AF - 47842�
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City of Fridley, Mimn.. ,
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BUILDING PERMIT NA 6396
nate: ,�' � ��'" � �
Owaer: � Bti9lder �
Address Addrese —
� �.O�TI�i!��- I�NG
No. � Str�et � � - � ✓ Part t
Lot �' '"- lock Addition or Sub-Divisfon ����' -�.�''.---��
Corner Lot �� Inside Lot Setback �—� _ Sideyard ��_ �T
3ewer IIevat4on — Founda.tion IIevation
DESCRIPTION OF BUILDII�G
To U .
Front �. Depth � Height � Sq. Ft � G'u. F't ��
nt Depth � I�eight ��. Sq. Ft Cu. F`t.
, 7.j►�e of Conatructlon ��� F�t. Coat �.��.�- '--�To be Completed
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/ �� /, �� �.
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In consideration oP the fasuance to me of a permit to construct the building
the proposed work ffi accordance with the drescrlption above set Porth and in ca
or�inances oP the dLy oP Fridley. � v% ,�
In camslderal3on of the payment of a fee of
,
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permit is here'6y granted to
above I agree to ao
�Ith af 1 7Sioviafons of
to construct the buflding or addition as descrlbed above. This �ermft is granted uPon
the expresa c�ndition that the person to whom it is granted and his agents, einployees and workmen, in all work
doae in, around and upon said building, or anypsrt thereof, shall conform in all respecta to the ordinance� of
Fridley, Minn�ota g location, conatruction, alteration, maintenance, repair and moviag of bufldinga
within the dty limits�a d�thia pernnit may be revoked at aTMY time upon violai3on of any of the P�visiona of said
ordivances. /� . oa /i
�� �
n Nonc�
'Ii�s permit dea eot eerer fhs coeslrnetloe, tealaqaNen Po� �rMng, plumbing, en heaNeg, awar er waisr. Bs sms fo me
th� BQildle9 i�der hr aipuata p��hs /or lhas i�ns.
✓
OVJrier �° 9
Addres
APPLICATIO�T �OR BUILDil1TG PERMIT
CITY OF Tc`ItIDZ►EY, 1�iNNESO'I'A
�� � 3 � � .. �
• , Ad�ress_ � ,
Loct�Taoiv o� sua:�vz�c
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No. Street �,� � art of Lot •
Lot � � ��i'� �� � 8].ock � , Addit n or Subdiv�.s �.o
Corn�r ?�ot Inaide Lot Setback„�Side-Yard��,�,_
SEtidEYt ELEVATION �'OUNDATIOIV ELEVATiON
Applicant attach to t'�iis form CertiLicate of Surve� of T,ot and
proposea building locat3on.
..To Ioe used aso
DE��tTPTION Oi� BZJILDING
� Depth � � i3eight
Sq. Ft. I�"1- � Cu. Ft.
Fsont_______ DepL'h_„�I�eight
Sq. Ft. Cu. Ft.
Type of Constzuction �� G�►'�`°�- Estimated Co�•�,�% �����
r, a/ c�— D < �� y1;.,� � i� _
lo be
T°he unde=signecl hereby makes application for a g�era►it �or the work
herein speci�c�ted, agree�.ng to do al1 work in strict accordance with
the City of Fridlay Oscdinance� and ruling o� the Department o� 8uild-
ings, and hereby cleclares that a].l the faete atid representations
s�ated in th3s application are true and cprrect.
