AF - 47833�
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City of Fridley, Minn.
BUILDING PERMIT
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Date: °-" �" '-' � �
Owaer: Builder
Address Address .—
No 653�
, LOC TI BUILDING
No. �__�'_� Street � � _ Part t� �
Lot °' 81ock Addition or Sub-Divisi� �� 1����� d
�' �° �
Corner Lot _ Ine�tde Lot _._. r� Setback --.��� Sidey►ard �� � f�, �,�
Sewer IIevatian ....._.._ � Fo�mda.tion IIevation
DESCRIPTION OF BUILDING
To Used • �
Front � Depth Height � Sq. F� Cu. �
n Depth FTeight Sq. Ft Cu. F�
Type oP Construction ��
� Fst, ,�.� �o be Completed
In constderation oP the issuanoe to me of a permft to construct the building
the proposed work in accsordance with the d�scrlption above set forth and in ca
ordinances of the dty oP FrfcIIeY• � J/1 � .�v ,
���
Ea consideration of the payment of a Pee oP �� , permit is
granted to
above, I g�eg to do
t�th all pra�ons of
to construct the buflding or addition as descrlbed above. Thi�p�� t is granted upon
the express c�ndition that theperson to whom it is granted and hfs agents, employees and worlanen, fn all mork
done in, around and upoa safd building, or any part thereof, st�all conform in all reapects to the ordinanc�s of
FridleY� Minnesoffi � location, constructCon, alteration, maintenance, repair and moving o4 bufldings
wio��� dtY limfts�eand t1�a permit may be revoked at any time upon vio�n of aay of the proviaions of slaid
Bt�lldinS Inspector
^ NOTICe:
'Ihis p�emh dea nof eevsr t6s eoealrucH�, IestalHtim fer wlei�, pMm6teg, en haNne, se�ru e� wafsr. B� wn to rM
Nn Buildin8 Insp�etor fo� pp�ralr p�rm6a 1or th�a hwn.
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APPLICATION F'OR BUILDING PERMIT
CI1`Y OF FRIDLEY� MINN�SOTA
-�
OWt}dEli' S NAl� ,,.y.� � A BUILDER �
�D�ss � I � — �' 9 � �vo `►� s �D�S �
LOCATION OF BUZLD�NG
No. � �� � Street `
..,_ Part of Lot
Lot �- ��- 3 Block Addit3o�i or Subdlviaion � � �
�e_a�
Corner Loe��naide Lut_�Setback '� •5 � Si�le-Yard � �� � �/ � � �
SEWER ELEVATION FOUNDATION EGEVA't''tOR
Applicant attach to this form Z'wo Certificates of Survey of Lot aad proposed build-
ing location drawn ori theae Certificates.
DESCRIPTION OF BUILDING
To be used as;
��- Front d� � Depth �' l� Height
Sq. Ft.�� �- o Cu. Ft.
. Front Depth Height
Sq. Ft. Cu. Ft.
Type of Construction �j2.� Estimated Cos� ��J, ���
To be Completed
The undersigned hereby makes application for a permit for the work herein specified,
a�reeing to do all work in strict accordaace with ehe City of Fridley Ordinances and
ruliags of the Department of Buildings, aad hereby declares that all the facts anci
representations atated in this appl3cation are trae and correct.
DATE � �
SIG� � d .
(Schedule of Fee Costs can be found on the Reverae Side).
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BUII,DING PEIit9IT FEE SCHEDULE
Section 2. The Inspector of Buildings shall, before issuiug anq permit fAr
�he erecC�on of any building or structure, or for any addition to any exist-
iag bu3lding or etructure, or for any alterations or repaite to any exi�tin�
building or atructure, upon application therefor, require the paymen� by the
applicant for such permiL.t of fees ta the amount herein below aet forth e.nd
in the manner herein provided to-wit:
2.Z. For any such permit for the erection o# anq fiace-proof buildi.ng, other
th�n a garage' warehouse, factory or grain elevator, os for the erection of
any fire-proof addition. for aimilar occupancy, to anq euisting building
anail v� at the rate of $1.40 for each one thousand cubic feet, or fraction
�hereof, in such cubical contenta.
