AF - 48000� � � �� _ _
sue�ecr PE NO.
c�ty of Fr�aley 126os
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T '
� � R TN
� ' COMMUNITY DEVELOPMENT DIV.
' j V � ��
r � PROTECTIVE INSPECTION SEC. (, � �
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�� �"��1 � CITY HALL FRIDLE� 55432 NUMBER REV. DATE PAGE OF APPROVED BY
""� � ,�� 812-�0-3450
910-F15 � �
JOB ADDRESS 554 La.fayette Street N.E.
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. SZ - 55 D Riverview Heights SHEET
2 PROPERTYOWNER MAILADDRESS ZIP PHONE
E, F, Montugue 554 La.fayette Street N.E.
3 CONTRACTOFi MAIL ADDRESS ZIP PHONE LICENSE NO.
Same
4 ARCHITECTORDESIGNER MAILADDRESS ZIP PHONE LICENSENO.
5 ENGINEER MAIL ADDRESS ZIP PHONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
❑ NEW ❑ ADDITION �7 ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK patio & Stair�vay 14' x 12'
9 CHAN(iE QF USE FROM ` TO
STIPULATIONS
SEPERATE PERMITS R�Q.UIRED FOR 4NIRiNG,
HEATING, PtU�I6�NG AND SICNS.
SEPARATE PERMITS ARE REOUIRED POR ELECTRICAL, PLUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. ],O O
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS 3USPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT ],(8 2O]_(
ANY TIME AFTEFi WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY �ERTIFY THAT 1 HAVE READ AND EXAMINED THIS APPLICATION ]_ STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OROINANCES GOVEFINING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT S38S. OO . SO
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 PERFORMANCE OF CONSTRUCTION. � yS`S.00
/j-� ^- LT� % �_� � � ^ � � ��� PLAN CHECK FEE TOTAL$S SO
f �` � � ! �
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SIGNATUREOFCONTRACTOR AUTHORI2EDA6ENT IDATE) yyHEiV PROPERLY VALIDA ED H IS Y R PERMIT
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SIGNATUREOFOWNERIIFOWNERBUILDERI IDATEI B DG. N5P 9 pATE
APPLICATION FOR RESIDENTIAL, ALTERATION,
OR ADllITION BUILDING PERMIT
CITY OF FRIDLEY, NIINNESOTA
OWNER `S NAME : `C 7 P ����J' �% � BUILDER :
ADDRESS; �� 1 ADDRESS:
NO • . S`�5� S TREET : !1'� ��G✓� ���° -a��/(�C. ,_
LOT: 5^Z-�' S�. BLOCK: � ADDITION: �,'jlr�l� ��
CORNER LOT: INSIDE LO'�:_�S�TBACK: SIDEYARD
Applican�t at�ach to this form Ztao Certificates of Survey of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
Ta Be Use� As: �
�'�� d � �
ont: r- _ DePth' ��'� Iieight• ���
Square Feet : %� �p$ . Cubic Feet : � l��lp
Front• Depth• Height•
Square Feet; Cubic Feet:
�
�pe of Construction: f�i�,�/�,���lQy�,���tima,ted Cost: $ `3�`j
,
To Be Complet�d: � �f /�9-%� �
-�.-�
The undexsigned hereby makes app�icativn for a permit for �he work herein
specified, agreeing to do all work in stiict accordance with the City of
Fridley Ordinances and rulings of the Department of Buildings, and hereby
declares that all the•facts and representations stated i.n this application
are true and correct.
DATE : _ �y '� � �" ` � S IGNATURE • ��G"! �_
(See Revers� Side For Additional Infonnati n.)
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BUILDING P�RMIT FE� SC�EDULE
SECTION 2. The Inspector of Buildi.ngs 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 fox such permit of fees to the amount herein below set forth and in
the ma.nner hexein provided to-wit:
iT'NIFORM BUILDING 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.
AD�ITIONAL INFORMATION
Fox the purpose of computing feas for building percnits, 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.r
height of the roof surface of the main gable of a pitched roof.
For repairs or alterations to an existing stxucture, the fee sha11 be at the
rate of $3.00 per 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 $5.00.
VERIFICATION OF FOUNDATION
NOTE: Permits for construction will be issued a minimum of 24 hours from the
tune of application, to allow for proper review of the pxaposed 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 require3 before proceeding with the framing.
CERTIFICATE OF OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (10) days prior
to �he 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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SUBJECT PER .
City of Fridley , 1312
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
r
� � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
� �y-------� � �,7 /
r � � PROTECTIVE INSPECTION SEC.
1 = �
�� /'�'1 � CITY HALL FRIDLEY 55432 NUMBER REV. DATE PAGE OF APPROVED BY
•"'� � ,�� 612-560-3450
910-F15 Augu5t 1, 9�5 �
JOB ADDRESS 554
Lafa ette Street N.E.
1 LEGAI. LOT NO. BLO�K TRACT OR ADDITION SEE ATTACHED
DESCH. � 52-55 D Riverview Hei hts Addition SHEET
2 PROPERTYOWNER MAILAQC��iESS ZIP PHONE
�g4
ta e Lafa ette Street N.E.
3 CONTRA TOR MAILA RESS ZIP PHONE LICENSENO.
u "
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDING
7 CLASS OF WORK
❑ NEW I� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE ❑ REMOVE
B DESCRIBE WORK
construct a 20 x 22 ft detar.hed garage
9 CHANGE OF USE FROM TO
STIPULATIQI�IS
1. Provide a hard surface drive
��PERATE PERM1
TS REQ�IREO FO�t �V�Rt(�G,
HE�+�
1NG, P����1NG AND SIGNS.
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING, TMPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
VENTILATING OR AIR CONDITIONING. WOOd fr3�e
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPEIVDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT L,}�jO 4 600
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION S.TA�LS 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 1.7]_
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. ' S9.00
�-
PLAN CHECK FEE TOTAL FEE
�.'L6".,�►'�R° ' '�.4�y �" � ' °� ,9' $10.71
� SIGNATUREOFCONTF CTORORAUTHORIZEDAGENT IDATEI EN PROPER Y VA D TH�IS Y� ERM T/
�
SIGNATURE OF OWNER IIF OWNER BUILDERI IDATEI BIDG INSP ATE
� _ � ' _
. .