�1.- � � r � �' IQITATUIaL•' e •
DATE �1.-
(Schedule of Fee Cosics can be xound oa the Reyerse ide).�
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suir�naN� pE�crr r� sc�nvr�
Sec�tion 2. The Inspector of Buildinr�s ahall, befoYe issuing any
per�ni•� for the erec�ion oi any building or struc�uace, or for any
addi�3on to any �x�.stjnc� �uilding or s�t�cuc�ure, or for any alte�atione
or repa�.rs to any �xis�t�.ng buiYding or s�ruc�cure, upon application
�Iz�reior, require �he pay�nent by �the a�plicant Lor such per�nit o�
:�ees �o the amount herein belaw set �ortY� and in the manner herein
px�ovided to-wito
2.1. For any such pe�n3.t for �the erecti.on o�E any f3re-proo� building,
o�:Tner than a garago, wa�rehouse, factoxy or grain elevato�, or for �the
erect�.on of any i�re-p�oo� addition, for s3milar occupancy, to any
exis�ti ng bu�.lding sha11 be at the rate o� $1.9�0 for each one thousand
culoic feet, or ��action thereo�E, in such cubical conten�s.
2a2. For any such perm��t �or the erec�ion o� any fire-proof gara e,
wa�ehouse fac�o �
, ry or grain eleva�tor, or �or the erection o:� any sise�
prooi addi�tion, �or si�nilar occupancy, co any existing bu�ilding shall
be at the ra�ta oi $1.25 yor each one thousand cubic feet, classi�ied
as "�iteproo�" by �eci:�.on 502 0� the M3.r�n,eapolis Building Code.
FIO�
2.3. For any such permit for the e�ec�ion of any non-fireproof build-
ing o�,her than a garage, warehouse, fac�ory or grain elevator, or any
non-sixe�roo� addi��on., for s3milar occupancy� to any ex3.s�ting bu3ldingo
Pe�cmit $1.00 for each one thou8and cub ic feet.
�xG�s
�
2.�. For any such �erra3� for the erection o� any non-fireproo�
garage, warehouse, �actory or gra�.n elewator, or for the erect3on of
ar�y non-fireproof addi�3.on, for sim3.lar occupancy, to any existing
buiid3.ng or �or each such building or additione Ninaty Cen�ts for each
one �housand cubic �eet or fraction �chereof, 3n the cubical contents
the.reof wi�h a min3.z�nwv o� $4.00.
T'or the purpose o� compu�ting fees for bu3lding permits the cubical con-
tents o� any build3.ng or addition to a unifo�m height throughou� by
multiplying the ground a�cea covered ;xom a point six (�6) inches below
�he rloor line o� the basesnent or ce�.la:� to the average height of the
uppeY surface or �CO 'che average heigh� of the roof surface o�E tlze nta�i.n
gable of a pitched �ooi.
2.5. For repairs or alterations to an exis�ting structure, the fee
shall be at �he rafie of $3.00 per each Fi�e Hundred Doll a�es ($500.00)
or i�actior� �hereor in �the cos� o� all proposed work.
2.6. 3n no case shall the fee�ehaz�ed sor any permit as se� forth in
Section 2 be less tb-�a $q,.00.
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�. C. C��C«��� C�i1tC� c�SSOC�Gt��s� �UtC.
LAND SfJRVE'f�RS
Ac�oka, Minn�sota
CERTIFICATE OF S13R�'EY:
Ralph Lund
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� DENOTES
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CL 1 Y e:.l : Y 1 L' � Ll �� V�.L e7 � �� �� a
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c�a�t�� M�n�e�ot�
1 HEREBY CERTIFY THAi THIS IS A TRUE AND CCRRECT RFFf:Fs�MTATION OF A SURVEY OF YHE BOUNDARIES OF THE ABOVE
DESCRI6ED LAND, AND THE LOCATION OP ALL BUILDirJGS, TMcR;r �+d, aND ALL VISIBLE ENCROACHeAENTS, IF ANY, FROM OR ON SAID
LA1dD.
AS SURVEYED BY ME THIS .�,lt�d DAY OF ... .��e..�'.�'�5-��'� � ��
.. _ , . ... ................... A.D. 19.'. .:.. ...
N. C. HOIU:n AP�:� AS5 CIATE� INC. — 1AND SURV�YG'�S
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�r ��ss ca�.ccna►noxs '���F � � �`' ��a�°t�r oF��nvcs ,� � _ �E�.r,� �' ��� � �' � • ��°�
A.S.H.V:E.
