AF - 47982sue�ecr P O.
City of Fridley _ 20123
' , AT THE TOP OF THE TWINS g � I L D I N G P E R M I T RECEIP .
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. COMMUNITY DEVEIOPMENT DIV.
�' PROTECTIVE INSPECTION SEC.
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� � /�"1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BV
�"""� � �'� 612-571-3450 910-F15 9/20/89 � �
JOB ADDRESS 1666 Kristin Court N. E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 4 �- �a��r Q� SHEET
2 PROPERTY pWNER MAIL ADDRESS ZIP PHONE
Joel Arne
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO.
Brickner Builders 624� Hi,.ghHray #65 N,E�, #208, Fridley 55432 574-9871
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDFESS Z�P PHONE IICENSE NO.
8 USE OF BUILDING '
Residential
7 CLASS OF WORK
�] NEW � ADDITION ❑ ALTERATION O REPAIR 0 MOVE � REMOVE
8 DESCRIBE WORK
Construct a 39' x 22� Dwelling a,nd a 22� x 22`� Ga,xage
8 CHAN(3E OF USE FROM TO
STIPULATIONS
Provide a ha.rd sur,�ace drivewaky. Pxovide City with copy of verifying
suruey be�ore capping. Provide sod in the �iront and side yards. See notations on
plan. Paid Park Fee of $1,500.00. Paid 5torm Sewer Escrow of $800.00
Driveway Escrow: 18'' + 6� = 24� x$13.50 =$324.00
SEWER LOCATION: ����� 38' East of Manhole
WATER LOCATTON: 27`' East of Manhole
nYa EI�EV:
SEPARATE PERMITS ARE RE�UIRED FOR ELECTRICAL, PLUMBING, HEATIN(3, �PE OF CONST. OCCUPANCY (3ROUP OCCUPANCY LOAD
VENTILATING OH AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTHUCTION ZONING SO. FT. CU. FT.
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R^�.
ANY TIME AFTER WORK IS COMMENCED. • NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION ]. STALLS GARAGES
AND KNOW THE SAME TO BE TI;UE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND,ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT .�`114 85Q $57a43
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCT O THE PERFORM OF CONST UCTION. $C�92.O0 $575.00
PLAN CHECKFEE TOTALFEE
� d ' � -�� None $1,324.43 + DW/PF/SS
NATUHE FCONTRACTORO UTHORIZEDAGENT IDATEI WHEN PROPERLY VALIDATED THIS IS VOUR PERMIT
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SiGNATUREOFOWNERIIFOWNERBUILDERI IDATEI BLDG INSP nATE
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1�1 AND 1�2
�; � ciing Pennit Application
Effective 5/1/88
C�onstxuctian Address: �� C� �%�r i S T✓ /� �� ��I-
Le9a1 Desc.'�c'��� _�� T �� �C/C ) %� E�l�"jf1�' ��/C1
Owt�er Naaie & Addres.s : _ c% �L /� /1/ � � . �
ooritractor: rJ� � C/!I9/ C� � U� c,� ���; Tel .# S�� - i�' j
/ �
Address: _ (� �- r� �iGV9i �,( � �'�0' ,��/r✓��J!
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Attach to this applicaticn, a Oertificate of S�vey of the
lot, urith the prc�osed c�onstYUCtian drawn an it to scale.
�t'I�i �' �pg�i�
LNIIVG AREA: Ip �+h _ Width Heic�t Sq. Ft.
� ARII�: Lengtil _ Width i�ight Sq. Ft.
DDCR ARF�: Iength Width Hgt/(�aurl Sq. F't.
O�:
C�orner Iot [] Inside Iot [�] Ft. Yd Setback �s� Side Yard Setbacks /� e- / J�
Zj�pe of Cbnstnu�tion: _fOlAN/,� .S�i%c. �.�i?/6 � Fstimated �t: $ �—
�
Approx. ooanpletion Date: _ J'� - i,� -,�� I{�.