2.2. For aay such permit for the erectioa� of anq fire-proof garage, wasehause,
f�.ctory or grain eievator, or for the erectioa of any fire-proof edditioa,
fcr similar occupancy, to anq exiating building shall be at the rate of $1.25
fo� emch one t�ousand cubic feet, clasaified as °1fireproof" by Section 502 of
the Minneapolis Bu31d3ng Code.
��USES
2.3. For any such permit for the erectioa of any non-fireproof building otbe�
than a garage, warehouse, factory or grain elevator, or aay non-�ireproof
additioa, for s�tmilar occupancy, to aay exietiag building - permit $1.00 for
each one thoua8nd cubic feet.
GARAGES
2.4�. For any such permit for the erectian of any non-fireproof garage,
w�rehouse, factory or grain elevator, or for the erection of any non-f�.a�egroo�
addit3.an, €or similar occupancy, to any existiag building or for each such �
� lding or addit3on - ainety centa ($0.90) for each one tbousand cubic feet
or fraction ehereof, in the cubical ceontents thereof with a matnamum of $4.00.-
For the purpose of camputing fees for building permits, the cubical contents
of anq building og addition to a uniform 'height throughout by multiplying.the
grou�nd area covered from a poiat six (6) inehea belo4a°`the floor line of the
basemeat or -cellar to the average heighC of the upper eurface or to the
averege haight of the roof surface of the maia gable of a p�.tched roof.
2.5. For repairs or alterations to an eaciating structure, the fee ahall be
at the rate of $3.00 per each Five Hundred Dollare ($500.00) or frection
thareof in the coat of a!1 prop�,sed,work.
2.6. In no caee ahall the fec? chac��d fnr aup per�3c es eet fosth in
SeCtiaa 2 be less than $4_t10.
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; �t�NG$ TIlE�iN. A� .�LL �SIeAE: BrC�1Mli� `�F � �##�►. C��iF� ° ' :�5�
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AS SURVEYED i1f ME TH5 �BTH_ DAY QF ._ MAY �j�j _ �� � ;�
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City of Fridley, inn
BUILDING PERMIT
Date: April 10, 1968
pwaer; William Z. Besnett 8��, Same
pd� 572 Rimball St. N'. E. Ad� Same
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LOCATION OF BUILDING
No. 572 5treet K�ball St. N. E. � � p� of Lot
� 42 & 43_ Bl� E Addition or Sub-Divisfan ._ �verview Heights
Coraer Lot _ 7ns�tde Lot Setback �_ Sideyard
Sewer IIevation
Foimda.tion IIevation
DESCRIPTION OF BUILDING
To be Used as:
_ Ga.ra�e �t 16' �p� 22' H��t 10' �. � 352 �� 3520
Front Depth I�eight Sq. Ft Cu. Ft
Zj►pe of Construction Fra.me �� �_$_..1�000 .__ To be Completed 6/1%68
In consideration of the �tsauance to �e of a permit to conatruct the building descrll�d above I agree to do
the proposed work fn accordance with the description above set forth and in compliance with afl provisiona of
or8inaaces of the dty of Fiidley. �
In camsfderation oP the payment of a f� of $ 5.00 , permit is hereby graated to Wi11�.a.m L.
Besnett to canatruct the buflding or addition as described above. Thia �t ia grantsd upon
the expresa condition that the person to whom it is granted and his agents, employees an worl�en, in all work
dane in, aaound and u�n said building, or any part thereof, shall �nPorm in all respecta to the ordinance� of
FridleY, Minnesota regarding locatton, construct�fon, alteration, maintenance, repair and moving of buildinge
wlthin the dty ]imits and thia perrmit may be revoked at ar�y 13me upon violation of of the P�visiona of ea�d
ordinanc:es. �
� � nspector
v
arence Belisle
NOTIC�
ibh psrmh doa not eever ths eoes�rueHoe, 6nh11alloe to� �rlrine, plumbine, en 6eatine, ssw�� o� rnter. B� wn to a�
tho Bnildlag IespKtee fo� ssparat� parmhs fer lhas Itams.