Weatheratrips G� Coaswction IVo. . �. Fnsulat�op .
Windows Doors � Reference Out. Wall In� Wall Ce�7ing Roof . Flooa K'u4d How �lpplied
Yea—No (; Yea—No 19 � . � � �
F7.� a��� Roont Gength �' ""'Widt6. +�' �="Height �`'� o:: � Fl.� �� � kr''� <�$ Room Length � � ``�idth �, �°�feight T-�
• Windowa and_ Doors—Crackage and Area . .' .• Windows and �i?oors--Cracliage end Area
�Vldth Helght Na ot Lfneal [. Aroa . Wldtb 8elght No. ot Llnea! fk Aeea .
'�TO. ot Daoe o[ Dan Il6bts ot craCk �p: tt � No. ot pane . of pane flghb of craok p. tb • • '
' ; d<,. �j,� �y- ,� . �." . _='#� ° `�e;. , � .,�y . . � � ,�,` `•,� °�: .y � � ` ' '}"i�p; � � .
.�k r` 'v t, ,ar �as_,::, ,�-;-,�.% �Yl L,. . . ���. . ,
't � 9� ` F r
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� .. . . � - � � �. �� �'.,». :P� .,��r� ��� _ .�,=�,� . .
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• ' Coef. �tn �•' f � e �` � � a� u � '� r �,° �ee% Btu
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�O�I�ifB�IOD. _� � . ���$ ' $ f � �eP8t100 . u� � v' . � pa' �-' r5'' F.'�y,�3:
�855 ' ��� -� �°°. a� :`� �8fs ' _ sa� c,R> _, �° f �'+.'�
6,
F.sp. w8�� f ',x° '�;�� �,}� ' �° Q.i 'f� GEp. �1/8� ce� ii` �� `�' f: _�d '
--Net esp. wall � ' i re� . �' �'` � �' - �; �:'� Net ap. wall ' . � � ; � �, 4 � � � :� ; .�>
_ k
Int: wall In� wall o.
CCl�lllg r� �� F s : ' .' �$� � . � �� � � `�� vCYl�g Zssi1 �', ;1�, s =X � �,xf � r,
� a5 '�' �`` "`� � Floor �- �:, ,.� f> n_°� -
Floor � ' ,s� �`- �.. � �. _ , ,
Tatal Btu. . �� ' �'� � ' Total Btn. . � � �` ��- r
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Required sq. h. �E.D.R. or aq. ine. W.A. Leader area .. �� �q. h�E.D.R. or aq. in�. WA Leader area
p�� �; . � n p��� ���L v
� �. •I ",� �Fa ��"� a�"' l�Wm I �� . .�,1� '. =�� ' :,,�. R�^+�j�t rrv-� '�r f �.I �` . ._`�'�y;`I i�pp�' �� f , `�:,_. �MLO . �f'� ' .p�� .
_.tA .:.i _ � a ,,..�
w�iadowa $ad D�ra�eracka� ana Area �� w-mdo,+va .nd noo�—C�nk�e ana Area � �
WId4h HWSpt Na of Lfoeal ' � WIdW 8at�ht 1Va of .Llneal i4 Ares
Na ot e ot paae: llsbts ot craeic q. tt Na ' ot pane o1 paas ll�hta � ot erack sQ. ft , �
� .. �`'�l' .: ;�,.gc' �. �, n . �° � + ' . . �A ye+ �':;. � �`.� . �, � e� i�. F"� Pa 4,F , . .
� . Coef. � Btn
�In6ltration � �� � _` w ; �' ]n6ltration
6,,;,..A_ ��, —
Glaaa � � . �= :-�� �-, � ��; d= Glaes
EZn• wdY � '' :'c, Sf ai s � . . � � A . �. � ��" x. „
�,.. �, _ . � : -.�
NGt esp. wall ' • � � a � -" �';" ]Vet pcp. well
In� wall � In� w+all
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m° fr� .