0
Proposed Driveway Width If New Opesiing Desired: ���Ft. V$ y�a� �� $
DATE: �` � i-�� W' + 6' See Back Page
-� �'r�c�,rrr: Te1. #_ ���' � �� )/
Permit Fee $ �� � ► �
State S�rch�t�ge $�s�
SAC Charge S_ ��,��
Drivc�+raY �sc-tvw S ���•OC�
park Fee $ �� ��
S ^ $ �BO�U
�T°u�a�v► �r�a�
. �.
srrx�TTa�s:
$ � �1/�'. �
C,TTY QE �iII�Y
Fee Sci�edu,le aaz l�everse Side
$.50/$1,000 Valuation
$575 per SA�C Unit
Alt. „A" or Alt. "B" l�bwe
Fee �ern�TM� by �i *,�r; *7
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Zhe Quef Buildirg Official st�all, before is.,.�u,ing permits for the erection of any
building or stn�ine, or for any additiaai to any escisti,r�g building or stnicture, or
for any alteratio� or �epair to any existing buildinq ar stnicture, upcxil aPPlication
the.r�efore, s�equire the payment by t2ye applicant for ax� ��; t of fees to th+e amau�t
herein belvw set forth ar�d in ti�e manner i�er+ein p�wided to�wit:
T�►D�L VAt1JE
$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
��
Sl5 (MitLim� Fee is $15 plus surc�arge)
$15 fcr fitst $500 plus $2 for eadi additional $100 or
fractiaai tiyereof, to ar�d includiT�g S2, 000
$45 for first $2,000 plus $9 for each a�litional $1,000
cr fractiaa'i thereof, to at�d including $25, 000
$252 for first $25,000 plus $6.50 for eac� add.itional $1,000
or fr��.ion thel�eof, to and including $50, 000
$414.50 for first $50,000 plus $4.50 for earh additional
$1,000 or frdctian thereof, tp ar�d jncludjnq $100,000
$639.50 for fitst $100,000 plus $3.50 for eacfi additional
$1, 000 or fraction thereof, to and incluclir�g $500, 000
$500,001 to $1,000,000 $2039.50 for the fiYSt $500,000 plus $3 for each a�ditional
$1,000 ar frdCtion therepf, to and jncluding $1,000,000
$1,000,001 ar�d up $3539.50 for the first $1,000,000 plus $2 for each additional
$1, 000 or fraction thereog
BtIV�C �Pi�BI�T ffiC[�OW
(�o�rete Cnrb �reets Only) -
Alternate ��A�� ; Re�moval and re�lace�ent of c�rb arid gutter a�nly - Driveway width plus
6 feet times $13.50.
AlteYnate ��g��; R�noval ar�d re�laoe�oent of c� ani gutter ar�d install a 3 foot wide
ePP�� with 6 incii deg�th -�ive�ray width plus 6 feet times $15.75.
�'I�+: �� �'; M �., ��- ;�_u,�� ; Y •;,
P�ermits for ooa�sttvCtfari will be i,ssued a mini,�r„� �f 24 halr5 fz'� the time of
application to allvw for p�mper review of the pz�ed �� of the
ca�,stnictiaai site.
A Oertificate of S�vey of the lot, st�owing the locatiaa� of the fau�dation onoe it has
it has been aari�tsuc.�ted �ill be � before prco�aeding with the fiavti�g,
RONALD F. NIEYER
° LAND SIIRVEYOR
LAND SURVEYINO SUBDIV1910N DE910N
T6LEPHONE 771-4386
985 J6B81E ST. $T. PAUL. M1NN. 3D101
I hereby certify that this survey was prepared by me and that I am a duly
Registe�ed Land Surveyor unde� the laws of the State of Minnesota. �
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�G R�g. No. 9051 Date: .r,�..� O�
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Lat 4� Bloak 1, HEATHER OAKS� Anoka County� Minnesota.