•A�PLICATION fOR RL•Si'DL'NTIA�, ALTL'RAIION,
. . OR AllllITION. BUILDIti'G P�R�I�iIT
� CITY OF FRIDLEY, riINNESOTA •
. .. .
' . � � � � d�,�e ►� � ►� � � .
OWNER'S N�11�i�: t� �- 6�1 �� BUILD�R:
, ADDRESS : � 7 d � d � j %�% ADDRES S : .� � y S l�I/ !� � l� �� °� � �c7
. . .
NO:. � STREET• '
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T : `s`2 � `S�� BLOCI:: • ADDIT�OIQ : /1, � I� Q ►/' (/' < �i � _���
. CORNER LOT: INSIDE LOT:�_SETBACK: ___ SID�YAP.D:
.�.Applicant attacr. �o this forac. �tao Certificates. �f Survey .of L�oC and .pxoposed
building location drawn on these Cextificates. � .
.� � �BESCRIPTION OF BUILDING �
. .
Ta Be Used As : ' . . . �
• - Front : Depth : � ' Height :
. . Square Feet: Cubic.Fee�:
.� � � Front:� �-� Depth:. � � Height:
. , � � Square Feet; Cubic Feet: '
. .r, .
Type of�Construction: � � � �6 � Estimated Cos�: $ � � D �
, �e �� .
To�Be Completed: � . • -
"� The undersigned hereby makes applicativn for a pezmit for the work herein
apecif ieci, agreeing to do all worlc in strict accordance ��ith the Citp of
' Fxidley Ordinances and rulings ot the Department of Buildings, and her�by
declares that all the facts and xepresentations stated in this application
are'txue and corrcct. � �
� � � � � ' . � �1 � . --�/� � � -
� • DATE: � - Z° � ° 7 . �`- SIGNATURE • �
(See I�everse Side For Additional Informat n'
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� 5�CTION 2. Tlie Inspector oi IIuildings shall, bciore issuing permits for the
execCion of any building or structure, or tor any addition to any existing
building or structure, or ior nny altcration ar repairs to any exisL-ing
building or struc.ture, upon application thereiore, require the payment by the
applicant ior such pennit of fees to the amount hcrein below set forth and in
the mannen c�rein provided Co-wit: . . • .
a .
UNZFORM BUILDII�G CODL: �pe 1, 2& 4-$2.15 for each one thousand cubic
feet, or fraction thereof, in such cubical contents. ij�pe 3& S-$1.85 for
each one thousand cubic feet. � • �'
ADDITIONAL INFORI�IATION
For the purpose �f computing fees for buildin� iermits, the cubical contents -
of any building or.addition, is determined by multiplying�the ground area
. covexed from a point six (6) inches below the floor line of the basement �
ox the cellar ta the average heights of the uppex surface or to the avQrage�.
:height of the•roof surface of the main gable of a pitched roof.
• For repairs .or alterations to•an existing structure, the fee shall be at the
° rate of $3.00 per each five huridred�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 $5.00. �. � � , �
� � � � VERIFICATION OF FOUNDATION �
. , � ►
� NOT�: Pexmits for construction will be issued.a minimum of 24 hours fxom the
tisne of application, to allo�o for pxoper rettiew of the proposed structure and.
• �� the construction site. , . • �., �
A Certitied Survey of the lot, showing the location of the foundation, once it
has,been constructed, will be required before proceedin� with the framing.
CERTIrICATE OF�OCCUPANCY '
Applieation for a Certitic�te of Occupancy shall be made ten (10) days prior
to the use or occupancy of any structure for which a buildin� permit has been
� issued; and said structure shall noC be used ox occupied until a Certificate
� " • • of Occupancy h�s been issuedo . , . o �
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926-2656 , 11 V llJi��� ��1 � � ��v
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'� 5145 Oliver Avenue South
� MINNEAPOLIS, MINNESOTA 55419
Customer Name M�' ���� Y�- f=' %YtD N7'f}bu
Address _ •SS'�/ �.A- FR� V � S� /!!•L=
c�ty f=�� �z�;� �P �ss y� 2
/
�Permit By ���b� �CB�_
❑ Legd Description
❑ Loi
❑ Blk.
� Add'n
❑ Value
J'�Scluare With � uf e..
� Rods �
�f Mesh � /
�Sod Rem. - By�u�w�iw �Cta�C
O 5-Bcg Mix
f�`6-Bag Mix
�j,Tomping
� No Tcmping
2-Starting ParMs Only
S.P.L
S.S.P.L 7
R.P.L. �
Alley
G' r ��� "'� House
F. Street
Oti+e► - AF►'�nP '1'O b � -
_ Ff u3.� e,. +4� cicse
CONDUIT
�O.H. Dr. Offset
�S.D. Laotion
O Blocks
Home Phone ��� �? y�s
Business Phone 33 9" �"'2- � f�
Buildrng Code Area l%�'� ���y`
INDICATE THE ITEMS BELOW OM LAYOUT
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P-4 REV. �.: ,. ,
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CO;l+ISTOCK & DAVIS, iNC. Consulting Enaineers and Land Surveyors
1446 County Road J, blpls., Minn. 55432, 7$4-9346
LOT SURVEY OF OWiVER: Eugene Montaque
LOTS 52, 53, 54 & 55 . 554 La�Fayeite Street
BLOCK D, RIVERVIEW HEIGNTS Minneapolis, MTnn. 55432
�RIDLEY, MINNES�TA
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Lots 52, 53, 54, & 55, Block D, Riverview Heights, Anoka County
SCALE: /"-30'
+Denofe.P lra� r�onume�f f'aund
�Oe�ofes i�on in�ur�ent sef
I hereby certify that this survey, plan or report was prepared by me or under my direct
supervision and that I am a duly Registered Land Surveyor under the laws of the State
of Niinnesota.