YM T�Ct
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Cedmg. . � �7 • � ,� �� a�,� Ce�lu�g � �' ` � f� �-; ;' � _ `�' '�-
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Floor . . . , �' � � Floor �� �a �'� ��';y
Total Btn. , � �:: � � � Total Btn. . °�� � �"
Required aq. fw E.D.R. or aq. ms. �A L;e�der ana �--- ----- Reqnired sq. k. E.D.R. or aq. ina. W.A, Leader area
j ��L ,. ., ��{� �;^� �:;, / p�� '__,�p, ��L .�* L p� �
.�' �� ,r�r �S i :fi� r F f�: -l� ( �� .a'�" `- ' ��1�[4 - k#. ..'%"_,�.r`O�`� d.. _'°a . �� d^ .t .r'*� : 1'?'4�un.x" 1W��1' �w: f� .�"'.. ��I�fO- ;p'�t� . K^ `"lG��l� .�'Se �
am .. o.- �
Windows and Doors--Crackage and Area � Win�wa aml �oora^Crac�ag�e and Area '
WIdt6 Hef6Dt No. o! Lineal tt • Ares . Wtdttr Helsht 1Va ot Ltnaal [4 � Arer
Na of psue ot pans • Ilshb ofcridk W..f� . Na oGpane ot psne Ilght� .o! eeaok ia. tt
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. �. . . q--.�' A�c 6- �I:' - -u� :�l�� 1..
I" ;..1 � IF" ,t y .? �' . >. �.}"� V� ��>: , A�.. A K_ '
. . p',..fr. ,i' �'., ��- y .ai:,' �f tY'9¢�, � �l'.' , �v �+,�`^ v�--�- r - '
.E,� > e ` �<" cr.� - - �" . j�" ya� sdh. .F`p ��� �� f +:�..`;, � � .
r, i�_ r � g,�" a g" �' .?'_,�. , .
� �,.
� . Coe#. � . &u . Coef . Btn
' � � . � � ;a � ¢-
1n61trat�on � � --� ' �' `= �:� L�6itrafion - .�.� �� • � �' �' �
, . . E �� �; . cY� �-� 0 a.t� �' 'r,t �8i8 ' y `r'r'- . � a , �fi� .,�
q�
' �'!�1� . � t � � ' . . � '� `,yi . . � C� r 4' k�' . . � - _ _.. .
. r1lAY � _: 1 �,� .;� -�e. �Y• � �' � �� �? � -"� n? q;,i
.N2� E� waU • �' � 39R ¢a' �'-' rr��' �`.:`• NtL EIp: W8� ' � ,a��A;'��F S�" �yl�'�� �� � ;,
, ��
lnw t�aU : ., . � Ia� wall .
Csiling , "�, . �. . � � . � ,� . � � •� �� �:,:� Ceilin8 �" � . . �r E$ ,� ' °a+' �e ^; s ,�.��,,, - �' � �" ro' d°,�', �. ��.
Fla�or � . ' . � � _ � `: � �,r" P -� � � � Floor � �' :�u � � � _ � "`�,
. "ToW �. .. . . � ,�•� ,� � ". � �':� Total Btu. : � � � � Y�.' � � ;�
Required ig. h. E.D.R or aq: ina. �.A. L:eader erea � �� Required �q. h, E.D.R. or sq: in�. WA. l.e�der area . �
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City of Fridley, Minn.
