AF - 47945sus�ecT PE
City of Fridley 2�. 0 3 8
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
i � R .
� � COMMUNITY DEVELOPMENT DIV.
�' PHOTECTIVE INSPECTION SEC. �� � �� S
•
� _
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i---. A �/�",,, CITY HALL FRIDLE� 55432 NUMBER REV. OATE PAGE OF APPROVED BY
Z �� 612-571-3450 910-F15 8/30/91 � �
JOB ADDRESS 1630 Kristin Court NE
t IEGAL �OT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. ].0 1 Heather �d�CS SHEET
2 PROPEHTY OWNER MAIL ADDRESS ZIP PHONE
Brickner Suilders Inc. 6240 Hwy 65 #207, Fridley 55432 . 574-9871
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑ ADDITION � ALTERATION ❑ REPMR O MOVE O REMOVE
8 DESCRIBE WORK
Construct a 48 � x 36. � Dwellin� a,nd a, 32 � x 25 � Ga,rage
9 CHANGEOFUSEFROM TO
STIPULATIONS
Pzoyide a, ha.rd sur�'ace driveway. Provide sod in the �'ront and side
yards. �rovide City with.copy of vexi�ying survey be�ore capping. See notations
on p1a,n, Elevation to be appoxamately l� �eet above curb level as agreed upon
with 1636 Kristin Court. Paid $1,500 Park Fee. Paid $800.00 Storm 5ewer.
SESniER & WATER LOCATIONS: Check with City Engineering Dept.
���;�����
B�#a�� digging call fo�
SEPAR�TE PERIVIITS REQ�J�RED �OR � al1 utility, locatit�ns
� Q�-0002
iN�Rt�G, HEATING. PLUMBING AND SIG�lS. ����,�E� �� ��
TYPE OF CONST. OCCUPANCY GROUP QCCUPANCY LOAD
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORI2ED 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 OFFSTREET PARKING
�
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION ]_ STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX '
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $1,23 � 9OO $GI..9S
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE SAC G�JO. OO
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $723.50 Fire SC �S`�.23.�0
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CHECKFEE TOTALFEE
1,559.35 + PF&S5
SIC,NATURE OF CON i RACTOR OR AUTHORI2ED AGENT IDATEi WHE PROP l ALI TE T IS IS YOUR PERMIT
X�?�� � _ � �- 9 � � �
_
SiGNATUFlE OF OWNER IIF OWNER BUILDERI IDATEI BLDG iNSP �p7E
�� [ �
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� �� I�1 �It�ID I�2
Building P�it Applicatian
Oa�tructian �iddress: i 3� �C'�C, f S i/«'' � T
_. : � � «� •1 •_ �
EffeCtive 1,/1/91 .
ow►�er Na�oe � "' � �: (U Y � c IC ►� e ►r 13 c� � 1 c� � � s �- �-a c. Tei. #--S7e/ - %�7�
aorYtracta�': 4.� v � t 1< � ` � �3 c� i 1 c� e v � -�- �, L 'rel. � �7 �f ' ��% /
,
�ic�ress: �, � �/ C� /�'�-° v � 5 �� � C�°�7 �dL 11�L � y ,/�'� / l� y� �S y 3 �
LiVII�1G ATtF�:
1i'aRef��. �:
� �i
Vi�i�l� i
Attacii to thi,s applicatian, a Qeitific�te of S�uvey of the
lat, with the p�cpoF�ecl casttvc�ian drawn an it to scale.
DB�C3t�'iZ0l�T �+ II�AGNH�II3�Tr
I��gth _� i�l�tarh � aeic�,t sq. Ft.
I� �3 a wiath a� 8eic;�t sq. Ft.
