AF - 48004%�`� i
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City of Fridley, Minn.
BUII,DING PERl�dI�'
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Date: .�..� /....� ....................
Owner . i� e. . •�: �. . . . � `. . . .
Addr�ss ���1. �. . � . . . . . . . . .
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N°
3157
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Builder ........ ...............�...
Address............................ ...
LO�ATI0�11 OF BUIL.DIIVC
No. °S6'7 ! . . . . Stree�� . . : '. . . . . . . .o . . . . . . . . . . . . . . . . . . Part of
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Lot �d'° . I.�. . B�ock . . . . . . . .. .�. �. . Addition or Sub-Division . . . . . . . . . . . .
Corner Lot ............ Inside Lot ....�.... Setback ..�.�.. Sideyard .�.e.� . . ......• '
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DESC1aIPTIOI�i O�' ��Ji1.DIli�C�
�T be Used as:
� . .�. . . . . Front . . . . . �. Depth � . . I3eight . . . . . �. Sq. F't. / .� � . Cu. F`t. �. .�.✓. � �
. . . . . . . . . . . . . . . . . . . . ont . . . . . . . . Depth . . . � . Height �. � . . . Sq. Ft. . . . . . . . . Cu. Ft. . . . . . . . .
Type of Construction �5�...... Es� Cost.�',��.�...�.. To be Completed ...................
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In consideration of tihe issuance to me of a permit to construct the buiiding desribed above, I agree to do
the proposed work in accordance with the descriptioa above set forth and in compliance with all provisions of
ordinances of the city of Fridley.
�'.'.�` .•.�°..��:�8-� .....................
In consideration of the payment of a fee of $. ���
...�......., permit is hereby granted to ...................
... .. .. .. ...... .. ... .. ... to construct the building or addition as described above. This permit is granted upon
the express condition that the person to whom it is granted and his agents, employees and worl�en, in all work
done in, around and upoa said building, or any part thereof, shai� conform in all respects to the ordinances of
Fridley, Minnesota. regarding location, conatruction, alteration, maintenance, repair and moving of buildiags with-
ia the city limits and this permit may be revoked at ar�y time upon viola.tion of any of the provisions of said
ordina.nces.
t �' _ wi .�_�
Building 7nspecbor
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NOTICE:
Thts pe�mlt do� not cove� the const�uctlon, installation o� altera4ion for wiring, plumbing, gas heating,
sewer o� water. Be sure to see the Building Inapecto� fo� separate permita fo� thesa Itema
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sue�ecr PE 1 .
City of Fridley 13319
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T •
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� • COMMUNITY DEVELOPMENT DIV. ��
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� /"'� � CITY HALL FRIDLEV 55432 NUMBER REV. DATE PAGE OF APPROVED BY
�----� � �•� 812-880-3450 9�0-F15 12/1/75 � /
JOB ADDRESS 561 Layfayette
1 LEGAL LOT NO. BLOCK TRACT OR ADDITION SEE ATTACHED
DESCR. 11_12 C Riverview HH � 'tS SHEET
2 PROPERTY OWNER MAIL ADDRESS ZIP PHONE
B an Coons 561 La fa ette Street N.E.
3 CONTRACTOR MAIL ADDRESS Z�P PHONE UCENSE NO.
Franklin Construction, Inc. 2611 East Franklin, Mpls
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PHONE LICENSE NO.
SAME
5 ENOINEER MAILADDRESS ZIP PHONE LICENSENO.
8 USE OF BUILDINO
7 CLASS OF WORK
❑ NEW ❑ ADDITION ❑ ALTERATION C� REPAIR ❑ MOVE ❑ REMOVE
8 DESCRIBE WORK
repair fire damage
9 CHANGE OF USE FROM TO '
STIPULATIONS
�EPERATE PERMITS REQUIRED Ft}F? `,�'��ii�;;
�EATING,' �'L��B�N� AN� �G��
TYPE OF CONST. OCCUPANCY OROUP OCCUPANCY LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBIN(i, HEATINO, r,,rood frame
VENTILATING OR AIR CONDITIONINO.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING S0. FT. CU. FT.
AGTHORIZED IS NOT COMMENCED WITHIN BO DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONED FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX �
AND ORDINANCES GOVERNINO THIS TYPE OF WORK WILL BE COMPLIED.
WITH WHETHER SPECIFIED HEREIN OR NOT. THE ORANTINCi OF A PERMIT $4�000 Z.00
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pERMITFEE SACCHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON. 24.00
STRUCTION OR THE PERFOR NCE OF CONSTRUCTION.