/, � /083Z 7/.��75 -�S7
Reg. No. Date Job No.
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� LAND SURVEYORS
An•:kc, ti;•n� ec��::
VEY:
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Telephone 421-6340
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'M4? TMIS IS A TRUE �ND COoiE�T vE�RE�EN'4^C�+ •:.f a S.�R•:Er OF THE BOt�vpAalc'S OF TME nB:vE
TFi° LOCAIIJN Of AU EU�LDW35, TNFaECN, �ND �lt '•�:blE ENCR7ACMMENiS, IF �NY, FRO+' OR ON Sa�D
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/� � W o�'� to—�g �) b ��� Minnesota Well and Boring
wELL oR BoawG �oCA N INNESOTA DEPARTMENT OF HEALTH Sealing No. H 12 � 3��
County Name WELL AND BORING SEALING RECORD M���esota u��Q�e No.
���A Minnesota Stafutes. Chapter f031 or W-series No.
(Leave blank d not known)
To h N ?�� Townshi No. Range No. Section No. Fraction sm. 1 Date Sealed Approximate Date Well
����Z*"� �'� %,� � ��° � .�� ''���'j�'�' ����L'ws�� orBoringConstructed �����6
l4 la �4
Numencal�iFeeLAd�ess�Fj.r�� Cj�,y����.�l�nng Location �,��. �
3 �! At+�� l�A ;,"�
Depth Before Sealing ft. Original Depth ft.
Show exact location of well or bonng Sketch map of well or boring Slatic Water Level ccurate
in section gnd with 'X'. � localion. showing property lines. �
roads. and buildings. ❑ Approximate
N �„�,
_i . i i i_ � �'G��� � ��.:�� f ��
, - �- -i - -i
_ � �Single Aquifer ❑ Multiaquifer fl. below above land sudace
i i i i
-'- - � - -1- -'- CASING TYPE
W i i i i E
� � � � T
-r -�- -r- -r T
� � � � teel ❑ Plastic ❑ Tile ❑ Other
n mlfa
I I 1 1 (��y
_� _ � _ - � _ _� � � e8 S ,LTiJ�af'
S Screen from to ft. Open Hole from to ft.
� � �^'� � � �� OBSTRUCTIOWDEBRIS/FlLL
❑ Obstruction ❑ Debris ❑ Fill
PROPERTY OWNER'S NAME
����o ���Tr�� �
Type of debris/obstruction
Mailing Address d diiferenl than property address indicated above.
���� ��������� �� n ���� Obstruction/Debris/Fill removed? ❑ Yes ❑ No
I�'e�V H���"ie �. ���� % PUMP
. �emoved ❑ Not Present ❑ Other
CASING
GEOLOGICAL MATERIAL COLOH HARDNESS OF �OM TO
FORMATION
li not known, indicate estimated formation log from nearby well or boring. Diameter Depth Set in oversize hole? Annular space initially grauted?
�� �,� � � � 'F" in. fram � to � � fl. ❑ Yes �o ❑ Yes ❑ No ❑ Unknown
�, �
���� ��.��� e�v� � s �� in. from to ft. ❑ Yes ❑ No ❑ Yes ❑ No ❑ Unknown
���� ��� � � � � in. from to tt. ❑ Yes ❑ No ❑ Y� ❑ No ❑ Unknown
M OD USED TO SEAL ANNULAR SPACE BE7WEEN 2 CASINGS, OR CASING AND BORE HOLE:
�°�� a ������ ����� � � �' � �� � Annular Space Exists
� °
��r� ��� �� �� ❑ Mnular space grouted with lremie pipe
❑ Casing Perforation/Nemoval
���� ��� �� . P� ��
��,��� �� ���� �� � �p in. from to ft. ❑ Pertorated ❑ Removed
������� °�� �`��� � �� '�� m. from ro R. ❑ Perforated ❑ Removed
Type ot pertorator
❑ Other
GROUTING INATERIAL
Groutingmaterial ������� from ��� to `���� R. yartls � ba s
from to ft. yards bags
REMARKS, SOURCE OF DATA, DIFFICULTIES IN SEALING
���y�� �� e��� '�.`� ���� ��� � from to R. yards bags
ai181��e� �i�e�ie'.�a �i� ��f%+d3�a" � f9�:l�a�r: u� ;
��� ���� ���� � ` 3�� � � � � � from to ft. yards bags
UNSEALED WELLS AND BORINGS
��,� �� � , i � � � ~ � � � Other unsealed well or boring on property? ❑ Yes o
������� m �.��
LICENSED OR REGISTERED CONTRACTOR CERTIFlCATION
This well or boring was sealed in accordance wfth Minnesota Rules, Chapter 4725. The intormadon contained in this report is
true to the best of my knowledge.
����� S�S.:_�.'.�__ Zl���l�k�t!? � ���gVi,oy �i�SL�s:, lS�.ba!
Conhactor Business Name License or ftegistrafion No.
According #� ���1 Stat� Reguiations ' `� ��`��
Authorized RepresentaGve Signafure Dafe
�o��C�P� H 121360 ��� �.����.,����.� ����
Name oi Person Sealing Well or Boring
HE-07434-01
BID SPECIFICATIONS
REMOVE FLAT ROOF/CONSTRUCT PITCHED ROOF
NAME: Anatoliy/Oksana Podolyanchuk
ADDRESS: 554 Lafayette St NE, Fridley, MN 55432
TELEPHONE: 785-4046 DATE: _ (ey� % �, ���(�
1) Provide protection of walls, windows, and bushes with tarps and plywood.
2)
3)
4)
5)
61
7)
8)
Carefully remove existing roof covering, plumbing, heating and other vents, roof sheathing,
electrical wiring, ceiling joists and ceiling covering.
Install treated plate with 1/2" diameter anchor bolts with 7" minimum embedment, 12" from
ends, 6' on center, on masonry walls.
