AF - 479989
a
BUILDING PERMIT
Village of Friclley, Minn. N� 2 5 5 9
Date �c�,'�'`.�:'; ; • �/,�� �. . .��.".� . . . . . . . . . . . . . . . . . . .
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Owner ����.�,.i . . .'�� .� .��;��_�. �,.• . . . . . . . . . . . . .
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Address .��.�`�. . �� ,�°.,.-r,,�.r'� ,��'�
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Builder...........................................
/ Address .........................................
Y � �.'�OCAT[ON OF BUILDIN�;
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No. ,��. ��:°. .� . . . . . . . Street ;r. ' � e:�-x.�,� �*�'= ��' :.,:��+��`��:�. . Part of Lot . . . . . . . . . . . . . . . . . . . . . . .
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Loi . . . . . . . . . . . . . . . . Block . . . . .�.�. . . . . . Addition or Sub-Division ��,_.��,�;.�,,�. . �a �,�: �; f, �� . . .���. ��
Corner Lot ............ Inside Lot ............ Setback ............ Sideyard �'�.� ...�.,.,,,,
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DES�RIPTION OF BUILDING
To be Used as:
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��,����'r1' . . .���ont .��. . . . Depth � �. . . . . Height . . . . . . . . . Sq. Ft. �l s�'�". . Cu. Ft. . . . . . . . .
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.................... Front ........ Depth ........ Height .........
Sq. Ft. . ....... Cu. Ft. ..... ...
Type of Construction _�_K . � 6��,. , Est Cost 'l�,���.��f. ��.�„? . . .. . . . . . . . To be Completed ��.���r,�.n�� .. .
In consid�ration of the issuance to me of a permit to construct the building deseribed above, I agree to do
the proposed work in accordance with the description above set forth and in compliance with all provisions o4
grdinances of the village of Fridley.
" ""'�;�' -�X,- f',�' r'rr �= •,° �.t';ra. . .,��..;;�+"�"'I'
, In consideration of the payment of a fee of $. .� .., permit � is h"` eby granted to �"'�
.�.} , . .
.... ........ to construct the building'' �r ad dition as described above. This � rmit � i�s' granted upon
��''-e�Cp��`'�c�Ti'dition that the person to whom it is granted and his agents, employees and worlunen, in all work
done in, around and upon said building, or any part thereof, shall conform in all'respects to the ordinances of
P'ridley, Minnesota regarding location, construction, alteration, maintenance, repair and moving of buildings with-
in the village lunifs and this permit may be revoked at any time upon violation of any of the provisions of said
ordinances. _, _ ,�+„
'���
Inspector
NOTICE: '
This permit does not cover the construction, installatlon or alteration for wiring, ptumbing, gas heating,
sewer or water. Be sure to see the Building Inspe�tor for separate permits for these items.
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City of Fridlep, Minn.
6431 University Ave. N. E., Minneapolis, Minn. 55432
BUILDING PERMIT
Date: _��Mav 6,, 197
p��; Adolph Kowaczyk g�� Inter City Builders
Adaress - 551._.Lafa�ette r1 E.. Address 2 SOA �1'ia.�x��-����� �T�,�-.
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LOCATIOfV OF BUILDING
NQ, 551 _�, g�t Lafayette N.E. ParE of Lot
�t 9�10� 11� 14 gl� C � Addition or Sub-Divlsion � Riverview Heigl.its Addn.
Corner Loi ._ .._ Inside Lot _..._ % Setback _.. Sideyard
Sewer Elevation Foundaiaion IIevation ___
DESCRIPTION OF BUILbING
To be Us�i as:
Gaxa$e Front —22� _ Depth --3Q' Height �..._ Sq. F�. -6.6,0-- Cu. Ft. -...�6,OiL
_ Front Depth Height Sq. Ft Cu. Fi.
Type of Construction Fram.e �st. cost r$3, O��.OA To be Campleted Ma; 3A,—l�]1
Provide Hard Surface Drive.
In considera.tion of the issuance to me of a permit to consfruct the
the proposed work in accordance with the description above sefi forth a
Or�anc:es of the city of FYiclley. /J . _,
l above I a� tp do
with a�l provisions a�
In consideration of the payment of a fee of $—].Z..��_, permit is hereby granted to Tnrpr ri t R„i ],deis
to construct the building or addition as descxibed above. This permit is granted �on
the express condition that the person to whom it is granted and his agents, employees and worl�en, �1n all WoTk
done in, around and upon said building, or any part thereof, shall conform in all respecta •to the orc�inanCeB oi
Fridley, Minnesota regarding loca.tion, construction, alteration, maintenance, repa3r and mov3ng of building8
�pithin the city limits and this germit may be revoked at any time ugon violat3on oE any of the provisions of said
ardiaaacea
E
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CI�ARENCE BEILSLE
NOTICE: !,
Yhis permit does nof eove� the eonatrueHon, installaHon fo� wiring, plumbine. 8� 6��9, �et or watet. � snre to sas
fha Building InspeeFa� fo� aeparate pertePta fo� theae (tems.
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pernut �To. �S' �� �a � ,� �-�
`�D T
O NO
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Lat ► or Cov the interior of this Building until
the follo g inspectoxs have made their inspec-
tion attd sQgned this card.
Inspectora comments: � � i S S ��
--e � 4�. i� r a t/� � �
Plumbing Insp.
Electrical Insp.
Htg., Vent., Afr Cond. Insp.
Bldg. Insp.