° PLAN CHECK FEE TOTAL FEE
1� �' f —�% � 26. 00
SION RE OF CONTR C OR Oii AUTHORIZED AGENT IDATEI . EN PROPER Y V ATED T IS IS Y/O�P R IT�/
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SI6NATUREOFOWNER(IFOWNERBUILDERI IDATEI BLDG INSP DATE
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APpLICATION FOR RES1llL'NTIAL, ALTERATION,
OR AllllITION BUILDING PERMIT
CITY OF F�IDLL'Y, MINNESOTA
OWNER' S NA� : a ����,� S BUILDER :� Kca.,n 1; rr l' U� ��1-, �� ,
ADDRESS ;.� r�,. ADDRESS :�j � L�, � CC�r� _� _ i�,pl S,
NO•. STREET:
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LOT : � I - 1 a. BLOCK: � _ ADDITION : Q ��v � �° �! i c' �l ,�e � 1 �1n� S
CORNER LOT: INSIDF LOT: SE�BACK: SIDEYARD:
Applicant attach :o this form Two Certificates of SurveY of Lot and proposed
building location drawn on these Certificates.
DESCRIPTION OF BUILDING
T� Be Used As;
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� � �K> Fron�:
Squaxe Feet:
Depth o
Cubic Feet°
Height:
Front: Depth: Height;
Squ.are Feet; Cubic Feete
Type of Consta-uction: � ; Estimated Cost: �� ,C�C� C� �%
�
To Be Completed; � eC > ��� 1�17.�
The undersigned hereby makes applicativn for a permit for the work herein
specified, agreeing to do all work in stiict accordance with the City of
Fr3.dley Ordinances and r_ulings of the Denart�nent of B�zildings, and herebS=
declares that a11 the facts and •representations stated in this application
are true and correct. .
- � � .
DATE : f °Z � � � �'S S IGNA.TURE ° �
(5ee Reverse Side For Additional Information.)
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BUILDING PERMIT FEE SCHEllULL
SECTION 2. The Inspector of Buildings shall, before issuing permits for �he
erection of any building or structure, or for any addition to any existing
building or structure, or for any altexation ox repairs to any existing
building ar structure, upon application therefore, require the payment by the
applicant for such permir of fees to the amount herein below set forth and in
the manner herein provided to-wit:
UIVIFORM BUILDING CODE: 2`ype 1, 2& 4-$2.15 for each one thousand cubic
feet, ox fraction thereof, in such cubical contents. Type 3& 5-$1.85 for
each one thousand cubic feet.
ADllITIONAL 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 io the average�-
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 hundred dollars ($500.00) or fraction thereof in
the cost of all pxoposed work.
In no case sha11 the fee charged for any permit as set forth in Section 2 be
less than $5.00.
VERIPICATION OF FOUNDATION
NOTE: Pex�ni�s for construction will be issued a minimum of 24 hours from the
time of application, to allow for proper review of the pxoposed structure and
of the construction site.
A Cextified Survey of th� lot, showing the location of the foundation, once it
has beari constructed, will be required before proceeding with the fxaming.
CERTIFICATE OP OCCUPANCY
Application for a Certificate of Occupancy shall be made ten (].0) days prior
to the use or occupancy of any structure for which a building permit has been
issued; and saicl structure shall not be used or occupied until a Certificate
of Occupancy has been issued.
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SuBJECT
City of Fridley
AT THE TOP OF THE TWINS g U I L D I N G P E R M I T
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r � L � PROTECTIVE INSPECTION SEC.
� �
� � �-"1 � CITY HALL FRIDLE� 55432 NUMBER REv
�""� � �'' 612-571-3450 9� 0-Ft 5
JOB ADDRESS 561 Lafayette Street NE
t LEGAL LOT NO. BLOCK TRACT OR ADDITION
DESCR. 11,12 C Riverview Heights
2 PROPERTY OWNER MAIL ADORESS
Andrew Carlson 561 Lafayette Street NE
3 CONTRACTOR MAILADDRESS
Same
d ARCHITECT OR DESIGNER MAIL ADDRESS
5 ENGINEER MAIL ADDRESS
6 USE OF BUILDING
Residential
7 CLASS OF WORK
O NEW ❑ ADDITION O ALTERATION
8 DESCRIBE WORK
Reroof Garage (4 Sq) 2nd Layer
9 CHANGE OF USE FROM
TO
DATE GAGE Of
10/16/95 / /
ZIP
O REPAIR
R
STIPULATIONS
Roofing can be the 2nd layer but not the 3rd.