Provide adequate headers above windows in bearing wood frame exterior walls of rear porch.
Install wood roof trusses to span entire roof.
Install roof sheathing - H clips to be used with 2' on center truss spacing.
Rewire ceiling light fixtures and wire for smoke detectors in bedrooms and centrally located
in hallways to sleeping areas.
Extend plumbing and heating vents through new roof.
9) Install one layer No. 40 coated base sheet from eaves to a point 12" inside the exterior wall
line above all heated spaces.
10) Install 15 Ib roof felt over entire roof.
11) Install proper amount of roof vents as per Building Code - 1/300 sf.
12)
13)
14)
15)
16)
17)
18)
19)
Install 240 Ib, 3 tab, self-sealing, asphalt shingles, or the equivalent, over entire roof (color
by owner).
Install sheathing and aluminum siding on gable ends.
Install aluminum soffit with adequate vents.
Install minimum 1" air chutes and R44 roof insulation.
Install minimum 22" x 30" attic access.
Install 5/8" Gypsum board on ceiling - tape and spray texture.
Install ceiling fixtures and smoke detectors.
Clean all construction debris from area.
I, ��'h���t P�f�a� ��ie�a�r�, , understand that this bid specification is only to help me, the
homeowner, obtain a grant for repairs to my home. Technical/structural elements shall be verified
by my contractor prior to commencement of construction. The City of Fridley is not liable for any
damage that may occur to the walls/foundation/etc. during/after this roof replacement.
SUBJECT Q, —�,
City of Fridley 2 5 5 5 7
AT THE TOP OF THE TWINS g � I L D I N G P E R M I T
r
; � " RECEIPT NO.
� `v _ ��� COMMUNITY DEVELOPMENT DIV. ����
r � � � PROTECTIVE INSPECTION SEC.
� j �
� /'�'1 � CITY HALL FRIDLE� SS432 NUMBEF REV DATE PAGE Of APPROVED B�
�"""'� � ,'' 612-571-3450 91aF15
9/30/97 � �
108 ADDRESS 554 Lafayette Street NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
�escR. 52-55 D Riverview Heights Addition SMEET
2 PROPERTY OWNER MAIL ADORES$ ZIP PFIONE
Anatoliy Podolyanchuk 554 Lafayette Street NE 785-4046
3 CONTRACTOR MAIL ADDRESS 21P PHONE LICENSE NO.
Same
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDFiESS ZIP PHONE LICENSE NO.
8 USE OF BUIIDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION � ALTERATION O FiEPAIR D MOVE O REMOVE
8 DESCRIBE WORK
Interior remodel; Construct 10' x 4' Deck; Construct canopy on side entry
8 CHANOE OF USE FROM TO
STIPULATIONS
See notations on plan.
WARMN�
Before digging cttl fOt
� . �II utility locations
��SEPARl4TE PERI�ItTS REQUIRED FOR 45a•O�o2
w1�NG, NEATtNG, PLUMBiNG AND SIGM$, REQUIRED BY LAil�f.
TVPEOFCONST. OCCUPANCY(iROUP OCCUPANCV�OAD
SEPARATE PERMITS ARE REQUIREO FOR ELECTAtCAL, PLUMBING, HEATIN(i,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AUTHOfi12E0 IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTpUCTION
OR WORK IS SUSPENDED OFi ABANDONED FOR A PERIOD OF 120 DAVS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1 STALIS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS Of LAWS yALUATION SURTAX
AND OROINANCES GOVERNING THIS TVPE OF WOFiK WILL BE COMPLIED
WITN WHETHER SPECIFIE� HEREIN OR NOT. THE GRANTING OF A PEFiM1T �I�OOO �.SO
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL TME pERMIT FEE , SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUCTION OF THE PERFORMANCE OF CONSTRUCTION. $3L►. ],rj Fire SC � 1. ��
PLAN CHECK FEE TOTAL FEE
$36.25
S�GNATUREOFCON7RAC ROAAUTh�OA�IEDAGENT 1OATEi HEN PROPERLY IDATED TH�S iS rOUFi PERMiT
r �
�����st �,�" -G°.�%�.;-��,� .°/— 30 �y , � �� /
S�GNATUAE Of OWNEA ��F OWNER BU EA� IDATEI BLDG SP qa
. . .. � .... . . ..... . .. . .. ... .. . . .. . ... .�, ...� .. .. . ... . . ... . . . .... .........�.> . .. . . .. ... . ..`.1 .r. �. .... . . . .�. . .. . . ...., . . , ... . ... . . .S��;ii�
NEW i 1
ADDN ( J
ALTER ( �
CITY OF FRIDLEY
S[�iGLE FAMILY AND DUPI.EXES R-1 AND R-2
BUILDING PERMIT APPL[CATION
ConstructionAddress: `��'`~ P° �rU�
��6�
f
Legal Description:
� �� S � r� �T �J'/ C��
Effectivc 1/1/97
���' �?���%
� �% ��� � 3 ;�
Owner Name & Address: � ��L�/� V �[�r`���;t �e°;�u,�,� Tel. # %T'=� � 1i'�G��E
�
Contractor. o � MN LICENSE #
Address:
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, �vith the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length
Length
Lengtn ��j ,
�� ��', .
Tel. #
w�a� Height Sq. Ft.
Width Height � Sq. Ft.
Width Ci� Hgt/Ground Sq. Ft_ ��� •%7
►'I��/_lz� � �i/�l�i/I �%A�/ � /f%A,�.m�lk� � / =.3'7�,'�CJ
Construction T e: �
yP � ��a cost: �_ J, �.
� (Fee Schedule bn Back)
� Driveway. G�trb Cti.�t Width Needed. � �t ' �� Ft' + . 6 Ft '= Ft x ` $ . — $ , � �
DATE:
' Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
S"1'[PU(_n"1'[ONS:
APPLICANT:
CITY USE ONLY
Tel. #
�
$ y�) Fee Schedule on �Reverse Side
$ /� .001 of Permit Valuation (lllOth%)
$ • � $.50/$1,�0 Valuation
$ $950 per SAC Unit �
$ $5.� (State Licensed Residential Contractors)
$ Alt. "A" or Alt_ "B" Above
$ � � $450.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ )
$ C', 2 `S
IiU[LD1,\G 1'i;itl��t['[' FFE SCE{EDC'[.t�.