Contains 9�545 sq. ft.. w �5�0o.o+�a� �.'t� ��� o�FS�- ��0+�
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RONALD F. MEYER
T.A ND SU'RYEYOR
LAND SURVEYING SUBDIVISION DE31GN
TELEPHONE 771-4586
985 JESHIE ST. ST. PAUL, MINN. 95101
I hereby certify that this survey was prepared by me and that I am a duly
Registered Land Surveyor under the laws of the State of Minnesota. ,
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� Reg. No. 9051 Date: � ��
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o Indicates iron monument
Lot 4, Bloak 1, IiEATHER OAI{S� Anoka County, Minnesota.
Contains 9,545 sq, ft..
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RONALD F. �IEYER
- LAND SIIRVEYOR
L.J�ND $VRVEI'IN6 SU9DIV��ION Dee�cN
TEL[PNONi 7i1-4�06
9BS Jeseie $T. ST. PAUL. MINN. a�1O1
I hereby certify that this survey was prepared by me and that I am � a duly
Registe�ed Land Surveyor under the laws of the State of Minnesota.
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o Indicates iron monument
Lot 4� Block 1, HEATHE�t OAKS�. Anoka County� P'Iinnesota.
Contains 9.545 sq. ft..
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archltectunoJ consultants tnc:
s�a s�sT a.s. o:ac.�rw..as6� *u.1��1-us snt.� �.�.- �-
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IiT07AL EXPOSED MfALL AREA ��¢$ sQ. tl s"U".�.L.�
2) TOTAL EXPOSED R�OF�EILING AREA. ��� � s4 tt. �pi!"�
MtALL AREA CALCULATIOhtS�
TOTAL 1KIND01h' AREA
GLAZED
70TAL GOOR AREA
70TAL GLASS OOOR AREA
_. GUIZED
70TAL FIREPLACE WALL AREA
70TAL Ih'ALL FRAMING AREA
NET INSULATED 1h'All AREA
70TA� RIM JOIST AREA
TOTAL FOUNDATION AREA (EXPDSED)
TOTAL FOUNDATION WINDOK' AREA
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1 q'" �q.ttx U" , � =
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lt i/em J!s fhe aome os,o� /ess fhan lfem l, you Aave met fhe In1en1 of
2 MCAR L160A6 A ond D.
ROOF�CEILINO CALCULATIONS�
?OTAL SKYLIGHT AREA
70TAL ROOF��'iEILIhG fRaN,ING AREA
NE7 INSULATED RDOf CEILING AREA
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' lo � 3 " "•ozz = 2 3
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.. N lfem 41s �he some os,a kss fhon Ifem 2, rou Aove met fhe ►ntenf of
2 MCAR I.f6008 A.ond 0.
�1.TERNATE BUIL�iNG ENYELOPE DE8lON
�. To utilire fhe tofoi enrelo�e syatem mettiod� the wm of Items 1 ond ? shcli �
ee preafer tf,cn the :�rm o�f 11ems 'J ond 4. � ,
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1 Aere6� ce►�tfy thot the Ou1ldlnp here describee meett,.pr �x�c-e�ed� Sfott of ,►rrK=�!a
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FRAMINO SECTION
� �Ior ofr �lfm . p,�g
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, t5.,z� P��f-�tE� z ,� .
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TO?AL A • I �}-
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SECTION (INSUL4TED)
� lnfsrlor oir /ilm �g '
2 ���- S R- •4S
3 -S�''b �►.►5 . �9.n
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�IST SECTION '
� %hr�or oir /!fm � 0.68
2 5 �' f.�+� �..rs • �, ��:
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3 - A � ��
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• ' TOTAL N ��
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ATION SECTION � ' ' �
� b�llrlor oir lilm 0.68
p _ � � St�fc- � e
3 IZ c. 6+-+'�' '� : �.2,5
4 �fidor �irlilm ='. , � .