Footings
Rough In
Final
CITY OF FRIDLEY
560-3450
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` APLICATION FOR RESIDENTIAL, ALTERATION,
` OR AllllITION BUILDING PERMIT
CITY OF FRIDLEY, MINNESOTA
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owr�x�s ru�:�� 1�A��� zY� BUILDER:J�T�► L'�i�t',B��L�e s
annx��s :�'�f 1 � ���,�� �/ , annxESS : ,��'r� l���i��r���� �'/�-
NO:.. v��� STREET:_ L,��� s� p�P �
LOT: �'l-lO!/-�5�� BLOCK: L1 ADDITION:�v�/t !%i �P � �3 �-S �
CORNER LOT: INSIDE LOT:�_SETBACK: SIDEYARD;
Applic:ant attach to this form ltao Certificates of Survey of Lot and proposed
building location drawn on theae Certificates.
BESCRIPTION OF BUILDING
To Be Used As:
_ ���,.,�,�,�,�Front: Z Depth: ��2 Height:� /� !
Square Feet ;��(� Cubic Feet : ��, 0 p
Front: Depth• Height•
Square Feet; Cubic Feet:
�pe of Constructioa: =��,p Estimated Cost:�p(� �
To Be Completed: ,�" �� - %l
The undersigned hereby makes applicativn for a permit for the work hereia
specified, agreeing to do all work in sttict accordance with the City of
Fridley Ordiaa.nces and zulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE : /' ` /-� S IGNATITRE •
��T� .
(See Reverae Side For Additioaal Informat a.)
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BUII�,DING PERMIT FEE SCHEDULE - ��
SECTION 2. '�he Inspector o�f Buildings shall, before issuing permits for the
erectiox� of any building or,structure, or for any addition to any existing
building or structure, or for any alteration or repairs to any existing
building or structure, upon application therefore, require the payment by the
applicant for such pexmi.t of fees to the amount herein below set forth and in
the manner herein prav3ded �o-wit:
UNIFORM BUILDING CODEs T�►p� 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. �pe 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORMATION
For the purpo�e of computi.ng fees for building permits, the cubical contents
of any building or additfon, is d�termined by multiplying the ground area
covered from a point six (6) inches below the floor line of the basement
or the cellar to the average heights of the upper surface or to the average.r
height o£ the roof surface of the ma,in gable of a pitched roof.
For repairs or alt�rations to an existing s�ructure, the fee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost o£ all proposed worke
In no case shall the fee cha�ged for any pexmit as set forth in Section 2 be
lesa than $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permfts for construction will be issued a minimum of 24 hours from the
time of application, to allowi for proper review of the proposed structure aad
of the construction site.
A Certified Survey of the lot, showing the location of the fouadation, once it
hae been constructed, will beirequired before proceedins� with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy o£ anj► structure for which a building permit has been
issued; and said structure shall not be used or occup3�ed until a Certificate
of Occupancy has been issued. �
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� SUBJECT P N O.
City of Fridley 12�99 ,
' ` AT THE TOP OF THE TdVINS g U I L D I N G P E R M I T R EIPT NO
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COMMUNITY DEVELOPMENT DIV. � ���
r � � PROTECTIVE INSPECTION SEC.
1 i �
�l /"�1 � CITY HALL FFiIDLEV SS4$Z NUMBER REV. DATE PAGE OF APPROVED BY
L•"'� � ,�� 612-560-3450
910-F15 4 9 75 � �
JOB ADDRESS 551 I�fayette Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. j�],O C Riverview Heights �iC�Cl].tlOTl SHEET
2 PROPEHTYOWNER MAILADDRESS ZIP PHONE
Adolph Kowalczyk 551 Lafayette Street N.E.
3 CONTRACTOR MAILADDRESS ZIP PHONE LICENSENO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS 21P PHONE LIGENSENO.
B USE OF BUILOING
Residenti:al
7 CLASS OF WORK
C� NEW ❑ ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WOHK
Construct a 12` x 16' Storage Shed
9 CHANOEOFUSEFROM TO
STIPULATIONS
SEPERA't°E PE�MIT� REQ�J�RED �'OR WIRlN�.
� C�E4ii��f�, PLl1i��ING AiV� SdGIVS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOC� Fr3IRG
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S�. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R l.
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE THUE 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 $ZZS.00 .'rJO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OF LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � yfiS.00
PLAN CHECK FEE TOTAL FEE
$5.50
SIGNATUREOFC�NTRACTOR� THORI2EDAGENT IDATEI �V EN PROP RL V D TED HIS IS YOUR PERMIT �
��� �� � �� u� ' i � •� �f�
r�s- 'GN UREOFOWNERIIFOWNERBUILDE IDATEI BLDG INSP �ATE --
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR AllllITION BUILDING PERI�IIT
CITY OF FRIDLEY, h1INNESOTA
OWNER' S NAME . �f � � >' ^ � ���./ L BUILDER • �Gtr�l Z._--
ADDRESS ; �Jr` �C � ADDRESS : �—
NO•. STREET•
LOT : -� �d BLOCK: (-_ ADDITION : �j J� ✓ e �% �fr: ►a/' /9` i�� q�1%��
CORNER LOT INSIDE LOT:�_SETBACK: SIDEYARD:
Applicant attach to this form 1�ao Certiiicates of Survey of Lot ar�d proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
To Be Used As:
� Front: � Depth: � �� Height: �
Square Feet: Cubic Feet:
Front: Depth: Height:
Square Feet; Cubic Feet:
Type of Construction: „�/�� Estima.ted Cost; $ �.oc..JP
To Be Completed: � ��G►:�%2�-.�-
The undersigned hereby ma.kes applicativn for a permit for the work herein
specified, agreeing to do all woxk in stTict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct.