TYPE OF Ci
SEPARATE PERMITS ARE REOUIREO FOii ELECTRICAL. PLUMBING, HEATING,
VENTILATING OF AIR CONDITIONING.
THIS PERMIT BECOMES NULI AND VOIO IF WORK OR CONSTRUCTION 20NING
AUTHORI2ED IS NOT COMMENCED WITHIN 60 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANDONEO FOR A PERIOD OF 120 DAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWL(
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINED THIS APPLICATION 1
AND KNOW THE SAME TO 8E TRUE AND CORHEC7. ALL PROVISIONS OF LAWS VALUATIOI
AND ORDINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED �2(�O
WITH WHETHER SPECIFIED HEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITY TO VIOLATE OR CANCEL THE pEpM1T FE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $21.00
STRUC110N OR THE PERFOFiMANCE OF CONSTRUCTION
A7 .U.PE OF CON�iGv OgLSR AUT ai2ED nGENT iDATE�
/! / V r q�
�ji ef•v= :�� I� � CJ l
..��oc nc nwuco ��c nwNFR Bw��ER� �OATE�
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RECEIPT NO.
R� �
APPROVED BY
SEE ATTACHED
SHEET
PHONE
780-9145
PHONE LICENSE NO
PHONE LICENSE NO.
PHONE UCENSENO
O MOVE ❑ REMOVE
OCCUPANCY GHOUP OCCUPANCYLOAD
S�. FT. CU. fT.
OfFSTREET PARKING
STALLS IGARAGES
N PFOPE Y VALI
�0 C.l�.y!
$.50
iAC CHARGE
Fire SC $.24
fOTALFEE
$21.74
) THIS IS VOUR PERMIT
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C[TY OF FRIDLEY
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
Building Permit Application
Cffective 8/ 1 /95
Construction Address: �� ( L r� F�4-`� � T T� S T, _
Legal Description:
Owner Name & Address: /�'�D i� �w �. G/� (� L. �Qi1/ Tei. #-7 80 -- `� �`� S
Contractor:
Address:
MN LICENSE #
Attach to this application, a Certificate of Survey of the
lot, � with the proposed coastrucbion drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Tel. #
LIVING AREA: Length Width Height Sq. F�
GARAGE AREA: Length Width Height Sq. Ft
DECg AREA: Length Width Hgt/Ground Sq. Ft.
OTHER: �E.-�cC� CrP��l�G� - 3 3 5y',u�res�- �'� j�y�-�' _
�orner Lot [] Inside Lot [] Ft Yd Setback Side Yard Setbacks
�'ype of Consiruction: � � $ � �� �
�►pprox. Completion Date:
{Cost on Back)
�riveway Curb Ctit Width Needed: F� + 6 Ft = Ft x$ _$
:�ATE: � � I � � 5 APPLICANT: � r �' � �� ,�� Tel. # � g� ° � ( `� S
�'ermit Fee
�ire Surcharge
�tate Surcharge
�'AC Charge
I,icense Surcharge
Driveway Escrow
Erosion Control
Park Fee
�ewer Main Charge
�.�.
�TIPULATIONS:
$ � %, ��
$ , �l
$ . �C�
$
$
$
$
$
$
$ � /. �
�ITY USE ONLY`
Fee Schedule on Reverse Side
.001 of Permit Valuation (1/lOth%)
$.50/$1,000 Valuation
$850 per SAC Unit
$5.00 (Shdte Licensed Re.sidential Coutcact,ors)
Alt °A" or Alt "B" Above
$450.00 Conseivation Plan Review
Fee D�eimined by Engineering
Agreem�t Necessary [ ] Not Nacessary [ )
BUILDING PERMIT FEE SCHEDULE
The Chief Building Official shall, before issuing perntits gor the erec;tion of any building or structurE, or for
any addition to any existing building or struc,ture, or for any alteration or repair to any existing building or
stxucture, upon application therefore, require the paym�t by the applicant for such �rmit of fees to the amount
herein below set forth and in the manner herein provided to-wit: '
TOTAL VALUE
$1 to $S00
$SOl to $2,000
$2,001 to $25,000
$25,001 to $50,000
$50,001 to $100,U00
$100,�1 to $500,000
$500,�1 to $1,�0,000
$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,(�l0
$62.25 for first $2,p00 pins $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 th�eof, to and including $50,000 .