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. . TOTAL R—�• � 3
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�ONSTRUCTI�N • � � •
cE�c a�c�ioN tiNSU�aTm�
' �� �inflrio► eir /!1 0,61
� � S�!'� E'�Q a[ IC .Sfe •
t 3 0.�w� �nt� h— g�
�, �:ferior oi► lilm (sfill 061
. . . • TOTAL p �5,��
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CEiLiNG FRANING SECTION . .
� � jnterl�r oir /llm 0.61
�'j �'� %t�r�et� .Sl�
, �3 '��� I.�s�a�.• • L[Z
�4 Inferior oir Ilfm 061
�5 �rn�rs e� sotr r►noe �.5�
: TOTAL p �°�•i3
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CEILING SECTION i1NSULATED�
( � fnferJ�r oir tilm 061
_ (p s�o. O�c K ; t��
(3 Q SS n_► r, ' �
. �q e:terfor oir tllm (still) . 061
. TOTAL p �,��_
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CEIUNG fRAA►.ING SEC710N . � •
� �,7nlerior ofr tilm pR�
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. �ans� �1.--. � R��o .
. �4 initrior o1r IiJm 0.61
�5 AYZ�nches of sofl vcod S.L
l�- '��'�� .TOTAL fi �
.0 � 1/R �
EXPDSED 6EAN CEILING SECTION -
• �,� fn/eri�t olr lJlm 061
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�5 t�ltrior oi► Iifm 011
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CHIM��EY AND STACK VERIFICATION
The undersigned hereby verifies that the existing chimney or stack;
1. Has been carefully examined Yes (,)
2. Is free from rust or deterioration Yes ()
3. Has no foreign objects lodged within Yes ()
4. Is securely supported Yes ()
5. Meets all current Code requirements for size and Yes ()
total BTU connected -
6. Ha s To ta 1 hea ti ng BTU' s of
All other BTU's
TOTAL
Rema rk s
No ( )
No ( )
No ( )
No ( )
No ( )
. Company
Signed By
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CIVIC CENTER • 6431 UNIVERSITY AVE. 1V.E. FRIDLEY, MINNESOTA 55432 • PHONE (612) 571-3450
December 14, 19.89.
Brickner Builders
6240 Highway #65 N,E.. � �20.8
Fridley, MN 55.432
Re: Final Ix�spection at 1666 Kri:gtt'`,n Cou�t NaE..G ,F,�i.dle�
Dear Sirs:
A final inspection was. conducted on Decemb.�� 14� 1�89� o� the aYio�e. a,ddx'es.s
and the following i'tem was: noted sahicfi. Tnnst be c�qpleted T2e,�'ore the structure
can be finaled:
Provide sod in the �ront and side yards by J'une.1A 19�0:,
The structure is approved �or occupancy. If you haye any question� on this
matter, please .�eel iree to contact me at 571�-3450.
Si rely,
DARREL G. CLARK
Chief Bnilding Official
DGC/mh
�
C� I I �F
FRIDLEY
FRIDLEY MUNICIPAL CENTER • 6431 UNIVERSITY AVE. N.E. FRIDLEY, MN 55432 •(6121 571-3450 • FAX (61?� 571-1287
May 23, 1997
Joel Arne _
1666 Krisrin Court
Fridley MN 55432
Subject: Heather Oaks Subdivision - Drainage Easement
Deaz Mr. Arne:
PW97-089
It has come to our attention that there has been a significant amount of landscaping done to the rear yards
of a nuxnber of the homes along the north boundary of the Heather Oaks Subdivision. This letter is being
sent to all residents along this line.
There is a 10-foot-wide drainage easement centered on this line to allow storm water runoff to drain to the
east and west into holding ponds. This area is intended to be swaled to channel this runoff. Landscaping
which raises the yard and changes this swale impacts the way storm water drains. City Code states that
changes on one property must not affect the neighboring properties. If we receive complaints that one
property has changed the drainage pattern so that water runs onto an adjacent properiy in a manner contrary
to its original design, we must investigate and possibly initiate Code Violation proceedings.