DATE : vp �- � l / � S IGNATURE : �
(See Reverse Side For Additional Infoxmation.)
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BUILDING PERMIT FEE SCHEDULE
SECTION 2. The Inspector of Buildings shall, before issuing permits for the
erection of any building or structure, or fox any addition to any eaisting
building ox structure9 or for any, alteration or repairs to any existing
building or stxucture, upon application therefore, require the payment by th�
applicant for such permit of fees to the amount herein below set foxth and in
the manner herein provided to-�vit:
UI�TIFORM BUILDTNG CODE: Type 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADDITIONAL INFORh4ATI0N
For the purpose of computing fees fox building pexmits, the cubical contents
of any building or addition, is determined by multiplying the gxound area
covered fxom a point six (6) inches helow the floox line of the basement
ox the cellar to the average heights of the upper surface or to the averager
�reight of the roof surface of the ma.in gable of a pitched roof.
Fox repaixs or alterations to an exisL-ing stru.ctuxe, the iee shall be at the
rate of $3.00 per each five hundred dollars ($500.00) or fxaction theraof in
the cost of all proposed work.
In no case shall the fee chaxged for any pexmit as set forth in Section 2 be
less than $5.00. ,
VEP.IFICATION OF FOUNDATION
NOTE: Permits for co�struction will be issued a minimum of 24 hours from the
ti.me of apglication, to allow for proper review of the proposed structure and
of the construction site.
A Certified Survey of the lot, showing the location of the foundation, once i�
has been constructed, will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and said structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
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... _. _ �.-�. .
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suedecr PERMI
City of Fridley , 13'786
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
t
� � R .
� ; L __�� COMMUNITY DEVELOPMENT DIV. ����L/`-��
r � PROTECTIVE INSPECTION SEC.
� �
� _ �
�� /"�1 � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
""� � ,�� 612-560-3450
910-F15 9/28/76 � �
JOB ADDRESS 551 Lafayette Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9� 9 �� Rj,VeTV1.f3W Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Adolph Kowalczyk 551 Lafayette Street N.E.
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS 21P PHONE LICENSENO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
6 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW O� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE � REMOVE
8 DESCRIBE WORK
Construct a 10' x 7' Addition to dwelling
9 CHANGEOFUSEFROM TO
STI PU LATION S
Owner may be required to pronide a one hour fire separation
bettv,xxeen garage and addition.
SEPERATE PERMITS REQtltREO F� VYIA1�,
HEATIN6,, PLtlM8tNt3 ANp 5101�.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIOfdING. WOOCI EidIRC.'
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT R 1
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.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S7OO $. SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. � S7• 5O
PLAN CHECK FEE TOTAL FEE
y�8.Q0
SiGNAT EOFCONiRnCTO oR UTHORiZED NT IDaTEI WHEN P OPER�V VALIDATED THIS IS YOUR PERMIT
�'�% �}�i�✓ �C� �`'ac.� ° � � �
.1
I NATURE NER11 O NERBUILDE 1 IDATEI BLOG INSP nAT—�
ti_
�sir ur I�AV6G1
APPLICATIQN FOR RESIDENTIAL ALTERATION,
ADDITION, OR REPAIR BUILDING PERMIT
� o ���, i fl' _. ; �° � :l : � � �
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' � �' ,(ir�r��'-':i," �Il.��.�<� � ' � �' ..a -/� �iC`
— / � -
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��
LOT: � BLOCK:^ %�
CORNER LOT: INSID� LOT:
p , �
A.DDIT.ION : �� �� �..c ,[>��
�— SE�L'I3ACiz.: SIDEYARD:
Applicant attach to this form:�ao Certificates of Survey of Lot and progos.ed
building location drawn on these Certifica�es. r
DESCRIPTION OF BUILDING
To Be Used As :
/ � o � � /'
' Front; �� _Depth; � Height: ���_
Square Feet: Cub%c Feet:
FronC; Depth: Height:
Square Feet; Cubic Feet:
✓
7.'ype of Construction; � Estimated C�st: $���.
--�-
To Be Completed t_��i„�� a
The undersigned hereby
specified, agreeing to
Fridley Ordinances and
declares that all the
are true and correct.
makes applicati�n for a permit for the work herein
do all work in stxict accordance �aith the City oi
rulings o� th� Depar�nen� of Buildings, and liereby
acts and representations stated in this application
DATE : "�� �� S IG1VATlJRE • : ` �L, �
(See Reverse Side For Additional Information.).
,, '
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l3UILDING P�RMIT FEE SCHIiDUJ..L-'�
SECTION 2. The Inspector of Buildings sha11, Uefore issuing permits for the.
erection of any building ox structure, or for any addition to any existing
building or structure, or for any alteratian or repairs to any existing.
building or structure, upon. application thexefore, require the payment by�the
applicant for such permit of fees to the amount �terein below set forth and in
the manner herein provided to-wit;
iVEW CONSTRUG'�ION: Si.ng].e Family Homes and Garages :$A�. 00/1000 cubic f eet
PLAN CHECK: 25 percent of building permit fee.
ADDITIONAL INFORMATION
For the purpose of computing fees for building permits, the cubical contents
of any building or addition, is determined by multiplying the ground area
covered from a point six (6) inches Uelow the floor line of the basement
ox the cellar to the average heights of the upper surface or to the average.�
height of the roof surfa�e o� the main gable of a pitched roof.