� Wiii{il �V' iV\Yii �• l �.•
Cbrner Iat [] Inside Iot [] Ft. Yd Setb�3ck Side Yani SetbacJts
Zype of o�t�c.�tia�: Estimat.ea oost: s 9������"
Appirox. Ck�pletiaei Drate:
Ptnpoe,ed D�iveway Width If New Opening Is Desired: Ft. $ $
Width + 6' See Back Fage
DAZ�: _� � � � 9 / APPLZCANr: �Z ��, Zte1. # S 7 i� - �� � /
�le�tit Fee $ �.�`_� � � �
Fire S1ur�sarge S B�'� a���
State S�e $ � d o�'�
SAC Q�ge $ �� �
�aiveway Escccw $
Patk Fee � $ ��
��� ����; ��.� �a.� $ � �,r�a
. ��
S'I'�JIATI�:
�`
�
$ �a��do'��
« �_,_ .y�
F1ee Sd�ech�le an Iieverse Side
.001 x Pexmit Valuatian (1/lOth $)
$.50/$1,OQ0 Valuatian '
$650 per SAC Unit
Alt. *'A" C�' Alt. "B" Above °
I�ae De�trermined by �i r�r; �
Aqr�e�t NeoessaYY [ � Not N�eo�sazY []
I �-`3, �i � t"
���.�=���
a� >
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r�.'F � 3� S�� � `I � Ca �
���: �
I �_�r� �i�, c �,';�r�4 �-,: _ a:i. � �i _
�e �ief Buildir�g Official ehall, befa�+e 38suirg permits fcr the erecticri of any
�; � dir�q a� �tzucture, a� fo� any additi.an to at�Y eaaistin3 buildin� aar stn�cture, or
for any alteratian a� i+e�air to a�Y �9 ��n9 ��, i� ePPlicatiaai
�ore, raquite the PaYmer�t bY the applicant fa� etrii petmit of feps to the a�otazt
��Il 17EZQ�/ 6� f�t1 aT� �T1 �1E �arnrar �iTl �'W�C� t0'i�T�t;
�� VAIIJE
$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
i��a.
S15 (Minim� 1�Iee is $15 Plus �)
S15 faac fiist $500 plus $2 far each edciitia��al S100 or
fractiCn ther�eof, to eT�d ir�cludit�g $2, 000
$45 fa� fiYSt $2, 000 plt� $9 for each addit3a�c�a1 $l, 000
Cz $aCtian t2�el�eof, to at�d fncludit�g $25, 000
$252 fo� first $25, 000 plus $6. 50 fa�' eadz ac]aitiac�al $1, 000
er fractian thereof, t� and ir�cludirg S5o, o00
S414.50 fa� fitst $50,000 plus $4.50 for ea� additica�al
$l, 000 C2' fiactian the=eof, to ar�ci including $100, 000
$639. 50 foZ' fir5t $100, 000 pl�; $3 . 50 fc�r e3cii edditio�al
$1,000 or ITaCtiGn t2rrecf, tc aT�d inClud,islg $500,000
$500,001 to $1,000,000 $2039.50 for the fiist 5500,000 plus $3 for each additional
$l, 000 ar fraCtiGn thel'eGf, to et�d izlCludiTlg $l, 000, 000
$1, 000, 001 ar�d up $3539. 50 for the first $1, 000, 000 plus $2 for eac3� additional
$1, 000 a� fractirn thereof
IItIVF.�Y LEPR'R88I�N �BC'liOIW
(Qoc�ccete Q�b StYeets C1�lY)
Alternate "A" : Re�noval ani replaoe�t Of atrb arid gutter anly - Drive�ray width plus
6 feet ti,me� $13.50.
Alternate "B" : Re�o�ral ani replave�t of wrb ani gutter and ir�tall a 3 fovt wide
apQz�oach with 6 indi de�th -�~ive�ray wi,dth plus 6 feet times $15.75.
.'�� i�_���'�' M � �I
P�ermits for �ian will be issued a m3nia� of 24 i�ouis fr� the time of
epplicatian to allvw fe� p�per review of ti�e p�vpos�ed etn�u�e and of the
eac�tivctian site.
A Oertificate of �v+ey of the lot, showing ti�e locatiaci of the faar]atian a�oe it has
it i�a.s been oocL�tn�cted t�ill be z�equired before pmooeed.ing with t2�e fram�in�.
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�ri�ckner
�uilder�
r' . 6240 Hwy. 65, Suite 206, Fridley, MN 55432
57 - 7-�---
- November 10� 1989 �
. �
DeMac. Homes Inc.
14405 21st Ave.
Suite 118-B
Plymouth� Mn. 5�+47
Attnt Keith McConnell
Res I?rainage at 1636 Kristin Court
Lot 9, Block l, Heather Oaks
Dear Keiths
After our telephone conversation the other day, I checked the grade and found
it to be very flat along the South line.
As I mentioned before, I feel some retaining may have to be done to keep the
water from backing up into your south side basement rrindow.
When we build a home on lot 10� Ne will be setting the home at the prop�r height
to achieve good and proper drainage. The lox area on our lot that is presently being
used for your runoff xill be eliminated and therefore Brickner Builders', Inc. will
in no way be responsi�ile for at�y drainage problems you ma.y incurr, after the construction
of a home on lot 10.