"I�lic Cl�ief I3uilding Officia! sl�all, bclorL issuing perniits for the erection ol� any building or structurc, or t��i-
a��y addition to any existing building or structurc, or for any alteration or repair io any cxisting buildint c�r
structure, upon app(ication theretore, require die payment by the applicant f'or 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
�?,OU1 to $Z5,000
$25,001 to $50,000
$50,001 to $1QQ,000
$100!,001 to $500,000
$SOO,OOI to $1,000,000
$1,000,001 and up
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
�62.2� for first S2,000 plus $12.50 for each additional $i,000
or fraction thereof, to and including $25,000 •
$349.75 for first $25,000 plus $9.� for each additional $1,000
or fraction thereof, to and • including $�0,000
$574.75 for fust $50,000 plus $6.25 for each additional
$1,� or fraction thereof, to and including $1Q0,000
$887.25 for fust $1�,000 plus $5.00 for each addition�l
$1,000 or fraction thereof, _to aad including �SQ0,000 -
. -.
$2887.25 for the first $SW,OOO�pius $4.25 for each additional -.
$1,� or fraction tliereof, to and including $1,000,000
$5012.25 for the fust $l,t}OD,O(}0 plus $2.75 for each additionai
$1,� or fraction thereof
DRIVEWAY DEPRESSION ESCROW
(Concrete Ctirb Streets Only)
Aiternate "A": Removal and replacement of curb and gutter only - Drive�vay width plus 6 feet times $13_50_.
A(ternate "B": Removal and repiacement of curb and gutter and install a 3 foot wide
approach tivith b inch depth - Driveway width plus 6 feet times $15.7�.
VERIFICATION OF FOUNDATION
f'c;-cnits for construction will be issued a minimum of 24 hours from the timc of application to allow �or pro��r
rc��ieu� 01� tfic pro�osed structure a►id of the construction site.
�� �:�c►�tificate of Sur-��ey <�t� tlie lot, showin�� the lc�cation ot� tt�c foundation �+�ice it has it t�as he::n c�nslruc:=t:::.'
...': i�� �-�yt�ir�;�l 1,�1i�r� (�r<�.:��din�, ���iti� [hc 1r:iinim,.
9 -.
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SuBJECT � j�,
c�ty of Fridley � 2 6 0 9 3
AT THE TOP OF TME TWINS g U I L D I N G P E R M I T
�
; � RECEIPT NO.
� • COMMUNITY DEVELOPMENT DIV. � �/�
� j V ��'��'�
f � � PROTECTIVE INSPECTION SEC.
1 . �
� ' /"'1 � CITY HALL FRIDLEV $$43Z NUMBER NEV DATE PAGE OF APPROVEO BV
�----� • •,, 612-571-3460 9�ap�5 5/27/98 / /
J08 ADDRESS 554 Lafayette St NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACNED
oescp. 52-55 D Riverview Heights Addition SFIEET
2 PROPERTY pWNER MAIL ADDRES$ ZIP PNONE
An.atoliy Podolyolnchuk 554 Lafayette Street NE 785-4046
3 CONTqACTOR MAIL ADDRESS ZIP PHONE LICENSE NO
Same
4 ARCHITECT OR OESIGNER MAIL ADORESS ZIP PHONE LICENSE NO.
5 ENGINEER MAIL ADDRESS ZIP PMONE LICENSE NO.
8 USE OF BUILDING
Residential
7 CLASS OF WORK
� NEW ❑� ADDITION ❑ ALTERATION ❑ REPAIR ❑ MOVE O REMOVE
8 OESCRIBE WORK
Construct a 20' x 13' Addition to Detached Gara e
9 CHANOE OF USE FROM TO
STIPULATIONS
Provide a hard surface drive. Provide concxete slab, minimum 8 inches
deep around perimeter with 1/2" x 7" anchor bolts, spaced no more than 6 feet
on center. Slab thickness minimum 4 inches. Treated sill plates on bottom of
studs.
�������
�efore diggin� call �r
ali utNity bcatimns
SEPARATE PERMITS 12EQUiRED �4� R�Q�t�I�En BY
yViRING, HEATING, PLUMBING'I�ii� ��
�!GlV�.
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBIN(i, HEATIN(i, TYPE OF CONST. OCCUPANCV dROUP OCCUPANCV LOAD
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SQ. FT. CU. FT.
AU7HOHI2ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO 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 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS yq�UATION SURTAX
AND ORDINANCES GOVERNING TH,IS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED MEREIN OR NOT. THE GRANTING OF A PERMIT �3 s 9OO � 1. 9S
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 �57. LS Fire SC $3. 9O
PLAN CHECK FEE T07A E
$ .10
S�GNATUAEOFCON7RACTOAOAAUTMOAl2EDAGENT IDATEI N P OP V ALIDAT D HIS IS VOUR PERMIT
SiGNATURE OF OWNER iiF OWNER BUILOER� IDATE� - ` ���' �
. 8L �NSP qqTE
NEW [ ]
ADDN [ ] � CITY O� FRIDLEY
ALTER [] SINGLE FAMILY AND I)UPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
ConstructionAddress: �.��/ L G��Cd �l� e �� ��. /�%�. �� s (,I��� t/ , � "I lj%
Legal Description:
Effective 1/1/98
0
� a � /�-
� a�
Owner Name & Address:�i��,�c' jP �' �p(�o ��t;� rn��1 c,c. � Tel. #��'�'- �$�'�/��
Contractor: MN LICENSE #
Address: Tel. #
' 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:
OTHER:
DESCRIPTION OF Il�IPROVEMENT
Length Width Height
Length e�o,� Width /j Height
Length Width �IgdGround
Sq. Ft.