.. r
rox repairs or alterations to an existing stxuci:ure, the fee shall be at the
xate of $3.00 per each five hundred dollars ($500.00) or fraction thereof in
the cost of all proposed work.
In no case sha11 the fee charged for any permit as set forth in Section 2 be
less than 57.50.
VERIFICATION OF FOUNDATION
NOTE: Permi�s for eonstruction �:ill lie 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 Certified Survey of the lot, showing the location of the foundation, once it
has been constructed, will be required before proceeding with the framing.
CERTIrICATE OF OCCUPANCI'
Application for a Certificate of Occupancy shall�be ma.de ten (10) days prior
to the use or occupancy of any structure for �ehich a building pei-mit has been
issued; and said structure shall r�ot be used or occup3.ed until a Cerrificate
of Occupancy has been issued. •
�
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g? . A. CARTWRIGHT ���������� ������ JAE.'HILL. GIVILt�Ma1� I A
A 6VUNT1 �UrlViri �����`��M�p ��
....�� COJNTY BUR��,e L q �yp � UR 6`E YORS
M{NMIArpLI• •uwvcre C. F. SANDMOFr
e{16 MALM STR6[T N W ALp�eTERdD UND[R LAWB OR STATE O/ MINHSrpTA CIVIL Et�/�INRRR- �
L!ITAlIll�rlfD IYW
BUN��r 4•7aDq LICCNBEO BY OROINANCE OF CITY 01' MINryQAPOLI�
owticw JAMFS MELBON
�02 UPPEN MIOWEST BUILDING • -- 33B 97Z1 $U/IVRYOq
MENNEPIN AT FIFTH - MINNEAPOLIB. MINN. lfDA01 ���Atl1�N[D ��:•
INOl1�f111AL � JNOICIAL �
�uaiN��{ - iOrOORArMICA6 P�1�Tti� QC�� �.[Ctlii[A�[ METROf'v�ITAN LAMD
C�TY LOT! - ►6AnIN0 . � BUAVI(1r4qs, [��tK�sw�O +wa�
,�-;
��t► LPH ..I. KOWALCZ�'K ' 338-�i:3.�
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I HkRE.BY CEI:T I FY THAI' TN I S I S A TkUi. Ar�1D CORRECT PLl,T ��P''
.�. �,UEVEY : F L��rS y,r,i0 10 (��OCK l% oF KIV[_KVIEb�J I���IG�'CS p,
���,u� �Y ��� `H I s�Ra unY �F P:lav 1971 .
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*I�iNRO _._.. ..J r' _ � f.�_ "___. _
.GARi wfilcjHl wNU OI_AON
e
CITY OF FRIDLEY
APPLICATION FOR RESIDENTIAL BUILDING PER��ITS
iNEW, ALTERATIONS, ADDITIONS, OR REPAIRS) .
Ko W �� s � C�c
OWNER: � BUILDER:-
Address: .S � � � Address: ` �a �
/
Tel . No . CJ - 3 i F� - 7 a`�Q /.� c�
No. �j��
Lfl!T : " �
Street:
C� �
BLOCK: "
ADDITION: ���Q� 9�w ��_�
v
COF�NER LOT: , INSIDE IAT: � S,^:TBACK: SIDEYARDS:
Applioant attach to this form �ao Certificates of Survey of Lot and proposed
building location drawn on these Certificates. .
DESCRIPTION OF BUILDING
To Be Used As:
��� p ,�a,�ont: Depthc Height:
'' >;
Square Feet: Cubic Feet:
Front:
Depth:
Height:
Square Feet: Cubic Feet: �.----------_��
Type of Construction: Estimated Cost: $ ��
\ -- -,
To Be Completed: �'� ---
/Alt. A Alt. B
Proposed Driveway Width If New Opening Is Desired $ $
(SEE REVERSE SIDE OF SHEET)
The undersigned hereby makes application for a permit for the work herei.n
specified, agreeing to do all work in strict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the facts and representations stated in this application
are true and correct. See reverse side for additional information.
DATE� �� � — ( / SIGNATURE: y/�
Stipulations:
�. �/ `� .�-
�� ��s��
��..�..
BUILDING PERt�1IT FEt SCHEDULE
SECTION 2. The Inspector of Buildings 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 repairs 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:
NEW CONSTRUCTION: Single Family Homes and Garages: $4.00/1,000 cubic feet.
PLAN CHECK: 25 percent of building permit fee. �
DRIVEWAY DEPRESSION: (Concrete Curb Streets Only)
Alternate A: Removal and replacement of concrete curb and
gutter only; Driveway width plus 6 feet x$11.75
Alternate B: Removal and replacement of concrete curb and
gutter and install a 3 foot wide approach with Farj
6 inch depth; Driveway width plus 6 feet x$15.�
� 11 � � � �' � •
For the purpose of computing fees for bua.lding permits, the cubical contents of any
building or addition, is determined by multiplying the ground area covered from a
point six (6) inches below the floor line of the basement or the cellar to the
average heights of the upper surface or to the average height of the roof surface
of the main gable of a pitched roof.
For repairs or �lterations to an existing structure, the fee shall be at the rate
of $3.00 gier each five hundred dollars ($500.00) or fraction thereof in the cost
of all proposed work.
In�no case shall the fee charged for any permit as set forth in Section 2 be less
than $7.50 plus $.50 state surcharge.