I am addressing the problem at this time eo it can be cor�Cected t�l.thout involvin�
the home oWher or the city.
�N E4R6 C
Pu� � 'dd
res�
cerd ohe d ��8i
1, S.wti�
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6. S!
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snd 2 when aldktonal eervlees a►a deslrad, and eor
t0" 8�s'as br1 nvsrss slde. Fedura to do thle wlll
a �I the nam of t er�
ne ees s ces ere evs a. onau
ido�el esrvtceUl raqu �
:4ta� ertd eddnaeq'� rddreii: �. 0 Reetribted De
. 1� e1 ,
�sed t4; �• . . , ' . � ' ,(�rticle: Nt
b . , . ��. .. .... - �, p T�J of Serv
• Reglstsred
ertHtad
�Dro�
Alwsys obttin
A ar apeen end C
PS Fon� 3811,,�er..,1y98
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Res�`ec �ully, ,;7 '
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" Brickner B ders'� Inc.
's (�^ (� � .' ...,. •
0 Insured ' `,� : t, ' c�: ,
❑ COD '
R+�ce t
� r�iara,��e
ure of addrstsee
xl mrd fie pmtd)
, � �
DOMESTIC RETURN RECEIPT
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�
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r J.Q. AN�ERSON'S �
� architecturo►I consulta►nts :...
sooe s� sr. a. E. osseo. r�. sa;ss rN, �s�t-K4-stss _...--
- --- - - - -- -- --- --- -: ._._ .,.� a..0 ...•
Plon �' ! � � —"�.° Oate � �
Owner�
Contractor•• ' �-'��`
Site Address� PHONE
1)TOTAL EXP03E0 WALrL AREA 3�� � sq. ft �i�U�! �1' a���•�
2) TOTAL EXPOSED ROOF�EILINQ AREA ��Z� s4 ft. x'U"' ��- �•�
MfALL AREA CALCULATIONS� .
. �
10TAL WINOOW AREA
GLAZED
70TAL DOOR AREA
?OTAL GLASS DOOR AREA
GLAZED
TOTAL FIREPLACE WALL AREA
TOTAL WALL FRAMING AREA
NET INSULATED WALL AREA
TOTAL RIM JOIST AREA
TOTQL FOUNDATION AREA (EXPOSED)
TOTAL FOUNDATION WINDOW AREA
� 7 � sq.ft.x�U�� ,�� %� r
� sq.ft.z�U��•�� = Z` 7
�e� sq.f� z �U�� '�� . �
�`� sq.ff.z�U��� - �
��I `��II,x'�11�_ o �
��� � `�"
�-� t'�` sq.ft.z�U�� '.� = Z � �
!�' sq.ft. x U�� -D� _ .'S^�
�� sq.ft.x�U�� � I� _ �Z � ,.
°r`�.,. sq.ft.z�U�� �.�. _ �
3) TOTAL
!f item 3 is the same as, oi less fhan ltem l, you have met 1he intent of
2 MCAR l.16008 A on d O.
ROOF/CElLINO CALCULATIONS�
TOTAL SKYLIGHT AREA
?OTAL ROOF��IUNG FRAMING AREA
NET INSULATEO ROOF CEILING AREA
�` �q.ttx�U���" - �°�
� ��- sq.ff.x�U��'�'_ � •�
��3 � �.. sq.n.X'u"�o2.2 = , �
� 4) TOTAL . `� ' �
_. If item 4 is the some as,or less than ltem 2, you hove met fhe Intent of
2 MCAR 1.16008 A ond 0.
ALTERNATE BUILDING ENVELOPE DESlON
.• To utilize ths fofol snvelope system meMod, the wm of ltems 1 and 2 iholl
_ be Qreater than the swn af Items 3 ond 4. .
1) +2) �
3) +4) _
� 1 hereby certFfy that fhs bufldlnp here descrtbed meets or �xceeds the tate of �mesotc
Ei►�rpy Conservaflon Act.