In order to avoid future conflicts, we request that you discuss any significant projects with your neighbors
so that concerns on these proj ects can be resolved before a problem is created. If you have questions and
would like to review how your future or past projects impact others, please call me at 572-3551. Thank you.
Sincerely,
w4
Jon H. Haukaas
Assistant Director of Public Works
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THE BELOW MUST BE FILLED IN WHEN REPLACING FUEL BURNiNG APPLIANCES OR THE
APPLICATION WILL BE RETURNED
•�i�i•► I ► I ► •►► •: �►� •��: 1•► � : I : _ �T�
Wfien � �a i an eYi_etin0 �ran __, the undersigned hereby verifies that the
venting has been examined and is free from rust, deterioration, obstructions,
and is securely supported and firestopped where required. Yes ( 1 No ()
The venting system is plasti�JPVC and meets all current codes and manufacturer
specifications including sizing, length, number of elbows and termination. Yes (� No ()
The undersigned also verifies that the replacement unit is a listed assembly
and meets the current codes and manufacturers specifications. This does
indude AGA-GAMA Category I Central Fumace Venting Tables for fan
assisted and natural draft appliances.
ThQ oY�� ceme ��en air is sized and installed to meet the current codes
and manufacturers speaflcations.
Whet1 requil'ed to ��+-��� a new cembuetien air� it will be s�ed and installed
to meet the current codes and manufacturers specfications.
Yes( ) No( )
Yes ( ) No ( )
Yes( ) No( )
�gn jp�jp0 a ne�+ ventin,veiu�m, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturers
speafications. This does include AGA-GAMA Category I Central Fumace
Venting Tables for fan assisted and natural draft appliances. Yes () No ()
Is the common vent and vent connectors sized and installed correctly after
an appliance has been removed from the common vent and vented
separately as per current codes. Yes () No ()
�.. ..«- .:- .�. �- .����.� -. .�. -� .��-.,. � ..��.�.�
Appliance #1 Type BTU Input Fan Assisted or Nat
Appliance #2 Type BTU Input Fan Assisted or Nat
AppGance #3 Type BTU Input Fan Assisted or Nat
Total Appliances Total Btu Input
Common Vent Type Vent Height Diameter inches
Appliance #1 Vent Connector Height ft Length ft Diameter in Type
Appliance #2 Vent Connector Height ft Length ft Diameter in Type
Appliance #3 Vent Connector Height ft Length ft Diameter in Type �
� r r • ► •,- • .a-
HEATING CO:
Signed By: Date :
�
CITY OF FRIDLEY
6431 iJNIVERSITY AVENUE NE
_ FRIDLEY, MN 55432
57"L-36U4 r'AX: (763) 571-12ii7
PERMIT NO.: 2004-02234
DATE ISSUED: 12/02/2004
ADDRESS : 1666 KRISTIN CT NE 'p �
PIN : 243024110115 �l �% � Q�' �
LEGAL DESC : HEATI�R OAKS
: LOT 4 BLOCK 1
PERMIT TYPE : BUII,DING
PROPERTY TYPE : RESIDENTIAL
CONSTRUCTION TYPE : ADDITION/ALTERATION
VALUATION : $ 3,500.00
NOTE: SEE NOTATIONS ON PLAN.
CALL GOPHER STATE ONE AT 651-454-0002 FOR UTII.,ITY LOCATIONS.
PROVIDE SMOKE DETECTORS IN ALL SLEEPING ROOMS AND ON ALL LEVELS OF TI� DWELLING PER R317 OF TI�
2000 INTERNATIONAL RESIDENTIAL CODE.
APPLICANT
STANDARD WATER CONTROL SYS (1522)
5337 LAKELAND AVE N
CRYSTAL, MN 55429-
(763)537-4849
OWNER
ARNE JOEL T& GAIL G
1666 KRISTIN CT NE
FRIDLEY, NIN 55432
AGREEMENT AND SWORN STATEMENT
This permit 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 lrnow the same to be true and correct. All
provisions of laws and ordinances governing this type of wor�
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 construction or e perf�rmance of construction.