_VERIFICATIOV OF FOUNDATION
NOTE: Permits �or construction will be issued a minimum of 24 hours-from the time
of application to allow for proper review of the proposed structu,re and of the
construction site.
.
A Certificate of Survey of the lot, showing the location of the foundation once it
has been constructed will be required before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior to the
use or occupancy of any structure for which a building permit has been issued; and
said structure shall not be used or occupied until a Certificate of Occupancy has :
been issued. -
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,,,. D�T�� HEATING 8 AIR CONDITIONING, INC.
$OIISE HEATING TE3T RECORD
Pern►it No.
owner .- �:'r�i ��,' t�=ftt�;,ia��„�;4v'!:•�
Address `���- � �'•s3;r�;%�� ��r�e�
Installed By �ao�� °� �.r°��ir�.k:, � q3i t�n�d? ti��?i�?�;
GAS DESIGNED UNIT
Make .��.�?�,�.:rc�l �3��
Modei �=�,�'d5�°°�
serial �?4!�£4�£367�
Rated Input �r-�aQ��
TEST
�°"� �k;�+�''
Pilot Timing��� r�'a� Limit Setting �
Pressure �f�, ��` �� Percent CO, <���
Input CFH <��� Percent O, ���
Stack Temp �%� � Percent CO �''�� ,�``�f��.�
��
Heat Anticipator Setting __, a°��
Date Tested �,,�r_���-�`'-�
--°�-._. /``
Name of Tester � _� -_ _, :�€ �,. � _���r�
sua�ecr O. ,�
c�ty of Fridley � ;� � �d
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T ��
�
i �
' � O
� • COMMUNITY DEVELOPMENT DIV.
� ; V �'����, ; / / �
r � � PROTECTIVE INSPECTION SEC.
� �
' � ����1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE PAGE OF APPR VEO BY
�'"""�� ,�� 612-571-3450 910-F15
10/27/95 / /
10B ADDRESS 551 Lafayette Street NE
1 LEGAL LOT NO. BLOCK TRACT Ofi ADDITION SEE ATTACHED
oesca. 9-10,11-14 C Riverview Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jerome Rowalczyk 14182 78 St, Elk River MN 55330 441-4684
3 CONTRACTOR MAIL ADDRESS Z�P PHONE LICENSE NO
Elk River Exteriors Inc 825 Ma.in St, Elk River MN 55330 441-7240 4457
4 ARCHITECT OR DESIGNEFi MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PHONE IICENSE NO
6 USE OF BUILOING
Residential
7 CLASS OF WORK
❑ NEW � ADDITION O ALTERATION � REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
Reside House; Replace Windows; Reroof House (5 Sq) Tear-off
8 CHANGE OF USE FROM TO
STIPULATIONS
Unde�layment must comply with the State Building Code. Replacement
bedroom windows must meet the State Egress Code.
OWNER CHANGED NU1�ER OF SQUARES ON ROOFING TO (5) LOWERING THE VALUE TO $7,000
AND CHANGING THE FEES. REFUNDED $13.�0 ON PO F4575�.
SEPARATE PERMITS ARE IiEOUIRED FOR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTqUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, Ofi IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANV TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
WI H WRHETHER SPECIF ED HEREIN'OR NOTOTNE GRANTING OF AOPERMT �7�800
(7,000) $3.90 (3.50)
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pERMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- @
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION. �137.25 �W124.75� Fire SC �7.80 �].00�
PLAN CNECK FEE TOTAL FEE
License SC $5.00 $153.95 (140.25)
SIGNATUFEOFCON'AACTOAO A THOFii EDAGENT IOATE� WHEN PfiOPER VALIDATED THIS IS YOUR PEFMIT
. ����� � - ��� � � � � f�� �
SiGNATUREO%OWNERUFOWNERBUILDERi �OATE�_ B OG INSP DaiE
PURCHASE ORDER
PURCHASED BY
_
_
C�TY OF
FRIDLEY
6431 UNN. AVE. N.E.
FRIDLEY. MN 55432-4384
�12-571-3450
•PRINTm ON RECYCLED PAPER.
' ACCOUNT
DEPAHTMENT
ic� �� �s` l�v
io�/ F�. 5 7 5 3
THIS NUMBER MUST APPEAR
ON ALLCORRESPONDENCE
SENT TO US
THIS DOCUMENT GOOD FOR PURCHASES UNDER $1,000.00 ONLY
SUPPUER ���� � �� � � "�
�D�� I � %� �f .
�� � � �
� �����
PHONE N0.• � L / ' � �� �
�� � ,
���
UNIT I r-�. PLEASE ENTER OUR ORDER FOR THE FOLLOWING
PAYMENT VOUCHER
BY SIGNING THIS DOCUMENT BELOW I HEREDO AUTHORIZE
PAYMENT AND THAT THE GOODS AMD SERUIGES HAVE BEEN
RECEIVED OR RENDERED AND ALL GTY GUIDELINES HAVE
BEEN FOLLOWED IN THE PROCUREMENT OF THE BELOW
STATED ITEMS.
t� '�?�f,� s � �
AMOUNT
,�, ��
TOTAL � �� ��
THIS AGENCY HAS A(iREED NOT TO DISCRIMINATE IN HIRINf3 PHACTICESON THE BASIS OF RACE, SEX, COLON, CREED, MARITAL STATUS, RELIGION,
OR NATIONAL ORIGIN AND HAS AGREED TO TAKE AFFIRMATIVE ACTION TO RECRUIT MINORITIES AND WOMEN INTO EMPLOYMENT. IT ENCOURAGES
FlRMS AND OTHER AGENCIES WITH WHOM IT PURCHASES PRODUCTS OR SERVIGES TO DO LIKEWISE.