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- BUILDING PERMIT No 7438
> ._
Date: � �` �._�°' .� �� �
OvKtter: ° Buflder / / �� 1
Ad&ess A
�OCATIO P BUILDING
No. G� Str�et y! `������ ,���. � �.�.�' Part Lo$
Lot m -Slock —� Addition or 3ub-Divfsion
Corner Lot —�Ine�de Lot .+. Setback .��:.�.�__._ Sideyard �� F�
3ewer IIevation Fo�mdation IIevation
DESCRIPTION OF BUILDING
as:
Front � '�' Depth � Height �� Sc�• �'t. ��L.�
t Depth �� ght Sq. Ft
t?�
Type oE Conatruction 't�r. F.�. a�� � To be Completed _
Cu. Ft ��� -�—=
G�. Ft.
In cansideratton oP the i�usnce to me of a permit to conatruct the bwllding descrll�d above, I agree to do
the proposed work ffi acc�r�iance with the drescription above set forth and in complfance;;with all provisf oP
cc ��
ordlnancxs oP the dty oP Frldley. ��° "'
�► ��i . - -_ �. �- . ; � .
�
Ia cona4derat[on of the paymeat of a fee oP $��� , pera►it is herebq granted to
to conatruct the building or addition as d�crYbed above. This �ermit is granted upon
the egpress condition that theperson to whom it ia graated and his agente, employees and workmen, in all work
done in, around ead upon said building, or anypart theneo� s6all conform in all reapects to the ordinance� of
Fridley, Minn�ota regarding location, camstruction, alteration, maintenaace� repair aad moving oP buildings
wlthin the dty limfts and thia permit may be revoked at any time upon violation�f aay of the Provisiona oP said
ordinaIICxa. �. � �i / /
Ins�et�r
n Nonc�
�. � aoe. �rof eewr �6. ceratrueH�, t�#aWHee �e. w6i�. Plomt+L+a. ea MaNes. �swu or wate.. s. w�. i�s a. �
N» Buildieg lesp�er ter ap�rw p�e�6s ter �h�a N�na.
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APPLICATION FOR BUILDING PLP1�T
CITY OF FRIDLEY, MINi�TES�TA
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ZOCAZ"�ON OF BIIII,DING �9
No. %� � ���^� �� - �°.� Street �art o� Lot � �"�°S'a
Lot �� �lock AddiCion or Subdivision ��c. �/���� 3�
0
Coraer Lot I� Inside Lot Setback 3� f Side Yard �I' �
SEWEli ELE�TATION FOUNDATION EL�VATION
Applicant attach td this foran �wo Cei�tifiC�tes of Survep of Lot aud proposed bui�.d-
ing location dr�.wn oa these Certificates.
DESCRIPT�OP� OF $UIZDING
To be used as:
%
� - � . ,�,
��, Front � o? �: �Lh � aZ _ Heighl� �i,,�
�`� �- �
Sq. Ft. �`" � Cu. Ft. �� � �� !'�
� `
Front Depth Height
Sq. Ft. Cu. Ft.
�
Type of ConsCruction �� �,.�-� Est3mated Coat ��� ��� _
To be Completed �� % ^- � � � � -
The undersigned hereby makea application for a permit for the work herein specified,
agreeing to do all work in strict accordance with the City of Fridley Ordfnances and
rulings of the Department of Buildiags-, and hereby declares that all the fac�s aad
representatioas stated in this application are true and cor�ect.
�
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�Schedule of Fee Gosts can be found on the Reverse Side).
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BUILDING PER��T F�E SC;iEDULE
Section 2. The Inapector of �Buildin�e et�811, before iesu3� atiq peamit for
the erection of a:ay b��ild�ing or structure, o�c. for any addition to any e�:ist-
ing building or strucCure, or for any alterat'ions or rep�ira to any existing
building or seructure, upon application therefor, require the pay�aeat by the
appl�cant for euch permiC of fees to the amounC hereia below set �orth ar.d
in the manner herein provided to-wit:
2.1. For any sucb permit for the erectioa o.i anq f3re-proof buildiag, other
than a garage� wareh.ou�e, factory'or-grain elevatot�, or £or the ereetion of �
aay fire-psoog addition, for similar occupaacq, to any existing buildir_g
ahall be at the rate of $1.40 for. �ach, one :thousand cubic feeC, or fractj on
thereof, in such cubical cantenta. "�
2.2; For any such permit.#os the erection of any fire-proof garage; warehouse,..
factory or grain elevator, or,for the erection of any ffre-proof additic�a,
for similar_occupancq, to any eaciating"'buildimg shall be at the rate of $1.25
for each oae thousand cubic feeC, clasa3,fied as "f3reproof" by Section SG2 of
ths M3nueapolie Building Code.