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APPLICATION FUS H�JILDING PERM�T
G"iTY OF FRIDLEY j Mi111I�50T�
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Otr�R'S,. NAI�IE�����„ ,M'' J . BUI�,b�:lt .
ADDRESS S%�.-��;�:��.�"; ��%� �,__,�Ii��SS�, _ � _ _.._
_, � � . ,.. . !�?:.
, � � LOCA�'I�1 01A• $U�LI�TPZ� �:.; t �,, � '_ . �;{ , � • �
. . ,•1. ..
NO.� %�_ �TREET�wt F�ig ' C�,° l�l�� _. �
� aT .Z F;, �/� BLOCK � G ,ADDITION OR . S�BDIVIS IQN����i�- .
��' .. :, , . . . , ..
.. ,.
CORNEA LO�� SIDE LOT. . SETBACK . SIDE �_`�A__
SEWEB SLEOATI ,r,,,__ TOP OF FOaTZNG � ' ,, - - — ,
Applicant attach to thia form 7'wa Cert3f3cate� of Survey af �ot and prapased
building� locatiaau J�lr�in , on tbese Certificatea .
, . .. ; ., . a ' � . . ,, ,
: � • _ ; pESCRS�ICtJ� 0�' B'UILDI� • . . • t . .
,� •� . • . . , - � ..- -
To Be �lsed As s ' " :� 'r{ . . . .
. . ; ,. � �. . / ! O
_ �.g��-° Front �;, Depttt� � He3ght__`��
. .;, �,��
�. ` ' . ��, ''.. . Square feet 3s� Cabic Feet �`�' ��� �
F�oAC �•Deptb Height•
. •, � , - .
. _. , , ; _
y Sq�iare feet � : ;:• <�Cubic FeeC ,
� � 0�� �• -o 0
Tqpe of Cans�ruct3on e^Bn�� Estimsted Co�t l '
To Be Completed � i � 8� � ��
,�_
The undereigned hereby makes application for e permit for tt�e work herein
apecified, sgreeiug to do all wotk in str3.ct �aco;dance �,th the �� 4€
Fridley Ordinaaces sa�l s�li�gs of the Department of Buildiogs, aad hereby
declares that all Che facts and represantations stated in thie application
are true and correct.
DATE � _ . _'1 �� 6 _..._�_SIGNATUR�--r����.,�2����'' .� _ _ ..
(Sohedule of Fee Coata caa be €ouad oa the Reverse Side).
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• BULLDiNG PERMIT FEE , SCHEDLI�.E �: � "> �::.
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, SECTiON. 2. The. Iitapector of �uildin�s. shall,, before ise�in�:��.p�;ra�i;�ei°'#or
the erectiott of �ny buildiag _o� st�t�cture� or-for any additio�ii C�i �anq
- exi�ting eEiuctuie �or. b�iidi,��y _o� f�r :any aZterati;on or repai�s ��ri �riy
e�cisting buildi�sg or structure, uprnl applicaiion,th�refote, �equi�e th�
. . the payment by the applicant �for suah periui� of 2'aas to tbe adnount::ii�serein
��lew �et £orth and in the �mat�r►ei h�rin prov�ided td-wi�:
_ _ .. � _ .. _: _;' ';. • .:).:iw+.'�i . - ,— �.�; � .
_- Uniform suili�ia�` Code: �� �l�gpe 1, x, 6 4-. $1;��5� ��or 'each one thousaad�'cubic
feee, sr fractio� thereof, in auch cubical conteata.. Type 3 S S-_ $1,.50 £or
. . ,each one Cheusand. cubic fe�t. . . : . . . � � ` � . , ? " �
. ,. . r. , .w � _ , ' . ' ....� . . . _ . . - . - '
F�r:the-pur�oe� e� computing feea`.€oz b�ild�rig peim�te. Che eubical��`
eantents ef aay building or additiaa t� a u��.form height;.t�hroughout 6g
multiply3Ag the ground area coverea frem a pofnt s3a (6) inchea below the fioo�
line �f tlae basement os�the ceila�r te`the average hei�bt of ehe upper surface
=-�t• tl�e�:rage �ietghC c� t� rot�f��s�rEa�--�-th� t�i�c�i �l�a►f�a- --- - - . _ _---
__ . - �
pitched .�oof . , _ . ; . , , .