$574.75 for first $SO,Opp pius $6_25 for each additional
$1,000 or frac:ti� thereof, to and including $100,000
$887.25 for first $100,000 plus $5.00 for each additional
$1,OD0 or fradion thereof, to and including $500,040
$2887.25 for the fust $500,000 plus $4.25 for �ch additional
$1,000 or fraction th�reof, to and inclading $1,000,000
$5012.25 for tfie first $1,000,� plus $2.75 for each additional
$1,000 or fraction dier�f -
DRIVEWAY DEPRESSION ESCRUW
(Concaete (;urb Streets Only)
Alternate "A": Removal and replacement of curb and gutter only _ Driveway width plus 6 feet times $13.50
Altern,ate "B": Removal and replacement of curb and gutter and install a 3 foot wide
approach with 6 inch depth - Driveway �vidth plus 6 feet tim� $15.75.
VERIFICATION OF FOUNDATION
P�uts f°r �°°st�uc;�°II wi11 be issued a minimum of 24 hours from the time of application to allow for proper
review of the pro�sed structure and of the cons�ruction site,
A Certificate of Survey of the lot, showing the la;ation of the foundation once it has it has been constructed
will be required before proce�ding with the fiaming.
� SUBJECT PERMIT NO.
c�ty of Fridley 2 612 0
' , AT THE TOP OF THE TWINS g U I L D I N G P E R M I T RE T NO.
f
� �` ��� COMMUNITY DEVELOPMENT DIV. �� � /�
r � L � PROTECTIVE INSPECTION SEC. ��
1 = i
� /�"1 � CITY FIALL FRIDLE� 55432 NUMBEP REV DATE PAGE OF APPROVEO BY
�'-"�' �'' 612=571-3460 9/0-F15 6/2/98 / /
JOB ADDRESS 561 Lafayette Street NE
t LEGAL LOT NO. BLOCK TRACT OR A�DITION SEE ATTACMED
oesca, 11-12 C Riverview Heights SNEET
2 PROPERTY OWNER MAIL ADDRESS 21P PMONE
Andrew Carlson 561 Lafayette St NE 780-9145
3 CONTRACTOR MAII ADDRESS 21P PHONE LICENSE NO.
Diamond Exteriors 2700 NE Winter St, Mpls., MN 55413 379-5712 20126834
4 ARCHITECT OR DESIGNER MAIL ADDRESS ZIP PNONE LICENSE NO.
5 ENGINEER MAII ADDRESS Z�P PHONE LICENSE NO.
8 USE OF BUILDIN(3
Residential
7 CLASS OF WORK
❑ NEW O ADDITION ❑ ALTERATION C� REPAIR O MOVE ❑ REMOVE
B DESCRIBE WORK
Reroof Garage (5 Sq) Tear-off
9 CHANOE OF USE FROM TO
STIPULATIONS
TYPE OF CONST. OCCUPANCV GROUP OCCUPANCV LOAD
SEPARATE PERMITS ARE REQUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING.
THIS PERMIT BECOMES NULL AND VOID IF WORK OR CONSTRUCTION ZONING SO. FT. CU. FT.
AUTHORIZED IS NOT COMMENCED WITHIN 80 DAYS, OR IF CONSTRUCTION
OR WORK IS SUSPENDED OR ABANOONED FOH A PERIOD OF 120 OAYS AT
ANY TIME AFTER WORK IS COMMENCED. NO. DWLG. UNITS OFFSTREET PARKING
I HEREBY CERTIFY THAT I HAVE READ AND EXAMINEO THIS APPLICATION 1 STALLS GARAGES
AND KNOW THE SAME TO BE TRUE AND CORRECT. ALL PROVISIONS OF LAWS VALUATION SURTAX
AND OF;DINANCES GOVERNING THIS TYPE OF WORK WILL BE COMPLIED $417 �,SO
WITH WHETHER SPECIfIED MEREIN OR NOT. THE GRANTING OF A PERMIT
DOES NOT PRESUME TO GIVE AUTHORITV TO VIOLATE OR CANCEL THE pEpMIT FEE SAC CHARGE
PROVISIONS OF ANY OTHER STATE OR LOCAL LAW REGULATING CON- $21 . OO � Fire SC �.�FL
STRUCTION OR THE PERFORMANCE OF CONSTRUCTION.