BQUSES
2._3., For any �such permit for the erection of any non-fireproof buildir.�; a�:i3er
thaa a gasage, warehouse, factory or grata elevator, or anq aoa-fire�rc�1�
addit3on, for similar occupancy, to any existia� building - permi,t $�,�pL gQs
eech one thousand cubic feet.
G _S
2•4_, For anq . such permiC for ehe erece:�t�,� �^ �r; non-fi:.Apx�of gara�e,
..�warehonae, factory or grain elev�tor; r�• {;,�• ►.tl� ��•�,:�ion o;� any non-fira�roof
additioa, €or •eimilar occupancy, to r=;;• ,�zr� s�;.r_� �,.= G d�ag or for each sLCh
__ -� l�v�ld3ng or_ addition - ninety cP*.at� �; ;;, �s?d ��,� eF,�;a oae tho�asaad culoic feet
or fraction thereof, ia the cu��c�� �C:4''Ti�r�:, ther�oi witb a minimum of $4.00.-
For the purpose of ca�puC3.ag Eees far t��awdin
of any.building or addition to a uaifQr.a hei lhtpthro�8houtebcumulti l�in the
ground area covered from a�poine six (6) inchea beZ�w�the floox.line of �he
basement or. cellar to the average height of t�ae r��F�per sur¢ace or to the �
aver�ge height of the roof surface of the main �able of a pitched roof.
2_5. l�or repairs or alCeratioa� to ea exiatia� structure, the Fee ehall be
a� the rate of $3.00 per each Five Hupdred poYlars ($5Q0.00) or #raction.
thereof�in-the cost of all proposed work.
2; In no case shall tti2 iee_. y��� � � �
Section 2 be le�s. thgn�$4.�pp� ��� ��_�� � set,for�h ia.
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' ' � THE E. B. MGDONOUGN CO. ' � 333-8478 .
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742 BUIL•DfiRS EXCHANGE BLDG.. MINNEAPOLIB L�S402 TELEPHONES { g48•8888 :� i ��
' 3CALE� 1 INC�EET i8S3 UNlYER81'fY AVENUE, ST. PAUL S8f04 . ,
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OF PROPERTY OF �, "'� � ��P�? llS'�P�' `�D�"% �/�tl �'� �• � / `�- . '� � ; �I
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� DESCR�BED AS.FOLLOWS ���� iC7 �"Q��Q.C.L'��E��G . � `'� �� �,
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CEP.TJFICATE OF LOCATIOIQ OF BUILDING • .^. CERTIFICATE OF SIIBVEY .
�� v 136� • I hereby certify that on ]� �" � I I� G
I herebvi certify that u*+ �
I mn�'e s suiroey of the locution of t'do buildm„ (s) o I B�eyed the property deacribed above and thut the abovo I� ,(,` �
aucvn described property and that the location of said "plat is a correct ropresontation of satd survoy. il ,,'i'i��l''
huilding(s is aorr ctly, otm o th9.�qbova plat.
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E. B. MCDS3 H. REG(STERED SURVEYOR. No. 1990 �
PAULJiC E. " •• No.44d9 �
JOFI . YAN. • '• . � _'� No.4489 , i
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o. 13$'2:r[ B2eClaln Hedmen Saha: i. �_-� {
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sue.i[Cr RMIT NO.
City of Fridley 3 0 8
AT TME TOP OF TME TW�NS � � I L D I N G P E R M I T
r
; ` RECEIPT NO.