. .>..Fo; _re�ai:a�. or.:�altiaratione to aa existin�,: s.truc`tur:e, the fee shall b.e..at the
r�Ce of $3.0� per each five hundred dollars ($500.00) or fraction thereof
. .. ._ . ._in; �he->�ost of a1Y� propos�d., wsrk. . . .�: ; .
. .. __. . .�:�,
_. In nq"c'�e��.ha.];��r,ths fee cha�cged f�r areq:-�rin�t :as set �orth in. Section 2 be
lesa than $S.AO. '
' _ :�..:: ��.' �„i .. ,. �_ ' ' _ . .� _'' ....^�5....
NS3SD Cena�etion Charges based an locat3en- �rea 1 or 2. � S,
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SUBJECT
; City of Fridley
� AT THE TOP OF THE TWINS
; , BUILDING PER
MIT
, �
� �L _ COMMUNITY DEVELOPMENT DIV.
r � � PROTECTIVE INSPECTION SEC.
� i ,
`-__.� �"" �,� CITY HALL FRIDLEY 55432 NUMBER REV.
` 612-571-3450 910-F15
JOB ADDRESS 5�2 K�m�,ll Street N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 42-43 E Rivervic�a Heights
2 PROPERTYOWNER MAILADDRESS
Robert Freude 572 Ki,mball Street N. E.
3 CONTRACTOR MAILADDRESS
R,,; lders & R�nodelers 3 517 Hennepin Avenue
4 ARCHITECTORDESIGNER MAILADDRESS
5 ENGINEER MAILADDRESS
B USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW
8 DESCRIBE WORK
Reside �aellina
9 CHANGE OF USE FROM
STIPULATIONS
DATE PAGE OF
5/24/83 / /
17163
9��%
APPROVED BY
SEE ATTACHED
SHEET
Z�P PHONE
Z�P PHONE LICENSE NO.
827-5481
ZIP PHONE LICENSE NO.
Z�P PHONE LICENSE NO.
O ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
x
TO
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING. V1.A�7].
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING
AUTHORI2ED IS NOT COMMENCED WITHfN 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 8E TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT $5,990
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE
PROVISIONS F ANY OTHER STATE OR LOCAL LAW REGULATING CON-
�RUCTION� THE PERFORMANCE OF CONSTFiUCT10N. $56.50
E
SIGNATURE OF CONTRACTOR OR UTHORIZE T 1DATE1
�IGNATUFE OF OWNER UF OWNER BUIIDERI IDATEI
PANCYGROUP
SQ
STAILS
VccUPANCYLOAD
CU. FT.
:T PARKING
GARAGES
$2. 99
4L FEE
$ 59 . 49
IIS IS YOUR PERMIT
CITY Or fRIDLCY �fiective �u9, i, 19e1
APPlICJ1Tla� FOR RCSIDCNT1/1� BUlLD1i1G PLR�IITS
(Nc,r. Alterot�ons. Additio�a. or Rcpairs)
orr��R: ��`3��3 � �f�� T��'� BUILDER: _� � i � ,o ti�'�1�.� -��_ �ya�,e ,e i�<
�
ADDP.ESS: � 2� �/�"I l�/�`�-G- j/'�� ADDRLSS: _3 S�/� %1��N� �{- ��-
TEl A0: ' ' TEL N0: �� `7 � f'�h� �'/
—
- Construction Location
—
• iTRLST NO a �- 6TItEET: _� / 1/Ui 1� J/� �- �,—S f � �-.�
2.OT: - � � - �'aj_�1I.00C= �DD2TIOHa �� �j' //v �/L; � /`f ---
----- � � /� 1�%%S
Cornez Lot: �_ =nsiele iot: �_ km��}= ____ Sid�yar�:
11pp2icant attscA to tl�is tor� t�wo Certificates of S1�rvey of lot ar�d
pzoposed buil�ing locatian erawn on eertificates to scale.
� . OESCRIPTIOit OF COIJSTP,UCT10f�
�- -� ld� Front: De tl�:
P Neight:
aquare Faei: Cubic Feet:
. Front: DePth: lieiyht:
6quare Fest: Q�bf c Peets
�
, j�oY� .