I�r.....al
���„� � � I ��, Qi� �ONSTRUCTION
FRAMING SECTION
iatertor otr film . 0 66
> �'' S1�t,4t .•4S
S St inches ot soN wood L�1
q ='�'I �C ��.+t-�+f L o L
I� S�G�..� � ► I
g exterio oir film 0.17
, '� TOTAL R � ( ' �
u=uR �°�
SECTION (INSULATED)
! i terior oir film 0.6
� " s.+�, �.� , 4S
3 S� '' rse�.+ �.� 1�1, o
q L51 sL �..+ •..� r�L l, o G�
5 s,�s,x b I
g exterior oir film 0.►7
TOTAL R L� • ��1
)IST S�CT�ON
4
5
U = VR �_
'nter�or oir film 0.66
� �' (1�vi�+ 1ra I `i , o
�'1 � S-C� ..wyo ( � oi
L �11 6.J ��F N-E t. o..�
� :� � Jea � � l
exferior oi► film 0.1'7
TOTAL R � � �
U = 1/R o �
ATION SECTION
� interPor pir film 0.68
-,�
Q ��I TQe 1.-+7 � o
3���
G�.t� v� I� �,� '2.
a �xterior oir film �
5 _ 0.17
TOTAL R � �%
U = 1/R�_
�
�
VENTED
CONSTRUCTION •
�EILING SECTION (INSULATED)
( � �interior air film 0.61
( 2 ''J� �a�r�rszc�K � sco
� ` 3 C�L��/hl 1 N� ` 1�
( q exterior air film (still) 0.61
. � TOTAL R . 4s• � g
U = i /R , OZZ
CEILING FRAMING SECTION
( � interior a!r film 0.61
( 2 �B Srr��r�cc,c. � Slo
( 3 -�ww�-a.� I Nsu�, 33
(q, interior air fitm 0.61
(5 �inches of soft wood 4,�5
. TOTAL R 3`�'� � 3
U = I/R �DZ.lO
CEILING SECTiON � INSULATED).
( � interlor air film 0.61 .
(2
(3
(4 exterior air flfm (stlll) 0.61
. TOTAL R
U = I/R
CEILING FRAMING SECTION _
( �.interior oir film 0.61
i�
(3
(4 interior Qir film 0.61
(5 in'ches of soft wood
.TOTAL R
.!1 = I/R
EXPOSED BEAM CEILING SECTION
(,� interior a1r film 0.61
(2.
(3
(4
(5 exterior air film 0.17
_ TOTAL R
i . _ w
L = I/R
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CHIlII�TBY lIND BT�CE VBRIFICATION
The undersiqned hereby verifies that the existinq chimney or stack:
1. Has been carefully examined Yes () No ()
2. Is free from rust or deterioration Yes () No ()
3. Has no foreiqn objects lodged within Yes () No ()
4. Is securely supported Yes () No ()
5. Meets all current Code requirements for
size and total BTU's connected Yes () No ()
6. Has total heatinq BTU's of
All other BTU's
TOTAL BTU's
Remarks
List Alterations Beinq Done:
HEATING COMPANY
Signed By �
Date '
-
_
CITYOF
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(612) 571-3450 • FAX (612) 571-1287
December 10, 1991
Brickner Builders
6240 Highway #65 N.E., #208
Fridley, NII�i 55432
Re: Final Inspection at 1630 Kristin Court NE, Fridley
Dear Sirs:
A final inspection was conducted on December 10, 1991 of the above
address and the following item must be completed before the
structure can be finaled:
Complete final grading and sod by June 1, 1992.
We will expect this item to be completed by the scheduled date and
a reinspection called for. Occupancy of the structure is approved.
If you have any questions o� this matter, please feel free to
contact me at 571-3450.
Sincerely,
D G. CLARK
Chief Building Official
DGC/mh
. _
_
C� I 1 �F
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY. MN SS�t32 •(612) 571-3450 • FAX (612) 571-I?87
December 17, 1991
Brickner Builders
6240 Highway #65 AT.E., #208
Fridley, MN 55432
Re: Final Inspection at 1630 Kristin Court NE, Fridley
Dear Sirs:
A final inspection was conducted on December 17, 1991 of the above
address and the following item must be completed before the
building permit can be finaled:
Complete final grading and sod by June 1, 1992.
We will expect this item to be completed by the scheduled date and
a reinspection called for. Occupancy of the structure is approved.
If you have any questions on this matter, please feel free to
contact me at 571-3450.
Sincerely,
�__--.
�
D G. CLARK
Chief Building Official
DGC/mh
�
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 OEVELOPMENT OIV.
r � � PROTECTIVE INSPECTION SEC.
1 . .
i-__-� ��"' �.� CITY MA�L FRIDLEv SS�J2 NUMBER
t 612-571-34b0 9t0-F15
JOB ADDRESS 1630 ICristin Court NE
t LEGAL �OT NO. BLOCK TRRCT OR ADDITION
oescR. 10 1 Heather Oaks
2 PROPERTY OWNER MAIL AODHES$
John Mlinarcik
3 CONTRACTOR MAIL ADORESS
Suburban Exteriors 9701 Penn Ave S Ste 1
A AHCMITECT OR DESIGNEFi MAIL ADDRESS
NEV D�TE P�GE Oi
8/31/99 / /
�E"RMIT NO.