WHITE, VENDOR - YELLOW, PURCHASING - PINK, ACCOUNTING - OOLDEN ROD, DEPT. HD.
NEW
ADDN
ALTER
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CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Cffective 8/ 1 /95
ConstructionAddress:�S� ��i�/��'TT�� _
Legal Description: �
�v
Owner Name & Address: �°�,�'e!�/�'" �i�r�L<?k�y���- 71S si 1�i�,(v�rr ���'el. # z/ /- �� �_
Contractor: - ? = - - !d ,t��'_� .L � _ MN LICENSE # � v v � v _%
Address:�;1�'�i �S (` 1 �i�� /i�,,-��..�� �'-�-'S � Tel. # `./�//- �� y�
LIVING AREA:T---
GARAGE AREA:
Attach to this applirdtion, a Certific�te of Survey of the
lot, � with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width
Length Width
DECg AREA: Length
OTHER:
� ���
Height Sq. Ft.
Height Sq. Ft
Hgt/Ground Sq. Ft.
�
�= �=�v�� �oj T%7P�—aj=� _���� � �- �°`�� '
Corner Lot [] Inside Lot [] F� Yd Setback Side Yard Setbacks
� ��Q �
Type of Conslruction: Fsbmatsd Cos�t: �' ���,r, v ,_," �'� Ar•
. _'_, f' i oc w lUc,,.�
#�pprox. Completion Date: ',��)��
(Cost on Baak)
i?riveway Curb Cut Width Needed: F� + 6 Ft = Ft x$ _$
�ATE: fa-� � - `��� APPLICANT: 9 Tel. # �/ � /-� � �'TC.
CITY USE ONLY ' � ,�2 � '
�.� �� �
� ���
��ermit F� %��, 7� $ /� %• � -S Fee Schedule on Reve,�se Side ����� .
�ire Surcharge ?�� $ . d� .001 of Permit Valuation (1/14th%) ,� �_C�C'�-
� � {�' �
�tate Surcharge ,�?.�.� $ �_�,�0 $.50/$1,000 Valuation l�
;AC Charge $ $850 per SAC Unit
iacense Surcharge �`'U$ �- pC� $5.(� (Siats Licensed Residential Coniractors}
�riveway Escrow
F�osion Control
Fark Fee
�ewer Main Charge
$
$
$
$
TOT $ ��rJ - �
�L��
�`TIPULATIOIf�i��
Alt "A" or Alt "B" Above
$450.00 Coc�rvation Plan Review
Fee Determined by Engineering
Agreement Ne��' [ ] Not Neces.sary [ )
_ � l.� 1t_,� cLn��
�
�� ��
� ��
���� ?
�UILDING PERMIT FEE SCHEDULE
The Chief Building Official sha11, before issuing permits for the erection of any building or structurE, or for
any addition to any existing building or structure, or for any altera,tion 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 $S00
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $1�,Q00
$100,001 to $500,000
$5(�,Wl to $1,�,000
$1,0�,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $1� or
fraction ther�f, to and including $2,(�)0
$b2.25 for first $2,000 pins $12.50 for each additional $1,000
or fraction th�eof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additionat $1,000
or fraction ther�of, to and including $50,000 .
$574.75 for first $50,000 plas �.25 for each additional
$1,000 or fraction thereof, to and including $1Q0,000
$887.25 for fust $100,000 plus $5.00 for each additional
$1,000 or frac�ion thereof, to and including $SW,O�
$2887.25 for the fir� $SOO,OQO plus $4.25 for each additional
$1,000 or fractioa thereof, to and including $1,000,000
$5012.25 for 1�e first $1,000,� plus $2.75 for each addifional
$1,000 or fraction thereof �
DRIVEWAY DEPRESSION ESCRUW
(Coacrete C�rb Streets Only)
Alt,ernaxe "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $13.50.
Alternate "B" : Removal and replacemem of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Drivewa,y width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for con�truction will � i�sued a minimwn 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 l�ation of the foundation once it has it has been constiucted
will be required before proceeding with the fiaming.
SUBJECT PERNUI..ND.
City of Fridley F �"� � �,� :j
r AT THE TOP OF THE TWINS g U I L D I N G P E R M I T � --�
� � RECEIPT NO.
� `y _____ COMMUNITY DEVELOPMENT DIV ' ���
r � � PROTECTIVE INSPECTION SEC.
1 �
( � ����1 � CITY HALL FRIDIE� 55432 NUMBER REV DATE PAGE OF APPROVED BY
�"'""�'� �'' 612-571-3450 910-F15 3/29/95 / /
JOB ADDRESS 551 Lafayette Street NE
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 9,10,11,1 C Riverview Heights SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
Jerome Rowalczyk 14182 78 St NE, Elk River MN 55330 441-4684
3 CONTRACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW I� ADDiTION C� ALTERATION O REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WOHK
Construct a 7' x 10' Addition to Dwelling; Change roof design
8 CHANGE OF USE FROM TO
STIPULATIONS
See notations on plan.