�YP� o= o�rstruction: _ �1' �'' .�/,Z� �)°�s G ��T�/ib`+ ' � �
. Estfa�sted Cost: `: � �%1'� `
7b 8e Cbr..plcted:
� 711t. A � �►1 t. 8
pzopcsed Dzivcti�ay iiidth If Nev Opening Ie Desired: :�` _^_
• - . 6EL RiVER;g SIDE OF bHF�T
e • • '
��e undessigned ?�ereby mal;es applie�►tion foz a per�eit icz the ��ozk hereir� apecified,
egzeeinq to l!o ,all vork L, 6trict •ccosd�ce with the City of Fridlep OzBinances end
rulii�9s of the Del�►�=bnert of Dvildingt, and ?�ereby declares thr►t all the facts and
seprea�t�tiens stated in t]�;s application are tzue and cosrect.
a�rF: _�� �� _ s�cN�►zv�€:
att�lacio„s:
����Z�
� ���
✓� ������'
,
.
t�
�
Sl7ILDING PERMIT !FE 6CHED�LE
The Inspectoz ot buildin9s •hall, �etore is�uing permits fos tAe
•r�ction ot �ny Ouildinq oz strneture, oz toz any a0dition to any
•sistiA� buileiA9 or stsyetnse, oz ior ary alteration oz s�paizs
to any •:istinq Dnildinq oz •tzuctuze. vpon •pplieation theseioze.
s�quiz� the payaent �y tAe applieant toz such permit ot ite� to tAe
•sonat etzeia belov set toztA ar►a in tT�e sannez bezei� p:ovided to-vit:
Tar,ii. vu,v�►�aN
=1.00 !� i5�0.00
SSO1 !a i2,000
i2,001 !� i2S,000
i25,001 to i50.000
�s
i10.00 ll3ninum Fee 515.00 plus surcharge
=10.00 tor the iirst t500 plus S1.S0 foz each
•dditional i100 oz tzaction thereof, to and
ir�cluding i2.000
S32.S0 toz the fizct 52,000 plus 56.00 foz each
additional Sl,000 oz traction thereof, tc and
ir�cluding i25, 000
:170.Sfl toz the first S25,OOD plus S4.50 ioz
eac1� .aaittonai a1,000 or fraction theseof, to
ar�a including t5�, 000
i50,001 t�c i1C0,000 :263.00 !os the fizct i50,00� plus
each additional 51,000 or fzaction
ar�e inciue�r� sloo, o00
=100,001 and vp i4d3.00 ioz the first 5100,000 plus
each additional 51.000 oz ir�ction
PI�W O�C7C: 25 percvit ot building permit fee
S3. 00 ior
thezeof , to
S2. 50 fcr
thezecf
DRIVii�tA1 DEPRESSION ES(�t�ii: Conczete Q�zb Stseets d�ly
111teznate 'A': Resn�v�el ar�d zeplaceioent of c.vzb ar�d guttez only ,
Ozivevay vidth pl-us 6 feet s 513.50
111ternate 'B': Re�oval ar�d zep2sceAes�t of curb ar�d qutter and install a 3 foot
vide approsch vith 6 inch depth
Dzive+:ay vidth plus 6 teet x i15.7S
V£RIFICATION OF FOUhDATION
Permita toz constructiar vil� be issuee a �einim�n of 24 houzs i:ao the time of
application to allow foz proper zeview of the proposed structuze and of t?►e
const� ction site.
11 Certificate of �n+ey of the lot. showing the loeation of the four�eation once it
has been oonstructed viil be zequired before proceedir�. vith the fra�oiriQ.
��!
�
�����HEATING HOUSE HEATING TEST RECORD
AIR CONDITIONING
AND ELECTRIC, INC.