30143
RECEIPT NO.
� �/ /
APVRpVED BY
SEE ATTACHED
SNEET
ZIP PHONE
572-8483
ZIP PHONE �ICENSE NO
�5431 881-8232 4289
ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDiiESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW O ADDITION ❑ ALTERATION 7� REPAIR O MOVE ❑ REMOVE
B DESCRIBE WORK
9 CHANGE OF USE FROM
STIPULATIONS
TO
Underlayment must comply with the State Bui.lding Code.
SEPARA7E PERMITS ARE REOUIRED FOq ELECTRICAL, PLUMBING. HEATIN(3, TYPE OF CONST.
VENTILATING OR AIR CONDITIONING
TMIS PEFMIT BECOMES NULL ANO VOID IF WORK OR CONSTRUCTION ZONING
AUTMORIZED IS NOT COMMENCED WITMIN 80 OAYS. OR IF CONSTRUCTION
OR WOiiK IS SUSPENDED OR ABANDONEO FOii A PENI00 OF 120 DAYS AT
ANY TIME AF7ER WORK IS COMMENCED NO DWLG. UNITS
1 HEREBY CEpTIFY THAT I MAVE REAO ANO EXAMINED TMIS APPLICATION
AND KNOW THE SAME TO BE TRUE AND COqREC7. ALl PROVISIONS OF LAWS VALUATtON
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILI BE COMPLIEO �3233
WI7M WHETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT
OOES NOT PRESUME TO GIVE AUTMORI7Y TO VIOLATE Oii CANCEI TME pEFMl7 FEE
PROVISIONS OF ANY OTMER STA7E OR LOCAL LAW REGUlA71NG CON• $97 � 25
TRUCTION R TME PERFOfiMANCE O ONSTFUCTION
PLAN CNECK f EE
r�-��� Li cens
S�GNA UpE OF CONCFACTOp OA 4UTMOp4E0 AGENT IO�TE� . �u s �
iD�iE�
S�.
S7ALLS
$5 .
OCCUPANCV�OAD
CU FT.
' PARKING
GARAGES
$1.62
AC CMARGE
Fire SC $3.23
DTA� EE
7.10
MIS IS �GGUR PERMI
�
rrEw � � �
ADDN
ALTER
Consuuction Address: �
Effective 5/10/99 � � � � �
[ ] CITY OF FRIDI.EY
[� SINGLE FAMII.Y AND DUPLEXES R 1 AND R 2 ��
BUII,DING PERMIT APPLICATION �
� / �. -.w 0 d � (1_ ,/1 A1 . � o . h
J
Legal Description:
�^�\
. "J
Owner Name & Address: � �� V ,� �.;��i�,� v / � .3� /� �,e�,Tel. # S �1 � ° c�' �! � �
Contractor: �„�,�-���.�, �C�yc.,��.� t.A NIN LICENSE # L! a� c� �
Address: �� '� � � N�m1r � :�;� � � ��Q. �/ � `� Tel. # � cS / ' �i � 3 �
Attach to this application, a Certificate of.�urvey of the
lot, with the proposed.�onstructioa drawn on it to scale. °
LIVING AREA:
GARAGE AREA:
DECB AREA:
Length
Length
Length
DESCRIPTION QF �1�OV�IVIEEN'T
Width Height Sq. Ft.
Rlidth Height Sq. Ft.
Width _ Hgt/Ground Sq. Ft.
01'HER:
. � °�� �� � �� �
Construction Type: Estimated Cost: $ ( �
Driveway C�rb C�t Width Needed: Ft. + 6 Ft = Ft x$
_$
DA1'�: � °36 ��1 � APPLICANT: �`��r �, Tel. # �S � 1 " �S � � �
Permit Fee $ ��%��^
Fire Surcharge $ , �3
Sta.te Surcharge $ O � �
SAC Charge $
License Surcharge .$ S. -UC7
Driveway Escrow $
Erosion Control $
Park Fee $
Sewer Main Charge $
TOTAL $ l C� � � �U
STIPULATIONS:
CITY USE ONLY
Fee Schedule on Reverse Side
.�1 of Pemnit iTaluation (1/lOth% j
$.50/$1,000 Valuation
$1050 per SAC Unit
$S.CO (�tate Licensed Residenrial Coaatraetors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
� , P
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,�01 to $z5,000
�25,�1 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
$23.50
$23.50 for first $SQO plus $3.05 for eaeh additional $100 or
fraction thereof, to and including.$2;(�30..