AR�� G
Before digging cali for
all utility locations
454-0002 S6�ARATE PERMITS REQUIRED FOR
REQUIREU BY LAW Vf/IRING, HEATIh�G, PLUMBINC AIVD SIGNS.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SO. FT. CU. fT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 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 CERTIfV THAT I MAVE READ AND EXAMINED THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING THIS TYPE OF WOFiK WI�L BE COMPLIED @
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT W3,979 $1.9g
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OR THE PERFOf;MANCE OF CONSTRUCTION. �63.0� Fire SC �3.98
PLAN CNECK FEE TOTAL FEE
$68.97
SIGNATURE OF CON'RACTOR OR AUTHON12 AGENT iDATEi WHEN PfiOPERLY ALIDATED THIS IS YOUR PERMIT
/� e.� ,
3-z�- � r . ��. �. �
b SiGNATUREOFOWNE iiFOWNERBU A� �DATE� BLDG NSP �i� E
NEW
ADDN
ALTER
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Construction Addre:
Legal Description:
CITY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Applica.don
Effective 1 / 1 /95
� � .
Owner Name & Address: `J �Rayn�= %i'ac��l � C ax�' E�� tP� u,�/� Tel. # y/- �(o� 5�
Contractor: �yl y S°� / t= MN LICENSE #,�y�a_ya�..�a; -G� �
Aaa��s: ; �-%�' a � � �s r d� � � �. ��� .v � S33 U Tel. # yNr-y� ��
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
LIVING AREA:
GARAGE AREA:
DECK AREA:
�THER:
DESCRIPTION OF IMPROVEMENT
I,ength �_ Width Jv Height �_
�ngth Wldth Height
�n� Wld� HgtlGround
Sq. Ft. 70 -
Sq. Ft.
Sq. Ft.
Corner Lot j] Inside Lot � Ft. Yd Setback Side Yard Setbacks
Type of Construction: ��, U d��� Estimated Cost: $�, 9� �', �
Approx. Completion Date:
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$ �
DATE: 3— o`t °�--7�'S APPLICANT: Tel. # ei/y/-yl���
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
Q ' ' vo
�
W 0
� 3. 9�
$ � qR°
$
$
�
$
$
$ _
$ 8
CITY USE ONLY
Fee Schedule on Reverse Side
,001 of Permit Valuatioa (1 / l Oth %)
�.soi$i,000 v���on
$850 per SAC Unit
$5.00 (State Licens� Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engine.�ring
Agreement Necessary [ ] Not Necessary [ ]
STIPULATIONS: -
��s
�;uua�rrvc; !'IiRMIT r[3E SCHEDCJLE
�I�tu: Ci�i;.t 13uiidin�; Uflicial shall, tx:forc issuing permiLS for ihc ercction of any building or stnicturc,
ur ii>r any :i�iciilion tu any cxisting buildint; or structurc, or for any altcration or repair to any cxistin�;
I�uiliiing c�r �u�ucture, u�n applicaUOa lhereCo�e, require the payment by the applicant for such Permit
�>f� I�c:� tc� thc: anu�unt hcrcin t>cibw tict li�rth and in thc ittanner 6creia �rovidcxt to-wil_
"1'O"I'AL VAI_Ul:
� I to $500
�501 to �2,000
�2,001 to $25,0(}0
�25;Q01 to �50,000
$50,001 to �100,000
�100,Q01 to $SOO,Q00
$500,001 to $I,Q00,000� -
$ I , 000,001 and up
° FEf:S
$15 (Minimum Fee is $15 plus svrchacge)
$15 for first $500 plus $2 for each additional $100 or
fraction thereof, to and including $2,000 �
.$45 for first $2,000 pius $9 for each additional $1;000
or fraction thereof, to and including $25,000 -
$252 for first $25,OOQ p(es $6_SO for each additional $1;000
or fraction thereof, ta_ and inclading �50,000
$414_50 for fi�rst $50,000 plus $4_SO for each additional
.$1,000 or fractiou ti��eof, to and including $100,000
$63950 for €�rst -$100,0� plus� $3.50 for each additional-
$1,0�0 or fraction thereof, to and includiug -$SOfl,000
$2039.50 for the 5rst $�O,Opp pins $3 for each additioaal
$1,000 or fradion thereof, to and inciuding $1,000,000
$3539_SO Eor the 5rst $1,000,0(i0 pius $2 for each additional
$1,0(?0 or fractioa thereof -
DRIVEWAY DEPRESSIOM FSCROW
(Concrete Cu,�fi Straets Only)
Alternate "A°: Removal and replacement of cuifi and gutter only - Driveway width plus 6 feet times
S13_50.
Alternate "B°: Removal and replaceraent of curb and gutter and instal.! a 3 foot �vide
approach with 6 inch depth - Driveway width plus 6 Feet times $1S_75.
VLRIFICA"T(ON OF FOUNDAT[ON
Permits for cor�st�uction will be issued a minimum of 24 hours from the time of application to allow
for pro�cr revic�v of tt�e proposed stnicture and of the construction site_
A Ccrtiiic:;ite of Survcy of die lot, sh�wing the location of dic founclation once it ha� it has hccn
construc:tc�i will bc rcquirec! tx:ti>rc procc�ding with lhc framing_
� . ,
. _ y �
. A. CARTWRIGHT
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City of Fridley
AT THE TOP OF THE TWINS � � I L D 1 N� P E R M I T
;,
,�
� ; V __��� COMMUNITY DEVELOPMENT OIV.