PLAN CNECK FEE TOTAL FEE
� License SC $5.00 $26.92
SIGNATUREOFCONiRACTORORAUTNOfiIZEDAGENi IDATEI WHEN PROPERL ALIOATED TNIS IS Y UR PERMIT
� ` � �
SiGNATUREOFOWNEAi�FOWNERBUILDERi �DATE� BLO -�NSp� ��ATE
MAY-28-1998 09�42 FROM CITY OF FRIDLEY TO
�`� � ]
A►DDN [ ] C�TY OF FRIDLEY
ALTER [� 5lNGLE FAI�lII,Y AND DUPLEXES R-1 AND R-Z
� BUILDIl�IG PE;R,MIT APPLICATION
3795710 P.01iO4
Effecrive 1/i/98
�
�� � � �C�
,� I
�01]StFllCiibIIA(iCk6SS. �(� f �v ��'� y�`�� �' '�_ �� I 1 � L-�Y e J����i � r-�
Legal Desc�ipdon:
Owner Name & Address: ��i �►�t�� Te1. f� f� i���°� 1 c�'�
Contractor. � r AM o t�t U���g �, n�� MN L�CENS� #�, � I 2(� �°��
- � -
Address: 27� � I'1� �. �� nf_�€1�r ��� N%PC�� /Vl r� �� �1.� Tel. #� Ial ti 7�I � 71 �
LIVING AREA:
GARAGE �Aa
DECg AREA:
pTHER;
Attach to this application, a Certificate of Survey of the
lot, with the proposed cot�stxuction drawn on it to scale.
DESCR�TION OF llVYPROVkN�NT
Length Width
L�ngth . Width
Width
T�eight Sq. Ft.
Height� Sq. Ft.
Hgt/Giound Sq. Ft.
_ .z � . �_.--n�
Constrcrction Type: Estimated Cost: $ �� % �
t�'ee Schedule on BaGk)
Driveway C�trb Cut Width Needed: Ft. + 6 Ft � Ft x$ �$
DATE: �-Z� - ,�
?ermit F�
?ire Surchazge
itate Surcharge
>AC Chazge
.icense Surcharge
�riveway Fscrow
3rosion Comt�rol
'ark F�
�ewer Main Charge
TOTAL
$ �l,v�i
$ • ��
$ � a�'�
$
$ �dZ�
�
$
$
$
$ ��• �
Tel. # � i �, �°� q �- �°5571 �
C�TY USE ONLY
�ee Schedule on Reverse Side
.00I of Permit Valuation (�/�Oth%)
�.50/$1,000 V�luation
$10� per SAC Utu�
$5.00 (Stat� iicensed Residential Contractors)
A�i�. ��A� Qr tilt. „Bp Above
$450.00 Cotiservatian Plan �Review
F� n���;��a by �i���
Agreement Necessary [ J Not Necessary [ j
1iPULATIONS: �
1: � a y
D ��
d
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CERTII= ICATE
rvote:
Bearings are assumed
,- -t -
-
house
OF SL�If��EY
fd. i.p. Illlf III
d �����.�,�
����
'.P. ,H, g1°pp'OO.O��E� � I �
� 50:0''� .7
.7� ��
', ` � Ot' � � 11 garage �
,.�
� �
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O T � � � ��� � �'� A L� I
� �I 9arag:;j�� �
1 i, _ -
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in 6.5 � i o' o, _
'� house tt' S61 o Q
o ; ' �� �^ I house
N "' I 1_
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£� �
28.3�i I
6-8 � 1
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36.g' �wootl 8 cYCione ' '
fence J
i `� �
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set i.p.� —� � eb� OD p� W back of curb
q.6�
� AF A'�f ET7E STR •
DESCRIPTION
LOT 11 8 12 RIVERVIEW HEIGHTS, ACCORDING TO THE PLAT THEREDF
ON RECORD AT ANOKA COUNTY, MINNESOTA
r
NORTH AMERICAN SURVEYS
7130 UNIVERSITY AVE.
FRIDLEY. MN. 55432
612-502-0579
� J Q
1 hereby certify thot this survey wos preDared by me or
untler my tlirect superv(ston and that I am a tluly Registered
Land Surva under the laws of +he Sto+e of Minnesota
� Date:,./�� [Jt� Zrs_ �999 Reg. No. 9293
'�
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sue�ecr PE
City of Fridley 3 i 6 3 4
�
AT THE TOP OF TME TW�NS g � I L D i N G P E R M i T
: � o.