$69.25 for first $2;0(�D plus $14.Od for each additional $1,(I�3
or fraction thereof, to and including $25,000
$391.25 for first $25,000 plus $10.10 for each additional $1,00�
or fracrion 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,OUO
$3,233.75 for the first $500,000 plus $4.75 for each additional
$1,000 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,� or fraction thereof
DI�YVEWAY DEPRESS�OI�T E�C�30W
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Altemate "B": Removal and replacement of curb and g�tter and install a_:3 footi wicie
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 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.
FTcOM :City of Fri�ley
Building
�ispecti�ns
'7�3-572-3�0�
FAX N0. :7635'11�87 Uec. 02 2005 dB:5�A�h P2
$��L���(� Permit No,: DD�
JCa,�+ SLDENTI.c�I1 AP]PI.1XC'ATX(]I�I �te�;�ed �y:_-�-
�:�'�� �F ���L�� D�tc Rec'd:
° � YovR �•Af�11L AODRFSS l�/L� LXEQ �. /LE7"
5!1'� AIlARESS �L G ! �„y„
rr�s N►r�r�wr ts: c� �waa�
'�NAIV'�'
�iD��!!T A(:OPY OF S7A?E LC�JS� M
YbUR STATE i.IC`EIJSE AD�RESS: Z.!
Wf17t M�P�"4tCA7'�i rs�,�e !e T 1—
C? BASEM�W'C FlNISN
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DESC1i,Ia� WOId�C ��G DON��
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Sl� OF IMPROV�Ib�Ni' � I,ENCi'i°�I, . : , tiRDTH . :' ` H�T�iHT . Ft, �:
t. , , � , � ..:, :C� 1�OUS� Y . � �, �.r� � , ,,.. . � , - ,
r�r� ct� squ�.e� �,�9 , - 8 j�ous� ��n�it� ... w" � As��aa�ar r��cr � ���
� �y � . � ' ` , � .,�' " . _ . i. �atisling F1oor PUn : �
, _ . ,:. , . ' : .s � ��'i`�ICHED GAR11t��
� � �a � ' ��; � t�,. � Prop� t'�oa�' �Un I
� PRC�'OS I} SI7.�. , . . , � ,�u ; 0 Dd��lC1���Cii+1�t1+DC �_�.-.< < , - ..: = �
FIif�AOS�DFt�tiliT: . _ , • 3. �is�of�a�ruBlamti�hscs�tabi`u�sd
�� F(tR NEW CON57RUCf1tJN (N�LUDING DEClC�S,
�� Rum � � � Trsnt •�DdTl4NS_ � PoR a a t �naaWr �
....,..�._, 0 Fascia
, � P� DJO�. � tl�t axlsl6�g etfuc�res
a. Twa reta oPe��neta� plmia
tN E7B�7'BrIG CP'&AJINGS O1'ea LiNa IACnTtQN OF W9NDUWs 3 Epepgp C�ul� m a
OR FOR N�W OP1sTIMOS-b8SCR18� SIT� OF � I
OY�NMii C'FU�+IGES & , �
Plan Rmvieu+
5urch�rrge
?ji8 $LlfibBf$C
dicense Surch�e
aAC �h�rgo
:urb Cnt �scrow
'srost� Control
'ark Fee
�e�e�Mai� Ch�rgc
AAE BASLID ON VA,Lt1ATION, INC�.�ING Tk�1E COST pF L�,uOlt AND M,A,T�,it.iALS;
(USlIaC itiE i997 i1.B.0 FEC SC��DULE)
� JOdi V14LUATIb1V $ �J. .S7 � nr�rCnh�,Nrv ^rvnr.