Sq. Ft. ,��p X/„5-
Sq. Ft.
�9� � �p'�
Construction Type: b �z-�l= � Estimated Cost: $ ���1�. �'b
(Fee Schedule on Ba�k)
Driveway Curb Cut Width Needed: Ft. + 6 Ft =__Ft x$ _$
I9AT�o
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driv�way Escrow
Erosion Control
Park Feo
Sewer Main Charge
TOTAL
APPLICANT:
CITY USE ONLY
Tel. #
$��'. a,$� Fee Schedule on Reverse Side
$ �3. `f'1S .001 of Permit Valuation (1/lOth%)
$ /. $.50/$1,000 Valuation
$ $1000 per SAC Unit
$ �-� $5.00 (State Licensed Resident'ral Contractors)
$ Alt. "A" or Alt. "B" Above
$ $450.00 Conservation P1an Review
$ Fee Determined by Engineering
$ Agreement Necessary [] Not Necessary [ J
$ �
�.
STIPULATIONS y���� ������.►�. ,,
�!� ��''..� /�J/•J, � �`��
��P��n ET�"� -�� ri.�l�s. w!� %'�ar � "�,�� y� �.
�L?'S S�� � O�f�-a /��Q� ?`�f�! ��� O, G. ��� ��/��i%�!�:�
/1?l�v', . %��r�.� c�ILL ��t�s-�c�--� �iv1 - uol
� 7� ol�'!'
BUII.DING PERMIT FEE SC�IEDULE
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
$2,001 to $25,000
$25,001 to $50,000
�50,(?O1 to $100,000
$100,001 to $500,000
$500,001 to $i,000,000
FEES
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each addiiional $1n0 or
fraction thereof, to and including $2,000
,
$62.25 for first $2,000 plus $12.50 for each additional $1,000
or fraction thereof, to and including $25,OOQ
$349.75 for�first $25,000 plus $�.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $�0;000 p�lus $6.���0� €ach addit�9na1
$1,000 or fraction�th�of�..ta and incl�ading;�100,000
$887.25 for first $100,OQ0 plus $5.(}0 for each additional
$1,000 or fraction ther�of, to and including $500,000
$2887.25 for the first $500,0(}0 plus $4.25 for each additional
$1,000 or fraction thereof, to and including $1,OOQ,000
$1,000,001 and up $5012.25 for the first $1,Q00,000 plus $2.75 for each additionat
$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 $13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wid°e
approach with 6 ineh depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review Qf 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.
' ,y .,u. C � � �. ° s . . � .. . � .. .
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OC[�t�1 C��tC� �' S'�.�C)C:.I C� f�'�;. .��ll'.
� �
� LAND SURVEYORS
An_kc, ':1.n, e�o�:s
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Telephone 421;6340
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�T TMIS IS A TRUE AND COo�ECT aF�RE�IN'��tC•+ �:F � SL�R'!;y pF THE BO?'VpARliS OF TME AB,^,VE
if IOCAl10N Of ALL EU�ID�N�.,S, �NFRC�N, .ND <<t '•�:61E ENCR��CMMEN�S, IF ���Y, FRO� OR ON 54'D
�., . .
. - • , . • -
y z I;.,,. „ DAY OF ,�' 1. �- A.D. 19 ::
. . .... ........ .. . . . ..... .. . . . .
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sue�ecr PE .
c�ty of Fridley � � � �� �
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T�
r
; � RE EIPT NO.
� • COMMUNITY DEVELOPMENT DIV.
r � L � PROTECTIVE INSPECTION SEC. �� ��
� �
i �
� � /'�'1 � CITY HALL FRIDLE� 55432 NUMBER REV DATE VAGE OF APPROVED BY
�'""� � ,'' 612-571-3450 910-Ft5 7/25/96 / /
J08 ADDRESS 554 Lafayette Street �E
t LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. SZ-55 D Riverview fleights Addition SHEET
2 PROPERTV OWNER MAIL ADDHESS ZIP PHONE
Oksana Podolyanchuk 554 Lafayette Street NE
3 CONTqACTOR MAIL ADDRESS Z�P PHONE UCENSE NO.
Kodiak Construction 2607 Bri hton NE, Minnea olis MN 55418 781-0286 8608
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
❑ NEW ❑ ADDITION ❑ ALTERATION � REPAIR ❑ MOVE O REMOVE
8 DESCRIBE WORK
Re lace flat roof with itched roof; sheetrock ceilings and insulate to R-44;
siding of gable ends
9 CHANGE OF USE FROM TO
STIPULATIONS
Provide smoke detectors to meet the State Building Code.
TYPE OF CONST. OCCUPANCY GROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE HE�UIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OH Alii CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZpNING S�. FT CU. PT
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 HAVE READ AND EXAMINED THIS APPLICATION 1 STA�LS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORREC7. ALL PROVISIONS OF LAWS VALUATION SURTAX
ANO ORDINANCES GOYERNING THIS TYPE OF WORK WILL BE COMPLIED
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT �16�000 �S.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEqM1T FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON-
STRUC710N OR THE PERFORMANCE OF CONSTRUCTION. �Z3%.ZS Fire SC $16.00
PLAN CHECK FE 7 L FEE
L n S .00 $266.25
SIGNATUREOFCON'RACTORORAUTHOR12EDAGENT (OATE� pR Y VA ID ED THIS IS /Y)OUR PERMIT
� � ( ' ✓ �
SiGNATUREOFOWNEA��FOWNERBUILDE�7i iDAT6 - DG ihSV p4TE
._ /� - _ •
rrEw
ADDN
ALTER
[]
[l
[]
CI1'Y OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
ConstructionAddress: �� ,L,��'�.
Legal Description: ��� % .S ��- � �
Owner Name & Address�
Contractor:
Address:
Effective 3/1/9t,
�3�i
��� ��p
%� '��C�L�1.4.t� ./ �L Tel. #
� MN LICENSE #�j�p��
� D(% �r �� � ��� Tel. # ���� .C�
Attach to this applicarion, a Certifica.te of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IlVIPROVEMENT
LIVING AREA: Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft.
