with tl�e p�vpose�d aa�vctian drawn an it to scale. ffi�C3tIPPIQ�T � II�@� LIVII+IG 11Tt'E'�i: ietigtii Width He,ic�t Sq. F't. �IRAC�: 71R@�: Lergth i�lidth 8eight Sq. Ft. D�C'dC l�,: LPSgth Wi�3tii 8gt/C�vtari Sq. Ft. O►�[t• Cbrner Lot [] Inside Lot j� Ft. Yd Setback Side Yazd Setbacks Z�pe of Ooa�t�uc.tiaaz: �tiS ii�' � � � r�� tim�ted Oc�t: $ �� ' Approx. Daag�letia� Date: �° �� S� pro�osed Driveway width If New Desired: Ft. $ S Width + 6' See Back Page DATE: O � AFPS�Ca�PTr: �2� �' � • � Permit Fee $ a S� C� � Fite S�arge $ � �� State S�arge S . �Z� SAC Q�azge S Doriveway F�crow $ Fark Fee $ sewer Main �Yye S : �� sr�r�,Tiat$: � S �� « �.:+= : �-_��'� i�ee Sci�e�ule cn Aeverse Side .001 x Permit Valuatian (l,/lOth $) $.50/$1.000 Valuatian $650 per SAC Unit Alt. "A" a�'Alt. "B" Above F�e De�tetminea by �i *,�r;�, � -� � �Y L ] � Ne�-�Y [ 7 � � �.. E _�r� �1�, c �Y�4 � "- = •:i, � �i �e Chief Huildir�q Official ehall, befaane 3ssuir�g pesmits for ti�e erectian of any bui.ld.inq a� etn�cture, o� fc� any aaditfan to anY 0dstirg buildin� a�r etn�cture, o�r for any alteratian or repa3r to anY �ist3n� build3iYJ aar �4�e� u�a�1 aPPlicatian tl�erefame, require the payment by t2�e applicar,t far euci, pexmit of fees to tr,e eaoo�mt ��il bE1Ci�1 6Gt f�l � 311 �lE' +�arfabr �, jn �i� tO�i1T�t: 'IDI'AI+ VAIUE $1 to $500 Ssoi to S2,oao 52,001 to $25,000 $25,001 tc $50,000 $50,001 to $1Q0,000 $100,001 to $500,000 i�� S15 (lsini�m► F1e�e 3s $15 Psus eutY3�azc�+e) S15 fc� fiist $500 plus $2 fc� eacii additiac�al. $100 or fractian theze+of, to ard ir�cluding $2, 000 $45 faor fitst $2, 000 plt� S9 fos eac3i additiar�al $l, 000 G� fiactian tl�el�+eof, to etld 1ilcluclir�g $25, 000 $252 fC�' fit�t $25, 000 pl� $6. 50 foz' eadi additias�l $1, Q00 C�r f�Ctian therBOf, to eT1d 1T�Cludirlg $50, 000 5414.50 far fitst $50,000 plus $4.50 for each additio�al $l, 000 a� fractian the're+ef, to and incluciirg $100, 000 $639.50 for fil�st $100,000 plus $3.50 fot' eaCh edditia�al $1, 000 or fractian thereof, to ani including $500, 000 $500,001 to $1,000,000 $2039.50 for the fitst $500,000 plus $3 for each additianal Sl� 000 a�' fiactiCn thet�eof, tc et�d 3ncludir�g $l, 000, 000 $1, 000, 001 ani up $3539. 50 for the first $l, 000, 000 pl� $2 for eac3i additional 51,000 or fractian thereof IItIV�Y �SI� FBQiCJW (Dac�crete Q�i� Sti�ce�ts Qn1Y) Alternate "A" : Re�oval ani replao�nt of c�b ard gutter anly - Oriveway width plus 6 fee�t times $13.50. Alternate „B" :�t�oval ar�d replav�ent of wrb ar�d gutter ar�d install a 3 foot wide appreach with 6 it�ch dep�tii -�iiveway utidth plus 6 feet tit�s $15.75. L'1-''+ �� ': M • . •�' ;�,u.��• M • ,I PPrmits for a�ar�tvct.ien will be issverd a minim� of 24 i�au� fi� the t3me of applicatian �o allaw fa� p�aper =eview of �e p�eposed sti�re ard of the �ian site. A Oertificate of S1�vey of the lot, siioGring the locatirn of the faar]atian ar�oe it has it has been will be required before pa�ooeedir�g with the fia�ir�g. � 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 � � i �� COMMUNITY DEVELOPMENT OIV. r � y � PROTECTIVE INSPECTION SEC. � � � � �"'1 � CITY HALL FRIDLE� 55432 NuMBEA AEV DnTE PAGE oc �"'"�"� �'� 612-571-3450 910-F15 4/17/97 / / JOB ADDRESS 6801 JEFFERSON ST NE 1 LEGAL LOT NO. BLOCK TRACT OR ADDITION DESCR. ]. 