� y'7. dS See I3ack Page !°or A'ee Scfadulc
s � 6S•k of Buitdin� Permit Fee
��— (.00OSj t�meg the tof�l job valt►eti�n — Mit�its�um $,SO
s .� .001 x P�mi! V�lUatiwt (1 / l 0°./0)
a �O�? $5.00 (Stata %Icensc�i Rasidenti�l Contractas}
� ��145Q � SAC 1,init (Plans to Iv1WCC fAr dctcnnittatio�)
$ tt*G1tc ftx$20�$
$ $450 Consctvaiian Plaq �tivlaw �'�
� �� Fea actcrmined by Lnginccring
$ Agrecmcnl r.cccssarY ( ) Non tdccassary (� )
� � . - --
- ------__ ._ _..._ .,,. .... ,,. .-� �...c ncprcra23i1 u�wea.oas•
T}itS !S AT! ltPPLICA"�fOM! Ff,1A''Ifi:2tLJtMiT•NQt VALiD UNTfL PRQCESS6U ° .-. �
her�by apply tor � buAdtng peronit ae�d ,l ackno�lcdgm `th��'Gtho �n�'ormatio� above �s con�ptetc���d eccur�te,;.�hsE 4l9�� vi+ork wtlt bo in
mforr�anop wlth c�e ordidances �ead cod�s of �he City o�'�'r�dJcy,�nd`'�lth lI1C MinnCSOtB CoftStruCttOl! �Od�,4; that I underst�nd t'�s, ia �nt e-°�'
srrr6at bUt o�i1y en"applicatiot� ftgr a_parPnflt and wark as not to stari without s J��mtt; that titc woik wtlt bc in`a�cordancc with �he aj�TAVed
an ut'the cas� Qfa!! work vahich raZuia�cs rcview and approv,� pt ., _
�h'A7UR��FAPPt,ICANT � � ,.,T,,,..,. �
Y ��i:�..�
. � � �
�Z��� �
JUL-27-2007 11:�7A FROM:
T=�d
�uilding
Inspectians
763-572�3604
SrTE AbDRi; 5 �.
�tliS Al'FUCAN'r IS:
awrr��
���
SUBMt7 A COPY OF
YOU1L STATE
�1r�SS wrn�
�t,�caTio�
pER1VIiT TYPE
TYPE OF WORK:
T0: 7E's35711�87 P: i?�2
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RES:�EN�'�A.L� A,�'PLxCA'I'I�N
L,,.1 1 �� �� ��l��� 1
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0 OVF'NE7t `�t�OrjTi;ACTOR
PGrmit 1do:'�
R�civcd By:
Datc Rc:c'
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c�'rACr� DBr�: Practical Syst�:m.;
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naDx�ss:, Hopkir�, MfV .y5343
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F�R TK5 16�.665 tbe pa�sK tec is s miai�nm ot �"�.� ar S'�o t►[ the total east up to SSDO.OU� wbich�ves� i� �atee, ftt she
imprt+vetne�ni� �nstSllatton Or rcp�estpeai oi a rrsieir�►tial fixtu�•e. axcludi�B d�e fixtwes. Crnis saoula re�i�cf +�nly thti aost o�labor )
L.�bor cost it�drr 5300 = x] i.08. Lsbor ��ost be�wer,n S3b0 �a SSOU � cost of labor ,r��„ x.OS ��_�.
FaH pxoJECrs vv� v�o� �xcF�s s� �� FEFS A� 3•�15�3 Oh S� O.t�G PER FIXTURL, LXC�Yi' W'3iF�tb �t�D. �a:ra�: c�tc�►zs r+o�r�.,
,��� �� Sa� ,,�. r ��.�_ M4b�l.: �ri ✓�2cJ 5��� ��.
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+� �•� �LAG'� {G,qSj-"�15.40 ,��y{� �/!►S GR�Li.,SiQ.00
�AtR TO Aat F.7►CHAAfGmt Sl5 .�.F�f1EF LIC:E (W�A) Sz5.0U GA,S tJMT H1R 574.00
B4LLSA'�35,00 FtJRNACE #35, 70 �1�D4L l�ATE k 535.00
G11�5IiRYER 510.00
�tt�v�YqWN�[t 5�1�00 �"W�,S 1'1PII�G 510.00 � �.�� �n�4 �lS.OD '���i
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Surcher�e
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.
� �,.�'_r..— i�1U111bEf Qi' �7tltlPl:6 � S� �.� ��� X ���.� � $r��..,..