Applicant Date ,
Bldg Insp
BUII.,DING PERNIIT FEE
FIItE SURCHARGE
STATE SURCHARGE, VALUE
TOTAL
PAID WITH CHECK # MASTER
SEPARATE PERNIITS REQLJIRED FOR WORK OTI-�R THAN DESCRIBED ABOVE.
97.25
3.50
1.75
102.50
DEC-01-2004 11:5A AM STAN��D WATER CONTROL 763 537 1882 P.01
���
NEVii° (] �,i CIIY OF FRIDI.EY Etfective 1/1t2Q03
P-AbDN [] 8431 University Ave NE, Fridley, MN 55432 (789) b72-9604 Bidg Insp
ALTER [ j �INOLE FAMILY AND DUPLEa(68 R-1 AND R-2 j763) 871-1�287 Fax
BUILDINf PERMIT APPLICATION
ConsVuction Address: ��0 l0 /1 /' %S�t'i /? l .7`
Legal Description:
Owner Name & A�
ConVactor: �
Address:.� �%
LIVINO AREA:
GARAGE AR�11:
D�CK AREA:
OTHER:
MN LICENSE # /��,��
�.�._Te�. # 1� - ���— �/.P`�9
Attach ta this �pplicatlon, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
D�SCRiP410N GF 11�1F�ROV�MENT
l,ength Wtdth Heipht Sq, Ft,
Length ,�� Wldth Height Sq. Ft.
Length Width HgVGround Sq. Ft.
Construction Type: ' � "C Estimated Cast: $__��U1�� ;(�j�
Driveway Curb Cut Width Needed: Ft. + s Ft = �t x$ �= g
DATE: / � I APPLICANT: Tel. �t ���;z7� �,��!G
�
Call (T63) 572-9804 tor Permit Fees if malling in appllcstlan. Fax to 763-871 •1287 if using credit card and we will
c�ll yvu for ca�d �umber.
Permit Fee
�ire Surcharge
State Surcharge
SAC Charge
Lfcense Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer M�in Charge
$ �' 2`,i
$ d��
$
$
$
�
�
$
$
CITY U3E ONLY -
Fee Schedule on Reverse Side
.00.1 c�f�PermltValuatio� (1hOth%)
�.50/$1,000 Valuation
$1275 per SA►C Unit
�5.00 (St�te Llcensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ .j
TOTAL $ • ,� �r�P��nTIONG•
i�i�v. �. ��t�� 7� ����;�I �E�H R�Ji�r IIyG SaLE�
fVkuV [ J CITY OF FRIDLEY
���'� (� G�31 Univer�ity Av� NE, Fridley, MN 55432
HLTER [ j SINGLE FAMILY AND DUPLEXES R-1 AIdD R-2
B�I�pING PERMITAPPLICATIQN
i�onsGuctiv�-� A�Jre�S:
��ydl L.��scriuti�li:
Own�� fdam� � t�ddress: �a��
C�ntractor:
NO.G53 q�-(P''�.'1i�5,'}/`7/�
�{/"V'd �(1'�" !!J�
Effective ih/200q
(763j 572-3604 Bldg Insp
(763) 57�1.�287 Fax �
�
� �
f�Y''N �i •..._. _ Tel. ' %cS�..,- ��'�'d��J
MN LIGENSE #
Address: �'�1�4 ��IP�LG �i RF,M� l i i,�;C Tel. # 6/Z - �.3 O
�1UD EXCELSIOR BLVD.
;�l.x AOGFING � REIVIOU L�� i���������� a Certificate of Survey af the
�1u� �xG�l.S�oR p�.y�w��f��d��sed eonstruction dr�wr� on it to scale,
'.+�- �1i1�..1��:, ��F1� i��,, �e��'� �'JJ•� 10
' � ,9�i�u I����t� L���F�tl'TI��J OF IflAPROVEM�IJT
���"e•�U�;I�:��;;LGi�ylh vVi�cl-� --- Meight Sq. Ft.