1 Rice Creek Terrace Plat 5 2 PROPERTV OWNER MAIL ADOHESS Z�P Bob Severson 6801 Jefferson St NW 3 CONTRACTOR MAIL ADORESS Z�P Columbus Exteriors Inc 2131 111 Ln, Coon Rapids MN. 554 4 ARCHITECT OR DESIGNER MAIL ADORESS Z�P 5 ENGINEER 6 USE OF BUILDING Residential 7 CLASSOFWORK � NEW MAIL ADDRESS ❑ ADDITION O ALTERATION 8 DESCRIBE WORK Install aluminum soffit & fas 9 CHANGE OF USE FROM STIPULATIONS TO ZIP ❑X REPAIR Ventilation must meet the State Building Code. TYPE OF CONST. SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, VENTILATING OR AIR CONDITIONING. THIS PERMIT BECOMES NULL AND VOID IF WOiiK OR CONSTRUCTION ZONING AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION OR WORK IS SUSPENDED OA ABANDONEO FOR A PERIOD OF 120 DAYS AT ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS I HEREBY CERTIFV TNAT I HAVE READ AND EXAMINED THIS APPLICATION 1 AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED ]OO WITH WHETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT �1 � DOES NOT PRESUME TO GIVE AUTHORITV 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 �r � PLAN CHECK FEE PE O. �'4'��. 1 il� nvPAOVEO er SEE ATTACHED SHEET PHONE 571-0677 PHONE LICENSE NO 368-9195 3509 PHONE LICENSE NO. PHONE LICENSE NO. O MOVE O REMOVE OCCUPANCY GROUP SQ.FT. STAILS ��2� ��'�.,��-.�� % '/ Licens SC .00 SIG E OF CON � RACTOA OA AUTMOA�2ED AGENT IDATEI E P1j(�1P LY VAL PANCYLOAD CU.FT OFFSTREET PARKING GAFAGES SU RTAX $.85 SAC CHARGE Fire SC $1.70 TOTALFEE $61.55 ED THIS IS YO1r1R PERMI . I / t / � �IJGt� 4 �� ' �DATE� DG �NS� qaTE � ` r�w � � ADDN [ ] CITY OF FRIDLEY ALTER [] SINGLE FAMII,Y AND DUPLEXES R 1 AND R 2 BUILDING PERMiT APPLICATION ConstructionAddress: � �o � �� l� � �S� .� `S � /v � Effective 1/1/97 .� l7� � Legal Description: O�vner Name & Address: �6 � s �'� ('�s� ^� � Tel. # �57� � � � ��_ Contractor: ��i, � d u� L= , X�� ' i a�J �rr� � MN LICENSE #-� S v� Address: �?� .�� /// � � �. �J � m�-- Q �1 D � �S `� 3 � -�el. # g(s g " �/` �'�_ Attach to tbis application, a Certificaxe of Survey of the lot, with the proposed construction drawn on it to scale. DESCRIPTION OF IlVIPROVEMEN'� LIVING AREA: Length Width Height GARAGE AR�A: Length Width Height DECK AREA: Length Width Hgt/Ground OTI�R: Sq. Ft. Sq. Ft. Sq. Ft. Construction Type: �(� m � h� b-�. �o�� Estimated Cost: $�� ` d� (Fee Schedule on Back) Driveway Curb Cut Width Needed: : Ft. + 5 Ft = Ft x$ _..� . DATE: ��- l �°� % 7 APPLICANT: . Tel. # g � � � �/ �' S Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: � �� t . r7� o^ $ � c.� $ $ � �� $ $ $ $ �� $ - �. CITY USE ONLY Fee Schedule on Reverse Side .(�1 of Permit Valuaxion (1/lUth%) $.50/$1,0� Valuation $950 per SAC Unit $5.00 (State Licenseci Residential Contractors) Att. "A" or Alt. "B" Above $450.00 Conservation Plan Review Fee Determined by Engineering Agre�ment Necessary [ ] Not Necessary [ ] �° ` ` BUILDING PERMiT FEE SCHEDULE The Chief Building Official shall, t�fore issuing permits for the erection of any building or structure, or for any addition to any exisring building or sttucd�re,� or for any alteration or repair to any existing building or structure, upon application therefore, require the paymern 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 $1,0�,000 $1,000,(}Ol 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 there�f, to and including $25,000 $349.75 for first $23,OOil plus $9.00 for each additional $1,(�0 or fraction thereof, �to and including $50,000 $574.75 for first $50,0(}0 plus $6.25 for each additional $1,� or fraction thereof, to and including $1(�;000 �° � ... $887.25;_for fust $1�,000 plus $5.00 for ea.ch additional :� . - =_ $1,�p0 or fraction thereof,_to.and including.