� ; y _.��_ COMMUNITV DEVEIOPMENT OIV. � /
r � � PROTECTIVE INSPECTION SEC. �
1 ., i
i---- = ��'��,'� CITY NALL FRIOLEV SSIJZ NUMBEi1 NEV DATE PAGE OF APOqOVED BY
t 1� 612-571-3450 9t0-F15 1/26/O1 / /
�oe no�aess 561 Lafayette Street NE
t LEGAL ��T NO. BLOCK TRACT Oii ADDITION SEE ATTACNED
oesca. 11,12 C Riverview Heights SHEET
2 PROPERTY OWNER MAIL ADDRES$ ZIP PHONE
Margaret McGowan 561 Lafayette Street NE 763-783-9019
3 CONTRACTOR MAIL ADORESS ZIP PMONE LICENSE NO
Norling Exteriors Inc 341 79 Way NE, Fridley, MN 55432 763-784-8936 20098700
4 AfiCHITECT OR DESIGNEF MAIL ADORESS ZIP PMONE LICENSE NO
5 ENGINEER MAIL ADDRESS 21P PHONE LICENSE NO
8 USE OF BUILDING
Residential
7 CLASS Of WORK
❑ NEW ❑ ADDITION O ALTERATION � REPAIR ❑ MOVE O REMOVE
8 �ESCRIBE WORK
Reside; soffit & fascia; replace 5 windows
9 CHANf3E OF USE FROM 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 for this provision would be if sheathing is an
approved weatherproof panel or when the siding is an approved weather
barrier. Vinyl siding is not a weatherproof covering unless the manufacturer
states this in their application guidelines. Call for inspection of wrap
before covering. Install soffit ventilation to meet the State Building Code.
Provide smoke detectors in all sleeping rooms and on all levels of the
dwelling per Section 310.9.1.2 of the 1997 Uniform Building Code.
TYPEOFCONST. OCCUPANCY GROUP OCCUPANCVIOAD
SEPARATE PERMITS ARE REOUIRED FOR ELECTRICAL, PLUMBING, HEATING,
VENTILATING OR AIR CONDITIONING
THIS PEFMIT BECOMES NULL AND VOIO IF WOFiK Oii CONSTFUCTION 20NING SC. FT CU FT.
AUTHORIZED IS NOT COMMENCED V�1ITHIN 60 OAYS. OR IF CONSTRUCTION
OR WORK IS SUSPENDEO OR ABANDONED FOR A PER100 OF 120 OAYS AT
ANV TIME AFTER WORK IS COMMENCED NO. OW4G. UNITS OFFSTREET PARKING
I HEREBY CERTIFV THAT I MAVE READ AND EXAMINED TMIS APPLICATION 1 S7A�LS GARAGES
AND KNOW THE SAME TO BE TFiUE AND CORRECT. ALL PROVISIONS Of LAWS VALUATION SURTAX
AND ORDINANCES GOVERNING TMIS TYPE OF WORK WILL BE COMP�IED @
WITH WMETMER SPECIFIEO MEREIN Ofl NOT. THE GRANTING OF A PERMIT �7 sSOO y�3. JS
DOES NOT PRESUME TO GIVE AUTMORITV TO VIOIATE OR CANCEL TME pEqMIT fEE SAC CNARGE
PROVISIONS OF ANY OTMER STATE OR IOCAL LAW REGULATING coN- 153.ZS Fire SC �7.SO
STqUCTION OR THE PERfOiiMANC6 OF ONSTFUCTION �
A/J P�AN GNECK FEE � TOT FEE
�,.�,.,�.2 k/ �� � /�-.0 -of License $5 .00 $ 69 .50
SiGNATUAE OF CON'FACTOA Op AU�MO NT IDATE� EN OPE ALID E THIS IS VO=�RM1 O/
I
S�GNATUAE OF OWNEp��� OwNEpBUqDEpi iD�TE� .!',a NS q`iE
NE11V [ ]
ADDN []
ALTER [ ]
Construction Address:
Legal Description: S�,
Owner Name 8� Address:
Contractor: Nor(,r
LIVING AREA:
�
Effective 1/1/2001
CITY OF FRIDLEY (763) 572-3604 Bldg Insp
SINGLE FAMILY AND DUPLEXES R-1 AND R-2
BUILDING PERMIT APPLICATION
��
�
�� �rc
�
Tel.# ?L3, 7ST3-4o►S
MN LICENSE # 2� ai�P7o a
Tel. # 7�3 - 7 8 z/-4 '�13�
Attach to this application, a Certificate of Survey of the
lot, with the proposed construction drawn on it to scale.