1�,i1=Ce4ULl���A: Leri�tti ti�iillh�� Height Sq. Ft.
ukCfC AREA; �ength __ Width Hgt/Grourld Sq. Ft. �
OTH�R
Construciion Type;�``� � r.roo�' -�- 2� � Estimated Cost: $ �,—b'-�"�% `����
Ur� Y�s����y C:�r� ��:u� 4;�iJ11 � I°l���I�u: 1=1. -r u 1=t =_�Ft �� ��
i .._-.r'
u!�"i �.: �� ° �� � r��PPI.IGA(dT: • -1 �"� G- �.?f'�:- Tel. # �� �.� ��' � f
� l �
Ca1) (7G3) 5i2-3604 for Rermit Fees it mailing in application. Fax to 763-571-1287 if using crodit ca�d and we wil) call
yQU for card nu�nber, ,
0
Permit Fee
. ,`, ,
. _, � ,_ii��
--,_,: :�.. ,�.�,-ii��.
I�i��:►��� �1�ai+�lidi��
UuI U �: ut Esc;r�w
�r�sicr�i �ontrol
1'arE; F�ee
�e�d�r tvl�in Ch�r�e
TOT-11_
CITY US� 4NLY -
� 9�' ��Fee Sch�dule on Reverse Side
� __----- ,UU`I �I 1-'�;fli-ill V:�ludli�ll (1l`10i11°/'v�
, l9 �.�u0:�°i,UuU 1�;�luati��-�
��� � � �� �'i ���:+ ���r 5�:�;.. u� ►il
� S � �� ��.u{1 ��tate !_i�erised Residential Contractors}
� Hft, "A" or Ntt. "�" Abov�
� ��50.�0 Consenration �lan Review
� Fee D�lerrnir-,ed by Engineerinq
� d�gr�ement I�d�cessary [ ) IVut N�ces�ary [ ]
� -�--- ` � ` '� _ STINi�l.hTlv�d�•
�
Building
Inspections
763-572-3604
763-502-4977 FAX
DATE � � (� (d
SITE ADDRESS �
THIS APPLICANT IS:
PROPERTY OW1�1ER/
TENANT
CONTRACTOR
SUBMIT A COPY OF
YOUR STATE LICENSE
AND CERTIFICATE OF
INSURANCE
PROPERTY TYPE
PERMIT TYPE
TYPE OF WORK:
DESCRIBE WORK BE[NG M
SIZE OF IMPROVEMINT
ROOFING
NUMBER OF SQUARES _
GARAGES •
PROPOSED SIZE:
PROPOSED HEIGHT:
IDING
❑ Vicryl
❑ Aliuninum
❑ Other
BUILDING
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 8-19-09
YOUR E-MAIL ADDRESS � 1J11
1N �
❑ OWNER
AnnxESS:! 1► to �P �irt�S?� � CA�
PHONE:
STATE
[ONE (,� Ql "i � `��"' `'r'j T�
�SINGLE FAMILY/AiEW CONSTRUCTTON
TWO FAMILY/NEW CONSTRUCTION
� ADDITION ❑ GARAG
0 BASEMENT FINISH ❑ ROOF
❑ DECK ❑ SIDING
0 SWIMM
❑ NEW HOME CONSTRUCT[ON
❑ MAINTENANCF/REPAIR
Permit No.:
► - - � : '���\�
� S�- `� `'t� I � ���.
EXP DATE
� 'b v0 cr
FAX � ° Y" ''
S(ZE
STORIES
'1SHED DOWS
❑ DRAIN TILE
❑ OTHER
NG POOL
❑ ADDITION
❑ HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
rvV ��
FT
BASEMENT REMODELING SUBMIT:
l. F.�cisting Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑Soffit ADDITIONS. & PORCHES SUBMIT:
O Trim 1• Site PIan/Survey showing the existing structures
� F��a and proposed project.