ADDRESS_ �� � �'►l�.tBAI.L �J°�r i1PT. FL�OR CITY ��1� SUBURB
OCCUPANT L7�(�9 CK8bP1, � �OWNER Si�M�
HEAT LOS3 �{t�l(�l � F�Tf� DATE HTCi. INST. Q-I f�� 9�
SOLD BY�7LAfK� irl�AT ONSTALLED BY ��1V.�� f�C�i
Electdeal Work By Oas Une By __$ird QCISTI(�(a
TYPE OF HEAT GA FA HW STEAM_ SPACE HTR._ UNR HTR. OTHER
G1AAS DESIGN CONVERSION
MAKE �B {�Y� RAAKE OF BURNER
Model �5 n � (� Model
Serlal � � 1 �-s � IHa�c. BTU Rat(ng
INPUT D MAKE OF FURNACE
THERMOSTAT
Valve �
Limlt �"C'
Limit Selting _
Fan Selting _
Pfiot Typa �
Pilot Make _
CONTROLS
f�
Vent Size �
IKIND OF LINER /8?�par� g�g � NONE "
Draft Hood Regulator i�? �
Flltere siz. /� .oL� X � Number �
Chlmney Loeation Inslde � Oufside
Chimney Consiruetlon � Lf�l-Sc, i�
Pilot Model �--- Smoke Bomb °"—' Wiring ��`�s ''
Pilo1 Timing __ 3� SG°�� E12Ei,o Draft "�' T�t Tag�_�/ �•� c
L W. Cut Ott �"� Door Pressuro °'� Ughting Inat. `�f ��
Pressure o� j� a.J� �Aercent CO� t:� Date Tested °-% Z� � �..
InputCFH ��� Percent0� �'� CompanyTesting L/g'/%�� �"EI
Stack Temp. � °� Percent CO Name of Tester l�i ° '�
Form 235
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CITY OF FRIDLEY
6431 I.TNIVERSITY AVENUE NE
FRIDLEY, MN 55432
572-36U4 FAX: (763) 571-1287
-----.._.._..�_.
PERM N0.:200401076
�
DATE ISSUED: 07/12/2004
I ADDRESS : 572 KIMBALL ST NE
I PIN : 033024230014
LEGAL DESC : UNAVAILABLE
: LOT BLOCK
PERMTT TYPE : PLUMBING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 200.00
NOTE: COMBUSTION AIR SHALL BE PROVIDED PER UMC CHAPTER 6 AND TABLE 6-A. INSTALL A GAS WATER
HEATER.
# ELEC WATER HEATERS 0 # NEW FIXTURES (EXIST OPENI1�iGS) a
# GAS WATER HEATERS
# GAS RANGES
VALUE (FOR 1�IINIMUM CALC)
APPLICANT
H P PIPEWORKS
3670 DODD RD STE 100
EAGAN, MN 55123-
(651)365-1340
C�1`:/�I �I C7
' OSBORNE DONALD E & MARY
572 KIlVIBALL ST NE
I FRIDLEY, MN 55432
1 # GAS DRYERS
0 # OF NEW FIXTURES
200 # WATER TRMT APPLIANCES
AGREEMENT AND SWORN 5TATEMENT
This pemut becomes null and void if work or construction
authorized is not commenced witin 60 days or if construction
or work is suspended or abandoned for a period of 120 days
at any time after work is commenced.
I hereby certify that I have read and examined this
application and know the same to be true and correct. All
provisions of laws and ordinances governing this type of worl�
will be complied with whether specified herein or not. The
granting of a permit does not presume to give authority to
violate or cancel the provisions of any other state or local law
regulating co ction or the performance of construction.
AUU��C�IIt_ � Date .
Bldg Insp- -� ���`��� Date ` ITi a
PLBG PERMIT MINIMUM FEE
PLBG FIXTURES (NEW OPENINGS)
PLBG FIXTURES (EXIST OPENING5)
WATER TREATMENT APPLIANCE
WATER HEATER - ELEC
WATER HEATER - GAS •
GAS RANGE FEE
GAS DRYER FEE
STATE SURCHARGE, PLBG FLAT
TOTAL
PAID WITH CHECK # 9176
SEPARATE PERNIITS REQUIRED FOR WORK OTHER THAN DESCRIBED ABOVE.