/ � � PAOTECTIVE INSPECTION SEC
i . ,
i-__.� �"' �.� CITY HALL FRIDLE� 53132 NU4BEa aEv
L et2—s»-3450 910-F/S
108 ADpRESS 551 Lafayette Street NE
t LEGAL �OT NO. BLOCK TRACT OR AODITION
oesca. 9-14 C Riverview Heights
2 PROPERTY OWNER MAIL ADDRES$
Todd Rautio 551 Lafayette Street NE
3 CONTRACTOF MAII ADDRESS
Same
4 ARCHITECT OR DESIGNER MAIL AOORESS
5 ENGINEER MAIL ADDRESS .
OATE
3/26/O1
ZIP
ZIP
PAGE Oi
� �
3 i 700
Br
SEE ATTACMEO
SNEET
PNONE
763-792-0823
PMONE IICENSE NO
PMONE LICENSE NO
PHONE LICENSE NO
8 USE Of BUILDING
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION kC] REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Remove & replace insulation and sheetrock in living room and bathroom on all walls
and ce ng
9 CHANdE Of USE FFOM
STIPULATIONS
See notations on plan.
TO
SEPARATE PERMITS AqE REOUIqEO FOR ELECTRICAL, PLUMBING, MEATING, TYPE OF CONST.
VENTILATING OR AIR CONOITIONING
THIS PERMIT BECOMES NULL AND VOID IF WOFiK OR CpNSTRUCTION 20NING
AUTHOHIZED IS NOT COMMENCED V�IITHIN 80 OAYS, Op IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO fOFi A PERI00 OF 120 DAYS AT
ANY TIME AFTEF WORK IS COMMENCED. NO. DW4G. UNITS
I HEREBV CERTIFV 7HAT I HAVE READ ANO EXAMINED THIS APPLICA710N 1
AND KNOW TNE SAME TO BE TRUE AND COFRECT. A�L PROVISIONS OF �AW$ yq�UATION
AND OROINANCES GOVERNING THIS TVPE OF WOFK WILL BE COMPLIED
WITH WHETHER SPECIFIED MEREIN Oii NOT. THE GRANTING OF A PERMIT �2aOOO
DOES NOT PRESUME TO GIVE AUTMORITY TO VIOLATE OFi CANCEL TME pEqMIT FEE
PROVISIONS OF ANY 07HER STATE Ofi LOCAL LAW REGUTATING CON-
STRUCTION OR TME PERFORMANCE Of CONSTRUCTION $69.ZS
OaAUIM E04GENT 10AtE�
�E�DEp� � i0♦►E� �
PANCY GROUP OCCUPANCYLOAO
� CU FT.
OFFSTFEET PARNING
STAIIS GARAGES
SURTAX
� $1.00
SAC CMAiiGE
Fire C $2.00
TOra EE
$ 2.25
R V LIDAT(yp MIS IS M�UF EFllM
�i ��5
N� [ l � Effective 1/1/2001
ADDN [] '. CITY OF FRIDLEY ���� (763) 572-3604 Bldg Insp
ALTER [ J SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMITAPPLICATION
Construction Address:
Legal Description:
Owner Name & Address:
Contractor:
e
Tel. #_ �(3-7102- ��� �
MN LICENSE #
Address: v Tel. #
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
� �
LIVING AREA: Length -�_ Width ��� Height_� Sq. Ft l�
GARAGE AREA: Length
DECK AREA:
OTHER:
�Do�r f !x,
Y'Cx� r1'l
Width Height Sq. Ft.
_ Width Hgt/Ground Sq. Ft
t- �e�/c � �i1.5'e�� �e]�.v� `� _� �t �o,o�/i
Construction Type: Estimated Cost: $ o( ,��
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _$
`�
DATE: 3�a�- (9 ( APPUCANT: � Tel. #
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrovri
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
$ :��� C> � .001 of Permit Valuation (1/10th%)
$ /; c�(� $.50/$1,000 Valuation
$ $1150 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 [ ]
g o�• o��
Cy ` e
l� �ei� J
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 siructure, 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
lxlow set forth and in the manner herein provided to-wit:
TOTAL VALUE
$1 to $500
$501 to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,000
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23 .50 for first $500 plus $3 .OS for each addirional $100 or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.00 for each additional $1,000
or fraction thereof, to and including $25,000
$391.25 for first $25,(�0 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, �
$993.75 for first $100,00U plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,000
$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
$1,000 or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Curb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
Altemate "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
Pernuts 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
he required before proceeding with the framing. New Houses Onlv
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COMMON VENT. VENT CONNECTOR AND COMBUSTION AIR VERIFICATION
When replacinst an existinst furance, 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 () No ()
The venting�,system is. plasticlPVC and meets all cuRent codes and manufacturer �" `
speciflcations :including sizing, length, number of elbows and termination. ` Yes O� No {� )
The undersigned also verifies that the replacement unit is a listed assembiy
and meets the current codes and manufacturer's specifications. This does
include AGA-GAMA Category I Central Furnace Venting Tables for fan
assisted and natural draft appliances.
The existins� combustion air is sized and installed to meet the cuRent codes
and manufacturer's specifications.
1iVh�n required �a instait � new c�mbu�ion-arir, it wi8 t�� sized and installe�
To meet the current codes and manufacturer's specifications.
Yes ( ) No ( )
Yes ( ) No ( )
Yes ( ) No ( )
When instailing a new ventin� svstem, the undersigned hereby verifies that
it is a listed assembly and meets the current codes and manufacturer's
specifications. 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 cuITent codes. Yes O No O.
Aaqliance Tvpe and Size/Common Vent and Vent Connector Information
Appliance #1 Type BTU Input Fan Assisted or Nat�______
Appliance #2 Type BTU Input Fan Assisted or Nat _
Appliance #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
ALTERATIONS• (Descrlbe)
; .
HEATING CO: � .
Signed By: ! Date : �