$500,�0. ; a. � �$2887.25 for the first $500,�0 plus $4 25 for each additional � . r' _, . .:�� .,- .�_ � , _,. .$1,�0 or frachon:thereof; to and including`$1,Q00;00(} _ _ -- _ _ _.._ � . _ �� . . . __ $5412.25 for the fust $1,�0,000 plus $2:75 for each. additional $1,000 or fraction thereof - DRIVEWAY DEPRESSION ESCROW = {Concrete C�rb 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 $15.75. VERIFICATION OF FOUNDATION Permits for construction will be issued a minimum af 24 hours from the time of application to allow for proper review of the proposed structure and of the construction site. A Certificate of Survey of the lot, showing the location of the foundation once it has it has been constructed wi(1 be required before proceeding with the framing. � SuB�ECT City of Fridley AT TME TOP OF THE TWINS g U I L D I N G P E R M I T i � , � � ; y �� COMMUNITY DEVELOPMENT OIV. r � � PROTECTIVE INSPECTION SEC. 1 S . � �'�'1 � CITY MALL FRIDLE� SS�JZ NUMBER pEV DATE �""�' �'' 612-571-3450 910-F15 3/19/99 JOB ADDRESS 6801 Jefferson Street NE t LEGAL �OT NO. BLOCK TfiACT Oii ADDITION DESCR. j 1 Rice Creek Terrace Plat 5 2 PROPERTY OWNER MAIL ADDRES$ 2�P Robert Severson 6801 Jefferson Street NE 3 CONTqACTOR MAIL ADORESS Z�P Same 4 ARCHITECT OR DESIGNER MAIL ADDRESS Z�P ENGINEER MAIL � 29035 ��3 � OF APPROVEO BY � SEE ATTACHED SMEET PMONE 571-0677 PHONE LICENSE NO PMONE LICENSE NO PMONE LICENSE NO 8 USE OF BUtLDING Residential 7 CLASS OF WORK �J NEW O ADDITION O ALTERATION ❑ REPAIR ❑ MOVE O REMOVE B DESCRIBE WOFK Construct a 12' x 8' Platform (not attached to house) out in rear yard. 9 CNANOE 0: USE FROM STIPULATIONS TO SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL. PLUMBiNG. HEATING, VEN7ILATING OR AIR CONDITIONING TMIS PERMIT BECOMES NULL ANO VOID If WORK OR CONSTRUCTION 20NING AUTHORIZED IS NOT COMMENCED WITMIN 80 OAYS. OR IF CONSTRUCTION OR WORK IS SUSPENOED OR ABANDONED FOp A PERIOD Of 12p DAVS AT ANY TIME AFTER WORK IS COMMENCED. NO. OWLG. UN I HEREBV CERTIFY TFIAT I NAVE READ AND EXAMINEO THIS APPLICA710N 1 AND KNOW TME SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yALUATION AND ORDINANCES GOVERNING THIS TYPE Of WORK WILL BE COMPLIED @ WITH WMETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT W885 DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEqMITfEE PAOVISIONS OF ANY OTMER STATE OR LOCAI LAW REGULA7ING CON- ST TION OR 7ME PERfORMANCE Of CONSTRUCTION �32.00 PLAN CNECK FE S�GN4TUpE0 CON'AACTOpOAAUTMOp�2EDeGENT IDAiE� . EN iO�fE� SO. STAILS LOAO CU f T GAiiAGES $.50 AC CHARGE Fire C $.88 �TAL F E .38 IS YQ,�IFt PEp T V '/ � r�� fE NEW ADDN ALTER [l Il Il ConstructionAddress: CITY OF FRIDLEY SINGLE FAMII.Y AND DUPLEXES R-1 AND R-2 BUILDING PERMIT APPLICATION � S �� _ f�� Effective 1/1/99 i.egal Description: � �"7' ,�� '�� t[° � �� h�� /r / al��i�z9 � � /�/� j .�°' Owner Name� & Address: `� ,,� � �� dA� �?S ��.� C,� �a � � � Tel. #� � ? l � � 7 � Contractor. � � MN LICENSE # Address: LIVING AREA: GARAGE AREA: DECK AREA: OTHER: Tel. �t Attach to this application, a Certificate of Survey of the 1ot, with the proposed construction drawn on it to scale. DESCRIPTION OF IMPROVEMENT Length Width Height Length Width Height Length 1 a' Width � Hgt/Ground 1' , a Sq. Ft. Sq. Ft. Sq. Ft. —��, � �C �. �1� Construction Type: � Estimated Cost: $ � , � (Fee Schedule on Back) Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ DATE: � `� APPLICANT: Permit Fee Fire Surcharge State Surcharge SAC Charge License Surcharge Driveway Escrow Erosion Control Park Fee Sewer Main Charge TOTAL STIPULATIONS: $ �� o $ - $ , �U $ $ $ $ $ $ $ �-3• � Tel. # CITY USE ONLY Fee Schedule on Reverse Side .001 of Permit Valuation (1/lOth%) $.50/$1,OU0 Valuation $1050 per SAC Unit $5.00 (State Licensed Residential Contractors) Alt. "A" or Alt. "B" Above $450. QO Conservation Plan Review Fee Determined by Engineering Agreement Necessary [ ] Not Necessary [ ] F u , � � BUII,DING PERMIT FEE SCHEDULE The Cluef 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 appl'ication 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-wits . �, 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 (Minim�.am 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. � % , .. _� 0 ?� � e s 5t--c 1-�b�14 O � � m � �i � e� � � � � 0 p � � e m � � � � ; 13�58 .� �' !"�b Nr3' � � �� , <�� ' ��o _ O � 1 � � N � �v � -� m � � � r' i t;1TY UF FklDLEY ��+�� g-�� i' �� .�� x� � �� '� � �� ; �, �' �� m � : �, I� I i�---I l I I I I I I I �s eA ei+ y.! �► a�r ia � �nn � b� tA 6A � r �► r .r �r ..� � O�� Q O O O O O O 0 og8888SooS�8 � � Z � � � � � .� �* � � ► ► � ; � � 0 0 � I � � z Q � � � � � � a � � I � � y, � � � � � in � � �. � �� v, �� . � us � � � � � � - � � � � �� m � rn � � >�{ fil � � L � F'. �/�:Li � �.� �� 0- ��•� „ N x� v � �m : m ''� w Z v � � m J ^ oNa � � O z v C � � � � � a � 2 � O O � � � A � � O a � � � C �i o� � � � � � �" � 'O rn � _�' � � D � g � � 1 � � SE�-21-26d4 13 � 59 � I T1' OF FR I DLEY p, 03,'03 FILL IN COMPLETELY FOR REPLACEIVIE(VT FUEL BU�NINti APPLIANCE PERMITS COMMQN VENT: VENT CONNECTOR AND CO�Bt1STtOM AIR VEQ�F�� V1When re�lacins� an �rx�sti�a fumece, the undersigned hareby verifle9 that the venting has been examined and is free from rust, deterio�ation, 017StNCfI0R8, and is securely supported and �restopped where r�auired. Y�S (} The venting system i� pl�stic/PVC and meets a(I current c�des and m�nu(acturer spec�icatlons includ(rrg sizing, length, num�r of efpows and ternninatidn. Yes () The undersigned alsv verlfles �at the replac�ment unit !s a Ilsted �sernbly and meets the current code� and manuiacturer's speclflcations. Thls does include AGA-GAMA Cat��ry I Central Fumace Venting Tabl�e for fan asslsted and naturaf draft applfances. The exls�n� combu�tlon alr 1s s(zed and instafled to meet the current codes and manufacturer's speci�catl�ns. When requlred to Install a new comlwstlon atr, it will be sized �and inStalled to meet the current �ndes and manufactuners speciftcatlnns. Yes ( } Yes { ) Yes { } When Inst�►11ir� a new vent(n�t svstem, the undersigned her�by verifies fhat it is a listed �ssembly and meets the current codes and manufactur�ers; specfflcatbns. Thls �foes InClude AC3A-GAMA Category I Central Fum�ce Venting Tables tor fan assisted and natural draft applfan�es. Yes {) No ( ) Nn { ) No ( } No ( ) No ( ) No ( ) Is the cammon vent �nd vent connectors sized and inst�fled correctly after an appliance has been removed from the common vent and vented separately as per curnent oodes. Yes () No () Aanlia��e Tvqe �nd $izetCommon Ve� and Vent C�nnector Information Appliance #1 Type 6TU Input _ Fan A§sisted or �lat Appliance #2 Type 8TU Inp�rt Fan Assisted ar Nat Appliance #3 Type �, BTU Input Fan Assisted or Nat iotal Appliances � Total �tu (nput Common Vent Type Vertt }�ight _ Diameter inches Applian� #1 Vent Connector Fietght ft Length ft Diam�ter in i'ype Appliance #2 Vent Connector Height R Length ft Diameter in Type Appliance #Ki Vent Connector Height R Length ft Dlam�ter in Type AL'f�IZATIONS: (Descri�l HEATING CO: Signed By: Date : TJTH_ F'. J.� a