� ; y__���_ COMMUNITY DEVELOPMENT DIV. � o��
r � � PROTECTIVE INSPECTION SEC.
1 = �
� /'�'1 � CITY MALL FFiIOLE� SS132 NUMBHA NEV OATE VAGE O` AVPROVED BY
���"'� � �'' 612-571-3450 g�aF�S 4/10/00 � �
J08 ADDfiESS 600 Kimball Street NE
t LEGAL ��T NO. BLOCK TRACT OR AODITION SEE ATTACHEO
oesca. 48,49,50 � P Riverview Heights SNEET
2 PiiOPERTY OWNER MAIL ADORES$ 21P PMONE
Robert Hasher 600 Rimball Street NE 784-0248
3 CONTRACTOR MAIL ADDRESS Z�P PMONE IICENSE NO
Same
e ARCMITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDFiESS ZIP PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION O ALTERATION pX REPAIR O MOVE O REMOVE
8 DESCRIBE WORK
Reroof House & Garage (22 Sq) Tear-off
9 CHAN(3E OF USE FROM TO
STIPULATIONS
Underlayment must comply with the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
SEPARATE PERMITS AiiE RE�UIRED FOR ELECTfiICAL, PLUMBING, HEATIN(i.
VENTILATING OR AIR CONDITIONING
TMIS PERMIT BECOMES NULL AND VOID IF WORK Ofi CONSTRUCTION 20NING S0. FT CU FT
AUTHOR12E0 IS NOT COMMENCED Y�1ITHIN 60 DAYS. OR IF CONSTqUCTION
OR WORK IS SUSPENDED OF ABANDONEO FOii A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTFEET PARKING
I NEREBY CERTIFV THAT I HAVE pEAD ANO EXAMINED THIS APPLICATION 1 STA��S GARAGES
AND KNOW THE SAME TO BE TRUE ANO CORRECT. ALl PROVISIONS Of LAWS VA�UATION SURTAX
ANO ORDINANCES GOVERNING THIS TVPE OF WORK WILL BE COMPLIED @
WITH WHETHER SPECIf�ED MEREIN OR NOT. TNE GRANTING Of A VERMIT y�1,923 $.96
DOES NOT PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL THE pEqMIT FEE SAC CMARGE �
PROVISIONS Of ANY OTHER STATE OR LOCAL LAW REGULATING coN• �69.25 Fire SC �p1.92
STRUCTION OR TNE PERFORMANCE OF CONSTRUCTION
PLAN CNECKFEE TOTAI.FEE
$72.13
�TUpEO�CON'AACTOpOpOUTMOp�ZEDOGENT �O�iE� yyM PROPERL� VALIDATEO THIS I$ VOUR ERMIT
N��• 1`��2�"�e� �--/`, - az� // �d
S�GNATUAE O� OWNEA ��% OWNEa BW�DEp� �DAfE� lpG �NS� �� E
. L
NEW
ADDN
ALTER
� � Effective 1/1/2000
� I CITY OF FRIDLEY (763) 572-3604 Bldg Insp
[] SINGLE FAMILY AND DUPLEXES R-1 AND R-2 �O� �^ �/
BUILDING PERMIT APPLICATION �
�� '�.V
Construction Address:
Legal Description:
Owner Name & Address: �� ` � Tel. #
Contractor: MN LICENSE #
Address: Tei. #
Attach to this application, a Certficate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
LNING AREA: Length Width Height Sq. F�
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER: a l ����o � a e�— �I� S�P D '� _ �
Construction Type: Estimated Cost: $ ��r�
' , , �.�/
Driveway Curb Cut Width Needed: Ft + 6 Ft = Ft x$ _$
DATE: ' � O� APPLICANT: �'�°��� �- � Gtic''� Tel. # /�.3 � %��%42�/'�
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ -��l� Fee Schedule on Reverse Side
$ � � .001 of Permit Valuation (1/10th%)
$ ��_ $.50/$1,000 Valuation
$ $1100 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 �rmits 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
�low set forth and in the manner herein provided tawit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,0(�
$25,001 to $50,0{�
$50,001 to $100,0�
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $500 plus $3.05 for each additional $1(� or
fraction thereof, to and including $2,U00
$69.25 for first $2,000 plus $14.� for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,Q00 plus $10.10 for each additional$1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,000 plus $7.00 for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,000 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $SOO,Ot�
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,Q00 or fraction thereof, to and including $1,000,000
$5,608.75 for the first $1,000,000 plus $3.15 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 $15.50.