DESCRIPTION OF IMPROVEMENT
Length Width Height Sq. Ft.
GARAGE AREA: Length Width Height Sq. Ft
DECK AREA: Length Width Hgt/Ground Sq. Ft
OTHER: c ��c� c� � gf- ..S �c7 ti n(� e�ww a E�. �
Constnaction Type: r- e�g Estimated Cost: $ 7�S��C
Driveway Curb Cut Width Needed: Ft. + 6 Ft = Ft x$ _�
DATE: l -oZ�o-O ( APPUCANT: • Tel. # 7 �:� - � �01- /Z �Ci
CITY USE ONLY -
Permit Fee
Fire Surcharge
State Surcharge
SAC Charge
License Surcharge
Driveway Escrow
Erosion Control
Park Fee
Sewer Main Charge
TOTAL
STIPULATIONS:
Call (763) 572-3604 for Permit Fees if mailing in application
$ o'���. �S� Fee Schedule on Reverse Side
$ �7_ �C� .001 of Permit Valuation (1/10th%)
$ �� ,'`lS` $.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 [ ]
�
$_ C�
._ -t
BUILDING PERMIT FEE SCHEDULE
The Chief Building OfFcial shall, before issuing pernuts 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
$i to $500
$501 to $2,000
$2,�1 to $25,000
$25,001 to $50,000
$50,001 to $1Q0,0�
$100,001 to $500,000
$500,001 to $1,000,000
$1,000,001 and up
FEES
$23.50
$23.50 for first $SQO plus $3.05 for each additional $1� or
fraction thereof, to and including $2,000
$69.25 for first $2,000 plus $14.� for each additional $1,000
or fraction thereof, to and including $25,(�0
$391.25 for first $25,Q00 plus $10.10 for each additional $1,000
or fraction thereof, to and including $50,000
$643.75 for first $50,0� plus $7.� for each additional
$1,000 or fraction thereof, to and including $100,000
$993.75 for first $100,�0 plus $5.60 for each additional
$1,000 or fraction thereof, to and including $500,(�0
$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 5treets Only)
Alternate A: Removal and replacement of curb and gutter only - Driveway width plus 6 feet times $15.50.
�� n
Alternate B: Removal and replacement of curb and gutter and install a 3 foot wide
11 n 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 ftom the time of application to allow for proper
review of the proposed structure and of the construction site.
A Certificate of 5urvey of the lot, showing the location of the foundation once it has it has been constructed will
be required before proceeding with the framing. New Houses Onlv
= , �r
City of Fridley
6431 University Ave NE
Fridley MN 55432
(763) 572-3604 or Fax (763) 502-4977
�C'D OCT 1�0 2007
Q� U� 7 —�l�c�—1
Water and Sewer Permit Application
❑ New Connection
❑ Existing
Date: %U �� �i � � �
Job Address:
�
�Utility Line Repair/Relocation
❑Water and Sewer Connection
�
Name of Applicant (Plumber): �
Name of Property Owne . ���_��1����.,,�,,,,,�,,
��r��
Existing Structure Pernut #
Permit Type: Sewer Fee: ��,�
Water Fee: T
Meter Fee:
Repair Fee:
Relocation:
State Surcharge: =��
SAC Charge:
Special Assessment Fee:
Tota1: $ 7'�/,��
Applicant Si
Inspector approval:
�a.c��
�
�r�r� cc�.�Q� -� �G2��
�,t �_
Building
Inspection�
763-572-3�04 �"
763-502-4977 FAX
DATE�
SITE ADDRESS _
T'HIS APPLICANT IS:
BITILDING 5�' `°"""
RESIDENTIAL APPLICATION
CITY OF FRIDLEY
EFFECTIVE 1-1-08
YOUR E-MAIL ADDRESS
❑ OWNER �ONTRACTOR
PR�PERTY OWNER/ N,aME:
TENANT pDDRESS: CITY
PHONE:
CONTRACTOR ADDRESS:
SUBMIT A COPY OF pHONE
YOUR STATE LICENSE
STATE LICENSE
PROPERTY TYPE I❑ SINGLE FAMILY/NEW CONSTRUCTION
❑ TWO FAMILY/NEW CONSTRUCTION
PERMIT TYPE � �DITION ❑ GARAG
❑ BASEMENT FINISH ❑ RQOF
❑ DECK ❑ SIDING
TYPE OF WORK: 0 NEW HOME CONSTRUCTION
❑ MAINTENANCE/REPAIIt
DESCRIBE WORK BEING