DECB AREA: Len Width Hgt/Ground Sq. Ft.
OTHER: � —!�T Z�a �' brli�/�! /���'�'� 1��C
5 ����i� � �/�� `Z/1110,� � 7'"� 2 -- -
� �T. �.� .T �i�i��-,�P
Corner Lot [] Inside Lot [] Ft. Yd Setback Side Yard Setbacks •
Type of Construction: Estiffiated Cost: $ `� �d, 4�
Approx. Completion L`�ate: �
(Cost on Back)
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$
DATE: APPLICANT:
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Pazk Fee
Sewer Main Charge
TOTAL
CITY USE ONLY
_�
Tel. #
$�� 7 as� Fee 5chedule on Reverse Side
$ /G.�� .001 of Permit Valuation (1/lOth%)
$ $. G5D $.50/$1,0� Valuation
$ $9� per SAC Unit
$ S d v $5.� (State Licensed Residential Contractors)
$ Alt. "A" or Alt. "B° Above
$ �50.00 Conservation Plan Review
$ Fee Determined by Engineering
$ Agreement Necessary [ ] Not Necessary [ ]
� �c��s
STIPULATIONS: ��-_ ��y�_
�
m
BUII.DING PERMIT FEE SCHEDULE
� 'hief Building Official shall, before issuing permits for the erection of any building or structure, or for
��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 permi� 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 �
$2,001 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
$21 (Minimum Fee is $21 plus surcharge)
$21 for first $500 plus $2.75 for each additional $100 or
fraction thereof, to and including $2,000
$62. 25 for first $2, 000 plus $12. 50 for each additional $1, 000
or fraction thereof, to and including $25,000
$349.75 for first $25,000 plus $9.00 for each additional $1,000
or fraction thereof, to and including $50,000
$574.75 for first $SO,OOO�plus $6.25 far eacl� additional
$1,000 or fraction thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,D00 or fraction thereof, to and including $500,000
$2887.25 for the first $500,000 plus $4.25 for each additional
$1,0(� or fraction thereof, to and including $1,000,000
$5012.25 for the first $1,000,000 plus $2.75 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 $13.50.
Alternate "B" : Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway width plus 6 feet times $15.75.
VERIFICATION OF FOUNDATION
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the proposed structure and of the conslxuction site.
A Certifica.te of Survey of the lot, showing the location of the foundation once it has it has been constructed
will be required before proceeding with the framing.
Sue�etT P NO.
c��y of Fridley 3 37 3
AT THE TOP OF TME TWINS g � I L D I N G P E R M I T
/
� � RECEIPT NO.
� `L _�_�_ COMMUNITY DEVELOPMENT DIV. � /
r � � PROTEC7IVE INSPECTION SEC. �� IlL �
� 7
1 � �
� �'�'1 � CIiY HALL FRIOLEY SS�32 NUMBER REV DATE VAGE OF APPROVED BY
�"""'� � ��� 763-571-3450 s�aF�S 7/24/03 / /
J08 ADDRESS 554 Lafayette St NE
1 IEGAL �OT NO. BLOCK TRACT OR AODITION SEE ATTACMED
oescA. 52-55 D Riverview Heights Addition SMEET
2 PFiOPERTY OWNER MAIL AOORES$ ZIP PMONE
Oksana Podolyaachuk, 554 Lafa ette St NE, Fridley, MN 55432 763-785-4046
J CONTRACTOR MAIL ADDRESS 21P PMONE UCENSE NO
Same as above
e ARCHITECT OR DESIGNER MAIL ADOFiESS ZIP PMONE LICENSE NO.
5 ENGINEER MAIL ADDRESS 21P PMONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS OF WORK
�.] NEW O ADDITION O ALTERATION p REPAIR O MOVE O REMOVE
X
8 DESCRIBE WORK
New sidin
9 CHANOE OF USE FqOM TO
STIPULATIONS
Per Section 1402, 1997 Uniform Building Code requires that a weather-
resistive barrier be placed over exterior sheathing to protect the interior
wall cover�ng. Exceptions to this provision wou�d be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherprooiE covering unless the
manufacturer states this in the applicatiom guidelines.
Call for inspection of wrap before covering.
SEPARAtE PERMI7S ARE REOUIRED FOR ELECTRICAL, PIUMBING, HEATING, TYPE OF CONST. OCCUPANCY GROUP OCCUPANC� LOAD
VENTI�ATING OFi AIR CONDITIONING
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION 20NING S0. FT CV fT
AUTHOR12ED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOii A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO DWLG. UNITS OFFSTREET PARKING
I HEfiEBY CEHTIFY 7NAT I HAVE READ AND EXAMINED TNIS APPLICATION S7A�L$ GAFAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALl PqOVISIONS OF LAWS VALUATION SURTAI(
AND OROINANCES GOVERNING TNIS TVPE OF WORK WILL BE COMPLIED �2 OOO.00 �Z.00
WITH WHETHER SPECIFIEO MEREIN Ofi NOT. TNE GRANTING OF A PERMIT �
DOES NOT PRESUME TO GIVE AUTNORITY TO VIOLATE OR CANCEL TME pEqMIT fEE SAC CNARGE
PROVISIONS OF ANY OTHER S7A7E OR LOCAI lAW REGULATING CON- @
STRUCTION OR TME PERFORMANCE OF CONSTRUC710N W69.2S ire SC �L.00
/ PLAN CMECK FEE TOTAL FEE
U $72.25
���S�GN4TUAEO�C 'pOCTOAOpAUTMOpIZE01GENT iOATE� EN PROPEALV VALIDATED 7M15 IS VO R PEii 17
�d '���i' ,Gt ��2�1 7 �? `1-�� 1 M
S�GNGTUAE O� OWNEp�i� O Ei1BU4DEA� iD�TE� �� �
B D �NSo qarE
NEW [ l
ADDN [ ]
ALTER [ ]
Construction Address:
Legal Description:
Owner Name & Address:
7
CITY OF FRIDLEY Effective 1/1/2003
6431 University Ave NE, Fridley, MN 55432 (763) 572-3604 Bidg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2 (763) 571-1287 Fax
BUILDING PERMIT APPLICATION
l�ffe S� �1/�.�1"C�l,
Tel. #763- 7�.5=�/D`/6
Contractor: r'� �� v � MN LICENSE #
Address: Tel. #
LIVING AREA:
GARAGE AREA:
DECK AREA:
OTHER:
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length �dth Height Sq. Ft.