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 $23.25.
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 construcrion site.
A Certificate of Survey of the lot, showing the locadon of the foundation once it has it has been constructed will
be required before praceeding with the framing. New Houses Onlv
�
Building
Inspections
763-572-3604
763-502-4977 FAX
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-2010
Permit No.:
���� � �
Received By: f'
Date Rec'd: ��
DATE /- ✓ YOUR E-MAILA A�DDRESS /��1�171T Kt L�� GONYI CCJST iL'eT
SITE ADDRESS �o � I11 i�9 � S �t� / y�
THIS APPLICANT IS:
PROPERTY OWNER/
TENANT
CONTRACTOR
SUBNIIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BEING
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
� Other
❑ OWNER �ONTRE
NAME:
ADDRESS: ���� �Iiryll
PHONE: %�03 '� ! S� �
NAME: rltS ��1[3I iY1'!
STATE LICENSE # � O ��
EXP DATE vs _
– ' -
PHONE — C� � FAX
j� S GLE FAMILY/NEW CONSTRUCTION SIZE
❑ TWO FAMIL W CONSTRUCTION STORIES
❑ ADDITION ❑ GARAGE/SHED ❑ WINDOWS
❑ BASEMENT FINISH ❑ ROOF ❑ DRAIN TILE
'�.DECK ❑ SIDING ❑ OTHER
� SWIMMING POOL
❑ NEW HOME CONSTRUCTION ❑ ADDITION
❑ MAINTENANCE/REPAIR _ ❑ REMODELING
WINDOWS
IN EXISTING OPENINGS ❑Yes ONo
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
� TYPE OF WINDOW TO BE INSTALLED NUMBER OF WINDOWS �
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
�. ( THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ ���� OCCUPANCY TYPE
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
�Soffit
� Trim
❑ Fascia
LOCATION OF WINDOWS
Z��
'ATE,rn�IP�
L
�1
_STAT$!�ZIP�
u
FT / aV �
BASEMENT REMODELING SUBMIT:
I. Exisring Floor Plan
2. Proposed floor plan
3. List of shvctural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
ADDITIONS. & PORCHES SUBMIT:
I. Site Plan/Survey showing the existing structures
and proposed project.
2. Two sets of construction plans
3. Energy Calculations
FOR WIl�IDOWS - PROVIDE U-VALUE AND
MANUFACTURE STICKER ON WINDOW.
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surcharge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
See Back Page for Fee Schedule
65% of Building Permit Fee
.001 times the total job valuation
.0005 x Pernut Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2100 per SAC Unit (Plans to MWCC for deternunation)
ft+6ft= ftx$24=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pavable to: City of Fridlev Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VALID UNTIL PROCESSED
I hereby apply for a bu� ding permit and I acknowledga that the information above is complete and accurate; that the work will be in
conformance with the ord ances and of th ity of Fridley and with the Minnesota Construction Codes; that I understand this is not a
permit but only an applic 'on f a permit an wo is not to start without a permit on site; that the work will be in accordance with the
approved plan in the case 1 ork which r uir review and approval of ns.
� �
SIGNATURE OF APPLICANT ( PRINT NAME n i O DATE
PLEASE NOTE: SEPARATE PERMITS ARE REQUIRED FOR PLUMBING, ELECTRICAL AND MECHANICAL WORK
Moline
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