x � Nusubcr af fixtur�� ��25.00 x 525.00 =�„ �_
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��. N��bcrof ti�cl.vt�:� (� S35.Cd _�x t35.� ��-_. �
Sxid e Surd�argo =
TaW � S�_��
Tl�S iS AN AFPWG4TlOT1 Fi)R A F1�tl�11�'-i�T VA!.ID UNTIL PRClCFSS�ED
1 hereby apply fbr a bullding pefrait aid I acknawtedge ��t �he intarmac�an abovc is �mpJece �d aetu:r.ste; shet ttie''"°rk w�l � in
coa�foia�eece v►tith the ofdinanc�.s end e:odes of �he �'itv of i'ridlty and wit1� �►e Miru�c�ata G�nsuur�irnt C.odes; tl�at 3 ut►derstaad thi� ��
n� n p�rpsn byt q�ly es ppplie�tion for e penait and tivark �s nrt ta st:ac wi[hou� a pumi�; rhst � work v�Ell t� ia �d�� wi+.h t�a
�PFruvod plon itt tbe east�af�all wo�le v� iuth raqwres t+evio�w sud a�pta�al of qtans. `i �. 86'r �.,....% '�7 :�'�%
� �l a. d -
SIGT3AiUR� OF APPUCANC
Ld wH6i:iT 9� �� 'q��
� � City ofFrid�e,y
�uild�:ng �nsp�ctions Department .
Ei431 Z.Jnive.rs�it}' Averi�e NE, Fridley, MN SS43Z
'763-572-36U4
FA:�: ?u3-;(1?.dy77
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Building pl,�g�G Pernut No.: � q
Inspections RESIDENTI�L APPLICATI4N Received By: ,
763-572-3604 CITY OF FRIDLEY ���
DATE �� I�"� I YOUR E-MAIL ADDRESS
S� �D�S L b�c� �I s t 1�• I�1 �
THFS APPLICANT IS: ❑ OWNER �ONTRACTOR
PROPERTY NpME: f i � �
�w�� ADDRESS: � CITY '�Yl d LQ Cn STATF,/VL_ f�ZIP S�� f,�
TENANT PHONE: �I ��-�'% a�- b�'I � �
CONTRACTOR N�; Cham io
SUBMIT A COPY OF STATE LI -�5"1 �O 0�.� �i`L�XP DATE �Z ' O�
YOUR STATE ADD '#� � CTTY STATE • ZIP
LICENSE WITH pHONE � FAX �
APPLICATION
PERNIIT TYPE � SWGLE FAMILY ❑ TWO FAMILY O TOWNHOUSE
TYPE OF WORTC: � ��''' `� �PL'�'��r
DETAILED DESCRIPTION OF WORK ����Ipi0.C�C% �J �V1(L Cc.1'�� � i S IP1Is✓�SI�D�
PER MS 16B.665 the permit fee is a minimum of $15.00 or 5% of the total cost up to $500.00, wIuchever is greater, for the
improvement, installaxion or replacement of a residential fixture, excludi.ng the fixtures. (This should reflect only the cost of labor )
Labor cost under $300 =$15.00. Labor cost between $300 to $500 = cost of labor x.OS =
FOR PROJECTS WHERE LABOR EXCEEDS $500, FEES ARE BASED ON $10.00 PER FIXT[JRE, EXCEPT WF�RE NOTED. FIXTURES: (1NDICATE TOTAL
NUMBER OF EACFi BELOVi�
BATH SINK/I.AV FLOOR DRAINS SHOWER WATER PIPING
BATHTUB GAS PIPING (x�a crrrtrc�rs� SWINMIING POOL WATER SOFTNER ($35)
CLOTHES WASHER �, KTTCHEN SINK WATER CLOSET BACKFLOVJ PREV. ($15)
� DISHWASHER _ LAUNDRY TRAY _WATER HEATER ($3� FOR IRRIGATION
_ WATER MEI'EER _ OTHER
�. - �... , ...c.. `,�iA� ��rg �� �a�:; �cr:� -a",�� �r.z,x ..a�s ID'S �� � �.'S.. �'� j ,� ^` •�iey ':
.�...-3z1.
Permit Fee $ _ - � � Number of fixtures @� $10.00 _� x �$10.00 = $ . p O
Surch e ' .50 Number of fixtures @$15.00 x$15.00 =$
TOTAL DUE $ . - - - Number of fixtures @ $35.00 x $35.00 = $
State Surchazge = $ .50
Tota1= $ p.�Z�
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 Consti-uction Codes; that I understand this is
not a permit but only an application for a permit and work is not to start without a permit; that the work will be in accordance with the
approved plan in the case of a ork which re uires review and approval of plans.
SIGNATURE OF APPLICANT � I PRINT NAME � DATE ����' ��
�a'S,. £, .. xa4 t �%� t � i $'i Z d 5 .� �P -,i.
....
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dh&`!�
City of Fridley
JBuilding Inspections Department
6431 University Avenue NE, Fridley, MN 55432
763-572-3604
FAX: 763-502-4977
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