2 Two sets f nstru t' 1
o co c �on p ans
WINDOWS 4,�O�yi��i%'� 3. EnergyCalculations
IN EXISTING OPENINGS��3(es ONo 1y� ON OF WIN�QV� S l�""' ` �/���,�Q�,./ FOR WINDOWS — PROVIDE U-VALUE AND
OR FOR NEW OPENINGS-DESCRIBE SIZE OF 4���� �L�'�R1/1d�����R•�tR�+R1►� MANUFACTURE S1'ICKER ON WINDOW.
OPINING CHANGES &
TYPE OF WINDOW TO BE INSTALLED ��L NUMBER OF WINDOWS ��
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
U THE 1997 U.B.0 FEE SCHEDULE)
TOTAL JOB VALUATION $ __ OCCUPANCY TYPF.
Petmit Fee
Plan Review
Fire Surchazge
Surcharge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
Total Due
� �,
.�
,
��:il�l11L
See Back Page for Fee Schedule
65% of Building Permit Fee
.00I times the total job valuation
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$2000 per SAC Unit (Plans to MWCC for determination)
ft+6ft= ftx$22=$
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks payable to: City of Fridley Attacli
THIS IS AN APPLICATTON FOR A PERMIT-NOT VALID UNTTL PROCESSED
� ,
'.
I hereby apply for a building permit and I acknowledge 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
permit but only an applicatio or a permit and work is not to start without a permit on site; that the work will be in ac ordance with the
approved plan in the case all w ch requires review and approval of pl s.
SIGNATURE OF APPLICANT �' PRINT NAME C P Y��s „� DATE � t T
;,
`
'
I` �
�
Page 2- Building Residential Application
BUILDING PERNIIT FEE SCHEDULE
The Chief'B�tilcling::0i'�cia� sh���;�b�f��e issuing permits for the erection of any buildiiYg -or, �°
structure, or for any addtion to any; existing bt�ii�lirig'or struciure, or for ar�y a�teration o� r,e�air
to any existing building or structure, upon application therefore,. require the payment by the
applicant for such permit of fees to the amount herein l�e�pvY seto£arth and in the manner herein
proyxc�ed to-wit: , , . � . � . � � � , ` _
,,•,.
. . ,`.,
TOTAL VALUE FEES
$1 to $500 '� _ ,� "`�� " $23.5A �(1Ylinimurn�Fe'eais`$23:5�0 plus si�Charg�} �: :
` $50;� ,to $2,000 , ,.i �9� 3ti + ,,6 $23,Sfl fox;�� $SOO;�1�t}� �3'�OS° for��ch,additianal $100 or fraction, to and
" includin $2,00� - '
2,001 to $25,OOd � ''° `$69.25 for 1� $2,000 pl�s $1� for each additional'$1;000 or fraction, to and
includin $$25,000
, to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fraction,
to and includin $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
includin $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $],000 or fraction to
` ,.,,�, '� . :_; . . , . „ _ , . �d �ncludin :$SOO,Q.bO , ,
$S�O,d01 to $1,0OO;Oi�6' � ' 3,233.95 gor e 1�`"$500;000 plus $4:�5 for eac7i'ail$itional $1,000 or
fraction to and includin $1,000,000
$1,000,001 and up $5,608.75 for the l�` $1,000,000 plus $3.15 for each additional $1,000 or
fraction
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 proposed structure and of the construction site.
: � .<t ,:
µ a:.,
A Certificate of Survey of the 1Qt;�.showin� the., �ocat'ion+ of the ex�sting �oundation will be :
�e a'• 'i.. p"a J! 1Y1 a c,• 9.1 c. ._
required before proceeding witti the frammg. I�`ev��H'ouses Onlv ,
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City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432
763-572-3604
Fax: 763-502-4977
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