0
0
0
0.00
0.00
0.00
0.00
0.00
35.00
0.00
0.00
0.50
35.50
Building
Inspections
763-572-3604
DATE � � f
SITE ADDRESS _
THIS APPLICANT IS:
.,
r�
BUILDING
RESIDENTIAL APPLICATION
CITY OF FR.IDLEY
a
YOUR E-MAIL ADDRESS
0
❑ OWNER @�ONTRACTOR
PROPERTY UWNER/ NAME: dD a wa (�Q (3� �j�v v� -�.
TENANT ADDRESS: .�7:L ICs-u... �c�. Vl S°'� � CITY
PHONE: 7tS �—% 8 6"� �j 7 7
CONTRACTOR NA�: �. e ' ' '
SUBMIT A COPY OF STATE LICENSE ��
YOUR STATE LICENSE ADDRESS:�
WITH APPLICATION pHONE 6 " %C�I �
PROPERTY TYPE � SINGLE FAMILY/M
0 TWO FAMII,Y/NEW
PERNIIT TYPE � �DITTON
❑ BASEMENT FWISH
O DECK
TYPE OF WORK: 0 �
❑ MAII�REN,4NCFlRR
DESCRIBE WORK BEING DONE: Q
S�ZE OF IlVIPROVEMENT
RooFnvG �
NUMBER OF SQUARES �
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other . •
wnvnows
IN EXISTING OPENINGS DYe.s OPdo
OR FOR NEW OPENINGS-DESCRIBE S1ZE OF
OPEAiWG CHANGES 8c
TYPE OF WII�iDOM TO BE INSTALLED
��ct v� v P's
•3 �`% E3Q' DATE
�ROOF
❑ SIDING
❑ SWIIJlNIWG POOL
�l
18,HOUSE 8c GARAGE
❑ ATTACF�D GARAGE
O DETACHED GARAGE
OSoffit
❑ Trim
❑ Fascia
L�ATION OF WIN�WS
� �W � ��V6
SIZE
STOItIFS
❑ wwnows
❑ DRAIN TILE
O OTt�R
� /
' � �-
� - - -. : � ��
� . - ► _ � i�'�i�
STATE��LIP S� 2
o�SSTA7'&!�IP •��
i
9dIDTH HEIGHT
BASEN�N'T RIIvIODELING SUBIvIlT:
1. Facisting Fi�r Plan
2. Proposed floor plan
3. List of struct�ral members to be used
F�.
FOR NEW CONSIRUCI70N IIdCLUDING DECKS,
ADDITIONS. & PORCI�S SLBMIT:
1. Site Plan/Survey showing the existing swch�res
� PmPo� ProJ�
2. Two sets of construc6on plans
3. Energy Calculations
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ay O O OCCiJPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surchazge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Char�
� . S See Back Page for Fee Schedule
$ 65% of Building Permit Fee
$ ,5- � .001 times the total job va(uation
$ �'� l,7 .0005 x Permit Valuation Minimum $.50
$ s. i9� $5.00 (State Licensed Residential Contractors)
$ $1675 per SAC Unit (Plans to MWCC for determination)
$ ft+6ft= ftx$21=$
$ $450 Conservation Plan Review
$ Fee Determined by Engineering
-$— Agreement ne�essary ( ) Non Necessary ( )
--$ _ , Make c6ecks aavable to: Citv of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a building permit and I aclrnowledge 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
pemut but only an application for a it 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 whic es review approval of plans. �
SIGNATURE OF APPLICANT PRINT NAME �� I�/�I� DATE �/`� / u�
a ��f%
, l�`�G �`- .
� ����"'/ ��/VV .� -� ._
Page 2- Builda.ng Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief Building Official shall, before issuing permits for the erection of any building or
structvre, or for an.y ad.diiion to an.y existing building or structure, or for any alteration .oi repair
to any existing building or structure, upon applica.tion therefore, require the payment by the
applicant for such permit of fees to the aznount herein below set forth and in the manner herein
provided to-wit:
VERIFICATION OF FOUNDATION
Permits for construction will be issued a�_�um of 24 hours from the time of applicaxion to
allow for proper review of proposed strueture and of the construction site.
A Cer[i�.caxe of Survey of t�e lot, showing the loca.tion of the existing foundation will be
required before proceedi.ng with the framing. New Houses Onlv
� City of Fridley
Building Inspections Department
6431 Un�iversity Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977