SIZE OF
ROOFING
NUMBER OF SQUARES _
GARAGES
PROPOSED SIZE:
PROPOSED HEIGHT:
SIDING
❑ Vinyl
❑ Aluminum
❑ Other
WINDOWS
IN EXISTING OPENINGS ❑Yes ❑No
OR FOR NEW OPENINGS-DESCRIBE SIZE OF
OPENING CHANGES &
TYPE OF WINDOW TO BE INSTALLED
Pemut N�
�-� —
Received R��• �
D���:��. 1 � �nn�
FAX
EXP DATE _
SIZE
STORIES
JSHED ❑ WINDOWS
❑ DRAIN TILE
�THER
NG POOL
❑ ADDITION
❑ REMODELING
WIDTH HEIGHT
� HOUSE ONLY
❑ HOUSE & GARAGE
❑ ATTACHED GARAGE
❑ DETACHED GARAGE
ATE ZIP
AT'E��i�na�IP J'�J'r �j %
BASEMENT REMODELING SUBMIT:
I . Existing Floor Plan
2. Proposed floor plan
3. List of structural members to be used
FOR NEW CONSTRUCTION INCLUDING DECKS,
❑Soffit ADDITIONS. & PORCHES SUBMIT:
❑ Trim 1. Site Plan/Survey showing the existing sWctures
❑ Fascia and proposed project.
2. Two sets of conswction plans
3. Energy Calculations
LOCATION OF WINDOWS
OF
ALL FEES ARE BASED ON VALUATION, INCLUDING THE COST OF LABOR AND MATERIALS:
(USING THE 1997 UBC FEE SCHEDULE)
TOTAL JOB VALUATION $ OCCUPANCY TYPE
Permit Fee
Plan Review
Fire Surcharge
Surcharge
License Surchazge
SAC Charge
Curb Cut Escrow
Erosion Contcol
Park Fee
Sewer Main Charge
Total Due
$
$
$
$
$
$
$
$
$
$
See Baok Page for Fee Schedule
65% of Building Permit Fee
.001 times the tota.l job valuation •
.0005 x Permit Valuation Minimum $.50
$5.00 (State Licensed Residential Contractors)
$18 per SAC Unit (Plans to MWCC for determination)
�� ft+6ft=�ftx$21=$ �/�—
$450 Conservation Plan Review
Fee Determined by Engineering
Agreement necessary ( ) Non Necessary ( )
Make checks pa_yable to: City of Fridley Attach
THIS IS AN APPLICATION FOR A PERMIT-NOT VAL[D UNTIL 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 pem►it but only an application for a permit and work is not to start without a
permit on site; that the work will be in accordance with the approved plan in the case of all work which requires review and approval of plans.
SIGNATURE OF APPLICANT
PRINT NAME DA
APPROVED BY .� l` �..,..,,/ __ DATE ���1
Page 2- Building Residential Application
' BUILDING PERNIIT FEE SCHEDULE c �.
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 permit of fees to the amount herein below set forth and in the manner herein
provided to-wit:
TOTAL VALUE FEES
$1 to $500 $23.50 (Minimum Fee is $23.50 plus surcharge)
$501 to $2,000 $23,50 for 1�` $500 plus $3.05 for each additional $100 or fraction, to and
including $2,000
$2,001 to $25,000 $69.25 for 15` $2,000 plus $14 for each additional $1,000 or fraction, to and
including $$25,000
$25,001 to $50,000 $391.25 for 1�` $25,000 plus $10.10 for each additional $1,000 or fra.ction,
to and including $50,000
$50,001 to $100,000 $643.75 for 1�` $50,000 plus $7 for each additional $1,000 or fraction to and
including $100,000
$100,001 to $500,000 $993.75 for 1�` $100,000 plus $5.60 for each additional $1,000 or fraction to
and including $500,000
$500,001 to $1,000,000 $3,233.75 for the 1�` $500,000 plus $4.75 for each additional $1,000 or
fraction to and including $1,000,000
$1,000,001 and up $5,608.75 forthe 1�` $I,000,000 plus $3.15 for each additional $1,000 or
fraction
VERIFICATION OF FOUNDATION
Permits for construction wil� 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.
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
City of Fridley
Building Inspections Department
6431 University Avenue NE
Fridley, MN 55432 �
763-572-3604
Fax: 763-502-4977