Length
Length
Width
Width
Height Sq. Ft.
HgUGround Sq. Ft.
Construction Type: �lC'�.r� S/��1�1� � ` Estimated Cost: $�� ��-O
Driveway Curb Cut �dth Needed: Ft. + 6 Ft = Ft x$ _$
.
DATE: 7-a'�- 03 APPLICANT: �� ���L�� Tel. #�� 3- 7,-y,�-�/��/6
Call (763) 572-3604 for Permit Fees if mailing in application. Fax to 763-571-1287 if using credit card and we will
call you for card number.
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Curb Cut Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
$ �' �% �
$ �%`.00
$ /.��
$
$ _'
$
$
$
$
� ��e �S
CITY USE ONLY -
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/10th%)
$.50/$1,000 Valuation
$1275 per SAC Unit
$5.00 (State Licensed Residential Contractors)
Alt. "A" or Alt. "B" Above
$450.00 Conservation Plan Review
Fee Determined by Engineering
Agreement Necessary [ ] Not Necessary [ ]
�
_ •�
BUII.DING PERMIT FEE SCHEDULE
The Chief Building Official 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 alteration or repair to any existing building or
structure, upon application therefore, require the payment by the applicant for such pemut 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,�0
$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 $3.05 for each additional $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 $25,000 plus $10.10 for each additional$1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,0� plus $7.00 for each additional
$1,000 or fraction thereof, to and including $1Q0,000
$993.75 for first $100,000 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 $1,0OO,OQO plus $3.15 for each additional
$1,000 or fraction thereof
CUI�B CUT ESCROW
(Concrete Curb Streets Only)
Removal and replacement of curb and gutter only - driveway width plus 6 feet, times the annually determined
rate.
Permits for construction will be issued a minimum of 24 hours from the time of application to allow for proper
review of the. proposed structure and of the construcrion site.
VERIFICATION OF FOUNDATION
A Certificate of Survey of the lot, showing the location of the existing foundation will be required before
proceeding with the framing. New Houses Onlv
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�I�L. IN �!►�9PL�LY �OR REPL,A�EI�EN'T' FtJEL �9JF�JVIN� �'p�.�hiG� P���iid1`�
��� �NT 9iE�1T �� iQR AE10� D Ct�I���STl�30V �V�RIF�C��i
1V�f�en � 'S �, 41'� und�r�igned hereby vesifiie� �hat �P�
m�nti�g has �en �xamit�� and is firee �'rom nast, deterioration, abstrirction�.
s�rtd is sec�refy supp�rt�d and ftre�topped where r�quired. �r�� �
�'hc� v�nting sy�t�rn is �Iast�,�IpyC and m�ets al! curr�nt �de� and manu9aot�rer
sp��ifica�ions includh1� sizirtg, length, number of �Ib�ws and terminatia�r�. ��� �}
ihe �r�der�igned �9so vLriftes tha4't� re�la�am�nt uni4 is a listed �ssernbly
and m�ets the cxarr�rrt codea �nd manu�cttc�rer's sp��catlon�. This dt°�e�
���d� ���-� C�teg�ry I��ntral Fum� Ventin� �'ables far fan
a�6sted �nd naturat dr�ft �ppli�ru�s,
Th� �46n rv�ba�tion ��r ie sized end instalied to m�et ttrs cta�nt �des
�nd r�a��uf��ut�r's s�ecific�tions.
Wher� required to irts�ti � new �re�bv tion air, if wilf be s��d �nd ins,�U�d
fo m�t the cu�r�rrt �rad�s �s�d m�nufiac�u�r�s specifrcat►�n�.
Y�� �j
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tvc ��
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�/h�n � � v tern tt� urtdersigned I�re�by v�ri��s that
it �S a I�st� ���rr�bly �y�d m�ets th� curr�n4 �nd ra�s��,�f��u��°�
speci�'i�ti��_ This dt��s ietelt�de At;A-C3AMA �t�gAry 1 C.�rrtral Fumac�
tl�ntiraq Tables fc�r fa�n a�sist�d and n�4ur�1 draft �pplia�c�s, y�� �� �� `�
Is the �mmesn �r�t �rtd v�nt �onn�Gto� sized and ir�stalled corre�tly �er
an ap�di�nce ha� f�t� retnoved �vn che �ommon v�nt �nd vented
s�p�rr�t�ly aa �r c�rr�nt c;o�s.
Yes (� Iva t )
�����y�� �r�d �ize/Coet9mon Yenz �n� l/ent ��sane,�tor I�a�
�pp�0i�nc�e �#� iype �� e l�. BTU Ir�pa�t ��� F�R e4�;siSted r t� ��
APP��nC� #� Ty� G� �� p�� �TU Inix,t m� Fan As�i�ted a
Appiiar�e �3 TYpe �iU Inp�et Fa� Assi$ted �r N�t
T�t�l Applian _`� Tatal �ttu lr�ut o:� Q�c � �'
�mrnon Ven4 Type b�»� V�r�4 Height � pia��t�r,� � in�he�
App9ia�� �1 i/ent ��rr�Gtor Pieight ��_#t E.engtF� `� ft Diameter _ y�� iR Type �c�
Appliance #2 Verrt Conneator Height _�f� �ngt� �ft �am�ter __�'o,_gn Type fv..
�pli�t�c� �3 �i�nt Cm�necto� H�ight �k 1,�ngth ft Diart��t�r __ in Typ�
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